Happy Healthy Long Life

Concerned About Brain Health, Alzheimer's or Dementia? Some Q & A with Dr. Randolph Schiffer of the Cleveland Clinic Lou Ruvo Center for Brain Health

"What looks to me now, based on the science we have, what really counts in your 40's  is to maintain a well integrated life of moderation, intellectual growth, and physical activity and you will probably reduce your risk substantially for Alzheimer's Disease."

-Dr. Randolph Schiffer, Director, Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, NV-

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Lucky me.  If I hadn't switched my work schedule, and decided to go to that early Monday morning yoga class I never would have had the chance to hear Dr. Randy Schiffer's NPR/WCPN interview on the Prevention of Alzheimer's Disease and Dementia.  Anything I can do to protect my brain is something I want to hear about.   Click here if you'd like to listen to the interview.

The Lou Ruvo Center for Brain Health was built as a center for the research, treatment, and prevention of brain diseases--and Schiffer is at the forefront of treating the earliest stages of dementia--what's known as Age-Associated Cognitive Impairment (AACI) and Mild Cognitive Impairment (MCI)--and preventing their escalation into Alzheimer's Disease and dementia.

So, Here You Go.  Q & A on Brain Health with Dr. Randolph Schiffer

If I Have Alzheimer's Disease in My Family History What Can I Do Now to Prevent It?

The best thing you can do is work on improving your cardiovascular risk factors

• Get regular physical exercise
• Get your blood pressure under control
• Get your cholesterol levels to a healthy number
• Get your blood glucose levels to a healthy number
• Improve your diet with lower fat, increased fruits & vegetables, increased anti-oxidants and phytonutrients

What's the connection between cardiovascular risk factors and brain health?

Cardiovascular diseases and the Alzheimer/brain diseases share similar blood vessel pathologies.  OK, Schiffer admits we lack the exact kind of science we'd like to have concerning this connection--but the science is extensive showing that risk factors like elevated blood pressure, elevated blood glucose, and elevated cholesterol are all robust predictors of cognitive impairment.  What the Ruvo Center hopes to determine is a direct correlation between lowering these risk factors and lessening dementia.

Tell me more?  What's the connection between the tiny blood vessels in the brain & Alzheimer's?

In the old days doctors said dementia was caused by "hardening of the arteries", and then that went out of fashion.  In fact, years ago, Schiffer snickered at that explanation.  He's not snickering anymore.  We now know that Alzheimer's is partly driven by the pathology of the tiny blood vessels of the brain. 

Here's what happens.  Think inflammation & oxidative stress in the brain.  In early Alzheimer's there are a number of changes in the brain that are caused by the body trying to fight off free-radical damage and oxidative stress--and this results in inflammation of the blood vessels of the brain--which leads to brain cell damage.  And the causes of this inflammation in the brain's blood vessels are the same as the causes of inflammation in the cardiovascular system.  What's good for the heart is good for the brain.  Think exercise, blood glucose control, blood pressure control, and eating foods high in antioxidants.  Click here to read more about lowering inflammation.

What else can I do to control the risk of getting dementia or Alzheimer's in addition to controlling cardiovascular risk factors?

• Keep physically active
• Keep mentally active in a way that causes you to learn new tricks & new information
• Avoid depression--or get it treated.  Depression later-in-life correlates with twice the risk of developing Alzheimer's
• Maintain your social networks  Click here to read more
• Drink some red wine in moderation  (OK red wine is high in polyphenols, and there is lots of research to back this up, but I'm wondering if it's a bit of a coincidence that this is the only "food" Dr. Schiffer mentions, and the fact that the Ruvo family is Nevada's largest wine, spirits, beer, and beverage distribution company)

Is there any connection between toxins in the environment and Alzheimer's?

Schiffer says no.  The old aluminum theory originated by Linus Pauling over 30 years ago is history.  Turns out that yes, there is increased aluminum in some of the plaques and tangles of the Alzheimer's brain--but now we know that aluminum just "goes into areas of injury".  It isn't the cause of the injury.  It also appears in the brains of stroke patients, and in brain tumors.

Schiffer also doesn't think it's likely that BPA from plastics is a player in Alzheimer's.  I have heard Alzheimer's expert Dr. Peter Whitehouse propose the theory of lead as a cause of Alzheimer's, and the research is compelling.  Click here to read more.

What about the "plaques and tangles" theory of Alzheimer's?  Isn't that the cause of dementia?

Yes, plaques and tangles were the oldest objective evidence that Alzheimer's was a neurological disease, and they've seen for years.  But, even though they are a partial marker of "risk" for Alzheimer's--here's the problem with the "plaque-and-tangle" theory.   Many people will die and have a brain full of plaques and tangles, and still have normal cognition.  Some people will have full-blown Alzheimer's and have very few plaques and tangles.  According to Schiffer, the relationship between those traditional Alzheimer neuro-pathologies and the clinical disease is not very strong.

Tell me more about how learning new things can help prevent Alzheimer's?

Schiffer says you need to make sure you engage in some kind of lifelong learning process--learning new tricks causes the brain to add new synapses, it produces new brain cells, and it enables new regions of the brain to acquire new functions.

Here's a big tip:  If the the learning isn't difficult it won't work.  So quit complaining & stretch yourself outside of your comfort zone.  

Here's how learning something new changes the brain:  The 2nd Nobel Prize ever won in the field of psychiatry was awarded a few years ago for the discovery of how the brain cells in snails change when they learn something new.  Now snails only have 8-12 brain cells, but when they learn something new the firing pattern of their brain cells changes in a structural way--just like putting a new software program  into a computer.

There are fixed measurable changes that occur when you learn new things, and it's thought that in the earliest stages of Alzheimer's these network connections of brain patterns--how the cells talk to one another--are the first brain connections to start failing.  The theory is that strengthening these connections, and building new networks will stave off cognitive decline

Read my "Stretching in St. Louis" post to see what Dr. Schiffer is talking about.   And Dr. Norman Doidge's quote about middle-age that I posted 2 weeks ago bears repeating:

"We rarely engage in tasks in which we must focus our attention as closely as we did when we were younger, trying to learn a new vocabulary or master new skills.

Such activities as reading the newspaper, practicing a profession of many years, and speaking our own language are mostly the replay of mastered skills, not learning.

By the time we hit our seventies, we many not have systematically engaged the systems in the brain that regulate plasticity for fifty years.

That's why learning a new language in old age is so good for improving and maintaining the memory generally.  Because it requires intense focus, studying a new language turns on the control system for plasticity and keeps it in good shape laying down sharp memories of all kinds.  And it keeps up the production of acetylcholine and dopamine.

Anything that requires highly focused attention will help that system--learning new physical activities that require concentration, solving challenging puzzles, or making a career change that requires that you master new skills and material."

How far do you have to go with learning new things?  What about learning a short poem, or learning about science from an interview like this?

According to Dr. Schiffer, we know it has to be something challenging, but everyone is different.  The key thing is that it has to be "active" learning, and it has to be in a new area--you have to push your brain to learn something new.  Right now the Ruvo Center is working on research to figure out which learning tasks are the best to improve specific memory deficits.  They're now using prescriptive learning tasks in visual memory, word recall, auditory recall, and in complex story reading.  To learn more about "cognitive training" check out the work of Dr. Michael Merzenich--a leader in the study of brain plasticity & a developer of "brain training" software--click here.

What's Different About the Treatment Approach at the Lou Ruvo Center?

The Center takes a multi-modal approach to treating early dementia.  It's dedicated to the proposition that cognitive brain disorders of later life are treatable--and the Center's purpose is to improve upon those treatments.

• Medication when appropriate
• Lowering cardiovascular risk factors like high blood pressure, cholesterol levels, obesity, elevated blood glucose levels
• Incorporating physical exercise
• Targeted cognitive strengthening exercises based on an individual's particular weaknesses--similar to strengthening weak quadriceps.
• Treatment of depression when appropriate
• Nutritional counseling

What's the Typical Work-up When Someone Comes to the Center Complaining of Some Memory Loss?

• The first step is determine a correct diagnosis, even though Alzheimer's is the most common cause of memory loss.
• The standard evaluation is an old-fashioned clinical history and physical examination.  This also includes a cognitive assessment battery, and some screening laboratory tests.
• According to Dr. Schiffer, even though the Center makes use of advanced brain imaging & technologies, in the early stages of Age-Associated Cognitive Impairment and Mild Cognitive Impairment, imaging will unlikely show any changes.  This is a slow acting disease, and imaging falls far short of the sensitivity of a good history and physical examination.
• When the diagnostics are complete, the staff has a consensus meeting to determine the diagnosis and the best approach to treatment.
• Schiffer believes that these disorders are treatable & there's ample evidence to support treatment with a multi-modal approach.

How do you know when an aging parent--or yourself--is having "abnormal" memory problems?

By the way, Schiffer says that now that he is losing his keys & cellphone, he doesn't consider that to be abnormal behavior.  So, how do we know what's going to become dementia, or what's going to just "stay the same"?  The short answer--we don't know yet.  When you run cognitive tests on  someone in the category of AACI (Age-Associated Cognitive Impairment) they're going to come out as "normal".  But, they are having changes in their thinking. 

Schiffer tells his younger physicians that a good rule of thumb is, "Anyone who comes in to see us--by definition, if they cross that threshold & complain about their memory--they're not normal.  We are not yet able to "see or detect" what's going on in their brains--but people don't come in unless something's going wrong."

Lest you get worried about this comment, remember, Schiffer is a believer in a multi-modal approach to improving brain health, and preventing unnecessary decline.  You can't argue with that! 

You'll have to excuse me now, while I down a glass of wild blueberry juice, and take off for my Spinning Class.  I've already exercised my brain enough, listening to Schiffer, and writing this post!!!!

Everything You Ever Wanted to Know About Losing Weight, Exercise, Stress, and Cardiovascular Risk from an Expert, Dr. Sharon Alger-Mayer. The Best Diet, How Much Exercise, the Hormone Stress Connection, the Best Phytonutrients, and the Healthiest Carbs

"Why is it so hard to to maintain a healthy weight and good eating habits?  It's multi-factorial.  Genetics loads the gun - but the environment pulls the trigger.

We are all different  genetically in our hunger and satiety cues--the rate at which we burn off calories, our dietary patterns, and the stress-causing changes in our brains."

-Dr. Sharon Alger-Mayer, Associate Professor of Medicine, Division of Clinical Nutrition, Albany Medical College, Albany NY-

"A habit cannot be tossed out the window; It must be coaxed down the stairs a step at a time."

-Mark Twain-

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Would you lose weight and start to exercise if it could save you money?

Starting this year almost everyone at my place of work is getting with the Program.  The diet & exercise program.  If lowering cardiovascular risk, and feeling great isn't enough motivation--maybe money will work!  If we want to pay 2009 rates for our health insurance in 2010 & 2011 we need to show that we are either healthy, or we are taking serious steps to get healthy. 

If you have hypertension, elevated cholesterol, diabetes, asthma, are a smoker, or you are overweight (BMI above 27) you need to join a free program (including Curves or Weight Watchers) and reach the set healthy goals by November 2010 to get your rebate.

Everyone, even those of us who are already in good shape--must still participate by joining a small "team" & tracking one or more healthy behaviors:

• Weight loss
• Pedometer steps (and we've all received a free pedometer)
• Daily exercise minutes
• Cups of fruits & vegetables consumed

Yes, it feels "big-brother-ish", but you aren't forced to participate--and frankly, I don't know anyone who isn't.   I've just logged in my exercise minutes, and how many fruits & vegetables I've eaten--and I have to admit, it's a great way to keep me honest--and motivated!

So, now let's bring on our diet and exercise expert--Dr. Sharon Alger-Mayer.

What's Eating You?  Food, Mood, and Cardiovascular Risk

For the past weekend I've been "up to my ears" listening to a fascinating lecture by Dr. Sharon Alger-Mayer--all about how diet, exercise, stress, sleep, belly fat, and brain chemicals affect our cardiovascular risk.

The lecture title says it all:  "What's Eating You?  Food, Mood, and Cardiovascular Risk", Audio-Digest Foundation--Family Practice  58(8): Feb. 28, 2010.  Click here

I'm going to do my best to highlight some of the "new to me" research Dr. Alger-Mayer presents.  Stick with me--there's a lot to cover.

Here's a chance to benefit from the knowledge, experience, and wisdom of a top-notch specialist without making an appointment.  

If I had to sum it all up in 6 key points it would be:

• Eat a diet that is 750 calories less than what you need to maintain your present weight.  Get a diet buddy or join a support group for the best chance of success
  
• The type of carbohydrates you eat makes a big difference and they actually affect your insuling-signaling genes.  Eat Low-Glycemic Carbs!  That means foods like beans, legumes, oats, quinoa, dark rye bread, vegetables, & fruits.
  
• Exercise often--short bouts are best, enough to burn 2800 calories a week, including 11,000 steps a day (5.5 miles), & 2 days of more intense exercise a week
  
• Consider adding phytochemicals like (but not limited to) cocoa, green tea, resveratrol (grapes or wine), acai berries, or hops (rho-iso-alpha-acids)
• Get enough sleep--at least 7.5 hours
• Find a way to manage stress to reduce fat-causing hormones (like cortisol) that pack on belly fat and increase inflammation.  Simplest stress reducers:  Exercise and deep breathing--one deep abdominal breath, hold for count of 4, and repeat.

 Who Is At Risk?  Who Needs to Get With the Program?  Where Do You Begin?

Lifestyle accounts for more than 50% of the deaths among middle-age women.

72% of cardiovascular mortality can be attributed to lifestyle factors. 

Metabolic Syndrome is what you want to prevent--or get rid of--if you have it.  If you've got a little too much belly fat, elevated blood pressure, high triglycerides, elevated blood sugar, low HDLs, and/or high triglycerides you're at risk for heart attack, stroke, and type-2 diabetes.  We're talking Metabolic Syndrome--and with the right diet, exercise, stress management, and the addition of some potent phytochemicals you just might turn that ship around.

Dr. Alger-Mayer's Prototype Patient:

• 52 year old woman
• High stress job, long hours, finds it hard to find the time to exercise
• Travels for work, eat too many restaurant meals, breakfasts on bagels or pastry, drinks 2-3 glasses of wine at night to wind down
• Poor quality sleep, wakes up frequently
  
• Feeling depressed, trouble concentrating, anxious, worried about her memory, worried about her health
• Insulin-resistance, high blood pressure, high cholesterol, family history of early heart attack, a history of weight issues, loses weight and puts it right back on.
• 5'6", 228 lbs, BMI of 37, waist circumference of 42" (>35" increases risk), elevated fasting glucose, HDLS & triglycerides are OK, LDL is elevated, C-Reative Protein (inflammation marker) is elevated at 3.4  Click here for BMI tables  Click here for CRP tables & "The Inflammation Connection"
  
• Meets criteria for Metabolic Syndrome even though none of her values are super high
• She is ready to get serious about losing weight and making a change    

Before getting started, here's what Dr. Alger-Mayer asks all her patients to do, because "knowledge is power".

• Keep a 3 day food record of what they are eating day-to-day
• Record how they are feeling--emotions & moods.  What's driving their food choices
• Wear a step counter for 3 days--not to change anything, but to see how active they are during the day
• Keep a 7 day record of their sleep cycle
• What are they doing for fun?  What do they have to look forward to?  What helps to diffuse their stress?

Getting Started When You're Feeling Overwhelmed - Where Do You Begin?

Dr. Alger-Mayer's typical patient is an intelligent bright woman who has struggled with this weight issue for many years. 

It's not just about knowing the issues.  She feels totally overwhelmed & challenged by life & finding the time & energy to make big changes is extremely difficult.

Alger-Mayer says you need to break down the process into a manageable set of goals.  Here's what Ms. Typical Patient wants to know from Dr. Alger-Mayer:

• Is there one diet that would be best for her particular medical risk factors?
• What about exercise? She knows she has to exercise, but how much does she need to do?
• Are there any nutritional supplements that would help?

Let's Talk Diet - What's the Best One?

• When it comes to weight loss--it doesn't matter.  According to a 2009 New England Journal of Medicine study that compared four different weight-loss diets (low vs. higher fat; low carb vs. higher carb; low protein vs. higher protein)--it just didn't make any difference.  All the diets achieved weight loss, and lowered cardiovascular risk factors, decreased waist circumference, and triglycerides.  The fasting insulin level dropped in all the diets except the 65% carb diet.  All 4 diets were basically healthy--they emphasized adequate fiber and low-glycemic carbs, were low in cholesterol, and participants were asked to do 90 minutes of exercise a week.  Most weight loss occurred in the first 6 months of this 2 year study that followed over 800 overweight adults.  Final conclusion: "Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize."
• What did make a difference?  The patients who attended at least 66% of the group support sessions lost the most weight--an average of 20 pounds over 2 years.
• To lose weight, you need to eat 750 less calories than you would need to maintain your present weight.
• Dr. Alger-Mayer emphatically points out that this study DOES NOT MEAN, that diet doesn't matter--and that you can eat whatever you want to, as long as you cut calories.  High fat and simple sugars are not good for you, and will not reduce your cardiovascular risk factors.
• My opinion: Go for plant-based, minimal to no added fats, low-glycemic carbs like beans, oats, legumes, fruits & vegetables, whole-grains, and minimal sugar.  No worries!

A Calorie is Not Just a Calorie.  Carbs Affect Our Genes.  What?

Some recent landmark studies have confirmed that the kind of carbohydrates we consume actually affect the genes in our abdominal fat--which has a tremendous impact on developing or curbing Metabolic Syndrome.

• The Carbohydrate/Gene Study.  Here's how the the low vs high glycemic carb study played out in 2 groups of people with Metabolic Syndrome.  One group was fed carbs that were high fiber low-glycemic (think oats, beans, quinoa).  The others group was fed carbs that were high fiber high-glycemic (think potatoes, whole wheat bread).  Both carbs had the same amount of protein and fat.  The low-glycemic carb meal produced a low insulin response, and the insulin-signaling genes in the abdominal fat were actually down-regulated.  But after the high-glycemic carb meal,  insulin shot up, and 62 different genes that are linked to the stress response, insulin-signaling and cytokine-mediated immunity were turned on.  Pretty amazing!  This study prompted endocrinologist Dr. David Ludwig to write an editorial called, "Putting your genes on a diet: the molecular effects of carbohydrate."
• Take away point:  The kind of carbs we eat have a significant effect on the gene regulation that affects how our bodies handle insulin--and don't forget that abdominal fat is a marker for an insulin response that is out of whack.  This process has nothing to do with how many calories we consume, or how much we weigh--but it has everything to do with what kind of carbs we are consuming.
• The effect of whole grains vs refined grains on the risk of cardiovascular disease in Metabolic Syndrome.   In this study the two groups being compared both reduced their calories by 500/a day for 12 weeks--but one group ate whole grains while the other consumed refined grains.   After 12 weeks both groups had the same weight loss--but the whole grain group had lost more belly fat, and had a 38% decrease the their C-reactive protein levels (inflammation marker).  The magnitude of the this C-reactive protein reduction was similar to the reduction achieved with statins.   
• Why do we want to eat foods that discourage belly fat--and that will down-regulate the genes in our belly fat?  Belly fat is completely different from the subcutaneous fat that surrounds our bodies. It's called omentum, and it acts just like an organ, secreting its own chemicals and hormones like adipokines that produce angiotensin II, that raises blood pressure. It also secretes tumor necrosis factor, interleukin 6, and C-reactive protein which lead to high blood pressure, insulin resistance, high cholesterol and inflammation that damages our brains & blood vessels. To read more about why you want to ditch the belly fat, click here.
• How do I find out which foods are low-glycemic?  The University of Sydney maintains the most reliable database.  Look for foods that have a glycemic index of 55 or under.  Click Here for the database.  Click Here for their excellent newsletter. Bottom line: you want very grainy "kibbled" least-processed breads & carbs that move slowly through your digestive system.

Why Exercise Matters If You Want to Keep Your Weight Off Forever!

The best data out there on the effect of exercise on weight loss comes from the National Weight Control Registry that was started in 1994 by Dr. James Hill and Dr. Rena Wing in Denver, Colorado.  The registry tracks over 5,000 people who have successfully lost an average of 60 pounds and have successfully kept it off for 5 years or more.  It aims to find out why these people are successful at keeping their weight off.

• The most powerful predictor of successful long-term weight loss is movement!  aka Exercise.
• On average people who have successfully maintained their weight loss, burn off 2800 calories a week which is quite a lot. 
• The calorie burn comes mostly from walking, 11,000 steps a day (that's 5.5 miles), and a higher intensity exercise for 2 days/a week--at an average of 6 METS--which is about an hour of jogging, bicycling, tennis or aerobics.  800 calories of the 2800 were burned as high intensity exercise.
• The exercise doesn't have to be in the form of long workouts--like 60-90 minutes at the gym.  People who had multiple short bouts of exercise on more days lost more weight and achieved similar cardiovascular benefits.

What Nutritional Supplements Can Help with Weight Loss and Reduce My Cardiovascular Risk?

It turns out that Metabolic Syndrome is tremendously impacted by the quality of our diet.   We are now beginning to understand that the phytonutrients in our food--which have nothing to do with calories or weight loss--are metabolically active, and have profound  effects on our signaling systems--and work through the same kinase systems that pharmaceutical drugs work on.

These phytonutrients can affect the insulin-signaling pathways which are closely linked to the inflammatory pathways in our body.

Here are a few examples of some of these active dietary phytonutrients:

• Green tea
• Ginseng
• Cinnamon
• Resveratrol
• Hops - used as the bitter flavoring for beer
• Cocoa

What happens when you add phytonutrient supplements to a high quality Mediterranean Diet?  Magic!!

Dr. Robert Lerman compared two groups of dieters on a super healthy Mediterranean diet high in omega-3s, low glycemic carbs, high quality proteins, and fruits and vegetables for 12 weeks.  One study group was supplemented with the phytonutrient hops (rho-iso-alpha acids) and an extract of acai berries.

Here's how the groups compared after 12 weeks:

• Resolution of Metabolic Syndrome:  43% of the phytochemical group vs. 22% of the diet only group
• Reduction of Framingham 10-year risk scores  dropped by 5.6% in the phytochemical group vs. 2.9% in the diet only group
• Weight loss was the same in both groups
• LDLs were reduced by 17% in the phytochemical group vs. 8.4% in the diet only group
• HDLs were increased by 7% in the phytochemical group vs. 3% in the diet only group
• Triglycerides dropped by 35% in the phytochemical group vs. 14% in the diet only group

Take away point:  The optimum way to use phytochemicals is to consume them as part of a healthy diet in whole foods (think lots of fruits & vegetables), rather than thinking, "I'll just go the health food store & buy some rho-iso-alpha acid pills & then just keep eating my regular diet."  I don't think so.

According to Alger-Mayer, diets high in saturated fat have a negative effect on those protein kinase pathways, and just may wash out the beneficial effects of these phytochemicals.

What Other Whole Food Phytochemical Supplements Does Alger-Mayer Recommend?

Resveratrol

This is the phytonutrient found in the skins and seeds of grapes and of course, in wine. 

• It's known to reduce cardiovascular risk by lowering blood pressure.
• It improves endothelial function (the lining of blood vessels) by increasing that "magic gas" nitric oxide--which makes blood vessels flexible and improves dilation.  Nitric oxide production increased 3-fold in endothelial cells that were "incubated" in red wine.
• It decreases blood platelet aggregation, which means less clumping and clotting
• It's known to activate cell proteins that prevent cell death in bacteria--suggesting a "possible" increase in human longevity.  Who knows?

Cocoa

The Greek name for cocoa means, "Drink of the Gods".  Maybe they were on to something.  Epichatechin is the polyphenol in cocoa that does its magic on the cardiovascular system.

• It lowers blood pressure
• It reduces insulin resistance and improves platelet function
• It increases nitric oxide production--that "magic gas" that improves endothelial function, and it has anti-oxidant and anti-inflammatory properties.
• In a recent meta-analysis in the journal Circulation, 75 grams of dark chocolate for 3 weeks increased HDLs by 14% and decreased LDL oxidation. Lowering blood pressure took even less cocoa to do the job.
• How does cocoa do all this?  It's probably because it increases the availability of nitric oxide, and it also increases arginase--which prevents nitric oxide from breaking down.  It's a 2-for-one!
• Cocoa's best benefit?  It inhibits the kind of inflammation that creates atherosclerotic plaque.
• This study will give you a good reason to drink cocoa daily.  One of the tests for a healthy vasculature is the ability of our blood vessels to dilate.  This study looked at the dilation of arteries after drinking a high flavanoid cocoa drink, compared to a low flavonoid drink.  There was a significant increase in vasodilation with the high flavonoid drink--and nitric oxide levels increased as the level of flavonoids in the cocoa increased.
• Watch out!  Avoid cocoa or dark chocolate that is "Dutch-Processed" or is treated with an alkali to decrease its bitterness--that destroys the flavonoids!

What Does Stress Have to Do with Diet and Weight Loss?

Plenty!  Stress decreases leptin---and low levels of the hormone leptin will increase food cravings even if you aren't hungry.  Stress also increases ghrelin---the hormone that keeps you eating even when you aren't hungry.

Alger-Mayer says that stress reduction is a key factor in managing our food intake--and it even plays a role in our ability to exercise.

What effect does cortisol have on weight loss?

• Stress increases cortisol, which increases the likelihood  of snacking--especially high calorie snacks. 
  
• It increases belly fat
• Cortisol increases significantly in women who are "high stress reactors"--snacking is strongly associated with daily stressers in women who are "high stress reactors".
• Cortisol-Abdominal Fat Connection. Men & women with a high waist-to-hip ratio had greater cortisol release when under stress than those with a low waist-to-hip ratio--suggesting the release of cortisol in response to stress contributes to abdominal fat.  Click here for a waist-to-hip calculator & chart.
• Rats fed a high-fat, high sugar diet and exposed to long-term stress had a 50% increase in visceral (belly) fat

Top ways to reduce stress

• Exercise.  It reduces stress, anxiety, depression, and raises dopamine--the feel good brain chemical--which may also reduce the craving for high fat, high sugar foods.
• Many of Alger-Mayer's patients tell her that when they exercise they are better able to stick to their meal plan and avoid cravings.  When they get knocked off track, their cravings come back.
• Turns out that wheel-running in rats is a protection against stress, anxiety, and depression.  It also affects their serotonin and noradrenaline (fight or flight hormone) levels, and increases their dopamine--the feel-good hormone.
• Exercise is actually an antidote for high sugar intake!
• How deep breathing helps reduce stress.   Try the "mini"--a simple technique developed by Dr. Herbert Benson, an interventional cardiologist who founded the Mind-Body Institute at Harvard.
• Within one minute of deep breathing you increase the calming parasympathetic system kicks in, the heart rate drops, blood pressure drops, and "yeah",  cortisol drops, too.
• Here's how to do it.  Take a deep breath, expanding into the abdomen.  Hold it for the count of 4, and breathe out.  Repeat.  Doing this simple technique when you start to feel stressed may reduce cortisol, and prevent our cells from being bathed in cortisol, increases our risk of belly fat. To learn more about Benson's technique's click here.
• Figure out a step-by-step plan.  Be clear & specific.  When will you eat?  When will you walk or exercise?  How long?  Find an exercise and diet buddy.  Alger-Mayer recommends Spark People--an online weight-loss community to help you find a group with similar ages and goals as yours.
• Get enough sleep!  Less than 6.5 hours of sleep causes increased hunger, impairs glucose tolerance.  Alger-Mayer suggests going to sleep 20 minutes earlier to start.
• Give yourself rewards for your diet or exercise success.

What am I now going to change after my "appointment" with Dr. Sharon Alger-Mayer? 

• I'm definitely going to to think twice about eating any high-glycemic carbs.
• I'm going to try very hard to get at least 7.5 hours of sleep.
• I'm going to program the free step counter I got from my workplace--and start using it.  I wonder how many steps I'm walking a day?
• I'm going continue with my daily cup of cocoa.
• I'm going incorporate Benson's mini's--the deep breathing technique--as needed.
• And that's enough for now!

Please let me know what you think of this summary.  I really appreciate feedback!

How Vitamin D Works - Answers From Dr. Bruce Hollis--Its Role in Cancer, Musculoskeletal Pain, Heart Disease, Inflammation, Infection, and the Brain

Target tissues for Vitamin D--Curr Opin Clin Nutr Metab Care 10:12-19, 2007

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"Since the Human Genome Project, we now know that Vitamin D is responsible for regulating over 10% of our genes.  It's not just responsible for skeletal health--but cells throughout the entire body are dependent on Vitamin D in order to work properly.

I'm talking  about brain function, nerve function, immune function, skeletal function--all dependent on adequate supplies of Vitamin D--including its important role in preventing 14 types of cancer, heart disease, autoimmune disease, diabetes, inflammation/inflammatory diseases, infection, and osteoporosis."

Happy Healthy Long Life post on Dr. Bruce Hollis' Vitamin D Research, Dec. 10, 2009

It's February!  By this time of the year if you live in the Northern half of the U.S. most of the vitamin D you've stored from the sunshine is long gone and you're at your lowest level of the year.  You haven't made a drop since October.  The average American's blood level in the winter is 15-18 ng/mL.

If you read the February 1, 2010 New York Times article, "The Miracle of Vitamin D: Sound Science, or Hype" you might be tempted to dismiss the recent research on Vitamin D.  I wouldn't advise it.  If you want to wait to get your "sunlight fix" or down your Vitamin D supplements until the gold standard randomized control Vital Study is complete--go for it. 

I wouldn't count on its results being conclusive.  The study group is too old-women over 65 & men over 60. The dose is the same for everyone which makes no sense when it comes to vitamin D--because everyone has a different base level of vitamin D--and vitamin D doses are weight dependent.  Plus, much of the benefit of taking vitamin D occurs years before disease may surface.

In December 2009 I reported on Dr. Bruce Hollis' research on the effects of Vitamin D in pregnancy and breast-feeding.  This post is the continuation of my summary of his interview with Joe and Terry Graedon on the People's Pharmacy, November 19, 2009. 

For my previous posts on vitamin D, click here:

• Dr. Bruce Hollis' NIH Vitamin D in Pregnancy Study is Now Complete. High Dose Vitamin D (4000 IUs) Significantly Improved Health & Outcomes for Moms and Babies. And Harvard Researchers' Theory of a Vitamin D - Autism Connection
• Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?
• Why is Vitamin D my favorite? Let me count the reasons.
• Caroline Adams Miller's Ten Non-Negotiable Pearls to a Life Well-Lived - Successful Balanced Happy. And the Possible Dementia Vitamin D Connection

Who is Dr. Bruce W. Hollis?

He's one of the leading authorities on vitamin D, as well as Professor of Pediatrics, Biochemistry and Molecular Biology, and the Director of Pediatric Nutritional Sciences at the Medical University of South Carolina in Charleston, SC.

If this vitamin is so important, why are so many of us deficient?

This potent hormone is made through the skin--we were designed to get it from the sun, not through food or supplements.  Most of us spend much of our time indoors, and when we are outside we're covered in clothing and sunscreen.  If you live above the 37th parallel (Richmond, VA-St. Louis, MO-Sacramento, CA) you can't make enough vitamin D from the sun for almost 6 months out of the year!

Why are the RDIs (recommended daily intakes) for Vitamin D so low - at 200 or 400 IUs?  Why is the normal blood level for Vitamin D set so low, at 31?

According to Hollis, the federal guidelines for vitamin D--set at 200-400 IUs/day are 100% absolutely incorrect!  They don't even begin to touch what we need.  The 400 IU recommendation was based on the amount needed to prevent rickets--based on no real data--and Hollis believes that for those recommendations to continue today, is medical malpractice.  Hollis' own recent safety & outcomes pregnancy study recommends 4000 IUs during pregnancy.  

We've known for over 30 years that if you get 15 minutes of sun exposure in a bathing suit between 10 and 2 o'clock, in the middle of the summer, your body will produce 20,000 IUs of vitamin D within 24 hours.  The body can make and release huge amounts of vitamin D--and yet national guidelines are still recommending only 400 IUs a day.

According to Hollis, most adults need 2000 IUs or more/day, and he takes 4000 IUs.  He monitors his blood levels with the 25-hydroxy vitamin D test, and tries to keep his levels at 50-60 ng/mL. 

4000 IUs would replete (maintain at the optimal level) almost all adults unless they were obese or had a high BMI.  In obese patients, Hollis has even found that 10,000 IUs was not be enough to adequately raise their blood levels.  There really is no rule of thumb for "the right dose" of vitamin D for obese individuals--you just have to monitor the blood levels and make adjustments through trial and error.

Why are doctors now testing for vitamin D levels?  If 31 ng/mL is normal, why would I want to go over that level?

The history of the 25-hydroxy-Vitamin D test.  Dr. John Haddad of Washington University School of Medicine developed the first test for measuring vitamin D in the blood back in the 1960s.  To figure out what a "normal" level of Vitamin D was--a level that prevents rickets--he measured a huge number of people, like office workers, physicians, and people of color.  Their average blood level was 27 ng/mL--and to prevent rickets you only needed to be above 10 ng/mL. 

Back in the 1970s, it looked like most everyone was "normal" if they were over 10 ng/mL.  Today, we know so much more--and rickets is the least of vitamin D deficiency diseases.  Fortunately, Haddad also tested lifeguards--and their levels were at 50-100 ng/mL.  Dr. Hollis believes that those are the optimum levels for good health--the physiological level one would reach if he were fully sun-exposed. 

Studies continue to show that the higher the vitamin D level, the lower the risk of diabetes, heart disease, multiple sclerosis, osteoporosis, infections, breast, prostate, and colon cancers, and rheumatoid arthritis.  31 ng/mL has now become the lowest normal level.

Classification of 25 OH Vitamin D status:

Insufficiency/Moderate Deficiency: < or = 30 ng/mL
Sufficiency/Optimal Levels: 31 to 80 ng/mL
Toxicity: > 100 ng/mL

What have we learned from new research on Vitamin D?

The Human Genome Project has opened our eyes.  10% of our genes are influenced by Vitamin D--and very few of these have to do with the skeleton or bone health.  Important processes like cell maintenance, cancer immune function, autoimmune function, infection and inflammation control--to name a few--are all affected by our levels of vitamin D. 

Around 2000 research began to surface about the optimal health effects of higher blood levels of vitamin D.  In Dr. Hollis' recent pregnancy study he found immune function improved significantly--and infection rates dropped--when vitamin D was supplemented in pregnant women to 4000 IUs.  He saw absolutely no adverse effects at this level.

How about some examples of how vitamin D supplementation has helped people in everyday medical practices?

An elderly home-bound population.  Dr. S of Getzville, NY is a geriatrician treating home-bound elderly with multiple chronic conditions.  "The medical community doesn't understand the physical limitations caused by vitamin D insufficiency.  The muscle and bone pain from low vitamin D can be considerable."

Here's just one example of how increasing a patient's level of vitamin D to an "robust level" benefited one of Dr. S's patients. He resolved a patient's debilitating limb pain--which was poorly responsive to narcotics--just by increasing the patients' vitamin D to optimum levels.  He has even helped patients who have stopped walking--when they were identified as having very low Vitamin D levels. 

To determine the best way to increase his patients' vitamin D levels,  he takes into account their current level and their weight, and uses a table (see below) that can be found in Dr. James Dowd's book, The Vitamin D Cure.  The table is based on the research of Dr. Michael Holick and Dr. Robert Heaney.

For those at moderate/average vitamin D deficiency Dr. Dowd recommends supplementing at 20 IUs/per pound and for those at highest risk (African Americans or a BMI over 30) he recommends a vitamin D dose of 25 IUs/pound.  In real life: a 185 lb. man might supplement at 3700 IUs.  A 300 lb. man might supplement at 7500 IUs.  A 125 pound woman might supplement at 2500 IUs.

According to Dr. S, this has revolutionized his practice.  By increasing his elderly patients' levels to the "best practice robust levels" of experts like Dr. Michael Holick and Dr. Bruce Hollis, he has seen "clinically satisfying success in a practice where there isn't a lot of success"--the chronically ill geriatric home-bound population. He sees the quality of life improve for both patients and their families, with improvements in functional mobility, walking, transfers, and mood--all without having to go to other prescription medicines.  He has also seen improvements in chronic arthritis pain.   Source: #749 Vitamin D Update Nov. 19, 2009 People's Pharmacy podcast

Source: James E. Dowd, M.D. The Vitamin D Cure.  2008

What's Dr. Hollis' reaction to Dr. S's Vitamin D experience with his elderly patients?

Hollis says he get emails and comments every week with similar positive effects of vitamin D. Resolved muscle pain, and reports of people who couldn't walk, or had to use a walker, and once they were put on adequate vitamin D they were able to walk.  (my comment: this sounds almost like a faith-healing story--but who knows?)  For Hollis, results such as Dr. S's are not uncommon. 

As for a vitamin D/mood connection--Hollis says there's some evidence to suggest it's possible.  There are vitamin D receptors in the brain and enzymes that metabolize vitamin D in the brain.  Vitamin D definitely has neuro-functions, and Australian researchers studying its effect on rodents know that offspring born from vitamin D deficient mothers have dramatic brain deficits that are both physical and biochemical--and these deficits are never resolved.  To Hollis this is a very scary prospect--thinking about  humans raised in a vitamin-D deficient environment.  He wonders about the potential for profound brain development deficits? 

What about vitamin D toxicity?

Normal blood levels are 31ng/mL (lowest acceptable level) to 100 ng/mL.  The optimum level would be 50-70 or 80 ng/mL, or whatever your physiological maximum level would be if you were fully sun-exposed--as are field workers or life guards.  Hollis says he doesn't even know what vitamin D toxicity is--he's never seen it, and never saw any adverse effects in his pregnancy study where women took 4000 IUs/day.  According to Hollis, there's little evidence of adverse effect under 10,000 IUs a day.

What about the effect of Vitamin D on rheumatoid arthritis?

Since vitamin D is an immune regulator, and has a profound influence on autoimmune processes, it may be possible to see improvements in rheumatoid arthritis and a slowing of disease progression.  However, vitamin D deficiency is more likely a trigger in developing autoimmune diseases like RA--not a cure for the disease.

The Iowa Women's Health Study found women taking vitamin D supplements were less likely to develop RA.  And in a recent article a surprisingly high incidence of vitamin D deficiency was found in inflammatory joint patients even in a sunny Mediterranean country. Animal studies have shown reduced joint inflammation with vitamin D supplementation.

There are just a few clinical studies on vitamin D for treatment of RA--but in 3 of 5 studies researchers saw improvements in symptoms.

Vitamin D and osteoarthritis

From Dr. James E. Dowd of The Vitamin D Cure: "The Framingham Study found a 2-3 fold faster rate of osteoarthritis progression in people who were in the lowest 20% of vitamin D levels compared to those in the highest."  Boston researchers found that when vitamin D levels rise, people with osteoarthritis function better, and the severity of symptoms and disability are reduced. 

Non-specific aches & pains in bones and muscles can be confused with osteoarthritis or fibromyalgia--but if it's  caused by osteomalacia it will improve dramatically (may take 3-6 months) with adequate vitamin D.

Can adequate levels of Vitamin D really prevent colds & the flu?

The higher the vitamin D level the lower the risk of upper respiratory tract infections.  According to Hollis there are ongoing studies on using vitamin D as an immune booster, and there is incredible evidence to show just how this works. 

Vitamin D activates the "Rapid Response" component of our immune system, called the innate immune system which  controls the production of natural "antibiotics" that attract bacteria & viruses.  These processes aren't activated if someone is vitamin D deficient.  And Hollis' pregnancy study offered conclusive proof that increasing levels of vitamin D absolutely controlled infection.  "The vitamin D  immune boost is a very real thing!"

What about the cancer connection? It seems so far-fetched.

Dr. Hollis has collaborated with Dr. Walter Willett and the Harvard School of Public Health for over 15 years, studying epidemiologic data on the effects of vitamin D on cancer.  These studies have routinely shown that an adequate vitamin D status protects against 13 or 14 different cancers, including breast, prostate, and colon cancer. 

Hollis is skeptical that vitamin D could treat cancer once you get it--its benefit is in preventing it in the first place--and having adequate levels will lower your risk.  Researchers in Nutrition Reviews project that a vitamin D blood level over 52 ng/mL would reduce breast cancer by 50%, and levels over 34 ng/mL would prevent 50% of the colon cancers.

Here's how it works: Vitamin D helps control cell growth and that's why we think that it will reduce the risk of many deadly cancers like prostate, breast, and colon by as much as 50 percent.  In its role as a hormone, vitamin D travels all over our body delivering messages to activate genes and control cell growth. 

If a cell turns cancerous, vitamin D delivers the instructions for that cell to self-destruct. Not enough vitamin D and that cancer cell might keep reproducing.  According to Hollis,  "vitamin D acts as a brake" when it comes to cancer.  It prevents cells from growing wildly out-of-control--and this mechanism has been studied for years.

Explain the difference between D2 and D3.  Is D3 superior?

D2 was commonly used in the U.S. because it was approved as a pharmaceutical in 1911.  But Hollis doesn't like to use it.  It's unnatural.  It comes from yeast.  It's functional, but D3 is preferable, and it's very easy to get these days.  If you have the option--Hollis says, "Use D3".

How do you get enough vitamin D if you have a severe malabsorption syndrome, colitis or celiac disease?

If you can't absorb vitamin D supplements adequately, you clearly need to get your vitamin D from the sun.  There are no vitamin D injections. When it comes to winter-time, dermatologists won't approve, but one option is short twice weekly visits to a sun tanning bed--10-15 minutes with face & neck covered with sunscreen.  It is effective.  Or play it safe and find out about getting controlled UV treatments in a medical setting.

What are normal vitamin D blood levels for children?

Hollis says normal levels for children are the same as for adults.  "Do you think a rapidly growing child needs less vitamin D than a staid (no-longer-growing) adult?"  A colleague of Hollis' in S. Africa recently measured blood levels of active-outdoor-playing children, both Black and Caucasian.  Both had similar levels--around 50 ng/mL.

Please explain how vitamin D affects cardiovascular health.

There is a 142% increased risk of heart attack in vitamin D levels under 15ng/mL.  According to Hollis, important recent research has shown that vitamin D acts as a natural statin, by decreasing inflammation.  It doesn't lower cholesterol.  It also prevents the infection-inflammatory processes and lowers blood pressure--both of which can contribute to damaged blood vessels, atherosclerotic plaque build-up, and clot formation.

Once you start taking vitamin D supplements how long will it take to increase your blood levels?

Hollis said most physicians should assume that their patients are vitamin D deficient, especially every person of color,  and order a base-line blood level test--the 25-hydroxy-vitamin D test.  For most people, supplementing with 2000-4000 IUs of vitamin D should be adequate.  1000 IUs will do very little except for a small child.

You'll need to wait 3 months before getting retested.  If someone is very low, and depending upon their size, it could take months to get their levels up to optimal--50 ng/mL-70mg/mL.  

What research on the horizon looks the most exciting?

Hollis is most excited about the current research on the effect of vitamin D on infections, as well as the multiple sclerosis/vitamin D research of Dr. George Ebers of Oxford University.  Ebers recently discovered that vitamin D deficiency is an environmental trigger for multiple sclerosis. 

"The Oxford University-led research, published in PLoS Genetics, suggests that vitamin D deficiency during pregnancy and the early years may increase the risk of offspring developing MS later in life." Click here to read more.

How about some "practice-based evidence" from primary care or internal medicine physicians?

Two comments from physicians in response to the Feb. 1, 2010 New York Times Vitamin D article were of particular interest to me.

Dr. Robert Baker 

 "The major problem with the proposed study is that it will give 2000 units of vitamin D a day without testing levels to determine an end point. 400 Units daily has been shown to raise levels only 5 ng., and 2000 Units daily has been shown in some studies to raise levels less than 20 ng.

I have tested 1800 people in primary care practice since 2005. 2/3rds are below 32 ng. but 1/3rd are below 20 ng., and 10% have levels in single digits. These figures are duplicated with published studies. So for many people raising the level even 20 ng. will not be enough.

The human body from sun alone will not make a level over 150 ng. A feedback mechanism breaks down vitamin D in the skin once this level is reached.

Lifeguards in August have been shown to have levels approaching this level. Humans evolving near the equator wearing scant clothing would also have had this level.

Sufficient vitamin D does not come from diet - amounts are small and several glasses of milk only have the small amount of 400 units of vitamin D because manufacturers add it.

So the wisdom of nature is already telling us the maximum level."  Click here for the NYT link

Robert Baker MD
Primary Care Internal Medicine
Cherry Hill, NJ
rcbaker200@comcast.net

Dr. Greg Plotnikoff

Vitamin D and Pain

Most clinicians who have read the literature and who prescribe vitamin D for patients based on their blood tests will affirm that replenishing vitamin D to a serum level of greater than 40 ng/ml can make a huge difference in chronic pain, muscular weakness and a wide range of non-specifc complaints.

The most impressive reports come from woman with muscle or bone pain on an aromatase inhibitor or persons with undiagnosed, chronic, non-specific musculoskeletal pain or unexplained significant muscular weakness.

No one with symptoms has fibromylagia or somatoform disorder until vitamin D deficiency has been ruled out or replenished.

Testing and replenishment is incredibly cost-effective.

The clinical effectiveness of D replenishment can be so profound, so unforgettable, that for practicing physicians there is no need for randomized controlled trials to assess the value of normalizing low vitamin D in persons who suffer.

Simply, test, replenish, monitor.

Why wait five years for a publication when one can have results of a blood test in a few days and results of replenishment in 2-6 months?

Asking this crucial question frustrates well-meaning researchers: Failing to ask this question frustrates patients.

— Greg Plotnikoff, MD

After 28 Days on Dr. Oz's Vegan Challenge, Cowboy Rocco is on His Way to Health--"If I Can Do It, Anyone Can!"

 

Click Here If You Don't See the Video

On September 24th, 53 year old Rocco Wachman of Scottsdale, Arizona was overweight, diabetic, with the heart of an 85 year old.  On his meat-heavy diet he was eating the equivalent of 2 1/2 pounds of saturated fat a week!  If he kept up this lifestyle, he was headed for serious trouble.

Dr. Oz came to the rescue--challenging him to take on a 28 day vegan diet that cut out meat, dairy, and eggs.  He was coached and monitored by Dr. Oz's sidekick, Dr. Michael Roizen--known as the "Enforcer" for his caring, consistent, "positive pushiness".  To read "Dr. Oz's 28-Day Vegan Challenge for Cowboy Rocco - Heart Disease Reversal Through a Plant-Based Diet Goes Mainstream - Sort Of"  click here.

Dr. Oz's 4 week plan for Rocco

Rocco is going to be followed by a cardiologist--thank goodness--and the plan is to totally reboot his taste buds.  No meat, no dairy, no eggs.  The emphasis is more on ditching the animal protein--not so much on the importance of adding in high nutrient vegetables, like greens, eating high fiber low-glycemic grains, or eliminating added fats.

Rocco is concerned about how this diet will affect his sugar.  Apparently he has type-2 diabetes and is on medication.  Dr. Oz says, "Not to worry.  I bet when you get rid of your belly, your blood sugar will come down, and you'll probably be able to get off your medications."

Week 1

Detox week.  No meat. No dairy.  No eggs.  Break fundamental habits.  Replace meat protein with nuts, beans, and seeds.  Take a B12 or multivitamin.  Rocco loves the taste of Oz's bean chili.

Week 2

Go forward.  Find alternatives to meat.  Emphasis is substituting meat for "fake meat" alternatives, like seitan, fake soy burgers,  faux barbecued ribs, or faux hot dogs.  Lots of soy protein here.

Week 3

Learn to avoid the junk food. Be cautious.  Just because it's not meat, dairy or eggs doesn't mean it's good for you.  Eating French fries & potato chips is not what the diet is about.  Oz encourages Rocco to find healthy snacks--fruit, vegetables, whole-grain or soy chips.  A little chocolate is OK as long as it has a 75% cacao content. 

Week 4

"Vegan meets reality"  Dr. Oz says it's now time to add back a tiny bit of meat--but just as an  "accoutrement".  In my opinion, this could be the downfall of this LITE version of a "heart-disease-reversal-diet".

28 Days Later--How Did Rocco Do?

On November 6, Rocco returned to Dr. Oz's show to see how well the diet had worked! 

It worked--check out Rocco's numbers:

Rocco's A1C Test--a measure of how one's body is managing glucose.  Diabetics need to keep their A1C below 7%.  A non-diabetic will have a level between 4-6%:    

Before:  9 (diabetic)    After:  7.7 (not perfect, but a lot better)

What's New With Rocco?

• "Everything feels different, as if a huge weight has been lifted off of me." -- "If I can do it, anyone can." -- "You've literally kick-started my life, and I have the opportunity of a lifetime!"
• He now walks 12,000 steps a day--keeping track with a pedometer.  He quit using his ATV and truck to get around his ranch.  To get in his 12,000 "steps" he now gets out of the house at 5:30 am, instead of the usual 9:00 am.
• Before the diet he was on 3 different medications--but he after only 28 days he was able to come off of 2 of these, one for cholesterol, and one for his diabetes. 
• His blood sugar is now in the normal range--99--down from 172.
• His acid-reflux is gone!
• Although he was supposed to re-introduce meat in week 4, after eating some meatloaf, he didn't find it as satisfying.  "I figure I will stay way from anything with a face or legs for a few more weeks at least."   Roizen recommends doing it slowly, only 2-3 ounces twice a week.

Rocco's Biggest Surprise with the Vegan Diet

• "Old Rocco" used to eat meat at every meal. The "New Rocco" now eats 5-7 times a day choosing from nuts, seeds, soy protein, vegetables and fruit.
• He's never hungry!  He learned that when he eats the amount of food the size of his palm--he isn't hungry any more--and that he just eats again 2 to 3 hours later.
• He now eats more times a day than he did as a meat-eater, but at the end of the day he's consumed less calories, and can lose weight.
• The first 7 days were the hardest.  "I had to retrain myself to wait for my stomach to tell my brain I was hungry.  Previously,  I let my brain tell my stomach when to eat."
• He plans ahead.  There's no meat or junk food in Rocco's house.  He keeps a stash of healthy foods on hand when traveling so he isn't tempted by fast foods restaurants. I did spot what looked like a gallon on milk in his fridge.
• Favorite vegan meal:  A soy burger, pan-fried, served with green onions and garlic, spread with hummus, and layered between two pieces of tomato.
• Rocco says that changing his diet isn't anything that he couldn't have done by himself, but the fact that he had the "hands on" support and prodding from Dr. Roizen upped his odds.  Besides, he had the pressure of millions of viewers counting on him, wanting to be inspired by his win!

Rocco Says His Former Meat-Eating/Junk Food Diet Was An Eating Disorder

• "I have an eating disorder & no one is out there to save fat guys."  Thank goodness for Drs. Roizen & Oz.
• "It's a problem.  I have to stay away from the things that created it--no different from drinking alcohol.  No different than if I was addicted to drugs, or some other behavior."

I'm really excited for Rocco.  He looks fabulous, and all his blood work, and body measurements have shown that diet & exercise can really improve one's health--and it can be done without drugs. 

If he continues on the straight and narrow he's going to be an inspiration to many.

But I still think he's playing with fire if he goes back to eating meat.  It's pretty easy to fall back into bad habits & bring back the food cravings that got him into trouble in the first place.  He said it himself:  "I have to stay away from the things that created it (his health problem)--no different from drinking alcohol."

The advice that I gave Rocco when he started his challenge still stands:

My advice to Rocco:  Read Dr. Calwell Esselstyn's book now that you've completed your 28-day challenge.  Stick to real whole foods and don't rely on faux soy foods.  Learn to cook.  Load up on healthy greens.  Get a VitaMix and start making Green Smoothies (low on fruit).  You really can change your taste buds!  Get inspired by the experience of Michael F., who lost loads of weight, changed his taste buds, and best of all--got healthy!

The Huffington Post Interviews Dr. Caldwell Esselstyn about Heart Disease: What Causes It, How to Prevent It, and How to Reverse It With a Plant-Based Diet

Look--if this former foodie-corned-beef-sandwich-chocolate-chip-cookie-loving-gal can ditch (mostly) the meat, dairy, added fats, sugar, and processed grains--anyone can. 

But, it's much more than just subtracting foods--it's adding in a bunch of heart-saving leafy greens, multi-colored fruits and vegetables, beans, and real grains. To read how to easily increase the greens in your diet, click here.

I made the gradual switch in March of 2008.  I actually thought I was a eating a healthy diet beforehand--but, I was deluding myseIf.  Honestly, your food preferences DO CHANGE, the longer you eat this way.  To read why I made the switch, click here.

I haven't had a follow-up lipid panel since then, because my doctor said it wasn't necessary--my numbers were already fine.  My husband, however, just had his follow-up 2 weeks ago.  He's off the statins, and sure enough, his numbers are better than they were on drugs. 

And his pesky triglycerides--they're in the healthy range for the first time.  If you follow the rules--it works!  Read: Running Man: My "Lab Rat" Husband.  Still Running Strong

Thought you might enjoy Dr. Esselstyn's interview with Kathy Freston on yesterday's Huff Post, sent to me by a thoughtful reader.

I appreciated this "refresher course",  learned something new, and it further motivated me to continue on this plant-based eating adventure. 

Be sure to click on the "cancer" and "type 2 diabetes" links for Freston's interviews with Dr. T. Colin Campbell on cancer, and Dr. Neal Barnard on type 2 diabetes.

Heart Disease: A Toothless Paper Tiger That Need Never Exist click here

by Kathy Freston, Health & Wellness Expert for Huffington Post, October 27, 2009

"If the truth be known coronary artery disease is a toothless paper tiger that need never, ever exist and if it does exist it need never, ever progress."

So says Dr. Caldwell Esselstyn, who was a researcher and clinician at the Cleveland Clinic for over 35 years. In 1991, Dr. Esselstyn served as the president of the American Association of Endocrine Surgeons, and organized the 1st National Conference on the Elimination and Prevention of Heart Disease. In 2005, he became the 1st recipient of the Benjamin Spock Award for Compassion in Medicine. Dr. Esselstyn is also an Olympic gold medalist in rowing, and he was awarded the Bronze Star as an army surgeon in Vietnam.

In this series of interviews I've conducted with extraordinary nutritional researchers and medical doctors, I've sought to understand the link between diet and the most common and dreaded diseases that are prevalent in our culture. What I'm hearing over and over is that a plant based diet is both preventative and healing, whereas a diet high in animal protein is destructive to our health - this is the case with cancer, type 2 diabetes, and heart disease.

The great news is that there is very real hope in shifting the course of our health. What is becoming very apparent through various peer reviewed studies is that by changing our diet - eliminating that which causes havoc in the body (animal protein) and adding in plant based proteins and eating lots of vegetables, legumes, beans, and whole grains, we can not only prevent disease, but also heal from it once it is already in motion. Following is a fascinating conversation I had on diet and heart health.

KF: What exactly is coronary heart disease?

CE: Coronary heart disease is the leading killer of women and men in western civilization. It is predicted to become the #1 global disease burden by 2020.

It consists of an inflammatory buildup of blockages in arteries to the heart muscle. These blockages are made of fat, cholesterol, calcium, and inflammatory cells. Blockages can become severe enough to cause symptoms such as shortness of breath or chest pain (angina). When blockages suddenly become complete, the portion of heart muscle fed by that blocked artery is now deprived of oxygen and nutrients, thus it is injured or now dies. This is a heart attack. The patient may survive or succumb if the event is accompanied by a fatal heart rhythm.

KF: Who develops heart disease?

CE: Everyone eating the typical western diet. In autopsy studies of our GI's who died in the Vietnam and Korean wars almost 80% at an average age of 20 years, had disease that could be seen without a microscope. Forty years later in 1999, a study of young persons between the ages of 16-34 years who have died of accidents, homicides and suicides, finds the disease is now ubiquitous.

KF: What is the cause of the disease?

CE: It is the typical western diet of processed oils, dairy, and meat which destroys the lifejacket of our blood vessels known as our endothelial cells. This cell layer is a one cell thick lining of all of our blood vessels. Endothelial cells manufacture a magical protective molecule of gas called nitric oxide, which protects our blood vessels. It keeps our blood flowing smoothly, it is the strongest dilator (widener), of our blood vessels, it inhibits the formation of blockages (plaques), and it inhibits inflammation.

KF: With such natural protection, why do we ever develop heart disease?

CE: Every western meal of processed vegetable oils, dairy products, and meat (including chicken and fish) injures these endothelial cells. As individuals consume theses damaging products throughout their lives, they have fewer functioning endothelial cells remaining and thus less of the protective nitric oxide. Without enough nitric oxide the plaque blockages build up and grow creating eventually heart disease and strokes.

KF: Can it be stopped or even reversed?

CE: Yes. First we must look at the lessons learned from cultures where there is a virtual absence of coronary artery heart disease such as rural China, the Papua Highlands of New Guinea, Central Africa, and the Tarahumara Indians of Northern Mexico. Their nutrition is plant based without oil.

Beginning in 1985 I initiated a study of seriously ill coronary artery disease patients. Their nutrition became plant based without oil. Their cholesterol levels plummeted. Their angina disappeared. Their weight dropped. I have reported this study at 5 years, 12 years, and 16 years, in the peer reviewed scientific literature and again beyond 20 years in my book Prevent and Reverse Heart Disease. In some of the patients we had follow up angiograms (x-rays) of previously blocked arteries demonstrating striking disease reversal, which is a testament to my often quoted statement "The truth be known coronary artery disease is a toothless paper tiger that need never exist and if it does exist it need never progress." The greatest gift to these patients is the increasing recognition that they are the locus of control for their disease - not some pill or procedure. They have made themselves heart attack proof and lose the greatest fear of all heart patients and their families - when will the next heart attack occur?

KF: What about drugs, stents, and heart bypass surgery?

CE: Admittedly in the midst of a heart attack a stent or bypass may be live saving, however, for the remaining 90% studies confirm that they do not prevent future heart attacks or prolong life. They are associated with significant complications such as hemorrhage, heart attack, stroke, cognitive decline, depression, and death. The benefits erode with the passage of time as the stents and bypasses may themselves develop blockage.

Some drugs may decrease blood pressure and the heart workload. Others interfere with clotting which helps a stent remain open. Statin drugs lower cholesterol. None of these drugs or interventions addresses the basic causation of disease and not surprisingly the disease progresses with the need for more drugs, stents, and repeat bypasses.

KF: Why aren't physicians using nutrition therapy?

CE: Most physicians have no training or understanding of the power of nutrition. In a busy practice they would not have the time for it. It is my belief that physicians must accord the plant based lifestyle transition its due. Every patient with cardiovascular disease should be referred to a physician or nurse practitioner with the knowledge and expertise in these counseling skills.

KF: But I understand physicians don't believe patients will make this transition. How come?

CE: Nutrition counseling is a skill which physicians don't possess. Of all the encounters a patient with cardiovascular disease experiences, perhaps the least time and lowest priority is nutritional counseling. I see many patients with heart disease who recount that nutrition was never even mentioned. It is therefore unlikely that the patient feels that nutrition is important.

KF: What is it that you do differently?

CE: In an intensive 5 hour counseling session for a group of heart patients, my first priority is to eliminate the mystery of what causes their disease. It has not been stress, or genes. It is their western diet of processed oil, dairy, and meat. Hypertension, diabetes, and smoking must be controlled but food trumps all. I spend at least an hour defining the protective role of endothelial cells and nitric oxide functioning as the ultimate guardians of our blood vessels. They quickly understand that their lifetime of ingesting these harmful products has totally overwhelmed and destroyed their endothelium to an extent where it is unable to protect them. They fully grasp that they must forever eliminate ingesting foods that will further destroy their already compromised endothelium. They understand heart disease is a food borne illness.

KF: Where is the good news?

CE: The patients understand that they can halt their disease. They are presented with my scientific articles demonstrating reversal of disease. They learn that anginal chest pain may diminish or disappear within 10-14 days in some patients while others may take longer. We share our data confirming reversal of carotid artery disease to the brain, coronary artery disease of the heart, peripheral vascular disease in the extremities, and the reversal of erectile dysfunction. They are made to appreciate how rapidly and powerfully the endothelial function may be restored. The most significant message in our counseling is patient awareness that they are empowered to be the locus of control of their disease.

KF: What is your take on the present management of heart disease through drug stents and bypass surgery?

CE: It is expensive, dangerous, and ineffective. None of these approaches addresses the factors that cause the disease. A doctor would never treat poison ivy without advising the patient to avoid exposure to poison ivy plants. Sadly the usual treatment of cardiovascular disease almost never includes hours of patient counseling so they may completely eliminate the foods which are injuring their endothelium. Stents may block, bypass veins shut down, drug doses increase, and blood vessel disease worsens. The present cost of this non-treatment of heart disease is unsustainable even in our wealthy nation.

KF: Dr. Esselstyn, are you a threat to the stenting and bypass industry?

CE: Not really. Stents and bypass surgery in an emergency setting are absolutely lifesaving. However, for non-emergency situations an intensive lifestyle trial of 3-6 months would eliminate the need for most interventions. It is of interest that when physicians and some interventional cardiologists themselves develop the disease they come knocking at my door.

KF: Why do you think this information on diet and heart disease is not more widely known? Is someone or something blocking your message?

CE: The government, drug industry, and some of my own profession. The USDA every five years produces a food triangle which promotes the very foods which guarantee that millions of Americans will perish.

The drug industry has a $21 billion dollar income from statin drugs alone. The stent manufacturers make billions more. Neither of these industries would want this epidemic resolved.

Physicians who perform stents and bypass surgery earn millions and are hardly clamoring for fewer patients.

KF: Any final thoughts?

CE: When people learn to eat plant based to eliminate heart disease it could inaugurate a seismic revolution in health. Other diseases that resolve include obesity, hypertension, stroke, heart attacks, gall stones, diverticulitis, asthma, osteoporosis, allergies, rheumatoid arthritis, multiple sclerosis, lupus, and a marked decrease in the common western cancers of breast, prostate, colon, endometrial, ovarian, and pancreatic.

For more information, go to www.HeartAttackProof.com.

Read more at: http://www.huffingtonpost.com/kathy-freston/heart-disease-a-toothless_b_334285.html?view=print

Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?

 

When it comes to good health, I pay very close attention to how the experts are taking care of themselves.

Dr. Michael Holick, the 62 year old Professor of Medicine, Physiology, and Biophysics at Boston University's Medical Center is probably THE world expert on Vitamin D & health--he's been studying Vitamin D for over 35 years.  When Holick talks--I'm listening!

What's his personal prescription for getting enough of this liquid gold?

1. 2000 IUs of vitamin D a day.

2. 3 glasses of milk a day = 300 IUs of Vitamin D

3. 400 IUs in his daily multivitamin

4. Between supplements & milk he's getting 2700 IUs a day

5.  He plays tennis & cycles outside in his free time.  He always wears sunscreen on his face--but leaves his arms & legs exposed--but he lives in Boston.  Sensible sun exposure on your arms & legs is the BEST way to build up your Vitamin D stores--10 minutes a day if you are fair-skinned, between the hours of 10-3, with sunscreen on your face, for 2-3 times a week. That ought to do it!

6.  What's his 25-hydroxyvitamin D level?  He's consistently in the 50-60 ng/mL range.  Just where you'd want to be to get all the health benefits of D.  30 ng/mL is the minimum and you can go all the way up to 100 & still be on the very safe side.

So, why am I writing about Vitamin D again?  There's just so much to say about it!  And besides, it's closing in on November--which means if you live north of Atlanta, Georgia there is no way you can get any vitamin D from the sun.  It's too high in the sky & the angle is too oblique.  By the end of the winter--if you aren't taking a Vitamin D supplement you are going to be deficient!  Not a good thing.

You can stand stark-naked on top of a building in Boston all day in February and get zippo Vitamin D!  So take that supplement & get some Real Sun in the summer!

Why Should I Care If I'm Sufficient or Deficient in Vitamin D?

I know, it sounds like snake-oil.  How can Vitamin D possibly have an effect on so many chronic diseases and conditions?

Simple--every cell and tissue in the body has a Vitamin D receptor--and all of them depend upon D for optimal health.  Here's just a sampling of the bad things that can happen if you aren't getting enough.

• Cardiovascular disease - increase risk of heart attack 142% if under 15 ng/mL
• Cancer - if you live in a northern latitude you have a higher risk of colorectal, breast, & prostate cancers.  Projected 50% risk reduction with over 1000 IUs a day.  Adequate Vitamin D actually inhibits cancer cell growth.
• Autoimmune Diseases
• Osteoporosis/fractures - study after study shows the necessity of Vitamin D to absorb calcium & build strong bones.  With sufficient Vitamin D you'll absorb 30% of the calcium in your diet.  Without Vitamin D, the absorption rate drops to 10-15%.  Although Dr. Holick recommends a Vitamin D level of 50 as the optimal number to prevent osteoporosis,  Dr. Heike A. Bischoff-Ferrari concluded that the minimum level of vitamin D to prevent hip and nonvertebral fractures in older adults should be at 75-80 nmol/l which is the equivalent of at least 32 ng/mL.  ("Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes" in Sunlight, Vitamin D and Skin Cancer, edited by Jorg Reichrath, 2008)
• Respiratory infections & flu - Yes, believe it!  Your immune system hums with D. Cytokine & immunoglobulin production is regulated by Vitamin D.  2009 Archives of Internal Medicine article shows the higher the Vitamin D, the lower the risk of upper respiratory tract infections.
• Osteomalacia - generalized & isolated bone pain - it can vanish with adequate Vitamin D
• Arthritis - both rheumatoid & osteoarthritis
• Multiple sclerosis -risk increases the further one gets from the equator.  Studies show the risk is reduced for outdoor workers, and in people with higher levels of Vitamin D.
• Schizophrenia - risk diminished in infants supplemented with D in first year of life.
• Type 1 Diabetes - Finnish study showed an 80% reduction in developing Type 1 diabetes for infants receiving adequate Vitamin D supplementation.
• Dementia - both vascular and Alzheimer's
• Fibromyalgia is often a misdiagnosed Vitamin D deficiency causing generalized muscle aches & pains.
• Type 2 diabetes.  May exacerbate type 2 diabetes & impair insulin production.  Obesity, associated with type 2 diabetes,  prevents adequate Vitamin D absorption.

Why Are So Many of Us Vitamin D Deficient & What Gets in the Way of Absorbing Adequate Vitamin D?

• We're Indoors & Wear Sunscreen. We spend most of our time indoors & when we're outside we're slathered in sunscreen, or mostly covered up with clothes.  Dermatologists have been telling us to wear sunscreen & avoid the sun for almost 40 years.  An SPF 15 reduces Vitamin D absorption by 95-99%
• No Mid-day Sun. To get adequate Vitamin D from the sun you would have to be exposed to the sun in the peak hours of 10 am to 3 pm.
• It's a Vitamin D Deficiency Epidemic!  Vitamin D deficiency (a level under 30 ng/mL) is epidemic  in adults over 50 (over 70% of us); 50% of children are deficient; 42% of young adults are deficient; and Vitamin D deficiency even exists in California, Florida, Arizona, and Saudi Arabia.  Personally, I don't know a single friend who wasn't deficient when they were first tested.
• It's an Age Thing. Age decreases the ability of the skin to make Vitamin D.  A 20 year old makes 3 times more Vitamin D than a 70 year old.
• Dark Skin Color.  African-Americans need to be out in the sun 5-10 times longer to get enough Vitamin D.  They are walking around with a natural SPF of 15.  Many researchers believe that the excessively low levels of D in African Americans may be responsible for their higher rates of prostate cancer, hypertension, and diabetes.  For an interesting story of skin color & Vitamin D click here 
• Obesity.  The more you weigh, the less Vitamin D is getting into your blood stream.  Obese people can only utilize 50% of their Vitamin D--because it ends up in their body fat & can't get into their blood stream.  They need to get 2-3 times as much Vitamin D from the sun or supplements to bring their levels up to normal.
• Kidney disease & Liver Damage.  Either one will impair the body's ability to activate circulating Vitamin D.
• Certain Drugs Inhibit Absorption of Vitamin D.  Like anticonvulsants, bile acid sequestrants (for cholesterol), Tagamet, corticosteroids, and heparin.

How Do I Find Out What My Level of Vitamin D Is?

• Ask your doctor to order a simple, low cost 25-hydroxyvitamin D test for you.  It's the only way to know what your baseline is.  Then follow-up a few months later if you are deficient.
• For optimal health aim for Dr. Holick's goal of 50 ng/mL.  Absolutely get yourself up to 30 ng/mL.  You're safe up to 100 ng/ML.  And it's impossible to get too much Vitamin D from the sun--the body will regulate it.  With supplements you would have to take over 10,000 IUs/a day, for six months to have Vitamin D intoxication.  Lifeguards wearing no sunscreen have been tested--they have super-high levels, and no intoxication.
• Every 100 IUs of Vitamin D you take, you can figure it will raise your Vitamin D level by 1 point, assuming you are not obese--which necessitates increasing the level by 50% or more.
• For those who are very low in Vitamin D, under physician guidance, you may need to take 50,000 IUs of Vitamin D2  (yes, D2--is now confirmed to be just as good as D3) once a week for 8 weeks, then 50,000 IUs every 2 weeks "forever" after, according to Holick.

How Much Vitamin D Can I Get Naturally From the Sun?  What's Safe?

• You can get your Vitamin D from the sun, from April-September if you live north of Atlanta, Georgia, and it is the best source of Vitamin D.
• If you are sunbathing mid-day on Cape Cod in the summer, wearing a bathing suit, without sunscreen, and you have fair skin, you will get 10,000-20,000 IUs of Vitamin D in just 15 minutes of exposure. Do that 2-3 times a week and you'll build up a healthy storehouse.
• The body is able to store the Vitamin D it gets from the sun far longer than it can store the Vitamin D it gets from supplements.
• Mother Nature has designed the body to store the Vitamin D we get from the sun in our body fat, and release it when we aren't "making" any more.
• Our Vitamin D levels peak in the summer--but in you are barely Vitamin D sufficient at the end of the summer (a level of 30 ng/mL) you will deplete those stores in one month.  By the end of the winter, you will be severely Vitamin D deficient, unless you are taking a supplement.
• Sensible sun exposure.  Here's what Dr. Holick advocates.  10-15 minutes of exposure on arms & legs in the peak sun hours of 10 am - 3 pm, two or three times a week.  Use a sunscreen on your face, and after 10-15 minutes get out of the sun or slather up.   Overexposure can increase non-melanoma skin cancer.   10-15 minutes is not overexposure. 
• To get exact guidance on how long you would need to stay in the sun to get enough Vitamin D, based on where you live, your skin type, the time of day, & the time of year--take a look at Dr. Holick's book, The UV Advantage, or try Dr. James Dowd's online sun exposure calculator.
• Vitamin D from the sun & depression.  Although Vitamin D is known to lessen depression and boost the mood--unfortunately, only the natural kind from the sun has this effect.

What About Skin Cancer?  I Thought It Was Risky to Be Out in the Sun Without Sunscreen?

• The American Academy of Dermatologists is still not recommending that we go out in the sun without sunscreen for any amount of time. They are recommending we take supplements and eat fish.  But remember, Dr. Holick is only recommending short sun exposure with the face protected by sunscreen, and the truth of it is--melanoma, the most dangerous of skin cancers, is usually found in the unexposed parts of the body that never see sunlight.
• Interestingly, occupational sun exposure decreases the risk of malignant melanoma and lifetime sun exposure is associated with a lower risk for malignant melanoma.
• The Dermatological & Cancer Societies of Australia have recently changed their position on sun exposure.  Now that studies have shown that 30-50% of Australian's are Vitamin D deficient because the sunscreen campaigns have been so successful, the Aussies are rethinking "their sunscreen message".  Their new message:  Get sensible sun exposure.  Enough to get adequate Vitamin D, not too much to increase cancer.

Any Special Recommendations for Pregnant Women & Infants?

• Vitamin-D deficient infants will never attain their genetically preprogrammed bone density or height.  That's one scary thought!
• A Boston study looked at 40 mother-infant pairs--the moms took the recommended 400 IU/day Vitamin D in their prenatal vitamin and drank 2.3 glasses of milk a day--at birth, 76% of moms were Vitamin D deficient--81% of newborns were deficient.
• All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet, according to Holick.
• Higher Vitamin D levels decreased the likelihood of preeclampsia, and reduced the need for C-sections.
• Moms who got adequate Vitamin D during pregnancy reduced the risk of wheezing disorders in their children by 61%.
• Breast-feeding moms need to be vigilant that their babies are getting enough Vitamin D.  The breast milk of moms who are not getting enough Vitamin D has a paltry 25 IUs of Vitamin D per liter (1 quart, 2 ounces).  Not even close to the 400 IUs their babies need.  It would take 4000-6400 IUs/a day for a breast-feeding mom to get enough Vitamin D into her breast milk to meet the baby's requirement of 400 IUs a day.  But according to Holick, until more studies are done, "it's not something we're recommending."  Hopefully, we'll be able to in the near future."  In the meantime--breast-feeding moms need to make sure their babies are getting 400 IUs/a day of a Vitamin D supplement.

What Kind of Supplementation Does Dr. Holick Recommend?

• 1000-1500 IUs/a day for most children
• 1500-2000 IUs/a day for adults
• All pregnant women need get 1000 IUs a day in addition to the Vitamin D in their prenatal vitamin, and an additional 200 IUs from their diet.
• The American Academy of Pediatrics now recommends 400 IUs/a day for infants.
• In August 2009 Dr. Holick participated in an Expert Panel convened by the Institute of Medicine to work on new recommendations for Vitamin D--in light of all the research that has come out recently.  Expect new standards sometime around the Spring of 2010.

Can You Get Enough Vitamin D from Diet Alone?  Not Likely!

• The only food that contains Vitamin D, is oily fish, like wild (not farmed) salmon--clocking in at 500-1000 IU a serving.  See a Boston University breakdown of Vitamin D for various fish here.
• Cod Liver Oil is an OK source.
• Some foods are fortified, but at a typical 100 IUs a serving that's about 10 glasses of milk a day.

Want to learn more?

Listen to Dr. Holick and Dr. James Dowd on the People's Pharmacy

The American Academy of Pediatrics updated Vitamin D guidelines for infants & children

The Audio-Digest Family Practice Summary of "Vitamin D: the Vital Vitamin".  57(12): Mar. 28, 2009

NPR Transcript from the Living on Earth broadcast of "Skin Color and Vitamin D"

Why Is Vitamin D My Favorite Vitamin?  Let Me Count the Reasons

"Institute of Medicine Studies a Boost In Vitamin D".  AMA News April 20, 2009  

Gretchen Reynolds.  Phys Ed. Can Vitamin D Improve Your Athletic Performance?  New York Times Sept. 23, 2009

So, What About Me?

I try hard, but rarely succeed in taking 2000 IUs of D a day, plus about 400 IUs from Citracal calcium supplements, and maybe an additional 400 IUs from an occasional multivitamin or from fortified food.  I'm not often out in the mid-day sun--but when I am, don't tell anyone--I'm not wearing sunscreen.

I haven't been retested in over 2 years, when it was 33 ng/mL at the end of winter.  I plan to retest in January 2010.

Getting Back the Zest - I'm Taking Coach Caroline Adams Miller's Advice & Taking a Day Off to Play & Not Think

Photo credit: Chris Blakely

"I give myself over to at least three or four hours a day to what, for an old guy, is spontaneous free play.  It could be reading or what I would call as extremely low-quality rogue tennis, hiking, playing with grandchildren.  But, you know, if a day goes by and I haven't, at this age, had some sense of timelessness and freedom and purposelessness, I'll probably be kind of ratty by supper-time."

-Dr. Stuart Brown, physician, researcher, and founder of the Institute for Play-

Saturday morning.  Hooray.   Not working.  Not traveling.  Nothing I must do or the sky will fall down.

I usually like to post a blog on Saturday morning--but since what I planned to write about would take some concentration, and some serious thought, I've changed my mind.

I haven't had much down-time lately, the skies are gray, it's cold outside, and it's time to listen to Coach Caroline Adams Miller's advice.  

"When you're tapped out--when you're brain is too full--or in a serious slump--the surefire recipe to get back into the game is to clear your mind and put some fun and zest back into your day--or life."      (paraphrasing Coach Caroline)

It's going to be all play and purposeless piddling around for me today!  And tonight -- It's going to be dancing to a playlist of classic rock & music from the 1950-70s - American oldies, British invasion and Motown. Woo Hoo!

You see, I just took the advice that Caroline Adams Miller gives to all her new clients.  Take the VIA Signature Strengths Test and see where the value of ZEST lines up among your other signature strengths.  I learned I have a serious ZEST problem.  Out of 24 strengths, ZEST comes in as a paltry #16 on my scale. What a shocker!  No wonder I'm feeling rather cranky.  I'm way too serious.

Check Out My VIA Scores - doesn't sound like a party-girl to me!

Top Strength:        Love of learning

Second Strength:  Curiosity and interest in the world

Third Strength:     Gratitude

Fourth Strength:   Judgment, critical thinking, and open-mindedness

Fifth Strength:      Perspective (wisdom)

No work for me today.  Take the test yourself and see if you need to take the day off to play as well.  This is a research-backed questionnaire out of Dr. Martin Seligman's prestigious Positive Psychology program at the University of Pennsylvania.  To register & take the questionnaire (it will take about 10 minutes) click here and you'll find the VIA Survey of Character Strengths under Engagement Questionnaires.

I'm a huge fan of Caroline Adams Miller and her recent essay on the importance of taking time out for play in order to recharge and get your groove back, is a must-read. 

She was inspired to write it when she saw first-hand how her 14-year old son was able to speed his own recovery from a sports concussion when he took the concussion clinic doctor's advice:  "Go home and "do not think"--just play!"

A Red Sox slugger David Ortiz, got similar advice when he experienced a serious slump!

Ortiz said Dave Magadan, Boston’s batting coach, had implored him to reduce the clutter in his mind. 

“I guess I was worried more about that than basically the ballgame,” Ortiz said.

“Trying to get so ready and so prepared and when the game comes, there’s nothing there.”

Jumping on the Bed, Concussions and David Ortiz  Click here for Carolyn's Blog

By Caroline Adams Miller

Created Oct 3 2009 - 3:50pm

The New York Times recently ran an article about Red Sox slugger, David Ortiz, who entered a prolonged slump earlier this year, and reduced his spectacular hitting numbers to just one home run during a two-month spring stand.

Extra batting practice didn't help. The advice of friends and coaches didn't, either. Dissecting his swing and stance was a bust. And then Ortiz woke up one morning and decided to attack his game with the spirit of a happy, 12-year-old Little Leaguer who was playing for the sheer fun of it.

What Ortiz learned from his slump was that clearing your mind and having fun was the surefire recipe for relaxing, eliminating shoulder stiffness resulting from anxiety, and recapturing his love of the game.
Although researchers have cited play as one of the most critical characteristics in developing a youngster's brain, problem-solving abilities, executive functioning and imagination, we often forget as adults how important it is to play. I always ask my clients to take the VIA Signature Strengths test when we first start to work together because I want to see where the quality of "zest" lines up among the other 23 strengths, and when it's very low, I know I have a client who needs more play in his or her life.

I had this lesson reinforced unexpectedly when my 14-year-old son, Bayard, suffered a concussion in football practice in the weeks preceding the start of high school. Almost immediately he experienced swings of nausea, sensitivity to light and sound, an inability to read, and extreme sleepiness. He fretted about the fact that all of his peers were starting high school without him while he lay at home in a darkened room, trying to listen to books on tape and adjust to the "new normal" of his life.

He tried to conjugate French verbs. His head screamed in pain. He wrote a short paper for English class. The headaches were fierce. He went to talk to a therapist about how to deal with the varied fallout from the concussion and what it might mean for school, sports and other activities. He grabbed his head and pleaded with the therapist to stop talking because the questions were so thought-provoking that he couldn't tolerate what his brain was doing in response.

The concussion clinic doctors examined his regression on the baseline tests and ordered him to go home and "not think," so that's what he did. He watched sappy movies, sometimes the same one over and over. He organized his bookshelf and precious National Geographic magazines. He refused to indulge any thoughts that might make him sad or anxious.

The following week his concussion assessment scores catapulted forward, all because he had decided to substitute fun and play for serious effort and concern.  Although my son isn't out of the woods yet, he's back in school, just like Ortiz is hitting again.

Creating your best life sometimes means returning to a state of childlike innocence, and seeing the world as a fun and happy place, and not a place where we have to drag our depression and tension from activity to activity, stressing our brains in ways that we may not even be aware of.

In a similar vein, positive psychologists are trying to learn how to teach adults to raise their zest scores because of the high correlation between success, happiness and zest. A happy person is often a flourishing person, and if childlike enthusiasm is one of the tickets to get there, it behooves all of us to learn how to play better and more frequently.

One easy way to do this is to be around other zestful people, and to have a role model in having more fun. My grandmother was my primary "fun" role model. She skipped down the street in her sixties, wore ridiculous fluffy pink bathing caps in her seventies, and delighted in the silly games she played with me, challenging me to a round of golf in her eighties (she won) . As a direct result of her influence and her role-modeling not to take life so seriously, I sport multi-colored fingernails, drive an impractical canary-yellow car with a smiley face on the spare tire, and jump on the bed of every hotel I stay in.

I guess it's no surprise that zest is my number-three VIA trait, but I'm angling to get it up to number-one this year because my son's injury has shown me in vivid clarity how valuable it is to not take life so seriously, and why it's more important than I ever could have thought to live out the Sesame Street mantra: "Come and play, everything's A-okay!"

What The Experts Say About The Side Effects Of Statins. What Are They? What Causes Them? Who Is Most At Risk? How Are They Treated?

Muscle problems are the best known of statin drugs' adverse side effects.  But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported.

Dr. Beatrice Golomb, MD, PhD, Director of the UC San Diego Statin Study Group, Dr. Marcella A. Evans,  UCSD School of Medicine
Am J Cardiovasc Drug 2008;8(6):373-418

Because statin-related myopathy will probably become more common with greater numbers of persons starting high-dose statin therapy and the increasing stringency of low-density lipoprotein cholesterol level targets, research to better identify patients at risk for statin myopathy and to evaluate management strategies for statin-related myopathy is warranted.

Dr. Tisha R. Joy, MD, and Dr. Robert A. Hegele, MD, Robarts Research Institute and Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
Ann Intern Med 2009 June 16;150(12)858-868

In the group that took red yeast rice, the average drop in LDL cholesterol was 43 points in 12 weeks.  We may actually have found a product that may be useful for patients and clinicians to deal with this problem of 'statin-caused muscle pain'.  There is a real potential here, but 'there are still a number of concerns' because the sources of red yeast rice 'are not very' reliable.

Dr. Ram Y. Gordon, MD, Dr. David J. Becker, Chestnut Hill Hospital, University of Pennsylvania School of Medicine, and Jefferson-Myrna Brind Center for Integrative Medicine, Philadelphia, Pennsylvania.
Ann Intern Med 2009 June 16(12):830-839

Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials.  We still do not know whether statins directly induce muscle atrophy or whether lowering lipid levels by any means in patients with vulnerable muscles causes myotoxicity.

Dr. Paul S. Phillips, MD, Scripps Mercy Hospital, San Diego, CA
Ann Intern Med 2009 Jun 16;150(12):885-6

There's no doubt about it.  Statins provide a tremendous benefit by lowering cholesterol and inflammation and decreasing the incidence of cardiovascular disease.

But...our bodies are all different.  Even the statins, drugs hailed to have a high safety profile, also have the potential for causing adverse effects in some of us--dependent on the dosage, drug interactions, co-existing medical conditions, age, genetics, activity level, gender and other factors.

If you've had questions about the side effects of statins, these four recent articles will definitely give you a better understanding of who experiences statin problems, what might cause the problems, and how to deal with them.

Many of these side effects could be easily dismissed or assumed to be related to something else.  Better to be forewarned.  According to Dr. Beatrice Golomb, the expert on adverse effects,  "physician awareness for adverse effects is reportedly low, even for those most widely reported by patients." 

What Are Drs. Beatrice Golomb, Marcella Evans, David Becker, Ram Gordon, Paul Phillips, Tisha Joy & Robert Hegele Saying About Statin Side Effects? 

 

Golomb and Evans' "Statin Adverse Effects.  A Review of the Literature and Evidence for a Mitochondrial Mechanism"

• Golomb is one of the top experts on the adverse effects of statins.  She has previously conducted a "randomized controlled trial" of persons living in San Diego, examining effects of low dose statins on thinking, mood, behavior, and quality of life.  Additionally, she runs one of the largest observational studies on adverse effects of statins--providing a database for people all over the world to self-report any side effect to statins that they have experienced.  Read more about her work at UCSD here.
  
• Her paper is the first comprehensive review of the subject, covering almost 900 studies on the adverse effects of statins.  It's an exhaustive analysis of the research, including the most highly regarded of studies, the randomized controlled trial.

1.  Top statin complaint:  Muscle pain, fatigue & weakness.  These also include rhabdomyolysis (rare but life-threatening), new difficulty walking, exercise limitations, muscle inflammation, shoulder stiffness and more.

2.  Second most common statin complaint:  Cognitive problems: memory, thinking & concentration,  problems finding the right word, experiencing "holes in one's memory".  Since most people are older when starting on statins, this is often difficult to distinguish from age-related memory loss, but Golomb says many have reported that their thinking & memory improves when they stop statins, or lower the dose.  Read "Do Statins Make You Stupid? Asks Wall Street Journal and the New York Times" for more on Golomb's research.

3. Less common statin complaints: Depression and irritability, non-muscular pain, cancer, liver problems, hemorrhagic stroke, blood glucose impairments, reduction in sleep quality, peripheral neuropathy, sexual dysfunction, male endocrine disorders, aggression, renal problems, neuro-degenerative disorders like Parkinson Disease & ALS and more.

4.  What's causing the problems?   According to Golomb, statin-induced injury to the body's "energy-producing cells"--the mitochondria, is the root cause of many of statin's adverse effects.  When the mitochondria are impaired the body produces less energy and we end up with more damaging "free radicals".  Additionally, statins lower the body's production of co-enzyme Q10, a key component in the mitochondria that is necessary to produce energy & destroy "harmful free radicals".  To make matters even worse, there is a real Catch-22:  Statins not only lower our CoQ10 levels, but they also reduce our blood cholesterol which is the way CoQ10 and other fat-soluble antioxidants are transported throughout the body.   So, not only do we end up with low CoQ10, when our cholesterol is lowered, the CoQ10 has difficulty moving through the body.
**According to Golomb, there is evidence that this mitochondrial/CoQ10 connection relates to both muscle & brain pathology.

5. Age and adverse effects.  Now throw in the fact that as we age our mitochondria (the energy powerhouses) naturally weaken, and we produce less CoQ10--adding statins to the mix may not always be wise.  According to Golomb, "The risk of adverse effects goes up as age goes up, and this (the mitochondrial/CoQ10 connection) helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even 'for' those with heart disease." 

High blood pressure and diabetes are also linked to higher rates of mitochondrial problems--which in turn ups the risk of statin complications for people with these conditions.

"Because statins may cause more mitochondrial problems over time--and as these energy powerhouses tend to weaken with age--new adverse effects can also develop the longer a patient takes statin drugs."  The risks go up as we age, as the dosage increases, and with certain genetic conditions that put one at a greater risk for developing side effects.

Joy & Hegele's "Narrative Review: Statin-Related Myopathy"

• This is the quintessential "cookbook" article on statin myopathy.  Believe me--this gets very complicated. The authors thoroughly explain what statin-caused muscle pain is.  Who is at risk.  What causes it.  What doses, which statins & circumstances increase the chances of risk.  And most importantly, how to make muscle pain go away.
• 10% of statin users experience muscle pain, but those numbers increase with excessive physical activity (which explains why most athletes avoid statins); when the statin dose increases; the older you get; in women; those with small body frames; with grapefruit juice consumption; in those with a family history of statin myopathy; in certain genetic profiles; with hypothyroidism; and in patients taking certain drugs--just to name a few.
• Muscle pain is usually in the thighs, calves or both, but 25% experience generalized muscle pain. The myopathy is described as heaviness, stiffness, or cramping, and is sometimes associated with weakness during exercise.  25% have tendon-associated pain.
• Professional athletes with familial high cholesterol rarely tolerate statin treatment because of muscular problems.  J Clin Pharmacol 2004;57:525-8
• Strategies to combat myopathy. Switch statins, particularly to fluvastatin (Lescol); try alternate-day use of certain statins like atorvastatin (Lipitor) or rosuvastatin (Crestor) because they are longer-acting; use of older generation non-statin drugs that work by inhibiting the absorption of cholesterol in the intestine, like ezetimibe and bile-acid-binding resins; and/or supplementing with CoEnzyme Q10.

Becker and Gordon's "Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients"

• This was a small study of 62 patients who had high cholesterol but couldn't tolerate statin therapy because of muscle pain.  Half the group were given three 600 mg of red yeast rice capsules twice a day; half took three placebos twice a day.  All 62 patients participated in a life-style change program of diet & exercise.
• During the 24 week study, LDL cholesterol decreased by 43 mg/dL in the red yeast rice group after 12 weeks--then dropped to 35 mg/dL at 24 weeks because of poorer compliance. The placebo group had a 15 mg/dL drop in LDL cholesterol.  Total cholesterol also improved in the red yeast rice group.
• Muscle pain scores, HDL cholesterol levels, weight loss, and muscle and liver enzymes levels remained the same for both groups--indicating that even though the red yeast rice lowered the subjects cholesterol, it did not cause muscle pain--the point of the study.
• Study limitations:  It was too small and short-term to indicate if the observed improvements would continue.  
• Red yeast rice is a dietary supplement and not regulated.  Potencies vary and when too potent they might cause muscle pain.  Lack of consistencies between manufacturers is a major problem with this therapy.

Phillips' Editorial, "Balancing Randomized Trials With Anecdote"

• Phillips is just the right physician to comment on both the Becker/Gordon red yeast rice article and the Joy/Hegele statin-myopathy "cookbook" review.  He runs a statin myopathy clinic, which now exceeds 600 patients, at the Scripps Mercy Hospital in San Diego, CA.  He knows statin-myopathy well--what works--what doesn't.
• According to Phillips, treating statin-myopathy is more of an art--and the clinical trials don't always tell the whole story, or provide clinicians with the best therapies.   "Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials." 
• Outside of the clinical trials, Phillips' clinic has discovered that vitamin D deficiency explains many mild cases of statin-induced aching. 
• He's also discovered that absorbable forms of CoEnzyme Q10, which may be depleted by statins, seem to help some patients with muscle pain---but most formulations sold over the counter may be inactive. I'm wondering which formulation he would recommend.
  
• Although clinical trials have convinced many physicians to switch patients with muscle pain over to ezetimibe (bile-acid-binding resins), there are many individual reports that suggest that ezetimbe might not be safe for patients who can't tolerate statins. The reason for this--many of these patients have an abnormal lipid metabolism--rendering both drugs unacceptable.
• In spite of the positive results of the Becker/Gordon study, Phillips' experience makes him reluctant to use red yeast rice to lower cholesterol & prevent muscle pain.  Why? Red yeast rice is not regulated or dose-standardized and since it contains the natural form of a lovastatin, it could have the potential for causing serious side effects.  In his clinic he "sees many patients in whom red yeast rice use has repeatedly caused recurrence of muscle toxicity symptoms, occasionally with increased creatine kinase (CPK) levels."
• The red yeast rice study only measured muscle pain.  Phillips wants to know--what about the malaise, fatigue, and weakness that he sees in his patients who use red yeast rice? 
• The FDA continues to warn against inconsistent and possibly toxic formulations of red yeast rice.  Phillips advises physicians not to prescribe it until it has been standardized and tested further.

Two other articles to check out:

Siddiqi, SA, Thompson, PD.  How do you treat patients with myalgia who take statins?  Curr Atheroscler Rep.  2009;11:9-14.

Jacobson, TA. Toward "pain-free" statin prescribing: clinical algorithm for diagnosis and management of myalgia.  Mayo Clin Proc.  2008;83:687-700.

From Becker/Gordon. Ann Intern Med 2009 June 16;150(12)858-868

Approach to Patients With a History of Statin-Associated Myalgias  (based on the Siddiqui & Jacobson articles--see full Becker/Gordon article to follow up on the references below)

1. Initiate or intensify therapeutic lifestyle changes (National Cholesterol Education Program Adult Treatment Panel III Guidelines) (18)
2. Decrease statin dose
3. Discontinue statin and rechallenge at a later date
4. Reduce dose of statin and add ezetimibe (19)
5. Use a different statin or statin-like supplement
    a. Fluvastatin, 80 mg/d (20)
    b. Rosuvastatin at a low dosage (5 or 10 mg/d) (21)
    c. Rosuvastatin once weekly (22), twice weekly (23), or every other day (24)
    d. Atorvastatin, 10–40 mg, 3 times weekly (25)
    e. Red yeast rice, 1800 mg, twice daily
6. Pulse statin therapy (16)
7. Switch class of lipid-lowering agent
    a. Use ezetimibe alone (19)
    b. Combine ezetimibe and colesevelam (26)
8. Check vitamin D levels and replenish if low (27)
9. Low-density lipoprotein cholesterol apheresis in qualified patients (16)
10. Add coenzyme Q10 (ubiquinone), 200 mg/d, to statin therapy (28)

I've never been prescribed, nor taken statins.  I know many who take them without a problem.  I know others who have experienced side effects that they never considered to be statin-related, but found they went away when they stopped taking statins.  I would always recommend discussing this with one's physician, and sharing any of these articles with them, as well.  You won't know what questions to ask, if you don't do the research.

Remember, there's always Option 2: Switch to a plant-based diet, and don't worry about side effects.

Click here and here for information on a non-drug approach to treating heart disease, cholesterol & inflammation.

It's Official Baby Watch Time! Ricki Lake & Abby Epstein's "Business of Being Born" and "Your Best Birth"

Business of Being Born

Right now my family is on what I call "Baby Watch".   Our first grandchild was expected 3 days ago, on May 28th--so it's sure to arrive any day now.

Sometime mid-pregnancy, back in January, my daughter-in-law decided to make the switch from regular OB to midwife--from labor room to birthing room--from no support to using a doula--who is there to coach, guide, and comfort her from the earliest start of labor on through breastfeeding. 

With 1 out of 3 births ending up as C-sections, she wanted to up her odds for a normal delivery.

Soon after that, my son & daughter-in-law rented Ricki Lake and Abby Epstein's documentary about giving birth in the U.S., The Business of Being Born. That's when they knew they had made the best possible decision. 

But, babies & births are unpredictable.  If they should need a C-section or a specialist, it's all one floor down--or up--or down the hall.

I got caught up in their enthusiasm, rented the film, and found myself aghast at how much labor & delivery had changed, even from when I gave birth almost 30 years ago--which was natural, without monitors or anesthesia. And I felt downright elated when seeing the experiences of moms who chose the midwife route. The film is a must-see for anyone thinking about pregnancy.

So, What Is the Typical Hospital Birth Today?

1.  67% of women give birth laying down (the lithotomy position), their feet in stirrups, which slows down labor, closes the pelvis by 25-30%, and eliminates the ability of gravity to work in their favor.

2.  Squatting is less stressful for the mom--puts gravity to work--but it's inconvenient for the doctor--who wants to stand up & have a clear view of the birth canal.

3.  Almost 1/3 of U.S. women now have C-sections.  40-45% of women in New York's Suffolk & Westchester counties end up having C-sections.

4.  C-sections should only be performed when needed to guarantee the well-being of the mother and infant--never out of convenience. It should not be the first choice for healthy mothers.  C-sections are major surgery--increasing risks to mother & baby.

5.  Normal labor clears liquid from the infant's lungs, preparing the baby to breathe outside the womb--Cesarean's impede this process.  Studies have shown that a vaginal birth “primes” a baby’s immune system by exposing it to various bacteria as it moves through the birth canal.  In one large study babies born by C-section were 80% more likely to develop asthma.

6.  Pitocin, the drug used to stimulate labor, can cause painful contractions, which then assures the use of an epidural to relieve pain--which then slows down the contractions--can lead to more drugs--or fetal distress--and may increase the doctor's recommendation for a Cesarean.  Pitocin sets a mother up for  "cascade of medical interventions".

7.  Normal labor is slow, unpredictable & unprofitable.  Compare 12 hours of normal labor with the possible 20 minutes for a Cesarean--complete with an anesthesiologist.

8.  Interesting that C-Sections seem to increase at 4 o'clock in the afternoon & 10 o'clock at night.

9.  Attendance at Lamaze classes (natural childbirth) has dropped 14% between 2000-2005.

10.  Obstetricians have surgical training.  Normal deliveries are just "so boring".  Hospitals thrive on a high turnover.  Speeding labor helps to fill & empty beds more quickly.

11.  80% of women have epidurals today.  In years past the epidural was not given until the mother was 5 centimeters dilated--to insure that labor would not slow down.  If you were too far along--you were encouraged to "just tough it out".  All that has changed.  Now mom can have an epidural as soon as she's admitted to the hospital, if she wants one.

12.  Once you have an epidural you're going to be closely monitored.  Labor slows--pelvic muscles slacken--you have to watch a monitor to even know when to push--you increase your chances for a C-section or a forceps delivery or vacuum extraction.  In 1/5 of women, blood pressure drops--which can cut off oxygen to the baby--another reason for a C-section.

13.  Midwives & lactation specialists see differences in the babies whose moms had epidurals.  They are more sluggish, may be harder to soothe, and frequently have trouble latching onto the breast.

My recommendations: 

 

Check out Ricki Lake and Abby Epstein's brand-new book:  Your Best Birth.  Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience.  New York:  Wellness Central, 2009.

Favorite quote from the film:

"Yes there's bliss and there's pain & you cannot have bliss without pain.  It's one of those days when you know you're alive.  If I can do that--I can do anything!!"

Watch the documentary, "The Business of Being Born"
Click here if you don't see the trailer.

Everday Insights by Ordinary People on Happiness & Health

Here's what makes me happy

Reading something that puts into words something that's just plain true.  Something I sort-of-kind-of-knew but had never put into words.  Something that makes life clearer, more understandable for me.  Until you can put a name on something, you can't understand it.


This Week's Wisdom (for me)

Elizabeth Fuller, commenting on The Perfect Gift

What I do know is that challenges aren’t what make me happy.

 My husband and I recently said to each other that our lives seem to have become a series of events to be gotten through.

Even though we enjoy many of the things we’re doing, we’re often so exhausted all we can think of is getting the most pressing projects done and putting them behind us. Finishing something successfully leads to relief rather than joy.

And yet we do have joy in our lives.

I’m not sure of exactly what that happiness depends upon, but I think it has to do with feeling deep down that something is right–--something as simple as our family being at home, engaged in doing different things, but together, joined inextricably in love.



Alex Lickerman, commenting on Want to Be Able to Predict If Someone Will Be Happy in the Future?

When happy people enter a room, it tends to pull everyone up.

When sad, depressed people enter a room, it tends to do the opposite.

In fact, in medical school, we were taught that if we found ourselves as doctors feeling depressed after interviewing a patient, that was a good indication the patient  was depressed!

I often think about the effect of "dueling life-conditions": when two people interact, who's life-condition will have more of an effect?  Will I pull you up or you pull me down? In effect, who at that moment is stronger in their current state?

So I'd say, good advice would be to make a genuinely happy disposition one of your criteria for a mate, but it's far better to focus on strengthening your own life state--to be able to resist the downward pull of others' negativity.

 

Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine, on Treating an Illness is One Thing.  What About a Patient With Many?

Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient.

Fred Powledge, a 74 year old writer with multiple health problems, who takes a dozen pills a day:

But what’s missing is someone who can look at the big picture and see my health as a whole. That falls to me alone, with the help of my very wise wife and frequent visits to reliable Web sites.   As our population ages, we need some kind of overseer to juggle all the diagnoses and prescriptons and look for conflicts and duplications. This would also help to counteract the notion in many people’s minds that the doctor knows best — because often the doctor doesn’t.

For complete article click here.

A Picture's Worth a Thousand Words

69% of us are eating too much sodium.  If you're over 40 the goal is under 1500 mg of sodium a day.  Here's where it's coming from. Best to cook it yourself and eat at home.

 

Source: Mattes, RD, Donnelly, D. Relative contributions of dietary sodium sources. Journal of the American College of Nutrition. 1991 Aug;10(4):383-393