On the medical front . . .

I had some follow-up blood work done in early January and spoke with my "vitality and longevity" doctor about the results.

Good news: my cholesterol numbers are great. The standard LDL/HDL ratio put me at half the normal risk for cardiac disease--about an eighth of what it was last August.

The number of cholesterol-carrying molecules is down to almost half of what it was last August. But last August I was at very nearly double what my doctor told me was high acceptable. . . . So though I'm close to being at the high acceptable range, I'm not "even" quite there. Wonderful progress, but he wants the number of molecules per deciliter of blood reduced still further.

Most worrying: my fasting blood sugar level has risen even higher than it was (and it was already at the upper edge of acceptable). . . . I'm not sure if my numbers (blood glucose and HgbA1c--glycosylated hemoglobin) place me in the range of pre-diabetic, but they are certainly not optimal.

But my doctor told me he believes part of the reason my blood sugar is off is because of some of the things he is having me take for my cholesterol: specifically, the large quantity of Niacin and, if I recall accurately, Vitamin D as well.

So to drive my cholesterol down even further, he has upped my dose of Simvastatin to 30mg a day (50% more than I was taking), and he's pushing me to cut back on my carbs even more.

I was pleased, two weeks ago, to read in our local paper what Dr. Andrew Weil had to say about cholesterol. He confirmed much of what my "vitality and longevity" doctor was saying about the size and number of cholestorol-carrying particles:

You may not know that LDL ("bad") cholesterol comes in two main forms -- small, dense particles and large, fluffy ones. [Stephen R.] Devries[, director of the Integrative Program for Heart Disease Prevention at the University of Illinois at Chicago and author of What Your Doctor May Not Tell You About Cholesterol,] explains that the small [cholesterol particles] are the dangerous ones: Because of their size, they're much more likely to get stuck in coronary arteries while the big, fluffy ones roll on through. The size of your LDL particles has a strong genetic basis.

This all sounds right. It accords with what my "vitality and longevity" doctor was telling me (though it is totally outside the knowledge of my regular, insurance-covered doctor).

However, Weil goes on to say,

If your LDL particles are small, Devries says you can change their size and number with simple lifestyle changes including weight control, a low-glycemic-index diet (www.glycemicindex.com), fish oil supplements and regular exercise.

I find that harder to believe . . . primarily because, while the number of particles in my blood has decreased dramatically under the regimen my doctor has given me--a regimen that, I would say, is not "simple" and includes far more than mere "lifestyle changes" (i.e., it includes statins)--the size of my cholesterol particles has hardly budged. And I have made the lifestyle changes . . . plus taken the additional steps. . . .

To top it all off, I get reports like this one I just read this morning (from Dr. Russell Blaylock's The Blaylock Wellness Report:

Statins Found to Increase Cancer Risk

A new 41,000-patient study reported in the Journal of the American College of Cardiology
found that taking statins to lower LDL-cholesterol was associated with a significant increase in cancer risk. Researchers were not certain if the increase was due to the dramatic lowering of the LDL-cholesterol or to taking statins.

My studies indicate both may be at fault. We know that statins significantly impair the immune system and that immune surveillance, a system whereby the body’s immune system continuously scans the body for newly appearing nests of cancer cells, is also impaired.

Great!

And my mom didn't die at 55 from heart disease; she died from cancer. Of course, her brother died at a relatively young age (not as young as she was, but still relatively young) from heart disease. But she didn't. And my dad is still alive. And heart disease hardly looks as if it's going to be the problem that "does him in."

. . . So I begin to wonder: What should I do?

Kind of the "same old" questions I keep running into with respect to theology: Whom does one believe? Everyone seems to focus on a different issue. . . .

Oh. And then this last note that our paper printed last week:

Vitamins don't prevent disease, new study says

. . . The eight-year study of 161,808 postmenopausal women echoes recent disappointing vitamin studies in men.

Millions of Americans spend billions of dollars on vitamins to boost their health. Research has focused on cancer and heart disease in particular because of evidence that diets full of vitamin-rich foods might protect against those illnesses. But that evidence doesn't necessarily mean pills are a good substitute. . . .

The study appeared in Monday's Archives of Internal Medicine. Co-author Dr. JoAnn Manson said that despite the disappointing results, the research doesn't mean multivitamins are useless. The data is observational, not the most rigorous scientific research. And it's not clear if taking vitamins might help prevent cancers that take years to develop, said Manson, chief of preventive medicine at Harvard's Brigham & Women's Hospital.

You can find a few more scraps of data on the subject in the original article.

More bad news on the medical front

After getting the news I did on Tuesday about my eyesight, I decided I should share the worst of my blood work numbers with my primary care physician (PCP) at Kaiser. Funny: in the midst of a brief back-and-forth with my PCP, I received another letter from Dr. Leonardi.

First, my correspondence with my PCP.

Dr C______:

I went "out of plan" to get some very detailed analytic work done by Dr. David Leonardi of the "Leonardi Executive Health Institute."

I thought you should see at least some of the results (most particularly, those that are "out of range" or near out-of-range). So here are what I sense are the more salient numbers from a 6/18/08 blood draw after a 12-hour fast with [testing norms] and, where available or different, [/optimal numbers]:

Glucose - 97 [65-95/<90]

Hemoglobin A1C - 5.4 [3.5-5.1]

Insulin - 6 [1-5]

Cholesterol - 209 [0-200]

Triglycerides - 153 [0-100]

Cholesterol, HDL - 44 [50-200]

Cholesterol, LDL, calculated - 134 [0-100/<70]

Coronary Risk Ratio - 4.8 [1-3.5/<3.0]

Cholesterol, VLDL - 31 [4-40]

WBC w/ Differential & Platelet - MCH - 33.2 [27-33]

Testosterone, Total - 441 [750-1100]

Testosterone, Free - 54.6 [90-130]

Estradiol, High-Sensitivity - <2 [10-40]

DHEA Sulfate - 143 [350-500]

Cortisol, AM - 6.8 [8-18]

IGF-BP3 - 5.8 [2-4]

TSH - 0.08 [0.3-2.0; T-3 & T-4 were normal]

Results from 8/6/08 blood draw after 12-hour fast:

LDL Particle # - 1942 [<1000]

LDL Particle Size - 20.0 [>20.5]

Small LDL Particle # - 1581 [<600]

Large HDL Particle # - 6.6 [>6.6]

Vitamin D - 25.0 [>50]

His response:

Well, they look okay. . . . [T]hey all look pretty good.

On our scale, your testosterone of 441 would be normal.

The particle sizes I don't know what to do with. That's not normally a test I run.

You have quite a bit of hormone deficiency but as they stand I'm not sure of the significance.

We could refer you to an endocrinologist and they could address all of those issues if you like.

The A1C is a tad high but that is not a good screening test and anything less than 6 is still normal.

The cholesterol is borderline high but I still wouldn't treat it with medications.

We could get you some testosterone injections and see what happens. It might fix a few of the other hormonal abnormalities.

Let me know what you want to do.

On the one side, I was astonished he was willing--and, apparently, Kaiser-Permanente would be willing--to even consider dealing with the testosterone issue. But to compare his comments to Dr. Leonardi's is . . . almost . . . distressing.

When we met three and a half weeks ago, Dr. Leonardi made a big deal about what he called "glycation"--a process by which sugar molecules become bonded to proteins in the body and create AGEs--Advanced Glycation End-products--the cause of many age-related chronic diseases, specifically type II diabetes, cardiovascular disease, Alzheimer's disease, cancer, peripheral neuropathy, deafness, blindness . . . and more.

As he put it,

No one dies of old age. Aging is the development of degenerative disease (heart disease, cancer, dementia (Alzheimer's and vascular), stroke, Parkinson's disease, diabetes, osteoporosis, and osteoarthritis, in particular).

And we now know what causes these things. The disease biochemical pathways have been mapped. We now have biomarkers that measure the disease pathways and to demonstrate the effect of our diet and activities on them. Put another way, we know what accelerates and retards--or even reverses--our progress down the path of degenerative diseases.

Much of what promotes disease, we do to ourselves.

What accelerates aging? According to Leonardi,

• Oxidative stress
  
   
• Glycation
  
   
• Inflammation
  
   
• Declining levels of vital hormones
  
   
• Dyslipoproteinemia (unhealthy patterns of serum proteins carrying fats & cholesterol)
  
   
• Acidic nutrition [Not necessarily referring to foods that are acidic within themselves--for example, oranges. Rather, acidic nutrition refers to foods that cause the body to produce acids so that its own pH balance moves to the acidic side].

Leonardi showed me how each and every one of these six factors interacts with the others to accelerate degeneration. And then he discussed how, by taking specific actions against these factors, one can retard and potentially, even, reverse their effects.

Though I found "new revelations" in each of these areas, for me, the biggest revelations had to do with glycation and hormones . . . with particular emphasis on glycation . . . because I can so readily affect it by what I eat.

Glycation occurs when "extra" sugar molecules randomly bump into proteins and form AGEs. --That's what an AGE is: a mass of proteins gunked up/stuck together by sugars. . . . High blood sugar levels (caused by intake of high-sugar--or, more accurately, high glycemic index/glycemic load--foods . . . from soda pop to cakes, mashed potatoes to bread, chips to cereals, and rice, corn, peas, bananas and grapes!) increase the probability that sugar molecules will bump into proteins and cause AGEs. So the thing I need to do, said Leonardi, is to maintain a low blood sugar level.

Hemoglobin A1C (HbA1C), said Dr. Leonardi, is the best way to measure average blood sugar levels over a long period (the past 60 days). It is, he said, a "direct measure of AGE formation."

The "normal" HbA1C level is 4.3 to 5.9 but our goal should be 4.3 to 5.0 because, said Leonardi, levels above 5.0 correlate with carotid plaque, colorectal cancer, and all-cause mortality (Dr. Leonardi referenced the original report).

Oh. Guess what my mother died of . . . at age 55? Yep, colorectal cancer!

And yet, with all these studies, and with my mother's history, my PCP says, "HbA1C is not a good screening test."

And though, as I pointed out back on August 29th, that Dr. Leonardi says LDL and HDL, on their own, are not good markers or predictors for heart attack but/and the number of LDL cholesterol particles per unit of blood is the #1 risk marker for heart attack (and my number is almost double the highest range of "normal"), and while, even on the basis of my LDL/HDL ratio my risk of having a coronary event appears high, my primary care physician not only doesn't know what to do with the particle number, but wouldn't treat my cholesterol with medication.

And this is the day after the Kaiser-Permanente ophthalmologist noted in my records, for my PCP to read, that I had just suffered serious (negative) results from non-arteritic anterior ischemic optic neuropathy.

*******

Meanwhile, the same day that I am engaging in this correspondence with my doctor, as I said above, I received a letter from Dr. Leonardi with the results of my "Carotid Intima-media Thickness Test (CIMT)"--An ultrasound measurement of the thickness of the artery walls in my neck--"the part of the wall of the carotid arteries that is affected by atherosclerosis."

The part of the wall measured is composed of the intima (a single layer of endothelial cells) and media (muscle layer adjacent to the intima).

Atherosclerosis (plaque formation) occurs between these two layers, increasing the thickness as plaque accumulates. Normative ranges have been determined for our population and are stratified by age and gender. Knowing how you stand relative to your peers and what "relative age" your CIMT represents gives us an impression of your relative risk of both stroke and heart attack.

A number of studies have validated CIMT as a good indicator of the risk of cardiovascular "event."

Dr. Leonardi explains that, after the tests are done,

Your results are then compared to a "normative" population so we can score your artery with the age that corresponds to the wall thickness. . . . Our goal [is] to track a reduction in your artery age every one to two years.

So what did the test show for me? Chronologically, I'm 52--just shy of 53--years old. Compared with the "normative" (i.e., average) population, my CIMT shows me to have the carotid arteries of an average 64-year-old!

********

I have radically altered my diet over the last four weeks since I visited Dr. Leonardi; my "discovery" Tuesday has motivated me even more.

********

I'll try to address the issue of hormones, and especially testosterone, in a future post.

Zevia, stevia and dietary supplements

I got my latest copy of Dr. Jonathan V. Wright's Nutrition & Healing and read about "The new 'diet soda' that's actually safe to drink." And the opening lines in the article?

For the first time in over 20 years, Holly and I have soft drinks in our refrigerator. (Ooooops, know we don't! We have "carbonated supplements" that look, taste, smell, and drink as if they were really soft drinks . . .)

Besides the strange reference to "carbonated supplements," the article caught my attention partially because of the news I received last week from my "vitality and longevity" doctor. (I still need to tell you about some of the details of the science that he shared with me. But let me tell you this story first.)

