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Posts from the ‘Prevention’ Category

Resist The Resistance: How to Combat the Global Antibiotic Crisis

Image Courtesy of The Economist – “The Spread of Superbugs”

“The growth of antibiotic-resistant pathogens means that in ever more cases, standard treatments no longer work, infections are harder or impossible to control, the risk of spreading infections to others is increased, and illnesses and hospital stays are prolonged.”


Antibiotic resistance is one of the most significant public health crises this planet faces today. Every year, the human species grows increasingly resistant to antibiotic treatment, largely due to the overuse or improper application of these medications. As a primary care doctor, I am frequently asked to prescribe antibiotics for illnesses that are not caused by bacterial pathogens.

The implications of this kind of abuse of antibiotics are so extreme that recently the CDC created its own FAQ homepage dedicated to informing and educating the public on antibiotic resistance, calling this issue “one of the world’s most pressing public health problems.”

So today I would like address some of the issues surrounding antibiotics and antibiotic resistance and also explain how you, as a savvy patient, can naturally boost your body’s immunity to bacterial infections so you’ll have less need for antibiotics.

Q: What is antibiotic resistance and how can it happen to me? 

A: Antibiotic resistance occurs when harmful bacteria and other microbes learn how to work around or sabotage antibiotic medications  used by doctors, veterinarians and agricultural producers to kill them off (examples: Amoxicillin, Cipro and Zithromax). Bacteria are clever and can “learn”: the more often and longer harmful bacteria “see” antibiotics, the better chance they have to transform themselves in ways that they become resistant. This is happening more and more, principally from the improper use of such medications.

Antibiotics are ineffective in treating illnesses caused by viruses such as the common cold, the flu, and actually the majority of common coughs and other common illnesses like sore throats. Yet because members of the general public do not understand this fundamental difference, these antibiotic drugs are often prescribed for problems not associated with bacterial infections – causing long-term resistance to treatment on part of the bad bacteria while the good bacteria in our bodies gets killed off unnecessarily. (In future blogs we’ll talk more about the importance of “good” bacteria in our guts.)

Q: Why should I care about antibiotic resistance? 

A: Progressive resistance by bacteria to treatment with antibiotics is a major public health crisis happening RIGHT NOW! Scientists find that most bacteria  have become resistant to antibiotic treatment due to non-discretionary use of such treatments. Over time, this has made it increasingly more difficult to properly treat serious illnesses caused by bacteria. While this is most devastating to weak or immune-compromised individuals, everybody’s health is at risk due to this resistance, so more discretion needs to be used to avoid escalation of this public health problem.

Q: How might I be inadvertently causing resistance in my body?

A: One common dangerous mistake is when you only take part of a prescription of antibiotics you DO need before your infection is fully treated. You’ll kill the susceptible bacteria, and the resistant ones left behind will grow wild. Always complete the course of treatment.

Side effects?  Call your doc, don’t just stop early!

Q: How can I naturally boost my immunity to bacterial infections? 

A: It’s easy! You can start with these simple steps:

1) Try taking an over-the-counter probiotic supplement once per day. “VSL3” is one probiotic that I particularly like, however there is a wide variety of probiotic products available at grocery stores and pharmacies which will all be helpful in aiding your immune system.

2) Taking 10 mgs of a zinc supplement daily has also been shown to be quite useful in preparing your body for a bacterial attack – it has beneficial effects on our immune cells, particularly CD3 and CD4 cells which help our bodies fight off infections. (Disclaimer: DO NOT TAKE ZINC IF YOU HAVE KIDNEY PROBLEMS!) If you prefer to get your nutrients from foods, here is a list of high-zinc foods:

3) Take 100-200 mg of Ginseng per day. Ginseng has been used for thousands of years in traditional Chinese medicine for effective immune enhancement and is another fabulous (and natural!) way to limit your need for antibiotic treatment.

4) WASH YOUR HANDS! Only plain soap and warm water are necessary. Wash your hands thoroughly for 30 seconds in the sink after potentially coming in contact with bacteria. Anti-bacterial soap is not required to make this effective, in fact the FDA has recently warned that these soaps may be posing an additional problem for bacterial resistance to antibiotics.

5) Most importantly: Talk to your primary care doctor when you are sick and work with her/him cooperatively on the best treatment. Many illnesses can be treated without antibiotic medications – and these drugs should not be used thinking they are a “fool-proof” method for becoming well every time you’re feeling under the weather.

Stay well and here’s to hoping you’ve learned something new!

Dr. Nolfo

Making 60 The New 40!


