Let’s talk about fasting

Let’s face it, covid came and we all wound up in our house binging Netflix and eating comfort food. We may have put on a little more weight than we care to admit. As the sun shines a little longer each passing day, we may be daring to have thoughts of getting active again…getting healthy…and maybe losing weight. But, what is the success rate for cutting back on calories and increasing exercise for weight loss? The sad statistic is one out of 100 will be able to succeed with this method. But why is this?

As it turns out millions of years of evolution accounts for this. In order to survive during times of little or no food, our metabolic rate goes down causing whatever food we consume to get stored as fat for when we truly fast out of necessity. When we do a prolonged (or greater than a day) fast, we remove the energy from our fat cells. This begins at around 36 hours of no food. At this point, all of our blood sugar stores are used up and we begin to remove calories from our fat cells to turn this into fuel which can be used any place in our body.

I tell all my patients that just about anyone can safely fast for up to seven days without medical supervision. Diabetics are the exception to this rule.  You can fast with diabetes but should be supervised by your doctor. Interestingly, Dr. Jason Fung, a Toronto-based diabetic specialist, has reversed and even cured hundreds of his diabetic patients getting them off all their medications using a water-only fast. (do NOT do this without discussing with your doctor first.)

What about fasting for other reasons? Fasting twice a year for five consecutive days can add an additional three years to your life. It also helps reduce the risk of hardening of the arteries and most types of cancer. Our body’s cells are able to use two different fuel sources: sugar, derived from eating protein and carbohydrates, and ketones, derived from the breakdown of fat cells. Cancer cells can only use glucose for fuel. When we fast, we enter a state of nutritional ketosis and the precancerous cells that we make daily cannot readily divide. At this point, they become more susceptible to destruction by our immune system. There is ongoing research on how fasting can not only help prevent cancer but also help to treat cancer.

Fasting is the one intervention that not only prolongs life but also saves us time and money. Exercise raises metabolism, helps us feel better, and reduces all-cause mortality. Fasting can do the same and is really the only proven way to lose weight and help keep it off.

~ Dr. Mike and Action Medicine team

Pfizer vs Moderna – what are the differences?

As we all hold our breath waiting for the one dose Johnson and Johnson vaccine to come out (more on that later) we are waiting for our turn to get either the Pfizer or Moderna vaccine. We covered how they work last week, but if they are using similar technology, what really is the difference?

This week, we’ll break down the Pfizer Vaccine vs Moderna. Well, effectiveness for both is pretty great. Pfizer states they are 95% effective and Moderna is 94.1% effective. Not too different there. They both require a second dose, so still quite similar. However, the timing between dosing is a little different: Pfizer has a 21 day separation between doses while Moderna has 28 days between doses.

Side effects for both are common…but are generally mild.. The most common reactions are injection site pain, fatigue, headache, muscle and joint pain, and fever (usually lasting 24 hours). The second dose is generally more likely to illicit such a response, but it is not indicative of a bad vaccine. Rather, it is evidence that your immune system has seen this intruder before and now knows what to do.

Some people have had anaphylactic reactions!!  Yes. And I’m not saying that wouldn’t be a terrifying ordeal to go through. However, the percentage of people with such a strong reaction are rare and to be expected when ANY type of medication/vaccine is given to such a large number of people. Someone will have a reaction. Thankfully, again, it is not a common occurrence.

Pregnancy. Well, the common denominator for both is that it is not recommended for pregnancy but should not be withheld from a pregnant person who is at high risk and eligible for the vaccine. Moderna states that there have been no issues in animal studies. Pfizer has not yet completed animal studies but states that no evidence of fetal harm exists thus far.

Storage. Very different here. Moderna ships at a chilly -4 degrees F. Scarf and hat weather in New England, no big deal. Pfizer, on the other hand, needs to be shipped at -94 degrees F. Frankly, there are not enough scarves and hats for that. Thankfully, they will not inject this arctic blast right into your arm and it will be thawed and able to be used over the next 5 days. Moderna is stable at fridge temperatures for 30 days and room temp for 12 hours.

Neither vaccine is approved for use with children…yet. Studies are ongoing. Right now, Pfizer is 16 and up while Moderna is 18 and up.

Who should NOT get the vaccine? Restrictions are the same for both: If you are allergic to any of the components of the vaccine, like   polysorbate you should not get the vaccine due to cross reaction to polyethylene glycol. If you had a severe allergic reaction to the first vaccine, you should not get the second.Thereis absolutely no such thing as a 100% risk free medication or vaccine. They don’t exist. However, the risk and impact of the actual disease needs to be weighed against the risk associated with the vaccine.

We recommend vaccination. It saves lives and will hopefully get us back to some semblance of normalcy. If you have doubts or reservations, these are valid and should be discussed with your health care provider. We’re happy to have a conversation with you, anytime.

Until next week, stay safe, wear your mask, and wash your hands 😊

 Brooke Rieth, NP and Action Medicine team

Vaccine technology and Beyond

Well hopefully I don’t get sued for making this reference, (and if so, jokes on you, I only “own” debt, so ha!), but let me set the stage for vaccine technology…it is 2007, around December, and “I am Legend” is playing on the theaters. It was super popular and, if it hasn’t already been burned in your memory (I’m still traumatized more than a decade later from the dog scene), it is about an apocalyptic world that is caused by none other than a vaccine gone wrong! (sounds of screaming).

Vaccine technology and Beyond

So, is this new covid vaccine the stuff of nightmares? Was it conjured up overnight in a mad scientist’s basement? WILL IT TURN US ALL INTO NIGHT WALKING ZOMBIES?? Um, no.

The mRNA vaccine is a new vaccine technology, this is true. But it wasn’t pulled from the ether specifically for covid. This form of vaccine delivery has been studied for decades for things like flu, rabies, cytomegalovirus, and ebola.

Why mRNA? The simple answer, it is faster to produce and does not require the use of the infection-causing agent. Traditionally, we would inject a weakened strain or inactivated strain of a virus to allow our body to recognize and form an attack against a pathogen. The mRNA simplifies this.

The mRNA vaccine

So how does it work? The mRNA vaccine sends the blueprints for a piece of protein found outside the virus. In the case of Covid, which looks like a medieval mace, it is one of those external spikes that we are reproducing. One small aspect of the virus. Nothing that can cause an infection. What our cells then do is :

1) Get rid of the instruction manual. We break down the mRNA sort of like an old-timey spy would burn a message after reading it.

2) Our cells display this protein piece allowing our immune system to cruise by and recognize that “hey, that doesn’t belong there”.

3) Our body decides to go to war with this invader protein and we start making antibodies to fight anything with this protein structure.

4) We develop an immune response to the protein spikes found all over the Covid 19 virus particles so should we come in contact with them, we already have the cavalry lined up and ready to take it down. Savvy?

Vaccine Technology Means Making Antibodies to Fight

The mRNA does not alter our DNA. We will not mutate or become “other”. I understand that all this can be confusing, especially with all the misinformation online and in the news. However, we would encourage all our eligible patients to get vaccinated when possible.

As always, we wish you all good health and a happy 2021!


Brooke Rieth, NP, Dr. Mike, and Action Medicine team

See the following references for additional information


Blog 2021

Happy New Year everyone! As I write this, we are just completing our first week in the new year, and what a week it has been. Hopefully, 2021 will slowly get itself under control and allow us to return to some semblance of normal.

In the meantime, I thought it might be nice to focus on something positive: THE VACCINE. The key to going back to restaurants, to traveling, to hugging our friends, to talking and laughing with reckless abandon. (I guess we will have to start wearing something other than pj bottoms though. That part is kind of a bummer).

So, THE VACCINE, (yes, I will keep putting it all caps), who gets it? Well, according to the current guidelines from now through February, the vaccines will go to health care workers, long term care facilities, first responders, congregate care centers, and home health care workers. Feb-April individuals with 1 comorbidity (like diabetes, blood pressure issues, COPD, etc), teachers: early education and K-12, grocery, utility, food and agriculture, sanitation, public works, and public health workers, adults 65+. April-June the vaccine will be available to general public.

Keep in mind that these guidelines may change, and I am but a mere messenger of current facts.

Also, just a friendly reminder that we are going to try to keep a small pantry going outside our office so if you know someone in need, or are in need yourself, please feel free to stop by. Conversely, if you have canned goods or other non-perishables you’d like to drop off, we are accepting everything from paper products to dried goods to canned goods.

