Medical Articles by Dr. Ray

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.

Aug

2023

New Diabetes Testing Recommendations

By Ray Schilling | Diabetes

Notably, the American Association of Clinical Chemistry (AACC) and American Diabetes Association (ADA) announced new diabetes testing recommendations. The document is entitled: “Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus.” It is directed mainly at laboratory physicians and clinicians treating diabetes. David B. Sacks, MBChB, chief of the clinical chemistry service at the National Institutes of Health (NIH), Bethesda, Maryland, and co-authors stated the following: “The guidance is focussed on the practical aspects of care in order to assist with decisions regarding the use or interpretation of laboratory tests while screening, diagnosing, or monitoring patients with diabetes.”

Continuous glucose monitoring

It is important to realize that since 2011 new technologies regarding blood glucose monitoring have come out. Another key point is that continuous glucose monitoring (CGM) is a new method to monitor blood glucose. This device attaches to the upper arm and a very fine needle punctures the skin. The device stays there for 14 days. Using blue tooth technology, you can then record your continuous sugar levels in relation to your meal intakes with your iPhone.

This blog contains more information regarding continuous glucose monitoring:

Here is the target population for the use of CGM:

teens and adults with type 1 diabetes
children with diabetes
pregnant women with type 1 diabetes
adults with type 2 diabetes taking insulin

Test accuracy

Co-author M. Sue Kirkman, MD is from the University of North Carolina, Chapel Hill. She mentioned that the accuracy of blood tests for patients with diabetes is not always reliable. She said: “We do a lot of testing in screening, diagnosis, and monitoring of diabetes and its complications, yet for many clinicians we think that any result we get – or that a patient gets from home testing – is perfect. We often don’t think about the accuracy or precision of some tests, things that might interfere with the result, intra-individual variation of the test, or how one test may compare to a test of higher accuracy.” She also added that blood samples when not properly processed can have inaccurate blood sugar levels in them (blood sugars too high or too low).

Initial diagnostic diabetes tests

In the past the initial diabetes test included either an A1C level, a fasting glucose, or an oral glucose tolerance test. But Dr. Kirkman noted: “There is large intra-individual variation of fasting glucose and even larger for 2-hour glucose on the oral glucose tolerance test…This means if you do the test one week and then repeat it the next day or a week later, the results will be quite different. This is a reason why confirmation of an abnormal test is important. Yet many times this isn’t done.”

Strong recommendations based on high research evidence

Measure fasting glucose in venous blood to establish the diagnosis of diabetes. The diagnostic cut-offs for diabetes are more than 7.0 mmol/L (or more than 126 mg/dL).
The guidelines recommend frequent blood glucose monitoring for patients with diabetes who are on insulin therapy. Those patients who are on multiple daily injections or insulin pump therapy, but are not using CGM.
Frequent blood glucose monitoring is recommended for all people with diabetes treated with intensive insulin regimens. This involves multiple daily injections or insulin pump therapy, but not using CGM.

Further comments

There is a new recommendation that patients whose diabetes is under control by diet and oral hypoglycemic pills alone no longer need routine blood tests.
The American Diabetes Association (ADA) recommends that the treatment goal is that the A1C should be less than 7% (less than 53 mmol/mol). The proviso is that this is achievable without causing hypoglycemic attacks.
The physician should do annual testing for albuminuria 5 years after diagnosis of type 1 diabetes. At the time of diagnosing type 2 diabetes albumin in the urine is tested regardless of the treatment modality.

New Diabetes Testing Recommendations

Conclusion

Recently the American Association of Clinical Chemistry (AACC) and the American Diabetes Association (ADA) announced new guidelines for the diagnosis of diabetes. These guidelines contain new recommendations regarding the testing of blood sugar, hemoglobin A1C and continuous glucose monitoring. It depends on the severity of the diabetes. In some patients their diabetes is under good control by diet and oral hypoglycemic pills alone. They no longer need to do glucose monitoring. But other patients with diabetes without good control need to do glucose monitoring and regular A1C testing. Some patients even have to do continuous glucose monitoring. The goal is to bring the A1C to less than 7% (less than 53 mmol/mol) to prevent complications from diabetes. These consist of diabetic neuropathy, diabetic retinopathy, diabetic nephropathy and vascular complications.

Aug

2023

About your Bowel Movements

By Ray Schilling | Abdominal Pain, coffee, exercise, fiber, food

This article is about your bowel movements. Dr. Michael Camilleri is a consultant and professor in the division of gastroenterology and hepatology at the Mayo Clinic in Minnesota. He mentioned that in the Victorian era it was thought that a person should have a bowel movement every day. But now gastroenterologists agree that three bowel movements per week are satisfactory. If you don’t have that spontaneously, you are said to suffer from constipation. On July 12 CNN published a review about the same topic.

But other people who consume a lot of fiber may have a bowel movement two or three times a day. This, too is considered normal. But in addition to the frequency of bowel movements the consistency of it is very important as well. “The stool form, appearance or consistency of the bowel movement is actually a much better criterion than the simple numbers to frequency,” Camilleri said.

Bristol stool chart

The Bristol Stool Chart classifies stools into seven groups. With this in mind, the healthiest types of stools are types three and four. This is where the stool is shaped like a sausage with cracks on the surface or snakelike and smooth.

Experts say that if you are excessively straining during an attempt to poop or if you feel like you have not totally emptied after a bowel movement, you have to make changes. Either you need to poop more often or you need to get a healthier stool quality.

Your body posture influences the ease of your bowel movements

If you put your feet on a stack of books, this raises your knees above your hips. In that position your pelvic floor muscles relax, which supports your bowel. The end result is that poop passes through more easily. This advice comes from Dr. Trisha Pasricha, a gastroenterologist at Massachusetts General Hospital and instructor of medicine at Harvard Medical School. She commented further: “We did not evolve to have our bowel movements sitting with our hips at 90 degrees on a chair, which is what we do now. We used to all have bowel movements squatting. Sitting at that sort of upright, 90-degree angle actually closes off the passageway.”

Proper food intake necessary for a good bowel movement

Start with a Mediterranean type diet, which consists of a lot of vegetables, salads, fruit, whole grains and nuts. According to the FDA the daily fiber load should be about 25 grams or more. Kiwis and prunes are useful as a dietary fiber source. On the other hand, you don’t want to overdo the fiber intake as it can cause abdominal bloating and loose stools. A high fat diet slows your digestive system down. But caffeine and caffein containing beverages stimulate your bowels. In addition, regular physical exercise gets your bowels moving.

Constipation

Constipation is an important symptom that prompts patients to see their physician. There seems to be a lot of confusion in the general public about this topic. There are enormous cultural differences. For instance, in Africa where the population eats on average a much larger amount of fiber, the bowel movements are much bulkier.

Sir Dr. Burkitt, the famous English surgeon, examined bowel movements (stools) of African tribes in comparison to his English countrymen and came to the conclusion that in the Western world we need to remedy our constipation problem and cancer of the colon problem by eating more fiber.

What we know now

He is still right: fiber is mainly treating constipation (not preventing cancer of the colon), but the chemicals that are also in the vegetables contain a multitude of natural anti-carcinogenic substances, which provide the powerful preventative action against colon cancer and many other cancers. Lycopene is one of these. Tomatoes and tomato products contain it.

Sir Dr. Burkitt’s observation that high bulk food (with vegetables and green leaves) prevents cancer is as valid today as it was in the early part of the 1900’s.

Chronic constipation

Chronic constipation cases that start insidiously, but then remain despite taking a high fiber diet, make the doctor think about other underlying causes such as hypothyroidism (= low thyroid function) or metabolic causes such as hypercalcemia and uremia from early kidney failure.

We find that elderly people become too inactive. This lowers the natural peristalsis of the gut. In combination with poor eating habits and chewing problems because of poor teeth it is often responsible for chronic constipation. Also, elderly people often are on multiple drugs, all of which have a weak “anticholinergic” side effect, which translates into suppressing peristalsis chemically resulting in constipation. Psychogenic factors and chronic depression as well as obsessive-compulsive behavior can also feed into constipation. It can lead to a hyper awareness of one’s own bowel pattern. This is unhealthy and requires counselling. But first the doctor must rule out any serious cause of chronic constipation.

Treatment for constipation (simple steps that help)

As mentioned above, the patient has to modify the food intake to include as much fresh and steamed vegetables as possible. This will lead to bulk in the colon and make the stool softer thus allowing it to pass through the rectum and anal canal easier. The other advantage of this simple step is that the bulkiness of the stool triggers the normal peristalsis movement of the colon moving the contents towards and through the rectum. Decreasing the passage time in the colon allows less water absorption, keeping the stool soft and pliable until it leaves through the anal canal. This is easily achieved by a diet rich in fruits and vegetables. Cereals containing bran like slow rolled oats (not instant oats) are also useful when taken with breakfast. Cut down on meat and fat consumption.

Enema with lukewarm water

A simple tool for chronic constipation is an enema with lukewarm water (1500 ml or 50 fl.oz.) in a Faultless enema bag without any additives in it. The person who gets the enema needs to lay on the left side. This way the water can flow in easily into the colon. When entering the nozzle into the anal canal, do not force it. Instead use a bit of Vaseline ointment to facilitate entrance. The response usually comes within 5 to 10 minutes following the enema. It works by dilatation of the bowel wall, which leads to a reflex bowel contraction. Although it would be safe to take this every day, usually you should not have to take it more than two or three times per week even in chronic constipation.

Extra fiber (bulking agents)

Next, if this is not tolerated or does not appeal to the patient, I would recommend a bulking agent such as psyllium (brand names: Prodiem Plain, Metamucil, Novo-Mucilax) and bran (Brand names: Kellogg’s All Bran and Post’s bran flakes). These are mild laxatives, which are safe to take every day and which will not make the patient hypokalemic.

Osmotic agents

Osmotic agent: One or two tablespoons of sorbitol as a 70% solution is a hyperosmotic solution, which stays in the gut and draws water by osmosis into the colon. The bulking effect creates peristalsis and the water retention makes the stool softer. It takes often 1 or two days to get the full effect. There can be transient abdominal cramps until the stool is passed. One variation of this theme is to give sorbitol in a mix with other osmotic agents as a micro-enema in the form of Microlax (from Pharmacia and Upjohn).

The emergency break (laxative)

The “emergency break”: Occasionally all of the above is simply too weak. The constipated person normally is controlled with the above measures, simply could not go to the bathroom for several days. Bisacodyl (brand name: Dulcolax) and sennosides (brand names: Ex-lax Sugar-Coated Pills and Senokot products) can help you unload any held back stool on a one-time only basis. Increase your vegetable and fruit intake, cut down on refined foods and fatty foods, which are devoid of fiber.

About your Bowel Movements

Conclusion

Because of its role in nutrient absorption and body detoxification the digestive system plays a direct role in overall health and wellness. When the colon is unclean, waste and toxins can become trapped. This places an extra strain on the detoxification organs (kidneys, liver) and weakens the immune system causing illness. It is therefore important to watch that your bowel movements are regular. When chronic constipation sets in there are several measures, we can take to keep our bowels moving. I explained this in detail above.

Jul

2023

Learn about Longevity from the Blue Zones

By Ray Schilling | diet, Fitness, Health, lifestyle, Mortality, Nutrition, Processed food, red meat, sleep

People who live in blue zones often turn 100 or older, so we can learn about longevity from the blue zones. The 5 most often cited blue zones are in Okinawa, Japan; Sardinia, Italy; Nicoya, Costa Rica; Icaria, Greece; and Loma Linda, California, United States. But there are many more blue zones throughout the world. These zones contain the most centenarians, people who have reached the age of 100. It is thought that it is the people’s lifestyle that makes them live much longer than the rest of the world.

Lifestyle of centenarians

People are active, are bicycling, walking, swimming, constantly on the go and they are careful about what they eat. They stay slim, but are muscular. Their diet consists mostly of vegetables and salads, with very little meat. They may consume a small piece of beef on Sundays, but not during the rest of the week. Fish may be a part of their diet two or three times per week.

Diet characteristic of blue zones

Sandee LaMotte published an article on March 4, 2023 at CNN, which describes the diet consumed in blue zones. People in blue zones are active, handle stress well, are close to friends, have a purpose in life and are often members of a social or religious group. They eat mostly a plant-based diet and they stop eating before they are full.

The food consists of complex carbohydrates. No processed foods are eaten. The American Heart Association says: “Complex carbohydrates, such as beans, peas, vegetables and whole grains provide vitamins, minerals and fiber that can go missing in processed and refined foods. In addition, they are digested more slowly, and the fiber helps you feel full longer.”

Origin of blue zone foods

The blue zone food has its roots in the African, Asian, Latino and Native American diets. Dan Buettner originally published an article about the blue zones in the National Geographic Magazine. Recently he published a collection of 100 blue zone recipes in book form.

The Mediterranean diet is very close to blue zone eating.

What blue zone meals contain

Buettner said: “The five pillars of every longevity diet, including the blue zone, are whole grains, vegetables in season, tubers, nuts and beans. In fact, I argue the cornerstone of a longevity diet is beans.” People in blue zones eat similar foods as those who eat a Mediterranean diet, but they do not eat as much fish as people on a Mediterranean diet. People on a blue zone diet don’t eat any milk products. On the other hand, goat and sheep’s milk cheeses such as feta and pecorino are part of the blue zone diet. In the blue zones the consumption of purple sweet potatoes, sesame seeds, fresh vegetables and fruit are the major staples.

More info about Blue Zone diet

All of the meals contain complex carbohydrates, micronutrients and a whole variety of fiber.

Perhaps the important difference to the Standard American diet is that in the blue zone there is a lack of beef, hamburgers, processed foods and highly processed carbohydrates like bread, pasta, sugar-sweetened beverages, salty snacks like potato chips, candies, cookies and processed meats (bacon, sausages or cold-cuts). People in blue zones eat very little bread and if they do, they eat sourdough bread, which does not raise the blood sugar level as the highly refined white bread.

Recapturing healthy foods

So, what foods are blue zone people really eating? Tofu, quinoa, mushrooms, lentils, beans, turnip greens, artichokes, asparagus, chickpeas and spinach are the main staples of their nutrition. They stay away from sugar, rarely eat meat (once or twice per week) and otherwise have a healthy lifestyle. Scientists think that longevity comes from the healthy lifestyle and diet, which centenarians practice. Several longevity genes get activated as explained in this publication. This translates into living long lives with very few illnesses and experiencing energy until the end of their lives.

Learn about Longevity from the Blue Zones

Conclusion

We can learn a lot from observing what centenarians eat and do. Scientist have investigated the lifestyle of people living in blue zones in various parts of the world. These zones contain the most centenarians, people who have reached the age of 100. People in blue zones eat mostly vegetables and very little red meat. They avoid sugar and processed foods. But they are also very active, have a rich social life and allow themselves enough sleep. Scientists accumulated evidence that genetic longevity switches are activated by the life style of people living in blue zones. It is the activation of these epigenetic switches that are responsible for the longevity of people in blue zones.

Jul

2023

Poor Health is Linked to Loneliness and Social Isolation

By Ray Schilling | Anxiety, Cancer, Cardiovascular disease, depression, heart attack, Heart Disease, Mortality

In June 2023 a new study showed that poor health has a link to loneliness and social isolation. It was also reviewed by CNN. There have been many studies in the past examining whether poor health shows an association to loneliness and social isolation. But this new study is different: it is a meta-analysis of 90 prospective studies with follow-up from 6 months to 25 years. The study included only persons age 18 years and older. There was a total of 2.2 million participants. The study specifically examined the links between loneliness, social isolation and early death.

The Meta-analysis

This new meta-analysis is significant, because with such a high number of participants the statistical strength is much better than with smaller studies. All of the 90 studies examined were prospective studies. The meta-analysis showed the difference between controls and various experimental groups suffering loneliness, social isolation and early death. The researchers identified independent risk factors of subsets among the 2.2 million subjects as discussed further below.

Loneliness

The definition of loneliness in the study was the subjective distress people feel when there is a discrepancy between the social relationships they have and what they want. If their is no fulfillment of the need for connection or intimacy in their relationships, this too can be a source of loneliness. There is increased isolation of Americans due to the increase in TV watching, spending more computer time and increase in cell phone use. This is loneliness by choice. But very few know that this can cause disease.

Social isolation

When people are under social isolation, they are under chronic stress, which translates into disease. In the statistics below it is apparent that cancer and cardiovascular mortality show a significant elevation from social isolation. In women with breast cancer there was a 51% increased mortality due to social isolation.

Findings of the study

Here are the findings form the metaanalysis. All the findings of patients suffering from loneliness and social isolation were in comparison to control groups without social deprivation.

There is a 32% all-cause mortality from loneliness and social isolation
Loneliness is responsible for a 14% increase in mortality compared to those who are not lonely
There is a 24% increased cancer mortality due to social isolation
Social isolation is responsible for a 34% increase of cardiovascular mortality
Socially isolated individuals with cardiovascular disease had a 28% increased all-cause mortality
Socially isolated women with breast cancer had a 51% increased all-cause mortality

Life style factors part of loneliness and social isolation

Turhan Canli, a professor of integrative neuroscience in the department of psychology at New York’s Stony Brook University had no involvement in the study. He said: ”People who feel socially isolated or lonely tend to have unhealthy habits, such as smoking, alcohol use, poor diet or little exercise. Having a small social network or little to no contact with the outside world can also make someone less likely to receive medical care if they don’t have anyone checking on them.”

Broadening social connections

We learnt how devastating loneliness and social isolation are for your health. It follows from this that the solution is to concentrate on broadening social connections as a preventative measure. Canli said: “Think of maintaining a social network like any other health-promoting activity: exercising regularly, eating well, looking after yourself.” Cultivate your social connections with a higher priority than in the past. Engage in new circles of like-minded people. Seek opportunities out like joining an exercise class or a discussion group.

Conclusion

Loneliness and social isolation are a real entity that threatens all of our health. A meta-analysis of 90 prospective studies (6 months to 25 years of follow-up) including more than 2 million people showed the following. There is a 32% all-cause mortality from loneliness and social isolation. Cancer mortality is up 24% due to social isolation. Socially isolated individuals with cardiovascular disease had a 28% increased all-cause mortality. Socially isolated women with breast cancer had a 51% increased all-cause mortality. There were more findings than these. Overall, this stresses the importance to cultivate your social connections, which prevents social isolation and loneliness. You will stay healthier for longer and not die prematurely.

Jul

2023

What to Do about Hot Flashes in Menopause

By Ray Schilling | Hormones, Insomnia, Menopause

This article is regarding what to do about hot flashes in menopause. It is important to realize that 80% of women who transition to menopause develop hot flashes and night sweats. Notably, this happens between 45 years and 55 years for most women. Another key point, two methods to fight menopause are non-hormonal methods including a new FDA approved drug and estrogen/progesterone therapy to replace missing hormones. Below I am reviewing both methods.

Non-hormonal methods to fight hot flashes

June 7, 2023 CNN published a review article about non-hormonal methods to fight hot flashes. In the article health professionals pointed out that there are a number of steps that the menopausal woman can take to lower the number and intensity of hot flashes. Indeed, menopausal symptoms include not only hot flashes, but also chills, night sweats, sleep problems, mood changes, vaginal dryness and pain during sex. It is important to realize that some women are not good candidates for hormone therapy, because they have a family history of estrogen-dependent cancers, cardiovascular disease, stroke, blood clotting disorders, deep vein thrombosis and chronic liver disease. The North American Menopausal Society just published the 2023 update to their recommendations for non-hormone therapy of menopause.

A new drug blocking hot flashes and night sweats

In this recommendation a new FDA approved drug is included. The pharmacological name is fezolinetant, the brand name is Veozah. To point out, this drug targets the neural activity in the brain that causes hot flashes and night sweats. It binds to the NK3 receptor, which regulates body temperature. The end result is a block of the KNDy (pronounced “candy”) neurons in the brain. To emphasize, these consist of kisspeptin, neurokinin B and dynorphin. The initials led to the abbreviation of the KNDy neurons (pronounced “candy”). To explain, the most common side effects are nausea and headaches. The only other medications that the FDA recognizes as effective for hot flushes and night sweats are low dose SSRI antidepressants.

Other recommendations of the 2023 non-hormone therapy of menopause update

By all means, triggers like caffeine and alcohol overconsumption and smoking should be avoided. Weight loss and cognitive therapy are reducing hot flashes. Clinical hypnosis is also effective as a treatment, as is Gabapentin. Specifically, a low-fat, plant-based diet and a half-cup of cooked soybeans per day led to a 88% reduction in moderate to severe vasomotor symptoms (hot flashes). Researchers compare this to a group with no dietary changes over 12 weeks.

Despite all of these measure menopausal women on hormone replacement did feel a lot more improvement.

Hormone replacement with estrogen and progesterone

Before we discuss this further a quick review of the Women’s Health Initiative in 2002 is necessary. This was a large study that showed that on Premarin and Progestin, two synthetic hormone products, women came down with breast cancer, heart attacks, stroke, and thromboembolic events. They were using the synthetic drugs conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using hormones from drug companies rather than compounded bioidentical hormones. But these synthetic hormones were not pure hormones; they were adulterated with side chains. These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in form of breast cancer, strokes and heart attacks.

European trials regarding bioidentical hormone treatment

However, studies in Europe showed over many years that hormone replacement with bioidentical estrogen and progesterone creams from compounding pharmacies have no deleterious side effects, but replace the action of the missing hormones in menopause. Women lose their hot flashes and night sweats, regain their previous energy and sleep again through the night. Here is a link what the Mayo Clinic recommends to treat menopause.

Present day recommendation from regenerative physicians

The key about hormone replacement after menopause is to balance estrogen replacement with bioidentical progesterone. The ratio of the two hormones needs to be about 200:1 (or higher) for progesterone versus estrogen. Estradiol, which is the main estrogen in women is a mild carcinogen when not properly balanced with progesterone. By having higher progesterone dosages for hormone replacement, the body is protected from cancer and other side effects. Dr. John Lee years ago coined the term “estrogen dominance”. He also recommended the ratio of 200:1 of progesterone versus estrogen to balance the two hormones. A postmenopausal woman can apply a bioidentical BiEst cream (estrogen) to her skin and combine this with a bioidentical progesterone cream. Alternatively, she may prefer to take oral progesterone (Prometrium) 100 or 200 mg at bedtime. These tablets consist of crystallized bioidentical progesterone. None of this will cause cancer or other detrimental conditions.

What to Do about Hot Flashes in Menopause

Conclusion

Recently a publication describes a new drug that helps with hot flashes. The pharmacological name is fezolinetant, the brand name is Veozah. It blocks special neurons in the brain that are responsible for hot flashes. But possible side effects of this drug are nausea and headaches. Contrary to this there is no side effect with bioidentical hormone replacement when the physician balances the concentration of estrogen and progesterone. In this case the hormone balance prior to menopause simply returns. In this case her hot flashes and other menopausal symptoms simply stop. Anti-aging physicians in Europe have shown decades ago that the described combination of BiEst and Prometrium is safe, contrary to the synthetic drugs that were used in the Women’s Health Initiative where women died from heart attacks, breast cancer and blood clots.

Jun

2023

Telomeres can Protect you from Premature Aging

By Ray Schilling | lifestyle, Mortality, telomeres

Longer telomeres can protect you from premature aging, and shorter telomeres lead to premature death and various diseases. But recently new research showed that sometimes longer telomeres can be responsible for cancer and lower life expectancy. I will discuss this further below.

Some facts about telomeres

Telomeres are the caps on the chromosomes that do not contain genes, but are important for cell division. When cells divide, the DNA with all the genetic information about us replicates. With cell division each copy of our DNA ends up in a new cell, but the telomere gets shorter with every cell division. The enzyme telomerase is able to lengthen our telomeres. A healthy Mediterranean diet, regular exercise, not smoking cigarettes, sleeping 7 or 8 hours every night are all factors that stimulate elongation of our telomeres. When telomeres are short, they can no longer divide, but the cells turn into senescent cells. They no longer divide, but they stay metabolically active and are significant in the diseases of the aging. They cause osteoarthritis, hardening of the arteries and cancer.

Mice with hyper-long telomeres live much longer than control animals and they have lower LDL cholesterol levels.

Animal studies confirm that short telomeres mean shorter lifespan

There were animal studies that showed that telomeres shorten more slowly in long-lived birds and mammals.

A study looked at the telomere shortening rates of different animal species. They found that those species that had the fastest telomere shortening rate were also the ones with the shortest life span.

Shorter telomeres can also cause several chronic health conditions.

Telomerase helps to keep telomeres from shortening

An important ingredient in every body cell is the enzyme telomerase. It attaches to telomeres and adds DNA to telomeres thus elongating them. Many healthy lifestyles increase telomerase and help shortened telomeres to get longer again.

What preserves the length of your telomeres?

I have previously reviewed factors that elongate telomeres. Here is a summary of this information.

Telomere length enhancers

Lifestyle changes can have positive effects on telomere length. Examples are smoking cessation, weight loss and stress reduction.
Dietary changes: we know that fish oil (omega-3 fatty acids) supplements elongate telomeres as does a low-fat diet.
Supplements like vitamin D3, antioxidants (vitamin C and E) and astragalus (TA-65) elongate telomeres as well. The astragalus supplement, TA-65 showed a significant elongation of telomeres after 12 months while controls lost telomere length.
Exercise: in a 24-week experiment of care workers regular aerobic exercise increased the telomeres by 67.3 base pairs.
Bioidentical hormone replacement in aging people: when hormones are missing after andropause and menopause, the natural hormones need replacing, or the telomeres are shortening.
High cortisol levels cause telomere shortening.
Human growth hormone elongates telomeres via telomerase activation.
The fasting mimicking diet (FMD) was shown to extend life and telomeres as well.

Conflicting research about longer telomeres

A publication in the New England Journal of Medicine dated May 4, 2023 showed that patients with a POT1 mutation had long telomeres. This mutation caused cancers, brain tumors, B- and T-cell lymphomas and bone marrow cancers. The long telomeres facilitated cancer growth. Normally this type of mutation is rare and in patients without this mutation long telomeres would lead to longevity.

Dr. Joshua Berkowitz, the Medical Director of IV Boost UK, said that further research needs to focus on the following: “Identifying genetic and epigenetic factors that contribute to aging and longevity, understanding the role of the microbiome in aging and longevity, and investigating the role of senescent cells in aging and age-related diseases.”

Telomeres can Protect you from Premature Aging

Conclusion

Our telomeres are needed for cell division. When telomeres get shorter with age there is a consensus that this leads to a potentially dangerous situation. The cells turn into senescent cells. They no longer divide, but they stay metabolically active and are causing the diseases of the aging. These are osteoarthritis, hardening of the arteries, cancer and many more. On the other end of the spectrum with regular exercise, a Mediterranean diet and a normal weight, telomeres can get elongated, which for most people means a longer life expectancy. However, recent research showed that patients with a POT1 mutation are vulnerable to facilitating cancer growth and premature death. Fortunately, the POT1 mutation is rare. Future research will clarify what the safest way is to achieve longevity.

Jun

2023

More Stem Cell Treatments of my lower Cervical and upper Thoracic Spine

By Ray Schilling | Arthritis, stem cells

Previously treated, I now needed more stem cell treatments of my lower cervical and upper thoracic spine. I reported before about stem cell therapy of my left knee and my spine. My knee continues to do well. I go to the gym for regular exercises and do ballroom dancing with my wife.

But my lower neck started aching again after about 3 months. Surprisingly, the lower back stayed well. This is where I had stem cell treatments of the facet joints of L4 to S1 one year earlier. I have chronically poor posture in the lower cervical/upper thoracic spine. It is not surprising that some of the symptoms of chronic pain in my lower neck/upper thoracic spine came back. My chiropractor told me that it was the C4/5 area of the lower cervical spine and the T3/4 area of the thoracic spine, which were stiff and likely caused my recurrent pain.

Specific details of my repeat stem cell treatment

I saw Dr. Weber on March 27 and 28. He did a liposuction on March 27, 2023. The fat sample was processed in a cell separator to get a highly concentrated stem cell fraction. I received a portion of this in normal saline intravenously. On March 28 Dr. Weber inserted interstitial needles right down to the facet joint bones of C4/5 bilaterally and to T3/4 bilaterally. Each side received 1.5 ml of stem cells and PRP. PRP stands for platelet rich plasma, which contains growth factors to stimulate the stem cells. I explained this in detail under the above link regarding last year’s treatment. Subsequently Dr. Weber used several laser frequencies for 20 minutes each to stimulate the injected stem cells, after which he removed the interstitial needles.

Follow-up following stem cell treatment

For about two weeks I felt a slight increase of pain in the injected areas. But using the Weber Laser watch with extension I treated the lower neck/upper back daily. This halved the pain and made it acceptable. In the third week after treatment, I occasionally forgot to treat with the laser, because the pain had improved. In the fourth week after the treatment, I treated my neck and upper thoracic spine only two to three times per week. My range of motion in the neck has improved by about 30%. My dance instructor noted that my upper back posture has significantly improved.

Discussion

When you read about stem cell treatments, you often get no information about follow-up data. Others tell you that one treatment would be good for 10 to 15 years. My own experience tells me differently. My left knee seems to be cured of the degenerative changes it presented with before. But my lower neck/upper thoracic spine suffered postural problems and stiffness since age 12. This means that we are trying to cure 66 years of poor posture with one session. Obviously, this is not likely to happen. I can be glad, if there is a gradual improvement and that pain issues are dealt with as time goes on. The good news is that stem cells will always be in my fat tissue as a potential resource. If needed, I can always return in 1 or 2 years and have another stem cell treatment to my lower neck/upper thoracic spine area and see more improvement as a result of this.

More Stem Cell Treatments of my lower Cervical and upper Thoracic Spine

Conclusion

Stem cell therapy from your own fatty tissue is an accepted treatment modality for degenerative changes in joints. These joints can be knees, hips, but also the small facet joints along the spine. Here I am describing a follow-up treatment for lower cervical/upper thoracic spine pain. One treatment alone may not give you complete relief. But stem cell treatments can be repeated in the next one or two years to get more relief than before. I do not know how many more treatments I will need, but I know that there is considerable improvement for a 66-year-old postural problem even now after two stem cell treatments. Time will tell, if I will become completely pain free. The important message to learn from this is that stem cell therapy can be repeated when it is only partially effective. You carry with you an endless supply of stem cells that you can tap into when you need it. And you can be certain that each treatment will result in improvement.

May

2023

Lung Cancer Screening Program

By Ray Schilling | Cancer, lung cancer, Smoking

In 2013 the US Preventive Services Task Force recommended a yearly lung cancer screening program. The target population was age 55 to 80. Specifically, this program was to screen people who currently smoke, or had quit within the last 15 years and had a smoking history of 30 or more pack-years. Screening occurs with a special CT scan using low-dose radiation for lung screening. In the US Medicare and Medicaid reimburse residents for the cost of this procedure. The BCMA Journal describes the introduction of a similar lung cancer screening program in BC since May 2022. In the US the lung cancer mortality experienced a 20% drop since the introduction of the lung cancer screening program. This is because physicians now find lung cancer at stage 1 where treatment with surgery, radiotherapy or chemotherapy is much more effective.

Feasibility of a lung cancer screening program

Typically, with the conventional plain X-ray screening of symptomatic patients 40% of them, which radiologists diagnosed had lung cancer at a late stage, namely stage 4. At that stage the 5-year survival is less than 10%. However, now they diagnose patients with early lung cancer at stage 1 using a low-dose CT scanner with the lung cancer screening program. At this stage the 5-year survival rate is 73% to 90%. We know that the main lung cancer cause is cigarette smoking, the second cause is the aging process.

Lung cancer screening program free for patients

Similarly to the US the government sponsors the BC Lung Cancer Screening Program with no cost to the patient. With yearly checks the low-dose CT scanner detects early lung lesions that are highly suspicious of lung cancer. The screening program includes the higher age group and the ones who were heavier smokers. This is the highest lung cancer risk group, which benefits most from the lung cancer screening program.

What happens when the lung cancer screening program identifies early lung cancer?

With all the nodules that the CT scan screening finds, some have the features of suspicious nodules that require biopsy to check histologically whether or not there is lung cancer present.

Various methods to do lung biopsies

The simplest way for the physician to do this is by way of a bronchoscopy, where he inserts a needle into the nodule and retrieves a tissue sample. The pathologist analyzes this biopsy under the microscope. Not all suspicious nodules are within easy reach by bronchoscopy. If a lesion is located close to the lung surface the physician can do a needle biopsy through the skin (transcutaneous biopsy or transthoracic biopsy). Some patients require a biopsy using video-assisted thoracic surgery, which is performed under general anesthesia. Other patients require an open biopsy, which the chest surgeon performs under general anesthesia. In this case the chest surgeon opens the chest cavity and removes a piece of lung tissue, which the pathologist later analyzes for cancer.

Test to determine the extent of the lung cancer

The lung cancer stages are: stage I, II, IIIA, IIIB and IV. Following the initial X-ray, the physician will order an MRI or CT scan in order to determine whether the lung lesion was the only finding or whether there were metastases nearby. The MRI/CT scan can show whether or not there is involvement of the lymph glands in the chest or not. If there are lymph glands in the chest, a thoracic surgeon may be called in to do a mediastinoscopy, where the surgeon can look into the space between the lungs and the rib cage and assess the extent of the metastases in this otherwise difficult to assess space.

Distant metastases

The oncologist will want to continue to do the staging tests by doing CT scans of the liver, the adrenal glands and the brain to determine whether distant metastases are present. Blood tests and bone scans will rule out bone metastases. Finally, when all this information is gathered, the oncologist can do what is called an” extent of disease evaluation”. The following could be found for the various stages.

Extent of disease evaluation: Staging of lung cancer

Stage:

I : solitary lung tumor of less than 3 cm (=1 1/4″) in diameter

II : tumor more than 3cm(= 1 1/4″) in diameter, local lymph gland metastases on the same side as the tumor

IIIA : peripheral lung tumor: invaded the chest wall; central lung tumor: invaded distal mediastinal nodes on the same side

IIIB : same as stage IIIA, but more extensive lymph gland invasion involving mediastinal organs and pleural cavity

IV : Any of the above stages, but in addition distal metastases

Is it wasted time to do the staging procedure?

Why are oncologists “wasting time” to do the staging procedures? Studies over several decades have taught us that treatment of cancer without staging often gives everyone a false sense of security, where they learn later that the real extent of the cancer was much worse than originally thought. While everyone was thinking no further therapy was necessary, the cancer quietly multiplied and spread until it was too late to do anything about it. With the progress in the treatment of childhood leukemia oncologists learnt that long-term survival and cure rates could show significant improvement with adequate staging in the beginning and by following appropriate treatment protocols. In the last few years this has paid off for lung cancer as well.

Treatment of lung cancer

When the oncologist does an “extent of disease evaluation” he can discuss with the patient and the family what stage the lung cancer is in and what the chances of survival for the lung cancer are based on a vast amount of knowledge. There is a discussion of treatment options in detail and the oncologist can tailor the therapy to the needs of the patient. In principle, the approach to treat stage I and II is mainly by surgery to remove all cancer within the healthy surrounding tissue.

Surgical risk and treatment of stage III and IV

With an oncological or thoracic surgeon this kind of surgery has only a mortality of 1% to 8%. In younger patients this risk is lower, in patients above 75 years of age the risk is higher. With surgery higher survival rates are achievable (up to 80 % in stage I, up to 50% in stage II). Stage IIIA can be managed surgically, but stage IIIB needs another approach. Usually with this stage as well as with stage IV radiotherapy and combination chemotherapy is needed.

Lung Cancer Screening Program

Conclusion

In the US a lung cancer screening program is in place since 2014. Since then, lung cancer mortality has dropped 20%. Also, in 80% of cases lung cancer is in stage I, the earliest form of lung cancer. In the past the majority of diagnosed lung cancer was in stage IV with a 5-year survival of only 5-10%. Now with the CT scan lung cancer screening program the 5-year survival is 73% to 90%. Treatment is mostly surgical for earlier-stage lung cancer (stage I, II and IIIA). For stage IIIB and stage IV a combination of surgery, radiation therapy and possibly chemotherapy is in use. The emphasis is on smoking cessation and yearly screening with a low-dose CT scanner.

May

2023

Colorectal Cancer in a younger Population

By Ray Schilling | Cancer, colorectal cancer

There seems to be a trend that physicians see colorectal cancer in a younger population. In the past colorectal cancer was almost solely confined to people above 50. But now some people get diagnosed as early as 35 years or 40 years.

On March 10 CNN published a report from Sara Stewart, a film and culture writer.

Example of person who was diagnosed with colorectal cancer at age 45

She describes that she was diagnosed at age 45 with a stage 3 colon cancer. She thinks that the medical profession does not pay enough attention to toxins that may be causing colorectal cancer. Statistics show that colorectal cancer among younger patients than colorectal cancer among younger patients than 55 increased increased from 11% in 1995 to 20% in 2019.

At the same time colorectal cancer has decreased from 66 per 100,000 in 1985 to 35 per 100,000 in 2019. This means the incidence of colorectal cancer almost halved in 34 years.

Since the 1980’s doctors did colonoscopies on a large scale, which contributed to the rates of colorectal cancer decreasing. With a colonoscopy the doctor removes any identified polyps, which otherwise convert into colorectal cancer. It is a preventative procedure, which is very effective in preventing this cancer.

Colonoscopy screening

Earlier on the medical profession recommended screening with colonoscopy at age 50 and beyond; now the recommendation is from 45 onward. But more and more people are coming down with colon cancer at younger and younger ages, like 30 to 35. With a screening colonoscopy at the age of 30, the doctor can prevent these cancers because he/she removes colorectal polyps that are precursors of cancer. If the physician does not find a polyp at the age of 30, the next screening could take place at age 38 or 40. With a positive polyp test further screening could take place every 3 years. This would prevent a lot of colorectal cancers.

Statistics of colorectal cancer in a younger population

Newer cancer statistics show the following:

In the US from 2011 to 2019, colorectal cancer rates increased 1.9% each year in people below the age of 55.
In younger than 50-year-old patient death rates from colorectal cancer climbed 1% each year. At the same time the overall death rate of colorectal cancer fell 57% between 1970 and 2020 (largely due to the effect of doing colonoscopies).
There are huge differences in cancer rates of colorectal cancer in different states: Utah colorectal cancer rates were lower: 27 cases per 100,000 people; in contrast, the number was 46.5 per 100,000 in Mississippi. This points to environmental/industrial factors playing a larger role in causation of colorectal cancer.

Causation of colorectal cancer in a younger population

In 2020 the National Cancer Institute reported about scientists “examining factors in the environment as potential causes of early-onset colorectal cancer. Such factors include air and water pollution, chemicals in soil and food, and pesticide use.” In some cases, there may be adverse lifestyle factors at play like poor diets (too much fat, too much meat and junk foods), excessive weight and lack of exercise. Dr. Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana Farber Cancer Institute, told NBC News the following.

Environmental factors causing early colorectal cancer

“It isn’t just diet and lifestyle, there is something else. We see so many young patients with colorectal cancer who follow very healthy lifestyles and diets.” Dr. Folasade P. May, an associate professor of medicine in the University of California, Los Angeles Vatche and Tamar Manoukian Division of Digestive Diseases added: “When something is affecting people who have their birth years in common, then we know it’s something in the environment that has led this whole group of people to have higher rates. Among industrial poisons benzene, asbestos, vinyl chloride, radon, and arsenic are examples of toxic substances that can increase the risk of cancer to those who are exposed.”

Colorectal Cancer in a younger Population

Conclusion

On the one hand colorectal cancer has decreased in frequency by almost 50% between 1985 and 2019. But on the other hand, colorectal cancer in the younger population has a much earlier onset, way before the previously common age of 50. Doctors find the cancer at a later stage, which has a higher mortality rate. Experts expect environmental factors to play a role like exposure to benzene, asbestos, vinyl chloride, radon, and arsenic. In addition, air and water pollution, chemicals in soil, food, and pesticide use could play a role. In some cases, there may be adverse lifestyle factors at play like poor diets (too much fat, too much meat and junk foods), excessive weight and lack of exercise.

Start initial colonoscopy screening at age 30

The solution to this problem could be a very early colonoscopy screening around the age of 30. In the case of an examination that is negative for polyps at age 30, the next screening could take place at age 38 or 40. With a positive test for polyps at age 30 further screenings could take place every 3 years. This would prevent a lot of colorectal cancer in the younger age population.

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

Continuous glucose monitoring

Test accuracy

Initial diagnostic diabetes tests

Strong recommendations based on high research evidence

Further comments

Conclusion

Bristol stool chart

Your body posture influences the ease of your bowel movements

Proper food intake necessary for a good bowel movement

Constipation

What we know now

Chronic constipation

Treatment for constipation (simple steps that help)

Enema with lukewarm water

Extra fiber (bulking agents)

Osmotic agents

The emergency break (laxative)

Conclusion

Lifestyle of centenarians

Diet characteristic of blue zones

Origin of blue zone foods

What blue zone meals contain

More info about Blue Zone diet

Recapturing healthy foods

Conclusion

The Meta-analysis

Loneliness

Social isolation

Findings of the study

Life style factors part of loneliness and social isolation

Broadening social connections

Conclusion

Non-hormonal methods to fight hot flashes

A new drug blocking hot flashes and night sweats

Other recommendations of the 2023 non-hormone therapy of menopause update

Hormone replacement with estrogen and progesterone

European trials regarding bioidentical hormone treatment

Present day recommendation from regenerative physicians

Conclusion

Some facts about telomeres

Animal studies confirm that short telomeres mean shorter lifespan

Telomerase helps to keep telomeres from shortening

What preserves the length of your telomeres?

Telomere length enhancers

Conflicting research about longer telomeres

Conclusion

Specific details of my repeat stem cell treatment

Follow-up following stem cell treatment

Discussion

Conclusion

Feasibility of a lung cancer screening program

Lung cancer screening program free for patients

What happens when the lung cancer screening program identifies early lung cancer?

Various methods to do lung biopsies

Test to determine the extent of the lung cancer

Distant metastases

Extent of disease evaluation: Staging of lung cancer

Is it wasted time to do the staging procedure?

Treatment of lung cancer

Surgical risk and treatment of stage III and IV

Conclusion

Colonoscopy screening

Statistics of colorectal cancer in a younger population

Causation of colorectal cancer in a younger population

Environmental factors causing early colorectal cancer

Conclusion

Start initial colonoscopy screening at age 30

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered