Oct
05
2019

Breast Cancer Risk Persists After Hormone Replacement Therapy

New research showed that the breast cancer risk persists after hormone replacement therapy (HRT). This is described in this CNN article. It is common knowledge for some time that female patients who use synthetic hormones as hormone replacement in menopause, have a 1.6-fold to 1.8-fold risk to develop breast cancer. However, since the abrupt ending of the Women’s Health Initiative (WHI) in 2002 the truth about the risks of HRT became known and made HRT more confusing. After all, in this trial they wanted to show once and for all that HRT would be beneficial. The expectation was that HRT would prevent osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestagen and Premarin, that were responsible for the negative effects. Had researchers insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. These horrifying results from the use of synthetic hormones still frighten many women. This is particularly so when it comes to replacing hormones after menopause.

Breast cancer risk study with HRT in more details

The research study described in the CNN article is based on this comprehensive Lancet study. The researchers did a Meta analysis of 58 prospective studies. Unfortunately all the hormones given were synthetic hormones (not bioidentical ones) that had the same configuration as in the WHI. On average women became menopausal at age 50. This is when the physicians commenced HRT. The prospective follow-up showed that 108,647 postmenopausal women developed breast cancer around the age of 65. 55,575 women (51%) had used HRT. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. 

More details about breast cancer risks

The risk of developing breast cancer was lower when women took estrogen only as a form of HRT. For years 1-4 the relative breast cancer risk for patients on estrogen alone was only 1.17-fold. Regarding years 5-14 with estrogen-alone replacement the breast cancer risk was 1.33-fold.

Women of average weight who started their HRT of estrogen/progestagen pills at age 50 with menopause one woman in 50 users developed breast cancer between the ages of 50 and 69. In women who used estrogen regularly, but progestagen only irregularly, one in 70 users developed breast cancer. For estrogen only users one in every 200 women developed breast cancer.

Discussion of the above results

Dr. Wright and Dr. John Lee have pointed out years ago that there are alternatives to taking synthetic hormones as HRT. Taking oral synthetic hormone preparations is problematical. First, the pharmaceutical company attached chemical side chains to the synthetic hormones. The women’s estrogen receptors recognize the synthetic hormones only partially. Hormone researchers developed progestagen to mimic a woman’s progesterone. But it turns out that the estrogen receptors read progestagens like an estrogen. This is the reason why there are higher breast cancer rates with the combination of estrogen/progestagen than estrogen alone. Secondly, there is a problem of estrogen dominance, which causes a higher likelihood that the patient develops breast cancer or heart attacks.

Avoiding estrogen dominance reduces breast cancer risk

If estrogen is balanced with progesterone, the cancer promoting effect of estrogen is counterbalanced, and the women on bioidentical hormone replacement are protected from the serious side effects women of the WHI had to endure.

Bioidentical estrogen applications are available through creams that women apply to the skin. This avoids the problem of the first-pass effect; if estrogens are absorbed from a pill in the gut they have to pass through the liver, which is the organ that metabolizes them.

Bioidentical hormone replacement as an alternative to HRT

In Europe there has been a strong resistance to using synthetic hormones. As a result long-term studies were able to show that there is no danger when bioidentical hormone replacements therapy uses creams that are applied to the skin or intravaginally. This avoids the first-pass effect in the liver, as is the case with synthetic estrogens and progestagens taken orally as pills.

John Lee stated that physicians should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, physicians should use only bioidentical hormones in a hormone replacement therapy. And they should also replace only as much as necessary to normalize the hormone levels. This is also the level where postmenopausal symptoms disappear. Dr. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks”.

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream application to the forearms or to the chest wall once per day. A woman on bioidentical hormone replacement applies bioidentical Bi-Est cream and progesterone cream to the skin of her forearms or chest wall. The hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

Difficulties to measure progesterone levels

Dr. David Zava, PhD gave a talk on breast cancer risks. This was a presentation at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. Dr. Zava, who runs the ZRT laboratory, spent some time to explain how to measure progesterone in a physiological way.

Blood (serum) progesterone levels do not adequately reflect what the hormone tissue level is like in a woman’s breasts. On the other hand saliva hormone levels are giving an accurate account of what breast tissue levels are like.

Progesterone blood levels versus progesterone tissues levels

Dr. Zava gave an example of a woman who received an application of 30 mg of topical progesterone. Next, laboratory tests observed hourly progesterone levels in serum and saliva. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream based on a misleading low blood test. This leads to overdosing progesterone. With salivary progesterone levels it is possible to see the physiological tissue levels, which is impossible with blood tests. Dr. Zava emphasized that testing blood or urine as progesterone hormone tests will underestimate bio-potency and lead to overdosing the patient.

Breast Cancer Risk Persists After Hormone Replacement Therapy

Breast Cancer Risk Persists After Hormone Replacement Therapy

Conclusion

A new Meta analysis of 58 prospective studies with a large amount of participants showed that standard hormone replacement therapy (HRT) for postmenopausal women causes breast cancer. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 after menopause had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. Unfortunately all of the patients had received the standard Premarin estrogen and synthetic progestagen combination. The body’s estrogen receptors read both of these synthetic hormones as estrogen, which led to estrogen dominance. Estrogen dominance (with missing natural progesterone) is known to cause breast cancer.

Comments and discussion of bioidentical hormone replacement (BHRT)

I have explained in my comment that the investigators should have used bioidentical hormone replacement therapy (BHRT) instead of making a similar mistake as in the Women’s Health Initiative, where synthetic hormones caused cancer, heart attacks and blood clots.

Bioidentical hormone replacement is started with progesterone creams first in order to avoid estrogen dominance. After hormone tests estrogen is gradually introduced as Bi-Est cream applied to the skin and balanced with the progesterone. The physician orders blood estrogen levels and progesterone saliva hormone tests from time to time to monitor the hormone levels. No cancer occurs with bioidentical hormone replacement. It also protects from osteoporosis, heart attacks and strokes.

Part of this blog was published here before.

Sep
14
2019

Beware Of Arsenic In US Wines

A former wine industry employee warns to beware of arsenic in US wines. Recently wine testers detected that many California wines contain high amounts of arsenic. Here is a full list of wines where arsenic was found. Often it is the cheaper wines that have the highest arsenic content.

Trader Joe’s has a problem with three wines. The 2 dollar Zinfandel (“Two Buck Chuck)”, their “Menage a Trois Moscato” and “Franzia White Grenache” were too high in arsenic. They had 3-5 times the allowable amount of arsenic than the limit that is acceptable for drinking water.

The lawyers of a lawsuit against the wine industry think that the norm for arsenic content in wine should be the same as the one established for drinking water. However, the wine industry is defending itself saying that people drink more water than wine.

Arsenic in rice

In the past there were high arsenic levels in rice.  An investigation found the high levels of arsenic in rice linked to high levels of arsenic in soil. By and large high arsenic levels in rice come from inadvertent human poisoning. As explained in the Consumers Report high arsenic values were found in rice grown in these states: Arkansas, Louisiana, Missouri, and Texas. These are the same states, where farmers grew cotton in the past. The U.S. has been the world’s leading user of arsenic at that time. Since 1910 about 1.6 million tons of arsenic been in use for agricultural/industrial purposes. Half of this occurred since the mid-1960s. Although arsenic is banned as an insecticide since the 1980’s, residues from the decades of use still linger on in agricultural soil today. For decades arsenic compounds were used for decades in an attempt to combat the boll weevil beetle.

Arsenic in grape juice, apple juice and chicken meat

Arsenic containing insecticides are also in use in the fruit growing industry. This explains the presence of arsenic in grape juice and apple juice. Another source of contamination with arsenic compounds comes from chicken feed that the chicken farmer uses to promote growth. As a result arsenic will be in chicken meat. For this reason alone it is recommendable to eat organic chicken that is free of arsenic.

Keep in mind that brown rice has persistently tested higher in arsenic than white rice.

Beware of arsenic in US wines and in your food

We know for some time now that chicken raised in farms have arsenic in their meat because of the practice to feed arsenic compounds to promote growth. Arsenic is a carcinogen, and is causing many cancers. As the last link said, there is a great need to regulate the food industry and check for arsenic contamination of food in general as well.

How do wine growers introduce arsenic into wine?

There are several possibilities how wine could become contaminated with arsenic. The example of arsenic in rice taught us that old cotton fields where in the past arsenic containing pesticides were in use could be the source of arsenic in rice today. If wine is grown in similar soil that has contamination with arsenic , it likely could get into the grapes.

At this point there has not been an investigation into arsenic in wine. The fact that the majority of wines had high arsenic values makes me believe that the wine growers spray arsenic compounds onto the leaves and grapes of wine plants to treat for various pests.

Organic wine

Organic wine must have a certification by an independent third-party organization. This organization does annual audits on vineyards. The grapes they grow and the soil on which the vine plants grow have to all be examined. Strict standards apply and the organic winegrower has to comply with them to receive the organic certification. Not only is there supervision by the organic certification body, but also by the department of agriculture. The wine grower cannot sell wine as “organic”, if it is not certified.

If you want arsenic free wine, buy organic wine. Here is a brief description of what certified organic wine is.

What arsenic does to your body

Long-term exposure to low doses of arsenic can interrupt the way cells communicate and function. It can contribute to developing diabetes, cancer, vascular disease and lung disease. In addition, high levels of arsenic can cause skin cancer, bladder cancer, lung cancer and heart attacks. It is the inorganic arsenic compounds that are more toxic. This is what researchers found in water and unfortunately also in wine. Organic arsenic compounds as found in seafood are less toxic.

Beware Of Arsenic In US Wines

Beware Of Arsenic In US Wines

Conclusion

There are a lot of unanswered questions regarding arsenic in regular wines. In the US the limit for arsenic in drinking water is 10 parts per billion (ppb). Wines on average have 24 ppb of arsenic in it. A legal case is presently awaiting a trial. The issue is whether the arsenic limits in drinking water also apply arsenic limits in wine. The wine industry is adamant that people drink more water than wine, so one could not compare the two. But the wine industry also wants to sell more wine.

You can switch to an organic wine, which by definition should have less arsenic in it. Arsenic can cause lung disease and various cancers (lung and kidneys). If you drink very little or moderately, you are fairly safe from toxic effects of arsenic. But this topic needs further evaluation, and caution is in order.

Dec
22
2018

Biological Age Is Different From The Chronological Age

Biological age is different from the chronological age said professor Morgan Levine from Yale Medical School. She is working in the department of pathology. She has found in her research that people of the same chronological age have very different biological ages. From a biological standpoint they may be much younger or older than their chronological age. When people are younger than their chronological age, they have less disease and less mortality. This article has reviewed the facts.

Measuring biological age

Dr. Levine also has developed tools how to determine the biological age. And when the biological age is higher than the chronological age, she recommends lifestyle changes that will set back the biological clock. We age differently according to what we eat, how our genetic make-up is, which we cannot change, whether we are physically active and what environmental toxins we are exposed to. So, the biological age determines our health status and what our final life expectancy will be.

Biomarkers for biological age

A simple blood test that your family doctor can order consists of the following. A fasting blood sugar, kidney and liver tests, immune tests and inflammatory tests. In addition the doctor will want to know whether you are smoking or not, how much alcohol you consume and how much red meat and processed meat you eat. A computer program processes these results, which determines your biological age.

Lifestyle improvements can lower biological age

Biological age testing has a strength built in. By changing your lifestyle you can lower it. When you exercise more regularly and switch to eating a Mediterranean diet you can lower your biological age. Other studies have shown that the Mediterranean diet is anti-inflammatory. A telomere test, which also determines the biological age, is fixed. It is not easily changed by dietary measures and increasing your exercise.

Dr. Levine said: “I think the most exciting thing about this research is that these things aren’t set in stone.”

Putting the biological age to the test

Dr. Levine was curious what her own biological age was. She entered her blood test data and lifestyle facts into the computer. She was surprised that her biological age was not as good as her first assumption. Now she is trying to get more sleep, has increased her exercise level and improved her diet.

Her research team is working on getting the algorithm online so that everyone will be able to put one’s blood tests and other data into the computer program and calculate the biological age. The program will also recommend what steps are likely most helpful to increase one’s health and decrease the biological age.

Lower your biological age

No one wants to live a long life, if they are in pain and have various illnesses like arthritis or Alzheimer’s. But things are different, if they can change lifestyle factors and maintain a low biological age for a long time. Now they can stay active, have no pains and are able to contribute to society.

“By delaying the onset of diseases and cognitive and physical functioning problems people can still be engaged in society,” Dr. Levine said. “I think that is the ideal we should be striving for.”

Other literature about biological age

Inflammation increases the biological age

In this publication the authors stressed that inflammation is the common denominator for developing disease and premature aging. The authors stress further that it is mandatory to change one’s lifestyle to lower the biological age and live longer.

Diastolic blood pressure predicts mortality

In an older study the diastolic blood pressure was related to mortality. The higher the diastolic blood pressure was, the higher the mortality.  The authors also noted that it was the persons with the higher biological age who were at the highest risk of dying.

Scientific study about the predictors for the biological age

Here is a scientific study that examines predictors for the biological age.  This is not easy reading, but I placed it here for completeness sake.

Link to a site that can calculate your biological age

Here is a link to a site that calculates your biological age. It is probably not as good as Dr. Levine’s computer analysis will be when it is available. However, it is a good approximation to what it will be like.

Biological Age Is Different From The Chronological Age

Biological Age Is Different From The Chronological Age

Conclusion

The dream of staying younger for longer is not new. Research has shown that we actually can do something about it. If we look after our lifestyle, don’t smoke, don’t drink excessively, eat a sensible Mediterranean-type diet and exercise regularly, our biological age will be less than our chronological age. It is the biological age that determines how old we get and whether or not we will suffer from age-related illnesses. Researchers also found out that when your biological age is younger than your actual age mortality will occur later. The math is simple. Let’s assume that your biological age is 15 to 20 years younger than your chronological age. As the average life expectancy presently is 80 years, your life expectancy can increase to 95 or 100 years.

May
19
2018

What lowers LDL cholesterol?

Many times we hear terms like LDL and HDL cholesterol , but what lowers LDL cholesterol? We have to go back to a time when the ongoing Framingham Heart Study wanted to find out what caused a heart attack or a stroke. In the 1960’s scientists found out that cigarette smoking increased heart attack risk and also blood cholesterol. Then in the 1980’s the news came out that HDL (high density lipoproteins) reduced the risk of heart disease. Eventually several research institutions agreed that LDL (low density lipoproteins) was the culprit for causing plaque deposits in arteries. This caused heart attacks and strokes. LDL is often referred to as the “bad” cholesterol.

Clarification of HDL and LDL cholesterol

Recently a review article asked the question: “What is the difference between HDL and LDL cholesterol?”

Below I will review what LDL and HDL cholesterol do in our system. I will also mention normal values for blood tests. This will help you to understand your own blood test results. Then I will review what you can do to lower LDL cholesterol and to increase HDL cholesterol.

The function of LDL and HDL cholesterol

Total cholesterol in the blood contains LDL cholesterol, small dense LDL cholesterol and HDL cholesterol. The small dense LDL cholesterol is more dangerous than LDL cholesterol. It infiltrates the lining of the arterial walls aggressively. A normal LDL level is less than 100 mg/dL. When triglycerides, another form of lipid is high in the blood, LDL cholesterol forms a lot more small dense LDL cholesterol. This is the case in diabetics or in obese people. It is the reason why they are very vulnerable to develop heart attacks and strokes. The optimal range for triglycerides is less than 80 mg/dL.

HDL cholesterol is protective from hardening of the arteries and protects you from heart attacks or strokes. HDL dissolves LDL cholesterol, brings it to the liver, and the liver excretes it into bile. You want to have more than 60 mg/dL of HDL cholesterol in your blood.

Cholesterol math

The total cholesterol conventionally is calculated like this:

LDL cholesterol + HDL cholesterol + (triglyceride/5) = Total cholesterol

You see that the small dense LDL is not part of it here, but high triglyceride levels would increase the total cholesterol value as the inclusion of 20% of triglycerides in this equation compensates for this.

There is also a ratio of total cholesterol to HDL cholesterol that is important. This ratio should be below 3.4 for both women and men. This is also known as the ½ average risk for a heart attack or stroke. If your value is equal to that or below, you are in a very low risk category to get a heart attack or stroke.

Now I will deal with the question: what lowers LDL cholesterol?

What lowers LDL cholesterol?

Now we need to review what can be done to lower an LDL cholesterol which is too high. Don’t tell me that you want to take one of the statin drugs. These drugs have serious side effects and are only indicated for the most serious cases of high cholesterol values.

Most common measures to reduce LDL cholesterol

  • Cut out red meat

    First of all, cutting out red meat (like beef, pork and sausages) to an absolute minimum, for instance once per week or less is important. The reason is that these meats have more cholesterol in them and also more saturated fats than any other foods. Compare that to poultry, fish and vegetables like beans, which are healthy food sources.

  • Eliminate trans fats

    Furthermore, we need to eliminate trans fats as they are causing heart attacks. There is an important difference between ruminant trans fats and artificial trans fats. Ruminant trans fats have been part of the human diet for millennia like milk fat and fat from cows that are on pasture or lamb. Milk products for instance contain fat with 2-5% natural trans fats. 3-9 % of the fat in beef and lamb consists of natural trans fats. Studies have shown that the body is able to handle these natural trans fats, and heart attacks are not more frequent in people eating moderate amounts of these products including butter from cows that graze on pasture.

  • Artificial trans fats

    Quite the opposite is true for artificial trans fats in margarine that comes from vegetable oil. Avoid bakery items like sweet pieces or muffins and other products that contain hydrogenated oils. Read labels! Use olive oil or coconut oil, but avoid vegetable oils like corn oil, safflower oil or grape seed oil to get away from trans fats and unstable oils that turn rancid. Rancid oils contain free radicals that oxidize LDL cholesterol and attack the lining of your arteries through small dense LDL cholesterol.

  • Cut out sugar and starchy foods

    Another important item is to cut out sugar and starchy foods because these will raise your LDL cholesterol and triglycerides, which also leads to hardening of your arteries. Starchy foods are broken down by pancreatic juices into sugar, which enters your blood stream, causing an outpouring of insulin from the pancreas. When the short-term storage of sugar as glycogen is exhausted in muscle and liver tissue, the liver has to process any surplus of sugar that is still there. The end results are triglycerides and LDL cholesterol. Unfortunately the protective HDL cholesterol does not reach higher levels, when the LDL cholesterol is increased. A persistent diet of high-refined carbs will increase the risk for heart attacks and strokes. It follows from this that we are all better off cutting out sugar and starchy foods from our food intake as it will reduce LDL cholesterol and small dense LDL cholesterol.

  • Increase your soluble fiber intake

    Increase your soluble fiber intake by eating vegetables, oats and oat bran, lentils, fruits and beans. Why does this decrease LDL cholesterol? The liver tries to eliminate too much cholesterol by binding it to bile salts and excreting it into your small bowel. But the last part of the small bowel reabsorbs some of these bile salts, and from there they return to the liver. This is called the enterohepatic pathway of bile salts. Soluble fiber intake binds those bile salts and prevents re-absorption in the enterohepatic pathway, eliminating cholesterol safely in stool. Clinical trials have also shown that soluble fiber from psyllium, pectin, beta-glucans and others reduce LDL cholesterol by binding bile salts in the gut (interrupting the enterohepatic pathway).

  • Plant sterols and fiber supplements

    Plant sterols (usually sold as sterol esters) are recognized by the FDA as reducing the risk of coronary heart disease, if taken in high enough amounts (2.4 grams of sterol esters per day). There are other useful supplements like artichoke extract, pomegranate, soy protein, Indian gooseberry (Amla), garlic and pantethine (vitamin B5) that are beneficial in terms of prevention of heart attacks and strokes. It would be too lengthy to get into more details here.

  • Take a whey protein supplement

    There are two major milk proteins, whey and casein. Only whey protein binds to total and LDL cholesterol, lowering both. It is available in health food stores. Follow the package insert of the whey product for dosing.

