Apr
16
2023

What you Must Know about Male Hormones

By | andropause, Anti-aging medicine, Cancer, Diabetes, hair loss, heart attack, Infertility, prostate cancer, prostate hypertrophy, Stroke, testosterone

Dr. Pamela Smith, an anti-aging physician gave a talk about what you must know about male hormones. She spoke on Saturday, Dec. 10, 2022 at the Sands Conference Center of the Palazzo Hotel in Las Vegas. The title was “What you must know about male hormones”. She presented 199 slides, so the following can only be a brief summary of what she said. She started by saying that the term “male menopause” goes back in time to 1944. Other terms are andropause and late onset hypogonadism.

Different testosterone levels at different ages

It is important to realize that at age 20 the blood testosterone level is around 900 ng/dL, but this declines after age 30. It is 550 ng/dL at the age of 40. At the age of 50 the testosterone level is 350 ng/dL. And at the age of 70 the testosterone level has shrunk to 200 ng/dL or less. With this in mind, there are also seasonal variations with higher levels of testosterone occurring in summer and early fall, and low levels happening in winter and early spring. A healthy male produces the following male hormones: Testosterone, 5-6 mgs/day; Androstenedione, 3 mgs/day; DHT, 0.300 mgs/day; DHEAS, 50 mgs/day; and DHEA, 15 mgs/day.

Functions of testosterone

In other words, testosterone is the male hormone responsible for the male body characteristics. Every male body cell has testosterone receptors on it. Truly, this way testosterone is involved in protein manufacture and muscle maintenance. In fact, bone formation depends on testosterone and oxygen uptake as well. It is also controlling blood sugar together with insulin. In addition, normal sperm production depends on testosterone. To clarify, testosterone also regulates cholesterol and the immune system. By all means, it also helps to improve mood, is important for mental concentration and helps protect against Alzheimer’s disease. Finally, there is stimulation of platelets and megakaryocytes by testosterone, which makes blood clotting easier.

Symptoms of andropause

It must be remembered, towards the end of their 60’s many men get symptoms of tiredness, loss of energy and depression. Specifically, they may get a bad temper, present with irritability, anxiety and nervousness. Specifically, they complain of a loss of memory, loss of sex drive and libido. Certainly, their erections are getting weak or they lose them altogether. There is a decreased intensity of orgasm and they are gaining weight. All this should prompt their physician to have a total testosterone blood test done. When the testosterone level is less than 500 ng/dL the person should see their physician for replacement testosterone therapy.

Other signs of testosterone deficiency

There are other signs and symptoms of testosterone deficiency: backaches and joint pains, loss of fitness, being overstressed. In addition, testosterone-deficient males experience a decrease in job performance and a decline in physical fitness. They have bone loss, elevation of their blood cholesterol and an increased risk of heart disease. They often also have increased insulin resistance, diabetes and metabolic syndrome. Mortality in men with low testosterone is much higher than in controls with normal testosterone. Several dozens of literature references were provided to support the above statements.

Testosterone replacement and hormone balance

When a patient is on testosterone replacement, a digital rectal exam should be performed to check for the size of the prostate gland. A PSA should be done every year (in former prostate cancer patients every 3 months). PSA should stay below 4.0 ng/mL. If the PSA rises by 1.5 ng/mL in one year or by 0.75 ng/mL in two consecutive years, a urologist should be consulted to rule out prostate cancer.

Men produce small amounts of estrogens, which are important for memory function of the brain and for strong bones. Androgens and testosterone aromatize into estrogen via the enzyme aromatase in fatty tissue. There are a few reasons why aromatase increases: obesity, excessive alcohol intake, chronic inflammation and high insulin levels.

The following medications lower estrogen levels: phenobarbital, carbamepazine, trazodone, chlordiazepoxide and sulcrafate.

Side effects from elevated estrogen levels

Increased estrogen levels in males cause gynecomastia (colloquially called “beer tits”), decreased sex drive, heart attacks, strokes and benign prostate hypertrophy. Elevated estrogen levels also cause insulin resistance, rheumatoid arthritis and prostate cancer. Dr. Smith referenced all of these statements again with many literature quotations.

Dihydrotestosterone (DHT)

This metabolite of testosterone is 3-times stronger than testosterone. It is formed from testosterone by the enzyme 5-alpha reductase. It is responsible for the male-specific characteristics, the male genitalia and the prostate gland. Low levels of DHT cause reduced sexual function, decreased libido and weakened muscle function. On the other hand, elevated DHT causes male pattern baldness, hirsutism and benign prostate hypertrophy (BPH). There are two 5-alpha reductase inhibitors, namely finasteride and dutasteride, that clinicians use to lower elevated DHT levels. This can reduce the risk of prostate cancer by about 50%. Dr. Smith provided many literature quotations to support these statements.

Testosterone replacement therapy

Based on more than 3 dozen literature quotations Dr. Pamela Smith outlined the following:

  • Most men tolerated transdermal testosterone application very well.
  • Erectile dysfunction affects 1 in 5 older men.
  • Erectile dysfunction in association with low blood testosterone and low libido responds to transdermal application of testosterone very effectively.
  • It may take 14-25 weeks before transdermal testosterone treats erectile dysfunction successfully, more than 50% of men respond to this.
  • Testosterone replacement prevents beta amyloid precursor protein production, which increases memory and decreases the risk of Alzheimer’s development.
  • High stress produces high cortisol levels in the blood, which affect the hippocampus, where memory is located. Testosterone is neuroprotective, and it preserves memory.
  • Transdermal testosterone decreases coronary heart disease by relaxing coronary arteries. This prevents heart attacks and strokes.
  • Testosterone decreases inflammation and lowers LDL cholesterol.

More facts about testosterone replacement therapy

  • Testosterone lowers inflammatory cytokines and stimulates interleukin-10 production. This has anti-inflammatory and anti-atherogenic actions, which prevents heart attacks.
  • There was a reduction in mortality from heart attacks in the testosterone treated group of between 66% and 92%. In addition, 30 nonfatal strokes and 26 nonfatal myocardial infarctions occurred in the control group, but none in the testosterone group. Testosterone deficient heart failure patients responded very well to testosterone replacement therapy.
  • Prostate cancer or benign prostate hypertrophy do not increase with transdermal testosterone replacement therapy.
  • A Meta-analysis showed that older men with the highest risk for prostate cancer have the lowest testosterone blood levels.
  • Type 2 diabetics with a high insulin resistance respond well to testosterone replacement therapy. They increase insulin sensitivity and lower their blood sugars. This improvement peaks after 3 months and the effect stays for 12 months.

Further facts about testosterone replacement therapy

  • Testosterone replacement is safe. It provides significant benefits for erectile dysfunction, for muscle mass, prevention of Alzheimer’s disease, prevention of heart attacks and strokes. Testosterone treatment is for males above the age of 50, there is no cut-off for higher ages. There are many controlled clinical trials spanning over 70 years, which support all of what is presented here.
  • Testosterone can’t be taken orally, because it is rapidly metabolized in the liver. Instead, patients use transdermal testosterone gel or cream. Gels are commercially available and very expensive. Compounding pharmacies can provide testosterone creams for you, which are considerably cheaper and can be dosaged according to the patient’s needs. Testosterone esters in oil are available for subcutaneous or intramuscular injection twice per week. This ensured a steady testosterone level.

Improvements after testosterone replacement therapy

  • Timing of improvements: cholesterol reduction occurs by 12 months, for triglycerides it takes 22 months. Testosterone levels take 4 to 12 weeks to normalize. Fasting blood sugars and Hemoglobin A1C come own within 3 months with further improvements by 12 months. Sexual desire and energy are back to normal within 3 to 6 weeks.
  • It is important that you go for blood tests to measure testosterone levels every 3 months initially (blood level). If the levels are stable, the physician may decide to only order tests every 6 months.
What you Must Know about Male Hormones

What you Must Know about Male Hormones

Conclusion

The goal in the aging male is to maintain optimal male hormone levels. This achieves optimal health and prevents diseases of older age. First, it is important to preserve his erections, but at the same time testosterone replacement therapy prevents Alzheimer’s disease and memory loss. It also prevents heart attacks and strokes. Testosterone helps to preserve muscle mass. Hormone replacement therapy keeps lipids like cholesterol and triglycerides under control. Testosterone replacement reduces blood sugars and prevents type 2 diabetes mellitus. Replacement therapy also reduces elevated insulin levels. The end result is that testosterone replacement therapy maintains the health of the aging male.

Apr
17
2021

Which are the Most and Least Contaminated Crops

By | breast cancer, Infertility, Nutrition, toxins

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Farmers are spraying many crops with pesticides, so which are the most and least contaminated crops? Recently, the Environmental Working Group’s 2021 Shopper’s Guide to Pesticides in Produce was published. The various fruit and vegetables are also called the “dirty dozen”. You see from this readily that the most contaminated crops are strawberries, followed by spinach and kale, collard and mustard greens. Nectarines, apples and grapes are next followed by cherries, peaches and pears. The list is made complete by bell and hot peppers, celery and tomatoes.

Safety of food

This means that it is not safe to eat any of these fruit and vegetables from regular crops, as they are all contaminated by pesticides. It is advisable to exchange these crops and buy the organic version of each instead. This is easy to do, and I have done this for years. If you have a garden or access to a community garden, you can also grow some of them yourself.

