The Synergy of Chinese Herbs

Herbal prescription in Chinese Medicine follows advanced and sophisticated dosage and combining protocols. For example an herb may have a specific action like raising prolapsed organs (for instance the herb sheng ma), however that action may only come out when that herb is prescribed with other herbs with similar actions. An herb might treat a particular symptom, but when prescribed with a guiding herb is capable of treating a related but different symptom in a different part of the body. In short, herbal medicine combining, or Dui Yao is not a additive, cumulative science, but a complicated science of synergy and complex interaction.

(entirely off topic, here's a really great video for any adrenalin junkies out there, if you haven't seen this nut, you should.)

Anyway, this is a pretty fascinating topic. We have a sense of how these things operate from a Chinese Medical Paradigm. Within our strange and interesting Chinese Medicine brains, acupuncturists really get these relationships, they make sense and are intuitive, because we have taken the time to build the rules and thought processes for how this world operates. Within the framework of western sciences these relationships are much more difficult to identify. In truth, like a lot of what happens in Chinese Medicine, western science just hasn't caught up yet. But there are some promising approaches developing out there, and I found one particularly interesting study.

"Synergistic therapeutic actions of herbal ingredients and their mechanisms from molecular interaction and network perspectives." (sorry no full text, but I'll try to give you all the juicy details.)

What this paper sought to do, was to elucidate the mechanisms by which herbs interact. (one example of this is Jiao Tai Wan. Huang lian and rou gui interact synergistically to improve symptoms of xin shen bu jiao (noninteraction of heart and kidney)). Chinese Medicine is rife with these sorts of combinations: nu zhen zi and han lian cao; gan cao, sheng jiang and da zao; sheng ma and huang qi; huang lian, huang bai, and huang qin; ma huang and gui zhi; bao shao and gan cao...and so on. We identify each of these combinations as embodying powers beyond the contributions of each individual herb. In some cases entirely new functions are created that are not found, even in lesser power, in the constituent ingredients.

Often one herb alters the ADME (absorption, distribution, metabolism and excretion) of the other. This is suspected to be the case in Jiao Tai Wan, and particularly with regard to absorption. As this study shows, the specific ratio of huang lian to rou gui enhances the absorption of huang lian across the intestinal membrane, thereby increasing the activity of huang lian without increasing its dose.

Constituents also act as teams to influence change in the body. This sounds oddly reminiscent of our understanding of how to build a formula with chief, deputy, assistant, and envoy.

a. Anti-Counteractive: reduce a network's counteractive activities against a constituent's effect. 

b. Complementary: actions positively regulate a target or negatively regulate a competing target. 

c. Facilitating: secondary actions of one constituent in enhancing the activity level of another. 

d. Potentiative modulation: affecting things like cell transports, permeability, delaying or reducing first pass excretion, or metabolism, all of which enhance the activity of the first constituent. 

 The paper gave some examples of studies that have been done into single herb synergism (multiple constituents in one herb act together to have effects larger than the effects of the individual constituents added together), as well as synergism from multiple ingredients.

Berberis:  Plants of this family contain the two key ingredients berberine and 5' methyoyhydnocarpin (5 MHC). What's interesting about these two ingredients is that while berberine has pretty good antibacterial actions, it is much more potent when in the presence of 5 MHC. In order to see why think about a bacteria. Bacterial cell walls have special little pumps on them that work to pump out synthetic and natural antibacterial agents, and keep them from killing the bacteria. These pumps are called multi drug resistant pumps. 5MHC inhibits the activity of these pumps allowing berberine to accumulate inside the bacteria and result in much more effective treatment. I'm not sure whether our big berberine herbs (huang lian, and huang bai) contain 5MHC. A quick glance at Chen didn't answer that question. If anybody out there knows let me know. (here's a link to the full text of this interaction.)

Onions and Garlic: Ancient food pairing. Goes together like acupuncture and flutes, especially in the presence of rich or fatty foods. Conveniently enough when together onions and garlic act in a synergistic manner to inhibit the peroxidation of lipids. You heard me right, go big on the onions and garlic to keep those newly absorbed triglycerides and free fatty acids from turning into little artery cloggers. This one is pretty tangled and complicated...what they found is that they could feed someone 100 grams of butter (sounds like a dare I responded to as a teenager), and onions and garlic limited the increase in serum cholesterol and plasma fibrinogen, and increased fibrinogen activity and clotting time.    Onions contain quercitin, myricetin, and kaempferol all of which inhibit various enzymes involved in splitting fats (lipoxygenase 5, 16, and phospholipase A2). Garlic contains sulfurous substances (diallyl disulfide, diallyl disulfide, allicin, alliin, ajoene, N-acetyl cysteine, S-allyl cysteine, S-ethyl cysteine, S-methyl cysteine, S-propyl cysteine) all of which inhibit the mechanisms that the body uses to upregulate those now-downregulated lipase enzymes, allowing the onions to have a stronger effect than they would otherwise. This is an example of an anti-counteractive effect.

Gou Teng and Tian Ma: These two herbs are found in the formula Tian Ma Gou Teng Yin, used for wind due to rising liver yang. This study looked at these two herbs and their actions on decreasing convulsions. Gou teng contains Hirsuteine, which decreases the incidence of seizures by blocking nicotinic receptor ion channel complexes. Tian Ma contains vanilline which inhibits acetylcholinesterase and butyrlcholinesterase, which results in decreased seizures caused by acetylcholine. But unfortunately this decreases acetylcholine degradation, which increases the activity of nicotinic acetylcholine receptor, which would lead to more seizures, if it wasn't for the actions of Gou Teng and that Hirsuteine, blocking nicotinic receptor channels. An example of what the study called an "anti-negatie effect."

Ren Shen and Zhi Gan Cao: The formula ban xia xie xin tang, among others, utilizes this combination. This combination was investigated in ulcerative colitis.  The authors used the entire formula, as well as individual isolates and those isolates in combination. The combination of ginsenoside saponins (GS) and glycyrrhizin (GZ) was effective beyond the effect of both used alone. GS is effective in decreasing the activation of defective Th1 response, while GZ is effective in suppressing defective Th2 response. Together they cover both divisions of aberrant immune response, resulting in benefit beyond either alone. I wasn't aware before reading this paper that this division existed in between these two herbs. That makes these two herbs a handy herb pair that I am likely to employ in my auto-immune formulas in the future, as long as the pattern fits.

It's nice to have western science backing us up for a change, but I'm not convinced of the power of these sorts of methods to really offer a whole lot to our understanding of Dui Yao at the moment. I for one will continue to trust the time honored classics in my herb pairing over the pages of "Bioinformatics and Drug Design." I think that most herbalists out there feel the same way. Studies can provide us with the nitty gritty molecular interaction details about why what we've been doing for thousands of years works so well, but at this point the main things they are likely to add are improvements on delivery methods and small tweaks on use. But the real gems are still to be found in the pages of the Shang Han Lun, Jin Gui and, for me the Pi Wei Lun. It doesn't mean that the information about absorption, distribution, metabolism and excretion isn't important. We are likely to need to know more and more of this in order to stay current in this field. Now excuse me while I go get some onions and garlic chopped for dinner.

Choosing Effective Supplements

The subject of supplements comes up a lot with my patients and the brand you choose has a lot to do with whether or not it is going to work for you. There are some not great companies out there selling substandard product. Here's all the information you need to navigate this area of health. In this blog post we cover:

-How to distinguish quality products from inferior products.

-How to ensure safety in dosage and use.

-A few strategies you can use to maximize benefits.

-Some general recommendations

First: How to distinguish quality from inferior products:

In 1994 the FDA passed the DSHEA (Dietary Supplement Health and Education Act. It laid the responsibility for the products safety on the shoulders of the manufactures, and left as well the responsibility of screening and testing on the companies as well. As long as no one is watching, many companies would just as well not do the testing, or put out inferior products knowing there would be no repercussions for it. From he FDA website: 

“the dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.”

