Writing A Medical Book

In my 40’s when I was practicing medicine, I was dreaming about writing a medical book. This was in the mid 1980’s and I was busy seeing 30 to 40 patients a day. I would never have found the time to write a medical book at that time. I thought, perhaps I could show how patients could stay younger for longer by adopting the right life style in order to stay well. Fast forward 3 decades, and the medical book writing began. But instead of one book the project turned into 4 books. There were too many topics to cover to fit them all in one book.

Prior to writing a medical book

First of all, in 2002 I published a large website. Its structure is like a book on the Internet: Net Health Book . It contains descriptions of the major diseases, mental and physical, and their current treatment modalities. I still maintain this work. Furthermore, I started another website in 2003, a weekly blog, called “Ask Dr. Ray” . This is a compilation of interesting research. Some medical research papers can get too scientific. For this reason I translated it into easier language. The topics tend to be anti-aging topics. This blog comes out Saturdays.

Retirement hobby

When I retired in 2010 I revamped my websites. In the process the web developer suggested I should add to Net Health Book a blog (nethealthbook.com/news) where I review current health news that I find interesting. This is a weekly blog, which I publish on Wednesdays. All of this is still going on, and it gave me lots of opportunities to write and publish on a smaller scale. In addition, I finally started publishing books.

A Survivor’s Guide To Successful Aging

My first book came out with Amazon in 2014. I had joined the A4M (American Academy of Anti-Aging Medicine) in the early 2000’s. The lectures at their conferences were very open-minded and pointed out details of what one could do to delay aging and avoid premature deaths. My own experience with changing our diet in 2001, starting bioidentical hormone replacement and changing my lifestyle became topics that were part of this book. I dedicated this book “to those who are willing to work on prevention in order to achieve a longer life without disabilities”. This is still the basis of prolonging your life.

Lifestyles can be deleterious

I start out in this book describing the obesity wave and how this changes the metabolism (metabolic syndrome). I used statistics from the Framingham Heart Study to show the detrimental effects of various lifestyles on mortality. Subsequent chapters deal with food, exercise, stress and missing hormones as life-shortening factors. There is a separate chapter on vitamins and supplements. They as a group can create 5.1% longer telomeres, which translated into 9.8 years of longer life expectancy (see also a study by Dr. Xu  in the book). Subsequently it describes how a change of your lifestyle can have a positive impact. Changing your eating habits and exercise activity will make a tremendous positive difference on the long term.

Successful Aging in the Kitchen

The book ends with an appendix, written by my wife: “Successful Aging in the Kitchen”. You are presented with recipes for 7 breakfasts, 7 lunches and 7 dinners. In addition she has provided 7 healthy desserts for you. Bon Appétit!

Healing Gone Wrong, Healing Done Right

In another book, which got appeared in 2016 I gave a few examples of how famous people were failed by medicine. It started already in the past: Ludwig van Beethoven’s physicians did harm instead of healing their patient. However, this is happening now as well: physicians mismanaged the health care of Elvis Presley, Churchill, Michael Jackson and JF Kennedy. The physicians treated symptoms, but they never properly attended to the causes of the ailments of their patients. The end result was premature death in all of them. Churchill who had good genetics made it to age 90, but during his last 15 years he suffered of severe disabilities.

Treatment of symptoms will fail, treatment of causes succeed

These examples of famous people’s health problems resemble to what happens to today’s patients in various office settings. Their symptoms are mostly being treated, but their causes often not. Simply treating symptoms will not work on the long term. It did not work in the past, and it does not work now.

Other chapters in this book

Other chapters in this book deal with preventing disease, keeping a healthy brain and keeping a healthy heart. Next I discuss why food matters, followed by the health of limbs and joints. Subsequently I am discussing how to keep toxins out. The next chapter deals with how to reduce the impact of cancer. It is always important to diagnose cancer as early as possible as removal by surgery has the highest success rate at an early cancer stage. The next chapter is entitled: “Stable hormones key to health”. If any of your hormones are missing (particularly around the age of menopause and/or andropause) it is time for nature identical hormone replacement. The next chapter gives you general thoughts on anti-aging. This is followed by “supplements yes, but do not overdo it”.

Alternative treatment for ADHD

A final chapter gives you an example of an alternative treatment for ADHD, where the idea of not just treating symptomatically, but treating causes is included. References and an index are also provided for the book.

Prostate Cancer Unmasked

Furthermore, I did not intend to write this book. But in early 2016 my PSA (prostate specific antigen) level jumped from 3 to 8.6. For years it had been in the 1.5 areas, then slowly increased to 3. But 8.6 was too high for comfort! I had an MRI scan done, which showed one lesion in my left prostate, which was suspicious for prostate cancer. I was referred to a urologist at the Vancouver Prostate Centre, one of the top clinics in Canada. But I had already researched the literature and came across research by Dr. Gary Onik from Ft. Lauderdale who warned me about the pitfalls of “standard therapy”.

The conservative urologist in Vancouver

The urologist in Vancouver told me that without a positive biopsy he cannot accept that the shadow on my MRI scan would be prostate cancer. And the only way they do a prostate biopsy was by random trans-rectal biopsies. He also wanted to include me in a random clinical trial where they would compare active intervention with active surveillance. I politely declined the trans-rectal prostate biopsy and the inclusion into a trial.

Assessment by Dr. Onik

I booked a flight to see Dr. Onik in Ft. Lauderdale. His method is well researched and orchestrated.

Initial assessment

He assesses you with a rectal ultrasound and he sees the prostate on a TV screen. He said right away that I had three separate lesions, one in the left as shown on the MRI scan and two in the right lobe, which was missed by the MRI scan. False negative lesions are common on MRI scans, which can become a source of cancer recurrence.

3-dimensional prostate biopsy

The following day he booked me for a 3-dimensional prostate biopsy via the perineal approach. The perineum is easy to sterilize, so there is no risk of septicemia. A metal grid with holes for biopsy needles was used to get 96 biopsies of my enlarged prostate. For a normal size prostate, Dr. Onik said about 60 biopsy needles are normal. You don’t feel anything, because you are asleep.

Cryoablation prostate surgery

Next was the cryoablation surgery of the 3 prostate cancer lesions. This happened one month after the biopsy. I was seen at the hospital in Ft. Lauderdale. The same grid from the biopsy was used to relocate exactly where the cancer lesions were. The pathologist had confirmed them as Gleason 6 and 7 prostate cancers. This was treated with Argon sounds and frozen twice. I felt nothing, because I was under a general anesthetic. But Dr. Onik told me that everything went very well. Some cancer was too close to the neurovascular bundle, so he used the NanoKnife, an invention where nano-size holes get blasted into cancer cells, but it leaves normal tissue intact.

I needed to do self-catheterization for about one month to empty my bladder, as there was a lot of swelling from the prostate hypertrophy and the surgery. But eventually my normal water works returned.

Follow-up blood work

My follow-up PSA blood work 3 months after the surgery was down to 1.0. Prior to the surgery the Oncoblot test was positive for prostate cancer. A repeat Oncoblot test 3 months after the surgery was now negative for prostate cancer. I realize that not every physician accepts this new cancer-screening test, but I felt a lot better to know that all the cancer markers were now gone.

9 cancer treatments reviewed

In my book I described a total of 9 prostate cancer treatments and their 10-year survival statistics. None of the other treatment methods were as good as Dr. Onik’s statistics. I believe it is linked to the precision of the 3-dimensional biopsy and the surgery being done through the same grid. If you do not perform the surgery this way, you miss cancer lesions and this becomes the source of failure 10 years down the road. My book details all these alternative treatments. It also has a section on lifestyle modifying factors. I needed to write this book as a service to any man who suddenly is faced with a possible diagnosis of prostate cancer.

Unmasking prostate cancer

Like me he needs to unmask the cancer. Is it really there? How far advanced is it? Which way to safely biopsy it (definitely NOT through the rectum for fear of blood poisoning=septicemia)? What is the best method to remove it? I came to the conclusion that Dr. Onik’s method was best for me. But with the information in this book you can decide what is best for you.

Medical Questions Answered

Finally I wrote my 4th book. From more than 4400 medical questions that I have answered on the site Quora.com I selected the most popular questions for this book. The editorial board of Quora said that I own the publishing rights for my answers. The questions were rephrased without changing the meaning. I selected more than 120 questions under 44 different headings.

Here are some of the areas that are covered: Acne, the best home remedies. Aging: can it be reversed? What is the limit for a human? Alcohol: how does it affect your body? Alzheimer’s disease: which foods promote brain health? Arthritis: what can you do about osteoarthritis? Back pain: what can I do about it? Cancer: why can cancer still not be cured? There are as well 15 other answers about cancer. Depression: will my depression ever go away? Diabetes: will a 600-calorie diet help diabetes control?

Further topics discussed

Diet: I want to get rid of sugar in my diet. How can I do this long-term? Other answers about diet are included. Exercise: How useful is cardiovascular exercise? Gut disease: Is “gluten free” food healthy? Heart disease: What can I do to clean out my arteries and reduce my risk for heart disease? Hormones: Is estrogen present in the male body? Life Expectancy: What is the theoretical life expectancy of humans? Lifestyle Habits: Can good habits change your life completely? Pain: Pain relief for a headache or other pain: Aleve, Advil or Tylenol? Pregnancy: Best age for a successful pregnancy? Prostate Cancer: How dangerous is prostate cancer? Does it kill you? Schizophrenia: What complementary approach may help a patient with schizophrenia? Sleep: What happens when you go to bed late every night? And many other answers under this topic.

And the book finishes with these topics

Sugar: will I be OK living without sugar? Vaccinations: Is there a connection between vaccinations and autism? Vitamins and supplements: Are taking vitamins and supplements healthy or are they harmful? Weight loss: I am working out every day, but I am not loosing weight. What should I do? There are many more answers under this topic. Younger for longer: What are three things I can do every day to stay younger for longer?

