Apr
14
2018

Where Does Fat Go With Weight loss?

People often wonder where does fat go with weight loss? This question recently came up in a CNN conversation.  The answer was originally researched by Dr. Ruben Meerman and Professor Andrew Brown.

Dr. Meerman is an assistant scientist at the University of New South Wales and author of “Big Fat Myths: When You Lose Weight, Where Does the Fat Go?” Professor Brown is the head of the School of Biotechnology and Biomolecular Sciences at the same university.

When you lose 1 kilogram of fat, where does fat go with weight loss?

The interesting answer to this question is that fat gets metabolized. Dr, Meerman and Prof. Brown pointed out that originally Leifson et al. answered this question who used heavy oxygen and found out that this was metabolized into heavy water.

Technically these experiments are fairly complex, but they allow the researchers to see exactly where the body incorporates these chemicals and where they end up with breakdown of fat. The BMJ paper describes that the breakdown of 1 kg of fat follows the following pattern: It breaks down into 0.84 kg of CO2 (carbon dioxide) and 0.16 kg of H2O (water). In other words, the lungs are the primary organs that get rid of fat and the kidneys excrete the water. There is a bit of extra energy in this chemical reaction as well, which dissipates through the skin and through exhaled air.

What did health professionals think where the fat would go?

The health professionals were doctors, dieticians and personal trainers. About 65% of them thought fat would evaporate into energy/heat. About 10% thought fat would end up in the feces. 5% thought fat would turn into muscle. Another 5% thought fat would turn into sweat or urine. 8% were correct that fat would become CO2 and H2O. 7% said they did not know.

The chemistry of fat deposits and metabolizing fat

The body deposited triglycerides from the liver metabolism of sugar and fatty acids into fat cells and stored them as oleate (C18H34O2), palmitate (C16H32O2), and linoleate (C18H32O2). Part of this are many chemical reactions, including a number of enzymes. These fatty acids form esters and turn into gigantic molecules with this chemical formula: C55H104O6. The BMJ paper further says that an overall chemical description of metabolized fat would look like this:

C55H104O6+78O2→55CO2+52H2O+energy. In plain English it means that 1 molecule of fat ester (from fat storage) is metabolized together with 78 molecules of oxygen. This results in 55 molecules of carbon dioxide, 52 molecules of water and energy.

Fat turns into carbon dioxide and water

Based on this chemical reaction a calculation of the breakdown of fat into carbon dioxide and water was possible. The surprising result is that 84% of fat becomes carbon dioxide and only 16% of fat becomes water. We exhale the carbon dioxide from our lungs and it is mostly the kidneys that excrete the water. People who lose weight are aware that they have to urinate more often. But they do not notice that they get rid of a lot of carbon dioxide, as this is a subtle process.

Some observations from the fasting mimicking diet

The fasting mimicking diet (FMD) was at the center of the most recent anti-aging conference in Las Vegas I attended. This was the 25th Annual World Congress on Anti-Aging Medicine in Las Vegas, Dec. 14-16, 2017. Late in December 2017 I started 5 days of FMD and have just completed my 4th round of it (FMD is done 5 days out of each month). My main interest in doing this is to prevent heart attacks and strokes and I like the idea of stimulating telomeres for anti-aging and increasing stem cell production. See more details under this link.

Personal experience of fasting mimicking diet

I keep meticulous records of my body measurements using daily body composition scales, which I record in a booklet. Between March 23, 2018 and March 28 I lost 1.5 kg from 64.8 kg to 63.3 kg. Fat composition was reduced from 14.1% to 12.2%. Visceral fat was reduced from 6% to 5%. My muscle percentage rose from 38.1% to 39.1%. The basic metabolic rate was 1471 Calories on March 23 and went down to 1449 Calories on March 28. My body mass index went from 22.0 to 21.5.

I definitely noticed the frequent urination, something I had noticed in the past in 2001 when I lost 50 pounds over 3 months. Of course it is understandable when you reduce your daily calorie intake to 600 Calories per day that you will lose this amount of weight. People have different metabolisms. It may be that you won’t lose as much as I did.

What causes mainly weight loss?

There are many people who think that extra exercise would help you lose weight. But a publication has established that only about 8% of weight loss is due to exercising. 92% of weight loss is due to dieting.

Regular exercise is important for conditioning of your lungs, heart, muscles and joints. But to keep things in balance a reasonable diet, like a Mediterranean diet, should also be part of the regimen.

Sugar overconsumption

The obesity wave in the US started to take off between 1976 and 1980. 40 years later it is still rising. It is interesting to note that both wheat flour and sugar consumption in the US were increasing parallel to the rising obesity figures. In the 70’s the old-fashioned wheat has changed into the force hybridized Clearfield wheat, which is now 100% of the commercially available wheat. Clearfield wheat contains 7-fold higher gluten amounts than the old-fashioned wheat that your grandparents consumed. Gluten stimulates your appetite, so you crave more wheat and you crave more sugar. This becomes a vicious cycle.

Excess calories are stored as fat

The liver metabolizes sugar from regular food and from processed food into triglycerides and LDL cholesterol (the bad cholesterol that plugs up arteries). As I mentioned above, the body stores any excess triglycerides as fat and deposits the excess into fatty cells. You see from this that essentially sugar and wheat end up as fat deposits. I suggest you change your food intake into eating sensible food with fewer calories. Start by eliminating most of your sugar, wheat and processed food intake. This will help you to melt fat away as I showed with an example of my 5 day FMD.

Where Does Fat Go With Weight loss?

Where Does Fat Go With Weight loss?

Conclusion

I reviewed facts about the chemistry of melting fat away. The question is where does fat go with weight loss? In the process of weight loss fat breaks down into carbon dioxide and water. I also documented how you can lose fat in just 5 days (1.1 kilogram) on a 600-calorie diet and reduce the body mass index from 22.0 to 21.5.

Most people do not recognize the importance of watching their diet to achieve weight loss. 92% of weight loss occurs as a result of dieting. Wheat and sugar consumption have a direct connection to the obesity wave that started between 1976 and 1980. I have cut out all wheat, all sugar and all processed food in 2001. This allowed me to lose 50 pounds then and my body mass index today is 21.5. It can be done, even if you are 73 years old.

Jul
16
2016

Mediterranean With Healthy Fat

If you want to lose weight, have you considered eating Mediterranean with healthy fat? A lot has changed in recent years regarding recommendations for healthy food intake. In the eighties and nineties there was a recommendation for a  low fat diet, which unfortunately was high in carbs and led to obesity. We learnt from this that carbohydrates break down in the gut into sugar. This converts into fatty acids, which go in storage as fat.

Studies regarding diets with unhealthy and healthy fats

Prospective study in the US

Here is a prospective study that followed 120,877 U.S. women and men over a longer time. Every 4 years there was weight gain of 1.69 lbs. for potato chips, 1.28 lbs. for potatoes, 1.00 lb. for sugar-sweetened beverages, 0.95 lb. for unprocessed red meats and 0.93 lb for processed meats. On the other hand from vegetables there was a weight loss of −0.22 lb., for whole grains −0.37 lb., for fruits −0.49 lb., for nuts −0.57 lb. and for yogurt −0.82 lb. The researchers checked cheese out and found it mostly neutral in terms of weight gain, while butter did cause weight gain.

Lancet study from Spain

In a study from Spain that was published in the Lancet in June 2016. The researchers followed 7447 asymptomatic men (aged 55–80 years) and women (aged 60–80 years) for about 5 years. They all had type 2 diabetes and three or more cardiovascular risk factors. They were randomly assigned to three Mediterranean diet types: a Mediterranean diet with olive oil, a Mediterranean diet with nuts and a control group on a low fat Mediterranean diet.

Weight loss when on Mediterranean diet

The interesting finding after 5 years was that there was weight loss around the waist in both the patients on the Mediterranean diet with nuts and with olive oil. Their weight loss was 0.95 lbs. for the olive oil group and 2.82 oz. in the Mediterranean diet group with nuts. The Mediterranean diet group with olive oil had lost 0.22 inches in the waistline, the other group on nuts lost 0.38 inches. These are hardly impressive losses! The researchers concluded that fat restriction is not necessary on the Mediterranean diet, as there was no weight gain with unrestricted healthy fats after 5 years.

Summary from a cardiologist

Dr. Dariush Mozaffarian, a cardiologist and epidemiologist of the Tufts Friedman School of Nutrition Science & Policy wrote an editorial regarding this Spanish study: ”A handful of nuts may be 160 calories, which is more calories than a can of Coke, but that doesn’t mean the can of Coke is a better choice”. He added: “Salt, sugar, starch, processed food and trans fats should be off the menu, not fat. Healthy foods are healthy foods, and bad foods are bad. It doesn’t matter, if the food is low fat or high fat. This is a separate issue.”

Mediterranean With Healthy Fat

Mediterranean With Healthy Fat

Conclusion

When wanting to lose weight, the key is to pay attention to your carb intake. Make sure it consists of unrefined carbs. You will do this if you eat vegetables and fruit. Cut out sugar and starchy foods as much as you can. Have lean, clean meats, but avoid red meat except perhaps for every two weeks some grass fed beef. Eat fish (important for its content of omega-3 fatty acids), also enjoy yogurt, nuts, olive oil and avocados. It is an extra benefit if you add regular exercise to this as well. You will notice that you gradually shed the unnecessary pounds. This is not a program for just a month or two. To stay well, make it a new lifestyle!

May
31
2014

Industry Sponsored Diet Soda Study Deceptive

Recently an industry sponsored study was reviewed by the media with this headline: “Diet soda helps weight loss, industry-funded study finds”. Before you get too excited about this study, let me tell you that you are being deceived. Essentially the study compared 150 overweight or obese people on water and a similar group of people on diet sodas. Both groups were counselled on the benefits of exercise and a healthier diet. At the end of 12 weeks the water group that did not drink diet sodas had lost 9 pounds, while the diet soda group that continued their former habit lost 13 pounds. The question now is why this 4 pound difference? The sponsor of the study would like you to think that the soda diet drink is healthier, because it helps you to lose weight. Let me explain to you that there are a few flaws in the study as follows.

1. Most often there are confounding errors in industry-sponsored studies. Even though it looks on the surface that the two groups were comparable, researchers should have checked out various parameters like sex distribution, other underlying illnesses, mental state (depressed or not etc.), diabetes and other factors to make sure that there is no metabolic bias between the two groups from the start of the study.

2. Deception built into study: we know from other studies that on the long-term diet sodas lead to weight gain by stimulating your appetite for sweets and their subsequent consumption. Often short-term studies show the opposite effect, so it would be false to assume that long-term results would be similar. But most readers who read this quickly would be tempted to think “so it must be OK to continue to consume diet soda drinks!” Off you go to the grocery store and buy another 6 or 12 pack. That’s exactly what the industry-sponsored study set out to do. Somewhere in the back-room of a big soft drink corporation the executives discussed among themselves that their statistics were bad; the sales of diet soft drinks were down; there was too much negative press fuelled by the health food industry. They had to do something about this, so they designed a study where the good guy was the diet soft drink. If the consumer is not buying the results, at least the study helped to confuse people and whenever there is confusion, at least part of the confused population will return to their old habits. After all the study showed “ it is OK”.

Industry Sponsored Diet Soda Study Deceptive

Industry Sponsored Diet Soda Study Deceptive

3. Excitotoxins are not OK. Unfortunately all artificial sweeteners are toxic to your brain, they are excitotoxins. MSG is another excitotoxin. The only exception is the natural sweetener stevia, a plant product, which is OK. Splenda is an insecticide, so this is belongs to the xenoestrogens, bad for you as it acts like a foreign estrogen and has cancer-promoting qualities when exposed to it for several decades. The rest of the artificial sweeteners are excitotoxins: they burn your brain cells very slowly and can lead to dementia. Unfortunately they are addicting and your brain will make you feel good when you drink more of it. So, the real reason why the study group on diet sodas did better than the water group is because they did not have to change that habit, there was no withdrawal to deal with and they felt fine. So they could concentrate on dieting and exercising and of course you would lose 13 pounds in 12 weeks doing that. The water group on the other hand had to cope with diet soda withdrawal and on top was challenged by an exercise and weight loss program. As there was no diet restriction, they could compensate a bit for their trouble of withdrawal and eat a few muffins or some extra bread to make up for the lack of their comfort diet drink fix (the satisfaction of consuming the excitotoxin). This slick short-term study design is what should have alarmed the publisher to ask a few hard questions.

4. There needs to be an internal logic in the study: Let’s do a thought experiment where we repeat the study and start with two comparable overweight/obese groups of people and put them on no sugar and no refined carbs for 2 weeks and also on no diet sodas for the same time. After two weeks they are both accustomed to this diet and the no diet soda habit and they have probably lost the same amount of weight from the calorie restriction. Now we start the one group on diet sodas and the other group on water, but strictly controlled for a similar calorie intake in terms of other foods or drinks as much as is humanly possible. I would predict that after 12 weeks the water group will have at least lost the same weight as the diet soda group, if not more. The diet soda group likely will have had some problems with sugar craving and may have had more dietary indiscretions (sneaking in snacks and underreporting them), but this would show up as weight gain.

You may be proud of having completed this well controlled study. The trouble is that your industry sponsor that produces the diet drinks will not like this outcome and would not allow the results to be published. In fact that kind of result would be actively suppressed.

Conclusion:

The diet soda study discussed here is a lesson in biased publishing. We are constantly bombarded by an endless string of meaningless publications that are designed to make the consumer insecure, or bias us for accepting a company’s product in the hope of achieving a certain result (like high sales). Even, if this is not accomplished the company has sold enough of their product just for giving it a try. Beware of the door-to-door sales person. This figure is very much present right in this publication. In this case it is the sales pitch of the diet soda manufacturers! You are looking at a study that was designed to make you buy more of the excitotoxin (aspartame or other artificial sweeteners), which likely contributed to your extra weight or obesity in the first place. It’s up to you to shut the door on this sales pitch. Instead of a diet soda I suggest you make your own drink: squeeze half an organic lemon and top this with mineral water of your choice. Sweeten it with a tiny amount of stevia. This has no calories and does not stimulate you to eat more sugar and starchy foods; but it quenches any thirst and you even get some water-soluble vitamins in the process.

Last edited May 31, 2014

Apr
05
2014

Yes, There Are Healthy Sugar Substitutes

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

General information why sweets and starches are bad for you:

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

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

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

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

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

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

Yes, There Are Healthy Sugar Substitutes

Yes, There Are Healthy Sugar Substitutes

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

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

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

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

The natural sweeteners:

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

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

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

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

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

Conclusion:

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

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

 

Reference:

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

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

Last edited Nov. 7, 2014

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Nov
30
2013

Statins Can Hurt The Consumer

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

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)

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

Jul
01
2008

High-protein, Low-refined carb diet useful in controlling diabetes

Diabetes type 2 is often associated with obesity (body mass index higher than 30.0 kg per meter squared). At the 16th European Congress on Obesity in Geneva Dr. Neil Mann presented a study of 99 patients. Half were put on a high protein diet, the other half on a high carbohydrate low glycemic index diet and followed for one year with periodic blood tests and examinations by their family doctors. The study population’s age ranged from 30 to 75 years and their body mass index varied from 27 to 40. The hemoglobin A1C level that is a measure of severity of the diabetic condition ranged from 6.5% to 10%.

The high-protein diet was structured so that 30% of calories came from protein, 40% came from carbohydrates and 30% came from fat. With the high-carbohydrate low glycemic index diet 15% of the calories came from protein, 55% from low glycemic index carbs and 30% from fat. In both groups the total calorie intake per day was restricted to 1500 calories and the carbohydrates were given as low glycemic index carbohydrates (less processed). In both groups the diabetes was better controlled with hemoglobin A1C, triglyceride levels and cholesterol levels normalizing. Both groups also showed an equal amount of weight loss that stayed down as long the patients adhered to the diet. However, the high-protein group was able to reduce diabetes pills (metformin) and insulin achieving the same results as the high-carbohydrate low glycemic index group that could not reduce their medications. The conventional approach is to use a low-fat, high-carbohydrate diet along with medication. However, this diet tends to lead to higher triglyceride levels, higher blood sugar levels and a reduction in the good cholesterol (HDL).

High-protein, Low-refined carb diet useful in controlling diabetes

High-protein, Low-refined carb diet useful in controlling diabetes

Dr. Mann who is a professor and head of the department of nutrition and food science at RMIT University, Melbourne, explained the people get confused when they hear the term high-protein diet as they think of the Atkins diet where the protein component was much higher. The diet that was investigated here is a more natural diet consisting of slightly higher protein and less processed carbohydrates. By containing more fat than in the conventional diabetic diet the patient is not getting hungry and finds it easy to stick to the diet, which leads to weight loss and improvement of the metabolism. Many patients can normalize their blood values and often even get off their diabetic medication (under careful supervision by their treating physician). The physician will address the three components of diabetic control (energy balance, glycemic control, and vascular complications) by recommending to the patient this high-protein/low-carb diet. This likely will replace the conventional approach of using a low-fat, high-carbohydrate diet.

