New Year, New You on NBC

Testosterone is the primary male sex hormone, or androgen.  Circulating levels of testosterone increase at the time of puberty and peak in early adulthood for men.  Testosterone is responsible for men looking like men and feeling like men.  Following that peak is a gradual but steady decline in testosterone levels beginning in the mid-30’s. Declining testosterone levels cause a variety of symptoms including loss of muscle mass and strength, increased belly fat, impaired brain function, disrupted sleep, loss of libido, impaired sexual function and general fatigue.  But, because the loss of testosterone is gradual these symptoms typically occur little by little, and the impact on a man’s life may not be felt until his 40’s, 50’s or later.  This is sometimes referred to as andropause, or the male menopause.  This gradual decline in vitality, function and quality of life is too often attributed to “just getting old” when in reality, many of those symptoms can be reversed with proper treatment.

It is readily apparent to most that testosterone plays a crucial role in male sexual function. Sexual potency peaks along with the raging hormones of a teenager.  Similarly, testosterone is essential for building and maintaining muscle mass, youthful energy and strength.  Considering testosterone therapy to improve the way you look, feel and perform would be good enough for many.  In fact, testosterone therapy has resulted in improved libido and erectile function in middle aged men.[i]  However, recent scientific evidence has demonstrated significant adverse health implications for men with low and declining testosterone levels.  Numerous studies have now established a strong association between low testosterone and depression, metabolic syndrome, type-2 diabetes, osteoporosis and cardiovascular disease.  In one study men with low testosterone had a nearly 50% increase in mortality over a seven year period.[ii]   An unmistakable link has also been established between erectile dysfunction and the development of cardiovascular disease.

Several studies have shown that restoring testosterone to more youthful levels in middle-aged men improved insulin-sensitivity, reduced serum cholesterol, fat mass, waist circumference and inflammatory bio-markers associated with heart disease, diabetes, and metabolic syndrome.  One study concluded that “that testosterone treatment in men has potentially beneficial effects on virtually all of the coronary risk factors, as well as an independent anti-plaque forming action.”  In men with heart failure, testosterone therapy also improved functional capacity, or the ability to perform physical activity without constraint.[iii]

So why aren’t more men getting testosterone therapy?  Many physicians do not recognize the symptoms of low testosterone as a treatable condition. Traditionally, physicians have been reluctant to prescribe testosterone therapy in large part out of a misguided fear of increasing prostate cancer risk.  Recent evidence has called that conventional paradigm into question.  A large meta-analysis out of Harvard University[iv], as well as a collaborative review of 18 prospective studies[v] concluded that no significant association existed between higher testosterone levels and prostate cancer risk.  Conversely, studies have shown an increased risk of prostate cancer and aggressive prostate cancer in men with low testosterone levels.  In a group of middle-aged men treated with testosterone and followed for more than 5 years, there was no increase in the incidence of prostate cancer and PSA levels remained stable.[vi] 

 What is the bottom line?  Any man over 40 or 50 that feels off his game, run down or is experiencing any of the symptoms of low testosterone should have a thorough evaluation looking for cardiovascular disease, pre-diabetes, and osteoporosis among others.  I recommend seeking out a physician experienced in preventive health and hormone therapy for men.  At Alternity Healthcare, we utilize comprehensive evaluations and state-of-the-art diagnostics to form the basis of an individual preventive health program.  Rather than narrowly focusing on just your hormone levels, our comprehensive programs will expose your total health picture and help you to achieve renewed, long-term health and vitality.   

Although numerous studies have demonstrated substantial health benefits from physical exercise, there is debate about the optimal type, duration and intensity to achieve the most favorable result.  When you mention exercise to most people, it congers up images of tedious endurance training; that is, traditional “cardio” that many exercise gurus tell you to do.  But recent scientific studies are pointing to another, more efficient option to strengthen your heart, improve lung function and overall fitness.  Shorter bursts of vigorous exercise benefits heart health as much as tedious endurance training.

A small study done at McMaster University in Canada compared healthy men and women riding stationary bikes.  Some exercised five days per week doing 40-60 minutes of moderate-intensity cycling.  Others did four to six sets of 30-second sprints on the bike allowing 4-5 minutes of recovery between sets; with a total exercise time of 15-25 minutes just three days a week.  After six weeks, the researchers found that the intense sprint interval training improved the structure and function of arteries as much as traditional, longer endurance exercise.

