Feb
25
2017

Heart Health Improves With Hormone Replacement

Dr. Pamela Smith gave a lecture in December 2016 showing that heart health improves with hormone replacement. Her talk was part of the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9 to Dec. 11, 2016) in Las Vegas, which I attended. The title of the talk was: “Heart health: The Importance of Hormonal Balance for Men and Women”. Her keynote lecture contained 255 slides. I am only presenting a factual summary of the pertinent points here.

1. Estrogen

Observations regarding risk of heart attacks

  1. Women have a lower risk of heart attacks before menopause compared to men of the same age.
  2. Heart attack rates go up significantly after menopause.
  3. Estrogen replacement therapy may reduce the risk of heart attacks by 50% for postmenopausal women.

Lipid profile after menopause

There is an elevation of LDL cholesterol, total cholesterol and triglycerides as well as lower HDL cholesterol levels. All of this causes a higher risk of heart attacks for postmenopausal women. Estrogen replacement therapy increases the large VLDL particles, decreases LDL levels and raises HDL-2. These changes are thought to be responsible for helping reduce heart attack rates in postmenopausal women who do estrogen replacement therapy (ERT).

Difference between oral and transdermal estrogen replacement

When estrogen is taken by mouth, it is metabolically changed in the liver. This reduces the protective effect on the cardiovascular system. In contrast, transdermal estrogen (from commercial estrogen patches or from bioidentical estrogen creams) has a higher cardioprotective effect. The liver does not metabolize transdermal estrogen. Dr. Smith explained in great detail using many slides how estrogen prevents heart attacks. Details about this would be too technical for this review. Apart from lipid lowering effects there are protective effects to the lining of the arteries. In addition there are metabolic processes in heart cells and mitochondria that benefit from estrogens. The end result is that postmenopausal women who replace estrogen will outlive men by about 10 years. Stay away from Premarin, which is not human estrogen, but is derived from pregnant mares. Also the tablet form is metabolized by the liver, which loses a lot of the beneficial effects that you get from transdermal estrogen. 

How can you document the beneficial effects of estrogen replacement?

  1. Carotid intima measurements in postmenopausal women on ERT show a consistent reduction in thickness compared to controls.
  2. The physical and emotional stress response is reduced compared to postmenopausal women without ERT.
  3. Hormone replacement therapy in postmenopausal women reduces blood pressure. Measurements showed this effect to be due to a reduction of angiotensin converting enzyme (ACE) by 20%. This is the equivalent of treating a woman with an ACE inhibitor without the side effects of these pills.
  4. Coronary calcification scores were lower in postmenopausal women on ERT than a control group without ERT. These calcification scores correlate with the risk for heart attacks.
  5. Oral estrogen replacement leads to proinflammatory metabolites from the liver metabolism of estrogen. This is not found in the blood of women using transdermal estrogen. The anti-inflammatory effect of transdermal estrogen is another mechanism that prevents heart attacks.
  6. Postmenopausal women on ERT had no increased risk of heart attacks or venous thromboembolism (clots in veins). Menopausal women without ERT have a risk of 40% of dying from a heart attack. Their risk of developing breast cancer is 5.5%, the risk of dying from breast cancer is about 1%. Oral estrogen use was associated with venous thromboembolism.
  7. Estrogen has antiarrhythmic effects stabilizing the heart rhythm. Dr. Smith said that in the future intravenous estrogen might be used to prevent serious arrhythmias following heart attacks.

Estrogen levels in males

Males require a small amount of estrogens to maintain their memory, for bone maturation and regulation of bone resorption. But they also need small amounts of estrogen for their normal lipid metabolism.

However, if the estrogen levels are too high as is the case in an obese, elderly man, there is an increased risk of heart disease. Factors that lead to increased estrogen levels in an older man are: increased aromatase activity in fatty tissue, overuse of alcohol and a change in liver metabolism, zinc deficiency, ingestion of estrogen-containing foods and environmental estrogens (also called xenoestrogens).

2. Progesterone

Progesterone is significantly different from the progestin medroxyprogesterone (MPA). MPA was the oral progestin that was responsible for heart attacks and blood clots in the Women’s Health Initiative. MPA increases smooth muscle cell proliferation. This in turn causes hardening of the coronary arteries. In contrast, progesterone inhibits smooth muscle cell proliferation, which prevents heart attacks. Progesterone also lowers blood pressure and elevates HDL cholesterol, but MPA does not.

Progesterone in males

In a small study Depo-Provera was given to males for 17 days. Blood tests showed a lowering of triglycerides, LDL cholesterol and Apo A-1.

3. Testosterone

Testosterone replacement in women

Testosterone in women does not only increase their sex drive, but also relaxes the coronary arteries in women who were testosterone deficient. This allows more blood flow to the heart. In postmenopausal women testosterone replacement lowered lipoprotein (a) levels up to 65%. The physician will only replace testosterone in women who have either enough of their own estrogen production or else have been replaced first with bioidentical estrogen. Otherwise testosterone alone can cause heart attacks in women.

Elevated testosterone in women with PCOS

Women with polycystic ovary syndrome (PCOS) can have increased testosterone levels when they go through premenopause or menopause.

Women with PCOS are at a higher risk to develop diabetes, heart disease and high blood pressure. 50% of women with PCOS have insulin resistance. 70% of women with PCOS in the US have lipid abnormalities in their blood.

Elevated testosterone levels in the blood can lower the protective HDL cholesterol and increase homocysteine levels. Both can cause heart attacks.

Women with PCOS have a 4-fold risk of developing high blood pressure.

Testosterone replacement in males

A 2010 study showed that low testosterone levels in males were predictive of higher mortality due to heart attacks and cancer. Low testosterone is also associated with high blood pressure, heart failure and increased risk of cardiovascular deaths. There was a higher incidence of deaths from heart attacks when testosterone levels were low compared to men with normal testosterone levels.

Low testosterone is also associated with the development of diabetes and metabolic syndrome, which can cause heart attacks.

It is important that men with low testosterone get testosterone replacement therapy.

DHT (Dihydrotestosterone)

DHT is much more potent than testosterone. Conversion of testosterone leads to DHT via the enzyme 5-alpha-reductase. While testosterone can be aromatized into estrogen, DHT cannot. Some men have elevated levels of DHT. This leads to a risk of heart attacks, prostate enlargement and hair loss of the scalp.

Andropause treatment

Only about 5% of men in andropause with low testosterone levels receive testosterone replacement in the US. Part of this is explained by rumors that testosterone may cause prostate cancer or liver cancer. The patient or the physician may be reluctant to treat with testosterone. Bioidentical testosterone has been shown to not cause any harm. It is safe to use testosterone cream transdermally. It does not cause prostate cancer or benign prostatic hypertrophy.

An increase of 6-nmol/L-serum testosterone was associated with a 19% drop in all-cause mortality.

Testosterone helps build up new blood vessels after a heart attack. Testosterone replacement increases coronary blood flow in patients with coronary artery disease. Another effect of testosterone is the decrease of inflammation. Inflammation is an important component of cardiovascular disease.

Testosterone replacement improves exercise capacity, insulin resistance and muscle performance (including the heart muscle).

Apart from the beneficial effect of testosterone on the heart it is also beneficial for the brain. Testosterone treatment prevents Alzheimer’s disease in older men by preventing beta amyloid precursor protein production.

4. DHEA

Dehydroepiandrosterone (DHEA) is a hormone produced in the adrenal glands. It is a precursor for male and female sex hormones, but has actions on its own. It supports muscle strength. Postmenopausal women had a higher mortality from heart disease when their DHEA blood levels were low.

Similar studies in men showed the same results. Congestive heart failure patients of both sexes had more severe disease the lower the DHEA levels were. Other studies have used DHEA supplementation in heart patients, congestive heart failure patients and patients with diabetes to show that clinical symptoms improved.

5. Melatonin

Low levels of melatonin have been demonstrated in patients with heart disease. Melatonin inhibits platelet aggregation and suppresses nighttime sympathetic activity (epinephrine and norepinephrine). Sympathetic activity damages the lining of coronary arteries. Melatonin reduces hypoxia in patients with ischemic stroke or ischemic heart disease. Lower nocturnal melatonin levels are associated with higher adverse effects following a heart attack. Among these are recurrent heart attacks, congestive heart failure or death. Melatonin widens blood vessels, is a free radical scavenger and inhibits oxidation of LDL cholesterol. Melatonin reduces inflammation following a heart attack. This can be measured using the C-reactive protein.

In patients who had angioplasties done for blocked coronary arteries intravenous melatonin decreased CRP, reduced tissue damage, decreased various irregular heart beat patterns and allowed damaged heart tissue to recover.

6. Thyroid hormones

It has been known for more than 100 years that dysfunction of the thyroid leads to heart disease. Hypothyroidism can cause heart attacks, hardening of the coronary arteries and congestive heart failure. Lesser-known connections to hypothyroidism are congestive heart failure, depression, fibromyalgia, ankylosing spondylitis and insulin resistance. Some cases of attention deficit hyperactivity disorder (ADHD) with low thyroid levels may successfully respond to thyroid replacement.

Thyroid hormones improve lipids in the blood, improve arterial stiffness and improve cardiac remodeling following a heart attack. Thyroid hormones help with the repair of the injured heart muscle. They also work directly on the heart muscle helping it to contract more efficiently. Lower thyroid stimulating hormone (TSH) values and higher T3 and T4 thyroid hormone levels lead to improved insulin sensitivity, higher HDL values (= protective cholesterol) and overall better functioning of the lining of the arteries.

Dr. Smith said that thyroid replacement should achieve that

  • TSH is below 2.0, but above the lower limit of normal
  • Free T3 should be dead center of normal or slightly above
  • Free T4 should be dead center of normal or slightly above

Most patients with hypothyroidism require replacement of both T3 and T4 (like with the use of Armour thyroid pills).

7. Cortisol

Cortisol is the only human hormone that increases with age. All other hormones drop off to lower values with age. The adrenal glands manufacture cortisol. With stress cortisol is rising, but when stress is over, it is supposed to come down to normal levels. Many people today are constantly overstressed, so their adrenal glands are often chronically over stimulated. This can lead to a lack of progesterone. It also causes a lack of functional thyroid hormones as they get bound and are less active. When women have decreased estradiol in menopause there is a decline in norepinephrine production, production of serotonin, dopamine and acetylcholine. Women with this experience depression, lack of drive and slower thought processes.

Heart Health Improves With Hormone Replacement

Heart Health Improves With Hormone Replacement

Conclusion

Seven major hormones have been reviewed here that all have a bearing on the risk of developing a heart attack. It is important that these hormones are balanced, so they can work with each other. Hormones can be compared to a team that works together and is responsible for our health. If one or several of the team players are ineffective, our health will suffer. For this reason hormone replacement is crucial. Hormones have effects on mitochondria of the heart muscles cells. They stabilize the heart rhythm as in the case of estradiol. But they can also strengthen the heart muscle directly through DHEA and estrogens in women and DHEA and testosterone in men. Thyroid hormones are another supportive force for the heart and can even be used therapeutically in chronic heart failure patients. When people age, many hormones are produced less, but blood tests will show this. Replacing hormones that are missing can add years of active life.

Taking care of the symphony of hormones means you are taking care of your most important organ, the heart!

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Nov
10
2015

Sugary Soda Drinks Make You Sick

Dr. Frank Hu and colleagues have recently re-examined the old question of what sugary soda drinks do to you. They usually contain high fructose corn syrup, a mixture of 55% fructose and 45% glucose. This sugar mix can be found in sugary soda drinks as well as in many processed foods like fruit spreads. Dr. Hu’s publication is listed in PubMed , but details can be found in this summary.

The study found that one or two cans of sugary soda drinks per day lead to

  • As high as a 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.

The study also found that there is a difference of how glucose, the main sugar that the body uses for energy is metabolized versus fructose from high fructose corn syrup or the breakdown of table sugar, a disaccharide consisting of glucose and fructose combined as one molecule. Glucose gets directly absorbed from the gut into the blood circulation and with the help of insulin gets further absorbed directly into body cells. In contrast the liver metabolizes fructose into triglycerides, which can cause fatty liver disease and also insulin resistance. Fructose also raises the bad cholesterol (LDL cholesterol). This in turn is a risk factor for developing diabetes, heart attacks and strokes.

It is fructose in sugary drinks and processed foods that are largely responsible for weight gain, metabolic syndrome, diabetes and cardiovascular disease.

The newest finding: heart failure can also be caused by high fructose corn syrup

A study in Sweden has recently shown that sugary drinks can cause heart failure. 4200 Swedish men were followed for 12 years in regards to food habits. The study found that the men who drank at least two sweetened drinks per day had a 23% higher risk of developing heart failure. Dr. Susanna Larsson, a co-author of the study, said: “The takeaway message is that people who regularly consume sweetened beverages should consider limiting their consumption to reduce their risk of heart failure”. Heart failure affects nearly 6 million Americans. It develops either on its own in persons with inadequately treated high blood pressure or in people who had a previous heart attack. It is a condition, which disables the heart to effectively pump enough blood with nutrients and oxygen into the tissues. People who are affected by this condition feel the symptoms: they get short of breath with minimal activity. They also may wake up short of breath in the middle of the night. It is a miserable life, as people with heart failure are severely limited in their activities. Even walking a flight of stairs becomes a struggle or even an impossible task. Total disability is the next step.The key is prevention: do not use high fructose corn syrup, and stay away from sugar in any form; instead use stevia to sweeten your food when needed.

Be careful how you replace saturated fatty acids

Dr. Frank Hu has also 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.

Cutting fructose out of diet lowers cholesterol and weight

A new study by Dr. Robert Lustig and colleagues from the University of California, San Francisco showed on 43 children that a change of diet reducing dietary sugar from 28% to 10% and replacing it with other complex carbohydrates led to a significant reduction in triglycerides, cholesterol and blood pressure.

The fructose stimulus was taken away, which stimulates a part in the brain, called nucleus accumbens, where the reward center is located. This is the reason why the more sugar you take in, the more addicted to sugar you become. Not surprisingly when the diet was changed, there were not only internal signs of improving with regard to blood tests, but physically the children showed weight loss just within 10 days as their total calorie intake had reduced. Another observation with regard to fructose metabolism is that ghrelin, the hunger hormone, which usually gets suppressed after a meal, will not get suppressed when you drink a sugary drink with fructose in it. The result is that you do not feel satisfied and you keep on consuming fructose containing drinks resulting in weight gain.

Sugary Soda Drinks Make You Sick

Sugary Soda Drinks Make You Sick

Conclusion

What we eat matters in terms of long-term consequences. This has been shown with refined sugar intake. Don’t lull yourself into the belief that honey is “healthy”. Even though it is a natural product, your body treats it according to its chemical composition: it is sugar, and unfortunately it will get you into health problems naturally. The currently fashionable agave syrup is largely composed of fructose: again, this is bad news for your health! No matter what type of sugar you choose, the long-term consequences have haunting qualities. Consequences of sugar intake are weight gain, diabetes, heart attacks and strokes. When you look at this, you will agree that is not worth to take any of these risks just to satisfy a sweet tooth. Biting into a crisp, sweet apple is enjoyable and has never harmed anybody. Eating a small helping of fruit salad to top off a meal can be a delicious finale to dinner. If you need a sweetener, you are better served using the plant-derived stevia, which is available as a powder or a liquid. Smallest quantities are adequately sweetening foods. Stevia has no calories and none of the consequences of sugar: you’ll enjoy the sweetness without the bitter aftereffects of tooth decay or heart disease!

Sep
25
2015

Testosterone

One of the driving hormones in a man is testosterone. It also is known that with age testosterone levels fall. The lesser known fact is the importance of monitoring testosterone levels in aging males, so they have the choice of intervening with the aging process. Here are the facts about testosterone, about replacement of testosterone and about the anxieties of the medical profession to deal with this.

Androgen receptors contained in key tissues

Androgen receptors are situated in the key organs like the brain, heart, muscles, bones, kidneys, fat cells, genitals, hair follicles and skin. They respond to all male hormones, called androgens, like testosterone, dihydrotestosterone (DHT) and DHEA. DHT is produced by metabolizing testosterone with the help of an enzyme, called 5α-reductase in the adrenal glands. This is responsible for hair loss in males and some females. There is a genetic factor for this. It is important that the man continues to have all tissues stimulated by testosterone when he ages or the key organs mentioned are going to suffer.

A lack of testosterone as the man ages (around 55 to 65) leads to a slowdown in thinking, osteoporosis in the bones, muscle atrophy (melting in of muscle tissue), and a lack of sex drive. Mood swings can turn the male into the “grumpy old man”. The skin gets thinned and is more brittle.

Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding in these animals is the fact that this condition is reversible by replacement of testosterone. In healthy males of a younger age all organs are working well. The problems starts when males age and the hormone regulation in the brain slows down, which ultimately leads to andropause in males, the equivalent of menopause in women. When testosterone is replaced in an aging man with low testosterone levels, the androgen receptors in key organs mentioned above are stimulated and normal organ function returns.

Reluctance of physicians to prescribe testosterone

It used to be taught to medical students that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients by a small percentage. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen.

When an orchiectomy was done (because of the belief that testosterone production was the culprit) inadvertently the real cause of prostate cancer (an estrogen surplus) was also removed thus improving the survival of these patients somewhat. Nowadays we have more sophisticated testing methods. Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot more modern references that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”). Dr. Morgentaler, a urologist from Harvard University has taken prostate cancer patients and put them on testosterone. To his and everyone else’s surprise testosterone treated prostate cancer patients improved, their prostate cancer either disappeared or become much less aggressive, which can be measured with the Gleason score based on its microscopic appearance. The result was that they did better, not worse on testosterone.

Unfortunately the history of testosterone, orchiectomy and prostate cancer as explained led to confusion among the medical profession. We now know that testosterone is innocent with respect to prostate cancer, testicular cancer or any other cancer. But some of the old-timers among the physicians doggedly hold on to their false belief from the past because they were taught this way. If a man asks one of these physicians for testosterone replacement he may not only be told that he/she could not do that, but will also receive a tirade of false statements about testosterone.

We dealt with the myth of prostate cancer that is not related to testosterone treatment. There is another myth that older physicians often cite: that testosterone would supposedly be causing blood clots. At the University of Texas Medical Branch at Galveston (Texas, USA) a large study was done involving 30,572 men, ages 40 years and older. They all had venous thromboembolism and received an anticoagulant drug or an intravascular vena cava filter following their diagnosis. They also had a low testosterone level and were given testosterone replacement therapy. They were followed and monitored for further venous thromboembolism. None were found in any of the men. The conclusion of the investigators was that filling a testosterone prescription was not associated with any clotting condition.

Aging and testosterone

The Massachusetts Male Aging Study showed that testosterone has been declining in the male population over a period of 20 years. Partially this was related to aging, but otherwise there may also be environmental factors, called estrogen-like substances or xenoestrogens, that have contributed to it as well. Although age is a factor, there is so much variation from man to man, that it is best to just measure testosterone and determine whether the total testosterone level is above or below 500 ng/dL. This seems to be the most reliable indicator in determining whether a man needs hormone replacement, apart from symptoms due to testosterone loss. These are: increased risks for prostate problems and/or cancer, cardiovascular disease, loss of bone density, a rise in cholesterol and urinary dysfunction. Dr. Randolph describes this in detail and also discusses who needs bioidentical testosterone replacement.

