​Background
 
Over the past 20 years, medicine has made incredible advances, and those of us in practice can attest to the incredible ways in which we can extend the life of our patients, beyond what we could have ever anticipated in medical school. But with longer lives comes the spectrum of cognitive decline and neurodegenerative diseases, namely dementia—an umbrella term for a number of neurodegenerative diseases, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In early June, a rare, albeit small (n=51), randomized clinical trial was published in Alzheimer’s Research & Therapy that determined the effectiveness of lifestyle changes on the progression of MCI and AD, and I am inspired by the findings.
 
It is estimated that 40% of global dementia cases are related to 12 modifiable risk factors. (Many of which also impact heart disease. Remember, what affects the heart affects the brain!). Several previous, small studies have shown the effectiveness of intensive lifestyle changes on the progression of MCI and early AD, but none had a control group nor were they randomized. That is what sets this study apart.
 
What did the study address?
 
Over the course of 20 weeks, participants and their spouses or study partners adapted the following lifestyle changes:

• A diet of minimally processed, plant-based, whole foods (no Beyond Meat here—remember, some plant-based foods can still be highly processed!), low in added sugar, refined carbs and harmful fats. Calories were unrestricted.
  
  
• Taking select* supplements. *Please consult me before divesting yourself of hard-earned money prior to taking something that may not be appropriate for your biochemistry or that interacts with medications prescribed for you.
  
  
• Moderate daily exercise, such as 30 minutes of walking or other cardio exercise, and mild strength training three times per week. Specific exercise guidelines were based on age and fitness level.
  
  
• Stress management via an hour of meditation, gentle yoga or breathwork daily.
  
  
• Support groups for participants and their spouses or study partners, 3 days a week.

 
In the study, all interventions were supported via 4-hour Zoom sessions three times a week for the participant and spouse or study partner.
 
The study aimed to determine if:
 

• these specific multi-modal intensive lifestyle interventions could affect MCI or cognitive function in cases of early dementia
  
  
• there was a correlation between the degree in lifestyle changes and the change in cognitive function
  
  
• the degree in lifestyle change affected the degree of biomarkers

 
What did they find?
 

• There were significant differences between the study group and control with regard to all four cognition and function tests, either by improvement over the control group, or less deterioration than the control group.
  
  
• There was significant correlation between the degree of lifestyle change (how closely participants adhered to the protocol, i.e. a dose response) and clinically relevant biomarkers for AD/MCI and cognition and function tests.
  
  
• Only the study group experienced positive microbiome changes.

 
Interestingly, in one of the biomarkers, the degree of change was similar to that affected by the clinical trials for new intravenous medications!
 
My takeaway
 
This study provides yet another reason for us to eat real food, move more, breathe better and connect more—all of which have multiple benefits to our health and wellbeing.
 
Let’s continue to work together on the path toward better health and wellness. Don’t forget, my concierge members also have access to the Concierge Choice Physicians Motivated Mondays program which provides a year’s worth of mini-resolutions focused on the prevention of cognitive decline through lifestyle changes. To sign up for the weekly emails, please contact CCP’s Erica Rios: [email protected]
 
Click here to visit past editions of Motivated Mondays.
 
Study source:
Ornish, D., Madison, C., Kivipelto, M. et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122 (2024). https://doi.org/10.1186/s13195-024-01482-z
 

I hope you enjoyed the holidays and have had a fresh start to the new year.
 
Now that it is nearly the end of January, I wonder: have you set wellness resolutions and health goals for 2024? Are you struggling to achieve those health goals or stick to those wellness resolutions? Are you surfing the internet for help? Are you falling down the rabbit hole in your search for a leg up in reaching your goals and resolutions? If so, you are not alone.
 
The internet has created a shift in patient care. Consumers can now gather health-related information for themselves and come primed to the healthcare encounter with a level of knowledge not seen by previous generations of physicians. In some ways, this is healthy empowerment for patients who have long felt a lack of control over their care. And it is indeed helpful when patients have a general understanding of their condition/s as it can facilitate the conversation and encourage compliance with the plan of care.
 
Yet, in other ways, access to online health information has undermined the doctor-patient relationship. Patients now come to the encounter prepared to lead their care in a direction that may not be in their best interest according to science. This is partly because the information on the internet is not monitored for accuracy. This is especially evident in the “blogosphere,” where influencers shell out health advice without a background, education or training in their subject matter.
 
There are several ways to determine if the medical advice you’re reading is sound. One of the greatest tip-offs to inaccurate or misleading information relates to your wallet. If the sale of supplements, services, subscriptions—or anything—comes along with the purported medical advice, think twice.
 
Here are a few additional questions to ask yourself before believing what you read:

• Does the sponsor of the information have relevant credentials in that topic?
• Do they provide references to back up their claims?
• What do they have to gain with your buy in?

 
There was a time when we could say traditional media sources (newspaper, radio, TV) were OK. That is rapidly shifting in an era of “advertorials” and “infomercials.” Two health-related sites that are conservatively OK are the NIH and WebMD. However, even that content can be taken out of context, misconstrued or simply not applicable to you, as the context of your whole health history is not considered in those articles.
 
Instead of consulting Dr. Google, I urge you to consult me, your actual doctor, instead. One of the wonderful benefits of concierge medicine is the time we can spend together which is often not available in other settings. Send me an email with your health goals and wellness resolutions. If you have already combed the internet and have found information you would like me to vet, include it in the email.  Then schedule an appointment. I will come to our encounter prepared to understand what you need during that visit, and we can have a dialogue about your questions or interest.
You may also wish to consider participating in Motivated Mondays, which is a reputable source of information for many of your typical wellness resolutions. Contact your Motivated Mondays coach, Michele McCambridge, MPH, to participate.
 
Cheers to your best health in 2024.

​Dear Concierge Members:
 
I trust this email finds you in good health and spirits ahead of the Thanksgiving holiday. As your dedicated healthcare provider, I wanted to take a moment to express my sincerest gratitude for the privilege of being a part of your wellness journey.
 
Throughout our interactions, whether for routine check-ups or times when you've sought my guidance, I have been continually impressed by your commitment to your health and honored by the trust you have placed in me. Your dedication to making positive changes has not only reflected on your own well-being, but has also inspired me in my profession.
 
It's patients like you who remind me why I chose to be a physician—to make a positive impact on lives, to provide care, and to be a source of support. Your openness in sharing your concerns and your active participation in healthcare decisions have truly made our doctor/patient relationship a remarkable one.
 
Please remember that your health and well-being remain my top priority. If you ever have questions, need guidance, or simply want to discuss an aspect of your health, please don't hesitate to reach out. I am here to provide you with the best service possible.
 
As we continue this journey together, I am excited to witness your progress and support you in achieving your health goals. Thank you once again for allowing me to be a part of your healthcare team.
 
Wishing you a Happy Thanksgiving.
 
Warm regards,
 
Dr. Nina Fallick

This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
 
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking.
 
What is the mechanism by which the relationship between oral hygiene and systemic health exists?
 
In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can translocate systemically via the damaged periodontium to damage other organs and systems.
 
In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection. If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes.
 
A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity.
 
There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
 

• Daily brushing and flossing. A soft brush is your go-to on this one. A hard toothbrush is not a friend to your gums and enamel. Add a water pick if you have the counterspace for it.
• Tongue scraping
• Replacing your toothbrush every three months or if you have been sick
• Visiting your dental hygienist at least twice a year, more often if indicated or recommended
• Replacing missing teeth or broken filings
• Addressing bruxism either with a mouthguard created by your dentist or by injecting Botox into the masseter muscles
• Identifying xerostomia, which is a common side effect of many medications
• Quitting smoking if you are a smoker

 
It has been said that the oral cavity is the mirror reflection to one’s overall health. If you have concerns, please schedule a visit with me for a discussion. I am happy to collaborate with you and your dental team to shine that mirror.
 
 

​A Scary Look at Data Misrepresentation in Nutritional Science
 
As consumers of information, we are barraged daily with conflicting information, nowhere is this more evident than in nutrition research where the information seems to change from week to week. Why is this the case?
 
We can start with how people eat: are the people in the fake headline above just eating ice cream? Likely they are eating the usual ice cream companions like cones, sprinkles, whipped cream and hot fudge. People follow patterns of eating behavior. It is virtually impossible to take a reductionist view of what people eat and limit it to a single food or nutrient.
 
Then, we can look at how the data is collected. Most often, nutrition research asks people to recall what they ate over a given period of time in the past. Do you recall how much ice cream you ate last summer? Last month? Last week? Was it soft serve or hard? What flavor was it? Was it dairy or dairy-free? Did you add toppings? Was it served in a cup or a cone? What type of cone? …Just how accurate do you think the information collected is?
 
Next, we can examine the participants in the study. How many participants are needed before one can make the observation in our fake headline? 3? 30? 300? What were the demographics of the participants? Was it a diverse group of people (age, ethnicity, socioeconomic status, geographical location, etc.)? If all the participants in our fake headline were 80-year-old Caucasian females living in the Bronx, then it would be nonsensical to the extrapolate trends from this data to anyone other than 80-year-old Caucasian females living in the Bronx.
 
Then, ask yourself, is observation causation? The answer is no. That is a fundamental issue with study design. Much nutrition research is observational. We observe “associations” between variables, but we cannot control unforeseen variables. Let’s take our fake headline: What if the participants in the study ate their ice cream on a sugar cone? How do we know the shark bite wasn't due to the cone and not the ice cream at all? By not measuring the sugar cone as a variable we have made a false association between ice cream and shark attacks.
 
In addition, it is rare in nutrition research to see a “gold standard” randomized control trial (RCT) in nutrition whereby people are randomly assigned to an intervention and a control group. In our fake headline, one group would eat ice cream, one group would not (the control group) but they would both go swimming at the beach. Then we would be able to draw comparisons between the two groups about a shark attack.
 
Sometimes the research comes up flat and nothing of interest is found. These negative results are important! They add to the body of knowledge on a subject. However, negative results aren’t highly sought after and are rarely published. This is referred to as publication bias. What if 10 previous studies found no association between eating ice cream and shark attacks, but because this was a positive result it was the only one published? The body of knowledge suffers as does the information disseminated to the public.
 
It is sad but true, that much research is funded by industries. The nut industry funds much of the research on nuts. The cacao industry funds much of the research on chocolate, and so on. Again, positive findings are more likely to be published, negative findings are repressed. Unfortunately, these positive findings are then used by the government to make nutrition guidelines and recommendations.
 
Researchers are human, they have egos and pride. The careers of scientists are built on their hypotheses, and, like industries, they have a vested interest in positive findings. Disappointingly, research is replete with insidious behavior meant to protect and promote careers.
 
Finally, there is the media; their job is to promote ratings. They are not obligated to properly vet the research (study design, participants, funding, etc.). Additionally, the media fails to properly explain the implication behind the headline (i.e. what does this mean to you?)
 
Where does this leave us, the consumers of information who want to make smart nutrition choices? Do we throw the baby out with the bathwater? Throw our hands up and eat Oreos for breakfast? Pringles for lunch? Not exactly. However, we do have a responsibility to take a look behind the headlines before making dietary decisions that impact our health. Sometimes that may mean getting the original research and using the above to decide if the study is valid for us.
 
Feel free to email Concierge Choice Physicians ([email protected]) with your questions or even send a headline or study to us, and we will be happy to answer your questions.

​After a few years of a very uncertain travel market and amid subsequent changes to the industry, many of us are resuming regular travel and taking much needed vacations. But before you hit the roads and skies for travel, be sure to prepare yourself and pack your bags for medical scenarios.
 
