Tag Archives: fish oil

New Warning on Statins and Safe Alternatives

The FDA has come out with new warnings on statin medications.  The more we learn about these drugs, the clearer it becomes they are far over prescribed as the risk outweighs the benefit in many people who are taking them.

Read the transcript:

Hi everybody, this is Dr. Court bringing you another 90 Seconds of Knowledge. Today we’re going to talk about statin medications. This is the most popular class of drugs in the US and people use it to lower their cholesterol levels. And, potentially, although the evidence is not very good, reduce the evidence or the occurrence of heart disease.

Yesterday the FDA’s come out without new warnings. Number one, statins can potentially cause memory loss, confusion and other cognitive deficits. This may take a few weeks or a few years to manifest, and I’ve actually seen this in my patients. We get them off the statins and they do very well. Their cognitive abilities come right back so, it is apparently reversible.

The other warning is it does increase the risk of diabetes. It increases the risk of diabetes pretty significantly. It actually increases it by 27%. That’s a problem because diabetes significantly increases the risk of heart disease, the very thing that statins are supposed to protect us against.

It also increases HA1C or hemoglobin A1C. So, what that means is it prevents you from controlling your blood sugar very well, which is a big problem.

So, if we can’t use statins, what do we do?  Well, first diet and exercise. Those are the biggies. That’s really where we should focus. But if we do need some additional assistance there are some natural substances that work very well. Red yeast rice is one that is a natural statin. It is not without side effect. It is very much lower in side effect anyway, but you should always take CoQ10 when you’re taking any kind of statin whether synthetic or natural like red yeast rice.

There is niacin. Niacin works very, very well. Good old B3. It works exceptionally well. It lowers LDL’s. It lowers total cholesterol. What we want to focus on is the LDL.  And it also lowers lipoprotein A, a very dangerous, particular kind of cholesterol.

There are plant sterols. Plant sterols act by binding up the cholesterol that we eat and preventing us from absorbing it. There are medications that do that but the plant sterols are something that you can buy over the counter.

And then, of course, good old fish oil. We can’t talk about it enough. Fish oil has so much benefit. It reduces cardiovascular disease mortality better than anything. And, it reduces sudden cardiac death by 90%. It’s very, very effective. So, if you do one thing, take some fish oil.  Those are your options. The statins are still out there and they do have side effects but some of the natural options tend to have a lower side effect profile.

If you have any questions, let us know. We’ll be happy to answer them.

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Fish Oil Protects the Aging Brain!

More great information on fish oil! In addition to recent reports that fish oil is a valuable and effective tool in the management of ADHD, heart arrhythmias, anxiety and inflammation, a new study found that omega-3s protect against an aging brain.  Check out the video below.

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How Your Diet Affects Your Mood

Depression and Bipolar

Food is fuel.  The fuel we put into our body determines how efficiently it runs.  It’s a pretty simple concept yet when it comes to brain function there is a disconnect for many physicians.

When people come to me for help with various conditions, dietary changes are almost always part of the program.  They are especially important if someone if suffering from a mood disorder.

If a poor diet can lead to poor function of the heart, gall bladder, immune system, pancreas, intestines, etc., then why couldn’t it lead to poor brain function? It can, but it’s always overlooked by traditional medicine.  Let me explain.

The Basics

Remember, food is fuel.  The neurons in your brain consume up to 40% of your circulating blood sugar at a resting state.  That figure can jump up to 80% when your brain is working hard like studying for a test or doing your taxes. Your blood sugar is the fuel your brain needs to keep going.

Low blood sugar occurs when people do not eat frequently enough or in an amount that satisfies the demands for energy of the entire body, including the brain.  Low blood sugar, or hypoglycemia, causes mood to change.  Most notably, people experience irritability. This irritability is relieved by simply eating food and allowing your blood sugar to rise back to a normal level.  Next time you’re feeling irritable and you haven’t eaten in a few hours, try eating a healthy snack.  It might just be the fix you’re looking for.

If something as simple as low blood sugar can alter your mood, what else can?

Alcohol

Alcohol is consumed the world over mainly for one reason and one reason only – it has mind altering properties. Let’s face it; alcohol does not taste good in the way that ice cream does.  People are not consuming it solely for the taste. The per capita consumption of ethanol in the United States is 2.31 gallons per year.  That means, on average, every American over the age of 15 consumes 2.31 gallons of pure alcohol per year.  This is equivalent to 702 beers, 410 glasses of wine or 197 shots per year, per person.

Alcohol works on the brain by affecting the neurotransmitter GABA.  GABA is an inhibitory neurotransmitter in the brain.  Initially, consuming alcohol elevates mood and reduces anxiety and stress.  As a matter of fact, most current pharmaceuticals aimed at reducing anxiety work by acting on GABA.

However, continuing to consume alcohol has a downside.  When consumed to excess, moods begin to go down and depression is often the consequence.  It also causes sleepiness which illustrates alcohol’s powerful depressive effects.  Always remember, alcohol is a depressant and it’s this way because it acts on the inhibitory neurotransmitter in the brain called GABA.

How Foods Affect Our Neurotransmitter Levels

A few weeks ago I wrote a post about neurotransmission and how getting your neurotransmitters measured is a good way to assess your mood status and possibly change it for the better.  I went into the details of some neurotransmitters and it would be good to read before continuing to read this post.  Click here to view it.

The neurotransmitters in our brain allow one nerve to talk to the next.  It is the level of these neurotransmitters, to a large extent, that govern how we feel.  Low levels of some neurotransmitters lead to anxiety while others may lead to depression.  The interplay between all of them is complex and a problem with mood is often due to more than low levels of a single neurotransmitter but there are primary players to blame in each mood disorder.

Carbohydrate Heaven

Many people have noticed that when they eat a meal that is high in refined carbohydrates they notice an elevation in mood.  So much so that people can often become addicted to this type of food just to feel good.  This is for one very real physiological fact – eating refined carbohydrates increases serotonin production in the brain.

Serotonin is the neurotransmitter that most of the anti-depressant drugs like Prozac and Paxil work on.  They work by tricking the brain into thinking it has more serotonin than it actually does.  Consuming refined carbohydrates works by actually increasing serotonin levels.  Here’s how.

There is a barrier between our brain and our blood.  It prevents things from getting into the brain that should not.  It is very effective.  However, it also prevents necessary nutrients from getting in as well.  They need a special pass to  get in.  This includes the amino acid tryptophan. Tryptophan is what the body uses to make serotonin.  If one consumes a diet very low in tryptophan, serotonin levels are likely to be low.  Tryptophan is found in foods that contain protein.

In order for tryptophan (an other amino acids) to get into the brain a transporter system exists.  It is called the large neutral amino acid transporter or the LNAA.  Competition for the LNAA is fierce.  Tryptophan is a weak competitor.  It is often left out of brain except when refined carbohydrates are consumed. When refined carbohydrates are consumed high amounts of insulin are secreted.  Insulin sends free amino acids out of our blood into our muscles when it is circulating.  Because tryptophan is a bound to albumin it is left unaffected by this process.  It is now free to circulate up to the brain where competition for the LNAA is now low and it gets into the brain more easily.  It also allows more serotonin to be produced.

Now, I hear what you’re saying.  I am not suggesting you go eat tons of refined carbohydrates to feel good!  As a matter of fact you should avoid them because they just lead to a blood sugar crash later in the day resulting in irritability.  Now you’re irritable and depressed – not a good combination!

What you should do is make sure you eat foods that are high quality proteins.  This includes mostly animal products like meat and eggs.  Also, supplementing your diet with 5-HTP is helpful.  This is the direct precursor of serotonin and is in fact a type of tryptophan. It passes into the brain freely and does not compete for the LNAA.

Not Enough B6

Vitamin B6 is an essential vitamin in many ways.  In terms of brain health, it is essential to allow the conversion of the neurotransmitter glutamate into GABA.

Glutamate is the primary excitatory neurotransmitter in the brain.  When levels are too high seizures are known to occur.  At lower levels anxiety occurs.

GABA is the primary inhibitory neurotransmitter.  At very low levels seizures occur and when levels are slightly decreased anxiety is the result.

Glutamate ——–> GABA – GABA is converted from glutamate and B6 is required to do this.

A diet that is low in B6 will cause glutamate to build up in the brain and GABA levels will be low.  This may result in anxiety.  Foods that are highest in B6 are:

  • Spinach
  • Bell peppers
  • Turnip greens

Consuming these on a regular basis may help if your problem is the conversion of glutamate to GABA.  You may also have to supplement with B6.  This is easy to find over the counter.

No Fish? No Happy

Omega-3 fatty acids have been touted to help everything from heart disease to pain and inflammation.  Research also points to another aspect.  Brain health.  People who have the lowest level of a particular omega-3 called DHA report depression as a problem significantly more than people with the highest levels of DHA.

DHA is important for growing babies, but research is starting to show that it is important for overall brain health for adults as well.

Just how it wards off depression is not clear.  One theory suggests that because DHA is important for the insulation surrounding the nerves, low levels may prevent neurons from communicating effectively.  Whatever the reason, the research is pretty clear that low levels are not good for optimal brain function.

Consuming fish regularly is a good step.  However, more people will not be able to consume enough fish to get enough DHA.  Consider supplementing with a fish oil that is high in DHA.  Most nutrition companies now make fish oil that is high in DHA.  This may help ease your depression and prevent further episodes.

This list could go on and on.  The moral of the story is that what you eat can have a significant impact on how you feel.  If you want to feel good, inside and out, you must eat a healthy diet.  Hopefully some of these tips have helped.

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Are we getting enough Vitamin D?

The Institute or Medicine (IOM) says we are.  They say we might even be getting too much.  Their recent report released on November 30th states that most Americans are getting enough vitamin D from their diet and supplementation is unnecessary.  In fact their conclusion to the report states “the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D.”  I couldn’t disagree more.

The IOM examined over 1,000 studies and reports to make their conclusions that people need no more than 600IU of vitamin D per day.  They concluded that people are getting enough vitamin D.  However, this blanket statement only applies to one health factor – bone health.

It is my fear that people will see the headlines on the news and assume they are getting enough vitamin D.  The headlines inevitably will read “Americans Getting Enough Vitamin D.”  They will not tell people this refers only to bone health.  Vitamin D does so much more than protect your bones.

The IOM says the evidence, at this point, is insufficient to say that vitamin D has a protective benefit in any other area of health.  Research, however, has shown it improves cancer rates, reduces the incidence of MS, decreases cardiovascular disease rates and many more.

So why the conflict?

Part of the problem is that the IOM based it’s conclusions on what it takes to maintain bone health and since 2000 the research for vitamin D has exploded.  Many studies, published in some of the world’s most respected peer-reviewed journals, have concluded in direct conflict with what the IOM has said.

The IOM has said the studies that were done that drew conclusions on vitamin D’s other health benefits were either poorly designed or were insufficient to conclude vitamin D is good for anything but bone health.  These studies that they dismissed were good enough to be published in many of the best journals in the world.  I guess the IOM does not agree.

Below is a graph of the disease reduction rates by serum levels of vitamin D.  As serum levels rise, the rates of many diseases are reduced.  For example, breast cancer levels are reduced by 30% when vitamin D levels are at 34ng/ml or higher.  The X’s represent reasonable extrapolations based on the research but is beyond existing data.

 

Vitamin D reduces the rates of all of these diseases. It is NOT just for bone health as the IOM has concluded. The references are listed above as well.

The IOM report readily admits that people do not get enough vitamin D by saying:

“While the average total intake of vitamin D is below the median requirement, national surveys show that average blood levels of vitamin D are above the 20 nanograms per milliliter that the IOM committee found to be the level that is needed for good bone health for practically all individuals.”

