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2013-10-25T12:27:00.001-07:00

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Low Homocysteine May Not Be That Great

2013-01-25T19:52:00.000-08:00

Homocysteine, a molecule created in the process of what's broadly called "methylation", is believed to be toxic to the endothelial cells that line blood vessels, and an association has been found between cardiovascular disease (CVD) and homocysteine. Some practitioners and researchers even believe that homocysteine is much more important than LDL cholesterol as a risk factor in CVD.

High homocysteine is associated with an extensively researched genetic variant (or polymorphism) named MTHFR C677T, and which if present can often be effectively addressed by eating more foods that contain natural folates such as green leafy vegetables or egg yolks, or by carefully adding a L-5MTHF supplement. (Not "folic acid"which may be toxic in this situation.)

Given the above, low homocysteine levels are typically lauded as a sign of good health. In fact, as with cholesterol, many clinical laboratories have recklessly (or by government decree?) put 0.0 at the low end of their reference interval for homocysteine.

Being no less flattered than most by such follies, I have been proud of my low homocysteine at 5.8, seeing it as a sign of health.

However…

The body detoxifies homocysteine essentially through either recycling the molecule back to methionine (the essential amino acid which it was built from in the first place), or by putting it through a pathway that ultimately converts it into sulfite/sulfate, alpha-ketoglutare, ammonia, and glutathione.

Given these options, if homocysteine is low in the body, it could be for three major reasons:

A high rate of conversion back to methionine. (A good reason in most cases.)
Low production because upstream processes are not working correctly or because a precursor such as methionine doesn't exist in enough quantity. (A bad reason because the ongoing generation and regeneration of homocysteine and methionine from each other drives other crucial processes in the body.)
A high rate of conversion of into sulfite/sulfate etc. (A bad reason if levels of sulfate, alpha-ketoglutarate or ammonia generated this way become toxic - more below.)

Let's look at the pathway in #3 because this is what I have researched when looking into my own issues and biochemistry,

There is an enzyme, CBS, responsible for the first step of conversion through this chain by turning homocysteine into an intermediate called cystathionine. As it happens, the CBS enzyme may be working too fast due to certain rather common variants of genes related to CBS activity. I have several of these variants (e.g., CBS C699T, A360A and BHMT 2,4,8) which make the CBS enzyme work up to ten times faster than normal.

When homocysteine is excessively pulled in this direction by CBS, the following compounds are created at possibly toxic levels:

Sulfite and ultimately sulfate - both toxic to the body, but sulfate less so. (When I recently peed on a test strip for sulfate, results came out very high.)
Alpha-ketoglutare - high levels can create excess glutamate in the presence of mercury and lead. Glutamate is an excitatory neurotransmitter involved in anxiety, ADHD, and pain sensitivity. (I have mercury fillings, by the way...)
Ammonia - high levels act as an irritant and may cause excess cortisol and contribute to the downward spiral of adrenal fatigue and hormone problems that is common in so many (euphemism for "virtually all") people. (Personally, I seem only mildly affected by this as my urinary ammonia is only slightly elevated, and my hormone profile fairly good.)

So what to do? It depends on the person (including which other road blocks are present) and how severe the problems are, but in outline one could, for example, do a ten day trial, reducing sulfur rich foods by say 2/3, while supporting the detoxification and elimination of ammonia and sulfur. (There are some protocols for this that go far beyond what I have room to discuss here.)

Pay attention to how you feel. If you feel worse, obviously stop. If you feel better, know that you shouldn't stay on a low sulfur diet forever (this will cause its own issues), but rather work with a practitioner to investigate how to improve your body's function in sulfur related pathways.

Take away points:

One can have low homocysteine and therefore receive a "clean bill of health", yet suffer from mild to severe health issues due to common metabolic pathway problems that result in low homocysteine.
If a person has homocysteine, say, below 6 umol/l (some practitioners say 7), it is reasonable to investigate underlying issues.

The Curse of No Symptoms

2012-11-24T14:50:00.002-08:00

A frequent misunderstanding in the world of health is that having no symptoms equals health. This is not so. Symptoms are often the last thing to happen when the is suffering from malfunction. Being symptom free can be a curse, because there are no warning signs until something dramatic happens. [Editor's note. I whipped this up quickly so I'm sorry for grammar/spelling errors.]

Signs of bone loss

Exhibit A (above):

At the dentist's office.
Dentist: "You look much younger than your age…"
Our Guy: "Well, yes, I take care of myself, and I probably have some good genes". [Delivered with a smirk - he's quite used to hearing this.]
Dentist: "Probably true, but do you see that dark space between the bone and the crowns?"
Guy: "Yes…"
Dentist: "That space is larger than it should be, indicating early bone loss."
Guy: "Oh..."

So why would a person, seemingly healthy for his age, have a problem with bone loss?

Well, on a broad health-philosophical level it boils down to this:

The curse of being relatively free of symptoms or external signs, but with underlying issues that doctors don't look for and that insurance companies will not pay anyone to look for.

Exhibit B:

Notice in his hair trace minerals test result below how all the minerals except copper are below the middle of the reference range. This indicates chronic and severe maldigestion. This guy is probably not absorbing enough nutrients to build and retain bone. (And if that's the case he might not be absorbing enough minerals for his body to fight diseases in the long run either...) Elevated copper also suggests chronic infection.

Chronic malnutrition

Exhibit C:

Could an important source of this problem have been discovered years earlier? Yes, if doctors were trained to look at blood tests results over time and if they were trained in their interpretation for what we could call subclinical malfunction (= malfunction without telltale symptoms).

Case in point:

Research suggests that the more the standard blood work marker MCV ("Mean Cell Volume") becomes elevated above 90, B vitamin deficiency and/or H Pylori infection is likely.

H Pylori is a pathogen that primarily lives in the stomach where it destroys the body's ability to produce stomach acid (HCL) which is needed for the breakdown of proteins and for the stimulation of the pancreas to release enzymes that digest foods and make their nutrients available to the body.

Elevated MCV = possible H Pylori infection

As you can see in the graph above showing data from several years' worth of blood tests, this 40-something's MCV values have been elevated for at least half a decade, and has also been creeping upwards, almost approaching 100 in 2011.

[Editor's digression: 100 is the point at which his lab results might raise his doctor's eyebrows. The doctor might then ask him to take B-vitamins, which as we will see would do nothing to address the actual underlying issue.]

Exhibit D:

Since our guy, apart from his exceptional youthful good looks, understood that these types of issues are never investigated or addressed by normal healthcare, he sought out a practitioner skilled in functional-nutrititional investigations.

[Editor's note: Excuse the didactic, self-serving tone here, but I'm very passionate about this. If you think that you will stay healthy through "regular medical checkups" alone, you are deluding yourself.]

Our handsome guy eventually got some testing done, including stool testing for GI pathogens.

Voila! H Pylori was found (and later killed):

I hope you can see how multiple pieces of evidence (dental x rays, hair samples, blood work) suggested and provided cumulative evidence for a problem, and ultimately led to the discovery of a key root cause? Cool isn't it?

Our guy is now on the following plan:

Digestive enzyme therapy and gut repair w. regular follow up testing.
Regular re-testing for recurrence of H Pylori. (Once reasonably sure that H Pylori is absolutely gone, he will also supplement with HCL.)
He will address the copper toxicity. (Copper accumulation leads to numerous problems in its own right.)

He knows that the process will take time, probably years. Repairing tissue and re-growing bone takes time, but he is also certain of a couple of big picture ideas about health and aging:

What people call "aging" is often not aging at all. It is the resulting degeneration that comes from chronic exposure to things like food sensitivity, infections, and toxicity which gradually erode the health of the body.
Being free of symptoms, whether it is because of symptom suppressing medications or because of one's body, for one reason or another, not producing noticeable symptoms (yet), is a dangerous proposition. (Who knows, if the H Pylori and digestive issues hadn't been discovered, our guy might suffer a "sudden" fracture a couple of decades in the future, or his teeth might begin to fall out of his mouth, or he might develop cancer because of a lack of proper nutrition.) [Editor's note: On the last point, read up on Bruce Ames' triage theory of aging.]

Bottom line: Disease prevention and functional investigation of one's body should ideally start long before one ever experiences symptoms.

Polyphenols and Xenohormesis (How resveratrol, ginseng etc work)

2012-10-01T12:46:00.001-07:00

I often recommend botanical compounds called plant polyphenols as part of helping people optimize their bodies' ability to getting rid of toxins and/or dealing with oxidative- or other types of stress,

Examples of polyphenols are curcumin from turmeric, EGCG from green tea, resveratrol from grapes, and silymarin from milk thistle. There are also polyphenols belonging to the family of botanical compounds called "adaptogens". (The most famous adaptogenic plant is Panax Ginseng.) Coffee has polyphenols too.

I know from observational experience, looking at lab results, and the scientific literature that polyphenols of various types often work very well to achieve desired effects with minimal unwanted effects. (I would add, especially when used as part of defined "protocols" for specific purposes rather than random supplementation.)

So how do polyphenols work?

Aren't they just like weaker, more "natural" versions of designer pharmaceuticals (aka biochemical monkey-wrenches), and hence just as un-natural and potentially harmful?

Not so!

It has been discovered that polyphenols' main pathway of conferring their effects seems to be to send messages to our genes.

Polyphenols tell the body to start doing certain things; for instance to create more anti-oxidants, or to alter its response to environmental stress.

This is a different way of action than, for instance, providing essential nutrients for processes that the body is already striving to perform at a certain rate, or from substituting compounds that the body might make on its own.

Interestingly, our bodies seem primed to receive messages from these compounds (in fact specific receptors for some of them have been found), but why would our bodies want to listen to strange biochemical messages from plants?

One explanation, which I find biologically compelling, is xenohormesis, and it goes something like this:

Plants produce higher quantities of polyphenols when under environmental stress. This is why grapes growing under harsh conditions are used in the most sought after wines in the world (polyphenols provide "complexity" to the taste), and it is why Swedish strawberries taste better than any other strawberries in the world (or, maybe that's just my nostalgia…).

Now, when animals (including us), eat these polyphenol rich plants their bodies receive advance warning of forthcoming stressful conditions, and may then adapt accordingly on the genetic/biochemical level. Such advance warning is life-serving, so this is why our bodies evolved and retained the biochemical means to "listen".

Example:

When wine grapes are made to suffer nutritionally, they produce more of the polyphenol resveratrol in the response.

When an animal then eats these grapes, the extra resveratrol in them tells the animal's genes that famine might be coming.

In response, the animal's physiology re-orients towards famine conditions without actually experiencing a lack of food yet. The famine-reorientation sets off reactions that have been found to increase longevity. (You have probably heard about caloric restriction, or CR, as a way to prolong life.) In this way, resveratrol acts as a "CR-mimetic", ie., giving the benefits of starvation without the downside.

Cool, isn't it ?!

Now before you go out and buy resveratrol or other polyphenol compounds to take indefinitely, be aware that if you make your body up-regulate, say, certain longevity processes, it must at the same time down-regulate something else. (Are you prepared for the potential problems from messing with your physiology in this way?)

Actually, the body seems to have evolved clever ways to counteract sustained and therefore possibly disruptive signals from plants and their polyphenols.

For instance, what often happens is that unless a polyphenol compound is cycled on and off, there will be diminished effects over time. The body's receptors seem to become deaf to the signal. This also makes biological sense. Who benefits from someone yelling "Fire! Fire! Fire!" long after a fire must reasonably have been extinguished?

So don't think about polyphenol compounds as universal panaceas. You are not going to override the bad effects from eating at McDonald's by putting curry (curcumin) on the burger.

However do think about them as powerful tools with a low risk/reward ratio in the toolkit of health, performance, and longevity.

"Organic", is it worth it? Q/A Part III

2012-09-14T10:30:00.000-07:00

[Also check out part I, and part II of this mini series.]

If toxicity depends on highly individualized factors, then what basic evidence should a person look for to indicate that it could be affecting him?

Aside from clear cut cases where removal of a suspect substance is immediately associated with better health, one's evaluation of the impact of toxicity isn't so much about getting conclusive evidence, but about stacking the cards favorably in terms of the totality of your lifestyle.

As with many things related to health, the cumulative effect over decades of affecting something seemingly marginal, is often astounding. This is why you can have two fifty-something siblings (or twins), where one is a health wreck, and the other perfectly healthy and fit. (The health wreck is typically the person who only thought in binary terms about health: "My doctor says I'm healthy, so I don't need to do anything", whereas the fit sibling is the one somewhat obsessed about health optimization.)

People ask me: "You look so young for your age, and you are so healthy, so why are you so picky with diet? Why do you take all these lab tests? Why do you eat fistfuls of supplements?". My answer is "Duh."

If farm workers who were exposed to pesticides got "alterations of the digestive, neurological, respiratory, circulatory, dermatological, renal, and reproductive system", and my goal is to be continue to be healthy and youthful for as long as possible, why shouldn't I want to minimize my own exposure to these substances if I can do so with minimal financial hardship or other negatives?

Anyway, I shall stop dodging your question. Here are some suggestions if you want some hard data to work with:

1) Check your genetics. Do a 23andMe. There are a couple of polymorphisms or SNPs such as APOE and MTHFR associated with poor detoxification capacity.

2) Run functional lab tests to assess your toxic load and excretion rates. Examples of such tests are hair minerals analysis, urinary organic acid tests, and tests for urinary lipid peroxides and urinary bile acids.

If your detoxification/excretion capacity is low, then you have a stronger case for working on reducing exposures and on improving detoxification/excretion.

Note that as a matter of sound therapeutic philosophy, removing overtly- or potentially harmful items (as determined by what our bodies could be reasonably exposed to be exposed to in evolutionary times) has the least inherent risk, whereas adding things like medications and supplements have higher risks because of their inverse U shape dose/benefit curves.

The first consideration in health is always to look at eliminating bad "stuff", before adding good "stuff" (over and beyond baseline nutrition).

Personally, since I have rather good genetics and decent hormonal- and gastrointestinal health, I don't actually obsess over buying pesticide free veggies, but rather take a middle of the road approach: I get some of my veggies form a CSA for part of the year, and I buy organic when a particular item is on the EWG's dirty dozen list. I supplement periodically with detoxification supporting supplements, and I do regular functional lab testing to monitor the status of important systems in my body.

"Organic", is it worth it? Q/A Part II

2012-09-14T10:21:00.004-07:00

I got some intricate questions on my first post on this subject, requiring more intricate answers. :)

How does the quantity of ingested pesticides compare to the total quantity of toxins absorbed by a human being in realistic quantities?

First of all, toxicity as a phenomena is not an either/or issue. A given substance's toxicity is a function of dose and exposure time relative to the organism's capacity to handle that particular profile of exposure without compromising health. This means that quantifying the toxicity of a given substance in a generalizable way is often difficult. This is particularly so when we are considering substances that are not toxic enough to reliably kill in a small acute quantity, but that with some probability may cause harm with chronic exposures.

I think that the above problem of context and quantification is one of the fundamental reasons why there will never be complete consensus about the toxicity of substances that are not positioned at extremes of the toxicity spectrum (such as botulinum toxin and water).

Those who expose us to pesticides and other synthetic, or "evolutionary novel", substances (with or against our will), tend to declare these substances as universally safe. And they do so with reference to relatively high "LD50s" (median lethal doses), while downplaying the potential harm from chronic low grade exposure.

Those, however, who take the opposite view will point to subtle effects observed with lower dose exposures on factors such as cancer risk and various health markers. The doses that are used in such studies are typically quite high compared to typical "realistic" everyday exposure, as this approach may be the only way to achieve statistical significance in the presence of confounding variables. So, for example, to study the effects on toxicity in humans, investigators often chose to include people who, for instance, get occupational exposure to the substances on a frequent basis.

Each side of this debate can easily be accused by the other side of cherry picking data; to not account for various contextual factor; to use either too low or too high doses in experiments; to be biased for financial or ideological reasons, etc.

So (to get back to your question!) an attempt to make an inventory of all our exposures (through ingestion, inhalation and skin contact) and assign a universally applicable toxicity level to each of them is a difficult task to say the least, and probably not meaningful as individual variability in terms of both specific exposures and "total body burden" is so high.

Another problem related to both exposure and individual propensities is the compounding effect of all types of environmental stress including toxicity. The presence above a certain threshold level in an individual of a given toxin could make that individual more vulnerable to any, or all, classes of toxins than would otherwise be the case. For example, if a person is exposed to mercury from leaking fillings his antioxidant reserves may be depleted and not be sufficient to neutralize the load of other potentially toxic exposures.

So, should you worry more about the pesticides in your food than, for instance, the air pollutants that you inhale?

Generally speaking, I think that you must come to some reasonably accurate estimates of your specific exposures and your vulnerabilities, and act accordingly.

Identify and take care of the obvious problems first.

If you, for instance, smoke a daily pack of cigarettes, jog frequently in a high traffic zone, live in a mold infested home, drink contaminated well water, eat junk foods on a daily basis, or expose yourself to any other established health risk, you should probably change those habits before you even think about pesticides in your vegetables, or low grade air pollution for that matter.

In other words, prioritize getting rid of the big and sustained exposures, and then survey your entire "perimeter" for potential lower risk threats and eliminate them as far as possible and desirable. (Context beyond pure health considerations, such as time, money, etc, obviously plays in strongly here.)

Remember that if the totality of what you are doing for your health (including diet, exercise, sleep, stress reduction, supplementation) is enough, you should be free of all persistent symptoms of any kind; or, if you are not there yet, you should see a gradual improvement of any persistent symptoms that you do experience. You should see good or improving results on functional lab tests. You should feel good, or gradually feel better. You should get stronger in the gym, or at least not move backwards.

What is the basic evidence that pesticides ingested in realistic quantities are harmful for a normal person?

Aside from the fact that there is no typical person relative to low potency toxins, and that harm is a very broad concept, the first types of evidence to consider are studies on health markers in animals exposed to pesticides, and studies on populations with occupational exposure.

You will probably find that you can look at such studies and come to very different assessments depending on your perception of risk and of harm, but that there are a lot of indicative findings.

I think that from a biological perspective it makes sense to believe that the toxic burden from manmade chemicals that have been added to the the background burden of natural toxins over just, say, a hundred years, is likely to be a challenge to the human body. This is because our genes have not had sufficient time to develop adaptations to the new level of environmental toxicity and/or to specific types of new toxins.

It it also reasonable to believe that we are even more vulnerable to toxins now (vs. pre-agricultural eras) because of a higher load of chronic stress which degrade the body's overall resistance to challenges, including chemical challenges. Incidentally, a crude measure of detoxification capacity is the presence of bile acids and lipid peroxides in the urine, and these markers tend to improve with reducing psychological-, dietary- and other types of chronic stress.

(I'm not saying that early eras were free of stress - quite the contrary, but that chronic stress was less common, and I think that the basic evidence in support of this idea lies in the fact that the human body is very vulnerable to chronic stress.)

So, the core issue is not that our bodies are inherently unable to deal with a variety of toxins. The issue is how to not exceed its capacity to do so.

Further regarding capacity, one needs to also take into account that even if one's body can detox and eliminate a certain quantity of toxins, such "processing" occurs at the expense of other processes in the body such as repair and regeneration. The body can only do so much given the resources that it has at its disposal.

The same Bruce Ames as mentioned above has proposed a compelling "triage theory of aging", essentially pointing out that modest shortages of micronutrients (vitamins and minerals) are likely one important factor behind the rise in chronic illness and premature aging. (The idea is that when the body is low on micronutrients, it will prioritize their use for processes needed for survival in the moment above repair processes that keep us functionally young).

If we integrate Ames' theory with the biochemical observation that micronutrients are used up in detoxification processes in the body, we arrive at the conclusion that the greater our toxic exposure (regardless of source), the greater our need for micronutrients for keeping ourselves youthful and healthy.

A problem however with adding micronutrients (or other compounds) as one's sole strategy to deal with toxicity is that micronutrients also become harmful above certain thresholds that are dependent on factors in each individual (each person essentially has an "RDA" at any given time for all nutrients), so reducing one's total toxic load seems to be the prudent choice over (only) trying to throw supplements at the problem. (I'm all for supplementation under reasonably controlled and monitored circumstances.)

Now, aside from these more theoretical types of arguments, it is frequently reported by health practitioners that helping patients discover and eliminate various toxins (which may be current exposures, or toxins accumulated in the body) improves symptoms and health outcomes. Perhaps these patients represent a subclass of particularly vulnerable people, but, how do you know for sure that you are not one of them now, or will become one of them later?

[Also read part III in this series!]

"Organic", is it worth it? Q/A Part I

2012-09-14T09:34:00.003-07:00

Q: Are organically grown fruits and veggies really healthier to eat? I mean, there's new research recently touted in the mainstream media indicating that their nutrient content isn't better than that in conventionally grown produce.

Yes, I think that organic produce is generally healthier and safer to eat than conventionally produced products. This is basically because they tend to have less pesticides in them. (More about the nuances of this later in this post.)

This said, note that the label "organic" is sometimes applied to questionable products, and more so after the USDA got involved in handing it out.

Some excellent and conscientious food producers can't afford to (or don't want to) buy the label "organic" from the USDA-maffia, whereas some shady operators who don't give a sh*t about the health of their customers are able to get the label.

So the label "organic" doesn't mean that you can happily suspend your thinking about if a particular product is really good for you.

Q: So, labels aside, what kinds of produce should I choose for health purposes?

There are two major health considerations with all foods:

1) How much potentially harmful "stuff" is in it?
2) How much nutritious "stuff" is in it?

Regarding the first consideration, it has been found (HT: SuppVersity) in a comprehensive study that organic produce (that is veggies and fruits grown without synthetic pesticides) generally has orders of magnitudes lower pesticide content than conventional products. (Duh!)

Why does that matter?

There is a large body of research that indicates that pesticide chemicals, ingested in realistic quantities, may impair health in numerous ways.

Yes, it is also true (as the brilliant Bruce Ames showed) that plants themselves produce toxins that may be just as harmful as toxins that are man made.

HOWEVER: One's total body burden of absorbed toxins in relation to one's body's detoxification/elimination ability (a function of genetics, health status, and stress levels) is what ultimately counts.

Most of us live in environments which, by default, expose our bodies to a higher toxic load than they are "designed" to cope with optimally (especially if we want to live for a long time past our reproductive age).

If we want to stay healthy our task is therefore to keep the total body burden of toxins as low as (practically) possible, while, on the other hand, optimizing our bodies' ability to deal with the toxins that we can't (or don't want to) avoid. (The latter involves, for instance, making sure that our digestive-, hormonal-, detox- and immune systems work correctly. A wide subject.)

What about the second consideration (nutritional content)? How can I get the most nutrition out of my fruits and vegetables?

To begin with, major factors that matter for the nutritional value of these foods are:

1) The nutritional quality of the soil in which the produce was grown. This factor is a function of what nutrients are already in the soil (how "depleted" the soil is), and of the type of fertilizer used during the growing process.

Regarding fertilizer, taking a biological viewpoint, I don't think that enough is known about nutrition to design a "multi-vitamin/mineral" for soils that produces as nutritious results as using, for instance, manure, or dead animals or plants for fertilizer.

2) The strain or variety that is grown, and its propensity to absorb and retain nutrients from the soil, as well as its ability to synthesize nutrients that we benefit from.

A focus on crop yields in the development of new strains (e.g., GMO) compromise these nutritional aspects.

3) The level of processing and transport that the produce undergoes before it reaches your plate. (The longer the supply chain, the less will be left of volatile nutrients.)

[Let me know if I missed or misinterpreted some aspect - I'm not an expert on agriculture!]

Regarding these nutritional considerations, I think that the label "organic" matters less than when considering toxic load.

Rather, the most important factor is probably large scale production vs. small scale local production - not necessarily "organic" vs. conventional.

Small farms typically (but not always) access less depleted soils to begin with, and if they also use good crop rotation practices and natural fertilizer (e.g., manure, and crop waste materials) their products should be more nutritious.

In addition, small farms, often try to compete by growing tastier products. This means using varieties which may grow slower than those used in large scale production and which both absorb and produce more nutrients. (Think about the difference in taste between the tomatoes that you get in Tuscany, Italy vs. supermarket tomatoes.)

Bottom line: (Here taking the luxury of considering health as virtually the only consideration.)

BEST: Locally produced fruits and vegetables from small farms that use "organic" practices and with a focus on taste, but not necessarily labeled organic. Ideally, visit the farm that you will be buying from. Make sure that it is not situated next to a major source of pollution. (I don't think I'd like to buy veggies home grown on a roof top next to a known polluter).

NEXT BEST: Items that are labeled "organic", but that are not necessarily local and/or small scale.

NEXT NEXT BEST: Conventional produce products that are not on EWG's dirty dozen list. ( http://www.ewg.org/foodnews/summary/ )

[Also see part II, and part III of this mini series.]

The Stress That is Killing You. (PDF Poster)

2012-07-16T09:24:00.000-07:00

Pottenger Got it Right

2012-06-21T08:19:00.001-07:00

In terms of therapeutic doctrine, mainstream medicine has traveled backward since the first half of the 1900s. Pioneers of physiology would roll in their graves if they saw what's going on today.

Physiologist Francis Pottenger ("Symptoms of Visceral Disease", 1919) wrote:

"Though I have devoted myself to the study of diseases of the chest—a so-called -'specialty' —for more than twenty years, experience has led me to see that such a thing as a medical specialty in the accepted sense of the term, can not exist. Diseases can not be divided into those of this and that organ; for the human body is a unit. One part can not be diseased without affecting other parts. No organ can be understood except in its relationship to other organs and to the body as a whole."

Pottenger's view should be trivial to observers of the human body, but modern medical textbooks have become sales catalogs for ultra-compartmentalized pharmaceutical treatments. No wonder, modern medicine has become reduced to emergency intervention or cargo-cult type "prevention" such as cholesterol-supression.

The general public is as mistaken – just look at how people seek treatments for "the thyroid" or for acne or for headaches or for virtually any issue without realizing that in most cases (outside broken legs) any problem manifest as symptoms or malfunction in a specific organ or tissue is actually rooted in a body-wide problem. (Check out my acne chart for an example of how something that may look like a skin issue is an issue related to just about everything in the body.)

Pottenger had a grander vision:

"The superior man in the medicine of the future will not be the great laboratory worker, or the man who is known for his studies in metabolism or the expert gastro- enterologist, or neurologist, or surgeon or he who stands preeminently above his confreres in his knowledge of diseases of the heart and arterial system or of the lungs, but the man who recognizes the fact that the truths derived from all of these sources of study and investigation must be interpreted as belonging to the human patient as a whole—in other words the internist who appreciates the unity of medicine. The distinguished specialist will be one who regards his field of study in its intimate relationships to the body as a whole."

Sadly, almost a hundred years later, we are still waiting for Pottenger's vision to become widely accepted.

However, the situation today is worse than only about compartmentalization and anti-physilogic divisions of the body.

Medieval style guild mentality and refusal to integrate new discoveries or observations that don't fit current dogmas are rampant. Specialists in medicine typically have to be kicked and dragged to look at the actual science in their own fields.

Hence we hear hilarious statements such as "gut flora has nothing to do with IBS" or "gluten is only a problem in celiac disease" or "obesity is only about calories in and calories out".

Continuing education for specialists seems to be mostly about skiing and golfing, but even so, relevant scientific papers are only mouse clicks away on the Internet.

The result of this situation is that patients, as well as anyone who is interested in avoiding becoming a patient, have to educate themselves about basic physiology and as well as proper therapeutic principles so that they themselves can be the "superior man in medicine" and take charge of their own health.

Father's Day Special: Who is Stealing Dad's Testosterone?

2012-06-17T16:00:00.000-07:00

Libido 101

2012-05-18T11:31:00.000-07:00

Stupidity: Ignoring the Ladder of Health

2012-05-08T06:57:00.001-07:00

Aside from the great variability in individual genetics, I find that the biggest confounder in understanding which practices are healthy or not in a given person is that actual physiology and optimal "inputs" (dietary etc) is a result of present and past stress exposure and related dysregulation/damage in the body.

A radical example is that walking barefoot (or with minimalistic shoes) is quite likely the best health promoting option in terms of footwear for a person who is reasonably healthy to begin with, however a Chinese woman who got her feet bound and deformed from childhood should obviously not be advised to join a barefoot runners club. (She might need extensive surgery first, if restoration of normal function is possible at all.)

Another example is periodic fasting, which may be very beneficial in a healthy person (improving insulin sensitivity and triggering cellular repair processes), but quite detrimental for someone with exhausted hormone production. (Hence hormone issues need to be addressed before fasting will lead to benefits rather than aggravated problems.)

Formal studies don't tend to take this sort of variability into account, as they are either performed on people at the very functional/healthy end of the spectrum ("healthy young men") or on people who have diagnosed diseases ("half-dead diabetics").

In other words, what sustains, promotes and enhances health in an overall healthy person is often very different from what a sick person needs to regain health or what a person under stress needs to do to support the body's fight against stress. (Incidentally, most people are quite sick and stressed these days - any kind of persistent symptom of any magnitude is a sign of a degenerative process somewhere in the body.)

One could say that there is a ladder of health to climb. At the bottom is mere day-to-day survival and at the top is supreme physical/mental function and longevity. At each step along the ladder between the top and the bottom, what is appropriate to do for one's health may be different from what is appropriate at the steps below and above.

For this reason, one should be cautious when using other people (such as gurus with "six-pack" abs etc) as templates for what to do for one's own health. (The same applies to using findings from scientific studies as gospel without careful consideration.)

One must know where one is on the ladder of health and what one's particular set of physiological weaknesses and strengths are.

So how does one figure this out in practice? Aside from careful self-experimentation, a good assessment is a "Functional Adrenal Stress Profile", which is a salivary test of important steroid hormones. This will let you know in a big-picture way your body's state in terms of external- and internal stress and how well it copes with stress. For instance, if your cortisol to DHEA ratio is elevated or crashed, fasting may not give you six-pack abs, but rather contribute to belly fat.

Notes on Chronic Illness and Inflammation

2012-02-21T14:14:00.001-08:00

I recently attended a series of seminars on chronic illness and inflammation. These are some notes from this event about hyper-sensitivity to mold toxins, the importance of genetics and inflammation for mercury toxicity, an online test for neuro-toxin exposure, alpha lipoic acid as a mercury chelator, phytonutrients as epigenetic triggers, and herbal anti-inflammatories in cancer-therapy. /CW

Note #1: There is a gene (or rather a cluster of genes) that makes some people extremely sensitive to mold toxins. Sensitive to the point where a minute exposure can create a cascade of inflammation resulting in terrible symptoms which are often misdiagnosed as fibromyalgia, asthma, emphysema, fatigue syndrome, etc. (If you have "inexplicable" health issues, this may be something to look into.)

Note #2: What makes some people able to live relatively unaffected with a mouthful of mercury while others cannot? 1) GENETICS: The presence of ApoE 3/3, 3/4, 4/4 makes you more vulnerable - check your genes with 23andme. 2) INFLAMMATION: Inflammation shuts down mercury detox pathways. (Chronic inflammation is in turn caused by poor food- and lifestyle choices.)

Note #3: Chronic conditions (especially those with a neurological component, such as fibromyalgia and dementia) often has an important component of neurotoxicity from fungi, bacteria, spirochetes (e.g., lyme), etc. One can determine if such a factor is likely to be present through an online test that measures the person's ability to detect visual patterns: "VCS Test" - Visual Contrast Sensitivity Test.

Note #4: Don't use the popular (and hyped) anti-oxidant Alpha Lipoic Acid if you have amalgam fillings. It chelates mercury and may put it into your brain. (When fillings have been removed, ALA can then be used in very specific dosing protocols to get mercury out properly.)

Note #5: ‎"Phytonutrients" such as curcumin (turmeric) & resveratrol (red grapes) work by flipping genetic switches that activate detox- & antioxidant systems. By taking such nutrients in effective amounts you are telling the body: "I know better than you do that you need to increase detox/anti-ox." Is such "central planning" a good idea? In today's toxic environment, I tend to think YES, but it should be done intelligently.

Note #6: Gliablastoma (a nasty type of brain cancer) may be put into remission by high dose curcumin, gingerol, and boswellic acid (these plant compounds turn on anti-inflammation genes). I think that the broad lesson is that a cornerstone of an anti-cancer lifestyle is to avoid foods and toxins that cause inflammation and oxidative stress. As the ancients said: "the cure points to the cause".

If you enjoyed these notes, you could get more by liking our Facebook Page.

Note: This is all for educational purposes only. Consult with a qualified healthcare practitioner to determine the applicability of this information.

Food Elimination Q/A Part Two (Effectiveness)

2012-02-08T12:51:00.000-08:00

I'm doing a lot of work on helping people identify and fix food sensitivities, so I often receive questions related to this. If you have a question, please put it in the comments section, and I will try to answer it in a follow up post. Thanks! /Christian

Please read part one of this Q/A first, if you haven't done so.

Q: Do you have any thoughts on the reliability of MRT (“Mediator Release Testing”) vs. other food sensitivity tests?

That's a good question, but it opens up a can of worms!

There are a couple of considerations with regard to “reliability” that we need to discuss, so let's dig in.

I like Mediator Release Testing (MRT) because it saves people a lot of time when trying to pinpoint certain types of food sensitivities that are otherwise quite difficult to detect (for instance, these sensitivities can have delayed symptoms,).

Now, as with all tests, MRT has its inherent limits (for instance, there are many types of food sensitivities that it just cannot discover), and, as with all tests, it can also certainly be abused in many ways when designing therapies based on its results.

The MRT measures a common type of food sensitivities, which are so called “cell-mediated reactions” to food proteins and chemicals.

These reactions (sometimes called “Type IV” sensitivities), which could be thought of as a type of “contact allergy” (think nickel allergy) do not need the involvement of antibodies. This is different from, for example, classic allergies (Type I - e.g., a person dying from exposure to peanuts) or so called IgG delayed sensitivities (Type III), which both involve antibodies that laboratory tests can look for.

So instead of looking for antibodies, MRT measures inflammatory “squirts” of “mediators” that cells produce when exposed to food proteins and chemicals. More squirting equals a higher degree of sensitivity.

Bottom line: What MRT measures is very different from other allergy and food sensitivity tests, and, well, these other tests don’t measure what MRT measures.

To concretize a bit more, MRT cannot discover celiac type gluten sensitivity (or cross reactivity with gluten, e.g, coffee looking like gluten to the body), or issues with lectins. Nor can the MRT discover problems with certain sugars and fibers or “FODMAPS”. (A burp/fart challenge test may be best for these, but I digress!)

However, concerning to the types of sensitivities that MRT does measure (and the other tests don't!), it does so with a high degree of accuracy. (90% according to a clinical study.)

So each type of food sensitivity testing (MRT, IgG, IgE, and many others) or, any other test for that matter, should be considered on its own merits (and limitations) in the context of the person that has the health complaint. (A fantastic idea, isn't it! Forget this under ObamaCare, by the way.)

If your health issues are really tricky, such as if you have autoimmune disease, you could benefit from a whole battery of food sensitivity tests that target different types of sensitivities. The limits mostly being price and the ability of your practitioner to interpret the tests correctly - sometimes more of an art than a science.

Personally, I love the MRT for basically one important and common task, which is that it assists with identifying foods that may cause inflammation of the gut lining (“the intestinal mucosal barrier”) .

This is big, because when the gut lining is perpetually assaulted by foods that cause inflammatory reactions, the stage is set for poor gut flora and intestinal permeability which in turn exacerbates “systemic” (whole body) inflammatory problems (acne, arthritis, migraines, etc), as well as problems with gluten and other types of sensitivities.

Constant inflammatory irritation of the gut lining is also a direct cause of cortisol issues and associated problems such as hormonal imbalances and dangerous visceral fat accumulation. (If you have a cortisol response from eating, you may experience it as a raised pulse rate during or after a meal.)

Now let’s look at two important factors that will determine how effective food elimination based on MRT or other testing technologies might be for you:

The first factor in effectiveness is how much dysfunction related to food sensitivity that you actually have and where exactly. In other words, for instance, the degree of “leaky gut", poor gut flora, or problems with immune function that you have.   These and other "functional" factors determine the degree to which reactive foods may cause problems for you, but these factors cannot be estimated with confidence through food sensitivity tests alone.

For instance, the MRT uses live blood cells which the laboratory exposes directly to food extracts, and for this reason it cannot tell if food proteins actually tend to leak into the blood stream in the process of your normal digestion. (I'm assuming that you don't juice and then inject your foods.)

In practice this means that a person with a high degree of leaky gut who tests reactive to, say, beef may therefore see powerful improvements in overall symptoms when eliminating beef from the menu, whereas another person with little “leakiness” may experience much more subtle improvements even if beef tests highly reactive. (This said, I actually have yet to encounter anyone who hasn’t reported some noticeable improvement, such as a bit of fat loss, after taking out MRT reactive foods for a couple of months.)

The second factor in effectiveness is the total “therapeutic force" applied to repair damage while eliminating reactive foods.

This issue is most often overlooked by people who think that food-elimination is the end-all-be-all. (It can be, but often it is not.)  

All healing, whether it is about healing an annoying paper-cut, or healing an entire digestive tract (or an entire body for that matter), depends on doing enough things right for a long enough time (this is what I call “therapeutic force”) so that a virtuous feedback loop can take hold in the body so that it may heal itself.

To put it differently: One cannot overcome the vicious cycle of a degenerative process without creating at least an equally powerful healing process.

Think of this as the need to use enough force when pushing a boulder up a hill so that it can reach the peak of the hill. Only then may the boulder roll down the slope on the other side.

If you, on the other hand, don’t apply enough (and sufficiently persistent) force to the boulder, you will be like Sisyphus - doomed to roll a boulder up a hill, only to see it roll back down again, and to repeat this for the rest of your life. Not very productive.

So to apply this idea to food sensitivities, it is quite common that people go through Sisyphean torture in the quest for the ultimate elimination diet. For example, people wind up eating extremely restricted diets, such as meat-only diets, or they find themselves stuck in the midst of an ever changing and confusing landscape of food sensitivities and associated symptoms coming and going.

In many cases these types of struggles come from focusing too narrowly on food elimination as the only therapy and therefore from not achieving sufficient “therapeutic force”.

The sticking points may be different from one person to another, but common ones are failure to correct cortisol issues (sleep and stress management are very important); failure to rebalance gut flora (probiotics therapy can accelerate the process); failure to get rid of any pathogens/parasites (very common if intestinal health has been poor for a long time); and the failure to supply enough restorative nutrients (a so called “gut repair protocol” can help tremendously).

Actually, in many cases, after a successful repair process (which can take a year or more) it is often revealed that reactive foods found on food sensitivity tests, particularly if they are “paleo foods” such as meat and veggies, are not actually true root causes of a person’s health problems, but that the foods were merely problematic in the context of dysfunction such as "leaky gut" or a gut flora that was out of balance.

Food Elimination Q/A Part One (Is food elimination for life?)

2012-02-08T12:50:00.000-08:00

I'm doing a lot of work on helping people identify and fix food sensitivites, so I often receive questions related to this. If you have a question, please put it in the comments section, and I will try to answer it in a follow up post. Thanks! /Christian

Q: Let’s say that I have discovered a few foods that I react badly too. Will I have to stop eating them for life?

To answer this in an as illuminating way as possible, I’m going to define food sensitivity very broadly:

Let’s consider “food sensitivity” as something that could include everything from abnormal blood sugar levels when eating carbs, to tummy discomfort when eating lactose, to autoimmune flareups from gluten or nightshades, to anaphylactic shock from eating peanuts.

If the food sensitivity is part of your “hard wiring” either because of genetics or because a part of your body has become irreparably damaged, then YES, you need to stay away from that particular food for the rest of your life.

An example of hardwired genetic food sensitivity is genetically based lactose intolerance. In this case, your body just doesn’t have the genetic information that it needs to make the needed digestive enzyme (lactase), and hence you will never be able to digest lactose on your own without ingesting some lactase at the same time. (Strictly speaking this may depend on your gut flora and if you drink raw milk, but let's not complicate things!)

(Note: To put this in the context of "Paleo": Paleo theory essentially holds that we are all genetically hardwired to be more or less sensitive to grains, legumes, dairy and certain other foods.)

The second category of "hardwired" food sensitivity is caused by irreparable damage.

One example of this is problems metabolizing carbohydrate due to the inability of the pancreas to produce insulin (diabetes). Another example is the poor ability to digest fat in people who have had the gall bladder removed.

In addition to these examples of irreparable damage, I would like to add that in a person with auto-immune disease there is the possibility that the immune system has become permanently unable to distinguish between “self” and and “non-self” in such a way that some foods will always be problem triggers. (An example is a person with Celiac disease who will have to stop eating gluten for life.)

Let’s now look at food sensitivity that is not hardwired, but that could be called functional (or “circumstantial”) food sensitivity:

In this case the sensitivity is a result of a degenerative process that has caused a degree of malfunction in some organ or system in the body such as the intestinal mucosa, gut flora, blood sugar regulation, or immune system (all of which can cause the body to react adversely to various foods).

This type of food sensitivity is most often present when people discover problems with typical paleo foods such as meats or seafood or inconspicuous fruits and vegetables.

If this is your situation, your prospects for being able to eat the food again without problems hinges on if you can successfully halt the responsible degenerative processes and restore proper function.

Part of the healing process is to stay away from the reactive foods for a significant time (say, three months), and then do an experiment with re-introduction.

Now, I deliberately said “part of the healing process”, because removing trigger foods may not be enough to to stop and reverse the underlying degenerative process that caused the food sensitivity.

In many cases one needs to do additional repair work in conjunction with eliminating reactive foods to regain full health and the ability to eat the excluded foods again.

Conversely, not doing the repair work can result in a merry-go-round of food sensitivities. The person may develop new sensitivities to whatever foods they are eating for a prolonged period of time. (This is a classic sign of “leaky gut”.)

Details of the repair process are far beyond the scope of this post, but, as a summary, one may have to use restorative nutrients to repair the digestive tract, as well as address other surrounding issues such as hormonal imbalance, gut pathogens, and toxicity issues that can all contribute to poor gut function.

PS. What I have found is that when a person doesn't have optimal health overall (could be anything from acne to obesity to auto-immunity), poor gut health is always part of various viscous cycles in that person's body, and that in order to heal the body, one must heal the gut… But to heal the gut one must also heal the rest of the body! (One of the big "paradoxes" of the enterprise of health!)

As seen on the subway around 3 PM: The "afternoon dip".

2012-01-12T13:01:00.001-08:00

The yawning; the sugar/coffee cravings; the unproductive stupor. Enter the "afternoon dip".

This is how it looks like on a salivary cortisol test.

The dip is a sign of suboptimal adrenal function. (Especially when occuring along with a pickup in night time cortisol - the "second wind".)

It's an epidemic, but it's not normal function.

Full disclosure: I strugle with this personally and fixing it takes time.

Example Investigation and Musings on Genetic Destiny

2011-12-30T15:57:00.000-08:00

I am working with someone to help him troubleshoot and get rid of his very troublesome health issues, which include fibromyalgia and chronic fatigue syndrome (CFS).

Incidentally, this person has been on a "paleo diet" for several years, but this hasn't helped with his most troublesome health complaints. This isn't an argument against the diet, but is merely an example that eating plan vanilla paleo is a necessary but often not sufficient step towards complete health.

Anyway, I wanted to share some tidbits from our investigation of his case. It should be quite interesting because we employed a range of tools (including 23andMe genetic testing) to home in on different problem areas.

Exhibit A: 23andMe genetic test results analyzed through Promethease software.

Here we found the genetic variant ("polymorphism") associated with problems with folate metabolism, and which is common in people with CFS and fibromyalgia and many other whacky health conditions. BINGO!

Exhibit B: …However, a test of plasma homocysteine showed a perfectly normal reading (7.9 umol/L with 15 considered elevated), so no apparent sign of a problem here when using this common doctor's office test.

The non-confirmation here shows one of the big limitations of genetic testing alone. Genetic testing just can't predict how genes are actually expressed in a person's body, and the body also has clever backup systems to prevent problems.

[Digression: This apparently normal homocysteine reading would typically be the end of the investigation for most people and their healthcare practitioners. However, VitalObjectives' heroic clients, who all want to do what it takes to get better, and who don't give up even if it means paying out of pocket for the privilege of pooping and peeing into vials and jars, push forward toward true resolution and restoration of health.]

Exhibit C: In order to dig further, we performed a test for urinary metabolic markers of methylation problems. BINGO! The high reading of "FIGLU" shows that the genetic propensity actually translates into a real problem, but this through a different pathway than the one that would result in elevated homocysteine. Through this finding we know with more certainty that proper function in the body may be supported through supplementation with a natural form of folate called 5-MTHF, and that the problem is both functional and genetic.

Now proponents of evolutionary thinking may ask: "How can it be that some people with this genetic issue develop health problems when many others do not? And, why hasn't this common variant/mutation been weeded out of the gene pool?".

This is an especially valid question since 5-MTHF is the natural form of folate that one could readily get from one's diet if one eats a proper human diet rich in items such as green leafy vegetables, egg yolks and liver.

So there must be additional necessary conditions present to cause trouble in a given individual - something that prevents a person from getting enough 5-MTHF from the diet, right? (Remember that the particular individual under investigation eats a paleo diet.)

Yes, the presence of such additional factors is quite demonstrably the case:

Exhibit D: A salivary panel looking at immune function in the mucosal barriers revealed that the immune system in the GI tract is likely to be very weak. The very low reading of 4.8 for Secretory IgA (a type of anti-body involved in the first line defense of the GI tract) indicates that chronic inflammation may have exhausted the immune system. This condition often correlates with poor absorption of nutrients because of destruction of the intestinal lining and problems with the gut flora.

Exhibit E: A hair trace minerals analysis confirms this idea as many nutritional elements (notably iron) are found to be low. Notable here is also that cobalt is non existent(!). Cobalt is involved in folate metabolism (in ways that I don't yet understand), so this reading may be another confirmation of abnormality in this area, and something to ponder further.

In summary, the findings revealed through this process indicate that my client likely would benefit from 5-MTHF supplementation, potentially for life. However, since we are also working on healing his gut and his absorption, it is not unlikely that supplementation ultimately becomes unnecessary. Genetics is not destiny.

Finally, here are some overall take away points:

1) Genetic testing is almost never the final word on any actual or potential health issue, but may give clues about where to look for functional signs of problems. Forget the idea of deriving your diet or supplementation regimen from genetic tests.

2) Often several different tests are needed to give an accurate enough picture to guide action. (The way single blood tests are used to prescribe powerful drugs or even "natural" remedies by some practitioners is just insane in my opinion.)

3) Most of the diagnostic tools that I and my client used above will become very difficult/expensive/impossible to get access to unless YOU fight against government intrusions into health, food, and medicine. Same thing with advanced supplements such as 5-MTHF (and probably even Vitamin D) in effective doses. So stop voting for Fascist politicians who in the name of "food safety", "consumer protection", "universal coverage" or crying babies rob you of access to your means of staying healthy and to save your own life.

Neglected aspects of effective & injury free strength training

2011-12-28T11:22:00.000-08:00

There is a lot of debate about the technical aspects of how to best lift weights for strength- and muscle gains, but, in my opinion, not enough discussion about some core psychological- and physiological aspects that can make all the difference regardless of what specific training techniques one choses.

#1: Be Howard Roark. Focus on your exercise set, and your body's signals. Don't think about what the meat-head across the room is doing, or what he thinks of you, which may switch your focus - a recipe for injury. (This is part of the reason that I'm a bit skeptical of Crossfit - many people just can't handle the "other-people" orientation inherent in the competitive element.)

Also, if you ever got repetitive strain injuries from plain office work, you may want to learn to listen to the signals of your body better. You may want to seek out a really good coach to watch your technique.

#2: Control inflammation by eating right. Train hard enough to turn some acute inflammation on - the trigger for muscle acquisition. Eat an anti-inflammatory diet (a paleo diet) to make inflammation turn off properly. (This is why pro sports teams eat gluten free diets.)

#3: Optimize cortisol to control inflammation and to maximize training intensity.

Not enough cortisol will contribute to inflammation, which weakens tissues and makes them more prone to injury and soreness. Many people aren't even aware that they have the problem (advanced "Adrenal Fatigue"), until bang! orthopedic surgery is needed.

On the other hand, chronic cortisol elevation is catabolic and hence counterproductive. Ideally, you'll want to have acutely high cortisol during training to maximize intensity, but after training cortisol should rapidly drop off to a healthy baseline. (Not too high and not too low.)

#4: Optimize androgens. Get enough sleep and control all types of stress, including stress from food sensitivities, gut pathogens, and annoying relatives.

Acne Troubleshooter v2.0

2011-12-07T15:15:00.000-08:00

The skin is a window into overall body function, and acne is a sign that something isn't working as well as it should.

I have updated my acne troubleshooting chart, which is based on more or less validated scientific theories about the mechanisms behind acne, as well as clinical observations of what types of issues may have to be resolved to say goodbye to acne forever.

Notably, I have included the important liver/detox/anti-oxidant axis, which I think is a missing link in dietary theories about acne.

It is not uncommon to see improvements in acne with good liver support supplements, particularly after grains, legumes, and dairy have been reduced in the diet.

Please click to make the diagram larger.

Cholesterol and CVD Risk in a Nutshell

2011-10-08T13:32:00.000-07:00

This is a brief summary of my current understanding about how to interpret cholesterol values as they appear on the blood chemistry panels that's done during regular medical check ups. (I deliberately don't list specific ranges, as this is about the essentials of what I think is a correct perspective.)

Elevated total cholesterol in the absence of inflammation (and associated oxidative stress) is unlikely to contribute to heart disease. (Though an extreme elevation or depression in cholesterol may indicate other problems in your body.)
Elevated cholesterol (especially high LDL relative to HDL) in the presence of inflammation is likely a risk factor. This is because this scenario involves LDL cholesterol carriers becoming oxidized and stuck inside the lining of blood vessels causing artherosclerosis as well as processes leading up to acutely threatening events such as infarctions.
The likelihood of cholesterol becoming target of harmful oxidation is higher in people who have blood sugar dysregulation (suggested by elevated triglycerides) such as the obese or (pre)-diabetic, because these malfunctions contribute to the formation of "small dense" highly oxidizable LDL as well as inflammation.

In other words, the more inflamed and/or diabetic your are (risk increases dramatically if you eat a typical Western diet) the more an elevation in cholesterol is likely to be a concern in regard to heart disease. In this situation, statin drugs may lower your risk somewhat, but possibly with side effects that will ultimately kill you from causes other than heart disease.

In people who do not fit the above disease- or dietary profile, cholesterol is likely of no particular concern unless it is heavily elevated or depressed. (Extremes in both directions may indicate chronic infection, genetic weaknesses related to cholesterol metabolism, or thyroid dysfunction.)

The apparently most relevant marker that suggests heart disease risk as it relates to inflammation is hsCRP ("High Sensitivity C Reactive Protein"). hsCRP tends to be well below 1.0 mg/L in healthy individuals with no acute infections.

This is not medical advice, and, as a health consultant, I don't diagnose or treat disease, but if your doctor isn't equipped with the knowledge to even discuss these points, he or she has no business trying to "treat" your cholesterol values as such.

(*Technically, what's listed on blood panels isn't actually cholesterol, but cholesterol carrier proteins, but, oh well, once we have declared war on a natural substance, who needs such distinctions...)

Thanks to Chris Masterjohn for contributing through lectures and writings to my understanding. (Any errors are mine and this is not an attempt at paraphrasing Chris.)

Thank you, Steve Jobs.

2011-10-06T10:19:00.000-07:00

Steve, I cannot thank you enough. You inventions fueled my interest in computers from when I was 12. You provided me with tools for work and fun that I have enjoyed using every day for hours and hours. You have been living proof that success and unwavering commitment to one's ideals are not just compatible, but that valid ideals, pursued relentlessly, are the drivers of lasting business- and personal success. You have been an inspiration when I have taken my own steps into the unknown, showing that failure is nothing to fear, but something to learn from.

The Wizard of Oz (Part I)

2011-10-03T09:05:00.000-07:00

OK, it is perhaps getting a bit old to criticize mainstream health advice. I mean, if you are reading this, you probably already suspect that cable television is the go-to place for learning at least 15 different ways to waste muscle-, bone- and brain mass by eating tofu and whole grains while running on a treadmill.

On the other hand, when I receive such a hilariously stupid promotional message as I did this morning, I can't resist the temptation to publicly register my mocking response.

The particular message was about Dr. Oz's (aka the Wizard of Oz's) health “tips” in Men's Fitness Magazine.

My snide remarks are inserted after each quoted section:

“Hi there-

Thought you may have interest in Dr. Oz's tips for living life to its absolute fullest. Help your man live to 100 with Oz’s advice! In the September issue of MF, he’s prescribing a mix of competition, training, nutrition, and preventative medicine that will keep your man tuned for the rest of his life!”

That is a decent intro, indicating that the advice is directed towards women who are then supposed to harass their men into taking some prescribed actions. (As we all know, health has nothing to do with internal motivation.)

“Annoyed that your guy isn’t taking care of himself? Wish you could help him get in the best shape of his life? Or maybe you just want to help him get back on track?”

So "your guy" is a fixer-upper in the health department?

There are three options:

1) Your guy knows he is out of shape, but doesn't care.
2) Your guy doesn't know (or evades) that he is out of shape, and doesn't care.
3) Your guy knows he is out of shape and does care.

For #1 my suggestion is that you acknowledge that you two have incompatible values regarding health and fitness. Loath it as you wish, but don't pester him with "Wizard of Oz"-info. If he truly is a man he will not tolerate it. (If he does tolerate it, he is not an alpha-male, and you must therefore leave him for a tattooed gangster/crossfitter [See, this is holistic health coaching at its best!])

For #2, my advice is to dump him. A brain-in-a-vat would be OK, but who wants to live with a brain-in-a-tub-of-lard?

If it is #3, then your guy has already tried every single health platitude spouted by Dr Oz's, resulting in even more stubborn love handles (the carb addiction fat site) and/or on his legs/chest (the estrogenic fat sites). Get him away from Dr Oz before he acquires an insulin/estrogen related cancer.

“For guys in their 20s

Twentysomethings’ testosterone levels are high, so they have a big desire to be sexually intimate and a need to build muscle mass. Place more emphasis on muscle-building activities. They should be working out every other day, building up their core, arms, and legs. The one activity they should definitely be doing is pull-ups. You know you’re fit if you can lift your own body weight at least 10 times—that’s the bare minimum.”

Doesn't this sound like a description of pubescent chimpanzee?

Anyway, I am past 40, yet the gist of the above actually fits me quite well, but with the difference that my "need" to build muscle is both driven by testosterone-induced vanity and my belief that muscle mass is one of the most important determinants of health and longevity.

“Guys in their 30s

Once your guy hits his 30s, he can start to move away from muscle-building activities a little bit and focus more on fitness. Young guys are more able to move around, but thirtysomethings are a little stiffer and start putting on more weight. So now they have to worry about not burning as many calories.”

On my 30th birthday, I barely knew what a second mortgage is, yet here Dr Oz proposes that one's 30s should be the time to scale back on that testosterone-driven muscle building craze and prepare for retirement (buying a mobility scoter?). The 30s is when guys just happen to become a little "stiff" and chubby (aka the "registered dietitian"-look), right?

Anyway, as far as I can tell, I begun to age backwards by my late 30s when I ditched the USDA/ADA/Oz diet and begun to pay attention to what people with superior health and fitness were actually doing.

“Guys in their 40s

By the time your guy is in his 40s, it all becomes about your body’s pliancy. Once he loses the ability to stay flexible and balanced, he starts to develop frailty—and frailty is what really hurts us when we get older. So I would spend more time doing yoga or balance activities, like doing exercises with your eyes closed. To improve your balance, do this simple test. Stand up straight with your arms folded across your chest, close your eyes, and raise one foot, bending the knee at a 45-degree angle. Set a goal of balancing for 15 seconds.”

Balance exercises are probably a good idea, but frailty...in one's 40s?!! :) Not that frail 40 year olds (or 20 year olds, or 10 year olds) don't exist today, but the fact that this particular "schedule" of degenerative aging is tossed around as normal and uncontroversial is a glaring admission of the intellectual- and practical failure of the government-pharmaceutical-medical establishment that the majority of people have chosen to endorse and listen to. Enough said.

“Guys in their 50s

The big epiphany—and this is going to blow your mind—is that the fitness level of someone who is 17 years of age is no different from someone who is 65 years of age. So your man has to be able to stay physically active throughout his life. Guys past the age of 50 should focus more on endurance activities as they get older—things like biking, running, the elliptical if he has weak knees, and swimming.”

So, suddenly after twenty years of progressive stiffness, frailty and obesity the typical 50 year old can suddenly enjoy fitness like a typical 17 year old. I can't follow the logic, but, oh well.

More “endurance activity”? I'm reminded of the middle aged, metabolically deranged men who suddenly realize: "I'm obese, I'm diabetic, I desperately need to do something! I need to train for a Marathon!".

This is one reason that gyms have CPR equipment.

We know the archetype from fitness centers everywhere: A sweaty, red-faced, and panting, 50-something with an enormous wheat-belly suddenly clasping his chest in terror.

Meanwhile, on the TV screen attached to the unfortunate's treadmill we see the face of a recently polypectomized Dr Oz doing his best to obfuscate the message of an actually quite fit 50-something: Gary Taubes.

Q/A: Will X cure or prevent Y in person Z?

2011-09-15T10:38:00.000-07:00

Question: There is this story in my family: In her 50s, my grandmother took a certain formula consisting of lecithin, raw wheat germ, "debittered" brewer's yeast, bone meal, and sunflower oil. This apparently cured her angina and atherosclerosis. Does this sound plausible? Should my relative who is suffering from heart disease today take this formula?

That concoction looks rather awful (!!!), but we must keep in mind that any nutritional deficiency (or nutritional "overload") can be causative in any health condition in a given individual.

For instance, too much calcium may contribute to heart disease in one person, whereas too little calcium may cause heart disease in another. (Nutritional calcium can either cure or contribute to the dysregulation of calcium metabolism.)

So even granted that the described formula actually was the instrumental factor in your grandmother's recovery - who knows, it may have pushed just enough micronutrients into her system to get excess calcium out of her blood stream, it is a mistake to assume that it would automatically benefit all individuals with heart disease.

Beyond such individual variation as discussed above, we also have to keep into account that the body is an interconnected system. This means that it is actually dangerous to treat a disease (aside from acute interventions, of course) or try to prevent it in a vacuum without considering systemic side effects - side effects, which again, could vary from person to person.

For instance, I believe that many people who go on heavy fish oil- and niacin dosages may perhaps prevent death from heart disease, but may increase their risk of dying from something else. (Pharmaceutical doses of niacin and fish oil can be toxic.)

These are some of the major reasons that I insist on doing functional analysis (such as assessing hormones, digestion, detoxification, and metabolism) of what's going on with a person, including looking at his or her health history, before recommending any type of supplement, and thereafter carefully monitoring feedback and results.

There is no inherently good or bad nutrient/formula/medication. Everything must be put into the context of the individual and the purpose at hand.

Practically speaking, most anything can rationally be tried for a limited time and then evaluated, but one must know that one's evaluation accounts for as many relevant effects as possible, and not merely consists of looking at lab results or symptoms in isolation.

(To the above conceptual points I must add that I find it hard to come up with any plausible scenario where it would make sense to feed anyone sunflower oil.)

Remember to always consult with a government approved/licensed practitioner before making any changes to diet and lifestyle. What I write here is for educational- and entertainment purposes only.

A lesson about the art of reading lab results

2011-09-09T12:18:00.000-07:00

Toxic metals are bad. We don't want them stored in our bodies. If they are, we want to eliminate the source (e.g., amalgam fillings, environmental sources), and help the body get rid of whatever is stored.

Here are two examples of laboratory assessments of nutritional- and toxic minerals using hair samples.

My question to the reader is who (person A or B) is having the worst toxic metals problem. In each case, toxic metals are presented to the right and nutritional mineral to the left.

(Click to enlarge the images.)

Person A:

Person B:

(This person has mercury fillings.)

OK. So who has a really serious problem? Person A, with a super high cadmium reading, or person B who has a visible low mercury reading? (Let's assume that cadmium and mercury are equally disruptive to body chemistry.)

By the method that most health care practitioners read lab results, it is quite obvious that person A, with the high cadmium has the worst problem, whereas person B has an expected (due to the mercury fillings) but low elevation in mercury.

This is totally backwards. The proper reading of these charts is that person A is far better off than person B.

Why? Because person A is actually moving cadmium out of his body such it shows up in the hair. Furthermore, we have corroboration that his body is able to do this quite effectively because all of his nutritional minerals are reasonably high, hence the enzymatic processes in his body can access an ample supply of needed minerals to deal with the cadmium. (Therapeutically, we would of course advice this person to support his body further in this effort as well as eliminating any sources of cadmium.)

Person B, on the other hand is low in virtually all nutritional minerals (K, potassium can typically be ignored on this type of test).

We also know that his dental fillings should supply enough mercury for it to show much higher readings if his body had enough nutritional minerals for the task of moving it out of vital tissues. What likely happens instead that the mercury from his tooth fillings end up in his brain-, or other tissues. Bad!

So what do we do? We start working on getting person B's nutritional mineral deficiency under control.

How do we do that?

Do we recommend a multi-mineral supplement?

Possibly, but, much more importantly, we need to work on enhancing this person's digestion. Very likely he is low in stomach acid (an effect by itself of zinc deficiency and/or H Pylori infection), and/or his digestion is systemically impaired in some other way. (Why else would virtually every mineral be low.)

So we will further investigate and deal with digestive- and gut issues before moving on to the mercury itself.

It would be quite useless (if not dangerous) to target the mercury first. Doing so might just increase the amount that would wind up where he doesn't want it.

The big lesson here is that one can't just read lab results and "treat" what's "too low" or "too high" without looking at the whole picture including the person's health history. (When did your doctor ask you to fill out a 45 minute health questionnaire before interpreting your lab work?)

The risk of causing real harm is imminent when lab values are taken at face value in a vacuum of ignorance about the patient. Unfortunately this is how most health care practitioners look at lab results.

(VitalObjectives is not a healthcare provider, but a company that coaches and teaches you how to achieve whole body health from the ground up, system by system.)

Nootropics

2011-08-25T20:42:00.000-07:00

Readers are welcome to got to my contact page and submit questions for the blog. I will read all questions, but can't guarantee an answer personally, or on the blog. The likelihood that I will answer is quite high though, as I like answering questions more than I enjoy writing original blog articles. :)

Someone wrote in with this question: I read a number of your blog posts and got curious. Do you have a position on nootropics?

Learning about nootropics (aka "smart drugs" or brain enhancers) is actually one of the things that got me interested in health/longevity/performance-optimization in the early 90s. (My modest experimentation in that area hopefully at least didn't shorten my lifespan significantly.)

Nootropics is a very broad category of substances ranging from pure pharmaceuticals (such as Parkinson's, Alzheimer's and psychiatric medications etc) to plant formulations/extracts with some pharmaceutical actions (e.g., coffee and ginko biloba) to isolated amino acids and other compounds (e.g., choline, inositol, vitamin D, steroid hormones) that are available from regular food, or manufactured by the body from food.

Given how different the risk/benefit profile is for each of these items, each must be evaluated on its own merits and particularly with an eye to if it is intended to be used temporarily or chronically.

In opinion, very few (if any) qualify for sustained long term use as they invariably create imbalances or other side effects if there is no dietary or functional deficiency to begin with. (I doubt that most people are born with a genetic caffeine deficiency.)

The body can't do something out of nothing and is a finite system with finite resources. If one area of function (such as mental function) is artificially ramped up, function somewhere else will invariably have to be sized down at some point. A simple example is that drinking too much coffee may lead to exhaustion of the sympathetic side of the endocrine- and autonomic nervous systems.

In my experience, few things in the realm of brain performance beat the following basics on a long term basis:

Sound nutrition: Anti inflammatory diet ("paleo"), appropriate macronutrient ratio for body-type/health-condition, vitamin/mineral supplements as needed.
Sleep. (Sleep might even be #1)
Restoration/maintenance of gut health (neurotransmitters are produced and/or metabolized in the gut).
Restoration/maintenance of steroid hormone balance/production.

Bottom line: Make the whole body optimally functional, and the brain will be optimally functional. (This may sound a little boring for those who want quick, pragmatic tricks, but then, well, go google for "Mondo 2000 and nootropics" and you'll see what type of stuff intrigued my less mature self twenty years ago.)

On top of the lifestyle/restorative foundation sketched above, feel free to intermittently add your nootropics of choice as an occassional performance enhancer for whatever job you need to get done.

My personal favorites are L-tyrosine and caffeine when I want to boost dopamine (the "go-do-something" neurotransmitter).

A nootropic mix that I use occasionally rapidly unwind jet lag is Alpha-GPC in the morning combined with melatonin, phosphatidyl serine and magnesium chelates around bed time.

But really, a "paleo" diet + fixing up my adrenal glands is what has given me the best brain boost that I've ever experienced.

(As always, this is for educational and entertainment purposes only. Check with your government approved/licensed health care practitioner before making any changes in diet, exercise, and supplements.)