Monday, December 30, 2013

Top Nutrition Stories of 2013

Probiotics, omega 3 fatty acids, and vitamin D were the most popular topics for nutrition related stories in 2013. I’ve written a couple of blogs about vitamin D and I mention omega 3 fatty acids in almost every blog, but I decided to tell the omega fatty acid story today.

The omega 3 fatty acids and their cousin, omega 6 fatty acids are very long chains of carbon molecules with a fatty acid on one end. The term omega means “forever”. Just think of the biblical reference “I am the alpha and the omega”. Because they are so long, omega fatty acids are difficult to digest. The omega 3 fatty acids have a double bond between the third and fourth carbon atoms on the terminal end. The omega 6 fatty acids have the same double bond between the sixth and seventh carbons. That is very important because humans can not make that double bond at the third or sixth carbon. We must obtain omega 3s and 6s in the diet. That is why they are essential, hence the name essential fatty acids. We can make double bonds at several other locations, so the omega 5s, 7s, and 9s are not essential.

Essential fatty acids are used to make anti-inflammatory compounds. They help form the cell membrane in every cell of the body. The lining of the digestive tract, the liver, and the heart are extremely dependent on a constant, rich supply of omega 3 and 6 fatty acids. NSAIDS, like Aleve and Advil, used to block inflammation, also block the chemical pathways of both these essential fatty acids. Each year in the US, over 16,000 people die from taking NSAIDS. Most of them bleed to death because they can not repair the digestive tract, the remainder die from liver failure or heart disease.

Omega 3 fatty acids are the most common nutritional deficiency in the United States. They were naturally occurring in red meat until we replaced the grass diet of cattle with grains. They do occur in fish, but not in farm raised fish like Tilapia. Farm raised fish are fed corn meal and just like the cattle can no longer produce omega 3 fatty acids. They are found in some seeds, like flax seed. However, the vegetable sources of omega 3 fatty acids contain no EPA or DHA, the most important of the omega 3 fatty acids. Although we can not make omega 3s we can convert omega 3s to DHA or EPA. However, just like the cattle and fish, the typical American diet inhibits that conversion.

Omega 6 fatty acids are common in our diet. But we have the same problem converting them into GLA (gamma linolinec acid). In addition, omega 6s can be converted to pro-inflammatory compounds. Because they are common in the diet and can promote inflammation, most nutritionists recommend against supplementation. However, if you look at the people who make inflammatory chemicals from extra virgin olive oil, they are the diabetics, people with hypothyroidism, and those with high serum lipids. These components of Metabolic Syndrome create the abnormal chemical pathways that promote inflammation. In these cases, omega 6 fatty acid metabolism needs to be corrected, not ignored.

The main drawback with omega 3 fatty acids is in processing. The vast majority of supplements are made from fish oil. We have contaminated our environment with mercury and it concentrates in the fish as it moves up the food chain. When you buy wholesale fish oil from Norway, you have the option of paying to have the mercury removed. Good companies pay the price and advertise “mercury free” or “high density molecular extraction” on the label. However, very few supplement companies have the laboratory resources to test for mercury removal. Several years ago 74 companies were indicted for mercury contamination in their fish oil products. Most had paid to have the mercury removed. The few companies that could test the wholesale oil refused to buy it and just stopped making fish oil supplements until clean fish oil was available again.

Almost any disease or condition is improved with the use of one or both of these essential nutrients. There are good studies on Parkinson’s disease, Senile Dementia, autoimmune disease, and even ADD and ADHD. The research is in, we need and we don’t get it. You absolutely must supplement omega 3 fatty acids. Don’t but the cheap stuff and look for “mercury free”. If taking omega 3 fatty acids upsets your digestive tract or you are interested in supplementing omega 6 fatty acids, seek professional nutritional advice. Correcting abnormal chemical pathways requires intimate knowledge of human nutrition.

Friday, December 20, 2013

Multivitamins Are Worthless

Three studies published this week in the Annals of Internal Medicine support the contention that multiple vitamins don’t help most people and can actually cause diseases that people taking them are trying to prevent, like cancer.
December 18, 2013

The first study found no benefit in preventing early death, heart disease or cancer. The second found that taking multivitamins did nothing to stave off cognitive decline with aging. The last study found that high-dose multivitamins didn’t help people who had had one heart attack avoid another.

“Enough is enough,” declares an editorial accompanying the studies. “Stop wasting money on vitamin and mineral supplements.”

Of course you have heard this information because medical doctors on all the major networks have played this story up all week. You might be surprised by this, but I agree, at least in part.

For over 30 years I have been saying that multiple vitamins are not worth the label printed on the bottle. You can not combine every micronutrient we know into a tablet and expect that it will have health benefits. Most multivitamins contain copper, iron, and zinc. These three minerals compete for absorption in the body and don’t belong together. In addition, the iron competes with the vitamin E as well. The B vitamin ratios are also all wrong, typically having too much thiamine (B1) and not enough riboflavin (B2) and niacinamide (B3). I had predicted that the multivitamin would be extinct by the year 2000. Wow, was I wrong!

