**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

My home page there is: ** https://www.quora.com/profile/Ray-Schilling**

Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

On Quora you can also write comments that I will answer.

Thank you for your trust in the past. Ray Schilling, MD
**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

My home page there is: ** https://www.quora.com/profile/Ray-Schilling**

Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

On Quora you can also write comments that I will answer.

Thank you for your trust in the past. Ray Schilling, MD
Dec
31
2016

What Works Against Alzheimer’s?

By | Alzheimer’s disease, Diabetes, Drugs, Inflammation, lifestyle, Nutrition, sugar

.Eli Lilly’s promising drug solanezumab failed; so, what works against Alzheimer’s? This drug was supposed to dissolve the amyloid deposits that function like glue and make the patients lose their memory. This phase 3 trial was to test the drug on patients to assess efficacy, effectiveness and safety. But instead it showed that the new drug did not stop the loss of memory.

Brain bleeding as a side effect of potential Alzheimer’s drug

Now all those who were hoping for solanezumab to be effective, will jump on another drug, aducanumab. Biogen from Cambridge, Massachusetts, has developed this drug. Out of 165 subjects only 125 completed preliminary studies. 40 patients who discontinued it, had negative side effects. These included fluid building up in the brain, which was thought to be due to removal of the plaques. But others, had brain bleeding.

Although the drug manufacturer is still hoping that aducanumab will work out as an anti-Alzheimer’s drug, I have my doubts. A drug that can have potential brain bleeding as a side effect does in my opinion not qualify as an anti-Alzheimer’s drug.

Factors that help prevent Alzheimer’s

1. Diet can be as effective as a drug in treating Alzheimer’s

In September 2015 researchers from Rush University published results of putting Alzheimer’s patients on the MIND diet. The MIND diet was a prospective study where 923 people aged 58 to 98 years participated. Researchers followed these people for 4.5 years. Three groups of diets were tested: Mediterranean diet, DASH diet and MIND diet.

The MIND diet study result

The adherence to the diet was measured: those who followed the diet very closely, other participants who were less diligent, and finally those who were not compliant with the diet. With regard to the MIND diet the group with the highest adherence to the diet reduced the rate of Alzheimer’s by 53% compared to the lowest third. This is like a highly effective Alzheimer’s drug! The second group still was able to reduce the rate of Alzheimer’s by 35%, which would be like a regular strength drug. The control diets were the DASH diet and the Mediterranean diet. The group that was strictly adhering to the DASH diet reduced Alzheimer’s by 39%, the group that was very conscientious in adhering to the Mediterranean diet reduced Alzheimer’s by 54%. The middle thirds of both control diets did not show any difference versus the lower thirds.

Findings of Alzheimer prevention by diet

The conclusion was that a strict Mediterranean diet had a very good Alzheimer prevention effect, as did a strict MIND diet. However, when patients did not adhere too well to a diet, the MIND diet was superior still yielding 35% of Alzheimer’s prevention after 4.5 years. The other diets, when not adhered to that well, showed no difference from being on a regular North American diet. Here is more info about the MIND diet.

Conclusion

Avoid the Standard American Diet. Adopt a Mediterranean diet and stick to it in a strict fashion or adopt the MIND diet. The other benefit is that there are no side effects!

2. Stress and Alzheimer’s

A 2010 study from Gothenburg University, Sweden examined 1462 women aged 38-60 and followed them for 35 years.

Psychological stress ratings went back to 1968,1974 and 1980. 161 females developed dementia (105 of them Alzheimer’s disease, 40 vascular dementia and 16 other forms of dementia). The risk of dementia was higher in those women who had frequent/constant stress in the past. The condition became more severe the more stress they had to face in the past. Women with exposure to stress on one, two or three examinations had higher dementia rates later in life in comparison to women who had no exposure to any significant stress. Specifically, dementia rates were 10% higher after exposure to one stressful episode, 73% higher after two stressful episodes and 151% higher after exposure to three stressful episodes.

Conclusion

Prevention of Alzheimer’s is possible by avoiding stress and seeking counselling when stress occurred .

3. Be creative, prevent Alzheimer’s and dementia

In an April 8, 2015 publication from the Mayo Clinic in Rochester, MN and Scottsdale, AZ 256 participants aged 85 years and older (median age 87.3 years, 62% women and 38% men) were followed for 4.1 years. Psychological tests measured mild cognitive impairment (MCI). At the time of recruitment into the study all of the tests for MCI were normal. As the study progressed it became apparent that there were various risk factors that caused the onset of MCI, which is the immediate precursor of dementia/Alzheimer’s disease.

The finding was that the presence of the genetic marker APOE ε4 allele carried a risk of 1.89-fold to develop MCI and later Alzheimer’s disease.

Further findings of the study

When patient showed signs of depression at the time of enrolment into the study, the risk of MCI development was 1.78-fold. Midlife onset of high blood pressure led to a 2.43-fold increase and a history of vascular disease showed a relationship of 1.13-fold higher MCI development. The good news was that four activities correlated with a lower risk of developing MCI with aging. When the person engaged in artistic activities in midlife or later in life the risk for MCI development 73% lower, involvement in crafts reduced it by 45% and engagement in social activities by 55%. In a surprise finding the use of a computer late in life reduced MCI development by 53%. These are very significant observations. This would be equivalent to highly effective anti-Alzheimer’s drugs.

Conclusion

If you stimulate your mind in older age, even browsing on the computer, this will help you to prevent Alzheimer’s disease.

4. Lifestyle factors contributing to Alzheimer’s

a) Sugar consumption: Sugar consumption and too much starchy food like pasta (which gets metabolized within 30 minutes into sugar) causes oxidization of LDL cholesterol and plaque formation of all the blood vessels including the ones going to the brain. On the long-term this causes memory loss due to a lack of nutrients and oxygen flowing into the brain.

b) Lack of exercise: Lack of exercise is an independent risk factor for the development of Alzheimer’s disease. Exercise increases the blood supply of the brain, strengthens neural connections and leads to growth of neurons, the basic building blocks of the brain. Exercise increases mood-regulating neurotransmitters like serotonin and endorphins.

c) Sleep deprivation leads to memory loss, but so does the use of aspartame, the artificial sweetener of diet sodas. Make your own homemade lemonade. Squeeze the juice of half a lemon. Add mineral water to fill an 8 oz. glass. Add a tiny bit of stevia extract for sweetening. Stir and enjoy. Stevia has been in use for thousands of years.

5. Hormone changes

A lack of testosterone in men and estrogen in women interferes with cognition and memory. For this reason it is important after menopause and andropause (=the male menopause) to replace what is missing with the help of a knowledgeable health professional.

Progesterone is manufactured inside the brain, spinal cord and nerves from its precursor, pregnenolone, but in women it also comes from the ovaries until the point of menopause. The myelin sheaths of nerves requires progesterone and progesterone also has a neuroprotective function. In menopausal women bioidentical progesterone is a part of Alzheimer’s prevention.

Melatonin is a hormone, a powerful antioxidant and a neurotransmitter at the same time. It helps in the initiation of sleep, stimulates the immune system and protects from the toxic effects of cobalt. Lab tests in Alzheimer’s patients found elevated values. In an aging person it is wise to use melatonin at bedtime as a sleep aid and to preserve your brain.

6. Genetic risk of Alzheimer’s

At the 22nd Annual A4M Las Vegas Conference in mid December 2014 Dr. Pamela Smith gave a presentation entitled ”How To Maintain Memory At Any Age”. She pointed out that there are about 5 genes that have been detected that are associated with Alzheimer’s disease and in addition the apolipoprotein E4 (APOE4). About 30% of people carry this gene, yet only about 10% get Alzheimer’s disease, which shows how important lifestyle factors are (in medical circles physicians call this the “epigenetic factors”) to suppress the effect of the APOE4 gene. She also stated that our genes contribute only about 20% to the overall risk of developing Alzheimer’s disease. This leaves us with 80% of Alzheimer’s cases where we can use the brain nutrients and hormones discussed above and exercise to improve brain function.

7. Vitamin D3 protects your brain from Alzheimer’s disease

Alzheimer’s disease is a neurodegenerative disease of old age. We know that it is much more common in patients with type 2 diabetes where insulin levels are high. Studies have shown that Alzheimer’s disease can be termed type 3 diabetes.

The resulting neurofibrillary tangles and amyloid-beta deposits damage nerve cells, which are responsible for the memory loss and the profound personality changes in these patients.

What does vitamin D3 have to do with this?

A 2014 study showed that a low vitamin D level was associated with a high risk of dementia and Alzheimer’s disease.

