GreenField Health Matters March 2022
Welcome Dr. Latha Radhakrishnan!
We are thrilled to announce that Dr. Latha has joined our team, both in a primary care role and as an endocrinology consultant. She presently hails from the Salem area, and brings with her more than 15 years of specialty experience in managing diabetes, thyroid conditions, adrenal insufficiency, hypogonadism, and other endocrine conditions. In her spare time, she enjoys hiking, vegetarian cooking, and listening to all varieties of music. She also is a student of ancient Indian philosophy and linguistics. Latha is a brilliant addition to the team. Please say hi to her next time you’re in the office!
Changes to Annual Wellness Visits
- Starting this (2022) calendar year to be in compliance with our insuring partners, GreenField policy changes require that all annual wellness visits will be preventive only going forward. This means that while you may have new concerns or updates on chronic issues to discuss at annual wellness visits, separate appointments will need to be scheduled for those concerns. Please do not hesitate to bring your concerns up to your provider, though - even if those will require an additional visit or two, we will ensure that these are addressed in a timely and thorough manner.
GreenField On Call for You 24/7
- The clinical team at GreenField is on call for all of our patients 24 hours a day, 7 days a week. That means that if you have any pressing need, question, or concern regarding your health, you can call on us at any time, and a clinician will be available to respond. Call support is available for patients of all ages. This is a benefit that we take pride in offering all GreenField members, and is one way we keep our commitment to reliably serving you. It is also one way we can help limit sometimes unnecessary/expensive/unpleasant trips to urgent care or the ER. Please do not hesitate to call us after/off hours when you need us by using the GreenField office phone number at 503-292-9560.
A growing area of interest in the field medicine over recent years is the tapering and de-prescribing of medications. This may sound somewhat anathema to the traditional idea of medical practice in some ways. And yet, it applies to best care practices for very many individuals. While medications can often be life-saving, they can also cause substantial harm. And sometimes these characteristics can apply to the same medication, depending upon circumstances and individual.
Take, for example, the family of medicines called PPIs (proton pump inhibitors). These are medicines such as omeprazole and pantoprazole that are used to treat peptic ulcers, Barrett’s esophagitis, and GERD/heartburn. These medicines can literally help save a life in the case of a bleeding gastric ulcer. However, chronic use also drastically impairs the absorption of a variety of key nutrients, including vitamin B12, magnesium, and zinc. And since studies demonstrate that fewer than 50% of people with GERD on PPI medicines actually need them, for many folks we are likely doing more harm than good!
And just so that there is some icing on this cake: we also know from randomized trials that putting healthy people without reflux on PPIs like omeprazole actually causes them to develop reflux.
So: sometimes life-saving, and sometimes harm-causing.
Here is another key example: benzodiazepine medications. These are medications used sometimes to stop seizures when they occur, but also for sedation in emergency settings and, more commonly, acute anxiety reduction. Examples include lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium). Benzodiazepines have the best evidence for use in difficult-to-treat seizure disorders and cases of acute seizure that need immediate interruption, and in these settings they can help save lives. The worst evidence they have is actually for treating anxiety - and this, again, is their most common use in modern medicine. This is because they do not actually treat the mechanisms or causes underlying anxiety; they simply sedate and suppress symptoms. And at the same time, because they are often used chronically in the anxiety context, they carry some of the highest short- and long-term risks of any prescription pharmaceuticals.
For example, benzodiazepines are known to decrease reaction time, and thus present a risk while those using them drive or operate heavy machinery. They are extremely habit-forming, and withdrawal from them actually can involve seizures and be life-threatening itself. They increase the risk for irreversible cognitive decline. And perhaps most significantly, based on a systematic review of almost 50 studies, chronic use of benzodiazepines is profoundly associated with an increased risk of death from all causes - between 50% and 500%, to be specific. This risk can reach these levels with as few as 20-50 doses per year. They don’t even have to be taken daily!
These are just two examples - there are more. And an important rule of thumb to remember is that as we age, so too do our risks of undesirable medication effects.
If you believe there are medications that you are on now but might do better with out, or if you would like to know more, please schedule some time with your GreenField provider to discuss. We would be happy to support whatever process will best serve your care needs. Please also consider consulting with this excellent resource: deprescribing.org/resources/deprescribing-information-pamphlets/
Greenfield/Optum was not involved with the study, does not endorse their viewpoints, etc.
The Health Benefits of Olive Oil
Back in health-related news recently, olive oil continues to impress in the health benefits it appears to confer. In a very well-powered observational study, adults age 56 and up who consumed more than ½ tablespoon (7 grams) of olive oil per day had an almost 20% lower risk of dying from heart disease, respiratory disease, and neurodegenerative disease, and a nearly 30% reduced risk of dying from cancer.
The effect was even more pronounced at times when saturated fat-dense animal fats from butter, other dairy fat, and mayonnaise were replaced with olive oil. This also appeared to be true when concentrated saturated fats from processed plant sources, such as margarine, were replaced with olive oil.
Similar benefits have previously been seen with unprocessed nut (walnut, pecan, macadamia, etc.) consumption, especially as pertains to lowering the risk for cardiovascular disease.
It is important to note here that not all olive oil is created equal; many olive oil products are adulterated with other - often less wholesome - oils. You are most likely to net yourself a quality product when purchasing organic, cold-pressed extra-virgin olive oil. The closer you are to purchasing from the producer directly, the better. It is also important to note that olive oil burns at only moderate/medium heat, effectively nullifying many of its health benefits, and at times introducing health risks. So best to avoid pan or deep frying, sautéing above low heat, and so on.
So the thesis statement is: blend some hummus, dress a salad, or garnish some veggies with a modest helping of extra-virgin olive oil daily, especially if that is going to reduce your intake of saturated fats. Have fun with it! And for any questions or ideas on how to work this into your daily routine, be in touch with your GreenField provider or GreenField nutritionist.
Your GreenField Integrative Physician, Dr. Matt Van Auken
And the entire team at GreenField Health
Disclaimer: the newsletter is not medical advice and we encourage patients to follow up with their PCP to address their specific health conditions