May
13
2017

Results Of Insomnia Studies

Results of insomnia studies are focusing on all angles of insomnia. We know for some time that the circadian rhythm is linked to deep REM sleep, which we only reach about 2 hours into our nightly sleep. There are several reasons why our normal sleep pattern can get disrupted.

1. Night owls have a CRY1 mutation

A recent publication on March 27, 2017 has detected a mutation of the human circadian clock called CRY1. This is a dominant gene that is responsible for delayed sleep phase disorder (DSPD). People with this genetic feature tend to go to sleep 2 hours later than the average person every day.

It occurs between 0.2% and 10% in the general population and is inherited by the autosomal dominant mode.

This gene is responsible for the phenomenon of persons being “night owls”.

2. Sleep deprivation in nursing homes

Another publication has zeroed in to what happens in the frail elderly who live in nursing homes.

Here is what sleep researchers have found out about nursing homes.

  • Older people also need 7 to 8 hours of sleep per night, not less as previously thought.
  • Let people sleep at night, and give them undisturbed sleep. The practice of waking them up every 2 hours is unnecessary and undermines a restful sleep with normal amounts of REM sleep.
  • The color of light matters: Blue/purple light coming from TVs, iPod’s, laptops or cell phones stimulates serotonin production that wakes you up. In contrast to this orange/red light stimulates melatonin production that facilitates sleep. A nursing home owner, Guildermann said: “We have made it darker at night, and what light they do have is orange/amber/red light, and we are having phenomenal results.”
  • Sleep, exercise and nutrition are the biggest components of health.

3. Night workers

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.

Your body rewards you, when you sleep 7 to 8 hours during the night, but it will penalize you severely, if you turn it upside down. The reason is the diurnal hormone rhythm that we all have built in. Sleep is regulated by melatonin during the night, which is released by the pineal gland (on the base of the skull). 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, for instance is highest in the morning, human growth hormone is highest between midnight and 3 AM.

There are examples of what happens when you do shift work for several years:

  1. A) A Swedish study found that white-collar shift workers had a 260% higher mortality compared to a control group of daytime white collar workers: Shift work and mortality.
  2. B) A study compared night workers in the age group of 45 to 54 with daytime workers and found a 147% higher mortality rate in the night shift workers: Shift Workers’ Mortality Scrutinized. Shift workers work at night and sleep during the day. This can be done, but it is against the physiology of your body, as I explained above. Remember that melatonin does not only regulate your sleep, it also is one of the main stimulant hormones of the immune system. If you manipulate your diurnal hormone rhythm by staying awake during the night and sleeping during the day, you pay the price by an increased risk of mortality (increased risk of death). I think this is not worth it!

4. What to do when you cannot sleep?

The first step is to take 3mg to 5mg of melatonin at bedtime. It should be taken between 10PM and 11PM. It takes 20 to 30 minutes for melatonin to take effect. If you do not fall asleep within that time frame you are likely thinking too much! Relaxation before going to sleep should be part of your evening ritual. It can happen that we experience demanding, stressful days, and despite all better effort, it is difficult to be entirely relaxed. After demanding days like that I would recommend taking 1 or 2 capsules of valerian (500 mg strength) from the health food store. This combined with the melatonin should help in more than 80%-90% of insomnia cases. If you cannot sleep, see your physician. Sleep studies may be required or you may have problems of the thyroid (hypo- or hyperthyroidism), which may need to be checked. Other medical problems including depression have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems the next day or the feeling of a mild hangover.

5. Telomeres and insomnia

Some people have no problem disciplining themselves to go to sleep between 10PM and 11 PM, which seems to be the window of opportunity to catch a good night’s sleep. Others are so used to do their late night activities (reading, watching TV, being online, going to the pub etc.) that they finally drop into bed at 1 or 2 AM. People need 7 to 8 hours of good sleep; even hard-core party goers need to get that much sleep. Nature does not make exceptions! When you go to bed only at 1AM or 2AM, it is difficult to get enough sleep.

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep. Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10 PM and 11 PM and sleep for 7 to 8 hours.

6. Electronics in the bedroom

There is new research showing that electronics in the bedroom can interfere with a normal sleep pattern. Dr. Ben Carter is the lead author and a senior lecturer in biostatistics at King’s College London. He completed a study involving 125,198 children with an average age of 14½ years. There were about equal amounts of males and females. Both sexes had the same problem. When they were allowed to use electronic media, this interfered with their sleep time. What electronic devices are we talking about? Watching TV, using the computer, the cell phone, tablets and computer games. The study was originally published at JAMA Pediatrics.

The blue/purple light of the TV screen or a computer screen stimulates the brain to produce serotonin. This undermines the melatonin production and as a result the person finds it extremely difficult to fall asleep.

Here is a list that contributes to better sleep habits and better sleep quality:

  • Ensure that the bedroom is dark, soundproof, and comfortable with the room temperature being not too warm. It is important to develop a “sleep hygiene”. This means going to sleep around the same time each night, to have some down time of 1 hour or so before going to bed and getting up after the average time of sleep (for most people between 7 to 9 hours). Sleeping in is not a solution, and an alarm clock will also help to develop a sleep routine.
  • Caffeine drinks, alcohol, nicotine and recreational drugs must be avoided. Smokers should butt out no later than 7PM, as nicotine is a stimulant.
  • Getting into a regular exercise program, either at home or at a gym is beneficial.
  • Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  • It is not a sensible idea to use the bedroom as an office, reading place or media center. It paves the way to the getting stimulated by cortisol, which keeps us awake. The bedroom is a place of rest and should be comfortable and relaxing.
  • Some sleepers wake up at night, and they are wide-awake! Leaving the bedroom and relaxing in the living room for a while can help. It goes without saying that playing video games will not help! An alternative is to take 3 mg of melatonin, which will helps to fall asleep faster, but melatonin will wear off after about 4 hours.
  • A self-hypnosis recording is a useful adjunct to a sleep routine. Listening to it before going to sleep helps to focus on relaxation and to stop ruminating about the day and its events. Keep the volume low.
Results Of Insomnia Studies

Results Of Insomnia Studies

Conclusion

Recent results of insomnia studies have reconfirmed that we need our regular sleep to maintain our health. We have seen that some nursing homes have a practice of waking the client up every 2 hours. This must be abandoned as it interferes with the restorative deep REM sleep. In turn this will interfere with hormone restoration overnight.

Children and adolescents must limit their time in front of the TV, iPhones and computer screens. The blue light has the frequency that over stimulates the brain and interferes with melatonin production. Some people work overnight as shift workers or party until the wee hours in the morning. This causes your telomeres in your body cells to shorten. When you restore your sleeping pattern to normal your telomere length will no longer be shortened.

Even people who are night owls due to an inborn CRY1 gene that is responsible for delayed sleep phase disorder can normalize their sleep pattern by following a strict sleep hygiene. As people get older they lose the ability to make melatonin, but this can be replaced by taking melatonin tablets at bedtime.

Remember what I said earlier: Sleep, regular exercise and good nutrition are the biggest components of health.

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Dec
03
2016

Electronics In The Bedroom

There is new research showing that electronics in the bedroom can interfere with a normal sleep pattern. Dr. Ben Carter is the lead author and a senior lecturer in biostatistics at King’s College London. He just completed a study involving 125,198 children with an average age of 14½ years. There were about equal amounts of males and females. Both sexes had the same problem. When they were allowed to use electronic media, this interfered with their sleep time. What electronic devices are we talking about? Watching TV, using the computer, the cell phone, tablets and computer games. The study was originally published at JAMA Pediatrics.

Result of the study on electronics in the bedroom

  1. When media bedtime use was allowed, there was a 2.17-fold higher risk of not getting enough sleep quantity. This was compared to kids who did not use media devices in the bedroom.
  2. There was a 1.46-fold risk of having poor sleep quality.
  3. There was a 2.72-fold risk of excessive daytime sleepiness.
  4. Even children who had access to media use, but did not use it at night had similar findings. They had a risk of 1.79-fold to get inadequate sleep quantity. There was a 1.53-fold risk of poor sleep quality. And excessive daytime sleepiness was present with a 2.27-fold risk.

Melatonin level influenced by electronics in the bedroom

The diurnal hormone rhythm has been well researched regarding our sleep pattern. Essentially two hormones work together.

In the morning when you open your eyes, light enters our eyes and is registered in the hypothalamus. There are also links from the hypothalamus to the pineal gland, where melatonin is synthesized and stored. The light signal stops the secretion of melatonin from the pineal gland, although it is still being produced during the day in the pineal gland, but stored there until the evening hours set in. You may have noticed that you start yawning when the light dims in the evening. That’s when melatonin is released into your system to let you know it’s time to slow down and go to sleep.

Of course, we have electrical light and can turn night into day if we choose to! This works for a limited time, but eventually tiredness sets in, and melatonin wins the upper hand. Melatonin is the master hormone of the circadian rhythm.

It is interesting to note that cortisol does exactly the opposite. Cortisol is the adrenal gland hormone that helps us cope with stress. When we are fully awake, we need cortisol to cope with the various stress situations of the day. Melatonin inhibits cortisol secretion and cortisol inhibits melatonin secretion, and they are natural opponents working together for your common good. This is part of the circadian rhythm. We can measure these hormones, and this is how researchers have found out how these two hormones work together.

