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Friday, 13 June 2014

Diabetes and Fruit

That's a great question. The answer is no. When it comes to people with diabetes and fruit, blood sugar levels are not so much about what fruit you eat, but how much of that certain fruit you eat. Many people believe that people with diabetes should not eat fruits because they are too sweet or have too many carbs.  Certain fruits do have more sugar than others, but that does not mean you should stay away from them if you have diabetes. Blood sugar levels are more affected by the total amount of carbohydrates you eat than the source of carb or whether the source is a starch or sugar. To the body, they are both sugar. To our eyes, candy bars and baked potatoes seem very different, but our bodies treat the sugar in both of them the same.

A serving of fruit contains 15 grams of carbohydrates. The size of the serving depends on the carb content of the fruit. The advantage of eating a low-carb fruit is that you can eat more of it. But whether you eat a low-carb or high-carb fruit, as long as the serving size contains 15 grams of carbohydrates, the effect on your blood sugar is the same.

The following servings of fruit contain about 15 grams of carbohydrates:

-1/2 medium banana

-1 1/4 cup (190 grams) cubed watermelon

-1 1/4 cup (180 grams) whole strawberries

-3/4 cup (124 grams) cubed pineapple


If you have questions about what to eat or not eat to help manage or even beat your diabetes condition, be sure to see your family doctor or primary care physician as soon as possible to seek treatment. Family doctors and primary care physicians are also great resources for prevention of diabetes as well. You can make this your healthiest year yet! 

Dr. Paul Leavitt is a Board Certified Family Doctor and practices at Leavitt Family Medicine in Hendersonville, TN. At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your questions and comments and invite you to visit us at www.LeavittFamilyMedicine.com Let us know how we can help you today!

Posted on 06/13/2014 10:39 AM by Paul J. Leavitt, M.D.
Tuesday, 01 October 2013

Now that their kids are back in school, many parents are dreading the upcoming cold and flu season.

More and more moms and dads are asking the question, "How can I keep my kids healthy this school year and prevent them from getting colds and flus?"

The way to avoid colds and flus is actually very simple. It starts weeks or even months before the dreaded cold and flu season hits, but it's never too late to start building up your immune system.

There are two factors in the cold-causing process. The first is the exposure to the bacteria or virus. Generally speaking, there is nothing we can really do to prevent our kids from being exposed. In a school cafeteria, bathroom, or classroom, every child will be exposed to every bug, but only a small percentage usually get sick. Why is this? The reason has to do with the second factor in the cold-causing process: susceptibility. Keeping your child’s immunity strong enough so they do not succumb to always-there infectious bugs in the first place is the goal. Here are some tips to keep your children healthy and in school.

Moisturize the Sinuses

During the first weeks of school, exposure to cold-causing bugs is certainly higher. When early Fall hits, the days get shorter and the nights get colder, bringing with them dry, cool air. Heaters can dry the air even more, thereby causing the mucous membranes in the sinuses to dry out. Due to the dryness, mucous membranes produce large amounts of reactive mucus. Pollens can also act as irritants to the sinuses. When excess mucus is produced, it provides the perfect breeding ground for a viral or bacterial infection. Keep sinuses moist by using cool mist humidifiers at night during those early back-to-school days, and keep them running straight through the Winter. Sinuses generally begin to dry out in mid-August, so the end of summer is not too early to start using them.

Early To Bed

One of the most difficult tasks for moms and dads is to get their kids to bed early. Between school and extra-curricular activities, kids can get worn out. Pre-high school kids should be in bed by eight o’clock. For high school kids, lights should be out by ten. If a child is up past these hours regularly, they will wake up tired and soon their immunity will suffer.

Get Hydrated-Drink Water

Dehydration in children can cause stomachaches, bone loss, hormonal problems, obesity, fatigue, mood swings, poor focus ability, skin conditions and much more. An average person can lose two to three quarts of water a day through non-exertion. Active kids can lose twice that amount. For kids doing sports, a two percent loss in body weight due to perspiration creates a 25 percent loss of their athletic ability. A good rule of thumb for active kids is to drink one half of their ideal body weight in pounds in ounces of water per day to avoid dehydration.

Eat Well and Early

In the afternoon, the brain demands the lion’s share of available blood sugar. If all your kids had for lunch was a cookie or a snack (which happens quite often in school), then their blood sugar may crash in the afternoon. This is why kids are ravenous when they get home from school. If you can, leave a good, healthy meal out for them when they get home from school.

Veggies are critical for optimal elimination. The cellulose in vegetables literally attaches to toxins and escorts them out of the body. Avoid late heavy dinners. They are difficult to digest and a quick route to constipation. Moving your bowels once per day is considered normal. Parents need to help their kids track their elimination. If they know what is normal, they can be educated to tell their parents if their elimination is off. Regular bowel movements are key to optimal health and immunity.

Scrub Up

Regular hand washing is one of the single best ways to fight infection. Younger children should be instructed in the importance of proper hand washing before eating, after using the restroom, and as soon as they get home. For situations where hand washing is not possible, supply your kids with small bottles of hand sanitizing gel. Germs and viruses can hitch a ride back home from school, so regular cleaning of kitchen and bathroom counters will go a long way towards lowering the germ count.

If you do catch an upper respiratory infection, such as strep throat, bronchitis, cold, pneumonia, sinus infection, or flu, be sure to see your family doctor or primary care physician as soon as possible to seek treatment. Family doctors and primary care physicians are also great resources for prevention of these infections as well. Following these tips will help your children stay well throughout the upcoming cold and flu season and to make this their healthiest school year yet.

Dr. Paul Leavitt is a Board Certified Family Doctor and practices at Leavitt Family Medicine in Hendersonville, TN. At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your questions and comments and invite you to visit us at www.LeavittFamilyMedicine.com Let us know how we can help you today!

Posted on 10/01/2013 5:13 PM by Paul J. Leavitt, M.D.
Saturday, 06 July 2013

What is Alzheimer's?

Alzheimer's is a form of dementia (also known as Alzheimer's Dementia) that occurs when portions of the brain's neurons (the brain contains approximately 100 billion of them) become damanged and fail to form communication networks. The reasons for this are still unknown. Damaged cells spread and eventually become destroyed, causing irreversible brain damage. While no cure is on the horizon, Alzheimer's is no longer brushed off as a normal part of aging as has happened in the past. Today's physicians are identifying symptoms and treating patients earlier on, thanks to increased awareness and understanding of Alzheimer's dementia.

Risk Factors for Alzheimer's

Age is still the greatest risk factor for Alzheimer's disease. Only four percent of cases are diagnosed in individuals under 65, and are believed to be genetic in nature. Diet and lifestyle choices can play an important role in determining risk factors. Connections have been seen between Alzheimer's and smoking, vascular disease, and higher caloric intake. One positive change people can make as they age is to increase activity, even if it's just walking for a few minutes every day.

Alzheimer's and Heart Health

Smoking, like artery disease, decreases the body's ability to send oxygen and blood to the brain. If patients have vascular disease in the heart, they most likely have vascular disease in other areas of the body, including the brain.

Healthy Body, Healthy Brain

A European study reported a link between obesity and Alzheimer's, mentioning the importance of regular exercise and healthy weight for reducing risk of Alzheimer's. A Swedish study showed patients who were clinically overweight (BMI of 25-30), were 71% more likely to develop dementia. Guidelines from the National Institute of Health recommend seniors exercise at least 150 minutes each week, including strength, balance, flexibility and cardio exercises. A Mediterranean diet is also helpful, proven to decrease cardiac risks and inflammation. Scientists have speculated about a link between possible brain inflammation and Alzheimer's dementia. Also helpful is taking a regular Vitamin D3 supplement for people with a deficiency.

Treatment Options

Family doctors often diagnose and treat patients with Alzheimer's, often times coordinating ongoing support for patients and their families and caregivers. These cases usually take a lot of time, including lengthy meetings with everyone involved in the patient's care. Some things to address include home safety, driving concerns and guns in the home. It's common to meet with the entire family for an hour or more to address these concerns.

While no treatment is available to stop Alzheimer's, medications can be highly effective in slowing progression of the disease. Your family doctor can also help in working to prevent Alzheimer's from happening. As mentioned before, nutrition, activity and lifestyle can all play a part in preventing or slowing the progression of Alzheimer's.

Symptoms of Alzheimer's

  • Memory loss that disrupts daily life
  • Challenges in planning or solving problems
  • Difficulty completing familiar tasks at home, at work or at leisure
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Decreased or poor judgment
  • Withdrawal from work or social activities
  • Changes in mood and personality

Source: Alzheimer's Association

If you or someone you love is experiencing symptoms of Alzheimer's, don't wait. Call your family doctor today. Your doctor can diagnose the patient using tests and can help develop a plan for treatment.

At Leavitt Family Medicine, we are here for you, for all of your health care needs. Let us know how we can help you today!

Posted on 07/06/2013 1:15 PM by Paul J. Leavitt, M.D.
Saturday, 06 July 2013

Be Sun-Smart--Skin-Protecting Tips for Summer

Enjoying Summertime fun almost always includes spending time in the sun. It's important to remember that ultraviolet (UV) rays from the sun can reach you on cloudy days as well as bright and sunny ones. UV rays can also reflect off of surfaces such as sand, water, snow and cement. Tanning by using a tanning bed, booth or sun lamp, can also expose users to UV radiation.

Worst Hours for Sun Damage

Between 10:00am and 4:00pm are the most dangerous for UV exposure outdoors in the continental United States.

What to Do to Protect the Skin You're In

  • Find Shade--especially during the hours listed above
  • Cover up--wear clothing to protect exposed skin
  • Don a Hat--Wear a hat with a wide brim to provide shade for the face, ears, head and neck
  • Sport Shades--Wear sunglasses that wrap around and shut out as close to 100% of both UVA and UVB rays as possible
  • Sunscreen Up--Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection
  • Nix the Bed--Avoid indoor tanning.

Follow Up with your Family Doctor

If your skin does become sunburned, or if you notice changes to your skin, such as new freckles or lesions after sun exposure, go see your Family Doctor. Some second degree sunburns can cause sun poisoning or extensive skin damage.

At Leavitt Family Medicine, your health is important to us. Let us know how we can help you today!

Posted on 07/06/2013 12:53 PM by Paul J. Leavitt, M.D.
Thursday, 06 June 2013

Spot the Symptoms and Take Action

Coughing is the primary symptom of asthma. Children who have asthma often start coughing after running, laughing or crying. They seem to cough more at night and have colds, bronchitis and other upper respiratory infections more frequently than children who do not have asthma. Other symptoms include wheezing, chest tightness and shortness of breath.

When having an asthma attack, children may have trouble talking or they may panic, becoming very anxious. Younger children may complain of stomachaches, headaches or scratchy, sore throats when their asthma is worsening. Other signs include lethargy or reduced energy, running out of breath, being unable to talk, neck muscles tightening or clenching with each breath, chest sucking in with each breath, and lips or nail beds turning grayish or blue.

If your child is having an asthma attack:

  • Remain calm.
  • Follow your child's emergency asthma action plan. (Talk with your family doctor ahead of time about what rescue medication to have on hand and exactly what to do when an asthma attack occurs.)
  • Help your child use his rescue inhaler properly.
  • Encourage your child to breathe slowly and deeply.
  • Call your family doctor if symptoms don't improve.
  • Call 911 if your child is getting worse or having difficulty breathing.

Wishing you and your family Good Health, Happiness, and Success!

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your comments and questions. Please let us know how we can help you today!

Posted on 06/06/2013 9:19 AM by Paul J. Leavitt, M.D.
Thursday, 18 April 2013

Wondering if you could have Diabetes?

Be sure to pay attention to the subtle and not-so-subtle warning signs.

For some people, the signs of diabetes can be obvious. Symptoms such as frequent urination, always feeling tired or run-down, and excessive and near-constant thirst can be hard to miss. But for other people, warning signs of diabetes are more subtle and much easier to miss. In fact, many people do not have any symptoms at all. Usually a routine blood test is what first alerts them to having diabetes. Getting regular blood work is important, because the sooner you know that you have diabetes, the sooner you can take control of it, make wise decisions, and reduce complications.

Diabetes Warning Sign #1: Feeling Fine

For many people, especially in the early stages of diabetes, they feel fine. Maybe not great, but no different than how they have been feeling for awhile. Experts estimate that approximately 7 million people have undiagnosed diabetes. Some people don't have alarmingly high blood sugar early on, others brush off subtle signs or confuse them with other problems. Even if you recognize only a subtle change in how you usually feel, it might be good to see your family doctor. Sometimes people don't know how bad diabetes had been making them feel until they get proper treatment.

Diabetes Warning Sign #2: Strong Thirst and Frequent Urination

People dealing with diabetes have been known to urinate up to 20 times per day, with a full bladder each time. When you have too much sugar (glucose) in your bloodstream, your kidneys kick into high gear to try to get rid of it. As this happens, the excess sugar soaks up water all over your body, causing you to become dehydrated and very thirsty very quickly. Hence the vicious cycle of thirst, urination, and fatigue.

Diabetes Warning Sign #3: Feeling Tired All the Time

Ok, so feeling tired happens to everyone, every now and then. Who couldn't use an extra few hours at the end of the day? For people dealing with diabetes, however, their cells are starving for sugar (glucose), which happens to be your body's primary source for energy. Low sugar in the cells means seriously drained energy. When people have diabetes, the excess blood sugar stays in the bloodstream, instead of going into the body's cells to be used for energy. I call this situation Running on Empty.  Add to this nightly trips to the bathroom, and you will definitely feel like you are dragging.

Diabetes Warning Sign #4: Recurrent Yeast Infections

The reason people with diabetes have frequent yeast infections is simple. Bacteria thrive in a high-sugar environment. They live on glucose. When there is a lot of glucose on hand, bacteria can overgrow, thus displacing the normal flora environment. Common infection sites include the mouth (this specific infection is called oral thrush), and any place where people sweat. Think armpits, neck, the areas between the toes and under the breasts.

Diabetes Warning Sign #5: Slow-Healing Cuts and Infections

Too much glucose in your blood can slow down the efforts of white blood cells, which go to work when your skin is cut, healing the damaged tissue. If you have diabetes, even minor injuries like razor microcuts will take longer to heal and can become infected.

Diabetes Warning Sign #6: Frequent Upper Respiratory Infections, Think Flus, Colds, Bronchitis, Pneumonia

People with diabetes have a weakened immune system that not only makes your cuts and bruises heal slowly but can also make you more vulnerable to the bugs (viruses) that cause colds and flu. You may even find you are just getting over one cold, just to catch another. Or you find yourself taking 'backsets', where you start to get better then get worse again.

Diabetes Warning Sign #7: Your Vision is Blurred

Extra glucose in the blood travels to the eyes and produces a sugar called sorbitol that blurs your vision. It's like looking through a glass that isn't clear. Many times, once the diabetes is treated, the blurred vision gets better. 

Diabetes Warning Sign #8: Unexplained Weight Loss

For people with diabetes, when the body does not get the energy it needs, it starts to break down fat and muscle, causing weight to drop. If you are losing weight and don't know why, call your family doctor. Breakdown of fat for energy can create ketones in the body, which are toxic.

Diabetes Warning Sign #9: You're Hungry All the Time

Diabetes stops sugar (glucose) from entering your cells, so your body can't convert the food you eat into energy. This, in turn, starves your cells. No matter how much you eat, nothing seems to satisfy your hunger. To make matters worse, all that extra food can also cause you to gain weight, which can start the cycle all over again, causing extra glucose (sugar) in the bloodstream. Diabetes causes this debilitating and dangerous cycle. The good news is that the cycle can be stopped.

Diabetes Warning Sign #10: Numbness, Pain, Tingling

For many people, this is the first sign they have a problem. Numbness, tingling, or pain in your feet or hands may be a sign of peripheral neuropathy, a condition caused by damage to your nerves. No one knows exactly why diabetes causes neuropathy, but when cells are starved it follows that the rest of the body (nerves, tissue, organs, bones) will be starved as well. 

If you have any of these symptoms of diabetes, call your family doctor today.Although diabetes can be a challenge, knowing is half the battle. Getting regular physicals with complete blood work is important to staying on top of your overall health. See your family doctor regularly. If you are not feeling exactly right, call your doctor right away. Diabetes can be diagnosed with simple blood testing. Your family doctor can help you manage your diabetes and take control of your health.

Wishing you and your family Good Health, Happiness, and Success!

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your comments and questions. Please let us know how we can help you today!

Posted on 04/18/2013 6:12 PM by Paul J. Leavitt, M.D.
Wednesday, 18 January 2012

You are definitely not alone. This is an issue I hear about quite often in my practice. The key to success for your weight loss is to look at it from each angle. First, it's important to get your thyroid checked with a simple blood test. You will need to look at the full thyroid panel, not just T4 or T3. Your family doctor can help you with this.

Your weight depends more on the number of calories you eat and how much physical activity you get than your metabolism, but it is true that it is more difficult to lose weight if your metabolism is not working properly. If your blood test does show you to have a slow thyroid, or have hypothyroidism, your family doctor can help you with ways to boost your level.

Focus on the factors you have control over. Make sure you are eating a healthy diet and getting regular exercise. Other areas that are important to provide an body environment conducive to weight loss are getting good sleep, positive stress management, and having a good support system. Sit down and talk with your family doctor about all of these areas along with your thyroid test. Your diet and exercise program does not have to be extreme, small changes can lead to big results.

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your comments and questions. Please let us know how we can help you today!

Posted on 01/18/2012 8:55 AM by Paul J. Leavitt, M.D.
Saturday, 12 November 2011

Hypothyroidism is a disorder of the thyroid gland, which is located in your neck. The thyroid produces hormones-- thyroxine or T4 and triiodothyronine or T3, that affect how the body works (for example, controlling metabolism). With hypothyroidism, also commonly known as slow or sluggish thyroid, the gland does not make enough thyroid hormone. Hypothyroidism affects both men and women. It can happen at any age but is more common in adult women.

Symptoms of Hypothyroidism

Mild hypothyroidism may not cause symptoms. Most people do not have all the symptoms listed below, but quite often may have several of the following:

  • Poor appetite and difficulty with bowel movements (constipation) can lead to gaining or losing weight
  • Anemia or low red blood cell or iron count
  • Becoming pale
  • Feeling cold quite often
  • Inability to sweat
  • Frequently feeling tired
  • Problems with mental abilities, including poor memory and feeling depressed
  • Trouble sleeping at night
  • Numbness and tingling in hands and feet
  • Hair changes, such as hair becoming thinner, more coarse or growing slowly
  • The voice may get deeper and raspy
  • Shortness of breath and changes in heart rate
  • Fluid retention especially around the eyes
  • Women may have problems with their menstrual cycle
  • Decreased interest in sex
  • With severe hypothyroidism the tongue may become enlarged, called macroglossia, and the skin may look darkened and rough, a condition known as hyper keratosis

Diagnosing Hypothyroidism

Be sure to sit down and talk with your primary care doctor. Your family doctor can do a complete physical examination and measure levels of thyroid hormones in the blood.

Treatment of Hypothyroidism

Medicine can replace hormones that your body does not make. It is inexpensive, very effective, and available in many doses to properly treat each patient's specific needs. The goal is to provide the body with enough hormone so that it works normally.

The medicine, called synthetic thyroid hormone or levothyroxine, should be taken daily because the body needs a new supply each day. Regular blood tests will ensure the right dose. The correct dose of levothyroxine has no side effects. Patients should start feeling better within a few weeks after starting thyroid medicine.

Dr. Paul Leavitt is a Board Certified Family Doctor in Hendersonville, TN. He enjoys taking care of patients of all ages and has special interests in hypertension, high cholesterol, diabetes, and thyroid disorders.

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We welcome your comments and questions. Please let us know how we can help you today!

Posted on 11/12/2011 1:02 PM by Paul J. Leavitt, M.D.
Saturday, 22 October 2011


One common symptom of gastroesophageal reflux disease (GERD) is heartburn-like pain. But a number of other conditions can cause that burning feeling in your chest.

Most often, your family doctor will be able to identify whether you have heartburn or GERD by doing simple tests.

Nine other conditions that can cause heartburn-like pain

  • Angina-- chest pain caused by lack of blood flow to the heart, can feel a lot like heartburn.

The biggest clue is if you get heartburn when you are doing strenuous or moderate activity. 

Also if you are over age 50 and get heartburn—especially if you have never had this kind of pain before—increases suspicion of angina. Suspicions are also raised for those who are younger but have heart risk factors such as hypertension, diabetes, or a family history of heart disease

  •  Gallstones-- a stone blocking your bile duct can cause pain,normally in the middle or upper-right side of the abdomen. Pain may be cramping, dull, or sharp, and often happens minutes after you eat.

If you have stomach pain after meals that doesn't get better after you take an over-the-counter acid-suppressing medication, gallstones should be suspected.

  • Ulcers-- cause a gnawing, burning sensation, usually felt in the upper abdomen. The pain can radiate up to the chest.

Acid-suppressing medications may help ulcer pain, but ulcers are most often caused by Helicobacter pylori, also known as H. Pylori, a bacteria that inflames the stomach lining, so you will need to see your family doctor and take antibiotics to clear the infection.

  • Hiatal Hernia-- happens when part of the upper stomach pushes through the diaphragm into the chest cavity, rather than staying in the abdomen where it belongs.

This condition pushes food and stomach acid up into the esophagus, causing heartburn. Other symptoms of hiatal hernia include chest pain, belching, and nausea. Your family doctor will typically prescribe acid-suppressing drugs, and recommend lifestyle changes such as eating smaller meals, avoiding alcohol, and not eating right before bed. Surgical repair may be needed in some cases.

  • Esophageal cancer-- this is a rare condition, but its presence is increasing in the United States.

Although having this condition is highly unlikely, if you have longstanding heartburn, and especially if you have risk factors for this condition such as smoking or drinking heavily, your family doctor may decide to order an upper endoscopy to examine your esophagus. 

  • Diabetes-- Poor control of diabetes can lead to nerve damage, which can affect the nerves of your digestive tract. This is called gastroparesis, and it dramatically slows the movement of food through the stomach which can cause heartburn.

For gastroparesis, treatment can include lifestyle changes like eating smaller meals, avoiding fat and fiber and taking medications. The key here is to get your blood sugar under control and your family doctor can help you with this goal.

  • Esophagitis-- Frequent acid reflux can cause inflammation of the esophagus. This condition can lead to more heartburn, as well as difficulty swallowing.

The esophagus can also become inflamed from taking certain medications, particularly if the pills are taken without water, allowing them to remain in the esophagus. Be sure to take medications with plenty of water. A third type of esophagitis, called eosinophilic esophagitis, occurs when white blood cells invade the esophagus. Your family doctor can assist in treatment for this. 

  • Pleurisy-- also known as pleuitis, this condition is an inflammation of the lining of the lungs and chest cavity and can cause heartburn-like chest pain. Pleuritis should be suspected if the pain or burning gets worse when you take deep breaths or are up moving around.

Pleuritis is usually caused by a viral or bacterial infection, and resolves when the infection does.

  • Costochondritis-- inflammation of the cartilage anchoring ribs to the breastbone causes sharp pain along the breastbone or sternum. It can be due to injury or infection, and typically is treated with anti-inflammatory medicines, pain relievers, and rest.


  • Anxiety-- I can't emphasize this condition enough. Although anxiety does not cause GERD, it can cause severe heartburn and make GERD symptoms worse. A person can have both anxiety-related heartburn and GERD-related heartburn. Stress and anxiety exacerbates this condition. One sign it's not just reflux is that treating the reflux problem doesn't make it any better.

Reducing stress and anxiety can ease heartburn. Try exercise, meditation, therapy, yoga, tai chi, or deep breathing.

Your family doctor can help you get to the root of the problem. Especially if acid-reducing medications have not helped, or if your heartburn-type pain is recurring, it is important to sit down and have a good discussion with your family physician about your specific symptoms and how to get to feeling better. 


Dr. Paul Leavitt is a Board Certified Family Doctor and practices at Leavitt Family Medicine in Hendersonville, TN. At Leavitt Family Medicine, we are here for you, for all of your medical and health care needs. We welcome your questions and comments and invite you to visit us at www.leavittfamilymedicine.com Let us know how we can help you today!


Posted on 10/22/2011 9:39 AM by Paul J. Leavitt, M.D.
Thursday, 20 October 2011

Researchers have found people with even slightly elevated blood pressure, called prehypertension, are at a 50% higher risk of stroke than people who have normal blood pressure, known as normotension. This is just one of the many reasons getting to goal, reaching your blood pressure goal, is so important.

Hypertension, or high blood pressure, is life-threatening because it can lead to stroke, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to decrease high blood pressure and protect your body, including blood vessels and organs. Reaching normal blood pressure level has been associated with risk reduction in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.

What are the defined levels of high blood pressure?

  • Normal blood pressure: less than 120/80 mmHg
  • Prehypertension: 120-139/80-89 mmHg
  • Hypertension: greater than 140/90 mmHg
  • Stage 1 Hypertension:140-159/90-99 mmHg
  • Stage 2 Hypertension: 160 or greater/ 100 or greater mmHg

All patients with blood pressure two or more consecutive readings greater than 120/80 should talk with their family doctor about developing a plan to get them to their blood pressure goal.

Your family doctor can help teach you what lifestyle modifications to make, including eating a healthier diet, quitting smoking, and getting more exercise. Temporary treatment with blood pressure medication is recommended to lower blood pressure to less than 140/90 mmHg. This blood pressure medicine can be used until blood pressure is lowered from lifestyle modifications. For patients who also have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80 mmHg.

How to Reach your Blood Pressure Goal

An essential step in preventing and treating high blood pressure is making healthy lifestyle choices. You can lower your blood pressure by implementing these lifestyle changes:

  • Lose weight if you are overweight or obese.
  • Quit smoking.
  • Eat a healthy diet (think lean protein, fresh fruits and vegetables, low fat dairy products, less trans and saturated fat.
  • Reduce the amount of sodium in your diet to less than 1,500 milligrams a day.
  • Get regular aerobic exercise (walk at least 30 minutes a day, several days a week).
  • Limit alcohol to two drinks a day for men, one drink a day for women.

These steps not only lower blood pressure, they enhance the effectiveness of high blood pressure medicine.

High Blood Pressure Follow-Up
After starting high blood pressure medication therapy, you should see your family doctor at least once a month until your blood pressure goal is reached. Once or twice a year, your family doctor will check the level of potassium in your blood and other electrolytes and BUN/creatinine levels (to check your kidney health).

After you reach your blood pressure goal, you should continue to see your family doctor every three to six months, especially if you have other conditions such as heart failure.

 Dr. Paul Leavitt is a Board Certified Family Doctor in Hendersonville, TN. He sees patients of all ages and has a special interest in high blood pressure, high cholesterol, and diabetes. At Leavitt Family Medicine, we are here for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 10/20/2011 9:43 PM by Paul J. Leavitt, M.D.
Wednesday, 19 October 2011

Hypothyroidism is a condition that happens when the thyroid does not make enough hormone. The thyroid gland is in the front of the neck just below the voice box. It releases hormones that regulate metabolism.

The most prevalent cause of hypothyroidism is inflammation of the thyroid gland, which damages glands cells. Hashimoto's thyroiditis, when the immune system attacks the thyroid gland, is the most common example of this inflammation. Some women can develop hypothyroidism after pregnancy (known as postpartum thyroiditis).

Common causes of hypothyroidism include:

  • Congenital (birth) defects
  • Radiation treatments to the neck to treat different cancers, which may also damage the thyroid gland
  • Radioactive iodine used to treat an overactive thyroid (hyperthyroidism)
  • Surgical removal of part or all of the thyroid gland, done to treat other thyroid problems
  • Viral thyroiditis, which may cause hyperthyroidism and is often followed by temporary or permanent hypothyroidism

Early symptoms include:

  • Being more sensitive to cold
  • Constipation
  • Depression
  • Fatigue or feeling slowed down
  • Heavier menstrual periods
  • Joint or muscle pain
  • Paleness or dry skin
  • Thin, brittle hair or fingernails
  • Weakness
  • Weight gain (unintentional)

Later symptoms include if left untreated:

  • Decreased taste and smell
  • Hoarseness
  • Puffy face, hands, and feet
  • Slow speech
  • Thickening of the skin
  • Thinning of eyebrows

A physical examination may reveal a smaller than normal thyroid gland, although sometimes the gland is normal size or even enlarged (goiter). The examination may also reveal:

  • Brittle nails
  • Coarse facial features
  • Pale or dry skin, which may be cool to the touch
  • Swelling of the arms and legs
  • Thin and brittle hair

Your family doctor can order specific lab tests to check for thyroid disorder.

Lab tests to determine thyroid function include:

  • TSH test
  • T4 test

Lab tests may also reveal:

  • Anemia on a complete blood count (CBC)
  • Increased cholesterol levels
  • Increased liver enzymes
  • Increased prolactin
  • Low sodium

The goal of treatment is to replace the thyroid hormone that is lacking. Levothyroxine is the most commonly used medication. Doctors will prescribe the lowest dose possible that effectively relieves symptoms and brings your TSH level to a normal range. If you have heart disease or you are older, your family doctor may start with a very small dose.

Lifelong therapy is required unless you have a condition called transient viral thyroiditis.

You must continue taking your medication even when your symptoms go away. When starting your medication, your doctor may check your hormone levels every 2 - 3 months. After that, your thyroid hormone levels should be monitored at least every year.

Very Important things to remember when you are taking thyroid hormone are:

Do NOT stop taking the medication when you feel better. Continue taking the medication exactly as directed by your family doctor.
If you change brands of thyroid medicine, let your doctor know. Your levels may need to be checked.
Thyroid medicine works best on an empty stomach and when taken 1 hour before any other medications.
Do NOT take thyroid hormone with fiber supplements, calcium, iron, multivitamins, aluminum hydroxide antacids, colestipol, or medicines that bind bile acids.

In most cases, thyroid levels return to normal with proper treatment. However, thyroid hormone replacement must be taken for the rest of your life.

If you are being treated for hypothyroidism, call your family doctor if you:

  • develop chest pain or rapid heartbeat
  • have an infection
  • symptoms get worse or do not improve with treatment
  • develop new symptoms

Be sure to sit down and have an in-depth discussion with your family doctor about your specific symptoms.

At Leavitt Family Medicine, we are there for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 10/19/2011 10:22 PM by Paul J. Leavitt, M.D.
Monday, 17 October 2011

People dealing with diabetes should get a flu vaccine every year. You should get the flu shot fairly early in the Fall because it takes about two weeks to start working. Flu season can last until early Spring, so there are benefits of getting your flu shot until February.  And if you haven’t already done so, a pneumonia shot is also recommended. This can be done any time during the year. One pneumonia shot is generally needed in a lifetime. Some conditions may require an additional pneumonia vaccine.

Why It's Important

Diabetes can weaken the immune system causing people with diabetes to be more likely to catch the flu and also to catch more severe cases of it. People with diabetes are six times more likely to be hospitalized with flu complications. People who have diabetes and get the flu or pneumonia are about three times more likely to die from it. 

More Ways to Protect Yourself this Flu Season

  • Encourage close family and friends to get their flu shot. Flu is highly contagious so keeping others well around you will lower your risk of getting the flu. 
  • Stay away from people who are sick with the flu since it is so contagious.   
  • Regularly wash your hands or use hand sanitizer. This is extremely important. Lysol has also been proven to kill the flu bug. While much of the flu is spread through the air, some is spread through touch. Think of all the things you touch daily that others do as well-phone, doorknobs, remote controls, keyboards, and money. Keep your hands clean especially before eating or touching your face and mouth. Another good habit is to wash your hands thoroughly the first thing when you get home.
  • Be sure to eat well--a healthy diet with good variety to boost your immune system. A diet that is rich in lean protein, fruits, vegetables, and whole grains is a good start. Talk to your family doctor to make sure you are doing all you can to boost your immune system, including getting good levels of vitamins and minerals.

*** Very Important Tip: Always talk with your family doctor before getting any vaccine. The flu vaccine should be avoided if you have an allergy to eggs, chicken, or if you have had a breakthrough flu, meaning you caught the flu two weeks or after getting your flu shot.

Most health insurance policies, including Medicare and Healthspring, cover costs for both the flu shot and pneumonia shot so there is no excuse not to get your vaccinations if you want them.

Dr. Paul Leavitt is a Board Certified Family Physician in Hendersonville, TN who practices at Leavitt Family Medicine. He is Accepting New Patients and Most Insurances including Healthspring and Medicare. We welcome your comments and questions. Let us know how we can help you today!

Posted on 10/17/2011 9:37 AM by Paul J. Leavitt, M.D.
Tuesday, 11 October 2011

Gout is an extremely painful form of arthritis. This condition is chronic in nature with severe, brutal acute attacks. Gout has long been associated with diet, particularly eating too much meat, seafood (shellfish) and alcohol. Because of this, treatment for gout used to involve severe dietary restrictions, which made the gout diet hard to stick with. Now that newer medications are available to treat gout, the need for a strict gout diet has been reduced, although following the guidelines is highly recommended.

The gout diet resembles the healthy eating plan recommended for most people in many ways. Besides helping maintain a healthy weight and avoiding many chronic diseases, this diet may contribute to better overall management of  your gout.


How does gout occur?

Gout occurs when high levels of uric acid in your blood cause crystals to form and accumulate around a joint. Your body produces uric acid when it breaks down purines. Patients with gout either under excrete or over produce uric acid. Which one you are will determine the type of medicine needed to resolve the attack. Purines occur naturally in your body, but you also get them from eating certain foods, such as organ meats (processed lunch meat such as bologna, hot dogs, ham), anchovies, herring, shellfish such as crab and lobster, asparagus and mushrooms.


How does it help?

A gout diet helps to control the production and elimination of uric acid, which may help prevent gout attacks or reduce their severity. If you look at uric acid crystals under a microscope, they look like tiny round balls with spikes all around them. Many patients say gout flare ups feel like hot needles stabbing them. Most cannot even tolerate the weight or touch of a bedsheet on the affected area. The diet is not a treatment for gout, but may help you control the number and severity of attacks. Obesity also is a risk factor for gout, so losing weight can help you lower your risk of attacks.

How does it work?

The gout diet reduces your intake of foods that are high in purines, which helps reduce your body's production of uric acid. If you are overweight or obese, it is important to lose weight. However, avoid fasting and rapid weight loss because these can bring on a gout attack. Drink plenty of liquids to help flush uric acid from your body. Avoid high-protein diets, which can cause you to produce too much uric acid (hyperuricemia).

To follow the diet:

  • Avoid or severely limit high-purine foods, such as organ meats, herring, anchovies and mackerel. Red meat (beef, pork and lamb) that has been cured or processed, and seafood (shrimp, lobster and scallops) are associated with increased risk of gout. Because all meat, poultry and fish contain purines, limit your intake.
  • Eat more plant-based proteins. Increase protein by including more plant-based sources, such as beans and legumes. Limit or avoid alcohol. Alcohol interferes with the elimination of uric acid from your body. Drinking beer, in particular, has been linked to gout attacks. If you're having an attack, avoid alcohol. When you're not having an attack, drinking one 5-ounce serving a day of wine is not likely to increase your risk.
  • Drink plenty of water. Fluids can help remove uric acid from your body. Aim for 8-16 eight-ounce glasses of water a day.
  • Choose low-fat or fat-free dairy products. Some studies have shown that drinking skim or low-fat milk and eating foods made with them, such as cheese or yogurt, help reduce the risk of gout.
  • Choose complex carbohydrates. Eat more whole grains and fruits and vegetables and fewer simple, refined carbohydrates, such as white bread, cakes and candy.
  • Limit or avoid sugar. Too many sweets can leave you with no room for plant-based proteins and low-fat or fat-free dairy products — the foods you need to avoid gout. Sugary foods also tend to be high in calories, so they make it easier to eat more than you're likely to burn off. Although there's debate about whether sugar has a direct effect on uric acid levels, sweets are definitely linked to overweight and obesity.
  • There's also some evidence that drinking four to six cups of coffee a day lowers gout risk in men.

Following a gout diet can help you limit your body's uric acid production and increase its elimination. It's not likely to lower the uric acid concentration in your blood enough to treat your gout without medication, but it may help decrease the number of attacks and limit their severity. Following the gout diet and limiting your calories — particularly if you also add in moderate daily exercise, such as brisk walking — also can improve your overall health by helping you achieve and maintain a healthy weight.

Be sure to call your family doctor and discuss your gout symptoms. By working with your primary care physician you can create a plan to minimize the frequency and severity of your gout attacks.

At Leavitt Family Medicine, we are here for you, for all of your health care needs. We appreciate your questions and comments; Please let us know how we can help you today!


Posted on 10/11/2011 11:35 AM by Dr. Paul Leavitt
Wednesday, 05 October 2011

Being diagnosed with prediabetes is not the end of the world, but it is a wake up call to get in better health. Prediabetes has other names tool-- metabolic syndrome, insulin resistance, syndrome X. If you have any of these terms, it is important to do something about it now.

Before people develop type 2 diabetes, known as diabetes mellitus, they usually have prediabetes or impaired fasting blood glucose. Blood sugar levels > 100 mg/dL (5.5 mmol) but < 126 mg/dL (7 mmol) are considered prediabetes.

Prediabetes means that your blood sugar level is higher than normal, but it's not yet increased enough to be classified as type 2 diabetes. Still, without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less. And, if you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.

There's good news, however. Prediabetes can be an opportunity for you to improve your health, because progression from prediabetes to type 2 diabetes isn't inevitable. With healthy lifestyle changes — such as eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight — you may be able to bring your blood sugar level back to normal. 

Prediabetes/diabetes type 2 has become a worldwide epidemic. 57 million people in the United States have prediabetes and most don't even know it, according to the American Diabetes Association.

Mistakenly, many people who believe they're "borderline diabetic" or have "a touch of diabetes" think that they're safe. But research has shown some long-term damage is being done to the body, especially the heart and circulatory system.

Risk factors for prediabetes and diabetes:

  • Being overweight or obese. This keeps your body from making and using insulin correctly. Being overweight can also cause high blood pressure.
  • Having a parent, brother or sister with diabetes. Having a relative with type 2 diabetes, more than doubles your risk of getting the disease.
  • Being of African-American, American Indian, Asian-American, Pacific Islander or Hispanic/Latino heritage.
  • Having gestational diabetes or giving birth to at least one baby who weighed more than 9 pounds (4.1 kilograms).
  • High blood pressure.
  • HDL or "good" cholesterol is < 35 mg/dL (0.9 mmol/L) or your triglyceride level is > 250 mg/dL (2.83 mmol/L).
  • Exercising fewer than three times a week.


You can have prediabetes and not know it. Two tests are commonly used to diagnose prediabetes:

  • Fasting blood glucose. Measures blood glucose first thing in the morning before you eat. A normal fasting blood glucose is between 70 to100 mg/dL (3.8 to 5.5 mmol). You have prediabetes if your fasting blood sugar is 101 to 125 mg/dL (5.6 to 6.9 mmol).
  • Oral glucose tolerance test. Measures blood glucose after fasting and again 2 hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dL (7.7 mmol) 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dL (7.8 to 11.0 mmol/L). If the 2-hour blood glucose rises to 200 mg/dL (11.1 mmol) or above, you have diabetes.If you have prediabetes, you should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle, including modest weight loss (as little as 5 to 7 percent of your current weight) and increasing physical exercise. This makes a major difference!


Prediabetes often has no signs or symptoms.

Darkened areas of skin, a condition called acanthosis nigricans, is one of the few signs of prediabetes. Common areas that may be affected include the neck, armpits, elbows, knees and knuckles.

Classic red flags of type 2 diabetes to look for include:

  • Increased thirst
  • Frequent urination
  • Fatigue
  • Blurred vision

Consult your family doctor if you're concerned about diabetes or if you notice any type 2 diabetes signs or symptoms.

The exact cause of prediabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.

What is known is that people who have prediabetes aren't quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods.

During digestion, sugar enters your bloodstream and with the help of insulin is then absorbed into the body's cells to give them energy.

Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that unlocks microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

When you have prediabetes, this process begins to work improperly. Instead of fueling your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin or both.

The same factors that increase the risk of developing type 2 diabetes increase the risk of developing prediabetes, including:

  • Weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially around your abdomen — the more resistant your cells become to insulin.
  • Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.Age. The risk of prediabetes increases as you get older, especially after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age. However, older people aren't the only ones at risk of prediabetes and type 2 diabetes. The incidence of these disorders is also rising in younger age groups.
  • Family history. The risk of prediabetes increases if a parent or sibling has type 2 diabetes.
  • Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders — are more likely to develop prediabetes.
  • Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of later developing diabetes increases. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you're also at increased risk of diabetes.
  • Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
  • Inadequate sleep. Several recent studies have linked a lack of sleep to an increased risk of insulin resistance. Research suggests that regularly sleeping fewer than 5.5 hours a night might up your risk of prediabetes or type 2 diabetes.

Other conditions associated with diabetes include:

  • High blood pressure
  • Low levels of HDL, or "good," cholesterol
  • High levels of triglycerides — a type of fat in your blood

When these conditions — high blood pressure, high blood sugar, and abnormal blood fats and cholesterol — occur together along with obesity, they are associated with resistance to insulin. This is often referred to as metabolic syndrome.


Here's some information to help you get ready for your appointment, and what to expect from your family doctor.

What you can do


For prediabetes, some question to ask your family doctor are:

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. And, be sure that you understand your doctor's recommendations before you leave.

What to expect from your doctor
Your family doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

Who should be tested
The American Diabetes Association recommends blood glucose screening if you have any risk factors for prediabetes. This includes if:

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Guidelines from the American College of Endocrinology suggest the following to treat prediabetes:

In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Healthy lifestyle choices remain essential, however.

Because the findings from several recent studies suggest that regularly getting a good night of sleep may reduce insulin resistance, try to get at least six hours or more of sleep each night.

Many alternative therapies — including cassia cinnamon, chromium, ginseng, glucomannan, guar gum, gymnema, magnesium, milk thistle, prickly pear cactus, soy and stevia — have been touted as possible ways to treat or prevent type 2 diabetes. Although some of these substances have shown promise in early trials, there's no definitive evidence that any of these alternative therapies are effective.

If you're considering dietary supplements or other alternative therapies to treat or prevent prediabetes, consult your family doctor. They can help you weigh the pros and cons of specific alternative therapies.

Healthy lifestyle choices can help you prevent prediabetes and its progression to type 2 diabetes — even if diabetes runs in your family.

If the list looks familiar, you're onto something. The same lifestyle changes that can treat or even reverse prediabetes help prevent the condition, too.


    You're likely to start by first seeing your family doctor.
  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You'll probably need to fast for at least eight hours prior to your appointment so that your doctor can measure your fasting blood sugar level.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.Make a list of all medications, as well as any vitamins or supplements, that you're taking.
  • Write down questions to ask your family doctor.Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together.
  • How can I prevent prediabetes from turning into type 2 diabetes?
  • Is there a medication I can take?
  • What types of side effects can I expect from medication?
  • I have other health conditions. How can I best manage them together?
  • How much exercise do I need?
  • Are there foods I need to avoid? Can I still eat sugar?
  • Do I need to see a dietitian?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
  • Has your weight changed recently?
  • Do you exercise regularly? If so, how long and how often?
  • Do you have a family history of diabetes?
  • You're overweight, with a body mass index above 25
  • You're inactive
  • You're age 45 or older
  • You have a family history of type 2 diabetes
  • You're African-American, Hispanic, American Indian, Asian-American or Pacific Islander
  • You have a history of gestational diabetes or have given birth to a baby who weighed more than 9 pounds (4.1 kilograms)
  • You have a history of polycystic ovary syndrome
  • You have high blood pressure
  • You have abnormal cholesterol levels, including an HDL cholesterol below 35 mg/dL (0.9 mmol/L) or triglyceride level above 250 mg/dL (2.83 mmol/L)
  • Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
  • Get more physical activity. Aim for 30 to 60 minutes of moderate physical activity at least five days a week. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day
  • Lose excess pounds. If you're overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
  • Take medications as needed. Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.


