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Insane Medicine – Know thy fats! (Before they become fats!)

Insane Medicine - Good fat - Bad Fat - slice of salmon
Insane Medicine – Good fat – Bad Fat – A slice of salmon

 

There are some key facts to know when you are in the store about fats to avoid: No Trans-Fats! The FDA is planning to have these removed from processed foods in the near future.  Lean towards Monounsaturated fats (MUFA) which are heart healthy.

  • Avoid vegetable shortening, which is abundant in baked foods and also sticks of margarine, which have Trans-fats in them.
  • Tub Margarine may be free of Trans- fats, but be careful as they may have partially hydrogenated oil in it.  That is the same as trans-fats! If you see that on the label, chose another brand!
  • For your spreads used in baking, try to aim for those with at last 2/3 oil in them to get the best results.
  • Aim for more MUFA. Olive Oil and Avocado Oil are the best choices to use in baking, dressings, cooking. They have 65% MUFA content!
  • Extra Virgin Olive still has the polyphenol antioxidants and vitamin E in it,. This choice is even better as it is more healthful.
  • Canola Oil is another option for MUFA.
  • Soybean and corn oils are higher in Polyunsaturated Fats (PUFA) . They have higher amounts of omega-6 fatty acids, but too much of this can be unhelpful in that it can increase body inflammation.
  • Hazelnut oil, flaxseed oils, and walnut oils are also healthful. Flaxseed oil breaks down at temperatures of 225 degrees, so it is best used in marinades, salads, but not cooking. Likewise Walnut oil, which smokes at 320 degrees ( a rather low temperature for baking.)
  • As far as nuts are concerned, consider Macadamia nuts, almonds, and hazelnuts for MUFA content. Walnuts have more PUFA in the form of alpha linolenic acid ( ALA) , a form of omega-3 fat that converts to EPA, which is heart healthy. Flaxseed and Hemp both supply ALA as well and are beneficial to health.
  • Fish poducts, especially tuna, salmon, sardines and other oily fish are high in omega-3 PUFA ( EPA – Eicosapentanoc acid and DHA – docosapentanoic acid). They are excellent choices for food. Try to eat two- four ounce servings a week.
  • For meat, consider skinless, breast meat of chicken and turkey.
  • For red meat, which has more harmful saturated fats, aim for ones that have a higher stearic acid content that is found in grass-fed beef and has more omega-3 as well. Remember that eating fish protects against inflammation, arthritis, diabetes, decreases arrhythmias, lowers triglyceride risk, and decreases blood pressure. To avoid contaminated fish (that have mercury, polychlorinated biphenyls, or dioxin), stay away form tilefish, shark, swordfish, and king mackeral. Instead, try tuna (bluefin, yellowtail, or skipjack), halibut, and salmon. Best choices for sustainable fish can be found at:  http://www.seafoodwatch.org/ and http://www.msc.org/ Other eco-friendly and healthful fish include pollack, haddock, albacore tuna, Barramundi, rainbow trout, and farmed shellfish such as blue mussels, oysters, and bay scallops. Farmed seafood offers excellent healthful and sustainable food.
  • Milk, cheese, and yogurt from grass-fed cows also have higher amounts of omega-3 FA content.

Insane Medicine – Inflammation and Aging – Mechanisms of poor aging!!

  • Inflammation affects the body in a number of ways, some we recognize physically and others not so much. For example, a cut on the skin can get red and inflammed. But there is a low grade, chronic inflammation that also occurs that increases as we age.
  • Many factors influence this inflammation, including genetics, lifestyle, and environmental agents. This can cause premature aging and disorders that accompany it, such as diabetes.
  • A study in the Canadian Medical Association Journal did suggest a link between elevated levels of Interleukin-6 (IL-6), a pro-inflammatory cytokine that when elevated, appears to drive other inflammatory marker up, such as CRP (C-reactive protein and fibrinogen).
  • IL-6 elevation appears to play a role in aging, causing people to age poorly when levels are elevated.
  • Successful aging is considered to have occured when an individual has good cardiovascular function ( no heart attacks) , good respiratory and musculoskeletal functioning (no emphysema/arthritis), and good mental well-being. In other words, there is an abscense of disability such as diabetes and severe arthritis or heart failure.
  • High levels of inflammation in the body are linked to cognitive decline (dementia and poor memory)
  • General body inflammation is involved in coronary artery disease, obesity, diabetes, chronic obstructive pulmonary disease (COPD), asthma, allergic conditions, rheumatoid arthritis, inflammatory bowel disease, and Alzheimer’s disease.
  • Inflammation can result in insulin resistance that then promotes obesity. Fat releases pro-inflammatory compounds that then worsens insulin-resistance. This results in a positive feedback cycle, making everything much worse.
  • Inflammatory markers being looked int incude tumopr necrosis factor (TNF), IL-6, C-reactive protein, prostaglandins, and leukotrienes. Elevations of these indicators reflects other conditions in the body, such as worsening arthritis.
  • In the Jupiter study, it was found that people with a nromal LDL (‘bad’) cholesterol would benefit from treatment with a statin to reduce the LDL even further if their CRP was elevated. The CRP elevation reflected an increased risk of heart attacks in these people despite normal or low cholesterol already. The statin (rosuvastatin), decreased the CRP and LDL cholesterol and ppears to decrease the risk of coronary events. Again, the elevated CRP reflects the inflammation in the coronary system, and this inflammation was improved by treatment with the statin.
  • Smoking worsens inflammation in the body and increases the risk of stroke and heart attacks. It promotes inflammation in the coronary arteries.
  • Obesity and high blood pressure also promote inflammation.

It is felt that IL-6 may be the driver of the inflammatory process, especially as increased levels of IL-6 (>2ng/L) increases mortality over three years. High IL-6 levels are associated with poor aging and increased risk of cardivascular events and death.

What to do:

  1. Eat a heart healthy diet including fatty fish, fruits, and vegetables. Include wine, tea, and chocolate, which have anti-inflammatory effects). The Mediterranean diet reduces inflammation.
  2. Avoid saturated fats, trans-fats, and refined sugar, which are pro-inflammatory.
  3. Get aerobic exercise. Being sedentary increases inflammation and pain.
  4. Lose weight  – obesity increases inflammation.
  5. Quit smoking.
  6. Take low dose aspirin if you had a prior heart attack.
  7. Take a statin if your docstor indicates a need. It helps inflammation and cholesterol.
  8. Don’t drink to excess.

Sleep at least 8 hours a day. AVoid stress, anxiety, depression through better coping mechanisms. Social isolation increases chronic inflammation.

http://www.cmaj.ca/content/185/16/E763.full.pdf+html?sid=f29c3195-e7d5-41f0-930f-adcbe22ac120

 

Other inflammatory markers:

Lipoprotein-associated Phospholipase A2) measures inflammation in the arteries –reference range: 81–259 ng/mL – below 200 is consistent with reduced risk of heart attack or stoke.

 

Insane Medicine – Uterine Transplant and successful subsequent pregnancy!?

 

Insane medicine - Number 7 is the uterus -
Insane medicine – Number 7 is the uterus –

uterus
uterus anatomy uterus anatomy

 

  • The first successful pregnancy after a transplantation of a uterus will give hope to those who can afford such a procedure if they lack a functioning uterus. Of course, the cost of that procedure would be quite excessive!
  • Mats Brännström, MD, at the University of Gothenburg, Sweden, documented their successful transplant the  subsequent childbirth of a 36 year old female with Rokitansky syndrome, an affliction in which the woman is born without a uterus. The transplant was from a 61 year old woman who donated her uterus!
  • The woman became pregnant through in-vitro fertilization within a year of the transplant. She was taking triple immunosuppression medications (tacrolimus, azathioprine, and corticosteroids) to protect against rejection.  She had one minor rejection episode during the pregnancy.
  • The baby was born at 31 weeks via c-section due to preeclampsia in the mother, a condition of high blood pressure and protein in the urine that affects some mothers. It can harm the fetus and mother. The baby was completely normal!!
  • Do you think that a man could receive that transplant and have a baby?

 

Diet and Heart attack prevention

 

 

 

 

The Mediterranean diet has scientific evidence of its efficacy in preventing heart attacks. There are several foods that play a large role in decreasing the inflammation in the body that leads to plaque build-up.

  1. Insane medicine - olive oil
    Olive Oil

    Extra Virgin Olive Oil (EVOO) is produced from olives and is rich in polyphenols that have anti-oxidant and anti inflammatory effects. It also has omega-3s and flavenoids, which are cardioprotective. It has a high content of monounsaturated fatty acids, which can decrease your LDL levels (bad cholesterol), and this is cardioprotective as well. EVOO can be cooked up to a temperature of 410 degrees F, so it can be used in most recipes. For higher temperatures, use regular olive oil. There are about 120 calories per teaspoon, so be careful how much is used! Compounds in EVOO include polyphenols (hydroxytyrosol, tyrosol, oleupein) and monounsaturated fats.

  2. Salmon and fatty fish such as halibut and sardines contain heart-healthy omega-3 fats. These lower triglycerides in your blood and stabilize plaques. The Omega-3 fatty acids are EPA (eicosapentanoic acid) and DHA (decosahexanoic acid).
    Insane medicine - Salmon
    Salmon –

     

  3. Red wine – is loaded with flavenoids and the antioxidant resveratrol. A glass of wine a day keeps the doctor away!
  4. Lentils and legumes – including beans and peas, have an abundance of minerals and vitamins and fiber, which lowers cholesterol. You can use soymilk to supply your daily dose of legumes in place of cow’s milk. Present in legumes are flavenoids (quercetin, anthocyanins) and isoflavones (genistein and daidzein), fiber, and phenolic acids (ferulic acid), all of which prevent artery plaque build up and inflammation.
    Insane medicine -Lentils
    Lentils

     

  5. Walnuts and flaxseeds – have a lot of alpha linoleic acid, a vegetarian omega 3 fat and fiber as well. Flaxseeds can be added to baked goods and pancakes to increase their fiber content and flavor.
    Insane medicine - flaxseeds
    Flaxseeds

     

  6. Greens and vegetables – including spinach, a very nutrient- dense vegetable, and red-purple colored vegetables such as radicchio, eggplant, and red beets all contain pigments that increase glutathione in our system, a natural antioxidant.You want to mix many different colored vegetables into your diet every day.
  7. Dark Chocolate and green tea – lowers blood pressure and cholesterol. Green tea is rich in antioxidants, especially polyphenols.
  8. Figs and fruits – dried fruits, pureed fruits – all are healthy, aim for three servings a day. They are high in polyphenol flavenoids and vitamins.
  9. Oatmeal and other whole grains – Oats are filled with soluble fiber ( a beta-glucan) that soaks up cholesterol. They are also high in antioxidants.

Alzheimer’s Disease – new screening tests in the near future?

 

 

Alzheimers disease brain tissue

Insane Medicine -Alzheimers disease
Alzheimer’s disease – neurons affected by plaques.
  • 5 million people are affected by Alzheimer’s Disease (A.D.) in the U.S., with a 1% incidence in the age group of 60-70 and 6-8% in the 85 year old category.
  • It is a progressive disease leading to eventual functional incapacity. There is a resulting loss of retention of recent memories at first with a progression to loss of remote memories in later stages. Language, abstract reasoning, and executive or decision making functions are impaired. Patients become household and work impaired. Some become delusional or psychotic.
  • This disease is the result of hyperphosphorylated Tau proteins that form neurofibrillary tangles inside the neurons. Also there are plaques of beta-amyloid that deposit in the brain, disrupting neuronal function.
  • Family history plays a role in the disease, with an individual having twice the average risk of disease if a first degree relative has Alzheimer’s.
  • Genetic changes, such as the presence of Apolipoprotein E4 mutation, increases the risk of A.D. by 2-5 times average risk by the age of 60-80.
  • Other causes of dementia must be ruled out before Alzheimer’s Disease is diagnosed. Reversible causes especially must be looked for, such as B12 deficiency, infections such as syphilis, thyroid disorders, autoimmune disorders, medication side effects, and drug abuse, especially alcohol.
  • A.D. results in difficulty in performing sequential tasks with poor decision-making skills eventually. This results in an at-risk population of elders, who are easy prey for con-artists looking to make money off impaired individuals.
  • Neuropsychiatric testing can help determine a person’s capabilities.
  • Cedar-Sinai Medical Center is developing a retinal imaging device that may identify A.D. 15-20 years earlier than other tests, such as PET scanning. Using curcumin, a compound found in the spice Tumeric, researchers discovered that the curcumin bound the Alzheimer’s plaques and could be seen in the retina. This resulted in 100% detection of the disease. Some people without the disease, however, tested positive with this testing.
  • Another retinal test is being evaluated by the Banner Alzheimer’s Institute using Fluorescent Ligand Eye Scanning (FLES). Researchers could detect beta-amyloid in the retinas of A.D. patient 85 % of the time.
  • Such retinal scans will allow for earlier detection of A.D.
  • There is no specific treatment for Alzheimer’s Disease, so there are a lot of ethical considerations that need to be evaluated in performing such tests. However, earlier detection may allow an individual to protect their financial and personal well-being from poor decision-making by allowing  specified power-of-attorneys to help make decisions when executive functioning starts to fail.
  • Other A.D. findings: Recently, a new protein, TDP-43, also seen in Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) ,has been associated with A.D. Additionally, A.D. patient can be screened for impairment through an inability of smell detection as well, using a 40-item smell detection test, called the University of Pennsylvania Smell identification Test.