These are only a few selections of all of the topics dealt with in this book.

Writing A Medical Book

Writing A Medical Book


I have reviewed briefly why I published the books mentioned above. My prostate cancer book developed out of the necessity that I had to deal with my newly diagnosed prostate cancer in 2016. I felt that the review process I went through would be good for those men who have to face a similar situation. The anti-aging book comes from my interest in anti-aging medicine. “Healing Gone Wrong, Healing Done Right” developed from the observation that physicians in the past and often even now tend to only treat symptoms. But if a cause can be found, this should be treated, as this often leads to a permanent cure.

Treating symptoms only will not improve the patient’s condition

Treating symptoms only will not improve the patient’s condition. “Medical Questions Answered” is a collection of medical topics where I answered various medical questions. It was a way for me to cover a vast array of medical topics. Some of the topics are dealt with in depth (acne for instance); others are very short. I have also two medical blogs that come out on Wednesdays and Saturdays. I hope that some of that medical information will be useful to you.


3 Cups Of Coffee Stop Clogged Arteries

There is a new coffee study that says 3 cups of coffee stop clogged arteries. The study appeared in the Journal of the American Heart Association on March 24, 2018. It was part of the cross sectional Brazilian Longitudinal Study of Adult Health. This study took place from August 2008 to December 2010. It followed 15,105 civil servants, aged 35 to 74 years. They were living in 6 Brazilian cities (Belo Horizonte, Porto Alegre, Rio de Janeiro, Salvador, São Paulo, and Vitoria). The final study sample comprised 4426 individuals who underwent CAC measurements.

CAC score

CAC stands for “coronary artery calcium”. Other tests in the past have shown that CAC is a very sensitive test that quantitates the calcification status of coronary arteries. The CAC score is also known as Agatston score. It also predicts how likely it is that a person with a high CAC count will develop a heart attack down the road. A score of 100 or less is considered to be a low risk for developing a heart attack later in life. If the score is between 100 and 400, it is a moderate risk. A score of more than 400 ranks as a high risk to develop a heart attack.

Study design

Upon entering the study the participants had an extensive entrance exam and interview. Part of this was a nutritional and lifestyle questionnaire. This told the examiners whether the patients were smokers or not. Their age ranged between 35 and 74 years. Participants took a CAC test. 4426 individuals who underwent CAC measurements became part of the study. The participants’ blood pressure and body weight were additional measurements.

Results of the study

There was a negative correlation between the amount of coffee consumed on a daily basis and the CAC score. Specifically, the following observation emerged regarding daily coffee consumption and the risk of a higher than 100 CAC score.

  • Less than 1 cup per day: odds ratio 0.85
  • 1 to 3 cups per day: odds ratio 0.73
  • More than 3 cups per day: odds ratio 0.33

These results show clearly that there is an inverse relationship between coffee consumption and risk of developing coronary artery hardening. Those who consume 3 or more cups of coffee have a lower coronary artery disease risk.

The risk to develop coronary artery calcification in coffee drinkers (3 or more cups) is 67% lower. The comparison group are non-coffee drinkers.

Discussion of the results

The research paper from Brazil compares their results with many other research facilities and concludes that others had very similar conclusions. For instance, a 2014 publication pointed out that consuming more than 5 cups of coffee per day had no association with heart disease and did not cause any increased mortality.

The 2015–2020 Dietary Guidelines for Americans recommends consuming 3 to 5 cups of coffee per day, which reduces the risk of getting diabetes type 2 or cardiovascular disease.

Korean study using CAC scores

One other relevant Korean study that involved 25,138 participants is also of note. The participants consumed 3 to 5 cups of coffee per day. They also underwent CAC tests. The coffee drinkers had a 41% lesser prevalence of CAC score in comparison to non-coffee consuming controls. The authors of the present study said that the Korean study was comparable to their own findings.

Comparison of study to previous literature

Mortality data and coffee consumption

In a large Harvard study that I discussed on Nov. 18, 2017 the end point was mortality data. There too, was a dose response curve. With 3 to 5 cups of decaffeinated or regular coffee there was a reduction of death rates by 15%. Less coffee consumption produced less reduction of mortality.

Stroke data and coffee consumption

In another review on March 4, 2013 I reviewed a 10-yer study that looked at the effect of 1 to 2 cups of coffee per day in 32,600 women. There was a 25-32% reduction of strokes compared to non-coffee or tea consuming controls. I also reviewed a Finnish study that consisted of 29,133 smokers (smoking 5 cigarettes a day) aged 50 to 69 who were stroke free when entering the study. It ended in 1993 and the study had lasted for at least 5 years. Drinking two cups of black tea or 8 cups of coffee reduced the stroke risk by 21 to 23%.

Stroke mortality and coffee consumption

In the Annals of Internal Medicine (June 17, 2008) researchers have found that coffee consumption can be beneficial to reduce stroke mortality. A study using the data from 41,736 male and 86,214 female subjects is quite informative. Researchers followed these people over 18 years in the male group and over 24 years in the female group. The risk of all-cause mortality decreased significantly with increasing coffee consumption in the male as well as in the female group. Men had a relative risk reduction of 20% in comparison to those with the lowest level of coffee consumption. Women with intermediate to high consumption of coffee had a relative risk reduction of 10% to 30 % when compared to the group that drank less than 1 cup of coffee per day. The end point here was risk of death from stroke.

3 Cups Of Coffee Stop Clogged Arteries

3 Cups Of Coffee Stop Clogged Arteries


Coffee has a number of anti-oxidant bioflavonoids that help increase survival. The main study reviewed measured the effects of coffee consumption by calcium scores of the coronary arteries. This is a specific way to look at the relative risk to come down with a heart attack in the future. Other ways to measure the beneficial effect of coffee are mortality as the end point, stroke or stroke mortality. I have reviewed some studies that used all of these end points. It is interesting to observe that consumption of 3 to 5 cups of coffee has such a beneficial effect. It does not matter whether it is regular or decaffeinated coffee. Both have the identical effect. This has been shown by a recent Harvard study.

Coffee and tea make you live longer

Coffee keeps the arteries open for longer, if we consume 3 to 5 cups of coffee per day. This allows our brain to think longer and allows our heart to beat for many more years. It is time to stop the research and to apply what was found: 3 to 5 cups of coffee per day. If tea is what you prefer, you are in luck. Everything I said about coffee also applies for green and black tea. There is one word of caution. Using copious amounts of sugar in your coffee or tea will most likely cancel some or all of the benefits. Cream and sugar-laced Frappuccino or Chai Lattes are calorie bombs and not conducive to good health. I use stevia instead of sugar to sweeten my coffee.


Prevent Plugged Arteries

There are several ways to prevent plugged arteries, which will translate into less heart attacks and strokes. The message is simple: if you get less heart attacks and strokes, you will live longer. Below I am examining ways to prolong life by various ways to prevent plugged arteries.

You probably heard of plaque formation in the arteries. This is the process where a combination of fat, calcium, cholesterol and cell waste forms a deposit (plaque) under the lining of the arteries.

The end result is that the blood won’t be flowing freely through the affected arteries. This can cause a heart attack or a stroke. Essentially, this is the point where a clot forms in the narrowed passage of the artery. It is also the point, when the clinicians make a diagnosis of a heart attack or a stroke.

Let’s examine what leads to plaque formation in the arteries.

Trans fats

Trans fats are contained in fried foods like French fries, in margarines and other butter substitutes. As margarine is a common ingredient of cakes, cookies, pastries and pies, these are all bad news for our heart health. I consider them off limits. If you eat those foods, you build up plaque in your arteries, which leads to premature heart attacks and strokes.

Lack of exercise

It has been common knowledge for a long time that being sessile leads to premature hardening of the arteries. In the late 1800s to the early 1900s physical exercise was promoted in various countries around the world.

The latter part of the 20th century saw a renaissance of the fitness movement. It was trendy to go running, cycling, and swimming or working out at a gym. It is not only trendy but healthy: cardiologists support all of these sports to help people stay healthy and keep the arteries free from plaque formation.

Too many refined carbs

Sugar and processed foods, especially those with added sugar to improve flavor, have a direct relationship to heart attacks and strokes. It is known that sugar causes high LDL cholesterol and high triglycerides. In addition sugar also causes inflammation of the arterial walls, which causes plugged arteries. However, sugar is only part of the problem. Starchy foods like rice, noodles, cakes, cookies and other foods made with flour get broken down into sugar. Both lead to insulin production. And both lead to changes of the lining of the arterial walls.

In the 1980s and 1990s there was a school of thought that a low fat diet would be healthy in terms of heart attack and stroke prevention (the low fat/high carb diet). This turned out to be a nutritional disaster: the high carb content of such a diet was the problem. It led to weight gain, obesity and death.

Red meat is a problem

Several studies have documented that saturated fat from red meat is only part of the problem. The other part is carnitine, which is abundantly present in beef, pork, lamb and venison. But mortality of people eating unprocessed red meat is only marginally elevated. It is when people eat processed red meat that there is a significant rise in mortality from heart attacks and strokes. This study examined this. They found that gut bacteria were stimulated by red meat to produce substances that stimulate bacteria in your gut to secrete TMA and TMAO, which makes your platelets more sticky and contributes to plugging your arteries. This research paper from the Cleveland Clinic explains it in more detail.

What must I do to prevent plugged arteries?

