Happy Healthy Long Life

The Sunday New York Times "Fat Trap" & "Why Lost Pounds Come Back"- It Misses the Mark! Forget the Genetic, Hormone, & Metabolic Excuses - Just Give Esselstyn Plant-Perfect a Try!

 

"Diseases of Affluence," by Dr. Kevin Patterson.  November 15, 2010, Maisonneuve Magazine

 

"We only have one chronic disease - and it's got multiple manifestations. 

Obesity, diabetes, heart disease, high blood pressure, osteoporosis, strokes, vascular dementia, and rheumatoid arthritis.   They're nothing more than food-borne illnesses."

 

-paraphrased from Dr. Caldwell B. Esselstyn, Jr.,in his recent talk in Medina, Ohio-

 

"[Dr. Rena Wing]...agrees that physiological changes probably do occur that make permanent weight loss difficult, but she says the larger problem is environmental, and that people struggle to keep weight off because they are surrounded by food, inundated with food messages and constantly presented with opportunities to eat.

'We live in an environment with food cues all the the time.  We've taught ourselves over the years that one of the ways to reward yourself is with food.  It's hard to change the environment and the behavior,' Wing says."

-Dr. Rena Wing, professor of psychiatry & human behavior at Brown University's Alpert Medical School, quoted in the NYT's "Fat Trap"-

 

 

If you received this story via email, click here to get to the web version with all the links & the video.

The lead story in the 2012 New Year's issue of the New York Times is called, "The Fat Trap."

Its partner story, the Well Blog post, "Why Lost Pounds Come Back,"  has garnered over 700 comments so far.

"The Fat Trap" is about how difficult it is to lose weight--and to keep it off.   It's meant to present the research on weight-loss--and to explain why genetics, hormones, a down-shifting metabolism, low-calorie diets, our innate physiology, and a whole host of other reasons make it nearly impossible to lose weight.

I believe Parker-Pope meant to help us understand why so many of us are overweight--and why it's such a battle to lose that weight.  But, I think she did a tremendous disservice to her readers. 

Ask anyone who is following Dr. Esselstyn's version of a "Plant-Perfect No-Added-Oil Diet".   It's just not as hard as Parker-Pope would have us believe.  We're eating a lot of delicious food--and we're preventing a whole host of chronic diseases at the same time.  The weight-loss is a sweet side benefit of a healthy plant-based diet.

Millions of readers may cheer this article, and say, "See, that's why I can't lose weight!   Why should I even bother?"

Tara Parker-Pope is a popular well-respected New York Times health columnist.  She's followed by millions of readers, daily.   When I read the online "ahead-of-print" publication of her upcoming Sunday Magazine article, "Fat Trap,"  on Wednesday night I was furious.  Really!

I was so disappointed in her conclusions--and the research she chose to cite.   Not all studies are applicable & translate to all diets.  And I was disappointed with her examples of  "diet success stories."  She could have done much better!

Full Disclosure:  Tara has struggled with her own weight loss.  I had no idea.  Although she wasn't overweight as a child, or until she went to college, "[D]uring the 23 years since graduating from college, I've lost 10 or 20 pounds at a time, maintained it for a little while and then gained it all back and more, to the point where I am now easily 60 pounds overweight,"  Parker-Pope explains.

 

Amy & The Healthy Librarian Decide to Offer Diet Advice to Tara Parker-Pope

 

Bottom Line:  Don't give up!  Why don't you just try a plant-based, whole foods, no-added-oil, high-nutrient diet for 4 weeks?  No nuts, no sugar, no chocolate.  You won't regret it!  You only have weight to lose--and health to gain.  Talk to Dr. Esselstyn!

As for the vegan recipes you often post as "healthy foods" on the New York Times--they will get you nowhere fast.  You have to ditch the oil, the sugar, the fake cheese, the chocolate (cocoa is fine), the nuts (except walnuts), & yes, even olive oil.  No more calories to count. No foods to measure.  Just eat whenever & whatever you want of the above-foods.

 

Who is Amy?  And Why Are We Giving Advice to Tara Parker-Pope?  Here's My Back Story:  

So, on Wednesday night, after I skimmed through "The Fat Trap,"  I took a look at the comments people were writing about the article.  

Was anyone else as frustrated with Tara's conclusions as I was?   By Wednesday evening, there were already hundreds of comments--so, I only had a chance to read the 5 most recent comments that were posted.

 

Can you believe this was the second comment I saw?  What are the odds, that this one was posted right before I looked at the comments section?

 

From Amy in California:

Dear TPP,

I would love to read everybody's comments, but for whatever strange reason, my comment section is not opening...

I appreciate what you honestly shared, but please do yourself a favor and visit the Healthy Librarian at: happyhealthylonglife.com!

She is a genius. Her blog is about the science behind health related food issues.I believe that if you follow her blog and actually get behind her advice about food (vegan/little or no fat) you will lose your weight, look amazing and be much healthier without ever feeling hungry.

Yes it is very difficult and requires changing how and what you eat, but if you wish to do it for yourself and for the planet (the consequence of a vegan diet is profound), you won't ever deal with weight issues again.

BTW I did not start reading her blog with any preconceived notions - actually sort of stumbled upon it and began reading.

Her advice is all science based - no fads, no unproven junk, just straight research - all there for you to read and ponder. 

For the first time in my life, my weight issues have been resolved.  I am not going to lie however.  It is truly difficult to follow the vegan diet completely, But the one thing I want to urge you to consider is that regardless of whether or not some people's bodies wish to be heavier than others - you can beat the fat if you believe it matters, and I think it does.  Do not just give up.

It is only going to get worse and eventually it will effect your overall health.

Dec. 28, 2011 at 8:38 p.m.

 

I about flipped!  I was shocked.  Dumbfounded.  I immediately replied to Amy's comment:

 

From The Healthy Librarian, U.S.A:

Wow, Amy! I don't know you--but thanks for the shout-out!

I could go on & on about how filling, easy & enjoyable this diet is & how fabulous I feel on a plant-based diet--but if anyone's really interested in great health, read my 15 month review (written 4 months ago)  "Fifteen Months Into the Esselstyn-Style Plant-Based No-Oil Way of Eating - The Healthy Librarian Spills the Beans - And It's All Good! Can't Wait to Compare Notes with Bill Clinton on Saturday":

http://www.happyhealthylonglife.com/happy_healthy_long_life/2011/08/15-m...

BTW--Dr. Caldwell Esselstyn, Jr. the doctor behind this Prevent & Reverse Heart Disease Diet was just voted the #1 Living Cleveland Clinic Doc, & #3 overall. They're the #1 hospital in heart care.  Click here to read "The 50 Best Cleveland Clinic Doctors.  Ever."

He recently was invited to speak to the town of Medina, OH by the local police chief who experienced a health turn-around of his own..

Here's the police chief's story, "Police Chief Patrick Berarducci's Gone Plant-Strong and is Cracking Down on Heart Disease in Medina, Ohio":

http://www.happyhealthylonglife.com/happy_healthy_long_life/2011/12/bera...

And here's a link to Esselstyn's talk (all research/science based):

http://medinatv.pegcentral.com/player.php?video=6a53c744e757e905ce791146...

Tara---just give it a 4 week try & see for yourself. I'd be happy to load you up with amazing recipes!

Dec. 28, 2011 at 11:21 p.m.

 

I was finally able to figure out who Amy was and she shared more of her story with me:

 

"I started doing the Esselstyn food plan almost one month after you did, and I was fortunate to stumble onto your blog which convinced me to jump in.

I immediately lowered my cholesterol, my blood pressure and my weight. I lost about 15 pounds and would have lost more except that I have had a really difficult summer staying on the plan due to our long trip to Africa and our son's return home from college.

HOWEVER, I am going to go back to being strict about it since I feel so much better and I noticed I got acid reflux when I went off the plan! YUCK. That is a nasty problem.

I like that you are sharing your favorite recipes. I too try to stick to some basics that I like. For me it is raw whole oats mixed with Ezekial grain cereal, ground flax seed, stewed prunes and fresh fruit with almond milk (40 cal). 

I also find that when I go out I order Salmon and that helps with socializing because I do agree with the other poster that it is hard to be social around food when going out with others or attending their celebrations like weddings etc...

Skipping oil is easier than I thought it would be, but I still add about 1/4 teaspoon of olive oil and basalmic vinegar to my salads. I do not have heart disease. I started doing this for my overall health and in order to live long and stay away from taking medications.

It is working great! Most people are shocked to find that I am 52. I went to my high school reunion (35th) this summer and definitely felt that I looked great.

That is the best thing about this food plan. YOU ARE NOT hungry.

I think the worst thing in the world is when people tell me they eat healthy and they keep gaining weight!  

Most people have no clue what eating healthy is.  And one last thing.  I really do not drink.

I believe that a lot of us who are over 50 do not realize how quickly the pounds pack on as we age.  We are not meant to eat much in general.  People eat now as something to do.  It is an "activity" and that is part of the problem too."

 

The Best of the "Fat Trap" Article

 

The National Weight Control Registry, which tracks about 10,000 people who have lost weight & have kept it off, has found these characteristics are common to successful "dieters".

1. The eat breakfast regularly.  (Let's hear it for steel-cut oats!)
2. Most watch  less than half as much television as the overall population.  (Thumbs Up for that one!)
3. They consistently eat the same foods and in the same patterns each day & don't "cheat" on weekends or holidays.  Sounds a lot like the Esselstyn-style plant perfect lifestyle.  (Ann Esselstyn's mantra)
4. They also appear to eat less than most people, with estimates ranging from 50-300 few daily calories.  Sounds a lot like my experience--without the extra calories of fats & processed foods, I'm naturally consuming fewer calories--without being hungry.  Read "Painless Calorie Restriction for People Who Love to Eat - Lessons for Health, Longevity, and Disease Prevention from the NIH CALERIE Study"
5. They exercise regularly.  (Thumbs Up, again!)

 

The Worst of the "Fat Trap" Article

 

1. It cites research about the failure of the quick-fix 500-550 low-calorie diets to sustain long-term weight loss.  Including the use of Optifast, a liquid diet.  And then translates this to diets, in general. Big duh!! Not relevant.
2. It blames the increase of the hunger hormone "ghrelin" and the decrease of the hunger-suppressing hormone "leptin"  for the weight loss problems in people who go on low-calorie diets, never considering that those diets are actually starving people.  No wonder their hormones are out-of-whack!  And Parker-Pope never looked at what happens when people eat high nutrient-dense plant-based no-added oil diets.  Why didn't Parker-Pope talk to Dr. Joel Fuhrman, Dr. John McDougall, or Dr. Caldwell Esselstyn?
3. Take a look at the kinds of foods eaten & the daily routine of Parker-Pope's "diet-success poster couple", Janice & Adam Bridge.  Not my idea of the "best diet".  They have to work so hard to maintain their weight loss--carefully weighing and measuring all their food--and exercising for 100-120 minutes a day, 6-7 days a week.  I absolutely admire how healthy they have become--and all their efforts--but, it just doesn't have to be that hard.  

 

OK--The Bridge's Refrigerator Photo Inspired Me to Share My Refrigerator & Pantry Photos

 

HL's & Lab Rat's Refrigerator - Filled with Veggies, Soups, Casseroles, Smoothies & More

 

The Canned Food Cupboard - A Couple "Outcasts" Still Left Behind

 

Part of the Pantry - Nothing But Whole Grains, Beans, & Rice

 

 

Don't Miss Dr. Esselstyn's Recent Medina, Ohio  Lecture

 

A reader from Michigan tracked down this video (& shared it with me) after he read my post about Police Chief Patrick Berarducci.  Don't miss it--but, fair warning, it's 2 hours long.  Click here for the video. Just give it time to load.

I never tire of listening to Dr. Esselstyn share his research, and Ann Esselstyn explain how to eat Plant Perfectly.  If you've never had the opportunity to listen to them in person--now's your chance.  Don't miss it.  We should all be as healthy & energetic as they are.

Can you think of a better way to get motivated for a Healthy 2012?

This will be the best 2 hours you have ever spent. 

• Shortcuts:  Dr. Esselstyn starts speaking at around 8 minutes into the program.
• DO NOT MISS listening to Dr. Esselstyn's patient, Art Citeros, share his story.  Talk about a testament to the healing power of plant-based foods!  Medications, stents, bypass surgeries, & more stents completely failed Art.  Even eating a mostly plant-based diet failed him.  For Art, the whole plant-perfect diet that included no-oil made all the difference.  No wonder Dr. Esselstyn is so strict!  Art's story starts at 1 hour, 15 minutes, & 47 seconds into the program.  1:15:47.

A huge thank-you to Guy in Michigan for finding this video & sharing it!

 

I Would Love to Hear Your Feedback on "The Fat Trap"

 

Something New - In case you missed it--please stop by & visit, whether you use Facebook or not.

Follow me on Happy Healthy Long Life - The Healthy Librarian's Facebook Page. Something new everyday--& you don't need a Facebook account to check out what's on the page.  

But, I'd love it if you'd click that thumbs-up LIKE Button on the top of page, and join in the conversation.

 

Update:  While proofing my links before posting, I just noticed this comment to Tara Parker-Pope's article in The New York Times. Wow, is all I can say!

From Thinner in New York:

The healthy librarian site is fantastic (happyhealthylonglife.com). 

Seriously: at least in my case and in those of 3 people I know (one with weight problems since childhood), weight loss **and maintenance** have been easy on a plant-based diet.

No starvation involved.

No exercise, either -- not for the weight loss. Exercise is important in and of itself, but when you follow a plant-based diet exercise is not essential for weight loss. (Another resource: Esselstyn's book Prevent and Reverse Heart Disease. This is the book Bill Clinton cites in his interview with Wolf Blitzer.)

• Dec. 29, 2011 at 10:33 a.m.

Thank you, Thinner!  And congratulations!!

 

 

The Healthy Librarian's Brain-Backup for This Week's Health News: Estrogen, Erectile Dysfunction, Diabetes, Dementia, Deli Meats, High-Protein Diets, Vitamin D, Bisphosphonates, Hot Flashes, and High Fiber Carbs

 

 

 

"Once You're Through Learning, You're Through"

 -John Wooden, the well-known UCLA basketball coach, who passed away at age 99-

If you you received this post via email, click here to get to the web version with all the links.

 

The research on the benefits of diet and exercise just continues to pile up on my desk! 

There's no way to keep up with it all--so today I'm "downloading" just a few of the papers that caught my attention this week. 

Nothing "earth shattering".   Much of what you'll see here is just further confirmation of prior research.

Thumbs Up: 

• A diet high in fiber-rich carbohydrates helps prevent type-2 diabetes & metabolic syndrome.
• Get your vitamin D level up to 33 or more, if you want your bisphosphonates to work.
• Bio-identical estradiol significantly improves the verbal memory of postmenopausal women
• Help to prevent dementia by avoiding diabetes & lowering your cholesterol.
• Avoid erectile dysfunction by making the necessary diet & lifestyle changes that improve cardiovascular health.
• Help to prevent stroke by steering clear of deli meats.

Thumbs Down:

• Deli-counter meats--yes, even low-fat turkey--contribute to an increased risk of stroke.  Looks like salt & nitrites are to blame.
• High-cholesterol is bad news for the brain--contributing directly & indirectly to amyloid plaque formation in the brain.
• A diet high in animal protein can promote type-2 diabetes by increasing low-grade inflammation.
• Conjugated Equine Estrogen may not be good for the brains of women at risk for dementia
• There's a link between hot flashes and high cholesterol.
• Diabetes is a major risk factor for dementia because it increases vascular disease.
• Erectile dysfunction needs a diet & lifestyle makeover--not Viagra & Cialis.

 

 

1.  Diet high in protein, processed meat raises risk of diabetes

 

High protein intake may facilitate type 2 diabetes and metabolic disturbances, mostly through the elevation of low-grade inflammation.

 

September 16, 2011.  Presented in Lisbon, Portugal at the European Association for the Study of Diabetes (EASD) 2011 Meeting.

 

Excerpt from Medscape (to view you must register, but it's free):  Results of a large population-based study (27,140 individuals) show that a high protein intake is associated with an increased incidence of type 2 diabetes.

In presenting their results at the recent European Association for the Study of Diabetes (EASD) 2011 Meeting, Swedish researchers suggest that replacing protein with carbohydrates, especially breads and cereals rich in fiber, may be preferable for avoiding incident diabetes. 

The study participants with the highest intakes of protein were at a 37% increased risk of developing type 2 diabetes, compared to those with the lowest intake.

High intake of processed meat was also associated with an elevated risk of diabetes, as was intake of poultry and eggs.  There was no association of diabetes risk with intake of fish or red meat, but when all animal sources of dietary protein were considered together, an increased risk was seen.  "So this indicates that protein per se may be of importance," according to lead author Ulrika Ericson.

High protein intake may facilitate type 2 diabetes and metabolic disturbances, mostly through the elevation of low-grade inflammation.

In summary, Ericson said a protective association exists with a high intake of fiber-rich breads and cereals.  And although high protein intake has been shown to be effective for short-term weight loss and glycemic control, it is associated with an increased risk of type 2 diabetes. 

So, the results of this trial suggest caution when considering high-protein diets--although Ericson says it's too early to make dietary recommendations based on merely on the observed associations.

 

For a better understanding of how high-fiber low-glycemic carbohydrates help to prevent type 2 diabetes & metabolic syndrome, take a look at:  

There's More to the Whole-Grain Story.  A Calorie is Not Just a Calorie.  Carbs Affect Our Genes.  What? (then scroll down halfway to find this gem!)

Tip: whole wheat bread may be high fiber, but it's also high glycemic.  Find a better choice!

Bottom line: you want very grainy "kibbled" least-processed breads & carbs that move slowly through your digestive system. 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.

