Category Archives: Nutrition

Eat your Fresh Fruit! – for better cardiovascular health: Latest New England Journal April 11, 2016

A recent study released in the April 10 edition of The New England Journal of Medicine demonstrated that fresh fruit consumption was associated with decreased blood pressure and decreased blood glucose.

Fresh Fruit Consumption and Major Cardiovascular disease in China

Increased fresh fruit consumption was associated with decreased risk of cardiovascular disease, decreased cardiovascular death, decreased coronary events, decreased hemorrhagic stroke, and decreased ischemic strokes.

fruits1

Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer_ systematic review and dose-response meta-analysis of prospective cohort studies

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases.

Dietary Nitrate Lowers Blood Pressure

Fruit and vegetable consumption and all-cause, cancer and CVD mortality analysis of Health Survey for England data.

Fruit and Vegetable Consumption and Risk of CAD – a metanalysis of cohort studies

Quantity and variety in fruit and vegetable intake and risk of coronary heart disease

Greater Total Antioxidant Capacity from Diet and Supplements Is Associated with a Less Atherogenic Blood Profile in U.S. Adults

Novel insights of dietary polyphenols and obesity

Cruciferous vegetable consumption is associated with a reduced risk of total and Cardiovascular disease mortality

The NEJM study released in this issue death with Chinese populations, some 450,000 Chinese in fact, with no prior stroke or hypertension to avoid confounding factors. IN Western populations, an inverse association had been seen in patients eating 80 gm of fruit a day, leading to a 5% decrease in cardiovascular death.

A low level of fruit intake is associated with a major increased cardiovascular risk rate. The study above chose China, since vegetable intake is high but fresh-fruit intake is much lower.  Cardiovascular disease causes 17 million deaths a year and is especially high in lower income countries. The effect of adding fruit to the diet of people with low consumption rate can detect larger effects.

Findings:

The association between the level of fruit consumption and cardiovascular risk in our study (a 40% lower risk of cardiovascular death and a 34% lower risk of major coronary events among participants who consumed fresh fruit daily as compared with those who never or rarely consumed fresh fruit) was much stronger than the associations observed in previous studies. < Current NEJM study April 2016.    This study involved some 512,000 people who had low intake of fruit already, making it easy to detect positive benefits. None of the patients had hypertension or Diabetes, and thus were not on any confounding medications. The study also took into account regression dilution bias (changes in baseline characteristics of a population during a study) that may impact findings. 

Fruit is high in fiber, potassium, folate, phytochemicals, and antioxidants all of which may mediate the positive impact of fruit intake.

Conclusion:

In conclusion, our evaluation of the relationship between fresh fruit consumption and cardiovascular disease in China showed that the level of fruit consumption was inversely associated with blood pressure and blood glucose levels.

Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010 a systematic analysis for the Global Burden of Disease Study 2010.

Up-regulating the Human Intestinal Microbiome Using Whole Plant foods, polyphenols and fiber

Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals

What is Xenohormesis

White Pitaya (Hylocereus undatus) Juice attenuates insulin resistance and hepatic steatosis in obese mice

Greater Total Antioxidant Capacity from Diet and Supplements Is Associated with a Less Atherogenic Blood Profile in U.S. Adults b

Feeding the brain and nurturing the mind linking nutrition and the gut microbiota to brain development

Cultivating healthy growth and nutrition through the gut microbiota.

 

 

 

Eat your greens – chlorophyll metabolites in our blood may be maintaining our blood anti-oxidants.

  • Eat your greens!
    Eat your greens!

    Everyone knows about CoQ10, with many people frequently taking it for ‘vascular health’ . It is true that ubiquinol in the blood stream is an anti-oxidant that helps maintain vascular integrity. Ubiquinol–10  is an endogenously synthesized lipid antioxidant that scavenges free radicals and is involved in a-tocopherol homeostasis. It prevents lipid peroxidation and in the process is oxidized to ubiquinone.

  • 95 % of the quinone is maintained as ubiquinol, which must be regenerated from ubiquinone after it prevents lipid oxidation.
  • The study below demonstrated derivatives of chlorophyll can catalyze the reduction of ubiquinone to generate ubiquinol in plasma. The chlorophyll in our system is obtained from green leafy vegetables, and it is derivatives of the chlorophyll that may be catalyzing the reforming of ubiquinol, rather than ascorbic acid, carotenoid, tocopherol and flavonoid antioxidants that are usually given the credit for this process.
  • In the blood stream, metabolites of chlorophyll , such as chlorophyllide a, pheophytin-a, pheophorbide-a, methyl pheophorbide-a, 10-OH-pheophorbide-a, 10- OH-methyl pheophorbide-a, pyro pheophorbide-a and methyl pyropheophorbide are formed and may catalyze the photoreduction of ubiquinone to ubiquinol.
  •  Both light and light-absorbing chlorophyll metabolites can be present in capillaries, arteries and veins of several animals including humans. If chlorophyll metabolites catalyze the photoreduction of plasma ubiquinol in vivo, it would be a novel mechanism to maintain high levels of plasma ubiquinol – and this is what the paper listed in it’s research proposes, is that light through our skin drives chlorophyl metabolites to regenerate the phytonutrient ubiquinol.
  • Dietary Chlorophyll Metabolites Catalyze the Photoreduction of Plasma ubiquinone
  • Bottom line: Eat your greens and get sunshine!

Consumption of fruits and vegetables was inversely associated with stroke incidence, stroke mortality, ischemic heart disease mortality, and CVD mortality.

Known modifiable risk factors for CVD include smoking, sedentary lifestyle, diet, dyslipidemia, hypertension, obesity, and type 2 diabetes.

The observed protective effect of consuming plant foods on chronic diseases is likely due to their bioactive components.

Plant Bioactives:

