Dec
14
2013

Pollution And Soaring Lung Cancer Rates

By | Allergies, Cancer, Hormones, Lung Disease, Obesity, Prevention

In early 1900 lung cancer was unheard of. This was before the cigarette industry started to mass-produce and market cigarettes.

However, ever since the arrival of the industrial revolution air quality has suffered. In China poor air quality has now reached such enormous values that the specialized cancer agency of the World Health Organization, the International Agency for Research on Cancer (IARC) has labeled poor air quality as one of the causes of lung cancer.

When you rank countries by average air pollution measurements, one sees that Europe, the US and South America overall have good ratings, whereas the Middle Eastern countries, China and India have poorer ratings.

However, when the pollution index of cities where the population is much denser than in the countries at large, are tabulated a much different picture emerges: Cities in Iran, India and Pakistan stand out as particularly bad followed by cities in China, Eastern Europe, Paris, London, Berlin, cities in California (the populous State), Chicago and New York.

Pollution does not stay local, but travels through the stratosphere around the globe. The result is that now 10 to 15% of lung cancer in the US occurs in patients who never smoked. This translates into 16,000 to 24,000 deaths annually of never-smokers in the US.

In certain cities such as Beijing the lung cancer rates have doubled in 9 years between 2002 and 2011. As this article shows lung cancer in never smokers can be caused from exposure to radon, to second-hand tobacco smoke, and other indoor air pollutants can also cause such cancers. But the outdoor air quality has been a problem ever since the industrial revolution, which started around Europe in the 1800’s and first part of the1900’s. In the latter half of the 1900’s much of the industrial wave has migrated to the Middle East, to India and China. But the air quality of the whole world has suffered as the jet stream and other air currents carry pollution in the stratosphere all around the globe.

Pollution And Soaring Lung Cancer Rates

Pollution And Soaring Lung Cancer Rates

History of pollution in various regions

1. In Germany’s  Ruhr district (“Ruhrgebiet”) in North Rhine-Westphalia, a highly populated industrial area, pollution reached a peak in the late 1950’s. From 1963 onward many of the coal mines, iron ore mines and other mineral mines closed down. 50 years ago the German Chancellor, Willy Brand was concerned about the environment and promised that blue skies would return to the Ruhr district again.  A special task force was initiated and maximally allowable limits were established for industries’ pollution emissions and enforced by the German government. Government and industry were co-operating in developing anti-pollution measures, which have cleared up a lot of the pollution since. With regard to car emissions lead free gasoline was introduced and carburetors ensured more complete burning of exhaust gases. This is now common and accepted anywhere except for diesel fume exhaust, which nobody wants to address despite proven carcinogenicity.

Now Germany is one of the leaders in green technology, which is also important for tourism.

2. England has its own legacy of pollution in soil and air from the industrial revolution. The soil of moorland, which soaked up acid rain for decades, is more acidy than lemon juice and it will take a long time despite industrial complexes having closed long time ago, before the soil quality will be returned to normal.

3. Hamilton in Ontario/Canada has had a longstanding pollution problem, which I witnessed from 1976 until my departure in 1978. It is well known that Stelco, the local steel plant downtown Hamilton is sending polluting emissions into the air. In 1976 a vising professor from Australia gave an interesting talk about a study that was done at that time regarding the risk of developing bronchogenic carcinoma (a synonym for lung cancer) in the immediate surroundings of the Stelco plant. He said that this was one of the first studies to show that the distance of people’s houses from the source of pollution mattered as that determined how concentrated the air pollution was (the closer the more polluted the air). This  affected cancer rates: they were much higher in the immediate surrounding of Stelco when compared to the average rate in the rest of Hamilton. This difference was very significant within a radius of 1 kilometer (= 0.62 miles) from the Stelco plant.

Just in May of 2013 the local cancer agency of Hamilton announced that the lung cancer rate in Hamilton was higher than elsewhere in Ontario because of a combination of poor air quality and of a higher percentage of people smoking. Then in August 2013 the city of Hamilton announced a new air pollution bylaw for stricter pollution measures to improve the air quality in the downtown area. It is just a pity that Hamiltonians had to wait until 2013 before the city approved an anti-pollution bylaw that could have been passed 50 years earlier like in Germany’s Ruhr district!

4. In 2008 Pittsburg, a former steel manufacturer town like Hamilton, Ont. outdid Los Angeles with regard to small particle air pollution.

Lung cancer prevention by the authorities

As mentioned before up o15% of lung cancer is caused by environmental exposure. So, we ourselves can only prevent 85% of lung cancer by not smoking and not exposing ourselves to industrial emissions or to smoke from incense. However, in many cities around the world you will get exposed to air pollutants that are well above the safe limits, so the risk of getting lung cancer from just breathing the air there can be much higher than in rural areas where there is no industry.

Technologies to control air pollution are widely available. We need to exert pressure on politicians to show leadership around the world. Government regulations to lower emission rates need to be put into place and inspectors need to ensure the rules and regulations are adhered to. Without reducing emissions of cancer producing gases and chemicals right at the source (open burning of cuttings in orchards or burning cut trees), cutting emissions of cars, planes, ships, diesel cars, locomotives, electric generator plants etc. the air quality will not improve. Despite some costs involved industry, governments and individuals have to work together to make clean air happen.

The residents of those countries that have low pollution values will not benefit, if pollution continues to occur in other parts of the world as it just travels in the stratosphere around the globe until it arrives right here at home! We need an international pollution police. Satellites can be used to monitor where pollution occurs and this can be followed up through the local regulatory bodies with penalties and remedial actions.

What can I do personally to prevent lung cancer?

1.The most obvious step is to quit smoking and ask smokers who come to your place to smoke outside (not in your home).

2.Consider moving away from the city, if the air quality is unacceptable to a place where there is low air pollution.

3.Vitamin D3 has been shown to prevent colorectal cancer, but as there are vitamin D receptors found on the surface of various cells in tissue around the body including the lungs, many researchers feel that this vitamin in higher doses (2000 IU to 5000 IU) has probably a wider applicability in preventing cancers, even lung cancer.

4.Cutting out sugar and adopting a Mediterranean type diet is a prudent thing to do; also cutting down your calories to the maintenance you need (mildly ketogenic diet). If you bought body composition scales, it would display what your daily calorie consumption is and you should not exceed this, or else you’ll gain weight. An aging man who is overweight will experience hormone changes as fat is being metabolized and the enzyme aromatase contained in fatty tissue will turn male hormones (testosterone, DHT, androstenedione) into estrogen. Estrogen (particularly estradiol) is a known carcinogen that has been proven to cause breast cancer in women and prostate cancer in men. However lung cancer is also being promoted in women by estrogen as discussed in this link. In men one needs to remember that lung cells have estrogen receptors and there is concern in aging men with higher estradiol levels that this can promote cell divisions in existing lung cancer. So, it is important to maintain a normal body mass index between 21 and 24 (well below 25.0 and well above 18.5, which are the official accepted limits). This way there is no problem with insulin resistance (too high an insulin level), and other metabolic substances (cytokines, growth hormone like factors and tumor necrosis factor-alpha from body fat) that are cancer promoting.

