Effects Of Metformin On The Gut Microbiome

Matthew Andry, MD talked about the effects of metformin on the gut microbiome. This talk was delivered at the 24th Annual World Congress on Anti-Aging Medicine. The congress took place from Dec. 9 to Dec. 11, 2016 in Las Vegas. A lot of the sessions that I attended dealt with the gut flora and how it affects our health. This talk belongs to the theme of what a healthy gut microbiome can do for us.

History of metformin

Dr. Andry is a clinical associate professor of the Indiana School Of Medicine.

He pointed out that metformin has been used for a long time for type 2 diabetes, particularly, if fasting insulin levels are high. Metformin is a biguanide, which was isolated from French lilac (also known as Goats Rue). In the middle ages this herb was used to treat “thirst and urination”. In retrospect we recognize these as symptoms of diabetes. Chemists were able to synthesize the active ingredient in this herb in the 1920’s. Since then it is known as metformin. Dr. Jean Stern was able to show in the 1950’s in clinical studies that Glucophage, the brand name of metformin was able to reduce blood sugar without raising insulin levels. Between 1977 and 1997 metformin enjoyed wide spread acceptance for treating diabetics. Several clinical investigators demonstrated that diabetic patients on metformin lived longer and had less heart attacks than patients who were treated otherwise.

Metformin is the first-line drug in the treatment of type 2 diabetes in children and adults. It is one of the most widely prescribed drugs throughout the world with 120 million prescriptions per year.

Off-label use of metformin

There are many other clinical conditions for which metformin have been found to be beneficial. Polycystic ovary syndrome (PCOS), obesity, prediabetes, metabolic syndrome and nonalcoholic steatohepatitis are a few examples of off-label use of metformin. Metformin is also used as an anti-aging agent as it was found to elongate telomeres, which helps people to live longer. Metformin has been identified as a possible cancer prevention agent. In prostate cancer it was found to have an effect against prostate cancer stem cells. Without these cells prostate cancer does not recur after surgical removal.

Action of metformin

Metformin increases the action of an enzyme, AMPK, which leads to lipid oxidation and breakdown of fatty tissue (catabolism). In the liver the metabolic pathway of making sugar from fatty acids, called gluconeogenesis is inhibited. Metformin causes increased uptake of sugar into skeletal muscle tissue. This is the reason for the previously mentioned stabilization of blood sugar. Metformin has two beneficial effects on the liver. First it stabilizes insulin sensitivity. This means that a given amount of insulin has a larger effect on the liver. Secondly metformin decreases the toxic effect of fatty acids on the liver tissue. In other words metformin has a healing effect on non-alcoholic steatohepatitis, a precursor to fatty liver and liver cirrhosis. Metformin also has an effect on the appetite center in the brain. It helps many obese and overweight people, but not all to lose weight. The mechanism for that effect is in the hypothalamus, where the appetite center is located. The neuropeptide Y gene expression in the hypothalamus is inhibited by metformin leading to reduced appetite.

Finally, metformin also normalizes the gut flora. This last point was the main focus of Dr. Andry’s talk.

Metformin and the gut

An animal experiment on mice showed in a study published in 2014 that metformin was stimulating the growth of a beneficial gut bacterium, Akkermansia. This is a mucin-degrading bacterium. But it also affects the metabolism of the host. The authors found that metformin increased the mucin-producing goblet cells.

Akkermansia muciniphila bacteria were fed to one group of mice. This group was on a high fat diet, but not on metformin. The mice showed control of their blood sugars, as did the metformin group. In other words manipulation of the gut flora composition could achieve control of the diabetic metabolism. The authors concluded that pharmacological manipulation of the gut microbiota using metformin in favor of Akkermansia might be a potential treatment for type 2 diabetes.

Effect of metformin on the gut flora

Akkermansia muciniphila bacteria comprise 3%-5% of the gut flora. It does not form spores and is strictly anaerobe, in other words oxygen destroys it. This is the reason why it is difficult to take it as a supplement. It is mostly growing in the mucous of the epithelium layer of the gut. The highest number of Akkermansia bacteria is found in the colon, lesser amounts in the small intestine of all mammalian species including the human race.

Here are the effects of metformin on Akkermansia:

  • Metformin increases the Akkermansia bacteria count both in a Petri dish as well as in the gut of experimental mice. This suggests that metformin acts like a growth factor for Akkermansia.
  • Metformin increased the count of Akkermansia bacteria by 18-fold up to a maximum of 12.44% (up from the normal 3-5%) of all of the gut bacteria.
  • Researchers observed that the mucin layer of the lining of the gut in metformin treated mice was thicker. This suggests that the thickness of the mucin layer plays a role in increasing the Akkermansia count.

Effect of the gut on the body’s metabolism

Other researchers have investigated how a high fat diet can change the composition of the gut bacteria, which in turn are altering the body’s metabolism. Essentially a shift in the bowel flora can increase the gut’s permeability. This is called leaky gut syndrome. It leads to absorption of lipopolysaccharides (LPS) from bad bacteria in the gut. The end result is endotoxemia in the blood. This causes systemic inflammation in the body. Insulin resistance and obesity develop and this can be followed by type 2 diabetes. It is interesting to note that the effects of a high fat diet that led to these changes can be reversed by increasing Akkermansia bacteria in the gut or by treating with metformin.

An interesting mouse experiment showed that the changes that take place in the gut bacteria with cold exposure could be transferred to germ-free mice with no gut flora. This changed their metabolism proving that gut bacteria have profound influences on the metabolism. The fact that the gut bacteria have a profound influence on the metabolism is not only true for animals, but also for humans.

Akkermansia Facts

Here are a few facts about the Akkermansia bacteria.

  • The amounts of Akkermansia bacteria in the gut are inversely related to how fat we are. This is measured by the body mass index (BMI). Fat people have less Akkermansia in their guts.
  • A high fat diet lowers the amount of Akkermansia in the gut
  • Systemic inflammation is present with low Akkermansia counts
  • A high fat diet causes gut permeability (leaky gut syndrome).
  • Low levels of Akkermansia causes worsened severity of appendicitis and inflammatory bowel disease.
  • Low levels of Akkermansia causes fat storage (both in subcutaneous fat and visceral fat).
  • Low levels of Akkermansia cause insulin resistance (associated with diabetes) and high blood sugars.
  • Increased Akkermansia counts increase brown fat’s ability to burn calories, which leads to weight loss. Decreased Akkermansia counts lead to fat storage (weight gain).
  • Increased Akkermansia improves gut-barrier integrity
  • Increased Akkermansia reduces visceral and total body fat
  • Increased Akkermansia reduces synthesis of sugar in the liver (gluconeogenesis)

We have 10 times more bacteria in the gut than we have cells in our body. The Akkermansia percentage of the gut flora can be decreased from antibiotics or food that contains traces of antibiotics. If there is a lack of Akkermansia species, there is more gut permeability, causing LPS increase and causing increase of inflammation in the body. This translates into high blood pressure, heart attacks, strokes, and degenerative neurological diseases like Parkinson’s disease, Alzheimer’s disease or MS. But it can also cause inflammatory bowel disease and autoimmune diseases.

