Category Archives: 1. Know Thyself : Your Data Dashboard

The Trouble with Iron: Part IV The Nitty Gritty of What Happens in Your Brain!

The Trouble with Iron: Part IV The Nitty Gritty of What Happens in Your Brain!

References: The MindSpan Diet, Nature Communications, Front Aging Neurosci, Maynard: Jr Biological Chem, Annual Review of Neurosci,

Bear with me. I need to know the details of just what happens in your brain that makes iron so destructive. So here goes. You can get a wonderful synopsis by reading the MindSpan Diet book, or if you want a deep dive, I’ve got links here to some of the most meaningful literature.

For starters, what is the role of the APOe -4 gene? Having one copy doubles your risk of Alzheimer’s (AD), but two copies is a 10 times risk. Only 2% of Americans have two copies, but they are 15% of AD. Just two years ago, the AD Neuroimaging Initiative published a very strong paper showing that the APOe gene drives iron into the brain, and the level of iron in the brain, (as measured by cerebrospinal fluid ferritin) correlated with cognitive decline.

Along comes gene number 2, the APP gene. It was found in Down’s folks, who inevitably get dementia, and who have 3 copies of the APP gene. (It’s on chromosome 21 which Down’s folks have 3 copies of instead of two.)

Now, here is the key. We have 20,000 genes. Only 20 of them are responsive to levels of iron in our environment. It’s called the Iron-Response Element. It gets turned on when there is more iron, turning on the production of the APP protein. APP protein has the job of exporting the extra iron out of the brain.

The importance and centrality of the IRE system and the APP gene comes from population research in Iceland. There, a small and homogenous population allows genetic research to flourish. There are Icelandic folks who have a genetic variation of the APP gene, and they get about 10 years of brain protection out of it. Or, they have a 7.5 times less likely to get AD at age 85 than the rest of Icelanders. Lucky devils. It completely negates the danger of the APOe-4 gene. That really fingers the APP system as being in the forefront of causing AD. There it is.

So, let’s just simplify the sequence.

1.   You have too much iron, either because you ate too much red meat, took too many iron pills, or had two copies of the APO-e 4 gene. (Bad luck or bad environment.)

2.  The IRE system turns on, like your sprinkler system in your building in response to a fire.

3.   The production of APP protein turns on. (The sprinklers are blasting water everywhere, trying to douse the flame of too much iron.)

4.  The brain equivalent of Servrpro comes along to clean up the mess and ends up clipping a piece off the APP protein that gets left behind. That piece ends up accumulating in plaques, called beta-amyloid.

5.   As amyloid pieces accumulate, the clean up crew has to work overtime, using up its ability to duplicate  (the cells can only duplicate themselves so many times, each time shortening their telomeres and finally being unable to clean up at all).  Clean up slows.

6.  AD accelerates and the brain falls apart.  You slow.

Well, you can’t control your genes. You got what you got. You also can’t control the other elements of the breakdown process. But you can control your iron. That’s what is in your power.

WWW.What will work for me. It’s all about lowering your ferritin. What we haven’t talked about yet is the roll of copper. That may be as bad as iron, and that is coming next week. For now, I’m thinking about how to get rid of my iron. I’ve got too much and I now have the supplies in my office to do “phlebotomy” – cleaning and carefully draining blood out of you. If you can’t give it to the blood donation center. Please, please, please, do that first. Remember – you are aiming for a ferritin of 40. Give yourself a year to get there. Each time you give blood, your ferritin will drop about 20-40 points.

Pop Quiz

  1.   The APP protein is responsible to get extra iron out of your brain? T or F              Answer: True

2.     The Iron Responsive Element is one of 20 proteins in our genome that turns on in response to too much iron, and it turns on the production of more APP? T or F                             Answer: In a nutshell, you got it

3.   Your iron level in your spinal fluid reflects what’s in your brain. T or F                      Answer: Right again. True

4.   Blood donation will lower your ferritin. T or F                                                                 Answer; True. Isn’t that just too easy?

5.   We have tried our best to make sure people have enough iron. That is good for…..?                   Answer: Young menstruating women. Not so good for those of us over age 50.

LifeSpan versus HealthSpan

LifeSpan Versus Healthspan

References:  WEForum 2017Compreh Physiology 2012,  Med Sci-Fi Sport Exercise,

We are living longer. But are we living better? In the 20th century, we doubled our life expectancy with the miracle of antibiotics, clean surgical technique, X-rays, immunizations and clean water.  Babies being born today in advanced societies have a 50:50 chance of living to be 100. But living longer isn’t necessarily better. There have been some disturbing trends lately. Obesity has managed to reverse the climb to longer lifespan in some societies, namely the USA.

As we live longer, we have more choices about lifestyle, making research into factors affecting confoundingly complex. It becomes impossible to do “randomized, placebo controlled” studies over decades without limiting free choice and spending more money than could be allocated. This article, from the World Economic Forum this year, offers insight into the laboratory of fitness, namely masters athletes. I have a dozen or so men and women older than 60 in my practice who would qualify as exceptionally fit. And I see their lab results and their vitality. They are aging differently than those of us who are less active.