What pesticides do in the body

People can acquire pesticides orally as contamination of crops. But people can absorb them as well by inhalation or through the skin. People affected by pesticides may complain about a sore throat, a cough, eye and skin irritation. They also may develop a headache, loss of consciousness, diarrhea, nausea and vomiting. In the worst case there can be profound weakness, seizures and death.

You may think:” Why worry? There is probably just a little bit left, and this surely will not harm me.” But make no mistake: many of the pesticides are hormone disruptors, and that “little bit” does matter!

Action of hormone disruptors

Hormone disruptors may have a molecular structure similar to estrogen. As a result, laboratory analysis may show smaller semen counts in males causing infertility.  Women can develop cysts in the ovaries, menstrual bleeding abnormalities and breast cancer. With pregnancy pesticides can cause early miscarriages. In addition, women can also have fertility problems as a result of hormone disruptors.

A French study showed that consumption of organic food reduces cancer risk

One way to find out what pesticides (insecticides) are doing to the body is to do a comparative study. In France researchers compared cancer rates between people who consumed organic food and others who ate regular food (treated with pesticides). Researchers recruited 68,946 French adults for the study. More than ¾ of the study population were women in their mid 40’s. Researchers divided these subjects into 4 groups depending on how many of 16 organic food groups they were consuming.

Details of the French study (organic food intake versus non-organic food intake)

First of all, the type of foods included fruit and vegetables, ready-to-eat meals, meat and fish, vegetable oils and condiments, dietary supplements and other products. Also, the investigators followed this population for an average of 4 ½ years. Finally, during that time 1,340 cancers developed. 459 breast cancers occurred, 180 prostate cancers, 135 skin cancers, 99 colorectal cancers and 47 non-Hodgkin lymphomas.

Those who ate the most organic food developed 25% less cancer on average. When it came to Hodgkin’s lymphoma, organic food consumers developed 73% less of it than people on regular food. Postmenopausal breast cancer was 21% less frequent among those who had the highest amount of organic food.

The least contaminated fruit and vegetables

The Environmental Working Group’s 2021 Shopper’s Guide for the least contaminated fruit and vegetables lists the following. Avocados, sweet corn, pineapples and onions. Papayas, frozen sweet peas, eggplant, asparagus, broccoli and cabbage are next. Finally, kiwifruit, cauliflower, mushrooms, honeydew and cantaloupe complete the list of the least contaminated crops. This means that you can buy these crops without concern whether or not you should buy the organic version. It is good to know what is acceptable and what you need to avoid by buying the organic version.

GMO foods and Roundup

It is interesting that there is no law in the US and in Canada that GMO foods should have a label that identifies crops with genetic modifications. This is changing rapidly as people realize that in many countries of Europe all GMO foods require labeling. Here is a publication that shows that the GMO labeling campaign is gaining momentum.

Genetically modified corn and soy contains the Bt toxin; it has been found in babies as mentioned in this article. Bt toxin damages the small bowel (the ileum) through Cry1Ab (the protein produced in genetically modified corn and soy). This in turn disables the absorption of vitamin B12. We know that this causes anemia. Historically the cause of pernicious anemia was due to a lack of vitamin B12 absorption.

Effects of Roundup

In a publication dated April 2013 Drs. Anthony Samsel and Stephanie Seneff discuss the effects of Roundup. They noticed that glyphosate inhibits the cytochrome P450 (CYP) enzymes in the liver. This is a crucial detoxification enzyme complex. When toxicity studies of glyphosate in mammals emerged, this was not common knowledge. The CYP enzymes in the liver are important to metabolize and eliminate estrogens and also help to detoxify xenobiotics, which are estrogen-like substances (residues from insecticides).

Glyphosate amplifies the effect of environmental toxins

Thus glyphosate (=” Roundup”) amplifies the damaging effect of environmental toxins and chemical residues from non-organic food that we eat. Researchers have shown a build-up of estrogens and xenoestrogens that are responsible for the development of many cancers (atypical Hodgkin’s lymphoma, breast cancer, prostate cancer, colon cancer etc.). Based on this data it makes sense to switch to as much organic food as you can afford. Organic food does not contain Roundup. For the sake of your health at least stay away from the “dirty dozen”!

Which are the Most and Least Contaminated Crops

Which are the Most and Least Contaminated Crops

Conclusion

The poisoning of the food chain is a real concern. As far as pesticides (insecticides) are concerned the Environmental Working Group’s Shopper’s Guide to Pesticides in Produce has been extremely useful. They publish a yearly guide of the “dirty dozen”, but also of the least contaminated fruit and vegetables. Regular crops with pesticide residues can cause infertility in both men and women. They also can cause early miscarriages in pregnant women. Generally speaking, they can cause headaches, loss of consciousness, diarrhea, nausea and vomiting. In the worst case there can be profound weakness, seizures and death. A French study showed that subjects on organic food developed 25% less cancer on average. When it came to Hodgkin’s lymphoma, organic food consumers developed 73% less of it than people on regular food. Postmenopausal breast cancer was 21% less frequent among those who had the highest amount of organic food.

The above contains parts from this blog.

Oct
19
2019

How Marijuana Affects Your Reproductive Health

By | Infertility, marijuana

The latest edition of the British Columbia Medical Journal contains an article on how marijuana affects your reproductive health.

Dr. Dunne is an assistant professor in the Department of Obstetrics and Gynecology at the University of British Columbia. She is the author of the linked review above.

Products of the Cannabis sativa plant like marijuana and hashish are most popular in North America. Since October 2018 smoking recreational marijuana is legal in Canada.

The medical community has some concerns, as we do not fully know the long-term effects of smoking marijuana. In the following I will summarize the effects on the male and female reproduction based on Dr. Caitlin Dunne’s report.

Consumption of marijuana

Marijuana contains over 500 compounds, of which 100 are cannabinoids. The ingredient that produces the high a user gets is due to tetrahydrocannabinol (THC). Cannabis is available in different forms. It can be smoked (raw leaves or extract), but it can also be converted into edibles. Ingestion of cannabis creates a longer-lasting experience. The reason for this is that the liver metabolizes cannabis into more psychoactive forms by the liver enzyme, cytochrome P-450. Smoking marijuana can irritate the airways; oral consumption of cannabis products can lead to vomiting, nausea and disorientation.

Contaminants in cannabis such as pesticides, microbial toxins and metals can also be harmful to recreational marijuana users.

Endocannabinoid system

Researchers found endogenous cannabinoids in the brain that function as messenger molecules. They need to activate their targets, the cannabinoid receptors, called CB1 and CB2. CB1 receptors are found mainly in the central nervous system. CB2 receptors are located mainly in the immune system. Reproductive organs have their own cannabinoid receptors. The lining of the uterus contains only CB1 receptors. Ovaries and testicles both use CB1 and CB2 receptors. THC from smoking or ingesting marijuana can stimulate these cannabinoid receptors also. But compared to the body’s own cannabinoids THC is much stronger. This leads to more pronounced effects that concern many physicians.

How marijuana affects your reproductive health: female fertility

The normal functioning of the body requires that the hypothalamus send gonadotropin-releasing hormone (GnRH) to the pituitary to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). The FSH release happens mainly in the first two weeks of the menstrual cycle. LH is released in the 3rd and 4th week of the menstrual cycle. Only when the female hormone rhythm works can a follicle in the ovary mature and ovulate normally. After ovulation the corpus luteum needs further LH stimulation to start prednisone production, which helps with embryo implantation and with sustaining the pregnancy.

THC from cannabis consumption interferes at all the levels of these hormone actions. Cannabinoids suppress GnRH, FSH and LH release.

This is the reason why moderate to heavy users of marijuana have infertility problems. If a woman is a moderate to heavy consumer of marijuana she cannot ovulate normally, and hence she has difficulties getting pregnant.

How marijuana affects your reproductive health: pregnancy

THC from cannabis use can cross the placental barrier. Levels in cord blood are three to six times lower than the mother’ blood level, as the placenta attempts to detoxify THC.

Prenatal exposure to cannabis can interfere with fetal growth and alter neurodevelopment. These children can have permanent effects regarding academic achievement and intellectual capacity. Other risks are hyperactivity, attention-deficit disorder, and impulsivity, but also future substance abuse.

CB1 receptors seem to regulate mitochondria, the energy packages of cells and cellular adenyl cyclase.

The end results are mitochondrial dysfunction and oxidative stress.

Clinical studies regarding cannabis use in pregnancy

Recently a BC study followed 243,140 pregnant women. Over an 8-year period cannabis use rose from 2.2% to 3.3%. Closer analysis of the pregnant cannabis group showed an increased risk of poor perinatal outcomes. 47% had smaller babies than expected (“small for gestational age” is the medical term). 27% were born prematurely, there was a risk of 2.4-fold that the baby died in the womb (“intrapartum stillbirth”). Women who used cannabis often used other illicit drugs as well. They also often had a history of mental illness. The authors relied on self-reporting, which means the cannabis use likely was underreported.

An American study

An American study from 2016 identified 7,851 pregnant patients who used cannabis. Like the BC study they showed a low-birth weight and preterm deliveries. But when the authors controlled for confounding factors, namely mainly tobacco use, statistical significance disappeared.

Often marijuana users are also tobacco users. Tobacco has long been proven to lead to prematurely born babies and babies that are too small for their age. The BC study had controlled for tobacco use and thee results were only due to smoking or consuming marijuana.