When children or adults expose themselves too much to electronic devices, the brain gets stimulated and sends signals to the adrenal glands to produce more cortisol. In between the hypothalamus and the adrenal glands there is a cascade of hormones that are involved in this.The hypothalamus sends CRH, the corticotropin-releasing hormone to the pituitary, which stimulates in turn the release of the messenger hormone ACTH to produce more cortisol in the adrenal glands. It is the extra cortisol that keeps kids awake. The same applies to adults who invite electronics into their bedroom. All the excitement from watching the various media gadgets leads to extra cortisol. And we just learnt that cortisol counteracts melatonin. 

What can parents do about electronics in the bedroom?

First of all, parents need to be firm with their kids. They need to explain to them that electronics need to be kept out of the bedroom. There needs to be a cooling down period one hour before bedtime where they do not watch TV, use the cell phone or other electronic gadgets. They may rebel against this first, but when they sleep better, they likely will be more agreeable. Here is a list that contributes to better sleep habits and better sleep quality:

  • Ensure that the bedroom is dark, soundproof, and comfortable with the room temperature being not too warm. It is important to develop a “sleep hygiene”. This means going to sleep around the same time each night, to have some down time of 1 hour or so before going to bed and get up after the average time of sleep (for most people between 7 to 9 hours). Sleeping in is not a solution, and an alarm clock will help also to develop a sleep routine.
  • Caffeine drinks, alcohol, nicotine and recreational drugs must be avoided. Smokers should butt out no later 7PM, as nicotine is a stimulant.
  • Getting into a regular exercise program, either at home or at a gym is beneficial.
  • Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  • It is not a sensible idea to use the bedroom as an office, reading place or media center. It paves the way to the stimulus of the cortisol effect that keeps us awake. The bedroom is a place of rest and should be comfortable and relaxing.
  • Some sleepers wake up at night, and they are wide-awake! Leaving the bedroom and relaxing in the living room for a while can help. It goes without saying that playing video games will not help! An alternative is to take 3 mg of melatonin, which will helps to fall asleep faster, but melatonin will wear off after about 4 hours.
  • A self-hypnosis recording is a useful adjunct to a sleep routine. Listening to it before going to sleep helps to focus on relaxation and to stop ruminating about the day and its events. Keep the volume low.

Some thoughts about sleep aids after electronics in the bedroom are removed

Sometimes an adolescent will have trouble falling asleep. Here is the solution of what to do: at the time the youngster is having problems sleeping, there is too much cortisol on board, which prevents the melatonin from being released from the pineal gland. What is missing is melatonin.

The first step is to take 3mg of melatonin at bedtime. It takes 20 to 30 minutes for melatonin to take effect. If the youth does not fall asleep within that time frame he or she is likely thinking too much. If that were the case, I would recommend taking 1 or 2 capsules of valerian root (500 mg strength) from the health food store. This combined with the melatonin should help in more than 80%-90% of insomnia cases. If the child still cannot sleep, see your physician. The adolescent may need sleep studies done or may have problems with the thyroid (hypo- or hyperthyroidism), which may need to be checked. Other medical problems, including depression, have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems.

Electronics In The Bedroom

Electronics In The Bedroom

Conclusion

A new study has shown that electronics in the bedroom will often keep children awake. It has become a huge problem in schools where students fall asleep or have problems paying attention. There are simple rules regarding a quiet bedroom without electronics that will go a long way of rehabilitating a child who has sleeping problems because of electronics. There are natural ways to help nature along, if the simple measures don’t work. Melatonin and valerian root help to calm the mind and help catching some healthy sleep. If the problem were persisting, an appointment with the family physician would be in order.

Even though this article deals with children and adolescents and the use of electronics in the bedroom, the same applies to adults. They are not immune to the stressors that disrupt sleep. They are just as likely to feel tired and sluggish after a restless sleep, and their performance at the workplace will suffer. Sleep hygiene is as important for adults as it is for adolescents.

Apr
16
2016

Sleeping Habits

When you are a child or a youngster sleeping habits are rarely a problem. But as people age, they tend to have problems falling asleep and sleeping through the night. Older people may also have certain hormone deficiencies, which can contribute to a change in sleeping habits.

Some basics regarding sleeping habits

There are a couple of facts that everybody should know about sleep, so you work with nature, not against it.

  1. The way our bodies are hardwired, we need 7 to 8 hours of sleep and we need to fall asleep between 10PM and 11PM.
  2. The reason for the relative rigid sleeping schedule time wise is the diurnal hormone rhythm. This is also known as the circadian clock that is dictated by the light of the sun (24 hour cycle). Light going into our eyes in the morning inactivates melatonin. But in the evening the pineal gland releases melatonin after sunset. This is what keeps the internal clock on time. We all know how we derail when we fly east or west. There are differences. I find that I am more affected when I fly west than east. The readjustment for me often takes one or two weeks for a 9-hour time zone difference.
  3. Melatonin is gradually produced less as we age. The highest melatonin production occurs around 10 years of age. From then on melatonin production declines. This likely is the reason why older people more often have insomnia problems.
  4. There is interplay between melatonin and cortisol. These two hormones complement each other. When you sleep melatonin governs and resets the hormones to be ready in the morning. This involves an early testosterone peak for the male and cortisol, which has to be ready the moment you wake up. It is cortisol coming from the adrenal glands that rules during the day and is giving us energy. Thyroid hormones also give you energy during the day. As I will explain below, human growth hormone is an energy-giving hormone as well that also clears your mind.
  5. What is not as much known is that human growth hormone (GH) provides energy for us. Growth hormone is released as a spurt between midnight and 3 AM, when you’re deep asleep. The purpose of that is to get you ready with regard to energy for the next day. If you drink alcohol after 5PM the afternoon before, you will miss most of that GH spurt during the night and have a hangover (lack of energy the following day).  At the 23 rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas the endocrinologist, Dr. Thierry Hertoghe from Belgium gave a talk about GH and said that even one drink during the evening before you go to sleep will cancel 75% of the GH spurt causing a lack of energy the following day. When you have alcoholic drinks evening after evening as many people do, you interfere with your deepest sleep, creating a fitful sleep and you can develop GH deficiency, which can be measured with blood and urine tests. GH deficiency leads to premature signs of aging, such as wrinkles, musculoskeletal problems, muscle weakness and dementia. Many people in their 80’s look “old”. In fact they may be growth hormone deficient and could be treated with human GH, if GH deficiency were confirmed by tests. Part of the aged appearance is reversible in cases of growth hormone deficiency by treating with daily GH injections.
  6. As we age, we produce less melatonin and less growth hormone. All of these hormone levels can be determined. If they are low, they should be replaced with small amounts of whatever hormone is missing.
  7. There are other hormones that are important for energy: cortisol from the adrenal glands, thyroid hormones and DHEA from the adrenal glands. When people get older there is a problem with melatonin production and an evening dose of melatonin supplement of 3mg is advisable. People beyond the age of menopause (females) and andropause (males) need bioidentical sex hormone replacement. Once they have sufficient hormone levels, they will also have more energy. It is advisable to get all of these hormones tested using a saliva hormone test. Growth hormone is a bit more difficult to assess, but IGF-1 levels give a first indication what your growth hormone levels are doing. The newest test is a 24-hour urine collection or an overnight urine sample looking for growth hormone metabolites. If levels are found to be low, daily replacement of growth hormone using a pen similar to insulin injections in diabetics can be given, using pure human growth hormone. You would need to seek the advice of a knowledgeable naturopath.

What does insomnia do to you?

From a psychological point of view performance is slower, there is a slower reaction time and there is a risk of developing anxiety or depression. The immune system gets weakened, high blood pressure can develop and there is a risk of developing heart disease, diabetes and cancer. It is common to gain weight becoming overweight or obese. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep. Shortened telomeres mean a shortened life span.

How to improve sleeping habits

Set your alarm clock for 8 hours later when you go to sleep. Make sure your bedroom is dark, but wake up to the alarm clock after 7 to 8 hours of sleep. Don’t sleep longer than 8 hours per night. Your internal diurnal hormone rhythm will thank you for regulating your sleep/wake rhythm by giving you the energy you want. I enjoy mine.

Sleeping habits include problems falling asleep or sleeping through

Falling asleep: As we mostly have a lack of melatonin, the first step is to take 3mg to 5mg of melatonin at bedtime. But it should be taken during the window of opportunity fitting into the diurnal hormone rhythm as mentioned above: between 10PM and 11PM. It takes 20 to 30 minutes for melatonin to take effect. If you do not fall asleep within that time frame, you are likely thinking too much. If that were the case, I would recommend taking 1 or 2 capsules of valerian (500 mg strength) from the health food store. This combined with melatonin should help in more than 80%-90% of insomnia cases.

Not sleeping through: Some of you, particularly if you are elderly, may wake up at 3 or 4 AM and have a hard time falling asleep again. At that time it would be safe to take another 3mg of melatonin and if this does not work within 20 minutes add another 500mg valerian capsule.

If you continue to have insomnia problems, see your physician. You may need sleep studies done or you may have problems with your thyroid gland (hypo- or hyperthyroidism), which needs to be checked. Other medical problems including depression have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems.

Part of good sleeping habits is to provide a quiet, comfortable bedroom

The following points are good checklist for a comfortable sleep environment (Ref.1).

  • Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average time of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
  • Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
  • Get into a regular exercise program, either at home or at a gym.
  • Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  • Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
  • If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
  • A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.
Sleeping Habits

Sleeping Habits

Conclusion

We need to be aware how important a proper hormone balance is when it comes to a healthy sleep pattern. Thyroid hormones and sex hormones are easy to measure. Bioidentical hormone replacement is needed, if one of the hormones is low. GH needs to be checked by an IGF-1 level and/or metabolites of GH in a 24-hour urine sample as explained above. Melatonin deficiency in older age is replaced the way I summarized above. With these measures sleeping habits improve, and you will get your 7 to 8 hours of restoring sleep. Forget the notion of the past that older people would not need as much sleep. Especially for an aging individual it is important to have a good night’s sleep in order to feel well and energized every day.

References

Ref.1: Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

Jan
16
2016

Low Thyroid (Hypothyroidism)

Dr. Pamela Smith gave a detailed talk regarding hypothyroidism at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. As a lack of thyroid hormones is one of the causes of premature aging, it is important to pay attention to your thyroid hormones. Here I am summarizing the highlights of this talk.

Thyroid disease, particularly low thyroid hormone levels, called hypothyroidism is very common in the population. Part of the problem is that in 72% of the world population dietary iodine is insufficient to provide adequate amounts of iodine to the body that is required for thyroid hormone production in the thyroid gland. The US Institute of Medicine has recommended 150 micrograms of iodine intake every day. Japan with its emphasis on seaweed intake is one of the few countries where thyroid deficiency is extremely low (Ref.1).

But apart from dietary factors there are many other factors that can lead to insufficient amounts of circulating thyroid hormones (see below).

The production of thyroid hormones

The thyroid gland produces the thyroid hormones by adding iodine atoms into the amino acid L-tyrosine to make thyroxin (T4) and triiodothyronine (T3). T3 is the main active hormone, which is about 5-times more powerful than T4. There is a feedback cycle between thyroid hormones, the hypothalamus and the pituitary gland. Both the hypothalamus and the pituitary gland have thyroid hormone receptors that sense the level of T3 and T4 and can modify the production of these hormones. The majority of T3, which is the main active thyroid hormone, is produced by conversion of T4 into T3 by a selenium-dependent enzyme.

Most of the thyroid hormones are bound in the blood by thyroid binding globulin. Only the free T3 and free T4 are metabolically active and will affect the metabolism of our body cells. The delicate balance can be easily disrupted. Oral contraceptives and sex hormone replacement therapy can increase the amount of circulating thyroid binding globulin, thus creating a thyroid hormone deficiency state, as the free T3 and free T4 are diminished.

Other factors influencing circulating thyroid hormones

  1. Low adrenal gland hormone activity can occur simultaneously with hypothyroidism. On the other hand, when thyroid hormones are low by themselves, the adrenal glands often compensate by producing more cortisol to offset some of the symptoms of hypothyroidism.
  2. An enzyme located in the liver, kidneys, pituitary gland, hypothalamus and brown fat is necessary for conversion of T4 to T3, the more active thyroid hormone. Anything that interferes with this conversion leads to hypothyroidism. Over the years medical research has identified many factors that interfere with this process. For instance, there are trace elements necessary for this enzymatic reaction, like selenium and zinc; if they are low in the diet, low T3 will be the result. But other nutrients, if missing, will also interfere with T4 to T3 conversion: iodine, iron as well as vitamins A, B2, B6 and B12.
  3. Several medications can also interfere with the conversion of T4 to T3: we already mentioned birth control pills; others are estrogen, lithium (patients with bipolar disorder are often on this), phenytoin, theophylline, beta blockers (such as propranolol), chemotherapy and clomipramine.
  4. But dietary factors can also lower T3 due to a lack of conversion from T4:too many cruciferous vegetables, a low carbohydrate diet, low fat diet, low protein diet, excessive alcohol use, walnuts and soy. In a study where the effects of soy were examined 37 adults on a high soy diet over three months 50% developed hypothyroidism. When the soy diet was stopped it took one month to normalize the thyroid function (Ref. 2).
  5. There is no end of factors that cause low T3 because of the inability to convert from T4: chronic inflammation due to cytokines, diabetes, aging, poisoning with heavy metals like mercury, lead and cadmium (cigarette smoking), fluoride, pesticides, exposure to radiation and stress. Other toxic substances that enter the body can interfere with the same T4 to T3 conversion process: dioxins, phthalates (chemicals added to plastics) and PCB. But excess calcium and copper (copper salts could come from spraying of organic fruit) can also lead to low T3.
  6. Other hormones can disbalance the equilibrium and cause low T3 because of a lack of conversion from T4: too much stress, which causes cortisol from the adrenal glands to rise. Surgeries associated with the same stress response (high cortisol levels) also have been shown to cause low T3.
  7. There is another conversion process that has been shown to lead to lowered T3: it is called “reverse T3 (rT3)”. rT3 is an inactive form of T3, which blocks thyroid receptors and renders T3 less active. rT3 is particularly important in stressful situations and in athletes who engage in extreme exercise. In these individuals T3 and T4 blood tests are normal, TSH is suppressed and rT3 is elevated. That’s how the doctor can diagnose this condition. Other conditions that lead to high reverse T3 are: aging, diabetes, exposure to free radicals (chemotherapy or radiation in cancer treatment), fasting, prolonged illness, toxic metal exposure, inflammatory cytokines, depression and anxiety, bipolar disorder, Alzheimer’s and Parkinson’s disease, chronic fatigue syndrome and fibromyalgia.
  8. After all this negative news it is almost a wonder that the thyroid is still doing its work! Since we know the risk factors, it is important to be aware that certain supplements and dietary habits can help to increase the conversion from T4 to T3. Here is a list of those that help: iodine, iron, zinc, selenium, potassium, Ashwaganda, and a high protein diet. Other positive factors are vitamins A, B2 and E; growth hormone, testosterone, insulin, glucagon, melatonin and estrogen (high dose).

Symptoms of hypothyroidism

There was an overwhelming amount of information about signs and symptoms of hypothyroidism that was reviewed. I can only highlight some of the more common symptoms here. It is important to know that some of these signs and symptoms occur several years before the lab values become abnormal; this is particularly true of the “eye brow sign” and the thinning of eyebrows is a pointer to hypothyroidism!

Depression, weight gain, constipation and migraine type headaches can be early non-specific signs of hypothyroidism. Women often present with irregular periods. Other symptoms are: decreased memory and inability to concentrate, anxiety/panic attacks, muscle and joint pains, a puffy face, swollen eyelids, decreased sexual interest, and sleep disturbance. Sparse, coarse, dry hair; missing hair confined to the outside 1/3 of both eye brows (eye brow sign) and carpal tunnel syndrome are also associated with a lack of thyroid function. Often there is also a loss of eyelashes or eyelashes that are not as thick. When blood tests show high cholesterol, iron deficiency anemia or vitamin B12 deficiency this should prompt the physician to order thyroid tests.

Blood tests for hypothyroidism

TSH, free T3, free T4, reverse T3 and thyroid antibodies need to all be ordered to have a complete documentation of what is going on. Among the thyroid antibodies these three types need to be ordered: antithyroglobulin antibody, antimicrosomal antibody and antithyroperoxidase (anti-TPO) antibody. There are a number of more studies that an endocrinologist would order in difficult to diagnose cases. Thyroid antibodies are an important cause of hypothyroidism in the US and can be due to Hashimoto’s thyroiditis, an inflammatory condition of the thyroid gland. Some people have autoimmune antibodies against adrenal gland tissue. There are also patients who have gluten sensitivity, and they may produce these autoantibodies to both the adrenal glands as well as the thyroid gland.

Treatment of hypothyroidism

Treatment for hypothyroidism consists of detoxification, proper nutrition and thyroid hormone replacement.

Detoxification can include intravenous chelation therapy, if heavy metals are involved. In some cases detoxification is all that is needed.

Proper nutrition with a Mediterranean diet and some iodine supplements or seaweed is important. But often the thyroid is damaged by the time hypothyroidism is diagnosed and thyroid hormones have to be replaced.

Replacement of thyroid hormones is best done by desiccated thyroid or compounded thyroid (both T3 and T4). The normalization of the TSH level is taken as the end point and should be below 2.0 (not the lab normal value of below 5); free T3 should be optimally between 3.5 and 4.3 and reverse T3 should be 50 to 150 pg/ml to be optimal.

If reverse T3 is high, the patient will have hypothyroid symptoms, even if T3 and T4 blood tests are normal. Because reverse T3 is derived from T4, the physician will have to lower T4 or take the patient off T4. Replacement with T3 will lead to lower TSH production by the pituitary gland and production of T4 and inappropriate conversion to reverse T3 will decrease.

Depending on what other conditions the patient presents with, it likely will help to eliminate stress, treat selenium and iodine deficiency, treat infections and treat growth hormone deficiency, if present.

There were many more pearls of wisdom in this very comprehensive talk on hypothyroidism, but there is not enough room in this blog to mention all of this. For more info read Dr. Pamela Smith’s book (Ref.3).

Low Thyroid (Hypothyroidism)

Low Thyroid (Hypothyroidism)

Conclusion

The thyroid is one of the main players involved in the maintenance of our health and well being. Hypothyroidism can develop for multiple reasons: inadequate iodine intake, toxins including heavy metals, autoantibodies from gluten or other sensitivity and certain medication usage. It is a fallacy to think that supplements, vitamins and lifestyle choices can “cure” thyroid deficiency. Once the levels are low, thyroid replacement is the only way to reestablish a hormonal balance! The treating physician must consider many factors when replacing thyroid hormones optimally. Desiccated thyroid hormone replacement (containing T3 and T4) is the best type of replacement of missing thyroid hormones. The needs can differ a great deal, as no patient is the same! For best results the treating physician needs to individualize treatment.

