Jun
03
2017

Fish, The Good And The Bad

I am going to review fish, the good and the bad. Fish can be very nutritious, because it contains a lot of healthy omega-3 fatty acids. But because of pollution it also has various degrees of mercury, PBC’s and other impurities.

I will discuss the good about fish oil first. Later we will learn that wild salmon is one of the best fish to eat, while we should avoid tuna due to mercury pollution.

The good about fish

Omega-3 fatty acids, also called marine oil, is an essential fatty acid. It balances omega-6 fatty acids of which we eat too much. Processed foods are full of omega-6 fatty acids, because they keep a long time on the grocery shelves without turning rancid. But when the omega-6 to omega-3 ratio is getting higher than 3:1 we are experiencing a problem. The body stimulates the arachidonic acid pathway, a metabolic pathway that produces inflammatory substances and arthritis. An old home remedy for arthritis is to use fish oil (cod liver oil). It changes the omega-6 to omega-3 ratio back to more normal levels, which can help arthritis patients. Early stage of arthritis can even heal.

Many processed foods contain only omega-6 fatty acids, because this is the cheapest way to produce them (they are based on vegetable oils). Instead of this you want to eat healthy fats like omega-3 fatty acids contained in nuts and fish. You can also add molecularly distilled, high potency omega-3 fatty acids (purified fish oil) as a supplement to help restore the balance between omega-6 and omega-3 in the food you eat. Avoid omega-6 fatty acids that are derived from corn oil, safflower oil, grape seed oil, soybean oil, cottonseed oil, canola oil and peanut oil.

Compare the metabolism of omega-6 fatty acids with that of omega-3 fatty acids.

The linoleic acid of omega-6 fatty acids gets metabolized into arachidonic acid, which causes pro-inflammatory mediators, PGE2 and LTB4 as shown in the metabolism link. On the other hand with omega-3 fatty acids alpha-linolenic acid (ALA) is metabolized into EPA, DHA and the anti-inflammatory mediators PGE3 and LTB5.

It is easily understandable why a surplus of omega-6 fatty acids from processed foods will disbalance the omega-6 to omega-3 ratio. This ratio should be 1:1 to 3:1, but many Americans’ omega-6 to omega-3 ratio is 6:1 to 18:1. Omega-6-fatty acids cause arthritis, heart disease and strokes. Be particularly careful avoiding soybean oil. It has become the most popular oil in the last few decades to foul up the omega-6 to omega-3 ratio. We consume it through processed foods and cooking oils.

Omega-3 supplements

When it comes to balancing omega-3 and omega-6 fatty acids in your diet, be aware that nutritional balancing can help you restore the ideal omega-6 to omega-3 ratio of 1:1 to 3:1. An easy way is to cut out processed foods as much as possible. Supplement with molecularly distilled fish oil capsules to add more omega-3 fatty acids into your food intake. Here is an example of rheumatoid arthritis patients that received omega-3 supplements. After 24 weeks their joint swelling and tenderness decreased significantly.

Rebalancing the omega-6 to omega-3 ratio was able to treat depression as this research showed. This makes you wonder how much depression may be caused by overconsumption of processed food.

Dr. Blatman suggested the following doses of omega-3 supplementation for various purposes:

  • 1 gram/day as supplementation for healthy adults with a good diet
  • 1-3 grams/day for people with cardiovascular disease
  • 5-10 grams/day for patients with an autoimmune disease, with chronic pain or with neuropsychiatric conditions

He mentioned that these doses are empirical, but in his experience this is what really works. Due to quality differences he suggested that you buy fish oil capsules in a health food store. Stay away from discount stores (the quality is the worst) and drug stores.

Other healthy oils are olive oil and coconut oil. They are also useful for cooking.

The bad about fish

1. Mercury and other pollutant

Pollution of the air, soil and rivers is causing accumulation of mercury and other heavy metals in ocean water.

This affects fish that live in the ocean. There is a pecking order of predators with the larger fish feeding on the smaller fish. The bigger the predator fish, the more mercury and other pollutants they accumulate. According to this link the safest seafood is wild salmon, pollock and oysters.

Tuna is too high in mercury, so is swordfish, and shark is even worse. I only consume fish from freshwater lakes or rivers, as well as salmon, oysters and shrimp. This way I get the lowest exposure to mercury. Why is mercury bad for you? It is a neurotoxin. It can harm your brain, heart, kidneys, lungs and the immune system. Specific symptoms can include loss of peripheral vision and lack of coordination with balancing problems. There may be impairment of speech and hearing. The key is to avoid mercury exposure.

2. Rancidity of fish oil

Rancid fish oil contains free radicals that attack the lining of the arteries. There would be no point in taking fish oil, if it is rancid and destroyed what you want to protect. When fish oil is stored, it can interact with oxygen and form lipid peroxides, which are free radicals. The Council for Responsible Nutrition’s quality standards monitors rancidity in fish oil. Get fish oil that meets or exceeds the Council’s standards. If you refrigerate fish oil, it stays fresh longer.

Managing mercury pollution

  1. The first line of defense is to stick to the smaller fish. They are they prey of the large predator fish. The following fish/mussels belong into the low mercury group (alphabetical order): anchovies, catfish, clam, crab, crawfish, flounder, haddock, herring, mackerel, mullet, oyster, perch, pollock, salmon, sardines, scallops, shrimp, sole, squid, trout and whitefish.
  2. You may want to supplement your omega-3 fatty acid intake by fish oil capsules. It is important that you choose the more expensive higher potency products. A molecular distillation process that removes mercury, PCB and other heavy metals creates these higher potency products. This way you only get the enriched omega-3 fatty acids in pure form. EPA and DHA in one capsule should be in the 900 mg to 1000 mg range, not less. I take 2 capsules twice per day as a daily supplement. This helps you as indicated above to balance the omega-6 to omega-3 ratio, which cuts down any inflammatory process in you.

More good news about omega-3 fatty acids

Omega-3 fatty acids have multiple anti-inflammatory effects. This helps for treating arthritis, osteoporosis, preventing heart attacks and brain shrinkage. Even depression can be influenced positively when krill oil and fish oil are both taken at the same time. It is best to think about krill oil and omega-3 fatty acids (fish oil) as complementary marine oils that have multiple beneficial effects on the body.

