As Physicians, We Still Don’t Get It


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.


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.


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 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

Fabulous Fiber

It almost goes without saying that everyone knows that eating a healthy diet is paramount to health and wellness. Although eating a healthy diet doesn’t always translate into living disease free because outside forces such as environment and genetics also play a part. In addition, as we age, joints begin to creak and energy levels drop. However, eating a healthy diet can slow the effects of old age and provide a lot of benefits throughout your life.

oatmeal and blueberriesThe Magic of Fiber

If there was a magic ingredient easily found in many foods that is not only inexpensive, tasty, can help you lose weight, avoid dangerous diseases and live longer, would you want to use it every day? Of course you would. However, there is such an ingredient and most of us choose to ignore it.

The magic ingredient is fiber, and 80% of us make the mistake of not getting the recommended amount of fiber each day.

New Research

New research published in The American Journal of Medicine (AJM) in December, reports on a study of 23,168 people who were monitored for their consumption of fiber. Of those studied, 80% took in far less than the recommended amount. Most of the men in the study consumed an average of less than half the amount required to keep a healthy heart.

Those who ate the least amount of fiber had a much-increased rate of risk factors for heart disease. These risk factors included chronic inflammation, obesity and a group of disorders called metabolic syndrome.

Metabolic Syndrome

Metabolic syndrome is described as a group of medical disorders, that when they occur together, increase the risk of cardiovascular disease by double and quintuples it for diabetes. There are studies that estimate that 25% of the American population suffers from this.

This group of disorders includes an increased blood sugar levels, abnormal cholesterol levels, high blood pressure, and excess fat around the belly. Any one of these symptoms may increase your chances of heart disease or diabetes however, having them all together increases your risk significantly more.

Benefits of Fiberfiber foods

Something that most everyone knows about fiber is that it is good for the digestive system and helps to avoid constipation and diarrhea by keeping food in the intestines moving along in a normal fashion.

There are two types of dietary fiber: soluble and insoluble. Either one is good for your digestive health. Research is growing that fiber helps control heart disease, certain cancers, diabetes (by controlling blood glucose levels), lowers cholesterol, helps control diverticular diseases, gallstones and kidney stones. All of these medical problems can be helped greatly by including the recommended amount of fiber in your diet. It can also help you lose or maintain weight by helping you feel full and it will contribute to your overall feeling of wellness.

Fiber Recommendations

The AJM study showed that most people get less than half the recommended daily amount of fiber each day. Here is what you should aim for on a daily basis:

  • Men aged 19 to 50                        38 grams
  • Men aged over 50                         30 grams
  • Women aged 19 to 50                  25 grams
  • Women aged over 50                   21 grams
  • Children age 1 to 3                       19 grams
  • Children age 4 to 8                       25 grams
  • Girls age 9 to 13                           26 grams
  • Girls age 14 to 18                         29 grams
  • Boys age 9 to 13                          31 grams
  • Boys age 14 to 18                        31 grams

fruit saladMeeting the Requirements

Perhaps part of the problem with getting enough fiber is translating grams of fiber into the food items we eat. You can find an excellent chart here. The information here helps translate grams of fiber into measurements that make more sense:

  • Applesauce                          2/3 cup                     3.6 grams
  • Baked Beans                        1 cup                       16 grams
  • Pinto Beans                          1 cup                       18.8 grams
  • Whole Wheat Bread             2 slices                    6 grams
  • Broccoli                             ¾ cup cooked            7 grams
  • Carrots                              ½ cup cooked            3.4 grams
  • Noodles whole wheat       1 cup                          5.7 grams
  • Peach                               1 medium                   2.3 grams

These are just a few examples of the information you will find. It can significantly improve your intake of fiber when you know how much of what will help you meet your daily requirements. Also, check the nutrition information on canned and boxed foods for fiber content. Getting enough fiber in your diet is important whether you follow modern medicine, holistic medicine or integrative medicine. Contact us at Miami Integrative Medicine and talk to Dr. Bordenave about a healthy diet that is best for you.


Published by Axiom Health Care Marketing




Staying at Peace

Maintaining an inner peace is just as important to your health and wellness as the food choices you make. Learning to focus your mind on goodness will bring healthy benefits to your life; Peace and wellness are a healthy partnership. Dr. Bordenave suggests that you focus your mind on positive thoughts and you won’t be as inclined to overindulge or over-react. 