A larger study, following 13,000 people for 15 years in the Harvard Health study found that people live longer if they do vigorous exercise, but not if they only do light or moderate exercise.[1]   Another study looking at the cardiovascular benefits of exercise in people following coronary artery bypass surgery (CABG) found that higher intensity interval training improved aerobic capacity (VO₂) significantly better than moderate intensity continuous training.  In fact, the study data showed 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.^[2]

What is VO₂?  There are a number of parameters that can be measured to assess your overall cardiovascular health but the one of the best is your aerobic capacity, otherwise known as your VO₂ max.  Measuring VO₂ max reveals how well your lungs can get oxygen into your blood, how efficiently your heart can pump that blood to your organs and exercising muscles and how well those muscles can utilize the oxygen for energy production.  The more oxygen your body can use, the better your body works.

Mitochondria are the power plants where fuel is burned, energy is produced and harmful free radicals are neutralized.  The number of mitochondria that you have in your cells determines your performance capacity.  But that number is not fixed.  There are several complex pathways that lead to an increased number of mitochondria.  The best known and most effective way to produce more mitochondria is with exercise.^[3]   Mitochondrial production increases in direct proportion to the amount of physical activity performed.^{[4] [5]}

I have previously reviewed in detail three nutritional supplements, Resveratrol, Alpha Lipoic Acid and L-arginine, which have been shown to augment mitochondrial production and thereby improve oxygen consumption.  Quercetin, a compound found in berries, onions grapes and red wine can also improve VO₂.  A study using elite cyclists demonstrated a 4% increase in VO2 over a six week trial [6], and a similar increase in healthy but untrained individuals given quercetin supplements over seven days.

Clearly, people that stay physically active throughout life reap substantial benefits from exercise.  But what about those getting a late start?  Can beginning an exercise program at any age make up for years of sedentary living?  The short answer is a resounding “yes”.

A study spanning 35 years in Sweden strongly suggests that starting to exercise at or after 50 years old is better than never starting at all.  Another British study traced men over 18 years, at an average age of 63.  This study revealed a strong link between exercise and survival.  A third study from Norway found that men who were physically fit enjoyed substantial protection from cardiovascular disease and early death.   Not to be outdone, a study of American veterans followed men over 25 years and noted a 38% lower mortality in men who were physically fit.  Just as important was the finding that men who were unfit at the start and improved their fitness had a 35% lower mortality than those who remained unfit.

So, improving your fitness level strengthens your heart, improves your vascular system, enhances lung function, reduces your risk for a myriad of chronic diseases and ultimately protects against premature death.  But exercise alone is not sufficient.  It should be part of an overall adoption of healthy lifestyle habits:  eating more fruits and vegetables, avoiding processed foods and added sweeteners, not carrying around excess body fat, not smoking, getting more sleep and managing stress.  If you are over 50 you should have a thorough medical evaluation prior to beginning an exercise program and seek guidance from an experienced trainer or exercise physiologist.  At Alternity Healthcare, we perform an extensive evaluation including VO₂ testing on all of our new patients.

 It is never too late or too early to start exercising.  You will feel better, look better and live better.  You could then spread the word to your children and younger friends who have become distressingly inactive, overweight and lazy.  Remember, leading by example is most effective.

What are added sugars? 

Added sugars included table sugar, brown sugar, high-fructose corn syrup (HFCS), honey, molasses, brown rice syrup, agave syrup and other caloric sweeteners in prepared and processed foods — for instance, in soft drinks, iced tea, candy, pastries, cookies and canned fruits.  These added sugars provide no nutritional value.  Some may find it surprising that honey is included here, but honey has 35% more calories per tablespoon than table sugar. 

Extent of the epidemic

Americans now consume over 100 pounds of added sugars per person per year; more than a 50% increase from 30 years ago.  This is equivalent to 22 teaspoons per day!  It is also nearly three times higher than the level found not to “conclusively demonstrate a hazard to the general public.”[1]   So how much of any substance can be consumed before it goes from harmless to toxic?  It is generally accepted that a glass of red wine may have certain health benefits, but we all know the problems that drinking too much can bring.  It is hard not to blame added sugars for the obesity and diabetes epidemics we now face in this country.  In 1980, approximately one in seven Americans was obese and almost 6 million were diabetic.  Thirty years later, coinciding with increased sugar consumption, one in three Americans are obese and more than 14 million are diabetic.