Specifically, the findings were as follows.

  • Vitamin D level of less than 10 ng/ml: 122% increased risk of Alzheimer’s
  • Vitamin D level 10 to 20 ng/ml: 51% increased risk of Alzheimer’s

The same research group found in two trials that vitamin D deficiency leads to visual memory decline, but not to verbal memory decline.

Generally supplements of vitamin D3 of 5000 IU to 8000 IU are the norm now. But some patients are poor absorbers and they may require 15,000 IU per day. The physician can easily determine what the patient needs in the dosage of vitamin D3 by doing repeat vitamin D blood levels (as 25-hydroxy vitamin D levels). The goal is to reach a level of 50-80 ng/ml. The optimal level with regard to nmol/L is 80 to 200 (according to Rocky Mountain Analytical, Calgary, AB, Canada).

8. Avoid sugar overload

We already mentioned sugar consumption under point 4. But here I am mentioning it again because of the insulin reaction. An overload of refined carbs leads to an overstimulation of the pancreas pouring out insulin. Too much insulin (hyperinsulinemia) causes hormonal disbalance and leads to diabetes type 3, the more modern name for Alzheimer’s. All starch is broken down by amylase into sugar, which means that anybody who consumes starchy food gets a sugar rush as well. Too much sugar in the blood oxidizes LDL cholesterol, which leads to inflammation in the body. The consequence of chronic inflammation are the following conditions: hardening of the arteries, strokes, heart attacks, Alzheimer’s due to brain atrophy, arthritis, Parkinson’s disease and cancer.

What Works Against Alzheimer’s?

What Works Against Alzheimer’s?

Conclusion

In the beginning we learnt about a failed phase 3 trial regarding an anti-Alzheimer’s drug. Next we reviewed several factors that can all lead to Alzheimer’s and that have been researched for many years. It would be foolish to think that we could just swallow a pill and overlook the real causes of Alzheimer’s disease. I believe there will never be a successful pill that can solve the increasing Alzheimer’s problem. It is time that we face the causes of Alzheimer’s. This means cutting down sugar to normalize your insulin levels.

Lifestyle changes necessary to avoid Alzheimer’s

We need to supplement with vitamin D3 because we know that it helps. For women in menopause or men in andropause it is time to replace the missing hormones with bioidentical ones. We need to handle stress and avoid sleep deprivation. And, yes we need to exercise regularly. Following a sensible diet like the Mediterranean diet or the MIND diet makes sense. And let us keep our minds stimulated. Chances are, when we do all of this that we will not need any Alzheimer’s pill. This is not good news for the drug companies, but will be very good news for you. Last but not least, there are no side effects, only health benefits!

Additional resource on how to preserve your memory.

Jul
18
2015

MIND Diet Helps Prevent Alzheimer’s

By | Alzheimer’s disease, Nutrition, Prevention

Researchers at the Rush University developed the MIND diet that helps prevent Alzheimer’s disease. MIND stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay” and is a hybrid between the Mediterranean diet and the DASH diet that had been developed to help control high blood pressure.

The MIND diet was a prospective study where 923 people aged 58 to 98 years participated. Researchers followed these people for 4.5 years. Three groups of diets were tested: Mediterranean diet, DASH diet and MIND diet.

The MIND diet study result

The adherence to the diet was measured: those who stuck to the diet very closely, another section of participants that were less diligent, and finally one segment of people who did not take the entire thing too serious. With regard to the MIND diet the group with the highest adherence to the diet reduced the rate of Alzheimer’s by 53% compared to the lowest third. The second group still was able to reduce the rate of Alzheimer’s by 35%. The control diets were the DASH diet and the Mediterranean diet. The group that were strictly adhering to the DASH diet reduced Alzheimer’s by 39%, the group that were very conscientious in adhering to the Mediterranean diet reduced Alzheimer’s by 54%. The middle thirds of both control diets did not show any difference versus the lower thirds. The conclusion was that a strict Mediterranean diet has a very good Alzheimer prevention effect, as does a strict MIND diet. However, when patients do not adhere too well to a diet, the MIND diet is superior still yielding 35% of Alzheimer’s prevention after 4.5 years while the other diets when not adhered to that well showed no difference from being on a regular North American diet.