What increases Akkermansia?

We can increase Akkermansia bacteria in the gut by eating Oligofructose-enriched prebiotics. Oligofructose belongs into the inulin type soluble fibers. It is found in a variety of vegetables and plants. This includes onions, garlic, chicory, bananas, Jerusalem artichokes, navy beans and wheat. But wheat can be problematic. Clearfield wheat is the modern wheat variety which is now grown worldwide. It is much richer in gluten and can cause problems with gut permeability.

Eating lots of vegetables and fruit will give you enough of oligofructose to maintain a healthy percentage of Akkermansia in your gut bacteria.

Metformin as pointed out earlier can be used as pharmacotherapy. But it must be stressed that the use of metformin for dysmetabolic syndrome is off-label. There are real side effects of metformin. Lactic acidosis with an unusual tiredness, dizziness and severe drowsiness can develop. Also chills, muscle pain, blue/cold skin and fast/difficult breathing has been described. Slow/irregular heartbeat, vomiting, or diarrhea, stomach pains with nausea are also listed under side effects.

Effects Of Metformin On The Gut Microbiome

Effects Of Metformin On The Gut Microbiome


Our gut bacteria are important for us, more so than you may be aware of. An anaerobe bacterium, Akkermansia makes up 3%-5% of the gut flora. This bacterium lives in the mucous layer of the lining of the gut and ensures that the gut wall is tight. When these bacteria are lacking (due to consumption of junk foods) the gut wall becomes leaky, which is why this condition is called “leaky gut syndrome”. Irritating toxic substances can now leak into the blood stream and lipopolysaccharides are among them. This causes inflammation in the gut wall, but can go over into the blood vessels and the rest of the body including the brain. High blood pressure, obesity, diabetes, heart attacks, strokes, and degenerative neurological diseases like Parkinson’s disease, Alzheimer’s disease or MS can develop from the inflammation. But it may also cause inflammatory bowel disease and autoimmune diseases.

Eating lots of vegetables and fruit will give you enough of oligofructose to maintain a healthy percentage of Akkermansia in your gut bacteria. In particular, onions, garlic, chicory, bananas, Jerusalem artichokes and navy beans provide lots of oligofructose to support Akkermansia in your gut bacteria.

As pointed out earlier metformin can be used as pharmacotherapy of dysmetabolic syndrome. But it must be stressed that the use of metformin is off-label. It is also important to remember, that with effects there are side effects of metformin.

It may be news to you, how close the health of the gut is connected to our overall health. With the knowledge that food can be your medicine, choose your foods wisely. Add some or all of the above named foods that help you support beneficial gut bacteria, and take care of your health!

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How To Avoid Being Hungry

Dr. Ludwig gave a lecture about how to avoid being hungry at a conference in Las Vegas. The actual topic was “Always Hungry?” I attended the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas where this lecture was given. Dr. Ludwig is a Harvard-based endocrinologist who has been researching weight loss methods and obesity for over 20 years. Here is a list of his major publications.

Dr. Ludwig stated that the low fat/high carb diet popular in the1980’s until the early 2000’s was misguided and probably even harmful. The theory at that time was that obesity was caused by too much saturated fat. This has since been proven to be wrong. Instead it has been proven that increased sugar intake is responsible for the obesity wave.

General information about weight gain

The carbohydrate-insulin model states that without insulin you cannot gain weight, because in order to store fat in fatty tissue you need insulin to transport fatty acids across the cell membrane of fat cells.

In this context it is important to note that high glycemic index food increases the blood sugar. This leads to stimulated insulin production, and the liver converts the extra sugar into fatty acids that get deposited as fat in fatty tissue.

The glycemic load from a person’s diet is the single best predictor for a rising blood sugar level. After food intake the blood sugar goes up, glucagon goes up, epinephrine goes up within 4 hours. It is the epinephrine, which after 4 hours makes you hungry again.

The nucleus accumbens is the addiction center. At 4 hours after a high glycemic index milk shake the nucleus accumbens was stimulated in 12 subjects of a double blind trial.

The nucleus accumbens does not work in isolation. It is not only involved in food satisfaction, but also in sexual satisfaction and even plays a role in satisfaction that some people get from playing video games.

Low-carbohydrate, Mediterranean or low-fat diet

In an Israeli study from the New England Journal of Medicine in 2008 investigators were interested to find out which diet was helping people to lose most weight. h

322 moderately obese subjects that were aged 52 years on average were randomized to one of the following diet groups.

They compared

  1. a low fat diet (Atkins type, restricted calorie) with a
  2. Mediterranean diet (low carb, restricted-calorie) and a
  3. Low fat/high carb diet (low fat, non-restricted-calorie)

What was the result? The mean weight losses were: 2.9 kg (low fat group), 4.4 kg (Mediterranean diet group), and 4.7 kg (low fat/high carb group). Of the 272 participants who had completed the intervention after two years of the study the weight loss was 3.3 kg, 4.6 kg, and 5.5 kg in the same sequence as above.

The ratio of total cholesterol to high-density lipoprotein cholesterol, which is a measure for the heart attack risk, was examined next. It was 20% lower from the baseline in group 2 (Mediterranean diet group). The low fat groups (group 1 and 3) were 12% lower from the baseline.

36 subjects had diabetes. There was a clear winner with respect to lower fasting blood sugar and insulin levels, namely the Mediterranean diet (group 2).

The authors concluded that the Mediterranean diet is preferable to low fat diets as they have shown an improvement in lipid profiles and in control of diabetes.

The “POUNDS LOST” study

This was a 2-year study that investigated 4 different lower calorie diets to help people lose weight. Despite the significant difference in diet composition, these 811 free-living overweight or obese adults ages 30-70 from Boston, MA and Baton Rouge, LA lost 16 pounds at 6 months and 9 pounds at the end of two years. The diets were 1) low fat (20%) or 2) high fat (40%) 3) average protein (15%) or 4) high protein (25% of total calories).

