May
05
2017

New Treatments For Premenstrual Syndrome

Dr. Pamela W. Smith gave a talk about new treatments for premenstrual syndrome (PMS). She presented this talk on Dec. 11 at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “New Treatment Modalities for PMS”.

Signs and symptoms of PMS

Dr. Smith discussed signs and symptoms of PMS first. She showed 9 slides where she listed all of the symptoms of PMS that commonly occur.

Symptoms are varied; they can mimic various psychological problems like anxiety, depression, panic attacks and more. But physical symptoms like abdominal bloating, acne, back aches, and asthmatic attacks are also common. There are a myriad of more symptoms of PMS: constipation, cramps, clumsiness, dizziness, drowsiness, decreased sex drive, facial swelling, forgetfulness, fatigue, headaches, a herpes-like outbreak, hot flashes, sensitivity to light and noise, insomnia, joint pains, mood swings, palpitations, restlessness, poor memory, sore throat, tearfulness, vomiting and weight gain.

What do we know about PMS?

  1. There is no definitive test that would help in the diagnosis of PMS. But we do know that there is a hormone dysfunction that leads to a monthly recurrence of symptoms during the two weeks prior to the woman’s menstruation. When her period begins or shortly after all of these symptoms disappear.
  2. PMS is very common; 70to 90% of women have a certain degree of PMS. In 20 to 40% of women symptoms are severe. Many researchers have shown that there is a problem in the feedback loop between the pituitary gland and the ovaries. This leads to a decrease of progesterone production in the ovaries. The result is an overabundance of estrogen, which is called estrogen dominance.
  3. But things can get complicated when other hormone changes occur. A woman may also turn hypothyroid. When she gets closer to menopause estrogen deficiency may also develop. Electrolyte disturbances can occur from high estrogen levels causing excessive aldosterone levels. This would lead to high sodium and low potassium blood levels. The end result may be an activation of the renin-angiotensin system, which could cause high blood pressure.
  4. Neurotransmitters are often disbalanced. When serotonin is low in the brain, depression can develop. Noradrenalin deficiency leads to a lack of focus, energy and memory.
  5. Hypoglycemia is also common among women with PMS. This may be due to cravings for sweets and consumption of starchy foods. Women who crave sweets may also consume caffeine excessively. But caffeine increases prostaglandin production in the body. This leads to breast tenderness, abdominal cramping, arthritis and back pains.
  6. A partial hysterectomy can cause PMS in a woman who never before had symptoms of PMS. The current school of thought is that blood supply to the ovaries after a hysterectomy has decreased, and this could be the reason for the onset of PMS.
  7. The birth control pill can bring on PMS due to the progestin component in it.
  8. Tubal ligations can also be a cause: 37% of women who had tubal ligations develop PMS. The reason is a change in hormone production. In these women estrogen is produced to a higher degree than progesterone is.
  9. Pregnancies, miscarriages and abortions can also bring on PMS.

Lab tests for women with PMS

Although there is no single test that would be able to diagnoses PMS, a variety of abnormal tests are often abnormal in association with PMS. Frequently there is deficiency for vitamin A, B6, E, magnesium, potassium, zinc and trace minerals. Calcium can be too high or too low, but blood tests will reveal that.

Four PMS types

Dr. Smith said that PMS has been divided into 4 subcategories depending on the main symptoms.

  • PMS A: Anxiety
  • PMS C: Carbohydrate craving
  • PMS D: Depression
  • PMS H: Hyperhydration

PMS A is associated with estrogen excess and progesterone deficiency. There is a diminished stress response in the hypothalamus/pituitary/adrenals axis. Symptoms are mainly anxiety, irritability, insomnia and emotional lability.

PMS C is associated with sugar craving, hypoglycemia, headaches, heart palpitations and spontaneous sweating.

PMS D is leading to increased neurotransmitter degradation. Symptoms consist of depression, crying, despair, feeling hopeless, fatigue, low libido, apathy and insomnia.

PMS H is caused by increased aldosterone activity triggered by estrogen surplus in the late luteal phase. Symptoms are weight gain, swelling of hands and feet, a feeling of bloating, breast tenderness or engorged breasts. Women will find that their clothes simply fit tighter.

Migraine headaches in PMS

Some women with PMS are plagued by migraine headaches. It may have started in puberty or after taking birth control pills for contraception. Sometimes the onset is after a pregnancy, miscarriage or abortion. When PMS develops and a woman has migraines, they usually occur around the same time in her menstrual cycle. With pregnancy the migraines disappear in the last trimester when progesterone hormone production from the placenta is the highest.

Hormonally related headaches can occur for 4 main reasons.

  1. When estrogen and progesterone are on the rise around the time of ovulation
  2. When a woman has hypoglycemia (due to hyperinsulinemia)
  3. When estrogen levels are changing
  4. When there is estrogen dominance

Treatment for PMS

Dr. Smith explained in detail the various treatment modalities for PMS. Treatment has to be personalized according to what type of PMS the doctor thinks that the patient is suffering of.

Dietary factors

In the beginning it is important to pay attention to the diet. Studies have shown that PMS patients tend to eat too many carbs and too much refined sugar compared to patients without PMS. PMS patients also eat too many dairy products and too much sodium. In addition PMS patients are deficient in iron, manganese and zinc. A good start is a Mediterranean diet, which is at the same time anti-inflammatory.

The recommendations is to eat 6 small meals a day. Avoid caffeine and alcohol. They are antagonists to the B complex vitamins. By avoiding sugar, you also avoid fluid accumulation and magnesium deficiency. A low fat, high-complex carb diet helps reduce breast tenderness. Reducing fat and increasing fiber in the diet decreases estrogen levels in the blood. These steps help PMS symptoms.

Nutritional supplements

Magnesium, vitamin B6, A, D3, E, L-tryptophan, calcium, zinc, fish oil (EPA/DHA) and evening primrose oil are the main supplements recommended for PMS patients. Your healthcare provider can advise you what you should take and what dosage.

Exercise

Regular exercise has very beneficial effects on reducing many symptoms of PMS. Even as little as 8 weeks of exercise -as was done in this study- had a significant effect. Exercise elevates endorphin levels, improves blood sugar stability, decreases norepinephrine and epinephrine in the brain and helps to decrease estrogen levels. This will control blood sugar levels, reduce anxiety, reduce estrogen-related symptoms and increase satisfaction.

Thyroid medication

Many women with PMS have borderline hypothyroidism or are overtly hypothyroid. In these cases the patient should receive small amounts of thyroid hormones.

Progesterone

Progesterone is the one hormone that is found persistently lacking in most PMS patients. The best test for this is a saliva hormone test, because this reflects the tissue levels. Blood levels test too low and are useless. Bioidentical progesterone cream is applied transdermally (through the skin) from day 14 to 25 of each menstrual cycle. Micronized progesterone pills are also bioidentical and could be used instead of the cream.

Botanicals

There are a number of home remedies, which are heavily promoted on the Internet. They may, however, not be as effective as advertised.

  1. Black Cohosh is said to balance estrogen and is anti-spasmodic.
  2. Chasteberry decreases LH and prolactin. It raises progesterone, acts as a diuretic and binds opiate receptors. This reduces PMS related aches and pains.
  3. St. John’s Wort helps these symptoms: anxiety, depression, mood swings, feeling out of control and pain.
  4. Ginkgo biloba is a mild blood thinner. Women who are on blood thinners should not use it! It improves depressive symptoms and mood, has anti-inflammatory effects and helps with anxiety control.
  5. Saffron: In a clinical trial the Saffron group did significantly better in PMS symptom control than the placebo group.  Saffron is rich in magnesium, vitamin B6, iron and other nutrients that are missing in PMS patients, which explains the effectiveness of this botanical.
  6. Other botanicals: Other botanicals are Lavender, Motherwort, and Dandelion.

Candidiasis

Due to prolonged exposure to high sugar and refined carb intake many women with PMS suffer from candidiasis (chronic yeast infection). Anti-Candida programs help to eradicate Candida overgrowth, which often improves several PMS symptoms.

Mind/body therapy

Cognitive-behavioral therapy helps for depression and anxiety. Hypnotherapy, yoga and biofeedback therapy are also useful methods.

New Treatments For Premenstrual Syndrome

New Treatments For Premenstrual Syndrome

Conclusion

At the present time there is a better understanding of PMS than in the past. Progesterone deficiency and other hormone weaknesses seem to be at the center of this condition. But vitamin and mineral deficiencies also play a role. The healthcare provider should order some baseline blood tests and hormone tests for the patient, including a saliva progesterone level.

Treatment consists of a combination of steps taken simultaneously. The dietary approach comes first: a Mediterranean diet will be beneficial. Next add nutritional supplements. Regular exercise is essential. Finally bio-identical hormone replacement of the missing hormones is necessary.

If there is an underlying chronic candidiasis infection, it needs treatment. The choice of drug would be nystatin. Some botanicals may be helpful, as discussed. When anxiety and depression are important parts of the PMS symptoms, mind/body therapy (such as cognitive therapy etc.) may also be helpful.

The key with PMS treatment is to not give up, but to re-evaluate the condition, if the initial attempt does not bring full relief. By not giving up and using all modalities of treatment the patient will be able to get rid of the condition, eliminate the symptoms of PMS and achieve well being.

Incoming search terms:

Apr
22
2017

Only Moderate Alcohol Consumption Benefits Your Heart

A new study from England finds that only moderate alcohol consumption benefits your heart. The study was released on March 22, 2017 in Great Britain. 1.937 million people (51% women, 49% men) had participated in this investigation over 6 years. The lead author, Dr. Steven Bell is a genetic epidemiologist. He said that this study was done to clear up some of the confusion from previous studies. He wondered why the control group without alcohol exposure had more cardiac problems than the moderate group. It did make sense though, that the high alcohol group had worse cardiac problems.

But he and researchers from Cambridge University and University College London did this study to get more detail. They wanted to know why the current non-drinking group used as a control was not looked at more carefully. It consisted of a mix of lifelong abstainers; people who drank formerly, but then gave it up. And the other group was those who drink on an occasional basis.

With this in mind the researchers designed their study. They also used also larger numbers to increase the reliability of the study.

Details of English study

The data comes from the Clinical Practice Research Datalink providing anonymous patient records from general practices in England. The patients upon entry into the study had to be older than 30 years, but have no evidence of cardiovascular disease. A total of 1,937,360 patients qualified to be part of the study.

Based on patients’ records and patients recollections people, researchers looked at 5 classes of drinkers:

  • Non-drinkers (14.3%)
  • Former or ex-drinkers (stopped drinking at one point, 3.7%)
  • Occasional drinkers (drinking rarely, 11.9%)
  • Moderate drinkers (drinking within sensible limits, 61.7%)
  • Heavy drinkers (hazardous alcohol use, 8.4%)

The end point of the study researchers concentrated on the frequency of cardiovascular diseases like angina, heart attack, sudden cardiac death, stroke, peripheral arterial disease, abdominal aortic aneurysm and others. I only listed 6 of the 12 cardiovascular diagnoses as otherwise it would get too technical.

More information: Most study participants were non-smokers, their BMI was within normal limits, and they also did not have diabetes.

Findings of the study

There were significant differences among subclasses of alcohol consumption and the development of cardiovascular diseases over 6 years.

  1. The findings were in line with a number of previous similar studies that showed a U-type dose response curve between developing cardiovascular diseases and alcohol consumption. The group of non-drinkers (where former and occasional drinkers were removed) often had a 20% to 56% increased risk of developing cardiovascular disease, while moderate drinkers had no added risk.
  2. On the other hand the heavy drinkers were at risk of developing cardiac arrest (50% increased risk) or heart failure (22% increased risk). A death from a sudden heart attack occurred in heavy drinkers with a risk of 21% increased risk. A former drinker had a 40% increased risk for this, but a non-drinker a risk of 56% increased risk!
  3. A non-drinker had a 32% increased risk of getting a regular heart attack, a former drinker had a 31% increased risk, an occasional drinker 14%, a moderate drinker no added risk, and a heavy drinker had a 12% reduced risk! This seemed to show that drinking alcohol keeps the coronary arteries open and clean. I have had pathology demonstrations with Professor Dr. Adalbert Bohle at Tübingen University during my medical training in 1969. At that time he pointed out how clear and wide open the coronary arteries were in chronic alcoholics. It was not heart disease that killed those patients; they had died from end stage liver cirrhosis, and we saw pathological slides of that.
  4. Heavy drinkers get more ischemic strokes (33% increased risk) and more intracerebral hemorrhages (37% increased risk).
  5. Obstruction of blood vessels in the lower legs (peripheral arterial disease) is common with heavy drinkers (35% increased risk) and even former drinkers (32% increased risk). Non-drinkers have a 22% increased risk while moderate drinkers have a 0% risk (no increased risk).
  6. There was no association between heavy drinking and aortic aneurysm. On the other hand, non-drinkers (32% increased risk) and former drinkers (23% increased risk) showed an increased risk of aortic aneurysm formation.

Other effects of alcohol consumption

The study above did not take into consideration that alcohol consumption has many other consequences beside cardiovascular effects. One for instance is the effect on the brain and the increase of serious car accidents. Another effect is the causation of cancer.

The American Cancer Society clearly states that alcohol consumption has been causatively associated with the following cancers.

  • Cancer of the mouth
  • Cancer of the pharynx (throat)
  • Cancer of the larynx (voice box)
  • Cancer of the esophagus
  • Cancer of the liver
  • Cancer of the breast
  • Cancer of the colon
  • Alcohol also plays a role with cancer of the pancreas

Many studies have shown a dose-response curve between alcohol consumed and the development of these cancers. In other words there is never a safe low dose, below which no cancer would be caused over time.

These authors conducted a metaanalysis of 16 prospective cohort studies including 6,300 patients. It showed that alcohol caused cancer of the colon and rectum. High intake of alcohol showed a 50% increased risk of causing colon cancer. With regard to rectal cancer the risk was 63% higher. In both cases the highest alcohol intake was compared to the lowest category of alcohol intake.

These authors concluded their discussion by pointing out that 6% of the worldwide cancer deaths are attributed to alcohol intake. They also stated that colorectal cancer risk increased by 50% in the heaviest alcohol users. Among the group of heavy drinkers the cancer death rate would likely be 9%. There would a reduction of mortality from cardiovascular disease by one third in middle and old age. The end result would be 6% mortality again; essentially there is no change.

No matter how you try to solve this equation, there is a risk of cancer deaths from exposure to alcohol. There is also a risk that heavy drinking can cause significant cardiovascular diseases mentioned.

Only moderate alcohol consumption benefits your heart

Only moderate alcohol consumption benefits your heart

Conclusion

Everything we do in life has consequences. With regard to drinking you know that accidents are more common in drinkers; with prolonged exposure to higher alcohol consumption you can get dementia. Moderate amounts appear to have significant protection from heart disease, but the risk for several cancers is not negligible. This point was not mentioned in the study I discussed in the beginning of my blog. In the latter part I included some data about cancer risks from alcohol consumption.

The paradox remains that non-consumption of alcohol is associated with a significant cardiovascular risk because of a U-shape dose response curve. Moderate alcohol use is associated with the lowest cardiovascular risk. The question is whether we can balance moderate drinking with staying in the low cancer risk area. The recommendation of 1 glass of wine for women and 2 glasses of wine for men has been confirmed by the above study. This is considered a healthy preventative dose with respect to cardiovascular risk. It is the official recommendation for cardiovascular disease prevention. The cancer literature clearly states that there is a small cancer risk from moderate alcohol intake. This is particularly true for the 8 cancers discussed.

Dr James Nicholls, the director of research and policy development at Alcohol Research UK had this to say. He pointed to the fact that there are other ways to prevent cardiovascular disease. For those who do not drink at present it would not make sense to take up drinking. You can strengthen your heart by starting a Mediterranean diet and starting to exercise regularly. The beneficial substance for your heart in red wine is known as resveratrol that can be taken as a supplement. Resveratrol has no side effects and does not have the cancer risk of an alcoholic drink. Dr. Nicholls added, “If you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.” It is really up to every individual to balance the wine glass with personal health!

Incoming search terms:

Feb
04
2017

Benefits Of The Ketogenic Diet

Dr. Jeff Volek, PhD, RD gave a talk that clarified the benefits of the ketogenic diet. He is a professor at the Department of Human Sciences at The Ohio State University, Columbus, OH, and teaches in the Kinesiology Program. His lecture was part of the 24th Annual World Conference on Anti-Aging Medicine in Las Vegas, Dec. 9 to 11, 2016.

There were 58 slides, some of them very detailed. I will summarize as best as I can what the presentation was all about.

History of diets

Dr. Volek stated that there were unintended consequences when the low fat/ high carb diet was introduced in the 1970’s and 1980’s. Ancel Keys, a physiologist had proposed in his diet heart hypothesis that saturated fat was the culprit that caused heart attacks.

As a result all major health agencies recommended the low fat/high carb diet. Obesity, diabetes, heart attacks, and strokes were the consequences. Another offshoot later from this was the statin craze where everybody was put on statins as high cholesterol was symptomatically treated. Nothing changed the diabetes and obesity wave and heart attacks and strokes continued to kill the affected persons. Among performance athletes the hypothesis was formed that carb loading would increase muscle performance. Researchers showed evidence that carb loading would improve performance. But athletes were dissatisfied with prediabetes and metabolic problems. Both the average consumer as well as the performance athlete noted that they felt better on a low carb/high fat diet. This is what the ketogenic diet is all about.

Diet heart hypothesis

With the diet heart hypothesis the saturated fat was removed from the diet and replaced by vegetable oils rich in linoleic acid. Dr. Volek explained that blood tests and other investigations were done on people who ingested the low saturated fat/high carb diet. The question was whether this would reduce heart attack rates and deaths by lowering serum cholesterol.

The Minnesota Coronary Experiment was a double blind study, which answered this question.

Cholesterol was reduced in the experimental group. But there was no reduction of heart attacks or strokes compared to a control group. Of concern was the large amount of refined carbohydrate content with the low fat diet. This essentially was responsible for the obesity and diabetes wave. The excess sugar turned into fat deposits and to insulin resistance, which caused diabetes. The low saturated fat/high carb diet of the 1960’s to 1990’s did not reduce heart attacks and strokes. To the contrary: the obesity/type 2 diabetes wave it had caused increased mortality from strokes and heart attacks further.

Laboratory tests on low fat/high carb diet versus the ketogenic diet

Forget hypotheses for a moment. Let us review what the different diets do in terms of lab tests. In a study where 40 overweight people with metabolic syndrome were put on a low fat diet or a low carb/ketogenic diet, the following blood test results were found. There were 20 patients in each group.

  1. Low fat/high carb diet

Triglycerides in the blood went down by 20%, saturated fatty acids by 22%. LDL (the bad cholesterol) rose by 4%. Insulin levels went down by 17% and leptin levels also down by 17%. Glucose levels were down by 1%.

  1. Low carb/ketogenic diet

Triglycerides went down by 52%, saturated fatty acids by 57%. LDL (the bad cholesterol) went down by 18%. Insulin levels went down by 49% and leptin levels by 42%. Glucose levels were down by 11%.

In this group of 20 subjects for each group the body mass index went down by 5% for the low fat diet and by 10% for the ketogenic diet after 3 months. The abdominal fat went down in that time by 12% for the low fat diet and by 20% for the ketogenic diet. The conclusion from these laboratory results and from the body measurements is that the low fat diet is showing some results of weight loss, but the ketogenic diet has superior results. The same is true for the blood tests. Only the ketogenic diet showed reduction of 7 key anti-inflammatory markers. In contrast, the low fat diet did not trigger the production of a single anti-inflammatory marker.

Anti-inflammatory benefits of the ketogenic diet

A 2008 study showed that several anti-inflammatory markers were greatly reduced from the ketogenic diet while a low fat diet did not show such a reduction.

As this 2009 study showed the LDL particles were getting bigger under the influence of a ketogenic diet, but they were getting smaller with a low fat diet.

Large LDL particles are also called pattern A particles, while small LDL particles are also called pattern B particles.

As this link shows there is good evidence that small LDL particles oxidize easier and are more atherogenic (causing hardening of the arteries). This means they lead to hardening of the arteries easier translating into heart attacks and strokes down the road. It is one thing that a ketogenic diet leads to larger LDL particles, which are more resistant to oxygenation. But it is another good thing that this diet is also anti-inflammatory. Overall this means that a ketogenic diet is counteracting the development of heart attacks and strokes.

Are saturated fatty acids in the diet causing heart attacks or strokes?

Dr. Volek discussed several large studies that have investigated this question. One of these studies discussed was a metaanalysis from 2010. Like all the other studies it showed that saturated fatty acids do not cause heart attacks and strokes. This is the secret behind the Inuit and the Eskimo diet. It is a high fat and meat diet. Lots of seafood is consumed as well, which provides omega-3 fatty acids.

Dr. Volek pointed out that if you replace a certain percentage, let’s say 5% of saturated fatty acids with carbohydrates, this would cause 7% more heart attacks. He showed literature evidence to back this up. What causes increased heart attacks and strokes is more refined carbs in your diet (sugar and starchy foods!).

Do saturated fatty acids in your blood increase the risk for disease?

Dr. Volek showed several slides with references to various publications. Elevated saturated fatty acids in the blood cause a higher risk of getting a heart attack, heart failure, metabolic syndrome and diabetes. But this does not happen with a ketogenic diet. The values of the saturated fatty acids in the blood are 4% lower when a ketogenic diet is started. With a low carb diet the calories derived from carbs are 12%. In comparison a low fat diet has 56% of carbs. Protein content in the low fat diet is 20%, in the ketogenic diet 28%. Saturated fat content in the low fat diet is 24%, in the ketogenic diet it is 59%. Let’s assume that both diets are kept at 1500 Cal. per day. Then the saturated fat content for the low fat diet is 12 grams and the carbohydrate content is 208 grams. For the ketogenic diet these values are as follows: 36 grams of saturated fat and 45 grams of carbohydrates. Despite a threefold higher saturated fatty acid intake the circulating level of saturated fatty acids in the blood were decreased by 4%.

You are what you eat, but go easy on carbs

Dr. Volek pointed out that what makes you healthy or sick is how many carbs you include in your diet. If you follow a ketogenic diet with only 12% carbs you are much better off than when you follow a diet like the low fat diet with 56% of carbs. The higher the carb percentage in your food, the higher the production of saturated fatty acids in your system and the higher the storage of saturated fatty acids in your body fat. Conversely, the lower the carb percentage in your food is the higher the oxidation of saturated fatty acids will be. In other words the saturated fatty acids disappear from your blood. Also, with a ketogenic diet the storage of saturated fatty acids is lower in your body fat. With a low fat diet your insulin resistance increases, while with a ketogenic diet insulin resistance decreases. The difference in calories in these two diets (56% derived from carbs in a low fat diet versus 12% derived from carbs in a ketogenic diet) explains why the obesity/type 2 diabetes wave has developed and why heart attacks and strokes still top the mortality figures today.

Endurance athletes win medals on a ketogenic diet

Dr. Volek shared a few cases of world-class athletes that are on a ketogenic diet. They did well for themselves winning medals. Tim Olsen won the Western States 100-mile endurance run from Squaw Valley to Auburn, CA in 2012. Zach Bitter was the 100-mile track record holder in 2015. Mike Morton won the American 24-hour distance running record for 172 miles. Two Tour De France bicyclists made first and second place, Chris Froome (first place) and Romain Bardet (second place).

Sports teams also have been successful on a ketogenic diet: the Columbus Crew soccer team; New Zealand national rugby union team, commonly called the All Blacks; the Los Angeles Lakers basketball team are all on ketogenic diets.

Dr. Volek also pointed out that the ketogenic diet has even been tested for the military. A ketogenic diet restores metabolic health, gives the soldiers more endurance, more stress resistance and decreased fatigue.

Benefits Of The Ketogenic Diet

Benefits Of The Ketogenic Diet

Conclusion

A ketogenic diet is on the one end of the carb spectrum with only 10 to 12% of calories derived from carbs. At the other end is the low fat/high carb diet that caused the obesity/diabetes wave. The Mediterranean diet is in the center. The more you are able to cut down the carb percentage in your diet by cutting out sugar and starchy foods, the more your metabolism gets stabilized and this can be measured with blood tests. The ketogenic diet makes you lose weight down to your ideal weight and makes you gain more muscle strength and physical endurance. Sophisticated blood tests have shown that inflammatory markers go down on a ketogenic diet and factors that lead to hardening of arteries also go down. The end result on the ketogenic diet is that the rate of heart attacks and strokes goes down, something which was the original goal of Ancel Keys. It did not work, but it promoted a wave of diabetes and heart disease! Ironically adding saturated fat and other healthy fats while cutting down carbs will achieve disease prevention. This is the opposite of what Ancel Keys had recommended to do and what the processed food industry has mimicked. The ketogenic diet lowers mortality by cutting down heart attacks and strokes. With this knowledge it will finally be possible to get people on a path to better health.

More information about ketogenic diet: https://www.dietdoctor.com/low-carb/keto

Incoming search terms:

Jan
14
2017

How To Avoid Being Hungry

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

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

General information about weight gain

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

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

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

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

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

Low-carbohydrate, Mediterranean or low-fat diet

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

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

They compared

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

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

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

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

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

The “POUNDS LOST” study

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

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

Sugar is the driving force

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

How to get out of the vicious food cycle

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

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

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

How To Avoid Being Hungry

How To Avoid Being Hungry

Conclusion

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

Incoming search terms:

Dec
31
2016

What Works Against Alzheimer’s?

Eli Lilly’s promising drug solanezumab failed; so, what works against Alzheimer’s? This drug was supposed to dissolve the amyloid deposits that function like glue and make the patients lose their memory. This phase 3 trial was to test the drug on patients to assess efficacy, effectiveness and safety. But instead it showed that the new drug did not stop the loss of memory.

Now all those who were hoping for solanezumab to be effective, will jump on another drug, aducanumab. Biogen from Cambridge, Massachusetts, has developed this drug. Out of 165 subjects only 125 completed preliminary studies. 40 patients who discontinued it, had negative side effects. These included fluid building up in the brain, which was thought to be due to removal of the plaques. But others, had brain bleeding.

Although the drug manufacturer is still hoping that aducanumab will work out as an anti-Alzheimer’s drug, I have my doubts. A drug that can have potential brain bleeding as a side effect does in my opinion not qualify as an anti-Alzheimer’s drug.

Factors that help prevent Alzheimer’s

1. Diet can be as effective as a drug in treating Alzheimer’s

In September 2015 researchers from Rush University published results of putting Alzheimer’s patients on the MIND diet. The MIND diet was a prospective study where 923 people aged 58 to 98 years participated. Researchers followed these people for 4.5 years. Three groups of diets were tested: Mediterranean diet, DASH diet and MIND diet.

The MIND diet study result

The adherence to the diet was measured: those who stuck to the diet very closely, another section of participants that were less diligent, and finally one segment of people who did not take the entire thing too serious. With regard to the MIND diet the group with the highest adherence to the diet reduced the rate of Alzheimer’s by 53% compared to the lowest third. This is like a highly effective Alzheimer’s drug! The second group still was able to reduce the rate of Alzheimer’s by 35%, which would be like a regular strength drug. The control diets were the DASH diet and the Mediterranean diet. The group that was strictly adhering to the DASH diet reduced Alzheimer’s by 39%, the group that was very conscientious in adhering to the Mediterranean diet reduced Alzheimer’s by 54%. The middle thirds of both control diets did not show any difference versus the lower thirds. The conclusion was that a strict Mediterranean diet had a very good Alzheimer prevention effect, as did a strict MIND diet. However, when patients did not adhere too well to a diet, the MIND diet was superior still yielding 35% of Alzheimer’s prevention after 4.5 years. The other diets, when not adhered to that well, showed no difference from being on a regular North American diet. Here is more info about the MIND diet.

Conclusion:

Avoid the Standard American Diet. Adopt a Mediterranean diet and stick to it in a strict fashion or adopt the MIND diet. The other benefit is that there are no side effects!

2. Stress and Alzheimer’s

2010 study from Gothenburg University, Sweden examined 1462 women aged 38-60 and followed them for 35 years.

Psychological stress was rated in 1968,1974 and 1980. 161 females developed dementia (105 of them Alzheimer’s disease, 40 vascular dementia and 16 other forms of dementia). The risk of dementia was reported higher in those women who had frequent/constant stress in the past and was more severe the more stress they were exposed to in the past. Women who were exposed to stress on one, two or three examinations were observed to have higher dementia rates later in life, when compared to women who were not exposed to any significant stress. Specifically, dementia rates were 10% higher when exposed to one stressful episode, 73% higher after two stressful episodes and 151% higher when exposed to three stressful episodes.

Conclusion:

Avoiding being stressed and seeking counselling when stress occurred could prevent Alzheimer’s.

3. Be creative, prevent Alzheimer’s and dementia

In an April 8, 2015 publication from the Mayo Clinic in Rochester, MN and Scottsdale, AZ 256 participants aged 85 years and older (median age 87.3 years, 62% women and 38% men) were followed for 4.1 years.

Mild cognitive impairment (MCI) was measured using psychological tests. At the time of recruitment into the study all of the tests for MCI were normal. As the study progressed it became apparent that there were various risk factors that caused the onset of MCI, which is the immediate precursor of dementia/Alzheimer’s disease. The finding was that the genetic marker APOE ε4 allele was associated with a risk of 1.89-fold to develop MCI and later Alzheimer’s disease. If there were current depressed symptoms present at the time of being enrolled into the study the risk of MCI development was 1.78-fold. Midlife onset of high blood pressure led to a 2.43-fold increase and a history of vascular diseases was associated with 1.13-fold higher MCI development. The good news was that four activities were associated with a lower risk to develop MCI with aging. When the person engaged in artistic activities in midlife or later in life the risk for MCI development was reduced by 73%, involvement in crafts reduced it by 45% and engagement in social activities by 55%. In a surprise finding the use of a computer late in life was associated with a 53% reduction in MCI development. These are very significant observations. This would be equivalent to highly effective anti-Alzheimer’s drugs.

Conclusion:

If you stimulate your mind in older age, even browsing on the computer this will help you to prevent Alzheimer’s disease.

4. Lifestyle factors contributing to Alzheimer’s

a) Sugar consumption: Sugar consumption and too much starchy food like pasta (which gets metabolized within 30 minutes into sugar) causes oxidization of LDL cholesterol and plaque formation of all the blood vessels including the ones going to the brain. On the long-term this causes memory loss due to a lack of nutrients and oxygen flowing into the brain.

b) Lack of exercise: Lack of exercise is an independent risk factor for the development of Alzheimer’s disease. Exercise increases the blood supply of the brain, strengthens neural connections and leads to growth of neurons, the basic building blocks of the brain. Exercise increases mood-regulating neurotransmitters like serotonin and endorphins.

c) Sleep deprivation leads to memory loss, but so does the use of aspartame, the artificial sweetener of diet sodas. Make your own homemade lemonade. Squeeze the juice of half a lemon. Add mineral water to fill an 8 oz. glass. Add a tiny bit of stevia extract for sweetening. Stir and enjoy. Stevia has been used for thousands of years.

5. Hormone changes

A lack of testosterone in men and estrogen in women interferes with cognition and memory. For this reason it is important after menopause and andropause (=the male menopause) to replace what is missing with the help of a knowledgeable health professional.

Progesterone is manufactured inside the brain, spinal cord and nerves from its precursor, pregnenolone, but in women it also comes from the ovaries until the point of menopause. Progesterone is needed in the production of the myelin sheaths of nerves and it has a neuroprotective function. In menopausal women bioidentical progesterone is a part of Alzheimer’s prevention.

Melatonin is a hormone, a powerful antioxidant and a neurotransmitter at the same time. It helps in the initiation of sleep, stimulates the immune system and protects from the toxic effects of cobalt, which has been found to be high in Alzheimer’s patients. In an aging person it is wise to use melatonin at bedtime as a sleep aid and to preserve your brain.

6. Genetic risk of Alzheimer’s

At the 22nd Annual A4M Las Vegas Conference in mid December 2014 Dr. Pamela Smith gave a presentation entitled ”How To Maintain Memory At Any Age”. She pointed out that there are about 5 genes that have been detected that are associated with Alzheimer’s disease and in addition the apolipoprotein E4 (APOE4). About 30% of people carry this gene, yet only about 10% get Alzheimer’s disease, which shows how important lifestyle factors are (in medical circles this is called “epigenetic factors”) to suppress the effect of the APOE4 gene. She also stated that our genes contribute only about 20% to the overall risk of developing Alzheimer’s disease. This leaves us with 80% of Alzheimer’s cases where we can use the brain nutrients and hormones discussed above and exercise to improve brain function.

7. Vitamin D3 protects your brain from Alzheimer’s disease

Alzheimer’s disease is a neurodegenerative disease of old age. We know that it is much more common in patients with type 2 diabetes where insulin levels are high. Studies have shown that Alzheimer’s disease can be termed type 3 diabetes.

The resulting neurofibrillary tangles and amyloid-beta deposits damage nerve cells, which are responsible for the memory loss and the profound personality changes in these patients.

What does vitamin D3 have to do with this?

A 2014 study showed that a low vitamin D level was associated with a high risk of dementia and Alzheimer’s disease.

Specifically the following observations were made.

  • Vitamin D level of less than 10 ng/ml: 122% increased risk of Alzheimer’s
  • Vitamin D level 10 to 20 ng/ml: 51% increased risk of Alzheimer’s

The same research group found in two trials that vitamin D deficiency leads to visual memory decline, but not to verbal memory decline.

Generally supplements of vitamin D3 of 5000 IU to 8000 IU are the norm now. But some patients are poor absorbers and they may require 15,000 IU per day. What the patients need in the dosage of vitamin D3 can be easily determined by doing repeat vitamin D blood levels (as 25-hydroxy vitamin D). The goal is to reach a level of 50-80 ng/ml. The optimal level with regard to nmol/L is 80 to 200 (according to Rocky Mountain Analytical, Calgary, AB, Canada).

8. Avoid sugar overload

We already mentioned sugar consumption under point 4. But here I am mentioning it again because of the insulin reaction. An overload of refined carbs leads to an overstimulation of the pancreas pouring out insulin. Too much insulin (hyperinsulinemia) causes hormonal disbalance and leads to diabetes type 3, the more modern name for Alzheimer’s. All starch is broken down by amylase into sugar, which means that anybody who consumes starchy food gets a sugar rush as well. Too much sugar in the blood oxidizes LDL cholesterol, which leads to inflammation in the body. The consequence of chronic inflammation are the following conditions: hardening of the arteries, strokes, heart attacks, Alzheimer’s due to brain atrophy, arthritis, Parkinson’s disease and cancer.

What Works Against Alzheimer’s?

What Works Against Alzheimer’s?

Conclusion

In the beginning we learnt about a failed phase 3 trial regarding an anti-Alzheimer’s drug. Next we reviewed several factors that can all lead to Alzheimer’s and that have been researched for many years. It would be foolish to think that we could just swallow a pill and overlook the real causes of Alzheimer’s disease. I believe there will never be a successful pill that can solve the increasing Alzheimer’s problem. It is time that we face the causes of Alzheimer’s. This means cutting down sugar to normalize your insulin levels. We need to supplement with vitamin D3 because we know that it helps. For women in menopause or men in andropause it is time to replace the missing hormones with bioidentical ones. We need to handle stress and avoid sleep deprivation. And, yes we need to exercise regularly. Following a sensible diet like the Mediterranean diet or the MIND diet makes sense. And let us keep our minds stimulated. Chances are, when we do all of this; no Alzheimer’s pill will be needed. This is not good news for the drug companies, but will be very good news for you. Last but not least, there are no side effects, only health benefits!

Additional resource on how to preserve your memory.

Oct
29
2016

High Insulin Levels Can Cause Alzheimer’s

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

Background information about Alzheimer’s

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

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

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

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

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

What treatment options are there for Alzheimer’s disease?

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

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

High Insulin Levels Can Cause Alzheimer’s

Conclusion

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

Jul
16
2016

Mediterranean With Healthy Fat

If you want to lose weight, have you considered eating Mediterranean with healthy fat? A lot has changed in recent years regarding recommendations for healthy food intake. In the eighties and nineties the low fat diet was recommended, which unfortunately was high in carbs and led to obesity. What we have learnt from this is that carbohydrates that get broken down in the gut into sugar are converted into fatty acids and stored as fat.

Studies regarding diets with unhealthy and healthy fats

  1. Here is a prospective study that followed 120,877 U.S. women and men over a longer time. Every 4 years it was noted that for potato chips 1.69 lbs. were gained, for potatoes 1.28 lbs., for sugar-sweetened beverages 1.00 lb., for unprocessed red meats 0.95 lb. and for processed meats 0.93 lb. On the other hand from vegetables there was a weight loss of −0.22 lb., for whole grains −0.37 lb., for fruits −0.49 lb., for nuts −0.57 lb. and for yogurt −0.82 lb. Cheese was also investigated and was found to be mostly neutral in terms of weight gain, while butter did cause weight gain.
  2. In a study from Spain that was published in the Lancet in June 2016. 7447 asymptomatic men (aged 55–80 years) and women (aged 60–80 years) were followed for about 5 years. They all had type 2 diabetes and three or more cardiovascular risk factors. They were randomly assigned to three Mediterranean diet types: a Mediterranean diet with olive oil, a Mediterranean diet with nuts and a control group on a low fat Mediterranean diet. The interesting finding after 5 years was that both the patients on the Mediterranean diet with nuts and with olive oil lost some waist circumference. Their weight loss was 0.95 lbs. for the olive oil group and 2.82 oz. in the Mediterranean diet group with nuts. The Mediterranean diet group with olive oil had lost 0.22 inches in the waistline, the other group on nuts lost 0.38 inches. These are hardly impressive losses! The researchers concluded that fat restriction is not necessary on the Mediterranean diet, as there was no weight gain with unrestricted healthy fats after 5 years.

Dr. Dariush Mozaffarian, a cardiologist and epidemiologist of the Tufts Friedman School of Nutrition Science & Policy wrote an editorial regarding this Spanish study: ”A handful of nuts may be 160 calories, which is more calories than a can of Coke, but that doesn’t mean the can of Coke is a better choice”. He added: “Salt, sugar, starch, processed food and trans fats should be off the menu, not fat. Healthy foods are healthy foods, and bad foods are bad. It doesn’t matter, if the food is low fat or high fat. This is a separate issue.”

Mediterranean With Healthy Fat

Mediterranean With Healthy Fat

Conclusion

When wanting to lose weight, the key is to pay attention to your carb intake. Make sure it consists of unrefined carbs. You will do this if you eat vegetables and fruit. Cut out sugar and starchy foods as much as you can. Have lean, clean meats, but avoid red meat except perhaps for every two weeks some grass fed beef. Eat fish (important for its content of omega-3 fatty acids), also enjoy yogurt, nuts, olive oil and avocados. It is an extra benefit if you add regular exercise to this as well. You will notice that you gradually shed the unnecessary pounds. This is not a program for just a month or two. To stay well, make it a new lifestyle!

Incoming search terms:

Mar
26
2016

Heart Attacks Can Kill

We rarely hear that heart attacks can kill; we are more likely to hear that a person was brought to the hospital with a heart attack. The doctors placed a stent or two and the person left the hospital two or three days later, fully recovered.

What silent changes occur before a heart attack?

A heart attack does not happen out of nowhere. There can be one or several risk factors present before, like smoking, a lack of exercise, being overweight or obese from eating too much sugar, consuming sugary drinks and eating lots of starchy foods. This will have changed the cholesterol fractions with the bad LDL cholesterol being high and the good HDL cholesterol being low. Triglycerides in this setting are also usually high. The end result is that the lining of the body’s arteries, including the coronary arteries are thickened to the point where blood has a harder time flowing through the opening of the coronary arteries. One day the heart muscle reports severe pain from a lack of oxygen and nutrients. There are essentially three coronary arteries that supply oxygen and nutrients to the heart muscle. For details follow this link.

Often people have 50% to 60% of coronary artery narrowing, but do not know about this. There are tests available that a person could do to check the amount of hardening of the arteries (for instance the IMT test, see below).

What happens after stent placement?

The interventional cardiologist inserts a catheter from a wrist artery or elbow artery backwards through the aorta and from there into each of the openings of the coronary arteries. By injecting a dye X-rays can be made that show the condition of each of the coronary arteries. If a blockage is identified, this can be overcome through angioplasty, where an instrument is used to pierce through the atheromatous deposits and reopen the coronary artery. To prevent re-stenosing, the cardiologist places a wire mesh stent that opens up upon withdrawal of the instrumentation. The end result is that the previously closed off coronary artery is fully functioning again and the stent keeps the previously narrowed coronary artery open. The cardiologist may have to place two or more stents during the same procedure.

A 5-year follow-up study summarized the outcome after stent placements in 1095 patients with 3-vessel coronary artery disease. Percutaneous coronary intervention, a fancy name for saying “angioplasty combined with stent placement” had a 5-year mortality rate of 14.6%, 9.2% heart attack rates and 24.4% reoccurring blockages requiring repeat procedures to reopen the coronary arteries. There were 3% strokes over 5 years demonstrating that not only heart vessels, but also brain vessels were affected by the hardening of the arteries.

What is heart failure?

You may think that the heart would now be entirely back to normal. But this is a gross simplification. The heart functions like a pump, and we know that pumps can fail. In the past when the heart stopped functioning, the person would die. This was the case because there was a complete irreversible closure of one or more coronary arteries. As a result the muscle of one part of the heart, typically involving the left heart chamber would stop functioning. This part of the heart is supplied by the left anterior descending coronary artery. The left heart chamber is the main pump that pushes blood out into the aorta and from there through the whole body. We need the left anterior descending coronary artery to be open and supply nutrients and oxygen to this vital heart pump all the time. When there is a 70% to 80% narrowing of this artery and the heart is not yet failing, there can be life threatening irregular heartbeats, called ventricular fibrillation from a lack of oxygen. This makes the heart muscle contractions no longer effective, as they are no longer synchronized making the heart muscle beat as one unit. This causes acute pump failure and the patients dies. The other possibility is that the patient has a massive heart attack that kills a large portion of the heart muscle off (called myocardial infarction or heart attack). If the patient is not lucky to have immediate access to a hospital with an interventional cardiologist waiting for him or her, even angioplasty and stent placement will not revive the dead portion of the heart muscle and the patient will not survive.

Using a echocardiography the ejection fraction can be determined. This is a measure of how well your heart empties with each heartbeat. Normally it would be between 50 and 70. Below 50 indicates that heart failure is present.

Patients who had a mild heart attack may only have an ejection fraction of 40 and get short-winded with mild activity. Other reasons for mild heart failure can be atrial fibrillation, a common chronic condition in older patients where the atrial chamber is not contracting properly, but fibrillating. Another cause can be inadequate treatment of high blood pressure, so the heart muscle has a hard time keeping up the blood flow against an abnormally high pressure gradient.

Many patients who had a heart attack and were quickly treated with angioplasty and stent insertion have had some minor persistent damage to the heart muscle resulting in abnormal echocardiograms with lowered ejection fractions. In the past without the acute intervention they would likely not have survived. Now due to modern medical technology these patients did survive, but they are left with a mild degree of heart failure, as a certain portion of their heart muscle has died off.

What kills the patient with a heart attack?

As explained above, when the heart muscle no longer is able to function as a pump, the patient dies. This can come from irregular heartbeats, particularly ventricular fibrillation that does not respond to emergency treatment with a defibrillator. This is an electrical device that resets  The reason can also be a heart attack that kills a significant part of the heart muscle. Ventricular fibrillation often occurs when not enough oxygen reaches the heart muscle and the special nerves that coordinate that heart muscle fibers to contract as one unit. Regular monitoring of the carotid intimal-medial thickness (IMT) by ultrasound will give a fairly accurate test for coronary artery hardening as the two are closely related.

