Jan
18
2014

The Superpowers Of Vitamin D

Introduction

This article deals with the superpowers of vitamin D. Originally, researchers found that vitamin D was the missing ingredient in preventing rickets in growing children. They established that 400 IU of vitamin D daily prevented rickets. Medical investigators determined that the active metabolite was vitamin D. The body has receptors on all vital organs for vitamin D. This includes the heart, brain, bones, kidneys and liver. In recent years new findings showed that the RDA of 400 IU of vitamin D3 daily was too low for many diseases. In other words, many diseases can develop when vitamin D intake is too low, particularly in the aging population. Researchers showed that higher doses of vitamin D3 in the range of 800 to 1000 IU per day prevent osteoporosis, falls and fractures in older adults and in nursing home populations.

The immune system requires higher doses of vitamin D3

But the immune system of everybody is dependent on higher doses of vitamin D3. Recently (Dec. 12 to 15, 2013) I attended a lecture at the A4M conference in Las Vegas where Dr. Eisenstein reviewed the latest on vitamin D3. It is now known that 2/3 of the US population is deficient for vitamin D as measured by blood tests (less than 25 ng/ml).  The standard test is the 25-hydroxy-vitamin D level (abbreviated as 25(OH)D level). It is now known that you require at least a level of more than 40 to 60 ng/ml of 25(OH)D as measured in the US, which translates to more than 100 to 150 nmol/L measured in metric units in other countries, to prevent cancer.

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

90% of the vitamin D3 that we need comes from exposure to sunlight. This transforms a cholesterol metabolite (7-dehydrocholesterol) into the vitamin D precursor (vitamin D3 or cholecalciferol). We absorb this from naturally occurring fish oil and oily fish. Otherwise this does not naturally occur in foodstuffs (Ref. 1). Dr. Eisenstein pointed out that it is well known that people living north of the 37th degree latitude lack vitamin D3 because of a lack of sun exposure, particularly in the winter season. People south of the 37th degree latitude have enough sun exposure. But wherever you live, it is advisable to have your vitamin D3 level measured (as 25(OH)D level). If you do not eat enough fish or fish oil, the levels likely are too low as is the case for 2/3 of the US population.

Oral vitamin D3 supplements

Patients whose vitamin D levels are too low have to take vitamin D3 supplements. Vitamin D3 is further metabolized by the liver and then by the kidneys into the active vitamin D compound, called 1,25(OH)2D3 (which is called “calcitriol”). The main effect of calcitriol is to absorb calcium and phosphate from the intestine into the blood stream. Together with vitamin K2 as explained in a prior blog these minerals are then taken up by the bone to prevent osteoporosis or rickets in the growing child. What has not been known for a long time is that vitamin D3 is also necessary for normal cell metabolism by most of your body cells, but particularly by the vital organs like the brain, the heart, the kidneys, the liver, the immune system and the bone.

Some people require higher doses of vitamin D3

However, doses of 5000 IU to 10,000 IU of vitamin D3 capsules per day are necessary for optimal vitamin D3 health. This leads to levels of below 150 ng/ml of 25(OH)D levels, which were shown by researchers to be safe. According to Dr. Eisenstein no toxicity has been found below 30,000 IU of vitamin D3 per day, but based on other authors a dose of 10,000IU should be adequate for most people. Strangely enough colored people also have to take vitamin D3 supplements as the higher melanin pigment in the skin filters out UV light so effectively that their 25(OH)D level can be low. Always err on the cautious side and have your vitamin D3 blood level taken. Vitamin D3 has a characteristic stereotactic configuration (cis-triene structure), which allows it to bind free radicals and function as an antioxidant (Ref.2).

What are some of the clinical effects of vitamin D3?

  1. Vitamin D3 has diverse effects on organs systems as Dr. Eisenstein summarized: vitamin D3 lifts depression and is of particular value for drug resistant depression. Take 5000 to 10,000 IU of vitamin D3 per day.
  2. Muscle power increases with vitamin D3, particularly in those who work out regularly.
  3. Many fertility clinics pay attention to vitamin D3 levels, as the higher the blood levels of vitamin D3 in a man, the faster this sperms move! And the more vitamin D3 she has on board, the better she ovulates. The end result is a higher pregnancy success rate when both partners take 5000 to 10,000 IU of vitamin D3 per day

Vitamin D improves teeth in offspring, helps with chronic pain

  1. Also, if a woman takes vitamin D3 during her pregnancy, the first set of teeth in the offspring will have fewer cavities.
  2. Brain development in autistic children is much improved with vitamin D3 in higher doses. This needs to be combined with detoxification methods and supervised by one of the DAN physicians.