Eat the right food

A Mediterranean diet is anti-inflammatory. It contains lots of vegetables, but little red meat. Fish and chicken that contain much less L-carnitine are more dominant in Mediterranean food. As mentioned above, you want to avoid trans fats. And you also want to avoid sugar and too many starchy foods. This includes sugar-sweetened beverages. Making these changes will keep your insulin levels in the normal range eliminating inflammation in your arteries. Avoid eating processed foods, because they contain food preservatives and lots of sugar that we want to avoid. Eat more unsaturated fats like avocados, walnuts, olives, trout, herring, and salmon. The last three contain marine-derived omega-3 fatty acids that are particularly helpful in preventing heart attacks and strokes by being anti-inflammatory and by elevating the protective HDL cholesterol. Drink lots of green or black tea, rooibos tea, or ginger tea. They contain antioxidants and bioflavonoids that prevent plugged arteries.

Regular exercise

Many publications have shown that regular physical exercise will lower blood pressure, condition your muscles including your heart and lower mortality.

Only 10 minutes of brisk walking every day reduced the death rate by 33% compared to those who did not exercise at all.

Regular physical exercise does not only prevent heart attacks and strokes, it also reduces the risk of getting another 35 chronic diseases, as the link shows.

Here are some common exercises: jogging, cycling, running, brisk walking, swimming, playing tennis and doing aerobics. All of them will strengthen your muscles and condition your heart and lungs.

Other ways to prevent plugged arteries

Smokers must quit smoking, as smoking has been identified as a major risk factor for heart attacks and strokes.

Exposure to prolonged stress is a factor that leads to hardening of arteries. Stress management is possible by counseling, by self-hypnosis, yoga, tai chi and other relaxation methods.

Risk factors associated with plugged arteries

We already have mentioned the risk factors that are associated with clogged arteries. But for clarity I would like to repeat the major risk factors here.

  • Smoking
  • High blood pressure
  • Elevated LDL cholesterol (the bad cholesterol)
  • Reduced HDL cholesterol (HDL is increasing with exercise)
  • Obesity (often associated by ingestion of too many carbs)
  • Insulin resistance and diabetes
  • Lack of exercise (too much sitting in front of the TV or doing computer work)
  • Unhealthy diet (Standard American diet instead of Mediterranean diet)
Prevent Plugged Arteries

Prevent Plugged Arteries


We often think that we have no input whether or not we get a heart attack or a stroke. This is completely wrong. If you adopt the solutions I have listed here, you can change things for the better. You will reduce your risk to get a heart attack or a stroke. Treat high blood pressure. Stop smoking. Cut out sugar and starchy foods to reduce triglycerides and LDL cholesterol. Exercise regularly and your HDL will protect you from heart attacks and strokes. Shed pounds, if you are obese by starting a Mediterranean diet and cutting out sugar. This will also improve your insulin resistance or diabetes. Start daily exercise as this reduces your risk of a heart attack or a stroke. In addition exercise reduces the risk of 35 chronic diseases that have also been mentioned in one of the links.

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Vitamin K For Bones And Arteries

Vitamin K for bones and arteries is gaining a lot of attention as a valuable supplement. Most of all in the blood vessels, but in addition in the heart, lungs and kidneys the matrix GLA protein is a key substance. Vitamin K2 is crucial for removing calcium from these organs, as matrix GLA protein is carboxylated. Carboxylation of the GLA protein functions much as a broom. This removes all superfluous calcium from blood vessels and organ tissues. If there is a lack of vitamin K2 intake, matrix GLA protein is uncarboxylated, which as a result invites vascular calcification. Essentially vitamin K2 has emerged as an important player in the regulation of bone conditions like osteoporosis, but also in the prevention of hardening of arteries. Vitamin K2 removes calcium from blood vessels and deposits calcium in bone preventing osteoporosis. I will review some key publications, which support this.

Arterial stiffness study in postmenopausal women

Aging blood vessels become stiff from calcification. By removing calcium it seems like the arterial wall becomes more flexible again. Dr. Knapen and colleagues from Maastricht University, The Netherlands followed 244 healthy, postmenopausal women for 3 years in this double blind, placebo-controlled 2015 study.

120 women received 180 micrograms of vitamin K2 (as MK-7) once daily. 124 women received placebo pills. Next researchers checked arterial stiffness through two types of tests. First of all, carotid intima-media thickness was evaluated by echo tracking. In addition aortic stiffness was tested by carotid-femoral and carotid-radial pulse wave velocity. After 3 years there was a significant reduction of uncarboxylated matrix GLA by 50%. This was missing in the placebo group. All of the markers for arterial stiffness showed a reversal improving flexibility above the median. This shows that hardening of arteries in postmenopausal women is reversible with the help of vitamin K2.

Bone metabolism study in Japanese men and women

This 2015 Japanese study investigated what the minimum amount of necessary vitamin K2 would be to improve osteocalcin carboxylation.

First of all, study 1 examined the effect of 0, 50, 100, or 200 micrograms of vitamin K2 (=menaquinone-7) daily. A group of 60 postmenopausal women received vitamin K2 for 4 weeks. Only the 200 microgram per day dosage showed an effect of carboxylating osteocalcin.

Second part of study

Furthermore, study 2 consisted of 120 men and women. Measurements involved the ratio between carboxylated and uncarboxylated osteocalcin to demonstrate the effect of vitamin K2. As a result of study 1 only a placebo group, a 100-microgram and a 200-microgram daily vitamin K2 group was part of the investigation. Both, the 100 microgram and the 200 microgram doses, reduced the circulating uncarboxylated osteocalcin fraction. Hence they concluded that vitamin K-2 effectively keeps the calcium in the bones and prevents osteoporosis. The investigators recommended taking more than 100 micrograms of vitamin K-2 per day to improve osteocalcin carboxylation.

You can find more detail regarding the interaction of calcium, vitamin D3 and vitamin K2 in this link.

Trabecular bone structure preserved in postmenopausal women

148 postmenopausal women were participating for 12 months in a randomized, placebo-controlled, double-blinded clinical trial. All these women had osteopenia. All of them received supplements with calcium and vitamin D3. In addition they received 375 micrograms of vitamin K2 or placebo pills. Examination involved tests for bone mineral density with dual X-ray absorptiometry (DXA). Furthermore a high-resolution CAT scanner determined the microarchitecture of the tibia bone.

After 3 months the uncarboxylated osteocalcin decreased by 65.6% rather than the placebo group of only 6.4% decrease. The trabecular number, spacing and thickness in the tibial bone were unchanged in the vitamin K2 group. In contrast to that there was a clear deterioration of the bone structure in the placebo group.

Summary of trabecular bone study

The bone density studies showed no detectable difference between the groups. The deterioration of the trabecular microstructure in the placebo group was consistent with expected age-related changes. On the other hand, the vitamin K2 group clearly demonstrated preservation of the trabecular bone structure in the tibial bone.

Vitamin K2 helps to eliminate toxic effects of calcium

This 2015 publication from Krakow, Poland explains rather well how vitamin K2 is important to reduce calcium from blood vessels.

At the same time the article points out that vitamin K2 is important for depositing calcium into bones to prevent osteoporosis. The removal of calcium from blood vessels occurs by carboxylation of matrix GLA protein. This functions like a shield to protect blood vessels from calcium entering into the arterial wall. This way the arteries are probably safe from calcification, and hardening of the arteries cannot take place. On the other hand calcium is binding to the bone. As explained above the hormone osteocalcin is responsible for this.Vitamin K2 is the main player in the process of carboxylization. As a result vitamin K2 makes it happen that calcium travels into the bone, where it belongs.

Rotterdam Study: reduced heart attack rates from vitamin K2

4807 subjects from the Rotterdam Study in the Netherlands were part of a study for considerable time (about 10 years) with no sign of any heart attack in the beginning.

The investigators were interested to correlate the effects of various doses of vitamin K1 and K2. How would this impact the frequency of heart disease, hardening of the aorta and all-cause mortality? Researchers adjusted the data for smoking, age, gender, body mass index, diabetes, education, and dietary factors. Next they compared the middle and upper tertile groups of vitamin K1 and K2 to the lower tertile of vitamin K1 and K2.

Results of Rotterdam Study

Most noteworthy, the relative risk for coronary heart disease was lower for the middle and upper tertile of the vitamin K2 group. They found that the middle tertile vitamin K2 intake lowered heart attacks by 27%. It was especially relevant that the upper tertile of vitamin K2 intake lowered heart attack rates by 57%.

In addition, all-cause mortality also showed a reduction for the middle tertile of vitamin K2 by 9% and for the upper tertile by 26%. Finally, severe aortic calcification was 29% less for the middle tertile of vitamin K2 and even 52% less for the upper tertile. Intake of vitamin K1 (=phylloquinone had no impact on any of the outcomes. The investigators concluded that adequate intake of vitamin K2 (=menaquinone) was crucial for anybody’s health. First of all, vitamin K2 lowers heart attack rates, in addition it reduces hardening of the arteries including the aorta and finally, it lowers all-cause mortality.

Vitamin K For Bones And Arteries

Vitamin K For Bones And Arteries


This review shows evidence that vitamin K2 supplementation is important for the prevention of osteoporosis and heart disease. It prevents heart attacks and hardening of arteries, including the aorta. The dosage necessary to achieve this is only 200 micrograms of vitamin K2 per day. However, in Japan higher doses like 375 micrograms per day are the common protocol for prevention of osteoporosis.

Effect of vitamin K2 for bones and arteries

How does vitamin K2 work? In the blood vessels vitamin K2 carboxylates the matrix GLA protein. Essentially this keeps calcium out of the arterial wall and prevents hardening of the arteries. This reduces heart attacks and significantly lowers mortality from heart attacks as well. The second effect of vitamin K2 is on bones. Vitamin K2 prevents osteoporosis to a large extent. It does so by binding calcium to the bone. The hormone osteocalcin, which is carboxylated by vitamin K2 effectively moves calcium from the bloodstream into the bone and keeps it in the bone. If you take vitamin K for bones and arteries, you double the benefit from this simple vitamin. Remember to take 200 micrograms of vitamin K2 daily. The benefits are certainly remarkable!


