Nov
18
2017

You May Want To Cut Down Coffee Consumption

By | addiction, coffee, heart attack, Mortality, Stroke

Many people drink too much coffee, so you may want to cut down coffee consumption. With all the good news about the health benefits when drinking coffee, some people went too far. They have overdone what was supposed to be good for them. Recently a study came out that tells you how to cut down coffee consumption.

But first I like to review the issue whether to drink caffeinated or decaf coffee. Next I will tell you how you can switch to decaf coffee.

Caffeinated and decaffeinated coffee have the same health benefits

  1. Recently a large study showed that coffee, caffeinated or not, has a connection with lower overall mortality.
  2. Coffee has long been a subject of heated discussions. Some praise it, and others condemn it. There are multiple past studies; some showed health benefits, some did not. This is why the Department of Nutrition, Harvard School of Public Health in Boston, MA. did a larger study. The purpose was to re-examine the health benefits for both caffeinated and decaffeinated coffee.

Mortality data regarding people who drank decaf coffee or regular coffee

Researchers assessed mortality among 74,890 women in the Nurses’ Health Study (NHS). Another 93,054 women in the NHS 2 study became part of this. And 40,557 men in the Health Professionals Follow-up Study were also part in this large study. The medium follow-up for all of these three groups was 22.5 years. 19,524 women and 12,432 men died during that time period. Ming Ding is a doctoral student at the Harvard School of Public Health department of nutrition. She was the lead author of this study. She pointed out that in the past there were confounding problems. Many studies had shown that both caffeinated and decaffeinated coffee consumption lowered the risk of cardiovascular disease. But the results in many studies were blurred. Studies often did not distinguish between smokers and non-smokers. This meant that the cardiovascular risk from smoking wiped out a beneficial effect from coffee drinking.

Confounding and other factors

Ding’s studies took this into account and also other confounding factors like how much sugary soda pop people were drinking and whether or not they were eating well. In addition they normalized for other factors that could interfere like drinking alcohol and eating red meat. Without normalizing for the factors mentioned above the study results were as follows. Study participants who had less than a cup of coffee and three cups a day had a 5% to 9% lower risk of dying than those who drank no coffee. Those who drank more than three cups a day did not see any benefit.

Dose response curve for regular and decaf coffee

After eliminating all the confounding factors researchers compared the various groups again, and the following linear dose-response curve emerged:

  • Less than 1 cup of coffee per day: 6% lower death rates than non-coffee drinkers.
  • 1 cup to 3 cups of coffee per day: 8% lower death rates.
  • 3 to 5 cups of coffee per day: 15% lower death rates.
  • More than 5 cups of coffee per day: 12% lower death rates.

Coffee consumption reduces diabetes and heart disease

Ming’s study connected with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and also less heart disease. She found that both, caffeinated and decaffeinated coffee, reduced the risk of getting diabetes later in life. When asked about what would be responsible for the reduced death rates with coffee consumption, she explained: “There are at least two known chemicals in coffee, namely lignans and chlorogenic acid that could reduce inflammation and help control blood sugar, both of which could help reduce the risk of heart disease”. You may want to cut down coffee consumption because you know decaf coffee does the same as regular coffee.

Other details about the caffeinated/decaf coffee study

Although there seems to be a linear response up to 5 cups of coffee consumption, above 5 cups this linear relationship disappeared. It was not explained whether there was a saturation point, whether there was yet another hidden confounding factor or whether there were detrimental effects on the adrenal glands with too much caffeinated coffee consumption.

Another finding was that it did not matter whether the coffee was regular (caffeinated) coffee or decaffeinated coffee. The results were identical.

Many other studies did not have the large numbers to show whether or not decaffeinated coffee was as effective in preventing heart disease as regular coffee.

Suicide rates and coffee consumption

There was another peculiar finding: suicides were down by 20% to 36%, if a person drank at least one cup of coffee per day. If a person consumed less than 1 cup of coffee per day the suicide rate was 36% higher than the control group with no coffee consumption. This is a rather peculiar finding, particularly for the consumption of less than 1 cup of coffee. Other studies also showed a decrease in suicide rates with coffee consumption.

Although previous studies had shown a reduction in liver and prostate cancer, after the removal of confounding factors this study did not show any effects on cancer causation or cancer death rates with coffee consumption.

Discussion

The Department of Nutrition, Harvard School of Public Health in Boston, MA has excelled in high quality nutritional studies for decades. This study is particularly important, because it is so large, giving it more statistical power. Secondly, the observation time of an average of 22.5 years is longer than most coffee studies in the past. Add to this the removal of the “noise” (called confounding factors) that interfered with the objective of the study, and you end up with a very meaningful result.

Clear results after confounding factors were removed

The important findings were that both caffeinated and decaffeinated coffee have the same effect of saving and extending lives. Perhaps you want to drink not more than 5 cups of coffee per day. That lowers your risk of premature death by 15%. It is most likely that it is the effect of lowering the rate of diabetes and heart attack rates that is responsible for the risk reduction. At least this was the opinion of the chief investigator. Cancer rates were not lowered by coffee consumption.

I sleep better when I drink decaffeinated coffee, so for me the notion that decaffeinated coffee and regular coffee have the same effect was important.

Revisit the statement: “you may want to cut down coffee consumption”

Now we know that there is no difference in benefits whether the coffee is caffeinated or not. Those of you who consume 3 to 5 cups of decaf coffee already enjoy a 15% reduction in risk of cardiovascular disease.

Those of you who take the same amount of regular coffee may get into a caffeine dependency problem. Because every time the caffeine stimulation wears off, you yearn for yet another cup of coffee. You need your fix, and this becomes a dependency problem. You have conditioned your body to that regular dose of caffeine, even though it is the bioflavonoids that are reducing mortality while caffeine is neutral.

My experience of coffee withdrawal

When I came across Ding’s research findings I was glad that now there was clarification about whether decaf coffee was as good as regular coffee. The next step for me was to cut out regular coffee and replace it by decaf coffee. Formerly I had been drinking 5 mugs of coffee daily (translated into 500 mg of caffeine daily). When I decided to quit this habit, I figured I should do it cold turkey from one day to the next. To my surprise this was a much bigger deal than I had thought.

Withdrawal symptoms

I craved the next cup of coffee, and I drank a decaf coffee. It did not help: Still, there was this craving for regular coffee! Yawning, restlessness and tiredness were symptoms that followed me all day long. Then there was irritability, a mild headache and almost flu-like symptoms. Eventually I went to sleep and woke up one hour later feeling a bit more energetic. But two hours later I had to lay down again. I was feeling that bushed. The following few days went better. There was more energy. But I still liked a noonday nap of about 1 hour.

Benefits of getting off regular coffee

This was not like me! Normally I have lots of energy and I don’t need naps. It took me 1-½ weeks to get over my 5-cup a day coffee withdrawal. But it was 100% worth it! Since then my energy is back to normal. I don’t have to chase coffee houses on a trip or ensure there is always a cup of regular coffee available for me at home (work does not apply, because I am retired). If I want I can replace my beloved coffee with another fluid. I love lemon juice sweetened with stevia instead of my decaf coffee. It is liberating that I no longer depend on the caffeine. But I still like the flavor of decaf coffee, and there is something enjoyable about the fragrance of freshly brewed coffee. And so I drink 3 to 4 cups of decaf coffee a day.

How to cut down coffee consumption

Here is a 2016 study from the Johns Hopkins University where 34 patients on 600 mg of caffeine per day received a 1-hour lecture about coffee withdrawal followed by a 6-week diary of their coffee consumption. They were asked to reduce their caffeine consumption down to 50 mg by week 6 of the coffee elimination program. Tests followed with salivary caffeine levels 6, 12 and 26 weeks after coffee cessation. There was also a 1-year follow-up telephone conversation. The results were that there was good compliance. Saliva caffeine levels verified this. The diaries over the first 6 weeks showed that the participants had gradually eliminated caffeine consumption. Perhaps this was a more humane way than my “cold-turkey” approach.

You May Want To Cut Down Coffee Consumption

You May Want To Cut Down Coffee Consumption

Conclusion

Many people are sensitive to too much caffeine consumption in coffee and other caffeinated beverages. But since the Harvard study that I mentioned above there is no need to overdose coffee or tea consumption. Decaf coffee has the same effect on lowering death rates by 15%, as does regular coffee. It pays to avoid caffeine, as you will avoid caffeine dependency. Drink decaf coffee instead!

I also discussed that withdrawal from regular coffee can be done more gently over a 6 week period. I did it from one day to the next and had a 1-½ week long withdrawal reaction. Do it slower or faster, whatever works best for you. The end result will be the same. Then enjoy it that you no longer depend on caffeine!

More info: https://www.askdrray.com/coffee-could-be-a-lifesaver/

Aug
20
2016

New FDA Food Guidelines

By | Cancer, Cardiovascular disease, coffee, Health, heart attack, Heart Disease, Mortality, Nutrition, Stroke, sugar

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

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

New FDA food guidelines regarding increasing fish and shellfish

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

The only problem with seafood can be its mercury contamination. The higher predator fish are in the food chain, the more contaminated fish meat is. The FDA recommends to avoid tuna fish as a food source, as it is very high in mercury. An exception is canned tuna as it has been washed and some of the mercury got lost in the food processing. Wild salmon, sardines and oysters are low in mercury and good sources of omega-3 oils.

New FDA food guidelines regarding reduction of saturated fat

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

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

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

In contrast olive oil is a much more stable oil. In the Mediterranean olive oil associates with longer lives.

New FDA food guidelines regarding protective effect of coffee

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

New FDA food guidelines regarding sugar reduction

An entirely new recommendation of the FDA says to reduce sugar in anybody’s diet. The FDA explains that too many processed foods contain sugar. Food merchants  add sugar in drinks like coffee, fruit juices, food items like muffins and cakes.

In the past decades it has become clear that sugar much more so than fat is the culprit. It is sugar and starchy food that causes hardening of arteries. The liver metabolizes sugar into triglycerides and LDL cholesterol. Elevated triglycerides and LDL cholesterol levels lead to deposited into arteries and fatty tissue. In this context it makes sense that the FDA now recommends a reduction of sugar intake.

 New FDA food guidelines regarding cholesterol

In the past scientists thought that cholesterol in meat would be the cause of high cholesterol in the blood. This was an oversimplification. We now know that only a small portion of the blood cholesterol comes from food sources.  Cholesterol from food sources is no longer of importance with regard to risks for heart attacks and strokes. It is sugar and too many starchy foods (bread, pasta, pizza, muffins, cakes cookies) that the body digests into sugar. This accounts for high cholesterol, as the liver metabolizes sugar into LDL cholesterol and triglycerides.

New FDA Food Guidelines

New FDA Food Guidelines

Conclusion

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

Dec
26
2015

Coffee Could Be A Lifesaver

By | Cardiovascular disease, Diabetes, heart attack, Heart Disease, Mortality, Nutrition, Prevention, Stroke

Coffee could be a lifesaver. But coffee has long been a subject of heated discussions. It has been praises or condemnations. Researchers designed many studies in the past; some showed health benefits, some did not. A new, larger study was done by the Department of Nutrition, Harvard School of Public Health in Boston, MA to re-examine this issue for both caffeinated and decaffeinated coffee.

Here is the study showing why coffee could be a lifesaver

Mortality was determined among 74,890 women in the Nurses’ Health Study (NHS), 93,054 women in the NHS 2, and 40,557 men in the Health Professionals Follow-up Study after a medium follow-up of 22.5 years. 19,524 women and 12,432 men died during that time period. Ming Ding is a doctoral student in the Harvard School of Public Health department of nutrition and was the lead author of the study that was published in the medical journal “Circulation”. She pointed out that in the past there were confounding problems: although many studies had shown that both caffeinated and decaffeinated coffee consumption lowered the risk of cardiovascular disease, the results in many studies were blurred. Studies often did not distinguish between smokers and nonsmokers; so a beneficial effect from coffee drinking was wiped out by the cardiovascular risk from smoking.

Ding’s studies took this into account and also other confounding factors like how much sugary soda pop people were drinking and whether or not they were eating well. In addition they normalized for other factors that could interfere like drinking alcohol and eating red meat.

Results of the coffee study

Without normalizing for the factors mentioned above the study results were as follows. Study participants had less than a cup of coffee and three cups a day had a 5% to 9% lower risk of dying than those who drank no coffee. Those who drank more than three cups a day did not see any benefit.

However, when the researchers removed all the confounding factors and compared the various groups again, the following emerged:

  • Less than 1 cup of coffee per day: 6% lower death rates than non-coffee drinkers.
  • 1 cup to 3 cups of coffee per day: 8% lower death rates.
  • 3 to 5 cups of coffee per day: 15% lower death rates.
  • More than 5 cups of coffee per day: 12% lower death rates.

Both caffeinated and decaffeinated coffee reducing mortality rates

Ming Ding was associated with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and heart disease. She found that both caffeinated and decaffeinated coffee reduced the risk of getting diabetes later.

When asked about what would be responsible for the reduced death rates with coffee consumption, Ding explained. “There are at least two known chemicals in coffee, namely lignans and chlorogenic acid. They both could reduce inflammation and help control blood sugar. Also, both could help reduce the risk of heart disease”.

Although there seems to be a linear response up to 5 cups of coffee consumption, above 5 cups this linear relationship disappeared. The researchers could not explain whether coffee consumption reached a saturation point, whether there was yet another obscure confounding factor or whether there were detrimental effects on the adrenal glands with too much coffee consumption.

Other findings like decreased suicide rates with coffee consumption

Another finding was that it did not matter whether the coffee contained caffeine or was caffein free. The results were identical.

Many other studies did not have the large numbers to show whether or not coffee without caffeine was as effective in preventing heart disease.

Finally, there was another peculiar finding; suicide rates were down by 20% to 36%, if a person drank at least one cup of coffee per day. But if a person consumed less than 1 cup of coffee per day the suicide rate was 36% higher than the control group with no coffee consumption. This is a rather peculiar finding, particularly for the consumption of less than 1 cup of coffee. But other studies have also shown a decrease in suicide rates with coffee consumption.

No effect on liver and prostate cancer

Previous studies had shown a reduction in liver and prostate cancer. But after the removal of confounding factors this study did not show any effects on cancer causation. Cancer death rates also did not show a reduction with coffee consumption.

Discussion

The Department of Nutrition, Harvard School of Public Health in Boston, MA produced high quality nutritional studies for decades. But this study is particularly important, because it is so large giving it more statistical power; secondly, the observation time of an average of 22.5 years is longer than most coffee studies in the past. The investigators also removed the noise (called confounding factors). This helped to accomplish the objective of the study and they ended up with a very meaningful result.

Apart from saving lives by drinking coffee, diabetes and heart attack rates lower as well

The important findings were that both caffeinated and decaffeinated coffee have the same effect of saving lives. Perhaps you want to drink not more than 5 cups of coffee per day. That lowers your risk of premature death by 15%. What counts is the effect of lowering the rate of diabetes and heart attack rates. This is most likely responsible for the risk reduction. At least this was the opinion of the chief investigator. The study showed that coffee consumption did not lead to a reduction in cancer rates.

I sleep better when I drink decaffeinated coffee. So for me the notion that decaffeinated coffee had the same effect as regular coffee was important.

Coffee Could Be A Lifesaver

Coffee Could Be A Lifesaver

Conclusion

Here is a study that is large enough, went long enough, and showed decisively that coffee can reduce the death rate. Both caffeinated and decaffeinated coffee showed the effect of reducing the death rate. The mortality reduction was by 15% up to 5 cups of coffee per day. This finding was true for both males and females. Coffee seems to also reduce the suicide risk by a mechanism that has not yet been determined. Do you want to live 15% longer than your previous life expectancy would have been without coffee? Then you may now have your coffee and enjoy it!

Apr
05
2014

Yes, There Are Healthy Sugar Substitutes

By | Cancer, Diabetes, Heart Disease, Nutrition, Obesity, Prevention, Weight loss

It is true that sweets are not good for you because they lead to fat accumulation and to diabetes. I explain how this works later in this blog. But who says you cannot sweeten your life with healthy ingredients? Not all sugar substitutes are the same; some are awful, some are in between and one is good (see below).

General information why sweets and starches are bad for you:

There is a triple whammy from sweets that you don’t really want:

a) First, sugar gets absorbed really fast through the gut wall and arrives in your blood stream within 15 to 20 minutes. Starches can be just as powerful in terms of blood sugar surges, but it takes perhaps 30 to 40 minutes for the peak of blood sugar to occur. The end result is the same: whether you load up with a pizza, a doughnut or drink a large, sugar-loaded soda drink, your pancreas reacts the same way. It produces a lot of extra insulin to bring the blood sugar level down. When you do this day after day your pancreas gets used to overproducing insulin and you develop insulin resistance meaning that your insulin receptors that are on every cell surface get tired and become less sensitive to insulin. Due to insulin resistance the muscle cells and the liver cells do not take up sugar (in the form of glucose) as easily as before.

b) Second, because excess sugar cannot be stored as glycogen (the storage form of glucose in the liver and the muscles), the liver converts excess glucose into triglycerides and oxidized fatty acids get taken up by white blood cells called macrophages. These attach to the inner lining of the arteries and lead to atheromatous plaques, the first stage of hardening of the arteries.

c) Third, glucose is an oxidizing agent that will oxidize LDL cholesterol. This makes the LDL particles much denser and forms the so-called very dense LDL lipoprotein fraction (VDLDL) that can be detected in special blood tests (Ref.1).

Not surprisingly people who consume sugar, sweets, soft drinks and starches on a regular basis will have very dense LDL particles (=VDLDL, also called “pattern B-LDL”). The treatment for this is to quit sugar and starchy foods.

I have explained in more detail what sugar does in this blog.

Yes, There Are Healthy Sugar Substitutes

Yes, There Are Healthy Sugar Substitutes

The food industry’s answer to low carb diet drinks and low sugar foods:

Many years back the food industry decided to offer alternative diet drinks that would not contain sugar, but instead have aspartame in it.

Dr. Blaylock has researched excitotoxins like MSG and aspartame (NutraSweet) and urges you in this link to abandon both. I agree with him. But while we are at it, don’t take other artificial sweeteners like sodium cyclamate in Canada (Sweet’N Low). Are you thinking of taking sucralose (Splenda) instead? Think again. What the industry seems to have forgotten is that it was originally developed as an insecticide. This website states that sucralose was actually discovered while trying to create a new insecticide. A researcher tasted it and found it exceedingly sweet. I have done the experiment myself in Hawaii where small ants are ubiquitous. I thought I take a package of Splenda from a coffee shop and do the experiment: In the beginning the ants were reluctant to eat it, but after a few hours they came and took it in. One day later there were only shrivelled up dead ants left in the area where Splenda had been sprinkled. Proof enough for me that Splenda was developed as an insecticide!

