Health Risks Of Night Shifts

One of the news stories in 2016 was about health risks of night shifts. The Bureau of Labor Statistics reported in 2000 that 15 million workers (16.8 % of the working population) were doing alternative shifts (night shift work mixed with daytime shifts). In 2016 they reported 14.8% were working alternate shifts. Among blacks, Asians and Latino Americans the percentage of working alternative shifts was higher, namely 20.8%, 15.7% and 16%, respectively.

Shift work is more common in certain industries, such as protective services like the police force, food services, health services and transportation.

Evidence of health risks of night shifts

There are several publications that showed evidence of health risks of night shift workers. Here is a random selection to illustrate the health risks of night shifts.

  1. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.
  2. This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Blood tests from daytime workers were compared to night shift workers. Inflammatory markers like the C-reactive protein and leukocyte counts were obtained. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.
  3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.
  4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.
  5. In a study from China 25,377 participants were included in a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work were unaffected with regard to cancer.
  6. A Polish study examined hormones and the body mass index (BMI) among 263 women who worked night shifts and 269 women who worked day shifts. When night shift workers had worked more than 15 years at nights, their estrogen levels, particularly in postmenopausal women were elevated compared to the daytime workers who served as controls. The BMI was also increased in the nighttime workers.
  7. Chronic lymphocytic leukemia (CLL): a study in Spain showed that working for more than 20 years in rotating night shifts was associated with a 1.77-fold higher risk of developing CLL. The authors noted that melatonin levels in that group were much lower than in controls that worked only day shifts. Working in straight night shifts did not show higher risks of CLL compared to daytime workers.
  8. In a Korean study from Seoul 100 female medical technologist who worked nighttime had their melatonin levels tested, which were compared to daytime workers.  They measured 1.84 pg/mL of melatonin for the nighttime workers compared to 4.04 pg/mL of melatonin in the daytime workers. The authors felt that this is proof that the diurnal hormone system has been disrupted. When the melatonin level is altered, the circadian hormone rhythm is also changed.
  9. A group of 168 female hospital employees doing rotating nightshift work in Southern Ontario hospitals were compared to 160 day workers. Cortisol production was assessed. Cortisol production in day workers and in shift workers on their day shift was similar. However, shift workers on their night shift had flatter cortisol curves and produced less cortisol. The authors felt that this disruption of cortisol production would explain why rotating night shift workers have a higher risk of cardiovascular diseases.
  10. A Danish study with female nurses followed 28,731 nurses between 1993 and 2015. Daytime nurses were compared to rotating nighttime nurses and the incidence of diabetes was measured. Night shift workers had a risk between 1.58-fold to 1.99-fold when compared to daytime workers to develop diabetes. The risk for evening shift workers was less (between 1.29-fold and 1.59-fold).

Diurnal hormone rhythm behind health risks of night shifts

Your body has its own rules. It rewards you, if you sleep 7 to 8 hours during the night, but it will penalize you severely, if you turn it upside down. The reason is our built-in diurnal hormone rhythm. A peak of melatonin regulates sleep during the night. Melatonin is released by the pineal gland (on the base of the skull) when it gets dark outside. Daytime wakefulness is regulated by the stress hormone cortisol from the adrenal glands. These two hormones inhibit each other, cortisol inhibits melatonin and melatonin inhibits cortisol. All the other hormones are also regulated according to the diurnal rhythm: testosterone is highest in the morning, human growth hormone is highest between midnight and 3 AM etc.

When you work daytime shifts, your diurnal hormone rhythm is unchanged. But if you work night time shifts, your hormones have to adapt. This is very similar to traveling east or west where you cross several time zones. Your internal diurnal hormone system has to adjust to these changes. Typically it takes 1 day to adjust to a 1-hour time zone difference.

In people who work permanent night shifts, the hormone changes stay adjusted and there is no further switching. But most employers want to be “fair” to everybody, so they introduced the rotating night shifts, which as all the publications cited above show is the worst thing you can do. It messes with your diurnal hormone rhythm, and some people never switch completely to the new hours worked. They don’t get enough daytime sleep because the kids are loud during the day etc. The rotating shift workers are running the highest risk of getting cancer, diabetes, cardiovascular diseases, obesity, cancer, leukemia, and they have low levels of melatonin.

Health Risks Of Night Shifts

Health Risks Of Night Shifts


When shift workers work constant night shifts, this is less stressful to our system than the more common rotating shift work. This is where you work night shifts for a period of time, then the schedule switches to day shift, and you keep on rotating. The least health risks are associated with regular daytime work. People exposed to rotating night shifts suffer from poor sleep. They have a higher risk of gaining weight, getting obese and acquiring diabetes in time. They are at a higher risk for heart attacks, strokes and cancer. All-cause mortality is about twofold higher than for workers who work day shifts.

The underlying problem seems to be a disturbance of the diurnal hormone rhythm. Normally this regulates our waking/sleeping rhythm and keeps us healthy. But with nighttime work melatonin production weakens, cortisol production is reduced and hormone rejuvenation during rest periods suffers greatly. This weakens the immune system, allows cancer to develop and leads to chronic inflammation causing cardiovascular disease and diabetes. The remedy to prevent this from happening is to catch little naps whenever you can during the day and, if at all possible, work daytime shifts permanently.

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Arthritis Drugs Can Cause Heart Failure

The British Medical Journal has published a research articles in Sept. 2016 showing that arthritis drugs can cause heart failure. This occurs particularly in elderly patients around the age of 77 years and older. This is an age where arthritis is often causing pain, and the pain is regulated with over-the-counter pills. These anti-arthritis drugs belong into the group of anti-inflammatory drugs, called NSAIDs. This stands for “non-steroidal anti-inflammatory drugs”. The study was entitled “Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries…”

Arthritis drugs can cause heart failure shows study

Adult patients above the age of 18 who started 27 different types of NSAIDs between 2000 and 2010 were followed. 92,163 hospital admissions for heart failure were noted; 8,246,403 patients who were not taking NSAIDS served as controls. There were 4 countries involved in this study providing 2.2 million patients from the Netherlands, 7.5 million from Italy, 13.7 million from Germany and 11.1 million from the United Kingdom.

Results of study

NSAID use of up to 2 weeks prior to assessment had a risk of 19% of resulting in a hospital admission for heart failure. A control group of patients who had not taken NSAIDs for at least 6 months or more had no hospital admission risk.

Seven traditional NSAIDs were found to be associated with hospital admission for heart failure. They were: diclofenac (brand name Voltaren), ibuprofen (brand name Motrin), indomethacin (brand name Indocin), ketorolac (brand name Toradol), naproxen (brand name Naprosyn or Aleve), nimesulide (brand name Mesulid and many others), and piroxicam (brand name Feldene). In addition two COX 2 inhibitors, etoricoxib (brand name Arcoxia) and rofecoxib (brand name VIOXX) were also having the same side effects.