Studies have shown that arthritis and osteoarthritis are helped by krill oil, but also by fish oil. Similarly, heart attacks and strokes are prevented with both krill oil and omega-3 fatty acids. It appears that both oils reduce inflammation in the arteries that is associated with high blood pressure, diabetes, obesity and the metabolic syndrome in obese people. C-reactive protein measuring inflammation was reduced by krill oil up to 30% compared to placebo within 30 days. Patients with arthritis had 20% and more reduction in stiffness and pain.

Krill oil is well absorbed into the brain and can prevent age-related brain shrinkage, preserve cognitive function and memory, prevent dementia and also possibly depression.

Other health conditions improve on both krill oil and omega-3 fatty acids like osteoporosis (in combination with vitamin K2, vitamin D3 and calcium), a weak immune system, diabetes, high triglyceride levels and cholesterol problems. Both marine oils prevent LDL cholesterol from being oxidized, which helps to prevent atheroma formation and hardening of the arteries. This prevents heart attacks and strokes.

Fish, The Good And The Bad

Fish, The Good And The Bad

Conclusion

In the past cod liver oil was given to children to prevent rickets. In the 1960’s Dale Alexander wrote a book called “Arthritis and Common Sense”. Since then medicine has been revolutionized in the late 1990’s by the idea that inflammation in the body is responsible for high blood pressure, diabetes, heart attacks, strokes, arthritis and even Alzheimer’s disease. It is in this area that omega-3 fatty acids are an important supplement as fish oil capsules and krill oil capsules. These supplements can be bought molecularly distilled to be free of mercury and other pollutants. The anti-inflammatory effect of omega-3 fatty acids is a powerful preventative for all these diseases mentioned. It no longer is a question, whether these supplements work. It has become a fact backed up by large studies including mortality statistics. Even the FDA has included seafood into their food recommendations. The key is to rebalance your omega-6 to omega-3 ratio and incorporate marine oils in your diet. Your body will thank you for it with a longer, healthier life.

Aug
20
2016

New FDA Food Guidelines

A recent news release describes 2016 new FDA food guidelines. In it double the amount of seafood (fish and shellfish) is recommended as well as a cut in saturated fat and in sugar. Coffee, which was labeled a culprit in the past is now recommended to a total of 400 mg of caffeine per day as it is heart protective. Cholesterol is no longer considered an enemy, but sugar, saturated fats and trans fats are.

Here is a breakdown of what each of these recommendations means.

New FDA food guidelines regarding increasing fish and shellfish

The anti-inflammatory effects of omega-3 fatty acids have finally entered the recommended diet plan of the FDA. This reflects the nutritional research over the last few decades that noticed a longer life expectancy for people who eat more seafood and less red meat.

The only problem with seafood can be its mercury contamination. The higher predator fish are in the food chain, the more contaminated fish meat is. This is the reason that tuna fish is not recommended as a food source, as it is very high in mercury. An exception is canned tuna as it has been washed and some of the mercury got lost in the food processing. Wild salmon, sardines and oysters are low in mercury and good sources of omega-3 oils.

New FDA food guidelines regarding reduction of saturated fat

It is now recommended that saturated fat should be reduced to 10% of the total daily caloric intake. This is not undisputed as some studies show that saturated fat may not be involved in the production of hardening of the arteries. Other studies have shown that breast cancer is more common when more saturated fat is consumed.

When the news came out in the 1980’s that saturated fats would be bad for arteries, there was a switch to polyunsaturated acids: safflower oil, canola oil, sunflower seed oil, corn oil and soybean oil or grapeseed oil.

However, the irony is that these vegetable oils were highly unstable and led to oxidation causing heart disease and cancer.

In contrast olive oil is a much more stable oil and has been associated with longer lives in the Mediterranean. Similarly, coconut oil is also more stable and is recommended for cooking as well.

New FDA food guidelines regarding protective effect of coffee

In the past few years many studies have shown the coffee consumption prolongs life. The FDA has now officially recognized these studies and recommends that consumption of up to 400 mg caffeine will help promote health. On the other hand the FDA also recommends that those who do not drink coffee, should not change their lifestyle just because of these recommendations.

New FDA food guidelines regarding sugar reduction

An entirely new recommendation of the FDA is that sugar should be reduced in anybody’s diet. The FDA explains that sugar is contained in too many processed foods, is added in drinks like coffee, fruit juices, food items like muffins and cakes.

In the past decades it has become clear that sugar much more so than fat is the culprit, when it comes to hardening of arteries. Sugar gets metabolized in the liver, triglycerides and LDL cholesterol are increased and this gets deposited into arteries and fatty tissue. In this context it makes sense that the FDA now recommends a reduction of sugar intake.

 New FDA food guidelines regarding cholesterol

In the past it was thought that cholesterol in meat would be the cause of high cholesterol in the blood. This was an oversimplification. We now know that only a small portion of the blood cholesterol comes from food sources, so that cholesterol from food sources is now no longer thought to be of importance with regard to risks for heart attacks and strokes. Instead it is sugar and too many starchy foods (Bread, pasta, pizza, muffins, cakes cookies) that get broken down into sugar, which accounts for high cholesterol by being metabolized in the liver into LDL cholesterol and triglycerides.

New FDA Food Guidelines

New FDA Food Guidelines

Conclusion

The new food guide by the FDA has fundamentally changed the previous recommendations based on newer nutritional studies. Now fish and shellfish should be doubled compared to previous recommendations. Coffee is no longer the enemy, but your friend. Sugar and starch over consumption is to be avoided, as this can raise cholesterol and triglyceride levels. Eat more vegetables and fruit. These recommendations closely resemble a Mediterranean diet, which has been shown to prolong life in several studies. Abandon the American Standard diet with hamburgers, processed foods and sugary drinks. Pay attention to the FDA food recommendations!

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Oct
17
2015

Depression Needs Treatment

Depression is common: 10% of all men and 20% of all women have a period of depression in their lives. In people with medical illnesses depression is more common: 20% to 40% (Ref.1).

The peak age for depression is usually the age of 25 to 44. There are special groups where depression is also common. In adolescents 5% are affected with depression and 13% of women tend to get depressed after delivery, a condition called postpartum depression.

