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Statin Drugs Can Increase Diabetes or High Blood Sugar

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This article by pharmacist Suzy Cohen, originally published at Mercola.com  is very important because doctors are told that diabetics especially need to go onto statin drugs on the unproven theory that cholesterol causes heart disease.  But by increasing blood sugar, lowering Vitamin D and lowering the anti-inflammatory CoQ10, statins can make matters worse.

There are now 900 studies proving  adverse effects showing complications from increased risks of moderate to serious liver dysfunction, acute kidney failure, moderate or serious myopathy, and cataracts.  (This particular metastudy did not look at the effects of statins on blood sugar.)  But if your doctor wants you to go onto statins let him or her know that they increase blood sugar, corrosive blood insulin levels and diabetes.

……………………………………………………………………………………………………………………………………………………………………….

The Hidden Diabetes Link No One is Telling You About…

By Suzy Cohen, R.Ph.

Statin DrugsCoronary heart disease is a leading cause of death in the United States, killing one in five adults, and doctors are very quick to prescribe statins. In fact, statin drug sales rank in the billions each year globally.

These drugs are so pervasive that they are no longer just indicated for hypercholesterolemia, they are also being prescribed for elevations in C reactive protein, and are promoted for kids as young as eight years old.

Heart disease is so pervasive that some have boldly suggested that we should put statins in our water supply as some kind of protection.

This is very disturbing.

Do You Really Need a Statin Drug?

By far, statin drugs are the most popular cholesterol-lowering drugs available today. They work in your liver by preventing your body from making cholesterol. The drugs block an enzyme called HMG-CoA Reductase. This can be helpful, but only if you are one of those people who happen to produce too much cholesterol.

It doesn’t do a good job at removing it from your clogged arteries, contrary to what most people think.

Physicians and health experts now agree that statins seem to offer more benefit through their ability to reduce dangerous inflammatory chemicals in your body, rather than by reducing production of cholesterol, which usually leads to uncomfortable, unwanted and dangerous side effects. One study found that lowering cholesterol too much actually backfires.

Cholesterol is good for you; it’s one of your body’s most powerful antioxidants, it makes important neurotransmitters and sex hormones so this madness to lower it as much as possible really concerns me. Plus, I believe the indiscriminate use of statins has contributed to the staggering rise in diabetes…

The Statin—Diabetes Connection Few People Know About

I watched this happen to my mom who was given a statin, and then told months later she suddenly had diabetes. All of a sudden? This happened many years ago, and it began my search to understand the connection. It also prompted me to write a book on the subject entitled “Diabetes Without Drugs” (Rodale, 2010).

It typically happens like this:

Many statin users come back to see their physician for a routine visit and after the blood work is drawn, they find their cholesterol ratios may be improved, but now they have high blood glucose.

It’s entirely possible that some physicians then mistakenly diagnose their patients with “Type 2 diabetes” when in fact they just have hyperglycemia—a side effect, and the result of a medication that was prescribed to them months earlier.

Do you think you have type 2 diabetes?

I will provide more information so you can see for yourself that so-called “diabetes” diagnosis might not really be genuine diabetes. It may just be hyperglycemia (high blood sugar)—the result of your cholesterol medication, and for some people, it may be reversible with drug discontinuation. Whether or not you are able to discontinue your medication is between you and your physician.

Research Suggesting Raised Blood Sugar is a Side Effect of Statin Use

Several studies have indicated that statins can cause high blood sugar, which can be mistaken for “diabetes.” For example, researchers in Glasgow, Scotland conducted a meta analysis, known as the JUPITER trial, which took into account 13 statin trials that each included 1,000 patients or more. The participants were followed for over than a year. The conclusion was there was indeed an increase, albeit small, in the development of Type 2 diabetes.

It should be considered that some of the patients in this meta analysis already had symptoms of insulin resistance or metabolic syndrome, so it could be said that they were on their way to diabetes anyway.

Now consider another meta-analysis published in the Lancet Here, the researchers reviewed randomized controlled trials beginning in 1994 and ending in 2009, for a total of 91,140 participants who took either a statin or a placebo.

