Medical Dilemas

There are a few health and life topics that seem to come up over and over again when coaching. I have provided a list of those common topics here and will update them regularly. If you have a specific concern feel free to contact me for suggestions to add to this list.

Artificial Sweetners


We probably know by now that diet drinks are an evil Boondoggle that fostered as much weight gain as standard drinks so one would buy more and try harder. The sweetener story gets worse as aspartame is a neurotoxin, and saccharine maybe as well (read Sweet Deception by Joe Mercola). There are newer ones such as Stevia, Erythritol, Xylitol, and Neotame but remember they reinforce the loop in your brain that sweet is right which will forever keep this temptation alive. And I am not sure that even though these artificial sweeteners are not absorbed into the bloodstream like glucose or other sugars, they may still trigger a Pavlovian response to elevate insulin growth factor and then insulin and cause inappropriate metabolic disruption. So less or no artificial sweeteners is preferred, and yes, unfortunately, honey is sugar as well ( use it medicinally on a sore throat or wound but not regularly in your diet).




Aspirin


The last newsletter ten years ago I suggested 81 mg coated baby aspirin use in someone with no history of gastric bleed, or other bleeding maladies was an excellent decision to reduce vascular events and secondary evidence saying it would reduce specific cancer risk (colon, prostate, ovarian,). Just a few months back the FDA advised against taking it if one is over 60 years as some new evidence suggests a slightly higher risk of cerebral vascular bleeds. I have backed off my daily use and now only use it when traveling and will be sitting in a car or on a plane for prevention of blood clots (DVTs) and I use it intermittently if I have some sore joints at that low-dose. I feel comfortable doing this as my measure of inflammation is quite low (C reactive protein <1). If one has a CRP level which is elevated, possibly baby aspirin use is justified along with other strategies to work to get the CRP level below one. There is no one-size- fits-all on this topic. As always, “be your own best doctor."




Blood Pressure


Many functional medicine physicians question the extensive use of blood pressure medicines in the United States. First of all, no decision on the drug should be based a physician office measurements solely due to the problem of “white coat hypertension." One should always check levels at home or work, in a consistent way, after two or three relaxation breaths, and remember the cuff needs to be at heart level, to best reflect what your pressure is in your normal life. Once again the Cochrane Reviews looked at a large population study and showed that those with “low” level high blood pressure and “intermediate” level high blood pressure had a survival decrement when treated versus non- treated. Those with more severe “high” high blood pressure, showed a survival benefit to treatment. This finding probably reflects the common phenomenon where people are placed on blood pressure medicines during a period of stress or busy work life and are still on them years later when they get up from a sitting position and get lightheaded and then fall leading to problems (syncope event). Once again underscoring the importance of starting every medical evaluation or visit with “deprescribing” or “what medicines can I get rid of today, and fix the root problem." Remember regarding medicine; if they are not helping you, they are hurting you. The FDA website for 2017 reports that over 400 people die a day from pharmaceutical complications ( that is like a 747 plane going down every day, and no one is talking about it). Although there is a passionate debate on the authenticity of these figures we all know many who have had events or close calls, and sourcing of medications is now in question so only take what you need.




Calcium


This mineral has been oversold in the American Diet and may contribute to vascular calcification if over-utilized without other vitamins. We as a country have the most calcium intake compared to other countries but some of the worst statistics on osteoporosis and bone fractures. Bone health requires vitamin D, a lot of less well-known minerals like strontium, boron, magnesium, coupled with healthy hormones and frequent weight- bearing exercises. Yes, you need to go out and “bend your bones” because when you do they react and lay down more matrix on the outer cortex to keep strong and aligned with your weight bearing forces. Gymnasts have the most robust bones by two standard deviations because of all the jumping, landing and the stress troops they put on bones during their workouts. I am not a big fan of bone density test because they're expensive, they check a few targeted areas, lead to a costly side effect producing pharmaceutical solutions (bisphosphonates) that after a few years can stop the healthy bone remolding that is needed to keep bones strong for the long-term. I always ask: is there ever a reason someone over 50 should not do everything to keep their bone strong, through diet and exercise (targeted if you're starting to lose height and thus using Pilates and yoga and other physical therapies) all of which worked better then pharmaceutical solutions. Other than vitamin D, Vitamin K2, and minerals and calcium through diet, I would suggest to be careful in the use of biphosphonate pharmaceutical strategies and only for short time use in extreme cases following fractures and failed non-pharmaceutical approaches. Safe weight-bearing exercises can get you a long way especially if you start early before your bones get fragile.




