Fat LINKS & Essential Oils for beautiful skin

While I have taken a hiatus from blogging, as I wrote my internal medicine boards and commenced my Rheumatology fellowship, my reading has not ceased! The last six month of my fellowship has left me amazed at how our bodies can manifest disease and how little we understand about autoimmune pathophysiology. I have never been more convinced that quality nutrition, sleep and stress management is essential to our homeostasis.

I’ve been gathering and synthesizing research to put out a series of posts on environmental toxins that are commonly found in our homes and personal products (think shampoo, soap and makeup!), but for now I wanted to share a few articles that I’ve come across supporting a previous post on the benefits of healthy fats in your diet, and how to incorporate these healthy fats into your life.

A guide for how to buy good quality oils: Is your olive oil really olive oil? – Dr. Hyman http://drhyman.com/blog/2016/03/17/is-your-olive-oil-really-olive-oil/

Bored of all your cooked foods tasting like coconut oil? Ghee is an excellent alternative for food that needs high heat! Recipe from 101 cookbooks http://www.101cookbooks.com/archives/how-to-make-ghee-recipe.html

Mark’s definitive guide to oils: http://www.marksdailyapple.com/healthy-oils/#axzz43dzHmXXf

ALSO for those of you interested in beauty and health, oils are being used more and more for both cleansing and moisturizing! These products are all natural and infused with beneficial essential oils!

https://www.vintnersdaughter.com/

Aknari Brightening Youth Serum

http://harlowskinco.com/shop/harlow-face-elixir

If these seem a little pricey, here is a guide to essential oils for your skin care needs:

The Ultimate Guide to Essential Oils for Skin Care

http://www.thedermreview.com/essential-oils-for-skin/

Am I my Microbiome?

Recently, more and more research has shown the significance of the human microbiome in health and disease. These theories will likely become a monumental shift in medical history; perhaps en par with the germ theory and vaccinations. Due to the exciting new and robust research on the implications of our symbiotic microbial community, we are coming closer to understanding disease processes, our immune system and how our bodies interact with our environments.

Below is a brief summary of what is of known function of our microbiomes:
– nutrient extraction: bacteria found in our gastrointestinal system have enzymes that assist in breaking down plant polysaccharides and lactose containing foods.
– immunologic development and education: there is growing evidence of the importance of the interaction between T regulatory cells and bacteria in the education and development of our immune systems. Further evidence has shown that bacterial breakdown of nutrients act as signaling receptors to immune cells in the gut.
– Disease pathogenesis: microbiome dysbiosis has been linked to a large variety of disease states including Type 1 Diabetes Mellitus, Obesity, Inflammatory Bowel Disease, allergic reactions and a plethora of autoimmune diseases.

Recently I have become interested in recent studies investigating how a dysfunctional microbiome may relate to autism spectrum disorder and neuropsychiatric ailments. I have found this particularly fascinating for health and wellbeing, as well as philosophical implications.

If you are new to microbiome information see more general summaries:

How microbes define, shape — and might even heal us

Your Health Depends on Your Gut Bacteria

And make sure to read these leaky gut links!

Beyond Paleo: Heal Your Gut

UltraWellness Lesson 4: Gut & Digestive Health

Autism

Animals studies have suggested that the gut’s immune system and microbiome, communicate and influence the nervous system’s function and development. Studies have shown that “germ-free” rodents display behavioural differences including antisocial and anxiety behaviours, release greater amounts of cortisol in response to novel environments, and have altered levels of neuropeptides. One study showed that behavior may readapt to replicate normally colonized mice if the germ free mice were colonized at 3 weeks. However, colonization at 6 weeks was too late to restore behavioural changes, indicating that this microbiome – neurochemical relationship can have long-term influences on development of responses and behavior.

Although the ‘normal’ or ‘optimal’ microbial environment has not been described there are certain organisms that are considered pathogenic and others as healthful, such as Bifidobacterium, Bacteroides and Lactobacillus species. We know that promotion of these ‘healthy’ strains is possible with intake of prebiotics ie. High fiberous and indigestible foods. While the reason is not understood, children on the autism spectrum demonstrate aversion to eating high fiber containing foods such as fruits and vegetables, preferring starches, sugars, and processed foods. It is possible that this aversion comes from alteration in the gut microbiome causing discomfort and inability to properly digest fiber-containing foods. Lack of intake will then lead to further underutilization and depletion of positive microbial communities and promote competitive grown of less beneficial phylotypes, leading to a self perpetuating cycle.

In another study, children with ASD and gastrointestinal complains were noted to have higher incidences of Sutterella in their ileum and cecum, as well as deficiencies in the expression of disaccharidase and glucose transporter genes, than age and sex matched controls. These children exhibited higher rates of behavioral disturbance. There are anecdotal reports of improved functioning following dietary changes in children with ASD and it seems plausible that interventions aimed at restoring the microbial balance in the gut could aid in the improvement of behaviours such as irritability, anxiety and social withdrawl.

A very exciting study published this year in Pediatric Research describes a randomized control trial of 75 children who were randomized to received probiotics from birth, or to receive placebo. At the age of 13 y, ADHD or AS was diagnosed in 6/35 (17.1%) children in the placebo and none in the probiotic group (P = 0.008). This suggests that probiotic supplementation early in life may reduce the risk of neuropsychiatric disorder development later in childhood.

Neuropsychiatry

The relationship between the microbiome, the immune system and neural response has become of growing interest in the psychiatric community. Neuropsychiatric diseases such as schizophrenia, obsessive compulsive disorders, attention deficit hyperactivity disorder, and chronic fatigue syndrome (to name a few), have been connected to the dysregulation between the immune and central nervous system in recent research. Most studies postulate a molecular mimicry hypothesis – a compromised colonic epithelial barrier allows entry of pathogenic products leading to stimulation of the immune system and development of brain-reactive autoantibodies.

In the past ten years studies have come out linking inflammation to depression. Evidence showed that inflammatory cytokines were elevated in depressive states, and other research showed that these markers were responsible for ‘sick behaviour’ (seclusion, burrowing) even in absence of infection or physical illness. Clinical depression has been linked to increased levels of immunoglobins against a variety of gram negative bacteria, many of which belong to the normal gut flora. It has been suggested that decreased gut integrity due to unhealthy microflora and other reasons (see leaky gut links) allow for translocations of bacteria or bacterial peptides instigating an inflammatory response. A recent study from the Canadian Center for Addiction and Mental Health, showed independent brain inflammation of patient with depression on PET scan proving that independent CNS inflammation does occur in this disease state.

For more information on depression and inflammation:
http://www.biomedcentral.com/1741-7015/11/200

All of this information emphasizes the complex relationships between our brain, gut and immune systems. It also highlights a more philosophical dilemma for humankind. We now understand that there is more bacterial genetic material in our bodies than human. This bacteria plays an important role in our homeostasis, immune development and wellbeing. Both Plato and Socrates suggested that knowing thyself would lead to insight into the human condition… I wonder what they would say, knowing we are more bacteria than anything else.

References:

Kau A, Ahern PP, Griffin NW et al. Human nutrition, the gut microbiome, and the immune system: envisioning the future. Nature. 2011: 15; 474 (7351) 327-336.

Mulle JG, Sharp WG, Cubells JF. The gut microbiome: a new frontier in autism research. Current Psychiatry. 2013: 15 (2); 337-350.

McCusker RH, Kelley KW. Immune-neural connections: how the immune system’s response to infectious agents infludences behavior. Journal of Experimental Biology. 2013: 216: 84-98

Hornig, M. The role of microbes and autoimmunity in the pathogenesis of neuropsychiatric illness. Current Opinion in Rheumatology. 2013: 25 (4); 488-495.

Berk M So depression is an inflammatory disease, but where does the inflammation come from? BMC medicine. 2013. See link above.

Parrty A, Kalliomaki M. A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial. Pediatric Research. 2015

Get Up, Stand Up.

Over the past decade researchers have uncovered an easy and inexpensive way to help prevent all cause mortality with a specific emphasis on cardiovascular disease. What is this perfect health intervention? Standing up.

This research has shown that sitting has a time-dependent direct associated with a progressively high risk of mortality. These findings have been noted and described in many reputable newspapers and magazines; and reviewed and promoted by health bloggers and experts (see links below). Despite consistent recognition, the concept has not yet permeated into social or medical culture, despite the fantastic public health implications. While I don’t want to be redundant by yet another blog describing these research findings, I do feel like a free, easy, and life-extending intervention is worth evaluating.

Sitting has become a ubiquitous part of our human behavior, and is now ingrained in our social and cultural conduct. Currently physician recommendation on physical activity is based on the American Heart Association’s suggestion of 30 minutes of moderate-intensity activity 5 days a week. These 30 minutes, not even every day, often breaks up a full day spent sitting. In my own social experiment I have started standing on the subway even if there are spaces to sit. I realize how rare it is for people to choose to stay standing when the have the option to sit. I hope the description of this research inspires others to rethink their reflexive decision to slump into a seated position at every chance, as it did for me.

A Canadian study evaluated over 17,000 people ages 18-90 years old. Daily sitting time, leisure time physical activity, smoking status as well as baseline anthropometric and physical fitness information was collected. The participants were followed over 12 years. The results found that greater daily time sitting was associated with elevated risk of mortality from all causes. These results remained statistically significant after adjustment for age, sex, smoking status and other physical activity. The results also suggested that leisure time physical activity cannot compensate for high amounts of sitting. (1)

A similar US study evaluated over 53,000 men and 69,000 women enrolled by the American Cancer Society to examine leisure time spent sitting and physical activity relating to mortality. This prospective study found that spending more time sitting was associated with mortality in both women and men. The results were astounding. When people spent more than 6 hours sitting in comparison with less than 3 there was a 40% higher all-cause death rate in women and a 20% increase in men. These results were strongest for cardiovascular disease mortality (2).

How does this happen? Studies have shown that sedentary time is linked with metabolic derangement that are consistent with processes that underlie most common disease mechanisms. That is – decreased insulin sensitivity, impaired glucose metabolism, increased waist circumference, elevated blood pressure, deranged cholesterol levels and inflammation. In lay terms – a sedentary lifestyle puts one at risk for cardiovascular disease and type 2 diabetes, the leading chronic diseases of our time.

These facts and figures are daunting. We live in a society built around sitting. We are no longer hunter-gatherers; modern humans are cerebral folk who need desks, computers, meeting tables and television programing. The good news? Australian researchers looked at the benefit of breaks in sedentary time in modifying cholesterol, glucose impairment, weight and blood pressure. It was found that any interruption in sedentary time was beneficial. Small changes in behavior may have big health implications. Further studies need to confirm this information, but the results suggest that simple short breaks, such as standing up to stretch your legs between commercials or emails, could provide a mortality benefit. (3)

 

For much more information please look at links below. An interesting topic that I did not touch on is the opportunity this research has to change workspaces. Ergonomic, sit to stand desks are being made and becoming more affordable.

New York Times:

http://www.nytimes.com/2012/12/02/business/stand-up-desks-gaining-favor-in-the-workplace.html?_r=0

http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/

http://www.nytimes.com/2011/04/17/magazine/mag-17sitting-t.html

Marks Daily Apple:

http://www.marksdailyapple.com/sitting-unhealthy/#axzz37jursVkM

http://www.marksdailyapple.com/standing-at-work/#axzz37jursVkM

Other: http://mashable.com/2011/04/22/standup-desks/

Scientific References:

1. Katzmarzyk PT, Church TS et al. Sitting time and mortality from all causes, cardiovascular disease and cancer. American College of Sports Medicine. 2009: 998-1005
2. Patel AV, Bernstein L et al. Leisure Time spent sitting in relation to total mortality in prospective cohort of US adults. American Journal of Epidemiology. 2010; 172 (4): 419-429
3. Healy GN, Dunstan DW et al. Breaks in Sedentary time: beneficial associations with metabolic risk. Diabetes Care. 2008; 31 (4): 661-666

Healthy, with full fat.

Avocados, nuts, coconut and olive oil, grass fed meat and pasture raised eggs are my staples. As my study of nutrition and my own diet has progressed, I have found that ‘healthy fat’ sources are central to my meals I choose these foods because they make me feel full and satisfied without side effects of bloating or post meal fatigue.

An in-depth study into this inclusion of cholesterol and fat rich foods was prompted by yet another flare in the fat vs. statins debate. The American Heart Association (AHA) released their recent guidelines for cardiovascular disease prevention, centering on lowering cholesterol. The controversy: To target those who are high risk, the guidelines suggest statin therapy for a broader range of patients. Pharmaceutical interests are heavily represented in the panel of authors.

First, my disclaimer – I am not against statin therapy. I recognize the data which has emerged over  the last 20 years of scientific study has shown efficacy of statin therapy in certain circumstances.  These include secondary prevention of heart attack and stroke, and other cases of high risk primary prevention, such as familial hypercholesterolemia.  I do, however, have disdain for the vilification of dietary fats. I believe that the biased correlation between cholesterol values with improved cardiovascular health has incorrectly led associations such as the AHA and USDA Center for Nutrition to recommend pro-inflammatory diets centered on carbohydrates. This puts people at risk of accelerated atherosclerosis, diabetes, cancer, dementia and autoimmune disease. Simply, cholesterol is not a proven surrogate of atherosclerosis. (1)

The danger of saturated fats is a concept not only believed by western medical practitioners, but is ingrained into our western society’s subconscious. Sitting precariously at the top of the food pyramid, just below junk food, are the protein sources that contain fats – fish, meat, cheese, nut butters. While candy and cookies get a place on the pyramid, oils do not. Very few people question where this concept came from, as it is now accepted as fact. In reality, a prominent researcher, Ancel Keys came up with a theory biased against saturated fats, in the 1950s . Despite objection against his single study results, he gained a spot on the American Heart Association’s advisory committee and developed the “diet-heart hypothesis” based on saturated fats in diet being the main contributor to heart disease. (1) There have been individuals who felt that blaming heart disease on saturated fat was premature and unwarranted, yet, the concept was embraced by the media, food companies switched to hydrogenated oils, and carbohydrates secured their spot as the foundation of our food pyramid.

Many will argue that despite a rocky initiation, the hypothesis has been proven by a multitude of studies showing the benefits of cholesterol lowering therapy in the 20^th century. While these studies do exist (2, 3, 4) many were published before the current research regulations required investigators to publish both positive and negative results. More recent studies have failed to prove any benefit of statins or other cholesterol lowering agents on cardiovascular events or mortality despite their ability to decrease Low Density Lipoproteins (LDLs) and total Cholesterol (tC). (5-9)

We know that atherosclerosis and cardiovascular disease have a multifactorial disease process, within which inflammation plays a central role. Perhaps the way in which statins have shown to confer benefit in some studies is through the modulation of the inflammatory disease process. It has been documented that statins reduce C-Reactive Protein (CRP) a known inflammatory marker (10, 11). Further it is has been documented that statins have blood thinning properties that would likely be beneficial in the setting of narrowed vessels.(1)

It is important to learn about dietary fats so that we can make educated decisions about our nutrition. Fats play critical roles in our bodily activities. Fats insulate the cells of our nervous system and our brains; are an important component of our sex and steroid hormones and immune cells; phospholipids are the major component for each and every cell membrane in our bodies and fats provide a clean energy source.

There are many types of fats, some with more beneficial roles than others. For a simplified summary:

Saturated Fats – found in animal products, such as meat, eggs and butter, as well as coconut oil, have now been shown to have a beneficial role in our health. (12-15) they are stable and do not oxidize when exposed to oxygen (as polyunsaturated fats do), they also produce more energy when burned as fuel as they take less energy to break their bonds than the unsaturated fatty acids.(1)

Polyunsaturated fats (PUFAs) –unstable and easily oxidized, these fats have important roles in our body. PUFAs have been popularized as they include the omega 3s and 6s. These fats are essential for our cell membranes and hormonal and immune system functioning and they are abundant in our brain. The end product of omega-6 metabolism is pro-inflammatory while omega-3 is anti-inflammatory. The optimal balance of omega 3:6 would be 1:1 of 1:4 however in a typical western diet we are consuming a pro-inflammatory balance of 1:16. (1) Linoleic acid, a specific omega-6 essential fatty acid, has been reported with inverse risk of cardiovascular events (16)

Monounsaturated fats – such as omega-9 found in olive oil is very resistant to oxidization. A Spanish study supplementing 4 tablespoons of olive oil daily v placebo showed a reduction in major cardiovascular events after a 5-years follow up. (13) A recent American study showed an inverse association between nut consumption with mortality after 30 years follow-up.(15)

Trans-unsaturated fats – found in hydrogenated oils used in fast food restaurants and margarines. Numerous meta-analyses and studies of dietary fats have pointed at trans-unsaturated as directly associated with risk of cardiovascular outcomes (16).

Multiple studies, including meta-analyses from the Netherlands in 2011 and in the Annals of Internal Medicine published in March of 2014, are showing that the intake of dietary saturated fats do not correlate with increased cardiovascular events. In fact, the latter study concludes “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.” (16)

 

In conclusion, the link between dietary fats and cardiovascular risk is weak. In fact, fats can be beneficial to our health, promote brain and immune health and help us maintain optimal body weight by helping us burn efficient fuel while feeling satiated. It is important to note that environmental toxins, such as pesticides, are stored in animal fats and to eat animal products such as butters, cheeses and meat will put one at risk of ingesting and storing these toxins in adipose tissue. This is why organic grass fed meat and pasture raised chickens and eggs are optimal.

In my own practice I will continue to prescribe statins for secondary prevention but the most important intervention I can make is to educate my patients regarding healthy eating practices which include a largely plant based diet low in processed foods and simple carbohydrates.

References:

1. Sinatra, S et al. The Saturated Fat, Cholesterol, and Statin Controversy: A Commentary. Journal of the American College of       Nutrition. 2014; 33:1.

2. Khush KK, et al. Lessons from the PROVE-IT trial. Higher dose of potent statin better for high risk patients. Cleveland Clinical Journal of Medicine. 2004; 71.

3. Schwartz GG, et al. Effects of atorvastatin on early reccurent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. Journal of American Medical Association. 2001; 285.

4. Cannon, CB, et al. Intensive versus moderate lipid-lowering with statins after acute coronary syndromes. New England Journal of Medicine. 2004; 350.

5. Rodriguez, Luis. The ENHANCE Trial: Analysis and Clinical Significance. Clinical Lipidology. 2010;5(2):161-166.

6. Rossebø, AB et al. Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. New England Journal of Medicine. 2008; 359:1343-1356

7. Tavazzi, L et al. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Oct 4;372(9645):1231-9.

8. Gruberg, Luis, et al. PREVEND IT: Prevention of Renal and Vascular Endstage Disease Intervention Trial. Clinical Cardiology. 2004:27.

9. Barter, PJ. Effects of Torcetrapib in Patients at High Risk for Coronary Events. New England Journal of Medicine. 2007; 357:2109-2122

10. Ridker, PM et al. JUPITER study group: Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. New England Journal of Medicine. 2008; 359.