They found that people treated with statin drugs showed a nine percent increase for diabetes. They did not evaluate other factors however, which would be considered pre-diabetes, so I suspect their nine percent number to be on the low side.

Insulin is a pancreatic hormone that reduces blood sugar. You want some insulin to maintain blood glucose levels, but too much of it is bad—it’s an inflammatory compound in your body when it is elevated. And guess what? The use of statin drugs appears to INCREASE your insulin levels! High insulin is extremely harmful to your health.

For starters, elevated insulin levels lead to heart disease, and isn’t that the reason cholesterol drugs are prescribed in the first place?

The ratio of glucose to insulin should be less than 10:1, this ratio is far more important than the levels of glucose or insulin alone. Keep that in mind if you seek a complete recovery. For more information about the harmful effects of elevated insulin levels, see my article on dearpharmacist.com, or my book Diabetes Without Drugs.

You want to keep insulin normal, to protect yourself from heart disease and high blood pressure. Chronically elevated insulin causes a cascade of inflammatory chemicals and high cortisol which lead to belly fat, high blood pressure, heart attacks, chronic fatigue, thyroid disruption, plus major diseases like Parkinson’s, Alzheimer’s and cancer.

Unfortunately, the most popular cholesterol drugs in the world seem to increase insulin levels. However, that’s just one mechanism by which these drugs can raise your risk for diabetes.

How Statins Raise Your Insulin

Keeping things simple, you might imagine it like this: When you eat a meal that contains starches and sugar, some of the excess sugar goes to your liver, which then stores it away as cholesterol and triglycerides. Now stay with me — when you have a statin on board, it’s like a message to your liver saying, “No! Don’t make any more cholesterol, please stop.”

So your liver sends the sugar back OUT to your bloodstream. As a result, your blood sugar goes up.

In 2009, it was proven that statins could directly raise blood sugar, whether or not you have diabetes. Over 340,000 people were included before this conclusion was made. The people who did not have diabetes but took statins experienced a rise in blood glucose from 98 mg/dl to 105 mg/dl. Those who already had diabetes and also took statins experienced a rise from 102 mg/dl to 141 mg/dl.

After adjustments for age and medication use were considered, researchers concluded that both diabetic and non-diabetic statin users showed a statistically significant rise in blood sugar.

Why take all these risks, just to get the convenience of taking a pill instead of eating a better diet and exercising?

It’s been scientifically discussed and even published in JAMA that eating a better diet could lower cholesterol as well as the statin drug lovastatin.

And of course, there are so many other benefits to eating a healthier diet that consists of fruits, vegetables, nuts, seeds, and lean meats. Besides feeling better and increasing lifespan, you can squeeze into those skinny jeans you’re hiding in your closet.

Another way statins can affect your blood sugar is via their “drug mugging” effect. A drug mugger is my term, and the title of my newest book, which describes how a drug can rob your body’s warehouse of a valuable nutrient. In the case of statins, they rob your body of two different nutrients, both of which are needed to maintain ideal blood sugar.

Two Important Nutrients Decimated by Statins

The first nutrient that is mugged is vitamin D. There have been mixed studies regarding the D-depletion effect of statins, but statins reduce your body’s natural ability to create active vitamin D called 1,25-dihydroxycholecalciferol, shortened to “calcitriol” when it is eventually converted to its active hormone form.

This happens because statins reduce cholesterol, and you need cholesterol to make vitamin D! It is the raw material that exposure to UVB from sunlight will convert to vitamin D.

It is well documented that D improves insulin resistance, so needless to say, when you take a drug mugger of vitamin D (like statins), then you increase your risk for diabetes.

More specifically, a 2004 study published in the American Journal of Clinical Nutrition determined that raising a person’s serum vitamin D levels (from 25 to 75 nmol/l) could improve insulin sensitivity by a whopping 60 percent.