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You May Want To Cut Down Coffee Consumption

Many people drink too much coffee, so you may want to cut down coffee consumption. With all the good news about the health benefits when drinking coffee, some people went too far. They have overdone what was supposed to be good for them. Recently a study came out that tells you how to cut down coffee consumption.

But first I like to review the issue whether to drink caffeinated or decaf coffee. Next I will tell you how you can switch to decaf coffee.

Caffeinated and decaffeinated coffee have the same health benefits

  1. Recently a large study showed that coffee, caffeinated or not, has a connection with lower overall mortality.
  2. Coffee has long been a subject of heated discussions. Some praise it, and others condemn it. There are multiple past studies; some showed health benefits, some did not. This is why the Department of Nutrition, Harvard School of Public Health in Boston, MA. did a larger study. The purpose was to re-examine the health benefits for both caffeinated and decaffeinated coffee.

Mortality data regarding people who drank decaf coffee or regular coffee

Researchers assessed mortality among 74,890 women in the Nurses’ Health Study (NHS). Another 93,054 women in the NHS 2 study became part of this. And 40,557 men in the Health Professionals Follow-up Study were also part in this large study. The medium follow-up for all of these three groups was 22.5 years. 19,524 women and 12,432 men died during that time period. Ming Ding is a doctoral student at the Harvard School of Public Health department of nutrition. She was the lead author of this study. She pointed out that in the past there were confounding problems. Many studies had shown that both caffeinated and decaffeinated coffee consumption lowered the risk of cardiovascular disease. But the results in many studies were blurred. Studies often did not distinguish between smokers and non-smokers. This meant that the cardiovascular risk from smoking wiped out a beneficial effect from coffee drinking.

Confounding and other factors

Ding’s studies took this into account and also other confounding factors like how much sugary soda pop people were drinking and whether or not they were eating well. In addition they normalized for other factors that could interfere like drinking alcohol and eating red meat. Without normalizing for the factors mentioned above the study results were as follows. Study participants who had less than a cup of coffee and three cups a day had a 5% to 9% lower risk of dying than those who drank no coffee. Those who drank more than three cups a day did not see any benefit.

Dose response curve for regular and decaf coffee

After eliminating all the confounding factors researchers compared the various groups again, and the following linear dose-response curve emerged:

  • Less than 1 cup of coffee per day: 6% lower death rates than non-coffee drinkers.
  • 1 cup to 3 cups of coffee per day: 8% lower death rates.
  • 3 to 5 cups of coffee per day: 15% lower death rates.
  • More than 5 cups of coffee per day: 12% lower death rates.

Coffee consumption reduces diabetes and heart disease

Ming’s study connected with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and also less heart disease. She found that both, caffeinated and decaffeinated coffee, reduced the risk of getting diabetes later in life. When asked about what would be responsible for the reduced death rates with coffee consumption, she explained: “There are at least two known chemicals in coffee, namely lignans and chlorogenic acid that could reduce inflammation and help control blood sugar, both of which could help reduce the risk of heart disease”. You may want to cut down coffee consumption because you know decaf coffee does the same as regular coffee.

Other details about the caffeinated/decaf coffee study

Although there seems to be a linear response up to 5 cups of coffee consumption, above 5 cups this linear relationship disappeared. It was not explained whether there was a saturation point, whether there was yet another hidden confounding factor or whether there were detrimental effects on the adrenal glands with too much caffeinated coffee consumption.

Another finding was that it did not matter whether the coffee was regular (caffeinated) coffee or decaffeinated coffee. The results were identical.

Many other studies did not have the large numbers to show whether or not decaffeinated coffee was as effective in preventing heart disease as regular coffee.

Suicide rates and coffee consumption

There was another peculiar finding: suicides were down by 20% to 36%, if a person drank at least one cup of coffee per day. If a person consumed less than 1 cup of coffee per day the suicide rate was 36% higher than the control group with no coffee consumption. This is a rather peculiar finding, particularly for the consumption of less than 1 cup of coffee. Other studies also showed a decrease in suicide rates with coffee consumption.

Although previous studies had shown a reduction in liver and prostate cancer, after the removal of confounding factors this study did not show any effects on cancer causation or cancer death rates with coffee consumption.


The Department of Nutrition, Harvard School of Public Health in Boston, MA has excelled in high quality nutritional studies for decades. This study is particularly important, because it is so large, giving it more statistical power. Secondly, the observation time of an average of 22.5 years is longer than most coffee studies in the past. Add to this the removal of the “noise” (called confounding factors) that interfered with the objective of the study, and you end up with a very meaningful result.

Clear results after confounding factors were removed

The important findings were that both caffeinated and decaffeinated coffee have the same effect of saving and extending lives. Perhaps you want to drink not more than 5 cups of coffee per day. That lowers your risk of premature death by 15%. It is most likely that it is the effect of lowering the rate of diabetes and heart attack rates that is responsible for the risk reduction. At least this was the opinion of the chief investigator. Cancer rates were not lowered by coffee consumption.

I sleep better when I drink decaffeinated coffee, so for me the notion that decaffeinated coffee and regular coffee have the same effect was important.

Revisit the statement: “you may want to cut down coffee consumption”

Now we know that there is no difference in benefits whether the coffee is caffeinated or not. Those of you who consume 3 to 5 cups of decaf coffee already enjoy a 15% reduction in risk of cardiovascular disease.

Those of you who take the same amount of regular coffee may get into a caffeine dependency problem. Because every time the caffeine stimulation wears off, you yearn for yet another cup of coffee. You need your fix, and this becomes a dependency problem. You have conditioned your body to that regular dose of caffeine, even though it is the bioflavonoids that are reducing mortality while caffeine is neutral.

My experience of coffee withdrawal

When I came across Ding’s research findings I was glad that now there was clarification about whether decaf coffee was as good as regular coffee. The next step for me was to cut out regular coffee and replace it by decaf coffee. Formerly I had been drinking 5 mugs of coffee daily (translated into 500 mg of caffeine daily). When I decided to quit this habit, I figured I should do it cold turkey from one day to the next. To my surprise this was a much bigger deal than I had thought.

Withdrawal symptoms

I craved the next cup of coffee, and I drank a decaf coffee. It did not help: Still, there was this craving for regular coffee! Yawning, restlessness and tiredness were symptoms that followed me all day long. Then there was irritability, a mild headache and almost flu-like symptoms. Eventually I went to sleep and woke up one hour later feeling a bit more energetic. But two hours later I had to lay down again. I was feeling that bushed. The following few days went better. There was more energy. But I still liked a noonday nap of about 1 hour.

Benefits of getting off regular coffee

This was not like me! Normally I have lots of energy and I don’t need naps. It took me 1-½ weeks to get over my 5-cup a day coffee withdrawal. But it was 100% worth it! Since then my energy is back to normal. I don’t have to chase coffee houses on a trip or ensure there is always a cup of regular coffee available for me at home (work does not apply, because I am retired). If I want I can replace my beloved coffee with another fluid. I love lemon juice sweetened with stevia instead of my decaf coffee. It is liberating that I no longer depend on the caffeine. But I still like the flavor of decaf coffee, and there is something enjoyable about the fragrance of freshly brewed coffee. And so I drink 3 to 4 cups of decaf coffee a day.

How to cut down coffee consumption

Here is a 2016 study from the Johns Hopkins University where 34 patients on 600 mg of caffeine per day received a 1-hour lecture about coffee withdrawal followed by a 6-week diary of their coffee consumption. They were asked to reduce their caffeine consumption down to 50 mg by week 6 of the coffee elimination program. Tests followed with salivary caffeine levels 6, 12 and 26 weeks after coffee cessation. There was also a 1-year follow-up telephone conversation. The results were that there was good compliance. Saliva caffeine levels verified this. The diaries over the first 6 weeks showed that the participants had gradually eliminated caffeine consumption. Perhaps this was a more humane way than my “cold-turkey” approach.

You May Want To Cut Down Coffee Consumption

You May Want To Cut Down Coffee Consumption


Many people are sensitive to too much caffeine consumption in coffee and other caffeinated beverages. But since the Harvard study that I mentioned above there is no need to overdose coffee or tea consumption. Decaf coffee has the same effect on lowering death rates by 15%, as does regular coffee. It pays to avoid caffeine, as you will avoid caffeine dependency. Drink decaf coffee instead!

I also discussed that withdrawal from regular coffee can be done more gently over a 6 week period. I did it from one day to the next and had a 1-½ week long withdrawal reaction. Do it slower or faster, whatever works best for you. The end result will be the same. Then enjoy it that you no longer depend on caffeine!

More info: http://www.askdrray.com/coffee-could-be-a-lifesaver/


Bioidentical Hormone Replacement

Recently Medical News Today published an article on bioidentical hormone replacement in the Sept. 19, 2017 edition.

Although it was partially informative, I felt that there was an underlying bias against the use of bioidentical hormone replacement. The article made it sound as if hormone replacement therapy would not be safe. But the opposite is true with bioidentical hormone replacement.

Why are many women afraid of bioidentical hormone replacement?

At the time when there was a lot of confusion about hormone replacement therapy (HRT) the results of the Women’s Health Initiative (WHI) made it even more confusing. After all there was one trial to show once and for all that HRT would be beneficial. The expectation was that HRT prevents osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestin and Premarin were responsible for the negative effects. Had research insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. But the horrifying results that are due to the use of synthetic hormones and that the WHI warned about linger on in the minds of many women.

