Feb
06
2016

Effects Of Hormones On The Heart

By | Alzheimer’s disease, Anti-aging medicine, Cardiovascular disease, heart attack, Heart Disease, High Blood Pressure, Hormones, Mortality, Nutrition, Prevention

Since February is heart month, this is a good time to discuss the effects of hormones on the heart. I believe that this is a timely topic to understand how we can protect ourselves from heart disease. During the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 11-13, 2015 in Las Vegas Dr. Ron Rothenberg gave a talk entitled ”Hormones And The Heart”. He stated that he wanted to give an overview of the effects on the endocrine system and on the cardiovascular system, in particular the effect of testosterone and estrogen. Also discussed were the effects of thyroid hormones, growth hormone, vitamin D and melatonin. In the following I will summarize what he explained in detail.

Testosterone treatment in men

He stated that there has been some confusion about the protective effect of testosterone on the heart in men. But Dr. Sharma and colleagues who investigated 83,010 male veterans with documented low testosterone levels clarified this confusion with this large study.

One group received testosterone replacement therapy, another did not receive replacement therapy and one group received replacement with testosterone, but the testosterone levels did not normalize.

Mortality reduction with testosterone replacement

The observation time for the various groups was between 4.6 years and 6.2 years. The results were impressive. A comparison between the results of men on testosterone replacement and the results of men without testosterone replacement, showed that there was a 56% reduction in overall mortality. Furthermore, there was a reduction of heart attacks by 24% and a reduction of strokes by 36%. There was no difference between the control group without testosterone replacement and the partial testosterone replacement group where the testosterone levels did not come up. It is clear from this that with proper testosterone replacement where the physician monitors testosterone levels and corrects the levels, significant reductions in strokes and heart attacks can be achieved. The explanation for these findings is simple: both, brain cells and heart cells in males, have testosterone hormone receptors that need to be stimulated for full function.

Hormone replacement in women

This topic was confusing for many years because of the insistence of the medical profession to use horse estrogen extracts from pregnant mares (Premarin) and synthetic Provera (instead of bioidentical progesterone). These artificial hormone-like substances were used in the much-discussed Women’s Health Initiative (WHI).

Dr. Rothenberg said about this study that investigators used the wrong estrogen, the wrong progesterone, the wrong route of administration of estrogen (oral estrogen causes inflammation), and the wrong women at age 63 who already had cardiovascular disease and breast cancer.

Revisiting the Women’s Health Initiative

One important aspect that was learnt by re-interpreting the WHI was that when estrogen replacement was initiated right away when menopause started, the heart attack risk went down by 34%. Estrogen and Provera together reduced the risk only by 28% (Provera being the wrong hormone). Again, the explanation for this findings is simple: women have both estrogen and progesterone receptors in heart and brain cells, which want to be stimulated with the natural hormones. When estrogen is missing, women need bioidentical replacement of what is missing with estradiol transdermal creams. When a woman is progesterone-deficient, she needs replacement with bioidentical progesterone transdermal cream or with micronized progesterone orally.

Estrogen

KEEPS study

With regard to estrogen replacement the KEEPS study has shed a new light on what is going on with hormone replacement in women.

700 women in early menopause participated in this study. Treatment consisted of 0.45 mg of Premarin (still the wrong hormone) or 50 micrograms of transdermal estradiol (the right active human estrogen). Women also received 200 mg of micronized progesterone (Prometrium, the real human progesterone) for 12 days each month. After 4 years of observation there was no case of breast cancer, uterine cancer, heart attack, transient ischemic attack, stroke, or blood clots in veins between the three groups. Both Premarin and transdermal estrogen had slightly reduced coronary artery calcifications on CT scans compared to the placebo group without hormones. The Premarin group increased the triglyceride and the CRP (a measure of inflammation) levels while the transdermal human estrogen did not do that.

It is a disadvantage to the woman, if she does not receive bioidentical hormone replacement after menopause 

Another study showed that due to the WHI study with the wrong synthetic hormones many women were fearful of starting estrogen replacement. The lack of hormone replacement with nature-identical hormones is responsible for the death of many women, who did not have the beneficial effects. They died of cancer and heart disease.

Dr. Rothenberg explained that this study and others have shown the following
  1. Bioidentical hormone replacement must be started immediately at or before menopause to have the best results in terms of cardiovascular and neuroprotective (Alzheimer’s) prevention.
  2. Oral estrogen induces inflammation, which causes heart attacks, strokes and venous thromboembolism (blood clots). To prevent this, estradiol must be given as a transdermal cream. This will avoid the first pass effect through the liver, which is the cause for inflammation. Transdermal estradiol does not have the first pass effect. Inflammatory cytokines are implicated in autoimmune processes, initiation of cardiovascular disease, osteoporosis and Alzheimer’s disease.
  3. If estrogen replacement is not done right away with the start of menopause, the estrogen receptor may get damaged, which means that when estrogen replacement is started at a later date, it is no longer effective.

Progesterone

Progesterone is the other female hormone that physicians often overlook. It balances the effects of estrogens, but the body can also metabolize it into estrogen or testosterone. Tiny amounts of testosterone are necessary for normal libido. In premenopause the ovaries already reduced progesterone production. She should receive progesterone replacement by transdermal bioidentical progesterone cream in premenopause.

Estrogen dominance needs to be treated with transdermal progesterone (or micronized oral progesterone). Both estrogen and progesterone can be accurately determined using a saliva hormone test. Blood tests are accurate for estrogen levels, but not for progesterone levels.

Thyroid replacement

Not infrequently thyroid tests are low (hypothyroidism) and cholesterol levels rise. This can lead to heart attacks and strokes. For instance, a slightly elevated TSH of 5.5 is associated with a total cholesterol level of 209 mg/dL, and a TSH level of 7.0 is associated with a cholesterol level of 270 mg/dL (normal less than 180 mg/dL). It is very important to detect hypothyroidism early and to treat it effectively to prevent cardiovascular disease. The active thyroid hormone is T3. Thyroid replacement has a stabilizing effect on the heart rhythm. It works together with testosterone in men and estrogen in women to stabilize metabolism of all cells, but in particular the heart muscle cells and brain cells. Hypothyroid patients are often depressed, but thyroid replacement lifts the depression. Cognitive deficits in patients with hypothyroidism are also remedied with thyroid treatment.

Growth hormone replacement

Growth hormone (GH) is important in childhood for bone growth and growth of all the organs. But GH still has an important function later in life. GH improves cardiac performance; it does so by thickening the wall of the left heart chamber, the main pump of the heart muscle. GH improves the contractility of the heart muscle, reduces the stress on the heart muscle wall and decreases vascular resistance. In animal experiments GH plays an important role in remodeling the heart after a heart attack.

GH deficiency occurs with aging; it leads to high LDL (bad) cholesterol and high triglycerides in the blood and increased fibrinogen, which causes blood clots. All of this increases the risk for heart attacks and strokes.

Age-related GH production declining

When people age, they lose GH production, which puts them at a considerable risk to get heart attacks and strokes, but they are also at a higher risk of serious falls due to muscle weakness and balance problems. When the doctor detects low IGF-1 levels in the blood and confirms low GH metabolites in a 24-hour urine sample, the time has come to do daily GH injections with human GH. You achieve this using a similar pen that is in use for insulin injections. The dosage is only between 0.1 mg and 0.3 mg per day before bedtime. This is remarkably effective not only for heart attack and stroke prevention, but also to treat muscle weakness, lack of mental clarity and general well being. Patients report that their joint and muscle aches disappear and they can engage in physical activities again.

Melatonin replacement

Most people think of melatonin as the “sleeping hormone”. The pineal gland releases melatonin. It rules overnight giving you a refreshing sleep. In the morning and during the day the light that enters your eyes inactivates it.

Melatonin is a powerful antioxidant, stabilizes the heart’s rhythm (anti-arrhythmic activity), is anti-inflammatory, anti-hypertensive and protects against heart attacks and strokes. People who have heart disease often have very low blood melatonin levels. Physicians can use melatonin intravenously in patients who have heart attacks. This will reduce the amount of damage to the tissue and stabilize the heart rhythm.

Age-related decline of melatonin production

Like with GH, the production of melatonin deteriorates significantly beyond the age of 40. Blood levels of melatonin can be easily ordered, and replacement is easy to do. 3 mg of melatonin taken at bedtime will be a sufficient dose for most people. You can take another 3 mg, if you wake up in the middle of the night. It will wear off within 3 to 4 hours.

Vitamin D replacement

The history of vitamin D3 is interesting. Vitamin D3, the active form of vitamin D has many actions: it stimulates the immune system and reduces the risk of infection, it reduces blood pressure, it reduces inflammation by reducing circulating cytokines, and it increases insulin sensitivity making insulin receptors more responsive.

Vitamin D3 binds to the vitamin D receptor, which is contained on all cells.

Many middle-aged and older people are deficient for vitamin D.  A lack of it leads to higher mortality. Vitamin D helps to restore circulation in patients with ischemic heart disease. Vitamin D insufficiency causes high blood pressure, diabetes and metabolic syndrome. In addition, vitamin D deficiency also causes enlargement and thickening of the wall of your heart’s main pumping chamber, heart failure and chronic vascular inflammation.

More on the effect of vitamin D3 preventing mortality

A prospective 7.3-year study looked at the hazard ratios of the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality files with lower 25-hydroxyvitamin D levels. There were 33,994 persons part of the survey, of whom 1,493 died.

Below 10 ng/ml of 25-hydroxyvitamin D level the mortality was 2.5 fold for all causes and 3.08-fold for cardiovascular causes compared to those with levels of 100 ng/ml or higher.

The recommendation presently is to maintain serum levels at 60-80 ng/ml of 25-hydroxyvitamin D to prevent cardiovascular disease.

Effects Of Hormones On The Heart

Effects Of Hormones On The Heart

Conclusion

The following is important to remember regarding prevention of heart disease.

  1. Never smoke or if you do, quit smoking.
  2. Have your thyroid hormones checked. Thyroid hormones are important as an energy source for your heart muscle, and they lower LDL cholesterol levels.
  3. Your sex hormones matter: in men it is testosterone, in women estrogen and progesterone that support your heart.

Other effects on the heart

  1. Vitamin D is not only important when we grow bones as youngsters, but it continues to be important when we are older. It supports our heart and other body functions. It is an essential team player, as it prevents premature deaths. Blood levels of vitamin D are easy to measure.
  2. Two hormones leave us rapidly as we age: melatonin and human growth hormone. However, the physician can measure the levels of both hormones and if low he can replace what is missing.
  3. There are only two more things you need to do: eat a Mediterranean type diet and exercise on a regular basis. This will ensure your heart is still healthy in years to come.

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Jan
16
2015

Telomere Length A Telltale Sign Of Aging

By | Alzheimer’s disease, Anti-aging medicine, Arthritis, Autism, Cancer, Diabetes, Fitness, heart attack, Nutrition, Osteoporosis, telomeres, Vitamins and supplements

Dr. Sandy Chang gave a talk at the 22nd Annual World Congress on Anti-Aging Medicine in Las Vegas Dec. 10-14, 2014 entitled “Telomere measurement as a diagnostic Test in cardiovascular and Age-related disease”, but a shorter title would be “telomere length a telltale sign of aging” (my choosing).

Dr. Chang pointed out that it is now well established that telomere length is directly related to health. The shorter the telomeres are the higher the probability to get the following: early menopause, infertility, diabetes, wrinkles, arthritis, osteoporosis, cardiovascular disease, Alzheimer’s, Parkinson’s, dementia, cancer, stress and a lack of stem cells. In this BMJ study from 2014 it was shown on a large population basis that shorter white blood cell telomeres lead to a higher risk of coronary heart disease causing heart attacks. Decreased telomere length is also associated with the development of breast cancer, cancer of the ovary and uterus, cancer of the prostate and skin cancer.

Because of these connections it makes sense to determine a person’s telomere length. If it is short, do check-ups more often to detect any cancer early when it can still be treated.

Telomere length measurements are now done in many infertility clinics as short telomeres both in the male and female is associated with infertility.

The newest finding and perhaps the most important is that a healthy lifestyle, vitamins and supplements can elongate telomeres while a poor lifestyle leads to shortening of telomeres.

Here are the factors that lead to shortening of telomeres:

– Chronic stress

– Poor diet and nutritional habits

– Chronic inflammatory diseases

– Metabolic disorders

– Lack of consistent exercise/sedentary lifestyle

– Obesity, high BMI and body fat

– Smoking

– Over consumption of alcohol

– Lack of sleep / insomnia

When short telomeres are detected, it is important for the physician to look at lifestyle changes to protect telomeres from decreasing their length even further. This has the potential of preventing dementia and Alzheimer’s when it comes to brain health. It can prevent osteoporosis and metabolic diseases (diabetes, metabolic syndrome). Telomerase is the buzzword today, which is an enzyme that all of our cells have. The purpose why we have telomerase in our cells seems to be helping us build up and repair telomeres. Any substance that preserves telomerase or prevents the breakdown of telomerase will prevent shortening of telomeres and will also prevent the above-mentioned diseases.

These supplements lead to lengthening of telomeres:

-Vitamin C and E

-Omega-3 and polyphenols

-Vitamin A and D3

-All of these help controlling oxidative stress, reduce DNA damage, reduce inflammation and build up telomere length.

-A good diet and nutrition (Mediterranean type diet) will prevent telomere shortening as well and also lead to telomere lengthening.

-T-65, an extract from astragalus has been shown in vitro to lengthen telomeres, but there is no publication yet about in vivo effects in humans.

-Resveratrol is useful to prevent shortening of telomeres as well.

-Exercise also is a simple means to prevent telomere shortening.

Telomere Length A Telltale Sign Of Aging

Telomere Length A Telltale Sign Of Aging

Another talk on telomeres was given by Dr. Harvey Bartnof with the title “Telomere Shortening and Modulation: Case Studies From The Clinic”.

This talk was a comprehensive review of what is known about telomeres, about the fact that many diseases are due to telomere shortening, about animal experiments, ways of how to lengthen telomeres and finally some data on human studies with regard to telomere lengthening.

In the following I will briefly review all of these areas that were discussed. Some of this material overlaps with Dr. Chang’s lecture.

What produces telomere shortening? Dr. Bartnof showed 4 slides that listed all of the conditions and diseases that are associated with telomere shortening. Telomere shortening is associated with twice the risk to die from a heart attack when compared to people with normal telomeres.

a) Known genetic conditions in humans associated with telomere shortening

There are three known genetic conditions due to telomere shortening: A premature aging syndrome, called dyskeratosis congenitalis; patients with this condition die prematurely from cancer, or from bone marrow failure.

People with Werner syndrome who have a genetic telomere loss have a mean life expectancy of only 54 years.

Idiopathic pulmonary fibrosis is another genetic condition with shortened telomeres due to mutations.

b) Telomere shortening associated with these health conditions

Professor Elizabeth Blackburn, PhD who is one of the three researchers who won the Nobel Prize in Physiology and Medicine for their work on telomeres in 2009 stated the following: “Telomere shortness is associated with just about all the major diseases of aging… from cardiovascular disease, death from cardiovascular disease, risks of cardiovascular disease, diabetes, diabetes risks such as insulin resistance, vascular dementia, to osteoarthritis.”