  1. Phytosterols are naturally-occurring plant sterols found in the non-saponifiable fraction of plant oils. Plants synthesize several types of phytosterols (e.g., sterols and stanols) that are structurally similar to cholesterol, except for the functional group substitutions on the sterol side chain at the C24 position. Beta-sitosterol (most abundant), campesterol, and stigmasterol comprise almost our entire intake of phytosterols. Since humans do not synthesize phytosterols, they must be obtained from the diet. The main dietary sources of naturally-occurring phytosterols are vegetable oils, nuts, grains and, to a lesser extent, fruits and vegetables. Commonly consumed products that are fortified with phytosterols, such as Benecol™ and Take Control™ are found in many foods. . Benecol spread contains stanol esters derived from tall oil (pine tree wood pulp) and Take Control margarine contains sterol esters from soybeans. Consuming 2–3 g/d of phytosterols from these products resulted in approximately 14% reduction in LDL  with no change in HDL. Thus, both sterols and stanols are equally effective in lowering LDL concentration. NCEP ATP 111 guuidelines: two grams of plant sterol or stanol esters daily for optimal dietary therapy for elevated LDL.
  2. Flavonoids: The most common flavonoids are flavones, flavanols, catechins, and anthocyanins, along with anthoxanthins. There is an inverse relationship between flavonoid intake and chronic diseases including CVD. Red wines contain an abundance of polyphenols including phenolic acids (for example, gallic acid, and caffeic acid), stilbenes (resveratrol), and flavonoids (for example, catechin, epicatechin, quercetin, rutin) . Gallic acid has more antioxidant activity than caffeic acid. Wine polyphenols can induce vasorelaxation via nitric oxide synthesis , decrease platlet aggregation, and decrease inflammatory mediators. Resveratrol is a polyphenol found principally in the skin of grapes and, in lesser amounts, in peanuts. It inhibits both LDL oxidation and platelet aggregation and scavanges free radicals.
  3. Lignans: Lignans are polyphenols found in plants, especially in flaxseed (secoisolariciresinol diglucoside), sesame seeds (sesamin, sesamolin), and soy, followed by whole-grains cereals (syringaresinol), and legumes, including nuts. Fruits and vegetables contain a wide variety of lignans (e.g., matairesinol (MAT), pinoresinol (PINO) and lariciresinol (LARI)) but in minute quantities. The proposed mechanisms by which dietary lignans could reduce the risk of CVD include the phytoestrogenic, and antioxidant activity of these compounds and their metabolites. Some plant lignans such as matairesinol (MAT), secoisolariciresinol (SECO), pinoresinol (PINO), and lariciresinol (LARI) are metabolized by intestinal bacteria to enterolignans (enterodiol and enterolactone) in various proportions.
  4. Resistant starches: Complex carbohydrates derived from starch contribute over half of humans’ daily energy requirements. Starch is a homopolysaccharide made in plants and stored in granules. Amylose and amylopectin are two polymers found in starch and are identified based on the glycosidic bond linking the α-D-glucose monomers. Amylose is a linear polymer with α-(1,4) linkages while amylopectin has linear α-(1,4) linkages and α-(1,6) branch points. There are four types of resistant starches – types one to four. Dietary sources of RS 1 include partially milled grains and seeds. RS 2 can be found in raw potatoes, legumes, just-ripe bananas, and high-amylose maize (HAM). RS 3 results from retrograded foods, such as potatoes, cereals, and breads. Chemically- or physically-modified starch and resistant maltodextrins are known as RS 4 and 5, respectively.  Due to lack of enzymatic hydrolysis, the direct contribution of glucose to blood from RS is minimal and allows for an attenuated post-prandial glycemic response.  Peripheral insulin sensitivity (Si) also improved by approximately 20% in individuals with metabolic syndrome consuming the same amount or RS.  There is  production of short chain fatty acids (SCFA) from RS fermentation by gut microbiota in the large intestine which tereby makes RS bioactive. The SCFA are capable of influencing risk, and even treatment, of NCDs such as diabetes and cancer through several mechanisms: decreasing luminal pH, enhancing mineral absorption, and stimulating the release of two satiety peptides known as glucagon-like peptide -1 (GLP-1) and peptide tyrosine tyrosine (PYY) to the periphery . RS can act as a prebiotic to selectively increase the concentration and viability of certain bacteria, such as Ruminococcus bromii .Intra-individual variation in gut microbiota may influence RS fermentation, the production of SCFA, and upregulation of GLP-1.
  5. Cyclic Dipeptides: Cyclic dipeptides (also known as 2,5dioxopiperazines; 2,5-diketopiperazines; cyclo (dipeptides); or dipeptide anhydrides) are relatively simple compounds and, therefore, are among the most common peptide derivatives found in nature. Consistent with a role for fermentation process in synthesis of cyclic dipeptides is the observation of high levels of cyclo (His-Pro) in foods that undergo fermentation and/or high heat treatment of protein-rich foods. Such examples are nutritional supplements (e.g., TwoCal HN and Jevity), milk, yogurt, sauces, and fermented fish . Active cyclic dipeptides include cyclo (His-Pro), cyclo (Leu-Gly), cyclo (Tyr-Arg), and cyclo (Asp-Pro). Of these only cyclo (his-Pro)[CHP] has been shown to be endogenous to animal kingdom. CHP may act as an appetite suppressant and satiety-inducer.  There is a possible role of CHP in insulin secretion and glucose metabolism.  CHP  causes higher insulin excursions without any change in C-peptide suggesting that CHP may decrease hepatic insulin clearance.    Items with CHP include tuna, fish sauce, Dried Shrimp , Spent Brewer’s Yeast hydrolysate, and others.
  6. Fruit Berries:  Polyphenols found in berries and other plant foods are particularly associated with anti-inflammatory, antioxidant, cardioprotective, and chemopreventive properties. Several compounds contribute to the antioxidant properties of berries and are typically found in the outer parts of the fruit or berry, most often as cinnamic and/or benzoic acid derivatives. Tanins, Anthocyanins,  carotenoids and stilbenes such as resveratrol are present in berries. Some amounts of resveratrol can be found in cranberries, strawberries, and other berries. Chokeberry, bilberry, and blackcurrant berries have the highest antioxidant capacity of the different berry fruits (umol Trolox/g fresh weight), and whole fruit extracts have greater antioxidant activity than many isolated phenolic compounds or vitamins . Strawberries are known to be high in phenolic compounds such as the phenolic acid derivative ellagic acid, and contain a significant amount of vitamin C. Blueberries are noted for a wide variety of anthocyanin compounds, while both cranberries and blueberries also contain significant concentrations of phenolic acids. Anti-oxidants in  Berries provide  anti-inflammatory activity, free radical scavenging and up-regulation of antioxidant enzyme genes, decreased levels and antioxidation of LDL, increases in circulating HDL, inhibition of platelet activation and aggregation, and improvements in endothelial function. Berries have been shown to provide improvements in blood pressure or hypertensive status due to increased NO bioavailability via activation of endothelial NO synthase.

Bioactive Plant Metabolites in the Management of Non-Communicable Metabolic Diseases

Statins’ effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementatio

Light-harvesting chlorophyll pigments enable mammalian mitochondria to capture photonic energy and produce ATP  <– we show that mammalian mitochondria can also capture light and synthesize ATP when mixed with a light-capturing metabolite of chlorophyll. To demonstrate that dietary chlorophyll metabolites can modulate ATP levels, we examined the effects of the chlorophyll metabolite pyropheophorbide-a (P-a) on ATP synthesis in isolated mouse liver mitochondria in the presence of red light (lmax5670 nm), which chlorin-type molecules such as P-a strongly absorb (Aronoff, 1950), and to which biological tissues are relatively transparent. We used P-a because it is an early metabolite of chlorophyll, however, most known metabolites of chlorophyll can be synthesized from P-a by reactions that normally take place in animal cells The same metabolite fed to the worm Caenorhabditis elegans leads to increase in ATP synthesis upon light exposure, along with an increase in life span.   Results suggest chlorophyll type molecules modulate mitochondrial ATP by catalyzing the reduction of coenzyme Q, a slow step in mitochondrial ATP synthesis. We propose that through consumption of plant chlorophyll pigments, animals, too, are able to derive energy directly from sunlight. We show that dietary metabolites of chlorophyll can enter the circulation, are present in tissues, and can be enriched in the mitochondria. When incubated with a light-capturing metabolite of chlorophyll, isolated mammalian mitochondria and animal-derived tissues, have higher concentrations of ATP when exposed to light, compared with animal tissues not mixed with the metabolite. The hypothesis is that photonic energy capture through dietary-derived metabolites may be an important means of energy regulation in animals.

  • To synthesize ATP, mitochondrial NADH reductase (complex I) and succinate reductase (complex II) extract electrons from NADH and succinate, respectively. These electrons are used to reduce mitochondrial CoQ10, resulting in ubiquinol (the reduced form of CoQ10). Ubiquinol shuttles the electrons to cytochrome c reductase (complex III), which uses the electrons to reduce cytochrome c, which shuttles the electrons to cytochrome c oxidase (complex IV), which ultimately donates the electrons to molecular oxygen. As a result of this electron flow, protons are pumped from the mitochondrial matrix into the inner membrane space, generating a trans-membrane potential used to drive the enzyme ATP-synthase.
  • Photons of red light from sunlight have been present deep inside almost every tissue in the body. Photosensitized electron transfer from excited chlorophyll-type molecules is widely hypothesized to be a primitive form of light-to-energy conversion that evolved into photosynthesis. Electrons would be transferred by a metabolite of chlorophyll to CoQ10, from a chemical oxidant present in the mitochondrial milieu. Many molecules, such as dienols, sulfhydryl compounds, ferrous compounds, NADH, NADPH and ascorbic acid, could all potentially act as electron donors. Intense red light between 600 and 700 nm has been reported to modulate biological processes. . Exposure to red light is thought to stimulate cellular energy metabolism and/or energy production by, as yet, poorly defined mechanisms. On a clear day the amount of light illuminating your brain would allow you to comfortably read a printed book. Photons between 630 and 800 nm can penetrate 25 cm through tissue and muscle of the calf . Adipose tissue is bathed in wavelengths of light that would excite chlorophyll metabolites. Utilization of these facts may have the potential for new therapies. A potential pathway for photonic energy capture is absorption by dietary-derived plant pigments. Dietary metabolites of chlorophyll can be distributed throughout the body where photon absorption may lead to an increase in ATP .

Chlorophyll-related compounds inhibit cell adhesion and inflammation in human aortic cells.

Chlorophyll Revisited Anti-inflammatory Activities of Chlorophyll a and inhibition of expression of TNFa

An Evidence Based Systematic Review of Chlorophyll by the Natural Standard Research Collaboration

An Evidence Based Systematic Review of Goji Lycium spp by the Natural Standard Research Collaboration

Risk of new-onset diabetes associated with statin use

 

 

 

Insane Medicine – Liraglutide (Saxenda) for weight loss!!

  • Liraglutide is a glucagon-like 1 peptide that has been available for diabetes management for a few years and now has an added FDA approval for weight loss management!!
  • There are more options for weight management as of now!
    There are more options for weight management as of now!

    obesity-big

  • To date, Phentermine/topiramate ER (Qsymia) is the most effective drug available. Locaserin (Belviq) is another approved drug for weight loss, but it is less effective.  However, it is better tolerated. Other options such as Xenical are helpful, but it prevents absorption of food and can cause excessive bloating and gas in some patients. Contrave (Wellbutrin and Naltrexone) is also effective but has neuropsychiatric effects.
  • Liraglutide is used to treat type 2 diabetes at a dose of 1.8 mg a day. It is injectable. The weight loss form of the drug is a dose of up to 3.0 mg a day injected. The amount of weight loss varies as the dose approaches the upper limit of 3 mg a day.
  • Liraglutide decreases appetite and therefore energy intake, which is how it causes weight loss. It also delays gastric emptying. Used as an adjunct to physical exercise and dieting, it has resulted in up to an 8 kg body weight loss over the 56 week course of treatment [ −8.0±6.7% (−8.4±7.3 kg)].
  • Liraglutide treatment was associated with reductions in cardiometabolic risk factors, including waist circumference, blood pressure, and inflammatory markers. Fasting lipid profiles were also improved as well. The combination of weight loss and improved glycemic control probably contributed to the observed reductions in the prevalence of prediabetes and the delayed onset of type 2 diabetes.
  • Side effects include an increased incidence of gallstones, which commonly increase with weight loss.  Nausea and constipation (or diarrhea) has been reported. Rarely, pancreatitis and kidney failure has occurred. The FDA has required a boxed warning about the risk of thyroid C-cell tumors in the package insert, and in patient’s with a family history of Multiple Endocrine Neoplasia Type 2 or medullary thyroid carcinoma, this treatment is to be avoided.
  • Treatment is started at 0.6 mg injected a day and increased weekly by another 0.6 mg until a total of 3 mg a day is injected. At 16 weeks, if a 4% body weight loss is not achieved, therapy should be stopped. Total cost per month is about $1000.00!
  • For patients who have a BMI>30 (Body mass index) and are not diabetic, or have a BMI>27 with a risk factor, such as hyperlipidemia or diabetes, Saxenda is a consideration for weight loss.
  • Liraglutide has effects on a number of metabolic systems
    Liraglutide has effects on a number of metabolic systems
    Liraglutide has effects on a number of metabolic systems
    Liraglutide has effects on a number of metabolic systems

    Liraglutide has effects on a number of metabolic systems
    Liraglutide has effects on a number of metabolic systems

Neuroprotective and anti-apoptotic effects of liraglutide on SH-SY5Y cells exposed to methylglyoxal stress