The authors concluded that any reduced, calorie-controlled diet would help obese or overweight people to achieve weight loss that lasts. It is interesting that it did not matter whether the diet was low or high in fat, or had low or high protein content. What did matter was that all diets were low in sugar.

Sugar is the driving force

Dr. Ludwig pointed out that without insulin you couldn’t gain weight. High glycemic index food increases blood sugar. The glycemic load is the single best predictor to indicate whether a person will gain weight or lose weight when this food is consumed. It is an irony that in the 1980’s and 1990’s the obesity wave was created by the wrong assumption that a low fat/high carb diet would be heart healthy. We have abundant data available that show otherwise: high sugar content of food brings the calorie count up as everybody can read on the food labels.This will lead to weight increase, which has been abundantly proven. Sugar also stimulates your nucleus accumbens, the food addiction center. As you probably know it is extremely difficult to get out of this food addiction cycle unless you cut out sugar. You even need to go one step further and include many starchy foods that will within 30 minutes of digesting them turn into sugar. Your system makes no difference whether you eat a few teaspoons of sugar or two slices of white bread. The response of your pancreas is insulin, which gladly stores the fatty substances your liver made as fat.

How to get out of the vicious food cycle

As the quoted publications and many other ones have shown, it only matters that you limit your refined carb intake. You can vary the fat content and you can vary the protein content and still lose weight provided you watch the low carb intake. You also need portion control, which is a given! Study glycemic index and glycemic load sites on the Internet. The links I provided are just some examples. The more you educate yourself about carbs, the better for you. Note that many fruit and vegetables belong to the low-glycemic load/index foods. Avoid the high glycemic index foods like dates and cornflakes. Stick to low-glycemic index foods, which are less than 55. With regard to low-glycemic load food the values should be below 10.

The Mediterranean diet is a very desirable diet, which has been proven to be anti-inflammatory.

The zone diet of Barry Sears is also an anti-inflammatory diet and he summarizes this in this link.

How To Avoid Being Hungry

How To Avoid Being Hungry


I have summarized the content of a talk given by Dr. Ludwig. We learnt from this that sugar and refined carbs are the driving force that leads to “feeling hungry”. This stimulates your nucleus accumbens, the food addiction center. Let’s assume that a person is obese or overweight and wants to lose some weight. You need to start by being strict with yourself. Cut out sugar and high-glycemic foods. This will remove the food addiction factor that keeps you going back to the wrong, high calorie foods. You will also consume more low calorie vegetables and fruit, which have more fiber that fills you up. Once you are used to the new way of eating, there is no need to count calories. I recommend that you weigh yourself daily on body composition scales and record the results. This allows you to monitor your body mass index (BMI), your weight, your fat percentage, and your muscle percentage. Typically you will lose 2 to 3 pounds per week on such a low-calorie diet. Later the weight loss will slow down to 1 to 2 weeks per week until you reach your goal. Don’t go lower than a BMI of 21.0 to 22.0 and discuss your goal with your doctor.


Gut Bacteria Can Protect Your Brain

The neurologist, Dr. David Perlmutter gave a keynote address where he pointed out that gut bacteria can protect your brain. The topic of his actual talk was “Rewrite your brain’s destiny” and the venue was the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. Many of the talks centered around the gut microbiome. In this talk Dr. Perlmutter stressed the fact that the right mix of gut bacteria will protect your brain, while the wrong mix can make you sick. There were many slides, but too much information to mention all of details of the talk here. I will summarize the broad outline of Dr. Perlmutter’s presentation and emphasize the practical implications this has for everyday life to prevent degenerative brain diseases.

A few facts

  1. Did you know that the brain uses 25% of the body’s energy, but has only a 3% of the body’s weight?
  2. The gut flora has trillions of gut bacteria with its own DNA material. 99% of the DNA material in our body comes from the gut bacteria and the bacteria on our skin surface; only 1% of the entire DNA in the body is your own DNA. We are eating for 100 trillion bacteria, but if they are good bacteria they provide us with important vitamins and they produce molecules that stimulate our immune system.
  3. This means we better have bacteria in our guts that are friendly, not the bad bacteria that can cause us problems. An Italian study determined the gut flora of children in central Africa (Burkina Faso) and compared the gut flora to children from developed countries in Europe. There was a significant difference with the African children having a healthy microbiome in the gut and the children from developed Europe having unhealthy gut bacteria. This is important new information. Many other research papers have established that leaky gut syndrome and autoimmune diseases are linked to dysbiosis, which is the name for the unhealthy microbiome in the gut.

Chronic inflammation

Dr. Perlmutter showed several slides where literature was cited showing that chronic inflammation in the civilized world is increasing. He also showed that dysbiosis (unhealthy gut bacteria taking over) is also increasing. On several slides Dr. Perlmutter showed that in civilized countries like Iceland, Denmark, Germany, the US, Japan and others the bacterial diversity of the gut bacteria in people was vastly reduced compared to the diversity of gut bacteria of people in Kenya, Ethiopia, Nigeria or rural India. The same countries that have diminished gut bacterial diversity (dysbiosis) also have the highest prevalence of Alzheimer’s disease. On the other hand the same countries with diverse gut bacteria have a low incidence of Alzheimer’s disease. When infestation with parasites was examined there was also a parallel between increased parasitic stress and low Alzheimer’s disease rates, again in countries like Kenya, Ethiopia, Nigeria or rural India. The same countries where gut dysbiosis was present the parasitic infestation was low.

Further research has established that gut dysbiosis leads to an inflammatory condition of the gut where lipopolysaccharides (LPS) from gut bacteria are absorbed causing inflammatory reactions within the body.

At the same time this leaky gut syndrome can cause obesity and leakage in the gut/brain barrier as indicated in this link. The result is neuroinflammation, cognitive impairment and vulnerability to develop Alzheimer’s disease. Our most dreaded brain diseases come from inflammation: Alzheimer’s, Parkinson’s disease, autism, multiple sclerosis etc. These are degenerative brain disorders due to chronic inflammation. If you eat a lot of red meat, sausages and processed foods your gut microbiome will undergo negative changes. If you eat healthy food with lots of vegetables, fruit and you cut out sugar and too many starches, you have a healthy microbiome, which develops a robust immune system. We have to rethink the gut/brain connection and learn how to prevent these chronic illnesses.

Obesity and gut dysbiosis

In the link above it was shown that obesity is associated with inflammation. It was also shown with MRI scans that the part in the brain, called hippocampus was shriveled up (atrophied). This is a typical sign of dementia and Alzheimer’s disease. The investigators also confirmed with mental health functional tests that these patients had cognitive decline.

Another study also noticed that in a group of obese patients the hippocampus part of the brain was shriveled up the more obese people were. Obesity is associated with dysbiosis of the gut flora.

Practical application: the DASH diet and the Mediterranean diet are both healthy, balanced diets, strikingly different from the Standard American diet. In a study the hypothesis was tested whether the DASH diet and the Mediterranean diet would postpone dementia in a group of elderly patients. The answer was: yes, the hypothesis is true.

What does gut dysbiosis do?

It was shown in mice that chronic inflammation of the gut through ingestion of an irritant (dextran sodium sulfate) led to reduced new nerve growth in the hippocampus compared to control animals. It only took 29 days to show a marked difference between experimental and control animals in terms of reduced growth in the nerve cells of the hippocampus, the center of cognitive control.

The negative mediators were inflammatory kinins released from the gut wall and affecting the brain.

Antibiotic treatments and antibiotic residues in milk, milk products, meat, but also in all GMO foods are the irritants of the gut wall in humans. The antibiotics change the gut flora and lead to dysbiosis, which then causes gut wall inflammation and the cascade of events described above. The new finding is that GMO food contains RoundUp (they are “Roundup ready” crops). The herbicide Roundup was originally patented as an antibiotic and still leads to significant dysbiosis. Dr. Perlmutter urged the audience to buy organic food as the only method to reduce our exposure to Roundup. Roundup contributes to causing celiac disease and gluten intolerance in addition to exposure to the modern wheat (Clearfield wheat). The FDA is starting to do testing on foods for Roundup (glyphosate).

If things are sounding bad for Roundup, it only gets worse: Roundup has now been linked to causing cancer. In medicine it usually takes some time before definite action is taken. The agriculture industry is so deeply entrenched in the use of Roundup; I suspect that denial will be the first line of defense. My first line of defense in turn is to stick to organic food.

To sum up: Roundup and the Standard American diet lead to dysbiosis in the gut, which causes leaky gut syndrome. This causes inflammation with the release of cytokines and LPS from the gut wall to the blood. These substances cross the blood/brain barrier and lead to inflammation in the brain. This affects the hippocampus with the classical sign of shrinkage. But Parkinson’s disease, multiple sclerosis, autism in children and Alzheimer’s disease in older people are all caused by chronic inflammation. There are three more brain-related diseases that are related to gut inflammation: stroke, depression and attention deficit hyperactivity disorder (ADHD). Dr. Perlmutter spent some time explaining that antibiotic overuse even leads to an increase of breast cancer as a Danish study has shown. Antibiotic use showed a linear increase of breast cancer as a result of increased antibiotic amounts used. The highest group had a twofold risk compared to a control group with no antibiotic use. Dr. Perlmutter interpreted this to indicate that chronic gut inflammation can even cause a disease like breast cancer.

What can we do to diversify our gut bacteria?

  1. Exercise: A recent study has shown that regular exercise is associated with a diversified gut flora. The reason seems to be the production of butyrate with exercise, which leads to a diversified gut flora. There are reduced LPS levels (lipopolysaccharides from gut bacteria) in people with a higher fitness score.
  2. Eat a DASH diet or the Mediterranean diet as indicated above.
  3. Avoid GMO foods because of the presence of Roundup, which functions like an antibiotic and leads to gut bacteria dysbiosis.
  4. Remember “Antibiotics are weapons of mass microbial destruction”. If you need to take them be careful that you rebuild your gut flora with probiotics. Use of antibiotics increases the risk of type-2 diabetes by 1.53-fold. It also causes a quadrupling of Alzheimer’s disease.
  5. A woman should consider natural childbirth whenever possible, as with a vaginal birth the child is “anointed with gut bacteria”. Vaginally delivered children remain healthier than children delivered by Cesarean section for several years.
  6. Acid-suppressing medications and NSAIDs (anti-inflammatory medication for arthritis) can also lead to dysbiosis. Proton pump inhibitors increase the risk of Alzheimer’s disease by 44%.
  7. Prebiotic fiber can prevent Alzheimer’s. Probiotics do the same.
  8. Avoid sugar: even the Oompa Loompa knew that “If you eat sugar, you get fat” as this YouTube video shows. And obesity is associated with gut dysbiosis with the associated higher risk of degenerative brain diseases.
  9. Take magnesium supplements (250 mg twice per day) and DHA from fish oil capsules. It stabilizes your brain metabolism.
  10. In severe, persistent cases of gut dysbiosis a fecal transplant can be considered by your gastroenterologist. This procedure is done in more than 500 hospitals in the US.
Gut Bacteria Can Protect Your Brain

Gut Bacteria Can Protect Your Brain


The diversity of gut bacteria is immensely important. As discussed, in rural areas of the world there is gut bacteria diversity. In civilized parts of the world dysbiosis of the gut flora frequently occurs. This can lead to gut inflammation and the inflammation eventually gets internalized and can even reach the brain. These are the points to remember: exercise; avoid GMO foods, use prebiotics and probiotics. Avoid antibiotics; also avoid meat from animals that were fed antibiotics for faster growth. Don’t eat processed foods and avoid sugar. A healthy gut creates a healthy body, and this includes a healthy brain as well.

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Magnesium Is Essential To Life

Magnesium is an important co-factor in many biochemical reactions, so magnesium is essential to life.

Many diverse diseases and cancers can develop from magnesium deficiency. The key is to supplement with magnesium regularly to get more than the government recommended daily allowance (RDA). The RDA for magnesium is 420 mg a day for males and 320 mg a day for females.

In the following I will review the diseases that occur without enough magnesium on board.

A lack of magnesium can cause heart disease

In this 2014 study 7216 men and women aged 55-80 with at high risk for heart attacks were followed for 4.8 years. The risk of death from a heart attack was found to be 34% lower in the high tertile magnesium group when compared to the lower magnesium tertile group.

The protective mechanism of magnesium was found to be as follows. Magnesium counteracts calcium and stabilizes heart rhythms. Magnesium helps to maintain regular heart beats and prevents irregular heart beats (arrhythmias). It also prevents the accumulation of calcium in the coronary artery walls. This in turn is known to lower the risk of heart attacks and strokes.

Another study, which was part of the Framingham Heart Study, examined calcification of the heart vessels and the aorta as a function of magnesium intake.

There were 2,695 participants in this study. For each increase of 50 mg of magnesium per day there was a 22% decrease in calcification of the coronary arteries. For the same increase of magnesium the calcification of the body’s main artery, the aorta, fell by 12%. Those with the highest magnesium intake were 58% less likely to have calcifications in their coronary arteries. At the same time they were 34% less likely to have calcifications of the aorta.