References

Ref. 1: Brownstein, D., “Iodine: Why You Need It, Why You Can’t Live Without It”. Medical Alternatives Press, 2004.

Ref. 2: Kelly, G., “Peripheral metabolism of thyroid hormones: A review,” Alt Med Rev 2000; 5(4):306-33.

Ref. 3: Smith, P. “What You Must Know About Thyroid Disorders”. Garden City Park, NY: Square One Publishers, 2016.

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Oct
03
2015

What Stress Does

We all are stressed out at times. Some people are stressed all the time and this is called chronic stress.

Acute stress

Let’s say you were involved in a minor rear-ender accident. It is annoying, but at least you were not injured. But you have to deal with the insurance company, get the repair done and maybe get a car rental during the time of repair. Yes, you may have a few days where you feel that your hands are shaky and your heart pounds, or your sleep may not be restful. But when everything is done things are back to normal. This is an example of acute stress with a shorter running time. It has a limited severity, is an inconvenience, but it does not really affect your body on the long-term.

Chronic stress

Let’s assume the car accident was more severe and you received a personal injury with a broken leg. You end up in hospital and the orthopedic surgeon fixes the fracture with a surgical plate. The leg has to be in a cast for several weeks, and you have to use crutches. Every day you feel reminded of the car accident, because it is awkward to walk with crutches. After weeks you notice that you have gained weight. Your doctor is also worried about you because your blood pressure showed higher readings. You do not sleep as well, waking up frequently and having nightmares about another fictitious accident. On top of that you came down with the flu. What happened here? The stress reaction released cortisol, which weakened your immune system and may be responsible for you catching the flu. On the long-term cortisol can also contribute to high blood pressure, but so can alcohol consumption. You may have increased your alcohol intake in the evening to relax more, but with the chronic stress and the cortisol increase this can cause high blood pressure. The weight gain that you noticed has to do with the fact that you cannot work out any more because of your healing leg fracture and you having to use crutches. Inadvertently you may also eat a bit more rich food; a lot of people do that as food can be used as comfort food. And why do you sleep less well? Chronic cortisol elevation leads to lower melatonin levels, as these two hormones are natural opponents. A high melatonin level leads to a low cortisol level and vice versa. With relaxation methods you can lower cortisol and the melatonin level increases normalizing your sleep. Chronically elevated cortisol can also lead to weight gain as sugar is converted into fatty acids that are stored as subcutaneous fat. Muscles can melt down when cortisol is high giving the appearance of spindly arms and legs.

Causes of chronic stress

Holmes and Rahe tested a stress scale in 1970, which has become the standard ever since. You get a certain amount of points for a stressful event, e.g. 100 for the death of a spouse; 45 point for retirement; 23 for trouble with the boss etc. Add up all of the points that are affect you right now; if the total score is less than 150 points there is only a minor risk of getting medical problems from the chronic stress; for 150 to 299 points the risk of illness is moderate and for 300 and more points you are at a significant risk for illness.

There is physical illness and mental illness that chronic stress can cause. Physical illness can be high blood pressure, hardening of the arteries. The long-term risks from this are possible heart attacks and strokes. But chronic adrenalin and noradrenalin elevation associated with chronic stress can burn part of your brain cells in the hippocampus and medial prefrontal cortex. This can lead to memory loss, spatial memory loss and aggression. Mental illness caused by chronic stress can be anxiety, depression, social isolation, panic attacks and panic disorder. Psychosomatic symptoms can include headaches, back pain, abdominal pain and difficulties concentrating.

Job stress and cancer

Perhaps one of the best examples of job stress and cancer is a study where the amount of breast cancer was correlated to the amount of stress. I discussed this in another blog. Briefly, women with a less responsibility had the lowest rate of breast cancer, but they too had some stress as there was a higher breast cancer risk after 15 years on the job versus only 5 years on the job. The same study showed that women with high responsibility had the highest breast cancer rates. A hormone disbalance can explain this based on high cortisol levels associated with chronic stress. If cortisol is high, the cortisol binding globulin (CBG) increases; this in turn also binds more circulating progesterone, as progesterone attaches to CBG. CBG is a transport protein for both cortisol and progesterone. The end result is that estrogenic compounds get the upper hand, a condition called estrogen dominance. I have explained under the above link that this was the real reason for the increase in breast cancer in the stressed women. Similar mechanisms are causing other cancers to occur more frequently with chronic stress.

Chronic stress and cardiovascular disease

High stress jobs were found to cause a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease when compared to low stress jobs. This was based on a British Medical Journal study in October 2002. As I discussed above under a brief description of chronic stress cardiovascular disease is often what develops as part of chronic stress. People who are under chronic stress feel that they do not have enough time to prepare good, healthy food at home. They tend to eat out more often. Even well educated people just swallow a quick hamburger and other processed foods. This increases the bad fats like trans fats and omega-6 fatty acids in their system causing inflammation of the blood vessels as explained in this blog. The LDL cholesterol and triglycerides get elevated, sugar from sugary snacks oxidizes the LDL cholesterol and your coronary arteries and brain arteries get clogged up. This sets anybody on the downward pathway, and it is now only a matter of time when the chronically stressed person will develop a heart attack or stroke.

Chronic stress extremes: PTSD and burnout in soldiers

Dr. Thierry Hertoghe gave a lecture during the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec.10 to 14, 2014). The title was: “Burnout: A multiple hormone deficiency syndrome”. Burnout is the extreme of chronic stress. He said that burnout is a common condition where several hormones are affected, with the cortisol axis being the main one, but other hormone glands being stressed as well. As a result endocrine glands age prematurely. Symptoms are fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness. The underlying hormone abnormalities are a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone and estrogen deficiency and oxytocin deficiency. Burnout is common in teachers and there is a questionnaire that has been developed for teachers (teacher’s burnout scale) to monitor them whether they are heading this way. Soldiers who return from combative situations often suffer from burnout or from PTSD. Their burnout severity can be monitored using the teacher’s burnout scale already mentioned. In suspected cases laboratory tests that measure hormone levels give concrete answers about hormone deficiencies. Treatment protocols were discussed in detail. Multiple bioidentical hormone replacements are necessary, possibly for prolonged periods, if not life long. In addition supportive counseling sessions from a counselor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Why is this important? It is important, because hormones are necessary on a cellular level and regulate the energy metabolism of every cell in the body. Also, by recognizing what is going on and helping the affected individuals, a lot of pain and suffering can be prevented.

Accelerated aging from telomere shortening

Chronic stress has been shown to cause telomere shortening. So does a lack of sleep (insomnia), smoking and alcohol overconsumption, all conditions that can be associated with chronic stress. What can we do about this? Learn what shortens telomeres and ultimately your life. Cut out what you can and take supplements that lengthen your telomeres.

Positive thinking combats stress

Negative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or by getting caught up in needless anxiety. Worrying does not get us anywhere, but it depletes our energy.

Self-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. Prayer is know to help people in sickness and in health. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.

Building social ties and mutually supportive relationships will also build you up. It makes you feel that you belong, you have your place in society, you help others, and they support you.

We need some stress to get us going, but we do not need “distress”. Dr. Hans Selye, the father of the general adaptation syndrome due to stress, gave a lecture about this topic in Hamilton, Ont. in 1977, which I attended. I vividly remember how he projected a picture of his skeleton showing bilateral hip replacements. He said that chronic stress could lead to arthritis. He had developed end stage arthritis in his hips requiring total hip replacements on both sides. He wanted to illustrate that stress leads to physical consequences; it may be a heart attack in one person, a stroke in another, arthritis in a third. Constant overdrive has physical consequences.

What Stress Does

What Stress Does

Conclusion

Stress can be deadly, particularly if it lingers on and becomes chronic. But we can reorganize our lives to minimize stress. Some people may decide to seek a less stressful occupation. Others may elect to stay at that job, but develop hobbies and get involved in relaxation methods to combat job stress. The key is to start thinking about what stress you may be under and then develop a plan to counter it so you can allow yourself to rebalance your life.

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Jun
13
2015

Preserving Our Energy

We are all aging, and as we do we are gradually losing energy until we reach our last breath. Here I like to review where our energy comes from and what we can do to preserve our energy. When we preserve our energy we are in fact also slowing down the aging process and this in essence is the approach to anti-aging.

Mitochondria are power packs of energy

Each of our body cells has many mitochondria to give us energy. Some organs are more demanding. They are the main players in our body like the brain, the heart, the liver or the kidneys. Their cells have thousands of these energy packages. Without the mitochondria there would be no energy available to these key organs to perform all the work they do. They allow us to think and produce brain hormones, to contract our heart muscle and pump the blood through our arteries. They are organs like the liver that are in charge of all of the major metabolic reactions or the kidneys that filter our blood for impurities and eliminate them in urine. Mitochondria can be likened to our power bundles that give our organs and us energy to get through life.

Get enough sleep

Sleep is an energy rebuilder. But it has to be deep enough and long enough, and there has to be enough REM sleep to give us the feeling that we had a refreshing sleep. As we age some of our hormone production slows down. One of those substances is melatonin. It is crucial for good and restful sleep. If our body is not producing enough, we can supplement with small dosages like 3 mg orally to help our body to initiate sleep. It is not an addictive substance. It is the body’s own hormone. Should you wake up later in the night, you could take another 3 mg of melatonin. There is no risk either to feel tired or “hung over” after taking melatonin.

Exercise regularly

The cheapest energy you can get is by exercising regularly. When you exercise on a treadmill, go jogging or go for a brisk walk you condition your heart, improve your lungs; in short you develop cardiovascular fitness. At the same time your muscles are strengthened with isometric exercises. You are optimizing your energy flow. In the process of exercising you create a stimulus for your mitochondria to multiply in the affected tissues. This applies as much to your muscles as it does to your heart and to your lungs. You will find that your muscle strength increases. With exercise you spend energy, but you feel more energetic from it because your body is being tuned up.

Manage stress

Self-hypnosis is a simple way to allow your whole body to relax. However, the various forms of yoga will do the same thing for you. Meditation is another way of finding peace and tranquility. All of these methods will re-energize you. They calm your brain, help you to cope with stress and rebalance your hormones at the same time.

Lifestyle

You need a lifestyle that is conducive to keeping your energies. Listed here are several factors that interfere with energy production.

  1. Smoking: If you smoke, you burn up energy with every cigarette you consume. You interfere with the oxygen transport through your lungs, but the chemicals that poison your system also poison the mitochondria of the cells. By smoking you are destroying your power packs. Pollution damages your lungs in a similar fashion as smoking does, but it is a slower process. There are a number of big cities with severe air pollution and they may not be worthwhile visiting.
  2. Sugar and starchy foods: Back in the 1970’s based on the Framingham Heart Study it was thought that hardening of arteries would be due to an accumulation of cholesterol from fat in the diet. Saturated fatty acids were accused to be the culprit. A low fat diet was supposed to be the solution. But the end result was the obesity and diabetes wave that we still see now. There had to be another explanation of where hardening of the arteries came from. Banning fats did not lead to better statistics. The new observation was that a low carb/medium fat diet was associated with low heart attack rates, low stroke rates, and even low cancer rates. Researchers also found the real culprit: They are sugar, starchy foods and processed foods. Sugar and starchy foods are metabolized in the liver into LDL cholesterol, triglycerides and they also oxidize LDL cholesterol. This starts a vicious process of inflammation of the lining of the arteries with fat deposits into the wall of the arteries. By eating the wrong foods we interfere with our body chemistry to the point where free radicals are produced that attack everything in us including our mitochondria. I have blogged about this many times before. You can read about it here.
  3. Alcohol: the famous one glass of red wine for women and two glasses of red wine for men is supposedly keeping us younger for longer. This is true for the resveratrol in the red wine, which is a powerful antioxidant. But to say that alcohol itself would prolong your life is a white lie. Alcohol is a nerve and cell poison; it robs you of energy. I take the resveratrol as a supplement from the health food store to protect my system. I stay away from alcohol.

Keep the arteries open

We need healthy arteries to pump blood through all of the branches and deliver oxygen and nutrients to the body cells. Unfortunately, as we age our arteries tend to get deposits that make them more narrow, and this could also raise our blood pressure. The end result is that less nutrients and oxygen will reach our body cells. We perceive that something is wrong by not feeling as energetic as usual. Simple lifestyle changes as mentioned below can improve our circulation and lower our blood pressure. Chelation therapy has also been shown as helpful in the TACT study.

Get rid of inflammation

Dr. Paul Ridker found that approximately 50% of patients with heart attacks had a normal cholesterol level. He was looking for a more meaningful screening test and found it in the C-reactive protein. If the test result was higher than 3 there was a high probability that there was inflammation somewhere in the body, but a test result of less than 1 was normal. In the meantime scientists have learnt that the C-reactive protein is a very sensitive tool to measure inflammation in the body, but it is not specific for heart attacks. It is also positive in people with arthritis, cancer, and autoimmune diseases. Chronic inflammation is also destroying immune cells: this explains the development of cancer as the end stage of chronic inflammation.

Chronic inflammation robs you of energy. We can do a lot with natural anti-inflammatory supplements to quench inflammation.

Preserve your immune system

We can strengthen our immune system by exercise, taking vitamin C regularly and by taking vitamin D3 supplements to just name a few. DHEA, the precursor hormone from the adrenal gland also helps stimulate the immune system.

Balance your hormones

As we age we loose hormones one by one. With melatonin this starts happening after the age of 20, with DHEA and growth hormone after you are in your mid thirties. Women start to get into menopause at the age of 45 to 55, but this can occur earlier or later. Men are going through their hormone change (andropause) at the age of 55 to 60. Both, women and men know when they are entering their hormone change because of a lack of energy and a few other unpleasant symptoms. Women get hot flashes. Men get grumpy, have erectile dysfunction, a lack of sex drive, week muscles and slower thinking. If you feel those symptoms, seek the help of a naturopath who is knowledgeable on bioidentical hormone replacement. Chances are that your regular doctor will want to prescribe synthetic hormones unless you can find an anti-aging physician. If your blood tests show deficiencies in the sex hormones, you will need to get a bioidentical hormone prescription. They are usually dispensed as creams, which you apply to your chest wall or non-hairy forearms in the morning. After 4 weeks your energy will be back, and your body will function normally again. All the body functions that you thought were gone forever just needed that extra stimulus from the missing bioidentical hormones.

Organic, GMO free food

I was tempted to just write “good food”. But this may be confusing to people. It is difficult anywhere in the world to get good food. Often insecticides and pesticides contaminate fruit and vegetables, which function as xenoestrogens blocking hormonal receptors. These residues are toxic for your body, and they are destructive to your energy. Organic food with the USDA certification or any independent certification is the best way to ensure that you get a good food product. I take this seriously and pay the extra dollar. We do not need plates heaped with foods. Small helpings of good quality foods are more important for our well-being.

Treat depression and mental disease

People who are depressed will complain of a lack of energy. Their brain circuits are constantly in overdrive being busy with negative thinking. Cognitive therapy can help depressed patients to face their negative emotions. It is a learning process of thinking step by step to distinguish what is real and what is magic thinking. It is important to seek qualified help. Depressed patients distort the way they think, but cognitive therapy sets their thinking straight (Ref.1). When the thinking is normalizing, the drained energy returns, people sleep better again and they can use the energy to move forward.

Positive thinking

Negative thoughts are draining you of energy. You want to stay optimistic within what’s reasonable. Be thankful for all the good things in your life. Minimize what’s negative, but think about positive solutions to get rid of energy draining parts in your days. Do this persistently until it becomes part of your life and you will have extra energy that you didn’t waste in negative thinking or by getting caught up in needless anxiety. Worrying does not get us anywhere, but it depletes our energy.

Preserving Our Energy

Preserving Our Energy

What can we do to prevent aging?

It follows from all that I said that anything that preserves energy would also prevent premature aging.

As mentioned, it is important to exercise regularly (gym, swimming, dancing, fast walking, jogging etc.). Have good, balanced nutrition, preferably organic food. Some supplements are also helpful: resveratrol, Co-Q-10; pages 100 to 103 of my book contain more vitamins and supplements (Ref.2). Here is a link to my website NetHealthBook, which also addresses vitamins and supplements (scroll down to table). Avoid sugar and starchy foods to avoid oxidizing LDL cholesterol. Use bioidentical hormones to replace what is missing. Get your 7 to 8 hours of sleep and don’t forget relaxation. Detoxify to get rid of toxins that would slow you down. Infrared saunas are one way to detoxify. It is helpful to consider chelation treatments. Last but not least have a positive outlook on life.

Conclusion

Our energy that we feel tells us whether we are staying healthy or whether we are at the verge of getting sick. It is best to maintain your energy at all times by doing a combination of things outlined above. You will retain youthful energy; you prevent cardiovascular disease, Alzheimer’s and even cancer. Most of all you have the energy to do the things you want and love to do.

I prefer to work on staying well and in the process I have the energy to do the things I want to do. Part of it is blogging, part of it is writing books, and part of it is dancing. The key is that I like what I am doing. I invite you to do what will keep you energized. Listen to your body.

 

References:

1. David D. Burns, MD: “feeling good – the new mood therapy” 1999, Harper Collins.

2. Dr. Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling

Mar
07
2015

Drink Your Coffee, But…

I have blogged about coffee drinking several times in the past. Coffee consumption and health benefits have become a news item again because of yet another study. The recent media reports are based on a South Korean study that involved 25,138 men and women with a mean age of 41.3 years.

Here I like to concentrate on aspects regarding coffee consumption that are often lost in the media when studies regarding coffee consumption are discussed. I will break it down into points and then conclude at the end with my recommendations.

1. Calcification of coronary arteries and osteoporosis

The South Korean study published online on March 2, 2015 showed that with up to 4 cups of coffee there was a direct linear relationship between consumption of coffee and prevention of heart attacks. Coronary artery calcium (CAC) deposits were measured by a CAT scan as they are known to be a good measure for a future risk of heart attacks. Less than 1 cup of coffee per day resulted in a 23% reduction of CAC in the coronary arteries compared to controls without coffee consumption. 1 to 2 cups of coffee reduced CAC’s (meaning the risk of heart attack rates) by 34%, while 3 to 4 cups prevented CAC’s and thus heart attacks by 41%. The fun stops at 5 cups of coffee per day as only 19% of CAC’s (heart attacks) were saved. Clearly there is something in coffee that shows detrimental effects, if the dosage is too high.

In the past there was a question as to whether coffee consumption would lead to osteoporosis in women. However, a study showed that there was no correlation between coffee consumption and osteoporosis.