Throughout our history, there has been a suspicious but not incontrovertible association between sugar consumption and disease.  From the late 19^th and early 20^th centuries there was a very notable increase in sugar consumption as the candy and soft-drink industries grew, along with a parallel increase in diabetes incidence and deaths.  

Is it just the calories?

Conventional recommendations from the Department of Agriculture or the American Heart Association[2] advise reducing sugar intake because of the excess empty calories; that is, the lack of any vitamins, minerals, protein, or fiber, that leads to weight gain and related diseases like diabetes.  High-fructose corn syrup has become one of the most vilified food additives but a growing number of nutrition researchers believe that there is little difference between HFCS and refined sugar, at least with respect to how they are metabolized in your body.  The evidence that HFCS consumption uniquely increases the risk of weight gain is very weak.[3]  HFCS is not used extensively outside the US but obesity rates are increasing worldwide.

Refined sugar (sucrose) is made up of two different sugar molecules, glucose and fructose in a 50-50 mixture.  Other carbohydrates, such as bread, potatoes and pasta break down to glucose.  That is, bread that does not contain HFCS.  Glucose is metabolized and used for energy by all cells in your body.  HFCS is 45% glucose and 55% fructose.  There is also fructose that occurs naturally in fruits, but the absorption rate of the sugar is blunted by the fruit’s fiber content.  Anywhere fructose is found in nature, there is always fiber present.  Fructose is metabolized by the liver and when present in sufficient quantities will be converted into fat.  The speed with which fructose arrives in the liver also influences the rate of conversion to fat.  This is a critical point, since soft drinks are by far the biggest culprits for the glut of sugar consumed, and the fastest way to absorb sugar.   In the 1950′s a typical soda contained 10 ounces; now we have 44 ounce Big-Gulps.  The more sugar consumed, the more insulin your body needs to produce to try and manage it.  In the presence of high insulin levels, more of your calories are stored as fat, creating a vicious cycle that ultimately leads to insulin resistance and fat accumulation in the liver.  And, what has become the most common form of liver disease, non-alcoholic fatty liver (NAFLD), has been linked to an increased consumption of fructose.[4]

Another hormone, leptin, is the satiety hormone.  It sends the signal to your brain to stop eating.  Its effects are essentially disabled in people with insulin resistance.  When leptin isn’t being released, or the signals not processed the way it’s supposed to–as happens in insulin-resistance–your brain doesn’t know you’ve already had enough to eat.  It thinks you’re starving, so you just eat more.  You end up in a vicious cycle of consumption and then disease.  In many obese individuals, leptin resistance contributes to thier difficulty in losing weight.

Sugars, lipids and hypertension

A study published last year looked at the relationship of added sugars to blood lipid levels.  Researchers compared the diets and blood profiles of over 6100 adults from the National Health and Nutrition Examination Survey.  Even after controlling for other variables including body mass index (BMI), physical activity, and total energy expenditures, the results showed that participants consuming the least amount of added sugars had higher HDL (good) cholesterol, lower triglycerides and lower LDL (bad) cholesterol.  The researchers concluded that there was an important association between increased sugar consumption and cardiovascular risk factors.  In another recent study, consumption of sugar-sweetened beverages was associated with significantly elevated blood pressure and increased BMI[5]

What does it all mean? 

Obesity, altered blood lipids, hypertension and insulin resistance adds up to metabolic syndrome; one of, if not the major risk factor for heart disease and diabetes.  While it hasn’t been conclusively determined what initially causes metabolic syndrome or what the initial event is in the insulin resistance cascade, there seems to be a remarkably strong correlation between liver fat and insulin resistance.[6]   Insulin resistance, obesity and metabolic syndrome are also closely associated with an increased risk of cancer.[7] 

If sugar consumption leads to insulin resistance, and insulin resistance is one of the fundamental underlying defects in cancer, as it is in type-2 diabetes and heart disease, then it seems to follow that excessive sugar consumption may cause cancer.  Even if the final scientific conclusions are not in, isn’t the association enough to make you rethink how much sugar you are willing to consume?

