Doctor's Life Magazine, Tampa Bay Issue 5, 2013

DOCTOR’SLife www.doctorslifetampabay.com

MAGAZINE

Business Lifestyles and Opportunities Issue 5, 2013 Tampa Bay Edition

WEIGHT MANAGEMENT AS A PRESCRIPTION

THE FUTURE OF FLORIDA

MEDICAID LONG TERM

CARE SERVICES AND WHAT IT MEANS FOR YOU

HORMONE

REPLACEMENT

THERAPY

What’s Inside From the Publisher

The Approach of the Holidays Page 4

Weight Management as a Prescription Page 20

Physician Spotlight Dr. George Northrup

Form 3008: A Letter to Physicians

Big Changes on the Horizon for Florida Medicaid Long Term Care Services

Page 8

Page 14

Page 6

Fit Corner

The Mediterranean Diet

Page 18

Advertisers Arden Courts

The Forte Group

Greiner’s Clothing

Hive 12-13 JCON Commercial

Nuviva 21 PNC Bank

Hormone Replacement Therapy

State of Real Estate

Page 16

Shea Barclay Group

Sport Court

Tampa Bay Luxury Real Estate

Tampa Testosterone

Page 10

Doctor’s Life Tampa Bay

Issue 5, 2013

(From left to right)

Evan P. Forte, CRPS® Financial Advisor

Ami K. Forte

Managing Director Wealth Management Wealth Advisor

Chuck D. Riggs III Financial Advisor

Chuck Lawrence

Associate Vice President Financial Advisor

James Streitmatter

Senior Vice President Financial Advisor

CRUCIAL DECISIONS CALL FOR DECISIVE ACTION. Ami Forte named #1 in Barron’s annual list of America’s Top 100 Women Financial Advisors 3 years in a row. *Source: Barron’s “Top 100 Financial Advisors,” April 16, 2012, as identified by Barron’s Magazine, and “Top 100 Women Financial Advisors,” June 4, 2012, using quantitative and qualitative criteria and selected from a total annual pool of over 3,000 nominations. Advisors who are selected have a minimum of seven years of financial services experience. Quantitative factors include, but are not limited to, compliance record, interviews with senior management, and philanthropic work. Investment performance is not a criterion. The rating may not be representative of any one client’s experience and is not indicative of the Financial Advisor’s future performance. Neither Morgan Stanley Smith Barney nor its Financial Advisors pay a fee to Barron’s in exchange for the rating. Barron’s is a registered trademark of Dow Jones & Company, L.P. All rights reserved. The views expressed herein are those of the author and may not necessarily reflect the views of Morgan Stanley Smith Barney LLC, Member SIPC. The strategies and/or investments referenced may not be suitable for all investors. Morgan Stanley Smith Barney and its Wealth/ Financial Advisors do not provide tax advice. Individuals are urged to consult their tax advisor regarding their own tax or financial situation before implementing any strategies. This article is directed to residents in the states where Ami Forte is registered. For more information, please go to my website: http://fa.morganstanleyindividual.com/thefortegroup/

THE FORTE GROUP AT MORGAN STANLEY 4114 Woodlands Parkway, Suite 200 | Palm Harbor, FL 34685

727-773-4610

Morgan Stanley Smith Barney LLC, member SIPC.

