The Environmental Cost of Meat

Continuing the thread from the last post, I want to shed some light on the environmental cost of our diet.  Here's a link to a 3 year old report from the Food and Agriculture Organization of the United Nations.  Let me highlight a few key points.

"The lifestock sector emerges as one of the top two or three most significant contributors to the most serious environmental problems, at every scale from local to global."

1. Livestock production accounts for 70% of all agricultural land and 30% of the land surface of the planet.

2. Massive amounts of deforestation in the Amazon is dedicated toward livestock (as feedcrop or pasture)

3. The consequence:  the livestock sector is reponsible for 18% of greenhouse gas emissions measured in CO2 equivalents.  This includes methane from the animals, nitrous oxide from manure and ammonia which leads to acidification of ecosystems.

The U.N. report concludes that greenhouse emissions from livestock are greater than all forms of human motor transportation!  That means that the world's appetite for meat causes more damage to the environment than all the planes, trains and automobiles in the world!

Climate Change & Your Dinner

World leaders have been meeting this week at the Climate Change Conference in Copenhagen.  Discussions include various methods of curbing greenhouse emissions including the use of green technology; solar and wind energy.  What do you think our leaders will be eating in Copenhagen?  Does it matter?  Evidence suggests that a leading cause of climate change may actually be your diet!

Let me direct your attention to this recent article.  The authors state:

"A policy of reducing consumption of red meat in wealthy countries and encouraging a limited consumption increase in poor countries would benefit the climate as well as human health."

At first glance, this may be seem to be liberal jargon or crazy ideas propagated by vegetarians bent on pushing their agenda.  But these authors are hardly alone in their assessment.  A study published in the May 2009 edition of the American Journal of Clinical Nutrition echoes this sentiment.  The study presents evidence of agriculture as a primary source of greenhouse gases.  They suggest "changes in the diet toward more plant-based foods" as well as reduction in beef and pork consumption in order to reduce our influence on climate change.

Is it really possible that our meat consumption has a significant effect on the climate?  Unfortunately, yes.  I'll provide some more data in the coming weeks.

Book Review: The World is Fat

The World is Fat: The Fads, Trends, Policies, and Products That Are Fattening the Human Race, Barry Popkin. (ISBN 978-1-58333-313-6)

Everyone knows that there are a lot of overweight people around.   While the causes may seem somewhat obvious, the truth is, there are many variables that contribute to obesity.  Sure- we eat too much, we eat the wrong things and we don't exercise.  But Popkin takes a deeper look and examines the changes in society, the food industry and our habits that all contribute to our growing waistlines.  He spends a fair bit of text bad mouthing soda (rightfully so), but perhaps the most interesting part is his take on several "trusted authorities" on nutrition.

"The American Dietetic Association is funded by many food companies and, I argue, views nutrition through the lens of the food industry. As the accrediting body for registered dietitians and university programs, the association has a great deal of power over its profession... this association has been working with the soft drink industry and ignoring the negative effects of their products.

At a time of great interest in and controversy about the role of soft drinks in our schools and our lives- and with numerous meta-analyses and other studies on this topic- they have retained old, and what I think are somewhat dangerous guidelines.  They often cite industry-funded studies but seldom cite opponents of their positions and meta-analyses.  This organization uses research biased toward the food company or industry that is funding them."

Popkin goes on to cite questionable tactics of the American Heart Association and the Clinton Foundation.  Admirably, Popkin doesn't simply thrash these groups for their dubious relationships with the food industry.  Rather, he points out the difficulty in discerning truth.  Science and industry have merged and there are serious consequences.

Vitamin D & Obesity

Summer is over. Fall is winding down and we're staring into winter. If you've not already done so, please go out and buy a vitamin D supplement. It's usually not appropriate to make blanket statements regarding supplement use. After all, supplement programs should be tailored to an individual's unique needs. However, vitamin D is one exception. Everyone who lives in Washington D.C., San Francisco or anywhere north of these cities absolutely must supplement with vitamin D between October and March.

Among the many diseases associated with vitamin D deficiency, a novel idea is popping up on the radar exploring its influence on obesity. This paper suggests that low levels of vitamin D promote an aberrant "winter response" that allows the accumulation of fat. The authors write, "It may be possible to reverse the increasing prevalence of obesity by improving vitamin D status."

Flu Season

We're in the thick of flu season and you've probably been inundated with warnings to receive immunizations against both seasonal flu and H1N1. The H1N1 vaccine has particularly been under fire as many ordinary citizens, for various reasons, seem to lack the confidence in this particular vaccine. Whether or not those concerns are warranted is a tough question to answer if we want to truly consider all sides of the issue. I won't do that here.

Nonetheless, in any health intervention of this magnitude, things are going to go wrong from time to time. Just this morning, physicians in Canada were warned not to use vaccines from one particular batch due to an unexpected level of harmful reactions.

Whether or not you have received the vaccinations, is there anything else you can do? Can the food you eat influence your susceptibility to the flu or your reaction to infection? The answer is: absolutely yes!

I came across this piece in the Wall Street Journal that deserves a read. To quote from the article:

To create immune cells to fight off a specific infection, the body has to rapidly draw nutrients from the bloodstream, says Anuraj Shankar, a researcher at the Harvard School of Public Health. "If you don't have an adequate intake of vitamins and minerals, you won't be able to produce the number of immune cells you need, and the immune cells you do produce may be compromised," Dr. Shankar says. That makes it impossible to mount an effective response to infection, he says.

Every cell in your body depends on an adequate fuel supply. Just as your car will sputter, clank and whine if you poured ketchup into the tank, your body will sputter along if you give it lousy fuel. While supplements can be useful, they don't come close to providing the benefits of a "real food" diet. So don't look for protection from a bottle of vitamin C or zinc. Vegetables & fruits will provide thousands of other compounds that you just won't find in a bottle of pills.