Other studies have clarified this and found that vitamin D3 and K2 are important to remove calcium from the arterial wall and transport calcium into the bone and deposit it there. Vitamin D3 and vitamin K2 seem to override all the other nutrients when it comes to osteoporosis prevention. The other factor in older women is hormone deficiency as they age necessitating bioidentical hormone replacement in addition to vitamin K2 and vitamin D3 to prevent osteoporosis.

2. Whether or not you put sugar into your coffee

is an important question. This is routinely done in Germany where I grew up. The addition of sugar changes the entire game plan, as it is sugar that oxidizes LDL cholesterol, which is directly deposited under the arterial walls. This is the root cause of hardening of the arteries. Coffee alone is beneficial; coffee with sugar is not. I use a tiny amount of KAL Stevia (which does not have the bitter aftertaste) instead of sugar to sweeten my coffee. This sweetens it to the equivalent taste of sugar, but without the detrimental oxidizing effect of sugar. Somebody like me who was conditioned to eat sugar from childhood on in Germany has been left with a “sweet tooth”; so I need to have this tiny bit of stevia as a crutch. Purists may disagree with me. Keep in mind that the Korean study was done without sugar.

3. What’s the difference between real and decaffeinated coffee?

The recent study showed that you need to drink the real thing (caffeinated coffee), if you want to reduce your risk to get the dreaded pigmented skin cancer, melanoma. Decaffeinated coffee did not have this melanoma protective effect. This points to the fact that there are several substances in real coffee and decaffeinated coffee that have different effects. Ref. 2 shows that there was a clear reduction in the risk of developing type 2 diabetes in people who drank either coffee, decaffeinated coffee or tea. Unfortunately many studies do not distinguish clearly between caffeinated coffee and decaf coffee.

4. Micronutrient components of coffee

As this link shows there are many micronutrient components in coffee such as caffeine, diterpenes, chlorogenic acids, and melanoidins. There is about 100 mg of caffeine contained in a tall (240 ml) Starbucks cup of coffee. This will stimulate the nervous system and your adrenal glands getting that energy rush.

Diterpenes consisting mainly of cafestol and kahweol are substances that have been found to increase the LDL cholesterol. The fact that we are dealing with a concoction of mostly beneficial, but also some less beneficial micronutrients in coffee is responsible for the lower beneficial effect of 5 cups of coffee mentioned in the South Korean study. Filtered coffee seems to largely remove these undesirable substances.

This link explains more details about the micronutrients in coffee.

5. Clinical conditions that are partially prevented by coffee consumption

The last link mentioned a study where a large group of people were followed and monitored for Parkinson’s disease. Those who had consumed only 1 cup of coffee per day were compared to controls without coffee consumption. This one cup of coffee per day prevented Parkinson’s disease by 40 to 60%. Similarly, in a study that investigated prevention of type 2 diabetes 4 to 6 cups of coffee per day prevented 28% of type 2 diabetes. In postmenopausal women decaf coffee was also significantly effective in reducing the risk to develop diabetes.

The Linus Pauling Institute link summarized that there were several studies that showed that colorectal cancer could be partially prevented by consuming real coffee (4 or more cups), which lowered the risk by 24% compared to non-coffee drinkers. Another study noticed that 1 to 2 cups per day of decaf coffee reduced the risk for colorectal cancer by 48%.

Cirrhosis of the liver, often due to excessive alcohol use can be prevented by 40% when at least 2 cups of coffee were consumed. More astounding than that is that the risk of death from liver cancer can be reduced by 50% when at least 1 cup of coffee was consumed compared to those who never consumed coffee.

However, liver and colon cancer are not the only ones that can be prevented to a large extent by drinking coffee. Breast cancer, prostate cancer, endometrial cancer, uterine cancer, oral cancer, brain cancer and lung cancer can also be significantly prevented by a regular cup of coffee. As there is a risk of increasing miscarriages in pregnant women, it is best not to consume coffee during pregnancy or at the most limit it to one cup per day. Also, nursing mothers should avoid coffee (even decaffeinated coffee) as caffeine gets transmitted into mother’s milk.

People with high blood pressure may be better off to not drink coffee or to drink decaf coffee, because caffeine has been shown to elevate blood pressure substantially.

6. What are the risks of drinking coffee?

Seeing that coffee is an effective drug-like compound with many benefits, it is worthwhile asking the question: what are the side effects of coffee consumption? There are people who are very sensitive to caffeine. They get over stimulated and experience heart palpitations, a lack of sleep and anxiety. They should refrain from coffee. They may even be over sensitive to decaffeinated coffee that still contains about 3% of caffeine. People with rheumatoid arthritis have been shown to deteriorate with coffee consumption, making this another subgroup of people who should stay away from coffee.

7. What is the process of decaffeinating coffee?

Essentially there are 4 processes of decaffeination that have been developed over time. As this link shows, all of the decaffeination processes are done with the green coffee beans. There are two solvent-based processes and two non-solvent based processes. The latter two are the healthiest: the Swiss water process and the carbon dioxide process. The problems with the older solvent-based processes are the chemicals used to extract the caffeine. They can be harmful to the body.

Organic decaffeinated coffees are manufactured with the environment-friendly Swiss water process.

Drink Your Coffee, But…

Drink Your Coffee, But…

Conclusion

There are some people who simply are too sensitive to caffeine. They should refrain from drinking coffee. Pregnant women and nursing mothers should either severely reduce coffee consumption to one cup per day or refrain from coffee altogether. Those with high blood pressure and rheumatoid arthritis patients better refrain from drinking coffee as well. The majority of us will benefit from coffee consumption, if this is your taste. You may prefer green tea or Oolong tea instead. As I explained above there is compelling evidence in the literature that many cancers, heart attacks, strokes and diabetes can be partially prevented by regular coffee consumption. Decaffeinated coffee can prevent type 2 diabetes to some extent and colorectal cancer as well. The majority of evidence shows that coffee drinking is healthy. So, go ahead and enjoy!

References:

Ref. 1: Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B. “Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies.” Circulation – February 11, 2014; 129 (6); 643-59.

Ref. 2: Huxley R, Lee CM, Barzi F, Timmermeister L, Czernichow S, Perkovic V, Grobbee DE, Batty D, Woodward M. “Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis.” Arch. Intern. Med. – December 14, 2009; 169 (22); 2053-63

Feb
20
2015

Hormone Changes With Burnout

At the 22nd Annual A4M Las Vegas Conference in mid December 2014 Dr. Thierry Hertoghe, an endocrinologist from Belgium gave a lecture on “Burnout: A multiple hormone deficiency syndrome”, in short: hormone changes with burnout. I have heard him speak on several congresses before. He is always very thorough and extremely knowledgeable. I decided to use this topic as a separate blog.

He said that burnout is common in teachers, soldiers, emergency room physicians (who have to deal with life and death situations) and firefighters. In essence they burn out their hormones. In burnout several hormones are affected, with the cortisol axis being the main one (low cortisol readings and flattening of the diurnal hormone curve), but at the same time other hormone glands are affected as well. As a result endocrine glands age prematurely and symptoms of fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness develop.

When hormone levels are measured, there is a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone/estrogen and progesterone deficiency and oxytocin deficiency. Holocaust survivors were found to have lower 24 hour cortisol levels. With burnout already the morning output of the adrenal glands is reduced. The health care provider must check prolactin levels, because if prolactin is not high, cortisol will work; however, if prolactin levels are high, cortisol will be ineffective and high prolactin levels have to be addressed first. There is a questionnaire that has been originally developed for teachers (teacher’s burnout scale) to monitor whether burnout is imminent. Soldiers who return from combative situations will also benefit from being assessed with the teacher’s burnout scale; they often suffer from burnout or from PTSD. In suspected cases hormone laboratory tests give concrete answers about hormone deficiencies.

In men growth hormone, melatonin, thyroid, testosterone, cortisol, DHEA and aldosterone have to be replaced to bring the hormone balance back to normal. Instead of aldosterone (a adrenal gland hormone) fludrocortisone is used. In women missing hormones are replaced by bioidentical progesterone and estradiol, but small doses of testosterone are also required.

Dr. Hertoghe discussed cortisol deficiency and its replacement at some length, as this is the main stress hormone that is deficient with burnout. Different treatment protocols for cortisol replacement are used as dosing varies for different degrees of burnout. Other hormones must also be replaced as necessary, possibly for a prolonged period of time, if not life long. Supportive counseling sessions have been shown to elevate cortisol levels and several studies were discussed. A counsellor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Balanced hormones are necessary on a cellular level to regulate the metabolism of every cell in the body.

Hormone balance and symptoms of various deficiencies

Cortisol is placed on one side of the scales and is balanced by androgens (DHEA), estrogens in women and testosterone in men, growth hormone and melatonin on the other side of the scales. When fainting is part of the burnout, it is because of extremely low aldosterone from the adrenal glands. The best treatment for this is fludrocortisone, which will bring the blood pressure up and remove the hazardous symptom of fainting. Symptoms of “slow thinking, slow moving” and tiredness are often from hypothyroidism. The best treatment for this is T3/T4 (Armour thyroid) treatment. Many physicians still use either T3 or T4, which is not physiological. Symptoms of “poor resistance to noise” are due to DHEA deficiency. In addition there often can be moderately poor resistance to stress and joint aches (arthralgias).

When permanent fatigue is present it is time to measure sex hormone levels. If deficiencies are found in a woman, bioidentical estrogen (Bi-Est) is given transdermally from day 5 to 25 of the cycle, and progesterone transdermally from day 15 to 25 of her cycle. Depending on how severe the hormone deficiency is hormone replacement doses in women range from 2.5 to 5.0 mg for bioidentical estrogen and from 100 mg to 150-200mg for bioidentical progesterone per day.

Sports fatigue

In this age of exaggerated sports activities a new entity of burnout, the sports fatigue has emerged. A low free testosterone/cortisol ratio is a reliable marker for overtraining. When this ratio shows a decrease of 30% or more, it shows that there is a temporarily incomplete recovery from intensive training. In the lab often an increase in the sex hormone-binding globulin (SHBG) can be measured, which leads to a lack of free testosterone. In a study of Chinese over-trained soldiers there was a complete recovery from this sports fatigue with multi-vitamins and a liposomal testosterone gel.

Sleep abnormalities

Restless, non-restorative sleep can be a symptom of melatonin deficiency and happens more often in people above the age of 50 as there is a natural hormone decline with age in the older generation. Treatment consists of replacement, which is easily achieved either with sublingual tablets (mild: 0.05mg, moderate: 0.15 to 0.5 mg, severe: 0.5 to 1mg). Oral melatonin doses are more problematical as there are average absorbers and poor absorbers. For mild, moderate to severe symptoms of insomnia the dosages are for average absorbers 0.2mg, 1 mg, 2mg and for poor absorbers 0.3mg, 1.5mg and 10mg. One should use the lowest effective dose of melatonin as it opposes cortisol and when melatonin is overused, adrenal gland weakness can be the result.

Exhaustion

An overpowering feeling of exhaustion can be due to growth hormone (GH) deficiency. This is diagnosed by taking insulin-like growth factor-1 (IGF-1) levels. When these are low, daily subcutaneous injection of low-dose human growth hormone is given. Depending on how severe growth hormone deficiency is, different GH doses are administered. The patient self-injects with an insulin injector. Mild GH deficiency requires 0.05 mg (1 click) per day, moderate deficiency 0.1 mg (2 clicks) per day and severe deficiency 0.15 mg (3 clicks) per day.

Adrenaline deficiency

Dr. Hertoghe pointed out with the help of a publication where runners had developed overtraining syndrome that adrenaline deficiency can be part of burnout. Laboratory tests on these runners showed that overnight catecholamine (metabolized adrenaline) excretion was only 50% of healthy runners. Often this is associated with thyroid deficiencies (in males and females) or with estrogen deficiency in women. Treatment consists in rectifying the thyroid and sex hormone deficiencies (estradiol and progesterone treatment in women).

Hormone Changes With Burnout

Hormone Changes With Burnout

Treatment of burnout

Dr. Hertoghe suggested a 5-step treatment protocol.

  1. Improve the diet

This involves the removal of sugar and starch as both lower the levels of essential hormones. He specified that sweets, chocolate drinks, soft drinks, milk, bread, pasta, commercial mueslis and high temperature cooked meats need to disappear from the diet plan.

The consumption of animal protein is desirable, but the food should be cooked at low temperatures. Fresh vegetable and fruit consumption should be increased. I like to add that these foods are best consumed as organic foods. These foods will increase your natural hormones and produce energy in your cells (ATP, NADPH).

  1. Improve your sleep

This requires a dark bedroom at night and day light exposure in the morning. Avoid TV’s, electrical alarm clocks, i-phones, computers at the bedside (EMF can disturb your sleep). If your environment is noisy, you may require ear plugs to shut out the noise. In case of hormone deficiency, it may be necessary to replace missing melatonin, growth hormone, see hormones above (especially progesterone in women), and oxytocin.

  1. Treat adrenal deficiency, if present
    The missing hormones here to be replaced are cortisol, DHEA and often aldosterone, which is replaced with fludrocortisone.
  2. Treat other associated hormone deficiencies

The other hormones, which are often overlooked, are growth hormone, thyroid hormones, estradiol/progesterone in women and testosterone in men.

  1. Treat nutritional deficiencies

The most common missing minerals and vitamins are iron, magnesium, folic acid, vitamin B12, vitamin E and others. Replacement of these along with the missing hormones is essential for normal cell function.

Conclusion

In an attempt to add to our physical fitness we may overlook our limits and run into a burnout situation without noticing it. Your medical care provider should think about multiple hormone and nutritional deficiencies that can be treated, although treatment can be multifaceted. If in doubt ask for a referral to an anti-aging physician.

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Nov
05
2014

How To Cope With Time Switches

In Europe daylight saving time begins on the last Sunday in March and wintertime starts on the last Sunday of October. Here in North America we start daylight saving time on the second Sunday of March and end it on the first Sunday of November each year.

Having gone through this exercise just last weekend I thought it would be worthwhile to comment in a blog how our bodies, particularly our hormones are affected by this.

You may have heard about the circadian rhythm with respect to hormones. The changes of the sun causing the day/night cycle have profound influences on our hormones, called the diurnal hormone changes or the circadian rhythm.

How do circadian rhythms work?

In the morning when you open your eyes, light enters our eyes and is registered in the hypothalamus (suprachiasmatic nuclei, see Ref.1). There are also links from the hypothalamus to the pineal gland, where melatonin is synthetized and stored. The light signal stops the secretion of melatonin from the pineal gland, although it is still being produced during the day in the pineal gland, but stored there until the evening hours set in. You may have noticed that you start yawning when the light dims in the evening. That’s when melatonin is released into your system to let you know its time to go to sleep.

Of course, we have electrical light and can turn night into day if we choose to! This works for a limited time, but eventually tiredness sets in, and melatonin wins the upper hand. Melatonin is the master hormone of the circadian rhythm.

It is interesting to note that cortisol does exactly the opposite. Cortisol is the adrenal gland hormone that helps us cope with stress. When we are fully awake, we need cortisol to cope with stress. Melatonin inhibits cortisol secretion and cortisol inhibits melatonin secretion, so they are natural opponents working together for your common good. This is part of the circadian rhythm. We can measure these hormones and this is how researchers have found out how this works.

How To Cope With Time Switches

How To Cope With Time Switches

Time switches affect the circadian rhythm

When we switched time back by one hour on our wristwatch and clocks, the internal time in our body did not accept that right away. The body needs to gradually adjust to this by reading the external signals: when are we opening our eyes? What is the light intensity when we get up, what is the light intensity when we go to sleep?  Some people find it easy to adjust; others find it very difficult to adjust. Some individuals breeze through the adjustment process in a day or two. For others it can as much as 1 or 2 weeks before the hormonal adjustment is completed.

Symptoms of problems adjusting the circadian rhythm

Symptoms due to time switch are a feeling of hangover on the first one to two days after the switch. This is despite you having gotten enough sleep, but the quality of sleep was not the same as before the time switch. Your head feels heavy, you are irritable, and you may feel mildly depressed. You also may find it more difficult to concentrate on one thing and you experience fatigue. Some experience insomnia. What is behind this is a disturbance of your cortisol levels. Your cortisol level is normally highest in the early morning hours, just before you wake up. As a male your testosterone level is also highest when you wake up thanks to the circadian rhythm. Both cortisol and testosterone have been built up during your deepest sleep. In women the ovarian hormones have not only a monthly rhythm, but also a 24 hour diurnal rhythm, based on the internal 24 hour clock. The hypothalamus and the pituitary gland are intimately involved in both sexes regarding this diurnal rhythm and are in communication with the pineal gland that produces melatonin to regulate all of the major hormone systems. So, when we switch our watch back by one hour in the fall or forward by one hour in the spring, our body clock is out of sync with the new time that rules the world. This state of being out of sync may last for a few days. We still get tired according to the old time and we still wake up according to the old time until our internal clock has readjusted. People have genetic differences on how quickly they readjust.

Newer research on how the body tells time is summarized here.

Jet lag

When we travel eastward or westward through time zones a phenomenon of being “out of sync” occurs as well, very similar to what happens with time switches. It is the same re-adjusting process of the internal circadian rhythm that our bodies have to come to terms with. Some people are affected more when they travel west though time zones, and it may take them longer to adjust to it compared to traveling east. But other people complain that for them it is just the opposite, and traveling east is the problem for them. North-south travel does not cause jet lag as the internal time and the external time remain synchronized. A very similar phenomenon is happening with the spring and fall time switches. Some people find it nervier when in spring the clock is advanced by one hour and others complain that fall is their difficult time when the time is switched back by one hour. There are genetic differences of how we adjust with our internal clocks.

Shift workers

Shift workers experience problems with the circadian rhythm as well. The switch between working day shifts and night shifts leads to a condition called “shift-work sleep disorder” (Ref.3). Similar to jet lag this is due to the fact that synchronization between the body’s inner clock and external cues are disrupted, and not enough time is allowed for recovery. It would be much more cost effective, if unions and employers allowed those who are naturally born to cope with night time shift to work those shifts and allow those who are sensitive to shift-work sleep disorder to work only day shifts. We live in an age of political correctness, but we tend to overlook how our bodies work.

What you can do to ease yourself into the time switch

1. As there is a lack of deep sleep with the time switch, it is not a bad idea to take a short nap when you feel tired during the day. Catch a nap on the weekend or on a day, when you are off work! It’s good for you! This will build up your adrenal gland hormones and give you the extra surge of energy you are craving for.

2. At the end of the day though, you need to go to bed according to the new time to train your pineal gland and your entire hormone system about the new time situation. Your body needs the cues from you, when you start and end your day, so that it can sync your internal clock with the outside time.

3. A simple remedy that fits right into your hormone rhythm is to take a melatonin tablet (about 3 mg for an adult), available at your health food store or drug store 30 minutes before bedtime. Ref. 2 states that melatonin “restores circadian rhythm“. This will help your circadian hormone rhythm by giving it an evening boost of melatonin telling your system it is time to go to sleep. At that time when you close your eyes the signals through the optic nerve are shut down, giving the circadian rhythm yet another signal about what time it is. In just a few days (for very sensitive people in 1 to 2 weeks) your entire hormone system including the circadian 24-hour undulations will be reset. Now your internal clock has been reset and is in sync until the next time switch.

More about hormones: http://nethealthbook.com/hormones/introduction-hormones/

References:

1. Melmed: “Control of Hormone Secretion” in: Williams Textbook of Endocrinology, 12th ed.Copyright 2011 Saunders, An Imprint of Elsevier

2. Rakel: Integrative Medicine, 3rd ed. Copyright 2012 Saunders, An Imprint of Elsevier

3. Daroff: Bradley’s Neurology in Clinical Practice, 6th ed. Copyright 2012 Saunders, An Imprint of Elsevier

Last edited Nov. 5, 2014

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Mar
01
2014

Smoking Remains A Health Hazard

Recently new statistics came out that show that 48.8 million people in the US (19% of the population) still smoke. 22 % of the population are male, 17% female. Smoking is responsible for 20% of all deaths in the US (1 in 5 deaths). It is interesting to note that in the older age group (above the age of 65) only 8% are smoking, but 22 % of the 25 to 44 year old group is smoking. Among the American population Native Americans have the highest percentage of smokers (32% are smokers). 10% of Americans of Asian descend smoke. Blacks, Whites and Hispanics are placed in between them and the American Indians. Finally, people who can least afford it (who are below the poverty level) have the highest percentage of smokers (29% smoke) while 18% of people above the poverty level smoke. Education seems to have a protective effects when it comes to smoking: of the least educated group of people 45% are smokers while only 5% with postgraduate education smoke.

Effects of cigarette smoke on the body

As this link shows the concoction of various ingredients in the smoke of cigarettes causes various parts of the body to react differently to these chemicals. Here is a rundown of diseases caused by smoking cigarettes.

1. Lung cancer: This is the most common cause of death in women who smoke, more common now than breast cancer. 90% of lung cancers in women are due to smoking. The same was true in males, but as a group they now smoke less than in the past.

2. Other cancers:  cervical cancer, kidney cancer, pancreatic cancer, bladder, esophageal, stomach, laryngeal, oral, and throat cancers are all caused by smoking. Recently acute myeloid leukemia, a cancer of the bone marrow has been added to the list of smoking related cancers.

3. Abdominal aortic aneurysm: As cigarette smoke destroys elastic tissue, it is no wonder that the loss of support of the wall of the aortic artery leads to the development of large pouches, which eventually rupture with a high mortality rate due to massive blood loss.

4. Infections of lungs and gums: Smokers are prone to infections of the lungs (pneumonia) and of the gums (periodontitis).

5. Chronic lung diseases: emphysema, chronic bronchitis, asthma.

6. Cataracts: lack of perfusion of the lens leads to premature cataract formation.

7. Coronary heart disease: hardening of the coronary arteries, which leads to heart attacks, is very common in smokers.

8. Reproduction: reduced fertility in mothers, premature rupture of membranes with prematurely born babies; low birth weight; all this leads to higher infant mortality. Sudden infant death syndrome is found more frequently in children of smoking moms (Ref. 1).

9. Intermittent claudication: after decades of smoking the larger arteries in the legs are hardening and not enough oxygen reaches the muscles to walk causing intermittent pausing to recover from the muscle aches. If it is feasible a cardiovascular surgeon may be able to do a bypass surgery to rescue the legs, often though this is not feasible and the patients lower legs or an entire lower limb may have to be amputated.

10. Others: osteoporosis is more common in smokers; poor eye sight develops due to age-related macular degeneration that sets in earlier and due to tobacco amblyopia, a toxic effect from tobacco on the optic nerve; hypothyroidism is aggravated by smoking and menopause occurs earlier.

Smoking Remains A Health Hazard

Smoking Remains A Health Hazard

What happens in the lung tissue in smokers?

Ref. 1 gives a detailed rundown of the changes in the lung tissue as a result of exposure to cigarette smoke. The various components of cigarette smoke lead to an activation of special white blood cells, called monocytes that after stimulation turn into tissue macrophages. In addition neutrophils (regular white blood cells) also get stimulated. Between them they produce cytokines and chemokines and the neutrophils secrete elastase that digests elastic tissue in the lungs. Breakdown products of the elastic tissue serve as a powerful stimulus to the immune system to mount an autoimmune response. After some time of being exposed to cigarette smoke the immune system considers part of the lining of the lungs as foreign and cytotoxic lymphocytes attack the lining of the air sacs (alveoli). Lung specialists consider chronic obstructive pulmonary disease (COPD or emphysema) to be an autoimmune disease (Ref.1).

The sad part is that when this condition has progressed far enough, even quitting smoking may be too late to stop the autoimmune disease by itself as the body has been sensitized and the immune system is convinced that the altered lung tissue should be attacked. Add to this that carcinogenic substances and toxins in cigarette smoke damage the DNA of all cells and the energy producing mitochondria, and the stage is set for the combination of chronic inflammation and the release of free radicals to cause all of the diseases mentioned above.

Quit smoking still important

It is extremely important to quit as soon as possible to avoid the full-fledged sensitization of the immune system against ones own lung tissue. Studies have shown that 36% of survivors of heart attacks will successfully quit, 21% of healthy men with a known risk of cardiovascular disease will quit when asked to do so and 8% of pregnant women will quit. When a physician examines a patient in the office and asks a smoker to quit smoking 2% of these smokers will respond and still not smoke 1 year after this doctor’s visit. This may not sound like much, but it is an encouraging effect. Perhaps the most important fact is what I mentioned in the beginning of this blog: the least educated group of people smoked the most (45%) while the most educated people smoked the least (5% of people with a postgraduate education). My hope is that the Internet and other educational media will contribute to education to convince people how important prevention is.

Pharmacological assistance to quit smoking

Nicotine replacement therapy can involve any of 2- and 4-mg nicotine polacrilex gum, transdermal nicotine patches, nicotine nasal spray, the nicotine inhaler or nicotine lozenges. Discuss with your doctor what may be best in your case. Typically one of these products is used for 3 to 6 months.

Bupropion is an antidepressant with a nicotinic acetylcholine receptor affinity. Bupropion is useful to help with the withdrawal from nicotine addiction, which occurs in depressed or non-depressed people. It strictly has to do with the stimulation of the nicotinic acetylcholine receptor.  Typically the dose is 150 mg of a sustained released bupropion tablet per day for 7 days prior to stopping smoking, then at 300 mg (two 150-mg sustained-release doses) per day for the next 6 to 12 weeks. 44% quit at 7 weeks versus 19% of controls. A newer nicotine partial receptor stimulator, varenicline, has been compared to bupropion. It was slightly more effective in helping people to get off cigarettes. Varenicline is started at a dose of 0.5 mg per day for 3 days, then 0.5 mg twice daily for 4 days, followed by a maintenance dose of 1 mg twice daily. If nausea is a problem, lower doses can be used. Varenicline has been approved for a 3-month period with an option of a second 3-month period, if relapse occurs. Discuss with your doctor what is best for you.

According to Ref. 1 a combination therapy of bupropion and nicotine patch was more effective than either one alone.

Will power, hypnotherapy

Hypnotherapy to quit smoking has been popular, but is not as effective as it is often claimed. Will power, measured by the “placebo” response is quite effective given the fact that nicotine is very addictive and yet 19% in the placebo group were able to quit on their own. According to Ref. 1 varenicline treatment for 12 weeks produced abstinence for 9 to 52 weeks and was compared to bupropion and placebo. The abstinence rates were 23%, 15%, and 10% for varenicline, bupropion, and placebo. This means that will power was still 2/3 as effective as bupropion and 43% as effective as varenicline. Don’t underestimate will power!

Conclusion

The best scenario is to never start smoking. The second best is to quit as soon as possible. Unfortunately, the third scenario of continuing to smoke is still very prevalent worldwide. I have seen the damage done first hand in practicing medicine, which motivated me to never smoke. But I am aware of the difficulties of quitting because of the highly addictive nature of cigarette smoking. Where is the support from governments on this? The problem is that the government benefits from taxation of cigarettes. Nevertheless it is laudable that there are government sites through the CDC to help you quit smoking.

At the end we are all responsible for our own health. If you are presently smoking, psych yourself up for the day that you will quit. Quitting means that you are deciding actively to live longer. Studies have shown that it takes often several attempts before you eventually quit successfully.More information on some of the topics mentioned:

1. Lung cancer and other cancers: http://nethealthbook.com/cancer-overview/overview/epidemiology-cancer-origin-reason-cancer/

2. Heart attack: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

3. Chronic obstructive pulmonary disease: http://nethealthbook.com/lung-disease/chronic-obstructive-pulmonary-disease-copd/

Reference

1. Mason: Murray and Nadel’s Textbook of Respiratory Medicine, 5th ed.© 2010 Saunders

Last edited Nov. 7, 2014