How marijuana affects your reproductive health: male fertility

Males on cannabis also contribute to infertility of the couple. The hypothalamic/pituitary/testicle hormone axis needs to also be intact for proper sperm cell maturation to take place. In medical language sperm cells are spermatozoa. The hypothalamus generated gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to release FSH and LH. LH stimulates testosterone production in the Leydig cells of the testicles. FSH stimulates spermatogenesis (production of sperm cells) from the so-called Sertoli cells. Testosterone, along with FSH provides a stimulatory effect on spermatogenesis. Whenever a system is that complicated, much can go wrong. Sperm cells contain both CB1 and CB2 receptors. When the man uses marijuana regularly, THC exposure can significantly interfere with CB1 and CB2 receptors.

Effects of THC on sperm motility, sperm concentrations and DNA

This leads to sperm cell mobility reduction. In an experiment where THC was added to sperm from 78 men in vitro (Petri dishes) researchers simulated high marijuana users and moderate marijuana users.

They found that lower THC concentrations caused 28% sperm motility reduction, high TCH caused 56% sperm motility reduction. Many other publications exist that documented similar results and correlated these findings with infertility of couples.

Studies on sperm cell motility and marijuana use are inconsistent. In 2019 a study came out from the Chan Scholl of Public Health where researchers analyzed 1143 semen samples and 317 blood samples.

They found no difference in terms of findings among men who smoked marijuana versus men who never smoked Marijuana. They looked at sperm concentrations, DNA aberrations of sperm cells.

This leaves many questions open regarding marijuana toxicity.

How Marijuana Affects Your Reproductive Health

How Marijuana Affects Your Reproductive Health

Conclusion

Marijuana affects the reproductive organs, but it is easier to document in women than in men. In women marijuana has an effect on fertility and on pregnancy, which is measurable. However, in men the results of investigations have been conflicting. Here is a statement of the Society of Obstetricians and Gynecologists of Canada. They believe “there is sufficient evidence of harm to advise women to avoid cannabis when pregnant”. Use of marijuana is also not advisable for women who are breastfeeding. At this point a similar clear suggestion regarding reproductive health cannot be made to men, but the in vitro study with TCH suggests that it is wise to refrain from marijuana when a man tries to father a child. Further studies will likely clarify these outlines.

May
11
2019

Male Fertility Could Be Improved Naturally

By | alcohol, diet, exercise, Fitness, food, Infertility, lifestyle, Men's Health, Nutrition, Obesity, omega-3 fatty acids, Pregnancy

A review article of CNN reviewed how male fertility could be improved naturally. Studies have shown that males contribute about 40 to 50% of the responsibility of any fertility problem of the couple. This means that a couple with infertility issues will benefit from interventions that include the male partner. Dr. Natan Bar-Chama is the director of the Center of Male Reproductive Health in New York. He is a board-certified urologist and male infertility specialist. Dr. Bar-Chama has done research into what affects male fertility. He found that there are several factors that are important for male fertility.

Lifestyle factors

The big factors that interfere with fertility are obesity, caffeine and alcohol intake, smoking, marijuana intake, lack of exercise and wearing too tight underwear resulting in increased scrotal temperature.

Obesity

Overconsumption of refined carbs like sugar and processed foods leads to obesity. The best for him is to change his diet to a Mediterranean diet. This supports weight loss and at the same time improves sperm quality.

Obese men tend to father children that often are not viable. It may be that it is due to genetic changes in the sperm in obese men. These changes can affect fertilization, but also embryo development. Researchers have detected sperm DNA fragmentation in sperm from obese men, which can lead to pregnancy loss. Weight loss in obese men improves sperm quality.

Caffeine and alcohol intake

More than 1 or 2 cups of coffee a day relates directly to difficulties for a couple to conceive. When it comes to alcohol intake, the male should not drink more than one glass of wine or the equivalent of alcohol in beer or spirits per day. Higher consumption results in male infertility due to poor sperm quality. Physicians have warned women for a long time that they should stop drinking alcoholic beverages, if they want to become pregnant. It is best, if both partners don’t drink for the sake of a healthy pregnancy.

Smoking

Stop tobacco and drug use. Smoking and drug abuse have been consistently shown to be bad for sperm quality and are associated with infertility. Marijuana use leads to low sperm counts, which is a cause of infertility.

Lack of exercise

Moderate aerobic exercise and resistance exercise can improve sperm quality.

However, excessive exercise has shown negative effects on sperm. Bicycling for 5 hours or more has been shown to reduce sperm quality due to the heating up of the scrotum and the testicular tissue. For the same reason men wearing boxer shorts instead of tight underpants were observed to have higher sperm concentration and sperm counts.

Antioxidants

Oxidative stress can damage sperm. This involves smoking, a junk food diet, obesity, pollution, radiation and heavy metals like mercury from big game fish (like tuna, shark, sable fish, sword fish etc.). Dr. Bar-Chama said: ”When you cause damage to cell membranes, you are impacting the ability of the sperm to attach, penetrate and activate the complex fertilization process”. In order to counter these negative effects of the environment it is helpful to take antioxidants.

Some of the common antioxidants are: vitamin C and E, beta-carotene, selenium, zinc, folic acid, lycopene and coenzyme Q-10. If you get 5 servings of fruit and vegetables, you get most of the antioxidant vitamins and minerals. You find selenium in Brazil nuts, sardines and halibut. Oysters, dark-meat poultry, crab, and fortified cereals contain zinc, which supports male fertility.

Omega-3 fatty acids

Omega-3 fatty acids from fish and seafood has been shown to increase the success rate of couples who want to get pregnant. Low mercury seafood like scallops, clams, shrimp, oyster, sardines, salmon and squid are a good source of omega-3 fatty acid.

Get some nuts

A handful of nuts or two also helps the male to produce more healthy sperm. This study showed that nut consumption improved the total sperm count. In addition, it increased vitality, motility, and morphology of the sperm.

Cut out processed meats

Another study showed that consumption of processed meat had a negative association with fertility rates in couples that desired children. However, eating chicken instead of processed meat gave the fertility rates a boost.

 

Male Fertility Could Be Improved Naturally

Male Fertility Could Be Improved Naturally

Conclusion

We have been lulled into thinking that when there are fertility problems in a marriage, it would likely be due to female reproductive problems. This kind of thinking is old school and has been disqualified by newer research. It turns out that often the problem originates from the man, if he is unwilling to change his lifestyle to get ready to father a child. As outlined above there are quite a few factors that interfere with sperm production and motility of the sperm. If he wants to father a child, he needs to take good care of his sperm by adopting healthy lifestyles. Sperm, it turns out are much more vulnerable to toxic changes, heat from tight clothing, and nutritional deficiencies.

Healthy food for the man results in a healthy child

Not everything is exclusively the responsibility of the female. The male also needs to eat balanced meals and might also benefit from some antioxidants and supplements. Omega-3 fatty acids from nuts and seafood are also good for sperm production and motility. Add some moderate physical exercise, and he will be ready to father a child. It is very much a team effort, as both parents- to- be have to do their part and embrace a healthy lifestyle.

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Aug
26
2017

Decreased Sperm Counts In Men

By | alcohol, autoimmune disease, blood test, diet, Drugs, Hormones, Infectious Disease, Infertility, Medical Condition, toxins

What do decreased sperm counts in men tell us about our world? A recent study has shown that over the past 40 years males in many centers that tested for sperm counts have lost 50% of the sperm count that was normal in the 1970’s. The question is, what could have caused this? Nobody has definite answers. But here are the factors that the Mayo Clinic lists for low sperm counts.

Medical causes of decreased sperm counts in men

  • A varicocele: A varicocele is dilatation of veins close to the testicles. It is presumed that this leads to a higher temperature inside the testicles and this causes a lowered sperm count and poor sperm quality.
  • Antisperm antibodies can cause infertility. Due to low sperm counts.
  • Infections in the testicles reduce sperm production. Gonorrhea and HIV infection are some of the common infections.
  • Some men develop retrograde ejaculation. With this the sperm enter the bladder on ejaculation instead of coming out from the tip of the penis. Alpha-blockers, a type of blood pressure medication can do this as a side effect. But there are also various health problems that can cause retrograde ejaculation like diabetes, surgery to the prostate, urethra and bladder. Spinal injuries can be also a cause of retrograde ejaculations. In many cases the sperm production in the testicles is still present and sperm could be sampled from there for artificial insemination.
  • Tumors of the pituitary gland can interfere with hormone production of testosterone and sperm counts will fall or stop. But other pituitary hormones, thyroid hormone and adrenal gland hormones are needed for fertility.
  • Chromosome defects like Klinefelter syndrome and others can be a cause of abnormal development of the male genitals with low or missing sperm production.
  • Celiac disease is a bowel disease that is due to gluten sensitivity. It causes low sperm counts and infertility, which responds to a gluten free diet. Sperm counts normalize with this diet.
  • There are medications that can decrease sperm production like chemotherapy, anabolic steroid use, antifungals and certain antibiotic medications and some ulcer medications.

Lifestyle causes leading to decreased sperm counts in men

Certain lifestyles and occupations can cause a man to have a decreased sperm count.

  • Drinking alcohol excessively can reduce testosterone production, which decreases sperm count.
  • Recreational drug use: steroids to increase muscle mass cause testicular atrophy and decreased sperm count. Cocaine and marihuana also decreases the sperm count.
  • Certain occupations like welding from exposure to heat and truck driving from prolonged sitting have been associated in some studies with infertility. But there are other studies that could not confirm this correlation.
  • Smoking: Men who smoke have lower sperm counts than men who don’t smoke.
  • Excessive weight: Obese men transform some of their testosterone into estrogen through the action of the enzyme aromatase, which is amply present in fat cells. This leads to low testosterone levels and low sperm counts.

Environmental causes of decreased sperm counts in men

The environment in terms of heat production around the scrotum or exposure to chemicals or ionizing radiation can lower sperm counts in men.

  • Heat around the testicles: studies do not all agree, but there is a tendency for low sperm counts when using saunas and hot tubs frequently. Sitting for longer times or using a laptop computer for longer periods can also increase the temperature of a man’s scrotum and lead to a low sperm count.
  • Exposure to heavy metals like lead, mercury and others can be the cause of infertility.
  • Exposure to radiation can reduce sperm production. With high doses of radiation sperm production may cease entirely. With lower radiation exposures sperm counts may be down for several years before they recover to normal.
  • Industrial chemicals: exposure to fumes from certain chemicals can lead to low sperm counts; benzenes, herbicides, pesticides, xylene, toluene, painting materials and organic solvents are on this list.

Recent study about decreased sperm counts in men as an indicator

We have now reviewed the major causes of low sperm counts in men. I like to revisit the recent sperm study I mentioned in the beginning of this blog. It is unlikely that men in North America, Europe and Australia would spontaneously produce less than 50% of the sperm than men 40 years earlier had produced. The next puzzling fact is that the study found normal sperm production in men in Africa, South America and Asia.

This points to epidemiological differences that reduce the sperm count in men in North America, Europe and Australia. In view of the multitude of possible causes it will require a task force that does a comparative study worldwide looking at exposure history, diets, social habits and other factors.

Fertility clinics are thriving because couples want children. With low sperm counts of males there is more infertility than there was in the past. Density gradient centrifugation is a reliable method of enriching sperm counts.

In the past a couple had no problem getting a successful pregnancy when they wanted it. Now couples often have to be assessed in a fertility clinic because of problems with regard to decreased sperm counts in men, which can cause infertility.

Decreased Sperm Counts In Men

Decreased Sperm Counts In Men

Conclusion

A new study has noticed that over the past 40 years many men have developed low sperm counts. This has caused significant problems with fertility among couples. Fertility clinics are busy trying to help these couples. Density gradient centrifugation has become a common technique to enrich sperm samples prior to artificial insemination. It is a puzzle why the recent study has found normal sperm counts in samples of men living in Africa, South America and Asia. In contrast men living in Europe, North America and Australia have 50% lower sperm counts. The reason may be multifactorial. It will require a team of experts to sort out this discrepancy and hopefully find an answer for men in Europe, North America and Australia to bring their sperm counts back to normal.

Nov
12
2016

Stress Drives Our Lives

By | Alzheimer’s disease, Diabetes, headache, heart attack, Heart Disease, Infertility, sleep, Smoking, stress, Stress management, Substance abuse

Every year the American Psychological Association (APA) monitors the American public how stress drives our lives. This yearly report has been compiled since 2007. About 75% of the people questioned reported that they have experienced moderate to high stress over the past month.

Symptoms when stress drives our lives

What kind of symptoms can stress cause? It can cause sleep deprivation, anxiety, headaches and depression. But there can be more symptoms from any disease that stress may cause. The “Stress in America” report from February 2016 shows on page 5 that unhealthy life habits are used by low-income Americans to cope with stress. A bar graph shows that watching television or movies for more than 2 hours per day is common. Another way of coping is to surf the Internet more often, take more naps or sleep longer. Eating more, drinking alcoholic beverages and smoking more are other unhealthy ways to cope with stress.

As the stressed person gains extra weight and eventually becomes obese, there is a higher rate of diabetes that can develop with all of its complications.

Causes of stress in our lives

The “Stress in America” survey was based on 3,068 adults in the US who completed the survey during August 2015. 72% were stressed out about financial issues. 22% of these said that they were extremely stressed in the past month as a result of money concerns. Other common concerns were work, the economy, family responsibilities and concerns about personal health. Average stress levels among Americans decreased when compared to 2007. On a 10-point stress score respondents rated their stress at 4.9 in 2016 compared to 6.2 in 2007. But according to the American Psychological Association this is much higher than a stress rating of 3.7 considered to be a healthy level.

Stress affects people from all walks of life, workers, women, young adults, students and those with lower incomes.

“Stress is caused by the loss or threat of loss of the personal, social and material resources that are primary to us” Stevan Hobfoll, PhD, a clinical psychologist from Rush University Medical Center said. “So, threat to self, threat to self-esteem, threat to income, threat to employment and threat to our family or our health…” is what causes stress.

Stress drives our lives causing disease

When stress is too much for our system, we are starting to see pathology develop. “Stress is seldom the root cause of disease, but rather interacts with our genetics and our state of our bodies in ways that accelerate disease” professor Hobfoll says. The following are common diseases that can result from chronic stress.

Heart attacks and strokes

In a 2015 Lancet study 603,838 men and women who worked long hours were followed for a mean of about 8 years with respect to heart disease or strokes. All of the subjects were free of heart attacks and strokes when they entered into the study. There were a total of 13% more heart attacks in those who worked extra hours in comparison to those who worked 40 hours per week or less. With respect to strokes there were 33% more strokes in those who worked long hours. Researchers noted a dose-response curve for strokes in groups with various workloads. Compared to standard working hours there were 10% additional strokes for 41-48 working hours, 27% for 49-54 working hours and 33% for 55 or more working hours per week.

Stress drives our lives and causes substance abuse

In order to cope with stress many of us treat daily stress with alcohol. It makes you feel good subjectively, but it can raise your blood pressure causing heart attacks and strokes down the road. A low dose of alcohol may be healthy, but medium and high doses are detrimental to your health.

Next many people still smoke, although scientists have proven long time ago that it is bad for your health. It can cause heart attacks, various cancers and circulatory problems leading to leg amputations.

Overeating is another common problem. Comfort food relieves stress, but it puts on extra pounds. As you know it is easier to put weight on than get it off. Being overweight or being obese has its own problems: arthritis in the hips and knees makes walking more difficult. The metabolic syndrome sets in, which is a characteristic metabolic change causing diabetes, high blood pressure, heart attacks, strokes and certain cancers. The more weight you carry, the less likely you are to exercise. This deteriorates your health outlook.

Diabetes

Stress causes too much cortisol secretion from the adrenal glands. This raises blood sugar, and when chronic can cause diabetes. In addition unhealthy eating habits associated with stress can cause weight gain and high blood sugars leading to diabetes.

In a 2012 California study 148 adult Korean immigrants were examined. They all had elevated blood sugars confirming the diagnosis of type 2 diabetes. They had a  elevated waist/hip ratio.

A high percentage of the study subjects had risk factors for type 2 diabetes. This included being overweight or obese and having high blood glucose readings. 66% of them said that they were feeling stressed, 51% reported feeling anxious, 38% said they were feeling restless, 30% felt nervous and 3% said they were feeling hopeless.

An Australian long-term follow-up study computed risk factors for developing type 2 diabetes. Stress was a major contributor to diabetes.

A 30-day episode of any anxiety disorder had a 1.53-fold risk to cause diabetes. A depressive disorder had a 1.37-fold risk to cause diabetes and posttraumatic stress disorder had a risk of 1.42-fold to cause diabetes.

Infertility

Stress changes hormones in women causing ovulation problems and infertility. 1 in 8 couples in America have problems getting pregnant. Physicians identified stress as at least a contributing factor. But in men stress can also reduce sperm count and semen quality as this study describes.

Alzheimer’s disease

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

Psychologists assessed the stress score in 1968,1974 and 1980. 161 females developed dementia (105 Alzheimer’s disease, 40 vascular dementia and 16 other dementias). The risk of dementia was higher in those women who had frequent/constant stress in the past. Women who had stress on one, two or three examinations suffered from higher dementia rates later in life. Researchers compared this to women did not have any significant stress. Specifically, dementia rates were 10% higher after one stressful episode, 73% higher after two stressful episodes and 151% higher after three stressful episodes.

Remedies for stress

Before you can attempt to remedy stress, you must first detect that you are under stress. You can recognize this when you have problems sleeping, you suffer from fatigue, when overeating or undereating is a problem, and if you feel depressed. Others may feel angry or are irritable. Some bad lifestyle habits may also make you aware that you are under stress. You may smoke or drink more in an attempt to manage stress. Some people abuse drugs.

Here are some suggestions how to remedy stress:

  1. Seek support from family, friends or religious organizations. If you engage in drugs or alcohol overuse or you feel suicidal, it is best to seek the advice from a psychiatrist or psychologist.
  2. Engage in regular exercise. This produces endorphins, the natural “feel-good” brain hormone. This reduces symptoms of depression and improves sleep quality.
  3. Do something that increases pleasure, such as having a meal with friends, starting a hobby or watching a good movie.
  4. Positive self-talk: avoid negative thoughts like “I can’t do this”. Instead say to yourself “I will do the best I can”. Psychologists have developed a technique where they teach patients how to turn negatives into positives. Psychologists call this therapy “cognitive therapy”. You may want to seek the advice of a psychologist to have a few cognitive therapy sessions.
  5. Daily relaxation: you may want to use self-hypnosis, tai-chi exercises or meditation to reduce your stress levels.

Stress Drives Our Lives

Stress Drives Our Lives

Conclusion

Stress is very common. Diverse diseases like heart attacks, strokes, diabetes and Alzheimer’s disease can all be caused by stress. It is important to minimize the impact of stress by seeking family support and support from friends. Engaging in regular exercise will release endorphins and make you feel better. Relaxation exercises and seeking counselling can all help you to manage stress. You cannot ignore or simply tolerate this force in your life. Stress is indeed there, but we can make a difference by managing it to avoid that stress manages us.

Aug
13
2016

Avoid BPA

By | Health, Hormones, Infertility, Obesity, toxins

After a lot of bad press as a hormone disruptor we know we should avoid BPA. Bisphenol A (BPA) is a synthetic compound that has been used since 1957 in plastic bottles and as lining inside cans, so they don’t rust.

Study showing why we should avoid BPA

Recently BPA has again hit the media as a new study has shown that there are things we can do to avoid high concentrations of BPA by changing our lifestyle.

This media report is based on a scientific study that Jennifer Hartl and coworkers have done. They followed patients who had consumed various items known to be contaminated with BPA and measured their urine BPA concentration 24 hours later. 9% of their study participants had consumed one can of food or more, while 2% had consumed 2 cans of food or more on the previous day. Researchers compared one can of food consumed to none. They found 24% of higher BPA concentration in the urine. With two cans of food consumed versus none they found that 54% of higher BPA concentration was found in the urine.

Researchers compared one or more specific types of canned foods to none consumed. Some interesting differences emerged. Canned vegetables and fruit showed 41% higher BPA in the urine test. Canned pasta measured 70%, but canned soup 229%. The researchers also tested canned beverages. None of them caused BPA elevation in urine tests.

What BPA does

93% of Americans 6 years and older have BPA in their urine indicating that it is in our bodies, and the body is attempting to get rid of it. It is known as an endocrine disruptor, but how effective BPA is as an endocrine disruptor remains to be seen. This link describes that BPA is 800-times weaker as an estrogen blocking substance in comparison to soy products.

There are two mechanisms of action where BPA interferes with normal body function.

  1. BPA functions as a weak estrogen and binds to the nuclear estrogen receptor. This partially blocks the action of the body’s own estrogen function.
  2. There is also a membrane based estrogen receptor on body cells that is involved in cell signaling and gene expression. BPA can add methyl groups to DNA, which silences gene expression. This latter mechanism is much more sensitive to BPA (probably by a factor of 1000-times) than the traditional effect on the nuclear estrogen receptor.

It is these newer findings that are of concern with regard to fertility in males. It is important that babies are not fed using regular plastic bottles, but rather that BPA-free bottles or glass bottles are used to avoid BPA exposure. Babies and children are particularly vulnerable to the hormone blocking effects of BPA as well as the interference of brain development and maturation by BPA.

Manufacturing of BPA free plastic

In an attempt to avoid BPA in manufacturing of plastic bottles and food containers industry has used other chemicals, among other materials something called BPS. This stands for “Bisphenol S”. A research paper found that BPS is an endocrine disruptor as much as BPA is and causes fat cells to grow rapidly. According to the author of this publication it may be partially responsible for the obesity wave. The author of this study recommends using glass containers as much as possible to avoid transfer of either BPA or BPS to food that comes in contact with plastic materials.

Avoid BPA from receipts

Have you ever thought that you may be able to absorb BPA through your skin from receipts when you buy items at a store? Yes, the machine of the checker prints receipts on heat sensitive paper. It contains BPA on it, which the body absorbs through the skin. If you scratch the printed part of the paper and it leaves a dark mark, it is thermal paper.

In this study workers were handling thermal receipts for four hours and their urine was monitored for BPA the following day. Another group was handling thermal receipts for 8 hours. In the first group that had exposure for 4 hours the BPA concentration in the urine rose to three times higher than the base rate. The second group exposed for 8 hours had BPA levels that were five times higher than the base rate. For comparison researchers measured another group that was wearing surgical gloves and their BPA concentration in the urine showed no change from the baseline.

I have changed my way of shopping. I think about whether I would ever want to exchange the item I just bought. If not, I tell the clerk that I do not want a receipt and he throw it out.

How you can avoid BPA exposure

  1. Do not use plastic containers to heat food in a microwave, use glass containers instead.
  2. Avoid all plastic food containers that have a “7” printed in a triangle on the bottom. Among these is a significant number that will release BPA over time.
  3. Avoid canned soups, such as tomato soup or canned mushroom soup. The paper reviewed at the beginning of this review showed these led to the highest BPA readings in urine tests the following day.
  4. Keep in mind that 2 out of 3 cans in supermarkets are positive for BPA. Eat as much fresh or frozen food as you can, but avoid canned food.
  5. Many canned beverages (such as beer, soda, juice) are acidic; this means that their thermal processing requirement is much different requiring lower temperature where BPA does not leach from the bottle into the stored fluid. These drinks when tested were BPA free.
  6. Among drinking water containers the following have been tested: Aquafina, Dasani, Arrowhead, Fiji and Kirkland Signature bottled water from Costco. They were all BPA free. Most water companies have now switched to BPA free containers, but avoid the containers with the “7” in a triangle as already stated, as some of them may leach BPA into the bottle content.
  7. Use fresh, unpackaged foods as much as possible. For instance, fruit and vegetables can often be had unpackaged. Check the packaging, check the type of plastic and if not sure, don’t buy it.
  8. Whenever possible, avoid handling thermal receipts; if possible, get an email receipt instead to avoid BPA exposure through the skin.

Avoid BPA

Avoid BPA

Conclusion

There has been a silent revolution where more and more plastic and resins have entered our lives. With it came the exposure to BPA, which is an endocrine disruptor. This may have consequences regarding male fertility. There is a change of fat metabolism in both sexes with weight gain as the end result. It also interferes with brain development in the fetus and in young children. BPA behaves like a cell poison.

In this blog I have shown ways to reduce exposure to BPA. We need to eat more fresh vegetables and fruit that merchants sell not in plastic. If merchants sell food in plastic or plastic containers, the wrapping material must be BPA and BPS free. The FDA and/or EPA must make labeling of containers mandatory. Whenever possible return to glass containers that are BPA free. Also bear in mind that heating plastics can release toxins. If you are heating food in a microwave, do not use plastic containers. Instead use glass or ceramics. It is common knowledge that they are safe!

Additional reference (Questions about BPA answered):

http://www.niehs.nih.gov/health/assets/docs_a_e/bisphenol_a_bpa_508.pdf

Apr
12
2014

Lead Still Poisoning Us

By | Cancer, Health, High Blood Pressure, Hormones, Infertility, kidney disease, Other neurological conditions, Prevention

We are living in an environment that puts emphasis on quality control, and companies around us take pride in their high quality products, supervised by the FDA. This is how it ideally should be. But is it really? Unfortunately not!

I read the headlines about lipsticks on April 4, 2014 and could not believe it!

When it comes to skin care or cosmetic products, things start to get scary.  Skin is not a barrier, but it is an organ of our body. From skin cream and ointment applications in medicine it is known that pharmaceutical compounds can be applied to the skin, and this way the body can readily absorb active substances.

When it comes to cosmetics, the skin areas to which cosmetics are applied have softer skin, for example the mouth. The vulnerable skin of the lips can readily absorb any chemical substance, and this is where health concerns get even more serious.

In 2010 as the above link shows the FDA determined that all of the “400 lipsticks tested had traces of lead in them, ranging from 0.9 to 3.06 ppm. Another study from California noted that there were other toxic metals in lip sticks and lip glosses containing chromium, cadmium, manganese, aluminum in addition to lead. Even to the unconcerned this sounds like a precarious cocktail of noxious substances! On June 1, 2013 I wrote a blog about toxins in the bathroom. I mentioned the dirty dozen of chemicals that repeatedly are found in cosmetics. With this new information of traces of lead still being in cosmetics, more so than previously reported, women need to be more careful about the choice of lipsticks that they are using.

1.History of lipsticks:

This overview explains that the long-lasting lipstick was only invented around the 1950’s (“Sticks on you, not on him” was the slogan).

Traces of lead were often recorded, but not really thought to be that dangerous. The thinking of the FDA at that time was that children needed to be protected from lead in house paints, but nobody mentioned that lead was part of the red pigment and therefore had to be part of a lipstick. The FDA did know this, but the concentration was supposed to be so small and absorption was thought to be negligible, so considered to be safe for an adult.

Lead Still Poisoning Us

Lead Still Poisoning Us

2. Evidence of considerable absorption of lead:

We know from several studies summarized in this link that various components of cosmetics including lipsticks and lip-glosses get absorbed through the skin. Lead is no exception to this. A 2011 study showed in children in Africa that lead-containing cosmetics for tribal ceremonies in children had higher lead concentrations in their blood than children who did not use these cosmetics.

When doing a PubMed review on the subject I came across a very interesting study: In India there is a practice that parents apply kajal (also called kohl or surma cosmetic) around their eyes, on old traditional practice. Unfortunately this is a lead-containing cosmetic, which is absorbed into the blood and can cause lead poisoning. According to this ancient belief this application of cosmetics around the eyes would keep their eyes cool and clean and is supposed to improve vision, strengthen the eyes and prevent eye diseases. None of these belief are compatible with Western medicine (although a lot of the Ayurveda medicine is valid).

In another 2010 study done in the mountainous Aseer region in the Southwest of Saudi Arabia here there is pristine air quality, 176 pregnant patients with a single baby were followed to see whether there was an effect with regard to lead poisoning in the offspring. Two groups of women were identified, those with lead levels of more than 200 mcg/L in the blood and another group with less than 200 mcg/L. The researchers noted that there was no difference with regard to prematurity, size of the baby or premature rupture of membranes (premature birth).

The conclusion of this study was that there was significant absorption of lead from 100% lead sulfide eye cosmetic “kohl” only on those who used it. To my surprise nobody mentioned anything about the lead levels in the children, which is an example of compartmentalization of science. Common sense would dictate that these children who were at higher risk from mothers with over 200 mcg/L should have received chelation treatments to remove lead (we do this in Western medicine!).

3. Different lip sticks and lip glosses analyzed in Europe and in the US:

A European study showed that 31% of lipsticks and 4% of lip glosses tested positive for lead. All of them had less than 0.88 mg/kg of lead (less than 1 mg/kg). Pink lipstick or lip gloss (0.81 and 0.38mg/kg) tested lower than purple lipstick or lip gloss (0.88 and 0.37mg/kg) and red (0.58 and 0.25mg/kg), but purple tested the highest! I did not know that until now when I researched this.  On average the tests show that the gloss has half the concentration of the lipstick.

Don’t be fooled by the difference in recommended safe levels in Canada (10 mg/kg) and Germany (20 mg/kg). Germany has a very powerful chemical industry with lobbyists that likely lead to this higher “safe” level. In Canada it is the Health Products and Food Branch of Health Canada. No country got it right so far:  A zero tolerance (meaning a blood level of 0 mg/kg in babies and adults alike) is the only solution for humans. A little bit over a long time can lead to chronic chronic lead poisoning.

One other interesting tidbit for those who need to apply something to their lips:

The more expensive lipsticks had much less lead in it than the cheaper varieties (don’t buy the dollar store brands).

Contrast this to an FDA initiated study between 2009 and 2012, published in 2012 that showed that the average lipstick concentration in 400 lipsticks tested  was 1.11 mg/kg, but the highest concentration was 7.19 mg/kg and 13 of them tested 3.06 mg/kg. Here is another review that shows more details (ppm equals mg/kg, so you can compare directly with the figures above. As stated before, in my opinion and that of toxicologists around the world who are the real experts in this a “0 mg/kg” level (no lead in the body) should be the acceptable norm!

Only organic lipsticks and lip-glosses are recommended, if you must wear any of such products. Here is a helpful blog that tells you more positive news (lead and chemical free products).

4. What are the effects of chronic low lead exposure?

Adult lead toxicity is not as common as in the past. Painters in the decades leading up to the 1970’s when laws became more stringent were the ones mostly affected (Ref.1). Keep in mind that more than 30 million tons of lead was released into the air in the US before the lead ban finally remedied this in the 1970’s.  This phasing out was completed in 1995. The mean blood lead levels of Americans declined by 35% since. The EPA is monitoring lead levels in public water systems.

Lead is a nerve poison. It leads to fatigue, insomnia, irritability, lethargy, headaches, difficulty concentrating, memory loss, and tremor. It can also affect the nerves of the extremities, more so in the arms than the legs, which was significant in the past century among painters using lead paints. (“Upper extremity paresis” found in painters). Chronic lead poisoning targets the kidneys and the bone marrow. In the kidneys leakage of the filtration units, called glomeruli, leads to loss of microglobulins that can be measured in the urine among other tests. Above a level of 30 mcg/dL (this is the same as above 300 mcg/L) electrophysiological studies reveal often the ulnar nerve conduction is disturbed, which is the cause for the arm weakness in painters. The bone marrow toxicity can be seen in stippling of red blood cells and anemia develops subsequently. High blood pressure and fertility issues are also common (low sperm count in men, higher rate of spontaneous abortions and stillbirths in women). The gums around the teeth show lead lines (blue discoloration).  I will not get into lead toxicity in children, as this is a big topic of its own. Needless to say symptoms are much worse as any pediatrician can tell you. It goes without saying that should you notice any of these symptoms, see your doctor and have appropriate tests done.

5. Treatment and prevention:

As we do not see acute lead poisoning as much as in the past, except sadly to say still in development countries and highly industrialized areas with lead emissions into the air, I like to emphasize the importance of prevention here.

a)    If you absolutely must have make-up and/or lip sticks or lip gloss, at least go for the expensive, organic products. You owe it to yourself. However, having said that keep in mind that anything you put on your skin anywhere is absorbed to a certain percentage. So, why mess with your body’s metabolism? I really question this. For your skin you can use a product called “Youth serum” from LifeExtension, where only a few drops will suffice to cover your face and neck with a thin film. Within a few seconds this is absorbed into the skin and it will stimulate your skin to grow where wrinkles are, so the wrinkles flatten out in time.

b)    Keep in mind that skin appearance is hormone dependent, males need testosterone as they age and women need bioidentical progesterone. The first link under point 2 above claims that progesterone would be cancer producing. This is not true: it is progestin, a synthetic copy of progesterone that does this. So, bioidentical progesterone in cosmetics would be cancer preventing in women (men should stay away from a woman who has applied this for at least two hours as skin transfer will block testosterone production). Worse still: if a manufacturer uses progestin (the synthetic version), the traces of it over a long period of time will act like xenoestrogens, which can cause breast cancer in the woman who uses such a product and through transfer can cause prostate cancer in a man.

c)    If you insist on using chemicals on your skin, you may want to consider seeing a naturopathic physician who does intravenous chelation. Lab tests are available to assess the levels of heavy metals and toxins in your body. If the levels are creeping up, chelation treatments from time to time may be needed in people with measured elevations of lead levels in blood tests and/or urinary lead level elevations.  Discuss this with your doctor.  Removal of any accumulated mercury, lead, and cadmium or other heavy metals will be an option. I have summarized detoxification methods elsewhere.

Conclusion:

In conclusion, I think that it has to be carefully considered, how much use of lipstick application is necessary. Next the choice of a high quality product is of utmost importance. Taking all the factors together, its constant use cannot be recommended, especially since there is not only lead present, which is a known health hazard. Beside lead there are many other chemicals that get absorbed and their effects have not been adequately tested by the agencies.

More information on vitamins and detoxification: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

References:

1. Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. Chapter 73, “Lead” by Michael W. Shannon, MD, MPH © 2007, Saunders

Last edited Nov. 7, 2014

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Mar
08
2014

Protecting Yourself From Environmental Toxins

By | Allergies, Asthma, Cancer, Dentistry, Diabetes, Infertility, kidney disease, Nutrition, Obesity, Prevention, Vitamins and supplements

These days you need to be aware of protecting yourself from environmental toxins. Environmental toxins are toxins that may be in your drinking water, in what you eat, in the air you breathe, or they enter your body through your skin when you swim in contaminated water or walk on a sandy, wet beach.

In the following blog I will address some of these issues and how we can defend ourselves against toxins.

The youngest and most vulnerable

Toxins are particularly bad for infants and premature babies. Notably, the reasons for this are the following ones: their kidney function (tubular secretion) is only 20% to 30% of that of an adult; the cytochrome P-450 enzyme system in the liver, one of the toxin eliminators is slowed down to only 25% to 50% of the adult activity and glucuronidation in the liver, another detoxification process, reaches adult levels only at the age of 3 years.

Function of liver and kidneys

It is important to realize that the kidneys and the liver are limiting the removal of toxins by way of urine and bile in the newborn. Stomach acidity in a premature has a pH of 4.7, in a full-term newborn 2.3–3.6 and in an adult 1.4–2.0. This is important to note as a lack of stomach acid increases susceptibility of newborns and infants to gastrointestinal infections and cause diarrhea. Percutaneous absorption in newborns is much higher than in adults, which makes them very susceptible to absorbing toxins through the skin (Ref.1).

Diabetes from environmental toxins

Environmental toxins can cause insulin resistance and type 2 diabetes.

Bisphenol A (BPA) is used to make polycarbonate and epoxy resins and is found primarily in food and beverage containers. People all around the world had exposure to BPA  since 1957 and as a result 90% of US residents have detectable levels of BPA in their urine. Ref.2 explains that the higher the urine concentration of BPA, the higher the risk is for developing diabetes.

Persistent organic pollutants are another source of concern: pesticides and herbicides, dioxins, polychlorinated biphenyls, hexachlorobenzene, and hexachlorocyclohexane have all been found in humans. Several investigators have shown that virtually all of the risk in obese patients to develop diabetes comes from the fat-soluble persistent organic pollutants (Ref.2).

Inorganic arsenic

Inorganic arsenic is another pollutant from soil and rock, which finds its way into the drinking water. About 8% of the public water system of the US exceeds 10 mcg/L for drinking water, which is the safe limit for drinking water by the US Environmental Protection Agency’s standard. Anything above those levels is considered toxic.Ref.2 describes that people who ingest inorganic arsenic will excrete it in the urine; the highest group with arsenic in their urine had a risk of 3.58-fold to develop diabetes when compared to the lowest group. Curiously enough organic arsenic that is found in fish and shellfish is excreted in the urine unchanged and does not cause diabetes. Overall this indicates to me that nobody should consume or cook with contaminated water that contains inorganic arsenic. Reverse osmosis filters will protect you from this risk.

Protecting Yourself From Environmental Toxins

Protecting Yourself From Environmental Toxins

Other toxins around the house

Volatile organic compounds are often contained in carpets, but also in laser and inkjet printers. They are part of everyone’s life as this link shows. Physicians reported varied symptoms like irritation of eyes, nose or throat, breathing problems, headaches, loss of coordination, damage to the liver, kidneys and the brain after exposure to volatile organic compounds. Researchers noted that long-term exposure can cause cancer in animals and there is suspicion  that it causes cancer in humans as well.

Air fresheners and cleaning solutions that contain ethylene-based glycol ethers and terpenes were the subject of a study that examined concentrations in the air and interaction with ozone that can also be released by some cleaners.

Fumes of chemicals can cause lung cancer

As this link shows the investigators concluded that with exposure to high enough concentrations and long enough exposures to these fumes lung cancer can be caused in cleaning personnel. They recommended to use cleaning solutions only in diluted form and to air out the premises well after cleaning. Another component of many air fresheners and cleaning chemicals is paradichlorobenzene, the same chemical that is contained in mothballs.

There have been problems with flame retardants: polybrominated diphenyl ethers, which are cancer producing; the US outlawed them in 2004, but older mattresses, upholstery, television, computer casings and circuit boards may still contain them.

Lead and mercury poisoning, and radioactive pollutants

Lead in paints was outlawed since 1978, so manufacturers have not used lead in paints anymore. Paint from buildings older than that still may contain lead. There have been serious lead poisonings in children who were gnawing on items painted with lead containing paint. Lead causes problems with your central nervous system, brain, blood cells and kidneys. Just last year a news story about lead found in fashion jewelry surfaced warning about cheap fashion jewelry from China. Lead from these items can lead to absorption through the skin and cause lead poisoning. Because of the apparent lack of regulations in China I do not put anything into my mouth or on my skin, if it originates from China.

Mercury contamination of the environment

Mercury from tuna and other predator fish: It is sad that there is pollution in oceans to the point where it has become unsafe to eat predator fish. In predator fish there is an accumulation of mercury through the food chain.

How did things develop this way? Back 100 years and more ago gold panning and the purification process of gold caused mercury to enter into rivers and allow mercury to end up in the oceans where it has since accumulated; it just sits there as it has nowhere to go.

Coal burning (yes, there is mercury in coal) also contributed to this by smoke emission from smoke stacks containing mercury vapors. Subsequently the pollution from the air returns to earth as rain pollution and drained through the river system into the oceans.

Monomethylmercury poisoning

It is monomethylmercury that accumulates in the tissue of humans. This affects many organs, such as the brain, kidneys, lungs, and skin. It causes various symptoms like red cheeks, fingers, and toes; there can be bleeding from the mouth and ears; it can cause rapid heartbeats, high blood pressure, intense sweating, loss of hair, teeth, and nails. It also can cause blindness, loss of hearing, impaired memory, and lack of coordination, disturbed speech and birth defects. You may think all mercury comes from the outside. However, silver amalgam fillings in your teeth could also be the source of mercury poisoning. It is a good idea to replace amalgam/mercury fillings with ceramic fillings.

Other marine pollution

There are many forms of other marine pollution as this link shows.

One particular concerning aspect is pollution with radioactive materials as the Fukushima disaster in Japan has shown. Following the catastrophe on March 11, 2011 radioactive material leaked into the ocean, which is described here. Dr. John Apsley II pointed out that with the explosions in Fukushima there were also several releases of radioactive pollution into the stratosphere. This pollution has subsequently traveled around the globe and has come down as radioactive rain. He has made it his ambition to help people minimize radiation exposure from nuclear accidents such as Fukushima.

Protecting yourself from toxins

Having said that pollution and toxins are problems that we are living with, how can we protect ourselves from all of that?

1. Avoid as many unsafe chemicals around you as you can. This includes checking ingredients in hair care and body care products, toothpaste, hair dyes, cosmetics, mouthwashes and underarm deodorants.  I have written a blog about toxins in the bathroom and what you should watch for.

2. I would recommend you switch from a standard food to organic food. It has become unsafe to eat non-organic meats, leafy vegetables, vegetables and fruit. There are too many residues of herbicides and pesticides contained also in meat, not only in vegetables and fruit. Washing will not remove these substances, even though some merchants may tell you otherwise. Buyer beware!

Detoxification

3. Detoxification methods are available and I have reviewed them in this blog. Briefly, to remove lead and mercury you need to follow a formal intravenous chelation protocol.  Depending on how many heavy metal toxins you have on board, you may need only a few treatments. At the most you may require up to 20. Here is a more conservative website stating that it would be safe to have silver amalgam fillings. I think that gold and ceramic fillings are much safer.

4. Genetically modified food is another danger as I have summarized in this blog. This is another reason why I like to stick to organic food. There is evidence that GMO food causes autoimmune diseases, infertility and chronic inflammation that can eventually lead to cancer. It may take decades to prove this, but I am not willing to be a human guinea pig.

Remove toxins from your home

5. I have mentioned in a prior blog that we live in a toxic world. You need to carefully look at your home and remove toxins. You need to assess your drinking water. A water analysis can tell you how good the water in your home is and whether there are concerns about inorganic arsenic. Usually places that sell filter systems can advise you in that regard. Your drinking water should either be pure water bottles or else reverse osmosis water from a filter system in your house.

6.Vitamins and supplements support your cell integrity and have anti-inflammatory and antioxidant effects that protect you from toxins. I discussed this in detail in my NetHealthBook under nutrition. For instance vitamin D3 in doses of 5000 IU or more and CoQ-10 are powerful anti-inflammatories and CoQ-10 is also an antioxidant and preserves mitochondrial function. High fish oil supplements (3 to 6 Grams per day) have anti-inflammatory effects and protect your cell membrane integrity. With these overlapping qualities of vitamins and supplements your body will be in a much stronger position to defend itself against the negative effects of toxins. When you take multivitamins, this translates into telomere lengthening of 5.1%. This converts into a survival advantage of 9.8 years over a lifetime). Ref. 4 explains this in more detail.

Exposure to radioactive substances

7. Exposure to radioactive substances is a scary thought, but this is becoming more and more a reality, at least for those who live close to disaster areas such as the Fukushima site in Japan or the Chernobyl site in the Ukraine. But according to Dr. Apsley II low dose radiation that we have already received in the US and in Canada following the Fukushima disaster is equally disastrous (Ref.3). Many of the vitamins and supplements I have mentioned are also cell and mitochondria protective and will help with DNA repair following radiation damage, but you must avoid sugar and other refined carbs and starches to reduce the oxidative effect on cells and on LDL cholesterol to prevent premature aging and cell death. Ref. 3 contains a lot more detail about this and explains what specific supplements you can take to detoxify your system. This will remove radioactive elements that function as free radicals in your body. There are specific antidotes for radioactive iodine-129 and iodine-131, radioactive cesium-137 and others.

Conclusion

Many people shrug their shoulders when they hear that pollution has an effect on their lives. They feel that they are powerless and cannot do anything about this. The truth is far from this! Above I mentioned seven points that you can follow to counter toxins. On top of that you can get politically active and urge your government representative to create a nuclear free zone in your area. Ref. 3 contains compelling evidence why this is so important not only for us now, but for future generations and the future of mankind.

Accountability of quality of food and beverages

We need to hold those who provide us with food and beverages accountable for the quality of these. Shrugging it off is not good enough. Get involved. Buy organic food. Avoid the section in the grocery store where they sell sugar and high carb foods. It’s good for your own health, but it will collectively change the mentality of the grocery store owners where you shop. Suddenly they notice that they are now left with the comfort foods that were big sellers in the past. This new trend will result in cheaper prices for healthy foods and more availability of organic food.

References

1. Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. © 2007 Saunders. Chapter 18:“Toxicologic Issues in the Neonate”.

2. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Chapter 31: “Insulin Resistance and the Metabolic Syndrome”.

3. Dr. John W. Apsley II : “Fukushima Meltdown & Modern Radiation: Protecting Ourselves and Our Future Generations” © 2011. Temet Nosce Publications, Sammamish, WA 98075

4. Xu, Qun, Parks, C.G., DeRoo, L.A., Cawthon, R.M., Sandler, D.P. and Chen, H. Multivitamin use and telomere length in women. American Journal of Clinical Nutrition 89 (April 2009):1857-63. Full text (PDF): http://ajcn.nutrition.org/content/89/6/1857.full?sid=9aab0e13-b4d2-42ad-b44c-15cffc6771c3

Last edited March 8, 2014

Jan
18
2014

The Superpowers Of Vitamin D

By | Alzheimer’s disease, Arthritis, Asthma, Autism, Cancer, fractures, heart attack, Heart Disease, High Blood Pressure, Infectious Disease, Infertility, Medical Condition, Multiple sclerosis, Nutrition, Osteoporosis, Other neurological conditions, Prevention, Vitamins and supplements

Introduction

This article deals with the superpowers of vitamin D. Originally, researchers found that vitamin D was the missing ingredient in preventing rickets in growing children. They established that 400 IU of vitamin D daily prevented rickets. Medical investigators determined that the active metabolite was vitamin D. The body has receptors on all vital organs for vitamin D. This includes the heart, brain, bones, kidneys and liver. In recent years new findings showed that the RDA of 400 IU of vitamin D3 daily was too low for many diseases. In other words, many diseases can develop when vitamin D intake is too low, particularly in the aging population. Researchers showed that higher doses of vitamin D3 in the range of 800 to 1000 IU per day prevent osteoporosis, falls and fractures in older adults and in nursing home populations.

The immune system requires higher doses of vitamin D3

But the immune system of everybody is dependent on higher doses of vitamin D3. Recently (Dec. 12 to 15, 2013) I attended a lecture at the A4M conference in Las Vegas where Dr. Eisenstein reviewed the latest on vitamin D3. It is now known that 2/3 of the US population is deficient for vitamin D as measured by blood tests (less than 25 ng/ml).  The standard test is the 25-hydroxy-vitamin D level (abbreviated as 25(OH)D level). It is now known that you require at least a level of more than 40 to 60 ng/ml of 25(OH)D as measured in the US, which translates to more than 100 to 150 nmol/L measured in metric units in other countries, to prevent cancer.

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

90% of the vitamin D3 that we need comes from exposure to sunlight. This transforms a cholesterol metabolite (7-dehydrocholesterol) into the vitamin D precursor (vitamin D3 or cholecalciferol). We absorb this from naturally occurring fish oil and oily fish. Otherwise this does not naturally occur in foodstuffs (Ref. 1). Dr. Eisenstein pointed out that it is well known that people living north of the 37th degree latitude lack vitamin D3 because of a lack of sun exposure, particularly in the winter season. People south of the 37th degree latitude have enough sun exposure. But wherever you live, it is advisable to have your vitamin D3 level measured (as 25(OH)D level). If you do not eat enough fish or fish oil, the levels likely are too low as is the case for 2/3 of the US population.

Oral vitamin D3 supplements

Patients whose vitamin D levels are too low have to take vitamin D3 supplements. Vitamin D3 is further metabolized by the liver and then by the kidneys into the active vitamin D compound, called 1,25(OH)2D3 (which is called “calcitriol”). The main effect of calcitriol is to absorb calcium and phosphate from the intestine into the blood stream. Together with vitamin K2 as explained in a prior blog these minerals are then taken up by the bone to prevent osteoporosis or rickets in the growing child. What has not been known for a long time is that vitamin D3 is also necessary for normal cell metabolism by most of your body cells, but particularly by the vital organs like the brain, the heart, the kidneys, the liver, the immune system and the bone.

Some people require higher doses of vitamin D3

However, doses of 5000 IU to 10,000 IU of vitamin D3 capsules per day are necessary for optimal vitamin D3 health. This leads to levels of below 150 ng/ml of 25(OH)D levels, which were shown by researchers to be safe. According to Dr. Eisenstein no toxicity has been found below 30,000 IU of vitamin D3 per day, but based on other authors a dose of 10,000IU should be adequate for most people. Strangely enough colored people also have to take vitamin D3 supplements as the higher melanin pigment in the skin filters out UV light so effectively that their 25(OH)D level can be low. Always err on the cautious side and have your vitamin D3 blood level taken. Vitamin D3 has a characteristic stereotactic configuration (cis-triene structure), which allows it to bind free radicals and function as an antioxidant (Ref.2).

What are some of the clinical effects of vitamin D3?

  1. Vitamin D3 has diverse effects on organs systems as Dr. Eisenstein summarized: vitamin D3 lifts depression and is of particular value for drug resistant depression. Take 5000 to 10,000 IU of vitamin D3 per day.
  2. Muscle power increases with vitamin D3, particularly in those who work out regularly.
  3. Many fertility clinics pay attention to vitamin D3 levels, as the higher the blood levels of vitamin D3 in a man, the faster this sperms move! And the more vitamin D3 she has on board, the better she ovulates. The end result is a higher pregnancy success rate when both partners take 5000 to 10,000 IU of vitamin D3 per day

Vitamin D improves teeth in offspring, helps with chronic pain

  1. Also, if a woman takes vitamin D3 during her pregnancy, the first set of teeth in the offspring will have fewer cavities.
  2. Brain development in autistic children is much improved with vitamin D3 in higher doses. This needs to be combined with detoxification methods and supervised by one of the DAN physicians.

6.Chronic pain typically improves when physicians treat vitamin D3 deficiency, which almost always is present in patients with chronic pain.

Prevention of flus and Covid-19, asthmatics improve

  1. To prevent flus and colds and other infectious diseases, take higher doses of vitamin D3. When you come down with a flu, it is safe to increase your daily vitamin D3 intake to 30,000 IU of vitamin D3 for a few days until your symptoms improve, then resume your maintenance dose of 5000 IU to 10,000 IU per day.  This year’s dominant flu is the type A, subtype H1N1 – also known as the swine flu. Children should get 50% of the dose regimen detailed for adults when they develop a flu (for children: 15,000IU for three to five days , with tapering to a maintenance dose of 2500 to 5000 IU until blood levels of 25(OH)D are available). Here is a website about the pros and cons of vitamin D where dosages are also discussed.
  2. Asthmatic patients do better with vitamin D3 supplements requiring less maintenance anti-asthmatic medicine to keep them balanced with regard to their airways.

Partial prevention of Alzheimer’s disease with vitamin D

  1. Chronic low vitamin D3 levels cause brain damage including Alzheimer’s disease. In this context it is important to know that the enzymatic conversion in the liver and kidneys slow down as we age.  Older patients require higher doses of vitamin D3. This may have been the reason for the confusion about relatively low doses of 400 IU of vitamin D3 preventing rickets in children versus the need for much higher doses of vitamin D3 in middle aged and older patients.
  2. There is a link of high blood pressure to vitamin D3 deficiency and it is better manageable with medication when vitamin D3 levels are normal.

Vitamin D lengthens telomeres and increases longevity

  1. Live longer with vitamin D3. How is this possible, you might ask: the answer has been found in the telomeres, the shoelace like structures at the end of the DNA strand of each cell. Vitamin D3 lengthens the telomeres and promotes telomere repair; there is an association of vitamin D3 and a longer life span. Centenarians have longer telomeres. You can measure telomere length, but it is a pricey test, which is not for everyone, contrary to supplementation with vitamin D3 that should be taken by everyone!

Vitamin D fights inflammation

  1. As already indicated, vitamin D3 strengthens the immune system. But it also modulates the inflammatory response from muscle damage, so athletes can perform better. Patients with multiple sclerosis will improve as it slows down the inflammatory process. But other inflammatory diseases like arthritis, inflammatory bowel disease and even cancer respond favorably to higher doses of vitamin D3. In these cases physicians use 20,000 to 30,000 IU of vitamin D3 daily. This information has not yet percolated into mainstream medicine.
  2. Higher percentages of cardiovascular disease occur in patients who have lower than 15 ng/ml  25-Hydroxy-vitamin D levels in their blood meaning that vitamin D3 supplementation prevents heart disease (Ref.3).

What are toxic vitamin D levels?

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25(OH)D blood levels taken from time to time. If vitamin D blood levels exceed 150 ng/mL reducing the vitamin D dose or stopping supplementation is prudent. Otherwise it has been difficult to establish a toxic range. Most publications about toxic levels of  vitamin D point out that anything above 150 ng/mL would be in the toxic range.

This website claims that 40,000 IU of vitamin D3 or more would lead to toxic levels where the blood calcium levels would be increased, which can be measured as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU per day and that led to a blood level of 400 ng/ml of 25(OH)D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine).

Toxic vitamin D levels difficult to find

The papers that indicated that it would be unsafe or unnecessary to take vitamin D3 were untrue. It seems that they had other agendas than communicating the truth. There was no release of calcium from the bones and calcium absorption from the gut was not too high. This would have caused calcification of the bones, soft tissues, heart and kidneys. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. Interesting that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

Patient taking unintentional high doses of vitamin D3 survived

I talked to a participant of the conference with a fellowship degree in anti-aging medicine what knowledge we have about vitamin D3 toxicity. He told me that there has been an unintentional overdose. In this case a compounding pharmacy made a mistake. A patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months. The patient felt sluggish, but did not have any other symptoms. His physician told him to stop the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. At this point no documented overdose of vitamin D3 exists.

Conclusion

Vitamin D3 is a vital supplement. Initially researchers showed that it prevents rickets in children. Subsequently physicians found that it also prevents depression, MS, infections and many cancers (Ref. 4). As usual there will be many critiques that doubt the validity of the above statements. But I have found that all of these effects described above were confirmed in several sources of various medical information. Keep in mind that negative rumours have a tendency to linger on for years.

More information on vitamin D3 for prevention of osteoporosis and hardening of arteries: https://www.askdrray.com/calcium-vitamin-d3-and-vitamin-k2-needed-for-bone-health/

Vitamin D3 deficiency can cause pancreatic cancer: http://nethealthbook.com/news/insufficient-vitamin-d3-linked-to-pancreatic-cancer/

References

1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed.,  © 2011 Saunders

2. Rheumatic Diseases Clinics of North America – Volume 38, Issue 1 (February 2012) , © 2012 W. B. Saunders Company

3. Wang TJ, Pencina MJ, Booth SL, et al:  Vitamin D deficiency and risk of  cardiovascular disease.   Circulation 117. (4): 503-511.2008.

4. “Recognition and Management of Vitamin D Deficiency”: American Family Physician – Volume 80, Issue 8 (October 2009),  © 2009 American Academy of Family Physicians