Feb
20
2021

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Recently two articles showed that fish oil reduces cardiovascular disease and mortality.

British study recording the effects of fish oil over 10 years

For one thing, the British Medical Journal published an article comparing people who supplemented with fish oil with people who did not. In this case, the ones who supplemented had a lower risk of mortality and had lower cardiovascular disease than the control group. In brief, 427,678 subjects were enrolled in this British study between 2006 and 2010. Questionnaires at the beginning of the study revealed how many capsules of fish oil the subjects consumed. Hospital records and death certificates provided information about cardiovascular disease mortality at the end of 2018. Altogether, 31% of the subjects said that they were taking fish oil supplements regularly.

In short, here are the results of the study showing what fish oil did.

  • 7% lower cardiovascular events
  • 16% lower risk of cardiovascular disease mortality
  • 20% lower mortality risk from heart attacks
  • 13% lower risk of death from any cause (when compared to people who did not use fish oil)

Discussion

Given these points, the authors stated that it was the omega-3 fatty acids in fish oil that caused all the beneficial effects. This included lowering of blood pressure, triglycerides and reducing the heart rate. Fish oil was also responsible for improvement of endothelial function, inflammation and blood clotting. In addition, fish oil protects against cardiac arrhythmias. They stated: “Fish oil supplementation could be an inexpensive, quick, safe way of increasing an individual’s omega-3 fatty acid intake”.

Mayo Clinic study of taking higher doses of omega-3 polyunsaturated fatty acids

A study dated Sept. 17, 2020 showed the cardiovascular benefits of higher doses of omega-3 fatty acids. This was the second of two articles that showed that fish oil reduces cardiovascular disease and mortality. It was published in Mayo Clinic Proceedings. This metaanalysis involved 40 interventional studies and 135,000 patients. Two types of omega-3 fatty acids, namely EPA and DHA were studied with regard to the prevention of cardiovascular disease. EPA and DHA supplementation had the following effects.

  • 35% reduction of risk of a fatal heart attack
  • 13% reduction of heart attacks in general
  • 10% reduced risk of coronary heart disease occurrence
  • 9% reduction of mortality from coronary heart disease

The researchers described that the higher the dose of omega-3 fatty acid supplementation, the greater the protection.

An extra dose of 1000 mg per day of EPA and DHA reduced the risk of cardiovascular disease as follows. There was a reduction of cardiovascular disease by 5.8% and of heart attacks by 9%. I take 1800 mg of EPA/DHA twice a day, a total of 3600 mg per day.

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Conclusion

Two independent studies of fish oil or omega-3 fatty acids came to similar conclusions.  Heart attacks and strokes are significantly reduced. And mortality in the group that used fish oil supplementation was also significantly reduced. An extra dose of 1000 mg per day of EPA and DHA reduced the risk of cardiovascular disease as follows. There was a reduction of cardiovascular disease by 5.8% and of a heart attack by 9%. Based on these findings the researchers recommended that patients should use EPA/DHA supplementation to reduce cardiovascular risk. EPA/DHA supplementation lowers blood pressure, triglycerides and the heart rate. Fish oil was also responsible for improvement of endothelial function, also for the prevention of inflammation and blood clotting. In addition, fish oil protects against cardiac arrhythmias. The end result is that you live a healthier life.

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May
19
2018

What lowers LDL cholesterol?

Many times we hear terms like LDL and HDL cholesterol , but what lowers LDL cholesterol? We have to go back to a time when the ongoing Framingham Heart Study wanted to find out what caused a heart attack or a stroke. In the 1960’s scientists found out that cigarette smoking increased heart attack risk and also blood cholesterol. Then in the 1980’s the news came out that HDL (high density lipoproteins) reduced the risk of heart disease. Eventually several research institutions agreed that LDL (low density lipoproteins) was the culprit for causing plaque deposits in arteries. This caused heart attacks and strokes. LDL is often referred to as the “bad” cholesterol.

Clarification of HDL and LDL cholesterol

Recently a review article asked the question: “What is the difference between HDL and LDL cholesterol?”

Below I will review what LDL and HDL cholesterol do in our system. I will also mention normal values for blood tests. This will help you to understand your own blood test results. Then I will review what you can do to lower LDL cholesterol and to increase HDL cholesterol.

The function of LDL and HDL cholesterol

Total cholesterol in the blood contains LDL cholesterol, small dense LDL cholesterol and HDL cholesterol. The small dense LDL cholesterol is more dangerous than LDL cholesterol. It infiltrates the lining of the arterial walls aggressively. A normal LDL level is less than 100 mg/dL. When triglycerides, another form of lipid is high in the blood, LDL cholesterol forms a lot more small dense LDL cholesterol. This is the case in diabetics or in obese people. It is the reason why they are very vulnerable to develop heart attacks and strokes. The optimal range for triglycerides is less than 80 mg/dL.

HDL cholesterol is protective from hardening of the arteries and protects you from heart attacks or strokes. HDL dissolves LDL cholesterol, brings it to the liver, and the liver excretes it into bile. You want to have more than 60 mg/dL of HDL cholesterol in your blood.

Cholesterol math

The total cholesterol conventionally is calculated like this:

LDL cholesterol + HDL cholesterol + (triglyceride/5) = Total cholesterol

You see that the small dense LDL is not part of it here, but high triglyceride levels would increase the total cholesterol value as the inclusion of 20% of triglycerides in this equation compensates for this.

There is also a ratio of total cholesterol to HDL cholesterol that is important. This ratio should be below 3.4 for both women and men. This is also known as the ½ average risk for a heart attack or stroke. If your value is equal to that or below, you are in a very low risk category to get a heart attack or stroke.

Now I will deal with the question: what lowers LDL cholesterol?

What lowers LDL cholesterol?

Now we need to review what can be done to lower an LDL cholesterol which is too high. Don’t tell me that you want to take one of the statin drugs. These drugs have serious side effects and are only indicated for the most serious cases of high cholesterol values.

Most common measures to reduce LDL cholesterol

  • Cut out red meat

    First of all, cutting out red meat (like beef, pork and sausages) to an absolute minimum, for instance once per week or less is important. The reason is that these meats have more cholesterol in them and also more saturated fats than any other foods. Compare that to poultry, fish and vegetables like beans, which are healthy food sources.

  • Eliminate trans fats

    Furthermore, we need to eliminate trans fats as they are causing heart attacks. There is an important difference between ruminant trans fats and artificial trans fats. Ruminant trans fats have been part of the human diet for millennia like milk fat and fat from cows that are on pasture or lamb. Milk products for instance contain fat with 2-5% natural trans fats. 3-9 % of the fat in beef and lamb consists of natural trans fats. Studies have shown that the body is able to handle these natural trans fats, and heart attacks are not more frequent in people eating moderate amounts of these products including butter from cows that graze on pasture.

  • Artificial trans fats

    Quite the opposite is true for artificial trans fats in margarine that comes from vegetable oil. Avoid bakery items like sweet pieces or muffins and other products that contain hydrogenated oils. Read labels! Use olive oil or coconut oil, but avoid vegetable oils like corn oil, safflower oil or grape seed oil to get away from trans fats and unstable oils that turn rancid. Rancid oils contain free radicals that oxidize LDL cholesterol and attack the lining of your arteries through small dense LDL cholesterol.

  • Cut out sugar and starchy foods

    Another important item is to cut out sugar and starchy foods because these will raise your LDL cholesterol and triglycerides, which also leads to hardening of your arteries. Starchy foods are broken down by pancreatic juices into sugar, which enters your blood stream, causing an outpouring of insulin from the pancreas. When the short-term storage of sugar as glycogen is exhausted in muscle and liver tissue, the liver has to process any surplus of sugar that is still there. The end results are triglycerides and LDL cholesterol. Unfortunately the protective HDL cholesterol does not reach higher levels, when the LDL cholesterol is increased. A persistent diet of high-refined carbs will increase the risk for heart attacks and strokes. It follows from this that we are all better off cutting out sugar and starchy foods from our food intake as it will reduce LDL cholesterol and small dense LDL cholesterol.