The use of bioidentical hormone replacement

Dr. John Lee pointed out in several of his books that the physician should only replace hormone loss with bioidentical hormones. He also pointed out that physicians should only replace those hormones that are at low levels or missing. This means that the woman should have confirmatory blood tests like FSH, LH, blood estrogen and salivary progesterone. If estrogen and progesterone are missing, the physician usually starts the woman on progesterone cream first. After two months, when laboratory tests show a saturation with progesterone , the addition of estrogen can follow, typically as the Bi-Est cream. This is a mix of estriol and estradiol.

Caution to balance against estrogen dominance

Progesterone is started first to balance against the potential cancer-inducing effect of estradiol. With the addition of progesterone a balance is the result, and estrogen will not cause breast cancer. This is also why Bi-Est is used: it is a mix of estriol and estradiol. Estriol is neutral with regard to causing breast cancer. Estradiol is the main natural estrogen in a woman, so some of it is necessary to make the woman feel normal. This is how the body receptors are functioning. But estradiol alone, when not in balance with progesterone, can cause breast cancer and uterine cancer.

The key is that only women who need bioidentical hormones should receive it. There are some women whose blood tests do not show a lack of estrogen, but only a lack of progesterone. These women should receive replacement with bioidentical progesterone to re-establish the hormone balance between estradiol and progesterone.

Safety of bioidentical hormone replacement products

As I have mentioned before, the Women’s Health Initiative in 2002 showed that on Premarin and progestin, two synthetic hormone products women came down with breast cancer, heart attacks, stroke, and thromboembolic events. They were using the synthetic drugs, namely conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using “pure hormones that a drug company had manufactured”. But these synthetic hormones were not pure hormones; they were adulterated with side chains so that pharmaceutical companies could patent them. These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in form of breast cancer, strokes and heart attacks.

Women’s Health Initiative authors whitewashed study results

Instead of admitting their mistakes, the full truth never became public. Instead the authors of the WHI study stated that it would be necessary to limit hormone replacement in menopause to the minimum amount of synthetic hormones to control symptoms, and their use should not exceed more than 5 years. These authors never distinguished between bioidentical hormones that fit the body’s hormone receptors and the synthetic hormones that irritated or blocked the body’s hormone receptors. There are thousands of women in Europe who have been on bioidentical hormones for decades, and they are doing just fine!

Bioidentical hormones in balance have no side effects

The truth is that bioidentical hormones –as long as they are kept in balance-do not have any side effects. Bioidentical hormones are the same that a woman produces in her ovaries before menopause sets in. The production of her bioidentical hormones kept her healthy. But the treating physician needs to carefully watch the balance of the hormones in the woman who is replaced with bioidentical estrogen and progesterone. This means that she needs to get enough progesterone to counterbalance estrogen stimulation. Hormones are constantly changing and if you don’t measure them, you don’t know what you are dealing with.

Dr. Lee said to measure hormone levels

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

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream applied to the forearms or to the chest wall once per day. This avoids the first-pass metabolism where the hormones, if absorbed from a pill in the gut have to pass through the liver. Part of the hormones can get metabolized and some of the hormone effect may disappear. By applying bioidentical Bi-Est cream and progesterone cream to the skin, the hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

What are the side effects of bioidentical hormone replacement?

Normally, when estrogen and progesterone are in balance, there should be no side effect. However, in the beginning of replacement therapy sometimes one of the hormones gets too high. If this happens with estrogen replacement, the woman becomes estrogen-dominant. She would experience symptoms of bloating, fatigue, weight gain, depression, headaches, loss of sex drive. She can also develop uterine fibroids, endometriosis and hypothyroidism. It was Dr. John Lee who first described this (Ref.1). There can also be mood swings, craving for sweets, irritability, and sluggishness in the morning. The key is to cut back on the estrogen dosage; alternatively, if progesterone is low in saliva tests, this hormone may need an increase, which would rebalance estrogen. At the end of fine-tuning of bioidentical hormone replacement the woman will feel normal and have no negative side effects, but the process of fine-tuning may take several months.

Difficulties to measure progesterone levels

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

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

Progesterone blood levels versus progesterone tissues levels

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

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement


Bioidentical hormone replacement, properly done, does not cause cancer, does not cause blood clots and prevents heart attacks and strokes. It also prevents osteoporosis and the associated fractures in older women. The key is that the natural hormones fit the body’s own hormone receptors. The reason why menopausal symptoms appear is that natural hormones (estrogen and progesterone) are missing. With the replacement of the missing hormones in a menopausal woman through bioidentical hormone replacement, the menopausal symptoms disappear. Contrary to the Women’s Health Initiative in 2002 when patients received synthetic hormones, there are no breast cancers, no heart attacks and no strokes with bioidentical hormone replacement. What is even better is that these women will live without all the postmenopausal problems, and their life expectancy will be about 10 years longer than without bioidentical hormone replacement.


Ref. 1. Dr. John R. Lee: “What your doctor may not tell you about menopause: the breakthrough book on natural hormone balance”. Sept. 2004.


Close Diabetes Control Prolongs Life


A 20-year study showed that close diabetes control prolongs life. A study divided 160 people with diabetes into two groups. The one group continued to get standard care. Yet the other group received a multi targeted, aggressive treatment protocol. As a result after 20 years the group with the intensive treatment protocol lived 7.9 years longer than the group with the standard treatment.

Dr. Oluf Pederson was the senior investigator of the physician team that followed the diabetes group. He said that they concentrated on a number of known adverse factors and treated them aggressively. These factors were first of all high blood glucose values and clotting risks, also high blood pressure and high triglycerides and in addition cholesterol values. Behavior modification was the therapeutic method to get people with risk factors to exercise more, adopt a healthy diet and stop smoking. Medication in select cases also played a role.

More details about the study

The intervention of intensive treatment lasted 8 years. After that the patients were still in a follow-up study for 13 years. At the beginning of the study patients were on average 55 years old and were borderline obese.

The investigation team screened for complications of diabetes. This included screening for kidney disease, heart disease and blindness. Dr. Joel Zonszein, the director of the New York Clinical Diabetes Center at Montefiore Medical Center said: ”These results are impressive and most patients do not receive the correct treatment, according to national surveys.”

Other studies about diabetes  

Foreign studies

Study from Croatia
  • Another study from Croatia involved 200 patients. It concentrated on patients who did not respond to metformin. Physicians used alternative treatment modalities, and they observed and measured blood sugars and hemoglobin A1C in the following 6 months. The study concluded that those patients who received aggressive treatment of their condition did better than those who did not receive the same vigorous approach.
Study from Japan
  • This Japanese study documented that female patients with type-2 diabetes developed kidney damage earlier than their male counterparts.  Consequently, the investigators pointed out how important it is to treat diabetes aggressively to avoid kidney damage.
Study from Singapore
  • This 2016 study from Singapore analyzed retroactively the impact of diabetes on the long-term survival after coronary bypass grafting (CABG).  5720 consecutive patients had their isolated first CABG surgery between 1982 and 1999. The mean follow-up was 13 years. 34.6% of the patients had diabetes, 51% had high blood pressure and 46.6% had elevated blood lipids. The initial mortality after the CABG surgery was 2.4% in the diabetic group and 1.8% in the non-diabetic group. 20-year survival rates following CABG surgery were 30.9% in diabetics and 49.2% in the non-diabetics, an 18.3% difference. The 20-year freedom from cardiac mortality rates was 56% in diabetics and 68.4% in non-diabetics. Other risk factors that led to cardiac mortality were the following: female gender (1.43-fold risk), diabetes (1.51-fold risk), previous heart attack (1.54-fold risk) and a low left ventricular ejection fraction of less than 35% (2.6-fold risk). The conclusion from this study was that long-term survival in diabetics following CABG surgery was much lower than that of non-diabetic controls. Hence the key to improving long-term survival for diabetics is to treat comorbidities like high blood pressure and elevated lipids aggressively as well as getting blood sugars and hemoglobin A1C values under control.

US studies

  • In this US study 558 youth (age less than 21) between February 2012 to July 2015 received follow-up. Between 40% and 50% of these diabetics needed insulin to improve their diabetes. Unfortunately their diabetes showed poor control, as their high hemoglobin A1C values indicated. Median HbA1C was 6.7%, 8.5%, 9.6%, and 9.7% in those with disease duration less than 1 year, 1-2 years, 2-3 years and less than 4  In other words, the longer the young patients had diabetes, the less seriously they took their treatment. Only 33% treated their high blood pressure and only 11% their elevated blood lipids. Microalbuminuria, an indicator of diabetic kidney disease, and non-alcoholic fatty liver disease were present in 5% to 6% of these young diabetic patients. The authors came to the conclusion that there were serious gaps in treating these young diabetics. Further follow-up data of the same group of patients in the coming years will provide further data. In conclusion, the new hemoglobin A1C ranges of 3.8% to 4.9% as the new normal range explains why these youths who do not treat their diabetes properly are at high risk to develop complications from their poorly controlled diabetes.
Heart attacks and erectile dysfunction
  • Heart attacks are more common among patients with uncontrolled diabetes. This US study classified diabetics according to the tightness of their diabetes control. Researchers found examining 606 men and 606 women with diabetes that they could reduce their risk of a heart attack, if they controlled smoking, glycated hemoglobin (hemoglobin A1C), systolic blood pressure, and total and high-density lipoprotein cholesterol. The control of all these risk factors could contribute to the prevention of heart attacks. 35% of men and 45% of women could prevent having a heart attack. A laxer control still would prevent 36% of heart attacks in men and 38% in women. A very aggressive diabetes control could prevent 51% of heart attacks in men and 61% in women. Most noteworthy: close diabetes control prolongs life.
  • Erectile dysfunction (ED) is a big problem among diabetic men. This study from Seattle shows the investigation of 136, 306 men with erectile dysfunction. 19, 236 of these men had diabetes prior to their ED problem. Over a two-year observation period diabetic men had much worse ED problems. As a result they needed to receive secondary line treatments  like penile suppositories or injectables. Others needed tertiary treatments like penile prostheses. In those whose diabetes control was good, oral agents as first-line therapies were usually sufficient.
More studies about risks and benefits of lifestyle
  • Middle-aged women with diabetes have a 4- to 5-fold higher risk for developing heart attacks while men do not show such a higher risk. It is probably particularly important for women to control diabetes when they are diagnosed with it to reduce the risk of coming down with a heart attack.
  • In 2011 Taylor from Newcastle University showed in a group of diabetes patients that he could cure diabetes permanently with an extremely low calorie diet. The trial was simple: he took overweight or obese patients with diabetes and put them on a starvation diet of 600-700 calories per day for 8 weeks. Consequently 43% of diabetic patients received a permanent cure of their diabetes. More info: http://nethealthbook.com/news/cure-diabetes-permanently/


