Monthly Archives: November 2012

Too Much Vitamin D! Yes, we have found a ceiling

Too Much Vitamin D!   Yes, we have found a ceiling.

Reference:  American Heart Association Meetings in Orlando, Nov 18, 2011 Report from Intermountain Medical Center, Dr Jared Bunch

For a column that has spent some effort to advocate for Vitamin D and its benefits, it’s important for us to also know where our upper limit is.  What is toxic?   I get that question all the time and we haven’t had a clear answer.  Now we do!  It’s atrial fibrillation that emerges as the risk.

Atrial fibrillation is when the top part of your heart, the atrium, that is meant to prime the ventricle with a coordinated filling beat, gets  spastic and effectively shivers like a little bowl of jello.  In effect, it is beating 400 beats a minute which the ventricle below just can’t do.  The net result is a chaotic beating of the heart with no pattern to the beat.  Often it’s too fast, around 140-160 but the output of blood is actually lower because the ventricle isn’t being primed properly.  You feel crummy.  Younger folks will often revert back to a normal rhythm when the offending cause of their atrial fibrillation goes away – most commonly too much thyroid hormone.

Dr Bunch was the lead investigator in this study and found that folks with an excessive level of Vitamin D, greater than 100 ng, have a two and a half time increased risk of developing atrial fibrillation.  The study has pretty good predictive power because they were following some 132,000 people.  The comparison was to folks with “normal levels” that they defined as 40-80 ng.

Isn’t that interesting!  See where we have come.  A few years ago we called normal 9-50 ng because that is what we observed in the population.  Now we are calling anything below 40 to be low.  The Institute of Medicine is saying its safe to take up to 4000 IU a day, which is what a young 20 year old Caucasian will make in 4 minutes of good sunshine.   But the IOM recommends only 600-800 IU a day for bone health.  That’s way too low for heart protection.  The average person taking 4000 IU a day will likely level off at around 40-50 ng.  On just 2000 IU a day, the average person in Wisconsin will level off around 30-40 ng – too low.

Only 5% of the population develops atrial fibrillation in their lifetime, but it becomes much more common as we age and develop heart failure.    This study becomes a bit of a caution to the Vit D enthusiasts who cheerfully take 10,000 IU a day without measuring a blood level.  On 10K a day, the average person will level off at 80 ng, but some petit folks with little body fat will be much higher.

WWW.  What will work for me?   I’m glad to hear the normal range being defined as 40-80 ng.  That’s pretty good science.  I got my level checked and I’m in the 60s.   The reduction in cardiac risk with more D is pretty impressive when your level gets to 45 or so, so I like to think of that as my floor.  A level of 100 is a long ways away.

Written by John Whitcomb, MD  Brookfield Longevity and Healthy Living Clinic,  262 -784-5300    17585 W North Avenue,  Suite 160

Making a Data Dashboard on Your Metabolic Risk for Diabetes – for FREE

Making a Data Dashboard on Your Metabolic Risk for Diabetes – for FREE

Reference:  Watkins et al, Stockholm Diabetes Meeting 2010

When you drive your car, you have a variety of tools in front of you.  You have a speedometer, a gas gauge, a radio dial, a thermostat, a seat belt monitor etc.  All so you can operate a car safely and comfortably.  You have data at your finger tips.  In medicine, we have curiously given over that power and information to our doctors without letting you in on the secret.  Bit by bit, that’s changing, and needs to change.  There is increasing data that lifestyle changes are more effective than pills at changing your risk for diabetes.   The relative effectiveness is on the order of 3 to 1 lifestyle over pills.  The real barrier is motivation.  You see your doctor and are told, “Exercise and lose some weight, see you next year.”  With that admonition, you might not do much.  Next year, you get a pill because you didn’t get better. But that pill won’t prevent long term complications.  Making lifestyle choices will.   Hence, the problem is motivation for change.

Enter the Tethys company with their PreDx test.  The Tethys company has combined 7 markers for diabetes risk into an aggregate scoring mechanism from a single fasting specimen of blood.  Their argument is that with seven risk factors for diabetes placed in front of you, you will develop your own intrinsic motivation to change behavior.   You need data, just like when you drive your car.  You need a variety of data from multiple angles that give you’re an aggregate risk analysis.  And, to be effective, you need to be able to get the data as often as you need to manage your life.  Most importantly, it needs to be free, so you get it often enough to change behavior.

The seven markers are glucose, HgbA1c, C-reactive protein, insulin, IL-2b, ferritin and Adiponectin.  All together, these tests can cost close to $ 2,000 if done separately.  But the Tethys company has persuaded enough insurance companies in America to cover it, including Medicare (not Medicaid) that they can now offer it to physicians to provide their patients access to it whenever they want.  Now, very few are going to come in and overuse it.  It costs society about $ 8000 a year to care for a diabetic.  To help someone turn back their risk factors from bad, to moderate, to better, to optimal.

This raises another critical point.  Diabetes is not a Yes or No diagnosis.  Granted, we say you are diabetic when your blood sugar is over 140, twice.  We are nervous when your sugar is over 120.  We advise you to exercise and lose weight if your sugar is over 100. But we know that you are still at risk for every point above 86.  So, your blood glucose is a continuum of risk, and the lower the better.  Optimum is less than 86.  That same logic applies to all of the 7 markers.  Glucose happens to be a late marker.  Adiponectin changes first. CRP may also be way earlier.  If we want to keep ourselves optimally well, isn’t is useful to know all the data that pertains to us?  And wouldn’t it be nice to have that data repeated in three months after we have had a chance to really try hard and lose those 10 extra pounds?

WWW. What will Work for Me?   I really like this idea and have started running the PreDx test in my practice.  Folks in large integrated health systems may not be able to get the PreDx test from the Tethys company because their labs may not be set up to do some of those tests.  But the idea of getting your glucose, your insulin, your CRP and your HgbA1c as a baseline, and then repeatedly if you aren’t close to optimal is a pretty good one.  My own score wasn’t optimum.  I’m a bit rattled.  I have a slightly elevated risk for becoming outright diabetic in the next 5 years.   Grrr.  Back to running and eating fewer carbs.

Insulin and Inflammation: Making a Data Dashboard

Insulin and Inflammation: Making a Data Dashboard

Reference:  Scientific American  Dec 16 2009

Last week we talked about making glucose an important part of our “data dashboard” as we learn how to manage our own chronic risks.   This week, it’s insulin.

What is insulin?  I’ve been taught my entire life that insulin is your hormone that controls your blood sugar.   If you look up insulin in Wikipedia, you will see the emphasis on insulin being your blood glucose controlling hormone.   I’m going to hypothesize that explanation is too simplistic.  Yes, it does control your blood glucose.   But what’s happening when you lower your blood glucose?  You are putting glucose into storage.  That’s called fat.  In nature, we want to store fat when we need to prepare for a long season coming ahead in which we will be starving.  That’s called Winter.   So, I’m going to offer a different explanation.  I would suggest that insulin is your STORAGE hormone.  It accomplishes that by having an effect on glucose.  It is released when you eat foods that are high in easily released glucose: fruits and grains.  Those foods ripen in late summer, early autumn, just before winter.  I would posit that insulin becomes the hormone that accomplishes the need to put on fat to store against lean times coming.

The only problem is that we never have the lean times.  Nor do we ever have a natural break in the rhythm of our lives and not have foods that make us release insulin.  Our bodies live in a constant state of “late summer”, thinking they have to store calories for the coming winter season.   Because our food supply is made up of what we like, instead of what is available by season, we eat foods every day that are high in free glucose.  Hence, we are always in storage mode.  So, we get fat.

But that’s not the whole story with insulin.  The dark side of insulin is that it is also intimately tied up with inflammation.    We have known for about a decade now that becoming overweight makes our fat cells release chemicals called cytokines.  TNF-alpha is a prime example.  Those cytokines suppress insulin-signaling pathways, making our bodies more insulin resistant.   As you become insulin resistant, you can no longer suppress FOXO-1.  FOXO-1 is the master switch to turning on interleukin 1-beta, which also suppresses insulin.   Confused?  Round and round we go.  Fat cells get so big, they die.  That causes more inflammation.   Which comes first, inflammation or insulin resistance?  No one is quite sure, yet.  The “common soil” hypothesis suggests that both processes rise out of the same origins.   And that’s the final conundrum.  Most of our illnesses of the modern era have inflammation as part of what makes them occur.   Hence, they are all associated with adult diabetes and obesity.  Being overweight is a high risk for Alzheimer’s, heart disease, cancer and diabetes.

If I’m to manage my life, I want to know my insulin level.  It often rises before glucose and driving it back to normal should be one of my goals.   What’s normal?  In America, we call 2-22 the normal range for insulin.  The slender, physically fit folks have levels below 5.  Overweight folks have levels much higher.

WWW.  What will work for me?   I want an insulin level below 5.  To do that, I need to be slender.   Hmmm.  Back to this weight loss thing.  Got any suggestions with Thanksgiving around the corner?   I’m going for the vegetables.    And muttering against the tyranny of FOXO-1.

Slowing Cancer Growth by Vegetables

Slowing Cancer Growth by Vegetables

Reference:  Barnard, Nutrition CancerSoliman Evid Based Alternative Med

To detect a cancer, you need about a billion cells.  That size a lesion can be picked up on mammogram.  To get to a billion, you have to have cells double about 30 times. (Try it on your calculator.)  A cancer cell doubles in about 30 to 500 days.  If it doubles in 30 days, you only need 30 months to get from one cancer cell to a detectable lesion.  If it takes 365 days to double, your tiny cancer will take 30 years to develop to detectable size.  So, ask yourself whether you want your inevitable cancer to multiply at 30 day doubling time, or 365 day doubling time. Just about all men have some prostate cancer in them when they die.  But there remains quite a difference between different cultures in the rate at which men die FROM their cancer, versus WITH their cancer.   The same data holds true for breast cancer.  It has been estimated that at least a third of women have some detectable cancer in their breasts by age 30.  It may have been there all along, just growing very, very slowly.  The whole story with cancer may not be that we get it or not.   We all have it.  The question is whether our bodies are welcoming hosts that make the cancer at home and provide it with all the nutrients it needs, and take away all its impediments.

That’s what Dr Barnard describes in this delightful little study.  He took blood from folks eating a Standard American Diet (SAD) and dripped it onto little cultures of breast cancer cells.  Result: 8 day dividing time.  Wicked disease.  Next try,  vegan diet with daily exercise.  In just two weeks, the cancer cells slowed their growth by 20% when the folks with the cancer started diet and exercise.   Their IGF-1 (growth hormone) levels dropped dramatically.  When Dr Soliman tried that experiment, he took prostate cancer cells and added the IGF-1 back and sure enough, the diet and exercise beneficial effect went away.   Their conclusion was that the vegan diet slowed the rate of cancer cell growth and concordantly increased the rate of cell death in cancer cells dramatically.  These results might well be mediated by the growth hormone.

When you add all these effects together, taking into account different researchers findings, you can project that a long term vegan diet will lower the rate of cancer double by as much as 70%.  This is in support of Colin Campbell’s findings from the Philippines where he found that children eating less than 5% animal protein got cancer from aflatoxin at dramatically lower rates than children eating high animal protein diets.

What is the magic of plants?  Is it the multitude of phytonutrients, flavonoids and other antioxidants?  Or is it something simpler?  How about acid – base balance?  How about plants just making your body more alkaline?  Probably not your blood, but your urine and the buffers in your blood.  That would be my bet.

WWW.  What will work for me?  My goal is to die WITH my cancers, and have them simply be well-behaved, quite little devils: like good children.  Seen but not heard.   I can accept that we are all getting them all the time.  It appears that vegan eating has an effect that we can’t quantify fully yet, but dramatic lowering of cancer doubling time is possible.  Cutting down our diets to less than 5% animal, and no trans fats and no sugar is pretty hard to do in America.  The value may be there to give it a try.  It likely will work better if you start before you have the obvious, detectable cancer.

Make a Data Dashboard – Glucose and Diabetes

Make a Data Dashboard – Glucose and Diabetes

Reference:  American Journal of Medicine, June 2008.

This is big.  Understanding glucose and its role in your health goes to the very heart of our modern epidemics.  We now understand that disordered glucose metabolism is key to the our risks for heart disease, stroke, Alzheimer’s and cancer.  Yes, cancer too.  Many of our cellular mechanisms that go awry with glucose are part of the mix that make cancer cells misbehave.   That’s why folks who are overweight get more cancer.  And more Alzheimer’s.  And strokes.  And, of course, heart attacks.  Which one did you want to sign up for?   Avoid them all and you will live longer, healthier and wiser.

We call disordered blood sugar diabetes.  But we don’t put that label on until we get to a blood glucose level of 140, twice.   What do we do with a level of 119?  We tell you to exercise and lose weight.  What about 96?  We say, “You are fine. See you next year.”   Well, that’s not good enough!  When you drive a car, you have a speedometer in front of you and a gas gage.  Both of them give you data by which you can modulate and plan your behavior.  Not to mention the radio, the thermostat, the lights and the turn signal.  We are used to having data that we use to modulate our environment and achieve safety.   Why not in our personal health lives?

It’s time to take that model to our personal health.  We need to understand glucose as a marker of disease that exists on a continuum.  It is not black and white.  You are not “sick” or “well” when your blood glucose is 141 (diabetes) versus 139 (not-diabetes).   When you drive and your speedometer is 72 mph and you pass a cop, you might just ease off a few miles.   In Elm Grove, if you are going 29 mph and pass a cop, you better ease off or you will help fund our city government.

This article is seminal and should be the foundation of how you monitor your glucose.  It shows a very simple fact.  Perfect blood glucose is actually a blood level of 86.  For every point above 84, you have a 6% increased chance of developing diabetes eventually.  And diabetes leads to heart disease……Alzheimer’s.   If your level is 102,  you are NOT safe.  You are better off if your level is 99…better if you are 92, better yet if you are 88 and just plain wonderful when you get to 80.  Whew.   This study supports the British Whitehall study that came to the same conclusion. The authors in this study followed 46,578 healthy folks whose glucose was under 100 and then who developed diabetes over 10 years.  This was enough people to be a pretty powerful statistically accurate study.   6% increase for every point!

WWW.  What will work for me.  I want a “data dashboard” of information that I can get whenever I want so that I can modulate my behavior.  I check my gas gauge and my speedometer every time I drive.  I weigh myself every day.  Now I need to know my glucose, frequently and accurately so that I can see what happens when I stop by Leon’s and have two scoops of chocolate.   Not pretty.   That’s how we will all learn to modulate our eating, our exercise.  Time for blood glucose to become widely and cheaply available.   We need our health data dashboard before us.

Written by John E Whitcomb, MD   Brookfield Longevity and Healthy Living Clinic 17585 W North Ave, Suite 160,  Brookfield, WI 53045  262-784-5300

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