  1. The risk for heart failure was not the same for every NSAID. The risks ranged from 1.16-fold to 1.83-fold. Specifically ketorolac had a risk of 1.83-fold, indomethacin 1.51-fold, piroxicam 1.27-fold, diclofenac 1.19-fold, ibuprofen 1.18-fold, and naproxen 1.16-fold. Translated into common language it means that ketorolac had a risk of 83% of causing a hospital admission due to heart failure. In the case of ibuprofen it was only an 18% risk.
  2. The risk for heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib when used at very high doses. Doubling the risk means a 200% risk. Typically, when an arthritis patient has a flare-up of pain, this is the time when the NSAIDs are usually taken at a higher dose and tend to also be taken for a longer time. Some NSAIDs had a significant risk for heart failure even at a medium dose. This was the case for indomethacin and etoricoxib. The good news was that celecoxib (brand names Celebrex and Celebra) at usual doses did not lead to an increased risk of heart failure.
  3. Dose-response curves were obtained where possible. Here the researchers looked at the effect of low, medium, high and very high doses of NSAIDs in patients. Again heart failure occurrence was studied among those patients. The result clearly showed that low and medium doses of NSAIDs were fairly safe, but high and very high doses of NSAIDs caused heart failure. Etoricoxib, Piroxicam and Rofecoxib were particularly toxic in higher doses. Indomethacin was toxic at medium and high doses. An important exception to the rule was celecoxib (brand names Celebrex and Celebra), which did not cause heart failure, either at low doses or high doses. This is one of the most used NSAIDs, so it is fortunate that it does not cause heart failure.

Discussion of study

The authors of this study discussed why they believe heart failure is developing in patients who take NSAIDs. They argued that NSAIDs inhibit prostaglandin synthesis and the enzymes COX1 and COX2. This is how inflammation and pain gets inhibited, which is a good thing. But at the same time blood supply to the kidneys is reduced, kidney function is impaired, and sodium is retained. This is a bad thing as it leads to fluid retention and fluid overload of the heart resulting in heart failure. As the prostaglandin inhibition is dose-dependent, the authors said this is the reason that the heart failure rate is also dose-dependent when measured in large populations, as was done in this study. A noted exception, as already mentioned, is the popular celecoxib, which does not cause heart failure, even at high and very high doses.

Arthritis Drugs Can Cause Heart Failure

Arthritis Drugs Can Cause Heart Failure


This publication has a lot of statistical power as it was based on research in 4 European countries and involved almost 10 million subjects that were compared to an equally large control population. Because of the size of the study population it was possible to calculate risk ratios for NSAIDs causing heart failure for 27 different types of NSAIDs. Furthermore, the authors succeeded in quite a few cases to calculate risk factors for different concentrations of NSAIDs used. This statistical method is called a dose-response curve. It is a powerful pointer to toxicity when high doses cause heart failure, but low doses don’t.

The physician can use the information from this publication to select one of the NSAIDs that is least harmful, like celecoxib (brand names Celebrex and Celebra) and tell the patient to use the least amount possible to minimize side-effects. Many aging arthritis sufferers will benefit from this. Hopefully the FDA will review this material and shut down the use of some of the more dangerous NSAIDs or force the manufacturer to attach a black box warning about the drugs that belong into this category. You should review what your favorite NSAID is and discuss this with your physician. Perhaps print a copy of this review and take it with you, in case your health provider has not heard about it yet.

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Sugar Can Cause Heart Attacks

Recently an online medical journal article from JAMA has revealed that sugar can cause heart attacks. As the Guardian reports, this analysis of influence peddling of the sugar industry going back 60 years has had far-reaching effects by confusing the public and policy makers in the US and around the world. At the same time the interference of the sugar industry was protecting its own interests. It increased sugar sales, but made people sick with obesity, diabetes and cardiovascular disease. This story is similar to the tobacco industry that was able for years to cover up that cigarette smoke is causing heart attacks and lung cancer.

Denying that sugar can cause heart attacks

When the English physiologist John Yadkin noted in the 1960’s that sugar was elevating cholesterol and triglycerides, the sugar industry was panicking. Something had to be done to stop this new research. As we can read in the online JAMA review the Sugar Research Foundation (SRF) had 319 correspondences (1551 pages) with Roger Adams. He was a professor who served on the SRF’s scientific advisory board (SAB) from 1959 to 1971. Another piece of evidence of influence peddling came from a review of correspondence between the SRF and D. Mark Hegsted. He was professor of nutrition at the Harvard School of Public Health. At the same time he was co director of the SRF’s first coronary heart disease research project. This took place from 1965 to 1966. There are 27 documents totaling 31 pages in the Harvard medical Library. It is clear from this correspondence that the SRF was looking for a way to undermine the new research findings of negative effects of sugar. The SRF was looking for a way to confirm that fat reduction would be beneficial for patients. This way many people would be put on a low fat diet, which in turn would ensure continuing and rising sales of sugar.

New evidence that sugar can cause heart attacks

New research came out by D. Mark Hegsted in the Annals of Internal Medicine in June 1965. It linked sugar consumption to cardiovascular disease. It noted that blood sugar levels were a better predictor of hardening of arteries than cholesterol levels or high blood pressure. Another paper stated that it was sugar rather than starches causing high triglycerides in the blood. He hypothesized that “perhaps fructose, a constituent of sucrose but not of starch, was the agent mainly responsible.” An editorial in the same publication noted that these new findings corroborated Dr. Yudkin’s previous research that sugar could cause heart attacks.

The sugar industry was very concerned about these studies. If publicized widely, it would have the capacity to lower sugar sales.

Sugar can cause heart attacks, but review paper ignores this

On July 1, 1965, the SRF’s Hickson visited D. Mark Hegsted to discuss his publication. He wanted him to be part of an extensive literature review that would show that it was too much saturated fat that was the cause of high cholesterol and triglycerides, not sugar. It also should state that a lowering of fat content from 40% to 20% was necessary and that polyunsaturated fatty acids should be used to replace much of the fat. The fact that the food industry would quietly increase sugar content in processed foods was not mentioned. The review paper was called “Project 226”. It resulted in a 2-part literature review by McGandy, Hegsted, and Stare. It was entitled “Dietary Fats, Carbohydrates and Atherosclerotic Disease,” and was published in the New England Journal of Medicine (NEJM) in 1967. Industry and non-industry funding of the review authors’ experimental research was disclosed. However, the funding by the Sugar Research Foundation was omitted. The authors of the study received handsome amounts of money from the SRF for their efforts. The story that was fabricated is all too well known, but false. It claimed that the medical literature would have shown that a reduction of saturated fat intake would lower cholesterol. It ignored triglyceride levels and stated that only cholesterol levels were significant with respect to coronary artery hardening. It also stated that replacement of saturated fat with polyunsaturated fatty acids like corn oil would also be beneficial in reducing heart attack rates.

Effect of the literature review on heart attack rates

Sadly the NEJM literature review has resulted in government policy for decades where the gospel was preached that a low fat diet would prevent heart attacks. The food industry has prepared processed foods, all low in fats and high in sugar that were supposed to he healthy. But the extra sugar made people fat, it did not decrease heart attack rates, but made them more frequent. Strokes were also on the rise and diabetes has become rampant. The reliance on corn oil has introduced another problem: omega-6 fatty acids are now consumed at an alarming rate. Corn oil has a 1:59 ratio for omega-3 to omega-6 fatty acids.

This means that corn oil contributes to the lack of omega-3 fatty acids in our food. When the ratio of omega-3 to omega-6 fatty acids falls below 1:3 or 1:4 the metabolism changes towards inflammation as the arachidonic acid system switches toward inflammation. Cardiologists have pinpointed inflammation as an important cause of hardening of arteries. Fish oil, a rich source of omega-3 fatty acids helps to prevent hard attacks and strokes.

The end result of the confusion regarding fat, sugar and heart attacks caused by the biased literature review meant misery, suffering and death for many for decades. But recently there has been a renaissance of Dr. John Yadkin’s research: Now it is clear what sugar is doing and how it affects our health.