In a Korean study a group with low magnesium levels was at a 2.1-fold higher risk of developing coronary artery calcifications compared to a group with normal magnesium levels.

Low magnesium increases your stroke risk

In a 2015 study 4443 subjects, men and women aged 40-75 were followed along.

928 stroke cases developed. The group with the highest 30% of magnesium intake was compared with the lowest 10% of magnesium intake. They had significantly lower blood pressure (7 mm mercury) and lower total cholesterol levels. They also had 41% less strokes than those with low magnesium intake.

In a 2015 study that lasted 24 years the authors investigated 43,000 men.

Those with the highest magnesium supplement had a 26% lower stroke risk. They had been compared to those with the lowest magnesium intake.

Among women low magnesium levels were shown to cause 34% more ischemic strokes than in controls.

This study was from 32,826 participants in the Nurses’ Health Study who were followed for 11 years.

It is clear from all these studies that supplementation with magnesium can prevent strokes.

Magnesium protects kidney function

This study examined 13,000 adults for 20 years to see how kidney function was dependent on magnesium levels. Those with the lowest magnesium levels had a 58% higher risk of developing chronic kidney disease. It makes sense when you consider that magnesium is needed to keep arteries healthy, blood pressure low, and blood sugars stable. In diabetics where blood sugar is not controlled kidneys develop kidney disease. This is called diabetic nephropathy. In the presence of magnesium supplementation and a low sugar diet people are less likely to develop diabetes or kidney disease.

Magnesium helps blood sugar control

A metaanalysis showed that magnesium supplementation was able to improve blood sugar control. This occurred in both diabetics and borderline non-diabetics within 4 months of supplementing with magnesium.

Magnesium has been known in the popular press to be an important factor in helping control blood sugar. Here is an article as an example.

Magnesium good for bones and teeth

Magnesium is important for calcium metabolism and this is helping your bones and teeth to stay strong. About half of the body’s magnesium is stored in bone. Teeth are the other location where a lot of magnesium is found.

Low levels of magnesium lead to osteoporosis, because one of the two structural components of bone (calcium and magnesium) is missing. In addition low magnesium causes inflammatory cytokines to increase. These break down bones. The Women’s Health Initiative showed that when daily magnesium intake exceeded 422.5 mg their hip and whole-body bone mineral density was significantly greater than in those who consumed less than 206.6 mg daily.

With regard to healthy teeth magnesium is important as it prevents periodontal disease.

This study found that there was less tooth loss and there were healthier periodontal tissues in 4290 subjects between 20 and 80.

Those who took magnesium supplements had healthier teeth.

Migraine sufferers improve with magnesium

A double blind randomized study showed that magnesium supplementation can reduce migraines. In this trial 600 mg of magnesium supplementation was used for 4 weeks.

This reduced migraines by 41.6% in the magnesium group compared to the non-supplemented control group.

Another study showed that both intravenous and oral magnesium are effective in reducing migraine headaches.

Intravenous magnesium showed effects on improving migraines within 15 – 45 minutes. The authors concluded that both oral and intravenous magnesium could be added as a supplement to other migraine treatments.

Cancer can be caused from too little magnesium

You may be surprised to hear that magnesium can even prevent some cancers. Two cancers have been studied in detail. I will limit my discussion to these two.

Pancreatic cancer

One study found that pancreatic cancer was reduced. 142,203 men and 334,999 women, recruited between 1992 and 2000, were included. After 11.3 years on average 396 men and 469 women came down with pancreatic cancer. On the male side they found that when the body mass index (BMI) was greater than 25.0 there was a 21% reduction of pancreatic cancer for every 100 mg of added magnesium per day. There were a lot of smokers on the female side, which interfered with the study as confounding factors undermined statistical validity.

In another study, the US male Health Professionals Follow-up Study was examined after 20 years of follow-up. Those with a BMI of above 25.0 on magnesium supplementation had a reduced risk of pancreatic cancer. The pancreatic cancer rate in the higher magnesium group was 33% lower than in the lower magnesium group. The higher group consumed 423 mg of magnesium daily, the lower group 281 mg per day. It is significant that in both studies it was the heavier patients who came down with pancreatic cancer. It is known that obesity is a pancreatic risk factor.

Colorectal cancer

A study done on Japanese men showed that magnesium could protect them significantly from colon cancer.

Men who consumed the highest amount of magnesium developed 52% less colon cancer over 7.9 years. They were compared to the group with the lowest 20% intake of magnesium. The women in this study did not reach statistical significance.

A study from the Netherlands examined colon cancer in patients. They found that only in patients with a BMI of greater than 25.0 magnesium did have protective effects. For every 100 mg of magnesium per day increase there was a 19% reduction of colon polyps. And there was also a 12% reduction of colorectal cancer for every 100 mg increase of magnesium per day.

Magnesium plays an important role in genome stability, DNA maintenance and repair. It also prevents chronic inflammation and reduces insulin resistance, all factors contributing to cancer reduction.

Live longer with magnesium

Consider that magnesium is the fourth most common mineral in the body. Add to this that magnesium is a co-factor of more than 300 enzymes in the body. Magnesium is required as an important co-factor in the conversion of chemical energy from food that we ingest. Magnesium is regulating blood sugar, blood vessel health and our brain electrical activity. 50% of our stored magnesium can be found in our bones, which helps the strength and integrity of them.

Because of the distribution of the enzymes that are helped by magnesium to function properly, virtually every cell in the body depends on our regular intake of magnesium.

Since the 1950’s soils are depleted of magnesium where vegetables are grown and fruit trees are raised. We simply do not get enough magnesium from food.

But chelated magnesium is freely available in health food stores. Take 250 mg twice per day, and you will have enough.

Because our metabolism slows down, there is a critical age where magnesium deficiency becomes more obvious than when we are younger. By the age of 70 there are 80% of men and 70% of women who do not get the minimum of magnesium-required amount they should get (350 mg for men and 265 mg for women).

At this age many people are on multiple drugs. For many proton pump inhibitors (PPI) are used to suppress acid production in the stomach. PPI’s have been associated with low magnesium blood levels.

This link explains that PPI’s should not be used for longer than 1 year.

Low magnesium levels accelerate the aging process on a cellular level. Low magnesium levels increase senescent cells that can no longer multiply. Some of them could cause the development of cancer. These senescent cells also can no longer contribute to the immune system. This causes more infections with an adverse outcome.

Remember to take chelated magnesium capsules or tablets 250 mg twice per day and you will be protected from low magnesium levels in your body.

