Archives for March 2017

Mar
25
2017

How Stress Affects Our Hormone System

Dr. Andrew Heyman gave a talk recently about how stress affects our hormone system. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Understanding the Stress, Thyroid, Hormone Connections & Prioritizing Systems”.

Dr. Heyman stressed that there is a triad of hormonal connections that is important to remember: the thyroid hormones, the stress hormones (adrenal glands) and the pancreas (insulin production). We need a balance of these hormones for optimal energy production and circulation. Under stress our sugar metabolism can derail, we develop obesity and fatigue. When balanced we experience vitality and wellbeing.

Metabolic activation pathways

Dr. Heyman projected a slide that showed the metabolic activation pathways. He stated that a number of different factors could influence the hormone system:

  • Diet: trans fats, sugar, too many carbs, food allergies.
  • Drugs: drug-induced nutrient depletion (over-the-counter drugs, prescription drugs).
  • Physical exercise: frequency and type matters.
  • Environmental exposure: chemicals, pesticides, herbicides, heavy metals, plastics, molds, and pollens.
  • Stress: physical stress, psychogenic stress.
  • Genetics: methylene-tetra-hydro-folate reductase enzyme deficiency (MTHFR mutation), APOE genes, lack of vitamin D
  • Disease: past or present conditions, active disease or syndromes.

Target areas within your system

The target areas in your system are the

  • Pancreas, where blood sugar can rise because of insulin resistance. Too much insulin production causes inflammation, hormone disbalances, kidney damage, and hardening of the arteries through plaque formation.
  • Thyroid gland, which gets activated by TSH (thyroid stimulating hormone), but can also be affected negatively by autoantibodies).
  • Brain: decrease in serotonin resulting in anxiety, depression and food cravings; decreased melatonin causing sleep disturbances; increased ghrelin and decreased leptin secretion leading to overeating and obesity.
  • Liver/kidneys: both of these organs are important for detoxification; the liver produces thyroid binding globulin, which when increased can lower the free thyroid hormones.
  • Immune system (gut, lymph glands): the Peyer’s patches in the gut mucosa produce a large portion of the immune cells; lymph glands, the bone marrow and the spleen supply the rest. A leaky gut syndrome can affect the whole body, causing inflammation and autoimmune reactions.
  • Hypothalamus/pituitary/adrenal glands: this is the main axis of the stress reaction. If the brain is stressed, the hypothalamus sends a cascade of activating hormones via the pituitary gland and the adrenal glands. This leads to cortisol overproduction, and release of epinephrine and norepinephrine from the center of the adrenal glands. High blood pressure, anxiety, heart palpitations, arrhythmias and more can develop from this.

Hypothalamus/pituitary/adrenal glands activation and clinical effects

The main hormone axis of the stress reaction goes from the hypothalamus via the pituitary gland to the outside surface of the adrenal glands where cortisol is released. It is also called the HPA axis. Stressed people make too much cortisol, which weakens immune functions, reduces human growth hormone production, increases belly fat, increases blood pressure and reduces insulin action. Stress also reduces estrogen production in women and testosterone production in men.

The final clinical presentation is osteopenia, then osteoporosis with spontaneous fractures of bones. There is cardiovascular disease leading to heart attacks and strokes, and cognitive decline with memory loss. There are complications with infections. Also the metabolic syndrome can lead to obesity and type 2-diabetes.

Stress and the hippocampus

In the center of our brain there is a memory-processing unit, the hippocampus that converts short-term memory into long-term memory. Repeated stress interferes with normal hippocampus function. High cortisol levels interfere with the proper functioning of the hippocampus causing memory problems.

Chronically elevated cortisol levels from chronic stress have been shown to lead to hippocampus atrophy and can cause Alzheimer’s disease.

Effects of chronic stress

Chronic stress leads to cardiovascular disease, to diabetes, chronic inflammation, Alzheimer’s disease, thyroid disorders, cancer, neurological disorders and autoimmune diseases. Inflammation research has shown that with chronic inflammation tumor necrosis factor-alpha (TNF-alpha) is released, as key player of chronic inflammation. This however leads to the release of other inflammatory kinins like IL6 and others. The resulting chronic inflammation can cause Crohn’s disease, rheumatoid arthritis, insulin resistance, dementia, metabolic syndrome, obesity and atherosclerosis with associated markers (decreased HDL, increased LDL, CRP and triglycerides).

