​With Thanksgiving approaching, my heart is filled with immense gratitude and warmth. I want to take a moment to express just how thankful I am for each and every one of my concierge members. Your decision to join my concierge program and prioritize your health is something I deeply appreciate.
 
In an era where healthcare often feels like a series of rushed appointments and impersonal interactions, I knew I needed to forge a new approach to patient support and enhance the service my team and I provide. My concierge program became the solution, helping us to build a more personalized patient environment, fostering a mutual dedication to improving health outcomes.
 
This journey has been incredibly rewarding for me, not just as a physician, but as a partner in your health. I’ve seen firsthand the positive changes and improvements that come from a more engaged and proactive approach to healthcare. It’s been inspiring to witness your progress and to work with you to maintain and improve your health over time, with greater continuity and understanding.
 
Together, we are not just managing health. We are thriving.
 
The opportunity to make a real difference in people’s lives is truly fulfilling, and I thank you for making that possible.
 
Practicing Gratitude for Your Health
 
“The heart that gives thanks is a happy one, for we cannot feel thankful and unhappy at the same time.” -Douglas Wood
 
In the spirit of Thanksgiving, I encourage you to identify all that you are thankful for and to develop a regular practice of gratitude. Gratitude is like a personal trainer for your mindset—just a few reps a day can boost your mood and strengthen your outlook!
 
Your practice doesn’t have to be hokey or complicated. It can be as simple as writing one line in a journal each day or keeping a note in your phone to share something that happened that day for which you are grateful.
 
For example, you can start by writing a note that states, “Good things always happen to me.” Then, throughout the day, look for positive things that occur and write them down.
 
When we regularly acknowledge and appreciate the positive aspects of our lives, we shift our focus away from stress and negativity, which can help lower levels of the stress hormone, cortisol. This shift not only improves emotional resilience but also supports better mental health by reducing symptoms of depression and anxiety. Furthermore, gratitude can enhance physical health by encouraging healthier lifestyle choices, such as improved sleep quality and more consistent exercise, which contribute to a stronger immune system and better cardiovascular health.
 
A Final Note
 
Thank you once again for reminding me why I chose this profession, and for being a major contributor to my gratitude practice each day.
 
As we move forward, I remain dedicated to ensuring your membership exceeds your expectations. Your feedback and experiences are invaluable, and I encourage you to share them with me and my team so that we can continue to improve and adapt to better serve your needs.
 
I wish you and your loved ones a wonderful Thanksgiving.

As the primary fat in the Mediterranean Diet, olive oil has been studied extensively for its health-promoting benefits. Regular consumption, defined as 1.5 - 4 tablespoons a day, has been observed to reduce the risk of total and cause-specific mortality. But not all olive oils are created the same. Thus, a study comparing the health benefits of EVOO to OO recently caught my eye.
 
Extra virgin olive oil (EVOO) is distinguished from olive oil (OO) by the extraction process. OO is produced via chemical extraction and processing, whereas EVOO is produced by crushing the olive thereby retaining and preserving the phenol content of the fruit (yes, olives are classified as a fruit!). It is the phenol content of the EVOO which is thought to impart the health-promoting benefits, not the fatty acid content (aka MUFAs).
 
The study participants
 
In the study comparing the two, 12,161 participants were assessed for variables such as sociodemographic factors, self-reported health conditions and medications, and diet, specifically their adherence to the Mediterranean Diet and type of olive oil consumed each day. Participants were followed for a mean 10.7 years.
 
The findings
 
Researchers found the risk of all-cause mortality and cardiovascular mortality was lower in those with the highest reported daily EVOO consumption, and this association was not replicated in those reporting OO consumption.
 
When total daily olive oil consumption was combined (i.e. adding together both OO and EVOO consumption), the risk of mortality was also reduced—but not as low for those with higher daily EVOO consumption (not combined with OO).
 
Interestingly, deeper reductions in all-cause mortality were noted in those reporting both higher EVOO consumption and physical activity, indicating a synergistic effect between the two, the mechanism of action for which is not fully understood.
 
How do we interpret this study?
 
We can start by noting it is not a randomized clinical trial (RCT). Instead, this study is strictly observational, meaning we can observe the results, but we cannot draw conclusions. Had the researchers randomly assigned half the participants to EVOO consumption and half to OO, we would have more conclusive results. So, I dug a little more into the research in PubMed. A review article of 34 studies in which EVOO was compared to other fats found EVOO superior in a variety of biomarkers and health outcomes—this was again believed to be imparted by the phenol content.
 