As an internist (A.K.A. adult medicine doctor, primary care provider), one of the best things about my job is variety. My youngest patient is 17; my oldest patient recently passed away peacefully at 104 and 4 months!

Two weeks ago I wrote here about helping my younger patients develop great health habits. Today, I want to focus on my patients over 35. (To my 35 and unders who are reading: share this with the ‘rents!)

I believe strongly that it’s never too late to make healthy life changes. NEVER! Using myself as an example, I was starting to get the creaks and groans of arthritis in the morning. Hours on the computer at the office were causing my shoulders to hunch forward, and I was starting to notice that I wasn’t as strong as I used to be, which is a sign of the natural loss of muscle mass that is especially bad for women as they age.

So my husband must have thought he wants me to hang around a while, because for Christmas 2013 he signed me up for some sessions with a personal trainer. THIS HAS BEEN LIFE-TRANSFORMING FOR ME! My trainer is Steve Cioppa*. Today we are going to hear from Steve in an interview with him I conducted earlier this week. But first……


While I’m well aware that all of your medical specialist should be board certified, I did not know how important a personal trainer’s certification is! Some trainers have literally only a few hours of training and do not know the physiology of the human body well enough not to seriously hurt you! 

So now that we’ve spilled some knowledge on ya about this topic , let’s spill a little more with an expert in the field!

:::: Check out this interview with CT Personal Trainer Steve Cioppa :::


Dr. Nolfo: Thanks for sitting down with me today Steve. Can you tell our readers what it means to be a certified personal trainer and why it’s so important for your clients?

Steve Cioppa: Your trainer should be certified by a nationally recognized organization such as NATIONAL STRENGTH AND CONDITIONING ASSOCIATION (NSCA) , THE AMERICAN COLLEGE OF SPORTS MEDICINE (ACSM) , THE AMERICAN COUNCIL ON EXERCISE (ACE) or THE NATIONAL ACADEMY OF SPORTS MEDICINE (NASM). A certified trainer will have rigorous training and also ongoing requirements for continuing education to maintain certification. There are many additional specialized certifications trainers can get on top of this  for example, I am certified to train with TRX  but they need the solid background.

Dr. Nolfo: Steve, what should the trainer do for you?

Steve Cioppa: As you get older, the focus should be on functional strength and fitness. Not only should your trainer be able to help you make your daily life tasks easier, you should be able to advance far beyond that and increase your ability to garden longer, shovel snow easier or improve in any sport you play. One of my 60+ year old clients was upset with me because he had to change all the clubs he used for golf after he added 20 yards to his golf swing! 

Steve Cioppa: Your trainer should have the skill simply to look at your posture and tell which of your muscles are weak and underused and prescribe corrective exercises to balance your body. This can eliminate a slew of unnecessary pains and limitations. I always recommend stretching the hip flexors and strengthening the posterior muscles.

 Here are examples of anterior pelvic tilt:

Here is an example of “upper cross syndrome”, which can cause shoulder pain and a hunched back:


Steve Cioppa: Look at the diagram of Upper Cross Syndrome. In this case, I would work on strengthening the rear shoulder muscles and stretching the chest area.

Dr. Nolfo: What would you say to those of our readers who might ask: “Isn’t it expensive to work with a certified trainer?”

Steve Cioppa: What is it worth to you to be stronger, have better balance, have more energy and have better body composition, which helps your metabolism? And those are only a tiny portion of the benefits. As Dr. Nolfo has written before, exercise, reduces risks of diabetes, cancers and Alzheimers. What is that worth? That’s everyone’s choice.”

Dr. Nolfo: Thank you so much for all the useful information! I will say, working with a personal trainer is without a doubt the best decision I’ve made in this stage of my life. Last night my daughter’s rock band played a gig and afterward we helped her bring her drums to the outside of the club. I snatched up a heavy cymbal bag and two drum stands like it nothing was nothing and I realized I could not have carried them so easily last year! It was a pretty empowering feeling. 

Steve Cioppa is a NSCA Certified personal trainer / TRX certified trainer with over 20 years of experience.  He can be reached at 203-767-5899 or

Work with a trainer? Think about it. As always, the information I have posted for you here is completely unsolicited – I have no financial ties with Steve!

Have a fabulous weekend,

Dr. Nolfo

Fighting Bad Cholesterol With GOOD Methods!