Hormone imbalance causes disease

  1. Excess cortisol production from stress leads to Th2 type inflammatory kinins; usually associated with this is a reduction of DHEA (a male hormone in the adrenal glands), which leads to reduced Th1 type kinins. The end result is chronic inflammation. When chronic stress has tired out the adrenal glands, a four-point salivary cortisol level test shows a flat curve. This indicates adrenal gland fatigue or, if worse, even adrenal gland insufficiency. Such a pattern is found in patients with leukemia, breast cancer, uterine cancer, prostate cancer, pituitary gland cancer and lung cancer.
  2. The metabolic syndrome is associated with dysregulation of the HPA axis. People who have this syndrome have a high morning serum cortisol level. High cortisol increases the risk to develop metabolic syndrome.
  3. Metabolic connections: high cortisol leads to a partial blockage of thyroid hormones, which in turn leads to hypothyroidism. Hypothyroidism will affect glucose tolerance, and if not treated leads to type 2 diabetes.

In a large study involving 46,578 members of Kaiser Permanente Northwest it was determined that for every 1 point above a fasting glucose level of 84 mg/dL there was an additional 6% risk to develop type 2 diabetes over the next 10 years.

Pathological hormone disturbances

The following hormone patterns were discussed in detail, an increased cortisol level, increased insulin level and decreased thyroid levels.

Elevated cortisol

Prolonged elevation of cortisol leads to atrophy of the hippocampus with brain atrophy and Alzheimer’s or dementia. The immune system gets altered, there is lower DHEA hormone leading to weaker muscles and weakened immunity. There is insulin resistance (decreased insulin sensitivity), decreased serotonin and increased depression. Carbohydrate cravings lead to weight gain (central obesity). Changes in the thyroid metabolism leads to hypothyroidism.

Increased insulin level

People who develop high insulin levels are usually sugar or carbohydrate addicts. As they gain weight they change their metabolism into the metabolic syndrome. The extra insulin that is floating around triggers the insulin receptors to become less sensitive (also called “resistant”). The people love to eat. They snack frequently on protein bars and candy bars. As they gain weight, their energy goes down and they often develop painful joints. This prevents them from being physically active. They notice episodes of foggy thinking. Women complain of frequent yeast infections.

The body tries to compensate by slightly decreasing thyroid hormones and slightly increasing cortisol levels.

Decreased thyroid levels

There is increased lactic acid production and decreased insulin sensitivity. Oxidative stress is increased. The patient is depressed and cognition and memory are reduced. The gut has slower motility. The mitochondria, the energy packages in each cell are reduced and functioning less productively. Cardiac function is reduced.

The body tries to compensate for the primary thyroid weakness by slightly elevating insulin and cortisol.

Treatment of stressed hormone system

Before the doctor can treat a disbalanced hormone system, blood tests have to be done that show what kind of hormone constellation is present. Dr. Heyman suggested the following support with supplements.

Treatment of thyroid disorders

Thyroid supplementation may involve any of these: Selenomethionine, iodine, chromium, thyroid glandular, tyrosine, ferritin, Ashwagandha, coleus forskohlii, 7-keto DHEA, ferritin and iron. Other possible supplements that were mentioned by Dr. Heyman were Rhodiola, schisandra, ginseng, Rg3, eurycoma longifolia, neuromedulla glandular, DHEA, tryptophan/5 HTP, licorice, Cordyceps.

This, however, is not all. Missing thyroid hormones have to be replaced with a balanced T3/T4 medication like Armour thyroid.

Adrenal support

The following supplements are used to support adrenals: Adrenal glandular, vitamin C, adrenal cortex extract, Holy Basil, Pharma GABA, Magnolia/Phellodendron, L-theanine, sterols & sterolins.

Pancreatic support

These supplements support the insulin production in the pancreas:

Chromium, vitamin D, magnesium, alpha-lipoic acid, fish oil, micro PQQ, bitter melon, cinnamon, arginine, vanadium, benfotiamine (synthetic derivative of B1 vitamin) and Bergamot.

Dr. Heyman completed his talk by giving a few patient examples, explaining what blood tests showed, what the hormone disbalance was, and which treatment options were helpful.

