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Thursday, December 31, 2015

Thanks to all the visitors! And Happy New Year!


Happy New Year! May It Be Blessed!


Thanks To All The Visitors Around The World!

The Rise of Functional Medicine


New Paradigm Gets to the Root Cause of Disease

LISA MARSHALL

By the end of 2014, Trina Mills, of Parker, Arizona, had given up on conventional medicine. She’d been diagnosed with a thyroid disorder 17 years earlier and taken medication ever since without feeling her symptoms of fatigue, muscle aches and stomach problems ever fully subside. She’d visited endocrinologists, gastroenterologists and a half-dozen other specialists, each of which offered a different diagnosis and prescribed a different drug.

At one point, she had her gallbladder removed. At another, her doctor suspected she had bleeding in her brain and sent her for a computerized axial tomography (CAT) scan. Some thought she was a hypochondriac; others said she was depressed. “I would tell them, ‘I’m just depressed that you can’t figure out why I’m so sick,’” she says.

Weighing a skeletal 82 pounds, the 54-year-old mother of three finally wrote out a living will and braced for the inevitable. Then she heard of a new Center for Functional Medicine opening at the prestigious, century-old Cleveland Clinic. As the first clinic of its kind to open at an academic medical center, it promised to look at the underlying causes of disease, while focusing on the whole person, rather than isolated symptoms.

Intrigued, Mills caught a flight to Ohio and soon was offering up 30 tubes of blood, stool and saliva samples, as well as an exhaustive life history. One year later, thanks to a series of personalized diet and lifestyle changes, she’s 10 pounds heavier and feels better than she has in decades. “I spent a lot of years and money in the traditional medical system and got nothing,” says Mills. With functional medicine, “In a very short time, they had me feeling nearly 100 percent.”

Distinctive Characteristics
In the 25 years since nutritional biochemist Jeffrey Bland, Ph.D., of Gig Harbor, Washington, coined the term, this science-based, whole-body approach to addressing chronic disease has gained widespread traction. More than 100,000 physicians—60 percent of them medical doctors—have trained with the Institute for Functional Medicine he founded in Washington and New Mexico, and numerous medical schools have added its tenets to their curricula. More naturopaths and chiropractors are also distinguishing themselves with a functional medicine emphasis.

“It is not alternative medicine at all,” stresses Bland, whose latest book, The Disease Delusion, details how functional medicine can curb chronic diseases like arthritis, diabetes, dementia, and heart disease, which constitute 78 percent of U.S. health care costs. “It’s the basis of 21st-century health care,” he says.

For most of the 20th century, conventional medicine centered on a singular objective: Arrive at a diagnosis and treat it with drugs or surgery. Then, the alternative medicine movement proffered a toolbox of more natural therapies, including acupuncture, herbs and massage to address these same diagnoses. The 1990s brought integrative medicine, a best-of-both-worlds approach.

“While all of the above have merit, they lack the necessary guidance to help practitioners determine which tools work best for which patient,” says Dr. Mark Hyman, director of the Cleveland Clinic’s Center for Functional Medicine. “Alternative therapies and conventional treatments are tools. We need a new map that can teach us how to skillfully use those tools,” maintains Hyman. “That map is functional medicine.”

Because one chronic disease such as diabetes can have dozens of underlying causes, or one culprit such as a genetic predisposition or exposure to toxins can lead to multiple chronic conditions, functional medicine focuses on systems, rather than organs, and origins, rather than diseases. “It’s about listening to the patient’s story in a different way, where the objective is not simply about arriving at a diagnosis,” explains Bland.

Ferreting Out Key Clues
Key to discovering the underlying origins of a health issue are a host of new gene, blood and gut health tests. “They allow us to look under the patient’s ‘metabolic hood’ at the genetic and biochemical factors influencing health,” says Naturopathic Doctor Kara Fitzgerald, who heads up a functional medicine clinic in Newtown, Connecticut.

For instance, certain genes influence how a person burns and stores fat. Depending on which variant a patient has, based on a genetic test, they might be guided toward a higheror lower-fat diet. Those genetically prone to difficulty in metabolizing the amino acid homocysteine (an excess of which can raise the risk of heart disease) might be advised to take folic acid supplements.

If a patient displays intractable gut problems, rather than simply look for blood or pathogens in the stool, Fitzgerald also looks at the DNA of their gut microbiome, mapping out which strains of good bacteria are present or absent and prescribing prebiotics, probiotics or whole foods to promote a healthful balance.

For another patient with thinning hair and aching joints, she might use specialized blood tests to look for micronutrient deficiencies, signs of allergies or certain autoantibodies—proteins produced by the immune system that mistakenly attack one’s own tissues—that might herald a brewing autoimmune disorder. “Research shows that predictive autoantibodies can show up in the blood 10 or even 20 years before an autoimmune disease such as Type 1 diabetes, multiple sclerosis or rheumatoid arthritis makes itself known,” says Fitzgerald, pointing to a seminal review published in 2007 in Scientific American: “If a patient with mild, early-stage symptoms is proactive with diet and lifestyle changes, they may be able to fend it off.”

High-tech tests aside, Bland stresses that what’s most important is “a tool that has been largely lost in medicine today: Knowing how to listen to the patient.”

In a typical exam, Fitzgerald thoroughly inspects often neglected body parts, including the tongue and fingernails, which can hold important clues to underlying health. She asks about past emotional trauma which might trigger chronic disease, and inquires about what environmental toxins and harmful chemicals both the patient and their birth parents may have been exposed to. One example might be a patient exposed to cigarette smoking in utero having a bias toward an allergic disease. If their parents grew up in a period of famine, they might have inherited a genetic disposition for rapid weight gain.

“She spent two-and-a-half hours with me,” in her initial consultation, recalls 52-year-old Lauren Zambrelli, of Long Island, New York, who credits Fitzgerald for helping her tame her multiple sclerosis into remission. “It was like having a sister for a doctor.”

Who Pays
Functional medicine doctors don’t shy away from prescription drugs when necessary, but they do lean decidedly toward the lower-tech modalities, using dietary supplements, allergen-free diets, exercise, mind-body practices and toxin avoidance as their primary tools. “We basically take out the bad stuff from the body and put in the good stuff,” says Hyman.

Maintaining good health is priceless, but without conventional insurance coverage, it can be expensive. While Mills’ doctor visits were covered by insurance (which is rare), she spends roughly $1,000 a month on supplements to address her diagnosed leaky gut syndrome, nutrient deficiencies and mercury poisoning. Zambrelli has paid thousands out of her own pocket, too.

Some people worry that, like most conventional physicians, some functional medicine practitioners place too much emphasis on expensive tests and too little on the most crucial and affordable remedy—self-care. “Functional medicine as a concept is an important step forward,” says integrative medicine pioneer Dr. James Gordon, founder of the Center for Mind-Body Medicine, in Washington, D.C., and San Francisco. “However, some practitioners do a lot of tests and prescribe a lot of supplements and work on cleaning out the gut, but neglect the psychological, spiritual and social issues. That concerns me.”

Bland and Hyman concede that some practitioners over-test, but say that will fade over time as they learn to better discriminate which ones are useful for specific patients. Several efforts also are underway to get more functional medicine providers and the acupuncturists, massage therapists and nutritionists they work with covered under the Affordable Care Act, which expressly emphasizes a need for more preventive medicine.

Viewing the big picture, Bland believes that functional medicine is just what the country needs to save on exploding healthcare costs. Rather than spending dollars on extraordinary measures to save heart attack victims or diabetics in emergencies, we can prevent such dire situations by identifying underlying problems sooner and halting their progression.

In the meantime, some patients are finding priceless relief. “Am I poorer right now? Yes,” says Mills. “Am I healthier? Way. It’s been so worth it.”

Learn More Online



Lobby for Change

  • To lobby for consistent insurance coverage of more complementary therapies, check out these resources.
  • CoverMyCare (CoverMyCare.org). This national grassroots advocacy campaign, a project of the Integrative Healthcare Policy Consortium, aims to support the proper full implementation of Section 2706 of the Affordable Care Act, which states that insurers cannot leave licensed practitioners like naturopaths, chiropractors, massage therapists or Oriental medicine practitioners out of their provider networks. It still lacks enforcement at the state level, although Oregon and Rhode Island recently passed legislation to fix the existing loophole; California, Hawaii, Minnesota and New Mexico are working to do the same.
  • American Sustainable Business Council (Tinyurl.com/IntegrativeReimbursement). The organization recently launched a campaign to urge insurers to cover integrative practices.


http://www.gonaturalawakenings.com/Healing-Ways-Archive/The-Rise-of-Functional-Medicine/

Tuesday, December 29, 2015

Hiatal Hernia Syndrome


Visceral manipulation: Dr. Failor taught us his technique in 1977, and many doctors still use it.1 It is effective, but can be a bit forceful. I trained in structural integration in 1996, and over the last five years I have developed a gentler method. I contact the epigastric area just inferior to the costosternal angle. I use a "claw" hand contact and support the contact hand with my other hand (Figure 5). I traction toward the left anterior superior iliac spine (ASIS) and wait for the soft tissue to begin a counterclockwise rotation. I just allow my fingers to follow the movement while continuing to apply the traction. In most cases, the rotation will shift to clockwise as I continue the traction. When the rotation is finished (usually 2 to 4 minutes at the longest), I add three additional clockwise thrusts of my hands. Dr. Failor called this "ballooning the stomach" and thought that it was important in order for the manipulation to hold.

Sunday, December 27, 2015

Sunlight - It Does Your Body Good


They determined that this is equivalent to taking 15,000 to 20,000 IUs of vitamin D. As a general recommendation, Dr. Holick suggests starting your sun exposure in the spring, going out for about one-third to one-half of the time it typically takes for you to turn a slightly darker shade in the middle of the summer.

    The app, dminder.info, that Dr. Holick helped develop, provides guidance for sensible sun exposure.

    So for example, if you normally get red after 30 minutes of exposure at noontime in June, then start out by exposing your arms, legs, abdomen, and back, for 10 to 15 minutes per day. After that, put on some protective clothing to prevent excess exposure.

    Each day, add a couple of more minutes to build up a tan. Keep in mind that the pigmentation of your skin will influence how much sun you can tolerate.

    The skin pigment melanin is a natural sunscreen, absorbing UV light coming into your skin. As a result, it markedly reduces the efficiency of your skin to produce vitamin D. As a result, dark-skinned individuals need more sun exposure than light-skinned individuals to produce the same amount of vitamin D.

What's the Ideal Vitamin D Level?

    What do you want your blood level to be? A study done in Africa on Maasai warriors, who are outside every day, showed they had a blood level of 25-hydroxyvitamin D averaging around 48 ng/ml. At present, a vitamin D (25-hydroxyvitamin D) level between 40 and 60 ng/ml is thought to be ideal for optimal health and disease prevention.

        "The Endocrine Society Clinical Practice Guidelines Committee that makes the recommendations to physicians for how to treat or prevent vitamin D deficiency [say that] your level should be at least 30 ng/ml. Forty to 60 ng/ml is a good range, and we know up to 100 ng/ml is perfectly safe," Dr. Holick says, adding that: "It's estimated that improving vitamin D status worldwide could reduce healthcare cost across the board by about 25 percent."

Saturday, December 26, 2015

How to Address the Crisis of Overweight Children


Processed Food Diet Is at the Heart of the Childhood Obesity Epidemic

    The long-held conventional view that obesity is either the result of "bad genetics" or poor lifestyle choices, combined with a certain amount of laziness or lack of willpower, has now largely been debunked.

    The fact that obesity rates 50 to 60 years ago were only one-third of what they are today is a potent clue that genetics are not to blame. Also, a number of other affluent nations do not have the same obesity problems as the U.S.

Doctors will design diets based on individuals’ genes: study


Doctors and dieticians will be able to design diets based on individuals' genes within next five years, according to a new study by University of Texas (UT) researchers.

The researchers, however, said better analytical tools will require to be developed in the coming years to quickly understand the relationship between an individual's genetics, behavior and weight-related diseases.

They explained that the potential that many genes involved with weight gain, weight loss, and regain weight and they pose a challenge. Researchers have found the gene that causes energy from food and store it as fat, variations in the gene and they way it interacts with other genes can differ from one person to other.

Dr. Molly Bray, a professor of nutritional sciences at UT Austin, said, "When people hear that genes may be playing a role in their weight loss success, they don't say, 'Oh great, I just won't exercise any more' … They actually say 'Oh thank you. Finally someone acknowledges that it's harder work for me than it is for others."

Dr. Bray said gains in collection of data on weight loss and weight gain, and better sensors to monitor diet, activity and stress, would help. When blended with genomic data with the help of a computer algorithm, Dr. Bray believes that the development of analysis tools is not far off.

Friday, December 25, 2015

Unsupersize me - importance of plant based diet - filmed in Gainesville



I have been using a whole-foods plant-based diet in my clinic to improve health for a long time now. It's good to see this movement spreading in Gainesville and elsewhere. The movie is free on FMTV and was filmed in Gainesville!

-CB

Juan-Carlos Asse, owner of Zen Fitness and director of the award winning documentary, Unsupersize Me, has been training for over 15 years. With his expertise and guidance, his clients have achieved amazing results, including many individuals losing over 100 pounds using his methods which encompass a whole food plant based nutrition plan coupled with his specialized training regimen.
"I teach people how to eat and exercise to reach their optimum level of health and sustain it for the rest of their lives. It's not difficult, it's just a matter of learning how to do it. My goal is for each client to learn within a month all they will need to know to achieve their goals."

With online training with Juan-Carlos you gain access to the Unsupersize Me workout regi men, cooking videos, shopping lessons, recipes, and a personal Skype session with Juan-Carlos.

Thursday, December 24, 2015

The Ultimate Guide to Oats


What are the health benefits of eating oats?
  •     Oats are rich in fiber, manganese, the B vitamins thiamin and riboflavin, vitamin E, iron, and protein.
  •     Oats are believed to help lower blood cholesterol, stabilize blood sugar, and reduce the risk of cardiovascular disease, Type 2 diabetes, obesity, and some cancers. 
  •     Oats have the highest proportion of soluble fiber of any grain. 
  •     The fiber in oats can help improve bowel health.
  •     Oats can aid in weight loss by keeping you feeling full for longer periods of time.
  •     The Mayo Clinic rates oats and oat bran as the #1 foods for reducing bad cholesterol and protecting your heart.


What about the glycemic index (GI)?
First a little background. The glycemic index measures the speed at which a food is digested and converted into blood sugar. Low GI foods are believed to be digested more slowly, keeping you feeling full longer, and help to stabilize blood sugars.

The glycemic index is only part of the health profile of food, because it doesn't identify the nutrients found in food. For example, potato chips have a lower GI than a plain baked potato; most nutritionists would agree that a baked potato is a healthier choice. So, the glycemic index of food is important (particularly for diabetics), but it is only one factor in evaluating the overall health impact of food. 

Here's the scoop about the glycemic index of oats:
  • While there is a difference in the GI of steel cut and rolled oats, it is a negligible difference. They both have a low GI and are considered a healthy choice.
  • Quick and instant oats both have a higher GI, so they may not keep you feeling full as long as groats, steel-cut and old fashioned oats. If you stay away from the pre-packaged sweetened & flavored varieties, plain instant oats are still considered low-glycemic carbs.
  • To lower the GI of instant oatmeal, you can add some protein like milk or nuts. The nuts are also a healthy fat and good for lowering cholesterol. A half scoop of protein powder can be added for a nutrition boost, too.

6 Metabolism Death Foods - Dr. Axe


There is nothing worse than starting an exercise program to burn fat, making some good diet changes, but still not seeing the results you want to see. Has that ever been you? It can be really frustrating.
The reason this happens is, even though you think you're consuming a healthy diet, there is often some hidden food in your diet that is ruining your weight loss efforts.

The foods that keep you from losing the last 10 pounds and keep you stuck at a plateau are what I call the metabolism death foods! The term may sound scary, and it can be.  Your body recognizes these foods as toxins and puts your body into a fight-or-flight response.

These foods alter the focus of your metabolism and can cause:
  •     Weight gain
  •     Thyroid dysfunction
  •     Fatigue
  •     Hormone imbalance
  •     Digestive disease

And the craziest thing about these foods is that they are often labeled as "health foods".

Here are the 6 metabolism death foods you need to switch out of your diet to take your metabolism and fat burning potential to the next level!

Tuesday, December 22, 2015

If You've Ever Eaten Pizza Before, This Will Blow Your Mind (Maybe Literally)


When I started researching pizza ingredients, one thing became abundantly clear. Pizza restaurants did not like the questions I was asking.

The only way to find out what may be lurking in your pizza is to review its complete ingredient list, which is often concealed from the public. I began calling the top pizza chains and easily found a couple ingredient lists online. But, when I called most pizza restaurants and began asking questions, they blatantly refused to share ingredient lists and their customer service reps were oblivious to what their ingredients were – they had no clue. 

Little Caesars, California Pizza Kitchen (CPK) and Mellow Mushroom have all refused to answer my questions about their ingredients. I was told by Mellow Mushroom's corporate offices that they will only comply with minimal government regulations, which require them to publish an allergen list. 

After sending me their dough ingredients, CPK suddenly claimed that due to "proprietary restrictions" they can't disclose their full ingredient lists. They went on to tell me that they "don't have an easy way to perform a search by individual ingredient" and would need to call each vendor first. While traveling, I stopped into a CPK in an airport to ask questions face to face. Both the manager and store clerk had zero access to ingredients. I even asked to look at the packages of their dough and other ingredients that got shipped to the store in and they said they did not have them.

I called many local pizza restaurants and was informed that it's their policy to NOT disclose ingredients to their customers. Little Caesars literally told me that if I was concerned about what was in it, I "just shouldn't eat there…" Ha! Don't worry, I won't!

Papa John's also has repeatedly refused to release their ingredient list, which really caused a stir last year with my friend Melanie Warner, author of the processed food exposing book "Pandora's Lunchbox". How can Papa John's claim to have "Better Ingredients… Better Pizza" without telling us what's really in it? While they say their lack of transparency is due to the proprietary nature of their recipes, they could be hiding some seriously harmful ingredients.  After repeated calls to corporate offices and some helpful photos sent to me by Melanie Warner, I was finally able to uncover some details about what is really in their pizzas.

Why are the ingredients so hard to find?  Why are they refusing to share their ingredients? What is it that these pizza restaurants don't want us to know?

Well, I'll tell you what they're hiding: Lots and lots of hidden MSG!

Red Wine: Superfood or Poison?


A new University of Washington (UW) study found arsenic in American red wines.  They tested 65 popular, inexpensive wines from California, Washington, New York, and Oregon.  The results showed all but one had arsenic levels exceeding the Environmental Protection Agency's limits on arsenic in drinking water.

This report follows a 2008 study from Kingston University in London finding that many wines throughout the world contain heavy metals up to 200 times the amount considered safe.

And some California residents have brought suit against 28 California wineries including Franzia, Mogen David, and Almaden for selling products that contain a "dangerous" level of arsenic. The lawsuit claims some of the wines tested 500% higher than what's considered safe.

Arsenic is a naturally occurring element.  It leaches out of rocks into soil and water and makes its way into the food chain.  In some forms, arsenic is toxic to humans.  Long-term exposure is linked with cardiovascular disease, diabetes, and cancers of the liver, lung, kidney, skin and bladder.

The EPA allows drinking water to contain no more than 10 parts per billion (ppb) of arsenic. The wine samples in the UW study ranged from 10 to 76 ppb, with an average of 24 ppb.

The Electronic Cigarette May Pose Major Health Risks - Dr. Axe


In 2015, Environmental Health Perspectives published a study that evaluated 51 types of flavored electronic cigarettes that were sold by leading brands and were appealing the youth, including Cupcake, Cotton Candy and Fruit Squirts. Of the three most common flavoring chemicals, diacetyl, acetoin and 2,3-pentanedione, at least one was detected in 47 of the 51 unique flavors tested. Diacetyl was detected above the laboratory limit, being present in 39 on the 51 flavors. Acetoin was present in 23 and 2,3-pentanedione in 46 flavors. Researchers concluded by stating that urgent action is recommended to further evaluate this potentially widespread exposure to respiratory disease-inducing compounds through flavored electronic cigarettes.

Monsanto Charged with Crimes Against Humanity


Earlier this year, dozens of food, farming, and environmental justice groups announced they will put Monsanto on trial for "crimes against nature and humanity" on October 16, 2016 (World Food Day), in The Hague, Netherlands.

The steering committee for the Monsanto Tribunal includes Vandana Shiva, Corinne Lepage (former environment minister of France), Gilles-Éric Séralini (toxicologist researching toxicities of GMOs and glyphosate), and Olivier De Schutter (former UN Special Rapporteur on the Right to Food), among others.

As noted by Andre Leu, president of the International Foundation for Organic Agriculture (IFOAM):
        "Monsanto is able to ignore the human and environmental damage caused by its products, and maintain its devastating activities through a strategy of systemic concealment:
        By lobbying regulatory agencies and governments, by resorting to lying and corruption, by financing fraudulent scientific studies, by pressuring independent scientists, and by manipulating the press and media.
        Monsanto's history reads like a text-book case of impunity, benefiting transnational corporations and their executives, whose activities contribute to climate and biosphere crises and threaten the safety of the planet."
CBS This Morning recently interviewed Monsanto CEO Hugh Grant about the lack of transparency when it comes to foods containing genetically engineered (GE) ingredients, and why the company spent $10 million to defeat GMO labeling in Colorado and Oregon alone.

Real-World Severe Hypoglycemia in Diabetics Exceeds Trial Rates


Real-world rates of severe hypoglycemia among certain subgroups of patients with diabetes are considerably higher than those seen in randomized clinical trials, a new analysis shows.

The findings were published online December 17 in Diabetes Care by Ram D Pathak, MD, an endocrinologist at the Marshfield Clinic, Marshfield, Wisconsin and the University of Wisconsin School of Medicine and Public Health, Madison, and colleagues.

Using electronic health records for an insured cohort of nearly one million adults with diabetes seen during 2005–2011, the majority of which was type 2 diabetes, the authors found rates of severe hypoglycemia requiring medical intervention of 1.4 to 1.6 per 100 person-years.

Skin-to-Skin 'Kangaroo-Style' Care May Benefit Newborns' Health


Newborns born at a low birth weight — less than 4.4 lbs. (2 kilograms) — who received kangaroo mother care had a 36 percent lower chance of dying prematurely, compared with low-birth-weight newborns who did not receive such care, the researchers found. Moreover, the low-birth-weight babies who received kangaroo mother care had a 47 percent lower risk of sepsis — a serious illness that occurs when the body has an overwhelming immune response to an infection — compared with those who did not receive kangaroo mother care, they found.

People with Multiple Sclerosis May Have Lower Levels of Key Nutrients


Women with multiple sclerosis (MS) may have lower levels of important antioxidant and anti-inflammatory nutrients, such as folate from food and vitamin E, than healthy people, according to a new study released today that will be presented at the American Academy of Neurology's 67th Annual Meeting in Washington, DC, April 18 to 25, 2015. For the study, researchers identified 27 Caucasian women with MS and compared them to 30 healthy Caucasian women between the ages of 18-60 and with body mass index of less than or equal to 30 kg/m2. Participants reported on their diet and nutrition over the previous year prior to starting vitamin D supplementation. On average, the women who had MS had lower levels of five nutrients with antioxidant or anti-inflammatory properties: food folate, vitamin E, magnesium, lutein-zeaxanthin and quercetin.

Friday, December 18, 2015

Polyphenols: What They Are, and Why You Need Them


Polyphenols are phytochemicals, meaning compounds found abundantly in natural plant food sources that have antioxidant properties. There are over 8,000 identified polyphenols found in foods such as tea, wine, chocolates, fruits, vegetables, and extra virgin olive oil,1 just to name a few.

Polyphenols play an important role in maintaining your health and wellness. Antioxidants as a group help protect the cells in your body from free radical damage, thereby controlling the rate at which you age.

If your body does not get adequate protection, free radicals can become rampant, causing your cells to perform poorly. This can lead to tissue degradation and put you at risk of diseases such as heart disease, cancer, and Alzheimer's disease, for example.

    Antioxidants can be divided into three major groups:
        Carotenoids, which are discussed in greater detail in my "Basic Vitamin A Primer"
        Allyl sulfides, found in garlic and onions
        Polyphenols (also known as phenolics)

Types of Polyphenols

Polyphenols can be further broken down into four categories, with additional subgroupings based on the number of phenol rings they contain, and on the basis of structural elements that bind these rings to one another.

As a general rule, foods contain complex mixtures of polyphenols, with higher levels found in the outer layers of the plants than the inner parts:
  • Flavonoids, which have both antioxidant and anti-inflammatory properties, found in fruits, vegetables, legumes, red wine, and green tea
    • Flavones
    • Flavonols
    • Flavanones
    • Isoflavones
    • Anthocyanidins
    • Chalcones
    • Catechins
  • Stilbenes, found in red wine and peanuts (resveratrol is the most well known)
  • Lignans, found in seeds like flax, legumes, cereals, grains, fruits, algae, and certain vegetables
  • Phenolic acids
    • Hydroxybenzoic acids, found in tea
    • Hydroxycinnamic acids found in cinnamon of course but also in coffee, blueberries, kiwis, plums, apples, and cherries

Causes of Foot Pain and Options for Treatment


Plantar Fasciitis

Plantar fasciitis — inflammation in the ligament that runs along the sole of your foot — is one of the most common chronic injuries in runners. The ligament attaches to the bottom of your heel bone, which is why the pain is often felt in your heel.

The cause can be traced to excessive stress placed on the heel bone and soft tissues, causing inflammation. Improper footwear is typically part of the problem, and research1 by Michael Warburton, a physical therapist in Australia, found that running barefoot decreases the likelihood of plantar fasciitis.

Treatments typically focus on relieving tension on the heel and lowering inflammation. While cortisone and anti-inflammatory drugs are typically prescribed, I would suggest trying non-drug alternatives first.

For starters, you'll want to make sure you're on an anti-inflammatory diet high in healthy fats and low in sugars and non-vegetable carbohydrates. There are also plenty of anti-inflammatory foods that may do the job in lieu of pharmaceutical drugs. This includes:
  • Herbs and spices such as cloves, ginger, rosemary, and turmeric
  • Animal-based omega-3 fat, such as krill oil
  • Fermented vegetables and traditionally cultured foods, which quell inflammation by "reseeding" your gut with beneficial bacteria that help optimize your immune function
  • Shiitake mushrooms also contain strong compounds with the natural ability to discourage inflammation, such as Ergothioneine, which inhibits oxidative stress

Coffee is good for you—unless it’s not!


Americans drink 400 million cups a day (yes, you read that correctly) and we spend $30 billion on it every year.

The good news is that there's a lot of research that links drinking coffee with health benefits, including lower risk of cancer, Parkinson's disease, obesity, diabetes, metabolic syndrome, and heart disease. I covered that research in detail in a recent podcast.

Here's the bad news: while coffee is undoubtedly beneficial for some people, it may be harmful for others.

I talked about some of the factors, including sleep, stress, and intolerance to proteins in coffee beans, that determine individual response to coffee in another podcast a while back.

But there's another important factor to consider: genotype.

Coffee is the primary source of caffeine for Americans. Caffeine is metabolized by an enzyme in the liver that is encoded for by the CYP1A2 gene. Unfortunately, about 50 percent of the population has a variant in the CYP1A2 gene that leads to slow processing of caffeine.

For these "slow metabolizers," drinking coffee:
  1.     Is associated with a higher risk of heart disease
  2.     Is associated with a higher risk of hypertension
  3.     Is associated with impaired fasting glucose
  4.     May not have the protective effects against some cancers that it appears to for "fast metabolizers" 

Chemicals In The Food Chain Causing Multiple Diseases - Parkinson's Disease From Milk Consumption


Recently,  Time  magazine reported on an increased link between milk consumption and Parkinson's disease. Robert Abbott, from Shiga University of Medical Science in Japan, published his findings in the journal Neurology . In the 1980s, pineapple farmers in Hawaii used an organochlorine pesticide on their crops. This pesticide got into the milk supply when cows were fed a gruel that contained the leftover parts from those pineapples. Men who consumed 2 glasses or more per day of this milk, which now had residues of specific organochlorines called heptachlor epoxide, had compromised nerve function in specific areas of the brain. As the scientists investigated when the cell damage had actually occurred, they found that the chemical accumulation had occurred prior to the damage, which points to the pesticide bringing about Parkinson's.

Emerging Picture on Role of EDCs, Microbiome in Obesity, Diabetes


In the week when the European Court of Justice ruled that the European Commission has not been quick enough in identifying and banning potentially harmful endocrine-disrupting chemicals, one expert said the true role such substances play in the development of obesity and type 2 diabetes is only just emerging.

For years, Americans have been told that they eat too much and exercise too little. And while these two factors are still vitally important, there may be more going on than meets the eye, Deborah Kurrasch, PhD, assistant professor at the University of Calgary, Alberta, told the recent Endocrine Society Hormones & Health Science Writers Conference in New York City.

And coupled with the role of endocrine-disrupting chemicals is the contribution of the gut microbiome to this mix, the conference heard.

"Your gut flora may be a primary factor for your health and longevity," Elena Barengolts, MD, professor of medicine at the University of Illinois at Chicago, told assembled journalists.

BPA-Free: Not Necessarily Any Better
The detrimental effects of endocrine-disrupting chemicals on the female and male reproductive systems — including links to hormone-related cancers like prostate and thyroid cancers — and on cognitive and behavioral problems like attention-deficit/hyperactivity disorder and autism have been recognized for some time, said Dr Kurrasch.

But the role these chemicals have likely played in the burgeoning rates of obesity and diabetes seen in the United States over the past 3 decades is only just becoming clear, she noted.

A recent study has found that the same caloric intake and amount of exercise would result in a body mass index (BMI) that is 2.3 kg/m2 higher in 2006 than in 1988, she noted, suggesting that maintaining the same weight as in the 1980s now requires more intense workouts and consumption of fewer calories (Obes Res Clin Pract. 2015; DOI:10.1016/j.orcp.2015.08.007).

Dr Kurrasch went on to describe the knowledge base to date on the more than 100 known endocrine-disrupting chemicals, which are believed to interfere with hormone systems, either by mimicking hormones or blocking normal hormonal signaling. And while bisphenol A (BPA) is the "poster child" of endocrine-disrupting chemicals, in fact there are 13 types of bisphenols and more than 100 known endocrine-disrupting chemicals.

A European study reported earlier this year suggested that health effects from endocrine-disrupting chemicals cost the European Community €157 billion annually, and this report linked prenatal exposure to BPA to childhood obesity, with associated lifetime costs of €1.54 billion.

Chemicals such as BPA have a similar molecular structure to endogenous human hormones and therefore may be mistaken as such by the human body, Dr Kurrasch explained. As fatty molecules, BPAs easily cross membranes like the placenta, where they can potentially act on fetal hormone receptors.

A major problem with BPAs is that they require linker molecules to form plastic and the latter break down over time and with repeated exposure to stresses like heat and sunlight, allowing BPA molecules to leach into food and drink ingested by humans.

Knowledge of this leaching effect has increased consumer demand for BPA-free products. In response, companies have found a "sneaky" way around the issue, one that does not necessarily mean these products are safe, Dr Kurrasch pointed out.

"What we're finding is that BPA-free does not mean bisphenol-free or endocrine-disrupting-free," she stressed.

"The manufacturers can replace molecules and not do any safety profile testing. It's completely legal. They don't have to disclose what they use, and they don't have to disclose whether it's safe," she emphasized.

Finding a Safer Path
Against the backdrop of this increasing concern about endocrine-disrupting chemicals, the FDA, European Union, and Canadian authorities have all said that BPA exposure likely does not pose health risks.

One argument runs that humans excrete these compounds, so they must be safe. But years of research and the fact that BPA has been found in adult and fetal blood refute this argument, Dr Kurrasch said.
The understanding lies in the correct interpretation of toxicology studies, she emphasized.

Many studies have assumed that if higher doses of endocrine-disrupting chemicals are not harmful, then lower doses must be safe, but the endocrine system does not follow this linear pattern — hormones have biphasic dose-response curves, she explained.

Solving the problem represents an almost overwhelming challenge, given the ubiquitous nature of plastics, not to mention the $375 billion plastics industry.

Rather than forcing companies to get rid of bisphenols altogether, Dr Kurrasch suggests encouraging attempts to find a safe alternative.

"We need to be realistic on what we're willing to accept," she emphasized, "There's responsibility on our side as consumers."

Role of the Gut Microbiome
Meanwhile, Dr Barengolts discussed the other end of the spectrum — what lies inside the gut and how this may also play a role in the development of obesity and diabetes.

Ninety-five percent of the bacteria in the human body live in the gastrointestinal tract, she explained. Some can produce a specific toxin called lipopolysaccharide (LPS) endotoxin that causes inflammation, and studies have shown that LPS endotoxin causes obesity and diabetes in animal models, Dr Barengolts pointed out.

And research in humans has shown that lean and obese people have different types of gut microbiota and that, importantly, certain foods — like a high-fat diet — can change the gut microbiota, affecting local immunity, permeability of the gut, and gut hormones.

The net effect is higher fat absorption and fat deposition in the wrong places, like the pancreas.
Nutrition can make a "huge difference" in bringing the microbiome back into balance, Dr Barengolts advised. "Fruits and vegetables time after time in prospective longitudinal studies have been shown to decrease all-cause mortality," she said.

And eating probiotics — foods that contain live bacteria like yogurt and pickled vegetables — can also help, keeping in mind the high-fat content of dairy and high salt in certain fermented foods.
And prebiotics — foods like fiber that only gut bacteria can metabolize — also play an important role. People who have problems digesting these types of foods should introduce them in small amounts, Dr Barengolts recommended, and increase portions slowly over time.

"We evolved eating plenty of fiber, and we evolved with our bacterium; that's why it's so important for health," she concluded.

http://www.medscape.com/viewarticle/856161

Endocrine Disruptors Cited as Diabetes Risk in Southeast Asia


The potential contribution of environmental endocrine-disrupting chemicals to the type 2 diabetes epidemic in Southeast Asia needs to be better characterized and addressed, four scientists from the region and the United Kingdom stress in a new commentary.

The study was published online November 10 in Lancet Diabetes & Endocrinology by Robert Gifford, PhD, a research fellow at the University of Edinburgh, Scotland, and University of Peradeniya, Sri Lanka, and colleagues.

Increasing evidence supports a possible link between exposure to endocrine-disrupting chemicals, such as pesticides and solvents, and the development of endocrine and metabolic disorders, including obesity and type 2 diabetes. In vitro data have shown that such chemicals can disrupt energy metabolism, beta-cell glucose sensing, and skeletal-muscle insulin sensitivity and trigger hepatitis.

Although most of these data come from high-income countries, the use of endocrine-disrupting chemicals is more widespread and less regulated in Southeast Asia, while at the same time, the region has the highest mortality from diabetes in the world, the authors say.

"There is a desperate need for relevant research from Southeast Asia to be published to help governments, industry, and other policymakers examine whether the current trends are contributing to the increase in diabetes," Dr Gifford told Medscape Medical News.

A Number of Factors Exacerbating the Problem
A number of factors in Southeast Asia could be exacerbating the endocrine-disruptor exposure problem. These include both human-caused exposure from dumping and suboptimal storage of chemicals and acts of nature such as monsoon rains that spread the chemicals, particularly in high-population areas.

Moreover, Dr Gifford and colleagues note, economic forces have contributed to the escalating use of some of these chemicals in industries such as manufacturing and farming.

However, as of now the evidence for cause and effect is not sufficient to give advice on what substances to avoid, he said.

In 2009, the US Endocrine Society issued a statement concluding that comprehensive research was needed to identify means of exposure and mechanisms of endocrine disruption. They recommended the urgent adoption of policies to reduce exposure and recently strengthened this advice.

In 2012, the World Health Organization issued a report echoing the conclusions of the Endocrine Society.

However, neither publication addressed the association between endocrine-disrupting chemicals and diabetes, nor did they include any data from Southeast Asia.

"We are concerned that the current mainstream literature on [endocrine-disrupting chemicals] has a paucity of discussion of diabetes when this is such a great global health concern. Furthermore, we are concerned there is a lack of evidence from developing countries, like [those in] Southeast Asia, where the effects of such diseases are felt more acutely," Dr Gifford said.

The authors are currently undertaking a pilot prospective study in Sri Lanka and hope to publish the results next year, and one or two other groups are doing related work.

"We hope to take this forward collaboratively; however, there are too many chemicals and too few studies," Dr Gifford lamented.

"It is our observation that clinicians in Southeast Asia are well placed and highly capable of producing the kind of data that would affect real progress in understanding endocrine-disrupting chemical etiology and diabetes."

"So we are really keen to involve them in trying to understand the effects of industrialization, globalization, and the 'green revolution' in diabetes and obesity," the scientists conclude.

The authors have reported no relevant financial relationships.

Lancet Diabetes Endocrinol. Published online November 10, 2015. Full text

http://www.medscape.com/viewarticle/855019

US Endocrine Society Warns Again on Endocrine Disrupters


Evidence increasingly links endocrine-disrupting chemicals (EDCs) to diabetes and obesity, among other conditions, according to the second scientific statement to address this issue from the US Endocrine Society.

The new statement builds on the Endocrine Society's landmark 2009 report, which examined the scientific evidence on EDCs and their impact on humans. It was published online September 28.

Unborn children are particularly at risk when exposed to endocrine disrupters, according to the society. Animal studies indicate that exposure to even tiny amounts in the prenatal period can trigger obesity in later years, and some disrupters directly target beta and alpha cells in the pancreas, as well as fat and liver cells. All of this can lead to insulin resistance and type 2 diabetes.

Endocrine disrupters can also alter the way cells grow and develop by mimicking, blocking, or interfering with the body's natural hormones.

Nearly everyone has been exposed to one or more of these chemicals, which include bisphenol A (BPA) found in food-can linings and cash-register receipts, phthalates found in plastics and cosmetics, flame retardants, and pesticides.

Indeed a literature review presented recently at the European Association for the Study of Diabetes (EASD) 2015 Meeting in Stockholm linked exposure to pesticides to a 60% increased risk of type 2 diabetes.

Stronger Evidence in Past 5 Years: Advice for Consumers and Doctors
The new statement corroborates earlier findings, linking endocrine disrupters — in addition to their impact on obesity and diabetes — to effects on male and female reproductive health, hormone-related cancers, prostate conditions, thyroid disorders, and neurodevelopmental issues.

In an online press conference with reporters on Monday, Andrea Gore, PhD, professor and Vacek chair of pharmacology at the University of Texas at Austin, and chair of the task force that developed the statement, said the group is highlighting obesity and diabetes this time because the evidence for effects on these diseases is much stronger than it was 5 years ago.

Information from the report should inform consumers and conversations doctors have with obese or diabetic patients, Dr Gore said.

She recommends a few easy steps for the public to reduce exposure, starting with avoiding water bottles. Refilling a travel cup with water reduces both exposure to the plastic chemicals and the number of bottles that wind up in landfills and oceans.

Also, avoiding microwaving plastics and processed foods can limit chemical exposure.

"When doctors talk about lifestyle to their patients," Dr Gore says, "they typically emphasize healthy diet and exercise, but I would be surprised if, as part of the healthy-diet conversation, they talk about…trying to stay away from microwaving plastics. You may have a healthy meal, but if it's in a plastic container, it's leaching chemicals."

Many Medical Specialties Affected
Dr Gore also advises that not just endocrinologists, but general practitioners, pediatricians, obstetrician-gynecologists, and fertility doctors should emphasize reduction of exposure to these disrupters when they talk to their patients.

She stressed the need for urgent research and testing of chemicals and gave this example of the potential scope of the threat: "In the US, the Toxic Substances Control Act (TSCA) includes about 85,000 chemicals, most of which have not been tested for their health effects, and humans are exposed to many. Not all of these chemicals are EDCs, but if even 1% of them were EDCs, that would be 850 chemicals."

The full statement will be published online in the society's journal Endocrine Reviews in October.

Among the actions, it will call for:

  • Further research to more directly establish cause-and-effect relationships between endocrine-disrupter exposure and specific health conditions.
  • Regulation to ensure that chemicals are tested for endocrine activity before their use is permitted.
  • Industrial partners to create products that test for and eliminate potential EDCs.
  • Education for the public and policy makers on ways to keep EDCs out of food, water, and the air, as well as ways to protect unborn children.

Dr Gore also advises rethinking the composition of teams that are researching effects of disrupters to extend beyond endocrinologists.

"We need basic translational research, clinical scientists, healthcare professionals, and physicians who are working with patients and others," she concluded.

The project was funded by the National Institutes of Health, Ministerio de Economía y Competitividad, Generalitat Valenciana, Academy of Finland, Environment and Quality of Life, Sigrid Juselius Foundation, and Turku University Hospital Special Research Fund. Dr Gore is the editor in chief of Endocrinology. Disclosures for the coauthors are listed in the paper.

Endocr Rev. Published online September 28, 2015. Abstract

http://www.medscape.com/viewarticle/851876

Thursday, December 17, 2015

How Your Health Benefits from Fiber, and Suffers from Antibiotics


Your gut microbiome also exerts a powerful influence on your weight. Gut microbes known as Firmicutes have been detected in higher numbers in obese individuals, who also may have 90 percent less of a bacteria called bacteroidetes than lean people.7 In a Medscape interview8 published in April, 2015, Dr Martin Blaser, who heads up the Human Microbiome Center at New York University, discussed the links between your gut microbiome, obesity, and chronic disease.

As noted by Dr. Blaser:
    "The basic idea is that the microbiome is ancient. The organisms that we carry are not random; they have been selected over eons of evolution. They are important for our physiology, and there is a lot of evidence for that. My big point is that they are changing. As a result of the change, there are health consequences ...

    I believe that there is a general paradigm that we are losing important organisms early in life, and that is fueling some of the diseases that are epidemic today."

EHRs: Lots of Documentation But Little Communication


Most EHRs Continue to Frustrate Clinicians
In spite of assurances from vendors, complaints continue to run bitterly deep from physicians and surgeons about the major players in the EHR market.[1] The community consensus is that a lot of us could do without EHRs. As professionals with exacting standards, it's intensely disappointing to see in EHRs a tool that doesn't rise to meet those standards. Physicians maintain these precise standards because the health and lives of their patients utterly depend on it.

Consequently, any discussion of these shortfalls is generally lost on those who feel that change is inevitable and that point-and-click or drop-down menus are "good enough." Similarly, those who see EHRs primarily as a data-harvesting platform, by which reporting metrics and guideline compliance may be achieved, miss the essential humanness of physician-patient interactions in their rush for technocratic perfection.

Nothing succeeds in glazing over the eyes of nonphysicians like "talking medicine." Perhaps, instead, a recent profile of Robert Macfarlane in a BBC article[2] may be able to illustrate the symbolism of what's being lost to those who don't work with patients, and with words, the way we do.

Pathogenic Gut Flora Tied to Heart-Failure Severity


Patients with chronic heart failure (CHF) are likely to have "intestinal overgrowth" of pathogenic gut flora and permeability that is associated with disease severity, new research suggests[1].
A study of 80 total participants showed that the CHF patients had "massive quantities" of pathogenic bacteria and candida vs a group of healthy controls. Specific types of the increased pathogens found in stool samples included Campylobacter, Shigella, Salmonella, Yersinia enterocolitica, and Candida species. Those with CHF also had significantly increased inflammation, intestinal permeability, and right atrial pressure (RAP), which is a signal of venous blood congestion.

In addition, most associations were stronger in those with moderate-severe HF (NYHA 3-4) vs those with mild HF (NYHA 1-2).

...

Interestingly, 100% of the CHF group had increased permeability and 78.3% of them had altered gut flora.

The full CHF group had substantially greater amounts of campylobacter vs the healthy controls group (85.3 vs 1.0 colony-forming units/mL, respectively; P<0.001). They also had larger quantities of shigella (38.9 vs 1.6) and candida (21.3 vs 0.8; both comparisons, P<0.001), as well as of salmonella (31.3 vs 0) and Yersinia E (22.9 vs 0; both comparisons, P<0.0001).

In addition, the CHF group had increased RAP (12.6 mm Hg) and systemic inflammation, as measured with C-reactive protein (12.5 mg/dL), and greater intestinal permeability vs the healthy controls (10.2 vs 1.5 mg, P<0.001).

The subgroup of moderate-severe CHF patients had significantly greater development rates of candida, campylobacter, and shigella compared with the subgroup with mild CHF. They also had greater intestinal permeability.

"Further studies are needed to confirm the link between gut pathogenic bacteria and CHF severity," write the investigators, "If confirmed, this link could suggest additional personalized therapeutic strategies . . . in support of traditional drugs," they write.

However, they note that there are currently "no clinical gut-flora modifiers available," and using probiotics could be potentially dangerous. "At present, reestablishing the gut microbiota may be the only option for patients to reverse intestinal dysbiosis," they write.

Consequence, Not Cause of HF?

The study's main take-home message, according to Hazen, is a reemphasis of the connection between cardiac function and bowel-wall edema, "and the breakdown of the barrier function of the intestines" in HF. In addition, "I think a lot of what was shown in the paper was a consequence of the heart failure and not a cause of the heart failure."

Hazen and other colleagues from Cleveland Clinic have written before about these issues and continue to study the associations. A new preclinical study published in Cell earlier today, for which Hazen was the principal investigator, showed that targeting and inhibiting gut microbes may prevent the development of atherosclerosis.

Sluggish during workouts? 3 nutrients you might be missing


1. Vitamin D (see link below for more details)

2. Magnesium (see link below for more details)

3.Vitamin C

You've heard about the immune supporting benefits of vitamin C. But this essential nutrient also supports exercise endurance and recovery. A higher blood level of vitamin C Vitamin has been shown to boost fat burn, both at rest and during exercise, which can delay fatigue and lengthen workouts. And vitamin C is required to make tendons, ligaments, cartilage, and bones, so it plays an important role in healing the wear and tear exercise puts on your body. Getting the right amount means you can make the most of your sweat sessions.

How to get enough
Citrus fruits and bell peppers, especially red, are top sources, in addition to broccoli, Brussels sprouts, kiwi, strawberries, and cantaloupe. Taking in at least five servings of produce a day that includes rich sources is enough to saturate your body's tissues (meaning any more will be excreted).
But if you do opt for a supplement don't go overboard. Too much vitamin C, from high dose supplements, can have a pro-antioxidant effect, which increases exercise-induced stress. The Tolerable Upper Intake Level, or UL (essentially the maximum advised daily intake) for vitamin C it's 2,000 mg a day. While some people may be fine consuming more than this amount megadoses have linked to bloating and digestive upset, diarrhea, nausea, vomiting, heartburn, headaches, insomnia, and even kidney stones.

Cynthia Sass, MPH, RD, is Health's contributing nutrition editor. She privately counsels clients in New York, Los Angeles, and long distance. Cynthia is also the sports nutrition consultant to the New York Rangers NHL team and the New York Yankees MLB team, and is board certified as a specialist in sports dietetics.

Sunday, December 13, 2015

How Not to Die - Eat Real Food for Health And Longevity


Most people who start eating a plant-based diet will feel very energized and will note a variety of health improvements. However, some people fail to thrive on a plant-based diet, and many times either B12 deficiency, carnitine deficiency, or both, are to blame. Dr. Greger notes that vitamin D deficiency is also rampant among vegans who fail to thrive.

Many of the problems associated with veganism can be avoided by eating a wide variety of real food. It may not have occurred to you, but you can actually be a very unhealthy vegan these days. The devil is in the details, as they say, and many vegans are essentially just eating a vegan junk food diet.

Dr. Greger expounds on this issue, noting:
    "It used to be that if you are a vegetarian, you had to by default eat healthy. What was there to eat? Now we have vegan doughnuts. We have vegan lard, vegan ice cream, vegan everything. It's like the gluten-free thing. Celiac patients used to be really healthy. What could you eat? You couldn't eat any junk food, right? You just had to eat real food.

    Now we got gluten-free Oreos or whatever you want to stuff in your face. Now you can eat just as unhealthy gluten-free as a non-gluten-free. The same thing with vegan. It has become so popular that you can get every disgusting processed food in vegan form. I see that a lot among college vegans. They're not doing well because they're not eating real food. That's important.

    If you look into some of the longest living countries, like Okinawa for example; they were eating animal products, but they were eating 95 percent whole plant foods. That's a much healthier diet than your strictest of the strict, 100 percent vegan here in the U.S. living on vegan Doritos."


Patients Advised to Take More Blood Pressure Pills


Elevated blood pressure, or hypertension, is associated with serious health problems, such as strokes, heart attacks, and kidney failure. Most people believe the problem with hypertension is that the elevated pressure damages the arteries and the body's organs. Actually, it is more often the other way around. The rise in blood pressure is a response to a sick body—the blood pressure goes up as a natural and proper adaptation—as an attempt to compensate for a plugged up cardiovascular system. After years of consuming the rich Western diet, the blood vessels develop blockages referred to as atherosclerosis, the artery walls stiffen, and the blood itself becomes viscous. All this change creates a resistance to flow, resulting in a decrease in the ability to deliver nutrients to the tissues. The body responds, as it should, with a rise in blood pressure.

The correct action for the patient to take is to decrease the resistance to flow by eating a healthy diet and exercising. Most people who follow the McDougall diet find their blood pressure decreases within a few days. Based on several collections of results from my clinic, the average reduction of blood pressure is about 14/11 mmHg in seven days, and at the same time medications used for treating hypertension are usually stopped. My customary protocol is to stop all blood pressure-lowering medications the first day of the Program, except for beta-blockers, which I slowly discontinue by cutting the dosage in half every two to three days. Unfortunately, not every patient experiences the reduction in numbers they desire. Despite their best efforts some people may need medications.

Saturday, December 12, 2015

Steps to a Healthy Microbiome


My patients are often surprised when I ask them where they were born and whether or not hospital walls and their mother's vaginal canal were key players in their emergence. As someone who follows a burgeoning literature on the role of the microbiome in regulation of immunity, inflammatory response, and brain health, the formative role of the birth experience in later mental health is one I choose to shine my investigative light on.

Mental health and wellness are often, if not always, a reflection of bodily and physiologic balance – endocrine, gut, immune, neurochemical. Through this lens, allergic and autoimmune disorders, metabolic derailments, and cancer are all relevant indicators of the nature of this multifocal imbalance and the pathway to repair.

Steps to a Healthy Microbiome
Pathologies such as obsessive-compulsive disorder can be seen as an inflammatory/immune/microbiome-based problem with a non-medication resolution (far from the hand-waving attribution of these symptoms to a "serotonin imbalance"). Increasing evidence supports the primary role of the gut microbiome in influencing stress-response patterns, most notably cortisol production and regulation[1].

When, with the completion of the Human Genome Project, we learned that we must have outsourced the vast majority of our human physiology to somewhere other than our 25,000 genes, we began to focus on epigenetics. This is the body's ability to manifest variable genetic expression within our epigenome without changes to the primary nucleotide sequences of our DNA itself, and this mechanism relies primarily on environmental cues, sometimes referred to as the exposome.

Saturday, December 5, 2015

Advertising and Milk

I recently saw this quote in the movie "Got The Facts on Milk". And loved it.


Advertising is the science of arresting the human intelligence long enough to get money from it.

~Stephen Leacock (1869-1944)~

Thursday, December 3, 2015

Proton pump inhibitor use may not prevent cancer in Barrett's esophagus



In patients with Barrett's oesophagus, we found no evidence of a protective effect from PPI on the development of OAC or HGD. In fact, we observed an increased risk for developing high-grade dysplasia and adenocarcinoma in the oesophagus with long-term PPI usage. This association can partly be due to bias associated to symptom driven PPI intake. Until the results from future studies can further elucidate the association, PPIs should be restricted to symptom control according to current guidelines. Hence, PPI may not protect against malignant progression in BO patients and in selected high-risk patients, clinicians may consider adding or replacing long-term medical treatment with other modalities.

http://onlinelibrary.wiley.com/doi/10.1111/apt.12693/full

Barrett’s esophagus (BE) is a condition in which the stratified squamous epithelium (SSE) of the distal esophagus undergoes intestinal metaplasia (transformation to columnar epithelium), which predisposes the epithelium to esophageal adenocarcinoma (EAC). The etiologic consensus for BE, remains a matter of debate; however, strong association with chronic gastroesophageal reflux disease (GERD) has been documented. An accurate representation of the prevalence for BE is still not clear, most likely due to a lack of protocol for screening. The alarming increase of EAC by 600% for the past 25 years suggests that BE has increased as well, as the latter represents the main risk factor for EAC. This emphasizes the importance of better understanding the causal process leading to intestinal metaplasia (BE) and suggests that a possible re-evaluation of the current protocol for the management and treatment of GERD and BE may be beneficial.

http://journal.frontiersin.org/article/10.3389/fonc.2014.00373/full#B10

The microbiome and its pharmacological targets: therapeutic avenues in cardiometabolic diseases


Cardiometabolic diseases (CMD) present a complex array of interrelated risk factors affecting more than one billion people with a dramatic impact on mortality, morbidity and quality of life. These factors (including impaired glucose tolerance, dyslipidemia, arterial hypertension, insulin resistance and central obesity) are epidemiologically clustered — the presence of at least three of five of these symptoms corresponding to the ‘metabolic syndrome’ clinical diagnosis. Although many pharmacological mechanisms have been suggested, the underlying causes of CMD and its potential therapeutic avenues remain to be fully explored. With the advent of high-throughput methodologies (metagenomics, metabolomics), the gut microbiome emerged as one of the key drivers for CMD. The gut ecosystem, as well as its individual members, was shown to contribute to the host metabolism. A lower bacterial gene count (LGC) is associated to increased adiposity, insulin resistance and dyslipidemia and dietary intervention can improve both bacterial gene richness and clinical metabolic outcomes. Patients with type 2 diabetes (T2D) also show specific compositional and functional changes in their metagenomes.

With the increasing number of clinical studies reporting associations between the composition of the gut microbiota and CMD outcomes, one question arises — how are these changes in microbial ecology translated into pharmacological messages to the mammalian host? Consisting of trillions of non-pathogenic bacteria living in a symbiotic relationship with their host, gut microbiota produces several signalling molecules (e.g., LPS, peptidoglycans, but also metabolites) that bind host proteins and impact signalling networks, therefore playing a central role as chemical messengers in the microbial–mammalian crosstalk. The identification of the pharmacological targets and signalling pathways of these metabolites is key to a better understanding the molecular crosstalk supporting the microbial–mammalian metabolic axis — and provides a suitable framework for the discovery of the mechanistic basis of these associations. In this context, fine mapping of the microbial signalling metabolome and its host molecular targets opens up novel pharmacological avenues for microbiome interventions.

...

Modulation of GLP-1 signalling is one of the possible routes through which prebiotics participate in the control of obesity and associated disorders. Treatment with the prebiotic oligofructose increases the total number of GLP-1 expressing cells in the colon of male Wistar rats. Interestingly, butyrate stimulates the production of GLP-1 in intestinal cells, highlighting that gut microbial modulation with prebiotics promotes the growth of butyrate-producing bacteria, thus increasing GLP-1 production. In general the beneficial effects of prebiotic and probiotics have been attributed to the increased SCFA production.

...

Faecal microbiota transplantation (FMT) was suggested as a strategy to transfer an ecologically stable bacterial community with beneficial properties. Studies on animal models demonstrated that murine microbiomes could be transplanted to impact body weight and that the architecture of the microbiome in obese mice matches the observations in obese patients. However, the effect of microbiome transplantations can be mitigated by environmental influences such as co-housing for animal models.

Vrieze et al. showed that transplanting patients with metabolic syndrome with intestinal content from lean donors resulted in an improvement of both insulin sensitivity and levels of butyrate-producing intestinal microbiota (Roseburia intestinalis and Eubacterium hallii). Hence, it can be speculated that this untargeted approach might be considered as a potential therapeutic strategy for glucose impairment disorders in humans.

...

Metabolomic approaches allowed the identification and monitoring of microbial metabolites as potential risk markers for CMD. However, the gut microbiota is a dynamic ecological community deeply affected by external stimuli and the causality of these correlations must be interpreted cautiously. A more complete understanding of the targets and pathways of these metabolites is therefore crucial, placing the study of the pharmacology of the microbial–mammalian interaction as one of the most relevant areas of future research in CMD. The microbial metabolites addressed exemplify the broad scope of the interaction between the gut microbiota and its mammalian host, and their potential to influence key mechanisms of CMD (e.g., glucose homeostasis, lipid homeostasis, inflammation, gut barrier integrity). Revisiting the pharmacology of these four classes of metabolites reveals the tip of the iceberg of the mammalian–microbial pharmacological interaction — and suggests how potentially powerful could be the plethora of metabolites that have been identified, but whose targets and signalling pathways remain to be fully understood. The modification of the gut microbiota, its metabolites and pharmacological targets arises therefore as a promising therapeutic avenue. As novel and powerful analytical methods provide a clearer understanding complexity of this interaction, specific interventions might be designed for personalized healthcare approaches.

http://www.ncbi.nlm.nih.gov/pubmed/26531326

Gut microbiota and host metabolism in liver cirrhosis


ABSTRACT
The gut microbiota has the capacity to produce a diverse range of compounds that play a major role in regulating the activity of distal organs and the liver is strategically positioned downstream of the gut. Gut microbiota linked compounds such as short chain fatty acids, bile acids, choline metabolites, indole derivatives, vitamins, polyamines, lipids, neurotransmitters and neuroactive compounds, and hypothalamic-pituitary-adrenal axis hormones have many biological functions. This review focuses on the gut microbiota and host metabolism in liver cirrhosis. Dysbiosis in liver cirrhosis causes serious complications, such as bacteremia and hepatic encephalopathy, accompanied by small intestinal bacterial overgrowth and increased intestinal permeability. Gut dysbiosis in cirrhosis and intervention with probiotics and synbiotics in a clinical setting is reviewed and evaluated. Recent studies have revealed the relationship between gut microbiota and host metabolism in chronic metabolic liver disease, especially, non-alcoholic fatty liver disease, alcoholic liver disease, and with the gut microbiota metabolic interactions in dysbiosis related metabolic diseases such as diabetes and obesity. Recently, our understanding of the relationship between the gut and liver and how this regulates systemic metabolic changes in liver cirrhosis has increased. The serum lipid levels of phospholipids, free fatty acids, polyunsaturated fatty acids, especially, eicosapentaenoic acid, arachidonic acid, and docosahexaenoic acid have significant correlations with specific fecal flora in liver cirrhosis. Many clinical and experimental reports support the relationship between fatty acid metabolism and gut-microbiota. Various blood metabolome such as cytokines, amino acids, and vitamins are correlated with gut microbiota in probiotics-treated liver cirrhosis patients. The future evaluation of the gut-microbiota-liver metabolic network and the intervention of these relationships using probiotics, synbiotics, and prebiotics, with sufficient nutrition could aid the development of treatments and prevention for liver cirrhosis patients.

INTRODUCTION
An increasing amount of recent evidence has demonstrated that several diseases, such as irritable bowel syndrome, inflammatory bowel disease, diabetes, allergy, cancer, obesity, autism and liver disease, are related to alterations in intestinal microbiota (known as dysbiosis). Gut-derived complications in liver cirrhosis such as small intestinal bacterial overgrowth and increased intestinal permeability (leaky gut), resulting in bacterial or endotoxin translocation-related systemic disorders such as spontaneous bacterial peritonitis, hyperdynamic state, portal hypertension, hepatorenal syndrome, hepatic encephalopathy, and multiple organ failure, have been reported in clinical settings. Different etiologies of liver cirrhosis, including viral hepatitis, alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD), have different gut microbiota and mechanisms of developing liver fibrosis. Furthermore, each disease has a different hepatic metabolism, suggesting further development in this research area. However, there have been few reports of correlations between gut microbiota and host metabolism in cirrhotic patients. This review will discuss (1) the relationship between gut microbiota and host metabolism in general; (2) the results of intervention for liver cirrhosis by probiotics; and (3) gut-microbiota and host metabolism in cirrhosis and the use of systems biology as a tool for analysis.

http://www.ncbi.nlm.nih.gov/pubmed/26556989