Archive for September 2016

Your body is better built than you can ever know.

Ever wonder why so many experts say the brain requires carbohydrates to live? Here’s the simple story behind that oft quoted “130 grams of glucose per day”.
Even though the 130 gram number probably isn’t the whole story, what still amazes me is that we are created with the ability to generate any needed glucose through the liver’s role in gluconeogenesis. That word means just like it reads. Glucose made new out of more basic stuff; seemingly out of nothing. We have the ability to generate all the glucose our brain and body will ever need. Gluconeogenesis can produce about 200-250 grams of glucose per day in the adult male. Therefore, we have no need to ever eat another carbohydrate again. Not that we have to never eat carbs just that we have the ability.
Given that we have the ability to survive and thrive on any level of intake of carbs in our diet, the question then becomes “How many carbs are optimal?” “What amount of carbohydrate intake makes me healthiest?”
That’s a very interesting question. If you’d like to know exactly how many carbs you should eat to be your healthiest you ever, give us a call at 539-0270 and set up a Medical Nutrition Management visit. We will determine your number, outline a specific game plan for your best health, and follow along with you step by step. At these one-on-one visits we have had thousands of pounds of documented weight loss, hundreds of medications stopped as they were no longer necessary, and reversal of diseases such as diabetes, high blood pressure, and high cholesterol. Come join the healthcare revolution and see just how healthy you can be!

Fatty Liver

Well, it looks like your liver enzymes are a bit high on your bloodwork.”  That comment or something like it is repeated by me a few times a day in the office.  Liver enzymes are a part of a typical chemistry panel that is checked for a physical exam or with numerous other standard blood work-ups.

So, when they’re high, what does that mean?  Overall it means something is irritating and at least slightly damaging the liver.  It could be anything from Chronic Hepatitis C to Autoimmune Hepatitis to a reaction to a medicine or supplement and so on.  But the most common thing for it to be is fatty liver.  And there are specific types of fatty liver.  Bear with me in getting an idea of what these basic types are because it does make a difference.  First, there is nonalcoholic fatty liver disease (NAFLD).  This involves deposits of fat in the liver cells not caused by excess alcohol intake.  It is the most common specific liver disease, probably involving over 20% of the population.  If you’re obese (BMI of 30 or higher), your odds are more like 70-80% of having NAFLD.

Then there is the next stage of fatty liver called nonalcoholic steatohepatitis (NASH) where the fatty deposits have started to more seriously inflame and damage the liver.  About 5% of those with NAFLD progress to NASH and about 15% of those with NASH progress to a final stage of nonalcoholic cirrhosis where liver failure or even liver cancer can occur.

What causes this whole spectrum beginning with NAFLD and sometimes ending in cirrhosis?  The big risk factors are the very things that are becoming an epidemic in our country, namely, obesity, diabetes, high triglyceride, hypertension, and a hugely common condition called metabolic syndrome which is a combination of several of these other problems.

As you might have guessed, there are also alcohol-related versions of all of these fatty liver problems.  If a man drinks more than two alcoholic drinks per night or a woman drinks more than one per night, alcoholic fatty liver disease (AFLD) and its whole progression to cirrhosis, can begin.  So if you are drinking this amount and beyond your liver is at risk and you need to either cut down or stop to keep a healthy liver.  But in the rest of the space here we want to stay with the nonalcoholic versions of fatty liver.

If you find yourself being told that your liver enzymes are high on a blood test, especially if it happens more than once, some further testing will likely be carried out.  Further blood testing, such as for hepatitis C and other causes, will probably be checked.  Often an ultrasound of the abdomen will be obtained to see if the liver shows fatty deposits or any other problems.  The problem is that these simpler tests can’t really distinguish well between NAFLD and the more serious NASH or even cirrhosis.  Only a liver biopsy can really do that, and as you can imagine we don’t want to expose everyone with fatty liver to that kind of invasive procedure, although sometimes it may be necessary.

So practically speaking, if your liver enzymes are high and perhaps you’ve gotten an ultrasound and it shows fatty liver, what’s to be done?  If you’re drinking in excess, cut down or stop.  Besides that, a low carbohydrate diet (typically 100 grams of carbs or less daily), regular aerobic exercise (for example, 30 minute fast walk or the equivalent almost every day), and, if you’re overweight, a 10% weight loss for starters, are some of the most effective treatments for this.  By the way, rapid crash dieting is not the way to go as it can sometimes make fatty liver worse.  There are also meds which can be considered for treating fatty liver.  But lifestyle changes are what really work best, although they are always much easier to understand than to actually do.