How Stress Affects Our Hormone System

How Stress Affects Our Hormone System

Conclusion

Dr. Andrew Heyman gave a talk at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. He talked about how stress affects our hormone system. Symptoms from stress can stem from different causes including hormone disbalances. Conventional medicine would simply treat the symptoms. However, this will not be successful with stress-induced hormone disbalances, because it does not treat the causes. Causal treatment of the hormone disbalance will restore the person’s wellbeing and the symptoms will disappear at the same time. Anti-aging medicine and integrative medicine are attempting to follow this approach.

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Mar
18
2017

What’s new about testosterone?

Dr. Gary Huber recently gave a lecture on what’s new about testosterone. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Evolution of Testosterone – Dispelling Myths & Charting a Future”.

History of testosterone

There are some notable historic landmarks with respect to the discovery of testosterone.

1869: Dr. Charles Brown-Sequard suggested that the “feebleness of older men” was due to a lack of testosterone. He injected himself with testicular extracts from dogs and guinea pigs.

1912: The Danish physician Dr. Thorkild Rovsing transplanted the testicles of a young soldier killed in battle into an old man with gangrene. The gangrenous wound healed completely.

1918: Dr. Leo Stanley sampled fresh testicles from executed prisoners at the San Quentin Prison and transplanted them to prison inmates. Some regained their sexual potency.

1930’s: Professor Adolf Butenandt collected 25,000 liters of urine from willing policemen. He was able to isolate a breakdown product of testosterone, androsterone. Eventually he isolated both progesterone and testosterone. He received the Nobel prize for his work with sex hormones in 1939.

Historical detours and misguided opinions about testosterone

1935: Because natural hormones cannot be patented, Big Pharma came up with the idea of modifying testosterone by adding a methyl group at the 17-alpha position of testosterone.

This allowed the new substance, 17 alpha-methyltestosterone to be swallowed as a pill. But the liver changed 17 alpha-methyl-testosterone into 17 alpha-methyl-estradiol, a strong estrogenic compound. This was not well metabolized. Shortly after introduction into patients it became evident that 17 alpha-methyl-testosterone caused liver cancers. This “testosterone equivalent” was used for 50 years until the FDA outlawed it because I caused liver cancer. It also caused suspicion among physicians about any testosterone replacement, even the bioidentical hormones that are safe.

Prostate cancer myths

Prostate cancer myth

Conventional medicine teaches (and I have believed this for many years) that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients a bit. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen. When an orchiectomy was done (because of the belief that testosterone production was the culprit) inadvertently the real cause of prostate cancer (an estrogen surplus) was also removed, thus improving the survival of these patients somewhat. Nowadays we have more sophisticated testing methods. Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot of more modern references, that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”).

It is important, when testosterone deficiency is present in an aging man, to replace the missing testosterone with bioidentical testosterone.

The old method of hormone depletion therapy in advanced prostate cancer cases is still practiced today, but has been proven wrong by Dr. Morgentaler and other researchers.

10% absorption rule myth

For years there has been a persistent myth that only 10% of testosterone would be absorbed through the skin. This was never proven, and newer studies could demonstrate that about 90% of testosterone gets absorbed through the skin.

Misleading science created myths

Unfortunately three key medical journals, JAMA, NEJM and PLOS ONE have published misleading studies. The content did not discuss physiology, mechanism of actions, appropriate dosing or true science. But their conclusions were that testosterone therapy was associated with heart attacks and strokes. There was an outcry about this particular study in the medical community reflected in the demand to retract this misleading article.

Unfortunately there were more similar false “studies” where controls were wrong or unequal groups were compared that should not have been compared. It is reminiscent of previous effort of the tobacco industry wanting to cover up that cigarette smoke causes lung cancer.

Here we have the problem that testosterone cures so many conditions for which the Pharma industry has many patented medicines that control the symptoms. But testosterone can actually treat the cause of the illness, testosterone deficiency, which leads to a cure of many other symptoms.

For a long time physicians were confused. But younger physicians are replacing the older generation and they treat testosterone deficiency with bioidentical testosterone in the proper dose.

Clinical observations about a lack of testosterone

There is evidence that men have lower testosterone as they age and this has worsened when we compare data from early 2000 to the 1980’s and 1990’s.

As this paper shows, men investigated in the 1980’s were still having higher testosterone levels in older age. But in the 1990’s and more so in 2004 these values have declined even more. This fact coincides also with other studies, showing decreased sperm health and increased infertility. The reason for this is also a lack of testosterone!