How sugar can cause heart attacks and more

It is clear that sugary soda has detrimental effects on us: as little as one or two cans of sugary soda drinks per day lead to

  • 26 percent greater risk of developing type 2 diabetes,
  • A 35 percent greater risk of heart attack or fatal heart disease, and
  • A 16 percent increased risk of stroke.

Dr. Frank Hu has participated in a study that spanned over 24 to 30 years and examined the replacement of saturated fat with polyunsaturated fatty acids (PUFA), monounsaturated fatty acids and whole grain carbohydrates. The study involved 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010). The diet was assessed with detailed questionnaires every 4 years. 7,667 cases of cardiovascular disease (CHD) occurred during the long observation times. Compared to controls that did not change their diet with respect to saturated fatty acid intake, those who replaced with PUFA had 25% less CHD, those who replaced with monounsaturated fatty acids had 15% less CHD and those who replaced saturated fatty intake with whole grains had 9% less CHD. In contrast, a subgroup that had replaced saturated fatty acid intake with carbohydrates from refined starches/added sugars ended up with a 10% increase of CHD.

We know now that sugar can increase cholesterol and triglycerides as Dr. John Yadkin has said in the 1960’s.

We also know that sugar can cause arthritis when combined with low omega-3 fatty acids and high omega-6 fatty acids. In the 1950’s Dan Dale Alexander wrote a book called “Arthritis and common sense”. The medical establishment did not accept that simple remedy and Dan Dale Alexander was classified as a “quack”. However, Dr. Mirkin describes a study from Berlin that later confirmed that Dan Dale Alexander’s observation was correct: an emulsion made by shaking orange juice with cod liver oil and taken three times per day on an empty stomach would indeed improve osteoarthritis.

High glycemic foods (sugar, starchy foods) were associated with breast cancer, colorectal cancer and endometrial cancer. The majority of trials showed this association although not all. The more obese patients were, the more pronounced the insulin resistance was and the more the relationship to these cancers became apparent. A diet that is high in starchy foods like potatoes, rice and bread is causing pancreatic cancer as was shown by researchers at the Dana-Faber Cancer Institute, Brigham and Women’s Hospital and Harvard School of Public Health.

Sugar Can Cause Heart Attacks

Sugar Can Cause Heart Attacks


The low fat/ high glycemic diet was a fad-diet based on fictitious science, sponsored by the sugar industry. In a way it became a human experiment and resulted in 60 years of suffering to show that this diet did not work. It caused the obesity wave, a wave of heart attacks, strokes and cancer, all caused by too much sugar in the diet. Associated with this are the consumption of processed foods with too much sugar and an abundance of omega-6 fatty acids causing inflammation and hardening of the arteries.

We finally know that sugar raises cholesterol (LDL cholesterol in particular) and triglycerides. This leads to fat deposits and hardening of the arteries resulting in strokes and heart attacks. Remove refined sugar, limit your starchy food intake and eat fish as a source of omega-3 fatty acids. Feast on vegetables, salads and have some nuts as another source of omega-3 fatty acids and you are well on your way to preventing heart attacks, strokes and many cancers. After reading all the facts it does no longer make sense to be a victim of the sugar industry and the associated health risks.


Seven Steps To Live Over 100 Years

Forbes invited me to publish a blog I wrote for Quora, “Seven steps to live over 100 years”.

The topic of habits by people who live more than a hundred years has been reviewed many times in the media. It continues to be popular. Here are seven things you can do to stay healthy followed by an explanation why.

Seven steps to live over 100 years – step1: Stay active

You want to stay active every day, even if you retire. You want to move and keep your mind busy. Part of that is to do a daily formal exercise routine to keep those muscles toned, which will prevent falls in the future.

Explanation: when you keep your muscles toned and you move about, your balance organ and coordination remains sharp, you are less likely to fall and break a hip. 50% of those who sustain a hip fracture die.

Seven steps to live over 100 years – step 2: Eat a healthy diet

Eat a Mediterranean type diet or follow the Okinawan diet. These diets contain less meat (or no meat as in the Seventh Day Adventist diet), but lots of vegetables and fiber. This keeps your cholesterol down, your arteries open and your metabolism controlled, preventing diabetes. If you are not obese and you have no diabetes, you are going to be OK with your cardiovascular system for decades to come.

Explanation: Heart attacks are still on top of the mortality list. Avoid them and you got it made, if you want to make it to 100 and beyond. But we need to stay away from the poor fats and the obsession about eating beef. Red meat, if eaten too often gives you a higher risk of getting cancer and heart disease. So eat it only once a week at the most, the rest would be chicken, turkey meat or fish. Nothing wrong with a vegetarian meal, let’s say kidney beans or lentils on a day in between. This still gives you protein for your muscles, but spares you a heart attack.

Seven steps to live over 100 years – step 3: Take care of your teeth

Brush your teeth and floss every day. This will control the bacteria in your mouth and prevent leakage into your blood affecting your heart valves. Studies have shown that this prevents heart attacks.

Explanation: When I heard this first about 20 years ago, I found it strange. But the literature is clear: chronic gingivitis is associated with bacteria that grow on the gums and spread into your blood. They can then colonize your heart valves and even the lining of the arteries, particularly where there is already hardening of the arteries (arterial plaque). This can lead to heart valve disease like mitral valve disease or heart attacks.

Seven steps to live over 100 years – step 4: prevention of disease

See your physician right away if there is a new skin lesion or anything that is different on your body. Removal of early cancer and treatment of any early medical condition is always easier to treat than waiting until it is out of control. Particularly with cancer treatment at an early stage, which usually involves only a small surgical procedure, this will reward you with a ripe old age.

Explanation: I learnt this point in general practice. Patients who waited until small problems become big problems were always much worse off than patients who saw me for small problems that we could remedy at an early stage. As mentioned above this is particularly important in cancer cases, as usually stage 1 and 2 of a cancer is curable with surgery. Once you get lymph node metastases and distant metastases, the cancer is much more difficult to treat, if at all. This is a principle that is pretty much true for any disease. The prevention factor is huge. Make use of it!

Seven steps to live over 100 years – step 5: Lifestyle matters

Watch excesses like smoking (cut it out!), alcohol intake, and recreational drugs. Smoking causes heart attacks, strokes, and cancers, which shorten your life. Recreational drugs just interfere with your body chemistry and have side effects. Cut them out, if you cherish growing older than 100. Alcohol needs to be kept at a very low consumption, if you want to preserve your liver, which is your central metabolic organ. If you can’t handle moderation with alcohol consumption, cut it out. No one has died from not consuming alcohol.

Explanation: I have already explained why lifestyle choices matter. The alcohol question is one that will be discussed back and forth for centuries. There are cardiologists who tell you that men should drink 1 to 2 drinks per day and women 1 drink per day and we all live longer, because of prevention of heart disease. The wine industry makes sure that you will hear this cardiology rule. It is true that centenarians often drink one glass of red wine per day. But there are plenty of centenarians who never drank in their life. It is a matter of personal choice.

Seven steps to live over 100 years – step 6: Avoid obesity and diabetes

I did mention to avoid obesity under point 2 above, which is associated with metabolic syndrome and diabetes. Your ideal body mass index should be in the 21 to 22 range. You can achieve this by following the diets I mentioned above. You should cut out sugar and starchy foods.

Explanation: I have followed such a diet since 2001 and my body mass index is between 21 and 22. I grew up in Germany where an emphasis was put on sweets and starchy foods. Needless to say my modified Mediterranean diet deviates from the good old German diet significantly. I find healthy food very tasty.

Seven steps to live over 100 years – step 7: Sleep and hormones

Getting sleep regularly, having an optimistic outlook on life, and having good relationships help to keep the immune system strong and keep your hormones balanced. This in turn will keep you healthy emotionally and physically.


