Tammy Jones, MD

05/02/2025

Welcome to the May to the edition first Fridays.
Today we would be talking about glucose metabolism, specifically the prediabetes and type 2 diabetes..

First lets talk about screening. When you go to a doctor's office you are typically screened with a glucose level, usually fasting and the level should ideally be between 65 and 99. Levels of higher than 100 suggest that your blood sugar is elevated in that moment but that does not necessarily mean that you have (pre)diabetes.
The more appropriate screening is a hemoglobin A1c which tests the sugar coating around red blood cells, red blood cells only live for 120 days so the sugar coating around the cell gives us an average of your blood sugar for the past 4 months. This is a level used to screen for type 2 diabetes. Oftentimes it is confirmed with a glucose tolerance test although this has fallen out of popularity as the confirmation for type 2 diabetes. Pregnant women still have this test done regardless of A1c.

Now results, when an A1c returns below 5.6 we consider that normal; however, if you are 5.5 or 5.6 please note that you are marching towards prediabetes. The difference between 5.6 and 5.7 is 1/10 of a point, your body really does not know the difference.

The reason that diabetes occurs is that when we consume foods our body can only store them in 1 of 3 places-my colleague Dr. Barnes calls them tanks. You cannot create or destroy energy- it simply changes forms, so, when we consume carbohydrates such as bread, rice, pasta, potatoes, foods made of flour and sugar as examples, your body turns those into "sugar". Our carbohydrate (sugar tank} is what we typically need for bursts of energy should remain at about 1/4 full. Once we burn through the carbs the body starts burning fat (which is why exercise helps to lose weight). In the American diet carbs are abundant- particularly in packaged foods. Because we consume more than the body actually needs that tank tends to increase to more like three quarters of a tank. If we are were not exercising to burn these carbs the body must now rely upon insulin to help lower the blood sugar. If this occurs day after day insulin then takes over one's metabolism-- this is what we call insulin resistance. Once the metabolism kicks over into insulin resistance insulin turns every carb we consume into fat because it is already working hard to lower the blood sugar on that 3/4 full tank.

If this continues year after year then the diagnosis will eventually switch to type 2 diabetes based upon parameters used for the diagnosis-specifically an A1c of 6.4 or greater.

THIS CONDITION IS REVERSIBLE!!!!
We really help the process when we increase our activity to burn off those carbs, this helps us to do that without using insulin which lowers the blood sugar and hence the A1c. The goal here is to "kick insulin in the teeth", and get it out of the way so that the other hormone involved in metabolism can take over. When we get insulin out of the way then glucagon takes over, when glucagon controls metabolism we burn fat and we lose weight, this process can and does reverse prediabetes and type 2 diabetes.

Additionally here at my practice we order an insulin resistance score and C-peptide (terminal molecule of insulin), these are additional tests that can advise us as to whether or not you truly are insulin resistance or at risk and whether or not your body is making excess insulin.

I know this is a lot of information; however, when we review your results our mind instantly works through the algorithm to see where you fall in this chain of events.
This is one of those modifiable diseases that a lot of people do not understand; therefore, they do not change. It is my hope to educate you enough that you feel empowered to make changes without prescription medications!

I take great care to personalize your experience based upon your results and determine the best path forward for you whether that is using exercise as medicine, food as medicine, or prescription medicines. My goal is always to allow you to live in Harmony with nature.

Cheers to great health, better outcomes and happy Mother's Day to all the mothers grandmothers, and godmothers!!

04/07/2025

April Edition
Welcome to spring Facebook friends.

The April edition of our information series is all about cholesterol.

At my practice I order the traditional lipid panel-considered the "calculated' cholesterol. It consists of the following:
Total cholesterol-this is a total based upon LDL and HDL

LDL- this is the "bad" cholesterol-to keep them apart remember that lousy starts with an L-LDL is the "lousy" cholesterol and should be low-this again is a calculated number.
Ideal LDL is less than 100 for most of us
with diabetes should have a level less than 70
with a history of heart attacks or strokes the goal is less than 55

HDL-this is the "good" cholesterol-happy starts with an "H" - the "happy" cholesterol should be high

Triglycerides 9TGA) which are fatty acids-this should be below 100-this value is often driven by blood sugar-levels that increase do so under the influence of insulin; decreasing levels reflect better blood sugar control. We can look at the HDL and TGA levels and often determine if you are prediabetic before we ever look at your blood sugar and A1c.

nonHDL cholesterol is the "cousin" to LDL-it "follows the lead" of the LDL-we want this below 100 as well.

and then there are ratios-we compare these numbers to determine overall risk of various illnesses.

There is a second panel that I include in every wellness exam:
This is termed the NMR panel. This panel evaluates actual particle numbers and sizes. Think of it this way

LDL-P tends to be small and compact -think marbles-they are compact and can cause damage when floating around and traveling through the blood vessel wall. These can be highly problematic if there is a moderate amount in inflammation in the body....we monitor the total number - (should be less than 900) and the size-they should be larger than 20.5 nm
It has an "offspring" called small LDL-P-this is the real problem maker-we like for this to be les than 400.
LDL is driven by diet-saturated (solid) fats tend to raise these levels
Fiber, lean protein and vegetables tend to lower these levels-less chicken skin and fatty beef will help, more fiber helps the body to bind part of it and eliminate it when you eliminate.

HDL-P (we like this to be >32.8)- tends to be large and fluffy-think cotton balls-these float around and do not cause any damage-they help to "pull" out the bad LDL-that is why they become fluffy-they are consuming some of the bad LDL. Large HDL-P does most of the work - we like this to be >7.2
HDL is driven by aerobic exercise. Your body will make more the more one exercises-especially aerobic activity.

Then there is VLDL-very low density lipoproteins-these are the first particles which come from the liver-yes the liver makes most of the cholesterol floating around in our blood stream. these particles last for ~4 hours-we like this level to be

02/07/2025

Welcome to our first edition of First Fridays

Today I am talking about inflammation;
Part of the my focus as an MDVIP physician is on root cause and corrective action for illness.
One of the many labs tests that we order in our practices is the inflammation panel
this consists of 6 tests:

MYELOPEROXIDASE; this is produced by the immune system. Normal levels are generally below 467 or so. Any level higher than that and we are concerned that the stress of the overactive immune system could potentially cause a rupture of any plaque in the body-if that plaque is around the heart= heart attack
brain=stroke
kidneys=kidney failure
clots in the lungs=pulmonary embolus

we focus on this as we can alter how the immune system is reacting based upon changes in lifestyle, diet, and of course treating any infection that you may or may not be aware that you have. One of the most common that is rarely discussed is gum disease-yes even bleeding gums is gum disease.

CRP-this is c reactive protein-basically a marker for inflammation in the bloodstream. This can be increased by anything that causes inflammation--obeisty, autoimmune disease, stress, poor sleep, infections, high blood sugar/prediabetes, diabetes, uncontrolled blood pressure, there is a long list...

LP-PLA2- we commonly call this a plaq test; it is an enzyme
which can cause a "wearing away" of the blood vessel lining-a worn lining can allow rupture under further stress-think a weakness in the wall of a hose/pipe/etc.... the same is true of our vessels.

OxLDL-this is oxidized LDL-LDL is our bad cholesterol. If it oxidizes (think browning of an apple before you eat it); it will begin to change shape and consistency, this is the beginniing of plaque formation in the blood vessel wall-not good family.