There is no doubt that vaccines, in general, have provided protection to many people over the years. Even anti-vaccine advocates will have to admit that. But remember that an effective vaccine is meant to help your immune system, not build it up.

Imagine an old time gladiator; an elegant warrior with brute strength and scary skills. That is your immune system. Vaccines, at their best, are like the guys that sharpen the sword and strap on the armor of the soldier. They do not replace the soldier... they just enhance his weapons.

Getting vaccinated, then turning around and feasting on Big Macs... is outrageous. Eat well this season.

Milk from sick cows

There is something called the somatic cell count (SCC) that is used to reflect the amount of pus in milk. More accurately, it is an indicator of mammary gland health and an elevated count indicates an infection.

"Milk SCC is a long-established barometer of milk quality. An elevated SCC is an indicator of udder infection (mastitits)." Journal of Dairy Science 2000;83(12):2782-2788.

A 2005 study published through the British Veterinary Association indicates that a SCC less than 100,000 cells/mL is considered to be healthy. SCC greater than 200,000 cells/mL indicates a bacterial infection.

In the United States, the legal limit is 750,000 cells/mL
In Canada, the legal limit is 500,000 cells/mL
In Europe, Australia and New Zealand, the legal limit is 400,000 cells/mL

The United States not only has the lowest standards, but the standards contradict expert opinion on an acceptable amount of pus in our milk! Defenders of the US policy will state that although the upper limit is 750,000, most dairy herds come in around 270,000 cells/mL. Let me point out that that is still a sick cow.

Pastuerization, thankfully, destroys most of the cells. But imagine this; you pull out a steak from the refrigerator that you've been meaning to grill. You smell it and it gives off a revolting smell. You barely contain your vomit due to the stench.

Will you just cook it a little longer? Or will you refuse to eat it? Most of us would probably throw it out. Yet, we drink dirty milk because it's been pasteurized.

Milk & Hormones

We've determined that the presence of growth hormone itself in milk may not be a major concern. Rather, the IGF-1 that results is more likely the cause of chronic health issues related to milk. Does this mean that there are no hormone-related issues with milk? Not necessarily.

Let's look at the conclusions of several research studies.

1. "Among the routes of human exposure to estrogens, we are particularly concerned about cows' milk, which contains considerable amounts of estrogens....milk and dairy products, which account for 60-70% of the estrogens consumed." Med Hypothesis 2001 Oct;57(4):510-4.

Some authors argue that the amount of sex hormones present is so small that it is not likely to have an effect. But remember that a little may not hurt an adult, but that same amount may injure a child.

2. "Exogenous contributions of estrogens will therefore constitute a relatively higher proportion of sex hormone activity in the immature child." Analytica Chim Acta 2007 Mar 14;586(1-2):105-14.

Many researchers agree that there is increased risk to young children due to these small amounts of sex hormones.

3. "Sexual maturation of prepubertal children could be affected by the ordinary intake of cow milk." Pediatr Int 2009 May 22
______________________________________

Many chemicals, including various hormones and cellular signals, produced in our bodies appear in breast milk. The same is true for cows. They produce milk containing many chemicals including sex hormones. So the question of organic versus non-organic milk becomes a moot point with respect to sex hormone levels. Even so, let's see what research has shown.

4. "Conventionally labeled milk had significantly less estradiol and progesterone than organic milk. ... Milk labeled rBST-free had similar concentrations of progesterone vs. conventional milk and similar concentrations of estradiol vs. organic milk..... Conventional, rBST free, and organic milk are compositionally similar." J Am Diet Assoc 2008 Jul;108(7):1198-203

This is not to say that organic milk and conventional milk are the same. It means that the sex hormone content is roughly the same.

Is exogenous intake of hormone good for you? Most of us have the visceral instinct that this is not good. Let's remember that even organic dairy is full of these hormones. It is pesticides that they are missing (which is a good thing). But removing one evil doesn't automatically remove all of them.

Milk and rBST

Recombinant bovine somatotropin (rBST) (aka cow growth hormone), is routinely used to increase milk production in cows. This hormone is banned in Canada, European Union, Australia and New Zealand but the United States continues to allow it.

The National Institutes of Health states that rBST is not present in significant amounts in milk as it is destroyed during the pastuerization process. However, rBST causes an increases in levels if IGF-1. IGF-1 is present in cow's milk and survives the pasteurization process.

The obvious question is, "So what? Is consumption of extra amounts of IGF-1 in cow's milk harmful to humans?"

This journal article makes some important points about IGF-1.

1. Milk protein consumption induces postprandial hyperinsulinaemia and shifts the growth hormone/insulin-like growth factor-1 (IGF-1) axis to permanently increased IGF-1 serum levels.

2. Insulin/IGF-1 signalling is involved in the regulation of fetal growth, T-cell maturation in the thymus, linear growth, pathogenesis of acne, atherosclerosis, diabetes mellitus, obesity, cancer and neurodegenerative diseases, thus affecting most chronic diseases of Western societies.

3. Of special concern is the possibility that milk intake during pregnancy adversely affects the early fetal programming of the IGF-1 axis which will influence health risks later in life.

Clearly, disruption of the IGF-1 axis has significant implications.

Folks, many people will tell you that even if we give rBST to cows, it is not a big deal because it doesn't make its way into milk. But that approach is incredibly short sighted. rBST does something to cows... that something is an increase in IGF-1. IGF-1 enters our body and according to some authorities, has a significant role in most chronic diseases.

Milk has the potential for damages. So is organic milk better for you? We'll address that in the next entry.

Cow's Milk and Type 1 Diabetes

In this study, infants were weaned to a cow's milk based formula. Antibodies to a variety of components in cows milk were tested for at age 3 months and 18 months. These children were then followed for the next 7 years. The authors concluded:

"An enhanced humoral immune response to various CM proteins in infancy is seen in a subgroup of those children who later progress to T1D (type 1 diabetes). Accordingly, a dysregulated immune response to oral antigens is an early event in the pathogenesis of T1D."