Causation of low testosterone

Dr. Huber pointed out that many studies have pointed to a variety of causes for low testosterone levels in men.

  • BPA, toxins and pesticides that occupy testosterone receptors and interfere with the hypothalamus/pituitary hormone function that stimulates the Leydig cells to produce testosterone.
  • The more stress men are under, the less testosterone production there is. Sleep deprivation below 5 hours per night leads to a significant lower testosterone production. Most testosterone is produced during the sleep in the early morning hours.
  • Weight gain and sugar overconsumption poison the testosterone producing Leydig cells.
  • Poly-pharmacy. Many drugs lower testosterone production: statins, diuretics, metformin, spironolactone, opiates, antidepressants, verapamil, alcohol, chemotherapy for cancer, antihistamines, ketoconazole, beta blockers, H2 blockers, finasteride, estrogens and alpha methyldopa.

Many references were provided that support these data. In one paper it was noted that the risk of a heart attack climbs to 4 times the risk of normal, when the man sleeps less than 6 hours per night. As sleep hours lower, the risk for metabolic syndrome increases by 42% and this leads to heart attacks. Testosterone replacement can reverse this risk as it a lack of testosterone production that caused the risk.

Link of low testosterone to cardiovascular disease

The literature is overwhelming that low testosterone has adverse effects on the cardiovascular system. To be more specific, the metabolic syndrome, heart disease (and strokes), diabetes and high blood pressure have their root in low testosterone.

Metabolic syndrome

Inflammation is mediated by cytokines such as IL-6. Dr. Huber mentioned one study where healthy men received IL-6. This promptly suppressed testosterone levels. He said that there are many cytokines that work in concert to suppress testosterone. One useful clinical test for inflammation is the C-reactive protein, which indicates whether or not inflammation is present in a person. Metabolic syndrome is common in obese patients. In a study CRP was found to be significantly associated with obesity. When CRP is high, testosterone levels are low. When the CRP level is high, there is a risk of getting the first heart attack.

On the other hand, when men with high inflammatory markers from low testosterone levels were replaced with testosterone, the tumor necrosis factor was reduced by 50%, IL1b by 37%, triglycerides by 11% and total cholesterol by 6%.

In the Moscow study a group of obese men with low testosterone levels were treated with testosterone injections. There was an impressive reduction of insulin (17%), CRP (35%) weight reduction of 4% and TNF-a reduction of 31% within 16 weeks.

Heart disease (and strokes)

Hardening of the arteries (medically called atherosclerosis) is due to chronic inflammation. A new heart attack/stroke specific biomarker has been developed. It is a ratio of oxidized LDL, divided by HDL. This has an odds ratio of 13.92 compared to a control without a risk for a heart attack or stroke.

Administration of testosterone hormone led to dilatation of coronary arteries. The Rotterdam study showed that low testosterone levels were associated with high risk for heart attacks and strokes, but that treatment with testosterone removed this risk. Testosterone increases AMP kinase for energy production in heart muscle cells, but also dilates coronary arteries for more blood supply to the heart.

Diabetes

Among men with diabetes 20-64% have low testosterone levels. In another study men with higher testosterone levels had a 42% lower diabetes risk. Testosterone levels are inversely related to body mass index and insulin resistance. Men with diabetes have lower testosterone levels than men who were not diabetic and were weight-matched. Most diabetics have high CRP values.

High blood pressure

Experience with androgen deprivation therapy for prostate cancer has shown that blood pressure gets elevated due to testosterone deficiency. Testosterone increases LDH, the protective subunit of cholesterol, and decreases LDL cholesterol and triglycerides. Testosterone also lowers inflammatory markers and reverses clotting factors making blood thinner. All of this leads to a widening of the arteries and lowering of blood pressure.

Treatment options for low testosterone

It is important to support the hypothalamic /pituitary/adrenal gland axis and remove other causes, such as stress and lack of sleep. Younger men can be stimulated in the pituitary gland through Clomiphene. Men older than 60 likely have true secondary hypogonadism and need testosterone replacement. Topical testosterone creams are available commercially or from compounding pharmacies. Injectable testosterone preparations that can be metabolized by the body are available. One such preparation is Delatestryl. A small dose (like 50 mg) is self-injected subcutaneously twice per week, which keeps the testosterone level stable. The last resort, if the creams or injections don’t work, is the use of testosterone pellets that a physician can implant under the skin.

What’s new about testosterone?

What’s new about testosterone?

Conclusion

At a recent Anti-Aging conference in Las Vegas that I attended, Dr. Huber gave an overview of testosterone. There has been an objective reduction of testosterone levels in men since the 1980’s due to pollutants in our environment. Testosterone plays a key role for heart and brain function. It affects sex drive, fertility and potency. But it also prevents diabetes, high blood pressure and weight gain. On top of that it prevents prostate cancer and likely many other cancers. The key with low testosterone is to replace it to high normal levels. Blood levels should be measured every two months, when replacement has been instituted, in order to ensure adequate levels.

References  Ref.1 Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008

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Mar
11
2017

Obesity And Diabetes Can Cause Cancer

Dr. Nalini Chilkov gave a talk about how obesity and diabetes can cause cancer. The original title was “Integrative Cancer Care, Increased Rates of Cancer and Cancer Mortality Associated with Obesity and Insulin Resistance, Nutraceutical and Botanical Interventions”. Her talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

In the following I will present a brief summary of her lecture.

Obesity is a major risk factor for cancer

Obesity causes 14% of all cancer deaths in men and 20% of cancer deaths in women.  This link explains this in more detail. The following 15 cancers were linked to obesity in terms of causation. They are: colon cancer, gastric cancer, gallbladder cancer, ovarian cancer, breast cancer, liver cancer, uterine cancer, endometrial cancer, rectal cancer, pancreatic cancer, cervical cancer, non-Hodgkin’s lymphoma, renal cancer, multiple myeloma and esophageal cancer.

The American Society of Clinical Oncology reported about a meta-analysis involving 82 studies. This involved more than 200,000 women with breast cancer. Premenopausal and postmenopausal women were compared who were obese or normal weight. Premenopausal, obese breast cancer women had a 75% increase in mortality compared to the normal weight breast cancer group. With postmenopausal, obese breast cancer women there was a 34% increase of mortality compared to the normal weight group.

With obese prostate cancer patients there is a similar observation. Obese patients have a more aggressive prostate cancer on the Gleason score and the cancer is in a more advanced stage at the time of diagnosis.

Diabetes increases mortality from cancer

Obesity is a common risk factor for both cancer and diabetes. But diabetes by itself is also increasing mortality of several cancers. In a consensus report details of the relationship between cancer and diabetes have been discussed in detail. The following cancers have been identified to have an increased risk of diabetes: pancreatic, gastric, esophageal, colorectal, liver, gallbladder, breast, ovarian, endometrial, cervical, urinary bladder, renal, multiple myeloma and non-Hodgkin’s lymphoma.

A meta-analysis suggests that cancer patients who are diabetic have a 1.41-fold increased risk of dying compared to those cancer patients who have normal blood sugars. Dr. Chilkov explained in detail what the various mechanism are that account for the faster cancer growth in obese and diabetic patients. High insulin levels is one of the risk factors, so is IGF-1, an insulin-like growth factor. The aromatase enzyme in fatty tissue turns male type hormones into estrogen, which also can stimulate cancer growth.

Carbohydrate restriction diet to prevent obesity

Low carb diets like the Mediterranean diet, the ketogenic diet and the Atkins diet will drop blood insulin and lactate levels. Cancer size and cancer growth are related to insulin and lactate levels. A low carb diet can reduce insulin-mediated uptake of sugar into cancer cells.

Research has shown that cancer metabolism slows down when a 10%-20% carb/high protein diet is consumed by the patient. This reduces the amount of sugar that is taken up by cancer cells. It also reduces insulin, so there is less cancer growth. A ketogenic diet is a more strict way to restrict carbohydrates. Intermittent fasting is also a useful method to reduce carbohydrate intake.

Here is an interesting study that illustrates the power of intermittent fasting. The study involved 2413 patients with early breast cancer who were followed for 7 years. Those breast cancer patients, who consistently did not eat anything between dinner and breakfast for 13 hours or more, had a 36% lower risk of having a cancer recurrence. There was also a 21% lower risk of dying from breast cancer when fasting was done for 13 hours or more overnight.

Supplements to prevent obesity, diabetes and cancer

A low carb diet and in some cases even a ketogenic diet is beneficial as a baseline. A regular exercise program is also useful for general fitness building and cardiovascular strengthening. In addition Dr. Chilkov recommended the following supplements.

  1. To reduce inflammation in the body, Dr. Chilkov recommended taking 2000 to 6000 mg of omega-3 fatty acids per day (molecularly distilled fish oil).
  2. Berberine 500 to 1000 mg three times daily. Dr. Chilkov said that Berberine has anti-cancer properties, improves insulin sensitivity and reduces absorption of sugars in the intestinal tract.
  3. Curcumin inhibits cancer cell division, invasion and metastatic spread through interaction with multiple cell signaling proteins. Several researchers showed that curcumin could lower blood sugar levels by stimulating insulin production from beta cells in the pancreas. Triglycerides, leptins and inflammation in fat cells are also lowered by curcumin. Insulin sensitivity increases through the action of curcumin. Dr. Chilkov recommended 300 mg/day of curcumin for 3 months.
  4. Resveratrol, the bioflavonoid from red wine is a powerful anti-inflammatory. This antioxidant has several other effects, which make it challenging to measure each effect by itself. This group of investigators managed to simultaneously measure these effects. They found that resveratrol lowered the C-reactive protein by 26% and tumor necrosis factor-alpha by 19.8%. Resveratrol also decreased fasting blood sugar and insulin; in addition it reduced hemoglobin A1C and insulin resistance. The recommended daily dose of resveratrol is 1000 to 5000 mg.
  5. Green tea catechins (EGCG) help to normalize the glucose and insulin metabolism. The dosage recommended was 1-3 grams per day.
  6. Reishi mushroom (Ganoderma lucidum) contain polysaccharides with antidiabetic and antiobesity effects. They make gut bacteria produce three types of short-chain fatty acids that control body weight and insulin sensitivity.
Obesity And Diabetes Can Cause Cancer

Obesity And Diabetes Can Cause Cancer

Conclusion

Obesity is a risk factor not only for diabetes, but also for cancer. Chronically elevated blood sugars, increased fasting insulin levels and increased IGF1 levels can cause cancer. In addition they can stimulate tumor growth and increase cancer mortality. It is for this reason that the health care provider should screen all diabetics for cancer. In her talk Dr. Nalini Chilkov gave clear guidelines what supplements will be beneficial to reduce the risk of obesity and diabetes as well as cancer. Start with a healthy, balanced diet. Add an exercise program. Then consider some of the above-mentioned supplements to reduce your risk for cancer, diabetes and obesity.

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Mar
04
2017

Weight Loss Surgery Is Unnecessary

Dr. Flavio A. Cadegiani gave a talk saying that weight loss surgery is unnecessary. Dr. Cadegiani is the director of a weight loss clinic called Corpometria Institute in Brasilia, Brazil. He is board certified in endocrinology and metabolism and in internal medicine. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

Here are the main topics that he presented.

Weight measurements are wrong when based on the BMI

Dr. Cadegiani stated that we do not understand obesity, because we look at it from the wrong angle. Current dietary approaches have failed. But obesity research is still proceeding in the wrong way. If all else fails, weight loss surgery is finally suggested as a last resort. But this is wrong.

The problem with body mass index (BMI) is that an athletic body type may be called “obese”, because the BMI exceeds 30.0. However in a very muscular person the reason for the elevated BMI is an increased muscles mass, not fat. Body composition scales reveal that, but a simple weight measurement does not.

Dr. Cadegiani recommended measuring waist circumference with <94 cm (37 inches) for men and <88 cm (34.65 inches) for women being normal.

10 reasons why we are misled by the BMI

  1. The inventor of the BMI was a mathematician. It was explicitly stated that the BMI would not predict the level of fatness of an individual. The other factors are bone mass and muscle mass.
  2. Because the BMI ignores the waist size, it is scientifically invalid.
  3. There are physiological reasons why it is wrong: there is no allowance made for the relative proportion of the bone, muscle and fat content.
  4. The BMI gets the logic wrong: the CDC site claims that the BMI “is a reliable indicator of body fatness for people”. This is simply not true!
  5. The BMI is based on bad mathematics: the formula assumes low muscle mass and high fat content.
  6. The BMI is lying by scientific authority: Dr. Cadegiani said it has an “air of scientific authority, but it is mathematical snake oil.”
  7. The BMI suggests that there are distinct categories of underweight, ideal, overweight and obese. It assumes sharp boundaries that hinge on a decimal place. All of this is nonsense.
  8. Cynical people could suspect that medical insurance companies lobby for the continued use of the BMI as it keeps their profits high. Sometimes insurance companies charge higher fees for people with an elevated BMI.
  9. Doctors can contribute to the continued use of the BMI, if they don’t feel the need to use another way of assessing their obese patients.
  10. It is embarrassing that we still base the assessment of obesity on a 200-year-old mathematical formula when more reliable measures are known.

Bariatric surgery done too easily

Dr. Cadegiani noted that publications on bariatric surgery (=weight loss surgery)

underreport surgical complications and deaths. The bariatric industry is rich, and 90% of the booths during obesity conferences belong to bariatric-related companies. Long-term follow-up studies are lacking. Those who do follow-ups report an increase of pancreatic tumors after 10 years following bariatric surgery.

Long-term follow-ups also describe a 70% increase of psychiatric disorders including depression and alcoholism. Those who had bariatric surgery experience a 200% increase in suicides.

Overcoming weight centered approach

Here is how to avoid the weight-centered approach that would lead the clinician to wrong conclusions.

There are four factors being taken into account:

  1. Metabolic blood markers are included in the assessment
  2. Body composition scales are used and incorporated in the assessment
  3. The patient participates by measuring waist circumference and body weight
  4. Clinical signs and symptoms are incorporated

Classic metabolic markers are liver enzymes and hormone levels like testosterone, Thyroid (T3) LH and IGF-1. The lipid metabolism is monitored through apoB and triglyceride levels. Inflammation is monitored through uric acid levels, ferritin and C-reactive protein (CRP). An oral glucose tolerance test and fasting insulin level can predict diabetes 5 to 10 years before it will occur clinically. Other metabolic markers are homocysteine and metalloproteinases. Insulin resistance can be measured with newer tests.

Oxidized LDLc is the only marker that is linked to diabetic retinopathy. Another marker, resistin is an independent marker for obesity-related cancer, cardiovascular disease and overall mortality. A triglyceride-waist circumference index has been found to be the best predictor for future development of diabetes.

Body composition analysis

The patient measures his/her own waist circumference and body weight on body composition scales. This gives additional information about fat and muscle composition. Dr. Cadegiani’s team likes to understand what is really going on in terms of what triggers fat excess.

Questions are: what is the level of emotional overeating? How much anxiety is there in the patient’s life that leads to overeating? What is the social and cultural environment? What were previous weight loss attempts? And what is the family history in term of excessive weight?

Other important factors are to check for binge eating disorders or night eating syndrome. In addition any patient planning to go for weight loss therapy should be checked for depression, mood disorders and suicide potential.

Otherwise body composition scales by electrical bioimpedance were found to be very useful in assessing fat and muscle percentage as well as visceral fat percentage.

Aggressive clinical approach improves metabolism

Dr. Cadegiani and his group have published their own research paper in February 2017 showing that an aggressive clinical approach can prevent the need for bariatric surgery.  This publication describes that in a group of 43 subjects who were thought to be bariatric surgery candidates only 3 patients (7%) went on to have the procedure done. 93% of the subjects were able to shed pounds with the method offered and avoided bariatric surgery.

They documented that clinical parameters and blood tests all improved on their program. The researchers focused on triggers that caused obesity in their patients. The measured markers were oxidized LDL cholesterol, triglycerides, the liver enzymes ALT and μGT, fasting glucose, Hemoglobin A1C, uric acid and CRP. All of these parameters improved with the modification in food intake. 81.2% of the weight loss was from the reduction of fat mass. 46.5% of patients had a normal waist circumference measurement at the end of the trial. They also achieved normal body fat and visceral fat percentages. As already stated 93% of all the patients in this trial avoided weight loss surgery, called bariatric surgery.

Dr. Cadegiani suggested that obesity should be approached with a scientifically based and responsible method. This will change the way we manage obesity.

Weight Loss Surgery Is Unnecessary

Weight Loss Surgery Is Unnecessary

Conclusion

Attention to detail of the patient with weight problems will allow the patient to reduce fat percentage. Waist measurements should be regularly performed as well as body composition scales measurements. This way the physician can follow the fat and muscle percentages. Key to success is to reduce the refined carb contents of food intake (sugar and starchy foods) and have a calorie deficit diet. Exercise is also an important component. An aggressive clinical approach to obesity can improve the clinical outcome and can prevent bariatric surgery.