6.Chronic pain typically improves when physicians treat vitamin D3 deficiency, which almost always is present in patients with chronic pain.

Prevention of flus and Covid-19, asthmatics improve

  1. To prevent flus and colds and other infectious diseases, take higher doses of vitamin D3. When you come down with a flu, it is safe to increase your daily vitamin D3 intake to 30,000 IU of vitamin D3 for a few days until your symptoms improve, then resume your maintenance dose of 5000 IU to 10,000 IU per day.  This year’s dominant flu is the type A, subtype H1N1 – also known as the swine flu. Children should get 50% of the dose regimen detailed for adults when they develop a flu (for children: 15,000IU for three to five days , with tapering to a maintenance dose of 2500 to 5000 IU until blood levels of 25(OH)D are available). Here is a website about the pros and cons of vitamin D where dosages are also discussed.
  2. Asthmatic patients do better with vitamin D3 supplements requiring less maintenance anti-asthmatic medicine to keep them balanced with regard to their airways.

Partial prevention of Alzheimer’s disease with vitamin D

  1. Chronic low vitamin D3 levels cause brain damage including Alzheimer’s disease. In this context it is important to know that the enzymatic conversion in the liver and kidneys slow down as we age.  Older patients require higher doses of vitamin D3. This may have been the reason for the confusion about relatively low doses of 400 IU of vitamin D3 preventing rickets in children versus the need for much higher doses of vitamin D3 in middle aged and older patients.
  2. There is a link of high blood pressure to vitamin D3 deficiency and it is better manageable with medication when vitamin D3 levels are normal.

Vitamin D lengthens telomeres and increases longevity

  1. Live longer with vitamin D3. How is this possible, you might ask: the answer has been found in the telomeres, the shoelace like structures at the end of the DNA strand of each cell. Vitamin D3 lengthens the telomeres and promotes telomere repair; there is an association of vitamin D3 and a longer life span. Centenarians have longer telomeres. You can measure telomere length, but it is a pricey test, which is not for everyone, contrary to supplementation with vitamin D3 that should be taken by everyone!

Vitamin D fights inflammation

  1. As already indicated, vitamin D3 strengthens the immune system. But it also modulates the inflammatory response from muscle damage, so athletes can perform better. Patients with multiple sclerosis will improve as it slows down the inflammatory process. But other inflammatory diseases like arthritis, inflammatory bowel disease and even cancer respond favorably to higher doses of vitamin D3. In these cases physicians use 20,000 to 30,000 IU of vitamin D3 daily. This information has not yet percolated into mainstream medicine.
  2. Higher percentages of cardiovascular disease occur in patients who have lower than 15 ng/ml  25-Hydroxy-vitamin D levels in their blood meaning that vitamin D3 supplementation prevents heart disease (Ref.3).

What are toxic vitamin D levels?

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25(OH)D blood levels taken from time to time. If vitamin D blood levels exceed 150 ng/mL reducing the vitamin D dose or stopping supplementation is prudent. Otherwise it has been difficult to establish a toxic range. Most publications about toxic levels of  vitamin D point out that anything above 150 ng/mL would be in the toxic range.

This website claims that 40,000 IU of vitamin D3 or more would lead to toxic levels where the blood calcium levels would be increased, which can be measured as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU per day and that led to a blood level of 400 ng/ml of 25(OH)D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine).

Toxic vitamin D levels difficult to find

The papers that indicated that it would be unsafe or unnecessary to take vitamin D3 were untrue. It seems that they had other agendas than communicating the truth. There was no release of calcium from the bones and calcium absorption from the gut was not too high. This would have caused calcification of the bones, soft tissues, heart and kidneys. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. Interesting that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

Patient taking unintentional high doses of vitamin D3 survived

I talked to a participant of the conference with a fellowship degree in anti-aging medicine what knowledge we have about vitamin D3 toxicity. He told me that there has been an unintentional overdose. In this case a compounding pharmacy made a mistake. A patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months. The patient felt sluggish, but did not have any other symptoms. His physician told him to stop the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. At this point no documented overdose of vitamin D3 exists.

Conclusion

Vitamin D3 is a vital supplement. Initially researchers showed that it prevents rickets in children. Subsequently physicians found that it also prevents depression, MS, infections and many cancers (Ref. 4). As usual there will be many critiques that doubt the validity of the above statements. But I have found that all of these effects described above were confirmed in several sources of various medical information. Keep in mind that negative rumours have a tendency to linger on for years.

More information on vitamin D3 for prevention of osteoporosis and hardening of arteries: https://www.askdrray.com/calcium-vitamin-d3-and-vitamin-k2-needed-for-bone-health/

Vitamin D3 deficiency can cause pancreatic cancer: http://nethealthbook.com/news/insufficient-vitamin-d3-linked-to-pancreatic-cancer/

References

1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed.,  © 2011 Saunders

2. Rheumatic Diseases Clinics of North America – Volume 38, Issue 1 (February 2012) , © 2012 W. B. Saunders Company

3. Wang TJ, Pencina MJ, Booth SL, et al:  Vitamin D deficiency and risk of  cardiovascular disease.   Circulation 117. (4): 503-511.2008.

4. “Recognition and Management of Vitamin D Deficiency”: American Family Physician – Volume 80, Issue 8 (October 2009),  © 2009 American Academy of Family Physicians

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

May
05
2013

Get Rid Of Toxins Safely

This article is about “get rid of toxins safely”. You often hear that people use chelation at home with natural foods. Is that true?

The standard chelation detoxification

I like to mention in the beginning that the proven way to reduce heavy metals in the blood (typically mercury and lead) is by intravenous chelating agents such as EDTA. However, the lowering of calcium levels as a severe side effect limits the application of it. There are also blood-thinning side effects to consider. EDTA is a chemically synthesized compound, not a natural substance. Conversely, vitamin C and Glutathione are both antioxidant substances that the body knows; they are non-toxic and can be used more easily intravenously to remove heavy metals like lead and mercury with fewer side effects than EDTA.

Natural ways to use chelation in order to detoxify

Although I think that EDTA has a place in the hands of those who are knowledgeable about the side effects, the vitamin C/Glutathione combination is probably a more physiological detoxification method as glutathione is synthesized by the liver to detoxify our bodies. Intravenous chelation is expensive, requires access to a vein and may not be a suitable way for many people to detoxify. There are natural ways to detox for those who cannot afford chelation or cannot chelate for other health reasons.  The major detoxification organs are: the liver, the kidneys, the gut, the lungs and the skin.

What about oral methods to detoxify?

Several methods of cleansing are fasting, the major cleanse or the raw food cleanse. I would not advise to do strict fasting without fluid intake as it takes fluid intake to be able to dissolve any released toxins into urine, feces, invisible fluid from exhaled air and nasal discharge. Next there is the “master cleanse” with lemon juice, maple syrup and cayenne pepper as indicated in the link above. Some people like trendy procedures that they find in a magazine or in a self-help book. I do not like it, as it reminds me too much of a cookbook approach.

A Vitamix is a good tool to create turn your fruit/vegetables into a chelating tool

I feel differently about a raw food cleanse as I will explain. First, I like to point out that raw food is not easily digested as your gut absorbs only about 30 to 40% of the nutrients. The cell walls of the vegetables you use are the barrier towards absorption. This is much different, if you put the raw fruit and vegetables into a blender with a high-power motor. (There are several brands like the BlendTec or the Vitamix.) The powerful blending process breaks up the cell walls and releases the content of the plant cells including their enzymes and nutrients, so that 80% of the nutrients are absorbed in your gut.

Get Rid Of Toxins Safely

Get Rid Of Toxins Safely

If you use organic ingredients (they do not contain toxins, artificial fertilizer residues etc.) you cannot go wrong! Use spinach, kale, banana, mango, greens, lemon juice, and for fat add some nuts like walnuts, Macadamia nuts, almonds (with the proviso that you are not allergic to them). With the help of a powerful blender all this will turn into a liquid drink that actually tastes OK. For protein supplementation I would also add some protein supplement like vegan protein from the health food store, whey protein or egg white protein (good to rotate these protein supplements). This mix is a complete nutritional program as it contains complex carbohydrates from fruit and vegetables, fat from nuts, protein from the protein supplement and fiber (from the whole vegetables and fruit).