This means that when the immune system reacted to cow's milk early, it eventually reacted to the pancreas and caused type 1 diabetes.

Again, many of you are having your infants avoid any form of cow's milk until after age 1. This is the formal recommendation from the American Academy of Pediatrics. But we need to think about these results intelligently and ask some questions.

If an infant is exposed to cows milk too early, he may initiate an aberrant immune response. This is fair enough. An obvious follow up question is; if a child is born with or develops a less than ideal immune system, will he mount an immune response to cow's milk later in life.... even if he isn't exposed until age 2 or age 3?

We don't know the answer yet but here's what we do know.
1. Many infants are born with poor immune function. When we eventually do a series on prenatal care, I'll elaborate.

2. Many kids have poor immune function. 75% of Amercians have low vitamin D levels. Kids are no exception. Vitamin D modulates the immune response. That would mean that at least 75% of kids have a less than ideal immune system. It may be overly aggressive to say "immune compromised" as that usually implies some sort of active disease process. But let's call it what it is... an immune system running on fumes.

3. Kids are already sicker than ever with asthma rates, autism rates, obesity rates on the rise. The constant intake of sugary snacks and junk foods only makes things worse.

Given THAT kind of immune system, does later exposure of cow's milk also lead to an immune response? Perhaps it won't lead to type 1 diabetes in all kids, but does an angry immune system cause other problems besides type 1 diabetes?

Milk and Infants

This article should be required reading for every mother getting ready to feed milk to her infant. Here are some of the highlights.

1. "The feeding of cow's milk has adverse effects on iron nutrition in infants and young children."

2. "... occult intestinal blood loss, which occurs in about 40% of normal infants during feeding of cow's milk."

3. " Calcium and casein both inhibit the absorption of dietary nonheme iron."

4. "The feeding of cow's milk to infants is undesirable because of cow's milk's propensity to lead to iron deficiency and because it unduly increases the risk of severe dehydration."

Some of you are thinking, "Duh! Everyone knows you don't start kids on cow's milk until after their first birthday!"

Isn't it nice to know that after age 1, it magically turns into something incredibly healthy for you. Or do we just learn to tolerate it?

Milk Proteins

Many experts have expressed the sentiment that human milk is perfectly designed for humans while cow's milk is perfectly designed for cows. The image of an infant suckling from his mother is quite endearing but can you imagine the sight of an infant fighting off baby calves to suckle off a cow?

If we're honest with ourselves, there's probably a certain visceral sense that it is absurd. But that's exactly what we are promoting when we advocate the use of milk as an absolutely necessary part of human development.

I grew up on milk. I loved milk. I enjoy cheese even more so it breaks my heart to know that milk and dairy products are actually dangerous to us. This is an uncomfortable truth but one that I am convinced plays a role in the degenerating health of many Americans.

To be clear, non-organic milk has another layer of problems compared to organic varieties. But before we discuss contaminants in non-organic milk, let's just look at clean, organic milk. The problem is not chemical contaminants, but the very nature of milk itself.

I'll encourage you to take a look at this article:
Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet 2007; 48(3): 189-198.

I'll summarize the major points of the paper.
1. Milk proteins consist of whey and caseins. There are many varieties of casein.
2. Within the beta-casein family, there are also many varieties; 2 of which are A1 and A2.
3. Upon digestion, A1 proteins yield a lot more of a product called, beta-casomorphin 7 (BCM 7)
4. BCM 7 is bad.

"BCM-7 has also been suggested as a possible cause of sudden infant death syndrome. In addition, neurological disorders, such as autism and schizophrenia, seem to be associated with milk consumption and a higher level of BCM-7."

"This bioactive peptide (BCM 7) exhibits a strong opioid activity and has been shown to stimulate human lymphocyte T proliferation in vitro."

This tells us that some of the breakdown products of milk can cause problems with your brain and promote activity of the immune system.

In fairness, this paper alone doesn't tell us whether that immune activity is acceptable or dangerous. But given the correlation between certain disorders and BCM 7.... and the inappropriate activation of the immune system in some of those disorders, it may be a safe jump to say that this is not a desirable activation.

This is still a matter of intense debate as evidenced here. In February 2009, the European Food Safety Authority (EFSA) rejected claims that milk may be hazardous to your health. But they did acknowledge that BCM 7 acts as an opioid and influences gut function.

For some people, the EFSA report is enough "proof" that milk is safe. How about you? Another way of stating their conclusions (my paraphrase) is that "there is only a 'little bit' of evidence that milk is not safe. We may uncover more evidence as research continues but in the mean time... keep drinking milk."

We'll keep digging into the evidence as we continue this series.

Dairy- New Perspectives

I recently came across a commentary in the May 2009 edition of the American Journal of Clinical Nutrition. You can read part of the argument here but I'll highlight the key points... taken directly from the article.

1. Osteoporotic bone fracture rates are highest in countries that consume the most dairy.

2. Most studies of fracture risk provide little or no evidence that milk or dairy products benefit bone.

3. Accumulating evidence shows that consuming milk or dairy products may contribute to the risk of prostate and ovarian cancers, autoimmune diseases, and some childhood ailments.

4. Bones are better served by... focusing efforts on increasing fruit and vegetable intakes, limiting animal protein, exercising regularly, getting adequate sunshine or supplemental vitamin D, and getting approximately 500 mg Ca/d from plant sources.

The article was specifically talking about dairy use while on a vegetarian diet. The counterpoint authors conclude, "Therefore, dairy products should not be recommended in a healthy vegetarian diet."

So if milk doesn't strengthen bones as we've all been lead to believe, then why do we consume so much of it?

Milk: It Does a Body ... good?

I came across this piece today saying that milk drinking started about 7,500 years ago in Central Europe.

" Most adults worldwide do not produce the enzyme lactase and so are unable to digest the milk sugar lactose. However, most Europeans continue to produce lactase throughout their life, a characteristic known as lactase persistence.... "

"Since adult consumption of fresh milk was only possible after the domestication of animals, it is likely that lactase persistence co-evolved with the cultural practice of dairying, although it was not known when it first arose in Europe or what factors drove its rapid spread." Professor Mark Thomas (University College London- Genetics, Evolution and Environment)

It is well established that the vast majority of the world population is lactose intolerant. But milk consumption is generally regarded as necessary for optimal health. The current USDA food pyramid has a special section devoted to milk and dairy products, giving it equal importance as whole grains, fruits and vegetables.

The next series I'll cover is on milk. If you ever want to see nutritionists get into a fight, take 10 of them, toss them in a room together and ask them if you should drink milk. Be prepared for a heated exchange with intense arguments citing pros and cons of milk.

We'll dive into some research, combine it with a rational understanding of human physiology and leave room for you to decide whether milk, in fact, does a body good.

Type 1 Diabetes and Wheat

A new report in Diabetes this month showed that patients with type 1 diabetes show significant immune responses to wheat proteins. Type 1 diabetes is an autoimmune condition where the immune system destroys insulin producing beta cells of the pancreas.

The authors state that the results indicate, "... a diabetes-related inflammatory state in the gut immune tissues associated with defective oral tolerance and possibly gut barrier dysfunction."

In other words, gut dysfunction may promote the immune response. This leads to an "irritated" immune system that goes on to attack other organs such as the pancreas.

This idea is hardly new. In a commentary of the article, one author writes, "Given that type 1 diabetes is the unfortunate consequence of the combined effects of the individual genetic setup and exogenous and host-related factors, it is not surprising that the gut might be involved in the process leading to clinical disease."

So it would seem that your immunologist (dealing with the autoimmune component) should be talking to your endocrinologist (about the endocrine abnormalities secondary to diabetes) and should bring in the gastroenterologist (to discuss best methods of dealing with intestinal permeability). If you are a type 1 diabetic, this is a conversation that should be happening.

Heart Disease- The Big Picture

You can see by now that a simple assessment of cholesterol alone (total, LDL, HDL) is not sufficient for determining your risk of a cardiovascular event. If you managed to lower your cholesterol levels using heavy hitters like Lipitor, great job... but don't get a false sense of security. Remember that many people with heart disease have normal cholesterol levels. Here's a summary of the other contributors to heart health.

1. Inflammation
2. CoQ10 levels
3. Gut dysfunction
4. Vitamin D levels
5. Hormone imbalances
6. Homocysteine levels
7. Essential fatty acids levels
8. Magnesium levels

Each of these variables needs to be targeted to ensure appropriate protection for your heart. This is by no means a comprehensive list. But it should provide a starting point for understanding some of the major players involved in heart disease. Thankfully, the same lifestyle measures of good food, stress reduction and exercise will lower cholesterol while also targeting these 8 variables we talked about.

Heart Disease- Magnesium

Next on the list of 'must have' nutrients for the heart is magnesium. Magnesium can be found in sunflower/pumpkin seeds, raw nuts, spinach & beans (incidentally, all foods that are very good for you).

This study from the George Washington University Medical Center found that low levels of magnesium lead to inflammation & oxidative stress that ultimately damage the heart and blood vessels.

This is particularly relevant because Americans have notoriously low levels of magnesium This was brought to our attention over 20 years ago in this study, where researchers called it, "the most underdiagnosed electrolyte deficiency in current medical practice."

More recently, a 2005 study in the Journal of the American College of Nutrition found that nearly 70% of Americans don't consume enough magnesium. This was found to raise inflammatory markers that play a role in heart disease.

Low magnesium may also have a role in the development of metabolic syndrome, another variable that promotes heart disease.

If you have heart disease, pay attention to your magnesium levels.

Heart Disease- Fish Oil

Nutritionists have been touting the benefits of fish oil for years. Studies have shown clear benefit to patients with a wide range of diseases; cardiovascular, neurological, metabolic and more. In the August 11, 2009 edition of the Journal of the American College of Cardiology, a recommendation was issued to people with and without heart disease.

500 mg of EPA and DHA for patients without heart disease
1000 mg of EPA and DHA for patients with heart disease.

The authors state that further study is needed to determine optimal dosage and that these appear to be minimum dosages.

Another recently published paper suggests that assessing the omega 3 content in red blood cells is an important measurable variable.

" The n-3 index (erythrocyte eicosapentaenoic acid plus docosahexaenoic acid) may be considered as a potential risk marker for coronary heart disease mortality, especially sudden cardiac death." Journal of Cardiovascular Pharmacology 2009 Jun 26. (epub ahead of print)

Other researchers agree and state this hope for future cardiac assessments,

"The day will probably come when a test such as the omega-3 index will be routinely included in lipid panels so that the clinician can address not only cholesterol, triacylglycerol, and lipoprotein abnormalities but also deficiencies in n–3 FAs." The American Journal of Clinical Nutrition 2008 Jun;87(6):1997S-2002S.

You should be aware that those tests are readily available to you and your physician. It is just not part of the routine assessment because standards take a very long time to change.

If you have heart disease or are at risk, ask your physician to assess your red blood cell fatty acid status.

Heart Disease- Homocysteine

If you are at risk of heart disease, ask your doctor to measure your homocysteine levels. What was once a relatively obscure laboratory measurement (from a blood draw); homocysteine assessments have become somewhat common place. Even so, many physicians stubbornly continue to look solely at cholesterol to determine cardiovascular risk despite evidence that up to 50% of patients with heart disease have normal levels of cholesterol.

Homocysteine is an amino acid that when produced in excess, can damage the inner lining of blood vessels. Elevated homocysteine has been shown to increase risk of stroke, coronary artery disease and death. Homocysteine can also accelerate atherosclerosis. While certain genetic mutations can cause high levels of homocysteine, it can also be a result of low B vitamin status including B6, folate and B12.