So if you find yourself in this ever growing group with fatty liver, make a specific plan with your physician.  We’ve seen this problem remedied over and over when people actually make these lifestyle changes for the long haul.  You’ll almost certainly feel better, and after all, your liver does a lot for you; help it out.


Fill in the blank. I want to ___________.

We all have goals and aspirations for our lives that are going unmet.  Our dreams usually aren’t lofty.  They center around being with family, traveling, or maybe enjoying a favorite hobby.  What keeps us from achieving these goals?  For many of us, it is the physical challenge of playing in the backyard with younger, faster family members.  Maybe it is the inability to easily walk through the exotic city streets or along the trails of a National Park.  Sometimes it’s the after effects of a chronic illness like diabetes or heart disease.  Our bodies just aren’t working the way we want them to.  We want to change but don’t know where to start.

Trinity Medical Associates is pleased to announce the launch of our Wellness Nurse program.  Katie Ellis, a registered nurse and certified personal trainer, is now available for private, one-on-one visits at our VitalSigns facility in Hardin Valley to develop a personalized exercise and wellness program to help you achieve your goals.  During each half hour visit, Katie will work with you to develop a specific exercise plan for your ability and goals.  She can demonstration each exercise and train you to be comfortable performing these exercises.  Being part of our VitalSigns and Trinity team she will reinforce the medical plan you and your doctor developed, the nutritional information available through our medical nutrition management program, and the teaching provided through our various VitalSigns programs.  This is fully integrated healthcare at its best.  Nutrition, exercise, and wellness all working for one single purpose: the health and well-being of the patient.

Katie will also be participating in our upcoming VitalCoach program.  Participants will utilize their mobile devices to track their activities and receive regular feedback and coaching on their success.  National studies have shown that health coaching can increase a patient’s success at staying healthy and being active.  Stay tuned for more details.

If you’d like to schedule a Wellness Nurse appointment with Katie please call 539-0270.  Visits are $25 and billable to insurance for established Trinity patients.




Stimulants are the new opioids

Over prescribing of ADD and ADHD stimulant medications, especially in adults, is a rapidly exploding issue. Inappropriate use is common at many universities and high pressure jobs. However, there remains a considerable number of patients who have legitimate need and should be cared for within the healthcare community.
Addressing a patient’s need for stimulant medications requires a careful and thoughtful approach. For many disorders, Trinity uses our multifaceted approach to therapy which so often improves, reverses, or even cures the common maladies of modern humankind. We address the three main pillars of health that are required for any person to be remain healthy: good nutrition, good exercise, and good sleep.
Nutritionally, studies have demonstrated that a lower carbohydrate dietary plan improves ADD/ADHD symptoms over other dietary interventions. Omega-3 fatty acids found in fish oil (or actually eating more fish) is one of the few supplements that improves ADD/ADHD symptoms. Vigorous aerobic activity consistently demonstrates improved symptom control especially if challenging tasks are performed within the 90 minute golden window following exercise. Finally, sleep is a critical element to good focus and concentration. Disorders such as sleep apnea, excessive screen time, as well as burning the candle at both ends severely limits the brain’s ability to concentrate for weeks and months on end.
Trinity has adopted the widely published guidelines from the American Academy of Pediatrics and the American Academy of Family Practice concerning the prescribing of stimulant medications These guidelines include such things as the following:
-Stimulants will only be prescribed after an appropriate history and physical is performed which supports the diagnosis
-Secondary causes for the symptoms including poor nutrition, poor exercise, and poor sleep have been fully addressed
-Follow up is required in person on a monthly basis until stable then every three months thereafter
-Medication changes are done in person only
-Regular use of Tennessee’s Controlled Substance Monitoring Database
-Refills are done on time. They are not filled early, after hours, or for long term supplies.
-Urine drug screens are required at random intervals to confirm the use of the prescribed medication as well as the absence of inappropriate chemicals.
-Long term prescribing of medications is not guaranteed and referral to a mental health specialist will be made if the situation warrants.
We feel that with our approach and the use of these guidelines we will continue to provide high quality care for individuals in need and limit the inappropriate use of these medications.