Jan
28
2017

Cardiovascular Disease And Inflammation

Dr. Mark Houston talked about cardiovascular disease and inflammation – “the evil twins”. He presented this lecture at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. Dr. Houston is an associate clinical professor of medicine at the Vanderbilt University Medical School in Nashville, TN 37232.

New thinking about cardiovascular disease and inflammation

Dr. Houston pointed out that the old thinking about cardiovascular disease has to be replaced with the new thinking. Here are a number of points regarding the new thinking.

  1. Coronary heart disease and congestive heart failure are diseases of inflammation. They are also coupled with oxidative stress, vascular immune dysfunction and dysfunction of the mitochondria.
  2. In the past it was difficult to reduce these cardiovascular diseases. With the new thinking there are now new treatment approaches that help cure cardiovascular disease.
  3. The development of heart disease has a long history. Endothelial dysfunction predates coronary artery disease by many years. This is followed by vascular smooth muscle dysfunction. Inflammation develops and structural changes occur in the small and larger blood vessels with atheromatous deposits (plaques) and final occlusion, at which point you get a heart attack.

Canadian physician Sir William Osler has already stated more than 100 years ago “A man is as old as his blood vessels”.

The old thesis was that cholesterol would lead to deposits that close coronary blood vessels and cause heart attacks. Dr. Houston called this the “cholesterol-centric “ approach. The truth is that with conventional blood tests you are missing 50% of all the high-risk patients that are going to develop heart attacks. They are missing the ones that have chronic inflammation, but normal cholesterol levels.

What was not known in the past was that oxidative stress associated with normal aging can lead to chronic low-grade inflammation. This oxidative stress leads to mitochondrial DNA changes. Associated with it are biochemical changes that cause chronic inflammation, which in turn will affect the lining of the arteries. There is a metabolic change described in the literature as metabolic syndrome, which leads to high blood pressure, hardening of the arteries and eventually heart attacks and strokes. The key today is to include in screening tests all parameters that will predict who is at risk to develop a heart attack or not.

Blood tests to screen for cardiovascular disease and inflammation

Blood tests and health history should be checked for dyslipidemia, high blood pressure (hypertension), hyperglycemia, smoking, diabetes, homocysteinemia, obesity etc. Also, patients with high GGTP (gamma-glutamyl transferase) levels in the blood are more at risk to develop diabetes. This in turn leads to inflammation of the arterial wall and heart attacks. There are 25 top risk factors that are associated with all causes for heart attacks.

Briefly, apart from the 7 factors already mentioned above the physician wants to check for high uric acid levels (hyperuricemia), kidney disease, high clotting factors (fibrinogen levels), elevated iron levels, trans fatty acid levels, omega-3 fatty acid levels and omega-6 to omega-3 ratio, low dietary potassium and magnesium intake with high sodium intake, increased high sensitivity C reactive protein level (hs CRP measuring inflammation). The list to test for cardiovascular disease risk continues with blood tests for vascular immune dysfunction and increased oxidative stress, lack of sleep, lack of exercise, subclinical low thyroid levels, hormonal imbalances for both genders, chronic infections, low vitamin D and K levels, high heavy metals and environmental pollutants.

The speaker stated that he includes a hormone profile and vitamin D levels. He does biochemical tests to check for mitochondrial defects. Micronutrients are also checked as cardiovascular patients often have many nutritional deficiencies. Inflammation is monitored through testing the levels of C-reactive protein (CRP).

In order to assess the risk of a patient Dr. Cohen, a cardiologist has developed the Rasmussen score, which is more accurate than the Framingham score.

The following tests are performed on the patient: computerized arterial pulse waveform analysis (medical imaging), blood pressure at rest and following exercise and left ventricular wall of the heart by echocardiography. Further tests include urine test for microalbuminuria, B-type natriuretic peptide (BNP, a measure of congestive heart failure), retinal score based on fundoscopy, intima-media thickness (IMT, measured by ultrasound on the carotid artery) and electrocardiogram recording (EKG).

Here is what the Rasmussen score means:

  • Disease score 0 to 2: likely no heart attack in the next 6 years
  • Disease score 3 to 5: 5% likely cardiovascular events in the next 6 years
  • Disease score > 6: 15% likely cardiovascular events in the next 6 years

Non-intervention tests to measure cardiovascular health

1. The ENDOPAT test

With this test the brachial artery is occluded with a blood pressure cuff for 5 minutes. Endothelial dysfunction is measured as increased signal amplitude. A pre- and post occlusion index is calculated based on flow-mediated dilatation. The values are interpreted as follows: an index of 1.67 has a sensitivity of 82% and specificity of 77% to predict coronary endothelial dysfunction correctly. It also correlates to a future risk for coronary heart disease, congestive heart disease and high blood pressure.

2. The VC Profile

This test measures the elasticity of the arteries. There is a C1 index that measures the elasticity of the medium and smaller vessels and the C1 index, which measures elasticity of the larger arteries and the aorta. The smaller the numbers are, the less elastic the arterial walls.

3.The Corus CAD score

This is a genetically based blood test. The score can be between 0 and 40. If the score is 40, there is a risk of 68% that there is a major blockage in one or more coronary arteries.

4. Coronary artery calcification

The CAC score correlates very well with major event like a heart attack. There is a risk of between 6- and 35-fold depending how high the CAC score is. The key is not to wait until you have calcification in your coronary arteries, but work on prevention.

Treatment of cardiovascular disease and inflammation

When heart disease is treated the doctor needs to address all of the underlying problems. It starts with good nutrition like a DASH diet or the Mediterranean diet.

Next anti-inflammatory and other supplements are added: curcumin 500 mg to 1000 mg twice a day, pomegranate juice ¼ cup twice per day, chelated magnesium 500 mg twice per day, aged garlic 1200 mg once daily, taurine 3 grams twice per day, CoQ-10 300 mg twice per day and D-ribose 5 grams three times per day. This type of supplementation helps for chest pain associated with angina. On top of this metabolic cardiology program the regular cardiac medicines are also used.

Additional supplements used in the metabolic cardiology program may be resveratrol 500 mg twice per day, quercetin 500 mg twice per day, omega-3 fatty acid 5 grams per day, vitamin K2 (MK 7) 100-500 micrograms per day and MK4 1000 micrograms per day. In addition he gives 1000 mg of vitamin C twice per day. This program helps in plaque stabilization and reversal and reduction of coronary artery calcification.

Case study showing the effect of metabolic cardiology program

Here is a case study of a heart patient that was treated by Dr. Houston. He was a white male, first treated for congestive heart failure as a result of a heart attack in June 2005. Initially his ejection fraction was 15-20%. His medications were: digoxin 0.25 mg once daily, metoprolol 50 mg twice per day, ramipril 10 mg twice per day, spironolactone 25 mg twice per day and torsemide 20 mg once daily. These medications were kept in place, but the metabolic cardiology program was applied in addition. Here are the results of his ejection fraction (EF) values after he was started on the metabolic program:

  • Initial measurement: EF15-20%. Marked shortness of breath on exertion.
  • 3 months: EF 20-25%. He reported improved symptoms.
  • 6 months: EF 25-30%. He said that he had now minimal symptoms.
  • 12 months: EF 40%. He had no more symptoms.
  • 24 months: EF 50%. He reported: “I feel normal and great”.
  • 5 years: EF 55%. He said” I feel the best in years”.

A normal value for an ejection fraction is 55% to 70%.

Cardiovascular Disease And Inflammation

Cardiovascular Disease And Inflammation

Conclusion

Testing for heart disease risk has become a lot more sophisticated than in the past, and the tests have opened up a window to early intervention. Metabolic cardiology is a new faculty of cardiology that assists in the reversal and stabilization of heart disease. It will help high blood pressure patients and stabilizes diabetes, which would otherwise have deleterious effects on heart disease. Metabolic cardiology improves angina patients. It also prevents restenosis of stented coronary arteries. As shown in one clinical example reduced ejection fractions with congestive heart failure will improve. This was achieved solely through the metabolic cardiology program.

As usual, prevention is more powerful than conventional treatment later. To give your cardiac health a good start, don’t forget to cut out sugar, exercise regularly and follow a sensible diet.

Incoming search terms:

Nov
05
2016

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

Conclusion

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.

Oct
01
2016

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

Conclusion

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.

Incoming search terms:

Apr
23
2016

Healing Powers Of Green Tea

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

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

Alzheimer’s disease

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

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

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

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

Cardiovascular disease

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

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

Obesity

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

Diabetes

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

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

Autoimmune disorders

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

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

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

Cancer

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

Toxicity of green tea extract

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

Healing Powers Of Green Tea

Healing Powers Of Green Tea

Conclusion

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

Incoming search terms:

Dec
26
2015

Coffee Could Be A Lifesaver

Coffee has long been a subject of heated discussions. It has been praised or condemned. Many studies have been done in the past; some showed health benefits, some did not. A new, larger study was done by the Department of Nutrition, Harvard School of Public Health in Boston, MA to re-examine this issue for both caffeinated and decaffeinated coffee.

Mortality was determined among 74,890 women in the Nurses’ Health Study (NHS), 93,054 women in the NHS 2, and 40,557 men in the Health Professionals Follow-up Study after a medium follow-up of 22.5 years. 19,524 women and 12,432 men died during that time period. Ming Ding is a doctoral student in the Harvard School of Public Health department of nutrition and was the lead author of the study that was published in the medical journal “Circulation”. She pointed out that in the past there were confounding problems: although many studies had shown that both caffeinated and decaffeinated coffee consumption lowered the risk of cardiovascular disease, the results in many studies were blurred. Studies often did not distinguish between smokers and nonsmokers; so a beneficial effect from coffee drinking was wiped out by the cardiovascular risk from smoking.

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 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.

However, when all the confounding factors were removed and the various groups were compared again the following 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.

Ming Ding was associated with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and 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, Ding 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”.

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 reached, whether there was yet another hidden confounding factor or whether there were detrimental effects on the adrenal glands with too much 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.

Finally, there was another peculiar finding; suicides were down by 20% to 36%, if a person drank at least one cup of coffee per day. But 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. But other studies have also shown 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.

Discussion

The Department of Nutrition, Harvard School of Public Health in Boston, MA has excelled in high quality nutritional studies for decades. But 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.

The important findings were that both caffeinated and decaffeinated coffee have the same effect of saving 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 had the same effect as regular coffee was important.

Coffee Could Be A Lifesaver

Coffee Could Be A Lifesaver

Conclusion

Here is a study that is large enough, went long enough, and showed decisively that both caffeinated and decaffeinated coffee will reduce the death rate by 15% up to 5 cups of coffee per day. This finding was true for both males and females. Coffee seems to also reduce the suicide risk by a mechanism that has not yet been determined. If you want to live 15% longer than your previous life expectancy would have been without coffee, you may now have your coffee and enjoy it!

Aug
07
2015

Sugar As White Death

Sugar is causing disability and mortality to a much higher degree than most people are aware of: a recent study pointed out that worldwide 184,000 deaths per year are attributable to sugar-sweetened beverage consumption; among those there are 133,000 deaths from diabetes, 45,000 deaths from cardiovascular disease and 6,450 deaths from cancers. Those people who developed disabilities from strokes, heart attacks, osteoporosis and severe arthritis measured 8.5 million disability-adjusted life years throughout the world and were related to sugar-sweetened beverages. 4.5% of these were from diabetes that was related to sugar-sweetened beverages.

These statistics are only regarding sugar-sweetened beverages! This does not take into account mortality from sugar in processed foods, in cookies, cakes and candies. It also does not take into account starchy foods like pasta, bread, bagels, white rice etc. that are all digested by amylase in the mouth and in the gut to turn into sugar within half an hour of ingesting them.

In the following I like to give an overview of what sugar does to our system.

History of sugar production

The initial production of refined sugar was developed in India as this review of the history of sugar shows.

In Great Britain the consumption of sugar was 4 pounds per person per year in 1700; it rose to 18 pounds per year in 1800, to 36 pounds per year by 1850 and over 100 pounds per year by the twentieth century. Similar figures are true for the US and in all developed countries. In 1747 the German chemist Andreas Marggraf identified sucrose in beet root. Since then technology was developed to extract sugar from the beet root, which was cheaper to do than extracting it from sugar cane. Both methods are in use today. In addition high-fructose corn syrup has been developed in 1970 and it replaces sugar in many uses, for instance in soft drinks and in processed foods.

Overall we are exposed to sugar in all disguises, such as sugar-sweetened beverages, candies, sweetened yogurt that is sold as “healthy”, power bars that are sugar laden and many more.

Effect of sugar on our bodies

1. Diabetes

As already pointed out above the average sugar consumption has increased from 4 pounds per person in 1700 to above 100 pounds per person in our time. Our poor pancreas has to cope with this additional burden of sugar and if it can’t, we get diabetes. The CDC says that in 2008 there were 8 cases of new type 2 diabetes cases per 1000 people in the US. The CDC projects that in 2050 this number will likely increase to 15 new cases of type 2 diabetes per 1000 people.

This shows you that the capacity of the human pancreas is limited. There is a breaking point regarding our insulin production. The insulin production has a limit, because the insulin producing cells in the pancreas can only produce a limited amount of this sugar-clearing hormone. When this point is reached the person is said to have developed diabetes. Diabetes causes heart attacks, strokes, kidney failure, blindness and circulation problems in the legs leading to amputations.

2. Cardiovascular disease

Diabetes is not the only problem that sugar causes. Our cardiovascular system is suffering because sugar makes the liver produce more LDL cholesterol that gets oxidized by sugar; the triglycerides are rising as well with continued sugar intake and with too much sugar intake there is excessive weight accumulation causing type 2 diabetes. This leads to more lipids in the arterial walls, called arteriosclerosis. The end results are heart attacks and strokes.

3. Cancer

It may not be obvious how sugar intake can lead to cancer. But sugar has been found to oxidize tissues and in the process produce dangerous free radicals. This causes chronic inflammation leading to mutations in the DNA of cells and weakening of the immune system. This will in time lead to cancer. Many cancer researchers have investigated this in detail in the last decades. I reviewed this in this blog, if you would like more information about it.

4. Brain atrophy and Alzheimer’s disease

Sugar overconsumption has been found to be one important factor in the development of Alzheimer’s disease, which is associated with the development of brain atrophy. Brain atrophy is just the mirror lesion in the brain that comes from hardening of the arteries. Brain atrophy develops when not enough nutrients and oxygen reach your brain cells. Part of the brain surface dies off and memory cells are lost. The end result is dementia or Alzheimer’s. Read more about this here.

5. Arthritis can come from sugar overconsumption

As I have summarized in this blog arthritis often is due to over consumption of processed foods including sugar products.

As I am explaining in this blog Dr. Hoffer has developed a simple supplementation for arthritis that will reverse the metabolic changes that are associated with arthritis. But you must switch to a Mediterranean diet without sugar and starchy foods, if you want to experience relief from your arthritis symptoms.

6. Low fat diet not helpful to reduce heart attack rates

As I pointed out before the low fat diet that was popular in the 1980’s until the early 2000’s did not help reducing heart attacks.

The low fat diet was laden with sugar, meaning that it was a low fat, high carb diet, and all of the problems I described above with weight gain, high LDL, high triglycerides and the development of diabetes caused more heart attacks and strokes. The real solution to preventing obesity and lowering heart attacks and strokes is to use a low carb/low to medium fat diet like the Mediterranean diet.

7. We need our muscles in older age

When we eat too many carbs from chocolate, candy, donuts and pasta there is not enough quality protein in our food to feed our muscles. If this is combined with a lack of exercise we are in double trouble of having flaccid muscles. This leads to falls and fractures, but is entirely preventable by eating a proper diet and exercising regularly.

8. ADHD can be fuelled by sugar

I have reviewed ADHD (attention deficit hyperactivity disorder) and mentioned that sugar and gluten sensitivity may be part of the problem. It is important to sort out nutritional factors by going through an elimination diet. Often our Western style diet (sugar and fat rich) is making things worse for the child with ADHD.

Apart from other measures avoiding sugar is very important for the ADHD patient.

9. Chronic inflammation

What causes chronic inflammation in the body and is responsible for both hardening of the arteries as well as arthritis? If you guessed sugar intake, you guessed right. I explained this in detail in this blog.

This concept is one of the biggest new things in the 21st century. The research goes back to the mid-nineties and culminated in the detection of an inflammatory marker, the C-reactive protein (CRP). The CRP level can now be used as a readily available blood test to detect inflammation in the body. Often this test will be positive in patients with arthritis, autoimmune diseases and cancer.

10. Obesity

Processed food contains wheat and sugar. The problem is that the high gliadin concentration in the Clearfield variety of wheat makes people addicted to food and sugar makes them gain weight. This is the cause of the obesity and diabetes wave. The remedy is to cut out all wheat and sugar as well as starchy foods. Switch to a Mediterranean diet without sugar and starchy foods.

11. Pimples and acne

Who would have thought that acne could come from a combination of sugar and milk products? Careful epidemiological studies have shown that in some regions of Africa, Brazil and Japan teenagers who eat the local food do not get acne, but when they switch to a Western style diet they come down with acne.

12. Tooth decay from too much sugar

Gum infections and severe tooth decay were found in the 1990’s to cause inflammation in the blood, which can be measured by using the C-reactive protein (CRP). Streptococcus viridans, a bacterium that populates gums and teeth can cause subacute endocarditis, a dangerous infectious disease of the heart valves, which can be responsible for sudden death in younger persons. There are other bacteria in the mouth that feed on sugar that we eat, particularly if we do not brush and floss our teeth regularly. This means there is double trouble: Sugar causes cavities and gum disease, but also causes heart attacks and heart valve infections.

Sugar As White Death

Sugar As White Death

Conclusion

When you consider how many organ systems are affected by sugar and starchy food consumption it is no wonder that people say that they feel better when they switch from the standard American diet to a Mediterranean type diet. We do not really want to buy a heart attack, a stroke, diabetes and Alzheimer’s disease when we go to the grocery store. But this is what you get in time when you buy the starchy foods and sugar containing processed foods that are in the center part of the grocery store. When I go shopping I always eye the groceries of my neighbor before or after me. Sometimes it is scary to look at the content of some of the shopping wagons. There is bread, potato chips, pretzels, chocolate bars, cookies, and the whole lineup that is really rich in sugar. Healthy yoghurt mixed with sugar has become unhealthy, granola is loaded with honey or maple syrup, jams contain 50% sugar, and on and on it goes. It is sobering to see how illness and disability is for sale, one shopping at a time. The reassuring truth is that you have choices!

Incoming search terms:

Dec
27
2014

Stem Cells, Telomeres, Hormones And Lifestyle

I recently attended the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec.10 to 14, 2014) and stem cells, telomeres, hormones and lifestyle were the highlights this year. Every year there seems to be something new to learn. There were a lot of talks about stem cell treatments, about how lifestyle changes can be healing and how telomeres are in the center of epigenetics. Epigenetics is anything a person can do with lifestyle to help the body work better. In the center of many talks were telomeres, the small caps at the end of the DNA. With every cell division telomeres get shortened a bit until at the end of our lives our telomeres are significantly shorter. In one talk a slide was shown where the measurements of white blood cell telomeres from blood tests of a population from 20 to 100 years were shown. At the age of 100 the average telomere length was only 40% of the average length of telomeres of the group at the age of 20.

In the past it was thought that our genes and how they function was something constant. Well, we have to rethink this both in positive ways as well as negatively. Using telomere blood tests it has been shown that certain diseases are associated with shorter telomeres. But on the other hand positive lifestyle changes and certain supplements can elongate telomeres by stimulating an enzyme called telomerase. Drinking excessively, doing drugs, smoking and even using non-steroidal anti-inflammatory drugs (NSAIDs) shorten your telomeres. This is what epigenetics is all about. It is true that you cannot change your genetics, but you can change the epigenetics (meaning the length of telomeres).