In essence, my doctor told me I need to pretty much swear off all sugars, anything with a high glycemic index. And soda pop, certainly, has an extremely high glycemic index! Of course, there is no way I am going to drink diet soda. Not only do I hate the taste of aspartame, but I am well aware of how bad it is for you. Just in case you are not, let me quote from Dr. Leonardi:

Aspartame is a sweetener made from two amino acids, phenylalinine and the excitotoxin aspartate. It should be avoided at all costs. Complaints about Aspartame account for approximately 70% of ALL complaints to the FDA. It is implicated in everything from blindness to headaches to convulsions. Invented by Monsanto as "Chemical Warfare," it destroys the Central Nervous System. It was also found to have no calories and tastes sweet, so it was decided to add Aspartame to our food for dieters and diabetics. Sold under dozens of brand names such as NutraSweet^® and Equal^®, Aspartame breaks down within 20 minutes at room temperature into several primary toxic and dangerous ingredients:

1. DKP (diketopiperazine; when ingested, converts to a near duplicate of a powerful brain tumor causing agent)
2. Formic acid (anti venom)
3. Formaldehyde (embalming fluid)
4. Methanol (a neurotoxin that causes blindness in large amounts)

But, y'know, a few sweets once in a while would be really nice!

So I was intrigued by this article. Is it possible someone has created a diet soda that I could drink? If so, I thought, with a name like Zevia^®, it is probably based on stevia, a sugar substitute I have been told is hard to purchase here in the United States.

Oh, yes! I was right. It is based on stevia. And it is because it is based on stevia that it is called a dietary supplement. To quote further from Dr. Wright:

As the company's website states, Zevia is "a dietary supplement that is nature's answer to diet soda."

A dietary supplement? . . . [W]hat's with the dietary supplement label?

As you've probably guessed, it has something to do with the FDA, which is why it's good that the company's founders are also attorneys who are better equipped to navigate the ridiculous barriers placed in the way of so many natural products, like Zevia's principal sweetener--stevia. You see, thanks to the FDA, stevia (to paraphrase Oscar Wilde) "may never speak its name" as a sweetener in any food or beverage. Instead, its use is limited strictly to "dietary supplements."

So to accommodate these FDA-related absurdities, Zevia's founders officially dubbed it "Zevia Carbonated Stevia Supplement." And printed on each can is one of my all-time favorite lawyer-esque statements: "A dietary supplement is not permitted to disclose the amount of calories, carbs, sodium, fat when there is ZERO. (For that reason, Zevia does not disclose them.)"

Despite the legal hoops the developers had to jump through, and the foolish mumbo-jumbo they have to put on their cans, I like Zevia's tagline: "Nature's Answer To Diet Soda^®."

You can learn more about Zevia at their website.

Question, however: Why does the FDA approved aspartame with all of its known problems, but they make it almost impossible for people to acquire stevia?
*******
While we're on the subject of stevia . . .

I should probably mention an article I read several months ago in The Economist about how "low-calorie sweeteners may make people fat." From the February 15th edition:

ARTIFICIAL sweeteners have long been touted as being good for the calorie-conscious. Unfortunately, a study just published in Behavioral Neuroscience by Susan Swithers and Terry Davidson of Purdue University in Indiana suggests that such compounds may actually end up making people fatter than they otherwise would be.

Dr Swithers and Dr Davidson came to this conclusion after a series of experiments on rats. In addition to standard laboratory food, they fed some animals yogurt flavoured with saccharin, while others had yogurt flavoured to the same degree of sweetness with normal sugar.

The researchers then carried out two experiments on their animals. One merely tracked the rats' weight over five weeks. This found that rats eating sweetener gained more weight than those eating sugar. The other experiment was more subtle. After two weeks on yogurt, the rats were given an unexpected treat—a chocolate pudding loaded with calories. Both groups gobbled this up. However, those animals that had been eating sugared yogurt reduced the amount of yogurt they ate for their next meal in proportion to the number of chocolate-flavoured calories they had consumed. Those on the sweetener made no such adjustment. . . .

They found additional anomalies. But their conclusion was most interesting:

Past research suggests that the brain thinks that sweetness is a sign of highly calorific food. Dr Swithers and Dr Davidson argue that artificial sweeteners confuse things. After repeated exposure to sweeteners, the brain forgets the connection and thus fails to stop the animal eating at an appropriate point.