Dec
17
2016

Magnesium Is Essential To Life

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

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

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

A lack of magnesium can cause heart disease

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

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

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

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

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

Low magnesium increases your stroke risk

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

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

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

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

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

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

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

Magnesium protects kidney function

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

Magnesium helps blood sugar control

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

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

Magnesium good for bones and teeth

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

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

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

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

Those who took magnesium supplements had healthier teeth.

Migraine sufferers improve with magnesium

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

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

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

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

Cancer can be caused from too little magnesium

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

Pancreatic cancer

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

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

Colorectal cancer

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

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

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

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

Live longer with magnesium

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

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

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

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

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

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

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

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

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

Here is why we live longer with magnesium supplementation

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

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

Magnesium Is Essential To Life

Magnesium Is Essential To Life

Conclusion

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

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Feb
06
2016

Effects Of Hormones On The Heart

Since February is heart month, I believe that this is a timely topic to understand how we can protect ourselves from heart disease. During the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 11-13, 2015 in Las Vegas Dr. Ron Rothenberg gave a talk entitled ”Hormones And The Heart”. He stated that he wanted to give an overview of the effects on the endocrine system and on the cardiovascular system, in particular the effect of testosterone and estrogen. Also discussed were the effects of thyroid hormones, growth hormone, vitamin D and melatonin. In the following I will summarize what he explained in detail.

Testosterone treatment in men

He stated that there has been some confusion about the protective effect of testosterone on the heart in men. But Dr. Sharma and colleagues who investigated 83,010 male veterans with documented low testosterone levels clarified this confusion with this large study.

One group was given testosterone replacement therapy, another was not given replacement therapy and one group was given replacement with testosterone, but normalization of testosterone levels was not achieved.

The various groups were followed for between 4.6 years and 6.2 years. The results were astounding: When results between testosterone treated men were compared to non-treated men there was a 56% reduction of all cause mortality, a reduction of heart attacks by 24% and a reduction of strokes by 36%. There was no difference between the non-treated control group and the partially treated testosterone group where the testosterone levels did not come up. It is clear from this that with proper testosterone replacement where testosterone levels are monitored and corrected, significant reductions in strokes and heart attacks can be achieved. The explanation for these findings is simple: both, brain cells and heart cells in males, have testosterone hormone receptors that need to be stimulated for full function.

Hormone replacement in women

This topic has been clouded for many years because of the insistence of the medical profession to use horse derived estrogen (Premarin) and synthetic Provera (instead of bioidentical progesterone). These artificial hormone-like substances were used in the much-discussed Women’s Health Initiative (WHI).

Dr. Rothenberg said about this study that investigators used the wrong estrogen, the wrong progesterone, the wrong route of administration of estrogen (oral estrogen causes inflammation), and the wrong women at age 63 who already had cardiovascular disease and breast cancer.

One important aspect that was learnt by re-interpreting the WHI was that when estrogen replacement was initiated right away when menopause started, the heart attack risk went down by 34%. Estrogen and Provera together reduced the risk only by 28% (Provera being the wrong hormone). Again, the explanation for this findings is simple: women have both estrogen and progesterone receptors in heart and brain cells, which want to be stimulated with the natural hormones. When estrogen is missing, women need bioidentical replacement of what is missing with estradiol transdermal creams. When progesterone is missing, replacement with bioidentical progesterone transdermal cream or with micronized progesterone orally is needed.

Estrogen

With regard to estrogen replacement the KEEPS study has shed a new light on what is going on with hormone replacement in women.

This study was done on 700 women in early menopause. They were treated with 0.45 mg of Premarin (still the wrong hormone) or 50 micrograms of transdermal estradiol (the right active human estrogen). Women also received 200 mg of micronized progesterone (Prometrium, the real human progesterone) for 12 days each month. After 4 years of observation there was no case of breast cancer, uterine cancer, heart attack, transient ischemic attack, stroke, or blood clots in veins between the three groups. Both Premarin and transdermal estrogen had slightly reduced coronary artery calcifications on CT scans compared to the placebo group without hormones. The Premarin group increased the triglyceride and the CRP (a measure of inflammation) levels while the transdermal human estrogen did not do that.

Another study showed that due to the WHI study with the wrong synthetic hormones many women were fearful of starting estrogen replacement. The lack of hormone replacement with nature-identical hormones is responsible for the death of many women, who did not have the beneficial effects. They died of cancer and heart disease.

Dr. Rothenberg explained that this study and others have shown the following:

  1. Bioidentical hormone replacement must be started immediately at or before menopause to have the best results in terms of cardiovascular and neuroprotective (Alzheimer’s) prevention.
  2. Oral estrogen induces inflammation, which causes heart attacks, strokes and venous thromboembolism (blood clots). To prevent this, estradiol must be given as a transdermal cream. This will avoid the first pass effect through the liver, which is the cause for inflammation. Transdermal estradiol does not have the first pass effect. Inflammatory cytokines are implicated in autoimmune processes, initiation of cardiovascular disease, osteoporosis and Alzheimer’s disease.
  3. If estrogen replacement is not done right away with the start of menopause, the estrogen receptor may get damaged, which means that when estrogen replacement is started at a later date, it is no longer effective.

