Monthly Archives: November 2013

Tom Hanks Has Diabetes

Tom Hanks has Diabetes

Reference:  Oct 7th, David Letterman Show  JAMA 2012

Tom Hanks is not overweight.  But he got diabetes.  What gives?  We thought that diabetes happens just to folks who are overweight and get insulin resistant.  That’s actually true for the most part, and the risk association is there.  Even with that, though, the majority of overweight people don’t become diabetic. They are just at higher risk than normal weight folks.  And certainly, the more overweight you are, the more insulin resistant you are and the more insulin you have to put out every day to control your blood glucose.  Eventually, your pancreas wears out as though it has a life time allotment of insulin it is able to make, and once that’s used up, your insulin levels fall, your fat cells are still resistant to your sugar then starts to inexorable climb.  You become “diabetic”.

But what gives with Tom Hanks? He looks normal weight.  That raises a very interesting point.  What if you are normal weight and still have slightly elevated insulin and glucose? What’s your risk in that circumstance?   That’s what the JAMA article above is all about.  Folks who are essentially normal looking and normal weight, but are insulin resistant and eventually become diabetic have TWICE the risk of dying from the complications of their diabetes as folks who are overweight and diabetic.  That article is describing Tom Hanks.

What is this conundrum about?  It’s all about waist size and belly fat.  You may be “normal weight” but be relatively inactive and sedentary.  You tummy may be bigger and you have a larger belt size or pant size.  Your weight is ostensibly normal, but your percent body fat is higher.  You keep that “normal” weight by having less muscle mass.  That belly fat is particularly dangerous stuff as it spews out boatloads of inflammatory cytokines.  In fact, if you biopsy it, it is not composed of just passive fat cells storing fat waiting for you to burn some energy. That fat tissue is actually filled with inflammatory cells, often attracted by fat cells that died and disintegrated.   The ratio of white cells to fat cells can become as high as 10:1 so the majority of cells in tummy fat can easily be inflammatory white cells.  The inflammatory cytokines that those fat cells put out turn on inflammation all over your body.  In your joints that causes pain.  In your brain it causes depression.  In your arteries it causes vascular disease.  (This is increasingly depressing.)

Tom Hanks told David Letterman that his doctor told him he could get rid of it.  That’s true.  You can too.  Exercise, losing weight, eating less high glycemic food, building up muscle mass with weight lifting in addition to aerobic exercise will all help.

  1. WWW.What will work for me?  Time to have a talk with your waist size.  If your waist is bigger than 31.5 inches for women, 35.5 inches for men…you are at risk.  If you don’t do some sort of core muscle building and you make living sitting at a desk, you may think you are slim and trim…but….!   You want you know your insulin level in addition to your glucose.  If your insulin level is below 5, you are likely in good shape.  Most health systems say that the insulin level should be between 2-22 or thereabouts.  That’s hoo-haw.  The average American is about 11.  That’s what this article is about. Tom Hanks is average, and in trouble.  The average American is in trouble.  We all need to know our insulin level.  Ask your doctor to get it next time you are in.  If you are at a level of greater than five, I would contend you are burning up your life time allotment of insulin, and on your way to trouble:  heart disease, Alzheimer’s, cancer and diabetes are all in your future.   My waist is 38 inches.  Bummer.  Height doesn’t seem to matter.  Double bummer.

Pop Quiz

1.  Adult onset diabetes occurs when your body is unable to control blood sugar because your insulin supply has run out, and then your blood sugar rises.  T or F

Bingo. True

2.   Adult onset diabetes is usually preceeded by many years of elevated insulin, often within the range of “normal” (2-22).  T or F

Exactly on the mark

3.   Folks who have normal weight adult onset diabetes often have a larger waist size, indicating more inflammatory visceral fat.  T or F

You got it exactly right.

4.  A normal weight diabetic person has three times the risk of dying from heart disease as an overweight person.   T or F

False.  It’s double, not triple. Double is bad enough.