Where does this leave us?
 
It would seem that EVOO might have benefits above and beyond that of other fats, including plain old olive oil. Specifically, a serving of 2 tablespoons of EVOO a day appears to be beneficial. It’s important to also remember the statistically observed synergy between EVOO and physical activity—so keep moving!
 
Buying EVOO
 
When purchasing, remember to read the label to make sure it says EXTRA VIRGIN olive oil and if you can find it unfiltered that’s even better! Check the expiration date, as phenol content wanes with time. Pesticide residue studies of European olive oils do not indicate contamination above threshold levels, thus if purchasing European olive oils, it may not be important to choose an organic version. And be sure to keep your EVOO away from heat (not next to or above the stove or oven) and away from light.
 
There exists both controversy and contradictory research results regarding the degradation of phenols with cooking. It seems prudent to save the pricey EVOO variety for salad dressings and for finishing/topping soups and vegetables for flavor and mouthfeel.
 
If you have questions about your specific EVOO recommendations in relation to your personal health, please reach out for a chat. You may also feel free to share this blog with your friends and family.


​SOURCES:
 
Ambra R, Lucchetti S, Pastore G. A Review of the Effects of Olive Oil-Cooking on Phenolic Compounds. Molecules. 2022 Jan 20;27(3):661. doi: 10.3390/molecules27030661. PMID: 35163926; PMCID: PMC8838846.
 
Donat-Vargas, C., Lopez-Garcia, E., Banegas, J.R. et al. Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort. Eur J Clin Nutr 77, 226–234 (2023). https://doi.org/10.1038/s41430-022-01221-3
 
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866.
 
Flynn MM, Tierney A, Itsiopoulos C. Is Extra Virgin Olive Oil the Critical Ingredient Driving the Health Benefits of a Mediterranean Diet? A Narrative Review. Nutrients. 2023 Jun 27;15(13):2916. doi: 10.3390/nu15132916. PMID: 37447242; PMCID: PMC10346407.
 
Gaforio JJ, Visioli F, Alarcón-de-la-Lastra C, Castañer O, Delgado-Rodríguez M, Fitó M, Hernández AF, Huertas JR, Martínez-González MA, Menendez JA, Osada J, Papadaki A, Parrón T, Pereira JE, Rosillo MA, Sánchez-Quesada C, Schwingshackl L, Toledo E, Tsatsakis AM. Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients. 2019 Sep 1;11(9):2039. doi: 10.3390/nu11092039. PMID: 31480506; PMCID: PMC6770785.
 
Guasch-Ferré M, Li Y, Willett WC, Sun Q, Sampson L, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Hu FB. Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults. J Am Coll Cardiol. 2022 Jan 18;79(2):101-112. doi: 10.1016/j.jacc.2021.10.041. PMID: 35027106; PMCID: PMC8851878.
 
Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean die t, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004 Oct;80(4):1012-8. doi: 10.1093/ajcn/80.4.1012. Erratum in: Am J Clin Nutr. 2005 May;81(5):1181. PMID: 15447913.

​A Scary Look at Data Misrepresentation in Nutritional Science
 
As consumers of information, we are barraged daily with conflicting information, nowhere is this more evident than in nutrition research where the information seems to change from week to week. Why is this the case?
 
We can start with how people eat: are the people in the fake headline above just eating ice cream? Likely they are eating the usual ice cream companions like cones, sprinkles, whipped cream and hot fudge. People follow patterns of eating behavior. It is virtually impossible to take a reductionist view of what people eat and limit it to a single food or nutrient.
 
Then, we can look at how the data is collected. Most often, nutrition research asks people to recall what they ate over a given period of time in the past. Do you recall how much ice cream you ate last summer? Last month? Last week? Was it soft serve or hard? What flavor was it? Was it dairy or dairy-free? Did you add toppings? Was it served in a cup or a cone? What type of cone? …Just how accurate do you think the information collected is?
 
Next, we can examine the participants in the study. How many participants are needed before one can make the observation in our fake headline? 3? 30? 300? What were the demographics of the participants? Was it a diverse group of people (age, ethnicity, socioeconomic status, geographical location, etc.)? If all the participants in our fake headline were 80-year-old Caucasian females living in the Bronx, then it would be nonsensical to the extrapolate trends from this data to anyone other than 80-year-old Caucasian females living in the Bronx.
 
Then, ask yourself, is observation causation? The answer is no. That is a fundamental issue with study design. Much nutrition research is observational. We observe “associations” between variables, but we cannot control unforeseen variables. Let’s take our fake headline: What if the participants in the study ate their ice cream on a sugar cone? How do we know the shark bite wasn't due to the cone and not the ice cream at all? By not measuring the sugar cone as a variable we have made a false association between ice cream and shark attacks.
 
In addition, it is rare in nutrition research to see a “gold standard” randomized control trial (RCT) in nutrition whereby people are randomly assigned to an intervention and a control group. In our fake headline, one group would eat ice cream, one group would not (the control group) but they would both go swimming at the beach. Then we would be able to draw comparisons between the two groups about a shark attack.
 
Sometimes the research comes up flat and nothing of interest is found. These negative results are important! They add to the body of knowledge on a subject. However, negative results aren’t highly sought after and are rarely published. This is referred to as publication bias. What if 10 previous studies found no association between eating ice cream and shark attacks, but because this was a positive result it was the only one published? The body of knowledge suffers as does the information disseminated to the public.
 
It is sad but true, that much research is funded by industries. The nut industry funds much of the research on nuts. The cacao industry funds much of the research on chocolate, and so on. Again, positive findings are more likely to be published, negative findings are repressed. Unfortunately, these positive findings are then used by the government to make nutrition guidelines and recommendations.
 
Researchers are human, they have egos and pride. The careers of scientists are built on their hypotheses, and, like industries, they have a vested interest in positive findings. Disappointingly, research is replete with insidious behavior meant to protect and promote careers.
 
Finally, there is the media; their job is to promote ratings. They are not obligated to properly vet the research (study design, participants, funding, etc.). Additionally, the media fails to properly explain the implication behind the headline (i.e. what does this mean to you?)
 
Where does this leave us, the consumers of information who want to make smart nutrition choices? Do we throw the baby out with the bathwater? Throw our hands up and eat Oreos for breakfast? Pringles for lunch? Not exactly. However, we do have a responsibility to take a look behind the headlines before making dietary decisions that impact our health. Sometimes that may mean getting the original research and using the above to decide if the study is valid for us.
 
Feel free to email Concierge Choice Physicians ([email protected]) with your questions or even send a headline or study to us, and we will be happy to answer your questions.

​After a few years of a very uncertain travel market, many of us are resuming regular travel and taking much needed vacations. But before you hit the roads and skies for travel, be sure to prepare yourself and pack your bags for medical scenarios.
 
Importantly, make sure to refill all your prescriptions ahead of your trip at least one week in advance of your departure and always bring at least a few extra days’ worth of medication with you. With the state of the travel industry, there is a high probability of your return not going quite as planned. You should always pack your medications in your carry-on—not in your checked suitcase—just in case your luggage is lost.
 
The Pack Smart Guide from the CDC offers a checklist to help you prepare for a healthy trip, including prescriptions, medical supplies, over-the-counter medicines, supplies to prevent illness or injury, first-aid kits and important documents. Many items in this list would be especially helpful if you are heading off the grid or traveling to an exotic location where medical supplies are not conveniently available at a local drugstore.
 
Also, keep in mind, I do not offer travel vaccines and would need to refer you to a travel health specialist or local pharmacy, so, please plan ahead. The CDC offers a complete list of destinations with travel health notices, recommended vaccines and precautions to consider for your specific destination.
 
Finally, make sure to enter my concierge contact details into your phone—including my cell number and email—and remember to pack your membership card so that you can reach me with any medical concerns during your trip. I can potentially offer a telemedicine visit, call in a prescription or, based on your destination, help to arrange a visit with a local Concierge Choice Physicians provider if needed.
 
As always, feel free to reach me with any questions. Safe travels!

​Three years ago, we were met with a global health crisis that resulted in many of us putting our other health concerns on pause, and I want to be sure you have all shifted your focus back to your overall health and wellness.
 
Have you kept up with your yearly physical? Is it time to do a full review of your medicine and treatment regimens? Have you gained or lost significant weight? How are your stress levels, sleep patterns, fitness programs and anxiety? 
 
Your annual comprehensive examination could be the foundation of your good health. Diseases and conditions such as hypertension, cancer, and anemia can be asymptomatic, for example, but a thorough history, physical examination, laboratory testing, and an in-depth discussion may prove revealing and lifesaving. We can also take advantage of this time together to create a plan to help you meet your wellness goals.
 
Let’s partner toward your best health. Please contact our office to schedule your annual exam. And as always, I am available should you have any concerns or questions.