Author Archives: DrBordenave

As Physicians, We Still Don’t Get It

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statins

I have read the AHA/ACC Statin Guidelines, as well as many of the tidal wave of articles printed both for and against the new recommendations, most written by equally respected expert physicians.

Is it just me or has something drastically changed with the practice of medicine in the U.S.?

I realize that medicine has transitioned from a most noble profession to a business, but it is mind boggling to notice such a wide diversity of expert opinions that differ and contradict each other. Most of those in favor of the new recommendations are cardiologists. After all, the American College of Cardiology and American Heart Association put out the recommendations. One prominent cardiologist even wrote he was surprised at the standard therapy for those 75 or older, with no statin recommendation for primary prevention in the elderly. Others, including the American Association of Clinical Endocrinologists, are so opposed to the new guidelines, that they will not endorse or follow the new recommendations.

If this isn’t concerning enough, two months later, the new BP Guidelines from JNC-8 were released. Raising of target BP to a systolic of 150mmHg and the elimination of previous target systolic pressure of 130mmHg in diabetics and those with chronic kidney disease. Most controversial and embarrassing still, was the defection of 5 of the 14 members that formed the panel, each of whom came out in opposition to the conclusions after its release.

guidelines

Let’s forget about the methodology used to create the guideline. Forget about the recommendations, and forget about the reasons why so many experts are in disagreement. What I see as the real issue is a complete shift in what is important to us as physicians.

It seems that there is an obsession with guidelines. We have so many guidelines that there is a guidelines clearinghouse to store them. There is also concern with the way guidelines are developed. A process with little or no transparency, made up of experts from a diverse body of special interests whose goal it seems is self-promotion for himself or herself or the organization they represent.

As a practicing physician, I am guide-lined to death. What’s worse is that very few physicians individualize the recommendations as they should, instead applying them equally to all patients, in a “one size fits all” model.

A serious problem arises for all of us when the recommendations by one medical group are not recognized or accepted by another medical group.

confused

When there is disagreement and opposition among the members of the guideline panel that releases recommendations anyway, then in my opinion we have a severely damaged and broken system.

We have experts that can’t agree on much and the patients and physicians who don’t know what to believe in or who to trust.

“First do no harm.” Maybe guideline panel members should continuously remind themselves of that phrase while they are formulating new guidelines.

It seems that in medicine there are too many “experts” giving too many recommendations that only cause confusion. It’s a disservice to patients and physicians. It needs to stop before we loose what little credibility we have left as physicians.

Science fails medicine not through lack of competence, but through lack of vision. Not for the lack of curiosity, but for the limit of things we are curious about. Not for the lack in the ability to investigate, but for the narrowness of the scope of things it is willing to investigate.doctor and patient

I am still waiting for the day that guidelines are published, that deal with the cause of chronic disease instead of the treatment. When all medical organizations, health groups and wellness stakeholders can unite in agreement demanding better quality and a more affordable food supply for the entire U.S. population. We need to start subsidizing organic produce and farming, stop the routine use of antibiotics and hormones in livestock, limit chemicals in our foods and improving the water supply. We should have nutrition education that starts in elementary school and we should begin reinstating physical education periods. This is what is needed, not more guidelines that push more drugs on a country overdosing in drugs.

This isn’t being an idealist, this is being a responsible physician.

Despite all the guidelines published and the increased use of statins, we spend $60 billion a week in healthcare and all we have to show for it is being in 46th position in healthcare outcomes and quality, behind Iran and ahead of Serbia.

Maybe its time we remember to put patients ahead of other interests.

This article has been written by:

Jorge Bordenave MD FACP ABIHM

Integrative Cardiologist

Miami Integrative Medicine

Healthy Foods part 1

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As an Integrative Medicine physician, using food and nutrition to help keep the mind and body functioning appropriately, is what we like to teach to our patients. Below are some healthy food choices and some of their benefits. Taken from the Huffington Post, I encourage you to read more on the following items.