Natural detoxification from organic fruit and vegetables

You will not get hunger pangs as with a fast or the master cleanse. Use the signs of your body as guidance. If you feel energized after 5 days, stop then and return to your normal food intake. This is a zone type diet, a Mediterranean diet or South Beach diet as explained below. Some people have the willpower to do 7 to 10 days of the liquid diet described. Good for them, at least they do not starve themselves as the calories and total nutrient content are there while they detoxify. What are the agents that lead to the detoxification process? The enzymes from the fruit and vegetables, the lack of toxins as you only consume organic ingredients, the extra vitamin C from the food and the glutathione from your liver are all working together for detoxification.

Are there supplements that can help you to detoxify?

Chlorella powder, which you can buy in health food stores, is one of the few supplements that can detoxify your body from heavy metals. As Dr. Mercola describes that in Japan chlorella powder is one of the most popular supplements to detoxify. It is difficult to get a complete, non-biased picture about chlorella. I did an extensive research in MD Consult about the scientific evidence for detoxification by chlorella in humans. Unfortunately, the search results came back only for experiments with mice and rats, but there were no human detox results.

Chlorella detoxification

Perhaps the Wikipedia description about the history of algae and chlorella as a possible food supplement sheds some light on the difficulties getting real hard data on chlorella detoxification. Researchers poisoned rats deliberately with cadmium (a heavy toxic metal). There was no evidence of detoxification with chlorella when the researchers stopped cadmium poisoning. However, the article goes on to say that chlorella did prevent absorption of cadmium from the intestines to a certain extent (in rats).

Liver detoxification and colonic detoxification

Dr. Max Gerson invented coffee enemas many years ago when he treated end stage cancer patients with natural methods. He found that when he detoxified them with raw juices, many cancer patients died from the toxic breakdown products of dying tumor cells. So he was in dire need of a procedure that would remove the toxic tumor substances efficiently.  This is when Dr. Gerson used coffee enemas. As the link above describes, coffee given through the colon as an enema (we would perhaps call it “coffee colonics” today) stimulates the liver and the bile flow thus detoxifying the blood effectively of toxic materials. In addition, the secretory capability of the large surface of the colon wall also helps the detoxification process. Juicing in combination with coffee enemas improved Dr. Gerson’s end stage cancer cure rates dramatically.

Dr. Kelley introduced supplementation with Mega pancreatic enzymes

Subsequently, Dr. Kelley developed his nutritional-metabolic therapy for end stage cancer patients where he added large amounts of pancreatic enzymes in addition to coffee enemas. Dr. Denis Burkitt is credited for recognizing the importance of fiber in the diet. He noticed that there was a striking difference between the colon cancer rates in England versus the rates in Africa. He analyzed food habits in both locations and found that in England there was not enough fiber consumption.

Diet high in vegetables, fruits and whole grains reduces colon cancer rates

A large study done by the Harvard Medical School showed that it was not so much the fiber that helped to prevent colon cancer. Further large scale studies were done and it was shown that a diet high in vegetables, fruits, and whole grains was what was responsible for a reduction in colon cancer rates. This type of diet will also help detoxify your system from carcinogenic substances in general and from other toxins as the soluble fiber inside the gut will attach to it and go down the toilet instead of being reabsorbed in the colon into your system causing cancer.

Skin detoxification

The skin is the largest body organ with a lot of skin surface where skin pores can help detoxify under the right circumstances. You can achieve this with infrared saunas, with exercise that leads to production of sweat and by soaking in Epsom salt baths. Traditionally this has been done for centuries in the European spas, originally described by Sebastian Kneipp. The medical establishment in Europe (France, England, Germany, Austria), unlike American physicians, embraced the concept of natural therapies under the term “balneology”, at least for a number of decades. But  overuse by patients (abusing the system), badmouthing the relatively weak effect of detoxifying by Big Pharma and lack of funds from the health insurance companies put a damper on his movement. Part of this approach was the use of skin detoxification with healing baths (using Epsom salt and other salts) and physical exercise to the point of sweating.

Wechselbäder according to Sebastian Kneipp

In addition, “Wechselbäder” according to Sebastian Kneipp (alternating hot and cold baths) are also useful to stimulate the circulation and the immune system. The major component of Epsom salt is magnesium sulfate, which can be absorbed through the skin to a certain degree. So, some of the healing effect of Epsom salt baths may have come from an indirect balancing of low blood magnesium and the normalization of many metabolic processes that require magnesium as cofactors. Here is another, more vernacular description of Epsom salt use. Some of the assumptions such as improvement of diabetes, improvement of digestive absorption or relief from migraine headaches may be a combination of exaggeration and placebo effect rather than reality.