Progesterone

Progesterone is the other female hormone that is often overlooked. It balances the effects of estrogens, but it can also be metabolized into estrogen or testosterone. Tiny amounts of testosterone are necessary for normal libido. Progesterone production from the ovaries is already reduced when the woman is premenopausal and should be replaced by transdermal bioidentical progesterone cream.

Estrogen dominance needs to be treated with transdermal progesterone (or micronized oral progesterone). Both estrogen and progesterone can be accurately determined using a saliva hormone test. Blood tests are accurate for estrogen levels, but not for progesterone levels.

Thyroid replacement

Not infrequently thyroid tests are low (hypothyroidism) and cholesterol levels rise. This can lead to heart attacks and strokes. For instance, a slightly elevated TSH of 5.5 is associated with a total cholesterol level of 209 mg/dL, and a TSH level of 7.0 is associated with a cholesterol level of 270 mg/dL (normal less than 180 mg/dL). It is very important to detect hypothyroidism early and to treat it effectively to prevent cardiovascular disease. The active thyroid hormone is T3. Thyroid replacement has a stabilizing effect on the heart rhythm. It works together with testosterone in men and estrogen in women to stabilize metabolism of all cells, but in particular the heart muscle cells and brain cells. Hypothyroid patients are often depressed, but thyroid replacement lifts the depression. Cognitive deficits in patients with hypothyroidism are also remedied with thyroid treatment.

Growth hormone replacement

Growth hormone (GH) is important in childhood for bone growth and growth of all the organs. But GH still has an important function later in life. GH improves cardiac performance; it does so by thickening the wall of the left heart chamber, the main pump of the heart muscle. GH improves the contractility of the heart muscle, reduces the stress on the heart muscle wall and decreases vascular resistance. In animal experiments it was found that GH plays an important role in remodeling the heart after a heart attack.

GH deficiency occurs with aging; it leads to high LDL (bad) cholesterol and high triglycerides in the blood and increased fibrinogen, which causes blood clots. All of this increases the risk for heart attacks and strokes.

When people age, they lose GH production, which puts them at a considerable risk to get heart attacks and strokes, but they are also at a higher risk of serious falls due to muscle weakness and balance problems. When the doctor detects low IGF-1 levels in the blood and confirms low GH metabolites in a 24-hour urine sample, the time has come to do daily GH injections with human GH. This can be done using a similar pen that is used for insulin injections. The dosage is only between 0.1 mg and 0.3 mg per day, given before bedtime. This is remarkably effective not only for heart attack and stroke prevention, but also to treat muscle weakness, lack of mental clarity and general well being. Patients report that their joint and muscle aches disappear and they can engage in physical activities again.

Melatonin replacement

Melatonin is a hormone that is mostly thought of as the “sleeping hormone”. It is released by the pineal gland and rules overnight giving you a refreshing sleep. In the morning and during the day the light that enters your eyes inactivates it.

Melatonin is a powerful antioxidant, stabilizes the heart’s rhythm (anti-arrhythmic activity), is anti-inflammatory, anti-hypertensive and protects against heart attacks and strokes. People who have heart disease are usually found to have very low blood melatonin levels. Melatonin can be used intravenously in patients who have heart attacks to reduce the amount of damage to the tissue and stabilize the heart rhythm.

Like with GH, the production of melatonin deteriorates significantly beyond the age of 40. Blood levels of melatonin can be easily ordered, and replacement is easy to do. 3 mg of melatonin taken at bedtime will be a sufficient dose for most people. Another 3 mg can be taken, if you wake up in the middle of the night. It will wear off within 3 to 4 hours.

Vitamin D replacement

The history of vitamin D3 is interesting. Vitamin D3, the active form of vitamin D has many actions: it stimulates the immune system and reduces the risk of infection, it reduces blood pressure, it reduces inflammation by reducing circulating cytokines, and it increases insulin sensitivity making insulin receptors more responsive.

Vitamin D3 binds to the vitamin D receptor, which is contained on all cells.

Many middfle-aged and older people are deficient for vitamin D.  A lack of it leads to higher mortality. Vitamin D helps to restore circulation in patients with ischemic heart disease. Vitamin D insufficiency causes high blood pressure, diabetes and metabolic syndrome, enlargement and thickening of the wall of your heart’s main pumping chamber, heart failure and chronic vascular inflammation.

A prospective 7.3-year study looked at the hazard ratios of the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files with lower 25-hydroxyvitamin D levels. There were 33,994 persons part of the survey, of whom 1,493 died.

Below 10 ng/ml of 25-hydroxyvitamin D level the mortality was 2.5 fold for all causes and 3.08-fold for cardiovascular causes compared to those with levels of 100 ng/ml or higher.

The recommendation presently is to maintain serum levels at 60-80 ng/ml of 25-hydroxyvitamin D to prevent cardiovascular disease.

Effects Of Hormones On The Heart

Effects Of Hormones On The Heart

Conclusion

The following is important to remember regarding prevention of heart disease.

