Dr. Bray Links

Saturday, December 31, 2016

Happy New Year 2017

Wishing you a Happy New Year with the hope that you will have many blessings in the year to come!

DocBray's Favorites 2016

Favorite Supplements

Favorite Health Podcasts

Thursday, December 29, 2016

Sauna Use Linked to Lower Dementia, Alzheimer's Risk

Partaking regularly in the relaxing practice of sauna bathing is associated with a decreased risk for dementia and Alzheimer's disease (AD) — at least in men, new research suggests.

Further results from the Kuopio Ischemic Heart Disease (KIHD) study, which included more than 2300 middle-aged men in Finland who were deemed healthy at baseline, showed that those whose sauna use averaged 4 to 7 times per week were 66% less likely to develop dementia at 20-year follow-up than men who used a sauna once a week. In addition, they had a 65% risk reduction for AD.

The report "provides promising results from the first prospective study that shows sauna bathing to be a potential protective lifestyle factor for common memory diseases," write the investigators, adding that the practice "may be a recommendable intervention" to prevent the condition in healthy adults.

However, they note that more studies are needed in different patient populations, including women.

Still, senior author Jari Antero Laukkanen, MD, PhD, professor at the University of Eastern Finland, Kuopio, told Medscape Medical News that he was pleased with the results.

"This study was surprising because the findings were so strong," said Dr Laukkanen. "People have positive feelings about sauna bathing," which may help in part to explain the associations found, he added.

The results were published online December 7 in Age and Ageing.


How Exercise Might Keep Depression at Bay


Exercise may be an effective treatment for depression and might even help prevent us from becoming depressed in the first place, according to three timely new studies. The studies pool outcomes from past research involving more than a million men and women and, taken together, strongly suggest that regular exercise alters our bodies and brains in ways that make us resistant to despair.

Scientists have long questioned whether and how physical activity affects mental health. While we know that exercise alters the body, how physical activity affects moods and emotions is less well understood.

Past studies have sometimes muddied rather than clarified the body and mind connections. Some randomized controlled trials have found that exercise programs, often involving walking, ease symptoms in people with major depression.

But many of these studies have been relatively small in scale or had other scientific deficiencies. A major 2013 review of studies related to exercise and depression concluded that, based on the evidence then available, it was impossible to say whether exercise improved the condition. Other past reviews similarly have questioned whether the evidence was strong enough to say that exercise could stave off depression.

A group of global public-health researchers, however, suspected that newer studies and a more rigorous review of the statistical evidence might bolster the case for exercise as a treatment of and block against depression.

So for the new analyses, they first gathered all of the most recent and best-designed studies about depression and exercise.

Then, for perhaps the most innovative of the new studies, which was published last month in Preventive Medicine, they focused on whether exercise could help to prevent someone from developing depression.

The scientists knew that many past studies of that topic had relied on people providing reports about how much they had exercised. We human beings tend to be notoriously unreliable in our memories of past workouts, though.

So the researchers decided to use only past studies that had objectively measured participants’ aerobic fitness, which will rise or fall depending on whether and how much someone exercises. Participants’ mental health also had to have been determined with standard testing at the start and finish of the studies, and the follow-up time needed to have been at least a year and preferably longer.

Ultimately, the researchers found several large-scale past studies that met their criteria. Together, they contained data on more than 1,140,000 adult men and women.

Among these million-plus people, the links between fitness and mental health turned out to be considerable. When the researchers divided the group into thirds, based on how aerobically fit they were, those men and women with the lowest fitness were about 75 percent more likely to have been given diagnoses of depression than the people with the greatest fitness. The men and women in the middle third were almost 25 percent more likely to develop depression than those who were the most fit.

In a separate study (some of the scientists were involved in each of the reviews), researchers looked at whether exercise might be useful as a treatment for depression. In that analysis, which was published in June in the Journal of Psychiatric Research, they pooled data from 25 past studies in which people with clinically diagnosed depression began some type of exercise program. Each study had to include a control group that did not exercise and be otherwise methodologically sophisticated.

The pooled results persuasively showed that exercise, especially if it is moderately strenuous, such as brisk walking or jogging, and supervised, so that people complete the entire program, has a “large and significant effect” against depression, the authors wrote. People’s mental health tended to demonstrably improve if they were physically active.

The final review offers some hints about why. Published in February in Neuroscience and Biobehavioral Reviews, it took on the difficult issue of what happens within our bodies during and after exercise that might affect and improve our moods. The researchers analyzed 20 past studies in which scientists had obtained blood samples from people with major depression before and after they had exercised. The samples on the whole indicated that exercise significantly reduced various markers of inflammation and increased levels of a number of different hormones and other biochemicals that are thought to contribute to brain health.

But the researchers also caution that most of the physiological studies they reviewed were too small and short-term to allow for firm conclusions about how exercise might change the brain to help fight off gloom.

Still, the three reviews together make a sturdy case for exercise as a means to bolster mental as well as physical health, said Felipe Barreto Schuch, an exercise scientist at the Centro Universitário La Salle in Canoas, Brazil, who, with Brendon Stubbs, a professor at King’s College in London, was a primary author on all of the reviews.

Many more experiments are still needed to determine the ideal amounts and types of exercise that might help both to prevent and treat depression, Dr. Schuch said.

But he encouraged anyone feeling overwhelmed by recent events, or just by life, to go for a run or a bike ride. “The main message” of his and his colleagues’ reviews, he said, “is that people need to be active to improve their mental health.”



Online Insomnia Therapy: A Dream Come True for Some Patients

Web-based therapy for insomnia is an effective option that could reach “previously unimaginable numbers of people,” researchers suggest.

Although cognitive behavior therapy for insomnia (CBT-I) is the first-line treatment for adults with chronic insomnia, there aren’t enough trained clinicians to deliver the treatment, according to Dr. Lee Ritterband of the University of Virginia School of Medicine in Charlottesville and colleagues.

To investigate whether web-based CBT-I is effective over the long term and might enable more people to benefit, the team randomly assigned 303 adults with chronic insomnia to a six-week automated, interactive and tailored web-based program (Sleep Healthy Using the Internet, or SHUTi, at www.myshuti.com) or an online, nontailored patient education program about insomnia.

To be included in the study, participants had to take more than half an hour to fall asleep at the beginning of the night or be awake for more than half an hour after initially falling asleep at least three nights per week for at least six months; average 6.5 hours or less sleep time nightly; and experience significant stress or impaired functioning due to sleep disturbances. About half of participants also had at least one medical or psychiatric condition.

Most of the participants - 77 in the SHUTi group (51 percent) and 69 in the patient education group (46 percent) - had taken a sleep aid at least once.
The research team reports in JAMA Psychiatry that SHUTi was significantly more effective than the patient education program with respect to insomnia severity, delay until sleep onset and time awake after sleep onset. By one year, insomnia was no longer a problem for 57 percent of SHUTi participants versus 27 percent of those receiving education.

In addition, 70 percent of SHUTi participants had seen at least some improvement, compared to 43 percent of participants who received education.

Ritterband told Reuters Health that the online intervention is not intended to replace face-to-face CBT-I, “but rather to expand the availability and access (to CBT-I) to meet the needs of the millions of people.”

“Internet interventions are not for everyone . . . Those who prefer face-to-face therapy can still have that as a possibility if available, but those who are interested in a web-based program, or who do not otherwise have access to a CBT-I specialist in their region, could now have an option,” he said by email.

“Given the high prevalence of insomnia and its costly impact, from both a personal and economic perspective, it is critical that we continue to develop and evaluate methods of care that can make a meaningful public health impact,” he concluded.

Dr. Aric Prather of the University of California, San Francisco, coauthor of an accompanying editorial, told Reuters Health, “This study provides the strongest evidence to date that web-based CBT-I is efficacious for treating patients with insomnia, including those with some psychiatric and medical comorbidities. These findings further highlight how technology can help scale the disseminations of needed interventions.”

“There is often a misplaced concern that the Internet will replace the skilled clinician,” he said by email. “While web-based therapies, including SHUTi, will certainly increase the swath of individuals who receive treatment, there will likely always be a need for skilled therapists to meet the needs of patients who prefer face-to-face encounters or present with complex cases that require personalized care.”

Dr. Shelby Harris, director, Behavioral Sleep Medicine at the Sleep-Wake Disorders Center at Montefiore Hospital in New York City, pointed out that the authors of the study made sure in advance that participants did not have any untreated sleep disorders.

“Given that sleep apnea is extremely common,” she told Reuters Health by email, “it is important that patients make sure that any other sleep disorders are thoroughly evaluated (and treated if necessary) by a sleep physician.”

Harris concluded, “Early treatment is best, so this is a great resource for patients initially struggling with insomnia who may first present to a primary care office.”

Ritterband and three coauthors have equity ownership in BeHealth Solutions, which licensed the SHUTi program and platform from the University of Virginia.


Zinc deficiency with ACE inhibitor and ARB blood pressure medications

Heart failure (HF) is a prevalent syndrome resulting in a high mortality rate. HF may be associated with zinc deficiency through a reduction in dietary intake, decreased absorption due to gastrointestinal edema, impaired motility or intestinal zinc losses. Diseases concomitant with HF such as diabetes mellitus (DM) and hypertension may enhance zinc deficiency. Medications given for HF may affect zinc metabolism in different ways. It was shown that thiazides may cause zincuria and a decrease in tissue zinc concentration. There is conflicting evidence about furosemide, even though patients with chronic furosemide treatment showed low tissue zinc levels in autopsies. Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) resulted in zincuria and zinc deficiency, but this outcome was not consistent in all studies. Beta-blockers did not alter plasma zinc concentration. Matrix metalloproteinases (MMPs) and ACE are zinc-containing enzymes, which play a role in the process of remodeling in HF. It was shown that ACE inhibitors may inhibit the activity of different MMPs. The exact interrelationship between HF, zinc-containing enzymes, zinc deficiency and the clinical manifestation of HF has to be investigated.



The BRAT Diet: Is It a Good Idea?

Alternative Dietary Strategies for Digestive Illness

Here are some ideas for you to try during and after digestive illness, instead of following the BRAT diet:

    Take probiotics or eat probiotic-rich yogurt: Certain probiotics can help reduce diarrhea, including Lactobacillus reuteri, Lactobacillus GG and Saccharomyces boulardii (15, 16, 17, 18).
    Take prebiotic fiber: Prebiotic fiber feeds healthy gut bacteria. In one study, diarrhea resolved significantly faster in children and adults given prebiotics, compared to those given a placebo (19, 20).
    Begin a regular diet within 24 hours of illness, as tolerated: Foods rich in protein, vitamins and minerals provide nutrition needed for proper recovery. Add small amounts of meat, fish, eggs, yogurt and cooked vegetables first.
    Avoid foods that worsen diarrhea: These include milk, sugar, fried foods, spicy foods and caffeinated beverages. You can add them back into your diet gradually after a few days.
    Include BRAT foods: Including bananas and rice as part of a balanced diet may help firm up loose stools. Bananas can also help replenish potassium lost in vomiting and diarrhea.
    Drink electrolyte-rich fluids: Bone broth, chicken broth or beef broth are good options to replace water and electrolytes. For children, oral rehydration solutions like Pedialyte are recommended (21).

    Bottom Line: Taking probiotics and prebiotics, consuming a balanced diet and rehydrating can help promote recovery from intestinal illness.


Wednesday, December 28, 2016

Mysterious illness tied to marijuana use on the rise in states with legal weed

"The first question he asked was if I was taking hot showers to find relief. When he asked me that question, I basically fell into tears because I knew he had an answer," Crowder said.

The answer was cannabinoid hyperemesis syndrome, or CHS. It's caused by heavy, long-term use of various forms of marijuana. For unclear reasons, the nausea and vomiting are relieved by hot showers or baths.

"They'll often present to the emergency department three, four, five different times before we can sort this out," said Dr. Kennon Heard, an emergency room physician in Aurora, Colorado.


Presidential Panel: Reduce Cancer Risks

Exposure to potential cancer risks in daily life is widespread but underestimated, especially for children, a presidential panel said today.

The President's Cancer Panel said the public remains by and large unaware of such common cancer risks as formaldehyde, benzene and radon. It's the first time the group has focused on environmental cancer risks in its annual report to the president.

"The mere fact that the President's Cancer Panel has this report is going to make people more aware," said panel chair Dr. Lasalle Leffall Jr., an oncologist and professor of surgery at Howard University College of Medicine.

The panel also recommends reducing environmental cancer risks a cornerstone of cancer prevention efforts and said doctors need to do a better job considering potentially harmful chemical exposures when diagnosing patients.

The report also faults U.S. policy for allowing most of the 80,000 chemicals in use to go largely unstudied and unregulated. For example, the report says, bisphenol A (BPA) remains unregulated in consumer products such as plastic bottles, can liners and food wrap "despite the growing link between BPA and several diseases, including various cancers."

Risks of environmental exposure are especially acute for children, who weigh less but – pound for pound — take in more food, water and air than adults. Toxic chemicals also remain active longer in children's bodies and their developing brains are more prone to chemical exposure.

Leffall said the panel decided to publish the report on environmental cancer risks this year even in absence of proof that particular exposures cause cancer. Case in point: Cell phones. Leffall said even though science has not shown electromagnetic energy from cell phone use causes cancer, the report takes a cautious approach and recommends callers wear headsets, or text, to reduce exposure.

To lessen cancer risks, the 240-page report also recommends:

* Removing shoes before entering the home to avoid tracking in toxic chemicals such as pesticides.

* Filtering tap water.

* Using stainless steel, glass or BPA-free plastic water bottles.

* Microwaving in ceramic or glass instead of plastic containers.

* Minimizing consumption of food grown with pesticides and meat raised with antibiotics and growth hormone.

* Minimizing consumption of processed, charred or well-done meats, which contain carcinogenic heterocyclic amines and polyaromatic hydrocarbons.

* Reducing radiation from X-rays and other medical sources.

The report singled out three chemicals as dangerous: formaldehyde, benzene and radon.

Almost all homes contain formaldehyde, considered a probable human carcinogen by the Environmental Protection Agency. Formaldehyde is used in plywood, particle board, foam insulation, carpet and draperies, furniture, permanent press fabrics and toiletries. Exposure is highest when these are newly installed, the report said. Also, an estimated 2 million Americans are exposed to formaldehyde at work, raising their risk of dying from Hodgkin's lymphoma and other cancers, according to the report.

Exposure to benzene is also widespread. Exhaust from cars and other vehicles contain benzene, listed as a known human carcinogen by the EPA.

Radon, which forms naturally and can collect in homes, is the second leading cause of lung cancer in the United States, behind smoking, resulting in an estimated 21,000 deaths annually, according to the report. The report recommends periodically checking the radon levels at home.

The President's Cancer Panel was created in 1971. Serving with Lefall is Margaret L. Kripke of the University of Texas M.D. Anderson Cancer Center. The panel's third member has not been appointed.


Tuesday, December 27, 2016

Lyme Disease Co-Infections

Tick-borne infections are zoonotic—meaning they are passed from animals to humans. "Vectors" like ticks, mosquitos and fleas transmit the diseases from animals like mice, rats, and squirrels to humans when they bite. Ticks can carry many bacteria, viruses, fungi and protozoans all at the same time and transmit them in a single bite. The most common tick-borne diseases in the United States include Lyme disease, babesiosis, anaplasmosis, ehrlichiosis, relapsing fever, tularemia, Rocky Mountain spotted fever (RMSF). Diseases acquired together like this are called co-infections.

Coinfections may be common – at least among those with chronic Lyme disease. A recently published LDo survey over 3,000 patients with chronic Lyme disease found that over 50% had coinfections, with 30% reporting two or more coinfections. The most common coinfections were Babesia (32%), Bartonella (28%), Ehrlichia (15%), Mycoplasma (15%), Rocky Mountain Spotted Fever (6%), Anaplasma (5%), and Tularemia (1%).


EEB welcomes strengthening of EU mercury laws

Brussels, 8 December 2016

The EEB today welcomed the deal struck in the early hours of yesterday (7 December) by the European Commission, EU Member States and the European Parliament to beef up the EU mercury regulation. This opens the way to the EU now swiftly ratifying the Minamata Convention on Mercury

Elena Lymberidi-Settimo, Zero Mercury Campaign Project Manager, commented:

"We are glad that the provisionally agreed text improves the Commission's initial proposal. It strengthens the EU mercury regulation and on a number of issues goes beyond the requirements of the Minamata Convention. This sends the right signal to the rest of world that mercury elimination is necessary and possible. The decision to end dental amalgam use in children and pregnant and breastfeeding women is great news, but it is disappointing that a general phase out was not agreed. The failure to end the export of all mercury-added products already prohibited in the EU and mercury use in some processes sooner rather than later also suggests that financial interests still prevailed over health and nature protection for certain issues."

In particular the EEB praised the proposed improvements for the management of mercury waste and the fact  that liquid mercury waste will have to be converted to a solid form before its final disposal in underground salt mines or in dedicated above ground facilities (with an additional solidification step).

Lymberidi-Settimo added:

"This is a clear gain in terms of environmental protection and reduced risk for future generations." 


Which foods may be addictive? The roles of processing, fat content, and glycemic load.

Although there is little evidence in humans of what foods may be addictive, animal models suggest that highly processed foods are associated with addictive-like eating. Rats with a propensity towards binge eating exhibit addictive-like behavior in response to highly processed foods, such as Oreo Double Stuf cookies or frosting, but not to their typical chow [28,29]. Rats maintained on a diet of highly processed foods, such as cheesecake, exhibit downregulation in the dopamine system that also occurs in response to drugs of abuse [30]. Further, rats are motivated to seek out highly processed foods despite negative consequences (foot shock), which is another feature of an addiction [31]. Therefore, at least in animal models, overconsumption of highly processed foods, but not standard rat chow, appears to produce some addictive-like characteristics. This reinforces the idea that not all foods are likely to be equally associated with addictive-like eating behaviors.

Animal research has also investigated whether food attributes typically added to highly processed foods, such as sugar and fat, are particularly implicated in “food addiction.” In animals, it appears that sugar may be most associated with addictive-like eating [32]. Rats given intermittent access to sugar in their diet exhibit a number of behavioral indicators of addiction, such as binge consumption, tolerance, and cross-sensitization to other drugs of abuse [33]. When the sugar is removed from the diet or when an opiate antagonist is administered, rats experience signs of opiate-like withdrawal, such anxiety, teeth chattering, and aggression [33–35]. Sugar bingeing has been shown to increase mu-opioid receptor binding [36] in a similar manner to drugs of abuse [37,38]. Bingeing on sucrose produces a repeated increase of dopamine, rather than the gradual decline over time, which is a hallmark of addictive substances [39,40]. Thus, behavioral and biological evidence in animal models suggest that sugar may be an addictive agent in highly palatable foods.

The prevalence of obesity in the United States continues to increase, with more than 85% of adults projected to be overweight or obese by 2030 [1]. Health care costs associated with obesity currently comprise almost 10% of national health care expenditures [2] and are projected to increase to 15% over the next 15 years [1]. There has been little success at preventing excessive weight gain or developing weight loss treatments that are effective long-term [3]. Multiple causes contribute to the obesity epidemic, such as increased energy intake, increased availability and ease of access to foods, larger portion sizes, and decreased physical activity [4–6]. Although the causes of obesity are multifactorial, one potential contributing factor is the idea certain foods may be capable of triggering an addictive response in some individuals, which may lead to unintended overeating.

Gearhardt et al. [7] developed and validated the Yale Food Addiction Scale (YFAS), which uses DSM-IV criteria for substance dependence to quantify symptoms of addictive-like eating (see Table 1). “Food addiction” is characterized by symptoms such as loss of control over consumption, continued use despite negative consequences, and an inability to cut down despite the desire to do so [8]. Addictive-like eating has been associated with increased impulsivity and emotional reactivity, which are similarly implicated in substance-use disorders [9]. Thus, “food addiction” may share common behavioral attributes with other addictive disorders. Neuroimaging studies have also revealed biological similarities in patterns of reward-related dysfunction between “food addicts” and substance-dependent individuals. Individuals endorsing symptoms of “food addiction” exhibit increased activation in reward-related regions (e.g., striatum, medial orbitofrontal cortex) in response to food cues, consistent with other addictive disorders [10]. Further, higher scores on the YFAS have been associated with a composite genetic index of dopamine signaling [11]. This multilocus genetic profile has been related to dopamine signaling capacity, which may also be a risk factor for addictive disorders [12,13].


However, rats bingeing on sugar do not experience an increase in body weight [38]. Thus, fat may also be an important food attribute for addictive-like eating, but through different mechanisms. Bingeing on fat-rich foods (e.g. shortening) is associated with an increase in body weight but may not result in opiate-like withdrawal symptoms [39]. One explanation is that fat may alter effects on the opioid system or enhance the palatability of the food [38,39]. Interestingly, when rats binge on highly processed foods high in both sugar and fat, they experience changes in the dopamine system akin to drugs of abuse but do not exhibit signs of opiate-like withdrawal [32]. This suggests that sugar and fat may both play important, yet distinct, roles in the addictive potential of highly processed foods.

Little is known about how these food characteristics might result in addictive-like eating in humans. Given the findings in animals, highly processed foods may be more likely to be consumed in an addictive manner. For drugs of abuse, processing may increase a substance’s addictive potential (e.g. processing grapes into wine) by elevating the dose, or concentration, of the addictive agent and expediting its rate of absorption into the bloodstream. Applying this logic to food attributes, it may follow that refined carbohydrates (e.g., sugar, white flour) and fat are important contributors to addictive-like eating. However, it is not just the presence of these nutrients, as they also appear in naturally occurring foods. Rather, the addictive potential of a food is likely to increase if the food is highly processed to increase the amount, or dose, of fat and/or refined carbohydrates and if the refined carbohydrates are absorbed into the bloodstream quickly (high GL). An essential next step in the consideration of “food addiction” is to determine which foods or food attributes pose the greatest risk in the development of addictive-like eating behaviors in humans.


FDA suggests limiting lead found in lipstick, shampoo

The Food and Drug Administration issued new draft guidance Thursday suggesting a limit on the amount of lead contained in cosmetics that are marketed in the United States. The FDA suggested a maximum amount of 10 parts per million for lead in lipsticks, lip glosses and lip liners, as well as externally applied cosmetics including eye shadows, blushes, body lotions and shampoo.

The guidance, which is a suggestion, not a requirement, does not apply to hair dyes that contain lead acetate as an ingredient or to topically applied products, Fox 6 Now reported.

“Although most cosmetics on the market in the United States generally already contain less than 10 ppm of lead, a small number contained higher amounts, and we are aware that some cosmetics from other countries contain lead at higher levels,” the FDA said on its website.

The guidance states that current laws don’t require cosmetic products or ingredients, other than color additives, to have FDA approval before they hit the market, and it doesn’t require cosmetic firms to share safety data with the agency.

According to the U.S. Environmental Protection Agency, Lead is a naturally occurring element found in small amounts in the earth’s crust. While it has some benefits, it can be toxic to humans and animals causing health issues. Exposure to lead can cause cardiovascular effects, kidney issues and reproductive issues in children. Lead exposure in pregnant woman could cause premature birth or reduced growth of the fetus.


Why Big Health Systems Are Investing in Community Health

by Taz Hussein and Mariah Collins
Harvard Business Review

The quest to contain health costs while improving the quality of care typically focuses on service delivery, such as reducing unnecessary or harmful medical procedures. But changes in health care financing are pushing some health systems to take a more holistic approach and address social factors that directly impact patients’ health. Think of it as the “community cure” for health care.

The rationale for thinking outside the clinical setting is compelling. According to a recent Robert Wood Johnson Foundation study, only 20 percent of the factors that influence a person’s health are related to access and quality of health care. The other 80 percent are due to socioeconomic, environmental, or behavioral factors –including unhealthy housing, poor diet, inadequate exercise, and drug and alcohol use.  As federal and state reforms prod payers to move away from traditional fee-for-service—which pays for volume, not outcomes—and toward a pay-for-performance model that rewards keeping people healthy, the economic argument for addressing social determinants of health becomes clear.

Poverty, for example, is associated with an increased prevalence of asthma; homelessness drives up emergency-room visits; and urban “fresh-food deserts” where it’s hard to find affordable, nutritious foods stoke the incidence of type 2 diabetes.

Doctors are adept at treating us when we’re sick, but not at keeping us well. But the U.S. health care system has been slow to move beyond pills and procedures. Only a handful of pioneers have begun to address patients’ “upstream” social needs to improve their health and reduce costs.

Kaiser Permanente Southern California is one such organization. Kaiser, one of the nation’s largest managed-care organizations, has found that just 1 percent of its patient population accounts for approximately 25 percent of its annual medical costs and that these costs are often related to social and behavioral issues that drive the need for care.

To address those factors—challenges around diet, housing, hygiene, and other issues—KP Southern California has teamed up with Health Leads, a national nonprofit that places volunteers at “family help desks” in outpatient clinics, emergency rooms, newborn nurseries, and health centers, where they collaborate with physicians, social workers, and other care providers to screen patients for a range of needs and connect them to community resources and social services. One of Health Leads’ first assignments from Kaiser was to work with high-cost diabetes patients, more than half of whom had two or more social needs—such as for better housing or counseling—a prevalence much higher than Kaiser expected. While it’s too soon for conclusive results from this effort, Health Leads’ program at Massachusetts General Hospital in Boston has contributed to improved cholesterol and blood pressure levels among adult patients.

While Health Leads helps patients cope with a variety of health-related social issues, ProMedica in northwest Ohio and southeast Michigan has chosen to focus its attention on the health effects of hunger and poor nutrition. ProMedica, which serves 1.5 million people, decided to act after a study showed that a large proportion of patients subsisted on low-cost junk food diets—things like pizza, tacos, chips, and soda. As a result, they suffered higher-than-average rates of obesity, diabetes, heart disease, and back issues.

ProMedica now screens all patients for hunger and poor nutrition. “When you look at poverty, there are so many [overwhelming] issues—education, crime, underemployment, and so on,” said Randy Oostra, ProMedica’s president and CEO. “But hunger [and malnutrition] was something we could get our arms around. We can screen every single patient we touch for hunger.”

In the program’s first nine months, the organization screened nearly 36,500 patients and found 1,500 (4.1 percent) suffered from chronic hunger. To address this problem, ProMedica is setting up a number of food “pharmacies” (essentially on-site food pantries) for low-income patients, offering nutrition counseling, and opening a supermarket in a low-income area that previously had none.

For others to follow, pioneers pursuing the “community cure” for lower costs and better care know they shoulder the burden of proof. For its part, Kaiser is measuring results by looking at factors like use of health care services, total cost of care, health outcomes, and patient satisfaction. Since its effort focuses on the highest users of care—the top 1 percent—there is some hope that it can demonstrate cost savings reasonably quickly. With its food and nutrition initiative, ProMedica is not counting on short-term cost impact. Rather, it is laying the groundwork for estimating return on investment by doing research to establish patients’ current experience with hunger, quality of life indicators, and medical care, as well as the cost of that care for a sample of patients.

Optimism about what the evidence will show led Kaiser and Health Leads to convene leaders from a dozen US health systems last year to explore what role their organizations should play in addressing social needs. And ProMedica—working with the AARP Foundation, the American Hospital Association, and others—has started the national Root Cause Coalition to engage health care systems, businesses, nonprofits, and government in tackling hunger and food insecurity.

The health care leaders we talked to believe their efforts will have an impact on the bottom line, both in terms of cost and patient health. “At the end of the day, health care executives have to run the business,” said Dr. Ross Wilson, chief medical officer of NYC Health + Hospitals, a public system that serves roughly 1.4 million people. “If the work on social needs reduces utilization and emergency department visits, you start to find a business model that is effective.”


Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention

Numerous randomized trials and observational studies have demonstrated a direct relationship between dietary sodium intake and blood pressure (1,2). Although the effect is strongest among those with hypertension (3), there is also a smaller but consistent effect of lowering sodium on blood pressure among those with high normal or pre-hypertensive blood pressure levels. The DASH-Sodium (Dietary Approaches to Stop Hypertension) trial, a dose-response trial with 3 levels of sodium intake, found a significant direct relationship between sodium intake and blood pressure levels that was evident among subjects both with and without hypertension (4). A recent Cochrane meta-analysis of data from 35 trials (1) found that a 100 mmol reduction in 24-h urinary sodium led to a reduction in systolic/diastolic blood pressure of 5.4/2.8 mm Hg among hypertensive individuals and 2.4/1.0 mm Hg among normotensive individuals.

How well this blood pressure reduction translates into a beneficial effect on incidence of cardiovascular disease (CVD) and particularly on total mortality remains controversial. A report from the Institute of Medicine in 2013 (5) found that there was a link between excessive sodium intake and risk of CVD, particularly for stroke. However, that report also found that the evidence for the effects of sodium intake below 2,300 mg/24 h was inconsistent and inconclusive. Few studies have available data in this range of sodium, and several that did report outcomes associated with these levels suffered from limitations due to reverse causation, possible confounding, and measurement error (6).

Since that report, additional observational studies (7,8) and a meta-analysis (9) have reported an increase in cardiovascular disease and mortality among those at the lowest levels of sodium intake, suggesting a U-shaped relationship between sodium and health outcomes. In contrast, data from 10 to 15 years of post-trial follow-up in TOHP (Trials of Hypertension Prevention) participants identified a direct linear relationship between average sodium excretion and CVD down to the lowest levels of intake (10). Unlike other reports, this last study used a gold-standard assessment of sodium intake based on the mean of several 24-h sodium excretions accrued over 1.5 to 4 years of exposure ascertainment. In the current paper, we report the relationship between sodium intake and total mortality during more extended follow-up through 2013, for a total of 23 to 26 years. We include results from analyses based on both the exploration of later effects of the randomized sodium reduction interventions in the TOHP trials and the observational relationship between average 24-h sodium excretion in those who were not randomized to an active sodium intervention.


Snickers maker criticizes industry-funded paper on sugar

Mars Inc., the maker of Skittles and M&M's, is breaking ranks with other food companies and denouncing an industry-funded paper that says global recommendations on limiting sugar are based on weak evidence.

The paper drew criticism this week because it was paid for by a group whose members include Coca-Cola, Hershey, Red Bull and Oreo cookie maker Mondelez.

Mars — which is also a member of the group, the International Life Sciences Institute — said Wednesday the paper undermines the work of public health officials and makes all industry-funded research look bad.

Company spokesman Matthias Berninger said the study, published by the Annals of Internal Medicine, creates more doubt for consumers rather than helping them make better choices.

Emails obtained by The Associated Press show two Mars executives were copied on discussions about the research project last year. But Berninger said Mars was not a driving force for the paper and would make clear to ILSI from now on that it does not support such work.

The situation highlights the potential for conflicts of interest in nutrition science. Critics say the nature of nutrition research leaves the door open for companies to cherry-pick projects that make their products seem healthy, or cast doubt on science that suggests they fuel obesity.


Notably, one of the paper's criticisms was the lack of transparency about possible conflicts of interest by those developing sugar guidelines. That's even though one of the paper's co-authors previously received funding that was not disclosed.

Joanne Slavin, a professor at University of Minnesota who helped write the study proposal, did not list that she received a $25,000 grant from Coca-Cola in 2014. When contacted by the AP, the Annals of Internal Medicine said it was looking into publishing a correction.

Christine Laine, editor-in-chief of the journal, said that grant should have been disclosed, especially since the author disclosed a grant from the Mushroom Council. Laine said she always tells researchers to err toward providing too much information, since it could otherwise "look like you're trying to hide something."

Slavin told The Associated Press she did not disclose some of her funders for reasons including differences in how money can be allocated. She said the Coca-Cola grant came through the university's foundation and such funding is not typically subject to disclosure.

She said she planned to file a new disclosure including the Coca-Cola grant and funding from Quaker Oats owner PepsiCo for an oatmeal study.

"What I'm going to do is list everybody who's funded our research in the last five years in any way, and I hope people aren't mad," Slavin said.

Slavin had also worked on a paper on sugar guidelines in 2012 funded by ILSI. That paper was co-authored by an employee of the group, with feedback from a Coca-Cola executive and others, according to emails obtained by the AP through a public records request. Slavin said she would list the grant for the first ILSI paper in her new filing.

Also in 2012, Slavin presented a session for dietitians sponsored by Coke and Pepsi called "The Confusing World of Dietary Sugars" at an event held by the Academy of Nutrition and Dietetics. A slide for the presentation concluded that efforts to "micromanage" diets by imposing strict dietary rules are difficult to support with science.

Slavin said she did not collaborate with the companies on the talk or receive compensation other than travel reimbursement. Emails obtained by the AP show she inquired afterward about an honorarium, apart from travel expenses, and was told the usual amount was $2,000. But Slavin told the AP she did not have a record of the money being paid.


Friday, December 23, 2016

Serum GGT activity as a marker of exposure to POPs and diabetes risk

Effects of the Dietary Detoxification Program on Serum γ-glutamyltransferase, Anthropometric Data and Metabolic Biomarkers in Adults

Persistent Organic Pollutants (POPs) are well-known environmental contaminants including polychlorinated bisphenyls (PCBs) and organochlorine pesticides (OCPs). These chemical compounds bioaccumulate in adipose tissue and come into toxins in body [1–3]. Furthermore, POPs have long-lasting adverse effects in our body from food chains. POPs increase reactive oxygen species (ROS), and lead to cell inflammations and oxidative stress [4–6]. It has been documented that POPs are associated with chronic diseases such as cancers, cardiovascular diseases, neuro-degenerative disease, and respiratory diseases [7,8]. Particularly, there are emerging evidences that these xenobiotics alter metabolic mechanism and elevate insulin resistance. It can be resulted in obesity, dyslipidemia, and type 2 diabetes [9–14]. In other words, POPs aggravate many chronic conditions through ingestion, and respiration. To our healthy life, it is important to reduce accumulating chemical agents in the human body.

Unfortunately, people are consistently exposed to various chemicals and these compounds accumulate in our body for several decades [15]. Accordingly, it is vital to avoid chemical materials exposure as well as to remove from the body. However, few studies on reducing POPs effectively from the body have been found in the literature. Traditionally, detoxification, toxin elimination intervention, has become well-used therapy to clean of intestine, alleviate toxic symptoms and lose weight [16]. As the pathway of removal of chemical agents is through urine and fecal elimination, detoxification approach diverse methods using fasting, laxatives and enzyme for specific period [1]. Though, it is preferable to natural methods than strict calorie restriction, intestine cleansing and using certain food or enzyme to discard noxious chemicals for health. As foods are the major sources of human toxic pollutants, detoxification intervention is an effective way of intaking foods containing lower POPs and decomposing toxin from the body naturally [17]. Therefore, we developed an integrated dietary and education program for toxin elimination.

Although these extensive therapies widespread utilizing remove toxins, it is controversy on effects and remedies of detoxification [1,18]. Since physiological biomarkers which reflect body toxin level and objective outcome indicators were not measured, it is insufficient to prove the effects of intervention to remove toxins [18]. Thus, physiological indicators which confirmed to body’s toxin level are necessary to measure the outcomes. It is widely established that serum γ-glutamyltransferase (GGT) is a biomarker of alcohol consumption, heart disease, hypertension and type 2 diabetes [19–21]. In addition, several studies suggested that increased GGT within its normal range can be predicted environmental pollutants [22,23]. Glutathione as an antioxidant combine xenobiotics intracellular and move toward extracellular to metabolite (phase II). GGT which located in cell membrane get involved in glutathione activities which conjugated various environmental pollutants [24]. Thus, the overall burden of toxicants can measure by GGT. Considering numerous synthetic chemicals to which we are exposed, measuring of certain manufactured materials does not understand to identify accumulating toxins in human body.

As environmental pollutants bioaccumulate in fatty tissue, it is essential to investigate the relationship between serum GGT and body fat indicators. Therefore, the present study was conducted to explore the effects of dietary detoxification program on serum GGT, weight, body fat percentage, body fat mass, waist circumference, lipid profiles, blood pressure and fasting blood glucose in adults.

J Lifestyle Med. 2016 Sep;6(2):49-57. Epub 2016 Sep 30.
Effects of the Dietary Detoxification Program on Serum γ-glutamyltransferase, Anthropometric Data and Metabolic Biomarkers in Adults.
Kim JA1, Kim JY2, Kang SW3.


Serum GGT activity as a marker of exposure to POPs

Serum GGT activity as a cumulative exposure marker for various xenobiotics

Although the aforementioned study on Korean men [1] revealed much lower serum GGT activity than that observed in CARDIA and FinMONICA participants [2, 3], there was a striking secular trend in serum GGT [15]. After statistical adjustment, we concluded that the secular trend was not caused by changes in health behaviours or obesity, suggesting that other environmental factors play a role.

Another avenue of thought arose from the observation that serum GGT demonstrated dose–response relationships with blood concentrations of lead and urinary levels of cadmium [16]. This work brought into focus the important function of GSH as a conjugating ligand for the phase II reactions that occur during xenobiotic metabolism. Many xenobiotics are eliminated from cells by phase I biotransformation, followed by phase II conjugation to an anionic group, such as GSH, and transportation into the extracellular space [17]. The first necessary step for further metabolism of GSH conjugates is to break γ-carboxyl linkage of GSH by cellular GGT (Fig. 1, right of the dotted line) [18]. Thus, GGT activity may increase with an increased exposure to xenobiotics, including environmental pollutants, which require conjugation with GSH [17]. Our updated viewpoint on serum GGT as a marker of exposure to xenobiotics is a more comprehensive interpretation, which includes our earlier proposal that serum GGT reflects oxidative stress. Exposure of cells to xenobiotics directly increases the production of ROS [19]. ROS are also conjugated with GSH [17], and consumption of GSH by conjugation with xenobiotics is related to the depletion of intracellular GSH [17]. Based on these propositions, we hypothesised that the associations between serum GGT activity and type 2 diabetes might be explained by exposure to environmental pollutants.

Serum GGT activity as a marker of exposure to POPs

For our hypothesis to be true, the environmental pollutants involved have to satisfy several conditions. First, human exposure to the presumed xenobiotics should be through food consumption, most likely meat. For example, the Korean secular trend of increasing serum GGT activity was similarly observed among all subgroups stratified by various factors, such as age, sex, smoking, alcohol drinking, obesity or job category [15], suggesting some common environmental exposures, such as food. Indeed, serum GGT was positively associated with meat intake in the CARDIA dataset [20]. Second, the xenobiotics should be associated with adipose tissue, because serum GGT activity is strongly associated with obesity. Considering the importance of adipose tissue in the pathogenesis of type 2 diabetes, pollutants stored in adipose tissue could be important. Third, the xenobiotics should be metabolised by GSH conjugation.

Following this logic, POPs, endocrine disruptors stored in adipose tissue, represented the most plausible candidate. POPs include hundreds of different chemical compounds with common properties, such as long-term persistence in the environment and bioaccumulation through the food chain. POPs are detectable in virtually everyone, with exposure occurring through fatty animal food in particular [21]. Some POPs are conjugated to GSH for their metabolism [22–24], and exposure to high amounts of certain POPs in occupational or accidental settings increase serum GGT activity [25, 26].

We tested this hypothesis in the NHANES dataset and found graded associations between serum concentrations of POPs and serum GGT [27]. We also found strong dose–response relationships between POPs and the prevalence of type 2 diabetes [28]. Parallel to the interactions of obesity and diabetes with serum GGT activity, the association between POPs and type 2 diabetes was stronger among obese persons, but type 2 diabetes was nearly absent, irrespective of obesity when POPs concentrations were very low [28]. This observation led us to hypothesise that POPs stored in adipose tissue might be more critical than obesity itself to understanding the pathogenesis of type 2 diabetes.

The studies described above focused on type 2 diabetes risk, reflecting our original hypothesis. However, serum GGT activity within its normal range has also been shown to prospectively predict other clinical outcomes [29–33]. Similarly, in the NHANES dataset, serum POP concentrations were positively associated with the prevalence of the metabolic syndrome, insulin resistance, hypertension, and cardiovascular diseases [34, 36].

Mitochondrial dysfunction has recently emerged as a mechanism unifying the pathogenesis of insulin resistance and type 2 diabetes [37]. Interestingly, it has long been reported that POPs can decrease mitochondrial oxidative capacity in various organs [38, 39]. Even though POPs are mainly stored in adipose tissue, physiological fatty acid release from adipose tissue between meals may be accompanied by some release of POPs, and they may keep redistributing to various organs, such as muscle, liver, or pancreas, even under normal physiological control of adipose tissue [40]. Furthermore, the lipolytic potential of some POPs may disturb normal adipose tissue metabolism and lead to an excessive release of POPs [41]. Thus, continuous chronic exposure to POPs may diminish mitochondrial function in various organs, eventually leading to insulin resistance and type 2 diabetes.

Diabetologia. 2008 Mar;51(3):402-7. Epub 2007 Dec 11.
Can persistent organic pollutants explain the association between serum gamma-glutamyltransferase and type 2 diabetes?
Lee DH1, Steffes MW, Jacobs DR Jr.


What Are Advanced Glycation End Products (AGEs)?

By Mary Jane Brown, RD

Overeating and obesity are known for causing serious health problems. They increase your risk of developing insulin resistance, diabetes and heart disease (1).

However, studies have found that advanced glycation end products (AGEs) may also have a powerful effect on your metabolic health — regardless of weight.

AGEs are harmful compounds. They accumulate naturally as you age and are created when certain foods are cooked at high temperatures.

This article explains all you need to know about AGEs, including what they are and how you can reduce your levels.

Person Taking a Roasted Chicken out of the Oven, Large

What Are AGEs?

Advanced glycation end products (AGEs) are harmful compounds that are formed when protein or fat combine with sugar in the bloodstream. This process is called glycation (2).

AGEs can also form in foods. Foods that have been exposed to high temperatures, as in grilling, frying or toasting, tend to be very high in these compounds.

In fact, diet is the biggest contributor of AGEs.

Luckily, your body has ways to eliminate these harmful compounds, including with antioxidants and enzymes (3, 4).

Yet when you consume too many AGEs, or too many form spontaneously, your body cannot keep up with eliminating them and they will accumulate.

While low levels are generally nothing to worry about, high levels have been shown to cause oxidative stress and inflammation in the body (5).

High levels have been linked with the development of many different diseases, such as diabetes, heart disease, kidney failure, Alzheimer’s and even premature aging (6).

Furthermore, people who have high blood sugar levels, such as diabetics, are at a higher risk of producing too many AGEs, which can then build up in the body.

Because of this, many health professionals are calling for AGE levels to become a marker of overall health.

Bottom Line: AGEs are compounds formed in the body when fat and protein combine with sugar. When they accumulate in high levels, they increase the risk of developing many different diseases.

Modern Diets Are Linked to High Levels of AGEs

Modern diets are linked to AGEs building up in the body.

This is mostly due to popular methods of cooking that expose food to dry heat.

These include barbecuing, grilling, roasting, baking, frying, sautéing, broiling, searing and toasting (7).

These cooking methods may make food taste, smell and look good, but they raise AGEs to dangerous levels (8).

In fact, dry heat causes AGE formation to increase by 10 to 100 times the levels in uncooked foods (7).

Certain foods, such as animal foods high in fat and protein, are more susceptible to AGE formation during cooking (7).

Foods highest in AGEs include meat (especially red meat), certain cheeses, fried eggs, butter, cream cheese, margarine, mayonnaise, oils and nuts. Fried foods and highly processed products also contain high levels.

So even if your diet appears reasonably healthy, you may consume an unhealthy amount of harmful AGEs just because of the way your food is cooked.

Bottom Line: AGEs can be made inside the body during digestion, or can be consumed in the foods you eat. Certain cooking methods can cause their levels in food to skyrocket.

When AGEs Accumulate, They Can Seriously Damage Health

The body has natural ways of getting rid of harmful AGE compounds.

However, if you consume too many AGEs in your diet, they’ll build up faster than your body can eliminate them. This can affect every part of the body, causing serious health problems.

In fact, high levels are associated with the majority of chronic diseases seen today.

These include heart disease, diabetes, liver disease, Alzheimer’s, arthritis, kidney failure and high blood pressure, among others (9, 10, 11, 12).

One study examined a group of 559 older women and found those with the highest levels of AGEs in the blood were almost twice as likely to die from heart disease than those women with the lowest levels (11).

Another study found that among a group of obese individuals, those with metabolic syndrome had higher blood levels of AGEs than those who were obese but had no other health issues (13).

Women with polycystic ovary syndrome, a hormonal condition where the levels of estrogen and progesterone are out of balance, have been shown to have higher levels of AGEs in their bodies than women without the condition (14).

What’s more, a high consumption of AGEs through the diet has been directly linked to all of these chronic diseases (5, 15).

This is because AGEs easily bind with receptors on many different cells. This damages the cells and promotes oxidative stress, the production of free radicals that can damage all cells, causing inflammation (16, 17, 18).

High levels of inflammation over a long period of time can cause damage to every organ in the body (19).

Bottom Line: AGEs can build up in the body, causing oxidative stress and chronic inflammation. This increases the risk of many different diseases.

Low-AGE Diets May Improve Health and Reduce the Risk of Disease

Findings from both animal and human studies suggest that limiting dietary AGEs helps protect against many diseases and premature aging (20).

Several animal studies have shown that eating a low-AGE diet results in lower levels of AGEs in blood and tissues by up to 53%, plus a lower risk of heart and kidney disease, as well as increased insulin sensitivity (21, 22, 23, 24, 25).

Similar results were found in humans. Restricting dietary AGEs in patients with diabetes or kidney disease, as well as in healthy people, reduced markers of oxidative stress and inflammation (26, 27, 28).

A one-year study gave 138 obese people a low-AGE diet. Participants benefited from increased insulin sensitivity, a modest decrease in body weight, lower AGE levels and lower levels of oxidative stress and inflammation (29).

Those in the control group, on the other hand, followed the regular-AGE diet. They consumed more than 12,000 AGE kilo units per day. AGE kilo units per liter (kU/l) are the units used to measure AGE levels.

By the end of the study, they had higher AGE levels and markers of insulin resistance, oxidative stress and inflammation (29).

Although a reduction in dietary AGEs has been shown to have clear health benefits, there are no guidelines for safe and optimal intake just yet (7).

Bottom Line: Limiting or avoiding dietary AGEs has been shown to reduce levels of inflammation and oxidative stress, meaning a lower risk of developing other chronic diseases.

So How Much Is Too Much?

The average AGE consumption in New York is thought to be around 15,000 AGE kilo units per day, with many people consuming much higher levels (7).

Therefore, a high-AGE diet is often referred to as anything significantly above 15,000 kilo units daily and anything well below this is considered low.

To get a rough idea of whether you’re consuming too many AGEs, have a look at your diet. Do you regularly eat grilled or roasted meats, solid fats, full-fat dairy and highly processed foods? If so, you’re probably consuming fairly high levels of AGEs.

On the other hand, if you eat a diet rich in plant foods such as fruit, vegetables, legumes and whole grains, and consume low-fat dairy and less meat, AGE levels will likely be lower.

If you regularly prepare meals with moist heat, such as soups and stews, you’ll also be consuming lower levels of AGEs.

To put this in perspective, here are some examples of the amount of AGEs in common foods (7):

  • 1 fried egg: 1,240 kU/l
  • 1 scrambled egg: 75 kU/l
  • 2 ounces (57 grams) of toasted bagel: 100 kU/l
  • 2 ounces of fresh bagel: 60 kU/l
  • 1 tablespoon of cream: 325 kU/l
  • ¼ cup (59 ml) of whole milk: 3 kU/l
  • 3 ounces of grilled chicken: 5,200 kU/l
  • 3 ounces of poached chicken: 1,000 kU/l
  • 3 ounces of french fries: 690 kU/l
  • 3 ounces of baked potato: 70 kU/l
  • 3 ounces (85 grams) of broiled steak: 6,600 kU/l
  • 3 ounces of braised beef: 2,200 kU/l

Bottom Line: If you regularly cook foods at high temperatures or consume large amounts of processed foods, your AGE levels are probably too high.

Tips to Reduce Your AGE Levels

The good news is there are lots of things you can do to reduce levels of AGEs in the body. Here are some suggestions:

Choose Different Cooking Methods

The most effective way to reduce your intake of AGEs is to choose healthier cooking methods.

Rather than using dry, high heat for cooking, try stewing, poaching, boiling and steaming.

Cooking with moist heat, at lower temperatures and for shorter periods of time, all help keep AGE production low (7).

In addition, cooking meat with acidic ingredients, such as vinegar, tomato juice or lemon juice can reduce AGE production by up to 50% (7).

Cooking over ceramic surfaces rather than directly on metal can also reduce AGE production. Slow cookers are thought to be one of the healthiest ways to cook food.

Limit Foods High in AGEs

Fried foods and highly processed foods contain higher levels of AGEs.

Certain foods, such as animal foods, also tend to be higher in AGEs. These include meat (especially red meat), certain cheeses, fried eggs, butter, cream cheese, margarine, mayonnaise, oils and nuts (7).

Try to eliminate or limit these foods and instead choose whole, fresh and natural foods, which are naturally lower in AGEs.

For example, foods such as fruits, vegetables and whole grains have lower levels, even after cooking (7).

Eat a Diet Full of Antioxidant-Rich Foods

Kiwifruit and Other Fruits and Vegetables

In laboratory studies, natural antioxidants, such as vitamin C and quercetin, have been shown to hinder AGE formation (30).

Moreover, several animal studies have shown that some natural plant phenols can prevent the negative health effects of AGEs (31, 32).

One of these is the compound curcumin, which is found in turmeric. Resveratrol, which can be found in the skins of dark fruits like grapes, blueberries and raspberries, may also help (31, 32).

Therefore, a diet full of colorful fruits, vegetables, herbs and spices may help protect against the damaging effects of AGEs on the body.

Get Active

Aside from diet, an inactive lifestyle can cause AGE levels to skyrocket.

In contrast, regular exercise and an active lifestyle have been shown to reduce the amount of AGEs in the body (33, 34).

One study among 17 middle-aged women found that those who increased the number of steps they took per day experienced a reduction in AGE levels (33).

Bottom Line: Choosing healthier cooking methods, limiting foods high in AGEs, eating more antioxidant-rich foods and exercising regularly can all help reduce AGE levels in the body.

Take Home Message

Modern diets are contributing to higher levels of harmful AGEs in the body.

This is concerning, since high AGE levels are linked to the majority of chronic diseases you see today. The good news is that you can make choices to lower your levels.

Choose healthy, whole and fresh foods, healthier cooking methods and an active lifestyle to protect your health.


Thursday, December 22, 2016

Diabesity and the Microbiome - Filomena Trindade (A Functional Medicine Perspective)

Diabesity and the Microbiome by Filomena Trindade is a presentation that took place at Silicon Valley Health Institute on September 15, 2016.

Diabetes and obesity are global health conditions which are increasing. Adult obesity prevalence increased from 13 to 32% between the 1960s and 2004. Changes in obesity prevalence among children and teens tripled, from nearly 5% to approximately 15% since the 1960s. Currently, 66% of U.S. adults are overweight or obese. The incidence of diabetes is increasing and afflicting new populations including children and developing societies. Diabetes is occurring at younger ages and at lower BMI levels. It appears that both our understanding of the disease and our treatment of the disease are inadequate. Current approaches are not working.

Filomena Trindade, MD, MPH is an international sought after speaker in functional medicine. She is a graduate of the fellowship in Anti-Aging, Regenerative and Functional Medicine and teaches in the Fellowship (a master's program through the University of South Florida) as well as for the Institute of Functional Medicine (IFM).

After obtaining her BA degree in Biology she went on to finish a master's in Public Health in the area of environmental health and epidemiology before starting medical school. She graduated first in her class in family practice from the University of California Davis School of Medicine and
did her residency training in family practice at the U.C. San Francisco/Santa Rosa Program. She has been in clinical practice for over 16 years.

Before starting her own private practice in 2004 in functional medicine she was the medical director of a non-profit organization that catered to the under-served. She is currently very active in developing teaching programs in Functional Medicine in the USA, Latin America and Europe.

Dr. Bernstein’s Amazing Story

Diagnosed with type 1 diabetes in 1946 at the age of 12, Dr. Richard K. Bernstein never set out to be a doctor. Not only that but according to statistics from the American Diabetes Association, he should have been long dead by now.

That he is very much alive and, in fact, in excellent health, can be attributed to two primary causes. The first is that he was originally trained as an engineer and attacked his disease as a problem to be solved and not a condition to be treated. The second is that he was fortunate enough to still to be alive when the first blood glucose meters arrived on the scene.

He is the first diabetic ever to monitor his own blood sugars.

These facts combined with Dr. Bernstein’s sheer determination to solve the problem of diabetes led to his revolutionary method of blood glucose normalization, which he demonstrates in the groundbreaking, perennial bestselling book, Diabetes Solution.

In 1969, after following ADA guidelines for more than twenty years, Dr. Bernstein had many of the debilitating complications of the disease. Sick and tired of being at the mercy of his disease, he obtained one of the early blood glucose meters. Hardly the cheap and common instrument it is now, the device was intended for a very small and specialized niche: To help keep hospitals from inadvertently allowing comatose diabetics to die at night when their labs were closed, because a diabetic in a coma smells of ketones and can be easily mistaken for someone who has been drinking heavily.

Dr. Bernstein obtained one of the devices at the princely sum of about $700—today, based on inflation, that’s nearly $5,000. Dr. Bernstein used himself as a guinea pig and began testing his blood glucose throughout the day, hoping to discover what made it go up and down. After considerable trial and error, not to mention research, he discovered that he could normalize his blood glucose through diet, exercise and medication—and that he could help others do the same.

This was his elegant, landmark breakthrough: The only difference between a diabetic and a non-diabetic is high blood sugars. All of the complications of diabetes are caused by high blood sugars. Therefore, if you can normalize blood glucose, you can prevent the complications or make them go away, which is exactly what a cure would do.

Except that when the then-engineer Richard Bernstein tried to persuade the medical community that he had found the answer, the medical community roundly ignored him—even told him that it was impossible. So, in his mid-forties, he decided the leave his successful career in business and go to medical school.

Even when the first edition of his landmark Diabetes Solution came out in 1997, Dr. Bernstein was still battling established notions about diabetes treatment. That’s less true today, but it’s also less important today in the era of consumer-directed healthcare plans and readily available health information on the Web.

Today, many thousands of patients and readers later, Dr. Bernstein continues to see and train patients, maintains a busy schedule that includes a monthly question-and-answer teleconference, and continues to refine his cutting edge program of blood glucose normalization. He reaches more patients than he ever could have back when he first opened his practice—and slowly, too slowly perhaps, the standard of care has been changing to mirror his ideas.

The simple, straightforward program that is detailed in his book Diabetes Solution, is based in good nutrition, healthy exercise, and (where necessary) small doses of medication. Dr. Bernstein will show you what he has learned during his 69 years of living with Type 1 diabetes and how, through intense research and experimentation he developed his unique but simple plan which has helped countless diabetics. “It’s astonishing no one thought of it before,” he says. “Many in the field of diabetes care still do not accept it!” But those who follow the program stick with it for one reason: it works!

Developed almost completely outside the mainstream of diabetology, his low carbohydrate solution has helped patients of various ages and symptoms, young and old. Achieving normal blood sugars is not as difficult as one might believe, and he has included case studies of patients who have experienced dramatic improvements in their diabetes.

Perhaps you or your loved ones may already be suffering from some complications of diabetes, such as gastroparesis, heart disease, kidney disease, retinopathy, frozen shoulder, etc.


M2-PK: A simple new stool test could replace expensive, uncomfortable screening colonoscopy

"Good Bye Colorectal Cancer & Inflamed Gut: Eliminate the Risks of Intestinal Disease and Colonoscopy! - a presentation by Prof. Adiel Tel-Oren MD, DC, DABFM, DABCN, CCN, LN that took place at the Silicon Valley Health Institute on July 21, 2016.

This lecture will empower you with wonderful news about the Silent Killer:
– How to diagnose colorectal cancer really early, when reversal is easy?
– Avoid the lifelong suffering, disability, & risks of colorectal surgery!
– The rarely-discussed combined cause of colon cancer & simple solutions.
– Why are virtually ALL Western intestines inflamed & diseased?
– What can YOU do to fight the inflamed gut epidemic?
– Eliminate the fear of colon cancer without invasive and risky colonoscopies.
– What about the typical stool tests recommended by your “Health Plan”?
These and many other questions are answered in this fact-filled scientific discussion that can save and improve many lives, including yours.

Wednesday, December 21, 2016

20 States Accuse Generic Drug Companies of Price Fixing

The lawsuit, filed by Democratic and Republican attorneys general, portrays a close-knit circle of generic drug executives and sales representatives who regularly socialize at conferences and gatherings like golf outings, cocktail parties and "girls' night out" events in the New Jersey area, where many of the companies are based.

But the collegial relationships, while common in many industries, veered into more overt anticompetitive tactics, Mr. Jepsen, Connecticut's attorney general, said.

"It's very damning," he said. "It reveals a culture of cronyism where, whether it's over a game of golf or a dinner or drinks, there's just systematic cooperation."

He described the behavior as deliberate. "There's nothing hidden about it," he said.

In the case of doxycycline, the complaint says that in 2013 Heritage contacted Mylan, the only other maker of a delayed-release version of the product at the time, and told executives there that Heritage planned to release its own version. According to the complaint, Mylan agreed to "walk away" from at least one major wholesaler and one large pharmacy chain to allow Heritage to gain a foothold in the market. The complaint quotes from emails that are redacted in the publicly available version and that the suit says show how Mylan and Heritage executives hammered out the details.

When a third competitor, Mayne, planned to enter the doxycycline market in 2014, it contacted Heritage and Mylan to negotiate details of how prices would be set and customers would be allocated, the suit says.