“ Your genome sequence can become a vital part of your medical record, thereby providing critical information about how to optimize your health”
– Leroy Hood MD, PhD
We have all heard talk of our genome. What is that? It is defined by the National Library of Medicine as
“…our complete set of DNA and all of its genes. Each genome contains all the information to build and maintain our organism. The human genome contains more than 3 billion DNA base pairs, contained in our chromosomes” …23 pairs of chromosomes, of which we get one pair from Mom and one pair from Dad, for a total of 46 chromosomes. These are found in every cell in our body that has a nucleus.
The study of these genes is called Genomics and was made possible by the discovery of the DNA structure by James D Watson and Francis H C Crick on February 28, 1953 at Cambridge University and by the Human Genome Project which in 2003 was successful in mapping the entire genome of the human species. Genomic Medicine is an emerging medical study devoted to using this information for better diagnosis of conditions and diseases to be able to better personalize therapy.
How is this practical for us? There are various areas of development of this study that are maturing as this note is written.
The most common form of this type of testing available to the lay public is direct-to-consumer advertising of analyses that provide personal ancestry and health information. The pertinent aspects are for your health, and focused on advising if you are at risk for a number of conditions and diseases, as well as noting simple traits. This information is interesting to the lay public but is best reviewed with your health professional to put the results into specific context as to how it relates to the patient’s personal health status.
Tumor DNA sequencing is an important aspect of cancer care. It can give more in depth information regarding a certain cancer that would aid the patient and physician with targeted therapies for hoped for better results. More information can be found at https://www.cancer.gov/about-cancer/treatment/types/precision-medicine/tumor-dna-sequencing
Pharmacogenomics, initially utilized in the 1950s, has become more refined and it enables physicians to use specific information of a patient’s genetics regarding how our body absorbs, distributes, metabolizes and excretes medicine we take (pharmacokinetics). Medications pass through the liver and we each have different genes for the substances we are born with to metabolize them (ex. cytochrome P450 enzymes). This testing can show us what we are able to better metabolize and what we may not metabolize, creating the inherent risks of either no effect or a toxic effect of a substance.
Some of the current available tests are in their early stages of use to the public and may be incomplete in their results. A solution to that may be in combinatorial pharmacogenomics that utilize a series of genes from the individual to better analyze their personalized metabolic pathways. These tests are currently available for psychotropic medications as antianxiety, antidepressant and pain medications.
On the horizon and currently being studied and perfected is Nutrigenomics, the study of how our personal genetics influence what we eat, and how what we eat affects our genes and metabolism.
Our internal genetic makeup can predispose us to certain diseases and can be affected by diet and lifestyle. Just because one has a predisposition does not mean they will automatically express it. Nutrients, and or the lack of them, can influence our susceptibility to disease.
A recent editorial in the American Journal of Medicine https://www.amjmed.com/article/S0002-9343(18)30748-4/fulltext reiterates data we have been aware for near 50 years and the numerous studies extolling the successes of a healthy lifestyle. Despite this, the message has become fragmented and over disputed in its efficacy. The facts remain however, that attention to good health habits such as not smoking, getting some regular physical activity, not overdoing it with alcohol intake and attention to good nutrition are, no doubt, fundamental in stemming the tide of metabolic syndrome that predisposes people to their genetic susceptibility to disease, as discussed above.
Changes in our lifestyle are not impossible to attain and are probably some of the easiest to attain. You should speak with me on how your current uses could be gently modified for feeling better.
As part of your membership I offer Nutritional, Lifestyle & Genomic Consulting. Some of you have already benefited from this care. Remember to follow up to assure lifelong changes for the better, and share this with someone you care about.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…“ An ounce of prevention is worth a pound of cure”
– Benjamin Franklin
”You don’t have to go on a diet, just change your diet.” But, there are so many choices and we are all different in our makeup, routines, environments, genetics, habits and comfort foods. Of course, but if you could feel better from a change in your habits and comfort foods, mixed in with some education on the subject, it might just be worth it.
It is not that difficult. Health minded approaches to nutrition have made their way to your local grocery store and your favorite restaurant. It is understandably difficult to know where to begin in our busy lives. Let’s try to understand how we nourish and what to nourish with.
Everyone is talking about taking probiotics, “they are good for you”.
The World Gastroenterology Organization Global Guidelines define a probiotic as “live microorganisms that confer a health benefit on the host when taken in the adequate amounts” and “strictly speaking, are live microbes shown in controlled human studies to impart a health benefit”. The evidence based applications for adults are associated with active disease imbalanced states such as acute diarrheal states, antibiotic related diarrheal states, irritable bowel syndrome, colitis and certain liver diseases. The Human Microbiome Project began in 2007 and is active today at the Mayo Clinic and Scripps Institute among other centers worldwide. What if you don’t have any of those conditions and you generally feel well?
What are my personal “probiotics” and how are they?
They are your own personal group on microbes localized mostly in your large intestine, the colon. They become associated with us while we are in the womb, increase in number during vaginal birth and stabilize as we begin to eat solid foods as a child, growing with us and diversifying based on a number of factors mostly environment and diet. They help digest what we feed them and they protect us when in a normal steady state. They bio-mathematically number over 40 trillion cells and add an average of an additional 600,000 genes to each human being. If your gut feels okay, they are most likely stable.
What they eat is important as they are processing it for us. They eat pre-biotics.
“What is a prebiotic?” you ask.
They are “dietary substances that positively influence the beneficial microbes and confer health benefits to the host”, us. The best example is fiber. That is one of the main reasons increasing fiber in your diet is good for you. It reduces the risk of certain cancers and is beneficial in reducing cardiac risk as well, both, when included in a regular regimen of physical activity.
“What do I look for when I shop for food or go out to a restaurant?”
Let’s check the glossary. Consider it your Berlitz guide to better nutrition.
Whole Food: an unrefined food, such as a single vegetable or piece of fruit.
Processed Food: the physical altering of whole food, which can include the addition of by-products, or other processed materials, in the final product.
Organic: grown without the use of synthetic fertilizers, pesticides, hormones or antibiotics. In order to be certified by the USDA, the producing farms must demonstrate their products are as such. Look for the green and white circular “USDA/ORGANIC” emblem.
Conventional Foods: a less expensive production process that employs the standard use of pesticides, synthetic fertilizers, antibiotics and hormones. The nutritional value is less than organic products. The slightly higher cost of organic products can be offset by the increased health benefits and requirement of less food ingested to confer both better satiation and nutritional value.
All Natural Foods: contain no artificial flavors, sweeteners, preservatives, or colorings. They are found in both conventional and organic products.
Genetically Modified Organisms GMO: the genetic modification of a plant, animal or other organism conferring qualities that make them more resistant to the environment. The task of production of GMO products is lessened, but the health implications of DNA modification are yet to be realized until further studies are completed. This could be better to keep in mind when choosing a probiotic product. Look for the Butterfly Emblem with “NON GMO Project VERIFIED”.
Getting a little education can go a long way in finding a better way to eat.
There are numerous approaches to this and as consumers we tend to get overwhelmed by the ads and hour long webinars hoping to sell a magic product, when all the information you need, is right in front of you at your grocers or local restaurant. Discovering how it relates to you specifically is the key.
As part of your continued General & Preventive Internal Medicine ongoing care I have included state of the art Nutritional & Lifestyle Consulting geared at optimal health for all interested. Through these new organized approaches, one can improve chronic conditions and help avoid many metabolic syndromes thereby improving Quality & Quantity of Life Ask me how it might help you.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…“ Life flows on within you and without you”
– George Harrison, Sgt. Pepper’s Lonely Hearts Club Band
Anti-aging is defined as “used to prevent or lessen the effects of aging”. The American Academy of Anti-Aging Medicine was founded in 1992 to advance therapies for “prevention, treatment and reversal of age related dysfunction”. Over the last two decades there has been a proliferation of approaches for use of anti-aging therapies to reduce frailty and dependency in advancing age. Data is present and slowly developing. Many services are available and marketed directly to the public. Cosmetic services may be the most advanced and are commonly utilized at patient choice. Hormonal remedies are directed at both women and men and the data available is slowly developing in the medical literature. Supplements and multivitamins are well established and there are differing opinions in the literature as to the substance, amount and use of the myriad of products available directly to the consumer. Stem cell therapy is a controversial but promising area of research somewhat limited by public controversy.
A dilemma can arise in the way in which these therapies are presented to the lay public. Terms are used to advertise the therapy in question that are colorful but may be misleading. At times it could be the difference between pushing the envelope of truth versus the reality of the desired outcome. This at times creates a situation of twisting the actuality of the claim and what the consumer may expect from the use of any of the services. An illustration of this is:
When it is said “become young again” or “turn back time”, what can be claimed is, it can improve your sense of wellbeing, temporarily. What probably shouldn’t be claimed is that, it can change the underlying attributes which lead to the changes, be they genetic, environmental or behavioral.
When it is said “anti-aging”, what can be claimed is that, it can attempt to regenerate damaged tissues. What probably shouldn’t be claimed is that it is capable of “actively resisting or refusing to comply” with the natural process of aging, as Webster’s defines “anti”.
When a process can “retard, stop or reverse aging”, what may be more appropriate is that it may assist in improving your general health if a definitive diagnosis is first made by a physician. What probably cannot be claimed is that it can “reverse, stop or retard” normal…natural…aging.
When we are told it can “extend your lifespan”, we must define lifespan as it is, the biological life existence of a species, which is about 120 years for humans and about 10-15 years for dogs. If the diagnosis matches the therapy it may help a patient to attain and exceed their life expectancy, ie the average number of years a person is expected to live.
As of 2015, life expectancy in the United States is 82 years of age for the ladies and 77 years of age for the gentlemen, with the average age being 78. The United States ranks 43rd out of 224 nations listed. The top three are Monaco, Japan, and Singapore with average life expectancies of 90 and 85 years, respectively. Israel and Italy come in at 11 and 14 with an average age of 82 years, with France, Canada and the United Kingdom at 81 years of age. African nations round off the bottom 10 nations in life expectancies of 50 years of age.
Hormonal therapy has been used extensively for years. Testosterone was isolated and synthesized in 1935 and was used widely until the mid-1950s. Estrogen replacement therapy came into wide use in the 1960s and was cautioned in the 1990s when the Woman’s Health Initiative Study noted a greater risk of breast cancer, stroke and cardiovascular disease in users, despite its’ benefits against osteoporosis and its’ ability to lower colorectal cancer risk.
Replacement of hormones requires a deficiency in the hormone. The control of the hormone secretion begins in the emotional center of the brain, the hypothalamus. From there the message proceeds to the pituitary gland where chemicals are released that can stimulate each one of the glands (ex. thyroid and adrenals) and the gonads (ovaries and testicles).
Primary causes are usually congenital and appear in children. Secondary causes are more related to external influences such as, Female Athlete Triad, a syndrome found in physically active women who exercise a great deal. It includes the triad of poor nutrition, premature loss of menstrual cycle and a reduction in bone density. Chronic illnesses like hypertension, obesity, excessive use of tobacco and/or alcohol, sleep apnea, work related stress and opioid induced androgen deficiency (first noted in the 1970s). From a clinical standpoint…work related stress/general stress can lead to excessive tobacco/alcohol use that can lead to obesity that can lead to hypertension and sleep apnea. That chain of events is very common in society.
Prescription of hormonal therapy is best served following a comprehensive history and physical exam with a physician. Baseline lab tests should be performed. In the case of testosterone replacement there are risks in the therapy. The main one is on the prostate and the PSA should be checked and followed periodically depending on the basic health of the individual. Cardiovascular risks are known when testosterone is used in body building. In deficient states it appears to be safe however at least one recent large study showed a higher risk of cardiac events with the findings being noted in men with prior risk factors for heart disease to begin with. The most common side effect is an increase in production of red blood cells which can cause clogging of the blood vessels.
There is always a balance between risk and benefit in virtually everything we do. In medicine we call that the risk to benefit ratio and the use of any intervention is guided by the first ancient law of the Art & Practice of Medicine – Primum Non Nocerum, First Do No Harm.
So it seems that the hope is to not battle nature but to work within it, learn from it and attempt to age in a healthy, successful and gradual fashion:
Try to remember what comedian Lewis Black says, “We’re all just little snowflakes”.
Enjoy the rest of the year and the holidays.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Much is heard daily, of new scientific and medical advances. All are important but oft times there is no further talk of them, they are replaced by new information or are years away from practical application. As our year winds down and we celebrate and look to a new year, let us review some recent information that can serve us all.
Keeping in mind, if we are advancing in birthdays, we are surviving. In regards to health that means we are staying well. The data reveals to us that between the ages of 15 and 35, injury leads the major causes of demise. From 35 to 65 years of age cancer is the leading cause, followed by cardiovascular disease. After 65, cardiovascular disease takes first place in years lost.
If we examine cancer, in Women the number one diagnosed cancer is breast, however it is in second place as cause of premature death. The top five causes of premature cancer deaths in women in 2015 are, in order: lung, breast, colon, pancreas and ovary.
For Men the most diagnosed cancer is prostate, however the top five causes of premature cancer death in men in 2015 are, in order: lung, prostate, colon, pancreas and liver.
All of these conditions can be minimized by lifestyle, knowing your family medical history and early detection through appropriate screening.
Let’s review some notable clinical medical news of the past year:
Screening for Lung Cancer: The National Lung Screening Trial including 50,000 patients at 33 centers showed a 20% reduction in lung cancer mortality by getting a low dose CT scan of the chest as regular screening for adults 55-80 years of age who have smoked the equivalent of a pack of cigarettes daily for 30 years, even if they have quit in the last 15 years.
Updated Screening Recommendations for Breast Cancer: The American Cancer Society has recently revised their advice for screening mammograms in average risk individuals. This currently has created a lack of cohesion on the part of treating physicians on fully accepting the latest recommendation. They now state that women should start getting mammograms at 45 years of age annually until 55 and then every other year. They state women should have the option to begin screening at 40, as has been the case for years. Women at high risk for breast cancer such as a positive family history or an early history of cancer in the family must speak with their doctors regarding appropriate screening procedures specific to their individual case. The chair of the guideline panel stated “These recommendations are made with the intent of maximizing reductions in breast cancer mortality…while being attentive to the need to minimize harm associated with screening.”
Dose of Jogging and Long Term Mortality: A Journal of the American College of Cardiology study evaluated 1100 healthy joggers and 4000 healthy non joggers to assess intensity of activity to risk of death. The lowest mortality was found in light joggers (1-2.5 hours weekly) with strenuous joggers being found to have no greater benefit than sedentary non joggers. Take home point is moderation is the key here.
Cologuard: is a non invasive screening stool test for colon cancer. It is indicated for average risk individuals 50 years or older. It is a stool collection test found to be more sensitive than the routine stool screening. It uses DNA technology to test for precancerous and cancerous cells in the stool. It however, does not replace the physical exam or the need for colonoscopy. The test is covered by some insurances and is not inexpensive. Speak with your doctor regarding your individual case.
Abdominal Aortic Aneurysm Screening: It is indicated that people between 65 and 75 who have ever smoked, should get a one-time ultrasound of the abdominal aorta. Anyone 60 or older with a family history of aneurysm should undergo physical exam and ultrasound screening, as well. It is common that CT scans and other ultrasounds previously done on the patient have already analyzed the aorta. Discuss your specific case with your doctor.
The Mediterranean Diet Reveals More: Researchers at Columbia University reveal in the October edition of Neurology results that individuals following a Mediterranean diet rich in vegetables, legumes, fruit, whole grains, olive oil and mild use of alcohol had larger brain volume than the similar group who did not follow the diet. The addition of fish in place of meat was additionally beneficial. The researchers stated “… a diet containing relatively less meat and perhaps more fish is good…the results are tentative, but it’s the strongest preventive approach we have promoting brain health together with exercise.”
And we leave you with the findings of the US Preventive Services Task Force suggesting that “high blood pressure readings in the doctor’s office be confirmed by home or ambulatory blood pressure monitoring before committing to long term blood pressure medication.” This too is case specific and merits discussion with the doctor.
Enjoy the rest of the year and the holidays.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…We have come a long way in advances to maintain health and prolong fruitful life. The latter part of the 20th century brought a renaissance in medical research and discovery. That knowledge is working today, as a colleague so aptly observed as “…it is a great time to be a patient.”
Let us examine how these advances have improved our chances of a long healthful life. Many of the improvements to our health have been added by vaccinations and new therapies, but the predominant improvement was in the realm of public health and the delivery of clean water sources and improved public work systems. Those protean changes have allowed us to be able to control and react to acute causes of illness.
In the 1960s the life expectancy in the United States was 67 years of age for men and 74 years of age for women. Today it is about 78 years old for men and 80 years old for women. This average increase of about 12% in 50 years appears conservative at best. Why is that?
With acute illness under better control we have become more susceptible to chronic illnesses. These cause us to age faster than we might like. The three leading causes of death in the United States today are cardiovascular disease (and its’ risk factors, obesity and diabetes), cancer and respiratory disease. All of these have a component of behavioral and social factors accounting for greater than 55% of premature mortality.
So, if 60 is truly the new 40, it can be so, if you want it to be, to a great extent.