A New England Journal of Medicine study from September 2013 explained that apart from testosterone the male body needs a small amount of estradiol, the female hormone for normal functioning. This is achieved through the enzyme aromatase contained in fatty tissue. But testosterone replacement must be given as the bioidentical testosterone, so that a small amount of it can be converted by aromatase into estradiol. I have reviewed this in a blog entitled “The Full Story About Testosterone”.

Risk of prostate cancer

Having reviewed the hard facts about prostate cancer risk, it is now clear that older men get prostate cancer because of lowered testosterone in their blood and increased body weight, where fat converts androgens by the aromatase into estradiol; this leads to estrogen dominance. Estrogen dominance causes breast cancer and uterine cancer in women and prostate cancer in men. When the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his prostate from prostate cancer.

Cardiovascular disease

As the cardiovascular system has a lot of androgen receptors on its cell surfaces, it is important that the man continues to have the proper stimulus from androgenic hormones (testosterone, dihydrotestosterone and DHEA) for proper contractility of heart cells and relaxation of smooth muscle cells in the arteries to control blood pressure. With a lack of testosterone there is hardening of the arteries, loss of muscle cells in the heart muscle and increase of blood pressure. So far there is only an indication that low testosterone is associated with diabetes, high blood pressure and heart attacks. It has not been proven that it is the cause (so webmd.com says). But careful replacement with bioidentical testosterone helps patients to get rid of their symptoms, have the energy to exercise and feel better. Long-term studies have already shown that hormone replacement saves lives, but the medical profession is slow to accept this (Ref.1). Here is a link that explains this a bit further.

If a man who is low in testosterone wonders whether it would be worthwhile to go on testosterone therapy, here is the clear answer: would you like to have a 47% lowered risk of dying, a reduction of 18% in heart attacks and 30% reduction in the risk for a stroke? This is what a 14-year follow-up study published in the European Heart Journal in August, 2015 found.

The same is true for cardiovascular disease as stated above: if the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his cardiovascular system to prevent heart attacks and strokes.

Loss of bone density

Older men can get osteoporosis, which can lead to compression fractures in the spine and to fractures in the hip, the ankle or wrist. It is thought that with the lack of testosterone there is also a lack of estradiol via the aromatase pathway in fatty tissue. This small amount of estradiol is thought to prevent osteoporosis all his life until the testosterone drops with older age. Once again it is important to monitor his total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL.

Rise in cholesterol

With obesity the metabolic syndrome sets in where the LDL cholesterol is increased. This is a direct risk for hardening of the arteries. In an obese older man with low testosterone there is a double risk from the low testosterone and the metabolic syndrome. As a result the heart attack and stroke rates in obese men with low testosterone are much higher than in obese men with normal testosterone levels. Men with obesity need to lose weight by changing their diet to healthier eating habits and starting a regular exercise program with swimming and walking. At the same time those with a testosterone level of lower than 500 ng/dL should have testosterone replacement with bioidentical testosterone.

Urinary dysfunction

A hyperactive bladder, dribbling, hesitancy and leaking bladder can all be part of testosterone deficiency. But this is not that easy to diagnose. A full consultation by an urologist may be necessary to assess various other causes that could hide behind these symptoms. Part of the work-up though is to measure the total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL

Alzheimer’s disease

Alzheimer’s disease can be due to a lack of testosterone. It is therefore important to measure the total testosterone level in a man. If it is lower than 500 ng/dL, as mentioned before , it is a sign that he needs testosterone replacement therapy to prevent Alzheimer’s disease.

Burnout

According to Dr. Thierry Hertoghe, an endocrinologist from Belgium, there are several hormones that can be missing in a person with burnout: a lack of cortisol, thyroid, growth hormone, testosterone/estrogen, progesterone and oxytocin. The middle-aged manager with burnout would have other hormones missing apart from testosterone. This needs to be measured with blood tests. Whatever is low would have to be replaced with bioidentical hormones.

Some details regarding testosterone measurements and delivery

The deeper you delve into testosterone replacement, the more details there are to consider.

First, there is a sex hormone-binding globulin that is mostly produced by the liver and circulating in the blood.

It is like a storage form of testosterone and only 1 to 2% of the total testosterone is unbound. This is called the free or bioavailable testosterone. Some physicians measure just that portion of testosterone.

Second, when it comes to replacement of testosterone in a man who is deficient for testosterone, there are several delivery systems, which some people find a little confusing. There are testosterone gels, which are least absorbed; another application are creams which are often prepared by compounding pharmacies. These creams are usually well absorbed. But some men do not absorb either creams or gels. They need testosterone injections or testosterone pellets. The goal is to replace testosterone in a manner that there is a fairly equal amount of testosterone available at all times. Some men achieve that only with testosterone pellets, others with testosterone cypionate injections. For this reason blood test that determine the levels of free testosterone are necessary.

Testosterone

Testosterone

Conclusion

Testosterone is a key hormone in the male and needs to be monitored, particularly when he is aging. A careful history of his symptoms needs to be taken by a knowledgeable physician or naturopath. If blood tests show that the total testosterone is less than 500 ng/dL replacement with bioidentical testosterone is needed.

 

References:

Ref.1: Dr. Abraham Morgentaler: “Testosterone for Life – recharge your vitality, sex drive, and overall health” McGraw-Hill, 2009

May
02
2015

Healthy Olive Oil

In the past it was thought that the monounsaturated fatty acids in olive oil would be the reason why it is protective of the heart. However, newer studies have shown that it is the polyphenols and among these in particular hydroxytyrosol that lower blood pressure and protect you from hardening of the arteries.

In a 2012 study from Spain it was found that mortality from heart attacks was 44% lower than that of a control group who did not incorporate olive oil in their diet.

How polyphenols in olive oil work for you

Only two tablespoons of extra virgin olive oil per day protect you from heart disease. It does so by reducing the total cholesterol level in the blood as well as the LDL cholesterol level. At the same time the more polyphenol is contained in olive oil (such as in extra virgin olive oil), the more HDL your body will produce, which is essential to extract oxidized LDL from arterial plaque. On top of that polyphenol rich olive oil will increase the size of the HDL particles (these larger particles are called HDL2), which are more efficient in extracting oxidized LDL from arterial plaques. A Sept. 2014 study in humans showed that higher polyphenol olive oil as found in extra virgin olive oil caused an increase in the more effective HDL2 particles, which cleans out plaques from arteries more efficiently than the regular, cheaper olive oil.

Endothelial function

The endothelium is the lining of the arteries. Normal endothelial functioning involves widening of the arteries and maintaining its flexibility. The body achieves this through production of a signal molecule, called nitric oxide; the endothelial cells that line our arteries from inside produce it. Exercise increases the production of nitric oxide as well (Ref.1).

In a group of patients with poor endothelial function 2 tablespoons of olive oil (polyphenol rich) per day given over 4 months (the time of the study) showed a significant improvement of endothelial function.

The authors suggested that an enzyme in the endothelial cells, called nitric oxide synthase is being stimulated by components of polyphenol-rich olive oil. This leads to protracted release of nitric oxide, which in turn keeps blood vessels flexible and wide open. Other investigators found that olive oil can influence even a hereditary gene variant of endothelial nitric oxide synthase found in people with a history of premature heart attacks. This high-risk group of people should take extra virgin olive oil regularly to prevent premature heart attacks and strokes.

Endothelial dysfunction occurs when the arteries no longer can deliver adequate amounts of blood to vital organs like the heart or the brain. Endothelial dysfunction is also present in patients with type 2 diabetes, obesity, high blood pressure and metabolic syndrome. Introducing extra virgin olive oil in the diet of these patients will help restore their endothelial function.

Lowering blood pressure

In a study on 23 hypertensive patients it was shown as far back as in 2000 that extra virgin olive oil over 6 months allowed physicians to reduce high blood pressure medications by 48%. When the study was crossed over, the reverse was the case for the control group on sunflower oil that had no such effect before.

Based on what was said about endothelial function above, it is easy to understand that the polyphenols of olive oil released nitric oxide, which is known to lower blood pressure. This is an important finding as high blood pressure is a known risk factor for the development of hardening of the coronary arteries leading to heart attacks, congestive heart failure, but also stroke. Regular intake of 2 tablespoons of extra virgin olive oil often will reverse high blood pressure and restore normal endothelial function.

Preventing heart attacks and strokes

In April of 2013 The New England Journal of Medicine published a Spanish diet study that showed that a participants on a Mediterranean diet with olive oil or nuts had 30% less heart attacks over 5 years than people on a low fat control diet. Other studies have also shown that olive oil and omega-3 fatty acids play a big role in preventing heart attacks and strokes. We also know that regular exercise reduces the risk further; so does keeping your body mass index below 25.0. Extra virgin olive oil is part of the protection from heart attacks and strokes, but it did not show protection against cancer.

Healthy Olive Oil

Healthy Olive Oil

Conclusion

It is a simple fact that incorporating 2 tablespoons of virgin olive oil in your daily food intake will definitely have all of the beneficial effects described above. It is readily available, is inexpensive and very effective. It is also not difficult to work into your eating routine: add olive oil and vinegar or lemon juice to your salads, and cook with olive oil. If you have not totaled 30 grams (2 tablespoons), then make up the difference by eating an extra teaspoon full of olive oil. This is not all! You need to cut down on processed foods as they are made with the wrong oils, such as safflower oil, corn oil, soybean oil and others. These are usually omega-6 containing oils that cause heart attacks and strokes. They are cheap oils use by food processors, and they are not doing anything for your health!

I would suggest that you read more about the powerful role of prevention that extra virgin olive oil has in our diet. Buy it and stick to it as a new healthy lifestyle habit. Two tablespoons a day is the weapon against disease!