Compare that to the blockbuster diabetes drug metformin, one of our pharmaceutical gold-standards, which can dispose of blood sugar by a meager 13 percent according to the New England Journal of Medicine.

Now, statins also suppresses your natural coenzyme Q10— also called “ubiquinol” in its active form; it makes energy for every cell in your body, and it’s produced mainly in your liver.

This powerful antioxidant just so happens to also play a role in maintaining blood glucose. When you deplete levels of CoQ10 by taking a drug mugger of it, like a statin drug, then you lose that benefit. You also raise your risk for heart failure, high blood pressure and heart disease as CoQ10 deficiencies can contribute to those conditions. A study by Hodgson et al, published in 2002 found that 200mg CoQ10 taken daily caused a 0.4 percent reduction in hemoglobin A1c.

Moreover, CoQ10 protects your body from oxidative stress, a strong contributing factor in the development of diabetes, metabolic syndrome and heart attacks. You want to make sure you have enough CoQ10 (or ubiquinol) on board to protect every cell in your body. The take home point is that statins annihilate this compound and you need it for good health.

In summary, if you take a statin medication and you’ve been told that you have diabetes, it may be drug-induced, and it’s possible that it can be reversed over the course of time. However, you will have to eat right, exercise, and take supplements that help to lower your risk for heart disease naturally.

About the Author

Suzy Cohen, R.Ph., has been a licensed pharmacist for 22 years, and has had a weekly syndicated health column for the past 13 years which you can get for free by signing up at her website Widely recognized as “America’s most trusted pharmacist,” she has appeared on The Dr OZ Show, The View, Good Morning America Health and The 700 Club.

Cohen is also the author of three books: The 24-Hour Pharmacist, Diabetes Without Drugs, and Drug Muggers: Keep Your Medicine from Stealing the Life Out of You.

For more information, see www.SuzyCohen.com.

Sources:

See Also:

Cholesterol: Unfairly Vilified?

Low Vitamin D tied to Diabetic Cardiovascular Disease

Coffee Beats Statin in Reducing Diabetes Inflammation

Niacin Outperforms Drug At Lowering Cholesterol

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How to Make Turmeric Honey For Inflammation

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Turmeric root. Photo taken in Kent, Ohio with ...
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Turmeric honey is one of my favorite ways to give turmeric.  Turmeric is an adaptogen, a nontoxic herb that regulates the immune and endocrine systems.  It also is antiseptic, is hepatoprotective, invigorates the blood, and helps prevent or treat infection.  Regarded as a panacea in Ayurveda, turmeric is widely used in food, medicine and skin care.  Indian curries, Persian dishes like masak lemak, Thai and Indonesian dishes like rendang use curry to color and impart flavor.  In skin care, its golden color and medicinal properties enhance dark skin.  (I have had people react in alarm when a turmeric foot soak turned my pale legs yellow!)  It is used ceremonially throughout South Asia, including Bengali weddings where it adorns the married couple or Pujas where the powder is moistened and formed into an image of Ganesha.  Rich in pigments it is used for dyes and to color food.  It is one of  my favorite herbs.

Turmeric contains  up to 5% essential oils and up to 5% curcumin, a polyphenol considered the most active constituient of turmeric, although I think it works best when mixed with its other natural antioxidants including curcuminoids, flavanoids and carotinoids.  Volatile oils include tumerone, atlantone, and zingiberone which is also found in the related plant, ginger. Other constituents include Vitamins C and E, sugars, proteins, and resins. It is used in Chinese and Ayurvedic medicine for the treatment of inflammation, flatulence, jaundice, menstrual difficulties, hematuria, hemorrhage, and colic.  Turmeric can also be applied topically in poultices to relieve pain and inflammation but will color the skin for a few days after removal.

Bengali Bride
Image by SoulSoup via Flickr

Turmeric is better absorbed when mixed with other constituents and  when used as a whole herb since flavanoids are best served with their synergistic compounds.  Pharmacokinetic studies in animals demonstrate that 40-85 percent of an oral dose of the isolate curcumin passes through the gastrointestinal tract unchanged, with most of the absorbed flavanoid being metabolized in the intestinal mucosa and liver. But that refers to the isolates.  One manufacturer of curcumin BCM-95®, mixes it back with the original compounds and increases  absorbtion 7.8 times more than curcumin alone.  (It  might be easier to stay with the original herb!)  Adding 5% black pepper or long pepper increases availability by 2000%.  And most compounds are increased in bioavailability when taken with honey or a fat source like ghee.

Turmeric: The Yellow Root
Image by Carlos Lorenzo via Flickr

I have been making turmeric honey for some time now.  Although curry powder typically contains both turmeric and pepper, the concentration of turmeric is rather low so I prefer to work with turmeric.   I take:

  • 9 parts dried turmeric powder
  • 1/2 part freshly ground black pepper (grind it finely)
  • 1/2 part dried ginger powder

Mix thoroughly.  Start adding a liquid honey into the powder.  It helps to warm the honey which allows it to absorb better.  I usually use a local honey, but a eucalyptus or manuka honey would add additional benefit.  Just make sure the honey is not whipped or crystallized because you need it to be runny.  Stir, slowly adding the honey until all the powder is dissolved and you have a thick paste.  The amount will vary depending on the moisture content of the honey, but a pound of turmeric in honey usually fills a 20 oz jar.  The exact proportions are not critical as this is a food grade herb.

Turmeric plant
Image via Wikipedia

What is it good for?  All kinds of things.  If you suffer from arthritis, back pain or any kind of joint pain, this helps reduce the inflammation.  I suggest it to most clients who suffer from autoimmune disease as it reduces flares when taken consistently at a teaspoonful per day.  I had one client who suffered from large  lipomas in her arms- after 6 months they had shrunk from softball size to golf ball size.  If your C-reactive protein levels are high, indicating inflammation, this can frequently lower them.  It is useful for reducing symptoms of crohn’s disease, lupus, RA, fatty liver, hepatitis and to prevent gallstones.  Turmeric helps detoxify so is useful after exposure to industrial or household toxins.  It can be  mixed with warm milk or nutmilks for children coming down with an infection.  You can mix it with other herbs or use the turmeric honey alone.

Turmeric honey can be use topically on sores and ulcerations, although I would thin with honey or water.  In India, turmeric powder is frequently applied to cuts, and honey also is used in this manner.  You can use it as a soak for skin conditions, at least if you don’t mind the color.

When I discussed this with David Winston, he suggested that ghee  might be substituted for honey for diabetic clients (who typically suffer from high levels of inflammation.)  You can melt ghee over a low flame and mix with the powders.  It will have a more bitter taste, and intuitively I think that the honey helps with assimilation.  If you want to reduce the honey, try one part melted ghee to two parts honey and stir well- adding a spoonful of lecithin will help  mix the two liquids before you add the turmeric mixture.  Just don’t use the same proportion of honey and ghee as this is considered unhealthy in Ayurveda.  And you can also thin honey with up to a third hot water to reduce it.

And a totally irrelevant thing to try as  long as you have the turmeric out:

Curcumin is used to indicate pH, with a yellow color in the presence of acids and a red color in the presence of bases.  The whole herb works too.  Take a little turmeric in a clear drinking glass and mix a half glass of water into it.  Now add a little lye drain cleaner or a lot of baking soda, and watch it turn a pleasing shade of red.  ( I couldn’t make the turmeric turn any yellower than it was with citric acid, so either it has the same color from acid to neutral, or my water is slightly acid.)

Turmeric in an alkaline solution turns red

See also:

Turmeric Sweet Turmeric

How to Make Thieve’s Vinegar To Protect from Respiratory Infections

Why A Parasite Cleanse Can Make You Worse

How to Make Magnesium Bicarbonate Water

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How to Make Thieve’s Vinegar To Protect from Respiratory Infections

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For medicinal use you need much higher ratios of herbs to vinegar

The traditional story is that during the Black Plague, a group of men were going into houses where people had died, stealing their goods.  The authorities figured that they would soon be infected and die, so did not pursue them until it became clear that they were resistant to the disease.  And then the motivation was to find what protected them.  Finally the thieves were apprehended and one confessed that his mother, a midwife, had provided them with a protective vinegar that they drank and washed with after handling the cadavers.  And in exchange for freedom, shared the recipe.