Re-calibrating Our Views On Cholesterol

As a doctor of Internal Medicine, I find that one common misconception many of my young adults (ages 35 and below) have is that “bad” (LDL or non-HDL) cholesterol is a problem of older age.  Too often the sentiment “Live while you are young!” is taken out of context by people in their teens, twenties and thirties to mean “Don’t worry about your health till you are older.” While it is true that after we reach the age of 20 our cholesterol levels begin naturally to increase, there are many factors besides age that determine the levels of bad cholesterol in our blood. While some of that is hereditary, many of these factors can be monitored and controlled from quite a young age. While I am a firm believer in living life to the fullest – I also am adamant that the choices we make about our health and wellness in our formative years provide a strong baseline for our bodies and minds of the future.

The Problems of Waiting Out Your Youth To Correct Cholesterol Levels

Patients of mine above the age of 50 are certainly at a higher risk of cardiovascular complications related to bad cholesterol than their younger counterparts. However, even children with poor dietary habits can have alarmingly high bad cholesterol levels and even the beginnings of blocked arteries before high school!

When one of my older patients at high risk has a very high LDL cholesterol (>190) and we have not been able to improve it with lifestyle changes such as exercise and diet, I may decide to use a prescription treatment for lowering those levels  to minimize the risks of complications like strokes or heart attacks. The most widely prescribed are statins, which quickly reduce bad cholesterol levels in the blood . Statins, such as Lipitor, Crestor or Zocor, work by inhibiting HMG-CoA reductase,  a liver enzyme which promotes cholesterol production in the human body.

(By the way, I have always advised my patients to CONTINUE their lifestyle efforts and to take Coenzyme Q10 whileon the statin, because statins deplete this substance which is a vital co-factor in your cells’ energy production.)

Despite the fact that I prescribe these medicines, as an advocate of a natural approach to health whenever possible, I’d much prefer that my patients never reach the point where taking a statin becomes their best option. While statins have proven to be extremely effective in reducing levels of bad cholesterol – their efficacy can be trumped by an array of side effects: muscle pain (not uncommon), liver problems (very rare) and increased risk of diabetes among them.

Today I’d like to talk specifically about one somewhat surprising side effect of statin use which has recently been highlighted by researchers in the peer-reviewed journal, Obesity.

In a new study, based on over 10 years of data collection, researchers found that patients prescribed statins “significantly increased their fat intake and calorie consumption, along with their BMI, in the last decade,” 

Why, you ask?  Patients taking these enzyme inhibitors are well aware of their positive benefits and therefore have a propensity for poor diet and lifestyle choices while prescribed them. Too often the mindset of “I take pills to lower my cholesterol – therefore I can eat whatever I want without getting sick” apparently becomes commonplace in those suffering from these kinds of health issues. Patients can become complacent with a poor, unhealthy lifestyle after viewing remarkably improved blood work results from a course of statins – and this is NOT a trend that doctors and patients should continue! When I read this I remembered that when the first statin, Mevacor, came out, one of my fellow doctors in my residency program told me he took it so he could “keep eating bacon and eggs”!

“Ok – I get it, Dr. Nolfo. You’d prefer I didn’t have to take statins if I had the choice. So what do I do instead? “

 I am SO glad you asked! There are many ways to keep our cholesterol at a healthy level:

1. Exercise!

Yes, I know I say it a lot. But countless other physicians and researchers like myself agree: Lack of physical activity can increase bad cholesterol (LDL) – and even DECREASE the good cholesterol! (HDL)

   2. DON’T SMOKE!

Smoking has been proven to lower your good cholesterol – BAD, BAD, BAD! And I seriously hope we don’t need to review the thousands of other health complications that can arise from such a terrible habit. Please don’t smoke! I like you just the way you are! 😉

3. See Your Primary Care Doctor Regularly

General health plays a large role in our cholesterol levels. It is best that you make regular visits with your primary care doctor so you can be screened for other health complications such as diabetes or hypothyroidisim, which can cause high cholesterol. Plus, it’s just the smart thing to do!

4. Eat Healthy, Real, Unprocessed Foods!

Clearly you saw this one coming! Diet is one of the most crucial factors in our cholesterol. Highly processed foods like chips, cookies, margarine, etc. can easily raise our levels of bad cholesterol. I have posted an array of healthy recipes of all kinds throughout this blog – please review for some great meal ideas to start changing your diet today! Vegan and Mediterranean diets have been shown to help cholesterol profiles. There is a little controversy about the effect of the Paleo diet on cholesterol, but my Paleo patients’ cholesterol profiles are usually quite good.\ because they don’t limit themselves to all meats and eggs and eat tons of fruits and veggies.

And just to give you a head start on the eating part – try this delicious and healthy black bean, corn and edamame salad! Not only is it perfect for the start of summer, but a new study shows that beans can help significantly reduce our bad cholesterol!

Go ahead, try this stuff!

Dr. Emily Nolfo

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