Wisdom Wednesday: ‘Good’ Cholesterol Might Be Bad Too

HDL cholesterol may be known as the “good” kind, but a new study suggests high levels of it are not always a good thing for women after menopause.

The study, of nearly 1,400 postmenopausal women, found that those with higher HDL levels were more likely to show “plaques” in their carotid arteries. Those arteries supply blood to the brain, and plaque buildup there signals an increased risk of both stroke and heart disease.

“We used to think, the higher the better,” said Dr. Karol Watson, director of the Women’s Heart Health Program at the University of California at Los Angeles. “But we’ve been rethinking HDL in recent years.” Watson, who was not connected to the study said “everyone agrees” that low HDL – below 40 mg/dL – is bad. But studies have also found that very high HDL is liked to trouble, too. For example, a 2016 study of over 630,000 people found that women and men with very high HDL – above 90 mg/dL – were more likely to die (of noncardiovascular causes) during the study period than those whose HDL was in the middle of the pack.

HDL is known as the “good” cholesterol because it does positive things, including clearing fat from the arteries and ushering it to the liver to be removed. But, Watson said, research suggests that HDL function can go awry when its environment is not ideal – such as when a person is obese or has diabetes or other health conditions causing chronic inflammation in the blood vessels. “HDL seems to be like a chameleon, changing based on its surroundings,” Watson explained.

Do Nightshade Vegetables Make Arthritis Worse?

Nightshade foods contain solanine, a chemical which some people believe may aggravate arthritis pain and inflammation. The Arthritis Foundation say that his is not true. However, if a person feels that certain foods trigger their arthritis symptoms, including nightshades, they should avoid these foods.

Nightshade vegetables are part of the plant family Solanaceae. Some species are toxic, including the belladonna plant, which is also called deadly nightshade. Other species are commonly cultivated and eaten by humans. Common nightshade vegetables include white potatoes, tomatoes, eggplant, bell peppers, cayenne pepper and paprika.

Solanine is found in trace amounts in potatoes and is normally safe, though the leafy stalks of the potato plant and green potatoes are toxic, and solanine poisoning has been reported from eating green potatoes.

A person may be allergic to one or more nightshade vegetables if they experience the following symptoms shortly after eating them: hives or a skin rash, shortness of breath, wheezing, coughing, tightness of the throat, pale skin, and anaphylaxis.

Nightshade vegetables are excellent sources of nutrition, and no research to date has linked them specifically to increased inflammation or other symptoms of arthritis. A person should speak with a dietitian if they are concerned about the effects of a particular food on their health.

My Take:
Nightshades are the fifth most common food allergy I find clinically. Only wheat, dairy, soy and corn test positive more often. They are a weird group of foods because the common link is the presence of solanine not their appearance or use in the diet.

Wisdom Wednesday: Coronary Risk Assessment

Most PCP (primary care physicians) and too many cardiologists prescribe statin drugs based on the total cholesterol and LDL levels. However, there are a couple of additional lab tests that can really define your cardiac risk factors. Three of these tests, the CRP, fibrinogen activity and homocysteine are included in my routine testing. The fourth, the L(p)a I run when I suspect that my patient’s elevated cholesterol is genetic (familial hypercholesterinemia).

The high-sensitivity C-reactive protein (CRP) measures inflammatory proteins in the blood. It is fairly specific for artery inflammation but dental issues and other vascular inflammatory conditions can also elevate the test. As I have reviewed in many previous blogs, artery inflammation is the real trigger for cardiovascular disease.

The normal range for CRP is 0.0 – 3.0, but levels less than 1.0 indicate low future risk of a cardiovascular event. Statin drugs actually do lower CRP and, in fact, that is why they do reduce the risk of CVA slightly. However, I believe there are better ways to lower CRP without the potential side effects associated with statin drugs.

Nattokinase, a protein extract from Japanese fermented soy, is excellent at reducing the CRP. It was discovered in 1980 by Dr. Sumi who looked at 173 different foods that seemed to reduce clots in the circulatory system. Generally, two capsules per day for three months will bring the CRP within medical norms.

Fibrinogen is a protein necessary for clot formation. The fibrinogen activity test is most commonly run to evaluate bleeding disorders. The normal range is 193-507 mg/dL. It’s levels below 193 that are associated with delayed clotting. However, levels above 507 are associated with cardiovascular disease. There is no known medical treatment to lower fibrinogen but my clinical experience has been that treating the other factors often results in a drop in the fibrinogen activity as well.

Homocysteine is in intermediate metabolite in the sulfur amino acid pathway. The normal levels are 0-15 umol/L. However, healthy levels are below 8. Homocysteine attaches to the LDL particle under the influence of fibrinogen, forming plaque against an inflamed artery wall when CRP is elevated. So medically, homocysteine is used to assess cardiovascular risk.

Proper conversion of homocysteine back to methionine is dependent on the active forms of folic acid and vitamin B12, so it is also used to evaluate potential folic acid and/or B12 deficiency. Conversion to cysteine is dependent on the active form of vitamin B6 yet the test is rarely considered an indication of B6 deficiency.

Can Frankincense Treat Cancer?

Frankincense oil is derived from the Boswellia tree. It has a long history in myth and folk medicine. In the Bible, it is one of three gifts offered to Jesus by the wise men, possibly because of its apparent healing powers.

Some supporters of herbal medicine argue that frankincense offers numerous health benefits. These supposed benefits include controlling bleeding, speeding up the wound-healing process, improving oral health, fighting inflammatory conditions such as arthritis, and improving uterine health.

Its most promising use may be as a cancer treatment. Cancer is a leading cause of death, killing 8.2 million people worldwide in 2012. Current research on the effectiveness of frankincense is limited, but early results are promising.

A 2006 study published in Planta Medica uncovered a number of ways the boswellic acid in frankincense might fight infection. Boswellic acid inhibited 5-lipoxygenase, a chemical involved in inflammatory processes. Researchers also found that boswellic acid might target free radicals and cytokines. Both of these play a role in inflammation. By disrupting inflammatory processes, frankincense could stop cancer before it starts.

The anti-inflammatory properties of frankincense suggest that it might also be effective in the treatment of diseases such as Rheumatoid arthritis, Crohn’s disease, Bronchial asthma and ulcerative colitis.

Some evidence suggests that frankincense might target cancer cells directly without harming health cells.

A 2009 study of bladder cancer studies how frankincense affected cultures of normal and cancerous bladder cells. The oil targeted cancerous cells, but it did not destroy healthy cells.

A 2015 study found similar effects in breast cancer. The researchers found that frankincense could kill breast cancer cells and disrupt the growth of future cancer cells.

Back Pain Patients Seek Pain Relief First, Mobility Second

When asked to choose between a treatment that would reduce back discomfort and one that would help them stand and walk, the vast majority of patients wanted to ease their pain, a new study found.

“There has long been a debate in the medical community over striking the right balance between pain relief and physical function,” said the study’s lead author, Dr. John Markman, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery in Rochester, N.Y.

“While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief,” Markman said in a university news release.

The study’s authors focused on nearly 270 patients who had trouble standing and walking and suffered from chronic back pain associated with lumbar spinal stenosis. The participants were asked to choose between a therapy that reduced their pain and one that would enable them to stand and walk. Nearly 80% of the patients said they would rather have relief from their pain than greater mobility, the study published recently in Neurology found.

“Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief,” said Markman.

The authors pointed out patients are playing a greater role in setting new standards for pain relief, demanding new medications that are both safe and effective.

Worse Psoriasis, Less Healthy Arteries

The skin disorder psoriasis appears linked with artery inflammation, raising the odds for heart disease, a new study says.

“As the amount of psoriasis increases, the amount of blood vessel inflammation increases,” said senior investigator Dr. Nehas Mehta, a clinical investigator with the U.S. National Heart, Lung, and Blood Institute.

His team also found that even mild psoriasis may indicate an increased risk for heart attack and stroke.
Just one psoriasis skin patch, or plaque, “might be biologically active, causing low-grade inflammation and starting a cascade, speeding up their blood vessel disease,” Mehta said.

“People really should know that psoriasis is not just a cosmetic disease,” he added.

Psoriasis is a chronic disease that affects about 3% of U.S. adults. It occurs when skin cells grow too quickly, causing thick, white or red patches of skin.

Blood vessel, or vascular inflammation is most likely the direct result of psoriasis, not treatment, Mehta said. Treating psoriasis may lower the risk for heart attack and stroke, he said. Mehta advises people with psoriasis to lower their risk of heart disease by controlling traditional risk factors.

“Avoid smoking, try to maintain a healthy lifestyle, including moderate exercise and a balanced diet,” he said. “You should also have your blood pressure, cholesterol and blood sugar checked. Try to do that, because psoriasis itself might be a risk factor.”

During Menopause, ‘Good’ Cholesterol May Lose Protective Effect on Heart

HDL cholesterol is commonly called the “good” cholesterol, but new research suggests that it could be harmful to women going through menopause.

The new study finds that rather than helping to inhibit the formation of dangerous plaque in the arteries, HDL cholesterol may increase its buildup during menopause. This process is known as hardening of the arteries, or atherosclerosis, and can lead to heart trouble.

“This was surprising,” said lead researcher Samar El Khoudary, an assistant professor of epidemiology at the University of Pittsburgh.

“We know that the good cholesterol is supposed to protect women,” she said. And, before menopause, good cholesterol does help protect against heart disease, El Khoudary said.

But during menopause, HDL cholesterol seems to add to the plaque buildup. She explained. “This was independent of other factors such as body weight and levels of bad cholesterol,” El Khoudary said.

It’s not clear why good cholesterol may turn bad, she said. “There are many biological changes that happen to women during the menopausal transition,” she said.

Among these changes is the addition of fat to the abdomen and around the heart. “This could put women in a state of chronic inflammation that could change the good cholesterol,” El Khoudary suggested.

Wisdom Wednesday: Inflammation – Part 4

Insulin, the hormone produced by the pancreas to escort glucose into the cells of the body, can stimulate inflammation. It is the most insidious inflammatory pathway and very difficult to reverse.

Most cells in the body require adequate insulin in the blood stream to facilitate glucose absorption. However, a majority of Americans are now insulin resistant. They eat too much and too much of the wrong foods – refined carbohydrates. As the pancreas increases the output of insulin to control glucose levels, the body slowly becomes insulin resistant. This occurs long before the eventual diagnosis of Type II diabetes. It is estimated that by the year 2050, over half of all Americans will be diabetic.

Today, many of these young Americans are already insulin resistant and pre-diabetic. The systemic inflammation caused by excess insulin production is evidenced by our inability to process omega 6 fatty acids, like olive oil.

Most nutritionists recommend against supplementing omega 6 fatty acids. They claim that the omegas 6’s are abundant in our diet and that they can be pro-inflammatory. Although both of those claims are true, I disagree with their recommendations. First, the omega 6 fatty acids in our diet need to be converted to GLA (gamma linolenic acid) and many people can not make that conversion. Secondly, it’s only the people who are insulin resistant that take healthy omega 6 fatty acids and convert them to inflammatory compounds. I recommend fixing the chemistry rather than denying the body an essential fatty acid. Essential means just that, your body can not make it, it is essential to the diet.

The key, of course, is cleaning up the diet, reversing all the factors associated with metabolic syndrome – central obesity, high blood pressure, low thyroid function, high serum lipids, and insulin resistance. In the meantime, the addition of sesame seed oil, and possibly GLA, to the diet will support healthy utilization of omega 6 fatty acids and effectively block the conversion to inflammatory compounds.

I have seen uncontrolled type II diabetics, on multiple medications, cut their medication by 75% with the simple addition of sesame seed oil and GLA, while reducing their blood sugar levels from over 250mg/dL to 85mg/dL in less than 3 weeks. Simultaneously, their inflammatory complaints – IBS, musculoskeletal pain, headaches, etc. also improve markedly.

In my office, as soon as I see impaired chemistry on the omega 6 fatty acids, I suspect insulin resistance as the cause. Fortunately, the glycohemoglobin A1c is a simple blood test that tells us what your blood sugar has been averaging for the past 60 days. I mention this test often in my blogs and I advise you to have this test run annually.

THE BOTTOM LINE:
Diabetes is epidemic in our county and is not only preventable, but often time’s reversible. The vast majority of pre-diabetics are undiagnosed. The odds are at least half of you reading this blog are pre-diabetic. Get an A1c performed. If you have any of the characteristics of metabolic syndrome and you suffer from inflammation, chances are your pain is being driven by insulin.

Wisdom Wednesday: Inflammation – Part 1

Regardless of what symptoms you have, inflammation is the key component. I frequently tell my patients, “if I had a magic wand and waved it to get rid of your inflammation, 80% of your symptoms would be gone.” There are several known chemical pathways for inflammation in the body. I will review the first three in this blog and cover the remainder in subsequent posts of Wisdom Wednesday.

The most common form of inflammation in the human body comes from prostaglandin production. At the site of injury, prostaglandins are released from damaged cells. The liver responds to this and releases large amounts of prostaglandins that promote systemic inflammation. That is why you often will “hurt all over” after a localized injury.

Typically musculoskeletal injuries, whether chronic or acute, will follow this prostaglandin pathway. NSAIDS (non-steroidal anti-inflammatory drugs) like Advil, Aleve, and aspirin block the prostaglandin pathways, reducing inflammation, and often providing relief. Unfortunately, they also block the prostaglandin anti-inflammatory pathways that omega 3 and omega 6 fatty acids follow. When taken for more than three days, these drugs interfere with cell membrane production and repair. With chronic use, GI bleeds, liver failure and heart attacks can occur. Several studies have documented that a minimum of 16,500 people in the US die each year from taking NSAIDS. Less than a third have any warning signals.

Omega 3 fatty acids often will block prostaglandin inflammation. I believe that the rampant inflammation seen in this country is due, in part, to omega 3 fatty acid deficiency. It is rated as the most common deficiency in America. Sometimes, omega 6 fatty acids are also necessary to block prostaglandin inflammation. However, if you have any of the attributes of metabolic syndrome (see earlier blogs), your body often will shunt the healthy omega 6 fatty acids from the anti-inflammatory pathway to make even more inflammatory prostaglandins.

A slightly less common inflammatory pathway is governed by leukotrienes and cytokines. When these chemicals are released from injury sites, they stimulate the immune system rather than the liver. The immune system then releases large amounts of leukotrienes and/or cytokines to promote systemic inflammation. This is a common occurrence in auto-immune diseases like rheumatoid arthritis, psoriasis, and Crohn’s Disease. NSAIDS have no effect on these inflammatory compounds. In fact, when NSAIDS block prostaglandins and the injury is not resolved, the body often defaults into the leukotriene/cytokine pathway. That is why NSAIDS often stop providing relief with continued use. Fortunately, leukotrienes and cytokines often will be reduced by two common herbs – ginger and boswellia.

Approximately 1500 herbs are used medicinally world wide. Of these, only 80 have had really good research. Both boswellia and ginger are part of those elite 80.

Ginger works by denaturing an enzyme called lipoxygenase. Lipoxygenase is required to form both leukotrienes and cytokines. Boswellia has an effect of the vagus nerve that results in reduced leukotrienes and cytokines. It is also often very effective in relieving asthma. In my office I prefer the ginger as it is inexpensive and easier to administer. Boswellia is quite expensive and must be taken with fat to be properly absorbed.

THE BOTTOM LINE:
If you suffer from inflammation, and I know you do, try supplementing omega 3 fatty acids. Chances are you are deficient anyway – it’s not in your diet anymore. If you have any factors associated with metabolic syndrome – central obesity, high blood pressure, high serum lipids, low thyroid function, or insulin resistance – limit your omega 6 fatty acid intake. Consider adding sesame seed oil to your diet. That will help block the conversion of healthy omega 6 fatty acids to inflammatory prostaglandins.