There are two comments I like to make. One is that when you have calm nerves, and your emotions are balanced, your stress hormones are controlled. We know that people who are laid back and easy going live longer. The type A personality is the one who gets a heart attack.

The other point is that hormones have running times. When they start missing, we get menopause or andropause. When we are in our 50’s it is time to have your hormones checked by a knowledgeable health practitioner (naturopath, anti-aging physician). At this point regular physicians are mostly uneducated about bioidentical hormone replacement. I mention this as in European studies it has been shown that replacement of missing hormones with bioidentical hormones resulted in more youthful lives. Life expectancy can be prolonged by 15 years using bioidentical hormones according to Dr. Hertoghe, an endocrinologist in Belgium.

Seven Steps To Live Over 100 Years

Seven Steps To Live Over 100 Years


People have always been fascinated about the factors that lead to a healthy age above 100 years. I am suggesting that you concentrate on enjoying your life and keeping toxins out. Engage in some form of exercise or stay active all the time. Adopt a healthy diet. This is where perhaps most people go wrong. They think they can go on pouring junk foods and alcohol down their throats and never get heart disease or cancer. The truth is not quite like that. We do need to adopt a healthy diet like the Mediterranean diet. We also need to limit drinking to a healthy level. Replacing missing hormones with bioidentical ones will prolong your life as well. Given these recommendations, happy journey to 100 and beyond!


New FDA Food Guidelines

A recent news release describes 2016 new FDA food guidelines. In it double the amount of seafood (fish and shellfish) is recommended as well as a cut in saturated fat and in sugar. Coffee, which was labeled a culprit in the past is now recommended to a total of 400 mg of caffeine per day as it is heart protective. Cholesterol is no longer considered an enemy, but sugar, saturated fats and trans fats are.

Here is a breakdown of what each of these recommendations means.

New FDA food guidelines regarding increasing fish and shellfish

The anti-inflammatory effects of omega-3 fatty acids have finally entered the recommended diet plan of the FDA. This reflects the nutritional research over the last few decades that noticed a longer life expectancy for people who eat more seafood and less red meat.

The only problem with seafood can be its mercury contamination. The higher predator fish are in the food chain, the more contaminated fish meat is. This is the reason that tuna fish is not recommended as a food source, as it is very high in mercury. An exception is canned tuna as it has been washed and some of the mercury got lost in the food processing. Wild salmon, sardines and oysters are low in mercury and good sources of omega-3 oils.

New FDA food guidelines regarding reduction of saturated fat

It is now recommended that saturated fat should be reduced to 10% of the total daily caloric intake. This is not undisputed as some studies show that saturated fat may not be involved in the production of hardening of the arteries. Other studies have shown that breast cancer is more common when more saturated fat is consumed.

When the news came out in the 1980’s that saturated fats would be bad for arteries, there was a switch to polyunsaturated acids: safflower oil, canola oil, sunflower seed oil, corn oil and soybean oil or grapeseed oil.

However, the irony is that these vegetable oils were highly unstable and led to oxidation causing heart disease and cancer.

In contrast olive oil is a much more stable oil and has been associated with longer lives in the Mediterranean. Similarly, coconut oil is also more stable and is recommended for cooking as well.

New FDA food guidelines regarding protective effect of coffee

In the past few years many studies have shown the coffee consumption prolongs life. The FDA has now officially recognized these studies and recommends that consumption of up to 400 mg caffeine will help promote health. On the other hand the FDA also recommends that those who do not drink coffee, should not change their lifestyle just because of these recommendations.

New FDA food guidelines regarding sugar reduction

An entirely new recommendation of the FDA is that sugar should be reduced in anybody’s diet. The FDA explains that sugar is contained in too many processed foods, is added in drinks like coffee, fruit juices, food items like muffins and cakes.

In the past decades it has become clear that sugar much more so than fat is the culprit, when it comes to hardening of arteries. Sugar gets metabolized in the liver, triglycerides and LDL cholesterol are increased and this gets deposited into arteries and fatty tissue. In this context it makes sense that the FDA now recommends a reduction of sugar intake.

 New FDA food guidelines regarding cholesterol

In the past it was thought that cholesterol in meat would be the cause of high cholesterol in the blood. This was an oversimplification. We now know that only a small portion of the blood cholesterol comes from food sources, so that cholesterol from food sources is now no longer thought to be of importance with regard to risks for heart attacks and strokes. Instead it is sugar and too many starchy foods (Bread, pasta, pizza, muffins, cakes cookies) that get broken down into sugar, which accounts for high cholesterol by being metabolized in the liver into LDL cholesterol and triglycerides.

New FDA Food Guidelines

New FDA Food Guidelines


The new food guide by the FDA has fundamentally changed the previous recommendations based on newer nutritional studies. Now fish and shellfish should be doubled compared to previous recommendations. Coffee is no longer the enemy, but your friend. Sugar and starch over consumption is to be avoided, as this can raise cholesterol and triglyceride levels. Eat more vegetables and fruit. These recommendations closely resemble a Mediterranean diet, which has been shown to prolong life in several studies. Abandon the American Standard diet with hamburgers, processed foods and sugary drinks. Pay attention to the FDA food recommendations!


Prevent Unhealthy Aging

We know that stress can age you prematurely, but what do we need to do to prevent unhealthy aging? This is exactly what this review by cardiologist Dr. Joel Kahn has done. It points out that the right lifestyle makes the difference.

Studies showing how to prevent unhealthy aging

Several studies have shown how to avoid getting heart disease, cancer and diabetes.

  1. Kahn reported that in 2001 the Harvard School of Public Health published a study where 84,941 healthy female nurses had been followed who were free of heart disease, cancer and diabetes at baseline. But only 3.4% of the 84,941 women managed to stay healthy after 16 years of the study. The secret? Their body mass index (BMI) was less than 25.0, their diet was high in polyunsaturated fat and fiber, low in trans fat and low in glycemic load, they engaged in regular moderate exercise with a minimum of 30 minutes per day; they did not smoke and they drank ½ an alcoholic drink per day. Their risk to get diabetes was 91% lower than the rest of the study. This shows you how powerful lifestyle choices are.
  2. In 2004 an international study (the INTERHEART study) reported in the Lancet the lifestyle of 15,152 cases that developed heart attacks in 52 countries with 14,820 controls who did not have heart attacks. The researchers found 9 risk factors that accounted for 90 to 95% of the heart attacks. They were smoking, elevated cholesterol risk ratio, diabetes, high blood pressure, abdominal obesity, stress, low intake of fruit and vegetables, high alcohol intake and lack of physical exercise. Obesity was considered a high risk when the waist circumference measured more than 35 inches in a woman or more than 40 inches in a man. All these 9 risks can be eliminated by lifestyle changes.
  3. The 2006 Health Professional Study spanned over 16 years in a group of 40 to 75 year old doctors without a heart attack at baseline. It noted that male doctors who were lacking the 5 heart attack risk factors had 87% less heart attacks than controls without health lifestyles. What were the lifestyle factors? A body mass index (BMI) of less than 25, being a nonsmoker, being physically active for more than 30 minutes a day, having not more than moderate amounts of alcohol intake and having a diet that was more than 40% plant based.
  4. In 2007 a Swedish study reported on 24,000 women after menopause that had no heart attacks initially. After 6 years of follow-up 308 women developed heart attacks. An analysis showed what the risk factors were for those who developed heart attacks. Those who did not have these risk factors reduced their risk of getting a heart attack by 92%. What lifestyle factors were protective? Four factors were identified: a low-risk diet (consisting of high vegetable and high fruit intake, whole grains, legumes, fish and moderate alcohol intake), not smoking, walking or biking 40 minutes daily and a low waist circumference.
  5. In 2008 the Harvard University released a study that was a further follow-up of the Health Professional study with more than 43,000 men and also the Nurses’ Health Study with more than 71,000 women. The question here was what would prevent the development of strokes? The investigators found that in both groups stroke risk could be reduced by 50% when the following 5 lifestyle factors were adhered to: no smoking, keep the BMI below 25, exercise at least 30 minutes daily with moderate activity, don’t exceed a modest alcohol intake, have a diet intake in the top 40% of fruit and vegetables and whole grains.
  6. A 14 yearlong study from the Netherlands was published in 2014, where almost 18,000 men and women without heart disease at the beginning of the study were followed. More than 600 heart attacks occurred throughout the study. People who stuck to 4 lifestyle habits reduced their heart attack rates by 67%; if they adhered to 5 lifestyle factors they reduced the heart attack rate by 83%. The 4 initial lifestyle factors were: doing an average of 30 minutes of physical activity per day, eating a Mediterranean style diet rich in fruit and vegetables and whole grains, not smoking and having more than one alcoholic drink per month. This gave you a reduced risk of your heart attack rate by 67%. Add one more good habit: sleep 7 or more hours per night on average. This reduces the risk of you getting a heart attack by 83%!
  7. A Swedish heart study with initially more than 20,000 men was going on for 11 years. There were 5 lifestyle habits the investigators identified as essential to reduce heart attack rates. Unfortunately only 1% of the study group adopted all 5 lifestyle factors, but they dropped their chance of getting a heart attack or dying of a heart attack by 86%. The lifestyle factors were: a diet rich in fruit and vegetables, legumes, nuts, whole grains and low fat; not smoking, moderate alcohol consumption, thin waistline and more than 40 minutes of physical activity.