Here is why we live longer with magnesium supplementation

Our blood vessels will not calcify as early; they keep elastic for longer, preventing high blood pressure. Our kidneys will function longer with magnesium, preventing end-stage kidney disease. We need our kidneys to detoxify our system! The more than 300 enzymatic reactions all over our body help that we have more energy and that cancer is prevented. When there are fewer strokes and less heart attacks this helps reduce mortality. It also helps that there is less of a risk for Alzheimer’s disease with magnesium supplementation, because insulin resistance is reduced, which has been shown to prevent Alzheimer’s disease.

The bottom line is we live longer and healthier; that is what is meant with longevity.

Magnesium Is Essential To Life

Magnesium Is Essential To Life


Magnesium is a key essential mineral. It balances calcium in the body and participates in many enzymatic reactions in the body as a cofactor. As long as we have enough of this mineral we won’t notice anything. It is with magnesium deficiency that things go haywire. You could get heart disease or a stroke. You could get kidney disease. You even could get pancreatic cancer or colorectal cancer. If this is not enough, magnesium deficiency can cause diabetes, osteoporosis and bad teeth. You may suddenly die with no obvious cause. But, if your magnesium blood level is balanced from regular supplements, you will carry on living and eliminate a lot of health problems.


Health Risks Of Night Shifts

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

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

Evidence of health risks of night shifts

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

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

Diurnal hormone rhythm behind health risks of night shifts

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

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

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

Health Risks Of Night Shifts

Health Risks Of Night Shifts


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

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

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High Insulin Levels Can Cause Alzheimer’s

Research published in April 2016 shows that high insulin levels can cause Alzheimer’s. Alzheimer’s disease has been known to occur more often in diabetics. But until recently it was not known why there would be this association. New research from New York University (NYU) has shed light on this puzzle. The key is an enzyme that breaks down insulin, called insulin-degrading enzyme (IDE). Melissa Schilling (no relation to me), an innovation professor at NYU has discovered the metabolic pathway between diabetes and Alzheimer’s disease. This finding has enormous implications regarding the prevention of Alzheimer’s, as I will discuss below. Here is a link to the original paper.

Background information about Alzheimer’s

Alzheimer’s disease affects about 5.2 million Americans and 44 million people worldwide. There is a progressive loss of cognitive functioning over a long period of time due to senile plaques in the cerebral cortex and the subcortical areas of the brain. These senile plaques are made up of amyloid-beta substance and of neurofibrillary tangles. This protein material is like glue, which prevents the neurons from working properly and causes memory loss and the confusion, which is so typical for Alzheimer’s patients. Normally amyloid-beta is in solution and prevents lipoproteins in the brain from oxidizing. But when the insulin-degrading enzyme is busy breaking down high levels of insulin, this enzyme system is overwhelmed. Amyloid-beta gets supersaturated, as it is not eliminated at a normal speed. This leads to the glue-like deposits of amyloid-beta in Alzheimer’s brains.

It is estimated that in 2004 the direct cost to the US of Alzheimer’s disease was $214 billion. By 2050 this could go up to $1.5 trillion, if no cure is found.

High insulin levels can cause Alzheimer’s, but other mechanisms too

Professor Schilling found in her research that there are four main malfunctions that can lead to high amyloid-beta in the brain of Alzheimer’s patients.

  1. With diabetes type1, when the patient does not receive enough insulin, the insulin-degrading enzyme in the brain is not working hard enough. This results in inadequate removal of amyloid-beta from the brain and neurofibrillary tangles of amyloid-beta are deposited.
  2. IDE requires zinc as a co-factor to work properly in breaking down amyloid-beta. Zinc deficiency is quite common, particularly in older people. With this mechanism insulin levels are normal, but amyloid-beta is removed poorly, as IDE function is diminished.
  3. In early type 2 diabetes there are high insulin levels and there is a competitive inhibition of the elimination of insulin and amylin-beta. This is probably the most common form of getting Alzheimer’s disease.
  4. Excess production of an amyloidogenic protein can lead to an overabundance of amylin-beta, which overwhelms the insulin-degrading enzyme.

What treatment options are there for Alzheimer’s disease?

Several implications follow from the four mechanisms that were described above.

  1. If a type 1 diabetic patient is insulin deficient, intranasal insulin would be beneficial.
  2. If the patient has type 2 diabetes, intranasal insulin or injected insulin would be the wrong approach. As stated earlier, there is the competitive inhibition of the elimination of insulin and amylin-beta. It is the insulin-degrading enzyme, which is the limiting factor. Simple dietary changes are needed where sugar is cut out and starchy foods are limited. This normalizes insulin levels and the IDE function returns to normal.
  3. Alzheimer’s patients and patients with mild cognitive dysfunction should be tested with glucose tolerance tests (GTT). It the test is abnormal, a knowledgeable dietician should be consulted.
  4. Obesity is strongly associated with hyperinsulinemia and diabetes. Again frequent GTT should be done followed by dietary intervention when abnormal.
  5. Professor Melissa Schilling stated that 86 million Americans are pre-diabetic, but they have no symptoms. Only glucose tolerance testing can diagnose that condition. This will prevent a lot of cases of diabetes and Alzheimer’s disease.
  6. Large parts of the population have no knowledge of the glycemic index of carbohydrates. In order to limit glucose overload and excessive insulin production educational nutritional programs are needed. This will be a powerful tool in Alzheimer’s disease prevention.
High Insulin Levels Can Cause Alzheimer’s

High Insulin Levels Can Cause Alzheimer’s


It has been known for some time that diabetics have a higher rate of Alzheimer’s disease. Alzheimer’s has also been called “Diabetes of the brain” or “Type 3 Diabetes”. This new research has shed some light on the connection of elevated insulin to Alzheimer’s disease. It was news to me that there is a competitive inhibition of the elimination of insulin and amylin-beta via the insulin-degrading enzyme. It boils down to recognizing that sugar overconsumption causes Alzheimer’s disease. If you want to keep your brain power until a ripe old age, you better eliminate a lot of sugar and adopt a healthy Mediterranean diet.

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Commuting Affects Your Health

A research report from Great Britain was recently reviewed by CNN; it revealed that commuting affects your health.

The longer we commute to work and back the more downtime we have where we do not move our muscles. But we also are exposed to more unhealthy snacks and sugary drinks that make us deposit more fat. The original research report was published here. What were the elements of this study?

Commuting affects your health, study design

Three consecutive annual waves of the British Household Panel Survey were utilized. These are longitudinal surveys of nationally representative households in Great Britain. The sample years were 2004/2005, 2005/2006 and 2006/2007. There were 15,791 participants in the study. Of these 4,056 were selected for the study. The main mode of travel to work was determined at each time point. The self-reported height and weight was taken to calculate the body mass index (BMI) at baseline and at 2 years. Attention was paid to switches of transportation mode (that is from active to sedentary and vice versa).

Commuting affects your health, results of study

  1. Switching from car commute privately to active travel (walking, bicycling) or public transport resulted in a significant loss in BMI. There were even larger reductions of BMI’s in those who enrolled in the first year in active transportation, because of the longer exposure. Those with the longest journeys who used active transportation had significant weight losses.
  2. A group of 787 people switched from active travel or public transport to the use of their private cars as transportation. This resulted in a significant BMI increase.
  3. The study concluded that any interventions that would allow private car commuters to switch to an active mode of transportation could contribute to the population’s BMI being reduced significantly.

Commuting affects your health, Cambridge experiment

In a 2016 study from Cambridge (Great Britain) a similar experiment was done. They studied traffic patterns in the county of Cambridgeshire. 1143 adults working in the city were compared with 1710 people who used the Cambridgeshire Guided Busway and who were intercepted. A new bus network that is intertwined with pedestrian pathways and cyclists had been open to the public since 2011. Walking and cycling were incorporated into longer commuting journeys where otherwise private car and public commute were used. There was a 1.8-fold increase of active travel after exposure to intervention where the benefit of active travel was explained to people. There was also a 2-fold decrease of commuting solely by car. The weekly cycling commuting time had increased to 1.34-fold compared to the previous level.

Those who had been most inactive in their commute at baseline were the ones who appreciated an active commute most. There was an association of active commuting, greater overall physical activity with an improvement of health and weight loss.

Commuting affects your health, US study

A multi-city study involved the largest 3,914 municipal jurisdictions, which were located in 473 of the most populous U.S. counties. This involved 48 states and the District of Columbia. In order to encourage more active commuting (walking, cycling) pedestrian zones or pedestrian-friendly zones with adjacent bus transportation were developed by many municipalities. A new concept of transit-oriented developments or districts (TODs) was adopted. TODs are higher density areas that are compact. They are mixed use areas, which are located around transit stops. This encourages walking. The study was published in 2016 and showed that the TOD zones had higher occupancy rates and many house owners had no car as they used public transportation only. TOD zones were more populous, people in it had higher income, and they were more racially diverse and younger. The occupants of TOD zones had a 2.1-fold higher rate of using public transportation and they also had a 2.48-fold higher rate of using active transportation to work.

Commuting affects your health, general comments

The majority of commuters in England and Wales spent 56 minutes in their cars going to and from work in 2013. In London this daily commuting time is 79 minutes. The US data are similar.

With a well-developed public transportation system the authorities developed various programs designed to replace at least some part of the commute by active commuting. This is good for your metabolism, it is good for your cardiovascular status and it gets you away from snacking junk foods while you are bored in your car.

In an poll from London, England where more than 1500 commuters were polled 55% reported increased stress levels, 33% reported increased snacking, 29% admitted to fast food consumption, 36% complained about sleeping problems, 41% said that they were doing reduced physical activity and 44% reported that they spent reduced time with their friends and family. 58% felt that flexible work hours would improve their health and wellbeing. Remember that how you are commuting affects your health.

My own experience watching commuting in various cities

Over the years I have traveled extensively in Germany, Austria and the US. In Europe it is interesting how many years ago the pedestrian zones in the old town centers have reshaped the commuting. The U-Bahn (subway) and commuter trains have intermingling networks that shoot you out to pedestrian zones. You are forced to walk before you can catch a connecting bus or tram.

  1. Vienna (Austria) for instance allows you to get out at the U-Bahn station of Stephansplatz, which is a pedestrian zone around the Stephan’s Church (Stephanskirche). There is an amazing array of shops and in a side alley you can even find a Starbucks, if you are so inclined. When you get tired of walking, you hop onto any of the U-Bahn connections. This brings you where you need to be. If you are too far from your goal, hop onto a tram and enjoy the sightseeing. There are also buses that can get you there. It is all covered under the same Vienna card, which I appreciated as a visitor. It is best to park your car in the periphery and use the commuting network to get you to where you want to go.
  1. Munich (Germany) has a lot of cycle paths, which run parallel to the pedestrian paths. I was surprised recently to see business people in black suits cycle to work. Otherwise there are the U-Bahn, S-Bahn, trams and buses that all interconnect.
  2. Münster (North Rhine-Westphalia, Germany) has an extensive network of cycle paths and pedestrian walks. Buses and trams are also constantly running. The old historic town is a pedestrian zone, but anybody can commute to anywhere between walking or using the bus/tram. I was amazed this spring when I visited; there were hundreds of people, young and old who cycled to and from work. The employers are providing huge metal racks where people can attach their bikes to with a lock.
  1. Berlin is another multi level commuting city in Germany. You can use the U-Bahn, S-Bahn (commuter train), bus or tram to get to work. Here is an informative video that explains.  I did not see many cyclists there. But hundreds of people are walking. Yes, there are many pedestrian zones and they interconnect with all of the commuter options. Berlin spreads over a vast area, so the S-Bahn, which is a local commuter train is particularly important. The shorter connecting trips are done by U-Bahn (subway). Buses and trams do the fine-tuning to get to your destination.
  2. Vancouver (BC, Canada) has some cycle pathways in the West end, close to Stanley Park. Otherwise there is a network of buses, the Skytrain, Sea Bus (between North Vancouver and downtown) and the West Coast Express (a commuter train). For the size of the city I think that Vancouver could benefit from studying some of the transportation modalities in Europe to entice the car travelers to use public transportation. When I travel to Vancouver, I use my own car, as it is so much faster to reach any goal. Public transportation is at this point not effectively connecting all the areas in this city.
Commuting Affects Your Health

Commuting Affects Your Health


In the past we often heard that there was nothing that could be done about traffic jams and commuter stress. Think again. Revitalization of city cores all over Europe, Great Britain and in the US has taken the TOD concept to heart and active commuting has become a reality. Whenever you can, use alternatives like cycling, walking and public transit to get to and from work. Studies have even shown that when you become an active commuter you likely will also become more active after work. Even using public transit makes the commute more active, as you are not sitting for an hour or more in your vehicle. You have to get out and walk in order to catch a connection. This all helps to keep you physically more fit than the commuting style, where you sit in a vehicle and possibly dip into junk food. It is not only about body mass index reduction and decreasing your waistline. Active commuting is also a lot less stressful than the passive modality, where traffic jams add to frustration and stress at the beginning and at the end of a workday.