5. If testosterone deficiency is present, which is common in older men, testosterone will have to be replaced with bioidentical hormones. It is a myth that testosterone would cause prostate cancer. Testosterone in males is necessary to maintain a normal metabolism including the immune system, which then can fight lung cancer and any other cancers.

6. Exercise and reducing beef consumption are also often mentioned in terms of preventing lung cancer.

7. Here are several recommendations from the LifeExtension Foundation that I found very useful in terms of lung cancer prevention. This link shows that antioxidant vitamins such as vitamin C, alpha tocopherol, the minerals selenium and zinc are also helping to reduce the lung cancer rate. Drinking green tea has also been shown to be effective in a dose-response curve manner (more tea protecting more from lung cancer). Vitamin B12 and folate have been shown to reduce abnormal bronchial cell growth in smokers as shown by repeat bronchoscopy studies.

8. Those who have been smokers in the past and those who have been around heavy smokers for more than 10 years in the past should consider having a preventative bronchoscopy done by a lung specialist (also called respirologist or pulmonologists). This way any suspicious areas with precancerous lesions can be biopsied during the procedure and attended to.

Hopeful research for new lung cancer treatments

Lung cancer is a disease that is best prevented. Once a person gets lung cancer, the prognosis is still very poor. However, cancer researchers are getting close to newer treatments involving genetically modified T-cells (killer cells) as was recently achieved for leukemia. Similar research is going on regarding ovarian cancer, melanoma, lung cancer and pancreatic cancer.

More information about lung cancer: http://nethealthbook.com/cancer-overview/lung-cancer/

Conclusion

It is not acceptable to let pollution take its course , the way politicians around the globe have handled this in the past 6 decades with a few notable exceptions mentioned. We all suffer a higher risk of getting lung cancer, even if we have been life-long non-smokers. Right now up to 15% of lung cancer in most populations are of this type. However, in Beijing this number is already much higher. The technology is available; Germany has led the way in the Ruhr district in the 1960’s and beyond. In my opinion the G8 meetings should have this high on their agendas and send technological aid to all the regions that have higher than the average world pollution index under the mandate of a special UN commission. This should be supported by the major industrial players with the knowledge that they will prevent the death of millions of potential consumers down the road, which will on the long-term pay off the relatively minor investment of installing pollution controls, before lung cancer levels rise even more.

Last edited Nov. 7, 2014

Dec
07
2013

Slow Down Aging And Prevent Disabilities

By | Alzheimer’s disease, Anti-aging medicine, Arthritis, Cancer, Diabetes, Fitness, Health, Heart Disease, Hormones, Nutrition, Obesity, Other neurological conditions, Prevention, Stress management, Weight loss

You have seen it many times before: a man or a woman retires at age 65; for a while you see them around at social functions; then they are not seen any more and they return in a wheel chair only to die prematurely. You ask yourself: what can I do better to avoid this death trap?

There are several aspects to this equation: first, we would like to slow down the aging process. Part of this is to retain our physical functioning. In the following I am discussing the ingredients that are necessary to achieve the goal of aging in dignity, but avoiding disability.

It starts with a healthy mind set

You need to be optimistic and have a mindset of believing in yourself that you can do it. With a negative attitude, you will manage to find something to complain about, no matter how perfect the day has been. Negative thinking is rampant, and depression tends to be higher in the older population. If you suffer from depression or you had negative events such as accidents or abuse in the past, it is important to do some house cleaning. Do not be hesitant seeking professional help and counseling from a health professional to help you build up your self-esteem.

Regular exercise is important

A regular exercise program helps you to get your day organized. If you think that you are too busy to find the time to exercise, you are sacrificing your wellness and in fact you sabotage your health. It’s time to rethink your lifestyle! The reason you need exercise is to set the automatic pilot on staying healthy and active. If you are accustomed to sitting down in front of the computer or television set for hours, your muscles do not get the exercise they need. Fast-forward several decades and you will be one of those who rely on walkers, wheel chairs and assisted living establishments. Without training your muscles you are more prone to falls and injuries. Your balance organ is not getting the impulses it needs on an ongoing basis to prevent you from falls later in life. People in their 80’s are often stable up to the point where they trip and fall. I have seen many patients like this arrive in an ambulance where I was doing my shift as the emergency physician in a community hospital. When I summarize the fate of all of the people in their 80’s who had falls and broke their hips over the years, 50% of them made it through the surgery and went back home (often with a walker or in a wheel chair) or ended up in a nursing home; the other 50% died from complications of the surgery, often from heart attacks during the surgery or from clots in their pelvic veins or in the leg veins that dislodged and turned into pulmonary emboli. A fracture and in particular a hip fracture in your 80’s is a serious, potentially deadly accident. So, you need strong muscles and joints and you need strong bones. All of this comes free to you from years of regular exercise in your 60’s and 70’s.

Slow Down Aging And Prevent Disabilities

Slow Down Aging And Prevent Disabilities

You guessed right: good nutrition is important!

Eat right and your body will function right. This is where a lot of people are sent on the wrong path due to clever advertising from the Agro Industry, Big Pharma, the American Dietetic Association and the United States Department Of Agriculture. So they preach that wheat and wheat products are good for you, but the lab tests show that it induces hyperinsulinemia and leads to diabetes. The genetic changes of wheat (“accomplished” through forced chemical hybridization in the 1970’s) are responsible for the metabolically very active wheat belly (accumulation of visceral fat) that Ref. 1 has described in detail. But others have researched this topic as well. Ref. 2 for instance confirms that gliadin, the glue in wheat, which allows dough to stick and makes it easy to create bread, bagels and pasta, is responsible for neurological issues like numbness of fingers and feet (peripheral neuropathy), balance problems and cognitive decline all the way to Alzheimer’s disease. If you continue to eat wheat and wheat products (all contained in conveniently packaged “processed” foods), you may very well find that your balance and muscle control will deteriorate by the time you are in your eighties. This condition is not new: one of the lecturers I listened to at McMaster University in Hamilton, Ontario in 1977 referred to those unfortunate individuals who were severely disabled as the “tea and toasters”. The tea in this case was probably the lesser evil, but the wheat induced malabsorption and malnutrition was a reality already in the mid and late 1970’s.

However, if you start eating organic foods to avoid the chemicals and estrogen-like xenoestrogens from pesticides, and you cut out sugar, high-density carbs and wheat products, you will no longer have problems with weight control and you will maintain your muscle, brain and nerve function. This is not what you learn from the regular agencies mentioned at the beginning of this paragraph, but Ref. 1 and 2 will fill you in on the details. Essentially, I follow a Mediterranean diet without sugar, starchy foods and wheat or wheat products. Ref. 2 stressed the importance of enough saturated and healthy fat (omega-3 fatty acid rich oils) in a balanced diet consisting of 20% protein and low carbs. No specific numbers were given regarding the %-age of fat. I would say that a limit of about 25 to 35% for fat would be reasonable except for the Inuit who are used to a fat content in their diet of 80%. The new thinking is that healthy fats are good for your brain and heart. Healthy fats are omega-3 fatty acids (EPA and DHA) derived from fish oil as they are very protective (anti-inflammatory) oils, so 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 (the ratio in this link is cited as omega-6 to omega-3) 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. Omega-6 fatty acids, found in safflower oil, sun flower oil, grape seed oil and canola oil are bad for you when not balanced by enough omega-3’s (flax seed oil and fish oil) as they lead to inflammation through the arachidonic acid system in the body. It may be a surprise to you that saturated fats are OK: animal fat like butter, lard, cream, ghee (clarified butter), and other animal fats provided they come from clean (not antibiotic or bovine growth hormone treated) animals. Buy organic and buy organic meats as well such as grass fed beef and bison, chicken and turkey.

Here is an example of what a day would look like nutritionally in terms of a breakfast, lunch and dinner (recipes by Christina Schilling):

Breakfast:  Great Greens Omelet

(2 servings)

1 tablespoon olive oil or coconut oil

3 chopped green onions

3 cups spinach leaves or a mix of greens: kale, spinach, Swiss chard

1 red pepper cut into strips

3 eggs and 3 egg whites

2 tablespoons grated Parmigiano

In non-stick pan sauté green onion, greens and pepper strips in oil, stir eggs and egg whites and pour over the vegetables, sprinkle with Parmigiano. Cook on medium heat, till the egg mixture has started to set. Turn over and briefly let cook. Remove from pan, divide into two portions and sprinkle with a bit of salt (optional). Serve with salsa and guacamole.

Lunch: Oriental Salad

(2 portions)

1 small Sui choy cabbage (Napa cabbage)

2 cups mung bean sprouts

1 small daikon radish, shredded to yield 1 cup

1 red pepper, cut into thin slices

3 green onions, chopped

1 medium sized carrot, cut into matchstick size pieces

1 can sliced water chestnuts, rinsed.

Dressing: 2 tablespoons sesame oil,

2 tablespoons rice vinegar,(light balsamic vinegar works too)

1-tablespoon tamari soy sauce

1 tablespoon Thai sweet chilli sauce

1-teaspoon fresh grated ginger

3 tablespoons chopped fresh cilantro

Prepare all vegetables and put into salad bowl. Stir all dressing ingredients together and pour over vegetable mix. Stir gently, cover and refrigerate. This salad can be consumed immediately or kept refrigerted for a day. To complete the salad with a protein portion add your choice of 6 oz. cooked shrimp or the same quantity of cubed or sliced grilled chicken.

Dinner:  Florentine Chicken

(2 servings)

1 large boneless chicken breast

1 tablespoon of chopped fresh basil-alternatively use 1 teaspoon dried basil.

1 tablespoon grated Parmigiano

4 thin slices prosciutto

1 tablespoon olive oil

2 tomatoes- cut into halves

3 chopped green onions

2 cups baby spinach leaves

pinch of salt

Spread chicken breast flat and top it with the basil, Parmigiano and prosciutto slices. Fold into half an hold the stuffed chicken breast together at the edges with a toothpick or two. Heat olive oil in frying pan, add onion and tomato slices and put the chicken breast on top. Put lid on the pan, and cook at medium heat till the chicken is cooked through. If you test with a fork, the juices will be clear. Remove vegetables and chicken from pan, put on serving plate and keep warm. Remove toothpicks from meat, and cut chicken breast into two portions. Put spinach into pan and let the leaves wilt at medium heat (cover with lid). Put spinach on the side of the chicken and tomatoes, and sprinkle with a bit of salt.

Dessert after dinner: Berry Sorbet

(2 servings)

2 cups of deep frozen berries (strawberries, blueberries or a berry mix, no sugar added)

¾ cup of organic yogourt or goat’s milk yogurt

a few drops of liquid stevia or small amount of powdered stevia-to taste.

Put into blender and process till smooth. You will have to open the blender jar to stir the contents in between. Serve with a dollop of whipped cream,  if desired.

What about the “slow down” of menopause and andropause?

It is a fact that as we age, our hormone glands do not produce as much hormones as when we were in our 20’s and 30’s. But if you find a health care provider who is interested in anti-aging medicine (there are about 26,000 physicians, chiropractors and naturopaths who are members in the A4M), your hormones can be measured accurately from saliva and blood tests. This will tell whether you are hypothyroid, deficient in sex hormones and whether you should be supplemented with the missing hormones in adequate doses through bio-identical hormones. For instance, women are often deficient in progesterone in menopause and men deficient in testosterone. Treatment needs persistence and patience, as it often takes months for the patient to feel better and up to 2 years, to find the exact balance for you where the hormones are re-balanced and your symptoms of tiredness, insomnia, hot flushes etc. disappear. All our body cells have hormone receptors that require stimulation for the cells to function normally. Your health professional needs to pay attention to this and not just treat your symptoms symptomatically. When your hormones are in balance and you take a few supplements, your bones will be strong (no osteoporosis), your brain will be clear, your hearing perfect, and your balance great. You will be much less likely in your eighties to fall and break a bone and your mind will be clear and sharp.

Stress management

As the baby boomers age, they need to be aware of the stress in their lives. You may have been accustomed to having lots of energy when you were in your child rearing years or in your active professional career. Often we do not even notice that there may be stress in our lives. But your adrenal glands know. This is really a subpart of what I said of hormones: they need to be in balance. But cortisol, which is produced in your adrenal glands, is different from the menopause/andropause hormones. Corticotrophin-releasing hormone (CRH) from the hypothalamus and adrenocorticotrophin hormone (ACTH) from the pituitary gland are the rulers of the adrenal glands. And it is how you handle stress when you are in your 40’s, 50’s and 60’s which will determine whether you come down with adrenal fatigue, various degrees of adrenal insufficiency or not. Ref. 3 is a whole book that deals with this topic. Here I like to mention only that the best test to diagnose adrenal problems is a four-point saliva hormone test for cortisol. You connect the four points and get a curve where the cortisol level is expressed as a function of time. If this curve is below the lower normal range, which the laboratory provides for you, you need to be managed by a knowledgeable health care professional in order to build up the reserves of your adrenal glands. Yoga, meditation, deep prayer, self-hypnosis and enough regular sleep are all proven methods to overcome any stress related issues. Sometimes more effort is needed to rebuild the adrenals by specific herbs or porcine adrenal gland cortex extracts. Your health care provider can tell you more regarding this.

Useful supplements

1. On March 17, 2013 I wrote in a blog about prevention of osteoporosis the following summary:

“The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 micrograms of vitamin K2 (also called MK-7). In the age group above 50 missing hormones such as bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women should be given as well. This works best, if you also watch your weight, cut down your alcohol consumption to a minimum (or better cut alcohol out altogether), exercise regularly (this builds up bone and muscle strength) and stick to a balanced diet resembling a Mediterranean or zone type diet (low-glycemic,  low fat, wheat free and no sugar).” I would add in view of Ref. 1 and 2 that “low fat” should now be replaced by “balanced fat diet”. With this I mean that nuts, almonds, olive oil, unsalted butter are allowed within reason. Lately there have been new insights that some cholesterol is needed for normal hormone production. What needs to be cut out are omega-6 fats and trans fats.

2. Omega-3-fatty acid supplements from molecularly distilled fish oil at a good dosage (3 to 6 capsules a day) will prevent chronic inflammation that often causes arthritis. Chicken cartilage (UC-II) from the health food store will desensitize your system in case you have rheumatoid arthritis or osteoarthritis. This will prevent crippling arthritic disease down the road.

3. Mitochondrial aging (the mitochondria are the energy packages in each body cell) is slowed down by the two supplements ubiquinol (=Co-Q-10, take 400 mg per day) and 20 mg of PQQ (=Pyrroloquinoline quinone). Co-Q-10 repairs DNA damage to your mitochondria and PQQ stimulates your healthy mitochondria to multiply. Between the two supplements you will have more energy.

4. Vitamin C 1000 to 2000 mg per day and a multivitamin supplement help to support the rest of your metabolism. Some may want to add PS (Phosphatylserine) 100 to 200 mg per day, which works together with vitamin D3 for Alzheimer’s prevention.

Conclusion

By now you noticed that nothing comes from ignoring the fact that we are aging. We need to pay attention to our body functions and think about what we can do to make us stronger. In the end we are our own caregivers. When we are in our eighties, we should still be active and our brains should function with a lot more experience than in our past. Our bones will be strong and our balance should prevent us from falling. I do not want to use assisted living and I do not like the confinement of a wheel chair. In the meantime I am going to carry on dancing.

More information on:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

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

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. 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.

3. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 7, 2014

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

Nov
09
2013

Successful Diabetes Treatment Requires Patient’s Discipline

By | Diabetes, Fitness, heart attack, Heart Disease, Hormones, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

90% of all diabetes cases are due to type 2 diabetes, which is associated with being overweight or obese. The other 10% are due to type 1 diabetes, which is caused by an autoimmune disease within the pancreas destroying the insulin producing beta cells. Diabetes, type 1 often occurs in childhood (hence the name “juvenile diabetes”), while type 2 diabetes is a condition of the middle aged and older population. There is however an alarming trend: overweight or obese youngsters are also being diagnosed with type 2 diabetes. Here I am discussing type 2 diabetes.

Causes that trigger diabetes

There is not just one way to get diabetes; it usually is a multifactorial disease. Sure, genetics play a minor role. But you need to have epigenetic factors to trigger the genes to develop diabetes: eating too much sugar, eating wheat and wheat products, drinking soda drinks that contain sugar or high fructose corn syrup. Alcohol binges can also cause diabetes as can accumulation of excessive weight (a body mass index above 25.0). Even when there is no genetic risk in your family (your family tree has nobody that came down with diabetes and all your ancestors lived into their 90’s), you can still develop diabetes, if you are exposed to one or more of the risk factors mentioned.

What is the reason why diabetes occurs?

At a Keystone Symposium from Jan. 27 to Feb.1, 2013 in Keystone, Colorado (Ref.1) leading scientific researchers gathered to discuss exactly this question. There seem to be several mechanisms, all of which lead to diabetes. It has been known for some time that in type 2 diabetes insulin resistance develops that renders the cells incapable of absorbing blood sugar (glucose) from the blood into the cells. It is because of this insulin resistance that doctors can diagnose diabetes when blood sugar levels are high.

Successful Diabetes Treatment Requires Patient’s Discipline

Successful Diabetes Treatment Requires Patient’s Discipline

There are at least 5 mechanisms that are presently known that can cause insulin resistance (and thus diabetes) by itself or in combination. For a deeper understanding of diabetes it is crucial to be aware of these. Without knowing the enemy, you cannot fight it.

1. When a person eats too much sugar or fructose the liver converts this into excessive fat that is accumulated in the body’s cells. As a result insulin receptors are becoming inefficient in absorbing sugar from the blood, and blood sugar levels stay high. The pancreas reacts to this by making even more insulin, which after a few years will cause the pancreas to fail in producing insulin. At this point the patient requires insulin or else gets into a diabetic coma.

2. Chronic inflammation is another mechanism that has been shown to cause insulin resistance. Obesity, the metabolic syndrome and diabetes have a common inflammatory denominator that results in insulin resistance. With the aging process there is also deterioration of mitochondrial function (mitochondria are the mini batteries inside of every cell that are responsible for you having energy). This causes fat accumulation and also insulin resistance. Exercise and weight loss are effective in combatting insulin resistance. Fasting has also been shown to improve insulin sensitivity.

3. The metabolism of visceral fat (the type of fat causing the apple appearance in obesity) is highly active and is associated with an increased risk for heart attacks and developing diabetes. The pear shaped woman runs less of a risk, as the fat around the hips is not metabolically active. On the other hand when these women enter into menopause, they also develop abdominal fat (apple-like fat distribution) with a high secretion of inflammatory substances causing insulin resistance, heart attacks and strokes.

4. Another mechanism of causing inflammation comes from invasion of organs with fat cells. The development of fat toxicity from these displaced fat cells can also cause insulin resistance. Heart cells have been shown to die from fat toxicity and in the pancreas the insulin-producing cells can be killed by fat toxicity as well causing diabetes or making existing diabetes worse.

5. Interestingly another line of research, namely researching binge drinking, has revealed that there is a short-term insulin resistance that lasts for several days until the alcohol has been properly metabolized. It is of concern that adolescents who are experimenting with binge drinking are very vulnerable to develop brain damage from this habit.

