Wednesday, November 30, 2016

Wisdom Wednesday: Lipid Panel

There are four basic markers in the lipid panel – total cholesterol, triglycerides, HDL and LDL. This week we focus on cholesterol only as there is so much misinformation about this blood test.


The laboratory range for the total cholesterol is 130-200 mg/dL while the functional range is 180-220 mg/dL. Cholesterol is a component of cell membranes, the myelin sheath and bile salts. It is the precursor for steroid hormones. Every cell in the body is able to produce cholesterol. The diet provides only 25% of the total cholesterol in the body as 75% is synthesized in the liver, intestines and skin.

The primary focus of general practice and cardiology has been on lowering total cholesterol as the key to preventing cardiovascular disease. Physicians often believe that the lower the cholesterol and LDL levels the better. However, there are several problems associated with reduced cholesterol.

Low cholesterol weakens cellular membranes and the quality of the myelin sheath that covers and protects the peripheral nervous system. It impairs memory and the ability to think. It results in poor steroid hormone production (e.g. cortisol, estrogen, testosterone, progesterone). It also impairs the immune system.

Levels below 180 mg/dL are associated with a 200% increase in cerebrovascular accidents, lung disease, depression, suicide and addictive behavior. A 300% increase in liver cancer is also noted.

Monday, November 28, 2016

Mercury Levels Dropping in North Atlantic Tuna

Mercury levels in one tuna species have decreased along with industrial emissions of the dangerous chemical element, a new study finds.

The results suggest that reductions in mercury emissions could quickly result in lower mercury levels in some species of ocean fish, according to researcher Nicholas Fisher and colleagues. Fisher is a professor at the School of Marine and Atmospheric Sciences at Stony Brook University in Stony Brook, N.Y.

Mercury, a neurotoxin, can harm the nervous system of humans. It accumulates in tuna and other types of fish, which has led to warnings against eating too much tuna, the researchers said in background notes.

Although increased coal burning in Asia has raised mercury emissions globally, levels have fallen in North America 2.8% a year between 1990 and 2007, the researchers said.

Over a similar period, mercury in north Atlantic waters dropped 4.3% annually. And mercury in the air above the North Atlantic Ocean declined 20% from 2001 to 2009, the researchers said. To assess the effects of those declines, the research team analyzed mercury levels in tissue samples from nearly 1,300 Atlantic Bluefin tuna caught between 2004 and 2012. During that time, mercury levels in the fish fell an average of 19%, the researchers said in a news release from the American Chemical Society. The findings were published recently in the journal Environmental Science & Technology.

Friday, November 25, 2016

Poor Sense of Smell May Signal Alzheimer’s Risk

A person’s sense of smell may help predict their risk for Alzheimer’s disease, a new study suggests.

The researchers included 183 older people, and 10 had possible or probable Alzheimer’s disease, the researchers said.

Study volunteers were tested on their ability to recognize, remember and distinguish between odors. These odors included menthol, clove, leather, strawberry, lilac, pineapple, smoke, soap, grape or lemon. The study participants were then asked to complete another test of odors. The second test included 10 new odors in addition to those from the original test. These tests were developed at Massachusetts General Hospital in Boston.

The participants also underwent genetic, imaging and memory tests. Those with a reduced sense of smell seemed to be at increased risk of Alzheimer’s, the researchers said.

“There is increasing evidence that the neurodegeneration behind Alzheimer’s disease starts at least 10 years before the onset of memory symptoms,” principal investigator Dr. Mark Albers, from the department of neurology at Massachusetts General, said in a hospital news release.

“The development of a digitally enabled, affordable, accessible and noninvasive means to identify healthy individuals who are at risk is a critical step to developing therapies that slow down or halt Alzheimer’s disease progression,” he added.

Wednesday, November 23, 2016

Wisdom Wednesday: The CBC (continued)

The white blood cells (WBCs) defend against infection and foreign substances through phagocytosis. They comprise about 1% of the healthy adult blood and have a life span of 13-20 days. Then they are destroyed by the lymphatic system. The number of WBCs in the blood are regulated by the endocrine system.