In the Splenda marketing scheme they decided to first introduce Splenda gradually into diabetic foods as a sweetener, then later sell it to the public at large. Don’t fall for it. It was a side product of insecticide research, and insecticides have the undesirable quality of being xenoestrogens, which block estrogen receptors in women. As a result of that estrogen can no longer access the body cells, including the heart. The final consequence for a woman is a higher risk for cardio-vascular disease. This can cause heart attacks, strokes and cancer. In men estrogen-blocking xenoestrogens can cause breast growth and cause erectile dysfunction.

The natural sweeteners:

One wonders why the food industry did not choose healthy sweeteners like stevia that has been used for decades in Japan and South America.

Other sweeteners like xylitol, sorbitol, maltitol, mannitol, glycerol, and lactitol are sugar alcohols. Contrary to what many believe they have calories, but much less than sugar, so they are perceived as “safe” as a dietary supplement for weight loss. These alcoholic sugar compounds still produce partial LDL oxidization; interfere with weight loss and still lead to a certain insulin response.  Stevia, a natural sweetener from a leaf of South America is safer and without any calories.

The key is that stevia will not oxidize your LDL cholesterol and will not cause a hyperinsulinism response following a meal. It is metabolically neutral. It is the ideal sweetener for people who desire to lose some weight. It is also safe as it is no excitotoxin. The FDA has recognized stevia as “generally recognized as safe” (GRAS).

What about fructose, agave syrup, honey, brown rice malt syrup, fruit juice concentrates, refined fructose, maple syrup?

The problem is that they are all sugars, which cause a full insulin response leading to obesity, diabetes and hardening of the arteries. This causes heart attacks and strokes. These natural sugar products also oxidize LDL cholesterol, which initiates plaque formation as discussed above; this is the first step leading to hardening of the arteries. It took the medical profession 30 years of observing that a low fat/high carb diet makes us fat and causes heart attacks, leads to strokes and causes diabetes. Let’s not make the mistake of trusting the food industry and mindlessly swallow so-called natural other sugars and sugar substitutes like xylitol, sorbitol, maltitol, mannitol, glycerol, and lactitol. You may want to chew the odd gum with xylitol, as this will prevent cavities in your teeth. But otherwise it is much safer to just stick to Stevia to sweeten your tea, coffee or food. There are brands that are less bitter than regular stevia products, like stevia from New Roots in Canada and stevia from KAL in the US (no, this is not a commercial, it is based on my own observations).

Conclusion:

Sugar is an emotional topic that can get people caught up in heated discussions. The sugar industry and the sugar substitute industry have also powerful lobby groups that provide the Internet and the popular press with conflicting stories to convince you to buy their product. This blog was meant as a no-nonsense guide to get you removed from the high-risk group of candidates for heart attacks, strokes or diabetes. Let’s not forget the metabolism behind the various sugars and starchy foods described above, which I have explained in more detail in my recently published book (Ref.2). Forget the emotions of severing yourself from your favorite fix and stick to a tiny amount of stevia that can replace the familiar sweet taste that you have become accustomed to from childhood onward. At least this is what I do. The only alternative would be to take the plunge and cut out any sweet substance altogether, which I am not prepared to do. If you can do it, by all means go ahead.

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

 

Reference:

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

2. Dr. Ray Schilling: “A Survivor’s Guide to Successful Aging“, Amazon.com, 2014

Last edited Nov. 7, 2014

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Nov
30
2013

Statins Can Hurt The Consumer

By | Anti-aging medicine, Arthritis, Diabetes, Fitness, heart attack, Heart Disease, High Blood Pressure, Hormones, kidney disease, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

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 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

Sep
28
2013

Sleepless Nights

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

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

Symptoms of insomnia

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

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

Research about insomnia

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

Sleepless Nights

Sleepless Nights

Causes of insomnia

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

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

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

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

Predisposing factors

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

Precipitating factors

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

Perpetuating factors

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

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

Drugs that can cause insomnia

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

Treatment of insomnia

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

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

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

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

Drugs and supplements for insomnia

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

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

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

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

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

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

Conclusion

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

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

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

References

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

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

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

Last edited Sept. 28, 2014

Jul
06
2013

The Inconvenient Truth About Convenience Foods

By | Diabetes, Health, heart attack, Heart Disease, High Blood Pressure, Hormones, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements

When your grandmother grew up there was very little convenience food, maybe ketchup and yes, there was processed cheese and coke. There were also bread and butter.

Now we go through a large grocery store and the center of the whole store is occupied by convenience food, row after row.

What is convenience food? It is pre-cooked or processed food that sits on a shelf waiting to be bought and consumed. You may be able to just eat it the way it is (power bars, fruit yoghurt snacks, ice cream, breakfast cereals etc.) or you just have to microwave it for a minute or two (ready made meals, pizzas). Even, if you make a fresh salad, you top it with a salad dressing that has been processed and may contain chemicals that are not necessarily healthy for you.

This blog is meant to make you think and get educated as a consumer. As a physician I am guided by what is healthy for you, but at the same time food needs to be interesting and taste good and be affordable.

