Obesity-Inflammation Related-Common Thread with Diseases-Part 2

 We continue from last week’s Part 1 with Michael Glade and his insights into obesity as it relates to the inflammation process.  A quick overview is two types of fat are present in the body: subcutaneous and visceral. Subcutaneous fat is the type found just underneath the skin, which may cause dimpling and cellulite. Visceral fat, on the other hand, is located in the abdomen and surrounding vital organs. It can infiltrate the liver and other organs, streak through your muscles and even strangle your heart; and turns out you can have it even if you appear to be thin.  It is the latter, visceral, fat that is linked to many other diseases, everything from bad cholesterol and hypertension to diabetes, heart disease and stroke. Dr. Glade believes at the core of the problem is the issue of inflammation.  Please refer to that article as we will continue here where we left off.

Break down of fatty acids in an abnormal fashion causes an inflammatory load which does unhealthy things to body tissue. If you expose cartilage, cancer, arthritic tissue to a specific signal of inflammation called alpha, they will always respond as if they are under attack.  Chronically exposed poor dietary input can cause or predispose a downward spiral in the body upset.  For example, the problem may be a missing array of essential fatty acids.  Over nutrition seems to be a problem and not sufficient oils or anti-inflammatory products.  If the body can stabilize with eating right, exercise, not smoking or drinking, then the body becomes more stable. 

With a wound you would expect a short term inflammation situation which is a good thing.  The brain is just like other tissue.  We need to replace at least at the same pace as old stuff carrying off. The human brain also experiences changes related to inflammatory factors.  The brain wants to heal with growth of new neurons, a normal response of learning that deals with activity where they grow and dispose of old stuff. 

 Conventional approaches to control of body fat includes weight loss and exercise.  MRI can identify the infiltration of visceral fat around and in specific tissue, but Michael Glade suggests the use of a laboratory test called C Reactive Protein (CRP) to get some inkling that inflammation is present.  There may be a balance between CRP and the oil EPA (Eicosapentaenoic Acid).  Normal  ranges are tested with a group of norms which may be difficult to identify.  What is normal within a group since the control group could represent those in the elevated portion of the population?  We just don’t know. (A test we may use is a genetic test which identifies inflammation from a hereditary factor, particularly when trying to decide if the influence may be environmental rather than hereditary.)

 One of the markers for longevity is control of abdominal fat which is identified as the visceral load.  An inflammation marker is a practical approach of getting the belly fat down.  The dual nature of obesity is that if there is an imbalance in the body, then there is going to be an unintended consequence.  The goal needs to be met to control and modify abdominal fat load. 

A few of the suggestions he gives are as follows:

*Our food supplies have become disconnected from nature.

*Learned failure is when you change lifestyle and then over-exercise. If the patient losses 10 pounds but hurts and is fatigued from over exercising,  they will have an excuse to not stay the course.

*When failure of weight loss occurred due to calorie restriction becoming very aggressive with omega 3 fats using  3-5 tablespoons of flax or fish oil would give good results.  The body wouldn’t change weight but it would reshape.

*Efficiently operating digestive tract is important.

*Activity needs to be increased.  Failures often are because activity isn’t high enough.

*Cause is heightened inflammation- imbalance can be tipped either way and neither may be the most beneficial.

*Anti-inflammatory medications often are mild poisons that push the body back into less inflammation-Dr. Glade questions if this is a good thing.

*Structural fats do very important replacement of fatty acid membranes.

* Use omega oils generally for inflammatory condition.  These are not generally stored or used in the body as caloric intake as the fundamental function of fatty acids in many ways is to restore balance.  They don’t suppress or stimulate inflammation.  Balancing inflammation is what they do and are essentially not drug like, they don’t turn off signals.  

*Suggested Ratio EPA:DHA  EPA 3,000 mg of product  4,000 mg DHA to renormalize triglycerides in the system.  This information is recognized by the drug industry.

Other products:

*Diet: avoid process starches and fatty acid meat and increase fruit and veggies.

* Development of brain is dependent upon DHA and is not found in most any place other than fish. 

* Berries, diversifying your response system is appealing.Recommended are 10 servings of fruit and vegetables per day. Salads are encouraged before meals.

* Starchy vegetables are off the menu. 

*Manganese, selenium, and other trace minerals can only come from our soil.  We are at a point of having to resort to food supplements.  Even if the soil is fortified, the soil is exhausted.  Consequently, trace mineral supplements are absolutely essential.

    - Selenium 100 mcg-anti cancer effective-balance with iodine

     – Chromium 1,000 mcg for sugar regulation of the body

*Boron 2 mg- places a role in digestion -good for inflammation in digestive tract and central nervous system

*Carnatine and acetyl-carnatine- heart and skeletal-less free-radical production

*Co-Q10 increases efficiency of fat burning and make systems more efficient-less free radical production resulting in feeling and moving better. 

Calcium-drop dairy because it causes inflammation-calcium supplement, vitamin D- Take optimum dose over 5-6 times per day for absorption.

Dr. Glade notes slim people fidget 2-3 hours more times per day and are always moving.

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Obesity-Inflammation Related; Common Thread with Diseases Part 1

Obesity is thought to be a disease of inflammation, according to Michael Glade, Ph.D. 

I became acquainted with his work through a DVD given to me by NeuroScience.  We have use NeuroScience protocols with great success; a company that focuses on “Target Amino Acids” as a means to address healing of the adrenal gland and balance neurotransmitters for the treatment of many symptoms including anxiety, sleep maintenance and insomnia, depression, and memory loss.

Dr. Glade is a Certified Nutritional Specialist (CNS) with degrees from the Massachusetts Institute of Technology (MIT) and Cornell University and teaching and research experience at Rutgers University, the University of Maryland, Northwestern University and at the Nutrition Institute of the University of Bridgeport. [1] 

Dr. Glade contends that when a patient has obesity for 5 years or more, the cellular mechanism is disrupted and regulation is thrown off through nutritional and other influences.  Cancer, arthritis, allergy, digestive literature look for a common thread which is traditionally separate in peoples minds as separate diseases, but it is looking more and more that they are individual symptoms manifested in an individual similarly condition.  It starts with people who eat improperly and once the  condition of unregulated inflammation develops, then under that umbrella,  one could end up with all the listed above common disease.

Insulin resistance falls under this umbrella where something goes arye in the metabolism of glucose within muscle cells.  People don’t get better, they get worse.  It doesn’t cure or arrest with the use of any existing medications. Control of diabetes II and insulin is not cured or suppressed by any existing treatment medications.  The premise is that people who have insulin resistance will slowly but surely deteriorate.  Dr. Glade believes there is something missing in that model.  We are treating a blood level of insulin but not the disease. He suggests that something, possibly environmental is the missing piece.

Research suggest abdominal fat in the visceral organ (around organs inside) appears to be genetically different from much of the than other fat in the body.  It is the most insulin responsive part of the body. In insulin resistance patients, the insulin is not responsive on the muscle whereas the belly fat stores is over reactive and sucks the insulin up.  The degree of hypersensitive reflects as the more inflamed they become.  The more inflamed they are the more tendencies they have to over-store abdominal fat.

Insulin control in the pancreas is disturbed when the body is carrying a high amount of an inflammatory formed, abnormal cytokine molecules produced by the body so one part of the body can communicate with another part. Overreactions throughout the body because of  lifestyle, environment, diet, result in tissue not normally responsive, but will then activate due to an overexposure of inflammation.  This will force the organ to over-respond.  This condition is not well monitored or regulated in the body.  The blood has an almost unlimited capacity to carry these inflammatory molecules in the body.  This response is what needs to be brought under control and can only be accomplished by improved lifestyle, environmental factors, detoxification, and a healthy diet.

Part 2 will address what can be done about this dynamic problem.

[1]Dr. Michael Glade emphasizes  specific dietary plans and supplement protocols, especially in programs targeted at brain function, weight reduction, smoking cessation, and life extension for the terminally ill.  Dr. Glade lectures extensively across the US and Europe. Dr. Glade is a noted researcher who is deeply appreciated in the nutritional and scientific communities for providing a significant body of peer-reviewed substantiation for multiple health claims that have been approved by the FDA.

Insurance – “Medical Necessity” Requirement Part 2

Services:  What does the requirement of  meeting “Medical Necessity” mean? 

What it does not mean is what your doctor thinks is beneficial or necessary.  No, the insurance company decides if recommendations meet community standards which are encompassed in the field of traditional medicine or medical literature reviewed by peers only.

If you see the doctor for a condition or illness that does not include a primary diagnoses, the service cannot be billed at a level that meets coding requirements and will be denied.

Conditions such as yeast infections, depression, anxiety, psychiatric codes, heavy metal burden, multiple chemical sensitivity, erectile dysfunction and many others are not primary diagnoses codes.  Irritable Bowel Syndrome is a primary code (criteria must be met for this as with diarrhea and constipation.)  Gas and bloat are not primary.

Some patients arrive at the doctors office with a short list, wanting only a specific condition addressed.  When this happens, it may automatically set the course for denial by the insurance company.  The insurance company wants to see primary diagnoses codes which are define by a coding standard.  Requirement for correct billing is an appropriate ICD-9 code or billing code and a primary CPT code.  

Uncovered codes are patient responsibility if waiver is signed.  Before you leave the clinic with a laboratory test, we will provide you with the cost of the test and the extent of what we believe your insurance will pay.  That amount will be collected at the time of service.   We cannot guarantee your benefit amount because your insurance will not guarantee the information received when we call and verify benefits.  They state and our business agreement states that you solely are responsible for bill regardless of your insurance coverage.

Sample Profiles (list not complete for covered and uncovered tests):

Pesticide Panels:   You must provide a payment for the total billed to the laboratory.  We can then bill your insurance company, later refunding you if coverage is accomplished. 

