Apr
25
2015

Rejuvenate With Stem Cells

We all age; but can we rejuvenate with stem cells? There is a limit to detoxification, to eating organic food, to exercising, to the effects of vitamins and supplements and even to the effect of bioidentical hormone replacements. The limit comes from our telomeres and from stem cells that get depleted in our body as we age. Some researchers report that in regions where we suffer from a disease stem cells are even more depleted than in the rest of the body.

We do not have all the answers yet. We would like to know why our stem cells in the fatty tissue or in the bone marrow do not migrate on their own into an aching back or a sore shoulder. There are all the aches and pains associated with old age. So, why do our own stem cells not help us? They seem to be locked away in fatty tissue and in bone marrow.

At the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec. 10-14, 2014) I learnt that there is a group of stem cell experts in California with affiliates all over the US. They simply take stem cells from the fatty tissue and sometimes also from the bone marrow, isolate the stem cells through a stem cell separator and infuse the stem cell rich fraction (minus fatty and connective tissue) in a bit of saline solution back into the vein of the patient. When the stem cells are in the blood stream, they get activated by the growth factors that are present in blood and can now find where they are needed and start the healing process.

Studies have shown that when stem cells are in circulation in the blood, they are very sensitive to signals from tissues that indicate that there is an inflammatory process. This is why stem cells will repair arthritic changes. The can repair a torn meniscus, a rotator cuff tear in the shoulder or repair a weak immune system. The interesting observation is that stem cells from fatty tissue, also termed mesenchymal stem cells, are pluripotent. This means they can develop into cartilage building cells (chondrocytes) and build up cartilage; this is badly needed in a person with severe osteoarthritis. But stem cells are flexible: they can turn into meniscus cells in a knee with a torn meniscus. They also can repair the damage and relief the patient of the chronic pain. In a shoulder with a rotator cuff tear they can turn into a tough ligamentous material mending the tear.

Some data even indicates that circulating stem cells can repair vital organs like the brain, heart, liver, kidneys and bone marrow; these latter observations were mostly done in animal experiments, but human data is starting to be published in the medical literature.

So, let’s examine what has been found useful with regard to stem cells that are taken from your fatty tissue or your bone marrow and injected into one of your veins.

Here is a website from Arizona that I am only showing as a typical example (I have no conflict of interest and no commercial connections to this group) of what I described above.

With websites like this it is also important to read the disclaimer: “Even though our treatments are done using autologous cells, our Stem Cell Therapies are not approved by the FDA. Stem Cell Treatments are not a cure for any condition, disease or injury, nor a substitute for proper medical diagnosis and care…” Another website from La Quinta, CA describes the use of mesenchymal stem cells for regenerative therapies.

Stem cell treatments are in flux. There is a large body of knowledge that has accumulated showing that with proper technique and aseptic conditions it is a safe procedure. The FBA has been watching this. There are publications regarding the safety of procedures with adipose mesenchymal stem cells; here is one example.

The next step is to show in clinical trials that a certain procedure with stem cells is effective in treating a certain condition.

Below I did a literature review, which are only a few examples, but does not claim to be complete; it highlights some of the problems with stem cell treatments.

Stroke treatment with intravenous administration of bone marrow mononuclear stem cells

This study from India showed no statistical difference of stroke patients treated intravenously with bone marrow derived mononuclear stem cells (the experimental group) and the control group that did not receive such treatment. The investigators examined both groups with functional brain tests and performed PET scans to look at the healing of the brain lesions. Unfortunately the tests showed no statistical difference, but did show that the stem cell procedures were safe. It may be that the wrong stem cells were used (mononuclear bone marrow stem cells) when adipose derived mesenchymal stem cells may have done better. In stark contrast to the study from India is the stem cell treatment for a severe stroke in the former hockey player, Gordie Howe that has gone through the media recently. His procedure was done in Mexico. The stem cells were administered via a lumbar puncture approach as well as intravenously. As you can see from this case, stem cell treatment is even possible in patients who are in their mid 80’s with impressive results.

Parkinson’s disease

Here is a feasibility study from March 2014. A 71-year-old Asian man with progressive supranuclear palsy, an aggressive form of Parkinson’s disease was treated with adipose tissue-derived mesenchymal stem cells that were administered intravenously and intrathecally (to get stem cells into the cerebrospinal fluid that bathes the brain). A remarkable functional recovery took place.

Possible side-effects

This is a report of pulmonary embolism after administering intravenous adipose tissue-derived stem cell therapy. The blood clots in the lungs were treated with anticoagulant therapy. Repeat CT scans of his lungs showed later that the emboli were dissolved spontaneously. It is not clear whether this was a case where familial clotting problems pre-existed as a relative of this patient experienced a similar occurrence after stem cell therapy as well.

A case of chronic autoimmune thrombocytopenic purpura

A rare form of autoimmune disease exists where the body forms antibodies against platelets that help your blood to clot. Here is a paper from June 2009 that describes how a man with this disease was cured using adipose tissue-derived mesenchymal stem cells that were injected intravenously.

Renal transplant survival in type 1 diabetes patient

This case report from India shows that adipose tissue derived mesenchymal stem cells that were given at the time of a kidney transplant to treat end stage kidney disease. The treatment stabilized the condition of this patient after a kidney transplant. At the same time some of the mesenchymal stem cells differentiated into insulin producing cells, which made it much easier to control this patient’s diabetes. In this case stem cells were providing stability following an organ transplant (kidney) and some stem cells turned into insulin producing pancreatic cells.

Osteonecrosis of hip treated with adipose tissue derived MSC

In this study from South Korea dated January 2012 two cases of osteonecrosis of the hip, where the hipbone died (osteonecrosis) are described. The following stem cell protocol helped: The fraction that contained the stem cells (called stromal vascular fraction) was mixed with platelet rich plasma and hyaluronic acid. Using a long needle this mixture was injected into the affected hip joint. Conventional medicine has nothing to offer except a total hip replacement. But here are two cases that showed complete resolution of their pain, regained hip function completely, and healing could be documented with the help of MRI scans.

Treating heart attack patients with stem cells

Here is a paper from The Netherlands, published in June 2014 that describes the problems with stem cell treatment in humans. It points out that much has been learnt from animal experiments. The problem following a heart attack is that there is a massive inflammatory response in the infarcted heart muscle, which makes it difficult for stem cells to establish themselves in the injured heart muscle. However, stem cells have been shown to prevent the development of cardiomyopathy that follows a massive heart attack and often is the cause of death. More refinements are needed for successful treatments, such as the ideal timing of stem cell injections in relationship to the time of the heart attack, the best treatment approach and what number of stem cells to inject are all questions that still need to be answered.

MS model in mice shows promise with adipose mesenchymal stem cells

Experimental encephalitis in mice is used as a model for MS in humans. It helps to preselect potentially effective treatments for MS in humans. In this 2013 paper from Australia researchers used mesenchymal stem cells from adipose tissue and injected them intravenously. To their surprise the mesenchymal stem cells were able to penetrate the blood/brain barrier and end up in the myelin lesions inside the brain. In contrast, bone marrow derived stem cells were unable to do that. The researchers stated that adipose mesenchymal stem cells should be considered “as a cell therapeutic that may be used to treat MS patients”.

A group from Iran published this paper in February 2015 further emphasizes that mesenchymal stem cells would be a logical way to treat MS in humans.

Immunosenescence

As we get older the immune systems weakens because of a process called immunosenescence.

A research group from Austria published a paper in December 2011 that is typical for the thinking that mesenchymal stem cells from fatty tissue have properties that help the immune system to get stimulated. Based on this human data it should be possible to stimulate the immune system by giving stem cells from the fatty tissue to the same person intravenously. This publication shows that this process, which would benefit people above the age of 50 or 60 when the immune system gets weaker, will indeed stimulate the immune system. However, at this point we do not have the data of large clinical trials where this would have been done with measurements of the immune function before and on several occasions after stem cell injection to get a feeling for how long the effect would last. We also do not know whether this procedure is associated with longevity.

Rejuvenate With Stem Cells

Rejuvenate With Stem Cells

Conclusion

Stem cell therapy is definitely coming and many applications are already established as I discussed in a prior blog. It is only recently that physicians are no longer worried about creating tumors with stem cell transfer. Now we are in a phase where various stem cell transfer methods (intravenous, intrathecal, interstitial) are being tested as a treatment for various illnesses. It looks like stem cells from fatty tissue may soon be used intravenously, but I have not seen any such trials when checked on PubMed. The activation of stem cells by laser light has only been mentioned sparingly in the literature. This combination (laser activated, intravenous mesenchymal injection) has the potential for being useful for a multitude of chronic illnesses like fibromyalgia, MS, generalized arthritis, just to mention a few. Mesenchymal stem cells are anti-inflammatory, and they can mend defects without leaving scars.

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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.

Mar
21
2015

What Alcohol Does To You

The media has praised alcohol  for preventing heart attacks, but let us examine what alcohol does to you. There are other articles in which we hear about alcoholic hepatitis and liver cirrhosis, both of which can be killer diseases. To get some clarification, let us discuss the various facts.

Dr. Finnel points out that 7.9% of all emergency room visits in the US are due to alcohol related conditions (Ref.1). When the causes of deaths that are a consequence to alcohol are listed, the top 8 causes are: cancer of the mouth and pharynx, alcohol abuse disorders, coronary heart disease causing heart attacks, cirrhosis of the liver, traffic accidents, poisonings, falls and intentional injuries. This is not what you read in the news. What you do read about is that one glass of red wine per day would be good for women and up to two glasses of red wine would be good for men to prevent heart attacks and strokes.

Bioflavonoids

It is the bioflavonoids , and among those in particular resveratrol, that are the active ingredients responsible for heart health. Resveratrol is a powerful antioxidant that protects against ischemia-reperfusion injuries. It is responsible for the cardio protective properties of red wine known as the “French paradox” (Ref.2). According to this reference resveratrol contributes to at least 3 processes that stabilize the metabolism.

Toxicity of alcohol

Alcohol toxicity is a complex problem. According to the WHO 5.9% of all deaths worldwide are a consequence  to alcohol. In 2012 the WHO recorded that 7.6% of deaths in males were due to alcohol. In comparison, 4% of female deaths were due to alcohol. Toxicity comes from the breakdown product acetaldehyde, which all cells can convert from alcohol, but liver cells are especially able to do this. According to Ref. 3 alcohol diffuses easily through all of the cell membranes and reaches every organ in the body. The toxicity of acetaldehyde is the reason  for shutting down the mitochondria which affect the energy metabolism and causing cell death. The immune system reacts with inflammation, when it attempts to repair the damage.

So, what are the major problems what alcohol does to you? These are the processes: First fat accumulation (steatosis), next chronic inflammation followed by necrosis (dying of cells) and fibrosis. An example of fibrosis is liver cirrhosis, where non-functioning connective tissue replaces liver cells.

Different tissue sensitivity to alcohol

Certain tissues are more susceptible to alcohol toxicity than others. As the concentration of alcohol is highest in tissues that are in direct contact with alcoholic drinks, cancers related to alcohol consumption develop in the oral cavity, pharynx, larynx, esophagus, and in the colon and rectum. The pancreas is particularly vulnerable to inflammation and fibrotic changes with subsequent degeneration into cancer of the pancreas. The heart tissue and the arteries are very sensitive to alcohol; hypertension, heart attacks, stroke, cardiomyopathy and myocarditis as well as irregular heart beats (arrhythmias) can develop. The brain is very sensitive to toxic effects of alcohol as well. This causes major depression, personality changes with violent behavior, car accidents and injuries.

Other toxic effects of alcohol on organs

Kidney disease (alcoholic nephropathy) is another alcohol caused illness. 5% of breast cancers in northern Europe and North America are directly related to the toxic effects of alcohol (Ref.3). Finally, the liver being so active in detoxifying alcohol is affected by developing liver cirrhosis, which accounts for a lot of premature deaths at a relatively young age (typically in the mid to late 50’s).

Ref. 3 goes on to say that literature exists which claims that 1 to 2 drinks per day would be useful for prevention of heart disease. But the observation of the authors is that people will not discipline themselves to stick to these limits and very quickly enter into the zone of alcohol toxicity. The authors further noted that with regard to causing any kind of cancer there is no safe lower limit; the risk is directly proportional to the amount of alcohol consumed and the risk starts right above the zero point.

