Medical Articles by Dr. Ray

Jan

2024

Fasting-Mimicking Diet Is Benefitting Cardiovascular Health

By Ray Schilling | diet, fasting mimicking diet, food, Heart Disease, Nutrition, Weight loss

A crossover study showed that a fasting-mimicking diet is benefitting cardiovascular health. This new study was done by Dr. Valter Longo et al. from the University of Southern California. It compared the effect of two diets. They were the fasting-mimicking diet versus an unrestricted diet. In other studies Dr. Longo compared the fasting-mimicking diet (FMD) with a Mediterranean diet. He said: “The significance is that fasting-mimicking diet cycles were able to decrease fat mass without reducing muscle mass and without requiring changes in the subjects’ preferred diet for 25 days a month. In contrast, the everyday Mediterranean diet required a change in everyday dietary habits and was associated with a 5 pounds loss of muscle.”

Findings of the effects of 5 days of the fasting mimicking diet per month

3 cycles of 5-day FMD per month showed the following effect. Fasting-mimicking diet patients experienced a remarkable decrease in trunk fat mass. Dr. Longo also showed in a previous study that the FMD reduces the circulating insulin-like growth factor 1. In addition, blood sugar, triglycerides, LDL and total cholesterol were reduced. In short, cardiovascular markers showed a protective effect in the FMD group.

Comments of a cardiologist to fasting mimicking diet

Dr. Rigved Tadwalkar is a cardiologist at Providence Saint John’s Health Center in Santa Monica, CA. He was not involved in the study by Dr. Valter Longo. He said: “When we look at different sorts of diets, we really want to get down to what sort of health benefit they actually provide. It was nice to see that both the fasting-mimicking diet and Mediterranean diet – which is almost like the mainstay of recommended diets right now – both led to weight loss and improvements in blood pressure, cholesterol, and blood sugar. These are all very important cardiometabolic parameters that lead to cardiovascular disease, so it’s nice to see that both are able to do so.”

Fasting-mimicking diet reduces abdominal fat

He went on to say: “What was interesting about the fasting-mimicking diet is that it had the added benefit of reducing abdominal fat, which was really important because that is a big reason why a lot of people diet. Not to mention it’s still important even from a medical standpoint because abdominal fat is a risk factor for cardiovascular disease.” He continued to point out that it will be important to show the long-term effect of the FMD. He suggested to have observations over several month and years. Also, he stressed the importance of showing the direct effect of the FMD on the reduction of cardiovascular disease. This would be in comparison to controls. All this requires much larger clinical trials with longer follow-ups.

Advantage of fasting-mimicking diet

The FMD is easy to follow. You only have to reduce your daily calorie intake for 5 days out of a month. The remaining 25 days they eat their normal diet. People are often unwilling to change their diet. With the FMD they only have to reduce their calorie intake to 500 to 600 calories per day. And this is only for 5 days in a row once per month. They will lose 0.5 to 0.7 units of body mass index (BMI) once a month. Compare the first day of your 5 day FMD with the day after your last FMD.

My experience with the fasting mimicking diet

I have done this for 6 years. In December of 2017 I listened to a lecture by Dr. Valter Longo at a conference in Las Vegas. Immediately after I started dong monthly FMD for 5 days. This kept my BMI within 21.0 to 22.0, because I use the FMD to correct any weight gains. Whether you want to adopt a DASH diet or a Mediterranean diet is another issue. This is eventually desirable to solve. But in the meantime stay in a healthy range with your BMI with the help of the FMD.

Fasting-Mimicking Diet Is Benefitting Cardiovascular Health

Conclusion

The fasting-mimicking diet (FMD) is a tool to reduce your abdominal fat. At the same time you improve your blood pressure, cholesterol, and blood sugar. You can achieve that by reducing your daily calorie intake. With the FMD you aim for between 500 and 600 calories for 5 consecutive days every month. With body composition scales you can see how your weight, fat percentage and body mass index reduce from before. These are all very important cardiometabolic parameters. If you allow them to get out of control they lead to cardiovascular disease. Start adopting the FMD to keep your weight the same or reduce it slightly. Worry about a possible diet change to a Mediterranean diet at a later point and introduce the beneficial changes. This makes dieting easier.

Jan

2024

Backup your New Year’s Resolutions by looking at short-term Consequences

By Ray Schilling | alcohol, Anxiety, Cancer, Cardiovascular disease, Diabetes, exercise, fasting mimicking diet, Health, heart attack, Insomnia, Smoking, sugar

In the New Year it pays to backup your New Year’s resolutions by looking at short-term consequences. An article in “the conversation” explains how you can keep yourself motivated to stick to healthy habits. The alternative would be to fall back into unhealthy habits, which lead to various disease conditions. Traditional thinking centered around keeping long-term outlooks in front of your mind when tempted by the smell of doughnuts. In these cases, you think that the long-term consequences of eating doughnuts or consuming sugary drinks result in diabetes and obesity. But the smell or taste of unhealthy foods can be so overpowering that the long-term consequences of potential diseases is forgotten. This is the point when your New Years resolution may fade away in favor of falling back to unhealthy eating habits.

Think short-term to resist temptation

The new approach is to replace the thinking of long-term outlooks by short-term outlooks. The authors cited an example of 4000 participants in 7 separate studies. When the short-term consequences of anxiety and a sugar and caffeine crash were explained for caffeine containing sugary drinks, 25% of participants were able to abstain from the energy drinks in comparison to those who were informed about long-term consequences.

Another experiment

A similar experiment involved the consumption of sugar in the form of cookies. One group of participants read about the short-term effects of eating sugar. A second group read about the long-term effects of eating sugar. A third group did not get any information about the effect of sugar. There was also a “reward system” for all the participants: they had to decide between receiving a tote bag or eating cookies. Those who had read about the short-term effects of sugar were 30% less likely to choose cookies than the ones who read about the long-term effects. The ones who read the short-term effects were 45% less likely to choose the cookies than the ones who read nothing about the effects of sugar.

Verbalizing short-term consequences

Here are some thoughts that help to verbalize short-term consequences:

For alcohol: excessive drinking can lead to poor sleep and hangovers.
Fast food can make you feel bloated or give you indigestion.
Sugar and starchy meals: make you bloated and give you an acidy stomach, also will lead to rapid weight gain.
Focus on the good taste of apples and carrots. People will eat more of it and get the health benefits without mentioning it.

You can keep your goals easier when you combine them with small rewards here and there. When you have achieved one thing, you could watch your favorite TV show. Another reward could be a brief visit to the gym that makes you feel more fit. Or go and buy yourself a new pair of shorts for the gym. The authors of this article provide evidence from studies that showed that several mini rewards distributed throughout the day are more effective than big rewards at the end of the day.

Measurements of weight fluctuations

I found that body composition scales are very useful to monitor your diet intake. Here is an example how I use this device. My weights, fat% and body mass index for a number of days is listed below. The first line shows the baseline measured in the morning. On Saturday lunchtime I was invited to a Christmas family dinner. I ate more than I should have had. You can see the results on the Sunday readings: weight up, fat up and BMI up. I watched my calorie intake throughout Sunday.

Weekday Weight (KG) Fat % Body mass index

Saturday: 63.6 13.2 21.7

Sunday: 64.0 14.2 21.9

Monday: 63.4 14.3 21.7

It took another two days (Wednesday) before the fat percentage was down to 12.9.

There is another powerful tool, Dr. Valter Longo’s fasting mimicking diet. I reported about this under this link. Briefly, once a month I eat only 500 to 600 calories daily for 5 days. This helps me to lose my body mass index from 21.8 down to 21.1 or 21.2. After that I can eat a normal diet until the next month when I do the fasting mimicking diet again. It is an easy way to keep my body mass index in the 21.0 to 22.0 range. My wife and I prepare our own 500 to 600 calorie diet with natural food.(No, you do not get much, but it can taste good!) We do not buy Dr. Longo’s expensive diet boxes.

Backup your New Year’s Resolutions by looking at short-term Consequences

Conclusion

Focusing on short-term goals and consequences increases the percentage of success for those who have New Year’s resolutions. You can use this for many different approaches: eating less sugar, losing weight, getting regular exercise, reducing your alcohol intake, cutting out fast food and increasing your healthy vegetable and fruit intake. I also added a description of what I do with the help of body composition scales to control my weight and body mass index. I also use Dr. Longo’s fasting mimicking diet once per month for 5-days. Since December 2017 (for 6 years) I practiced this. I find it extremely useful to maintain my body mass index in the 21.0 to 22.0 range. Medicine knows that it is important to keep your body mass index below 25.0. This will prevent heart disease, type 2 diabetes and cancer. It also helps to look forward to a healthy New Year.

Dec

2023

Any Form of Exercise is good

By Ray Schilling | Cancer, Cardiovascular disease, diet, exercise, Fitness, Health, heart attack, Mortality

Here are a few items that can prolong life; among them any form of exercise is good. This article concentrates on the exercise part in relation to longevity. A recent publication described how regular exercise prolongs your long-term survival. According to a study released on occasion of the American Heart Association’s Scientific Session 2023 there are 8 major factors that prolong life: healthy diet, physical activity, nicotine exposure, sleep health, BMI, cholesterol, blood sugar, and blood pressure. Among this group of factors regular physical activity plays a major role to prolong your life. Researcher who studied various people found that those who neglected their physical health had a chronological age of 53, but their average biological age was 57. On the other hand, a group of fit people who engaged in regular physical exercise had a chronological age of 41 years, but a biological age of 36.

Clinical trials showing that any form of exercise is good

JAMA Internal Medicine study by Dr. del Pozo Cruz

This study examined what the optimal amount of physical activity per week is to reduce mortality compared to an inactive population. 500,705 eligible US adults were observed for about 10 years. The abbreviations that the authors used in the study were as follows:

MPA: moderate aerobic physical activity

VPA: vigorous aerobic physical activity

MSA: muscle-strengthening activity

Results of mortality reduction with various amounts of physical activity

The best group engaged in more than 0 to 75 minutes of MPA combined with more than 150 minutes of VPA and 2 or more MSA sessions per week. Their mortality rate was 50% lower than an inactive comparison group.
The optimal combination for reduction of cardiovascular disease (CVD) and cancer mortality risk was as follows: more than 150 to 225 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week. This reduced combined mortality of CVD and cancer by 70%.
The researchers stated that the adjusted mortality rates represented 50% lower mortality rate for all-cause and cancer mortality. The mortality rate for CVD mortality was 3-fold lower than for inactive controls.

Smallest amount of exercise that reduces mortality

In a study published in the European Heart Journal the authors asked how little exercise per week was enough to reduce mortality from heart disease. They found that it takes at least 15–20 min/week of vigorous physical activity (VPA) to reduce mortality from heart attacks by 16–40%. If you increased the exercise level by 50–57 min/week the mortality rates reduced even further.

Are physically active jobs healthy?

Recent research showed that people who work in physically demanding jobs are more likely to develop early cognitive impairment. This is the pre-stage of Alzheimer’s disease. 15.5 % of people who worked in high levels of occupational physical activity developed dementia. This compared to 9% risk for people whose work involved a low level of physical activity, not too much and not too little. The finding confirms the notion that there is a need for balance of physical exercise. Several publications stressed what is optimal in terms of exercise: vigorous (75 to 300 minutes per week) and moderate physical activity (150 to 600 minutes per week). People who expose themselves to these amounts of exercise live the longest and stay healthy.

Discussion

The studies discussed here showed that the right amount of exercise can reduce mortality from heart disease and cancer. However, exercise is not the only factor that can do this. It is important to combine regular exercise with a healthy diet. Your diet should consist of fruits and vegetables, whole grains, low-fat dairy products, lean proteins and limit saturated and trans-fat, added sugars, and sodium. In addition, you need enough sleep, maintain a healthy weight, manage your stress, and don’t smoke.

Any Form of Exercise is good

Conclusion

In this review I touched on the importance of regular exercise to reduce mortality from heart disease and cancer. Vigorous (75 to 300 minutes per week) and moderate physical activity (150 to 600 minutes per week) reduce mortality from heart attacks by 16% to 40%. But physical exercise is only one factor of mortality reduction. If you want the full benefit from other factors, you must quit smoking, eat a Mediterranean type diet with fruits and vegetables, whole grains, low-fat dairy products and lean proteins. Also you should limit saturated and trans-fat, added sugars, and sodium. In addition, you need enough sleep, maintain a healthy weight and manage your stress. Once you adopted this lifestyle, you live longer and you will get less diseases.

Dec

2023

Too much Ultraprocessed Food Makes you sick

By Ray Schilling | Cancer, Cardiovascular disease, colorectal cancer, Diabetes, diet, Mortality, Nutrition

A Lancet study published on Nov. 13, 2023 found that too much ultraprocessed food makes you sick. Researchers noted that ultraprocessed animal products and sweetened beverages were linked to an increased cancer risk as well as other diseases such as strokes or diabetes.

In Europe more than half of the food intake consists of ultraprocessed food. In the US a 2019 study found that 71% of the food supply is ultraprocessed.

Details of the study

The details of the study were summarized in a CNN report. Researchers of the study collected nutritional data from 266,666 men and women (60% were women) from 7 European countries between 1992 and 2000. The researchers followed the participants for 11 years. During that time they observed the participants for the development of chronic diseases and cancer. During the observation time 21,917 primary cancers, 10,939 cardiovascular events, and 11,322 type 2 diabetes cases developed. On entry into the study participants were questioned about their food intake in the past 12 months. This was matched with the NOVA classification system. It became clear that not all ultraprocessed foods were detrimental to the health of the participants. Animal products and sugar-sweetened drinks and foods caused chronic diseases in the participants of the study. However, ultra-processed breads, cereals or alternative plant-based products were neutral in terms of health risks.

Main findings of the study: too much ultraprocessed food makes you sick

The main findings of the study were that ingesting mostly ultraprocessed food leads to a 9% increase of heart attacks, strokes, diabetes and cancer. This is in comparison to controls who ate very little ultraprocessed food. However, when you reduce your intake of ultraprocessed food your risk of developing these diseases reduces. The key is to eat more fruit and vegetables and concentrate on eating minimally processed food.

Other studies with similar findings

In 2022 the British Medical Journal published two studies that documented a higher colorectal cancer rate and cardiovascular disease rate when subjects were eating larger amounts of ultraprocessed foods (UPF). Specifically, when men had exposure to a high percentage of UPF in their diet they developed 29% more colorectal cancer after 28 years of observation in comparison to men who ate a low percentage of UPF. A related study that went on for 14 years showed a 32% higher risk for death from cardiovascular disease for men who ate a high UPF diet in comparison to men on a low UPF diet.

French study 2019

A French study in 2019 followed 44, 551 French adults 45 years or older for 7.1 years. A 10% increase of consumption of ultraprocessed food caused a 14% higher risk of all-cause mortality. The authors stated that 80% of all premature deaths from noncommunicable disease are due to cardiovascular disease (CVD), respiratory disease, cancer, and diabetes. The authors discussed in detail the problems with overconsumption of ultraprocessed food.

Some of the contents of ultraprocessed food

Ultraprocessed food contains:

High salt content, and high sodium intake has been associated with cardiovascular deaths and increased stomach cancer risk.
Excessive amounts of added sugar. There is an association between added sugar consumption and an increased risk of mortality from cardiovascular disease.
Ultraprocessed foods contain very little fiber. More dietary fiber in one’s diet has an association with lower death rates.
Studies have estimated that reducing saturated and trans fats, salt, and added sugar in the diet prevent cardiovascular deaths.
High temperature food processing produces acrylamide. Acrylamide is a known carcinogen.
Consumption of processed meat products causes a higher risk of colorectal cancer and stomach cancer.

More ingredients of ultraprocessed food

Artificial sweeteners can alter microbiota and can cause the onset of type 2 diabetes and metabolic diseases.
With bisphenol A coating in food packaging endocrine disruptors enter the food. Bisphenol A causes endocrine cancers and metabolic diseases, such as diabetes and obesity.
The food industry uses additives frequently in their formulations. Some studies raised concerns about the health consequences of food additives. For instance, the food industry uses titanium dioxide widely. There is an association of titanium dioxide and increased risk of chronic intestinal inflammation and carcinogenesis.

It is easy to see that when we expose our bodies to a mix of these ingredients this can cause cardiovascular diseases, cancers and diabetes. The final outcome is that this leads to premature deaths.

Too much Ultraprocessed Food Makes you sick

Conclusion

Too much ultraprocessed food (UPF) makes you sick. This is the conclusion of a large study, which the Lancet published on Nov. 13, 2023. Researchers followed 266,666 men and women (60% women) for 11 years. The main findings of the study were that ingesting mostly ultraprocessed food leads to a 9% increase of heart attacks, strokes, diabetes and cancer. This is in comparison to controls who ate very little ultraprocessed food. Other studies going back to 2019 and 2022 showed very similar findings.

Other studies

A French study from 2019 noted that a 10% increase of consumption of ultraprocessed food caused a 14% higher risk of all-cause mortality. Several studies in 2022 showed that men who had an exposure to a high percentage of UPF in their diet developed 29% more colorectal cancer after 28 years of observation in comparison to men who ate a low percentage of UPF. A related study that went on for 14 years showed a 32% higher risk for death from cardiovascular disease for men who ate a high UPF diet in comparison to men on a low UPF diet. It follows from this data that a simple diet consisting of vegetables, fruit, nuts and lean meat (chicken turkey, fish) with minimal amounts of UPF protects you from premature death.

Nov

2023

Help to Walk for Parkinson’s Disease Patients

By Ray Schilling | neurological disease, Parkinson’s disease

A new study describes how a spinal cord implant provides help to walk for Parkinson’s disease patients. The original study was published in Nature: . CNN published a simplified article that describes how a Parkinson’s patient with gait problems could walk again, when a spinal cord implant was inserted. This patient’s name is Marc Gauthier from a town near Bordeaux, France. He was 36 years old when he was diagnosed with Parkinson’s disease. For many years he could control his Parkinson’s disease symptoms with Dopamine replacement therapy.

Insertion of deep brain stimulator

But by 2004 the medication did not control his gait anymore. His doctors inserted a deep brain stimulator, which helped with tremors and muscle stiffness. But as the disease progressed, he developed a severe walking disorder. The drugs and the deep brain stimulator no longer helped his walking problem. His muscles stiffened up, and often he fell 4-times per day. He had to give up his work as an architect. Finally, in 2021 his doctors inserted a nerve stimulator with electrodes connecting to the lower spinal cord.

Spinal cord stimulation

Researchers from France, Switzerland and other parts of the world determined which part of the spinal cord were in need of electrical stimulation to improve his gait and balance problems. Dr. Eduardo Moraud is an author of the study and researcher at Lausanne University Hospital. He said: “The stimulation here is focused on the spinal cord. We target the region of the spinal cord that will control all the leg movements.” The team managed to develop an electric stimulator for implantation under the skin over the abdomen with electrodes going to the lower spinal cord. This way his physicians stimulated muscle groups and also relaxed them in sequence so that his gait improved and steadied. His balance stabilized as well and he could walk stairs again.

Future routine surgery to implant spinal stimulator

Marc Gauthier’s case is a first in approaching Parkinson’s disease with a spinal stimulator. The researchers stressed that they will improve the technology and learn from other patients how to individualize this technique. But eventually the spinal cord stimulator could become a routine approach for end stage Parkinson’s disease. Dr. Moraud said: “Addressing deficits of gait and balance in Parkinson’s disease is extremely challenging. These deficits can be very heterogenous. They can be variable across patients. They can affect walking but also symmetry, balance, posture. The neuroprosthetic approach that we have developed here allows for the first time to target and address these problems individually in a highly specific manner for each patient. It operates in real time, and importantly, it is complementary to other existing therapies.”

Marc Gauthier’s progress since his spinal cord stimulator

The researchers identified hotspots in the lower spinal cord with connection to the gait and balance problem of the patient. The surgeon connected the neuroprosthesis to these hotspots to stabilize gait, balance and muscle strength. Following the surgical procedure Mr. Gauthier had to undergo a few months of rehabilitation with the neurostimulator to practice walking, develop strength and coordination between the right and left leg. His body was no longer stiffening or freezing in place. He could now take a 3-mile lakeside stroll without stopping. He can now manage stairs going up or coming down smoothly. In the past his gait would suddenly freeze or he lost hist balance. None of this

Is happening now. He simply is walking normally.

The final word of Dr. Moraud

“The stimulation here is focused on the spinal cord. We target the region of the spinal cord that will control all the leg movements.” Inserting a neurostimulator is not a cure, simply a procedure to help the patient lead a normal life.

Help to Walk for Parkinson’s Disease Patients

Conclusion

A new surgical procedure, namely inserting a neurostimulator under the abdominal wall, is the latest approach to treat Parkinson’s disease. This is help to walk for Parkinson’s disease patients. The case, which I described here is the first case where doctors performed this new procedure. They identified hot spots in the lower spinal cord and connected them to the neurostimulator with electrodes. After a lengthy rehabilitation period the patient learned how to use the stimulator for optimal walking, balancing, and going stairs up and down. There are no more falls or gait problems and no freezing. At the end the patient can walk normally and even manage a walk of 3 miles. Researchers anticipate that this method will become an accepted treatment modality for gait problems of Parkinson’s disease patients.

Nov

2023

New Treatment against Advanced Bladder Cancer

By Ray Schilling | Cancer, laser therapy, Mortality

At a Cancer congress in Madrid, Spain a new treatment against advanced bladder cancer was discussed at this year’s European Society for Medical Oncology Congress. The standard treatment for advanced bladder cancer is gemcitabine in combination with cisplatin or carboplatin. According to CNN the median survival with the standard chemotherapy is 16.1 months. In contrast, treatment with the new intravenous antibody drug enfortumab vedotin in combination with intravenous pembrolizumab resulted in longer survival. The combination yielded a survival of 31.5 months for advanced bladder cancer patients. This new immunotherapy method resulted in a 96% longer survival. The safety profile of the two approaches were similar. 55.9% of patients taking the combination immune therapy developed skin rashes or hyperglycemia, while 69.5% of those taking platinum chemotherapy developed this.

Other new findings about advanced bladder cancer treatment

Dr. Thomas Powles is a professor of urology cancer at the University of London and director of the Barts Cancer Centre in the United Kingdom. He said:” The problem with chemotherapy is although it works quite well initially, resistance occurs quickly, and the median survival for metastatic bladder cancer has been about a year. What this study showed is, we did a big, randomized Phase 3 study where we compared a new treatment — two new drugs — with standard chemotherapy,” Powles said. “And in this randomized trial, when you gave those two drugs together, you reduced the risk of death for this cancer by over 50%. So, you’ve doubled survival, with patients living twice as long, and we’ve got long-term durable remission.”

Erdafitinib study

A second study from the New England Journal of Medicine used erdafitinib in comparison to standard chemotherapy. Erdafitinib is a small molecule inhibitor of fibroblast growth factor receptor and is effective in the treatment of cancer. This study compared 136 patients on erdafitinib with 130 patients on chemotherapy. Patients treated with standard chemotherapy had a median overall survival of 7.8 months. This compares to 12.1 median survival for the erdafitinib group. Erdafitinib, a kinase inhibitor drug, is slowing the spread of cancer cells.

Side effects that led to death were less common with erdafitinib than with chemotherapy. Only 0.7% of erdafitinib patients had serious side effects versus 5.4% of chemotherapy patients.

Nivolumab study

Another clinical trial was recently published in the New England Journal of Medicine.

Nivolumab is an immune checkpoint inhibitor that was originally developed for treatment of intractable melanoma. However, subsequently it was found to be active also against lung cancer, kidney cancer and bladder cancer. In the clinical study mentioned above 304 patients with intractable bladder cancer were treated with standard chemotherapy alone. They were compared to 304 patients on standard chemotherapy plus nivolumab.