More information about a Mediterranean type diet in firefighter’s, which is very similar to this study: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: 16th European Congress on Obesity, Geneva June 23, 2008

Last edited November 4, 2014

Apr
01
2008

H. Pylori Can Be The Culprit For Indigestion

Indigestion, heart burn, bloating and stomach discomfort are common problems. Often the reason is simple. Too much food and drink at a party, a plateful of deep fried Buffalo wings or a midnight order of double-pepperoni pizza will contribute to stomach upset and a bad night’s sleep. A few over the counter antacids will come to the rescue. If indigestion is a faithful but miserable daily companion, the excuse of “just having a sensitive stomach” becomes a form of denial and a dangerous form of self diagnosis. Something is wrong, and it is time to seek medical attention instead of over the counter meds. The first line of defense will be prescription drugs called “proton pump inhibitors” (PPI). They are designed to eradicate excessive acid production in the stomach. If symptoms are more severe, e.g. weight loss, a gastroscopy will be necessary. Even though the prevalence of a stomach infection with Helicobacter pylori (H.pylori) is declining, about 30% of patients with chronic stomach upsets test positive for an infection with these bacteria. This can cause recurrent stomach pains. In this case it becomes necessary to treat this with a combination of PPI’s and antibiotic medication. Eradication of H.pylori can mean a cure from a stomach ulcer. It also reduces the risk of developing gastric adenocarcinoma, a form of stomach cancer that could have developed out of an untreated gastric ulcer. Just because a person has heartburn does not mean that the condition is due to gastro-esophageal reflux of stomach acid. If after treatment with a PPI the problems of indigestion, heartburn, bloating or stomach aches reoccur, lab tests can give more information. According to a prospective trial conducted by Dr. Delaney and others the H.pylori serology (a blood test) is unreliable, but other H.pylori tests like urea breath test or stool antigen are reliable tests to establish whether a stomach infection with H.pylori is present or not.

H. Pylori Can Be The Culprit For Indigestion

H. Pylori Can Be The Culprit For Indigestion

If the bacterium is present, its eradication with antibiotic therapy will stop the stomach problems in a high percentage of cases with one treatment protocol. What was surprising was that after one year the treatment result of the treatment group with PPI/antibiotic combination was as successful as the control group that was treated with PPI’s alone. It was concluded that in the more severe cases with weight loss, vomiting, or overt bleeding an upper gastrointestinal endoscopy should be performed where a direct H.pylori test from samples is also done. However, in the vast majority of cases with minor symptoms can be treated safely by the general practitioner with PPI’s and follow-up examinations in subsequent visits. Treatment failures can then be referred to a gastroenterologist, if necessary.

More information about gastritis and H. pylori: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/gastritis/

Reference: British Medical Journal 336:623-624 (March 22, 2008)

Last edited November 3, 2014

Nov
01
2006

Body Can Fight Weight Loss

Embarking on a weight loss program needs long-term commitment and persistence. Many dieters have experienced the yo-yo effect of good initial results in losing weight, after which the weight loss stopped, and gradually the weight was gained back. Often dieters blame themselves for their lack of success or are criticized for a lack of self-control.
The “plateau effect” has been discussed and documented before, and now an Australian study has found that “it is not just you”. After initial success and weight loss the human body is designed to strongly resist attempts to lose weight. Dr. Neil King from Queensland University of Technology does research on appetite regulation and energy balance. He conducted studies on groups of people who were overweight and obese people. He found that weight loss from exercise and calorie restriction stops at a certain point, and this plateau remains firmly in place for a prolonged time, despite continuing dieting and exercise.

In the first study 30 obese men and women from Britain took part in a 12-week, laboratory based exercise program in which they exercised five times a week. The second study observed the weight loss in 200 Australian men who were enrolled in a commercial weight loss program, which involved both an exercise program and dietary advice. Although both groups followed different plans, their weight loss still plateaued. The first group averaged a loss of 3 kg during the first 8 weeks, and weight loss in the next 4 weeks was markedly reduced (0.7 kg). The second group had a variable pattern of weight loss, but it, too, showed a plateau.

Body Can Fight Weight Loss

Body Can Fight Weight Loss

Researchers believe that the human body is designed to cope with famine. As a result there is a built-in mechanism responsible for weight loss resistance. It may be a source of frustration to people on a weight loss program in a society where there are no food shortages, but it is meant to be a lifesaver in times when there was a shortage of food.
For the person who wants to lose weight it involves taking a closer look at the caloric output. Longer exercise times, higher intensity or cross training can combat the plateau effect, but patience is also needed along with the determination to carry on with the program.

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

Reference: The Medical Post, October 10, 2006, page 19

Last edited November 1, 2014