My version is slightly different, in that I use chili peppers which were not available at the time.  I love to make the vinegar and use it for both cooking and to put a quarter cup in my water bottle to build up resistance. Vinegar in water was called Posca by the Romans and accompanied most meals.  I take a tablespoon of the vinegar every few hours if I am coming down with an infection. All herbs are dried to increase the strength.

1/4 cup dried lavender blossoms

1/4 cup sage or white sage

1/4 cup lemon balm

1/4 cup rosemary

1/4 cup peppermint

2 Tbsp crushed chili peppers

2 Tbsp cloves

8 minced cloves of fresh garlic

1 oz. tinctured wormwood or Artemisia annua (Sweet Annie)

2 cups apple cider vinegar.

Mix the dried herbs well and place in a jar, along with the garlic.  Cover with the tincture and vinegar.  Let sit in a dark place for four weeks, shaking each day.  Strain and decant.  You can use the infused herbs after straining in soup stock if you wish.

I find that most of the Italian food spices will work well in the vinegar, so don’t be afraid to add or substitute with thyme, oregano, zatar, monarda (bergamot/bee balm), or similar anti-infective herbs.  (Increase the vinegar proportionally if you add.)  You can also use the artemisia leaves if you have them available, although I like a little alcohol in the vinegar.   I think that apple cider vinegar extracts best, so if you are using other kinds, use a bit less so the extract is stronger.

I also mix essential oils to form a version similar to the Young Living Thieves’ oil.  Rosemary, clove, oregano, thyme, peppermint and lavender in equal amounts can be combined, and the oil placed over glands or rubbed on the palms and inhaled.  Essential oils should NOT be consumed internally due to their extreme concentration which can burn tissues and kill gut bacteria.

Vinegar maker
Natural anti-malarial
Artiemisia leaves -Image by tonrulkens via Flickr
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Two Year Low Cal/Low Carb Diet Study Misleading

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A two year, $4 million  studyof 307 people, purporting to compare low carb to low fat diets has been completed, apparently showing similar weight loss after two years, but improved blood lipids for people who followed the low carbohydrate diet. They tell us study results show it doesn’t matter which way we diet.   But the study has several problems:

  • The low carb diet went for 12 weeks, after which people were encouraged to add 5 grams of carbohydrates daily for a week, increasing carbohydrates until their weight stabilized.
  • The low calorie diet went on for 2 years.  So a short term diet was compared to a long term diet.
  • No one looked at actual food intake.  Yep, a diet study with no data on what people actually ate eventhough they kept food diaries.
  • And data from dropouts was extrapolated and included, or as the rest of us call it, the data was made up.

Why Would You Include Data from Dropouts?

The last point may need some explanation.  Usually one would compare only people who followed the protocol, but in recent years people wondered what happened to the dropouts.  Why would you ever look at data from people who didn’t follow the diet?  It seems counterintuitive, but there are legitimate questions here, if  too many people drop out of a study it may be because the protocol causes real life problems.  If you are looking at what is called “Intent to Treat” then you might well look at the end result to see if prescribing a certain course of action is likely to help in the real world where people don’t always follow directions. It tells you what people might do in an experimental context, not which course of action is better.   But you want to use real end data on the dropouts, and to segregate it from the compliers.  If you mix the data together, then it is impossible to tell whether Protocol A (say a low carbohydrate diet) is better than Protocol B (say,  a low calorie diet) when people follow directions.  In other words, you would never use Intent to Treat (ITT) in a comparison of which diet is actually better.  An ITT analysis can draw the exact opposite conclusion to a traditional analysis.  But the researchers did just that in this study.