Consequences of insulin resistance

We know that insulin resistance is the cause for adult onset, type 2 diabetes. It is entirely preventable. But there are powerful influences on people’s lives that will allow one or more of these factors mentioned to cause diabetes. The most common cause is putting on excessive weight. The reason for this is that people like to eat fast foods, drink sugar-containing sodas, and feast on processed foods, bagels and cookies. The end result is a change of the metabolism with an increase in triglycerides from the liver, an increase in LDL cholesterol, particularly the very low-density lipoprotein sub fractions of cholesterol. It has been known for some time that this is the connection to the high, premature death rates from heart attacks in diabetics, in people with obesity and in people with the metabolic syndrome. Hardening of the arteries is accelerated by the deposition of foam cells in the walls of arteries. These are scavenger cells (macrophages) that have engulfed noxious fats. This leads to narrowed coronary arteries and also a general narrowing of arteries all over the body including the brain vessels. In diabetics hardening of the arteries is accelerated and leads to premature strokes, heart attacks and heart failure, kidney failure, blindness and amputations of limbs.

Important tests for borderline diabetics

I you have a fasting blood sugar that is above 100 mg/dL (5.5 mmol), but less than 126 mg/dL (7 mmol) you are considered to be prediabetic or “borderline diabetic”. In this case rather than waiting for disasters in terms of cardiovascular disease, take action and ask your doctor to do the following three tests.

a) Arrange for a glucose tolerance test where you are given 75 grams of glucose; then blood tests are taken at one, two and three hours after this challenge dose. These blood tests are checked for blood glucose levels and insulin levels and tell the doctor exactly what is going on in terms of your sugar metabolism. It shows the glucose clearance and also the insulin response from your pancreas.

b) Have a hemoglobin A1c test done: it shows how your blood sugars have been controlled over the last 2 to 3 months.

c) You also need a VAP (vertical auto profile) test, which tests your lipid profile. Both prediabetics and overtly diabetics have been shown to have lipid profile disorders. Apart from low values in sub fractions of HDL cholesterol this test will also measure the very-low density lipoproteins (VLDL), which has been shown to be responsible for heart attacks and strokes.

With these three tests your doctor can  tell you more accurately what treatment protocol you require to succeed in controlling or curing your pre diabetes or diabetes.

Conventional treatment of diabetes

The conventional treatment of diabetes is to send the patient to a dietician, to ask the patient to do regular exercises and to either start them on hypoglycemic drugs or on insulin injections. Unfortunately the dietician often will encourage the patient to eat “healthy multigrain bread”, which will stimulate your taste buds to eat more sugar, high fructose corn syrup and starchy foods making weight loss impossible. Often the treating physician is satisfied that a hemoglobin A1c of 7% or less is good enough for the diabetic. But non-diabetic people have a hemoglobin A1c of 4% and 5.6%. This should be your goal or you will suffer the consequences of uncontrolled diabetes.

This is what I would call the conventional, symptomatic treatment approach. This may be the approach for patients who are not willing to seriously change their lifestyles, but it is more powerful on the long-term to treat diabetes by treating the underlying causes.

Alternative treatment approach for diabetes

Based on the above discussion regarding the various causes of insulin resistance, it is important to analyze what would be the main contributory factors in your particular case of diabetes.

Here are some suggestions:

1. If you are on the typical North American diet, also known as Western diet, it would be important to face the fact that wheat, wheat products in processed foods and sugar including high fructose corn syrup are the main culprits in stimulating your appetite and making you a sugar and wheat addict. Ref. 2 describes this in detail and offers 150 recipes to overcome this addiction. For more information just follow this reference text. Essentially it is a wheat-free Mediterranean type diet without rice, pasta and bread. You will shed significant amounts of pounds within a short period of time and feel a lot more energetic (due to revitalization of your mitochondria). At the same time insulin resistance is disappearing, because the insulin receptors are fully functional again. The insulin production of the pancreas will go down to normal levels and fat from the visceral fat storage gets melted away resulting in less inflammatory substances circulating in your blood.

2. A regular exercise program in a gym with an aerobic component (30 minutes of treadmill for instance and 20 to 30 minutes of isometric machine exercises) will help you to lower the triglycerides, and increase the healthy HDL cholesterol. It will also improve insulin sensitivity and control inflammation in your body. The best is to exercise 7 days per week. Remember your body works for you 7/7 every week, but for those of you who need a little rest in between 5 days per week is still very good. You may have to adjust your medication and insulin dose downwards, ask your physician about that.

3. Cut out alcohol. This may sound radical to you, but studies show this to be true. I have not mentioned cutting out smoking (it is causing inflammation and insulin resistance), because this is an absolute must that is given. When it comes to alcohol, the famous 1 drink per day for cardio protective purposes may not show up statistically as a bad effect, but your body will nevertheless get the message and let you age somewhat faster than a person who stays sober all the time. Staying sober will allow your brain to think clearly and adhere to your overall lifestyle approach in treating diabetes. Cutting out alcohol protects your brain (including the hypothalamus), liver and pancreas and prevents the prolonged periods of insulin resistance mentioned above that last for days. By keeping your hypothalamus in good working order, your hormone balance will stay stable for as long as possible until you reach menopause (for women) or andropause (for men). When you reached this milestone, I suggest you engage in bioidentical hormone replacement, which I have reviewed here. Hormones are essential to keep you younger for longer.

4. It is useful to monitor your blood sugar with a home glucometer, as this will show you when your blood sugar normalizes. Stay in touch with your doctor at all times, as this will help you in your overall management of your diabetes. Also, you will want to discuss with your doctor that you should have a blood tests called “hemoglobin A1c” measured every three months to see how well your diabetes is controlled. It should be below 7% for sure, but better below 6%. Non-diabetic people have levels of 4% and 5.6%. You may not know that hemoglobin A1c is actually measuring the amount of advanced glycation end products (“AGE”) of red blood cells. These AGE substances essentially are firmly bound sugar/protein compounds that shut down the cell metabolism wherever they are formed. In my opinion it is best to aim at a hemoglobin A1c level of non-diabetic people (4% and 5.6%) to avoid the consequences of tissue damage of all vital organs, which is the reason why long-term diabetics have a life expectancy of 15 to 20 years shorter than non-diabetic persons. Some diabetic patients may benefit from the oral hypoglycemic drug, metformin (brand name: Glucophage), which has anti-inflammatory properties and is used in patients with type 2 diabetes and a high fasting insulin level, but this is a decision requiring your physician’s input.

5. Supplements: There are some supplements that are useful to take as an adjunct, like chromium, which helps insulin to transport glucose into the cell; alpha-lipoic acid, an antioxidant, which is useful to prevent glycation (formation of a complex between sugar and protein, which prevents normal cell functioning); and coenzyme-Q10, which supports your heart (A4M recommends 400 mg per day, higher than Dr. Weil’s link). Other supplements of merit are curcumin, cinnamon, genistein and silymarin (standardized extract of milk thistle), which suppresses a pro inflammatory molecule, which in turn helps to fight insulin resistance (Ref. 1). Omega-3 fatty acid supplements are anti-inflammatory and will improve insulin resistance as well (dosage 1000mg or more per day). According to Ref. 3 vitamin D3 is useful as a supplement for diabetics, because it activates DNA, is involved in cellular repair and deficiency of it is known to lead to higher mortality rates in diabetics. Ref. 3 recommends between 1000 and 4000 IU of vitamin D3 daily and suggests doing blood tests to measure effective vitamin D3 levels (keep 25-OHD in the blood between 30 and 80 ng/mL).

6.Patients whose pancreas no longer produces insulin will need insulin injections, but instead of using long-acting insulin once per day the best results in getting blood sugar control is by injecting insulin three or more times per day using short acting insulin. It is important to always monitor the blood sugar lowering effect by glucometer readings; the injections are best given just before meals (recombinant human insulin is the preferred insulin to be used). Ask your physician or diabetic coach for more details.

Conclusion

Diabetes used to be a dreadful disease that caused premature heart attacks, strokes, blindness, kidney failure, and limb amputations. With aggressive management of diabetes as well as strict lifestyle intervention this has changed. A diabetic who treats the causes of the illness can have a normal life expectancy. In many cases the initial diagnosis of type 2 diabetes can disappear, when treatment was started early enough and insulin resistance could be stopped in its tracks. Without the patient’s full co-operation disciplining him/herself to follow through on all of these recommendations the caregiver will fail in controlling the patient’s diabetes. It is the patient who owns the problem; it is the patient who needs to make every possible effort and follow through on all of the details of dieting, exercising, blood sugar monitoring using a glucometer and taking the required supplements.

More information on diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Reference

1. http://www.lef.org/magazine/mag2013/oct2013_2013-Keystone-Diabetes-Symposium_01.htm

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

3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Integrative Therapy; Supplements.

Last edited Dec. 17, 2014

Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Oct
05
2013

Fighting Back Against The Flu

By | Fitness, Infectious Disease, Lung Disease, Nutrition, Prevention, Stress management, Vitamins and supplements

Every year there is concern about the upcoming flu season. Mostly the discussion centers on the composition of the latest flu bugs and what type of strains would be included in the latest vaccine recommended. The first flu case of the season has just been reported in a child. Here I am going to review what you can do to minimize your probability of getting the flu, or if you get it, how to minimize the severity of the illness.

The immune system

We know for some time that the antibody-mediated immune system is what helps overcome flus. The body’s immune system produces antibodies against the flu via T-helper cells that recognize the glycoprotein (hemagglutinin) of the flu virus and pass a signal on to B cells (bone marrow derived lymphocytes), which in turn are turned on to produce a lot of antibodies (Ref.1). These protect you from future flus of this type. If you have pre-existing antibodies that fit the bug in circulation you are OK ,and you will usually not get the disease.

The factors that protect you from the flu

However, there are many other factors that support your immune system. I will discuss the most important factors in more detail here.

1. We do know that vitamin D3 strengthens the immune system. I would recommend 1000 to 2000 IU per day in the wintertime, but up to 4000 IU or 5000 IU per day during an active epidemic would be reasonable. There is less flu when people are taking Vitamin D3 supplements.

Influenza A was reduced in school children supplemented with 1200IU of vitamin D3. This study recommended higher doses of 2000 to 7000 IU of vitamin D3 per day; but it also stated that as a precaution serum vitamin D levels should be monitored (technically it is serum 25-hydroxy-vitamin D levels that are measured) to avoid vitamin D toxicity. Normal levels are between 40-70 nanograms per ml. Toxic levels are above 100 nanograms per ml. Your family doctor can order a serum 25-hydroxy-vitamin D level for you.

2. Eating fruit and vegetables is important for maintaining a healthy immune system. In a randomized study from Belfast, UK elderly volunteers (82 of them, aged 65 to 85) were assigned to either eat 2 portions or 5 portions of fruit and vegetables per day over 16 weeks. At 12 weeks into the trial both groups received a Pneumovax II vaccination, and the antibody response was measured at the end of the 16th week of the study.  There was a significant increase in antibody binding capacity to pneumococcal capsular polysaccharide in the 5 portion fruit and vegetable group compared to the 2 portion group that had no such increase. The authors concluded that there is a measurable improvement of the immune system when an older population increases their fruit and vegetable intake.

3. Avoid stress, because stress has been shown to weaken the immune system. This review shows that the immune system is weakened by the stress response via the elevated corticosteroid hormones (the stress hormone ACTH stimulates cortisol release from the adrenal glands). The stress of social isolation is also contributing to the weakening of the immune system in older people.

Fighting Back Against The Flu

Fighting Back Against The Flu

4. Exercise moderately and your immune system will get strengthened. Over exercising should be avoided as too much cortisol is released from your adrenal glands, which is toxic to lymphocytes thus weakening your immune system.

5.  Socializing is good for you as studies have shown that you live 2 ½ years longer. This study here is from Connecticut, but other studies confirmed this as well.

6. Make love. The endorphins that are released in the process stimulate the immune system.

7. Take probiotics, because they help your gut flora to stay normal. A normal gut flora promotes a stronger immune system as the Peyer’s patches (clumps of immune cells) in the gut wall are intimately linked to the immune system. In this way probiotics indirectly support your immune system.

8. Avoid smoking.  Smokers have more upper and lower respiratory tract infections than non-smokers. Here is information that explains this as well.

9. Get enough sleep. The circadian rhythm of your hormones ensures that your hormones function at their optimal level. Melatonin from the pineal gland is important in triggering the circadian rhythm, but melatonin itself supports the immune system as well. Your adrenal glands need resetting overnight so that cortisol is secreted according to your stress level, not too much and not too little. Overstimulation from performance sports, grief reactions, car accidents, injuries etc. lead to a surplus of cortisol and weakening of the immune system.

10. Take your flu shot (but without thimerosal) every year, but take it as a single shot (without thimerosal as a preservative). This CDC link explains that single shot flu vaccines are available without thimerosal. I recommend this type of flu vaccine. The central nervous system is extremely sensitive to nanograms of mercury, and it is for this reason that I would not buy into the argument of the CDC that one should not be concerned about safety of thimerosal. The newest for this flu season is the quadrivalent (or four-strain) flu vaccine, which is now available in pharmacies throughout the US.

11. Vitamins and supplements support your immune system, particularly vitamin D3. DHEA, which is available over the counter in the US stimulates antibody production when the flu vaccine is given, particularly in the elderly, in other words DHEA strengthens the immune system Vitamin C is known to support the immune system and is rapidly depleted in those who suffer from any viral infection. There are other nutrients that are useful to stimulate your immune system.

12. Consider herbs: Echinacea, Siberian ginseng, Asian and American ginseng, astragalus, garlic, and shiitake, reishi (also called “lingzhi mushroom”) and maitake mushrooms have all been shown to stimulate the immune system with negligible side effects.

13. Wash your hands, particularly when there is a flu going around. Door knobs for instance are known to keep live viruses for 2 to 8 hours, so washing your hands will reduce the amount of virus you are exposed to.

Conclusion

There is no single solution to prevent the flu, but we can all minimize our exposure to the virus and strengthen our immune system. Although it is wise to get a yearly flu shot to boost your immune system (without thimerosal as a preservative) just before the epidemics come around, this alone is not as good as combining the non-specific factors mentioned here with it. Particularly vitamin D3 (2000 IU to 4000 IU per day) and the old stand-by vitamin C (1000 mg to 2000 mg daily) will stimulate your immune system. Spice up your dinners with mushrooms that stimulate your immune system (maitake, shiitake, reishi mushrooms). Go to bed early enough to allow your circadian hormone rhythms to be reset overnight as you sleep. This will stimulate your immune system (from melatonin and DHEA of your adrenal glands).

More info on the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

References:

1. Long: Principles and Practice of Pediatric Infectious Diseases, 4th ed. Prevention. Vaccine. © 2012 Saunders

Last edited Nov. 7, 2014

Sep
07
2013

Preserve Your Muscles And Joints

By | Anti-aging medicine, Arthritis, Diabetes, Fitness, Health, Heart Disease, Men's Health, Nutrition, Obesity, Prevention, Vitamins and supplements, Women’s Diseases

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a)    It starts with good nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b)   Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

c)   Watch your weight:

It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

d)   Exercise:

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

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

References:

1. 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

Mar
17
2013

Calcium, Vitamin D3 and Vitamin K2 Are Needed For Bone Health

By | Fitness, fractures, Hormones, Osteoporosis, Prevention, Vitamins and supplements

Introduction

I am reviewing in this blog why calcium, vitamin D3 and vitamin K2 are needed for bone health. Recently there has been a lot of coverage in the press regarding postmenopausal treatment of women to prevent osteoporosis. It is all based on this original publication February 26, 2013.

Essentially, there are a number of studies where researchers did a meta-analysis of several trials. They studied osteoporotic bone fracture frequency in female subjects taking 400 IU vitamin D and 1000 mg calcium daily. The researchers measured the frequency of osteoporotic fractures as the indicator  for osteoporosis in these postmenopausal women. The conclusion was that there was no value in taking these supplements to prevent osteoporosis. Many other media publications carried this story.

No kidney stones in study with calcium and vitamin D3

Just two days earlier (Feb. 24, 2013) another study was released with a much larger patient base of 36,282 postmenopausal women of the Women’s Health initiative in the US who were followed up for 7 years. Initially there confusion how compliant the patients were taking their supplements. The required supplementation consisted of 1000 mg of calcium carbonate and 400 IU of vitamin D3. 7 years into the trial the researchers compared the supplement compliant group with the control group taking placebos.

Calcium and vitamin D3 supplementation significantly reduces risk of hip fractures

The study group had 35% to 38% less fractures of the hip than the placebo group. This supplementation did not cause kidney stones in the study group. This was in contrast to what previous smaller studies showed. Some physicians insisted citing the older studies that vitamin D3 and calcium supplementation would cause kidney stones. But the above study refutes the causation of kidney stones by supplementing with vitamin D3 and calcium. In other words, all of these kidney stone concern you have so often read in the media are not true.

Outline of this review

In order to make sense of supplementation as osteoporosis prevention I will first review what a normal bone metabolism requires.  I will then comment on what is missing in some of the studies and why it still makes sense to supplement to prevent osteoporosis. In addition, at the end of this blog I will also recommend a sensible supplementation regimen.  All this is based on a balanced review of the medical literature.

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Bone metabolism

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? Vitamin K2 stimulates a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the bloodstream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

The physician can measure osteocalcin levels in the blood and use this as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 control osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

The skeleton of an average adult contains 1–1.3 kg of calcium and 99% of this is mostly in the form of hydroxyapatite.

The key vitamins for bone metabolism are vitamin D and vitamin K2

Calcium absorption from the small intestine requires vitamin D3 (Ref.1). To transport calcium from the blood into the bone we require both vitamin D3 and vitamin K2 (=menaquinone). This blog explains that several studies have shown that vitamin K2 (or MK-7) plays a double role of preventing calcification of the arteries and bringing the calcium into the bones of osteoporotic women.

Apart from Vitamin K2 that is necessary for osteoporosis prevention other factors have shown to be of importance. For instance, testosterone is an anabolic hormone (meaning a hormone that builds up) and it has clearly been shown that it is bone building: It does so by stimulating osteoblasts, which are bone producing cells that reside inside the bone.

Vitamin D3, vitamin K2, Calcitonin and osteocalcin

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? It does so by stimulating a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the blood stream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

Osteocalcin levels in the blood can be measured and used as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 controls osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

Vitamin K2 also prevents heart attacks and strokes

Vitamin K2 has a second function: it removes calcium from the arterial walls and tissues. How does it do this?

Matrix GLA protein is found in tissues of the heart, lungs, kidneys and blood vessels. When vitamin K2 stimulates carboxylation of this protein, it will function like a broom and clean out calcium deposits (calcification) from blood vessels and organ tissues. As vitamin K2 is needed for this carboxylation process, it appears that nature had in mind to remove calcium from soft tissue organs and blood vessels and form hydroxyapatite in the bone for bone strength.

Vitamin K2 is the key to deposit calcium into the bone

It seems that vitamin K2 is the key vitamin necessary to do this job. Another player is magnesium, which is part of of the normal function of more than 300 cellular enzyme systems. In terms of hormones the three hormones parathyroid hormone (PTH), vitamin D3 and calcitonin need to interact normally, all requiring magnesium as cofactor. In addition, zinc, copper, boron, and manganese are also essential as trace minerals. They act as cofactors with regard to specific enzymes of the bone metabolism (Ref. 1).

Bioidentical hormone replacement essential after menopause and andropause

In the aging person hormonal deficiencies are also factors for causing osteoporosis to develop. As this link shows, Dr. John Lee found bioidentical progesterone topical cream very helpful in women with respect to increasing bone mass density by 15% over 3 years.

When bloods tests show testosterone depletion men need to replace what is missing with bioidentical testosterone. So, bioidentical hormone replacement in both men and women is part of a bone health management program to prevent osteoporosis.

Some trials that demonstrate how you can build up bone

  • In this paper parathyroid hormone  was used in combination with 1000 mg of calcium and 400 IU of vitamin D3 in a group of postmenopausal women with osteoporosis. Within 3 month of treatment there was an increase of bone mass density in the lower back (lumbar spine) of 4.7%, which translates into a yearly increase of bone mass density of 18.8%. In the past when physicians tested other agents for bone regeneration, this type of result never occurred. There is a  variation of this hormone,  a parathyroid hormone look-alike with the name Teriparatide (PTH 1-34). The patient administers this once daily as an injection of 20 mcg up to 2 years. Physicians found this useful in treating fractures of the vertebrae and other fractures in osteoporotic postmenopausal women (Ref.2).

Effect of Vitamin K2, estrogen and calcium citrate supplementation

Calcitonin and calcium strontium

  • Calcitonin is very effective in reducing bone pain when the patient has compression fractures from osteoporosis; the physician can prescribe it as an intranasal spray of 200 units daily (Ref. 2). However, on March 5, 2013 the FDA announced that salmon calcitonin would not be safe for humans as there is a slight risk that cancer can develop as a “side-effect”.
  • According to Ref. 2 physicians sometimes use strontium ranelate in Europe for the treatment of postmenopausal osteoporosis. Researcher showed that strontium ranelate builds up bone and decreases the amount of bone resorption. Side effects include nausea and diarrhea.

The team players of bone metabolism to build strong bone

We are now in a position to analyze why the researchers of the first paper (citation above) concluded that calcium and vitamin D3 supplementation were not enough to make a statistical difference in the treatment of postmenopausal women in comparison to placebos. As explained bone metabolism is a complex process involving several team players, where the key player is vitamin K2, which the researchers of that study ignored completely. The examples I mentioned above in point form show that exercise and calcium are also important. Vitamin K2 by itself worked quite well as it is so powerful. Hormones like PTH and calcitonin are effective, but more difficult to take for the average consumer and the FDA now has banned calcitonin.

Importance of vitamin D3 as a supplement

Vitamin D3 is important for absorption of calcium from the intestine, but also for depositing calcium into the bone in addition to vitamin K2. The WHI study mentioned above is highly significant because of a 1/3 reduction of hip fractures after 7 years of vitamin D3 and 1000 mg of calcium per day supplementation. If you add vitamin K2, exercise and bioidentical hormone replacement in postmenopausal women who need it, the prevention of hip fractures, wrist fractures and vertebral compression fractures likely will be as high as 50% in those who are taking their supplements regularly (compliance issues like forgetting the supplements or deliberately not taking them were mentioned in several of the studies).

Vitamin K2 helps to reduce heart attacks, strokes and osteoporosis

With the right supplementation, which includes vitamin K2 as mentioned above, you achieve that you lower your heart attack and stroke risk as the vitamin K2 removes the calcium from the blood vessels and deposits it into the bones, while at the same time strengthening your bones. Attention to proper nutrition, exercise and your hormone balance (using only bio-identical hormones to replace what’s missing) will also reinforce osteoporosis prevention. The bonus of using bioidentical hormone replacement therapy is that you prevent heart attacks and strokes in addition to preventing osteoporosis. I think that this is a good deal!

An easy-to-follow osteoporosis prevention program

The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 to 200 micrograms of vitamin K2 (also called MK-7). In the age group above 50 several hormones can be missing.

Hormone depletion in menopause and andropause

That’s why the doctor recommends bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women with hormone depletion. This works best, if you also watch your weight and cut down your alcohol consumption to a minimum. Cutting alcohol out completely would be even better. In addition, exercise regularly as this builds up bone and muscle strength.  It also helps, if you stick to a balanced diet (Mediterranean or Zone type diet). These diets are low-glycemic, low fat, wheat free and without sugar).

If you want to age gracefully, you need not only a healthy heart and a healthy brain. You also need healthy bones as this prevents disabilities.

References

  1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed. Copyright © 2011 Saunders, An Imprint of Elsevier
  2. Rakel: Integrative Medicine, 3rd ed. Copyright © 2012 Saunders, An Imprint of Elsevier

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I received the following feedback (Originally on Nov. 10, 2013)

 Dr. Ray, I read your March 17 Blog entry which suggested 100 ug of Vitamin K2 with 5000 IU of D3.   I have atherosclerosis and have radically changed my diet (plant only), but also now take an average of about 3000 IU of Vitamin D3. Dr. Kate Rhéaume-Bleue (book on K2) recommended taking about 200 ug per day of K2, but increasing K2 to about 1,000 ug if taking around 5,000 IU of D3 to ensure proper activation of MGP. What is your opinion with regard to a D3/K2 ration?  Thank you

 Answer from Dr. Ray (Originally on Nov. 12, 2013, modified April 29, 2021)

I appreciate your question about what doses of vitamin K2 to take. There are varied recommendations, but I like to go by human trials and what they have actually shown. In this review in 2010 from the Life Extension Magazine a study is cited that showed that only 45 micrograms of vitamin K2 was enough to get the calcium out of the arterial walls and into the bones.

200 micrograms of Vitamin K2 daily

Dr. Mercola reviewed the literature and found that most investigators were now using 180 to 200 micrograms. In the past I took 100 micrograms of vitamin K2 per day. However, a few years ago I increased it to 200 micrograms per day. With regard to vitamin D3 absorption my anti-aging doctor found that I have an absorption problem regarding vitamin D3. This is why I need 10,000 IU of vitamin D3 daily. This brings my vitamin D blood level up into the high normal range (between 50 and 80 ng/mL). Toxic vitamin D blood levels start only above 150 ng/mL.

Avoid sugar and too much starch consumption

Remember that other risks for cardiovascular disease are sugar and starch consumption. The liver turns this into triglycerides and too much LDL cholesterol, which plugs up your arteries. Avoid wheat because of the gliadin content. This causes an addiction to wheat and sugary foods. Here is a summary how leaky gut syndrome and autoimmune illnesses may develop from this. If you want to consume beef, reduce your consumption to once or twice per week. It id best to stick to only eat grass fed, antibiotic free beef). But I rather prefer to eat organic chicken, turkey and lean pork. I understand that you have a plant only based diet, but I would recommend to you to reconsider that. Ask your doctor to check your ferritin from time to time. This way you do not miss an iron deficiency that may develop. For other readers: Don’t forget your vegetables (organic, please).

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