A patient in danger of getting into trouble can be referred to a cardiologist and angioplasty and stent placement can prevent further deterioration for the time being. It is much safer to do these procedures electively rather than during an emergency when the patient is in distress.

Prevention of heart attacks, any volunteers?

Following the overview above it becomes apparent that prevention to not get heart disease is the best approach with regard to hardening of the arteries. This can be achieved by doing the following:

  1. You must abandon the Standard American diet. This means no processed food, no refined sugar intake, avoid as much starchy foods as possible. Adopting a Mediterranean diet or a DASH diet is a first step. The DASH diet was developed to help patients with high blood pressure to reduce their blood pressure through the use of this diet. Reducing blood pressure will also reduce the risk of heart disease.
  2. Avoid excessive alcohol intake (more than two drinks per day for men and more than one drink per day for women) as the toxic effect of alcohol kills heart muscle cells. This in turn leads to heart failure.
  3. Regular physical exercise will condition your lungs and heart and improve your cardiac output. By having bigger reserves the person becomes more resilient to developing a heart attack.
  4. Increasing your fiber intake to 30 to 35 grams per day using vegetables and fruit and additional fiber supplements. Common fiber supplements consist of psyllium husk and/or others from the health food store. Take it in the morning with breakfast and with lunch. By avoiding extra fiber at dinnertime you sleep better at night. It turns out that fiber intake is very important to lower LDL cholesterol and triglycerides by interfering with the enterohepatic pathway that leads to recirculation of bile salts rich in these fatty substances. The net results are lower LDL cholesterol and triglyceride levels and higher HDL cholesterol (the good cholesterol) levels.
  5. Take some vitamins and supplements. Vitamin B2, B6, B12 and methyl folate will support methylation pathways. Vitamin D3 in a good dose like 5000 IU per day or more and vitamin K2, 200 micrograms per day will remove calcium out of the arteries and transport it into the bones; this effectively prevents hardening of the arteries and prevents osteoporosis at the same time. Omega-3 supplements (EPA/DHA) are very useful to keep inflammation under control and delay hardening of the arteries; it helps to lower LDL and increase HDL.
  6. Have your hormones checked. Some doctors do not feel comfortable doing this; maybe you want to see a naturopath about it instead. Your body needs the hormone receptors satisfied by adequate bioidentical hormone levels; otherwise you age prematurely and give up body functions that you would rather keep. Normal hormone levels prevent osteoporosis, premature hardening of the arteries, Alzheimer’s, erectile dysfunction and premature wrinkles. The essential hormones involved in cardiovascular disease prevention are thyroid hormones, sex hormones and in some aging people also human growth hormone.
  7. Once every 2 years it would be good to measure your heart function as is outlined in this blog.
  8. There are many more factors that have been identified by researchers to contribute to hardening of the arteries.  It is useful to read this and think about which of these factors may apply to your case.
Heart Attacks Can Kill

Heart Attacks Can Kill

Conclusion

I have explained that hardening of the arteries is the cause of heart attacks. This is caused by a multitude of factors including sugar and processed food overconsumption, smoking, excessive alcohol intake, obesity, undertreated high blood pressure and diabetes. Simply doing angioplasties and placing stents will not stop the process of what led to the heart attack in the first place. Almost 15% died within 5 years following those procedures and 9% got another heart attack. They did not change their diets and stayed inactive. There is another sad aspect about clogging of coronary arteries: the more coronary artery flow we lose through hardening of the coronary arteries, the lower our ejection fraction of the heart as a pump has become. When we reach the point of less than 50% of ejection fraction, we enter disability country with clinical heart failure, forcing us to wear continuous oxygen masks and being unable to exercise or walk. Heart failure is as deadly as terminal cancer having a very high mortality rate.

Concentrate on prevention now, because heart disease remains the number one killer. Remember that we can largely prevent heart disease when we follow the steps mentioned above!

More info about heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Nov
28
2015

Diet And Brain Health

The fact that the type of diet you eat has a lot to do with your brain health keeps popping up in the medical literature, and this year has not been any exception.

The Mediterranean diet in particular has been shown to have very positive effects on postponing Alzheimer’s disease by as much as 5 years.

A clinical study on 674 elderly patients (mean age 80.1 years) without dementia, was published in the journal “Neurology”. It examined the question whether adherence to the Mediterranean diet would affect the degree of brain atrophy, which in turn is known to correlate with the onset of Alzheimer’s disease.

The findings were interesting: a high adherence to the Mediterranean diet led to a higher total brain volume, total grey matter volume and total white matter volume as measured with high-resolution structural MRI scans. Lower meat intake led to higher brain volume and more fish intake caused the mean cortical thickness of the brain to increase. Parts of the brain that are affected in Alzheimer’s patients with atrophy like the cingulate cortex, parietal lobe, temporal lobe, and hippocampus showed good volumes with the MRI scans when patients adhered to the Mediterranean diet. These volumes started to shrink when the diet was poor.

Those who adhered to the Mediterranean diet have brains that on MRI scan look 5 years younger and are much less likely to get affected by Alzheimer’s disease. Physicians have known for a long time that people, who eat a healthy diet, exercise regularly, don’t smoke and who keep mentally stimulated will generally have healthier brains than people who don’t do these things.

What is the Mediterranean diet?

It involves eating meals that are made up of plants: vegetables, fruit, cereals, beans and nuts. You can eat fish and poultry twice per week. You cut down the amount of meat and dairy you eat, but you can have a glass of wine per day, if you like. Butter is not used for cooking, but olive oil is used instead. Here is more information of what is included in the Mediterranean diet.

Because there is less fat and less high glycemic index carbs in this diet, it is also a diet that lends itself for weight management. You shed a few pounds and reach your ideal body mass index without paying much attention to this.

Apart from the Mediterranean diet another diet, called the MIND diet has also been shown to prevent brain atrophy. This diet is a combination of the DASH diet that was developed for controlling high blood pressure and the Mediterranean diet.

The Mediterranean diet makes you live longer

The Nurses’ Health Study that has been going on since 1976 showed that telomeres, the caps on chromosomes, were getting shorter in nurses who lived on junk foods, but surprisingly nurses on the Mediterranean diet preserved their telomeres. Longer telomeres are associated with slower aging. And people with longer telomeres reach an older age without diseases like heart attacks, liver disease or cancer.

Exercise on top of the Mediterranean diet

It is not a good idea to just rely on a healthy diet, like the Mediterranean diet to prevent heart attacks, strokes and other diseases. You need regular exercise as the other ingredient to keep you well. When you combine exercise with a healthy diet your abdominal girth shrinks as this study showed.

Another study showed that when a Mediterranean type diet is combined with regular exercise, adult onset diabetes occurrence could be reduced by 28-59%.

This is quite a significant effect of two simple interventions: a healthy diet and regular exercise.

Don’t smoke

It does not make sense to go on a healthy diet, exercise and then smoke! Interestingly an Iranian study showed that when people became health conscious, adopted a healthy diet and exercised, they also started to quit smoking. People who did all of this, quit smoking, eating healthy and exercising regularly, were also the happiest and most content.

Exercise your brain

The evidence shows that any stimulation of brain activity, particularly anything that requires active and abstract thinking will protect the brain from developing Alzheimer’s disease.

Another study showed that prevention of Alzheimer’s disease is achieved by quitting smoking, treating high blood pressure, stimulating the brain and treating diabetes.