  • Increase your omega-3 fatty acid intake

    Omega-3 fats naturally present in fish oils and nuts. They increase the amount of circulating HDL cholesterol, which binds the bad LDL cholesterol. Go ahead and eat salmon, herring and mackerel as well as walnuts, ground flaxseeds and almonds. You can also take molecularly distilled (or pharmaceutically pure) EPA/DHA supplements. This pure form of fish oil is free of mercury and other heavy metals. EPA stands for eicosapentaenoic acid or omega-3 fatty acid. DHA is the acronym for docosahexaenoic acid, an important supplement for the brain. Tests have shown that fish oil supplements at a dosage of 3.35 grams per day of EPA plus DHA reduce triglycerides by up to 40%, equally to Lipitor, but without the statin side effects. The end result: your total cholesterol/HDL ratio decreases, as does the risk for heart attacks and strokes. Here is a review of other oils in your diet.

Measures that will increase HDL cholesterol 

  • Eat foods with anthocyanin

    In a 24-week study with diabetic people HDL levels rose by 19% when food was eaten that was rich in anthocyanin. This consisted of eggplant, purple corn, red cabbage, blueberries and blackberries. The advantage of raising the HDL cholesterol level is that the total cholesterol to HDL ratio decreases, which lowers the risk for heart attacks and strokes.

  • Exercising regularly

    Exercising will increase your HDL cholesterol, which again decreases the ratio of total cholesterol to HDL cholesterol. This number should be between 1 and 3.5, the lower, the better.

  • Take a supplement called Ubiquinol, or Co-Q-10

    Adults above the age of 60 need 400 mg once daily, younger people need between 200 mg and 300 mg daily. Co-Q-10 prevents oxidation of LDL cholesterol, which would aggressively attack the arterial walls causing hardening of the arteries. What causes oxidation of cholesterol? The answer is clear: fried foods like french fries or deep fried chicken will lead to oxidation; other culprits are margarine, commercially baked goods and cigarette smoking.

  • Calcium and vitamin D3

    Recently a study on postmenopausal and overweight or obese women found that supplements of calcium combined with vitamin D3 lowered cholesterol.

  • Polyphenols

    Flavonoids are the largest group among the polyphenols in such common foods as vegetables, fruits, tea, coffee, chocolate and wine. Over 130 studies on humans have shown improvement of the lining of the arteries (endothelial functioning) and lowering of blood pressure. Polyphenol consumption has a connection to a lower risk of mortality from heart attacks. Eat a Mediterranean type diet or a DASH diet, and you will automatically get enough polyphenols with your food. However, resveratrol, the powerful red wine polyphenol, warrants a separate daily supplementation as it prevents LDL oxidation in humans (Ref.1). Take about 250 mg of resveratrol daily.

  • Niacin/ nicotinic acid

    This supplement comes as “flush-free niacin” and also as extended release niacin. It can raise the beneficial HDL cholesterol by 30 to 35% when patients take higher doses of 2.25 grams per day. In a metaanalysis of 7 studies researchers found a significant reduction of heart attacks and transient ischemic attacks. These are precursor syndromes before developing a stroke. Niacin can change the small particle LDL into a large particle size LDL, which is less dangerous. Niacin also reduces oxidation of LDL, which stops the atherosclerotic process. For a healthy person 500 mg per day of flush-free niacin is adequate.

  • Curcumin

    This is a powerful heart and brain protector combining three different mechanisms in one. It is reducing oxidative stress. But it is  also an anti-inflammatory. In addition it counters the process that threatens to destroy the lining of the arteries. One study on healthy volunteers showed reduction of 33% in lipid oxidation, a 12% reduction of total cholesterol and an increase of 29% of the protective HDL cholesterol when patients took 500 mg of curcumin for only 7 days (Ref.1). This is the daily dose I would recommend for prevention of heart attacks and strokes.

  • Vitamin E (tocopherols)

    This fat-soluble vitamin is an antioxidant and in the past health practitioners knew about its use as being heart supportive. Strangely enough some conservative physicians bad-mouthed this vitamin. In the meantime health practitioners have returned to using the vitamin. It turns out that there are 8 different types of tocopherols, with the alpha tocopherol being the best-known, but you also want to be sure that you are getting gamma tocopherol with your balanced vitamin E supplement every day. Newer research has shown that tocotrienol is more powerful than tocopherols. I take 125 mg of tocotrienols daily.

What lowers LDL cholesterol?

What lowers LDL cholesterol?

Conclusion

Over the years cardiovascular researchers have accumulated knowledge about supplements that will reduce LDL cholesterol or increase HDL cholesterol. It has practical value: you can look at your own lab results and choose what fits your situation best. You should always make these decisions together with your health care provider. None of the methods reviewed here have any serious side effects. On the other hand statins, as I have reviewed in the link provided, do have significant side effects. Keep in mind that cholesterol is a normal body component that our body needs to make human cell walls. But we do not need to smoke (stopping it lowers LDL cholesterol). We need regular exercise (increases HDL cholesterol). Keep your cholesterol and triglyceride values within the normal ranges that I listed and as a result you will do well in terms of preventing heart attacks and strokes!

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Jan
06
2018

Lyme Disease The Great Imitator

Dr. Pamela Smith talked about Lyme disease the great imitator when she gave a presentation. This was at the 25th Congress of the American Academy of Anti-Aging Medicine, Dec. 14-17, 2017, which I attended. Dr. Smith gave a talk about how to approach a complex patient when multiple systems are affected. Part of that talk dealt with Lyme disease, which I will review below in some detail.

Transmission of Lyme disease

Lyme disease is one of the fastest growing infectious diseases in the US. As a result about 200,000 new cases of Lyme disease occur in the US every year.

The transmission occurs through ticks that that carry a spirochete, called Borrelia burgdorferi.

This bacterium, much as syphilis, which also is caused by a spirochete, produces imitator disease patterns. Clinically it can be a challenge to diagnose Lyme disease.

The common way of transmission to humans is by infected ticks that bite the skin. But Dr. Smith said that transmission of the spirochete can also occur by breastfeeding, blood transfusions, in vitro fertilization and finally by sex. Although originally Lyme disease infected ticks were found on deer, other species can also be carriers. Ticks from mice, foxes, raccoons, songbirds, chipmunks, and squirrels can also transmit Lyme disease.

Clinical presentation of Lyme disease

Only 30 – 40% of adults with Lyme disease have the characteristic rash of the “bull’s-eye lesion” (erythema migrans). With children this presentation is even less common (only 10% have erythema migrans). If there is a bull’s-eye lesion, this will last from one week to several months. A laboratory test using an enzyme-linked immunosorbent assay (ELISA test) can confirm the diagnosis of the disease.

Disseminated early or late Lyme disease

Fatigue, headaches and weakness can be non-specific symptoms of Lyme disease. Furthermore, other non-specific symptoms like back pain, muscle and joint pains as well as chills can detract the physician from diagnosing Lyme disease. In addition irregular heartbeats, nausea, vomiting, swollen lymph glands, memory loss, gait problems, bladder and kidney problems are other symptoms. Finally, liver problems, sore throat, fever, seizures, depression, dementia, hallucinations, mood swings and arthritis can be other symptoms.Even eating disorders, verbal aggression, schizophrenia and suicide can be symptoms of Lyme disease.

Common symptoms that have a link to Lyme disease

Common symptoms of Lyme disease include headaches, fatigue, joint pain and swelling of joints, stiffness of the neck or back. There can be difficulties with concentration, speech or writing. Further symptoms are sleep disturbances, numbness or tingling of arms or feet and forgetfulness. 

Lyme disease development

Borrelia burgdorferi can be found inside body cells and outside of cells as biofilms. This form makes them resistant as it allows Borrelia burgdorferi to exchange DNA and makes them resistant to antibiotics. There are also two major forms of Borrelia burgdorferi, namely cell-wall forms and cystic forms. Once the patient has been bitten by the infected tick Borrelia can quickly change shape into the more difficult to treat cystic form. Within 24 hours Lyme disease can spread to other parts of the body. Common such areas are the eyes, brain tissue and glial cells, heart, collagen, synovial fluid of joints and skeletal muscle fibers.

Lyme disease can also complicate many other diseases. These are ALS, Alzheimer’s disease, fibromyalgia, MS, bipolar disorder, neurological disease, heart disease (Lyme carditis) and autism.

Treatment of Lyme disease

  1. Dr. Smith said that Lyme disease is often complicated by dysfunctional gut flora. She prefers to start patients on a sugar-free and gluten-free diet. The patient also has to take probiotics.
  2. 75% of Lyme disease patients show a cure after three weeks of Doxycycline 100 mg twice per day. Alternatively cefuroxime 500 mg twice per day is a medication of choice.
  3. Cefuroxime only treats the cell‐wall forms. Doxycycline treats the intracellular forms. Metronidazole or tinidazole will help to eradicate the cystic forms of Lyme disease.
  4. Grapefruit seed extract is another treatment modality if the patient is allergic to Metronidazole. It eradicates the cystic form of Lyme disease.
  5. Serrapeptase from whole leaf stevia extract will also help to eradicate Borrelia biofilms and persisters.
  6. Monolaurin, a coconut oil extract is effective in treating all three morphological forms of Borrelia burgdorferi.

Patients with neurological symptoms

Patients with neck stiffness, headaches or neuropathy need treatment for a longer period of time. These patients also need monitoring for recurrent Lyme disease at the end of the treatment.

Case presentation of a patient with Lyme disease

Dr. Smith presented one of her patients with Lyme disease in detail. She was a 45-year old executive. She suffered from extreme fatigue. It took quite a few tests to find out that her antibody titers against Lyme disease were very high.

Here is her long list of symptoms: hair loss, four urinary tract infections in quick succession, brain fog, extreme fatigue, systemic pain, musculoskeletal pain, anxiety and depression, eczema, psoriasis, itching, stomach ache, trouble eating, weight loss of 12 pounds, flu, strep presented like meningitis.

Comprehensive treatment of patient with Lyme disease

Dr. Pamela Smith instituted a comprehensive treatment protocol. It turned out that she had developed gastritis, which was the reason for her weight loss. This needed conventional treatment. After the treatment with antibiotics, her energy picked up, and her appetite came back. She also engaged in yoga and other self-awareness programs. She deliberately slowed down her lifestyle activities. Her symptoms were mostly gone or significantly diminished. She was able to function. She experienced energy, joy, and could focus again. The only symptoms left were some mild pain, some bladder problems, some limitations with her diet and mild brain fog.

Husband had Lyme disease

Part of the work-up was to test her husband for Lyme disease. He tested positive. He was also treated although he was entirely asymptomatic. When his treatment was finished, the doctor tested him for a specific antibody and this came back as negative. This meant that he now was free of Borrelia burgdorferi and would no longer be able to infect her. The doctor thought that it was most likely through sex that she had contracted Lyme disease. The problem is that some people are completely asymptomatic, but nevertheless they can be carriers of Lyme disease.

Lyme Disease The Great Imitator

Lyme Disease The Great Imitator

Conclusion

Lyme disease, the great imitator, has become a more common disease in the US and around the world. Years back Lyme disease was often overlooked. But lately physicians have diagnosed Lyme disease earlier as diagnostic tests have improved. With earlier treatment a lot of suffering of the patient can be prevented. But in many cases symptoms are confusing as Lyme disease involves several organ systems. This makes the diagnosis more difficult. By diagnosing Lyme disease earlier, treatment can start at an earlier stage, and the patient will soon return to a state of wellness.

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Aug
26
2017

Decreased Sperm Counts In Men

What do decreased sperm counts in men tell us about our world? A recent study has shown that over the past 40 years males in many centers that tested for sperm counts have lost 50% of the sperm count that was normal in the 1970’s. The question is, what could have caused this? Nobody has definite answers. But here are the factors that the Mayo Clinic lists for low sperm counts.

Medical causes of decreased sperm counts in men

  • A varicocele: A varicocele is dilatation of veins close to the testicles. It is presumed that this leads to a higher temperature inside the testicles and this causes a lowered sperm count and poor sperm quality.
  • Antisperm antibodies can cause infertility. Due to low sperm counts.
  • Infections in the testicles reduce sperm production. Gonorrhea and HIV infection are some of the common infections.
  • Some men develop retrograde ejaculation. With this the sperm enter the bladder on ejaculation instead of coming out from the tip of the penis. Alpha-blockers, a type of blood pressure medication can do this as a side effect. But there are also various health problems that can cause retrograde ejaculation like diabetes, surgery to the prostate, urethra and bladder. Spinal injuries can be also a cause of retrograde ejaculations. In many cases the sperm production in the testicles is still present and sperm could be sampled from there for artificial insemination.
  • Tumors of the pituitary gland can interfere with hormone production of testosterone and sperm counts will fall or stop. But other pituitary hormones, thyroid hormone and adrenal gland hormones are needed for fertility.
  • Chromosome defects like Klinefelter syndrome and others can be a cause of abnormal development of the male genitals with low or missing sperm production.
  • Celiac disease is a bowel disease that is due to gluten sensitivity. It causes low sperm counts and infertility, which responds to a gluten free diet. Sperm counts normalize with this diet.
  • There are medications that can decrease sperm production like chemotherapy, anabolic steroid use, antifungals and certain antibiotic medications and some ulcer medications.

Lifestyle causes leading to decreased sperm counts in men

Certain lifestyles and occupations can cause a man to have a decreased sperm count.

  • Drinking alcohol excessively can reduce testosterone production, which decreases sperm count.
  • Recreational drug use: steroids to increase muscle mass cause testicular atrophy and decreased sperm count. Cocaine and marihuana also decreases the sperm count.
  • Certain occupations like welding from exposure to heat and truck driving from prolonged sitting have been associated in some studies with infertility. But there are other studies that could not confirm this correlation.
  • Smoking: Men who smoke have lower sperm counts than men who don’t smoke.
  • Excessive weight: Obese men transform some of their testosterone into estrogen through the action of the enzyme aromatase, which is amply present in fat cells. This leads to low testosterone levels and low sperm counts.