Recent research supports basic tenets to these effects. This year the Journal of the American Medical Association reported the results of a study on over 90,000 participants in the Adventist Health Study noting that certain diets reduce colorectal cancer risk. A vegetarian diet can reduce the risk of colorectal cancer by up to 20%, with the fish eating, or pescovegetarian, benefiting the most. The Cooper Center Longitudinal Study reiterates the American Cancer Society research results noting midlife individuals who take part in regular moderate to high level physical activity can reduce the risk of breast, colon, uterine and prostate cancer by up to 20%.
The Lancet reported in 2014, using data from over 5 million patients in the United Kingdom’s Clinical Practice Research Datalink, that increased Body Mass Index (BMI) above normal for the individual, was associated with a major increase in the risk of gallbladder, kidney, liver and uterine tumors. We continue to confirm the importance of regular physical activity and healthful nutrition as the basis for good health.
That being said, there is hope in studying centenarians, those of us who live beyond 100 years of age. Despite the observation that longevity is related to good genetics in about 30% of cases, not all healthy older adults have “good genes”. The Leiden Longevity Study observed that many participants over 90 years of age were found to carry a number of risky genetic factors for expressing serious illness. It led them to the conclusion that other combinations of genes, along with a person’s environment and lifestyle, worked in concert for healthy longevity. Dr. Nir Barzalai, Director for Aging Research at the Albert Einstein College of Medicine New York, in studies performed has made the observation that in addition to heeding the advice regarding diet and physical activity the healthiest elders were outgoing, optimistic and easy going . There is growing worldwide consensus that a simple positive attitude toward life itself may be the key factor in remaining healthy and well.
These findings are supported by The Legacy Project headed by Dr. Karl Pillemer of the College of Human Ecology at the Weill Cornell Medical College. Their 10 Principles of Optimal Living are,
• Choose a career for the intrinsic, not financial, rewards.
• Act, as you will need your body for a hundred years.
• Say “Yes” to opportunities.
• Travel more.
• Say it now, at some point it may be too late.
• Time is of the essence.
• Happiness is a choice, not a condition.
• Time spent worrying is time poorly used. Be concerned if need be, and act upon that which you may have some control over.
• Think small. Attune yourself to simple daily pleasures.
With our major advances in knowledge, coupled by these basic observations, and of course, a checkup with your Doctor, “60 is the new 40”, can be a reality.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…How and what we obtain as our nutrition for life is a complex set of events based on a myriad of factors. Mores and habits are crucial to life and survival. As an infant in the womb amniotic fluid is ingested to initiate the suckling reflex. As a child our environment dictates our nutrition, leading to lifelong patterns of how we eat.
In recent history food has become more easily accessible in modern cultures further adding to environmental aspects of how we eat. Simple overindulgence caters to increased body weight and the metabolic consequences the body suffers. Hypertension, hyperlipidemia, cardiovascular disease, diabetes and gout are all conditions that are more prevalent when our weight rises above a healthy limit for the individual.
“Today 1 out 5 Americans is overweight and getting fatter…obesity is the nations’ most serious health problem” is an excerpt from the book Food is Your Best Medicine by Henry Bieler MD, in 1965. In the following years, medical science entered into a renaissance of discoveries of therapies to offset and treat disease, saving innumerable lives. Despite this the quote, the fact still holds true with even higher percentages. At present, research is readdressing other factors that guide eating, and seeking to define the roots of the problems by which we gain nutrition.
On a global scale, the need to adequately produce safe, nutritious, culturally oriented foods needed to feed populations has long been underway and becoming better defined. I direct your interest to an excellent series of articles called the New Food Revolution to be found in National Geographic Magazine between May and December 2014.
On an individual level, biopsychosocial research drawing from concepts from the 60s and 70s and coupled with current data, is adding to the issue. Stress as a cause of overeating associated with environmental and genetics factors have been identified. It addresses the choice of foods we make, how we make those choices and whether or not we choose physical activity as a necessity. Ongoing research at the Nestles Institute of Health Sciences in Lausanne, Switzerland and the Division of Personalized Nutrition and Medicine at the FDA Center for Toxicological Research have been studying how diets based on genetic makeup could improve individual health. The research of Dr. Jose Ordovas of Tufts University has shown that the intake of higher fat dairy foods will lead to greater weight gain in certain individuals over others depending on the type of an apolipoprotein A2 gene they carry.
The hope is to monitor lifestyle and food preferences through a better understanding of our genetics thereby matching the individual with nutrition that better interacts with their own body. So, have trust in yourself that through correct nutrition you are able to reduce the burdens incumbent with personal disease. A good start is finding your Body Mass Index (BMI) on this chart, click here, then see the Doctor and discuss how to better maximize your path to maximum health.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…“Summer’s here and the time is right…” – Mickey Stevenson & Marvin Gaye 1964
Welcome back to the time of year where one thinks of relaxing a bit and enjoying the things that longer daylight hours offer us. Something salubrious, a break from the regular day to day activities. It can be a time to explore, learn something new, or open our minds to a new book. Whatever you like.
Revisiting Great Concepts
Recently, a topic of great medical, and general health, interest has come back to study. This is the topic of Mind Body Medicine, or biopsychosocial medicine. Much research had been done on this concept between the 1930’s and the 1970’s, but had been left to file with the advent of the renaissance of modern pharmacology. There has been a historical advance in the science of the treatment and prevention of disease over the last forty years. As a result, a myriad of medical advances have been successful in the ability to keep us staying well and extending quality longevity.
With these great advances we are given the opportunity to reflect on basic concepts of well being. We have the opportunity to reflect, and pose three questions, “What makes us sick?”, “What makes us well?” and “What can we do about it?”. These are the basic principles of Mind Body Medicine.
Our nervous system is made up of balanced systems. The voluntary system, which we use for conscious movement, and the involuntary, or autonomic system. The autonomic system is balanced within itself by the sympathetic(fight or flight) and the parasympathetic(rest and digest) systems. The interactions between these systems in our nervous system and its’ effect on our glands and immunity can be the difference between illness and health.
The involuntary, autonomic system can be thought of, as similar to, the Chinese concept of good health being a balance between two systems of energy. The Yin (passive, ie the parasympathetic) and the Yang (active, ie the sympathetic) forces are felt to balance each other in all vital processes. When one is under stress the sympathetic system dictates the emotional reaction. Through the gentle act of taking a slow deep breath across the nasal passages and exhaling slowly by mouth, one can engage the parasympathetic nervous system. This physiological force allows the innate mechanisms of the human body to react in a bit of therapeutic balance. Try it sometime, you’ll find it in the Owner’s Manual to the Human Body.
And Some Seasonal Tips to Free Up Your Day
Summer is a time for being outdoors. Using sunscreen reduces our risks of all skin cancers. An ounce of prevention is worth a pound of cure. Remember to:
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…When you go to the doctor for the first time, you are asked to give a history of your medical problems. You should also be asked about the history of medical problems in your close family members—as well as those that may have been present in distant relatives going back at least two generations, to your grandparents or even great-grandparents. Many common, treatable diseases can be the result of a combination of environmental factors and genetic factors received from our ancestors. With the diversity of genes, we are the product of no less than eight generations of relatives.
The U.S. Office of Public Health Genomics officially and formally acknowledged the importance of family history in 2002, when it launched the Family History Public Health initiative. This effort strives to inform the general population about the importance of knowing and recording diseases from progenitors. It also researches links between family history and such common health risks as cancer, diabetes and heart disease.
With advances in medicine, people are more able to have a more exact understanding of the conditions our relatives have or had. By carefully assessing and archiving that information, we are better able to understand our relative susceptibility to these conditions.
In this way, we may be able to prevent or intervene early upon certain conditions that otherwise would interfere with our quality of life. Small symptoms that may otherwise be overlooks can paint an entirely different picture when your health care provider already knows what to look for, thanks to the mapping of family history provided upon your initial consult.
The importance of chronicling family history is not only valid for individuals, but for communities as well. The knowledge gained can also be applied to the understanding of disease inheritance that can impact how medicine is developed and practiced as a whole.
It all starts with doing a little homework. Attached is the Family Tree of Health used by the offices of Dr. Levine. Use this and bring it with you when you see your general health practitioner so that you can discuss the importance of your family history of health.
For more information, you can visit a dedicated family health site through the National Institute of Health or download your own copy of Family Medical History in Disease Prevention AMA. Members can feel free to raise any questions they may have with Dr. Richard A. Levine directly, or submit inquiries through the Consult the Doctor form at Priority Concierge MD.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Taking care of your total health means more than getting the correct diagnoses and treatments. Before symptoms show up, you can be practicing prevention. It’s essential that your healthcare providers are always monitoring your health to notice any fluctuations while consistently informing you about preventive techniques.
Throughout my entire career as a primary care physician, I have emphasized the importance of preventive care. In 1990, I acted as head of the Professional Education Committee of the American Cancer Society in South Palm Beach County. I was instrumental in getting them to change “The 7 Warning Signs of Cancer” to “Prevention and Early Detection.” I feel that it’s important for all individuals to continuously seek ways to prevent cancer before obvious warning signs even begin to emerge.
Throughout the 1990s, I was the local coordinator of Put Prevention Into Practice. This national organization is dedicated to bringing the health community together for one essential cause: clinical prevention techniques. This program informs practitioners and benefits patients through the development of tools, resources and additional materials and additional materials to educate us on the importance and use of excellent preventive care. It’s sponsored by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).
Put Prevention Into Practice offers perspective on how simple check-ups—such as blood pressure, cholesterol, weight and mood—can help a certified caregiver detect any changes or symptoms that may lead to poor health. The patient past history and family history can be reviewed for clues of higher than usual risk for certain conditions. It helps patients to course-correct before small matters turn into more grievous concerns. It also discusses the important of regular doctors’ visits and immunizations.
The other component to the prevention process is early detection. The American Cancer Society, www.cancer.org, reminds us that “90% of cancers can be cured if discovered at the right stage.” Priority Concierge membership comes with regularly scheduled check-ups that allow you to stay on top of your health. Your doctor can continuously seek very early warning signs. If you’re ever feeling different than usual and think “it might be nothing,” you can always feel free to call me directly or schedule an in-between appointment. The last thing you want to do is hesitate to bother your doctor because you aren’t sure if a small issue is going to turn into a larger one. By the time people wait to see a physician, it is often much harder to treat critical health issues.
Of course, the number one way to prevent illness is by staying informed. That’s why I don’t just treat patients; I make it my priority to educate them as well. This blog is just one way that I keep members up to date with the relevant information they need to keep making healthy choices and implementing them in everyday life. I’m also always seeking ways to convey new and updated information to my patients, such as through this downloadable Know Your Risks prevention reference sheet. It’s just one of the many benefits of membership. Learn more here and look forward to holiday offers that allow you to share the gift of health with your friends and family.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…When considering the word “obesity,” many people imagine critically overweight individuals and think:
“That isn’t me. I don’t need to take serious medical steps to control my weight—yet.”
But although obesity is often depicted in its most dramatic light, the fact is that oncoming and mild obesity can still endanger your health. And more importantly, when individuals are overweight and refuse to acknowledge the consequences of putting off lifestyle changes, they may severely harm themselves. The environment in which we live exposes us to large portions of highly caloric foods 24/7. Most people know the correct choices for a healthy diet—yet strong social, genetic, cultural and psychological influences make it difficult to adhere to healthier eating patterns.
The truth is that over 33% of all Americans are overweight—and even tipping the scales into the realm of obesity by a few pounds can have exponential consequences on your health. One way to gauge your weight in relationship to potential health risks is to keep track of your Body Mass Index (BMI). This equation incorporates the height and weight of the individual in relation to what it should be for better health. Here’s a chart that can help determine your optimal BMI.
Maintaining a healthy weight is not a matter of appearance, it is a matter of life or death. Too many individuals simply need to lose 10-40 pounds to get back on the road to health and happiness. That’s why researchers have developed a more effective approach to weight loss and maintenance. It respects the need to individualize the problem from patient to patient by considering lifestyle factors. By using the patient’s eating, exercise and coping habits, physicians are able to understand and explain symptoms that lead to abnormal patterns of eating and exercise. With a clearer understanding of the factors that cause them to make the wrong choices, patients are better able to: Eat Less. Eat Better. Weigh Less.
As a primary care physician who is committed to preventive healthcare as well as integrative treatment plans, I believe that weight management should be a strong component of my practice. My office has integrated a nationally renowned, clinically sound method for losing weight. The extremely personalized nature of a concierge medical practice avails me the time and ability to offer this comprehensive plan as part of an all-inclusive healthcare strategy for members who might benefit from lowering their weight.
For more information, please contact my office to schedule a visit and learn how you can lose weight and live better.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…According to U.S. National Health Observances, July is UV Safety Month. At the height of summer, when everyone is spending time outdoors, it’s the perfect time to become more informed about ultraviolet—also known as UV—rays. Read on to learn more about what they are, why you need protection and ways to stay safe when you’re out in the sun.
What are UV Rays?
Ultraviolet rays are very strong waves of energy that come from the sun. Classified as either UV-A, UV-B or UV-C rays (according to wavelengths and intensity), only the first two kinds penetrate the ozone layer. While this light does benefit the ecosystem and human health in small doses, it can also be harmful in larger or stronger quantities. Reflected sunlight (from the water, for example) may seem weaker but is actually the most dangerous, because it is also amplified. Fair-skinned adults, senior citizens and children are most susceptible to harm from ultraviolet rays.
Weather services provide daily UV index measurements of 1-10 (lower ratings are better), so you can learn which days are especially dangerous to be outdoors. But did you know that you can also encounter harmful ultraviolet rays indoors? Tanning beds emit UV-A and UV-B, which means that those who visit tanning salons on a regular basis may be 74% more likely to develop melanoma skin cancer. In addition to the tips below, you can learn more about protecting your skin by visiting this article from MayoClinic.com.
Read More…1) Always wear sunscreen. This doesn’t mean just when you’re heading to the beach. Even short-term exposure to UV rays can be harmful during summer months, especially if it’s gained through repeated activity, like a long walk through the parking lot twice a day.
- Look for products with SPF 15 – 50
- Avoid sprays, as the creams provide a greater coating for skin protection when used in an abundant amount
- Use products marked “Broad Spectrum Protection” as those protect against both UVB and UVA radiation
- Areas that most often encounter sunlight are most susceptible, including the hands and face
On the plus side, wearing sunscreen on a daily basis can have cosmetic as well as health benefits—keep your youthful appearance for many extra years with soft, smooth skin.
2) Buy quality sunglasses. Although it is not commonly known, your eyes can sunburn much like your skin. Even if there isn’t immediate sight loss or pain, the damage that is caused by long-term neglect may affect your vision as you age.To protect your eyes, you should always wear a pair of sunglasses that have strong UV protection—an asset that is almost always indicated on the label or lens. Although many people choose sunglasses based on their appearance, a pair of sunglasses that does not block ultraviolet rays is a waste of your hard-earned money. On that same note, not all sunglasses are made equal. A cheaper pair of sunglasses most likely will not offer the same optometric benefits as higher-priced pair, even if they have very dark shades. When you but more expensive sunglasses, you’re not just paying for a designer brand. In most cases, sunglasses are more expensive because they offer much more protection for the delicate surface of your eyes. When in doubt, consult with your eye doctor or primary care physician to pick out the best pair of everyday sunglasses to shield your sight.
3) Keep covered. Sunglasses alone aren’t enough. A hat with a broad lid or brim is an excellent second layer of protection for your eyes as well as your entire face. You should also always keep your body covered when you’re in the sun. It’s hard to think about long sleeves in the summer, but lightweight cottons, linens other breathable fabrics offer plenty of alternatives to stay cool while covering up.Another way to minimize exposure is simply staying indoors when the sun is at its apex between 10 a.m. and 2 p.m. Even if you’re having a fun family day outdoors, the timing is perfect to head inside for some lunch and refreshments—and a safe break from the sun’s worst rays.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Summer is a good time to reassess the general safety in our daily lives. This may be in the form of home safety, as it is a time when young people are out of school and spending more time around the house and yard. And for those who reside in Florida, the Gulf Coast and along the Eastern United States, summertime is Hurricane Season. The official Hurricane Season runs from June 1-November 30 each year, with the majority of activity occurring in the first half of September. Thus, it is fitting that summer is when we should review our own personal Hurricane Preparedness Plan.
Hurricanes are one of the few natural disasters that we can actually closely monitor and predict well in advance of their arrival. It’s vital that those in affected areas take advantage of storm tracking and home preparedness. The three phases of preparation include before, during and after the storm.
Before the arrival of a storm, we are able to track it by staying tuned to local weather forecasts and utilizing the National Weather Service’s National Hurricane Center (www.nhc.noaa.gov). This resource allows us to monitor the path and changing nature of the storm. Effective May 2010, improvements to the site include increases in lead time reporting to threatened communities with regard to watches and warnings. This allows for better preparation in advance of the arrival of a storm. You can also monitor local conditions online through the National Doppler Radar Site (https://radar.weather.gov).
It is also essential to determine if you will stay in your own home or choose another secure location for the duration of the storm. If there is doubt to the structural integrity of your primary home, strongly consider relocating to a safer environment, be it a friend’s home or an official shelter. If you have any doubts, you may wish to leave the area; this decision should be made well in advance, with enough time to safely travel. If you choose to stay at home throughout the storm, preparation is essential. It is important to have basic items that you will need, such as:
1) A working cell phone with a home and car charger. Place important phone numbers into your cell phone directory for ease of use.
2) Any prescription medications; you should have at least a months’ worth of refills.
3) Copies of key documents such as a recent bank statement and home survey.
4) A secure property. Gathering advice from the myriad of sources available through websites, news stations, local government bulletins and newspapers.
5) Access to an automobile with a full tank of gas.
6) Cash for later needs.
During the storm, personal physical safety takes precedence. Under no circumstances should you venture outside. Storms usually pass relatively quickly, but the short-lived intensity can be surprisingly destructive. One major caution is that no one should venture outside in the “eye” of the storm. This is the big hollow center seen on satellite images. Although the storm may suddenly halt, the highest winds are on the walls of the eye. A hurricane can go from calm to hundreds of miles per hour in velocity in an instant.
After the storm has passed, there may be many lingering hazards–standing water and downed electrical lines being high on that list. Before leaving your home, it’s important to find out about local conditions. If you are able, contact your power and phone companies to electronically register your service outage. This helps them gain a picture of areas in greatest need. To stay in contact with others, it’s good to have a serviceable phone landline, as they are often the first to return to normalcy. Cellular phone lines are typically disrupted the longest; yet sometimes calls can be placed to areas outside the path of the storm. A cellular charger for use in the car is an indispensable tool, because it can be powered by the car battery even if your house is powerless. It’s also a smart idea to avoid driving around too early after the storm passes. It is not only dangerous, due to road conditions, but you will also have to wait in long lines for your next gas refill.
Simple planning and preparation can be extremely helpful in weathering a storm, as well as keeping us safe from everyday hazards. For more information specific to your personal lifestyle, visit www.redcross.org and your local news and television channels.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Stress is a state of physiological or psychological strain caused by physical, mental or emotional stimuli that tend to disturb the functioning of an organism. When stress reactions are elicited, and if they are inappropriate or inadequate, they may lead to disease states. Dorland’s Medical Dictionary.
Stress is a part of living. It is determined by your physical and emotional response to a particular situation. Historically, it has been critical to survival. It can be a positive experience when its reaction is geared toward growth and positive change. However, when it affects you adversely, it may compromise your well-being. In today’s world, the psychological threats to that well-being can be prolonged and cumulative in effect. Medical research has shown that long-term stress is associated with the disruption of certain normal body processes.
The “Heart and Soul” study conducted by the University of California, San Francisco Department of Medicine showed that “psychological factors, such as depression and anxiety are independently associated with an increased risk of both diabetes and cardiovascular disease. Higher levels of depression, anger expression, hostility and pessimism were significantly associated with increased prevalence of the metabolic syndrome.”
Ohio State University College of Medicine performed clinical trials on a population of women following surgery for breast cancer. The results showed that patients receiving intervention regarding their emotional distress, social adjustment and health behaviors, had an actual improvement in their immune system, as compared to the group that did not address those factors. The patients “were found to have a reduced risk of breast cancer recurrence and death from breast cancer.”
How to Cope
Your reaction to stress is unique to your personal experiences and genetic makeup. Here are some tips for reducing and coping with stress:
Tools for helping you may be found by research, some helpful sites are: www.mayoclinic.com/health/stressmanagement/MY00435 and www.calm.com
When to Seek Help
If you find stress disrupting your day for more than two weeks at a time, seek professional assistance. Visit your primary care physician to discuss the need for help openly and confidentially.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…“I don’t need a doctor, I am healthy.”
We’ve all heard or said that before. But health can be relative. Although most of us are aware of what is considered the healthy thing for us to do, putting it into practice can be a far different matter. And the truth is that we are not each individually equipped to diagnose our own general state of health.
Your health status is subject to change. Sometimes a change in our state of health can come on more abruptly, such as an infection or physical change in our body’s comfort or performance. This is when most people decide it’s time to visit a doctor. However, sometimes it is a gradual occurrence, often noticed over time and related to self-evaluation: “I used to be able to do that.” / “I don’t have the time for this anymore.”
Many people aren’t aware that a primary care physician can help prevent poor health before you may even be aware of it. It is important to seek out and establish a working relationship with a doctor who can monitor your health over time. Someone who can develop a long-term relationship with you, maintain your health, help reduce your risk of disease and diagnose risks at a point when they may be dealt with effectively. Primary Care Physicians (PCPs) such as General Internists, Family Practitioners, OB/GYNs and Pediatricians are trained and experienced in the comprehensive care of the whole patient.
The American College of Physicians recently released a report based on over 20 years of research, with a bibliography of over 100 supporting articles, evaluating the role of primary care physicians in the medical field. It states that today’s shortage of PCPs is lowering the entire nation’s quality of healthcare while increasing its cost. Based on this evaluation, researchers surmise that unless primary care is more heavily emphasized, the entire country will face an increase in preventable and premature deaths.
Page five (11/71) of the report states that: “An increase of 1 primary care physician per 10,000 population in a state was associated with a rise in that state’s quality rank by more than 10 places, and a reduction in overall spending by $684 per Medicare beneficiary. By comparison, an increase of 1 specialist per 10,000 population results in a drop in overall quality rank of nearly nine places and an increase in overall spending by $526 per Medicare beneficiary.”
Furthermore, the report goes on to say that: “Living in a primary care shortage area represents an independent risk factor for a preventable hospitalization.” But when patients visit one primary care physician who is knowledgeable of their history and health, well-being is ensured through ongoing holistic care.
In 2007, Dr. Richard A. Levine restructured his practice to offer one-on-one concierge services. This change was motivated by his desire to best address the needs of his patients in South Florida. Members have year-round access to one primary care physician who oversees their every medical need. Through full-time access, enhanced communication and patient advocacy, Dr. Levine helps members maintain wellness. Emphasis is placed on early detection and preventive measures to keep patients out of the hospital and in good health. Member benefits also include coverage for dependents 15-29 years of age.
How Is A Shortage of Primary Care Physicians Affecting The Quality and Cost of Medical Care. To learn more about the benefits of membership with Dr. Levine, please call (561) 368-0191.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Although the simple process of fermentation has been allowing humans to enjoy alcoholic beverages as far back as recorded history, it wasn’t until approximately one thousand years ago that enthusiasts began to refine the distillation process in order to concentrate and control alcoholic content. Today, alcohol is not only a commodity, it’s a full-fledged industry. Alcohol is a prevalent presence in our society, accessible on almost any street corner and integral to social settings. In the past, such as times of prohibition, lawmakers have found the pervasion of alcohol to be a major encumbrance on society. Fortunately, through educational tools and programs, there are methods other than prohibition which can be used to promote the safe use of alcohol.
Responsible Consumption of Alcohol
To responsibly consume alcohol, one must be aware of exactly how much alcohol they are drinking and its potential effects on their body and mental faculty. Typically, alcohol can take effect within ten minutes. But this may depend on how much protective mucous is lining the stomach for absorption. Women and those who take non-steroidal medicines, such as ibuprofen and naproxen, generally have less mucous covering; therefore, the effects of alcohol may be stronger.
The first thing to know is that not all drinks are created equally. A good rule of thumb is that one beer equals one glass of wine which equals one shot of alcohol. A visual aid with further information for moderation can be found here.
Although alcohol is categorized as a depressant, it may also exhibit effects of an excitant. This may affect behavior at the time of consumption as well as sleep patterns following even moderate drinking. Moderate drinking is defined as two drinks per day or four per occasion for men. It is one drink per day or three per occasion for women. Anything over this amount may be considered excessive alcohol consumption, especially if limits are surpassed on a regular basis. Repeated abuse is a sign of alcohol dependency.
Identifying Dependency on Alcohol
Given the prevalence of alcohol today, it is difficult to discern how much alcohol is too much. A useful starting point to determine whether alcohol consumption is becoming out of hand is the CAGE questionnaire which asks four simple questions:
1. Have you ever felt that you should cut down on your drinking?
2. Have people ever annoyed you by criticizing your drinking?
3. Have you ever felt guilty about your drinking?
4. Have you ever had a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?
For each ‘yes’ answer, one point is allocated. Scores of two or above are thought to indicate alcohol dependence which should be addressed with the help of a professional.
When Alcohol Becomes a Problem
Alcohol consumption is considered a problem when it begins to impact your well-being or when it becomes a lifestyle pattern or social crutch. Alcohol abuse symptoms are detectable long before critical behavioral patterns and health problems develop. To help monitor your alcohol intake, you can employ the following strategies:
• Set personal drinking limits, and keep track
• Regulate how much you consume per serving
• Avoid situations where drinking is the main activity
• Avoid those who regularly abuse alcohol
• Moderate your own personal access to alcohol
If you or someone you know may have a psychological or physical problem related to alcohol addiction or excessive consumption of alcohol, see your personal physician to discuss this openly and confidentially. There are also ways to seek help through programs such as the Substance Abuse & Mental Health Services Administration. You can use the Substance Abuse Treatment Facility Locator to pursue treatment, or call the 24-Hour Helpline at (800) 662-HELP.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Exercise means different things to different people. To the athlete, it is a priority that keeps them in optimum shape and able to perform. To the average individual, regular exercise may be pursued because of how good it makes them feel. To the sedentary, exercise is good advice that just seems to be hard to implement.
There are many benefits to completing regular, moderate exercise. A recent study in Circulation, a publication of the Journal of the American Heart Association, confirmed that a daily 30-minute walk was associated with a 40 % risk reduction for cardiovascular disease. There are numerous other benefits to regular physical activity, such as:
• Managing weight. This in turn leads to lower blood pressure and lower cholesterol. This is in part due to increased circulation and speeding up digestion. If one extends their activity beyond 30 minutes, such as another 10-15 minutes, it aids in utilizing fat stores as energy. This is because we store sugars in our muscles that are used for initial activity, but after about 30 minutes, they run low and fat becomes the primary source of energy.
• Preventing and controlling of Type II Diabetes Mellitus.
• Reducing the risk of osteoporosis and giving strength to the structures that support arthritic joints, including muscles, tendons and ligaments.
• Strengthening the immune system, which can help reduce the risk of cancer.
• Elevating our mental well-being by helping to reduce anxiety, alleviating mild depression and improving sleep patterns.
How to Get Started
If you have not had a medical check up, see your doctor first. Your primary care physician can help you develop a workout plan tailored to your age, health, gender and lifestyle needs.
The simple art of walking can be the best start. It can be initiated in several ways, keeping safety in mind first. Here are a few tips:
• Always walk in a safe environment, such as near your home, at a gym or even in your home.
• Make sure you have a comfortable pair of walking shoes. Look for styles labeled “walking sneakers” when you shop. You may want to purchase a pedometer, a small instrument you wear that measures your distance. Although time spent in physical activity is more important physiologically, it is fun to see that on a regular basis, one can log up to 400 miles per year completing usual activities.
• Try to have a regular time of the day for your exercise. This will make it easier to be consistent. Make sure to exercise at least six times a week.
Remember: Regular exercise isn’t just about extending quantity of life, but also about improving the quality of your day-to-day experiences. This will help you to remain independent and enjoy vitality while experiencing an enriched, fulfilling life.
For more information about exercise, weight management and heart health, visit: www.americanheart.org.
Be Well,
Richard A. Levine MD FACP
Journey…Observation…Knowledge
Read More…Recognized as One of the Best Internists in Boca Raton
Dr. Levine has been recognized as one of 2024-25’s top internists in Boca Raton by Castle Connolly for his compassionate care and personalized service.
Office Hours
Monday – Friday 8am – 4:30pm
Our Location
7280 W Palmetto Park Rd, Suite 205 North
Boca Raton, FL 33433
Phone: (561) 368-0191
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