Medical Articles by Dr. Ray

Dec

2015

Coffee Could Be A Lifesaver

By Ray Schilling | Cardiovascular disease, Diabetes, heart attack, Heart Disease, Mortality, Nutrition, Prevention, Stroke

Coffee could be a lifesaver. But coffee has long been a subject of heated discussions. It has been praises or condemnations. Researchers designed many studies in the past; some showed health benefits, some did not. A new, larger study was done by the Department of Nutrition, Harvard School of Public Health in Boston, MA to re-examine this issue for both caffeinated and decaffeinated coffee.

Here is the study showing why coffee could be a lifesaver

Mortality was determined among 74,890 women in the Nurses’ Health Study (NHS), 93,054 women in the NHS 2, and 40,557 men in the Health Professionals Follow-up Study after a medium follow-up of 22.5 years. 19,524 women and 12,432 men died during that time period. Ming Ding is a doctoral student in the Harvard School of Public Health department of nutrition and was the lead author of the study that was published in the medical journal “Circulation”. She pointed out that in the past there were confounding problems: although many studies had shown that both caffeinated and decaffeinated coffee consumption lowered the risk of cardiovascular disease, the results in many studies were blurred. Studies often did not distinguish between smokers and nonsmokers; so a beneficial effect from coffee drinking was wiped out by the cardiovascular risk from smoking.

Ding’s studies took this into account and also other confounding factors like how much sugary soda pop people were drinking and whether or not they were eating well. In addition they normalized for other factors that could interfere like drinking alcohol and eating red meat.

Results of the coffee study

Without normalizing for the factors mentioned above the study results were as follows. Study participants had less than a cup of coffee and three cups a day had a 5% to 9% lower risk of dying than those who drank no coffee. Those who drank more than three cups a day did not see any benefit.

However, when the researchers removed all the confounding factors and compared the various groups again, the following emerged:

Less than 1 cup of coffee per day: 6% lower death rates than non-coffee drinkers.
1 cup to 3 cups of coffee per day: 8% lower death rates.
3 to 5 cups of coffee per day: 15% lower death rates.
More than 5 cups of coffee per day: 12% lower death rates.

Both caffeinated and decaffeinated coffee reducing mortality rates

Ming Ding was associated with another research paper that had shown that coffee drinkers have a lower risk of developing type 2 diabetes and heart disease. She found that both caffeinated and decaffeinated coffee reduced the risk of getting diabetes later.

When asked about what would be responsible for the reduced death rates with coffee consumption, Ding explained. “There are at least two known chemicals in coffee, namely lignans and chlorogenic acid. They both could reduce inflammation and help control blood sugar. Also, both could help reduce the risk of heart disease”.

Although there seems to be a linear response up to 5 cups of coffee consumption, above 5 cups this linear relationship disappeared. The researchers could not explain whether coffee consumption reached a saturation point, whether there was yet another obscure confounding factor or whether there were detrimental effects on the adrenal glands with too much coffee consumption.

Other findings like decreased suicide rates with coffee consumption

Another finding was that it did not matter whether the coffee contained caffeine or was caffein free. The results were identical.

Many other studies did not have the large numbers to show whether or not coffee without caffeine was as effective in preventing heart disease.

Finally, there was another peculiar finding; suicide rates were down by 20% to 36%, if a person drank at least one cup of coffee per day. But if a person consumed less than 1 cup of coffee per day the suicide rate was 36% higher than the control group with no coffee consumption. This is a rather peculiar finding, particularly for the consumption of less than 1 cup of coffee. But other studies have also shown a decrease in suicide rates with coffee consumption.

No effect on liver and prostate cancer

Previous studies had shown a reduction in liver and prostate cancer. But after the removal of confounding factors this study did not show any effects on cancer causation. Cancer death rates also did not show a reduction with coffee consumption.

Discussion

The Department of Nutrition, Harvard School of Public Health in Boston, MA produced high quality nutritional studies for decades. But this study is particularly important, because it is so large giving it more statistical power; secondly, the observation time of an average of 22.5 years is longer than most coffee studies in the past. The investigators also removed the noise (called confounding factors). This helped to accomplish the objective of the study and they ended up with a very meaningful result.

Apart from saving lives by drinking coffee, diabetes and heart attack rates lower as well

The important findings were that both caffeinated and decaffeinated coffee have the same effect of saving lives. Perhaps you want to drink not more than 5 cups of coffee per day. That lowers your risk of premature death by 15%. What counts is the effect of lowering the rate of diabetes and heart attack rates. This is most likely responsible for the risk reduction. At least this was the opinion of the chief investigator. The study showed that coffee consumption did not lead to a reduction in cancer rates.

I sleep better when I drink decaffeinated coffee. So for me the notion that decaffeinated coffee had the same effect as regular coffee was important.

Coffee Could Be A Lifesaver

Conclusion

Here is a study that is large enough, went long enough, and showed decisively that coffee can reduce the death rate. Both caffeinated and decaffeinated coffee showed the effect of reducing the death rate. The mortality reduction was by 15% up to 5 cups of coffee per day. This finding was true for both males and females. Coffee seems to also reduce the suicide risk by a mechanism that has not yet been determined. Do you want to live 15% longer than your previous life expectancy would have been without coffee? Then you may now have your coffee and enjoy it!

Dec

2015

Beer Belly Bad News

By Ray Schilling | alcohol, andropause, Cardiovascular disease, heart attack, Heart Disease, Hormones, Inflammation, lifestyle, Mortality, Nutrition, Stroke, Weight loss

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

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

Abdominal girth to hip ratio instead of BMI

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

Weight gain leads to metabolic syndrome

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

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

Why is a beer belly dangerous?

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

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

Estrogen from aromatase in beer bellies

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

What can you do about a beer belly?

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

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

German obesity wave after WWII in the 1960’s

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

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

Unhealthy hydrogenated fats, starchy food and sugar caused beer bellies

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

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

Steps of how to get rid of the beer belly

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

Eliminate sugar and high fructose from diet

Remove sugar and high fructose corn syrup from your diet.

Remove empty starches from your diet

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

Regular exercise

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

Rebalance your food intake

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

Moderate your alcohol intake

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

Bioidentical hormone replacement

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

Lack of function of key organs in menopause and andropause

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

Lack of hormones causes heart attacks, strokes and cancer

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

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

Beer Belly Bad News

Conclusion

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

Dec

2015

Processed Meat Causes Cancer

By Ray Schilling | Cancer, Cardiovascular disease, Heart Disease, Nutrition, Processed food

A report from the World Health Organization (WHO) has stated that processed meat causes cancer. The report also stated that to a lesser degree red meat is also cancer causing. Overall there are 34,000 people per year worldwide who die from cancers that are related to the consumption of processed foods. They are mainly colorectal cancers, pancreatic cancer and prostate cancer.