 

Also take a look at:  Larrson, SC, Virtamo, J., Wolk, A. "Red Meat Consumption and Risk of Stroke in Swedish Men,"  Am J Clin Nutr 2011 Aug;94(2):417-21.

 

"The largest study to date on the relationship of stroke to red meat consumption suggests higher intake of processed meat, but not fresh red meat, is associated with an increased risk for stroke, including cerebral infarction.

The findings suggest meats that consumers often think are healthier, such as low-fat deli turkey, ham, and bologna, may actually increase the risk for stroke if intake is high enough, the study authors note. 

The investigators speculate that sodium in processed meats, which can contribute to the development of hypertension if intake is high enough, might contribute to a higher risk for stroke by promoting vascular stiffness or oxidative stress.

Nitrites used as preservatives may also contribute to increased stroke risk."  Read more in Medscape (must register first--but it's free)

 

 

2.  HIgh Cholesterol tied to Alzheimer's disease lesions

 

"Our study clearly makes the point that high cholesterol may contribute directly or indirectly to plaques in the brain," corresponding author Dr Kensuke Sasaki.  

September 13, 2011.  Matsuzaki T, Sasaki K, Hata J, et al. Association of Alzheimer disease pathology with abnormal lipid metabolism: The Hisayama study. Neurology 2011; 77:1068-1075. 

 

Excerpt from Heartwire.  Kyushu, Japan - A new study has found a correlation between dyslipidemia and the presence of amyloid plaques in the brain at autopsy, one of the key signs of Alzheimer's disease.

According to the analysis, levels of total and LDL cholesterol, as well as ratios of LDL to total cholesterol and LDL to HDL cholesterol, were significantly higher among subjects with increased numbers of neuritic plaques vs those with fewer plaques. No such relationship was seen with numbers of neurofibrillary tangles, the other cardinal pathological sign of Alzheimer's disease.

"Our study clearly makes the point that high cholesterol may contribute directly or indirectly to plaques in the brain," corresponding author Dr Kensuke Sasaki (Neurological Institute, Kyushu University, Japan) said in a statement by the American Academy of Neurology.

However, he added, "Failed treatment trials of cholesterol-lowering drugs in Alzheimer's disease mean there is no simple link between lowering cholesterol and preventing Alzheimer's."  (My comment:  Could changes in one's cholesterol that come from diet & lifestyle have more of a protective impact than those from statins?  And don't forget that Alzheimer's & vascular dementia are years in the making!)

The study, published in the September 13, 2011 issue of Neurology, looked at autopsy brain specimens from 76 men and 71 women who had undergone clinical examination in 1988 and had total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides measured at that time. Of the 147 subjects, 34% had been diagnosed with dementia when alive.

 

For additional perspective read,  Mayo Clinic Researchers Discover the Nitric Oxide Connection to Brain Health, Alzheimer's, and Cognitive Impairment. Better Keep Your Endothelial Cells Healthy with Diet & Exercise

 

3.    Bisphosphonates Most Effective With Higher Vitamin D Levels  

 

Women whose mean level of serum 25 hydroxy vitamin D (25[OH]D) was at least 33 ng/mL were almost five times more likely to benefit from bisphosphonates than those whose levels fell below that cutoff.

 

September 21, 2011.  American Society for Bone and Mineral Research (ASBMR) 2011 Annual Meeting; Abstract #1137. Presented September 18, 2011

 

Excerpt from Medpage Today & Medscape: Bisphosphonate therapy for osteoporosis is much more likely to be effective among patients whose blood serum levels of vitamin D are elevated, according to research presented here at the American Society for Bone and Mineral Research (ASBMR) 2011 Annual Meeting.

Postmenopausal women with low levels of circulating vitamin D are much less likely to respond to treatment with bisphosphonates, researchers said here.

Women whose mean level of serum 25 hydroxy vitamin D (25[OH]D) was at least 33 ng/mL were almost five times more likely to benefit from bisphosphonates than those whose levels fell below that cutoff (OR 4.53, 95% CI 2.17 to 9.48, P<0.0001), according to Amanda Carmel, MD, of Weill Cornell Medical College in New York City, and colleagues.

In addition, for each 1 ng/mL decrease in 25(OH)D level, there was a 5% decrease in likelihood of responding to treatment (OR 0.95, 95% CI 0.92 to 0.98, P=0.0007), Carmel reported at the annual meeting of the American Society for Bone and Mineral Research.

"The current study is the first to identify a threshold level of 25(OH)D that defines improved outcome to bisphosphonate therapy such that patients with a mean 25(OH)D ≥ 33 ng/mL had a substantially greater likelihood of responding to bisphosphonates," the authors wrote.

"This threshold value of ≥ 33 ng/mL for 25(OH)D is higher than the level considered adequate by the Institute of Medicine report for the general population, arguing that higher levels may be required for specific therapeutic outcomes."

According to coauthor Richard S. Bockman, MD, PhD, the results may help explain discrepancies in responses to bisphosphonates seen in controlled studies compared with the real-world environment.

 

4.   17β-Estradiol Improves Postmenopausal Memory Performance

 

"We found consistently that [CEE] may not be good for the brain, at least in women with increased risk of dementia. And 17β-estradiol had better effects," said Dr. Rasgon.

 

September 19, 2011.  Wroolie, TA et al, "Differences in verbal memory performance in postmenopausal women receiving hormone therapy: 17β-estradiol versus conjugated equine estrogens"  Am J Geriatr Psychiatry 2011 Sep;19(9):792-802. Click here for article

 

Hormone therapy compounds differ significantly when it comes to their effects on cognition in postmenopausal women, especially on verbal memory, new research suggests.

In a cohort study of almost 70 healthy women between the ages of 49 and 68 years who were at risk for Alzheimer's disease (AD), those receiving hormone therapy containing 17β-estradiol showed a significant improvement in verbal memory performance compared with those receiving compounds with conjugated equine estrogen (CEE).

"There is a differential effect of the type of hormone therapy on brain function," principal investigator Natalie Rasgon, MD, PhD, professor of psychiatry and of obstetrics and gynecology at Stanford School of Medicine in Palo Alto, California, and director of the Stanford Center for Neuroscience in Women's Health, told Medscape Medical News.

"We found consistently that [CEE] may not be good for the brain, at least in women with increased risk of dementia. And 17β-estradiol had better effects," said Dr. Rasgon.

She reported that the investigative team is now working on "even more exciting data" that she hopes can be translated into clinical practice.

Don't miss Cynthia Gorney's balanced ground-breaking article all about the beneficial effects of estrogen & the brain--The Estrogen Dilemma, that appeared in the Sunday April 18, 2010 New York Times Magazine.  Click here for the article.  Read more about it in this post.

 

5. Hot Flashes Linked to Higher Cholesterol

 

Several recent studies have linked hot flashes to an increased risk for heart disease, and now new research suggests a link between these menopause symptoms and increased cholesterol.

 

September 21, 2011.  North American Menopause Society (NAMS) 22nd Annual Meeting, paper presented by  Rebecca C. Thurston, PhD, assistant professor of psychiatry and epidemiology, University of Pittsburgh School of Medicine and Lori Mosca, MD, PhD, professor of medicine, Columbia University; director of preventive cardiology, New York-Presbyterian Hospital; past president, American Society for Preventive Cardiology. 

 

Excerpt from Medscape article by Salynn Boyles (to access Medcape articles you need to register). 

Several recent studies have linked hot flashes to an increased risk for heart disease, and now new research suggests a link between these menopause symptoms and increased cholesterol.

The study is being presented in Washington D.C. this week at the 22nd annual meeting of the North American Menopause Society.

Researchers followed more than 3,000 women in their 40s and early 50s for seven years as they transitioned through menopause.

After taking into account other heart disease risk factors they found hot flashes and, to a lesser extent, night sweats to be predictive of higher cholesterol The more hot flashes the women had, the higher their LDL "bad" and HDL "good" cholesterol.

"I think hot flashes and night sweats tell us something about women's cardiovascular risk and health, but it is also likely that this message is quite complex," study researcher Rebecca C. Thurston, PhD, of the University of Pittsburgh tells WebMD.

Columbia University professor of medicine Lori Mosca, MD, PhD, tells WebMD that it is not clear if hot flashes or other menopausal symptoms have any direct impact on heart attack and stroke risk.

One message that is clear, she says, is that menopause is associated with substantial alterations in heart disease risk.

 

6.  More Evidence Links Diabetes and Dementia

 

"We have clearly demonstrated that diabetes is a significant risk factor for the development of dementia, especially of Alzheimer's disease, in (the) general public," said Dr. Yutaka Kiyohara, a professor in the graduate school of medical science at Kyushu University in Fukuoka.

 

September 19, 2011.   Kiyohara, Y, Ohara, T. et al, "Glucose tolerance status and risk of dementia in the community: The Hisayama Study,"  Neurology, 2011 Sep 20;77(12):1126-34.  (click here for the article)

 

Excerpt from HealthDay, Ellin Holohan: 

People with diabetes are at significantly higher risk of developing all types of dementia, including Alzheimer's disease, finds a new study that bolsters previous research connecting the two illnesses.

The study of more than 1,000 people in Japan found that 27 percent of those with diabetes developed dementia, compared to 20 percent of people with normal blood sugar levels.

Further, the study showed that pre-diabetes -- higher than normal blood sugar levels -- also raised the risk of dementia.

"We have clearly demonstrated that diabetes is a significant risk factor for the development of dementia, especially of Alzheimer's disease, in (the) general public," said Dr. Yutaka Kiyohara, a professor in the graduate school of medical science at Kyushu University in Fukuoka.

The study, conducted from 1988 to 2003, is published Sept. 20 in Neurology.

The study followed 1,017 men and women, age 60 and older, who took a glucose test to find out if they were diabetic or pre-diabetic. They were then tracked over an average of 11 years each. In all, 232 developed dementia, either Alzheimer's, vascular dementia, all-cause dementia or another form.

Of the 150 who had diabetes, 41 developed dementia, compared to 115 of the 559 people without diabetes. Among the 308 people with pre-diabetes, 76, or 25 percent, developed dementia.

Even having high levels of sugar two hours after taking glucose was linked to dementia, the researchers said, noting the importance of consistent blood sugar control.

Diabetes affects close to 26 million children and adults in the United States, with 7 million of them undiagnosed, according to the American Diabetes Association. Another 79 million have pre-diabetes. Obesity increases the risk of diabetes, and as Americans become heavier, more are developing diabetes.

While prior research has shown a link between diabetes and dementia, the Japanese study is important because of its size and duration, said another expert.

Another expert noted that diabetes could be connected to dementia because it contributes to vascular disease, disrupting the flow of oxygen to the brain and other organs.

"Diabetes is a major risk factor for vascular disease," said Dr. Spyros Mezitis, a clinical endocrinologist at Lenox Hill Hospital in New York City. "If the blood vessels are not allowing enough oxygen to get to the brain, you can get dementia."

The study will "change the way we practice medicine" and could lead to quicker referral of diabetics to neurologists when they show signs of memory loss or other cognitive problems, he said.

The goal for patients is to avoid the progression of vascular disease and to maintain proper blood sugar levels, he noted.

 

For more on the adverse effects of blood sugar spikes on the brain, click here.

 

7.  Erectile Dysfunction May be Linked with Cardiovascular Trouble--an Independent Risk Factor for Heart Disease, Stroke and Death.

 

"A number of prior individual studies have shown that men with erectile dysfunction are at increased risk for fatal and nonfatal cardovascular events. 

Men with erectile dysfunction should be aware of this significant increase in cardiovascular risk and take proactive steps to adopt a healthy lifestyle and better control their cardiovascular risk factors,"  Dr Greg Fonarow, MD, UCLA, commenting on the article.

 

 September 14, 2011.  Dong, YR, Zhang, YH, Qin, LQ , "Erectile dysfunction and risk of cardiovascular disease meta-analysis of prospective cohort studies,"   J Am Coll Cardiol  2011 Sep 20;58(13):1378-85  click here for the article

 

Excerpt from HealthDay:

Although it is well accepted that cardiovascular disease is a risk factor for erectile dysfunction, it has not been clear whether erectile dysfunction is an independent risk factor for cardiovascular disease, the researchers noted.

"Erectile dysfunction significantly increased the risk of cardiovascular disease, and the increase was probably independent of conventional risk factors," said lead researcher Dr. Li-Qiang Qin, from the department of nutrition and food hygiene in the School of Public Health at Soochow University in Suzhou.

As such, "erectile dysfunction may not only contribute to cardiovascular risk prediction, but also serve as a potential target for cardiovascular disease prevention," Qin said.

The report was published in the Sept. 13 online edition of the Journal of the American College of Cardiology.

For the study, Qin's team culled data on the relationship between erectile dysfunction and cardiovascular disease from 12 studies published between 2005 and 2011 that included a total of 36,744 people and an average follow-up of 4 to 16.2 years. This process, called a meta-analysis, tries to pool data from several sources to tease out a pattern that might not be obvious in a single study.

The researchers found a significant association between erectile dysfunction and the increased risk of cardiovascular disease, heart disease, stroke and death.

In fact, men with erectile dysfunction had a 48 percent increased risk for cardiovascular disease, a 46 percent increased risk for heart disease, a 35 percent increased risk for stroke and a 19 percent increased risk of dying of any cause, compared to men without the condition.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, noted that "erectile dysfunction impacts some million 18 million men in the United States."

Cardiovascular disease and erectile dysfunction share many common risk factors, including diabetes, obesity, smoking, hypertension and high cholesterol, he said.

Read more here: From the New York Times: For a Common Male Problem, Hope Beyond a Pill. Diet, Exercise, & Lifestyle Changes Improve E.D.

 

Crazy Busy Between Now & Mid-October

I'm not sure how much I'll be blogging in the upcoming weeks--with Rosh Hashanah/Yom Kippur starting tomorrow night--and soon after I'll be traveling out-of-town to help my kids with the arrival of grandchild #2. Woo Hoo!

In between work--I'll be busy cooking for the holidays, and planning & prepping meals to stock my kids' fridge!  I want to spend time playing with the grandbabies--not stuck in the kitchen!

If I have any free time I just might be able to sneak in a post or two!  No promises.

Lab Rat's written a terrific post on how to grow sprouts in your kitchen.  I've got new recipes to share, the update on my new strength-training routine, more hot-off-the-press health news, and my promised follow-up post with my favorite tips, tools, snacks & pantry staples for a simplified plant-based kitchen!

 

The Healthy Librarian's Friday Four: Diet & Lifestyle Affect Telomere Length, the Multivitamin & Breast Cancer Connection, Estrogen & the Brain of Normal Weight Women, and Olive Oil's Anti-Inflammatory Effects

"When the telomeres become short, then you start cutting into actual chromosomes where there are genes essential for our body.  To prevent the fraying DNA in all those aging cells from seeding maliganant tumors, the body turns them dormant. Your body shuts down more and more cells every day and you become old."

-Emmuanel Skorkalakes, of the Wistar Institue in Philadelphia-

"if too much telomere DNA is lost--for instance, due to excessive cell division--the chromosomes can become unstable, which can increase the risk of cancer.  Where we have been able to look...telomere shortening appears to be a very early and common event in the development of cancer."

-Dr. Alan Meeker, Johns Hopkins researcher who studies telomere shortening-

Four new published studies caught my attention this week when they passed my desk.  Together they add one more piece to the puzzle of how lifestyle & diet so strongly affects our health--and there is no escaping the effect of health on happiness.

• Waist Size, Omega-6 Oil Consumption, & Fiber Intake Affect Telomere Length.  This study was based on measurements of the telomere length in 2284 female participants from the Nurses' Health Study.  The women who had the highest intake of cereal fiber had the longest telomeres.  As intake of  polyunsaturated fats (omega-6s) increased,  and the waist circumference expanded (>32 inches)--telomere length shortened.  The authors say the associations were modest, but "support the hypothesis that body composition and dietary factors are related to leukocyte telomere length, which is a potential biomarker of chronic disease risk."--American Journal of Clinical Nutrition (2010) 91:1273-80, May.  "Association between diet, lifestyle factors, and telomere length in women"  Previous studies have shown that increases in exercise & omega-3 consumption also increase telomere length.  Click here and here

• Multivitamin Use Is Associated with a 19% Increase in Breast Cancer Risk in a Swedish Study.  This study followed 35,329 cancer-free Swedish women for 9 1/2 years to determine if there was any relationship between multivitamin use and breast cancer.  Although the study found a 19% increase risk of breast cancer associated with multivitamin use--the authors can only speculate as to the reasons.  Because the multis contain so many different vitamins & minerals it's difficult to know what might be responsible for the breast cancer association.  The authors speculate that folic acid might be a "suspect".

"Folic acids in supplements could possibly increase the risk of breast cancer.  High doses of folic acid from supplements or fortified foods are of concern because synthetic folic acid is more bioavailable than folate from natural food sources and, hence, potentially more potent in promoting cancer growth."  (note: The U.S. fortifies processed foods & cereal products with folic acid.  Sweden does not.)

"Findings from animal studies showed that folic-acid deficiency reduced chemically induced mammary cancer."

Additional studies have shown increased breast cancer with folic-acid supplementation (synthetic), but decreased breast cancer when folate from food sources was increased.

Other adverse components of the multivitamin that the authors consider are: iron and zinc.  Multivitamin use has also been associated with a significant 5.3% increase in mean breast density--which is a risk factor for breast cancer. 

It's difficult to draw conclusions here--and as researchers ALWAYS SAY, "Further study is warranted."  Especially since more than 40% of women take multivitamins.  Article cited: American Journal of Clinical Nutrition (2010) 91:1268-72, "Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women"

Bottom Line: Eat food--not supplements.  As Dr. Joel Fuhrman says, "Only by eating an assortment of natural foods that are micronutrient-rich can you get enough of these compounds to protect yourself from the common diseases that afflict Americans."

• Declines in Estrogen Really Can Affect Your Thinking--If You Have a Normal Weight.  Postmenopausal women with normal body mass indexes (BMI) of 18.5-25 experience more rapid declines in memory, verbal fluency, and visual-spatial processing than women with BMIs above 25.  It's the estrogen, baby!  Women with higher BMIs don't necessarily experience the "estrogen brain drain" because they have more circulating estrogen being produced by their fat tissue.

I discovered this provocative study through a Medscape blog authored by Dr. Alan Jacobs, a specialist in clinical neuroendocrinology--a combo of neurology, psychiatry, ob/gyn, and medical endocrinology. 

Here's a Dr. Jacob's brain tip: Because of his extensive research he personally takes 600-800 mg/day of DHA (Omega 3's contain both DHA & EPA) for brain health.  For his patients with mild cognitive impairment he prescribes 2000 mg/day of DHA to protect against Alzheimers.  

He also notes:  "Current neuroscience views a likely window of benefit lasting approximately 7 years post-menopause where estrogen replacement therapy may protect a woman from AD/unhealthy brain aging for decades down the road, and that this protection, however strong or slight, cannot be attained by starting estrogen at 65 or 70--and that estrogen need not be taken all the way up to the age of risk for AD (ie>65)  For Dr. Jacobs blog  (look under physician blogs--Diabetes & Endocrinology. Click here  You will have to register for Medscape if you want to access his blog--but it's free & easy to do.  If the link doesn't work--google: Heads and Tales: The Neuroendocrine Blog of Alan R. Jacobs, MD   Article cited: Psychoneuroendocrinology (2010) 35:516-524, "Accelerated postmenopausal cognitive decline is restricted to women with normal BMI: Longitudinal evidence from the Betula project.  For more on the brain & estrogen connection click here.

• Extra-virgin Olive Oil That is High in Phenols (anti-oxidants) Can Turn-off Pro-inflammatory Genes--Offering a Possible Explanation for Olive Oil's Health Benefits.  This was a small study, run on 20 people-all with metabolic syndrome--comparing the effects of eating high-phenol extra-virgin olive oil to that of low-phenol extra-virgin olive oil.  Note:  It's likely that the extra-virgin olive oil commonly available in grocery stores does not have a high-phenol content.  As mentioned in a previous post on wine & olive oil--high-phenolic olive oil is the green first-harvest-press variety.  Click here for that post.  But don't forget that olive oil is still 120 calories a tablespoon & 14 grams of fat.There are many other fruits & vegetables that exceed olive oil in anti-oxidant/phenol content!  Tipster for this article: Medical Librarian Mary C.

If you're looking for a green first-press olive oil, M.G. recommends  Bariani  It's a cold extracted first-press green olive oil produced in California, and available in the U.S.  Article cited:  BMC Genomics (2010) 11:253 "Gene expression changes in mononuclear cells from patients with metabolic syndrome after acute intake of phenol-rich virgin olive oil"

"We identified 98 differentially expressed genes when comparing the intake of phenol-rich olive oil with low-phenol olive oil. Several of the repressed genes are known to be involved in pro-inflammatory processes, suggesting that the diet can switch the activity of immune system cells to a less deleterious inflammatory profile, as seen in metabolic syndrome."

"These findings strengthen the relationship between inflammation, obesity and diet and provide evidence at the most basic level of healthy effects derived from virgin olive oil consumption in humans," study leader Francisco Perez-Jimenez of the University of Cordoba, Spain.

The Healthy Librarian's Brain Back-Up: Sugar Raises Triglycerides, Fat Damages the Brain, Marriage and Health, Tips From Integrative Medicine Physicians, Estrogen and the Brain

"Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, age 99-

If you received this via email Click Here to get the web-version of this post--with all the links.

OK, guys, bear with me.  I'm going to do something I rarely do--be brief.

I'm long on information and short on time.

If I don't blog now about some of the thought-provoking new articles I've read this week--and some recommendations from readers--they'll get pushed aside by the next new studies or articles to cross my path.

So here's what I've been reading this week:

It's Time to Ditch the Sugar Once and For All!  Sugar is Shown to Increase Triglycerides, Lower HDLs, and Increase the Risk of Metabolic Syndrome, Cardiovascular Disease, and Stroke.

We already know that excess sugar can pack on the pounds, put you at risk for type-2 diabetes, and cause blood sugar spikes that damage the brain--no I'm not making that last one up--click here for "that story".

But here's the "hot off the press" news just published today in JAMA  showing that sugar can raise triglycerides and lower HDLs, increasing our risk of heart disease and stroke.

The JAMA article is based on the latest analysis of data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)--and it backs up recent findings from the Framingham Heart Study. 

Bottom Line:  Increased sugar consumption promotes elevated triglycerides and lower HDLs--which are strong markers for metabolic syndrome and cardiovascular disease.  And if you want to know exactly why high triglycerides are so nasty read my earlier post: "Why You Might Want to Keep Your Triglycerides Under 80. Following the New AHA "Ditch the Sugar" Guidelines Will Help!"

And there's more bad news when it comes to high triglycerides--it increases the risk for strokes. "Bad News: High Triglycerides Are Linked to Stroke Risk. Good News: You Can Do Something About It!"

Being Fat Is Bad for the Brain--New York Times'  writer  & evolutionary biologist Olivia Judson has compiled the latest research on why belly fat is bad for the brain.  Click here for her article, Brain Damage in the April 21, 2010 New York Times.

• Belly fat at age 40 puts one at a higher risk for dementia in one's 70's--California study.
• Folks who were overweight in their 40's had a more rapid decline in their brain function as they aged--compared to their thinner counterparts.  Swedish study.
• A study of middle-age people (44-66 years old) found "that the obese tended to have smaller, more atrophied brains than thinner people."

Judson's well done piece continues with more studies, complete with journal citations, and she speculates as to the reasons why overweight people are at a greater risk for dementia--and more importantly--is it possible to turn the process around?   Seems fairly obvious to me--inflammation, elevated cholesterol, hypertension, type-2 diabetes all affect the blood vessels of the brain--as well as the heart.

To read more about the belly fat--brain connection click here and here.

Is Marriage Good For Your Health?  That All Depends.  But It Pays To Be Nice To Your Spouse!

Tara Parker-Pope's article, Is Marriage Good For Your Health, published in the April 18, 2010 New York Times Sunday Magazine is fascinating.  Click here for the article.

It's a worthy read, based on 30 years of stress/immune function research conducted by the Ohio State University duo, viral immunologist Dr. Ronald Glaser, and his wife, psychiatrist Dr. Janice Kiecolt-Glaser-- as well as researchers from the University of Chicago, the University of Utah, and the University of Virginia.

• Your marriage affects your immune system--for good or for ill.
• A good marriage brings health & well-being--with less chance of having pneumonia, surgery, cancer, and heart attacks.
• A troubled marriage, or a nasty divorce will adversely affect your immune system.
• If you're single and never married--you're apt to be healthier than those who have divorced.
• Any health advantage from marriage comes from the quality of the relationship--not the institution of marriage.

Here are some gems:

1. The Glasers conducted a fascinating experiment on married couples to measure how quickly their skin healed when their arms were subjected to eight tiny blisters--using a dermatologic blistering device.  After the procedure the couples were asked to talk for 30 minutes.  At one session they were asked to talk about subjects that evoked conflict and tension.  At another session they discussed topics that evoked pleasant, loving, supportive feelings.  The results were remarkable.  When couples argued it took a full day longer for the blisters to heal, than when they discussed something pleasant.  The couples who exhibited the highest hostility when they argued, took two full days longer to heal their blisters, than those who had less animosity.

2. "Kiecolt-Glaser told [Parker-Pope] that the overall health lesson to take away from the new wave of marriage-and-health literature is that couples should first work to repair a troubled relationship and learn to fight without hostility and derision.  But if staying married means living amid constant acrimony, from the point of view  of your health, 'you're better off out of it."

3. From Timothy W. Smith's research on couples who have been happily married for around 36 years:  Smith found the quality of one's marriage even affected coronary calcium scores. "The solution isn't to stop fighting.  It's to fight more thoughtfully.  Difficulties in marriage seem to be nearly universal.  Just try not to let the fights be any nastier than they need to be.  Saying, "Honey, you're driving me crazy!", a pat on the back or a squeeze of the hand, all signal affection in the midst of anger. "Most of the literature assumes that it's how bad the arguments get that drives the [negative health] effect, but it's actually the lack of affection that does it."

Advice from the Glasers based on 30 years of studying the effects of stress on health & marriage:

• Take time off together and make sure disagreements don't degenerate into personal attacks.
• Don't fight dirty.  Never go far enough down the road where you hurt each other.  Know enough to avoid those kind of arguments.
• Some level of stress is inevitable--even in the happiest of marriages.  So use those moments of stress as an opportunity to repair the relationship--rather than damage it.
• An on-going disagreement is so uncomfortable.  "It's a pit-in-your-stomach kind of thing.  But when your marital relationship is the key relationship in your life, a disagreement is really a signal to try to fix something."

Advice from Six Top Minnesota Physicians Who Practice Integrative Medicine.

A big "Thank You" to the Minnesota reader who sent me this Minnesota Monthly article, Heal Thyself, by Sarah Moran, that appears in the magazine's May 2010 issue.   Click here to read the sage advice of these six physicians.

"People are clamoring for--doctors who uncover the root cause of illness instead of just treating or masking the symptoms--physicians who take body, mind, and spirit into account and look carefully at the influence of lifestyle habits like diet, activity, and rest."

Dr. Thomas Sult on Digestive Health:

• For digestive health eat whole foods. Unprocessed fruits, vegetables, nuts, seeds, lean protein, and whole grains result in more probiotics, the "good" bacteria in your gut that detoxifies, improves immune function, and aids digestion.
• Choose foods with soluble fiber, like shallots, bok choy, chicory, garlic, and onions.  They encourage growth of good bacteria.
• Eat fermented foods regularly.  Make or find live fermented vegetables, sauerkraut, kefir, kimchi, and miso, which breed probiotics.

Dr. Carolyn Torkelson on Breast Cancer Prevention:

• Maintain a healthy weight.  There's a connection between obesity and breast cancer.  Estrogen production in fatty tissue may be to blame.
• Reduce omega-6 fatty acids, found in fast food, and polyunsaturated vegetable oils, and increase omega-3 fatty acids, found in cold-water fish.  Consider daily supplements of 1-2 grams of fish oil.
• Ask your doctor to check your vitamin D level.  There may be a relationship between low levels and breast-cancer risk.
• Drink green tea.  Its antioxidant properties may decrease risk.

Dr. Henry Emmons on Dealing With Depression and Anxiety:

• Exercise. Mild aerobic exercise quells anxiety.  Vigorous aerobic exercise reduces sluggishness.
• Take a daily B vitamin complex, 2,000 mg of an Omega-3 fatty acid supplement, and 2,000-4,000 IUs of vitamin D
• Calm your mind with meditation, breathing, and yoga practice.
• Develop close, meaningful relationships.
• Eat healthy foods.  Learn your Ayurvedic type to further tailor your diet.

Check out the entire article--it's a quick worthwhile read!

Hormone Replacement and the Post-Menopausal Brain.  Why Timing Is Everything!  Here's Hoping.

Don't miss Cynthia Gorney's balanced ground-breaking article, The Estrogen Dilemma, that appeared in the Sunday April 18, 2010 New York Times Magazine.  Click here for the article.

Millions of women either stopped taking hormones--or decided not to start them after the Women's Health Initiative was abruptly ended in 2002.  Too bad it was studying the wrong kind of hormone replacement--estrogen from the urine of pregnant mares--and a synthetic progestin--Wyeth's Premarin and Prempro.

Gorney does an excellent job of explaining why the W.H.I. didn't end up telling us what we really need to know about the benefits of hormone replacement--or how estrogen can benefit the post-menopausal brain when hormone replacement is started at the right time--within a small window of time--when a women is in her fifties.  But timing seems to be everything.  And the hormone replacement needs to be the bio-identical kind--estradiol and natural progesterone.

"That’s why University of Southern California brain scientist Roberta Diaz Brinton says that the timing hypothesis — the proposition that estrogen could bring great benefit to a woman who starts it in her 50s while having the reverse effect on a woman 10 years older — makes sense even though it is still experimental.

She and other scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissue. It makes new cells grow. It increases what’s called “plasticity,” the brain’s ability to change and respond to stimulation. It builds up the density and number of dendritic spines, the barbs that stick out along the long tails of brain cells, like thorns on a blackberry stem, and hook up with other neurons to transmit information back and forth. (The thinning of those spines is a classic sign of Alzheimer’s.)

But when estrogen hits cells that are already sick — because they’re dying off as part of the natural aging process or because they’ve been damaged by beta amyloid — something else seems to happen. Dropped in as a new agent, like the wrong kind of chemical solvent sloshed onto rusting metal, estrogen doesn’t strengthen or repair. It appears useless.

Sometimes it sets off discernible harm. You may recall additional W.H.I. news a few years ago about hormones increasing the risk for aging-related dementia; those stories emerged from a subgroup of W.H.I. participants who were all at least 65 when they started the hormones. There are arguments about that data, like nearly everything else connected to the W.H.I., but the age factor alone reinforces what Brinton and other timing-hypothesis researchers observe in the labs when they give estrogen to ailing cells.

“It’s like the estrogen is egging on the negative now, rather than the positive,” she said.

“We know that if you give neurons estrogen, and then expose them to beta amyloid, many more will survive. But when we expose them to amyloid and then give them estrogen — now you don’t have survival of the neurons. In some instances, you can actually exacerbate their death.”

And since once again it will be years before we get to the bottom of the estrogen dilemma--and find out if the combination of right timing and taking natural hormones at ever-decreasing doses as one ages--is a wise decision--Gorney leaves us with this to consider:

"Every midlife woman I know keeps redrawing for herself the defensible lines of intervention in the “natural” sequence of human aging.

Obsessive multiple plastic surgeries are silly and desperate. Muscles kept in good working order are not.

Where on that spectrum is a hormones-saturated pharmaceutical patch? What if the timing hypothesis is even partly right?

Suppose all we learn about replacement estrogen, in the end, is that if it’s started early enough it might protect the heart and the brain, and that its chemistry makes some of us feel more the way we did at 40 than the way our mothers did at 65?  Not an elixir of youth. More like . . . reading glasses."

Certainly something to think about!

To read more about the estrogen debate check out:  "Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

There are even more excellent reads in the April 18, 2010 New York Times Magazine "The Science of Living a Healthy Life"

Consider taking a look at:

Weighing the Evidence of Exercise--Does working out really help your lose weight--or keep it off?

Dr. Does-It-All: He publishes books, writes for magazines and newspapers, hosts TV & radio shows nd still performs surgery every Thursday.  How Mehmet Oz became America's doctor.

Oops!  I did it again.  Thought I'd knock this off in one hour.  Not even close.  Sorry!

The Research Behind the Benefits of a Little Touch - High-Fives, a Pat on the Back, a Touch of the Arm

"Researchers have begun to focus on a different, often more subtle kind of wordless communication: Physical contact.  Momentary touches, they say--whether an exuberant high five, a warm hand on the shoulder, or a creepy touch to the arm--can communicate an even wider range of emotion than gestures or expressions, and sometimes do so more quickly and accurately than words."

"It is the first language we learn, our richest means of emotional expression throughout life."

-Mind: Evidence That Little Touches Do Mean So Much, by Benedict Carey, New York Times, February 23, 2010-

If you are receiving this via email, click here to go to the web version of this post to get all the links.

A few weeks ago one of the research psychologists where I work told me that everyone in her department is convinced about the power of massage.  And not for relieving muscle aches.  She said massage produces so many positive hormones--like oxytocin--and lowers negative ones--like cortisol, that she considers it preventive medicine, not a luxury. 

She has a monthly standing appointment for herself--having seen the tremendous benefits of massage on patients with chronic pain and heart failure.

I've been sharing her story with all my friends--and after reading Benedict Carey's story on the benefits of touch in yesterday's New York Times--I'm sharing both, with you.  Read Carey's short piece, and I guarantee you won't think about a hand on the shoulder in the same way ever again.

The Research on Touch

• Students who receive a supportive touch on the back or arm from a teacher are nearly twice as likely to volunteer in class than those who were not touched.
• A sympathetic touch from doctors leaves patients with the impression that the visit lasted twice as long compared to those who were not touched.
• A massage from a loved one can ease pain, soothe depression, and strengthen a relationship.
• The best basketball teams tend to touch more than the worst teams.  The "touchiest" teams are currently the best: the Boston Celtics and the LA Lakers.  And the "touchiest" player in the NBA is Kevin Garnett of the Celtics.  "Within 600 milliseconds of shooting a free throw, Garnett has reached out and touched four guys,"  according to Dr. Dacher Keltner, whose paper on touch in the NBA will be published in May 2010.  And in case you're wondering--it's not that the best teams touch more because they are winning--the researchers controlled for this in their study.  But they're aren't ready yet to conclude that touch improves performance. 
• Touch  releases oxytocin, the hormone that creates a sense of trust--and it reduces cortisol, the hormone of stress.   Exactly what the research psychologist told me a few weeks ago!
• Couples who touch more have more satisfying relationships.  Take note!   But, it's not clear yet if there's a causal effect.

The Science Behind Why We Touch--Why We're Wired For Touch

• Touch reduces stress--oxytocin is released, we relax, we feel good, we feel bonded. 
• When stress is reduced, the brain is better able to think & problem-solve.
• When we receive a supportive touch, we unconsciously think, "OK, I can share the load."  Who knew?
• According to psychologist James A. Coan of the University of Virginia, "We think that humans build relationships precisely for this reason, to distribute problem-solving across brains.  We are wired to literally share the processing load, and this is the signal we're getting when we receive support through touch."
• Check out the latest research at the January 2010 meeting of the Society for Personality and Social Psychology, "Gimme Five!"  Tactile Communication and its Prosocial Consequences"
  

Now go out there today and hand out some supportive touches, high-fives, and hugs.  You just may unwittingly find some volunteers to help you solve your problems!

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-

If you are receiving this post via email click here to get to the web version with all the links.

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

If you are receiving this via email click here for the full web version.

"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
[email protected]

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

The Longevity/Vigor Quest. It's Centenarian Joe Rollino Matched Against the Anti-Aging Medicine of Cenegenics Medical Institute. Lifestyle Modification vs Pharmaceuticals

The Great Joe Rollino at 103

The Great Joe Rollino as a young man.

 

 

 

 

 

 

Joe Rollino, was 104, just 2 months shy of turning 105, when he was fatally injured by a minivan in Brooklyn on January 11, 2010.  He was on his daily early morning walk to pick up coffee, a tabloid, and a lottery ticket.  Until the end he was strong, healthy, and a picture of health!

If not for the New York Times, I would never have heard of Joe Rollino.  He was man from a different time. Growing up near the turn of the century, quitting school at 10 years old to join the carnival.  He led a career as a Coney Island strongman, a boxer, and a trainer, who billed himself as "The Strongest Man in the World".  

At 5-feet-4-inches 122 pounds, in his prime he once lifted 475 pounds with his teeth, 675 pounds with just one finger, and moved 3200 pounds with his back.  He bent quarters with his teeth and fingers and continued to demonstrate his coin-bending skills into his 100's.

"Pound for pound, in the feats that he practiced, he was one of the greatest performing strongmen we've ever had, if the lifts he's credited with are accurate.   For his size, Joe was apparently one of the strongest men who ever lived."

-Terry Todd, co-director of the Stark Center for Physical Culture and Sports at the University of Texas, who knew Joe for 40 years-

 

What Can We Learn From New York City's Oldest & Strongest Man?

• He was a lifelong vegetarian, as was his mother--which at the time was unusual.
• He never drank, smoked, or indulged in sweets.  At his 104th birthday party he blew out all the candles on his cake, but passed on eating a piece.  He said if he never would have made it to 104 if he ate that kind of stuff.
• He ate oatmeal every morning.
• "He was the picture of health until he died.  He had no glasses, no hearing aid.  He had no assistive walking device and didn't take any prescription drugs of any kind,"  according to his close friend Arthur Dreschler, president of Joe's club, "The Association of Oldtime Barbell and Strongmen".
• Rain or shine he still walked 5 miles every morning (albeit a little slowly), and exercised daily--which sometimes included swimming laps in the Atlantic ocean.  He continued to lift weights five days a week--even exercising before his 104th birthday party luncheon.
• He was a devotee of the "Iron Game", a body-building philosophy that supports weight-lifting as an enjoyable lifelong hobby but strongly eschews steroid use.
• He was a longtime member of the Coney Island Polar Bear Athletic Club--a group who swims in the icy Atlantic ocean 3 to 4 times a week.   They call it "winter bathing" and attribute their good health to the practice.  They believe "if they stay in for 5 to 10 minutes, the cold water kills germs that fester inside one's body."  All the Polar Bear members claim that once they started "winter bathing" they haven't been sick.  Same for Joe, who at 103 said he couldn't remember the last time he was sick.  His friend, fellow Polar Bear buddy, and former Brooklyn homicide detective,  Louis Scarcella, said Joe held the Club's record, swimming every day, no matter the weather for eight years, never missing a day.
• "Muscle strapped to bone" is how Louis Scarcella described Joe.  Until the day he died, people described him as physically active, agile, and loose.  Mentally lucid and sound.  "His memory was nothing short of astounding, especially when you consider he fought at about 122 pounds, often against boxers weighing 50 pounds more than he.  To say he was a physical marvel, would be a gross understatement." 
• "If he told me he was 75, I would have said he looked great for his age, and here he was 104 years old," said extremely-fit 61 year old  retired NYPD detective, Arthur Perry.
• Friends said he lived life to the fullest, and looked forward to every day with enthusiasm.  He was never skeptical, cynical, angry or resentful. 

To read more about Joe click here.

 
 

The Other Side of The Vigor Quest--$10,000 a Year for H.C.G., Growth Hormones, and Testosterone

Contrast Joe Rollino's simple healthy low-tech lifestyle with the kind of big buck pharmaceutical techniques featured in the fascinating January 17th, New York Times Magazine article by Tom Dunkel, "Vigor Quest".  Click here for the full article.

It's the kind of anti-aging medicine that costs lots of out-of-pocket-cash, and follows controversial skimpy medical evidence. It might bring vigor for now, but serious adverse effects down the road.  The jury is still out.  It's part good common sense, like a low glycemic-diet, weight-training, aerobic exercise, omega-3 supplements--and part human lab rat experimentation.

But its devotees say, "Lifestyle alone isn't enough." 

To combat the corrosive effects of aging, every three months the followers of Cenegenics Medical Institute's  brand of anti-aging medicine--and they now number around 10,000--get 10 vials of blood drawn, in order to measure all sorts of hormone and blood chemistry levels--checking to see what sort of pharmaceutical tweaking is in order. 

A little more testosterone?  A bit more human growth hormone?  Perhaps some H.C.G.--human chorionic gondatropin, a commonly used fertility drug that is distilled from the urine of pregnant women, and can stimulate the testes to secrete more testosterone.

Author Dunkel interviewed John Bellizzi,  a 51 year-old amateur soccer player and businessman from Rye, NY, who got fed up with using Advil, hot tubs, and surgery to keep him in the game. 

Two years ago Bellizzi consulted with Manhattan endocrinologist Dr. Florence Comite, who is affiliated with Cenegentics.  Comite calls her work, "...aggressive prevention, the basis of which is metabolism modulation.  Twenty years from now, this will be the standard of care."  She's like an "ace mechanic who keeps Bellizzi running in spite of worn parts."

Turns out, Comite has impeccable credentials--she's Yale-trained, with former stints at the N.I.H., and as a part-time faculty member at Yale.

Now, two years after working with Comite, Bellizzi is a believer.  He no longer collapses on the couch after soccer games, he can play an hour longer than before, he feels mentally sharper, and he is 15 pounds lighter.  It might be the changes in his diet, eliminating the junk food, adding some mainstream supplements, and having a more well-rounded exercise regimen. 

Bellizzi credits his turnaround to the controversial H.C.G. he injects--which also happens to have a list of scary side effects.
 

The Cenegenics' Poster Child Dr. Jeffrey Life

Who hasn't seen this picture of Dr. Life in every airline's complimentary magazine?  He's the 71 year old doctor, who was once fat and unfit, until he re-invented himself with diet, exercise, and the Cenegenics brand of pharmaceuticals.

For Life this means:

• 1,000 milligrams of calcium a day
• Co-Q10 twice a day
• 5,000 IU of vitamin D a day
• 4 grams of fish oil a day
• 10 mg of melatonin at bedtime
• A testosterone injection once a week
• A human growth hormone injection once a day

Read the article.  Interesting provocative reading, but no thank you!  I'm sticking with my simple lifestyle modification plan of diet and exercise!  It's the Start of the New Year, the Start of the New Decade, and the Start of My Sixties. Some Simple Strategies for Staying Healthy and Happy. At Least I Can Hope!

So, what do you think?  Joe Rollino or Dr. Jeffrey Life?  

Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

"Unfortunately....one large study (the Woman's Health Initiative - WHI) sent us back into the Middle Ages, because its data were misunderstood, misinterpreted, and misreported...But keep in mind that the majority of postmenopausal women who do not use hormonal-replacement therapy will not merely experience unpleasant symptoms; they will risk diseases brought about by loss of bone, loss of blood vessel elasticity, and decreased protection from cardiovascular disease."

Winnifred Cutler, PhD.

"Most experts say women should take hormones for only a few years after menopause, and only if their symptoms are severe. Now, in a new book, biologist Winnifred Cutler claims that Hormone Therapy is safe for long-term use and highly beneficial -- as long as you do it right. Here, she makes her case."

Stephanie Young, "The Other SIde of the Hormone Controversy. A New Argument for Hormones"

Oh Boy.  This book is sure to be controversial.  Ever since the WHI was halted in 2002 the "standard recommendation" has been:  Only go on hormones if your menopausal symptoms are intolerable, and then go on the lowest possible dose for the shortest possible time! 

Dr. Cutler believes  this is not only unwise, it's an incorrect assumption.  "Panic trumped good science."

I happen to have a very savvy physician who is a national expert on menopause and women's health.  We've discussed at length the whole hormone issue and how the results of the WHI (the Women's Health Initiative) were misinterpreted, which basically brought the use of hormone replacement therapy to a screeching halt.

I read the results and the interpretations of the WHI study in the medical journals for myself, and together with my doctor's advice I made the completely radical & unorthodox decision to start hormone replacement therapy even though I didn't have any "intolerable" menopausal symptoms--which post-WHI, is the only reason to start HRT.

Full Disclosure Here:  I decided to take HRT for prevention--and because I knew from the literature, and the WHI, that if one wanted to receive any of the benefits of hormone replacement--like prevention of osteoporosis, urogenital health, possible brain health & flexible blood vessels--there is just a small window of opportunity when you can begin HRT.  If you wait too long after menopause to start, once blood vessels start to stiffen, you could put yourself at risk for adverse cardiovascular effects.

But I wasn't about to take Premarin, the equine-derived estrogen or a synthetic progestin like Provero or the combination of the two, called Prempro.  Let's just say, these are the synthetic hormones that were probably responsible for some of the adverse results of the WHI.

Together, we decided upon a regimen that closely duplicates a woman's natural cycle; the daily use of a bio-identical topical estrogen (estradiol-17 beta) cream called Estrasorb; and for 12 days a month--a bio-identical pill form of progesterone, called Prometrium.  As time went by--the doses of both of these have been cut in half.

Books and articles cross my desk constantly, but last week when I spotted Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause by Winnifred Cutler, I scooped it up and couldn't put it down.

What a find!  Finally, a book written in plain language by a biologist who has studied and written extensively about hormones and has reviewed many of the studies on the subject. Cutler studied over 3,000 peer-reviewed articles--and she cites 880 of them in her book.  

I've reserved a copy at my local library and I can't wait to read the entire book.  Dr. Cutler certainly has the credentials and background to write such a book, and she has no vested interest in selling hormones, no pharmaceutical research funding, or hidden agenda.

Be sure to read Stephanie Young's interview with Dr. Winnifred Cutler, "The Other Side of the Hormone Controver--A New Argument for Hormones" in More magazine, April, 2009.   Click here.

A Study You Should Know About But May Not:  KEEPS is an ongoing study--"Kronos Early Estrogen Prevention Study"--which aims to study what the WHI did not.  Can HRT prevent  cardiovascular disease (atherosclerosis in particular) in women, if it's given early--immediately after menopause.  Unlike the WHI, it's comparing a bio-identical estrogen/progesterone combo with the synthetic Premarin.  Many researchers feel that bio-identical hormones given transdermally & right after menopause will make all the difference. For more click here.

In other words--it's the study that's answering the questions that the WHI did not.

Here are a few highlights from "Hormones for Your Health":

1.  How hormones got a bad name from the WHI study

• One result cannot be applied to all.  Dr. Fred Naftolin, an eminent biomedical scholar at Yale has said the "WHI has been inappropriately used to create guidelines (for physicians) that are incorrect for any group other than the overweight, average-seventeen-years-postmenopausal population on which the particular regimen (synthetic Premarin, Provera or Prempro) was tested."
• The study participants weren't particularly "healthy".  "The WHI participants ranged in weight from simply overweight to frankly obese, with an unusually high incidence of arterial hypertension and a high prescription drug use to control other conditions.  Nearly 50% of the study population started out with several serious cardiovascular risk factors."
• The WHI was not a preventive study.  The WHI, contrary to its claims, wasn't designed to study "primary prevention"--which is preventing disease in an already healthy population.  You can't study "primary prevention" in healthy women when the majority of the women  enrolled either already have cardiovascular disease or are at a high risk for getting cardiovascular disease, because they were overweight, well past menopause, & hypertensive.
• Not all progestins and estrogens are alike.  Synthetic progestins (medroxyprogesterone acetate-generic Provero) affect the body differently than bio-identical progesterone.  Research has long shown adverse cardiovascular effects from the synthetic form. The bio-identical variety is also dosed in a cycle that is similar to a woman's natural cycle--taken only 12 days a month.  Transdermal (topical) estrogen has a more favorable and safer effect than oral forms.

2.   Postmenopausal hormone deficiencies can lead to:

• Decline in bone quality
• Diminished cardiovascular health
• Urogenital atrophy--atrophy of the urogenital tissues in up to 47% of women.
• Wrinkled skin
• Blood vessel thickening and atherosclerosis
• Cognitive decline
• Increase in fat, decrease in muscle.

3.   Benefits of Hormonal Therapies--The Well-Known & Lesser-Known

• Skin benefits with increased thickness, greater blood flow, faster wound healthing, greater water-holding capacity, less wrinkling
• Healthier vaginal tissues.  Responsible for higher acidity which prevents infections; less dryness, less atrophy, less thinning, less urinary tract infections
• Less hot flashes & night sweats
• The nose benefits from estrogen & progesterone.  Without hormones the nose is drier, feels stuffier, produces less mucus.  Since the nose is the first line of defense against airborne infections, hormone therapy helps the body to fend off colds & flu.
• Estrogen and your voice.  There are estrogen receptors in the voice box--women taking HRT had fewer voice complaints, hoarseness, vocal cord dystrophy.
• Estrogen and your teeth.  More estrogen--less tooth loss.
• Estrogen and progesterone and your eyes.  Hormone users had better vision and fewer eye conditions.
• Estrogen and progesterone and sleep quality.  Hormone users had superior sleep quality compared to non-users.
• Estrogen as an antioxidant--lessening the damage of oxygen free radicals that attack the cell membranes of blood vessels.
• Estrogen and gut/intestinal function.  Helps the absorption of key minerals, like calcium,  and helps to maintain the healthy functioning of the gut
• Estrogen, more positive profile for maintaining stable blood sugar, and preventing type II diabetes.

4.  The Big Scare: The Hormone Breast Cancer Question

• Cutler devotes an entire chapter to explaining the entire controversy--how to understand in real numbers the actual risks; why the type of hormones; the kind of dosing & regimen (mimicking a natural cycle); and the method of delivery (oral vs. transdermal) are important to understanding this controversy.
• Breast cancer rates with statin therapy are comparable to breast cancer rates with HRT.
• "Even in the WHI study, the risk of breast cancer on an individual basis was low. In the WHI, of the 8,506 women taking Prempro, 166 cases of invasive breast cancer occurred; in the 8,102 assigned to placebo, 124 cases were detected, that is, 1.95 percent versus 1.53 percent, or a difference of 0.42 percent. So 99 percent of women will not be at increased risk of breast cancer regardless of which hormones they take."

  "And remarkably, most studies show that postmenopausal women who develop breast cancer when they are on hormones are less likely to die from it than postmenopausal women who have breast cancer and are not on hormone therapy. This points to the complexity of the relationship between hormones and breast health."

5.  Choose Hormones Wisely - What Should You Take?

• Estradiol-17 beta taken transdermally (patch, cream, gel).  This mode will not increase triglycerides, and it will enhance heart rate variability.
• Bio-identical progesterone like Prometrium taken on a natural cycle of 12 days a month.  A sequential regimen lowers the risk of breast cancer, builds better bones, better mental function and a healthier cardiovascular system.
• For urogenital health, consider the ESTring which delivers a very low dose of estrogen  (estradiol) at a steady rate locally, not systemically.  It's a small flexible ring inserted vaginally.  It's an option for women who aren't able to take hormones.

6.  Hormones and the Brain

• Estrogen increases the electrical activity of the regions of the brain responsible for verbal and spatial working memory.
• Hormone users perform better in tests of executive function, except when using the synthetic form of progestin (medroxyprogesterone acetate, Provera)
• The brain is receptive to estradiol-17 beta--accept no substitutes.
• Conjugated equine estrogens like Premarin, Prempro or their generic equivalents do not produce the same benefits as the bioidentical estrogen and Cutler believes they may be actually detrimental.  Steer clear of synthetic progestins, like Provera or the generic medroxyprogesterone acetate.

7.  Hormones and the Heart

• Women who start hormone therapy before age 60 have a significantly better likelihood of enjoying good cardiovascular health.
• The best scores of heart health in the Nurses Health Study were in women using hormones, and who had their uteruses & ovaries intact.
• Once women stopped taking hormones they lost their advantage over "never-users".
• A Swedish study found hormone users had lower triglycerides, lower LDL cholesterol, less obesity, less type-II diabetes, less carotid atherosclerosis and lower risk of developing calcium deposits in the coronary artery.

Click here for an excerpt, the Table of Contents & the Index.

Obviously, hormone replacement therapy isn't for everyone.  It's a decision for both you & your doctor.   We're all different, with different risk factors and family histories.  Cutler's book advises us to not get so easily scared by the WHI--to not dismiss the hormone option out-of-hand.  Read the book--and then make a decision.  But remember, there's only a small window of opportunity to start--should you choose to take the HRT route.

Good health isn't found in isolation--with just a pill, a patch or a cream--it must include exercise, a healthy diet, stress reduction, and a healthy lifestyle.