While vitamin supplements are helpful in lowering homocysteine, a heart healthy diet alone also has this cardioprotective effect. This study showed that you can naturally lower homocysteine by increasing intake of vegetables, fruits and berries (and subsequently folate levels) for a few months.

The point is, cholesterol has long been a marker for heart disease. We now understand that homocysteine is also a very important marker and can easily be lowered by increasing B vitamin intake through diet or supplementation. Nonetheless, it is important that we don't mistake homocysteine as "the new cholesterol" and misinterpret it to be the sole determinant of heart disease risk. All diseases, including heart disease, involve multiple variables. Now that we've identified this particular contributor, be sure you know where your homocysteine levels are.

"Homocysteine, however, remains an important field of study as an unconventional risk factor, one facet of a complex metabolic puzzle- a veritable Rubik's cube- that promotes atherosclerosis." Mayo Clinic Proceedings 2008 Nov; 83 (11) :1200-2.

Vitamin D in Kids

We've been doing a series on heart disease but this breaking news needs to be mentioned. A study in the current edition of Pediatrics found that 70% of kids in the United States have low levels of vitamin D.

The researchers say, "We expected the prevalence of vitamin D deficiency would be high, but the magnitude of the problem nationwide was shocking."

Falling in line with our discussion on heart disease, the authors note...
"25(OH)D (vitamin D) deficiency is common in the general US pediatric population and is associated with adverse cardiovascular risks."

In other words, kids with low vitamin D are at risk of heart disease as adults. We've been talking about ways to address your concerns if you have heart disease, but this news tells us that we can help our kids by making sure they have adequate vitamin D.

I really like the tone the researchers take here. Let's reduce risk factors for the next generation by getting them out in the sun.

Heart Disease- Gut

The gut appears to be the root of many problems, including heart disease. This may be a result of increased bacteria and their toxins crossing the gut and affecting heart function.

Unfortunately...
"In recent research, the gut has received very little attention from cardiologists as its role in the pathogenesis of cardiovascular disease is poorly understood." Eur Heart J 2005 Nov;26(22):2368-74. Epub 2005 Jun 24.

However, we are beginning to understand that when you have a leaky gut, you experience ...

"chronic inflammation and malnutrition....therefore, future studies need to address the pathophysiology of the intestinal barrier whose reactivity seems to be crucial for heart function." Curr Opin Clin Nutr Metabl Care 2008 Sep;11(5):632-9.

While leaky guts may adversely affect heart health, the bacteria that live in the gut also play a role. Microbiota that normally reside in our gut have profound implications on many aspects of human health; the heart is no exception.

"Understanding these microbial activities is central to determining the role of different dietary components in preventing or beneficially impacting on the impaired lipid metabolism and vascular dysfunction that typifies coronary heart disease and type II diabetes."
Curr Med Chem 2006;13(25):3005-21.

An important point to make here is that people who have problems with their gut often have absolutely no gut symptoms! Common extraintestinal manifestations include,

"symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level." European Journal of Surgery Volume 164, Supplement 583, 31 December 1998 , pp. 29-31(3)

If you have heart disease, be sure to ask your doctor about underlying gut dysfunction that may be making your heart condition even worse.

Heart Disease- Testosterone

The hormones in our body play a significant role in heart health. Boston University researchers say, "the evolving role of androgens in metabolic syndrome and cardiovascular disease is of paramount importance."

Testosterone, the most famous androgen, has a protective effect on the heart (at least in men). Atherosclerosis tends to increase as testosterone levels drop. Low testosterone was once considered to be relatively rare phenomenon since men don't have the dramatic fall in sex hormones that women experience during menopause. But we now understand that low testosterone levels are "frequently unrecognized but also common." Int J Clin Pract 2007 Feb;61(2):341-4.

This doesn't meant that older men should run out and begin testosterone replacement therapy. In fact, the use of testosterone therapy is still a matter of large debate because of mixed findings in clinical studies. A better method may be to identify the reason for the drop in testosterone. These previous entries in this blog identify some reasons for loss of testosterone.

A large part of the problem is insulin resistance and poor blood sugar regulation. Insulin resistance will drive down testosterone levels in men. The result? A relatively unprotected heart.

If you have heart disease, has your doctor talked to you about your testosterone levels?

$147 billion per year

$147 billion per year. That's how much we spend on obesity each year. A new report released today found that nearly 10% of our health care dollars go toward direct care of obesity related diseases. Obese people spend $600 more per year on prescription medications compared to normal weight individuals. Medicare expenditures are $1700 for obese individuals compared to normal weight individuals. Drug costs alone are $1400 higher for obese Medicare patients. Keep in mind that this does not include overweight... just obesity.

We're currently in a political climate where health care is a primary issue. I know we want drug companies to lower costs... insurance companies to care less about money and more about their clients. We talk about greed, bureaucracies, regulating insurers etc. But let's change the conversation from how we've been hurt to how we can help. Let's take ownership over our own health. There are costs that our lifestyle decisions collectively put on the health care system.

Let's put a new spin on 'political activism' and get physically active to do our part at chipping away at this health care crisis.

Heart Disease- CoQ10

It is well known that while statins block the production of cholesterol, they also block the body's own production of Coenzyme Q10, an important player in energy production. As recently as 2007, some doctors argued that although that may occur, it's really not a big deal. This illogical reasoning was balanced by rational voices that raised concern and pointed to the possibility of CoQ10 deficiencies causing muscle pain. If you dig deep into this issue, you'll find that 2 sides are shouting at the other...

"Statins cause muscle pain!"
"No- they don't!"
"Yes they do!"
"No they don't!"

Folks- whether or not it directly causes muscle pain is not the issue. The issue is that CoQ10 levels go down. This is bad. CoQ10 levels are associated with:

1. Parkinson's disease Neurosci Ltrs 2008 Dec 5;447(1):17-9. Epub 2008 Sep 30
2. Cerebellar ataxia Cerebellum 2007;6(2):118-22.
3. Diabetes Nutrition Research 2008 Feb;28(2):113-21.
4. Breast, Lung, Pancreatic, Skin Cancers J. Amer Acad of Derm 2006 Feb;54(2):234-41.
5. Allergies Allergy 2002 Sep;57(9):811-4.

... and many more problems. Perhaps you don't experience muscle pain while on your statin. For this reason, many physicians are unwilling to say you should be on CoQ10. Muscle pain is a "red herring." There are bigger problems with statins as listed above.

But specifically for the heart....how important is CoQ10? A 2008 study showed that in patients who already had heart disease, it was an independent predictor of mortality. In other words, the less CoQ10 you have, the more likely you are to die.

If you are on a statin, you should be taking Coenzyme Q10.

Heart Disease- Old School

In the old days, the biggest predictor of heart disease was elevated cholesterol levels. The standard of care was to do everything possible to lower cholesterol levels. At times, lifestyle and dietary changes were recommended but the emergence of statin drugs made the task so much easier. Statins (like Lipitor, Crestor, Zocor) generally do an excellent job of lowering cholesterol levels.

Then, data emerged that nearly 50% of people who have heart disease actually have normal levels of cholesterol. It appears that inflammation may play a more important role in promoting heart disease; regardless of cholesterol levels. Regretfully, rather than thoroughly re-examining our understanding of heart disease and seeking imaginative solutions for it, we simply found new rationale to keep doing what we've been doing. More statins, more statins and more statins.... because not only do statins reduce cholesterol, they also reduce inflammation!

Let me quote something from a WebMD article referencing a 2008 New England Journal of Medicine article (I generally like WebMD... but this was just a little too crazy).

" Millions of Americans take statins to lower their cholesterol, but dramatic findings from a study of the statin drug Crestor suggest that millions more might benefit from treatment...The study was funded by Astra-Zeneca, which makes Crestor."

Is it just me or does that sound like a line from a low budget infomercial? It goes on...

"This study was designed to identify new groups of patients who could benefit from statin therapy, and it did that," Mayo Clinic cardiologist and American Heart Association past-president Raymond Gibbons, MD, tells WebMD"

Imagine that! A study paid for by the makers of Crestor, deliberately designed to see if more people should take Crestor, finds that more people need to take Crestor.

Yes- this kind of science has a certain stink about it. But just because it smells a little bit doesn't meant that there isn't some truth hidden in the pile of money-driven, self-serving hogwash. In the coming series on heart disease, we'll dissect heart disease and show ways for you to think about it. There is more to it than statins.

Like most chronic diseases, it is incredibly complex. Multiple variables that influence the pathogenesis and progression have been identified. I hope that when you're through with the series, you'll feel empowered and equipped to open up meaningful lines of dialogue with your doctor.

Vitamin D and Heart Disease

The number 1 killer in the United States is still heart disease. The cholesterol model for heart disease has shown some cracks in its logic, we need to turn our attention in other directions. While heart disease is certain to have many causes, one simple thing we can do is make sure we have adequate vitamin D levels. This article shows how valuable vitamin D research is in advancing the clinical management of heart disease.

In the near future, I'll do a series on heart disease and dissect the problem beyond cholesterol and conventional management of this killer.

Undiagnosed Celiac Disease

A new study published in the July 2009 edition of Gastroenterology found that young people today are 4.5 times more likely to have celiac disease than young people 50 years ago. Another alarming fact is that people with undiagnosed celiac disease have a 4 fold increase of death than in patients without celiac disease.

One of the study authors comments, "Celiac disease has become much more common in the last 50 years, and we don't know why."

He goes on to state, "This study suggests that we may need to consider looking for celiac disease in the general population, more like we do in testing for cholesterol or blood pressure."

Immune responses to gluten are not uncommon. Get checked.

Vitamin D Deficiency

Vitamin D has been all over the news lately. Vitamin D deficiency was once considered to be a rare occurrence. But recent research has shown that many of us are actually deficient in this important nutrient (it's actually a hormone for you nutritional purists).

A 2009 study found that 75% of Americans were deficient in vitamin D. This is a frightening statistic! Low vitamin D levels are associated with everything from autoimmune disorders, neurodegenerative problems, heart disease, chronic pain and some cancers. Another recent study showed that vitamin D levels are inversely related to progression of multiple sclerosis.

As usual, let's exercise a bit of common sense as we interpret these findings. This does not mean that low vitamin D causes these problems. But it is clearly an identifiable risk factor. Most (if not all) diseases are multifactorial. In other words, there are usually multiple variables that interact and cause disease. For example, what causes heart disease... a bad diet or lack of exercise? The answer is; both. Each are risk factors that cooperate to kill your heart. The more effectively we can reduce these risk factors, the better off we'll be.

Please talk to your doctor about your vitamin D levels. Now that we're in the middle of summer, it's the best time to 'stock up' on vitamin D. Get out in the sun (exercising caution in preventing burns) to load up on vitamin D.

Running: Overtraining- Prevention 2

Eat good food, sleep well and hydrate well. These are no-brainers when it comes to prevention of overtraining syndrome. A good multivitamin & fish oil are also good additions (this is true even for non-runners). But one important nutritional supplement seems to be especially significant; phosphatidylserine.

Let's look at some of the evidence supporting the use of phosphatidylserine.
" The findings suggest that phosphatidylserine (PS) is an effective supplement for combating exercise-induced stress and preventing the physiological deterioration that can accompany too much exercise. PS supplementation promotes a desired hormonal status for athletes by blunting increases in cortisol levels." Journal of the International Society of Sports Nutrition 2008 Jul 28;5:11.

"This is the first study to report improved exercise capacity following phosphatidylserine supplementation. These findings suggest that phosphatidylserine might possess potential ergogenic properties." Medicine and Science in Sports and Exercise 2006 Jan;38(1):64-71

"...chronic oral administration of phosphatidylserine may counteract stress-induced activation of the hypothalamo-pituitary-adrenal axis in man." European Journal of Clinical Pharmacology 1992 April; 42 (4):385-388
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In the world of sports nutrition, there are many supplements and research studies that show benefits of various agents in improving sugar metabolism, energy production, fat breakdown, other variables that can aid performance (creatine, carnitine, ribose to name a few). Phosphatidylserine is worth consideration because of its ability to regulate hormones shifts by stabilizing the HPA axis.

Running: Overtraining- Prevention 1

If you are overtrained, it can be difficult to recover. As with most conditions, prevention is the best step. The single best training step you can take to prevent overtraining is the use of a heart rate monitor.

There are a few different ways that athletes utilize heart rate monitors. A doctor by the name of Phil Maffetone devised a method of finding your maximum heart rate. This is calculated by subtracting your age from 180. So if you are 40 years old... (180 - 40= 140) your maximum heart rate should be 140.

Those of you familiar with heart rate monitors may realize that at first glance, this seems a bit low. The traditional method has been to subtract your age from 220; use that as the maximum heart rate and then to train between 65-85% of that maximum. For the 40 year old person (220-40= 180) 65-85% of 180 is 117-153. The traditional recommendation is to train closer to the 85% point for increases in overall performance and aerobic capacity.

For our 40 year individual, the question arises; should I train at 140 or 153 bpm? The answer is 140. This is a good opportunity to make this point: There is a big difference between "training for performance" versus "training for performance AND good health."

Training for performance is a relentless, "all-in, do what it takes" attitude that demands the most of your body. For example, you can drive your car fast all the time (performance) but you must realize that the life of the engine, tires and brakes will suffer as a result of that. On the other hand, if you take good care of your car and drive responsibly, it will certainly give you excellent performance when you need it.

Training at 140 (for this imaginary 40 year old runner) may seem slow and awkward at first. You may feel like you're doing a gentle jog rather than a training run and you may experience some frustration. But over time, you will be able to run faster while maintaining that slower rate. This has the important effect of minimizing chemical and hormone stress while programming the aerobic engine of your metabolism. For more on this, read Maffetone's book, "In Fitness and In Health."

To be clear, healthy individuals may perform just fine while training at the higher heart rate derived from the traditional calculation. But the hidden cost of that is potential hormone and metabolic shifts that have long term implications. If you are already overtrained or getting to that point, it is essential that you follow the 180-age formula for heart rate.

Running: Overtraining & Immunity

You should be convinced by now that overtraining has significant health consequences as a result of hormone shifts. Another question that arises is the effects on immunity.

Overtraining is associated with compromised mucosal immunity. This means that you are more prone to infection. It is clear that overtrained athletes have a decrease in salivary IgA. This is an immunoglobulin that serves to protect mucous linings. That means that when viruses or bacteria get into your nasal cavity or gut, you are more likely to suffer an infection because you have fewer antibodies in the area to defend you. Exercise Immunology Review 2004;10:107-28.

The immune system falls out of balance. Many of us have a general idea that people can have weak or strong immune systems. This black or white approach toward physiology is not accurate. Although I mentioned in the previous paragraph that mucosal immunity is compromised, we should understand this to mean that one component of immunity is compromised. It's not fair to say you have a globally weak immune system. One paper that speak to this point states:

" It is concluded that an increased incidence of illness associated with overtraining syndrome and in response to excessive exercise is not due to immunosuppression per se, but rather to an altered focus of immune function, with an up-regulation of humoral immunity and suppression of cell mediated immunity." Sports Medicine 2003;33(5):347-64.

This is the equivalent of our armed forces failing to cooperate during a time of war. While each branch may be powerful alone, there must be central coordination for success.

Another group of researchers echo this sentiment and states:
" Whereas athletes are not clinically immune deficient, it is possible that the combined effects of small changes in several immune parameters may compromise resistance to minor illnesses such as upper respiratory tract infection." Medicine and Science in Sports and Exercise 2000 Jul;32(7 Suppl):S369-76.

You can see that overtraining has major negative impact on the immune system.

Running: Overtraining & Hormones

Let's dig a little deeper into the effects of overtraining.

Testosterone levels will decline. A team of researchers grouped 286 subjects into moderate or heavy exercise groups. They ran for 2 hours, 5 days per week for about 1 year. After that, they spent 9 months with a low intensity running schedule. They found that the pituitary hormones LH and FSH (luteinizing hormone, follicle stimulating hormone) decreased, testosterone levels decreased, and sex hormone binding globulin levels increased. Levels improved back to normal during the low intensity recovery period. They concluded,

"Long-term strenuous treadmill exercises (overtraining syndrome) have a deleterious effect on reproduction." Journal of Endocrinology 2009 Mar;200(3):259-71. Epub 2008 Dec 9

Females can also experience reproductive dysfunction. While the mechanisms are still to be determined, the probable suspect is decreased estrogen production as a result of overtraining. This does more than set women up for poor athletic performance. It sets you up for osteoporosis, infertility, decreased muscle mass & behavioral problems. Journal of Endocrinological Investigation 2001 Nov;24(10):823-32.

The hormone cost of overtraining is considerable. The consequences of these shifts are significant.

Running: Overtraining

Overtraining may involve more than just a drop in your athletic performance. Common symptoms include: headaches, insomina, pain, loss of enthusiasm for running, increased number of injuries, slower healing time, slower recovery time, frequent infections, loss of appetite and more.

Classically, the treatment for overtraining syndrome is rest. Depending on the extent of compromise to your body, this may require complete rest or a substantial reduction in your training time. Let me explain a little of the hormone physiology behind the syndrome.

1. Cortisol production is a priority in your body.
Just as we can say your heart is more important than your feet and your brain is more important than your spleen, we can say that cortisol is simply "a little more important" than many other hormones.

2. Cortisol, testosterone and estrogen have a common mother.
The precursor to all these hormones is pregnenolone. Generally, there's enough pregnenolone to go around so we make adequate amounts of all hormones, but when physical (or emotional) demands are extraordinarily revved up, cortisol production takes priority.

Do you remember the old Star Trek episodes where the Captain would say, "more power to the shields!" during times of attack? Presumably, sending the available power to shields took priority over the lights in the kitchen, powering the microwave oven or whatever else required power. The limited amount of available resource needed to be carefully distributed to get through the day.

Similarly, our pregnenolone needs to be transformed into what matters most at the time.

3. Over time, you won't even make enough cortisol.... or testosterone... or estrogen... to get through the day.
In Star Trek; eventually, the shields went down.
In California; eventually, you'll run out of water.
In overtraining; eventually, you'll run out of cortisol.

When your cortisol production "dries up", other hormone production will also suffer.
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Let me ask women a question? What happens when estrogen levels decline?
The answer is; the classic symptoms of menopause. Muscle mass declines, bone density decreases, fatigue, discomfort, insomnia etc. Sounds familiar?

Now to the men. What happens when testosterone levels decline?
The answer is: muscle mass declines, bone density decreases, fatigue, discomfort, insomnia etc.

Now a question to all runners. What happens when you are overtrained?
The answer is: muscles don't recover as well, bone loss, fatigue, discomfort, insomnia etc.

Running: Protect Your Adrenal Function

As the last entry discussed, the adrenal glands are subject to stress during training. This is perfectly acceptable if you have healthy adrenal status. But if you have some level of adrenal fatigue, you must be prepared to train wisely. If the idea of "adrenal fatigue" sounds a little strange to you, we should describe it more accurately as "hypothalamic-pituitary-adrenal axis dysfunction." This is the biological system that regulates adrenal activity and is commonly referred to as the HPA axis.

HPA dysfunction is common and is related to multiple symptoms.

1. Chronic fatigue. Psychosomatics 2008 Sep-Oct;49(5):450.
2. Irritable Bowel Syndrome. Neurogastroenterology & Motility 2009 Feb;21(2):149-59. Epub 2008 Aug 5.
3. Altered immune function. Journal of Neuroimmunology 2002 Dec;133(1-2):1-19.
4. Depression Psychological Medicine 2009 Apr 1:1-4.

If you already have some level of HPA dysfunction, then aggressive training may actually harm your health. This doesn't mean that you shouldn't run at all. Interestingly, low intensity exercise reduces burden on the adrenal glands. Journal of Endocrinological Investigations 2008 Jul;31(7):587-91.

Because HPA dysfunction is not a "disease" per se, there are no accurate numbers for how many Americans are affected but adrenal health is relatively simple to assess. It involves a simple saliva test that many functional laboratories (i.g. Diagnos-techs, Metametrix, Genova Diagnostics) perform.

If you have experienced a drop in performance, slower race times, slower recovery, gastrointestinal discomfort or fatigue, you may be overtrained. More on overtraining next time.

Running: A Fresh Look

I like to run. I am not a fast runner; quite average in fact. But it gives me a chance to renew my body and my mind. Running outside helps me think more clearly, meditate and recharge while I give my muscles, bones and heart a great workout. I'm sure there are many of you who are passionate about running and can relate to the mental and physical boost it provides. For you running nuts, I wanted to do a short series that gives a fresh look to an old movement.

First off, I won't talk about the cardiovascular and general health benefits that running provides. You all know about that and it's been well researched and written about by hundreds of authorities. Instead, let's start by looking at the hormonal milieu that your body goes through.

A 2008 paper in the European Journal of Internal Medicine found that cortisol levels are increased after running a marathon. This comes as no surprise as cortisol is famous for being a "stress hormone." A 26.2 mile race is quite a physical stressor.

Cortisol itself is a great hormone but in today's hectic world, the "emotional marathon" of daily life takes its toll. Coupled with other physical demands such as irregular meal times & sleep deficit, we continue to tax the adrenal glands (the body part that produces cortisol) until there is either overburden or outright fatigue of these glands.

In other words, training with "burned out" adrenal glands can be hazardous. We'll make a case in future blog entries.

Your Insurance and Tobacco

The story making headlines this morning is the report in the New England Journal of Medicine that several life & disability insurance companies invest billions of dollars into tobacco company stock. This seems to cross obvious moral and ethical lines, suggesting an attitude of "dollars over principles", but I'll leave further commentary to others.

The take home message here: You are in charge of your health.

The last thing I want is for readers to become absorbed in a "the evil world is out to get you" kind of attitude. I just want us all to realize that no one else; no 3rd party, insurer, friend or professional will care about your health as much as you will.

Be empowered. Take ownership. Take control of your health. No one else will do it for you.

Is Health Care in Trouble?

President Obama has consistently called for dramatic health care reform. Most economists agree that if the health care system isn't fixed, it has the potential to drag down the entire economy. Check out this June 2009 report from the White House Council of Economic Advisors. It states,

"Health care expenditures in the United States are currently about 18 percent of gross domestic product, and this share is projected to rise sharply. ... is projected to reach 34 percent by 2040"

There is no arguing the need for reform. The debate seems to be what that reform will look like and how it will be paid for.

I recently read an article and one line burned into my brain. The author wrote, "America doesn't have a health care problem. It has a health problem." (I've searched high and low but cannot remember or find the source).

This may be a bit of an overstatement but the point it makes is clear.
1. Nearly 50% of Americans have at least 1 chronic disease.
2. Risk factors for chronic disease are largely preventable.
3. Chronic disease accounts for 75% of health care spending.

If you put 2 and 2 together, this translates as "75% of our health care dollars, or $1.5 trillion, can be saved by living well."

I appreciate the efforts to streamline medical care, insure the uninsured and promote electronic medical records to improve efficiency and save dollars. But that savings will not equal the $1.5 trillion that we have the power to save by making wise decisions.