The consequences of uncontrolled diabetes are severe: blindness, kidney failure, increased risk of heart disease, and painful peripheral nerve damage. Today, most practitioners focus treatment on strict blood sugar control. While people with diabetes obviously need to keep their blood sugar down, the real goal of effective control is lowering the risk for damage. This is referred to as microvascular disease (kidney, eye, nerves, intestine, bladder, others) and macrovascular disease (heart, peripheral artery disease, stroke, other).

Unfortunately, the number of people with diabetes, pre-diabetes, and related conditions of poor glucose control have increased—wildly.

Even though more medicine than ever is being given out. We are in an epidemic of diabetes that has not stopped for two decades. A new approach to diabetes recognition and treatment is needed. America is in the midst of a diabetes epidemic. Over the past 20 years, the number of adults diagnosed with diabetes has much more than doubled, and children are being diagnosed with diabetes in alarming numbers. Diabetes has also caused an epidemic of heart disease, and keeps the kidney dialysis centers busy.

Blood glucose causes damage through a process called glycation, the same process that causes food to brown in an oven. When you cook sugar in a pan, it will become brown caramel.  After more cooking it will become sticky. Glycation (defined as sugar molecules reacting with proteins to produce nonfunctional structures in the body) is this process combined with proteins, leading to deposits and disruption of key parts in tissues. Proteins become disfigured and destroyed, causing nerve damage, heart attacks, kidney disease, slow bladders, cognitive and memory loss, blindness, intestinal problems, and more.

Oxidative stress is also a central cause of the damage caused by diabetes. Diabetics suffer from high levels of free radicals that damage arteries throughout the body, from the eyes to the heart. Oxidation is similar to biological rusting. When fat becomes rancid, it is because of oxidation. Many scientists recognize that oxidation is one of the fundamental causes of diabetes itself. Diabetics should understand their need for antioxidant assistance to help reduce oxidative stress that is involved in causing diabetic complications.

Inflammation is another common problem in diabetes. A protein in the blood called C-reactive protein reflects the extent of inflammation in many diabetics. We target inflammation so it may be reduced, since it too is one of the processes that further diabetes and cause misery.  A condition known as metabolic syndrome affects about 40% of Americans, and poor glucose handling is a central part of the condition. Inflammation is central to metabolic syndrome, which is another of our special interests.

There are tiny structures in cells called mitochondria, often termed the “powerhouses of cells” since it produces energy. In diabetes, mitochondria themselves become ill, and need support. They become deficient in some nutrients, and identifying and correcting their abnormal function—restoring them to health—is one of our goals.

Estimated average glucose (eAG)… something new

Estimated average glucose is a new way to find out how well you are managing your diabetes.

←You can convert your HbA1c numbers to average glucose using this table

How does it relate to A1C?

Hemoglobin A1c is known to most diabetics as a test that tells your average sugar over the 2-3 months before it was drawn. The A1c level is given in a percentage, and many doctors like to keep it below 7, or below 7.5, depending.

Instead of the A1c percentage, which tells how much a blood protein is glycated, the same information is given in “estimated average glucose”, or eAG. The advantage is that eAG uses the same units (mg/dl) as your glucose meters.

90% OF ALL DIABETES CAN BE PREVENTED WITH NUTRITION, LIFESTYLE, AND EXERCISE——this is where we come in…

Diabetes facts:

• Diabetes is caused by abnormal metabolism of glucose, either because the body does not produce enough insulin or because the cells become desensitized to the effects of insulin.
• Type 1 diabetes is caused by an autoimmune reaction that destroys the insulin-producing beta cells in the pancreas. Type 2 diabetes is caused by decreased insulin sensitivity.
• Type 2 diabetes has reached epidemic proportions in America. The incidence of this disease, which is caused by obesity and genetic predisposition, has increased dramatically over the past five years. It is more common among older people than in other segments of the population, although it is also affecting children at increasing rates.
• People with mild to moderate type 2 diabetes should avoid drugs and therapies that increase levels of insulin. Their disease is characterized by elevated levels of both insulin and glucose. Instead, therapy should focus on strategies to increase insulin sensitivity.
• Possible complications in diabetes arise from damage to enzymes and other proteins that impair their function and from resulting damage to blood vessels. The subsequent decreased blood flow, increased vulnerability to oxidant stress, and decreased antioxidant capacity all interact to produce end-organ damage to the eyes, nerve tissue, kidneys, and cardiovascular system.
• Weight is a powerful influence on diabetes. Losing weight is a major goal of improvement.  Fat cells produce a number of their own hormones, and many cause or promote inflammation, leading to complications.
• It’s a lot more complicated than just high sugar levels!

But are there any natural solutions to this national crisis?

A well known medical practitioner, answered this question some years ago: “Nutritional supplements are a must for anyone with diabetes. Vitamins, minerals, essential fatty acids, and herbs are natural compounds that, if used rationally and in a balanced manner, can have profoundly positive effects on blood glucose levels.”

Natural health practitioners, or “naturopaths,”  and homeopathic physicians all feel similarly, noting that alternative remedies can help or support the body use insulin more efficiently, control blood sugar levels, and can ease diabetic complications in many ways.  We address all of them at once, to help you the fastest possible way.

We are experts in natural healing, and use an amazing number of natural products, most you may never have heard about.  They support and unburden the body, giving it an opportunity to heal itself. Many of these substances and products have several specific effects which produce beneficial structural and functional changes in the person with sugar difficulties. For the most part, they are in the categories below.

These preparations can ease your mind & improve your health

1. Those that support and balance glucose. These help maintain healthy blood sugar levels, allowing you to take back control of your life. There are several of them, and you may not need them all. We combine some of them for your convenience. You can regard them as sugar metabolism tonics to help you steady blood sugar balance, working in harmony with your body to help promote healthy insulin levels.