“To assess departures from the missing-at random assumption under informative withdrawal-that is, the missing weights are informative for which patients chose to withdraw or continue to participate in the study-we present sensitivity analyses. As such, we assume that all participants who withdraw would follow first the maximum and then minimum patient trajectory of weight under the random intercept model.” (italics mine)

So they did not use real outcomes for the noncompliers or even assume that the real outcomes on the others would apply.  They extrapolated them based upon a model that significantly understates the difference between the two groups. (They spent more time and charts on the model than on the real data, not all of which is reported in the full text study.)  That means the data were made up based on the group that continued, not at the average rate, but at the “minimum trajectory”.   In other words they extrapolated at the low end of the data, which minimizes the effectiveness of the diet.  Consider that adding in the dropouts alone can make significant differences.  Richard Feinman who has looked at Intent To Treatment gives the following table showing how ITT masks the true response of those that follow a low carb diet in two prior studies:

Weight Loss in Diet Comparisons and the Effect of Analysis.
    Data for 12 months Weight Loss (kg)
 

 
    With Drop-outs SD Only Study Subjects SD
 

 
Foster, et al. low carb 4.4 6.7 7.3 7.3
  low fat 2.5 6.3 4.5 7.9
  difference 1.9   2.8  
 

 
Stern, et al. low carb 5.1 8.7 7.3 8.3
  low fat 3.1 8.4 3.7 7.7
  difference 2   3.6  
 

 
Feinman Nutrition & Metabolism 2009 6:1   doi:10.1186/1743-7075-6-1

Frank Hagensays “if you use the numbers that include the people who dropped out of the diet, in the “With Drop Outs” column, where the low carb group in the “Foster, et. al.” study only lost 1.9 kg more than the low fat group. But look at the column titled “Only Study Subjects”, comparing those that actually followed the low carb or low fat diet, and you find that the low carb dieters actually lost 2.8 kg [6 pounds] more than the low fat dieters (47% more weight). For the “Stern, et. al.” study, we find even greater numbers: a difference of 2 kg between the diets using ITT and 3.6 kg [8 pounds] when counting those that actually followed the diet plans. That’s 80% more weight loss.”  As you can see, the difference in outcomes is quite a bit more distinct when dropouts are not included.

In this study,  the authors did not segregate the data  for only people who followed the diet.  So we do not know what percentage of the low carbohydrate dieters were still on a low carbohydrate diet at the end nor what percentage were on a low calorie diet.  Judging from the triglyceride rates which drop when carbohydrates are low, few of the final group of dieters were still on a low carbohydrate diet. This is confirmed by the higher level of urinary keytones at 3 and 6 but not 12 or 24 months.  But that would happen anyway because of the design of the study.

Triglyceride Effects:

Diet Group 3 Mos. 6 Mos. 12 Mos. 24 Mos.
Low Fat -17.99 -24.3 -17.92 -14.58
Low Carb -40.08 -40.06 -31.52 -12.19

What Is A Low Carbohydrate Diet?

Common sense would say that to compare two diets, one low carbohydrate and one low calorie, you need to have some sort of set criteria for what is eaten and to run both diets similarly.  In the study, the low carb group had a very low carbohydrate induction phase followed by gradual increases of 5 grams daily each week, increasing indefinitely.  The low fat group did not increase calories during this time.  As the abstract says:

A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low–glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; ≤30% calories from fat). Both diets were combined with comprehensive behavioral treatment.

Low Carb Diet Pyramid (not based on Atkins), if you must have a pyramid

Now if you are on a low carbohydrate diet for 12 weeks months, and then transition to a higher carbohydrate diet, with no outer level specified, then you are off of the low carbohydrate diet  at 100 g daily  by week 28 (or 6 months )and on a high carbohydrate diet of over 150 grams ten weeks after that. At 12 months, you’d be up to 210 grams per day which probably causes weight gain.  So even those who followed the protocol were not on a low carbohydrate diet for most of the two years. We are comparing a low-calorie weight-loss diet that lasted for two years with a low-carb diet that reached maintenance level within 6 months.