This means that it is up to use to police these supplements. There are a lot of ways that manufacturers can create inferior products. The first thing to understand is that there are a lot of possible ingredients in a supplement besides just the ingredient you are looking for. Let’s say your taking milk thistle for liver health. Well, there may be much more than just milk thistle in your supplement. Here’s a picture of the typical anatomy of a supplement:

As you can see there is much more going on here than just the main ingredient. In a lot of cases these other ingredients may be causing serious harm in your future, while you think you are taking care of your health. Here’s a look at some of the most dangerous additives to supplements:

Parabens: Common preservative material, have estrogen like activity in the body affecting both men and women:

-Methyparaben

-Ethylparaben

-Polyparaben

-Butylparaben

Pthalates: Used as a plasticizer. Estrogen like material that will stimulate our receptors. Resulting in infertility, sexual dysfunction, and increase risk of cancer.

-Benzylbutylpthalate

-Di2ethylhexylpthalate 

-Diisodecylpthalate

Notice that “paraben” or “pthalate” is only at the end of the ingredient name, without knowing this, you might well pass right over the ingredient name as you scan through.

Titanium Dioxide is another interesting additive. In it’s natural form it is pretty benign. But much of the titanium dioxide is in the form of superfine particles, or nanoparticles. These have been found to cause some pretty significant health issues. Here’s Christopher Chang from the May, 2010 issue of the “Journal of Autoimmunity.”

“Nanomedicine has already opened up a new avenue of research in cancer therapy, drug delivery, and immune regulation. While the benefits of this new science to human civilization are seemingly immeasurable, it is also important to appreciate that these particles can also lead to harmful effects on human health.”

-and again:

“Increased mutation frequency has also been described in cultured human lymphoblastoid cells exposed to ultrafine TiO2 particles. TiO2 nanoparticles have been shown to be cytotoxic in mouse fibroblast cells...”

And a paper out of the UCLA research laboratories found that titanium dioxide damages cells and the genetic level.

Artificial colors are another issue. Many studies have shown that artificial colors contribute to, or exacerbate the symptoms of autism, ADHD, and other behavioral disorders. The artificial colorings are usually found as either “lakes” or “dyes” the difference is that the lakes are the fat soluble forms of coloring and the dyes are those used for water soluble applications. Fat soluble toxins are more damaging than water soluble toxins, because they detoxify from our bodies differently and likely will be present for longer in our tissues that water soluble. If you have to chose between a product containing “lakes” and another containing “dyes,” I’d recommend the dyes. But there are many natural ingredients that can be used for color, including caramel, beet juice, and beta carotene, so in truth there is no need for any artificial dyes or colorings in our supplements.

Magnesium Stearate: is an excipient that is often added to supplements for a few reasons. First it provides bulking so that it can fill out a supplement to a larger size if that is something that makes taking the supplement more convenient. Second it is added to help lubricate the machines. As the tablets or powder moves through the processing and manufacture machinery it is likely to cause binding, slowing, or may stick to the machines. Magnesium stearate is a fatty acid (stearic acid) bound to magnesium and as a result it’s presence in supplements results in less physical friction in processing. In and of itself it is already present in our diet. However its presence does decrease the speed at which supplements break down, and if it is used in excess in supplements then it can decrease our absorption of the ingredients. My recommendation would be to consider it a necessary evil in some brands, and to not necessarily exclude a product by virtue of seeing magnesium stearate on the ingredients, but rather to look for where it appears on the ingredients. It should be a minor player. In unethical and poor quality manufacturing it may make up 50% or more of the weight of the product. It should appear near the end of the additional or inactive ingredients list. Here's some more information on this.

Allergens: are often present in supplements. Due to the relative freedom that supplement companies enjoy, the presence of things like corn, soy, and wheat may not be clearly stated on products containing them. If you have an issue with any of these, or other items I would recommend that you seek products that clearly state they do not contain these ingredients. You can also call the company and have them send you confirmation that these ingredients are safely absent (in writing or email), not just verbal confirmation. Some things to look for include:

Zein: a corn derived protein coating.

Gluten: even if it doesn’t say on the ingredients assume it’s there, unless it states that it is free of it.

Maltodextrin: a corn derived starch

Whey, Casein, and Lactose: dairy derived ingredients

Soy Lecithin: soy lecithin is typically extracted from soybean oil, rather than from the bean itself and is rarely allergenic, however it still can be in people who are especially sensitive. 

Dosage and Use

Supplements and herbs are capable of interacting with medications and their use should ideally be evaluated by an herbalist, naturopath or your acupuncturist. If you are on any of the following medications you are especially at risk for interactions. 

Serotonin modifying medications such as Zoloft, Prozac, Celexa, Lexapro, etc.

Highy protein bound drugs: Warfarin, Phenytoin, Carbamazepine, Valproic Acid, Valium.

Digoxin

Some supplements, such as PGX and Huang Lian Su may be used specifically to decrease absorption, and will interact with your absorption of many medications. Magnesium can interfere considerably with the amount of thyroid medication absorbed. There are a number of contraindicated herbal combinations in traditional chinese medicine because the actions cancel one another out. Such combinations include seaweed and licorice and ginseng and radish. This is another reason that it is best to consult with a trained herbalist or naturopath when selecting supplements. 

In general it is best to avoid supplements with long lists of ingredients. In that case there is often too little of each ingredient to have a significant benefit for your condition. If you have any adverse effects, you won’t know which ingredient you need to eliminate. 

If a little bit of a supplement is good, more is not necessarily better. There is often an ideal therapeutic dose, below which you won’t get results and above which you either won’t get results, or you’ll get adverse reactions. Vitamin C is a good example of this. Above a certain dosage the Vitamin C is no longer absorbed and will result in diarrhea instead. Another concern is that when you take in a supplement your body requires particular metabolic pathways in order to convert that supplement to a usable form for you, or as it works in your body you need to metabolize the byproducts of it’s actions. Above a certain dosage your body can’t keep up with the byproducts. Toxins buildup and instead of helping you, your supplement is slowly poisoning you. Stick to your dosage recommendations. 

Make sure you supplements have been independently analyzed by a third party. Any supplement company worth spending your money on will have their products independently analyzed by a third party. Because the FDA doesn’t do this, many companies realized the need to prove to their customers that their brands actually contain what they say they do. In order to do that they pay another company to come in and do quality analysis on their supplements. They ensure purity, potency, shelf stability, the lack of any contaminants, and the proper dissolubility of the products. Usually this will appear on the supplement. There are a few logos you can look for on your products to ensure that they are independently analyzed: 

USP stands for United States Pharmacopeia. It is a non-profit group that analyzes products and those that pass are able carry their logo on the product:

There are quite a few other companies as well, and just because a product you are looking at doesn’t carry the USP logo doesn’t mean it isn’t quality assured. You often need to call the company and request a copy of their certificate for the product you are getting. 

Maximize your benefit:

Water soluble vitamins get cleared out of the body faster, to maintain idea levels these need to be dosed multiple times per day. Examples include Vitamin C, B vitamins, and Choline.

Fat soluble supplements should bring more caution when it comes to pollutants and contaminants. Make sure that these especially are coming from reputable sources. Examples include: fish oil, flaxseed, CoQ10, Vitamin D, A, E, and K.

Minerals such as magnesium, iron, calcium and zinc are best absorbed with a small amount of an acidic material such as orange or tomato juice (this is especially true in the elderly who often have insufficient stomach acid production).

Phytates are naturally occurring molecules that plants use to store phosphorus. When these are consumed they bind to minerals in our diets, especially iron and zinc, but also magnesium and calcium and pull them out of solution (chelate) so that we cannot absorb them. Beans, tofu, grains, and nuts are some the largest sources of phytates in our diets. Taking mineral supplements with meals containing these molecules will significantly decrease the absorption of these minerals. (Also remember that a lot of grains and flours are enriched with these types of minerals, however they do us little practical good nutritionally because we can’t absorb them bound to phytates.)

Synthetic vs Natural: Vitamins are complex molecules and as such they possess the quality of "chirality". This means that they can exist in two mirror images configurations. When you look into the mirror you see yourself not identical to how people see you, but reversed, the same is true of chiral molecules. They can exist in what’s called a D or an L configuration. Identifying which is which involves shining light through a tube of the molecule and seeing which way it rotates the light. (I know, pretty far out huh?). When these molecules are being used by our bodies they are being plugged into enzymes and receptors. That means it matters which configuration they are in. In order to visualize this think about your two hands. They are chiral, in that they are mirror images of one another, that cannot be superimposed on one another. They look identical otherwise, but when you go to shake someone’s hand, if you have your right hand full and you go to shake their hand with your left hand, it doesn’t really match up and you have an awkward handshake, the right hands, or left hands however fit together nicely. Such is the case with the enzymes and receptors in your body. They are used to seeing molecules come in with a particular configuration, all of life has pretty much agreed that all amino acids are used in their L configuration and all sugars are used in their D configuration. When biological process create these molecules they are in their correct orientation. When the ingredients in your supplement come from natural sources they work well with the body. When they are synthesized in a laboratory they are made in equal parts D and L (in fact a good way to spot a synthetic supplement is to look at the ingredients and look for ingredients preceded by DL, such as DL alpha tocopherol). The part we can’t use needs to be excreted from the body, requiring biological energy that could be better used on making sure you are healthy and thriving. 

Here’s your take away: make sure your supplements are:

-All independently quality assured.

-Sourced from natural means rather than synthetic.

-Not interacting with your medications.

-Not chalk full of additives, binders, flavorings, and colorings.

-Taken in a way to maximize the benefits and minimize the harms.

My list of recommended supplements. Unless you are totally dialed in when it comes to diet, I think these are things you should be on to maintain optimal health. These are links to these supplements available from manufactures I trust and use for my own patients.

-Magnesium
Pure Encapsulations Magnesium - Citrate - 180 capsules
-Cod Liver Oil

Green Pastures - Blue Ice Fermented COD Liver Oil, Unflavored, 120 capsules
-Probiotics

Jarrow Formulas Jarro-dophilus EPS, 120 Capsules
-Vitamin D3

Metagenics, D3 5000, 120 Softgels

Thanks for reading!

Nutrition Seminar

Okay everybody. Let’s talk nutrition. 

It’s a bit scary though, this subject is rife with conflict. It is crazy. I would much rather bring up abortion or evolution with a random stranger at the grocery store than dare talk about the garbage in their shopping carts. I suppose that’s mainly because the views that I hold aren’t exactly the status quo yet. But they are gaining ground out there and people are definitely coming around. 

So what do I think is healthy nutrition? Not so fast. First, lets look a little closer at the conventional wisdom out there. 

What do we know about nutrition? What’s healthy to eat and what’s not healthy? Well those are huge questions. Questions that drive entire industries, including but not limited to food companies. The agriculture industry, the pharmaceutical industry and plenty of other folks out there are interested in what we eat and are watching carefully the changing whims of the people so they can be ready to make a profit. Well, we better make sure all the things we’ve heard are correct. 

Let’s start by looking at some common nutrition wisdom and analyzing it carefully. I’m gonna start big. Go big or go home right? Well, I am home, but I’ll go big anyway. We’re going to start by looking at what may be the single biggest nutrition myth perpetuated today:

Saturated fat causes heart attacks and obesity. Fat makes you fat, and clogs your arteries. That’s actually pretty straight forward thinking. It seems like common sense. Fat on your plate jiggles, fat on your body jiggles, there you go. Artherosclerotic plaques in your arteries look like grease, piece of cake...literally.

Fat is one of three macronutrient classes. Macronutrients make up the fuel sources for our bodies. The different macronutrient types are: fat, protein, and carbohydrates. The idea that the health woes of our society are all the result of a single macronutrient class is an attractive idea. First, it provides a simple understanding of a complex subject. It’s tempting to over simplify and over generalize. Our brains seek to find order within complex systems, and as a result we come to incorrect conclusions. If history is any guide the only truly safe bet we can make about any of the conclusions science has reached is that it’s more complicated than we think. We would love to think that fat is the problem and if we can find a way to eat zero fat, we’d experience zero heart attacks.

Well, unfortunately it’s a little more complicated than that. This is the starting point that got Ancel Keys looking at fat intake as the cause of heart disease way back in the 1940s. He was so convinced that this was the case that he made it his single minded purpose to show that this was true. He collected data on fat intake and graphed it against the number of heart disease related deaths in various countries and his graph indeed did demonstrate a correlation between the intake of fat and the number of deaths from heart disease. This is a result we call a “correlation.” It shows that one variable correlates with another variable. It is important to point out that “correlation is not causation.” Which is a common issue among people on both sides of any nutrition argument. Anytime we look at data on nutrition we typically are looking at epidemiological data. That is we look at populations of people, measure two variables present and try to see if they seem related. To understand why this is an imperfect approach lets look at a few other correlations. 

Here’s Ancel Keys’ original graph showing the relationship between saturated fat and heart related deaths:

Just to demonstrate how sometimes a correlation may not represent a causation, here’s another graph, based on the most recent data on heart related deaths:

In my graph I looked at the current number of heart related deaths per country graphed against the number of mcdonalds in that country. You can see clearly that as the number of McDondald’s restaurants increases the number of deaths from heart attacks decrease. All we need to do is build more McDonald’s and we’ll see our rates of heart attacks drop to zero. Case in point: Correlation does not equal causation. 

Is it that the presence of McDonald’s represents an indicator of a separate variable that wasn’t measured. Perhaps the more affluent countries have more disposable income and have attracted more McDonalds restaurants? They also, because of their increased wealth, have better access to medical services and better emergency care of heart attacks, which results in fewer deaths in those populations. The relationship we see in these correlation studies might not be due to the variable they measured but due to a second variable reflected in the first. Because we are looking at heart attack deaths and not the total number of heart attacks, those countries with better medical care available would have a misleadingly lower number than comparable populations with better medical care. Hence the dangers of relying on epidemiological, or observational data when assessing health factors. 

Another way to look at this is to see if there are cultures out there that eat a diet high in fat and remain relatively disease free. Well, as you probably guessed, there are such cultures. The first two that come to mind are the Maasai tribe from Tanzania and the Inuit from the icy north. Both eat a large amount of their calories, more than 60%, from fat. Yet both cultures have low rates of heart disease and chronic disease, and general outstanding health that basically make the rest of us slobs look like Gary Busey. It is important to note that these cultures are also eating traditional ethnic foods, prepared in traditional ways, entirely devoid of processed and refined ingredients and additives.

So maybe fat isn’t the evil death monger we have been led to believe it is. So then the real culprit must be the carbohydrates, right? Well, next we look to the Kitavans, a tribe in the pacific islands that, despite their very high carbohydrate intake, continue to demonstrate less heart disease rates, and better markers of cardiovascular health than ours in the western, more affluent cultures. The Kitavans get roughly 65% of their calories from carbohydrates. The sources include yams, potatoes, fruit, honey, taro and cassava. They also consume pork and fish, but not nearly as much protein as many other cultures with higher rates of heart attacks and strokes. 

So if it isn’t the fat, and it isn’t the carbohydrates, then maybe it’s the protein. Turns out there isn’t a culture that I know of that represents an excessive consumption of protein. Mainly because protein is not separated from fat and carbohydrates in most natural food items. But we do have data looking at relative protein intake and rate of heart attack deaths between countries. Germany eats about 20% less protein than Portugal does, yet has roughly twice the rate of heart attack deaths. If you look carefully at the total protein intake between countries and compare that to the rates of heart attack related deaths there isn’t a correlation.

The conclusion we can draw from this information is that there is no case for condemning any one macronutrient category. A better understanding would be that diet and health are linked through complex relationships that include as many variables as there exist in our diet choices, and every decision we make in terms of our diet has ramifications of varying degree in our health. It’s a little less satisfying, but hey, welcome to health and nutrition. Any system that's been around millions and millions and millions of years (like our metabolisms, digestive systems, and enzyme processes) will have worked in some complicated machinery that responds to pretty subtle gradations in our environments. 

I don't want to suggest that macronutrients don't matter. Once we get a patient pretty dialed in on their nutrient intake and make sure they are actually eating real food at most meals, we turn back to macronutrients. A higher carb intake can enhance thyroid signaling, decrease cortisol levels, and help with weight gain, while a higher fat and protein diet can support weight loss. We might change the macronutrients eaten at different meals to maximize the metabolic process and help maintain energy levels through the day. Neither do I suggest that the Inuit could pack up their harpoons and sleds and ship off to stay with the Kitavans and not have a hard time on a drastically different macronutrient intake. In other words macronutrients are more of an individual question for you and not a smoking gun for the population at large. 

The next part in our seminar was where I shut the heck up about the macronutrients and finally got to some information that people might be able to actually use. We got talking about vitamins, minerals and micronutrients instead. In other words the rest of what's in our food that supports our life, besides just the macronutrients: fat, protein, and carbohydrate.

Vitamins were originally "discovered" in 1912. They were difficult to identify at first so they were named with just letters (C, A, E etc.) Until we were able to identify the actual chemical structure of each (Ascorbic acid, Carotene, and Tocopherol, respectively). Vitamins are "essential" for us meaning that our bodies don't make them sufficiently to support our functions. Minerals are also essential.

A lot of us say, "I get all my vitamins and minerals cause I take a vitamin." Unfortunately there are a lot of reasons why this approach is insufficient. It's much better to get your vitamins from food if you can. In order to illustrate this concept we talked about a few examples at the class. The first was folic acid (typically found in vitamins and "enriched" food) vs Folate (the natural form found in food from natural sources.) Folic acid and folate are not active in our bodies until they are converted to tetrahydrofolate. In the case of Folate this happens as it crosses the intestinal mucosa. In the case of folic acid from a vitamin, folic acid is absorbed, goes to the liver and is converted there by an enzyme called dihydrofolate reductase. In the meantime all this unconverted folic acid is swimming around in your body contributing to big C. Yep cancer. Increased rates of colon cancer correlate with increased intake of folic acid. That is until these people switch to folate and the cancer rates return to normal. The issue is this: Folic Acid is not found in natural food sources. Our bodies didn't get exposed to it till 1945 when they synthesized this in a laboratory. The dihydrofolate reductase enzyme has other things to stay busy with rather than fixing our vitamins so they don't kill us. The good news? Some vitamins made by companies with integrity do put folate rather than folic acid in their pills even though it's more expensive. We'll cover this issue a bit more in the upcoming class on choosing effective supplements. 

Another example of this issue we covered is Vitamin E. Looking at populations who consumed more vitamin E and also had lower rates of prostate cancer, researchers came to the reasonable conclusion that perhaps supplementing vitamin E would protect men against prostate cancer. They set out to study this by setting up a 12 year study. Instead of seeing the cancer rates decrease, they needed to stop their study early because it became obvious that the treatment group was developing more cases of prostate cancer than the control group. The problem with this study is that the type of Vitamin E used was the typical synthetic form found in most supplements (which is typically extracted from petroleum material). Vitamin E is the molecule Tocopherol. There are multiple forms of this molecule and the different forms are denoted with different greek letter prefixes. Alpha tocopherol is the type most commonly used in vitamins and in supplements. The type most prevalent in our diet is gamma tocopherol. Most alternative practitioners use mixed tocopherols, or vitamin E supplements high in gamma tocopherol when treating patients. Again the food source of this vitamin seems to prevent Prostate cancer, while the synthetic form seems to result in increased prostate cancer. 

So bottom line? Much better to get your vitamins and minerals from your food rather than from a multivitamin or a handfull of pills. There are of course exceptions where the food sources may be inadequate for specific people, that what our next seminar will cover. 

How do you ensure that the food that you are eating is higher in nutrients? Well you get real food coming from real sources. The one thing that was the same between the cultures we looked at was that they were eating a traditional diet, entirely devoid of processed and refined foods and ingredients. The food they were eating was high in nutrients. It was coming from natural and wild sources, or it was cultivated using traditional ethnic techniques rather than conventional industrial approaches. Their food was coming from an ecosystem. The food item they harvested was a link in a complex chain.  It supported and received support from a rich web of other organisms. This all results in more nutrients in the food they were eating. These nutrient include vitamins, minerals, phytonutrients, and even living organisms like bacteria. 

It isn't possible for us to get all of our foods from a natural environment. We've got jobs and families, and don't really have the time to be traipsing around picking mushrooms and hunting game. What we can do is choose to buy our foods from those farmers and ranchers that maintain a more natural environment for the food they're growing. Here's a diagram I found that illustrates this concept:

Notice that every waste product from one area in the farm sustains another area in the farm. The waste from the corn harvest is composted back into the soil, the manure from the livestock goes to supplying the nutrients for the growth of the grass and vegetables, the scraps could go to the chickens. In this case there is also an aquaculture, where a fish pond helps to recycle nutrients into food and support the rest of the farm. This is closer to a natural ecosystem, with each step relying on other steps adjacent. This ends up increasing the nutrients in the food obtained from this system because the nutrients are maintained in the system, recycled from step to step. The same magnesium, zinc, copper, and boron are incorporating in one organism then another, then another, and the food in turn obtained from this type of farming provides more of these same nutrients. In conventional farming practices the fertilizer is not recycled material from the farm, but industrial fertilizers that provide Nitrogen, Phosphorus, and Potassium, but not much else. (Think macronutrients for plants without any additional vitamins or minerals). As a result the plants pull the vitamins and minerals they need out of the soil to grow. The vitamins and minerals get shipped off in the crop yield and as a result the soil gets quickly depleted of these minerals and vitamins, meaning the crops get depleted of these vitamins and minerals. We end up getting the same looking vegetables, but with radically different nutritional benefits. Here's an illustration of how the above flow chart would look for more of an industrial, or Big Agriculture operation:

As you can see the trace minerals are depleted from the operation, The population eating this frankenfood ends up, to quote Maoshing Ni and Cathy McNease "overfed, but undernourished." Meaning, although they are getting more calories than they need, they aren't getting sufficient nutrition.

So the moral to this story is look for food grown in a traditional style ecosystem. Unfortunately, buying organic isn't necessarily enough. I know of amazing farmers that put out unbelievably nutritious food, but aren't considered "organic" (Polyface Farm comes to mind). As well as organic operations that operate much like the flow chart above, depleting their soil and bringing in organic, but no less stripped industrial style fertilizers. I get my eggs from a local farm, Abundantly Green. The chickens dig through the compost and are pastured, meaning they forage in the fields for bugs. The chicken's highly nitrogenous waste fertilizes the grass that in turn feeds the cows, and so on. That is a natural style ecosystem. Understanding that about their farm is more important to me than knowing if they are organic or not (which they happen to be). The eggs I get from their farm are rich, with amazingly bright colored yolks that turn my omeletes an incredible bright orange. The organic eggs I get from the store on the other hand, have pale, flat yolks, bland flavor and fragile shells. The difference is that the chickens at Abundantly Green live a life and eat a diet more in line with their evolution and result in better quality eggs. My recommendation would be t go find a local farm and get to know them. If the people that provide your food won't let you walk through their operation, that's a bad sign. See the chickens, ask questions, feel the grass. Get to know your food from its source, and health benefits will be dramatic.

Next we covered some super foods that I think everybody should make bigger parts of their diets. Some specific foods that I would recommend are:

Greens:
Kale, chard, collards, mustard greens, beet greens, etc. These are highly nutritious additions to a diet. They are high in Magnesium, iron, calcium, vitamin K, and fiber. Magnesium is deficient in the majority of the american population and deserves some serious attention. In addition the brassica family (kale, chard, brussel sprouts, broccoli, cauliflower, etc) has actions that speed up both phase I and phase II conjugation in the liver. This results in faster detoxification of environmental toxins, more tight regulation of hormone levels, and decreased long term oxidative damage from toxin build up. (read slower aging). The fact that they provide a good source of vitamin K is important as well. Vitamin K is involved in the clotting cascade as well as being a key factor in the proper utilization fo calcium. In the absence of sufficient Vitamin K and Vitamin D calcium can lay down in the arterial walls leading to increases arthersclerosis and cardiovascular risk.

Pastured Foods:
This refers to allowing animals that in nature would forage for their own food to follow their natural inclinations and eat their natural diet. Think cows out grazing in the grass, their natural food, being outdoors with space to move and eating their natural diet. The alternative is feedlot operations where the cows are kept in small enclosures without any growing grass anywhere nearby. The only topography provided comes from the piling up mounds of their manure. The food is trucked in and poured into troughs, and by the way comes from food sources that cows have never eaten in the history of the cow (such as corn, chicken parts, and ground bones.) Pastured food is more expensive but is well worth the price. Grass fed is another term that usually can be used interchangeably. Pastured is not the same as organic; pastured animals may or may not be organic, but are likely much better for you than animals raised in a feedlot setting under organic conditions. You can get pastured beef, chickens, eggs, milk, cheese, butter, and pork.

Raw Dairy:
Milk is not a terrible food. Even though dairy is a relatively recent introduction into our historical diet, genetic studies into different populations have established that some ethnicities are well adapted to consume dairy without any adverse effects. This is a personal question. If you have decided that you work well with dairy, and that your ethnic background makes you well suited to consume dairy (those from the northern european regions tend to have the highest incidence of persisting lactase production after infancy, and are best suited to continue consuming dairy into adulthood.) It is best to consume raw dairy. This preserves some important nutrients, by avoiding the pasteurization process. There was a landmark study called the "Gabriella study" which found that consuming raw dairy greatly decreased the incidence of asthma in youth. Part of the reason that raw dairy maintains healthy immune regulation is that it provides active probiotic cultures in the form of mainly Lactobacillus strains. It also provides a richer source of various vitamins and nutrients than does pasteurized milk. In fact raw, whole fat milk contains every known fat soluble vitamin. Check out the farm supplying your milk and make sure that you trust them and they take the process seriously.

Local Foods:
Eating local means choosing foods that have been grown in the local soil, shipped a minimum distance and in turn tend to be eaten soon after harvesting. This maintains the maximum nutrients in the food you choose. If you are eating foods that have been grown in Chile, shipped to florida, trucked across the country, kept on a palate in the refrigerated warehouse of a grocery store supplier for a few days and finally put on the shelf, you are missing out on significant nutrition. These fruits were picked before ripening, meaning that all the vitamins haven't had a chance to form. The fruits and vegetables have lost considerable amounts of vitamins through the shipping process. The fruits and vegetables have been bred to last on the shelf, often at the cost of nutrition and flavor. Also, when you eat local you are supporting the local economy, providing jobs for your kids, and for the neighbors kids, putting more money into the local government coffers and supporting the people you see at the bank and at the local chamber of commerce. It's a great thing to do for your health, your friends and the community.

Seasonal Foods:
There is a concept in Chinese Medicine, that each food represents a particular energetic state. Any biological system is also in an energetic state. By choosing the right foods at the right times you can bring any imbalances in your system back into balance. The foods that are available at different times of year, tend to align very well with the energetic landscapes we have in our bodies at any given time. Take for instance the fruits and vegetables of the summer: bright fruits, juicy, sweet. These are all of a cooling energetic nature. When the weather is warm this aligns well with your internal environment. When the weather cools off the fruits aren't growing anymore and we see more gourds, squash, and tubers coming out. These foods are heartier and align better with the cooling months of fall. In winter we traditionally eat more stews and stocks, broths, and meats. Just by eating the foods that are available and fresh at a given time of year you end up automatically staying in balance with the seasons and giving yur body just the type of foods it needs at that time of year.

Healthy Fats:
Fat has been chased enough by the lynch mob. Fats are not unhealthy foods. The source of fats you choose can make them either good for you or bad for you. The important thing is where they come from. Some healthy sources are: coconut oil-contains lauric acid a natural anti-inflammatory, consists of mainly medium chain triglycerdes, which absorb quickly and actually contribute to weight loss. Fish Oil-balances omega 3 and omega 6 ratios to decrease inflammation, lower cholesterol, improves cardiovascular health. Pastured fats-butter, grass fed beef, and pastured pork.

Proline and Glycine rich broths:
Proline and glycine are two amino acids responsible for the formation of collagen formation. These amino acids are also involved in the formation of the intestinal membrane. They are typically deficient in our diets as we don't consume a large amount of the types of tissues that are rich in these amino acids (cartilage, connective tissue, and epithelial tissues). In order to remedy this a great step you can take is making a glycine and proline rich broth from the large joint bones of cow and pigs. It's easy to throw a few in a crock pot and cook it slowly over several days. The benefits on your health after a few weeks of consumption will be obvious, including healthier skin, decreased joint pain, better digestion, improved mood (often), and healthier hair.

Bacterial Support:

Our food supply is overly hygienic. Pasteurized milk, antibiotics in our meat and dairy, and processed food all lead to a less robust bacterial presence in our colons. Our colony of bacteria (termed our microbiota) constitutes a lotal of over 10 times more cells than we have human cells in our bodies. It contributes immune regulation, assistance in breaking down and digesting different food items, as well as absorption of minerals and vitamins. In short, it's important. 

Ideal foods: Jerusalem artichokes, onions, garlic, green bananas, cultured foods (sauerkraut, kimchee).

The big picture here is summed up by a short phrase: "eat close to the ground".

The common trend here is the more steps your food takes before getting onto your plate the worse for you. As a result we have food-like substances that our grandmothers would never recognize as food. Processing, storage, transport, manufacturing, or unnatural cultivation methods all represent food that is further from the ground when you eat it, and typically less nutritious. Minimize steps between harvest and plate in order to reap maximum benefit from your food. 

Thanks for everyone who made it to our class. If you had questions that didn't get answered feel free to add those to the comment section below. 

Steps to minimize damage from freshwater blue green algae toxins

I went out on a friend's boat yesterday, for some beautiful fun in the sun. There was a sign at the dock stating that the lake was experiencing a bloom of the neurotoxin producing freshwater cyanobacteria, but there were a lot of other wakeboarders out there and some kids swimming. Like the rest of them it didn't stop me, but it was on my mind the entire day, as I was trying not to swallow any water. Then later I took a really nasty knock. Our boat driver took a hard turn at high speed. He's a pretty good driver, and has been around boats a long time, so I felt pretty safe. He also has a jet boat so he can pretty much floor it to 50 mph and turn as hard as he can and the boat will spin gracefully across the water. Not this time. There was a wake that met us and stopped us in our tracks heading sideways. I was in a seat without support from the side and I headed face first into the opposite gunnel. Not sure how I ended up on the floor of the boat, but my friends said it looked like a car accident impact. I had now introduced the second oxidative stress on my body of a major trauma and had new found concern over the state of my neurological function. So when I woke this morning to the stiffness and aches from a fun day, I started looking around online. 

The Kitsap Public Health District issued a warning regarding Kitsap lake due to the proliferation of blue-green algae. They produce a toxin called b-N-methylamino alanine. It is a chemical created by the algae as a byproduct of metabolism and as a protection against excessive consumption by animals. It causes damage in people by affecting a particular structure in nerve tissue, resulting in excessive accumulation of glutamate. It results in oxidative damage as well, meaning that it depletes the body's natural anti-oxidative processes. It has been implicated in the development of neurological disorders including Lou Gehrig's disease and alzheimer's disease. For instance in Guam the factors of climate, and the ecosystem dynamics result in BMAA (b-N-methylamino alanine) being concentrated in the inhabitants, and there is a correlating increase in ALS (Lou Gerhig's disease) in that population. Other studies have found an increased concentration of this non-proteinogenic amino acid in the brains of those with alzheimer's disease and parkinson's disease. 

While it is possible that I won't feel any negative effects from this, I have a significant family history of neurological decline with aging and would like to keep my wits as long as possible. I know I took more than a few forceful injections of lake water down my throat and up my nose. So I started doing some research and settled on some steps I'm going to take. If anybody out there experiences similar exposures this might help you guide your choices as well.  