One particular vitamin in the B family enhances insulin sensitivity and increases the activity of glucokinase, the enzyme responsible for the first step in the utilization of glucose by the liver. Glucokinase concentrations in diabetics are very low. Animal studies have shown that a diet rich in this vitamin can improve glucose tolerance and enhance insulin secretion.

2. Improving insulin sensitivity. There are two or three substances which we use that have been shown to raise insulin sensitivity in experimental situations, and may be very useful. Others actually stabilize the absorption of glucose, and permit easier control, according to many studies.

3. Those that delay glycation. One particular form of this natural substance is considered to be the most potent antiaging form because of its ability to enhance glucose metabolism, quench toxic free radicals, and help block formation of advanced glycation end-products (AGEs).

Sugar (glucose) in the blood can bind to proteins, particularly when blood levels are high. This binding causes the formation of AGEs, which accumulate with time and contribute to some of the signs of aging.

4. Antioxidants are potentially beneficial. One specific powerful antioxidant positively affects important aspects of diabetes, including blood sugar control and the development of long-term complications such as disease of the heart, kidneys, and small blood.

It plays a role in preventing diabetes by reducing fat accumulation. In animal studies, this remarkable substance reduced body weight, protected pancreatic beta cells from destruction, and reduced triglyceride accumulation in skeletal muscle and pancreatic islets.

This particular antioxidant has been approved for the prevention and treatment of diabetic neuropathy in Germany for nearly 30 years. Intravenous and oral forms reduce symptoms of diabetic peripheral neuropathy. Animal studies have suggested that it is more effective when taken with gamma-linolenic acid, a special anti-inflammatory omega-6 fat.

Diabetes also damages deep nerves that control vital organs, such as the heart and digestive tract. In a large clinical trial, people with diabetes who had symptoms caused by nerve damage affecting the heart showed significant improvement without significant side effects from this substance.

5. Those that help biochemical reactions in the body and keep things humming… There are a number of preparations we have that help energy conversion and keep your body tuned. Some have been used to decrease the damage associated with diabetes.

6. Those that help mitochondria function properly. We believe mitochondrial function is one fundamental key to recovery in the body.

In addition to these there are those that support the heart, the arteries, suppress the inflammation associated with diabetes, and those that oppose effects of aging. There are just too many to talk about here, but they are remarkable in that their effects are surprising, and they have no side effects to speak of.

A great number of popular natural remedies have helped many people in their constant struggle to maintain healthy blood sugar levels. When used together, they are synergistic. While there are many more that we use, this gives you an idea of that is available here in this office to help support blood sugar and the potential damage it causes. Knowing which are best for you, how they should be used, and which preparation to turn to, that is our profession, and we do it well.

In summary, support of glucose, inflammation, glycation, oxidation, mitochondrial function are fundamental ways we help you. Remember, it is not just glucose that is too high—the many feared complications include heart disease, stroke, neuropathy, loss of vision, kidney failure, nerve degeneration in the stomach, bladder, and elsewhere (autonomic neuropathy), peripheral artery disease, frequent infections, Alzheimer’s disease, gum disease, and even several cancers.

References are available upon request.

Please call for an appointment to discuss these possibilities,  which ones will help you the most, and get started: 713-790-9191.  Remember, your greatest asset is good health, and knowledge of what is possible is the beginning of happiness.

In response to several emails, we include some food for thought about eating. There are lots more… Help us make the “perfect” list. Email us with your additions (or subtractions) and tell us why, with references or sources, if any. We welcome your comments and opinions!

1. Avoid “mindless eating.” Think about everything you eat.
2. Keep a food diary for two weeks. Review it, ask yourself, “what am I getting out of each of these foods, and how can I improve things.” This automatically lowers your calorie intake 5-10%.
3. Make an appointment with us. Find out what you really need to be healthy—scientifically.
4. Cut down on the amount of food you eat, unless you are really thin.
5. Eat mostly plants.
6. If it was made in a factory, ie, not by God, don’t eat it.
7. Avoid processed meats like the plague-hot dogs, luncheon meat, sausage, almost all sliced deli meat, even if you get it at a meat counter. It’s a bag of toxic chemicals spiked with excess salt.
8. Keep portions of everything other than vegetables moderate or small.
9. Do not buy or eat anything with more than 5 ingredients listed. Most “food” you buy is FAKE!
10. This also applies to supplements—any “formula” with more than a few ingredients, especially “proprietary”—avoid it!
11. Avoid red meat, especially pork.
12. Shop in farmer’s markets. In grocery chains, keep to the periphery. The center aisles of the store are filled with processed food. This means a) fake, b) lots of toxins, c) lots of salt and sugar.
13. Stay away from fast food.
14. The more you prepare food at home, the healthier you will be.
15. Steam, grill, or eat vegetables raw. Grill, bake, or roast chicken, lean meat, fish.
16. The more you eat out, the fatter and sicker you will become. Your cholesterol and inflammation skyrockets when you eat out.
17. Stay away from full fat dairy. Arteries are paralyzed immediately for hours after eating a single fatty meal.
18. Cut down on salt. The American Heart Association recommendations are 1,500 mg salt per day. Read your labels.
19. Cut down on sugar, including high fructose corn syrup. Cell mediated immunity is cut in half for 120 min after a sugar drink (75g sugar).
20. Drink plain, pure water. Give up carbonated and sugary drinks.
21. Go for low glycemic foods. Get our fact sheets “The glycemic index” and our list of high glycemic foods that will give you big belly or thunder thighs.
22. You need 30-40g of mixed soluble and insoluble fiber per day. The best is from vegetables. You need fiber even if your bowels are fine… fiber has lots of functions other than regularity!
23. At a meal, vegetables should be the largest portion, and eat those first.
24. Eat beans (fresh or frozen only) at least 5 times per week.
25. Stop eating BEFORE you are full. Try not to be “full”—ever.
26. Do not eat any “food” that will not rot. The longer the shelf life, the worse it is for you.
27. If a food makes a health claim on a package more than once, avoid it. The more claims and praises, the less you should eat.
28. The same for supplements, especially online. The more claims and promises, the faster you should run away.
29. Eat slowly, and at a table.
30. Eat at least one large salad daily. See our paper “Salads-the art of building a great one”!
31. Eat only one portion of raw, unsalted nuts daily, about 15 medium nuts. No more than this. A handful is 2 to 4 portions.
32. Preferred fruits are cherries, dark grapes, kiwi, plums, pears, papaya, mango, and apples.
33. Avoid juices, commercial drinks, punches. Exceptions include a very few highly concentrated juices, hard to find.
34. Eat a rainbow of bright and deeply colorful produce.
35. Keep your weight in range and steady.
36. Learn about “energy dense” foods, which put on weight and have few nutrients. Instead, look for “nutrient dense” foods that contain high amounts of nutrients you need, instead of empty calories. Very important in healthy diets.
37. Divide your food intake this way
38. Exercise! Walk at least 1 hour daily, in addition to that. If you don’t have time, walk to do your errands.
39. To lose weight you need to cut down what you eat. Don’t expect to lose weight just from exercise. You will need OVER 1 hour of STRENUOUS exercise EVERY day to do that!
40. DON’T EAT: candy, donuts, pastries, sodas, canned soups, canned beans, shakes, crackers, cookies, sweetened breakfast cereals, instant rice, instant grains, frozen fried or breaded foods, white bread or anything made with white flour, anything made with shortening, salad dressings other than olive & vinegar.