Many supplements, including several multivitamins now add a phytofood base. This is nothing more than powdered plant food. For example, Standard Process grows 23 different crops on their organic farms in Racine, Wisconsin. They harvest and process those plant materials into a plant based supplement, using things like pea vine juice, carrots, and barley. Greens Plus and Sun Chlorella are other examples of phytofoods. This is what should have replaced the multivitamin. They provide a host of micronutrients, in very small doses as they are found in plants to supplement a good diet.

My biggest objection to the media coverage this week has been the universal leap from multivitamins are worthless to all vitamin supplements are therefore worthless. Every MD on every newscast, just like the editorial comment in the Annals of Internal Medicine, makes this absurd declaration. Just because aspirin, Aleve, and Advil kill over 16,000 people a year in the United States doesn’t make all drugs bad. In fact, it doesn’t even make aspirin, Aleve, and Advil bad. It just means they need to be used with good knowledge.

We all know the quality of our food decreases daily. Farm raised fish no longer contain omega 3 fatty acids, nor does red meat. Tomatoes are picked when they are still green and firm, and then shipped to local sites to be flooded with carbon dioxide to turn them red. Unripe tomatoes don’t bruise but they contain little of the nutrients we need on a daily basis.

A hundred years ago, if you had enough food to eat, then you got all the nutrients needed to promote health. Today, no matter how much you eat, you can not get those nutrients from the food available.

Throw away that multiple. Seek professional advice from a nutritionist with a degree in the field. Become educated yourself. There are a few givens – we all need omega 3 fatty acid supplementation. All women and many men need calcium supplementation. At least 25 percent of the population needs folic acid, B6, and/or B12 supplementation. Over 50 percent of us need to take some vitamin D. Simple laboratory tests can demonstrate these deficiencies. Have testing performed at least on a yearly basis.

Wednesday, December 18, 2013

Idea of Healthy Obesity Is Tested

The idea that there are obese people who are nonetheless healthy may be a myth.
December 13, 2013

Although some overweight or obese people have normal cholesterol, glucose levels and blood pressure – elements of so-called metabolic health – a new study suggests that obesity itself increases the risk for heart disease, stroke, diabetes and death.

Last week the Annals of Internal Medicine published a report that followed more than 61,000 adults, most for at least 10 years. About 9 percent of the subjects were obese and metabolically healthy – that is, they had normal LDL, HDL and total cholesterol, along with healthy blood pressure and blood sugar levels.

Compared with metabolically healthy people of normal weight, the obese group had a 24 percent increase in risk for total and nonfatal cardiovascular events like heart attack and stroke, and death by any cause.

Increased weight, waist circumference, blood pressure, and insulin resistance all rose together. However, increases in triglycerides, glucose, or LDL cholesterol were not associated.

“The message here is pretty clear,” said the lead author, Dr. Caroline K. Kramer, a researcher at the University of Toronto. “The results are very consistent. It’s not O.K. to be obese. There is no such thing as healthy obesity.”

The study appears to be pretty obvious – if you are overweight, your health suffers. However, if you look more closely, it says something more profound – They found no correlation between high triglycerides, high glucose, or high LDL cholesterol and increased cardiovascular events. Waist circumference was a better indicator of health risk! Please note they did see a correlation between insulin resistance and cardiovascular events.

More than 50 percent of Americans having their first heart attack have normal or even low cholesterol. We don’t need to put statin drugs in the drinking water; we need to focus on the real risk factors of metabolic syndrome – central obesity (weight around the middle), insulin resistance, and low thyroid function.

What is the difference between insulin resistance and fasting blood glucose? The fasting glucose tells you how well your body controls blood sugar levels without the stress of eating (adding more sugar) for at least 8 hours. That’s like an open book test, setting the bar too low. By the time the fasting glucose is high, insulin resistance is out of control and you are a full blown diabetic.

The glycohemoglobin A1c is a simple test that measures insulin resistance. It actually measures the percentage of red blood cells (RBCs) that are saturated with glucose. Normal is below 5.7 percent. Because RBCs live about 120 days, this test measures your average blood glucose over the course of the past two months.

Watch your weight, especially your waist line. Have yearly laboratory tests, but insist on a glycohemoglobin A1c and don’t be too concerned with the serum lipids. If you want to see if your cholesterol is really a risk factor, have an L(p)a run. It is the only lipid test that really correlates with increased risk of cardiovascular events.

Sunday, December 15, 2013

Acid-Suppressing Drugs Linked to Vitamin B12 Deficiency

A new study published in the Journal of the American Medical Association reports that people who use certain acid-suppressing drugs for two years or longer are at increased risk of vitamin B12 deficiency.
December 10, 2013

This can lead to anemia, neuropathy, depression, fatigue, or dementia. The drugs are proton-pump inhibitors, or P.P.I.’s and histamine 2 receptor antagonists. They are available by prescription and over the counter under names like Prevacid, Prilosec and Nexium. Nearly 157 million prescriptions were written for P.P.I.’s in 2012.

“People who are taking this medications are more likely than the average person to be vitamin B12 deficient, and it’s a potentially serious problem,” said Dr. Douglas Corley, senior author of the study. Of note, the study was funded by Pfizer, which makes a P.P.I. called Protonix.

Patients who took P.P.I.’s for more than two years were 65 percent more likely to have a vitamin B12 deficiency, the researchers found. Higher doses of P.P.I’s were more strongly associated with the vitamin deficiency, as well.

These drugs prevent the stomach from manufacturing hydrochloric acid (HCl) thus reducing the symptoms of acid reflux. However, HCl is the first major step in digestion. It breaks down protein, separates calcium ions from their substrate, and prepares vitamin B12 for assimilation in the small intestine. It is also the triggering mechanism for the gallbladder to release bile and the second major step in digestion once the food bolus enters the small intestine. We now know (and have predicted) that P.P.I.’s cause osteoporosis, anemia, dysbiosis, and chronic Candida infections. Clinically, I see frequent gallbladder congestion associated as well.

Unfortunately, if you burp once in a while, that seems to be enough criteria to prescribe one of these drugs. A simple test of the pH of the stomach will detect over-acid production, but the testing is seldom run. A lack of HCl production will also cause acid reflux, as the food putrefies, producing organic acids in the stomach. It is estimated that a lack of HCl accounts for 50 percent of the cases of acid reflux.

The cause in most cases is poor diet. Food sensitivities, over eating, excessive fat and sometimes even poor food combining are real issues. When a patient obtains relieve from the drug, they continue their poor eating habits further compromising general health.

Avoid these P.P.I,’s like the plague! Your symptoms are warning signals that the digestive tract is in trouble. Have your diet evaluated. Often just reducing caloric intake will dramatically improve or eliminate symptoms.

Thursday, December 12, 2013

Taking Vitamin D May Be Losing Its Shine

New Research On The Benefits Of Vitamin D Raises More Questions.
December 6, 2013

Researchers at France’s International Prevention Institute in Lyon analyzed data from several hundred observational studies and clinical trials examining the effects of vitamin D levels on so called non bone health – including links to illness such as cancer, diabetes and cardiovascular disease.

They found that the benefits of high vitamin D levels seen in observational studies were not replicated in randomized trials where participants were given vitamin D to see if it would protect against disease.

Lead researcher, Philippe Autier said “What this discrepancy suggests is that decreases in vitamin D levels are a marker of deteriorating health”. He explained that serious illness like cancer and diabetes may reduce vitamin D concentrations but that does not necessarily mean that raising vitamin D levels would prevent the illness from occurring.

After several years of being touted as the next cure all, opinions on vitamin D are beginning to swing back. You will continue to see more studies published that focus on the limitations of vitamin D, rather than the benefits. Vitamin C had a similar run during the 1970’s fueled by the claims of Linus Pauling. He recommended very large doses of vitamin C for every known disease on the planet. The Linus Pauling Institute, founded by him, has since refuted virtually every one on his claims. Today, vitamin C is recognized as an essential nutrient that is an important antioxidant in the body, but not a cure all. Vitamin D will eventually settle in its’ rightful place as well.

Vitamin D is a hormone, not a vitamin. Our body manufactures it from cholesterol (yes, that horrible fat that must be removed from the body by drugs) when sunlight strikes the skin, making vitamin D3. We also get vitamin D2 and D3 in the diet, primarily from oily fish. D2, and D3 are not really vitamin D, they are precursors and are transported to the liver and converted to 25-hydroxy vitamin D. However, it is still not truly vitamin D but rather a stable form that can be accurately measured on blood tests. Every cell in the body absorbs a little of this form, but much of it remains in circulation in the blood stream. The final conversion to true vitamin D occurs in the kidneys and 1,25-hydroxy vitamin D is produced and functions as a hormone controlling calcium metabolism.

Every cell also can make the final conversion, but that vitamin D remains in the cell where researchers believe it oversees protein replication from DNA. This is where all the questions remain. If vitamin D really acts like a librarian, selecting genetics like books in a library, its function could be vital to disease prevention. Currently, we can not measure vitamin D levels in the cell. In fact, we measure the precursor, 25-hydroxy vitamin D, in the blood because the final form, 1,25 hydroxy vitamin D, is used almost as fast as it is made, so blood levels change by the minute.

Don’t give up on vitamin D. When the pendulum stops swinging, it will still have value. However, avoid the high level supplementation that has been so popular. Taking 50,000 IU of vitamin D is a massive overdose. It is using a vitamin as a drug. Stick with doses up to 4,000 IU per day unless you have blood work showing a true deficiency.

Tuesday, December 3, 2013

High-Fat Diets In Puberty Linked To Breast Cancer

Young women approaching puberty could reduce their risk of breast cancer if they avoid high-fat diets, researchers from Michigan State University claim.
Friday, November 29, 2013

The research published in the current online issue of Breast cancer Research suggests that eating a diet high in saturated animal fats not only speeds up the development of breast cancer, but also may increase the risk of developing the disease.

Experimenting on mice, the researchers from the Breast Cancer and the Environmental Research Program at Michigan State University (MSU) found that just 3 weeks after embarking on the high-fat diet, mice showed changes in the breast, including increased cell growth and alterations in the immune cells.

They note that these changes are permanent and may lead to the rapid development of precancerous lesions, and ultimately, breast cancer.

This is excellent basic research. More funds need to be expended in looking at the basic cause of disease. MSU began as an agricultural college; they are well suited to such studies.