The pathologist has the last word

When I studied medicine at the University of Tübingen, Germany I attended lectures in the pathology department where Professor A. Bohle, M.D. demonstrated pathology findings of deceased patients. Dr. Bohle had a special interest in Mallory bodies. These are alcohol inclusion cysts within liver cells that can be stained with a bright red dye.

Histological documentation of toxic effects in livers of corpses

I will never forget when Prof. Bohle pointed out that the livers of this most diverse population whose bodies we had the privilege as medical students to study had a rate of 25% positive Mallory bodies. He wanted to impress on us as medical students to watch out for the alcoholics that are usually missed in general practice. Obviously 25% of the pathology population was affected by the consumption of alcohol. It was Prof. Bohle’s hope that we could perhaps interfere on the primary care level before things went out of control. Many of these corpses belonged to traffic accidents that could have been prevented (now seat belts and alcohol limits are standard, in 1968 they were not).

Alcohol as an aging substance

Consistent use of alcohol on a regular basis will slow down cell metabolism and hormone production significantly. The major effect of alcohol leads to poisoning of the mitochondria in multiple organs, which translates into faster aging and a shortened life expectancy. This in turn results in a change of appearance. An older person who has abused alcohol for a number of years may look 5 to 10 years older than their chronological age.

50% of people above the age of 65 drink daily (Ref.4). Some more statistics: alcohol abuse in elderly men is 4-times higher than in elderly women. 5% to 10% of all dementia cases are related to alcohol abuse. About 15% of older adults are experiencing health risks from abusing alcohol. And about 90% of older adults are using medications and close to 100% of medications can adversely interact with alcohol (Ref.4).

Social pressure

These are the scientific facts , and then there is social pressure when you are invited to a party.

When you are young and invincible, do you care what the science says? You want to have a “good time” and not worry about consequences. The data about long-term exposure and a slowly increasing cancer risk is there. The wine industry will remind you that 1 drink for women and two drinks for men will protect you from heart attacks. They will withhold the cancer information from you, as they don’t really want to hear about that (yes, it’s bad for their business!).

Resisting social pressure and doing what is good for you

Can you have a good time at a party without drinking alcohol? Yes, you can. You can talk and you can listen; you are probably more with it than those who had too much to drink. I like mineral water and hold on to a glass of that.

I explained in a blog before how I was convinced by three speakers at an A4M conference to join those who abstain from alcohol.

Socializing without alcohol is doable. You may at times miss it, but you can warm up even to a crowd that had a few drinks too much. It is about choice: we can choose what we want out of life.

What Alcohol Does To You

What Alcohol Does To You

Conclusion

I have attempted to show you the toxic effects of alcohol. Although alcohol has played an important role in the social lives of millions over the centuries, it is becoming more apparent that alcohol is a cell poison and shortens our lives. The beneficial effect of the 1 or 2 drinks marketed by the beer and wine industry and some cardiologists does nothing to counter the threat in terms of a whole array of cancers at much smaller amounts of alcohol. Fortunately, resveratrol and omega-3 fatty acids as supplements as well as exercise will more than make up for the 1 or 2 drinks that you do not really need. And neither exercise, omega-3 fatty acids, or resveratrol are cell poisons. The choice is yours!

References

Ref. 1: John T. Finnell: “: Alcohol-Related Disease“ Rosen’s Emergency Medicine, Chapter 185, 2378-2394. Saunders 2014.

Ref. 2: “Hurst’s The Heart”, 13th edition, The McGraw-Hill Companies, Inc., 2011. Chapter 54. Coronary Blood Flow and Myocardial Ischemia.

Ref. 3: Ivan Rusyn and Ramon Bataller: “Alcohol and toxicity”, 2013-08-01Z, Volume 59, Issue 2, Pages 387-388; copyright 2013 European Association for the Study of the Liver.

Ref. 4: Tom J. Wachtel and Marsha D. Fretwell: Practical Guide to the Care of the Geriatric Patient, Third Edition, Copyright 2007 by Mosby.

Mar
07
2015

Drink Your Coffee, But…

I have blogged about coffee drinking several times in the past. Coffee consumption and health benefits have become a news item again because of yet another study. The recent media reports are based on a South Korean study that involved 25,138 men and women with a mean age of 41.3 years.

Here I like to concentrate on aspects regarding coffee consumption that are often lost in the media when studies regarding coffee consumption are discussed. I will break it down into points and then conclude at the end with my recommendations.

1. Calcification of coronary arteries and osteoporosis

The South Korean study published online on March 2, 2015 showed that with up to 4 cups of coffee there was a direct linear relationship between consumption of coffee and prevention of heart attacks. Coronary artery calcium (CAC) deposits were measured by a CAT scan as they are known to be a good measure for a future risk of heart attacks. Less than 1 cup of coffee per day resulted in a 23% reduction of CAC in the coronary arteries compared to controls without coffee consumption. 1 to 2 cups of coffee reduced CAC’s (meaning the risk of heart attack rates) by 34%, while 3 to 4 cups prevented CAC’s and thus heart attacks by 41%. The fun stops at 5 cups of coffee per day as only 19% of CAC’s (heart attacks) were saved. Clearly there is something in coffee that shows detrimental effects, if the dosage is too high.

In the past there was a question as to whether coffee consumption would lead to osteoporosis in women. However, a study showed that there was no correlation between coffee consumption and osteoporosis.

Other studies have clarified this and found that vitamin D3 and K2 are important to remove calcium from the arterial wall and transport calcium into the bone and deposit it there. Vitamin D3 and vitamin K2 seem to override all the other nutrients when it comes to osteoporosis prevention. The other factor in older women is hormone deficiency as they age necessitating bioidentical hormone replacement in addition to vitamin K2 and vitamin D3 to prevent osteoporosis.

2. Whether or not you put sugar into your coffee

is an important question. This is routinely done in Germany where I grew up. The addition of sugar changes the entire game plan, as it is sugar that oxidizes LDL cholesterol, which is directly deposited under the arterial walls. This is the root cause of hardening of the arteries. Coffee alone is beneficial; coffee with sugar is not. I use a tiny amount of KAL Stevia (which does not have the bitter aftertaste) instead of sugar to sweeten my coffee. This sweetens it to the equivalent taste of sugar, but without the detrimental oxidizing effect of sugar. Somebody like me who was conditioned to eat sugar from childhood on in Germany has been left with a “sweet tooth”; so I need to have this tiny bit of stevia as a crutch. Purists may disagree with me. Keep in mind that the Korean study was done without sugar.