Slow and Steady for Health

If you are looking for the benefits of an 2005-04-18-leafy-sea-dragon-tai-chi-2exercise program that doesn’t involve running, weightlifting, or intense aerobics, look into tai-chi. The slow and controlled movements of this Chinese martial art have been shown to amazing health benefits and can burn as many calories as skiing. This article can help you learn more about this ancient form of exercise and discipline:

Posted by: Axiom Healthcare Marketing

DASH To Lower Blood Pressure

High blood pressure, or hypertension, is often called “the silent killer.” Because it presents no obvious physical symptoms, many people who suffer from it are unaware of their condition or the risk it poses to their health. Many studies have drawn connections between hypertension and diet – excess consumption of sodium, for example, is linked to elevated blood pressure. Today that link is clearer than ever.

What is DASH?


In recent years, nutritionists and medical researchers have discovered a great deal of new information about the nutrients in food and how they can influence our health. One result of this work is the creation of a diet that has proven to lower blood pressure significantly without the use of medication. Known as the DASH diet – Dietary Approaches to Reducing Hypertension – it focuses on consuming foods that are low in saturated fat, total fat, cholesterol, processed sugar, and sodium. Examples of the kinds of foods included in the diet are whole grains, fruits, vegetables, fish, poultry, and low- or no-fat dairy products.

Proven Results with DASH

The proof of the effectiveness of the DASH plan comes from two studies sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The first study included 459 adults, evenly divided between men and women, of whom 27% had high blood pressure. The participants were divided into three groups: one group was fed a typical American diet; the second group ate the same diet, supplemented by additional fruits and vegetables; the final group ate a DASH diet. All participants consumed about 3,000 milligrams of sodium daily. While members of both the second and third groups showed reduced hypertension, the reductions under the DASH were significantly greater. Participants on the DASH plan showed results as quickly as two weeks after changing their diets.


The second study focused more specifically on the role of dietary sodium in conjunction with different diets. In this study, 412 individuals were divided into two groups: one on a typical American diet and one on the DASH plan. The researchers then varied the participants’ daily intake of sodium each month. One month, participants received 3,300 milligrams of sodium daily, about what the average American consumes. The amount was then reduced to 2,300 milligrams/day for a month, and to 1,500 for a month. Again, those on the DASH diet showed the greatest reductions in blood pressure, with the most dramatic results produced by the lowest-sodium (1,500 milligrams/day) DASH diet. Even participants who had only very slightly elevated blood pressure, or prehypertension, showed great improvement under the plan.

The DASH Diet

The DASH diet requires no special foods or supplements, nor does it require any additional preparation than a standard diet. It emphasizes the importance of eating foods that contain nutrients that researchers have linked to lower blood pressure, including potassium, calcium, magnesium, protein, and fiber. The DASH plan contains recommendations for daily servings from several different food groups. These include:

  • 6-8 servings of whole grain (1 serving = 1 slice of bread, 1 ounce dry cereal, or ½ cup cooked cereal, pasta, or rice.
  • 4-5 servings of vegetables (1 serving = 1 cup raw leafy vegetables, ½ cup cooked vegetables, or ½ cup vegetable juice)
  • 4-5 servings of fruit (1 serving = 1 medium fruit, ¼ cup dried fruit, ½ cup fresh, frozen, or canned fruit, or ½ cup fruit juice)
  • 2-3 servings of low/no fat dairy (1 serving = 1 cup milk or yogurt, or 1 ½ ounces of cheese)
  • 6 or fewer servings of lean meat/poultry/fish (1 serving = 1 ounce cooked meat or 1 egg)
  • 2-3 servings of fats or oils (1 serving = 1 teaspoon of margarine of vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of salad dressing)

10 24 12 JB Picture

In addition, the diet prescribes weekly dietary intake of two other food groups:

  • 4-5 servings/week of nuts/seeds/legumes (1 serving = 1/3 cup nuts, ½ cup cooked peas or beans, 2 tablespoons of peanut butter, or ½ ounce of seeds)
  • 5 or less servings/week of sugars (1 serving = 1 tablespoon of sugar/jelly/jam, ½ cup of sorbet or gelatin, or 1 cup lemonade)

Watch the SaltSaltShaker

As mentioned earlier, the DASH diet has its greatest benefits in lowering blood pressure when you limit sodium intake as well. Because the DASH plan includes lots of foods that are naturally low in sodium, such as fruits and vegetables, your sodium intake will likely decrease just by adopting the diet. However, a lot of foods and food additives contain sodium, so it is wise to monitor your food choices. A partial list of such products includes processed cereals, soy sauce, baked goods, baking soda, and monosodium glutamate, or MSG. Be sure to read the labels on processed or prepackaged foods carefully to make sure you are not getting “hidden” sodium from these products.