The median complete response with the nivolumab-combination therapy was 37.1 months. In contrast, with gemcitabine–cisplatin alone it was only 13.2 months. Side effects of the two treatments were about similar. The authors concluded that treatment with the immune checkpoint inhibitor, nivolumab plus standard chemotherapy with gemcitabine–cisplatin resulted in better survivals than treatment with gemcitabine–cisplatin alone.

Discussion

Immunomodulation is one of the newest approaches to cancer treatment. But at the Hope 4 Cancer Clinic immunomodulation is only one aspect of a comprehensive approach to cancer treatment.They mention that they restore the microbiome in the gut. Great detail is spent to a full spectrum nutrition. Detoxification and non-toxic cancer therapies are employed. Oxygenation helps to restore the acid/base balance. Immunomodulation with the newer agents mentioned above helps as well to combat cancer. Low-dose laser photodynamic therapy with various light frequencies helps to destroy cancer cells as well. These lasers activate a variety of sensitizers, which are taken up by cancer cells and lead to their destruction. Finally, the cancer patients are taught how to achieve spiritual and emotional well-being. The Hope 4 Cancer Clinic demonstrates that treatment with immunomodulation is best combined with other treatment modalities to improve patient survival.

New Treatment against Advanced Bladder Cancer

Conclusion

Physicians used three different immune therapies to treat advanced bladder cancer. Erdafitinib vedotin, a kinase inhibitor drug, in combination with intravenous pembrolizumab resulted in a survival of 31.5 months for advanced bladder cancer patients versus 16.1 months with standard chemotherapy. Another clinical trial showed that patients on standard chemotherapy had a median overall survival of only 7.8 months for advanced bladder cancer. This compares to 12.1 months median survival for the erdafitinib group. Finally, nivolumab, an immune checkpoint inhibitor was combined with standard chemotherapy. When end stage bladder cancer patients were treated with this combination, they survived 37.1 months. In comparison, the control group with chemotherapy alone (gemcitabine–cisplatin) survived only 13.2 months. There is definitely better survival of patients when immunomodulation is used. The hope is that future immunomodulators will have a stronger effect against cancer with less side effects.

Oct

2023

News from the Blue Zones Regarding Longevity

By Ray Schilling | alcohol, andropause, Cancer, Cardiovascular disease, diet, exercise, heart attack, Hormones, lifestyle, Menopause, testosterone

This article is about news from the Blue Zones regarding longevity. Blue Zones are areas where many centenarians live. Medical News Today ran a review article about Blue Zones on Sept. 23, 2023. These Blue Zones are located in Sardinia, Italy; Ikaria, Greece; Nicoya, Costa Rica; Loma Linda, California and Okinawa, Japan. Many studies looked at centenarians in these areas and analyzed what lifestyles led to their longevity. Dan Buettner summarized at a conference that only 20% of deaths in the world are due to genetic conditions. 80% of people can postpone their death date by adopting healthy lifestyles.

Factors associated with longevity

Dan Buettner called the factors that lead to prolonged life “Power 9”. The following factors must be adopted simultaneously, if you want to reach 100 years of age and more:

Moving naturally and regularly
People in Blue Zones have a purpose in life
Reduce stress in your life
Practice the 80% diet rule, which is to stop eating when 80% full
Adopt a plant-based diet.
Consume alcohol in moderation
Be part of a community
Put family first
keep a social circle that supports healthy behaviors

A diet for longevity

Dan Buettner analyzed the dietary habits of centenarians. He found that 90% of the diet they consumed consisted of whole food, plant-based sources and about 65% of their diet were complex carbs. Buettner noted: “The pillars of every longevity diet in the world are whole grains, nuts, greens, and other garden vegetables, tubers and beans.” For years the benefits of a Mediterranean diet were investigated and found to be life prolonging. It also emphasizes vegetables, whole foods, greens, grains, nuts and beans. The review article in Medical News Today that I mentioned above contains recommendations of how to change your diet to a healthier one.

Regular exercise

We are built in a way that requires regular exercise. When you exercise regularly, your body produces healthy HDL cholesterol that balances the unhealthy LDL cholesterol. Overall, this counteracts clogging of arteries and prevents heart attacks and strokes.

When you prevent strokes and heart attacks, you live longer.

Have a purpose in life

When you have a purpose in life, your mind is focused on what excites you. Achieving what is your dream satisfies you. Your brain releases feel-good brain hormones (dopamine, serotonin, endorphins, and oxytocin). When these hormones are released, you relax and cope with stress better. Your blood pressure normalizes, hardening of the arteries is postponed. At the same time, you prevent heart attacks and strokes. This contributes to longevity.

Reduce stress in your life

When under stress, your adrenal glands release adrenaline and cortisol. In the short term these stress hormones help you to cope better with stress. But when stress gets chronic, it weakens your immune system and increases your risk for a heart attack or stroke. It ages you faster. You can counter stress in your life by adopting stress management techniques. Regular exercise stabilizes your emotional life. You can listen to relaxation recordings or to relaxing music to calm your nerves. Developing friendships is another method of coping with stress. Here is more information on how to reduce stress in your life.

Limit alcohol consumption

In the past it was thought that small amounts of alcohol would prevent cardiovascular disease. But these studies overlooked the fact that even small amounts of alcohol can cause various cancers. So, by limiting the amount of alcohol consumption you also limit your probability of getting cancer.

Be part of a community

Many psychological studies showed that social isolation leads to health problems. It follows from this that being part of a community stabilizes your health and prevents disease. When you socialize with other people you counter stress and prevent loneliness.

Putting family first

When you care about your family, family members will care about you. Studies showed that this is an important factor in preventing disease. It even reduces mortality. Lower mortality leads to longevity.

Keep a social circle that supports healthy behaviors

Strangely enough here is another psychological factor that leads to longevity: getting support from a social circle. Being part of a social circle can create positive energy that prevents health problems.

Discussion of factors that lead to longevity

It is interesting to see that a lot of the longevity factors are psychological in nature. But physical factors are also important, like a Mediterranean diet and regular exercise. One factor that was not mentioned by Dan Buettner is the importance of preservation of hormone stability. I attended many yearly conferences of the American Academy of Anti-Aging Medicine (also known as A4M). They take place in the middle of December in Las Vegas every year. Over the years many lectures centered around hormone deficiencies. They collectively lead to premature aging and deaths. However, speakers also stressed that when you replace the missing hormones, you can reach a balance point where life gets prolonged.

Hormone replacement

One of the speakers, Dr. Hertoghe, an endocrinologist from Brussels mentioned in various talks that a lack of human growth hormone (HGH) in older age can lead to premature death. When IGF-1 levels in the blood are low, replacing the missing HGH with regular HGH injections can add 26.5 years to your life expectancy. But other hormones like thyroid hormones, testosterone in males, and progesterone and estrogen in females can prolong life when replaced after menopause or andropause (the male version of menopause).

News from the Blue Zones Regarding Longevity

Conclusion

Many factors contribute to longevity in centenarians. A lot of the factors are psychological in nature, like having a purpose in life or reducing stress in your life. Others are: be part of a community, put family first and keep a social circle that supports healthy behaviors. Physical factors causing longevity are moving naturally and regularly; adopt a plant-based diet; and consume alcohol in moderation. There is one important factor of longevity that Dan Buettner overlooked: your hormone balance. When we approach age 60 and beyond many people stop producing adequate amounts of hormones.

Replacing missing hormones

Anti-aging doctors have done studies showing that replacing missing hormones in proper doses will prolong life. Dr. Hertoghe, an endocrinologist from Brussels mentioned in various talks that a lack of human growth hormone (HGH) in older age can lead to premature death. When IGF-1 levels in the blood are low, replacing the missing HGH with regular injections can add 26.5 years to your life expectancy.

Oct

2023

Sudden Cardiac Death in Athletes

By Ray Schilling | heart attack, Mortality

This article is about sudden cardiac death in athletes. Dr. Robert A. Harrington and Dr. Manesh Patel reported from the European Society of Cardiology 2023 Congress in Amsterdam. Notably, this congress took place from August 25-28, 2023 with 30,000 participants. Another key point is that one of the important topics was sudden cardiac death in athletes. In general, you normally assume that athletes are healthy, and their hearts would support their peak athletic activities. It is important to realize as Drs. Harrington and Patel reported that under certain circumstances athletes can suddenly die.

Bronny James, a high school basketball player was rescued from a cardiac arrest as this article shows. Apparently, he has a congenital heart condition, which makes him more vulnerable to get an irregular heartbeat. It must be remembered that his can cause his heart to stop beating. Fortunately, he was revived at the Mount Sinai Hospital in New York. To clarify, there are a number of non-invasive procedures that interventional cardiologists use to correct abnormalities in a heart. Specifically, following such procedures the person’s heart is more stable.

Ventricular fibrillation

To explain, irregular heartbeats leading to ventricular fibrillation is one cause of death in athletes. Another key point, often there can be other underlying conditions that lead to this. Examples are a long QT interval on an ECG, a big thick heart (medical term: hypertrophic cardiomyopathy), and dilated aortas in tall people.

Success stories of reviving people and athletes with sudden cardiac death

In other words, over the years two methods showed success in rescuing athletes with sudden cardiac deaths. The first is CPR (cardiopulmonary resuscitation). This keeps the blood flowing and delivers oxygen to the lung capillaries. Next the emergency medical team is called in who provide an automated external defibrillator to the chest. This can revive up to 100% cases of athletes with sudden cardiac deaths. The key is to do CPR right away and to have the emergency medical team use the automated external defibrillator (AED) right away.

Screening methods to prevent sudden cardiac death in athletes

With this in mind, the medical profession has started to do preventative tests of athletes. First, Italy is one of the countries that has persistently done standard screening. Physicians order ECG’s and echocardiograms. They can readily diagnose hypertrophic cardiomyopathy with these tests. Second, a new stethoscope can get sounds and some ECG signals at the same time. This helps to diagnose several abnormal cardiac conditions.

Third, another point is that there have to be enough people around a sports event who have experience in performing CPR (cardiopulmonary resuscitation). Certainly, the sooner you start CPR, the more successful is the outcome with respect to a full recovery. Next medical personnel with the AED equipment are necessary to bring the heart rhythm back to a sinus rhythm. When the patient’s heart beats normally again, the patient needs transportation to the nearest hospital for further monitoring and stabilization.

Commotio cordis

When there is a lower chest impact from a hockey puck, baseball or lacrosse ball the heart can suddenly come to a standstill. Physicians call this commotio cordis. These athletes need immediate CPR to keep them alive followed by timely administration of an automated external defibrillator. Often the heart beats normally after this. If immediate medical help is not available, these young athletes die and it becomes an upsetting newspaper story.

Sudden Cardiac Death in Athletes

Conclusion

Dr. Harrington interviewed Dr. Manesh Patel, a cardiologist from Duke University regarding sudden cardiac death in athletes. A thump to the chest from a hockey puck or a baseball can cause the heart to stop beating. In order to save this athlete from dying bystanders have to start CPR right away. This helps to continue blood circulation and brings oxygen into the tissues. Next medical personnel apply electrode pads from an automated external defibrillator (AED) to the chest wall. One or two electric shocks are administered. This often revives the heart or converts irregular heart contractions to the normal sinus beats, and the athlete recovers. The emergency medical team transports the patient to the nearest hospital for observation and further treatments. CPR and AED in combination can save up to 100% of cases that would otherwise turn into sudden cardiac deaths.

Sep

2023

Allergies to Red Meat after a Tick Bite

By Ray Schilling | Allergies, anaphylactic reaction, food, Prevention, red meat

A new disease has arrived, allergies to red meat after a tick bite. This condition has surfaced in Australia and in the southeast of the US. It is linked to the bite by a lone star tick. Researchers determined that alpha-gal, which is galactose-α-1,3-galactose from the saliva of the tick is responsible for causing an allergy. Meat from mammals also contains alpha-gal. Due to a cross reaction between a lone star tick bite and alpha-gal in beef and other meats a person can develop a sensitivity to alpha-gal. This has the name alpha-gal syndrome (AGS). Between 2010 and 2022 the CDC recorded about 110,000 suspected cases of AGS in the US.

Symptoms of alpha-gal syndrome

A person who was previously sensitized by a lone star tick bite often only gets symptomatic after eating beef. The symptoms are hives, a skin rash, nausea or vomiting, heartburn or indigestion and diarrhea. Other symptoms could be a cough, shortness of breath, difficulty breathing or a drop in blood pressure. Some patients develop swelling of the lips, throat, tongue, or eye lids. Others complain of dizziness, faintness or severe stomach pains. These symptoms usually develop 2 to 6 hours after eating a meal with beef or dairy products. The person who was previously bitten by a lone star tick was sensitized following this encounter and produced specific antibodies against alpha-gal. The second encounter of the body from ingested alpha-gal containing food is the reason why the allergic reaction takes place. The more alpha-gal is ingested by different foods that contain it, the more severe the allergic reaction becomes.

Diagnostic tests for alpha-gal sensitivity

Allergists have the following tests available to them to check your immune system.

One test is called the alpha-gal U953 immunocap, a blood test.
The mammalian meats immunocap (Beef, Lamb, Mutton, Pork and Rabbit are available) shows specific antibodies as a result of exposure to these meats.
In severe cases of alpha-gal sensitivity blood tests for a mast cell tryptase level may also be necessary. This test can distinguish between a higher or lower risk of alpha-gel sensitivity. Tryptase is an enzyme, which is higher in people with mastocytosis. There is often an elevation of tryptase in patients who have allergies to both insect bites and tick bites.

Foods that contain alpha-gal

The Australasian Society of Clinical Immunology and Allergy describes in great detail what foods contain alpha-gal and what not. The main culprit in developing alpha-gal syndrome is mammalian meat. The most popular among these is beef, but veal, pork, lamb, buffalo, venison, rabbit and guinea pig also belong into this category. Other meats are deli meats like bacon, ham, salami, silverside, chorizo, prosciutto and others. When a person reacts to eating one or more of these items, we are dealing with a cross reaction. It is between the alpha-gal from the original tick bite and alpha-gal from the meat the person ingested.

There are more obscure mammalian meats that contain alpha-gal: whale, dolphin, seal, goat, kangaroo, wallaby and possum. But gelatin products and fats from mammals also contain alpha-gal.

What foods do not contain alpha-gal?

The following foods are OK to eat for people with alpha-gal sensitivity: chicken, mollusks, crustaceans, turkey, quail, goose, fish, duck, eggs, legumes, lentils and soy products (tofu, tempeh). According to the allergy.org website, you have to be careful about jams, soups and gravies, as merchants often mix gelatines into their products. Stay away from energy drinks with taurine, sausages (even chicken sausage) and cheese spread. Avoid rennet, jelly-based lollies, mousses and desserts. All of them contain alpha-gal.

Treatment for alpha-gal syndrome

There is no known treatment for sensitivity to alpha-gal. However, experience has taught allergists that strict avoidance of alpha-gal in food improves the symptoms. After about 3 to 4 years of a strict diet that excludes alpha-gal many patients are no longer sensitive to alpha-gal and can tolerate a certain amount of alpha-gal in their diet. But others continue to be sensitive to alpha-gal. They have to adhere to strict avoidance of alpha-gal in food and stay away from tick bites.

Allergies to Red Meat after a Tick Bite

Conclusion

A new condition, alpha-gal syndrome has joined the rare, but important group of new diseases. It is a sensitivity to a sugar, called galactose-α-1,3-galactose, or alpha-gal. It is present in the mouth and saliva of the lone-star tick in the US and Australia. A bite from this tick can be the first sensitizer in a human. But unfortunately, alpha-gal is also present in many foods as mentioned in detail above. Repeated exposure to alpha-gal regardless of the origin causes hypersensitivity, which can get life-threatening. There is no treatment for this condition other than to adopt a very meticulous avoidance of alpha-gal in the diet. After 3 to 4 years of such a diet the hypersensitivity to alpha-gel disappears in many, but not in all patients. When the hypersensitivity persists, the patient has to continue with the alpha-gal avoidance diet.

Sep

2023

How the Immune System affects Parkinson’s Disease

By Ray Schilling | autoimmune disease, diet, Fitness, immune system, Inflammation, Parkinson’s disease

This article explains how the immune system affects Parkinson’s disease (PD). Notably, in the past physicians thought that Parkinson’s disease was due to a degenerative change of the substantia nigra. This explained why balancing was a problem, why shaking of the hands occurred and why falls happened often. It it important to realize that nobody thought about the immune system. And no-one knew that an autoimmune process could be behind Parkinson’s disease.

T cells that react to a damaged protein called alpha-synuclein

There are specific changes in the immune system approximately 10 years before Parkinson’s disease symptoms occur in patients who come down with the disease. Researchers from the La Jolla Institute for Immunology showed that T cells play a key role in causing PD. They react to a damaged protein called alpha-synuclein build up in the dopamine-producing brain cells. Laboratory physicians can assay this through a simple blood test, which becomes a screening tool for early Parkinson’s disease. The reactive T cells stay around for about 10 years, then fade away. There seem to be other immune factors that weaken the initial aggressive phase of the T cells.

The role of inflammation in Parkinson’s

When the immune system malfunctions chronic inflammation can develop. In farmers exposed to pesticides the later development of Parkinson’s disease was observed. The researchers thought that the pesticides caused an irritation of the immune system leading to chronic inflammation. There is evidence that the gut bacteria are different in Parkinson’s disease patients when compared to normal controls. The gut absorbs the metabolites of the abnormal gut bacteria and causes chronic inflammation. In an attempt to stop the inflammatory process, the immune system can develop autoimmune antibodies, which can cross react with cells of the substantia nigra. This in turn can cause Parkinson’s disease.