For customized dietary, nutritional, supplement advice, call us for a consultation. For general nutrition comments, please visit http://healthscienceresearch.com/?cat=119

For information about weight loss programs, visit http://healthscienceresearch.com/?cat=97. For maximum effectiveness, these programs are all customized to fit your own metabolic needs.

For more Food & Weight info, click on the tab below >Resources & Links<  or just go directly to http://healthscienceresearch.com/?cat=109

For Diets, go to Diets under >Resources & Links< or directly to http://healthscienceresearch.com/?cat=120

Our libido and sexual enhancement program is designed to provide maximum support for essential function involved in sexual arounsal and the physical aspects of sexual pleasure and performance. It is entirely natural, but employs the most potent of substances and highest doses available.

Contrary to the impression that sexual desire and performance is associated with youth, and that age inevitably lowers sexual function and enjoyment, better sex is possible at all ages, and in people with many health problems. Many people find it difficult to talk about these things, but research clearly shows that sexual vigor is part of overall health and happiness at all stages in life. 

Many people seek some type of “aphrodisiac” or a drug for sexual enhancement. Often they are disappointed, because a “Love potion #9” that works in everyone has not yet been discovered. However, by carefully supporting its various components, restored and improved sexual function is a distinct possibility for almost everyone. 

In humans, sex has four phases: desire, arousal, orgasm, and resolution, or detumescence. Each stage is controlled by different biochemicals and hormones. Deficiencies in any of these elements may cause a disturbance in the natural flow of events, and sexual desire and performance decreases. Frequently as people advance into middle age and beyond, lack of interest in sex progresses so steadily, they hardly notice it is not part of their life any more.  Sadly, they accept it, thinking it is “normal.” However, sexual function may be depressed even in the young. 

Our program not only targets basic health issues that may contribute to sexual dysfunction, but is specific and highly personal. Among common causes are vascular and heart issues, low testosterone levels (also called hypogonadism), poor glucose handling (diabetes, metabolic syndrome), overweight and obesity, inflammation due to other conditions, side effects of medication, alcohol, smoking and other agents, and stress, anxiety with depression.  Frequently it is a combination of factors that must be addressed. We seek the most important of these, especially those which may have been overlooked.

First, we emphasize the basics: a healthy diet, exercise, stress reduction, and improved sexual habits. 

Next, we seek to identify those features of lifestyle which may interfere with sexual function.  Many, such as inadequate sleep, can be addressed along with, for instance, improvement of pleasure during orgasm.

Third, hormones are considered.  We employ natural hormones of the highest quality. 

Fourth, we support health of the peripheral vascular system. Poor arterial health is a common problem associated with inadequate sexual performance.  In men, it may be physically evident with erectile dysfunction. However, recent research indicates this also occurs in women as well. We seek to improve the integrity and stability of the walls of blood vessels. In addition, increasing blood flow is also a goal. There is a close connection between cardiovascular conditions and sexual problems, and the common denominators are generally the blood vessels, inflammation, and glucose handling. 

Fifth, we direct attention to overall energy levels that may affect sexual function. 

Sixth, general mental energy and vigor may be lacking. If appropriate, support is provided in this area. 

Last, we target various subtle mood changes and emotional aspects of sexual performance that may be improved. 

Natural support is a powerful weapon in assuring maximum sexual performance in both men and women. There are some surprising possibilities many people may not know. For instance, a traditional Chinese medicine derived from plants is known to suppress activity of any enzyme that decreases the male sexual response. This means that the sexual response may be prolonged as well as made more intense, by delaying the usual, and often rapid, decay (detumescence) in sexual interest and fulfillment.

Overall, our approach may involve one or more of the following steps:

• Dietary intervention, with attention to deficiencies, sensitivities, intolerances, and allergies
• Cellular and global body detoxification, including heavy metals, pesticides, and total toxic burden
• Homeopathy
• Environmental control
• Protection against damaging glycation
• Correction of defective methylation, sulfuration, conjugation  
• Antioxidant support
• Anti-inflammatory measures
• Stress reduction
• Brain neurotransmitter support
• Optimization of sleep and sleep hygiene
• Rebalancing of the autonomic system
• Restoration of optimum cellular nutrition
• Mitochondrial oxygenation and function reduction
• Essential fatty acid fractionation and balancing
• Elimination of triggers

The evidence tells us that true prevention works better than drugs, and lasts longer than surgery—but only if you do it. And that seems to be the problem—doing it. Despite the huge numbers of “diet—exercise—live right” articles in magazines and newspapers, most people talk the talk, but don’t walk the walk.

When many physicians talk about “prevention”, they really mean what they do—vaccinations, screening tests and giving drugs for coronary artery disease, hypertension, cholesterol and triglycerides to “prevent” heart attacks and detect cancer early. For instance, aspirin and statins are given for “primary prevention” of heart disease-the prevention of a first event in patients who are at risk. That’s not just lingo, it’s the point of view. While these measures may be huge advances, critically important, and save lives, some may be band-aids rather than a fundamental solution. An example of the difference is the Texas mandate for insurance companies to pay for screening for calcium and arterial plaque in arteries with CT scans* and ultrasound.  These tests are really good for screening, are evidence-based and underused, but they do not change the prevalence of the problems of fatty deposits in arteries from scratch. Sure, they may identify arterial calcium/fatty deposits for future treatment. Lifestyle changes — nutrition, exercise, stress control, etc. — act in earlier steps, and are disease-modifying, two fundamental advantages in preventing and fighting illness.  *if you discount radiation

Is prevention a myth in this world of multiple medications, scans, and procedures?  Or  is it simply a more rewarding, pleasant, effective, and fundamental way of life to complement such medical management?

When it comes time to change diet and lifestyle—“real” prevention—most doctors now assume it is hopeless, and the patient will not change at all. Even though lifestyle changes are listed first in all treatment guidelines for chronic illnesses, Docs still write the prescription during the initial visit, without bringing up diet. Sadly, they are right! Only 7% of Americans actually lead a preventive life. Most people will not change, some not even attempt it. So in recent years, there have been articles titled “PREVENTION IS A MYTH” in medical journals.

Perhaps too many people do want the prescriptions first… They gladly take the prescription, thinking it is an essential part of the visit.  Yet in just a short period of time, often a few weeks, they stop taking the medication too! In fact, about half eventually stop.  Is there any sense to this sequence?

Could their increased risk for disease be related, for instance, to double or triple cheeseburgers and fries, or prime rib, a box of cookies, all with the fat they contain paralyzing arteries for hours after being consumed? Or huge amounts of salt eaten throughout the day, every day?  Or perhaps six sugary drinks every day that put on weight, leech calcium out of bones, and inflame the body’s cells? Some kids  think that they are eating “vegetables” because they put ketchup on a paper-thin piece of iceburg lettuce in their burger! Most people either don’t want to hear it, or let it roll off.

The scientific basis for prevention is substantial, strong, and current

This past year there have been dozens of papers in medical journals that have conclusively shown that when people try to make healthy choices, they can succeed. Just doing the basics in small steps makes a big difference in their risk for chronic disease-strokes, heart attacks, thinning of bones, cancer… all reduced by large numbers. How about extending your life by up to 70%?  Sound good?

In April, 2009 a report from Harvard Medical School reported that 90% of diabetes could be prevented by attention to 5 simple health habits. For each lifestyle factor corrected, the incidence of diabetes fell by 35%.

The following month on May 20, in the Journal of the American Medical Association (JAMA),   it was reported that people with low fitness ratings had 40% higher risk for death from any cause, and 47% higher risk for cardiovascular disease. Adequate exercise (also called “physical activity” so people do not become frightened or paralyzed by what they should be doing) is grossly under-appreciated, under-rated, and under-used as a non-pharmaceutical means of treating common degenerative disorders of lifestyle.  Increased activity alone may be as effective (or more so, in terms of multiple effects) as approved drugs and other methods of preventing and/or treating depression, diabetes, cardiovascular disease (including coronary artery disease, hypertension and stroke), breast, colorectal and other cancers, and cognitive disorders. The program Exercise is Medicine®, endorsed by the American College of Sportsmedicine, is a most significant positive step in the public interest.

In July, 2009, the Journal of Nutrition found that if you eat a healthy diet, you are likely to live longer. Surprise! This was a huge study from the National Cancer Institute, involving 350,886 participants in a National Institutes of Health/AARP data base.

And in July, JN’s sister publication, the American Journal of Clinical Nutrition, a Tufts University study showed that women who followed the Dietary Guidelines for Americans, which have been criticized as minimal and imperfect, enjoyed slower progression of coronary artery disease (hardening of the arteries).

The August 10, 2009 issue of the Archives of Internal Medicine described how just four simple healthy habits cut the risk of diabetes by 93%, heart disease by  81%, stroke by 50%, and cancer by 36%. But if you added vitamin D and calcium, according to a second release, you could drive cancer risk down over 60%. One executive in a cancer organization claimed 85%. Practicing 5 healthy habits would save well over 100,000 lives per year.

There are many more publications, and they all tell the same tale: the documented basis for simple nutrition and lifestyle advice to prevent chronic disease is startling. But is all this evidence getting people to act and change?  No.

In this past year it was also found that 9% of the national health budget is used for complications of overweight and obesity. And all this excess weight drives diabetes and related conditions, such as metabolic syndrome and prediabetes, which have been rising at about 5% yearly. Right now, about 45% of our population qualifies for the term “metabolic syndrome” and it probably rises by the day. In fact, progress in extending life expectancy in other areas, such as smoking, is being wiped out by the obesity epidemic.

Diabetes was the subject of a special diabetes issue April 15, 2009, of the JAMA, with a notable discussion about the public health problem it poses. In December 2009,  Diabetes Care, a major journal of the American Diabetes Association, published a paper concluding that diabetes will nearly double in the US in the next 25 years and the cost of treating it will almost triple—to $336 billion in 2007 dollars. That assumes obesity and overweight will continue afflicting about 65% of Americans, which is doubtful.

Good grief, is all this overwhelming, or what? What do we need to wake up? And it is just only a sample of the overall problem crushing us. If this continues, Americans are destined to become a country of invalids, medically dependent and care-needy. In addition, with a new health care system in place or not, we will inevitably become bankrupt soon if some major change does not occur. The answer lies not in more approvals for drugs, or expansions of “indications,” simply because drugs are not that effective for lowering prevalence rates of chronic disease, and may cause even greater dependence and expense. The proposal to give entire populations a “polypill” containing 5 cheap drugs, in part to neutralize poor lifestyle habits, is laudable but culturally embarrassing and only a crutch.

What is the answer, then?

We must strike at, and reverse, the basic cause—our poor lifestyle habits.

In specific conditions, the record of change is disappointing. The diets of patients with coronary artery disease remain poor one year after the initial diagnosis.  Even worse, the diets of patients who undergo coronary artery bypass surgery actually grow more likely to deposit fat in arteries (atherogenic) during the year after their procedure, despite dietary advice. In other words, after undergoing a procedure which is a major life event, their diets get worse.  Could it be that some post-operative heart patients then think, “now I’m fixed, so I can eat anything I want?” As Arnold used to say, they’ll “be back”.

As far as specific nutrients are concerned, Americans are also losing the battle to keep their intake and blood levels up to the minimum required to prevent disease, and failing horribly to bring them up to the amounts needed for optimum health. There are no better examples than fish oil and vitamin D, with multisystem, well proven benefits both in prevention and treatment of many diseases, all supported by a tsunami of papers in respected peer reviewed medical journals in the past several years. Both are seriously underused and undervalued. In fact, fish oil has been called a “polypill” itself with respect to disease prevention.

Nutrient inadequacies are not corrected by drugs-they are entirely different approaches, and not “competitors”

Many women in this country are taking medications called bisphosphonates and estrogen to treat conditions such as osteopenia, osteoporosis, and recurring fractures due to thinning of their bones. The purpose of these drugs is to replace insufficient bone mass. Surprisingly, while the package inserts for these medications recommend taking calcium and vitamin D, a significant number of women fail to do so, or take only a fraction of what they need. By not supplying the raw materials from which bone is made, they are greatly diminishing the drug’s effect, and defeating their purpose.  The medication does not replace the need for the basic ingredients needed for more bone.  Sometimes the simple, inexpensive, nutritional approach may be critical.

Think of this possible sequence for a moment.  Suppose a woman was taking one of these drugs to increase her bone mass, but failed to take calcium and vitamin D.  After a year or so, when her bone density test showed no improvement, her physician might give her a more potent medication, one that was more likely to have serious side effects…  In this example, the problem was not a biphosphonate that had insufficient “strength”, but rather no raw materials for the biphosphonate she was taking to use.

In heart failure, not only is vitamin D of  importance in causing problems, but micronutrient deficiencies have been known for decades. Back in July, 2001, a review in the Journal of the American College of Cardiology highlighted the problem. Eight years later, October 27, 2009, another paper in the same Journal about mineral deficiencies in heart failure called it an unmet need.  Recurring hospitalizations for heart failure remains an unsolved problem. Many of the micronutrients of value are inexpensive, yet their potential in this lethal disease remains ignored.

Another example is potassium and magnesium balance. Not only are poor intakes of both common in Americans, but contribute to many diseases. Deficiencies in either are generally not detected using conventional blood levels of these ions, simply because the lion’s share is inside cells. Once blood levels become abnormal, there is usually a much greater problem than realized with the total amounts in the body. Both are extremely important in high blood pressure, heart failure, abnormal rhythms, nerve function, etc. Correction of inadequate intakes could affect public health significantly. Most times, the mild acidosis that concerns people, whether true or not, could easily be reversed by raising their potassium intake.

Contrast for a moment the reduction of risk for coronary artery disease of 85% through lifestyle changes, with the reduction of 40% using statin drugs. Compare the benefits of minimal extension of lifespan in heart disease using statin drugs, and the more significant lowering of mortality from all causes reaped after using the Mediterranean diet.  Consider the steep rise in protective high density lipoproteins, “good cholesterol” or HDL, from exercise, fish oil and perhaps niacin, compared to the minimal to modest elevation from the use of some medications.  There is no question statin drugs are valuable when needed, but giving them to the entire population to neutralize consequences of bad habits that lead to obesity, metabolic syndrome and high levels of inflammation may be unwise.

Reflections

Just as JFK asked about what we can do for our country, we must ask ourselves, “What are we willing to do for our own health?” This should be our question, rather than say “Doctor, make me thin/get rid of my diabetes” by magic (despite my sabotaging habits), with society subsidizing the (ineffective) process.  Lifestyle modification, admittedly difficult at first, does not chalk up huge drug bills, one prescription after the other, each eventually abandoned. Lifestyle changes also require fewer tests to monitor whether medications are working, or for potential adverse drug reactions.

Positive lifestyle habit changes needn’t be large, or many. Just a couple of small steps in a positive direction can make a big difference.  Commit and resolve to be healthy!  A positive lifestyle leads to a healthy body and the mental depth to successfully deal with these demanding times.

To begin, commit to prevention—real prevention, on a personal level. Everyone already knows that poor lifestyle habits lead to chronic disease. But most people just want to get the quick fix—the “magic pill”, or surgery, get it covered on their insurance, and go back to their old habits. What they don’t realize is that the quick fix has another price—side effects, and after surgery, more surgery when the problem returns. And it typically does. What comes after heart stents? More stents, until there’s no room left in coronary arteries for additional stents—then bypass surgery. Wonder why?

Does it surprise you that 85% of cardiovascular disease, and over 90% of diabetes is preventable through what you eat and do every day?   Little things certainly do matter.

Not only do good habits cut risk, but when medication and surgery are needed, being in shape helps assure a smooth, successful outcome with fewer complications.

We must also rid ourselves about the notion of the “quick fix.” We must realize there ain’t no quick fix. You’ve got to get light, and quit the chips, pork rinds, processed snacks, and volume eating. Most Americans don’t even know what the sensation of that light diet feel is, and how invigorating when they know the feeling of good health.

This month the American Heart Association advises health, not disease, after seeing 2009’s statistics…

The Annual Report of the American Heart Association will be published in their journal, Circulation, Jan 26, 2010. This traditional review of statistics about heart disease and stroke is, for 2010, being used to revisit the concept of cardiovascular health, rather than cardiovascular disease.