Almonds

Almonds are a rich source of fiber, protein, heart-healthy fat, antioxidants and vitamins and minerals, making them a one-stop food. Almonds however are high in calories, so eat them in moderation.

Apples

Apples are an excellent source of pectin, a soluble fiber that can lower blood cholesterol. The fruit is also high in fiber and its peel contains ursolic acid, which has been shown in some studies to lower the incidence of obesity.

Artichoke Hearts

These vegetables are high fiber, containing 12 grams per cup. They also are a vegetable with one of the highest antioxidant contents.

Avocado

Packed with cardio=healthy monounsaturated and polyunsaturated fat. They are also rich sources of vitamin C, E, potassium, and lutein. The monounsaturated fat helps improve absorbtion of carotenoids, lycopene and beta-carotene; antioxidants found in many vegetables.

Beets

The dark red color indicates the powerful phytonutrient package of beets. Beets are rich in betalains, such as betanin and vulgaxanthin, natural substances that in addition to giving them their coloration, also provide anti-inflammation and antioxidant properties.

Beans

Beans good for your heart thanks to a high fiber content. Their fiberous quality also makes them protective against certain cancers and a top-rated food for diabetics. When combined with a grain, they comprise a high-quality vegetarian source of complete protein.
Beans are an excellent dietary source of folate and also have high levels of iron, potassium and magnesium.

Bell Peppers

The peppers are loaded with vitamin C, and unlike many other sources of the nutrient, bell peppers are relatively low in sugar. They also provide fiber and several antioxidants from the carotenoid class (alpha-carotene, beta-carotene, lycopene, lutein, cryptoxanthin and zeaxanthin). Carotenoids improve eye health, and are associated with a reduction in cancer risk and a lower risk of cardiovascular-related death.

Blackberries And Raspberries

Berries are low in calories and are excellent sources of fiber, vitamin C, antioxidants and phytochemicals. Some research suggests they help with such divergent health challenges as age-related mental decline, heart disease, some cancers and urinary tract infections.

Black Tea

Along with green and white teas, black tea is full of antioxidant flavonoids. Studies suggest they may have strong anti-inflammatory and immune boosting properties, be protective against certain cancers, cardiovascular disease and diabetes.

Blueberries

All berries provide healthful antioxidants, vitamins, fiber and phytochemicals, but studies show that blueberries have a particular and unique health benefit.
Among the fruits with the highest level of antioxidants, blueberries have been linked to lowering cholesterol, reducing diabetes risk, slowing the aging process, improving motor skills and supporting urinary and vision health. A natural compound called anthocynanin, which gives blueberries their color, may be the main component of its antioxidant and anti-inflammatory properties.

Broccoli

Broccoli is high in fiber, low in calories, rich in the antioxidants vitamin C and beta carotene. This cruciferous vegetable is also rich in vitamins K, E, B and the minerals, calcium, iron, selenium and potassium. That means broccoli is wonder-food, promoting eye health and preventing macular degeneration with the carotenoids lutein and zeaxanthin; protecting against cancer, heart disease, stroke and building strong bones.

Broccoli is also rich in sulforaphane that research shows may help fight breast cancer. In a recent Chinese study, women who consumed the most cruciferous vegetables were 62% less likely to die of breast cancer and, if they had a history of breast cancer, were 35% less likely to experience a recurrence.

Brown Rice

Fiber-packed and nutrient dense brown rice helps fill you up while being relatively low in calories. A recent Harvard study, found that eating two or more servings of brown rice helped protect against Type 2 diabetes, compared to five servings of white rice, which increased the risk.

Brussels Sprouts

Another cruciferous vegetable, Brussels sprouts may play a role in protecting against heart disease perhaps by reducing inflammation. They contain important nutrients like omega-6 fatty acids (in the form of ALA), vitamin A, B vitamins (thiamine, niacin, and folate), and vitamin E. In addition, the antioxidant, antiestrogen and chemopreventive properties of the Brussels sprouts may make them useful in preventing recurrence of cancer.

Cherries

These fruits are packed with vitamins A and C, iron and calcium, and are a low-calorie food. They also are a good source of fiber, and have virtually no sodium or fat.
Cherries are packed with antioxidants, and emerging studies suggest that eating cherries or drinking cherry juice may promote heart health, play a role in pain management, support recovery from exercise, and even help you fall asleep faster.
Experts at the Penn Institute on Aging at the University of Pennsylvania also note that cherries’ antioxidants help protect the body from the harmful effects of by-products known as free radicals, made normally when the body changes oxygen and food into energy.

Chia Seeds

Chia seeds are actually from the Salvia hispanica plant, and have been a part of the diets of the Aztecs and Mayans. The little seeds are super-rich in antioxidants and omega-3 fatty acids, which research has shown to be important in lowering inflammation in the body and reducing the risk of heart disease and cancer.
One tablespoon contains 6 grams of fiber and is full of beneficial omega-3 fatty acids. They’re also abundant in antioxidants and contain more calcium than milk per serving, even having more calcium and fiber than flaxseed.

Coffee

The benefits of coffee have been more researched lately, with potential health benefits including the ability to protect against heart failure, lower depression risk, lower risk of some cancers, protect against diabetes and possibly even help you live longer.

Cranberries

This little red fruit is actually a powerful urinary tract infection preventer, as it’s able to stop bacteria from clinging to the urinary tract walls, according to the University of Maryland Medical Center. However, the National Center for Complementary and Alternative Medicine notes that there is not yet enough evidence to say that cranberries can actually treat UTIs.
Some studies have also shown that cranberries have lots of antioxidants and may even be able to lower the amount of dental plaque we have in our mouths (which is a risk factor for gum disease, according to the National Center for Complementary and Alternative Medicine.

Dark Chocolate
The flavonoids in cocoa are cardio-protective, by lowering blood pressure, raising levels of good cholesterol and lowering levels of bad cholesterol, helping with blood flow and improving insulin sensitivity.

Edamame

This green soy bean is packed to the gills with important nutrients like folate, protein, magnesium, potassium and fiber. One half a cup has about 8 grams of protein.
And studies have shown that soy-containing foods — such as tofu and edamame — may even be able to protect the body from diseases like diabetes, cancer and heart disease, Heller says.

 Eggs

Eggs provide perfect protein in a nutrient-rich, low-calorie, low-fat package.
That’s because they are full of choline, which is good for memory, and the vision protecting phytonutrients lutein and zeaxanthin.
While Eggs contain about 212 mg of cholesterol per large egg, the Mayo Clinic points out that having four egg yolks a week doesn’t seem to have an effect in increasing heart disease risk.

Flax Seed

Flax seeds are high in omega-3 fatty acids, fiber and lignans-a phytonutrient linked with lower risks of heart disease and possibly some cancers.
The abundant amount of fiber in flax seed makes you feel full faster and keeps blood sugar stable.
Flaxseeds can be purchased ground or whole (and you can grind them on your own in a coffee grinder) and then added to foods.

Ginger

A “superstar of Traditional Chinese Medicine,” ginger root can be consumed as a tea (from boiled root) or eaten sliced as part of a dish.
Ginger has demonstrated anti-inflammatory properties, can help with nausea and digestive challenges and possesses anti-viral properties.
The National Institutes of Health also notes that ginger — fresh dried, and/or juiced– can also be used to treat migraines, toothache, rheumatism, cough, upper respiratory tract infections, stomach pain and burns.

Inflammation Part One

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Inflammation  is a normal process that keeps us healthy. It is our body’s defense response mechanism to infection, injury or any noxious stimuli.

Simply put, inflammation is the body’s physiological response to any injury, infection or any irritant.

Inflammatory processes are common and a normal defense response of the body, acting to protect against invading organisms and processes that affect that can potentially cause us harm.

Acute inflammation is an immediate, overwhelming response to a trauma, irritation, endo-toxins, bacteria, viruses, micro-organisms and other noxious stimulus. For example, whenever we cut ourselves or sustain any other type of injury, within a few milliseconds the inflammatory cascade becomes activated. Damaged cell membranes first release products of arachidonic acid metabolism, like prostaglandins and leukotrienes, as well as bradikinins and histamins all of which are substances that have an important role in an acute inflammatory process.

These chemical mediators cause an increased blood flow to the site of injury and are typically the cause of the initial localized pain associated with an acute inflammatory process. The increase flow of blood and fluid into the injured area, causes swelling and the increased vasodilation causes redness.

The immune system also becomes activated, and white blood cells, by a process called chemotaxis, arrive at the site of injury. Neutrophils are the white blood cells responsible in finding and eliminating any bacteria. It does so by engulfing these micro-organisms, and destroying them with potent enzymes within its cell structure. The neutrophils are helped in removing cellular debris by another type of white blood cell called macrophages.

Depending on the type of injury, the hematologic system can also be activated with platelets quickly clumping to form a localized blood clot to stop any potential bleeding.

In addition to these blood cell components the injured area is also flooded with other anticoagulant factors and chemicals that work together to protect the body from the potential damage.

In a healthy person, this response to injury or infection is quick and efficient, with resolution occurring before the immune system is chronically activated. After the acute process is contained and resolved, the skin eventually returns to its normal color and temperature.

An example of this would be with a flare up of gout. As uric acid levels increase they may precipitate and form crystals and deposit in the fluids and lining around the joints. This causes the area to become irritated and inflamed, manifested by redness, swelling and tenderness to the affected area. Another more common example of an acute inflammation is that of a common head cold.

In contrast, to an acute inflammatory response, a chronic low-level inflammation is a persistent inflammation due to chronic irritation by exposure to a noxious stimuli or an auto-immune reaction. Instead of a response by neutrophils and macrophages it is monocytes, lymphocytes and fibroblasts that typically predominate. As this inflammation continues indefinitely, other components of the body’s defense system become activated. The compliment system is activated to aid antibodies and phagocytic cells in removing noxious stimuli. Phagocytic cells that engulf and destroy invading cells and generate and produce many enzymes and chemicals like reactive oxygen species. The coagulation system is activated to limit bleeding, by forming a network of fine protein strands that localize to the area of injury. The kinin system of proteins is activated and acts as inflammatory mediators to cause vasodilatation and finally the fibrinolysis system is activated to limit and counter balance the coagulation system. Several different inflammatory mediators result from each of these systems, all of which form part of the immune response.

Reactive oxygen species are unstable compounds useful in eliminating various noxious threats if left un checked can lead to oxidative damage of nucleic acids and proteins, causing illness.

Chronic inflammation can become a state of continuous stimulation that for whatever reason, cannot seem to turn it self off. In these settings chronic inflammation leads to involvement of the immune system.

An immune system that cannot turn itself off, then turns against the body, producing a myriad of chronic diseases.

Some individuals may have a genetic predisposition to develop certain chronic inflammatory diseases.

Chronic inflammation can result from an acute inflammation, or develop slowly and have a delayed onset, lasting for months or years, and end with tissue destruction, tissue fibrosis or cell death.

In chronic inflammation, we don’t have the typical cardinal signs of heat, redness, swelling and pain as in an acute inflammatory process, and many times we are not even aware of an ongoing inflammation. Most low grade inflammation produce no identifiable symptom because it typically occurs in cells, tissues and organs deep within the body and often times we are not aware that the illness.

Examples of chronic inflammation include; atherosclerosis or hardening of the arteries, peptic ulcer disease, psoriasis, rheumatoid arthritis, pancreatitis, Alzheimers disease, inflammatory bowel disease, allergies, obesity, cancer, diabetes, asthma and many others.

from the book: “Change your Diet, Change your Health” (2012)