Reference:

Ref.1. Current Medical Diagnosis and Treatment 2015, chapter 10 Heart Disease. By Thomas M. Bashore, MD; Christopher B. Granger, MD; Kevin Jackson, MD; Manesh R. Patel, MD: Heart Disease. Lange, 2015.

Dec
06
2014

Regrets Following Holiday Foods

Countless blogs have been written about gaining pounds with holiday food. This is not my topic in this blog. I am looking at the medical evidence of what is happening to our bodies, some of which is permanent. I like to focus on the gallbladder, blood pressure, heart function and gout. I will provide little clinical vignettes that make my points clear.

Gallbladder disease

Many patients are unaware that their gallbladder has developed stones that accumulate over several years, perhaps even several decades. But, if infection sets in there is an acute flare-up of gallbladder pain, which can be excruciating. Also, when one of the stones is transported into the gallbladder duct, there is a sudden colicky pain similar to labor pains. In cases where the migrating stone blocks the common bile duct, the patient can get jaundiced and the pancreatic juice can get backed up leading to an acute pancreatitis.

What does that have to do with overindulging during a Thanksgiving meal? Fatty sauces, ham, and gravy can all lead to more cholesterol deposits in the gallbladder and make stones larger. Add to this a rich dessert with ice cream and a dollop of whipped cream and you’ve got yourself a fairly fatty feast. So, this one fatty meal can make a difference by bringing on symptoms of a previously undiagnosed condition, and you spend hours in an emergency room of a hospital.

The scenario could look like this case:

Fred is a 40-year-old teacher, somewhat overweight who enjoyed a holiday meal at his parent’s place for Thanksgiving. His health has been good with no surgeries. Following the turkey dinner, which he enjoyed he noticed right upper abdominal pain, and he started to vomit. As the pain did not improve, his parents called an ambulance that brought him to a hospital. The emergency physician said that he was concerned about Fred’s gallbladder. He ordered a CT scan and this showed multiple stones with one of the stones being stuck in the cystic duct. Despite pain medication and bed rest the situation did not resolve (the stone did not pass). A surgeon was called in and a laparoscopic cholecystectomy was performed. Fred recovered within only 3 days and could return to teaching. The fatty food of the Thanksgiving dinner was only the tip of the iceberg in this case. The fact that there have been many pre-existing gallbladder stones tells us that this patient had the chronic habit to eat foods with too much fat and cholesterol. Here is a blog that I found containing sensible eating suggestions.

High blood pressure

Extra salt intake leads to an elevation of blood pressure. If a person has borderline high blood pressure, the extra salt intake from holiday meals can get the blood pressure out of control and this in turn can cause a stroke (typically a hemorrhagic stroke) or is a strain to the heart leading to a heart attack or to congestive heart failure.

Janice is a 50-year-old janitor who has had problems with borderline high blood pressure readings. Normally her blood pressure was 140 over 90, and when she watched her salt intake it would go down to 125 over 80. She bought a blood pressure monitoring device, just so she could measure her own blood pressure at home. Following the Thanksgiving turkey dinner she noticed that she developed fullness in her head and a headache and her face looked flushed. She took her blood pressure with a reading of 160 over 100. It had never been that high. When she saw her doctor he asked her what she had for Thanksgiving dinner: they sat together with friends and had potato chips with dip and drank some red wine with it. Next for the meal she enjoyed the roasted, brined turkey and ham. Yes, she did add some more salt to the mashed potatoes too.

The doctor found her blood pressure to be 165 over 100. He explained to her that she needs to go on a DASH diet, which is low in salt. He also started her on blood pressure pills. Here is another link for a low salt diet.

Heart attack following turkey dinner

When working as an intern in teaching hospitals of McMaster University of Hamilton/Ont. during my training in 1975 to 1978 I noticed a strange correlation between holidays like Thanksgiving and Christmas and intensive care unit admissions with acute heart attacks. Later a formal study was published that there is indeed such a correlation between consuming a big meal with fat, salt and refined carbohydrates and the development of a heart attack.

This likely does not develop without prior silent conditions of high triglycerides, high cholesterol and insulin resistance leading to inflammatory substances circulating in the blood. The C-reactive protein is one of the substances that has emerged as a useful monitoring device and a fasting insulin level. Both should be low or the person is at a higher risk of developing a heart attack.

Add to this a festive, large meal and you got troubles at your hand like in the next case:

Joan is a 62-year-old high school principal who developed chest pain within 2 hours of having enjoyed her Christmas dinner. She was known to have high cholesterol levels for about 5 years and she had been taking statins for 4 years as diet alone could not control it. But she loved food in general and was about 20 pounds overweight. The doctor had discussed exercise with her, but she felt too busy doing other things. Now all of this came back to her as she was recovering in a hospital bed from an emergency stent procedure. They had to insert two stents to overcome narrowing of the coronary arteries. She was now pain free and felt that she needed to do something about her lifestyle. She would see a dietician and record her weights daily. She wanted to loose 20 pounds and yes, she wanted to start mild exercise when her doctor allowed it and gradually build it up to a maintenance program.

Regrets Following Holiday Foods (Gout Patient)

Regrets Following Holiday Foods (Gout Patient)

Gout attack following rich meal

It is known since the Middle Ages that feasting on a large meal of beef combined with lots of beer or wine can cause a gout attack. Gout at this time was known as a disease of the affluent. The poor obviously could not afford big feasts. Today we know that purines are the end product of meats and this gets excreted in the kidneys. However, alcohol prevents the purines to be excreted in the urine so that uric acid levels exceed a certain limit beyond which uric acid crystals are precipitated in soft tissues like around joints, which is very painful.

The following case will illustrate this:

Carl, a 45-year-old sales person suddenly developed excruciating pain and swelling in his left big toe. He went to the emergency room of the closest hospital. After some tests he was told that he had come down with acute gout. His blood tests showed a high uric acid level and biopsy samples from the left toes also revealed uric acid crystals. With the help of colchicine and allopurinol things turned back to normal within 3 days.

The gout episode occurred just 4 hours after his holiday meal consisting of a few beers and copious amounts of turkey meat. He also seems to be addicted to soft drinks which are sweetened with high fructose corn syrup which he consumes freely all day long.

It is known that sugar from soft drinks make a person 85% more prone to develop gout than a person who uses diet drinks or water.

Here is a diet sheet for Carl to prevent his next gout attack.

Conclusion

Who would have thought in the past that food could be a dangerous substance with the potential of making us sick? But this is exactly what I wanted to point out in this blog. Of course, it does not stop at holidays where we tend to eat more of what we normally eat. It pays dividends watching what we consume even in the days between feasts. For instance a DASH diet is a good idea for those of us who may have developed borderline high blood pressure. Avoiding excessive red meat is a good idea for prevention of heart attacks and strokes, as your cholesterol stays lower. Avoiding soft drinks with sugar and fructose is good prevention for avoiding obesity, cancer, heart attacks and strokes. Get the greens going (vegetables, salads etc.) to live longer without disabilities.

Last edited Dec. 6, 2014

Oct
24
2014

TACT Study Proves Effectiveness of Chelation

Even though the Trial to Assess Chelation Therapy (TACT Study) has been published in March 2013 (Ref. 1), it still needs to make its way into the common public knowledge. The National Institute of Health was noticing an “alarming 68% increase” of chelation therapy between 2002 and 2007. These patients had problems with previous heart attacks and others had angina due to coronary artery disease, so they sought relief through intravenous chelation treatments. The purpose of the TACT study was to see whether chelation treatments with EDTA were safe and whether they would show any benefits when compared to a placebo group.

TACT study design

A total of 1708 patients were randomized into two groups, 869 treated with EDTA chelation therapy and 869 in treated with placebo infusions of normal saline/dextrose. Treatments were blinded (nobody knew what was given in the intravenous). 134 research sites in Canada and the US were involved in this trial including the Mayo Clinic. Patients had to be at least 50 years old, but the average age was 65 years. They had all a prior heart attack, but not less than 6 weeks before enrolment; on average they did have their heart attack 4.6 years before enrolment. Participants had to quit smoking at least 3 months before entering into the study and if they had revascularization procedures (bypass surgeries or stents), this had to be done more than 6 months in the past.

31% of the study population had diabetes. 83% had revascularization procedures done in the past. The majority of patients were taking heart medications (72% beta blockers, 73% statins to lower cholesterol and 84% aspirin to thin the blood).

65% completed 40 infusions, 76% completed at least 30 infusions.

The chelation infusion was the standard infusion usually used in chelation clinics, namely containing EDTA (the chelating agent), salts and vitamins as indicated in this Mayo clinic summary report. The follow-up period was for 4 years. There was a drop-out of 30% for various reasons and 17% refused their consent to carry on in the study.

TACT Study Proves Effectiveness Of Chelation

TACT Study Proves Effectiveness Of Chelation

Results of the TACT study

Overall mortality in the chelation group was down 2.8% versus the placebo group. Heart attacks in the chelation group were down 19.5%; strokes down 20% and hospitalization rates were down 28.6% when compared to the values of the placebo group.

Diabetic patients (the subgroup of 31%) appear to have greater benefits from chelation treatments than the non-diabetic ones. The diabetic group benefitted by 39% with regard to risk reduction (strokes, heart attacks, mortality) versus the non-diabetic chelation group (only a 4% reduction).

Perhaps as important as the results of the effect of the chelation study versus the placebo group was the fact that the side-effect profile was indistinguishable between the two groups. This establishes for the first time that chelation therapy is safe and that it also has beneficial effects.

It is interesting that when the results of the TACT Study were announced at the 2012 American Heart Association meeting in Los Angeles, the majority of cardiologists did not believe the results (that chelation was effective); instead they were looking for alternative explanations to explain the effect and suggested that this study needed to be repeated again.

What are the benefits of chelation therapy?