  1. Never smoke or if you do, quit smoking.
  2. Have your thyroid hormones checked as thyroid hormones are important as an energy source for your heart muscle, and they lower LDL cholesterol levels.
  3. Your sex hormones matter: in men it is testosterone, in women estrogen and progesterone that support your heart.
  4. Vitamin D is not only important when we grow bones as youngsters, but it continues to be important when we are older. It supports our heart and other body functions. It is an essential team player, as it prevents premature deaths. Blood levels of vitamin D are easy to measure.
  5. Two hormones leave us rapidly as we age: melatonin and human growth hormone. However, levels of both hormones can be measured and if low, they can be replaced.
  6. There are only two more things you need to do: eat a Mediterranean type diet and exercise on a regular basis. This will ensure your heart is still healthy in years to come.
Dec
26
2015

Coffee Could Be A Lifesaver

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

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

Ding’s studies took this into account and also other confounding factors like how much sugary soda pop people were drinking and whether or not they were eating well. In addition they normalized for other factors that could interfere like drinking alcohol and eating red meat.

Without normalizing for the factors mentioned above the study results were as follows. Study participants had less than a cup of coffee and three cups a day had a 5% to 9% lower risk of dying than those who drank no coffee. Those who drank more than three cups a day did not see any benefit.

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

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

Ming Ding was associated with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and heart disease. She found that both caffeinated and decaffeinated coffee reduced the risk of getting diabetes later in life.

When asked about what would be responsible for the reduced death rates with coffee consumption, Ding explained: “There are at least two known chemicals in coffee, namely lignans and chlorogenic acid that could reduce inflammation and help control blood sugar, both of which could help reduce the risk of heart disease”.

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

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

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

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

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

Discussion

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

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

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

Coffee Could Be A Lifesaver

Coffee Could Be A Lifesaver

Conclusion

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

Apr
11
2015

Fish Oil, Your Best Supplement

There was a story in CNN last year describing the dramatic recovery of a youngster who was involved in a hit and run brain injury. The physicians involved in his care strongly recommended “to let him go”. His family did not give up on him and tried bioidentical progesterone cream first and finally fish oil in high doses, which lead to a successful recovery from this young man’s brain injury. Nine weeks after the accident the patient was transferred to the rehabilitation hospital, still unconscious. At that time the family increased the fish oil dosage to 20 grams (=20,000 mg) per day. Within two days the young man woke up from his coma and called his mother on a cell phone.

The benefits of fish oil

Fish oil is sold under various brand names. The high potency ones contain about 1400mg of fish oil in one soft gel. Each soft gel has 647mg EPA (Eicosapentaenoic acid, commonly known as omega-3 fatty acid) and 253 mg DHA (Docosahexaenoic acid) and other fatty acids. Any of these more potent fish oil preparations are molecularly distilled meaning that mercury, cadmium and PBA impurities have been removed from the product before it is passed on to consumers.

Fish oil boosts your memory, it helps brain cells to function better. EPA is more beneficial for the lining of arteries and prevents heart attacks and strokes. The DHA component of fish oil is the building block of brain cells, and likely it was DHA that brought the young man with the hit and run accident back to consciousness.

Fish oil also has anti-inflammatory properties, which is important for arthritis and prevention of heart attacks.

Everyday supplementation with fish oil

For persons with no arthritis and health risks a good fish oil supplement dose would be 1 or 2 of the higher potency fish oil capsules per day. This will help to prevent inflammation. The American Heart Association recommends to consume salmon two times per week, which will also give you a good dose of fish oil.

People with arthritis need more fish oil

As this link shows people with arthritis need more omega-3 fatty acids (EPA), namely 2.7 grams or more (=2700 mg or more) per day.

This would mean 5 capsules of the high potency supplement I described above to bring the total EPA to just above 3000 mg per day. People who have arthritis have so much more inflammation in their body that they need this higher amount of fish oil to get the condition under control. When you start fish oil supplements for arthritis it takes about 2 to 3 months for the fish oil to work before the inflammation is under control. So be patient.

Fat metabolism

When it comes to the metabolism of fatty acids, it is important to know the ratio of omega-6 to omega-3 fatty acids that we take in. For instance, there are a lot of omega-3 fatty acids in fish and seafood. On the other hand there is more omega-6 fatty aid in chicken and processed meat. Omega-6 fatty acid gets metabolized into arachidonic acid that causes inflammation. Most processed foods have too much omega-6 fatty acids in them. Here is a hint: when we consume more omega-3 fatty acids by increasing our fish oil supplementation, we counterbalance the omega-6 to omega-3 ratio. This will slow down aging, will control inflammation in the body and will prevent disabilities.

Side effects of fish oil

  1. Be aware that there is a difference between “fish oil” and “cod liver oil” or “halibut liver oil”. Cod liver and halibut liver oil has vitamin A in it; so avoid these formulations as this could lead to toxic levels of vitamin A.
  2. Fish oil is generally safe; there may be a mildly upset stomach at higher dosages, which is harmless and the dosage can be reduced until the stomach accepts it.
  3. Fish oil tends to thin the blood and theoretically there may be a problem when a person takes aspirin or blood thinners. Discuss this with the doctor. Patients with atrial fibrillation on blood thinners should discuss with their doctor whether it is safe for them to take fish oil supplements.
  4. Patients on platelet inhibitors (ASA and others) should first clear with their physician whether it is safe. The FDA did a review on this and stated that theoretically there could be interference in these situations, but practically no case was found that would have substantiated this.
  5. The cytochrome P450 pathway in the liver, which is used to eliminate antidepressants, erythromycin and many acid suppressing drugs (cimetidine, ranitidine) etc. is not interfering with the elimination of fish oil. The FDA confirmed this. This means that you will not have to fear that you overdose with fish oil because of drug interactions in the liver.

Fish oil supplementation in diabetes and heart disease

Many studies have shown that fish oil improves the control of diabetes, improves heart disease based on narrowing of coronary arteries and lowers blood pressure. It does so because of the anti-inflammatory effect of fish oil; this improves endothelial functioning, which leads to more nitric oxide production and lowering of high blood pressure. Patients find that they do not need as much insulin some time after starting fish oil supplementation, and their blood sugar is better controlled. They also get more energy, which may help to motivate them to engage in regular exercise, which in turn helps improve diabetes, prevents cardiovascular disease and Alzheimer’s disease.

Fish oil to prevent Alzheimer’s disease

Apart from other factors mentioned in this link the regular consumption of fish and fish oil will help improve memory and Alzheimer’s in general. It is the DHA contained in fish oil that is needed by the brain and the omega-3 fatty acids in fish oil help keep the cardiovascular system healthy.

A study in the medical journal Alzheimer’s and Dementia from June 14, 2014 followed 193 older men and women with Alzheimer’s patients for 5 years. Every half-year they had a magnetic resonance imaging study (MRI scan) of the brain and neuropsychological testing. 117 subjects used fish oil supplements throughout the study. They were the ones who maintained their brain volume and in particular the hippocampus area, which is important for memory. They also preserved their brain function compared to those subjects who did not consume fish oil. They showed shrinkage of the brain and a decrease in size of the hippocampus as well as poor brain function in neuropsychological testing. Patients who were carriers of the apolipoprotein E4 gene did not show the protective effect with fish oil.

Fish Oil, Your Best Supplement

Fish Oil, Your Best Supplement

Conclusion

Consumption of fish and supplementation with fish oil capsules is a valuable adjunct to all of the other health measures you can take to preserve brain and heart function like regular exercise and consumption of a Mediterranean diet. Take a supplement, which is higher dosed and is molecularly distilled (also called pharmaceutically pure). This way you will get all the health benefits, and you will avoid exposure to toxins from the ocean, which are not eliminated in the less potent, non-purified and cheaper fish oils.

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Sep
24
2014

Two Approaches To Heart Disease

Over the years I noticed that there are two approaches to heart disease that people and physicians seems to subscribe to.

1.The conventional approach to heart disease

The patient essentially ignores health advice, may smoke cigarettes and eat in a lot of fast food restaurants. People who do not care about their heart drink sodas, eat lots of sugar, starch and processed foods. They may think that they are invincible. Famous politicians have subscribed to this type of approach including former vice president, Dick Cheney.

But the big surprise comes when acute chest pain hits and an ambulance has to be called. We are lucky in the industrial countries where a 911 service is available. You call that number when in distress and an ambulance with all the modern equipment will rush to you. The problem though is that you have neglected your arteries for all those years and it is likely that one or two of the three coronary heart vessels are severely narrowed so much that your heart reported chest pain. This pain signals that one area of the heart muscle was not getting enough oxygen and nutrients.

On arrival at the hospital the emergency physician sees you. Nurses put monitors up, attach electrodes to you, and IV-lines are put into your veins, just in case things get worse and they would need to give you quick life-saving medicine intravenously. They have also given you an oxygen mask, and after 30 minutes or so you feel much better. A cardiologist has been called in by the emergency physician and will assess you.

This will very likely be the verdict: “We have to do a coronary arteriogram where I advance a thin catheter through your femoral artery backwards to where the coronary arteries originate from. We can then study each coronary artery separately and determine whether an angioplasty needs to be done.” Upon your questioning he explains that an angioplasty is a procedure where a catheter is advanced through a new clot that often forms during a heart attack and a stent is left behind that will keep the previously blocked off coronary artery open.

Within an hour the procedure will be completed. The cardiologist will explain that he found significant narrowing, such a san 85% narrowing in the anterior descending coronary artery and a second lesion in the right coronary artery with maybe 55% narrowing. He has stented both of these arteries successfully. But he warns you that the stents may close off, if you are unable (or rather unwilling) to change your lifestyle. He also will be very specific with what he meant: Quit smoking immediately, get into a regular exercise program and adopt a strict heart healthy diet like the Mediterranean diet. They would keep you overnight just to observe your heart rhythm and blood pressure. In the morning, if everything is OK he will likely discharge you.

Comment: Unfortunately this scenario is all too familiar to me having worked as a family physician doing my rotations as an emergency physician in a community hospital for 16 years. I found that people tended to NOT think preventatively unless they were forced to. When an acute event like a heart attack happens, a higher percentage of people is committed to prevention, but medical people call this “secondary prevention” as this prevention was only started after a close call. Our sample patient above could have developed a serious arrhythmia (irregular heart beats after a heart attack) and suddenly slipped into a coma and died before the interventional cardiologist could have placed the stents.