Kidney detoxification

The kidneys along with the liver are the major, natural detoxification organs of the body. However, they need enough fluids to dissolve water-soluble toxins and eliminate them from the body through the urine. Consume clean water intermittently during the day (reverse osmosis water in glass bottles or BPA free bottled water). Because alcohol is a cell poison damaging the vital organs like the brain, heart, liver and kidneys it is best to minimize any alcohol intake to the absolute minimum (best to avoid alcohol altogether). The main filtration devices in the kidneys are the glomeruli, little packages of convoluted capillaries, which filter the blood several times per day.

Too much salt and sugar interfere with normal glomerulus function

High salt intake, too much sugar and too much starch interfere with normal function of the glomeruli. Insulin resistance in cases of metabolic syndrome and diabetes (often in people with obesity) can damage the kidneys.  In this case the filtration devices of the kidneys suffer damage and cause toxin accumulation. To prevent damage of the kidney capillaries you need a healthy, basic diet like the Zone diet, South Beach diet or the Mediterranean diet as mentioned in this link.

This will keep fat deposits out of your arteries and maintain the capillaries of the glomeruli of your kidneys. This means that the filtration process continues to work until a ripe old age. Your doctor can order tests (creatinine clearance) to assess whether the filtration capacity of your kidneys is normal.

Many toxins are fat-soluble

Many toxins are fat-soluble and store in the fatty tissues. When you lose weight, you need to drink more fluids to get rid of the water-soluble toxins. This occurs through the kidneys. You can also use coffee enemas to rid yourself of fat-soluble toxins (through bile and bowel movements).

There are a lot of websites that want to sell you herbs that should cleanse your system. They have a marginal effect. But I like to stress that you want to adopt one of the diets mentioned above first. This starts you with a healthy baseline. Such herbs as Buchu (Agathosma Betulina), Burdock, Echinacea and Yellow Dock Root (Rumex Crispus) are supposed to help the kidneys to detoxify. I am not certain whether there is medical proof for this.

Conclusion

Detoxification starts with adopting healthy food and lifestyle habits first. A low carb, low fat type diet (zone diet, a Mediterranean diet or South Beach diet) are essential. They are the footing from which the other detoxification methods work. Some of the toxins will leave you when you work out and sweat. More will leave you when you enjoy an Epsom salt bath. This gives you some extra magnesium, which in turn detoxifies your system. The detoxification takes place  through several biochemical reactions where magnesium is a cofactor. Colonics or enemas will help remove toxins through your colon and they are more effective when coffee enemas are used (stimulation of your liver through the splanchnic nerves).

Infrared saunas

Infrared saunas can help to mobilize toxins and detoxify them through your skin. Take ample amounts of fluids as this will help remove some toxins through the kidneys and the urinary system. If the physician detects major heavy metal poisoning, the traditional intravenous chelation treatments are more recommendable. A naturopathic physician or A4M physician (anti-aging physician) could advise you what is best in your case. Overall the thought is that by removing toxins the mitochondria in our cells will work more efficiently. They are particularly concentrated in the brain, heart, liver, and kidneys. When they work more effectively they give you more energy and prevent major diseases. These diseases are cancer, cardiovascular disease (heart attacks and strokes), diabetes, arthritis and loss of cognitive function. The latter prevents Alzheimer’s disease and dementia.

More information about:

1. Chelation therapy: https://www.askdrray.com/tact-study-proves-effectiveness-of-chelation/

2. Vitamins, minerals and detoxification: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

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Apr
21
2013

On World Health Day 2013 the Focus is on Hypertension

Introduction

This article is about this: on World Health Day 2013 the focus is on hypertension. In the US high blood pressure causes 348,000 American deaths per year, in the world its death toll amounted to 9.4 million every year. This is unfortunate as high blood pressure is an illness, which can both be effectively treated and prevented. Uncontrolled high blood pressure (hypertension) causes heart attacks and strokes, can cause kidney failure, heart failure and blindness. You control blood pressure with lifestyle changes and/or medication,  and these risks go away.

The age standardized death rate  (Ref. 1) for both sexes in the US for heart disease is 80.5 per 100,000 and for strokes 25.4. In Canada these rates are 66.2 and 22.9. For  Germany the rates are 75.0 and 31.2, in Italy 51.7 and 34.9 and for Japan 31.2 and 36.7. The death rates from cardiovascular disease per 100,000 people in the same countries is as follows: in the US 172.2, in Canada 130.7, in Germany 200.2, in Italy 153.5 and in Japan 107.1.

There are obviously significant differences in these countries, which I will discuss further below.

Topic of high blood pressure

World Health Day was celebrated on 7 April 2013 to commemorate the founding of the WHO in 1948. In 2013 the topic of high blood pressure made the World Health Organization edit a PDF publication of 155 pages. It is entitled “Global Atlas on cardiovascular disease prevention and control” (Ref.1, be patient, loads slowly). In it prevention and treatment for high blood pressure are discussed in detail. This text points out that there has been a remarkable decline in death rates from heart attacks and strokes (collectively called “cardiovascular disease”) between 1981 and 2000 in the United Kingdom.

Decline in death rates from heart attacks and strokes

A thorough analysis of this showed that 58% of this decline was due to risk factor reduction in the whole population. This included reduction of smoking and heavy alcohol consumption, reduced salt intake, combatting physical inactivity and reduction of saturated fat intake. The other 42% of the decline in cardiovascular disease is due to treatment by a physician. So, it is clear from this that the majority of mortality prevention comes from the patient, less than 50% comes from the treating physician. However, it is important that physicians will educate their patients to cut out risk factors themselves in order to prevent hypertension.

World Health Day 2013, Focus on Hypertension

World Health Day 2013, Focus on Hypertension

Risk factors for high blood pressure

On World Health Day 2013 the focus is on hypertension. In the past it was thought that most cases of high blood pressure would be due to “essential hypertension”, a term saying “we don’t know what causes high blood pressure”. Many physicians still use this term. Physicians thought that only a small amount of cases were due to “secondary” hypertension with an apparent cause (e.g. kidney disease, hormonal imbalance, pregnancy). But in the meantime research by Harvard University and other research institutions has shown that there are a number of specific causes that contribute to high blood pressure, either alone or in combination.

Common causes of high blood pressure

Here are the commonly known causes: too much salt in our diet; we tend to not eat enough vegetables and salads; we like to sit in cars, in front of the TV or in front of the computer (physical inactivity). Many people still smoke, although tobacco is known to cause high blood pressure and lung cancer. Too much alcohol is known to cause hypertension as well. So the following steps will prevent high blood pressure:

  1. consuming less salt
  2. eating a balanced diet (preferably the DASH diet)
  3. engaging in regular physical activity
  4. avoiding tobacco use
  5. avoiding harmful use of alcohol (more than 2 oz. or 60 Grams per day)

Diabetes worsens the risk for heart attacks and strokes

Physicians know that diabetes worsens the risk for heart attacks and strokes and increases the risk of high blood pressure as well. So, some hidden risk factors for high blood pressure related to diabetes are as follows: a high fasting blood sugar; obesity; food with too much fat, too much sugar and too many starches (not enough complex carbohydrates).

What can we do to reduce death rates from high blood pressure?

As Canada is one of the countries where the death rate from strokes and heart attacks is lower than in the US or Germany, I like to point out some of the reasons for this. I practiced medicine in Canada for many years. The “Canadian Hypertension Education Program” have been guidelines for practicing physicians to follow providing effective screening and treatment of high blood pressure. Cardiologists at various continuing education conferences have promoted this.

High blood pressure recalls at my medical office

At my office I had a hypertension recall program where my staff called every patient with high blood pressure into the office every 3 months. We would review the home-measured blood pressure readings from the patient (recorded in a little booklet). I also took the blood pressure of the patient and so did my staff on the patient’s arrival. We reviewed the blood pressure medication and reviewed the possible side effects. I explained to the patient what to do, if the blood pressure was higher than normal (possible adjustments of the medication at home). I also encouraged my patients with regard to the life style issues (the 5 points mentioned above). Over the years the number of patients who developed heart attacks or strokes declined, as one would expect.