In any age group with depression there is a risk of suicide, but with adolescents this is particularly true.

About 10% to 15% of people with general medical illness are developing depression, such as patients with Parkinson’s disease, stroke, Alzheimer’s disease, cardiac disease, HIV infection, end-stage renal failure and cancer.

Causes of depression

Officially it is not known what causes depression. That is what medical textbooks say. However, other books like Datis Kharrazian’s book “Why isn’t my brain working?” offers several scenarios that can cause depression and he has examples of cases that were cured of depression (Ref.2). He points out that deficiencies in two major brain transmitters can cause depression: serotonin and dopamine.

  1. Serotonin is produced in the midbrain from the amino acid tryptophan in two biochemical steps. These biochemical conversions require iron, vitamin B6, vitamin B12, niacin, folic acid and magnesium as co-factors. But you also need the “large neutral amino acid transporter” (LNAA) to transport tryptophan through the blood/brain barrier into the brain.
  2. Dopamine is a neurotransmitter that is produced in the frontal lobes of the brain. It is also necessary for learning. Dopamine is synthetized by the brain from tyrosine, which has to be manufactured in the liver from the amino acid phenylalanine. You need to have a healthy liver to produce tyrosine, which needs to be transported through the blood/brain barrier into the brain; similar to tryptophan this requires the “large neutral amino acid transporter” (LNAA). People with hepatitis, fatty liver, insulin resistance or diabetes may have problems with the LNAA transporter, which can cause dopamine deficiency (Ref.2). But as mentioned earlier they may also have low serotonin because tryptophan was not transported into the brain. This will happen with sugar overconsumption, as insulin resistance develops and affects the LNAA transporter resulting in both low serotonin and dopamine (Ref.2).
  3. Since the 1990’s it is known that inflammation is also a possible factor in the causation of neurological disease including depression. Ref. 2 points out that gut issues can become brain issues as inflammatory substances can leak trough a leaky gut into the blood stream and trough a leaky blood/brain barrier into the brain. Hypothyroidism can activate brain inflammation and lead to an imbalance of the neurotransmitters. Gluten sensitivity is also an important cause of depression through the inflammatory connection, but few physicians recognize the full impact of this.

Tests for depression

There are no laboratory tests that would define depression. However, every patient should be checked for hypothyroidism, a common cause of depression. If hypothyroidism is found, this can easily be treated by thyroid hormone replacement.

Otherwise the diagnosis of depression is made based on mental status examination, history and review of symptoms. A good start is to ask: “In the past 2 weeks how little interest or pleasure in doing things have you had?” and “Have you been feeling down, depressed, or hopeless in the past 2 weeks?” (Ref.3).

There are detailed psychometric questionnaires available such as the Beck Depression Inventory that can assist the physician to establish the diagnosis.

Myths of depression

One of the myths regarding depression is that it would be contagious. A study on 2000 high school students showed that depression was not infective. The contrary was true: human interaction with friends who had a “healthy mood” improved depression. By the same token, when you constantly compare yourself with your Facebook friends, and you are not in the best mood, your mood may worsen and you could become depressed.

Treatment of depression

Despite advances in the treatment of depression the response rate with antidepressant therapy is limited to 60% to 70%. According to Ref.4 inadequate dosing and misdiagnoses account for the fact that 30% to 40% of treated people with depression have treatment failures. Typically the first antidepressant involves a selective serotonin reuptake inhibitor (SSRI), but newer trials have shown that the older monoamine oxidase inhibitors (MAOIs) have a higher success rate when treating depression initially (Ref.4).

A good antidepressant for mild to moderate depression is St. John’s wort, which is recommended by Ref. 5 as having less side-effects as other antidepressants.

In treatment resistant depression the psychiatrist often employs other combinations of antidepressants. In addition cognitive/behavioral therapy is added, which makes the overall treatment more successful. It goes without saying that complicated cases of depression belong into the hands of an experienced psychiatrist.

Suicides

Unfortunately there is still a stigma attached to have a mental disease like depression and people are in deep denial. Friends who do not understand depression may inadvertently say things that make the symptoms of the depressed person more severe and distance themselves at a time when they would need support from friends. The end result is loneliness, feelings of being misunderstood and having suicidal thoughts. Often it is men who will resist seeking treatment for depression, women are better in getting treatment started.

This is where a psychiatrist needs to intervene. If this does not happen, people start attempting suicide and finally commit suicide. In the US committed suicides have a gender ratio of male to female of 3:1 to 10:1. These situations become very difficult. The family needs to step in and talk to the patient. It is best to accompany the patient to the hospital for an assessment. Going to the hospital may be done privately or by ambulance. Don’t be shy to call 911 for an ambulance. Better to be cautious than have a major crisis that ends in completed suicide.

Alternative depression treatments

There are alternative treatments for depression.

1. Magnetic therapy for depression: This therapy is also called transcranial magnetic stimulation (TMS) and was approved for Canada and in 2008 by the FDA.

But it is not as powerful according to Ref. 3 as unitemporal electroconvulsive therapy.

2. Bifrontal electroconvulsive therapy (ECT): Electroconvulsive therapy with two pedals applied to the front of the skull appears to have the best results in terms of treating depression.

3. Omega-3 fatty acids (EPA and DHA) are powerful anti-inflammatory agents, which will take care of the inflammatory component of depression. Both fish oil and krill oil in combination give the optimal response as outlined here.

4. Vitamin D3 is also anti-inflammatory and will contribute to an improvement with existing depression, but it also helps prevent the development of depression when taken in regularly as a supplement.

5. Light box therapy: The observation of seasonal affective disorder (SADS) can develop as a result of lack of light. This has led to the discovery that light boxes are helpful for treating depression and also for prevention of depression due to seasonal affective disorder.

A light box should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often it takes up to 4 weeks to reach its full benefit.

6. It is known for a long time that alcohol is a depressant; it can actually cause depression and in persons with bipolar disease it can trigger a flare-up of that disorder as well.

7. Finally it matters what you eat: sugar and too much starchy foods (high glycemic index carbs) lead to insulin overproduction and insulin resistance. This causes inflammation, and this will cause depression. As mentioned earlier it also lowers the two key brain transmitters, dopamine and serotonin.

The solution is an anti-inflammatory diet, the Mediterranean diet without sugar and high glycemic index carbs; only low glycemic index carbs are allowed. This will normalize insulin production and eliminates inflammation.

8. Vitamin supplements: Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.5). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

9. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.6).

10. Exercise on a regular basis helps to equalize the mood and seems to exert a slight anti-depressant effect on the person who engages in regular physical activity.

Depression Needs Treatment

Depression Needs Treatment

Conclusion

I have attempted to show the complexity of depression and what is known about its causes and treatment. Very likely there are several causes for depression and further research will hopefully bring more clarity to this. Treatment modalities, both conventional and unconventional have been developed over the years by trial and error. The physician and patient need to use common sense: if a treatment is working, stick to it and use it. If it does not work, move on and try something else. More difficult cases should be referred to a psychiatrist who has the most experience with difficult to treat cases. Do not neglect life-style factors and alternative depression treatments as they can often help to stabilize depression significantly. We all must be vigilant about suicide risks in depressed patients and act by calling 911, if necessary to intervene.

More info on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

1. Depression, Major: Fred F. Ferri M.D., F.A.C.P., Ferri’s Clinical Advisor 2016, by Elsevier, Inc.

2. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

3. Goldman-Cecil Medicine “Major depressive disorder” 2016, by Saunders, an imprint of Elsevier Inc.

4. Massachusetts General Hospital Comprehensive Clinical Psychiatry, Second Edition: Theodore A. Stern MD, Maurizio Fava MD, Timothy E. Wilens MD and Jerrold F. Rosenbaum MD © 2016, Elsevier Inc.

5. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.

6. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

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Jul
31
2015

Two Is Better Than One: Omega-3 And Krill Oil

Omega-3 fatty acids have gotten a lot of limelight in the press; krill oil was kept more in the background by the media. But both omega-3 and krill oil are important for your health.

What can confuse you is the following paragraph that I picked up from Facebook:

“I cannot believe that in the last 7 days 3 Doctors have asked me what krill omega-3 is. One would think that those who look after our health would realize that the high levels of mercury in the regular omega-3 has reached dangerous levels. Krill oil is harvested from pristine waters of the Antarctic Ocean and tested to be free from harmful levels of mercury. If you have not heard of it, it is for brain, heart, joint and immune health.”

Clarification of what Omega-3 fatty acids are

Depending on where fish is within the ocean’s pecking order of feeding, the levels of mercury of the fish oil that contains omega-3 fatty acids will be higher or lower. Tuna, for instance is one of the predator fish on top of the line. They are large predator fish, and as a result, not a fish you want to eat as it has very high levels of mercury. Salmon on the other hand is lower in the line of predator fish. That’s why it is still recommended to eat salmon two or three times per week. Fish oil is pooled from various fish and then molecularly filtered through a special filter that removes heavy metals like mercury, cadmium and others. Knowing these facts, the Facebook text above may be accurate in stating, “regular omega 3 has reached dangerous levels”, but it is inaccurate for the molecularly filtered omega-3 fish oil, which is the only one I would recommend as a supplement. Having said that there are still significant differences in quality according to a report online that tested 51 common products in the US. The omega-3 fatty acids EPA and DHA are stored in the membranes of platelets and in circulating plasma triglycerides, which is useful for the functioning of the lining of our arteries. This is called endothelium and needs to be healthy to lower blood pressure and prevent hardening of the arteries. Omega-3-fatty acids support the cardiovascular system foremost and the brain secondarily.

Where does Krill oil come from?

Krill oil comes from tiny crustaceans called krill that provides additional benefits that are not found in fish oil alone. Although the initial concentration of raw krill oil has less mercury per milliliter than omega-3 fatty acid fish oil, it still needs to be molecularly filtered to remove heavy metals. Also bear in mind, that the tiny crustaceans live in the same polluted ocean waters as other fish. It is a sad fact that our oceans are no longer pristine! The same is true for the Antarctic Ocean. After the filtering process both krill oil and omega-3 fatty acid fish oil are equal in their quality (free of mercury, other heavy metals, PCB and dioxins).

The omega-3 fatty acids of krill oil have an affinity to bind with phospholipids in red blood cells. This enables krill oil to cross the blood-brain barrier and get into the brain cells providing support for the brain. In this respect krill oil has an edge over omega-3 fatty acids to support the brain. But secondarily it is also good for your heart and the lining of the arteries.

Benefits of marine oils like krill and fish oil

It is best to think about krill oil and omega-3 fatty acids (fish oil) as complementary marine oils that have multiple beneficial effects on the body.

Studies have shown that arthritis and osteoarthritis are helped by krill oil, but also by fish oil. Similarly, heart attacks and strokes are prevented with both krill oil and omega-3 fatty acids. It appears that both oils reduce inflammation in the arteries that are associated with high blood pressure, diabetes, obesity and the metabolic syndrome in obese people. C-reactive protein measuring inflammation was reduced by krill oil up to 30% compared to placebo within 30 days. Patients with arthritis had 20% and more reduction in stiffness and pain.

Krill oil is well absorbed into the brain and can prevent age-related brain shrinkage, preserve cognitive function and memory, prevent dementia and also possibly depression.

Other health conditions improve on both krill oil and omega-3 fatty acids like osteoporosis (in combination with vitamin K2, vitamin D3 and calcium), a weak immune system, diabetes, high triglyceride levels and cholesterol problems. Both marine oils prevent LDL cholesterol from being oxidized, which helps to prevent atheroma formation and hardening of the arteries. This prevents heart attacks and strokes.

Fear mongering Facebook write-ups

In this context let me clarify the fear mongering Facebook write-up cited at the beginning of this blog. It is a misconception to think that krill oil is devoid of mercury. It is only so, if it was molecularly filtered, which removes all of the mercury and more, but it leaves the beneficial DHA and EPA (omega-3 fatty acids) intact. In the same vein omega-3 fatty acids from fish oil are initially more mercury containing, but after molecular filtration are entirely mercury free, the same as krill oil after molecular filtration. But the mix of omega-3 fatty acids is slightly different with krill oil being a bit richer in DHA and attaching to red blood cells easier while fish oil omega-3’s attach to triglycerides in the liquid phase of the blood, called plasma and also to platelet membranes. So neither krill oil or omega-3 fatty acids are better than the other; they are slightly different and that’s why you benefit from a mix of both. It would be a big mistake to follow the Facebook advice above and only take krill oil by blindly trusting the quotation. In my opinion it is simply a marketing plot to get you switched from fish oil to krill oil.

What combination of Krill oil and omega-3 fatty acid should I take?

Most trials with krill oil have been done with 300 mg of krill oil per day.  I take a dosage of one capsule per day of 300 mg. There are several manufacturers that produce similar products. I also take 3 capsules of omega-3 fatty acids twice per day. Each capsule has 647 mg of EPA and 253 mg of DHA, which translates into a daily dose of 3882 mg of EPA and 1518 mg of DHA. Again, there are several products from which you can choose. The reason I take a relatively high dose of fish oil is the fact that I come from a family background with severe arthritis that started in several relatives at an age of 50+. I have no sign of arthritis at age 70. It may be the result of taking these supplements and staying away from sugar and starchy foods. I need my joints to do ballroom and Latin dancing and I also need them to attend the gym regularly. Exercise by itself has been shown to prevent arthritis and prevent heart attacks and strokes. We need the benefit from all these things in combination: good nutrition, supplements and exercise.

Two Is Better Than One: Omega-3 And Krill Oil

Two Is Better Than One: Omega-3 And Krill Oil

Conclusion

Both krill oil and fish oil (omega-3 fatty acids) are needed as supplements to prevent arthritis, strokes, heart attacks, osteoporosis, diabetes, dementia, Alzheimer’s and inflammation. The key to a good krill oil or fish oil supplement is to buy the more expensive products that are molecularly distilled and therefore more concentrated, but also free of heavy metals and other contaminants. These supplements are only a small part of your overall anti-aging program that needs to include good nutrition (organic food), exercise, other supplements and if necessary bioidentical hormone replacement.

Reference: Dr. R. Schilling: “A Survivor’s Guide to Successful Aging“. Paperback through Amazon.com, 2014. This text explains the anti-aging program I follow and includes recipes composed by my wife for 1 week.

Apr
15
2015

Avoid Brain Atrophy

When a 24-year old football player (Chris Borland) suddenly decides to quit his active sports career, because he wants to plan for a disability-free long life without brain atrophy, the world listens. Chris did his research about traumatic brain injuries, which can lead to degenerative brain disease or chronic traumatic encephalopathy (CTE). Trauma to the brain is just one cause of brain shrinkage (medically termed “brain atrophy”).

I like to take a broader overview of the topic of brain atrophy, which looks at all of the factors that can lead to brain shrinkage including physical injuries to the brain from blows to the head.

The vast majority of cases of brain shrinkage do not come from physical injuries, but rather from medical illnesses. Many of them including many sports injuries are preventable. This is the topic of my blog today.

Brain atrophy means a loss of brain cells, which causes a smaller brain. An MRI scan (around 800 to 1000$) will give information about the brain.The most sophisticated tool to depict the functioning of the brain may be the SPECT scan (ranging from 2000 to 2500$).

What causes brain atrophy?

It is important to realize that a multitude of different factors can cause the same end result – brain atrophy. All of these factors work together causing brain atrophy and the more factors are at play the worse the outcome. So, let’s review the various known causes of brain atrophy.

Diabetes

It has been known for a long time that diabetics can develop brain atrophy and dementia when their blood sugars are not well controlled. This leads to the formation of advanced glycation end-products (AGEs).

Insulin and IGF-1, a factor produced by the liver in response to human growth hormone have been found to counter the development of brain atrophy in diabetics.

The key in patients with diabetes is a close control of blood sugars, best measured as the hemoglobin A1C blood test. At the 22nd Annual World Congress on Anti-Aging Medicine In Las Vegas (Dec. 10-14, 2014) Dr. Theodore Piliszek stated that the new normal range for hemoglobin A1C is 3.8 to 4.9%, quite a bit lower than the normally recommended values. Accepting the old values that proclaim levels of 5.5. as normal automatically puts you in a higher risk of developing brain atrophy and dementia.

Cardiovascular disease

What is good for the heart is good for the brain. That is what Dr. Perlmutter stated in his book (Ref.1). But the reverse is also true: if your cardiovascular system is sick, your brain gets sick!

Here is a full-text article that describes how intimately connected heart function and brain function is.

Cardiovascular disease is a broad term and includes atrial fibrillation, blood clots in the coronary arteries or brain vessels (medically called “thrombotic events”), high and low blood pressure, heart failure, heart valve defects, low cardiac output, inflammation in the blood and a genetic marker, called Apo E, which is commonly associated with Alzheimer’s disease.

The end result of any of these conditions will cause brain atrophy. Once a problem is identified, it is important that the patient is seeing the appropriate specialist who will take care of the risk factor in order to prevent brain atrophy.

Vitamin B deficiency

Some people are born with a certain degree of a methylation defect, a deficiency of certain enzymes, which prevents methylation of brain hormones and other metabolic products. This can lead to depression, schizophrenia, memory loss and you guessed right: brain atrophy, which manifests itself as Alzheimer’s disease or dementia.

By using the proper nutrients with high enough supplements of vitamin B2, B6 and B12 this biochemical process can be restored and brain atrophy can be prevented. SAMe is also a useful supplement that supports methylation and a normal brain metabolism. Ref.2 explains methylation defects in more detail.

Obesity

The question is whether the “brain shrinks as the waist expands”. The answer is a clear “yes”. Researchers have found that the grey matter (with which we think) in the frontal lobes of the brain shrink in obese people of all ages. The researchers found further that the grey matter shrunk in the temporal and parietal parts of the brain of people in middle and old age.

The key here is to cut out refined carbs (sweetened sodas, pasta, bread, sugar in any form), as they are the ones that cause obesity. This occurs by the liver metabolizing sugar and turning it into fat that is stored. Just by cutting out sugar and starchy foods both my wife and I lost 50 pounds each in 2001. It can be done, but it takes a bit of will power.

The terminology may be confusing here: it is really sugar that causes brain atrophy via causing obesity and damage to the blood vessels.

Smoking and alcoholic beverages

Smoking leads to brain atrophy by damaging the blood vessels that are supposed to supply the brain with nutrients. If blood vessels close off or hardening of the arteries reduces the blood flow to the brain, brain cells die and brain atrophy develops.

Smoking also robs the body of vitamins, which slows down the brain cell function.

Alcohol is a nerve cell poison; it causes brain atrophy by directly damaging the brain cells (grey matter).

The results are memory loss, poor judgment, problems planning one’s future, loss of control with regard to emotions. This can lead to violent behavior and problems with regard to inter-personal relationships.

Genetic factors

ApoE4 gene variant, which causes inherited Alzheimer’s disease, causes a change of brain metabolism with deposits of a glue-like substance in the brain that damages nerve connections resulting in memory loss.

Researchers believe that ApoE4 is implicated in 20 to 25% of all Alzheimer’s cases.

Despite this apparent negative story, there is hope by radically changing one’s diet and taking supplements. Not every patient with one or two doses (alleles) of ApoE4 comes down with Alzheimer’s.

Avoid Brain Atrophy

Avoid Brain Atrophy

What can you do to prevent brain atrophy?

Supplements: Take regular B complex vitamins (particularly B2, B3, B6, folic acid, B12), vitamin E and C, carnosine, acetyl-L-carnitine, boron, ginger, coenzyme Q-10 (or CoQ-10), curcumin, vinpocetine, zinc, grape seed extract, blueberry extract, Ashwaganda, glyceryl-phosphoryl-choline, SAMe, huperzine A and DMAE. All of these have been found to support brain function and often restore memory function. Unfortunately regular anti-Alzheimer’s medications are not keeping their promise and on average just delay Alzheimer’s by 3 to 6 months. For details how these supplements work see this link.

Omega-3 fatty acids including DHA: These essential fatty acids from fish oil are very useful as they are anti-inflammatory and help support the normal brain metabolism, particularly DHA. In a Feb. 2015 US study from the Rhode Island Hospital 193 Alzheimer’s patients, 397 individuals with mild cognitive impairment and 229 normal individuals were followed for 5 years with MRI scans and cognitive tests every 6 months. 117 subjects were taking fish oil on a regular basis. The study showed a decline in gray matter in those who did not take fish oil and in carriers of the apolipoprotein E4 gene (a gene liked with Alzheimer’s disease). The gray matter on the MRI scans and brain function measure with cognitive function tests were much better preserved in those who took fish oil supplements.

Resveratrol: This powerful antioxidant is an anti-aging supplement. It is preventing heart disease, hardening of the arteries and helps preserve brain function by keeping the brain vessels from getting clogged up. DHA and omega-3-fatty acids are helping in that regard as well.

Eat nuts: Nuts are healthy (provided you are not allergic to them); but just because you are allergic to one kind does not mean you are allergic too all of them. Often a person allergic to hazelnuts will not be allergic to Macadamia nuts, cashew nuts or walnuts. Nuts contain a mixture of essential fatty acids, blood vessel friendly, saturated fatty acids and minerals that are all brain supportive.

Exercise regularly: Whoever moves and exercises keeps the heart healthy and whatever keeps the heart healthy keeps the brain healthy as stated before.

Stress management and sleep (avoid chronic overstimulation of your brain): In our hectic society everything has to be instant, the expectations of managers are high, the labor force is stressed. The fastest runner, the best player etc. is celebrated. The rest of us often feel like “underdogs”, if we allow this type of thinking to rule ourselves. Use yoga, self-hypnosis, meditation, religious mediation and prayer to counter some of the stress from everyday life. We need some stress to get us going, but we do not need “distress”. Dr. Hans Selye, the father of the general adaptation syndrome due to stress, gave a lecture about this topic in Hamilton, Ont. in 1977, which I attended. I vividly remember how he projected a picture of his skeleton showing bilateral hip replacements. He said that chronic stress could lead to arthritis. He had developed end stage arthritis in his hips and required total hip replacements on both sides. He wanted to illustrate that stress leads to physical consequences; it may be a heart attack in one person, a stroke in another, arthritis in a third. Constant overdrive has physical consequences.

Avoid sugar and starchy foods: I left this point as the last as it may be more difficult to understand. I started touching this topic under “obesity” above. 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, so essentially you get a sugar rush from any starchy food as well. Too much sugar in the blood oxidizes LDL cholesterol, which leads to inflammation in the body. The consequence of this are the following conditions: hardening of the arteries, strokes, heart attacks, Alzheimer’s due to brain atrophy, arthritis, Parkinson’s disease and cancer. I have blogged about these topics in many separate blogs.

Conclusion

In this blog I have reviewed how brain atrophy develops. There are a multitude of factors that over a lifetime can lead to brain atrophy. Repetitive head trauma from contact sports is only one reason; poor nutrition with too much sugar and starch and missing essential fatty acids (omega-3/DHA) is another potential cause. Add to this a lack of exercise, too much stress, alcohol and smoking and you covered most of the causes. Studies have shown that even when you carry the ApoE4 gene trait, only 30% will express it as supplements can suppress the expression of it. The key is prevention. Preserve your brain cells, prevent brain atrophy!

References:

Ref. 1: David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

Ref.2: William J. Walsh, PhD: “Nutrient Power. Heal your biochemistry and heal your brain”. Skyhorse Publishing, 2014.

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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Oct
04
2014

The Problem Are Sugar And Starchy Foods

Fareed Zacharia interviewed Chief Medical Correspondent Sanjay Gupta on CNN on Sept. 10, 2014 regarding why sugar is worse than fat.

I like to explain why it is important to rethink the issues of fat, cholesterol, sugar, starchy foods, longevity, prevention of cardiovascular diseases (strokes, heart attacks) and cancer.

I have blogged about this many times before, but perhaps an overview regarding these issues would be in order.

The Framingham Heart Study indicated first that too much cholesterol in our system was a problem leading to heart attacks and strokes (Ref. 3). As more research was done, the reasons for this have become clearer.

1.Liver metabolism

The liver plays a major role in the metabolism of glucose. Digestion of refined starchy foods starts in the mouth where amylase from the saliva digests the surface of the pasta or white bread you eat. The stomach carries on with this process and the job is finished in the small intestine with the help of pancreatic enzymes (Ref.1). This digestive process is so efficient that within 20 to 30 minutes all of the refined carbs from pasta, donuts and bread appear as sugar in the blood stream. The portal vein system that collects the nutrients from the gut delivers all sugar straight to the liver where it is reassembled into glucagon as the storage form in the liver and skeletal muscles. This would all be good, would we have periods of fasting in between our sugar consumption. Periods of famine are no longer part of modern civilization, but consumerism is. Most of the processed food contains sugar and this leads to excess sugar uptake, which has to be processed by our liver. The end result is production of LDL cholesterol, oxidization of LDL cholesterol by sugar and in the process the production of VLDL (=very low-density lipoproteins) that leads directly to deposits in the arterial walls and clogging of arteries. Triglycerides are also produced, which leads to fat deposits (the cause of the obesity wave all around us).

2. Where does the fat that we see around us come from?

In the past we thought that it was from too much saturated fat and cholesterol in the food that would have caused the accumulation of fat and cholesterol in the body. Now we know that this was an over-simplification. In fact more cholesterol and fat comes from metabolized sugar and with a slight time delay also from starchy foods.

Sugar and starchy foods (like pasta, white rice, white bread, potatoes, grapes, honey etc.) get metabolized by your liver into LDL cholesterol, triglycerides, and fat. This does not mean that you should not pay attention to the total fat content and the quality of fats you eat.

3. The finer points about subfractions of cholesterol

You have heard many times about the good (HDL) and the bad (LDL) cholesterol. Sugar and refined starches do not only lead to the production of LDL cholesterol, but also to oxidized LDL cholesterol, which is very aggressive (VLDL=very low-density lipoproteins) leading directly to deposits in the arterial walls and to clogging of arteries. Your doctor can order a detailed lipid profile test, if you belong into a higher risk group to determine your VLDL level.

It may surprise you to read that many of the foods that were demonized in the past 2 to 3 decades like whole eggs; unprocessed grass-fed red meat, coconut oil etc. are now seen to be good for you.

But there are provisos: supplement with molecularly distilled omega-3 fatty acids, have enough vitamin D3, vitamin K2 and calcium in your diet or supplement with these. This will make sure that calcium will leave the blood stream (not lead to arteriosclerosis) and enter into the bones where it is needed for healthy bone structure. The anti-inflammatory effect of vitamin D3 and of the omega-3 fatty acids will prevent arthritis, strokes, heart attacks and cancer.

The Problem Are Sugar And Starchy Foods

The Problem Are Sugar And Starchy Foods

4. Four major conditions causing heart attacks and strokes

According to Ref. 2 only 4 conditions have been proven over the years to lead to serious hardening of arteries causing strokes and heart attacks: dyslipidemia (high triglycerides, high LDL cholesterol and VLDL), hypertension, cigarette smoking, and/or diabetes (Ref. 3). What has not been appreciated until recently is the fact that sugar and refined starchy foods metabolized by the liver are the culprits in causing plaque in arteries as the oxidized LDL cholesterol is aggressively invading the arterial wall and is inflammatory. A total cholesterol level greater than 5.2 mmol/L (200 mg/dL) has been shown to be associated with increased heart attacks and strokes. Ref. 2 also points out that dietary changes; days of fasting and weight loss have all been shown to stabilize and reduce plaque lesions and reduce heart attacks and strokes. It is the rupture of unstable plaques that lead to attraction of platelets and thrombus formation. It is this localized thrombosis that leads to the closure of coronary arteries or brain vessels causing heart attacks and strokes. According to Ref. 2 there are 9 factors that determine whether we get a stoke or heart attack, the four factors mentioned above (dyslipidemia, hypertension, cigarette smoking, diabetes) and abdominal obesity, lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and a psychosocial risk. This latter factor includes any kind of chronic stress like interpersonal stress at work or home, depression, financial stress, major life events like marriage, death, divorce, and lack of control. Counseling is useful for support regarding psychosocial risk factors. It is significant to note that according to Ref. 2 several studies have shown that 90% of heart attacks and strokes can be prevented by paying attention to these 9 risk factors. Managing stress effectively and seeking professional help for psychosocial difficulties as well as avoiding the  physical health risks will contribute to good allover health.

Conclusion

Where does this leave us? For decades we have been told that saturated fats and cholesterol in our diet were the culprits and we replaced them with sugar that is part of a low-fat diet. We need to pay attention to the glycemic index and cut out high glycemic foods. However, it is OK to eat some carbs from the medium glycemic food list and most of our carbs from the low glycemic food list. With regard to fat it is important to consume only the healthy fats including omega-3 fatty acids. By taking care of the 4 major causes of heart attacks and strokes and also attending to the additional minor contributors mentioned above you will be able to eliminate 90% of the cardiovascular events. As you change these things you will also prevent many cancers as you changed the body metabolism and chronic inflammation has been taken care of as well as I pointed out in several blogs before. Finally, pay attention to stress management. The body and mind work together.

I have discussed all of these items in detail in my book as well (Ref. 3).

More information on high density and low density carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/

References:

1.Townsend: Sabiston Textbook of Surgery, 19th ed.,Copyright 2012 Saunders.

2.Melmed: Williams Textbook of Endocrinology, 12th ed.,Copyright 2011 Saunders.

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

Last edited Nov. 8, 2014

Apr
19
2014

Measuring Your Heart Function

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

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

Measuring Your Heart Function

Measuring Your Heart Function

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

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

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

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

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

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

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

Last edited Nov. 8, 2014

Mar
29
2014

Alternative Treatment Of Hyperactivity (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD or ADD, attention deficit disorder) has been in the spotlight on and off over the years. It affects 8% to 10% of school-aged children, and about 2% to 5% of adults who still have this condition.

Typically a parent receives a note from school that they must come to a teacher/parent meeting and it is discussed that the child is disruptive in class, not paying attention, interrupting the teacher inappropriately and forgetting to do their homework. The teacher suggests that this may be a sign of hyperactivity. The school nurse is also of this opinion and they suggest getting a prescription for Ritalin or Adderall (amphetamine type medications), drugs that have been shown in other kids to be fairly effective in treating the symptoms.