The study suggested only continuing the additional carbohydrates “until desired weight was achieved”  but since the average starting weight was 226 pounds, and average weight loss was 27 pounds at maximum, then “desired weight” was never achieved.

A better design would probably had the induction diet for two weeks, followed by a 60-80gram low carbohydrate diet for the entire period.  This is the methodology used in the Atkins diet books which the researchers claim they were using.

And What Were The Results?

According to the study, “During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, … had greater increases in high-density lipoprotein [good] cholesterol levels.”  The low carb group also had more adverse effects, primarily bad breath, constipation, and dry mouth during the first six months of the study which all could have been avoided with some simple counselling on which foods to eat.
Let us look at the results while participants were still on the low carb diet at 6 months:

Indicator          Low Fat          Low Carb

Weight loss          25                          27     pounds

Triglycerides     -24.3                  -40.6

HDL                          +0.9                  +6.2

TGL/HDL                 2.15                   1.39     (under 2 preferred)

As we can see, all parameters were better with a low carbohydrate diet at the 6 month period when carbohydrates had just reached maintenance levels.  Curiously blood sugar was not tested although most participants are likely to suffer from Metabolic Syndrome (diabetics were excluded.) The advantage continued at 12 months although by that time carbohydrate levels were approaching the weight gain level and some of the weight gain was noted.  By 2 years, only the gain in good cholesterol persisted, although in fact there was a “strong trend” to lower blood pressure in the formerly low carbohydrate group.

At the end of two years, while the low fat group was still dieting and the low carb group had been off their diet for a year, weight loss was the same (well there was slightly more weight loss in the low carb group but  it wasn’t considered significant.)  This should be news, although I admit the story is still muddled.  It certainly doesn’t lead to the conclusion that the type of diet doesn’t matter though, as the researchers have been saying.

Ketones and Low Carbohydrate Diets

Ketone Production

Why would they design a weight loss study this way?   Tom Naughton looked up the papers the researchers had previously done, and found a bias for low fat diets in their previous research.  I don’t necessarily suspect that they deliberately were seeking to waste $4 million or to mislead the  public about diets.  I think that the bias about a ketogenic diet’s safety and an imcomplete knowledge about how it works probably biased the study design.  First off, the Atkins diet, upon which the low carb diet was ostensibly based, starts with an induction period (usually 2 weeks of an extremely low carb ketogenic diet) and then adds carbs gradually until just before the body stops producing ketones, somewhere between 60-80 grams for most people.  It doesn’t add carbs forever.

Ketones are normal byproducts of burning fat which are water (blood) soluble.  These blood-soluble  fats are a source of energy for tissues including the muscles, brain and heart. Ketones can significantly substitute for sugar in the brain.  But both ketosis, a normal way of extracting energy from fat, and ketoacidosis, a dangerous  condition where the body is breaking down its own tissues from starvation or Type 1 Diabetes, produce ketones.  Ketones are easily measured  but distinguishing the cause is not.  So the presence of keytones seems to send off alarms even when the cause is benign.  I have heard many doctors and nurses caution against ketosis in a low carb diet “just to be sure” when what was really dangerous would be ketoacidosis- ketosis is the point of most low carb diets because it indicates burning fat.  This study did measure ketones, but didn’t distinguish between the causes, so treats the presence of ketones in the urine as potentially dangerous.  This causes me to believe that the researchers wanted to limit the time spent in ketosis, and sloppily did not put an upper limit on carbohydrates.  Unfortunately there is no discussion of the carbohydrate increase design in the study.