Importantly, make sure to refill all your prescriptions ahead of your trip at least one week in advance of your departure and always bring at least a few extra days’ worth of medication with you. With the state of the travel industry, there is a high probability of your return not going quite as planned. You should always pack your medications in your carry-on—not in your checked suitcase—just in case your luggage is lost.
 
The Pack Smart Guide from the CDC offers a checklist to help you prepare for a healthy trip, including prescriptions, medical supplies, over-the-counter medicines, supplies to prevent illness or injury, first-aid kits and important documents. Many items in this list would be especially helpful if you are heading off the grid or traveling to an exotic location where medical supplies are not conveniently available at a local drugstore.
 
Also, keep in mind, I do offer travel vaccines and may need lead time to order the vaccines specifically needed for your trip so, please plan ahead. The CDC offers a complete list of destinations with travel health notices, recommended vaccines and precautions to consider for your specific destination.
 
Finally, make sure to enter my concierge contact details into your phone—including my cell number and email—and remember to pack your membership card so that you can reach me with any medical concerns during your trip. I can potentially offer a telemedicine visit, call in a prescription or, based on your destination, help to arrange a visit with a local Concierge Choice Physicians provider if needed.
 
As always, feel free to reach me with any questions. Safe travels!

End-of-life care planning is important while we’re still healthy, and the pandemic has made it clear that illness and disability are not reserved for the elderly. Do your loved ones know your thoughts and wishes should a situation arise? According to the National Institute on Aging, 1 in 3 people guessed incorrectly when asked how their loved one would want their end-of-life care handled. It can be an uncomfortable subject to discuss and, in some families, maybe even a taboo subject. However, advance care planning empowers our loved ones when it comes time to handle our end-of-life care and decisions and helps make sure that our preferences and arrangements are known and honored.
 
One primary aspect of advance care planning includes legally designating a person to make healthcare decisions for you if you are unable to communicate these decisions yourself. This designated person is known as a healthcare proxy (or durable power of attorney healthcare agent, surrogate, representative, attorney-in-fact, or patient advocate). A healthcare proxy decides the types of medical care, procedures, treatments, or services you receive, as well as who provides that care and where. If not otherwise predetermined in advance care directives, they may also make decisions about autopsy, tissue and organ donation, and what happens to your body after death.
 
The American Bar Association has a helpful guide for selecting a healthcare proxy.
 
Your appointed healthcare proxy will have access to your medical records. If you are a Medicare recipient, Medicare will need to know about this individual which can be communicated by completing their Authorized Representatives form.
 
It is important to note a separate document is required to assign a person to handle your finances. Your healthcare proxy can only make medical decisions for you. Contact your lawyer for more information on a power of attorney for your finances.
 
I encourage a discussion about assigning a healthcare proxy and opening the conversation of advance care planning—including a Living Will—at your next visit. For Medicare patients, this is a covered service under Medicare Part B during your Annual Wellness Visit. For non-Medicare patients, feel free to call my office to schedule an appointment, or speak with me about your advance care planning thoughts and goals at your next annual concierge physical exam.

​Three years ago, we were met with a global health crisis that resulted in many of us putting our other health concerns on pause, and I want to be sure you have all shifted your focus back to your overall health and wellness.
 
Have you kept up with your yearly physical? Is it time to do a full review of your medicine and treatment regimens? Have you gained or lost significant weight? How are your stress levels, sleep patterns, fitness programs and anxiety? 
 
Your annual comprehensive examination could be the foundation of your good health. Diseases and conditions such as hypertension, cancer, and anemia can be asymptomatic, for example, but a thorough history, physical examination, laboratory testing, and an in-depth discussion may prove revealing and lifesaving. We can also take advantage of this time together to create a plan to help you meet your wellness goals.
 
Let’s partner toward your best health. Please contact our office to schedule your annual exam. And as always, I am available should you have any concerns or questions.