Preserving health and vitality to prevent unhealthy aging

There is a clear pattern in all of these large studies. A healthy lifestyle preserves your health by keeping your joints and muscles in good working order. Your heart and lungs are staying well conditioned, because you engage in cardiovascular training every day. This keeps your nitric oxide going, which is an important signaling molecule that in turn reduces your blood pressure.

When we remove disabling diseases like strokes and heart attacks and prevent diabetes from developing, life expectancy is increasing. When people remain physically active even in old age, this translates into fewer disabilities and less frailty. Even Alzheimer’s disease is observed to occur less when good lifestyle habits are adhered to.

Prevent Unhealthy Aging

Prevent Unhealthy Aging


The studies cited here show how lifestyle factors can make a significant difference in preventing heart attacks and strokes. In the past even doctors ignored the risk of smoking. A few years back conventional medicine negated that lifestyle factors could make a difference. Now we have more studies than we need to prove that this is so. It is more important that we adhere to as many of the lifestyle factors identified in these studies to make a real difference in our lives. We also need to set an example to the next generation and to our peers. Adopting healthy lifestyle factors has to become a cultural habit for society at large. This will help reduce healthcare costs, but most importantly this will help you and me to live longer, healthier lives.


Hormone Replacement Therapy In Menopause

Back in the 1980’s many physicians were hopeful that hormone replacement therapy in menopause (HRT) could extend the lives of postmenopausal women by approximately 10 years, if HRT would be started early enough. But the HERS study (Heart and Estrogen/progestin Replacement Study) in 1998 and the WHI study (Women’s Health Initiative) of 2002 changed things dramatically.

The HERS study did not show any benefit with regard to prevention of heart disease. Instead it showed more gallbladder disease (1.38-fold) and blood clots (2.89-fold) develop in the experimental group versus the placebo.

The WHI study was complex and had several arms. There also were some methodological errors in the study as pointed out here.

Instead of a decrease in heart attacks, there was an increase, when estrogen and progestin was combined. There were more cases of colon cancer, more blood clots and heart attacks in the placebo groups compared to the experimental groups. It seems that something went wrong with these trials.

Unknown facts about hormone replacement therapy in menopause

  1. Both clinical trials used the wrong hormones to do the trials. If you use the wrong hormones in a trial, you would expect to get the wrong test results. Horse derived estrogen (equine estrogen) is hardly a match for bioidentical, human estrogen in women. But decades ago the drug manufacturer had decided that estrogen was easiest to manufacture on a large scale when urine from pregnant mares was used. The product contains conjugated horse estrogen and is known by the name Premarin. Premarin is not bioidentical to human estrogens.
  2. The other hormone, medroxy progesterone (MPA) is a progestin, a bad copy of the bioidentical progesterone that a woman’s corpus luteum of one of her ovaries produces. This is in the second half of her menstrual cycle. During pregnancy the placenta produces lots of progesterone to protect the pregnancy. As Dr. Masley, a cardiologist stated synthetic progestins cause heart attacks, while progesterone does not. Masley said: “Medroxy progesterone (MPA) increases the risk for heart disease and for breast cancer. I can’t understand why any physician would recommend medroxy progesterone during menopause, but it is still in use.”
  3. Next there is the question whether the liver changes the composition of an oral hormone tablet metabolically or not. The answer is: yes! Dr. Masley stated in the link above that oral estradiol, when compared to estrogen rubbed onto the skin, increases levels of inflammation by 192%. The C-reactive protein (CRP),can be measure with a blood test.The risk for a blood clot increases by 400%. A woman using estrogen should always use the estrogen patch or an estrogen cream with bioidentical estrogen to avoid these complications.
  4. Measure hormones – don’t estimate: Hormones are constantly changing and if you don’t measure, you don’t know what you are dealing with. Dr. John Lee showed a long time ago that you should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, you use only bioidentical hormones to replace and you replace only as much as is needed to normalize the levels. This is also the level where postmenopausal symptoms disappear. 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.”
  5. The elusive progesterone: when progesterone is measured as a blood test it may come back as high while it can be low in a saliva hormone test in the same woman. Dr. Lee has pointed out that studies have shown that progesterone levels in tissue are usually higher by several factors when compared to blood levels and that blood levels are not reliable predictors of tissue levels (Ref.1). On the other hand he found that saliva levels have a good correlation with tissue levels in organs like the ovaries or the uterus. Dr. Lee preferred saliva hormone tests for this reason. When it comes to progesterone levels you can trust saliva test, but you cannot trust blood tests. Many physicians ignore that fact and strictly order blood progesterone levels coming to false conclusions.
  6. We know that estrogen and progesterone must be balanced to avoid troubles of developing heart attacks or cancer. In the link under point 4 above Dr. Lee stated that women without breast cancer have saliva progesterone hormone levels that are more than 200-fold higher than the saliva estradiol levels. On the other hand women with breast cancer have a ratio of less than 200 to 1 with respect to progesterone to estradiol saliva levels. There is a similar ratio in men where the ratio of testosterone to estradiol must be larger than 20 to 1 or he is at a higher risk of developing prostate cancer. Unfortunately many older men, when overweight or obese, have high estrogen levels and the ratio is less than 20 to 1.
  7. Masley has mentioned that in the first 6 years after menopause using a topical form of estrogen and micronized progesterone as tablets can minimize the risk of future heart attacks and strokes. But after 10 years it is less obvious what is the best solution. The question is what type of estrogen application is used. Is it estradiol or is it Bi-Est or Tri-Est, which are other topical estrogen applications. Tri-Est is 80% estriol, 10% estrone, and 10% estradiol while Bi-Est is 80% estriol and 20% estradiol. Tri-Est in particular would be very close to the natural composition of estrogens in a woman’s body.

What to do after 10 years of hormone replacement therapy in menopause

Given the insecurity what to do after 10 years of menopause, my suspicion is that there are other factors that play a role with respect to hormone replacement. A lot of women have extra pounds accumulated. Fatty tissue contains an enzyme called aromatase.

This makes estrogen from androgenic hormones including testosterone. The adrenal glands situated above the kidneys produce these hormones in menopause. The more overweight or obese a postmenopausal woman is, the higher the estrogen levels in her blood because of the action of the aromatase. Most physicians have not measured hormones in the past, but just replaced hormones monitoring only postmenopausal symptoms. This is changing. What I said under point 4 above is happening more. Naturopaths tend to be more comfortable with bioidentical hormone replacement the way I have described it. If you did hormone tests (preferably saliva hormone tests) you would pick up higher estrogen levels and low progesterone levels with unfavorable progesterone to estrogen ratios as mentioned. These women do not need estrogen (they have it already in their systems). They need progesterone replacement only. Progesterone can be taken as micronized bioidentical progesterone capsules at night or as progesterone bioidentical cream to be applied to the skin. Here is another take on the use of bioidentical hormones.

Hormone Replacement Therapy In Menopause

Hormone Replacement Therapy In Menopause


Bioidentical hormone replacement is complex. It requires some basic knowledge of the facts mentioned above. I find it surprising that two separate research groups could not free themselves of the Big Pharma grip. In not doing so they unwillingly produced studies showing all of the undesirable side effects of using artificial hormones. When manufacturers modify natural hormones with unnatural side-chains, the end products are synthetic hormones. These do not fit the appropriate natural hormone receptors. The anti-aging community as represented by the A4M group (American Academy Of Anti-Aging Medicine) with more than 25,000 physicians worldwide has been saying this all along. Now we know that it is really true. Use hormone replacement knowledgeably and use bioidentical hormones!


  1. Dr. John R. Lee: “Natural Progesterone – The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.

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Healing Powers Of Green Tea

Powerful catechins that are a special form of bioflavonoids provide the healing powers of green tea. Research teams have proven that these catechins are only contained in green tea, not so much in black tea. The most effective of several catechins contained in green tea is EGCG, which stands for EpiGalloCatechin-3-Gallate. It crosses the blood/brain barrier and is very important for the protection of the brain from Alzheimer’s disease. But green tea or green tea extract has a diversified pharmacological action. It is said to protect you from cardiovascular disease, from obesity, from diabetes, from autoimmune disorders, from cancer and from Alzheimer’s and dementia.

In the following I like to comment on how green tea or its extract can protect from all of these diseases.

Alzheimer’s disease

Although there are 5 or 6 approved anti-Alzheimer’s drugs, none of them work for very long. They may at best postpone the deteriorating memory for 6 months, but then the effect of the drug wears off. The reason is that the drugs do not stop the production of the deadly beta-amyloid. It is the beta-amyloid that damages nerve cells that you want to preserve so you can think and memorize. In contrast a simple phytochemical, the catechin EGCG has been shown in animal experiments and in human trials to stop beta-amyloid production and increase solubility of beta-amyloid fragments in the brain. The end result is better memory and no further deterioration.

In a study of 13,988 elderly Japanese observed over 3 years the group that consumed 3 to 4 cups of green tea daily had 33% less strokes, cognitive impairment and osteoporosis.

Researchers at the University of Basel, Switzerland enrolled 12 healthy volunteers aged 21 to 28 and fed them extracts of green tea or placebo fluid via feeding tubes. This was done to rule out taste as a factor. Functional MRI scans were applied as the subjects were given memory-stimulating tasks. Only the green tea extract was boosting activity in the frontal brain of the subjects. This was located in a specific area, called dorsolateral prefrontal cortex. This area is known to be involved with language comprehension, reasoning and learning. It also switches short-term memory into long-term memory, called working memory processing.

Studies in animals have shown that nerve cells are protected from the toxic effect of beta-amyloid and at the same time the production of new brain nerve cells (neurons) is triggered by green tea extract. This is really good news for Alzheimer’s disease patients and their families: green tea extract delays further memory deterioration and stimulates the development of new nerve cells in the brain!

Cardiovascular disease

In a 2006 Japanese study 40,530 Japanese adults aged 40 to 79 years without history of stroke, coronary heart disease, or cancer at baseline were observed for 7 years. Diaries were kept about how many cups of green tea each person was drinking per day. The biggest effect was seen with regard to prevention of heart attacks and strokes.

Men had a mortality reduction of 12% for heart attacks when they drank 5 cups or more of green tea; in women the corresponding mortality reduction for heart attack was 31%, a bigger effect. Overall mortality from strokes was lower than from heart attacks making the effect of green tea consumption even more beneficial with respect to stroke prevention. In this study no cancer preventing effect was observed for green tea.


It appears that green tea increases heat production and burns fat in the process. There was a small effect in terms of weight loss and a beneficial effect increasing the protective HDL cholesterol in this 2012 Polish study on obese patients. The authors compared either 379 mg of green tea extract, or a placebo, daily for 3 months. They concluded: “The results of this study confirm the beneficial effects of green tea extract supplementation on body mass index, lipid profile, and total antioxidant status in patients with obesity.”


Although there are claims in some studies that green tea would prevent diabetes, this question was thoroughly investigated in this Chinese 2014 study.

No effects were noted on fasting blood sugars or on hemoglobin A1C values, a very sensitive indicator for the presence or absence of diabetes. All these lab tests were unchanged following consumption of green tea or green tea extract. Forget using green tea for diabetes prevention; cut out sugar and starchy foods instead.

Autoimmune disorders

Sjogren’s syndrome and lupus are both autoimmune diseases. Green tea extract has shown in humans that symptom severity can improve; green tea polyphenols (GTPs) possess anti-inflammatory properties that benefit patients with autoimmune diseases.

In an animal model arthritis researchers determined that T helper cells are weakened and bone resorption is inhibited by EGCG from green tea extract.

Researchers at Harvard Medical School, Boston, MA have noted that green tea extract is useful in calming down the immune response in autoimmune diseases. They concluded: “Altogether, these studies identify and support the use of EGCG as a potential therapeutic agent in preventing and ameliorating T cell-mediated autoimmune diseases.”


Many research papers have found that EGCG from green tea extract has immune modulatory effects that are useful in combination with chemotherapy. A combination of cisplatin therapy with green tea extract has been found to have more effects on colorectal cancer and ovarian cancer than each one on its own. Similarly chemotherapy of breast cancer had better results in humans when EGCG from green tea extract was added as an immune modulation. More research, particularly in humans is needed to fully understand the mechanism of action of EGCG.

Toxicity of green tea extract

Animal experiments showed that higher doses of green tea extract could cause toxicity in the liver and in the nose of rats and mice. I was not able to find objective evidence for green tea toxicity in the PubMed system with respect to humans.

Healing Powers Of Green Tea

Healing Powers Of Green Tea


Perhaps the most important discovery regarding green tea extract is that it crosses easily through the blood/brain barrier into the brain. This can postpone Alzheimer’s disease and can even lead to new neuron formation. The beneficial cardiovascular effects are also useful and combine well with exercise and good nutrition for prevention. Particularly stroke prevention is a useful property of EGCG from green tea extract. The effect on obesity is marginal whereas there was no effect of green tea on prevention of diabetes. The immune modulatory effect of green tea extract is useful in the treatment of autoimmune diseases and of cancer. Existing treatments for these conditions are becoming more effective by adding green tea extract.


