GERD is a common condition caused by gastric acid reflux into the esophagus. This irritates the esophagus and frequently causes heartburn and other symptoms including belching, coughing, wheezing, heartburn, nausea, vomiting, regurgitation of food, rarely hoarseness, and even occasionally major gastrointestinal bleeding. The chest pain can sometimes simulate symptoms of a heart attack, and on occasion a sufferer ends up spending several days in a coronary care unit before a heart attack is ruled out. On the other hand, I have run into cases of individuals self-medicating with over the counter drugs for GERD, but later it turned out it was angina and a precursor for a heart attack. Hiatal hernia, (a condition in which part of the stomach moves above the abdomen) can also pecipitate symptoms.
Basic common sense treatments for GERD that have been used for decades include avoiding food that commonly causes symptoms. (common precipitators of pain include chocolate, spicy foods such as pizza, caffeine, alcohol, and even peppermint), avoiding aspirin and Motrin type drugs (as they can increase gastric acid), avoiding lying down after meals, sleeping with the head of the bed elevated, taking all medicines with a 8 ounces of water, and even weight reduction (which reduces intra-abdominal pressure that pushes up on the stomach).
Many drugs can worsen symptoms including anticholinergics for seasickness, beta blockers and calcium channel blockers for hypertension and heart disease, bronchodilators for asthma, some Parkinson drugs, sedatives, and tricyclic antidepressants. However if you suspect you’re being affected, don’t stop the medicine on your own; talk it over with your doctor.
Tests to confirm diagnosis range from barium swallow x-ray to upper GI endoscopy by a gastroenterologist. A stool guaiac test (for blood) is a good idea, but is underused.
Occasionally GERD can have serious complications. Chronic exposure of the lower esophagus to acid sometimes transforms the normal esophageal cells to abnormal cells called “Barrett’s esophagus”. These cells have a small but definite risk of turning into cancer.
Treatments of GERD: Antacids such as Maalox, Mylanta, and Tums neutralize stomach acid and usually provide quick relief. Side effects include diarrhea or constipation. Milk used to be recommended to neutralize acid. It does relieve pain temporarily, but results in an acid rebound, and is not recommended.
H-2 receptor blockers such as Tagamet, Pepcid, Axid, and Zantac reduce acid production. They don’t work as quickly as antacids but provide longer relief. Side effects are rare but Tagamet can sometimes act as an anti-androgen, so men should choose an alternative drug.
Proton pump inhibitors block acid production and allow the damaged esophageal tissue to heal. PPI’s include Prevacid, Prilosec, Nexium (the famous little purple pill), Protonix, and Aciphex. In the test tube, all PPI’s are equal, but many people feel that one of them consistently work better than the others. I wish I could tell you side effects are rare, but there is one underpublicized serious effect. Several years ago it was discovered that chronic maintenance use of PPI’s decreases calcium absorption and is associated with an increase in hip fractures in young people. Many Fantastic Fifties members are aware of the pandemic of vitamin D deficiency present in North America. Use of PPI’s is another reason to get a 25-hydroxyvitamin D level, and aggressively correct low levels with supplements. The vitamin D would increase calcium absorption and help counteract this side effect of the PPI’s.
Medications to strengthen the muscular barrier between the esophagus and stomach are occasionally used in severe cases. Surgery is used only in the most intractable cases, but is frequently unsuccessful.
The generics of these drugs for GERD are very inexpensive. For example, some of the OTC PPI’s can be obtained for $6 a month. Treatment should result in a relief of symptoms in almost all cases.
11/3/09
WELCOME TO NEW READERS
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
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
11/1/09
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
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