Amino Acid Assays, Nutritional Based Assays-most insurance companies do not pay these items, however, through an agreement with the laboratory, we can accomplish quality assays for amino acid serum, RBC mineral, organic acid and fatty acid profile for a very low cost.

Genetic Testing-.While this is not a covered expense at this time, there is talk that it may be in the future.  You should consider, if that benefit becomes available, the consequences your genetics may have on life insurance, for example.  

Comprehensive Detoxification Panel:  Portions of this tests are not covered by insurance, therefore, unbilled portions are paid to the patient.  We notify you what we believe your responsibility will be.

DMPS Chelation Therapy and Metals Challenge Test-Does not meet medical necessity and is therefore paid by the patient.  See next segment.

EDTA Chelation Therapy and Metals Challenge Test-We use this therapy for reducing specific heavy metal burden.  Because the conditions we treat are due to chronic exposure, only on rare occasions does insurance ever pay.  Payment is always due date of service.  Toxicity is defined by blood test only and is rarely seen in patients with acquired body burden.   The appropriate test in this case usually will not qualify you to meet medical necessity.  Payment in full is required by the patient.

Environmental Pollutants-We will not bill for this service as most of it is not covered by insurance, therefore, paid in full by the patient.

Food & Inhalant Testing-covered if qualified.  Qualifying a patient includes ages under four, autoimmune disease and chronic skin conditions such as eczema or psoriasis where the doctor believes skin testing may worsen the condition, chronic use of antihistamines without benefit and steroid use.

Hair Analysis-We will not bill for this service as  it is not covered by insurance, therefore, paid in full by the patient.

Vitamin Mineral IV’s-generally not covered and PPO insurances requires that you provide documentation after the service is performed to see if it meets medical necessity.  Therefore, we require payment upfront with a waiver.  In almost every case, insurance does not cover. 

Nutritional Consults by Certified Nutritionist-typically uncovered. 

Other tests such as the ION and TRIAD panel by Metametrix is payable in advance.  We will then bill your insurance company and refund any portions paid.  

Stool Testing:  Payable if criteria is met.

Center for Environmental Medicine

Health Watch Central

Insurance – Medical Necessity – Part 1

Center for Environmental Medicine is a medical practice providing health care to families and individuals from a holistic approach; applying therapies studied from allopathic (conventional or contemporary medicine whose practitioners prefer to claim “The Standard of Care”), alternative, integrative, complementary and functional medicine or CAM.  These services in the health insurance industry may sometimes fall under the category of “not medically necessary” and is further addressed below.  This is true for all practices.  Additionally, with strictly conventionally practices you will see tests and services that do not meet medical necessity.

The ultimate purpose of our work is to serve and help people regain health and sustain wellness.  Our vision is to create a center that seeks to reach out to the public, to assist in the healing process through detoxification and restoration of the inherent balance in the body with the safest therapies available. Ultimately the goal is to treat the whole body which includes emotional and spiritual health. Our methods may include nutritional biochemistry, lifestyle modification, bodywork, chelation therapy, and bioenergetics.  We address target amino acid which ultimately accesses the balance of neurotransmitter and adrenal support. We provide diagnostic laboratory tests including esoteric tests not generally accepted by mainstream medicine.  We seek to exchange ideas, educate and assess all with a holistic, open-minded and functional medicine approach.  Every member of the health care team, which includes the patient, must understand when we give our best, then we ask for a patient who comes with integrity and interest in resolving their health issues. 

Many people look to their insurance in helping to meet their health care needs.  While we cannot guarantee coverage, we have a good understanding of what information insurance is seeking in order to process a claim efficiently, accurately, and to the benefit of the insured.  We will ask for assistance from the patient in providing supportive assessments related to history which is how we accomplish meeting strict requirements by the insurance company to meet medical necessity.  To be clear, it isn’t always possible.  When insurance is not available, we provide the patient with viable options which may help to accomplish their goals.

The term “medical necessity” is often misunderstood by the patient.  Understanding the definition of this term prior to medical treatment often relieves a patient of frustration as they plan their strategy of an affordable health goal. 

From Wikipedia, a free web encyclopedia related to medical information, medical necessity is a legal doctrine related to activities which may be justified as reasonable, necessary, and/or appropriate, base on evidence-based clinical standards of care.  Definitions to each plan are outlined within the insurance contract to the individual consumer. 

The insurance company may only pay for items and services that are “reasonable and necessary for the diagnosis or treatment of illness or injury…”  Your doctor may have a different opinion outside of this definition based on his clinical experience and scope of practice.  While the insurance company’s goal is to cover specific benefits only, the doctor’s goal is to achieve your healthcare goals. Your insurance company allows for your right to choose the type of care you select, but they reserve the right to make the final determination if they will pay for a service or not.  Ultimately, it is your responsibility to understand what your insurance benefits are. 

Benefits are based on the patient’s specific contract.  Co-pays by law are due before insurance can be billed.  In some cases, a laboratory test may be only partially covered.  In all cases we tell a patient in advance that we do not guarantee coverage, inform them what is usually not covered and allow them to make the choice of how they approach their health.

Center for Environmental Medicine