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.