Environmental causes of decreased sperm counts in men

The environment in terms of heat production around the scrotum or exposure to chemicals or ionizing radiation can lower sperm counts in men.

  • Heat around the testicles: studies do not all agree, but there is a tendency for low sperm counts when using saunas and hot tubs frequently. Sitting for longer times or using a laptop computer for longer periods can also increase the temperature of a man’s scrotum and lead to a low sperm count.
  • Exposure to heavy metals like lead, mercury and others can be the cause of infertility.
  • Exposure to radiation can reduce sperm production. With high doses of radiation sperm production may cease entirely. With lower radiation exposures sperm counts may be down for several years before they recover to normal.
  • Industrial chemicals: exposure to fumes from certain chemicals can lead to low sperm counts; benzenes, herbicides, pesticides, xylene, toluene, painting materials and organic solvents are on this list.

Recent study about decreased sperm counts in men as an indicator

We have now reviewed the major causes of low sperm counts in men. I like to revisit the recent sperm study I mentioned in the beginning of this blog. It is unlikely that men in North America, Europe and Australia would spontaneously produce less than 50% of the sperm than men 40 years earlier had produced. The next puzzling fact is that the study found normal sperm production in men in Africa, South America and Asia.

This points to epidemiological differences that reduce the sperm count in men in North America, Europe and Australia. In view of the multitude of possible causes it will require a task force that does a comparative study worldwide looking at exposure history, diets, social habits and other factors.

Fertility clinics are thriving because couples want children. With low sperm counts of males there is more infertility than there was in the past. Density gradient centrifugation is a reliable method of enriching sperm counts.

In the past a couple had no problem getting a successful pregnancy when they wanted it. Now couples often have to be assessed in a fertility clinic because of problems with regard to decreased sperm counts in men, which can cause infertility.

Decreased Sperm Counts In Men

Decreased Sperm Counts In Men

Conclusion

A new study has noticed that over the past 40 years many men have developed low sperm counts. This has caused significant problems with fertility among couples. Fertility clinics are busy trying to help these couples. Density gradient centrifugation has become a common technique to enrich sperm samples prior to artificial insemination. It is a puzzle why the recent study has found normal sperm counts in samples of men living in Africa, South America and Asia. In contrast men living in Europe, North America and Australia have 50% lower sperm counts. The reason may be multifactorial. It will require a team of experts to sort out this discrepancy and hopefully find an answer for men in Europe, North America and Australia to bring their sperm counts back to normal.

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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. He presented his talk 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 new substance, 17 alpha-methyltestosterone, was a new compound. The FDA could patent it. Men liked it, because they could swallow this testosterone derivative as a pill. However, the liver changed 17 alpha-methyl-testosterone into 17 alpha-methyl-estradiol, a strong estrogenic compound. The body could not metabolize this testosterone compound too well. Shortly after introduction into patients it became evident that 17 alpha-methyl-testosterone caused liver cancers. This “testosterone equivalent” was on the market for 50 years before the FDA outlawed it because it 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. The belief that testosterone production was the culprit of prostate cancer led to the practice of physicians to do orchiectomies. This inadvertently removed the real cause of prostate cancer, an estrogen surplus. This improved the survival of these patients somewhat. Nowadays we have more sophisticated testing methods.

Estrogen causes prostate cancer, testosterone does not

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.

Some physicians still practice the old method of hormone depletion therapy in advanced prostate cancer cases. But Dr. Morgentaler and other researchers have shown that it is wrong to do hormone depletion therapy or orchiectomies.

10% absorption rule myth

For years there has been a persistent myth that the skin would only absorb 10% of testosterone. There was never any proof of this and newer studies showed that indeed the skin absorbs about 90% of testosterone.

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 they concluded that testosterone therapy was causing 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”. The problem with these was that the controls were wrong or they compared unequal groups that were not comparable. It is reminiscent of previous effort of the tobacco industry wanting to cover up that cigarette smoke causes lung cancer.

Testosterone replacement treats the cause of the deficiency

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 confusion plagued the older physician generation. 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

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, the less 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 production occurs during the sleep in the early morning hours.

Less testosterone from weight gain and sugar overconsumption

Weight gain and sugar overconsumption poison the testosterone producing Leydig cells.

Poly-pharmacy can lower testosterone

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. One paper reported 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 is 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.

Testosterone treatment and inflammation

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. Researchers developed a new heart attack/stroke specific biomarker. 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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Jun
04
2016

Genetic Screening For Better Health

Dr. Matt Pratt-Hyatt gave an overview about genetic screening for better health at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. The title of the talk was: ”Genetic Screening: A Tool for Better Health with Age”. He showed that with more sensitive genetic screening techniques minor genetic changes can be detected. These are a lot more common than previously thought of. Matt Pratt-Hyatt, PhD is Associate Laboratory Director for the Great Plains Laboratory in Lenexa, KS.

Specifically, Dr. Pratt-Hyatt explained that single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”) were the most common type of genetic variations among people. These genetic changes in the DNA often cause disease. Different types of genetic testing can identify the gene defects of SNPs. One of the questions is how aging can be better managed when genetic defects are known.

When it comes to our genetic material there are over 3 billion base pairs, all contained in 23 chromosomes. These are home to 20,000-25,000 genes, most of which are normal.

A gene has three regions all of which can have mutations. In the middle there is the coding region; one end is the regulatory region for transcription initiating; at the other end the transcription termination signals are located. Minor mutations in any of these regions can have major implications for the health of the individual or they can stay silent SNPs. SNPs are classified into missense mutation or nonsense mutation. This description just shows how intricate and complex the process of mutations can be!

There are three types of sequencing that are common:

Three types of genetic screening for better health

  1. Sanger sequencing
 utilizes certain dyes that correspond to specific nucleotides of the DNA. The benefits of Sanger sequencing is that it can cover one gene completely. It can find previously unknown mutations. But the disadvantage of Sanger sequencing is that you cannot process a large number of genes.
  2. The Florophore-base detection looks at multiple SNPs in a single run. This method is cheaper than whole genome sequencing. But one of the disadvantages of Florophore-base detection
is that only a limited number of SNPs can be processed per run. It also can miss new mutations.
  3. Benefits of next generation sequencing 
are that it can look at 1000s of SNPs per run. It is much more accurate than previous technologies. A drawback
though is that the equipment is much more expensive.

The physician does not have to order all of these tests, but can make the choice of the appropriate one for the patient. The following are some applications with regard to how genetic screening can be useful for better health.

Detoxification as part of genetic screening for better health

Since the 1970’s and 1980’s it has become clear that there are many steps in the detoxification process in the liver. It involves major enzyme systems that are controlled by the P450 genes. We know several genetic defects that run in different families. These effects are very important for drug detoxification and metabolism.

The P450 detoxification system in the liver

Any mutation in one of the P450 controlling genes will lead to accumulation of the drug that is normally detoxified by this enzyme system. Without discontinuing or lowering the drug there can be toxicity at higher levels. When people age, they often have spontaneous mutations of the P450 detoxification system. The physician who prescribes medications should take this into account. Common drugs that cause problems with the P450 controlled detoxification are antidepressants, the blood thinner Coumadin, the antibiotic erythromycin, the asthma medication Theophylline and many others.

Patient with atrial fibrillation

Here is an example of how important this knowledge is in an elderly patient who was sent to the hospital with an irregular heartbeat. The electrocardiogram allowed a diagnosis of atrial fibrillation. The doctor treated the patient with a cautious loading dose of 0.5 mg of Coumadin in an attempt to thin the blood of the patient. This would prevent a blood clot or a stroke due to the arrhythmia. Normally a small dose like this would not do much in terms of blood thinning. It would take several days of small doses of Coumadin dose like this to achieve blood thinning.

Defect of gene controlling P450 system

Unbeknown to the physician, this patient was different as he had a defect in the Cyp2c9 gene, a subtype of the P450 system. Very quickly the patient developed bleeding gums and bruising of the skin in various locations. When blood tests were taken, the INR, a measure of the clotting system, was 3.7, a value that should not have exceeded a level of 2 to 3. Genetic testing confirmed a homogenous mutation of the Cyp2c9 gene that explained the toxicity of Coumadin in this case, one of the many drugs that is detoxified by the P450 system.

Mental health as part of genetic screening for better health

Many mental illnesses can be caused by defects in various parts of the brain metabolism. This is particularly so when it involves the synthesis of brain hormones. If there are genetic defects, this can lead to the particular brain metabolism that is associated with depression or schizophrenia. Even dementia, Alzheimer’s disease and Parkinson’s disease can be caused by genetic defects. Methylation pathway defects are another source of possible genetic defects, which can affect multiple metabolic pathways. This is the cause of many diverse conditions like autism, diabetes and some hereditary cancers. The reason it is important to be aware of such genetic aberrations is that often vitamin B2, B6, niacin, vitamin B12 and the minerals magnesium and zinc can stabilize a person with methylation defects.

Cholesterol as part of genetic screening for better health

People with obesity have problems with their lipid metabolism, diabetes, high blood pressure and often heart disease and strokes. Changes in cholesterol metabolism are at the center of these problems. Cholesterol is one of the building blocks of cell membranes, and cholesterol is one of the normal components in the blood as long as the subfractions are properly balanced (LDL and the HDL cholesterol). Unfortunately many people have minor or major defects of the biosynthetic pathway of cholesterol. There are 5 genes that control the acetyl CoA biosynthesis. 21 genes involve the main cholesterol biosynthesis pathways. Over 10 genes control cholesterol metabolites. Historically these genes were detected because of various familiar gene defects that caused problems with the biochemical processes surrounding cholesterol. Familial high cholesterol levels (familial hypercholesterolemia) is one of these common conditions.

Patients who have this condition will often have high cholesterol and also often have a family history of gall bladder surgery for gallstones and a history of premature heart attacks or strokes. Early diagnosis and careful clinical intervention can improve the outlook for many patients.

Genetic Screening For Better Health

Genetic Screening For Better Health

Conclusion

Modern medicine cannot help all of the genetic conditions. But you can work around many minor genetic abnormalities. In addition, if the physician knows the genetic defect, it is possible to avoid drug interactions. It is encouraging that newer test methods have now shown success, as they are more affordable than in the past. As time progresses the price of these genetic tests will come down even further. Mental health, detoxification pathways and the metabolic syndrome of obesity are practical applications where genetic tests have significance.

Mar
05
2016

Catch Cancer Early

Cancer of the cervix was the first cancer where physicians practiced early diagnosis (Pap test), so they could catch cancer early. Subsequently this reduced the mortality due cancer of the cervix significantly.

Pap test

When the Pap test was invented and used on a large scale, cervical cancer could be diagnosed at the earliest stage, which is “stage 0” or “cancer in situ” (the earliest local cancer). In 1943 Dr. Papanicolaou published the book “Diagnosis of Uterine Cancer by the Vaginal Smear” where he described in detail how to do the Pap test. This became the norm very quickly and the use of the Pap test spread all around the world following WWII.

This was important, because later physicians detected that cure rates of close to 100% were possible by removing the tiny accumulation of local cancer cells (cancer in situ). This could be achieved by surgical removal (cone biopsy), radiation therapy, and cryotherapy or later also with laser treatment. The key to success in cancer treatment is early detection and early treatment.

Other cancer prevention and early detection

Melanoma

With melanoma, a darkly pigmented skin cancer, the earliest stage, namely stage 0 or carcinoma in situ is treated by surgical excision leaving a wide margin of healthy skin around it. This is the cure, because the physician detected it early and there was no invasion yet into the surrounding tissues.

Breast cancer (ductal carcinoma)

The most common breast cancer type is ductal carcinoma in situ (DCIS), of which 80% are diagnosed by mammography. Treatment for this is usually by local surgical excision, called lumpectomy followed by radiation.

Colon cancer screening with colonoscopy

Colon cancer typically arises out of colonic polyps. A physician typically does a colonoscopy in high-risk patients with a history of colon cancer in a first degree relative.Typically he does this every three years. When he finds a polyp, he removes it during the procedure. My mother died at the age 59 of colon cancer. I had colonoscopies every three years since the age of 40 and on several occasions polyps were removed. Had I not had the colonoscopies, an unnoticed carcinoma in situ would have developed within one of the polyps and subsequently invasive colon cancer could have developed. Colonoscopies are a means of true colorectal cancer prevention.

The newest development: Oncoblot test to detect in situ cancers

At the 23rd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec. 11-13) Dr. Mark Rosenberg spoke about the universal cancer marker ENOX-2 that is only expressed during embryogenesis (the development of the fetus) and in adulthood only again when cancer develops. A test has been developed to check for the ENOX-2 gene, which becomes positive 5 to 7 years before cancer can be detected clinically. This is called Oncoblot test. Sensitivity of ENOX-2 is high and false positives are negligible, which makes the ENOX-2 marker ideal for cancer screening.

Green tea and capsicum may suppress cancer gene

There are various isoelectric points for various cancer tissues, so the lab physician can tell the treating physician from which tissue a positive cancer test originates. The interesting aspect is that a combination of green tea and capsicum has been able to suppress the expression of the gene, and the cancer gene can be turned off. Corresponding biopsy samples showed that the cancer cells had disappeared. This is an entirely new concept and will have to be further investigated by clinicians for the various cancer types.

25 cancers that can be screened for using the Oncoblot test

Here are the 25 cancers that are screened with the Oncoblot test: Bladder, Breast, Cervical, Colorectal, Endometrial, Esophageal, Gastric, Hepatocellular (liver), Kidney, Leukemia, Non-Small cell (lung), Lung Small cell, Lymphoma, Melanoma, Mesothelioma, Myeloma, Ovarian, Pancreatic, Prostate, Sarcoma, Squamous Cell, Follicular Thyroid, Papillary Thyroid, Testicular Germ Cell, Uterine. Considering that testing for all of these cancers is 1000 USD, this means that each specific cancer test is only 40 USD per test. I suspect that in future the price will come down as mass screening will be done. But the key is that this test is available right now; it is highly specific and highly sensitive.

A specific and sensitive cancer screening test

But the important finding right now is that we have a very sensitive and very specific cancer screening test for over 25 various cancer types that can detect these cancers in the in situ stage (very early).

This has not been the case in the past except with the introduction of the Pap test for cervical cancer.

Change of treatment protocols may be required

The company producing the Oncoblot test states that the results need to be discussed between patient and treating physician. Although the treatment protocol does not change, there will be a lot more early diagnoses of cancer than in the past. In the past stage 1 and 2 stage cancers had the label “early cancers” and physicians developed protocols to treat these early cancers. But with this very sensitive blood test (Oncoblot test) the diagnosis of “in situ cancers” (stage 0) is possible. Mind you, it sets you back about 1000 USD, the cost for processing your blood and the test. Despite the monetary barrier I believe that enough people will go for this test, because with the knowledge that an early cancer diagnosis is possible, it can be treated effectively with high cure rates.

Down side of positive Oncoblot test, when tumor not spotted

The down side may be that those who had the test and are positive for a specific cancer may have to undergo additional tests to locate and treat the tumor.

Suggested future approach to cancer detection and treatment

I envisage four steps to the future of cancer diagnosis and treatment.

Screening for cancer 

To achieve this the Oncoblot test is a useful screening tool. Other similar tests that are in development will do this also in the future. This will give a tissue specific cancer diagnosis at the earliest possible point in time when clinically in most cases no tumor is present clinically for another 5 to 7 years.

Staging of the cancer found

This requires confirmation of the cancer by doing imaging studies and possibly biopsies. An MRI scan of the affected area will likely be very useful, also to rule out early lymph gland metastases. Without being certain about the stage of the cancer the treating physician can not be certain what treatment schedule to follow as treatments differ for various stages of a cancer.

Minimal invasive therapy

Ablative cryotherapy or low-dose laser phototherapy using three different photosensitizers as shown in the example of end stage prostate cancer in this link under the heading “Photodynamic therapy of a group of inoperable prostate cancer patients”. The tragedy in this pilot study was that all of the men presented with end stage prostate cancer, which is difficult to cure. But early prostate cancer is may be easier to cure with the same method, simply because the cancer cells are local (in situ). Every cancer expert knows that cure rates are very high in the early stages of cancer, with the highest cure rates for cancer in situ (stage 0) and somewhat lower success rates for stages 1 and 2.

Poorer long-term survival with more advanced cancers

Stages 3 and 4 have very poor cancer cure rates, as the cancer has already invaded the surrounding area in stage 3 and presents with distant metastases in stage 4. To make an impact in these latter cases requires toxic therapies like chemotherapy, radiotherapy and/or extensive surgery. Having said this, 20% of these end stage prostate cancers still experienced a cure with the triple photosensitizers and low-dose laser therapy (see link above), which conventional therapies would not have achieved.

Retesting for residual cancer using Oncoblot test 

Two months after the completion of the cancer treatment the physician can reorder the Oncoblot test. This will reassure the patient and physician as well that all of the cancer cells have disappeared. As this test is so sensitive, any remaining cancer cells would shed tumor protein into the blood. The Oncoblot test would pick this up immediately. In the few cases that would remain positive this would enable the physician to do further tests. The physician could modify the treatment and hopefully get rid of the last cancer cell.

Examples of two clinical scenarios

Two common cancers are prostate cancer in men and breast cancer in women.

1. Prostate cancer

Prostate cancer is very common in older men. From the age of 50 onwards the risk of getting prostate cancer is higher with every decade.

Another problem is that not every prostate cancer is invasive. Some cancers are low grade and sit around for a long time and may never metastasize. A cancer expert discusses this here.

To attempt to distinguish between the aggressive form of prostate cancer and the slower “wait and see type”, a score has been developed, called the 4K score. This score combines the PSA test and a prostate specific kallikrein marker within one blood sample. Patients with a high 4K score are the ones who have an aggressive prostate cancer that needs urgent treatment. Patients with a low 4K score are the ones where many urologists recommend to wait and observe.

Treat prostate cancer in the early stage

If I were the patient I would lean towards treating any kind of prostate cancer. Cancer can do whatever it wants to.  You do not really know how these cancer cells will behave in the future. The only difference in prostate cancer is that the prostate has a tough capsule. The tumor stays localized for a long time, sometimes for decades. The prostate cancer grows slowly until it breaks out of this shell and metastasizes to the rest of the body. At that point it is often too late to rescue the patient, because it suddenly is a late stage. As stated earlier, late cancer stages lead to poor treatment successes. Knowing this, I would suggest to use a radical prostatectomy in a stage I cancer.

2. Breast cancer

This is common in women. Often the physician detects early cancer on a routine mammography or else with the Oncoblot test. An MRI scan can localize the tumor when it has a certain size. But it may take 5 to 7 years following an Oncoblot test before the cancer can be visualized. This may be a diagnostic dilemma, which has to be worked out in the future. Most breast cancers develop from the epithelium of the breast ducts. Low-dose laser phototherapy with photosensitizers can treat this early cancer stage. If a repeat Oncoblot test 2 months later is negative, the treatment was successful. If it is still positive, surgery, which is more invasive can still be done.

Follow patient closely, if Oncoblot test remains positive following surgery

If not, the clinician will have to closely follow the patient with repeat MRI scans of the breasts. Without utilizing the Oncoblot test this method (the MRI scan) is still superior. Perhaps in the future another way besides the Oncoblot test to localize early cancer becomes available. The fundamental difference between breast cancer and prostate cancer is that breast tissue is very vascular. This encourages any cancer of the breast to metastasize very early. For this reason it is crucial to treat breast cancer very early to have optimal treatment successes.

Catch Cancer Early

Catch Cancer Early

Conclusion

The introduction of the Oncoblot cancer-screening test may revolutionize diagnosis and treatment of 25 or more cancers. A person who has one of these cancers can get screening with this test. I have only highlighted the possibilities with the example of two cancers. I explained what this might mean in practical terms for the diagnosis of prostate cancer and breast cancer. The exciting news is that cancer can now be detected earlier. The confusing part is that it can be diagnosed 5 to 7 years before the cancer is clinically detectable. Many physicians may feel uncomfortable treating cancer that early. I have seen many cancer patients in their end stages in clinical practice. I can only state that it is better to be too early than too late diagnosing cancer.

Cancer that will respond to treatment

Only stage O (cancer in situ) and stage 1 (and sometimes stage 2) can be treated successfully and guarantee a cure. Experience will teach us what the best way is in the future. In the meantime this is an approach to an early diagnosis without taking any risks.