5.   This all suggests that knowing your insulin level might be one of the most important pieces of data for you to know in your personal data dashboard.  T or  F

True.  And less than 5 is normal, not 2-22.   Americans are all getting fatter and more resistant.  That’s why we see that range.

6.  Every overweight person will become diabetic.  T or F

False.  The majority will not.  At least not yet.  But the risk gets higher and higher with more weight.

7.  Height allows you to have a larger waist size.  T or F

Sorry John.   No.

The Value of Optimism: Longer Life

The Value of Optimism

The Value of Optimism: Longer Life

Reference:  J Pers Soc Psychology

Is your glass half empty, or half full?  Haven’t you heard that question before?  And how often have you reflected on the way you answer?  Do you let your self sink into worry about what may happen to you, and how you are trapped in the current circumstance you are in?  Or do you look forward to what you can do today and what possibilities there are laid out before you?   Are you an optimist or a pessimist?

Well, this study outlines the differences in terms of life expectancy.  How long we live has many variables:  class, wealth, marital status, community, smoking, exercise, food, …on and on.  To find a large body of very similar people with similar behaviors, beliefs and social status is a rare find.  Hence, the longevity studies of the School Sisters of Notre Dame is a unique opportunity.   Here, the researchers found 180 women who all had written an essay about themselves, their hopes and dreams back in their early years, and then lived very similar life styles of American Catholic Sisters in service to their various causes.  Now, in their late 80s and 90s, with only a tiny few left, meaningful research can be completed on what happens to folks who have different emotional attitudes to what the world offers.  To be in the study, they had to have been born before 1917, and had all written their autobiography before age 32.   These essays were tracked for words and phrases with high or low positive emotions.  The groups were compared and their longevity measured with that metric being the deciding measure.  The findings were stunning.  Those with high positive emotions lived, on average, 10.7 years longer.  That’s not a small number.  In fact, it’s up there with the Harvard Professionals Study for dramatic effect on longevity.  (5 behaviors that will add 14 years to your life if you follow all 5 at age 60: no smoking, daily exercise, weight control, good diet and a glass of wine).

This study should be a clarion call to each of us to consider our own response to stress.  Stress is necessary and good for you.  It motivates you to get out of bed, get dressed and face the day. But stress can also slowly wear you down.  How each of us faces stress defines the endocrine response within us.  An optimist thinks of life as an interesting puzzle to sort out and respond to.   Your internal cortisol response is lower, and less damaging.  A pessimist continues to worry, to obsess, to panic.  The connection between unresolved stress and illness is becoming more and more defined.  This study shows us the bottom line.  If you remain pessimistic, you live a self fulfilling prophesy.  Yes, you are doomed.   Yes, you are in trouble.

The good news is: there is a way out.  You can learn to be optimistic.  There are behaviors that can change a grumpy pessimist into a sunny optimist.  That is also part of what the nuns teach us.  Living in community, in love, with meditation and acts of service – caring for others – doesn’t that sound like nuns living in their convents?

If you want more links to the value of optimism:
Your word use reveals the age you are likely to reach
Positive view of life after retirement extends life expectancy
Looking down on the elderly raises chance of heart attack
No fear in the face of aging extends life expectancy
Contented men live longer, contented women don’t
Contented people live longer
Stay fit and untroubled by negative feelings for a long life
Feeling good? You’re likely to live longer
Optimists live longer
Belief in a just world extends life expectancy

WWW. What will Work for me?   I so enjoy learning these insightful truths.  In the Christian tradition Jesus says, “Don’t look back”.   That’s what I’m familiar with. But every religious tradition has similar messages.  That’s what inspires us.  It brings heaven to earth.  I live one mile from the Mother House of the School Sisters of Notre Dame.  I can see the spire of their convent from my window.  I hope I can be as optimistic as the best of them.

Pop Quiz

1.  An optimist looks actively for the possibilities that life has to offer?  T or F

That might be a nice interpretation.

2.   Pessimists have higher stress level hormones?  T or F

True.  Data not presented here, but it’s out there.

3.   Stress hormones gradually turn into disease and shorter life span.

T or F

That’s the key connection this study demonstrates.

4.  It’s easy to duplicate this study.  T or F

False. Almost impossible as we don’t have many nuns going into lives of service any more.

5.   You can change from being a pessimist to being an optimist.  T or F

True.  There are increasingly sophisticated methods for so doing.

Testosterone Therapy and Adverse Outcomes

Testosterone Therapy and Adverse Outcomes

Reference:  JAMA Nov 2013

Headlines on the morning news, “Men taking testosterone have up to 30% increased risk of adverse events from taking the testosterone”.   8700 men in the VA system with testosterone levels below 300 were treated with topical testosterone therapy.  They were then followed for an average of 531 days (not very long).  The rate of heart attacks and strokes were tabulated and the report published because the statistical findings were so remarkable.   Sounds like Testosterone therapy is  a dangerous thing, right?  30% increased risk in just 1 year and a half can’t be ignored.

What’s going on?   I’m delighted to see this report.  I think it highlights some very important issues.  Here is my read.  If you Google low testosterone and mortality, it’s easy to find hundreds of references indicating trouble with “low T”. That’s what got the whole thing started.   The problem comes with method and measurement.  When you give a hormone topically, it goes into your lymph system.  Hormones, (testosterone, estrogen, progesterone, cortisol, Vitamin D) are all based on the fat molecule, cholesterol.  Fat doesn’t dissolve in water.  When those hormones are secreted, they last in the blood somewhere between 5-20 seconds.  Most of them are bound by a transport molecule called SHBG or Sex Hormone Binding Globulin.  This study was based on blood levels.  Prior to treatment most folks have an equilibrium between their blood and their lymph, because their bodies are doing what comes naturally and are in homeostasis.  The hormone is coming from the right place at the right time.  When you treat topically, you aren’t putting it into the blood, you are putting it into the lymph system which is outside the blood stream.  To get to blood levels that are high enough to keep people happy, you have to give very large doses.

The normal human male makes about 6-12 mg of testosterone a day.  Giving  topical doses of 50-100 mg a day, which is common with the standard treatment regimens (not mentioned in this study), results in better blood levels, but unfortunately, you have bathed your body in very high total intracellular levels.  We should be measuring our hormones by salivary levels when we give topical doses.  An alternative route is to get 24 hour urine measurements of all the hormones your body makes to make sure you are getting the right dose and mix, because we find all the breakdown products, and what is happening to them.

Do we get adverse effects from too much testosterone?  This is a very important insight, though not unexpected.  I suspect if we have you gobs of cortisol, we could show bad things happening.  (Anyone who has taken Prednisone for a while will concur.)  Imagine flippantly giving you way too much thyroid?

WWW. What will work for me.   I’m changing my practice with this study.  I’ve been leaning to using a fixed dose of testosterone by shot because with a needle you ensure penetration of the skin, and you give an average of just 13 mg a day, roughly the right dose.  But should I use blood levels to check the dose.  I don’t think so.  This is just one study, but we should always react quickly when remarkable findings emerge when it makes sense, and a sensible alternative method exists.

Pop Quiz

1.  If I search on Google for health outcomes and low testosterone, I find lots and lots of scary studies that show low T to be bad for men.  T or F

Very true.

2.   Testosterone and estrogen are easily measured in the blood because that’s where we secrete the hormones to.  T or F

False. They are fat based hormones and disappear in free form from the serum within 15-20 seconds, leaving tiny amounts behind.  Measuring those tiny amounts may be fraught with error.

3.   Measuring hormones in the serum and using that as a basis for replacement might result in overtreatment.  T or F

Bingo

4.   Hormones do their work in the tissue, not in the blood.  Saliva levels reflect what’s in the tissue much more accurately than blood levels.  T or F

That’s it in a nutshell.

5. The average man makes about 3-5 mg of Testosterone a day.  T or F

Want answers:  Dr Whitcomb can help you sort out this confusion at www.LiveLongMD.com

Oxytocin: The Primer

The Oxytocin Primer

Reference:  Passion, Sex and Long Life by Thierry Hertoghe

What is oxytocin?  It’s one of our pituitary hormones.  It is secreted deep in our brain (paraventricular nuclei in the hypothalamus) by neurons that have a long axon attached to them that runs down into the back of the pituitary.  At the end of those axons are terminals from which oxytocin is secreted.  We discovered it and started using it around child birth.  When a woman is at the end of labor, oxytocin kicks in and assists in making her uterus make that final push.  Her brain is flooded with it and the screaming bloody baby now looks like the most beautiful thing on this planet.  She bonds with wonderful, tender loyalty to that infant.  It’s hers.  If her labor gets interrupted and stalls, the Ob-Gyn doctor can order a “pit drip” which is doctor – nurse talk for oxytocin by IV to help the labor finish up.  That’s how we have been using oxytocin.

That’s not the only place that oxytocin works.  When a woman is breast feeding, the stimulation to her breasts also releases oxytocin.  When a couple share an intimate moment and reach orgasm, they secrete a rush of oxytocin.  As we age, we make less oxytocin and our receptors become less and less sensitive.  The part of our brain that mediates emotion called the amygdala is loaded with oxytocin receptors.  It makes sense that intimate, loving events with intense, trusting relationships are called “oxytocin moments.  This part of the brain is deeply involved and damaged in schizophrenia, suggesting that oxytocin may play a role there.

But that’s not how oxytocin broke onto the secular scene.  Dr Hertoghe talked with Dr Flechas about 15 years ago, a fibromyalgia specialist, about his experiences with oxytocin.  Dr. Flechas had a patient who related to him that her pain went away after reaching orgasm.  He wondered if this could be related to oxytocin.  With a bit of experimentation with oxytocin and compounding it, she was able to have her chronic pain markedly reduced.   As Dr. Flechas experimented with more fibromyalgia patients he started having strange experiences.  He had one couple that took the first dose of oxytocin in the office and left without any apparent effect.  On the way home, however, she became so enamored and amorous the couple had to stop at a motel for “relief”.  The husband was quite enthusiastic.

All the mechanisms by which oxytocin performs its pain magic aren’t known but in animal models rats have been shown to have higher levels of the body’s natural morphine like substances like beta-endorphin and l-enkephalin.  And when given morphine blockers the oxytocin effect doesn’t work.  The hypothesis is developing that the chronic stress many of us live under depletes oxytocin, lowering peoples’ total body store of oxytocin and allowing the balance to tip towards chronic pain.  The core problem may be the chronic stress.  We can’t always fix the stress, but we can replace the oxytocin.

WWW. What will work for me?  I want to learn about it.  Next week we will cover a bit more about this new hormone that we were meant to have, and which is depleted as we live past our historical natural age.  Feeling tired? Want more tenderness?  Don’t we all!

Pop Quiz

1.  Oxytocin is the hormone women make when thy give birth?  T or F

True.  It helps make the uterus sqeeze the last bit of labor and then helps the brain feel feelings of intense emotional attachment.

2.  Oxytocin is the hormone that also floods us when we have a peak sexual experience.  T or F

True.  That’s why it has been called the love hormone.

3.   Oxytocin curiously causes pain in some people.  T or F

Actually false.  It has been shown to relieve pain in many unexpected places like folks with fibromyalgia, or kids with chronic abdominal pain.

4.  The part of your brain that mediates emotion, the amygdala, has tons of oxytocin receptors.  T or F

True. This may be why it has such strong emotional effects.

5.   Experimental models with chronic pain seem to show that it alleviates that pain by mimicing or enhancing natural morphine like substances.  T or F

T