Don’t look for any change in our eating habits, patient counseling, or treatment protocols regardless of how many studies demonstrate the correlation between diet and cancer. Just like heart disease and diabetes, where the link is well documented, we acknowledge that diet is cause, then ignore the fact, and move on to new forms of drug therapy.

There are several good studies correlating estrogen and breast cancer. Simply adding cruciferous vegetables, like broccoli or cabbage, to the diet will minimize that risk. How did the medical community respond to this information? They developed a drug, Tomoxifin, that targets estrogen dominant cancers, rather than promote prevention. Further studies have shown that adding a cruciferous supplement to the diet, makes the Tomoxifin 50 times more effective at preventing the recurrence of cancer. Seldom, if ever, is this information passed from the oncologist or gynecologist to the patient.

Clean up your diet and your daughter’s diet as well. Cut out the saturated fats and trans-fats, add in the cruciferous vegetables. If you have a family history of breast cancer, or you just want to assess your risk factors, ask your doctor to perform genetic testing, salivary, and urine hormone levels. Look for a future blog on hormonal and genetic testing.

Thursday, November 21, 2013

New Recommendations for Statin Therapy

Harvard professors claim the new online cholesterol calculator is flawed and overstates a person’s risk of heart disease.
Monday, November 18, 2013

The new guidelines were developed by the American Heart Association (AHA) and the American College of Cardiology (ACC).

Under the new guidelines, people will be advised to take statins based on a number of different health risk factors. These risk factors include if they already have heart disease, if their LDL cholesterol is extremely high (180mg/dl) or if they’re middle aged with type 2 diabetes.

In addition, people between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5% or more are advised to take a statin. Experts say this new rule could greatly increase the number of patients who will now be advised to take these drugs.

Forty-nine percent of Americans over the age of 60 currently take statin drugs. Statins are the most commonly written prescription in the United States. Statistically, statin drugs reduce the risk of sudden heart attack by one third. That seems like pretty compelling evidence to support statin use. However, the risk of sudden heart attack is only three percent and statin drugs reduce it all the way down to two percent. That’s a whopping decrease of one percent! Furthermore, more than half the population’s suffering their first heart attack have normal or even low cholesterol. The ACC has countered that statistic by suggesting that statin drugs should be added to our drinking water so everyone will be treated.

Statin drugs work (when they work) because they reduce inflammation, not because they lower total cholesterol and LDL cholesterol. In fact, the disruption of cholesterol metabolism by statin drugs causes cardiac myopathy (heart muscle disease) in ten percent of patients. Cholesterol is the raw material necessary for the body to create sex hormones, vitamin D, and a host of other complex chemicals needed for the body to function properly.

The most common cause of high cholesterol is an excess of saturated fat and trans-fats in the diet. Although the AHA and ACC both claim that dietary changes are the cornerstone of treatment, little or no attention to diet occurs in practice. The second major cause is an underactive thyroid. Synthroid (synthetic thyroid hormone) is the second most commonly prescribed medication in the United States. It is estimated that at least one third of cases of hypothyroidism are autoimmune in nature. Clinically, I estimate that number is closer to half of all cases. Although Synthroid alleviates some symptoms, it does not treat the underlying cause or reduce the cardiac risk associated with hypothyroidism.

The number three cause of high cholesterol is an imbalance in the flora of the digestive tract. Unhealthy bacteria can produce an estrogen analog, a chemical that resembles estrogen. The body absorbs this estrogen look-a-like and it stimulates cholesterol production. Overproduction of cholesterol from genetic flaws is the forth most common cause of high cholesterol. This can be determined by a simple blood test, the L(p)a. Elevation of the L(p)a is the only lipid blood test that does correlate with an increased risk of heart disease. The test is seldom run before placing a patient on statin drugs. Despite being genetically controlled, both niacin and gingko leaf extract have been shown to be very effective in reducing the L(p)a in several studies.

Talk to your doctor about truly implementing a serious program of diet and exercise before resorting to statin drugs. You must be an active participant in your health care. Have through laboratory testing to include a thyroid profile, glycohemoglobin A1c, fibrinogen, homocysteine, and CRP (high sensitivity C reactive protein) in addition to the serum lipids. If you and your physician still decide you need to take a statin, add Co Q 10 to your supplements to offset some of the side effects of this drug.

Thursday, November 14, 2013

The SMART Ride 10

This is a departure from my typical blog format. It’s a discussion about my health and well being. On Friday, November 15th, my wife and I will get on our bikes and pedal from Miami to Key West for The SMART Ride. The course is 165 miles over the course of two days and is rated as the “best ride in Florida”. If you’ve ever driven the overseas highway to Key West you can imagine how beautiful it is viewed from a bicycle at 18 miles an hour.

The obvious health benefits of training for four months can not be overstated. I rode over 1500 miles in preparation for this event. My training was basically two spinning classes a week and a long road trip every weekend. On the road, I varied the mileage from 40 to 65 miles, gradually building my stamina, then giving my body a break by dropping the distance once every 3 or 4 weeks.

The spinning classes added intensity. I found using a heart rate monitor invaluable, in addition to monitoring my RPMs, calorie burn, and distance over time. My goal each class was to get my heart rate above my aerobic zone (> 130 bpm) but below my Vmax (159 bpm), my maximum recommended heart rate.

Setting goals and then developing a plan to reach those goals also has health benefits. It is an ongoing process that forces you to frequently evaluate your performance against the standard you have developed. Increased interaction between the mind and physical body has been shown to delay or even reverse senile dementia.

However, I believe the most important aspect of this kind of endeavor is the selfless act of giving. SmartRide 10 is a charity event that benefits those living in Florida with HIV/AIDS. We were required to raise a minimum of $1250 per person to qualify for this ride. The cost of the ride is totally underwritten so 100% of the donations each rider raises go to specific organizations approved by a volunteer board. Everyone knows someone affected by this disease. In my case, I just remember close friends of mine who died way too young as I watched them waste away. In my mind, I see them smiling at me in support of my efforts. That feeling of love and caring, of working to help others, does more for my health and well being, than all the exercise of a life time. How fortunate am I, to have found a way to put it all into one package? – SmartRide 10.

Wednesday, November 13, 2013

Inflammation – Friend or Foe?

A vast majority of medical care is aimed at reducing inflammation. It’s not just the anti-inflammatory drugs like cortisone, Aleve, and Advil. Pain killers, anti-histamines, like Benadryl, and even some chemotherapy drugs all target inflammation. Inflammation has five characteristics – pain, swelling, heat, redness of the overlying skin, and loss of motion. Reducing inflammation will improve some or all of these symptoms.

Inflammation is the body’s first response to injury. It is protective in nature, brings attention to the injury and forces you to support the healing process. Without inflammation, damage would continue unabated as evidenced by the progressive damage in leprosy. Lepers are unaware of minor injuries because of the infection in their nervous system (Hansen’s Bacillus). Simple cuts and bruises go unattended causing the severe damage that horribly disfigures the victims.

Today, however, inflammation runs unchecked. Our bodies are losing the basic chemistry designed to curb and control inflammation. There are six well identified inflammatory pathways in the human body. Prostaglandins (PG2) are the most common. When an injury occurs, arachadonic acid is released by the damaged cells. This produces PG2 both in the injury site and in the liver to stimulate body wide inflammation. Once the inflammation has served its purpose, the body releases other prostaglandins (PG1 and PG3) to reduce the inflammation. PG1 & 3s are made by the body from essential fatty acids, PG1 from omega 6 fatty acids and PG3 from omega 3 fatty acids. They are considered essential because we can not manufacture omega 3 and 6 fatty acids in our body. They must be in the diet. However, omega 3 fatty acids are the most common nutritional deficiency in the US today. Although we still have a lot of omega 6 fatty acids in our diet, common health issues have altered the chemistry of the body. Most of us now convert healthy omega 6 fatty acids into arachadonic acid, creating more inflammation rather than less.

The overuse of NSAIDS, like Aleve and Advil compounds this problem. NSAIDS block PG2 reducing inflammation. However, within 3 days of use, they also block the PG1 and PG3 series that control inflammation. The result – 16,500 people in the US die every year from the unbridled inflammation caused by taking NSAIDS. Most of them bleed to death internally, the rest die from liver failure or heart attack.

Red meat used to be a source of omega 3 fatty acids. But when you feed cattle grains rather than grass, they can no longer produce omega 3 fatty acids. The same thing has happened to farm raised fish. Tilapia contain little or no omega 3 fatty acids because they are raised on corn meal.

Taking 2,000mg of omega 3 fatty acids every day can be a great benefit. Avoid NSAIDS. If they must be used limit the use to three days or less and increase your omega 3 fatty acids. If you have any signs of metabolic syndrome – overweight, insulin resistance, high blood pressure, or high serum lipids, consider talking to your doctor or nutritionist about taking some sesame seed oil daily. This will block the conversion of omega 6 fatty acids into PG2 and encourage production of PG1.

Monday, November 11, 2013

Evidence Based Medicine

Healthcare Leadership Forum Examines Implementation of Evidence-Based Medicine in Daily clinical Practice.
October 29, 2013 – Philadelphia

Evidence based medicine (EBM) is a common catch phrase used by physicians when discussing patient procedures and outcomes. What does it mean and how is it currently used by your doctor? EBM evolved from clinical epidemiology in the 1980s. In 1996, David Sackett, MD, wrote that “evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” This definition has since been adopted by major health organizations.

Evidence-based decision making certainly has a place in clinical practice. However, it is only one side of a triangle that forms the cornerstone that drives daily practice decision making. The second aspect is clinical experience and the third, and in my opinion, most important is patient preference. Unfortunately, these last two factors are often ignored or even belittled in consultation with health care providers.

Since the use of the term EBM became widespread, I find physicians using it as a blockade to avoid entertaining alternative therapies. The term for this behavior is hypocognition (the absence of a simple, consolidated mental framework that new information can be placed into). Vitamin D is a classic example. Several years ago a well constructed, double-blind, placebo controlled study was performed using a once a week dose of 50,000IU of vitamin D. The study showed good benefits from vitamin D supplementation and has become the “gold standard” for prescribing vitamin D. Every week in my practice, I see patients taking this massive overdose of 50,000IU of vitamin D, once per week, prescribed by their physician. They come to me with multiple joint pain, muscle pain, and muscle spasm. If this practice is questioned, the immediate response is “that’s evidence-based medicine” because that’s what was done on the study. The physician never asks why the study was constructed is this manner or if this protocol is safe or effective for the patient, because it’s EBM and is now the standard of practice.

In truth, the massive, once-a-week dose was done for the sole purpose of making it possible to actually monitor the test subject to ensure that they swallowed the pill. Daily doses of a more reasonable, safer, better utilized vitamin D supplement just were not practical for study purposes. The Nutrition Board recommends doses up to 4,000IU per day without laboratory testing and confirmation of serum levels of vitamin D to recommend daily dosing above 4000IU. That is a simple framework to incorporate the knowledge gleaned from this landmark study.

Your preference as a patient is a least as important as the evidence-based recommendation by your physician. Stand your ground and ask them to relate their recommendation to their clinical experience and your specific situation. If they can not do both, then seek another opinion.

Wednesday, November 6, 2013

Testosterone Treatments Linked To Heart Risks

USA Today reports on a recent study published in the Journal of the American Medical Association.
November 6, 2013

Testosterone treatments may increase risks for heart attacks, stokes and death in older men with low hormone levels and other health problem, a big Veterans Affairs study suggests.

The results raise concerns about the widely used testosterone gels, patches, or injections that are heavily marketed for low sex drive, fatigue and purported anti-aging benefits, the authors and other doctors said.

Men who used testosterone were 30 percent more likely to have a heart attack or stroke or to die during a three-year period than men with low hormone levels who didn’t take the supplements. Hormone users and nonusers were in their early 60s on average, and most had other health problems including high blood pressure, unhealthy cholesterol and diabetes.

This is not the first study to show increased risk from using testosterone as HRT (hormone replacement therapy). It’s making big news because of the dramatic increase in prescriptions for testosterone in the past few years. Over 5 million men used testosterone in the US with sales totaling 1.6 billion dollars in 2011. Just look at the recent television ads and you know those numbers are much higher today.

More than 50% of men over the age of 45 suffer some form of sexual dysfunction. This is really a statement about our declining health as a nation and the generally accepted idea that we can just cover up some of the symptoms with drugs (in this case hormones) and the problem will go away. As men age, testosterone production shifts from the testicles to the adrenals. However, many men do not have the good general health to make the transition. Long term adrenal stress, poor liver function, and subclinical hypothyroidism are behind this and many of our chronic, degenerative diseases. Metabolic syndrome is the name given to the list of predisposing factors that ultimately lead to diabetes, heart disease, and death.

Several herbs are commonly used to support healthy adrenal function. Clinical studies have showed marked improvement in both testosterone and sexual function with the use of Tribulus, Korean Ginseng, Ashwaganda, and Rehmannia. The South American herb Maca also shows great promise, but needs more research. These herbs are all adaptogens, not only supporting repair and regeneration of the adrenal glands, they also repair DNA as shown by DNA fragmentation studies on human sperm.

If you suffer from low testosterone levels, have an evaluation with a qualified nutritionist. First address your general health. It’s quite possible that improving your health will resolve the hormone deficiency.

Tuesday, October 22, 2013

Vitamin D Supplements Do Not Improve Bone Health?

According to a new study published in the The Lancet, adults taking vitamin D supplements did not improve their overall bone mineral density, reports Medical News Today. Researchers from the University of Auckland in New Zealand analyzed data from 23 studies involving 4,082 healthy adults with an average age of 59. They found that adults who took supplements of vitamin D for an average of two years did not see any improvements in their bone health, apart from a small increase in bone density around their femoral neck. “Most healthy adults do not need vitamin D supplements,” said lead author Ian Reid from the University of Auckland.

First and foremost, bone density does not measure bone health. Dense bone is often old, brittle bone as exemplified by all the hip fractures caused by taking biophosphonates, like Boniva and Fosamax. These drugs preserve bone density by keeping the body from removing bone as it ages and preventing the body from forming new bone. Is this any way to treat osteoporosis?

Second, vitamin D has many, many functions in the body. It really is not a vitamin but a hormone. It is necessary for the absorption of calcium from the digestive tract, the first step to incorporating calcium into bone. However, there are many additional factors involved in calcium metabolism. Besides, bone is just a repository for calcium, which is exchanged continually with the blood stream to act as a buffer to control the pH of the blood. The real strength of bone comes from collagen, the protein matrix of bone that holds the calcium.

Third, vitamin D deficiency is epidemic, even in South Florida, where I practice, and the daily sun stimulates production of vitamin D in the skin. In the northern half of the United States, every winter a majority of the population is deficient from lack of adequate sunshine and poor diet. In my practice, it is the most common factor associated with an impaired immune system.

The nutrition board allows practitioners to recommend up to 4000IU per day of vitamin D, without any lab work to identify any deficiency. For supplementation above that level, laboratory testing is recommended.

Finally, the use of the prescription strength 50,000IU dose taken once a week is a dramatic overdose to the body. Unfortunately, many physicians have prescribed this dangerous dosage under the guise of “evidence based medicine”. They fail to understand that the study used a high, weekly dose only to monitor the test subjects. That is, in order to know that they were taking the supplement, they watched them swallow it every week. Daily monitoring just is not logistically feasible. In really, double blind, placebo controlled, crossover studies comprise only 1/3 of an evidence based practice, like mine. Another third is the practitioner’s clinical experience, and the final third (and most important) is patient preference.

Have your vitamin D level checked. The medical norms are 30-100, but I prefer levels above 40. If you are unwilling to test, then just supplement 2,000IU per day. That may not be enough, but it could very well prevent a chronic, life threatening illness.

Friday, October 18, 2013

The Blue Man Group

Paul Karasas, the “blue man”, infamous for his appearance on Oprah in 2010, recently died at the age of 62. He had a medical condition called argyria, caused by deposition of silver into the tissues that turns the skin blue. The controversy is the claim that the condition was caused by drinking colloidal silver and applying it to his skin. Silver has been used as a medical treatment for infection for literally thousands of years. Today silver is used in topical creams for infection, in several medications, and is required by law as an application to newborn infants eyes in most states.

Silver is a heavy metal and can be toxic. It is found is many forms, chemically bonded to acids such as silver nitrate (used on newborns) and silver chloride (used in film). Colloidal silver is made by passing a low electric current through silver electrodes in distilled water. This creates a microscopic suspension of solid silver molecules in the water that varies from about 5 to 10 parts of silver per million parts of water. I have successfully used colloidal silver in my practice for the past 20 years. Eye infections, outer ear infections (swimmer’s ear), sore throats, sinus infections, intestinal flu, and even vaginal infections respond well to direct application. I particularly like to use it in a Netti Pot for sinus infections. Personally, I keep a bottle on hand at all times. If I wake up in the middle of the night with a little sore throat, a simple 30 second gargle and swallow, and the sore throat is gone. I also recommend colloidal silver when patients have symptoms of both viral and bacterial infection, or maybe even a fungal element as well. The classic example is a “head cold that moves into the chest”. Often there are at least two different infective agents involved. Colloidal silver has anti-viral, anti-biotic, and even anti-fungal activity. There have been 4 recent studies showing colloidal silver to be effective against MRSA.

Dosage is the big issue. Colloidal silver is for occasional, intermittent use only. Paul Karasas admittedly drank 10 ounces of silver per day for 15 years. Some critics claim he used silver chloride, not colloidal silver. We may never know the truth about the “blue man”, but my entire family doesn’t use 10 ounces in a year.

Colloidal silver is safe, and very effective for treating a variety of infections. Like niacin, and omega 3 fatty acids, and most things, a little bit is good, too much can be an issue.

Friday, October 11, 2013

Tom Hanks Could Reverse His Diabetes

Type II diabetes is simply caused by a poor diet. In Tom’s defense, his dramatic weight fluctuations to meet the various roles he has played required terrible dietary practices. In gaining, or losing 30 pounds or more over relatively short spans of time, he has highlighted an exaggerated form of SAD (the Standard American Diet).

Americans just eat too much, too much of everything – protein, carbohydrate, and fat. Obesity rates, currently at 37 % nationally, are skyrocketing. Type II diabetes is also at epidemic levels and scientists predict about half the adult population of the United States will be diabetic by 2050, unless our eating habits change. Only one diet has been shown to increase longevity – reduced caloric intake. So Tom, you and the rest of the country have to start eating less.

Now let’s talk about food quality. It is estimated that early man, the hunter-gatherer, ate a bushel basket of fruits and vegetables per day. That seems like a lot of food, but it was not a lot of calories. These foods were high in fiber and much of the material passed through as undigested bulk. Today, the bulk of our diet is refined carbohydrates, devoid of insoluble fiber, and loaded with calories. These simple sugars rush into our blood stream and tax our pancreas and liver, dismantling our ability to manage blood glucose levels.

The solution is quite simple – I recommend 5 servings of vegetables each day, 2 fruit servings, and 3 servings of protein. If Tom (and the rest of the nation) would just meet these simple goals daily, there is little room for the refined foods and they drop away from the diet. Unfortunately, when I review food journals in my practice, I often find diets that average less than one serving of fruits or vegetables per day. The protein intake is usually adequate, unless the patient is trying to lose weight, then they typically will restrict the protein intake as well, piling on more refined carbohydrates. Then they wonder why they can’t lose weight.

Early detection of diabetes is where you need to start. It is not enough to test your fasting glucose. That just shows how well your body manages glucose without the stress of adding any calories from eating. Everyone should have a glycohemoglobin A1c performed yearly. This test measures what percentage of your RBCs (red blood cells) are saturated with sugar. The A1c tells us what your blood sugar has averaged over the course of the past two months. Tom Hanks A1c has been elevated for years prior to his diagnosis of Type II Diabetes. Yours may be elevated as well. Every week I see young adults with early signs of diabetes, all undetected, all unaware of the devastating disease they are creating by eating SAD.

Wednesday, October 9, 2013

Vitamin B12 – Are You Deficient?

In a word, YES, you may very likely be deficient in vitamin B12. The most common food source is red meat. So if you are a vegetarian, or limit your animal foods to fish and chicken, you need to supplement. But even if you are an “all American red meat eater”, a real carnivore, the odds are pretty high that you are still deficient.

Much has been written about how hard it is to absorb B12. You need adequate HCl (depleted by Prilosec and all the other protein pump inhibitors). You need intrinsic factor and healthy epithelial lining in the small intestine. While these are significant issues, the real issue is conversion.

The food form of vitamin B12 is cyanocobalamin. If all the factors listed above are working and B12 is absorbed into the lining of the small intestine, it must be converted to one of the bio-available forms to be used by the body. Methylcobalamin and adenocobalamin are the two bio-available forms that are produced by those small intestine cells. Once converted, both forms are released into the blood stream and go to work. Vitamin B12, folic acid, and vitamin B6 are involved in many, many chemical pathways in the body.

The ability to convert vitamin B12 is controlled by our genetics and unfortunately many of us have a genetic impairment that limits or prevents us from converting B12. Eight percent of the population have inherited a defective gene from both parents and will never make the conversion. These patients are easy to identify as they are always be anemic (have a low red blood cell count, low hemoglobin, or low hematocrit) because B12 is necessary to make red blood cells. The more common issue is the person who inherited a defective gene from just one parent. Sometimes they can convert B12, sometimes not. If they are under stress from illness, poor diet, lack of exercise, long work hours, etc., they may not convert B12. Twenty-five percent of the population is afflicted with this genetic defect. That’s one of every four people!

So, looking at all the issues with vitamin B12, it’s a pretty good guess that you are deficient. Not quite 50/50, but close. Fortunately, the solution is quite easy. The bio-available forms of B12 – methylcobalamin and adenocobalamin are readily available in supplement form. You can also take a sublingual form that is absorbed without passing through the digestive tract. Clinically, I find that that supplementing the patient with partial impairment for 30 days will often restore normal conversion, eliminating the need to supplement.

Let’s discuss B12 shots briefly. Most of the injections contain cyanocobalamin, the food quality form. When you inject the food quality form into the tissues of the body, where does the conversion occur? The vitamin never has an opportunity to be converted by the cells of the small intestine. All injections of B12 should be either methyl or adenocobalamin, not cyanocobalamin.

If you look at your last blood test, the lab probably ran a CBC (complete blood count). It’s a common lab test. If the RBC count, hemoglobin, or hematocrit are low, you might need more vitamin B12. If the MCV (mean corpuscular volume) is above 92, you are probably deficient in B12 and/or folic acid.

Saturday, October 5, 2013

100 Glasses of Wine on the Wall, 100 Glasses of Wine

Everyday we all read about new studies in health and what they might mean. Much of the information is conflicting and often creates more confusion than insight into health and human body. So I’ve decided to start blogging to bring some order to the chaos. So I invite you to read along, comment, criticize, and question. Health is a journey, not a destination, so let’s start shall we?

Resveratrol and exercise is no country for old men, research claims.
July 22, 2013
A new research study by scientists at the University of Copenhagen published today shows that resveratrol reduces the cardiovascular benefits of exercise in men over 65 years of age. This conclusion is based on a eight week study of 27 healthy, physically inactive men around age 65. During the eight weeks all the men performed high-intensity exercise. Half the men took 250mg of resveratrol daily; the other half took a placebo.

The study was double blind so neither the participants or the researchers knew which received the resveratrol or placebo. The researchers concluded that exercise training was highly effective in improving cardiovascular health parameters, but the resveratrol attenuated the positive effects of training on several parameters including blood pressure, plasma lipid concentrations, and maximum oxygen uptake.

They theorized that the lack of anti-oxidant activity as a result of taking resveratrol might reduce triggers for tissue repair and improvement.

Double blind placebo studies are, in general, valid. Adding cross-over (reversing the placebo with the resveratrol for another eight weeks) would have increased validity. However, I see two major flaws in this study. First, a glass of wine contains about 2.5mg of resveratrol. So, 250mg is the equivalent of 100 glasses of wine daily! Obviously, there was no alcohol involved but how could anyone possibly achieve those kinds of levels in their daily diet? This is a common theme in health care – If a little bit is good, a lot will be a lot better. Vitamin B3 – Niacin is very effective at reducing serum lipids and especially the L(p)a marker genetically linked with coronary risk factors. That is, if the dosage is between 100 and 500mg daily. However, prescription strength niacin (2500mg) had to be pulled from the market as it was causing, not preventing heart attacks. When you take any nutrient at an extremely high levels, it can act much like a drug, forcing profound chemical changes in the body, with unfavorable or even life threatening results.

Second, all chemical reaction in the body is oxidation. The chemical term is Redox Reaction. One chemical, like vitamin C, gives up an electron to another molecule, like vitamin E. The vitamin E is “reduced” and vitamin C is oxidized to a “free radical”. This allows the vitamin E to act as an anti-oxidant and now donate and electron to reduce another free radical. A lack of anti-oxidant activity is death to the body.

Resveratrol is an important phytonutrient, have some. Have a glass of red wine with dinner on occasion. Maybe take a supplement that contains a little resveratrol, like grape seed extract.

Thursday, October 3, 2013