Heart Attacks Can Kill

We rarely hear that heart attacks can kill; we are more likely to hear that a person was brought to the hospital with a heart attack. The doctors placed a stent or two and the person left the hospital two or three days later, fully recovered.

What silent changes occur before a heart attack?

A heart attack does not happen out of nowhere. There can be one or several risk factors present before, like smoking, a lack of exercise, being overweight or obese from eating too much sugar, consuming sugary drinks and eating lots of starchy foods. This will have changed the cholesterol fractions with the bad LDL cholesterol being high and the good HDL cholesterol being low. Triglycerides in this setting are also usually high. The end result is that the lining of the body’s arteries, including the coronary arteries are thickened to the point where blood has a harder time flowing through the opening of the coronary arteries. One day the heart muscle reports severe pain from a lack of oxygen and nutrients. There are essentially three coronary arteries that supply oxygen and nutrients to the heart muscle. For details follow this link.

Often people have 50% to 60% of coronary artery narrowing, but do not know about this. There are tests available that a person could do to check the amount of hardening of the arteries (for instance the IMT test, see below).

What happens after stent placement?

The interventional cardiologist inserts a catheter from a wrist artery or elbow artery backwards through the aorta and from there into each of the openings of the coronary arteries. By injecting a dye X-rays can be made that show the condition of each of the coronary arteries. If a blockage is identified, this can be overcome through angioplasty, where an instrument is used to pierce through the atheromatous deposits and reopen the coronary artery. To prevent re-stenosing, the cardiologist places a wire mesh stent that opens up upon withdrawal of the instrumentation. The end result is that the previously closed off coronary artery is fully functioning again and the stent keeps the previously narrowed coronary artery open. The cardiologist may have to place two or more stents during the same procedure.

A 5-year follow-up study summarized the outcome after stent placements in 1095 patients with 3-vessel coronary artery disease. Percutaneous coronary intervention, a fancy name for saying “angioplasty combined with stent placement” had a 5-year mortality rate of 14.6%, 9.2% heart attack rates and 24.4% reoccurring blockages requiring repeat procedures to reopen the coronary arteries. There were 3% strokes over 5 years demonstrating that not only heart vessels, but also brain vessels were affected by the hardening of the arteries.

What is heart failure?

You may think that the heart would now be entirely back to normal. But this is a gross simplification. The heart functions like a pump, and we know that pumps can fail. In the past when the heart stopped functioning, the person would die. This was the case because there was a complete irreversible closure of one or more coronary arteries. As a result the muscle of one part of the heart, typically involving the left heart chamber would stop functioning. This part of the heart is supplied by the left anterior descending coronary artery. The left heart chamber is the main pump that pushes blood out into the aorta and from there through the whole body. We need the left anterior descending coronary artery to be open and supply nutrients and oxygen to this vital heart pump all the time. When there is a 70% to 80% narrowing of this artery and the heart is not yet failing, there can be life threatening irregular heartbeats, called ventricular fibrillation from a lack of oxygen. This makes the heart muscle contractions no longer effective, as they are no longer synchronized making the heart muscle beat as one unit. This causes acute pump failure and the patients dies. The other possibility is that the patient has a massive heart attack that kills a large portion of the heart muscle off (called myocardial infarction or heart attack). If the patient is not lucky to have immediate access to a hospital with an interventional cardiologist waiting for him or her, even angioplasty and stent placement will not revive the dead portion of the heart muscle and the patient will not survive.

Using a echocardiography the ejection fraction can be determined. This is a measure of how well your heart empties with each heartbeat. Normally it would be between 50 and 70. Below 50 indicates that heart failure is present.

Patients who had a mild heart attack may only have an ejection fraction of 40 and get short-winded with mild activity. Other reasons for mild heart failure can be atrial fibrillation, a common chronic condition in older patients where the atrial chamber is not contracting properly, but fibrillating. Another cause can be inadequate treatment of high blood pressure, so the heart muscle has a hard time keeping up the blood flow against an abnormally high pressure gradient.

Many patients who had a heart attack and were quickly treated with angioplasty and stent insertion have had some minor persistent damage to the heart muscle resulting in abnormal echocardiograms with lowered ejection fractions. In the past without the acute intervention they would likely not have survived. Now due to modern medical technology these patients did survive, but they are left with a mild degree of heart failure, as a certain portion of their heart muscle has died off.

What kills the patient with a heart attack?

As explained above, when the heart muscle no longer is able to function as a pump, the patient dies. This can come from irregular heartbeats, particularly ventricular fibrillation that does not respond to emergency treatment with a defibrillator. This is an electrical device that resets  The reason can also be a heart attack that kills a significant part of the heart muscle. Ventricular fibrillation often occurs when not enough oxygen reaches the heart muscle and the special nerves that coordinate that heart muscle fibers to contract as one unit. Regular monitoring of the carotid intimal-medial thickness (IMT) by ultrasound will give a fairly accurate test for coronary artery hardening as the two are closely related.

A patient in danger of getting into trouble can be referred to a cardiologist and angioplasty and stent placement can prevent further deterioration for the time being. It is much safer to do these procedures electively rather than during an emergency when the patient is in distress.

Prevention of heart attacks, any volunteers?

Following the overview above it becomes apparent that prevention to not get heart disease is the best approach with regard to hardening of the arteries. This can be achieved by doing the following:

  1. You must abandon the Standard American diet. This means no processed food, no refined sugar intake, avoid as much starchy foods as possible. Adopting a Mediterranean diet or a DASH diet is a first step. The DASH diet was developed to help patients with high blood pressure to reduce their blood pressure through the use of this diet. Reducing blood pressure will also reduce the risk of heart disease.
  2. Avoid excessive alcohol intake (more than two drinks per day for men and more than one drink per day for women) as the toxic effect of alcohol kills heart muscle cells. This in turn leads to heart failure.
  3. Regular physical exercise will condition your lungs and heart and improve your cardiac output. By having bigger reserves the person becomes more resilient to developing a heart attack.
  4. Increasing your fiber intake to 30 to 35 grams per day using vegetables and fruit and additional fiber supplements. Common fiber supplements consist of psyllium husk and/or others from the health food store. Take it in the morning with breakfast and with lunch. By avoiding extra fiber at dinnertime you sleep better at night. It turns out that fiber intake is very important to lower LDL cholesterol and triglycerides by interfering with the enterohepatic pathway that leads to recirculation of bile salts rich in these fatty substances. The net results are lower LDL cholesterol and triglyceride levels and higher HDL cholesterol (the good cholesterol) levels.
  5. Take some vitamins and supplements. Vitamin B2, B6, B12 and methyl folate will support methylation pathways. Vitamin D3 in a good dose like 5000 IU per day or more and vitamin K2, 200 micrograms per day will remove calcium out of the arteries and transport it into the bones; this effectively prevents hardening of the arteries and prevents osteoporosis at the same time. Omega-3 supplements (EPA/DHA) are very useful to keep inflammation under control and delay hardening of the arteries; it helps to lower LDL and increase HDL.
  6. Have your hormones checked. Some doctors do not feel comfortable doing this; maybe you want to see a naturopath about it instead. Your body needs the hormone receptors satisfied by adequate bioidentical hormone levels; otherwise you age prematurely and give up body functions that you would rather keep. Normal hormone levels prevent osteoporosis, premature hardening of the arteries, Alzheimer’s, erectile dysfunction and premature wrinkles. The essential hormones involved in cardiovascular disease prevention are thyroid hormones, sex hormones and in some aging people also human growth hormone.
  7. Once every 2 years it would be good to measure your heart function as is outlined in this blog.
  8. There are many more factors that have been identified by researchers to contribute to hardening of the arteries.  It is useful to read this and think about which of these factors may apply to your case.
Heart Attacks Can Kill

Heart Attacks Can Kill


I have explained that hardening of the arteries is the cause of heart attacks. This is caused by a multitude of factors including sugar and processed food overconsumption, smoking, excessive alcohol intake, obesity, undertreated high blood pressure and diabetes. Simply doing angioplasties and placing stents will not stop the process of what led to the heart attack in the first place. Almost 15% died within 5 years following those procedures and 9% got another heart attack. They did not change their diets and stayed inactive. There is another sad aspect about clogging of coronary arteries: the more coronary artery flow we lose through hardening of the coronary arteries, the lower our ejection fraction of the heart as a pump has become. When we reach the point of less than 50% of ejection fraction, we enter disability country with clinical heart failure, forcing us to wear continuous oxygen masks and being unable to exercise or walk. Heart failure is as deadly as terminal cancer having a very high mortality rate.

Concentrate on prevention now, because heart disease remains the number one killer. Remember that we can largely prevent heart disease when we follow the steps mentioned above!

More info about heart attacks:


Book Review: “Healing Gone Wrong – Healing Done Right”, By Ray Schilling, MD

This book entitled “Healing Gone Wrong – Healing Done Right” (Amazon, March 18, 2016) is dealing with the practice of medicine then and now. Medical errors, false diagnoses and wrong treatments are nothing new in the history of medicine. It happened in the past, and it is happening now. My first book dealt with anti-aging and was entitled “A Survivor’s Guide to Successful Aging” (Amazon 2014).

Book overview

Chapter 1 describes that famous people like President Kennedy, Elvis Presley, Churchill, Beethoven or more recently Michael Jackson have something in common: all of them suffered the consequences of blatant medical mistakes. In Beethoven’s time lead containing salves to plug the drainage holes from removing fluid from his abdomen caused lead poisoning. In this chapter I review also how the illnesses of the above-mentioned celebrities were treated, but then ask the question: “What could have been done better to prevent some of the disastrous treatment outcomes?”

Chapter 2 deals with how modern drugs seem to come and go. We learn that twenty-first century medications that are touted as the latest therapeutic agents are having their potentially deadly consequences too: COX-2 inhibitors, the second generation of “improved” arthritis drugs cause strokes and heart attacks! Your doctor may still prescribe some of these dangerous drugs for arthritis now.

Chapter 3 deals with the fact that medical treatments for people’s diseases may be inappropriate when the doctor treats only symptoms, but nothing is done about the causes of their illnesses. This is a scary thought.

Chapter 4 asks the question whether we could learn something from these poor health outcomes in the past, so that we will be able to prevent any disastrous outcomes pertaining to our own health care in the present and future. As we will see, the problem today is still the same as it was in the past, namely that many physicians still like to treat symptoms instead of the underlying cause of an illness. Even though Big Pharma has the seducing concept of a pill for every ill, it is not always in your best interest, when these medications have a slew of side effects. “Gastric reflux” means a mouthful of stomach acid. This is a fact the suffering patient knows already! Big Pharma simply offers the patient with the symptom of gastric reflux a multitude of medications to suppress this symptom. But it is more important to dig deeper to find the reason for the illness and treat the underlying cause.

Chapter 5 concentrates on the brain and how we can keep our brains functioning optimally until a ripe old age. This review spans from prevention of head concussions to avoiding type 3 diabetes (insulin sensitivity from overconsumption of sugar). It manifests itself in Alzheimer’s disease. It is a form of diabetes of the brain that leads to deposits of a gooey substance. Prevention of this condition is also reviewed .

Chapter 6 reviews what we now know about how to keep a healthy heart. Certain ingredients are necessary such as regular exercise, a healthy Mediterranean diet, supplements etc. The good part is that what is good for the heart is also good for the brain. You are preventing two problems (brain and heart disease) at the same time.

Chapter 7 delves into the question why healthy food intake matters. Without the right ingredients of our body fuel, the body machinery will not work properly. The Mediterranean diet is an anti-inflammatory diet that is particularly useful.

Chapter 8 talks about healthy limbs, bones and joints. We are meant to stay active in our eighties and nineties and beyond. No osteoporosis, no joint replacements, no balance problems that result in falls! Learn about how to deal with problems like these in this chapter.

Chapter 9 deals with detoxification. What do we do as we are confronted with pollution, with radiation in the environment and poisons in our daily food? A combination of organic foods, intravenous chelation treatments and taking supplements can help us in that regard.

Chapter 10 deals with reducing the impact of cancer in our lives. A lot of facts have come out in the past 10 years telling us that reduction of sugar and starchy food intake reduces cancer. Curcumin, resveratrol and vitamin D3 supplements also reduce cancer rates as does exercise and stress management. All of this is reviewed here.

Chapter 11 checks out your hormone status. Women need to avoid estrogen dominance; both sexes need to replace the hormones that are missing. By paying attention to your hormonal status and replacing the missing natural hormones with bioidentical ones, most people can add 10 to 15 years of useful, active life!

Chapter 12 is refining some of the thoughts about anti-aging. You will learn about the importance to keep your mitochondrial DNA healthy. Apart from that there are ways how to keep your telomeres longer; certain supplements that are reviewed will help. Also your lifestyle does make a big difference in how old you can turn.

Chapter 13 investigates the limits of supplements. Many supplements are useful, but you do not want to overdo it and get into toxic levels. More is not necessarily better!

Chapter 14 reviews an alternative approach to treating ADHD. Attention deficit and hyperactivity disorder has been over diagnosed, has been neglected and has been over treated with dangerous drugs. An alternative treatment plan is discussed, which includes a combination of therapeutic steps.

Chapter 15 gives you a brief summary of the book.

Kirkus Review

Kirkus Reviews reviewed the book on March 17, 2016: “A retired physician details how various preventative measures can fend off disease and disability in this consumer health guide. Schilling (A Survivor’s Guide to Successful Aging, 2014) had a family medicine practice in Canada for many years before retiring. Although Schilling ventures into some controversial territory in his latest book, it’s generally an engaging, helpful synthesis of ideas that draws on reputable research from the Mayo Clinic and other sources. Overall, it serves as an intensely detailed wake-up call to the importance of preventative health. He largely brings an accessible and even-tempered tone to his narrative, warning readers, for example, that preventative health measures can only aid in “a delay of aging, not ‘eternal living.’ ” A thought-provoking, impassioned plea to be proactive about one’s health.”

Healing Gone Wrong – Healing Done Right

Healing Gone Wrong – Healing Done Right


In this book it becomes evident that it is better to prevent an illness whenever possible rather than to wait for illness to set in and cause disabilities or death. You heard this before: “Prevention is better than a cure” or “an ounce of prevention is better than a pound of cure”. I will give an explanation, based on scientific data that there is indeed evidence to support these notions on a cellular level. The mitochondria, the energy packages within our cells, are the driving force that keep people vibrantly healthy well into their nineties. All this can only happen when the mitochondria function properly. If the mitochondria are poisoned and as a result of toxins malfunction, we are not looking at a person with vibrant health. Instead sixty or seventy year-olds may be confined to a wheelchair. If you want a life without disabilities, a life without major illnesses and enjoy good health to a ripe old age, you are reading the right book.

The book is written in American English.

Available in the US:

In Canada:  

In other countries the book is available through the local Amazon websites.