Monthly Archives: June 2011

Vitamin D Guidelines from the Endocrine Society! Sanity at LAST

Vitamin D Guidelines from the Endocrine Society!  Sanity at LAST

Competency:  Vitamin D

Date:  6/20/2011

Reference:  Endocrine Society Guidelines

At last, at last!  We have guidelines that make physiological sense.  Thank goodness.  And the language is a masterfully written document to match with the recent timid guidelines put out the Institute of Medicine, our supposed national center for medical leadership.  I was very disappointed by the IOM report last November, as they dodged their responsibility, talked only about bone health, and made it sound like their recommendations global.  The Endocrine society has masterfully stated virtually the same guidelines, to be politically correct, but they put in all the necessary caveats to make sense.

For example, the Endocrine Society Guidelines (ESG) call for getting everyone to a minimum level of 30 ng.   It doesn’t suggest everyone be screened, but you can’t know you are at 30 ng unless you get a test.  And for those who are at risk, meaning living in a northern state, wearing clothes, working indoors, getting older, being overweight, taking a huge number of medications that suppress levels etc, may require taking 3-4 times as much.  In fact, the ESG suggest that many situations also call for a loading dose to get started when you are deficient and that a good way to do that is 50,000 IU once a week for 2-3 months.  And the guidelines do also give a much higher upper limit of safety, while coyly mentioning that the human body will naturally make some 20,000 IU when exposed to adequate sunshine.  Instead of the IOM upper limit of 4000 IU a day, the ESC name 10,000 IU a day as a safe upper limit..  For those folks with various disease states that make for problematic D production, serial monitoring is called for.  Lots of testing!

This is a masterful document of political tightrope walking, pushing the limits up to much more reasonable levels.  They do recommend D administration for fall prevention but do not go to the other “non-calcemic” benefits such as cardiovascular disease prevention or cancer prevention at levels above the normal daily dose.  But then they state, “The vitamin D receptor is present in most tissues and cells in the body (3, 12). 1,25(OH)2 D has a wide range of biological actions, including inhibiting cellular proliferation and inducing terminal differentiation, inhibiting angiogenesis,

stimulating insulin production, inhibiting renin production, and stimulating macrophage cathelicidin production.”  Let me translate:  D is really good for helping cancer (cellular proliferation inhibition), inhibiting cancer (inhibiting angiogenesis), helping diabetes (stimulating insulin production), helping high blood pressure (inhibiting rennin production), helping fight infections (cathelicidin production).  So what’s left?  We are all overweight, all have diabetes, hypertension, getting older, working indoors, getting the flu, having heart attacks and cancer.  So, what did I miss?  They even have guidelines for newborns, raising the upper limit for newborns to 2000 IU a day.  Hurray, hurray, hurray!

WWW.What will work for me.  I’m just tickled pink.  The most emotionally charged topic I have seen in medicine for decades is finally coming out of the closet.  The unbelievable resistance in the house of medicine to one of the miracles of modern medicine is finally getting clarified with official sanction.  The guidelines don’t talk about autoimmune disease (that 40% of women have) and that have strong D linkages, but they finally talk real human physiology and real doses.  Getting your blood level to a floor of 30 ng is lifesaving, and if you know anyone in your family that isn’t taking D, talk to them about it.  It’s that urgent.  It’s life saving.  And now you have official guidelines.  You can safely tell a new mother that her newborn should get 400 IU a day and can safely take 2000 IU a day as an upper limit.  You can safely say we can all must take at least 600-800 and that 10,000 IU a day is safe.  I for one take that much and my blood level is 80.  I believe the science will finally indicate that 60-80 is what is the optimal human level, as that is what our bodies get to when we have abundant sunshine naturally.


Written by John Whitcomb, MD

Brookfield Longevity and Healthy Living Clinic, LLS

17585 W North Ave, Suite 160

Brookfield, WI 53045


All Things in Moderation is the Key to Getting Fat

All Things in Moderation is the Key to Getting Fat

Reference:  Mozaffarian, NEJM, June 24, 2011

Competency:  Weight Control

Haven’t you heard that all your life?  Everything in moderation!  Another version is, “A calorie is a calorie is a calorie.”  Simple physics!  Turns out both are wrong.  This is the key to the vast majority of us getting overweight.  In a gigantic landmark study that data mines the three largest ongoing health and nutrition studies out of Harvard that are following 120,877 health care professionals, Dr. Mozaffarian found some critically important ideas that turn a lot of our biases on their heads.

First of all, he started with folks that were normal weight.  He examined just what it was in habit and lifestyle that tended to pack on the pounds over the years.  The average person in the study only gained 3.4 pounds every 4 years.  After 20 years, however, that was 16.8 pounds.  And those who ate potato chips regularly gained the most (1.69 pounds), or potatoes (1.28 lbs) or sweetened beverages (1.0 pounds) or red meat (.95 pounds) or processed meat (.93 pounds) compared to folks who didn’t eat those foods.