  • Increase your soluble fiber intake

    Increase your soluble fiber intake by eating vegetables, oats and oat bran, lentils, fruits and beans. Why does this decrease LDL cholesterol? The liver tries to eliminate too much cholesterol by binding it to bile salts and excreting it into your small bowel. But the last part of the small bowel reabsorbs some of these bile salts, and from there they return to the liver. This is called the enterohepatic pathway of bile salts. Soluble fiber intake binds those bile salts and prevents re-absorption in the enterohepatic pathway, eliminating cholesterol safely in stool. Clinical trials have also shown that soluble fiber from psyllium, pectin, beta-glucans and others reduce LDL cholesterol by binding bile salts in the gut (interrupting the enterohepatic pathway).

  • Plant sterols and fiber supplements

    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 are beneficial in terms of prevention of heart attacks and strokes. It would be too lengthy to get into more details here.

  • Take a whey protein supplement

    There are two major milk proteins, whey and casein. Only whey protein binds to total and LDL cholesterol, lowering both. It is available in health food stores. Follow the package insert of the whey product for dosing.

  • Increase your omega-3 fatty acid intake

    Omega-3 fats naturally present in fish oils and nuts. They increase the amount of circulating HDL cholesterol, which binds the bad LDL cholesterol. Go ahead and eat salmon, herring and mackerel as well as walnuts, ground flaxseeds and almonds. You can also take molecularly distilled (or pharmaceutically pure) EPA/DHA supplements. This pure form of fish oil is free of mercury and other heavy metals. EPA stands for eicosapentaenoic acid or omega-3 fatty acid. DHA is the acronym for docosahexaenoic acid, an important supplement for the brain. Tests have shown that fish oil supplements at a dosage of 3.35 grams per day of EPA plus DHA reduce triglycerides by up to 40%, equally to Lipitor, but without the statin side effects. The end result: your total cholesterol/HDL ratio decreases, as does the risk for heart attacks and strokes. Here is a review of other oils in your diet.

Measures that will increase HDL cholesterol 

  • Eat foods with anthocyanin

    In a 24-week study with diabetic people HDL levels rose by 19% when food was eaten that was rich in anthocyanin. This consisted of eggplant, purple corn, red cabbage, blueberries and blackberries. The advantage of raising the HDL cholesterol level is that the total cholesterol to HDL ratio decreases, which lowers the risk for heart attacks and strokes.

  • Exercising regularly

    Exercising will increase your HDL cholesterol, which again decreases the ratio of total cholesterol to HDL cholesterol. This number should be between 1 and 3.5, the lower, the better.

  • Take a supplement called Ubiquinol, or Co-Q-10

    Adults above the age of 60 need 400 mg once daily, younger people need between 200 mg and 300 mg daily. Co-Q-10 prevents oxidation of LDL cholesterol, which would aggressively attack the arterial walls causing hardening of the arteries. What causes oxidation of cholesterol? The answer is clear: fried foods like french fries or deep fried chicken will lead to oxidation; other culprits are margarine, commercially baked goods and cigarette smoking.

  • Calcium and vitamin D3

    Recently a study on postmenopausal and overweight or obese women found that supplements of calcium combined with vitamin D3 lowered cholesterol.

  • Polyphenols

    Flavonoids are the largest group among the polyphenols in such common foods as vegetables, fruits, tea, coffee, chocolate and wine. Over 130 studies on humans have shown improvement of the lining of the arteries (endothelial functioning) and lowering of blood pressure. Polyphenol consumption has a connection to 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.1). Take about 250 mg of resveratrol daily.

  • 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 patients take higher doses of 2.25 grams per day. In a metaanalysis of 7 studies researchers found a significant reduction of heart attacks and transient ischemic attacks. These are precursor syndromes before developing a stroke. Niacin can change the small particle LDL into a large particle size LDL, which is less dangerous. Niacin also reduces oxidation of LDL, which stops the atherosclerotic process. For a healthy person 500 mg per day of flush-free niacin is adequate.

  • Curcumin

    This is a powerful heart and brain protector combining three different mechanisms in one. It is reducing oxidative stress. But it is  also an anti-inflammatory. In addition it counters the process that threatens to destroy the lining of the arteries. One study on healthy volunteers showed reduction of 33% in lipid oxidation, a 12% reduction of total cholesterol and an increase of 29% of the protective HDL cholesterol when patients took 500 mg of curcumin for only 7 days (Ref.1). This is the daily dose I would recommend for prevention of heart attacks and strokes.

  • Vitamin E (tocopherols)

    This fat-soluble vitamin is an antioxidant and in the past health practitioners knew about its use as being heart supportive. Strangely enough some conservative physicians bad-mouthed this vitamin. In the meantime health practitioners have returned to using the vitamin. It turns out that there are 8 different types of tocopherols, with the alpha tocopherol being the best-known, but you also want to be sure that you are getting gamma tocopherol with your balanced vitamin E supplement every day. Newer research has shown that tocotrienol is more powerful than tocopherols. I take 125 mg of tocotrienols daily.

What lowers LDL cholesterol?

What lowers LDL cholesterol?

Conclusion

Over the years cardiovascular researchers have accumulated knowledge about supplements that will reduce LDL cholesterol or increase HDL cholesterol. It has practical value: you can look at your own lab results and choose what fits your situation best. You should always make these decisions together with your health care provider. None of the methods reviewed here have any serious side effects. On the other hand statins, as I have reviewed in the link provided, do have significant side effects. Keep in mind that cholesterol is a normal body component that our body needs to make human cell walls. But we do not need to smoke (stopping it lowers LDL cholesterol). We need regular exercise (increases HDL cholesterol). Keep your cholesterol and triglyceride values within the normal ranges that I listed and as a result you will do well in terms of preventing heart attacks and strokes!

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Sep
23
2017

Close Diabetes Control Prolongs Life

 

A 20-year study showed that close diabetes control prolongs life. A study divided 160 people with diabetes into two groups. The one group continued to get standard care. Yet the other group received a multi targeted, aggressive treatment protocol. As a result after 20 years the group with the intensive treatment protocol lived 7.9 years longer than the group with the standard treatment.

Dr. Oluf Pederson was the senior investigator of the physician team that followed the diabetes group. He said that they concentrated on a number of known adverse factors and treated them aggressively. These factors were first of all high blood glucose values and clotting risks, also high blood pressure and high triglycerides and in addition cholesterol values. Behavior modification was the therapeutic method to get people with risk factors to exercise more, adopt a healthy diet and stop smoking. Medication in select cases also played a role.

More details about the study

The intervention of intensive treatment lasted 8 years. After that the patients were still in a follow-up study for 13 years. At the beginning of the study patients were on average 55 years old and were borderline obese.

The investigation team screened for complications of diabetes. This included screening for kidney disease, heart disease and blindness. Dr. Joel Zonszein, the director of the New York Clinical Diabetes Center at Montefiore Medical Center said: ”These results are impressive and most patients do not receive the correct treatment, according to national surveys.”

Other studies about diabetes  

Foreign studies

Study from Croatia
  • Another study from Croatia involved 200 patients. It concentrated on patients who did not respond to metformin. Physicians used alternative treatment modalities, and they observed and measured blood sugars and hemoglobin A1C in the following 6 months. The study concluded that those patients who received aggressive treatment of their condition did better than those who did not receive the same vigorous approach.
Study from Japan
  • This Japanese study documented that female patients with type-2 diabetes developed kidney damage earlier than their male counterparts.  Consequently, the investigators pointed out how important it is to treat diabetes aggressively to avoid kidney damage.
Study from Singapore
  • This 2016 study from Singapore analyzed retroactively the impact of diabetes on the long-term survival after coronary bypass grafting (CABG).  5720 consecutive patients had their isolated first CABG surgery between 1982 and 1999. The mean follow-up was 13 years. 34.6% of the patients had diabetes, 51% had high blood pressure and 46.6% had elevated blood lipids. The initial mortality after the CABG surgery was 2.4% in the diabetic group and 1.8% in the non-diabetic group. 20-year survival rates following CABG surgery were 30.9% in diabetics and 49.2% in the non-diabetics, an 18.3% difference. The 20-year freedom from cardiac mortality rates was 56% in diabetics and 68.4% in non-diabetics. Other risk factors that led to cardiac mortality were the following: female gender (1.43-fold risk), diabetes (1.51-fold risk), previous heart attack (1.54-fold risk) and a low left ventricular ejection fraction of less than 35% (2.6-fold risk). The conclusion from this study was that long-term survival in diabetics following CABG surgery was much lower than that of non-diabetic controls. Hence the key to improving long-term survival for diabetics is to treat comorbidities like high blood pressure and elevated lipids aggressively as well as getting blood sugars and hemoglobin A1C values under control.

US studies

  • In this US study 558 youth (age less than 21) between February 2012 to July 2015 received follow-up. Between 40% and 50% of these diabetics needed insulin to improve their diabetes. Unfortunately their diabetes showed poor control, as their high hemoglobin A1C values indicated. Median HbA1C was 6.7%, 8.5%, 9.6%, and 9.7% in those with disease duration less than 1 year, 1-2 years, 2-3 years and less than 4  In other words, the longer the young patients had diabetes, the less seriously they took their treatment. Only 33% treated their high blood pressure and only 11% their elevated blood lipids. Microalbuminuria, an indicator of diabetic kidney disease, and non-alcoholic fatty liver disease were present in 5% to 6% of these young diabetic patients. The authors came to the conclusion that there were serious gaps in treating these young diabetics. Further follow-up data of the same group of patients in the coming years will provide further data. In conclusion, the new hemoglobin A1C ranges of 3.8% to 4.9% as the new normal range explains why these youths who do not treat their diabetes properly are at high risk to develop complications from their poorly controlled diabetes.
Heart attacks and erectile dysfunction
  • Heart attacks are more common among patients with uncontrolled diabetes. This US study classified diabetics according to the tightness of their diabetes control. Researchers found examining 606 men and 606 women with diabetes that they could reduce their risk of a heart attack, if they controlled smoking, glycated hemoglobin (hemoglobin A1C), systolic blood pressure, and total and high-density lipoprotein cholesterol. The control of all these risk factors could contribute to the prevention of heart attacks. 35% of men and 45% of women could prevent having a heart attack. A laxer control still would prevent 36% of heart attacks in men and 38% in women. A very aggressive diabetes control could prevent 51% of heart attacks in men and 61% in women. Most noteworthy: close diabetes control prolongs life.
  • Erectile dysfunction (ED) is a big problem among diabetic men. This study from Seattle shows the investigation of 136, 306 men with erectile dysfunction. 19, 236 of these men had diabetes prior to their ED problem. Over a two-year observation period diabetic men had much worse ED problems. As a result they needed to receive secondary line treatments  like penile suppositories or injectables. Others needed tertiary treatments like penile prostheses. In those whose diabetes control was good, oral agents as first-line therapies were usually sufficient.
More studies about risks and benefits of lifestyle
  • Middle-aged women with diabetes have a 4- to 5-fold higher risk for developing heart attacks while men do not show such a higher risk. It is probably particularly important for women to control diabetes when they are diagnosed with it to reduce the risk of coming down with a heart attack.
  • In 2011 Taylor from Newcastle University showed in a group of diabetes patients that he could cure diabetes permanently with an extremely low calorie diet. The trial was simple: he took overweight or obese patients with diabetes and put them on a starvation diet of 600-700 calories per day for 8 weeks. Consequently 43% of diabetic patients received a permanent cure of their diabetes. More info: http://nethealthbook.com/news/cure-diabetes-permanently/

 

Close Diabetes Control Prolongs Life

Close Diabetes Control Prolongs Life

Conclusion

The new hemoglobin A1C ranges that are desirable are between 3.8% to 4.9%. When diabetics bring their hemoglobin A1C level into this range, they do not get complications from their previously poorly controlled diabetes. Close diabetes control prolongs life. But as can be seen from a brief review of the literature physicians tend to be lax, patients are lax, and diabetes is often not well controlled. This leads to erectile dysfunction in males, to heart attacks and kidney failure in both sexes. Blindness and painful diabetic neuropathy are also common complications of poorly controlled diabetes. Amputations from clogged arteries are also among the complications. “Close diabetes control prolongs life” is the new mantra that everybody with diabetes needs to follow.

Lifestyle changes control diabetes and prolong life

As stated above Dr. Taylor from Great Britain has shown that a brief 600 to 700 calorie diet can cure 43% of diabetic patients permanently. Quit smoking, bring the glycated hemoglobin (hemoglobin A1C) into the normal range, control your systolic blood pressure as well as your total and high-density lipoprotein cholesterol. Do all these things, exercise regularly, and your diabetes will be well controlled. Remember: close diabetes control prolongs life!

Oct
01
2016

Sugar Can Cause Heart Attacks

Recently an online medical journal article from JAMA has revealed that sugar can cause heart attacks. As the Guardian reports, this analysis of influence peddling of the sugar industry going back 60 years has had far-reaching effects by confusing the public and policy makers in the US and around the world. At the same time the interference of the sugar industry was protecting its own interests. It increased sugar sales, but made people sick with obesity, diabetes and cardiovascular disease. This story is similar to the tobacco industry that was able for years to cover up that cigarette smoke is causing heart attacks and lung cancer.

Denying that sugar can cause heart attacks

The English physiologist John Yudkin noted in the 1960’s that sugar was elevating cholesterol and triglycerides. The sugar industry panicked. They wanted to do something to stop this new type of research. As we can read online the Sugar Research Foundation (SRF) had 319 correspondences (1551 pages) with Roger Adams. He was a professor serving on the SRF’s scientific advisory board (SAB) from 1959 to 1971. Another piece of evidence of influence peddling came from a review of correspondence between the SRF and D. Mark Hegsted. He was professor of nutrition at the Harvard School of Public Health. At the same time he was co director of the SRF’s first coronary heart disease research project. This took place from 1965 to 1966.

Historic falsification of research findings by John Yudkin

There are 27 documents totalling 31 pages in the Harvard medical Library. It is clear from this correspondence that the SRF was looking for a way to undermine the new research findings of negative effects of sugar. The SRF was looking for a way to confirm that fat reduction would be beneficial for patients. This way physicians would put many people on a low fat diet. This in turn would ensure continuing and rising sales of sugar.

New evidence that sugar can cause heart attacks

New research came out by D. Mark Hegsted in the Annals of Internal Medicine in June 1965. It linked sugar consumption to cardiovascular disease. It noted that blood sugar levels were a better predictor of hardening of arteries than cholesterol levels or high blood pressure. Another paper stated that it was sugar rather than starches causing high triglycerides in the blood. He hypothesized that “perhaps fructose, a constituent of sucrose but not of starch, was the agent mainly responsible.” An editorial in the same publication noted that these new findings corroborated Dr. Yudkin’s previous research that sugar could cause heart attacks.

The sugar industry was very concerned about these studies. If publicized widely, it would have the capacity to lower sugar sales.

Sugar can cause heart attacks, but review paper ignores this

On July 1, 1965, the SRF’s Hickson visited D. Mark Hegsted to discuss his publication. He wanted him to be part of an extensive literature review that would show that it was too much saturated fat that was the cause of high cholesterol and triglycerides, not sugar. It also should state that a lowering of fat content from 40% to 20% was necessary and that polyunsaturated fatty acids should be used to replace much of the fat. The fact that the food industry would quietly increase sugar content in processed foods was not mentioned. The review paper was called “Project 226”. It resulted in a 2-part literature review by McGandy, Hegsted, and Stare. It was entitled “Dietary Fats, Carbohydrates and Atherosclerotic Disease,” and was published in the New England Journal of Medicine (NEJM) in 1967. Industry and non-industry funding of the review authors’ experimental research was disclosed.

Falsified study from 1967 in the New England Journal of Medicine

However, the funding by the Sugar Research Foundation was omitted. The authors of the study received handsome amounts of money from the SRF for their efforts. The story that was told is all too well known, but false. There was the claim that the medical literature would have shown that a reduction of saturated fat intake lowered cholesterol. Triglyceride levels did not matter. Only cholesterol levels counted with respect to coronary artery hardening. There was also the statement that replacement of saturated fat with polyunsaturated fatty acids like corn oil would be beneficial in reducing heart attack rates.

Effect of the literature review on heart attack rates

Sadly the NEJM literature review has resulted in a government policy that lasted for decades. The gospel was that a low fat diet would prevent heart attacks. The food industry prepared foods that were low in fats and high in sugar and supposedly healthy. But the extra sugar made people fat, it did not decrease heart attack rates, but made them more frequent. Strokes were also on the rise and diabetes has become rampant. The reliance on corn oil has introduced another problem: omega-6 fatty acids are now consumed at an alarming rate. Corn oil has a 1:59 ratio for omega-3 to omega-6 fatty acids.

Corn oil causes inflammation

This means that corn oil contributes to the lack of omega-3 fatty acids in our food. When the ratio of omega-3 to omega-6 fatty acids falls below 1:3 or 1:4 the metabolism changes towards inflammation as the arachidonic acid system switches toward inflammation. Cardiologists have pinpointed inflammation as an important cause of hardening of arteries. Fish oil, a rich source of omega-3 fatty acids helps to prevent hard attacks and strokes.

The end result of the confusion regarding fat, sugar and heart attacks caused by the biased literature review meant misery, suffering and death for many for decades. But recently there has been a renaissance of Dr. John Yadkin’s research: Now it is clear what sugar is doing and how it affects our health.

How sugar can cause heart attacks and more

It is clear that sugary soda has detrimental effects on us: as little as one or two cans of sugary soda drinks per day lead to

  • 26% greater risk of developing type 2 diabetes
  • A 35% greater risk of heart attack or fatal heart disease
  • A 16% increased risk of stroke

Dr. Frank Hu’s study

Dr. Frank Hu has participated in a study that spanned over 24 to 30 years and examined the replacement of saturated fat with polyunsaturated fatty acids (PUFA), monounsaturated fatty acids and whole grain carbohydrates. The study involved 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010). The researchers did detailed diet assessments every 4 years. 7,667 cases of cardiovascular disease (CHD) occurred during the study. Compared to controls that did not change their diet with respect to saturated fatty acid intake, those who replaced with PUFA had 25% less CHD, those who replaced with monounsaturated fatty acids had 15% less CHD and those who replaced saturated fatty acid intake with whole grains had 9% less CHD. In contrast, a subgroup that had replaced saturated fatty acid intake with carbohydrates from refined starches/added sugars ended up with a 10% increase of CHD.

Effect of sugar

We know now that sugar can increase cholesterol and triglycerides as Dr. John Yudkin has said in the 1960’s.

We also know that sugar can cause arthritis when combined with low omega-3 fatty acids and high omega-6 fatty acids. In the 1950’s Dan Dale Alexander wrote a book called “Arthritis and common sense”. The medical establishment did not accept that simple remedy and Dan Dale Alexander was classified as a “quack”. However, Dr. Mirkin describes a study from Berlin that later confirmed that Dan Dale Alexander’s observation was correct: an emulsion made by shaking orange juice with cod liver oil and taken three times per day on an empty stomach would indeed improve osteoarthritis.

High glycemic foods and starchy foods cause cancer

High glycemic foods (sugar, starchy foods) caused breast cancer, colorectal cancer and endometrial cancer. The majority of trials showed this association although not all. The more obese patients were, the more pronounced the insulin resistance was and the more the relationship to these cancers became apparent. A diet that is high in starchy foods like potatoes, rice and bread is causing pancreatic cancer as was shown by researchers at the Dana-Faber Cancer Institute, Brigham and Women’s Hospital and Harvard School of Public Health.

Sugar Can Cause Heart Attacks

Sugar Can Cause Heart Attacks

Conclusion

The low fat/ high glycemic diet was a fad-diet based on fictitious science, sponsored by the sugar industry. It became a human experiment and resulted in 60 years of suffering. During that time it became apparent that this diet did not work. It caused the obesity wave, a wave of heart attacks, strokes and cancer. This was all caused by too much sugar in the diet. Associated with this are the consumption of processed foods. There is too much sugar and an abundance of omega-6 fatty acids in processed food. This causes inflammation and hardening of the arteries.

What sugar does

We finally know that sugar raises cholesterol (LDL cholesterol in particular) and triglycerides. This leads to fat deposits and hardening of the arteries resulting in strokes and heart attacks. Remove refined sugar, limit your starchy food intake and eat fish as a source of omega-3 fatty acids. Feast on vegetables, salads and have some nuts as another source of omega-3 fatty acids. You are well on your way to preventing heart attacks, strokes and many cancers. After reading all the facts, there is no need to be a victim of the sugar industry. This also helps you to stay away from sugar’s associated health risks.

Dec
19
2015

Beer Belly Bad News

You heard the expression “beer belly”, but now we learn “beer belly bad news”. It is an unflattering term for increased abdominal girth, especially in males. It is quite often that this picture is found in middle-aged men who consume more beer than what is good for them, but they may also mill around the hot dog stands at the ball game instead of being physically active. Any leftover calories are stored as belly fat, which protrudes their stomach as if they were pregnant.

There is a big difference between belly fat and body fat. Belly fat is metabolically much more active. Body fat is more sessile. So, it is the belly fat we need to do something about as this has been shown to be associated with heart attacks, strokes and diabetes.

 

Abdominal girth to hip ratio instead of BMI

Originally it was thought that excessive weight would best be measured with the body mass index (BMI). But subsequently it was shown that athletes with well-developed muscles could have BMI’s that were in the overweight (between 25.0 and 30.0) or even obese category (more than 30.0). Also, some people with heavy bones can have excessive BMI values despite them being normal based on other measurements. The new measurement is the old fashioned abdominal girth to hip ratio.

Weight gain leads to metabolic syndrome

You measure the abdominal girth, the hip girth and divide the abdominal girth by the hip girth. Normally this should be 80% (=0.8) or less for women and 90% (=0.9) or less for men. But a person with a beer belly will have ratios of 1.2 or 1.5.

If you take blood tests of that person you would also find elevated triglycerides, lowered HDL cholesterol (the protective cholesterol) and elevated LDL cholesterol (the bad cholesterol). In addition, we know from studies that often the insulin level is elevated in the sense of hyperinsulinism. In fact that person has often the metabolic syndrome, which is a characteristic change of the metabolism in an obese person. The blood is thicker with clotting factors floating around, there are inflammatory kinins that circulate and these factors work together on causing hardening of the arteries.

Why is a beer belly dangerous?

There are not only cardiovascular risk on the long-term causing heart attacks and strokes down the road. There is a danger of fat deposits in the liver, called fatty liver disease.

In time this can turn into liver cirrhosis and in some cases develop into liver cancer. Because belly fat causes inflammation in the system including in the lining of the blood vessels, this can in time also affect the immune system, weakening it and eventually allowing cancer to develop. Common cancers that are associated with obesity are breast cancer, ovarian cancer and uterine cancer in women, prostate cancer in men and pancreas and colon cancer in both sexes.

