Dr. Todd Butz Sometimes Gives His Sheep Animal Crackers with Their Grain

 You are here for a reason...  

                                                                102-year-old Holistic Physician Gladys McGarey, M.D.

Todd Butz, M.D.

Todd began life in a small rural town on the outskirts of the borough of Marietta in Lancaster County. The girl who would become his wife, Barb (seven years younger than him), lived about a mile away “as the crows fly.” His parents and her parents had purchased land from the same local farmer. And though one of his brothers was best friends with her brother, Todd didn’t meet Barb until he was already practicing medicine. 

This happened in 1994 at a 150th-anniversary banquet for their Catholic church. Todd’s mother had insisted that her four kids (including Todd’s two older brothers and his younger sister) attend, and  Barb was there. She and Todd married three years later.

 Dr. Todd Butz told me that he has been “fortunate, lucky, and blessed” as he had a lot of good people in his life and great parents. His father (in the family sign business) was of quiet, stoic German stock, while his mother (an R.N.) was an animated and passionate Italian.   

He believes that “creativity is what life is about” and early in his training he combined German technical insight and Italian passion with his family’s interest in sports to invent a unique exercise machine. It is worth telling this story in some detail.

You see, Todd was doing a Sports Medicine fellowship with Graduate Hospital in Philadelphia when he had a “crazy idea.”  He imagined a device to exercise “the torso” as he felt swimming did. Something to work the abdominal, hip flexor, and lower back muscles. Something that would allow for a prolonged session at a moderate aerobic intensity.  

He dreamed up a contraption that he called an ABDO-Cycle. You sat in it and it used a weighted flywheel with steady resistance to permit the user to perform repeated abdominal crunches and back extensions for minutes at a time. 

Barb on the ABDO-Cycle

Todd spent years (and a lot of money) on his idea. He tried to do the patent work himself but had to get an attorney (who charged him $10,000 to eventually use many of Todd’s own words). A friend’s father, an entrepreneur, helped him find an engineer to build a prototype. But the investor wanted substantial equity in the (proposed) company and Todd didn’t like that idea. 

Time passed, and after a prototype was finally fabricated, he decided to shop it around himself. A professional and talented graphic designer (it was Barb) produced a finely detailed brochure complete with a model (Barb, again) using the machine. The major fitness companies nibbled but didn’t bite. Dr. Butz said that he learned a lot about life from this experience. More than he learned, he noted, from college. 

(The model--the machine, not the girl–still resides in his attic. The girl is in the house proper.) 

It is not surprising that Todd’s creative drive would result in a piece of exercise equipment since he was part of a sports-oriented family. His dad had played football at the University of Florida and Todd and his brothers were in all the usual team sports from a young age. 

His mother (though not an athlete herself) was a fierce motivator (and a pretty good cook). He said that while she wouldn’t put direct pressure on him to do things, or to perform, she had her way. For example, he can still hear her saying (when he was away in medical school), “We have supper on Sunday and I made a lasagna and two dozen meatballs.” He knew what she really meant, and he could hardly fail to show up.

So after a childhood wrapped up in team sports and with no particular academic direction, Todd decided to go to the University of Delaware for football. While there, he first toyed with the idea of being an athletic trainer or a physical therapist. But when he watched the team doctor on the sidelines he decided to aim higher. 

University of Delaware football field (Credit: University of Delaware)

So he quietly squeezed in the needed premed courses. He didn’t tell anyone about his lofty goal until he was accepted to Hahneman and was on the wait list at Thomas Jefferson Medical College, both in downtown Philadelphia. 

Where should he go? He took advice from his knowledgeable football coach (who became a cardiologist). Todd waited a bit, got in to Jeff, and joined the coach, Joseph Bering, who was already there, two years ahead of him. 

He initially loved it in Philadelphia. But after two years of studying the basic sciences in the middle of a busy noisy city, he missed the peaceful countryside. So when he took a few clinical rotations at Geisinger Hospital in Danville in rural Northeast Pennsylvania, he was comforted by the calm environment, where he could see “cornfields and sunsets” again.

Sunset and cornfield (Credit: SimonSkafar)

During medical school, Todd’s evolving interests in sports, exercise, and preventive medicine led him to take an enlightening rotation with the famed Dr. Kenneth Cooper (who coined the term “aerobics” in 1968) at his clinic in Dallas. Dr. Cooper (who still works out five times a week at 93) was onto something that resonated with Todd.

