JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Your Life Your Health - Lipoic Acid and the Antioxidant Network

James L. Holly,M.D.

September 25, 2003

Your Life Your Health - The Examiner

While many antioxidants are found in the diet, and play important roles in supporting health, conventional antioxidants are like facial tissue: use them once, and they are no good to you any more. The antioxidant network is different. While other antioxidants work in isolation, the five members of the antioxidant network work together to form the indispensable core of the body's free-radical defense and "recycling" system. The antioxidants network is made up of:

The vitamin E complex (tocopherols plus tocotrienols),
Vitamin C
Coenzyme Q10
Glutathione (GSH)
Alpha Lipoic Acid (The R portion of Alpha Lipoic Acid is the important part)

The network antioxidants have the unique ability to "recharge" one another into their active forms once they have inactivated free radicals. Of this network, lipoic acid is the least-known, yet it plays the most important role. Lipoic acid's place at the heart of the network springs from its remarkable versatility. Alpha lipoic acid is the most important antioxidant for anyone to take. Alpha Lipoic acid is:

Soluble in both fat and water, which means it is active in both cellular membranes and watery cellular fluid;

Retains some of its antioxidant powers even after stepping in to block free radicals
Able to directly or indirectly "recycle" all of the other members of the network back to their active antioxidant form when they become neutralized in taking down free radicals.
The only antioxidant you can get from diet and supplements that will actually restore the youthful efficiency and energy-producing potential of the body's cellular "power plants" (the mitochondria).

In the late 1980s, scientists realized that alpha-lipoic acid, a compound initially classified as a vitamin when it was discovered three decades earlier, possessed potent antioxidant properties that could prevent healthy cells from getting damaged by unstable oxygen molecules called free radicals. In fact, this vitamin-like compound has proved to be many times more potent than such old guard antioxidants as vitamins C and E.

Because it dissolves in both water and fat, this so-called "universal antioxidant" is able to scavenge more wayward free-radical cells than most antioxidants, the majority of which tend to dissolve in either fat or water but not both. Alpha-lipoic acid can reach tissues composed mainly of fat, such as the nervous system, as well as those made mainly of water, such as the heart.

Also known as lipoic acid or thioctic acid, alpha-lipoic acid is mainly derived from dietary sources:

Spinach
Liver
Brewer's yeast

Scientists have discovered that the body does manufacture small supplies of its own. In order to get the concentrated doses needed to treat specific ailments, however, many experts recommend supplements.

Health Benefits

In addition to functioning as an antioxidant, lipoic acid assists the B vitamins in producing energy from the proteins, carbohydrates, and fats consumed through foods. Intravenous forms of alpha-lipoic acid are administered in hospitals to treat cases of acute mushroom poisoning and for other cases of acute poisoning that affect the liver.

Studies indicate that alpha-lipoic acid supplements hold promise for treating various disorders, including HIV infection, liver ailments, and glaucoma. But it has been most intensively studied for preventing complications from diabetes. Specifically, alpha-lipoic acid may help to treat symptoms of nerve damage in people with diabetes.

Diabetic Neuropathy (Nerve Damage)

Alpha-lipoic acid has been used for decades in Europe to counter nerve damage in people with diabetes (types 1 and 2). Known as diabetic neuropathy, this often very painful condition tends to develop in people who have had uncontrolled diabetes for a long time. The neuropathy may be caused in part by free-radical damage to nerves resulting from poorly regulated blood sugar (glucose). As an antioxidant, alpha-lipoic acid helps to block such damage. In addition, because of its effect on glucose metabolism, lipoic acid may improve the glucose-lowering action of insulin (the hormone that regulates blood sugar).

In one clinical trial, 328 people with diabetic neuropathy received either 100 mg, 600 mg, or 1,200 mg a day of alpha-lipoic acid for three weeks. Participants who took 600 mg daily had the greatest reduction in pain and numbness. In a separate study, blood sugar levels dropped in 74 people with type 2 diabetes who took 600 mg or more of alpha-lipoic acid daily.

Alpha-lipoic acid may also aid the large percentage (approximately 25%) of people with diabetes who risk sudden death from nerve-related heart damage. In one study, improved heart function was observed in people at risk for this complication who took 800 mg of alpha-lipoic acid daily for four months.