Sedentary behavior is being increasingly recognized as the driver of many of our modern conditions. Part of this discernment comes from the recognition that athletes, (high end performers) have a disproportionately share of good health. They don’t get in trouble. They still die, but their time of end-of-life disability is markedly compressed, compared to the majority of the sedentary population. They become a unique research cohort, one that we couldn’t duplicate with “randomized research”. In effect, what happens with athletes is that they reach their peak in their 30s, like all of us, but then don’t show much decline until close to the very end. The rest of us show inexorable, linear decline. “Patch, patch patch, after 40!,” we say.

At every age in life, starting exercise of any kind has benefit. And the risk of complications from exercise is far lower than the risk of remaining sedentary. The real risk is sitting. Considering computer games at home, TV, computers at work and cell phones in-between, we are mesmerized by electronic distractions that leave us sedentary. In fact, research in 2009 of 17,000 Canadians of all ages showed a dose relationship of sedentary behavior to all cause mortality, regardless of levels of exercise. That means 30 minutes in the gym does you no good if you are sitting the rest of the day. Bother.

The Author cites four strategies with references on each: 1) Move More (Just get started and move more), 2) Move Slow, (Aim for 10,000 steps a day) 3) Move Fast (Add some high intensity something, even for just 10 minutes) and 4) Move Heavy (Add some weights). Read those hyperlinks. It’s the best of our knowledge.

WWW.What will work for me. Sedentary behavior is the new smoking. If you want to live better, longer, you have to do it. Build it in every day. A day without exercise is as bad as a day of smoking.

Pop Quiz

1. Our grand-kids are likely to live to be 90+. T or F Answer: False if they are sedentary, but true if they get the exercise bug and take care of their diet.
2. Our society is becoming more active. T or F Answer: Mixed picture. But as a general rule, false. Bless those who make the answer slightly true.
3. 30 minutes at the gym has beneficial effects? T or F Answer: Sure, it helps. Its benefit may be completely erased by an 8 hour day of sitting.
4. There is a dose relationship between exercise and good health. T or F Bingo
5. Getting sweaty isn’t necessary. T or F Answer: False, if you want optimal results. Getting sweaty 3-4 times a week is much better for you.


Magnesium: Supermineral for Bones

Magnesium: Super-mineral for Bones

References: European Jr Epid April 2017,

When you get to be 65, as a women, your highest risk of premature disability and death comes from a broken bone. Higher than heart disease and cancer. Tell me about it. Much the same for me as a male. At age 65.5, I have fallen and broken my calcaneus (heel bone) and five months later, am still limping around. We don’t die from all of our fractures, but hip fractures result in a huge mortality. About one in 8 women will have a fractured hip and as many as 30% of them will never return home once it happens. Again, I carry a personal grudge against fractured hips having lost my mother-in-law to that event. Her mail was still on the dining room table when she died, four months later. 
Hence, my intense interest in this research. Magnesium isn’t something we talk about much in traditional medicine. It’s hard to measure. Your bones contain about 50% of your bodies total magnesium supply, albeit it is only 1% of your bone’s content. Your serum magnesium only represents 1% of your total body reservoir, so that is just a tiny sample. By the time your serum magnesium is low, you have a massive deficit, and to get that deficit, your bones have to be awfully deprived. 
The core physiology of what happens with lower magnesium is that the crystals of calcium in your bone get larger and more brittle. Brittle isn’t good. Taking calcium won’t help. Nor will vitamin D help. There appears to be a spooky relationship between Vitamin D deficiency and magnesium. Your low Vitamin D status may be tied up with low magnesium. 
Through most of human history, where did we get our magnesium from? Green plants. Raw. When we cook plants, their cells break down and all the internal magnesium leaks out. When we eat bread and grains instead of vegetables, our magnesium intake drops. When we add animal and sugar, our magnesium drops further. When we deplete our soils with intensive industrial farming, forcing our plants to grow with large doses of fertilizer, our soil magnesium drops, and our food intake of magnesium drops further still. And when we measure our serum magnesium, we really don’t see the deficit until the cow is out of the barn and in the neighbors pasture. 
The study was fairly robust. It looked at 2,245 middle aged Finnish men and followed them for 20 years. They found that those with the lowest magnesium had 44% more hip fractures. Only 22 men had a serum magnesium about 2.3. None of them had a fracture. Notice, only 1% of the men had that blood level. And you should come back to me and say, “Serum doesn’t catch it until way too late.” 
I measure Red Cell Magnesium and rarely, ever, find someone over 6.0. Most of us are in the four range.  There are studies showing that magnesium supplementation helps prevent cognitive decline. And red cell magnesium of 5.5 and above is often the minimum recommended. I aim for 6. To date, of several hundred folks tested, I have only seen 2 who have come to me with a magnesium level of 6. Both were taking daily supplements of magnesium. 
What’s my conclusion? Over 95% of us are functionally low on magnesium. The very best way to get it is with a diet of abundant green vegetables. Or just buck it up and take a supplement. Magnesium threonate is the most recent popular model for brain health. Without good bones, your brains can’t get you anywhere.

WWW.What will work for me. I’m taking magnesium threonate every day. My red cell level was only 4.9 when I tested. Second test pending still. Your should know your red cell magnesium. Aim for 6. Eat more spinach.

The Apo-B/Apo A-1 Ratio Predicts Severity of Heart Disease

The Apo-B/Apo A-1 Ratio Predicts Severity of Coronary Artery Disease

References: Lipid Health Dis, Hunt Study,

I get asked all the time about whether folks should be on a statin, or whether their lipid panel is trouble. They tell me their total cholesterol. Their doctor just told them to be on a statin. What should they do? Now, I say, “Let’s look at your lipids and see if you really are at risk. Turns out, your total cholesterol just isn’t the issue at all.” The HUNT Study from Norway has thrown a significant monkey wrench into the whole affair be discovering that women who have cholesterol above 200 live longer than women below 200. So, why are we treating you to lower your level below 200? What are your real risks?

Along comes the Singulex company and starts with a new test I hadn’t seen before, the Apo – B / Apo A-1 ratio. Sounds like a lot of excessive slicing and dicing. So, I did some reading and here is what I found out.

Apo – B is essentially the docking protein of the LDL particle. Got that? It’s the site of binding the LDL particle to a fat cell. Simple. And just what is the LDL particle doing? It is essentially carrying extra fat you have manufactured in your liver, to your fat cell for storage. You make extra fat when you eat too many carbohydrates. Through most of human history, we had extra, easily available carbohydrates only a couple of times a year: most notable at the end of the harvest season when the fruit trees and the grains were ripening, and we could eat like a pig. At that time, you want your LDLs to go up, delivering fat to your fat cells. Easy as pie. What happens when you stop eating carbs? Not quite as easy, but even better than than pie. Your LDLs start to change size and shape, and your HDL’s start to climb. And your triglycerides fall like a rock.

When you stop eating carbohydrates, your liver doesn’t have to manufacture triglycerides. Net effect is that you make fewer and fewer LDL particles, but they get bigger and bigger and fluffier and fluffier. And harmless. This unpacks the lunacy of measuring total cholesterol and using that as criteria for being on a statin. The analogy I make is “having a pickup truck full of basketballs would be, (What, 50 basketballs?) is much safer than having a 5 gallon bucket full of golf balls, (500 golf balls?) Golf balls are deadly, basketballs are harmless. It is only the small, dense, dangerous, LDLs that cause heart disease.

Back to the Apo – B / Apo A-1 ratio. The Apo A-1 protein is the docking protein on the HDL particle. It sucks lipids out of stuffed white cells in the walls of arteries that are trying to clean up the mess of small dense, LDLs. If those white cells die, they turn into a lipid pool that sets off all sorts of inflammation and becomes the basis for plaque. You want HDLs. They are your friend. You want more Apo A-1 Protein. Get it?

What the the ratio do? Turns out, it is the MOST accurate ratio for predicting risk for heart disease. You want less than 0.6. It means your HDL is climbing higher. That’s the bottom number, the denominator. And your LDL is falling, that’s the top number. And it takes into account the size and fluffiness of both particles. That’s it. It’s what you want to know to keep yourself safe.

How can you change it? Simple as pie. Aka, no pie. No sugar, no carbs. More fat and carbs in the form of “above-ground vegetables”. You now have a marker you can demonstrate is getting better and better with your eating.

WWW.What will work for me. I love having data that gets to the “heart of it”. With data, and knowing how to interpret it, I can drive my own metabolism. There is lots of research now showing it is the best. Upshot for me. Eat less carbs, more eggs and spinach.


Pop Quiz

‪1. Your Apo B protein is what?

The docking protein on your LDL particle. The more LDLs you have, the more Apo B you will have. In other words, as LDLS get smaller and denser and more numerous, your Apo B goes up.

‪2. You Apo A – 1 is what?

The docking protein on your HDL particle. That’s the good one. You want more HDLs.

‪3. How do you raise your HDLs?

Eat few carbs. Repeat, eat fewer carbs. I’ve raised my HDL’s from 28 to 61 in 4 months by eating 5 eggs a day. The best I could get with Niacin was up to 31.

‪4. So, explain in your words what the Apo B / Apo A-1 ratio is?

It is the bad cholesterol particle count divided by the good particle count. When it gets below 0.6, you’re good. Any lowering is on the path to good.

‪5. I need to keep my cholesterol count below 200. T or F

False, false, false. Read the HUNT study. Look at your ratio. Get a cardiac calcium scan. And if you can’t stop eating ice-cream, well, maybe you should be on a statin.

The Case Against Sugar: A Book by Gary Taubes

The Case Against Sugar, By Gary Taubes

Reference: The Case Against Sugar by Gary Taubes

It has been worth the wait. It was my Christmas present, and didn’t come till this last week. What a treasure. Gary Taubes new book has a different tone. He’s mad. We wants to know why sugar fell off the stage of scientific inquiry in the 1960s and 70s with fat becoming the enemy for the next forty years.

That’s what he details in this book. First of all, the curious addictive quality of sugar that we all demonstrate. Of course we act that we. It has served us well as long as we were living in the jungle and sweet only occurred just before the 6 month starvation season. Sugar makes you eat more so you put on weight, store calories and have enough to make it through the next dry patch.

But there is much much more. Did you know, for example, that the American cigaret industry really took off because they started soaking their tobacco leaves in sugar it allowed smokers to inhale much deeper, and get more seriously addicted? That was great for tobacco sales. Not so good for smokers. That’s still how cigarets are being made today.

But the most troubling part that Gary details is the clear historical record of populations being exposed to sugar, and then becoming fat, then obese, then diabetic, then cancerous, then heart attacks and kidney failure. Population after population showed this all around the world.

And our American scientific community blamed it on us. We were lazy and we ate too much. It could all be easily cured by better Puritan values of “eat less and exercise more”. We know that is what our health care system has said to us for years. Where did that come from? That’s the indictment. The sugar industry has funded critical players on the American nutrition scene for decades, never insisting that they tell outright lies, (well, maybe) but more that they focused the spotlight on fat and just ignored sugar, letting it slide out of sight. Because American medicine has not invested in its physicians understanding nutrition, there really hasn’t been the ability of American medicine to really understand adult human nutrition. We just learn by rote, memorize some convenient rules, and tell folks to get out there and eat less and exercise more.

As readers of this column you should know that it is not the calories you eat that make you fat, it is the hormonal effects of those calories that affects the amount that you eat for the next 12-24 hours.. For example, teens at a summer camp given identical calorie content of either high fat or high sugar breakfasts, are proven to eat more, later in the day, when they eat carbs. It is the insulin response to carbs, and sugar, that sets us off down the path of gaining weight and eating more. Insulin is your storage hormone, not your blood sugar controlling hormone.

Gary even has a nice section on the really dangerous chemical called fructose. It is half of table sugar (sucrose is a glucose hooked to a fructose). Fructose immediate damages your liver, forcing you to make small, dense, dangerous LDLs, making fatting liver, raising insulin, and starting the path to hypertension, diabetes, high cholesterol…….. Humans appear to tolerate fructose well enough when it comes in the package of an apple. But in table sugar, and in every form of added sugar (70% of all prepared foods have sugar added to them: bread, pasta sauce, ketchup, peanut butter etc) we get too much, to our peril.

The verdict is in. This is a brilliant book. He’s mad. There’s more in it about cancer, about kidney failure..the prosecutor is talking to the jury, and he’s mad. It’s a good thing some of those wicked food scientists who shaped American nutrition back in the 60s-80s are dead. Because they would have to hang their heads in deep shame. They harmed us so much, for a few pieces of silver.

WWW. What Will Work for Me. I just finished reading the book. It’s actually just as good as his others. The case is made for us cutting it out. Then I read today the study showing that our food stamp program has 10% of it spent on sugared sodas. And the food industry lobbies heavily to not let us restrict that. So our poor folks get sicker. So, let’s punish them and take their health care away now.

Pop Quiz:

‪1. Sugar is a natural food, but not so terrible other than it’s empty calories. T or F

False, false, false. It’s as dangerous as alcohol. Causes as many metabolic damaging effects. And probably just as addictive

‪2. About 20 years after starting to eat sugar, folks starting getting sick. T or F

That’s what hundreds of studies have detailed.

‪3. Cancer rates in societies without sugar are just the same as ours. T or F

False, false, false. Cancer rates rise in proportion to populations eating sugar. Insulin is one of cancers most potent growth factors.

‪4. I’ll be ok if I cut down and only have sugar on weekends. T or F

It may be true. If your fat cells are small enough, the human body has lots of resilience in it. You likely need to cleanse it out of you with good behavior for the next week.

‪5. If I eat a food with sugar secretly inserted in it, what happens next.

A: I eat more.

Sunlight: A Lot More Than Just Vitamin D

Sunlight: A Lot More Than Just Vitamin D

Reference: Science News, Cell,   Published Oct 10, 2016

You know that we need Vitamin D and that we get it only from sunshine. (Well, a tiny bit is artificially added to milk and Cod Liver Oil has some in it). And you know that, in Wisconsin, we stop making Vitamin D about October 1, not because it’s cold and cloudy but because the angle of the sun is now so low that almost all UVB is filtered out by the atmosphere. And you know that you need to have a blood level of at least 32 ng and optimally in the range of 45-55, which most folks can achieve with 20,000 iu a week. Ok, so far, so good.

But we feel different in winter, and the human body makes a whole host of other chemicals and hormones in response to sunlight. If you feel that your mood changes in the winter, read on. Here is the explanation.

First of all, as reported in Science News, elegant research in the journal, Cell, shows that mice, exposed to UVB radiation increase the amount of β-endorphin in their blood. It goes away in about a week. β-endorphin isn’t there for your pleasure seeking feelings, it’s present throughout your body and plays a role in many processes, including part of your immune balancing system. When the mice were given a blocking drug to morphine called naloxone, they actually showed some signs of withdrawal, as though they were habituated or addicted to the sunlight. Don’t you feel good when you get good bright sunlight?

Serotonin is one of your happy hormones. Bit by bit we are assembling evidence that sunlight makes for more serotonin. Whether it’s through Vitamin D production, leading to more serotonin, or other complex processes, we aren’t sure, but sunlight does cheer you up. Oxytocin is your bonding hormone. Without it, mother mice reject their babies. With it, we bond and feel great attachment to our mates and our offspring. Again, sunlight appears to increase oxytocin release.

Finally, there is dopamine. It is part of our portfolio of happy hormones. It appears that you might need at least 30 minutes to increase dopamine receptors and thereby increase sensitivity to dopamine, but sunlight does it.

So what’s a person to do in Wisconsin to keep our mood up when the sun goes down? Well, first and foremost, think about the portfolio of hormones that are affected by sunlight and consider other means by which you can increase them. A good night’s sleep, good exercise, entertaining positive thinking, keeping up on supplementation of Vitamin D, enjoying the pleasure of good friends, participating in strong community and loving family…all seems to make good sense, and good hormones.

WWW.What will work for me. I take 20,000 IU of D a week and 50,000 IU when I get a cold. I try to keep exercising regularly so that I get sweaty enough to take a shower. I haven’t had many vegetable oils, but I’ve had lots of vegetables. But I’m really thinking about is a nice trip to someplace sunny. Wouldn’t that be nice? Visualize that 5 mile long beach and how good you feel when you are walking on it.

Pop Quiz

‪1. β-endorphin levels go up in humans with exposure to sunlight? T or F

‪Oops, maybe, maybe not. It’s proven in mice. It’s even blocked with morphine blockers in mice. And humans and mice overlap a lot. But the research was in mice. Not humans. It confirms our hunch about how we feel with sunlight, but it’s not proven in humans yet.

‪2. We go into withdrawal when we stop getting sunlight? T or F

Well, it’s true for me. But we don’t have that research in humans. If you answered true, you may well reflect the majority opinion of how we all feel as the days get shorter and sunlight weaker.

‪3. There are other hormones released on exposure to sunlight. T or F

True. Particularly the “happy hormones”, oxytocin, serotonin, dopamine.

‪4. You can’t make much Vitamin D after October 1 in Wisconsin. T or F

True. Now, if you are particularly sun sensitivity and have very fair skin, and originate from far Northern European countries, your skin is likely still able to pick up some D at midday for a couple more weeks. You won’t burn. If you have olive skin or darker, your chance is past. Dark Africans need 6 times the amount of sunlight to get to the same D level. Older folks getting closer to 70 will need as much as 4-5 times the amount of sunlight to have the same D effect as younger folks.

‪5. When I take Vitamin D, I feel happy. T or F

Well, not really. Except for that you remembered to do it. D may help you make more serotonin and prevent warding off the winter blues, but you don’t feel it immediately. What is more likely is that you don’t descend into January depression. It’s harder to prove the absence of a negative versus the presence of a positive.

The Great Sugar Conspiracy

The Great Sugar Conspiracy

Reference: JAMA Inter Med Sept 2016,  Published Oct 3, 2016

If you are an average American, you are getting roughly 10-15% of your calories from sugar. Hmmm. Of 800,000 foods in America found by Lustig’s graduate students team, 600,000 of them have sugar added to them. When you go to the grocery store, you find cheerful markers on most food items claiming they are “LOW FAT” and hence, meant to be good for you. But low fat almost always means, high sugar. Where did this all come from?

It came from a remarkably successful PR campaign waged by the sugar lobby back in the 1960s. That’s what this week’s article details. The remarkable influence of the sugar lobby on the leading nutritional experts of the day. In the 1960s there were two leading nutritionists who held opposing views on how coronary artery disease wreaked its havoc. Angel Keys (The K in K-rations) was highly regarded because of his prominent role in Army nutrition. He advocated that fat was the enemy. John Yudkin believed it was sugar. He was off in England and what did those English know anyways!

Now, 60 years later, letters written between scientists and public policy folks are in library archives and open for the public. When these letters were unearthed and examined, the authors of this review find a terribly inconvenient truth.

Rojer Adams, a professor at the University of Illinois, was on the Sugar Research Foundation’s scientific advisory council. His letter, written to Mark Hegsted, professor of nutrition at Harvard, asking him to write a review of article on the mechanisms and risks of sugar versus fat is the smoking gun. Hegsted was also on the Sugar Research Foundations research council. He agreed to write a review article downplaying the risky components of sugar and emphasizing the problems with cholesterol and fat.

Angel Keys rose in time to greater and greater prominence, and he carried the torch forward. He was a bully in public and at meetings of anyone who disagreed with him, and literally hounded any opposing opinion off of the agenda of national meetings. High fat was his bugaboo. As chair of the NIH funding committee for research, you crossed Ancel Keys at your peril.

Early research suggested that sugar was in fact, the enemy. The Sugar Foundation swung into action and started Project 226, essentially to pay Hegsted and his boss, Stare, at the Harvard School of public health to write a review article downplaying sugar and pointing the problem to fat. That article was written, and published in the New England Journal of Medicine without mentioning its Sugar industry sponsorship. Hegsted got paid.

From there, it’s all history. It was the 1980s and food guidelines came out recommending lowering dietary fat, which means more sugar of one kind or another. Over the next 20 years, every food in America became low fat and consequently high carb. Ancel Keys ruled at the NIH and no-one question the hegemony of Hegsted and Keys. You gained 20 pounds.

This was the biggest public health policy disaster in American History. We didn’t let good science be conducted because secret, behind the scenes, payments led to the corruption of our medical research process. It took 20-30 years to fully correct that error. We are still struggling with it today.

WWW.What Will Work for me. It’s a struggle to avoid sugar. It tastes good and all of us are vulnerable to its effects. You eat sugar, you want more and you eat more. I’m so aware of my own sugar sensitivity. If I eat regular peanut butter on a spoon, I stop at one spoon and feel full. If I eat a brand name that has sugar in it, I can have 4-5 spoonfuls before I stop. But the science is now solid. Avoid sugar. If you want to escape the damage of heart disease and Alzheimer’s.

Pop Quiz

‪1. Sugar isn’t as harmful as people make out? T or F

False. It’s the core enemy of metabolic problems. MUCH worse than fat.

‪2. Our belief that cholesterol is the problem is the result of a carefully crafted PR campaign based on bribery to key doctors, paid for by the Sugar Industry. T or F

Spot on.

‪3. Our food guidelines followed the outcome of the PR guidelines, and suggested we eat a ceiling of 35% fat. T or F

True. That’s how we got there.

‪4. 35% fat should be the floor of our eating, with encouragement to go higher – aka, to 50% or the Mediterranean Diet. T or F

Again, true.

‪5. It’s critical for all published research to have openness as to funding sources. T or F

True. (Same idea would be good for politics, don’t you think?)

Too Much Thyroid is Not a Good Thing for Your Brain

Too Much Thyroid is Not a Good Thing for Your Brain


What is too much thyroid? Our bodies have a unique method of telling us if we think we are getting enough thyroid hormone. Thyroid hormone is made in our thyroid gland, in the front of our necks. T4 is the substrate molecule that circulates in your body for 36 hours and is gradually changed to T3 by the enzyme de-iodinase. Your hypothalamus in your brain reads how much T4 and T3 it is receiving and decides if that is enough for it to be happy. It then communicates with your pituitary gland to make TSH (Thyroid Stimulating Hormone) to nudge the thyroid to make more. TSH has become the established norm for deciding about sufficient thyroid. This study looked at TSH levels and the subsequent development of dementia.

Keeping a healthy brain is one of our highest priorities. As we get older, dementia robs us of our relationships, our memories, and just about everything that is meaningful and important. What this study found was that a LOWER TSH (meaning that your brain thinks you can back off a little on thyroid production) is associated with greater increase of dementia. 313 non demented Koreans were evaluated and followed for 5 years with thyroid testing and mental status testing. Now, the average TSH in the healthy brain group was 2.24 and in the group that showed MCI (mild cognitive impairment) it was 1.78. Those are both, technically, normal. Stated differently, for every 1 mIU/L decrease in TSH, there was a 1.7 fold increased risk for MCI progression. If you already had MCI, a 1 mIU/L decrease in TSH resulted in a 6.8 times risk of progression to frank dementia. Ouch!

This isn’t completely new. TheRotterdam Study in 2000 showed that a TSH below 0.4 (frankly too low – meaning way too much thyroid hormone) had a 3 fold increased risk of developing dementia. That study followed 1843 non demented people for just 2 years. The Framingham study published in 2008 followed 1864 folks and showed that a TSH between 0-1 had a doubling of Alzheimer’s risk. There are more, and all say the same thing. Lower TSH means higher risk for dementia.

Traditional Internal Medicine focuses purely on the TSH. Functional medicine askes us to look at the free T3, reverse T3 and TSH combined. You get a richer picture when you look at all three, but I find there are frequent conflicts where the free T3 is “technically low”, but the TSH is still

Now,low thyroid (shown by HIGH TSH) isn’t good for your brain either. But that’s for another day.

Bredesen, my guru for Alzheimer’s prevention, asks for TSH between 1-2. He doesn’t reference free T3. The big question then comes, which reference point is the most important.

WWW.What Will Work for Me. I’m very interested in this. We aren’t as clear as we would like to be on this topic. For now, I’m putting my chips on Bredesen. For myself, I take a bit thyroid hormone to keep my own TSH between 1-2. Should I let it drift up to 2.4? Stay tuned.

Pop Quiz

‪1. A high TSH means your are getting too much thyroid? T or F

False. This is the mistake of a first time reader. TSH is STIMULATING hormone. A high TSH says your brain thinks you aren’t getting enough, and is trying to get your tired old thyroid to make more.

2. This article is the first to show that lower TSH’s, in the normal range predict cognitive decline in Koreans. T or F

Exactly the point. What’s new is that these folks were in the normal range and they were followed for longer than prior studies.

‪3. Korean’s brains are different than ours, so I don’t need to worry about it. T or F

Sorry, despite the behavior of certain N. Korean leaders who might bring this into question, all of our brains are the same. It’s nice to see the robust Korean medical community starting to contribute to the world body of knowledge.

4. There is a clear connection between free T3 and TSH? T or F

As things currently stand, it’s partially right but mostly helpful when your thyroid function is low, resulting in a higher TSH, now lower.

5. Some of our best Alzheimer’s treatment leaders use thyroid as part of their decision making for Alzheimer’s treatment. Goal: TSH 2-4.5 T or F

Trick question. True, they use it. False. Modern internal medicine says up to 4.5 TSH is ok. Bredesen aims for a TSH between 1-2. Details matter. Low thyroid isn’t any good either.

Pregnanolone: Memory Cure

Pregnanolone and Memory: The Importance of “Neurosteroids”

Reference: Elsevier Science Direct 2014, Life Extension

Published Jan 4, 2016

Ever heard of pregnanolone?   Probably not, and shouldn’t be expected to. But if you are over 50, you likely should know about it. Your body is making much less now than you used to, and that may be part of why you can’t remember why you walked into that room, or where you put your keys. Your memory isn’t as supple as it used to be, and you feel stressed out about it.

Pregnanolone is the first steroid hormone made from cholesterol. It is the first of 6 steps towards making estradiol, another important Neurosteroid, or Progesterone, or Testosterone, all important sex hormones, but also brain hormones. Turns out that our brains make them too, and use them locally.

For memory to occur, you need to stimulate cells. The principal stimulating chemical is called glutamate, and it turns on the NMDA receptor. That’s the beginning of the cascade that puts down new synapses and creates memory. Now, glutamate functions in a very narrow range. Too much glutamate and you get “neuroexictotoxicity” and cell death. That’s the means by which MSG causes brain damage and may be part of the cause of Alzheimer’s and Parkinsons. And that’s where pregnonolone comes it. Not only does it get the memory switch turned on, but it softens the raw damage of too much glutatamate, protecting cells from overstimulation.

The research supporting all this has been done mostly in animals. For example, researchers have shown that pregnanolone reverses impaired learning in older rats. And it happens quickly. It gets even more interesting when you look at anxiety and memory. The side effects of many anti-anxiety medications, like Valium, is that they impair memory. Well, not if you take pregnanolone along with them. And if you want to withdraw from them, pregnanolone may be your best friend, making it easier to do with less rebound anxiety.

The mechanisms of neurosteroids is beginning to be understood. They appear to have a dramatic impact on two areas of brain health. First, they seem to make mitochondria more effective. Mitochondria are the little organs inside the brain cell that make energy molecules. Your brain uses 20% of your bodies energy, so each cell is producing a lot of it. Like our own power plants, producing energy has negative consequences that need amelioration. Reactive oxygen species escape the electron cascade in mitochondria, and need to be soaked up. The neurosteroids appear to help with that.

Pregnanolone also helps with the memory enhancing component of sleep called REM (Rapid Eye Movement) sleep. It increases the time you spend in REM sleep, and upregulates the amount of acetylcholine you make when you do so.

Finally, pregnanolone appears to play a role in building nanotubules inside the brain cell. These tubules appear to be part of the scaffolding that allows new synapses to be constructed and maintained. And that’s the core structure of memory being made. Cool, huh!

WWW. What will work for me. I’m interested in understanding how memory works. I’ve never measured my own levels, but I’m on it. It’s a pretty cheap supplement, and 15 mg a day appears to be the starting dose. Because it’s the parent hormone to many other steroids, there is some concern that it might spark some of the hormone sensitive cancers, but that has not been proven in any fashion. My New Years Resolution is to build a portfolio of memory enhancing ideas for myself, and for you.   Hang on.


Pop Quiz


  1. Pregnanolone is a steroid hormone made in your brain? T or F

True. In your sex organs as well, but also in your brain

  1. It’s levels gradually rise with aging. T or F

False. They drop dramatically

  1. Pregnanolone, and all the neurosteroids, protect the brain from the damaging effects of too much glutamate. T or F

True, and don’t use that to justify eating more MSG

  1. Taking pregnanolone may help withdraw from Valium and other addicting drugs. T or F


  1. Pregnanolone may help your memory by increasing your REM sleep? T or F



Insulin Index is the Way to Understand Weight Loss and Diabetes Control

The Insulin Index: The Best Way to Manage Diabetes and Weight Loss

Published: Nov 9th 2015

Reference:   AJCN Miller, AJCN Holt and Miller,   Diabetes Blog,

What’s the Insulin Index? It’s the measure of how much your insulin goes up in response to a standard dose of any given food, when compared to a standard dose of white bread (1000 kjoules worth or about 250 calories.)   We know white bread provides you with very easily digestible carbohydrates, and has a “high” glycemic index. We want to know how much insulin you secrete in response to foods, because that is what really controls diabetes and weight gain/loss.

Dr Miller has developed this idea over the last 20 years and now has over 180 foods posted on line. You can easily look up many lists.   The core finding is essentially that the more sugar (which is a pure carbohydrate of two kinds: glucose and fructose) and carbohydrate (which is mostly glucose in very long strings that have to be broken down to simple glucose) foods have, the higher the insulin release. The wild card to be put in here is that protein itself becomes insulogenic when eaten in large quantities.   That is because your liver is quite competent at converting extra amino acids into glucose. You can only use so much protein to build or replace muscle. After that, the building blocks of protein, amino acids, are easily converted into glucose, and that spikes insulin.

How does that convert into information you can use?   Well, the highest insulin index foods will be those made from pure glucose.   Hence Jelly Beans (117) and Pancakes (110) will be very high compared to white bread (100).   But so will baked beans (88) and boiled potatoes (88).   That happens because those are foods filled with carbohydrates – imagine a baked potato is nothing more than a bucket of Mardi Gras necklaces in which each bead is a glucose. When you eat food made from those carbohydrates, your body can unzip those strings of carbs very effectively and rapidly, and that leads to the release of insulin. These are also foods that have been altered from their native state, altered by farmers to be larger and more carbohydrate filled, and finally, cooked in a fashion to make the carbohydrate much more accessible.

Now, what is intriguing is that a lot of low fat dairy ends up being very insulogenic. Low fat yogurt, for example has a glycemic index of 31 but an insulin index of 84.   Skim milk has a glycemic index of 29 but an insulin index of 60. Low fat cottage cheese has a glycemic index of 10 but an insulin index of 52.   Why?   Dairy doesn’t have glucose in it in a pure form but rather in the form of lactose, that takes a while to digest. But the extra protein floods in rapidly.

And what is the role of fat? It’s insulin neutral so has little effect.

How do I synthesize all this information? I believe our metabolism was shaped by millions of years of eating green plants which have carbs tightly wrapped up in fiber. These got digested in our colons, very slowly.   We still have those foods.   We call them spinach, asparagus, cucumbers, broccoli, eggplant – any green vegetable that grows above ground. Civilization has led us to grow and manufacture foods that are richer in carbs than we have ever seen before. They get digested in our small bowels. They used to be seasonal, and available only I the fall, but are now available year around. They cause a dramatic spike in glucose, which causes a dramatic spike in insulin. During most of human history, that was very beneficial because that led you to store calories in September and October so that you had a calorie reserve for January and February.

WWW. What will work for me.   I measure my insulin and glucose and those of my clients and find this to be very true. Many folks, trying to lose weight and control their diabetes, can’t succeed because they are eating too much protein. When you shift them to more fat, and more green vegetables, their insulin goes down and you can measure it. They lose weight, their diabetes gets better. They use less insulin, if they are taking it as a medication. I’m fascinated how sabotaging dairy is for weight loss. At least low fat dairy.   In my home, we have the full fat stuff, or whipping cream.   I suspect the admonition to drink low fat dairy and eat low fat yogurt is exactly opposite what we should be doing.


Pop Quiz

  1. The insulin index measures how much insulin my body makes in response to different foods. T or F
  2. True
  3. Foods very high in simple glucose like pancakes, have very low insulin indexes. T or F
  4. Exactly false. If you said true, go to jail, go directly to jail and read the article again. Dramatically opposite
  5. Dairy is an insulogenic food. Why?
  6. It has low level of pure glucose but a flood of animal protein, which can also set off insulin.
  7. Insulin serves as my storage hormone, saving calories to burn later in the year when the times are leaner. T or F
  8. For the last 65 million years of mammalian history. Changed recently in the last 10,000 years with agriculture and dramatically in the last 100 years with industrial civilization
  9. To lose weight, I have to get my insulin level down, so that I stop storing calories.
  10. It’s easier to control my diabetes if I’m not shifting calories in and out of fat cells all the time and just use them slowly as they show up.
  11. Perfect, which is what green plants will do for you as they are digested very, very slowly by the wonderful biome of helpers in your colon.