Primary prevention is much more powerful and this is what I like to cover next.

Two Approaches To Heart Disease

Two Approaches To Heart Disease (Placement Of Stent Shown)

2. The preventative approach to heart disease

Most people never have to be rushed to the hospital with chest pain. They engage in various ways of “primary prevention”.  So, what exactly is this?

They keep very active, like walking or jogging, dancing, working out in a gym, biking or swimming etc.

They also like a healthier than normal lifestyle: eat at home as much as possible, and many adopt to buy only organic food. Why, you may ask? Organic food does not contain insecticide residues that resemble estrogenic substances (so-called “xenoestrogens” which accelerate hardening of the arteries). But organic food also does not contain GMO (genetically modified food). We know enough about GMO now to indicate to us that autoimmune diseases with inflammation of the arteries and the gut can occur. But the full impact on people’s health will not be known for several more decades. So why experiment with yourself? Buy organic instead. It is known to be safe.

Vitamins and minerals can be very useful supplements that also prevent premature aging of our blood vessels.

Anti-aging research has shown that with aging come various hormone defects. Melatonin is one of the first to go (in your twenties). But melatonin tables that are widely available in drug stores and health food stores can come to your rescue:  3mg of melatonin at bedtime will give you a good night sleep and provide powerful anti-oxidant effects. DHEA is an adrenal gland hormone that can be measured in your blood (or in saliva). In case it is low, it can be easily replaced with supplements. In the 50’s or 60’s women and to a lesser degree men will start to show thyroid under-functions. We call this hypothyroidism. Have your TSH and T4 levels checked and talk to you doctor about whether you need thyroid replacement, if the values are off.

It is somewhat more difficult to explain the rest of the hormones. But you know that women get into menopause and men about 10 to 15 years later will hit andropause, which is the male equivalent of menopause in women.  An easy way to check this out is by doing a hormone panel from just one tube of spit. Yes, it is a saliva hormone panel I am talking about. For women it is estrogen, progesterone, cortisol, DHEA and testosterone that should be analyzed. For men it is testosterone, DHEA, cortisol, estrogen and progesterone. I am aware that these are the same 5 hormones, but I listed them in the order of importance for women and men. In this blog you find more details about bio-identical hormone replacement.

I have followed a primary heart attack prevention program since 2001 and it seems to suit me well.  Just to check things out I had a carotid intima test, which showed no hardening of the arteries. Just two weeks ago my optician took images of the retinal vessels and found hardly any hardening of my retinal arteries. I scored high on a Bruce treadmill protocol in March of 2013 and my lipid VAT values were excellent indicating a low risk for a heart attack.

I have delved into this subject in more detail in my book entitled “A Survivor’s Guide to Successful Aging” (Ref. 1).

Conclusion

Prevention of a disease is always better than curing a disease, this applies to heart attacks as well. While you do something good for your heart, you are at the same time preventing strokes and many degenerative conditions like Parkinson’s disease, Alzheimer’s disease. In addition you also prevent cancer. It really is a good deal!

More information on prevention of heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/prevention-heart-attack/

Reference:

1. Dr. R. Schilling: “A Survivor’s Guide to Successful Aging“. Paperback through Amazon.com, 2014.

Last edited Nov. 8, 2014

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

May
10
2014

The Full Story About Testosterone

Much has been written about what happens when women get into menopause. This begs the question: do men experience a change of life? As a matter of fact, they do. It is called “andropause”, and they can experience problems as a result. Here is a study from the Massachusetts General Hospital in Boston, MA, which was published in the New England Journal of Medicine (Sept. 2013) describing in detail what happens when men get into andropause (the male equivalent of the menopause).

We know from other studies that in obese men testosterone is converted into estrogen because of the enzyme aromatase that converts testosterone into estrogen resulting in erectile dysfunction and loss of sex drive. In lean men above the age of 55 there is a true testosterone reduction because the testicles produce less testosterone. This results in less sex drive, moodiness and lack of energy. But these men will do well with bioidentical testosterone replacement.

Main findings of the Massachusetts General Hospital study:

  1. Testosterone was responsible for thigh muscle development and leg press strength, for erectile function and sexual desire.
  2. Surprisingly, estradiol (the main estrogen component in both sexes) plays a significant part in sexual desire in the male. This became particularly apparent in the post-andropause male who desired hormone replacement. When bioidentical testosterone is used to replace what’s missing there was no problem with sexual desire or erectile function as a small amount of the testosterone was aromatized into estradiol. The researchers were able to measure both testosterone and estradiol levels.
  3. Here is a surprising fact: a lack of estrogen leads to abdominal obesity. This could also be verified by hormone measurements.
  4. In the past doctors used synthetic testosterone products like methyltestosterone, danazol, oxandrolone, testosterone propionate, testosterone cypionate or testosterone enanthate. The problem with these synthetic testosterone products is that the body cannot metabolize a portion of them into estrogen that is desirable for a normal sex drive, so the testosterone compounds alone are not doing their job as well as the bioidentical testosterone that the body can aromatize.

In obese men the problem is that there is too much estrogen in the system, which leads to a disbalance of the hormones in the male with a relative lack of testosterone. Overweight and obese men produce significant amounts of estrogen through aromatase located in the fatty tissue. Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Excessive levels of estrogen cause breast growth, muscle weakness, lead to abdominal fat accumulation, heart disease and strokes. Dr. Lee described what happens in men who enter andropause years ago as indicated under this link.

The Full Story About Testosterone

The Full Story About Testosterone

Testosterone to estrogen ratio:

Dr. Lee indicated that in his opinion saliva hormone testing is more reliable than blood tests (Ref. 1). One of the advantages of doing saliva hormone tests of estrogen and testosterone is that you can calculate directly the ratios of these two hormones. In hormonally normal younger males the testosterone to estrogen ratio is larger than 20 – 40 (Ref.2). The testosterone to estrogen ratio in obese men is typically less than 20 meaning it is too low. But lean men in andropause produce too little testosterone and their testosterone to estrogen ratio is also less than 20, because they may still have enough estrogen in their system from aromatase in the fatty tissue, but they are lacking testosterone due to a lack of its production in the testicles (Ref. 1 and 2).

When a man in andropause is given bioidentical hormone replacement with a testosterone gel or bioidentical testosterone cream this is absorbed into the blood and body tissues and then partially metabolized into a small amount of estrogen. This can be seen when saliva hormone tests are done; a higher level of testosterone is detected and much lower estrogen level so that the testosterone to estrogen ratio is now 20 to 40 or higher and the affected person will no longer be the “grumpy old man” that had been a source of distress to his partner before.

This New England Journal of Medicine study is important because it confirmed what anti-aging physicians had been saying for years: a small amount of estrogen is necessary for the male for bone health as estrogen receptors will regulate the bone density, it also helps for a normal sex drive. The same is true for women: a small amount of the opposite hormone (testosterone) will help a woman’s sex drive, but she needs the right mix of progesterone to estrogen (a progesterone to estrogen ratio of 200:1 using saliva tests) to feel perfectly normal as a women.

Health and well-being of a man depend on normal testosterone levels:

It is important to realize that testosterone is not only supporting a man’s sex drive and libido, key organs like the heart, the brain and blood vessels contain testosterone receptors as well. The body of a man was designed to respond to testosterone all along. It is when testosterone production is no longer keeping up that premature aging becomes apparent, as the target organs do no longer receive the proper signals.

A healthy heart in a man depends on regular exercise and testosterone stimulation whether he is young, middle aged or old. The same is true for the lining of the arteries where testosterone receptors are present to help with the normal adjustment to exercise and relaxation. The brain cells have receptors for all of the sex hormones and in a man they are used to higher levels of testosterone and lower levels of progesterone and estrogen. If you take the balance away, the aging man will feel miserable and grumpy. Depression will set in. Here is a brief review how one man’s life has been changed by testosterone replacement.

So, bioidentical hormone replacement is not just a matter of replacing one hormone, you need to pay attention to all of the hormones. Lifestyle issues enter the equation as well. I have reviewed the issue of bioidentical hormone replacement for women and men in this blog.

Conclusion:

When a man reaches the age of 55 or older there comes a point where a lack of testosterone and estrogen sets in. It is wise to start doing intermittent blood or saliva hormone tests before this point is reached in order to gage when bioidentical hormone replacement treatment should be given. Along with an assessment regarding the hormone status it would be wise to also assess lifestyle issues as often other factors play a role in premature aging. I have reviewed these factors systematically in a recent publication (Ref. 3). It is best to combine bioidentical hormone replacement with life style interventions to achieve optimal preservation of a man’s health.

More information about male menopause (=andropause): http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/male-menopause/

References:

  1. John R. Lee, MD: “Hormone Balance for men- what your doctor may not tell you about prostate health and natural hormone supplementation”. 2003 by Hormones Etc.
  2. George Gillson, MD, PhD, Tracy Marsden, BSc Pharm: “You’ve Hit Menopause. Now What?” 2004 Rocky Mountain Analytical Corp. Chapter 9: Male Hormone Balance (p.118-148).
  3. Dr.Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling”.

Last edited Nov. 8, 2014

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Mar
22
2014

Protect Yourself From Radioactivity

Even though the Chernobyl catastrophe was bad enough, it appears now the 2011 Fukushima Daiichi nuclear power plant catastrophe was 7 to 10 times worse in terms of worldwide radioactive pollution. Even as late as Feb. 20, 2014 there was a new report of further radioactive water spill into the Pacific Ocean.

It is important that you start thinking about preparing yourself to cope with radioactive pollution.

In this blog I will briefly review the history of several radiation disasters in various parts of the world and will mention how coping mechanisms with radiation were fortuitously developed. Finally, I will summarize what you can do to reduce any damage to your health that is caused by radiation leaks.

History of the first nuclear bombs with radioactive fallout in 1945

On Aug. 9, 1945 the second atomic bomb was dropped on Nagasaki, Japan. Dr. Akizuki  worked at the St. Francis Hospital (Uragami Daiichi Hospital), about one mile from the epicenter. He and a staff of 20 were serving at this hospital that looked after 70 tuberculosis patients.

Miraculously all of the staff and most of the patients survived because of a vegetarian diet, which consisted of uncontaminated brown rice, fermented foods, sea algae and vegetables. Dr. Akizuki did not allow sweets of any kind. Salt was allowed as the main condiment. Everybody was fed at least one helping of a soup with fermented soy and seaweed in it (wakame miso soup). Other investigators have confirmed that in a mouse model miso soup has radio protective effects.

The staff and the patients of another hospital also one mile form the epicenter were not so lucky. Almost 100% of them died. They were not on the strict miso/seaweed diet without sugar and sweets.

Protect Yourself From Radioactivity

Protect Yourself From Radioactivity

The experience with Chernobyl

Perhaps the best way to start reviewing the Chernobyl disaster of April 26,1986 is by looking at how children fared who had been directly exposed to the radiation spill from this disaster. As this link shows about 7 million people living in the nearby area were exposed to the highest radiation exposure ever since the atomic age. The children of this population have experienced a 2,400 % increase in thyroid cancers, a 100 % increase of cancers and leukemia and a 200% increase of breast cancer. There were about 800,000 men who risked their lives when working on containing the radiation spill. 25,000 of these men have died and 70,000 are disabled. 20% of the deaths (5000 men) were due to suicide. Here is a report for those who like more details about the health consequences as a result of the Chernobyl disaster. Here are more questions and answers regarding the Chernobyl disaster.

The question is whether a similar accident could happen with any of the other nuclear power reactors. This link explains that such an accident can “only happen in a reactor operating with a Positive Temperature Effect combined with a Positive Steam Effect, and built without a containment structure to mitigate the potential atmospheric effects of a worst-case reactor accident.” It goes on to say that only the reactor in Chernobyl was this type of a reactor, the RBMK series made by the former USSR. The link above goes on to say: “All other reactors for the production of electricity, including all those in America, operate on natural Negative Temperature and Negative Steam Effects, and are encased in air-tight multi-layered containments, the integrity of which rivals that of Egypt’s pyramids.” It ends with this rather strong statement: “This being understood, it is entirely correct to say that an accident like the one that occurred at Chernobyl in 1986, will never happen anywhere else.” The same website reports in another section about the Fukushima disaster, without mentioning that this should not have happened. Nobody could have predicted the forces of nature (a double whammy of an earth quake of the magnitude 9 on the Richter scale, followed by a horrendous tsunami), which destroyed part of the nuclear power plant. From the literature it is not clear whether the government went through any major efforts to provide chelating agents, Prussian Blue and iodine salts to the affected population either in Chernobyl or in Fukushima to minimize the radiation effects from the radioactive emissions.

Part of the problem in Chernobyl was at the time that this all happened behind the iron curtain and that there was a news blackout, which only gradually improved after 1989. In Japan the problem was severe denial and underreporting on behalf of the Japanese government.

Goiania accident involving radioactive cesium-137 in Brazil

On September 13, 1987 two fellows illegally entered an abandoned private radiation treatment hospital in Goiania where a radiation unit containing cesium-137 had been used for treating cancer patients. They stole the radiation head thinking that it might  be valuable scrap metal that they could sell. They managed to sell it to a junkyard owner, Devair Ferreira.

Having a lack of insight that the radiation head would contain radioactive cesium-137, which was emanating ionizing radiation, Devair proceeded to probe for a precious metal with a screwdriver. As the details in the Wikipedia link show, shortly after a total of 112,000 people were screened for potential radiation exposure. There were 4 deaths including the junkyard owner’s wife, and his 6-year old daughter. He himself survived the incident. 249 people were significantly contaminated with cesium-137 and 1000 people had received a dose twice the amount of the yearly background radiation. 20 patients developed radiation sickness and required treatment. As this link shows the Brazilian authorities arranged treatments for  patients who had proven contact with cesium-137 with 10 Grams of Prussian Blue daily, which reduced the effective radiation exposure by 70%. This was the reason for the relatively low mortality and disability rates from this serious accident.

The Fukushima experience

Fast-forward to the latest disaster that has made clear how an earthquake of the magnitude of 9 on the Richter scale followed by an enormous tsunami in combination could lead to the Fukushima disaster in Japan. Following the catastrophe on March 11, 2011 there have been several leaks of radioactive material into the ocean, which are described here.

Dr. John Apsley II also pointed out that with the explosions in Fukushima there were also significant releases of radioactive pollution into the stratosphere that subsequently traveled around the globe. He has made it his ambition to help people minimize radiation exposure from nuclear accidents such as Fukushima.

The initial denial of the Japanese authorities caused a problem of assessing the true significance of the Fukushima incident.

As mentioned in the introduction to this blog there are still ongoing releases of radioactive material, which will eventually work their way into the oceans and into the atmosphere. Dr. Apsley II describes in detail in his book that there were 29 radioactive elements that were released into the air and into water, the main ones being Cesium-137 (and 134) Iodine-131, Plutonium-238 and 239, Strontium-89 and 90 and Uranium-234 and 238. As the body takes up these radioactive elements, they have different organ preferences and they metabolize differently so that each of them causes a certain disease pattern. Radioactive Iodine for instance causes thyroid disease and thyroid cancer, while radioactive Plutonium is causing leukemia, heart disease, lung and breast cancer, several childhood cancers and infant mortality. There is a wave of radioactive cesium-137 coming across the Pacific Ocean that will start to show on the west coast of Alaska, Canada and the US mainland by 2015 and stay peaked until 2020 and beyond.

Ref. 1 points out that it is difficult to know the real concentration of the radioactivity in the water and in the radioactive rain over the US and Canada, as government agency measurements were kept hidden or were falsified. However the author comes to the conclusion in comparing various reference sources that the radiological leak and impact of the Fukushima crisis was and is about 7-fold to 10-fold bigger than that of Chernobyl.

Depending on what story you believe, the fear mongering or the more balanced reasoning arguing that there is enough water in the ocean to significantly dilute the amount of spilled radioactivity, you may or may not eat the sushi on the West coast.

With all this noise it is unclear whether the local population made use of the simple method of chelation at home using miso soup and uncontaminated seaweed. One would hope so. But did they know that it is only effective in combination with a strict diet without sugar and starchy foods?

Protection from radioactive fallout

This brings us to toxicity studies and simple ways of how to protect you from radiation in the environment. First, you need to know how radioactive materials can enter your body. Most nuclides (that is another name for radioactive compounds) enter the body through contaminated food via the gut where they are absorbed into your blood. You can inhale gases like gaseous radioactive Iodine or Radon. Cesium, which has now leaked into the Pacific Ocean can be absorbed through your skin when you walk on a beach that is contaminated with radioactive Cesium-137 containing ocean water. Cesium-137 has a half-life of 30 years meaning that after 30 years it still emits 50% of today’s gamma rays (these are strong X-rays). The biological half-life of Cesium-137 in the body is 110 days. But we do not want this stuff in our bodies causing free radicals to destroy our body cells. So we need effective methods to remove radionuclides.

By reviewing the history above, we already have learnt of two effective ways to remove such radionuclides: Miso soup with seaweed in Nagasaki; and Prussian Blue in Brazil. Prussian Blue works on eliminating the radioactive Cesium-137 before it is absorbed from the gut into the blood. It disappears from the body with bowel movements and also in the urine. However, it should only be taken, when there is proven food contamination with Cesium-137 as it can seriously affect your potassium levels, which could cause serious side effects to your heart. A physician knowledgeable in the use of Prussian Blue can monitor your potassium levels and follow you along.

In comparison to that it is easy to implement dietary habits as was done in Nagasaki:  miso soup and seaweed can be consumed without any side effects. So, why is it important to avoid sugar and starchy foods? The reason is that sugar oxidizes your cholesterol and any tissue it comes in contact with. It also causes the pancreas to overproduce insulin, which causes an inflammatory reaction. Cesium-137 also causes an extreme inflammation in your body, because of the free radicals that are caused from the gamma radiation of cells. Add to this a situation where there is a fire burning inside of your body (inflammation from sugar and starch consumption) and you have a recipe for disaster, comparing it to dumping gasoline into a fire. Inflammation is amplified ,and the radioactive Cesium-137 causes havoc in your system. You quench the fire when you do not eat sugar and starch and you give it an extra dousing by taking chelating agents (miso soup with seaweed), which removes the radioactive Cesium-137. The successful outcome of Dr. Akizuki’s treatments in his hospital in Nagasaki speaks volumes.

There are a number of other useful antioxidants like melatonin, vitamin C, and glutathione. Co-Q10 supports the mitochondria and protects cholesterol from being oxidized. But other substances are also useful. Cabbage contains isothiocyanates that will bind radionuclides before they are even absorbed from the gut. Edible clays, like calcium bentonite works similar to Prussian Blue, but it also supplies extra calcium for the body. For further details consult Ref. 1, which contains a lot more details.

Conclusion

The surprising twist for me when I researched this topic was the fact that what is good for your heart, what prevents Alzheimer’s disease and what helps you to live longer also helps you to cope with processing and eliminating radioactive pollutants. When we adopt a healthier lifestyle now, we are at the same time preparing ourselves for the worst nuclear pollution.

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

Reference

1. Dr. John W. Apsley II : “Fukushima Meltdown & Modern Radiation: Protecting Ourselves and Our Future Generations” © 2011. Temet Nosce Publications, Sammamish, WA 98075

Last edited Nov. 7, 2014

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Feb
19
2014

Every Patient Is Unique

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

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

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

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

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

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

Menopausal women with symptoms

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

This is how conventional medicine would handle this patient

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

Every Patient Is Unique

Every Patient Is Unique

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

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

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

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

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

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

Two men with depression

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

Here is the conventional medicine approach

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

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

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

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

Conclusion

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

More information on:

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

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

Last edited Nov. 7, 2014

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Jan
18
2014

The Super Powers Of Vitamin D

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

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

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

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

What are some of the clinical effects of vitamin D3?

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

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

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

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

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

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

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

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

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

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

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

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

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

What are toxic vitamin D levels?

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

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

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

Conclusion

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

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

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

References

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

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

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

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

Last edited Nov. 7, 2014

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