Monthly Archives: July 2017

The Trouble with Iron

The Trouble with Iron

References: The Mindspan DietEndocrine Society MeetingHow Much Iron in My CerealJr of Nutrition,

Ready to blow your mind with a whole new set of ideas? Want to live a lot longer and have your brain survive with you? Want to have an organizing principle that explains much of the trouble with modern nutrition, that is a complete curve ball from anything you have ever heard before? Here goes. Please read the next couple of weeks of The News with great attention to the details in this column.
Dr Person Estep is not am MD, he’s the smart kind, a PhD at Harvard Medical School, in Genetics and Health Science. HIs research is into those populations of people whose brain survives into their later years, and why. I’ve just devoured his book, and if you want to preserve your brain, you should too. This is a must read.
Let me start with a few core principles and ideas that he presents. First, the concept of MIND SPAN. I want my brain to survive longer than my body. My LIFE span makes me nervous, if it’s longer than my brain span. That’s Alzheimer’s (AD). Get that? Of course your do. We all do, and right now 50% of are getting it if we have the “good fortune” of living to 85. That’s idea #1.
Concept #2 for us to all know is the idea of Antagonistic Pleitropy. (Wow, if you get this, you can skip medical school.) It’s actually a simple idea. What it means is that your bodies needs change as you age. What was good for you once, becomes bad for you later. Biology works by natural selection, and reproduction is the driving force. If you can’t pass on your genes, they can’t change. So, natural selection works only until you stop reproducing. Nature is not interested in you once the pressure of natural selection is over. Get it? What is good for you before passing on your genes, may be bad for you later. Women have to give iron to their babies. The human body needs iron for it’s blood making. And through most of human history, our guts were filled with tiny worms that made us lose iron. In this mix, men have to make sperm. Trillions of them. But sperm doesn’t involve the losing of iron. Making babies does. Lots of iron. The human species has resulted in a model that generally, in both genders, accumulates iron easily. That’s good for women, while they are making babies. And its good for all of us when we keep losing iron from intestinal parasites. What happens to us after we stop reproducing? Well, nature has no way of repairing or changing that tendency to accumulate iron after our reproductive years. What happens if we keep accumulating iron? What happens when we get good plumbing and sanitation and stop getting pin worm? Our iron leak stops.
What happens, if we decide that our society is across the board iron deficient and we add iron to all of our grains? (Look at your breakfast cereal and see how much iron you are getting. Look at your “fortified bread” and see how much iron you are getting. Consider that the USDA says that we need 18 mg of iron a day, and good science shows that actually you probably need much less, like 4 mg a day, once you hit 50. What’s happened is that in America, we have added abundant iron to our diet, to our baby formula, to our grains, our breakfast cerealsour rice, to our whole food chain. And that may be a big problem.
What if I told you that accumulating ferritin in your pancreas pushes you into diabetes? What if I told you that amyloid plaque in your brain may be a side effect of a desperate attempt to get that toxic iron out of your brain. We’ll get to that in the coming weeks.
For now, think about these two core ideas and please, look at your “fortified” flour on your shelf and read the labels for your source of iron. Think about how red meat provides you lots of iron. And next week, we’ll have more details.

WWW.What will work for me. My mind is being totally turned upside down. I can’t wait to tell you the rest. This is a whole new way of exploring the metabolic problems we face with aging. But for now, stop taking any iron in your diet. STOP. Trust me. Stop. Stop your vitamin pill with iron. Stop your fortified cereal. Get skeptical about red meat. I’ll prove it to you. Or else buy the book. Next week.

 

Pop Quiz

  1. The human body accumulates iron easily, too easily. When is that good, and when is it bad?                                                                        Answer: It’s good if you are a young female, having lots of babies and with lots of intestinal parasites – like humans were until 100 years ago when we cleaned up our toilets, our guts and stopped having so many babies. It’s bad when you are male, have a clean gut, live longer than 35 years.
  2. What is this effect called?                                     Answer: Antagonistic Pleiotropy. (Go straight to your third year in medical school.) What’s good for you at one age or circumstance, becomes bad for you later.
  3. We decided, as a society, that every one should have how many milligrams of iron a day?                                                                             Answer: 18
  4. How many milligrams do mature adults, past the age of child bearing need? Answer: Probably around 4.   Certainly no more than 8.
  5. Should I worry about the red color of my ibuprofen pill?                              Answer: Yes, that is actually oxidized iron. Buy another brand. The ibuprofen is good for your brain. The Iron is not.