Close Diabetes Control Prolongs Life

Close Diabetes Control Prolongs Life


The new hemoglobin A1C ranges that are desirable are between 3.8% to 4.9%. When diabetics bring their hemoglobin A1C level into this range, they do not get complications from their previously poorly controlled diabetes. Close diabetes control prolongs life. But as can be seen from a brief review of the literature physicians tend to be lax, patients are lax, and diabetes is often not well controlled. This leads to erectile dysfunction in males, to heart attacks and kidney failure in both sexes. Blindness and painful diabetic neuropathy are also common complications of poorly controlled diabetes. Amputations from clogged arteries are also among the complications. “Close diabetes control prolongs life” is the new mantra that everybody with diabetes needs to follow.

Lifestyle changes control diabetes and prolong life

As stated above Dr. Taylor from Great Britain has shown that a brief 600 to 700 calorie diet can cure 43% of diabetic patients permanently. Quit smoking, bring the glycated hemoglobin (hemoglobin A1C) into the normal range, control your systolic blood pressure as well as your total and high-density lipoprotein cholesterol. Do all these things, exercise regularly, and your diabetes will be well controlled. Remember: close diabetes control prolongs life!


Resveratrol Effective In Humans

Resveratrol has been labeled a powerful antioxidant; but is resveratrol effective in humans?

  1. Quack watch says: don’t buy into the hype that resveratrol is effective in humans.
  2. WebMD claims that there would not be enough medical evidence to say that the average person should supplement with resveratrol to receive benefits.

Despite these recommendations the following evidence supports that resveratrol is indeed effective in humans.

Resveratrol effective in humans: high blood pressure patients

A 2017 study of high blood pressure patients examined resveratrol supplementation with two groups, 46 stage 1 hypertension patients and 51 stage 2 hypertension patients. Stage I hypertension had a systolic blood pressure of 140–159 mmHg and a diastolic blood pressure of 90–99 mmHg. Stage 2 hypertension was defined as a systolic blood pressure of 160–179 mmHg and a diastolic blood pressure of 100–109 mmHg. Each subgroup was divided into two groups, one receiving regular antihypertensive medication, and the other group receiving regular antihypertensive medication plus Evelor. Evelor is a micronized formulation of resveratrol. The trial lasted two years. The purpose of the trial was to determine the effect of resveratrol, which was added to the regular antihypertensive medication (or not) to see whether it had blood pressure lowering effects. The interesting result showed that the resveratrol addition was sufficient to bring the blood pressure down to normal levels with only one antihypertensive drug. The control group without resveratrol needed two or three drugs to get the blood pressure under control. In addition, liver function tests showed that resveratrol normalized negative side effects of the antihypertensive drug on the liver. Both liver enzymes, glutamate-pyruvate transaminase (SGPT) and gamma-glutamyl transferase (Gamma-GT) were normal in the group where resveratrol had been added.

Resveratrol effective in humans: diabetes patients

Resveratrol helps diabetes patients. Resveratrol, the bioflavonoid from red  wine is a powerful anti-inflammatory. This antioxidant has several other effects, which make it challenging to measure each effect by itself. This group of investigators managed to simultaneously measure these effects. They found that resveratrol lowered the C-reactive protein by 26% and tumor necrosis factor-alpha by 19.8%. Resveratrol also decreased fasting blood sugar and insulin; in addition it reduced hemoglobin A1C and insulin resistance. The recommended daily dose of resveratrol was 1000 to 5000 mg.

Resveratrol effective in humans: improves bone density

Resveratrol improves bone density in men: 66 middle-aged obese men with an average age of 49.3 years and a mean body mass index of 33.7 were recruited for this randomized, double blind, placebo-controlled trial. The purpose was to study whether there would be changes in bone turnover markers (LDH, an enzyme involved in bone turnover), but also whether bone mineral density (BMD) would increase. Resveratrol was given to a high group (1000 mg per day), a low group (150 mg) and a placebo (fake pills) were given to the third group. The end point was an elevation of the bone alkaline phosphatase (BAP). This was measured in the beginning of the study and at 4, 8 and 16 weeks. The high group of resveratrol had a 16% increase of the BAP throughout the study and a 2.6% in lumbar spine bone density (measured by a trabecular volumetric method). The low resveratrol group showed no bone restoring effect. MJ Ornstrup, MD, the lead investigator said that this was the first time that a clinical team has proven that resveratrol can potentially be used as an anti-osteoporosis drug in humans. She added that resveratrol appears to stimulate bone-forming cells within the body.

Resveratrol effective in humans: anti-aging effects

The Nurses’ Health Study showed that both a Mediterranean diet and resveratrol can elongate telomeres.

The fact that you can have a longer life with a Mediterranean diet is known for some time. But now a study has shown that the reason for a longer life is the fact that telomeres get elongated from the Mediterranean diet. Telomeres are the caps at the end of chromosomes, and they get shorter with each cell division. This is the normal aging process.

The finding of elongated telomeres comes from the ongoing Nurses’ Health Study that started enrolling subjects in 1976. At that time 121 700 nurses from 11states enrolled in the study. In 1980 diet sheets were used to determine who was adhering to a Mediterranean diet. 4676 middle-aged participants were identified to qualify for this study. This diet consists of a combination of vegetables, legumes, fruits, nuts, grains and olive oil. Fish and lean meats were also consumed. The control group followed a regular diet. Between 1989 and 1990 blood tests were obtained to measure telomere length in white blood cells. It is known that smoking, stress and inflammation shortens telomeres. The lead author Marta Crous-Bou stated that overall healthy eating was associated with longer telomeres compared to the control group. But the strongest association was found in women who adhered to the Mediterranean diet when compared to the controls. For the best diet adherence score there was a 4.5 year longer life expectancy due to slowed telomere shortening.

Longer telomeres have been found to be associated with the lowest risk to develop chronic diseases and the highest probability of an increased life span. I have reviewed the importance of lifestyle factors in this blog where I pointed out that Dr. Chang found a whole host of factors that can elongate telomeres by stimulating telomerase. It has been shown in humans that increased physical activity elongated telomeres. So did vitamin C, E and vitamin D3 supplementation, resveratrol, a Mediterranean diet and marine omega-3 fatty acid supplementation. In addition higher fiber intake, bioidentical estrogen and progesterone replacement in aging women and testosterone in aging men, as well as relaxation techniques like yoga and meditation are also elongating telomeres.

Aging is due to shortening of telomeres. Elongation of telomeres by resveratrol leads to prolonged life (or anti-aging).

Resveratrol effective in humans: resveratrol and cancer

As this overview shows, it seems that several mechanisms of action give resveratrol the power to be an anticancer agent. Resveratrol is anti-proliferative and has anti-angiogenesis mechanisms. In addition resveratrol stimulates apoptosis, which is programmed cell death. All these actions together help resveratrol to have anticancer properties. Resveratrol can also be used in combination with other cancer treatments, which improves survival figures. As the link above explains, more cancer clinical trials with a variety of cancers and larger patient numbers are required, but many smaller clinical trials have already been very successful showing efficacy of resveratrol as a chemotherapeutic agent.

In this 2015 publication about malignancies and resveratrol an overview is given about the use of resveratrol and cancer treatment. It summarizes that the development of cancer is a multifactorial process that involves the 3 stages of initiation, promotion and progression. One of the cancer promoting factors is chronic inflammation. Resveratrol has been shown to be anti-inflammatory. At this point it is not clear how the animal experiments will translate into the human situation. More clinical observations are necessary.

Resveratrol effective in humans: cardiovascular disease

Resveratrol has beneficial effects on preventing hardening of the arteries, diabetes, various cancers and inflammatory conditions like Crohn’s disease and arthritis. As this link explains resveratrol also stimulates the antiaging gene SIRT1 by 13-fold. This confirms the anti-aging effect of resveratrol. This 2012 study has also confirmed that resveratrol from red wine is what is responsible for the “French paradox” (longer life expectancy despite high saturated fat intake).

Resveratrol effective in humans: polycystic ovarian syndrome 

Polycystic ovarian syndrome could be significantly healed with resveratrol in a randomized, double blind, placebo-controlled trial. It involved 30 subjects who completed the trial. 1500 mg of resveratrol or placebo were administered daily for 3 months. Serum total testosterone was decreased by 23.1% at the end of 3 months in the experimental group versus the placebo group. There was also a decrease of dehydroepiandrosterone sulfate of 22.2%. Fasting insulin level was reduced by 31.8%. At the same time insulin sensitivity was increased by 66.3%. The authors concluded that resveratrol had significantly reduced ovarian and adrenal gland male hormones (androgens). This may be in part from the drop in insulin levels and the increase of insulin sensitivity.

Resveratrol effective in humans: anti-arteriosclerotic effects in diabetics

A double blind, randomized, placebo-controlled study was done on 50 diabetics. The cardio-ankle vascular index (CAVI) was used to determine arterial stiffness. The purpose of this study was to determine the effect of resveratrol on the stiffness of arteries in a group of diabetics and compare this to a placebo. Diabetics are known to have premature hardening of the arteries (arteriosclerotic changes). After 12 weeks of taking 100 mg of resveratrol per day there was a significant reduction in arterial stiffness in the experimental group, but not in the placebo group. Blood pressure also decreased by 5 mm mercury (systolic) in the experimental group.

Resveratrol effective in humans: ulcerative colitis patients

56 patients with mild to moderate ulcerative colitis received 500 mg of resveratrol or placebo and were observed for 6 weeks. This was a randomized, double blind, placebo-controlled pilot study. Bowel disease questionnaires were used to assess the bowel disease activity before and after the treatment. The resveratrol group decreased the disease activity significantly, but it also increased their quality of life. Blood tests showed that this improvement occurred as a result of reducing oxidative stress by resveratrol.

Resveratrol effective in humans: Alzheimer’s disease prevention

Here is a study where 52 Alzheimer’s patients were divided into two groups; one group was given 200 mg of resveratrol for a number of weeks, the other group placebo pills. There was a significant improvement in memory tests in the resveratrol group and functional MRI scans showed better functional connectivity in the hippocampi of the subjects. It is known that the hippocampus is the seat for short-term memory, which is lost in Alzheimer’s patients.

Resveratrol Effective In Humans

Resveratrol Effective In Humans


Resveratrol has a long history of showing evidence of improving health. It does so by countering oxidation of LDL cholesterol, which lessens hardening of arteries. This prevents heart attacks and strokes. Resveratrol is also a powerful anti-inflammatory, which helps patients with diabetes, with Crohn’s disease and arthritis. There is even a cancer preventing effect of resveratrol because of anti-proliferative and anti-angiogenesis effects as well as stimulating apoptosis. Because of these combined anticancer properties resveratrol is a chemotherapeutic agent that can be combined with conventional anticancer drugs.

There are enough randomized, double blind, placebo-controlled trials in humans to show that resveratrol is effective in preventing and treating several disease conditions. The medical establishment claims that there would not be enough medical evidence to say that the average person should supplement with resveratrol to receive health benefits. After my review outlined above I come to the opposite conclusion. It is quite clear that resveratrol has several important healing properties. It can improve diabetes; prevent hardening of arteries, lower blood pressure, attack osteoporosis and prevent Alzheimer’s disease. I have been taking 500 mg of resveratrol daily for years. It has not harmed me.

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Curcumin And Cancer

Many clinicians give their attention to curcumin and cancer. It may not be used as a primary treatment, but may be added as an adjunct to other cancer treatments. Curcumin is the effective ingredient of the old Indian spice, turmeric. The question is how effective curcumin is against cancer? Is it safe to use? What is the evidence?

Frequency of cancer

According to the American Cancer Society there will be 1,688,780 new cancer cases diagnosed in 2017 and 600,920 cancer deaths will occur in the US.

Causes of cancer

Cancer can be caused in many different ways. Hidden in the many causes may be the possible solution to new cures.

  1. A lack of exercise may contribute to the development of cancer because of a lack of tissue circulation. And exercise will help to support your normal cell metabolism (explained below). Wrong foods may or may not have a contributory role regarding cancer development (a high sugar and starch diet causing insulin response, which changes the metabolism). The Mediterranean diet is an anti-inflammatory diet and has been credited to prevent a lot of cancers.
  2. Cancer can be caused by chemicals, called carcinogens. But it can also be caused by oncoviruses. It can be genetically caused, that’s why it tends to run more often in certain cancer prone families. But Warburg has researched the metabolism of cancer almost 100 years ago, even got the Nobel price for it in 1931 and yet the elusive cancer cure has not materialized yet.
  3. Following Warburg’s research Watson/Crick detected DNA in our cells. Ever since geneticists were fascinated by it. They also found that a cancer suppressive gene, regulated by the p53 gene could develop mutations and then cancer would occur: Tumor Suppressor Genes For decades this was the “in” thing. But in the last 5 to 10 years there is a revitalization of the original Warburg idea that one should concentrate on the metabolic differences between cancer cells and normal cells. This is starting to show some timid results.
  4. Cancer cells are more acidic from lactic acid and burn glucose for energy without requiring oxygen (anaerobic pathway), while normal cells burn glucose in the aerobic pathway in the mitochondria. This difference is important. Cancer cells were found to be more vulnerable to be killed by certain manipulations.
  5. Take cryoablation therapy for prostate cancer. Cryosurgery for prostate cancer. The more vulnerable cancer cells are preferentially killed over the normal cells through a local deep freeze method. Another example is photodynamic therapy for cancer that has been used for lung cancer and esophageal cancer.  This method may be a lot more universally applicable than believed so far. A photosensitized dye is injected and later when normal cells have eliminated the dye, but the defective cancer cells are still containing the dye a laser beam is used to kills the cancer cells preferentially, absorbing the specific laser wavelength that is specific for the dye.
  6. Nobody knows which way cancer research is going. But I think it will be consumer driven: consumers want better cures, and when new methods appear that have better cure rates, these will be pushed forward while less effective methods will become history. I think that Warburg will be revitalized and new therapies will continue to be developed from this as I indicated.

Curcumin and cancer: malignant conversion

There are three development stages for any cancer to develop.

This was originally researched with skin cancer, but also confirmed with cervical cancer. It is called the “malignant conversion” that needs to take place before a normal cell has become a cancer cell. There are three stages.

  • Initiation
  • Promotion
  • Progression

This is important to know in the context of curcumin. Basic research has shown that curcumin interferes with all of these stages of tumor development, both in terms of prevention as well as in terms of being curative. Here is a link that points out the complex multiple steps of cancer growth that curcumin interferes with.

As can be seen from it, curcumin interferes with the initiation of multiple cancers, reduces inflammation, and interferes with angiogenesis and this reduces the amount of metastases that can form. But curcumin further interferes with proliferation of cancer cells, reduces invasion, prevents resistance and improves survival. The underlying molecular and genetic reasons for curcumin’s actions are all contained in that link.

Curcumin and cancer: research in tissue culture and animal experiments

When it comes to cancer research, you usually hear about in vitro culture experiments and animal experiments. This type of research is used to establish that there is an anti-cancer effect, that it is reproducible and non-toxic. The September issue of the 2016 Life Extension Magazine reviewed this in detail. It was entitled “How Curcumin Targets Cancer”.

But as a former clinician I am more interested in seeing cancer patients cured. This has to be verified by clinical trials first. When I looked through PubMed.com for objective evidence of the effects of curcumin in cancer patients, this type of information was more difficult to find. But in the following there are a number of examples that I did find.

Curcumin and cancer: clinical trials

1. Reduction of tumor necrosis factor-alpha

A 2016 meta-analysis of eight randomized studies investigated the effect of curcumin in patients with various inflammatory diseases including cancer. They found that curcumin consistently reduced tumor necrosis factor-alpha. In cancer patients this inflammatory substance is responsible for further cancer growth and developments of metastases.

2. Poor bioavailability of curcumin

A study with increasing amounts of curcumin showed poor absorption of curcumin into the blood. In this study dosages between 500 mg up to 12,000 mg per day of curcumin were given. 500 mg to 8000 mg of curcumin did not result in any positive serum level of curcumin. Only the higher dosages, 10,000 and 12,000 mg of curcumin were associated with positive curcumin levels in the blood serum. In order to have effects of curcumin, higher amounts have to be taken. Higher amounts of curcumin have been tested for toxicity and were found to be safe and were fairly well tolerated.

3. Precancerous colonic polyps reduced in number and size

A smaller study consisted of 5 subjects with familial adenomatous polyposis (FAP). This is an autosomal-dominant disorder where hundreds of colorectal adenomas develop in the lining of the colon. From these colorectal cancer can arise. Five patients received 480 mg of curcumin and 20 mg quercetin orally three times per day. After 6 months the number of polyps and the size had reduced by 60.4%.

4. Premalignant colonic lesions suppressed by curcumin

44 eligible smoker subjects received a baseline colonoscopy where aberrant crypt foci (ACF) were determined. ACI are the very first focal areas in the colon from which colon cancer develops. Smokers are known to have more of these lesions, which was the reason that smoker subjects were used for this trial. The patients received either a supplement of 2000 mg of curcumin or 4000 mg of curcumin for 30 days. These are fairly high doses, but they were used to overcome the poor absorption of curcumin. Colonoscopies were done again after one month of curcumin supplementation. 41 subjects completed the study. In the 4000 mg curcumin group the ACF numbers were reduced significantly by 40% compared to the 2000 mg group, which showed no reduction. The 4000 mg group showed a 5-fold increase of curcumin blood levels compared to baseline. There was no change in blood levels in the 2000 mg group.

5. Reduction of radiation dermatitis with radiation therapy in breast cancer patients

30 breast cancer patients were divided into an experimental group and a placebo group. All of them had a mastectomy first, which was followed by radiation therapy. The experimental group received 6 grams (2 grams three times per day) of curcumin during the time of radiotherapy following mastectomy. The severity of radiation dermatitis following radiotherapy was significantly reduced in the experimental group when compared to the placebo group. Only 28.6% had significant radiation dermatitis in the curcumin group versus 87.5% in the placebo group.

6. Chronic multiple myeloma patients

An Australian study involving chronic multiple myeloma patients found that curcumin at 4 Grams per day and even more so at 8 Grams per day stabilized the disease and improved kidney function.

