Approach to Specific Medical Conditions
Our approach to chronic medical conditions such as heart disease, strokes, high blood pressure, diabetes, bad cholesterol is initial risk reduction for mortality (early death) and then treating the cause of these diseases (usually unhealthy weight). Below is a list of our specific approaches to chronic medical diseases.
Heart Disease and Stroke
To review the basics, heart disease can be plaques in your arteries of the heart, a history of heart attack, or if your heart is just not pumping normally. A heart attack means heart tissue has died usually from an acute event where the arteries to the heart have suddenly become blocked.
Stroke means brain tissue has died from sudden blockages in the arteries leading to the brain or the arteries/veins in the brain acutely rupturing.
Excellent medicine reduces the risk for heart disease and strokes by identifying and reducing the common risk factors. We aggressively seek to reduce these risk factors which are high blood pressure (hypertension), tobacco use, high cholesterol, and diabetes.
For those using tobacco, we will work with you using medications, counseling, or on-line resources. Currently chantix, wellbutrin, and nicotine replacement are the available medications to help patients with their efforts to stop smoking. Remember, on average people who successfully stopped smoking needed 7 attempts. Stay positive. We can help you stop smoking and greatly reduce your risk for a stroke and heart attack. For those with unhealthy weight, wellbutrin has the nice side effect of weight loss. We do not recommend using smokeless tobacco or vaporizing tobacco as a means to stop tobacco use.
High blood pressure (Hypertension)
There has been changes to the overall blood pressure goals in the past years. At the end of the day, we pursue individualized blood pressure goals. We seek to lower the blood pressure as low as possible balancing the side-effects.
We reduce medications that can promote weight gain such as beta-blockers and seek to reduce weight in those patients with unhealthy weight. We know that weight loss can reduce the need for medications for high blood pressure.
High cholesterol (hyperlipidemia, dyslipidemia)
Basics: Total Cholesterol is a screening test. The breakdown of the cholesterol panel is most important. LDL and triglycerides are the bad cholesterols that lead to strokes and heart attacks. HDL is the good cholesterol that cleans up any plaque deposits in the arteries.
We pursue to keep the LDL and triglycerides (both bad cholesterol) as low as possible. We use weight loss and medications to lower the bad cholesterols as much as possible. We recommend exercise to increase the HDL (good cholesterol).
We recommend reducing red meat to less than 10 percent of your diet and in general pursue a whole food, plant based nutrition plan. We do not recommend over the counter fish oil, because the quality of the over counter fish oil (omega-3) is suspect and could harm our patients.
We pursue diabetes with the overall strategy to reduce weight and to reduce the weight-promoting medications. Diabetic medications have advanced, and we now have diabetic medications that actually reduce weight, reduce blood pressure, and have mortality benefit (reduces your risk of dying earlier). The ideal combination is metformin, SGLT-2 inhibitor such as Jardiance (empagliflozin) or Farxiga, and GLP-1 receptor agonist such as Victoza, Ozempic, or Bydureon BCise.
We remove/reduce diabetic medications that promote weight gain such as insulins, glipizide, glyburide, actose, pioglitazone.
If our patients with diabetes also suffer from weight, then we aggressively pursue weight loss through our sustained medical weight control program.