Nine Risks for Cognitive Decline

Nine Risks for Cognitive Decline

References: The Lancet, July 2017BBC News

This week, in London, the Alzheimer’s Association International Congress, just met. One of their presentations was a publication in the Lancet detailing the current best evidence of risk factors for developing cognitive decline. The over arching principle is that the brain does show changes with time that eventually lead to withdrawal and loss of cognitive function. It shows up as short term memory loss, but starts with other risks. Prevention should be focused on building a “cognitive reserve” earlier in life. If there is to be an inevitable downward slope, change the grade of the slope.
Your brain is constantly tasked with decided what to keep and what to throw away. It is not a hoarder. It repeatedly questions what memories to discard, what are important, and which are less important. The stop sign you passed on the way to work may not be all that important to remember. It gets tossed. Where you put your keys is important, only in the short term, but can be forgotten. Your spouses birthday, now, that is important. Your brain has to sort those out. Routine and repetition can lead to letting go.

In order to do all that sorting, your brain needs data. It needs to be exercised, flexed, challenged, used. Knowing that, the list presented at the meeting makes sense. They estimated that approximately one third of dementia was amenable to prevention by early intervention. That starts with mid life hearing loss. This is the first paper that I have seen with a meta- analysis of multiple high quality studies of hearing loss as a risk for cognitive decline. It accounted for 9% of the risk. Following that was lack of a completed high school eduction (8% risk), smoking (5% risk), failure to seek early treatment for depression, (4%), physical inactivity, 3%, social isolation (2%), high blood pressure (2%), obesity (1%), Type II diabetes (1%). These all add up to the 35% percent of modifiable risk factors.
Continuing life long learning keeps your brain working with new data. Doing something “hard” every day, keeps your brain solving problems. Staying socially engaged with humans keeps all your filters of human interaction functioning. These factors appear to be important, and make sense. They flatten the slope of decline.
What is quite new in this examination is the consideration that diabetes accounts for only 1% of risk, obesity 1%, smoking 5% and physical inactivity 3%. These are far lower than prior estimates and suggest that there was no attempt or discussion about reduction and change of lifestyle risk factors. That is likely because the prior model of weight loss is all about low fat, which doesn’t work. Hence, no one has been able to succeed with weight loss, diabetes reversal, high blood pressure reversal etc. With the proper use of low carb for weight loss, modifiable risks for cognitive decline will appear to be more meaningful and effective.
WWW.what will work for me. I’m paying attention to the hearing loss concern. This is the first study that shows it to be so high on the list. It’s never been so high in any prior study. I’m going to find a time to get myself checked. I haven’t seen any other study like this, so this could be a statistical blip, but it sure catches my eye. Pay attention.

Pop Quiz

  1. The current article suggests that as much as 35% of dementia can be prevented. T or F                                              Answer: That’s there data from statistical analysis. I think the number can be much high.
  2. Mid life hearing loss can be postponed until you are on Medicare. T or F                Answer: False. It leads to social isolation.
  3. Cognitive decline is a natural process. T or F                                     Answer: Sadly true if you live long enough. Age is the strongest risk factor. What is not discussed here but is quite intriguing is that dementia may be the result of a protective or natural process going awry.
  4. Hearing loss may be far more important a risk factor than we care to acknowledge. T or F Answer: Yup
  5. The combination of diabetes, high blood pressure, obesity are all one parcel of common problems best reversed with a low fat American Heart Diet. T or F Answer: It’s true they are all one parcel, it’s false that the AHA diet will help you.

 

Don’t Eat Mac and Cheese

The Poison in your Mac and Cheese

References: KleanUpKraft.org, New York Times, CNN,

It was all over CNN, BBC, New York Times this week. “What Chemicals are in your Mac and Cheese?” Mac and Cheese. My kids were raised on it. It’s one of America’s iconic foods. The pinnacle of American comfort food. Here’s the rub. Ten years ago, we banned phthalates because they were found to be “endocrine disruptors” in children and exposure resulted in behavioral and neurodevelopmental issues. All the big retailers withdrew their children’s toys that had phthalates. Kids chewing on their rubber ducky were getting phthalates that soaked out of them.