Literature review in the medical journal Canadian Family Physician

A recent review in the Canadian Family Physician mentions that there is room for improvement regarding the Canadian statistics. As mentioned above Italy and Japan are doing better with regard to mortality from heart attacks and strokes compared to Canada. We have a health care system in Canada that is available to every Canadian resident and funded by provincial taxes. In this system patients do not have to pay for office visits (although they pay for it indirectly through taxes). For the patient with high blood pressure, it means that there is a system in place, which helps prevent cardiovascular disease and treats high blood pressure effectively. In my opinion the home recording of self-measured blood pressure readings at least once per day with a home blood measure monitor is vital to encourage the patient to be engaged with regard to his/her blood pressure problem.

Newer findings about high blood pressure

For years physicians did not know where high blood pressure came from. In the last few years research has shown that nitric oxide plays an important role in preventing high blood pressure. The lining of your arteries produce nitric oxide (by the so-called “endothelial cells”). This is the natural artery relaxer.

Foods that produce nitric oxide in the body are spinach, kale, red beet, cabbage varieties and other vegetable greens. These foods, which are also contained in the DASH diet, and regular exercise will stimulate the lining of your arteries to produce nitric oxide, which prevents high blood pressure, heart attacks and strokes.

Treating high blood pressure with medication

If these measures and recommendations to prevent high blood pressure do not help, it is time to treat it. It is important that the patient who needs high blood pressure treatment with medication, takes the medicine regularly. This has the name”compliance”. By keeping the blood pressure reading below 120/80 you prevent your risk of getting a heart attack, a stroke, heart failure or blindness from broken retinal vessels. If the patient develops any side effect from the medication, it is important to see the physician about this right away. It may be that the medication has to be adjusted or altered.

Nitric oxide

Nitric oxide can be taken as a supplement (Neo40), which allows the endothelial lining to be regenerated as indicated in this interview with the inventor, Dr. Nathan Bryan from the University of Texas Health Center in Houston.

The older we are, the more likely it is that our blood pressure will be high. As this link shows, 2 out of 3 people above the age of 60 in the US have systolic hypertension (the upper value of the blood pressure is elevated). As we age, it appears that the lining of the arteries do no longer produce the required amount of NO (nitric oxide). NO is necessary to prevent high blood pressure and prevent hardening of the arteries.

Adopt the Mediterranean diet 

So, it would be wise to adopt the Mediterranean diet. This includes lots of vegetables, spinach, kale, bok choy, Swiss chard and others to boost your NO production. You still measure your blood pressure regularly. If you do not have a home blood pressure monitor, go to a pharmacy that allows you to check your blood pressure for free. If it is above 120 over 80 seek the advice of a health professional. You can find more information in Ref. 1.

In essence, what World Health Day 2013 asks us to do is to pay attention to your blood pressure and make sure it is normal.

More on high blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

References

Ref. 1)  http://www.nethealthbook.com/articles/cardiovasculardisease_hypertension.php

Last edited Nov. 6, 2014

May
01
2008

Glucose and Colorectal Cancer Are No Sweet Deal

It has been noted in various publications that insulin resistance carries a host of health risks: aside from type 2 diabetes, there is cardiovascular disease. Also high insulin levels are associated with growth hormone like substances in the body. These substances are contributing to the development of some cancers.

There is other extensive medical literature stating that glucose (=sugar) and refined carbohydrate (cookies, cakes, French fries, doughnuts, bread, rice, potatoes)  intake lead to chronic inflammation in blood vessels throughout the body, but also to a weakening of the immune system. This explains why such varied diseases as high blood pressure, hardening of arteries with resulting strokes and heart attacks, diabetes, asthma and cancer are caused by the same chronic inflammation that in turn is brought on by our eating habits of a refined diet consumed by most industrialized nations. This blog deals only with cancer of the colon and cancer of the rectum as a result of  chronic inflammation.

Researchers from Minnesota and Maryland examined 375 individuals with recurrent polyps (=adenomas) and the identical number without recurrent adenomas. They followed the course of the patients for 4 years. In their study they looked at fasting serum. Patients who were found to have the highest levels of both insulin and glucose in their serum were at an approximately 50% higher risk of colorectal cancer recurrence. The strongest risk factors were elevated glucose levels.

Glucose and Colorectal Cancer Are No Sweet Deal

Glucose and Colorectal Cancer Are No Sweet Deal

The individuals with the highest glucose levels also tended to be slightly older, have a higher waist to hip ratio and a higher body mass index. These results do point out the necessity of keeping a close tab on glycemic control in person with a history of colorectal polyps. It also is evident that consuming foods with a low to medium glycemic index will help to reduce the risk for colonic cancers.