Estrogen from aromatase in beer bellies

In men beer bellies produce a lot of estrogen, the female hormone. This is so because fat tissue contains the enzyme aromatase that metabolizes male hormones into estrogen. Estrogen in men is only good in traces, but when the body produces it massively, it will counter testosterone production and will cause heart attacks and strokes.

What can you do about a beer belly?

We need to understand how beer bellies develop. One of the sources of fat from beer bellies is the consumption of foods that contain a lot of fructose. Food manufacturers have been diligent in mixing high fructose corn syrup into sugary drinks and into a myriad of processed foods.

Sugar itself can only be processed and stored until the glycogen stores in the liver and the muscles are filled. The liver metabolizes a surplus of sugar into triglycerides and LDL cholesterol. This is also the case for any fructose that comes from metabolized sucrose (table sugar) and from the high fructose corn syrup popular with the food processing industry. One problem is that fructose can only be processed by the liver, while glucose gets directly taken up by cells with the help of insulin.

German obesity wave after WWII in the 1960’s

The surplus of fructose metabolizes into triglycerides and LDL cholesterol before the body stores it as fat in fat cells. Unfortunately a lot of the fat will end up between your guts, in the liver as fatty liver and in the beer belly, a metabolically more active form of fat.

The sad part is that in the 1960’s I have seen the German economic wonder (“Wirtschaftswunder”) where many mid fifty to mid sixty business men died as a result of obesity and subsequent heart attacks and strokes. At that time Germans who were starving during World War II lived it up. This was in the late fifties and 1960’s. They ate whatever they could: cakes, fatty cheeses, whipped cream, fatty foods like pork roasts and beef.

Unhealthy hydrogenated fats, starchy food and sugar caused beer bellies

They also consumed loads of bread, buns, pasta and sugar. Margarine also became popular with its hydrogenated fatty acids that also contained free radicals. The end result was that they gained weight, did not exercise and developed their beer bellies.

In the 1980’s the school of thought was that saturated fatty acids  were responsible for heart attacks, strokes and obesity.  A low fat/high carb diet became popular and continued to steadily increase. Sure, the hydrogenated fatty acids did not help and should be cut out. But the bigger problem was the consumption of high fructose corn syrup and over-consumption of high glycemic-index carbohydrates.

Steps of how to get rid of the beer belly

Here is the solution of what to do get rid of the beer belly.

Eliminate sugar and high fructose from diet

Remove sugar and high fructose corn syrup from your diet.

Remove empty starches from your diet

The second effective step is to cut out as many empty starches that you can cut out like white rice, bread, sweets, cookies, cakes, ice cream and pasta. Starchy foods metabolize in the gut into sugar, which causes an insulin response. The extra insulin is responsible for developing inflammation in the arteries, which eventually leads to heart attacks and strokes.

Regular exercise

Exercise on a regular basis. This will produce HDL cholesterol, the protective cholesterol, which balances LDL cholesterol.

Rebalance your food intake

Perhaps the most important step is to rebalance your food intake. With this I mean that you replace high glycemic-index carbs with low glycemic-index carbs. This means you will eat a lot of salads, steamed vegetables, and fruit. This gives you a lot of extra fiber, which your system needs to slow down the rate of sugar absorption. It also  helps you to lower LDL cholesterol and detoxify your body in the gut where fiber binds toxins.

Moderate your alcohol intake

If you are heavily into alcoholic drinks, this is another source of refined carbohydrates. They metabolize into LDL cholesterol, triglycerides and can cause fatty liver disease and liver cirrhosis. A moderate consumption of alcohol (one drink for women per day and two drinks for men per day) lowers the risk of heart attacks and strokes, while excessive alcohol intake increases the risk.

Bioidentical hormone replacement

Bioidentical hormone replacement may be something you have not heard about. But if you are a woman above the age of 40 or a man above the age of 50 chances are that you need some hormone tests. As a male, your natural hormone production from your testicles or adrenal glands is likely not keeping up.  As a woman, your ovaries or adrenal glands are no longer keeping up with the demand of regular life. Part of the aging process is that the production of our sex hormones slows down. It does so shortly before menopause in women and shortly before andropause in men.

Lack of function of key organs in menopause and andropause

This will not only manifest itself in hot flashes and sleep disturbance in women. Men experience erectile dysfunction and grumpiness. Eventually this leads to a lack of energy production in the heart, the brain and other organ systems. When these organs have sex hormone receptors, but circulating sex hormones are missing, they cannot function optimally.

Lack of hormones causes heart attacks, strokes and cancer

A lack of hormones translates into yet another cause of heart attacks, strokes and certain cancers. This is an area where conventional medicine disagrees with anti-aging medicine. Years in general practice have taught me that heart attacks, strokes, colorectal cancer and pancreatic cancer happen more often when hormones are missing in both sexes. Cancer of the breasts, uterus and ovaries and prostate cancer are more common when sex hormones are missing. These cancers occur when natural sex hormone production declined.

On the other hand, with bioidentical hormone replacement the metabolism of all cells will return to normal. With this the likelihood of not developing all these illnesses at an earlier time is diminishing as well. It is not a panacea for eternal life, but it will add significant longevity. And with this comes the knowledge that you will not get premature disabilities, which is what we all need.

Beer Belly Bad News

Beer Belly Bad News

Conclusion

We need to assess our food intake habits and cut out the items that contribute to the beer belly. Next we need to ask ourselves what other change in lifestyle we require.  Think about anything to improve our body shape and our energy metabolism. Life is too precious to just throw away years of fruitful living in our golden retirement years. Work on these factors in midlife or even in younger years and you will enjoy disease-free aging.

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Oct
04
2014

The Problem Are Sugar And Starchy Foods

Fareed Zacharia interviewed Chief Medical Correspondent Sanjay Gupta on CNN on Sept. 10, 2014 regarding why sugar is worse than fat.

I like to explain why it is important to rethink the issues of fat, cholesterol, sugar, starchy foods, longevity, prevention of cardiovascular diseases (strokes, heart attacks) and cancer.

I have blogged about this many times before, but perhaps an overview regarding these issues would be in order.

The Framingham Heart Study indicated first that too much cholesterol in our system was a problem leading to heart attacks and strokes (Ref. 3). As more research was done, the reasons for this have become clearer.

1.Liver metabolism

The liver plays a major role in the metabolism of glucose. Digestion of refined starchy foods starts in the mouth where amylase from the saliva digests the surface of the pasta or white bread you eat. The stomach carries on with this process and the job is finished in the small intestine with the help of pancreatic enzymes (Ref.1). This digestive process is so efficient that within 20 to 30 minutes all of the refined carbs from pasta, donuts and bread appear as sugar in the blood stream. The portal vein system that collects the nutrients from the gut delivers all sugar straight to the liver where it is reassembled into glucagon as the storage form in the liver and skeletal muscles. This would all be good, would we have periods of fasting in between our sugar consumption. Periods of famine are no longer part of modern civilization, but consumerism is. Most of the processed food contains sugar and this leads to excess sugar uptake, which has to be processed by our liver. The end result is production of LDL cholesterol, oxidization of LDL cholesterol by sugar and in the process the production of VLDL (=very low-density lipoproteins) that leads directly to deposits in the arterial walls and clogging of arteries. Triglycerides are also produced, which leads to fat deposits (the cause of the obesity wave all around us).

2. Where does the fat that we see around us come from?

In the past we thought that it was from too much saturated fat and cholesterol in the food that would have caused the accumulation of fat and cholesterol in the body. Now we know that this was an over-simplification. In fact more cholesterol and fat comes from metabolized sugar and with a slight time delay also from starchy foods.

Sugar and starchy foods (like pasta, white rice, white bread, potatoes, grapes, honey etc.) get metabolized by your liver into LDL cholesterol, triglycerides, and fat. This does not mean that you should not pay attention to the total fat content and the quality of fats you eat.

3. The finer points about subfractions of cholesterol

You have heard many times about the good (HDL) and the bad (LDL) cholesterol. Sugar and refined starches do not only lead to the production of LDL cholesterol, but also to oxidized LDL cholesterol, which is very aggressive (VLDL=very low-density lipoproteins) leading directly to deposits in the arterial walls and to clogging of arteries. Your doctor can order a detailed lipid profile test, if you belong into a higher risk group to determine your VLDL level.

It may surprise you to read that many of the foods that were demonized in the past 2 to 3 decades like whole eggs; unprocessed grass-fed red meat, coconut oil etc. are now seen to be good for you.

But there are provisos: supplement with molecularly distilled omega-3 fatty acids, have enough vitamin D3, vitamin K2 and calcium in your diet or supplement with these. This will make sure that calcium will leave the blood stream (not lead to arteriosclerosis) and enter into the bones where it is needed for healthy bone structure. The anti-inflammatory effect of vitamin D3 and of the omega-3 fatty acids will prevent arthritis, strokes, heart attacks and cancer.

The Problem Are Sugar And Starchy Foods

The Problem Are Sugar And Starchy Foods

4. Four major conditions causing heart attacks and strokes

According to Ref. 2 only 4 conditions have been proven over the years to lead to serious hardening of arteries causing strokes and heart attacks: dyslipidemia (high triglycerides, high LDL cholesterol and VLDL), hypertension, cigarette smoking, and/or diabetes (Ref. 3). What has not been appreciated until recently is the fact that sugar and refined starchy foods metabolized by the liver are the culprits in causing plaque in arteries as the oxidized LDL cholesterol is aggressively invading the arterial wall and is inflammatory. A total cholesterol level greater than 5.2 mmol/L (200 mg/dL) has been shown to be associated with increased heart attacks and strokes. Ref. 2 also points out that dietary changes; days of fasting and weight loss have all been shown to stabilize and reduce plaque lesions and reduce heart attacks and strokes. It is the rupture of unstable plaques that lead to attraction of platelets and thrombus formation. It is this localized thrombosis that leads to the closure of coronary arteries or brain vessels causing heart attacks and strokes. According to Ref. 2 there are 9 factors that determine whether we get a stroke or heart attack, the four factors mentioned above (dyslipidemia, hypertension, cigarette smoking, diabetes) and abdominal obesity, lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and a psychosocial risk. This latter factor includes any kind of chronic stress like interpersonal stress at work or home, depression, financial stress, major life events like marriage, death, divorce, and lack of control. Counseling is useful for support regarding psychosocial risk factors. It is significant to note that according to Ref. 2 several studies have shown that 90% of heart attacks and strokes can be prevented by paying attention to these 9 risk factors. Managing stress effectively and seeking professional help for psychosocial difficulties as well as avoiding the  physical health risks will contribute to good allover health.

Conclusion

Where does this leave us? For decades we have been told that saturated fats and cholesterol in our diet were the culprits and we replaced them with sugar that is part of a low-fat diet. We need to pay attention to the glycemic index and cut out high glycemic foods. However, it is OK to eat some carbs from the medium glycemic food list and most of our carbs from the low glycemic food list. With regard to fat it is important to consume only the healthy fats including omega-3 fatty acids. By taking care of the 4 major causes of heart attacks and strokes and also attending to the additional minor contributors mentioned above you will be able to eliminate 90% of the cardiovascular events. As you change these things you will also prevent many cancers as you changed the body metabolism and chronic inflammation has been taken care of as well as I pointed out in several blogs before. Finally, pay attention to stress management. The body and mind work together.

I have discussed all of these items in detail in my book as well (Ref. 3).

More information on high density and low density carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/

References:

1.Townsend: Sabiston Textbook of Surgery, 19th ed.,Copyright 2012 Saunders.

2.Melmed: Williams Textbook of Endocrinology, 12th ed.,Copyright 2011 Saunders.

3. Dr. R. Schilling: “A Survivor’s Guide to Successful Aging“. Paperback through Amazon.com, 2014.

Last edited Nov. 8, 2014

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May
21
2014

Forty Percent Of Premature Deaths Can Be Prevented

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

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

1. Cancer:

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

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

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

2. Heart disease:

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

Forty Percent Of Premature Deaths Can Be Prevented

Forty Percent Of Premature Deaths Can Be Prevented

 

3. COPD/emphysema:

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

4. Stroke:

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

5. Unintentional accidents/injuries:

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

Conclusion:

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

More information on:

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

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

Last edited Nov. 8, 2014

Apr
05
2014

Yes, There Are Healthy Sugar Substitutes

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

Jan
11
2014

From Inflammation To Heart Attacks, Strokes And Arthritis

Have you ever wondered why people who limp from arthritis in their hip also often get heart attacks? And have you ever wondered why people with high blood pressure get strokes and/or heart attacks?

It is not that difficult to understand, although many people do not like to hear the truth.

After the holidays with lots of sweet presents and rich food it is a good time to reflect about the internal connections between our organs.

Let’s follow what foods can do to our system, then you will understand what to do to get out of a trap, where food is not friendly but damaging to your body.

1.    Sugar, omega-6 fatty acids and trans fats enter your system

When you opened the cheap chocolate bars, ate the pastas, the turkey gravy and the ice cream for dessert, your stomach faithfully digested all that food and broke it down into glucose (a simple sugar), omega-6 fatty acids and highly reactive trans fat with free radicals (from deep fried foods, margarine, shortening, pie crusts, cake mixes, frostings and non dairy coffee creamers just to mention a few).  Within ½ hour the sugar molecules from the digested meal will enter your blood stream.

2.    The metabolism sets in

We know from years and years of research that the glucose in the blood triggers the release of insulin from the pancreas, which facilitates absorption of sugar into your liver and muscles where it is stored as glycogen. This is meant to be a storage form of sugar, just in case you do not eat for a few hours, but need energy to burn for your physical activity. When you have saturated the glycogen storage in liver and muscles, your liver metabolizes sugar into fatty acids and triglycerides. There is the transport LDL cholesterol that is supposed to supply the brain and heart with healthy cholesterol for these organs to replace cell membranes. Instead, the LDL cholesterol that is supposed to be balanced by the protective HDL cholesterol gets oxidized from the extra sugar and from the free radicals of the TRANS fats that are now being outlawed by the FDA for exactly that reason. So, the oxidized LDL cholesterol turns into the vicious VDLDL particles, which can be measured as a special blood test by your doctor. The overabundance of omega-6 fatty acids start an internal fire by stimulating the arachidonic acid pathway, which causes inflammation in your arteries, your joints and your immune system.

From Inflammation To Heart Attacks, Strokes And Arthritis

From Inflammation To Heart Attacks, Strokes And Arthritis

3.    The consequences of eating foods which spike your blood sugar levels

The end result is hardening of your arteries and the beginning of arthritis in your joints. Mind you, this does not happen overnight, but when you eat this way decade after decade it takes its toll. Typically in your forties or fifties you will notice some swollen knuckles. Don’t just let this happen. Think that this is a sign that something is festering in you! If you don’t interfere, there could be one wrong move, when you play sports and a meniscal tear in your knee could put an end to the fun. Sure, you will find a reason that the angle of your jump was unfortunate and this was simply enough for your meniscus to tear. But could it be that there were inflammatory changes in your meniscus long before this incident, the meniscal material softened up, dried up because of a lack of proper nourishing synovial fluid? I found when I was in primary care practice that this was what caused the majority of meniscal tears. A normal meniscus does not tear easily, but decades of malnutrition will lead to these hidden changes, where a meniscus can be softened and is prone to damage without a warning.

Arthritis in your joints is similar to the process of what I described regarding meniscal degeneration. An imbalance of the omega-6/omega-3 ratio where people take in 12 to 16 times as much omega-6 fatty acids from processed food compared to omega-3 fatty acids from fish oil or fish consumed, causes inflammation of the joints via the arachidonic acid metabolism.

What about the arteries? It is no secret that many people in their 60’s have suddenly an episode of chest pain that leads to a referral to a cardiologist who will do a heart catheterization. A stent or two may have to be placed because of hardening and narrowing of the coronary arteries. In many trials where people with coronary artery disease were followed laboratory tests showed that these individuals had low 25-hydroxy-vitamin D levels in their blood and the calcium that was meant to make their bones strong, ended up in the arteries. Vitamin K2 is often also missing because of malnutrition.

People with high blood pressure often do not have enough nitric oxide production from their arteries, because they do not eat enough vegetables, they are too sessile and they eat too many sweets and starchy foods. As a result  the liver overproduces triglycerides and fat, and oxidized LDL cholesterol damages the lining of the arteries. Just treating high blood pressure with blood pressure lowering medications will not correct the underlying metabolic disbalance. This is why people who had 2 or three stents for coronary artery hardening will come back 5 or 10 years later and need more stents until they die of a full-blown heart attack. You must stop the underlying metabolic derangement, if you want to prevent further deterioration.

4.    Inflammation takes its toll

But what do the lining of the arteries, the inflamed joints, a degenerative meniscus and heart attacks and strokes have in common? It is the INFLAMMATION that changes the body chemistry. It gets even more complicated, because the extra calories that we consume get stored as visceral fat. This is done automatically when you eat too much sugar and starchy foods as you may have done over the holidays. Remember, our ancestors were hunters and gatherers, and our genetic make-up is still the same. So, when the glycogen stores are full, any surplus sugar gets metabolized by the liver into triglycerides, fatty acids and LDL cholesterol and gets stored as body fat. The most active fat is the visceral fat between our guts and around our body organs. This produces interleukins and other inflammatory cytokines that circulate in the blood causing inflammation in all our arteries.

This is the link between the various manifestations of inflammatory conditions in our bodies. We rarely think of all of these various conditions as being linked. We concentrate on each disaster as it strikes, but think that it is only a one-point-in-time event. We do not see the years of abuse of our bodies that have preceded any of these events.

5.    Disaster strikes in different ways

We usually hear about a person who just got a heart attack. Now it is an emergency!  Nobody thinks about the years of inappropriate food intake and the lack of exercise that led up to this heart attack event.

The same is true for a sudden stroke. The patient arrives at the hospital in an ambulance and cannot move one arm and one leg. Initially the patient may be unconscious. There is too much action required by the emergency personnel to ask the question why it had to come to this. The truth though is that the blood vessel deterioration in the brain vessels that led to the stroke have quietly happened years before the acute event.

And then there is the aging 75-year-old man with a stiffening hip and arthritis in the hands. The inflammation has been quietly developing in the synovial membranes of the joints for more than a decade. The patient probably swallowed anti-inflammatory medications for years for arthritis symptoms, which as you guessed has not changed the underlying biochemistry. But now it has come to the point where a total hip replacement is required, just to be able to continue to walk. I have experienced that scenario in the hospital setting many times. Many patients went through the total hip replacement surgery with no problems. But other patients had their total hip replacement done and they developed a heart attack under the general anesthetic, because unbeknown to the orthopedic surgeon the patient also had severe hardening of the arteries that had not shown up on the pre-surgical electrocardiogram. A stress test or a Thallium heart scan when the patient still could exercise would have shown this hidden cardiac condition before the surgery, so that a cardiologist could have addressed this condition before the surgery. After that the total hip replacement would most likely have been uneventful.

6.Prevention is the key

The lesson to be learned from all of this is: prevent these disasters from happening in the first place. Do the following:

1) Good, balanced nutrition

2) Regular exercise.

3) Take vitamins and mineral supplements for bone health.

4) As you age, have your hormones measured and replace what is missing.

5) Avoid toxins. Use detoxification.

6) Avoid junk foods.

I have covered these topics in many blogs before as indicated in the above links.

Conclusion

Health disasters are mostly not accidental, but are rather caused by not paying attention to the silent metabolic changes based on improper nutrition and a lack of exercise, which could also be termed as a lack of prevention. It takes some time, often even some suffering to understand the deeper meaning of what I discussed above (that prevention is much more powerful on the long-term than curative medicine). I speak from experience having worked in the medical field for more than 30 years. Curative medicine will take care of an emergency, but the underlying inflammation and metabolic derangement will persist, if this is not changed through the steps mentioned above. Treat inflammation and LDL oxidation by modifying your lifestyle. Think prevention!

More information on inflammation medicine: https://www.askdrray.com/chronic-inflammation-causes-cancer-heart-attacks-and-more/

Last edited Nov. 7, 2014

Dec
21
2013

Buying Into High Carb, Low Fat Myth Makes You Sick

If you are like most people, you probably still think that “healthy grains” like wheat are good for you and are “essential for a well balanced diet”. Ever since Kellogg’s introduced cereal for breakfast and the bagel was invented as a mid morning snack, which has captured the tastes of millions, the Agro Industry and the food industry have lobbied to have “healthy grains” in the food pyramid or on your plate. The very thought of “the daily bread” is deeply ingrained in our culture.

Other agencies like the Heart Foundation, the Academy of Nutrition and Dietetics (formerly “American Dietetic Association“) and the American Medical Association have reiterated this statement over and over until both the public and physicians accepted this as the truth. However, the scientific data does not support this point of view!  It has been a myth!

We are gradually learning that there has been a big misinformation campaign going on as far back as 1984 (and before) when a consensus panel came up with revised normal values for cholesterol and we as the medical profession were told (myself included) to treat high cholesterol levels much earlier and more aggressively than in the past with statins.

Big Pharma is still pushing for this. Now that I am retired for more than three years I can freely write about what is really going on. The truth has already leaked out, but it is not yet common knowledge.

I like to review the switch from the old school of thought that a high carb/low fat diet would be healthy to the new school of thought that a low carb/high healthy fat diet is healthy. Before you panic, sit back, relax and read what I am saying.

Buying into High Carb, Low Fat Myth Makes You Sick

Buying Into High Carb, Low Fat Myth Makes You Sick

A brief history of the high carb/low fat diet recommendation

It was the Framingham Study, which is an ongoing study since 1948 where a large group of people was followed for decades to sort out what causes heart attacks and strokes and how one could develop a program of prevention. This objective at the beginning of the study was very noble and promising. However, as time went on the results from the Framingham Study that were published intermittently appeared to be more and more confusing.

First there was the lipid theory that was based on the observation that high lipids (called triglycerides) and high cholesterol in the blood would cause heart attacks and strokes. It was assumed that it must have been the fats in the diet that would have caused this. Based on this thinking the lipid theory of arteriosclerosis was formulated, a theory trying to explain how heart attacks were caused.

If this theory were true, a lowering of the blood lipids and cholesterol should have lowered the rates of heart attacks and strokes. Many large trials were done and the statins were developed to lower cholesterol. In a recent blog I have explained that this has not lowered the mortality rates from heart attacks and strokes, but instead of admitting that the researchers made a mistake, many are still doggedly holding on to the dogma of the lipid theory. The truth is that the lipid theory has not been proven to be true; the recommendation of a high carb/low fat diet has also not worked out to save lives by preventing heart attacks and strokes. In fact the opposite is true: older people with high cholesterol live longer and have less Alzheimer’s disease than those with lower cholesterol levels in the blood as Ref. 1 has explained in detail. Dr. Perlmutter mentioned a study from the Netherlands (Ref. 1, page78) involving 724 individuals who on average were 89-year old that were followed for 10 years. Those with high cholesterol lived longer than those with low cholesterol, exactly the opposite of what the lipid theory predicted! Specifically, for each 39% increase in cholesterol there was a 15% decrease in risk of mortality. Think about it: the brain and the heart have LDL receptors on their cell surfaces for a reason. The reason is that both vital organs burn fat and need cholesterol to build up the membranes of the brain and heart cells.