Next the child is seen by the doctor who confirms the diagnosis and Ritalin (methylphenidate) is prescribed.

In an attempt to quickly control the situation, the side effects of Ritalin are often not discussed in detail: agitation, insomnia, nervousness, anxiety, nausea, vomiting and loss of appetite, palpitations, dizziness, headaches, an increase in the heart rate, blood pressure elevation, and even psychosis (Ref.1).

It is easy to just write a prescription for Ritalin and hope that all is well. Had the parents heard of all the possible side effects, they may have asked whether there were alternative treatments available.

The causes of hyperactivity (ADHD)

The exact cause of ADHD remains unknown, but there is a clustering of this condition in some families, so there seems to be a clear genetic component (Ref.2). It appears that several genes are involved, namely those associated with serotonin and glutamate transporters, but also those affecting dopamine metabolism. Males are affected with ADHD more often than females (in children 3:1, in adults 1:1).

Alternative Treatment Of Hyperactivity (ADHD)

Alternative Treatment Of Hyperactivity (ADHD)

Some remarks regarding brain development are in order: Dr. Kharrazian describes that the grey matter of the brain develops before the age of 9 and the development of the white matter is completed by the age of 19 (Ref. 3, p.3). In ADHD patients the frontal brain is underdeveloped resulting in an inability to suppress unacceptable behavior, immediate desires and impulses. Prescription drugs may alter the behavior on the surface, but the frontal brain development is still lagging behind. The only thing that can influence this is behavioral/cognitive therapy and extra tutoring while the symptoms are controlled. The window of opportunity is closed by the time the ADHD patient has reached the age of 19. After that a juvenile ADHD turns into a permanent adult ADHD. The cases that had only childhood ADHD and outgrew it were the ones where the frontal lobe abnormalities had corrected themselves before the age of 19.

This review article has noted that there is an association between a Western style diet (sugar and fat rich) and ADHD.

Interestingly both Ref. 1 and 2, which I would categorize as having originated from mainstream conventional medicine circles, deny such an association. But the link also noted that a healthy diet with fiber, folate, and omega-3 fatty acids as well as supplementation with iron and zinc when these minerals are found to be low in the blood, do make a significant difference in ADHD patients towards normalization of their symptoms.

One of the under diagnosed causes of ADHD is gluten sensitivity as Dr. Perlmutter described in his book (Ref. 4, pages 150-158). This can spare the child or teenager the toxic side effects of anxiolytics, antidepressants or antipsychotics that may be inappropriately prescribed by their physicians, and a gluten free diet would allow the brain to recover very quickly in such cases. A food sensitivity history and some simple gluten sensitivity blood screening tests will diagnose this condition or rule it out.

To complicate matters even more, Dr. Amen has mentioned in several books that there are at least 7 different subcategories of ADHD that he has found in ADHD patients when studying thousands of single-photon emission computed tomography brain scans (SPECT brain scans). Dr. Amen mentions that the 7 subcategories of ADHD are the combined type ADD, the primarily inattentive ADD subtype, overfocused ADD, temporal lobe ADD, limbic ADD, ring of fire ADD and trauma induced ADD. Dr. Amen explains that each of these types needs to be treated differently and some of the treatment failures are explained by the fact that the wrong type of ADD was treated (Ref.5).

Treatment of ADHD

In the following I mention 5 steps that are useful for treating ADHD patients.

  1. A first step toward normalization of the metabolic changes in the brain metabolism of the affected child or adult is to adopt a diet that has been linked with low risk for ADHD: avoid food additives, cut out refined sugar, avoid known food allergies like gluten sensitivity and others. You may need to test the patient for food allergies using an elimination diet. Add a good amount of molecularly distilled omega-3 fatty acids (the pure form of omega-3 without mercury, lead or PCBs) as this has shown beneficial effects in ADHD patients.
  2. Involve a behavioral psychologist for behavioral/cognitive therapy treatments. This is particularly effective in the 9 to 19 year old category where the frontal region of the brain is still developing.
  3. Work together with the schoolteacher and get supplemental teaching in areas of academic weakness to reduce the frustrations in the classroom setting.
  4. In adolescent girls who just started their period, a relative lack of progesterone (estrogen dominance) may be a contributory factor. A small dose (20mg to 30 mg) of bioidentical progesterone from day 6 to 16 of the menstrual cycle may help significantly in alleviating the symptoms of ADHD. You may need to consult a naturopathic doctor or anti-aging physician to get a prescription for that.
  5. If all of this helps only marginally, then a smaller amount of Ritalin may be helpful; however, blood tests should be drawn from time to time to monitor for drug toxicity as the rate of absorption and elimination of the drug varies significantly from patient to patient.

It is interesting that studies have shown that a combination of Ritalin or Adderall with alternative treatment methods had a better outcome than either method alone.

Conclusion

It is important to think about the various possible causes of ADHD and not just get caught up in the knee-jerk reflex of treating ADHD with Ritalin (note that this was only step 5 above, if all the other things failed). In co-operation with the school system and using alternative ways at home first (change of diet, possible addition of low dose bioidentical progesterone cream in girls) and additional tutoring in weak school subjects the need for Ritalin may be avoided. If all else fails, the conservative approach is still available, but I suggest that drug monitoring (blood levels that should be done from time to time to avoid toxicity) is important.

More information about ADHD: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

References

1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed., © 2013 Mosby.

2. Jacobson: Psychiatric Secrets, 2nd ed., © 2001 Hanley and Belfus

3. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

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

5. Daniel G. Amen: “Use Your Brain To Change Your Age” © 2012, Harmony Books, An imprint of Crown Publishing.

Last edited Nov. 7, 2014

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Feb
01
2014

Early Alcohol Use Will Result In Memory Loss Later In Life

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

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

Review of the effects of alcohol

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

Early Alcohol Use Will Result In Memory Loss Later In Life

Early Alcohol Use Will Result In Memory Loss Later In Life

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cardiology view of preventative alcohol

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

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

Conclusion

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

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

References:

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

Last edited Nov. 7, 2014