Join me to support American Heart Association Go Red For Women campaign, and raise awareness about heart disease! Heart disease continues to be a number one killer of women. Major cardiology trials traditionally excluded women, and most of the treatments were validated and investigated in men. American Heart Association supports community effort to increase awareness of the impact of heart disease in women, and provides resources for much needed research into gender related differences in diagnosis and treatment. I am very excited to bring this first event on behalf of the Integrative Cardiology Center of Long Island to my friends at Equinox of Roslyn,and my patients! Please, click here to make a contribution to the American Heart Association Go Red For Women Campaign.
It is no secret to many of my colleagues and friends that exactly one year ago, I abruptly fell off my professional trajectory. I lost the battle I was fighting-trying to bring new and fresh ideas and a measure of fairness and accountability into a dictatorial academic establishment-and, pretty much, lost the war. The year that followed was a spectacular ride, filled with new ideas, meeting great people, creating business ventures such as my integrative practice and a start-up company, and relentlessly forging ahead. I listened to my inner voice, and learned that self-doubt is a luxury that I cannot afford. I uncovered the confidence and focus I did not know existed, the clarity of vision, and the guts to convince others in its value. Ultimately, through these efforts, and the unwavering support of my family and friends, I regained my inner happiness.
Yet happiness is an elusive concept. As the 2015 approaches, and many of us are making the New Year’s resolutions, the very idea of happiness often equates with external values and attributes, the material things, and is devoid of inner focus. This is poignantly expressed by Dr. Robert Oliva in his recent blog post “The Truth About Stress and Its Cure.”
The inner focus may be just what the doctor ordered to cure the pervasive stress, despondency and malaise experienced by many American physicians. One does not have to go far to hear their unhappy voices. Check out the community dialogue on Sermo.com, or a book by my former colleague, “Doctored: The Disinlussionment of an American Physician“. There is no question that we are at the most significant inflection point in the history of medicine in this country. Physicians have been marginalized and turned into “providers”, and over the course of several decades, the health insurance corporate tactics enriched the companies while costing us trillions of dollars. Older generations of doctors, our mentors, spent too much time defining their happiness through external attributions, and acquiesced to the troublesome developments even though they were internally unhappy over a loss of autonomy, public trust, and income. The Accountable Care Act, while sorely needed and a very significant step in the right direction, only added to the unhappiness and disengagement already experienced by many.
My resolution and my wish for 2015 is for myself and my colleagues to cure ourselves by finding and growing our inner happiness. Go beyond your professional exterior, your titles, positions and degrees, and focus on listening to your inner voice. In every one of us, there are dreams, ideas and aspirations that hold the keys to fulfillment. The growth of inner happiness is critical to our survival as physicians, and is a catalyst for change from passive observers who are feeling victimized to masters of our destiny.
Happy and Healthy 2015 to all of my colleagues and friends! I want to hear your stories and suggestions on curing the American physicians.
The Fit in Your Genes program is a remarkable, revolutionary program. Our first 20 participants are well under way in achieving their weight loss goals! The program takes advantage of the genetic blueprint that is unique to each individual. At the core of the program is a full sequencing determination of the genetic makeup responsible for your sensitivity to various types of exercise, macronutrients, nutraceuticals and supplements, and lifestyle measures. The program offers comprehensive testing to determine personalized approach to weight loss. This approach not only functions to keep the pounds off, but promotes wellness from within.
What would be the value of the genetic program in weight loss? After all, there is no shortage of diet and exercise advice. The use of dietary supplements is a booming business, totaling nearly $4 billion annually in the United States. The Internet is saturated with multiple websites, forums, and discussion groups that promote and endorse various products. Physicians, nutritionists, health coaches, and other professionals have created various diets, programs and approaches, some more beneficial than others. Fierce debates continue about merits of diet in various health conditions, including prevention of heart disease and cancer. Yet, we are in the midst of the most significant epidemic of chronic illnesses. Diabetes, high blood pressure, and elevated cholesterol continue to affect younger and younger individuals. The American population continues to grow progressively more obese year after year. Despite multiple resources, and billions of dollars spent, the solution does not appear to be in sight.
The genetic program offers a unique opportunity. It is a chance to go back to the ground floor. To help you understand how the genetic program for weight loss may be of value, not just in losing weight but also in fostering wellness, consider this. Suppose you decide to build a house. You would ask an architect for a blueprint. The blueprint calls for specific details, provides standardized measurements, defines materials, and ultimately guides the construction. Of course, once the walls are constructed, you put on your personal imprint. This imprint may include your own color palette, choice of finishing materials, even landscaping. It is very common for busy developers to utilize nearly the same blueprint over and over again in construction, making adjustments for personalization or location. Yet, many of these houses, built from similar or identical blueprints, look and feel very different. Your genetic makeup is the blueprint that is guiding construction of your house of wellness and illness. The environment, lifestyle choices, interactions with food, toxins, exercise, medications and supplements all work upon this genetic blueprint to create your personalized imprint. And it is this imprint, the phenotype, or the external appearance is what we often seek to change. However, just as in construction, the external appearance changes do not change the blueprint. To enact a fundamental change, the one that would drastically change the entire house, one would need to take the blueprint into consideration, and act upon it. By determining your genetic blueprint for weight loss, you are enacting a fundamental change that leads to much more than an appearance change. It changes the entire house!
There are several components to the genetic program. The initial testing is carried out by obtaining a small sample of your cells. This is performed by swiping a Q-tip on the inside of your cheek. This sample is sent to be processed in a sequencer. The test result is available in about four weeks. While you are waiting for your test results, you will start with a detoxification phase of the program. Once you test results are received, a recommendation will be made for diet adjustments, exercise regimen, and supplement use.
Each individual starts with a unique blueprint, and the influences of lifestyle and environment on this blueprint are responsible for weight loss, weight re-gain, wellness, and illness. The impact of inflammation in promoting obesity, and related chronic diseases, cannot be overestimated. Thus, the genetic blueprint serves as a fundamental scientific basis for setting goals guiding the weight loss and wellness interventions. It is an objective starting point. The nutritional, exercise, and nutraceutical components of the program are directed to manage much more than the weight loss. The goal is to control inflammation and pro-inflammatory conditions that interfere with weight loss, promote weight re-gain, and diminish organ reserve.
Many of our participants are passionate and determined to lose weight and improve their wellness. We are here to help them every step of the way. Our patients success and safety are our primary concerns. The Fit in Your Genes program is a medically supervised program. It requires face-to-face visits with a licensed physician, and offers support through a team of health coaches and yoga instructors. During the detoxification, a virtual video visit is available for additional support. To assure our patient safety, we respectfully ask that patients abide by the following rules of participation:
- Patients cannot participate in any additional programs if they already are enrolled in the Fit in Your Genes program. Enrollment in another program would preclude detoxification and personalized supplement selection. Patients may be eligible for the Fit in Your Genes program if they discontinue another program for at least two weeks prior to enrollment.
- Patients taking their own supplements must present them for verification of compatibility with the supplements recommended by the genetic testing. If a full list of ingredients, country of origin, site of manufacture, authenticity, and purity of the supplements cannot be established, the supplements must be discontinued. The supervising physician reserves the right to request that any supplement be discontinued if its safety cannot be ascertained.
- Patients cannot use additional substances, such as supplements, medicinal foods, herbs, or homeopathic remedies once the program commences unless such substances have been approved by a physician supervising the program.
- The initial program fee includes a before and after consultation with the supervising physician, performance of the genetic test, and a detoxification kit.
- The subsequent fees include supplements and nutraceuticals, health coach, and yoga sessions. The first health coach session is complementary to all program participants.
The quest for weight loss is an essential component of vitality and wellness. It is well known that overweight and obesity result in less productivity at work, disturbed sleep, inflammatory state, and early onset of chronic and debilitating diseases. The obesity is a state of chronic malnutrition that is fueled by inflammation, and it adds more fuel to the inflammation fire daily. Billions of dollars are spent annually to treat consequences of obesity and chronic diseases. Pharmacological treatments or drugs are mainstay of these approaches. There are even drugs for obesity, and bariatric surgery is available to help patients suffering from consequences of excessive weight. The genetic program offers an opportunity to address root causes of obesity and chronic diseases.
The sequencing of the human genome, completed in 2003, opened the doors to providing genetic information for research, and, most recently, made it available directly to the public. Availability of highly precise and efficient sequencers (such as the ones from Illumina) resulted in minituarization of the genetic information, making it available and affordable to look for single-nucleotide polymorphisms, or SNPs, and their association with various diseases. However, as illustrated by the story of the 23and Me, the path to making such information available on-demand is complicated by regulatory and ethical dilemmas. The role of genetic information in clinical decision making is uncertain.
Recently, the New England Journal of Medicine reported on the results of an opinion poll in a case of a hypothetical patient seeking genetic sequencing because of a strong family history of malignancy. The majority of the responders favored genetic testing (60%), with mixed responses as to the extent of such testing to be performed. The authors called for genetic consultations to be carried out by trained geneticists. However, in real-life clinical practice, the statistical and population information provided by such genetic consultations is simply not enough.
As a cardiologist focused on bringing the practice of functional medicine into traditional cardiology domain, I rely on several genetic tests for a variety of reasons. The decisions to test are highly individualized, and have to be made based on patient’s history, objective findings and preferences. In one case, a patient with a distant history of atrial fibrillation sought advice. After normal physical exam and normal echocardiogram, we opted to run a genetic test that may help to determine his risk of atrial fibrillation and stroke. His one and only episode of atrial fibrillation occurred previously while he was treated for hypothyroidism, and has not recurred. Thus, genetic results would be of value in determining if indeed an elevated risk of atrial fibrillation existed independently of hypothyroidism, a reversible condition that could cause atrial fibrillation when untreated. Detection of a carrier state associated with an elevated risk of atrial fibrillation and stroke would result in more aggressive surveillance, and, possibly, earlier treatment.
The decisions get more complicated when genetic testing that identifies a predisposition or likelihood of a disease must be carried out in a context of early disease diagnostic testing. The genetic predisposition as well as early disease may be modified by environmental and lifestyle influences. A patient this week reported that her father died of a massive myocardial infarct in his 40s. How should we proceed? In addition to history, physical exam, electrocardiogram, echocardiogram and possibly a stress test, we can consider imaging for subclinical atherosclerosis, such as obtaining a coronary calcium score. Addition of genetic testing to gauge probability of early myocardial infarction and vascular disease independently of traditional risk factors may be of value if the calcium score is greater than zero. In such circumstances, once sub-clinical disease is identified, a patient who carries a genetic variant forecasting an increased risk of heart disease and its complications may benefit from more aggressive attempt at disease stabilization and risk factor reduction, with supplements, medications, and lifestyle changes. In contrast, for patients with a score of zero (identifying a situation with no discernible vascular disease), detection of a carrier state associated with an increased risk may prompt more aggressive screening, and even result in over-testing.
The applicability of genetic testing is limited by patient acceptance and insurance reimbursement. Many patients view genetic testing as delivering an irreversible verdict, a final “say” about disease and illness. Yet, in most instances, genetic testing presents an opportunity for a change, focused and early intervention, and a possibility for a lifelong commitment to prevention.
The Dietary Supplement Health and Education Act of 1994 (DSHEA) has been an important and, of course, controversial rule released by the Federal Food and Drug Administration. After attempts to restrict supplement industry failed amid intense lobbying effort, FDA agreed to the proposal by Sen. Orin Hatch to provide guidelines for manufacturers and users of supplements. The bill was signed into law by President Clinton in 1994. The bill defines supplements as:a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients. Furthermore, a dietary supplement must be labeled as a dietary supplement and be intended for ingestion and must not be represented for use as conventional food or as a sole item of a meal or of the diet. In addition, a dietary supplement cannot be approved or authorized for investigation as a new drug, antibiotic, or biologic, unless it was marketed as a food or a dietary supplement before such approval or authorization.
DSHEA required that supplement labels clearly reflect the ingredients, net weight, source of materials (including parts of plants), disclaimer that differentiates them from pharmacological drugs, and a safety disclaimer. Manufactures could put additional statements at their discretion.
The DSHEA drew criticism nearly immediately for not being restrictive enough. The fact that amount of vitamins or minerals in the supplements was not regulated prompted many to label them as ineffectual and wasteful.
It is true that many supplements have sketchy scientific evidence, and variations in their content make any attempt for evaluation difficult even when ingredients are the same.
At the ICCLI, our philosophy for supplement use is as follows:
-We will only recommend supplements that are manufactured domestically and are in compliance with the DSHEA.
-Supplements are purchased through our virtual dispensary from leading manufacturers that design medical grade formulations for use under physician supervision only. These are high potency formulations known to produce specified desirable effects in scientific studies.
-A detailed electronic prescription is generated individually for each patient, and is attached to their electronic medical record as well as available for personal record keeping. We encourage each patient to have their supplement prescription available for all of their doctor visits.
-A complete list of all active and inactive ingredients is available for all supplements, as well as information on their manufacturer.
-We ask that our patients sign an informed consent that explains uses and limitations of supplements.
Most importantly, the use of virtual dispensary allows Dr. Druz to pass her practitioner discount to her patients.
Feel free to contact us for more information. In further posts, we will explore use of supplements for various conditions, and highlight the most notable of the ingredients and how they can serve you on your way to optimal wellness!
Despite scarcity of funds, NIH announced generous awards that would allow medication testing using human tissue chips. In this unique system, human tissue is arranged on experimental framework material to mimick interplay of various organs in a body, and determine safety of drugs under development.
This represents one of many advances toward safety and tolerability of medications. At the Over 50 fair today, I gave a talk on the genetic testing for the cytochrome P450 polymorphisms. This system is responsible for processing nearly all of the drugs that are used in clinical practice. The lecture was well attended, and numerous questions at the end were reflective of the intense interest drug testing and safety generates. The test is performed by swabbing a Q tip inside a patient’s cheek. Results are available in about 2 weeks. Over 280 medications can currently be assessed for safety based on personal genetic variability of the cytochrome P 450 system.
So far, the “med-tuning” using the personalized genetic testing for common alleles of the P 450 system has exceeded my expectations. In one instance, a patient of mine on multiple medications was found to be hypotensive. I stopped one of his blood pressure drugs, and his blood pressure improved. When the genetic testing results became available, the discontinued drug was the safest one for him! I now have the opportunity to readjust his medications so that he achieves optimal blood pressure and heart rate control using the safest medications based on his genetic profile. In another instance, I stopped a water pill for a patient who became dehydrated in a hot climate. Before restarting it, I tested this patient’s P450 system. The drug appeared to be safe for him, and no substitution was needed. He was counselled to maintain his fluid intake in warm weather, and to resume this medications.
The genetic testing for medication safety is an important piece of the medications selection puzzle, and allows a truly personalized approach. Of course, it does not shed light on possible effects (and side-effects) of medications under extenuating circumstances such as diseased states, dehydration, fever. The tissue chip research supported by the NIH will add significantly to the understanding of complex organ- medication interactions.
I encourage all of my patients on at least one medication to have a genetic test for safety and side-effects profiles. All of my patients receive a color-coded hard copy of their results to use as needed during doctors appointments or hospital admissions. Over 100,000 deaths occur annually due to medication toxicity, and the annual cost exceed 182 billion. Medicare and most major carriers cover the test. I negotiated a significant discount for the test for those of our patients not covered by insurance. This simple test, performed once, may be a life-saver!
The Fit in Your Genes Program is a ground-breaking approach to weight loss. It is based on individually designed, genetically-guided approach to nutrition, exercise, and micro-nutrient supplementation that allows sustained and reproducible weight loss result.
Three areas of focus
Unlike other approaches where counting calories, avoiding certain macro-nutrients ( think low-carbohydrates or liquid diets) or performing aggressive exercise are required, this program is set to individually tailor your efforts in three major areas responsible for weight loss:
DO: exercise type, frequency and duration
EAT: percentage of protein, fat and carbohydrate you should consume
TAKE: vitamins and supplements supporting weight loss
The test is completely bloodless, and is done by collecting cells from the inside of your cheek by rubbing it with a soft, cotton-tipped applicator. The testing involves FULL genetic sequencing, and results are available in 2- 3 weeks. We typically initiate a detox program while you are awaiting your results.
What are the “DO”, “EAT” and “TAKE” parts of the program?
The “DO” part provides a genetically guided advice on frequency and type of exercise that would benefit weight-loss effort. All of us have seen men and women who seem to exercise for hours on end yet their weight-loss is modest. Alternatively, we also encountered individuals who slim down nearly immediately with even a modest amount of exercise. The opinions on type, frequency and duration of exercise are varied. Even among the experts, disagreements abound, and clearly no one size fits all. The Fit In Your Genes Program tests for variations in 3 or more genes that determine our sensitivity to various types of exercise, and are useful in creating an individually tailored program that is specific to YOU. Thus, it is no longer necessary to wonder if you should be doing what another person is doing, or if you should be following a brand-new class, exercise, or routine. Rather, you can decide based on your personal genetic profile if a new exercise or class, or some of it features will fit well with your unique exercise determinants.
