Feb
01
2025

Treatment of Hormone Deficiencies with Bioidentical Hormones

Dr. Thierry Hertoghe discussed treatment of hormone deficiencies with bioidentical hormones at the Anti-Aging Conference in Las Vegas, which I attended. He was one of the keynote speakers Dec. 13, 2024. He is a well-known endocrinologist from Brussels/Belgium and has given many lectures at these yearly Anti-Aging Conferences before. The actual title of his presentation was: “General Overview of the Importance of Bio-identical Hormone Replacement Therapies.”

General remarks

  • When the body ages, hormone glands are aging as well, and they often don’t produce enough hormones as in younger years.
  • In this case the physician can prescribe replacement hormones, but it is important that they are bioidentical hormones (not synthetic).
  • The Women’s Health Initiative showed in the past what happens when synthetic hormones are used to treat postmenopausal symptoms: many patients came down with strokes, heart attacks, breast cancer, uterine cancer and blood clots.
  • Well before that study European endocrinologists have pointed out that there are no complications when the physician prescribes bioidentical hormones.
  • Never treat a hormone deficiency in isolation. Often there are multiple hormone deficiencies present at the same time and the physician needs to address each one on its own.

Thyroid disease

Dr. Hertoghe pointed out that the most common thyroid disease in older age is hypothyroidism. Blood tests show high TSH with this, free T3 and free T4 are low. He warned that high meat consumption (beef, poultry and fish) as your evening dinner leads to prolonged low T3 overnight and in the morning. Dr. Hertoghe’s recommendation was to consume most animal protein at breakfast, a lesser amount at lunch and none at supper. Treatment of hypothyroidism is with a mix of T3 and T4. Each one alone does not stabilize the patient as well as the mixture. The physician orders blood tests every 2 months and adjusts hormone levels based on the results.

Testosterone for men

Young men have ample production of testosterone in their testicles. When men reach the age of 60 or older testosterone blood levels often decline. Testicles of a male produce mainly testosterone, also some dihydrotestosterone and a smaller amount of estradiol. All of these hormones balance each other. Older men can develop erectile dysfunction. It would be a mistake to just treat them with Viagra for this. Their metabolism is missing testosterone, which protects the heart and the brain. They need hormone replacement with testosterone. This is either administered topically or by intramuscular injection every two weeks (or twice per week with a lower amount). If hormone replacement does not solve the erectile dysfunction, the physician can still add Viagra later. The physician orders testosterone blood levels every 3 months and adjusts the testosterone dose up or down.

Estrogen and progesterone for women

Estrogen develops normal breasts; progesterone prevents excessive breast development. Women with huge breasts have progesterone deficiency, they are estrogen dominant. Both hormones are necessary for good coronary artery blood flow. A lack of both hormones causes heart attacks. In menopause hormone replacement with bioidentical hormones is necessary. Dr. Hertoghe discussed this in detail. Depending on what blood levels show a postmenopausal woman may also require a small amount of testosterone replacement. Women who had surgery that removed their ovaries in the past are often testosterone deficient. I discussed this topic previously here.

Adrenal cortex hormones

Two essential hormones are produced in the adrenal glands, namely cortisol and DHEA (=Dehydroepiandrosterone). Cortisol provides energy, is anti-inflammatory, but leads to the breakdown of muscle tissue. DHEA is the natural counterpart to cortisol as it gives you energy and builds up your muscles. It also stimulates axillar hair growth.

Cortisol

The physician can determine the level of cortisol either through blood tests, in 24-hour urine tests or in saliva tests.

Two cortisol conditions are important:

  • Adrenal gland insufficiency or Addison’s disease: the adrenal glands cannot produce enough cortisol. This presents with confusion, vomiting and progressive hyperpigmentation of the skin.
  • Cushing’s syndrome: these patients usually have fat accumulation in the abdomen and they bruise easily. Some patients have a benign tumor in the adrenal gland that produces too much cortisol. Resection of the tumor cures the condition.

Dr. Hertoghe demonstrated images of various patients with cortisol problems and discussed management of them.

In patients who require cortisol replacement the physician prescribes the bioidentical hydrocortisone. This molecule is identical to what the body produces in the adrenal glands. Synthetic corticosteroids are not properly metabolized and cannot participate in the diurnal hormone rhythm. Unfortunately many conventional physicians still order the more powerful synthetic corticosteroid hormones that have many side effects.

DHEA

This hormone is important for both men and women. It supports health and physical appearance. Blood tests easily detect the storage form of DHEA, namely DHEAS. When deficient in it, women need 15 – 20 mg of DHEA per day in the morning. Men require 25 – 30 mg upon awakening. Unfortunately, a lot of the vitamin merchants are pushing the 50 mg DHEA tablets, which is overdosed. DHEA melts fat in and builds up muscle mass. It also increases blood supply to the heart thus preventing heart attacks.

Melatonin

This hormone improves sleep and opposes premature aging. Older people, particularly after the age of 65 produce much less melatonin than in the past. A blood test determines whether or not you are deficient in melatonin. Melatonin deficient patients should swallow 3 mg capsules of melatonin at night. If necessary, another dose of 3 mg may be swallowed in the middle of the night. Higher doses than 6 mg of daily melatonin suppress cortisol production in the adrenal glands as these two hormones are natural opponents. Dr. Hertoghe mentioned a study of women who regularly consumed alcohol. This was compared to a control group of women non-drinkers. The urinary metabolites of melatonin were 6.4-fold lower in the drinking group. Another important action of melatonin is a significant improvement of blood supply to the heart under the influence of melatonin. Together with other hormones this helps to prevent heart attacks.

Growth hormone and IGF-1

Both of these hormones can be detected in 24-hour urine collection. Most of the human growth hormone is metabolized in the liver into IGF-1(insulin-like growth factor-1). The blood level of IGF-1 reflects accurately whether a person is growth hormone (GH) deficient or not. A low IGF-1 blood level means that this person requires growth hormone injections. Growth hormone deficiency leads to facial swelling, lack of energy, fat accumulation and hair loss. With GH replacement the face becomes firmer and younger looking, body composition improves with well-developed muscles. Hair growth normalizes and the person has abundant energy. GH also protects the heart muscle and coronary arteries.

Treatment of Hormone Deficiencies with Bioidentical Hormones

Treatment of Hormone Deficiencies with Bioidentical Hormones

Conclusion

Dr. Thierry Hertoghe was one of the key note speakers on Dec. 13, 2024 at the Anti-Aging Conference in Las Vegas, which I attended. He is an endocrinologist from Brussels/Belgium. He shared some of the common hormone disbalances that he encountered in his practice. It is important to replace missing hormones only with bioidentical hormones, not with synthetic hormones. This helps to rebalance all of the hormones. In addition, the diurnal hormone rhythm is functional again when the doctor prescribes bioidentical hormones. Synthetic hormones do not properly participate in the diurnal hormone rhythm. Patients who replaced their missing hormones have a normal or better than normal life expectancy. They are also less prone to chronic diseases.

Dec
28
2024

Anti-Inflammatory Diets Improve Inflammation

A CNN review article noted that anti-inflammatory diets improve inflammation. This is important for medical conditions that also have inflammation attached to it. For instance, rheumatoid arthritis, diabetes or chronic kidney disease all carry inflammation with them. But according to a 2019 study more than 50% of all deaths stem from chronic inflammatory conditions.

Here is a more complete list of what type of clinical conditions are associated with chronic inflammation:

  • cardiovascular disease, such as heart disease and stroke
  • obesity
  • cancer
  • chronic obstructive pulmonary disease
  • asthma and allergies
  • diabetes
  • chronic kidney disease
  • chronic pain — for example, from some sources of back pain, headache disorders, arthritis and other joint conditions
  • non-alcoholic fatty liver disease
  • autoimmune diseases, such as rheumatoid arthritis, lupus, ulcerative colitis, and Crohn’s disease
  • depression
  • neurodegenerative conditions, such as Alzheimer’s disease

Some people may have two or more of these chronic diseases at the same time. This increases the risk of death. This is even more of a reason to follow an anti-inflammatory diet.

Anti-inflammatory diet

The CNN article suggests that an anti-inflammatory diet has the potential to reduce inflammatory cytokines. This is important and can also improve symptoms of chronic inflammatory diseases. A large study was conducted in 2021, which showed that people on an anti-inflammatory diet had a lower probability to get complications.  Anti-inflammatory diets protected them from heart attacks, strokes, coronary heart disease and more.

Here are the ingredients of an anti-inflammatory diet

Why are anti-inflammatory diets so healthy? It is because they are rich in fiber, omega-3 fatty acids, antioxidants, polyphenols, vitamins, and unsaturated fats can have anti-inflammatory effects. Fruit options can include:

  • apples
  • fruits with stones or pips, such as peaches, plums, apricots, and cherries
  • grapes
  • citrus fruits such as oranges, lemons, limes, and grapefruit
  • pomegranates

Vegetables are high in fiber and other important vitamins and nutrients. Include a variety of colors of vegetables in your daily diet. Options can include:

  • green leafy vegetables, such as spinach, kale, radicchio, and arugula
  • cruciferous vegetables, such as broccoli, cauliflower, cabbage, and brussels sprouts
  • tomatoes
  • root vegetables, such as turnips, beets, radishes, and onions
  • potatoes
  • sweet potatoes

Whole and cracked grains are another source of fiber.

Nuts and seeds

Nuts and seeds contain polyphenols, which can have an anti-inflammatory effect. Nuts and seeds can include almonds, peanuts, cashews, hazelnuts, flaxseeds, sesame seeds, chia seeds, sunflower seeds, and pumpkin seeds.

Healthy oils

Vegetable oil like olive oil are important for cooking and for salad dressings.

Fish

Fish that is high in fatty acids and omega-3s can be important in an anti-inflammatory diet. These fish varieties can include salmon, tuna, sardines, and mackerel.

Herbs and spices

Some herbs and spices may have anti-inflammatory effects, as they can be high in phenols and antioxidants. These include clove, sage, oregano, cinnamon, rosemary, turmeric, black pepper, and ginger, among other options.

What to avoid

Highly processed foods like hamburgers, french fries, cakes and others must be removed from your food list. They are associated with heart attacks, strokes and cancer. In addition, the following food component must be avoided, if you value your life.

  • Refined carbohydrates: This can include products made with white flour, such as white bread, pasta, breakfast cereals, and pastries.
  • Trans fats: These can include foods labeled as having partially hydrogenated oils in them. Examples include baked goods such as cakes, pies, and frozen pizzas, as well as fried foods such as donuts or fries.
  • Some saturated fats: red meat, chicken with the skin on, milk, cheese, and cream contain high levels of certain saturated fats that promote inflammation.
  • Sugar: Sugary foods or foods with a high glycemic index can be inflammatory. Examples can include sugary drinks and sodas, sugary cereals, and candy.
  • Red meat and processed meat: This can include beef, lamb, goat, and pork meat, as well as processed hot dogs and sausages, among others. These meats have an association with colorectal cancer.
  • Certain spreads and cooking fats: Some fats such as margarine, shortening, and lard can be inflammatory.
Anti-Inflammatory Diets Improve Inflammation

Anti-Inflammatory Diets Improve Inflammation

Conclusion

You hear bad things about chronic inflammation and premature deaths. What you may not have heard a lot yet is that anti-inflammatory diets actually can safe lives. Above I have listed the most common inflammatory diseases. I also described the ingredients of an anti-inflammatory diet. With this diet researchers found that cardiovascular disease was reduced by 38%, strokes were reduced by 28%. It is not that difficult to adopt a healthy anti-inflammatory diet. Keep trans fats and highly processed foods away. Eat more vegetables, fish and avoid red meats. Add some nuts and cold pressed extra virgin olive oil. Good health will thank you for this diet change.

Oct
12
2024

Cardiovascular Risk Markers Predict Heart Attacks and Strokes

An article in The New England Journal of Medicine stated that cardiovascular risk markers predict heart attacks and strokes. A summary of this study was also published by NBC News.

30-year follow-up of the Women’s Health Study

This is based on a 30-year follow-up study of the Women’s Health Study. In the beginning of the study all women had blood tests taken. In the beginning none of the women had cardiovascular disease.  The blood tests were LDL cholesterol, lipoprotein(a) and high-sensitivity C-reactive protein (CRP). When either of these markers was high at the beginning of the clinical trial, it turns out that 30 years later the person either was dead from cardiovascular disease or had a heart attack or stroke.

More details of the study

In the beginning of the study 27,939 initially healthy U.S. women had 3 of the mentioned blood tests taken. If only one of them was elevated, there was a risk in the next 30 years to get a myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes. The initial age of the patients was 54.7 years. During the next 30 years of follow-up 3662 cardiovascular events took place. Hazard ratios for the primary end point in a comparison of the top with the bottom quintile were calculated. The following hazard ratios were derived:

  • 70-fold for high-sensitivity CRP
  • 36 for LDL cholesterol
  • 33 for lipoprotein(a)

Each biomarker showed an independent contribution to the overall risk. The risk of developing cardiovascular disease was highest when all three biomarkers were elevated.

Traditional risk calculation

Cardiologists calculated risk for cardiovascular events by the traditional 10-year estimates of risk. The authors suggest that physicians should do screening blood tests with these three biomarkers. If any of the biomarkers is elevated, measures to reduce cardiovascular risk should be initiated. This will be very effective to prevent cardiovascular events for the next 30 years.

Be proactive, prevent heart disease

As we get older, many people develop elevations of high-sensitivity CRP, LDL cholesterol and lipoprotein (a). But don’t wait for this to happen. Here are 9 steps you  can follow to prevent it.

  • Maintain a healthy weight
  • Quit smoking
  • Choose good nutrition
  • Be physically active
  • Treat hypertension adequately
  • Manage diabetes, if you have it
  • Stress management
  • Limit alcohol intake
  • Get enough sleep

Comments to the steps you can take to prevent cardiovascular disease

The ideal body mass index is between 21.0 and 22.0. I found that the fasting mimicking diet helps me to stay in that BMI range. Good nutrition eliminates red meat and emphasizes vegetables and salads. Fish, lean chicken and turkey meat are healthy. Avoid all processed meats like sausages. Watch your calorie intake to keep your body mass index stable. In addition, avoid excessive salt and sugar intake. Avoid highly processed carbohydrates and processed food. Eliminate fried fast food, chips and baked goods from your diet as they contain trans fats. Trans fats cause hardening of the arteries.

Aim to get 30 to 60 minutes of daily activity. Do two or more strength training sessions a week. This raises the protective HDL cholesterol and prevents cardiovascular disease. Excessive alcohol intake leads to cardiovascular disease and high blood pressure. Limit your alcohol intake, if you find it hard to eliminate it altogether.

Cardiovascular Risk Markers Predict Heart Attacks and Strokes

Cardiovascular Risk Markers Predict Heart Attacks and Strokes

Conclusion

A unique 30-year follow-up study of the Women’s Health Study identified three risk factors that a doctor can be determin from a blood sample. They predict whether a person will develop cardiovascular disease 30 years down the road. The three risk factors are high-sensitivity CRP, LDL cholesterol and lipoprotein (a). The best approach to prevention of heart disease is to adopt the approach of the Mayo Clinic described above. It comes down to the basics of good nutrition, regular exercise, maintaining a healthy weight, limiting excessive alcohol intake and stress management.

May
13
2024

Reduction of Alcohol Intake Is Associated with Less Heart Attacks and Strokes

Recently Korean researchers showed that a reduction of alcohol intake is associated with less heart attacks and strokes. This was published on March 28, 2024. The researchers followed 21,011 participants who were heavy drinkers. The baseline examination took place 2005-2008 and a follow-up exam was between 2009 and 2012. Definition of heavy drinking was as follows:

  • For men: 4 drinks (56 g) per day or more than 14 drinks (196 g) per week.
  • For females: more than 3 drinks (42 g) per day or more than 7 drinks (98 g) per week.

Reduced alcohol intake resulted in a 23% reduced risk of heart attacks or strokes, which was a significant finding. Patients benefited most from alcohol reduction regarding angina and ischemic strokes. This study was also reviewed in Medscape:

Other studies showing benefits of less alcohol intake

A 2018 study in Plos Medicine examined a US population of 99,654 adults (68.7% female).

At the time of the enrolment, they were 55–74 years old. The overall time of follow-up was 8.9 years. Scientists looked at the various risks of cancer development or deaths from cardiovascular disease as a function of the amount of average alcoholic drinks consumed. The results were as follows:

  • Never drinkers: 1.09-fold risk of cancer or death.
  • Infrequent drinkers: 1.08-fold risk of cancer or death.
  • Heavy drinkers: 1.10-fold risk of cancer or death.
  • Very heavy drinkers: 1.21-fold risk of cancer or death.

Heart attack risk and cancer risk from alcohol consumption are different

In addition, with respect to cardiovascular risk it followed a J-curve. This means that light alcohol use reduced the probability of death from a heart attack or stroke, but with moderate or heavy alcohol use the risk of death increased. In contrast, with respect to cancer there was a linear curve, which means that no dose of alcohol was safe for cancer development. The more alcohol you consumed, the higher the risk of cancer development was. Another study also showed that only moderate alcohol consumption benefited people in preventing heart attacks and strokes.

Chinese study

In 2021 a joint US/Chinese study examined the effects of alcohol consumption on cancer, deaths from cardiovascular disease and mortality in general. 83,732 adult Chinese participants were free of cardiovascular disease (CVD) and cancer in the beginning of the study. The researchers categorized participants based on self-reported alcohol consumption into 6 groups.

  1. 0 g alcohol/week (non-drinkers).
  2. 1-25 g alcohol/week.
  3. 26-150 g alcohol/week.
  4. 151-350 g alcohol/week.
  5. 351-750 g alcohol/week.
  6.  > 750 g alcohol/wk.

Results of the US/Chinese study

After 10 years of follow-up there were 6411 cases of CVD, 2947 cancers and 6646 deaths. After 10 years of observation researchers calculated the risk for cancer, CVD and mortality as follows. The risk groups are the same as mentioned above.

The lowest risk was group 2 with 1-25 g alcohol per week, which was set as 1.0. In comparison to these non-drinkers had a risk of 1.38-fold.

  1.     1.38-fold risk
  2.     1.0
  3.     1.15-fold
  4.     1.22-fold
  5.     1.33-fold
  6.     1.57-fold

The peculiar finding in this study was that non-drinkers had a risk of developing cancer, heart attacks or strokes like heavier drinkers. The risk curve has the name of a J-curve, which means the risk goes first down (like group 2, the 1-25 g alcohol/week group). Subsequently the risk curve goes up in a linear fashion. When people smoke and drink the risk is higher than the risks of people who only drink alcohol.

Reduction of Alcohol Intake Is Associated with Less Heart Attacks and Strokes

Reduction of Alcohol Intake Is Associated with Less Heart Attacks and Strokes

Conclusion

The fact that alcohol is a cell poison has been public knowledge for some time. I reviewed three studies that showed that less alcohol consumption saves lives. It does so by causing less cancer, heart attacks and strokes. The peculiar finding was that the group consuming 1-25 g alcohol/week had the best health statistic. This group had the lowest risk of causing cancers or cardiovascular disease (CVD). In comparison non-drinkers had a 1.38-fold risk to cause cancer or CVD. Those participants who were smoking as well had risks much higher than people consuming alcohol alone. If you want to live longer and stay healthy don’t smoke and drink not more than 1-25 g alcohol/week. This translates into 1.6 to 1.8 alcoholic drinks per week.

Dec
09
2023

Too much Ultraprocessed Food Makes you sick

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

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

Details of the study

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

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

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

Other studies with similar findings

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

French study 2019

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

Some of the contents of ultraprocessed food

Ultraprocessed food contains:

  • High salt content, and high sodium intake has been associated with cardiovascular deaths and increased stomach cancer risk.
  • Excessive amounts of added sugar. There is an association between added sugar consumption and an increased risk of mortality from cardiovascular disease.
  • Ultraprocessed foods contain very little fiber. More dietary fiber in one’s diet has an association with lower death rates.
  • Studies have estimated that reducing saturated and trans fats, salt, and added sugar in the diet prevent cardiovascular deaths.
  • High temperature food processing produces acrylamide. Acrylamide is a known carcinogen.
  • Consumption of processed meat products causes a higher risk of colorectal cancer and stomach cancer.
More ingredients of ultraprocessed food
  • Artificial sweeteners can alter microbiota and can cause the onset of type 2 diabetes and metabolic diseases.
  • With bisphenol A coating in food packaging endocrine disruptors enter the food. Bisphenol A causes endocrine cancers and metabolic diseases, such as diabetes and obesity.
  • The food industry uses additives frequently in their formulations. Some studies raised concerns about the health consequences of food additives. For instance, the food industry uses titanium dioxide widely. There is an association of titanium dioxide and increased risk of chronic intestinal inflammation and carcinogenesis.

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

Too much Ultraprocessed Food Makes you sick

Too much Ultraprocessed Food Makes you sick

Conclusion

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

Other studies

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

Apr
06
2023

Erythritol is Linked to Heart Attacks and Strokes

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.

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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!

Jul
28
2022

What Electronic Cigarettes Do to You

A review paper of Canadian researchers showed what electronic cigarettes do to you. They can be an effective smoking cessation aid for motivated smokers who eventually want to quit. But when people continue to inhale electronic cigarettes, their use can cause heart attacks, strokes, high blood pressure and increased heart rates. With regard to the lungs electronic cigarettes can cause vaping-associated lung disease, obstructive pulmonary disease, asthma and chronic cough. A literature review showed that e-cigarettes are less harmful to the heart and the lungs than smoking combustible cigarettes.

Increased use of e-cigarettes in younger people

In Canada the 2017 Canadian Tobacco, Alcohol, and Drugs Survey, which included all ages, found that 15.4% tried e-cigarettes. But among adolescents between 15 to 19 years old 22.8% were using e-cigarettes. For young adults aged 20 to 24 the figure of e-cigarette users was 29.3%. In addition, there was a significant increase of Canadian adolescents aged 16 to 19 from 29.3% in 2017 to 37.0% in 2018. Data from the US shows similar trends. E-cigarette use among US high school students increased from 11.7% in 2017 to 27.5% in 2019.

Some facts about e-cigarettes, cigarette smoking and smoking cessation

  • First, researchers noted that the smoking of e-cigarettes has a 3.62-fold risk of leading to subsequent cigarette smoking.
  • Second, a UK study found that when people used e-cigarettes for smoking cessation, 80% of the e-cigarette group were still smoking e-cigarettes after 1 year. In contrast, only 9% of those who used traditional nicotine replacement therapy (Nicorette etc.) to quit smoking were still using nicotine replacement after 1 year.
  • One study compared heart attack rates in a group of regular cigarette smokers and compared this to e-cigarette smokers. Cigarette smokers had a 2.72-fold higher heart attack rate than non-smokers, while e-cigarette smokers had a 1.79-fold heart attack rate compared to non-smokers.

Effect of e-cigarette use on heart and lung disease

Several studies looked at the relationship between e-cigarette use, heart attacks and strokes. There was a 1.4-fold higher incidence of coronary artery disease in e-cigarette smokers in comparison to non-smokers. The e-smokers had a 1.71-fold higher stroke incidence and 1.59-fold higher heart attack rates. In a large metaanalysis done with e-cigarette smokers, researchers noted the following facts: Electronic cigarette smokers were compared to non-smokers. Researchers noted a 2.27-fold increase of the heart attack rates in e-cigarette smokers. There was a 2-fold elevation of the systolic and diastolic blood pressure in e-cigarette smokers.

Switching from cigarette smoking to e-cigarettes

Patients who switched from tobacco smoking to chronic electronic cigarette use had a 7-fold reduction of their systolic blood pressure and a 3.65-fold reduction of their diastolic blood pressure. The researchers concluded that switching from cigarette smoking to e-cigarettes had some merit in terms of risk reduction for cardiovascular disease. But the final judgment on this is still pending. Certainly, quitting entirely from cigarette smoking is the best choice. I reported previously that e-cigarette smokers find it difficult to quit completely and if they smoke conventional cigarettes to stop that.

Effect of e-cigarettes on lungs

In addition to cardiovascular effects there is a direct effect from e-cigarette smoking on the bronchial tubes and the lungs. The vaped substances from e-cigarettes contain a lot of noxious gases that irritate the lining of the respiratory tract. This syndrome is called EVALI (electronic vaping associated lung illness). In 2019 and 2020 there was a rush of EVALI cases in the US with 2807 hospitalizations and 68 deaths. In Canada there were 19 cases of EVALI, 15 hospital admissions, and no deaths. Patients with EVALI have problems breathing, they cough and they have chest pain. Researchers suspect that vitamin E acetate and tetrahydrocannabinol are the major culprits that cause EVALI. But at this time there is no definite proof for that.

Poor quality of vaping fluid from the black market

These substances are not present in commercial e-cigarettes, but when you buy vaping fluid on the black market, it is often mixed in. Prolonged use of e-cigarettes can cause changes on spirometry, such as chronic obstructive pulmonary disease (COPD). Chronic use of e-cigarettes may cause premature onset of COPD.

What Electronic Cigarettes Do to You

What Electronic Cigarettes Do to You

Conclusion

E-cigarette use is increasing at an alarming rate among youths and persons who never smoked. The emerging evidence from researchers showed that there is a risk when you expose yourself to the smoke of e-cigarettes. There is an association of both heart disease and respiratory disease to e-cigarette smoking, but the risk is less than with exposure to regular cigarette smoke. Some researchers think that a switch from cigarette smoking to e-cigarettes could provide a viable harm reduction strategy for some smokers. But unfortunately, many continue to smoke e-cigarettes instead of quitting altogether. And in this case the risks for heart disease and lung disease remain!

Feb
13
2022

How healthy are Carbohydrates?

A recent review article asked: how healthy are carbohydrates? The three food components that occur in natural food are carbohydrates, fats and protein. Among the carbohydrates it is important to distinguish between simple carbohydrates (such as sugar) and complex carbohydrates. Simple carbohydrates are readily absorbed into the blood, which causes an insulin peak. After a few hours the peak is gone, and there is a “crash”. You will know the feeling of feeling hungry just a few hours after eating doughnuts! Complex carbs like peas, beans, fruit and vegetables take longer to get digested. The final breakdown product of the digestive process is sugar as well. But this process takes longer meaning that the concentration of sugar in the blood is much lower. There is also no “crash”. The result is that complex carbs cause less insulin secretion into the blood.

Long-term effect of eating too much sugar

Integrated over several decades of life, this means that a person who constantly consumes beverages with sugar and snacks containing sugar is at a higher risk of developing type 2 diabetes. In contrast, a person who eats well balanced meals where the insulin secretion is low, will not develop diabetes and have much less hardening of the arteries. This translates into a lower risk to develop heart attacks and strokes.

The types of carbohydrates

Before I discuss the health effects of various carbohydrates, we need to look at the types of carbohydrates.

Simple carbohydrates

Table sugar is a disaccharide, which consists of one molecule of glucose and one molecule of fructose.

The enzyme amylase very quickly breaks down the chemical bond between fructose and glucose and creates these monosaccharides in the small intestine from which they are rapidly absorbed. Milk sugar is a disaccharide, which consists of a molecule of glucose bound to a molecule of galactose. Milk contains 2 to 8% of milk sugar. We have to watch these simple carbs, because they trigger insulin production and lead to accelerated hardening of the arteries, heart attacks and strokes.

Complex carbohydrates

In contrast, complex carbs are healthy, because they take some time to be digested in the digestive tract. They consist of polysaccharides, long chains of sugar molecules. Both starches and dietary fiber consist of complex carbohydrates. They often are present in vegetables and many fruit. Complex carbs slow down the absorption of their breakdown products and minimize the insulin response. Dietary fiber is the indigestible part of fruit and vegetables. It contributes to good gut health as the beneficial gut bacteria can multiply on the fibre particles.

Healthy carbs

When simple carbohydrates dominate in our food intake, we are in trouble because they are loaded with calories. Overconsumption of them leads to weight gain and obesity, to diabetes, heart attacks, strokes and even cancer. On the other hand, consumption of complex carbohydrates is healthy. We get them from eating apples, bananas, berries, vegetables like spinach, tomatoes and carrots. Other healthy complex carbs are whole grain flour, quinoa and brown rice. Black beans, lentils, peas and garbanzo beans are also healthy complex carbs. Dairy products like low fat milk, yogurt and ricotta cheese are healthy as well.

Mediterranean diet as an example of a healthy, balanced diet

In 2019 a study was published where women with polycystic ovary syndrome (PCOS) were either put on a Mediterranean diet or not. This study showed that a Mediterranean diet was anti-inflammatory, reduced insulin resistance and reduced testosterone levels in PCOS patients.  But the same is true in a general population. The Mediterranean diet is one example of a healthy, balanced diet with complex carbohydrates. It prevents insulin resistance, inflammation and hormone disbalance. Other diets have similar effects like the DASH diet, the Zone diet and the Pritikin diet.

Quantity and quality of your food intake matters

A 2018 study from India showed that it matters how many carbohydrates we consume.  On average Indians eat a diet with 65-75 percent of calories coming from carbohydrates. Many of these carbs are the unhealthy simple carbohydrates. How healthy are  carbohydrates? The authors recommended to reduce complex carbohydrates to 50-55% and to add 20-25% protein, mostly from vegetable sources and add 20-30% from fat. The fat consumption needs to include monounsaturated fats (e.g., olive oil, nuts and seeds). Among the carbs a lot of green leafy vegetables help to balance the diet. This prevents the development of type 2 diabetes, heart attacks and strokes.

The above addresses the issue of quality of food. But it is also important what quantity of food we are eating. This is where counting or estimating calories comes in. If we overeat, we will very quickly gain weight and eventually can develop obesity.

The glycemic index and glycemic load

In order to help you with the choice of right carbohydrates the glycemic index was developed.

Here is another reference about the glycemic index/glycemic load.

In table 1 towards the end of the last link you find a column designated “GI” for glycemic index. All the foods that have a value less than 55 are foods that you can eat freely.

Problematical carbohydrate foods

Baked russet potatoes and boiled potatoes are very high on the GI index list. Puffed rice cakes, doughnuts, jelly beans and corn flakes measure high on the glycemic index list. But water melons, dried dates, white bread and white rice are also items to be avoided.

You best avoid anything with a glycemic index above 55. The column to the right of GI shows you a serving size and the last column on the right the glycemic load. The lower the glycemic load per serving, the better it is for your health. The glycemic index and the glycemic load are useful concepts of helping you to sort out your diet items.

My wife and I used this in 2001 to shed weight. We both lost 50 pounds (=22.72 kilograms) each in a period of 3 months.

Fasting mimicking diet (FMD)

According to Dr. Longo intermittent fasting stimulates the stem cells of the bone marrow. This leads to new clones of lymphocytes (B cells and T cells), which are part of the immune system. Your immune system becomes stronger from this.

Dr. Longo has done detailed mouse experiments, which inspired him to develop a new diet plan. Patients would receive a fasting mimicking diet (FMD) on 5 consecutive days per month. The rest of the month consists of a normal, balanced diet. 5 days of the month the person consumes a low 600-800-calorie diet. This reduced calorie intake is enough to ensure adherence to the diet, but low enough to lead to enormous positive metabolic changes including youth-preserving stem cell stimulation.

I am following the FMD

I have followed a FMD since December 2017. It helps me to keep my weight (BMI) in the 21 to 22 range. I feel more energetic and have managed to stay in good health.

The above chapter on the FMD was previously published here.

How healthy are Carbohydrates?

How healthy are Carbohydrates?

Conclusion

Healthy eating consists of 50-55% calories from complex carbohydrates; add to this 20-25% protein, mostly from vegetable sources and add 20-30% of total calories from fat. The fat consumption needs to include monounsaturated fats (e.g., olive oil, nuts and seeds). Unfortunately, most “convenience foods” (=processed foods) are incompatible with a healthy lifestyle. They contain too much simple carbs (sugar). Many people live on 65-75 percent of calories coming from simple carbohydrates, which are too many carbs. It should be complex carbs that digest slower and that do not induce insulin resistance. The glycemic index and glycemic load are useful concepts to help you chose the right foods that keep you healthy. The fasting mimicking diet can help you to take the last few pounds off that may be difficult to shed. Weight loss and weight maintenance are possible when you choose the right foods.

Nov
28
2021

Marijuana and Uncontrolled Vomiting

Marijuana was considered safe in the past, but now marijuana and uncontrolled vomiting suddenly make the news. Recently there also were reports of marijuana causing heart attacks and schizophrenia.

Abdominal pain with cannabis hyperemesis syndrome

Cannabis hyperemesis syndrome or cannabinoid hyperemesis syndrome (CHS) is a relatively new disease entity. It occurs in people who use marijuana daily for several years. But people affected by this condition often do not realize that it is an overdose of marijuana that brings on the nausea and vomiting of CHS. When they started marijuana use, they may have used intermittent doses of marijuana to treat nausea and vomiting. In intermittent doses marijuana may have been helpful, however constant use is a different story! During several years of use of marijuana, patients never had abdominal pains or vomiting, until one day CHS started.

Possible mechanisms regarding marijuana and uncontrolled vomiting

The body has its own endocannabinoid system with cannabinoid receptors that are distributed throughout the body. There are two cannabinoid receptors, CB1 and CB2. In the central nervous system, there are mainly CB1 receptors, in the rest of the body CB2. It appears that stimulation with intermittent small doses of marijuana suppresses nausea and vomiting in the hypothalamus area. However, constant stimulation of CB2 receptors in the gut with higher doses of marijuana are the cause of CHS. When a person develops cannabis hyperemesis syndrome, the only permanent cure is to stop marijuana use completely. This eliminates the CB2 receptor stimulation and allows the body to heal the gut. Researcher believe that Tetrahydrocannabinol, or THC is more powerful than the endocannabinoids. THC overwhelms the CB1 and CB2 receptors. When people who were cured of CHS restarted marijuana, their symptoms of nausea and abdominal pain returned.

In some people hot bath and hot showers help uncontrolled vomiting

Researchers noted that people reported how sometimes having a hot shower or a hot bath stopped the vomiting. The hypothalamus controls both body temperature and vomiting. A hot bath may send a signal to the hypothalamus, which interrupts the vomiting for a period of time. But with continued use of marijuana the vomiting reoccurs.

Increased strength of marihuana preparations

Dr. Wang, an associate professor of pediatrics at the University of Colorado Anschutz Medical Campus in Aurora, Colorado noted: “It’s been well documented that the amount of THC that now comes in cannabis is increasing substantially. In the ’90s the average was like 4% or 5%. Now in Colorado, it’s anywhere from 15% to 20%.” This means that THC causes more and more toxicity in patients.

In Colorado medical marijuana was legal since 2009 and recreational marijuana was legal since 2014. Dr. Wang researched the cannabis hyperemesis syndrome in Colorado. He found over 800,000 cases of vomiting in Colorado between 2013 and 2018. This was an increase of 29% from the time before marijuana became legal.

Symptoms of cannabis hyperemesis syndrome

The 5 most common symptoms of cannabis hyperemesis syndrome are continuous nausea, repeated vomiting, abdominal pain, weight loss because of decreased food intake and dehydration from fluid loss. Many people have several showers a day because it diminishes their nausea.

Three phases of cannabis hyperemesis syndrome

The cannabis hyperemesis syndrome often presents in 3 stages: the prodromal phase, the hyper emetic phase, and the recovery phase.

During the prodromal phase symptoms consist of nausea and abdominal pain early in the morning. The eating pattern is still normal in this phase. Some people increase their marijuana consumption as they hope to treat the nausea this way. This phase can last for months or years.

During the hyper emetic phase all of the 5 symptoms mentioned above can occur. This phase often continues until the patient gives up all marijuana consumption. This is when the recovery phase starts.

In the recovery phase the patient returns to a normal eating pattern. All of the symptoms gradually disappear. This phase lasts between days to months. But if the patient starts marijuana again, the symptoms return very quickly.

Treatment of cannabis hyperemesis syndrome

Patients who have severe vomiting require treatment in a hospital. The doctor starts intravenous fluids to treat dehydration. Some medicine to stop vomiting helps in the beginning. The physician must convince the patient to completely stop marijuana use, which helps to treat nausea and abdominal pain. Antacid medication like proton-pump inhibitors is useful to treat stomach lining inflammation. Frequent hot showers help to tone down nausea and vomiting. Hot showers seem to work via the hypothalamic brain center, which is responsible both for nausea/vomiting and heat perception. The physician may prescribe small amounts of benzodiazepams to treat anxiety.

By avoiding marijuana in any form THC, which is a powerful stimulus for CB1 and CB2 receptors gets washed out of the system. This allows the endocannabinoid system to rebalance itself. As long as the patient stays away from marijuana there is usually a complete recovery.

Marijuana and Uncontrolled Vomiting

Marijuana and Uncontrolled Vomiting

Conclusion

Since marijuana is legal in many jurisdictions the cannabis hyperemesis syndrome (CHS) occurs more and more often. Emergency teams at hospitals are kept busy treating these types of patients. It appears that CHS develops in patients who use marijuana regularly and use it in higher concentrations. Nausea and vomiting are the most common symptoms. Some patients can cope for a period of time by taking frequent hot showers. But eventually this home remedy does no longer work. A brief hospital stay may help the patient to recover from this syndrome. The patient needs to stay away from marijuana products to recover from CHS completely, otherwise there will be a relapse.

Oct
16
2021

Marijuana Causes Schizophrenia and Heart Attacks

Two new studies showed that marijuana causes schizophrenia and heart stacks. Marijuana use has been increasing significantly in the general population since the 1990’s. Initially many believed that marijuana would be harmless. But increasingly there are medical publications showing the opposite.

In the following I present data how the use of marijuana causes these two documented side effects, heart attacks and schizophrenia.

Schizophrenia increased since the 1990’s

A July 21, 2021 study from Denmark included all people of Denmark who were older than age 16 from January 1, 1972 to Dec. 31, 2016. The number of participants were 3 ,595 ,910 women (50.0%) and 3 ,590 ,924 men (50.0%). The total number of individuals in the study were 7,186 ,834.

Here are the figures of the percentages of cannabis related schizophrenia cases in Denmark according to the study:

  • 1995: 2% of all schizophrenia cases related to cannabis use in Denmark
  • 2000: 4% of schizophrenia cases due to cannabis use
  • 2010: 8% of all schizophrenia cases from cannabis use

The researchers found that the risk of coming down with schizophrenia heightens with increased cannabis use. Heavy users are more likely to develop schizophrenia than light users.

Cannabis use disorder

One subgroup of cannabis users are people with a cannabis use disorder. They use cannabis, but they become tolerant to it. This requires a higher dose of cannabis to achieve satisfaction. But they are unable to reduce cannabis. They spend more and more time to obtain cannabis, use it and recover from the effect. They give up other activities in favor or cannabis and they continue the use despite negative consequences. Researchers found that this group of individuals had the highest risk to develop schizophrenia. The authors of the Danish study found that patients with cannabis use disorder over the past 2 decades have increased their risk for developing schizophrenia by 3- to 4-fold. They feel it is because of the increase in use and the increase in potency of cannabis.

Heart attacks increased with cannabis use

A Canadian study assessed a cross-sectional study of 2017 and 2018.

The study in question was the American Behavioral Risk Factor Surveillance System survey of US adults. The authors zeroed into young adults (aged 18–44 yr.) with recent cannabis use and a history of a heart attack. Among 33,173 young adults there were 4,610 respondents with recent cannabis use (17.5%). 61 respondents among the recent cannabis users reported that they had a heart attack, which is 1.2%. In comparison non-cannabis users had a heart attack rate of only 0.8%. The adjusted odds ratio for cannabis users compared to non-users was 2.07. This means that the probability of getting a heart attack when using cannabis was 2.07-fold higher when compared to non-users. Also, the investigators found that a history of a heart attack had a probability of being due to cannabis use with a probability of 2.31-fold.

Cannabinoid receptors

Researchers found endogenous cannabinoids in the brain that function as messenger molecules. They need to activate their targets, the cannabinoid receptors, called CB1 and CB2. CB1 receptors are found mainly in the central nervous system. CB2 receptors are located mainly in the immune system. Reproductive organs have their own cannabinoid receptors. The lining of the uterus contains only CB1 receptors. Ovaries and testicles both use CB1 and CB2 receptors. Tetrahydrocannabinol (THC) from smoking or ingesting marijuana is the main psychoactive compound in cannabis. It stimulates these cannabinoid receptors also. But compared to the body’s own cannabinoids THC is much stronger. This leads to more pronounced effects that concern many physicians.

The overwhelming response of the cannabinoid receptors to THC leads to a blunting of the signals of the body’s own cannabinoids. This causes a breakdown in communication between neurons and body cells.

Marijuana Causes Schizophrenia and Heart Attacks

Marijuana Causes Schizophrenia and Heart Attacks

Conclusion re. marijuana causes schizophrenia and heart attacks

Legislators in Canada and many of the states in the US legalized the use of marijuana. As a result, the cannabis use in the younger age group of adults (between 18 to 44 years) has increased significantly. This means that more and more people are exposed to THC from cannabis, which overstimulates the body’s own endocannabinoid system. As explained this leads to a breakdown of communication between neurons and body cells. In time diseases like heart attacks and schizophrenia can develop, a fact overlooked by the media and the public. The overuse of marijuana leads to more than a 2-fold risk to get a heart attack and a 3- to 4-fold risk of coming down with schizophrenia. These are the facts right now. But with further increased use of cannabis researchers will likely find many other diseases that THC can trigger.