If you look at the graph above you will see that the research is consistent with that statement.  At 20 ng/ml of serum vitamin D 99% of cases of rickets is prevented.  This is a disease of soft bones in children.  But what about all of the other wonderful, researched benefits of vitamin D? The IOM has seemingly missed the boat.

The graph above would suggest that a level of 60 ng/ml is optimal to protect a person from the diseases listed.  This is a serum level that cannot be obtained by current diets.  A person must supplement to reach this level and the IOM’s recommendation of 600IUs per day obtained from diet is exceptionally low.

I recently tested a patient who was under my care and was taking 4,000IUs per day as I had recommended.  Her serum vitamin D level came back at 18ng/ml.  By any current laboratory’s standard this patient was deficient in vitamin D.  And that’s after taking 4,000IUs per day for 2 months!  How can the IOM say 600IUs is enough for everyone.  It makes absolutely no sense whatsoever.

The IOM’s own report concluded that the average intake is below the median requirement but that blood levels were above the 20ng/ml required for healthy bones according to the quote above in gray.  How could that be possible?  Perhaps the 20ng/ml of serum vitamin D is too low as well.  This would make much more sense.  Instead of making that conclusion the IOM simply concluded that people must somehow be getting enough vitamin D.

I couldn’t disagree more.

The IOM has taken an exceptionally conservative stance on this.  Their stance on this is equivalent to saying that people shouldn’t exercise more than 10 minutes a day because any more than that might lead injury.

I recommend my patients get at least 2,000IUs per day of vitamin D.  I myself take 8,000IUs per day.  The benefits of taking vitamin D far outweigh any perceived “risks” associated with it.  Vitamin D is very safe and I hope this report doesn’t persuade any physicians into thinking it’s not.

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10 Simple Ways to Live to 100

Fresh vegetables are important components of a...

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Exercise –

Exercising is a key to staying healthy and research shows that people who exercise age more slowly. This is perhaps because exercise has been associated with preventing telomere shortening.  Telomeres are strands of DNA at the ends of each chromosome that shorten as we age.

Don’t Smoke –

Smoking causes the skin to wrinkle and wreaks havoc on our brains, heart and lungs.  The inflammation caused by smoking is thought to speed the aging process.

Eat a Healthy Diet –

You are what you eat.  A healthy diet provides antioxidants that gobble up free radicals that speed the aging process.  It also helps support a healthy weight which is important in preventing a host of diseases.

Stop Snoring –

Sleep apnea, a condition is which people stop breathing during sleep because tissues in your throat collapse blocking the airway, can cause high blood pressure, memory problems, weight gain, and depression.

Take Resveratrol –

Resveratrol is a powerful antioxidant found most prevalently in the skins of grapes. It provides the health benefits associated with red wine. Just like exercise, it slows telomere shortening. It is available in supplement form.

Manage Your Stress –

Excessive stress leads to the production of hormones in the body that are harmful to long term health. High stress levels delays healing, increases fat deposition and suppresses the immune system.

Keep Your Insulin Levels In Check –

Insulin is a hormone in the body that is secreted in response to carbohydrate consumption.  An excessive level, due to excessive carbohydrate and sugar intake, is associated with increased cellular aging.  Keep grains and sugar to a low level in your diet.

Get Out in the Sun –

Being in the sun not only improves mood, but it produces vitamin D.  Vitamin D affects up to 10% of your genes and allows them to work optimally.  Vitamin D has also been shown to reduce the rate of many types of cancer.

Get Your Fats –

Eating a diet high in healthy fats, like omega-3, is essential for heart and brain health.  Good sources include fish and nuts.  To get optimal benefit, however, most people will likely have to supplement with fish oil.

Control Your Blood Pressure –

High blood pressure increases the risk of cardiovascular disease, stroke and a host of other diseases.  Controlling it will allow you to live longer.  It is best to control it by losing weight and exercising.

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Fish Oil and your Baby’s Health

Fish oil caps

Image by Stephen Cummings via Flickr

A recent study published in the Journal of the American Medical Association has concluded that “the use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood.”

The ingredient they tested, docosahexaenoic acid, or DHA, has been shown repeatedly in other studies to be helpful for women and their babies.  Unfortunately, this study, because of where it has been published, will get all the headlines and I fear that some people will decide that fish oil during pregnancy is unnecessary.  This couldn’t be further from the truth.

This study followed roughly 2400 women from less than 21 weeks gestation to birth and analyzed data regarding the mother’s mood postpartum and the child’s cognitive development at 18 months.  Half of the participants were given fish oil containing 800mg/day of DHA and half were given a vegetable oil placebo.  What the study found was that depression scores in women taking the DHA were the same as the women taking the placebo and the cognitive development of the children was the same at 18 months regardless of intervention.  While you cannot argue with the findings of the study (they found what they found) I do have a problem with the implications this makes for high DHA fish oil.

Many studies have concluded that fish oil and DHA in particular is important for improving brain function.  Observational studies have shown that consumption of fish oil reduces postpartum depression and raises the I.Q. of children.  This is in direct contrast to what this study has concluded.  A 2003 study showed that children with higher levels of DHA had higher I.Q. scores at age 4 than controls.

Other benefits are known as well.  Fish are a rich source of long-chain omega-3 polyunsaturated fatty acids (PUFA), essential nutrients that have important structural and physiological roles in several body systems, including neurological, immune, and cardiovascular. Because humans cannot synthesize omega-3s, these nutrients must be consumed in the diet. Conversion from the parent omega -3, (linolenic acid), to the more biologically active long-chain omega-3 DHA and eicosapentaenoic acid (EPA), is inefficient and therefore consumption of some preformed omega-3 is important for optimal health.

Possible Flaws

Perhaps this recent study was unable to properly assess cognitive performance at 18 months.  It is much easier to assess in a 4 year old.  Also, the benefits may not be seen until later in life.  In a society where we want results immediately it is easy to understand why they would try and observe for the benefits of DHA at only 18 months.  However, a very real possibility exists; maybe these benefits are not observable that quickly.  Are the negative effects of a bad diet on heart disease observable in a 20 year old?  Of course not.  We must wait much longer (perhaps until the person is at least 45) to clearly see the cause and effect relationship. This example perfectly illustrates the fact that not all relationships are readily available directly after treatment.  Unfortunately, these studies continue to employ a drug based research approach to nutrition.  They are separate entities and need to be researched accordingly.

Another possible flaw is that they did not assess dietary intake of omega-3s in the study participants.  This is problematic because it is possible patients already had enough DHA to provide the benefits.  It is also possible that the control group ate more fish and therefore had enough serum DHA to skew the results.  This is something that should be addressed when this is studied again.

A third flaw is that this supplement provided 800mg/day of DHA with only 100mg/day of EPA.  Research is mixed on the effect of EPA on depression and brain function.  However, many authors argue that EPA is important in this picture and this study failed to take that into account.  Their goal was to test high dose DHA but we must consider that hardly anything in nutrition works in isolation.  It almost always works in tandem with other nutrients.  This is again an example of a drug based research approach to nutrition.  Drugs are tested in isolation and work in isolation because they are synthetic.  For that reason they cannot work synergistically with the body.  The body has no innate chemical pathway for them to work with because they do not exist in nature.  This allows them to work independent of the body’s systems but also allows them to be tested independently.  Nutrition is not like that.  Not one bit.

One good thing about this study is that DHA was shown to be safe with virtually no side effects.  This is good because women can continue to take fish oil without any fear of negative effects on their babies.

The bottom line is this: fish oil supplementation has been shown repeatedly to be beneficial for many factors in health.  There seems to be little down side to taking fish oil.  This recent study is just one study.  It will unfortunately get a lot of press because it was published in JAMA.  I will continue to encourage my patients to take fish oil during pregnancy because the vast majority of research is positive and I am confident that it is a benefit to my patients.

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Fighting Depression Naturally

Depression

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Depression is a huge problem in the United States.  The numbers are quite amazing. Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder. Depression is not just a disorder for adults, however. As many as one in 33 children and one in eight adolescents have clinical depression.

Depression is characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. Unipolar depression, the most common mood disorder in the U.S., was first described by Hippocrates in the 5th century B.C. He believed that depression was caused by an imbalance in the four humors – blood, phlegm, yellow bile and black bile.  Excess black bile caused depression according to Hippocrates. In fact, the Greek term for depression, melancholia, means black bile.

This view may seem far fetched, but the fact that depression is a physical process is correct. Even Freud wrote of the various presentations of depression which range from mild and cognitive, to severe and somatic.
There are several ’causes’ of depression.  I put ’causes’ in quotes because no one really knows for sure what ’causes’ depression.  There are many theories.  In my opinion, an imbalance in the neurotransmitter system is a scientifically sound explanation as to how a person could develop a mood disorder.  I also like to consider that if a person is not in good general health, depression is more likely to take hold.  This is a view that is also supported by the research.
So if these are two ’causes’ of depression, how can we effectively treat it?  Good question.  See my answers below.

Get Healthy

First and foremost a person that is depressed must make every effort to get healthy.  This includes exercise and dietary changes.  Junk in equals junk out.  Period.  If all one eats is McDonald’s value meals they are very unlikely to be healthy and much more likely to develop depression in my opinion.  Did you ever see the movie SuperSize Me?  A documentarian decides to eat nothing but McDonald’s for 30 days to see what happens.  Not only did he fall apart physically but he developed depression! Now, this is just one case and is a bit anecdotal, but the result confirmed the  hypothesis I made before I even saw the movie.

You must eat a healthy diet in order for your body to work properly and be healthy.  For some reason modern medicine has separated the health of our body from the health of our minds.  It is widely understood that to have a healthy body we need to eat nutritious foods.  It is far less accepted that to have a healthy mind we need to have a healthy diet.  Why is this the case?  The food that we eat provides fuel to our bodies and to our brains. The same food nourishes our entire system, not simply our physical bodies.

Exercise is unbelievably critical.  In fact, research has shown that the #1 cure for depression lasting less than 7 years is exercise.  Exercise does many things for the body. It improves blood flow, is a great stress reliever and changes the chemical balance in the brain to name just a few.  If you feel as if you suffer from depression and you do one thing for yourself this should be the one.  It has long lasting benefits in terms of depression and helps get the rest of your body healthy as well.

Supplements to take

There are several supplements that have been shown to reduce depression.  I would not suggest trying them all at once.  And I would suggest you consult a physician that is trained in functional medicine before you start a program.

5-HTP

If your problem is low serotonin this may help you.  5-HTP is short for 5-hydroxytryptophan.  5-HTP is the direct precursor in the body for serotonin.  Taking it may increase your serotonin levels and improve your mood.

St. John’s Wort

This is an herbal product that is used here in the U.S. to help with depression.  It acts by affecting the serotonin system.  I have found that it helps some, but not all depressed patients.  It’s a popular depression treatment in Europe.

SAMe

Short for the chemical name S-adenosylmethionine, it is pronounced “sammy.”  This has worked well in my practice for many people.  It is available over the counter in the U.S., but it’s used in Europe as a prescription drug to treat depression.

Omega-3 Fatty Acids

Diets higher in omega-3 fatty acids are known to protect people from depression.  It also appears that consuming more omega-3s reduces the symptoms of depression.  Consuming more in one’s diet is not likely to be enough.  Most people will have to supplement their diet with the oil or capsules to gain the most benefit.

This is just a small sample of the things that one can do to naturally ease depression.  People are most successful when combine exercise, diet and supplements together.  It will give you the best chance of improving your mood and feeling happier and more alive.

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