Sep
29
2018

No Amount Of Alcohol Is Good

New research, more extensive than previous research has shown that no amount of alcohol is good.

This is completely against the widespread belief that moderate consumption of alcohol would prevent heart disease.

Specifically, previous research had shown the following: one glass of alcohol per day for women and 2 glasses of alcohol for men was reportedly make us live longer.

New research with larger population numbers

But a new study involving much larger population groups, all ages, and drinkers versus non-drinkers came to a different conclusion. It concluded that the previous recommendation was based on only heart attack rates, but excluded other causes of sudden death like heart failure, a rupture of the aorta (aneurysm), high blood pressure that kills (fatal hypertensive disease) and strokes. With the compilation of all these cardiovascular diseases, the statistics suddenly started to look different. Now even small amounts of alcohol killed. What is worse, there was clear evidence that binge drinkers have much worse survival statistics than moderate drinkers. When you drink according to the American Heart Association’s recommendation, you drink smaller amounts of alcohol daily.

Binge drinking

But many of us like to live it up on weekends or whenever there are friends over who also like a few drinks. This binge drinking habit lowers the life expectancy by an average of 10 years. It does so because the list of complications I mentioned above. In addition there are alcoholic liver cirrhosis, pancreatitis and various cancers that shorten your life.

Global health study

The funders of this global health study was the Bill and Melinda Gates Foundation, and it looked at the burden that alcohol puts on 195 countries. The original study appeared in the Lancet. The combined study population was 28 million individuals. There were 649,000 cases of various deaths due to alcohol. Here is a summary of the abbreviated outcome of the global health study. As you can see from this, there is no safe level of alcohol consumption as even small amounts of alcohol over a long period of time lead to significant damage in the body. You can prevent heart attacks to a certain extent. But instead people die from a ruptured aorta, from strokes or from heart failure. The leading cause of death for men and women age 15 to 49 worldwide was alcohol. It accounted for almost 1 in 10 deaths.

Some alcohol-related statistics

The following were the observaions in the study.

  • Over 300 disabilities and diseases were directly related to alcohol consumption. The findings were collected in 195 countries, classified by age and sex. The data was gathered between 1990 and 2016.
  • Globally, 2.4 billion people drink alcohol. 25% are women who consume 0.73 drinks on average each day, 39% are men drinking 1.7 drinks a day.
  • Denmark, Norway and Germany drank the most alcohol globally.
  • For ages 50 and up the leading causes of death were: road injuries, suicides and tuberculosis.

More statistics

  • Most deaths caused by alcohol came from cardiovascular disease and cancer for all countries.
  • When you look only at drinkers, the standard recommendation of the American Heart Association regarding low alcohol consumption seems true. But the new study compared non-drinkers with drinkers. From this it is clear that even one drink a day has a risk of premature death.
  • At the age of 40 cutting down long-term alcohol use will add 1 to 2 years of life expectancy.
  • For all ages 2.8 million people die globally every year from alcohol related diseases.
  • Half of the world does not drink at all. This means that the ones, who drink, consume double as much as the statistics show.
  • Americans prefer beer. They drink about 27 gallons of beer, 2.6 gallons of wine and 2.2 gallons of spirits per adult/year.

Common clinical conditions from alcohol consumption

Binge drinking is the consumption of 5 drinks or more in an evening for men or 4 drinks for women. The CDC is concerned about binge drinking, because of its association with significant organ damages. There are 4 major concerns regarding these effects. Heart disease and cancer; diabetes; memory loss and appearance. In the following I will zero in on these alcohol-related conditions. 

Heart disease

As this article pointed out above, there is a very limited protective effect, but mostly in above 55-year-old women who drink in moderation (1 glass of alcohol; per day). They have some protection from developing heart attacks, because their LDL cholesterol gets lowered and their clotting system is influenced in positive ways. But 6% of breast cancer in women is due to the effect of alcohol consumption, which is a downfall. For both men and women binge drinking is what kills. Binge drinkers who drink more than 100 grams of alcohol per week (more than 7 drinks in the US) experience increased deaths. The causes are heart failure, strokes, fatal hypertensive disease and fatal aortic aneurysm, where the main artery bursts. Apart from that alcohol-related pancreatitis and liver cirrhosis can kill as well.

Cancer

A relatively new finding is that alcohol has a close relationship to causing various cancers. Alcohol weakens the immune system. Also, alcohol has a negative influence on the bacterial composition, the microbiome in our digestive tract, is. This can be a cause for colon cancer. Liver cancer, mouth cancer and breast cancer also has a direct relationship to increased alcohol consumption. Esophageal cancer and laryngeal cancer are also related to alcohol consumption.

Diabetes

Alcohol can stimulate the pancreas to release insulin, which may give you hypoglycemic attacks. As alcohol contains empty calories, over the course of several years alcohol consumption can add to your weight, causing obesity and type 2 diabetes. As diabetes has detrimental effects on the heart and blood vessels, this mixed with alcohol consumption, can worsen cardiovascular disease thus increasing the risk for heart attacks and strokes.

Memory loss

In the beginning of chronic alcohol consumption you may enjoy the relaxing effect of alcohol. This is merely the toxic effect of alcohol on brain cells. Alcohol has the effect of inhibiting brain cells, which makes you feel relaxed, super-sociable and even silly. In reality you are starting to loose control. After several years of this effect you are left with feelings of anxiety, depression and anger. This is when trouble starts to occur. People out of control are more likely to get into fights and get injured or killed. People can develop blackouts where they do not remember parts of the evening or an entire event. Memory loss is starting. The hippocampus is an important part of the brain that is involved in processing short- term memory into long-term memory. A form of dementia can occur that was brought on by chronic alcohol overconsumption.

Appearance

Alcohol dries out the skin cells and body cells. The face gets wrinkles. Your skin looks parched and gives you the appearance of a prematurely aged person. Alcohol can interfere with your sleep and when you have a lack of it you end up with dark circles around your eyes as well as puffy eyes. It does not make for a good picture, whether it happens inside the body or on your skin!

No Amount Of Alcohol Is Good

No Amount Of Alcohol Is Good

Conclusion

A new study that was larger and more comprehensive than any previous study has exposed the myth that one drink for women and two drinks for men would protect you from heart disease. It may protect you from heart attacks, but it definitely does nothing to protect you from other heart conditions. There is also sudden death from heart failure, a rupture of the aorta (aneurysm), high blood pressure that kills (fatal hypertensive disease) and stroke. When you factor all that in as well, even your low, moderate alcohol consumption has health risks. The global health study, funded by the Bill and Melinda Gates Foundation looked at the burden that alcohol puts on 195 countries. The combined study population was 28 million individuals.

Alcohol related deaths and diseases

649, 000 registered cases of various deaths occurred due to alcohol. This included deaths from traffic accidents, injuries, cancer, heart disease and suicide. This global study compared the life expectancy and disease frequencies of alcohol-consuming people with non-alcohol consuming people. It concluded that non-alcohol consuming people live on an average up to 10 years longer than their alcohol-consuming counterparts. No studies up to now have been that comprehensive. The results from twenty-eight million people speak for themselves, and the death statistics are clear. It is worthwhile to look at the details and draw your own conclusion.

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Jul
15
2017

Getting Rid Of Sugar

Scientific papers describe how unhealthy added sugar is, so getting rid of sugar in your diet is the answer.

An article was published in CNN that describes a one-month sugar detox program.

Brooke Alpert, the co-author of the book “The Sugar Detox: Lose the Sugar, Lose the Weight — Look and Feel Great” describes the details of a sugar detox program.

 The first three days of sugar detox

You need to go cold turkey for three days to eliminate any sugar to break the addiction cycle. During this time you may experience anxiety, sugar craving and moodiness.

You must not consume any added sugars during the first 3 days, but also keep away from fruit. Avoid starchy vegetables. This includes corn, sweet potatoes, peas and butternut squash. You also need to avoid dairy, because of the milk sugar in it. In addition avoid grains and alcohol. “You’re basically eating protein, vegetables and healthy fats”, says Alpert. You would enjoy a breakfast with 3 eggs any style. Lunch contains 6 oz. of poultry, tofu or fish. Add a green salad. For dinner your helpings are bigger, but it would be similar to lunch, perhaps with added vegetables. Snacks can be 1 oz. of nuts or a few slices of bell peppers with hummus. Your beverages: unsweetened tea, black coffee or water.

People should avoid sweeteners according to Alpert. Dr. Robert Lustig, professor of Pediatrics and member of the Institute for Health Policy Studies at the University of California, San Francisco agrees. He said that artificial sweeteners cause you to store more fat. Dr. Lustig added: “You also end up overeating later on to compensate for the increased energy storage”.

Day four of sugar detox

On day 4 the patient can reintroduce an apple. It will now taste a lot sweeter, because in the past sugar suppressed the natural fruit sugar taste. Full fat, unsweetened cheese and yogurt are also part of the diet. Alpert added: “Fat, fiber and protein slow the absorption of sugar, so taking out fat from dairy will make you absorb sugar faster.” Higher sugar content vegetables like carrots, snow peas and high-fiber crackers can be part of the diet in the second half of the first week.  Those who like it can also add three glasses of red wine.

Second week of sugar detox 

Add a serving of berries that are full of antioxidants. Also add an extra serving of dairy. You can also eat more starchy vegetables like winter squash and yams.

Third week of sugar detox

Barley, quinoa and oatmeal can now be added back. Grapes and clementines are now also allowable. Those who like wine can now add another glass of red wine. One ounce of dark chocolate per day can also be added. “Week three should be quite livable,” Alpert said.

Week four of sugar detox

You now can have two starches per day, like bread and rice. In addition you can enjoy high-fiber crackers. You can have 5 glasses of red wine per week. You may want to eat a sandwich. Once you have completed 31 days no fruit is off-limits. You can allow yourself the occasional indulgences like an ice cream or a piece of cake at a birthday party. “Because the addictive behavior is gone, having ice cream once or twice will not send you back to square one. The whole purpose is to give people control and ownership and a place for these foods in our life,” Alpert said.

Weight loss with sugar detox

There can be a lot of weight loss with a sugar detox; depending on how much sugar the person was consuming before the detox started. Alpert recalled that of 80 subjects who tested the sugar detox people lost between 5 and 20 pounds within 31 days. Many people reported that their belly fat was going and they had to readjust their belts. There were other things participants noted: brighter eyes, fewer dark circles around the eyes, clearer skin, more energy and not as many mood swings.

Many people are not properly educated; they reduce fat intake, but add sugar and start gaining weight. By cutting out sugar and adding healthy fats in their diet, they now feel satisfied. The sugar craving has disappeared.

Side effects of sugar detox

You may feel grumpy and weak. This likely is due to low blood sugar and a piece of fruit will help you overcome this. In other cases it could be due to too little fluid intake and when you drink some water, this feeling will pass. Make sure you have supportive family and friends through the first three-day of sugar detox. “You need people around you to help you be successful,” Dr. Lustig said. “The whole family has to do it together.” Some irritability is expected due to sugar and caffeine withdrawal. This will pass and get better with every day. There are persons who should not go on this program: diabetics, people who take medicine to control blood sugar and extreme athletes. Pregnant women should also not follow a sugar detox program.

Why it is important to limit sugar intake

The American Heart Association (AHA) clearly spelled out what the limits are for added sugars:

For men: a daily dose of 9 teaspoons of sugar from all foods,

For women: a daily dose of 6 teaspoons of sugar from all foods.

When you start reading labels, which I started to do since 2001, you realize that it is very easy to exceed these daily limits. What does this do? It makes your pancreas produce more insulin than is good for you. You start switching your metabolism into the metabolic syndrome, you gain weight, and you get inflammation. This is what the AHA is concerned about. You start developing high blood pressure; get high LDL cholesterol, high triglycerides, and atheromatous plaques in your coronary and brain arteries. Eventually you come down with a heart attack or a stroke.

In the last 100 years sugar consumption per person has skyrocketed.

This has led to a disbalance of our diet and it is because of this that we are facing the obesity wave now. All I am saying is replace sugar with stevia extract, which to my knowledge does not have the undesirable side effects that other sweeteners do and eat a Mediterranean type diet, which we know is balanced.

Watch the maximum recommended sugar intake per day set by the American Heart Association and balance your meals, and you will do a lot better than on the Standard American diet. The Mediterranean diet is anti-inflammatory.

