First, some people may be coming to this web site to read "Getting Vitamin D Results." The web site is http://GettingVitaminDResults.blogspot.com. To view the article, it's necessary to copy and paste it on your browser. An easier way is to just goggle "Getting Vitamin D Results," but it has to be in quotation marks. The link for the article should appear on top of the list.
As of July 29, 2010, the blog for this newsletter has been accessed by people from 40 states and 17 countries. Specifically entry #9, the report on complete remission of MS with vitamin D alone, has been accessed by a large number of people who have MS or know someone with MS.
Welcome to the members of the Fantastic Fifties of South Jersey, the Taproom Luncheon Club of Haddon Township, NJ, the Henry Raich Senior Group of Cherry Hill, NJ, the St. Mary's Breast Cancer Support Group of San Francisco, and members of other groups that visit this site. Tips of the hat go to my cousin in San Francisco and friends in Florida, Massachusetts,and South Jersey who are spreading the word about Vitamin D, As a result many more people who never would have heard the message have gotten tested and discovered they were Vitamin D insufficient.
Welcome to some of the 400 followers of http://www.twitter.com/robertbakermd
and http://www.twitter.com/VitaminDWebSite
who have clicked onto this blog.
This Health Newsletter is about a variety of subjects, but I want to stress Vitamin D here. The evidence continues to mount that the realization of the pandemic of Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least 40 years..
Since I first said this in 2008 I have come to learn that I understated the benefit. Easily treated Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least a century
11/3/09
11/1/09
5. TREATMENT OF HIGH CHOLESTEROL
MEDICAL TREATMENT OF HIGH CHOLESTEROL
High cholesterol is present in a high % of American adults. Lowering the LDL cholesterol has been proven in many studies to greatly cut the incidence of illnesses caused by atherosclerosis,such as heart attacks, some strokes, and peripheral artery disease. It does this by preventing the formation, progression, and even causing regression, of atherosclerosis. The goal should be an LDL cholesterol of less than 100 mg.,and in diabetics and those that have already have atherosclerosis, a better goal is less than 75 mg.
Statins inhibit the formation of cholesterol, and are the most effective drugs in lowering cholesterol. They also lower triglycerides somewhat. Frequently companies claim superiority of their product, but all statins are effective and generally well tolerated. The main side effects are well known. Less than 1 person out of 200 develops muscle soreness and weakness, which is reversed quickly with stopping the medicine. Rarely when the medication is continued in spite of these warning signs, more serious side effects occur. Probably everyone has heard that statins can affect the liver. Less than 2% of people taking higher doses of statins develop elevated liver enzymes, which also is quickly reversed by stopping the medicine. It’s recommended that liver enzymes be rechecked after 3 months of treatment, and yearly after; however in practice most doctors test more frequently. Statins that are available now are Mevacor (Lovastatin), Lipitor, Lescol, Pravachol, Crestor, and Zocor (Simvastatin). The dose of various statins varies.
Fibric Acid Derivatives (Lopid and Tricor) lower triglycerides usually 25% to 50%. Triglycerides are a different fat in the blood that is also a risk factor for atherosclerosis and is frequently treated at levels over 300 mg. High triglycerides are especially more common in diabetes. Adverse effects are rare. Lopid, although less expensive than Tricor, can rarely cause gallstones. Both of these drugs have shown a reduction in heart attacks in those that have elevated triglycerides.
Niacin (nicotinic acid) has a favorable effect on LDL cholesterol, triglycerides, and increases HDL cholesterol (the good cholesterol) as much as 35%. Niacin can cause skin flushing and itching, which is a very annoying side effect that keeps it from being used more often. Extended release niacin and taking an aspirin or Advil before a dose sometimes reduces the side effects. In my experience in practice, niacin is a difficult drug to take because of the flushing.
Zetia prevents the absorption of cholesterol that we eat in our diet. A combination of Zetia and Simastatin (Zocor) is available as Vytorin. It lowers LDL cholesterol up to 65%, and is often very effective when people are resistant to a statin alone.
Before statins were available in 1987, resins like Questran, Colestid , and Welchol were used These drugs bind bile acids in the intestine, and increase clearance of cholesterol from the blood. They can lower LDL cholesterol by 20%. Severe constipation is a side effect that prevents more widespread use.
Fish oil (omega-3’s) can decrease triglycerides up to 50%, and have many other beneficial effects. It is available over the counter, or in the form of Lovaza. Patients often buy fish oil capsules and take 1 or 2 a day; they are underdosing. 2 to 4.8 grams of omega 3’s is considered a therapeutic dose. If you take fish oil, discuss the dose with your doctor.
The combination of long acting niacin and lovastatin (Mevacor) is available as Advicor.
Statins are the drugs of first choice for most people with a problem of elevated cholesterol. They can decrease coronary events and deaths, and are a major reason why the incidence of heart attacks has gone down in the United States over the past few decades. Several of the statins are on the generic drug lists of Walmart, Target, Walgreens, and Wegmans; so they are very affordable.
THE NON-DRUG TREATMENT OF HIGH CHOLESTEROL
The non-drug treatments of elevated cholesterol are many. Virtually all newborns are born with a blood cholesterol of less than 150 mg, and it is a “rich diet” in combination with genetics that elevates the values as we get older.
Loss of excess weight, control of diabetes, and physical activity can lower cholesterol and triglyceride values. Adequate treatment of hypothyroidism can lower an elevated cholesterol. Cholesterol responds to reduction in dietary fat and cholesterol; triglycerides respond quite well to decreasing intakes of fat, sugar, and alcohol.
Both dietary cholesterol and dietary fat raise the serum cholesterol. Don’t be tricked by food labeling; some foods are labeled low in fat but are high in cholesterol, and vice versa. Egg yolks are very high in cholesterol, whereas potato chips are high in fat. Some special interest industries have falsely promoted over the years the idea that their products are part of a healthy diet. The egg industry in particular has financed research considered “junk science” by medical authorities. Egg yolks raise cholesterol, no matter that quantity or type of egg. Cow’s milk and most meats are very high in fat, ranging frequently from 50 to 80%.
Both soluble and insoluble fiber products lower cholesterol. One study showed that eating oatmeal 3 times a week for 6 months lowers cholesterol 10%, however that means no butter in the oatmeal. Bran products provide insoluble fibers, however bran muffins are often mixed with much fat, negating the positive effects. Fruits and vegetables provide soluble fiber (although fruits should be limited to 2 a day in the treatment of elevated triglyceride).
Adjuncts to dietary therapy can be included. Psyllium in doses of 5 grams twice a day, oat bran, pectin, and guar gum, can produce a 5-10% decrease in LDL cholesterol.
The 30% fat promoted by the American Heart Association for decades has been shown in studies to lead to no significant drop in cholesterol. Another words, it doesn’t work. 20% fat diets have a significant effect on lowering cholesterol. The Pritikin regression diet, the McDougall diet, and the Ornish diet, all high carbohydrate, low fat (HCLF diets), all less than 10% fat, have a major effect in achieving reductions of total cholesterol below 150 mg, and LDL cholesterol (bad cholesterol) below 100 mg. Nathan Pritikin published scientific studies in the 1970's showing that 85% of type II diabetics on oral medication and 50% on insulin can be off those medications within one month on the Prikin regression diet, and the figures remained similar at one year follow up. Dr. Dean Ornish published studies using cardiac cathaterizations showing that atherosclerosis in the coronary arteries can regress on the Ornish program. (Both programs include daily exercise, and the Ornish program includes relaxation anti-stress techniques).
These diets can be difficult to adhere to in the age of convenience stores and eating out. I have seen cases of a cholesterol level of 300 mg. dropping to 200 mg. in one month on this type of diet. The terms “high carbohydrate” if very misleading. They require almost exclusively complex, not simple carbohydrates and are also high in soluble and insoluble fibers. Many published studies publish misleading conclusions by comparing the Adkins diet (high in protein, low in all carbohydrates), or the Mediterranean diet (high in olive oil) with a diet that is high in all kinds of carbohydrates, complex and sugars, and then erroneously draw the conclusion that they are superior to the HCLF diet. There have been accusations and evidence that some of these misleading studies have been financed by the olive oil manufacturers.
In the 1960’s, the concept of lowering cholesterol by eating a lot of polyunsaturated fats (vegetable oils) was promoted by the American Heart Association. The studies showed it lowered cholesterol only 10% but increased the incidence of various cancers. Some of these fats we now know as “trans-fats” and they have gone from being recommended by health authorities to being banned in many areas. Nathan Pritikin was an early voice in pointing this out to the public in the 1970’s that substituting vegetable oils for saturated oils doesn’t work.
Vegetarian diets tend to be lower in fat or cholesterol SOMETIMES. Some vegetarians eat a lot of oils and dairy products, which negate the beneficial effects.
Olive Oil: Olive oil is a monounsatured fat, different from the polyunsaturated and saturated fats. There is evidence that it is better than saturated or poluunsastured fats. However in a direct comparison with true HCLF diets, they are second best.
Adkins diet: The debate about the Adkins diet goes back almost 4 decades. Dr. Adkins got a lot of attention when he promoted his products by saying you can eat all the eggs and butter, etc. you wanted. Although the Adkins diet does allow significant amounts of fat and is high protein, it severely restricts simple sugars, sharing in common an important characteristic of the HCLF diets. The publicity associated with the Adkins diet often says eat all the meat you want. The actual Adkins program as detailed in the various books gives examples of dinner meals consisting of 4 or 5 ounces of chicken or fish, and very insignificant amounts of whipped cream included in desserts. By eliminating ALL simple sugars, the diet is also eliminating a lot of products that are very high not only in fats but in salt – cakes, pies, cookies, etc. So the initial success of the Adkins diet is due to eliminating most sugar and a lot of fat from the diet, despite its reputation as a high fat diet. A lot of the initial weight loss is water weight because of the reduction in salt. Short term total cholesterol can be reduced; long term it depends on what type of foods one eats on the Adkins diet. If one truly eats large amounts of meat and fat, that type of diet has been proven rerpeatedly to be unhealthy in terms of both atherosclerosis and cancer. Long term studies of the Adkins diet and weight loss are not convincing.
Vegan or Vegetarian diets: In general, vegetarians and vegans have lower cholesterols and lower atherosclerosis disease rates than non-vegetarians and vegans. It really depends on the degree of adherence. If the diet includes more oils than the non-vegetarian or vegan, the benefit of the diet is partly negated. The inclusion of dairy products by some vegetarians is a story in itself. Of the HCLF diets mentioned above, the McDougal diet is a very low fat vegan diet with the addition of no oils and very limited sugars. The Ornish and Pritikin regression diet approaches this type of diet, but does include relatively small amounts of non-vegan products.
WHAT DOESN’T WORK:
Cutting down to 3 eggs a week doesn’t work. An egg contains over 225 mg. of cholesterol. Decades ago a cardiologist in Richmond, Virginia, experimented on himself and drew daily cholesterol levels while eating 6 eggs a day. There was a 50 mg. increase in cholesterol within a few weeks, at which point he quit the study. I know about this because he was my instructor in medical school.
Substituting polyunsatured fats (as the American Heart Association recommended for a few decades) not only doesn’t work; it causes an increase in cancer. This was known in the early 1970’s. To this day, a significant portion of the public thinks polyunsaturated fats such as various vegetable fats are healthy.
Cutting fat but continuing to eat high amounts of simple sugars will prevent weight loss and tends to keep the cholesterol level up.
GENETIC CONDITIONS AND CHOLESTEROL
One in 500 Americans have a gene for dominant hypercholesterolemia. This frequently leads to cholesterol levels of over 300 mg, and if not corrected, a high incidence of atherosclerosis and heart attacks. Studies have shown that the gene does interact with diet. Their grandparents may have had levels in the 200’s, whereas they have levels in the 300’s. If a person has a double dose of the gene (usually one from each parent), a very rare condition, his or her cholesterol can exceed 1000, and yes, it does interact with the diet, but other measures have to be taken to prevent early illness.
IT "ONLY" TOOK 6 DECADES
The pathologist Dr. Aniltsichkow first discovered that role of cholesterol in atherosclerosis in 1914. His studies were prominently published in Germany. In spite of that, it took 6 decades to receive increasing attention, to the point now that many heart attacks are now avoided by lowering cholesterol levels.
The scientist Nathan Prikin accelerated this awareness in the 1970’s with his research.
Conclusion: The scientific discoveries about atherosclerosis first made in 1914 are now proven beyond any doubt. The potential remains that most atherosclerosis, a leading cause of death, can be prevented.
High cholesterol is present in a high % of American adults. Lowering the LDL cholesterol has been proven in many studies to greatly cut the incidence of illnesses caused by atherosclerosis,such as heart attacks, some strokes, and peripheral artery disease. It does this by preventing the formation, progression, and even causing regression, of atherosclerosis. The goal should be an LDL cholesterol of less than 100 mg.,and in diabetics and those that have already have atherosclerosis, a better goal is less than 75 mg.
Statins inhibit the formation of cholesterol, and are the most effective drugs in lowering cholesterol. They also lower triglycerides somewhat. Frequently companies claim superiority of their product, but all statins are effective and generally well tolerated. The main side effects are well known. Less than 1 person out of 200 develops muscle soreness and weakness, which is reversed quickly with stopping the medicine. Rarely when the medication is continued in spite of these warning signs, more serious side effects occur. Probably everyone has heard that statins can affect the liver. Less than 2% of people taking higher doses of statins develop elevated liver enzymes, which also is quickly reversed by stopping the medicine. It’s recommended that liver enzymes be rechecked after 3 months of treatment, and yearly after; however in practice most doctors test more frequently. Statins that are available now are Mevacor (Lovastatin), Lipitor, Lescol, Pravachol, Crestor, and Zocor (Simvastatin). The dose of various statins varies.
Fibric Acid Derivatives (Lopid and Tricor) lower triglycerides usually 25% to 50%. Triglycerides are a different fat in the blood that is also a risk factor for atherosclerosis and is frequently treated at levels over 300 mg. High triglycerides are especially more common in diabetes. Adverse effects are rare. Lopid, although less expensive than Tricor, can rarely cause gallstones. Both of these drugs have shown a reduction in heart attacks in those that have elevated triglycerides.
Niacin (nicotinic acid) has a favorable effect on LDL cholesterol, triglycerides, and increases HDL cholesterol (the good cholesterol) as much as 35%. Niacin can cause skin flushing and itching, which is a very annoying side effect that keeps it from being used more often. Extended release niacin and taking an aspirin or Advil before a dose sometimes reduces the side effects. In my experience in practice, niacin is a difficult drug to take because of the flushing.
Zetia prevents the absorption of cholesterol that we eat in our diet. A combination of Zetia and Simastatin (Zocor) is available as Vytorin. It lowers LDL cholesterol up to 65%, and is often very effective when people are resistant to a statin alone.
Before statins were available in 1987, resins like Questran, Colestid , and Welchol were used These drugs bind bile acids in the intestine, and increase clearance of cholesterol from the blood. They can lower LDL cholesterol by 20%. Severe constipation is a side effect that prevents more widespread use.
Fish oil (omega-3’s) can decrease triglycerides up to 50%, and have many other beneficial effects. It is available over the counter, or in the form of Lovaza. Patients often buy fish oil capsules and take 1 or 2 a day; they are underdosing. 2 to 4.8 grams of omega 3’s is considered a therapeutic dose. If you take fish oil, discuss the dose with your doctor.
The combination of long acting niacin and lovastatin (Mevacor) is available as Advicor.
Statins are the drugs of first choice for most people with a problem of elevated cholesterol. They can decrease coronary events and deaths, and are a major reason why the incidence of heart attacks has gone down in the United States over the past few decades. Several of the statins are on the generic drug lists of Walmart, Target, Walgreens, and Wegmans; so they are very affordable.
THE NON-DRUG TREATMENT OF HIGH CHOLESTEROL
The non-drug treatments of elevated cholesterol are many. Virtually all newborns are born with a blood cholesterol of less than 150 mg, and it is a “rich diet” in combination with genetics that elevates the values as we get older.
Loss of excess weight, control of diabetes, and physical activity can lower cholesterol and triglyceride values. Adequate treatment of hypothyroidism can lower an elevated cholesterol. Cholesterol responds to reduction in dietary fat and cholesterol; triglycerides respond quite well to decreasing intakes of fat, sugar, and alcohol.
Both dietary cholesterol and dietary fat raise the serum cholesterol. Don’t be tricked by food labeling; some foods are labeled low in fat but are high in cholesterol, and vice versa. Egg yolks are very high in cholesterol, whereas potato chips are high in fat. Some special interest industries have falsely promoted over the years the idea that their products are part of a healthy diet. The egg industry in particular has financed research considered “junk science” by medical authorities. Egg yolks raise cholesterol, no matter that quantity or type of egg. Cow’s milk and most meats are very high in fat, ranging frequently from 50 to 80%.
Both soluble and insoluble fiber products lower cholesterol. One study showed that eating oatmeal 3 times a week for 6 months lowers cholesterol 10%, however that means no butter in the oatmeal. Bran products provide insoluble fibers, however bran muffins are often mixed with much fat, negating the positive effects. Fruits and vegetables provide soluble fiber (although fruits should be limited to 2 a day in the treatment of elevated triglyceride).
Adjuncts to dietary therapy can be included. Psyllium in doses of 5 grams twice a day, oat bran, pectin, and guar gum, can produce a 5-10% decrease in LDL cholesterol.
The 30% fat promoted by the American Heart Association for decades has been shown in studies to lead to no significant drop in cholesterol. Another words, it doesn’t work. 20% fat diets have a significant effect on lowering cholesterol. The Pritikin regression diet, the McDougall diet, and the Ornish diet, all high carbohydrate, low fat (HCLF diets), all less than 10% fat, have a major effect in achieving reductions of total cholesterol below 150 mg, and LDL cholesterol (bad cholesterol) below 100 mg. Nathan Pritikin published scientific studies in the 1970's showing that 85% of type II diabetics on oral medication and 50% on insulin can be off those medications within one month on the Prikin regression diet, and the figures remained similar at one year follow up. Dr. Dean Ornish published studies using cardiac cathaterizations showing that atherosclerosis in the coronary arteries can regress on the Ornish program. (Both programs include daily exercise, and the Ornish program includes relaxation anti-stress techniques).
These diets can be difficult to adhere to in the age of convenience stores and eating out. I have seen cases of a cholesterol level of 300 mg. dropping to 200 mg. in one month on this type of diet. The terms “high carbohydrate” if very misleading. They require almost exclusively complex, not simple carbohydrates and are also high in soluble and insoluble fibers. Many published studies publish misleading conclusions by comparing the Adkins diet (high in protein, low in all carbohydrates), or the Mediterranean diet (high in olive oil) with a diet that is high in all kinds of carbohydrates, complex and sugars, and then erroneously draw the conclusion that they are superior to the HCLF diet. There have been accusations and evidence that some of these misleading studies have been financed by the olive oil manufacturers.
In the 1960’s, the concept of lowering cholesterol by eating a lot of polyunsaturated fats (vegetable oils) was promoted by the American Heart Association. The studies showed it lowered cholesterol only 10% but increased the incidence of various cancers. Some of these fats we now know as “trans-fats” and they have gone from being recommended by health authorities to being banned in many areas. Nathan Pritikin was an early voice in pointing this out to the public in the 1970’s that substituting vegetable oils for saturated oils doesn’t work.
Vegetarian diets tend to be lower in fat or cholesterol SOMETIMES. Some vegetarians eat a lot of oils and dairy products, which negate the beneficial effects.
Olive Oil: Olive oil is a monounsatured fat, different from the polyunsaturated and saturated fats. There is evidence that it is better than saturated or poluunsastured fats. However in a direct comparison with true HCLF diets, they are second best.
Adkins diet: The debate about the Adkins diet goes back almost 4 decades. Dr. Adkins got a lot of attention when he promoted his products by saying you can eat all the eggs and butter, etc. you wanted. Although the Adkins diet does allow significant amounts of fat and is high protein, it severely restricts simple sugars, sharing in common an important characteristic of the HCLF diets. The publicity associated with the Adkins diet often says eat all the meat you want. The actual Adkins program as detailed in the various books gives examples of dinner meals consisting of 4 or 5 ounces of chicken or fish, and very insignificant amounts of whipped cream included in desserts. By eliminating ALL simple sugars, the diet is also eliminating a lot of products that are very high not only in fats but in salt – cakes, pies, cookies, etc. So the initial success of the Adkins diet is due to eliminating most sugar and a lot of fat from the diet, despite its reputation as a high fat diet. A lot of the initial weight loss is water weight because of the reduction in salt. Short term total cholesterol can be reduced; long term it depends on what type of foods one eats on the Adkins diet. If one truly eats large amounts of meat and fat, that type of diet has been proven rerpeatedly to be unhealthy in terms of both atherosclerosis and cancer. Long term studies of the Adkins diet and weight loss are not convincing.
Vegan or Vegetarian diets: In general, vegetarians and vegans have lower cholesterols and lower atherosclerosis disease rates than non-vegetarians and vegans. It really depends on the degree of adherence. If the diet includes more oils than the non-vegetarian or vegan, the benefit of the diet is partly negated. The inclusion of dairy products by some vegetarians is a story in itself. Of the HCLF diets mentioned above, the McDougal diet is a very low fat vegan diet with the addition of no oils and very limited sugars. The Ornish and Pritikin regression diet approaches this type of diet, but does include relatively small amounts of non-vegan products.
WHAT DOESN’T WORK:
Cutting down to 3 eggs a week doesn’t work. An egg contains over 225 mg. of cholesterol. Decades ago a cardiologist in Richmond, Virginia, experimented on himself and drew daily cholesterol levels while eating 6 eggs a day. There was a 50 mg. increase in cholesterol within a few weeks, at which point he quit the study. I know about this because he was my instructor in medical school.
Substituting polyunsatured fats (as the American Heart Association recommended for a few decades) not only doesn’t work; it causes an increase in cancer. This was known in the early 1970’s. To this day, a significant portion of the public thinks polyunsaturated fats such as various vegetable fats are healthy.
Cutting fat but continuing to eat high amounts of simple sugars will prevent weight loss and tends to keep the cholesterol level up.
GENETIC CONDITIONS AND CHOLESTEROL
One in 500 Americans have a gene for dominant hypercholesterolemia. This frequently leads to cholesterol levels of over 300 mg, and if not corrected, a high incidence of atherosclerosis and heart attacks. Studies have shown that the gene does interact with diet. Their grandparents may have had levels in the 200’s, whereas they have levels in the 300’s. If a person has a double dose of the gene (usually one from each parent), a very rare condition, his or her cholesterol can exceed 1000, and yes, it does interact with the diet, but other measures have to be taken to prevent early illness.
IT "ONLY" TOOK 6 DECADES
The pathologist Dr. Aniltsichkow first discovered that role of cholesterol in atherosclerosis in 1914. His studies were prominently published in Germany. In spite of that, it took 6 decades to receive increasing attention, to the point now that many heart attacks are now avoided by lowering cholesterol levels.
The scientist Nathan Prikin accelerated this awareness in the 1970’s with his research.
Conclusion: The scientific discoveries about atherosclerosis first made in 1914 are now proven beyond any doubt. The potential remains that most atherosclerosis, a leading cause of death, can be prevented.
10/10/09
Vitamin D Quiz #1
http://vitaminddeficiency.blogspot.com/2009/10/vitamin-d-facts-and-fallacies.html
Take a 3 minute quiz on vitamin D; know more than most medical personnel about Vitamin D. It's necessary to copy and past the above internet address.
Take a 3 minute quiz on vitamin D; know more than most medical personnel about Vitamin D. It's necessary to copy and past the above internet address.
10/1/09
4. VITAMIN D AND PREVENTIVE MEDICINE
With the national debating health care, there has been much talk on "preventive medicine."
Well, how's this for preventive medicine? Would this be good for the country? The rate of breast cancer, prostate cancer, and colon cancer drops 30 to 50% in 5 years (2014) at the cost of $5 a month.
Early humans lived near the equator, didn't wear many clothes, and didn't go to the nearest CVS for sunscreen. Noone was low in Vitamin D (it is made by sunlight). It is so prevelent that at least 20% of the genes rely on it to function (although as they do more research, that figure rises). Without a sufficient level, calcium isn't absorbed sufficiently (result - osteoporosis), cells hyperproliferate -(result - cancer) and inflammatory cells hyperproliferate (result - autoimmune diseases - MS, lupus, rheumatoid arthritis, type I diabetes). Also a natural class of antibiotics made by the body does't get produced. With all the concern about swine flu this season, I have read many studies with evidence that a level of Vitamin D of at least 50 nanograms lessens the chance greatly of contracting seasonal and Swine(H1N1)flu.
If we don't live near the equator,(north of Georgia, practically no vitamin D can be made 8 months of the year), we wear a lot more clothes, and we use sunscreen or don't go out much in the sun during the summer. (I'm not advocating we do sunbathe - skin cancer interacts with many factors such as Westernized diet, early humans didn't get skin cancer, Americans do). In fact, levels didn't just drop over thousands of years; a recent study proved that levels have dropped 20% nanograms in just 28 years in the United States.
After 20 years of being in primary care practice and never ordering a vitamin D level (noone else did), I have been surprised since 2005 as to what I didn't know. It involves tested 1700 people so far for 25-hydroxyvitamin D, and finding out first hand that virtually everyone with osteoporosis or osteopenia has a low level, 90% of people who had gotten various types of cancer have a low level, practically all people with lupus, MS, type I diabetes.. And the levels aren't just low, they are VERY low. Oh yes, 70% of normal healthy people also have low levels.
This information in no ways changes what we already know about the many risk factors for various cancers. If an individual has the risk factors and genetics in place putting them at risk for cancer, then low Vitamin D is the "straw that broke the camel's back."
And everything I found has been discovered by medical researchers in the last 15 years (85% of all Vitamin D research has been done in that time period.
So as researchers and vitamin D experts have said - wave a magic wand and make everyone's vitamin D level 32 nanograms ----- that would eliminate 50% of these diseases.
Although there has been much progress in awareness the past 5 years, there are several problems holding the progress back.
1) doctors and various aspects of the medical profession stand to lose a lot of income.
2) at $5 a month, noone is in line to make a lot of money from people taking vitamin D. Vitamin D3 available in vitamin stores is the same vitamin D, the same molecule that is made by the sun. (prescription Vitamin D2 is available for vegetarians).
3) just the act of testing vitamin D along with the routine blood work is a pain for doctors, because it means calling back 70% of patients and explaining to them they need to take vitamin D.
4) the enemies of vitamin D and preventive medicine (and yes, there are enemies) promote "Vitamin D toxicity derangement syndrome" (VDTDS). Toxicity can occur at levels greater than 200 nanograms. Those levels are impossible to obtain unless very enormous amounts of Vitamin D are taken over at least 8 months. No side effects occur at less than 200 nanograms. Unfounded fear of this keeps many people from taking sufficient vitamin D.
The actual "normal level" is considered 32 to 100 nanograms (as per Labcorp and others), but experts note that maximal bone density requires a level of 40 nanograms, and increased anti-cancer effect has been noted at 52 nanograms. These experts recommend an ideal level of 50 to 80 nanograms.
Full time male lifeguards have had their level tested at the end of the summer. Their levels are 100 ng. (and think about it - that would mean this is the level that humans had for thousands of years). Not coincidentally, this is the maximal level the body can reach by sun alone. After this level is reached, the chemicals break down and the level doesn't go any higher.
Vitamin promoters have "cried wolf" several times over the past 3 decades. Vitamin C was supposed to cure cancer, vitamin E was supposed to prevent heart disease. These claims were never based on valid research; and many were outright fradulent. The evidence of Vitamin D's connection in preventing these various diseases is greater than the evidence that cigarette smoking is a main cause of lung cancer.
The 4 step program for "recovery":
1. insist that your doctor order a 25-hydroxy vitamin D level. It is covered by insurance like any other blood test; it is non-fasting. Many insurance companies pay the laboratory a negotiated rate of about $50. Don't assume your doctor has already gotten if for you along with other tests. If he or she didn't specifically tell you what your vitamin D level was, he or she didn't get the test.
2. insist on getting a copy of the written results. Don't rely on anyone telling you "it's normal." (In New Jersey, the law states a person can request a copy of the results be sent to them from the laboratory).
3. decide what level you want. Minimal "normal" is 32 nanograms. Ideal is 50 to 80 nanograms. There levels can be reached within a maximal of 6 months. Remember, the average lifeguard in August has a level of over 100 ng.) Levels can be repeated in 6 months and then perhaps once a year to ensure the level is high enough.
4. Without a level, it's impossible to recommend the correct dose for a particular person. More people are taking Vitamin D than 2005, but most of those people are taking small insufficient doses that won't get the level up to even 32 ng.
4. don't look back, look forward. Most people's worlds would be different if everyone had known about this 20 years ago, (I know mine would be) but gong forward is what we have to emphasize.
WHAT INSURANCE COMPANIES COULD DO NOW TO EASE THE HEALTH CARE CRISIS
Some pilot programs have given discounts for maintaining a good cholesterol level, or a certain weight. The programs are working! Insurance companies could announce a pilot program offering discounts of 5% off the health care insurance premium if the customer produces proof that their total 25-hydroxyvitamin D level is 32 nanograms. I predict what would happen is that the insurance companies would find out within a few years that the discount could be increased as they would save far more than 5%. (Osteoporosis alone is a multi-billion health care cost).
Well, how's this for preventive medicine? Would this be good for the country? The rate of breast cancer, prostate cancer, and colon cancer drops 30 to 50% in 5 years (2014) at the cost of $5 a month.
Early humans lived near the equator, didn't wear many clothes, and didn't go to the nearest CVS for sunscreen. Noone was low in Vitamin D (it is made by sunlight). It is so prevelent that at least 20% of the genes rely on it to function (although as they do more research, that figure rises). Without a sufficient level, calcium isn't absorbed sufficiently (result - osteoporosis), cells hyperproliferate -(result - cancer) and inflammatory cells hyperproliferate (result - autoimmune diseases - MS, lupus, rheumatoid arthritis, type I diabetes). Also a natural class of antibiotics made by the body does't get produced. With all the concern about swine flu this season, I have read many studies with evidence that a level of Vitamin D of at least 50 nanograms lessens the chance greatly of contracting seasonal and Swine(H1N1)flu.
If we don't live near the equator,(north of Georgia, practically no vitamin D can be made 8 months of the year), we wear a lot more clothes, and we use sunscreen or don't go out much in the sun during the summer. (I'm not advocating we do sunbathe - skin cancer interacts with many factors such as Westernized diet, early humans didn't get skin cancer, Americans do). In fact, levels didn't just drop over thousands of years; a recent study proved that levels have dropped 20% nanograms in just 28 years in the United States.
After 20 years of being in primary care practice and never ordering a vitamin D level (noone else did), I have been surprised since 2005 as to what I didn't know. It involves tested 1700 people so far for 25-hydroxyvitamin D, and finding out first hand that virtually everyone with osteoporosis or osteopenia has a low level, 90% of people who had gotten various types of cancer have a low level, practically all people with lupus, MS, type I diabetes.. And the levels aren't just low, they are VERY low. Oh yes, 70% of normal healthy people also have low levels.
This information in no ways changes what we already know about the many risk factors for various cancers. If an individual has the risk factors and genetics in place putting them at risk for cancer, then low Vitamin D is the "straw that broke the camel's back."
And everything I found has been discovered by medical researchers in the last 15 years (85% of all Vitamin D research has been done in that time period.
So as researchers and vitamin D experts have said - wave a magic wand and make everyone's vitamin D level 32 nanograms ----- that would eliminate 50% of these diseases.
Although there has been much progress in awareness the past 5 years, there are several problems holding the progress back.
1) doctors and various aspects of the medical profession stand to lose a lot of income.
2) at $5 a month, noone is in line to make a lot of money from people taking vitamin D. Vitamin D3 available in vitamin stores is the same vitamin D, the same molecule that is made by the sun. (prescription Vitamin D2 is available for vegetarians).
3) just the act of testing vitamin D along with the routine blood work is a pain for doctors, because it means calling back 70% of patients and explaining to them they need to take vitamin D.
4) the enemies of vitamin D and preventive medicine (and yes, there are enemies) promote "Vitamin D toxicity derangement syndrome" (VDTDS). Toxicity can occur at levels greater than 200 nanograms. Those levels are impossible to obtain unless very enormous amounts of Vitamin D are taken over at least 8 months. No side effects occur at less than 200 nanograms. Unfounded fear of this keeps many people from taking sufficient vitamin D.
The actual "normal level" is considered 32 to 100 nanograms (as per Labcorp and others), but experts note that maximal bone density requires a level of 40 nanograms, and increased anti-cancer effect has been noted at 52 nanograms. These experts recommend an ideal level of 50 to 80 nanograms.
Full time male lifeguards have had their level tested at the end of the summer. Their levels are 100 ng. (and think about it - that would mean this is the level that humans had for thousands of years). Not coincidentally, this is the maximal level the body can reach by sun alone. After this level is reached, the chemicals break down and the level doesn't go any higher.
Vitamin promoters have "cried wolf" several times over the past 3 decades. Vitamin C was supposed to cure cancer, vitamin E was supposed to prevent heart disease. These claims were never based on valid research; and many were outright fradulent. The evidence of Vitamin D's connection in preventing these various diseases is greater than the evidence that cigarette smoking is a main cause of lung cancer.
The 4 step program for "recovery":
1. insist that your doctor order a 25-hydroxy vitamin D level. It is covered by insurance like any other blood test; it is non-fasting. Many insurance companies pay the laboratory a negotiated rate of about $50. Don't assume your doctor has already gotten if for you along with other tests. If he or she didn't specifically tell you what your vitamin D level was, he or she didn't get the test.
2. insist on getting a copy of the written results. Don't rely on anyone telling you "it's normal." (In New Jersey, the law states a person can request a copy of the results be sent to them from the laboratory).
3. decide what level you want. Minimal "normal" is 32 nanograms. Ideal is 50 to 80 nanograms. There levels can be reached within a maximal of 6 months. Remember, the average lifeguard in August has a level of over 100 ng.) Levels can be repeated in 6 months and then perhaps once a year to ensure the level is high enough.
4. Without a level, it's impossible to recommend the correct dose for a particular person. More people are taking Vitamin D than 2005, but most of those people are taking small insufficient doses that won't get the level up to even 32 ng.
4. don't look back, look forward. Most people's worlds would be different if everyone had known about this 20 years ago, (I know mine would be) but gong forward is what we have to emphasize.
WHAT INSURANCE COMPANIES COULD DO NOW TO EASE THE HEALTH CARE CRISIS
Some pilot programs have given discounts for maintaining a good cholesterol level, or a certain weight. The programs are working! Insurance companies could announce a pilot program offering discounts of 5% off the health care insurance premium if the customer produces proof that their total 25-hydroxyvitamin D level is 32 nanograms. I predict what would happen is that the insurance companies would find out within a few years that the discount could be increased as they would save far more than 5%. (Osteoporosis alone is a multi-billion health care cost).
9/6/09
Links
Robert Baker MD Health Newsletter
http://RobertBakerMDHealthNewsletter.blogspot.com
Getting Vitamin D Results
This link contains an audiotape that can be listened to rather than reading.
http://GettingVitaminDResults.blogspot.com
Twitter:
Various facts on Vitamin D
http://www.twitter.com/RobertBakerMD
Links to Research on Vitamin D
http://www.twitter.com/VitaminDWebSite
Other health information can be obtained by clicking on "View My Complete Profile" on the left hand side of this blogspot
http://RobertBakerMDHealthNewsletter.blogspot.com
Getting Vitamin D Results
This link contains an audiotape that can be listened to rather than reading.
http://GettingVitaminDResults.blogspot.com
Twitter:
Various facts on Vitamin D
http://www.twitter.com/RobertBakerMD
Links to Research on Vitamin D
http://www.twitter.com/VitaminDWebSite
Other health information can be obtained by clicking on "View My Complete Profile" on the left hand side of this blogspot
9/1/09
3. TREATMENT OF HYPERTENSION
MEDICAL TREATMENT OF HYPERTENSION
Hypertension is present in 20% of all Americans and is even higher in those over 50. Control of hypertension has been proven to be effective in preventing heart attacks, heart failure, and strokes. Virtually all prescription drugs have side effects, and some of the common ones are mentioned, but obviously someone taking medication for hypertension should not make changes or stop a medication without discussing it with his or her physician.
Diuretics are first-line therapy for many, and include hydrochlorthiazide (HCT), and Hygroton. Stronger “loop” diuretics are Lasix and Edecrin. Side effects include lowering the potassium levels, muscle cramps of the leg, and frequent urination leading to interrupted sleep. Potassium-sparing diuretics include Dyazide, Amiloride, and Aldactone. Many people end up needing to taking prescription potassium, 800 mg.(20 mEq)a day, but this can frequently be avoided by getting the potassium in the diet. It is well known that a banana contains potassium (10 mEq), but it is less well known that a baked potato contains 15 mEq of potassium. Diuretics are frequently used in combination with other types of hypertension drugs.
ACE inhibitors (angiotensin converting enzyme) are also often used as first-line. It has been shown to be particularly protective of the kidneys and heart when impairment is present. They are even recommended for diabetics who don’t have hypertension but have protein in the urine (a very early sign of kidney disease). Examples are Lisinopril, Lotensin, and Capoten. An occasional side effect is hives.
ARB’s (angiotensin receptor blockers) are equally protective for the heart and kidneys. Examples are Cozaar,Benicar,and Diovan.
Beta blockers counteract adrenaline, and are excellent for people who have other indications for them, such as migraine, angina, heart attack, heart failure, and even stage fright. It is less often used initially. Examples are Inderal, Atenolol, and Lopressor. They slow the heart rate, which often is a desirable effect.
Calcium-channel blockers (Cardizem, Verapamil, Calan, Norvasc) and direct vasodilators (Hydralazine and Minoxidil) work by dilating arteries. Some of these can cause annoying swelling (edema) of the legs.
Central alpha-adrenergic agonists (Catapres) decrease the activity of the nerves that interact with adrenalin. They are very effective used with other drugs for severe hypertension, but frequently cause fatigue that may limit their use.
An important principle in dealing with your hypertension is “don’t give up.” The majority of people with hypertension need more than one drug for good control. If a diuretic is used initially, an ACE inhibitor or ARB can be added for better control, and vice versa.
I have seen over the years instances of people who don’t take their blood pressure medicines because of the expense. Most diuretics,some ACE inhibitors and beta blockers are inexpensive. ARB’s tend to be expensive. Many times doctors may not know the cost of some of the medications they are prescribing. The pharmacies of Walmart, Target,and Shop Rite have lists of generic drugs for less than $4 a month, which is often less than insurance copays. Generics are regulated by the FDA and there hasn’t been a problem with generic anti-hypertensive drugs in decades. There are drugs from each class of anti-hypertensives with the exception of ARB’s on these lists. Don’t hesitate to discuss with your physician the use of these lists. $12 a month will enable most patients to take even 3 medications for hypertension, if that’s what’s necessary. Many drug stores enable you to get a blood pressure reading free of charge, so it’s easy to keep track of your blood pressure between office visits.
The message to remember is that good control of hypertension does work and does prevent serious,even catastrophic,illnesses.
THE NON-DRUG TREATMENT OF HYPERTENSION
In my second year of medical school, a cardiologist stated on our initial lecture on hypertension that once a patient has a high blood pressure reading, he or she always has to be on an anti-hypertensive drug for life. It is now known that the statement was totally false. Although the inaccuracy of this blanket statement is known by a growing number of Americans, the effectiveness of the non-drug treatment of hypertension is under publicized to the public, and as a result, underused.
Weight reduction: Not everyone with hypertension is overweight, but it is a major risk factor in hypertension. In those that are, weight reduction can lower blood pressure. The percentage drop in weight necessary to see a difference varies frequently from 10 to 30%.
A “2 gram sodium restricted diet” has been standard suggestions to those with hypertension for years. In the 1950’s, when only a few anti-hypertensive drugs were available, the “Duke University” diet used a brown rice and fruit diet and frequently dramatically lowered the blood pressure. A common response to telling a patient that salt restriction may help their hypertension is “I don’t add any salt to my food.” Studies have shown that the usual American diet can still contain over 5 grams of sodium without using any table salt. Now that food products are labeled, reading labels for the first time for sodium content can be quite shocking. Soups frequently contain 700 mg. of sodium per serving, and many people eat two servings at a meal. Fast food outlets frequently have sodium information available on the internet, but how many people actually take the time to research this information? Most people know that fast food french fries are salty, but how many know that fast food hamburgers frequently contain as much sodium as a serving of French fries.
A study published in September, 2009 in the American Journal of Health Promotion estimated the effect that a reduction of sodium to 2300 mg./day in the United States. Hypertension cases was predicted to be reduced by 11 million cases, saving in health care costs would total $18 billion, and 312,000 quality of life years would be gained, worth $32 billion annually.
Vitamin D insufficiency has been shown to adversely effect enzymes related to the control of blood pressure, and some studies have shown that correcting the insufficiency can improve blood pressure. Remember, at least 70% of Americans have vitamin D insufficiency, and over 95% have levels that are less than ideal.
Calcium supplementation has been reported to have a minor effect on lowering blood pressure. The calcium data is questionable, as the same dairy industry that has been accused of sponsoring deliberately misleading studies is behind much of the calcium data. Societies with very low calcium intakes but don't have rich diets have less, not more, hypertension.
Magnesium supplementation has been shown to have a definite but small effect in lowering mild hypertension. In the October 2009 issue of American Journal of Hypertension a study gave 600 mg. of magneisum daily, and the systolic and diastolic blood pressure readings dropped a few points over 12 weeks compared to placebo.
Low animal protein diets, such as vegan or vegetarian diets, frequently lower blood pressure independent of the weight of the individual.
Exercise and relaxation have an independent effect on lowering blood pressure.
Lack of sleep, especially chronic, has been shown to have a deliterious effect on blood pressure.
Pain can acutely or chronically raise blood pressure. Severe dental pain and chronic back pain in particular has been shown to have an effect on blood pressure, but the effect can probably be found in pain of all kinds.
Alcohol has a very variable effect. Many alcoholics have normal blood pressure. But in a definite percentage of drinkers, alcohol can have a major effect on raising blood pressure, with rapid improvement with cessation of drinking.
Caffeine can raise blood pressure acutely and long term, although the coffee lobby has tried to suppress this information with misleading publicity.
Eating whole grains can lower blood pressure. In the September, 2009 American Journal of Clinical Nutrition a study showed that men who eat the top 20% of whole grains have 19% less hypertension than those that ate the bottom 20%. Other studies have shown a similar effect in women.
Avoiding high sugar foods can lower blood pressure in some people. Eating high sugar foods cause the heart rate to increase in some, but not all, people, with pulse rates increasing as much as 20 beats per minute for as much as a few hours. Along with this, the blood pressure can go up. Specifically a study was presented at the American Heart Association Hypertension Research Conference September, 2009. 74 men were given an extra 50 Calories a day of fructose for just 2 weeks. The systolic blood pressure increased by 6 mm., the diastolic blood pressure increased by 3 mm.
Patients especially who suffer from many side effects of anti-hypertensive drugs such as fatigue or erectile dysfunction can benefit from modifying the many factors in the non-drug treatment of hypertension. The information is not new; a classic article “Non-Drug Treatment of Hypertension” by Norman M. Kaplan, M.D., was published in the Annals of Internal Medicine in March, 1985.
Revised 10/18/09
Hypertension is present in 20% of all Americans and is even higher in those over 50. Control of hypertension has been proven to be effective in preventing heart attacks, heart failure, and strokes. Virtually all prescription drugs have side effects, and some of the common ones are mentioned, but obviously someone taking medication for hypertension should not make changes or stop a medication without discussing it with his or her physician.
Diuretics are first-line therapy for many, and include hydrochlorthiazide (HCT), and Hygroton. Stronger “loop” diuretics are Lasix and Edecrin. Side effects include lowering the potassium levels, muscle cramps of the leg, and frequent urination leading to interrupted sleep. Potassium-sparing diuretics include Dyazide, Amiloride, and Aldactone. Many people end up needing to taking prescription potassium, 800 mg.(20 mEq)a day, but this can frequently be avoided by getting the potassium in the diet. It is well known that a banana contains potassium (10 mEq), but it is less well known that a baked potato contains 15 mEq of potassium. Diuretics are frequently used in combination with other types of hypertension drugs.
ACE inhibitors (angiotensin converting enzyme) are also often used as first-line. It has been shown to be particularly protective of the kidneys and heart when impairment is present. They are even recommended for diabetics who don’t have hypertension but have protein in the urine (a very early sign of kidney disease). Examples are Lisinopril, Lotensin, and Capoten. An occasional side effect is hives.
ARB’s (angiotensin receptor blockers) are equally protective for the heart and kidneys. Examples are Cozaar,Benicar,and Diovan.
Beta blockers counteract adrenaline, and are excellent for people who have other indications for them, such as migraine, angina, heart attack, heart failure, and even stage fright. It is less often used initially. Examples are Inderal, Atenolol, and Lopressor. They slow the heart rate, which often is a desirable effect.
Calcium-channel blockers (Cardizem, Verapamil, Calan, Norvasc) and direct vasodilators (Hydralazine and Minoxidil) work by dilating arteries. Some of these can cause annoying swelling (edema) of the legs.
Central alpha-adrenergic agonists (Catapres) decrease the activity of the nerves that interact with adrenalin. They are very effective used with other drugs for severe hypertension, but frequently cause fatigue that may limit their use.
An important principle in dealing with your hypertension is “don’t give up.” The majority of people with hypertension need more than one drug for good control. If a diuretic is used initially, an ACE inhibitor or ARB can be added for better control, and vice versa.
I have seen over the years instances of people who don’t take their blood pressure medicines because of the expense. Most diuretics,some ACE inhibitors and beta blockers are inexpensive. ARB’s tend to be expensive. Many times doctors may not know the cost of some of the medications they are prescribing. The pharmacies of Walmart, Target,and Shop Rite have lists of generic drugs for less than $4 a month, which is often less than insurance copays. Generics are regulated by the FDA and there hasn’t been a problem with generic anti-hypertensive drugs in decades. There are drugs from each class of anti-hypertensives with the exception of ARB’s on these lists. Don’t hesitate to discuss with your physician the use of these lists. $12 a month will enable most patients to take even 3 medications for hypertension, if that’s what’s necessary. Many drug stores enable you to get a blood pressure reading free of charge, so it’s easy to keep track of your blood pressure between office visits.
The message to remember is that good control of hypertension does work and does prevent serious,even catastrophic,illnesses.
THE NON-DRUG TREATMENT OF HYPERTENSION
In my second year of medical school, a cardiologist stated on our initial lecture on hypertension that once a patient has a high blood pressure reading, he or she always has to be on an anti-hypertensive drug for life. It is now known that the statement was totally false. Although the inaccuracy of this blanket statement is known by a growing number of Americans, the effectiveness of the non-drug treatment of hypertension is under publicized to the public, and as a result, underused.
Weight reduction: Not everyone with hypertension is overweight, but it is a major risk factor in hypertension. In those that are, weight reduction can lower blood pressure. The percentage drop in weight necessary to see a difference varies frequently from 10 to 30%.
A “2 gram sodium restricted diet” has been standard suggestions to those with hypertension for years. In the 1950’s, when only a few anti-hypertensive drugs were available, the “Duke University” diet used a brown rice and fruit diet and frequently dramatically lowered the blood pressure. A common response to telling a patient that salt restriction may help their hypertension is “I don’t add any salt to my food.” Studies have shown that the usual American diet can still contain over 5 grams of sodium without using any table salt. Now that food products are labeled, reading labels for the first time for sodium content can be quite shocking. Soups frequently contain 700 mg. of sodium per serving, and many people eat two servings at a meal. Fast food outlets frequently have sodium information available on the internet, but how many people actually take the time to research this information? Most people know that fast food french fries are salty, but how many know that fast food hamburgers frequently contain as much sodium as a serving of French fries.
A study published in September, 2009 in the American Journal of Health Promotion estimated the effect that a reduction of sodium to 2300 mg./day in the United States. Hypertension cases was predicted to be reduced by 11 million cases, saving in health care costs would total $18 billion, and 312,000 quality of life years would be gained, worth $32 billion annually.
Vitamin D insufficiency has been shown to adversely effect enzymes related to the control of blood pressure, and some studies have shown that correcting the insufficiency can improve blood pressure. Remember, at least 70% of Americans have vitamin D insufficiency, and over 95% have levels that are less than ideal.
Calcium supplementation has been reported to have a minor effect on lowering blood pressure. The calcium data is questionable, as the same dairy industry that has been accused of sponsoring deliberately misleading studies is behind much of the calcium data. Societies with very low calcium intakes but don't have rich diets have less, not more, hypertension.
Magnesium supplementation has been shown to have a definite but small effect in lowering mild hypertension. In the October 2009 issue of American Journal of Hypertension a study gave 600 mg. of magneisum daily, and the systolic and diastolic blood pressure readings dropped a few points over 12 weeks compared to placebo.
Low animal protein diets, such as vegan or vegetarian diets, frequently lower blood pressure independent of the weight of the individual.
Exercise and relaxation have an independent effect on lowering blood pressure.
Lack of sleep, especially chronic, has been shown to have a deliterious effect on blood pressure.
Pain can acutely or chronically raise blood pressure. Severe dental pain and chronic back pain in particular has been shown to have an effect on blood pressure, but the effect can probably be found in pain of all kinds.
Alcohol has a very variable effect. Many alcoholics have normal blood pressure. But in a definite percentage of drinkers, alcohol can have a major effect on raising blood pressure, with rapid improvement with cessation of drinking.
Caffeine can raise blood pressure acutely and long term, although the coffee lobby has tried to suppress this information with misleading publicity.
Eating whole grains can lower blood pressure. In the September, 2009 American Journal of Clinical Nutrition a study showed that men who eat the top 20% of whole grains have 19% less hypertension than those that ate the bottom 20%. Other studies have shown a similar effect in women.
Avoiding high sugar foods can lower blood pressure in some people. Eating high sugar foods cause the heart rate to increase in some, but not all, people, with pulse rates increasing as much as 20 beats per minute for as much as a few hours. Along with this, the blood pressure can go up. Specifically a study was presented at the American Heart Association Hypertension Research Conference September, 2009. 74 men were given an extra 50 Calories a day of fructose for just 2 weeks. The systolic blood pressure increased by 6 mm., the diastolic blood pressure increased by 3 mm.
Patients especially who suffer from many side effects of anti-hypertensive drugs such as fatigue or erectile dysfunction can benefit from modifying the many factors in the non-drug treatment of hypertension. The information is not new; a classic article “Non-Drug Treatment of Hypertension” by Norman M. Kaplan, M.D., was published in the Annals of Internal Medicine in March, 1985.
Revised 10/18/09
6/1/09
2. UPDATE ON VITAMIN D - 2009
Why our daughters need their D level checked: It’s been know for decades that vitamin D deficiency weakens muscles. A study in the Dec, 2008. issue of Journal of Clinical Endocrinology & Metabolism reports its association with Cesarean delivery. Vitamin D levels were measured in 253 mothers. The rate of C-section was 14% for levels over 15 ng., and 28% for levels less than 15 ng. Normal is 32 to 100 ng). Many pregnant women would benefit if physicians ordered D levels for all their pregnant patients and treated to at least a level of 32 ng.
As for yourself - Vitamin D receptors are present in the brain. A recent study in the Journal of Geriatric Psychology and Neurology studied 2000 people over 65. Those with the lowest Vitamin D levels were more than twice as likely to have cognitive problems (an early sign of Alzheimers disease) than those with the highest. This shows that D deficiency may be an important not previously recognized link to Alzheimers.
And for infants- Autism is an epidemic that didn’t exist when we were born. It is a complex disease with various factors, as yet not fully understood, contributing to its origins. Studies have shown a higher incidence of autism in women who were pregnant during the winter when Vitamin D levels are lowest. Other studies have shown higher autism rates within the same state in counties that have more rainfall (and therefore less sunshine). Autism is higher in African Americans (who have levels 10 to 15 ng. lower because less sunlight is absorbed through darker skin). The New York Times in March, 2009, reported a surge of autism in Minneapolis among Somalian immigrants. Sweden is now reporting a rate of autism among Somalians at 3 times the rate of non-Somalians.. This is just some of the growing evidence that vitamin D deficiency is an important factor in autism. It will take decades to prove it, studies are only being talked about at this point, and the theory is relatively new. Some case reports have shown some improvements with correction of vitamin D insufficiency, but no large studies have been done. The tests done for an autistic child are quite extensive but routinely don’t include a 25-hydroxyvitamin D level. The Vitamin D Council is recommending that every such child should be tested; and any insufficiency should be treated by their physician. For this and many other reasons, 25-hydroxyvitamin D levels should be a routine pre-natal test. Any pregnant woman should be proactive and insist her obstetrician get the test.
The missing link- Why didn’t we hear of vitamin D deficiency 30 years ago? A March, 2009 study in Archives of Internal Medicine did a vitamin D level on about 15,000 blood samples that had been stored from both 1990 (average 30 ng.) and 2003 (average 24 ng.) The drop was 20%, and only 25% of 2003 levels were normal. Less sunlight exposure is felt to be the main explanation. This largely explains the increasing incidence of osteoporosis and other conditions associated with vitamin D deficiency.
Is Vitamin D a “secret?” Major publications have written about vitamin D in the past few years. In September,2006, Reader’s Digest published an article entitled:”The Miracle Vitamin: New evidence shows that getting enough D may be the most important thing you can do for you health.” In February, 2008, Parade Magazine listed vitamin D levels as one of “5 Medical Tests That May Keep You Well;” In the same month, Jane Brodie of the New York Times wrote “An Oldie Vies for Nutrient of the Decade.” Suggestions have even been made by prominent experts that the Surgeon General issue a report on Vitamin D because of the beneficial effect public awareness would have on decreasing health care costs and improving public health. I believe that the realization of the pandemic of vitamin D deficiency is the most important medical discovery in at least 40 years.
A guiding principle with taking Vitamin D
For those who like to keep things simple as more information becomes discovered about Vitamin D, the following should be remembered. If preventing osteoporosis was the ONLY thing that Vitamin D did,that would be enough reason to treat Vitamin D levels to at least 40 nanograms, and probably 50 nanograms.
Vitamin D and Cancer
One of Vitamin D's main actions is to prevent hyperproliferation of cells. That term describes what happens with cancer. There are substantial studies over the past several decades that show that low 25-hydroxyvitamin D levels vary inversely with the incidence of breast, prostate, and colon cancer. In a well publicized large study published in 2007, the lower the level, the more agressive the breast cancer. Prostate cancer studies have shown that vitamin D lowers the PSA level, an important tumor marker, and has effective anti-tumor action against prostate cancer.
Other cancers:
There are also many studies showing that vitamin D has activity in actually treating established cancer, especially breast and prostate cancer. Fewer studies have been done with less common cancers.
Thyroid cancer: There are in vitro and animal studies showing that thyroid cancer cells are significantly slowed down in their multiplication with Vitamin D. Thyroid nodules (which are a pre-cancerous lesion) are very common in hyperparathyroidism, and this condition is almost always associated with a low 25-hydroxyvitamin D level, which overstimulates the parathyroid glands.
Pancreatic cancer: Studies show that the incidence of pancreatic cancer is twice as common with low vitamin D levels.
Lung Cancer: Studies show a strong correlation of lung cancer with vitamin D levels, and substantial evidence that vitamin D has an chemotherapeutic effect when used in established cancer.
Vitamin D and the interaction of other risk factors
Many cancers have identified risk factors. Thyroid cancer is strongly associated with radiation to the neck as a child. Breast, prostate,and colon cancer have a number of proven risk factors. It has been well known and proven since 1965 that cigarette smoking causes lung cancer, and it is less well known that cigarette smoking is a strong risk factor of pancreatic cancer. A low vitamin D level works in conjunction with other risk factors. It is a non-specific stimulus to hyperproliferation of abnormal cells, and if these cells are damaged by other risk factors, it is a lot easier for cancer to develop. 25-hydroxyvitamin D levels, along with genetic factors, may be a large part of the explanation of why some smokers never get lung cancer. The same could be said of other cancers with their own risk factors.
What does this means in real terms? In an estimate so shocking it's hard for many to believe; according to leading Vitamin D experts and based on research studies that have been done, if every woman had a 25-hydroxyvitamin D level of 32 nanograms (the lowest level considered as normal, although it's far below the ideal level), the incidence of breast cancer would be cut 50%. The same probably can be said with men and women for colon, and men for prostate cancer. The same is also likely true for other cancers, but research has not been done yet.
Vitamin D and hereditary cancer genes - a theory
There are no studies that can be found regarding the BrCa1 gene, BrCa2 gene, and other heredity cancer symdromes and 25-hydroxyvitamin D levels. The BrCa1 gene has one of the most profound effects on it's carriers of all known hereditary cancer genes. Not all of it's female carriers get breast cancer, (it's frequently in the 30's when carriers that do get breast cancer become diagnosed, although just about all get ovarian cancer by the age of 58 if the ovaries aren't removed.) Would agressively treating 25-hydroxyvitamin D levels preferably to over 50 nanograms reduce the incidence of breast cancer in BrCa1 gene carriers? This is unknown, but could be an easy study to do, given the large amount of BrCa1 female carriers who follow the path of mammograms and MRIs of the breasts starting in their 30's. Unfortunately, I don't think this study is imminent. Carriers shouldn't wait; they should treat their vitamin D insufficiency to ideal levels.
As for yourself - Vitamin D receptors are present in the brain. A recent study in the Journal of Geriatric Psychology and Neurology studied 2000 people over 65. Those with the lowest Vitamin D levels were more than twice as likely to have cognitive problems (an early sign of Alzheimers disease) than those with the highest. This shows that D deficiency may be an important not previously recognized link to Alzheimers.
And for infants- Autism is an epidemic that didn’t exist when we were born. It is a complex disease with various factors, as yet not fully understood, contributing to its origins. Studies have shown a higher incidence of autism in women who were pregnant during the winter when Vitamin D levels are lowest. Other studies have shown higher autism rates within the same state in counties that have more rainfall (and therefore less sunshine). Autism is higher in African Americans (who have levels 10 to 15 ng. lower because less sunlight is absorbed through darker skin). The New York Times in March, 2009, reported a surge of autism in Minneapolis among Somalian immigrants. Sweden is now reporting a rate of autism among Somalians at 3 times the rate of non-Somalians.. This is just some of the growing evidence that vitamin D deficiency is an important factor in autism. It will take decades to prove it, studies are only being talked about at this point, and the theory is relatively new. Some case reports have shown some improvements with correction of vitamin D insufficiency, but no large studies have been done. The tests done for an autistic child are quite extensive but routinely don’t include a 25-hydroxyvitamin D level. The Vitamin D Council is recommending that every such child should be tested; and any insufficiency should be treated by their physician. For this and many other reasons, 25-hydroxyvitamin D levels should be a routine pre-natal test. Any pregnant woman should be proactive and insist her obstetrician get the test.
The missing link- Why didn’t we hear of vitamin D deficiency 30 years ago? A March, 2009 study in Archives of Internal Medicine did a vitamin D level on about 15,000 blood samples that had been stored from both 1990 (average 30 ng.) and 2003 (average 24 ng.) The drop was 20%, and only 25% of 2003 levels were normal. Less sunlight exposure is felt to be the main explanation. This largely explains the increasing incidence of osteoporosis and other conditions associated with vitamin D deficiency.
Is Vitamin D a “secret?” Major publications have written about vitamin D in the past few years. In September,2006, Reader’s Digest published an article entitled:”The Miracle Vitamin: New evidence shows that getting enough D may be the most important thing you can do for you health.” In February, 2008, Parade Magazine listed vitamin D levels as one of “5 Medical Tests That May Keep You Well;” In the same month, Jane Brodie of the New York Times wrote “An Oldie Vies for Nutrient of the Decade.” Suggestions have even been made by prominent experts that the Surgeon General issue a report on Vitamin D because of the beneficial effect public awareness would have on decreasing health care costs and improving public health. I believe that the realization of the pandemic of vitamin D deficiency is the most important medical discovery in at least 40 years.
A guiding principle with taking Vitamin D
For those who like to keep things simple as more information becomes discovered about Vitamin D, the following should be remembered. If preventing osteoporosis was the ONLY thing that Vitamin D did,that would be enough reason to treat Vitamin D levels to at least 40 nanograms, and probably 50 nanograms.
Vitamin D and Cancer
One of Vitamin D's main actions is to prevent hyperproliferation of cells. That term describes what happens with cancer. There are substantial studies over the past several decades that show that low 25-hydroxyvitamin D levels vary inversely with the incidence of breast, prostate, and colon cancer. In a well publicized large study published in 2007, the lower the level, the more agressive the breast cancer. Prostate cancer studies have shown that vitamin D lowers the PSA level, an important tumor marker, and has effective anti-tumor action against prostate cancer.
Other cancers:
There are also many studies showing that vitamin D has activity in actually treating established cancer, especially breast and prostate cancer. Fewer studies have been done with less common cancers.
Thyroid cancer: There are in vitro and animal studies showing that thyroid cancer cells are significantly slowed down in their multiplication with Vitamin D. Thyroid nodules (which are a pre-cancerous lesion) are very common in hyperparathyroidism, and this condition is almost always associated with a low 25-hydroxyvitamin D level, which overstimulates the parathyroid glands.
Pancreatic cancer: Studies show that the incidence of pancreatic cancer is twice as common with low vitamin D levels.
Lung Cancer: Studies show a strong correlation of lung cancer with vitamin D levels, and substantial evidence that vitamin D has an chemotherapeutic effect when used in established cancer.
Vitamin D and the interaction of other risk factors
Many cancers have identified risk factors. Thyroid cancer is strongly associated with radiation to the neck as a child. Breast, prostate,and colon cancer have a number of proven risk factors. It has been well known and proven since 1965 that cigarette smoking causes lung cancer, and it is less well known that cigarette smoking is a strong risk factor of pancreatic cancer. A low vitamin D level works in conjunction with other risk factors. It is a non-specific stimulus to hyperproliferation of abnormal cells, and if these cells are damaged by other risk factors, it is a lot easier for cancer to develop. 25-hydroxyvitamin D levels, along with genetic factors, may be a large part of the explanation of why some smokers never get lung cancer. The same could be said of other cancers with their own risk factors.
What does this means in real terms? In an estimate so shocking it's hard for many to believe; according to leading Vitamin D experts and based on research studies that have been done, if every woman had a 25-hydroxyvitamin D level of 32 nanograms (the lowest level considered as normal, although it's far below the ideal level), the incidence of breast cancer would be cut 50%. The same probably can be said with men and women for colon, and men for prostate cancer. The same is also likely true for other cancers, but research has not been done yet.
Vitamin D and hereditary cancer genes - a theory
There are no studies that can be found regarding the BrCa1 gene, BrCa2 gene, and other heredity cancer symdromes and 25-hydroxyvitamin D levels. The BrCa1 gene has one of the most profound effects on it's carriers of all known hereditary cancer genes. Not all of it's female carriers get breast cancer, (it's frequently in the 30's when carriers that do get breast cancer become diagnosed, although just about all get ovarian cancer by the age of 58 if the ovaries aren't removed.) Would agressively treating 25-hydroxyvitamin D levels preferably to over 50 nanograms reduce the incidence of breast cancer in BrCa1 gene carriers? This is unknown, but could be an easy study to do, given the large amount of BrCa1 female carriers who follow the path of mammograms and MRIs of the breasts starting in their 30's. Unfortunately, I don't think this study is imminent. Carriers shouldn't wait; they should treat their vitamin D insufficiency to ideal levels.
3/1/09
1. UNDERSTANDING YOUR CHOLESTEROL NUMBERS
Cholesterol is made up of LDL and HDL. LDL cholesterol (the “bad cholesterol”) is deposited onto the walls of arteries, causing inflammation and atherosclerosis, and the end result is a heart attack or blockages in arteries of the neck or leg. HDL cholesterol (the” good cholesterol”) takes cholesterol away from the artery walls. Total cholesterol numbers can be misleading at times. If someone has an unusually high HDL cholesterol, that’s good, but it raises the total cholesterol. A high HDL can be due to genetics and can be raised by exercise. For those of you interested in formulas, total cholesterol = LDL + HDL + triglycerides/5 (but this is not valid if the triglyceride is over 300 mg.).
Normal cholesterol has changed over the years as more research was done. In 1974, normal was up to 250 mg. In the 1990’s, normal was reduced to a maximum of 200 mg. Normal LDL is below 100 mg. Normal HDL cholesterol is 40 mg. or greater. A few years ago research showed that for someone who has already had an illness caused by atheroslerosis, such as a heart attack, or if someone has diabetes, there is further benefit in getting the LDL below 75 mg. The ratio of LDL to HDL, once thought to be important, is not emphasized now. The reversal of atherosclerosis, which was proven by studies in the 1990’s to be possible, requires very low cholesterol; preferably an LDL below 100 mg.
Cholesterol, first discovered in 1910 to be the primary substance that makes up atherosclerosis, and modified by many factors from the genes we are born with to the food that we eat, remains the most important of many risk factors for atherosclerosis.
SUPPLEMENTAL INFORMATION
NORMAL (IDEAL LEVELS)
Total Cholesterol ..... < 200 mg.
LDL Cholesterol ..... < 100 mg.
..... 100 to 130 mg. is considered borderline
LDL Cholesterol if a heart attack or other atherosclerosis event has taken place < 75 mg.
LDL Cholesterol in diabetics ..... < 75 mg.
HDL Cholesterol ...... > 40 mg.
Triglycerides ...... < 150 mg.
Excess weight, dietary cholesterol, dietary fat, and poorly controlled diabetes raise LDL cholesterol. Although much has been made about polyunsatured fats vs. saturated fats since the 1970’s, studies have shown a minimum drop in switching from saturated fats to polyunsaturated fats. Polyunsaturated fats and cancer promotion is a whole different issue. Genetics strongly interact with the above factors; some obese people have low cholesterol, some thin people have high cholesterol.
Exercise and genetics raise HDL cholesterol to better levels. HDL frequently varies inversely with triglycerides.
Triglycerides are very responsive to weight gain or loss and diabetes control. An obese person can frequently get large drops in triglycerides with only a 10% weight loss.
Blood samples should be obtained after an overnight fast. Non-fasting samples can raise cholesterol a few mg. but can raise triglycerides a great deal.
OTHER RISK FACTORS
Elevated blood pressure, blood sugar (diabetes), levels of homocysteine (associated with insufficient levels of vitamin B12 or folic acid), high insulin levels (usually found in obese individuals), and vitamin D insufficiency can accelerate atherosclerosis. Elevated C-reactive protein is an indication of inflammation within the coronary arteries; levels can be lowered by the same measures used to lower LDL cholesterol.
HOW IMPORTANT ARE THE RISK FACTORS?
The notion that 50% of people suffering a heart attack have normal cholesterol levels has been spread usually by people who are selling information or products that require the minimizing of the importance of cholesterol. The way this is done is that these people take a high number, 225 mg. or 250 mg. as a "normal" cholesterol, or a high number of LDL cholesterol as "normal". This notion has been clearly disproved, but unfortunately will live on.
The truth has been shown by a study all the way back in 2003! in the Journal of the American Medical Association . A study looked at 3 comprehensive studies and concluded that 90% of coronary heart disease (CHD) had a history of elevated cholesterol, hypertension, cigarette use, or diabetes. In 2005 an Annals of Internal Medicine study showed that 8% of CHD events will actually occur with only borderline abnormal levels of multiple risk factors.
Normal cholesterol has changed over the years as more research was done. In 1974, normal was up to 250 mg. In the 1990’s, normal was reduced to a maximum of 200 mg. Normal LDL is below 100 mg. Normal HDL cholesterol is 40 mg. or greater. A few years ago research showed that for someone who has already had an illness caused by atheroslerosis, such as a heart attack, or if someone has diabetes, there is further benefit in getting the LDL below 75 mg. The ratio of LDL to HDL, once thought to be important, is not emphasized now. The reversal of atherosclerosis, which was proven by studies in the 1990’s to be possible, requires very low cholesterol; preferably an LDL below 100 mg.
Cholesterol, first discovered in 1910 to be the primary substance that makes up atherosclerosis, and modified by many factors from the genes we are born with to the food that we eat, remains the most important of many risk factors for atherosclerosis.
SUPPLEMENTAL INFORMATION
NORMAL (IDEAL LEVELS)
Total Cholesterol ..... < 200 mg.
LDL Cholesterol ..... < 100 mg.
..... 100 to 130 mg. is considered borderline
LDL Cholesterol if a heart attack or other atherosclerosis event has taken place < 75 mg.
LDL Cholesterol in diabetics ..... < 75 mg.
HDL Cholesterol ...... > 40 mg.
Triglycerides ...... < 150 mg.
Excess weight, dietary cholesterol, dietary fat, and poorly controlled diabetes raise LDL cholesterol. Although much has been made about polyunsatured fats vs. saturated fats since the 1970’s, studies have shown a minimum drop in switching from saturated fats to polyunsaturated fats. Polyunsaturated fats and cancer promotion is a whole different issue. Genetics strongly interact with the above factors; some obese people have low cholesterol, some thin people have high cholesterol.
Exercise and genetics raise HDL cholesterol to better levels. HDL frequently varies inversely with triglycerides.
Triglycerides are very responsive to weight gain or loss and diabetes control. An obese person can frequently get large drops in triglycerides with only a 10% weight loss.
Blood samples should be obtained after an overnight fast. Non-fasting samples can raise cholesterol a few mg. but can raise triglycerides a great deal.
OTHER RISK FACTORS
Elevated blood pressure, blood sugar (diabetes), levels of homocysteine (associated with insufficient levels of vitamin B12 or folic acid), high insulin levels (usually found in obese individuals), and vitamin D insufficiency can accelerate atherosclerosis. Elevated C-reactive protein is an indication of inflammation within the coronary arteries; levels can be lowered by the same measures used to lower LDL cholesterol.
HOW IMPORTANT ARE THE RISK FACTORS?
The notion that 50% of people suffering a heart attack have normal cholesterol levels has been spread usually by people who are selling information or products that require the minimizing of the importance of cholesterol. The way this is done is that these people take a high number, 225 mg. or 250 mg. as a "normal" cholesterol, or a high number of LDL cholesterol as "normal". This notion has been clearly disproved, but unfortunately will live on.
The truth has been shown by a study all the way back in 2003! in the Journal of the American Medical Association . A study looked at 3 comprehensive studies and concluded that 90% of coronary heart disease (CHD) had a history of elevated cholesterol, hypertension, cigarette use, or diabetes. In 2005 an Annals of Internal Medicine study showed that 8% of CHD events will actually occur with only borderline abnormal levels of multiple risk factors.
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