From the Publisher

www.doctorslifetampabay.com

all is upon us and before we know it, the holidays will be here and we will be welcoming in the new year. This is the time of year when weeks turn into days, days turn into hours and hours turn into minutes. Time seems to move just a little faster when we get into October and November. In this issue of DLM we worked with Helen King, deputy director of the Area Agency on Aging of Pasco-Pinellas. She provided us with the major changes for Florida Medicaid longterm care services and how it might affect you. She also gave us the heads up to keep your eyes open for Form 3008 and why it is important. Amie Fulks, a Florida licensed real estate broker, helped with the question a lot of us have had on our minds: to sell or not to sell. Our friends with Nuviva Medical Weight Loss Clinic provided their take on weight management as a prescription. We know that weight management is not the cure-all for all medical conditions, however there are a lot of studies and research that point to the conclusion that it definitely helps in huge ways. The Centers for Disease Control and Prevention (CDC) states that as weight in individuals increases to the levels referred to as “overweight” and “obesity,” the following major health conditions are not only at risk but increase: coronary heart disease, type 2 diabetes, certain cancers, high blood pressure, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, and gynecological problems. We sat down with Dr. George Northrup for this issue’s Physician Spotlight. Dr. Northrup is a board-certified general and forensic psychiatrist that also practices in addiction and weight management, so as soon as we learned about his favorites here in Tampa Bay, we dove right into the connection between bad nutrition, obesity and forms of mental illness and how they can all be connected. The huge elephant in room with this issue is the editorial on male Hormone Replacement Therapy (HRT). This area has been a grey area for many years and it is not the opinion of DLM that male HRT is good or bad. What makes this subject so interesting is that there is strong medical research and data supporting both sides and today pharmaceutical companies are spending hundreds of millions of dollars marketing it. There is no way this could be ignored. The DLM staff and I would like to extend our gratitude to our entire readership and supporters for what has been an amazing year so far. Today I received a phone call from a lady that was inspired and touched by the article on pet therapy with Harmony Home, which was published in Issue 3. She thanked me a million times for the article and requested to speak with someone at Harmony Home to learn more about it and how she can get involved. That call is a perfect example of why we do what we do. Be well,

-Ed

MAGAZINE

Business Lifestyles and Opportunities Issue 5, 2013 Tampa Bay Edition

WEIGHT

MANAGEMENT

AS A PRESCRIPTION

THE FUTURE OF FLORIDA

MEDICAID LONG TERM

CARE SERVICES

HORMONE

REPLACEMENT

THERAPY

AND WHAT IT MEANS FOR YOU

TAMPA BAY Tampa Headquarters 1208 East Kennedy Blvd. #1029 Tampa Fl, 33602 813-444-9204 Tampa Bay Publisher Ed Suyak publisher@doctorslifetampabay.com Creative Director Bryan Clapper Editorial Director Ed Suyak Assistant Editorial Director Danielle Topper Advertising Account Executive CJ Cooper Contributing Writers Amie Fulks Helen King Jimmy Barker Tommy Parks Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.

Ed Suyak Publisher publisher@doctorslifetampabay.com 4

DOCTOR’SLife

www.doctorslifetampabay.com

Doctor’s Life Tampa Bay

Issue 5, 2013

100 N. TAMPA ST. SUITE 3530 TAMPA, FLORIDA 33602 PHONE: 813-251-2580 FAX: 813-251-2580 WWW.SHEABARCLAY.COM

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Physician Spotlight

Dr. George M. Northrup, M.D., P.A. Doctor’s Life wants to know

How long have you lived in the Tampa Bay Area? I have lived in Tampa since 2002. What is your favorite Tampa Bay restaurant? We have so many good restaurants, but I find myself partial to Charley’s Steak House. Where is your favorite place in Tampa Bay to relax? My backyard. I spent a year designing the pool and outdoor kitchen. Now, I am enjoying it. Come on over. What is your favorite event to attend in Tampa Bay? Again, we are very fortunate to have so many wonderful choices. We have great organizations and our own citywide festival of Gasparilla. My favorite event, although still somewhat in its infancy, is Cars and Couture by Luxe Fashion Group. They just do a fantastic job. What is the name of your favorite book that you read this year? Let’s Pretend This Never Happened. It is a hilarious tale of a girl’s dysfunctional family. She put the FUN in dysfunctional. You are a board-certified general and forensic psychiatrist. You also practice weight management and treat addictions. Do each of the areas that you practice relate to one another and if so, how? These are so intimately interconnected. I treat obesity as a process addiction. Food is an inherent reward to the brain and then we as a society reinforce this with food treats for a doing a good job or to soothe a scraped knee, etc. Food, especially highly palatable food, has a language and machinery similar to other addictions as evidenced by terms like “food cravings” and “chocoholic.” Additionally, failed diets are failed attempts to control overeating (like failures at quitting smoking), preoccupation with food and shame over eating behaviors are again similar to traditional addictions. Is good nutrition essential for our mental health and why? Yes. The body needs certain nutrients in certain quantities to function its best. And the brain is the control center for all the processes; so you certainly want it running at its finest! Are there a number of mental health conditions that may be influenced by dietary factors and if so what are some of them and why? Severe vitamin deficiencies can present as gross mental health problems involving cognition and mood. However, most people living in developed countries don’t suffer these maladies. Instead, there are more subtle changes that can be influenced by Omega 3 balance and other nutritional factors. What major health conditions are related to being overweight? It’s funny, many people will lose weight for aesthetic reasons as the results are tangible and obvious to the eye. However, obesity is a risk factor for conditions that kill people regularly, such as heart disease. But, a person cannot look in the mirror and see their shortened life span. Additionally, weight affects diabetes, which again shortens life span and can substantially hinder day to day quality of life. 6

Dr. Northrup attended medical school at the University of South Florida. After training at the University of North Carolina at Chapel Hill and the University of Florida he made his way back to the Bay area. Dr. Northrup practices at the interface of mind and body using a whole patient approach to help people find their best quality of life. From coaching techniques to psychotherapy to medications, Dr. Northrup is expert with a full array of tools to help people live the best life possible. His practice is located in a comfortable renovated south Tampa bungalow. In addition to psychiatry, Dr. Northrup practices in addiction and weight management. Dr. Northrup embodies his own approach to patient care by keeping himself healthy with portion control, strength training, and playing sports.

What are some of the simplest but important daily lifestyle changes we can make in order to sustain a mentally and healthy balanced life? I could write a book in response to this question, but I’ll try to be succinct. 1. Manage your stress level...learn not to sweat the small stuff. 2. Listen to biological cues. For example, eat when your body says it’s hungry and stop when it tells you it’s had enough. People have learned to ignore biological cues in favor of social cues and other stimuli. 3. Get some kind of physical activity. The brain likes the body to be active. 12. What advice would you give to other physicians in regard to discussing weight management with their patients? 1. First, have the discussion at all. I think many primary care physicians are now doing this. 2. Help patients make a short term plan. The question of what are you going to do differently now. And more importantly, help patients make a reasonable, long term plan that includes some simple rules they can apply consistently. People have to change their relationship with food to have long lasting results.

Doctor’s Life Tampa Bay

Issue 5, 2013

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The Most Important Form, the “3008” A Letter to Physicians Dear Busy Physician: It’s a known fact that you spend a substantial amount of your time on paperwork and documentation; i.e., patient charts, billing, and insurance companies’ requests, to name a few. You became a doctor to treat patients, right? And to feel the satisfaction of doing what’s best for them, right? It’s unfortunate to have paperwork compete with patients. What if I told you that you could complete some paperwork AND help your patient obtain home- and community-based services to assist them to remain in the community? In the world of qualifying for long-term care services funded by the state of Florida, THE MOST IMPORTANT FORM, is known as the “3008” and it’s sent to physicians who have patients on state waiting lists getting ready to come off the list and receive services. The federal government requires that the “Medical Certification for Nursing Facility/Home- and Community-Based Services Form, AHCA MedServ-3008,” be signed by a licensed medical doctor or doctor of osteopathy. This certifies a person’s need for Medicaid-funded nursing facility placement or homeand community-based services. Did you know that without your completion of the 3008 form and a return back to the requesting agency, you will prevent 8

your patient from ever obtaining the services for which they are eligible and for which they may have waited months and possibly years to receive? Nothing moves forward for your patient without the completed 3008. Sadly, our experiences have been that some physicians never return the form, even after numerous requests of your office staff. We have to believe that you/they didn’t realize how important the 3008 is to your older and/or disabled patient. So, now you know how critical the form is. Although there may be other priorities on your desk, I can only say how essential the completed and signed 3008 is for your patient’s quality of life in their community. After all, isn’t quality of life in our community part of quality of health care? Can you ask your staff to be on the lookout for any 3008 that comes to your office? Maybe you can move it to the top of the list or pile for urgent completion? Hint, Hint! Sincerely, Your grateful partner in serving your patient Helen King, Deputy Director Area Agency On Aging Of Pasco-Pinellas, Inc.