Phthalates make kids toys soft and pliable. But phthalates are plastic chemicals that have a lot of beneficial applications. Your electrical wiring in your house is coated with phthalate plastics. Your vinyl flooring is resilient and pliable because of phthalates. And now we find in in your kids food. How did it get there? It’s not added to the food, it leaches out of the plastic tubing that is pliable and long lasting because it is made with phthalates. In manufacturing Mac and Cheese, there is plastic tubing that is made with phthalates. Voila. There you have it. The packaged Mac and Cheese had four times the level of regular cheeses, even the processed stuff in slices that comes between two layers of plastic.

What did this study show? Of thirty brands of Mac and Cheese, 29 had at least one phthalate, and some had six. The most common one, DHEP, is the one most commonly found and is the one most widely restricted. Kraft Foods made 9 of the 30 samples tested. There are 2 million packages of it sold every day in America. Hmm. So your kids are still getting it.

Your first response may be, “Give me a break. You can’t get that much out of the tubing from making the stuff.” Wrong, wrong. You get parts per billion. That doesn’t sound like much but it’s as much as four times the level of your own hormones. Therein lies the rub. Phalalates have been particularly linked to the suppression of testosterone.

The good news is that once you stop eating or ingesting them, they flush out pretty quickly.

www.What will work for me. It’s so easy to make your own mac and cheese. Just get some nice sharp cheddar and gorgonzola and make your own. Just don’t squirt it through plastic tubing. In the meantime, I’m not even buying Mac and Cheese any more when I stop at the grocery for food pantry donations. It you want to change the system, let your purchasing habits drive the market. If you want to change your testosterone, don’t buy packaged mac and cheese.

 

Pop Quiz

  1.  Processed foods that come in boxes are made in large, industrial sized factories, where high pressure, high heat manufacturing methods leach phthalates out of plastic tubing, enough to have detectable phthalates in the food being made. T or F Answer: If you followed all that, you got it.
  2. The concentration of phthalates in processed food is not meaningful. T or F Answer: It’s in parts per billion, some four times what your own active hormones are.
  3. Phthalates are known to suppress estrogen. T or F                       Answer: well yes, but the real damage appears to be to testosterone, needed by both men and women.
  4. If I buy organic Mac and Cheese, I can get away from phthalate contamination? T or F                                                            Answer: Nice try. False.
  5. Our kids are particularly susceptible to phthalates, which is why we banned them from kiddie toys. Makes sense to ban it from their food.                          Answer: Not if your food lobby pays your members of Congress enough to keep quiet. But we should. (Pay attention to the language – “We are going to reduce regulations that are job killing.” Might be code for not paying attention to food contamination.)

 

 

Sufficient Vitamin D Improves Vascular Health

Sufficient Vitamin D Improves Vascular Health

References: Indian Jr Endo MetabAmerican Journal of Cardiology,

I was excited last year when it was reported that Vitamin D helped folks with congestive heart failure. When 233 patients with congestive heart failure were randomly given Vitamin D, their 6 minute walk time didn’t improve, but their ejection fraction increased 23% relatively, or 6% absolutely. The dose was 4000 IU a day, with no loading dose. Note, half of us will die of congestive heart failure, so this is a big deal for older folks, particularly those with congestive failure. You may not be able to walk further, but you are still walking. Most folks with an ejection fraction (the percent of blood your heart can pump out with each stroke, where normal is 65 and dead is 18) in the low 20s die within a year or less. So, being around fora year to finish a study is cool. I added Vitamin D to my Congestive Heart Failure protocol.

I’ve been watching for mechanisms of just how it works. Here it is! In this study, 103 folks with Vitamin D deficiency (below 20 ng) were given 60,000 IU a week for 8 weeks. Measurements were taken of vascular function like carotid-femoral pulse wave velocity, brachial-ankle pulse wave velocity, arterial stiffness index and oxidative stress markers like serum malondialdehyde levels and total antioxidant status. They demonstrated about a 10% reduction in pulse wave velocity, (996 cm.sec to 899 cm/sec) and systolic blood pressure from 115 to 106. All were statistically significant. Lowering blood pressure (996 cm.sec to 899 cm/sec) and systolic blood pressure from 115 to 106. All were statistically significant. Lowering blood pressure even 2 points reduces risk for vascular disease 4-6%.
[Now, there are any number of studies that are referenced in this article where Vitamin D didn’t help heart disease. Many of these have been highlighted in the popular press to suggest that vitamin D supplementation doesn’t work.

Cardiologists like to quote them to justify having a cath instead of taking D. Hmmm. Just about every one of those studies gave lower doses of D, in the 2000 iu range, for 6-8 weeks at a time. This is a good example of the utter stupidity of most studies that essentially don’t understand the physiology of Vitamin D. Your bodies fat tissue soaks up D and stores it. It is fat soluble. You are a big tank. If you are overweight, you are a bigger tank. When you start a new dose, it will take your body a full year before a new homeostasis is achieved. In the long run, a dose of 3-4,000 IU a day is sufficient in most folks to get to a level of 50 ng, my definition for replete.

This study effectively gives a loading dose. 60,000 IU a week gets to threshold.   I give 100,000 IU because that has been proven to raise your D level 14 ng a day. If someone is low, < 20 ng, you can give two doses in a row. They will add 14 ng a day and in two days will be at 45-50. Finally, Vitamin D works as your stem cell hormone, telling stems cells to wake up and start maturing into mature cells. Mature cells can do their function. It takes months for a mature cell to grow and start doing its function. If your D level is rising so slowly that you don’t have enough for a year, a study lasting 12 weeks, with an inadequate dose of D will never show an effect.

The final point to make about D is the clear need for it to be accompanied by K2. Weston Price highlighted this in the 1920s because that is what he observed when he documented the lifestyles and diets of “primitive” people. Like every pioneer, Weston Price didn’t get everything right, and his foundation has a few tangents that are off base, but by and large, he opened the door on omega fats, K2 and D, something we didn’t appreciate for another 70 years. When you look at D in isolation, you will often likely miss the beneficial effect if you don’t control for Vitamin K input. Increasing recognition of the complexity of our metabolism can be seen in the interplay of D and K2. They are really part of a biological partnership. Both are fat soluble.

www.What will work for me. I’m getting a better understanding of how D and K work together. Seeing a study where adequate doses of D make an impact when similar inadequately dosed folks didn’t get an impact is an important distinction. The self righteous deniers of this effect can’t explain that. Once they are ensconced in nay-saying, they keep nay-saying. As for me, I cheerfully take my D, 3500 IU a day in the form of 100,000 once a month. And I wear a hat and sun screen. Just one more skin cancer to take off my back.

Pop Quiz

  1. Vitamin D works by……….? Activating many genes, (10% of the human genome) which stimulates stem cells to become mature cells.
  2. It takes Vitamin D how long to change your blood level? Answer: If you don’t take enough, you will never get to an adequate blood level but generally you reach a new homeostasis in about a year after starting a new dose.
  3. To get to an adequate blood level Vitamin D, you need a loading dose of …..? Answer: 100,000 IU for every 14 ng you are deficient. If you want to get to a level of 50, and your level is 8, you need ………….? Answer: 3 doses of 100,000 IU, one day apart each.
  4. Your arterial blood velocity will drop when you take Vitamin D, which means your arteries have gotten stretchier and your blood pressure has dropped. T or F
    Bingo.
  5. To prove that Vitamin D works on heart disease, you likely need to do what in terms of designing a study? Answer: It has to run longer than a year, have a loading dose, and take sufficient D to get to a level of 50. This has never been done. Any study with less, shorter, and no loading dose, no monitoring of blood level and no randomization will not show scientifically meaningful results. Meanwhile, the physiology of benefit sits right here, in this study.

Luteinizing Hormone and the Development of Alzheimer’s

Lutienizing Hormone and the Development of Alzheimer’s

References: Horm Behavior 2015PNASNeurobiolog AgingScience Daily,

Luteinizing hormone rises sharply with menopause. It is the hormonethat stimulates egg production and ovulation in women, and sperm/testosterone production in men. The ovaries no longer respond to the effect of FSH and LH, and their rise marks the definitive marker of menopause. Hormone levels fall. Hot flashes, hair loss, lousy sleep, etc all ensue. Misery. Sorting out the confusion is no mean feat, particularly because there remains widespread confusion over the elevation of breast cancer risk with post menopausal hormone replacement. This confusion stems primarily from not recognizing the adverse affects of non-human estrogen compared to the beneficial effects of bio-identical human estrogen.

There is a legitimate question in there. Is it lack of estrogen that is dangerous, or the rise in the hormones that encourage the secretion of estrogen, namely luteinizing hormone. What effect does long term LH have on the female brain? That’s the question raised here. How is the lack of Estrogen and Progesterone played out? Is it the lack of Estrogen that is the issue, or the damaging effect of too much LH?
That’s what this week’s article is about, the possible role of LH in causing Alzheimer’s. The authors carefully review the animal literature that demonstrates the damaging effect of high levels of HCG on rodent brains. HCG is very similar to LH, differing by only in the beta subunit, and is shown to have the same experimental effects on brains, namely an increase in amyloid beta proteins, neurofibrillatory tangles, and decreased problem solving ability. With menopause, LH rises sharply. With surgical menopause, it happens faster still. Epidemiological studies do link higher levels of LH in elderly women to more Alzheimer’s.

What does it take to suppress LH? You can do it with balanced hormones, which includes testosterone. Estrogen alone doesn’t do it.   It takes estrogen, testosterone and progesterone to fully suppress LH. Progesterone can be shown to do it within 90 minutes of administration, but it’s through an Estrogen dependent receptor.

Now, it’s not total Estrogen that appears to have a protective effect but rather free estrogen. That’s the nuance. There have been conflicting reports about estrogen not being protective for Alzheimer’s, at least when simple total levels are measured. But when Sex Hormone Binding Globulin (SHBG) is measured, one gets a reflection of actual free (biologically active) estrogen levels. SHBG binds 99% of estrogen, so its level strongly reflects free estrogen (the remaining 1%). Measuring total Estrogen will not give a sufficiently detailed picture of the actual hormonal milieux of the aging female brain. High SHBG has been correlated with Alzheimer’s. We do know that the use ofbirth control pills raises SHBG in women FOREVER, even after short periods of use. And we know that birth control pills alter women’s brain, changing the nature of women’s memory: emotional impact is improved, memory of details are lost. There are multiple studies showing that cognitive decline is reduced with birth control pills, which seems to suggest they are protective. What has not been done yet is a study looking at the risk of Alzheimer’s disease after using the pill in young adulthood.

So this is a real rat’s nest of conflicting issues. The bottom line appears to be that LH may be the mediating factor in cognitive decline, but that occurs in the absence of adequate normal hormonal levels. If those levels are replaced, perhaps the measurement of LH should be a consideration for proper full replacement therapy, as that is the actual causative agent for damage. The lower, the better. And for men, with low testosterone, is the use of Clomid, an LH agonist, safe? We have no information. As long as it is raising T, it probably is, but this remains an issue to watch closely.

www.What will work for me. This appears to be an issue we have to understand. There is emerging consensus that human estrogen is good for the human female brain, and testosterone for the human male brain. Is the role of that utility come from suppressing LH. Something to be closely monitored. Stay tuned.

 

Pop Quiz

  1. Luteinizing hormone can be shown to make the pathology of Alzheimer’s occur in rat.    T or F                                                                                                                         Answer: Probably true. Most of the rat research has been dose using HCG which is very close to LH, with very similar actions but a much longer half life.
  2. LH levels drop with menopause. T or F                                                    Answer. False, false, false. It’s the high levels of menopause that are the whole problem, and thereafter, Alzheimer’s begins to show up.
  3. This would suggest that women who go through menopause earlier, have the onset of dementia earlier. T or f                                                                                Answer: True
  4. The confusion over risks for hormone replacement therapy are mostly from the confusion over bio-identical hormones versus artificial. T or F                              Answer: repeatedly, true.
  5. Do you want to know you LH levels?                                                         Answer: I think I do.