An enormous amount of clinical investigations have been done since in cohort groups like people with diabetes, high blood pressure, obesity and cancer.

There is natural shortening of telomeres due to the aging process. When we compare telomere length of body cells of a 20-year old and call this 100%, the telomeres of a 100-year old person are on average only 40%. A study from the Karolinska Institute found in a group of matching twins where one twin had shortened telomeres, this twin had a 2.8 times greater risk of death than the twin with normal telomere length.

However, as already mentioned a number of other factors can lead to shorter telomeres like chronic stress in workers who look after Alzheimer patients, being of the Caucasian race (compared to African-American), having had less education, chronic unemployment, depression, pessimism, single people versus married people, phobic anxiety in women and hostility in men, poor sleep and too little sleep, migraine headaches in women, low physical activity, smoking cigarettes and alcohol consumption. The list does not stop here. Other conditions are associated with telomere shortening like heroin abuse, exposure to smog, polycyclic aromatic hydrocarbons and lead, cardiovascular disease, diabetes, cancers, osteoporosis, osteoarthritis, rheumatoid arthritis, cirrhosis of the liver, inflammatory bowel disease, chronic obstructive lung disease, Alzheimer’s disease, Parkinson’s disease, chronic kidney disease and disability in the elderly.

c) Effects of medications on telomere length

Antidepressants used against depression have a telomere lengthening effect, but NSAID’s, aspirin and interferon-alpha shorten telomeres. Other telomere shortening effects come from cancer chemotherapy.

d) Telomerase activation elongates telomeres

Successful experiments in various mouse strains showed that special strains that were telomerase deficient, could be reconstituted to normal by reinserting telomerase: atrophied organs regrew back to normal size and function. In humans it was shown that increased physical activity elongated telomeres, so did vitamin C, E and vitamin D3 supplementation, resveratrol, a Mediterranean diet, marine omega-3 fatty acid supplementation, higher fiber intake, bioidentical estrogen in women and testosterone in men, relaxation techniques like yoga and meditation. The Astragalus-derived telomerase activator TA-65 has been shown in animal experiments to elongate telomeres. The human data about TA-65 is still spotty or not available (it is also very expensive and may be unnecessary given the fact that so many other agents are known to lengthen telomeres).

e) Human data on telomere lengthening

Much can be achieved by changing one’s lifestyle: cut out toxins like cigarette smoking and alcohol abuse. Get involved in a regular exercise program, which has been shown to increase HDL cholesterol and to elongate telomeres. Adopt a Mediterranean type diet including olive oil; take vitamin E, D, C and supplements with resveratrol and murine omega-3 fatty acids, all of which elongate telomeres. Get enough sleep (7 to 8 hours per night) and do yoga and meditation. Avoid distress and tone down your stress level to eustress (normal stress level associated with every day living). An older person should use bioidentical hormones to replace missing hormones. All of this taken together will create a milieu in your body where telomeres get elongated and you live longer without disease. Several clinical conditions were mentioned where baseline telomere length was assessed initially and was found to be too short; simple lifestyle changes were then initiated, which were able to improve telomere length and treat these diseases successfully. In addition TA-65 (also termed T-65) was given in some of these cases, but in a subsequent discussion Dr. Bartnof admitted that he could not comment on how effective TA-65 by itself was as it was only one component of many other effective telomerase stimulators given. Till further research is out on this substance, it may be just very costly without spectacular benefits on its own.

Conclusion

I gave a summary of the talks by Dr. Chang and Dr. Bartnof regarding telomeres, but these were not the only talks about telomeres, although quite representative for the others. Both speakers pointed out how powerful lifestyle is for our body functions as this is what lengthens our telomeres and allows us to live longer, disease-free lives. Stem cells also have telomeres, but they are on average longer than the rest of the body cells (called somatic dells). An improved lifestyle will keep our stem cells in good shape, so they are there when needed to replace aging somatic cells.

The new logic of a healthy lifestyle is:

A healthy lifestyle causes healthy telomeres of somatic cells and of stem cells; this causes health until a ripe old age. In the next few weeks I will blog about more topics from the 22nd Anti-Aging Conference in Las Vegas. Stay tuned.

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

Mar
17
2013

Calcium, Vitamin D3 and Vitamin K2 Are Needed For Bone Health

By | Fitness, fractures, Hormones, Osteoporosis, Prevention, Vitamins and supplements

Introduction

I am reviewing in this blog why calcium, vitamin D3 and vitamin K2 are needed for bone health. Recently there has been a lot of coverage in the press regarding postmenopausal treatment of women to prevent osteoporosis. It is all based on this original publication February 26, 2013.

Essentially, there are a number of studies where researchers did a meta-analysis of several trials. They studied osteoporotic bone fracture frequency in female subjects taking 400 IU vitamin D and 1000 mg calcium daily. The researchers measured the frequency of osteoporotic fractures as the indicator  for osteoporosis in these postmenopausal women. The conclusion was that there was no value in taking these supplements to prevent osteoporosis. Many other media publications carried this story.

No kidney stones in study with calcium and vitamin D3

Just two days earlier (Feb. 24, 2013) another study was released with a much larger patient base of 36,282 postmenopausal women of the Women’s Health initiative in the US who were followed up for 7 years. Initially there confusion how compliant the patients were taking their supplements. The required supplementation consisted of 1000 mg of calcium carbonate and 400 IU of vitamin D3. 7 years into the trial the researchers compared the supplement compliant group with the control group taking placebos.

Calcium and vitamin D3 supplementation significantly reduces risk of hip fractures

The study group had 35% to 38% less fractures of the hip than the placebo group. This supplementation did not cause kidney stones in the study group. This was in contrast to what previous smaller studies showed. Some physicians insisted citing the older studies that vitamin D3 and calcium supplementation would cause kidney stones. But the above study refutes the causation of kidney stones by supplementing with vitamin D3 and calcium. In other words, all of these kidney stone concern you have so often read in the media are not true.

Outline of this review

In order to make sense of supplementation as osteoporosis prevention I will first review what a normal bone metabolism requires.  I will then comment on what is missing in some of the studies and why it still makes sense to supplement to prevent osteoporosis. In addition, at the end of this blog I will also recommend a sensible supplementation regimen.  All this is based on a balanced review of the medical literature.

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Calcium, Vitamin D3 and Vitamin K2 Needed For Bone Health

Bone metabolism

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? Vitamin K2 stimulates a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the bloodstream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

The physician can measure osteocalcin levels in the blood and use this as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 control osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

The skeleton of an average adult contains 1–1.3 kg of calcium and 99% of this is mostly in the form of hydroxyapatite.

The key vitamins for bone metabolism are vitamin D and vitamin K2

Calcium absorption from the small intestine requires vitamin D3 (Ref.1). To transport calcium from the blood into the bone we require both vitamin D3 and vitamin K2 (=menaquinone). This blog explains that several studies have shown that vitamin K2 (or MK-7) plays a double role of preventing calcification of the arteries and bringing the calcium into the bones of osteoporotic women.

Apart from Vitamin K2 that is necessary for osteoporosis prevention other factors have shown to be of importance. For instance, testosterone is an anabolic hormone (meaning a hormone that builds up) and it has clearly been shown that it is bone building: It does so by stimulating osteoblasts, which are bone producing cells that reside inside the bone.

Vitamin D3, vitamin K2, Calcitonin and osteocalcin

But vitamin D3, vitamin K2 and strontium together have also been shown to build up bone density within one year.

So, how does vitamin K2 deposit calcium into the bone? It does so by stimulating a hormone, called calcitonin, which is produced by specialized C cells (parafollicular cells) inside the thyroid gland and released into the blood stream. Calcitonin arrives in the bone where it binds firmly with receptors of osteoclasts (bone remodeling cells), which stops breakdown of bone. Calcitonin is helped by another hormone, called osteocalcin, which is produced by the bone producing cells with the name osteoblasts.

Vitamin K2 controls osteocalcin, which is a calcium-regulating hormone

Osteocalcin levels in the blood can be measured and used as a research tool to see whether a medication is effective in building up bone mass density (BMD). Vitamin K2 controls osteocalcin as a calcium-regulating hormone. If vitamin K2 is present, carboxylation of osteocalcin will lead to mineralization of the bone (new bone formation); if vitamin K2 is absent, osteoporosis sets in.

Vitamin K2 also prevents heart attacks and strokes

Vitamin K2 has a second function: it removes calcium from the arterial walls and tissues. How does it do this?

Matrix GLA protein is found in tissues of the heart, lungs, kidneys and blood vessels. When vitamin K2 stimulates carboxylation of this protein, it will function like a broom and clean out calcium deposits (calcification) from blood vessels and organ tissues. As vitamin K2 is needed for this carboxylation process, it appears that nature had in mind to remove calcium from soft tissue organs and blood vessels and form hydroxyapatite in the bone for bone strength.

Vitamin K2 is the key to deposit calcium into the bone

It seems that vitamin K2 is the key vitamin necessary to do this job. Another player is magnesium, which is part of of the normal function of more than 300 cellular enzyme systems. In terms of hormones the three hormones parathyroid hormone (PTH), vitamin D3 and calcitonin need to interact normally, all requiring magnesium as cofactor. In addition, zinc, copper, boron, and manganese are also essential as trace minerals. They act as cofactors with regard to specific enzymes of the bone metabolism (Ref. 1).

Bioidentical hormone replacement essential after menopause and andropause

In the aging person hormonal deficiencies are also factors for causing osteoporosis to develop. As this link shows, Dr. John Lee found bioidentical progesterone topical cream very helpful in women with respect to increasing bone mass density by 15% over 3 years.

When bloods tests show testosterone depletion men need to replace what is missing with bioidentical testosterone. So, bioidentical hormone replacement in both men and women is part of a bone health management program to prevent osteoporosis.

Some trials that demonstrate how you can build up bone

  • In this paper parathyroid hormone  was used in combination with 1000 mg of calcium and 400 IU of vitamin D3 in a group of postmenopausal women with osteoporosis. Within 3 month of treatment there was an increase of bone mass density in the lower back (lumbar spine) of 4.7%, which translates into a yearly increase of bone mass density of 18.8%. In the past when physicians tested other agents for bone regeneration, this type of result never occurred. There is a  variation of this hormone,  a parathyroid hormone look-alike with the name Teriparatide (PTH 1-34). The patient administers this once daily as an injection of 20 mcg up to 2 years. Physicians found this useful in treating fractures of the vertebrae and other fractures in osteoporotic postmenopausal women (Ref.2).

Effect of Vitamin K2, estrogen and calcium citrate supplementation

Calcitonin and calcium strontium

  • Calcitonin is very effective in reducing bone pain when the patient has compression fractures from osteoporosis; the physician can prescribe it as an intranasal spray of 200 units daily (Ref. 2). However, on March 5, 2013 the FDA announced that salmon calcitonin would not be safe for humans as there is a slight risk that cancer can develop as a “side-effect”.
  • According to Ref. 2 physicians sometimes use strontium ranelate in Europe for the treatment of postmenopausal osteoporosis. Researcher showed that strontium ranelate builds up bone and decreases the amount of bone resorption. Side effects include nausea and diarrhea.

The team players of bone metabolism to build strong bone

We are now in a position to analyze why the researchers of the first paper (citation above) concluded that calcium and vitamin D3 supplementation were not enough to make a statistical difference in the treatment of postmenopausal women in comparison to placebos. As explained bone metabolism is a complex process involving several team players, where the key player is vitamin K2, which the researchers of that study ignored completely. The examples I mentioned above in point form show that exercise and calcium are also important. Vitamin K2 by itself worked quite well as it is so powerful. Hormones like PTH and calcitonin are effective, but more difficult to take for the average consumer and the FDA now has banned calcitonin.

Importance of vitamin D3 as a supplement

Vitamin D3 is important for absorption of calcium from the intestine, but also for depositing calcium into the bone in addition to vitamin K2. The WHI study mentioned above is highly significant because of a 1/3 reduction of hip fractures after 7 years of vitamin D3 and 1000 mg of calcium per day supplementation. If you add vitamin K2, exercise and bioidentical hormone replacement in postmenopausal women who need it, the prevention of hip fractures, wrist fractures and vertebral compression fractures likely will be as high as 50% in those who are taking their supplements regularly (compliance issues like forgetting the supplements or deliberately not taking them were mentioned in several of the studies).

Vitamin K2 helps to reduce heart attacks, strokes and osteoporosis

With the right supplementation, which includes vitamin K2 as mentioned above, you achieve that you lower your heart attack and stroke risk as the vitamin K2 removes the calcium from the blood vessels and deposits it into the bones, while at the same time strengthening your bones. Attention to proper nutrition, exercise and your hormone balance (using only bio-identical hormones to replace what’s missing) will also reinforce osteoporosis prevention. The bonus of using bioidentical hormone replacement therapy is that you prevent heart attacks and strokes in addition to preventing osteoporosis. I think that this is a good deal!

An easy-to-follow osteoporosis prevention program

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 to 200 micrograms of vitamin K2 (also called MK-7). In the age group above 50 several hormones can be missing.

Hormone depletion in menopause and andropause

That’s why the doctor recommends bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women with hormone depletion. This works best, if you also watch your weight and cut down your alcohol consumption to a minimum. Cutting alcohol out completely would be even better. In addition, exercise regularly as this builds up bone and muscle strength.  It also helps, if you stick to a balanced diet (Mediterranean or Zone type diet). These diets are low-glycemic, low fat, wheat free and without sugar).

If you want to age gracefully, you need not only a healthy heart and a healthy brain. You also need healthy bones as this prevents disabilities.

References

  1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed. Copyright © 2011 Saunders, An Imprint of Elsevier
  2. Rakel: Integrative Medicine, 3rd ed. Copyright © 2012 Saunders, An Imprint of Elsevier

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I received the following feedback (Originally on Nov. 10, 2013)

 Dr. Ray, I read your March 17 Blog entry which suggested 100 ug of Vitamin K2 with 5000 IU of D3.   I have atherosclerosis and have radically changed my diet (plant only), but also now take an average of about 3000 IU of Vitamin D3. Dr. Kate Rhéaume-Bleue (book on K2) recommended taking about 200 ug per day of K2, but increasing K2 to about 1,000 ug if taking around 5,000 IU of D3 to ensure proper activation of MGP. What is your opinion with regard to a D3/K2 ration?  Thank you

 Answer from Dr. Ray (Originally on Nov. 12, 2013, modified April 29, 2021)

I appreciate your question about what doses of vitamin K2 to take. There are varied recommendations, but I like to go by human trials and what they have actually shown. In this review in 2010 from the Life Extension Magazine a study is cited that showed that only 45 micrograms of vitamin K2 was enough to get the calcium out of the arterial walls and into the bones.

200 micrograms of Vitamin K2 daily

Dr. Mercola reviewed the literature and found that most investigators were now using 180 to 200 micrograms. In the past I took 100 micrograms of vitamin K2 per day. However, a few years ago I increased it to 200 micrograms per day. With regard to vitamin D3 absorption my anti-aging doctor found that I have an absorption problem regarding vitamin D3. This is why I need 10,000 IU of vitamin D3 daily. This brings my vitamin D blood level up into the high normal range (between 50 and 80 ng/mL). Toxic vitamin D blood levels start only above 150 ng/mL.

Avoid sugar and too much starch consumption

Remember that other risks for cardiovascular disease are sugar and starch consumption. The liver turns this into triglycerides and too much LDL cholesterol, which plugs up your arteries. Avoid wheat because of the gliadin content. This causes an addiction to wheat and sugary foods. Here is a summary how leaky gut syndrome and autoimmune illnesses may develop from this. If you want to consume beef, reduce your consumption to once or twice per week. It id best to stick to only eat grass fed, antibiotic free beef). But I rather prefer to eat organic chicken, turkey and lean pork. I understand that you have a plant only based diet, but I would recommend to you to reconsider that. Ask your doctor to check your ferritin from time to time. This way you do not miss an iron deficiency that may develop. For other readers: Don’t forget your vegetables (organic, please).

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Oct
01
2006

Good Nutrition Is Gender Specific

By | Cancer, Health, Heart Disease, Nutrition, Prevention, Stroke

It is well known that various health concerns are related to the gender of a person, but there are findings that suggest that even nutrition has to be tailored to the needs of males or females.
Calcium is known to be beneficial to bone health, and while high calcium diet may protect a woman from osteoporosis, it does not have the same evidence for men. As a matter of fact, high calcium intake in males may increase their risk of prostate cancer. For the male it means that calcium should be used in moderation and vitamin D intake could help to offset some risks.
Fat choices, mostly sources of monounsaturated fats in the form of olive oil are important for both, men and women, and for both the omega-3 fatty acids that are found in fish are excellent. Men, especially those with a risk of prostate cancer, should be cautious about loading up on flaxseed and canola oil. Alpha-linolenic acid in these two oils may be a problem for the prostate.
Iron is also emphasized in healthy nutrition, but men need less than women. In the presence of an abnormal gene, excessive iron can accumulate to harmful deposits in various organs.
Social habits, for example the drinking of alcohol seem to have more grave implication to women than to men. The glass of wine that may help reduce the risk of heart attacks and certain strokes may seem harmless enough, and average men don’t seem to develop health problems, as long as the alcohol intake is low. Larger amounts will increase the risk of many ills for males and females alike, but even low doses of alcohol may increase a woman’s risk of breast cancer.
“Super Foods” have made headlines, and all of them are known because of their high content in antioxidants. A recent study from the University of Oslo, Norway, under Dr. Bente Halverson examined, which of them are ranking highest. At the top are, in the order of strength: blackberries, grape juice from Concord grapes, artichoke hearts, walnuts and strawberries. The researchers came up with a list of high oxidant foods on the basis of typical serving sizes.

Good Nutrition Is Gender Specific

Everybody needs to find healthy food

These are the winners among the super foods and spices: blackberries, walnuts, strawberries, artichokes, cranberries, brewed coffee, raspberries, pecans, blueberries, ground cloves, grape juice and unsweetened baking chocolate. Males as well as females of all age groups will benefit from those.
Dr H. Simon, associate professor of medicine at Harvard Medical School points out that there are fundamental facts in nutrition that apply to everyone. But there is also a fine print, which varies according to gender, age and medical conditions.

More information about nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

Reference: The Medical Post, September 19, 2006, page 25

Last edited November 1, 2014

Feb
01
2006

Macular Degeneration Risk Less With Vitamins

By | Eye Diseases, Nutrition, Vitamins and supplements

Age related macular degeneration (AMD) is one of the more frequent reasons for loss of vision in the ageing population. The disease is also the most prevalent reason for blindness in developed countries.
A group of researchers from the Netherlands made it their mandate to investigate, in which proportion antioxidants were useful in the prevention of AMD. Supplementation with vitamins C, D and E was used and also beta-carotene and zinc. The observations were made using questionnaires from the Rotterdam Study (1990-1993).

The group on which the research concentrated consisted of inhabitants 55 years of age or older living in a middle class suburb of Rotterdam. Of 5836 at the baseline with a risk of AMD 4765 had reliable data of their dietary habits. At the end of the study 4170 participated in the follow up.
Dietary intake of vitamin E and zinc was inversely associated with the development of AMD: the group with an intake of vitamin E and zinc had less macular degeneration than those whose diet was deficient. A higher than median intake of all the four nutrients, vitamin E, zinc, vitamin C and beta-carotene showed even more benefit. The risk to develop macular degeneration was reduced by an impressive 31 %.

Macular Degeneration Risk Less With Vitamins

Macular Degeneration Risk Less With Vitamins

These results are of importance to the ageing population and the elderly. A high dietary intake of the four nutrients is important in the risk reduction of age related eye diseases like AMD.

Reference: JAMA. 2005; 294:3101-3107; Vol. 294, No. 24, December 28, 2005

Last edited December 6, 2012

Aug
01
2005

Comfort Foods Make PMS More Uncomfortable

By | Mental Health, Nutrition, Prevention, Women’s Diseases

Premenstrual depression, moodiness, insomnia, abdominal cramps and headaches are some of the symptoms that create havoc for up to 40 % of menstruating women. Premenstrual Syndrome (or PMS for short) does not just mean a” cranky” few days for the women who suffer from it, but a host of unpleasant effects. Many experience bloating and breast tenderness, and they find that their daily functioning at work and in personal relationships is impaired. Food cravings are part of the picture, and often the so-called “comfort foods” are high on the list like ice cream, chocolate, cookies, or cake. Unfortunately these are not helpful at all, whereas other foods can be beneficial. The American College of Obstetricians and Gynecologists has published recommendations already in 2000 in which a diet of complex carbohydrates was recommended and supplementation of calcium, magnesium and vitamin E. Small meals that are rich in complex carbohydrates and that also contain protein and fat are useful to keep blood sugar levels stable. Even though some women crave sugar, candy, baked goods and pop, the rapid fluctuations in blood sugar only contribute to moodiness and irritability. Caffeine can also contribute to irritability, but by the same token, quitting coffee or tea abruptly will make many feel worse. A gradual decrease would be the gentler approach.
Alcohol intake is an especially bad idea, as it is a depressant and does nothing to lift the mood. People who have bloating or edema should avoid sodium.
Trials have shown what works to control PMS. More than 400 women were enrolled in a study group and were given 1,200 mg of chewable calcium carbonate daily. Those taking the supplement benefited from a 48% decrease of symptom severity. Within the Nurses’ Health Study II researchers followed up on a group of 1,057 women who got PMS and another group of 1,968 women who did not during 1991 and 2005. Women who consumed 400 IU of vitamin D a day had a lower relative risk of developing PMS. Consumption of calcium and vitamin D were measured by a food questionnaire. Calcium consumption of about four daily servings of fortified orange juice, skim-or low-fat milk or low-fat yogurt was inversely related to PMS.

Comfort Foods Make PMS More Uncomfortable

Comfort Foods Make PMS More Uncomfortable

The lead author of the study was Dr. Elizabeth Bertone-Johnson PhD, from the department of public health at the University of Massachusetts in Amherst. Her colleagues agree that vitamin D and calcium is beneficial to women of all ages, since these nutrients also reduce the risk of osteoporosis. Trials of vitamin B6 in doses of up to 100 mg daily seemed to help, as reported already in 2003 in a review by American Family Physician.

For the patient it means that small, regular meals are a good idea. So are complex carbohydrates, low-glycemic fruit like apples or berries and lots of vegetables. Consume low-fat milk or low-fat yogurt. Give the calcium supplements and the vitamin B6 a try. Minimize red meat, saturated and trans fats. Avoid salt, refined carbs, sugar, salt and alcohol. All of these aspects can make a significant contribution to a reduction of PMS symptoms as well as to health and wellness.

More info on premenstrual syndrome: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/pms/

Reference: The Medical Post, June 28.2005, page 23

Last edited October 29, 2014

Feb
01
2004

Less Multiple Sclerosis (MS) With Vitamin D Supplement

By | Multiple sclerosis, Uncategorized

In multiple sclerosis (MS) the body’s immune system appears to attack the insulation material of nerve cells (called “demyelination”) leading to areas of focal inflammation. These areas can be depicted with MRI scans (see white MS lesions, compared to a normal brain). A new study showed that vitamin D supplementation (as part of a multivitamin supplement) was reducing the risk of developing MS in women when compared to women who did not take supplements. This study was published by Munger et al. from the Department of Nutrition, Harvard School of Public Health, Boston/MA, in the Jan. 13, 2004 edition of Neurology.

The study is based on data from two large nurses health studies (NHS with 92,253 women followed from 1980 to 2000 and NHSII with 95,310 women followed from 1991 to 2001). The study material was pooled into one database. Among these 187,563 women 173 developed MS during the course of the original studies. When the group of women who took 400 IU or more of Vit.D supplements (as multivitamins) were compared to the group who took less than 400 IU or none, the investigators found that they were 40% less likely to develop MS. Other factors that can lead to higher frequencies of MS such as smoking or latitude at birth had been adjusted for. There has not been a change in the results of the protective effect of Vit.D. With food being the only source for vitamin D (skim milk, fish) the protective effect against MS was not demonstrable. However, when food vitamin D was combined with additional multiple vitamin tablets (with vitamin D) the protective effect against MS was observed.

Less Multiple Sclerosis (MS) With Vitamin D Supplement

Less Multiple Sclerosis (MS) With Vitamin D Supplement

In the introduction the authors pointed out that Vit. D has been shown in other studies to be an immune response modulator weakening autoimmune reactions. This effect has been shown clearly in a mouse model of MS, called experimental autoimmune encephalopathy. There are also data available from human research, which showed that certain cytokines are released in the presence of vitamin D so that the immune cells are less likely to attack the brain tissue. There were also seasonal variations that could be demonstrated in this study, which indicated that MS lesions were progressing at times when vitamin D levels were low and that they were regressing when vitamin D levels were high.

The authors of this study stressed that this is the first study to suggest a protective effect of vitamin D against MS, which would have to be confirmed in other studies that preferably would also include males. It shows a very strong statistical connection, but cannot conclusively prove causation. The investigators said that further studies will also be needed to confirm the notion that vitamin D may be beneficial as part of the treatment in MS patients.

Link regarding vitamins and minerals: http://www.nethealthbook.com/articles/vitaminsmineralsandsupplements.php#vitaminsandminerals

Last edited December 8, 2012