Despite this compelling evidence Big Pharma is in denial and you will still find the lipid theory of arteriosclerosis heavily mentioned on the Internet as the only “valid” explanation for how heart attacks and strokes would be caused.

Inflammation as the alternative explanation of arteriosclerosis

Since the mid 1990’s the first reports surfaced to explain that about 50% of patients with normal cholesterol levels still develop heart attacks. In these patients the C-reactive protein, an inflammatory marker, was very high indicating that an inflammatory process likely caused their illness.

Subsequently further research was able to show that the LDL cholesterol, when oxidized by sugar was responsible for clogged arteries in these patients. It also became apparent that diabetics have a much higher risk to develop heart attacks than patients with normal blood sugars. This led to the conclusion by several different research teams that the lipid theory was wrong and needed to be abandoned.

Instead a new theory has developed that explains that heart attacks and strokes develop in patients where free radicals have damaged LDL cholesterol. This oxidizes LDL cholesterol and leads to hardening of the arteries (arteriosclerosis). Sugar from increased carbohydrate intake has a lot to do with this: it leads to glycation of protein causing glycation end products (abbreviated as AGE’s).

This is an appropriate name as it really is the cause of premature aging, of developing wrinkles, of getting premature hardening of arteries and having a 50-fold risk of free radical formation. This in turn will lead to more tissue aging. LDL used to be thought of as the “bad cholesterol” (I myself have used that term in the past). LDL is now known to be the friendly and important transport form of cholesterol, which is sent from the liver to the brain and heart cells that need it for their metabolism. If LDL is oxidized, however, it becomes useless and the heart and brain cannot absorb cholesterol for membrane synthesis via the LDL receptors. The end result is that vital organs like the heart and the brain do not get enough oxygen and nutrients, which leads to heart attacks and strokes. The free radicals that are released from oxidized LDL cholesterol and that circulate in the blood cause an inflammatory response in the lining of the arteries all over the body, which you know as hardening of the arteries (arteriosclerosis).

This may sound complicated, but all you need to remember is that sugar and starch consumption lead to accelerated hardening of arteries in your body, which causes heart attacks and strokes.

Reassessment of what a heart healthy, brain friendly diet is

The above-mentioned research findings require a complete re-thinking of what a healthy diet would be. The villain turned out to NOT be saturated fat (meat, eggs, butter and avocado), but rather TRANS fat (margarine, hydrogenated polyunsaturated fatty acids) and I agree with the FDA that this should be abolished.  Trans fat is full of free radicals oxidizing LDL cholesterol, which we just learnt is causing hardening of arteries. It is sugar and starches that turned out to be the main villain. Omega-6 fatty acids, found in safflower oil, sun flower oil, grape seed oil and canola oil are bad for you also as they lead to inflammation through the arachidonic acid system in the body. Conversely flaxseed oil, omega-3 fatty acids (EPA and DHA) derived from fish oil are very protective (anti-inflammatory) oils, as is olive oil and coconut oil. These latter two are anti-inflammatory monounsaturated fatty acids. Keep in mind that you want to change the ratio of omega-3 to omega-6 fatty acids more in the direction of omega-3 fatty acids, so that the ratio will be between 1:1 and 1:3. Most Americans are exposed to ratios of 1:8 to 1:16 (too many omega-6 fatty acids in fast food and processed foods), which leads to inflammation of the arteries as well.

The new “heart and brain healthy diet” consists of no refined carbohydrates (sugar and starch), but about 45% complex carbohydrates (organic vegetables like broccoli, spinach, cauliflower, Brussels sprouts, peppers, onions, garlic, peppers, Swiss chard, zucchini, asparagus etc.), 20 % protein and 35% saturated and other fats like omega-3 (1:3 mix with omega-6) fatty acids and monounsaturated fats (like olive oil or coconut oil).

According to Ref.1 you can even eat butter, lard and other animal fats provided they come from clean (not antibiotic or bovine growth hormone treated) animals. Dr. Perlmutter (Ref.1) points out that even extreme diets like the Inuit diet with 80% saturated fat and 20% protein leads to longevity with healthy arteries. The patients who died in the many trials including the Framingham Study did so, because of free radicals from sugar, starch and wheat. Wheat contains the addictive gliadin molecule (part of gluten), which makes people eat more sweets and starchy foods. The liver turns the extra calories into visceral fat deposits that in turn cause the release of cytokines like tumor necrosis factor alpha (TNF alpha) and COX-2 enzymes.

This causes inflammation, heart attacks, strokes and cancer.

Contrary to what Big Pharma wants you to know cholesterol is an anti-inflammatory, LDL is a cholesterol transporter (provided it is not oxidized) and HDL is protective of hardening of the arteries as long as the “ratio of total cholesterol to HDL cholesterol” is less than 3.4 for males and 3.3 for females. This is the cholesterol risk ratio 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).

Paradigm shift in causation of heart attacks and strokes, but also of cancer, and neurological diseases

As pointed out in Ref. 1 there has been a paradigm shift in our thinking about what causes inflammation and what causes all of the major diseases including premature aging. Many physicians are not up to date in this new thinking although it has been in the medical literature since about 1995. In my colleagues’ defense I like to say that they are busy people and they do not always have the time to do their continuing education. However, it is imperative that the public learns about this paradigm shift as it affects literally everyone. In my YouTube video on the home page of www.nethealthbook.com I have talked about this new thinking in the summer of 2012. Now we are learning that there is an anti-inflammatory, cholesterol containing, fat rich diet without refined carbs, but containing ample complex carbs, which is a modified zone diet or a modified Mediterranean diet that will prevent all these diseases. At the same time it is a weight loss diet as cholesterol and fat in your diet stops the liver from producing lipids and triglycerides and helps you to lose weight. Critics will say that it sounds too good to be true, but I agree with Dr. Perlmutter and Dr. Davis, both of whom have provided ample evidence that it is true. Try some of their recipes. Just read Ref. 1 and 2, where recipes are listed in the back part of their books. Or try the recipes I listed for one day in this blog. I am publishing a book entitled “A Survivor’s Guide To Successful Aging” through Amazon.com, which will come out later in early 2014 where you can find recipes for 1 week in the last chapter.

Conclusion

There has been a paradigm shift in the thinking of how hardening of the arteries is caused. Now it is known that an inflammatory process causes it. It is an overindulgence in sugar, starch and wheat products that causes the liver to produce lipids, cholesterol and leads to the “wheat belly” and the “grain brain”. All of this causes cytokines to bring about an inflammatory reaction that affects the lining of arteries causing heart attacks, strokes, but also Parkinson’s disease, MS, autism, asthma, arthritis, epilepsy, Lou Gehrig disease and Alzheimer’s disease (Ref.1). The inflammation does not stop there. If you keep up the high carb/low fat diet, it will lead to various cancers (Ref. 1 and 3). The solution is a diet high in healthy fats (I would call it a low carb/medium high healthy fat diet) as outlined above consisting of 30 to 35% healthy fat, 20% of protein and 45 to 50% of complex carbs, but none of the refined carbs. I have followed such a diet since 2001. I am enjoying that I can now eat  a reasonable amount of healthy fats, which I was not aware of being allowed before I read Ref. 1 and 3, but I continue with the antioxidant vitamins and anti-inflammatory supplements to prevent LDL oxidization. I hope that many of you can benefit from prevention so you can enjoy a healthy life without being a victim of illness or disability.

More information on:

1. arteriosclerosis: http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

2. paradigm shift regarding hardening of the arteries: My book “A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling” explains the content of this blog in much more detail.

References

1. 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.

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

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

Last edited Nov. 7, 2014

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