Getting Rid Of Sugar

Getting Rid Of Sugar

Conclusion

We learnt about how a sugar detox can get you off sugar addiction. I also summarized why it is important to keep sugar consumption within limits set by the American Heart Association. Too much sugar can derange our metabolism, which is called metabolic syndrome. This can lead to diabetes. Eating a Mediterranean diet and keeping sugar intake low is the pathway to good health. It also keeps inflammation at bay.

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Nov
20
2015

Zero Alcohol In Pregnancy!

The American Academy of Pediatrics warned recently that pregnant women should not drink any alcohol at all (“zero alcohol in pregnancy!”) to prevent learning disabilities and fetal abnormalities in their children. Even having one drink when pregnant can lead to mental difficulties in the offspring.

There is no safe amount of alcohol to drink through pregnancy

Dr. Cheryl Tan, an epidemiologist at the CDC said: “There is no safe amount, no safe time, and no safe type of alcohol to drink during pregnancy. It’s just not worth the risk”. Dr. Tan from the CDC did an extensive phone survey study where drinking behaviors of non-pregnant women and pregnant women were recorded. The results were as follows. 1 in 10 pregnant women said that they had consumed alcohol in the past 30 days; also 1 in 33 stated that she had been binge drinking (4 drinks or more).

Growth retardation and other problems in the baby when mother drinks alcohol

Pediatricians have found over the years that even one alcoholic drink per day in a pregnant woman will lead to growth retardation in the baby. But this is not all: there are a myriad of problems with the consumption of alcohol, like problems with hearing and vision, also heart, kidney and bone deformities. As the nervous tissue is very sensitive to the toxic effect of alcohol, the offspring of mothers who drank when pregnant often have neurodevelopmental issues such as difficulties with abstract reasoning, processing of information and ADHD.

Pregnant women drinking only in the first trimester compared to women who abstained, had more problems with their offspring. They were noted to be 12-times more likely having a child with neurodevelopmental issues. Women drinking in the first and the second trimester, but not the third were 61-times more at risk, while women drinking during all three trimesters increased the risk 65-times.

Medical science can be the problem

There was a previous study in only 2010 stating that it would be OK for a pregnant woman to drink one or two glasses of alcoholic drinks as the study showed no neurodevelopmental problems up until the age of 5 of the children born.

But at the end of the study the scientists did note that each mother and child is different in how they metabolize alcohol. The obstetrician should discuss with the pregnant woman what to do. This type of study makes no sense at all. It seems to carelessly suggest to women to get pregnant and continue to drink.

There can be a serious compromise in terms of neurodevelopmental development

Remember that all of the nervous tissue has to develop out of a fertilized egg, then form into the neural tube and grow into the cerebellum and the brain. On each of the multiple steps of embryonic development there is enzyme induction that determines the next step in the development and many of these important decision points can be interrupted by alcohol. The newest study from the CDC indicates very clearly that it is not safe to drink at all throughout pregnancy. The reason is that there can be a serious compromise in terms of neurodevelopmental development.

Previous toxicity studies regarding the fetal alcohol syndrome

A study from Ghana documented that fetal alcohol syndrome exists in this African country, although previously not too much was medically noted. Physicians and nurses picked up 90% of children with fetal alcohol syndrome as “failure to thrive”. 80% of these children had heart disease and 50% had hernias.

A study from Poland showed the correlation between prenatal exposure to alcohol and developmental problems in children. The sad results is that among the 7 to 9 year olds there were 2% who suffered from fetal alcohol spectrum disorder. And 0.4% of the offspring had fetal alcohol syndrome. There was a great need in Poland to develop diagnostic skills to diagnose neurodevelopmental disorders.

Developmental abnormalities in humans and in animal models with alcohol exposure

These human findings are mirrored by animal studies using a mouse model where alcohol was administered at certain times during pregnancy. The researchers could not find any safe time period during the pregnancy of mice where alcohol was not toxic. All concentrations of alcohol caused congenital abnormalities. To the contrary: chromosomal abnormalities developed as a result of alcohol exposure that persisted into life after birth. Fetal alcohol syndrome birth defects can be pinpointed to the exact exposure time in pregnancy. It is at certain specific times in pregnancy when certain organ formations take place.

Fetal Alcohol Spectrum Disorders

The newest study from a group of pediatricians states unequivocally that no exposure to any alcohol is safe throughout any pregnancy. In 1973 fetal alcohol syndrome was first published with a cluster of genetic abnormalities. It has been recognized that subtler neurodevelopmental syndromes are due to lower alcohol concentrations during pregnancies. This results in what physicians now call “fetal alcohol spectrum disorders”.

It is the key observation that researchers could not find any neurodevelopmental problems in women who did not drink. Women who did not drink a single alcoholic beverage during their pregnancy were the strong point of the study. They formed the control group that caused the strong statement in this research paper.

“The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely,” said Dr. Janet F. Williams, one of the leading authors of the report from the American Academy of Pediatrics.

Zero Alcohol In Pregnancy!

Zero Alcohol In Pregnancy!

Conclusion

The question whether it is safe to drink a bit of alcohol when pregnant has finally been answered. It has been shown clearly that a woman who is pregnant should refrain from all forms of alcohol. It is for the sake of giving birth to a healthy baby. Despite the definition of fetal alcohol syndrome in 1973 it has taken until 2015 before clear answers came.  Studies now lead to guidance from the health care profession and the CDC as well regarding drinking and pregnancy. How can we expect to have a healthy next generation both physically and neurodevelopmentally? We have to take responsibility during the next generation’s pregnancy. This is the responsibility of the mother, the father and society at large.

Aug
22
2015

Tools To Turn 100

A Swedish longevity study that went on for 50 years gave me the idea to blog about the factors that can help you to turn 100 and still have your mental capacity and good health. Let me introduce you to this study.

Researchers at the Sahlgrenska Academy in Göteborg, Sweden (which is the same as the University of Gothenburg) decided back in 1963 to follow a group of 855 Gothenburg men born in 1913 until they would either die or turn 100. The idea was to find out what killer diseases are in the way to reach such a ripe old age and if they would survive, what was it that made them to reach this age.

Think of it as a race to turn 100. The researchers had checkpoints along that journey: various surveys were conducted at the age of 54, 60, 65, 75, 80 and 100 to consider the factors that lead to longevity. 27% (232) of the original group reached the age of 80, and 13% (111) made it to 90. Only 1.1% of the men made it to the age of 100.