As this topic is so large, I have decided to give an overview about the conference in this blog and in future blogs provide more details about some of the key talks.

A review like this is always personal. Other people probably would find other talks more illuminating. So here are my personal impressions about the topics that I found most fascinating.

Stem cells

There were several talks about stem cells. Dr. Joseph Purita talked about the rejuvenating effects of PRP (platelet rich plasma) on stem cells that are injected. This was a fairly technical talk, but pointed out how important it is to provide the appropriate growth factors to nurture transplanted stem cells for a long-term success. The sources of stem cells can be from fatty tissue around the “love handles” or the abdominal fat. A stem cell separator is used to separate stem cells from the rest of the tissue. This is combined with PRP coming from centrifuged blood and is combined with the stem cells and injected. The newest insight is that short-term exposure to red, green and blue soft lasers further activates stem cells. Another source for stem cells is the bone marrow, usually from the pelvic bone, particularly for orthopedic surgical problems like non-healing fractures or torn ligaments. Slides were shown of completely healed avascular necrosis following stem cell treatment. At other lectures on prolotherapy combined with stem cell therapy completely torn anterior cruciate ligaments in the knee and a complete rotator cuff tear in the shoulder in another patient were healed (MRI scan shown before and after treatment).

Lifestyle

Dr. David Katz gave a presentation about “Integrative Medicine: A Bridge Over Healthcare’s Troubled Waters”. He pointed out that the first three things on the McGinnis list of actual causes of deaths in the US in 1993 were tobacco use, diet and lack of exercise. In 2004 the revised list no longer contained tobacco as the number one killer. All of the public campaigns had changed the culture of smoking so that the average American has changed the lifestyle. Stopping smoking has become desirable, and people know the devastating consequences of smoking. Dr. Katz stated that there is no magic pill to reduce mortality. However, if a healthy lifestyle were a pill, this is exactly what would reduce mortality by 80%. If you exercise on a regular basis, eat a Mediterranean type diet, and avoid sugary drinks you will prevent 80% of heart attacks, strokes and many cancers.

Telomeres

Dr. Sandy Chang gave a talk about “Telomere measurement as a diagnostic test in cardiovascular and age-related disease”. He pointed out that there is a large body of literature showing that telomere length is directly related to health. The shorter the telomeres are, the higher is the probability to experience problems: early menopause, infertility, diabetes, wrinkles, arthritis, osteoporosis, cardiovascular disease, Alzheimer’s, Parkinson’s, dementia, cancer, stress, a lack of stem cells. These are a number of factors that shorten telomeres: stress, poor diets, smoking, obesity, chronic inflammatory diseases, metabolic disorders like diabetes, over consumption of alcohol and lack of sleep.

Dr. Chang mentioned that there is 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 in women and testosterone in men, relaxation techniques like yoga and meditation are also elongating telomeres.

Other speakers also talked about telomeres: Dr. Al Sears’ talk was entitled: “Telo-Nutritioneering: The latest generation of telomere modulators”. He mentioned that in his research he has identified at least 123 nutrients, vitamins and natural compounds that will elongate telomeres, often by stimulating telomerase. Vitamin C will significantly delay shortening of telomeres, which translates into delayed aging. In addition vitamin C has recently been shown to stimulate telomerase activity in certain stem cells. There is an herb, called Silymarin extract, which was recently found to increase telomerase activity threefold. N-acetyl cysteine is a building block for glutathione, a powerful anti-oxidant. In addition it has been shown to turn on the human telomerase gene. Other telomerase stimulators are green tea extract, ginkgo biloba, gamma tocotrienol (one of the components of the vitamin E group), vitamin D3 and folic acid.

Dr. George Rozakis gave a talk entitled “Nutrigenomics” where he mentioned that many diseases are due to methylation defects, a cellular pathway that required vitamin B2, B6 and B12. People with this defect have minor genetic variations that lead to elevated homocysteine in the blood. For instance migraine sufferers often have methylation pathway problems, which involves histamine overproduction and 92% of them can be helped with a histamine-restricted diet. Correcting a methylation pathway defect with the help of L-methylfolate can cure other diseases like depressive illness that does not respond to conventional antidepressant medication.

Stem Cells, Telomeres, Hormones And Lifestyle

Stem Cells, Telomeres, Hormones And Lifestyle

Hormone changes with stress

Dr. Thierry Hertoghe gave a lecture on “Burnout: A multiple hormone deficiency syndrome”. He said that burnout is a common condition where several hormones are affected, with the cortisol axis being the main one, but other hormone glands being stressed as well. As a result endocrine glands age prematurely. Symptoms are fatigue, exhaustion, gastrointestinal problems, anxiety, depression and aggressiveness. The underlying hormone abnormalities are a lack of cortisol, thyroid deficiency, growth hormone deficiency, testosterone and estrogen deficiency and oxytocin deficiency. Burnout is common in teachers and there is a questionnaire that has been developed for teachers (teacher’s burnout scale) to monitor them whether they are heading this way. Soldiers who return from combative situations often suffer from burnout or from PTSD. In suspected cases laboratory tests that measure hormone levels give concrete answers about deficiencies. Treatment protocols were discussed in detail. Multiple bioidentical hormone replacements are necessary, possibly for prolonged periods, if not life long. In addition supportive counseling sessions from a counselor or psychiatrist will help to tone down increased brain activity and help regain the internal balance. Why is this important? Because hormones are necessary on a cellular level and regulate the energy metabolism of every cell in the body.

Conclusion

This year’s conference was a very interesting combination of new information on stem cell therapy, telomeres and lifestyle intervention. As we age we lose hormones, which makes us age faster as the telomeres shorten faster. Shorter telomeres lead to inflammation in the body, which cause a myriad of disease processes. This aging process can be countered by adopting a healthier lifestyle with regular exercising, a Mediterranean diet and abandoning unhealthy habits like smoking, excessive drinking or taking illicit drugs. Vitamins and supplements, particularly resveratrol, CoQ-10 and omega-3 fatty acids will help to elongate and stabilize our telomeres. As Dr. Katz said: “A healthy lifestyle will reduce your mortality rate by 80%”.

Incoming search terms:

Feb
19
2014

Every Patient Is Unique

Modern Western Medicine tends to see the disease of a patient as a unique entity. Conventional medicine behaves as if a disease is associated with characteristic symptoms, findings and lab test results, which are then treated in a standard fashion by treating the symptoms of the disease.

The reality though is different: The same disease can present in various patients with different symptoms.