7. Descriptive studies

Descriptive studies investigating the effect of various doses of curcumin have been done regarding breast cancer,  and advanced pancreatic cancer. But these clinical trials were all rather small.

8. Chemoprevention of cancer

A phase II trial enrolled 21 patients with end-stage pancreatic cancer patients. The only FDA approved treatments for this are gemcitabine and erlotinib, but this would normally only lead to clinical responses in less than10% of patients. In this study the investigators used curcumin to enhance the anti-tumor response of either gemcitabine or erlotinib. The study summary stated: “Oral curcumin is well tolerated and, despite its limited absorption, has biological activity in some patients with pancreatic cancer.” 2 of the 21 patients had stable disease for more than 18 months; one of the 21 patients had a brief tumor regression of 78%, but then relapsed and died.

9. Chemoprevention of prostate cancer

Chemoprevention of prostate cancer is discussed in this publication: There was specific reference made to prevention of prostate cancer and the opinion of the researchers was: “At present, there is no convincing clinical proof or evidence that the cited phytochemicals might be used in an attempt to cure cancer of the prostate.”

Curcumin And Cancer

Curcumin And Cancer


For years there have been reports to indicate that curcumin was a promising natural supplement that can improve cancer survival. There are poorly founded reports of effects of curcumin on colorectal cancer, pancreas cancer, prostate cancer, breast cancer, ovarian cancer and others. But on closer look the hype seems to come mostly from in vitro studies (tissue culture experiments) or from animal studies. Clinicians, however, demand well-constructed randomized clinical trials with clear research objectives before they can accept a new agent like curcumin to be effective. These clinical trials are missing! Instead there are many in-between trials of questionable quality as listed above.

There have been problems of bioavailability due to poor absorption of curcumin. To a certain extent this could be overcome by pushing the dosage to 6000 to 8000 mg per day. But a significant percentage of people (around 30%) suffered from abdominal cramps and nausea and had to discontinue these high doses of curcumin. Newer curcumin compounds have been developed, but at this point it is not known what the bioequivalent dosage is of these newer curcumin agents in comparison to the original curcumin dosages.

It is quite possible that new trials will one day be performed that may bring better news on survival rates of various cancer patients involving curcumin therapy. But in my opinion right now it is not yet prime time for curcumin!

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Death From Heartburn Drugs

A study was recently published showing that death from heartburn drugs can come early, when compared to controls. The study was published in June 2017 in the online British Medical Journal Open. The researchers were located at the Washington University School of Medicine, Saint Louis, Missouri, USA.

349, 312 US veterans on proton pump inhibitors (PPI) were compared to an equal amount of veterans on conventional H2 blockers. Over a follow-up period of 5.71 years there was an increased risk of death of 25% when patients took PPI drugs. It did not matter to what the PPI group was compared, there were always more deaths in the PPI group compared to other control groups.

Causes of death

According to the senior author, Dr. Ziyad Al-Aly many deaths were due to kidney disease, dementia, fractures, pneumonia, Clostridium difficile infections and cardiovascular disease. Out of 500 patients who took the PPI drug there was one death within one year. But over the years the deaths increased. Dr. Al-Aly thinks that the PPI drug is interfering in some way with the genetic expression of some genes and suppressing others. These genetic differences may explain the early deaths.

As this was a retrospective study, it can only show an association of PPI drugs with earlier deaths, but this does not prove causation. It would require a prospective random study to prove causation.

Other studies regarding the risk of PPI drugs

  1. An Icelandic study from May 2017 showed that there was a 30% increased risk of fractures in males and females following PPI drugs when observed over 10 years. Opiates were associated with an almost 50% risk, sedatives with a 40% risk of increased fractures. Control groups of NSAIDs, statins and beta-blockers showed no increased fracture risk, nor did histamine H2-antagonists.
  1. An article from March 2017 is a critical review of the safety of PPI drugs. It notices that with long-term use there are adverse effects like fractures of the long bones, enteric infections and hypomagnesemia. PPI’s can increase the risk for heart attacks and can cause kidney disease and dementia. One of the problems is that gastroesophageal reflux usually dictates the long term use of anti acid drugs like PPI’s, but the longer patients are taking these drugs, the higher the death rate and side-effect rate. The physician should only use PPI drugs initially and after a few weeks switch to the less potent histamine H2-antagonists (like ranitidine).
  2. A Danish study from April 2017 noted an increased risk for listeriosis in patients who were on PPI drugs. Over 5 years there was a 2.81-fold higher risk of developing listeriosis in patients on PPI’s compared to a control group. If patients were on corticosteroids and a PPI the risk was even higher, namely 4.61-fold increase to develop listeriosis. In contrast, the use of histamine H2-antagonists was associated with a risk of only 1.82-fold of developing listeriosis.
  1. In a Dec. 2016 study from Dublin, Ireland patients older than 65 were examined with regard to their PPI drug use. Data was compiled for 1997 and for 2012. It was noted that the maximal PPI dose for long-term use was prescribed to 0.8% of individuals in 1997 and to 23.6% in 2012. The risk of getting high dose PPI drugs prescribed in 2012 was 6.3-fold compared to 1997. Examination of the health records showed that the indication for prescribing PPI drugs was not associated with significant gastrointestinal bleeding risk factors. The study concluded that there was definitely room for improving prescribing habits.
  1. This January 2016 paper describes the standard treatment of H. pylori and gastric and duodenal ulcer treatment, which involves the triple therapy consisting of a PPI and two antibiotics. It pointed out that this treatment protocol “improves healing and prevents complications and recurrences”.
  2. A paper from Leipzig, Germany dated July 2016 reviews the usage of PPIs. It mentions that there has been a significant increase of prescriptions in the past 25 years. Patients on PPI’ are at a greater risk for fractures. There is also a risk of low B12 levels from malabsorption of B12. This should be checked from time to time, and if necessary B12 injections should be given.
  3. A Canadian study from May 2015 found that Clostridium difficile infections (CDI) were linked to chronic antibiotic use or to prolonged use of high doses of PPI drugs. There was a 1.5-fold risk of recurrent CDI in patients older than 75 years who were taking PPI drugs continuously. There was a 1.3-fold recurrence of CDI after antibiotic re-exposure.

Alternative remedies for heartburn

  • Dr. Weil recommends the use of deglycyrrhizinated licorice (DGL) for heartburn or early ulcers.
  • Here is a clinical study with 56 patients with duodenal and gastric ulcers that was published in 1968. It could be shown both radiographically as well as clinically that the ulcers healed and that stomach spasms subsided with DGL treatment. At that time it was not known that DGL had antibacterial effects and that often chronic heartburn, stomach and duodenal ulcers can be made chronic by H. pylori infections that are simultaneously present.
  • A December 2016 study showed that probiotics could be a valuable adjunct in triple therapy for H. pylori infection. The study also points out that H. pylori is present in about 50% of the world’s population.

Antibacterial effects of DGL

  • A paper of December of 2012 shows that an important tooth decay bacterium responds to DGL.
  • In a 1989 study 20 patients with aphthous mouth ulcers were followed. DGL mouthwash led to a 50 to 75% improvement in 15 patients within one day of treatment and by the 3rd day there was complete resolution.
  • Here is a suggestion of a four-step approach against H. pylori.
  • DGL has been shown to be useful in gut regeneration in patients with Clostridium difficile infection.


I started with a review of a recent paper that pointed out the side effects of PPI drugs. PPI’s are used for acid reflux disease, stomach and duodenal ulcers, either alone or as part of the triple therapy. Because many of these problems are associated with a chronic infection of H. pylori, I reviewed the literature surrounding deglycyrrhizinated licorice (DGL), a natural antacid remedy. It turns out that DGL can be quite useful either as a parallel treatment or instead of the triple therapy.

The problem over the past 25 years is that physicians have been treating acid problems with higher and higher doses of PPI’s. They are also using ASA prophylaxis against heart attacks and strokes more often. This has caused gastric erosions that are bleeding, which in turn caused physicians to prescribe more PPI’s. The side effects of PPI’s can be viewed as iatrogenic (doctor- induced) disease. This is an artificial disease that occurs from the side effects of overprescribed medicine. PPI’s are a very useful short-term anti-acid medication. But this medication should not be used for more than 4 to 8 weeks. But as patients receive years and years of this medication, serious problems like heart attacks, fractures, kidney disease, dementia, and pneumonia as well as Clostridium difficile infections become the consequence. Overall there was an increase of the death rate of 25%.

It sounds quite reasonable that doctors should return to a more conservative approach as the FDA has suggested. Alternative natural methods including DGL and probiotics can also be utilized.

Death From Heartburn Drugs

Death From Heartburn Drugs


A recent study from the online British Medical Journal Open has pointed out a high death rate among long-term proton pump inhibitor (PPI) drug users. These drugs are used to suppress acid formation in the stomach. They are helpful, if there are significant gastrointestinal bleeding risk factors present. But prolonged use of PPIs causes severe side effects as described, including a chronic persistent Clostridium difficile infection (CDI) of the gut that can become resistant to antibiotic therapy. In cases of recurrent CDI one important step is to discontinue PPIs. The physician should consider switching to one of the conventional histamine H2-antagonist drugs (like ranitidine). Overusing PPIs in an older population is not responsible, as this leads to disease that is caused by a physician! There is no need for this to happen. The prescribing physician has to exercise caution and restraint and the patients, and their loved ones need to be aware of multidrug interactions. PPIs belong to the drugs that are eliminated in the liver through the cytochrome P450 enzyme system (CYP2C19). But this enzyme system interfering with the drug elimination process may also eliminate other drugs taken by the patient. The end results can be toxic drug levels of PPIs. It can potentiate the side effects and become responsible for the 25% increased risk of death when the patient takes PPI drugs chronically. Even though PPIs are the newer medication, newer does not always mean better.

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