Seeing deaths from processed meat in perspective

When you relate the 34,000 processed food related cancers to all of the 8.2 million cancer deaths per year worldwide, the cancer numbers related to processed food amount to only 0.41 % of all the cancer deaths in the world, which is a very small percentage. In comparison to these numbers smoking as a cause of cancer is responsible for the death of 1 million people per year. Furthermore, there are 600,000 deaths due to drinking alcohol, and 200,000 deaths due to breathing polluted air. Of course it has to be emphasized that it is important to avoid cancer causes wherever possible!

Nevertheless we are talking about preventative deaths and the public should be informed about what the risks are due to consuming processed meats, cigarette smoking, drinking alcohol and breathing polluted air.

Pancreatic cancer study

A large multi-ethnic study analyzed data from 190,545 men and women at the Cancer Research Center at the University of Hawaii. In an average follow-up time of 7 years there were 482 incidents of pancreatic cancer, and it became obvious that processed meats play a role in the increase of pancreatic cancer. After taking other risk factors into consideration like a positive family history, age, smoking and diabetes mellitus, those patients who consumed the largest amount of processed meats had a 67% increased risk for pancreatic cancer as opposed to those who had the lowest intake of these foods. A diet rich in red meats increased the pancreatic cancer risk by about 50%.

Alternatives to red meat

Poultry, fish, dairy products and egg intake showed no pancreatic cancer risk factor, nor did it matter how much fat, saturated fat or cholesterol was consumed over the 7 year observation period.

The lead investigator of the study, Dr. Ute Noethlings, observed that the risk increase is a consequence of meat processing. The main culprit would very likely be carcinogenic substances which are used in processed meat production.

Too much red meat

Grain fed or corn fed and antibiotic treated regular beef changes the gut bacteria and can cause superbugs. The change of the gut flora can lead to inflammation in the gut lining and a condition called “leaky gut syndrome”. We carry almost 2 pounds of gut bacteria in us at any given time. Residual antibiotics from regular beef and chicken reduce that amount and change the composition of our gut flora.

Adopt sensible nutrition

Consuming regular beef will change your liver metabolism and lead to accelerated hardening of the arteries. This in turn causes deadly heart attacks and strokes. On the other hand, grass fed beef or organic beef do not have the same effect. To prevent leaky gut syndrome, heart attacks and strokes from developing you can also take probiotics every day, which should include these two species: Lactobacillus acidophilus and Bifidobacterium bifidus. This keeps your gut flora stable and does not allow your food to undermine your health. But this does not mean that you pop a supplement, and you can blissfully ignore sensible nutrition!

Red meat can cause heart attacks in diabetics

Red meat is one of the sources of protein, but doctors from the Harvard School of Public Health reported in the January edition of Diabetes Care, that a type 2 diabetes diet should go easy on red meat.

Type 2 diabetics are at risk for subsequent coronary heart disease (CHD), and intake of iron rich food was significantly associated with a greater risk of fatal CHD. The results come from a prospective study of 6,161 women from the Nurses’ Health Study.

Diabetes more common when diet contains red meat

All of these patients reported a diagnosis of adult onset diabetes, and they were followed between 1980 through 2000. This amounts to an impressive 54,455 person-years follow-up. Attention was paid to the food questionnaires, which were monitored for the consumption of iron and red meat. Red meat consists of beef, pork or lamb as a main dish. Red meat is also in beef in roast beef sandwiches and mixed dishes, hamburger, hot dog, processed meat and bacon. The examiners of the study also took note of other nutrients such as seafood and poultry.
Women with diabetes who ate the most iron in the form of heme found in red meats had a 50% increased risk of total coronary heart disease as compared to those with the lowest intake. The risk ratio with women was more obvious for postmenopausal women when compared with premenopausal women .

Western diet with red meat and processed meat causes higher heart attack and cancer rates

Lean beef may be a good protein food to the average population. But type 2 diabetics might choose to cut back on red meat and processed red meat sources. They can replace red meat with a heart-friendlier choice. Fresh seafood, rich in omega -3 fatty acids, would rank high on the list of a healthy eating plan.

Another prospective study of 72,113 women over 18 years found a definitive relationship between dietary patterns and cancer and heart attacks. A prudent diet with high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains had a very low cancer and heart attack rate. Conversely a Western diet consisting of high intakes of red meat, processed meat, refined grains, French fries, and sweets/desserts led to a higher cardiovascular mortality risk of 22% and a higher cancer mortality risk of 16%.

Processed Meat Causes Cancer

Conclusion

The World Health Organization announced that processed food is carcinogenic. This piece of news is not entirely new. Hopefully it will work its way into the consciousness of the population at large. Meat processors producing sausages, ham and other processed meat varieties will not stop advertising their products. They advertise in a way to make them sound tasty and delicious for the consumer. Colorful images seduce the prospective buyer. These images make you drool. But this is a make-believe world in the art of commercials. In the end it is the consumer who has to make a decision which food is tasty and also beneficial.

Healthy food leads to healthy people

Customers need to make the choice for health and stop buying foods that border to being nutritionally hazardous products. This is when we will see a true change in health statistics. But while you are thinking about changes, do not forget to quit smoking. Also, cut down your alcohol consumption and perhaps, if possible move to a less polluted area. All of that will help to reduce mortality rates!

More info about pancreatic cancer: Causes of cancer of the pancreas.

Nov

2015

Diet And Brain Health

By Ray Schilling | Alzheimer’s disease, Fitness, Nutrition, Prevention, Vitamins and supplements

The fact that the topic of diet and brain health keeps popping up in the medical literature, is significant. This year has not been any exception.

The Mediterranean diet in particular has been shown to have very positive effects on postponing Alzheimer’s disease by as much as 5 years.

A clinical study on 674 elderly patients (mean age 80.1 years) without dementia, was published in the journal “Neurology”. It examined the question whether adherence to the Mediterranean diet would affect the degree of brain atrophy. Researchers already knew that Alzheimer’s disease was less common on a Mediterranean diet.

The findings were interesting: a high adherence to the Mediterranean diet led to a higher total brain volume, total grey matter volume and total white matter volume as measured with high-resolution structural MRI scans.

Quality of diet influences cortical thickness of brain

Lower meat intake led to higher brain volume. In addition, more fish intake also caused the mean cortical thickness of the brain to increase. Parts of the brain in Alzheimer’s patients showed atrophy like in the cingulate cortex, parietal lobe, temporal lobe, and hippocampus with good volumes on MRI scans when patients adhered to the Mediterranean diet. These volumes started to shrink when the diet was poor.

Those patients adhering to a Mediterranean diet have brains that on MRI scan look 5 years younger and are much less likely to develop Alzheimer’s disease. Physicians have known for a long time that people, who eat a healthy diet, exercise regularly, don’t smoke and who keep mentally stimulated will generally have healthier brains than people who don’t do these things.

What is the Mediterranean diet?

It involves eating meals derived from plants: vegetables, fruit, cereals, beans and nuts. You can eat fish and poultry twice per week. You cut down the amount of meat and dairy you eat, but you can have a glass of wine per day. Instead of butter olive oil is used instead. Here is more information of what is included in the Mediterranean diet.