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Sugar Can Cause Heart Attacks

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

Denying that sugar can cause heart attacks

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

New evidence that sugar can cause heart attacks

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

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

Sugar can cause heart attacks, but review paper ignores this

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

Effect of the literature review on heart attack rates

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

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

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

How sugar can cause heart attacks and more

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

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

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

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

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

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

Sugar Can Cause Heart Attacks

Sugar Can Cause Heart Attacks


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

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


Seven Steps To Live Over 100 Years

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

Seven Steps To Live Over 100 Years

Seven Steps To Live Over 100 Years


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


Avoid BPA

After a lot of bad press as a hormone disruptor we know we should avoid BPA. Bisphenol A (BPA) is a synthetic compound that has been used since 1957 in plastic bottles and as lining inside cans, so they don’t rust.

Study showing why we should avoid BPA

Recently BPA has again hit the media as a new study has shown that there are things we can do to avoid high concentrations of BPA by changing our lifestyle.

This media report is based on a scientific study that Jennifer Hartl and coworkers have done. They followed patients who had consumed various items known to be contaminated with BPA and measured their urine BPA concentration 24 hours later. 9% of their study participants had consumed one can of food or more, while 2% had consumed 2 cans of food or more on the previous day. When one can of food consumed was compared to none, 24% of higher BPA concentration in the urine was found. With two cans of food consumed versus none 54% of higher BPA concentration was found in the urine tests.

When one or more specific types of canned foods were compared to none consumed, some interesting differences emerged. Canned vegetables and fruit showed 41% higher BPA in the urine test. Canned pasta measured 70%, but canned soup 229%. The researchers also tested canned beverages. None of them were associated with elevated BPA in urine tests.

What BPA does

93% of Americans 6 years and older have BPA in their urine indicating that it is in our bodies, and the body is attempting to get rid of it. It is known as an endocrine disruptor, but how effective BPA is as an endocrine disruptor remains to be seen. This link described that BPA is 800-times weaker as an estrogen blocking substance compared to soy products.

There are two mechanisms of action where BPA interferes with normal body function.

  1. BPA functions as a weak estrogen and binds to the nuclear estrogen receptor. This partially blocks the action of the body’s own estrogen function.
  2. There is also a membrane based estrogen receptor on body cells that is involved in cell signaling and gene expression. BPA can add methyl groups to DNA, which silences gene expression. This latter mechanism is much more sensitive to BPA (probably by a factor of 1000-times) than the traditional effect on the nuclear estrogen receptor.

It is these newer findings that are of concern with regard to fertility in males as this study on rats showed: It is important that babies are not fed using regular plastic bottles, but rather that BPA-free bottles or glass bottles are used to avoid BPA exposure. Babies and children are particularly vulnerable to the hormone blocking effects of BPA as well as the interference of brain development and maturation by BPA.

Manufacturing of BPA free plastic

In an attempt to avoid BPA in manufacturing of plastic bottles and food containers industry has used other chemicals, among other materials something called BPS. This stands for “Bisphenol S”. A research paper found that BPS is an endocrine disruptor as much as BPA is and causes fat cells to grow rapidly. According to the author of this publication it may be partially responsible for the obesity wave. The author of this study recommends using glass containers as much as possible to avoid transfer of either BPA or BPS to food that comes in contact with plastic materials.

Avoid BPA from receipts

Have you ever thought that you may be able to absorb BPA through your skin from receipts when you buy items at a store? Yes, the receipt that is printed on heat sensitive paper has BPA on it that gets absorbed through the skin. If you scratch the printed part of the paper and it leaves a dark mark, it is thermal paper.

In this study workers were handling thermal receipts for four hours and their urine was monitored for BPA the following day. Another group was handling thermal receipts for 8 hours. In the first group that was exposed for 4 hours the BPA concentration in the urine rose to three times higher than the base rate. The second group exposed for 8 hours had BPA levels that were five times higher than the base rate. For comparison another group was measured that was wearing surgical gloves and their BPA concentration in the urine showed no change from the baseline.

I have changed my way of shopping. I think about whether I would ever want to exchange the item I just bought. If not, I tell the clerk that I do not want a receipt and the receipt is thrown out.

How you can avoid BPA exposure

  1. Do not use plastic containers to heat food in a microwave, use glass containers instead.
  2. Avoid all plastic food containers that have a “7” printed in a triangle on the bottom. Among these is a significant number that will release BPA over time.
  3. Avoid canned soups, such as tomato soup or canned mushroom soup. The paper reviewed at the beginning of this review showed these led to the highest BPA readings in urine tests the following day.
  4. Keep in mind that 2 out of 3 cans in supermarkets are positive for BPA. Eat as much fresh or frozen food as you can, but avoid canned food.
  5. Many canned beverages (such as beer, soda, juice) are acidic; this means that their thermal processing requirement is much different requiring lower temperature where BPA does not leach from the bottle into the stored fluid. These drinks when tested were BPA free.
  6. Among drinking water containers the following have been tested: Aquafina, Dasani, Arrowhead, Fiji and Kirkland Signature bottled water from Costco. They were all BPA free. Most water companies have now switched to BPA free containers, but avoid the containers with the “7” in a triangle as already stated, as some of them may leach BPA into the bottle content.
  7. Use fresh, unpackaged foods as much as possible. For instance, fruit and vegetables can often be had unpackaged. If it is packaged, check the type of plastic it is packaged in and do not buy, if you are unsure.
  8. Whenever possible, avoid handling thermal receipts; if possible, get an email receipt instead to avoid BPA exposure through the skin.
Avoid BPA

Avoid BPA


There has been a silent revolution where more and more plastic and resins have entered our lives. With it came the exposure to BPA, which is an endocrine disruptor. This may have consequences regarding male fertility, change of fat metabolism in both sexes with weight gain as the end result. It also interferes with brain development in the fetus and in young children. BPA has to be considered as a poison.

In this blog I have shown ways to reduce exposure to BPA. We need to eat more fresh vegetables and fruit that are not sold in plastic, or if plastic is used for packaging, the containers must be BPA and BPS free. The labeling of containers needs to be made mandatory by the FDA and/or EPA. Whenever possible we need to return to glass containers that are guaranteed BPA free. Also bear in mind that heating plastics can release toxins. If you are heating food in a microwave, do not use plastic containers. Instead any use glass or ceramics, which are known to be safe!

Additional reference (Questions about BPA answered):