Originally EDTA was used to treat children with lead poisoning in Germany. However, workers who were exposed to lead containing paints in various industries also were described to have improve significantly with EDTA chelation (see this chelation history link).

In the 1990’s environmental concerns about heavy metal poisoning of the earth atmosphere came more into the forefront. This 2007 paper reports about heavy metal poisoning in detail.

A new concern for those who like organic food is the use of copper sulfate by organic food growers to spray against fungal and bacterial growth on crop as copper sulfate is one of the 5 chemicals used in organic agriculture approved by the USDA.

Those who consume organic foods may inadvertently expose themselves to copper in their system. This will reduce zinc levels as zinc naturally counterbalances the effects of elevated copper levels. But normal zinc levels are needed for normal body function, particularly in males.

As I have explained in this blog before, chelation therapy and several other methods can detoxify the body. Pollution continues to play havoc with our system and we need to consider taking steps to counteract that. In this blog I explained that we live in a toxic world and I mentioned several steps we can take to counteract this including chelation therapy. Particularly heavy metals like lead, mercury, cadmium and copper will be reduced in the blood by intravenous EDTA chelation treatments.

Conclusion

I felt that I should take some time explaining the carefully conducted TACT Study that was a randomized double blind, government sponsored study examining the effects of chelation treatments. It showed that there were significant improvements in terms of cardiovascular recovery, but it also showed that it was entirely non-toxic. Chelation should be done by an American College for Advancement in Medicine (ACAM) certified practitioner to ensure that you get the same chelation treatment as described in the TACT Study. People with heart conditions will need 30 to 40 treatments (usually 1 week apart) to improve. However, a person with a normal heart who considers detoxification will only need 10 treatments initially (twice per week or weekly), then one every three months for maintenance. We all reside on the same planet and are exposed to ongoing pollution and food toxicity. Due to this reality the topic of chelation and detoxification is worth some serious consideration not only for patients with heart health issues.

More information about vitamins and detoxification: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

Reference: 1. J. American Medical Association (March 27, 2013, Vol. 309, No. 12)

Last edited Nov. 8, 2014

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May
21
2014

Forty Percent Of Premature Deaths Can Be Prevented

A new report from the CDC (Center of Disease Control) in the US has revealed that up to 40% of premature deaths could be prevented by simple lifestyle changes. As this link shows every year about 900,000 premature deaths occur in the US, which are due to 5 major diseases that in the opinion of the CDC can be prevented by 20 to 40%. Here are the diseases that kill: cancer, heart disease, COPD/emphysema, stroke and accidents/injuries. These conditions were responsible for 63% of all deaths in the US in 2010.

Let’s discuss each of these conditions and how one could lower the risk of dying from them.

1. Cancer:

The Framingham Heart Study has shown that smoking and cancer are closely related. Smokers who quit can significantly reduce their risk of getting cancer. We also know that exercise and prophylactic supplements like fish oil and vitamin D3 have cancer preventative effects.

Antioxidant supplementation that included beta-carotene, vitamin A, vitamin C, and vitamin E daily or on alternate days for 1 to 12 years, along with selenium supplementation reduced the incidence of cancer of the esophagus, colon, pancreas, stomach or the liver. Insulin resistance due to sugar and starch overconsumption is causing cancer, particularly breast cancer, colorectal cancer and endometrial cancer. I have discussed this in a recent blog.

Pollution has been linked to increased lung cancer risks as discussed here.

2. Heart disease:

Heart disease can be caused by several factors in combination. Lifestyle issues are important: Smokers need to quit smoking as the Framingham Heart Study has shown more than fifty years ago that smoking causes heart attacks. Obesity and diabetes also contribute significantly to the risk of heart disease. Often these are connected to faulty nutrition, which is another lifestyle issue that comes to mind when too much sugar and starchy foods are taken in; your liver will convert these into fatty acids, triglycerides and elevated, oxidized LDL cholesterol, which gets deposited under the lining of the arteries. A lack of exercise adds to this problem as a lack of exercise lowers the protective HDL cholesterol and fat is deposited under the lining of the arteries. Start exercising and your protective HDL cholesterol will rise, your total cholesterol to HDL ratio will lower to healthier levels and your risk for hardening of the arteries and for getting a heart attack will fall. If you have diabetes, it is important that you manage your blood sugars well; this means that if you inject insulin, you want the blood sugar tests to be within the normal range and the hemoglobin A1C values to be below 5.5%. Poorly controlled diabetes is an important cause of heart attacks and strokes. High blood pressure is also an important cause of developing heart attacks and strokes. It is important to control your blood pressure by taking blood pressure lowering pills and also by exercising regularly. Exercise seems to send a signal to relax the blood vessels thus lowering the blood pressure, which in turn prevents heart attacks.

Forty Percent Of Premature Deaths Can Be Prevented

Forty Percent Of Premature Deaths Can Be Prevented

 

3. COPD/emphysema:

Chronic obstructive pulmonary disease (COPD) or emphysema is mostly caused by chronic exposure to cigarette smoke from smoking. The earlier you can quit, the better your chances that your breathing will not be the limiting factor when you age. But it is also important to avoid exposure to other noxious gases, such as from welding and from exposure to pollution. This may involve a decision to move to a less polluted area. Or it might involve a job retraining. Those who are suffering from COPD can be helped to a certain extent by a portable oxygen tank with nasal prongs.

4. Stroke:

As mentioned before, quitting smoking, controlling high blood pressure and controlling blood sugar, if you suffer from diabetes have been shown to stabilize your blood vessels including the ones that supply your brain. The key is to prevent hardening of the arteries by a healthy lifestyle. Exercising and keeping your weight under a body mass index of 25.0 have been shown to be effective stroke prevention. Healthy nutrition as indicated above under “heart disease” is equally important for stroke prevention. Go green (eat more vegetables, consume more green smoothies), cut down grains, sugar and starchy foods and you will live longer without strokes and heart attacks. Remember, what’s good for your heart is good for your brain!

5. Unintentional accidents/injuries:

Wearing helmets when bicycling, wearing seat belts when driving in a car, avoiding risky behaviors are all measures that save lives. One factor stands out in all of this: if you drink too much, you run the risk of being involved in unintentional accidents or injuries. People may not like to hear this, but your brain lacks the natural inhibitory impulses when you are under the influence of alcohol, so you become more daring and you may not pay attention for the split second that could have prevented an injury or accident. People react very differently to alcohol. Some people feel inebriated after only ½ a glass of wine or beer whereas others can drink more before they make mistakes. The best is to be sober when you drive, ski, use power tools or walk in traffic. Even climbing ladders requires a clear mind!

Conclusion:

As the CDC said 20 to 40% of premature deaths (deaths that occurred before the age of 80) could have been prevented, if the above-mentioned recommendations were followed. Let me rephrase this: 180,000 to 360,000 premature deaths every year in the US before the age of 80 could have been prevented! Curative medicine cannot help with these statistics as a heart attack or stroke has happened when it has struck you. Cancer and end stage lung disease are similar conditions that you are suddenly faced with when they occur and unintentional accidents just seem to happen. This is where the importance of prevention can be seen, because these little baby steps every day are adding up to something formidable, a force to be reckoned with. Be part of the solution, think prevention!

More information on:

1. Cancer mortality: http://nethealthbook.com/cancer-overview/overview/cancer-mortality-rate/

2. Higher vitamin D3 intake lowers mortality from heart attacks, strokes, cancer, fractures due to osteoporosis: http://nethealthbook.com/news/higher-vitamin-d-levels-associated-lower-risk-mortality/

Last edited Nov. 8, 2014

Apr
19
2014

Measuring Your Heart Function

Recently I came across a book by Dr. Steven Masley, cardiologist (fellow of the American Heart Association, see Ref.1). The heart’s function is to pump your blood reliably all your life. It is a complicated organ, but it works well, if we treat it well. Western medicine has taught us that with complicated machinery and tests we can assess how the heart is doing. But until recently there was no reliable easier way to assess our cardiac health function. The purpose of this blog is to summarize a three-pronged approach to measure your heart and blood vessel health. It is described in detail in Ref.1, but I doubt that many people have yet read this important reference book. It is also important to FIRST see your doctor whether you are able to do the Bruce protocol (treadmill test, the third component below). If you neglect to be cleared by your doctor you run the risk of possibly getting angina pains or getting a heart attack.

1. Carotid IMT or carotid intimal-medial thickness test: You measure the degree to which there is hardening of the coronary arteries indirectly by measuring the thickness of the lining of the carotid arteries (carotid IMT or carotid intimal-medial thickness test). Dr. Masley has showed over a period of 10 years and more in many patients at his Health Center that there is a close correlation between the degree of coronary artery hardening and the degree of hardening of the carotid arteries. He stated that his research has shown that “90% of the time, the carotid arteries, the coronary arteries, and even the arteries of your legs all grow plaque at the same time”. The gold standard for checking the condition of your coronary arteries is a heart catheterization as Dr. Masley explains (page 58). But he adds: “IMT testing should be the new gold standard for cardiovascular plaque testing. However, this is not yet the case. Despite its usefulness, 95% of doctors are not ordering this screening test for their patients. You can rest assured that this is a situation I am to change“.

Measuring Your Heart Function

Measuring Your Heart Function

2. A detailed lipid analysis called the VAP test: A detailed laboratory test analyzing your lipid fractions (LDL, HDL, total cholesterol and VAP test). The buoyant HDL fraction, called HDL2 is the key to having a low risk for hardening of the arteries. HDL2 is large, fluffy and is designed to remove garbage from within the lining of the arteries. Also, the cholesterol ratio is another measurement for a low risk for hardening of the arteries when it is less than 3.0. The first two tests assess how much hardening of the arteries there is present and when they are normal, there is a relative reassurance that nothing drastic (like a heart attack or stroke) should happen within the next 10 years provided you keep up a regular exercise program and healthy food intake.