“The AHA is refocusing efforts on lifestyle factors that can prevent the development of cardiovascular disease in the first place, and some of the statistics in this document show us just how far we have to go…”

What to do

The solution: personal responsibility for our own health, trying to make improvements in small steps. Yes, it can be tough, but the reward is great. The power of what we can do together to help our health is awesome, according to a recent N Y Times Editorial.

The bottom line: It’s up to you. People only make changes when they really believe it is in their best interest.

For instance, learn about the Mediterranean-type diet. Despite walls of diet books, it is the only diet proven to extend life, in a most pleasant way. Risks for chronic degenerative diseases are significantly reduced by this diet. Forget about the fad diets, which are usually short on science, but long on claims and naked proclamations.

And best wishes for your program. In future editorials we will offer a list of  important health changes that you can easily incorporate into your routine.  Little by little.

Reproducing this article for any purpose, in part or entirely, requires specific permission.

Many physicians recommend taking blood pressure in the evening just before retiring.  In part, this may be due to the belief that nighttime blood pressures are more predictive of future complications and events.  In searching for answers on different web sites, recommendations vary considerably.  So when is best?

Blood pressure elevations should not be neglected

Uncontrolled high blood pressure may lead to heart attacks, strokes, kidney disease, heart failure, ad abnormal rhythms of the heart, including sudden death, and blindness. The further bad news is that over 91% of Americans will develop hypertension in their lifetime, and now about one in three of us have high blood pressure of one type or another.  Even worse, nearly one-third who have it are unaware they do. There are also many misconceptions about blood pressure, some of which are addressed on the American Heart Association site.

Blood pressure generally goes down during sleep, and rises upon awakening. Physical and mental activity and other stimuli raise blood pressure normally—it goes up to provide additional blood flow for activities and is regulated by a complex set of reflexes and hormonal adjustments. The early morning rise in blood pressure does add some risk for a heart attack or stroke at that time. Some people have blood pressures that do not drop by the time they go to bed, and surge excessively in the early morning—they are the ones who have greater risk of premature death.

How to Take Blood Pressures

Measurement of blood arterial pressure is done with an inflatable rubber cuff, standardized for medium-sized arms, and a gauge. The standard mercury column has largely been replaced by other devices, because of the danger of column breakage and accidental mercury poisoning.  For larger arms, a larger cuff must be used, lest the pressure read will be falsely high.  For smaller arms a smaller cuff is necessary.  Failure to do this may result in a falsely low blood pressure reading.  For the same reasons, a blood pressure cuff to take a reading in the thigh must be larger. Measurement of the blood pressure from a cuff at the wrist is not recommended, although recording pressure directly from a catheter in an artery at the wrist does reflect the pressure accurately.

In taking blood pressure, a doctor or nurse inflates the cuff, which momentarily interrupts the blood flow in the (brachial) artery deep in the elbow area, then listens on top with a stethoscope for the appearance, change in character, and disappearance of sound produced by the surging pulse. Unfortunately, many blood pressures are taking incorrectly. And the automatic blood pressures are certainly not infallible–they are just machines. Since major changes in medication are usually based upon just this one reading, an error can cause the doctor to make major, inappropriate adjustments to prescription drugs.

AHA Guidelines call for the patient to be sitting still, quietly, in a chair at least 5 min before the blood pressure is measured, with the arm supported at the level of the heart, not have caffeine, alcohol, or smoke for at least ½ hour beforehand, and have the proper size cuff placed on the skin, not over an irregular piece of clothing. There should be no conversation, no talking on a cell phone, or TV. The area under the cuff should be at least 1” above any bony part of the elbow, firmly seated on soft tissue.  The cuff material should be firmly layered flat, with the final Velcro grip uniform, so that when the cuff is inflated there are no layers that inflate alone, trapping air in a particular area, so that the cuff “bubbles up” in pockets. After inflation, there should be no irregularly distributed lumps and bumps of air, nor material, in the cuff. Cuffs should be deflated at a rate of 2-4 mmHg per heartbeat. A paper in the AMA News last year called for improvement in blood pressure-taking, since the numbers are frequently the only basis for important changes in treatment.  Although the diagnosis of hypertension depends upon high measurements on two to three separate occasions, even a single elevated reading has predictive value. A single high reading should not be interpreted as a clean bill of health, even if two are normal afterwards.  Most of the time, patients tend to “explain away” elevations, and underestimate the seriousness of the problem.

Home blood pressure monitoring is also a useful addition to office visits. While both aneroid and electronic monitors for home use are available, the electronic ones, with both automatic inflation and deflation, are preferred. Wrist and fingertip models are less accurate. Ask your doctor for recommendations, and pre-fit the cuff to your arm size before purchasing. Then compare the machine’s readings to those in your doctor’s office immediately, and at less-than-yearly intervals. Pressures may be taken immediately after arising, 3-5 hours after that, then 2 in the evening. All should be recorded methodically. Once a pattern is established, your physician will suggest the best times to monitor treatment. This will depend upon your lifestyle, exercise, and which type of medication you are taking. Most medications do not last 24 hours, and this works for most people because their blood pressure falls in the evening. A new tool available for following blood pressure is accessible at www.healthvault.com, or at americanheart.org/BloodPressureManagementCenter.

In the May, 2008 issue of Hypertension, The American Heart Association (AHA) and the American Society for Hypertension (ASH) jointly issued a seminal Call To Action On Use For Home Blood Pressure Monitoring, with the full content of the article available  as well.

The presence of office staff when blood pressures are taken may raise it, commonly known as “white coat” hypertension.  For this and other reasons, it is sometimes useful to monitor blood pressures over a period of time outside the office.  To clarify or solidify the diagnosis, ambulatory blood pressure monitoring (ABPM) may be requested. A device is worn for 1-2 days, and includes a cuff which automatically inflates at 15 min intervals while awake and every 30 min at night. Readings are stored, and later transferred to a computer in a doctor’s office. A diary of eating, sleeping, physical activity, emotions, and drugs taken should accompany the recording for best interpretation. Ambulatory monitoring is used to exclude the white coat effect, or help decide whether treatment is adequate.  Although not routine, it has been called the “gold standard” of diagnosis and treatment, and should be done more often. In medicine, generally when measurements are not taken, or less reliable ones are used, the true severity of the condition is unrecognized. When ambulatory BPs are used, a study in the American Journal of Medicine, Dec 2008, showed only 15% of patients being treated had acceptable pressures throughout the day.  Only about 40% of patients taking medications for hypertension have their blood pressures under control, using office and/or home blood pressure readings.

Using ambulatory monitoring, the normal 24-hour blood pressure pattern has been identified as follows:

• BP rises upon awakening, peaks around midmorning, perhaps 10 AM, and decreases throughout the day into the night to reach a trough early the next morning, perhaps 3AM.
• From that point it rises slowly, but the rate that it rises increases upon awakening, perhaps 6AM, as physical activity begins.

Dipping–that’s what blood pressure does…

Traditionally it has been believed that raised night-time readings, or failure to “dip” at night, typically about 10%, may predict cardiovascular complications. But a paper in the journal Lancet (October 6, 2007;370(9594):1219-1229) questioned this conventional view. The authors found that while night time blood pressures were better at predicting premature death. The daytime readings were also good at predicting all cardiovascular events—but not in patients taking antihypertensive drugs. Since most such medications are taken in the morning, by nightfall their effects wane, and blood pressure rises. In any case, when readings are higher at night than in the day, there is a higher risk of death from all causes. The authors concluded that blood pressures should be taken throughout the day.

High blood pressure is classified in stages, as indicated in this table.

A word about salt. Although the debate about whether salt should be restricted for healthy people continues, there is no question that for populations, and as a public health measure, salt intake is much too high, and restriction lowers blood pressures. In fact, excessive salt intake is responsible for about 17-30% of all high blood pressure worldwide. The ill effects of excessive salt intake in relation to the needs of the human body, which are extremely small, is not just blood pressure elevation. Salt intake drives up the incidence of cardiovascular disease, in part because blood pressure elevations amplify and accelerate atherosclerosis or coronary artery disease. A recent paper in the British Medical Journal found that just an extra 5 grams of salt, about one teaspoon, raises rates of stroke by 23% and all cardiovascular disease by 17%.  Another study published in the New England Journal of Medicine confirmed the report, calculating that lowering dietary salt by 3g/day would lower new cases of  heart disease by about 90,000/year, stroke by 49,000/yr, heart attacks by 76,500/yr and deaths from any cause by 68,000/yr. This amounts to between $10-24 billion in health care costs annually, equivalent to 293,000 human life-years!  An accompanying editorial called lowering dietary salt intake compelling, inexpensive, and highly effective. Even just 1g less of salt would produce substantial public health improvements.

In addition, recently a careful and scholarly review of all the evidence concerning salt  prompted the American Heart Association to revise recommendations for salt intake in setting 2020 goals for heart health promotion and reduction of heart disease. Now the current recommendation is a daily intake of less than 1,500 milligrams of sodium (=3.8g of salt), down from a prior recommendation of 2,300mg of sodium (5.8g of salt).  Some of our current fast food and not-so-fast meals easily contain more than this in one sitting. Adhering to this amount is definitely a worthwhile challenge, but a must for anyone with high blood pressure.  Much of the lack of blood pressure control that patients and physicians face is actually due to unrecognized excess salt intake.  The most frequent trigger for hospital admissions in people with heart failure is due to a sudden increase in salt consumption.

Unfortunately, salt is “hidden” in almost all foods we all commonly consume. Yet another reason to prepare foods yourself at home, favor a diet high in fresh vegetables and fruits, and avoid processed, pickled, and canned foods.

Conclusion

A sensible approach, at the outset, is to take your blood pressure at different times during the day, depending upon your schedule. If you work, take a reading in the morning, an hour after you return home, and later in the evening. It should be done at the same time each day, at the same point in your routine. If you are taking medication for your blood pressure twice a day, you may want to take it just before your evening dose, to see how long the first dose kept your blood pressure down. If you have symptoms, then take your blood pressure right away when you have them. Out of interest, a spot check or two at the moment you awaken might be of interest. Your doctor will want to know this initial pattern, to better advise when the next readings should be taken, and perhaps begin or adjust the medication dose and/or timing.  And, please, read labels on every food you pick up at the supermarket before you buy it, keeping in mind the 1500 mg/day ceiling.

Niacin, in larger (pharmacological) doses than needed for simple B vitamin replacement and recommendations, has a powerful effect on fats in the blood, largely because it affects processing of fats and cholesterol in the liver.  Numerous studies have established that niacin lowers triglyceride (TG), very low-density lipoprotein, and total cholesterol levels in the blood.  Niacin is also one of the best agents to raise high-density lipoprotein (HDL) levels. In amounts between 1500 and 2000 mg two to three times daily, niacin blocks the breakdown of fats in adipose tissue, more specifically the very-low-density lipoprotein (VLDL), precursors of low-density lipoprotein (LDL) or “bad” cholesterol. Because niacin blocks breakdown of fats, it causes a decrease in free fatty acids in the blood and, as a consequence, decreased secretion of VLDL and cholesterol by the liver.

By lowering VLDL levels, niacin also increases the level of high-density lipoprotein (HDL) or “good” cholesterol in blood, and therefore it is sometimes prescribed for patients with low HDL, who are also at high risk of a heart attack. Raising HDL levels lowers risk for atherosclerosis as much as, if not more than, equivalent lowering of bad cholesterol, LDL.

A clinical study, results of which were presented at the Nov, 2009 annual Scientific Sessions of the American Heart Association and published simultaneously in the New England Journal of Medicine, suggest that in combination with statins, Niaspan®, a sustained release prescription form of niacin, is more effective than Zetia® at reducing fat deposits in arteries.

