Tan Medicine

Diet for Suspected Carbohydrate Maldigestion/Malabsorption

2011-10-12T09:59:00.000-07:00

Here is a quick overview of foods that are allowed/not allowed when carbohydrate maldigestion/malabsorption is suspected.

What is carbohydrate maldigestion/malabsorption?
Many of us are familiar with lactose intolerance, which means the inability of the body to break down, to digest and to absorb lactose--which is a type of sugar or carbohydrate that is found in milk. Inability to break down this type of carbohydrate causes gas, bloating and sometimes diarrhea.

While lactose intolerance is the most widely known carbohydrate maldigestion syndrome, other forms of maldigestion exist. Some of the most common ones include the inability to properly break down the carbohydrates or the cellulose in vegetables and grains. Animals and humans have different abilities to digest carbohydrates. For example, cows can easily digest grass and hay. Humans on the other hand, cannot digest grass and hay, but there are plants--we call vegetables and grains--that we can digest and derive nutrition from. However, not everybody's ability to digest vegetables is the same (similar to the idea that not everyone's ability to digest lactose is the same).

Below is a quick view guide of foods that are generally okay and generally "not allowed" when someone is doing an elimination-challenge diet to test the idea of carbohydrate malabsorption might be causing gastrointestinal problems.

If you have any questions about this diet, please add a comment below.

Quick View

	Generally Okay	Not Allowed	Notes
Meat and Fish	chicken, turkey, fish, beef, lamb, shellfish, scallops	Processed meats such as hot dogs, cold cuts, smoked foods, fast food type meats	Some good quality processed meats (there are many at Whole Foods) that do NOT have added sugar or carbohydrates may be allowed. Read the label, if there are no or very low carbohydrates and sugars, then it should be okay.
Vegetables	Fresh or frozen, but all vegetables should be cooked: spinach, carrots, tomatoes, squash, beets, asparagus, cauliflower, eggplant, pumpkin, waterress, string beans, onions, garlic.	For some people, members of the brassica family may be harder to digest; a solution would be to cook them longer or eat smaller amounts--broccolli, kale, chard, cauliflower, bok choy.	No raw vegetables in the beginning. If you seem to have symptoms from a particular vegetable, cook them longer the next time to break down molecules.
Grains/Complex Carbs	None	No bread, rice, pasta, potato, sweet potato, quinoa, corn, barley, rye, amaranth, flour substitutes, couscous, garbanzo beans, hummus, yams, okra, mungbeans, soybeans--soy beans, soymilk, tempeh, tofu, seitan, etc	Lentils, split pea and white beans may be allowed starting around month 2-3, if symptoms improve at that time. These should be soaked for 12-24 hrs (soaking water discarded) before cooking. Anecdotally, many are also able toL tolerate quinoa.
Fruit	Ripe bananas (with brown spots on the skin; not fully ripened bananas contain a lot of starch/complex carbs); apples, pears, blueberries, strawberriesIf still having loose stools or diarrhea, it is best to avoid all fruits even those above. Start on fruits only once the symptoms have become stable.	Canned or dried fruit with added sugar/corn syrup/sweetener.	With active diarrhea, no raw fruits, except for ripe bananas. If you find that you cannot tolerate fruit, you can poach them in hot water with some honey to further break down molecules. Limit to 1 cup of fruit a day because fruit contains sugar which can feed the microorganisms.
Dairy	Butter, ghee, some cream.	Milk, processed cheese, whey protein powder, mozzarella, ricotta, margarine, yogurt
Oils	Almost all oils are okay: olive oil, coconut oil, soybean oil, butter, corn oil
Nuts	Peanut butter, almond butter, almond flour, hazelnuts, pecans	Processed nuts or “honeyed” nuts that contain sugar or starch
Sweeteners	Honey	sugar, corn syrup, high fructose corn syrup, molasses, maple syrup, stevia, chocolate, carob, cocoa, sucralose or splenda
Spices	Amost all spices are allowed except for “pre-mixed” spices which contain sugar or starch or dextrin or modified starch or maltodextrin
Drinks	Water Tea Coffee-no sugar, some cream		If diarrhea has subsided, Diluted fruit juices (50-50) with no added sugars Very dry wine (because this means the sugars have been fermented into alcohol)-2 servings/week

Hypothyroidism 101

2011-09-18T20:51:00.000-07:00

Hypothyroidism or low thyroid function affects 5% of the total population but up to 15% of women. The incidence increases with age.

Symptoms include:

Fatigue, low energy (99%)

Weight Gain

Gets cold easily (89%)

Dry or coarse skin (89%)

Constipation (61%)

Hair Loss

Forgetfullness (61%)

Irregular menses

Elevated cholesterol

The above is not a complete list and as you may notice, the symptoms are not very specific because they could be caused by other health issues.

Because of this, lab tests are usually done to prove or disprove the the diagnosis of hypothyroidism.

TSH (Thyroid Stimulating Hormone). Higher levels of TSH indicates decreased thyroid function. What is normal TSH?
T4 is the less active form of thyroid hormone. Medications like Levothyroxine and Synthroid are forms of T4.
T3 is the more active form of thyroid hormone. Medicatons like Cytomel are T3.
T4 is converted into T3 primarily in the liver, but also in the kidneys. The co-factors for converting T4 to T3 include the nutrient selenium and iron.

Hypothyroidism is usually treated with thyroid hormone replacement. Optiions include:

T4=Synthroid, Levothyroxine
T3=Cytomel
Combination T4/T3= Armour, Nature-Throid

What is Normal TSH?

2011-09-18T20:50:00.001-07:00

TSH or Thyroid Stimulating Hormone is secreted by the pituitary gland in response to the levels of thyroid hormones circulating in the body. If the amount of thyroid hormone (T4 and T3) are too low, TSH will go up to stimulate the thyroid gland to produce more hormone. (Hypothyroidism 101)

Therefore, when TSH goes up--it means that the thyroid is under-functioning and needs more stimulation to produce thyroid hormone. TSH is one main way to diagnose hypothyroidism or low thyroid gland function.

What is considered normal TSH? Normal TSH values are stated on the lab report, each lab has a different range depending on the type of test they use, as well as the "normal" population they measured from. Typically, normal TSH is between 0.4 to 4.5 or 5.5. The higher the TSH, the worse performing the thyroid gland is (therefore, you generally want a lower TSH).

However, there is a debate as to what the normal range should be.

When I was in naturopathic medical school in 2003, the upper limit of normal range was as high as 10.5. Currently, the upper limit of normal TSH is 4.5 or 5.5. Some scientists think that normal TSH values should be lower than they currently are. A number typically quoted is an upper limit of 2.5. This is because 95% of the population has TSH levels that are between 0.4 and 2.5. I have had obstetricians and pre-natal clinicians send their patients to me with TSH levels of 4.2 recommending that I start them on thyroid hormone to bring their TSH levels down to 2.5 or below (hypothyroidism during pregnancy can lead to mental retardation).

What number do I use in clinical practice?

I do not adhere to a black and white diagnosis of hypothyroidism based on TSH values only. The decision of whether or not to treat someone with thyroid hormone should be done on a case to case basis. If I have a patient who has a TSH of 4.2, and who has symptoms of fatigue, difficulty thinking, weight gain and feeling cold all the time, or has fertility issues, or has with positive antibodies and with no other good medical explanation of those symptoms--I would seriously consider a trial of thyroid hormone. (Which thyroid hormone to use?) This is very reasonable in my opinion. On the otherhand, if somebody has a TSH of 4.2 but does not have any symptoms, I probably will not treat because you expose someone to the risks of taking a medication with no clear benefit you are working towards.

Armour Thyroid vs Synthroid/Levothyroxine

2011-09-18T18:21:00.000-07:00

Question:
Dr. Tan, can you explain the difference between Armour Thyroid and Synthroid or Levothyroxine? Do you have a preference between the two?

Answer:
If you've been diagnosed with hypothyroidism, you'll know that Armour Thyroid, Synthroid, Levothyroxine are all different types of thyroid hormone medication.

First, some background. The thyroid gland produces different types of thyroid hormone, the most important of which are T4 and T3. T4 makes up the majority of thyroid hormone made by our thyroid glands, it is weaker and is considered to be a "reserve" form of the hormone. T4 is converted into T3 (which is considered to be more potent or active) in peripheral tissue such as the liver, kidney and intestines.

Synthroid, levothyroxine, levothroid are all different medication names for T4. These are the most widely prescribed thyroid medication. The assumption is that the person taking these medications are able to convert T4 (reserve form) to T3 (active form) efficiently. The benefits of taking plain T4 is that it is stable, it has a long half life, and patients would often not feel a major difference if they do not take their dose at exactly the same time everyday.

Armour Thyroid is made from dried pig thyroid gland and therefore contains both T4 and T3 naturally. The ratio of T4 and T3 in Armour Thyroid is similar to human thyroid hormone output, but not exactly the same. The benefit of taking Armour Thyroid is that it naturally contains T3 (active form) already and may be helpful for people who do not convert T4 to T3 well (there may be several reasons for this including nutritional deficiencies). The downside is that if a patient skips a dose, they will feel more than if they were taking plain T4 because the T3 component of Armour Thyroid is more potent and it also has a shorter half-life in the body. Nature-Throid, West-Throid are other brand names of T4/T3 combination thyroid medications.

Do I have a preference? Armour Thyroid seems to make more sense to me than plain T4 because it more closely resembles how our body naturally produces thyroid hormone--which is a combination of both T4 and T3. However, some patients may have problem taking a medication sourced from pigs/animals; in these situations, if a patient is NOT doing well on Synthroid/Levothyroxine/Levothroid despite normal TSH levels, and need some T3, I may add in some Cytomel which is a pharmaceutical form of T3 to augment the T4.

IBS: Exercise Helps 43% of IBS Sufferers

2011-01-20T12:30:00.000-08:00

Exercise has long been known to improve constipation. But a new study published in American Journal of Gastroenterology also shows that exercise can improve other symptoms of IBS (Irritable Bowel Syndrome) including gas, bloating, constipation and diarrhea. IBS is estimated to affect up to 15% of Americans. In this study,

43% of those who exercised experienced a significant improvement, defined as something that "it made a difference in their daily lives."
exercise means 20 to 60 minutes of moderate to vigorous exercise, such as brisk walking or biking, for 3 to 5 days a week
too much exercise can worsen diarrhea in some people

Given that exercise is generally safe and provides other benefits such as weight loss or maintainance and cardiovascular fitness, my opinion is that regular exercise should be part of the most basic treatment plan for IBS.

GERD Trigger Foods

2010-12-20T11:31:00.000-08:00

Patients with GERD--which is typically experienced as heartburn or sometimes chest pain--frequently ask if diet changes can help. Here is a list of common food triggers to avoid:

a. Reduce the fat content of every meal.
b. Avoid if possible: *** are most common triggers

1. refined sugar
2. caffeine ***
3. alcohol ***
4. chocolate
5. onions
6. peppermint
7. spearmint
8. tobacco
9. spicy foods ***
10. milk products
11. tomato ***
12. citrus
13. wheat*** (I don't see this published in many journal articles, but anecdotally, many of my patients tell me that eliminating wheat has been helpful; and eating a lot of wheat makes symptoms worse)

GERD--Lying on Left Side Helps

2010-12-20T11:24:00.000-08:00

GERD (Gastroesophageal Reflux Disease), where acid from the stomach goes up into the esophagus causing heartburn, affects up 20% of the adult population sometime in their life. Among those with GERD, up to 70% will have symptoms worse at night when lying down.

Treatments include: avoid trigger foods (including reducing fat and alcohol in meals), eating smaller portions, and the use of proton pump inhibitors such as Prilosec.

One interesting study found that lying on the left side might also be helpful--specially for those who feels their symptoms mostly when lying down at night.

Walking 6 Miles a Week Promotes Brain Health

2010-10-14T10:57:00.000-07:00

Several new studies this year show that keeping active can help preserve or promote brain function.

A study done at the University of Pittsburg showed that those who walked at least 6 miles per week showed less brain shrinkage than people who walked less. This study was done over a period of nine years and used MRI's to verify brain size. Other studies show that exercise not only prevents brain shrinkage but that in fact this translates into better cognitive function.

What does this mean?

It means aiming to walk about One Mile Everyday of the Week.

Hearty Chicken Soup Recipe

2010-08-08T21:19:00.000-07:00

Ingredients:

1 pound chicken breast or thigh or combination, no skin
3 heads garlic
1 whole onion, chopped
5 sticks celery, chopped
3 whole carrots, chopped
1-2TB Olive Oil
1 bay leaf
2 cups spinach (optional)
2 cups cabbage, chopped (optional)
Salt, black pepper to taste

Heat olive oil in a cooking pot, then add the pieces of chicken to light cook them on each side. Use a wooden spoon to break the chicken into smaller bite-size pieces

Add the 3 heads of garlic and chopped onion to sweat, about 3 minutes

Add the chopped cellery and chopped carrots to sweat, another 3 minutes

Pour some hot water into the pot (about 1.5 quarts)

Add the bay leaf, bring the soup to a boil

Simmer for 30 minutes to 1 hour, add salt and pepper to desired taste

The soup will have 4 servings and keeps well in the refrigerator.

Breakfast Smoothie

2010-08-08T21:15:00.000-07:00

Here is a convenient and delicious breakfast smoothie that is full of protein and phytochemicals (anti-oxidant plant pigments). The addition of Thorne Mediclear Plus also provides essential multivitamin-minerals and detox factors.

In a blender, add the following ingredients:
Room temperature water
1 cup frozen blueberries (such as from Trader Joe's)
5 pieces frozen strawberries

Blend
Add 2 scoops Thorne Mediclear
Add 1 TB Nordic Naturals Cod Liver Oil Orange Flavor (optional)
Add stevia (optional) or honey (optional)

Blend again

Recipe: Chicken Vegetable Soup

2010-08-08T19:56:00.000-07:00

½ lb grilled chicken or fresh chicken or left over chicken - cubed
1 diced carrots
1 diced zucchini
1-2 handfuls spinach leaves (add at end)
1 clove garlic, minced

Heat some oil, add garlic to extract flavor, add carrots, zucchini to sweat, then add
2-4 cups chicken broth to boil, for 20-30 minutes

then add spinach and cook for another 3-5 minutes

Recipe: Carrot Soup

2010-08-08T19:53:00.000-07:00

1-2 lbs. organic carrots, chopped into one inch chunks

4 cups organic chicken or vegetable stock

1/2 cup onion, minced

1 clove garlic, minced

2 TBS olive oil

1 Bay Leaf

Salt and Pepper to Taste

Optional Seasonings:

Add shredded ginger to the soup to create a carrot-ginger soup

Heat olive oil in a pot.

Add minced onion and garlic until they are soft, usually 3-5 minutes

Add carrots and toss in the oil/onion/garlic mixture

Add the stock and bay leaf, let simmer for 20-25 minutes until carrots are very soft

Remove the bay leaf

Put carrots and stock in a blender and blend until you get a creamy texture

Serives 3-4

Dairy Elimination & Phlegm

2010-04-14T18:11:00.000-07:00

For years, naturopathic doctors have recommended that patients who have frequent colds, allergies, congestion, asthma, sinusitis or are who are simply more prone to these conditions to consider a trial of eliminating dairy from their diet.

This is based on an observation that some people do better (by having less phlegm and congestion) when they avoid dairy, which includes milk, cheese, yogurt and whey. If they benefit from dairy elimination, great! If it doesn't make a difference, then at least they know that dairy does not affect their symptoms.

A new study may explain why. It turns out certain types of milk contain a protein called beta-CM-7 which stimulates mucus cells in the respiratory tract to produce more mucus.

Again, dairy does not have this effect on everyone, only a certain group of people react to beta-CM-7 this way. It's worth noting also that some may react to one type of dairy, but not to other types (say, someone can react to milk but not yogurt). While it's difficult to predict who will react and to what type of dairy, I advise my patients to just test it out--one type of dairy at a time.

Better Foods for Better Moods

2009-11-23T16:01:00.000-08:00

There are yet more reasons to prefer whole unprocessed foods vs processed foods.

A study published in the British Journal of Psychiatry (November 2009) which tracked subjects from 1985 to 2004 showed that those who ate whole foods more frequently had: (1) less probability of being depressed; (2) almost half as likely to develop diabetes. An interesting side note, the study noted that people who ate more processed foods were also more likely to be divorced.

Here is more information on what a whole foods diet looks like. If you plan to embark on increasing your vegetable intake, refer to this list of foods with the highest/lowest amount of pesticides.

How to Quit Smoking

2009-11-23T15:30:00.000-08:00

Quiting smoking is not easy and may need several attempts before success. Aside from increasing the risk for lung/throat/mouth cancers and asthma, smoking is also a risk factor for gum disease, heavy metal exposures and more frequent colds and infections.

This new study published in the Archives of General Psychiatry (November 2009), shows that a combination of the nicotine patch plus a nicotine lozenge seems to be most effective. The abstinence rate at 6 months is 40% for those on nicotine patch + lozenge vs. only 34% for those on nicotine patch alone; those who only took the drug Buproprion (aka Wellbutrin or Zyban) fared even worse at only 32% success rate.

Smoking abstinence rates at 1 week, 8 weeks, and 6 months, respectively, were as follows:

Placebo: 23.3%, 30.2%, and 22.2%
Bupropion alone: 34.5%, 40.2%, and 31.8%
Nicotine lozenge alone: 29.2%, 40.4%, and 33.5%
Nicotine patch alone: 40.5%, 44.7%, and 34.4%
Bupropion plus lozenge: 37.4%, 50.4%, and 33.2%
Nicotine patch plus lozenge: 43.4%, 53.6%, and 40.1%

Ginger Quels Nausea During Chemotherapy

2009-06-24T18:40:00.000-07:00

A study done by the University of Rochester confirms that ginger is indeed effective in treating nausea related to chemotherapy. In this study, the subjects started taking ginger 3 days prior to chemotherapy, twice a day, for a total of 12 days. This was on top of standard anti-emetics prescribed. They used ginger capsules in this study, where the most effective dose is equivalent to about 1/2 teaspoon ginger.

The results are impressive. Patients on standard anti-emetics + placebo rated their nausea 4-5/10, while those on standard anti-emetics + ginger rated 1-2/10 only.

Mercury in Fish

2009-03-10T09:10:00.000-07:00

Here is a list of high-medium-low mercury seafood from www.nrdc.org.

High Levels (Avoid Totally)
Bluefish, Grouper*, Mackarel (King, Spanish, Gulf), Marlin*, Orange Roughy, Seabass, Shark*, Swordfish*, Tilefish*, Tuna (Ahi*, Yellowfin*, Bigeye, Canned Albacore)

Medium Levels
Bass, Carp, Cod (Alaskan), Croaker, Halibut*, Lobster, Mahi-mahi, Monkfish, Perch, Sablefish, Skate*, Snapper*, Tuna (canned chunk, light), Sea trout

Low Levels
Anchovies, Calamari, Catfish, Clam, Arctic cod, Crab, Crawfish, Crayfish, Haddock* (Atlantic), Herring, Mackarel (N. Atlantic), Oyster, Perch, Pollock, Salmon**, Sardine, Scallop*, Sole, Tilapia, Trout (freshwater), Whitefish, Whiting

*Overfished
**May contain PCB's, buy wild salmon only

Cauliflower Soup

2008-11-23T16:32:00.000-08:00

Cauliflower, after it is cooked and processed through a blender, produces a buttery (yet non-dairy) and creamy soup. This is an easy way to get your daily dose of veggies.

Ingredients:
1 head cauliflower, chopped into smaller pieces
2 quarts organic chicken stock, or water if not available
1 T olive oil + 2 cloves garlic
1-2 tsp Italian seasoning blend
1 Bay Leaf
Salt + Pepper to taste

Heat the garlic in the olive oil in a pot until the garlic sizzes. Add in the chopped cauliflower, chicken stock, Italian seasoning and bay leaf. Simmer x 15-20 minutes. Discard bay leaf, then carefully put the cauliflower and the soup into a blender and puree. Add some more Italian seasoning + salt + pepper to taste.

Dairy-Free. Gluten-Free.

Tips for Health-Basic Treatment Guidelines

2008-08-15T10:43:00.001-07:00

These are the Basic Treatment Guidelines I give out to almost all my patients. These tips are only useful if they are practiced on a daily basis. Remember, that health is about doing something good for yourself on a daily basis.

1. Eat well. Have adequate amounts of protein everyday. Eat lots of vegetables daily, at least 1 and 1/2 cups cooked, more if raw. Use a healthy source of fats such as extra virgin olive oil. Take some fish oil daily. Remove sugars and other sources of empty calories. Do not overeat!

2. Drink well. Choose plain water whenever you can over soda or other sugared drinks, including juices. I generally tell people to drink their weight in pounds divided by 2, in ounces (e.g. 150 lbs divided by 2 = 75 oz of water a day). Drink more if you are dehydrated from exercise, alcohol, excess caffeine or travel.

3. Exercise well. Choose an exercise that you enjoy or do, it may be as simple as walking. Aim for at least 30 minutes 4 out of 7 days. Mix up something cardiovascular with some resistance (could be weights, swimming, etc). Yoga is an excellent choice as it combines strength, flexibility and proper breathing.

4. Sleep well. Aim for your 8 hours of sleep--make it a priority. Try to go to bed before midnight. Sleep in a dark, quiet room; and when you wake up, open the curtains so you get enough sunlight/light. This will keep your circadian rhythms more regular. Sleep well also means to rest and relax well--do something enjoyable, light-hearted regularly.

5. Detox well. A "detox" does not have to be fancy and it doesn't equate to doing elaborate things like a fast. For me, detoxing well means having a bowel movement everyday (this means eating well and having enough fiber), drinking lots of water and exercising. Foods that promote detoxification include vegetables (specially cruciferous, beets, artichoke, dandelion, burdock).

6. Supplement well. While I believe some people can get all of their nutrients from a well-balanced, well-planned out diet (assuming they have healthy digestion to extract the nutrients from food), I still see the value of daily supplementation because so many of us live stressed-out, time-starved lives. My basics are: a good multivitamin mineral formula, B-complex, fish oil, and probiotics (at least a few months of every year).

Anti-Inflammatory Diets

2008-08-15T09:48:00.000-07:00

Anti-inflammatory diets can be an important tool in dealing with chronic disease. What does an anti-inflammatory diet look like?

You can use the search box to the right to search for Anti-Inflammatory Diet Recipes

Overall

A natural whole foods diet that emphasizes fresh foods. It contains adequate amounts of protein, lots of vegetables, healthy grains and healthy oils (more later). It also emphasizes moderate eating, i.e. do not overeat.

Include

A good source of protein such as fresh meats or protein-rich plant foods such as legumes, beans, lentils. There is some evidence that red-meats can increase inflammation primarily because of their higher iron content, so these should be eaten in moderation. If you eat meats, go for white meat (such as chicken) or wild fish (avoid tuna due to concerns with mercury). If you are vegetarian, make sure that you combine grains + beans/legumes to get complete protein. Egg whites are complete protein sources. I am not a fan of milk, cheese or dairy products-these could be eaten in moderation if you are sure you do not react to them. If it is difficult for you to obtain adequate protein, then consider supplementing with a rice, hemp or whey protein drink. Protein also helps you regulate your blood sugar to give you a more constant source of energy and to prevent sugar/junk food cravings.
At least 2 cups of vegetables every single day. Aim for 4 cups if possible. Try to have an assortment of colored vegetables--dark green leafy (spinach, kale), yellow and orange from squashes and carrots, purples from eggplants, reds from beets. Cruciferous vegetables such as broccoli, kale, cabbages are excellent.
A good source of fats. My favorite is organic extra virgin olive oil-many studies support its beneficial effects. It can be used for salads and sauteing; if you need an oil that is used for higher temperatures, coconut oil is a healthier choice. Avoid fried foods. Eliminate trans-fats/partially hydrogenated fats completely. Have some omega-3 fatty acids several times a week. Best food sources are wild salmon, sardines, anchovies; if this is not practical, a molecularly distilled fish oil is a good idea.
Adequate amounts of water. Carry a water bottle if you must. Drink extra to prevent dehydration from excess coffee/caffeine consumption, alcohol, sports activities, airplane trips. Generally, I follow this formula: your weight in pounds divided by two = water needed per day in ounces (e.g. 150 lbs divided by 2 = 75 ounces, then add more if drinking coffee/alcohol, sports etc.)
Include some fruit, but not too much. My favorites are nutrient and anti-oxidant dense ones such as blueberries and pomegranates.
Healthy grains such as quinoa and brown rice. Many people are sensitive to wheat so eat wheat if you are sure you do not react to it.

Remove

Sugar, soda, white flour and other empty calories. You can enjoy them from time to time of course, but always in moderation.
Trans-fats or "partially hydrogenated fats" which are ubiquitous in packaged goods.
Any extra calories, in other words, do not overeat!

Lowering Cholesterol Naturally

2008-08-12T14:33:00.000-07:00

This is an excerpt of an interview I did with the Wellness Advisor Magazine.

WA: Why is it important to try to lower cholesterol if it is high and maintain healthy cholesterol levels?

Dr. Tan: The main reason to lower cholesterol is to decrease the risk of dying from a heart attack. Based on our biggest study to date (Lancet 2007), if you lower cholesterol even by about 4 mg/dL at age 40-49, you reduce the risk of a fatal heart attack by half; at age 50-69, by a third; and at age 70-89, by a sixth. This applies to both men and women. Small improvements can create a big impact. This is quite significant considering that heart disease is one of the leading causes of death in the U.S. The generic guideline is to lower total cholesterol to less than 200 mg/dL — preferably with low LDL (also known as “bad cholesterol”) and high HDL ( “good cholesterol”). If you want more specific guidelines or want to figure out which factors affect your personal risk of heart attack, use a Framingham Risk Calculator, you can google it.

Even though cholesterol is important, we should still put it in perspective. For example, not smoking, maintaining your ideal weight, exercising, eating a good diet, and managing stress have a huge impact on health. Cholesterol is one factor out of many — and interestingly enough, if you address your weight, exercise more and eat well, you have an excellent chance at improving your cholesterol level. They are all related. The solution is not one thing, it is many things done consistently everyday.

Of course, not all methods of reducing cholesterol are the same — some are better than others — in my opinion.

WA: What are some lifestyle changes one can make to try to lower cholesterol naturally?

Dr. Tan: There are so many to choose from: dietary changes, exercise, the use of certain foods and supplements all have some data to support their ability to improve cholesterol levels. Losing weight if you are overweight is also very important. Reducing the waist line to no more than 35 inches in women, and 40 inches in men is important. Some studies show that each of those elements by themselves can improve cholesterol and/or reduce the risk of heart disease; some studies show that combining those might work even better. The evidence is there, we just need to do it, and do it consistently. Of course, try to manage stress and do something light-hearted often too. To see some of the evidence behind the positive effects of exercise in reducing cholesterol see this link:

http://www.ncbi.nlm.nih.gov/pubmed/18645633

WA: What diet changes can one make to help support a lower cholesterol level?

Dr. Tan: On a big-picture level, eat more natural, whole foods rather than processed foods; eat enough protein, lots of vegetables, complex carbohydrates and adequate amounts of healthy oils (which means no trans-fats, but more omega-3 fatty acids and monounsaturates like extra virgin olive oil). In terms of specifics, aim for at least 25 grams of fiber daily - through oatmeal, vegetables, whole grains and other fiber sources like psyllium husk. Try to have cold water fish like salmon (wild only) on a regular basis (studies say two servings a week) - if this is not possible, a reputable source of fish oil or omega-3 fatty acids is highly recommended.

There are studies to support a Mediterranean diet which is generous with vegetables, fruits, beans, and whole grains, moderate amounts of fish and chicken, and low amounts of red meat, and olive oil as the main oil. Side note, extra virgin olive oil is high in polyphenols or plant pigments, which have been shown by themselves to improve cholesterol.

And as always, don’t overeat. If you’re overweight, eat less and choose foods that have more nutrients per gram, such as vegetables, instead of empty calories from sugar, soda or white bread.

It can take up to 6-12 months to see the effects of diet on cholesterol levels, so be patient, and be consistent. But you will feel better on so many levels, it’s worth it.

WA: Are there ways to increase HDL?

Dr. Tan: Most evidence supports the use of niacin to increase HDL - up to 35%. The beneficial effect is dose dependent. Niacin can cause flushing which people don’t like - in these cases, it makes sense to start at a low dose and slowly build up. If people end up taking large doses of niacin, it is important that they ask their doctor about checking for liver enzymes because liver injury is a potential side effect at high doses. There is evidence supporting the use of exercise, red wine, polyphenols in berries in increasing HDL too.

WA: Are there supplements one can take to help lower cholesterol?

Dr. Tan: There are many. If you think most of your excess blood cholesterol is from the diet, plant sterols and/or stanols prevent the absorption of dietary cholesterol and have actually been given an FDA nod for their use in decreasing heart disease risk; soluble fiber is good for this too. If most of your excess cholesterol is made by your body, B vitamins such as niacin and pantethine have evidence to support their use. Red yeast rice is also effective - it acts like statin drugs, so be aware that there is a potential to have the same side effects as statins such as muscle disease. There are other supplements such as guggulipids, artichoke extract and policosanol - but the evidence is mixed or they are hard to find or expensive, so I don’t mention them too often.

By the way, anyone taking statin drugs or red yeast rice should take some Co-Q10 as well because statins and red yeast rice can reduce the body’s natural Co-Q10 levels.

Anti-Inflammatory Morning Smoothie

2008-08-11T14:49:00.000-07:00

This is the morning smoothie I make on days when I'm working and busy. I like it because it contains a good amount of protein (27+ grams, which keeps my blood sugar steady throughout the day), contains about 2 servings of fruit and is so rich in phytonutrients.

Essentials:
-2 scoops of Mediclear by Thorne; this is a rice based protein that is well tolerated even by most people and is suitable for dairy-free, gluten-free diets; it is also a multivitamin-mineral blend. (if this will be a main source of protein, I suggest adding a few scoops of Hemp Protein as well to get all the essential amino acids)
-1/2 - 1 cup of blueberries and strawberries; organic only specially for strawberries; they also contain a lot of fiber an anti-oxidants
-sometimes 1 banana for taste/texture; a dash of honey for taste; and I use a greens-powder drink if I remember
-Mix in a blender with water or rice milk to desired consistency

Variations:
You can add 1/2 very ripe banana to thicken consistency if desired

Meditation to Reduce Stress

2008-03-10T09:43:00.000-07:00

Here is a breathing exercise that I do with patients during their office visits. It takes 5 minutes and it's so easy to do. I've had patients who have panic attacks, anxiety issues and even IBS who have had dramatic benefits from doing this exercise daily.

Seated position. Can be done on an office break, etc.
1. Start with a good posture. Have both feet flat on the ground. The lower leg and the thigh are in L shape, and the thigh and torsoe are in another L shape. Feel grounded; feel the chair catching all your weight. Neck is relaxed. Have a soft gaze on the floor in front of you, or, close your eyes.

2. With the inhale, imagine your breath flowing from the bottom of your left foot up through your legs, then your abdomen, then your chest.

3. With the exhale, imagine your breathing flowing from your chest, then your abdomen, then out through the bottom of your right leg.

4. Breathe in through the bottom of your left foot, then out through the bottom of your right foot.

Diet Soda Increases Risk for Metabolic Syndrome

2008-02-07T09:36:00.000-08:00

One common question I get when treating patients who are overweight, or have elevated blood sugar, or the beginnings of metabolic syndrome is: is it better to drink diet soda instead of regular soda?

A study published in the journal Circulation tracking 9,514 adults over 9 years, it was shown that consuming just one diet soda a day increases one's risk of developing metabolic syndrome by 34%. This is significant considering that those people who ate the most fried food increased their risk by 25%. It's still unclear why this is so-if it's because of some chemical in diet soda or perhaps because of some other behavior or foods eaten by people who also drink diet soda.

Better to drink filtered water or tea if you want to be healthy.

Hot Tap Water and Lead

2008-02-01T17:31:00.000-08:00

It's been shown that hot water has a greater corrosive effect on pipes and can leach out heavy metals such as lead. A study in Scotland has shown that using hot tap water in the preparation of food or baby formula is correlated with increased lead levels in the blood of infants.

Best to use a water filter.

High Mercury Levels in Tuna Sushi

2008-02-01T17:10:00.000-08:00

A report published by the New York Times showed that mercury levels in tuna sushi--in high-mid-low end-restaurants were elevated and can exceed safety limits established by the Environmental Protection Agency.

ADHD: Medication--Is It Worth It?

2008-02-01T16:57:00.000-08:00

Does using medication for ADHD improve outcomes in the long run? Long term studies done in the US and Finland suggest that:

-Medication does not seem to affect long term outcome :while about 60% of American children with ADHD are medicated while virtually no Finnish kids are medicated, these two populations are very much alike (on various measures) by the time they are 16-18 yeras old.

-Children who are "fidgety" and "can't-sit-still" have a higher chance of out-growing these symptoms; while those who have symptoms of being "dreamy, inattentive and forgetful" are more likely to struggle with this condition.

In a separate note, this article also suggests that cognitive-behavioral approaches (where children can learn tools of how to focus, learn material etc) as an alternative to medication.

Adverse Effects of HPV Vaccine

2007-07-12T22:52:00.000-07:00

The British Medical Journal has recently reported adverse reactions attributed to Gardasil, the newly marketed vaccine for HPV infections. Since 2006, 1,637 adverse events have been reported, including three deaths--seemingly among women who have heart or blood clotting problems.

Majority of the side effects were benign such as headaches, nausea and dizziness. However, 371 of the adverse effects were quite serious including paralysis, Bell's palsy, and Guillain-Barre syndrome. A high percent of pregnant women have also been reported to be adversely affected by the vaccinations.

ADHD and Fungicides

2007-07-12T18:32:00.000-07:00

One large scale study (involving 475 children) shows that prenatal exposure to hexachlorobenzene (HCB), a fungicide commonly used in agriculture, affects children as they grow up. The authors of this study used an ADHD score test to analyze children's behaviors and correlated it with prenatal exposure to HCB. They conclude that prenatal exposure to HCB:

is associated with a decrease in the behavioral competence at preschool ages. These results should be considered when evaluating the potential neurotoxicologic effects of HCB.

The "Dirty Dozen"

2007-07-12T18:19:00.000-07:00

The Environmental Working Group has developed a list of fruits and vegetables that have been found to have the highest amount of pesticides. This list is based on 43,000 published tests done by the US Department of Agriculture between 2000-2004.

These are the fruits and vegetables to avoid buying if conventionally grown. Instead, try to buy them organic, as it will be money well-spent:

Peaches, Apples, Sweet Bell Peppers, Celery, Nectarines, Strawberries, Cherries, Lettuce, Grapes (imported), Pears, Spinach, Potatoes. Get the complete list here.

Prostate Cancer, Lycopene and PSA

2007-07-10T23:04:00.001-07:00

While many studies show that lycopene--an anti-oxidant found in tomatoes--may prevent prostate cancer, it is still unclear if it can help somebody who already has prostate cancer.

A study done in 2005 shows that lycopene may be helpful for those who have metastatic prostate cancer. In this study, 78% of those who underwent orchidectomy and consumed 2 mg of lycopene twice daily had complete PSA reduction, vs. 40% complete PSA reduction among those who had surgery only.

Are You Getting Enough Vitamin D?

2007-07-10T18:51:00.000-07:00

Vitamin D is very important: for building and maintaining bone density, preventing hip fractures, preventing cancer, and maintaining good moods.

If you think you are getting enough Vitamin D from the sun, you may want to reconsider. A newly published study shows that even among individuals living in Hawaii, with an average total body sun-exposure of 11 hours per week without sunscreen, 51% showed LOW serum vitamin D levels.

You can easily test for Vitamin D through a blood test. Ask your doctor about a 25-Hydroxy vitamin D test. This study recommends that the ideal blood level should be about 60 ng/dL.

Pubmed ID: 17426097

ADHD and Cod Liver Oil

2007-07-09T18:53:00.000-07:00

We've heard that polyunsaturated fatty acids (PUFA's), also known as omega-3 fatty acids, is important for proper brain development--specially in DHA form. Can it help children with ADHD?

One recent Australian study shows that supplementation with PUFA's can indeed help with ADHD related inattention, hyperactivity and impulsivity. Another study shows that PUFA's are also helpful in children diagnosed with ADHD who also have specific learning difficulties.

When giving children PUFA's, it is important to choose a product that is free of mercury or other heavy metals, as well as to ensure that the child has good anti-oxidant status. This is because PUFA's can oxidize in the body if doesn't have enough anti-oxidants.

Vitamin D Helps Prevent Cancer

2007-07-08T19:19:00.000-07:00

A 4-year study shows that Calcium plus Vitamin D helps reduce the incidence of cancer among post-menopausal women.

In this study, they used 1,100 iu of Vitamin D, which is higher than the current recommended daily allowance for this vitamin, and appears to be a safe dose.

Mercury Free Vaccines

2007-01-26T21:10:00.000-08:00

Finally, most vaccines given to infants are now mercury or thimerosal free* with the exception of flu shots or the tetanus-diphtheria shots given to children 7 years or older. The CDC estimates that most vaccines given out since 2003 had been thimerosal free.

Unfortunately, the FDA now admits that infants prior to 2003, who were following the recommended vaccination schedule, may have been exposed to mercury that exceed mercury safety limits set by the EPA. The FDA website says:

...depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury.

One estimate shows that a 7.5 lbs infant given the Hepatitis B vaccine at birth is exposed to mercury levels that exceed EPA guidelines by 36%!

Removing mercury in vaccines is certainly a step in the right direction. But it doesn't mean that these vaccines, specially the manner they are administered where infants are exposed to several pathogens all at once, are now suddenly completely safe. Parents should still weigh the pros and cons of each vaccine that their child receives, the age at which they receive them, and the scheduling of the shots.

*mercury free means that the vaccine can still contain up to 0.0002% mercury.

Diabetes: Weight Training Works

2007-01-22T18:56:00.000-08:00

Several studies now show the importance of using weights or resistance training among diabetics:

One study showed that 16 weeks of weight training among type 2 diabetics improved muscle quality, made the use of insulin more efficient and decreased inflammation. Study ID: 17211497

In fact, a separate study shows that strength training is more beneficial than aerobic type of exercise. Researchers concluded:

Srength training was more effective than endurance training in improving glycemic control. With the added advantage of an improved lipid profile, we conclude that strength training may play an important role in the treatment of type 2 diabetes.

Study ID: 16084803

See pubmed for the articles.

Why dietary changes help Autism

2007-01-22T18:46:00.001-08:00

Many parents report that their children's symptoms of Autism improve when they avoid certain foods--chocolate, dairy, wheat, corn, bananas, apples. What's the biochemistry behind this observation?

A pilot study done in Italy has shown that children with Autism have a harder time metabolizing certain chemicals that are found in food. One particular group, phenolic amines, are known to be neurotoxic and can aggravate symptoms of Autism.

Read the study abstract on pubmed. Study ID: 10435209

Mercury Causes Immune System Dysfunction

2007-01-14T19:52:00.000-08:00

While mercury has long been proven to be neurotoxic, new evidence shows that mercury is toxic to the immune system as well. Several animal model studies have shown that mercury can increase production of antibodies, or anti-nuclear antibodies, or produce lupus-like symptoms--the same manifestations we see in many auto-immune conditions.

Researchers at the John Hopkins University, after studying human subjects in the Amazon basin found:

significantly increased prevalence of antinuclear and antinucleolar antibodies and a positive interaction between mercury and malaria. These results suggest a new model for mercury immunotoxicity, as a co-factor in autoimmune disease, increasing the risks and severity of clinical disease in the presence of other triggering events, either genetic or acquired.

The malaria component of the study is interesting because it suggests that a triggering event, such as malaria or another infection, can begin the auto-immune disease process. Clinically, we often hear of many patients whose auto-immune diseases begin after a bout with EBV, bad flu, or similar infections.

76% of Parents Think Mercury Detox Helps Autism

2007-01-14T19:21:00.000-08:00

23,700 parents of children with autism have spoken: a survey conducted by the Autism Research Institute shows that among parents who pursued heavy metal chelation as a treatment, 76% reported improvements.

The second most effective therapy cited by parents was dietary changes (gluten and casein elimination)--65% said it helped.

Heavy Metal Removal Improves Kidney Function

2007-01-13T17:19:00.000-08:00

A study published in the New England Journal of Medicine shows that non-diabetic patients who received heavy metal chelation for lead were able to improve their kidney function or at least limit disease progression compared to controls.

Because almost everyone is exposed to lead these days, it is reasonable to investigate if a person with deteriorating kidney function does have elevated lead levels. In this study, 64 of 202 patients (more than 1 and 4 persons) were found to have elevated lead levels, and were given chelation therapy, which improved their kidney function.

Autism and Inflammation

2007-01-11T22:06:00.000-08:00

Several studies now show that children with Autism have lower markers for anti-oxidant molecules such as glutathione and super-oxide dismutase. We still don't know if it's because they tend to produce fewer enzymes that make the anti-oxidants, or if they just use more anti-oxidants because of greater oxidative stress. Or both.

Many patients have reported improvement with improvement in their anti-oxidant status, either through supplementation or by eliminating things that cause oxidation.

What causes oxidative stress? Some culprits may be an undiagnosed food allergy--perhaps to wheat or milk proteins, or heavy metals which are potent oxidizers.

Smelly Paint

2007-01-10T22:11:00.000-08:00

Thinking of doing some painting in your living space? Consider using non-toxic paints, which are now available.

Toluene and other organic (i.e. carbon-containing-molecule) solvents have been linked to a host of illnesses: neurological complaints, memory loss, Parkinson's, fertility problems, lung cancer and non-Hodgkin's lymphoma. This is based on epidemiologic data.

Instead, ask for zero-VOC (Volatile Organic Compound), water-based paints. Note that "zero-VOC" can still contain up to 5g of VOC per liter. If solvents are unavoidable, you can hasten its evaporation by turning up the heat in your home while you are out, the first few days after a paint job. If you've been exposed, know that glutathione (the body's anti-oxidant) is involved in metabolizing toluene. Glutathione is increased by selenium, turmeric, alpha lipoic acid and Vitamin C.

To see the abstract of relevant studies, go to pubmed. Study ID's 15146016,14695312,16034164,16732556,16878041,16757511,15076649, 14758870.

Mercury May Play Big Role in Chronic Fatigue Syndrome

2007-01-09T17:27:00.000-08:00

A study done by the Karolinska Institute in Sweden links mercury and heavy metals with Chronic Fatigue Syndrome. They found:

That 83% reported long term health benefits following dental amalgam removal; 22% no change, and 2% worsening.
These findings were not only subjective. They found that among persons with CFS, their lymphocytes (or immune cells) were more reactive to heavy metals compared to healthy individuals, particularly to inorganic mercury, phenylmercury and gold.

You can view the study abstract by visiting pubmed. Study ID is 11460087.

Genetic Basis for Multiple Chemical Sensitivity

2007-01-09T13:29:00.000-08:00

Here's more evidence to support the theory that Multiple Chemical Sensitivity may be caused by an impaired ability to metabolize toxins or chemicals.

This study, published in the International Journal of Epidemiology, showed that there were significant genetic differences in people with MCS vs controls in two specific genes (CYP2D6 and NAT2) which are known to be used in the body's detoxification pathways.

Interestingly, in MCS sufferers, there is a greater chance that these genes are active. CYP2D6 is known to both activate and deactivate detox pathways, while NAT2 is involved with converting arylamines to metabolites. It is possible that when these genes are upregulated, the intermediary metabolites created may cause more symptoms than the original toxin itself.

Life Saving (Natural) Treatment for Diabetes

2007-01-08T00:04:00.000-08:00

Reduce mortality or the need for kidney transplants among diabetics with kidney disease by 50% by just changing diets. This is significant news even for diabetics who just want to prevent kidney disease in the future.

An Italian study has found that among diabetic patients with kidney disease who followed a Carbohydrate Restricted, Low-Iron, Polyphenol Enriched diet, only 20% needed a kidney transplant or died four years after starting this diet VS 39% of diabetic patients who followed the current standard advice of protein-restriction. Briefly, this diet means:

Reducing carbohydrates from current consumption by 50%
Replacing iron-rich meats such as beef with low-iron meats such as chicken or fish; as well as eating protein rich foods that inhibit iron absorption such as soy
Elimination of all beverages except for tea and red wine. Tea is highly beneficial because black tea binds to iron to prevent absorption, while green tea is a good source of polyphenols. Red wine consumption is limited to 150 mL.
Exclusive use of polyphenol enriched olive oil

The study says that except for carbohydrate restriction, other foods were allowed ad-libitum, meaning "at one's pleasure." Although I would always say to follow this within reason.

You can also view a nice summary of this study from the American Academy of Family Physicians website.

New Year Resolutions

2007-01-07T23:27:00.000-08:00

Simple, easy new year's resolutions that can have a big impact on your well-being:

1. Get more sleep. Before you reach for the melatonin, work on the basics first. Sleep hygiene means trying to go to bed the same time each night, have a ritual such as taking a hot shower or drinking some tea (chamomile is very calming), and avoid heavy exercise before bedtime.

2. Get moving. An interesting study from 2005 finds that people who tend to fidget or move more throughout the day tend to be thinner. They estimate that they use 350 calories more than non-fidgety types. What does this mean in our everyday life? It can mean walking for ten minutes at lunchbreak, watching TV standing rather than just sitting on the couch, getting up from your desk job a few minutes every hour to stretch, taking public transport one day a week.

3. Meditate. Take a few moments to step back from the rush and stress of daily life. Sit back, and watch things unfold--watch your thoughts pass through your head, observe your mental chatter, be fully present to your breath going in and out of your lungs, turn off the computer a few minutes earlier than you normally do and be idle for a while. You can meditate with your eyes closed or while looking at a tree or falling water. It doesn't matter how you do it or for how long, just do it. Think of meditation as radical idleness.

4. Everyday, perform an act of self care. Before you go to bed, ask yourself what you have done today to nourish your body or your soul. Self-care includes being more kind and easy on yourself.

5. Drink more water and eat more vegetables. You're heard this one before--that's because these two simple acts are very powerful medicine. They simultaneously cleanse and nourish us.

Good luck! I invite you to post your personal resolutions as well as tips that may be useful for others. Thank you and have a wonderful and healthy year ahead!

Plastics & Puberty

2007-01-05T18:40:00.000-08:00

New York Times ran two recent articles on precocious puberty (one,two). It seems that American children are showing signs of puberty earlier than previous generations and this has raised concerns for many.

What's to blame? It may be a combination of factors: widespread exposure to hormones in meats and milk; hormone-mimicking molecules found in plastics (such as phthalates), household and personal cleaning products and PVC; and childhood obesity as fat cells secrete estrogen. Some say it's because children are healthier these days. One article narrates how a child got exposed to testosterone through a testosterone cream his father used by skin-to-skin contact.

We do not know how these products affect children in the long run and into adulthood. Precocious puberty may only be the tip of the iceberg, considering that hormones act on almost all cells in the body.

What can we do? One big step is to avoid exposure--eat more organic meats and milk, use "green" household products, use glass instead of plastic containers to store food. Cook in stainless steel pans instead of teflon.

Skin Deep

2007-01-02T18:42:00.000-08:00

Should we be concerned about soaps and cosmetics?
Absolutely. Our skin is a living organ and absorbs what we put on it, specially substances that are oily or lipophilic (def. capable of combining or dissolving in lipids or fats) like lotions, creams, some soaps and cleansers because these easily pass through our lipid cell membranes.

Many products out there do contain ingredients that are known to be harmful to health or carcinogenic. How can this happen? Because the cosmetic industry is largely unregulated. They do not have to go through a safety check from the FDA. Even if they did have to go through FDA, I would still be careful: we already know rigorous screening from the FDA has allowed many drugs with harmful side effects to go to market.

What brands should we avoid?
Check out the website www.ewg.org, an environmental advocacy group. This website names names. They have listings by type of products like toothpastes, skin care, hair care, make-up etc. Generally, the "organic" brands tend to be safer, but I was pleasantly surprised how some cheaper brands available in neighborhood stores actually stack up pretty well compared to more expensive brands.

It will take work to find the brands that will have the right balance between safety and the cleaning or enhancing effect we want from the products. But it's worth it.

Wild vs Farmed Salmon

2007-01-02T18:41:00.000-08:00

Farmed salmon has been shown to have 5-10x more PCB's than wild salmon, and higher levels of pesticides like DDT, flame retardants and other carcinogens.

Based on EPA guidelines (updated 1999), humans should not be eating farmed salmon more than once a month. Much less for children or older people. FDA guidelines, which allows for more frequent consumption of farmed salmon, were published in 1984 and are outdated--they do not reflect newer data. In my opinion, we should never consume farmed salmon until corrections to the fish-farming industry are made and implemented. Farmed salmon can be a reasonable source of protein in the future if done sustainably and safely--but until then, I would stay away from it.

How to tell if salmon is farmed or not? If the label does not explicitly state that the salmon is wild, then assume that it is farmed.

Wild salmon is a much safer choice compared to farmed salmon, and a better source of omega-3's. If we translate the EPA advisory, we can eat wild salmon 5-10x in a month.

PCB's are ubiquitous and it has been detected in many of our meat based protein sources: beef, chicken, other seafoods, even milk. So the bottomline is to minimize our exposure: do not overeat, eat organic as much as possible, rotate between different protein sources. Consider vegetarian sources of protein.

Heavy Metal Chelation

2007-01-02T17:39:00.000-08:00

Heavy metal chelation is done to pull out heavy metals from body tissues. Before chelation, a provocation test is usually done to measure the baseline heavy metal load of a patient.

Chelation can be done orally with agents like DMSA which binds to heavy metals in the body so that it can be excreted in the urine. DMSA has been used safely in children who have lead poisoning. Thus, it can also be used in children with Autism who have suspected elevated mercury levels.

Chelation is usually done in cycles and over a period of time to account for the movement of heavy metals from inside the cells to outside, where DMSA can bind to it.

Ribose and Chronic Fatigue Syndrome, Fibromyalgia

2006-12-28T18:04:00.000-08:00

A pilot study conducted at the Fibromyalgia and Fatigue Center in Dallas, TX shows promising results that D-Ribose may help Chronic Fatigue Syndrome and/or Fibromyalgia.

66% of patients reported improvements which may include improvements in energy; sleep; mental clarity; pain intensity; and sense of well-being.

D-Ribose is one of the steps in the energy production pathways of the body. A truly significant improvement of fatigue after taking D-Ribose may indicate genetic deficiency in myoadenylate deaminse enzyme.

You can view the study abstract in pubmed. Study ID 17109576.

Carnitine Helps Chronic Fatigue Syndrome

2006-12-19T17:53:00.000-08:00

Two grams of carnitine per day has been shown in a small open-label randomized trial to improve symptoms of Chronic Fatigue Syndrome. Two forms of carnitine were used in this study, acetylcarnitine and propionylcarnitine, where 59% and 63% of subjects reported improvement respectively.

Interestingly, acetylcarnitine improved mental fatigue while propionylcarntine improved general fatigue.

Carnitine is an amino acid that helps the mitochondria create energy and ATP.

High Protein Diet Good for Diabetes Type II

2006-12-18T14:51:00.000-08:00

A study published in the American Journal of Clinical Nutrition has shown that a diet with a higher protein ratio (30-40-30 protein-carbohydrate-fat based on calories) showed clear benefits for diabetes type II patients.

They showed improvements in blood sugar control, hemoglobin A1C (dropped 0.8 points) and reduction in triglycerides.

You can see a sample menu here; and a summary of "nutrition facts" here.

The diets still looks like the standard American diet (SAD) and can definitely be improved on by the inclusion of healthier types of proteins and fats.

Some notes:
1. Diabetics with any form of renal disease should see a professional first before they increase protein.
2. Remember that 1 gram of carbohydrates or protein = 4 calories; fat=9 calories.

Pesticides, Multiple Chemical Sensitivity and Chronic Fatigue Syndrome

2006-12-11T16:41:00.000-08:00

A study published in the American Journal of Epidemiology of 3,531 British veterans of the Gulf war and the war in Bosnia shows that the incidence of "Multiple Chemical Sensitivity was particularly associated with Gulf deployment and self-reported exposure to pesticides."

Another study published in the Annals of Occupation Hygiene shows that the incidence of chronic fatigue is correlated to exposure to organophosphate pesticides.

Organophosphates are potent neurotoxins and are used in various pesticides, herbicides and nerve gases which works by inhibiting the acetylcholinesterase function in nerve cells.

Do I need a Liver Biopsy for Hep C?

2006-12-09T18:47:00.000-08:00

Currently, liver biopsies are not considered mandatory for HCV patients. However, it provides some good information such as determining the level of fibrosis/histological changes to predict prognosis and to guide choice of treatments. It is useful in patients whose diagnosis is uncertain, are immunocompromised, or when other co-infections are suspected. The decision of whether or not to have a biopsy is a balance between the usefulness of the information you get vs the risks of the procedure.

It is important to find a doctor who does a lot of biopsies and have done a lot of biopsies. Finding a more experienced doctor can reduce the risks of the procedure.

There are other tests that may be used to approximate the information provided by a biopsy such as ultrasound techniques, and a new test called Fibrosure by LabCorp which is used to estimate the level of liver fibrosis. This test is much less invasive than biopsies.

Diabetes: Bring Back That Feeling

2006-12-09T15:30:00.000-08:00

Loss of feeling, pain, burning sensations in the limbs is a serious problem faced by patients with diabetes; it can even contribute to issues such as foot ulcers.

A meta-analysis of four clinical trials by the British Diabetic Association shows that Alpha Lipoic Acid can help. They conclude that:

The results of this meta-analysis provide evidence that treatment with alpha-lipoic acid (600 mg/day i.v.) over 3 weeks is safe and significantly improves both positive neuropathic symptoms and neuropathic deficits to a clinically meaningful degree in diabetic patients with symptomatic polyneuropathy.

They saw improvements such as reduction in pain, numbness and burning in as little as 8 days from start of treatment.

Daily I.V. or intravenous therapy can be quite inconvenient and painful for some patients. Luckily, I have seen results with oral alpha-lipoic-acid. The dosages have to be adjusted accordingly, but it is definitely a viable alternative to I.V. treatment.

This study is not available online, but you can see the abstract on pubmed. Type in 14984445 in the search box.

What are the complications of Hepatitis C?

2006-11-09T18:50:00.000-08:00

CDC data shows that for every 100 persons infected with HCV:

55-85% might develop chronic infection (i.e. they do not clear the virus)
70% might develop liver disease
5-20% might develop cirrhosis over 5-20 years; liver cirrhosis in turn can cause esophageal varices, higher rates of infection etc.

High Protein For Weight Loss in Diabetes

2006-11-09T15:14:00.000-08:00

Do high protein, lower carb diets apply to persons with diabetes? This study published in Diabetes Care shows that a high protein (30-40-30 protein-carbs-fat) diet among persons with diabetes type II has some significant benefits:

1. Reduction of body weight by 11 lbs in 5 weeks.

2. Reduction of abdominal body fat.

This seems to apply only to the women in the study but the men. They still don't know why that is.

Notes:
Diabetics with kidney disease or protein in their urine should consult a professional first before increasing protein intake.

Glycemix Index Foods Helps Diabetes, Study Shows

2006-11-09T14:29:00.000-08:00

A meta-analysis of 14 randomised control studies published in the Diabetes Care Journal shows that choosing low glycemic index foods can reduce Hemoglobin A1C (HgbA1c) by 7.4%, this translates to about 0.6 reduction in HgbA1C. This is huge because other studies have shown that a 1.0 reduction in HgbA1C reduces heart attack risk by 17% and diabetes related death by 21%. More importantly, this study concludes that:

The incremental benefit (of low GI foods) is similar to that offered by pharmacological agents that also target postprandial hyperglycemia.

The Glycemic Index (GI) reflects how certain foods can spike up blood sugar after they are eaten. It is a functional measure of how foods actually affect bloog sugar levels. For example, if you eat equal sized portions of potatoes vs sweet potato--the potato will spike up blood sugar more than sweet potato. Hence, sweet potato is the better choice.

University of Sydney has an excellent website on glycemic index that contains a database of foods and their GI.

Stevia Sweetener for Diabetes

2006-10-09T15:43:00.000-07:00

Stevia is a sweetener made from the stevia plant with virtually no caloric value and negligible effect on bloog glucose levels.

An analysis of the World Health Organization shows that this product is safe, and noted that there is evidence that it might even be beneficial for diabetics with hypertension.

It is a natural product, as opposed to Splenda or Sucralose which is a chlorinated sugar molecule that has been shown in some animal studies to adversely affect various organs of the body.

You can download the WHO study here. It is a big file.

Anti-oxidant Thearpy in Diabetes

2006-09-09T16:16:00.000-07:00

Persons with diabetes have a lot of oxidative stress due to increased blood sugar. There is good evidence that anti-oxidant therapies is beneficial. Here's a sampling:

Vitamin C--Oral supplementation with of 2g/d decreased inflammation in person with combined Type II diabetes and coronary atherosclerosis (blocked artery). Diabetic Medicine Journal.

Vitamin E--Various studies have shown benefits such as reduction in oxidation of LDL (bad) cholesterol or reduction the reduction of C-reactive protein which is a marker for inflammation. There is a wide range of doses, from 100IU/d to 1,200IU/d. Here's a sample study from Diabetic Care Journal.