3. Bruce protocol (Treadmill test): The Bruce protocol (treadmill test) is often done by a cardiologists, but can also be done through many gyms, where a trainer with experience in exercise physiology will do it. This functional test measuring cardiac output has been developed many decades back and has withstood the test of time. Here is an overview what this is. As the slope of a treadmill and the speed of the belt are increased, the heart needs to do more work to maintain blood flow to your extremities and vital organs. The trainer or exercise physiologist measures the response of the heart activity in relation to the increase of the exercise load. A complicated formula allows calculating how much your maximal cardiac output is. This test has several variations and can be complicated to understand. Essentially, the higher the numbers you can create, the better. Here is a table with various results of the VaO2max from Bruce protocols and how they are interpreted.

4. Treating abnormalities found with the three basic tests: These are the necessary tools that tell you where you are in regard to your heart function. People with heart failure should not do this third test, because their heart muscle is too weak to sustain this and they would get heart failure meaning that blood gets backed up into the lungs and there could be severe breathing problems leading to a lack of oxygen (anoxia) in the heart tissue, which in turn can cause irregular heart beats (fibrillation of the heart muscle) and a heart attack. Assume that the first two tests were within the normal limit for your age, then the Bruce protocol would give you the maximum heart output at the peak level of your treadmill test. At this point you are measuring directly the cardiac output (in other words what your heart is capable of pumping for you in a certain time unit). This measurement is what physicians call the VaO2 max  or maximal oxygen consumption. This is the best index for maximal heart capacity. If your levels are higher than normal, you have extra reserves with respect to your heart as a pump for times when you need it. If this latter tolerance test shows poor results, it usually means that you were inactive and you would benefit from an exercise program. If the first test shows hardening of the arteries more than is appropriate for your age, you would need to look at your eating habits. At the same time often the VAT values and the cholesterol ratio is off meaning that you are eating the wrong foods and it shows in your blood test results.

5. Advise regarding diet, exercise and relaxation: Dr. Masley’s book has several sections that explain what needs to be done when things are not normal. For instance, the author does not mince words when it comes to eating the right fats and cutting out sugar and starchy foods. For instance on page 199 there is a neat table that lists the fiber content of different foods. We need more fiber to slow down the absorption of sugary substances, which will minimize the insulin response following a meal. Dr. Masley also mentions that omega-3-fatty acids from fish and good seafood choices will balance the omega-6-fatty acids that would lead towards the arachidonic acid pathway, which causes arthritis, inflammation and cancer. There are many more dietary recommendations, too numerous to repeat them all here. Suffice it to say that molecularly distilled omega-3 fish oil, vitamin D 1,500 to 3000 Units daily, and magnesium supplements are all good for you heart. Vitamin K2 gets calcium out of your blood vessels and into the bone (100 micrograms per day). Other worthwhile supplements mentioned in the book are CoQ-10 (50 to 200 mg twice per day), but it would be wise to have blood levels drawn, which should be above 2.5mcg/ml to which the CoQ-10 intake could be titrated. Curcumin and Resveratrol are also recommended. Most of all, it seems that regular physical exercise such as a balanced gym program is the single most effective way to reverse hardening of the arteries as measured by the carotid IMT testing.

Conclusion: Times have changed. It used to be thought that our lives were following a one-way street downwards. During periods of malnutrition, lack of exercise, being sessile and abusing alcohol and drugs this may well be the case. However, we now know that this is reversible. Change to healthier food, start smoothies with organic vegetables in a mixer, get going and walk. Jog or use a gym to get regular exercise. Physical exercise reverses the fat deposits inside the lining of the arteries. The HDL-2 fraction rises and helps counteract the elevated LDL cholesterol. Even the mood of the person who exercises regularly becomes more stabilized. Using these simpler three tests the physicians will not need the more complicated Thallium heart scans, heart catheterization etc. These three tests described above are well worth being done every two years, so that you can monitor what’s going on with your heart and blood vessels in general. What questions do you have? You could ask them below.

More information on heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/

References: 1. Dr. Steven Masley, MD: “The 30-day Heart Tune-Up – A Breakthrough Medical Plan to Prevent and Reverse Heart Disease”, Center Street, A Division of Hachette Book Group Inc. New York, Boston, Nashville, USA © 2014.

Last edited Nov. 8, 2014

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Jan
11
2014

From Inflammation To Heart Attacks, Strokes And Arthritis

Have you ever wondered why people who limp from arthritis in their hip also often get heart attacks? And have you ever wondered why people with high blood pressure get strokes and/or heart attacks?

It is not that difficult to understand, although many people do not like to hear the truth.

After the holidays with lots of sweet presents and rich food it is a good time to reflect about the internal connections between our organs.

Let’s follow what foods can do to our system, then you will understand what to do to get out of a trap, where food is not friendly but damaging to your body.

1.    Sugar, omega-6 fatty acids and trans fats enter your system

When you opened the cheap chocolate bars, ate the pastas, the turkey gravy and the ice cream for dessert, your stomach faithfully digested all that food and broke it down into glucose (a simple sugar), omega-6 fatty acids and highly reactive trans fat with free radicals (from deep fried foods, margarine, shortening, pie crusts, cake mixes, frostings and non dairy coffee creamers just to mention a few).  Within ½ hour the sugar molecules from the digested meal will enter your blood stream.

2.    The metabolism sets in

We know from years and years of research that the glucose in the blood triggers the release of insulin from the pancreas, which facilitates absorption of sugar into your liver and muscles where it is stored as glycogen. This is meant to be a storage form of sugar, just in case you do not eat for a few hours, but need energy to burn for your physical activity. When you have saturated the glycogen storage in liver and muscles, your liver metabolizes sugar into fatty acids and triglycerides. There is the transport LDL cholesterol that is supposed to supply the brain and heart with healthy cholesterol for these organs to replace cell membranes. Instead, the LDL cholesterol that is supposed to be balanced by the protective HDL cholesterol gets oxidized from the extra sugar and from the free radicals of the TRANS fats that are now being outlawed by the FDA for exactly that reason. So, the oxidized LDL cholesterol turns into the vicious VDLDL particles, which can be measured as a special blood test by your doctor. The overabundance of omega-6 fatty acids start an internal fire by stimulating the arachidonic acid pathway, which causes inflammation in your arteries, your joints and your immune system.

From Inflammation To Heart Attacks, Strokes And Arthritis

From Inflammation To Heart Attacks, Strokes And Arthritis

3.    The consequences of eating foods which spike your blood sugar levels

The end result is hardening of your arteries and the beginning of arthritis in your joints. Mind you, this does not happen overnight, but when you eat this way decade after decade it takes its toll. Typically in your forties or fifties you will notice some swollen knuckles. Don’t just let this happen. Think that this is a sign that something is festering in you! If you don’t interfere, there could be one wrong move, when you play sports and a meniscal tear in your knee could put an end to the fun. Sure, you will find a reason that the angle of your jump was unfortunate and this was simply enough for your meniscus to tear. But could it be that there were inflammatory changes in your meniscus long before this incident, the meniscal material softened up, dried up because of a lack of proper nourishing synovial fluid? I found when I was in primary care practice that this was what caused the majority of meniscal tears. A normal meniscus does not tear easily, but decades of malnutrition will lead to these hidden changes, where a meniscus can be softened and is prone to damage without a warning.

Arthritis in your joints is similar to the process of what I described regarding meniscal degeneration. An imbalance of the omega-6/omega-3 ratio where people take in 12 to 16 times as much omega-6 fatty acids from processed food compared to omega-3 fatty acids from fish oil or fish consumed, causes inflammation of the joints via the arachidonic acid metabolism.

What about the arteries? It is no secret that many people in their 60’s have suddenly an episode of chest pain that leads to a referral to a cardiologist who will do a heart catheterization. A stent or two may have to be placed because of hardening and narrowing of the coronary arteries. In many trials where people with coronary artery disease were followed laboratory tests showed that these individuals had low 25-hydroxy-vitamin D levels in their blood and the calcium that was meant to make their bones strong, ended up in the arteries. Vitamin K2 is often also missing because of malnutrition.

People with high blood pressure often do not have enough nitric oxide production from their arteries, because they do not eat enough vegetables, they are too sessile and they eat too many sweets and starchy foods. As a result  the liver overproduces triglycerides and fat, and oxidized LDL cholesterol damages the lining of the arteries. Just treating high blood pressure with blood pressure lowering medications will not correct the underlying metabolic disbalance. This is why people who had 2 or three stents for coronary artery hardening will come back 5 or 10 years later and need more stents until they die of a full-blown heart attack. You must stop the underlying metabolic derangement, if you want to prevent further deterioration.

4.    Inflammation takes its toll

But what do the lining of the arteries, the inflamed joints, a degenerative meniscus and heart attacks and strokes have in common? It is the INFLAMMATION that changes the body chemistry. It gets even more complicated, because the extra calories that we consume get stored as visceral fat. This is done automatically when you eat too much sugar and starchy foods as you may have done over the holidays. Remember, our ancestors were hunters and gatherers, and our genetic make-up is still the same. So, when the glycogen stores are full, any surplus sugar gets metabolized by the liver into triglycerides, fatty acids and LDL cholesterol and gets stored as body fat. The most active fat is the visceral fat between our guts and around our body organs. This produces interleukins and other inflammatory cytokines that circulate in the blood causing inflammation in all our arteries.

This is the link between the various manifestations of inflammatory conditions in our bodies. We rarely think of all of these various conditions as being linked. We concentrate on each disaster as it strikes, but think that it is only a one-point-in-time event. We do not see the years of abuse of our bodies that have preceded any of these events.

5.    Disaster strikes in different ways

We usually hear about a person who just got a heart attack. Now it is an emergency!  Nobody thinks about the years of inappropriate food intake and the lack of exercise that led up to this heart attack event.

The same is true for a sudden stroke. The patient arrives at the hospital in an ambulance and cannot move one arm and one leg. Initially the patient may be unconscious. There is too much action required by the emergency personnel to ask the question why it had to come to this. The truth though is that the blood vessel deterioration in the brain vessels that led to the stroke have quietly happened years before the acute event.

And then there is the aging 75-year-old man with a stiffening hip and arthritis in the hands. The inflammation has been quietly developing in the synovial membranes of the joints for more than a decade. The patient probably swallowed anti-inflammatory medications for years for arthritis symptoms, which as you guessed has not changed the underlying biochemistry. But now it has come to the point where a total hip replacement is required, just to be able to continue to walk. I have experienced that scenario in the hospital setting many times. Many patients went through the total hip replacement surgery with no problems. But other patients had their total hip replacement done and they developed a heart attack under the general anesthetic, because unbeknown to the orthopedic surgeon the patient also had severe hardening of the arteries that had not shown up on the pre-surgical electrocardiogram. A stress test or a Thallium heart scan when the patient still could exercise would have shown this hidden cardiac condition before the surgery, so that a cardiologist could have addressed this condition before the surgery. After that the total hip replacement would most likely have been uneventful.

6.Prevention is the key

The lesson to be learned from all of this is: prevent these disasters from happening in the first place. Do the following:

1) Good, balanced nutrition

2) Regular exercise.

3) Take vitamins and mineral supplements for bone health.

4) As you age, have your hormones measured and replace what is missing.

5) Avoid toxins. Use detoxification.

6) Avoid junk foods.

I have covered these topics in many blogs before as indicated in the above links.

Conclusion

Health disasters are mostly not accidental, but are rather caused by not paying attention to the silent metabolic changes based on improper nutrition and a lack of exercise, which could also be termed as a lack of prevention. It takes some time, often even some suffering to understand the deeper meaning of what I discussed above (that prevention is much more powerful on the long-term than curative medicine). I speak from experience having worked in the medical field for more than 30 years. Curative medicine will take care of an emergency, but the underlying inflammation and metabolic derangement will persist, if this is not changed through the steps mentioned above. Treat inflammation and LDL oxidation by modifying your lifestyle. Think prevention!

More information on inflammation medicine: http://www.askdrray.com/chronic-inflammation-causes-cancer-heart-attacks-and-more/

Last edited Nov. 7, 2014

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Nov
30
2013

Statins Can Hurt The Consumer

Lovastatin (Mevacor, from Merck) was the first statin drug approved by the FDA in 1987 as a cholesterol-lowering drug in the US. It made history in helping high-risk heart attack patients reduce their cholesterol levels and has helped safe many lives. But with the detection around 2002 that heart disease is an inflammatory disease, and that measuring the C-reactive protein with a blood test was a better than measuring cholesterol levels in predicting who would be at risk for developing a heart attack, the landscape has changed. Lifestyle changes have also been shown to be very effective in reducing cholesterol, C-reactive protein and triglyceride levels. In fact, lifestyle changes will reduce the risk for heart attacks and strokes. The newest flurry of activity with calls for putting more people on statins (see this recent news article) makes me suspicious that there could be a misrepresentation of the facts.

In this blog I am analyzing the literature to get to the bottom of the facts on reducing risk for heart attacks and strokes. I also come to my own conclusion.

Facts about cholesterol

Cholesterol is a waxy substance that is part of the cell walls and plays a vital role in our metabolism. Liver cell membranes, for instance contain about 30% cholesterol. However, most of the cholesterol in our body comes from metabolism, 20 to 25% from the liver, the rest in the gut, adrenal glands and the reproductive organs, and also from the brain (the myelin sheaths contain a lot of cholesterol). 50% of the body’s cholesterol is recycled through bile salts and reabsorption of cholesterol in the gut (called the enterohepatic pathway).

Cholesterol is vital for cell function, for insulation of nerve fibers (myelin sheaths) and for synthesis of our steroid hormones (sex hormones and vitamin D3, which  is now considered to be a hormone). The medical establishment took most of the information regarding heart attack and stroke prevention from the ongoing Framingham study. This clearly pointed to the importance of lowering the LDL cholesterol fraction (the “bad” cholesterol) and maintaining or increasing the HDL fraction (the “good” cholesterol). When it was realized that concentrating only on lowering cholesterol missed 50% of all heart attacks that researchers refocused and found the missing link, namely inflammation. Inflammation is at the cause of heart attacks and strokes, high cholesterol and lipids were only secondary phenomena. Ref. 2 points out that a comprehensive approach to treating a patient with high cholesterol should involve a combination of treatments aimed at the underlying risk factors for heart disease or stroke in a particular patient. This involves sophisticated blood tests where a metabolic derangement can be pinpointed. It should include measuring cholesterol fractions, lipids, the C-reactive protein, hormone levels and more.

Statins Can Hurt The Consumer

Statins Can Hurt The Consumer

How the traditional thinking about cholesterol has changed

The Framingham study has provided the basis for the drug industry to produce statins until about 2002 when our thinking about cholesterol being the culprit for causing heart attacks has forever changed. Subsequently further research showed that other factors like inflammation of the blood vessels, the metabolic syndrome associated with obesity and lack of exercise were also to blame for causing heart attacks and strokes. Recently more details have come to light, which point to multiple causes like the consumption of too much sugar, too much trans fats, too much salt and eating too much over processed convenience food.  We end up gaining weight, develop the metabolic syndrome and inflammation of arteries (including the coronary arteries of the heart and the brain vessels). It is the lack of nitric oxide in the lining of the arteries, which combined with inflammatory substances from visceral fat are responsible for hardening of the arteries as the ultimate consequence of faulty nutrition and lack of exercise. We also know that oxidized LDL, particularly the very low-density lipoproteins (VLDL), will release free radicals and damage the arterial walls. CoQ-10 is a supplement, which is known to counteract this. One important test that had developed out of the Framingham study is the “ratio of total cholesterol to HDL cholesterol”, which is used by cardiologists to determine the risk of coronary artery disease. The average risk of this ratio for Americans is 5.0 for males and 4.4 for females. The ideal ratio to strive for is  the “1/2 average risk” ratio of 3.4 for males and 3.3 for women (Ref.2). A fit, slim person who eats a low carb, normal fat diet (modified Mediterranean diet) will often have a ratio of only 3.0, well below the 1/2 average risk. The moment you introduce grains in your diet (cereals, bread, pasta) your liver will convert carbs into LDL cholesterol, while HDL cholesterol will drop resulting in a high risk ratio of above 5.0 (often 7 or 8 or more). The LDL will get oxidized and is deposited into your arteries setting you up for coming down with a heart attack or stroke down the road.

How do statins work?

The statins are a group of drugs that inhibit an enzyme, called the hydroxymethylglutaryl–Coenzyme A (HMG-CoA), which leads to a lowering of cholesterol, specifically a fraction known as the LDL cholesterol. The success story of lovastatin (Mevacor) led to a flurry of new HMG-CoA reductase inhibitors (cholesterol lowering drugs) such as fluvastatin (Lescol), pravastatin (Pravachol), simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor) in the late 1980’s and the 1990’s. Collectively it is now a 26 billion industry in annual sales.

Later investigations showed that there were other mechanisms by which statins helped, namely they were found to decrease the inflammatory reaction, which can be measured by lowering of the C-reactive protein. However, there are significant side effects in about 1 to 3% of people who take this medication, particularly an inflammation of liver cells (evident from elevation of liver enzymes) and a myopathy, which is a painful muscle condition (Ref. 1). This latter fact, which can occur in as many as 33% of the population at large (particularly the exercise minded) has limited the use of statins in competitive athletes where myopathies can occur in as many as 75% of athletes treated with statins (Ref.2). The reason for that is that the muscles of athletes cannot keep up with the demands put on them when they are kept in check by the HMG-CoA reductase inhibitors. On the other hand statins have prevented heart attacks and deaths from heart attacks and strokes in about 25% to 35% of patients treated with them as many clinical trials have shown (Ref.1), but simple supplements that have no side effects can do the same or do even better (see below).

The lack of cholesterol synthesis by the body’s cells when statins are given, leads to an expression of more LDL receptors on the cell surfaces. LDL binds to these receptors and enters the cells, which removes the circulating high risk LDL fraction of cholesterol from the blood thus causing a drop in LDL cholesterol. All of the side effects of statins (pull down to side effects in this link) can be explained as a result of the slow-down of organ functions (brain, muscles, gut, adrenal glands, etc.) as cholesterol synthesis is reduced.

New information from the Framingham Heart Study

So far everything I said made sense. But when I came across Ref. 4 I noticed that there was a bombshell of new information from another follow-up study of the Framingham Heart Study (Ref. 5) that did not fit in with the latest marketing drive of the statin manufacturers. In this study from 2005 Boston researchers had studied the outcomes of 789 men and 1105 women over a period of 16 to 18 years with respect to cognitive function. Participants were divided into total cholesterol groups that showed levels that were desirable (less than 200), borderline (200 to 239) or high (above 240). The astounding results were that higher cognitive functioning as documented in multiple cognitive tests in these three groups showed the best performance in the group with the highest cholesterol and the worst cognitive test outcomes in the lowest cholesterol group, quite opposite of what was expected.

Another important piece of research (April 2013) comes from Spain where doctors followed a group of 7447 patients with a high cardiovascular risk who were put on a Mediterranean diet with olive oil, a Mediterranean diet with nuts or a regular diet. The end point was death from heart attack or stroke. After 4.8 years the study had to be interrupted as the Mediterranean groups showed a significant survival advantage over the group on a regular diet.

Ref. 4 cited literature evidence that statins cause a 48% increased risk in postmenopausal women who take statins to develop diabetes. It also cites compelling evidence that diabetes patients are twice as likely to develop Alzheimer’s disease within 15 years and are 1.75 times more likely to develop any kind of dementia in the same time period.

Dr. Seneff from the Computer Science and Artificial Intelligence Laboratory at MIT explains in great detail that statins effectively reduce cholesterol synthesis in the liver, which in turn starves the brain of one of its main nutrients explaining why patient develop Alzheimer’s disease and dementia as a result of statin treatment.

So, the lessons to be learnt from these clinical trials are that you want to offer your brain enough cholesterol and healthy fat to have a normal metabolism. Fortunately, what’s good for your heart is also good for your brain. Conversely avoid statins, if you can and try alternatives first. Ref. 4 explains that for years the experts had the wrong theory that low fat/high carb was what would be good for your heart and brain, but the opposite is true: what is good for your heart and brain is a high healthy fats/low refined carb diet.

Make sure that with your blood tests that fasting insulin is low (no insulin resistance), that the ratio of total cholesterol to HDL cholesterol is less than 3.4 (low risk for heart attacks or strokes) and that the hemoglobin A1C level is low (4.8 to 5.6%, ideally less than 4.5%), which means you are not diabetic.

How alternative treatment can save you from heart attacks

Lifestyle treatment through dietary intervention, moderate exercise, and weight loss has been somewhat neglected by mainstream medicine, but is now recognized in regular textbooks of medicine as first-line treatment (Ref. 3). Most patients can lower LDL cholesterol by 10 to 15% through a change in diet. High-risk patients with established heart disease (narrowing of coronary arteries) require a drop of 30 to 60% of LDL cholesterol; this high-risk patient group may need an addition of a statin. In patients with metabolic syndrome or diabetes high triglycerides are often present and will respond to decreased intake of simple sugars, alcohol, and calories (Ref.3). Total calorie intake should be adjusted according to what the weight is when weighed every day with the goal of reducing the weight when overweight or obese, but maintaining the weight when it is in the normal body mass index range (BMI of 20 to 25). The total fat intake should be around 25%-35% of the total calorie intake. Specifically, saturated fat needs to be less than 7% of total calories, polyunsaturated fat up to 10% of total calories and monounsaturated fat up to 20% of total calories. Healthy fats according to Ref. 4 are extra-virgin olive oil, organic butter, almond milk, avocados, olives, nuts, nut butters and cheese ( except for blue cheeses). Other healthy fats are sesame oil, coconut oil, and the oils found in seeds like flaxseed, sunflower seeds, pumpkin seeds and chia seeds. Note that trans-fats (such as in margarine and baked goods) are a “no-no” as it causes free radicals in your body, which would accelerate the hardening of your arteries. Complex carbohydrates from vegetables and fruit are the main source of total calories providing 50%-60% of the total calories. Fiber intake needs to be 20-30 grams per day. Protein intake should be about 15% of total calories. Fat should provide 25% to 35% of the total calories per day. Cholesterol intake should be less than 200 mg per day. You may want to consider the use of plant sterols (2 grams per day) to enhance LDL cholesterol lowering. Physical activity from moderate exercise should expend at least 200 kcal per day (better 300 kcal).

Which supplements prevent heart attacks and strokes?

There are several nutrients that have been shown to be powerful preventers of heart attacks and strokes. I will review them briefly here (based on Ref. 2):

1. Coenzyme Q10 (CoQ10): The cells lining the arteries are only working well when their mitochondria are working properly producing chemical energy in form of ATP. CoQ10 is an important component of the mitochondrial metabolism; it is also the only fat soluble antioxidant that gets absorbed into the LDL particles where it protects these from oxidation. Statins suppress CoQ10 synthesis, so patients on statins need to take CoQ10 supplements daily to counteract this. However, anybody who is healthy now should take CoQ10 as a daily supplement for prevention. I take 400 mg per day.

2. Vitamin E (tocopherols): this fat soluble vitamin is an antioxidant and has been praised in the past as being heart supportive, was subsequently bad-mouthed by some conservative physicians, but lately has been resurrected. It turns out that there are 8 different types of tocopherols, with the alpha tocopherol being the most known, but gamma tocopherol is the one you want to make sure you are also getting with your balanced vitamin E supplement every day as this is the one that is a powerful anti-inflammatory. Simply ask staff at your health food store for a vitamin E supplement with gamma tocopherol in it. Take 400 IU per day (of the mix).

3. Curcumin: This is a powerful heart and brain protector combining three different mechanisms in one; it is reducing oxidative stress, is an anti-inflammatory and counters the process that threatens to destroy the lining of the arteries. One study on healthy volunteers showed a reduction of 33% in lipid oxidation, a 12% reduction of total cholesterol and an increase of 29% of the protective HDL cholesterol when 500 mg of curcumin was taken only for 7 days (Ref.2). This is the daily dose I would recommend for prevention of heart attacks and strokes.

4. Polyphenols: Flavonoids are the largest group among the polyphenols contained in such common foods as vegetables, fruits, tea, coffee, chocolate and wine.  Over 130 studies have been done on humans showing improvement of the lining of the arteries (endothelial functioning) and lowering of blood pressure. Polyphenol consumption has been associated with a lower risk of mortality from heart attacks. Eat a Mediterranean type diet or a DASH diet and you will automatically get enough polyphenols with your food. However, resveratrol, the powerful red wine polyphenol warrants a separate daily supplementation as it prevents LDL oxidation in humans (Ref.2). Take about 250 mg of it daily.

5. Niacin/nicotinic acid: This supplement comes as “flush-free niacin” and also as extended release niacin; it can raise the beneficial HDL cholesterol by 30 to 35% when higher doses of 2.25 grams per day are used. In a metaanalysis of 7 studies it has been shown to significantly reduce heart attacks and transient ischemic attacks (precursor syndrome before developing a stroke). Niacin can change the small particle LDL into a large particle size LDL, which is less dangerous. Niacin has also been shown to reduce oxidation of LDL, which stops the atherosclerotic process. For a healthy person 500 mg per day of flush-free niacin is adequate.

6. Fish oil (omega-3-fatty acids): Because heart attacks are due to an inflammatory process and high LDL cholesterol is thought to be only a secondary phenomenon, it is very important to have this additional tool of an important anti-inflammatory supplement. In the past it was still safe to eat fish fairly frequently per week. But with mercury, radioactive iodine from Japan’s leaking reactor and carcinogenic PBC’s all congregating in the ocean waters, it is no longer safe to consume fish in large quantities. The remedy to this situation is molecularly distilled (or pharmaceutically pure) EPA/DHA supplements. EPA stands for eicosapentaenoic acid or omega-3 fatty acid. DHA is the acronym for docosahexaenoic acid. Fish oil supplements at a dosage of 3.35 grams per day of EPA plus DHA were shown to reduce triglycerides by up to 40%, equally to Lipitor or even more effective, but without the statin side effects. The amount of the dangerous small dense LDL is also being reduced with fish oil. Fish oil supplements have reduced the mortality from heart attacks and strokes and led to a higher survival from non-fatal heart attacks. At the same time these preventative fish oil doses will also treat and prevent arthritis.

7. Other useful supplements: Soluble fiber from psyllium, pectin, beta-glucans and others have been shown in clinical trials to reduce LDL cholesterol by binding bile salts in the gut (interrupting the enterohepatic pathway). Plant sterols (usually sold as sterol esters) are recognized by the FDA as reducing the risk of coronary heart disease, if taken in high enough amounts (2.4 grams of sterol esters per day). There are other useful supplements like artichoke extract, pomegranate, soy protein, Indian gooseberry (amla), garlic and pantethine (vitamin B5) that have been proven to be of benefit in terms of prevention of heart attacks and strokes. It would be too lengthy to get into more details here.

Conclusion

Recently there was a review in a medical journal that demonstrated that clinical guidelines (in this case for clinical guidelines for lowering cholesterol) erred 40% of the times when measured against scientific tests as this link explains. When it comes to saving lives by preventing heart attacks and strokes, what is needed is a multifactorial approach that treats the multifactorial causes of cardiovascular disease. Just pushing for treating more people with statins as Big Pharma is attempting to do is not addressing the fact that cholesterol is needed for our metabolism and the synthesis of our hormones. It is much superior to use a combination of different approaches that overlap and thus potentiate each other in their effects excluding statins first. Exercise creates more nitric oxide production by the lining of the arteries, which opens up arteries and prevents spasms. A proper diet with as many of the proven vitamins and other support factors will control inflammation and oxidation of LDL cholesterol particles as explained. This will prevent heart attacks and strokes as has been shown in many clinical trials. Only patients who come from families with genetically high cholesterol or high triglycerides and those patients who had heart attacks and strokes should be exposed to statins as they are at a higher risk of developing a heart attack or stroke. They need all of the help they can get in addition to the lifestyle factors mentioned. Most other patients and the public at large will do quite well without statins (no side effects of diabetes, Alzheimer’s and muscle pains). And, yes, a diet high in healthy fats, but low in refined carbs is what your brain and heart need (the opposite of what you have thought, see Ref. 4).

More information about side-effects of statins (acute pancreatitis): http://www.askdrray.com/pancreatitis-can-occur-with-statin-use/

Lower cholesterol with Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

 

References

1. Bonow: Braunwald’s Heart Disease – A Textbook of Cardiovascular Medicine, 9th ed. © 2011 Saunders.

2. Life Extension: Disease Prevention and Treatment, Fifth edition. 130 Evidence-Based Protocols to Combat the Diseases of Aging. © 2013

3. Melmed: Williams Textbook of Endocrinology, 12th ed. © 2011 Saunders.

4. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

5. http://www.psychosomaticmedicine.org/content/67/1/24.full.pdf

Last edited Nov. 7, 2014