Two high profile stroke victims highlight this trend among younger people.  Delaware attorney general Beau Biden suffered a stroke at age 41 last year.  His was classified as “mild” and he has made a good recovery.  Typically younger people recover better as they have retained more brain plasticity and have fewer co-morbidities to complicate their recovery.

 Less fortunate was rapper Nate Dogg who died this week from congested heart failure and complications from previous strokes.   He was only 41, but according to the LA Times and USA Today, he suffered from two previous strokes; the first at age 38 and the second the following year.  I certainly do not know all the details of his condition, but having a stroke puts you at significantly increased risk of having subsequent strokes.  It should be a wake-up call.

 How can you prevent a stroke?  Although there are several risk factors that you cannot change, such as family history, being African American or male[1], there are a number of risk factors that are modifiable.  A large case-control study evaluating the risk factors for stroke ahs identified 10 modifiable risk factors that are associated with 90% of stroke risk.  Of those modifiable risk factors, hypertension was the most important for all stroke types.[2]  In that study a history of hypertension was associated with a more than 2.5-fold increase in the risk for stroke.  The other risk factors included smoking, abdominal obesity, lack of regular physical exercise, diabetes, diet and alcohol intake, abnormal lipid profile, stress and depression.

 Not coincidentally, the risk factors for stroke and heart disease are the same; the relative importance of each risk factor varies for each disease.  And, the same lifestyle modifications that could reduce your risk of both heart disease and stroke also reduce your risk of diabetes and being obese, which further reduces your risk of having a vascular event.  It all boils down to modifying your lifestyle to avoid these debilitating chronic diseases, improve your quality of life and reduce your chance of dying prematurely.

Many health and nutrition experts have long recommended limiting dietary saturated fats and avoiding full fat dairy products.  Marion Franz, a registered dietitian with the American Diabetes Association nutrition task force was quoted as saying, “the link between eating saturated fats and heart disease is well established.” Yet a recent meta-analysis failed to show any increased risk of coronary heart disease or cardiovascular disease from saturated fats.[1]  Trans fats found in hydrogenated oils are industrially produced and have been associated with higher risks from heart disease.   In contrast, researchers found that adults with the highest levels of trans-palmitoleic acid in their blood had a three-fold lower risk of developing diabetes.  Interestingly, those individuals also had lower body fat, higher good cholesterol levels, and lower triglyceride levels, which are all associated with better cardiovascular well outcomes.[2]   Trans-palmitoleic acid is a naturally occurring fatty acid found in milk, cheese, yogurt, butter and meat.

This study examined 3,736 participants in the National Heart, Lung, and Blood Institute-funded Cardiovascular Health Study, who have been followed for 20 years in an observational study to evaluate risk factors for cardiovascular diseases in older adults.  “It’s exciting because traditionally fats were just seen as artery cloggers, but they seem to be both harmful and protective,” said lead author and Harvard epidemiologist Dariush Mozaffarian. “The fatty acid world is becoming more interesting and complex.”

There are a number of problems with the current low-fat recommendations.  It has created an environment where people avoid all fats indiscriminately, when many are healthy and beneficial.  In fact, in order to burn fat you need to eat fat.  Another major problem has been the substitution of refined carbohydrates for the fats.   It is abundantly clear that excess highly processed carbohydrates leads to insulin resistance and the accumulation of excess body fat (see “Low Fat vs Low Carb”). 

Being overweight or obese is far more than just carrying around excess weight or wearing bigger clothes.  It is a well-established risk factor for diabetes, heart disease, hypertension, elevated cholesterol, stroke, metabolic syndrome, arthritis, several cancers and premature death.

We all know that adopting a healthier lifestyle can significantly reduce the epidemics of obesity and type 2 diabetes.  The same healthy lifestyle modifications can lower your risk of heart disease and certain cancers.  Should we all start drinking more milk?  No, these finding are still preliminary.  There have been several studies that suggest dairy lovers have a lower diabetes risk, but there are also many studies linking the same benefit to the Mediterranean diet — typically low in dairy, but high in fats from olive oil and fish, and rich in high-fiber grains, vegetables and legumes.  A separate meta-analysis of 17 prospective studies looking at the association between dairy consumption and cardiovascular disease concluded that milk consumption was not harmful but did not demonstrate any significant cardiovascular risk reduction.[3]

So for the meantime, it is best to maintain a healthy weight by exercising regularly and following a diet lower in refined carbohydrates, higher in protein and healthy fats than the typical American diet.  But if you enjoy milk, there is no reason to avoid it because of its fat content.

[2]  Mozaffarian D, Cao H, King I, Lemaitre R, Song X, Siscovick D, Hotamisligil G, ‘Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in U.S. Adults: A Cohort Study’, Ann Intern Med December 21, 2010 153:790-799

[3] Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, et al. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 2010; DOI: 10.3945/acjn.2010.29866.

Despite its benefits, far too many Americans are chronically sleep deprived.  We live in very stressful times.  One-third of Americans are losing sleep over the state of the U.S. economy and other personal financial concerns.[1]  According to the National Sleep Foundation, 20 percent of us get less than 6 hours sleep a night.  For many others, a good night’s sleep is increasingly losing out to the distractions and extremely hectic nature of our modern life. Some hard-charging professionals even shun regular sleep in deference to the philosophy “I’ll sleep when I am dead”.  Well it turns out that getting enough sleep, and other kinds of rest, just might postpone when your death occurs as well as increase the effectiveness and joyfulness of your life.

One way to think about the function of sleep is to compare it to another of our life-sustaining activities: eating. Hunger is a protective mechanism that has evolved to ensure that we consume the nutrients our bodies require to grow, repair tissues, and function properly.  Both eating and sleeping are regulated by powerful internal drives. Going without food produces the uncomfortable sensation of hunger, while going without sleep makes us feel overwhelmingly sleepy. And just as eating relieves hunger and ensures that we obtain the nutrients we need; sleeping relieves sleepiness and ensures that we obtain the sleep we need.

 Insufficient sleep may alter crucial hormone functions and energy expenditures.  A recent study found that a restriction in the amount of sleep time compromised the effectiveness of a reduced calorie diet for weight loss and reduction of metabolic risk factors.[2]  Another study found that sleep deprivation was associated with a two-fold risk of being obese in children and adults.  That research also suggested that those who slept less have a greater increase in body mass index and waist circumference over time and a greater chance of becoming obese over time.[3]  Obesity has, in turn, been linked to a variety of chronic and life-threatening diseases, including sleep apnea; a common disorder in which the upper airway is intermittently narrowed or blocked, disrupting sleep and breathing during sleep.  Researchers from the Sleep Heart Health Study found that sleep apnea doubled the risk for strokes in men, and increased the danger for women.[4]

 Physiologic studies suggest that a sleep deficit may put the body into a state of high alert, increasing the production of stress hormones and driving up blood pressure, a major risk factor for heart attacks and strokes. Moreover, people who are sleep-deprived have elevated levels of substances in the blood that indicate a heightened state of inflammation in the body, which has also emerged as a major risk factor for heart disease, stroke, cancer and diabetes.  Other studies have found that sleep influences the functioning of the lining inside blood vessels, which could explain why people are most prone to heart attacks and strokes during early morning hours.[5]  The strongest evidence seems to be linking sleep deprivation to an increased mortality risk.  Otherwise healthy people who do not get enough sleep or who shift their sleep schedules because of work, family or lifestyle appeared to be significantly more likely to die sooner.

 How much sleep is enough?  Generally, experts recommend seven to nine hours per night.  But, as it turns out there is no absolute number of hours. Everyone requires more or less sleep depending on a variety of factors including your individual makeup as well as your lifestyle. What counts is that you are getting enough sleep for your body and mind to be replenished, whether that is six, seven, or eight hours or more.

[2] Nedeltcheva A, Kilkus J, et al. “Insufficient Sleep Undermines Dietary Efforts to reduce Adiposity”.  Ann Int Med. October 5, 2010

vol. 153 no. 7 435-441

[3] Cappuccio F, et al. “Sleep Deprivation Doubles Risks Of Obesity In Both Children And Adults.” ScienceDaily 13 July 2006.

[4] Redline S, Yenokyan G, et al. Obstructive Sleep Apnea- Hypopnea and  Incident Stroke.  American Journal of Respiratory and Critical Care Medicine Vol 182. pp. 269-277, (2010)

[5] Wolfe B, Volzke H, et al. Relation of Self-reported Sleep Duration with Carotid Intima Media Thickness in a General Population Sample. Eur J Cardiovasc Prev Rehab. Volume 196, Issue 2, Pages 727-732 (February 2008)

Well, let’s look at the facts.  Last year over half a million Americans suffered adverse events due to prescription medications.[1]  Almost 100,000 people die yearly as a result of complications from pharmaceutical drugs.[2]  To be sure, the FDA is under pressure to approve drugs faster, and they undoubtedly are under-staffed to review the $2.5 trillion worth of foods, drugs and medical devices they are currently responsible to oversee.[3]  But ultimately, it is the American consumer that gets hurt; and the pharmaceutical industry that lines its pockets with billions of dollars in the process.

In 1992 Congress passed the Prescription Drug User Fee Act, ostensibly to provide the FDA with desperately needed funds to make it more efficient.  The idea was to shift some of the cost of research involved in drug approvals to the pharmaceutical companies.   It essentially allows the drug makers to pay a fee to the FDA to approve their drugs.  This year, that user fee is estimated to be $920 million; nearly one third of the FDA budget![4]

Does that fee unduly influence FDA decisions?  It is hard to imagine that it wouldn’t.  The agency entrusted to regulate the pharmaceutical industry is now financially dependent on that same industry for funding.  Dr. David Graham, a senior drug safety researcher at the FDA who was pivotal in having Vioxx removed from the market was quoted as saying: “As currently configured, the FDA is not able to adequately protect the American public. It’s more interested in protecting the interests of industry. It views industry as its client, and the client is someone whose interest you represent. Unfortunately, that’s the way the FDA is currently structured.”[5]

Is there any evidence to back-up that claim?  Well, in the 40 years preceding the Prescription Drug User Fee Act, the FDA only recalled 8 medications it had previously approved.  Since 1992, that number is more than 22 drugs, and climbing.[6]  The latest drug casualty is Meridia, a weight loss drug pulled from the US market by its maker, Abbott Labs because it increases the risks for heart attacks, strokes and death.[7]  This isn’t the first weight loss drug to cause serious cardiovascular complications; remember Fen Phen and Redux?[8]  At least this time, the FDA eventually got it right by recommending Meridia’s removal from the US market.  It is troubling that European regulators banned it more than nine months ago.   What was the delay?  John Jenkins, MD, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, suggested we need more weight loss drugs, “We’re still very committed to working with (manufacturers) to help them to develop and gain approval of safe and effective drugs to help patients manage weight”[9]

Last month I reported on the cardiovascular issues resulting in tens of thousands of deaths attributed to the diabetes drug Avandia.  It was banned in Europe but remains available in the US, albeit with tighter restrictions.[10]   There was a concern that diabetics would have fewer medication choices.  Really?  Type-2 diabetes can largely be prevented and reversed through lifestyle modifications.  But that approach would hinder profits.

Theses are just a few of the drug problems we know about.  More are likely to be recalled under the current approval system, and many remain on the market with dubious scientific benefit.  They continue to be prescribed in large part due to the weight of the pharmaceutical industry’s marketing initiatives to both physicians and the general public.  That is not to say that all pharmaceutical drugs are harmful.  Quite the contrary, there are tremendous life-saving medications available when needed.  But, many of the chronic conditions for which they are prescribed are preventable.

You may not hear that from big-pharma’s advertising, because it is much more profitable to treat symptoms with expensive drugs than to make you aware of the range of natural alternatives to prevent illness. Eat real food, not processed foods laden with chemicals and preservatives. Avoid sugars, starches and processed grains.  Drink more water.  Take high quality nutritional supplements; unlike pharmaceutical drugs, there are no widespread reports of deaths from vitamins.[11]  Exercise vigorously and regularly; it is the fountain of youth.  Get enough sleep to recharge and revitalize yourself daily; 7-9 hours are needed.  Learn to manage stress, enjoy more of your life, and keep things in proper perspective.

 Help is there but you must seek it out and make a commitment to the lifestyle changes necessary.  How do you want to live your life 10, 20, 30 years or more from now?  You can’t wait until then to decide.  What you do now will determine whether you remain vital, healthy and engaged in your later years, or whether you will be frail, feeble and drooling on yourself in a nursing home waiting for someone to change your diaper.  Which is your future vision?

[2] Moore, Thomas J., AB; Cohen, Michael R., RPh, MS, ScD; Furberg, Curt D., MD, PhD., “Serious Adverse Drug Events Reported to the Food and Drug Admin.,” Arch Intern Med. 2007; 167(16): 1752-1759

[3] Gardiner, Harris, “The Safety Gap,” New York Times Magazine Nov. 2, 2008

[4] Zajac, Andrew, “Freeze? What Freeze? FDA in Line for Another Budget Boost,” Los Angeles Times Feb. 2, 2010

[5] Loudon, Manette, “The FDA Exposed: An Interview With Dr. David Graham, the Vioxx Whistleblower,” Organic Consumers Association Aug. 30, 2005

[6] Center for Drug Evaluation and Research Report to the Nation 2005: http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/WhatWeDo/UCM078935.pdf

[7] James W, Caterson I, et al.  Effects of Sibutramine on Cardiovascular Outcomes in Overweight and Obese Subjects. N Engl J Med 2010; 363:905-917. Sept 2010. 

[8]Curfman G, Morrissey S, Drazen J.  Sibutramine – Another Flawed Diet Pill. N Engl J Med 2010; 363:972-974 Sept 2010.

[9] Abbott Withdraws Sibutramine from Market. http://www.medscape.com/viewarticle/730155

 [10] 47,000Deaths and Counting. http://alternityhealthcare.com/2010/09/25/47000-deaths-and-counting/

[11] “No Deaths from Vitamins, Minerals, Amino Acids or Herbs,” Orthomolecular Medicine News Service Jan. 19, 2010; http://www.orthomolecular.org

Avandia was introduced in 1999 and a study performed by its maker, SmithKline Beechem (later acquired by Glaxo) found that it posed a significantly increased risk of cardiovascular events and bone fractures.  What did they do?  They suppressed the data for the next 11 years!   A SmithKline executive was quoted in a recently uncovered internal email written in 2001: “This was done for the US business, way under the radar.  Per senior management request, these results should never see the light of day to anyone outside of GSK.”  Since its introduction, an estimated 47,000 people taking Avandia have suffered serious cardiovascular events or died just by taking the drug to treat their type-2 diabetes.[1]  Sales of Avandia peaked at $3.4 billion in 2006.

Evidence of significant heart risks was apparent since at least 2007 when the FDA strengthened warnings about heart failure.[2] [3]   Several later studies have linked Avandia (Rosiglitizone) with an increased risk of heart attacks, heart failure and strokes, by as much as 30-40%.[4] [5] GlaxoSmithKline, its maker continued to defend Avandia’s safety profile.  The FDA again began investigating Avandia earlier this summer when the previously suppressed info came to light.  Despite pretty damning evidence, the FDA ultimately decided not to remove it from the market. Instead they have imposed very strict limitations on its use that will take several more months to go into effect.  Curiously, looking at the same data, the European advisory committee has banned it completely.

Actos is in the same chemical family as Avandia, but most studies have not found similar cardiovascular risks with Actos. On the heels of Avandia’s problems, Actos sales have risen to over $4.6 billion.  A recent study, however, has found similar heart risks with Actos as Avandia.[6]   If that was not enough, the FDA is currently investigating data linking long-term use of Actos to an increased risk of bladder cancer. [7]

 So, we have a group of individuals already at increased risk for cardiovascular disease by virtue of their diabetes, and many have an additional independent risk from being obese.  Then the very drugs developed ostensibly to help them, further increases that heart risk; and the critical information is hidden from doctors and the public for more than a decade.

 What can you do?  Adopting a healthier lifestyle can prevent the vast majority of type-2 diabetes cases.  Clearly avoiding diabetes and other preventable chronic diseases, reduces the need for prescription medication and is preferable to treating it after the fact.  Get an in-depth evaluation and know your risks.  Take a proactive approach to your health.  How you live now will directly influence the length and quality of your life in the decades to come.

[2]Singh S, Loke Y, Furberg C. “Long Term risk of Cardiovascular Events with Rosiglitizone: a meta analysis.  JAMA, September 12, 2007—Vol 298, No. 10

[3] Nissen S, Wolski K. “Effect of rosiglitizone on the risk of Myocardial Infarction and Death from Cardiovascular causes”. N Engl J Med, June 2007 356;24

[4] Nissen S, Wolski K. “Rosiglitizine Revisited: an updated meta-analysis for myocardial infarction and cardiovascular mortality”. Arch Intern Med. 2010;170(14):1191-1201.

[5] Home P, Pocock S, et al. “Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial”.  The Lancet, Volume 373, Issue 9681, Pages 2125 – 2135, 20 June 2009

[6] Wertz D, Chang C, et al. “Risk of Cardiovascular Events and All-Cause Mortality in Patients Treated With Thiazolidinediones in a Managed-Care Population”.  Circulation: CV Quality and Outcomes. 2010;3:538-545. Published online before print August 24, 2010, doi: 1161/CIRCOUTCOMES.109.911461

[7] U.S. Food and Drug Administration. FDA drug safety communication: ongoing safety review of Actos (pioglitazone) and potential increased risk of bladder cancer after two years exposure.  (http://www.fda.gov/Drugs/DrugSafety/ucm226214.htm.)

 Low fat recommendations have been the mainstream message from such esteemed organizations as the American heart Association, the AMA and the USDA (creators of the food pyramid) among others.  The logic behind this school of thought seems intuitive.  Since increased blood lipids were associated with cardiovascular disease, and, cholesterol is a major component of arterial plaque, reducing dietary intake of saturated fats and cholesterol should remedy the situation.  In addition, fat is more calorie dense than carbohydrates, so eliminating fats from the diet should reduce caloric intake and result in weight loss.   There are, in fact, some clinical studies supporting the benefits of low fat diets on blood cholesterol levels and regression of arterial plaque.  This philosophy has been questioned in recent years.  An 8 year study of postmenopausal women eating a reduced fat diet over 8 years derived no significant benefit relative to cardiovascular disease, stroke, and coronary heart disease or CVD risk factors.[i]  As logical as the low fat diet seemed intuitive is the question:  if low fat was all it was purported to be, why over the last 30 years of low fat promoted diets and low-fat food products of every stripe, have Americans become more obese than ever, and cardiovascular disease remains the leading killer?

 The answer is based more on indisputable physiology and nutrition science than intuition.  Excess carbohydrates cause obesity, lead to insulin resistance, and signals the body to make and store more fats.  High carbohydrate meals, particularly simple, easily absorbed carbs found in sugar, pasta, potatoes or anything made with white flour, stimulate the secretion of insulin.  That insulin causes the carbs to be taken up by cells for energy but if not needed immediately, stored as fat.  That rapid reduction in blood sugar causes hunger which leads to more carbohydrate ingestion and the cycle continues.  As a result, blood cholesterol and triglyceride levels go up, thereby increasing cardiovascular risk.  Earlier this month, a randomized comparative study of low carb and low fat diets concluded that weight loss was comparable between the two but only the low carb diet reduced cardiovascular risk parameters.[ii]  Generally speaking, the low-carb approach is more satisfying and sustainable since it does not require limiting calories.  The fat and protein content keep you feeling full longer obviating the need to count calories.

 Is it just as simple as eating low carb?  Of course not.  No diet strategy taken to an extreme is good.  Individauls metabolize food substrates differently.  The diet that has most consistently been shown to reduce the risk of chronic diseases is a Mediterranean-style diet.  It is not low fat nor strictly low carb.  At Alternity Healthcare we make our recommendations are individualized and based on an extensive diet analysis, a thorough metabolic assessment and nutritional consultation with our registered dietician, Dr. Cassandra Forsythe.  Here are some guidelines:

• Eat real food – something grown or has a parent.  Something your grandparents would recognize as food.
• Eat healthy fats, such as omega-3 fats found in fatty fish (salmon, sardines), olive oil, nuts.  Fats should comprise about 30% of calories.
• Consume most of your carbohydrates from colorful fruit and vegetables
• Eat lean grass-fed meats, free-range poultry and wild caught fish
• Avoid simple, refined carbohydrates, sugars and artificial sweeteners
• Avoid trans fats and processed foods

[ii] Foster G, Wyatt H, et al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet. A Randomized Trial. Annals IM August 3, 2010 vol. 153 no. 3 147-157