Preserving brain function in aging adults

Results from animal studies indicate that alpha-lipoic acid may improve long-term memory. Much remains to be learned about whether this occurs in humans, but it may be worth trying this powerful antioxidant when a disease such as Alzheimer's starts to erode memory. In addition, alpha-lipoic acid holds promise for preserving brain cells following a stroke or other type of trauma that restricts blood flow to the brain.

Preventing cancer

As an antioxidant, alpha-lipoic acid holds promise for protecting the body against changes in healthy cells that lead to cancer. The evidence for this cancer-preventive effect is still preliminary, however.

Lessening numbness and tingling

Alpha-lipoic acid may benefit anyone whose limbs tend to tingle or become numb, or "fall asleep" due to nerve compression. In animal studies, alpha-lipoic acid increased blood flow to the nerves and improved transmission of nerve impulses.

Protecting the liver in cases of hepatitis and other types of liver disease.

As an antioxidant, alpha-lipoic acid shields the liver from potentially harmful cell changes and assists it in flushing toxins from the body. This makes it useful in treating such liver disorders as chronic hepatitis and cirrhosis. Alpha-lipoic acid supplements have also proved effective in minimizing liver toxicity following exposure to poisons such as heavy metals (including lead) and toxic industrial chemicals such as carbon tetrachloride.

Combating chronic fatigue syndrome

Because it plays a part in cellular energy production, some nutritionally oriented physicians recommend alpha-lipoic acid for the treatment of chronic fatigue syndrome. While evidence of its effectiveness for this condition is anecdotal, alpha-lipoic acid is a broad-spectrum antioxidant and immune system booster. This means it may be able to play a valuable role in increasing energy and maintaining overall health in chronic fatigue syndrome sufferers.

Reducing the incidence of cataracts

Alpha-lipoic acid has kept cataracts from forming in animals, an effect that may occur in humans, too, but still requires more investigation. The compound also increases the potency of vitamins C and E, both nutrients that protect the eye's lens from harmful ultraviolet light.

General Information about alpha-lipoic acid

You can buy alpha-lipoic acid either as a single supplement or in combination products with other antioxidants, such as vitamins C and E.

For general antioxidant protection: Take 100 mg twice a day.
To preserve brain function in aging adults: Take 100 mg twice a day.
To prevent complications of diabetes: Take 200 mg twice a day to guard against related conditions such as cataracts, macular degeneration, and heart disease. In addition, make sure to get 1,000 mg vitamin C and 400 IU vitamin E daily.
For diabetic neuropathy: Take 200 mg three times a day.
For numbness and tingling: Take 200 mg twice a day.
For hepatitis: Take 100 mg twice a day. In addition, take 1,000 mg vitamin C and 400 IU vitamin E daily.
For preventing cataracts: Take 100 mg twice a day.

Guidelines for Use

Alpha-lipoic acid can be taken either with or without food.

If you have diabetes, taking alpha-lipoic acid for long periods may require an adjustment in your dosage of insulin or other diabetes medications. Consult your doctor for guidance.

Possible Side Effects

Alpha-lipoic acid is very safe at commonly recommended dosages, although occasionally it causes mild stomach upset and in rare cases it can trigger an allergic skin rash. If you experience any of these reactions, reduce the dose or stop taking the supplement.

Cautions

If you suffer from any type of medical condition, consult your doctor before trying alpha-lipoic acid supplements. Don't take alpha-lipoic acid if you are pregnant.

The following are some recommended dosages for various ailments:

Aging -- 100 mg once a day
Cancer Prevention -- 100 mg twice a day; may be partially covered by daily antioxidant complex
Cataracts -- 100 mg twice a day
Chronic Fatigue Syndrome -- 100-200 mg a day
Diabetes For antioxidant protection -- 100 mg twice a day to help prevent complications of diabetes
Diabetic neuropathy -- 200 mg 3 times a day
Hepatitis -- 100 mg twice a day

Next week, we'll discuss why the "R" form of alpha lipoic acid is preferred.

Remember, it is your life and it is your health.

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD