May
18
2019

A Pill Against Obesity

By | diet, Drugs, exercise, food, Nutrition, Weight loss

At the 26th European Congress on Obesity in Glasgow, Scotland a pill against obesity was introduced. Here is a report about this on CNN. The biotechnology company, Gelesis had funded the research. This company also developed the product. The FDA has accepted this product, which is marketed under the name “Plenity”. The FDA gave clearance for Plenity as a prescription weight loss product for use in overweight adults with a body mass index above 25.0. Genesis has announced that Plenity will be available in the US by 2020. The cost of it is yet unknown.

How Plenity, a pill against obesity, works

Plenity actually is a medical device. It is a capsule that contains tiny little gel pieces that dissolve in the stomach. Patients take one capsule with water before lunch and dinner. When the gel pieces swell it gives a fullness feeling that limits calorie intake. The hydrogel pieces increase the volume of the stomach and small intestine. By the time the gel particles arrive in the large intestine, enzymes have partially broken down the hydrogel, water is released and the rest is expelled in the feces. Dr. Ken Fujioka, a weight loss expert, endocrinology researcher at Scripps Clinic and scientific advisor to Gelesis said: ”The most compelling aspects of this approach are its effectiveness, novel mechanism of action and impressive safety data. This approach creates another arm in the treatment algorithm of weight management and could be used by an overwhelming majority of people struggling with weight issues”.

Randomized placebo controlled weight loss study with Plenity

Gelesis sponsored a weight loss study with 223 patients in the experimental group and 213 in the placebo group. The length of the weight loss study was 171 days. The placebo group lost 4.39% body weight, while the group on Plenity lost 6.41%. There were very few side effects, like an abdominal fullness or bloating.

Discussion regarding Plenity, a pill against obesity

Along with taking Plenity the investigators asked the patients to also stay physically active and adhere to a sensible diet. I know from my own experience that a change in diet can make you shed significant weight and you can keep it down. In 2001 I lost 22.7 kg (=50 pounds) over 3 months, down from 85.5 kg. I weigh now 62.8 kg. With this data you can calculate that I lost 22.7/85.5=26.5% of my original weight. I did so in 90 days, not in 171. It was the difference in food intake that enabled me to lose this weight. I had cut out all sugar, starchy foods, processed food and wheat.

The pill will help patients feel full after small helpings, instead of having hunger pangs, and this can be valuable and will contribute to being successful with losing weight. But long-term weight control only works with an adjustment of dietary habits and lifestyle choices. 

Keeping weight loss in perspective

The authors stated that their best patients were losing 5% and 10% when they watched their diet and exercised. When I compare my own data (26.5% weight loss) and theirs I conclude that they did not try hard enough. And they did not have to rely on any diet pills. It is clear from the data that the placebo group had significant weight loss with just watching their diet and exercising. I do acknowledge that Plenity has a slightly better effect. However, when people complete with their weight loss program, they will continue to eat their former diet regimen. This will make them gain everything back what they have lost.

For 18 years I have not gained back what I lost in 2001 because I have stayed on the same diet that some people may label as “radical”. There is nothing wrong with vegetables, salads, lean poultry, fish, nuts, fruit etc. I suspect that people could easily lose 10% to 20% of weight without any weight loss pills, if they took a similar approach as I did.

A Pill Against Obesity

A Pill Against Obesity

Conclusion

Weight loss seems to be a topic that is of interest to many people. There is the expectation that the new weight loss pill Plenity will be the solution to people’s diet problems. However, the difference in weight loss between the placebo group and the experimental group was only 2.02%! It took the researchers 171 days to be able to say that there was a significant difference between the Plenity group and the placebo group.

Cutting out junk foods

When I did my own weight loss program based on dietary changes alone I had lost 26.5% in only 90 days. I suggest that people should not forget to change their food intake, cutting out junk food and adopting a healthy food intake. They may not require Plenity pills at all or for a much shorter time. Preparations for the time after the weight loss achievement are necessary or else there will be rebound weight gain. Long-term success is only possible with sensible dietary choices and lifestyle choices, such as regular physical activity.

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Nov
26
2017

Prevent Cancer, Cut Sugar

By | Cancer, Inflammation, Nutrition, Obesity, Processed food, sugar, Weight loss

If you want to prevent cancer, cut sugar! This is the message of an Oct. 13, 2017 study. The research team had done experiments for 9 years, when they concluded that it was refined sugar that caused spontaneous mutations of RAS proteins. RAS proteins are responsible for cell growth. When a substance like sugar turns them on all the time, they can cause mutations that lead to cancer. In this article research concentrated on yeast cells, and the publication is in Nature Publication. The CNN publication describes this in simpler language. Essentially the research team found that a sugar molecule, fructose-1,6-bisphosphate, was responsible in obese patients and in diabetic patients to mutate a RAS protein, which as a result can turn into an oncogene causing cancer.

Evidence that sugar causes obesity and type 2 diabetes

  1. A September 2017 US study followed 41 children age 9 to 18 with initial fructose consumption of >50 g/d. The treatment of the children consisted of an isocaloric fructose restriction of only 9 days. Following that their liver fat content decreased from 7.2% to 3.8%. In addition intraabdominal fat decreased and new fat production was reduced from 68% to 26%. The authors pointed out that reduction of sugar consumption in obese children was a very effective treatment tool.
  2. This August 2017 study from Helsinki followed 71 obese males for 12 weeks. They consumed 75 grams of added fructose every day in addition to their normal food intake. The liver fat content increased and cardiovascular risk factors worsened as blood tests showed. The investigators concluded that the adverse cardiometabolic effects were a result of the added fructose. They were not secondary to the weight gain (a theory in the past).
  3. This February 2017 study from the US the Taiwanese Healthy Aging Longitudinal Study in Taiwan was also of interest. It consisted of a 5-year long study involving middle-aged and elderly patients with type 2 diabetes. The result was that patients with more physical activity, a better diet and a higher score regarding psychosocial health did much better with respect to managing their diabetes. Maintaining a healthy lifestyle is particularly important for the elderly to prevent diabetes.

Evidence that obese patients and type 2 diabetics get more cancer

  1. In this 2016 study from Poland the effect of diabetes causing various cancers was under investigation. The authors pointed out that worldwide in 2014 there were 387 million cases of type 2 diabetes and it was still rising. When they looked at correlation between various cancers and type 2 diabetes they found that diabetes had the strongest association between pancreatic cancer and liver cancer. But there was also an association between diabetes and breast cancer, bladder cancer and kidney cancer. Head and neck cancers were more frequent among diabetics. Some diabetic medications made cancer frequencies worse, others, like metformin made them better.
  2. In this March 2016 article from the BJC (British Journal of Cancer) cancer frequencies were correlated to patients with obesity and to patients with diabetes. Researchers found that some types of cancer correlated with obesity, whereas others did with diabetes and not with obesity. They found that type 1 diabetes had its own set of cancer risks while type 2 diabetes had a different set of cancers that correlated to the disease

More on cancer risks in diabetics

  1.  A 2015 study from Malaysia with an 11-year follow-up describes that type 2 diabetes had increased in the population which researchers studied. The investigators concentrated on a female population where they found a strong correlation between diabetes and endometrial cancer, ovarian cancer, breast cancer and cervical cancer. In a group of 860 cancer patients they found that 26.5% were diabetics. They were at a much higher risk of getting these cancers.
  2. A 2016 study from the US examined 2,836 veterans who had problems with their esophagus. 1,704 received a diagnosis of esophageal adenocarcinoma, 1,132 of them had gastroesophageal reflux disorder. Among the cancer patients there were 30.8% diabetics. The researchers calculated that for diabetics there was a 2.2-fold higher risk of developing esophageal cancer. The only other risk factor they could identify was nicotine dependence, which showed an association with a 1.7-fold risk of to develop esophageal cancer.

Evidence that sugar causes cancer

As explained earlier research found that fructose-1,6-bisphosphate is responsible in yeast cells to lead to RAS mutations. Human cells have the same metabolism as yeast cells, and they also have RAS protein and fructose-1,6-bisphosphate. Fructose-1,6-bisphosphate is important for cancer development in humans. Yeast cells are diploid cells as are human cells. But yeast cells are not human organisms, so the parallel stops at one point.

  1. A 2014 study from China showed that fructose-bisphosphate aldolase was a marker for lung cancer metastases. This enzyme breaks down fructose-1,6-bisphosphate. Depletion of fructose-bisphosphate aldolase A reduces cell motility of cancer cells and the ability to cause more tumors. In other words, the key for cancer cells to thrive is the presence of fructose-1,6-bisphosphate.
  2. In this 2013 study from Beijing gastric cancer biopsies research examined these samples for fructose-1,6-bisphosphatase, the enzyme that breaks down fructose-1,6-bisphosphate.

The enzyme was under expressed in 86.2% of the gastric cancer biopsies. This meant that glycolysis was stimulated in the cancer cells. An overabundance of fructose-1,6-bisphosphate caused tumor cells to get into an active phase and to metastasize.

Discussion of why sugar causes cancer

I have previously discussed this topic in a blog 3 ½ years ago. At the time a few steps were missing from the knowledge we have today. Nothing has become different regarding the connection of sugar overconsumption and the risk of developing cancer. First of all, we have learnt that fructose overconsumption or sugar overconsumption leads to fructose-1,6-bisphosphate in the blood, which stimulates RAS proteins to mutate and stimulate oncogenes to cause cancer. In addition, people who are overweight, obese or have diabetes have too much insulin production, which can also lead to cancer causation. Finally, obese people have a lot of very active kinins in the blood that can cause cancer as well. In conclusion, what has changed between March 2014 and now is that we have a lot more detail why things happen the way they do. Connections that used to be obscure have now a rational explanation.

The message is that we need to cut out refined sugar from our diet, cut out starchy foods and cut out processed foods. This will improve our metabolism and reduce our risk of getting cancer. We will also lose weight, which I have experienced in 2011 when I lost 50 pounds over 3 months. What did I do? I was just doing what I described to you: cutting out sugar, starchy foods and processed foods.

Prevent Cancer, Cut Sugar

Prevent Cancer, Cut Sugar

Conclusion

Want to reduce your risk for getting cancer drastically? Then cut out sugar and starchy foods along with processed foods (which have too much sugar in it).  Strangely enough it was only now that researchers have found the missing link. The culprit is fructose-1,6-bisphosphate, a metabolic byproduct from sugar consumption. It stimulates a RAS gene, which can mutate, turn into an oncogene and eventually cause cancer. This fact was not known a few years ago. But the knowledge that cancer can occur due to diabetes, obesity and insulin resistance goes back a long time.

We need to learn from science: cut out refined sugar, starchy foods and processed foods. This will change insulin resistance into insulin sensitivity. Fructose-1,6-bisphosphate will not accumulate, but get normally metabolized. This way fructose-1,6-bisphosphate does not pose a problem for RAS proteins. Your insulin level will normalize, the previous kinin overproduction will disappear and your risk for cancer will decrease.

We have allowed the sugar industry to undermine our health for too long. It is time to take back the control over our lives, assess our food habits and make the necessary changes.

May
09
2015

Radiation From Fukushima Less Than Expected

By | Alzheimer’s disease, Diabetes, heart attack, High Blood Pressure, Inflammation, Radiation Protection, Stroke

Introduction

In the following I am describing “radiation from Fukushima less than expected”. I have blogged about the fallout from the Fukushima disaster in Japan before. At that time scientists predicted the levels of radiation to be high around 2015 on the US West Coast. The water with the radioactive contamination took that long to arrive on the Western shores of North America.

The predictions were based on the known water currents in the Pacific Ocean and the amount of radioactive pollutants released. With that data it scientists extrapolated what would happen in the future. The future is here; we just heard about reports that the polluted water has arrived.

Measurements of sea water for radioactivity

Scientists measured the radioactivity of the nuclear isotope composition in the water directly. This showed that the concentration was much lower than previously assumed. So, you can swim in the ocean of the West Coast of the US and Canada. You can also safely walk on the beaches. The scientists who did the present calculations pointed out the following. Let us assume that you swim in the ocean for 6 hours for 7 days per week continuously. You do that for a period of one year. Your radioactive exposure amounts to 1000 times less than that of a dental X-ray.

Video summing up the outfall from the Fukushima disaster

Here is a video that puts things into perspective (look at the video located on top of the page).I highly recommend watching this. It sums up how the Fukushima disaster affected marine life. But that the West coast of the US and Canada do not seem to be in danger. There are no highly toxic levels of nuclear isotopes of the West coast of North America.

Why should we trust these measurements?

You may ask yourself: why should I trust these measurements? As pointed out in my previous blog, there were a number of radioactive elements released into the atmosphere. They also leaked into the Pacific Ocean. Cesium-137 and Cesium-134 are both part of the Fukushima incident. Scientists measured these isotopes and found them higher than previous concentrations at the coast of British Columbia. Cesium-134 has a much shorter half-life and can therefore only come from Fukushima. But Cesium-137, which has a half-life of 30 years, showed an increase to a higher than previous level because of the Fukushima disaster.

Previous nuclear weapons tests

Underwater nuclear weapons tests in the 1940’s to early 1990 before the Comprehensive Test Ban Treaty was enacted caused the previous baseline of Cesium-137 levels in the ocean. Fortunately, only about 25% to 30% of the original accumulation of radioactivity was present before Fukushima added more Cesium-137. The other nucleotides Iodine-131, Plutonium-238 and 239, Strontium-89 and 90 and Uranium-234 and 238 are also helping scientists to sort out the contribution of radioactive pollution from Fukushima when in comparison to the baseline before.

Why it matters what you eat

It appears that you are completely safe when you hear such good news about radiation from the Fukushima disaster. Not quite so. Any source of radiation, which includes traveling by plane, getting mammograms in women, getting CT scans, lung X-rays, dental X-rays etc. has an effect on your system. It causes an inflammatory response, which worsens with the consumption of sugar and starchy foods. Researchers found that sugar and starchy foods oxidize LDL cholesterol, which in turn causes inflammation in your arteries. The oxidized LDL cholesterol also travels through your whole body including your brain. Even Alzheimer’s disease is an inflammatory brain disease. Overconsumption of sugar and starchy foods can in part cause Alzheimer’s disease.

Radioactive exposure causes a strong inflammatory response

Now add to this radioactivity exposure, which causes a strong inflammatory process in your body from free radicals that circulate in your blood. As a result the problem with the background radiation being a bit higher than what it was before is also the oxidative stress from sugar and starchy foods causing more inflammation within the body. We need to remember that the victims of Nagasaki, Japan were the ones that did not follow the dietary advise of Dr. Akizuki. He had ordered a strict vegetarian diet, which consisted of uncontaminated brown rice, fermented foods, sea algae and vegetables. Dr. Akizuki did not allow sweets of any kind, but some salt as the main condiment. Everybody was fed at least one helping of a soup with fermented soy and seaweed in it (wakame miso soup).

Dr. Akizuki’s regimen allowed people to survive after the atom bomb

It was this regimen that helped tone down inflammation in the body. It countered the negative effects of the radiation of the atom bomb.

Other causes of radiation

We are exposed to the leftover of 25% of the nuclear experiments from the nuclear bomb testing (the Leftover radioactive Cesium-137 mentioned above). In addition background radiation from sunbursts and cosmic radiation have to be absorbed by our system. As the radiation fuels inflammation, we cannot afford to continue to indulge in sugar and starchy foods that lead to hyperinsulinism, inflammation and oxidation of LDL cholesterol. If we cast all caution to the wind, we will get degenerative diseases like arthritis, inflammation of the lining of the arteries leading to high blood pressure, heart attacks and strokes. Obesity and diabetes will also undermine our health. All of this leads to disabilities and premature deaths.

Radiation From Fukushima Less Than Expected

Radiation From Fukushima Less Than Expected

Conclusion

I am glad that the Fukushima news are a lot better than anticipated for the West Coast of the US and Canada. However, we should not forget that, like the burden of radiation, certain foods (sugar, high fructose corn syrup and starch) also cause inflammation in our system. We need to remember how effective Dr. Akizuki’s diet was back in 1945 protecting those who were in immediate proximity to the atom bomb in Japan.

Today we should consume a Mediterranean diet, which is also full of antioxidants and is thought of to be anti-inflammatory.

Supplements that protect you from radioactive contamination

We can also take antioxidant vitamins like vitamin C, glutathione, fish oil and others that will protect us from anything that oxidizes LDL cholesterol or produces free radicals. Common sense needs to prevail. Radiation is a burden that fuels inflammation in our bodies, but dietary measures can greatly contribute to keeping us out of trouble. Vitamin supplements in general help with their anti-oxidant effects to protect your vital organs (heart, kidneys, brain, lungs, liver, bone marrow). I have discussed this in detail under this link. Note that I am recommending Io-Plex SR, which is an iodine supplement to be taken twice per day to protect you from fluoride, bromide and chlorine pollution. It will also protect the iodine receptors in your body from traces of radioactive salts in fish, sea water and the environment.

Oct
04
2014

The Problem Are Sugar And Starchy Foods

By | Cancer, heart attack, Heart Disease, Nutrition, Stroke

Fareed Zacharia interviewed Chief Medical Correspondent Sanjay Gupta on CNN on Sept. 10, 2014 regarding why sugar is worse than fat.

I like to explain why it is important to rethink the issues of fat, cholesterol, sugar, starchy foods, longevity, prevention of cardiovascular diseases (strokes, heart attacks) and cancer.

I have blogged about this many times before, but perhaps an overview regarding these issues would be in order.

The Framingham Heart Study indicated first that too much cholesterol in our system was a problem leading to heart attacks and strokes (Ref. 3). As more research was done, the reasons for this have become clearer.

1.Liver metabolism

The liver plays a major role in the metabolism of glucose. Digestion of refined starchy foods starts in the mouth where amylase from the saliva digests the surface of the pasta or white bread you eat. The stomach carries on with this process and the job is finished in the small intestine with the help of pancreatic enzymes (Ref.1). This digestive process is so efficient that within 20 to 30 minutes all of the refined carbs from pasta, donuts and bread appear as sugar in the blood stream. The portal vein system that collects the nutrients from the gut delivers all sugar straight to the liver where it is reassembled into glucagon as the storage form in the liver and skeletal muscles. This would all be good, would we have periods of fasting in between our sugar consumption. Periods of famine are no longer part of modern civilization, but consumerism is. Most of the processed food contains sugar and this leads to excess sugar uptake, which has to be processed by our liver. The end result is production of LDL cholesterol, oxidization of LDL cholesterol by sugar and in the process the production of VLDL (=very low-density lipoproteins) that leads directly to deposits in the arterial walls and clogging of arteries. Triglycerides are also produced, which leads to fat deposits (the cause of the obesity wave all around us).

2. Where does the fat that we see around us come from?

In the past we thought that it was from too much saturated fat and cholesterol in the food that would have caused the accumulation of fat and cholesterol in the body. Now we know that this was an over-simplification. In fact more cholesterol and fat comes from metabolized sugar and with a slight time delay also from starchy foods.

Sugar and starchy foods (like pasta, white rice, white bread, potatoes, grapes, honey etc.) get metabolized by your liver into LDL cholesterol, triglycerides, and fat. This does not mean that you should not pay attention to the total fat content and the quality of fats you eat.

3. The finer points about subfractions of cholesterol

You have heard many times about the good (HDL) and the bad (LDL) cholesterol. Sugar and refined starches do not only lead to the production of LDL cholesterol, but also to oxidized LDL cholesterol, which is very aggressive (VLDL=very low-density lipoproteins) leading directly to deposits in the arterial walls and to clogging of arteries. Your doctor can order a detailed lipid profile test, if you belong into a higher risk group to determine your VLDL level.

It may surprise you to read that many of the foods that were demonized in the past 2 to 3 decades like whole eggs; unprocessed grass-fed red meat, coconut oil etc. are now seen to be good for you.

But there are provisos: supplement with molecularly distilled omega-3 fatty acids, have enough vitamin D3, vitamin K2 and calcium in your diet or supplement with these. This will make sure that calcium will leave the blood stream (not lead to arteriosclerosis) and enter into the bones where it is needed for healthy bone structure. The anti-inflammatory effect of vitamin D3 and of the omega-3 fatty acids will prevent arthritis, strokes, heart attacks and cancer.

The Problem Are Sugar And Starchy Foods

The Problem Are Sugar And Starchy Foods

4. Four major conditions causing heart attacks and strokes

According to Ref. 2 only 4 conditions have been proven over the years to lead to serious hardening of arteries causing strokes and heart attacks: dyslipidemia (high triglycerides, high LDL cholesterol and VLDL), hypertension, cigarette smoking, and/or diabetes (Ref. 3). What has not been appreciated until recently is the fact that sugar and refined starchy foods metabolized by the liver are the culprits in causing plaque in arteries as the oxidized LDL cholesterol is aggressively invading the arterial wall and is inflammatory. A total cholesterol level greater than 5.2 mmol/L (200 mg/dL) has been shown to be associated with increased heart attacks and strokes. Ref. 2 also points out that dietary changes; days of fasting and weight loss have all been shown to stabilize and reduce plaque lesions and reduce heart attacks and strokes. It is the rupture of unstable plaques that lead to attraction of platelets and thrombus formation. It is this localized thrombosis that leads to the closure of coronary arteries or brain vessels causing heart attacks and strokes. According to Ref. 2 there are 9 factors that determine whether we get a stroke or heart attack, the four factors mentioned above (dyslipidemia, hypertension, cigarette smoking, diabetes) and abdominal obesity, lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and a psychosocial risk. This latter factor includes any kind of chronic stress like interpersonal stress at work or home, depression, financial stress, major life events like marriage, death, divorce, and lack of control. Counseling is useful for support regarding psychosocial risk factors. It is significant to note that according to Ref. 2 several studies have shown that 90% of heart attacks and strokes can be prevented by paying attention to these 9 risk factors. Managing stress effectively and seeking professional help for psychosocial difficulties as well as avoiding the  physical health risks will contribute to good allover health.

Conclusion

Where does this leave us? For decades we have been told that saturated fats and cholesterol in our diet were the culprits and we replaced them with sugar that is part of a low-fat diet. We need to pay attention to the glycemic index and cut out high glycemic foods. However, it is OK to eat some carbs from the medium glycemic food list and most of our carbs from the low glycemic food list. With regard to fat it is important to consume only the healthy fats including omega-3 fatty acids. By taking care of the 4 major causes of heart attacks and strokes and also attending to the additional minor contributors mentioned above you will be able to eliminate 90% of the cardiovascular events. As you change these things you will also prevent many cancers as you changed the body metabolism and chronic inflammation has been taken care of as well as I pointed out in several blogs before. Finally, pay attention to stress management. The body and mind work together.

I have discussed all of these items in detail in my book as well (Ref. 3).

More information on high density and low density carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/

References:

1.Townsend: Sabiston Textbook of Surgery, 19th ed.,Copyright 2012 Saunders.

2.Melmed: Williams Textbook of Endocrinology, 12th ed.,Copyright 2011 Saunders.

3. Dr. R. Schilling: “A Survivor’s Guide to Successful Aging“. Paperback through Amazon.com, 2014.

Last edited Nov. 8, 2014

May
31
2014

Industry Sponsored Diet Soda Study Deceptive

By | Health, Hormones, Nutrition, Prevention, Vitamins and supplements, Weight loss

Recently an industry sponsored study was reviewed by the media with this headline: “Diet soda helps weight loss, industry-funded study finds”. Before you get too excited about this study, let me tell you that you are being deceived. Essentially the study compared 150 overweight or obese people on water and a similar group of people on diet sodas. Both groups were counselled on the benefits of exercise and a healthier diet. At the end of 12 weeks the water group that did not drink diet sodas had lost 9 pounds, while the diet soda group that continued their former habit lost 13 pounds. The question now is why this 4 pound difference? The sponsor of the study would like you to think that the soda diet drink is healthier, because it helps you to lose weight. Let me explain to you that there are a few flaws in the study as follows.

1. Most often there are confounding errors in industry-sponsored studies. Even though it looks on the surface that the two groups were comparable, researchers should have checked out various parameters like sex distribution, other underlying illnesses, mental state (depressed or not etc.), diabetes and other factors to make sure that there is no metabolic bias between the two groups from the start of the study.

2. Deception built into study: we know from other studies that on the long-term diet sodas lead to weight gain by stimulating your appetite for sweets and their subsequent consumption. Often short-term studies show the opposite effect, so it would be false to assume that long-term results would be similar. But most readers who read this quickly would be tempted to think “so it must be OK to continue to consume diet soda drinks!” Off you go to the grocery store and buy another 6 or 12 pack. That’s exactly what the industry-sponsored study set out to do. Somewhere in the back-room of a big soft drink corporation the executives discussed among themselves that their statistics were bad; the sales of diet soft drinks were down; there was too much negative press fuelled by the health food industry. They had to do something about this, so they designed a study where the good guy was the diet soft drink. If the consumer is not buying the results, at least the study helped to confuse people and whenever there is confusion, at least part of the confused population will return to their old habits. After all the study showed “ it is OK”.

Industry Sponsored Diet Soda Study Deceptive

Industry Sponsored Diet Soda Study Deceptive

3. Excitotoxins are not OK. Unfortunately all artificial sweeteners are toxic to your brain, they are excitotoxins. MSG is another excitotoxin. The only exception is the natural sweetener stevia, a plant product, which is OK. Splenda is an insecticide, so this is belongs to the xenoestrogens, bad for you as it acts like a foreign estrogen and has cancer-promoting qualities when exposed to it for several decades. The rest of the artificial sweeteners are excitotoxins: they burn your brain cells very slowly and can lead to dementia. Unfortunately they are addicting and your brain will make you feel good when you drink more of it. So, the real reason why the study group on diet sodas did better than the water group is because they did not have to change that habit, there was no withdrawal to deal with and they felt fine. So they could concentrate on dieting and exercising and of course you would lose 13 pounds in 12 weeks doing that. The water group on the other hand had to cope with diet soda withdrawal and on top was challenged by an exercise and weight loss program. As there was no diet restriction, they could compensate a bit for their trouble of withdrawal and eat a few muffins or some extra bread to make up for the lack of their comfort diet drink fix (the satisfaction of consuming the excitotoxin). This slick short-term study design is what should have alarmed the publisher to ask a few hard questions.

4. There needs to be an internal logic in the study: Let’s do a thought experiment where we repeat the study and start with two comparable overweight/obese groups of people and put them on no sugar and no refined carbs for 2 weeks and also on no diet sodas for the same time. After two weeks they are both accustomed to this diet and the no diet soda habit and they have probably lost the same amount of weight from the calorie restriction. Now we start the one group on diet sodas and the other group on water, but strictly controlled for a similar calorie intake in terms of other foods or drinks as much as is humanly possible. I would predict that after 12 weeks the water group will have at least lost the same weight as the diet soda group, if not more. The diet soda group likely will have had some problems with sugar craving and may have had more dietary indiscretions (sneaking in snacks and underreporting them), but this would show up as weight gain.

You may be proud of having completed this well controlled study. The trouble is that your industry sponsor that produces the diet drinks will not like this outcome and would not allow the results to be published. In fact that kind of result would be actively suppressed.

Conclusion:

The diet soda study discussed here is a lesson in biased publishing. We are constantly bombarded by an endless string of meaningless publications that are designed to make the consumer insecure, or bias us for accepting a company’s product in the hope of achieving a certain result (like high sales). Even, if this is not accomplished the company has sold enough of their product just for giving it a try. Beware of the door-to-door sales person. This figure is very much present right in this publication. In this case it is the sales pitch of the diet soda manufacturers! You are looking at a study that was designed to make you buy more of the excitotoxin (aspartame or other artificial sweeteners), which likely contributed to your extra weight or obesity in the first place. It’s up to you to shut the door on this sales pitch. Instead of a diet soda I suggest you make your own drink: squeeze half an organic lemon and top this with mineral water of your choice. Sweeten it with a tiny amount of stevia. This has no calories and does not stimulate you to eat more sugar and starchy foods; but it quenches any thirst and you even get some water-soluble vitamins in the process.

Last edited May 31, 2014

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Apr
19
2014

Measuring Your Heart Function

By | Anti-aging medicine, Fitness, heart attack, Heart Disease, Nutrition, Prevention, Stroke

Recently I came across a book by Dr. Steven Masley, cardiologist (fellow of the American Heart Association, see Ref.1). The heart’s function is to pump your blood reliably all your life. It is a complicated organ, but it works well, if we treat it well. Western medicine has taught us that with complicated machinery and tests we can assess how the heart is doing. But until recently there was no reliable easier way to assess our cardiac health function. The purpose of this blog is to summarize a three-pronged approach to measure your heart and blood vessel health. It is described in detail in Ref.1, but I doubt that many people have yet read this important reference book. It is also important to FIRST see your doctor whether you are able to do the Bruce protocol (treadmill test, the third component below). If you neglect to be cleared by your doctor you run the risk of possibly getting angina pains or getting a heart attack.

1. Carotid IMT or carotid intimal-medial thickness test: You measure the degree to which there is hardening of the coronary arteries indirectly by measuring the thickness of the lining of the carotid arteries (carotid IMT or carotid intimal-medial thickness test). Dr. Masley has showed over a period of 10 years and more in many patients at his Health Center that there is a close correlation between the degree of coronary artery hardening and the degree of hardening of the carotid arteries. He stated that his research has shown that “90% of the time, the carotid arteries, the coronary arteries, and even the arteries of your legs all grow plaque at the same time”. The gold standard for checking the condition of your coronary arteries is a heart catheterization as Dr. Masley explains (page 58). But he adds: “IMT testing should be the new gold standard for cardiovascular plaque testing. However, this is not yet the case. Despite its usefulness, 95% of doctors are not ordering this screening test for their patients. You can rest assured that this is a situation I am to change“.

Measuring Your Heart Function

Measuring Your Heart Function

2. A detailed lipid analysis called the VAP test: A detailed laboratory test analyzing your lipid fractions (LDL, HDL, total cholesterol and VAP test). The buoyant HDL fraction, called HDL2 is the key to having a low risk for hardening of the arteries. HDL2 is large, fluffy and is designed to remove garbage from within the lining of the arteries. Also, the cholesterol ratio is another measurement for a low risk for hardening of the arteries when it is less than 3.0. The first two tests assess how much hardening of the arteries there is present and when they are normal, there is a relative reassurance that nothing drastic (like a heart attack or stroke) should happen within the next 10 years provided you keep up a regular exercise program and healthy food intake.

3. Bruce protocol (Treadmill test): The Bruce protocol (treadmill test) is often done by a cardiologists, but can also be done through many gyms, where a trainer with experience in exercise physiology will do it. This functional test measuring cardiac output has been developed many decades back and has withstood the test of time. Here is an overview what this is. As the slope of a treadmill and the speed of the belt are increased, the heart needs to do more work to maintain blood flow to your extremities and vital organs. The trainer or exercise physiologist measures the response of the heart activity in relation to the increase of the exercise load. A complicated formula allows calculating how much your maximal cardiac output is. This test has several variations and can be complicated to understand. Essentially, the higher the numbers you can create, the better. Here is a table with various results of the VaO2max from Bruce protocols and how they are interpreted.

4. Treating abnormalities found with the three basic tests: These are the necessary tools that tell you where you are in regard to your heart function. People with heart failure should not do this third test, because their heart muscle is too weak to sustain this and they would get heart failure meaning that blood gets backed up into the lungs and there could be severe breathing problems leading to a lack of oxygen (anoxia) in the heart tissue, which in turn can cause irregular heart beats (fibrillation of the heart muscle) and a heart attack. Assume that the first two tests were within the normal limit for your age, then the Bruce protocol would give you the maximum heart output at the peak level of your treadmill test. At this point you are measuring directly the cardiac output (in other words what your heart is capable of pumping for you in a certain time unit). This measurement is what physicians call the VaO2 max  or maximal oxygen consumption. This is the best index for maximal heart capacity. If your levels are higher than normal, you have extra reserves with respect to your heart as a pump for times when you need it. If this latter tolerance test shows poor results, it usually means that you were inactive and you would benefit from an exercise program. If the first test shows hardening of the arteries more than is appropriate for your age, you would need to look at your eating habits. At the same time often the VAT values and the cholesterol ratio is off meaning that you are eating the wrong foods and it shows in your blood test results.

5. Advise regarding diet, exercise and relaxation: Dr. Masley’s book has several sections that explain what needs to be done when things are not normal. For instance, the author does not mince words when it comes to eating the right fats and cutting out sugar and starchy foods. For instance on page 199 there is a neat table that lists the fiber content of different foods. We need more fiber to slow down the absorption of sugary substances, which will minimize the insulin response following a meal. Dr. Masley also mentions that omega-3-fatty acids from fish and good seafood choices will balance the omega-6-fatty acids that would lead towards the arachidonic acid pathway, which causes arthritis, inflammation and cancer. There are many more dietary recommendations, too numerous to repeat them all here. Suffice it to say that molecularly distilled omega-3 fish oil, vitamin D 1,500 to 3000 Units daily, and magnesium supplements are all good for you heart. Vitamin K2 gets calcium out of your blood vessels and into the bone (100 micrograms per day). Other worthwhile supplements mentioned in the book are CoQ-10 (50 to 200 mg twice per day), but it would be wise to have blood levels drawn, which should be above 2.5mcg/ml to which the CoQ-10 intake could be titrated. Curcumin and Resveratrol are also recommended. Most of all, it seems that regular physical exercise such as a balanced gym program is the single most effective way to reverse hardening of the arteries as measured by the carotid IMT testing.

Conclusion: Times have changed. It used to be thought that our lives were following a one-way street downwards. During periods of malnutrition, lack of exercise, being sessile and abusing alcohol and drugs this may well be the case. However, we now know that this is reversible. Change to healthier food, start smoothies with organic vegetables in a mixer, get going and walk. Jog or use a gym to get regular exercise. Physical exercise reverses the fat deposits inside the lining of the arteries. The HDL-2 fraction rises and helps counteract the elevated LDL cholesterol. Even the mood of the person who exercises regularly becomes more stabilized. Using these simpler three tests the physicians will not need the more complicated Thallium heart scans, heart catheterization etc. These three tests described above are well worth being done every two years, so that you can monitor what’s going on with your heart and blood vessels in general. What questions do you have? You could ask them below.

More information on heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/

References: 1. Dr. Steven Masley, MD: “The 30-day Heart Tune-Up – A Breakthrough Medical Plan to Prevent and Reverse Heart Disease”, Center Street, A Division of Hachette Book Group Inc. New York, Boston, Nashville, USA © 2014.

Last edited Nov. 8, 2014

Feb
08
2014

Sugar As A Cause Of Cancer

By | Cancer, Diabetes, Health, Nutrition, Obesity, Prevention

It has been known for a long time that cancer cells can survive without the ordinary aerobic pathways of energy production. They can get energy from a metabolic pathway, which bypasses normal cell metabolism (aerobic glycolysis). But many attempts of designing a cancer therapy to exploit this difference have so far been unsuccessful.

This Mayo Clinic website even explains that it would be a myth that cancer would grow better with sugar. The following pieces of research question this myth.

Sugar makes cancer grow faster (activates oncogenes) in fruit flies

In this study from the Icahn School of Medicine at Mount Sinai in New York City fruit flies were used as an animal model. You may ask, why fruit flies; we are not fruit flies, we are humans! As incredible as it sounds, on a cellular level our cell metabolism and the cell metabolism of fruit flies is identical. But the generation time of fruit flies is much shorter and results can be seen in days and weeks. To achieve the same in human trials would take months and years. Also, researchers could breed a strain of fruit flies that was susceptible to develop tumors. When they were fed sugar, the fruit flies developed insulin resistance within a short time. This model was chosen by the researchers as it is known for some time that in humans insulin resistance from diabetes, obesity, and other metabolic diseases leads to a higher risk of developing breast cancer, liver cancer, colon cancer and pancreatic cancer. The researchers wanted to sort out what the metabolic advantage of the cancer cells was under these conditions.

The researchers found that the sugar in the diet activated silent cancer causing genes (called “oncogenes)” in the fruit flies that in turn helped to promote insulin resistance and the development of tumors. Because of the insulin resistance sugar could not enter into the normal body cells, but the tumor was using up all of the sugar allowing the tumor cells to multiply at a rapid rate. The end result was that the sugar from the diet fed the cancer cells directly making them grow faster. Interestingly, when these flies that had developed tumors on a high sugar diet were switched to a high protein/low sugar diet, the tumors stopped growing and were contained.

In this fruit fly example the researchers were subsequently able to block cancer cell growth by special cancer suppressing drugs (acarbose, pyrvinium and an experimental drug AD81), which were given in combination. 90% of the flies given the triple-drug treatment survived to adulthood while control flies not treated with this regimen all died of their tumors.

Although this model was only done in fruit flies and one could question whether or not this was relevant to what is happening in human cancer patients, the following piece of research puts this fear to rest.

Sugar As A Cause Of Cancer

Sugar As A Cause Of Cancer

Human breast cancer cell study in vitro

In January 2014 the American Society for Clinical Investigation published a collaborative study between the Lawrence Berkeley National Laboratory, Berkeley, California, CA and the Hokkaido University Graduate School of Medicine, Japan, which used human breast cells in tissue culture showing that sugar could cause breast cancer.

The original papers of this US/Japanese research team are quite technical and I do not expect you to understand this link where it is published. I posted it for those who want in depth information. The researchers used a simple tissue culture model where they could observe tumor growth in cell cultures under the microscope using a gel where the breast tissue samples were placed side by side with normal breast cells that served as controls. The cell cultures of both normal cells and malignant cells were obtained from the same reduction mammoplasty tissue samples. This way the cell cultures mimicked a situation as close to the reality of what is going on in a woman’s body when breast cancer develops.

The normal breast epithelial cells were seen in culture to get organized as a roundish cell formation (an acinus formation) while the cancer cells were growing as irregular cell clumps. This visual effect was reproducible and is depicted in the paper. With high sugar concentrations in the growth medium breast cancer cells multiplied at a faster rate, not so the normal cells. But some normal cells underwent a transformation into abnormal and cancerous cell types. On the other hand, when sugar concentrations were severely restricted, morphological changes took place where cancer cells slowed down their growth or stagnated while some of them even changed into the normal cell formation (acinus formation). Using various known oncogene stabilizers the investigators could show that the same effect was noted as with the low sugar concentration in the growth medium.

The investigators tested whether other cell lines of breast cancer would show similar results as to the effects of sugar feeding or restriction. They were able to show that high sugar feeding activated cancer cells, no matter where the cancer cell lines originated. The authors discussed that metformin, which is known to control the metabolism in diabetic patients and lowers blood sugar levels, has also been shown to calm down growth of cancer (due to stopping oncogene stimulation), which improves the survival rates of many different cancer types in diabetic patients; it also reduces the risk of developing cancer in those who are taking metformin.

Other investigators have shown in mouse experiments that an impressive lowering of cancer rates could be achieved with low carb diets.

Human evidence for cancer causation and cancer prevention

Several clinical studies seem to indicate that there is a higher cancer rate in diabetics where insulin resistance can lead to activation of cancer producing genes (called oncogenes) and cause various cancers. In this link colorectal cancer and pancreatic cancer are discussed in relationship to diabetes and insulin resistance. High glycemic foods (sugar, starchy foods) were associated with breast cancer, colorectal cancer and endometrial cancer. The majority of trials showed this association although not all. The more obese patients were, the more pronounced the insulin resistance was and the more the relationship to these cancers became apparent. A diet that is high in starchy foods like potatoes, rice and bread is causing pancreatic cancer as was shown by researchers at the Dana-Faber Cancer Institute, Brigham and Women’s Hospital and Harvard School of Public Health. High glycemic diets have shown to cause colorectal cancer, diabetes and being overweight. The Standard North American Diet (SAD) is a pathway to many chronic illnesses due its high load in refined carbohydrates. Ironically the abbreviation for it is “SAD”, which in my opinion reflects adequately its sad influence on health and well being. We know now that sugar and starchy foods lead to insulin overproduction, which in turn causes the metabolic syndrome (also known as “insulin resistance”). This causes the immune system to weaken and fat to be deposited as visceral fat in the stomach area. Visceral fat is metabolically very active as it secretes cytokines like tumor necrosis factor alpha (TNF alpha), COX-2 enzymes and others. Insulin and growth factors from the visceral fat gang up together with the elevated blood sugar, which activates tumor-producing genes (oncogenes) to cause cancer.

While cancer rates are higher in patients with insulin resistance, they were lower in patients who did have normal insulin levels. It is important to concentrate your efforts on normalizing weight, which will normalize insulin sensibility and avoid the development of cancer. Sugar avoidance and avoidance of cereals and starchy foods will help you achieve this goal.

Conclusion

Although the idea that sugar could cause cancer has been around since 1924 (Dr. Warburg), it has taken up to now to be proven in animals and humans.

The purpose of this blog was to show how there is a connection between the consumption of sugar and starchy foods and various cancers in man. Animal experiments are useful in suggesting these connections, but many clinical trials including the Women’s Health Initiative have shown that these findings are also true in humans. It is insulin resistance due to sugar and starch overconsumption that is causing cancer.

We are now in a position to know why people who consume a low carb diet, develop less cancer than people who consume a high carb diet. I have followed such a low carb diet (also known as low-glycemic index food diet) since 2001 and find it easy to follow. However, I do not dispute that it takes some discipline to change the old way of eating to the new one. The benefits are definitely worth it: you are feeling well now and you are staying well as you age.

More information about hyperinsulinism that can cause breast cancer: http://nethealthbook.com/cancer-overview/breast-cancer/causes-breast-cancer/

Last edited Nov. 7, 2014

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Jan
25
2014

Live Your Best Life

By | Anti-aging medicine, Cancer, Fitness, Health, heart attack, Heart Disease, Hormones, Insomnia, Nutrition, Obesity, Prevention, Stress management, Stroke, Vitamins and supplements, Weight loss

While attending the 21st Annual World Congress on Anti-Aging, Regenerative & Aesthetic Medicine the audience was treated to a magnificent speech by the keynote speaker, who you all know from the TV show  “The Doctors”, namely the ER-doctor, Dr. Travis Stork.

He said that there are 4 main ingredients that are necessary to live the “best of your life”.

1. Healthy living starts in the kitchen

You want to make sure that you leave out unhealthy foods. This includes that you also need to cut out sugar. Be aware how important protein is, so you need protein with each meal. This includes legumes, fish, chicken, turkey meat and others. Saturated fat is essential, can improve your health and makes you feel full, but stay away from unhealthy, sugary snacks.

Snacks do not harm your health, but they must be healthy ones like nuts three times per day. To include nuts three times per day lowers your risk of dying by 39% and your rate of heart attacks by 52%.

In order to prove a point about cutting out junk foods, the TV producer convinced Dr. Stork to go on a junk food diet for 7 days to see what would happen. He gained 8 pounds after 6 days, his mood was getting subdued and he started to look forward to his next meal as if he was addicted to the junk foods. But suddenly he could not take it anymore and was concerned about getting sick from this experiment (rightfully so). He told his producer that he had to stop this experiment. He explained that most of his fat accumulation was happening in the abdominal area (visceral fat) and he showed a video that illustrated this further. He explained that the visceral fat is metabolically very active, produces inflammatory agents and causes changes in the heart vessels that eventually lead to heart attacks and strokes.

Live Your Best Life

Live Your Best Life

2. “I need you to start working out!”

We were designed to get moving. Our ancestors were gatherers and hunters, so they were constantly on the move. Our genetics have not changed, but our lifestyle habits are far removed: the sessile habits are not suiting us well healthwise. Translated into modern life this means: sit less; do gardening; use pacing as a technique to move when you are on the phone. Take the stairs instead of the elevator; walk (a minimum of 30 minutes three times per week). Personally, I like to add that our body never takes a holiday, so I think we should exercise 7 days per week.

3. Mind and body are connected

Stress can ruin your health. Happy people are 50% less likely to die prematurely. Laughter heals. A funny video was shared with the audience where a parent ripped a piece of paper into smaller and smaller pieces and the toddler watched with glee and laughed every time when the paper was ripped into two smaller parts. A service dog can be a great companion for disabled individuals, but pets have a positive impact on the health of any individual. They can be of help to reduce stress.

It is known that mind and body are connected. As a result, if your mind and body are balanced, your hormones get balanced and this helps to keep your metabolism in check. If your metabolism is balanced, you will avoid getting diseases like heart attacks, strokes, arthritis, and even cancer.

4. Make sure you get enough sleep

40% of people do not get enough sleep. You can change your sleep behavior. How do you do it?

a)    Have a consistent bedtime/waking time. Set your alarm clock to the same time every morning. Aim for 7 to 8 hours of sleep per night.

b)    Avoid late night caffeine as it prevents a good night’s sleep.

c)    Get active throughout the day; this will prepare you to get tired in the evening.

d)    Towards the end of the day have a to-do-list ready for the next day. This prevents tossing and turning and thinking about what you want to do the following day. You know that it is all written down on the list, so you can relax and get to sleep.

e)    No bright lights in the bedroom, no bright alarm clocks, no control lights of electronic gadgets and have light-blocking window coverings in place. Do not have a TV in the bedroom, also no cell phone, and stay away from the computer for 1 hour before your bedtime.

After you re-programmed your body and mind to a regular sleep rhythm, you automatically get tired when you should and your hormones and body chemistry find a new balance, which contributes to good health.

Dr. Stork stated that we all need to prevent disease. We do this by making health our hobby. There is no need to be obsessed about it. “Just live your best life!”

Conclusion

I summarized Dr. Stork’s presentation from the anti-aging conference, as it struck me how simple it really is to live a healthier life. If we all follow these simple steps, we are a long way into anti-aging, because it gives us the footing we need to further refine it from there.

In many previous blogs I have mentioned these 4 factors that are needed to slow down aging. However, there are other factors that may be needed like bioidentical hormone replacement when there are hormone deficiencies; detoxification, if there is evidence of toxicity; and vitamins and other supplements. Anti-inflammatory and antioxidant vitamins and supplements like CoQ10, vitamin D3 and omega3-fatty acid/DHA supplements are needed to keep LDL from getting oxidized as this is the reason why people die of heart attacks and strokes and get cancer.

I have recently written a book entitled “A Survivor’s Guide To Successful Aging” (being published at Amazon.com in March 2014), which explains the science behind why it is important to cut out sugar and starch. Sugar and starchy foods are the foods that oxidize LDL cholesterol, and ultimately it is the oxidized LDL cholesterol that causes deaths from heart attacks and strokes. In this text I have explained how proper nutrition, exercise, hormone rebalancing, supplements and lifestyle changes will allow you to prevent the major illnesses from setting in thus extending your life expectancy considerably. Included in the book is a chapter (written by my wife, Christina Schilling) that contains 7 days of recipes for breakfasts, lunches, dinners and desserts as well as snacks.

Last edited Oct. 25, 2014

Dec
07
2013

Slow Down Aging And Prevent Disabilities

By | Alzheimer’s disease, Anti-aging medicine, Arthritis, Cancer, Diabetes, Fitness, Health, Heart Disease, Hormones, Nutrition, Obesity, Other neurological conditions, Prevention, Stress management, Weight loss

You have seen it many times before: a man or a woman retires at age 65; for a while you see them around at social functions; then they are not seen any more and they return in a wheel chair only to die prematurely. You ask yourself: what can I do better to avoid this death trap?

There are several aspects to this equation: first, we would like to slow down the aging process. Part of this is to retain our physical functioning. In the following I am discussing the ingredients that are necessary to achieve the goal of aging in dignity, but avoiding disability.

It starts with a healthy mind set

You need to be optimistic and have a mindset of believing in yourself that you can do it. With a negative attitude, you will manage to find something to complain about, no matter how perfect the day has been. Negative thinking is rampant, and depression tends to be higher in the older population. If you suffer from depression or you had negative events such as accidents or abuse in the past, it is important to do some house cleaning. Do not be hesitant seeking professional help and counseling from a health professional to help you build up your self-esteem.

Regular exercise is important

A regular exercise program helps you to get your day organized. If you think that you are too busy to find the time to exercise, you are sacrificing your wellness and in fact you sabotage your health. It’s time to rethink your lifestyle! The reason you need exercise is to set the automatic pilot on staying healthy and active. If you are accustomed to sitting down in front of the computer or television set for hours, your muscles do not get the exercise they need. Fast-forward several decades and you will be one of those who rely on walkers, wheel chairs and assisted living establishments. Without training your muscles you are more prone to falls and injuries. Your balance organ is not getting the impulses it needs on an ongoing basis to prevent you from falls later in life. People in their 80’s are often stable up to the point where they trip and fall. I have seen many patients like this arrive in an ambulance where I was doing my shift as the emergency physician in a community hospital. When I summarize the fate of all of the people in their 80’s who had falls and broke their hips over the years, 50% of them made it through the surgery and went back home (often with a walker or in a wheel chair) or ended up in a nursing home; the other 50% died from complications of the surgery, often from heart attacks during the surgery or from clots in their pelvic veins or in the leg veins that dislodged and turned into pulmonary emboli. A fracture and in particular a hip fracture in your 80’s is a serious, potentially deadly accident. So, you need strong muscles and joints and you need strong bones. All of this comes free to you from years of regular exercise in your 60’s and 70’s.

Slow Down Aging And Prevent Disabilities

Slow Down Aging And Prevent Disabilities

You guessed right: good nutrition is important!

Eat right and your body will function right. This is where a lot of people are sent on the wrong path due to clever advertising from the Agro Industry, Big Pharma, the American Dietetic Association and the United States Department Of Agriculture. So they preach that wheat and wheat products are good for you, but the lab tests show that it induces hyperinsulinemia and leads to diabetes. The genetic changes of wheat (“accomplished” through forced chemical hybridization in the 1970’s) are responsible for the metabolically very active wheat belly (accumulation of visceral fat) that Ref. 1 has described in detail. But others have researched this topic as well. Ref. 2 for instance confirms that gliadin, the glue in wheat, which allows dough to stick and makes it easy to create bread, bagels and pasta, is responsible for neurological issues like numbness of fingers and feet (peripheral neuropathy), balance problems and cognitive decline all the way to Alzheimer’s disease. If you continue to eat wheat and wheat products (all contained in conveniently packaged “processed” foods), you may very well find that your balance and muscle control will deteriorate by the time you are in your eighties. This condition is not new: one of the lecturers I listened to at McMaster University in Hamilton, Ontario in 1977 referred to those unfortunate individuals who were severely disabled as the “tea and toasters”. The tea in this case was probably the lesser evil, but the wheat induced malabsorption and malnutrition was a reality already in the mid and late 1970’s.

However, if you start eating organic foods to avoid the chemicals and estrogen-like xenoestrogens from pesticides, and you cut out sugar, high-density carbs and wheat products, you will no longer have problems with weight control and you will maintain your muscle, brain and nerve function. This is not what you learn from the regular agencies mentioned at the beginning of this paragraph, but Ref. 1 and 2 will fill you in on the details. Essentially, I follow a Mediterranean diet without sugar, starchy foods and wheat or wheat products. Ref. 2 stressed the importance of enough saturated and healthy fat (omega-3 fatty acid rich oils) in a balanced diet consisting of 20% protein and low carbs. No specific numbers were given regarding the %-age of fat. I would say that a limit of about 25 to 35% for fat would be reasonable except for the Inuit who are used to a fat content in their diet of 80%. The new thinking is that healthy fats are good for your brain and heart. Healthy fats are omega-3 fatty acids (EPA and DHA) derived from fish oil as they are very protective (anti-inflammatory) oils, so is olive oil and coconut oil. These latter two are anti-inflammatory monounsaturated fatty acids. Keep in mind that you want to change the ratio of omega-3 to omega-6 fatty acids (the ratio in this link is cited as omega-6 to omega-3) more in the direction of omega-3 fatty acids, so that the ratio will be between 1:1 and 1:3. Most Americans are exposed to ratios of 1:8 to 1:16 (too many omega-6 fatty acids in fast food and processed foods), which leads to inflammation of the arteries as well. Omega-6 fatty acids, found in safflower oil, sun flower oil, grape seed oil and canola oil are bad for you when not balanced by enough omega-3’s (flax seed oil and fish oil) as they lead to inflammation through the arachidonic acid system in the body. It may be a surprise to you that saturated fats are OK: animal fat like butter, lard, cream, ghee (clarified butter), and other animal fats provided they come from clean (not antibiotic or bovine growth hormone treated) animals. Buy organic and buy organic meats as well such as grass fed beef and bison, chicken and turkey.

Here is an example of what a day would look like nutritionally in terms of a breakfast, lunch and dinner (recipes by Christina Schilling):

Breakfast:  Great Greens Omelet

(2 servings)

1 tablespoon olive oil or coconut oil

3 chopped green onions

3 cups spinach leaves or a mix of greens: kale, spinach, Swiss chard

1 red pepper cut into strips

3 eggs and 3 egg whites

2 tablespoons grated Parmigiano

In non-stick pan sauté green onion, greens and pepper strips in oil, stir eggs and egg whites and pour over the vegetables, sprinkle with Parmigiano. Cook on medium heat, till the egg mixture has started to set. Turn over and briefly let cook. Remove from pan, divide into two portions and sprinkle with a bit of salt (optional). Serve with salsa and guacamole.

Lunch: Oriental Salad

(2 portions)

1 small Sui choy cabbage (Napa cabbage)

2 cups mung bean sprouts

1 small daikon radish, shredded to yield 1 cup

1 red pepper, cut into thin slices

3 green onions, chopped

1 medium sized carrot, cut into matchstick size pieces

1 can sliced water chestnuts, rinsed.

Dressing: 2 tablespoons sesame oil,

2 tablespoons rice vinegar,(light balsamic vinegar works too)

1-tablespoon tamari soy sauce

1 tablespoon Thai sweet chilli sauce

1-teaspoon fresh grated ginger

3 tablespoons chopped fresh cilantro

Prepare all vegetables and put into salad bowl. Stir all dressing ingredients together and pour over vegetable mix. Stir gently, cover and refrigerate. This salad can be consumed immediately or kept refrigerted for a day. To complete the salad with a protein portion add your choice of 6 oz. cooked shrimp or the same quantity of cubed or sliced grilled chicken.

Dinner:  Florentine Chicken

(2 servings)

1 large boneless chicken breast

1 tablespoon of chopped fresh basil-alternatively use 1 teaspoon dried basil.

1 tablespoon grated Parmigiano

4 thin slices prosciutto

1 tablespoon olive oil

2 tomatoes- cut into halves

3 chopped green onions

2 cups baby spinach leaves

pinch of salt

Spread chicken breast flat and top it with the basil, Parmigiano and prosciutto slices. Fold into half an hold the stuffed chicken breast together at the edges with a toothpick or two. Heat olive oil in frying pan, add onion and tomato slices and put the chicken breast on top. Put lid on the pan, and cook at medium heat till the chicken is cooked through. If you test with a fork, the juices will be clear. Remove vegetables and chicken from pan, put on serving plate and keep warm. Remove toothpicks from meat, and cut chicken breast into two portions. Put spinach into pan and let the leaves wilt at medium heat (cover with lid). Put spinach on the side of the chicken and tomatoes, and sprinkle with a bit of salt.

Dessert after dinner: Berry Sorbet

(2 servings)

2 cups of deep frozen berries (strawberries, blueberries or a berry mix, no sugar added)

¾ cup of organic yogourt or goat’s milk yogurt

a few drops of liquid stevia or small amount of powdered stevia-to taste.

Put into blender and process till smooth. You will have to open the blender jar to stir the contents in between. Serve with a dollop of whipped cream,  if desired.

What about the “slow down” of menopause and andropause?

It is a fact that as we age, our hormone glands do not produce as much hormones as when we were in our 20’s and 30’s. But if you find a health care provider who is interested in anti-aging medicine (there are about 26,000 physicians, chiropractors and naturopaths who are members in the A4M), your hormones can be measured accurately from saliva and blood tests. This will tell whether you are hypothyroid, deficient in sex hormones and whether you should be supplemented with the missing hormones in adequate doses through bio-identical hormones. For instance, women are often deficient in progesterone in menopause and men deficient in testosterone. Treatment needs persistence and patience, as it often takes months for the patient to feel better and up to 2 years, to find the exact balance for you where the hormones are re-balanced and your symptoms of tiredness, insomnia, hot flushes etc. disappear. All our body cells have hormone receptors that require stimulation for the cells to function normally. Your health professional needs to pay attention to this and not just treat your symptoms symptomatically. When your hormones are in balance and you take a few supplements, your bones will be strong (no osteoporosis), your brain will be clear, your hearing perfect, and your balance great. You will be much less likely in your eighties to fall and break a bone and your mind will be clear and sharp.

Stress management

As the baby boomers age, they need to be aware of the stress in their lives. You may have been accustomed to having lots of energy when you were in your child rearing years or in your active professional career. Often we do not even notice that there may be stress in our lives. But your adrenal glands know. This is really a subpart of what I said of hormones: they need to be in balance. But cortisol, which is produced in your adrenal glands, is different from the menopause/andropause hormones. Corticotrophin-releasing hormone (CRH) from the hypothalamus and adrenocorticotrophin hormone (ACTH) from the pituitary gland are the rulers of the adrenal glands. And it is how you handle stress when you are in your 40’s, 50’s and 60’s which will determine whether you come down with adrenal fatigue, various degrees of adrenal insufficiency or not. Ref. 3 is a whole book that deals with this topic. Here I like to mention only that the best test to diagnose adrenal problems is a four-point saliva hormone test for cortisol. You connect the four points and get a curve where the cortisol level is expressed as a function of time. If this curve is below the lower normal range, which the laboratory provides for you, you need to be managed by a knowledgeable health care professional in order to build up the reserves of your adrenal glands. Yoga, meditation, deep prayer, self-hypnosis and enough regular sleep are all proven methods to overcome any stress related issues. Sometimes more effort is needed to rebuild the adrenals by specific herbs or porcine adrenal gland cortex extracts. Your health care provider can tell you more regarding this.

Useful supplements

1. On March 17, 2013 I wrote in a blog about prevention of osteoporosis the following summary:

“The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 micrograms of vitamin K2 (also called MK-7). In the age group above 50 missing hormones such as bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women should be given as well. This works best, if you also watch your weight, cut down your alcohol consumption to a minimum (or better cut alcohol out altogether), exercise regularly (this builds up bone and muscle strength) and stick to a balanced diet resembling a Mediterranean or zone type diet (low-glycemic,  low fat, wheat free and no sugar).” I would add in view of Ref. 1 and 2 that “low fat” should now be replaced by “balanced fat diet”. With this I mean that nuts, almonds, olive oil, unsalted butter are allowed within reason. Lately there have been new insights that some cholesterol is needed for normal hormone production. What needs to be cut out are omega-6 fats and trans fats.

2. Omega-3-fatty acid supplements from molecularly distilled fish oil at a good dosage (3 to 6 capsules a day) will prevent chronic inflammation that often causes arthritis. Chicken cartilage (UC-II) from the health food store will desensitize your system in case you have rheumatoid arthritis or osteoarthritis. This will prevent crippling arthritic disease down the road.

3. Mitochondrial aging (the mitochondria are the energy packages in each body cell) is slowed down by the two supplements ubiquinol (=Co-Q-10, take 400 mg per day) and 20 mg of PQQ (=Pyrroloquinoline quinone). Co-Q-10 repairs DNA damage to your mitochondria and PQQ stimulates your healthy mitochondria to multiply. Between the two supplements you will have more energy.

4. Vitamin C 1000 to 2000 mg per day and a multivitamin supplement help to support the rest of your metabolism. Some may want to add PS (Phosphatylserine) 100 to 200 mg per day, which works together with vitamin D3 for Alzheimer’s prevention.

Conclusion

By now you noticed that nothing comes from ignoring the fact that we are aging. We need to pay attention to our body functions and think about what we can do to make us stronger. In the end we are our own caregivers. When we are in our eighties, we should still be active and our brains should function with a lot more experience than in our past. Our bones will be strong and our balance should prevent us from falling. I do not want to use assisted living and I do not like the confinement of a wheel chair. In the meantime I am going to carry on dancing.

More information on:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

3. Vitamins, minerals and supplements: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

References

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

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

3. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 7, 2014

Nov
09
2013

Successful Diabetes Treatment Requires Patient’s Discipline

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

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

Causes that trigger diabetes

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

What is the reason why diabetes occurs?

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

Successful Diabetes Treatment Requires Patient’s Discipline

Successful Diabetes Treatment Requires Patient’s Discipline

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

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

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

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

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

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

Consequences of insulin resistance

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

Important tests for borderline diabetics

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

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

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

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

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

Conventional treatment of diabetes

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

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

Alternative treatment approach for diabetes

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

Here are some suggestions:

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

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

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

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

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

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

Conclusion

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

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

Reference

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

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

3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Integrative Therapy; Supplements.

Last edited Dec. 17, 2014

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