A brief summary of what Alzheimer’s disease is

A few years back the Pittsburgh PET scan was invented. It uses a Pittsburgh B compound radio-tracer to visualize the pathology in the Alzheimer’s brain. This research tool has made it possible to detect even the earliest Alzheimer’s disease (AD). The basic problem in Alzheimer’s patients is that there is brain atrophy, which can be more located in the front of the brain or in the back. There are two types of AD, the early onset AD (EOAD) and the late onset AD (LOAD). Using the Pittsburgh PET scan it was noted that the brain atrophy with EOAD is severe and located in the back of the brain; in contrast to that with LOAD, which is the more common form of AD the brain atrophy is located in the front of the brain. This imaging tool also allows quantitating the amyloid load; amyloid is a gooey substance that is produced by the inflammatory changes in the brain of Alzheimer’s patients (Ref.1). There are multiple possible causes why Alzheimer’s should develop in a person, but nothing conclusive has been determined. In February, 2015 I summarized a talk given by Dr. Smith at the 22nd Annual A4M Las Vegas Conference that also mentioned that there are many causes that can lead to Alzheimer’s disease.

The bottom line is that atrophy of the brain leads to loss of memory, personality loss and premature death.

The MIND diet

This diet was developed by Martha Clare Morris, Ph.D., a nutritional epidemiologist of Rush University in Chicago and her colleagues. The team observed that some foods were associated with a delay in the onset of Alzheimer’s disease while others contributed to an earlier onset of Alzheimer’s.

This is how they developed the term of the 10 “brain-healthy food groups” and the 5 unhealthy food groups.

Meet the 10 “brain-healthy food groups”: green leafy vegetables, other vegetables, berries, beans, nuts, poultry, olive oil, whole grains, fish and wine.

The 5 unhealthy food groups are: red meats, cheese, pastries and sweets, butter and stick margarine, fried or fast foods.

The 10 brain-healthy food groups are full of anti-oxidants, resveratrol and healthy fatty acids. They prevent hardening of the arteries and prevent the deposits of beta amyloid in the brain, which prevents Alzheimer’s disease. There is a bit of an issue about wine, which I have reviewed in this blog. You can replace wine with resveratrol extract as a supplement in order to get away from the toxic effect of alcohol, which is a cell poison. The choice is yours.

Why are the unhealthy foods unhealthy? There is too much trans fat in butter, cheese and margarine, which accelerate hardening of your arteries. The same problem exists with red meats, pastries and fried or fast foods. Sweets pose another problem: the sugar causes insulin levels in your blood to raise, which in turn causes inflammation in the support tissue of your brain, called glia cells, which secrete the beta amyloid that damages brain cells. At the same time sugar is metabolized by the liver into fat and triglycerides, which causes hardening of the arteries. The end result is earlier onset of Alzheimer’s.

According to Morris blueberries and strawberries, which are part of the brain-healthy food groups have been shown to be the most potent berries in terms of protecting against Alzheimer’s disease and preserving cognitive function.

With the late onset AD (=LOAD) that is the most common form of AD genetic factors hardly play a role. But what we eat will determine whether or not we get AD and we can postpone it significantly, if we eat mostly foods from the 10 brain-healthy food groups.

MIND Diet Helps Prevent Alzheimer’s

MIND Diet Helps Prevent Alzheimer’s

Conclusion

The MIND diet has been shown to be able to postpone the development of Alzheimer’s disease. It was developed based on the observation that some foods are good for us in terms of preserving cognitive function whereas others are bad. Knowing this it is advisable to eat mostly vegetables, poultry, fish, olive oil, nuts, beans, berries, whole grains, and some wine may be enjoyed as well. At the same time you need to avoid the bad foods mentioned above, like pastries, sweets, red meat, cheese and fast foods.

It is a small price to pay to keep your brain function until a ripe old age. The advantage with the MIND diet is that if you should occasionally deviate from the ideal, you still maintain a significant advantage over the DASH diet or the simple Mediterranean diet.

Reference:

1. Goldman’s Cecil Medicine, Twenty-Fourth Edition, Goldman, Lee, MD; chapter by David S. Knopman: Alzheimer’s Disease and Other Dementias, p. 2274-2283 Saunders 2012.

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

Apr
21
2013

On World Health Day 2013 the Focus is on Hypertension

By | Diabetes, Eye Diseases, Fitness, Heart Disease, High Blood Pressure, kidney disease, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

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