Dr. Maddrey

Back in Philly, looking for a career path, Todd methodically crossed off one specialty after another (“Not this, not this…”). He finally settled on internal medicine, maybe cardiology. When it was time to look for a residency the Chairman of Medicine at Jefferson, the illustrious liver specialist Dr. Willis Maddrey, urged him to stay there for a life in academics. But Todd didn’t want that, he wanted to move back home.

In 1990, Lancaster (quite close to home) only had Family Medicine programs, so he ventured a bit farther away and looked at York Hospital’s Internal Medicine residency, York would be okay, still less than an hour’s drive from his home. 

As soon as he visited, he was impressed. He loved the congeniality as the doctors and nurses talked to one another face-to-face instead of communicating coldly on the patient’s chart, as they did in Philly.

Instantly comfortable in this atmosphere he thought, “This is where I want to be."

Todd had a happy experience as a resident. He believed he had outstanding training with a long list of wonderful physicians as he took specialty and general internal medicine rotations. (This was when almost all the attendings taught on a volunteer basis and gave freely of their time despite busy private practices.) 

After three years in York, Todd’s interests led him to the one-year Sports Medicine fellowship with a Graduate Hospital affiliate on the Main Line near Villanova. The staff at the large center served as the team doctors and therapists for the Phillies, Eagles, Flyers, and 76ers as well as Villanova athletes. They also did executive physicals, stress testing, and cancer screening. 

At the end of that year, Dr. Butz was again offered the option of staying in the Philadelphia area but chose to return home instead. (By the way, he had not yet met Barb.)  

Dr. Landis

What could he do? Thinking outside the box, he had an idea for a position in York. Over a steak dinner, he and Dr. William “Tex” Landis of the Brockie Internal Medicine group sketched the plan on a napkin. From his experience as a resident, he knew the practice and the physicians well. He proposed (that is, invented, created) a brilliant role for a single guy: he would admit and manage the Brockie patients (including new patients coming through the busy ER) at night. 

This would allow the overworked internists who were running back and forth from the office to the hospital and taking night-call to count on getting regular sleep. The idea was accepted, and Dr. Butz did this full-time for five years. And it was during this nocturnal phase of his career that he met and then married Barb.

But as the night schedule became too stressful to maintain, and thinking ahead, he had other plans. So in 1999, he went half-time with the enlarging WellSpan system and started a preventive medicine clinic across the river near Lancaster. At that time, before the Affordable Care Act changed things, preventive services, he noted, were generally not covered by insurance.

He did stress-testing and calculated VO2max (how much oxygen you can use during exercise) using Dr. Cooper’s data, and other stuff like that. Nearly 25 years ago, Dr. Butz counseled interested people on the importance of a balanced diet and regular exercise. He advised them to stop smoking, to get enough sleep, and to be better at managing life’s inevitable stresses. 

Todd thought that it was “crazy” that “we wait for people to get sick and then pump them with pills.” He knew that prevention of illness was a much saner approach to long-term health. Dr. Peter Attia, writing in his 2023 bestseller Outlive, calls this (not so new) idea “Medicine 3.0.” 

(In his book, Dr. Attia carefully explores the best science and emphasizes the age-old appeal of a personalized nutrition plan to prevent cardiovascular disease and diabetes and the complications thereof. He is especially enthusiastic about the remarkable ability of regular aerobic activity and strength training to delay the onset of a wide variety of diseases and to meaningfully extend our “healthspan,” not simply our lifespan. And he eventually recognizes that achieving emotional health often requires prevention.)  

While Dr. Butz was a resident, he had given a Grand Rounds presentation to the staff entitled (quoting a phrase often attributed to Hippocrates around 2,500 years ago) “Let Food be Your Medicine.” He is still keenly invested in this idea and feels that “we do best on fuels that our remote ancestors ate.”  

As we sat and talked, Todd mentioned the decades-long “Seven Countries Study” spearheaded by Ancel Keys. First published in 1978, the observational study of middle-aged men was started in 1958 near the height of the heart disease epidemic. Serum cholesterol, blood pressure, diabetes, and smoking were clearly seen as risk factors for coronary disease. And it suggested that certain dietary patterns played a role.

Location of cohorts (often in villages) in the 7-Countries Study

The nutritional aspect appeared to be the amount of saturated vs. unsaturated fat in the typical diet. The countries with a lot of saturated fat in the diet (e.g., Finland) tended to have way more heart disease than those with much less (i.e., Japan). Part of the war on heart disease became a war on saturated fat and cholesterol in the diet.

So as we became increasingly health-conscious and weight-conscious, we became fat-conscious. And in the 1980's the American food industry responded. Since saturated fat was “bad” they would use sugar to replace it in prepared foods and snacks to keep them tasty (and to keep us buying). 

We ate less fat. But a lot more sugar. Yes, a lot more sugar. And as we took more of our calories as “added sugar” (most often in surgery drinks) we ingested more calories overall. The prevalence of obesity and type 2 diabetes nearly doubled from 1980 to the early 2000s and has continued to rise. We became fatter and sicker, rather than thinner and healthier.  

The shocking increase in obesity from 1987 to 2021 (Credit: CDC)

What happened? Table sugar (sucrose) is 50% glucose and 50% fructose. Glucose is used immediately as fuel. Fructose is metabolized differently than glucose and if it is excessive it is stored as fat (to survive a cold winter with sparse food supplies). It is put away first in muscles, and then in the liver. Too much eventually leads to insulin resistance, diabetes, an increase in LDL and a decrease in HDL cholesterol (made in the liver), elevated triglycerides, and chronic inflammation.  

Part of the problem for us is that sugar is enticing and rewarding, and, therefore, potentially addicting. It produces momentary pleasure, a desire for more of it, and uncomfortable withdrawal symptoms when it is no longer available.  As Gary Taubes states in (probably rightly) calling sugar a drug of addiction: it makes children happy, at least for the period they’re consuming it…(but the) downside is that they “will come to expect another dose, perhaps to demand it on a regular basis.” (p. 31) We get hooked early.

(A childhood memory: Uncle Sol sold candy. I looked forward to his visits and I can recall the excitement at seeing the long thin red licorice “shoelaces” or “lariates” he brought with him. I twisted, braided, and knotted them in anticipation of their chewy sweet taste. The pleasant sugar high was soon followed by a disheartening letdown; I wanted more. I knew early on that sugar affected me strongly and I gave it up nearly altogether in my teens, in the early 1970’s.)

(Don't they look good?)

Dr. Butz said that the massive decades-long Keys study can be criticized for “cherry-picking” the data (leaving out countries that were initially to be included, 20 countries in total) and ignoring or downplaying the role of high sugar intake in heart disease. 

The truth, said Todd, is that no correlation could have been established between fat consumption and heart disease if the data from all 20 countries were used.  Nevertheless, Keys and his colleagues championed a diet low in saturated fat to combat heart disease (by lowering, it turns out, the all-important serum LDL cholesterol) . The possible role of too much sugar and simple carbohydrates, was ignored.  

Anyway, enough about sugar. Let’s get back to our main subject, Dr. Butz. He ran back and forth to his Lancaster clinic for three years until the commute became too much for his soon-to-be growing family. So, for their protection, he put his preventive medicine practice and the soaring ABDO-Cycle dream away and took a hospital position with good benefits.  

Dr. Van Wyck

As Todd returned to WellSpan full-time in the fall of 2002, he helped Dr. Rita Van Wyck do inpatient medical consults for the psychiatrists (where he learned a lot about mental health). And as the local family practices were one-by-one bought by the system he helped Dr. Douglas Rubelmann admit patients from the different groups. He also did some moonlighting for the Brockie physicians who had been greatly disappointed when he left his night-coverage position with them. 

Recounting this part of his journey, Dr. Butz told me, with a quick laugh, that he “seemed to do the things that other people didn’t want to do.” And he quickly added that he likes new challenges.

But over the years, the easy fellowship at the hospital that so impressed him began to erode. The expanding health systems became more corporate, industrialized, and impersonal. Todd said that doctors are, by nature, independent. So they were easy isolated targets, sitting ducks, as the art of medicine was lost to a business with multiple layers of managers setting and enforcing policy. Physicians gradually became “disengaged.”

Morale declined, so that simply walking through the hospital corridors became a gloomy experience. Dr. Butz recalled one of the corporate solutions: the 5/10 rule, a take on the “Ritz-Carlton 5/10 Way” designed to improve customer satisfaction. 

The idea is simple. If you are ten feet from someone in the hospital you make eye contact and greet them with a smile. If you are within five feet you smile and say hello. Mandated civility to improve the bottom line, sort of like a high-end hotel.

So Dr. Butz took on a new challenge in 2014 after Dr. Jonathan Whitney asked him to help with so-called case management as a physician advisor. In the late 1990s Medicare and private insurance companies, to reduce spending on healthcare overall, labeled some in-hospital services as “outpatient status.” They could reimburse the hospital much less for this than the same service deemed as “inpatient.” There had to be a clear justification for “inpatient status” or such additional payments would be denied. 

According to a 2016 Report on Medicare Compliance newsletter:

To comply with the two-midnight rule (for a justified admission), Todd Butz, physician adviser at WellSpan Health in York, Pa., is trying to get physicians on the same page, free of considerations that are beside the point. That means placing patients in observation or admitting them as inpatients because that’s the appropriate level of care, regardless of the impact on copays or skilled nursing facility admissions, or the hospital’s worries about revenue, patient-satisfaction scores or readmission penalties.

Dr. Whitney and Todd sometimes had to call out insurance companies when it was felt that their decisions about payment were wrong. Dr. Butz reviewed pediatric, obstetric, and surgical cases as well as internal medicine encounters, so he had to broaden his medical knowledge significantly, and he liked that challenge.

He did this for more than four years for WellSpan and then decided to work as a self-employed consultant for a hospital in Maine that sought his specialized expertise. Todd did this for another five years until Optum came to Maine and his services were no longer needed.  

So in May of last year (2023) as he felt “out of balance” he chose to take a break from the grind of working seven days a week. He needed to “unwind.”  At age 60, as “the next chapter has yet to be written,” Dr. Butz has been spending more effort on his farmette a few miles south of his home. He and his wife and their two teenage children can “unplug” in the peaceful environment that is like a “time machine.”

There is an 1850s log cabin with enough steeply banked ground to need a few sheep to keep the grass and weeds down. He stops by to feed the two ewes daily; they like Animal Crackers (this English delicacy was first made in the US at Stauffer’s in York in 1871, where they still turn out a million daily) along with their grain. 

The Butz's quiet rural retreat

He also has a good-sized and varied organic vegetable garden and he planted ten young fruit trees (already bearing fruit). He is paying careful attention to nutrition as he tries to adhere to a version of a low (starchy-) carbohydrate diet that includes beef from pasture-raised cattle and “lots of eggs” (scrambled, and always with onion) laid by happy free-range hens. He makes his own butter and yogurt, and he enjoys snacking on olives and tree nuts instead of chips (despite the fact that York County is the unofficial potato chip capital of the entire world).  

Returning to a regular exercise regimen, to routine physical activity, he often starts his day with a long meditative swim at the York JCC, where we sometimes cross paths and chat. 

What have we learned from Dr. Butz? Prevention of illness makes more sense than waiting to treat entrenched disease. We can start improving our food choices by cutting back on starchy carbohydrates, sugar, and calories. The Mediterranean diet is a good model, and buying fresh local produce or even growing some of our own vegetables is preferred to mindlessly consuming highly processed packaged food. Regular exercise is essential for good health; we need to keep moving and stay strong. So it might be time to brush off the old ABDO-Cycle, stationary bike, or treadmill collecting dust in the attic.  And we should, following Todd, not be afraid to take chances, to be creative, to try something new. And it is good to feel connected to the land.

Dr. Todd Butz and his family

Readings and References:

1. Anon. "Guided by Pocket Card, Doctors Are Coaxed To Keep it Simple With Two-Midnight Rule." Report on Medicare Compliance, Volume 25, Number 34, September 19, 2016. (Explaining Todd's foray from direct patient care.)

2. Attia, Peter, M.D. with Gifford, Bill. Outlive: The Science & Art of Longevity. Harmony Books, New York, 1993. (Synthesis of a lot of fascinating deep technical information, but quite readable and recommended highly.)    

3. McGarey, Gladys, M.D. The Well-Lived Life: A 102-year-old Doctor's Six Secrets to Health and Happiness at Every Age. Atria Books. New York, 2023. (The "mother" of holistic medicine in 1978 addressing the health of the brain, body, and, especially, spirit. You can watch her YouTube interview.) 

3. Nozowitz, Dan. "Why are So Dang Many Potato Chip Brands from Pennsylvania?" Atlas Obscura. October 24, 2017. (Is it the climate? The soil? The German ancestry?)

4. Taubes, Gary. The Case Against Sugar. Alfred A. Knopf. New York, 2016. (A strong argument that we need to pay attention to.)

By Anita Cherry  (04/21/24)

Soaring Hawk in Flight in Florida (Photo by SC)