11. Lorgeril, M. Disappointing Recent Cholesterol-Lowering Drug Trials: Is it not time for a full reappraisal of the Cholesterol Theory? World Review of Nutrition and Dietics. 2009;100

12. Kuipers RS et al. Saturated fat, carbohydrates and cardiovascular disease. Netherlands Journal of Medicine. 2011 Sep;69(9):372-8.

13. Estruch, R et al. Primary prevention of cardiovascular disease with Mediterranean diet. New England Journal of Medicine. 2013; 268.

14. Jordi Mayneris-Perxachs, et al. Effects of 1-year intervention with a mediterranean diet on plasma Fatty Acid composition and metabolic syndrome in a population at high cardiovascular risk. PLOS one, online publication. 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961210/pdf/pone.0085202.pdf

15. Bao, Y. Association of nut consumption with total and cause-specific mortality. New England Journal of Medicine. 2013; 369.

16. Aschercio etc al. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. British Medical Journal. 1996; 313:84.

 

Additional Reading for Nutrition Enthusiasts:

Real Food: What to Eat and Why by Nina Plank

In Defense of Food: An Eaters Manifesto by Micahel Pollan

Grain Brain by Dr. David Perlmutter

Anticancer: A new way of life by Dr. David Servan-Schreiber

How to Cook Meat

The choice to eat meat can be a very polarizing topic in health and nutrition circles. In my practice I think its important to assess an individual’s personal dietary needs and requirements, but personally I subscribe to a pseudo-paleo diet. From both my reading and personal experience, I feel that good quality, free range, grass fed meat can provide an excellent source of protein and fat to one’s diet providing important building blocks for growth and health maintenance. Today I offer two links from an excellent blog, Mark’s Daily Apple. The first describes how to optimally prepare and cook meat to reduce unhealthy secondary effects of the cooking process, the second is a link to 10 recipes for marinades that incorporate a healthy balance of ingredients to protect your meat from the harmful effects of a flame!

Easy Overview:

HCAs (heterocyclic amines) dangerous carcinogenic chemicals produced by meat being exposed to high temperatures. These cause DNA mutations.

AGEs (Advanced Glycation Endproducts) oxidization products that drain stores of antioxidants and can initiate inflammatory cascades which are involved in any chronic disease process including diabetes, cardiovascular disease, autoimmune disease and cancer.

What to do?

Attempt to cook over low to medium heat, not above 400F

Use saturated fats which are more resistant to heat (coconut oil, butter, ghee)

Use antioxidants in your marinade (olive oil, turmeric, ginger and garlic!)

MARINADE and use liquids which have protective effects rather than directly places meat on heat source

For lots more info check out the links!

http://www.marksdailyapple.com/is-gently-cooked-food-better-for-you/#more-47052

http://www.marksdailyapple.com/how-to-marinate-meat/#axzz2r3zdpklW

Apple Cider Vinegar (from Hippocrates to Dr. Periwinkle)

This week my boyfriend caught me gargling with apple cider vinegar. This concoction is a remedy passed down from my mother for when my throat senses a ticklish feeling of a cold coming on. My love asked if apple cider had any bactericidal properties and I realized that despite apple cider being a household staple and a recent natural medicine darling, I really didn’t know its beneficial properties.

Looking into the healing properties of apple cider vinegar put me in great company. Hippocrates recommended the use of vinegars to heal wounds, Cleopatra dissolved pearls in vinegar to create a love potion, and the founder of forensic medicine in China cleansed his hands before and after an autopsy with vinegar. The internet is filled with the plethora of postulated health benefits including anticancer effects, improved circulation, skin cleansing, varicose vein busting, and pH balancing. Here I am for clarity.

Antibacterial: Apple cider vinegar has shown to have antibacterial properties. This being said, it is not recommended to clean your wounds with vinegar as Hippocrates once did. At its level of concentration in our kitchens it would not help clean you or your counters of human pathogens. While ear infections have been shown to be susceptible to vinegar therapy the acidity is damaging to surrounding structures. This does give merit to my home remedy, as viral and bacterial pathogens in the upper respiratory tract would likely be susceptible to vinegar. Apple cider vinegar has been used to soothe sore throats and aid in sinus clearance for a long time, and could not hurt.

Impaired Glucose Tolerance/Diabetes: Diabetic rats ingesting food with apple cider vinegar showed significant change in HbA1c. A small study in humans showed that taking a tablespoon of apple cider vinegar at bedtime lowered morning glucose levels by 4-6%. Other human studies have shown decreases in postpradial glucose levels and elevation in post meal insulin levels. The mechanism of this is still unknown.

Cholesterol & Heart health:  Rats made to ingest apple cider vinegar enriched diets also showed significant decrease in low-density lipoprotein (bad) cholesterol as well as an increase in high density lipoprotein (good) cholesterol. This study also showed a significant decrease in triglycerides. Human studies yet to come.

Weight Loss: This is one of the oldest indications for therapeutic use of vinegars. From studies in humans, people who eat vinegar with meals feel fuller and more satisfied more quickly than others. Another study showed that apple cider vinegar actually slows gastric emptying which may be the mechanism that makes us feel full with less food.

Anticancer: Different vinegars have been shown to inhibit growth, if not induce death, of cancer cells in a controlled scientific environment. While anti-tumour factors have not been identified, vinegar is a dietary source of polyphenols which are rich antioxidants. While this research is exciting, human epidemiologic research has shown mixed results.

Folk Lore: Despite having no evidence, health sites and excerpts from natural health books suggest the following likely benefits of apple cider vinegar not yet proven by evidence based medicine

-aiding an upset stomach

-preventing indigestion (if taken before a meal)

-improving skin tone and reducing varicose veins

-whitening teeth

I love apple cider vinegar, I find it flavourful, rejuvenating, and it sure does kill that tickle in my throat! I would encourage everyone to try it! But as with all health recommendations, it is best to use this substance in moderation. Don’t run to buy apple cider vinegar tablets, instead enjoy as an ingredient in meals. Apple cider vinegar has been shown to interact with diuretics, cause hypokalemia, accelerate osteopenia and can lead to hypoglycemia if taken in excessive amounts.

Have a happy and healthy Winter season!

xoA

 

References:

Johnston C, Gaas C. Vinegar: Medicinal Uses and Antiglycemic Affect. edGenMed. 2006; 8(2): 61

Johnston C. Examination of Antiglycemic Effects of Vinegar in Healthy Adults. Ann Nutr Metab. 2010;56(1):74-9.

Ostman E et al. Vinegar Supplementation lowers glucose and insulin response and increases satiety after a bread meal in health subjects. Eur J Clin Nutr. 2005 Sep;59(9):983-8.

Shishenbor F et al. Apple cider Vinegar attenuates lipid profiles in normal and diabetic rats. Pak J Biol Sci. 2008 Dec 1;11(23):2634-8.

Probiotics for health

A new trend in integrative health circles has been the increasing research on probiotics and their role in optimizing health aiding in the treatment and prevention of illness. It is well known that our gut contains more bacteria than the total number of cells in our bodies, we are understanding more and more how a balance of this micro biome is an indication of our own health. In illness we see shifts in the balance of these ‘bugs’ and we can eat foods and take supplements to alter our flora to help shift our gut to health.

Recent evidence has shown probiotics to be specifically useful for a number of things including acute diarrheal illnesses, Antibiotic therapy related diarrhea, Irritable Bowel Syndrome (particularly type C), Inflammatory bowel disease, and urogenital health such as treatment and prevention of yeast infection.

Our gastrointestinal system makes up a large portion of our immune system and although few studies have been completed to correlate overall immune function with probiotic supplementation, many people believe diets with increased probiotics promote the immune system. Below is a link to an article that showed a positive correlation between eating probiotic yogurt and increased CD4 count in HIV infected individuals.

So where to find these probiotics? Different strains have different efficacies for different disorders, but for a normal healthy individual recommendation would be to look for a supplement with the greatest number of strains and the highest number of microorganisms. If you are looking for a more natural method of supplementation it is easy to get probiotics through food sources. Think of any non cooked fermented food: Kefir, Sauerkraut, Kombucha, Kimchi, miso and yogurt with live cultures are all good options.

Cool links for more info!

A recent overview of resarch evaluating use of probiotics in gastrointestinal disorders including IBS and antibiotic related diarrhea on medscape: http://www.medscape.com/viewarticle/811647?nlid=36967_430&src=wnl_edit_medp_fmed&uac=163528HT&spon=34

Information for probiotic consumers: http://cdrf.org/home/checkoff-investments/usprobiotics/

Elevation in CD4 after eating yogurt: http://www.ncbi.nlm.nih.gov/pubmed/20463586

A New-Orleans dietician posted more info on food sources: (remember that natural yogurt is high in probiotics however if it is processed as much of our yogurt in North America is, only yogurt with added cultures have probiotic efficacy) http://www.nola.com/health/index.ssf/2013/04/yogurt_beyond_8_foods_that_are.html

Another overview of health benefits from a Harvad blog: http://www.health.harvard.edu/fhg/updates/update0905c.shtml

Cordyceps, an increasingly popular exercise enhancing supplement – whats the safety and efficacy like?

Recently, I’ve noticed an increasing number of my friends back in Canada and the States taking a supplement containing Cordyceps sinensis, which is purported to be an exercise enhancer. Being curious (and, as with most exercise enhancing supplements, suspicious), I decided to peruse PubMed and other databases for studies looking at the action of Cordyceps in terms of exercise endurance.

Cordyceps Campanotus

As a fairly new sports supplement, studies on exercise endurance with Cordyceps sinensis have only been published from the late 1990’s. While they are all double-blinded, randomized controlled trials, the majority of them have fairly small sample sizes. Three of the six trials I found stated that Cordyceps supplementation improved exercise endurance, either through work output, time to complete a set exercise, VO₂ max, or increased ventilatory and metabolic thresholds, as shown through blood lactate levels.^1,2,3 Conversely, three trials found no change in peak power output, time to exhaustion, peak heart rate, blood lactate, ventilatory threshold, respiratory compensation point, VO₂ max, or muscle tissue oxygenation saturation.^4,5,6

As previously mentioned, almost all trials were of a low power, involving less than 30 participants each, barring a trial by Zhu and Rippe that reported significant results; however, this trial was funded by the company that produces CordyMax, so there may be bias in their results.² The other two trials that found a positive relationship between supplementation and exercise endurance were not published as full journal articles. Trials reporting improved exercise end-points had given participants 1-3g/d of Cordyceps for 6-12 weeks, and those with non-significant findings had given participants 1-3g/d of Cordyceps for 1-5 weeks.^1,2,3,4,5,6 Another important point to note is that the subjects from the three trials with significant findings were male and female, aged 50-75y, whereas the three trials that did not report significant findings studied healthy males aged 18-50y, and amateur male athletes.^1,2,3,4,5,6 If Cordyceps does improve exercise endurance, perhaps it only makes a significant difference if taken for a longer period of time, and in those who are not already reaching peak levels of cardiovascular fitness.

Bottom line: there have not been enough high-power trials to draw a concrete conclusion in relation to the effect Cordyceps sinensis may have on exercise endurance. In any event, toxicity studies of a similar strain of Cordyceps on rats did not yield any adverse effects (they were given 5.33g/kg/day of Cordyceps guangdongensis for 13 weeks),⁷ and none of the aforementioned trials reported any adverse events, so if you do decide to give Cordyceps a try, it is unlikely that you would experience any side effects.

If you have tried a Cordyceps supplement, please let us know, and tell us if you’ve found it effective (or not)!

Cordyceps supplement

On a side note, a number of studies are being conducted on Cordyceps sinensis looking at potential anti-organ-rejection, anti-cancer, and immunopotentiation effects.

1) Chen S, Li Z, Krochmal R, Abrazado M, Kim W, Cooper CB. Effect of Cs-4 (Cordyceps sinensis) on exercise performance in healthy older subjects: a double-blind, placebo-controlled trial. J Altern Complement Med. 2010 May;16(5):585-90.

2) Zhu J, Rippe J.CordyMax enhances aerobic exercise capacity and metabolism, and endurance performance in healthy, mid-age to elderly, sedentary humans. FASEB J. 18(5):A931. 2004.

3) Xiao YX, Huang Z, Chen G. Increased aerobic capacity in healthy elderly humans given a fermentation product of cordyceps Cs-4. Med Sci Sports Exerc.1999;31:S174.

4) Colson SN, Wyatt FB, Johnston DL, Autrey LD, Fitzgerald YL, Earnest CP. Cordyceps sinensis- and Rhodiola rosea-based supplementation in male cyclists and its effect on muscle tissue oxygen saturation. J Strength Cond Res. 2005 May:19(2):358-63.

5) Parcell AC, Smith JM, Schulthies SS, Myrer JW, Felingham G. Cordyceps sinensis (CordyMax Cs-4) supplementation does not improve endurance exercise performance. Int J Sport Nutr Exerc Metab. 2004 Apr;14 (2):236-42.

6) Earnest CP, Morss GM, Wyatt F, Jordan AN, Colson S, Church TS, Fitzgerald Y, Autrey L, Jurca R, Lucia A. Effects of a commercial herbal-based formula on exercise performance in cyclists. Med Sci Sports Exerc. 2004 Mar;36(3):504-9.

Yan WJ, Li TH, Lin QY, Song B, Jiang ZD. Safety assessment of Cordyceps guangdongensis. Food Chem Toxicol. 2010 Nov;48(11):3080

Contemplations on Vitamin D

I did an elective last month in primary maternity care (GPs that provide obstetric services) in Penticton, BC. During our neonatal checks we always asked (and if they weren’t we suggested) whether new moms were giving their babies Vitamin D supplemental drops. That’s something we had to note along with whether they were breast or bottle-fed and whether they had safe car seats.

I wondered why Vitamin D had become a standard medical recommendation. What studies now showed such strong benefit that allopathic medicine has it integrated into its best practice? Further, how much should they actually get daily?

If it’s so important in babies, how important is it in adults and why? How much should we actually get daily?

What I found is an astounding amount of discourse. Please feel free to sift through the attached links and papers to get some great information.

Vitamin D deficiency is a well-known risk factor for rickets. Some evidence suggests it may increase susceptibility to autoimmune diseases such as multiple sclerosis (MS), rheumatoid arthritis and type 1 diabetes, as well as certain cancers, heart disease and even dementia. With this is mind, researchers group looked at disease-associated regions of the gene map to see if they had higher levels of VDR binding. They found VDR binding was “significantly enriched” in regions linked to several common autoimmune diseases, such as MS, type 1 diabetes and Crohn’s disease, as well as in regions associated with cancers such as leukemia and colorectal cancer. (http://genome.cshlp.org/site/press/gr107920.xhtml)

Further, an article in the Journal of Clinical Oncology concluded that Vitamin D deficiency may be associated with poor outcomes in breast cancer. (http://jco.ascopubs.org/content/27/23/3757.short)

Vitamin D has also been implicated in preventing and treating heart disease. (Vitamin D insufficiency in congestive heart failure: why and what to do about it? Zittermann A,  Schleithoff SS,  Koerfer R. March 2006. http://www.ncbi.nlm.nih.gov/pubmed/16819575)

In contrast, a meta-analysis study found that it did not protect from death due to cardiovascular disease. (J Clin Endocrinol Metab. 2011;96:1931-1942.)

The Canadian Cancer Society

At least 1 vitamin D randomized control trial (RCT) is underway in the US, though it will be a while before we know the results. The VITAL study (Vitamin D and Omega-2 trial) will include 20,000 men and women and will study whether taking a vitamin D supplement or fish oil supplements can reduce the risk of cancer or cardiovascular disease.

Read more: http://www.cancer.ca/Canada-wide/Prevention/Vitamin%20D/What%20research%20shows.aspx?sc_lang=en#ixzz1VDVXSLCT

BABIES:

As stated on the American Centre for Disease Control website (http://www.cdc.gov/breastfeeding/recommendations/vitamin_d.htm), the American Academy of Pediatrics (AAP) published guidelines recommends a daily intake of vitamin D of 400 IU/day for all infants and children beginning in the first few days of life.

Human milk typically contains a vitamin D concentration of 25 IU per liter or less. Therefore, a supplement of 400 IU per day of vitamin D is recommended for all breastfed infants. Adequate amounts of vitamin D can be achieved by currently available multivitamin products containing 400 IU of vitamin D per mL or the newly available preparations that contain 400 IU/mL vitamin D alone without other vitamins. These products are available over the counter.

If an infant is weaned to vitamin-D fortified infant formula (consuming at least 1000 mL per day) or a child one year of age or older is weaned to vitamin-D fortified milk, then further supplementation is not necessary.

ADULTS:

As stated in the Rx Files however additional research is required to confirm that vitamin D supplements do actually prevent cancer (and at what dose). In the mean time it is unlikely to be harmful for adults to take up to 1000 IU/day of Vit D (they do warn to avoid taking >2000 IU/day considering all  sources including diet, milk and dairy, vitamins). (http://www.rxfiles.ca/rxfiles/uploads/documents/Vitamin-D-andCancer-RapidRx28Jun07-Rxfiles.pdf)

In adults, where can we get Vitamin D apart from through sun exposure or in a supplement?

The Office of Dietary Supplements US National Institutes of Health (http://ods.od.nih.gov/factsheets/vitamind/) has a great website out that lists food sources of Vitamin D. Natural sources in fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best. Fortified foods like milk, provide most of the vitamin D in the American diet. For example, almost all of the U.S. milk supply is voluntarily fortified with 100 IU/cup. (In Canada, milk is fortified by law with 35–40 IU/100 mL, as is margarine at ≥530 IU/100 g.)

Prevention of type 1 diabetes mellitus

Although cow’s milk may be associated with an increase of risk for type 1 diabetes, one component, vitamin D, may be protective. Support for this hypothesis comes from a case control study in seven European countries that suggested that supplementation with vitamin D in early infancy can protect against development of type 1 diabetes [43]. A similar protective effect was noted in a birth-cohort study of over 10,000 children [44]. The children who regularly took vitamin D (2000 IU daily) had a reduced risk of type 1 diabetes compared with children whose vitamin D intake was less (RR 0.22). (Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group. Diabetologia 1999; 42:51.)

Treatment of Psoriasis

Topical vitamin D analogs for the treatment of psoriasis include calcipotriene (calcipotriol), calcitriol, and tacalcitol. Although topical vitamin D analogs are effective as monotherapy for some patients, a systematic review found that combination therapy with a topical corticosteroid is more effective than either treatment alone (Mason AR, Mason J, Cork M, et al. Topical treatments for chronic plaque psoriasis. Cochrane Database Syst Rev 2009; :CD005028.)

Improves Immune Functioning in Older Adults (Gloth FM 3rd, Gundberg CM, Hollis BW, et al. Vitamin D deficiency in homebound elderly persons. JAMA 1995; 274:1683.

6 Chinese Herbs

A link to Holistic Primary Care, a scientific journal educating about natural medicine (short and sweet!)

http://www.holisticprimarycare.net/topics/topics-a-g/acupuncture-a-oriental-med/16-six-chinese-herbs-every-doctor-should-know