As fat, carbohydrates and protein are the main food groups that we eat, I will deal with each of these categories first followed by vitamins and minerals, which we also need.

Fats and oils

Many convenience foods are full of saturated fatty acids, which contribute to the overall calorie count of the package and are one of the main reasons why we gain weight and deposit fat into our arteries in preparation for a heart attack or stroke down the road. As you may know the worst form of fat is hydrogenated fat, also known as “trans fat”.

It contains free radicals from the hydrogenation process, which damage your cells and interfere with normal body metabolism. Read labels and avoid any foods that have a long shelf life as this is due to hydrogenated fats and chemicals known as food preservatives.

This food group also contains sausages and other processed meat; I wrote a separate blog about this recently.

If you eat cheese, reduce your saturated fat intake by buying cheese with only 18% fat (such as Cantenaar cheese, Jarlsberg light, skim milk mozzarella and goat cheese). Avoid the rich 45% type cheeses. The best oil in your kitchen would be an organic cold pressed olive oil. It figures prominently in Mediterranean cooking.

The Inconvenient Truth About Convenience Foods

The Inconvenient Truth About Convenience Foods

Sugar, starch and other carbohydrates

A large portion of snacks from the mid section of the grocery store contains all forms of sugar: high fructose corn syrup, sugar, honey, agave syrup, maple syrup etc.  You may think that a harmless fruit juice would be healthy until you see from the ingredient list on the label that it contains 5 to 6 teaspoons of sugar per cup (250 ml) of juice.

Unfortunately our body is not equipped to process all the sugar that the food industry wants us to consume and we develop insulin resistance; the liver converts the excess sugars into fat and deposits it into our arteries and as fat deposits between our guts (visceral fat) and as subcutaneous fat in the thighs, around the hips and the waist. It is no secret that a lot of obesity is related to overconsumption of sugar containing convenience foods (snacks and sugar-laden drinks).

Often low calorie alternatives contain aspartame or sucralose (Splenda). Aspartame is an excitotoxin damaging your brain cells and sucralose was developed in the 1950’s as an insecticide. We do not want to replace disease-promoting sugar with toxins as sweeteners. Safe alternatives for sugar are xylitol, mannitol, and stevia.

What is sometimes overlooked is the fact that your body digests bread, starchy foods such as potatoes, and pasta, rice and flour products like pizza or cookies within 30 minutes into sugar that is as harmful to your pancreas as plain sugar or high fructose corn syrup. The body reacts with the same overproduction of insulin converting the excess sugar into fat and depositing it in your body as described above. Much of the obesity wave we see in the past 3 decades is due to baked goods like bagels, bread, pasta and pizza. It is much better to enjoy your stevia-sweetened coffee without any bakery pieces to go along with it.

Protein in meats, dairy products and sausages

You would think that a healthy cut of meat from the grocery store would be a good source of protein for you. You probably did not think that it could be contaminated with a superbug when you bought it. This is especially true for ground meats like hamburger meat. If you bought a portion of organic meat you can be more certain that you are buying a qualitatively superior product. I discussed this whole issue of superbugs in meat and meat products in this blog recently.

We need to be aware of the agroindustry, the feedlots and what they fed the animals. I only buy organic meat and organic dairy products as my source of protein. I avoid sausages altogether because of the food additives that they contain, which are cancer causing.

The problem with prepared meats like chicken nuggets and others is that they contain breading and food preservatives and they have been deep fried, which makes these items an unhealthy choice.

What are some of the problems with dairy products? Despite the allegations that bovine growth hormone would be harmless to your health, your body thinks otherwise. Your body has hormone receptors that are very specific and bovine growth hormone can block them so your own human growth hormone from the pituitary gland cannot function properly. This is why I would recommend only organic milk products. You may have heard that in many European countries bovine growth hormone is banned for that reason.

Next the fat content of dairy products needs to be monitored: go for low-fat milk, cheese and yoghurt. While we are talking about yoghurt, stay away from fruit yoghurts that have all kinds of sugar and food additives mixed in. Add fruit of your choice and stevia, if you need a sweet taste.

Vitamins and minerals

The more foods are processed, the less natural vitamins and minerals stay behind. Particularly vitamin C and the B complex group are affected, but also magnesium, which is an important co-factor to enzymatic reactions within our cells. Often processed foods contain too much salt with sodium displacing potassium from the cells resulting in a lack of energy and high blood pressure.

Your best prevention is to stick to as little processed food as possible and to eat organic. If you eat enough organic greens and vegetables, there is an ample supply of vitamins and minerals. Prepare your own soups as canned products are high in sodium; another unwanted additive is often sodium glutamate (MSG), which comes under many disguised names. It belongs to the group of excitotoxins like aspartame and is not welcomed by your brain cells.

Public Awareness

Lately there has been more of public interest and awareness to the detrimental effects of convenience foods. Alarming reports about the increase in the obesity rates, the rise in diabetes type 2 even in children have been in the media for some time. The publications are not only North American, but also European, as can bee seen in this link.

New legislation is being introduced in many states of the US regarding school snacks and vending machines in schools.

Not all food news is bad. Recently it was reported that fish oil could protect against the effects of junk food. Omega-3-fatty acids contained in fish oil are helping to rebalance the ratio between omega 3 and omega 6-fatty acids in food, which often is disbalanced towards an overabundance of omega-6 fatty aids in processed foods. Rebalancing the omega3/omega6 ratio in food helps to normalize the metabolism of the brain and prevents hardening of arteries.

What you can do to get healthy food

It starts when you buy food. Read labels and look for calories, sugar, fat and sodium content. You may be surprised how many stores carry organic foods now. The price may not be that much more. There is a useful app for your cell phone, Buycott, that you may want to download. This way you can scan items in the store and find out what ingredients are contained in a particular food item and which company produces it.

With meats it is particularly important to buy organic (because of superbugs and also because of the aspect that feed lot animals often receive antibiotics and hormones). Stick to organics also with vegetables and greens (xenoestrogens in non-organic greens that block hormone receptors). Milk products also need to be organic because of the bovine growth hormone facts mentioned above.

When you eat out, things become more difficult unless you find an organic food restaurant. You can always prepare your own salad for lunch with organic greens and a lean protein food, which you keep refrigerated until you are ready to consume it. On weekends a portable picnic in a park can be a great way to relax and socialize, especially in summer.

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

Last edited Nov. 6, 2014

Mar
04
2013

Coffee, Tea, Vitamin C And E Prevent Stroke And Dementia

By | Health, Prevention, Stroke, Vitamins and supplements

Introduction

It is important to realize that several studies showed that coffee, tea, vitamin C and E prevent stroke and dementia. Elizabeth E. Devore, ScD, now with Brigham and Women’s and Harvard Medical School, did a long-term study involving 5,395 people aged 55 and older who were part of the long-term Rotterdam Study of medical conditions and other factors in older adults. Notably, over the 14-year observation period 601 patients developed strokes and 599 patients developed dementia. Surely, detailed dietary questionnaires were available from the study that helped the author to detect what the protective factors were in those who did not develop strokes or dementia. Researchers excluded other factors (including tea and coffee consumption) and they studied only antioxidant factors. They noticed that there were no differences in terms of stroke or dementia rates when they compared the lowest and highest percentiles of antioxidant groups.

Tea and coffee consumption protective of strokes and dementia

But when the lowest and highest percentiles of tea and coffee consumers were analyzed and compared, about 90% of strokes and of dementia disappeared meaning that tea and coffee consumption is protective for both.  Dr. Devore explained that other studies have shown that vitamin C helps prevent strokes and vitamin E helps to prevent dementia and that both vegetables and fruit as well as tea and coffee have been shown in other studies to help reduce both.

Here is another article that investigated the role that vitamin E plays in reducing brain aging and preventing dementia and Alzheimer’s.

In a meta analysis vitamin C was shown to help prevent hemorrhagic and embolic strokes.

Coffee, Tea, Vitamin C And E Prevent Stroke And Dementia

Coffee, Tea, Vitamin C And E Prevent Stroke And Dementia

More studies show health benefits of vitamin C, E, vitamin D3, coffee and tea

Vitamin C and E are not the only beneficial vitamins for the brain. Vitamin D3 can help prevent thromboembolic strokes as the Honolulu study going on for 34 years showed.

What about coffee and tea? There is a 10-year study involving 32,600 women where 1 or two cups of coffee per day led to a 25-32% reduction of strokes compared to non-coffee or tea consuming controls.

Black tea and coffee reduced stroke risk

Males also experience a reduction of thromboembolic strokes with tea or coffee consumption. There has been a Finnish study that consisted of 29,133 smokers (smoking 5 cigarettes a day) aged 50 to 69 who were stroke free when entering the study. It ended in 1993 and had lasted for at least 5 years. Drinking two cups of black tea or 8 cups of coffee reduced the stroke risk by 21 to 23%.

Fruit and vegetables contain a lot of vitamin B complex. As this link shows vitamin B can lower cysteine, a blood component that contributes to heart attacks and strokes.

So, what should you do to prevent strokes and dementia?

Stop smoking, if you do. Avoid alcohol and drugs as much as you can. Your brain cells have very sensitive mitochondria that give you energy, but they are very sensitive to toxins. Avoid brain injuries like concussions as they can accumulate and lead to dementia. Whatever you can do for your heart is good for stroke prevention. This includes weight loss (down to a body mass index of 22.0), exercise, and sensible food intake. Sensible food intake includes complex carbs, cut out sugar, have lean meat, more chicken, turkey, lean pork and only occasional beef. Take multiple vitamins including B, C, D3, E and drink tea or coffee. Some health-oriented people may not want to hear this latter point (tea, coffee), but the studies show it is brain and heart protective.

Further information

More information on dementia: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/dementia/

Links regarding the Elizabeth E. Devore, ScD study:

1) http://www.everydayhealth.com/stroke/how-antioxidants-really-protect-against-stroke-and-dementia-3194.aspx

2) http://www.webmd.com/healthy-aging/news/20130220/high-antioxidant-diet-may-not-prevent-stroke-dementia-study-finds

Here is a link to the National Stroke Association about stroke prevention: http://www.stroke.org/site/PageServer?pagename=prevent

 

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Jul
01
2008

Have A Cup Of Coffee And Decrease Your Death Risk

By | Health, Heart Disease, Nutrition

Coffee can be good for you, and this is one of the items, which even tastes good! There are some exceptions as discussed in previous articles: more than 2 cups per day can increase the risk for miscarriages in pregnant women. People who are anxious or nervous can find that coffee will aggravate anxiety. Patients with rheumatoid arthritis should also not indulge in the flavorful brew.

Aside from these exceptions researchers have found that coffee consumption can be beneficial. A recent study using the data from 41,736 male and 86,214 female subjects has evaluated data over a follow- up time of 18 years in the male group and 24 years in the female group. The risk of all-cause mortality decreased significantly with increasing coffee consumption in the male as well as in the female group.

Men had a relative risk reduction of 20% as compared to their counterparts with the lowest level of coffee consumption. Women with intermediate to high consumption had a relative risk reduction of 10% to 30 % as compared to the group that drank less than 1 cup of coffee per day.

Have A Cup Of Coffee And Decrease Your Death Risk

Have A Cup Of Coffee And Decrease Your Death Risk

The limit of the study in this case was the self-reported nature of coffee consumption, but the researchers feel that the modest benefit of reduction of all-cause and CVD death warrants further investigation.

Reference: June 17, 2008 Annals of Internal Medicine

Last edited December 4, 2012

Feb
01
2003

Coffee — What’s The Scoop…

By | Health, Nutrition, Prevention, Women’s Diseases

In a recent issue of The Medical Post, a weekly news magazine for Canadian Physicians (The Medical Post, Jan. 28, 2003), Dr. Suzan Biali has revisited what is medically known about the effects of coffee on health.

This doctor is a family physician in Vancouver/B.C., but also has a degree in dietetics. Here is a summary in table form of what this medical review found.

Dr. Biali also mentioned the recent publication in the November issue of the Lancet by the Dutch investigators that coffee consumption of more than 7 cups per day would cut diabetes in half.

Summary: It would appear that coffee consumption is better than previously thought of. Most people can benefit from it. But this is a personal preference issue. Some groups of patients should refrain from coffee consumption entirely such as patients with rheumatoid arthritis.

Coffee -- What's The Scoop...

Coffee — What’s The Scoop…

Others such as women in early pregnancy (particularly the first 3 to 4 months) should refrain from it. When infertility is a problem it is wiser to refrain completely from coffee as well. Patients with a tendency to ulcers likely should refrain or cut down the coffee consumption. The majority of the population likely could enjoy a cup of coffee and prevent degenerative neurological diseases (Alzheimers and Parkinsons disease). Some patients with psychiatric illnesses (phobias, anxiety disorders) likely should stay away from coffee as should patients with high blood pressure or heart rhythm irregularities.

Coffee — what’s the scoop?
Effects of coffee on: Comments:
first trimester pregnancy 5 or more cups a day can cause miscarriages
infertility women who drink 250 mg of caffeine per day (5 to 6 cups) experience infertility
no hip fractures a large Minnesota study showed in 2001 that there were NO hip fractures with coffee consumption
calcium in bones despite the rumors otherwise, there is NO link of coffee consumption to calcium loss
rheumatoid arthritis (RA) This is the patient group where osteoporosis has been found to be present with coffee consumption; a Finland study found a 2-fold risk with more than 4 cups per day, and a 15-fold risk with more than 11 cups per day (in RA patients only)
Alzheimers and Parkinsons the cells in the basal ganglia that produce dopamine get stimulated by coffee; this is also the seat of the addiction (though mild) to coffee and the cause for headaches when coffee is suddenly withdrawn. This effect  prevents Alzheimers and Parkinsons, both bad degenerative neurological disorders.
stomach problems anybody with a tendency for stomach ulcers or duodenal ulcers tends
to get worse with coffee. Arabian type coffee is less acidy than South American coffee. Coffee does not cause ulcers, but may stimulate existing acid production and in higher doses may stimulate H.pylori growth.
panic attacks and insomnia more sensitive people tend to feel anxious with a single cup of coffee per day, others can tolerate many cups. When a patient complains about panic attacks or insomnia the physician will likely inquire about how much coffee the person drinks.
high blood pressure long term coffee users show almost no effect on blood pressure, it does not cause high blood pressure. Those with high blood pressure
or a history of a stroke still should refrain from drinking coffee

Last edited December 10, 2012