Naturopathic physicians, integrative physicians and anti-aging physicians see patients as unique individuals with characteristic personality traits and slightly varied presentations, which may be shared in a disease entity, but differ substantially from person to person.

It is important to be aware of this uniqueness, if the caregiver wants to achieve the optimal treatment result.

Big Pharma does not like this approach as they would like you to think that the conventional medicine system is superior. A certain disease is treated a certain way, preferably with the most expensive drugs.

I thought that in this blog it would be good to shed some light on this important topic.

Menopausal women with symptoms

Let us consider an example of a 55-year old woman who has hot flashes, dry skin, a loss of hair from the outer aspect of her eyebrows, does not sleep well and has lost her sex drive. She also has put on 20 pounds in the last year despite no change in her diet.

This is how conventional medicine would handle this patient

The doctor examines the woman and does a Pap test as well. A conventional doctor would likely order standard blood tests consisting of a complete blood count, thyroid tests (T4, TSH) and FSH and LH levels. The conventional physician would find that the thyroid hormones are low with a high TSH (thyroid stimulating hormone) and would treat the woman with Synthroid (a synthetic thyroid hormone drug). The LH and FSH were found to be high indicating to the conventional physician that the woman is in menopause. He would offer the standard PREMPRO (a synthetic hormone preparation containing a mare estrogen combination with a progestin) with the warning that he will give her the lowest estrogen combination and only up to 5 years because of the negative findings of the Women’s Health Initiative.

Every Patient Is Unique

Every Patient Is Unique

Here is an example how a naturopathic or anti-aging physician’s would investigate and treat the patient

A naturopathic physician or an anti-aging physician would likely add a female saliva hormone panel to the other blood tests mentioned above and also do a T3 hormone level as part of the thyroid blood tests. The doctor will explain to the patient that she was found to be menopausal and also hypothyroid. With respect to the hypothyroidism the physician will explain that apart from thyroxin (T4) there is a second hormone, triiodothyronine (T3) that is also necessary in order to replace all of the thyroid hormones that humans have. Drug companies assume that T4 (Synthroid) will reverse automatically into whatever amount of T3 the body needs, so they have convinced most conventional doctors to prescribe T4 drugs only (like Synthroid). The problem is that as the body ages, the enzymes necessary to convert T4 into T3 do not work as well as in a younger age.This can be verified by testing T3 and T4 levels simultaneously.

The end result is that the patient who only gets T4 replaced may still have some of the symptoms like lack of energy and depression even when T4 has been replaced. Not so with the patient treated by the naturopath or the anti-aging physician who put our patient on Armour (porcine-derived thyroid hormone replacement containing both T4 and T3).

With regard to the blood tests and the saliva hormone tests the second patient was told that the blood tests confirmed menopause (high LH and FSH) and that the saliva female hormone panel showed what was going on. In this particular patient the female saliva hormone tests showed that the progesterone level was low, the testosterone level was low and estrogen was normal. Another hormone, DHEA-S (which is DHEA sulfate, the storage form of DHEA) was also on the low side. Cortisol that had also been tested was normal. The physician explained that the woman’s adrenal glands showed a slight weakness not producing enough DHEA, which is a precursor to testosterone. The low testosterone level was responsible for her lack of sex drive. Progesterone, which needs to be high enough to counterbalance estrogen, was missing, which was likely the cause of her hot flashes and the lack of energy together with the missing thyroid hormones. The physician explained that the woman needed a small amount of DHEA tablets by mouth, a full replacement of progesterone (through the use of a bioidentical hormone cream) and also a small amount of bioidentical testosterone cream to normalize her hormones.

A reassessment of the patients 2 months later showed that the first woman still had some depression and lack of energy, while the second woman felt her normal self again. Both women had regrown their eyebrows from replacing the missing thyroid hormones and have lost several pounds since the beginning of their treatments, but obviously there were quite different clinical results. The first woman was treated in a “standard conventional medicine” fashion, which will lead to breast cancer as unnecessary estrogen was given. She also will be at risk of getting cardiovascular disease as she was replaced with Progestin, a synthetic drug thought by conventional physicians to represent “progesterone”. The Women’s Health Initiative has proven that this was the outcome with PREMPRO and yet this drug is still on the market!

The second woman received an individualized and personalized holistic treatment protocol. The low progesterone from missing her ovulations after menopause was being replaced and her body very quickly responded favorably by making her feel normal again. The missing adrenal gland hormones and testosterone were replaced and this normalized her sex drive. Both, progesterone and thyroid hormones (T3 and T4) are anabolic hormones and they gave her back her energy and restored her sleep pattern. With normal hormone levels she also lost her depression symptoms.

Two men with depression

If you thought that the difference of these two clinical approaches were just coincidental, think again. The next examples are two men in their early 50’s who see their physicians because they felt depressed and had a lack of energy. Both were normal weight.

Here is the conventional medicine approach

The physician took a history, during which a lack of sex drive was also noted. He examined the patient and came to the conclusion that physically nothing was wrong with the man, but a diagnosis of depression was made. This would account for the tearfulness, sleep problems and loss of sex drive. The doctor prescribed one of the standard antidepressants (in this case sertraline, brand name Zoloft). Three weeks later the patient returned and as he was better, a repeat prescription for the antidepressant was given. After a further two months the patient was reassessed. When the symptoms were reviewed, it became apparent that a lack of sex drive was still present, if anything the patient felt the antidepressant had made this worse. Some of the depressive symptoms have improved on the conventional antidepressant. The doctor discussed that the antidepressant could be increased by one tablet per day. The doctor also discussed the option of using Viagra for the decreased sex drive and difficulty having an orgasm.

This would be the  naturopathic or anti-aging physician’s approach. Again similar to before a history was taken and a physical examination was done. The physician noted that the patient was in the age where a lack of sex drive could indicate an early andropause (the male equivalent of menopause, often difficult to spot with the first presentation). A depression questionnaire indicated that the man was moderately depressed. The patient was sent for blood tests and for saliva hormone tests (a male hormone panel). The physician stated that he would like to arrange for cognitive therapy treatment to sort out the various factors of his depression, but also help his mood by trying to start him on St. John’s wort, an herb that has been proven to be effective for mild to moderate depression. The blood work came back as normal. However, the hormone tests showed that testosterone was in the lower third of the normal range. DHEA-S, cortisol and estrogen were normal. So a few weeks later when the tests had come back the patient was called in.  The doctor explained to him that the low testosterone level would explain why his sex drive had deteriorated along with his symptoms of depression. Bioidentical testosterone cream was added to the antidepressant herbal treatment. The result was that within one month this patient’s sex drive was back to normal. Together with the cognitive therapy treatments and the herbal antidepressant the depression was also resolved. After a further three months of counseling he was able to stop the St. John’s wort. Due to the counseling sessions he felt stronger than ever before and his mood remained stable even when the counseling sessions were terminated. He continued to use the bioidentical testosterone cream regularly.

These are examples of two different approaches in two identical men in their early 50’s. It appears to me that the conventional approach did a disservice to the sick person, only treated symptoms, but did nothing to solve this patient’s real problems. The second case’s depression was treated properly and the physician luckily also did not miss the underlying early andropause with low testosterone levels. Repeat testosterone levels showed a high normal testosterone level, which was now in the upper 1/3 of the normal range.

The conventional approach missed the early testosterone deficiency, which  would cause heart disease, should the testosterone levels become even lower. Viagra certainly would not be the answer as this has a number of potentially serious side effects. The antidepressants at even higher doses would cause more erectile dysfunction, which was what he hoped to have treated.

Conclusion

People often have several conditions at the same time. It takes intuition, readiness to do testing, repeat close observation and repeat examination on the part of the physician. This needs to be coupled with good listening skills to sort out a patient. On behalf of the patient it is important to tell the physician all of your symptoms and observations. Be patient and never give up. A good patient/physician relationship will go a long way in sorting out complex medical problems. Every patient is unique. Not every symptom means the same thing in two different patients.

More information on:

1. Menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Last edited Nov. 7, 2014

Incoming search terms:

Feb
01
2014

Early Alcohol Use Will Result In Memory Loss Later In Life

Researchers found that heavy alcohol use in males during midlife paves the way to memory loss from dementia later in life.

I thought that this would be a good topic to review the effect of alcohol in general. Alcohol is a known cell poison, yet cardiologists keep on referring to the beneficial effects of that 1 glass of wine per day that will prolong your life. I will attempt to explain these diverse effects, where small amounts are supposed to be good for you while high amounts can be very damaging.

Review of the effects of alcohol

50% of the world population drinks alcohol, 10% to 20% have chronic alcoholism (Ref.1).  Just recently a Guardian news study was released showing that an astounding 25% of Russian men die before reaching the age of 55, compared to only 7% of men in the United kingdom and less than 1% of men in the US. The study looked at the effects of consuming large amounts of vodka.  There are about 10 million chronic alcoholics in the US. Chronic alcohol consumption leads to 100,000 deaths every year in the US. More than 50% of these deaths are from traffic accidents, the rest from medical problems caused by alcohol (Ref.1). Most of the alcohol gets detoxified through the liver cells and is metabolized into acetaldehyde. This involves the cytochrome P-450 system. That means that when a person also takes narcotics, sedatives or psychoactive drugs that are also metabolized through this liver enzyme system drugs and alcohol are taking much longer to be metabolized. This can lead to lethal overdoses that we hear about on TV all the time, hence the warning that you must not mix alcohol with drugs.

Early Alcohol Use Will Result In Memory Loss Later In Life

Early Alcohol Use Will Result In Memory Loss Later In Life

Alcohol is a cell and nerve poison. The most vulnerable organs in the body are the liver, brain, heart, pancreas, bone marrow and stomach. So, here are a number of conditions caused by drinking alcohol:

a)    Anemia: When a person drinks heavily and regularly anemia shows up in a blood test. Alcohol has a toxic effect on the bone marrow, which interferes with the production of red blood cells. But certain vitamins required by the bone marrow to manufacture red blood cells are often also missing in the diet of an alcoholic, which contributes to anemia as well.

b)    Cirrhosis of the liver develops in 10% to 20% of heavy drinkers. With cirrhosis part of the liver cells get replaced by fibrotic tissue and in advanced cases this can lead to a hepatic coma and death. Others are developing alcoholic hepatitis. This is an inflammation of the liver with fever and jaundice where the skin and eyeballs turn yellow. It is associated with severe abdominal pain.

c)    Gastritis: Alcoholic gastritis is common, but often undetected. The affected individual may just have stomach pains for a few days, or vomit food and/or blood in addition. With continued use of alcohol it may turn chronic. Alcoholic gastritis can turn into gastric ulcers with massive bleeding that often lead to death.

d)    Pancreatitis: The pancreas is a particularly vulnerable glandular tissue, which gets damaged by regular alcohol intake and with chronic alcohol intake gets partially replaced by fibrotic tissue causing the feared and painful chronic pancreatitis. This is a condition with vomiting and severe abdominal pains that can be unrelenting.

e)    High blood pressure, seizures, dementia, depression, heart irregularities and nerve damage:

You may ask yourself how all of these conditions would be reasonably under one heading. The heading for this is “nerve damage”. Let me explain: The sympathetic nerve is very sensitive to alcohol toxicity and when the sympathetic nerve fibers are damaged, you will develop high blood pressure. You see your physician, get blood pressure medication, but the pressure is difficult to control, if you continue to drink alcoholic beverages. It does not make sense to just add blood pressure pills and hope that this will cure your problem. Seizures are due to direct nerve damage in the more sensitive parts of the brain, which will cause these areas to produce extra electrical activities, which we call seizures. Again, just treating with anti-seizure medications is not the solution. Avoidance of alcohol is the other part of the treatment schedule. Dementia from heavy alcohol use is due to direct nerve atrophy in the brain. Our brain shrinks normally 1.9% to 2.8% per decade, depending on which research papers you read. But in the presence of heavy drinking the frontal lobe of the brain is particularly vulnerable to brain shrinkage.

As this publication shows, mild and moderate drinkers did not suffer more frontal lobe shrinkage than abstainers, but heavy drinkers had a 1.8-fold higher risk of frontal lobe shrinkage on average when compared to abstainers. It was calculated that alcohol had contributed 11.3% to that frontal lobe shrinkage.

The rest of the toxic effect on the nerve tissue explains why depression would develop. The frontal brain contains most of the serotonin producing nerve cells. When serotonin-producing nerve fibers get damaged, the body does not produce enough serotonin to prevent depression from setting in; GABA producing cells often also get damaged, which causes anxiety. It’s not good enough to just prescribe anxiolytic drugs to which the patient will get addicted. The whole person needs to be treated, and abstinence from alcohol has to be part of the program.

Heart irregularities (atrial fibrillation, ventricular fibrillation) can be life-threatening complications due to the toxic effect of alcohol on the nerve fibers within the heart muscle. Emergency physicians are aware of the connection of these conditions to alcohol consumption. Some people’s hearts are more sensitive to the effects of alcohol than others. The most common cause of temporary atrial fibrillation is excessive alcohol intake (holiday heart) according to Ref. 2.

Finally there is the effect of alcohol on nerves in the body. This explains that heavy alcohol consumers can come down with painful pins-and-needles sensations in their hands and feet or with numbness or loss of muscle strength. When the parasympathetic nervous system is affected embarrassing incontinence or constipation can result. Erectile dysfunction in men is also very common. Viagra and continuing to drink is not the solution.

f)      Gout: This painful formation of uric acid crystals in joints can be precipitated in sensitive individuals by consuming alcohol in combination with eating large helpings of beef. There may be a history of gout in the family. Treatment for this is to refrain from alcohol and avoid foods that are leading to uric acid production when ingested.

g)    Cancer: When the body detoxifies alcohol in the liver, the breakdown product is acetaldehyde, which is a known cancer producing substance. A whole array of cancers are known, which come from heavy, chronic alcohol consumption: cancers in the mouth, larynx, esophagus, stomach, pancreas, liver and colorectal cancer have all been linked to excessive alcohol intake.

h)    Cardiovascular disease: heart attacks and strokes can be caused particularly by binging; it is thought that binging makes platelets from the blood more sticky so they clump together and cause blood clots, which in turn leads to heart attacks and strokes.

i)      Infections: Alcohol weakens the immune system, which is another effect on the bone marrow similar to causing anemia, except that this is the toxic effect on the white blood cells and lymphocytes. Heavy alcohol consumers are more prone to pneumonia, to HIV, sexually transmitted diseases, and tuberculosis.

Cardiology view of preventative alcohol

Despite all of these hair raising toxic effects cardiologists have painted the rosy picture that 1 glass of wine for women and 2 glasses of wine for men per day will prevent heart disease. What is the true story here?

Ref.2 points out that there are about 100 prospective studies that confirm that there is an inverse relationship between mild to moderate alcohol consumption and “heart attack, ischemic stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes”. It describes further that the reduction of risk in these various studies was persistent and consisted of a 20% to 45% risk reduction. Using blood tests investigators have found that this is because of an increase of HDL cholesterol, reducing blood clotting, making platelets less sticky and reducing inflammation as evidenced by a reduction of the C-reactive protein. Further research has pinpointed that it is the phenols and resveratrol that are contained in alcoholic beverages that are responsible for the beneficial effects. The bad news is that three glasses of wine or more do the opposite, so does binge drinking. Unless you are extremely disciplined and never increase your allowed limit (1 drink for women, 2 drinks for men) you will CAUSE heart disease rather than PREVENT it (Ref.2). Some people have a family history of breast cancer or colon cancer and they should avoid alcohol altogether; also people coming from alcoholic families should avoid alcohol.

Conclusion

Where does this leave us with regard to prevention of heart attacks, strokes and hardening of the arteries in the legs (peripheral vascular disease)? If you are disciplined and stick to the limits, you could prevent 20% to 45% of cardiovascular risk. The brain study mentioned in the beginning of the blog would also confirm that there was no difference between dementia or brain shrinkage when mild to moderate drinkers were compared to abstainers over 10 years. What is not told by the wine industry is that the same effects that prevent cardiovascular disease in mild to moderate drinkers can also be achieved by natural means: exercising regularly will raise your protective HDL cholesterol; taking ginkgo biloba, flax seed and omega-3 fatty acids thins your blood and the platelets are getting less sticky; omega-3 reduces inflammation and resveratrol elongates telomeres making you live longer. At the A4M conference in Las Vegas in December 2011 there were three speakers who pointed out that even small amounts of alcohol will poison mitochondria of your cells and interfere with normal hormone action. This was enough to make me join those who abstain alcohol completely. One thing has not yet been investigated in long-term studies, namely how small effects of alcohol may affect the body over several decades and over an entire lifetime. Despite all the promises of interest groups that red wine is a trendy drink for those interested in heart health, the fundamental long-term studies are missing. What does a guy do with a healthy heart and a brain that is not functioning too well? I just do not want to be the guinea pig in that worldwide study.

More information on alcoholism: http://nethealthbook.com/drug-addiction/alcoholism/

References:

  1. Kumar: Robbins and Cotran: Pathologic Basis of Disease, Professional Edition, 8th ed. © 2009 Saunders
  2. Bonow: Braunwald’s Heart Disease – A Textbook of Cardiovascular Medicine, 9th ed. © 2011 Saunders

Last edited Nov. 7, 2014

Incoming search terms:

Jan
18
2014

The Super Powers Of Vitamin D

Originally, when vitamin D was found to be the missing ingredient in preventing rickets in growing children the recommended daily allowance (RDA) to prevent rickets was found to be 400 IU of vitamin D. The active metabolite has been identified as vitamin D3 for which the body has receptors on all vital organs (heart, brain, bones, kidneys, liver). In recent years new insights have been gained as it turns out that the RDA’s were set much too low for many diseases that can develop when vitamin D intake is too low, particularly in the aging population. Higher doses of vitamin D3 in the range of 800 to 1000 IU per day have been shown to prevent osteoporosis, falls and fractures in older adults and in nursing home populations. But the immune system of everybody is dependent on higher doses of vitamin D3. Recently (Dec. 12 to 15, 2013) I attended a lecture at the A4M conference in Las Vegas where Dr. Eisenstein reviewed the latest on vitamin D3. It is now known that 2/3 of the US population is deficient for vitamin D as measured by blood tests (less than 25 ng/ml).  The standard test is the 25-hydroxy-vitamin D level (abbreviated as 25(OH)D level). It is now known that you require at least a level of more than 40 to 60 ng/ml of 25(OH)D as measured in the US, which translates to more than 100 to 150 nmol/L measured in metric units in other countries, to prevent cancer.

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

90% of the vitamin D3 that we need comes from exposure to sunlight, which transforms a cholesterol metabolite (7-dehydrocholesterol) into the vitamin D precursor (vitamin D3 or cholecalciferol). This is what we absorb from naturally occurring fish oil and oily fish, but otherwise this does not naturally occur in foodstuffs (Ref. 1). Dr. Eisenstein pointed out that it is well known that people living north of the 37th degree latitude lack vitamin D3 because of a lack of sun exposure, particularly in the winter season. People south of the 37th degree latitude have enough sun exposure, but wherever you live, it is advisable to have your vitamin D3 level measured (as 25(OH)D level). If you do not eat enough fish or fish oil, the levels likely are too low as is the case for 2/3 of the US population. Vitamin D3 supplements will have to be taken by those whose levels are too low. Vitamin D3 is further metabolized by the liver and then by the kidneys into the active vitamin D compound, called 1,25(OH)2D3 (which is called “calcitriol”). The main effect of calcitriol is to absorb calcium and phosphate from the intestine into the blood stream. Together with vitamin K2 as explained in a prior blog these minerals are then taken up by the bone to prevent osteoporosis or rickets in the growing child. What has not been known for a long time is that vitamin D3 is also necessary for normal cell metabolism by most of your body cells, but particularly by the vital organs like the brain, the heart, the kidneys, the liver, the immune system and the bone. However, doses of 5000 IU to 10,000 IU of vitamin D3 capsules per day are required for optimal vitamin D3 health. This will lead to levels of below 200 ng/ml of 25(OH)D levels, which have been proven to be safe. According to Dr. Eisenstein no toxicity has been found below 30,000 IU of vitamin D3 per day, but based on other authors a dose of 10,000IU should be adequate for most people. Strangely enough colored people also have to take vitamin D3 supplements as their the higher melanin pigment in the skin filters out UV light so effectively that their 25(OH)D level can be low. Always err on the cautious side and have your vitamin D3 blood level taken.

Vitamin D3 has a characteristic stereotactic configuration (cis-triene structure), which allows it to bind free radicals and function as an antioxidant (Ref.2).

What are some of the clinical effects of vitamin D3?

1. Vitamin D3 has diverse effects on organs systems as Dr. Eisenstein summarized: vitamin D3 lifts depression and has been found to be of particular value for drug resistant depression. Take 5000 to 10,000 IU of vitamin D3 per day.

2. Muscle power increases with vitamin D3, particularly in those who work out regularly.

3. Many fertility clinics pay attention to vitamin D3 levels, as the higher the blood levels of vitamin D3 in a man, the faster this sperms move! And the more vitamin D3 she has on board, the better she ovulates. The end result is a higher pregnancy success rate when both partners take 5000 to 10,000 IU of vitamin D3 per day

4. Also, if a woman takes vitamin D3 during her pregnancy, the first set of teeth in the offspring will have fewer cavities.

5. Brain development in autistic children is much improved with vitamin D3 in higher doses. This needs to be combined with detoxification methods and supervised by one of the DAN physicians.

6.Chronic pain typically improves when vitamin D3 deficiency, which almost always is present in patients with chronic pain, is treated with vitamin D3 supplementation.

7. To prevent flus and colds and other infectious diseases, take higher doses of vitamin D3. When you come down with a flu, it is safe to increase your daily vitamin D3 intake to 30,000 IU of vitamin D3 for a few days until your symptoms improve, then resume your maintenance dose of 5000 IU to 10,000 IU per day.  This year’s dominant flu is the type A, subtype H1N1 – also known as the swine flu. Children should get 50% of the dose regimen detailed for adults when they develop a flu (for children: 15,000IU for three to five days , with tapering to a maintenance dose of 2500 to 5000 IU until blood levels of 25(OH)D are available). Here is a website of Dr. Cannell where he discusses dosages as well.

8. Asthmatic patients do better with vitamin D3 supplements requiring less maintenance anti-asthmatic medicine to keep them balanced with regard to their airways.

9. Chronic low vitamin D3 levels cause brain damage including Alzheimer’s disease. In this context it is important to know that the enzymatic conversion in the liver and kidneys slow down as we age requiring higher doses in older patients. This may have been the reason for the confusion about relatively low doses of 400 IU of vitamin D3 preventing rickets in children versus the need of vitamin D3 in middle aged and older patients where much higher doses are required as already explained.

10. High blood pressure is linked to vitamin D3 deficiency and it is better manageable with medication when vitamin D3 levels are normalized.

11. Live longer with vitamin D3. How is this possible, you might ask: the answer has been found in the telomeres, the shoelace like structures at the end of the DNA strand of each cell. Vitamin D3 lengthens the telomeres and promotes telomere repair; this is associated with a longer life span. Centenarians have longer telomeres. You can measure telomere length, but it is a pricey test, which is not for everyone, contrary to supplementation with vitamin D3 that should be taken by everyone!

12. As already indicated, vitamin D3 strengthens the immune system, but it also modulates the inflammatory response from muscle damage, so athletes can perform better. Patients with multiple sclerosis will improve as it slows down the inflammatory process. But other inflammatory diseases like arthritis, inflammatory bowel disease and even cancer will respond favorably to higher doses of vitamin D3 (20,000 to 30,000 IU of vitamin D3 in these cases). This is information that has not yet percolated into mainstream medicine, but will do so in the next few years (or decades?).

13. Higher percentages of cardiovascular disease are found in patients who have lower than 15 ng/ml  25-Hydroxy- vitamin D3 levels in their blood meaning that vitamin D3 supplementation prevents heart disease (Ref.3).

What are toxic vitamin D levels?

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25(OH)D blood levels taken from time to time. If any of these levels exceed 200 ng/ml it would be prudent to reduce the vitamin D dose or stop supplementation for a while. Otherwise it has been difficult to establish a toxic range.

This website claims that 40,000 IU of vitamin D3 or more would lead to toxic levels where the blood calcium levels would be increased, which can be measured as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU per day and that led to a blood level of 400 ng/ml of 25(OH)D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine). So, all of the papers that either indicated to the public that it would be unsafe or unnecessary to take vitamin D3 seem to have other agendas than communicating the truth. Had it been true that calcium would be released from the bones or calcium were absorbed too much from the gut, this would have caused calcification of the bones, soft tissues, heart and kidneys. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. Interesting that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

I talked to a participant of the conference (who has a fellowship degree of the A4M) about what is really known about vitamin D3 toxicity. He told me that there has been an unintentional overdose where a compounding pharmacy made a mistake, so that a patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months, before the mistake was uncovered. The patient felt sluggish, but did not have any other symptoms. He was told to stop the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. At this point no overdose of vitamin D3 has been established.

Conclusion

Vitamin D3 is a vital supplement that has been shown to prevent not only rickets in children, but also depression, MS, infections and even many cancers (Ref. 4). As usual there will be many critiques that doubt the validity of the above statements. But I have found that all of these effects described above were confirmed in several sources of various medical information. Keep in mind that negative rumours have a tendency to linger on for years.

More information on vitamin D3 for prevention of osteoporosis and hardening of arteries: http://www.askdrray.com/calcium-vitamin-d3-and-vitamin-k2-needed-for-bone-health/

Vitamin D3 deficiency can cause pancreatic cancer: http://nethealthbook.com/news/insufficient-vitamin-d3-linked-to-pancreatic-cancer/

References

1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed.,  © 2011 Saunders

2. Rheumatic Diseases Clinics of North America – Volume 38, Issue 1 (February 2012) , © 2012 W. B. Saunders Company

3. Wang TJ, Pencina MJ, Booth SL, et al:  Vitamin D deficiency and risk of  cardiovascular disease.   Circulation 117. (4): 503-511.2008.

4. “Recognition and Management of Vitamin D Deficiency”: American Family Physician – Volume 80, Issue 8 (October 2009),  © 2009 American Academy of Family Physicians

Last edited Nov. 7, 2014

Incoming search terms: