Seven Myths About Cholesterol

By Dr. Ebanks | Published: January 31, 2010

Most people today think they know what cholesterol is, where it comes from, and what it does.  If you follow the popular media or most diet books, cholesterol is a deadly poison that comes from food which clogs arteries and causes heart attacks.  Like most things having to do with the human body, however, the role of cholesterol is much more complicated than this simple picture suggests.  In fact, all these assumptions are so oversimplified that they are flat-out wrong.

Myth #1: Cholesterol has no beneficial effects

The most basic misconception is that cholesterol is some sort of toxic substance that has only negative effects on the body.  Nothing could be further from the truth.  In fact, most of the cholesterol circulating in your blood is actually produced by the body instead of being derived from your food.  It is a necessary component of cell membranes and a precursor for many hormones.  It also plays a role in digestion in the synthesis of bile acids.

Cholesterol is synthesized in the liver and intestines from a substance called Acetyl-Coenzyme A (or Acetyl-CoA).  Acetyl-CoA is vital to aerobic respiration, helping extract energy from food.  All cell membranes contain cholesterol, where it regulates their flexibility and viscosity.  Cholesterol also helps regulate the passage of material across the membrane.  On the one hand, it reduces cell membrane permeability to various charged ions, while on the other it is part of the active transport mechanism that incorporates certain large molecules into cells. 

Many hormones use cholesterol as a precursor.  The body uses cholesterol as the raw material for all steroid hormones.  Steroid hormones are involved in an enormous variety of signaling pathways in the body.  Hormones like aldosterone and cortisol regulate blood pressure, blood volume and stress responses.  The primary female sex hormones, estrogens and progesterone are also derived form cholesterol, as are the male sex hormones, testosterone and dihydrotestosterone.  It can also be converted by enzymes into vitamin D.

In addition to all these effects, the liver converts cholesterol to bile, which is necessary for digestion.  Bile makes fats in food soluble and aids in the absorption of fat by the intestines.  Bile is also necessary for the absorption of the fat-soluble vitamins, including vitamins A, D, E and K. 

Myth #2: People with high cholesterol have short lives

The idea that high cholesterol can shorten lives is based on the erroneous assumption that people with elevated cholesterol inevitably develop cardiovascular diseases and therefore die earlier than others.  The reality is that high cholesterol has effects that vary by person and this assumption has not been demonstrated. 

One meta-analysis of many different studies showed that studies which did not support a link between high cholesterol and high mortality have been systematically under-reported and ignored[1].  In some studies, groups that had cholesterol-lowering intervention had higher mortality than control groups.  This may be either due to possible beneficial effects of cholesterol[2] or it may be due to the side effects of the medications used to control cholesterol[3].  The side effects of statins, the drugs most often used to control cholesterol levels can be serious, and need to be balanced with the potential benefit of lowering cholesterol.  Some of these side effects include serious problems like muscular damage, liver damage, and kidney failure, especially when a statin is used with certain other medications[4].

Myth #3: High cholesterol causes heart disease

Cholesterol and heart disease are commonly linked, and have been ever since the discovery of the disease atherosclerosis.  “Athero-”refers to a soft gruel-like deposit and “sclerosis” means the process of becoming hardened, so the term indicates soft deposits are first laid down in a place they shouldn’t be (like the artery walls) and then become hardened over time.  The term “arteriosclerosis,” which literally means “hardened arteries,” is often used interchangeably.

Cholesterol crystals are often found at the center of the plaques that form in atherosclerosis.  This has been taken to indicate that high blood cholesterol causes these plaques, in turn causing narrowing of the arteries and eventually leading to complete blockage and heart disease. 

The difficulty is that studies are not demonstrating that these changes are due to high cholesterol levels.  The concentration of cholesterol in the blood is not associated directly with heart disease in people with family histories of high cholesterol[5].  In one study, in fact, those with the highest cholesterol levels had the lowest risk of heart disease[6].

Emerging evidence implicates chronic inflammation in the etiology of cardiovascular disease.  According to the American Heart Association, “high-sensitivity C-reactive protein (hs-CRP) levels are an independent marker of cardiovascular disease risk.”[7]  And, elevated homocysteine levels were associated with increased risk for mortality in patients with coronary artery disease.[8]

Myth #4: Cholesterol levels are an accurate measure of heart disease

Talking about your cholesterol count is now almost as common as discussing your golf score.  In both, the convention is that the lower the number, the better you are.  This assumption is again not demonstrated by the science.  Data from the landmark Framingham Heart Study revealed that the distribution of cholesterol levels among individuals that had a heart attack and those that did not essentially mirrored each other.  While cholesterol is involved to some degree in the development of arterial plaque, it alone is not the problem.

Most heart attacks occur in people who have “normal” cholesterol.  Using cholesterol as the predictor of a future heart attack is not even as good as flipping a coin.  In a very large study looking at the lipid numbers of more than 136,000 people admitted to hospitals with coronary artery disease, more than 70% of those individuals had LDL cholesterol numbers in the “normal” range, and 50% had numbers considered in an “optimal” range.[9]

Much more important than total cholesterol, HDL and LDL cholesterol are the various sub-particles.  Cholesterol is carried in the blood in a variety of different proteins.  Each of these particles contains cholesterol, triglycerides and lipoproteins.  HDL cholesterol (“good”) has different lipoproteins than LDL cholesterol (“bad”).  Within each class, the particles differ in size and density.  Simply measuring LDL tells nothing about the particle size or number.  The ability of cholesterol to penetrate the arterial lining is dependent on the amount of inflammation present, type of lipoprotein carrying it, the particle size and number rather than on the level of cholesterol in the blood.  Two of the most important sub-particles are: Apolipoprotein (apo) B, a component of LDL and apo A-1, a component of HDL.  Several international studies have concluded “the apo B/A-1 ratio was the most important risk factor” and its “predictive power is superior to…any other lipid parameter or ratio”.[10]

The best assessment of your risk for future heart attack is to measure the actual disease process, not just a surrogate marker.  In the past, this would have meant an invasive procedure like a coronary catheterization that carries a not inconsequential risk.  More recently calcium scoring by high speed CT scan has been promoted but there are concerns about the amount of radiation exposure.  What is one to do?  There is another option:  carotid intima-media thickness measurement using carotid ultrasound.  The value of this technology has been recognized by the American Heart Association, the American College of Cardiology and the American Society of Echocardiographers for the early detection of heart disease is asymptomatic individuals.  A study out of the Mayo clinics found CIMT superior to calcium scoring, concluding that “subclinical vascular disease can be detected by CIMT in young to middle-aged patients with a low Framingham Risk Score and a Coronary Artery Calcium Score of zero”[11]

Myth #5: Everyone should be on prescriptions to control cholesterol

This scenario would certainly provide considerable benefit to the financial balance sheets of pharmaceutical companies that make statin drugs, but the public health benefits are somewhat more dubious.  Statin drugs deplete coenzyme-Q10, which is central to cellular energy production and heart health.  They can also cause muscle pains and weakness, flu-like symptoms, liver dysfunction, peripheral neuropathy, cognitive impairments, total global amnesia and interfere with neuro-synaptic transmissions in the brain.

Although some statin drugs, most notably Lipitor, have been shown to lower heart attack risk and lower cholesterol, it is now believed that they are two independent effects.  The latest scientific information suggests that statins reduce heart attack risk by reducing silent inflammation; the same risk reduction mechanism attributed to fish oil, stress reduction and healthy lifestyles.  All of the latter do not carry the potential risk of statin side effects and are quite a bit less costly to implement.  Several studies comparing omega-3 fish oils to statins demonstrate significant reduction in all cause mortality in heart failure patients taking fish oil, but statins did not affect all cause mortality or cardiovascular admissions. 

One drug, Zetia, is not absorbed and lowers cholesterol in the gut.  It has no effect on blood vessels or systemic inflammation and has failed to demonstrate any effect on the progression of atherosclerosis.  Recent studies have shown participants taking Ezitimibe (active ingredient in Zetia and Vytorin) may actually have an increased risk for cardiovascular events by increasing carotid intima-media thickness.[12]

A recent pharmaceutical industry sponsored study concluded that giving Crestor to people with normal cholesterol reduced the risk of cardiovascular events by 50%.[13]  This reduction was attributed largely to the reduction of inflammation as measured by C-reactive protein.  This sounds impressive until one scrutinizes the raw data.  It turns out that the 50% percent risk reduction occurred in less than 3% of the study population.  In other words, there was no effect in more than 97% of participants.  Things that make you say: “Hmmm…”

Myth #6: “Zero-cholesterol, low-fat” foods are “heart healthy”

This is a myth that is heavily promoted by packaged food companies.  As mentioned, dietary cholesterol is not the source of most blood cholesterol.  By saying “low-fat” or “zero cholesterol” on the package, however, they hope to convince the consumer their product is good for your health and will protect your heart. 

Unfortunately, this can be a very poor assumption.  Typically low fat means increased carbohydrates; and frequently highly refined carbohydrates and simple sugars.  The heart disease epidemic in the US mirrors our obesity epidemic.  These modern phenomena coincide with the dramatic increase in the consumption of sugar and other highly refined carbohydrates.  This excessive carbohydrate diet leads to excess insulin production and insulin resistance, predisposes to type-2 diabetes and metabolic syndrome, reduces the size of LDL and HDL particles and results in increased inflammatory cytokines.  Reading the standardized “Nutrition Facts” label is always a more-accurate source of nutritional information than claims made on the package.

Myth #7: Eggs are bad for you

On the contrary, a special edition published in the American Journal of Clinical Nutrition contained nine separate articles demonstrating the importance of high quality protein in the diet to maintain a healthy body composition.  A major finding was that inadequate protein in the diet contributes to increased risks for obesity, muscle wasting (sarcopenia) and chronic diseases.   Eggs are a source of all natural and very high quality protein that keeps you satisfied longer.  More than half of the eggs protein is found in the yolk.

Another recent study reported in the European Journal of Nutrition followed a group of overweight but otherwise healthy adults given 2 eggs daily for 12 weeks while on a calorie restricted diet.  A control group followed the same diet but avoided eggs altogether.  Both groups lost the same amount of weight and had drops in their blood cholesterol levels.   Lead researcher, Dr. Bruce Griffen, stated, “There is no convincing evidence to link an increased intake of dietary cholesterol or eggs with coronary heart disease through raised cholesterol.  Indeed, eggs make a nutritional contribution to a healthy, calorie restricted diet.  We have shown that when two eggs a day are eaten by people who are actively losing weight on a calorie restricted diet, blood cholesterol can still be reduced”[14]

Does all this mean that cholesterol is a scam, or that it is perfectly OK to eat all the saturated fat one wishes?  No.  The bottom line is this: cholesterol is necessary for normal function by the body.  Blindly reducing cholesterol levels without actually assessing the risk is not a wise course of action.  Villifying cholesterol in general obscures the wide variety of biological responses for which it is essential.  While some patients with established or advance coronary artery disease can indeed benefit from reducing cholesterol, others may not, and pharmaceutical interventions are not without risk.  Having a doctor that can accurately determine the cardiac risk through measurements like carotid intima-media thickness (CIMT), sub-particle lipid profiles such as the VAP panel or LPP test, and inflammatory markers gives the best chance of having guided, targeted intervention with optimal results.  The Institute of Medicine estimates that more than 90% of all cardiovascular disease is preventable through appropriate lifestyle modifications.

[1] Ravnskov U. Cholesterol lowering trials in coronary artery disease: frequency of citation and outcome. BMJ. 1992;305(6844):15-19. 

[2] Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM. 2003 Dec;96(12):927-34.

[3] Langsjoen PH, Langsjoen JO, Langsjoen AM, Lucas LA. Treatment of statin adverse effects with supplemental Coenzyme Q10 and statin drug discontinuation. Biofactors. 2005;25(1-4):147-52.

[4] United States Food and Drug Administration. Information on Simvastatin/Amiodarone. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm118869.htm. Accessed 2010, Jan 4

[5] Miettinen TA, Gylling H. Mortality and cholesterol metabolism in familial hypercholesterolemia. Long-term follow-up of 96 patients. Arteriosclerosis. 1988 Mar-Apr;8(2):163-7.

[6] Hopkins PN, Stephenson S, Wu LL, et al. Evaluation of coronary risk factors in patients with heterozygous familial hypercholesterolemia. Am J Cardiol. 2001 Mar 1;87(5):547-53.

[7] Americna Heart Association Scientific Sessions, 2008

[8] Mager A, Orvid K, et al. Impact of Homocysteine-Lowering Vitamin Therapy on Long-Term Outcome of Patients With Coronary Artery Disease. Am J Card. Vol 104, (6), Pages 745-749 (15 September 2009)

[9] Sachdeva A, Cannon C, et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J, Jan 2009 111-117

[10] Yusuf S, Hawken S, Ounpuu S, on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.

[11] Carotid Intima-Media Thickness and Coronary Artery Calcium Score as Indications of Subclinical Atherosclerosis.  Mayo Clin Proc. March 2009 ; 84(3):229-233

[12] Tatlor A, Villines C, et al. Extended-release Niacin or Ezitimibe and Carotid Intima-Media Thickness. NEJM Nov 26, 2009 (22) Volume 361:2113-2122

[13] Ridker P, Danielson C, et al. Rosuvostatin to prevent vascular events in men and Women with Elevated CRP. NEJM Nov 20, 2008. (217) Volume 359:2195-2207

[14] Nicola L. Harman, Anthony R. Leeds and Bruce A. Griffin. Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss. European Journal of Nutrition. Volume 47, Number 6, September, 2008.

Posted in Heart Disease, Nutrition | Tagged , , , , , , | 4 Comments

Making Successful New Year’s Resolutions

By Dr. Ebanks | Published: January 1, 2010

new year'sAs we start 2010, and the battle for weight loss rages on, many will make the all too familiar New Year’s resolution to lose weight, exercise and get into better shape.  It is, after all, fairly common knowledge that obesity (particularly abdominal obesity), physical inactivity and smoking all increase the risks of developing chronic diseases and dying prematurely.  A recent study has even estimated the “combined health benefits” of eliminating those three risk factors; showing a 59% lower risk of cardiovascular event and a 77% lower risk of death from cardiovascular disease.[1]  Unfortunately, most do not accomplish their goals.  This is, in part because their goals are not attainable (losing too much weight in too short a period of time, or only for a vacation or particular event) or they do not have an organized plan.  So, that frequently means crash dieting or seeking a magic pill that doesn’t exist. 

 Crash dieting may sound like a good idea to some.  Just cut down your calories to near starvation amounts and you’ll lose weight.  Although eating insufficient calories may prompt some short term weight loss, these types of diets can be harmful to your body and health.  Usually, reducing calories to very low levels causes your body to miss out on much needed vitamins, minerals and other nutrients, which can lead to low blood pressure, sodium depletion, impaired immunity and even heart attacks.  Any weight loss is typically short lived, as severe calorie restriction is not sustainable.  Rapid, unhealthy weight loss through severe calorie restriction slows your metabolism which leads to greater weight gain than that lost once normal eating is resumed, or other adverse health complications.

 Turning to physicians does not always guarantee success.   Too many doctors merely prescribe a weight loss pill and advise their patients to eat better and exercise, but fail to provide the necessary guidance.  So what might be the key?  According to a recent studies, the answer could be as simple as providing lifestyle modification counseling.  In our December 2008 newsletter, I reported on the SYNERGIE[2] study that found greater success in reducing body fat and signs of metabolic syndrome in a lifestyle modification program that included supervised exercise and nutrition counseling.  Further supporting the benefits of individualized lifestyle modification counseling programs in achieving healthier body composition was a randomized study that showed high-frequency telephone contact with a dietitian led to the same weight loss as in-person contact and more weight loss than low-frequency contact, e-mail contact, or no contact.[3]  There is no dispute that the key to successful weight loss is a lifestyle change.  Per this study, that success may begin with something as simple as regular phone consultations to provide ongoing support and encouragement.  It is crucial that individuals receive some form of lifestyle modification counseling to achieve success.  The lack of it may contribute to failure.

