Nov
09
2013

Successful Diabetes Treatment Requires Patient’s Discipline

By | Diabetes, Fitness, heart attack, Heart Disease, Hormones, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

90% of all diabetes cases are due to type 2 diabetes, which is associated with being overweight or obese. The other 10% are due to type 1 diabetes, which is caused by an autoimmune disease within the pancreas destroying the insulin producing beta cells. Diabetes, type 1 often occurs in childhood (hence the name “juvenile diabetes”), while type 2 diabetes is a condition of the middle aged and older population. There is however an alarming trend: overweight or obese youngsters are also being diagnosed with type 2 diabetes. Here I am discussing type 2 diabetes.

Causes that trigger diabetes

There is not just one way to get diabetes; it usually is a multifactorial disease. Sure, genetics play a minor role. But you need to have epigenetic factors to trigger the genes to develop diabetes: eating too much sugar, eating wheat and wheat products, drinking soda drinks that contain sugar or high fructose corn syrup. Alcohol binges can also cause diabetes as can accumulation of excessive weight (a body mass index above 25.0). Even when there is no genetic risk in your family (your family tree has nobody that came down with diabetes and all your ancestors lived into their 90’s), you can still develop diabetes, if you are exposed to one or more of the risk factors mentioned.

What is the reason why diabetes occurs?

At a Keystone Symposium from Jan. 27 to Feb.1, 2013 in Keystone, Colorado (Ref.1) leading scientific researchers gathered to discuss exactly this question. There seem to be several mechanisms, all of which lead to diabetes. It has been known for some time that in type 2 diabetes insulin resistance develops that renders the cells incapable of absorbing blood sugar (glucose) from the blood into the cells. It is because of this insulin resistance that doctors can diagnose diabetes when blood sugar levels are high.

Successful Diabetes Treatment Requires Patient’s Discipline

Successful Diabetes Treatment Requires Patient’s Discipline

There are at least 5 mechanisms that are presently known that can cause insulin resistance (and thus diabetes) by itself or in combination. For a deeper understanding of diabetes it is crucial to be aware of these. Without knowing the enemy, you cannot fight it.

1. When a person eats too much sugar or fructose the liver converts this into excessive fat that is accumulated in the body’s cells. As a result insulin receptors are becoming inefficient in absorbing sugar from the blood, and blood sugar levels stay high. The pancreas reacts to this by making even more insulin, which after a few years will cause the pancreas to fail in producing insulin. At this point the patient requires insulin or else gets into a diabetic coma.

2. Chronic inflammation is another mechanism that has been shown to cause insulin resistance. Obesity, the metabolic syndrome and diabetes have a common inflammatory denominator that results in insulin resistance. With the aging process there is also deterioration of mitochondrial function (mitochondria are the mini batteries inside of every cell that are responsible for you having energy). This causes fat accumulation and also insulin resistance. Exercise and weight loss are effective in combatting insulin resistance. Fasting has also been shown to improve insulin sensitivity.

3. The metabolism of visceral fat (the type of fat causing the apple appearance in obesity) is highly active and is associated with an increased risk for heart attacks and developing diabetes. The pear shaped woman runs less of a risk, as the fat around the hips is not metabolically active. On the other hand when these women enter into menopause, they also develop abdominal fat (apple-like fat distribution) with a high secretion of inflammatory substances causing insulin resistance, heart attacks and strokes.

4. Another mechanism of causing inflammation comes from invasion of organs with fat cells. The development of fat toxicity from these displaced fat cells can also cause insulin resistance. Heart cells have been shown to die from fat toxicity and in the pancreas the insulin-producing cells can be killed by fat toxicity as well causing diabetes or making existing diabetes worse.

5. Interestingly another line of research, namely researching binge drinking, has revealed that there is a short-term insulin resistance that lasts for several days until the alcohol has been properly metabolized. It is of concern that adolescents who are experimenting with binge drinking are very vulnerable to develop brain damage from this habit.

Consequences of insulin resistance

We know that insulin resistance is the cause for adult onset, type 2 diabetes. It is entirely preventable. But there are powerful influences on people’s lives that will allow one or more of these factors mentioned to cause diabetes. The most common cause is putting on excessive weight. The reason for this is that people like to eat fast foods, drink sugar-containing sodas, and feast on processed foods, bagels and cookies. The end result is a change of the metabolism with an increase in triglycerides from the liver, an increase in LDL cholesterol, particularly the very low-density lipoprotein sub fractions of cholesterol. It has been known for some time that this is the connection to the high, premature death rates from heart attacks in diabetics, in people with obesity and in people with the metabolic syndrome. Hardening of the arteries is accelerated by the deposition of foam cells in the walls of arteries. These are scavenger cells (macrophages) that have engulfed noxious fats. This leads to narrowed coronary arteries and also a general narrowing of arteries all over the body including the brain vessels. In diabetics hardening of the arteries is accelerated and leads to premature strokes, heart attacks and heart failure, kidney failure, blindness and amputations of limbs.

Important tests for borderline diabetics

I you have a fasting blood sugar that is above 100 mg/dL (5.5 mmol), but less than 126 mg/dL (7 mmol) you are considered to be prediabetic or “borderline diabetic”. In this case rather than waiting for disasters in terms of cardiovascular disease, take action and ask your doctor to do the following three tests.

a) Arrange for a glucose tolerance test where you are given 75 grams of glucose; then blood tests are taken at one, two and three hours after this challenge dose. These blood tests are checked for blood glucose levels and insulin levels and tell the doctor exactly what is going on in terms of your sugar metabolism. It shows the glucose clearance and also the insulin response from your pancreas.

b) Have a hemoglobin A1c test done: it shows how your blood sugars have been controlled over the last 2 to 3 months.

c) You also need a VAP (vertical auto profile) test, which tests your lipid profile. Both prediabetics and overtly diabetics have been shown to have lipid profile disorders. Apart from low values in sub fractions of HDL cholesterol this test will also measure the very-low density lipoproteins (VLDL), which has been shown to be responsible for heart attacks and strokes.

With these three tests your doctor can  tell you more accurately what treatment protocol you require to succeed in controlling or curing your pre diabetes or diabetes.

Conventional treatment of diabetes

The conventional treatment of diabetes is to send the patient to a dietician, to ask the patient to do regular exercises and to either start them on hypoglycemic drugs or on insulin injections. Unfortunately the dietician often will encourage the patient to eat “healthy multigrain bread”, which will stimulate your taste buds to eat more sugar, high fructose corn syrup and starchy foods making weight loss impossible. Often the treating physician is satisfied that a hemoglobin A1c of 7% or less is good enough for the diabetic. But non-diabetic people have a hemoglobin A1c of 4% and 5.6%. This should be your goal or you will suffer the consequences of uncontrolled diabetes.

This is what I would call the conventional, symptomatic treatment approach. This may be the approach for patients who are not willing to seriously change their lifestyles, but it is more powerful on the long-term to treat diabetes by treating the underlying causes.

Alternative treatment approach for diabetes

Based on the above discussion regarding the various causes of insulin resistance, it is important to analyze what would be the main contributory factors in your particular case of diabetes.

Here are some suggestions:

1. If you are on the typical North American diet, also known as Western diet, it would be important to face the fact that wheat, wheat products in processed foods and sugar including high fructose corn syrup are the main culprits in stimulating your appetite and making you a sugar and wheat addict. Ref. 2 describes this in detail and offers 150 recipes to overcome this addiction. For more information just follow this reference text. Essentially it is a wheat-free Mediterranean type diet without rice, pasta and bread. You will shed significant amounts of pounds within a short period of time and feel a lot more energetic (due to revitalization of your mitochondria). At the same time insulin resistance is disappearing, because the insulin receptors are fully functional again. The insulin production of the pancreas will go down to normal levels and fat from the visceral fat storage gets melted away resulting in less inflammatory substances circulating in your blood.

2. A regular exercise program in a gym with an aerobic component (30 minutes of treadmill for instance and 20 to 30 minutes of isometric machine exercises) will help you to lower the triglycerides, and increase the healthy HDL cholesterol. It will also improve insulin sensitivity and control inflammation in your body. The best is to exercise 7 days per week. Remember your body works for you 7/7 every week, but for those of you who need a little rest in between 5 days per week is still very good. You may have to adjust your medication and insulin dose downwards, ask your physician about that.

3. Cut out alcohol. This may sound radical to you, but studies show this to be true. I have not mentioned cutting out smoking (it is causing inflammation and insulin resistance), because this is an absolute must that is given. When it comes to alcohol, the famous 1 drink per day for cardio protective purposes may not show up statistically as a bad effect, but your body will nevertheless get the message and let you age somewhat faster than a person who stays sober all the time. Staying sober will allow your brain to think clearly and adhere to your overall lifestyle approach in treating diabetes. Cutting out alcohol protects your brain (including the hypothalamus), liver and pancreas and prevents the prolonged periods of insulin resistance mentioned above that last for days. By keeping your hypothalamus in good working order, your hormone balance will stay stable for as long as possible until you reach menopause (for women) or andropause (for men). When you reached this milestone, I suggest you engage in bioidentical hormone replacement, which I have reviewed here. Hormones are essential to keep you younger for longer.

4. It is useful to monitor your blood sugar with a home glucometer, as this will show you when your blood sugar normalizes. Stay in touch with your doctor at all times, as this will help you in your overall management of your diabetes. Also, you will want to discuss with your doctor that you should have a blood tests called “hemoglobin A1c” measured every three months to see how well your diabetes is controlled. It should be below 7% for sure, but better below 6%. Non-diabetic people have levels of 4% and 5.6%. You may not know that hemoglobin A1c is actually measuring the amount of advanced glycation end products (“AGE”) of red blood cells. These AGE substances essentially are firmly bound sugar/protein compounds that shut down the cell metabolism wherever they are formed. In my opinion it is best to aim at a hemoglobin A1c level of non-diabetic people (4% and 5.6%) to avoid the consequences of tissue damage of all vital organs, which is the reason why long-term diabetics have a life expectancy of 15 to 20 years shorter than non-diabetic persons. Some diabetic patients may benefit from the oral hypoglycemic drug, metformin (brand name: Glucophage), which has anti-inflammatory properties and is used in patients with type 2 diabetes and a high fasting insulin level, but this is a decision requiring your physician’s input.

5. Supplements: There are some supplements that are useful to take as an adjunct, like chromium, which helps insulin to transport glucose into the cell; alpha-lipoic acid, an antioxidant, which is useful to prevent glycation (formation of a complex between sugar and protein, which prevents normal cell functioning); and coenzyme-Q10, which supports your heart (A4M recommends 400 mg per day, higher than Dr. Weil’s link). Other supplements of merit are curcumin, cinnamon, genistein and silymarin (standardized extract of milk thistle), which suppresses a pro inflammatory molecule, which in turn helps to fight insulin resistance (Ref. 1). Omega-3 fatty acid supplements are anti-inflammatory and will improve insulin resistance as well (dosage 1000mg or more per day). According to Ref. 3 vitamin D3 is useful as a supplement for diabetics, because it activates DNA, is involved in cellular repair and deficiency of it is known to lead to higher mortality rates in diabetics. Ref. 3 recommends between 1000 and 4000 IU of vitamin D3 daily and suggests doing blood tests to measure effective vitamin D3 levels (keep 25-OHD in the blood between 30 and 80 ng/mL).

6.Patients whose pancreas no longer produces insulin will need insulin injections, but instead of using long-acting insulin once per day the best results in getting blood sugar control is by injecting insulin three or more times per day using short acting insulin. It is important to always monitor the blood sugar lowering effect by glucometer readings; the injections are best given just before meals (recombinant human insulin is the preferred insulin to be used). Ask your physician or diabetic coach for more details.

Conclusion

Diabetes used to be a dreadful disease that caused premature heart attacks, strokes, blindness, kidney failure, and limb amputations. With aggressive management of diabetes as well as strict lifestyle intervention this has changed. A diabetic who treats the causes of the illness can have a normal life expectancy. In many cases the initial diagnosis of type 2 diabetes can disappear, when treatment was started early enough and insulin resistance could be stopped in its tracks. Without the patient’s full co-operation disciplining him/herself to follow through on all of these recommendations the caregiver will fail in controlling the patient’s diabetes. It is the patient who owns the problem; it is the patient who needs to make every possible effort and follow through on all of the details of dieting, exercising, blood sugar monitoring using a glucometer and taking the required supplements.

More information on diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Reference

1. http://www.lef.org/magazine/mag2013/oct2013_2013-Keystone-Diabetes-Symposium_01.htm

2. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Integrative Therapy; Supplements.

Last edited Dec. 17, 2014

Nov
02
2013

MS Is A Multifaceted Disease

By | Allergies, Multiple sclerosis, Nutrition, Prevention

A new study was recently released that showed that MS is a multifaceted disease. A significant number of people without multiple sclerosis have narrowing of their neck veins. There is a new theory that chronic cerebrospinal venous insufficiency due to narrowing of veins outside the skull may be responsible in causing MS in a significant percentage of patients. Using venograms in MS patients and in controls without MS a recent study from the University of British Columbia, Vancouver, BC showed that normal controls also had narrowing of neck veins and the authors felt that this invalidated the vascular theory of MS. This story is based on this Lancet publication.

Brain oxygenation is what counts

What was not mentioned in this publication was that venous blood flow on the surface of the brain can get obstructed inside the skull. It’s all about brain tissue oxygenation; if the brain gets enough oxygen, all is well. If there were a lack of perfusion due to venous congestion inside or outside the skull, the patient would be in trouble.  I will discuss this further below.

In this blog I will discuss first how to diagnose MS, then mention some newer studies about neck vein circulation with SPECT scanning. I will then review various causes of MS and return to a discussion of the Vancouver study from above.

How MS is diagnosed

The physician can combine a number of tests to diagnose MS. This includes the patient’s symptoms such as balancing problems, double vision, memory problems, fatigue etc. Neurological examination, imaging studies like MRI scanning, lumbar puncture to examine the cerebrospinal fluid and evoked potential studies is what a neurologist orders. The physician requires all of these findings to decide whether the criteria for making a diagnosis are in keeping with all the symptoms of MS. In 2001 an international neurological panel developed the McDonald criteria for diagnosing MS, which were revised in 2010.

MS Is A Multifaceted Disease

MS Is A Multifaceted Disease

Newer ways diagnosing perfusion problems in MS patients (SPECT scan)

One of the newer functional scans is a SPECT scan. It shows areas where there is a lack of blood supply to the brain, but can also identify areas where too much blood circulates. Here is a site where the technique of the SPECT scan is reviewed in more detail.

SPECT scan results in MS patients

SPECT scans in MS patients showed a significant reduction in blood flow to the frontal lobes and to the left temporal lobe. Reduced activity of the left temporal lobe on SPECT scans correlated with MS patients having a deficit in verbal fluency and having a problem with verbal memory. This indicates that a reduction in blood flow to these areas of the brain associates with developing MS.

Perhaps a SPECT scan of the brain (which is where the action of MS is) may be a better indicator for MS than looking for veins in the neck by ultrasound or venograms, as SPECT scans look directly at brain perfusion. The question is whether these blood circulation problems in MS patients may cause deficiencies in the brain of oxygen, nutrients and possibly of other internal mediators.

Known causes of MS

There are a number of known causes of MS, which I will review below.

Autoimmune disease

As this link shows, MS is a disease due to inflammation of the brain. The area where there is inflammation leads to demyelination from loss of the myelin sheaths, which causes the white lesions visible on MRI scans of the brain. One such cause is an allergy to wheat and wheat products. Gliadin antibodies and anti-tissue transglutaminase antibodies were positive in a significant number of MS patients, but not in controls. This suggests at least in part that immunological causes are at play. I agree with this blog that describes that there is significant evidence that gluten intolerance can lead to MS and the positive tests that were found by researchers are likely just the tip of the iceberg.

Overlap of celiac disease and MS

Dr. William Davis describes in Ref. 1 and 2 that you can have celiac disease with no gut symptoms, in other words a person can develop autoimmune symptoms from gliadin and gluten sensitivity without diarrhea or bowel cramps. Dietary lectins, particularly the ones found in wheat lead to leaky gut syndrome and subsequently to autoimmune diseases. One of these autoantibodies can cause MS by destroying the myelin sheath. In a mouse model Mayo Clinic researchers have shown that an antibody injection can be used to block autoantibodies against the myelin sheath. Investigations are ongoing with regard to whether this type of treatment would work in humans as well.

Genetic factors

It is known that a human leukocyte antigen (HLA -DRB1) shows an association with the risk for developing MS. Caucasians have a higher risk of developing MS and they also carry the HLA-DRB1 antigen more often. Another genetic factor is a variation of the IL7R gene. You can read about it under the HLA-DRB1 link. On average the risk of getting MS in the general population is about 10 to 20%.

Nutrition and dietary factors

It has been described that vitamin D3 levels when obtained from in MS patients are low. Vitamin D3 can prevent against MS to a certain degree, so does sun exposure. In countries where malnutrition is common, MS occurs more often.

According to Dr. Terry Wahls who is a clinical professor of medicine at the University of Iowa Carver College of Medicine, a diet of vegetables, fruit, meat, no grain, no dairy, no sugar, no corn and no potatoes can cure MS. Dr. Wahls herself had severe MS in the past and cured it with the help of this diet!

Infections

Certain infections can cause MS. Probably the best correlation was found between the mononucleosis virus (Epstein Barr virus) and the later development of MS.

Chronic cerebrospinal venous insufficiency

According to Dr. Zamboni from Italy clogged veins in the neck can cause MS. Dr. Zamboni placed stents into neck veins that showed narrowing.  He found that about 50% of MS patients had improvement with the placement of stents. This allows the blood from veins around the brain to drain normally. This could improve brain circulation in the areas described above where SPECT scans detected a lack of blood supply to certain parts of the brain.

Discussion of the Vancouver publication

It is important to note that certain areas of the brain were not circulating blood as well as others. SPECT scans depicted the blood circulation of the brain. 50% of patients with chronic cerebrospinal venous insufficiency experienced a cure from MS with simple venous stent procedures. This is remarkable. Sure, the Vancouver researchers found that normal controls also have a significant amount of venous abnormalities in their necks. But this does not explain the successes in those MS patients who got better with a simple venous stunt procedure. We also need to be cognizant that Big Pharma sponsored the Vancouver study researchers.

Measuring brain circulation in MS patients

SPECT scans on both the control groups and the experimental MS groups before and after stent procedures need to be done. This way we know whether the brain circulation following stent procedures improved or not. However, this is what I would have expected to see. In other words more research is necessary by other investigators. The question they need to answer is whether or not the surgical stents provided help. Did the surgical procedure help to normalize their brain circulation or not?

Conclusion

Our knowledge regarding MS is getting more multifaceted as new research is emerging. Diet appears to be a major contributing factor, as vitamin D3 is essential for normal brain function and for a normal immune system. At the same time researchers identified grains and wheat as a cause of MS in a subgroup of patients. Leaky gut syndrome can cause autoimmune antibodies, which subsequently can bring on MS. Avoid the foods Dr. Wahls described as being causative in developing MS and you can improve MS remarkably or get cured. The same is true for avoidance of wheat and wheat products as Dr. Davis described.

Multifaceted causes of MS

In my opinion not every MS patient benefits from a stent, but vitamin D3 deficiency or a history of mononucleosis infection in the past does not explain the causation of every MS case. We simply do not have all of the answers yet. But we do have enough information to thoroughly investigate MS patients;  the treating physician will then use clinical judgment to decide which treatment would be the most suitable one for an individual MS patient.

More information on multiple sclerosis: http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/

References

1. Stern: Massachusetts General Hospital Comprehensive Clinical Psychiatry, 1st ed. “DSM-IV SUBTYPES OF MDD”. Copyright © 2008 Mosby

2.  William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

3.  William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies 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 takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. 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.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. 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.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

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

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. 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

Last edited Nov. 7, 2014

Oct
19
2013

Healthy Choices Start In Your Brain

By | Alzheimer’s disease, Anti-aging medicine, Diabetes, Fitness, High Blood Pressure, Infectious Disease, Mental Health, Other neurological conditions, Prevention, Stroke, Substance abuse, Vitamins and supplements

This article deals with healthy choices start in your brain. You may have seen the CNN heading “Where is self-control in the brain?”  If we want to make any healthy choices in life including sound financial choices, we need a balanced brain that makes the right decisions for us.

Two ways of making food choices

Researchers at the Caltech in Pasadena, CA have examined this question in detail using functional MRI scans and found out that there are two loci on the frontal lobe of the brain that control your impulses: the “ventral medial prefrontal cortex” (red in this link) that processes your initial image (like seeing a delicious ice cream cone”) and the “dorsolateral prefrontal cortex”(green in this link), where you decide that this is not healthy for you because it has too much sugar in it.

Two groups of volunteers

The Caltech researchers found a group of volunteers who were impulsive and made the wrong choice simply based on their taste buds without consideration for their health in general. An equally large group of volunteers was also found who had functional activity in the ventral medial prefrontal cortex and the dorsolateral prefrontal cortex, the latter of which modified the final decision into the healthy choice. The impulsive group made their decision to buy simply with the activation of only the ventral medial prefrontal cortex.

Balanced thinking required to make the right choices

The researchers think that it is this kind of lack of balanced thinking that decides whether we are going to make the right or wrong health choices for ourselves. The sad part is that ultimately, the summation of bad health decisions during life can become the cause of developing dementia, such as Alzheimer’s disease. The good news is that many of the causes of dementia can be avoided, which means that the average person could prevent dementia. I will discuss this in detail here.

Causes of dementia

It is interesting to study patients with various forms of dementia as it is often in the frontal and temporal portions of the brain where brain cells are dying off resulting in impulsive buying, impulsive behavior and lack of recent memory. It is also important to recognize that a number of conditions or factors can cause dementia:

1. Genetic causes

There are two types of frontotemporal lobe dementias, a tau-protein positive FTD and a ubiquitin-positive FTD, which has been shown to be due to a deficiency in progranulin. Both of these genetic defects are located on chromosome 17. In Alzheimer’s dementia, which occurs later in life there can be genetic defects at chromosomes 21, 14 or 19. Epigenetic factors like exercise, avoidance of alcohol, and taking omega-3 supplements can even partially prevent or postpone the onset of dementia from genetic causes.

Healthy Choices Start In Your Brain

Healthy Choices Start In Your Brain

2. Toxins like alcohol

Another example of how people can get dementia is through the effect that regular alcohol consumption has on our brains and bodies. This image of an MRI scan shows a normal brain for comparison on the right and  the MRI scans of the brain of a chronic alcoholic on the left.  When a chronic alcoholic has severe atrophy of the brain a psychiatric condition, called Korsakoff’s syndrome can occur. This psychotic condition as a result of the brain having been poisoned by regular alcohol intoxication. Essentially the toxic effect of high daily doses of alcohol have shrunk not only the surface of the brain, but also the deeper substance of the brain. The patient is psychotic, has loss of memory and is unable to care for him/herself.

3. Vascular damage to the brain

Strokes can cause vascular dementia that leads to Alzheimer’s disease-like memory loss. This link points out that diseases like hypertension, obesity, diabetes, atrial fibrillation, ischemic heart disease and dyslipidemia all predispose you to possibly get a stroke with subsequent dementia.

4. Traumatic head injuries

In boxers, football players and combat soldiers brain cells can get lost from repetitive head trauma leading to dementia (in this case it is called “dementia pugilistica”).

5. Infectious dementia

HIV in AIDS patients can affect the brain and cause an HIV-associated dementia. Bacterial meningitis and viral meningitis can kill brain cells and cause a form of dementia as well.

6. Immune disorders

We know that MS can go on to develop dementia as a late complication. In MS there are autoantibodies against myelin, the insulation material that surrounds nerve fibers. An important category of immune disorders is autoimmune disease that can cause dementia. The cardiologist, Dr. William Davis, has presented compelling evidence that wheat allergies can cause dementia, but if detected early and treated by a gluten free diet, this clears up the mind and stops further development of dementia (Ref.1 describes wheat allergies causing dementia; a wheat free diet is described in Ref.2).

7. Hormone deficiencies

A classical example is hypothyroidism, which in the past before thyroid medicine was available, often led to dementia. A simple blood test, TSH (thyroid stimulating hormone) can detect whether or not you are hypothyroid. The A4M recommendation for a normal level is below 2 (not below 5 as often reported by official lab value reports).

8. Lack of vitamins

Thiamine (=vitamin B-1) is often missing in alcoholics. If you are missing vitamin B-6 and vitamin B-12 in your diet, this can predispose you to develop dementia as well. Aging people lose a factor from the gastric mucosa (the intrinsic factor) that is essential to absorb vitamin B-12 in the mall bowel, which predisposes them to develop pernicious anemia and dementia. A simple vitamin B-12 injection can prevent this from happening.

9. Too much sugar consumption

Sugar consumption has skyrocketed in the 1900’s and keeps on going up in the new millennium as well. Here is a review that discusses the possibility that Alzheimer’s can be triggered by overconsumption of sugar. The higher the blood sugar levels in diabetics, the higher the risk for developing Alzheimer’s disease. A study in Seattle has confirmed this. High insulin levels are found in type 2 diabetes; they are responsible for making brain cells stimulate the production of the gooey substance amyloid that causes Alzheimer’s disease. The authors of this study showed this to be true both in humans and in animal models.

10. Lifestyle issues

These include lack of exercise, excessive weight (obesity, being overweight) and poor diet (fast foods). They play an enormous role in terms of causation of dementia in addition to the other factors mentioned. On the other hand organic foods Lack of toxins) and a Mediterranean type diet will preserve your brain cells.

Treatment of dementia

At present treatment of dementia is very limited, as we do not have a complete understanding of dementia at this point. The traditional treatment of dementia outlined here will only marginally delay further deterioration of dementia, but ultimately fail. In my opinion this is because the medical profession has been concentrating on fighting the symptoms of dementia rather than the cause.

Given the known causes mentioned above, I like to give you a list of 6 recommendations. These will help you to prevent Alzheimer’s disease and dementia in general.

Cut out sugar

I would suggest that you cut sugar out of your diet and replace it with stevia. This also includes dates, grapes, bananas; also wheat and wheat products and starchy foods like pasta, potatoes, rice and bread (see Ref. 1 and 2 for details). The manufacturers of soda drinks, pies and cakes will not be happy about this recommendation, but it will please your brain cells. You will also be surprised how easy it is now to lose weight, which will please you (this also lowers your risk for heart attacks and strokes).

Limit your alcohol consumption

Severely limit your alcohol consumption to less than 1 drink for women and 2 drinks for men per day (better still would be to stay sober) unless you want to become part of the hospital population mentioned in one of the links at the beginning of this blog.

Have your hormones checked

Have your hormones checked, particularly your thyroid hormones, but also estrogen and progesterone levels in women and testosterone in men. Our brain cells have hormone receptors for a reason. They need stimulation from our hormones, even in menopause or andropause. Replace the missing sex hormones with bioidentical hormone creams and missing thyroid hormones with thyroid tablets (Armour is the best mix of T3 and T4 thyroid hormones, not Synthroid).

Prevent repetitive brain injuries

Prevent repetitive brain injuries before it is too late. Rethink whether you really need to box, street fight, play football, rugby or hockey. An Accumulation of head concussions can cause Alzheimer’s later in life!

Use vitamins for prevention of dementia

Use vitamins for prevention of dementia: The B complex vitamins like B-2, B-6, B-12 (by injection); vitamin D3 has recently been shown to be effective in slowing down Alzheimer’s disease. Vitamin D3 is low in Alzheimer’s patients and vitamin D3 supplements will slow down this disease. Although vitamin C showed equivocal results, it does have some neuroprotective qualities and decreases β-amyloid production and acetyl cholinesterase activity. A Mediterranean-type diet (Ref.2) is also helpful in preventing dementia

Do regular exercise

Exercise daily. It will discipline you to stick to the other points mentioned above. It gives you some extra endorphins and will make you feel good about yourself.

Conclusion

Although we do not yet have a complete picture regarding Alzheimer’s disease and dementias, we do know enough to reduce our risk of getting them. When you cut out wheat and wheat products, your immune system stops production of autoimmune antibodies against your brain cells. Your opiate receptors in the brain will no longer  seduce you to eat more and more sugar, starchy foods or high fructose corn syrup. You no longer have a problem cutting out high glycemic index foods (Ref.1). This will reduce insulin and reduce IGF-1 growth factors. These can lead to the production of the gooey amyloid substance that makes you lose your memory. The orbitofrontal part of your brain (particularly the dorsolateral prefrontal cortex) will be reminding you what you read here: healthy lifestyle choices start in your brain.

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Oct. 19, 2013

Oct
05
2013

Fighting Back Against The Flu

By | Fitness, Infectious Disease, Lung Disease, Nutrition, Prevention, Stress management, Vitamins and supplements

Every year there is concern about the upcoming flu season. Mostly the discussion centers on the composition of the latest flu bugs and what type of strains would be included in the latest vaccine recommended. The first flu case of the season has just been reported in a child. Here I am going to review what you can do to minimize your probability of getting the flu, or if you get it, how to minimize the severity of the illness.

The immune system

We know for some time that the antibody-mediated immune system is what helps overcome flus. The body’s immune system produces antibodies against the flu via T-helper cells that recognize the glycoprotein (hemagglutinin) of the flu virus and pass a signal on to B cells (bone marrow derived lymphocytes), which in turn are turned on to produce a lot of antibodies (Ref.1). These protect you from future flus of this type. If you have pre-existing antibodies that fit the bug in circulation you are OK ,and you will usually not get the disease.

The factors that protect you from the flu

However, there are many other factors that support your immune system. I will discuss the most important factors in more detail here.

1. We do know that vitamin D3 strengthens the immune system. I would recommend 1000 to 2000 IU per day in the wintertime, but up to 4000 IU or 5000 IU per day during an active epidemic would be reasonable. There is less flu when people are taking Vitamin D3 supplements.

Influenza A was reduced in school children supplemented with 1200IU of vitamin D3. This study recommended higher doses of 2000 to 7000 IU of vitamin D3 per day; but it also stated that as a precaution serum vitamin D levels should be monitored (technically it is serum 25-hydroxy-vitamin D levels that are measured) to avoid vitamin D toxicity. Normal levels are between 40-70 nanograms per ml. Toxic levels are above 100 nanograms per ml. Your family doctor can order a serum 25-hydroxy-vitamin D level for you.

2. Eating fruit and vegetables is important for maintaining a healthy immune system. In a randomized study from Belfast, UK elderly volunteers (82 of them, aged 65 to 85) were assigned to either eat 2 portions or 5 portions of fruit and vegetables per day over 16 weeks. At 12 weeks into the trial both groups received a Pneumovax II vaccination, and the antibody response was measured at the end of the 16th week of the study.  There was a significant increase in antibody binding capacity to pneumococcal capsular polysaccharide in the 5 portion fruit and vegetable group compared to the 2 portion group that had no such increase. The authors concluded that there is a measurable improvement of the immune system when an older population increases their fruit and vegetable intake.

3. Avoid stress, because stress has been shown to weaken the immune system. This review shows that the immune system is weakened by the stress response via the elevated corticosteroid hormones (the stress hormone ACTH stimulates cortisol release from the adrenal glands). The stress of social isolation is also contributing to the weakening of the immune system in older people.

Fighting Back Against The Flu

Fighting Back Against The Flu

4. Exercise moderately and your immune system will get strengthened. Over exercising should be avoided as too much cortisol is released from your adrenal glands, which is toxic to lymphocytes thus weakening your immune system.

5.  Socializing is good for you as studies have shown that you live 2 ½ years longer. This study here is from Connecticut, but other studies confirmed this as well.

6. Make love. The endorphins that are released in the process stimulate the immune system.

7. Take probiotics, because they help your gut flora to stay normal. A normal gut flora promotes a stronger immune system as the Peyer’s patches (clumps of immune cells) in the gut wall are intimately linked to the immune system. In this way probiotics indirectly support your immune system.

8. Avoid smoking.  Smokers have more upper and lower respiratory tract infections than non-smokers. Here is information that explains this as well.

9. Get enough sleep. The circadian rhythm of your hormones ensures that your hormones function at their optimal level. Melatonin from the pineal gland is important in triggering the circadian rhythm, but melatonin itself supports the immune system as well. Your adrenal glands need resetting overnight so that cortisol is secreted according to your stress level, not too much and not too little. Overstimulation from performance sports, grief reactions, car accidents, injuries etc. lead to a surplus of cortisol and weakening of the immune system.

10. Take your flu shot (but without thimerosal) every year, but take it as a single shot (without thimerosal as a preservative). This CDC link explains that single shot flu vaccines are available without thimerosal. I recommend this type of flu vaccine. The central nervous system is extremely sensitive to nanograms of mercury, and it is for this reason that I would not buy into the argument of the CDC that one should not be concerned about safety of thimerosal. The newest for this flu season is the quadrivalent (or four-strain) flu vaccine, which is now available in pharmacies throughout the US.

11. Vitamins and supplements support your immune system, particularly vitamin D3. DHEA, which is available over the counter in the US stimulates antibody production when the flu vaccine is given, particularly in the elderly, in other words DHEA strengthens the immune system Vitamin C is known to support the immune system and is rapidly depleted in those who suffer from any viral infection. There are other nutrients that are useful to stimulate your immune system.

12. Consider herbs: Echinacea, Siberian ginseng, Asian and American ginseng, astragalus, garlic, and shiitake, reishi (also called “lingzhi mushroom”) and maitake mushrooms have all been shown to stimulate the immune system with negligible side effects.

13. Wash your hands, particularly when there is a flu going around. Door knobs for instance are known to keep live viruses for 2 to 8 hours, so washing your hands will reduce the amount of virus you are exposed to.

Conclusion

There is no single solution to prevent the flu, but we can all minimize our exposure to the virus and strengthen our immune system. Although it is wise to get a yearly flu shot to boost your immune system (without thimerosal as a preservative) just before the epidemics come around, this alone is not as good as combining the non-specific factors mentioned here with it. Particularly vitamin D3 (2000 IU to 4000 IU per day) and the old stand-by vitamin C (1000 mg to 2000 mg daily) will stimulate your immune system. Spice up your dinners with mushrooms that stimulate your immune system (maitake, shiitake, reishi mushrooms). Go to bed early enough to allow your circadian hormone rhythms to be reset overnight as you sleep. This will stimulate your immune system (from melatonin and DHEA of your adrenal glands).

More info on the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

References:

1. Long: Principles and Practice of Pediatric Infectious Diseases, 4th ed. Prevention. Vaccine. © 2012 Saunders

Last edited Nov. 7, 2014

Sep
28
2013

Sleepless Nights

By | Health, Hormones, Insomnia, Mental Health, Pain, Prevention, Sleep apnea, Substance abuse, Vitamins and supplements

Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

Symptoms of insomnia

The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression,  anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

Research about insomnia

Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

Sleepless Nights

Sleepless Nights

Causes of insomnia

Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

Predisposing factors

We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

Precipitating factors

A situational crisis like a job change or the death of a loved one can initiate insomnia.  However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

Perpetuating factors

Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

I will return to this classification and the factor model of causation of insomnia when we address treatment options.

Drugs that can cause insomnia

One major possible cause for insomnia  can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

Treatment of insomnia

So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

The following general points are useful to get into the sleeping mode (modified from Ref. 3):

  1. Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
  2. Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
  3. Get into a regular exercise program, either at home or at a gym.
  4. Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  5. Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
  6. If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
  7. A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

Drugs and supplements for insomnia

1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta).  They seem to be better tolerated.

3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

Conclusion

A lack of sleep (insomnia) is almost a given in our fast paced lives.

When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

References

1. David N. Neubauer, MD (John Hopkins University, Baltimore, MD): Insomnia. Primary Care: Clinics in Office Practice – Volume 32, Issue 2 (June 2005)  © 2005, W. B. Saunders Company

2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

3. Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

Last edited Sept. 28, 2014

Sep
14
2013

Food Processing Can Be A Danger To Your Health

By | Alzheimer’s disease, Cancer, Diabetes, Gastrointestinal Disease, Health, heart attack, Heart Disease, High Blood Pressure, Infectious Disease, Nutrition, Obesity, Prevention, Stroke

This article is entitled: food processing can be a danger to your health. Food processing is found everywhere: in pizzas, hamburgers, ready to eat deep frozen dinners, and in the myriad of packages that you see in the center of the grocery store. There are aisles and aisles of ready-made food packages including potato and corn chips, power bars, low fat yoghurt, and on and on it goes. So, what are the problems with these foods? Here are the major players that you will find (sometimes not) on the food ingredient lists.

Hidden sugar

With the recommendation for the past few decades that we should use low fat yoghurt a whole industry has sprung up surrounding low fat products. If you study the labels you will see that this has been done at the expenses of adding hidden sugar content. Don’t go for the berry or other fruit yoghurt, because it is over processed, sweetened with sugar or high fructose corn syrup. This is a fast track to becoming a diabetic. Stick to plain yoghurt with 2 to 3 % fat, which has only the original milk sugar in it, but no additives. Also, in the US you ought to avoid any milk and milk products containing bovine growth hormone, which is solely there for increasing the milk farmer’s profit, but will seriously undermine your health (it blocks your growth hormone receptors).

Added sugar changes your metabolism

Ref. 1 and 3 explain in detail how the metabolism is being changed through added sugar and an overdose of starchy foods, which is the reason for the pancreas over producing insulin. This in turn causes such varied diseases like heart attacks, diabetes, inflammatory conditions like arthritis, MS, Alzheimer’s disease and cancer.

Cut out cookies, excessively starchy foods like potatoes, bread, pasta and rice. Within half an hour of ingesting these your system will be overrun with sugar, the breakdown product of starchy food.

Added salt

The chef adds salt often to preserve foods, to lengthen their shelf life and to stimulate your appetite. Restaurants add salt to stimulate your appetite for more liquids. As a result more beverages (alcoholic and nonalcoholic) will be ordered, which is where the profit margin is highest. High amounts of salt will not be beneficial to you, as it will raise your blood pressure and on the long-term will cause high blood pressure, heart attacks and strokes. When you buy organic food, there is no additional salt in it, although you get sodium chloride, which is naturally present in the vegetables and fruit. Add very little salt, if any; instead add  herbs and spices, which contain valuable trace minerals.

Food Processing Can Be A Danger To Your Health

Food Processing Can Be A Danger To Your Health

Hidden fat

Whenever you have a food that was deep fried such as potato chips, corn chips or French fries, there is the danger of exposing yourself to trans fats from polyunsaturated fatty acids. This is also true for deep fried chicken or any other ready to eat foods that have been prepared in the deep fryer. This type of oil is often reused after it is filtered and advanced glycosylation end products (AGE’s) are accumulated in it. This ages your cells including your skin much faster. AGE’s also worsen diabetes by causing more complications like heart attacks and kidney failure. For the same reason you should avoid burning meats on the BBQ or food that you cook on a stove.

Beware of hidden fat in hamburgers

Hamburgers also have a lot of hidden fat, sometimes as much as 50%. This fat enters your bloodstream and finds its way as fat deposits in your arteries. After decades of eating too many hamburgers and sausages your coronary arteries clog and you require a stent or a bypass surgery. If you do not want to become a statistic prematurely, cut out sausages, hamburgers and other processed meats replacing them with lean turkey breast, organic chicken and lean pork, venison or grass-fed lean cuts of beef or bison.

MSG and other food additives

Many foods have artificial sweeteners in them, which includes excitotoxins like MSG and aspartame. Food manufacturers add MSG to stimulate your appetite, but it has devastating effects on your brain cells on the long term. Food manufacturers disguise the name by using synonyms like yeast extract, sodium caseinate, broth stock, malt extract, natural flavors and others. Soda drinks either have added sugar, in which case your insulin response makes you want to eat more calories in a day leading to obesity and to dementia. Diet conscious people use aspartame in low-calorie drinks, but it causes insulin resistance making you gain weight. It also damages your brain.

I recommend stevia extract

I recommend the plant extract stevia, which is a sweetener that does not have the deleterious effects of aspartame. Sucralose (Splenda) was developed through research on insecticides when a student found out that it tasted sweet. Although Big Pharma has succeeded to introduce sucralose into the diet of diabetics, it is a sweetener that in my opinion is not safe. First it kills ants: a few years ago, I did an experiment where I took a package of Splenda from Starbucks and sprinkled it on Hawaiian ants.

Experiment with Splenda powder and ants in Hawaii

In the beginning they were reluctant to eat it, but after a few hours they came and took it in. One day later there were only dead ants left in the area where I sprinkled Splenda before. I refuse to eat insecticide-laced soda! Second, when you read the link about the “sweet deception about Splenda” above you find that it has reduced the growth rate of rats, caused anemia in mice, enlarged the liver and the brain of rats, shrunk ovaries of rats and caused kidney damage with calcifications in rats. We have no official human data, although millions of Splenda doses have been consumed.  Nobody has done clinical safety studies in man.

Gluten and gliadin

One of the food additives you may not think much about is gliadin, which bakers user to bind the ingredients together. Its origin is wheat, which is usually the Clearfield variety of wheat (a dwarf variety). Dr. William Davis (Ref.1) has examined the effects of wheat and wheat products on humans in detail. Suffice it to say that it is safest to avoid wheat and wheat products entirely; otherwise, you could develop bowel disease like celiac disease, ulcerative colitis, Crohn’s disease; heart disease, obesity, autoimmune diseases, but also CNS disease like Parkinson’s disease, ataxia, and dementia (including Alzheimer’s disease).

Other health problems associated with marketing and so-called “best practices” of agroindustry

Milk and milk products are not as innocent as in the past when no marketing boards were around. Animals are no longer freely roaming on green pastures. The farmer keeps them in high-density facilities and they put them on antibiotics to prevent infectious illnesses. So the rumor goes. In reality farmers have found out that antibiotics and bovine growth hormone will both increase milk production. The profit principle has been applied and as a result the consumers of milk and milk products have a change of their bowel flora from the antibiotics, which can cause heart attacks. The bovine growth hormone from milk and milk products causes breast cancer and prostate cancer.

Superbugs

Superbugs have emerged as a danger from treating beef animals with antibiotics in feeding lots leading to resistant bacterial strains that can cause human disease like flesh eating disease etc. These superbugs imported from the grocery store and meat market are what can make us sick! Eating only organic meat and organic foods are one way that we can use to protect ourselves. Organic milk or goat milk are alternatives to regular (unhealthy) milk.

Toxins in our foods

Roundup is rampantly present in agroindustry to protect crops from weeds. Traces of it are present in most regular crops. Despite claims that Roundup would be safe for the consumer, newer research has shown that it is not. Genetically modified crops are routinely sprayed with Roundup, as they are resistant to this herbicide, so I recommend to stay away from these crops as well.

Your best protection is to buy organic foods, as inspectors test these crops for Roundup contamination.

Heavy metals

Heavy metals can be another source of food toxicity. Red wine was found to contain heavy metals, which could undermine that heart healthy effect of a glass of red wine per day.

Mercury is toxic to the central nervous system. It comes from the effluent of gold mines, the smog from coal burning and volcanic activity, which finds its way into the ocean. Fish is the main source of exposure to humans as explained in this link.

Conclusion

We need to be vigilant about the food we eat. The more food processors create new items, the more ingredients they mix in. We need to ask questions about food preparation. Did the food processors mix in food additives? Are they harmless or bad for our health? Beware of sugar as this causes insulin levels to raise causing obesity, diabetes, heart attacks, strokes and cancer. Watch the addition of salt, which causes high blood pressure, heart attacks and strokes. Avoid polyunsaturated fats, cook with olive oil instead. It’s the Mediterranean way of preventing heart attacks. No butter, no margarine, because this fat ends up in your arteries. Avoid wheat and wheat products that food manufacturers often mix into foods. Cook your own food whenever possible. Eat lots of vegetables and salads.

Keep the glycemic index of your food low

Watch the glycemic index and avoid high glycemic index foods. Sweeten with stevia, but avoid all other sweeteners. This way you avoid the insulin response discussed above.

The dietitians of the US have summarized the problems the American public faces in Ref. 2. Essentially, we need to take back the responsibility for our own food preparation and become less dependent on manufactured foods. Ref. 3 lists a good collection of wheat-free recipes.

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. The Profession of Dietetics at a Critical Juncture: A Report on the 2006 Environmental Scan for the American Dietetic Association; Journal of the American Dietetic Association – Volume 107, Issue 7 (July 2007)

3.  William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

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Sep
07
2013

Preserve Your Muscles And Joints

By | Anti-aging medicine, Arthritis, Diabetes, Fitness, Health, Heart Disease, Men's Health, Nutrition, Obesity, Prevention, Vitamins and supplements, Women’s Diseases

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a)    It starts with good nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b)   Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

c)   Watch your weight:

It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

d)   Exercise:

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

More information on fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

References:

1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Aug
31
2013

Peanut Allergies Are Deadly

By | Allergies, Asthma, Health, Nutrition, Prevention

Introduction

This article is about “peanut allergies are deadly”. In the US 1.5 million suffer from peanut allergies (Ref.1). People who have peanut allergies have to avoid peanuts and foods that contain even traces of peanuts lifelong. Here is a recent example of a 13-year old girl who died at a camp when she tried food contaminated with peanuts. Before we discuss peanut allergies in detail, we need to review first how the immune system is functioning.

How the immune system is primed to develop an allergy

Our immune system knows the difference between our own body components and substances that come from the outside. Scientists call this tolerance to our own surface proteins; and scientists call it an immune reaction that is mounting as a reaction to anything different from the surface antigens. There are different cells that make up the immune system. One of the main working cells of the immune system are the lymphocytes. A subtype are B cells that originate from the bone marrow producing antibodies when an immune reaction occurs. Antibodies fit like a lock and key to the surface of an antigen, in this case the peanut protein. T helper cells are T lymphocytes (thymus derived lymphocytes). They help the B cells to recognize the difference between the own protein components and the outside components.

IgE antibodies directed against peanut protein

There are also T killer cells, which when parasites or viruses enter the body activate them. With regard to peanut allergies, it is the B cells and T helper cells that interact. The B cells produce a powerful, very specific IgE antibody directed against peanut protein. There are memory B cells, which continue to produce these specific anti-peanut protein antibodies. They can cause severe allergic reactions when future exposure to peanuts (even traces) occurs. The more often a person allergic to peanuts encounters traces of peanuts, the more  the immune system gets boosted. This produces even more antibodies of the IgE type through reactivated B memory cells (Ref. 2). 98% of the population does not react to peanut exposure with allergies. But the other 2% who may have genetic susceptibility factors that predispose them to this often develop life-threatening reactions. These have the name “anaphylactic reaction”.

What is an anaphylactic reaction to peanuts?

The most extreme form of allergies involving IgE antibodies can cause anaphylaxis. In the beginning stages of a peanut allergy there may only mild symptoms such as hives on the skin, itching and tingling around the mouth, a runny nose, a scratchy throat, wheezing, stomach cramps, vomiting or diarrhea. However, with a more severe allergy an asthma attack can develop. In this case the blood pressure drops leading to fainting or shock. In addition, severe airway obstruction in the throat or lungs can cause suffocation.

I vividly remember an 11-year-old boy who arrived by ambulance in the emergency room of the hospital where I was working as the on-call physician. He had a hard time talking as his throat was swelling up as part of his anaphylactic reaction, within minutes he passed out completely (shock). Fortunately, an anesthetist was in the department and could intubate him very quickly.

Period of unconsciousness

However, despite adrenaline treatment, oxygen by artificial ventilation and high doses of corticosteroid drugs he did not wake up until 10 hours later. In retrospect it turned out that he had eaten some crackers of a familiar brand that he knew as being free of peanut flour. However, he saw an ad that the same brand of crackers was available as cheese crackers and he tried one of these. This prompted his admission to the hospital. The parents read the ingredients later: the label on the cheese crackers noted in small print that the flour of the cheese crackers contained peanut flour! Always read labels, even if it is a familiar brand! Fortunately for this boy he did not have brain damage from the time of his unconsciousness. He has been extremely careful since and is reading labels and avoiding unknown food items.

Peanut Allergies Are Deadly

Peanut Allergies Are Deadly

Cross-reactions between peanuts and other allergens

Allergies can be made worse when a person has inhalant allergies from pollens of trees or grasses that can share protein components from protein found in foods. The latest findings are that there are cross allergies between Fenugreek and lupine, which are both legumes, as are peanuts, so there are common antigens present in their proteins. A mouse-testing model has shed more light on this. Fenugreek has been shown to control mild diabetes by improving insulin resistance, but it cannot be consumed by persons who are highly allergic to peanuts because of the cross allergy mentioned.

There are other possible cross allergies to legumes like lentils, soy and chickpeas.

Other factors that can cause allergies to get worse

In the past the RAST test was often used.  This is a blood test for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. However, since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test. Children who have food allergies to egg, milk, wheat, nuts, peanuts and soy often outgrow these allergies when they age, in other words their immune system can develop tolerance to many of these foods. Not so with peanut allergies! They tend to be very persistent.

Immune responses to food allergies are complicated

There are complications with immune responses to food allergies. They contained immediate type immune reactions and delayed type immune reactions. Allergists investigate the immediate immune responses with the above mentioned ImmunoCAP Specific IgE test. They can measure the delayed immune responses using the ELISA test. Positive IgE antibody tests for peanut protein are a marker that the person likely has more other allergies. An allergist should investigate them in that regard (Ref. 2).

New wheat varieties complicate the lives of people with allergies

What complicates the allergy sufferers’ lives even more is the fact that new wheat varieties were introduced. This happened in the 1970’s. The new wheat has the name Clearfield wheat. It has a much higher gliadin (gluten) and lectin content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population (Ref.3). In addition, genetically modified foods like soy, corn, sugar beets, canola and others have challenged the immune system of sensitive humans even more.

Autoimmune diseases from GMO food and modern wheat

We do know that some people can develop autoimmune diseases from GMO foods and modern wheat, and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past. The geneticists developing GMO foods were unaware how sensitive the immune system is.  The immune system detects a few different amino acid sequences in a protein mounting a strong immune response to it.

Treatment for peanut allergies

The key for sufferers from peanut allergies is to avoid exposure to it. Read labels and use common sense. If a food item has no label, do not attempt to eat it. Food manufacturers often mix peanut flour into the dough of crackers. But not every product has a label that identifies whether peanut flour is in it. Alternatively it says so only in fine print. With peanuts the antibodies usually circulate in the blood life long. The reason is that the B memory cells do not diminish and experience reactivation very quickly on repeat exposure. At this time they produce antibodies again. As exposure to peanuts can cause severe asthma or anaphylactic shock, it is important to carry an EpiPen with you and to know how to use it.

Oral immunotherapy

In Europe attempts have been made to develop an oral desensitization method for food allergies including peanut allergies, but it has not produced concrete results yet. Recently, however, research from Texas, USA showed that it is possible to desensitize patients with peanut allergy by oral desensitization. In Australia where food allergies are more prevalent than in the US, tolerance to peanut, nut and shellfish allergies is being pursued by oral immunotherapy. Another group in Australia has developed a vaccination method using peptides, which are a sequence of amino acids, but shorter than the full peanut protein. It appears that this is the future direction of treatment for peanut and other IgE allergies: a kind of vaccination treatment to induce competing antibodies, which will neutralize the allergic IgE antibodies.

Conclusion

Peanut allergies have become more troublesome as the food industry has mixed peanut flour into Thai sauces, drinks, cookies, crackers and such. The person allergic to peanuts must read food labels and eat as much single-ingredient natural food as possible. This goes against the tendency of food processors who produce foods with a long rat tale of ingredients. If you see a label “may contain nuts or peanuts”, stay away from this product, as it is safer. Always carry an EpiPen or Twinject with you, just in case you develop an anaphylactic reaction (you only have a few minutes to stop the allergic reaction with adrenaline). In the future vaccination with a peanut protein specific peptide vaccine as mentioned regarding the Australian research, will probably become the treatment of choice.

More information on status asthmaticus (an acute asthma attack).

References

1. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter: Food Allergy. © 2008 Mosby.

2. Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed.© 2009 Churchill Livingstone.

3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Aug
17
2013

Postpartum Depression

By | Mental Health, Prevention, Women’s Diseases

Recently there has been a lot of publicity around the topic of postpartum depression (PPD). Typically the reports originate from a case where depression led to catastrophic consequences. It is sad that it often takes a tragedy before a problem like this is publicly more acknowledged. But sadly reports are often one-sided and are missing vital information about pre-existing risk factors. The family doctor often misses the diagnosis of postpartum depression. There is often denial on behalf of the mother and family. The mother is getting no support from support groups, even though there are such groups.

Swift treatment often not given

And swift treatment that would be available is often not given. The results are finally making headlines. Once a mother is desperate and deeply depressed (“psychotic depression”) she is capable of killing the baby, herself and others who are close. PPD affects 15% of mothers (Ref.1); a small percentage of them may have postpartum psychosis, which is the most severe form of PPD.

Risk factors for postpartum depression

Ref. 1 reviews  several risk factors that can lead to postpartum depression. For instance, a history of a major depressive episode or anxiety attack during the pregnancy predisposes a young mother to develop PPD. However, there may also have been a history of dysphoria (intense feeling of discontent) before her periods in the past; stressful events during the pregnancy or right after birth. Often there is poor social support or a marital conflict. Other factors are low income, young maternal age or immigrant status with deprivation. A lack of support from the partner can also be a major factor.

Up to 85% of women experience postpartum blues within the first 10 days after the delivery of the baby. Symptoms such as mood swings, fatigue, confusion, tearfulness, mild elation and irritability are common during these initial days following her delivery.

Progesterone levels decreased up to 3 months

Researchers found a decrease in progesterone levels following delivery for at least one month, sometimes up to 3 months. This leads to sleep problems (insomnia), which coupled with the baby crying in the middle of the night causes more sleep disruption. Electroencephalography studies documented abnormal brain wave patterns in women following the birth of a child.

Only 1 in 500 mothers after birth develop what physicians call “postpartum psychosis”, which is a recognized psychiatric emergency.  The symptoms here are extreme mood swings with confusion, poor judgment, disordered thoughts (“delusions”), paranoia (where they think that someone is after them or it is the baby’s fault that they feel that way).

Erratic behavior and impaired functioning

Erratic behavior and impaired functioning are also part of this symptom complex. It is this state that needs to be monitored in a psychiatric unit as it is associated with a high suicide and homicide rate. A psychiatrist with experience in treating PPD needs to treat the patient.

Urbanization leads to a lack of support, which is particularly devastating to new mothers who need all the support they can get. This is reflected in a higher percentage of PPD in urban areas versus the percentage of PPD in more rural areas where there is more family support.

 

Postpartum Depression

Postpartum Depression

Hormone changes with postpartum depression

Some people do not understand why a woman who just had a baby would not be happy and content. Most women are. However, the stress from the pregnancy and from childbearing can be too much on her system. There can be a point where the hormones no longer are in balance and the young mother loses her coping mechanisms.

Serotonin concentrations in the brain of women during pregnancy are at a higher level due to higher estrogen levels that slow down the degradation of serotonin. Serotonin is the brain hormone that makes you feel good. Estrogens and progesterone are very high during the pregnancy, but this changes right after the baby’s delivery and during the time of recovery in the first few days and weeks. Studies showed that there was a 15% higher thyroid autoantibody rate in postpartum depression patients in comparison to controls without depression.

Patients with higher thyroid autoantibody rates respond to thyroid

Patients with thyroid autoantibodies associated weakly with postpartum depression and responded favorably to thyroid replacement therapy. Progesterone levels were much lower in patients with depression and in patients without depression following delivery. The reason for this likely is the fact that with the delivery the placental source of natural progesterone disappeared. Researchers replaced progesterone in a group of patients, but they die not observe any significant improvement of PPD. However, they did not explain whether the progesterone replacement involved bioidentical hormones or synthetic hormones.

Dr. Michael Platt described a case of a postpartum woman who was hypothyroid as well (Ref.2). She responded to hormone replacement with thyroid hormones and progesterone by shedding 60 pounds (she always had a weight problem) over 10 months changing from a size 20 to a size 4. She was able to wean herself off the anti-depressants.

Breast feeding women on bioidentical progesterone

In breast feeding women this could be a significant difference as women on bioidentical progesterone can breast feed and will positively influence their breast-fed child’s brain development (brain cells have a lot of progesterone receptors, which are stimulated by progesterone).

A recent Canadian study involving pregnant women and women after delivery of their babies showed that there was a significant drop of progesterone levels in saliva samples for several weeks, particularly with breast feeding. The authors explained that the lack of ovulation with a lack of progesterone synthesis in the ovaries was responsible for this. It takes several weeks for most women to regain regular menstrual cycles. It would follow from this that there is room for bioidentical progesterone replacement in the first few months of the postpartum period until the ovaries have resumed their normal cyclical hormone activity.

Conventional treatment for postpartum depression

With baby blues the symptoms are much less severe (in comparison to PPD) and are starting 2 to 3 days after childbirth, resolving spontaneously within 10 days after delivery. PPD occurs within 3 months following delivery and responds to treatment with antidepressants and psychotherapy such as cognitive behavioral therapy.  Breast feeding needs to be stopped, as it is known that metabolites of the antidepressants end up in breast milk. Typically, a less toxic antidepressant is used like paroxetine (Paxil), otherwise citalopram (Celexa), and fluoxetine (Prozac). In the rare cases where PPD is so severe that psychotic symptoms are present (postpartum psychosis) hospitalization is mandatory (Ref.3). Some of these cases may require electroconvulsive therapy (ECT) and/or lithium treatment for mood stabilization. Thyroid hormone therapy has also shown a beneficial effect in treating antidepressant-resistant cases of PPD (Ref.4).

Alternative treatment of postpartum depression

Although review texts of the treatment of PPD mention that estrogen replacement in postnatal women with PPD was beneficial, there is a warning that this could cause blood clots and anticoagulant measures would have to be combined with this to prevent deep vein thrombosis. Researchers suggested progesterone replacement, which is a treatment modality where blood clots are no danger. However, there are no formal trials yet, so most medical professionals ignore this suggestion. Here is forum of women who have taken postpartum progesterone with positive effects.

Dr. Katherina Dalton published a trial involving 30 PPD patients with a positive response rate of 95% when treated with natural progesterone.

Bioidentical progesterone treatment reduces symptoms of postpartum depression

Before treatment patients were suffering from an average of 7.57 symptoms, after the treatment only 2.1 symptoms remained. (Figures with details regarding this study under the above link).

There are many descriptive observations without controls like this where natural progesterone creams are part of a holistic approach to treating PPD. Dr. Mercola describes here how useful natural progesterone therapy can be. He also cautions that the woman should take bioidentical progesterone cyclically to mimic nature’s biorhythm to allow progesterone receptors to recover in between treatments.

There are many websites that have useful information about natural progesterone cream treatment for PPD, such as this.

Conclusion

It is common sense that a woman may need natural progesterone following a delivery. She just gave birth to her placenta, which was a virtual progesterone factory. It  protected her body and the baby’s brain all throughout the pregnancy. If women decided to use natural progesterone for 3 to 6 months, this would make a big difference.  The majority of women would not experience the baby blues or PPD. Eventually regular menstrual cycles return, the patient’s own ovarian progesterone production resumes and there no longer is a need for progesterone cream until after the birth of the next child or at the arrival of menopause. Medicine is full of examples where common sense was applied for effective treatment options despite missing randomized studies.

Natural progesterone treatment of PPD

Natural progesterone treatment of PPD is one such example. Physicians used bioidentical progesterone intuitively, but it worked in many patients. The progesterone receptors do not distinguish whether or not researchers did a clinical trial. But they do not like the synthetic versions of progesterone, as they block the receptors leading to progesterone deficiency.  The physician can combine natural progesterone treatment with traditional treatments of PPD.

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

References

1.Teri Pearlstein, MD, Margaret Howard, PhD, Amy Salisbury, PhD and Caron Zlotnick, PhD: “Postpartum depression” : American Journal of Obstetrics and Gynecology – Volume 200, Issue 4 (April 2009)

2. Dr. Michael E. Platt: The Miracle of Bio-Identical Hormones; 2nd edition, © 2007 Clancy Lane Publishing, Rancho Mirage, Ca/USA (p.53-55).

3. Bope & Kellerman: Conn’s Current Therapy 2013, 1st ed.© 2012 Saunders

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