Because there is less fat and less high glycemic index carbs in this diet, it is also a diet that lends itself for weight management. You shed a few pounds and reach your ideal body mass index without paying much attention to it.

Apart from the Mediterranean diet the MIND diet has also been shown to prevent brain atrophy. This diet is a combination of the DASH, which physicians developed for controlling high blood pressure, and the Mediterranean diet.

The Mediterranean diet makes you live longer

The Nurses’ Health Study that has been going on since 1976 showed that telomeres, the caps on chromosomes, were getting shorter in nurses who lived on junk foods, but surprisingly nurses on the Mediterranean diet preserved their telomeres. Longer telomeres have an association with slower aging. And people with longer telomeres reach an older age without diseases like heart attacks, liver disease or cancer.

Exercise on top of the Mediterranean diet

In addition to relying on a healthy diet, like the Mediterranean diet, for your health, think about doing regular exercises. These two ingredients together will prevent heart attacks, strokes and other diseases. When you combine exercise with a healthy diet your abdominal girth shrinks as this study showed.

Another study showed that when a Mediterranean type diet is combined with regular exercise, adult onset diabetes occurrence could be reduced by 28-59%.

This is quite a significant effect of two simple interventions: a healthy diet and regular exercise.

Don’t smoke

It does not make sense to go on a healthy diet, exercise and then smoke! Interestingly an Iranian study showed that when people became health conscious, adopted a healthy diet and exercised, they also started to quit smoking. People who did all of this, quit smoking, eating healthy and exercising regularly, were also the happiest and most content.

Exercise your brain

The evidence shows that any stimulation of brain activity, particularly anything that requires active and abstract thinking will protect the brain from developing Alzheimer’s disease.

Another study showed that prevention of Alzheimer’s disease is achieved by quitting smoking, treating high blood pressure, stimulating the brain and treating diabetes.

Diet And Brain Health

Conclusion

us. This approach will be the most successful way to prevent Alzheimer’s disease. It starts with quitting smoking. It goes on to starting a Mediterranean diet and staying on it. Regular exercise will take care of preventing heart attacks and strokes. But exercise also ensures that all of your brain cells continue to get oxygen and nutrients. This in turn prevents brain shrinkage.

Weight loss included in Mediterranean diet

The Mediterranean diet has a lower calorie content than the Standard American diet, there will be weight loss. The weight loss will continue until you reach your ideal body mass index. You can stimulate your brain by actively doing computer work, doing puzzles, playing a music instrument and phoning friends. In addition you may want to read reading books etc.. All this will contribute to preventing Alzheimer’s. Watching TV or movies is not an active mental activity. This is passive thinking, which means it is not as valuable as the other activities. Pick a hobby that enhances your life, and your brain will thank you for it too!

Nov

2015

Zero Alcohol In Pregnancy!

By Ray Schilling | alcohol, fetal alcohol spectrum disorders, Pregnancy

The American Academy of Pediatrics warned recently that pregnant women should not drink any alcohol at all (“zero alcohol in pregnancy!”) to prevent learning disabilities and fetal abnormalities in their children. Even having one drink when pregnant can lead to mental difficulties in the offspring.

There is no safe amount of alcohol to drink through pregnancy

Dr. Cheryl Tan, an epidemiologist at the CDC said: “There is no safe amount, no safe time, and no safe type of alcohol to drink during pregnancy. It’s just not worth the risk”. Dr. Tan from the CDC did an extensive phone survey study where drinking behaviors of non-pregnant women and pregnant women were recorded. The results were as follows. 1 in 10 pregnant women said that they had consumed alcohol in the past 30 days; also 1 in 33 stated that she had been binge drinking (4 drinks or more).

Growth retardation and other problems in the baby when mother drinks alcohol

Pediatricians have found over the years that even one alcoholic drink per day in a pregnant woman will lead to growth retardation in the baby. But this is not all: there are a myriad of problems with the consumption of alcohol, like problems with hearing and vision, also heart, kidney and bone deformities. As the nervous tissue is very sensitive to the toxic effect of alcohol, the offspring of mothers who drank when pregnant often have neurodevelopmental issues such as difficulties with abstract reasoning, processing of information and ADHD.

Pregnant women drinking only in the first trimester compared to women who abstained, had more problems with their offspring. They were noted to be 12-times more likely having a child with neurodevelopmental issues. Women drinking in the first and the second trimester, but not the third were 61-times more at risk, while women drinking during all three trimesters increased the risk 65-times.

Medical science can be the problem

There was a previous study in only 2010 stating that it would be OK for a pregnant woman to drink one or two glasses of alcoholic drinks as the study showed no neurodevelopmental problems up until the age of 5 of the children born.

But at the end of the study the scientists did note that each mother and child is different in how they metabolize alcohol. The obstetrician should discuss with the pregnant woman what to do. This type of study makes no sense at all. It seems to carelessly suggest to women to get pregnant and continue to drink.

There can be a serious compromise in terms of neurodevelopmental development

Remember that all of the nervous tissue has to develop out of a fertilized egg, then form into the neural tube and grow into the cerebellum and the brain. On each of the multiple steps of embryonic development there is enzyme induction that determines the next step in the development and many of these important decision points can be interrupted by alcohol. The newest study from the CDC indicates very clearly that it is not safe to drink at all throughout pregnancy. The reason is that there can be a serious compromise in terms of neurodevelopmental development.

Previous toxicity studies regarding the fetal alcohol syndrome

A study from Ghana documented that fetal alcohol syndrome exists in this African country, although previously not too much was medically noted. Physicians and nurses picked up 90% of children with fetal alcohol syndrome as “failure to thrive”. 80% of these children had heart disease and 50% had hernias.

A study from Poland showed the correlation between prenatal exposure to alcohol and developmental problems in children. The sad results is that among the 7 to 9 year olds there were 2% who suffered from fetal alcohol spectrum disorder. And 0.4% of the offspring had fetal alcohol syndrome. There was a great need in Poland to develop diagnostic skills to diagnose neurodevelopmental disorders.

Developmental abnormalities in humans and in animal models with alcohol exposure

These human findings are mirrored by animal studies using a mouse model where alcohol was administered at certain times during pregnancy. The researchers could not find any safe time period during the pregnancy of mice where alcohol was not toxic. All concentrations of alcohol caused congenital abnormalities. To the contrary: chromosomal abnormalities developed as a result of alcohol exposure that persisted into life after birth. Fetal alcohol syndrome birth defects can be pinpointed to the exact exposure time in pregnancy. It is at certain specific times in pregnancy when certain organ formations take place.

Fetal Alcohol Spectrum Disorders

The newest study from a group of pediatricians states unequivocally that no exposure to any alcohol is safe throughout any pregnancy. In 1973 fetal alcohol syndrome was first published with a cluster of genetic abnormalities. It has been recognized that subtler neurodevelopmental syndromes are due to lower alcohol concentrations during pregnancies. This results in what physicians now call “fetal alcohol spectrum disorders”.

It is the key observation that researchers could not find any neurodevelopmental problems in women who did not drink. Women who did not drink a single alcoholic beverage during their pregnancy were the strong point of the study. They formed the control group that caused the strong statement in this research paper.

“The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely,” said Dr. Janet F. Williams, one of the leading authors of the report from the American Academy of Pediatrics.

Zero Alcohol In Pregnancy!

Conclusion

The question whether it is safe to drink a bit of alcohol when pregnant has finally been answered. It has been shown clearly that a woman who is pregnant should refrain from all forms of alcohol. It is for the sake of giving birth to a healthy baby. Despite the definition of fetal alcohol syndrome in 1973 it has taken until 2015 before clear answers came. Studies now lead to guidance from the health care profession and the CDC as well regarding drinking and pregnancy. How can we expect to have a healthy next generation both physically and neurodevelopmentally? We have to take responsibility during the next generation’s pregnancy. This is the responsibility of the mother, the father and society at large.

Nov

2015

Sugary Soda Drinks Make You Sick

By Ray Schilling | Alzheimer’s disease, Cancer, Cardiovascular disease, heart attack, Heart Disease, Inflammation, Nutrition, Stroke

Dr. Frank Hu and colleagues have recently re-examined the old question of whether sugary soda drinks make you sick. They usually contain high fructose corn syrup, a mixture of 55% fructose and 45% glucose. This sugar mix can be found in sugary soda drinks as well as in many processed foods like fruit spreads. Dr. Hu’s publication is listed in PubMed , but details can be found in this summary.

The study found that one or two cans of sugary soda drinks per day lead to

As high as a 26 percent greater risk of developing type 2 diabetes,
A 35 percent greater risk of heart attack or fatal heart disease, and
A 16 percent increased risk of stroke.

Difference in metabolism between fructose and glucose

The study also found that there is a difference of how glucose, the main sugar that the body uses for energy is metabolized versus fructose from high fructose corn syrup or the breakdown of table sugar, a disaccharide consisting of glucose and fructose combined as one molecule. Glucose gets directly absorbed from the gut into the blood circulation and with the help of insulin gets further absorbed directly into body cells. In contrast the liver metabolizes fructose into triglycerides, which can cause fatty liver disease and insulin resistance. Fructose also raises the bad cholesterol (LDL cholesterol). This in turn is a risk factor for developing diabetes, heart attacks and strokes.

It is fructose in sugary drinks and processed foods that are largely responsible for weight gain, metabolic syndrome, diabetes and cardiovascular disease.

The newest finding: heart failure can also be caused by high fructose corn syrup

A study in Sweden has recently shown that sugary drinks can cause heart failure. Researchers followed 4200 Swedish men for 12 years in regard to their food habits. The study found that the men who drank at least two sweetened drinks per day had a 23% higher risk of developing heart failure. Dr. Susanna Larsson, a co-author of the study, said: “The takeaway message is that people who regularly consume sweetened beverages should consider limiting their consumption to reduce their risk of heart failure”. Heart failure affects nearly 6 million Americans. It develops either on its own in persons with inadequately treated high blood pressure or in people who had a previous heart attack. It is a condition, which disables the heart to effectively pump enough blood with nutrients and oxygen into the tissues.

Symptoms of heart failure

People who develop this condition feel the symptoms: they get short of breath with minimal activity. They also may wake up short of breath in the middle of the night. It is a miserable life, as people with heart failure experience severe restrictions in their daily activities. Even walking a flight of stairs becomes a struggle or even an impossible task. Total disability is the next step. The key is prevention: do not use high fructose corn syrup, and stay away from sugar in any form; instead use stevia to sweeten your food when needed.

Be careful how you replace saturated fatty acids

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

Cutting fructose out of diet lowers cholesterol and weight

A new study by Dr. Robert Lustig and colleagues from the University of California, San Francisco showed on 43 children that a change of diet reducing dietary sugar from 28% to 10% and replacing it with other complex carbohydrates led to a significant reduction in triglycerides, cholesterol and blood pressure.

The nucleus accumbens in the brain is the reward center for addictions

The fructose stimulus was taken away, which stimulates a part in the brain, called nucleus accumbens, where the reward center is located. This is the reason why the more sugar you take in, the more addicted to sugar you become. Not surprisingly when physicians changed the diet, there were internal signs of improving with regard to blood tests. But physically the children also showed weight loss just within 10 days as their total calorie intake had reduced. There is another observation with regard to fructose metabolism. Normally after a meal there is suppression of ghrelin, the hunger hormone. But when you drink a sugary drink with fructose in it, there is no suppression of ghrelin. The result is that you do not feel satisfied and you keep on consuming fructose containing drinks resulting in weight gain.

Sugary Soda Drinks Make You Sick

Conclusion

What we eat matters in terms of long-term consequences. This is certainly true for refined sugar intake. Don’t lull yourself into the belief that honey is “healthy”. Even though it is a natural product, your body treats it according to its chemical composition. It is sugar, and unfortunately it will get you into health problems naturally. Even the fashionable agave syrup contains largely fructose: again, this is bad news for your health! No matter what type of sugar you choose, the long-term consequences have haunting qualities. Consequences of sugar intake are weight gain, diabetes, heart attacks and strokes. You will agree that is not worth to take any of these risks just to satisfy a sweet tooth.

Alternatives to sugar

Biting into a crisp, sweet apple is enjoyable and has never harmed anybody. Eating a small helping of fruit salad to top off a meal can be a delicious finale to dinner. If you need a sweetener, it is better for you to use the plant-derived stevia, which is available as a powder or a liquid. Smallest quantities are adequately sweetening foods. Stevia has no calories and none of the consequences of sugar: you’ll enjoy the sweetness without the bitter aftereffects of tooth decay or heart disease!

Nov

2015

Eat Your Avocado

By Ray Schilling | Anti-aging medicine, Arthritis, Cancer, Cardiovascular disease, Health, heart attack, Heart Disease, Nutrition, Obesity, Stroke, Vitamins and supplements

“Eat your avocado” is an appropriate invitation to eat this super food with many positive effects on people’s health. That is to say, first, it helps arthritis, in addition it is good for your vision, besides it protects against cardiovascular disease, moreover it fights metabolic syndrome, further it helps in weight maintenance and finally, it even protects against some cancers. Avocado contains healthy oils and many vitamins and minerals.

Avocado composition

80% of an avocado is fiber making it a valuable food to prevent colon cancer. Among the minerals it is noteworthy that avocados are rich in boron and potassium. In terms of vitamins it is rich in vitamin E (alpha-tocopherol), vitamin B6, folate, vitamin K and pantothenic acid. It does not contain cholesterol, but contains monounsaturated fat (oleic acid). In fact, oleic acid is the compound in olive oil responsible for lowering your blood pressure. The oils in avocado contain first 71% monounsaturated fatty acids, secondly 13% polyunsaturated fatty acids and thirdly 16% saturated fatty acids. This mix promotes healthy blood lipids, but also helps in the absorption of fat-soluble vitamins and phytochemicals. In addition to all that avocados contain phytosterols, a number of carotenoids, non-carotenoid antioxidants, alpha-linolenic acid (an omega-3 fatty acid) and glutathione.

Cardiovascular disease protection

The combination of fiber and folate in avocado help to reduce LDL cholesterol. Oxidized LDL leads to hardening of arteries. The folate reduces homocysteine, which is a risk factor for heart disease. Phytosterols that are similar in structure to cholesterol compete with cholesterol absorption in the gut.

In a 2015 study several diets were compared with regard to LDL lowering potential, either a low fat diet, or two forms of medium fat diets, where one contained one avocado per day. The results were surprising in that the low fat diet led to a reduction of LDL by 7.4 mg/dL while the avocado diet caused a reduction of LDL by 13.5 mg/dL.

The oils in avocados also seem to suppress the appetite center in the brain helping people to eat less and controlling obesity and diabetes.

Arthritis prevention

In a 2014 study hip osteoarthritis was examined for over 3 years. Researchers could show that an extract from avocados and soybeans was protective of osteoarthritis. The anti-inflammatory components of avocado like omega-3 fatty acids, carotenoids, phytosterols and non-carotenoid antioxidants all work together in countering joint inflammation. Boron abundantly contained in avocado also was found to be essential for healthy joints.

Eye protection

Avocado has its own mixture of carotenoids, like alpha- and beta-carotene, lutein, zeaxanthin, neochrome, chrysanthemaxanthin and others. The green pulp contains these. They have anti-inflammatory properties. The fatty acid profile of avocados helps to absorb carotenoids, as they are fat-soluble. Researchers conducted a a two phase clinical study to show that avocado added to salsa or to salad was leading to a 5- to 15-fold higher absorption of the carotenoids in salsa and salad when compared to avocado-free salsa and salad.

This is an important observation that we should remember: always eat some avocado with any fruit or vegetable that contains carotenoids, as this will improve the absorption of the carotenoids tremendously.

Why is that so important for eye disease? In a 2008 study a total of 1802 women aged 50 to 79 years from Iowa, Wisconsin, and Oregon were followed who had intakes of lutein and zeaxanthin above the 78^th percentile. Researchers compared these women to women below the 28th percentiles in the Women’s Health Initiative Observational Study. This involved eye examinations in both groups. The eye specialists examined their eye lenses for nuclear cataracts. The surprising finding was that women with the highest quintile category of diet or serum levels of lutein and zeaxanthin had 32% less nuclear cataracts than women in the lowest quintile of lutein and zeaxanthin.

The conclusion was that carotenoids of avocados have vision protective effects.

Metabolic syndrome and obesity

This 2013 study included 17,567 US adults and part of the National Health and Nutrition Examination Survey (NHANES) 2001-2008. Researchers compared avocado eaters and non-avocado consumers. Interestingly, avocado eaters had a much better overall food quality in their diet. They ate more vegetables, fruit, fiber and less added sugar. Calorie and sodium intake were identical in the two groups. But body weight, body mass index and waist circumference were significantly lower in avocado eaters than in the non-avocado control group. The cardio protective HDL cholesterol was significantly higher in the avocado group. The odds ratio for developing metabolic syndrome, the change in metabolism due to obesity was 50% lower in avocado consumers than in non-consumers. All of this is good news for the consumer, if we eat some avocado.

Skin, beauty and anti-aging

We don’t like to develop too many wrinkles, as they are a sign of premature aging. The oils of avocados have been used for some time in skin care products as they stimulate collagen production in the skin and reduce wrinkles. But when you eat avocados, the carotenoid substances (such as lutein and zeaxanthin) serve for skin protection, protecting you from UV light damage. In addition, avocados contain vitamin E and glutathione, which help to scavenge free radicals. Otherwise the skin would prematurely age and wrinkle. The end result is that you see a reduction in the development of wrinkles, when you consume avocados. The beneficial effects on your blood vessels in combination with protecting your skin will age your body slower, a point that has been noted in the anti-aging literature.

Cancer blocking properties

In the following I will briefly review the findings of several cancer research groups, but this review is by no means complete.

Leukemia

This 2015 study describes a new chemotherapeutic agent, derived from avocado that they named Avocatin B. Avocatin B is active against the difficult to treat acute myelogenous leukemia (AML). It works by targeting mitochondrial components of AML, but does not affect healthy leukocytes or leukocyte progenitor stem cells.

Colon and esophageal cancer

The authors of this study from Iran describe four phytoextracts of avocado for treatment of patients with esophageal cancer and colon cancer. They noted that the phytoextracts have a much lower toxicity than standard chemotherapeutic agents and significantly slow growth of these cancers. They plan to use these phytoextracts as complementary treatments of esophageal and colon cancers.

Oral cancers

This paper describes that avocado extracts were shown to be successful in treating oral cancers.

Cancer prevention

In this paper it is discussed that the phytochemicals in avocados arrest cancer cells in their cell division cycle and lead to apoptosis, which is natural cell death. The authors believe that eating avocado regularly can help prevent a whole array of different cancers by this mechanism.

Eat Your Avocado

Conclusion

Avocados are a super food, which has many beneficial effects. Perhaps one of the outstanding effects is prevention of obesity and the metabolic syndrome as discussed. Women may want to eat it because of the beneficial effects on skin and beauty. We all should have an interest in wanting to prevent heart attacks, strokes and cancer.

But who does not want to prevent cataract surgery and keep good vision until a ripe old age? It is possible by eating avocados. And would you not want to prevent osteoarthritis? Eat avocados and add some omega-3 fatty acid from distilled fish oil as well to get the full anti-inflammatory effect. Your joints will thank you and let you swiftly move wherever you want to go.

I thought you should know about the health benefits of eating avocados. They make a nice addition to your food, not only as guacamole, but in a wide variety of dishes. Use a few slices on your salad. Make a tasty dip. And find inspiring recipes online that you can easily find and copy.

Oct

2015

There Is Help For Hair Loss

By Ray Schilling | Anti-aging medicine, Cosmetic surgery, hair loss

It is good to know that there is help for hair loss. One area where aging shows is the head! Often people who are aging are experiencing hair loss. Some individuals have a genetic trait that makes them vulnerable to early hair loss, while others are keeping their hair until a ripe old age. With regard to hair pigment it is similar: some people keep their own hair color well into their 40’s or 50’s, but later the grey hair shows. Loss of hair color is about loss of hair pigment. One or more genes regulate whether or not we lose the hair pigment early or not. While there is not much we can do about our hair pigment other than coloring our hair every 3-4 weeks, there is something we can do about hair loss on our scalp.

Androgenic alopecia

Physicians call male and female hair loss “androgenetic alopecia”. It occurs in individuals who are genetically exposed. Interestingly baldness is rare in Chinese, Japanese and in Native American populations. Baldness more commonly affects men of Caucasian descent.

Onset of hair loss

In people who are prone to hair loss baldness typically starts in the temporal areas.

The genetic factors that lead to baldness can be inherited either from father or mother’s side. They are polygenic, meaning that there is not only one cause of hair loss. Gene frequency is most commonly associated with Caucasians. In Africans the frequency is lower and lower still in American Indians, Asians, and the Inuits.

Types of hair loss

The Norwood scale is used as classification of hair loss in men. In women hair loss is classified using the Ludwig and Savin scale. This helps to record the findings of a hair examination and is useful for research purposes as well.

Hormonal factors regarding male pattern baldness

There are several hormonal factors that are involved in the development of male pattern baldness. 5-alpha reductase converts testosterone (T) to dihydrotestosterone (DHT). DHT is more powerful than testosterone, causes shortening of the hair cycle and miniaturization of hair in the balding areas. After several years those who have genetically predisposed androgen receptors in balding areas come down with baldness. There are two isoenzymes of 5-alpha reductase, type 1 and type 2. Individuals born without type 2 5-alpha reductase do not develop androgenic baldness.

Aromatase can cause baldness

Another factor for baldness can be an enzyme, aromatase, located in the fatty tissue that converts testosterone into estrogenic hormones. A lack of testosterone can lead to baldness by this mechanism. Many men in their 50’s and 60’s who are overweight or obese are balding because of this mechanism. The other mechanism, as explained above is via DHT in genetically susceptible men. This process starts to occur mostly in individuals who are in their forties.

Treatment of hair loss

Mild cases of hair loss

This may respond to topical treatment with minoxidil that can be used on the scalp as liquid or hair foam. Systemic treatment in men is possible with finasteride (Propecia) or Dutasteride (Avodart). It helps to block the hormonal pathways regarding 5-alpha reductase and DHT that leads to baldness. In aging men in their 50’s and 60’s it may be that testosterone levels are low. Blood tests can test for this: the total testosterone level should be above 500 ng/dL. If it is less, testosterone replacement by bioidentical testosterone cream or by injection should be considered and usually works quite well with respect to regrowth of scalp and body hair.

Moderately severe hair loss

This can be treated with PRP (platelet rich plasma). This treatment modality cures about 30% of hair loss. There have to be enough hair-rejuvenating stem cells around the bald skin to stimulate hair growth. However, when baldness has set in for some time in an area of the scalp with previous hair growth, there comes a point where the hair follicles die off and even stimulation with PRP will not help. When dermatologists used extracellular matrix (called “A cell”) in combination with PRP the success rate for hair growth in a bald area jumps up to 70 to 80%. The A cell material recruits stem cells from the blood that create hair follicles in the bald skin starting hair growth again.

Severe hair loss

A cell and PRP treatment are not sufficient for this. It requires more invasive treatment: the bald skin usually does not contain any hair follicles. So, what can one do in such cases? Dermatologists detected that dense hair from the back of the head (nuchal area) is transplantable to a bald skin area. It will usually grow very well there. In the beginning of doing hair transplants little discs were transplanted and this looked at times like checkered hair growth in the previously bald area. Newer research showed that miniaturized transplants with perhaps three hair follicles harvested under the microscope from the dense area and transplanted into the bald area give a smooth, natural looking appearance. These are “follicular unit hair transplants”. Nowadays hair transplant physicians will only do this type of hair transplant procedure because of the superior cosmetic result.

There Is Help For Hair Loss

Conclusion

Baldness is no longer a stigma in today’s society, particularly with males. So many men just shave off whatever hair they still have and live with baldness. However, other men and women want something done about the bald scalp; they can do so in various stages, first treat topically with minoxidil, then by trying PRP or PRP with the A cell treatment. Finally follicular unit hair transplants can restore a full head of hair where there was baldness before. In women with crown baldness follicular unit hair transplants can be very useful. This elegant method gets rid of this annoying crown baldness, and women who went for this procedure seem to be very happy with the results.

More info on hair restoration.

More info on hair loss.

References

Oct

2015

Depression Needs Treatment

By Ray Schilling | Alzheimer’s disease, Cancer, depression, Diabetes, Medical Condition, Parkinson’s disease, Vitamins and supplements

Depression is common and depression needs treatment. 10% of all men and 20% of all women have a period of depression in their lives. In people with medical illnesses depression is more common: 20% to 40% (Ref.1).

First, the peak age for depression is usually the age of 25 to 44. There are special groups where depression is also common. In adolescents 5% are affected with depression and 13% of women tend to get depressed after delivery, a condition called postpartum depression.

Second, in any age group with depression there is a risk of suicide, but with adolescents this is particularly true.

Third, about 10% to 15% of people with general medical illness are developing depression, such as patients with Parkinson’s disease, stroke, Alzheimer’s disease, cardiac disease, HIV infection, end-stage renal failure and cancer.

Causes of depression

Officially it is not known what causes depression. That is what medical textbooks say. However, other books like Datis Kharrazian’s book “Why isn’t my brain working?” offers several scenarios that can cause depression and he has examples of cases that were cured of depression (Ref.2). He points out that deficiencies in two major brain transmitters can cause depression: serotonin and dopamine.

Serotonin

First of all, serotonin is produced in the midbrain from the amino acid tryptophan in two biochemical steps. It is important to realize that these biochemical conversions require iron, vitamin B6, vitamin B12, niacin, folic acid and magnesium as cofactors. But you also need the “large neutral amino acid transporter” (LNAA) to transport tryptophan through the blood/brain barrier into the brain.

Dopamine

Furthermore, dopamine is a neurotransmitter that is produced in the frontal lobes of the brain. Notably, it is also necessary for learning. The brain synthesizes dopamine from tyrosine, which has to be manufactured in the liver from the amino acid phenylalanine. You need to have a healthy liver to produce tyrosine, which needs to be transported through the blood/brain barrier into the brain; similar to tryptophan this requires the “large neutral amino acid transporter” (LNAA). People with hepatitis, fatty liver, insulin resistance or diabetes may have problems with the LNAA transporter, which can cause dopamine deficiency (Ref.2). But they may also have low serotonin, if tryptophan did not enter the brain because of a transportation problem. This will happen with sugar overconsumption, as insulin resistance develops and affects the LNAA transporter resulting in both low serotonin and dopamine (Ref.2).

Inflammation

Finally, in the 1990’s researchers confirmed that inflammation is also a possible factor in the causation of neurological disease including depression. Ref. 2 points out that gut issues can become brain issues as inflammatory substances can leak trough a leaky gut into the blood stream and trough a leaky blood/brain barrier into the brain. Hypothyroidism can activate brain inflammation and lead to an imbalance of the neurotransmitters. Gluten sensitivity is also an important cause of depression through the inflammatory connection, but few physicians recognize the full impact of this.

Tests for depression

There are no laboratory tests that would define depression. However, every patient should receive a blood test to check for hypothyroidism, a common cause of depression. When the tests confirm hypothyroidism, the physician can easily treat this with thyroid hormone replacement.

Otherwise the physician diagnoses depression by doing a mental status examination, history and review of symptoms. A good start is to ask: “In the past 2 weeks how little interest or pleasure in doing things have you had?” and “Have you been feeling down, depressed, or hopeless in the past 2 weeks?” (Ref.3).

There are detailed psychometric questionnaires available such as the Beck Depression Inventory that can assist the physician to establish the diagnosis.

Myths of depression

One of the myths regarding depression is that it would be contagious. As a matter fo fact, a study on 2000 high school students showed that depression was not infective. The contrary was true: human interaction with friends who had a “healthy mood” improved depression. By the same token, when you constantly compare yourself with your Facebook friends, and you are not in the best mood, your mood may worsen and you could become depressed.

Treatment of depression

Despite advances in the treatment of depression the response rate with antidepressant therapy has a limit of 60% to 70%. According to Ref.4 inadequate dosing and misdiagnoses account for the fact that 30% to 40% of treated people with depression have treatment failures. Typically the first antidepressant involves a selective serotonin reuptake inhibitor (SSRI), but newer trials have shown that the older monoamine oxidase inhibitors (MAOIs) have a higher success rate when treating depression initially (Ref.4).

For example, a good antidepressant for mild to moderate depression is St. John’s wort, which is recommended by Ref. 5 as having less side-effects as other antidepressants.

In treating resistant depression the psychiatrist often employs other combinations of antidepressants. In addition the health professional recommends to add cognitive/behavioral therapy, which makes the overall treatment more successful. It goes without saying that complicated cases of depression belong into the hands of an experienced psychiatrist.

Suicides

Unfortunately a mental disease like depression still has a stigma attached to it. As a result many people are in deep denial about the fact that mental disease exists. Friends who do not understand depression may inadvertently say things that make the symptoms of the depressed person more severe and distance themselves at a time when they would need support from friends. The end result is that the patient feels lonely, misunderstood and that suicidal thoughts enter the mind. Men often resist seeking treatment for depression, women are better in seeking professional help and getting effective treatment.

Need for a psychiatrist to help prevent suicides

This is where a psychiatrist needs to intervene. If this does not happen, people start attempting suicide and finally commit suicide. In the US committed suicides have a gender ratio of male to female of 3:1 to 10:1. These situations become very difficult. The family needs to step in and talk to the patient. It is best to accompany the patient to the hospital for an assessment. You may want to go to the hospital in your private car or by ambulance. Don’t be shy to call 911 for an ambulance. Better to be cautious than have a major crisis that ends in completed suicide.

Alternative depression treatments

There are alternative treatments for depression.

Magnetic therapy for depression: This therapy is also called transcranial magnetic stimulation (TMS) and was approved for Canada and in 2008 by the FDA. But it is not as powerful according to Ref. 3 as unitemporal electroconvulsive therapy.

Bifrontal electroconvulsive therapy (ECT): Electroconvulsive therapy with two pedals applied to the front of the skull appears to have the best results in terms of treating depression.
Omega-3 fatty acids (EPA and DHA) are powerful anti-inflammatory agents, which will take care of the inflammatory component of depression. Both fish oil and krill oil in combination give the optimal response as outlined here.

Vitamin D3 and light box therapy

Vitamin D3 is also anti-inflammatory and will contribute to an improvement with existing depression, but it also helps prevent the development of depression when taken in regularly as a supplement.
Light box therapy: The observation of seasonal affective disorder (SADS) can develop as a result of lack of light. This has led to the discovery that light boxes are helpful for treating depression and also for prevention of depression due to seasonal affective disorder.

The patients should use a light box for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often it takes up to 4 weeks to reach its full benefit.

Avoid alcohol and too much sugar

It is known for a long time that alcohol is a depressant; it can actually cause depression and in persons with bipolar disease it can trigger a flare-up of that disorder as well.
Finally it matters what you eat: sugar and too much starchy foods (high glycemic index carbs) lead to insulin overproduction and insulin resistance. This causes inflammation, and this will cause depression. As mentioned earlier it also lowers the two key brain transmitters, dopamine and serotonin.

The solution is an anti-inflammatory diet, the Mediterranean diet without sugar and high glycemic index carbs; only low glycemic index carbs are part of this diet. This will normalize insulin production and eliminates inflammation.

B vitamins, electroacupuncture and exercise

Vitamin supplements: Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid often helps. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.5). Folate and vitamin B12 are methyl donors for several brain neuropeptides.
The symptoms of depression often improve with electro acupuncture, as shown in many studies. This treatment ameliorates the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.6).
Exercise on a regular basis helps to equalize the mood and seems to exert a slight anti-depressant effect on the person who engages in regular physical activity.

Depression Needs Treatment

Conclusion

I have attempted to show the complexity of depression and what we know about its causes and treatment. Very likely there are several causes for depression and further research will hopefully bring more clarity to this. Over the years psychiatrists have developed treatment modalities, both conventional and unconventional, by trial and error. The physician and patient need to use common sense: if a treatment is working, stick to it and use it. If it does not work, move on and try something else. More complex cases should be referred to a psychiatrist who has the most experience with patients that are difficult to treat. Do not neglect life-style factors and alternative depression treatments as they can often help to stabilize depression significantly. We all must be vigilant about suicide risks in depressed patients and act by calling 911, if necessary to intervene.

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

References

1. Depression, Major: Fred F. Ferri M.D., F.A.C.P., Ferri’s Clinical Advisor 2016, by Elsevier, Inc.

3. Goldman-Cecil Medicine “Major depressive disorder” 2016, by Saunders, an imprint of Elsevier Inc.

Oct

2015

Tissue Repair With Extra Cellular Matrix

By Ray Schilling | extra cellular matrix, regenerative medicine, scar tissue, wound healing

Are you ready to learn about futuristic medicine consisting of tissue repair with extra cellular matrix? On September 5, 2015 I watched an interesting documentary on Discovery Channel while working out on the treadmill in the gym. This gave me the idea that this would be good material for a blog. After a little research on the Internet I found the full extra cellular matrix story, which you can read about below.

An amputated finger grows back

Lee Spievak, a man who loves flying model aircraft had an injury to his his right middle finger. A rotating model airplane propeller chopped off the end of his right middle finger. His surgeon felt that there was nothing much that could be done. But his brother who works in regenerative medicine knew about a powder made from pig’s bladder tissue, which Dr Stephen Badylak from the University of Pittsburgh, had pioneered. His brother sent a sample of powder (extra cellular matrix, ECM) to Lee Spievak who sprinkled some on the open wound (the stump).

New tissue forming with extra cellular matrix powder

Within two applications he saw that new tissue was forming. In a matter of 4 weeks it sealed up, the wound and a new finger grew to the same length as before. In the course of 4 months his nail, skin, his feeling and even his fingerprint were back to normal.

This story happened in Cincinnati in 2005. In this news story it is explained why the ECM powder worked so well: it prevented the wound from closing and it stimulated the body to heal.

A large thigh muscle defect grows back

Marine Sergeant Ron Strang was severely wounded by a roadside bomb in Afghanistan where a large part of his left quadriceps muscle (left thigh) was ripped off. After several surgeries the surgeons decided that Ron was a good candidate for part of a trial that is ongoing involving about 80 Veterans with similar injuries. Dr. Steven Badylak from the University of Pittsburgh suggested with the next surgery to put extra cellular matrix from pig bladder into the remaining quadriceps muscle to see whether it would regrow part of it.

Surgery with addition of extra cellular matrix from pig’s bladder

The surgery followed by physical exercise was so successful that Sergeant Strang is now able to run and do all the activities he wants. There is still a scar, but in comparison to the initial injury where a big chunk of muscle was missing, the remaining scar was insignificant.

Dr. Badylak explains in the video of the link that the insertion of the sheet of extracellular matrix immediately recruits the patient’s own stem cells, which makes new muscle cells, new nerve tissue, new skin, whatever the body needs to heal what’s missing in the injured area.

Dog gut growing into a dog aorta

Dr. Badylak from the University of Pittsburgh had a veterinary medicine degree before he studied medicine and became a surgeon. From the beginning his interest was in regenerative medicine.

After he saw the success with Lee Spievak’s finger regeneration, he thought that there must be a way to regenerate other tissues. He started doing experiments on dogs where he removed part the arch of the aorta and replaced it with a piece of gut from the same dog to see whether the dog would survive and whether the gut would be strong enough to withstand the pressure from the outflowing blood in the aorta. He figured that the tubular structure of the gut would be a better template than the synthetic aorta pieces that are still in use by thoracic surgeons. To his surprise the first dog (his own dog named Rocky) survived and did well.

Dog experiments to understand how extra cellular matrix works

He accumulated data on a total of 15 dogs. All of them survived and did well. He could not understand what had happened, so he reexamined one of these dogs where he got histological samples and analyzed them under the microscope to see what was going on. What he expected was the typical findings of the gut transplant, but instead he found a new aorta with all of the histological findings of aortic tissue. There was a transformation of a piece of gut into aortic tissue!

Next Dr. Badylak repeated the surgical procedure, but this time he inserted a piece of gut from a cat, removed the lining of it (the mucosa) and the muscle layer, (the muscularis),. The remainder was only the extra cellular matrix, a thin tubular structure of ECM.

Aorta scaffolding made of extra cellular matrix survives in dogs

When he was done, he was wondering whether the body would reject the catgut ECM. After all, it came from another species. Normally with whole organ transplants one can expect rejection of the foreign tissue. None of that happened. The experiment went flawlessly: the transplant survived like all the others and again the ECM had turned into dog aorta. It was possible to integrate the extra cellular matrix into the aorta without any scar formation! None of this fitted any conventional medicine model; it was the blueprint for the regenerative medicine model.

Dr. Badylak recognized that this was a huge step forward, and he would need easy access to ECM material. He got it from the pig slaughterhouses dotting the Indiana countryside surrounding Purdue. There would never be a shortage of tissue for preparing the scaffolding of the ECM for various applications.

Repair of tissue defects with extra cellular matrix in various body regions successful

By now the surgeon had proven that the gut or ECM transplant was switching off an inflammatory reaction, which suppressed scar formation, and simultaneously promoted regeneration. But the missing puzzle still was how the body generated the aortic tissue.

Dr. Badylak tested whether the procedure would work for large veins, smaller arteries and Achilles tendons. He did this all in dogs and using pig’s ECM. The answer was it worked all beautifully with no scarring and perfect healing results. Control dogs did not get the ECM, but were only operated on and then repaired conventionally in their Achilles tendons. They developed a limp from scar tissue. This is what often happens in humans as well with conventional surgery. But none of the dogs that had 3 cm cuts and then received a treatment with pig’s ECM developed a limp or scarring. They healed perfectly.

Large company supports Dr. Badylak’s work

In 1992 DePuy licensed Badylak’s ECM-derived “biologic scaffolds” for all orthopedic applications. DePuy is a big company that makes supplies for hip and knee replacements and much more. This was an ideal support for Dr. Badylak’s work.

In 1999 the FDA approved pig’s bladder ECM for human applications. This included the use of pig’s ECM for shoulder rotator cuff tears in patients. The FDA also approved it for abdominal hernias and for esophageal reflux damage. In addition the FDA approved it to induce the regrowth of the outer lining of the brain following brain surgery.

He could now continue his research and find out what the missing puzzle was. How did the body use the pig’s ECM and repair tissues?

Stem cell recruitment by ECM

Dr. Badylak was visiting a colleague of his in Los Angeles, Dr. John Itamur who had previously repaired a rotator cuff tear on a patient 8 weeks earlier using porcine ECM. The same patient had an unrelated shoulder injury. This required surgery just adjacent to the previously repaired rotator cuff. The surgeon decided to take a small biopsy to see how the healing tissue looked. This was when Dr. Badylak came for a visit. The microscope showed a surprise: the scaffolding had disappeared as expected. But there were a lot of new cells there. They did not look like inflammatory cells, muscle cells or nerve cells; they were stem cells. Dr. Badylak read several papers that told him that ECM breaks down into so-called crypteins. These peptides have powerful stem cell recruiting properties.

Experiment show how extra cellular matrix recruits stem cells

In 2003 he started groundbreaking experiments in mice that proved this theory to be correct. He X-rayed a group of mice to kill all of their bone marrow stem cells. Then he injected stem cells tagged with a fluorescent marker. They repopulated the bone marrow with these tagged stem cells from the same strain of mice. Now he removed a piece from the Achilles tendon and repaired the defect with pig ECM. Stem cells tagged with a fluorescent marker were flooding the Achilles tendon repair area. Even months after the Achilles tendon repair with ECM the new Achilles tendon was still filled with some of these tagged cells showing that some of them had matured into regenerated tissue.

Video showing would healing with extra cellular matrix and the final outcome of dog Rocky

Here is a link that contains a video about Sergeant Strang and his severe leg injury (repair of a rectus muscle tear). You may wonder how Rocky, the initial dog did who had an aortic segment replaced by a piece of gut. Rocky lived for another 8 years and was healthy until the very end.

Tissue Repair With Extra Cellular Matrix

Conclusion

You saw how the observation of a healing finger turned into experiments on dogs. Aortic defects and Achilles tendon defects healed without scarring. You learnt how pig’s or cat’s ECM were in use as scaffolds and that the body absorbed this. They recruit stem cells from the host’s body that subsequently do the healing. The exciting news about ECM is that it promotes healing, recruits stem cells, but also suppresses inflammation and scar formation.

We already hear that ECM is used in hernia repairs, rotator cuff repairs for shoulder injuries, and also in hair transplants, where Acell material is mixed in to improve the transplant success.

It is being used in lower esophagus surgery in cancer cases and with reflux esophagitis.

What will be the next application for ECM? We do not know everything, but it is a promising step into the future of regenerative medicine!