Diet And Brain Health

Diet And Brain Health

Conclusion

Although the focus here was on diet and brain health, the most success is achieved by following a comprehensive program that involves a review of your lifestyle. This approach will be the most successful way to prevent Alzheimer’s disease. It starts with quitting smoking. It goes on to starting a Mediterranean diet and staying on it. Regular exercise will take care of preventing heart attacks and strokes, but exercise also ensures that all of your brain cells continue to get oxygen and nutrients, which in turn prevents brain shrinkage. Because the Mediterranean diet has a lower calorie content than the Standard American diet, there will be weight loss until you reach your ideal body mass index. Stimulating your brain by actively working with the computer, doing puzzles, playing a music instrument, phoning friends, reading books etc. will all contribute to preventing Alzheimer’s. Watching TV or movies is not an active mental activity, it is passive thinking, which means it is not as valuable as the other activities. Pick a hobby that enhances your life, and your brain will thank you for it too!

Aug
29
2015

Problems With The Western Diet

Lately there have been various news reports cautioning us about the Western diet. We eat too much processed food, we eat too much sugar and we have to be careful with how much fat and what kind of fat we eat. Take this story from the CNN. Half the world lives in big cities. And this number will reach 70% in the year 2050, if the urbanization trend continues at the same rate. With it comes the consumption of fast food. The wealthier people are, the more meat they eat. This is exactly what is bad for us. Too much meat can cause gout, particularly when paired with alcohol. First it is time to explain some more about the Western diet. “The biggest features of a Western diet are overconsumption of over-refined sugars, highly refined and saturated fats, animal protein and a reduced intake of plant-based fibers,” says Ian Myles. He is located at the U.S. National Institute of Allergy and Infectious Diseases. This statement is specific enough: we are eating too much fat, red meat, salt and sugar, and too little fiber.

Too much fat

In processed foods we get too many omega-6 fatty acids, which have been shown to cause clogging of arteries and causing heart attacks and strokes, if not balanced with enough omega-3 fatty acids. But many processed foods still have hidden trans fats, which distribute free radicals in your system; this in turn causes hardening of the arteries again. Free radicals also age you faster. A candy bar with palmitic acid and fructose for instance, leads to a slow grade inflammation. The immune system mistakenly takes palmitic acid for the gut bacterium E.coli and mounts an immune reaction. This low-grade inflammation causes inflammation in the blood vessels, but also weakens the immune system. The sugar part of the candy bar oxidizes LDL cholesterol leading to clogging of arteries, which causes heart attacks and strokes.

Too much red meat

Grain fed and antibiotic treated regular beef changes the gut bacteria and can cause super bugs. The change of the gut flora can lead to inflammation in the gut lining and something called “leaky gut syndrome”. We carry almost 2 pounds of gut bacteria in us at any given time. But residual antibiotics from regular beef and chicken reduces that amount and changes the composition of our gut flora.

You can read in this blog that the changes taking place from consuming regular beef changes your liver metabolism and leads to accelerated hardening of the arteries, which in turn causes deadly heart attacks and strokes. On the other hand, grass fed beef or organic beef do not do this. To prevent leaky gut syndrome, heart attacks and strokes from developing you can take probiotics every day, which should include these two species: Lactobacillus acidophilus and Bifidobacterium bifidus. This keeps your gut flora stable and does not allow your food to undermine your health.

To much salt and sugar

Too much salt is often in processed food to prolong the shelf life. But we humans are very sensitive to overdoses of salt. Our kidneys have to work overtime to get rid of the excess salt. We need to drink enough water to allow the kidneys to produce urine, which will eliminate the excess salt. Persistent excessive salt intake will also cause high blood pressure. High blood pressure can cause heart problems, strokes and aortic aneurysms. Restaurant food often contains too much salt and sugar.

Too little fiber

The more food is processed, the less fiber it will contain. If you go for the pizza, it may taste good, but where is the fiber? If you eat bread and butter, where is the fiber? You may say that you like a donut. I ask you again: where is the fiber? The end result is that toxins that normally would have been bound to fiber in the colon and were eliminated in the stool are now interacting with the wall of the colon causing colonic polyps and colon cancer. It may not only be fiber as plant-based diets rich in fruits, non-starchy vegetables, legumes, and whole grains were shown to be associated with a lower risk of the most common cancers. That’s the reason why people who consume a Western diet have higher rates of cancer in general. They lack fruits and vegetables.

Polyunsaturated fatty acids

The recommendation in the 1980’s until about 2010 of a low fat diet to prevent heart attacks and strokes has failed miserably. It turned out that polyunsaturated fatty acids are of the omega-6 type, which gets metabolized into arachidonic acid and causes inflammation. The immune system gets suppressed from the chronic inflammation and the person becomes more prone to infections. As low fat diets are typically high in carbohydrates, there is a calorie surplus causing weight gain. Dr. Fife explains in his book that polyunsaturated acids interfere with the insulin receptor feeding into insulin resistance, which makes it even more difficult to control the metabolism and leads to more weight gain (Ref.1). The end result is what we have observed over the last few decades, a relentless obesity wave in the civilized world. It is a direct result of the Western diet.

Cancer caused by the Western diet

Breast cancer, colon cancer and prostate cancer are cancers that are related to the Western diet. But there are likely many other cancers that are also caused by it.

We know that free radicals cause cancer, such as from trans fats and rancid polyunsaturated fatty acids found in processed foods. Cancer is more common in obese people and people with diabetes.

Habits that make us eat more

There are habits that make us eat more like snacking and falling for so-called “fitness food” which contains dubious ingredients. It may come as a surprise, but married people can also fall prey to unhealthy habits together, forgetting about working out and sneaking in “skinny cocktails”. Read what Cynthia Sass, registered dietician had to say about this on CNN.

Solution to the Western diet

You may expect me to say that you should modify this or that in the Western diet. Modification does not work. You have to get radical here! The real solution is to abandon the Western diet altogether. Replace it with the Mediterranean diet without sugar and starchy foods. It is not that as bad as you can see from 1 week of recipes that my wife included in my book: “A survivor’s Guide To Successful Aging”.

You can eat cooked organic spinach, a piece of meat with slices of Avocado for breakfast. Cooking is done mostly with coconut oil or olive oil. Alternatively you may enjoy an egg or egg white vegetable omelette with lots of greens, mushrooms, onions and salsa and avocado on the side. Add to this caffeinated or decaffeinated coffee with stevia. Alternatively, a bowl of rolled oats, flaxseed and nuts with fresh fruit and organic milk, goat milk or yoghurt would make an excellent, sustaining breakfast. I am mentioning all of this to show you that you can get away from your familiar pancakes with maple syrup, sausages, waffles, toasts and muffins etc.

Food needs to be prepared form scratch with organic ingredients. GMO foods need to be avoided as the final judgment on these is decades away, and you do not want to become a human guinea pig.

Problems With The Western Diet

Problems With The Western Diet

Conclusion

The only way to “improve” a Western diet is to eliminate it and replace it by the Mediterranean diet. Throw all the processed food into the trash where it belongs! Avoid omega-6 fatty acids (polyunsaturated fatty acids), which have been shown to weaken the immune system and cause insulin resistance. The best fats are omega-3-fatty acids from marine oils (fish oil), coconut oil and olive oil. Forget all the other oils that are heavily advertised. They are not healthy.

I stick to organic foods although they are more expensive. Don’t forget that apart from a good diet you need to engage in a regular exercise program in order to prevent heart disease and cancer. And don’t stress out over the changes that you are about to make. Remember to manage your stress and relax!

References:

  1. Bruce Fife, C.N., N.D.: “The Coconut Oil Miracle”, 5th edition,2013, Penguin Books, NY 10014

Incoming search terms: