Medical Articles by Dr. Ray

Nov

2013

Statins Can Hurt The Consumer

By Ray Schilling | Anti-aging medicine, Arthritis, Diabetes, Fitness, heart attack, Heart Disease, High Blood Pressure, Hormones, kidney disease, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

Lovastatin (Mevacor, from Merck) was the first statin drug approved by the FDA in 1987 as a cholesterol-lowering drug in the US. It made history in helping high-risk heart attack patients reduce their cholesterol levels and has helped safe many lives. But with the detection around 2002 that heart disease is an inflammatory disease, and that measuring the C-reactive protein with a blood test was a better than measuring cholesterol levels in predicting who would be at risk for developing a heart attack, the landscape has changed. Lifestyle changes have also been shown to be very effective in reducing cholesterol, C-reactive protein and triglyceride levels. In fact, lifestyle changes will reduce the risk for heart attacks and strokes. The newest flurry of activity with calls for putting more people on statins makes me suspicious that there could be a misrepresentation of the facts.

In this blog I am analyzing the literature to get to the bottom of the facts on reducing risk for heart attacks and strokes. I also come to my own conclusion.

Facts about cholesterol

Cholesterol is a waxy substance that is part of the cell walls and plays a vital role in our metabolism. Liver cell membranes, for instance contain about 30% cholesterol. However, most of the cholesterol in our body comes from metabolism, 20 to 25% from the liver, the rest in the gut, adrenal glands and the reproductive organs, and also from the brain (the myelin sheaths contain a lot of cholesterol). 50% of the body’s cholesterol is recycled through bile salts and reabsorption of cholesterol in the gut (called the enterohepatic pathway).

Cholesterol is vital for cell function, for insulation of nerve fibers (myelin sheaths) and for synthesis of our steroid hormones (sex hormones and vitamin D3, which is now considered to be a hormone). The medical establishment took most of the information regarding heart attack and stroke prevention from the ongoing Framingham study. This clearly pointed to the importance of lowering the LDL cholesterol fraction (the “bad” cholesterol) and maintaining or increasing the HDL fraction (the “good” cholesterol). When it was realized that concentrating only on lowering cholesterol missed 50% of all heart attacks that researchers refocused and found the missing link, namely inflammation. Inflammation is at the cause of heart attacks and strokes, high cholesterol and lipids were only secondary phenomena. Ref. 2 points out that a comprehensive approach to treating a patient with high cholesterol should involve a combination of treatments aimed at the underlying risk factors for heart disease or stroke in a particular patient. This involves sophisticated blood tests where a metabolic derangement can be pinpointed. It should include measuring cholesterol fractions, lipids, the C-reactive protein, hormone levels and more.

Statins Can Hurt The Consumer

How the traditional thinking about cholesterol has changed

The Framingham study has provided the basis for the drug industry to produce statins until about 2002 when our thinking about cholesterol being the culprit for causing heart attacks has forever changed. Subsequently further research showed that other factors like inflammation of the blood vessels, the metabolic syndrome associated with obesity and lack of exercise were also to blame for causing heart attacks and strokes. Recently more details have come to light, which point to multiple causes like the consumption of too much sugar, too much trans fats, too much salt and eating too much over processed convenience food. We end up gaining weight, develop the metabolic syndrome and inflammation of arteries (including the coronary arteries of the heart and the brain vessels). It is the lack of nitric oxide in the lining of the arteries, which combined with inflammatory substances from visceral fat are responsible for hardening of the arteries as the ultimate consequence of faulty nutrition and lack of exercise. We also know that oxidized LDL, particularly the very low-density lipoproteins (VLDL), will release free radicals and damage the arterial walls. CoQ-10 is a supplement, which is known to counteract this. One important test that had developed out of the Framingham study is the “ratio of total cholesterol to HDL cholesterol”, which is used by cardiologists to determine the risk of coronary artery disease. The average risk of this ratio for Americans is 5.0 for males and 4.4 for females. The ideal ratio to strive for is the “1/2 average risk” ratio of 3.4 for males and 3.3 for women (Ref.2). A fit, slim person who eats a low carb, normal fat diet (modified Mediterranean diet) will often have a ratio of only 3.0, well below the 1/2 average risk. The moment you introduce grains in your diet (cereals, bread, pasta) your liver will convert carbs into LDL cholesterol, while HDL cholesterol will drop resulting in a high risk ratio of above 5.0 (often 7 or 8 or more). The LDL will get oxidized and is deposited into your arteries setting you up for coming down with a heart attack or stroke down the road.

How do statins work?

The statins are a group of drugs that inhibit an enzyme, called the hydroxymethylglutaryl–Coenzyme A (HMG-CoA), which leads to a lowering of cholesterol, specifically a fraction known as the LDL cholesterol. The success story of lovastatin (Mevacor) led to a flurry of new HMG-CoA reductase inhibitors (cholesterol lowering drugs) such as fluvastatin (Lescol), pravastatin (Pravachol), simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor) in the late 1980’s and the 1990’s. Collectively it is now a 26 billion industry in annual sales.

Later investigations showed that there were other mechanisms by which statins helped, namely they were found to decrease the inflammatory reaction, which can be measured by lowering of the C-reactive protein. However, there are significant side effects in about 1 to 3% of people who take this medication, particularly an inflammation of liver cells (evident from elevation of liver enzymes) and a myopathy, which is a painful muscle condition (Ref. 1). This latter fact, which can occur in as many as 33% of the population at large (particularly the exercise minded) has limited the use of statins in competitive athletes where myopathies can occur in as many as 75% of athletes treated with statins (Ref.2). The reason for that is that the muscles of athletes cannot keep up with the demands put on them when they are kept in check by the HMG-CoA reductase inhibitors. On the other hand statins have prevented heart attacks and deaths from heart attacks and strokes in about 25% to 35% of patients treated with them as many clinical trials have shown (Ref.1), but simple supplements that have no side effects can do the same or do even better (see below).

The lack of cholesterol synthesis by the body’s cells when statins are given, leads to an expression of more LDL receptors on the cell surfaces. LDL binds to these receptors and enters the cells, which removes the circulating high risk LDL fraction of cholesterol from the blood thus causing a drop in LDL cholesterol. All of the side effects of statins (pull down to side effects in this link) can be explained as a result of the slow-down of organ functions (brain, muscles, gut, adrenal glands, etc.) as cholesterol synthesis is reduced.

New information from the Framingham Heart Study

So far everything I said made sense. But when I came across Ref. 4 I noticed that there was a bombshell of new information from another follow-up study of the Framingham Heart Study (Ref. 5) that did not fit in with the latest marketing drive of the statin manufacturers. In this study from 2005 Boston researchers had studied the outcomes of 789 men and 1105 women over a period of 16 to 18 years with respect to cognitive function. Participants were divided into total cholesterol groups that showed levels that were desirable (less than 200), borderline (200 to 239) or high (above 240). The astounding results were that higher cognitive functioning as documented in multiple cognitive tests in these three groups showed the best performance in the group with the highest cholesterol and the worst cognitive test outcomes in the lowest cholesterol group, quite opposite of what was expected.

Another important piece of research (April 2013) comes from Spain where doctors followed a group of 7447 patients with a high cardiovascular risk who were put on a Mediterranean diet with olive oil, a Mediterranean diet with nuts or a regular diet. The end point was death from heart attack or stroke. After 4.8 years the study had to be interrupted as the Mediterranean groups showed a significant survival advantage over the group on a regular diet.

Ref. 4 cited literature evidence that statins cause a 48% increased risk in postmenopausal women who take statins to develop diabetes. It also cites compelling evidence that diabetes patients are twice as likely to develop Alzheimer’s disease within 15 years and are 1.75 times more likely to develop any kind of dementia in the same time period.

Dr. Seneff from the Computer Science and Artificial Intelligence Laboratory at MIT explains in great detail that statins effectively reduce cholesterol synthesis in the liver, which in turn starves the brain of one of its main nutrients explaining why patient develop Alzheimer’s disease and dementia as a result of statin treatment.

So, the lessons to be learnt from these clinical trials are that you want to offer your brain enough cholesterol and healthy fat to have a normal metabolism. Fortunately, what’s good for your heart is also good for your brain. Conversely avoid statins, if you can and try alternatives first. Ref. 4 explains that for years the experts had the wrong theory that low fat/high carb was what would be good for your heart and brain, but the opposite is true: what is good for your heart and brain is a high healthy fats/low refined carb diet.

Make sure that with your blood tests that fasting insulin is low (no insulin resistance), that the ratio of total cholesterol to HDL cholesterol is less than 3.4 (low risk for heart attacks or strokes) and that the hemoglobin A1C level is low (4.8 to 5.6%, ideally less than 4.5%), which means you are not diabetic.

How alternative treatment can save you from heart attacks

Lifestyle treatment through dietary intervention, moderate exercise, and weight loss has been somewhat neglected by mainstream medicine, but is now recognized in regular textbooks of medicine as first-line treatment (Ref. 3). Most patients can lower LDL cholesterol by 10 to 15% through a change in diet. High-risk patients with established heart disease (narrowing of coronary arteries) require a drop of 30 to 60% of LDL cholesterol; this high-risk patient group may need an addition of a statin. In patients with metabolic syndrome or diabetes high triglycerides are often present and will respond to decreased intake of simple sugars, alcohol, and calories (Ref.3). Total calorie intake should be adjusted according to what the weight is when weighed every day with the goal of reducing the weight when overweight or obese, but maintaining the weight when it is in the normal body mass index range (BMI of 20 to 25). The total fat intake should be around 25%-35% of the total calorie intake. Specifically, saturated fat needs to be less than 7% of total calories, polyunsaturated fat up to 10% of total calories and monounsaturated fat up to 20% of total calories. Healthy fats according to Ref. 4 are extra-virgin olive oil, organic butter, almond milk, avocados, olives, nuts, nut butters and cheese ( except for blue cheeses). Other healthy fats are sesame oil, coconut oil, and the oils found in seeds like flaxseed, sunflower seeds, pumpkin seeds and chia seeds. Note that trans-fats (such as in margarine and baked goods) are a “no-no” as it causes free radicals in your body, which would accelerate the hardening of your arteries. Complex carbohydrates from vegetables and fruit are the main source of total calories providing 50%-60% of the total calories. Fiber intake needs to be 20-30 grams per day. Protein intake should be about 15% of total calories. Fat should provide 25% to 35% of the total calories per day. Cholesterol intake should be less than 200 mg per day. You may want to consider the use of plant sterols (2 grams per day) to enhance LDL cholesterol lowering. Physical activity from moderate exercise should expend at least 200 kcal per day (better 300 kcal).

Which supplements prevent heart attacks and strokes?

There are several nutrients that have been shown to be powerful preventers of heart attacks and strokes. I will review them briefly here (based on Ref. 2):

1. Coenzyme Q10 (CoQ10): The cells lining the arteries are only working well when their mitochondria are working properly producing chemical energy in form of ATP. CoQ10 is an important component of the mitochondrial metabolism; it is also the only fat soluble antioxidant that gets absorbed into the LDL particles where it protects these from oxidation. Statins suppress CoQ10 synthesis, so patients on statins need to take CoQ10 supplements daily to counteract this. However, anybody who is healthy now should take CoQ10 as a daily supplement for prevention. I take 400 mg per day.

2. Vitamin E (tocopherols): this fat soluble vitamin is an antioxidant and has been praised in the past as being heart supportive, was subsequently bad-mouthed by some conservative physicians, but lately has been resurrected. It turns out that there are 8 different types of tocopherols, with the alpha tocopherol being the most known, but gamma tocopherol is the one you want to make sure you are also getting with your balanced vitamin E supplement every day as this is the one that is a powerful anti-inflammatory. Simply ask staff at your health food store for a vitamin E supplement with gamma tocopherol in it. Take 400 IU per day (of the mix).

3. Curcumin: This is a powerful heart and brain protector combining three different mechanisms in one; it is reducing oxidative stress, is an anti-inflammatory and counters the process that threatens to destroy the lining of the arteries. One study on healthy volunteers showed a reduction of 33% in lipid oxidation, a 12% reduction of total cholesterol and an increase of 29% of the protective HDL cholesterol when 500 mg of curcumin was taken only for 7 days (Ref.2). This is the daily dose I would recommend for prevention of heart attacks and strokes.

4. Polyphenols: Flavonoids are the largest group among the polyphenols contained in such common foods as vegetables, fruits, tea, coffee, chocolate and wine. Over 130 studies have been done on humans showing improvement of the lining of the arteries (endothelial functioning) and lowering of blood pressure. Polyphenol consumption has been associated with a lower risk of mortality from heart attacks. Eat a Mediterranean type diet or a DASH diet and you will automatically get enough polyphenols with your food. However, resveratrol, the powerful red wine polyphenol warrants a separate daily supplementation as it prevents LDL oxidation in humans (Ref.2). Take about 250 mg of it daily.

5. Niacin/nicotinic acid: This supplement comes as “flush-free niacin” and also as extended release niacin; it can raise the beneficial HDL cholesterol by 30 to 35% when higher doses of 2.25 grams per day are used. In a metaanalysis of 7 studies it has been shown to significantly reduce heart attacks and transient ischemic attacks (precursor syndrome before developing a stroke). Niacin can change the small particle LDL into a large particle size LDL, which is less dangerous. Niacin has also been shown to reduce oxidation of LDL, which stops the atherosclerotic process. For a healthy person 500 mg per day of flush-free niacin is adequate.

6. Fish oil (omega-3-fatty acids): Because heart attacks are due to an inflammatory process and high LDL cholesterol is thought to be only a secondary phenomenon, it is very important to have this additional tool of an important anti-inflammatory supplement. In the past it was still safe to eat fish fairly frequently per week. But with mercury, radioactive iodine from Japan’s leaking reactor and carcinogenic PBC’s all congregating in the ocean waters, it is no longer safe to consume fish in large quantities. The remedy to this situation is molecularly distilled (or pharmaceutically pure) EPA/DHA supplements. EPA stands for eicosapentaenoic acid or omega-3 fatty acid. DHA is the acronym for docosahexaenoic acid. Fish oil supplements at a dosage of 3.35 grams per day of EPA plus DHA were shown to reduce triglycerides by up to 40%, equally to Lipitor or even more effective, but without the statin side effects. The amount of the dangerous small dense LDL is also being reduced with fish oil. Fish oil supplements have reduced the mortality from heart attacks and strokes and led to a higher survival from non-fatal heart attacks. At the same time these preventative fish oil doses will also treat and prevent arthritis.

7. Other useful supplements: Soluble fiber from psyllium, pectin, beta-glucans and others have been shown in clinical trials to reduce LDL cholesterol by binding bile salts in the gut (interrupting the enterohepatic pathway). Plant sterols (usually sold as sterol esters) are recognized by the FDA as reducing the risk of coronary heart disease, if taken in high enough amounts (2.4 grams of sterol esters per day). There are other useful supplements like artichoke extract, pomegranate, soy protein, Indian gooseberry (amla), garlic and pantethine (vitamin B5) that have been proven to be of benefit in terms of prevention of heart attacks and strokes. It would be too lengthy to get into more details here.

Conclusion

Recently there was a review in a medical journal that demonstrated that clinical guidelines (in this case for clinical guidelines for lowering cholesterol) erred 40% of the times when measured against scientific tests as this link explains. When it comes to saving lives by preventing heart attacks and strokes, what is needed is a multifactorial approach that treats the multifactorial causes of cardiovascular disease. Just pushing for treating more people with statins as Big Pharma is attempting to do is not addressing the fact that cholesterol is needed for our metabolism and the synthesis of our hormones. It is much superior to use a combination of different approaches that overlap and thus potentiate each other in their effects excluding statins first. Exercise creates more nitric oxide production by the lining of the arteries, which opens up arteries and prevents spasms. A proper diet with as many of the proven vitamins and other support factors will control inflammation and oxidation of LDL cholesterol particles as explained. This will prevent heart attacks and strokes as has been shown in many clinical trials. Only patients who come from families with genetically high cholesterol or high triglycerides and those patients who had heart attacks and strokes should be exposed to statins as they are at a higher risk of developing a heart attack or stroke. They need all of the help they can get in addition to the lifestyle factors mentioned. Most other patients and the public at large will do quite well without statins (no side effects of diabetes, Alzheimer’s and muscle pains). And, yes, a diet high in healthy fats, but low in refined carbs is what your brain and heart need (the opposite of what you have thought, see Ref. 4).

More information about side-effects of statins (acute pancreatitis): https://www.askdrray.com/pancreatitis-can-occur-with-statin-use/

Lower cholesterol with Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

References

4. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

5. http://www.psychosomaticmedicine.org/content/67/1/24.full.pdf

Last edited Nov. 7, 2014

Nov

2013

Stop Obesity

By Ray Schilling | Arthritis, Cancer, Diabetes, Health, heart attack, Heart Disease, High Blood Pressure, Nutrition, Obesity, Prevention, Stroke, Weight loss

Introduction

This article is about “stop obesity”. Being obese is not just a problem that is known as “middle age spread’. It has become an alarming condition that affects all age groups, children, adolescents and adults; it has escalated into a health problem that affects a large percentage of the US population. As this link shows, in 2020 the obesity rate among adults in the US was 42.4%. Another third was obese. That means that more than two thirds of the population exceeded the upper limit of a normal body weight (a body mass index of less than 25.0). Other countries in the Western world share in the record of being the fattest nations: they are Mexico, New Zealand, Chile, Australia, Canada, The United Kingdom, Ireland and Finland. Not every country with high living standards has high obesity rates. Japan and Korea by comparison have obesity rates of 3 to 4%.

Health consequences

The diseases resulting from obesity include high blood pressure, cardio-vascular problems (heart attacks and strokes), and type II diabetes. This results in health expenses spiraling upwards. The excessive weight creates additional problems. Not only the heart and blood vessels face an overload, but the joints are also bearing the brunt in the form of joint diseases like arthritis or back pain. These conditions are not fatal, but they account for less productivity at the work place and they create disabilities. In the public sector obesity presents more problems: how can an obese individual be accommodated in a standard airline seat? How can nursing personnel in a hospital manage to lift or transfer a very heavy patient without a mechanical lift? Obesity can be compared to a snowball that is on a downhill run and if it is not stopped in time, will turn into a deadly avalanche.

Stop Obesity

Causes of obesity

In the last few years it has become clearer how obesity was created. It originated from the perfect storm that a number of practices of the food industry brought about:

Processed food has become more prominent in the super market, laden with salt (creating high blood pressure) and sugar (causing diabetes).
Wheat and wheat products are contained in a lot of processed foods, and if they are not in it directly, food manufacturers add MSG (mono sodium glutamate) to stimulate your taste buds. This leads to food addictions encouraging you to eat bigger portions and to eat more sweet, calorie-laden foods.

Gliadin and sugar stimulate your appetite

Wheat has undergone forced hybridization in the 1970’s changing the genetic make-up of wheat significantly. The result is much more gliadin, the gooey substance that stimulates your opiate receptors and makes you addicted to food and sweets (Ref. 1).
Sugar and high fructose corn syrup are a huge problem for our bodies: sugar consumption in any form leads to overproduction of insulin, insulin resistance and diabetes. 10 to 15 years of life can be lost from premature death due to sugar overconsumption. The causes are accelerated hardening of the arteries with premature heart attacks, strokes and kidney damage. Alcohol in its many disguises is also a problem. The body metabolizes it similar to sugar, excess calories from alcoholic drinks are stored as fat.

Oil with omega-6 fatty acids, bovine growth hormone in milk and antibiotic residues in beef

The oils that are now used to produce baked goods are the cheaper omega-6-fatty acid containing oils derived from safflower, sunflower, soybean, cottonseed and canola. The result is a disbalance of the omega-3/omega-6 ratio in our diet, which causes inflammation in our bodies. This in turn causes heart attacks, strokes, arthritis, asthma, inflammatory bowel disease and Alzheimer’s disease (Ref. 2).
In the US there are problems with bovine growth hormone in milk and milk products unless you buy organic milk and milk products. This too causes your fat to accumulate as it blocks your own growth hormone receptors. Antibiotic residues in beef from feedlots also contribute to obesity in humans.

We are more sessile

Add to this the fact that we have become more sessile, driving cars, watching games rather than playing games, watching TV and sitting in front of the computer for hours on end. All this burns up less calories than if you work out in a gym.

Knowing the enemy helps us to fight the causes of obesity. Here is my recipe to counter what the agro-industry has been doing to us.

What can be done to stop obesity?

Cut wheat out of your diet

1. The biggest factor is to cut out genetically modified wheat that is now the only source of wheat around the world. When you cut out all wheat and wheat products from your diet, you will lose 400 calories every day. Ref. 1 describes this in detail and provides 150 recipes of tasty foods. Dr. Davis allows you a fair amount of monounsaturated fatty acids, which makes dieting a lot easier and you will find that once you have lost the necessary pounds, you will keep your weight down easily. How come I know? Because I have done this myself since 2001. Why does it work?

Gliadin from wheat stimulates your opiate receptors

Because gliadin from wheat is an addictive protein that stimulates your opiate receptors in the brain and makes you want to eat more wheat and wheat products, which means taking in more and more calories (Ref.1). It also stimulates your taste buds to eat more sugar and starchy foods. So, you need to cut out wheat.

Watch the glycemic index of your food

2. Next you need to look at the glycemic index of your food. Low and medium glycemic foods are OK to eat, but not the high glycemic index foods. It is clear from this link that white bread, pasta, rice, low-fiber cereals and baked goods are not desirable, because they are high glycemic on the index. On the other hand fruit, vegetables and legumes are desirable food choices, as they are low glycemic index foods. Legumes are higher in their carbohydrate content, and a helping of ca. ½ a cup should not be exceeded. Fruit that are high in fruit sugar (grapes, pineapple, mangoes, papayas, bananas) should be consumed in moderation. Fruit juices present an overload of sugar; just remember that it takes several apples to make one serving of apple juice! The same goes for alcoholic drinks. It likely is responsible for much of the obesity wave.

Eliminate all monosodium glutamate (MSD)

3. Perhaps the most important step is to look at the food that goes into your mouth, eliminate all MSG (monosodium glutamate) and then switch to organic food. I remember that 1/3 of the items on the kitchen shelf and in the fridge had to be thrown out when my wife and I first learnt about this in 2001. We studied the food labels of every food item that was in our kitchen. We added the switch to organic food in the last three years, after hearing about it from Suzanne Somers’ books and at several A4M anti-aging conferences in Las Vegas. Take the time to prepare most of your food that you eat yourself at home from natural, organic ingredients. This way you can avoid sugar and extra salt, which would be present in processed foods.

Watch your oils, cook with extra virgin, cold pressed organic olive oil

4. Watch oils and fat when you cook: extra virgin, cold pressed organic olive oil is your best friend when it comes to cooking Mediterranean type food. Lately there is a trend of cooking with coconut oil, but I think this is a marketing hype (if you decide on coconut oil, make sure it is virgin and fresh pressed, not processed). Ref. 2 explains that it is important to avoid all polyunsaturated oils as they turn rancid and lead to free radicals in your blood and in your fatty organs like the brain. In order to reintroduce the balance between omega-3 and omega-6 fats, it is useful to take 3 capsules or more (up to 6 or 7 per day in persons with arthritis) of a strong, molecularly distilled EPA/DHA supplement daily that will restore your prostaglandins.

Certain fish is healthy

This ensures that no inflammatory reactions take place in your tissues preventing heart attacks, strokes, arthritis, asthma, inflammatory bowel disease and Alzheimer’s disease.

Nutritionists recommend fish as highly desirable as it is a good source of omega-3 fatty acids, which have anti-inflammatory qualities. But unfortunately, there is mercury contamination in predatory fish. I find it difficult to recommend it as healthy unless you are willing to undergo chelation therapy on an ongoing intermittent basis to remove heavy metals. Fish like sardines or wild salmon are the better choices. Tuna, swordfish or shark should never be consumed as their toxic mercury load is dangerously high.

Exercise keeps you healthy

5. Finally, a word about reintroducing exercise. As kids we were more active. You may have played games as a youth. What our bodies need at all times is movement, walking, dancing, in short some form of activity every day. The easiest is to work out in a gym for 1 hour every day (30 minutes of aerobics like a treadmill or elliptical for 30 minutes and isometric exercises like working with machines or weights). Add on top of this whatever you can. This stimulates your metabolism, your blood circulation and rebalances your hormones.

Conclusion

Obesity is a national concern and a concern that affects nations internationally. Bear in mind that the food processors are not on a mission to increase the well being of the consumer, but have the motivation to increase their profits. In the past bad dietary advice added more injury to this situation, when the food science behind diets lacked development. But now we know that a low fat high carb diet does not work; instead a balanced fat, low glycemic index diet as in a Mediterranean diet is what is beneficial. The large amounts of sugar that food processors are currently adding have no place in sensible human nutrition.

Avoid overeating with grains, watch your oil intake

The senseless overfeeding with grain has also presented its results: it has fattened up North America and other nations. We need quality fats (olive oil, omega-3-fatty acids and nuts). Organic food whenever possible is important in order to avoid poisoning ourselves with pesticides, antibiotic residues or bovine growth hormone. Add regular exercise to this and your recipe for treating and preventing obesity is complete.

More about metabolic syndrome (the metabolic changes associated with obesity): http://nethealthbook.com/hormones/metabolic-syndrome/

References

1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

2. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

Nov

2013

You Can Fight Back Against Arthritis

By Ray Schilling | Arthritis, Fitness, Nutrition, Obesity, Prevention, Vitamins and supplements, Weight loss

This article is about the fact that you can fight back against arthritis. It is important to realize that osteoarthritis affects about 4 to 5% of the population with women outnumbering men by 2 to 1. Notably, the age of onset typically is less than 50 years, but becomes more evident and more disabling beyond the age of 50. About 40 to 60% of osteoarthritis is genetically linked as twin studies in women have shown (Ref.1). Synonyms for osteoarthritis are degenerative joint disease, osteoarthrosis and arthrosis. Till recently arthritis was accepted as something that was inevitable: people were getting old, getting stiff and sore, and had to “take it easy” as a result when they got older. In general, things are not as uncomplicated, as arthritis affects about 53 million Americans, and it has become the leading cause of disability in the US.

First thing to remember is that rheumatoid arthritis is an autoimmune disease. It is not a disease of “old age” but can affect people of every age group. The body reacts to components in joint tissue, and this immune reaction to collagen will produce inflammation, pain and ultimately disability.

Another key point, so far osteoarthritis was believed to be the result of wear and tear affecting the aging population, but more recently it has been discovered that osteoarthritis is also accompanied by the similar inflammatory immune factors that are involved in rheumatoid arthritis.

Cytokines from the immune system attack joints

In particular, when the body attacks collagen, which is needed to keep the joints moving smoothly, microscopic particles of it wander into the blood stream. There they are perceived as foreign molecules, and the immune system produces inflammatory substances (cytokines). These are sending out an army of “killer T-cells” to combat the collagen, which is perceived as a foreign matter. They are bombarding the exposed cartilage with toxic substances. Certainly, this means a chaotic combination of oxidative stress and more inflammation. Over time the cartilage that was meant to protect the joint in its function to move freely is eroded and destroyed.

Pain in the joints

For the person suffering from this disordered reaction, it means that the joint is not only creaking but causing pain, which is made even worse by weight bearing (walking, standing). Indeed, any person suffering from osteoarthritis will complain that he or she feels stiff and sore especially after a period of inactivity.

Certainly, commercials for anti-inflammatory medication are plentiful, and many sufferers resort to the pain relief that is promised. The warnings are mentioned right after the commercial or on the medication package, if the patient reads the fine print. Most anti-inflammatory medications are causing irritation of the stomach, and the kidneys get damaged (nephropathy)with prolonged use from these pills despite the promises in commercials of a happy, active and pain free life.

Causes of arthritis

There are many varied causes that can all contribute to developing arthritis. By all means, it is important to take a critical look at lifestyle choices. For instance, excessive body weight puts an additional burden on the joints in the body. Indeed, increased body fat is not just sitting at the abdomen as an inert potbelly. To emphasize, abdominal fat is a highly active metabolic organ that releases inflammatory substances into the blood stream, which distributes them throughout the body. It is known to damage blood vessels.

Inflammation and smoking lead to arthritis

To clarify, inflammation will damage the joints as well. The statistics show that 33.8 % of obese women have arthritis. The percentage for obese men shows that 25.2 % suffer from arthritis. Another key point is that smoking leads to circulatory problems and lack of oxygenation in the body’s tissues. It is a mistake to believe that damage is done only to the lungs or the heart. The joints will be affected as well.

Mechanical stress causing arthritis

Mechanical stress with inadequate self-repair is one cause; misalignment of bones such as knock-knee (genu valgum) and bowleggedness (genu varum) will lead to premature osteoarthritis of the knees as can loss of muscle strength. Exercise without injury does not contribute the risk for developing osteoarthritis; it is actually part of the rehabilitation plan.

According to Ref. 2 there are other causative factors, such as increased age, female sex, race (black women have a twofold increase of arthritis over Caucasian women), estrogen deficiency, nutritional factors, genetics, metabolic and endocrine disorders, joint trauma, joint deformity, occupational factors and sports participation (accumulation of mini injuries).

One of the newer findings is that osteoarthritis is actually an inflammatory condition where numerous destructive processes occur within the affected joints leading to a breakdown of cartilage and supportive synovial fluid factors (proteoglycans). These findings lead to the possibility of new therapeutic approaches discussed below.

Diagnosis of osteoarthritis

According to Ref. 1 there are no blood tests and analysis of synovial fluid is non-diagnostic. Diagnosis of osteoarthritis is made by history, X-rays of the affected joints and clinical findings. There are joint tenderness and swelling of the affected joints. Heberden’s nodes (swelling of the distal interphalangeal joints or DIP joints) and Bouchard’s nodes (swelling of the proximal interphalangeal joints or PIP joints) are present. There can be a decreased range of motion and a grating sound of two ends of bones rubbing together (called “crepitus”). X-rays show typical osteoarthritis details with a narrowing of the joint space of the affected joint, subchondral sclerosis (increased bone formation around the joint) and new bone formation at the joint margins, called “osteophytes”).

Integrative therapy of arthritis

Ref. 2 points out that integrative treatment of arthritis is aimed at reducing joint pain, increasing joint function and reducing further joint deterioration. Some measures are symptomatic only, others are disease modifying.

Nutrition

Dietary habits can promote good health or have disastrous consequences. The news has been out for some time that the typical North American diet with a high load of omega-6 fatty acids will stoke the fires of inflammation in the body and lead to arthritis, heart disease and cancer. Soybean oil, cottonseed oil and safflower oil contain the cheaper omega-6 oils that are widely used in food processing and bakery products. Refined carbohydrates contribute to unhealthy spikes in blood sugar levels and wreak havoc in their own way paving the downward slope to insulin resistance, metabolic derailment, and diabetes. Take a hard look at your shopping wagon. Stay away from processed foods, shop the periphery of the supermarket, and choose organic meats, vegetables and fruit. Use heart healthy fat in the form of virgin olive oil. A

Mediterranean diet particularly useful

Mediterranean type diet will be a good choice. Just bear in mind, that a heap of pasta like Fettuccine Alfredo does not constitute what a healthy Mediterranean diet is all about. An anti-inflammatory diet such as a Mediterranean diet also includes deep-water fish as a source of omega-3 fatty acids or molecularly distilled omega-3 capsules (you need 7 to 8 high potency, molecularly distilled fish oil, 1000mg per capsule) every day.

This approach has shown beneficial effects in beginning stages of osteoarthritis.

It is important to cut out sugar and starchy foods to reduce insulin resistance, which would otherwise maintain the inflammatory chronic condition causing arthritis and cardiovascular disease. Physicians could show that cutting out wheat and wheat products is beneficial in reducing inflammation. Such an anti-arthritis diet prevents heart attacks and strokes at the same time.

Weight loss

Ref. 2 points out that one study showed that weight reduction of only 10% had a 28% improvement in joint function. Weight reduction in combination with an exercise program makes the improvements even more striking.

Exercise

Exercise consists of aerobic training, resistance training and muscle strengthening. When researchers observed patients with osteoarthritis throughout controlled exercise programs, flexibility and range of motion of the affected joints were improving. They found that a minimum of three days per week of exercise was necessary to show joint range of motion improvements. However, the best results were there when patients exercised most of the days. Joints become less swollen, show improved circulation and less pain. Researchers determined that prior to an exercise program those with increased cardiovascular risk should first undergo an exercise stress test. This measured their cardiovascular reserve and established that it was safe to start a program.

Treat inflamed joint first, then exercise

Physicians found that an acutely inflamed or swollen joint required treatment first before the start of an exercise program. Lack of exercise will promote more disability. While a person with arthritis may be unable to run a brisk race due to joint discomfort, he or she will find water exercises and swimming much more manageable. Group programs for people with arthritis are available and you may enjoy the supportive company.

Heat and cold therapy

Ref. 2 points out that three weekly 30 minute sessions of microwave diathermy for 4 weeks showed a significant reduction of joint swelling in knee osteoarthritis with improved joint function and reduced pain. On the other hand cold packs for aching muscles after strenuous exercises can decrease muscle spasm and increase the pain threshold. Range of motion increased with cold application and there was a reduction of joint swelling. Patients who have cold sensitivity (such as Raynaud disease) need to refrain from the latter treatment modality.

Acupuncture and electro acupuncture

Researchers found these treatments useful as an adjunct to anti-inflammatory medication with NSAIDS (non steroidal anti-inflammatory drugs). The advantage was that they could reduce the dosage of NSAIDS, which eliminated the potential serious side effects of gastric bleeds and kidney damage. Note that people with pacemakers or CNS stimulators cannot use electro acupuncture.

Intraarticular steroid injections

When osteoarthritis or rheumatoid arthritis affects only a few joints, a physician can inject a corticosteroid into the joint. However, there are limitations, as the physician can inject each joint not more than 3 to 4 times. Otherwise there can be damage to the joint cartilage, which would make the arthritis worse. However, I have seen surprisingly good results for a long period of time, which allowed the patients to exercise and stabilize the joints that way.

Complementary treatments

A number of supplements and herbs are effective in reducing inflammation. Omega-3 fatty acids are the precursors for anti-inflammatory prostaglandins in the body, which helps both patients with osteoarthritis and rheumatoid arthritis. As I indicated earlier, only higher doses of omega-3 fatty acids cause this effect. Also, for safety reasons only use molecularly distilled omega-3 fatty acid supplements. These avoid toxicity from mercury and PBC’s. Yes, they are more expensive.

Curcumin

Health care workers in India and Asia used curcumin, the active ingredient of the spice turmeric, for its anti-inflammatory and antioxidant properties for centuries. It helps not only arthritis, but also against the illnesses in association with it, such as obesity, diabetes, heart disease and autoimmune conditions. Ref. 2 points out that curcumin neutralizes inflammatory agents circulating in the blood of patients with arthritis.

Standardized ginger extract

Research showed that standardized ginger extract reduced pain significantly in patients with knee osteoarthritis.

Other common supplements for building up cartilage in the joint are glucosamine sulfate and chondroitin, both available at the health food store. They stimulate glycosaminoglycan formation, which in turn builds up hyaline cartilage, the enamel-like coating of the bone within the joint.

An oral desensitization to treat arthritis

Researchers asked themselves whether itv is possible to enhance joint health of patients in other ways? New answers have emerged. In the past, people who were suffering with colds or flus were consuming a steaming bowl of chicken soup. Colds and flus also cause an inflammatory reaction within the body.

A steaming bowl of chicken soup

While a lot of health professionals dismissed this home remedy as old-fashioned and useless, a team of scientist from the University of Nebraska decided to research the matter a bit closer. They discovered that it was not the vegetables, but a component in the chicken broth that showed anti-inflammatory activity. The chicken derived type II collagen functions to regulate the immune system, so it stops attacking proteins normally found in healthy joint cartilage. Results of a pilot study have shown remarkable results. A dose of 40 mg per day of un-denatured type II collagen (UC-II) showed a significant reduction in pain and swelling from arthritis. It also yielded good results in terms of relief from joint pain and stiffness due to exercise.

Un-denatured type II collagen (UC-II)

Animal studies on dogs and horses demonstrated that both animal groups that frequently suffer from arthritis got significant relief. Human clinical trials with UC-II showed similar effectiveness.

Researchers treated a group of patients with knee osteoarthritis with the supplement for 90 days. 33% experienced a reduction in their osteoarthritis. There was a reduction of knee pain by 40%. Those patients who received the standard treatment without any supplement had 15.4% less pain. There was an improvement of joint function by 20% in the group on the supplement. There was only 6% of improvement in the patient group receiving standard care.

Healthy patients showing more knee mobility on UC-II

Researchers also assessed healthy patients who did not suffer from arthritis, but received the supplement to evaluate how they would fare with exercise-induced knee pain. They treated them with a daily dose of 40 mg of UC-II. After day 90 and 120 the treatment group group with the supplement could exercise for significantly longer periods before experiencing joint pain. They also recovered faster after joint pain. The placebo group who swallowed “fake pills” did not show these changes. When researchers examined knee joint flexibility, the supplement group had significant increases in their knee mobility, but no such luck for the placebo group!

UC-II desensitizes the immune system

Numerous toxicological essays have evaluated the supplement. There is no oral toxicity. Researchers did not detect any mutations in bacterial genomes. This is a standard screen to ensure that a substance is non-carcinogenic.

The oral administration of the UC-II supplement works through desensitization of the immune system. It reverses T-cell attacks on exposed cartilage. If our joints are healthy and intact, we normally do not react to our own cartilage. But the protective barrier between blood and cartilage diminishes as we age. Early treatment with UC-II may help induce immune tolerance even in healthy individuals and protect them from reactions of the immune system to their own cartilage.

Conclusion

The supplementation with UC-II offers a different approach to modify joint inflammation of arthritis. Standard treatment at this point consists mainly of symptomatic treatment. Side effects to the drugs can be serious, if they are in use on a long-term basis. Few are tolerable to modify the course of the disease.

The UC-II supplement addresses the root of the disease (autoimmune disease). The patient experiences relief of symptoms within a few weeks of starting it. A person with arthritis can fight back with lifestyle changes and the UC-II supplement.

More information on osteoarthritis: https://nethealthbook.com/osteoarthritis/

References

2. Rakel: Integrative Medicine, 3rd ed., 2012 Saunders

Nov

2013

Successful Diabetes Treatment Requires Patient’s Discipline

By Ray Schilling | Diabetes, Fitness, heart attack, Heart Disease, Hormones, Nutrition, Obesity, Prevention, Stroke, Vitamins and supplements, Weight loss

90% of all diabetes cases are due to type 2 diabetes, which is associated with being overweight or obese. The other 10% are due to type 1 diabetes, which is caused by an autoimmune disease within the pancreas destroying the insulin producing beta cells. Diabetes, type 1 often occurs in childhood (hence the name “juvenile diabetes”), while type 2 diabetes is a condition of the middle aged and older population. There is however an alarming trend: overweight or obese youngsters are also being diagnosed with type 2 diabetes. Here I am discussing type 2 diabetes.

Causes that trigger diabetes

There is not just one way to get diabetes; it usually is a multifactorial disease. Sure, genetics play a minor role. But you need to have epigenetic factors to trigger the genes to develop diabetes: eating too much sugar, eating wheat and wheat products, drinking soda drinks that contain sugar or high fructose corn syrup. Alcohol binges can also cause diabetes as can accumulation of excessive weight (a body mass index above 25.0). Even when there is no genetic risk in your family (your family tree has nobody that came down with diabetes and all your ancestors lived into their 90’s), you can still develop diabetes, if you are exposed to one or more of the risk factors mentioned.

What is the reason why diabetes occurs?

At a Keystone Symposium from Jan. 27 to Feb.1, 2013 in Keystone, Colorado (Ref.1) leading scientific researchers gathered to discuss exactly this question. There seem to be several mechanisms, all of which lead to diabetes. It has been known for some time that in type 2 diabetes insulin resistance develops that renders the cells incapable of absorbing blood sugar (glucose) from the blood into the cells. It is because of this insulin resistance that doctors can diagnose diabetes when blood sugar levels are high.

Successful Diabetes Treatment Requires Patient’s Discipline

There are at least 5 mechanisms that are presently known that can cause insulin resistance (and thus diabetes) by itself or in combination. For a deeper understanding of diabetes it is crucial to be aware of these. Without knowing the enemy, you cannot fight it.

1. When a person eats too much sugar or fructose the liver converts this into excessive fat that is accumulated in the body’s cells. As a result insulin receptors are becoming inefficient in absorbing sugar from the blood, and blood sugar levels stay high. The pancreas reacts to this by making even more insulin, which after a few years will cause the pancreas to fail in producing insulin. At this point the patient requires insulin or else gets into a diabetic coma.

2. Chronic inflammation is another mechanism that has been shown to cause insulin resistance. Obesity, the metabolic syndrome and diabetes have a common inflammatory denominator that results in insulin resistance. With the aging process there is also deterioration of mitochondrial function (mitochondria are the mini batteries inside of every cell that are responsible for you having energy). This causes fat accumulation and also insulin resistance. Exercise and weight loss are effective in combatting insulin resistance. Fasting has also been shown to improve insulin sensitivity.

3. The metabolism of visceral fat (the type of fat causing the apple appearance in obesity) is highly active and is associated with an increased risk for heart attacks and developing diabetes. The pear shaped woman runs less of a risk, as the fat around the hips is not metabolically active. On the other hand when these women enter into menopause, they also develop abdominal fat (apple-like fat distribution) with a high secretion of inflammatory substances causing insulin resistance, heart attacks and strokes.

4. Another mechanism of causing inflammation comes from invasion of organs with fat cells. The development of fat toxicity from these displaced fat cells can also cause insulin resistance. Heart cells have been shown to die from fat toxicity and in the pancreas the insulin-producing cells can be killed by fat toxicity as well causing diabetes or making existing diabetes worse.

5. Interestingly another line of research, namely researching binge drinking, has revealed that there is a short-term insulin resistance that lasts for several days until the alcohol has been properly metabolized. It is of concern that adolescents who are experimenting with binge drinking are very vulnerable to develop brain damage from this habit.

Consequences of insulin resistance

We know that insulin resistance is the cause for adult onset, type 2 diabetes. It is entirely preventable. But there are powerful influences on people’s lives that will allow one or more of these factors mentioned to cause diabetes. The most common cause is putting on excessive weight. The reason for this is that people like to eat fast foods, drink sugar-containing sodas, and feast on processed foods, bagels and cookies. The end result is a change of the metabolism with an increase in triglycerides from the liver, an increase in LDL cholesterol, particularly the very low-density lipoprotein sub fractions of cholesterol. It has been known for some time that this is the connection to the high, premature death rates from heart attacks in diabetics, in people with obesity and in people with the metabolic syndrome. Hardening of the arteries is accelerated by the deposition of foam cells in the walls of arteries. These are scavenger cells (macrophages) that have engulfed noxious fats. This leads to narrowed coronary arteries and also a general narrowing of arteries all over the body including the brain vessels. In diabetics hardening of the arteries is accelerated and leads to premature strokes, heart attacks and heart failure, kidney failure, blindness and amputations of limbs.

Important tests for borderline diabetics

I you have a fasting blood sugar that is above 100 mg/dL (5.5 mmol), but less than 126 mg/dL (7 mmol) you are considered to be prediabetic or “borderline diabetic”. In this case rather than waiting for disasters in terms of cardiovascular disease, take action and ask your doctor to do the following three tests.

a) Arrange for a glucose tolerance test where you are given 75 grams of glucose; then blood tests are taken at one, two and three hours after this challenge dose. These blood tests are checked for blood glucose levels and insulin levels and tell the doctor exactly what is going on in terms of your sugar metabolism. It shows the glucose clearance and also the insulin response from your pancreas.

b) Have a hemoglobin A1c test done: it shows how your blood sugars have been controlled over the last 2 to 3 months.

c) You also need a VAP (vertical auto profile) test, which tests your lipid profile. Both prediabetics and overtly diabetics have been shown to have lipid profile disorders. Apart from low values in sub fractions of HDL cholesterol this test will also measure the very-low density lipoproteins (VLDL), which has been shown to be responsible for heart attacks and strokes.

With these three tests your doctor can tell you more accurately what treatment protocol you require to succeed in controlling or curing your pre diabetes or diabetes.

Conventional treatment of diabetes

The conventional treatment of diabetes is to send the patient to a dietician, to ask the patient to do regular exercises and to either start them on hypoglycemic drugs or on insulin injections. Unfortunately the dietician often will encourage the patient to eat “healthy multigrain bread”, which will stimulate your taste buds to eat more sugar, high fructose corn syrup and starchy foods making weight loss impossible. Often the treating physician is satisfied that a hemoglobin A1c of 7% or less is good enough for the diabetic. But non-diabetic people have a hemoglobin A1c of 4% and 5.6%. This should be your goal or you will suffer the consequences of uncontrolled diabetes.

This is what I would call the conventional, symptomatic treatment approach. This may be the approach for patients who are not willing to seriously change their lifestyles, but it is more powerful on the long-term to treat diabetes by treating the underlying causes.

Alternative treatment approach for diabetes

Based on the above discussion regarding the various causes of insulin resistance, it is important to analyze what would be the main contributory factors in your particular case of diabetes.

Here are some suggestions:

1. If you are on the typical North American diet, also known as Western diet, it would be important to face the fact that wheat, wheat products in processed foods and sugar including high fructose corn syrup are the main culprits in stimulating your appetite and making you a sugar and wheat addict. Ref. 2 describes this in detail and offers 150 recipes to overcome this addiction. For more information just follow this reference text. Essentially it is a wheat-free Mediterranean type diet without rice, pasta and bread. You will shed significant amounts of pounds within a short period of time and feel a lot more energetic (due to revitalization of your mitochondria). At the same time insulin resistance is disappearing, because the insulin receptors are fully functional again. The insulin production of the pancreas will go down to normal levels and fat from the visceral fat storage gets melted away resulting in less inflammatory substances circulating in your blood.

2. A regular exercise program in a gym with an aerobic component (30 minutes of treadmill for instance and 20 to 30 minutes of isometric machine exercises) will help you to lower the triglycerides, and increase the healthy HDL cholesterol. It will also improve insulin sensitivity and control inflammation in your body. The best is to exercise 7 days per week. Remember your body works for you 7/7 every week, but for those of you who need a little rest in between 5 days per week is still very good. You may have to adjust your medication and insulin dose downwards, ask your physician about that.

3. Cut out alcohol. This may sound radical to you, but studies show this to be true. I have not mentioned cutting out smoking (it is causing inflammation and insulin resistance), because this is an absolute must that is given. When it comes to alcohol, the famous 1 drink per day for cardio protective purposes may not show up statistically as a bad effect, but your body will nevertheless get the message and let you age somewhat faster than a person who stays sober all the time. Staying sober will allow your brain to think clearly and adhere to your overall lifestyle approach in treating diabetes. Cutting out alcohol protects your brain (including the hypothalamus), liver and pancreas and prevents the prolonged periods of insulin resistance mentioned above that last for days. By keeping your hypothalamus in good working order, your hormone balance will stay stable for as long as possible until you reach menopause (for women) or andropause (for men). When you reached this milestone, I suggest you engage in bioidentical hormone replacement, which I have reviewed here. Hormones are essential to keep you younger for longer.

4. It is useful to monitor your blood sugar with a home glucometer, as this will show you when your blood sugar normalizes. Stay in touch with your doctor at all times, as this will help you in your overall management of your diabetes. Also, you will want to discuss with your doctor that you should have a blood tests called “hemoglobin A1c” measured every three months to see how well your diabetes is controlled. It should be below 7% for sure, but better below 6%. Non-diabetic people have levels of 4% and 5.6%. You may not know that hemoglobin A1c is actually measuring the amount of advanced glycation end products (“AGE”) of red blood cells. These AGE substances essentially are firmly bound sugar/protein compounds that shut down the cell metabolism wherever they are formed. In my opinion it is best to aim at a hemoglobin A1c level of non-diabetic people (4% and 5.6%) to avoid the consequences of tissue damage of all vital organs, which is the reason why long-term diabetics have a life expectancy of 15 to 20 years shorter than non-diabetic persons. Some diabetic patients may benefit from the oral hypoglycemic drug, metformin (brand name: Glucophage), which has anti-inflammatory properties and is used in patients with type 2 diabetes and a high fasting insulin level, but this is a decision requiring your physician’s input.

5. Supplements: There are some supplements that are useful to take as an adjunct, like chromium, which helps insulin to transport glucose into the cell; alpha-lipoic acid, an antioxidant, which is useful to prevent glycation (formation of a complex between sugar and protein, which prevents normal cell functioning); and coenzyme-Q10, which supports your heart (A4M recommends 400 mg per day, higher than Dr. Weil’s link). Other supplements of merit are curcumin, cinnamon, genistein and silymarin (standardized extract of milk thistle), which suppresses a pro inflammatory molecule, which in turn helps to fight insulin resistance (Ref. 1). Omega-3 fatty acid supplements are anti-inflammatory and will improve insulin resistance as well (dosage 1000mg or more per day). According to Ref. 3 vitamin D3 is useful as a supplement for diabetics, because it activates DNA, is involved in cellular repair and deficiency of it is known to lead to higher mortality rates in diabetics. Ref. 3 recommends between 1000 and 4000 IU of vitamin D3 daily and suggests doing blood tests to measure effective vitamin D3 levels (keep 25-OHD in the blood between 30 and 80 ng/mL).

6.Patients whose pancreas no longer produces insulin will need insulin injections, but instead of using long-acting insulin once per day the best results in getting blood sugar control is by injecting insulin three or more times per day using short acting insulin. It is important to always monitor the blood sugar lowering effect by glucometer readings; the injections are best given just before meals (recombinant human insulin is the preferred insulin to be used). Ask your physician or diabetic coach for more details.

Conclusion

Diabetes used to be a dreadful disease that caused premature heart attacks, strokes, blindness, kidney failure, and limb amputations. With aggressive management of diabetes as well as strict lifestyle intervention this has changed. A diabetic who treats the causes of the illness can have a normal life expectancy. In many cases the initial diagnosis of type 2 diabetes can disappear, when treatment was started early enough and insulin resistance could be stopped in its tracks. Without the patient’s full co-operation disciplining him/herself to follow through on all of these recommendations the caregiver will fail in controlling the patient’s diabetes. It is the patient who owns the problem; it is the patient who needs to make every possible effort and follow through on all of the details of dieting, exercising, blood sugar monitoring using a glucometer and taking the required supplements.

More information on diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Reference

1. http://www.lef.org/magazine/mag2013/oct2013_2013-Keystone-Diabetes-Symposium_01.htm

2. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Dec. 17, 2014

Nov

2013

MS Is A Multifaceted Disease

By Ray Schilling | Allergies, Multiple sclerosis, Nutrition, Prevention

A new study was recently released that showed that MS is a multifaceted disease. A significant number of people without multiple sclerosis have narrowing of their neck veins. There is a new theory that chronic cerebrospinal venous insufficiency due to narrowing of veins outside the skull may be responsible in causing MS in a significant percentage of patients. Using venograms in MS patients and in controls without MS a recent study from the University of British Columbia, Vancouver, BC showed that normal controls also had narrowing of neck veins and the authors felt that this invalidated the vascular theory of MS. This story is based on this Lancet publication.

Brain oxygenation is what counts

What was not mentioned in this publication was that venous blood flow on the surface of the brain can get obstructed inside the skull. It’s all about brain tissue oxygenation; if the brain gets enough oxygen, all is well. If there were a lack of perfusion due to venous congestion inside or outside the skull, the patient would be in trouble. I will discuss this further below.

In this blog I will discuss first how to diagnose MS, then mention some newer studies about neck vein circulation with SPECT scanning. I will then review various causes of MS and return to a discussion of the Vancouver study from above.

How MS is diagnosed

The physician can combine a number of tests to diagnose MS. This includes the patient’s symptoms such as balancing problems, double vision, memory problems, fatigue etc. Neurological examination, imaging studies like MRI scanning, lumbar puncture to examine the cerebrospinal fluid and evoked potential studies is what a neurologist orders. The physician requires all of these findings to decide whether the criteria for making a diagnosis are in keeping with all the symptoms of MS. In 2001 an international neurological panel developed the McDonald criteria for diagnosing MS, which were revised in 2010.

MS Is A Multifaceted Disease

Newer ways diagnosing perfusion problems in MS patients (SPECT scan)

One of the newer functional scans is a SPECT scan. It shows areas where there is a lack of blood supply to the brain, but can also identify areas where too much blood circulates. Here is a site where the technique of the SPECT scan is reviewed in more detail.

SPECT scan results in MS patients

SPECT scans in MS patients showed a significant reduction in blood flow to the frontal lobes and to the left temporal lobe. Reduced activity of the left temporal lobe on SPECT scans correlated with MS patients having a deficit in verbal fluency and having a problem with verbal memory. This indicates that a reduction in blood flow to these areas of the brain associates with developing MS.

Perhaps a SPECT scan of the brain (which is where the action of MS is) may be a better indicator for MS than looking for veins in the neck by ultrasound or venograms, as SPECT scans look directly at brain perfusion. The question is whether these blood circulation problems in MS patients may cause deficiencies in the brain of oxygen, nutrients and possibly of other internal mediators.

Known causes of MS

There are a number of known causes of MS, which I will review below.

Autoimmune disease

As this link shows, MS is a disease due to inflammation of the brain. The area where there is inflammation leads to demyelination from loss of the myelin sheaths, which causes the white lesions visible on MRI scans of the brain. One such cause is an allergy to wheat and wheat products. Gliadin antibodies and anti-tissue transglutaminase antibodies were positive in a significant number of MS patients, but not in controls. This suggests at least in part that immunological causes are at play. I agree with this blog that describes that there is significant evidence that gluten intolerance can lead to MS and the positive tests that were found by researchers are likely just the tip of the iceberg.

Overlap of celiac disease and MS

Dr. William Davis describes in Ref. 1 and 2 that you can have celiac disease with no gut symptoms, in other words a person can develop autoimmune symptoms from gliadin and gluten sensitivity without diarrhea or bowel cramps. Dietary lectins, particularly the ones found in wheat lead to leaky gut syndrome and subsequently to autoimmune diseases. One of these autoantibodies can cause MS by destroying the myelin sheath. In a mouse model Mayo Clinic researchers have shown that an antibody injection can be used to block autoantibodies against the myelin sheath. Investigations are ongoing with regard to whether this type of treatment would work in humans as well.

Genetic factors

It is known that a human leukocyte antigen (HLA -DRB1) shows an association with the risk for developing MS. Caucasians have a higher risk of developing MS and they also carry the HLA-DRB1 antigen more often. Another genetic factor is a variation of the IL7R gene. You can read about it under the HLA-DRB1 link. On average the risk of getting MS in the general population is about 10 to 20%.

Nutrition and dietary factors

It has been described that vitamin D3 levels when obtained from in MS patients are low. Vitamin D3 can prevent against MS to a certain degree, so does sun exposure. In countries where malnutrition is common, MS occurs more often.

According to Dr. Terry Wahls who is a clinical professor of medicine at the University of Iowa Carver College of Medicine, a diet of vegetables, fruit, meat, no grain, no dairy, no sugar, no corn and no potatoes can cure MS. Dr. Wahls herself had severe MS in the past and cured it with the help of this diet!

Infections

Certain infections can cause MS. Probably the best correlation was found between the mononucleosis virus (Epstein Barr virus) and the later development of MS.

Chronic cerebrospinal venous insufficiency

According to Dr. Zamboni from Italy clogged veins in the neck can cause MS. Dr. Zamboni placed stents into neck veins that showed narrowing. He found that about 50% of MS patients had improvement with the placement of stents. This allows the blood from veins around the brain to drain normally. This could improve brain circulation in the areas described above where SPECT scans detected a lack of blood supply to certain parts of the brain.

Discussion of the Vancouver publication

It is important to note that certain areas of the brain were not circulating blood as well as others. SPECT scans depicted the blood circulation of the brain. 50% of patients with chronic cerebrospinal venous insufficiency experienced a cure from MS with simple venous stent procedures. This is remarkable. Sure, the Vancouver researchers found that normal controls also have a significant amount of venous abnormalities in their necks. But this does not explain the successes in those MS patients who got better with a simple venous stunt procedure. We also need to be cognizant that Big Pharma sponsored the Vancouver study researchers.

Measuring brain circulation in MS patients

SPECT scans on both the control groups and the experimental MS groups before and after stent procedures need to be done. This way we know whether the brain circulation following stent procedures improved or not. However, this is what I would have expected to see. In other words more research is necessary by other investigators. The question they need to answer is whether or not the surgical stents provided help. Did the surgical procedure help to normalize their brain circulation or not?

Conclusion

Our knowledge regarding MS is getting more multifaceted as new research is emerging. Diet appears to be a major contributing factor, as vitamin D3 is essential for normal brain function and for a normal immune system. At the same time researchers identified grains and wheat as a cause of MS in a subgroup of patients. Leaky gut syndrome can cause autoimmune antibodies, which subsequently can bring on MS. Avoid the foods Dr. Wahls described as being causative in developing MS and you can improve MS remarkably or get cured. The same is true for avoidance of wheat and wheat products as Dr. Davis described.

Multifaceted causes of MS

In my opinion not every MS patient benefits from a stent, but vitamin D3 deficiency or a history of mononucleosis infection in the past does not explain the causation of every MS case. We simply do not have all of the answers yet. But we do have enough information to thoroughly investigate MS patients; the treating physician will then use clinical judgment to decide which treatment would be the most suitable one for an individual MS patient.

More information on multiple sclerosis: http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/

References

2. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Oct

2013

Being SAD in Fall (Seasonal Affective Disorders)

By Ray Schilling | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

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

References

Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Oct

2013

Healthy Choices Start In Your Brain

By Ray Schilling | Alzheimer’s disease, Anti-aging medicine, Diabetes, Fitness, High Blood Pressure, Infectious Disease, Mental Health, Other neurological conditions, Prevention, Stroke, Substance abuse, Vitamins and supplements

This article deals with healthy choices start in your brain. You may have seen the CNN heading “Where is self-control in the brain?” If we want to make any healthy choices in life including sound financial choices, we need a balanced brain that makes the right decisions for us.

Two ways of making food choices

Researchers at the Caltech in Pasadena, CA have examined this question in detail using functional MRI scans and found out that there are two loci on the frontal lobe of the brain that control your impulses: the “ventral medial prefrontal cortex” (red in this link) that processes your initial image (like seeing a delicious ice cream cone”) and the “dorsolateral prefrontal cortex”(green in this link), where you decide that this is not healthy for you because it has too much sugar in it.

Two groups of volunteers

The Caltech researchers found a group of volunteers who were impulsive and made the wrong choice simply based on their taste buds without consideration for their health in general. An equally large group of volunteers was also found who had functional activity in the ventral medial prefrontal cortex and the dorsolateral prefrontal cortex, the latter of which modified the final decision into the healthy choice. The impulsive group made their decision to buy simply with the activation of only the ventral medial prefrontal cortex.

Balanced thinking required to make the right choices

The researchers think that it is this kind of lack of balanced thinking that decides whether we are going to make the right or wrong health choices for ourselves. The sad part is that ultimately, the summation of bad health decisions during life can become the cause of developing dementia, such as Alzheimer’s disease. The good news is that many of the causes of dementia can be avoided, which means that the average person could prevent dementia. I will discuss this in detail here.

Causes of dementia

It is interesting to study patients with various forms of dementia as it is often in the frontal and temporal portions of the brain where brain cells are dying off resulting in impulsive buying, impulsive behavior and lack of recent memory. It is also important to recognize that a number of conditions or factors can cause dementia:

1. Genetic causes

There are two types of frontotemporal lobe dementias, a tau-protein positive FTD and a ubiquitin-positive FTD, which has been shown to be due to a deficiency in progranulin. Both of these genetic defects are located on chromosome 17. In Alzheimer’s dementia, which occurs later in life there can be genetic defects at chromosomes 21, 14 or 19. Epigenetic factors like exercise, avoidance of alcohol, and taking omega-3 supplements can even partially prevent or postpone the onset of dementia from genetic causes.

Healthy Choices Start In Your Brain

2. Toxins like alcohol

Another example of how people can get dementia is through the effect that regular alcohol consumption has on our brains and bodies. This image of an MRI scan shows a normal brain for comparison on the right and the MRI scans of the brain of a chronic alcoholic on the left. When a chronic alcoholic has severe atrophy of the brain a psychiatric condition, called Korsakoff’s syndrome can occur. This psychotic condition as a result of the brain having been poisoned by regular alcohol intoxication. Essentially the toxic effect of high daily doses of alcohol have shrunk not only the surface of the brain, but also the deeper substance of the brain. The patient is psychotic, has loss of memory and is unable to care for him/herself.

3. Vascular damage to the brain

Strokes can cause vascular dementia that leads to Alzheimer’s disease-like memory loss. This link points out that diseases like hypertension, obesity, diabetes, atrial fibrillation, ischemic heart disease and dyslipidemia all predispose you to possibly get a stroke with subsequent dementia.

4. Traumatic head injuries

In boxers, football players and combat soldiers brain cells can get lost from repetitive head trauma leading to dementia (in this case it is called “dementia pugilistica”).

5. Infectious dementia

HIV in AIDS patients can affect the brain and cause an HIV-associated dementia. Bacterial meningitis and viral meningitis can kill brain cells and cause a form of dementia as well.

6. Immune disorders

We know that MS can go on to develop dementia as a late complication. In MS there are autoantibodies against myelin, the insulation material that surrounds nerve fibers. An important category of immune disorders is autoimmune disease that can cause dementia. The cardiologist, Dr. William Davis, has presented compelling evidence that wheat allergies can cause dementia, but if detected early and treated by a gluten free diet, this clears up the mind and stops further development of dementia (Ref.1 describes wheat allergies causing dementia; a wheat free diet is described in Ref.2).

7. Hormone deficiencies

A classical example is hypothyroidism, which in the past before thyroid medicine was available, often led to dementia. A simple blood test, TSH (thyroid stimulating hormone) can detect whether or not you are hypothyroid. The A4M recommendation for a normal level is below 2 (not below 5 as often reported by official lab value reports).

8. Lack of vitamins

Thiamine (=vitamin B-1) is often missing in alcoholics. If you are missing vitamin B-6 and vitamin B-12 in your diet, this can predispose you to develop dementia as well. Aging people lose a factor from the gastric mucosa (the intrinsic factor) that is essential to absorb vitamin B-12 in the mall bowel, which predisposes them to develop pernicious anemia and dementia. A simple vitamin B-12 injection can prevent this from happening.

9. Too much sugar consumption

Sugar consumption has skyrocketed in the 1900’s and keeps on going up in the new millennium as well. Here is a review that discusses the possibility that Alzheimer’s can be triggered by overconsumption of sugar. The higher the blood sugar levels in diabetics, the higher the risk for developing Alzheimer’s disease. A study in Seattle has confirmed this. High insulin levels are found in type 2 diabetes; they are responsible for making brain cells stimulate the production of the gooey substance amyloid that causes Alzheimer’s disease. The authors of this study showed this to be true both in humans and in animal models.

10. Lifestyle issues

These include lack of exercise, excessive weight (obesity, being overweight) and poor diet (fast foods). They play an enormous role in terms of causation of dementia in addition to the other factors mentioned. On the other hand organic foods Lack of toxins) and a Mediterranean type diet will preserve your brain cells.

Treatment of dementia

At present treatment of dementia is very limited, as we do not have a complete understanding of dementia at this point. The traditional treatment of dementia outlined here will only marginally delay further deterioration of dementia, but ultimately fail. In my opinion this is because the medical profession has been concentrating on fighting the symptoms of dementia rather than the cause.

Given the known causes mentioned above, I like to give you a list of 6 recommendations. These will help you to prevent Alzheimer’s disease and dementia in general.

Cut out sugar

I would suggest that you cut sugar out of your diet and replace it with stevia. This also includes dates, grapes, bananas; also wheat and wheat products and starchy foods like pasta, potatoes, rice and bread (see Ref. 1 and 2 for details). The manufacturers of soda drinks, pies and cakes will not be happy about this recommendation, but it will please your brain cells. You will also be surprised how easy it is now to lose weight, which will please you (this also lowers your risk for heart attacks and strokes).

Limit your alcohol consumption

Severely limit your alcohol consumption to less than 1 drink for women and 2 drinks for men per day (better still would be to stay sober) unless you want to become part of the hospital population mentioned in one of the links at the beginning of this blog.

Have your hormones checked

Have your hormones checked, particularly your thyroid hormones, but also estrogen and progesterone levels in women and testosterone in men. Our brain cells have hormone receptors for a reason. They need stimulation from our hormones, even in menopause or andropause. Replace the missing sex hormones with bioidentical hormone creams and missing thyroid hormones with thyroid tablets (Armour is the best mix of T3 and T4 thyroid hormones, not Synthroid).

Prevent repetitive brain injuries

Prevent repetitive brain injuries before it is too late. Rethink whether you really need to box, street fight, play football, rugby or hockey. An Accumulation of head concussions can cause Alzheimer’s later in life!

Use vitamins for prevention of dementia

Use vitamins for prevention of dementia: The B complex vitamins like B-2, B-6, B-12 (by injection); vitamin D3 has recently been shown to be effective in slowing down Alzheimer’s disease. Vitamin D3 is low in Alzheimer’s patients and vitamin D3 supplements will slow down this disease. Although vitamin C showed equivocal results, it does have some neuroprotective qualities and decreases β-amyloid production and acetyl cholinesterase activity. A Mediterranean-type diet (Ref.2) is also helpful in preventing dementia

Do regular exercise

Exercise daily. It will discipline you to stick to the other points mentioned above. It gives you some extra endorphins and will make you feel good about yourself.

Conclusion

Although we do not yet have a complete picture regarding Alzheimer’s disease and dementias, we do know enough to reduce our risk of getting them. When you cut out wheat and wheat products, your immune system stops production of autoimmune antibodies against your brain cells. Your opiate receptors in the brain will no longer seduce you to eat more and more sugar, starchy foods or high fructose corn syrup. You no longer have a problem cutting out high glycemic index foods (Ref.1). This will reduce insulin and reduce IGF-1 growth factors. These can lead to the production of the gooey amyloid substance that makes you lose your memory. The orbitofrontal part of your brain (particularly the dorsolateral prefrontal cortex) will be reminding you what you read here: healthy lifestyle choices start in your brain.

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Oct. 19, 2013

Oct

2013

Music More Powerful Than Anti-Anxiety Drugs

By Ray Schilling | Autism, Cancer, heart attack, Mental Health, Pain, Stress management, Substance abuse

When was the last time you saw your physicians for anxiety and you were given a prescription that said: “for anxiety listen to your favorite music!” instead of receiving a prescription for an anti-anxiety drug (anxiolytic). This is exactly what a recent study suggests that showed prior to surgery you can control your anxiety either with anti-anxiety drugs or by listening to your favorite music. Listening to your favorite music will do you no harm, while many drugs do have harmful side effects.

How singing can change the brain chemistry

Other studies have investigated how singing can change your brain functioning in terms of brain chemistry. The researchers found that singing will release dopamine in your brain, which is responsible for feeling pleasure; it will stimulate your immune system by elevating immunoglobulin A and decreasing cortisol (the stress hormone). This in turn will preserve your immune cells (lymphocytes). Oxytocin levels of your brain are increased, which promotes social affiliation. It also calms down the autonomic nervous system resulting in a better airway opening, calming of your heart rate and soothing the wave-like muscle contractions in your gut, medically called peristalsis. You would refer to that as “butterflies in your stomach”. Music therapy reduces pain and anxiety by 50% and is important for children and adults alike.

Pain and anxiety reduced

A study in Germany showed that pain and anxiety were significantly reduced with music therapy. A Taiwanese study of women in labor found that music therapy significantly reduced pain and anxiety of women during labor. Ref. 1 explains that music therapy is useful as an adjunct to treating cancer pain, and reducing anxiety associated with colposcopy procedures. It also can help when treating patients who had heart attacks in the setting of a cardiac care unit.

Music More Powerful Than Anti-Anxiety Drugs

Hypnosis and guided imagery

Music has been successfully combined with clinical hypnosis and guided imagery where words are carefully chosen to help the patient experience pleasant feelings, which counteract the experience of pain, anxiety or fear of dying. A simple relaxation CD or tape with soothing background music will facilitate this type of therapy. This is useful for patients in a palliative care unit where they prepare themselves to accepting the inevitable death from an incurable disease. But chemotherapy patients undergoing these procedures for cancer treatments also have benefitted from a significant reduction in nausea, vomiting (side effects of chemotherapy) and pain.

Autism and music therapy

A Cochrane study showed that autistic children did better in terms of communication skills when music therapy was incorporated into the treatment protocol. One of the core deficits in autistic children is in the area of communication and social skills. This is where music therapy was most effective. Behavioral problems (stereotypic behavior) in autistic children did not respond to music therapy. A comprehensive treatment program for autistic children should therefore incorporate music therapy. Here is a blog that describes what difference music therapy can make in the lives of autistic children written by a member of the American Music Therapy Association.

Substance abuse and music therapy

An area where you may not expect music therapy to have a role is in the area of drug and substance abuse rehabilitation , which is discussed in more detail in this site. The beauty about music therapy is that it is not a drug, yet the natural endorphins that are released by the brain help the affected person getting through withdrawal easier. Music therapy helps building up self-esteem, participating in group activities, promoting self awareness and expressing feelings.

Mood disorders in adolescents

One important area where music therapy has been employed is with anxiety and depression in adolescents. Adolescents spend an average of 4 hours per day listening to music. So they are already programmed to listen to music. With the help of a music therapist they can be directed to listening to the type of music that will help them get motivated, relax more, make them feel accepted and be part of their peer groups. In this study the authors suggested to combine music therapy with dance and art therapy. In this way the whole person gets involved in the treatment and this can be integrated with conventional antidepressant treatments at reduced doses (with less side-effects) or with cognitive therapy.

General objectives of music therapy

Music therapy is best incorporated into a treatment protocol as an adjunct. It can help reduce the use of drugs for psychiatric patients, for people with anxiety and for patients with pain conditions. The Cleveland clinic has a useful summary about music therapy, which describes the uses of it for reducing anxiety, for helping with coping skills, mood improvement and distraction from pain. There are registered music therapists you can ask for help. The website of the American Music Therapy Association may have other useful links for you.

Conclusion

Music therapy is a treatment modality with no side effects, but providing effective treatment for quite an impressive range of clinical conditions as discussed. Music therapists are widely available in the US and many other countries. This treatment can be integrated with conventional or complementary treatments. It helps people to heal the body as a whole unit (mind and body).

More information on anxiety disorders: http://nethealthbook.com/mental-illness-mental-disorders/anxiety-disorders-panic-disorders-phobias-ocd-ptsd-anxiety-others/

References

Last edited Nov. 7, 2014

Oct

2013

Fighting Back Against The Flu

By Ray Schilling | Fitness, Infectious Disease, Lung Disease, Nutrition, Prevention, Stress management, Vitamins and supplements

Every year there is concern about the upcoming flu season. Mostly the discussion centers on the composition of the latest flu bugs and what type of strains would be included in the latest vaccine recommended. The first flu case of the season has just been reported in a child. Here I am going to review what you can do to minimize your probability of getting the flu, or if you get it, how to minimize the severity of the illness.

The immune system

We know for some time that the antibody-mediated immune system is what helps overcome flus. The body’s immune system produces antibodies against the flu via T-helper cells that recognize the glycoprotein (hemagglutinin) of the flu virus and pass a signal on to B cells (bone marrow derived lymphocytes), which in turn are turned on to produce a lot of antibodies (Ref.1). These protect you from future flus of this type. If you have pre-existing antibodies that fit the bug in circulation you are OK ,and you will usually not get the disease.

The factors that protect you from the flu

However, there are many other factors that support your immune system. I will discuss the most important factors in more detail here.

1. We do know that vitamin D3 strengthens the immune system. I would recommend 1000 to 2000 IU per day in the wintertime, but up to 4000 IU or 5000 IU per day during an active epidemic would be reasonable. There is less flu when people are taking Vitamin D3 supplements.

Influenza A was reduced in school children supplemented with 1200IU of vitamin D3. This study recommended higher doses of 2000 to 7000 IU of vitamin D3 per day; but it also stated that as a precaution serum vitamin D levels should be monitored (technically it is serum 25-hydroxy-vitamin D levels that are measured) to avoid vitamin D toxicity. Normal levels are between 40-70 nanograms per ml. Toxic levels are above 100 nanograms per ml. Your family doctor can order a serum 25-hydroxy-vitamin D level for you.

2. Eating fruit and vegetables is important for maintaining a healthy immune system. In a randomized study from Belfast, UK elderly volunteers (82 of them, aged 65 to 85) were assigned to either eat 2 portions or 5 portions of fruit and vegetables per day over 16 weeks. At 12 weeks into the trial both groups received a Pneumovax II vaccination, and the antibody response was measured at the end of the 16^th week of the study. There was a significant increase in antibody binding capacity to pneumococcal capsular polysaccharide in the 5 portion fruit and vegetable group compared to the 2 portion group that had no such increase. The authors concluded that there is a measurable improvement of the immune system when an older population increases their fruit and vegetable intake.

3. Avoid stress, because stress has been shown to weaken the immune system. This review shows that the immune system is weakened by the stress response via the elevated corticosteroid hormones (the stress hormone ACTH stimulates cortisol release from the adrenal glands). The stress of social isolation is also contributing to the weakening of the immune system in older people.

Fighting Back Against The Flu

4. Exercise moderately and your immune system will get strengthened. Over exercising should be avoided as too much cortisol is released from your adrenal glands, which is toxic to lymphocytes thus weakening your immune system.

5. Socializing is good for you as studies have shown that you live 2 ½ years longer. This study here is from Connecticut, but other studies confirmed this as well.

6. Make love. The endorphins that are released in the process stimulate the immune system.

7. Take probiotics, because they help your gut flora to stay normal. A normal gut flora promotes a stronger immune system as the Peyer’s patches (clumps of immune cells) in the gut wall are intimately linked to the immune system. In this way probiotics indirectly support your immune system.

8. Avoid smoking. Smokers have more upper and lower respiratory tract infections than non-smokers. Here is information that explains this as well.

9. Get enough sleep. The circadian rhythm of your hormones ensures that your hormones function at their optimal level. Melatonin from the pineal gland is important in triggering the circadian rhythm, but melatonin itself supports the immune system as well. Your adrenal glands need resetting overnight so that cortisol is secreted according to your stress level, not too much and not too little. Overstimulation from performance sports, grief reactions, car accidents, injuries etc. lead to a surplus of cortisol and weakening of the immune system.

10. Take your flu shot (but without thimerosal) every year, but take it as a single shot (without thimerosal as a preservative). This CDC link explains that single shot flu vaccines are available without thimerosal. I recommend this type of flu vaccine. The central nervous system is extremely sensitive to nanograms of mercury, and it is for this reason that I would not buy into the argument of the CDC that one should not be concerned about safety of thimerosal. The newest for this flu season is the quadrivalent (or four-strain) flu vaccine, which is now available in pharmacies throughout the US.

11. Vitamins and supplements support your immune system, particularly vitamin D3. DHEA, which is available over the counter in the US stimulates antibody production when the flu vaccine is given, particularly in the elderly, in other words DHEA strengthens the immune system Vitamin C is known to support the immune system and is rapidly depleted in those who suffer from any viral infection. There are other nutrients that are useful to stimulate your immune system.

12. Consider herbs: Echinacea, Siberian ginseng, Asian and American ginseng, astragalus, garlic, and shiitake, reishi (also called “lingzhi mushroom”) and maitake mushrooms have all been shown to stimulate the immune system with negligible side effects.

13. Wash your hands, particularly when there is a flu going around. Door knobs for instance are known to keep live viruses for 2 to 8 hours, so washing your hands will reduce the amount of virus you are exposed to.

Conclusion

There is no single solution to prevent the flu, but we can all minimize our exposure to the virus and strengthen our immune system. Although it is wise to get a yearly flu shot to boost your immune system (without thimerosal as a preservative) just before the epidemics come around, this alone is not as good as combining the non-specific factors mentioned here with it. Particularly vitamin D3 (2000 IU to 4000 IU per day) and the old stand-by vitamin C (1000 mg to 2000 mg daily) will stimulate your immune system. Spice up your dinners with mushrooms that stimulate your immune system (maitake, shiitake, reishi mushrooms). Go to bed early enough to allow your circadian hormone rhythms to be reset overnight as you sleep. This will stimulate your immune system (from melatonin and DHEA of your adrenal glands).

More info on the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

References:

Last edited Nov. 7, 2014

Sep

2013

Sleepless Nights

By Ray Schilling | Health, Hormones, Insomnia, Mental Health, Pain, Prevention, Sleep apnea, Substance abuse, Vitamins and supplements

Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

Symptoms of insomnia

The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression, anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

Research about insomnia

Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

Sleepless Nights

Causes of insomnia

Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

Predisposing factors

We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

Precipitating factors

A situational crisis like a job change or the death of a loved one can initiate insomnia. However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

Perpetuating factors

Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

I will return to this classification and the factor model of causation of insomnia when we address treatment options.

Drugs that can cause insomnia

One major possible cause for insomnia can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

Treatment of insomnia

So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

The following general points are useful to get into the sleeping mode (modified from Ref. 3):

Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
Get into a regular exercise program, either at home or at a gym.
Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
Do not use your bedroom as an office, reading place or media center. This would condition you to be awake. Reserve your bedroom use only for intimacy and sleeping.
If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

Drugs and supplements for insomnia

1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta). They seem to be better tolerated.

3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

Conclusion

A lack of sleep (insomnia) is almost a given in our fast paced lives.

When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

References

2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

Last edited Sept. 28, 2014