Cholesterol


Yes, this critical building block for hormones, membranes and nerve sheaths has escaped from prison. Most clinicians now accept that the cholesterol you eat is irrelevant to the blood cholesterol levels. I have met and discussed this topic with Dan Diamond Ph.D. and lipid spokesperson, and he firmly believes that it is also irrelevant what level it is in the blood. I have listened to many lipid experts speak on this, and I still hold out some question on the single small particle LPA, and one should have this under 100. The relevant part of the lipid panel for me is the triglyceride level which is a surrogate marker for inflammation and fructose metabolism, and one should work hard to get this under 100 or as low as possible. A good ratio to follow and pursue is to have the HDL/Triglyceride ratio higher than one which puts you in the favored state of bad cholesterol clearing lipoprotein (HDL) and a low triglyceride. The impact of cholesterol-lowering medications is very minimal on cardiac events (MI or Cardiac Death) with an absolute benefit between 1/60 and 1/200 true benefit while the cost of significant side effects and financial loss. When you step back though and look at large studies, there is a modest impact outside of cardiac disease that is now thought to be related to the metabolic effects on the cell independent of cholesterol. Yes, I am happy with my LDL of 240 to 250, but I keep an eye on my HDL/triglyceride ratio and like to see it greater than1 or even 3.




Genetic Blue Print


We have all heard the statement; "choose your parents carefully as they determine your health outcomes." Yes, we thought your chromosomes/ genes primarily determine your longevity and health, and there was not much we can do about it. In the last ten years, researchers have identified the process and field of Epigenetics which implies that the lifestyle or environment and external stimuli on an organism either suppresses or enhances the phenotypic manifestation of a gene. So yes the lifestyle issues we learn from our parents are critically important and in the old debate of nature versus nurture, nurture may be more important. Even more incredibly we now know that the Microbiome of our body and especially our intestinal track communicates intimately with genetic expression within our body. So more or less, you don't feed your body, you feed the bacteria in your gut that then decides what to pass on to you in the intestine. So keep your microbiome happy as we are all dependent on it. This new science is all good news, and the complementary term that goes with this is “plasticity." Our bodies and especially the brain can respond to external stimuli and create new cells, connections, and functions that can serve us favorably. And don't underestimate the importance of setting the intention to help catalyze that change.




Hormone Replacement in Men


Men are much more fortunate in that: “Menopause” is not a cliff as in women but a slow downhill decline. Currently, there are commercials everywhere about coming in to get your "T “ checked so you can get “back in the game." Unfortunately, it's never as simple as the commercials suggest. Some easy things to consider; if you notice morning erections then things are probably working okay, and that is a decent barometer of adequate testosterone level. Also generally if a man has abdominal obesity and cannot see his “junk” when standing to urinate, then it probably isn't working. The abdominal fat or white fat causes estrogenization/aromatization (production of estrogen rather than testosterone especially during times of stress) and may lead to breast enlargement, muscle wasting, and declining testosterone levels. Kryptonite to the creation of testosterone is low percentage deep sleep (< 10 percent ) low zinc levels, not enough good fats in the diet, stress that steers testosterone precursors to cortisol, and on and on. Most of the time testosterone levels normalize by fixing general health imbalances (sleep quality, high-quality fats, manage stress, initiate weight-bearing exercises, and possibly some supplements to help). Some laboratory tests are essential to review; testosterone, and luteinizing hormone level which comes from the pituitary to drive testosterone production, and look at free testosterone and bound testosterone. This way one can determine if the testicles are working correctly. We do know now that testosterone replacement does not seem to likely cause higher rates of prostate cancer but frequently when one starts on testosterone replacement, one is committed to replacing long term as you typically shut down your production by feedback inhibition. This replacement long term commitment is the danger of not trying to fix it through natural strategies and addressing the root cause. One should try to fix it even if libido/sex life is not a concern, as testosterone is critical to cognitive function, bone strength, muscle maintenance, and much more. Unfortunately, alcohol intake fosters aromatase activity and drives testosterone to become estrogen. There are plenty of excellent resources on the Internet on how do to start fixing this problem by lifestyle changes before one resorts to creams, gels and shots, changes that will also help many other organ systems. Remember don't settle on being average, or low standard, seek the hormonal levels of your favorite age and feel great.




Hormone Replacement in Women


The last four decades of medical history with HRT in women post-menopause is a sad story which I will briefly review. Before the 90s, many women took some form of hormone replacement to ease the overnight drop in the hormones estrogen and progesterone from menopause to replace their natural estrogen and progesterone. This replacement mitigated the abrupt onset of hot flashes, sleep disturbance, anxiety, and in some hair loss, memory issues, libido failure, vaginal dryness and more. The Women Health Initiative was organized to look at the benefits of hormone replacement versus placebo and was the most expensive organized clinical trial as of today in this country. The study organizers reported early 1992 a non-significant increase in early breast cancer in the hormonal arm and suspended that arm of the trial at that time. Ultimately this was found to be a nonsignificant event, clinically irrelevant and those that took the hormonal supplement even though it was from a pregnant horse mare source (Premarin) and at higher doses than currently preferred, had less death from breast cancer than the placebo arm. The hormonal use arm had many improvements in quality of life, bone function, cognitive and sleep function, but the erroneous report of the early data considerably changed the practicing approach in this country and never corrected itself (please consider a recent podcast the Drive, interview by Dr. Peter Attia on this topic). Why is it unreasonable not to find the lowest possible replacement dose, and bioidentical preparation, to enable a hormonal environment to keep a woman feeling youthful like she felt in her 30s and 40s? There was a prior nurses study with a hormone replacement arm that never showed an increase in breast cancer risk. The absence of hormone replacement and the resulting sleep disruption, emotional disruption, cognitive dysfunction, immune and repair disruption will significantly accelerate the other risk factors far more significant than any possible concern for breast cancer. Some authors believe that the reason women have a much higher rate of dementia than men is their rapid and earlier loss of hormones compared to their male counterparts. And yes, women need some testosterone, and generally have 1/10 the level of men where it fosters healthy bone, muscle maintenance, and cognition.




Salt


People fought in wars for salt in the past, and it is a necessary ingredient for survival. I put a pinch of good sea salt in my morning water to get me started every day. Yes, sea salt has magnesium and potassium and other minerals along with sodium chloride. So spend the extra money on good sea salt. Salt has some negative baggage, and some of my happiest patients were cancer patients that I suggested add some sea salt to the morning water to recover production of mineral corticoids and blood pressure that perfused the brain so they could regain some of their function. The British Medical Think Tank called Cochrane Reviews looked at this issue and identified that low and intermediate users of salt had worse health outcomes in a significant analysis. There are highly salt-sensitive hypertensive patients (thought to be 3% of the population), frequently black males with something called Renin sensitive hypertension that need to curtail salts. Most recent research finds that salt is more of a problem in the current high carbohydrate diet's of the last few years and once one gets back to the proper macro ratios of fat/carbohydrate/protein, salt is excreted and rarely causes fluid retention. When one starts the low carb diet, there is a diuresis, and dry mouth thought related to upregulated excretion of sodium. Once an individual balances and the appropriates more moderate rate of carbohydrates in the diet, especially processed carbs, salt intake rarely becomes a problem.




Sun Exposure


Sunburn is a dermatologic manifestations of Inflammation that if unmanageable by the body could lead to DNA injury. This DNA injury may lead to accelerated aging or if the insult is too great for the body possibly even DNA injury and subsequent mutations that can lay the groundwork for malignant cellular transformation. Our natural protective mechanisms or the density of melanocytes to protect with pigment that limits this injury is different in all of us. A light-skinned individual who burns with a short exposure time but persist in trying to get a tan is like a polar bear trying to live in the desert; ultimately problems will develop.

Look at a sunburn as a permanent ”chink in your armor” for Long-term dermal health and cancer free years. When we get a sunburn which will happen through life experience, managing it with strategies to help the inflammation in the body‘s reaction to it with reactive oxygen species. Pure aloe vera gel helps with the symptoms and appears to have some anti-inflammatory and antibiotic benefits. Working internally with an increase in your antioxidant regimen that may include additional vitamin C possibly in the 3 to 5000 mg range, other food-based sources of antioxidants like multicolor vegetables and berries, and then possibly traditional pharmaceutical anti-inflammatory tools such as aspirin.

I have even deployed vitamin C paste on the skin with good results. Remember your body has a limited resource of recovery enzymes and substrate, so try to rest and limit your activity after a sunburn so your body can direct it’s activity toward the skin event.

Remember ”sun is good but sunburn is bad” ,