INSOMNIA

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

          It is exhausting and frustrating when you have difficulty falling asleep or staying asleep. Sleep deprivation is not the same as insomnia. In sleep deprivation one has an adequate ability to fall asleep yet an inadequate opportunity to sleep. In insomnia, one has an adequate opportunity to sleep yet an inadequate ability to sleep with sufficient quantity and/or quality of sleep. Insomnia is defined as an inability to have adequate sleep 3 or more times per week for 3 months, without co-existing mental nor physical disorder that causes sleep impairment resulting in dissatisfaction with the quality and/or quantity of sleep AND daytime impairment or distress. 1/9 Americans meet these criteria with equates to over 40 million people. Women are twice as likely as men to suffer with insomnia. African Americans and Hispanic people experience insomnia more than Caucasians. About 2/3 people experience sleep impairment 1 night/week. There is an hereditary aspect to the problem 28 to 45 percent of the time (depending on the study). >$30 Billion per year is spent on medications for sleep in the USA.

          Our sleep-deprivation is caused by many socially engineered factors. Too much light, especially blue wavelength light from LEDs; use of alarm clocks because we have to punch time cards for work; room temperatures too high; the use of caffeine, tobacco and alcohol. Also, internal factors such as aging and worrying have a significant influence. Our over-active sympathetic nervous system  causes a release of the adrenal hormones Epinephrine and Norepinephrine that support a flight-flight-freeze response to threats to our survival {both real and imagined}, which increases our heart rate and blood pressure and keeps us alert). Also, with the release of Cortisol from the adrenals (which supports our ability to sustain stress) there is an additional stimulus to remain alert. These hormones also cause an increased metabolic rate with consequent increased core body temperature; stimulation of the thalamus gate-keeper to remain open for sensory input for processing by the cerebral cortex,; and, for the emotion generating area of the limbic system (the amygdala) plus the memory recollection center (the hippocampus) to remain active. The result is ALERTNESS thwarting sleep. PLUS, our sleep-procrastination is a problem. Due to our fears of missing out we amuse ourselves with late-evening TV and digital entertainments which can interfere with achieving a good sleep pattern.

          A Key Principal for managing insomnia is find the cause then treat the cause.

CAUSES OF INSOMNIA:   1) Acute Insomnia: Transient and short-term cause of insomnia include: jet lag; shift work; high altitude;  poor sleep environment: uncomfortable room temperature—too hot or too cold; excessive or unpleasant noise; situational stresses: illness or death of a loved one, unemployment, separation or divorce, exam prep; acute medical/surgical illness or hospitalization; use of stimulants such as caffeine, amphetamines, tobacco, cocaine, MDMA, methylphenidate, modafinil, and phentermine; withdrawal from alcohol, sedatives, stimulants; and, excessive mental or physical stimulation in the hours before bedtime. 2) Chronic Insomnia: is typically linked to psychiatric or medical conditions including: a) Common Psychiatric Conditions: anxiety with intruding ruminations, depression (which can also trigger hypersomnolence), mania (bipolar disorder), PTSD and schizophrenia. b) Chronic Medical Conditions:  pain, obstructive sleep apnea, restless leg syndrome and periodic leg movements, menopause or andropause, coronary artery disease with nocturnal dyspnea or angina, GERD, degenerative neurological disorders such as Parkinson’s disease and Alzheimer’s disease with dementia with nocturnal agitation, brain tumors, strokes, brain trauma, circadian rhythm disorder, medications such as stimulants for ADHD and narcolepsy, alcohol and drug users, nocturnal asthma and pregnancy.

          ***A thorough history and physical examination with diagnostic testing, especially considering a sleep lab study, is very important in order to make an appropriate diagnosis and precision treatment recommendations. Suggestions about supplements and medicinal essences are intended for educational purposes and are not prescriptions for managing your health concerns. Be sure to inform your physician of any supplements that you are taking in order to evaluate any possible conflicts with prescription medications.

DEVELOP STRICT SLEEP HYGIENE HABITS:   

           Here are some suggestions to try before considering a prescription medication. AVOID CAFFEINE (coffee, tea, caffeinated sodas), NICOTINE, and other  Stimulants such as chocolate, Sudafed or Afrin nasal spray, or, if that is too much of a challenge, then don’t use any for at least 6 hours before bedtime. AVOID HEAVY MEALS and  ALCOHOL before sleep. AVOID SUGARY OR SPICY FOODS 4 to 6 hours before bedtime. However, if awakening during the night is a problem, then try eating a light snack  of good fats (not carbs) before bedtime. A couple almonds, a few spoons of yogurt, a couple teaspoons of almond butter or peanut butter on a cracker can frequently do the trick. Drinking warm milk and/or eating a banana may help you get ready for bed. The amino acid tryptophan in these foods can help you to sleep.

           Allow enough time for sleep. Most people need 7 to 9 hours of sleep each night. Fix a bedtime and an awakening time. Avoid napping during the day. And especially in the evening.  Arrange a sleep environment that is very dark, comfortable, quiet and cool {set the thermostat for 65 degrees in the bedroom} to facilitate falling asleep quickly and staying asleep. Use comfortable bedding and keep the room well ventilated. Block out all distracting noise. Consider a white noise generator. Reserve the bed for sleep and sex. Don’t use the bed as an office, work or recreation space. Let your body learn to associate the bed with sleeping. AVOID TV in the bedroom. Don’t take your worries to bed. Worrying is a prayer for that which you don’t wish to happen. Instead, practice relaxation techniques before going to bed. Yoga, deep breathing, visualizations, progressive muscle relaxation can all help relieve anxiety and muscle tension. Establish a pre-sleep ritual such as a warm bath (especially using Epsom salts—5 cups: the magnesium will relax your muscles), or a few minutes of reading or praying. Get into your favorite sleeping position. If you don’t fall asleep within 15-30 minutes, get up and go into another room and read until you get sleepy. Consider elevating the foot of your bed a few inches to increase circulation to your brain.  Regular AEROBIC EXERCISE is the best way to improve your sleep and modify pain. However, don’t do heavy exercise within 3 hours before bedtime because it raises your core body temperature and it takes several hours to return your core body temperature to normal. The best time for aerobic exercising is in the morning.

          COGNITIVE-BEHAVORAL THERAPY (CBT):  is the most effective psychological intervention to help with insomnia. It consists of a comprehensive program for educating and modifying behaviors.  The most effective use of CBT combines several of these methods. Rather than just relieving symptoms, it addresses the underlying cause(s) of insomnia. 1) Sleep Education: understanding the sleep cycles and learning how beliefs, behaviors and outside factors affect sleep. 2) Cognitive Control and Psychotherapy: helps control or eliminate negative thoughts and worries that keep one awake. It may help to eliminate worrisome beliefs about sleep such as a single restless night will make one sick. 3) Sleep Restriction: limiting the amount of time spent in bed rather than lying in bed awake which can become a habit leading to poor sleep. 4) Remaining Passively Awake: avoiding any effort to fall asleep. Worrying that one can’t sleep can keep one awake. 5) Stimulus Control Therapy: helps remove factors that condition the mind to resist sleep. Eg. One is coached to use the bed only for sleep and sex; and, to leave the bedroom if unable to sleep within 15 minutes. 6) Sleep Hygiene: changing basic lifestyle habits that can influence sleep: eg. Smoking or drinking caffeine late in the day; drinking a “nightcap” of alcohol; not regularly exercising; avoid napping; winding-down 2 hours before sleep time. 7) Relaxation Training: learning to calm the mind and body: eg. meditation, progressive muscle relaxation and hypnosis. 8) Biofeedback Training: learning to influence heart rate, skin temperature, muscle tension and skin electrical conduction. 9) Sleep Diary: keeping a detailed record of sleep patterns and influences for 2 weeks.

***This handout is intended for sharing information. If you consider trying any non-prescription supplements, please discuss this with me so that we can be sure that there will be no drug-supplement adverse interactions, and to be sure that your choice may be good for your overall care and health.

NON-PRESCRIPTION ALTERNATIVES:

          These products will support and enhance normal sleep mechanisms. Consider using: 1) VALERIAN ROOT capsules– 150 to 300 mg of a standard extract (0.8% valeric acid). Use 1 capsule at bedtime. Note: it smells like dirty gym socks, however, it is an ingredient in many proprietary sleep aids because it is effective. Don’t take with alcohol. 2)  MELATONIN–this comes as capsules, drops and lozenges. Women should start at 1 mg to 3 mg at bedtime and increase the dose every 4-7 days to 3 to 10 mg (may use up to 30 mg); Men should start at 3 mg to 5 mg and increase the dose every 4-7 days to 10 to 15 mg (may use up to 30 mg). 3) LAVENDER ESSENTIAL OIL (to be used topically)–add to a warm bath before bedtime or use as aromatherapy by placing some drops in an air  infuser or sprinkled on bed clothes/bedding. 4) The following TEAS (which can also be used as tinctures)  have been found to be helpful: a) lemon balm, b) passion flower, c) chamomile, d) catnip, e) hops, and/or rooibos. 5) Consider 5-hydroxy-tryptophan (5-HTP) 50 to 200 mg at bedtime. (CAUTION: Don’t use this if taking an anti-depressant.) 6) Consider GLYCINE 3 gm at bedtime. People fall asleep quicker, drop into delta-wave sleep faster, and report increased alertness with less daytime drowsiness, improved memory performance and less fatigue. 7) Consider using an aqueous extract derived from peeled rhizomes and roots of a non-mouldy Noble KAVA cultivar, limiting use to 250 mg kavalactones daily for acute or intermittent use. This will minimize a very rare hepatotoxicity risk. It is wise to limit its use to 6 weeks at a time and discontinue its use if there is persistent nausea, jaundice or weight loss. Then, get liver enzyme testing if there are any adverse findings. Used wisely, kava is a safe and effective aid for good sleep and to relieve moderate anxiety. 8) ZIZYPHUS seed (Suan Zao Ren; red date; the spiny jujube) is a Chinese herb beneficial for sleep, menopausal symptoms and anxiety. The dose is about 4.5 gm of the dry seed extract. 9) Magnesium L-Threonate 1,000 to 2,000 mg taken at bedtime can be very helpful with sleep management. This form of magnesium most easily crosses the blood-brain barrier with comprehensive benefits for sleep, anxiety and cognitive function. {It can be obtained from www.LifeExtension.com.}  However, magnesium oxide 400-800 mg, magnesium glycinate 400-500 mg, and magnesium asporatate 400-500 mg can also be very effective. 10) SAMe (s-adenosylmethionine) 800 to 1600 mg daily can benefit insomnia. It promotes the function of the enzyme that converts N-acetylserotonin to melatonin. 11) A proprietary blend called “SleepCycle” from www.puretango.com  has Xylaria Nigripes or “Wulinshen” as a main ingredient. It is a fungus containing GABA which improves sleep, shortening the time to fall asleep while helping to stay asleep longer, awakening refreshed without bothersome side effects. In fact, it has the pleasant side effect of improving cognitive function and a sense of well-being. Wulinshen also seems to have a cumulative effect, improving sleep quality with continued use. Additionally, melatonin, 5-HTP, L-Theanine plus a blend of valerian, passion flower, lemon balm, Dong quai, Hops, polygala and Jujube are added to the mixture for additional sleep benefits. The recommended dose is 2 capsules 30 minutes before bedtime. 12)  Lactium is a protein hydrosolate that can be used to relieve stress and promote restful sleep without side effects. Drinking warm milk has often been suggested for promoting sleep. Unfortunately, adults no longer have the enzymes of a newborn child which allows the release of this relaxing milk peptide. Lactium 150 mg taken 1 hour before bedtime improves sleep quality and reduces the time for sleep onset after 2 weeks of use. There is no awakening-sedation nor addiction with continued use.  Additionally, bioactive milk peptides activate brain cell receptors for neurotransmitters that reduce anxiety, such as GABA, serotonin and dopamine. Unlike benzodiazepine drugs, which activate the same receptors but which can become habit forming, bioactive milk peptides induce relaxation and sleep without the disinhibition side effects that are associated with risk taking behavior with such drugs. Studies demonstrate supplementing with bioactive milk products compared with placebo additionally improved digestion, cardiovascular function, cognitive function and social difficulty and reduced the stress response, including elevated blood pressure, heart rate ad cortisol levels. {Eur J Nutr. 2005;44(2):128-32.} 13) If your main problem is an active mind ruminating about things that happened during the day or things that need to happen in the future, then consider using the amino acid L-Theanine 200 mg: take 1 or 2 tabs once or twice per day. 14) Passion Flower rebalances signals in the endocannabinoid system that acts like a dimmer switch to tone down the amount of neurotransmitters that get released. It is useful to help you fall asleep and to stay asleep and to restore your sense of a calm focus. It is safe to use with children. It has been found to be useful helping to calm kids with Autism and with ADHD. A good proprietary product is called “Neural Balance” and is available from www.neural-balance.com 15) “PharmaGABA” is a proprietary product that modifies the natural neurotransmitter gamma-amino-butyric acid (GABA) in a fermentation process with the bacteria  Lactobacillus hilgardii. It can help to improve sleep quality and decrease awakenings. Additionally, it can help to relieve anxiety. The dose is 50 mg up to 200 mg daily.

OVER-THE-COUNTER MEDICATIONS:

          Antihistamines are used for the side-effect of drowsiness. {Histamine is a key neurotransmitter for alertness.} Typically they contain Diphenhydramine (Benadryl, Sominex, Sleep-Eez, Nytol) or Doxylamine (Unisom). Prescription Hydroxyzine (Atarax or Vistaril) may also be used. Side-effects include: daytime drowsiness, cognitive impairment, dizziness, drunken movements, urinary hesitancy, blurred vision, dry mouth and dry throat. Caution should be exercised in people with glaucoma, benign prostatic hypertrophy and cardiac dysrhythmias. BE AWARE: studies show in people >60 yo who use anti-histamines regularly have impaired memory and an increased risk for developing dementia!!

PRESCRIPTION ALTERNATIVES: 

          Caution: People who are recovering from alcoholism should AVOID using benzodiazepines, Zalepion (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta) for insomnia because there is strong evidence of relapse associated with their use. Trazodone up to 100 mg at bedtime is the preferred medication for recovering alcoholics and people with an addiction history.

          “Sleeping Pills” are a misnomer. There is a significant difference between natural sleep and drug-induced SEDATION. Sedation does NOT equal sleep. Sedatives anesthetize the cerebral cortex but do NOT produce the electrical activity that is associated with sleep nor any of the restorative benefits! They produce an imbalance in the chemicals which  signal the brain to achieves normal sleep, and they  significantly limit restorative NREM slow-wave sleep. Also, the unconscious  “limbo state” produced can result in abnormal sleep behaviors which range from the harmless and humorous to the disturbing and dangerous.

          Currently there are no prescription medications used for sleep that enhance health and longevity. They all have serious potential side-effects. Thus, I believe that the risks do NOT outweigh the benefits of their use which, when compared to using a placebo, only minimally shortening the time for falling asleep. Compare this to the real risks of DEATH and CANCERS. The risk of death increases with the quantity used. For example in a 2 ½ year long study: ½ to 18 pills/year increased the risk by 3.6 times and >132 pills/year increased the risk 5.3 times. The risk of death occurs because of increased infections {since there is no immune benefit which is gained with natural sleep}; increased fatal car crashes; increased falls and consequent hip fractures {especially in the elderly}; and, increased heart disease and strokes. Especially worrisome is the fact that >50% of all sleeping pill prescriptions are for the elderly.

           In addition to the above non-pharmacological suggestions, I may be willing to prescribe A SHORT COURSE of medication for people who suffer from chronic insomnia. REMEMBER: the first-line therapy is CBT-I. Medications are intended only for short-term use (7 to 10 days) and really should never exceed 4 weeks. Unfortunately, they are being used off-label for extended periods of time.

          Weighing the risks versus benefits is fundamental. ALL of the sedative-hypnotics carry the risks of dependency, withdrawal and rebound insomnia. These include both the benzodiazepines and non-benzodiazepine hypnotics, although the older medications such as benzodiazepines carry a higher risk.  Anti-depressants can also be used for their side-effect of drowsiness.

  1. Benzodiazepines:  non-selectively target receptor sites in the brain that modulate the effects of the neurotransmitter gamma-aminobutyric acid (GABA). There are 3 categories: a) Long-acting: common brands include: Clonazepam (Klonopin), Diazepam (Valium), Flurazepam (half-life 70-90 hours) and Quazepam (Doral). b) Medium-acting: common brands include: Triazolam (Halcion), Lorazepam (Ativan) and Temazepam (Restoril). c) Short-acting: common brands include: Alprazolam (Xanax) and Oxazepam. These may be useful for air-travelers who want to reduce the effects of jet lag. Side-effects for all the benzodiazepines include allergic reactions, including angioedema of the face; increased depression; respiratory depression; residual daytime drowsiness with risks of motor vehicle accidents and falls in the elderly; memory loss—sleep walking, sleep eating, odd mood states: significantly aggravated by drinking alcohol and using antihistamines; and, urinary incontinence, especially in the elderly. NOTE: I am concerned about some recent studies that show a strong association between using benzodiazepines and significantly increased risks for dementia. When used for 3 to 6 months, the risk of developing Alzheimer’s disease is increased by 32%. When used for more than 6 months, the risk increases to 84%. Also, these drugs cross the placenta and enter breast milk and should be avoided in pregnancy and with nursing. First trimester use is associated with cleft lip in newborns. Interactions: although relatively safe if taken alone in an overdose, benzodiazepines are potentially very dangerous for respiratory depression in combination with drinking alcohol. Prolonged use creates physical dependence making discontinuation very problematic. Withdrawal symptoms: can last for 1 to 3 weeks after stopping the drug and include gastrointestinal distress, sweating, cardiac dysrhythmias, and, in severe cases, hallucinations and seizures. Rebound insomnia: paradoxically, benzodiazepines can cause nocturnal sleep disturbance and anxiety. There is a higher incidence of these problems especially when using the short-acting drugs.
  2. Non-Benzodiazepine hypnotics: although they have been advertised as causing less physical dependency than benzodiazepines, they are still subject to abuse. a) Ambien: typically induces sedation for 7 to 8 hours. AMBIEN IS A MEMORY ERASER RATHER THAN A MEMORY ENGRAVER. The FDA has recommended lowering the previous typical dose of 10 mg to 5 mg or lower, particularly for women who eliminate the drug more slowly than men. Although very popular, PLEASE NOTE: I choose NOT to prescribe Ambien because I believe that it is a dangerous drug which significantly impairs the memory and cognitive function. b) Lunesta: mayslightly improve both sleep maintenance and daytime alertness. It is the first medication approved to be taken on a long-term basis. c) Sonata: is short-acting lasting about 4 hours and useful for inducing sleep or for people with the inability to return to sleep once awakened in the middle of the night. d) Rozerem: is the only non-controlled medication. It targets melatonin receptors. However, I believe that it is an irrational choice: why not use OTC melatonin instead of the expensive prescription? e) Belsomra (suvorexant): is a new orexin-receptor antagonist being heavily advertised with a cute cuddly cat logo. “It might help you nod off a few minutes faster or stay asleep slightly longer, but that small benefit comes with some big safety concerns, such as being too drowsy to drive the next day or feeling like you can’t move or talk.” {ConsumerReports.com, July 12, 2015.} The FDA initially rejected doses of 30 to 40 mg because they posed too great a risk for causing motor vehicle crashes. The dose of 10 mg is no better than using a placebo. Compare: using Ambien 10 mg: sedated 20 min faster than a placebo and remained unconscious 34 min longer than placebo, with Belsomra 20 mg: sedated 6 min faster than placebo and remained unconscious 16 min longer than placebo. Neither are impressive nor, in my opinion, worth the risk. ***All these medications have serious side-effects: including daytime drowsiness and abnormal sleep behaviors: sleep-walking, sleep-eating, sleep-driving and social interactions with NO MEMORY for what has transpired. They impair short-term memory and can cause hallucinations and sleep paralysis. All these effects are augmented when consuming alcohol.
  3. Anti-Depressants: are used predominantly off-label for the side-effect of drowsiness. They are NOT addictive. They can be useful for modifying the pain threshold if pain is a confounding problem aggravating insomnia. They can be useful for concomitant depressive symptoms. They are my drug of choice for chronic insomnia. The preferred agents block serotonin 5 HT2A or 5 HT2C receptors and lack strong cholinergic activity such as: {for initial dosing} Trazodone (Desyrel) 50 mg, Doxepin (Sinequan) 25 mg and Mirtazapine (Remeron) 15 mg.  Although the older tricyclic agents have a higher side-effect profile because of their strong cholinergic activity, they can also be useful, such as Amitriptyline (Elavil), Nortriptaline (Pamelor), Imipramine (Tofranil) and Desipramine (Norpramin). However, I am not cavalier about using the anti-depressants because they change the architecture and function of the brain. {READ: “Anatomy of an Epidemic” by Robert Whitaker, published in 2010.}

***Also, consider reading “The Sleep Revolution” by Arianna Huffington. AND, “Why We Sleep” by Matthew Walker, PhD.

          ***THE GLYMPHATIC SYSTEM:  The more waste products lying around the brain, the greater the chance for Alzheimer’s disease to take root. Since 25% of the body’s overall energy is consumed by the brain, there are a lot of waste products to be cleaned up. The glymphatic system is the brain’s clean up system. Specialized brain cells scavenge diseased and damaged bits of protein and metabolic waste. With age, these cells become impaired. Also, the neuron surrounding supportive glial cells shrink in size when sleeping, opening spaces between cells by as much as 60% which allows cerebral spinal fluid to be pumped through and clear out waste. Lymphatic vessels surrounding the brain then deliver the waste to the lymphatic system of the body which gets rid of the toxins. With aging, adults often struggle to get enough sleep, which impairs the clean up system. THUS, since sleeping is crucial to removing toxins, keeping a regular sleep schedule becomes increasingly important with aging. Irregular sleep hours and long day time naps can disturb an effective sleep cycle clean up process. Also, sleeping on your side, in a fetal position, rather than on your back or stomach, does a better job of cleaning house. And, sleeping on your left side maximizes your body’s circulation, because most venous return travels up your right side and these veins can be compressed when you lie on them. However, getting good sleep is much more important than worrying about whether or not you sleep on your side and what side you sleep on.

REF.  Dr. Elsie Taveras “Lack of Sleep linked to behavioral problems I kids”, March 2017, Reuters.com. “ Children who aren’t getting the recommended amount of sleep (>11 hours) have more difficulties with attention, with emotional control, wit reasoning, with problem solving, and also have behavioral problems.” …”The more chaotic and less predictable a sleep schedule, the more difficulty kids tend to have with sleep.” Consequences of sleep deprivation include: problems in school due to poor concentration, falling asleep in classes, problems with teachers; behavioral issues due to poor impulse control and bullying; mental disorders such as ADHD and depression; and, negativity and stubbornness resulting in a poor attitude and poor cooperation, isolation, poor performance, and poor social skills. While adults get lethargic with a lack of sleep, kids speed-up, become emotionally weak and violent, and have mood swings. They are unable to understand what is wrong with them.

SUGGESTIONS:

  1. Maintain a regular bedtime and getting-up time, including weekends and holidays, if possible.
  2. Create a winding-down time in the evening, and a relaxed bedtime ritual—eg. reading or telling stories together, and tucking-in for the night with a lullaby.
  3. Avoid caffeine, colas, and chocolate at night.
  4. Avoid heavy meals and sweets at night.
  5. Keep the bedroom a comfortable temperature (around 65 degrees), with darkness and quiet.
  6. Avoid all screens and music.
  7. Exercise for at least 60-minutes daily, but not within 2 hours of bedtime.
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EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

“Eating alone will not keep a man well, he must also take exercise.” {Hippocrates, 400 B.C.)   

“Exercise is loathsome.” {Mark Twain}   

“The best exercise is the one you like because then you are likely to stick with it over time.” {Martin Bibals}        

“GET MOVING; KEEP MOVING; AND, DON’T STOP.” {Jordan D. Metzl, MD}

          Regular exercise is a key to health, wellness and longevity. In the early 1900s, Medicine shifted its focus from the prevention of disease to its treatment. Simultaneously and coincidentally, Americans fell in love with spectator sports. Physical activity was no longer the medicine for the masses, but it became the privilege of elite athletes. We forgot/ignored the benefits of exercising: Regular exercise will help you to sleep better. Exercising increases blood flow to the brain helping to create new brain cells and blood vessels because of the increased Brain-Derived Neurotropic Factor (BDNF). This repairs and protects the brain cells from degeneration, both by repairing and restoring cellular mechanisms. Exercising releases endorphins and other chemicals that dull pain and improve your mood, especially decreasing your anxiety and lightening your depression. This helps with building and maintaining your resiliency.

          Regular exercise enhances memory and quicker learning. Your work will be more productive. Also, you’re medical costs will be less. You’ll have decreased risks for developing chronic diseases: for example, type 2  Diabetes is both preventable and treatable, as well as CAD and CVD. Exercising helps to burn fat better for energy, causing fat cells to shrink. {Since muscle mass is heavier than fat, don’t be over-focused on your scales, because your weight may actually increase while your body fat decreases. The real question is do your clothes fit better?} You can help to prevent and treat dementias. The increased blood flow reduces toxins (beta-amyloid and alpha-synuclein) that cause aging and cell death, and reduces inflammation. You can protect your chromosomal telomeres and slow your cellular aging: exercise increases Nuclear Respiratory Factor 1 (NRF1) which protects telomeres from shortening. You can increase blood flow to your skin and help wounds to heal faster. By producing weight bearing muscle contractions, you can make your muscles grow, and, also, increase your bone density. You can decrease your risk for at least 13 different types of cancer, including breast, ovarian and colon cancers. Regular exercising can help with rehabilitation from strokes, and help to  improve other chronic physical diseases and emotional problems.

          You will experience few or no adverse side-effects. Your costs will be low or absent. Exercise is safer and more effective than any drug on the market for health. Although it is much easier to take a pill for what ails you, the risks and side-effects are much more problematic. Exercise benefits both young and old, women who are pregnant, and people who are well or ill. You don’t need a fancy health club, clothes or equipment. JUST MOVE. ***Some exercise is better than none, and even a little exercise can do you a lot of good.

          Humans are notoriously bad at assessing the long-term benefits and risks of their lifestyle choices. The promise that: “exercise is good for you” is not a strong enough motivator to make regular exercising a part of one’s daily lifestyle and choices. Here is a glimpse at the problem: only 20% of Americans get the recommended 150 min of strength and aerobic training per week. More than 50% of “Baby Boomers” take zero exercise per week. Over 80 million Americans (over 6 years old) are inactive. Many schools have eliminated Gym classes from their curriculums. Half of High Schools don’t have weekly PE classes. Only 15% of Elementary Schools require PE 3 days per week. The result is Exercise Deficit Disorder. Long term consequences include: obesity;  increased osteoarthritis; increased low back pain; increased anxiety; increased depression; poor skin complexion; increased risks for heart disease, cancers, dementia, diabetes, and early death.

          Humans are motivated by immediate rewards. Although people are motivated for health and personal growth, knowledge alone is usually not sufficient to motivate change. And, the best motivation is not externally imposed, but, rather, elicited from within the person. The hardest part of any work-out regimen is getting started. Don’t be stopped by the most common excuses: “I’m too…busy, tired, lazy”. Know that exercise releases “feel good” endorphins, and there are ways to manage Delayed Onset Muscle Soreness (DOMs).

  1. ***Rather than focus on how good exercise is for your health, {which it really, really is, but it is a nebulous standard}, focus instead upon how exercise will give you an energy boost, improve your mood, enhance your productivity, and improve your sleep.
  2. PICK AN EXERCISE PROGRAM THAT YOU ENJOY. Forget the idea that exercise is supposed to hurt or feel like punishment, or else its not helping you– {“no pain, no gain”}, and, therefore, not worth doing. THIS ISN’T TRUE. If you enjoy something, then you will look forward to participating again, and, thus, you will most likely take the time to make the activity a part of your daily routine.
  3. Make exercising a social opportunity. A friend will offer you encouragement and will help to keep you accountable to yourself (possibly because you want to avoid their judgmental disappointment and disapproval). Exercise can be a time for high quality personal connections with your friend(s).
  4. Don’t back down from a little competition. A competitive atmosphere focuses on different qualities than a chummy  one does. With competition, the most active participants become the benchmarks to beat, and, thus, everyone’s activity level is increased. In a social group, people who drag their feet seem to draw the most attention, draw down the group energy, and give others an excuse for less participation.
  5. Make exercising non-negotiable. Be sure to make yourself prominent reminders, and, become aware of your self-sabotaging triggers. Your goal is to make regular exercising an automatic choice.
  6. Put money on the line. Studies show that people are motivated more by losses than by gains, and that they prefer getting rewards now rather than later. For example, if you are trying to lose weight, consider sending a donation, each day that you don’t meet your exercise goal, to an organization that you hate. AND, give yourself a non-food reward for accomplishing your goal.
  7. Use a Fitness Tracker. {In order to avoid unrealistic expectations, be aware of  the caveat: a tracker can’t force you to change your behavior, it is merely a source of information.} First, establish your exercise baseline for a week. Then start your exercise program and evaluate your data over time, looking for any improvements. Then, understand what you changed so that you can do it again and continue improving. Once you have a realistic assessment of your abilities, it will be easier for you to commit yourself to an individualized program and a long term behavioral change. Remember, “it’s the learning, not the digits.” {Ref. Martin Gibala: “The One Minute Workout.”}        

                                                 AEROBIC EXERCISING:

  1. Doing an aerobic exercise program for at least 30 minutes 3 times per week will maintain your body’s basal metabolic rate (BMR). Your weight will remain stable if there is a balance between caloric input and energy output. If you don’t have an aerobic program, and you restrict calories, your BMR will decrease to conserve energy during relative starvation. In order to lose weight and remain healthy, it is necessary to maintain a normal BMR, and then restrict caloric intake.  The WHO and US CDC recommend making your exercising goal be 150 minutes per week (divided however you choose) in order to effectively lose weight, achieve cardiovascular fitness, and enhance your overall health and sense of well-being. {This includes time for twice weekly muscle strengthening.} {NOTE:  For time-conscious people: ***High Intensity Interval Training can produce the same results in half the time.***} Think of your exercise as THE BEST MEDICINE you can give yourself. REMEMBER:  in order to prevent injuring yourself by over-doing it initially, because of your enthusiasm to see results quickly, when starting out: GO SLOWLY, and then steadily build up to your desired goal. And, more is NOT necessarily better. There is a “sweet zone”. Too much exercising can stress your joints and your heart-lung capacity.
  2. Look OUTWARD (rather than the usual advice to look inward) to support your motivations for exercise. Motivation is often thought of as a quantity of inward reserve, and people often lament its absence as a personality flaw. Instead, manipulate your environment to support your motivation. For example, purchase an audiobook that you’ll really enjoy and look forward to listening to, and make it available ONLY when working out. Your desire to engage with the plot will support your motivation to exercise.
  3. When choosing an aerobic exercise activity, have FUN! Pick something that you will enjoy doing so that you will incorporate it into your lifestyle changes. If you go power walking, walk with a partner that enjoys a good conversation. Or, vary your activities from working out at a gym, to swimming, to dancing in order to keep it fun. Or, create your own energetic music CDs so that you can crank up the volume for an exuberant work out. Try exercising mindfully: bring attention to your breath, your steps, your surroundings, and you will find that your pains will be alleviated.
  4. If you choose RUNNING more is NOT better, especially as we get older. A 2 to 3 mile run is all that is needed. Runners with the greatest longevity ran at a slow to moderate speed for 1 to 2 hours/week. Time is required for recuperation after a work-out. After age 45, people generally have their joints feel better after a brisk walk compared to a run. Women runners have a greater risk to injuring their bodies than men. Women have higher arches, and, when running, point their toes outward, and land with a heel strike which increases their skeletal impact. Also, they generally have less hip and core body strength, have an anatomical shift in their hips and their knee alignments, and have increased body fat. {In contrast, women have more joint flexibility than men, and they are better at pacing themselves in a race.}  Remember that stretching and warming-up your muscles is important to preventing injuries. Also, remember to stretch again after running. If you suffer from arthritis, it is much better to participate in non-impact aerobic activities such as swimming, working out on a glider or an elliptical trainer, or rowing.
  5.           However, a theory proposed by Dennis Bramble and Daniel Lieberman in a paper published in Nature in 2004 proposes that humans are born to run and to run far. The theory proposes that early humans evolved endurance adaptations for running to be able to chase prey animals “until the animals collapsed from exhaustion and heat stroke. Winning the footrace meant dinner. In addition to being furless, we have far more sweat glands than most other mammals, giving us an advantage over furrier animals that have to stop and pant to cool down. A larger gluteus maximus muscle—a big butt—is a distinctively human feature.We rely on it minimally for walking, but it’s crucial to stabilizing us when we run. Our legs have long tendons—that act like springs, helping generate force and reducing the energy cost of running. And they don’t seem to provide much benefit to walking, another piece of evidence that our bodies are made for running.” {Reported in Discover Magazine, July/August 2018, pp. 50-51.}
  6.           “There are 2 types of muscle fibers: Type 1 (slower contracting or slow-twitch fibers) and Type 2 (faster contracting or fast-twitch fibers). Everyone has a mix of both fibers in their muscles. Fast-twitch fibers are for short, powerful bursts; they contract quickly but also fatigue quickly. Slow-twitch fibers have more mitochondria (the cell’s powerhouses that use oxygen to make energy) so they don’t fatigue as easily and are ideal for longer activities. Sprinters have more fast-twitch fibers, while endurance athletes have more slow-twitch. Although partly genetic, there’s some evidence we can train in order to change the proportion of fibers our muscle have.” {Reported in Discover Magazine, July/August 2018, p. 50.}
  7. WALKING lowers your risks for diseases and probably will extend your life. Walking helps to keep you limber longer and helps to make you feel happier. In a study of 80,000 women, their risk of breast cancer was decreased by 42% by walking for a few hours per week. Other studies similarly demonstrate a decreased risk of kidney and prostate cancer mortality by walking. Walking has the lowest “quit rate” of any exercise. In a study of 400,000 Taiwanese who walked for 15 minutes daily, they lived 3 years longer than their sedentary peers. A 5-minute walk outdoors can elevate your mood and enhance your creativity, decrease your anxiety and depression, and increase your sense of well-being. SUGGESTIONS for success: pick-up your pace so that it becomes a power-walk rather than a stroll. {Maintain a pace that makes you a little breathless when walking and talking.} Count your steps: your goal is 7,000 to 10,000 steps/day, with 3,000 purposeful steps. Break-up your day into 50-step mini-walks every 45 minutes. Walk with a group for mutual support.
  8. ***High-Intensity Interval Training (HIIT) alternates periods of intense exercise with periods of less-intense exercise or recovery time. “If you want the benefits of very time-efficient exercise, then you need to push hard. There is no way around that.” {Martin Gibals} For example, consider riding a stationary bike for 10-minutes 3 days per week for a total of 30 minutes per week: after a 3-minute warm-up, pedal very hard and fast for a 20-second spurt of intense energy, then pedal less hard for a minute, then repeating this sequence two additional times, followed by 3 more minutes of slower pedaling.
  9.                                                       TOTAL FITNESS
  10.           1)   In addition to regular aerobic exercising, Total Fitness is achieved by enhancing your muscle strength, doing regular stretching, and, improving your balance and coordination.
  11.           2)  What counts as moderate-intensity exercise? Brisk walking, playing with your kids, dog walking, carrying heavy groceries, mowing the grass with a push mower, raking leaves, car washing, gardening, snow shoveling, etc. when done for at least 10-minutes at a time. ALL movement counts. Plus, to protect against injuries and to build muscle and bone, you need interval strength training. In addition to using free weights and resistance training, Tai Chi, Yoga and Pilates are excellent forms of strength training.
  12.             3)  In studies, dynamic resistance training is superior to static (isometric) resistance training for building muscles through the full range of motion of your joints. Pilates and working out with Nautilus equipment are two example of effective dynamic resistance training.
  13.             4)  RESISTANCE TRAINING increases your muscle mass, thus, generating more strength, and faster muscle force (power). Unless you over do it, you won’t become muscle bound. Resistance training also helps to make your bones more dense. Ten million Americans (80% are women) have osteoporosis (thin and breakable bones). {A decrease in sex hormones with aging helps to create this common problem.}  Resistance training also helps to improve your metabolism, increase your glucose tolerance (or, said another way, decrease your insulin resistance) and decrease your risks from type 2 diabetes. It also helps to decrease both coronary artery disease and cerebrovascular disease risks. Other than doing free weight lifting or using a dynamic weight resistance machine, such as a Nautilus device, there are various simple ways to do resistance training such as: Yoga, Tai Chi, Pilates, using flexible bands, sitting up and down using a chair and your own body weight, swimming, doing Zumba dancing, doing heavy gardening such as raking and digging, doing vigorous house cleaning, taking the stairs rather than using an elevator, jumping rope, etc. The stronger you are,  the more self-esteem, confidence, and positive thinking you will usually have.  However, because resistance training requires work and effort, only about 20% of people actually follow strength training recommendations. PLEASE DON’T BE LAZY.
  14.               Resistance exercises have a greater impact on cognitive function than aerobic exercises. It increases blood flow to the brain, thus, increasing oxygenation and the provision of nutrients. It helps to promote angiogenesis from existing blood vessels and neurogenesis from stem cells in the hippocampus {an area responsible for organizing memories}. It increases the production of neurotransmitters: serotonin {which helps to regulate mood and sleep}, acetylcholine {which helps with cognition, learning and memory}, and GABA {the main inhibitory modulator}. It also increases neurotropins {proteins that regulate neuron survival}.  [Mavros, et. al. “Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: outcomes of the study of mental and resistance training,” J. of the American Geriatric Society, October 2016.]
      1.             5)  In my opinion, Hatha Yoga and Pilates are the best ways to completely stretch your muscles and joints, tone and strengthen your muscles, especially your “core” abdominal muscles, and achieve overall physical fitness, and mental, emotional and spiritual balance, inner harmony, and peacefulness.
      2.             6)  I applaud the American Academy of Sports Medicine’s program: “Exercise Is Medicine”. They recommend that physicians should inquire about exercise with each health visit. They recommend following the 5 A’s approach: Ask, Advise, Agree, Assist, and Arrange. People should be asked about what barriers they face in order to exercise and what helps to facilitate their choice to exercise. After assessing a person’s physical activity level, the practitioner is advised to prescribe physical activities that the person will agree to pursue. Physical activity counseling can be offered along with referral resources to help facilitate the process. Within a person’s social and economic context, it is important to support and empower the person, just like a good coach, by emphasizing that they have both choices and competence. Motivational interviewing is useful to explore and resolve ambivalences and insecurities and to understand and encourage/support internal motivators for behavioral changes. By understanding a person’s values and goals, a health care provider can help people to envision a better future. Depending upon a person’s personality, they may choose to “leap-into the deep end of the pool” and make massive changes in their lifestyle, which can be disruptive and stressful.  Or,  they may choose to ease into the “shallow end of the pool” and take baby-steps, focusing upon small and measurable goals and achievements. Either way, the exercise prescription must be “patient-centered” and individualized in order to be effective for the long term. Setting goals work best when they are realistic, specific and present oriented. Challenges to maintaining changes is the rule and not the exception. Thus, it is very helpful to maintain a continued coaching partnership in order to  encourage and support a person’s health goals.
  1.     SUPPLEMENTS TO CONSIDER FOR ENHANCED ATHLETIC PERFORMANCE
  1. Consuming an over-abundance of calories for a long time will suppress the AMPK (adenosine monophosphate-activated protein kinase) system—the metabolic master switch. AMPK activation: reduces insulin resistance and supports glucose transport, inhibits the metabolic syndrome’s associated inflammation, increases utilization of stored fat for energy, improves mitochondrial fat burning, reduces weight gain by enhancing the effect of the anti-obesity hormone: adiponectin, and improves immune function and other bodily functions that support longevity. A suppressed AMPK system leaves the body in a state of continued energy storage and reduced energy utilization. Cutting calories forces the body to activate AMPK. Exercise is another powerful AMPK activating strategy. (Note: Only when you are adding exercising will calorie reduction be truly effective for weight loss.) ***For people who have problems exercising because of physical problems, there are supplements to promote AMPK activation.*** Two documented ingredients include:  a) Gynostemma pentaphyllum and b) Trans-tiliroside. A proprietary product is available, called “AMPK Activator” from www.LifeExtension.com. Also,  Hesperidin, found in citrus peel extracts and in orange juice, activates AMPK, as does the medication Metformin. AMPK activation helps to remove excess stored fat, particularly metabolic abdominal fat, and to decrease metabolic syndrome risk factors. Increased AMPK activity also normalizes hyper-activated mTOR activity. {Excessive mTOR accelerates cell aging and malignant transformation, and depletes stem cells.}
  2. RE-FUEL YOUR MITOCHONDRIA:  “Mitochondrial Dysfunction” results in obesity, insulin resistance, diabetes, anxiety, depression, neuro-degenerative diseases, aging, chronic fatigue syndrome and fibromyalgia syndrome. {Consider: if the blood test Reverse T3 is high, then mitochondrial dysfunction is present.} The following NUTRIENTS can help to re-fuel the mitochondria energy generating centers in each cell:  a) D-Ribose 5 gm/tsp: 1-2 tsp three times per day. b) ALA (Alpha-Lipoic  or R-Lipoic Acid) 300 mg to 400 mg/day. c) CoQ 10 (or its activated form Ubiquinol) at least 200 mg/day. d) NADH (Nicotinamide Adenine Dinucleotide –reduced form) 10 mg twice per day. e) L-Carnitine 2,000 to 3,000 mg/day.
  3. Short term supplementation with powdered cherries boosts athletic performance. Using 480 mg of powdered cherries caused half-marathon runners to average 13% faster finish times compared to taking placebos. Inflammatory markers were 47% lower, and there were attenuated markers of muscle catabolism, a better maintained redox balance, increased performance, and post-run muscle pain faded faster. {J Int Soc Sports Nutr. 2016 May 26.}
  4.         Tart cherry juice is also helpful for osteoarthritis pain and other inflammatory conditions, particularly gout. It is easier to take when mixed in a fruit smoothie. For example, 100 patients with a history of gout received 1 Tbs of Brownswood Acres tart cherry juice concentrate [which can be obtained at Whole Foods] twice per day. 92% of the patients had >50% reduction in the number of gout attacks. Their uric acid levels did not change. Tart cherry constituents can switch critical genes off and on; modulate cell-signaling molecules like tumor necrosis factor; and, target multiple cardiovascular factors producing a 65% reduction in early mortality. Tart cherries surpass red wine and dark chocolate in antioxidant content. Tart cherries are rich in the flavonoid anthocyanin and contain novel anthocyanins absent from blueberries or bilberries. They also contain higher amounts of phenolics and anthocyanins than sweet cherries. It is useful for treating osteoarthritis, inflammation related to obesity and the metabolic syndrome, and lowering triglycerides associated with cardiovascular disease.
  5.           Rich sources of polyphenolic compounds, such as tart cherries, play a neuro-protective role and exert a variety of anti-carcinogenic effects. 20 women were given 2, 10.5 ounce bottles of tart cherry juice or a placebo for 3 weeks. Those taking the cherry juice had reduced levels of the inflammatory marker C-reactive protein. Obese adults given 8 ounces daily of tart cherry juice for 4 weeks had markedly decreased inflammatory markers: sedimentation rates, tumor necrosis factor levels, and monocyte chemotactic protein. Runners were given tart cherry juice or a control drink for 5 days before, on the day of, and for 2 days after a marathon race. Runners drinking the tart cherry juice had significantly lower inflammation biomarkers (Interleukin-6 and C-reactive protein) than the placebo group. They also recovered isometric strength quicker and demonstrated an accelerated recovery following strenuous exercise. Runners in a double-blind trial participating in a 24-hour relay race drank two 355 ml beverages containing either tart cherry juice or a placebo daily for 1 week prior to the race and during the race. Both groups reported muscle pain after the race but the runners who drank tart cherry juice experienced a substantially smaller pain increase after the race.
  6. Cordyceps sinensis extract is a parasitic fungus that grows on caterpillar larvae native to high altitude regions of China, Nepal and Tibet. It has pharmacologically active anti-oxidant, anti-inflammatory and lipid lowering properties. It enhances the immune system and increases stamina for endurance athletes through greater aerobic capacity and oxygen use. It stabilizes blood sugar metabolism and increases libido and sexual functionality.
  7. Velvet Deer Antler (VDA) is a pillar of Traditional Chinese Medicine used to strengthen and replenish blood, reduce and reverse signs of aging, relieve pain and inflammation, overcome exhaustion, accelerate wound healing, reduce blood pressure, treat insomnia, relieve headaches, improve mood and memory, help infertility, restore vitality, heighten libido and increase muscle strength and endurance. One key component is a growth hormone called insulin-like growth factor “IGF-1”. This keeps muscles strong and helps to heal cartilage and tendon injuries. Also, glycosaminoglycans are plentiful which help to restore healthy cartilage. It contains Type II collagen along with a rich supply of minerals including potassium, sodium, calcium, copper, zinc, iron, selenium, magnesium and phosphorus. A proprietary product called “VDA Pure” can be obtained from www.VDAPure.com . The recommended dose is 2 caps daily before eating.
  8. Asian ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) “can be used as a tonic to combat feelings of lassitude and debility, lack of energy and ability to concentrate, and during convalescence,” according to the German Commission E advisory about herbs.  The suggested dose is 1 tsp steeped in a cup of boiling water to make a tea.  Ginseng can improve athletic performance when taken regularly for up to a month, and it can also beneficially stimulate the immune system.  It is an adaptogen for managing adrenal stress, and improves alertness, coordination and memory.
  9. Dimethylglycine (DMG): is an amino acid adaptogen made in the liver which diminishes in quantity as we age. It was formerly promoted by athletes as “vitamin B-15”. DMG aids in critical processes associated with cellular respiration and energy production, immune response, and oxygen utilization in the body. It helps to prevent fatigue, improve physical endurance and performance, and supports mental clarity. DMG stimulates both antibody response and cellular immunity. It has also been used to support cardiac function in heart disease. Additionally, it makes all other nutrients taken with it work better. High quality DMG can be obtained from www.TargetedNutrients.com . Typically usage is 1 cap once or twice daily.
  10. Beetroot juice can raise serum nitrate levels which can improve athletic performance, lower blood pressure and protect against glaucoma. Nitrate is metabolized to nitric oxide which helps to dilate smooth muscles, and improve blood vessel flexibility and tone. It enables athletes to use less oxygen while exercising at the same intensity, which makes exercising easier, and one can continue it for longer. Blood nitrate levels peak two to three hours after consuming beetroot, and remain elevated for six to nine hours. The key is to drink beetroot juice three hours before exercising, and take it daily to maintain higher blood levels of nitrate. One of the leading 2.4 ounce beetroot “sport shots”, called “Beet It”, provides 400 mg. Most blood pressure lowering studies have used 180 mg of beetroot juice daily. So, you could take half of “Beet It” one day and half the next. Serious athletes can use one or two shots daily. Two shots will saturate the blood stream and provide maximum benefits, so larger amounts will have no additional effects. Be aware, your urine may turn pink, but this is a harmless side effect.
  11. Resistance training is supported by key nutrients. And, when used together, they  provide synergistic benefits: a) Whey Protein: helps to preserve lean body mass. Although the Institute of Medicine recommends 0.8 grams/kg body weight (which equals about 58 gm in an aging adult weighing 160 lbs), the optimal dose is 1.0 to 1.3 gm/kg body weight (which equals 73 to 94 gm in an aging adult weighing 160 lbs). b) Creatine:  improves the Type 2 (fast contracting) muscle fibers that commonly atrophy in older adults. It helps to increase muscle force, power and mass and to decrease fatigue. c) Branched Chain Amino Acids (BCAAs):  especially leucine, isoleucine and valine (which are also found in whey protein), helps to promote muscle tissue synthesis. Also, they help to decrease the perception of exertion and mental fatigue during exercising. d) Glutamine:  helps to replenish muscle stores of glycogen (a ready source of stored energy). Also, in healthy adults, taking 2 gm of the amino acid glutamine will increase the output of human growth hormone by four times. e) Vitamin D3:  helps to preserve Type 2 muscle fibers and to protect cognitive function. f) Carnitine:  is an amino acid which helps to transport fatty acids into the intracellular mitochondria for fuel for the production of ATP energy. It supports exercise recovery, enhances performance, and decreases general fatigue. Propionyl-L-carnitine helps to regulate levels of ATP. g) D-Ribose:  helps to facilitate ATP production and to facilitate the speed of muscle function recovery after high-intensity exercising.  h) Omega-3 Fatty Acids:  eicosapentaenoic acid (EPA) helps to preserve muscle mass. And, both decosahexaenoic acid (DHA) and EPA are anti-inflammatory, and help to manage sarcopenia. 6 gm of deep sea fish oil can help to eliminate muscle soreness after resistance training.

                   DELAYED ONSET MUSCLE SORENESS (DOMS)

          Immediate muscle soreness is due to the partial metabolism of glucose (for energy) into lactic acid, which accumulates waiting for increased oxygenation after an exertion has finished, in order to be fully metabolize into carbon dioxide and water: the “oxygen debt”. The results of the incomplete oxidation of glucose  into lactate resolves within a few hours after exercise. DOMS occurs a day or two later as a consequence of repairing the micro-tears in the muscles caused by the exercise. The soreness, stiffness, mild swelling, tenderness, decreased strength and decreased range-of-motion will resolve in a few days. And, with your next exercise, you will be stronger and DOMS will be milder. Since it takes time for healing, it is important to space-out your resistance training during the week.

          You CAN have gain without (a lot of) pain. Drinking 2 cups of tart cherry juice can reduce both exercise-induced  inflammation and DOMS. {Be aware of  consuming the extra calories.} NOTE: A pre-emptive use of NSAIDs the day before and the day of a long distance race did NOT reduce DOMS (compared to non-users), and the users had mild endotoxemia due to the consequent drug-induced leaky-gut. Using NSAIDs intermittently for pain management after exercising may be helpful, if needed. BOTH localized Cold Therapy and Heat Therapy can reduce joint and muscle soreness, but cold is superior. However, tub hopping from hot water to cold water and repeating, probably isn’t worth the effort. Therapeutic Massage can help with DOMS. {Most studies look at massage within 3 hours after exercising for at least 20 minutes.} A foam roller is a low-cost alternative for self-massaging.

                  PRECISION EXERCISE RECOMMENDATIONS

  1. For Weight Management:  Initially, focus on adjusting your diet to decrease your total calorie intake.  Adjusting one significant lifestyle change at a time is a successful strategy to increase your own compliance and persistence. {For example, a decreased input of 500 cal/day equals 3,500 cal/week, which equals 1 pound of body fat reduced per week. Compare this to vigorous walking for 2 hours which equals using 500 cal.} In a 12-week comparison study, people who attended Weight Watchers lost about 9 lbs, versus people who simply worked-out at a Gym, who lost about 3 lbs. So, initially establish a structured eating-plan that you will adhere to, that includes reducing your portion size and the amount of food that you actually consume. And, for exercise, at first, simply determine to move more.
  2.           Once you have experienced successful weight loss, then combine your dieting with exercise. {It becomes easier once you have lost some weight and feel better rather than when you feel heavy and lack energy.} Pair cardio training with resistance training. Cardio activities burns calories and resistance training keeps you toned so that you lose fat rather than muscle. People who regularly work-out are twice as likely to keep the weight off than those who don’t. Exercise stimulates hormones which signal burning more fat as fuel. Emphasize to yourself how much better you feel when you are active. This may help to cancel-out any feelings of deprivation which could result in self-sabotaging behaviors. Remember that exercising is NOT a free-license to binge eating.
  3. To improve your Stress level, Self-Esteem and Mood:  In a 1999 study at Duke University, people who did aerobic exercise for 45-minutes 3x/week improved their moods equivalent to matched sedentary people using the SSRI Zoloft. Exercise increased their serotonin levels and their endorphin levels, and decreased their cortisol levels. The effect on mood only lasted for about 24 hours, so, regular exercise is the key to success. Mix-up your activities for fun and fitness: vary the kinds of exercise, frequency, timing and intensity. Remember that you need both cardio and strength training.
  4. To increase your Energy and decrease your Fatigue:  try a low to moderate intensity exertion for 20 minutes, 3 to 4 times per week. You will feel better within 4 weeks for all conditions. The intracellular size and number of your mitochondria {energy centers} will increase. You will increase burning your fat for energy, decrease your insulin resistance with a consequent good decrease in your glycation process, and balance both your intracellular and extracellular salts and fluids. You will sleep better: fall asleep quicker, remain asleep longer, and awaken more refreshed. Exercise energizes you. Don’t give-in to feeling drained of energy. Fake yourself-out: instead of saying that you feel “too tired”, say that you will walk for just 10-minutes—you’ll likely go longer because you will start to feel better.
  5. To ease chronic health problems and limit medical visits:  monitor yourself with a fitness tracking device such as FitBit or a Garmin watch. All movement counts. An encouraging 2013 study compared people doing short activity bursts, such as raking leaves or pacing when talking on the phone, with 150 min/week of aerobic bike riding. The groups had similar BP, lipid levels, waist circumference, and C-reactive protein inflammatory markers. When starting out: be sure to see a Pro and Go Slow. Increased endorphins will ease your pains. Try to minimize IMPACT aerobic activities: your joints will feel happier because they will be better lubricated and respond to inflammation more effectively, thus, easing your arthritis. Your heart rate and blood pressure will decrease, and your glucose intolerance will improve. Anticipate a slow and steady improvement.

                             EXERCISE AND CARDIOVASCULAR DISEASE

          An observational study published in Circulation, 5/15/2018, of 11,000 adults in the Atherosclerosis Risk in Communities (ARIC) study, demonstrated people doing 150 minutes of vigorous exercise weekly were 31% less likely to develop congestive heart failure (CHF). Couch potatoes who started exercising decreased their risk of CHF by 23%. This study supports the JAMA July 22/29, 2009 study of 20,000 male physicians who had a healthy lifestyle for more than 20 years who developed significantly less CHF. A similar study of 36,000 Swedish women published in the Archives of Internal Medicine, 5/11/2009 who were eating a DASH diet (to manage hypertension) along with doing regular exercise for 7 years had a 37% decrease in CHF.

                     THE PROBLEM OF SARCOPENIC OBESITY IN AGING

          After age 50 there is an exponential drop in muscle function. (This starts to occur after age 40 and accelerates after age 75.) Sarcopenia means a loss of muscle mass, strength and function. There is a faster decline in Type 2 (fast contracting) muscle fibers compared to Type 1 (slower contracting) muscle fibers. Therefore, there is a decreased speed of muscle contractions with aging. Evaluating muscle function and strength is more important than evaluating muscle mass. Muscle “power” is a function of force-strength and velocity. {Imagine the difference between just placing a fist against the side of a head (force) and then adding velocity to the fist placement (power)}. Power drops quicker than muscle mass. With decreased muscle power, especially in the core and lower extremities, there is decreased capacity to accomplish the functional tasks of daily living and an increased risk of falls and injuries, with an increased risk of consequent death. Because women start out with less power then men, older women have increased problems with a loss of balance and decreased muscle power which increases their risk of falls and hip and vertebral fractures (especially with their additional increased risk for osteoporosis.) This is primarily caused by suboptimal sex hormonal support, inadequate dietary protein intake and nutritional deficiencies, oxidative stress and inflammation. This is most often found in people who are physically sedentary and inactive.

          Obesity has become a significant increasing problem in America. In a study of nursing homes, in 1992 about 15% of patients (mostly women) had a BMI (Body Mass Index: weight divided by stature) of >30 (defining obesity). By 2002 the average BMI had increased to >25%. A fall risk for over-weight people was 15% compared to a fall risk for obese people of 25%. The combination of obesity plus sarcopenia (decreased muscle power) makes the loss of independence 2 to 3 times more likely because of diminished capacity for activities of daily living (ADL).

          Our aging population needs a combination of power training (eg. high velocity dynamic muscle resistance training using lower weights at higher speeds) twice per week along with aerobic interval training three times per week in order to improve their functional outcomes. While aerobic training helps the cardiovascular and cerebrovascular systems, resistance training provides superior protection against injuries. It stimulates human growth hormone which supports cell growth and regeneration. It also supports local mechano-growth factors. And, it enhances bio-identical hormone replacement therapy (BHRT) interventions.

           A report in the magazine The Week, 6/15/2018, (from reviewing an article on  MedicalNewsToday.com,) states that moving the large muscles of the legs (walking, climbing stairs, running) triggers brain stem cells to renew brain neurons. Researchers immobilized the hind legs of mice for 28 days then they examined the subventricular zone in their brains. They found a 70% decrease in neural stem cell activity. This helps to explain why people who are bedridden often deteriorate rapidly in their cognitive functions.

                                        JUST DO IT!   {Nike Shoes Slogan}

A good reference is “The Science Of Exercise” edited by Siobhan O’Connor and Mandy Oaklander, TIME Inc. Books, 2018.

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Exercise (HIIT)

One of the easy and probably the most effective exercise regimen is High Intensity High Interval Training (HIIT). HIIT can be done at almost all ages, almost anywhere, with or without any special equipment. Best of all, you can do it at home!

This is how to do it:

Warm up for 15 minutes, adding a few 20-second bursts at the end to prepare for the workout. Run, bike, or row for 30 seconds at a nearly all-out effort. Take three minutes active recovery and repeat the 30 on/3 off pattern five or six more times. Finish with a 10-minute cool down.  You can do this on a stationary bike, or in a swim pool, or outside on the grassland, or even up and down the stairs.  Of course, make sure you do this in a safe environment.  You don’t want to hurt yourself nor others who may be around.  Repeat this 3-5 times a week.

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Healthy Eating Habits

Healthy Eating Habits:

  1. Eat your last meal at least 3 hours before your bed time (before 7 pm for most people).
  2. Wait between 13 and 18 hours before you eat another meal.  In other words, if you eat your supper of the previous day at around 7 pm, then don’t eat breakfast until at least 8 am, or better, until 12 noon!  This is intermittent fasting (13-18 hours fasting without food, you can drink water though) allows your mitochondria (an important cellular organ in metabolism) to recover.
  3. The first meal of the day should be the biggest,  should be heavily fat with 80-90% of the calories from healthy fat. One won’t feel much hungry throughout the day after such a fatty meal.
  4. Try to fast for at least 24 hours a week (e.g., on a Saturday), drinking water only.

The above measures are proven to improve your health, improving your mitochondria and helps you to lose weight.

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Presentation (@1pm Monday, Apr. 2nd, 2018):KetoDiet for Weight Loss and Health

In our regular Monday Lecture Series, Dr. Cheng will present on Ketogenic Diet (KetoDiet for short) for Weight Loss and Health. Topics to be discussed include:

  1. What is Ketogenic Diet?  Why (healthy) fats are good for you.  Why carbs are bad. KetoDiet, it‘s health benefits.
  2. Why is KetoDiet a foundation for all chronic disease?
    1. Case studies of KetoDiet and nutritional therapy for autoimmune diseases like psoriasis, skin rash.
  3. Nutritonal KetoDiet (for health or for chronic disease management) vs. Restricted KetoDiet (for cancer management).
  4. How to eat on ketogenic diet, introduce some keto recipes.
  5. Other factors in a healthy diet.
    1. Brief introduction to oxidative stress, mitochondrial health, and nutritional approach to health.
  6. How to combine KetoDiet with our current weight management protocols to better manage your weight and other chronic diseases (autoimmune disorders, diabetes, heart disease and even cancer).

Date and Time: Apr. 2nd, 2018, Monday, at 1 pm.

Address: Cheng Integrative Health Center/Doctor‘s Weight Loss Center, 6149 St. Andrews Rd., Columbia, SC 29212 (across stree from Cici’s Pizza, in fornt of the K-Mart).

Dr. Richard Cheng, MD

 

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Ketogenic Diet

Ketogenic means ketone producing.  ketone is produced when fats are digested.  So ketogenic diet means ketone producing diet, or in other words, ketogenic diet contains predominantly (healthy) fat, very little carbs and appropriate amounts of proteins. Ketogenic diet is different from Atkins diet, and is NOT a high fat diet.  The total calories one needs to consume is limited (to one’s needs).

Benefits of ketogenic diet:

  1. weight loss
  2. anti-inflammatory (anti-oxidant)
  3. lower cancer risk
  4. muscle strengthening
  5. inhibiting appetite
  6. reducing insulin levels (insulin inhibits fat release.  So this reduction in insulin release can help in more fat release and weight loss).

Ketogenic Diet:

  1. Healthy fats calories, about 80-85% of the total calories.
  2. Protein calories: about 10% of the total calories
  3. Carb calories: 5-8%.

Healthy Eating Habits:

  1. Intermittent Fasting: Every day there should a period of 13-18 hour without food intake, water is ok. One may choose either to skip breakfast or skip dinner.  Research shows this type of intermittent fasting boosts your mitochondrial (Mito) function.  Mito is the rechargeable battery in your cells.  Dysfunction of Mito is found to be a major contributor to most, if not all, chronic diseases esp. cancer, and aging, including obesity.
    1. Skipping breakfast. For example, if one finishes dinner at 7 pm, then do not eat anything until at least 8 am (13 hours fasting) or, even better, 11 am (16 hours).
    2. Skipping dinner: Don’t eat anything after 4pm.  Then eat breakfast at around 8-10 am (that’s 16-18 hours fasting).
  2. Ketogenic Diet (see above). One other reason why I advocate ketoDiet is the drastic reduction of carbohydrates.  Carbs cause lots of problems, esp. today’s carbs are heavily contaminated by all sorts of pesticides, herbicides, more so than other foods.  Carbs like wheat are a major to cause to many GI problems such as leaky gut which contribute to our autoimmune diseases and symptoms.  Allergy is just one of them. (I have been on the KetoDiet for a while now.  I really feel the difference: improved stamina, reduced seasonal allergy symptoms (I used to take Zyrtec daily.  But now, even in this pollen season, I have gone a whole week without needing Zyrtec.  This is amazing since for the last 25 years, I have never, NEVER, skipped several days, let alone a whole week, without an allergy pill).

 

 

 

 

Posted in Misc | Comments Off on Ketogenic Diet

Estrogen In the Aging Male

Dangers of Excess Estrogen In the Aging Male

November 2008

By William Faloon

How Excess Estrogen Levels Occur in Aging Men

In males, the main biologically active estrogen is estradiol. The primary source of estradiol in men is from the conversion (aromatization) of testosterone. As men age, the production of androgens from the adrenals and gonads is decreased. The aromatization of testosterone to estradiol is often maintained, but due to a variety of factors, more testosterone is aromatized in fatty tissues, causing a further imbalance of the ratio of testosterone to estrogen, i.e. too much estradiol and not enough testosterone. The result is a deficiency of beneficial testosterone and an excess amount of estradiol.34

As men age, the amount of testosterone produced in the testes diminishes greatly. Yet estradiol levels remain persistently high. The reason for this is increasing aromatase activity along with age-associated fat mass, especially in the belly.5 Estradiol levels correlate significantly to body fat mass and more specifically to subcutaneous abdominal fat. The epidemic of abdominal obesity observed in aging men is associated with a constellation of degenerative disorders, including heart disease, diabetes, and cancer.9,35-38

Subcutaneous abdominal fat acts as a secretory gland, often producing and emitting excessive levels of estradiol into an aging man’s blood.39 One’s waist circumference is a highly accurate prognostic measurement of future disease risk, with excess estradiol secretion being at least one of the deadly mechanisms associated with the difficult-to-resolve problem of having too much abdominal fat.5,40

Symptoms of excess estrogen in aging men include the development of breasts, having too much abdominal weight, feeling tired, suffering loss of muscle mass, and having emotional disturbances. Many of these symptoms correspond to testosterone deficiency as well.41

PROTECTING AGAINST TOXIC ESTROGEN METABOLITES
It is not just excess estradiol that poses health risks. Specific estrogen metabolites may also initiate and promote hormone-related cancers. Daily consumption of cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts),54-59 along with isoflavone-rich soy foods60-64 converts these dangerous estrogen metabolites (such as 16-alpha-hydroxyestrone) to safe ones (2-hydroxyestrone) that may protect against prostate cancer.

For those who don’t eat these cancer-protective foods on a daily basis, low-cost supplements can supply the most active constituents of cruciferous vegetables (such as indole-3-carbinol and sulphoraphane)65-70 and soy (genistein and daidzein).71-74

Don’t Lower Your Estrogen Too Much!

When reviewing the studies about the multiple pathological effects of excess estrogen in aging men, it may be tempting to take high doses of an aromatase-inhibiting drug (like Arimidex®) to slash estrogen levels as low as possible. Don’t do this, as men need estrogen to maintain bone density, cognitive function, and even to maintain the inner lining of the arterial wall (the endothelium).42

Most Life Extension members know that too little cholesterol (below 150 mg/dL) can be more dangerous than too much cholesterol (levels over 200 mg/dL). The same may hold true for estrogen. We have recommended that ideal ranges for estradiol for most aging men are between 20 and 30 pg/mL of blood. Below 18 pg/mL increases osteoporosis risk, while levels greater than 30 pg/mL increase heart attack and stroke incidence.

The availability of low-cost blood tests enables aging men to optimize their estradiol levels using natural approaches and/or prescription drugs.

Estrogen and Men’s Bones

Osteoporosis is not just a risk for aging women. Men also suffer crippling fractures caused by loss of bone mineral density. When aged men suffer a bone fracture, their risk of dying is significantly higher than women.43,44

In a study published two years ago, doctors analyzed blood levels in three groups of men for estradiol only, testosterone only, and estradiol and testosterone together. In men with low estradiol (2.0-18.1 pg/mL of blood), hip fractures were more than three times higher compared with men who had estradiol levels of 18.2-34.2 pg/mL.45

Men with estradiol levels greater than 34.3 pg/mL had a slightly higher risk of hip fracture compared with those in the range of 18.2-34.2 pg/mL. This study helps confirm Life Extension’s recommended range for estrogen levels in aging men.

Interestingly, this study also showed in the group of men whose blood was measured for estradiol and testosterone, those who were low in both these hormones suffered a startling 6.5 times greater incidence of hip fractures. The authors of this study concluded, “men with low estradiol levels are at an increased risk for future hip fracture. Men with both low estradiol and low testosterone levels seem to be at greatest risk for hip fracture.”45

Conflicting Data

With the voluminous amount of scientific studies being published today, contradictions inevitably arise, and this is not always due to study design flaws.

Conflicting Data

For the past decade, Life Extension has reported on dozens of studies showing that higher testosterone levels significantly reduce a man’s risk of cardiovascular disease. In fact, we just did a comprehensive database search and identified a total of 50 studies that document the protective effects of testosterone against cardiovascular disease in men.

A study published two years ago, however, contradicts this. This study showed greater incidences of heart attacks in men with higher testosterone and lower heart attack risks in older men with higher estradiol. (In younger men, estradiol level had no impact on heart attack incidence in this study.) The authors of the study admitted a limitation to the study was only measuring baseline levels of hormones. This study nonetheless was used at the anti-aging conference to proclaim that estradiol protects against heart attack.46

There are scientific studies that demonstrate estrogen’s potential beneficial effects to a man’s vascular system. These protective mechanisms, however, have to be weighed against pathological damage the very same estrogen can induce.

As I mentioned earlier, despite the documented dangers of excess estrogen, levels that are too low also present risks, not only to bone,45,47-49 but to the vascular system as well.46,50,51 If a man were to intentionally lower his estradiol too much, he could very well suffer vascular disease because estrogen is vital to proper endothelial function.52,53

This is why it is so important for aging men to have annual blood tests. If estrogen is too low (below 18-20 pg/mL), or too high (above 30 pg/mL), corrective action should be taken.

How to Reduce Excess Estrogen

In aging men, a large percentage of estradiol is synthesized in abdominal adipose (fat) tissues.42Reducing waist circumference confers huge health benefits, one being a lowering of estradiol levels.

One of the most effective ways for men to reduce belly fat is to restore their free testosterone to youthful ranges. Nutrients that inhibit the aromatase enzyme can help boost testosterone levels by preventing its conversion (aromatization) into estradiol.

As men grow older, however, their testicular testosterone production declines precipitously. This means that inhibiting aromatase might not sufficiently maintain testosterone levels because not enough is being produced internally. Fortunately, low-cost compounded testosterone creams are available that can be rubbed on the skin for absorption into the bloodstream.

For men with excess aromatase activity, this topically absorbed testosterone might convert into too much estradiol. If this happens, the use of very low-dose aromatase-inhibiting drugs (0.5 mg of Arimidex® twice a week) may be all that is needed to protect against estrogen overload. Some men don’t need these drugs and can use nutrient formulas that have aromatase-inhibiting properties.

There is no need to guess what you need, as a blood test taken 30-45 days after initiating testosterone-replacement not only reveals a man’s estradiol level, but also ensures that the PSA has not spiked (indicating possible pre-existing prostate cancer), that the dose of testosterone cream is appropriate, and that there are no other side effects occurring.

To view a wide range of estrogen-lowering strategies, one can view Life Extension’s Male Hormone Restoration Protocol.

What if Your Estrogen Level is Too Low?

Some men are so deficient in aromatase that they do not make enough estrogen.

If a blood test reveals estradiol below 20 pg/mL, which may occur if Arimidex®, for example, is being taken at too high a dose, one should consider reducing the dose. Alternatively, applying a tiny dose of a compounded topical estradiol cream to the skin several times a week may also help increase estradiol levels. Follow-up blood tests 30-45 days later can assess if too much or too little topical estradiol cream is being used.

There is also evidence that consuming phytoestrogens from soy might provide similar benefits for the bone75-79 and vascular system.80-88

Summary

What if Your Estrogen Level is Too Low?

It is hard to imagine that before 1906, doctors did not even know that a hormone (estrogen) was secreted by the ovaries in women. It was not until 1930 that the isolation of the estrogen complex in pure form was published.

Less than 80 years later, scientists are debating what the optimal levels of estrogen should be in men. This exponential leap in scientific knowledge is a marvel in itself!

The role that estrogen plays in men’s health is an important topic discussed at medical conferences today. As outlined in this article, testing one’s estradiol level is critical because it can be a serious problem if it is too high or if it is too low.

I am pleased to announce that the everyday low price for the Male or Female Blood Test Panels has been reduced from $299 to $269. This price reduction is made possible by the large volume of blood testing Life Extension members have been ordering.

In addition to estradiol, the Male Panel measures PSA, free testosterone, DHEA, C-reactive protein, homocysteine, along with cholesterol lipids, glucose, and blood cell counts and chemistries.

I encourage any member who has not had this comprehensive blood test conducted over the past 12 months to take advantage of this new lower price. To order the Male or Female Panel by phone, call 1-800-208-3444.

If the results reveal estradiol levels are too high or too low, corrective measures can easily be taken to protect your precious health.

References
1. Colmou A. Estrogens and vascular thrombosis. Soins Gynecol Obstet Pueric Pediatr. 1982 Sep;(16):39-41.

2. Abbott RD, Launer LJ, Rodriguez BL, et al. Serum estradiol and risk of stroke in elderly men. Neurology. 2007 Feb 20;68(8):563-8.

3. Tivesten A, Hulthe J, Wallenfeldt K, et al. Circulating estradiol is an independent predictor of progression of carotid artery intima-media thickness in middle-aged men. J Clin Endocrinol Metab. 2006 Nov;91(11):4433-7.

4. Mohamad MJ, Mohammad MA, Karayyem M, Hairi A, Hader AA. Serum levels of sex hormones in men with acute myocardial infarction. Neuro Endocrinol Lett. 2007 Apr;28(2):182-6.

5. Vermeulen A, Kaufman JM, Goemaere S, van Pottelberg, I. Estradiol in elderly men. Aging Male. 2002 Jun;5(2):98-102.

6. Dunajska K, Milewicz A, Szymczak J, et al. Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis. Aging Male. 2004 Sep;7(3):197-204.

7. Wranicz JK, Cygankiewicz I, Rosiak M, et al. The relationship between sex hormones and lipid profile in men with coronary artery disease. Int J Cardiol. 2005 May 11;101(1):105-10.

8. Tivesten A, Mellstrom D, Jutberger H, et al. Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS Study in Sweden. J Am Coll Cardiol. 2007 Sep 11;50(11):1070-6.

9. Tengstrand B, Carlstrom K, Fellander-Tsai L, Hafstrom I. Abnormal levels of serum dehydroepiandrosterone, estrone, and estradiol in men with rheumatoid arthritis: high correlation between serum estradiol and current degree of inflammation. J Rheumatol. 2003 Nov;30(11):2338-43.

10. Stork S, Bots ML, Grobbee DE, van der Schouw YT. Endogenous sex hormones and C-reactive protein in healthy postmenopausal women. J Intern Med. 2008 Mar 12.

11. Zegura B, Guzic-Salobir B, Sebestjen M, Keber I. The effect of various menopausal hormone therapies on markers of inflammation, coagulation, fibrinolysis, lipids, and lipoproteins in healthy postmenopausal women. Menopause. 2006 Jul;13(4):643-50.

12. Hemelaar M, Kenemans P, Schalkwijk CG, Braat DD, van der Mooren MJ. No increase in C-reactive protein levels during intranasal compared to oral hormone therapy in healthy post-menopausal women. Hum Reprod. 2006 Jun;21(6):1635-42.

13. Tripathi Y, Hegde BM. Serum estradiol and testosterone levels following acute myocardial infarction in men. Indian J Physiol Pharmacol. 1998 Apr;42(2):291-4.

14. Pugh PJ, Channer KS, Parry H, Downes T, Jone TH. Bio-available testosterone levels fall acutely following myocardial infarction in men: association with fibrinolytic factors. Endocr Res. 2002 Aug;28(3):161-73.

15. Singh PB, Matanhelia SS, Martin FL. A potential paradox in prostate adenocarcinoma progression: oestrogen as the initiating driver. Eur J Cancer. 2008 May;44(7):928-36.

16. Ellem SJ, Risbridger GP. Aromatase and prostate cancer. Minerva Endocrinol. 2006 Mar;31(1):1-12.

17. Cavalieri E, Rogan E. Catechol quinones of estrogens in the initiation of breast, prostate, and other human cancers: keynote lecture. Ann NY Acad Sci. 2006 Nov;1089:286-301.

18. Bosland MC. Sex steroids and prostate carcinogenesis: integrated, multifactorial working hypothesis. Ann NY Acad Sci. 2006 Nov;1089:168-76.

19. Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6;100(3):170-83.

20. Ho CK, Nanda J, Chapman KE, Habib FK. Oestrogen and benign prostatic hyperplasia: effects on stromal cell proliferation and local formation from androgen. J Endocrinol. 2008 Jun;197(3):483-91.

21. Lowsley OS. The development of the human prostate gland with reference to the development of other structures at the neck of the urinary bladder. Am J Anat. 1912;13:299-348.

22. Prins GS. Development of the prostate. In: Haseltine F, Paulsen C, Wang C, editors. Reproductive Issues and the Aging Male. New York: Embryonic, Inc;1993: 101-12.

23. Prins GS, Birch L, Couse JF, et al. Estrogen imprinting of the developing prostate gland is mediated through stromal estrogen receptor alpha: studies with alphaERKO and betaERKO mice. Cancer Res. 2001 Aug 15;61(16):6089-97.

24. Prins GS, Birch L, Tang WY, Ho SM. Developmental estrogen exposures predispose to prostate carcinogenesis with aging. Reprod Toxicol. 2007 Apr;23(3):374-82.

25. Prins GS, Tang WY, Belmonte J, Ho SM. Perinatal exposure to oestradiol and bisphenol A alters the prostate epigenome and increases susceptibility to carcinogenesis. Basic Clin Pharmacol Toxicol. 2008 Feb;102(2):134-8.

26. Ho SM, Tang WY, Belmonte de Fausto J, Prins GS. Developmental exposure to estradiol and bisphenol A increases susceptibility to prostate carcinogenesis and epigenetically regulates phosphodiesterase type 4 variant 4. Cancer Res. 2006 Jun 1;66(11):5624-32.

27. Rajfer J, Coffey DS. Effects of neonatal steroids on male sex tissues. Invest Urol. 1979 Jul;17(1):3-8.

28. Henderson BE, Bernstein L, Ross RK, Depue RH, Judd HL. The early in utero oestrogen and testosterone environment of blacks and whites: potential effects on male offspring. Br J Cancer. 1988 Feb;57(2):216-8.

29. Giton F, de la Taille A, Allory Y, et al. Estrone sulfate (E1S), a prognosis marker for tumor aggressiveness in prostate cancer (PCa). J Steroid Biochem Mol Biol. 2008 Mar;109(1-2):158-67.

30. Prins GS, Korach KS. The role of estrogens and estrogen receptors in normal prostate growth and disease. Steroids. 2008 Mar;73(3):233-44.

31. Scarano WR, Cordeiro RS, Goes RM, Carvalho HF, Taboga SR. Tissue remodeling in Guinea pig lateral prostate at different ages after estradiol treatment. Cell Biol Int. 2005 Sep;29(9):778-84.

32. Matsuda T, Abe H, Suda K. Relation between benign prostatic hyperplasia and obesity and estrogen. Rinsho Byori. 2004 Apr;52(4):291-4.

33. Rohrmann S, Nelson WG, Rifai N, et al. Serum sex steroid hormones and lower urinary tract symptoms in Third National Health and Nutrition Examination Survey (NHANES III). Urology. 2007 Apr;69(4):708-13.

34. Vermeulen A. Androgen replacement therapy in the aging male—a critical evaluation. J Clin Endocrinol Metab. 2001 Jun;86(6):2380-90.

35. Choi BG, McLaughlin MA. Why men’s hearts break: cardiovascular effects of sex steroids. Endocrinol Metab Clin North Am. 2007 Jun;36(2):365-77.

36. Kaneda Y, Ohmori T. Relation between estradiol and negative symptoms in men with schizophrenia. J Neuropsychiatry Clin Neurosci. 2005;17(2):239-42.

37. Zou B, Sasaki H, Kumagai S. Association between Relative Hypogonadism and Metabolic Syndrome in Newly Diagnosed Adult Male Patients with Impaired Glucose Tolerance or Type 2 Diabetes Mellitus. Metab Syndr Relat Disord. 2004;2(1):39-48.

38. Abu-Abid S, Szold A, Klausner J. Obesity and cancer. J Med. 2002;33(1-4):73-86.

39. Kula K, Walczak-Jedrzejowska R, Slowikowska-Hilczer J, et al. Important functions of estrogens in men—breakthrough in contemporary medicine. Przegl Lek. 2005;62(9):908-15.

40. Anderson LA, McTernan PG, Barnett AH, Kumar S. The effects of androgens and estrogens on preadipocyte proliferation in human adipose tissue: influence of gender and site. J Clin Endocrinol Metab. 2001 Oct;86(10):5045-51.

41. Lund BC, Bever-Stille KA, Perry PJ. Testosterone and andropause: the feasibility of testosterone replacement therapy in elderly men. Pharmacotherapy. 1999 Aug;19(8):951-6.

42. Gooren LJ, Toorians AW. Significance of oestrogens in male (patho)physiology. Ann Endocrinol (Paris). 2003 Apr;64(2):126-35.

43. Seeman E. The dilemma of osteoporosis in men. Am J Med. 1995 Feb 27;98(2A):76S-88S.

44. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999 Mar 13;353(9156):878-82.

45. Amin S, Zhang Y, Felson DT, et al. Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study. Am J Med. 2006 May;119(5):426-33.

46. Arnlov J, Pencina MJ, Amin S, et al. Endogenous sex hormones and cardiovascular disease incidence in men. Ann Intern Med. 2006 Aug 1;145(3):176-84.

47. Nuti R, Martini G, Merlotti D, et al. Bone metabolism in men: role of aromatase activity. J Endocrinol Invest. 2007;30(6 Suppl):18-23.

48. Gennari L, Nuti R, Bilezikian JP. Aromatase activity and bone homeostasis in men. J Clin Endocrinol Metab. 2004 Dec;89(12):5898-907.

49. Khosla S, Melton LJ 3rd, Riggs BL. Estrogens and bone health in men. Calcif Tissue Int. 2001 Oct;69(4):189-92.

50. Phillips GB. Is atherosclerotic cardiovascular disease an endocrinological disorder? The estrogen-androgen paradox. J Clin Endocrinol Metab. 2005 May;90(5):2708-11.

51. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999 Jun 10;340(23):1801-11.

52. Sader MA, McCredie RJ, Griffiths KA, et al. Oestradiol improves arterial endothelial function in healthy men receiving testosterone. Clin Endocrinol (Oxf). 2001 Feb;54(2):175-81.

53. Sudhir K, Komesaroff PA. Clinical review 110: Cardiovascular actions of estrogens in men. J Clin Endocrinol Metab. 1999 Oct;84(10):3411-5.

54. Traka M, Gasper AV, Melchini A, et al. Broccoli consumption interacts with GSTM1 to perturb oncogenic signalling pathways in the prostate. PLoS ONE. 2008;3(7):e2568.

55. Kirsh VA, Peters U, Mayne ST, et al. Prospective study of fruit and vegetable intake and risk of prostate cancer. J Natl Cancer Inst. 2007 Aug 1;99(15):1200-9.

56. Xiao D, Singh SV. Phenethyl isothiocyanate inhibits angiogenesis in vitro and ex vivo. Cancer Res. 2007 Mar 1;67(5):2239-46.

57. Chan JM, Gann PH, Giovannucci EL. Role of diet in prostate cancer development and progression. J Clin Oncol. 2005 Nov 10;23(32):8152-60.

58. Giovannucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective study of cruciferous vegetables and prostate cancer. Cancer Epidemiol Biomarkers Prev. 2003 Dec;12(12):1403-9.

59. Kristal AR, Lampe JW. Brassica vegetables and prostate cancer risk: a review of the epidemiological evidence. Nutr Cancer. 2002;42(1):1-9.

60. Grainger EM, Schwartz SJ, Wang S, et al. A combination of tomato and soy products for men with recurring prostate cancer and rising prostate specific antigen. Nutr Cancer. 2008 Mar;60(2):145-54.

61. Heald CL, Ritchie MR, Bolton-Smith C, Morton MS, Alexander FE. Phyto-oestrogens and risk of prostate cancer in Scottish men. Br J Nutr. 2007 Aug;98(2):388-96.

62. Kurahashi N, Iwasaki M, Sasazuki S, et al. Soy product and isoflavone consumption in relation to prostate cancer in Japanese men. Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):538-45.

63. Holzbeierlein JM, McIntosh J, Thrasher JB. The role of soy phytoestrogens in prostate cancer. Curr Opin Urol. 2005 Jan;15(1):17-22.

64. Lee MM, Gomez SL, Chang JS, et al. Soy and isoflavone consumption in relation to prostate cancer risk in China. Cancer Epidemiol Biomarkers Prev. 2003 Jul;12(7):665-8.

65. Aggarwal BB, Ichikawa H. Molecular targets and anticancer potential of indole-3-carbinol and its derivatives. Cell Cycle. 2005 Sep;4(9):1201-15.

66. Garikapaty VP, Ashok BT, Chen YG, et al. Anti-carcinogenic and anti-metastatic properties of indole-3-carbinol in prostate cancer. Oncol Rep. 2005 Jan;13(1):89-93.

67. Sarkar FH, Li Y. Indole-3-carbinol and prostate cancer. J Nutr. 2004 Dec;134(12 Suppl):3493S-8S.

68. Chinni SR, Li Y, Upadhyay S, Koppolu PK, Sarkar FH. Indole-3-carbinol (I3C) induced cell growth inhibition, G1 cell cycle arrest and apoptosis in prostate cancer cells. Oncogene. 2001 May 24;20(23):2927-36.

69. Yao H, Wang H, Zhang Z, et al. Sulforaphane inhibited expression of hypoxia-inducible factor-1alpha in human tongue squamous cancer cells and prostate cancer cells. Int J Cancer. 2008 Sep 15;123(6):1255-61.

70. Myzak MC, Tong P, Dashwood WM, Dashwood RH, Ho E. Sulforaphane retards the growth of human PC-3 xenografts and inhibits HDAC activity in human subjects. Exp Biol Med (Maywood). 2007 Feb;232(2):227-34.

71. Zhang LL, Li L, Wu DP, et al. A novel anti-cancer effect of genistein: reversal of epithelial mesenchymal transition in prostate cancer cells. Acta Pharmacol Sin. 2008 Sep;29(9):1060-8.

72. Banerjee S, Li Y, Wang Z, Sarkar FH. Multi-targeted therapy of cancer by genistein. Cancer Lett. 2008 May 18.

73. Kikuno N, Shiina H, Urakami S, et al. Genistein mediated histone acetylation and demethylation activates tumor suppressor genes in prostate cancer cells. Int J Cancer. 2008 Aug 1;123(3):552-60.

74. Nagata Y, Sonoda T, Mori M, et al. Dietary isoflavones may protect against prostate cancer in Japanese men. J Nutr. 2007 Aug;137(8):1974-9.

75. Ma DF, Qin LQ, Wang PY, Katoh R. Soy isoflavone intake inhibits bone resorption and stimulates bone formation in menopausal women: meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2008 Feb;62(2):155-61.

76. Atkinson C, Compston JE, Day NE, Dowsett M, Bingham SA. The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2004 Feb;79(2):326-33.

77. Harkness LS, Fiedler K, Sehgal AR, Oravec D, Lerner E. Decreased bone resorption with soy isoflavone supplementation in postmenopausal women. J Womens Health (Larchmt). 2004 Nov;13(9):1000-7.

78. Uesugi T, Fukui Y, Yamori Y. Beneficial effects of soybean isoflavone supplementation on bone metabolism and serum lipids in postmenopausal japanese women: a four-week study. J Am Coll Nutr. 2002 Apr;21(2):97-102.

79. Droke EA, Hager KA, Lerner MR, et al. Soy isoflavones avert chronic inflammation-induced bone loss and vascular disease. J Inflamm (Lond). 2007;417.

80. Seok YM, Baek I, Kim YH, et al. Isoflavone attenuates vascular contraction through inhibition of the RhoA/Rho-kinase signaling pathway. J Pharmacol Exp Ther. 2008 Sep;326(3):991-8.

81. Si H, Liu D. Phytochemical genistein in the regulation of vascular function: new insights. Curr Med Chem. 2007;14(24):2581-9.

82. Colacurci N, Chiantera A, Fornaro F, et al. Effects of soy isoflavones on endothelial function in healthy postmenopausal women. Menopause. 2005 May;12(3):299-307.

83. Liang YL, Teede H, Dalais F, McGrath BP. The effects of phytoestrogen on blood pressure and lipids in healthy volunteers. Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Aug;34(8):726-9.

84. Kapiotis S, Hermann M, Held I, et al. Genistein, the dietary-derived angiogenesis inhibitor, prevents LDL oxidation and protects endothelial cells from damage by atherogenic LDL. Arterioscler Thromb Vasc Biol. 1997 Nov;17(11):2868-74.

85. Wenzel U, Fuchs D, Daniel H. Protective effects of soy-isoflavones in cardiovascular disease. Identification of molecular targets. Hamostaseologie. 2008 Feb;28(1-2):85-8.

86. Si H, Liu D. Genistein, a soy phytoestrogen, upregulates the expression of human endothelial nitric oxide synthase and lowers blood pressure in spontaneously hypertensive rats. J Nutr. 2008 Feb;138(2):297-304.

87. Chan YH, Lau KK, Yiu KH, et al. Isoflavone intake in persons at high risk of cardiovascular events: implications for vascular endothelial function and the carotid atherosclerotic burden. Am J Clin Nutr. 2007 Oct;86(4):938-45.

88. Rimbach G, Boesch-Saadatmandi C, Frank J, et al. Dietary isoflavones in the prevention of cardiovascular disease–a molecular perspective. Food Chem Toxicol. 2008 Apr;46(4):1308-19.

From Lifeextension.com

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Holiday office hours- close at 12/25/2017 and 1/1/2018

We will close at 12/25/2017, Monday, for Christmas holiday.

and close at 1/1/2018, Monday, for New Year holiday.

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Microbiome, Leaky Guy, Dysbiosis and Health and Chronic Diseases

MICROBIOME AND  PROBIOTICS

          We have co-evolved with the microbiota. Probiotics are beneficial live microorganisms which when taken in adequate amounts confer a beneficial health effect on the host. Most are bacteria. Almost every society has consumed some type of fermented food. Using probiotics is SAFE. Approximately 5000 species of microbes reside in a healthy human body. 100 trillion microbes reside in a human body. This is 10 times the number of human cells and 100 times the number of human genes. Some people propose that we are not autonomous agents. Rather, we are biomolecular networks called “holobionts” with the host and microbial genomes referred to as “hologenomes”.

          The GI tract contains 90% of these microbes in a symbiotic relationship. The large intestine is one of the densest microbial ecosystems on the planet. The vagina is like a sparsely populated prairie compared to the lower gut which is like a rain forest teeming with life. People are very different from one another, but they are consistent with themselves. Two healthy Americans’ microbial communities can differ by as much as 90%, but an individual’s distinctive ensemble of bugs tends to stay stable over many years.

          Microbes predigest our food, chemically modify the pills we take, shape our immune system responses, and repel infectious invaders. Nearly ¾ of the body’s immune cells are in the Gut Associated Lymphoid Tissue (GALT). The microbial inhabitants of the GI tract stimulate the immune system for optimal functioning.  GALT immune responses differentiate between beneficial and harmful dietary proteins (antigens) and beneficial and harmful microorganisms (bacteria, viruses, parasites).  Probiotics activate B-lymphocytes , T-lymphocytes and macrophages, stimulate the complement system, and reduce responses to “like-antigens”.  They digest nutrients and compete for nutrients with pathogens; modify the local pH to create conditions unfavorable to pathogens; produce bacteriocins that inhibit pathogens; scavenge superoxide radicals; stimulate epithelial mucin production; enhance intestinal barrier functions; compete for adhesions with pathogens; and modify and metabolize pathogen derived toxins.

          Probiotics have several mechanisms for their clinical effects:  1) direct interaction with intestinal cells with effects on intestinal barrier functions.  Skin and mucosal surfaces have adherent normal bacterial flora which provides protective barriers where neutrophils attack and macrophages engulf and ingest foreign bodies. The complement system stimulates and mobilizes the phagocytes (clean-up cells).  2) Interaction with immune intestinal B-lymphocytes stimulates plasma cells to produce antibody immunoglobulins such as increasing IgA.  Also, T-lymphocytes (which include killer, helper, suppressor and memory cells)  produce stimulating chemicals (lymphokines) and destructive chemicals (lymphotoxins).  3) They modulate gut microbes and compete for gut nutrients and metabolic pathways.  4) They directly antagonize intestinal pathogens.  And, 5) they create metabolic effects.

***I strongly recommend using probiotics to help manage constipation;  diarrhea;  irritable bowel syndrome;  infant colic; and, especially while taking antibiotics and after using antibiotics***  Probiotics are found in fermented foods such as  yogurt, beet kvass, kefir, sauerkraut, and, kombucha. The easiest way to consume adequate amounts are in powder or capsule form. I recommend for children 5 to 15 billion count capsules (which can be opened  onto food or mixed in a drink) daily, and for adults 15 to 30 billion count capsules daily. There is no upper limit and no adverse side effects.  NOTE: As we age, we tend to selectively lose one of the main players in our colon, namely Bifidobacterium species. The best way to restore them is to consume them (look for Bifido-rich yogurt or probiotic capsules) and to provide them with the food they need to live on in our colons: lots of vegetables, a little fruit, and limiting (toxic) doses of sugar that might feed competing species.

          ALSO NOTE: ***soil-based spore-forming bacteria are essential for our health. They are “pseudo-commensuls” because they pass through the gut rather than establishing a home there. Our ancestors regularly consumed them when eating wild foods and drinking from ponds and streams. The spores not only survive traversing through the hydrochloric acid and bile salts of the stomach,  they are activated to viably reach the intestines. An excellent product {that is unfortunately only available through a health care provider}  is called “Mega-Sporebiotic” from Microbiome Labs which contains Bacillus indicus, HU36; B. subtilis, HU58; B. coagulans; B. licheniformis; and B. clausii.

          I also strongly recommend reading the book by Dr. Josh Axe, MD called “Eat Dirt”.

          Six host factors disrupt our natural gut bacteria balance:  1)  Antibiotics: disrupt the number and relative proportions of gut bacteria. 2)  Infant Formula: breast feeding transfers bacterial diversity from mother to baby. Caesarian section delivery also disrupts this normal transfer of flora.  3)  Excessive hygiene.  4)  Our Western Diet high in animal proteins, fats , sugars and refined carbohydrates. 5)  Modern medical treatments such as artificial ventilation, skin-penetrating devices, tubes and catheters and their attendant antibiotic use.  6)  Age. 

          Our immune system co-evolved with parasites. Their absence can profoundly affect immune regulation leading to physical and psychological consequences. IgE immunoglobulin evolved to help manage parasites. Because of our overly cleanly environment with minimal parasites, IgE now responds to allergens with manifestations of Allergic Rhinitis and Asthma. People who are infected with hookworms have a lower incidence of auto-immune diseases than parasite-free modern humans. People who have been immunized with Bacille-Calmette-Guerin (BCG) are not only protected against developing tuberculosis, but they are less likely to develop melanomas.

                                THE IMPORTANCE OF MULTIPLE SPECIES

          Although good bacteria can be found in small amounts in food, changing the entire ratio of gut bacteria requires substantial and consistent dosing with supplements providing potent levels of beneficial bacteria to enable their survival. {Therap Adv Gastroenterol. 2010 Sept;3(5):307-319.}  Two types of probiotic bacteria commonly used include Lactobacillus and Bifidobacterium. There are many specific types of the bacteria within each of these two broad groups, and health benefits associated with one type may be unique to that specific species and not hold true for others. This means that using multiple different species delivers better odds of reversing the negative effects of “dysbacteriosis”, a condition where there is an imbalance between good and bad bacteria. {Eur J Nutr. 2011 Feb;50(1):1-17 and Anaerobe. 2012 Aug;18(4):405-413.}

Probiotics and Allergy:  Lactobacillus and Bifidus reduce the risk of eczema for children when used by pregnant and breast-feeding women. Lactobacillus reduces symptoms of eczema/atopic dermatitis for children and adults. Probiotics prevent and treat food allergies. The neonatal gut starts out nearly sterile. Breast-feeding, the environment, use of antibiotics all influence the infant’s microflora. Probiotics play an important role in establishing and maintaining a child’s general health. There is also benefit in preventing upper respiratory tract infections.  Probiotics improve the endogenous intestinal barrier and enteral antigen balance; improve regulation of secretory inflammatory mediators; decrease the Th1/Th2 ratio and reduce serum IgE levels.

Probiotics for Infant Regurgitation:  In a randomized controlled trial, formula-fed infants (mean age: 6 weeks) received lactobacillus reuteri or placebo for 4 weeks. The median number of regurgitation episodes during the final 7 days was lower with active treatment than with a placebo: 1 vs. 4 episodes. {Eur J Clin Invest. 2011;41:417-422.}

Probiotics and Vaginosis:  The vagina and its microbiota form a finely balanced ecosystem dominated by  lactobacilli. Lactobacilli play an important role in maintaining a favorable vaginal acidic pH and hydrogen peroxide production. Probiotics can improve vaginal health, microbiota balance, and reduce and treat some vaginoses. For example, some women can prevent recurrent vaginal yeast infections by routinely douching with plain yogurt once per month. This replenishes normal vaginal flora with healthy probiotics that suppress yeast.

Probiotics for aspirin-induced GI damage: In a randomized trial, elderly patients taking 100 mg/day of aspirin who had unexplained iron deficiency anemia received L. casei (5.5 billion to 63 billion) for 3 months. Compared with a control group that did not receive probiotics, the L. casei group had significantly fewer small intestinal mucosal breaks and significant improvement in intestinal mucosal appearance. {J Gastroenterol. 2011;46:894-905.}

Probiotics before colonoscopy:  In a double blind study, constipated patients scheduled for colonoscopy received probiotics (Bacillus subtilis and Streptococcus faecium) or placebo 3 times daily for 2 weeks prior to the colonoscopy. Compared with placebo, the probiotics increased the proportion of patients who had a satisfactory bowel preparation (54.9% vs. 20.8%). {Dig Dis Sci. 1010;55:2344-2351.}

Probiotics may boost your mood. A gut full of beneficial bacteria seems to promote the production of brain neurochemicals that ease feelings of anxiety and depression, while an abundance of harmful  bacteria may actually trigger these symptoms.

                                                    TAKING “PREBIOTICS”

          Prebiotics are carbohydrates that feed the beneficial bacteria in your body. Prebiotics include: slightly green or under-ripe bananas; durum pasta or egg noodles; sourdough bread; boiled rice (especially arborio, S. Andrea, and originario); the pectin in green apples; onions, leeks, and garlic (raw or cooked); Jerusalem artichokes; asparagus; raw chicory root; cooked oats; blueberries; and cooked dried beans (pinto, black).

          Eating prebiotics feeds Akkermansia microphilia, a bacteria which helps to regulate the immune system; increases vitamin D receptors and helps to regulate their function; helps fat absorption; helps bile-salts to function as nutrient signaling molecules; and, causes decreased C. difficile in the gut. NOTE: CBD oil also helps to feed A. microphilia and helps improve gut health.

                                          SPECIFIC DISEASE BENEFITS

          Although research tying specific probiotic strains and species to particular diseases is still in its infancy, scientists have identified a few disease treatment benefits for six of the most studied probiotic species:

  1. Lactobacillus acidophilus:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis. Increased HDL  (good) cholesterol.  Improved markers for metabolic syndrome, inflammation, and heart disease.  Improved allergy-driven immune response.  Improved markers  for ulcerative colitis and irritable bowel disease.   Increased control of blood sugar. Decreased   the DNA damage that can trigger malignant cell development.
  2. Lactobacillus rhamnosus:   reduced diarrhea and improved bowel comfort in cases of radiation-induced enteritis. Improved markers for metabolic syndrome, inflammation, and heart disease. Reduced  allergic response to milk in milk sensitive patients. Improved markers for ulcerative colitis, Crohn’s  disease  and improved irritable bowel syndrome. Also, there is an important association with helping with weight loss.
  3. Lactobacillus paracasei:  enhanced therapeutic management of minimal hepatic encephalopathy. Improved markers for metabolic syndrome, inflammation and heart disease in elderly patients. Improved markers  for ulcerative colitis.
  4. Bifidobacterium lactis:  improved immune function in healthy elderly individuals. Greater weight  gain and less gut inflammation in preterm infants.  Improved  immune response and respiratory symptoms from birch pollen allergies in children. Increased control of blood sugar.
  5. Bifidobacterium bifidum:  improved markers for liver inflammation and damage in alcohol-related liver disease. Improved inflammation profiles in ulcerative colitis.
  6. Bifidobacterium longum:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis.  Increased  HDL cholesterol.  Improved  markers for ulcerative colitis and Crohn’s  disease. Decreased  the  DNA damage that can trigger malignant cell development.  They improve cognition and decrease stress physiology and behavior. {This was not noted when people were given Lactobacilli because different bacterial strains will cause different effects.
  7. The probiotic Lactobacillus Reuteri lowers cardiovascular risk:  L. reuteri 30242 produces an enzyme called bile salt hydrolase which makes cholesterol less absorbable so that it becomes trapped in the gut and later excreted in fecal matter. Further cholesterol reduction comes from the organism’s ability to increase cholesterol metabolism, thereby promoting its breakdown and excretion. It additionally reduces inflammatory markers.  A proprietary product called “FlorAssist Heart Health Probiotic” is available from www.LifeExtension.com.  
  8. Saccharomyces cerevisiae, is a yeast found in sourdough bread, which helps to normalize intestinal microbial flora and specifically relieve symptoms associated with irritable bowel syndrome. Also, Saccharomyces Cerevisiae-Derived Peptides (SCDP): 500 mg twice per day help to induce weight loss by limiting calorie intake by modulating appetite regulating hormones, reducing new fat production, reducing body weight and fat mass, and, most importantly, reducing the size and weight of dangerous abdominal fat. Having a waist circumference out of proportion to BMI is an important cardiovascular risk factor. A proprietary product is available from www.LifeExtension.com called “Eatless peptide complex”. {Additionally, Perilla frutescens is an herb in the mint family that has beneficial flavonoids, especially vicenin-2 and rosmarinic acid which inhibit excitatory nerve and muscle activity in the intestines, which relaxes gut motility and reduces pain perception. It reduces inflammatory signaling molecules. And, it also supports the intestinal barrier reducing permeability–leaky gut. A proprietary product containing 150 mg of Perilla leaf extract plus the probiotic Saccharomyces cerevisiae called “Tranquil Tract” is available from www.LifeExtension.com.
  9. Another product combines a 15 billion colony forming unit blend of 6 different probiotics PLUS 4 types of BACTERIOPHAGES called “Florassist GI with Phage Technology”.  The addition of bacteriophages is designed to remove unwanted bacteria in the intestines to make room for the beneficial probiotics. Phage cocktails have been used successfully in numerous human clinical and therapeutic settings to treat common bacterial invaders, including staph, strep and E. coli. They have demonstrated an extremely strong safety profile. Phage therapy encourages the growth of healthy bacteria in the gut microbiome which can competitively reduce harmful bacteria. Developed more than 100 years ago, phage therapy is experiencing a revival with the rise of antibiotic-resistant bacteria.
  10. S. salivarius strain BLIS M18 and Bacillus coagulans GBI-30, 6086 supplementation results in significant improvement in oral and gum health. S. salavarius produces enzymes that help break down dental plaque and neutralizes acid to maintain a healthy oral pH.  A low pH demineralizes teeth and creates an environment in which bad bacteria thrive. It produces “lantibiotics” that kill competing organisms associated with periodontitis and reduces levels of cytokines associated with gingivitis. Bacillus coagulans competitively inhibits the growth of Streptococcus mutans which contributes to tooth decay and also reduces the production of inflammatory cytokines that promote the inflammatory response. A proprietary product is available from www.LifeExtension.com called “Florassist Oral Hygiene”.
  11. S. salvarius K12 promotes throat health by helping to regulate inflammation and reduce damage caused by organisms that reside in the throat. It produces locally acting lantibiotics that target and inhibit beta hemolytic streptococcal infections. Clinical studies demonstrate a significant reduction in strep throat infections in people supplementing with S. salivarius K12 lozenges. It also contributes to a reduction in viral sore throats attributed to a reduction in cytokine signaling molecules including interferon gamma. A proprietary product is available from www.LifeExtension.com called “Florassist Throat Health.”
  12. The combination of Lactobacillus helveticus R0052 plus Bifidobacterium longum R0175 helps to restore normal neurochemical and hormonal balances that obviate the symptoms of anxiety and depression. This combination also helps to decrease anger and hostility scores and chronic stress levels, and improved mood scores, and reduced stress induced abdominal pain, nausea and vomiting. A proprietary product is available from www.LifeExtension.com called “Florassist Mood”.
  13. Pu-erh Tea is a unique probiotic. It is made from Camellia senensis leaves in the Yunnan district of southwest China. Fully fermented black tea is aged under high humidity and molds and bacteria grow on the leaves. It has less caffeine than black tea and the bacteria produce a small amount of lovastatin which can help to lower lipids. It is an acquired taste because the tea may smell musty and taste stale.
  14. Lactobacillus helveticus can improve sustained attention, especially in older adults.

          A probiotic that is 100 times more potent than the average probiotic is called “VSL#3” containing 3 species of Bifidobacterium, 4 species of Lactobacillus, and 1 species of Streptococcus. There are 450 billion bacteria in each flavored and unflavored packet that can be mixed into cold or room temperature beverage or soft foods, or a vegetarian capsule that contains 112.5 billion bacteria in each capsule. It can be obtained from www.vsl3.com. Prescription strength “VSL#3-DS” (double strength) contains 900 billion live cultures of bacteria. It is particularly helpful for gastrointestinal problems including IBS and Ulcerative colitis. There are no adverse effects nor risk of overdosing.

                                                   LEAKY GUT SYNDROME

          Leaky gut syndrome may be the underlying cause for developing and exacerbating auto-immune diseases.  Zonulin is a protein at the tight junction between the epithelial cells lining the small intestine which selectively opens up the space between enterocytes and allows certain substances to enter the body while keeping others in the gut.  It is thought that large protein molecules, foreign substances and even microorganisms can enter the blood stream when the space at the tight junction between cells in the small  intestine is wider than it should be. Antibodies then target these antigens that don’t belong in the body, and an immune response develops. Where an auto-immune disease develops is a function of the antibodies attacking similar proteins in the body. Thus, the same basic problem has many manifestations. The tight junctions between enterocytes are perpetually opening and closing in response to a plethora of stimuli such as food, hormones, inflammatory markers, and the dietary state. Certain microorganisms can hijack the cellular pathways at these tight junctions or increase the zonulin levels, leading to increased gut permeability. One of the most powerful triggers is gliadin, a protein found in wheat. Like gluten, it has been linked to celiac disease. The idea that a porous intestine directly leads to disease is controversial. However, physicians don’t know enough about the gut, which is our biggest immune system organ, so we need to acknowledge our ignorance and keep an open mind because this theory may indeed be an accurate explanation. Food sensitivities are real. I believe that probiotics are essential for management. Also, anecdotally, thousands of people have benefitted from a gluten/gliadin-free (wheat free) diet even if they test negative for celiac disease. Additionally, nutritional supplements such as glutamine can be beneficial. 

                                                                    DYSBIOSIS

          When the ratio 85% “good microorganisms” to 15% “problematic microorganisms” of a healthy gut is disturbed, a condition called “dysbiosis” occurs. Also, an overgrowth of certain organisms can cause this problem, such as an overgrowth of Candida albicans. For example, 2 phyla of anaerobic bacteria, Firmicutes and Bacteroidetes, are so-called “fat-bugs” because they are associated with obesity. Food emulsifiers and artificial sweeteners enhance the growth of these bacteria which also results in insulin resistance. These fat-bugs can cause food cravings and manipulate our behavior: they change the number of dopamine receptors AND also change the reward centers in the brain. We need the balanced 15% problematic bacteria to keep our GALT stimulated so that our immune system can help us to prevent and fight off an infection. The GI tract is really the external world inside us, so we need this protection.

                                                 THE GUT-BRAIN CONNECTION

          The “Enteric Nervous System (ENS)” is separate from the Central Nervous System (CNS). It is composed of 2 thin layers of over 100 million nerve cells—more than in the spinal cord. The ENS lines the GI tract and controls blood flow, secretions and contractions. It also helps us to unconsciously “feel” (like a second brain) what is occurring in the GI tract. It has glial cells to support the gut neurons. It uses over 40 different neurotransmitters. It produces 50% of the body’s dopamine and 95% of the body’s serotonin. L. brevis can produce GABA. It has a barrier, similar to the blood-brain barrier, for protection. It may have its own memory (although it is not capable of thought). The gut and the brain are connected by the vagus nerve with about 90% of the signals going from the gut to the brain. {The vagus nerve also connects cardiac functions.} The bi-directional communication occurs by various physiological channels including autonomic pathways, neuro-endocrine pathways and neuro-immune pathways. People with Parkinson’s disease have the same protein clumps in the ENS as in the CNS. And, people with Alzheimer’s disease have the same neurofibrillary tangles and amyloid plaques in the ENS as in the CNS. {Thus, a gut biopsy may make earlier diagnosis possible.} 

          Both external and internal STRESS can create a challenge or a threat that disrupts an organism’s homeostatic balance. It can alter the composition and the function of the gut microbiota. For example, maternal stress can affect the fetal gut microbiome directly and through epigenetic factors. This can affect systemic dysregulation in early life and persist into adulthood. Potentiation of heightened anxiety may be transmitted because of this complex mixture of both biological factors as well as psychological factors that act in feedback loops. Chronic stress is associated with dysregulation of the hippocampal-pituitary-adrenal (HPA) axis. Irritable bowel syndrome results from a heightened gut sensitivity and limited ability to modulate an acute stress response.

          Vaginally delivered infants have a different and increased variety of  microbiotia than babies born by C-section. (Variability in flora becomes similar by about 8-weeks.) Hospital use of antibiotics and different feeding patterns (bottle vs. breast-feeding) also affect neurobiological development. Aging adults in long-term facilities compared to living in their communities have less diversity in their gut microbiome. 

          Changes in the microbiota may help to ameliorate psychological disorders. A probiotic cocktail has been associated with improving depression on the Beck Depression Inventory. L. helveticus can improve sustained attention in older adults. Polyunsaturated omega-3 fatty acids modify the gut microbiota resulting in improved cognition, dampened HPA activity with less anxiety and depression, and improved psychological well-being.

                                                THE GUT-HEART CONNECTION

          Probiotics can reduce both systolic and diastolic blood pressures. The greatest effect is found when the baseline BP is elevated and when the daily consumption is >100 billion colony forming units for over 8 weeks duration. Lactobacilli help to reduce blood cholesterol levels. Some bacteria express the enzyme bile salt hydrolase which affects intestinal cholesterol reabsorption. Yogurts help to decrease total cholesterol andLDL-cholesterol and improve the LDL/HDL ratio. There is an inverse relationship between fiber consumption and CVD: the more fiber ingested, the less the risk for CVD. Prebiotics stimulate bacteria to produce butyrate which helps to lower cholesterol, triglycerides and atheroma plaques.

          Modifiable risk factors include: 1) Obesity: Germ-Free mice (GF-mice) are a useful model. They are leaner than wild mice. When there is a fecal transplant from obese mice to GF-mice, they become fatter than from lean mice donors. 2) Cholesterol levels: certain gut microbes, such as Eggerthella, Pasteurellaceae and Butyricimonas alter the bile acid pool which modulates hepatic and systemic lipid and glucose metabolism. 3) Toxic burden: microbes can directly alter chemical activity and structure; produce metabolites that compete for detoxification pathways; and, affect expression of detoxification enzymes. 4) Leptin and Insulin resistance: microbial fermentation of dietary fiber produces a short-chain fatty acid called butyrate which increases leptin expression in adipocytes and improves insulin sensitivity. 5) Inflammation: gut microbes mediate inflammatory signals. Age-associated dysbiosis causes increased inflammation and increased CVD. 6) Nutrient deficiency: gut microbes synthesize B-vitamins, vitamin K and vitamin C and some are absorbed by the host. However, “greedy microbes” may preclude absorption. 7) TMAO and Heart disease: Trimethylamine-N-Oxide (TMAO) is produced via microbial metabolism of choline to trimethylamine (TMA) with subsequent oxidation in the liver. An increased amount of TMAO is an independent risk factor of increased CVD. It is microbial dysbiosis, and not dietary choline, which is the problem.

          The liver is a key player between the gut and the heart during nutrient deprivation (that is, fasting). In fasted GF-mice, the heart relies upon glucose metabolism for energy. Evolutionarily,because the heart needs a constant supply of energy to function, it has the capacity to use different substrates, depending upon availability. In mammals, fasting conditions cause an increased production of ketone bodies in the liver which results in increased ketone utilization by the heart, brain and other tissues. Gut microbes can cause increased acetate production which increases the pool of hepatic Acetyl CoA which is the starting molecule for ketone production.

          Gut pathologies and CVD: 1) Dysbiosis: animals with hypertension have an increased Firmicutes to Bacteroides ratio, and they have decreased bacterial diversity and richness. Also, they have decreased butyrate and acetate microbial metabolites with resultant increased inflammation. People with chronic CHF also have decreased microbial diversity and diminished important bacterial genra. 2) Small Intestinal Bacterial Overgrowth (SIBO): is associated with increased arterial stiffness and decreased Matrix Gla Protein (MGP), which when activated prevents the calcification of blood vessels. Decreased MGP is related to decreased vitamin K absorption by the small intestines and/or to decreased vitamin K production by colonic bacteria. Also, SIBO causes systemic inflammation which is associated with increased CVD. 3) Infections: Chlamydia pneumoniae and Helicobacter pylori infections are associated with increased CVD. Patients with chronic CHF had increased quantities of pathogenic bacteria, including Campylobacter spp, Shigella spp, Salmonella spp, Yersinia enterocolitica, and Candida spp in their colons. Bacterial DNA can be identified in >50% of coronary plaques. 4) Intestinal Permeability: A “leaky gut” allows bacteria and their metabolites to enter the blood stream, triggering an immune response, and allowing them to become associated with the heart. TLR4, a receptor of the adaptive immune system, binds to lipopolysaccharides which are a component of gram-negative bacterial cell walls. This binding initiates inflammatory signaling. In mice, if the TLR4 receptor is ablated, there is decreased atherosclerotic plaque formation. Increased intestinal permeability both induces inflammation and weakens coronary plaque stability. {Plaque rupture is the trigger for an acute MI.} Patients with chronic CHF have increased intestinal permeability compared with healthy controls.

                                         SUGGESTIONS TO HEAL A LEAKY GUT

    1. Eat probiotic rich foods—fermented foods like kefir, yogurt and sauerkraut.
    2. Eat raw honey and bee pollen.
    3. Get a dog or a cat for a pet.
    4. Swim in the ocean.
    5. Get grounded: “Earthing”.
    6. Regularly take soil-based, spore-forming probiotics, such as “Megasporebiotics”.
    7. Eat locally from Farmer’s Markets.
    8. Substitute for cow’s milk: such as coconut milk, almond milk, hemp milk, rice milk, goat milk or sheep milk.
    9. Substitute for wheat flour: coconut flour, almond flour, manioc (tapioca) flour, sprouted ancient grain flours such as buckwheat, sorghum, amaranth, quinoa and millet.
    10. Choose healthy oils: coconut oil (or manna), olive oil, flaxseed oil.
    11. Substitute for sucrose (table sugar): honey (especially manuka honey), green leaf stevia, maple syrup.
    12. ***Use BONE BROTH: it contains gut sealing collagen, key amino acids (proline, glycine, and glutamine), and easily absorbed minerals.

NOTES:

  • Coconut products are high in lauric acid which kills pathogenic bacteria and fungi.Fermented vegetables enhance nutrient absorption and provide both prebiotics and probiotics.
  • Fermented daily products (kefir and yogurt) provide probiotics and decreased lactose.
  • Cooked vegetables, especially boiled or steamed) are easier to digest than raw and are packed with vitamins, minerals and antioxidants.
  • Grass-fed meats and wild-caught deep sea fish have increased omega-3 fatty acids.
  • Soil-based organisms help heal the gut. a) Bacillus subtilis elicits an immune response that supports healing the gut lining and suppresses pathogenic bacteria. b) Bacillus coagulans improves nutrient absorption. Spores are activated by stomach acid and bile salts and produce lactic acid in the intestines which helps to reduce inflammation.
  • Medicinal mushrooms, such as Cordyceps, Reishi, Shiitake, Lion’s Mane, and Turkey Tail, help to balance microbes in the microbiome. They supply prebiotics to keep them fed. They boost the immune system, detoxify chemicals and heavy metals, and help to reduce histamine release. They inhibit pathologic immune responses in auto-immune disorders, destroy tumors and cancer cells, and help to fight viruses and Candida. They act as adaptogens to balance cortisol and stress responses.
  • Blue-green Algae, such as Spirulina and Chlorella, are nutrient rich.
  • Beneficial yeast, such as Saccharomyces boulardii destroy pathogenic bacteria and improve diarrhea; relieve intestinal gas and bloating; repair intestinal wall mucus membranes; strengthen GALT; help inflammatory bowel disease; help acne; and, help destroy Candida albicans.
  • Bentonite clay (1 teaspoon 3x/day) can help with constipation and cleansing the intestines. However, too much along with not enough water can be constipating.
  • Bone Broth is nutrient dense, easy to digest, full of collagen and the beneficial amino acids proline, glycine and glutamine. It helps to decrease inflammation and heal a leaky gut by restoring the mucosal lining. It provides easily absorbed minerals such as calcium, phosphorus, magnesium, silicon and sulfur. It contains glucosamine which helps to stimulate and heal the immune system. Beef bone broth is high in types 1 and 3 collagen which helps the skin and nails. Chicken bone broth is hight in type 2 collagen which helps the gut and joint cartilage. Fish bone broth is high in type 1 collagen which helps to produce human type 1 collagen which is found in 90% of the body. Drink 1 to 2 cups of bone broth daily “to heal and seal”.

          

                                       CONSIDERATIONS FOR THE FUTURE

  1. Treating colitis with fecal transplants to re-establish healthy gut flora in patients who have received antibiotics with consequent resistant C. Difficile infections.
  2. Banking a patient’s own microbiome before chemotherapy in order to be re-inoculated them afterwards to speed their recovery.
  3. Treating babies with microbes that shape the immune system to stave off autoimmune diseases like asthma and psoriasis. For example, c-section babies, who miss out on their mother’s vaginal flora through a passage through her vagina, can be washed with their mother’s vaginal fluid after birth to give them a similar protective advantage.

An Interesting story:  Soldiers stationed in Morocco during World War II were getting gravely ill with dysentery, and no one could figure out why or how to stop it. They noticed that locals weren’t getting as sick. When Moroccans began to get ill, they would follow their camels and eat the droppings. Although  this seems disgusting, we now know that the droppings were full of B. subtilis bacteria which cured the disease.

Dr. Chuck Wile, Seminar Series at the Cheng Integrative Health Center, on 12/4/17

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FIBROMYALGIA SYNDROME (FS) MANAGEMENT SUMMARY

Fibromyalgia syndrome is a collection of symptoms without a known cause. Commonly people may experience pain trigger points and generalized pain, fatigue, sleep disruption, anxiety and depression, “brain fog” with difficulty concentrating, chronic headaches, touch sensitivity, environmental sensitivity, muscle spasms, muscle and joint stiffness, and bowel problems. Based on large amount of research, Dr. Dan Purser, MD proposes that the underlying cause for FS is copper toxicity. Because of a genetic defect, there is an excessive amount of the metabolite of hemaglobin, known as Pyrrole, which is bound to the body’s key antioxidant, glutathione, for urinary excretion, decreasing the quantity of glutathione. Also, excretion of pyrrole pulls zinc, vitamin B6 and other nutrients from the body. This creates an imbalance of the copper and zinc ratio in the body resulting in an excess of  “free copper”, unbound to ceruloplasmin. This “free copper” deposits in muscles causing pain and systemic toxicity. Molybdenum is a co-factor for enzymes that help to detoxify copper and other heavy metals. With FS, there is also a molybdenum deficiency. The detoxifying enzymes are consequently dysfunctional. Thus, the primary treatment for FS involves first supplementing with zinc and vitamin B6, then, slowly adding molybdenum. Additionally, supplementing with topical glutathione and other nutrients helps people to experience significant symptom relief. An additional hypothesis regards FS as a mitochondrial defect. Thus, supplementing with phospholipids, the adrenal hormone DHEA, various nutrients, and oxytocin has also been helpful.

Contributed by Dr. Chuck Wile, MD

-This again shows the importance of balance (or the lack thereof) of various nutrients, vitamins, as well as the importance of mitochondria in our health. Those diagnosed with FS should schedule an appointment to see us for a proper workup and treatment.  – Dr. Richard Cheng

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