Medical Articles by Dr. Ray

May

2023

Lung Cancer Screening Program

By Ray Schilling | Cancer, lung cancer, Smoking

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

Feasibility of a lung cancer screening program

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

Lung cancer screening program free for patients

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

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

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

Various methods to do lung biopsies

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

Test to determine the extent of the lung cancer

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

Distant metastases

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

Extent of disease evaluation: Staging of lung cancer

Stage:

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

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

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

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

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

Is it wasted time to do the staging procedure?

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

Treatment of lung cancer

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

Surgical risk and treatment of stage III and IV

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

Lung Cancer Screening Program

Conclusion

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

May

2023

Colorectal Cancer in a younger Population

By Ray Schilling | Cancer, colorectal cancer

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

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

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

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

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

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

Colonoscopy screening

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

Statistics of colorectal cancer in a younger population

Newer cancer statistics show the following:

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

Causation of colorectal cancer in a younger population

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

Environmental factors causing early colorectal cancer

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

Colorectal Cancer in a younger Population

Conclusion

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

Start initial colonoscopy screening at age 30

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

Apr

2023

Help with Menopausal Symptoms

By Ray Schilling | blood test, Diabetes, diet, Inflammation, Insomnia, irregular periods, Menopause, Nutrition, sleep

At the 30^th A4M Conference mid-December Dr. Anna Cabeca lectured about “Help with menopausal symptoms”. A4M stands for “Conference of the American Academy of Anti-Aging Medicine”. It is a yearly event at the Sand Conference Center of the Venetian Palace in Las Vegas. The following is a summary of the very detailed lecture by Dr. Anna Cabeca.

Definition of postmenopausal symptoms

Dr. Cabeca’s detailed title for her lecture was: “Menopause: Hot flashes, brain fog and vaginal dryness; 3 symptoms women don’t have to experience.” The first thing to remember is this detailed list of symptoms of menopause:

Hormones are disbalanced
Unusual behaviors and moodiness
Gaining weight (accumulating fat)
Tiredness
Loss of willpower
Sleep disturbance: can’t sleep or sleeps all the time
Brain fog and memory problems
Lost your “edge”
No sex drive
Aging rapidly
Hair loss
Thyroid problems
Hysterectomy (to remedy excessive periods)

Hormone changes with menopause

To clarify, there are major hormone changes with menopause as follows. To explain, at the age of 35 progesterone suddenly experiences a major reduction, which completes by the age of 45. In contrast, estrogen levels remain high until the age of 40 when it, too is reduced to background activity by the age of 50. In fact, at this point estrogen production is still more than progesterone synthesis. This is the basis of what is called estrogen dominance.

In general, symptoms of estrogen dominance are: PMS, hot flashes, night sweats, mood swings, weight gain, vaginal dryness, brain fog, irregular periods, less libido, missing or increased periods, bone loss and sleep disturbance.

To emphasize, the production of male hormones, DHEA and testosterone, slows down around the age of 30 and reaches a low plateau around the age of 45. This explains, for example, the lack of sex drive mentioned above. In addition, it is also partially responsible for brain fog, tiredness, hair loss and unusual behaviors and moodiness.

Perimenopause and menopause increase risk for diabetes

By all means, there is a clear relationship between age and the risk of developing diabetes in both males and females. But it must be remembered that the hormone weaknesses in combination with weight increases can also trigger diabetes.

Head-to-toe patient work-up

There are two parts to a patient’s work-up, a thorough assessment and a patient’s education.

The patient’s assessment includes:

Energy, mind, spirit
Hormone balance
Inflammation
Assessment of diet and nutritional intervention
Gastrointestinal health and digestion
Detoxification
Structural investigation

Surely, another key point is that patient education is important to be successful in the multiple step intervention to normalize the metabolism, shed excessive weight and help the patient to refocus.

Comments to the patient’s assessment

Indeed, the display of energy in a patient is closely related to hormone balance. Notably, when hormones are measured and they are out of balance, this usually explains the multiple symptoms. It is important to realize that inflammation is measured with the high-sensitivity CRP blood test. This test measures the level of inflammation. Initially, the level may be 30, but with weight loss it often normalizes with values of 2 or 3. At the same time weight loss stabilizes blood sugar (indicated by an initially high, but later normalizing hemoglobin A1C) and diabetes can completely disappear. Frequently, an analysis of the diet often shows that the patient is eating too much sugar and starchy foods.

Faulty nutrition, heavy metals and osteoporosis

In addition, many patients also eat too much meat and processed meat products, which leads to elevated cholesterol and triglycerides. Also, introducing more vegetables and fruit reduces lipids in the blood. Certainly, patients’ blood tests often show high levels of heavy metals like mercury, lead and cadmium. This can be chelated out with intravenous EDTA. Often 6 treatments at weekly intervals will rid the body of these toxins from pollution and the consumption of fish that has high mercury content.

Structural investigation of the bone with bone density measurements can diagnose osteoporosis. An initial remedy for this is supplementation with 5000 IU of vitamin D3 and vitamin K2 200 micrograms daily.

Low carb diet can help rebalance body metabolism

People who are overweight or obese get metabolic changes in their blood that physicians call metabolic syndrome. It raises blood pressure, often leads to elevation of cholesterol, triglycerides and blood sugars and also causes inflammation. A diet like the Mediterranean diet can help stabilize the metabolism. Dr. Anna Cabeca recommended a ketogenic diet, but from my reading a Mediterranean diet will achieve the same. In addition, a ketogenic diet carries a higher risk of heart attacks and strokes. For this reason I cannot recommend a ketogenic diet. The end result is an improvement of organ function, improvement of blood tests and less reliance on medications. Our body simply performs and functions better.

Fasting improves mitochondrial health

Mitochondria are small particles inside the plasma of all the body cells. Their functioning is essential for our energy and for cell metabolism in all of our organs. The energy, which is produced by the mitochondria is stored in a small molecule, called adenosine triphosphate or ATP. I discussed earlier that heavy metals must be removed from the body by chelation therapy. One known effect of heavy metals is the poisoning of mitochondria. A person who has high blood levels of heavy metals in the body complaints of low energy and brain fog. After several intravenous chelation treatments, the energy returns and the brain fog disappears.

The fasting mimicking diet of Dr. Valter Longo is another tool to reactivate mitochondria.

Bioidentical hormone replacement

Many postmenopausal women require some help with regard to their hormonal balance. There are doctors who specialize in this area. They order a baseline panel of hormones. If there is a lack of progesterone, they order bioidentical hormone replacement, a hormone cream that the patient applies herself to the forearm or abdomen. Hormone saliva tests must show a ratio between progesterone and estrogen of 200 to 1 or higher. Many women have too much estrogen in their system relative to progesterone. By balancing this hormone ratio, the risk of getting cancer from estrogen that is not in balance experiences a significant reduction. The patient will also feel more energy and sleep better.

Help with Menopausal Symptoms

Conclusion

Menopause does not have to be the dreaded time in a woman’s life, when her periods stop. With a bit of attention to her nutrition, her hormone balance and other symptoms the physician can help her experience none of the symptoms. It will require some hormone and other blood tests. It may also require some detoxification with intravenous EDTA infusions. At the end that postmenopausal patient will feel energy again, clear up her foggy brain and sleep better. In addition, the woman will regain her sex drive and feel more energy. The physician treats estrogen dominance by adding progesterone cream supplementation. This also assist with regard to sleeping better.

It does take the effort to have all the necessary blood tests and saliva tests to establish deficiencies. A physician who has experience in anti-aging medicine will be of important help to bring a menopausal patient back on the road to wellness.

Apr

2023

What you Must Know about Male Hormones

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

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

Different testosterone levels at different ages

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

Functions of testosterone

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

Symptoms of andropause

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

Other signs of testosterone deficiency

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

Testosterone replacement and hormone balance

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

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

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

Side effects from elevated estrogen levels

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

Dihydrotestosterone (DHT)

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

Testosterone replacement therapy

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

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

More facts about testosterone replacement therapy

Testosterone lowers inflammatory cytokines and stimulates interleukin-10 production. This has anti-inflammatory and anti-atherogenic actions, which prevents heart attacks.
There was a reduction in mortality from heart attacks in the testosterone treated group of between 66% and 92%. In addition, 30 nonfatal strokes and 26 nonfatal myocardial infarctions occurred in the control group, but none in the testosterone group. Testosterone deficient heart failure patients responded very well to testosterone replacement therapy.
Prostate cancer or benign prostate hypertrophy do not increase with transdermal testosterone replacement therapy.

A Meta-analysis showed that older men with the highest risk for prostate cancer have the lowest testosterone blood levels.
Type 2 diabetics with a high insulin resistance respond well to testosterone replacement therapy. They increase insulin sensitivity and lower their blood sugars. This improvement peaks after 3 months and the effect stays for 12 months.

Further facts about testosterone replacement therapy

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

Improvements after testosterone replacement therapy

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

What you Must Know about Male Hormones

Conclusion

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

Apr

2023

Erythritol is Linked to Heart Attacks and Strokes

By Ray Schilling | blood clots, Cardiovascular disease, heart attack, Mortality, Stroke

A recent publication found that erythritol is linked to heart attacks and strokes. The study from the Cleveland Clinic was published Jan. 19, 2023 in Nature. It showed that people with diabetes had a 2-fold risk of getting a heart attack or stroke. Researchers measured the highest concentration of erythritol in their blood versus a control group with no erythritol in it. The study further showed that erythritol causes platelets to form clots, which could break of and travel to the heart or brain vessels. This triggered a heart attack or stroke. Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute said: “We never expected this. We weren’t even looking for it.”

Erythritol is what causes heart attacks and strokes

What the research team was looking for was “find unknown chemicals or compounds in a person’s blood that might predict their risk for a heart attack, stroke or death in the next three years. “This is how erythritol was identified as a risk factor.

Erythritol is a sugar alcohol

Like sorbitol or xylitol, erythritol is a sugar alcohol, which occurs in many fruits and vegetables. Erythritol has less laxative effect than some of the other sugar alcohols. It tastes like sugar and adds bulk to any stevia-based sweeteners. These are the reasons why it became the preferred zero calorie sweetener of the industry. Also, in a mixture it diluted the pronounced sweet effect of stevia, but added the crystalline texture appearance like sugar to the sweetener. This is what the consumer expected of a sweetener.

The clinical trials showing there is a link between erythritol and heart attacks as well as strokes

One group of patient’s tests were 1,157 blood samples from people at risk for heart disease collected between 2004 and 2011. Another batch of blood samples came from over 2,100 people in the United States and an additional batch from 833 samples gathered by colleagues in Europe through 2018. 75% of the participants in all three populations had coronary disease or high blood pressure, and about 20% had diabetes. Over 50% were male and in their 60’s and 70’s. All of those samples showed the following. Higher levels of erythritol showed a correlation to a greater risk of heart attack, stroke or death within three years.

Blood coagulation

Our blood has a delicate balance between coagulation from clotting factors and platelets on the one hand and fibrinolysis, which counters clotting, on the other hand. This ensures that we are not spontaneously bleeding and also not getting clots from hypercoagulation. The researchers found that it is this balance, which erythritol disturbs. Dr. Hazel said: “But what we’re seeing with erythritol is the platelets become super responsive: A mere 10% stimulant produces 90% to 100% of a clot formation”. This was the reason for the higher heart attack and stroke rates in the higher levels of erythritol in the blood.

Erythritol levels checked in healthy volunteers

The last part of the study involved tracking blood tests of erythritol in 8 healthy volunteers. They drank beverages containing 30 Grams of erythritol, which is the amount many Americans consume. According to the National Health and Nutrition Examination Survey, which examines American nutrition each year 30 Grams is the average daily consumption of Americans. The researchers took blood tests of erythritol for the next 3 days including tests of clotting risks. Dr. Hazen said: “Thirty grams was enough to make blood levels of erythritol go up a thousandfold. It remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days.”

Reaction of the industry

Robert Rankin, the Calorie Control Council’s executive director, an industry association, wrote in an email: “The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages.” But this seems to be a lame excuse. The platelet clotting effect of erythritol simply was not what the FDA expected or tested for. The same was true for other regulatory bodies when they released it as safe. I have drawn my own conclusion and thrown out all sweeteners I had in my possession that contained erythritol.

Conclusion

Sometimes studies come out of the blue, which change our everyday practice. One of these studies is Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute. He showed that erythritol as an artificial sweetener is not harmless as previously thought of. This included the FDA as a regulatory agency, which labeled erythritol as GRAS (=generally recognized as safe). Now new evidence of clinical studies showed that erythritol is responsible for a twofold risk of heart attacks, strokes or death in the next three years. Dr. Hazen included all kinds of controls and also fed healthy volunteers erythritol. No matter how he looked at it, the risk remained.

Erythritol causes clots, which cause heart attacks and strokes

In animal experiments he could also show that erythritol caused platelets to stick together and cause clot formation. These clots could travel into the heart and brain vessels and cause heart attacks and strokes. For any consumer it is the most sensible approach to NOT use any sweetener that contains erythritol. This involves reading product ingredients before you buy any sweetener. Assuming that products are harmless, when the label reads “Stevia” is a fallacy! In numerous products the ingredient list will show the word “erythritol”. Buyer beware!

Mar

2023

Hormone Imbalance can Impact Health

By Ray Schilling | birth control pill, Hormones, Insomnia, irregular periods, lifestyle, mitochondria, sleep, stress

Dr. Erika Schwartz spoke at the 30^th Anti-Aging Conference in Las Vegas about “hormone imbalance can impact health”. The talk was scheduled early in the morning on Dec. 10, 2022. She pointed out that when hormones are in balance people have energy, they sleep well, they have normal sexual functioning and they are fertile. But in contrast, when hormones are not in balance, their weight goes up, they suffer from fatigue, depression, and anxiety. In addition, they often have skin and hair changes, changes in menstrual regularity, acne, infertility and decrease in libido. Finally, they may have problems in building muscle mass, women develop vaginal dryness and men erectile dysfunction. However, people also can develop autoimmune conditions and various cancers.

Symptoms of hormone imbalance at various ages

Teens

Most importantly, acne is an embarrassing, but common symptom. Depression, PMS, mood swings and headaches are also very common. By the same token, weight gain occurs frequently from faulty diets (fast food, lack of vegetables and fruit and sugary soda drinks).

The twenties and thirties

The birth control pill interferes with the normal function of LH and FSH resulting in lack of ovulation and infertility. Other symptoms are bloating, constipation, weight changes, libido changes and postpartum depression.

The forties and fifties

Mood changes and irritability, weight problems, menstrual changes, and changes in sexual desire are typical for this age group.

The sixties and over

Hot flashes are common in this age group, but they can start in women from the age of 50 onwards. Other symptoms are night sweats, insomnia, skin and muscle changes. Many diseases of the aging occur like diabetes, arthritis, cardiovascular disease, dementia, degenerative and autoimmune diseases.

Diagnosis of hormone imbalance

The doctor takes a detailed history about exposure to environmental pollutants, the birth control pill in women and medications. In addition, the doctor wants to know whether the patient consumed meat from animals that were treated with antibiotics. Next the physician inquires about physical changes, symptoms of hirsutism, menstrual

irregularities and infertility. There are three steps to diagnosing hormone imbalances:

Listen to the patient and inquire about the subjects just mentioned.
Order extensive laboratory tests including hormone levels.
Review all of the medications and supplements the patient is taking.

How do hormone imbalances affect our bodies? They affect our mental health, our sleep, brain function, libido, energy, weight, digestion (leaky gut), joints and the immune system.

Two clinical examples about hormone imbalances

Dr. Schwartz gave two clinical examples showing how correction of hormone imbalances led to normalization of the hormone imbalance.

Example 1

A 17-year-old female complained about acne in her face, had no periods, was fatigued and had migraine headaches. She was in senior high school and wanted to look and feel better before graduation. Her periods started at age 12, but were irregular. Her physician started her on the birth control pill at age 14. Within one year she stopped having any periods and also started getting hyperpigmentation in her face. Dr. Schwartz noted that she had no allergies and that she did not take any supplements. She took Estarylla (ethinyl estradiol/ norgestimate), a BCP formulation and Excedrin for migraines. Her ferritin level was 12 (11 to 307 micrograms per liter is normal for women). TSH was 5.16 (normal now 0.5-2.5). This meant she was borderline iron deficient and also mildly hypothyroid.

Diagnosis and treatment plan

Dr. Schwartz diagnosed a hormone imbalance. The treatment schedule consisted of stopping the BCP, start a low dose 30 mg NP thyroid in the morning. In addition, the doctor prescribed adrenal support pills and low-dose iron pills with vitamin C. The doctor also addressed lifestyle and self-awareness issues with the patient. 4 months later she was seen again and had regular periods, no more migraines and she felt more energy. The face pigmentation was gone and she felt great.

Example 2

A 42-year-old woman presented to Dr. Schwartz with psoriatic arthritis, weight gain, problems sleeping, brain fog and irregular periods. Her last menstrual period was 6 months ago. Her doctor had recently placed her on a statin drug and put her on the BCP Mirena. This is a progestagen releasing IUD placed in the uterine cavity, which was given to her in an attempt to regulate her periods. She was divorced and a mother of 3 children. At work she was a business partner in a high stress law firm. Personally, she was trying to date, but has been unsuccessful so far. She would like to lose weight and gain more energy. What she was hoping for was that her doctor address her overall health.

Medication and blood tests

She did not have any allergies. Her medications consisted of Rosuvastatin 10 mg daily and Mirena for the last year. As supplements she took Turmeric. Blood tests showed that her hemoglobin A1C was 5.7, the vitamin D blood level was 17 ng/mL (very low). The TSH level measured 1.29 (in the normal range). Estradiol blood level was in the lower range, progesterone level the same. Finally, her testosterone level was low as well. The other blood tests were all normal.

Diagnosis for this patient and treatment plan

Dr. Schwartz diagnosed hormone imbalance due to natural and environmental factors.

She ordered Mirena to be removed and to stop Rosuvastatin. Instead, she started the patient on vitamin ADK ( a mix of vitamin A, vitamin D and vitamin K)– 5000 IU daily. She also started her on Omega3 1000mg daily. In addition, she discussed a well-balanced diet, regular exercise and sleep issues (7-8 hours every night) with her.

Hormone replacements

As blood tests showed a low estradiol level, she started her on Estrogel, a form of estrogen. She also started her on progesterone tablets (Prometrium) 100 mg at bedtime as well. This keeps progesterone and estrogens balanced. As her testosterone was on the low side, she started her on Testosterone cypionate 100 mg/ml (0.4 cc per injection) intramuscularly once a month. Dr. Schwartz also started adrenal support, 2 capsules in the morning. Further she was told to start 3 capsules of NMN (Nicotinamide Mononucleotide Supplements) daily and 5 units of Semaglutide subcutaneously weekly. The latter medication helps the pancreas to release the right amount of insulin when blood sugar levels are high.

Follow-up at 6 months

The doctor reassessed he patient after 6 months. She had developed increased self-awareness. She lost 30 pounds and she slept for 7.5 hours most nights. Her energy level has increased and she improved her dietary choices. She had started regular work-outs. Overall she was now happier at work and at home with her children. She feels now more like an age of 25, and she has been starting to date.

General remarks about hormone imbalance

When hormones are in balance, we are healthy. Hormones can get out of balance at any age; the examples above involved 17 and 42 year old patients. Keep in mind that it is impossible to have optimal health without balanced hormones. Dr. Schwartz said that the more pieces of the puzzle you address, the more likely you are going to truly help improve quality and quantity of life. Lifestyle factors that must be addressed are:

Diet
Exercise
Stress Management
Sleep
Breathing
Mitochondrial and cellular integrity

Hormone Imbalance can Impact Health

Conclusion

Hormone imbalances occur frequently when our lifestyle factors are slipping. Often untoward side effects of medication are also contributing to the hormone imbalance. The holistic doctor takes a thorough history, examines and takes blood tests including key hormone tests. When imbalances of hormones are detected, this has to be addressed with supplements and hormone replacements. At the end the hormones balance each other and the patients’ abnormal symptoms disappear. It only takes a few weeks before the patient will feel normal again.

Feb

2023

Fruit and Vegetables for Children

By Ray Schilling | diet, food

We know for some time that fruit and vegetables for children are important. Now a new study from the CDC showed that not enough children eat fruit and vegetables. Researchers interviewed the parents of nearly 18,000 children ages 1 to 5 in 2021. They asked the parents what their children consumed the previous week. They paid particular attention to fruit, vegetables and sugar sweetened beverages. The results were published in the CDC’s Morbidity and Mortality Weekly Report on February 17, 2023. The results were surprising and also were published by CNN.

Almost 50% of the children did not eat a vegetable every day and about 33% of them did not eat a fruit every day.
57% of the children drank at least one sugar sweetened drink per week.
A 1-year-old child was much more likely to eat a fruit or vegetable a day and less likely to consume a sugary drink compared to the older children up to the age of 5.

Dr. Heather Hamner, a senior author of the study and a senior health scientist at the CDC stated that there were some interesting findings in different states. She said: “This is the first time we’ve had state-level estimates on these behaviors. It’s a really good time to think about the programs and policies that states have in place and areas where they can continue to work and improve to make the nutrition environment the best it can be for our young children.”

Comparison of children’s food intake state by state

Here are some of the highlights when food behaviors were compared state to state.

More than 50% of twenty states including Washington, DC drank a sugar sweetened drink in the preceding week.
80% of the children in Mississippi had one sugar sweetened drink in the preceding week, the highest of all states.
In contrast, only 38.6% of children in Maine drank a sugar sweetened drink at the same time, the lowest of all states.
Over 50% of 20 states did not eat a vegetable every day in the preceding week.
In Louisiana nearly 60% of the children did not consume a daily vegetable and almost 50% did not eat a daily fruit.
On the bright side: Vermont reported the highest rate of daily consumption of fruit and vegetables among the age 1 to 5 children group.

Racial differences among children’s eating habits

The investigators analyzed food habits of black children versus Caucasian children. They found that children of black parents were less likely to eat a daily vegetable or fruit while white children were more likely to consume fruit and vegetables.

About 70% of black parents reported that their child was consuming at least one sugar-sweetened drink in the preceding week. The investigators termed the household with poor food habits “households with marginal or low food sufficiency “. In these households the children were less likely to consume a daily fruit or vegetable. At the same time, they were more likely to drink a sugar sweetened drink.

General needs of children

Children in the age group of 1 to 5 need daily fruit and vegetables for their normal development. The CDC has established some time ago that Children ages 2 or 3 should have at least a cup of fruit and a cup of vegetables every day while kids ages 4 to 8 should have 1.5 cups of each every day. The CDC report said: “Limiting or reducing foods and beverages higher in added sugars, including sugar-sweetened beverages, is important because added sugars are associated with increased risk of obesity, dental caries, diabetes, and cardiovascular disease.”

Laying a foundation for future healthy eating habits

Dr. Hamner said: “We’ve found that it can take up to 10 times for a child to try a new food before they like it,” she said. “Continuing to try and expose young children to a wide variety of fruits and vegetables is an important piece.” Another point is that parents should not only stick to fresh vegetables and fruit, but also include frozen and canned versions for greater variety.

Adding these essential vitamins is laying a strong food foundation for your child and has a lasting impact. Dr. Hamner added: “One of the things that’s really important is early dietary behaviors. This is really when kids are laying the foundation for some of those dietary behaviors, so starting out strong and making sure that they’re creating these healthy behaviors … that’s going to set them up as they go into adolescence and adulthood.”

Preventing adult food habits

A large portion of snacks from the mid-section of the grocery store contains all forms of sugar. There is high fructose corn syrup, sugar, honey, agave syrup, maple syrup etc. You may think that a harmless fruit juice would be healthy. But then you read the ingredient list on the label. It says that it contains 5 to 6 teaspoons of sugar per cup (250 ml) of juice.

Unfortunately, our body is not equipped to process all the sugar that the food industry wants us to consume, and we develop insulin resistance; the liver converts the excess sugars into fat and deposits it into our arteries and as fat deposits between our guts (visceral fat) and as subcutaneous fat in the thighs, around the hips and the waist. It is no secret that a lot of obesity is related to overconsumption of sugar containing convenience foods (snacks and sugar-laden drinks).

Artificial sweeteners

Often low-calorie alternatives contain aspartame or sucralose (Splenda). Aspartame is an excitotoxin damaging your brain cells and sucralose was developed in the 1950’s. It was a side product in the development as an insecticide. We do not want to replace disease-promoting sugar with toxins as sweeteners. Safe alternatives for sugar are xylitol, mannitol, and stevia.

Starchy foods

What is sometimes overlooked is the fact that your body digests bread, starchy foods such as potatoes, and pasta, rice and flour products like pizza or cookies within 30 minutes into sugar that is as harmful to your pancreas as plain sugar or high fructose corn syrup. The body reacts with the same overproduction of insulin converting the excess sugar into fat and depositing it in your body as described above. Much of the obesity wave we see in the past 3 decades is due to baked goods like bagels, bread, pasta and pizza. It is much better to enjoy your stevia-sweetened coffee without any bakery pieces.

When you replace some of the excess starchy foods with vegetables and fruit, you rebalance your diet and reduce the extra sugar load. When a child starts this process early in the age group of 1 to 5, healthy eating habits get imprinted, which prepares the individual for adolescence and adulthood.

Fruit and Vegetables for Children

Conclusion

Healthy eating is what you learn in childhood. A thorough analysis of children in the age group of 1 to 5 by the CDC showed the following. In the US children of this age consume too much sugar-containing beverages. At the same time, they avoid vegetables and fruit. They also found that 80% of the children in Mississippi had one sugar sweetened drink in the preceding week. This was the highest of all states. In contrast, only 38.6% of children in Maine drank a sugar-sweetened drink at the same time. This was the lowest of all states. In addition, they found that children of black parents were less likely to eat a daily vegetable or fruit. But white children were more likely to eat daily vegetables or fruit. About 70% of black parents reported that their child was consuming at least one sugar-sweetened drink in the preceding week.

Households with marginal or low food sufficiency

The investigators termed the households with poor food habits “households with marginal or low food sufficiency “. In these households the children were less likely to consume a daily fruit or vegetable. At the same time, they were more likely to drink a sugar sweetened drink.

The researchers concluded that early childhood behaviors were influencing the lives of adolescents and adults. Unfortunately, this influence is often negative leading to obesity and cardiovascular disease. But the opposite can also be true. Parents can use their influence on their children by increasing vegetable and fruit intake and reduce sugar-containing drinks. This helps the children to adopt healthy food habits well into adolescence and adulthood.

Feb

2023

Common Nail Salon Tool Causes Skin Cancer

By Ray Schilling | Cancer, Skin Disorders

A recent publication in Nature Communications found that a common nail salon tool causes skin cancer. The researchers voiced concerns about the use of ultraviolet radiation from nail dryers with gel manicures. They were shown to cause DNA breaks in the exposed skin. The artificial nails require ultraviolet radiation to harden them. But the ultraviolet light hits the skin around the nails and of the fingers, which can be the first step in causing skin cancer.

Three stages in the development of skin cancer

In the 1970’s and 1980’s a lot of basic research using mouse models has been done about 3 stages of skin cancer development. Dr. Kripke was one of the pioneers in this field (see Ref. 1 and 2). However, it turned out later that the human skin is not identical to mouse skin and that human skin seems to be more resistant than that of inbred mice. Nevertheless, the basic concept that was researched then has held up to scrutiny over the ensuing decades. The development of skin cancer in man requires three steps.

1. Initiation

Initiators for skin cancer are UV light, tar, nitrogen mustard, psoralen to name a few. The DNA of skin cells undergoes some configurational changes, but when left alone it does not go on to cancer development.

2. Promotion

Common promoters for the development of skin cancer are: Ultraviolet light, phenol, anthralin, phorbol esters, benzoyl peroxide.

3. Carcinogenic effect

The role of carcinogens in skin cancer is not understood very well. However, the classical studies of scrotal cancer in chimney sweepers pointed to the importance of carcinogens in soot of chimneys (Ref.3). This is one of the first human examples for a carcinogen. Another carcinogen is arsenic. We do not know enough about long-term exposure to small amounts of carcinogenic compounds in drinking water or in polluted air. Other carcinogenic effects are excess radiation from X-rays or irritation from chronic inflammation (lupus lesions, burn scars, decubitus ulcers, chronic osteomyelitis). Repeated exposure to UV light also has carcinogenic effects on the skin by leading to DNA breaks. UV light exposure plays an important part in every step of skin cancer development.

More causes of skin cancer

Squamous cell cancer of the oral cavity and lip has been linked to chewing tobacco or betel nuts. There is also a link to certain viruses such as the human papillomavirus. This model for cancer development is applicable for many other cancers, if not for all forms of cancer. Many stabilizers and antimicrobial/antifungal substances such as parabens are also mild carcinogens. Many physicians warn their patients not to use parabens in tooth paste, cosmetics, shampoos, conditioners and body wash products. I agree with this opinion. Go to a health food store and get alternative products without parabens in it. Read labels! Numerous paraben-free products are also on the shelves of drugstores. If you read the word ”paraben”, leave the product on the shelf. Exposure to UV light and several sunburns in succession can also cause skin cancer.

Common nail salon tool causes skin cancer: further discussion

Ludmil B. Alexandrov holds dual titles as associate professor of bioengineering and cellular and molecular medicine at the University of California San Diego. He said: ”If you look at the way these devices are presented, they are marketed as safe, with nothing to be concerned about. But to the best of our knowledge, no one has actually studied these devices and how they affect human cells at the molecular and cellular levels until now.” Those who want to continue gel manicures, can use some precautions to minimize the risk of skin cancer. Use a sunblock that contains zinc and titanium on the skin of your fingers around the nails. This will block the damaging UV rays. But the safest way is to stop using nail dryers, which are necessary with gel manicures.

A common Tool in the Nail Salon may Damage your DNA and Cause Skin Cancer

Conclusion

We sometimes lose sight of what modern procedures can do to us. One example is the use of gel manicures that require exposure to UV light to harden the gel nail polish. Several layers are applied during a manicure session. Most people do not think that the accumulated exposure to UV light can lead to DNA breaks and eventually cause skin cancer. But dermatologists have noted that there is a direct link between the amount of UV light exposure and the risk to develop skin cancer later in life.

Prevention of UV light exposure

The logical conclusion is to stop using these applications of gel nail polish. However, if the person finds it difficult to abandon this manicure procedure, a compromise is to cover up the skin of your fingers with a sunblock that contains zinc and titanium. You can apply this to the skin of your fingers around the nails. To a certain extent this will block the damaging UV rays, but it is not a guarantee.

References

Kripke ML, Sass ER,eds.”Antigenicity of murine skin tumors induced by UV light”.JNCI 1974;53:1333-1336.
Kripke ML. “Immunology and photocarcinogenenis”. J. Am. Acad.Dermatol. 1986;14:149-155.
Potter M.”Percivall Pott’s contribution to cancer research”. NCI Monogr.1963;10:1.

Jan

2023

Repairing epigenetic Defects can Slow down Aging

By Ray Schilling | Anti-aging medicine, green tea, regenerative medicine, Stress management

A new publication found that repairing epigenetic defects can slow down aging. This is a newer concept, which is gaining momentum in the longevity research world. David Sinclair is a professor of genetics at the Blavatnik Institute at Harvard Medical School. He is also co-director of the Paul F. Glenn Center for Biology of Aging Research.

Here is the summary of how epigenetic factors can slow down aging:

Double-stranded DNA breaks can erode the epigenetic landscape
Loss of epigenetic information accelerates the hallmarks of aging
Epigenetic reprogramming changes aging into more youthful appearance
Researchers can manipulate the epigenome, thus driving aging forward and backward

Professor Sinclair said that the conventional thinking about aging is no longer sustainable. The old theory was that genetic mutations undermine our DNA, creating a junkyard of damaged cellular tissue that leads to deterioration, disease and death. Instead, Dr. Sinclair said: “We believe it’s a loss of information – a loss in the cell’s ability to read its original DNA so it forgets how to function – in much the same way an old computer may develop corrupted software. I call it the information theory of aging.”

Here is what Dr. Sinclair and his team have established

DNA in the cells function like the body’s hardware. The epigenome is the software.
Proteins and chemicals make up the epigenes that sit “like freckles on each gene”. It is the epigenome that turns genes on and off. Pollution, environmental toxins, human behaviors such as smoking, eating an inflammatory diet or suffering a chronic lack of sleep will all trigger a change in the epigenetic information. Dr. Sinclair added: “And just like a computer, the cellular process becomes corrupted as more DNA is broken or damaged.”
“The cell panics, and proteins that normally would control the genes get distracted by having to go and repair the DNA,” he explained. “Then they don’t all find their way back to where they started, so over time it’s like a Ping-Pong match, where the balls end up all over the floor.”
“The astonishing finding is that there’s a backup copy of the software in the body that you can reset,” Sinclair said. “We’re showing why that software gets corrupted and how we can reboot the system by tapping into a reset switch that restores the cell’s ability to read the genome correctly again, as if it was young.”
Sinclair went on to say: “It doesn’t matter if the body is 50 or 75, healthy or affected by disease. Once that process has been triggered, the body will then remember how to regenerate and will be young again, even if you’re already old and have an illness. Now, what that software is, we don’t know yet. At this point, we just know that we can flip the switch.”

History of longevity research

Dr. Sinclair started his research into longevity as a graduate student by working with yeast cells. He studied the genes that controlled aging in yeast. After he identified the aging gene, he also could determine the same gene in mice. He developed ICE, short for “inducible changes to the epigenome”, basically temporary, fast-healing cuts. They mimic the aging process due to exposure to pollution and sunlight. Mice treated with the ICE method for one year looked like regular mice would look after two years. The Sinclair team of researchers were able to age tissues in the brain, eyes, muscle, skin and kidneys of mice using the ICE method.

Mice turning younger again

But what is more important, they also showed that these aged mice could turn younger again. Dr. Sinclair’s researchers took human adult skin cells, reprogrammed them to behave like embryonic or pluripotent stem cells and injected them into the older mice. To their surprise this triggered the test animals to become younger again. Dr. Sinclair said that fortunately they went back to an age between 50% and 75% of the normal life span. None of the animals developed cancer. The researchers injected the cocktail into damaged retinal ganglion cells at the back of the eyes of blind mice. Then they activated the rejuvenation process of the retinal ganglion cells by feeding the mice antibiotics. Surprisingly, the mice regained most of their eyesight. In a similar way the researchers could rejuvenate aged muscle cells, skin cells and kidney cells of mice.

Human longevity

We are not at the point yet where human research similar to mouse research is being done. But Dr. Sinclair is convinced that more human data will be on the way. He pointed out that telomere tests of leukocytes in blood tests of individuals with healthy lifestyles already show that they have a significantly lower biological age compared to their chronological age. His advice for longevity is this:

Focus on plants for food and eat less often
Get sufficient sleep
Exercise regularly and get short-winded for 10 minutes at least three times a week
Regular exercise will also help you to maintain your muscle mass
Don’t get upset about unimportant things. In other words, manage your stress
Have a good social support group

Other ways to reduce your biological age

I attended the 22nd Annual World Congress on Anti-Aging Medicine In Las Vegas (Dec. 10-14, 2014) that dealt with telomere length and how nutrition can positively influence what our genes express. This ultimately determines how long we live. Dr. Al Sears gave one of the talks at the conference. He pointed out that shortened telomeres are causing cells to behave like old cells. In the lab we can lengthen telomeres. Telomerase activated animals regrew their brains! In the human situation the goal is to find ways to preserve the length of our telomeres in all our key organs. Dr. Sears said a patient with short telomeres who starts telomerase stimulating supplements, develops longer telomeres in leukocytes within one month of commencing the supplementation.

The following supplements lengthen telomeres

Dr. Sears pointed out that the following supplements lengthen telomeres in humans.

Acetyl-L-carnitine and resveratrol are two substances that reliably elongate telomeres.
Vitamin C will significantly delay shortening of telomeres resulting in delayed aging.
In addition, researchers showed recently that vitamin C stimulates telomerase activity in certain stem cells.
The herbal Silymarin extract increases telomerase activity threefold.
N-acetyl cysteine is a building block for glutathione, a powerful antioxidant. In addition, it has been shown to turn on the human telomerase gene.
Other telomerase stimulators are green tea extract, ginkgo biloba, gamma tocotrienol (one of the components of the vitamin E group), vitamin D3 and folic acid.

The following link lists Dr. Sears’ recommended daily doses of these telomerase stimulating supplements.

Repairing epigenetic Defects can Slow down Aging

Conclusion

Epigenetic defects appear to be more important than genetic abnormalities. The problem is that epigenetic changes through pollution or sun exposure can switch off genetic switches. This makes us age much faster than healthy controls. In this review I described mouse experiments that Professor David Sinclair did. He is professor of genetics in the Blavatnik Institute at Harvard Medical School, Boston, MA. He demonstrated in mice that he could age them faster with the ICE method, short for “inducible changes to the epigenome”, basically temporary, fast-healing cuts. They mimic the aging process due to exposure to pollution and sunlight. He also showed that these aged mice could turn younger again.

Rejuvenation of older mice

Dr. Sinclair’s researchers took human adult skin cells that have been reprogrammed to behave like embryonic or pluripotent stem cells and injected them into the older mice. To their surprise this triggered them to become younger animals again. None of them developed cancer and they turned back to 50% to 75% of their original age. There is no application to humans yet, but Dr. Sinclair’s team is planning to address this issue next.

Jan

2023

Cortisol is the Number 1 Longevity Hormone

By Ray Schilling | Cardiovascular disease, Hormones, immune system, Stroke

At the 30^th American Anti-Aging Academy Medicine Conference in Las Vegas one topic was that cortisol is the number 1 longevity hormone. Dr. Thierry Hertoghe, an endocrinologist from Brussels, Belgium gave a comprehensive lecture on Saturday, Dec.10, 2022. He explained that cortisol from our adrenal glands is vital to our health. Certainly, it is important for our quality of life and for health in general. Indeed, cortisol keeps us alive when various circumstances challenge our health. Specifically, cortisol is on the bottom of the hormone cascade of corticotropin releasing hormone (CRH) from the hypothalamus/ Adrenocorticotropic hormone (ACTH) from the pituitary gland/and cortisol from the adrenal glands. It is important to realize that this is the hormone axis of the stress reaction that Dr. Selye first described.

Production of cortisol

Sedentary men produce 30 mg of cortisol per day, women 20 mg/day. Under stressful conditions ACTH production increases and causes an increase of cortisol production in the adrenal glands. To clarify, stressed men produce 40 to 60 mg per day and stressed women produce 30 to 40 mg/day. In addition, the older a person is, mononuclear leukocytes have less type 1 and type 2 glucocorticosteroid receptors.

Action of cortisol

Dr. Hertoghe pointed out that cortisol increases energy and stress resistance. It causes blood sugars to increase and also elevates blood pressure. The immune system gets stronger, allergies and inflammation decrease. Cortisol shapes our bodies: when there is cortisol deficiency the body is thin; with normal cortisol production the body has a normal configuration. Your body develops swelling and obesity with cortisol excess, but when cortisol is missing the body gets frail and thin.

Cortisol deficiency

Low cortisol production leads to low blood sugar and low blood pressure. This diminishes glycogen stores in the liver and muscle mass. A lack of circulating cortisol reduces gluconeogenesis in the liver, which is an alternative pathway of glucose production. One of the hallmark symptoms is mental fatigue, particularly in times of stress. With cortisol deficiency the person feels fatigue in the second part of the day.

Chronic fatigue syndrome

The peak age for chronic fatigue syndrome patients is 31 years. The mean duration of the illness lasts 7 years. 58% of patients have free serum cortisol levels at 20:00 hours, which is less than normal. In 40% of patients the total cortisol level is less than normal.

Burnout

With burnout the urinary free cortisol is diminished. Patients with cortisol deficiency have a hyper sensitivity to stress.

A lack of cortisol leads to feeling no energy and having no stress resistance. The person feels tense and has negative thinking. A person who has sufficient cortisol is full of energy, expresses emotions and handles stress well. With enough cortisol a person is relaxed, has positive feelings and finds solutions everywhere.

Adrenal crisis

Dr. Hertoghe explained that an adrenal crisis happens when there is not enough cortisol production in the adrenal glands to support the metabolism and the cardiovascular system. Gastrointestinal diseases, infectious diseases or stressful events like surgery, exposure to heat, strenuous physical activity, major pain or pregnancy can all trigger an adrenal crisis. When glucocorticoid therapy is withdrawn, this can also cause an adrenal crisis.

Addison’s disease

With Addison’s disease there is a lack of energy, muscle weakness, loss of appetite and unintentional weight loss. The reason for the symptoms is that the adrenal glands are not producing enough cortisol and aldosterone. There was a more than 2-fold increased risk of dying from Addison’s disease compared to a normal population in a Swedish study.

In another study the serum cortisol levels were determined in patients with heart attacks. The ones who had extremely low levels of cortisol were at almost a 9-fold risk of dying within 30 days compared to patients with a normal serum cortisol level. One of the famous patients with Addison’s disease was J.F. Kennedy. He collapsed in London, England and was finally diagnosed correctly in a British hospital after having suffered for several years without the correct diagnosis. This disease is not always easily diagnosed.

Cortisol therapy

With an adrenal crisis or Addison’s disease cortisol therapy can be life-saving. The physician uses physiological doses of glucocorticosteroid hormones (cortisol and others) and in emergency situations higher than normal doses. Dr. Hertoghe said that survival data were gathered with various severe disease conditions as follows.

Coronary heart disease survival

Dr. Hertoghe reported about a study that observed 1090 adults over 11 years. There was a 40% reduction of mortality when patients were treated with cortisol following a heart attack compared to controls who did not get cortisol treatments. The researchers also found that there was a 39% lower stroke risk when treatment with cortisol was instituted.

In a clinical trial with 39 patients who had heart attacks those patients treated with pharmacological doses of methylprednisolone (3 grams daily) experienced a significant reduction in infarction size.

In another study with 1118 patients Dr. Hertoghe reported a 28% reduction in mortality over 28 days compared with a placebo group. In this study medical researchers gave 2-3 grams of methylprednisolone early on into the heart attack. In the same study, after 6 months there was a 33% mortality reduction.

Stroke survival

Following a stroke, low cortisol levels (270 nmol/L) and high cortisol levels (550 nmol/L) both had an association with a poor long-term prognosis 1 year after follow-up. However, the study also showed that patients with normal cortisol levels (between 270 nmol/L and 550 nmol/L) following a stroke had a very good long-term prognosis.

AIDS survival

AIDS patients belong into the group of chronic diseases that are associated with low cortisol levels in the blood. There are also clinical signs of low cortisol, namely dark circles around the eyes, hollow cheeks, brownish pale skin with pigment spots, hand creases that are pigmented and weight loss. Severely ill AIDS patients often have severe lung infections (Pneumocystis carinii pneumonia) due to their immune deficiency. A study involving 23 AIDS patients used methylprednisolone in the treatment group and no methylprednisolone in the placebo group. The clinicians administered 40 mg of methylprednisolone every 6 hours for 7 days in addition to antibiotic treatment for 3 weeks. They compared this to the placebo group without methylprednisolone. 75% of the treatment group survived until the hospital discharge compared to only 18% of the placebo group.

Sepsis and septic shock

Treatment of patients with septic shock with ACTH (the stress hormone) infusions showed that 88% had a cortisol response among survivors. The ultimate non-survivors only had a 27% cortisol response of their adrenal glands when stimulated by intravenous ACTH. Dr. Hertoghe pointed out that this suggests that some patients with septic shock may have relative adrenocortical insufficiency. This would explain why the adrenal glands of septic shock patients can be non-responsive to ACTH. In these cases, it is important that the physician treat with either intravenous cortisol or with synthetic glucocorticoids.

Treating septic shock with intravenous hydro-cortisol

One study showed that treating septic shock with intravenous hydro-cortisol gave the following results compared to placebo:

7- fold higher septic shock resolution when compared to the placebo group
8 – fold survival in the intensive care unit
2 – fold higher hospital survival
2 – fold better septic shock reversal in 7 days
8 – fold better survival in the next 28 days.

Overall, this study clearly revealed that septic shock recovery is much better with intravenous hydro-cortisol treatment.

Cancer survival

A study found that breast cancer patients with metastases had flat saliva cortisol curves when compared to patients without breast cancer. If left alone breast cancer patients with a flat cortisol curve die earlier than those who used cortisol supplementation. The researchers found out that the natural killer cells (NK cells) in these patients were missing. These are special lymphocytes that can kill cancer cells with their enzyme vesicles.

Glucocorticoid treatment

Dr. Hertoghe talked about short-term high-dosed glucocorticoid therapy and the difference between synthetic cortisol equivalents (Dexamethasone etc.) and the natural cortisol. He also talked about adding small amounts of these hormones: DHEA, fludrocortisone (0.1 mg daily orally), and bioidentical vasopressin to optimize cortisol replacement.

Cortisol is the Number 1 Longevity Hormone

Conclusion

One of the vital hormones in our bodies is cortisol, the stress hormone. There is a hormone cascade starting with CRH in the hypothalamus, which stimulates ACTH release from the pituitary gland. This in turn releases cortisol from the adrenal glands. The end product, cortisol is the number 1 longevity hormone. It helps us to survive any stressful event. It gives us energy, stimulates the immune system and helps us to overcome dangerous illnesses. Dr. Hertoghe, an endocrinologist from Belgium gave a detailed lecture at the 30^th American Anti-Aging Academy Medicine Conference in Las Vegas on Dec. 10, 2022. Dr. Hertoghe discussed how to survive a heart attack or stroke, sepsis, AIDS or Addison’s disease (=adrenal gland insufficiency) by adding appropriate cortisol doses or equivalent synthetic glucocorticosteroids. One thing is clear: we all need cortisol until the end of our lives.