Doctor’s Life Tampa Bay

Issue 5, 2013

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o sell or not to sell, is that your question? If you are a homeowner, having spent years on the sidelines T waiting for prices to recover, you may be wondering if now is the right time to sell your property. Or, should you wait longer in anticipation of further rise in home value? What are the risks of this strategy? The answer is, it depends. While it is certainly a better time to sell than a few years ago, there may still be a chance of additional rise in prices in the near future that you may capitalize on by holding off a little while longer. Trying to gauge timing of the resales in the housing market is a bit like riding the stock market. It’s not always easy to recognize the turning point. For most homeowners, it should be a more comprehensive decision than just, “When can I sell to get the highest price?” Homeowners should consider what their costs of opportunity are by remaining in a house they do not want. Of course, a consideration Amie Fulks of this strategy is in waiting to sell their current house until prices rise, then the price of the replacement house they want to purchase may similarly rise, including the risk of rise in mortgage rates. So their potential profit from the sold house is simply used to pay a higher price on the replacement house. If the replacement house would provide the family greater happiness, then they are forgoing enjoying that new neighborhood, better school, etc.

Additionally, as a large number of homeowners who have negative equity in their home gain relief from rising prices, this negative-equity issue eases, and homeowners are likely to list their property for sale. This increases the supply of available homes, slowing down growth in housing prices. So what should homeowners in this situation do? First, if you live in an area where prices are increasing rapidly, don’t expect this rate of increase to continue for much longer. There will be diminishing returns to waiting longer as underwater homeowners begin to list their homes and buy-andlease investors begin to lose interest due to decreasing returns. Second, qualified first-time and trade-up homebuyers are currently getting the lowest rates in history on 30- and 15year mortgages. Rates will not stay this low. Period. The Federal Reserve has been keeping rates artificially low through “quantitative easing,” and they have indicated that they will relax their bond-buying programs when the economy reaches specific employment thresholds. As this occurs, rates will move higher, and I believe that they will move quickly. In summary, if you are looking to sell, know your local market and recognize that changes are coming. To quote an old adage, “Don’t step over a dollar to pick up a penny.” For a complete analysis of your property and the local market affecting the value of your home, please feel free to contact Tampa Florida Luxury Real Estate today!

Doctor’s Life Tampa Bay

Issue 5, 2013

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Big Changes on the Horizon for

Florida Medicaid Long Term Care Services By Helen King Deputy Director, Area Agency On Aging Of Pasco-Pinellas, Inc.

hile much attention is currently on the federal health care reform, the Affordable Care Act and “exchanges,” right under your nose, there is reform on Medicaid taking place in the state of Florida. Many changes will be affecting the way Medicaid long term care services and traditional Medicaid are being provided to low income individuals, but it has nothing to do with national health reform nor the Affordable Care Act.

Doctor’s Life Tampa Bay

Issue 5, 2013

As a physician in Florida, you may have a practice that is largely made up of older persons and/or caregivers of older persons. Many of them may be utilizing community services as a means of supporting a more independent life as they age. If Medicaid is the source of payment for their long term care services, you need to pay attention to these changes discussed in this article.

Why the Reform?

In 2011, the Florida Legislature passed legislation for Medicaid programs to move to a managed care capitated model. The legislation passed, in part, due to the belief that the state could save money. The outcome of that legislative approval has just begun to unroll in August 2013 in central Florida for Medicaid recipients who need long term care. Gradually, region by region Medicaid beneficiaries needing long term care will be moved to Managed Care organizations. On Feb. 1, 2014, Pasco and Pinellas Counties (Region 5) and Region 6 (Hillsborough, Hardee, Highlands, Manatee, and Polk Counties) will transition to the program, officially known as Statewide Medicaid Managed Care Long Term Care Program (SMMCLTCP). A primary goal is to use managed care to provide services to help seniors and disabled adults stay in their homes or communities, rather than going into nursing homes. There is a long list of services under the Long Term Care Program. Services such as adult day health care, assisted living, case management, home-delivered meals, and medication management are but a few of the covered services to be available.

Who Plays a Role?

The Agency for Health Care Administration (AHCA) plays the lead role in the state for SMMCLTCP. They handle the overall administration and contracting at the state level. There is also an enrollment broker providing “choice counseling” whose role it is to assist the Medicaid long term care clients in choosing a managed care provider. The company operating as the enrollment broker is Automated Health Systems (AHS). There are multiple Managed Care Organizations (MCOs) throughout the state that were selected by a competitive bid process by AHCA. Each designated MCO in their assigned area will then have a network of providers delivering covered services to eligible consumers. Finally, Area Agencies on Aging, serving as Aging and Disability Resource Centers (ADRCs) (there are eleven in Florida) will play a role involving long term care education and assistance in accessing the MCOs’ grievance process. They will also continue the role of screening clients and placing them on the waiting list based on priority needs. Additionally, the Area Agencies on Aging each have a Helpline (or Senior Helpline or Elder Helpline, depending upon the area) that acts as the gateway or entry point for information and referral and access to screening of consumers.

What’s the Impact in the Tampa Bay area?

The Area Agency on Aging of Pasco-Pinellas and the West Central Florida Area Agency on Aging locally administer Medicaid Waivers: the Aged and Disabled Waiver (ADA) and the Assisted Living Waiver (AL). Those will be eliminated and the clients will be moved to managed care in February. Besides those two waivers, other programs that are transitioning are the Aged and Disabled Adults under 60 clients who are currently managed by the Department of Children and Families (DCF); Issue 5, 2013

Nursing Home Diversion which is currently managed under the Department of Elder Affairs (DOEA) CARES Unit; and two that are not in this area, Channeling Waiver and Frail Elder Option. In addition to those home and community based service programs, individuals residing in nursing homes that are eligible for a Medicaid Institutional Care Program (ICP) are also transitioning into Medicaid Managed Care. The Agency for Health Care Administration (AHCA) selected four Managed Care organizations in Region 5 and five MCOs in Region 6. The plans in region 5 are: American Elder Care, Molina Healthcare, Sunshine State Health Plan, and United Healthcare. Those same providers are in Region 6 plus one more, Coventry.

Existing clients have a big task ahead of them in our area. Clients in the Tampa Bay region have until Jan. 16, 2014 to select a Managed Care provider. If they don’t choose, a provider will be chosen for them.

Existing clients have a big task ahead of them in our area. Based upon information from AHCA, clients already in waivers in Region 5 and 6 will know they need to take action when they begin to receive communications regarding the transition in October. Thereafter, subsequent reminder letters will arrive at intermittent dates. Clients in the Tampa Bay Region have until January 16, 2014 to select a Managed Care provider. If they don’t choose, a provider will be chosen for them. By March 1, 2014, all regions in the State of Florida will be transitioned to managed care for long term care programs. Once that monumental task is well underway, AHCA will then turn its attention to the broader Medicaid population who will also be placed in managed care plans. That program is known as Managed Medical Assistance Program and it will be fully in place by October 1, 2014. For additional information on the Florida Medicaid Long Term Care Program, go to http://ahca.myflorida.com/ SMMC.

Doctor’s Life Tampa Bay

Hormone Replacement Therapy By Jimmy Barker Owner & Operator of Tampa Testosterone

t is extremely frustrating for a man who puts forth the effort to eat well, exercise on a regular I basis, gets plenty of sleep but yet always feels tired, has trouble focusing at work, is putting on unwanted fat and has lost his sex drive. Unfortunately, this describes what millions of men struggle with every single day, but most just accept it as a part of getting older. The good news is that men don’t have to suffer any longer! Proper hormone treatment can alleviate these symptoms and it can even provide long-term health benefits for aging males.

Research has shown that the optimization of male and female hormones not only improves aesthetics, but also mental, emotional and physiological health. Hormone therapy, like testosterone replacement therapy (TRT), was once thought to be just for athletes and body builders. More studies are being done to show the health benefits testosterone therapy has for men. TRT has been shown to improve cardiac function, lean muscle mass, memory, sleep patterns, sex drive and reduce body fat, osteoporosis, Alzheimer’s, Jimmy Barker dementia and depression. The extended results can be an improved marital relationship, general well-being, drive and ambition to succeed in business. For many struggling men, testosterone therapy can be a life-changing medical treatment. Recent studies have proven that some of the initial concerns the medical community believed about testosterone therapy is not true. Evidence from double blind placebo studies indicates testosterone does not increase the size of a healthy prostate. In some scenarios, it is even possible to provide a man testosterone that previously had prostate cancer. In order to minimize risk, it is vital to perform suitable testing prior to engaging in a therapy program and continuing to monitor prostate and overall health by performing routine blood work and physician follow ups. The medical community is beginning to support the benefits of TRT instead of being concerned by the myths that were associated with it. This is evident by the increase in spending by the major pharmaceutical companies willing to invest in testosterone therapy research and advertising. In 2010 there was less than $1 million spent by pharmaceutical companies related to the marketing of testosterone therapy. In 2012, that number rose to $100 million. Many men are realizing that low testosterone may be the cause of their daily struggles. Unfortunately in today’s medical world, men who are seeking a way to improve their testosterone levels have all been lumped into one category regardless of age. A man with moderate or even low testosterone levels can still be deemed “normal” according to common lab reference ranges. Our clinic breaks that mold and assesses the individual as whole—not just their “Total Testosterone” level. It is crucial to evaluate all factors that play into male menopause (a.k.a. manopause) including a man’s hormone levels as well as each symptom he may be struggling with. We are now seeing men in their early 30’s coming to us with low testosterone symptoms. These cases need to be handled with more scrutiny, but sadly it is not that uncommon for a 35 year old man to be suffering from as many “low T” symptoms as a typical 50-year-old man. 16