More information about:

1. Colon cancer: http://nethealthbook.com/cancer-overview/colon-cancer/

2. Sugar causes cancer: https://www.askdrray.com/sugar-as-a-cause-of-cancer/

Reference: The Medical Post, April 1, 2008, page 21

Last edited November 3, 2014

Mar
01
2008

U.S. Dietary Guidelines May Have Contributed To Obesity

Dr. Paul Marantz of the Albert Einstein College of Medicine, New York has taken a closer look at the current obesity epidemic. He and his coauthors are observing that Americans have listened to the recommendations to reduce their fat intake. This recommendation which first made its appearance in 1980 pointed out the risk of a high fat diet and its connection to cardiovascular disease. Even though there is enough evidence that a modification of fat intake could reduce cholesterol, the government guidelines against fat have not managed to improve cardiovascular disease outcome. The authors of the publication noted that Americans have slightly reduced their fat intake, but their carbohydrate and total calorie intake have actually increased. The consequence is logical: higher calorie intake is contributing to the rise in obesity and the increase in adult onset diabetes. Dr. Marantz drew on records from the Centers for Disease Control and Prevention to arrive at these results. From 1971 to 2001 fat intake has decreased by 9% in women and 5% in men, but carbohydrate intake went up by 6% in women and 7% in men. Total daily caloric intake went up by 335 calories in women and by 168 calories in men. Both genders showed an increase in obesity. While 55% of men and 41% of women were overweight or obese in 1971, by 2001 the rate had risen to 70% in men and 62% in women. The reasons for this are very likely due to many factors. Aggressive marketing of low-fat foods may have given the public the impression, that these foods can be consumed without consequences.

U.S. Dietary Guidelines May Have Contributed To Obesity

Obesity on the rise since the 1970’s

Another reason likely is that fat in the diet can induce satiety and stop us from eating excess calories. It has not helped to label fat in the diet as an enemy instead of pointing out that small amounts of heart healthy fats in the daily diet are an important part of our nutritional team players and allies in the quest to good health. Key to successful dieting is to consume a low fat diet, rich in unrefined, low glycemic carbohedrates. Caloric intake has to be restricted for successful weight loss.

More information about:

Refined carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/

Metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: American Journal of Preventative Medicine, Feb. 8, 2008

Last edited November 3, 2014

Aug
01
2006

New Screening For Cardiovascular Disease

Checking out the patient’s heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patient’s diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.

Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient’s risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes.

New Screening For Cardiovascular Disease

New Screening For Cardiovascular Disease

It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

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

Reference: National Review Of Medicine, July 30, 2006, page 7

Last edited November 1, 2014

Aug
01
2005

Tight Blood Sugar Control In Diabetics Cuts Heart Disease

Successful treatment of type 1 diabetes in the past usually meant compliance in taking insulin shots and paying attention to a diabetic diet. Since the arrival of specific lab tests like the HbA1c levels, patient education has become more sophisticated: it is not enough to just be on shots, eat sensibly and otherwise hope for the best. As a result, it is a must for patients to monitor their glucose levels closely.
Research that was presented at the American Diabetes Association during the 65th annual scientific session spelled out the benefits very clearly: strict control of glucose levels helps patients with type 1 diabetes to decrease the risk of stroke and cardiovascular disease by 57%!

It has been known that tight glucose control helped to reduce diabetic nephropathy (kidney disease) and diabetic retinopathy (eye disease) in diabetics, but this is the first time that controlling glucose levels has been associated with cardiovascular disease, reports the main investigator, Dr.David Nathan from, director of the diabetes center at Massachusetts General Hospital in Boston. He also reported that every 1% reduction in HbA1c (glycosated hemoglobin) correlated with a 20% reduction in cardiovascular risk for the diabetes type 1 patient.

These findings are significant, as the risk reduction is larger than seen in any other trials, like administering medication (statins) or placing stents.

Tight Blood Sugar Control In Diabetics Cuts Heart Disease

Tight Blood Sugar Control In Diabetics Cuts Heart Disease

A similar risk reduction may also occur in patients with type 2 diabetes, but at this point no specific research on this group is available. In the meantime it is of great importance to any patient with type 1 diabetes.

More information about:

1. Diabetes treatment: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/treatment-type-2-diabetes/

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

Reference: The Medical Post, July 5,2005,page1, 58.

Last edited October 29, 2014