What were the causes of death for the other ones who did not make it? 42% of deaths after the age of 80 were due to heart attacks, 20% due to infectious diseases, 8% due to strokes, 8% due to cancer, 6% due to pneumonia and 16% due to other causes. 23% of the men over 80 were diagnosed with Alzheimer’s or dementia.

What else did the researchers find out? Factors that made people survive were refraining from smoking, maintaining a healthy cholesterol level and limiting coffee consumption to not more than 4 cups per day.

Another marker for longevity was either paying high rent for a condominium or own a house; in other words, a certain amount of wealth seems to be associated with longevity. Passing a fitness test at age 53 riding a bicycle was another peculiar finding of the study. This one points to the importance of fitness and clarity of thought as markers for longevity. There was a genetic factor also, as those who had a mother who lived to a ripe old age also survived longer than others who did not have this longevity advantage. However, researchers stressed that overall this genetic factor was of minor importance, the other factors that are under our control were much more important.

Two of the men who were 100 years old dropped out of the study: one because of dementia, the other one for personal reasons. Here are some of the facts about the other seven: none of them smoked; 2 lived at home, 5 in assisted living facilities. All of them wore hearing aids; all of them had good spatial and temporal cognition. All of them were slim, had good posture, but all used walkers to prevent falls or assist them walking. They were all able to read and watch TV, and most of them wore glasses.

Dr. Wilhelmsen who was part of the entire 50-year research effort said about the centenarians: “All of them were clinically healthy, satisfied with their circumstances and pleased to be living where they were.”

Other research about marriage, health and life expectancy

There is some peculiar research that found that men who are married are healthier than single men. This study came from the University College in London and was based on a group of 10,000 British people who were born within one week of each other on March 1958.

Being married or living common-law was beneficial for men compared to single men. One biomarker was the metabolic syndrome (a cluster of obesity, high blood pressure and diabetes), which was found to be 14% higher in non-married males while in females it did not matter whether they were married or not: they had the same low rate of metabolic syndrome. The longer men were married, the healthier they were. This was not so for the single male. Women, who married in their late twenties or early thirties, were much healthier in their later midlife compared to women who never married.

Harvard has published some interesting facts on men and marriage. A survey of 127,545 American adults showed that married men live longer than the unmarried males of the controls. A review of studies in the early 2000 suggested that when men were married to a well educated woman this may be causing heart attacks in the men. Quite peculiar, isn’t it? But this was refuted in a larger 2009 study, which found that married men live longer and are healthier when the partner is well educated.

Unhappiness and stress were singled out as a cause of high blood pressure, which leads to heart attacks later. Harvard reveals several other facts that are important with respect to longevity: cancer mortality is higher in unmarried men than in married ones; married men are at a lower risk of developing depression. They were found to have higher rates of satisfaction with life in retirement than their peers who never married. Marriage protects cognitive function and leads to a reduced risk of Alzheimer’s disease. Marriage is also associated with improved blood sugar levels and better outcomes with respect to cancer treatment or when hospitalized for other reasons.

General factors leading to longevity

We heard now several interesting points that seem to be linked to longevity. But what is it exactly that is behind some of these observations?

1. Diet

The Mediterranean diet is the gold standard as it has been shown to lead to the lowest mortality rates among diets.Note that longevity increases even more when sugar and starchy foods are avoided. And yes, a Mediterranean diet cuts down the risk for Alzheimer’s disease.

2. Exercise

It has been shown in many studies that regular exercise will reduce all diseases by about 50%! This is better than any medication; this is simply a must, if you are at all interested in living longer and healthier. Not only will your heart benefit from that, but your mind will thank you and not enter into dementia.          

3. Alcohol

This has been drummed to death, but the limit is 1 glass of red wine for women and 2 glasses of wine for men. Personally I do not believe that this is true. I have explained in a blog that the same heart protective effect can be achieved by 250 mg of resveratrol as supplement and avoiding alcohol altogether will prevent a number of cancers.

4. Smoking

Originally the Framingham Heart Study has shown that smoking is an important risk factor for heart attacks and strokes. Hundreds of other studies have verified this. Despite this fact women as a group are now repeating the experiment that has already been completed for men: smoking causes lung cancer and many other cancers as well as cardiovascular disease. I see young women thoughtlessly walking around town puffing their lives away.It shows you how powerful cigarette commercials are. Sometimes it is frustrating to watch this as a health care provider!

5. Stress management

This means seeking ways to reduce stress like meditation, self-hypnosis, yoga and others. This also means building social ties and mutually supportive relationships. It makes you feel that you belong, you have your place in society, you help others, and they support you.

6. Avoiding iatrogenic disease

Physician-caused illness is getting more common. Medications have become stronger and often have more potent side effects. For instance, if a physician treats a gluten-induced rash called dermatitis herpetiformis with a drug called Dapsone, the patient can get severe anemia, violent abdominal cramps and bloody diarrhea. A strict gluten-free diet would probably have helped the patient to clear up the rash. All of the symptoms that the patient had to suffer as a result of Dapsone were from this “iatrogenic disease”, which simply means they happened as a result of the doctor’s malpractice that had caused a medication-induced disease.

7. Avoiding exposure to free radicals

Many different agents like substances from pollution, radiation, rancid unsaturated oils and others contain free radicals that damage tissues and cause inflammation. Antioxidants like vitamin C, E and resveratrol can stop this as is reviewed here.

8. Using vitamins and supplements

As already indicated this will help to reduce free radical exposure by the use of antioxidants; reduce inflammation by using omega-3 fatty acids, Co-Q-10, vitamin C and E, resveratrol and others.

9. Avoid accidents

As you are aware, accidents can kill. Wear seat belts, drive safely, and stick to speed limits, particularly in curves. Also don’t drink and drive, don’t use your phone and don’t text and drive. The use of street drugs is also a common cause for accidents.

10. Use bioidentical hormone replacement

When we experience the change of life, called menopause in women and andropause in men we can allow nature to knock us off the planet or use scientific knowledge. It has been proven that it is perfectly safe not to use Big Pharma’s hormone concoctions that the body cannot recognize. Synthetic hormones cause iatrogenic disease as proven in the Women’s Health Initiative. Bioidentical hormones, however simply replace what is missing in menopause and andropause.

The reason this is important is that our system has hormone receptors on the surface of all body cells. In order to have normal function, we depend on bioidentical hormones to assist cell metabolism. For instance the heart muscle in a man has testosterone receptors as has his brain. In women estrogen receptors and progesterone receptors are contained in the cells. Using the right mix of bioidentical hormones based on saliva hormone tests or blood hormone tests can help the treating physician or naturopath to rebalance the body’s natural hormone needs with bioidentical hormone creams applied to the skin.

Tools To Turn 100

Tools To Turn 100

Conclusion

Tools to turn a hundred years old and still be fairly alert and fit are listed above. It is important that we start thinking along those lines, because it is only prevention that gets us safely there. If you allow yourself to constantly live it up and run your health down, how can you expect to turn 100? In the last 50 years the life expectancy has risen at least 20 years (85 years now, 65 years then). Now we are seeing a downward trend in the obesity and overweight population and the diabetics. They are the ones vulnerable to iatrogenic disease and mortality. They also are at a higher risk to die from heart attacks and strokes and they are more likely to get Alzheimer’s disease. Also, single men would do well to see their physician more often to check out their health status and perhaps change detrimental lifestyles that married men would not get into, because their wives talk to them. If you can switch from a curative approach in healthcare that usually does not work too well anyways to a preventative approach, you have a good chance to make it to 100. I talk to you then.

Mar
21
2015

What Alcohol Does To You

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

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

Bioflavonoids

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

Toxicity of alcohol

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

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

Different tissue sensitivity to alcohol

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

Other toxic effects of alcohol on organs

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

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

The pathologist has the last word

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

Histological documentation of toxic effects in livers of corpses

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

Alcohol as an aging substance

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

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

Social pressure

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

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

Resisting social pressure and doing what is good for you

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

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

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

What Alcohol Does To You

What Alcohol Does To You

Conclusion

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

References

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

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

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

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

May
21
2014

Forty Percent Of Premature Deaths Can Be Prevented

A new report from the CDC (Center of Disease Control) in the US has revealed that up to 40% of premature deaths could be prevented by simple lifestyle changes. As this link shows every year about 900,000 premature deaths occur in the US, which are due to 5 major diseases that in the opinion of the CDC can be prevented by 20 to 40%. Here are the diseases that kill: cancer, heart disease, COPD/emphysema, stroke and accidents/injuries. These conditions were responsible for 63% of all deaths in the US in 2010.

Let’s discuss each of these conditions and how one could lower the risk of dying from them.

1. Cancer:

The Framingham Heart Study has shown that smoking and cancer are closely related. Smokers who quit can significantly reduce their risk of getting cancer. We also know that exercise and prophylactic supplements like fish oil and vitamin D3 have cancer preventative effects.

Antioxidant supplementation that included beta-carotene, vitamin A, vitamin C, and vitamin E daily or on alternate days for 1 to 12 years, along with selenium supplementation reduced the incidence of cancer of the esophagus, colon, pancreas, stomach or the liver. Insulin resistance due to sugar and starch overconsumption is causing cancer, particularly breast cancer, colorectal cancer and endometrial cancer. I have discussed this in a recent blog.

Pollution has been linked to increased lung cancer risks as discussed here.

2. Heart disease:

Heart disease can be caused by several factors in combination. Lifestyle issues are important: Smokers need to quit smoking as the Framingham Heart Study has shown more than fifty years ago that smoking causes heart attacks. Obesity and diabetes also contribute significantly to the risk of heart disease. Often these are connected to faulty nutrition, which is another lifestyle issue that comes to mind when too much sugar and starchy foods are taken in; your liver will convert these into fatty acids, triglycerides and elevated, oxidized LDL cholesterol, which gets deposited under the lining of the arteries. A lack of exercise adds to this problem as a lack of exercise lowers the protective HDL cholesterol and fat is deposited under the lining of the arteries. Start exercising and your protective HDL cholesterol will rise, your total cholesterol to HDL ratio will lower to healthier levels and your risk for hardening of the arteries and for getting a heart attack will fall. If you have diabetes, it is important that you manage your blood sugars well; this means that if you inject insulin, you want the blood sugar tests to be within the normal range and the hemoglobin A1C values to be below 5.5%. Poorly controlled diabetes is an important cause of heart attacks and strokes. High blood pressure is also an important cause of developing heart attacks and strokes. It is important to control your blood pressure by taking blood pressure lowering pills and also by exercising regularly. Exercise seems to send a signal to relax the blood vessels thus lowering the blood pressure, which in turn prevents heart attacks.

Forty Percent Of Premature Deaths Can Be Prevented

Forty Percent Of Premature Deaths Can Be Prevented

 

3. COPD/emphysema:

Chronic obstructive pulmonary disease (COPD) or emphysema is mostly caused by chronic exposure to cigarette smoke from smoking. The earlier you can quit, the better your chances that your breathing will not be the limiting factor when you age. But it is also important to avoid exposure to other noxious gases, such as from welding and from exposure to pollution. This may involve a decision to move to a less polluted area. Or it might involve a job retraining. Those who are suffering from COPD can be helped to a certain extent by a portable oxygen tank with nasal prongs.

4. Stroke:

As mentioned before, quitting smoking, controlling high blood pressure and controlling blood sugar, if you suffer from diabetes have been shown to stabilize your blood vessels including the ones that supply your brain. The key is to prevent hardening of the arteries by a healthy lifestyle. Exercising and keeping your weight under a body mass index of 25.0 have been shown to be effective stroke prevention. Healthy nutrition as indicated above under “heart disease” is equally important for stroke prevention. Go green (eat more vegetables, consume more green smoothies), cut down grains, sugar and starchy foods and you will live longer without strokes and heart attacks. Remember, what’s good for your heart is good for your brain!

5. Unintentional accidents/injuries:

Wearing helmets when bicycling, wearing seat belts when driving in a car, avoiding risky behaviors are all measures that save lives. One factor stands out in all of this: if you drink too much, you run the risk of being involved in unintentional accidents or injuries. People may not like to hear this, but your brain lacks the natural inhibitory impulses when you are under the influence of alcohol, so you become more daring and you may not pay attention for the split second that could have prevented an injury or accident. People react very differently to alcohol. Some people feel inebriated after only ½ a glass of wine or beer whereas others can drink more before they make mistakes. The best is to be sober when you drive, ski, use power tools or walk in traffic. Even climbing ladders requires a clear mind!

Conclusion:

As the CDC said 20 to 40% of premature deaths (deaths that occurred before the age of 80) could have been prevented, if the above-mentioned recommendations were followed. Let me rephrase this: 180,000 to 360,000 premature deaths every year in the US before the age of 80 could have been prevented! Curative medicine cannot help with these statistics as a heart attack or stroke has happened when it has struck you. Cancer and end stage lung disease are similar conditions that you are suddenly faced with when they occur and unintentional accidents just seem to happen. This is where the importance of prevention can be seen, because these little baby steps every day are adding up to something formidable, a force to be reckoned with. Be part of the solution, think prevention!

More information on:

1. Cancer mortality: http://nethealthbook.com/cancer-overview/overview/cancer-mortality-rate/

2. Higher vitamin D3 intake lowers mortality from heart attacks, strokes, cancer, fractures due to osteoporosis: http://nethealthbook.com/news/higher-vitamin-d-levels-associated-lower-risk-mortality/

Last edited Nov. 8, 2014

Feb
01
2014

Early Alcohol Use Will Result In Memory Loss Later In Life

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

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

Review of the effects of alcohol

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

Early Alcohol Use Will Result In Memory Loss Later In Life

Early Alcohol Use Will Result In Memory Loss Later In Life

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cardiology view of preventative alcohol

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

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

Conclusion

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

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

References:

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

Last edited Nov. 7, 2014

Nov
30
2013

Statins Can Hurt The Consumer

Lovastatin (Mevacor, from Merck) was the first statin drug approved by the FDA in 1987 as a cholesterol-lowering drug in the US. It made history in helping high-risk heart attack patients reduce their cholesterol levels and has helped safe many lives. But with the detection around 2002 that heart disease is an inflammatory disease, and that measuring the C-reactive protein with a blood test was a better than measuring cholesterol levels in predicting who would be at risk for developing a heart attack, the landscape has changed. Lifestyle changes have also been shown to be very effective in reducing cholesterol, C-reactive protein and triglyceride levels. In fact, lifestyle changes will reduce the risk for heart attacks and strokes. The newest flurry of activity with calls for putting more people on statins (see this recent news article) makes me suspicious that there could be a misrepresentation of the facts.

In this blog I am analyzing the literature to get to the bottom of the facts on reducing risk for heart attacks and strokes. I also come to my own conclusion.

Facts about cholesterol

Cholesterol is a waxy substance that is part of the cell walls and plays a vital role in our metabolism. Liver cell membranes, for instance contain about 30% cholesterol. However, most of the cholesterol in our body comes from metabolism, 20 to 25% from the liver, the rest in the gut, adrenal glands and the reproductive organs, and also from the brain (the myelin sheaths contain a lot of cholesterol). 50% of the body’s cholesterol is recycled through bile salts and reabsorption of cholesterol in the gut (called the enterohepatic pathway).

Cholesterol is vital for cell function, for insulation of nerve fibers (myelin sheaths) and for synthesis of our steroid hormones (sex hormones and vitamin D3, which  is now considered to be a hormone). The medical establishment took most of the information regarding heart attack and stroke prevention from the ongoing Framingham study. This clearly pointed to the importance of lowering the LDL cholesterol fraction (the “bad” cholesterol) and maintaining or increasing the HDL fraction (the “good” cholesterol). When it was realized that concentrating only on lowering cholesterol missed 50% of all heart attacks that researchers refocused and found the missing link, namely inflammation. Inflammation is at the cause of heart attacks and strokes, high cholesterol and lipids were only secondary phenomena. Ref. 2 points out that a comprehensive approach to treating a patient with high cholesterol should involve a combination of treatments aimed at the underlying risk factors for heart disease or stroke in a particular patient. This involves sophisticated blood tests where a metabolic derangement can be pinpointed. It should include measuring cholesterol fractions, lipids, the C-reactive protein, hormone levels and more.

Statins Can Hurt The Consumer

Statins Can Hurt The Consumer

How the traditional thinking about cholesterol has changed

The Framingham study has provided the basis for the drug industry to produce statins until about 2002 when our thinking about cholesterol being the culprit for causing heart attacks has forever changed. Subsequently further research showed that other factors like inflammation of the blood vessels, the metabolic syndrome associated with obesity and lack of exercise were also to blame for causing heart attacks and strokes. Recently more details have come to light, which point to multiple causes like the consumption of too much sugar, too much trans fats, too much salt and eating too much over processed convenience food.  We end up gaining weight, develop the metabolic syndrome and inflammation of arteries (including the coronary arteries of the heart and the brain vessels). It is the lack of nitric oxide in the lining of the arteries, which combined with inflammatory substances from visceral fat are responsible for hardening of the arteries as the ultimate consequence of faulty nutrition and lack of exercise. We also know that oxidized LDL, particularly the very low-density lipoproteins (VLDL), will release free radicals and damage the arterial walls. CoQ-10 is a supplement, which is known to counteract this. One important test that had developed out of the Framingham study is the “ratio of total cholesterol to HDL cholesterol”, which is used by cardiologists to determine the risk of coronary artery disease. The average risk of this ratio for Americans is 5.0 for males and 4.4 for females. The ideal ratio to strive for is  the “1/2 average risk” ratio of 3.4 for males and 3.3 for women (Ref.2). A fit, slim person who eats a low carb, normal fat diet (modified Mediterranean diet) will often have a ratio of only 3.0, well below the 1/2 average risk. The moment you introduce grains in your diet (cereals, bread, pasta) your liver will convert carbs into LDL cholesterol, while HDL cholesterol will drop resulting in a high risk ratio of above 5.0 (often 7 or 8 or more). The LDL will get oxidized and is deposited into your arteries setting you up for coming down with a heart attack or stroke down the road.

How do statins work?

The statins are a group of drugs that inhibit an enzyme, called the hydroxymethylglutaryl–Coenzyme A (HMG-CoA), which leads to a lowering of cholesterol, specifically a fraction known as the LDL cholesterol. The success story of lovastatin (Mevacor) led to a flurry of new HMG-CoA reductase inhibitors (cholesterol lowering drugs) such as fluvastatin (Lescol), pravastatin (Pravachol), simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor) in the late 1980’s and the 1990’s. Collectively it is now a 26 billion industry in annual sales.

Later investigations showed that there were other mechanisms by which statins helped, namely they were found to decrease the inflammatory reaction, which can be measured by lowering of the C-reactive protein. However, there are significant side effects in about 1 to 3% of people who take this medication, particularly an inflammation of liver cells (evident from elevation of liver enzymes) and a myopathy, which is a painful muscle condition (Ref. 1). This latter fact, which can occur in as many as 33% of the population at large (particularly the exercise minded) has limited the use of statins in competitive athletes where myopathies can occur in as many as 75% of athletes treated with statins (Ref.2). The reason for that is that the muscles of athletes cannot keep up with the demands put on them when they are kept in check by the HMG-CoA reductase inhibitors. On the other hand statins have prevented heart attacks and deaths from heart attacks and strokes in about 25% to 35% of patients treated with them as many clinical trials have shown (Ref.1), but simple supplements that have no side effects can do the same or do even better (see below).

The lack of cholesterol synthesis by the body’s cells when statins are given, leads to an expression of more LDL receptors on the cell surfaces. LDL binds to these receptors and enters the cells, which removes the circulating high risk LDL fraction of cholesterol from the blood thus causing a drop in LDL cholesterol. All of the side effects of statins (pull down to side effects in this link) can be explained as a result of the slow-down of organ functions (brain, muscles, gut, adrenal glands, etc.) as cholesterol synthesis is reduced.

New information from the Framingham Heart Study

So far everything I said made sense. But when I came across Ref. 4 I noticed that there was a bombshell of new information from another follow-up study of the Framingham Heart Study (Ref. 5) that did not fit in with the latest marketing drive of the statin manufacturers. In this study from 2005 Boston researchers had studied the outcomes of 789 men and 1105 women over a period of 16 to 18 years with respect to cognitive function. Participants were divided into total cholesterol groups that showed levels that were desirable (less than 200), borderline (200 to 239) or high (above 240). The astounding results were that higher cognitive functioning as documented in multiple cognitive tests in these three groups showed the best performance in the group with the highest cholesterol and the worst cognitive test outcomes in the lowest cholesterol group, quite opposite of what was expected.

Another important piece of research (April 2013) comes from Spain where doctors followed a group of 7447 patients with a high cardiovascular risk who were put on a Mediterranean diet with olive oil, a Mediterranean diet with nuts or a regular diet. The end point was death from heart attack or stroke. After 4.8 years the study had to be interrupted as the Mediterranean groups showed a significant survival advantage over the group on a regular diet.

Ref. 4 cited literature evidence that statins cause a 48% increased risk in postmenopausal women who take statins to develop diabetes. It also cites compelling evidence that diabetes patients are twice as likely to develop Alzheimer’s disease within 15 years and are 1.75 times more likely to develop any kind of dementia in the same time period.

Dr. Seneff from the Computer Science and Artificial Intelligence Laboratory at MIT explains in great detail that statins effectively reduce cholesterol synthesis in the liver, which in turn starves the brain of one of its main nutrients explaining why patient develop Alzheimer’s disease and dementia as a result of statin treatment.

So, the lessons to be learnt from these clinical trials are that you want to offer your brain enough cholesterol and healthy fat to have a normal metabolism. Fortunately, what’s good for your heart is also good for your brain. Conversely avoid statins, if you can and try alternatives first. Ref. 4 explains that for years the experts had the wrong theory that low fat/high carb was what would be good for your heart and brain, but the opposite is true: what is good for your heart and brain is a high healthy fats/low refined carb diet.

Make sure that with your blood tests that fasting insulin is low (no insulin resistance), that the ratio of total cholesterol to HDL cholesterol is less than 3.4 (low risk for heart attacks or strokes) and that the hemoglobin A1C level is low (4.8 to 5.6%, ideally less than 4.5%), which means you are not diabetic.

How alternative treatment can save you from heart attacks

Lifestyle treatment through dietary intervention, moderate exercise, and weight loss has been somewhat neglected by mainstream medicine, but is now recognized in regular textbooks of medicine as first-line treatment (Ref. 3). Most patients can lower LDL cholesterol by 10 to 15% through a change in diet. High-risk patients with established heart disease (narrowing of coronary arteries) require a drop of 30 to 60% of LDL cholesterol; this high-risk patient group may need an addition of a statin. In patients with metabolic syndrome or diabetes high triglycerides are often present and will respond to decreased intake of simple sugars, alcohol, and calories (Ref.3). Total calorie intake should be adjusted according to what the weight is when weighed every day with the goal of reducing the weight when overweight or obese, but maintaining the weight when it is in the normal body mass index range (BMI of 20 to 25). The total fat intake should be around 25%-35% of the total calorie intake. Specifically, saturated fat needs to be less than 7% of total calories, polyunsaturated fat up to 10% of total calories and monounsaturated fat up to 20% of total calories. Healthy fats according to Ref. 4 are extra-virgin olive oil, organic butter, almond milk, avocados, olives, nuts, nut butters and cheese ( except for blue cheeses). Other healthy fats are sesame oil, coconut oil, and the oils found in seeds like flaxseed, sunflower seeds, pumpkin seeds and chia seeds. Note that trans-fats (such as in margarine and baked goods) are a “no-no” as it causes free radicals in your body, which would accelerate the hardening of your arteries. Complex carbohydrates from vegetables and fruit are the main source of total calories providing 50%-60% of the total calories. Fiber intake needs to be 20-30 grams per day. Protein intake should be about 15% of total calories. Fat should provide 25% to 35% of the total calories per day. Cholesterol intake should be less than 200 mg per day. You may want to consider the use of plant sterols (2 grams per day) to enhance LDL cholesterol lowering. Physical activity from moderate exercise should expend at least 200 kcal per day (better 300 kcal).

Which supplements prevent heart attacks and strokes?

There are several nutrients that have been shown to be powerful preventers of heart attacks and strokes. I will review them briefly here (based on Ref. 2):

1. Coenzyme Q10 (CoQ10): The cells lining the arteries are only working well when their mitochondria are working properly producing chemical energy in form of ATP. CoQ10 is an important component of the mitochondrial metabolism; it is also the only fat soluble antioxidant that gets absorbed into the LDL particles where it protects these from oxidation. Statins suppress CoQ10 synthesis, so patients on statins need to take CoQ10 supplements daily to counteract this. However, anybody who is healthy now should take CoQ10 as a daily supplement for prevention. I take 400 mg per day.

2. Vitamin E (tocopherols): this fat soluble vitamin is an antioxidant and has been praised in the past as being heart supportive, was subsequently bad-mouthed by some conservative physicians, but lately has been resurrected. It turns out that there are 8 different types of tocopherols, with the alpha tocopherol being the most known, but gamma tocopherol is the one you want to make sure you are also getting with your balanced vitamin E supplement every day as this is the one that is a powerful anti-inflammatory. Simply ask staff at your health food store for a vitamin E supplement with gamma tocopherol in it. Take 400 IU per day (of the mix).

3. Curcumin: This is a powerful heart and brain protector combining three different mechanisms in one; it is reducing oxidative stress, is an anti-inflammatory and counters the process that threatens to destroy the lining of the arteries. One study on healthy volunteers showed a reduction of 33% in lipid oxidation, a 12% reduction of total cholesterol and an increase of 29% of the protective HDL cholesterol when 500 mg of curcumin was taken only for 7 days (Ref.2). This is the daily dose I would recommend for prevention of heart attacks and strokes.

4. Polyphenols: Flavonoids are the largest group among the polyphenols contained in such common foods as vegetables, fruits, tea, coffee, chocolate and wine.  Over 130 studies have been done on humans showing improvement of the lining of the arteries (endothelial functioning) and lowering of blood pressure. Polyphenol consumption has been associated with a lower risk of mortality from heart attacks. Eat a Mediterranean type diet or a DASH diet and you will automatically get enough polyphenols with your food. However, resveratrol, the powerful red wine polyphenol warrants a separate daily supplementation as it prevents LDL oxidation in humans (Ref.2). Take about 250 mg of it daily.

5. Niacin/nicotinic acid: This supplement comes as “flush-free niacin” and also as extended release niacin; it can raise the beneficial HDL cholesterol by 30 to 35% when higher doses of 2.25 grams per day are used. In a metaanalysis of 7 studies it has been shown to significantly reduce heart attacks and transient ischemic attacks (precursor syndrome before developing a stroke). Niacin can change the small particle LDL into a large particle size LDL, which is less dangerous. Niacin has also been shown to reduce oxidation of LDL, which stops the atherosclerotic process. For a healthy person 500 mg per day of flush-free niacin is adequate.

6. Fish oil (omega-3-fatty acids): Because heart attacks are due to an inflammatory process and high LDL cholesterol is thought to be only a secondary phenomenon, it is very important to have this additional tool of an important anti-inflammatory supplement. In the past it was still safe to eat fish fairly frequently per week. But with mercury, radioactive iodine from Japan’s leaking reactor and carcinogenic PBC’s all congregating in the ocean waters, it is no longer safe to consume fish in large quantities. The remedy to this situation is molecularly distilled (or pharmaceutically pure) EPA/DHA supplements. EPA stands for eicosapentaenoic acid or omega-3 fatty acid. DHA is the acronym for docosahexaenoic acid. Fish oil supplements at a dosage of 3.35 grams per day of EPA plus DHA were shown to reduce triglycerides by up to 40%, equally to Lipitor or even more effective, but without the statin side effects. The amount of the dangerous small dense LDL is also being reduced with fish oil. Fish oil supplements have reduced the mortality from heart attacks and strokes and led to a higher survival from non-fatal heart attacks. At the same time these preventative fish oil doses will also treat and prevent arthritis.

7. Other useful supplements: Soluble fiber from psyllium, pectin, beta-glucans and others have been shown in clinical trials to reduce LDL cholesterol by binding bile salts in the gut (interrupting the enterohepatic pathway). Plant sterols (usually sold as sterol esters) are recognized by the FDA as reducing the risk of coronary heart disease, if taken in high enough amounts (2.4 grams of sterol esters per day). There are other useful supplements like artichoke extract, pomegranate, soy protein, Indian gooseberry (amla), garlic and pantethine (vitamin B5) that have been proven to be of benefit in terms of prevention of heart attacks and strokes. It would be too lengthy to get into more details here.

Conclusion

Recently there was a review in a medical journal that demonstrated that clinical guidelines (in this case for clinical guidelines for lowering cholesterol) erred 40% of the times when measured against scientific tests as this link explains. When it comes to saving lives by preventing heart attacks and strokes, what is needed is a multifactorial approach that treats the multifactorial causes of cardiovascular disease. Just pushing for treating more people with statins as Big Pharma is attempting to do is not addressing the fact that cholesterol is needed for our metabolism and the synthesis of our hormones. It is much superior to use a combination of different approaches that overlap and thus potentiate each other in their effects excluding statins first. Exercise creates more nitric oxide production by the lining of the arteries, which opens up arteries and prevents spasms. A proper diet with as many of the proven vitamins and other support factors will control inflammation and oxidation of LDL cholesterol particles as explained. This will prevent heart attacks and strokes as has been shown in many clinical trials. Only patients who come from families with genetically high cholesterol or high triglycerides and those patients who had heart attacks and strokes should be exposed to statins as they are at a higher risk of developing a heart attack or stroke. They need all of the help they can get in addition to the lifestyle factors mentioned. Most other patients and the public at large will do quite well without statins (no side effects of diabetes, Alzheimer’s and muscle pains). And, yes, a diet high in healthy fats, but low in refined carbs is what your brain and heart need (the opposite of what you have thought, see Ref. 4).

More information about side-effects of statins (acute pancreatitis): https://www.askdrray.com/pancreatitis-can-occur-with-statin-use/

Lower cholesterol with Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

 

References

1. Bonow: Braunwald’s Heart Disease – A Textbook of Cardiovascular Medicine, 9th ed. © 2011 Saunders.

2. Life Extension: Disease Prevention and Treatment, Fifth edition. 130 Evidence-Based Protocols to Combat the Diseases of Aging. © 2013

3. Melmed: Williams Textbook of Endocrinology, 12th ed. © 2011 Saunders.

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

5. http://www.psychosomaticmedicine.org/content/67/1/24.full.pdf

Last edited Nov. 7, 2014

Nov
09
2013

Successful Diabetes Treatment Requires Patient’s Discipline

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

Sep
28
2013

Sleepless Nights

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