At Leavitt Family Medicine, we are here for you, for all your medical needs. We welcome your questions and comments; Please let us know how we can help you.

Posted on 10/05/2011 5:35 PM by Paul J. Leavitt, M.D.
Monday, 26 September 2011

Added sugar is a big concern; Here is what you can do to cut back and ramp up your health 

Most Americans get more than 22 teaspoons — or 355 calories — of added sugar a day, which far exceeds USDA guidelines and American Heart Association recommendations.

 Lots of people are eating and drinking more sugar than ever because it is added to so many foods and beverages. Added sugar is most likely a major factor in the rise in obesity and other health problems.

What exactly is added sugar, what makes it so dangerous and what can we do about it? It does not mean you have to avoid sugar at all costs. Sugar occurs naturally in some healthy foods, including fruits. However, it is added to many other foods and beverages. Desserts, sodas and energy/sports drinks are the top sources of added sugar in most American diets. Foods high in added sugar do nothing to help your health. In face they do little more than add extra calories to your diet. And they pave the way for potential health problems. With a little knowledge, these health problems can be avoided.

Reasons added sugar is in so many foods
All sugar, whether natural or processed, is a simple carbohydrate your body uses for energy. Sugar occurs naturally in some unprocessed foods that are staples of a healthy diet — fruits, vegetables, milk and some grains. Sugar that is added to foods and beverages is known as added sugar. Sugar is added to processed foods because it:

Enhances flavor
Provides texture and color to baked goods
Preserves foods and fuels fermentation
Acts as a bulking agent in baked goods and ice cream
Neutralizes the acidity of foods containing vinegar and tomatoes

Why Added Sugar is Dangerous

Added sugar is often found in foods that also contain solid fats. Together solid fats and added sugars — called SoFAS — make up a whopping 35 percent of total calories in a typical American diet. When you get so many calories from foods containing SoFAS, it's a bad sign. Chances are you are getting too many calories, causing excess weight and obesity

Too much added sugar can lead to such health problems as:

Tooth decay. All forms of sugar promote tooth decay by allowing bacteria to grow. The more often and longer you snack on foods and beverages with either natural sugar or added sugar, the more likely you are to develop cavities, especially if you don't practice good oral hygiene.

Poor nutrition. If you fill up on foods laden with added sugar, you may skimp on nutritious foods, which means you could miss out on important nutrients, vitamins and minerals. Regular soda plays an especially big role. It's easy to fill up on sweetened soft drinks and skip low-fat milk and even water — giving you lots of extra sugar and calories and no nutritional value.

Weight gain. There's usually no single cause for being overweight or obese. But added sugar likely contributes to the problem. Sugar adds calories to food and beverages making them more calorie-dense. When you eat foods that are sugar sweetened, it is easier to consume more calories than if the foods are unsweetened.

Increased triglycerides. Eating an excessive amount of added sugar can increase triglyceride levels, which may increase your risk of heart disease.

Recommendations regarding added sugar
In the 2010 Dietary Guidelines for Americans, the U.S. Department of Agriculture (USDA) recommends cutting back on calories from SoFAS. For most people, that means no more than about 5 to 15 percent of total daily calories should come from SoFAS.

The American Heart Association has specific guidelines for added sugar — no more than 100 calories a day from added sugar for most women and no more than 150 calories a day for most men. That's about 6 teaspoons of added sugar for women and 9 for men.


To reduce the added sugar in your diet, follow these tips:

  • Cut out sugary, nondiet sodas.
  • Limit candy, gum and other sweets that are high in added sugar.
  • Choose breakfast cereals carefully. Although healthy breakfast cereals can contain added sugar to make them more appealing to children, skip the non-nutritious, sugary and frosted cereals.
  • Have fresh fruit for dessert instead of cakes, cookies, pies and other sweets.
  • If you choose canned fruit, make sure it's packed in water or juice, not syrup.
  • Have your children drink more milk or water and less fruit juice and fruit drinks — and yourself, too. Even though 100 percent fruit juice has a high concentration of natural sugar, drinking too much juice can add unwanted calories.
  • Eat fewer added-sugar processed foods, such as sweetened grains like honey-nut waffles and some microwaveable meals.
  • Go easy on the condiments — sugar is added to salad dressings and ketchup.
  • Opt for reduced-sugar varieties of syrups, jams, jellies and preserves.
  • Be aware that dairy-based desserts and processed milk products, such as ice cream and sweetened yogurt, can contain lots of added sugar.
  • Avoid sugar-sweetened tea and blended coffee drinks with flavored syrup, sugar and sweet toppings.
  • Snack on vegetables, fruit, low-fat cheese, whole-grain crackers, and low-fat, low-calorie yogurt instead of candy, pastries and cookies.
  • Recognizing added sugar

If you're not sure which foods and beverages contain added sugar, do not worry.The biggest culprits behind excessive amounts of added sugar are soft drinks and sugary fruit drinks.

Ways to spot added sugar:

  • Check the list of ingredients. Ingredients are listed in descending order by weight. So if you see sugar listed among the first few ingredients, the product might be high in added sugar. Know that sugar goes by many different names, though — it may not be easy to spot added sugar even in the ingredient list. And natural sugars generally aren't included in the ingredient list.
  • Sugar goes by many different names, depending on its source and how it was made. This can make it confusing to identify added sugar, even when you read ingredient lists and food labels. One easy way: Check for ingredients ending in "ose" — that's the chemical name for many types of sugar, such as fructose. There's no nutritional advantage for honey, brown sugar, fruit juice concentrate, or other type of sugar over white sugar.

Common types of sugar and added sugar:

  • Brown sugar. Granulated white sugar with added molasses for flavor and color, commonly used in baking.


  • Cane juice and cane syrup. Sugar from processed sugar cane. Further processing produces brown or white solid cane sugar.


  • Confectioners' sugar. Granulated white sugar that has been ground into a fine powder, sometimes with a small amount of cornstarch. Commonly used in icings and whipped toppings.


  • Corn sweeteners and corn syrup. Corn sugars and corn syrups made from corn and processed cornstarch.


  • Dextrose. Another name for glucose.


  • Fructose. Sugar that occurs naturally in fruits, vegetables and honey.


  • Fruit juice concentrate. A form of sugar made when water is removed from whole juice to make it more concentrated.


  • Glucose. A simple sugar that provides your body's main source of energy. Also called blood sugar because it circulates in your blood.


  • Granulated white sugar. This is table sugar, or pure crystallized sucrose, made by processing raw sugar from sugar cane or sugar beets. It's commonly used in baking or to sweeten tea or coffee.


  • High fructose corn syrup. The most common sweetener in processed foods and beverages, this is a combination of fructose and glucose made by processing corn syrup.


  • Honey. A mix of glucose, fructose and sucrose created from nectar made by bees.


  • Invert sugar. Used as a food additive to preserve freshness and prevent shrinkage, this is a mix of fructose and glucose made by processing sucrose.


  • Lactose. Sugar that occurs naturally in milk.


  • Maltose. Starch and malt broken down into simple sugars and used commonly in beer, bread and baby food.


  • Malt syrup. A grain syrup made from evaporated corn mash and sprouted barley.


  • Molasses. The thick, dark syrup that's left after sugar beets or sugar cane is processed for table sugar.


  • Sucrose. The chemical name for granulated white sugar (table sugar).


  • Syrup. Sugar comes in many forms of syrup, a thick, sweet liquid that can be made from the processing of sugar or from sugar cane, grains such as corn or rice, maple sap, and other sources.


  • White sugar. Same as granulated white sugar (table sugar).


From my experience as a family doctor, I have seen that sugar can have an addictive quality. Have you ever noticed when you eat sugary or salty snacks it is not long until you crave them again? You can break the cycle. It only takes about two weeks to end the craving for sugar. So the next time you're tempted to reach for a sugary drink, grab a glass of water instead.

Talk to your family doctor about tips to change your health for the better. At Leavitt Family Medicine, we are here for you, for all your medical needs. Please let us know how we can help you today!

(Information Source:Mayo Clinic)

Posted on 09/26/2011 9:31 AM by Paul J. Leavitt, M.D.
Friday, 23 September 2011

Is it true that smoking causes wrinkles?

Yes. Premature wrinkles are great reasons to quit smoking, and the sooner the better. Smoking can speed up the normal aging process of your skin, contributing to wrinkles. These skin changes may occur after only 10 years of smoking.

The more you smoke and the longer you smoke, the more skin wrinkles you are likely to have — even though the early skin damage from smoking can be difficult to see at first.

Smoking does not cause wrinkles just on your face. Smoking is also associated with increased wrinkling and skin damage on other parts of your body, including your inner arms. You can prevent worsening of wrinkling by quitting smoking now.

How does smoking lead to wrinkles? The nicotine in cigarettes causes narrowing of the blood vessels in the outermost layers of your skin. This reduces blood flow to your skin. With less blood flow, your skin does not get as much oxygen and important nutrients, such as vitamin A.

Many of the over 4,000 chemicals in tobacco smoke also damage collagen and elastin, which are fibers that give your skin its strength and elasticity. As a result, skin begins to sag and wrinkle prematurely because of smoking.

Also, prolonged and repeated exposure to heat from burning cigarettes and the facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — may contribute to wrinkles.

If you are interested in quitting smoking, talk to your family doctor and work together to form a plan that will best help you quit for good. The benefits to your body begin within the first 24 hours of stopping smoking.


 ]At Leavitt Family Medicine, we are here for all of your medical needs. We welcome your questions and comments; please let us know how we can help you today!

Posted on 09/23/2011 10:33 AM by Dr. Paul Leavitt
Thursday, 22 September 2011

My resolution this year was to take better care of my health. I was diagnosed last year with metabolic syndrome. What can I do to fix this?

Metabolic syndrome is simply insulin resistance and inflammation within the body. It is also known as pre-diabetes or syndrome X. The American Heart Association defines metabolic syndrome as having an elevated waist circumference, high triglycerides, reduced good cholesterol (HDL), hypertension (>130/85), and elevated blood sugar.

Common risk factors are stress, obesity and sedentary lifestyle. . You are not alone as many people deal with this syndrome and the good news is it is reversible. Positive changes include daily physical activity, reduced caloric intake, finding new outlets to handle stress, losing excess weight and limiting sugar, salt, and fat in the diet.

A great way to track your progress is to sit down and talk with your family doctor as you begin your lifestyle changes. Get your complete blood work done and discuss your plan to achieve your health goals. Redrawing labs every six months will show what progress you’ve made in improving your health. Your doctor can be a great partner and coach in helping you achieve your health goals. This is the year to begin living the life you want to live!

At Leavitt Family Medicine, we are here for you. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 09/22/2011 5:02 PM by Dr. Paul Leavitt
Thursday, 22 September 2011


For a while now, I have had abdominal pain. I thought it would go away, but it hasn’t. What could it be?

Sometimes new patients to my practice say they have lived with abdominal pain for years. They have been told it is in their head or that it is part of getting older. Nothing could be further from the truth. Abdominal pain can be somewhat tricky to deal with, but with a good history and physical examination, the cause of the pain can be found.

Think of your abdomen as a tic-tac-toe board. Right upper pain can be gallstones or a liver mass. Middle pain can be a stomach ulcer, inflammation of the pancreas or gastritis. Left sided pain can be diverticulitis or sometimes constipation. Pain along the sides can be either a kidney infection or renal stones. Lower abdominal pain can signify appendicitis on the right side and sigmoid spasms on the left. Generalized pain can sometimes be celiac sprue, irritable bowel syndrome, or Crohn’s disease. Ulcerative colitis usually starts from the rectum and works backward.

The key to getting rid of the pain is getting medical attention right away. Sit down and have a discussion with your family doctor about your specific abdominal pain.

At Leavitt Family Medicine, we are here for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 09/22/2011 11:36 AM by Dr. Paul Leavitt
Wednesday, 21 September 2011

I have diabetes and check my blood sugar four times a day. Is there a better way of monitoring my blood sugar?

Yes, there could be. If you have non-insulin dependent diabetes mellitus, known as type 2 diabetes, daily blood glucose monitoring may not be necessary. 

Two different blood tests are available to help monitor your blood glucose levels. 

The first test is the hemoglobin A1C test, which measures what your blood sugar has been running on average for the last three months.  You do not need to be fasting for this test to get an accurate reading. 

The second test is new, and is called the Glycomark test.  This test has been approved by the FDA to measure intermediate term glycemic control with diabetes. It allows your doctor to determine how well your blood sugar is controlled after eating meals, which can be problematic for patients with diabetes.

Both tests are usually done every three to six months. Be sure to sit down and have a good discussion with your family doctor about achieving and maintaining your blood sugar goals.

At Leavitt Family Medicine, we are here for you, for all of your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 09/21/2011 3:46 PM by Dr. Paul Leavitt
Wednesday, 21 September 2011

I have been told I have high cholesterol. What is normal and how can I get there?

Reaching your cholesterol goal is one of the most important things you can do for your health. Hyperlipidemia, or high cholesterol, is directly associated with increased risk of heart disease, coronary artery disease, stroke, and heart attack.

Your cholesterol level, found through a simple blood test, includes Total Cholesterol, HDL (known as good cholesterol), Triglycerides (a type of fat found in your blood), and LDL (known as bad cholesterol).

Normal range for most adults is Total Cholesterol (125-200mg/dL), HDL (>40mg/dL), Triglycerides (<150mg/dL) and LDL (<130mg/dL).

However, patients with coronary heart disease or diabetes should aim for an LDL of <100mg/dL; patients with diabetes and known heart disease should aim for an LDL of <70mg/dL.

Ways to lower your cholesterol include lifestyle modifications such as eating a heart-healthy diet—reduce saturated fat (especially trans fat) and salt intake, doing at least 30 minutes of physical activity every day—walk, bike, swim, jog, dance—whatever you love to do, do it, reducing stress, not smoking, and getting enough sleep.

Natural supplements, such as Omega 3 fatty acids from fish oil, vitamin E, and antioxidants will help. Also, various medications can lower blood cholesterol levels. The types of medications include statins, selective cholesterol absorption inhibitors, resins (also known as bile acid-binding drugs), fibrates, and niacin.

For the best possible results, you should sit down and talk with your family doctor. Discuss your specific cholesterol goals and how to reach them.

At Leavitt Family Medicine, we are here for you, for all your medical needs. We welcome your questions and comments; Please let us know how we can help you today!

Posted on 09/21/2011 12:12 PM by Paul J. Leavitt, M.D.
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