If you have been diagnosed with hypertension and are looking for a natural way to control your blood pressure, taking up the DASH diet is a good place to start. Of course, you should consult with a physician before you start any new dietary regimen. The DASH diet, however, has helped many people control their hypertension and lead healthier lives. It could do the same for you!


Take A Deep Breath

Relieving stress can be as simple as breathing, if you know how to do it. This article presents some basic breathing techniques to help you relax.

Mind Body Medicine

Posted By: AXIOM Health Care Marketing

What’s So Super About Superfoods?


You’ve probably heard about “superfoods,” but what are they and what makes them “super”? Check out this article, which discusses 3 “superfoods” and how they contribute to a healthy lifestyle.

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Holiday Wishes from Miami Integrative Medicine

Christmas 2012

The staff at Miami Integrative Medicine would like to wish everyone Happy Holidays, Merry Christmas and a Happy New Year!


Dr. Bordenave’s practice is located at:

 4908 SW 8 street, Coral Gables, Fl. 33134.

They are open Monday thru Friday 9am to 5pm.

Phone: 305.446.2444


Posted by Axiom Administrative Services

 69 Appaloosa Lane, Bldg C, Ste. 201
Ormond Beach, Florida 32174
Phone/Fax: 800-888-6348                         
Integrated Healthcare Marketing Services

Dr. Bordenave brings passion for Integrative Medicine to AXIOM family

For Immediate Release on 6-28-2012
Contact: Eric Bem
Office: 305-967-7446

Healtcare SEOMiami, Florida- Integrative Medicine is a medical field that is focused on treating each patient on an individual basis. The principles behind this specialty focuses on not just healing a patient’s ailment, but also helping the patient by helping them invoke change. This is the belief, philosophy and passion for Dr. Jorge Bordenave.

Dr. Bordenave knows that prescribing medicine is just one way to help treat illness, but he believes that patients rely too much on medications alone. A core principle of Integrative Medicine that Dr. Bordenave stresses is that a major part of a patient’s healthcare lies with the patient’s themselves. While taking medicine may provide a temporary relief, a more effective solution is changing the way we approach our health, as patients. He believes that knowledge is power and patients need to start educating themselves about different treatments that are available and lifestyle changes that can lead to better long-term health.

Dr. Bordenave is a physician who is trying to promote change, both in the medical community and with his patients. This is what Dr. Bordenave is accomplishing on a daily basis. He is helping patients with treatment and lifestyle changes that are empowering them to live a better, healthier future. Dr. Bordenave knows that as more resources become available for patients, more people will consider taking an Integrative Medical treatment approach for their ailments. Although there are many sites available on the internet dedicated to providing users with health information, Dr. Bordenave’s site is a great resource for patients looking to learn more about his philosophy.

Dr. Bordenave has been ahead of the curve when encouraging patients to take a more active approach to educating themselves about their own healthcare. With Healthcare Reform passing as of June 28, it will be as important as ever for patients to be knowledgeable about their own health. They will need to know about types of insurance coverage and the different policies that their physician will accept. Fortunately, since Healthcare reform is such a hot-button issue the number of resources out there for patients is immense.

This dedication to helping his patients take charge of their healthcare is what has turned Dr. Bordenave into the well respected physician he is, and one of Florida’s’ premier healers. That is why AXIOM was so excited to add Bordenave to its client list. Dr. Bordenave is one of the most passionate and dedicated professionals in the industry and that is what AXIOM looks for in physicians. AXIOM is dedicated to helping the best out there reach more patients and instill positive change in their lives. AXIOM, an Integrated Healthcare Marketing company, is currently helping Dr. Bordenave increase his Web presence so that he can reach and help more people. The assistance includes a redesign of his current site, a development of an interactive blog and lead generation for his completed site. For more information about AXIOM visit their Web site.



Dr. Jorge Bordenave’s practice is located at:

4908 SW 8 Street
(corner of 8 st and Granada Blvd)
Coral Gables, Florida 33134
Phone: 305-446-2444





Mailing Address:Axiom Administrative Services, LLC
PO Box 730956
Ormond Beach, Florida 32173
Phone/Fax: 305-967-7446

Physical Address:Axiom Administrative Services, LLC
69 Appaloosa Lane, Bldg C, Ste. 201
Ormond Beach, Florida 32174
Phone/Fax: 305-967-7446