MICROALBUMIN/CREATININE RATIO: this refers to the permeability of the kidneys. think filters-like cheesecloth. If the holes in the cheesecloth are "normal" nothing but fluid filters through; if they become slightly larger then small amount of protein slip through the larger openings where they wouldnt if they were normal.

and finally

ISOPROSTANE/CREATININE RATIO: this too looks at the kidney, it is a measure of oxidative stress that can show in the urine. Again, our goal is to minimize or eliminate this oxidation-additonally-oxidative stress also increases the risk of developing cancer.

so this is a brief introduction the the inflammation panel provided via MDVIP. IF you would like to learn more please schedule a consultation; I would be happy to explain how my practice and the model is different than a traditional practice and to see if it is the right fit for you.

Cheers and see you next month at our second FIRST FRIDAY

01/14/2025

01/14/2025

Concierge Medicine
What Is Concierge Medicine and How Is MDVIP an Alternative?
Concierge medicine is becoming more mainstream especially in primary care. Learn more about it.

What is concierge medicine?
Concierge medicine is an umbrella term used to describe a relationship between a patient and physician in which the patient pays an annual or monthly fixed fee. Patients pay the fee for conveniences like same-day appointments and 24/7 physician availability.

To provide those conveniences, most concierge medicine physicians – whether primary care physicians or medical specialists – see fewer patients or set aside days of the week when they see only their concierge service patients. Their practices are subsidized by patient fees, which vary widely.

Concierge Medicine Cost
At the high end, some patients pay tens of thousands of dollars a year to see a physician. All primary care services are covered, and visits are unlimited. Some physicians who practice in these models may have a small number of very wealthy clients.

On the low end, some concierge medical services charge a smaller annual fee — $200 for example — so they can offer same- and next-day appointments. But patients may not see the same primary care provider. Instead, they may see a medical extender like a nurse practitioner or a different physician. Preventive services are not typically included in the fee. The services offered are similar to urgent care.

MDVIP vs. Concierge Medicine
MDVIP-affiliated primary care practices are sometimes compared to concierge primary care, but MDVIP goes beyond, by focusing more on prevention and wellness. Patients continue to receive basic covered preventive physicals and screenings offered in traditional primary care practices. But they also receive an array of preventive services not typically covered by commercial insurance or Medicare, nor offered by most concierge physicians. The fee for MDVIP — typically between $1,800 and $2,200 a year — pays for those additional defined preventive services. This is the MDVIP Wellness Program, which patients receive annually.

In addition to the comprehensive health screenings and tests, which have been shown to give patients a clearer view of their health, MDVIP-affiliated physicians go through the results and work with their patients to develop a personal wellness plan designed to maintain or improve their test numbers and reduce their risks of common health conditions like heart disease.

Another difference between MDVIP and most concierge medicine practices: The MDVIP program is backed by published studies. Researchers have looked at the MDVIP primary care model and produced nine different studies that have shown patients in MDVIP-affiliated practices:

Experience fewer hospitalizations
Utilize urgent care and emergency departments less often
Receive more preventive services
Better manage certain chronic conditions like diabetes and heart disease, and
Are more satisfied with their doctor-patient relationship than patients in traditional primary care practices.
A National Network
MDVIP has a national network of more than 1,000 physicians; when members are traveling and sick, their MDVIP-affiliated physician may arrange care with another physician in the network. Most other concierge medicine practices are solo operations. Even concierge medicine companies with multiple physicians typically only have primary care providers in a few cities – not across the country.

Same Day Care
Patients in MDVIP-affiliated practices enjoy the same conveniences offered by many concierge programs because their doctors see fewer patients. For example, MDVIP-affiliated physicians offer same- and next-day appointments that last as long as needed. And they’re available by phone after hours.

Improved Patient-Physician Relationship
Plus, MDVIP-affiliated physicians have time to get to know you, which studies show improve both the doctor-patient relationship and health outcomes. And since you'll see your physician — not a physician extender or one of many doctors — you'll have continuity of care, which studies have also shown lead to better outcomes.

MDVIP goes beyond concierge medicine — it is affordable, personalized medicine with a doctor who knows you and has both advanced preventive care services and conveniences available, which are rare in today’s primary care environment.