We probably know by now that diet drinks was 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).

The last newsletter ten years ago 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."

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.

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. Gymnast has 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.

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 than 1 or even 3.

We have somewhat already touched on this, but I'll put a sword in the heart of grains one more time. Most of our grains are tainted from the mass use of Round-Up/Glyphosate sprayed on our crops to increase the yield but at a grave cost to safety. Many in our population have sensitivities to the glutens in grains, and additionally, grains metabolize to sugars leading to high insulin growth factor and insulin levels. High insulin levels trigger all the cascades of pro-inflammatory and proliferation when overstimulated. I would flip the triangle upside down and make the smallest part the occasional high-quality grains sourced cleanly, and put high-quality vegetables at the full bottom, clean saturated and monosaturated fats above it, and clean protein sources above the next level. Fruits are essential but are careful to stick to the high polyphenol low sugar options such as berries. Avoiding the fructose and water packages such as grapes, pears, peaches, bananas except on special occasions. Fruit juices are almost always a bad idea and similar to high sugar sodas in their sugar content.

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.

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 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 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.

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 change 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.

This issue is a controversial topic, but I side with the Bulletproof Diet and infogram or clean meats, prepared safely, in low volumes, for the issues of health (moral and environmental grounds for not eating meat not discussed here). Most studies that suggest the excess risk of certain cancers from surveys of food intake originate from the last 25 years where processed meats are likely the mainstay of the diet. There are no extensive studies that incorporate natural grass fed raised animals that are steroid/antibiotic free as part of the meat diet. Many of the amino acids and nutrients such as vitamin K2 and vitamin B2 are rich in meat especially organ meats and are hard to get in a non-meat eating diet. The Bulletproof Diet and others highly emphasize that the meat or fish should be the smallest portion on the plate and overshadowed by copious high-quality vegetables dressed with clean fats/oils to carry them into the system. Additionally, try to follow cooking principles that limit nitrosamine generation and avoid overcooking or blackening. Spices such as rosemary, garlic, and ginger greatly mitigate carcinogen by-products when cooking meat.

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 up-regulated excretion of sodium. Once an individual balance and the appropriate more moderate rate of carbohydrate in the diet, especially processed carbs, Salt intake rarely becomes a problem.

These also have been released from prison, but make sure you source them cleanly (Grass-fed meat, no steroids, no antibiotics, wild caught fish). Avoid human-made oils and created vegetable oils as they are highly inflammatory especially when cooked. Olive oil is excellent and authentic, but it does have a low smoke point so don't cook with it except that low heat.

I shudder as I write this as my kids will remind me that I often said: "one can sleep when they are dead” and “ I don't need more than five hours." I may have been forecasting my early demise. Most of the wellness conferences I attend now report that good, high-quality sleep is the most important thing not to screw up. Sleep restores the immune system, reboots sex hormones, helps the brain release lymphatic toxins and recover for the next day while processing memories while allowing the liver and G.I. tract to process the evening's dinner and then detoxify itself. There are many sleep trackers, but I like the Oura Ring have been an early user and have spoken with their developers over the last few years. I anticipate this will be used in health monitoring of cancer patients and may replace sleep lab visits. The ring gives you an excellent cell phone Interface that shows you the architecture of your sleep and let you know how much deep, REM and light sleep you get each night and then gives you a readiness score with suggestions. I have experimented with various sleep aids over the years and followed outcome with my personal Oura Ring and also feedback from patient experiences. A quick list of inexpensive easy things that work include: Setting an alarm to go to bed a few hours after dark when are diurnal rhythm will give us the best deep sleep (midnight used to be the middle the night), consider taking your magnesium dose in the evening as this helps with staying asleep and in muscle relaxation (start at 200 mg and go up to 1000 milligrams but be careful of possible laxative effect), turn down your lights, screens 1 to 2 hours before bedtime and consider using blue blocking glasses, and make sure you use “Night shift” on your phone and computer to automatically block the blue light that tells the brain it is “daytime”, keep your room cool or consider taking a hot shower or bath before bedtime so you're cooling off and your melatonin level will rise, consider the "Sleep Induction mat” (about 25 dollars at bulletproof.com and it induces an acupressure like endorphin response and helps put you into a slumber in 8 to 10 minutes), create a ritual for the steps going to sleep and pay attention to keeping things as dark as possible with the use of eyeshades, blackout curtains, earplugs if necessary. If a spouse snores and that is a problem, there is a new product called Smart Nora to take a look at but of course, steer your spouse to sleep work up as well. Challenge yourself to add 30 minutes to your sleep-time until you can wake up relaxed without an alarm. Do not make the mistake of accepting inadequate sleep to exercise or study more as the trade-off will hurt you long-term. Sleep medicines should be evaluated very carefully and only used short-term, long-term uses have may cause dementia and many times one does not get deep sleep similar to a night of heavy drinking. A common corrupter of deep sleep is large late meals, alcohol, or emotional triggering events like arguments or scary movies. The physiologic dose of melatonin is 0.5 mg to 1 mg, yet many preparations have 5 to 10 times that amount. I would recommend you avoid using it except in a low dose and similar to what the body produces. If you want to try something natural and the chamomile teas, valerian teas or supplements, and lavender aromas don't work, Navy Seal and physician Kurt Parsley’s combination product called “Sleep Remedy” worked with most of my patients with no adverse effects. Kurt is a sleep expert and has helped many Navy SEALs recover the rhythm of sleep despite their unpredictable schedule. He was always kind enough to give me samples to try with our cancer patients before they purchased it on the Internet.

Sunlight helps make and activate vitamin D which is critical to many functions, sets your daily rhythm, creates a reaction under the skin to produce nitric oxide and lower your blood pressure, and activates photoreceptors on the retina to make more serotonin in the brain creating less depression and negative mood swings. So some sun exposure is vitally necessary and correlates with longevity in most population studies, but sunburn is terrible as it causes injury and reactive oxygen species that needs repairing before mutagenic risk occur. So what I told patients for years; some sun is good, sunburn is terrible, so brief exposure to the arms and legs is an essential and free health benefit. If someone has a prior melanoma or exceedingly high propensity towards non-melanoma skin cancer (basal cell nevus syndrome), in that case, I will encourage them to be much more careful about high-intensity Solar exposure. There is more data on safe sunblocks now as many of the lotions have hormone modifiers so pick a clean brand with complete blockade (UVA, B, and C) and mainly reapply often especially if you get in the water or sweat.

You may have heard the statement that vitamin takers “have the most expensive urine” and “a good diet is all you need." Yes, indeed some excess vitamins and unutilized vitamins are eliminated in the bowel or urine from time to time. How many of us eat the perfect nutrition-rich, organically grown, well-balanced meals each day? How many people want to be average? If you were seeking a high-performance above normal function and life span, then there are a few things to consider getting from high-quality vitamins. I experiment with a lot of products, but the “ low hanging fruit “ include enough vitamin D to keep your level over 50 ng/mL (dose will likely be 8 to 10,000 IU per day with intermittent brief sun exposure to activating). Also consider a good quality omega 3 oils - 2 to 6,000mg per day ( consider Nordic Naturals, Carlson’s or Bulletproof Brands or even an algae source of which there are many, remember if you get a vegetarian source such as flaxseed or Chia seed, buy them whole as when you grind or mill them they quickly become rancid and are inflammatory). Magnesium- 400 to 1000 per day possibly at night to help with sleep and elimination in the morning, find a mixture of the various subtypes (glycinate, theonate, oxide, and citrate). Zinc- this forgotten mineral is low in many that are over 50 and greatly helps with sex hormones, taste, and immune function and there is an important ratio between zinc and copper in the body (consider a 10 to 20 mg dose especially if one has low testosterone). Iodine-surprisingly this is a missing link in a lot of peoples thyroid function and a supplement of 100 to 200 mg a day is not unreasonable. Other products to consider is supplemental digestive enzymes especially at times of stress with the larger meal of the day, and consider probiotics before, during, and after any course of antibiotics along with many highly fermented foods. There is one more topic that is quite complicated and controversial; genetic variances of methylation, where a third of the population have significantly reduced in their ability to add a methyl group to mostly B vitamins and make them useful in the body. Without going down into a big rabbit hole, one can get their methylation status from their 23 and Me data, or a specific methylation profile from a laboratory company, or you can just make sure to take “methylated” folic acid and B12 (if your homocysteine level is greater than 8, a marker for methylation dysfunction, look into this further).