I hope this little blog finds you all happy and healthy going in to the new year. Stay safe, keep wearing your mask, and be well 😊

Brooke Rieth FNP

Dr. Mike

What are you Grateful for?

2020 is drawing to a close, and many of us are happy to see it go. It’s been a weird, difficult time. We came into the year with Australia burning off the global map. We only had a moment to worry about that before Covid took center stage, changing the lives of people around the world. There have been protests, there have been riots, ( we all learned about the Tiger King), I think 2 royals decided they wanted to live as “commoners”, we had a presidential race that was nothing short of insane, and WHAT ABOUT THE MURDER HORNETS????

There has been a tremendous amount of loss and sadness. We have experienced the growing pains felt across the nation as our country takes baby steps towards further equality. There is fear and uncertainty about the future…but there is also hope and (dare I say) some truly positive things that have happened this year.

Please put down your tar and feathers, I’m not trying to paint a rosy tint to this year, but there is no denying we have reconnected with our family and friends: sometimes virtually, sometimes from eliminating the commute as we work from home (sometimes forced). We did the projects we have been putting off. Maybe we learned a new skill (shout out to all the bakers out there). All I am saying is, there were some good moments.

I realize I can write the above paragraph because, so far, I’m doing ok. My lights are on. I’m warm.  I’m not worried about whether I’ll be able to eat next week. And, THANK THE LORD, I have enough toilet paper (seriously people, what was that?). I am extremely grateful to be in the position I am in. But I realize, this is not the reality of everyone.

We are dragging ourselves into the 12th month of 2020. The 10th (?) month of pseudo-quarantine. Businesses are hurting. People are hungry and lonely and worried. And, now, amongst the worsening surge of cases, we are having the holidays. Whether secular or religious, most people acknowledge a holiday in December, (be it Hanukkah, Christmas, Kwanzaa, Winter Solstice, or just second turkey and mashed potato day), with food and gifts.

At Action Medicine, we are aware that this additional strain on the budget may be too much. We want to do what we can. We have set up a little pantry outside our office 2nd fl lobby. You can take what you need or leave what you can. We accept dry goods, nonperishable items, paper products, personal hygiene, etc.

If you are interested, but limited in transportation, please message us privately, or call us. We will arrange for you to get what you need.

Hang in there guys. Hope is on the way.

Let’s just do what we can for now to help one another have the best holiday we can under our current circumstances.

Thank you!

Brooke Rieth, NP Dr. Mike & Action Medicine team

Covid Cases on the Rise

It’s no secret that the covid case numbers are up across the nation. Massachusetts has seen our less than 1% positivity rate creep up to almost 3%. I get it. Everyone is burned out. We’re tired of social distancing. We’re tired of isolation. We’re tired of not doing anything. It absolutely stinks.

Unfortunately, we cannot let our guard down. The fact that the pandemic is still raging right when we are supposed to be coming together with our family over an ill-fated bird is hitting a lot of people particularly hard.

There are ways to safely come together for the holiday season. They are, of course, not without risk, but for people determined to have some family gatherings this holiday season, there is a smart (wicked-smaht) way to go about it.

  • Keep it small. This is not the year to have 40 people over at your house. Close friends or relatives only.
  • Quarantine. Quarantine. If you plan on getting together with a small group of people, you should all agree to really self-isolate for 14 days before getting together to minimize the risk of picking something up beforehand. Nobody wants to be remembered as “Covid Mary” (Instead of “Typhoid Mary”…see what I did there).
  • Get tested. If you have been self-isolating for 14 days, get a covid test. Nothing is 100%, but a period of isolation and a negative covid test is about as good as it can get right now.

Obviously, this is not a green light for get-togethers. Nor is this a fail safe way to avoid getting sick – anytime there are social gatherings the risk for exposure is going to go up. However, we know that people are going to do what people do. So, we would just like to offer advice for the safest way to go about your business this holiday season.

Please stay safe and take care of one another. – Your socially distanced Action Medicine Team.

Here’s a tasty muffin recipe to try at home:






How will Covid-19 affect the healthcare economy?

This is based on an October 20, 2020 editorial in The Journal of The American Medical Association by David Cutler, PhD and Lawrence Simmons, PhD, both economics professors at Harvard University.

SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) Pandemic is the greatest threat to prosperity and well-being in the United States since what we encountered in the great depression.

The following statistics are based on present (overly) optimistic United States predictions that the virus will be substantially contained by the end of 2021.

The monetary loss to the US is based on unemployment claims, people having less money to spend, business revenue decline, death, and reduced quality of life.

If we follow our current trajectory, 650,000 cumulative deaths will occur through the end of next year in the US. The value of a statistical life is controversial but is conservatively estimated at $7 million dollars per life. Therefore, the economic cost of premature deaths expected through next year is an estimated $ 4.4 trillion.

Long term impairment occurs in approximately 1/3 of survivors of severe or critical disease. (Double the number of deaths). This yields an estimated loss of $2.6 trillion through the end of next year.

Mental health toll is an additional component. It is estimated that an additional 80 million people will have mental health issues as a result of Covid. The cost of these conditions is estimated to be about $20,000 per person per year, or $ 1.6 trillion.

Let’s add up the numbers:

Category                                                             Cost (Billions of US dollars)

Lost GDP                                                            7,592

Premature deaths                                            4,375

Long term health impairment                     2,572

Mental health impairment                            1,581

Total                                                                    16,121 (trillion)


This is a loss of 90% of the US Gross Domestic Product (GDP). This means each family of 4 loses $200,000. As a comparison, the total loss from the Great Depression was 1/4 as large.

The Congressional Budget Office predicts $76 Trillion in additional losses over the next decade if we don’t have another pandemic.

If we instituted wide scale testing, contact tracing and isolation (even assuming many will not quarantine), projected economic return is approximately 30x the cost. (i.e. $6 million invested averts $176 million in costs).

The Rockefeller Foundation estimates that 30 million tests per week plus contact tracing would cost around $100 billion ($100 billion times thirty equals $3 trillion in savings).

Currently, we spend most of our resources on acute care treatment (reactive care) with very little on public health services and infrastructure (proactive care).

A minimum investment of 5% of any covid economic relief should be devoted to such health measures as testing, contact tracing, and isolation and should remain in place indefinitely. We need the political will to make it happen.

~Dr. Mike Tremblay & Action Medicine team

Third Anniversary of Action Medicine, couldn’t have done it without you!

dog with a birthday hat
dog with a birthday hat

October 1st is the three year anniversary of Action Medicine, DPC!

Wow! We couldn’t have done it without you!

I would like to thank all of our patients for placing their trust in us and continuing to support us in this most unique medical model that is catching on across the United States. I would also like to thank Brooke, Max, Danielle and Jane for all the hard work to get us up and running.


Our History

2016: We researched and planned!

In 2016 after contemplating retirement from the moral injury of traditional primary care, Jane and I read about a new model called direct primary care. Instead of dealing with insurance companies you make an affordable contract directly with your patients and have nothing to do with insurance billing. By lowering overhead (eliminating insurance filing administrative costs) we see fewer patients in a given day and spend more time with each person. Same-day visits are possible and patients can communicate virtually through phone, text, email or video chat.


We did our research, went to conferences and interviewed other doctors who already went through the process and it took about a year to get all the paperwork and logistics done. We had to disentangle ourselves from corporate medicine and all of the insurance contracts we were put in by our prior organization and this was no small task.


2017: We opened!

October 2017 was a busy month. We sold our building to Dr. Salem who is the dentist downstairs and did a build out on the second floor to be our new home. It took several months to accomplish this but we did it! Our patients were very happy with the new space.

About 200 of our original patients stayed with us from the previous practice, thank you all so much for believing in our new direct primary care endeavor!


2018 & 2019: We Grew and Had Fun!

Our practice grew slowly but steadily.

What a great time we were having as a medical practice! This was the first time in about 20 years we could say that.


Why are we having such a good time?

Because we used to have 30 patients per day, and we could only work on one or two problems per visit. Now our schedule only allows eight patients a day, spending an hour to go over as many issues as needed. This system helps us practice preventative medicine, better for the patients! We will cap our growth at 400 patients per provider instead of 3000, to allow for more personalized care.

As a result of a more relaxed schedule I was able to do more research and bring more information about wellness back to my patients. For the first time I could remember, I came to work and left work with a smile on my face. I actually felt like I was doing some good.

Thank you for being part of the future of medicine with us.

-Dr Mike

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