You should not attempt to take niacin yourself for this purpose; you need to have professional guidance, since there are contraindications, interactions, and need for monitoring, especially liver function tests. That said, here are three forms which are of high quality, pure, reliable, free from contaminants, with substantial potential health benefits. All the products are available from this office by calling 713.790.9191 or emailing healthreception@att.com.

Live Extension product 00372 contains 500 mg of niacin in each capsule. Life Extension comments that niacin is the only B vitamin that can be synthesized in the body from the amino acid tryptophan. In its coenzyme forms, niacin is crucial to energy transfer reactions, particularly the metabolism of glucose, fat, and alcohol. Niacin’s beneficial effects on blood lipids is well-documented.

The product contains gelatin and magnesium stearate, but is absolutely devoid of milk, egg, fish, peanuts, shellfish traces, soybean, tree nuts, wheat, yeast, gluten, corn or rice, sugar, artificial sweeteners, flavoring, colors or preservatives.

Life Extension’s product 00096 contains 1000 mg niacin per capsule. They advise beginning with one capsule per day, but great individual variation in the flushing, a transient side effect of niacin that usually disappears with use in a few days, is well known.

About.com states that nicotinic acid benefits your lipid profile by lowering LDL cholesterol by 15 to 25 percent, lowering triglycerides by 20 to 50 percent, and raising HDL cholesterol by 15 to 30 percent. The LDL-lowering effect may not be evident at doses less than 2,500 mg/day, however.

The Arbiter-6 HALT, November, 2009 study in the New England Journal of Medicine, was accompanied by two editorials. One discussed niacin vs a cholesterol drug, the other using add-0ns to statin treatments.

Niacin is also available in a second form, extended release niacin in a dietary variety. One that we recommend is made by Prothera. The  prescription drug in extended release form are the most popular ones used (Niacor®, Niaspan®, Slo-Niacin®).

Prothera states that slow release of niacin over several hours helps avoid the uncomfortable flushing action of this B-vitamin, so that its full benefits on cholesterol metabolism can be obtained.

The product contains niacin (as niacin USP) 500mg 2500% DV, and vegetarian stearine, cellulose, silicon dioxide, magnesium stearate, and carboxymethylcellulose sodium.

The extended release form is true nicotinamide, the variety that was used in the clinical investigations proving efficacy in favorable lipid reductions.

The third form of niacin is usually called “no-flush” because the facial flushing and associated problems are diminished.  However, there is some question whether this form is as effective as the native, original  niacinamide described above.  In people who cannot tolerate the above, no-flush may be a good choice.

Life Extension says that No-Flush Niacin contains a special form of niacin, inositol hexanicotinate, consisting of six molecules of niacin chemically linked to an inositol molecule. It is hydrolyzed in the body to free niacin and inositol, which is a very slow process. Its unique properties allow for niacin activity without the characteristic niacin flush that is unacceptable to many people. A video is viewable at  http://www.lef.org/images/products/btn_featured_video.gif

For people interested in niacin in these ways, we strongly recommend calling us for a visit to discuss the supplements, their effects, scientific basis for use, and ways to ensure best results. There are caveats, and many tips for use we have found to guide you over time.  Niacin is a wonderful adjunct and tool, and most people are able to tolerate and benefit from its effects. You just have to know how.

One turning point might have been in Dec 1991, when the British Medical Journal published a study reporting that the white coats doctors wore were a source of cross infection from doctor to patient, especially in surgical areas. About 25% of doctors’ coats carried Staph aureus. They also stressed the value of hand washing (see the article on this site, Handwashing—why, when and how in the Health Headlines Archives link to the right of this article).

The idea of your doctor flipping his/her contaminated tie on you as you are being examined or inspected, wafting over some microbes that could wind up in your lung and blood, is not pleasant. This might happen in the office, clinic, or hospital.  Organisms from communities are not as resistant to antibiotics as hospital acquired infections.  Worse, patients in the hospital are more likely to have depressed immune systems that cannot fight bugs well.

Hospital acquired infections (HAIs)  are a major problem, amounting to over 2 million cases and causing some 26,250 deaths per year, with a price tag of over $4.5 billion annually. Since they are, in large part, preventable, Medicare stopped reimbursing  for such complications as of August, 2007.

By 2004, at a time when MRSA infections (staph bacteria that are resistant to usual penicillin antibiotics) were really in the news, almost half of the neckties doctors wore in New York Hospital Medical Center in Queens, a part of the New York Hospital-Columbia Presbyterian Health System, contained potentially harmful bacteria.  Nonetheless, it was believed these bugs were carried from the community into the hospitals and posed no real threat. The results were reported at the American Society for Microbiology conference that year, and CBS carried the story.

Due to the rising incidence of MRSA infections in the UK, notoriously difficult to treat, hospital consultants there were told not to wear neckties in order to help stop the spread of the superbug. Shortly after that, Britain’s NHS recommended that doctors stop wearing white coats altogether, since the coats also spread germs.  The edges of white coats, cuffs and pockets, are well known to be “dirty.”

Many physicians believe that the white coat is a respected, time honored  tradition they are reluctant, even unwilling, to abandon. Others feel that wearing scrubs is too informal, and is disrespectful of patients.

In 2008, the Scottish NHS banned white coats. A year later, the American Medical Association considered a resolution recommending the same, but it has not passed, awaiting further scientific proof.

Evidence suggests that hand washing is far more important in transmitting disease than neckties or white coats.

Economic opportunity abhors a vacuum. A company in Florida  has developed a line of silk neckties that are treated to resist germs, allowing physicians to continue with traditional dress and minimize risk. So far, there has not been much study concerning white coats that have been washed frequently with bleach, or specially treated. 

Meantime, for your own edification, next time you visit your provider’s office, watch how many times hands are washed, and beware neckties that dangle next to your nose, mouth, and eyes. You can be fairly certain that both unwashed hands and unwashed neckties are bacteriologically contaminated.