WBCs are also found in the lymphatic system. A majority of the cells are created in the bone marrow, then trained in the thymus. However, the spleen, liver and thymus can also produce WBCs if the bone marrow is unable to keep up with the demand.

An increase in WBCs is found in acute viral or bacterial infection, stress, intestinal parasites, a diet high in refined foods, or certain cancers.

A decrease can occur in chronic viral or bacterial infection, pancreatic insufficiency, bone marrow insufficiency, anemias due to folic acid, vitamin B6, or B12 deficiency, nutritional deficiencies, or chronic intestinal parasites.

Clinically, I use Andrographis Complex, colloidal silver, Neutrophil Plus, and Ultra Vir-x for infection fighting. Echinacea is best used as a preventative but it does provide a little support during acute infections. Think of Echinacea as “duct tape” for the immune system.

A chronic low WBC count responds really well to Ultra Vir-x and Neutrophil Plus, but variable doses of vitamin A and vitamin C can also raise a low WBC count over time.

The various types of WBCs are generally listed by the percentage of the total WBC count they represent. Neutrophils are the most common WBC, normally over 50%. They have a life span of 8 days and are usually the first responders to infections. They increase with acute infection, high stress, intestinal parasites, inflammation and Leaky Gut. They can decrease with chronic viral infection, food allergies, digestive insufficiency, bone marrow insufficiency, and anemia.

Lymphocytes are the second most common WBC. The functional range is 24-44%. They react to toxic by-products of protein metabolism and are able to recognize hundreds of millions of different molecules. The various types of lymphocytes provide a more specific immune response to offenders.

Monday, November 21, 2016

Healthy Living Can Overcome Genes Linked to Heart Disease

New research shows that people can minimize an inherited risk for heart attack by living right – exercising, eating healthy, staying slim and quitting smoking.

Even with a little effort in these areas, people can cut their high genetic risk of heart disease by more than half, said senior researcher Dr. Sekar Kathiresan, director of the Center for Human Genetic Research at Massachusetts General Hospital in Boston.

But the opposite also is true, Kathiresan warned. People born with a genetic advantage protecting them against heart disease can ruin their good luck through unhealthy lifestyle choices.

“For heart attack at least, DNA is not destiny,” Kathiresan said. “You have control over your risk for heart attack, even if you’ve been dealt a bad hand.”

Kathiresan presented his findings Sunday at the American Heart Association’s annual meeting, in New Orleans. The study was published simultaneously in the New England Journal of Medicine.

For their research, Kathiresan and his colleagues pooled data on more than 55,000 participants in four large-scale health studies.

The researchers analyzed each person’s genetic risk for heart disease using a panel of 50 gene variants. They also judged each person’s lifestyle based on four factors: smoking, body weight, diet and exercise.

The requirements to have a good lifestyle were not rigorous, Kathiresan said. “It’s safe to say we’re not being that aggressive in terms of the lifestyle score,” Kathiresan said. Even these minimal lifestyle changes mattered greatly for people at high genetic risk of heart disease.

Friday, November 18, 2016

U.S. Doctors Don’t All Follow Prediabetes Screening Guidelines

Only about half of U.S. family doctors follow guidelines on screening patients for prediabetes, a new study finds.

More than one-third of American adults have prediabetes, and most don’t know it. Prediabetes means that that blood sugar levels are higher than normal but not high enough to be diabetes. Diagnosing and treating prediabetes can prevent patients from developing diabetes, a leading cause of death in the United States.

University of Florida researchers surveyed more than 1,200 family doctors in academic medical settings nationwide. They found that those doctors with a positive attitude toward prediabetes as a clinical condition were more likely to follow national screening guidelines and offer treatment for their patients. Prediabetes treatments include medicine, exercise and losing weight.

Other doctors were more likely to suggest their patients make general lifestyle changes that may reduce heart disease risk, but aren’t associated with lowering blood sugar levels. Doctors also cited patients’ ability to make lifestyle changes, stay motivated and economic resources as significant barriers to preventing diabetes.

The study was published Nov. 8 in the Journal of the American Board of Family Medicine.

“Some physicians think that a prediabetes diagnosis ‘overmedicalizes’ patients, and some believe it is best to focus on providing general advice on healthy lifestyle,” study author Arch Mainous III said in a university news release. Mainous is chairman of health services research, management and policy in the College of Public Health and Health Professions.

The American Diabetes Association recommends prediabetes screening for adults who are overweight or obese and after age 45. The U.S. Preventive Services Task Force recommends screening for people between 40 and 70 years of age who are overweight or obese.

Wednesday, November 16, 2016

Wisdom Wednesday: The Complete Blood Count (CBC)

This is the most common laboratory test performed – CBC with differential. It is divided into three segments – the red blood cells (RBCs), the white blood cells (WBCs), and the platelets. Today’s blog will concentrate on the RBCs.

The conventional RBC normal range is from 4.6-6.0 million/uL for men and 3.8-5.1 million/uL for women. The functional range for men is 4.2-4.9 and 4.0-4.5 for women. Red blood cells are the most common blood cell making up 25% of all the cells in the human body. They carry 98% of all oxygen to tissues.

Young RBCs are called reticulocytes. Although it takes two days to produce one RBC, your body produces 2.4 million per second.

RBCs have a life span of 120 days and are filtered by the spleen. They are very flexible, flowing easily through the small capillaries and can circulate the body in 20 seconds.

A decrease in the RBC count can be caused by anemia, chronic liver or kidney dysfunction, free radical damage or blood loss. The RBC count increases in dehydration, asthma or respiratory distress, vitamin C deficiency and Polycythemia.

Hemoglobin is the iron carrying portion of the RBC. Four molecules of oxygen can attach to each molecule of hemoglobin. The laboratory range for hemoglobin is 12-16 g/dL but I prefer 14-15 for males and 13.5-14.5 for females. The hemoglobin is decreased in iron deficient anemias, nutritional deficiency, intestinal parasites, internal bleeding, vitamin B6 or copper anemia. It is increased in dehydration, Polycythemia, adrenal dysfunction, asthma, spleen hypofunction and elevated testosterone.

The hematocrit (HCT) measures the percent of RBC’s in the blood. The laboratory range is 36-50% in males and 34-44% in females. I narrow that slightly for the functional range. The hematocrit is a key component of anemia and dehydration screening.

Monday, November 14, 2016

More Than Half of Americans Have Chronic Health Problems

“The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity, the co-occurrence of two or more chronic medical conditions” said study authors, Elizabeth Lee Reisinger Walker and Dr. Benjamin Druss.

They emphasized that people with multiple health issues need more access to care and better coordination among their health care providers.

The Emory University researchers examined public health records to find out what percentage of U.S. adults have chronic medical conditions, mental illness or substance abuse problems, and how many were also living in poverty.

Chronic medical conditions looked at in the study included asthma, cirrhosis, diabetes, heart disease, hepatitis, high blood pressure, HIV/AIDS, lung cancer pancreatitis and stroke, according to the report.

The study, published online recently in Psychology, Health & Medicine, found that nearly 40% had a least one chronic medical condition. In addition, about 18% had been diagnosed with a mental illness in the past year, and about 9% abused drugs or alcohol during that time.

Overall, about 15% were living in poverty, the investigators found. Among those with chronic conditions, many had less than a high school education, were unemployed, were receiving government aid and had no health insurance.

“Just over half of adults in the U.S. have one or more chronic conditions, mental disorder, or dependence on substances. These conditions commonly overlap with each other and with poverty, which contributes to poor health,” Walker said in a journal news release. “In order to promote overall health, it is important to consider all of a person’s health conditions along with poverty and other social factors.”

Friday, November 11, 2016

Water: Can It Be Too Much of a Good Thing?

Dehydration is a familiar foe for endurance athletes. But did you know that drinking too much water can be potentially fatal, particularly if not treated properly? And you don’t have to be an elite athlete like a marathoner to fall victim to what doctors call water intoxication.

Water intoxication occurs when a person has consumed so much water that the salt levels in the blood become diluted, said Dr. Aaron Baggish, co-medical director of the Boston Marathon.

“When sodium concentrations are low in the blood, it actually allows water to leak out of the blood into the other tissues, a condition known as hyponatremia, added Baggish, who’s also associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.

The brain appears to be the organ most affected by hyponatremia, and begins to swell as water leaks out of the blood and into brain cells, he said. Usually, the symptoms are mild, such as confusion, headache and nausea. But if left untreated, people might wind up suffering seizures, Baggish said. In the worst cases, the brain continues to swell uncontrollably, resulting in a potentially fatal condition called brain stem herniation, he said.

“The brain is soft tissue that’s contained in a fixed skull. When the brain swells, there’s one real way it can go as an exit path, and that’s down to the bottom of the skull where there’s a hole that connects the brain to the spinal cord,” Baggish said.

Death from water intoxication is very rare among athletes like marathon runners, said Dr. William Roberts, a former president of the American College of Sports Medicine.

“We’ve noted maybe a half dozen deaths out of probably 3 or 4 million finishers, so it’s not a very common cause of fatality,” said Roberts, who’s also a professor with the University of Minnesota’s Department of Family Medicine and Community Health. Marathon runners are more likely to die from a heart attack or heat stroke, he said.

Wednesday, November 9, 2016

Wisdom Wednesday: Functional Blood Chemistry

This time every year I encourage my patients to have broad based laboratory testing of their blood and urine. These tests are excellent predictors of general health and help me correlate and confirm my QA (Quintessential Applications) findings.

I do this through our holiday newsletter, reducing the lab fees for the months of December, January and February. For the next several weeks, I will be reviewing the routine tests I recommend on the Wisdom Wednesday blog.
Comprehensive Metabolic Profile (CMP) – this series of tests provides information about electrolytes, liver, kidneys, bone and mineral status. It contains 14 tests as compared to the Basic Metabolic Panel with has 7. Managed care will often only order the BMP to save money.

The tests are:
  • Glucose
  • Calcium
  • Albumin
  • Total Protein
  • Sodium
  • Potassium
  • CO2
  • BUN
  • Chloride
  • Creatinine
  • Alkaline Phosphatase
  • Bilirubin
  • Anion Gap (calculated measurement)

The patterns seen on the metabolic panel:
  • Dehydration
  • Digestive imbalances
  • Malabsorption
  • Protein assimilation
  • Hypochlorhydria
  • Dysbiosis
  • Insulin resistance
  • Diabetes
  • Liver/gall bladder
  • Inflammation
  • Cardiovascular
  • Renal insufficiency
  • Edema
  • Metabolic acidosis
  • Metabolic alkalosis
  • Male urinary issues
  • Adrenal dysfunction

Function ranges and laboratory ranges can vary widely from test to test. For example, the laboratory range for the fasting glucose is 65-99 mg/dL while the functional range is 80-100 mg/dL. That’s pretty close. However, the laboratory range for calcium is 8.5-10.8 mg/dL but the functional range is much narrower at 9.2-10 mg/dL. In most cases the narrowed functional range allows the practitioner to see patterns in general health before they indicate obvious disease.

The Bottom Line:
The CMP is an inexpensive broad based look at metabolism. The BUN and creatinine are excellent indicators of kidney function while the SGOT and SGPT reflect liver status. Although the fasting glucose does have value, I prefer the hemoglobin A1c as an indicator of long term glucose control.

Monday, November 7, 2016

Irregular heart Rhythm Patients May Not Always Need Blood Thinners

People with an abnormal heart rhythm called atrial fibrillation (A fib) typically take powerful blood thinners to prevent strokes. However, those who suffered only short bouts of A fib – estimated at 20 seconds or less – were at no more risk for stroke or other heart complications than people without atrial fibrillation, a new study shows.

“Some patients have atrial fibrillation 100% of the time, while others might have only a few seconds of atrial fibrillation once a year,” explained study author Dr. Steven Swiryn. He’s a clinical professor of cardiology at the Feinberg School of Medicine at Northwestern University in Chicago.

“Where atrial fibrillation only happens rarely and lasts a short time, it can be difficult to detect,” Swiryn said.

Implanted devices such as pacemakers and defibrillators monitor a patient’s heart rhythm constantly, and they can spot short episodes of atrial fibrillation, he said.

“We can then more accurately answer the question, ‘How much atrial fibrillation does the patient have to have in order to be at risk of stroke and benefit from anticoagulation?’ Swiryn said.

The answer seems to be that patients with only short episodes of atrial fibrillation aren’t at enough risk for a stroke to warrant blood thinners, he said. “This allows physicians to avoid prescribing anticoagulation unnecessarily, since the risk of bleeding may be more than the benefit of stroke prevention,” Swiryn said.

Atrial fibrillation is the most common abnormal heart rhythm condition, and affects about 2.7 million Americans.

Friday, November 4, 2016

Calcium Supplements Won’t Harm the Heart

Over the past decade, a number of studies have raised questions about whether calcium supplements might contribute to heart disease or stroke. Just this month, a study of U.S. adults found that supplement users were more likely than nonusers to have plaque buildup in their heart arteries. (Calcium is a component of artery-clogging “plaques.”)

But a new research review, commissioned by the National Osteoporosis Foundation (NOF), has come to a different conclusion. On balance, the review found, the evidence doesn’t support a connection between calcium supplements and heart disease or stoke.

As long as people don’t go overboard, calcium supplements should be considered “safe from a cardiovascular standpoint,” say the guidelines from the NOF and the American Society for Preventive Cardiology. Getting calcium from foods such as milk, yogurt and tofu is still preferred, the groups say.

The guidelines and evidence review were published online Oct. 24 in the Annals of Internal Medicine.

The researchers analyzed 31 studies. Four of them were clinical trials, where older adults (mostly women) were randomly assigned to take calcium, with or without vitamin D.

None of those trials showed that supplement users had higher risks of heart disease, stroke or death than participants given placebo pills, the review found.

The rest of the studies the Tufts team analyzed were observational: They looked at the relationship between people’s calcium intake, from diet or supplements, and their risk of heart disease or stroke. Again, the researchers found the studies showed no consistent connection between higher calcium intake and higher cardiovascular risks.

Wednesday, November 2, 2016

Wisdom Wednesday: DHEA

DHEA is a hormone that is naturally made by the human body. It can also be made in the laboratory from chemicals found in wild yam and soy. The human body cannot make DHEA from these chemicals so simply eating wild yam or soy will not increase DHEA levels. However, the human body can make progesterone from wild yam when ingested, but not from topical creams or gels.

Supplementation of DHEA appears to be effective in persons over the age of 40 for a wide variety of conditions. However, the standard dosage of 25-50mg per day, is excessive (in my opinion) as the human body typically produces about 25mg per day when healthy.

I prefer a dosage of 5-10mg per day. Anything higher than that and you are using HRT (hormone replacement therapy) rather than reestablishing normal adrenal function. My concerns on dosage come from a study showing that at a dose of 5-12.5mg of DHEA daily, the telomeres attached to the nucleus of the cells of the body actually lengthen. Telomere length has been strongly tied to health and longevity. Higher daily doses of DHEA actually shortened telomeres.

DHEA is made from cholesterol naturally via two enzymes and is highly localized to the adrenal glands. It is also made in smaller quantities in the testes, ovaries, and brain. Circulating levels of DHEA in the brain can be 6-8 times higher than in the blood stream.