Doctor’s Life Tampa Bay

Issue 5, 2013

Not everyone is going to be a candidate for testosterone therapy. Many people are just seeking therapy as another supplement for their gym regimen. We see people all the time who play weekend doctor and gym physician. These guys are usually not candidates— especially if they are younger. We very rarely see men under the age of 30 who qualify for treatment. We try to make sure everyone understands they should be trying other remedies to correct their issues before resorting to testosterone therapy. The reality is that by the time most men come to TRT clinics, they have been struggling with low testosterone symptoms for many years. They want their life back and are willing to commit to TRT if it means they will live a better quality of life from this point forward. We must not forget about the high-risk clientele. They should not be excluded from therapy if the proper precautions are taken. Men who have had testicular or prostate cancer may also be suffering from low testosterone. It’s crucial to work with a specialist who knows how to minimize the risks and maximize the benefits—especially for patients with high-risk medical conditions. The dark side of hormone replacement therapy is the rampant abuse in gyms, which has caused it to be associated with anabolic steroids and HGH. It is important to be aware that certain patients may be approaching their doctor for the wrong reasons. Although TRT has gained the attention of the abusive crowds, we must not ignore the major health benefits. There is a true placement for men who have a testosterone deficiency and medical need. It is important that you refer your patients to a clinic that understands this and focuses on your patient’s overall health, not just an aesthetic improvement. Be mindful that there are clinics out there specifically geared towards male hormone treatment and some that only work with females. Refer to a specialist, because hormone deficiencies require a delicate assessment to ensure proper treatment—especially when it comes to men vs. women. If a testosterone patient is not prescribed an accurate protocol for their specific needs, the patient could end up with a lack of results, mood swings, prostate issues, cardiac problems or liver damage. Hormone replacement therapy has come a long way. Currently there are several techniques for administering testosterone therapy such as oral based supplementation, gels, pellet inserts or injections. Absorption and success rate varies depending on the delivery method. Although some feel an injection is the most difficult to administer, it is still considered the most controlled and safe method. Most would agree injectable testosterone is the safest means of administration and poses lowest risk to the patient due to the lowest number of unwanted side effects. The biggest complaint patients have is the inconvenience and lack of access to receive their therapy when it is convenient for them. No one wants to drive to a clinic every week for the rest of their life to get an injection or go by the pharmacy so often that the staff knows all of your private medical needs. We have designed a monthly delivery program in which the medications are shipped directly to the client’s home. Their prescriptions arrive in a systematic means on a monthly basis so they don’t miss any of their dosages due to a busy schedule. More men these days are paying attention to their health and want to feel their best regardless of their age. Testosterone is the lifeblood of what makes a man a man. Unfortunately for all men, it is not a matter of “if” your testosterone levels will decrease, but a matter of “when”. The fact is that we are all going to grow old, but no one wants to actually feel old. Testosterone therapy now provides aging men with an effective solution to many of their daily struggles and allows them to elevate their quality of life for their remaining years.

Issue 5, 2013

Doctor’s Life Tampa Bay

Fit Corner

The Mediterranean Diet: Is the heart-healthy eating plan right for you and your patients?

ASK THE COACH

f you’re looking for a heart-healthy eating plan, the Mediterranean diet might be right for you and your patients. The Mediterranean diet incorporates the basics of healthy eating and is based on typical prepared Mediterraneanstyle foods and recipes. I would not even consider it to be a diet but rather a Mediterranean-influenced style of preparing and eating. What could be wrong with a splash of flavorful olive oil and perhaps even a glass of red wine? It is common for most healthy diets to incorporate the combination of fruits, vegetables, fish and whole grains, and a restricted amount of unhealthy fats. It is true that these parts of a healthy diet remain tried-and-true however subtle variations in proportions of certain foods could make a difference in your risk of heart disease. What are the benefits of the Mediterranean diet? Research has shown that the traditional Mediterranean diet reduces the risk of heart disease. There has been an overwhelming amount of studies that demonstrate that adults that follow a Mediterranean diet are associated with a reduced risk of death from heart disease and cancer, as well as a reduced incidence of Parkinson’s and Alzheimer’s diseases. The dietary guidelines for Americans recommends the Mediterranean diet as an eating plan that can help promote health and prevent disease. It seems this style of eating is something more of us should adapt into our life if you have not already. The diet alone brings huge health benefits however the Mediterranean diet also expresses the importance of being physically active and enjoying meals with family and friends. Key components of the Mediterranean diet: • Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts • Eating fish and poultry at least twice a week • Limiting red meat to no more than a few times a month • Replacing butter with healthy fats, such as olive oil • Using herbs and spices instead of salt to flavor food • Drinking a glass of red wine (optional) The Mediterranean diet traditionally includes fruits, vegetables and grains. For example, residents of Greece on average eat six or more servings a day of antioxidant-rich fruits and vegetables. The most common form of protein is fish and seafood. Meat is more commonly used as an ingredient in vegetable dishes than prepared as the main dish. Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans- fat, and the bread is an important part of the diet. However, throughout the Mediterranean region, bread is eaten plain or dipped in olive oil, not eaten with butter or margarine. Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat, but most of the fat is healthy. Because nuts are high in calories, they should not be eaten in large amounts. Suggested serving size is a handful a day. For the best nutrition, stick with whole natural nuts. That means UNSALTED! 18

Doctor’s Life Tampa Bay

Question: How important of a role does diet play in being fit and healthy? Answer: A nutritious, well-balanced diet along with physical activity is the foundation of good health and staying fit. Healthy eating includes consuming high-quality proteins, carbohydrates, heart-healthy fats, vitamins, minerals and water in the foods you take in while minimizing processed foods, saturated fats and alcohol. Eating in this manner helps you maintain your body’s everyday functions, promotes optimal body weight and can assist in disease prevention. Tommy Parks Speed and Strength Coach Mississippi State University BA in Exercise Science Professional Baseball for 9 Seasons NFL punter with San Francisco 49ers & NY Jets

Issue 5, 2013

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WEIGHT MANAGEMENT AS A PRESCRIPTION

By Jimmy Barker Owner of Nuviva Medical Weight Loss of Brandon, Certified Nutrition Coach

veryone knows that Americans have a weight problem. Over two-thirds of adults in this country are overweight or obese. This epidemic will have considerable ramifications if we don’t find a way to make significant changes quickly. The medical community has been hearing this for years, but the question we now need to address is, “How can we be more proactive and focus on weight loss rather than simply treating the medical conditions caused by being overweight?” Dealing with obesity is a daily struggle—even when it comes to activities many of us take for granted. Try getting out of bed with an extra 100 pounds strapped to your back every day. Imagine trying to find a hanger so that your XXXL shirt doesn’t fall on the floor. Wouldn’t you want to find a close parking spot if you knew you would get winded walking to your next meeting? No one should have to deal with the embarrassment of not being able to fit into a restaurant booth or having to purchase two airplane seats. Sadly, these struggles and embarrassments pale in comparison to the major health conditions that can result from obesity. Weight gain can create additional medical problems that compound, causing more and more weight gain and Continued on Page 22

Doctor’s Life Tampa Bay

Issue 5, 2013

It’s Not Just a Diet. It’s a New Life!

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eventually end up causing more severe conditions. Gaining weight often causes sleep apnea because of the pulmonary issues and added pressure on the patient’s chest. Sleep apnea can lead to a lack of desire to be active, eating high sugar foods in order to try and increase energy, leading to more weight gain and possibly metabolic syndrome. Metabolic syndrome along with high blood pressure can lead to coronary heart disease and potentially type 2 diabetes. One condition after the other continues to affect the patient’s health until eventually the patient may be faced with a stroke or even cancer. It is time to put a stop to this! So… what can be done? Of course, every physician understands the importance of eating healthy and maintaining a healthy weight, but the reality is that the far majority of physicians don’t have the extra time to counsel and educate patients about proper nutrition and exercise. The physician can refer the patient to a weight loss service, but now there are an over abundance of weight loss services available. Many of the patients have probably already tried several of these services with moderate success, but end up gaining all the weight back. There are even medically supervised weight loss clinics, but unfortunately many of those services take the easy way out and have become pill factories for appetite suppressants and offer no real education to help patient keep the weight off. Admittedly, high doses of appetite suppressants and low calorie diets will in fact cause a patient to lose weight for a period of time. However, those diets are extremely unhealthy, not sustainable long term and they usually end up leading to metabolic damage, medication dependency and eventually many patients gain back more weight than they originally lost. Weight loss has come a long way over the years. Some programs are still under the old mentality that one diet fits all. The truth is, we all have different tolerances and needs. However, understanding and utilizing proper nutrition is the ultimate key for success. Programs that have variations in diet and try to understand a patient’s strong and weak points while also keeping in tune with modern medicines, supplements and medical therapies provide a means to ultimate success. Unlike other programs that have stuck to 1950’s idea of taking a pill and starving yourself, modern day understanding is both to lose weight during therapy and to help a client maintain long term success by continuously educating the patient throughout the process. An effective weight loss service will initially perform the appropriate medical tests and take the time to truly assess a patient’s health in order to determine the proper method of care. Luckily, there is nutrition and weight loss specialists that understand the importance of a patient’s overall health when it comes to weight loss and these specialists can design customized programs to fit each patient’s personal and medical needs. These physician supervised weight loss programs check family health 22

history, perform an in-office physical, conduct thorough blood work, evaluate the patient’s heart and perform routine doctor follow-ups. These programs are mindful of medical conditions that may be present and take the time to make sure patients can participate in the program without putting the patient at risk. Ideally, these programs also monitor the patient’s progress weekly to assure their safety and provide the accountability that many patients require for success. There are treatments available geared towards losing fat and sustaining muscle mass. Within those programs, one of the most commonly used medications is an appetite suppressant. This can be effective if prescribed in a low dosage and used as a weight loss tool to avoid falling off track rather than as a replacement for proper nutrition. B12/MICC injections can be used to improve metabolism and burn fat. But these injections are in effect, just another piece of the puzzle. Some of the more advanced programs are using hCG, which has the believed benefit of saving muscle mass and burning fat. hCG has been approved in higher doses by the FDA for female fertility treatment and for select hormonal treatments in males. There is a large amount of anecdotal evidence that indicates hCG works well for weight loss and helps the body differentiate between different types of fats. This therapy is believed to help patients maintain structural and reserved fat, while targeting abnormal or accumulated fat in conjunction with a low calorie diet. There are also extreme weight loss options that go as far as invasive surgical procedures for people who don’t have the will power for proper dieting. Regardless of the method, nutritional balance, education, physical activity and psychological discipline all are important for long-term success. Anyone who has lost weight can attest that it has been a lifechanging event both for them and those close to them. In addition to the aesthetic changes, weight loss can have dramatic medical benefits as well. Safe, effective weight loss has been shown to help patients wean off medications like insulin and high blood pressure medications. Successful weight loss will help alleviate certain musculoskeletal pain, aid in the longevity of knee or hip replacements, reduce the risk of stroke, cancer and diabetes. The medical benefits are countless, but equally important, a healthy weight allows for a healthy lifestyle, improved sense of well-being and confidence in both personal and professional life. We have a duty to best serve our patients and inform them of the most effective treatments available for their conditions. If your practice is unable to directly provide comprehensive weight loss services, then take the time to research the medically supervised weight loss programs in your area. Find out who is providing the type of care your patients deserve, so you can adequately provide references to your overweight clients. Your trusted direction will provide them an opportunity to improve their quality of life forever.

Doctor’s Life Tampa Bay

Issue 5, 2013

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