3. What’s the difference between real and decaffeinated coffee?

The recent study showed that you need to drink the real thing (caffeinated coffee), if you want to reduce your risk to get the dreaded pigmented skin cancer, melanoma. Decaffeinated coffee did not have this melanoma protective effect. This points to the fact that there are several substances in real coffee and decaffeinated coffee that have different effects. Ref. 2 shows that there was a clear reduction in the risk of developing type 2 diabetes in people who drank either coffee, decaffeinated coffee or tea. Unfortunately many studies do not distinguish clearly between caffeinated coffee and decaf coffee.

4. Micronutrient components of coffee

As this link shows there are many micronutrient components in coffee such as caffeine, diterpenes, chlorogenic acids, and melanoidins. There is about 100 mg of caffeine contained in a tall (240 ml) Starbucks cup of coffee. This will stimulate the nervous system and your adrenal glands getting that energy rush.

Diterpenes consisting mainly of cafestol and kahweol are substances that have been found to increase the LDL cholesterol. The fact that we are dealing with a concoction of mostly beneficial, but also some less beneficial micronutrients in coffee is responsible for the lower beneficial effect of 5 cups of coffee mentioned in the South Korean study. Filtered coffee seems to largely remove these undesirable substances.

This link explains more details about the micronutrients in coffee.

5. Clinical conditions that are partially prevented by coffee consumption

The last link mentioned a study where a large group of people were followed and monitored for Parkinson’s disease. Those who had consumed only 1 cup of coffee per day were compared to controls without coffee consumption. This one cup of coffee per day prevented Parkinson’s disease by 40 to 60%. Similarly, in a study that investigated prevention of type 2 diabetes 4 to 6 cups of coffee per day prevented 28% of type 2 diabetes. In postmenopausal women decaf coffee was also significantly effective in reducing the risk to develop diabetes.

The Linus Pauling Institute link summarized that there were several studies that showed that colorectal cancer could be partially prevented by consuming real coffee (4 or more cups), which lowered the risk by 24% compared to non-coffee drinkers. Another study noticed that 1 to 2 cups per day of decaf coffee reduced the risk for colorectal cancer by 48%.

Cirrhosis of the liver, often due to excessive alcohol use can be prevented by 40% when at least 2 cups of coffee were consumed. More astounding than that is that the risk of death from liver cancer can be reduced by 50% when at least 1 cup of coffee was consumed compared to those who never consumed coffee.

However, liver and colon cancer are not the only ones that can be prevented to a large extent by drinking coffee. Breast cancer, prostate cancer, endometrial cancer, uterine cancer, oral cancer, brain cancer and lung cancer can also be significantly prevented by a regular cup of coffee. As there is a risk of increasing miscarriages in pregnant women, it is best not to consume coffee during pregnancy or at the most limit it to one cup per day. Also, nursing mothers should avoid coffee (even decaffeinated coffee) as caffeine gets transmitted into mother’s milk.

People with high blood pressure may be better off to not drink coffee or to drink decaf coffee, because caffeine has been shown to elevate blood pressure substantially.

6. What are the risks of drinking coffee?

Seeing that coffee is an effective drug-like compound with many benefits, it is worthwhile asking the question: what are the side effects of coffee consumption? There are people who are very sensitive to caffeine. They get over stimulated and experience heart palpitations, a lack of sleep and anxiety. They should refrain from coffee. They may even be over sensitive to decaffeinated coffee that still contains about 3% of caffeine. People with rheumatoid arthritis have been shown to deteriorate with coffee consumption, making this another subgroup of people who should stay away from coffee.

7. What is the process of decaffeinating coffee?

Essentially there are 4 processes of decaffeination that have been developed over time. As this link shows, all of the decaffeination processes are done with the green coffee beans. There are two solvent-based processes and two non-solvent based processes. The latter two are the healthiest: the Swiss water process and the carbon dioxide process. The problems with the older solvent-based processes are the chemicals used to extract the caffeine. They can be harmful to the body.

Organic decaffeinated coffees are manufactured with the environment-friendly Swiss water process.

Drink Your Coffee, But…

Drink Your Coffee, But…

Conclusion

There are some people who simply are too sensitive to caffeine. They should refrain from drinking coffee. Pregnant women and nursing mothers should either severely reduce coffee consumption to one cup per day or refrain from coffee altogether. Those with high blood pressure and rheumatoid arthritis patients better refrain from drinking coffee as well. The majority of us will benefit from coffee consumption, if this is your taste. You may prefer green tea or Oolong tea instead. As I explained above there is compelling evidence in the literature that many cancers, heart attacks, strokes and diabetes can be partially prevented by regular coffee consumption. Decaffeinated coffee can prevent type 2 diabetes to some extent and colorectal cancer as well. The majority of evidence shows that coffee drinking is healthy. So, go ahead and enjoy!

References:

Ref. 1: Ding, Ming; Bhupathiraju, Shilpa N; Satija, Ambika; van Dam, Rob M; Hu, Frank B. “Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies.” Circulation – February 11, 2014; 129 (6); 643-59.

Ref. 2: Huxley R, Lee CM, Barzi F, Timmermeister L, Czernichow S, Perkovic V, Grobbee DE, Batty D, Woodward M. “Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis.” Arch. Intern. Med. – December 14, 2009; 169 (22); 2053-63

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Feb
28
2015

Low Fat Diet Not Protective Of Heart Attacks

The British Medical Journal (BMJ Publishing Group, James J DiNicolantonio) published a critical editorial review regarding the lack of science behind the low fat diet guidelines. The low fat guidelines were enacted in 1977 in the US and in 1983 in England. The devastating fact was that it was based only on a study of 2467 men (not a single female included) and there was no evidence of lower heart attacks in the low fat diet group when compared to the normal diet control. Yet the guidelines were the cause of the obesity and diabetes epidemic that followed causing heart attacks and strokes. February, the month where we think about heart disease  is the appropriate month to discuss the findings of this British Medical Journal article that exposes it all.

The BMJ Publishing Group re-traced all of the data that were available at the time of the decision in 1977. There were six randomized clinical trials with a mean duration of 5.4±3.5 years where low fat diet was compared to normal diet. The researchers found that the authorities who wrote the dietary recommendations for a low fat diet should have come to the conclusion that there was no statistical difference between the experimental group and the control group. The summary of the present re-analysis of the studies that were available to the US government in 1977 and to the UK government in 1983 was as follows: “There was no statistically significant relationship between dietary interventions and all-cause mortality.”

It was noted that the all cause mortality was identical in the experimental group and the control group (370 deaths in both groups). No significant difference of coronary heart disease (CHD) was observed between the low fat diet group and the control group.

There was no statistically significant difference in deaths from CHD (heart attacks). The reductions in mean serum cholesterol levels were significantly higher in the intervention groups; however, this did not result in measurable differences in mortality from CHD or all-cause mortality.

What is further troubling is that the six randomized studies that were the basis of all of these observations included only 2467 men, but not a single woman. Yet the diet recommendations were made for both men and women alike.

The authors concluded “It seems incomprehensible that dietary advice was introduced for 220 million Americans and 56 million UK citizens given the contrary results from a small number of unhealthy men”.

Dr. Robert Olson of St Louis University warned Senator George McGovern that the studies did not support the dietary recommendations the Senator was about to announce. To this objection Senator McGovern replied: “Senators don’t have the luxury that the research scientist does of waiting until every last shred of evidence is in”.

There was very good evidence that dietary changes (low fat diet) will not change the rate of heart attacks and strokes. Yet the government committees in the US and in Great Britain did not consider this evidence. Other publications have examined the consequences of replacing saturated fats with carbohydrates in the recommended low fat diets.

Based on this link the following observations regarding low fat diets were made:

  1. In processed foods low fat diet meant that more sugar was added to bring the saturated fat content down. This has detrimental effects on insulin sensitivity and causes type 2 diabetes on the long-term. Small LDL particles are increased and so are triglycerides, while HDL is reduced. Blood clot markers increase, weight increases causing obesity. Saturated fats were replaced with polyunsaturated fats of the omega-6 type (including oils from corn, soybean, safflower and cottonseed).
  2. However, randomized controlled trials showed that when trans-fats and saturated fats were replaced with omega-6 polyunsaturated fats (without simultaneously increasing omega-3 fatty acids) increased death rates from heart attacks and strokes were found.
  3. The Anti-Coronary Club trial showed that more people died from heart attacks when saturated fat was replaced by polyunsaturated fat.
  4. The reason for the heart attack causing omega-6-fatty acids (from polyunsaturated fats) has been worked out in several research papers between 2006 and 2012 (cited in this link): they cause inflammation, cause cancer, weaken the immune system, lower the protective HDL cholesterol and increase the susceptibility of LDL cholesterol to be oxidized.
  5. When saturated fat was replaced by polyunsaturated fatty acids (omega-6) there was more breast cancer and prostate cancer.

This review ended with the statement that there is a lack of data supporting that a low fat diet helps prevent heart attacks and strokes. We have now clinical trials that numbered 347 747 participants. These trials showed that increased fat intake did not cause heart attacks. The women’s health Initiative included 48, 835 postmenopausal women showing that a low fat diet did not reduce cancer, and it also did not prevent heart attacks or strokes. All of this supports what has been summarized before in a critical review regarding “The Oiling of America“.

Low Fat Diet Not Protective Of Heart Attacks

Low Fat Diet Not Protective Of Heart Attacks

Conclusion

Enjoy saturated fat as it does not cause you harm. Cut out omega-6 fatty acids like oils from corn, soybean, safflower and cottonseed. Use virgin olive oil or coconut oil instead. Take regular supplements of omega-3 fatty acid (marine derived) to balance natural omega-6 fatty acids in turkey or chicken meat. You can eat cheese (in the US buy organic or imported cheeses from Europe where bovine growth hormone is illegal) and enjoy nuts.

It is most important to avoid sugar, honey and high fructose corn syrup as these all oxidize LDL cholesterol, which is the pre-stage for hardening of the arteries. The oxidized LDL cholesterol is incorporated into the plaques of arteries and leads to strokes and heart attacks. This also means that you must avoid all processed foods that contain sugar and high fructose corn syrup (read labels).

It is not that difficult to follow such diet recommendations as my wife and I have done this since 2001. We use stevia to replace sugar for sweetening (no calories, no effect on insulin). Do what’s good for your body!

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Jan
16
2015

Telomere Length A Telltale Sign Of Aging

Dr. Sandy Chang gave a talk at the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas Dec. 10-14, 2014 entitled “Telomere measurement as a diagnostic Test in cardiovascular and Age-related disease”, but a shorter title would be “telomere length a telltale sign of aging” (my choosing).

Dr. Chang pointed out that it is now well established that telomere length is directly related to health. The shorter the telomeres are the higher the probability to get the following: early menopause, infertility, diabetes, wrinkles, arthritis, osteoporosis, cardiovascular disease, Alzheimer’s, Parkinson’s, dementia, cancer, stress and a lack of stem cells. In this BMJ study from 2014 it was shown on a large population basis that shorter white blood cell telomeres lead to a higher risk of coronary heart disease causing heart attacks. Decreased telomere length is also associated with the development of breast cancer, cancer of the ovary and uterus, cancer of the prostate and skin cancer.

Because of these connections it makes sense to determine a person’s telomere length. If it is short, do check-ups more often to detect any cancer early when it can still be treated.

Telomere length measurements are now done in many infertility clinics as short telomeres both in the male and female is associated with infertility.

The newest finding and perhaps the most important is that a healthy lifestyle, vitamins and supplements can elongate telomeres while a poor lifestyle leads to shortening of telomeres.

Here are the factors that lead to shortening of telomeres:

– Chronic stress

– Poor diet and nutritional habits

– Chronic inflammatory diseases

– Metabolic disorders

– Lack of consistent exercise/sedentary lifestyle

– Obesity, high BMI and body fat

– Smoking

– Over consumption of alcohol

– Lack of sleep / insomnia

When short telomeres are detected, it is important for the physician to look at lifestyle changes to protect telomeres from decreasing their length even further. This has the potential of preventing dementia and Alzheimer’s when it comes to brain health. It can prevent osteoporosis and metabolic diseases (diabetes, metabolic syndrome). Telomerase is the buzzword today, which is an enzyme that all of our cells have. The purpose why we have telomerase in our cells seems to be helping us build up and repair telomeres. Any substance that preserves telomerase or prevents the breakdown of telomerase will prevent shortening of telomeres and will also prevent the above-mentioned diseases.

These supplements lead to lengthening of telomeres:

-Vitamin C and E

-Omega-3 and polyphenols

-Vitamin A and D3

-All of these help controlling oxidative stress, reduce DNA damage, reduce inflammation and build up telomere length.

-A good diet and nutrition (Mediterranean type diet) will prevent telomere shortening as well and also lead to telomere lengthening.

-T-65, an extract from astragalus has been shown in vitro to lengthen telomeres, but there is no publication yet about in vivo effects in humans.

-Resveratrol is useful to prevent shortening of telomeres as well.

-Exercise also is a simple means to prevent telomere shortening.

Telomere Length A Telltale Sign Of Aging

Telomere Length A Telltale Sign Of Aging

Another talk on telomeres was given by Dr. Harvey Bartnof with the title “Telomere Shortening and Modulation: Case Studies From The Clinic”.

This talk was a comprehensive review of what is known about telomeres, about the fact that many diseases are due to telomere shortening, about animal experiments, ways of how to lengthen telomeres and finally some data on human studies with regard to telomere lengthening.

In the following I will briefly review all of these areas that were discussed. Some of this material overlaps with Dr. Chang’s lecture.

What produces telomere shortening? Dr. Bartnof showed 4 slides that listed all of the conditions and diseases that are associated with telomere shortening. Telomere shortening is associated with twice the risk to die from a heart attack when compared to people with normal telomeres.

a) Known genetic conditions in humans associated with telomere shortening

There are three known genetic conditions due to telomere shortening: A premature aging syndrome, called dyskeratosis congenitalis; patients with this condition die prematurely from cancer, or from bone marrow failure.

People with Werner syndrome who have a genetic telomere loss have a mean life expectancy of only 54 years.

Idiopathic pulmonary fibrosis is another genetic condition with shortened telomeres due to mutations.

b) Telomere shortening associated with these health conditions

Professor Elizabeth Blackburn, PhD who is one of the three researchers who won the Nobel Prize in Physiology and Medicine for their work on telomeres in 2009 stated the following: “Telomere shortness is associated with just about all the major diseases of aging… from cardiovascular disease, death from cardiovascular disease, risks of cardiovascular disease, diabetes, diabetes risks such as insulin resistance, vascular dementia, to osteoarthritis.”

An enormous amount of clinical investigations have been done since in cohort groups like people with diabetes, high blood pressure, obesity and cancer.

There is natural shortening of telomeres due to the aging process. When we compare telomere length of body cells of a 20-year old and call this 100%, the telomeres of a 100-year old person are on average only 40%. A study from the Karolinska Institute found in a group of matching twins where one twin had shortened telomeres, this twin had a 2.8 times greater risk of death than the twin with normal telomere length.

However, as already mentioned a number of other factors can lead to shorter telomeres like chronic stress in workers who look after Alzheimer patients, being of the Caucasian race (compared to African-American), having had less education, chronic unemployment, depression, pessimism, single people versus married people, phobic anxiety in women and hostility in men, poor sleep and too little sleep, migraine headaches in women, low physical activity, smoking cigarettes and alcohol consumption. The list does not stop here. Other conditions are associated with telomere shortening like heroin abuse, exposure to smog, polycyclic aromatic hydrocarbons and lead, cardiovascular disease, diabetes, cancers, osteoporosis, osteoarthritis, rheumatoid arthritis, cirrhosis of the liver, inflammatory bowel disease, chronic obstructive lung disease, Alzheimer’s disease, Parkinson’s disease, chronic kidney disease and disability in the elderly.

c) Effects of medications on telomere length

Antidepressants used against depression have a telomere lengthening effect, but NSAID’s, aspirin and interferon-alpha shorten telomeres. Other telomere shortening effects come from cancer chemotherapy.

d) Telomerase activation elongates telomeres

Successful experiments in various mouse strains showed that special strains that were telomerase deficient, could be reconstituted to normal by reinserting telomerase: atrophied organs regrew back to normal size and function. In humans it was shown that increased physical activity elongated telomeres, so did vitamin C, E and vitamin D3 supplementation, resveratrol, a Mediterranean diet, marine omega-3 fatty acid supplementation, higher fiber intake, bioidentical estrogen in women and testosterone in men, relaxation techniques like yoga and meditation. The Astragalus-derived telomerase activator TA-65 has been shown in animal experiments to elongate telomeres. The human data about TA-65 is still spotty or not available (it is also very expensive and may be unnecessary given the fact that so many other agents are known to lengthen telomeres).

e) Human data on telomere lengthening

Much can be achieved by changing one’s lifestyle: cut out toxins like cigarette smoking and alcohol abuse. Get involved in a regular exercise program, which has been shown to increase HDL cholesterol and to elongate telomeres. Adopt a Mediterranean type diet including olive oil; take vitamin E, D, C and supplements with resveratrol and murine omega-3 fatty acids, all of which elongate telomeres. Get enough sleep (7 to 8 hours per night) and do yoga and meditation. Avoid distress and tone down your stress level to eustress (normal stress level associated with every day living). An older person should use bioidentical hormones to replace missing hormones. All of this taken together will create a milieu in your body where telomeres get elongated and you live longer without disease. Several clinical conditions were mentioned where baseline telomere length was assessed initially and was found to be too short; simple lifestyle changes were then initiated, which were able to improve telomere length and treat these diseases successfully. In addition TA-65 (also termed T-65) was given in some of these cases, but in a subsequent discussion Dr. Bartnof admitted that he could not comment on how effective TA-65 by itself was as it was only one component of many other effective telomerase stimulators given. Till further research is out on this substance, it may be just very costly without spectacular benefits on its own.

Conclusion

I gave a summary of the talks by Dr. Chang and Dr. Bartnof regarding telomeres, but these were not the only talks about telomeres, although quite representative for the others. Both speakers pointed out how powerful lifestyle is for our body functions as this is what lengthens our telomeres and allows us to live longer, disease-free lives. Stem cells also have telomeres, but they are on average longer than the rest of the body cells (called somatic dells). An improved lifestyle will keep our stem cells in good shape, so they are there when needed to replace aging somatic cells.

The new logic of a healthy lifestyle is:

A healthy lifestyle causes healthy telomeres of somatic cells and of stem cells; this causes health until a ripe old age. In the next few weeks I will blog about more topics from the 22nd Anti-Aging Conference in Las Vegas. Stay tuned.

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Dec
06
2014

Regrets Following Holiday Foods

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

Gallbladder disease

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

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

The scenario could look like this case:

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

High blood pressure

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

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

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

Heart attack following turkey dinner

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

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

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

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

Regrets Following Holiday Foods (Gout Patient)

Regrets Following Holiday Foods (Gout Patient)

Gout attack following rich meal

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

The following case will illustrate this:

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

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

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

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

Conclusion

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

Last edited Dec. 6, 2014

Nov
25
2014

Gluten Intolerance Or Food Sensitivities?

A report about gluten free food is circulating in the media based on this publication. It points out that gluten-free food is not as healthy as the companies want you to believe it to be.

Wheat is the source of gluten, so rice, potato, corn and sugar are used to replace wheat. Corn is deficient in niacin leading to B3 deficiency; and the amino acids lysine and tryptophan (missing in corn) are needed for production of serotonin in the brain, which prevents you from getting depressed.

The reference cited above points out that rice can be contaminated with arsenic, which is a toxin.

Gluten-free food is a special form of processed food. Any processed food is not as good as natural food that you buy from the periphery of the grocery store.

So, what do we know about gluten sensitivity?

Causes of increased diagnosis of gluten sensitivity

Only 1% of people are gluten sensitive at this point. Just 30 years ago this number was 0.025%. 10 years ago 0.04% of people were thought to have gluten sensitivity. The difference may be due to improved sensitivity of the testing methods. But another factor is the new wheat, called Clearfield wheat, which was obtained through chemically forced hybridization of wheat resulting in significant genetic modifications from the original wheat. This type of wheat is now grown all over the world. As I explain in this blog Clearfield wheat has a significantly higher percentage of gluten, which likely contributes to the increased gluten sensitivity in the population at large and particularly among patients with irritable bowel syndrome (IBS).

Irritable bowel syndrome and other food sensitivities

According to Ref. 1 among patients with irritable bowel syndrome (IBS) 4 to 5% have true gluten intolerance (celiac disease). In the general population (without IBS) the gluten sensitivity percentage is less than ¼ of that. On the other hand lactose intolerance in the US is found in 25% of all adults and in 35% to 45% of IBS patients. Another common food sensitivity is fructose and sorbitol intolerance, which occurs in about 40% of patients with IBS and about the same percentage in non-IBS controls. This means that if you leave out sorbitol and fructose, about 40% of people will find relief from abdominal cramps or bloating. A common item that people chew on, according to Ref.1 is sorbitol-containing chewing gum. If this type of chewing gum is eliminated, 40% of people will feel better in their gut. So, keep in mind that the majority of people with food sensitivities do not have gluten sensitivity, but lactose intolerance and allergies to fructose and sorbitol.

Other manifestations of celiac disease

Celiac disease is not only a disease that manifests itself in a skin rash (as originally described in celiac patients). It is responsible for a significant amount of ADHD (attention deficit hyperactivity syndrome) or ADD (attention deficit syndrome) and can even cause Parkinson’s disease. It stands to reason that these conditions can be improved with an appropriate diet.

 

Gluten Intolerance Or Food Sensitivities?

Gluten Intolerance Or Food Sensitivities?

Gluten-free foods often contain problematic replacements

When you go to a grocery store or health food store and look at their gluten free shelves, they offer you an array of products like gluten-free bread and bakery items, cereals, cookies, pastas and many other processed foods. As explained above wheat is the main source of gluten and when you replace it, the substitutes are rice, tapioca starch, quinoa, potato, corn and sugar. We already pointed out some deficiencies of corn. There are also concerns of toxicities as in rice, particularly if it comes from imported material (arsenic). As the majority of people with food sensitivities are allergic to milk sugar (lactose), fructose and sorbitol, these items have to be screened carefully by reading all of the details on the food labels of the products. If you suspect other food allergies, see your primary care physician doctor for testing to these allergens and also have several of the gluten sensitivity tests done. If the gluten sensitivity tests are all negative, you only need to pay attention to milk sugar, fructose and sorbitol, particularly, if you have been diagnosed with IBS.

Hidden sugar and starch content of gluten-free food

What has not been mentioned so far is the sugar and starch content, which eventually leads to higher calories. Sugar is easy to spot on the food label as this is usually listed clearly. I stopped buying dark chocolate, even the 85% variety as they are selling me 10 grams of sugar in a 40 gram helping (25% of sugar). All the health benefits are no longer applicable when you consume that much sugar with a supposedly healthy food item. So add up the sugar you are getting and add up the calories you are seeing listed. Usually, if the sugar content is high, the calories are high.

As an example, when you research on Google regarding gluten-free corn chips, the food content of a typical product is listed as follows: 12 chips (28 g) contain 0 g glucose, 7 g fat, 14 g carbohydrate, 4 g protein, 100 mg sodium and 250 mg of potassium. It also lists that the total calories are 140, of which fat contributed to it 60 calories. 78% of the 80 calories left (namely 62.4 calories) came from the carbohydrate (starch in corn) and 22% of the remaining calories were protein derived (this I had to calculate). As the stomach digests the corn chips within half an hour into sugar, you really have eaten 62.4 calories from sugar. The Internet tells you that 2.3 g of sugar from a sugar cube are the equivalent of 9 calories. Our “sugar math” can be completed by doing this: 62.4 / 9 x 2.3 g = 15.94 or 16 grams of sugar. So, the food industry actually lied to you by saying that there was 0 g sugar in the 12 corn chips. What happened is that your body digested the 14 grams of carbohydrates and converted it into sugar, which was absorbed into your blood stream. Your pancreas could tell you a story, because it had to produce insulin to keep your blood sugar level in balance!

You may wonder how I solved the dark chocolate problem, which by the way would double as a gluten-free food: You buy 100 % unsweetened Baker’s chocolate (0 g sugar on the label) and liquefy it in a little bowl in a pot with hot water. Add a tiny bit of stevia sweetener and add a tiny bit of vanilla extract into the well-stirred chocolate liquid. Prepare a form out of aluminum foil with a rim. Pour the content carefully into this (watch it, hot!) and let it sit to cool down. When it is at room temperature, cut into smaller pieces, which you keep in a glass jar. This is 100% gluten-free chocolate, 100% chocolate and 100% healthy.

Conclusion

Not all is well in the gluten grocery row of your friendly super market. There are problems in that 20 to 25% of people believe they may have gluten sensitivity when in reality only 1% have it. But the majority of people have not done a gluten-screening test, which would confirm that they have indeed celiac disease. As pointed out above, it is much more likely that a food sensitivity may be caused by another offending agent rather than gluten (milk sugar, fructose and sorbitol). Avoiding the offending food components is the treatment protocol.

Those who take in gluten-free food will expose themselves to unnecessary toxins, to extra sugar leading to obesity and metabolic syndrome that leads to premature heart attacks and strokes. For those who do need to be on a strict gluten-free diet, they can safely do so by following a strict gluten free diet at home (preparing your own meals from healthy ingredients), preferably with organic foods. There are many websites that you can find online that have meal suggestions.

More information about celiac disease.

References:

1. Rakel: Integrative Medicine, 3rd ed. Patrick J. Hanaway, MD: “Chapter40: Irritable Bowel Syndrome. Integrative Therapy”. Copyright 2012 Saunders, An Imprint of Elsevier

Last edited Nov. 25, 2014

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Nov
16
2014

Smoking E-Cigarettes Of No Benefit

Electronic cigarettes (e-cigarettes) were invented to help people get away from the carcinogenic content of real cigarettes and they were thought to help people in the process to quit smoking as well.

In the October 2014 issue of the BC Medical Journal a review article is entitled: “Electronic cigarettes: Do we know the benefits vs. the risks?” In it Dr. Roy Purssell, the Chair of the Emergency Medical Services Committee in BC, Canada reviewed the literature about e-cigarettes (Ref.1). He pointed out that several studies have shown that the number of cigarettes used may have declined with the use of e-cigarettes, but the quitting rate on e-cigarettes is not higher than when quitting conventional cigarettes.

Why were e-cigarettes developed?

Originally they were marketed as an alternative to cigarette smoking with the thought that they would only contain the nicotine, but not the myriad of cancer producing chemicals. However, studies now show that this is not the case. As explained earlier people use e-cigarettes, but they often still smoke real cigarettes on the side, in effect just reducing the number of cigarettes smoked per day. Says Dr. Purssell: “Reducing the number of cigarettes smoked per day is much less effective than quitting entirely for avoiding the risks of premature death from all smoking-related causes of death” (also based on Ref. 2).

Chemical composition of e-cigarettes

E-cigarettes are battery-operated vaporizers that give you the feel of smoking a tobacco cigarette. The container inside the e-cigarette can be refilled with “e-juice” that can be bought through the Internet. The liquid contains highly concentrated nicotine, propylene glycol, glycerin, and flavorings (you can choose from cinnamon to cherry flavor and more). The liquid is vaporized by a heating element and the vapor is inhaled. No long-term experiments are available at this time with regard to the safety of these inhaled chemicals in humans. Only short-term experiments are behind the FDA’s declaration that propylene glycol would be “generally recognized as safe” (GRAS) as a food additive. But there is still a difference between inhaling and ingesting propylene glycol, and the same is true for glycerin.

The manufacturers of e-liquid (or e-juice) always put this disclaimer on their products: “Warning: Always keep e-cigarette liquid in a safe place and out of reach from children and pets. Nicotine in its pure form is a poison, and can cause harm if ingested by a child.”

Smoking E-Cigarettes Of No Benefit

Smoking E-Cigarettes Of No Benefit

Toxic effects of e-juice (e-liquid)

From September 2010 to February 2014 there were 2405 reports to the poison control centers in the US about e-cigarette exposures. In the month of February 2013 there were 70 calls, in February of 2014 there were 215 calls, a 300% increase.  More than 50% of these cases involved young children.

In BC, according to Dr. Purssell the Drug and Poison Information Centre received 70 calls between July 1, 2013 and June 30, 2014. 50% of these involved children who were younger than 4 years old. There was no case of serious toxicity. If, however, enough fluid is swallowed, there can be deaths from nicotine overdose, particularly in children and in pets. Seizures can be caused by nicotine overdoses and poisoning of the breathing center in the brain stem.

Nicotine is highly addictive. In children and in adolescents nicotine has a negative effect on brain development. Here is a report from the Minnesota Poison Control Center, which reports poisoning incidences with e-juice that was swallowed by young children and it reports also about adolescents who overdosed on e-cigarettes.

It appears that the nervous system is more sensitive for toxic effects of nicotine at a younger age.

Regulations of e-cigarettes

At this point e-cigarettes are illegal because the FDA is still examining the pros and the cons. The situation in Canada is similar: Under the Canadian Food and Drugs Act regulations it is currently illegal to sell e-cigarettes containing nicotine. The international Union against Tuberculosis and Lung Disease has issued a position statement saying that its preferred opinion is to regulate e-cigarettes as tobacco products. The UK will be following this advice.

Dr. Purssell commented: ”This is a reasonable course of action for a product that delivers a highly addictive substance with negative effects on brain development and can cause serious poisoning.“

While the Internet merchants are busy marketing these products, it is important that the legislators around the globe take swift action to draft policies and regulations now to protect children and adolescents.

Conclusion

In conclusion it can be stated that smoking e-cigarettes will not have any benefits whatsoever. Smokers still smoke, as the addictive substance (nicotine) in e-cigarettes undermines their efforts to quit. It may be true that they are not exposing themselves to lung cancers as much as those who puff away on regular cigarettes, but instead their cardiovascular system is exposed to the nicotine that causes heart attacks and strokes. It sounds very sobering that they just traded one cause of  unnecessary death (lung cancer) for another one (cardiovascular disease leading to strokes and heart attacks).

More information on:

1. Causes of lung cancer: http://nethealthbook.com/cancer-overview/lung-cancer/causes-lung-cancer/

2. Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

3. Strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/stroke-prevention/

References:

1.BC Medical Journal Vol. 56, no.8, October 2014 (www.bcmj.org)

2.US Department of Health and Human Services. The health consequences of smoking – 50 years of progress: A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention and Health Promotion, Office on Smoking and Health, 2014.

Last edited Nov. 16, 2014

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 stroke 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

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