I'm going to go dose up on Alpha Lipoic Acid (600 mg per day for a week) (an antioxidant that is able t cross the blod brain barrier). I can't get a link to this article in the full text, but here's a snippet:

"The metabolic antioxidant α-lipoate (thioctic acid, 1,2-dithiolane-3-pentanoic acid; 1,2-dithiolane-3 valeric acid; and 6,8-dithiooctanoic acid) is absorbed from the diet and crosses the BBB. It is taken up and reduced in cells and tissues to dihydrolipoate, which is exported to the extracellular medium. Hence, protection is afforded to both intracellular and extracellular environments. Both α-lipoate and especially dihydrolipoate are potent antioxidants. For example α-lipoate was shown to scavenge hydroxyl radicals, singlet oxygen, and nitric oxide. In addition, α-lipoate chelates a number of transition metals, regenerates through redox cycling of other antioxidants (such as vitamin C and vitamin E), and raises intracellular levels of glutathione (Packer et al., 1997)."

Gilgun-Sherki et. al."Oxidative stress induced neurodegenerative diseases: the need for antioxidants that cross the blood brain barrier", Neuropharmacology (2001)

I'm gonna decrease my carbohydrate intake (low carb diets, by inducing a ketogenic state are protective against neurological damage). 

Dose up on Vitamin C (it penetrates the BBB (blood brain barrier). It will have synergistic benefits with alpha lipoic acid, and helps with collagen formation (which thanks to a bit of a bump I took, I might benefit from as well). 

I'm taking NAC (n-Acetyl Cysteine). Which will enhance glutathione production, the body's main antioxidant. 

Lastly, I'm taking spirulina, another type of blue green algae without the toxic b-N-methylamino alanine farts. Spirulina is one supplement of many that people may choose when trying to detoxify specific compounds out of their bodies. The reason I choose spirulina is that there is a law in alternative medicine called the law of similarities or "like treats like." Spirulina, by virtue of its class as an algae acts on metabolic pathways that I think will be more advantageous to the clearing of BMAA from my body than some of the other choices. 

Hoping that nobody needs this info, but if you do. Hopefully this can support some of your choices. 

Man-O-Pause

Male menopause is no joke. Ladies, seriously don't joke about it. We're sensitive.

Thank you everybody for making it to my seminar on male menopause on Tuesday the 17th. As promised I've put together the notes from the class here for your reference.

First, we covered the basic cause of male menopause. As we age the Leydig cells in the testes make less and less testosterone. The result is that as men age they start to demonstrate symptoms associated with a decrease in male testosterone activity. To make matters worse the numbers of Sex Hormone Binding Globulins (SHBG) also increases with age. The SHBGs bind to testosterone in our blood stream and make it inactive. Only after it cleaves off of this carrier protein is it able to perform all the manly binding and stimulating that testosterone is responsible for in our bodies.

So we end up with this double whammy of lower testosterone and less of that testosterone able to be active in our blood. How does this show up in terms of symptoms? Well, I'm glad you asked. There are a lot of important things that testosterone does in our bodies, and the problems presenting when testosterone get low run the gamut from emotional, to physical to everywhere in between. Lower energy, and decreased muscle mass are the main physical manifestations. The mental manifestations include slower cognition, poor memory, and less focus. The emotional changes can include depression, anxiety, and a less competitive attitude. A lot more men out there these days are making use of testosterone replacement therapies than had in previous decades. The increase is likely due to a number of factors which we'll get into deeper below.

But first, what can be done about this? Well, as I covered in the class there are three main areas that we can work with to influence hormone production and synthesis: diet, lifestyle, and supplements.

When we look at diet, first we want to think about where our hormones come from. Here's a brutally oversimplified figure depicting hormone synthesis: (for the whole enchilada check out this great chart).

So we start with cholesterol. That requires  that our diet is sufficient in healthy fats to make this all-important hormone precursor. The cholesterol gets converted to pregnenolone, and then from there takes a stroll down different paths to arrive at its final product like a sex hormone or a stress hormone. But the important part for now is that all of these hormones begin as cholesterol. 

The first step to establishing healthy testosterone levels then is to ensure that healthy fats are coming in. This has played out in the work of a California nutritionist named Kim Schuette, recently featured as a speaker in the Real Food Summit. Kim has done some amazing work on patients with erectile dysfunction. The amazing part is that she did this through dietary changes. This involved a diet structured around traditional fats like butter from pastured cows (pastured means cows raised eating grass rather than grains), cod liver oil (which you can pick up here) and the elimination of grains and processed food. Not a bad gig being able to reverse erectile dysfunction through diet alone. Kinda speaks about how far we've come from a healthy natural diet. The troubling thing about all this is that these poor guys were actually told by the authorities that they were on the best diet possible. They were told by the powers that be, including the USDA and the Surgeon General, that saturated fats and cholesterol in our diets were causing heart attacks and strokes and that we need to eat little or no saturated fat to be healthy. Take a look at my establishing accurate cardiovascular risk post to get the whole picture on this issue, but there is a lot more going on than fats, and outlawing an entire macronutrient type from our diet is dangerous for our health, and kinda not smart. So the message is: eat healthy fats including: grass fed beef, pastured eggs, cold water fish, cod liver oil, coconut oil, and butter and milk from pastured cows.

Other ways we can tweak our diets to get the best results in terms of testosterone levels? Well, the next thing to think about is the aromatase inhibitor. This is where my earlier picture of hormone synthesis shows itself to be woefully inadequate. Here's a better illustration: (note the aromatase between testosterone and estrogen.) 

Aromatase is an enzyme that converts testosterone into estrogen. It makes sense then that if this enzyme is really active then there will be more estrogen and less testosterone in your blood. So you can inhibit this enzyme and end up with the opposite scenario in place. Luckily, there are several things in our environments, and in our diets that do exactly that. 

Here's are the main foods we talked about: the brassicas (cabbage, kale, chard, brussel sprouts), red wine and olive oil, and oysters. Also white button mushrooms contain phenols that effectively inhibit the aromatase enzyme. These are general guidelines, there are other foods that have this same effect, but these were the foods that I found the best support for their activity.

These are foods to eat, are there also foods to avoid? Yes. There are a number of foods that have phytoestrogens in them. These are chemicals that look similar enough to estrogen that they actually stimulate estrogen receptors in the body and result in the effects that having more estrogen would cause. A few of these foods are: soy products, yams, flax seeds, oats, beans, lentils, and whole grains. Obviously a lot of these are healthy foods and entirely eliminating them from your diet may not be necessary. Rather, if you are struggling with testosterone issues, don't make these foods main staples in your diet. Instead make them periodic parts of your rounded diet (that is also rich in healthy sources of healthy fats.)

There are also estrogen-like chemicals in some not so nice places. These are mainly the result of industrial processing, or artificial ingredients added as stabilizers, emulsifiers, and preservatives to cosmetics, foods supplements, and even some foods. Whenever choosing lotions, sunscreen cosmetics or supplements make sure that there are no pthalates, parabens, or BPAs present in these items. Parabens are mainly found in cosmetics, lotions, and soaps. The pthalates are found in these same products as well as often being incorporated into the outer coating on supplements, vitamins and prescription medications. Everybody is probably familiar with BPA aka Bisphenol-A by now. This is a plasticizer that is often used with food packaging. It is ubiquitous in the food world: soup cans, juice cans, soda cans, water bottles, plastic packaging, clamshells, even baby bottles used to contain BPA. This is most easily avoided by eating real food. The more a food is processed the more packaging it will have around it, the more likely it is that BPA is in the packaging and in the food. Eat foods that don't require as much packaging, like fresh fruits and vegetables, meats, eggs, cheese, and if you eat beans get them as dried beans and soak them rather than buying a can of them. Buy the ingredients and make the soup rather than buying a can of soup. There was a study fairly recently at Harvard where they subjected students in the cafeteria to either canned soup or homemade soup for a week and checked the BPA levels in the 2 sets of subject, those fed the canned soup had over 1,000% higher levels of BPA (yes that was 3 zeros, one thousand percent higher). The BPA absolutely makes it into our bodies, and it absolutely causes endocrine disruption. 

That pretty much wraps up the diet section. Next lets talk about lifestyle. In order to maintain a healthy testosterone levels the most important thing in terms of lifestyle is to chill out. Here's that diagram again:

Notice that cortisol sits at the end of a different pathway than testosterone? That's important. Cortisol is the body's main stress hormone and anytime we are under a great deal of stress our production of Cortisol gets ramped up. Pregnenolone is the raw material that gets used to make both of these hormones. The more that goes to making cortisol, the less is available to make testosterone. We end up making a lot less testosterone. So when we get heavily stressed we see our testosterone levels plummet. Now in the short term, such as with acute stress like a physical danger, that type of stress stimulus can be a good thing and can actually result in higher levels of testosterone down the road. It is the type of chronic stress that is more common in our culture that is the real problem. When stress occurs in short bursts with an obvious end, that stress becomes a force that makes us stronger and teaches us new things. Because it is so short lived it doesn't significantly influence our sex hormone synthesis. When we have the kind of stress that comes from a job we don't like or from financial woes, or relationships, we end up with stress that endures for much longer than intended. Testosterone levels are effected. So a great step to take in order to improve testosterone levels is to find some type of a relaxation routine you can fit into your day, and stick to it regularly. A great example would be finding 15 minutes in the morning and sitting comfortably and trying to do nothing. Deep breathing is an instant and easily available activity that has been found to lower cortisol levels. Whatever you are into, use that as a means to reduce your chronic stress level. Other important steps you can take to lower your cortisol levels are: get adequate sleep, get sufficient micronutrients (an unhealthy diet is a source of chronic inflammation and that inflammation results in higher cortisol levels), avoid excessive training (don't forget to take rest days), reduce inflammation in general (Reduce your exposure to the constant sources of low level inflammation. A good example is the ridiculously uncomfortable high heels that women feel they need to wear. The constant friction and discomfort, besides being a mental stressor, are also a source of physical inflammation, resulting in higher cortisol levels as well.)

Strength resistance training is another important step to take in order to increase testosterone levels. Numerous studies have found that resistance strength training increases the testosterone levels in men and women, as well as decreases the cortisol levels in as short as 4 weeks. 

Taking part in competitive play can also boost testosterone levels. One study confirm this by pitting subjects against one another in a number game where they compete for time. The winning participant had higher recorded testosterone levels after the game. The degree to which losing a competitive game might decrease testosterone levels isn't clear. This study also found that when the game was preceded by a visualization exercise that involved seeing oneself win the game, that the testosterone levels were increased more significantly. The take home message is to set goals that you can attain, visualize succeeding in attaining them and then go do it. 

We also talked about supplements that can be taken to increase testosterone levels. 

Healthy Fats: Get on some healthy fats: fish oil, or cod liver oil (I'd recommend fermented cod liver oil from green pastures). Look for about 1,000 mg of fish oil per day. Pastured butter and dairy are other good options.

Vitamin D3: Vitamin D supplementation (in those that truly are deficient) is likely to increase testosterone levels. Ensure through blood testing that indeed your levels are low before supplementing. There are Vitamin D receptors on many of our organs and tissues and the reproductive tissues are no exception. I recommend 1,000-4,000 iu per day until blood levels of vitamin D3 have reached optimal level.

Natural Aromatase Inhibitors: There are a number of supplements that have been found to, or are suspected to inhibit the aromatase enzyme, thereby slowing the conversion of testosterone to estrogen. One of these is Chrysin. Make sure that you get a supplement that pairs it with Piperine in order to enhance the absorption. Look for a  dosage around 2gms per day. Another aromatase inhibitor is grape seed extract. It also is a potent antioxidant and has been found to have some great anti-cancer actions. So not a bad one to add to the cabinet. Look for about 50-200mg/day. 

Chines Herbs: There are a number of Chinese Herbs that have been shown to increase testosterone levels. The three that we talked about are: Bai Ji Li, Yin Yang Huo, and Wu Jia Pi. These are all herbs that are considered to be of a warm temperature energetically, and have particular affinity to the organ systems kidney and liver in Chinese Medicine. This indicates that these herbs would be beneficial for treatment of the symptoms associated with low testosterone levels. Studies examining the effect these herbs have on testosterone levels later showed that indeed these herbs do increase testosterone levels in subjects. It is best to get these herbs the way they are prescribed in traditional chinese medicine, that is paired with approriate balancing herbs, within a carefully crafted herbal formula. When Chinese Herbs are prescribed by a trained Chinese Herbalist they rarely are given without taking part in a complete formula of several herbs. This ensures that any possible side effects are avoided, absorption is optimized and the effects of the formula are balanced and comfortable for the patient. Seek out a knowledgeable practitioner for your herbs. In this way you can also be sure that you are receiving a quality product that is free of toxins, heavy metals, and adulterants. 

So that's pretty much all we covered: get your diet right, chill the heck out on a daily basis, look for some good supplements and utilize some mental visualization exercises. Thanks again everybody that made it out for it. 

Establishing Accurate Cardiovascular Risk

Thanks to everyone that made it to my Cardiovascular health seminar on June 19th. This was part of our wellness workshops that we do every other tuesday at our clinic. As promised I've posted the information from the talk here. It was a bit bio-chemistry heavy, so even if you were at the class, it isn't a bad idea to go through the information again in case it didn't all stick the first time.

None of this information came directly from me, and rather is sourced from a lot of people that I really respect, including Chris Masterjohn, Chris Kresser, and the authors of dozens of published medical studies.

Basically our talk covered the real causes of cardiovascular disease. We have, as a culture, hanged our blame for cardiovascular disease on Cholesterol since a number of studies were incorrectly interpreted, or outright misrepresented to show that higher cholesterol levels cause heart attack and artherosclerosis.

Initial studies into artherosclerosis used rabbit models and found that injected cholesterol did not cause any artherosclerosis, but feeding rabbits cholesterol did cause artherosclerosis. What this means is that it is the introduction into the blood stream from the digestive system that becomes the crucial factor to creating the artherosclerotic plaques. This factor is something called a lipoprotein. These are the vehicles that carry cholesterol through the blood. The last L in HDL and LDL refers to this lipoprotein.

It works like this: cholesterol is fat soluble, which means it cannot be dissolved in blood (which is water based). In order to move through the blood it needs to be carried in a lipoprotein. A lipoprotein is the vessel that delivers cholesterol to the cells, brain and areas of the body that need it. Coincidentally it's also how fat soluble vitamins are carried through the blood.

We have this idea that cholesterol is bad in any quantities and the lower we can get our number the better. But in fact cholesterol is a vital part of proper body function, and does multiple important things including: sex hormone synthesis, stress hormone synthesis, cell membrane integrity, proper brain function, proper eye function, nerve conduction, development, bile creation, fat soluble vitamin absorption, and several studies are finding that adequate cholesterol levels have a protective effect against mental and emotional disorders.

If the cholesterol isn't the problem, what is? The lipoproteins that carry the cholesterol through the body are capable of oxidizing (or becoming denatured, or molecularly malformed). This oxidation creates a molecule that can penetrate through the inner most layer of the arteries, and once embedded in the arterial walls, can attract immune cells to cause inflammation, the result being the formation of an artherosclerotic plaque. If the LDL is not oxidized, studies indicate that even if they do penetrate into the vessel wall they will not attract the immune cells that ultimately result in an artherosclerotic plaque.

The body tries to protect against the oxidation of these Lipoproteins by packaging them with antioxidants when they are created. When the liver packages cholesterol and sends it out into the blood stream it includes Vitamin E and Coenzyme Q10, both of which are powerful antioxidants and protect the lipoproteins from oxidation. One reason that LDL is associated more highly with artherosclerosis than HDL is that the LDL cholesterol is packaged with less vitamin E than HDL. This extra Vitamin E is able to protect the HDL from oxidation more so that the HDL cholesterol isn't likely to penetrate into the vessel lining and cause the aggregation of immune cells.

The real fallacy of the current cholesterol testing is the thought that it is the total amount of cholesterol in the blood that causes the problem. What we're finding out is that it isn't the amount of cholesterol as much as it is the number of lipoproteins. The more LDL lipoproteins in the blood the more capacity for oxidative damage. It's like carpooling. If there are 400 people on the highway with you and they're all in their own individual cars, there are a lot of cars, and probably some snarled traffic. If on the other hand that same number of people are all carpooling and rather than 400 cars there are 9 buses, 15 vans and 10 cars, then there are only 34 vehicles rather than 400. Much less traffic, much less road rage. The same thing goes for cholesterol. If your LDL cholesterol is 100 and your particle size is very small, then you have a lot of vehicles on the road and more chances for oxidation. On the other hand if you have a lot of large fluffy particles (everybody's carpooling) then your chances of these LDLs oxidizing is much less. Another way to think of it is imagine you are in a room with balloons (LDL particles) all over the floor. You put on spiked shoes, are blindfolded and have to walk across the room trying not to step on and pop any balloons (you are now oxidative damage). The same amount of air has to be used to fill the balloons in the room, but you can use as many or as few balloons as you like. You would choose to fill only a few balloons really full, then you will have less chances of stepping on a balloon. If you fill a lot of balloons only partially full then you are more likely to step on a balloon with every step, you'll have more popping. So the ideal with LDL is to have fewer particles, that are large, rather than lots that are small. In fact this particle size is much more important than the total amount of LDL cholesterol these lipoproteins carry.

Another factor to consider is what makes up the lipoproteins. If the problems start when these LDL particles oxidize, then the question becomes: can we make them more stable and keep them from oxidizing? The answer fortunately is, yes. Lipoproteins are made from polyunsaturated fatty acids. These are inherently unstable fats, so we want to make sure we get them from good sources and don't over consume them. The industrial seed oils typically used in America for cooking are actually already oxidized because of the heat needed to extract them. Using only cold pressed, or extra virgin oils reduces the pre-oxidation of these fats so that when they are used to construct the Lipoprotein membranes they are already much more stable.

The last factor to consider is the antioxidant capacity of both our lipoproteins and our blood. Our antioxidant capacity is a relative thing. We begin with our background level of inflammation. This is a result of the amount of stress, injury, toxins, our metabolic rate and unhealthy nutritional ingredients. Then that background inflammation is measured against our antioxidant level (a function of the antioxidants we take in and the antioxidants that our bodies manufacture (like glutathione, superoxide dismutase and coenzyme Q10). We may be more than covering our inflammation with our antioxidant level if we are eating a healthy and nutrient rich diet, or we may be coming in way under par if we are frequenting fast food and consuming junk food. The more our antioxidant deficit the more these Lipoproteins will oxidize and lead to artherosclerosis and heart disease. 

We also need to protect our endothelium. Remember the oxidized LDL need to actually penetrate into our endothelium in order to initiate the formation of arthersclerotic plaques. We can prevent this by improving the integrity of our endothelium. How do we do this? Something called shear stress. Shear stress is a term in physics referring to stress occurring parallel to a surface, or in terms of fluid dynamics in a laminar flow to the walls. In blood vessels we see that the areas with the greatest shear stress have the least incidence of artherosclerosis and the areas with the least have the greatest incidence of artherosclerosis. Shear stress causes the endothelial cells to get busy protecting the vessel walls by improving collagen synthesis, organizing cells in a more protective formation, causing dilation of the vessel and increasing the blood flow through the region. We can increase our shear stress in our vessels simply enough, by getting some exercise. (And we can help this proces along by making sure we are getting adequate vitamin C in our diets as Vitamin C is an important cofactor in the formation of collagen)


So, are there tests that can give us a true evaluation of our true cardiovascular risk? Yes, here are the tests that I recommended and in fact we can order these tests directly through our office. 


LDL particle size
This can be measured by various labs, the testing methods include the VAP (vertical auto profile), the NMR (nuclear magnetic resonance) and a few types of electrophoresis testing. These tests are inexpensive and are often covered by insurance.

Apo B/A1
This tests the actual number of particles. Apo B refers to apolipoprotein B which is a protein found on the surface of LDL particles. There is only one of these proteins per particle so looking at the count of Apo B will tell you how many LDL you have in the blood, or how many cars on the road. The Apo A1 tells you how many HDL you have, as there is one and only one Apo A1per HDL particle. Recent studies seem to indicate that it is the ratio of the two that indicates most reliably the cardiovascular risk.

HsCRP
The High Sensitivity C-Reactive Protein is an indicator of the amount of inflammation in the blood. This is a useful marker as it will indicate the tendency for the LDL particles to oxidize, and as we know it is the oxidized particles that really pose the most risk in terms of cardiovascular risk.

Just to recap:
1. Get accurate testing...see above.

2. Reduce the chances of oxidation: ensure adequate antioxidant capacity by reducing your oxidative risk (stress, food and environmental toxins, general physical damage, metabolic activity-ie excessive calories, industrial seed oils, unhealthy omega 3:6 ratio) and increasing your antioxidant activity (eats your fresh greens and fruits, grass fed meats, organ meats, and eliminate nutrient poor and calorie dense foods)

3. Improve endothelial integrity: get moving!

Thanks for reading, and thanks all those who made it to this seminar!
Kieran

PS: here's a letter you can bring to your doctor requesting more accurate testing:

Establishing Accurate Cardiovascular Risk 

The typical measures used to evaluate a person’s risk of experiencing a heart attack or stroke, or other disease risk associated with Atherosclerosis are the LDL (low density lipoprotein), HDL (high density lipoprotein), VLDL (very low density lipoprotein), particle size (the smaller, denser the LDL the worse), the total cholesterol (the added together LDL and HDL), blood pressure, and triglycerides. 

While these measures are valuable, newer research is showing that there are other measures that more accurately indicate cardiovascular risk. 

Apo B/A1

Apo B-Apolipoprotein B is a measure of the artherogenic particles (particles that cause artherosclerosis found in LDL and VLDL cholesterol). The best measure of this test uses it as a ratio measured against apolipoprotein A-1 (a protein found in HDL cholesterol), an ideal ratio yields a lower number. In the medical journal “Nutrition, Metabolism, and Cardiovascular Disease” Schianca et al established 0.9 as the upper safe ratio for males, and 0.8 for females. A clear cut off is difficult to establish and many would argue that the idea of a clear number at which absolute health risk is established is a result of flawed logic and rather the relative risk of CV event increases with an increased Apob/ApoA-1 ratio and needs to be weighed with other signs of risk such as those below.

HsCRP

High Sensitivity C reactive protein is a marker of inflammation. 2 concurrent readings 2 weeks apart should be done for best accuracy. A HsCRP less than 2 mg/L demonstrates the lowest risk factor. 

LDL particle size

Established through Vertical Auto Profile, Electrophoresis, or Nuclear Magnetic Resonance, this identifies patients as either pattern A or B in regards to their LDL particle size. Our understanding of lipid metabolism would indicate that the smaller, denser particles have spent more time in circulation and would therefore have accumulated more oxidative damage, resulting in more artherogenic capacity. 

Conclusion

The problem with current cholesterol testing is that it fails to measure the ability of that cholesterol to cause damage. Cholesterol is an essential part of a healthy functioning body. The amount of cholesterol in the body isn’t the issue as much as the ability of that cholesterol to oxidize. The likelihood of the cholesterol to oxidize is a function of the anti-oxidative capacity of the body, and the overall level of inflammation in the body. Drugs to reduce total cholesterol fail to fully address this issue. This end is better served by ensuring the body has adequate anti-oxidative capacity through healthy diet, relaxation, and in some people supplementation. CoQ10 and Alpha Lipoic Acid are 2 potent antioxidants that assist in the fat soluble tissue. Amino acid supplementation can also help by promoting the production of glutathione, the body’s antioxidant powerhouse. N-acetyl Cysteine is a great start for this. Lastly, milk thistle increases the generation of glutathione by optimizing liver function. 

Kieran Jones L.Ac. Advanced Wellness and Rehabilitation