 Nutrition is not about a single “perfect” diet.  These studies reflect the philosophy at Alternity Healthcare: providing superior patient care with ongoing support for success.  Under the supervision and guidance of Cassandra Forsythe, PhD, RD, we create customized nutrition programs that meet the individual needs of our patients, based upon the results of an extensive Comprehensive Health Assessment.  Proper nutrition can help stabilize insulin and blood sugar levels, reduce inflammation, boost your immune system and prevent illness and chronic diseases like type-2 diabetes[4], cardiovascular disease[5] and certain cancers.[6]

 Some safe tips to keep in mind when changing your eating habits:

 Choose low-glycemic foods

  • Focus on nutrient-dense foods
  • Incorporate more colorful fruits and vegetables
  • Eat lean meats and fish
  • Include healthy essential fats
  • Choose whole grains
  • Avoid sugars, preservatives and chemical additives

 Better yet, take the right step to optimize your health.  Call 860.561.2294 today to schedule your Comprehensive Health Assessment and see the NEW YOU in the New Year.

 

[1] Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking and normal waist girth on morbidity and mortality in men.  Arch Intern Med 2009; 169:2096-2101

[2]  Després JP on behalf of the SYNERGIE investigators. Lifestyle management of abdominal obesity and related cardiometabolic risk: the SYNERGIE trial. 77th European Atherosclerosis Society Congress; April 27, 2008; Istanbul, Turkey

[3] Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients: A Randomized Trial . Andres G. Digenio, James P. Mancuso, Robert A. Gerber, and Roman V. Dvorak Ann Intern Med February 17, 2009 150:255-262;

[4] Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes. Ann Intern Med September 1, 2009 5:306-314 

[5] Nutrition and cardiovascular disease.  Arterioscler Thromb Vasc Biol. 2007 Dec;27(12):2499-506. Epub 2007 Oct 22.

[6] Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity.  CA Cancer J Clin 2006; 56:254-281 doi: 10.3322/canjclin.56.5.254

Posted in Nutrition, Youthful Aging, obesity | Tagged , , , , , , , , , , , , , | Leave a comment

Endurance vs Interval Training

By Dr. Ebanks | Published: January 1, 2010

marathon vs sprintFor decades, most experts and public health agencies have advocated moderate intensity, long duration exercise to improve health and maintain body weight.  Despite that, more Americans are overweight or obese than ever.  And, cardiovascular disease is the leading killer of Americans.  Recently the Institutes of Medicine issued new recommendations urging all Americans to increase the duration of their exercise to at least one hour every day.  It is as if you are being told that all your health problems could be solved and your heart made stronger if you could only overcome your laziness and make yourself do enough of that boring drudgery. 

 One small detail that is overlooked is the number of “well conditioned” endurance runners that die suddenly at the heights of their careers.  In the 1970’s, Jimm Fixx claimed that the secret to heart health and long life was endurance running – up until he died of a heart attack – while running.   In the 1980’s, Jack Kelly (husband of grace Kelly) went out for his usual morning run and, shortly after, dropped dead of sudden heart failure. At the time, he was the president of the US Olympic Committee.

 Esimates from the American College of Cardiology’s 58th Annual Scientific Session showed the death rate for marathons was 0.8 per 100,000 participants.  Even if uncommon statistically, if you’re the one, it is 100% for you.  Just last year in the 2009 Detroit marathon 3 runners, aged 36, 65 and 26, collapsed and died suddenly toward the end of a half marathon.[1]  We shouldn’t forget what happened at the first ever marathon:  Phidippides ran 26.2 miles from marathon to Athens to report on the victory of the Greeks over the invading Persians.  When he arrived, he announced “Nike!” which means victory, then collapsed and died.  Is that really the model we want to emulate?

 Undoubtedly endurance running makes your heart more efficient, evidenced by the lower resting heart rate of well-trained athletes, but may impair its reserve capacity.  That is, the portion of its maximal output not used during routine activity.  Trading reserve capacity for greater efficiency at continuous duration may not be what you want.  Hear attacks do not occur for lack of endurance.  They occur when there is a sudden increase in cardiac demand that exceeds the heart’s capacity to supply blood and oxygen, such as heavy physical exertion, sex, shoveling snow or suddenly encountering unusual stress. 

A growing body of information reveals the varied detrimental effects of prolonged endurance exercise.   A study from Massachusetts General Hospital documented elevated markers of cardiac damage in runners following a marathon.[2]    Troponin, a protein found in cardiac cells and is a marker of cardiac damage was measured.  It is also used in emergency departments to determine whether heart damage occurred during a heart attack.  The runners all had normal cardiac function and no signs of troponin prior to the race.  Shortly after completing the event, 60% of the runners had elevated troponin levels; 40% high enough to indicate destruction of heart muscle cells. 

Another study documented increased inflammatory markers and markers of cardiac damage persisting more than 24 hours following a marathon.[3]  Several studies have also revealed that marathon runners have reduced bone mass[4]  Another study of male long-distance runners showed that they had lower levels of testosterone and higher levels of the stress hormone cortisol, and that these levels did not return to normal after a break in training.[5]

It is becoming clear that the real key to losing body fat, maintaining body composition and strengthening your heart is to exercise in shorter bursts at a higher intensity.

Patients who’ve had coronary artery bypass graft (CABG) surgery were found to get more long-term cardiac benefit from higher intensity aerobic interval training than from moderate continuous training.  In a recent Norwegian study, VO2 peak improved significantly between baseline and week 4 in the aerobic interval group (27.1 versus 30.4 mL/kg-1/min-1; p < 0.001). VO2 peak also improved with moderate continuous training (26.2 versus 28.5 mL/kg-1/min-1), but not to a statistically significant extent.  Between 4 weeks and 6 months, VO2 peak continued to improve in the aerobic interval training group, from 30.4 to 32.2 mL/kg-1/min-1 (p < 0.001). Again, the change in the moderate training group did not reach statistical significance (28.5 versus 29.5 mL/kg-1/min-1).  In fact, these data show that the 4 week improvement in VO2 in the interval training group was greater than that achieved in the moderate continuous training group after 6 months.[6]

Research carried out at the Physical Activities Science lab in Québec, Canada compared high intensity interval training (HIIT) to moderate intensity endurance training.[7]  The researchers calculated that the group doing long slow distance exercise burned more than twice as many calories while exercising than the group doing high intensity intervals. However, skinfold measurements showed that the HIIT group lost more subcutaneous fat. Even more interesting was the fact that when the difference in the total energy cost of the program was taken into account the subcutaneous fat loss was ninefold greater in the HIIT program than in the traditional long slow distance cardio program. What this means is the HIIT group got nine times more fat-loss benefit for every calorie burned exercising.  Moderate intensity endurance exercise burns a higher percentage of fat during exercise.  Compared to endurance exercise, high-intensity intermittent exercise causes more calories and fat to be burned following the workout.  Would you prefer the gaunt, frail appearance of a marathoner’s body or the robust, muscular physique of a sprinter?

If you have health problems or are overweight and not used to exercise you do need to build a traditional aerobic cardio base first. However, sticking religiously to the same long slow distance program flies in the face of scientific evidence. Once you have your aerobic base it is time to make the step up to interval training.  Providing the right exercise prescription, guidance and ongoing follow-up is imperative for safety and long-term success.  Every individual is different. 

At Alternity Healthcare, creating your customized program for exercise and lifestyle modification is based upon an intensive fitness assessment as well as other diagnostic information gathered during your full day Comprehensive Health Assessment:

  • Biochemical assessment of hormone status and disease risk using blood biomarkers
  • State of the art body composition and bone density analysis
  • In depth cardiovascular diagnostics, including the HeartSmart IMT plus™ and VO2 aerobic capacity analysis
  • Muscular strength and flexibility
  • Posture, balance and core strength
  • Detailed nutrition profile

Take control of your health and life; find your NEW YOU. 

 

[1] http://www.freep.com/article/20091018/SPORTS23/91018016/1318/3-runners-die-in-Detroit-marathon. Detroit Free Press.

[2] Thompson P., et al.  Marathoner’s Heart?  Circulation. Nov 28, 2006, vol. 114, issue 22

[3] Siegel A., et al.  Effect of Marathon Running on Inflammatory and Hemostatic Markers.  Amer J Card. Vol 88, No 8 October 15, 2001

[4] Hetland ML, Haarbo J, et al. Low bone mass and high bone turnover in male long distance runners. Journal of Clinical Endocrinology & Metabolism, Vol. 77, 770-775, 1993.

[5] Houmard JA. Costill DL. Mitchell JB. et al. Testosterone, cortisol, and creatine kinase levels in male distance runners during reduced training. Int J Sports Med. 1990 Feb;11(1):41-5.

[6]Moholdt T, et al.  CABG Patients get More Long-term Benefit from Aerobic Interval Training. Am Heart J 2009;158:1031-1037

[7] Tremblay A, et al.  Metabolism (1994) Volume 43, pp.814-818

Posted in Exercise, Nutrition, Youthful Aging, obesity | Tagged , , , , , , , , | Leave a comment

All About Hemp by Cassandra Forsythe, PhD, RD

By Dr. Ebanks | Published: December 24, 2009

What is hemp?

“Hemp is not marijuana”

A lot of negative perception surrounds hemp, due to its association with marijuana (which some people feel is a detrimental substance). However, the hemp plant, botanical name Cannabis Sativa L., is just one variety of many Cannabis strains (1). Hemp crops used today for food and fabric contain a much smaller concentration of the psychoactive component, THC (Delta-9-tetrahydrocannabinol) than varieties used recreationally. In Canada and the European Union, only varieties containing less than 0.3% THC in their flowers can legally be farmed, while marijuana flowers typically contain 3 to 20%. In the U.S., debate over the threat of hemp farming to health and safety, keeps the crops pretty much illegal (a license to grow crops can be obtained from the Drug Enforcement Administration, but it’s usually refused). Overall, hemp food products that you find on the shelves today in the U.S. and Canada come from plants grown mostly in Canada where farmers have been allowed to grow them since 1998 under the Controlled Drugs and Substances Act.

Hemp is a very versatile plant. Its fibers, core, seeds and flowers can be used as raw materials to form products ranging from food to paper, to clothing and carpeting. Some of us even have had the pleasure of wearing hemp clothing, derived from hemp fibers, which is surprisingly comfortable and versatile.

Hemp: An eco-friendly plant

A fabulous property of hemp is that it’s an eco-friendly crop that rarely needs pesticide treatments for bugs or herbicides for weeds (1). This way, consumers can be assured that they chemical residues are avoided in their hemp foods. Also, many hemp companies certify that their plants contain no Genetically Modified Organisms (GMOs) and/or are grown organically.

Why is hemp so important?

Healthy food with healthy fats

The fatty-acid composition is one of the key properties of hemps nutritional benefits (2, 3). The oil, which makes up half of the weight of the seeds, contains 75% essential fatty acids, of which ~20% are the omega-3, alpha-linoleic acid (ALA). It also contains ~3% of the healthy omega-6 fatty acid, gamma-linoleic acid (GLA), and ~1% of the rising omega-3 fatty acid star, stearidonic acid (SDA).  Overall, the omega-6 to omega-3 ratio of hemp oil is a fabulous 3:1, while most modern diets are an alarming 10:1, or more.

This unique ratio of omega-6 to omega-3 ensures that you can consume the oil without needing to balance it with any other lipid product.  High content of omega-6 fatty acids in the diet, relative to omega-3s are associated with numerous health issues, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases (4). Therefore, hemp oil alone offers benefits that few other fats provide. In fact, due to the unique fatty acid profile of hemp, it has the power itself to treat atopic dermatitis in humans (5).

Another fantastic “fat” property of hemp oil is that it contains a high content of naturally-occurring vitamin E compounds (tocotrienols and tocopherols) (1,2,3). These free-radical scavenging antioxidants protect the oil from oxidation and rancidity. Typical levels of vitamin E per 100 grams of oil are about 100 to 150 mg. Therefore, one to two tablespoons of hemp oil can meet the daily requirements of vitamin E for healthy adults (DRI: 15 mg/day).

In addition to the above fat-soluble compounds, the oil of hemp also contains high concentrations of phytosterols known to have beneficial effects on health; chlorophyll which is shown to be anti-carcinogenic; carotenes necessary for healthy eyesight and growth; and lecithin for ideal cell-membrane composition and brain function (1).

New ways to bump up blood EPA levels

The spotlight on omega-3 fats is usually given to the longer chain fatty acids, EPA and DHA, found abundantly in cold-water fatty fish and seafood. These fats have numerous cardiovascular and metabolic benefits that people tout and love. The other omega-3s are often down-played (like ALA) because they don’t appear to have the same physiological properties as EPA and DHA. For this reason, fish oil is an increasingly popular supplement that people consider a staple of their health regimen. But, fish sources are quickly becoming depleted and alternative sources of long chain omega-3 fats are desired.

Interestingly, the omega-3 fatty acid, SDA, is now being recognized as another beneficial fat, and is considered a “pro-EPA” fat (6) When humans consume SDA, blood content of EPA in phospholipids can increase two-fold (7,8). SDA is an intermediate in the omega-3 pathway from ALA to EPA (Figure 3), but it does not accumulate in blood lipids like ALA (9). So, this special omega-3 fat is converted completely to its downstream products, most importantly EPA (7, 9). The ability of SDA to increase EPA blood levels leads to an increase in the overall blood omega-3 index, which is considered an important risk factor for cardiovascular disease (10). Oils rich in SDA, such as hemp oil, provide a vegetarian source of SDA and sustainable option for obtaining ideal omega-3 fat levels in the body, which can reduce disease risk.

GLA: Control your weight with this unique omega-6 fat

Gamma-linolenic acid, or GLA, is another significant component of hemp oil (1%–6%, depending on species of Cannibis). GLA is a beneficial omega-6 fatty acid known to affect vital metabolic roles in humans, ranging from control of inflammation and vascular tone to initiation of contractions during childbirth. GLA has been found to alleviate psoriasis, atopic eczema, and PMS, and may also benefit cardiovascular, psychiatric, and immunological disorders. Ageing and disease (diabetes, hypertension, etc.) have been shown to impair GLA metabolism, making dietary sources desirable.

Recently, Dr Stephen Phinney and colleagues at the University of California have also shown that GLA supplementation was helpful for body weight regulation after significant weight loss (11). These researchers studied obese women who recently lost a large amount of weight (~60 lbs). Based on previous animal research showing that GLA was helpful for appetite control and prevention of weight-regain, they administered 890 mg of GLA from 5 g of borage oil to each subject (to give ~1 g of GLA to each person), or a placebo (olive oil), for one year following weight loss. The women who didn’t receive the GLA regained over 16 lbs in that subsequent year, whereas those who did receive GLA only regained 4 lbs. The proposed mechanism for this effect of GLA was via one of two hypotheses:

  1. Increased Arachadonic Acid (AA) levels in blood lipids due to GLA supplementation. Obese individuals and those with Metabolic Syndrome are classically found with depressed AA levels in tissue lipids (12,13). Further, increased AA in blood lipids is related to enhanced lipid sensitivity, down-regulation of lipogenesis, up-regulation of lipid oxidation, and increased leptin secretion (10,11)
  2.  Conversion of GLA to its elongation product, DGLA, which has anti-inflammatory effects, via production of beneficial eicosaniods that may operate in weight gain suppression (11).

 Hemp oil contains ~450 mg of GLA per tablespoon. Thus, to achieve an intake of ~1 g of GLA to help prevent weight-regain, all you need is 2 tablespoons of hemp oil per day mixed into smoothies or as a salad dressing.  Although you can achieve the same dose of GLA with a smaller dose of borage or evening primrose oil, hemp oil is the only natural food oil that doesn’t require packing into supplement form. Also, it’s a higher-yielding crop that is much easier to cultivate.

Hemp: A healthy protein source 

Hemp seeds are one of the few vegetarian protein sources providing a complete spectrum of all the essential amino acids. The seeds contain 25%–35% protein, and some of the hemp protein isolate products on the market today contain as much as 70% protein per 100 grams – this is a similar macronutrient breakdown to whey protein isolate with 21 grams of protein per serving, and minimal carbohydrates.  It also mixes very well in water or juice and compliments the great taste of berries in your favorite smoothie.

The protein in hemp comes from two high-quality storage proteins, edestin and albumin, which are easily digested. When compared to soy protein isolate, the protein in hemp has actually been deemed superior due to its higher content of most of the essential amino acids and methionine, cysteine and arginine (14). Overall, the protein makeup of hemp is highly complete, highly absorbable, hypo-allergenic and a great way to get more sustainable, earth-friendly amino acids into your diet.    

 Hemp: A stellar high-fiber choice

Hemp fibers are usually saved for production of durable fabrics and specialty papers, leaving the seeds as the food byproduct (1, 14). Of the whole seeds, about half to 25% of the total carbohydrate content is fiber, both insoluble and soluble forms. Some brands of hemp protein powder extracts even contain up to 14 grams of fiber per serving!  Theoretically, hemp food products could supply a person with all the fiber they need in one day.

What you should know about hemp

Why are hemp food products slightly green?

The green color of hemp oil, hemp butter, and hemp proteins is due to the high content of chlorophyll within the mature seed that is not destroyed during low-temperature processing of hemp foods. Although this chlorophyll can quicken auto-oxidation of oil exposed to light, as long as the oil is kept in a cold, dark container, this won’t be an issue. Benefits of chlorophyll in food include protection against several types of cancer, including colon and breast (15). So, when you try your hemp oil, butter and protein powder, know that being green is good.

Hemp seeds aren’t really seeds, but they pack a nutritional punch.

The fruit of hemp is not a true seed, but an “achene”, a tiny nut covered by a hard shell.  Whole hemp seed contains approximately 20-25% protein, 25-35% oil, 20-30% carbohydrates and 10-15% insoluble fiber (1) as well as a rich array of minerals, particularly phosphorous, potassium, magnesium, sulfur and calcium, along with modest amounts of iron and zinc (2).  It is also a fair source of carotene, a Vitamin A precursor.

The seeds are small, soft and round, making them easy to chew and digest. They taste similar to a pine nut, but contain a different array of beneficial nutrients.

What are the best uses for hemp oil?

Because of the highly unsaturated nature of the oil, it’s extremely sensitive to oxidative rancidity under heat and light. For this reason, it’s best not to use the oil for baking or frying. However, go ahead and use hemp as a healthy dipping oil, on salads or added to smoothies.

What other food products are made from hemp?

 It seems that with advances in technology and production, the possibilities for hemp food are endless. Here are some of the most popular food products that you can find readily available in stores today.

 Hemp Beverage – An excellent substitute to Rice, Soy or Cow’s milk. Use as you would on cereal, in smoothies, or just as a tasty drink.  

 Hemp Butter – Because it’s not made from a nut, it’s acceptable for those with tree nut allergies. Plus, it tastes great on toasted Ezekiel bread.  

 Hemp Seeds – Wonderful addition to salads, or simply eaten as a snack.

 

What’s a tasty hemp smoothie recipe I can make today?

 Easy Berry-licious Hemp Smoothie

Ingredients

2/3 Cup water

One scoop Hemp Pro 70

1 Tbsp Hemp Seed Oil

1/3 Cup frozen mixed berries

½ medium banana

 Directions

Mix all ingredients in a blender, pour into a cup, and enjoy! Easy and tasty.

 Nutrition: 360 calories, 22 g protein, 27 g carbs, 4 g fiber, 19 g fat, 14 g polyunsaturated fat

  Summary and Recommendations

 Hemp foods are widely under-appreciated, but carry so many health benefits. They’re an earth-friendly way to achieve more protein, healthy fats and fiber in your diet. Most people can benefit from these products in more ways than one:

  • A tasty, organic, vegetarian and vegan food
  • Tolerable by those with nut allergies
  • Provides a wide array of essential omega-3 and 6 fatty acids
  • A way to bump up dietary fiber intake
  • A new protein choice for smoothies and baking
  • Supports hemp growing for a healthier,  happier planet

 Hemp Food Product Links

 Manitoba Harvest Hemp Products

 Finola Hemp Seed variety

 Global Hemp

 Nutiva Hemp Products

 Ruth’s Hemp Foods

 Living Harvest Hemp Foods

 References

1)     http://www.hort.purdue.edu/newcrop/ncnu02/v5-284.html

Hemp: A new crop with new uses for North America. p. 284–326. Small, E. and D. Marcus. 2002.  In: J. Janick and A. Whipkey (eds.), Trends in new crops and new uses. ASHS Press, Alexandria, VA.

 2)     Hemp seed oil: A source of valuable essential fatty acids.  Deferne, J.L. and D. W. Pate, 1996.  Journal of the International Hemp Association 3(1): 1, 4-7.

 3)      Hempseed as a nutritional resource: An overview. Callaway JC. Euphytica. 140: 65-72, 2004.

 4)     The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Simopoulos AP. Exp Biol Med. 2008 Jun;233(6):674-88.

 5)      Efficacy of dietary hempseed oil in patients with atopic dermatitis. Callaway JC et al. J. Dermatol. Treat. 2005, 16, 87-94.

 6)      The synthesis and accumulation of stearidonic acid in transgenic plants: a novel source of ‘heart-healthy’ omega-3 fatty acids. Ruiz-López N et al. 2009 Sep;7(7):704-16

 7)      Dietary stearidonic acid is a long chain (n-3) polyunsaturated fatty acid with potential health benefits. Whelan J. J Nutr. 2009 Jan;139(1):5-10.

 8)      Stearidonic acid-enriched soybean oil increased the omega-3 index, an emerging cardiovascular risk marker. Harris WS et al. Lipids. 2008 Sep;43(9):805-11.

 9)     Metabolism of stearidonic acid in human subjects: comparison with the metabolism of other n-3 fatty acids. James MJ, Ursin VM, Cleland LG. Am J Clin Nutr. 2003 May;77(5):1140-5

 10)  Tissue omega-6/omega-3 fatty acid ratio and risk for coronary artery disease. Harris WS, Assaad B, Poston WC. Am J Cardiol 2006;98:19i-26i

 11)  Gamma-linolenate reduces weight regain in formerly obese humans. Schirmer MA, Phinney SD. J. Nutr. 2007 Jun;137(6):1430-5.

 12)  Obesity and weight loss alter serum polyunsaturated lipids in humans. Phinney SD, Davis PG, Johnson SB, Holman RT. Am J Clin Nutr 1991;53:831-838

 13)  Erythrocyte Fatty Acid Composition and the Metabolic Syndrome: A National Heart, Lung, and Blood Institute GOLDN Study. Edmond K. Kabagambe et al. Clinical Chemistry. 2008;54:154-162

 14)  Physicochemical and functional properties of hemp (Cannabis sativa L.) protein isolate. Tang CH, Ten Z, Wang XS, Yang XQ. J Agric Food Chem. 2006 Nov 15;54(23):8945-50

 15)   http://cebp.aacrjournals.org/content/15/4/717.full.pdf Heme and Chlorophyll Intake and Risk of Colorectal Cancer in the Netherlands Cohort Study. Balder HF et al. Cancer Epid. Biomarker Prev. 2006; 15(4): 7171-25.

Posted in Nutrition, Youthful Aging, obesity | Tagged , , , , , , | 1 Comment

Surprising Health Benefits of Sex

By Dr. Ebanks | Published: December 22, 2009

lovers under covers sepiaI don’t imagine there are very many people who need convincing that sex is a good thing, or that would need coaxing to engage in more sex.  Sex is extremely pleasurable and that should be sufficient reason to vigorously pursue it.  The one caveat is to avoid risky, indiscriminate sex that could potentially create very unhealthy situations, such as STD’s, AIDS or unwanted pregnancies.
 
What specifically constitutes “good sex”  is as variable as there are different tastes in clothing or food.   There has been quite a bit of study on this topic, though not all of it would pass rigorous scientific scrutiny.  It is no surprise that more sex in a monogamous relationship fosters intimacy and marital bliss.    The surprising consensus is that regular vigorous sexual activity can also improve the overall quality of your life, and, some of the benefits even accrue to those more predisposed to individual self-pleasuring:

  •  Helps to maintain a healthy body composition.   Sex burns between 75 and 150 calories per half-hour.  It is comparable to  other physical activities like yoga 114 calories per half hour, dancing – rock 129, walking – 3mph 153, weight training 153, canoeing – 2mph 153, volleyball 174.  Sexual arousal and orgasm releases the hormone testosterone which, among other things, is necessary to build and maintain bone and lean muscle tissue.
  • Improves cardiovascular health.  Sex is exercise that raises heart rate and blood flow.  In a study published in the Journal of Epidemiology and Community Health, researchers found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month.  No increase in stroke incidence was found.
  • Relieves stress, improves sleep.  People having frequent sex often report that they handle stress better. The profound relaxation that typically follows orgasm for women and ejaculation and/or orgasm for men, may be one of the few times people actually allow themselves to completely relax. Many indicate that they sleep more deeply and restfully after satisfying lovemaking.
  • Boosts the immune system.  Wilkes University in Pennsylvania says individuals who have sex once or twice a week show 30% higher levels of an antibody called immunoglobulin A, which is known to boost the immune system.
  • Relieves pain.  Through sexual arousal and orgasm the hormone oxytocin is secreted in your body which in turn causes the release of endorphins. Because of these natural opiates sex acts as a powerful analgesic.
  • Age more youthfully.  Every time you reach orgasm, the hormone DHEA (Dehydroepiandrosterone) increases in response to sexual excitement and ejaculation.  DHEA can boost your immune system, repair tissue, improve cognition, keep skin healthy, and even work as an antidepressant.  In a 2002 British study, researchers found a 50 percent reduction in overall mortality in the group of men who said they had the most orgasms.
  • Reduces prostate cancer risk.  A study recently published by the British Journal of Urology International asserts that men in their 20s can reduce by a third their chance of getting prostate cancer by ejaculating more than five times a week.  Another study, reported in the Journal of the American Medical Association, found that frequent ejaculations, 21 or more a month, were linked to lower prostate cancer risk in older men, as well, compared with less frequent ejaculations of four to seven monthly
Posted in Exercise, Heart Disease, Men's Health, Women's health, Youthful Aging | Tagged , , , , , , , , , , | Leave a comment

Obesity, Heart Disease and IMT testing

By Dr. Ebanks | Published: November 19, 2009
HeartSmart IMT and the “Biggest Loser”
biggest loser logo
HeartSmart
IMT  technology was used as part of the extensive cardiovascular pre-screening performed on all of the contestants
 on NBC’s “The Biggest Loser” television series. 
 
The goal was to heighten the awareness of the increased risk obesity and excess body fat causes for cardiovascular disease.
 
These scans were performed by a prominent Beverly Hills cardiologist, who sent the images to heartSmart for analysis, IMT measurement and reporting.
 
But, you don’t have to go to Beverly Hills to take advantage of this life-saving technology.  It is available right here in Connecticut at Alternity Healthcare.
 
For more information on IMT testing and our Advanced Cardiovascular Screening, 

 
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Women Need Testosterone Too!

By Dr. Ebanks | Published: November 19, 2009

woman-bicep-curlsAlthough estrogen remains the central female hormone most frequently used in both wellness and disease prevention, much less controversy surrounds the use of testosterone in women, though the evidence either supporting or discouraging its use is scarce. Nicknamed ‘‘the hormone of desire’’ and promoted in the popular media as the rescuer from the plight of decreasing libido in aging women, testosterone has gained rapid acceptance in the prevention and wellness arenas at a time when controversy and confusion surround estrogen and progesterone therapies. 

Testosterone is produced by the ovaries and adrenals in young women in low doses (free testosterone levels range between 2–8 pg/mL). The bulk of the present research on the use of testosterone has been conducted on women with surgical menopause, hypopituitarianism, anorexia nervosa, and primary adrenal insufficiency; patients with HIV and low body weight;[1] and patients with steroid- and oral contraceptive–induced suppression of endogenous androgens. Although there has been little if any formal study on testosterone use in normal aging in women, we know that adequate levels of testosterone play an important role in helping women maintain a healthy body composition.

 Women begin to gain body fat 10 years before they experience menopause, and many women gain weight when taking birth control pills, but doctors frequently overlook the role that testosterone can play in helping to ameliorate this weight gain. Testosterone therapy results in an increase in fat-free body mass and mitigates central fat deposition associated with estrogen use.[2] In a double-blind placebo-controlled small study of androgen-deficient women, testosterone replacement demonstrably increased thigh muscle mass as measured by CT scanning.[3]

 Loss of libido in the aging female is the most common complaint that leads physicians to consider testosterone deficiency as a possible cause and the main consideration for treatment with testosterone. Multiple factors directly affect sexual inclination. Poor relationship status, self-image issues, multiple medications and their side effects, other stress factors, aging, and concurrent chronic or acute illnesses are some of the most frequently encountered deterrents of sex drive. Many of these factors cannot be altered, and all factors should be taken into account.  While circulating testosterone levels do not definitively diagnose low testosterone as the cause for loss of libido, it may be helpful to keep in mind that premenopausal women have a range of 20 to 75 ng/dL total testosterone while postmenopausal women can present with values as low as 5 to 10 ng/dL.  The seminal study on impaired sexual function improvement with supplemental testosterone comes from a double-blind, placebo-controlled study in the New England Journal of Medicine. Seventy-five women 31 to 56 years old after undergoing oophorectomy (removal of ovaries) and hysterectomy were randomly assigned to receive placebo, conjugated estrogen and either 150 mcg or 300 mcg doses of transdermal testosterone. The women who received the higher dose of testosterone reported a two- to threefold increase in sexual desire, masturbation, sexual intercourse, and sense of positive well-being as compared with placebo or conjugated estrogen alone.[4]

 Besides helping women maintain lean muscle mass and an enjoyable sex life well into their forties, fifties, sixties and beyond, there is some evidence pointing to additional positive effects of testosterone on a woman’s health as she ages.  A report in the Journal of Women’s Health examined the hypothesis that testosterone deficiency is a key predictive factor for heart disease in aging women or women who have had hysterectomies.[5] Cardiovascular disease is the leading cause of death in postmenopausal women. Women who have hysterectomies are three times more likely to develop cardiovascular disease compared to women who have not had one. Women who have hysterectomies often receive estrogen replacement therapy but not testosterone replacement.  Although this seems to make sense in context of the numerous reports linking low testosterone to an increased risk of cardiovascular disease and premature death in men, a recent observational study may suggest the opposite.

  In this study, researchers measured levels of testosterone in 344 women, aged 65-98 years. They found that women with the highest testosterone levels — in the top 25 percent of this study group— were three times as likely to have coronary heart disease compared to women with lower testosterone levels. These women were also three times as likely to have a group of metabolic risk factors called the metabolic syndrome compared to women with lower testosterone levels.   A greater degree of insulin resistance is the proposed mechanism.  Testosterone therapy reduces insulin resistance, metabolic syndrome and cardiovascular risk in men.  Curious.  This is a pre-publication report, so seeing the full study in next month’s Journal of Clinical Endocrinology and Metabolism should be interesting.

 Breast cancer is the most common cancer in women.  Acting through androgen receptors, testosterone opposes estradiol induced proliferation of human breast cell lines[6]. Cases where endogenous testosterone levels are elevated, such as with polycystic ovary syndrome, are associated with breast tissue atrophy and a decreased risk of breast cancer.[7] There are, however, conflicting data on the potential role of supplemental testosterone in the development of breast cancer.

Though treatment with testosterone in the aging woman is gaining popularity, there is a definitive need for studies specific to this population to evaluate the safety and efficacy of testosterone as a therapeutic modality for postmenopausal women, as well as for younger women with loss of libido, to define its best use in prevention and wellness.   It is thought by some to be the missing link in hormone replacement therapy.  As more studies show the benefits of improved quality of life, preserved sexual function, restored libido, and healthy body composition from testosterone therapy, the more routine it will become for women seeking to optimize their health.

 

[1] Dolan S, Wilkie N. Arch effects of testosterone administration on human immunodeficiency virus-infected women with low weight. Arch Intern Med 2004;164:897–904.

[2] Davis S, Walker K. Effects of estradiol with and without testosterone on body composition and relationship with lipids in postmenopausal women. Menopause 2000;7:395–401.

[3] Miller K, Biller B, Beauregard C. Effects of testosterone replacement in androgen-deficient women with hypopituitarism; a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2006;91:1683–90.

[4] Shifren J, Braunstein G, Simon J. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.        NEJM 2000;343:682–8.

[5] Rako S. Testosterone deficiency: a key factor in the increased cardiovascular risk to women following hysterectomy or with natural aging?    J Womens Health. 1998 Sep;7(7):825-9

[6] Ando S, De Amicis F. Breast cancer from estrogen to androgen receptor. V Mol Molecular and Cellular Endocrinology 2002;193:121–8.

[7] Gammon M, Thompson W. Polycystic ovaries and the risk of breast cancer.

Am J Epidemiol 1991;134:818–24.

Posted in Bioidentical hormones, Heart Disease, Women's health, Youthful Aging, cancer, obesity | Tagged , , , , , , , , , , , | 2 Comments

Testosterone is Essential for Optimal Health

By Dr. Ebanks | Published: November 16, 2009

sugar-obesityA realization is dawning in clinical medicine that testosterone has a prominent role in maintaining good health.  That is not to say that more is always better.  Just like other readily understood areas of human existence, there is an optimum range, below and above which can be detrimental.  Typically people enjoy environmental temperatures between 40 degrees and 90 degrees.  Temperatures above and below this range cause some discomfort, injury and eventual death.  Even within this “normal” range there exists a smaller range representing the optimal temperature.  Although it may not be universal, people are most active, happy and productive around a temperature of 75 degrees.  Similar ranges can be described for physiologic functions.  A resting heart rate between 60-80 beats per minute is healthy, as is getting 7-9 hours of sleep per night or blood glucose of 60-100 mg/dl.

 Testosterone levels are no different.  There is a strong and growing body of evidence supporting the notion that low testosterone concentrations in men predisposes them to a higher risk of  chronic degenerative diseases, poor physical and mental health and premature death.[1] [2]  Although it has not been directly studied, there is ample anecdotal evidence from athletes and bodybuilders that supraphysiologic (above normal range) levels of testosterone confer little health benefit, and are probably harmful in the long term.

 Low testosterone concentration in men is, however, clearly unhealthy.  Men with low testosterone levels are at increased risk of cardiovascular disease (CVD), type-2 diabetes, obesity, and prostate cancer.  Testosterone therapy in men with low testosterone produces changes that are associated with lower risk of CVD.  These changes include reduced visceral (abdominal) obesity and insulin resistance, improved lipid profile, reduced blood inflammatory markers, and better exercise tolerance.[3]    Bolstering the beneficial effects testosterone therapy can have on heart function, injections of long-acting testosterone was shown to increase the blood-pumping ability and heart muscle strength in men with heart failure.  Improvements in functional exercise capacity and insulin resistance were also noted.[4]

 Metabolic syndrome is a constellation of health problems and risk factors including abdominal obesity, high triglycerides, high LDL cholesterol, low HDL cholesterol, hypertension and high fasting blood glucose.  It confers an increased risk for developing future CVD, stroke and type-2 diabetes.    New research presented at The Endocrine Society’s 91st Annual meeting in Washington, DC earlier this year demonstrated that long term testosterone therapy in middle-aged and older men with low testosterone levels led to significant improvements in their fatty liver disease, risk factors for CVD and diabetes and features of the metabolic syndrome.  Specifically, study participants were age 36 to 69 years and experienced:

  •  Decreased waist circumference in 6 months
  • Decreased LDL in six months
  • Increased HDL over two years
  • Decreased total cholesterol and triglycerides in one year
  • Decline in c-reactive protein (marker of inflammation)
  • 77% of men with metabolic syndrome at baseline no longer had metabolic syndrome after 2 years.

 Metabolic syndrome has become more common since it was first described in the early 1980’s.  Along with increasing rates of obesity, it is largely attributed to lifestyle and dietary changes.  Curiously, during the same period, the average testosterone concentration in men has also been falling.[5]   Obesity is a major risk factor for cardiovascular disease.  There is an inverse (opposite) relationship between testosterone level and obesity.  In particular, numerous studies have shown that a low testosterone level correlates with increasing abdominal obesity, higher body fat percentage and higher insulin levels.  High insulin levels promote fat storage and leads to insulin resistance.  Low testosterone is frequently a precursor to type-2 diabetes.[6]   Obesity, insulin resistance and type-2 diabetes are all factors contributing to the risk for having a heart attack.

 As testosterone levels fall, body fat increases.  Fat cells contain an enzyme, aromatase, which converts testosterone to estrogen.  This leads to a vicious cycle, as estrogen not only promotes fat accumulation, it decreases the body’s sensitivity to low testosterone.  This is believed to be mediated through a hormone called leptin and causes the body to fail to increase testosterone production as levels fall.

 Testosterone therapy appears to have a multitude of beneficial effects:  reduces insulin resistance by reducing visceral fat, which reduces inflammatory cytokines, reduces fatty acid delivery to the liver and improves lipid profiles, reduces risk for diabetes and cardiovascular disease, improves cardiovascular function, and has been shown to be an effective treatment for erectile dysfunction, even among some men that do not respond to Viagra-like drugs.[7]

 What is the optimal testosterone concentration for men with regard to overall health?  Although the definitive study has not been done, mounting scientific evidence supports maintaining testosterone in the upper third of the normal range rather than the lower third.   While improving sexual desire and erectile function are important for quality of life, testosterone has a much wider therapeutic role in maintaining optimal health.

 

[1] Lauglin, et al. Low serum testosterone and morality in older men. J Clin Endo Metab, 2008 Jan                      

 

[2] Khaw, KT, Dowsett, M, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 2007 Dec

 

[3] Jones TH, Saad F. The effects of testosterone on risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet, 2004 Sept

[4] Lellamo F, Jones TH. Testosterone therapy may help men with heart failure, J Amer Coll Card, 2009 Sept

[5] Tavison TG Araujo AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab,  2007 Jan.

[6] Haffner SM, Shaten J, et al. Low levels of sex hormone binding globulin and testosterone predict the development of non-insulin dependent diabetes mellitus in men.  Multiple risk Factor Intervention Trial. Am J Epidemiol, 1996 May.

[7] Greco EA, Spera G, et al. Combining testosterone andPDE5 inhibitors in erectile dysfunction: basic rationale and clinical evidences. Eur Urol, 2006 Nov.

Posted in Heart Disease, Men's Health, Nutrition, Type-2 Diabetes, Youthful Aging, obesity | Tagged , , , , , , , , , , , , , , , | Leave a comment

Breast Cancer Risk is Influenced by Lifestyle Choices

By Dr. Ebanks | Published: October 23, 2009
 
 five ladies Diet  and Exercise are Cancers’ Adversaries

 

 

 

Excluding cancer of the skin, breast cancer is the most frequently diagnosed cancer in women.  According to the American Cancer Society’s Surveillance and Health Policy Research, an estimated 192,370 new cases of invasive breast cancer are expected to occur among women in the US during 2009; about 1,910 new cases are expected among men. 
In addition to invasive breast cancer, 62,280 new cases of
in situ breast cancer are expected to occur among women
in 2009. Of these, approximately 85% will be ductal carcinoma in situ (DCIS). In situ breast cancer incidence rates
have stabilized since 2000, and invasive breast cancer rates have decreased 2.2% per year between 1999 – 2005.   African American women have a 10% lower risk of developing breast cancer than white women yet are 37% more likelyto die from the disease.
The World Health Organization (WHO) estimates that at least one-third of all cancers are preventable.  Screening can detect cancer in its earliest, most treatable stages but what can you do to reduce your risk of ever getting the disease?
In general, reducing modifiable risk factors that are associated with increased oxidative stress can help.  Eliminating things such as tobacco use, eating an unhealthy diet, carrying excess body fat, being sedentary or inactive, drinking excessive alcohol, being exposed to environmental toxins and having hormonal imbalances should be your goal.
Smoking is associated with at least 15 different cancers, including breast cancer.  Nearly 30% of all cancer deaths are attributed to tobacco use.
Excess body weight, particularly abdominal (visceral) fat increases the risk of breast, colon, esophagus, kidney, pancreas, prostate, stomsch and uterine cancers.
Although consuming alcohol in moderation, particularly red wine, has been associated with health benefits, there is a strong link between alcohol consumption and breast cancer.  In my May 2009 newsletter, I reported on the “Million Women Study” that suggested low to moderate alcohol consumption among women is associated with a statistically significant increase in cancer risk.  Women should limit alcohol to one drink per day or avoid it altogether.
Following a Mediterranean diet has consistently been associated with reduced risk for chronic degenerative disease, including cancers.  A study in the British Medical Journal in 2008 found a 12% reduced cancer risk in individuals that closely follwed a Mediterranean style diet compared to controls.  Soluble fiber was also found to be inversely associated with breast cancer risk; “As soluble fiber increases, the risk of breast cancer decreases” according to a 2009 study reported in the American Journal of Clinical Nutrition.
Vitamin D and antioxidants are crucial in reducing your risk of breast cancer.  The role of vitamin D is discussed spearately.  A study reported in April 2009 in the International Journal of Cancer found a moderate increase in breast cancer risk in women with low dietary intake of antioxidants and antioxidant supplements.  In early laboratory research, resveratrol  was found to suppress the abnormal cell formation leading to most types of breast cancer and in mice, curcumin inhibited growth of metastatic breast cancer cells.
Exercise is probably the closest thing we have to a fountain of youth.  It has been consistently associated with health inprovement, better body composition, lower rates of cardiovascualr disease, dementia and cancer.  According to a joint study by the National Institutes of Health (NIH) and AARP n 2008, “women who engaged in more than 7 hours per week of moderate-to-vigorous exercise for the {previous} ten years were 16% lesslikely to develop breast cancer than those who were inactive…”  Multiple studies in the Journal of The National Cancer Institute since 2005 have shown up to a 20% reduced risk of developing breast cancer in women who increased their lifetim physical activity level, with the greatest benefit realized by starting before age 20.
Getting adequate sleep is important for overall health and cognitive function, but a study from Japan’s Tohoku University Graduate School of Medicine last year found that sleeping less than 7 hours was associated with a 62% increase in breast cancer risk.
Hormone balance is a controversial topic in women’s health.  There is little dispute, however, that the proliferative effects of estrogen need to be balanced by the antiproliferative effects of natural progesterone.  This is best accomplished in the peri-menopausal or post menopausal woman with bioidentical hormones.  Ensuring that estrogen is metabolized in a benefical manner is also essential.  There are two main estrogen metabolites; 2-hydroxyestrogen and 16 alpha-hydroxyestrogen.  The 2-OH estrogen is considered the “good type because it does not cause breast cell proliferation.  the 16 alpha-OH has a strong affinity for the estrogen receptor and strongly stimulates cell proliferation in estrogen sensitive tissues.  It has been shown to play a role in the preservation of bone tissue, therefore an optimal ratio of the two is important.  A third metabolite, 4 hydroxy (4OH) estrogen promotes cancerous changes but does not bind to the estrogen receptor; rather it directly damages cellular DNA.  Synthetic estrogens, like Premarin, reduce the formation of 2OH estrogens and are typically metabolized to the 4OH estrogen; good reasons to avoid them.
So, making a few lifestyle modifications can help you look better, feel more vital and reduce your risk of many chronic degenerative diseases including breast cancer.

 

 

 
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Low Vitamin D Levels Put Your Health At Risk

By Dr. Ebanks | Published: October 23, 2009
 
 healthy stretchDo You Get Enough Vitamin D? 

 
Now that the long sunny days of summer are gone and winter is on the doorstep, it is even more important that you assess your vitamin D status.  The health benefits to having sufficient vitamin D levels have permeated the media in recent years.  We now know that nearly 85% of the US population are vitamin D deficient.  We spend too many hours indoors and use tons of sunscreen when were are out in the sun.  It certainly is prudent to use reasonable precautions about sun exposure but this vitamin D deficieny epidemic has put many of us at increased risk for many diseases, including osteoporosis, heart disease, obesity, insulin resistance, Alzheimere’s disease, arthritis, autoimmune diseases and cancers of the breast, colon, pancreas and prostate.  A recent study also showed that individuals with chronic pain required significantly more pain killers and were treated 60% longer  when their vitamin D levels were low compared to normal.
Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced in the body when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D, also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D, also known as calcitriol.
In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3 (cholecalciferol). Vitamin D2 is manufactured by the UV irradiation of ergosterol in yeast, and vitamin D3 is manufactured by the irradiation of 7-dehydrocholesterol from lanolin and the chemical conversion of cholesterol. The two forms have traditionally been regarded as equivalent based on their ability to cure rickets, but evidence has been offered that they are metabolized differently. Vitamin D3 is more than three times as effective as vitamin D2 in raising serum 25(OH)D (active vitamin D) concentrations and maintaining those levels for a longer time, and its metabolites have superior affinity for vitamin D-binding proteins in plasma. Any supplements should preferentially contain vitamin D3 rather than the more common D2.
Vitamin D emerged as a protective factor in a prospective, cross-sectional study of 3,121 adults aged 50 years (96% men) who underwent a colonoscopy. The study found that 10% had at least one advanced cancerous lesion. Those with the highest vitamin D intakes (>645 IU/day) had a significantly lower risk of these lesions.  More recently, a clinical trial focused on bone health in 1,179 postmenopausal women residing in rural Nebraska found that subjects supplemented daily with calcium (1,400-1,500 mg) and vitamin D3 (1,100 IU) had a significantly lower incidence of cancer over 4 years compared to women taking a placebo.
A recent meta-analysis found that use of vitamin D supplements was associated with a reduction in overall mortality from any cause by a statistically significant 7%. The subjects in these trials were primarily healthy, middle aged or elderly, and at high risk of fractures; they took 300-2,000 IU/day of vitamin D supplements.
“Vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors,” said Thomas J. Wang, M.D., assistant professor of medicine at Harvard Medical School in Boston, Mass.   “The higher risk associated with vitamin D deficiency was particularly evident among individuals with high blood pressure.”In a study of 1,739 offspring from Framingham Heart Study participants (average age 59, all Caucasian), researchers found that those with low blood levels of vitamin D had twice the risk of a cardiovascular event such as a heart attack, heart failure or stroke in the next five years compared to those with higher levels of vitamin D.

In a study previous cited in the October 2008 newsletter, and reported at the 2008 American Oncology Meeting, researchers retrospectively looked at more than 500 women over a period of 11 years. What they found was that those women who had been deficient in vitamin D at the time of their breast cancer diagnosis were 73% more likely to die from breast cancer than those with sufficient vitamin D at the time of diagnosis. In addition those that were deficient in vitamin D at the time of their diagnosis of breast cancer were almost twice as likely to have recurrence or spread over those years. 

In a major epidemiological study by Cedric Garland PhD and others, the researchers exhaustively reviewed the medical literature on the relationship between breast cancer and vitamin D levels. According to the analysis done in this article, if women kept their vitamin D blood levels at approximately 52 ng/ml, we could expect a 50% reduction in the risk of breast cancer.

Many nutritional and vitamin D researchers recommend supplementing with 1000-2000 IU of vitamin D3 daily for most people.  Current evidence suggests that the optimal blood level for vitamin D is between 60 to 80 ng/L ( the “normal” range is 30 to 100 ng/L). 

Maybe it time to plan a winter vacation to a sunny destination.  In the meantime, be sure to get a high quality vitamin D supplement and have your blood level checked; it could change your life.
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