Monthly Archives: September 2018

Mitochondria Primer 1

References: Mitochondria and the Future of Medicine,

You need to know what mitochondria are. Why, because they decide when you live or die. They are at the nexus of your brain being healthy. They provide your energy. So what are they? Energy factories. They are tiny organelles inside each and every cell that make your energy molecule called ATP.

They probably result from the fusion of two bacteria two billion years ago. One took up residence in the other, and was able to stay because it helped the other. It had learned how to burn energy from fat in what we now call “the electron transport chain”. In that chain, the new resident was able to extract the latent energy in fat by shifting the electrons across membranes and grabbing the resulting energy in the form of a molecule called ATP. ATP has three phosphate groups lined up that can carry the energy around for use elsewhere. The boost of energy production was from 2 ATP per glucose to 38, 19 fold! A regular human cell can only make 2 ATP per glucose without its mitochondria. We could never have evolved such delicate, magnificent cells if we hadn’t first gotten a reliable source of energy. That partnership of those first two cells was the beginning of complex life on earth. Each mitochondria today has about 10,000 electron chain complexes in it, processing our fuel needs one ATP molecule at a time. The proteins in the chain are lined up in a precise complex allowing energetic electrons shed their energy to be captured by the transport chain and then attached to ADP molecules with two phosphates, remaking ATP with three phosphates.

Over the millennia, the new resident gradually lost most of its own DNA, depending on its host to provide most of its genes, except for the very critical few that it needed to decide when to make more energy, or when to make less. “When to hold em, when to fold em”. And it hung on to 10 sets of those 37 genes (compared to 22,000 proteins in humans) in each mitochondrion.

The human cell is incredibly complex and very energy dependent. We would not be what we are without our little power plants chugging away. You are 10% mitochondria by weight. A human egg has 100,000 of them, lying dormant until fertilized when the 100 mitochondria from a sperm get knocked off. Hence, all your mitochondria come from your mother. We can trace your maternal lineage through your mitochondria, not your paternal. Muscle cells of athletes have 300-400 while us couch potatoes have only 150-200. (Getting in shape builds more mitochondria – of course!) Heart cells have 5,000, as does the brain. But the retina is probably the champ at 7,000 per cell. Vision is hard work. And aging eyes get mitochondrial diseases we call macular degeneration.

Is that enough for one week? Reread this letter. Learn it. We all need to know how to manage and care for our mitochondria.

www.what will work for me. I’m trying to bring the concept of mitochondria into my practice. We all should know about them and how to care for them. When I treated my father’s mitochondrial disease called congestive heart failure, his ejection fraction improved dramatically by about 30% and lived 5 years longer than his projected lifespan. Considering that 50% of us have some congestive failure when we die, and that is a mitochondrial disease, should be enough to convince all of us that the care of our mitochondria is important. Hence, this series. Part 2 and 3 still coming.

Pop Quiz

  1. How much a boost to energy supply did mitochondria provide?                   Answer: 19 fold
  2. You can track your genes for your family most accurately through what modality?    Answer: Not Ancestry.com,,,,,your mitochondria. You can read all about “Mitochondrial Eve” to see how we figured out that humans came out of Africa about 90,000 years ago, having started somewhere in Ethiopia.
  3. What cell has the most mitochondria of all?                                                  Answer: the female ova, otherwise the retina.
  4. If your heart can’t make enough energy to pump blood, what clinical disease do we call that? Answer: Congestive heart failure. which 50% of us have when we die. Makes sense. You die when your heart poops out. Your heart poops out when its mitochondria can’t supply the energy you need.
  5. What happens in your muscle cells of your leg when you walk every day at least two miles? Answer: Build more mitochondria: aka, getting in shape.

Statin Rage

Statin Rage

References: QJMPharmacotherapyPharmacotherapyTrans NeurodegenAm J MedATVBScientific AmericanGraveline,

You know statins are widely advertised as being good for your heart. And the literature supports that if we look at you as a “walking heart” with little more attached on the outside. Considering that the house of medicine makes the most money off you for heart disease, cardiologists hold a lot of sway over the health care system. Hence, when the heart doctors (aka medical “God”) say, “Thus spoketh….., thou shall take statins!” the house of medicine snaps to attention and does so. I’m not here to argue the whole case, just the case of cognitive damage as shown in “statin rage”. These are not innocuous drugs, and you are more than just a heart. Your brain might be important too. If you act like a jerk, your love relationships suffer and they might be more important to you than your arteries.
What does the literature say about cognitive effects? Quite a lot actually. What caught my attention was a plea from a client who has repeatedly felt terrible anger when exposed to statins. And he is a very high risk for heart disease, and “needs” his statin. Or does he? Is there another way? (Hint: YES!!)
I reviewed several studies. The first in Translational Neurodegeneration suggests there are two competing processes going on. They review all the studies of cognitive decline, and find design problems with all the studies: for example, most patients in some studies are on low dose statins whereas high dose is what makes the side effects, and most patients are actually on higher doses. But they end up concluded that there really are some folks who get pretty severe memory issues, and get better when the statin is stopped. They plead that we be aware of those effects and be brave enough to stop the statin if memory issues occur. Just stop!
In the QJM study, four patients were found with “manifestations of severe irritability” included homicidal impulses, threats to others, road rage, generation of fear in family members, and damage to property. All got better on stopping the statin, and worse again when it was restarted. Conclusion: be brave enough to stop!
There is more. Scientific American has a nice review on memory loss and statins. Duane Graveline, NASA astronaut, lost his memory for the duration of being on statins and wrote a book about it. You might want to read that book if it catches your eye.
www. What will work for me. Loss of memory, road rage. How much can you take? These effects may not be common, but they are indications that there is brain damage/effects of taking statins. And published studies in randomized fashion of cognitive ability again show damage, albeit not that commonly. One could ask, just how well do the people selling the drug report of effects that could damage their sales? Only you can answer that one. As for me, I’ll change my diet to avoid taking statins. There are other answers that are just as effective. For example, consider Gundry’s report at the American Heart meeting just a month ago. Hmmm. Cheaper, better, no side effects.

 

Pop Quiz

  1. Statins can damage your brain. T or F                                     Answer. True as shown by memory loss, cognitive decline, rage, and mood…….
  2. The only organ that matters in your body is your heart, and as long as you let your heart be the only organ that is talked about, statins are useful. T or F                 Answer: Ok, do you get the irony?
  3. Randomized studies, conducted by the folks selling a product, are likely to be absolutely clear about picking up pervasive, subtle shifts in cognitive ability?       Answer: Can you tell that I’m on a rant here? I’m deeply skeptical about the integrity of our pharmaceutical industry, considering their demonstrated history.
  4. Is there a role for statins?                                                                              Answer: I think there is. Someone who wants to keep eating donuts and ice cream, sugar and white flour, and has had a heart attack, likely needs to be on a statin. Those willing to eat differently and let their lab tests, including their cholesterol, be their guide, there are choices.
  5. How common is statin rage?                                                                 Answer: Rare. It’s there, but not common. Many other brain effects. It’s a “no brainer”. Gotta stop.

 

 

Being A Short Term Couch Potato is Dangerous

References: ProverbsDiabetologica,

You have to know where I’m coming from. A childhood memorizing Bible verses had its share of Proverbs. And the term “Sloth” was never a good thing. You could argue that the foundation of our Puritanical work heritage is the avoidance of the appearance of sloth. It’s in the book of Proverbs 9 times. Then came binge TV watching and the opening of the NFL season, and March Madness and whatever, (Reruns of …..Mash?) and we descend into a temporary state of stupor. We become couch potatoes. Slothful. No exercise. King Solomon would have gone nuts over couch potatoes. Was he right?
Is it bad for us? Horrible! This week’s referenced study in Diabetologica took 45 habitually active adults, average age 36, with or without close relatives with adult-onset diabetes and had them reduce their exercise dramatically for 14 days (10,000 steps a day to 1,500). They then resumed their normally active lives. At the end of their “slothlike” period and again upon resuming activity their body fat composition by DEXA scan was performed as well as glucose sensitivity measurements. The data is not pretty. It’s not good to be slothful.
Both groups decreased exercise by 81% and increased couch time by 3.5 hours a day. Pooling data from both groups, following the step reduction there was a decrease in whole-body insulin sensitivity, muscle insulin sensitivity index, cardiorespiratory fitness and lower limb lean mass. Further, there was a significant increase in total body fat, liver fat and LDL-cholesterol. Of course LDLs went up. LDLs are the extra fats you are shipping from your fatty liver to your bat cells. Voila. In the twinkling of an eye, metabolic syndrome. And that’s the first step to becoming diabetic, in fact.
After resuming normal exercise there were significant between-group differences: following step reduction, those participants with diabetic relatives accumulated 1.5% more tummy fat and increased more triglycerides. After resuming normal activity, those participants with diabetic relatives engaged in lower amounts of vigorous activity and had lower muscle insulin sensitivity. They didn’t recover as fast, or as completely.
What does this mean? It’s heavy. Exercise, even just walking, cleans up your metabolism markedly. Not exercising….now, there’s the rub. Not exercising is the trigger for all that ails us. Metabolic syndrome, which none of the study participants developed, in the strictest terms didn’t happen because the study was only 14 days long. It starts in small steps, like a weekend of NFL football. How about a weekend of Starwars movies! And then gets worse as we get into “slothful” life style patterns of prolonged sedentary behavior. If you have diabetic relatives, it may be because they don’t exercise quite as much, or are a teeny bit fatter, or eat a teeny bit more sugar…..but more exercise will help them. Like most research, the authors say, “Larger studies…..” That’s hooey. You know what you need to do.

www.What will work for me? I’ve had a two-year siege getting my broken ankle better. I finally got up to 5 miles at a clip and went on the hiking club hike this last weekend. The weather celebrated by pouring rain on us. I’m finally back to better walking. This study is a signature study. In exquisite biological detail, it lays out the benefits of getting your butt off the couch, and the dangers of keeping it there. First, I ruin booze. Now I ruin the couch. What’s left for Sunday afternoon?

Pop Quiz

  1. It’s good to take a sabbatical and Sabbath and relax once in a while. T or F           Answer: Of course that’s true. Get your sabbatical on the walk around the lake, not in the TV schedule.
  2. Every single one of us gets some evidence of damage by prolonged sedentary activity. T or F Answer: True as true can be. It only takes two weeks of simply doing the activities of daily living to bring it on. Getting into your car and walking from the parking lot to your desk job doesn’t count as exercise.
  3. If you start to exercise, you can reverse it all? T or F                                        Answer: That’s the good news. True. If you have family with diabetes or are diabetic yourself, it may take longer but every step helps and contributes to repair.
  4. Fatty liver happens more if you don’t exercise? T or F                                     Answer: Yup and about 50% of Americans have it
  5. What’s the most prominent piece of furniture in your living room?              Answer…………..

The Case Against Alcohol

 

The Case Against Alcohol

References: The LancetCNNCell Commun SignalScience,

This is no small study. Using 694 “data points” for alcohol consumption by populations and 592 prospective and retrospective studies on alcohol use from 195 countries, projections were made about the total and real risks of alcohol. This is an important study because it shifts the overall net balance of alcohol’s effect to negative from positive. They looked at 23 health outcomes against alcohol use and developed a new method of assessing what is the lowest risk point for consumption (aka, what can you get away with).
For decades, we have been saying that a drink a day was good for you. Maybe not for women, but generally ok. That changes now. The data is hard to deny, much as alcohol itself makes us want to say it is ok.

The details are as follows. For the age group of 15-49 which generally doesn’t die of diseases, alcohol is the leading cause of death when you take into account accidents, suicide, overdose and everything else (bar fights, drunk driving, domestic disputes). Women, ages 15-49 have a 3.8% chance of death from alcohol and men a 12.2% chance of death in that age range that can be attributed to alcohol. With that sort of granularity, reading the study gives you confidence that the authors did a pretty deep dive to get to these conclusions.

For older folks above age 50, the rise of cancer in relationship to alcohol consumption becomes the driving statistical engine to bring the net benefit to zero. Zero. There is no safe level. Young or old. No safe level.

Now, guess what the alcohol industry has frantically said in response….you got it. They quote the American Heart study saying a drink a day keeps the doctor away, etc. Even the vaunted Harvard Men’s Health Study had one drink a day as part of their formula for extra longevity. The problem with all those studies was looking at JUST one condition, like death from heart attack, instead of the whole spectrum.

And the data is equally clear for alcohol and driving. No level is safe. No level.
Now, I’m curious about mechanism and what’s behind all this. I think the clue comes down the Longo’s research into longevity and resiliency. His research shows that alcohol turns off mTOR, the gene that builds protein and cells. Growth and development helps you reproduce and make babies, but inhibiting it helps you live longer. Yin and yang. Dietary restriction is hard on reproducing but great on living longer. Alcohol turns it off living longer. Bummer.

Is there a benefit to alcohol? Well, yes. When structured in cultural practices that use it to create community, enhance connection and love between humans, that’s good. It’s a pretty slippery slope. Seeking pleasure is a universal force. Comes with a price.

www.what will work for me. Lousy puritanical message. I heard so much of this in my conservative boarding school background. It’s wearingly tedious to admit that those rigid old Victorians were right. I’m no tea-totaller. But I’m cutting down. One drink, only when I go out with friends. Time to back peddle down to two drinks a week, not one a day. And only in the social context of having a meal with loved ones. And then not driving with my loved ones with alcohol. Grrrr.

 

Pop Quiz

  1. One drink a day will help you live longer. T or F Answer: Used to be called true, now called false.
  2. Why the change? Answer: When you take into account all the conditions like trauma, domestic violence, traffic accidents as well as everything else, you fine other causes of death that statistically contribute to higher death rates.
  3. What was the prior error? Answer: If you would focus only on heart attacks, well yes, there are a few less. Or just one age group.
  4. Is there blowback against this data? Answer: Hell doesn’t freeze easily. The alcohol industry is bigger than we are.
  5. What is a prudent person to do? Answer: Love and connection is what life should be about. Cherish your loved ones. Don’t drink and drive, but do create community, family, dinners together, connection, sacred spaces. Have some communion together. And maybe that much alcohol……..0.25 oz communion wine.