The “EAT” part is really the most impressive part of the program. One knows that there is no shortage of diet advice. At the ICCLI, we do not use “diet” as a word to describe what should be a live-long pattern of healthy eating. You can probably find a “diet” advice or program for every letter of the alphabet! And while some ways of eating (such as Mediterranean diet) are clearly proven to be advantageous not just for weight loss but also for reduction in cardiac events, again, no one size will fit all. A healthy way of eating needs to be individualized. The true power of genetic testing allows us to do just that. You will literally see down to a single percentage point what is YOUR specific, individual macro-nutrient requirement. No more need to avoid ALL carbohydrates, or to go extra heavy on proteins-genetically-guided program will allow you to eat according to your genes. We will craft a healthy and genetically-guided path to allow you to feel in control of your food intake, and to eliminate the “yo-yo” effect.
The “TAKE” part of the program is truly on a cutting edge. It allows to tailor supplements and vitamins to your specific genetic make up so that cravings and imbalances are reduced. If you have a sweet tooth, to paraphrase a famous saying, “there is a gene for that!” Once your genetic variability is known, we will provide an essential micro-nutrient support that would seal the success of your weight loss effort.
According to the National Institutes of Health (NIH), the burden of chronic diseases is tremendous:
It is estimated that 3 in 4 adults over age 65 and 1 in 15 children suffer from two or more chronic medical conditions — such as diabetes mellitus, chronic kidney disease, hypertension, and chronic pain. As patients develop more chronic conditions, they are likely to use more health care services and suffer negative outcomes such as unnecessary hospitalizations, adverse drug reactions, declining functional status, and mortality. These growing problems emphasize the need for more research to improve health outcomes of patients with multiple chronic conditions.
NIH recently awarded over $19 million to various health care systems over 5 years to address management of chronic conditions. Here is the issue, though: promoting research into improving situation of patients with multiple chronic conditions does not address the fact of how miserably we failed at preventing these very same conditions from occurring. It perpetuates the notion of health as an accident. After all, with nearly 75% of adults over 65 and almost 10% of all children afflicted with two or more chronic conditions, one would certainly take it as a norm that nearly everyone should be experiencing these outcomes!
Nothing can be further from the truth. Health is not an accident. Many of my patients take great pride in their daily efforts directed at preserving their vitality, wellness and freedom from disease. No, do not expect medical insurance companies to pay physicians or help patients to meaningfully engage in such preventive efforts. This decision is up to you. Ask yourself: do you want to be one of the statistic referenced above? Or do you want to commit to a path of wellness that promotes more than accidental health?
At the Integrative Cardiology Center of Long Island, we have created cutting-edge, one-of-a-kind programs that help you in your quest. Contact us to learn more, sign up for the newsletter, or return to this blog for more.
What if one day you found yourself overweight, dealing with high blood pressure, diabetes, high cholesterol, or suffering from heart disease? Millions of people in this country and all over the world are living with these conditions, suffering chronically from the physical, emotional and financial burdens imposed by disease. Yet over 70% of these ills are fully preventable! At the Integrative Cardiology Center of Long Island, we are putting full-scale prevention effort into practice to help you and your family to develop a fulfilling and productive pathway to wellness.
Transform & Empower Your Health
Our personalized approach to prevention and treatment of cardiovascular disease and its risk factors provides much more than traditional cardiac care by incorporating practice of functional medicine. We offer groundbreaking, one-of-a-kind programs:
- Fit In Your Genes for weight loss
- HEART for patients with hypertension, diabetes, high cholesterol, coronary artery disease, heart failure
- HEART Protect for cardio-protection of patients undergoing treatment with chemotherapy and radiation.
Our programs are based on personalized genetic and metabolic testing to achieve optimal and sustainable results. Each program includes:
- Yoga with well-known, dedicated teachers
- Health coach-guided nutrition
- Biofeedback for stress reduction
- Bio-active foods and supplements
Our Care is Centered Around You
We will guide you every step of the way toward your goals. The focus at the Integrative Cardiology Center is to treat underlying causes of disease, not just symptoms, and address an entire organism, not just the organs. Our practice uses state-of-the -art, scientifically-proven genetic and metabolic testing and domestic, high-quality supplement manufacturers. Our dedicated, passionate practitioners have the vision and ability to bring you the benefit of wellness and vitality for life.