Lifestyle factors that people can change to prevent PD

Dr. Rebecca Gilbert, vice-president and chief scientific officer for the American Parkinson Disease Association (APDA) commented on the importance of lifestyle changes. She said: “It makes intuitive sense that instituting lifestyle modifications that potentially decrease inflammation may decrease the risk of Parkinson’s disease. Exercise, for example, has been shown to reduce inflammation and is probably one of the many reasons that exercise reduces the risk of Parkinson’s disease and also improves established Parkinson’s disease.” She commented further: “Also, we should avoid things like excessive alcohol and nicotine that we know have negative effects on the immune system,” she added. “And managing our stress as best as possible can slow and help maximize outcomes of many diseases.”

Changing diet can help postpone Parkinson’s disease

With regard to the best diet that will help Parkinson’s disease patients she said: “The MIND diet emphasizes whole grains, vegetables, nuts, legumes, and berries. Fish is the preferred protein and olive oil is the preferred fat. Recently a study showed that adherence to the MIND diet and the Mediterranean diet had an association with later onset of Parkinson’s disease.”

The gut connection to Parkinson’s disease

According to the WHO the global prevalence of Parkinson’s disease has doubled in the last 25 years. At this point we do not know why this is so. But many investigations have shown that there is a significant difference in the gut bacteria composition of healthy controls and Parkinson’s disease patients. There is a 30% difference between the bacterial composition of healthy controls and patients with Parkinson’s disease. This has led to Braak’s Hypothesis of Parkinson’s Disease. This hypothesis says that an unknown pathogen enters through the nose, the person swallows it and it ends up in the gut. Absorption gets it into the gut wall and it migrates through the vagus nerve into the central nervous system where it leads to accumulation off alpha-synuclein in the substantia nigra. This destroys the dopamine producing cells in that region causing the symptoms of PD.

Can any diet fight gut dysbiosis?

In 2022 study they found that flavonoids, the pigments of fruit were associated with a lower mortality of patients with Parkinson’s disease.
In an earlier study of 2018 researchers determined that a protein from fish with the name parvalbumin helped Parkinson’s patients to stop producing alpha-synuclein. PD patients suffer from clumping of alpha-synuclein, which causes their symptoms.
Restriction of refined carbohydrates “especially diets with a low glycemic index, rich of vitamins and polyphenols, a Mediterranean diet for example, can be recommended”.

Regular exercise to prevent Parkinson’s disease

Regular physical exercise maintains body function and muscle strength. Dr. Emer MacSweeney said: “Being physically active is one of the best things you can do for your body. Exercise helps protect against many diseases and keeps the heart, muscles, bones, and brain in optimum condition. Exercise promotes the oxygenation of the brain and stimulation of multiple neurochemicals.”

Several studies showed that patients with PD deteriorate slower, if they exercise regularly. Part of that response is due to the release of endorphins and serotonin, but we do not know all of the positive mechanisms of exercise at this time.

How the Immune System affects Parkinson’s Disease

Conclusion

Recent research changed what we know about Parkinson’s disease (PD). Braak’s Hypothesis of Parkinson’s Disease states that an unknown pathogen enters through the nose, gets swallowed and ends up in the gut. From there it gets taken up into the gut wall and migrates through the vagus nerve into the central nervous system. There it leads to accumulation of alpha-synuclein in the substantia nigra. This destroys the dopamine producing cells in that region causing the symptoms of PD. But we also know that chronic inflammation can aggravate the symptoms of PD patients. When the composition of the gut bacteria deteriorates, this too will make PD patients worse.

Lifestyle changes help to postpone Parkinson’s disease

A healthy diet, like the MIND diet, DASH diet or the Mediterranean diet have beneficial effects on PD patients. Many studies also found that regular physical exercise is a stabilizing factor in PD patients. There are still many gaps in what we know about the causation of PD. But the above summarized factors are a good start.

Findings of the effects of 5 days of the fasting mimicking diet per month

Comments of a cardiologist to fasting mimicking diet

Fasting-mimicking diet reduces abdominal fat

Advantage of fasting-mimicking diet

My experience with the fasting mimicking diet

Conclusion

Think short-term to resist temptation

Another experiment

Verbalizing short-term consequences

Measurements of weight fluctuations

Conclusion

Clinical trials showing that any form of exercise is good

JAMA Internal Medicine study by Dr. del Pozo Cruz

Results of mortality reduction with various amounts of physical activity

Smallest amount of exercise that reduces mortality

Are physically active jobs healthy?

Discussion

Conclusion

Details of the study

Main findings of the study: too much ultraprocessed food makes you sick

Other studies with similar findings

French study 2019

Some of the contents of ultraprocessed food

More ingredients of ultraprocessed food

Conclusion

Other studies

Insertion of deep brain stimulator

Spinal cord stimulation

Future routine surgery to implant spinal stimulator

Marc Gauthier’s progress since his spinal cord stimulator

The final word of Dr. Moraud

Conclusion

Other new findings about advanced bladder cancer treatment

Erdafitinib study

Nivolumab study

Discussion

Conclusion

Factors associated with longevity

A diet for longevity

Regular exercise

Have a purpose in life

Reduce stress in your life

Limit alcohol consumption

Be part of a community

Keep a social circle that supports healthy behaviors

Discussion of factors that lead to longevity

Hormone replacement

Conclusion

Replacing missing hormones

Ventricular fibrillation

Success stories of reviving people and athletes with sudden cardiac death

Screening methods to prevent sudden cardiac death in athletes

Commotio cordis

Conclusion

Symptoms of alpha-gal syndrome

Diagnostic tests for alpha-gal sensitivity

Foods that contain alpha-gal

What foods do not contain alpha-gal?

Treatment for alpha-gal syndrome

Conclusion

T cells that react to a damaged protein called alpha-synuclein

The role of inflammation in Parkinson’s

Lifestyle factors that people can change to prevent PD

Changing diet can help postpone Parkinson’s disease

The gut connection to Parkinson’s disease

Can any diet fight gut dysbiosis?

Regular exercise to prevent Parkinson’s disease

Conclusion

Lifestyle changes help to postpone Parkinson’s disease

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