What this identifies is that a calorie is not a calorie.  That concept doesn’t take into account what your body thinks of that calorie.  How much does it sate you?  How much does it tempt you to have a little more?  This has big implications.  It debunks the old saw that “all foods are ok in moderation.”  They aren’t.  There are some plain bad foods.  Those that don’t fill you up, that raise your blood sugar too fast and force your body to store those calories, that alter your metabolism in an inflammatory way are bad foods.  It’s denial to say they are ok.

And this study proves it.  It took the massive size and time of this huge ongoing study to show the process that most of us suffer through.

But it wasn’t just food that showed a gradual calorie preserving effect.  Sleep was also identified as an issue.  For those who got less than 7 hours of sleep a night (or more than 9) also tended to gain weight.  And just watching one hour of TV a day showed up as a .31 pound weight gain.  Can’t you see it coming?  “Honey, don’t watch CSI or you will gain 5 ounces……over the next 4 years.”

And of course, those who exercised regularly didn’t gain anywhere near as much!

WWW.  What will work for me.  Well, my Grandma used to cheerfully say, “It’s all good in moderation.”   I think she was talking about the carrots on my plate.  Not the icecream I was waiting for.  This study was with normal weight people who gradually got a bit pudgy.  And it shows how they got there.  The implications for those of us who are a bit pudgy and would like to go back….. no more potato chips.  Eating almonds, nuts, fruits replaces baloney and pizza.  Now if we could just get our kids to go along.  My proverbial 41 year old mother with two kids……they do want sugar, cake, baloney and pizza.  Can you sneak in walnuts, broccoli and play outdoors?

Aerobic Exercise and Your Executive Brain

Aerobic Exercise and Your Executive Brain

Competency:  Exercise

Reference:  American College of Sports Medicine Congress, June 10th, 2011 Denver

Use it or lose it!  Very simple.  As we age, the slope and velocity of our deterioration increases. We have a voice and control over just how much we let ourselves go.  The secret is aerobic exercise, aka: sweat.  And this study shows the details.

Up till now we have known that brain structure and function deteriorate with age.  Your brain shrinks.  We’ve said that’s normal.  Well, it is because most of us let it happen.  Because most of us let it happen, is it really normal.  The real question is:  is it inevitable?  It is reversible?  Surely, we all know very old men and women who are perfectly intact brains and who show no cognitive decline.  How did they do it?

Dr Tseng of the Exercise and Environmental Medicine Cerebrovascular Lab at Texas Health Presbyterian Hospital in Dallas 10 Masters Athletes, average ages of 73 who had been exercising rigorously for at least 15 years, and compared their brains to matched controls of similar ages who were couch potatoes.  Normal, older American men.  What they found was that WHITE matter (not gray matter) was much better preserved in the athletes.  White matter is all the wiring beneath the grey matter that connects all the parts of the brain to each other.  You have parts in your brain that are discretely assigned to vision, to speech, to hearing, memory and emotions.  That’s all part of grey matter.  Those discrete brain regions have to talk to each other in complex fashions.  And quickly.  To be fast, you have to be hooked up.  You can measure the speed of a young person’s brain responding to a sound impulse in their ear.  A young brain lights up with recognition in about 310 msecs at age 20.  Nice and fast.  By age 50, response time is 350 msec.  Oops.  40 msec gone.  Can’t remember the checkbook whereabouts.  By 380 msec, you have Alzheimer’s.  All a matter of 20-30 msec of processing speed. That is the difference between a functioning 50 year old who sits and ponders for a second to remember “that person’s name”, or “the restaurant we went to that time…” and dementia.

It’s the wires in between that keep you younger.  Magic Bullet #2 is exercise.   It preserves your wiring better than anything else yet discovered.  We’ve known for years that a mere walking 30 minutes a day for 6 months will show measureable improvement in memory that will last for up to 18 months after stopping.  That’s just walking.  Now, speed it up, and speed your brain up.  There is no other way.  Getting sweaty.

WWW:  What Will Work for me.  I’ve got a million excuses.  My best ones I can’t remember.  But I’m now spooked enough by my own failings and frailties.  I’ve forgotten enough appointments, enough reminders to bring home milk to no longer find it easy to ignore.  I’m trying to walk every day.   I need friends to encourage, to remind to cajole, to support me and ask me when I last got enough exercise to be sweaty.  Running a mile, that’s my first goal.  Tennis anyone? Over age 60, getting sweaty is job One for anyone interested in keeping themselves alert, independent, functioning and in relationship

Cancer Cells LOVE Acid

Cancer Cells LOVE Acid

Competency: Anti Cancer Life Style

Reference:  Lisanti et al Kimmel Cancer Center, Jeffereson Medical School,  Pusblished on line in Cell Cycle, June 1, 2011

Our bodies are constantly mantaining a very delicate balance of acid and alkali.  We keep our pH’s (our acid measurement) in a very precise narrow range.  Cancer cells don’t like that range.  They want more acid and they make a tiny microenvironment of acid around themselves.  That leads to a relationship of the cancer cells to the cells around them in which the cancer cells accelerate the aging of the cells around them in order to make a more acid environment.

Dr Lisanti had previously discovered that cancer cells stress out nearby cells, forcing them to make more lactate.  That makes their “micro-environment” more acidic, because lactate is an acid.  They cause “oxidative stress”, which then pushes the lactate making process.  Oxidative stress is another word for inflammation in the connective tissue.   In effect, the cancer cells make the cells around them grow older faster by making them inflamed and stressed by higher amounts of oxidative stress.

The findings were so significant that they authors published three separate papers together to flesh out their work.  One paper documented the ability to predict which breast cancer patients would have metastases by the aging signature of the cells, in other words, their inflammation and aging pattern that looked almost identical to Alzheimer’s aging and inflammation.   A second paper documented the “lactate shuttle” in which the cancer cells force local cells to make more lactate (an acid) with a subsequent lactate shuttle into the cancer cell where it gobbles the lactate up.   The heavy duty scientific name of the lactate pumps is MCT1 and MCT4 .  These pumps exist in muscle and you feel them when you run so hard your muscles burn and you get terrible shin splints.  Well, cancer cells are doing all that to the cells around them, giving them “cancer splints”.  They are acting like queen bees, making all the slave cells around them work hard to feed them.

And that’s the mechanism the queen bee cancer cells use to get more lactate, and make more acid.  They use the body’s natural protective mechanism of inflammation and turn it on its head to stimulate themselves to grow. “What we found is that cancer cells are accelerating aging and inflammation, which is making high-energy nutrients to feed cancer cells,” says Dr Lisanti.  The implications are huge.  We can retard cancer by making an alkaline environment, be eating antioxidants, by reducing our acid load.

WWW:  What Will Work for Me.  This is FASCINATING.  I’m totally wrapped up in this because it gives second hand confirmation why eating tons of vegetables, bright colored foods high in antioxidants reduces your risk of cancer.  It also confirms why we should think about our diet being “alkaline” – again, eating more vegetables and less meat.  I much prefer cheese and pizza.  Cancer does too!  Back to the dinner table: time to be serious about more fruits and vegetables.  Summer is here. Gorge!

Written by John E Whitcomb, MD

Brookfield Longevity and Healthy Aging Clinic

17585 W North Ave, Suite # 160

Brookfield, WI 53045

Salt May Not be the Devil We Thought

Salt May Not be the Devil We Thought

Competency:  Safe Electrolytes

Reference:  JAMA, May 4, 2011

This is downright confusing!  What’s a person to believe?  This study comes out and made headlines all over the place that a LOW SALT DIET RAISES YOUR RISK OF A HEART ATTACK.  Exactly opposite what we are meant to believe.  What did this study do to show that and how do I get some understanding?

Here is what the researchers did.  They took a 24-hour urine sample on 3,681 healthy European men and women, under age 60 and measured the total amount of sodium they excreted.  This is the accurate gold standard for determining the amount of salt you eat.  So, their first measurement was precise.  Then, they followed them for eight years to see what happened.  And the answer was….. Surprise!  They were all healthy when they started and didn’t have high blood pressure.  Over the course of the study, 6% of them had a heart attack, and 2% died of heat attacks or strokes.  What they found was that those with the LEAST sodium consumption had a 56% GREATER risk of death from heart attack or stroke than those with the most.

That’s backwards!  It’s meant to be the other way around.  Science is so frustrating when it turns us on our expectations with good data.  Was this good data?  It may not have been.  They only took one sodium sample by way of 24-hour urine.  That may not have been an accurate portrayal or real intake.  A few more over those 8 years would have helped.  And they were all rather slender folks, compared to us Americans.  And they were all pretty Caucasian, and Americans are now black, white, brown and everything in between.  So, does it apply to us?

What’s my personal bias?  Well, I’ve made a switch in my beliefs in the last 5 years.  I used to think hypertension and heart disease was all linked to salt.  I don’t anymore.  I think hypertension is a reflection of inflammation in the arteries, “endothelial dysfunction” if you will.  And our arteries are pretty simple little devils. They can only do a few things:  relax and stretch or constrict and narrow.  Or they can put out hormones and call in the helper troops – like white cells when they get stressed out.  Where does inflammation come from? A lot of sources, but salt isn’t necessarily one of them.  Sugar and white carbs, however, are.  Sugar, with its fructose forces you to put out uric acid and uric acid wipes your arteries clean of nitric oxide.  And nitric oxide is what makes your arteries relax.  Hence, I believe its sugar that really causes hypertension.  Salt makes it worse once it’s in place.  But the core enemy is sugar.

WWW. What Will Work for me.  I think it’s important to know that we are currently trying to cut down on sodium.  I don’t add it to any food anymore.  I believe we should use less.  There is so much data out there, it’s hard to refute with one study.  But I believe sugar is worse.  It’s harder to cut down on sugar than salt.    But this was a well-done study, conducted prospectively.  I’m going to watch for more.  Still not adding the saltshaker back.