A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management

Liraglutide (Saxenda) for Weight Loss

http://ajpgi.physiology.org/content/302/2/G225

Insane Medicine – Akkermansia muciniphila and the Gut biome

  • The bacteria in your gut create a huge ecosystem or biome that has major effects on your overall health. More and more studies are demonstrating this, including the one below.
  • The gut microbiota diversity and function plays a role in the development of obesity and metabolic ailments.
  • Akkermansia muciniphila is a mucin-degrading bacteria found in the mucus layer of the intestine that has been found to help improve your metabolic status by increasing insulin sensitivity and glucose regulation.
  • Obese individuals and those with Type 2 diabetes differ from leaner individuals in the constitution of their gut micobiome and the microbial gene richness. It has been found in mice that higher levels of  mucin-degrading bacteria (Akkermansia muciniphila) are inversely associated with body fat and glucose intolerance. In other words, these bacteria help improve glucose metabolism and improve overall metabolic health.
  • The article below demonstrated that Akkermansia muciniphila, when increased in the gut, resulted in healthier metabolic status in obese people. This was accomplished by caloric restriction, which then resulted in increased microbial gene richness ( a good thing) and improved glucose homeostasis and blood lipids. Following a FODMAP diet also increased Akkermansia muciniphila in the gut.
  • The higher the Akkermansia muciniphila bacteria levels are in the gut, it seems that you will have better glucose metabolism, better waist-to-hip ratios, lower fasting glucose levels, better triglyceride levels,  and better fat distribution.
  • Increasing amounts of fat in the form of fat hypertrophy is a proinflammatory condition and is associated with bad cardiometabolic risk. This inflammatory risk is measured through insulin levels, interleukin-6, lipopolysaccharide levels, and C reactive protein levels in the blood stream. Caloric restriction leads to increased Akkermansia muciniphila and other healthy bacteria, which increases the overall microbial gene richness. These bacteria lower the inflammatory markers through their metabolic activity. This results in better metabolic outcomes.
  • How does this all occur? Akkermansia muciniphila ferments waste products into other items that other beneficial bacteria species can feed on. Short chained fatty acids are one of those items as well as acetate, which becomes an anorectant when absorbed in the body. In other words, you eat less.
  • The key here is that the gut biome plays a tremendous role in our overall health, and caloric restriction results in a  boosting of the healthy richness of our gut biome, which is probably a key part of overall health!

KEY study in GUT :  http://gut.bmj.com/content/early/2015/05/22/gutjnl-2014-308778.full.pdf+html

Akkermansia

 

 

 

http://www.gutmicrobiotaforhealth.com/akkermansia-as-a-target-for-obesity-authors-explained-1496

 

http://www.biotanutrition.com/2015/01/17/akkermansia-muciniphila-a-biomarker-of-healthy-gut/

 

Dao M, Everard A, et al. Akkermansia muciniphilaand improved metabolic health during a dietary intervention in obesity: relationship with gut microbiome richness and ecology. Gut.2015. 

Gut Bacteria and Food Allergies:

  • Gut bacteria also seem to play an integral role in other aspects of our health including food allergies. The presence of Clostridia in our gut appears to be protective against food allergies by causing the release of Interleukin-22 from gut cells, thereby decreasing permeability of the gut to allergens, which cause allergic reaction. Without gut permeability, the antigens cannot create an allergic immune response. Food allergies have been increasing in recent times due  to modern dietary and hygienic practices, which disturb our natural gut biome.High fat diets, antibiotics,  and formula feeding have all affected our gut bacteria, some of which protect us against food allergies. In a study, it was shown that germ-free mice and mice treated with antibiotics both reacted to peanuts, however, when clostridia was introduced, the reaction went away! This demonstrates how Clostridia decreases food allergies.  The study, “Commensal bacteria protect against food allergen sensitization,” was the source of this information.
  • Clostridia protects against Food Allergies

Insane Medicine – Acid in our bodies is a problem – Metabolic acidosis (MA)

Acid is not good
Acid is not good

acid house acid mushroom

  • Our bodies are always in a battle with too much ACID. I discussed this briefly before and am revisiting this topic again because of the metabolic impact metabolic acidosis (MA)  has on our bodies (that is, too much acid)
  • In the process of digesting meats and animal proteins, our body produces acids as well as internal processes that contribute to high acid levels. Our body uses bicarbonate and other  mechanisms to neutralize the excess acid.
  • Metabolic acidosis (MA) affects every system in our body. MA at a chronic level activates bone resorption and can increase the rick of osteoporosis. Treatment of MA can decrease this risk when it is present. Skeletal strength is impaired by MA because the body cannibalizes it’s own muscle to help neutralize the extra acid. Likewise, MA will impair insulin release and insulin receptor functioning. This results in glucose intolerance and diabetes. MA will also cause the progression of kidney failure and impair the functioning of thyroid hormones and it’s receptors.
  • We see metabolic acidosis in 1 out of 30 patients with normal  kidney function. the number affected increases as kidney function declines.
  • BMC Nephrol, 2013 Jan 9;14:4 : Use of bicarbonate to normalize MA can prevent progression of chronic kidney disease. How much bicarbonate and what type of bicarbonate is used? Sodium bicarbonate, in amounts starting at 1300 mg twice a day to get the serum bicarbonate levels to 24 mg/dl. Baking soda has 850 mg of sodium bicarbonate in a teaspoon.
  • Sodium bicarbonate intake does not worsen high blood pressure because the sodium load resulting from the sodium bicarbonate cannot be reabsorbed in the kidney through the usual NACL cotransporter.
  • The body normally excretes extra acid loads produced in the body in the form of ammonia, which is produced from glutamine (an amino acid) When metabolic acidosis is present, the body quickly runs out of glutamine from its usual sources and gets extra glutamine from muscle breakdown. The glutamine then goes to the kidney to be broken into ammonia which absorbs the extra acid.  So metabolic acidosis leads to increased muscle breakdown and weakness.
  • Diet affects the production of acid, especially with the consumption of animal proteins, which results in a lot of acid production in the body. This speeds UP the loss of kidney function in predisposed individuals. It has been shown that fruits and vegetables create little acid production in the body and a vegan diet as such decreases the rate of kidney function decline in patients with kidney failure.

 

Here is the summary:

  1. Treatment of metabolic acidosis, when the serum bicarbonate level is below 20 mmol/L, using sodium bicarbonate at doses of 1300 mg twice a day to increase serum bicarbonate to 24 mmol/L has positive impacts in multiple fronts as below.
  2. Increased bone density results from treatment of MA, thus decreased fractures and falling.
  3. There is better glucose control by treating MA due to better insulin sensitivity and insulin receptor responsiveness.
  4. Treatment of metabolic acidosis decreases the progression towards kidney failure in susceptible individuals with chronic kidney disease.
  5. Treatment of MA results in better muscle strength and muscle mass.
  6. Eat more fruits and vegetables to decrease your intake of acids.
  7. Have your doctor asses your blood for low bicarbonate (Less than 20 mmol/L)
  8. Consult your doctor prior to initiating any medical regimen as discussed.

Insane medicine – Replace saturated fats in your diet with Vegetable oils (Linoleic acid) to lower cardiac risk!

Replacing saturated fat with vegetable oil is associated with lower coronary artery disease risk based in a study in Circulation recently released (Circulation. 2014;130:1568-1578).

  1. Exchanging 5% of consumed calories from saturated fat sources (red meat and butter) with foods containing linoleic acid (an n-g fatty acid that is polyunsaturated and found in vegetable oil, seeds, and nuts) can decrease coronary heart disease events by 9%. So swap out your saturated fat sources with polyunsaturated fat to help out your heart!
  2. Linoleic acid (polyunsaturated fat) intake was inversely associated with heart disease, such that the more linoleic acid taken in, the lower the risk of heart disease. At the best outcomes, there was a 15% lower heart-risk and 21% lower death rates in those who consumed the most linoleic acid sources.
  3. Replace butter, lard, and fat from red meat with liquid vegetable oils when you prepare and cook foods.  By replacing saturated fat in this way, total and LDL cholesterol is reduced.
  4. Sources of Linoleic acid (an omega-6 polyunsaturated fat) include: soybean, sunflower, safflower, and corn oil, as well as nuts and seeds.
  5. Fats have 9 calories per gram. Use 1.5-3 tablespoons of vegetable oil daily to get 5-10% of calories from linoleic acid (100-200 calories total) It is important to replace saturated fat with these sources of polyunsaturated fats (linoleic acid) and not just adding this to the total fat intake.
  6. Linoleic acid does not promote inflammation based on a neutral effect on inflammatory markers or arachidonic acid levels (which increase in inflammation).

Cooking oil examples:

Safflower oil – 78 % PUFA (Linoleic acid)

Sunflower oil – 69% PUFA (Linoleic acid)

Corn oil – 62%

Soybean oil  – 61 %

Peanut Oil  – 34%

Canola oil  – 29%

Lard – 12 %

Palm oil – 10%

Olive oil  – 9%

Butterfat  – 4%

Palm kernel oil  – 2%

Coconut oil – 2%

 

General notes about fats:

  • Greater intake of trans-fats (hyrogenated oil for example) relative to polyunsaturated fats (PUFA) is associated with higher cardiac risk. N-3 omega fatty acids and alpha-linoleic (ALA), also an n-3 fatty acid) are associated with good cardiac risk. Linoleic acid (LA) , an n-6 PUFA most commonly eaten in the Western diets, also has been shown to be beneficial in preventing cardiac risk, but less investigation had been done regarding this fatty acid. Linoleic acid reduces LDL levels, which is a positive effect for decreasing cardiac risk. LA can be elongated into arachidonic acid, which is inflammatory and thrombogenic (blood clot forming). Studies have shown that LA is in fact not pro-inflammatory in the body. It does not increase C-reactive protein . It also has no effect on other inflammatory marker such as cytokines, fibrinogen, soluble vascular adhesion molecules, plasminogen activator inhibitor type 1, or tumor necrosis factor-α.
  • There appears to be a linear response to increasing LA intake – as one takes in more LA, there is less coronary events (heart attacks) and less death! Thus n-6 fatty acids (Linoleic acid) has cardioprotective effects! Increasing LA intake by 5% led to 9% less coronary heart disease and 13% less death!
  • It had been assumed that LA is converted to arachidonic acid (AA), which is inflammatory. AA  is the main precursor of eicosanoids with inflammatory and thrombogenic properties, such as prostaglandin E2, thromboxane A2, and leukotriene B4. It has been found, however, that the conversion of LA to AA is tightly controlled in the body, thus there is no increase in inflammation.

 

Insane Medicine – Lowering Dementia Risk

Dementia
Dementia

Research is demonstrating that treating multiple risk factors for dementia results in better outcomes than treating each factor individually. Risk factors include:

  1. Poor nutrition
  2. obesity’smoking
  3. physical inactivity
  4. cardiovascular risks
  5. depression
  6. social isolation
  7. lack of mental stimulation

Strategies to help deal with these risks have been shown to help improve cognitive performance. Just treating single variables such as high blood pressure or lack of exercise has less effect than hitting multiple factors at once. A study in Lancet Neurology (August 2014) revealed that one-third of Alzheimer’s Disease (AD) cases are attributable to modifiable factors and thus AD may be reduced in prevalence by improved education , treatment of depression, and management of vascular risk factors such as physical inactivity, smoking, hypertension, obesity, and diabetes.

  • Get regular exercise: this reduces stress, improves blood flow to the brain, strengthens connection of neurons in the brain, improves medical health and balance, thus reducing falls. The goal is 30 minutes of aerobic activity five times a week (walking, dancing, biking as examples) and strength training twice a week.
  • Challenge your brain: Demanding brain activities utilizing different aspects of your intellect help protect against cognitive decline, making your mind more efficient and able to focus. So expose yourself to new ideas and challenges mentally, so that you can maintain your memory skills and concentration abilities. Things like cross-word puzzles, checkers or cards help build up your brain as do math problems. Research shows that staying intellectually engaged may prevent AD. These types of brain challenges add to your cognitive reserve. Social interaction also plays a role in preventing cognitive decline. It has been found that those who play more games or puzzles were more likely to perform better on test of memory, learning, and information processing. They also have greater brain volume in areas associated with memory. Mental workouts enhance brain blood flow and promote cell growth, stronger neuron connections, and keep the brain efficient. It makes the brain less sensitive to trauma such as drugs, stroke, or disease. The internet has resources to help:  http://brainworkshop.sourceforge.net/  or http://sporcle.com/  or http://syvum.com/teasers/  or http://www.braingle.com/  or http://www.billsgames.com/brain-teasers/   So consider crossword puzzles, jigsaw puzzles, word searches, math problems, an brainteasers to exercise your mind!
  • Treat mental illness, especially depression: Sadness, hopelessness, and lack of energy may signal depression. Depression is associated with a high risk of cognitive decline. See your doctor to help get treatment.
  • Eat a healthy diet: Eat complex carbohydrates such as whole grains, legumes, fruits, and vegetables. Avoid sodas, sweets, and excess sugars. Protein is essential for growth and cell maintenance, so consider lean meats, fish, poultry, eggs, low fat dairy,  nuts, and beans. Chose healthy fats such as omega-3 fatty acids found in flaxseed oil, fish, and nuts. Monounsaturated fats are also healthful and is present in olive and canola oils. Polyunsaturated fats from corn, safflower, and sunflower seeds are fine as well. Avoid trans-fats. Remember to include your micronutrients and phytochemicals (found in plant sources).
  • Treat cardiovascular risks: Stop smoking, lose weight, be physically active, treat high blood pressure and diabetes, take your prescribed medications.

Avoid Trans-fats in your diet. It is found in many junk foods, especially fast foods, processed foods, baked goods, margarine, and other sources. These products and trans-fats perform about 10% worse on cognitive tests than those who consumed minimal amounts. Trans-fats promote oxidative stress and damage the memory center of the brain, the hippocampus.

Magnesium is essential for brain functioning. It is found in green leafy vegetables, whole grains, nuts, legumes, and hard water. Magnesium helps in energy production, needed especially in the brain. It helps in the formation and release of neurotransmitters as well as functioning of connections in the brain (synapses) to process new information. Studies in Molecular Brain (September 2014) demonstrated that magnesium L-threonate (MgT) supplementation prevented memory decline and prevented synapse loss in mice prone to AD. It also reduced the deposition of beta-amyloid protein in the brain (a cause of AD) Risk factors for magnesium depletion include chronic alcoholism, diabetes, excessive coffee intake, inflammatory bowel disease such as Chrone’s disease, diuretic intake, liver and kidney disease,  and excessive soda and salt intake.The RDA is 400 mg a day – http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/  This link points to sources of magnesium for your diet. Foods included are Almonds, spinach, cashews, peanuts, shredded wheat cereal, soy milk, black beans, whole wheat bread, avocado, baked potato, brown rice, plain yogurt, and others.

This sounds dumb but avoid head injury – it has been shown that older adults who have a head injury are at higher risk of dementia, especially over the age of 65. The main reason for these injuries are falls, many of which are preventable and may be due to deconditioning and weakness from lack of exercise. Remember that exercise increases strength and balance.

Remember to not be anxious over your health – don’t become a hypochondriac. Maintain your health through proper eating, exercise, risk management of cardiovascular problems (high blood pressure, high cholesterol, smoking cessation), taking your prescribed medications, and regular physician check-ups will maximize your health. Don’t get preoccupied with health matters and fears of disease such that they interfere with your daily activities and enjoyments in life. Keep yourself busy and distracted by learning new tasks and volunteering. Consider meditation, relaxing your body and mind, concentrating on the present moment. Exercise your body to reduce stress and reduce your anxiety. This will build your physical strength and increase your feelings of well-being. Keep your head up with positive feeling and be grateful for the good things in your life and those things you can control. Don’t stress out!!

 

 

 

Insane medicine – Vitamin D supplements help reduce cancer and cardiovascular risk

Vitamin D supplementation has huge beneficial health effects. First, lets discuss the physiology of Vitamin D and the effects of deficiency.

Vitamin D

The process starts with ingestion of Vitamin D2 (ergocalciferol) from plant sterols or yeast or with Vitamin D3 (cholecalciferol) obtained from oily fish.. UVB irradiation of skin 7-dehydrocholesterol can also produce vitamin D. These vitamin D precursors go to the liver where they are converted to 25-hydroxyvitamin D (which is what your doctor tests for to see if you are deficient in vitamin D!). 25-hydroxyvitamin D is transferred to the kidney where it is converted to the most active form, 1,25 dihydroxyvitamin D.
vitamin D review vitamin D

The active 1,25-dihydroxyvitamin D will increase calcium absorption by the intestines which increases our calcium reserves
vitamin D balance vitamin D vitamin D deficiency vitamin D metabolism and deficiency vitamin D effects

 

Vitamin D (1,25-dihydroxyvitamin D) has multiple roles in the body as shown above. There are over 300 different binding sites for Vitamin D throughout the human genome with receptors present in all human tissues.  The parathyroid glans in the neck secrete PTH to activate and regulate vitamin D.

  • Risk factors for vitamin D deficiency include age>65, breastfeeding mothers, insufficient sunlight exposure, certain medications (anticonvulsants, steroids, others), obesity, physical inactivity, liver and kidney disease, and dark pigmented skin. Vitamin D deficiency was historically associated with rickets ( a bone disease)
    Insane Medicine - rickets due to vitamin D deficiency
    Insane Medicine – rickets due to vitamin D deficiency.

    Of course rickets is rare in the U.S. due to fortified foods.

  • Studies are clear that vitamin D is important for health and prevention. There is an inverse association of 25-hydroxyvitamin D serum levels with risk of death due to cardiovascular disease and cancer. In other words, low vitamin D  levels in the body are associated with higher cardiac events and higher risk of cancer!!
  • Supplementation with vitamin D3 reduces overall mortality in older adults!
  • Vitamin D deficiency is based on a blood level of less than 20 ng/mL of 25-hydroxy vitamin D. It appears that correcting vitamin D levels may be on par with health risks such as smoking, alcohol consumption, and physical inactivity!
  • Based on calculations from one study, 12.8% of all deaths in the U.S. can be attributed to vitamin D deficiency. So for every 10 ng/ml decline in serum vitamin D, there appears to be a 16% increase in all cause mortality.  Supplementing with vitamin D3 decreased all cause mortality by 11%. There appears to be no benefit or protection  by supplementing with vitamin D2. Vitamin D2 is less potent and active than vitamin D3. It may be that calcium is needed to be used with vitamin D2 to be effective.
  • You can obtain enough vitamin D by exposure to sunlight (UVB) for 15 minutes a day if you are light skinned. Dark skin requires up to an hour of exposure to create enough daily vitamin D. Our body produces vitamin D in the skin and does so at higher levels in the summer time. Obviously, in the winter time, we are at risk of deficiency due to less skin exposure. Sun block will prevent UVB from reaching our skin and therefore will prevent the skin from creating vitamin D.
  • Vitamin D toxicity (levels greater than 150 ng/ml) result from high intake of vitamin D (greater than 10,000 units/day)
  • The bottom line: Get your 600-800 IU of vitamin D3 every day. Vitamin D3 is the best form of vitamin D. Boosting your vitamin D levels can decrease your cardiac and cancer risks!
  • http://www.vitamincouncil.org/   <–Vitamin D information!
  • Chowdury R, et al Vitamin D and risk of cause of specific death. BMJ 2014;348:g1903.doi: 10.1136/bmj.g1903

Insane Medicine – Dietary Review!

I wanted to generalize some overall health information in this particular blog and incorporate items that are important for increasing successful strategies for aging and maintaining your health.

  • Remember that circulation is important in your body because it provides energy and sustains life in the various tissues. Regular exercise is a way to keep your body maximally conditioned. Your circulation delvers oxygen and nutrients to your body and at the same time allows toxins to be removed as it passes through the liver, kidney, and lymph systems. So be certain to keep moving and exercise to maximize your health.
  • Eat more plant foods. As a result of doing this, you take in less fat and will increase your fiber intake. This allows more protecting antioxidants to be incorporated into your body. Ingesting more fiber allows for better waste removal, and less fat intake results in a decreased tendency for your blood to thicken and clot, thus decreasing cardiovascular risk. The large amount of protecting agents in plant-based diets results in less inflammation in the body and less cellular damage.
  • Choose plant foods with strong flavors and with bright colors. Have a healthy fat focus in your diet. Chose your beverages you drink wisely, in other words, stop drinking sodas! Try your best to allow your stomach to be empty  and have ‘hunger pains’ for at least two thirty minute periods each day.
  • Remember that the body evolved in a world where salt, sugar, and fat were scarce and are like addictive drugs. Be careful to avoid choosing processed foods when possible and not adding salt and sugar to your meals. Avoid sodas ( which are high in sugar content)! Even noncaloric beverages may be increasing our desire for sweet food and spurring increasing rates of obesity.
  • Fructose in our foods has been a source of increasing weight gain in our society. Fructose and glucose (both sugars) have a differential effect on the brain. Glucose will reduce activation of brain regions that are involved in appetite, motivation, and reward and will increase our sense of satiety and decrease our food seeking behavior. Fructose does not do this. It is sweet, but it makes us want more! Corn sweeteners (fructose) have correlated with rising obesity.
  • Plant-based foods give us phytochemicals which act as protectors. Plant-based foods give smell, taste, and fragrance to our diet. They have an antioxidant effect. Kale, cabbage, broccoli, and  arugula have a sulfur based mustard taste that increase detoxification enzymes in the body. You should get 5-9 servings of colorful, flavorful vegetables in your diet each day – five servings for smaller people and at least nine servings if you are a big person. How much is a serving for vegetables? One-half cup cut up is equal to a serving, in general, for vegetables (for raw spinach, a whole cup is equal to a serving)
  • So again – look for colorful vegetables, as they have higher levels of phytochemicals in them, For example, zucchini has a green outside but mostly colorless interior, and therefore is a poorer choice of a vegetable. Instead, go for the carrots, spinach, broccoli, and yellow squash as options, since they have more color to them and therefore more protective phytonutrients! You will find higher levels of Vitamin A in deep orange vegetables such as carrots. The carotenoids and retinol in these vegetables impart the orange coloring and give the protective qualities of these vegetables.  Cruciferous vegetables have a big, strong flavor with sulfur components. They have powerful antioxidants in them and include arugula, broccoli, brussel sprouts, cauliflower, kale, kholorabi, radish, rutabaga, and turnips. Citrus fruits are high in Vitamin C, which helps fight infection. They also have an antihistamine/anti-allergic effect as well as anti-oxidant effect, which protects cell membranes and DNA in the body from oxidative damage. Vitamin C is important in the production of collagen component of connective tissues such as tendons and ligaments.
  • Eating up to nine servings a day of vegetables was associated with 24% less obesity in one study. Why? Because you eat less of other fatty foods.
  • Fiber rich foods  are very important in the diet. Vegetables, fruits, beans, whole grains are all rich sources of protective nutrients and phytochemicals and have a lower glycemic load as well. Eating foods with high fiber content results in less obesity since people who consume high-fiber foods feel more full. Likewise, higher fiber meals cause increase transit through the gut and decrease carcinogen exposure. This results in less colon cancer risk! Soluble fiber decreases cholesterol levels while fibrous food will increase the amount of protective gut bacteria.
  • We will be discussing the gut biome over time in this blog. Your gut has a population of bacteria that live and thrive but also help us maintain homeostasis. Alterations in the gut biome (bacterial population) can result in inflammation and disease. Immune compromise can occur if the gut biome is altered or destroyed. It turns out that soluble fiber is a food source for these necessary gut bacteria to remain healthy, and hence us as well.
  • We need 25 grams of fiber every day. A rule of thumb is one gets 2 grams of fiber per vegetable/fruit serving, so 5 servings of vegetables equals 10 gm of fiber.
  • Whole grains are a good source of fiber. One slice of whole grain bread is equal to a serving. A cup of cooked oatmeal is considered a serving. A thought for increasing fiber content is to use wheat berries, which cook like brown rice. Adding sunflowers to them can make a nutritious bundle.
    Wheat berries cook like brown rice and taste great when mixed with sunflower seeds!
    Wheat berries cook like brown rice and taste great when mixed with sunflower seeds!

    Cooked beans, peas , and lentils have 6 gm of fiber per half-cup of cooked item. They are excellent sources of fiber.

    Consider adding mung beans, which are bean sprouts that cook like lentils, in a dish with some olive oil, salt, and pepper and placing it over pasta.
    Consider adding mung beans, which are bean sprouts that cook like lentils, in a dish with some olive oil, salt, and pepper and placing it over pasta.

     

  • Always be certain that you check to see if a bread item is whole grain. Check the ingredient list. You want whole, sprouted, or malted wheat or whole grain on the label. Beware if it says wheat flour, for that is the same as white flour.
  • Put as many vegetables on your salad as possible. Lettuce has very little fiber.
  • Be certain to take in 5-10 grams a day of soluble fiber out of the 25-35 grams of fiber that is needed. Soluble fiber lowers cholesterol levels and feeds the healthy gut bacteria to support our immune system. An orange (medium) has 3-5 grams of soluble fiber, while a half cup of beans has 3-5 grams. Two tablespoons of ground flaxseed has 1.5 grams of soluble fiber. Flaxseed can be ground into flaxmeal.
  • Of note, a high fiber diet provides a low glycemic load, which is great for diabetics, but particle size of the fiber source is important. For example, old fashioned or scottish oats are best for fiber sources, whereas smaller particle sized grain products lose the fiber benefits. It turns out the glycemic index is higher in small-particles of grains (they get absorbed easier).
  • Higher glycemic-load foods are associated with chronic diseases. As people absorb more carbohydrates and gain weight, their insulin level increases in response, which promotes increased fat storage, thereby leading to the need for more insulin to control blood  sugar. This results in diabetes over time. Also cancer is more common in obese individuals as insulin-like growth factor (IL-GF) drives cancer growth. IL-GF is involved in glucose metabolism. A diet with a low glycemic load would include non-starchy vegetables except potatoes. Whole grains are high in glycemic load and make diabetes more difficult to contol. Pasta, rice, potato, and virus have high glycemic loads and are not as healthy. Fruit has high fiber content and a LOW glycemic index. High fat foods also have lower glycemic load. So aim for foods with lower glycemic indices as they allow for better body sugar control.
  • Fats affect inflammation in the body. High body fat content, especially abdominal fat,  is linked to cancer risk, diabetes, arthritis, Alzheimer’s disease, and autoimmune disorders. In an anti-inflammatory diet, one wants to avoid excess fat.  Decrease your fatty food intake, especially fried foods and fast foods. Decrease your dressings and mayonnaise on your foods. Decrease the amount of sweets in your diet, especially cookies and cake. Eat more fish and seafood (not fried) at least 2-3 times a week, except for farmed salmon, which should be eaten only once a month. Avoid sweetened beverages and limit foods with sweeteners. Eat more vegetables, fruits, whole grains, and beans.
    Beans are good!
    Beans are good!

    524-1147141

    Use extra virgin olive oil to toss in your vegetable or salad to allow easier coating of the leaves with your favorite dressing. By doing that, you will use less dressing and spread it out evenly!
    Use extra virgin olive oil to toss in your vegetable or salad to allow easier coating of the leaves with your favorite dressing. By doing that, you will use less dressing and spread it out evenly! Less dressing=Less fat!

     

  • Fat balance is important in your diet. Avoid the pro inflammatory fats, such as omega-6 polyunsaturated fats (PUFA) such as corn, cottonseed, soy, safflower, and sunflower oils, which are high in omega-6 oils. decrease your meat intake and decrease fish intake that are fed these products such as farm-grown salmon! Omega-3 PUFA are anti-inflammatory. and are present in flaxseed oil. Also, pasture-fed livestock (‘grass-fed’) have less omega-6 fatty acid in them. Avoid livestock that are fed grain or corn at any time, since that increases the amount of proinflammatoy PUFA in them. ‘Grass finished’ livestock means that the livestock ate grass until they are butchered. Choose grass-fed products only!
  • Some fat-health guidelines include avoiding fat soluble contaminants by eating food items lower on the food chain, such as smaller animals (fish) and avoiding farmed salmon. Eat only organic products. Avoid saturated fats, present in processed foods and dairy products or red meat. Avoid rancid fats by limiting aged cheese and meat (deli meat) in your diet. Chose healthy fats, which increase satiety and help absorb fat soluble vitamins. Healthy fats include avocados, olive oil, sardines, nuts, seeds, and olives.  Larger animals have more time to get contaminants in them. Chicken and sardines, which are lower on the food chain, live short lives. low in the food chain, and accumulate less toxins. Don’t eat fats that are solid at room temperature,. Avoid processed foods and meats (deli meats)
  • Rancid fats add oxidative stress to your body.Increase your monounsaturated fat intake such as avocado and olive oil, which are heart-healthy.  It was found that people who eat less saturated fat and more monounsaturated fats in their diet have better cognitive performance and verbal memory over time!
  • Osteoporosis prevention: Increase the following: exercise, calcium intake, vitamin D, protein and potassium . They all help build healthy bones! Protein is needed to build the bony matrix. Avoid caffeine (>300 mg a day) and avoid smoking and excessive sodium intake. Avoid being too thin. These factors all impact bone health in negative ways. Excessive sodium in the diet causes the kidneys to waste calcium in the urine. Be certain to get 1200 mg of calcium a day in the diet. For example, 1 or 2% no-fat milk has 300 mg of calcium per cup, while yogurt has 250 mg in 6 ounces. Please note that not all tofu has enough calcium in it, so check the labels. Also, corn tortillas (traditional mad with lime) has calcium in it ( fiver per day provides a lot of calcium)
  • Calcium bioavailability in the diet depends on the source of the calcium. There is calcium carbonate, calcium citrate, calcium malate, calcium phosphate, calcium gluconate, and calcium lactate. Tums has calcium carbonate in it and excessive use can decrease digestive enzymes and increase bloating gas production as a result, so avoid excessive tums. Avoid calcium from dolomite, bonemeal, and oyster shells (they have lead contaminants in them). Calcium mixed with Vitamin D and magnesium is an excellent supplement for bone health, especially as a 2:1 ratio (calcium 500mg/magnesium 250 mg). People absorb calcium better in small quantities through the day rather than a single large bolus. Be aware that calcium interacts with many medications and interferes with absorption of some medications, such as tetracyclines, biphosphonates, aspirin, and others. Some medications deplete calcium, such as aluminum antacids, steroids, anticonvulsannts, which deplete calcium supplies in the body. Calcium mixed with thiazide diuretics can lead to high, toxic blood levels of calcium in some people. Of note, a study recently suggested that calcium supplements may increase the risk of heart disease in some people by depositing in the coronary vessels. This appears to be not true.
  • Vitamin D is also an important component to bone health and body health. Deficiency in this vitamin has been associated with Alzheimer’s disease, autoimmune disorders, stroke, and musculoskeletal decline, among other things. Optimally, blood levels should be 30-80 ng/ml. The RDA for vitamin D in people aged 50-71 is 400 IU/day and for those over 70, the RDA is 600 IU/day. You can take up to 4000 IU/day safely per some sources. Vitamin D3 is the most active form of Vitamin D. Vitamin D is neccessary for optimal calcium and magnesium absorption in the gut. Our western style diet results in a high acid intake that leaches our bones. Chronic low grade acidosis in the body with our acidic diet, leads to bone derangement, especially in people with poor kidney function.
  • The shift to eating a better acid-base balanced diet can be made by including more plat foods in your diet (they are rich in alkaline materials). Consider this to boost bone health.
  • The recommended intake of protein is .4-.6 gm of protein per pound of weight. The average protein intake should be 55-100 gm per day. Protein content is high in beans, peas, and lentils (7 gm in a half cup) and high in poultry, fich, and lean meat (7 gm in 10 oz meat). Consider eating nuts and seeds for protein supplementation ( 7 gm in  1/4 cup, especially pumpkin seeds, which have 18 gms!)

Insane Medicine – Celiac or FODMAPS? Maybe it’s not a Gluten-free problem!

  • There are a lot of assumptions that there is better health and weight loss that can be achieved by going gluten-free. In reality, that may not be so depending on the food choices you make. Most gluten-free foods are not enriched or fortified with essential vitamins and minerals. Therefore, some gluten-free diets can lack essential nutrients.
  • We have discussed celiac disease elsewhere, but as a quick refresher, it is an autoimmune disorder of the bowel with a wide range of presentations and symptoms including abdominal pain, constipation, weight loss, anemia, mouth ulcers, arthritis, miscarriage, migraines, depression, seizures, bone loss and osteoporosis, fatigue, and many other signs and symptoms. It is diagnosed with specific blood tests and endoscopy to get bowel biopsy samples. http://insanemedicine.com/?p=64  <Prior FODMAP article
  • Gluten sensitivity can present just like irritable bowel syndrome (IBS), however, in IBS, there is no damage to the small intestines.
  • The signs and symptoms of celiac disease can seen in many other disorders and are therefore non-specific. After all, who hasn’t had a headache or constipation? We must keep in mind that there are other illnesses that can also exist. One possibility is FODMAP sensitivity.
  • FODMAP is the acronym for fermentable oligosaccharides, disacharides, monosaccharides and polyols. These are sugars which might not be digested or well absorbed in by the body and are left in the gut to be fermented by bacteria in the GI tract. The result is abdominal pain, gas, and cramping.

Which sugars are included in FODMAPS?:

  1. Polyols: Isomalt, mannitol, sorbitol, and xylitol. These are present in stone fruits such as avocados, mushrooms, cherries, peaches, plums, and cauliflower. Candy has sorbitol and xylitol in it.
  2. Galactans (galactooligosaccharides) occur in brussel sprouts, lentils, soybeans, broccoli, cabbage, and beans.
  3. Fructose (monosaccharide) is found in numerous items such as pears, watermelon, mangoes, blueberries, honey, agave, high-fructose corn syrup laden drinks such as gatorade, dried fruits, and apples.
  4. Lactose (disaccharide) is present in milk products.
  5. Fructans (oligosaccharide) is present in onions, rye, wheat, barley, artichokes, garlic, leeks, and bananas.

Because IBS is similar to FODMAP sensitivy, one can try to restrict items with DODMAP’s in them for 6-8 weeks to see how it works.  You need to limit the items listed above and consider other items that are LOW IN FODMAPS: alfafa, green beans, carrots, herbs, cucumber, lettuce, tomatoes, zucchini, bananas, oranges, grapes, melon, meats, fish, chicken, tempeh,rice, oats, quinoa, gluten-free bread, almonds and pumpkin.

Be certain to eat soft, cooked foods and frequent small meals a day.

 

Low FODMAP diet site:

http://med.monash.edu/cecs/gastro/fodmap/