Low carbohydrate diets have been shown to increase weight loss in a number of studies including the current diet, the last Foster study and the Stern study discussed above,  but their reporting has been often distorted because of the low fat bias in nutrition which has been in effect since Ancel Keys promulgated the lipid hypothesis  based upon highly selected country data in 1963.  For instance in the Farmington study, high fat diets were associated with lower rates of most cancers but the headlines and research summaries focused on the few, less common cancers that were associated with high fat diets.  The researchers indicated that they wouldn’t have gotten funding for further analysis afterwards.  (Atkins archives).  A meta study (now withdrawn) by the Cochrane Group showed a weighted average of 5.1 vs 7.5 lbs at 12  months, but was reported as “no significant difference”.   A 2006 study by vegan-proponent Neil Barnard showed that a low glycemic index, flourless, vegan diet, that had fewer carbs than the American Dietetic Diet, was healthier, but it was not described as lower carbohydrate or even low grain diet.  The ADA diet has 6-11 servings of grains or starches a day plus fruits and vegetable sources of carbohydrates, giving approximately 220 g per day and allows unhealthy refined starches and vegetable oils (also avoided by the vegan group).   Only now, since Gary Taube’s New York Times article What If It’s All Been a Big Fat Lie? blasted through the establishment anti-fat bias, have low carbohydrate diets been considered potentially allowable.

Blood lipids and blood pressure were better for those who followed the diet

If you only look at weight loss, the differences between a low carbohydrate and low calorie diet are minimal unless the low carb diet is ketogenic, but the low carb diet has a slight advantage.  If you look at overall health parameters including blood sugar, HDL, TGL and blood pressure, a low carb diet has distinct advantages.  Based upon this study at every point there was no difference in bone loss.  During an induction period there are significant side effects to a low carbohydrate diet for 7-16 days, including a dry mouth, bad breath, headache and constipation but these will pass after the sugar withdrawal symptoms pass- essentially you are coming off of a drug.  Mineralization, lots of green vegetables and adequate hydration will help prevent this.

If you wish to learn more, including ways of transitioning with fewer side effects,  I cannot suggest anything better than  Paul Bergner’s course “Insulin Resistance: Pathophpysiology and Natural Therapeutics” which puts everything together with CDs and over a hundred pages of resource materials.  (I have no financial interest in promoting this, but it is the best I have found.”)

Sources:

Eades, Michael.  Metabolism and Ketosis

Foster, et. al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet A Randomized Trial

Feinmann, Richard.  Intent to Treat:  What is the Question?

Hagen, Frank.  Lies, Damn Lies and Statistics.

Howard BVet al.: Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial.

Howard BV, et al.: Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial.

Naughton, Tom.  Another Biased Study? Maybe…

Naughton, Tom.  Inside Information from “Fat Throat”

Barnard, N. Diabetes Care, August 2006; vol 29: pp 1777-1783. News release, Physicians Committee for Responsible Medicine.

Cochrane Database.  Advice on Low Fat Diets for Obesity.

Taube, Gary.  What If It’s All Been A Big Fat Lie?

See Also:

What Does Research Say About Eating Meat?

Fructose, Sugar, Poison and Obesity

The China Study Misrepresents Data: Does Not Support a Vegan Diet.

Strategies for Insulin Resistance

Simple Ways to Support Brain Function

 

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August Herbal Blog Party: Herbs for Fertility

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There are many ways herbs can help a couple deal with fertility.  A simple red clover infusion  can  kick off a pregnancy for many women.   Herbalists can make specific formulas for the five parts of the menstrual cycle identified by Chinese medicine or more simply incorporate menstrual charting with formulas, using herbs to tonify the yin or yang phases of the menstrual cycle as needed.  One may even managed to open a blocked fallopian tube with a phlegm stasis formula.  Or reduce insulin resistance in PCOS.  Or improve sperm quality and motility in the male partner.  Or use flower essences with a frightened first time mother. We can even use plants to deal with the residues of sexual abuse so that a prospective mother can embrace her fertility.

Here are the results of our August Herbal Blog Party where different people wrote articles on various aspects of fertility:

The indomitable Henriette Kress’s article Trying to Get Pregnant? looks at stress, tight jeans, model-thin proportions and discusses going off of carrot seed or taking lily and peony.

Kristena Haslam at Dreamseeds Organics has written a tribute to Exotic, Erotic Damiana and even has a picture of the (in)famous Mexican Liqueur bottle shaped like  a sitting pregnant woman.

Gail Faith Edwards of Blessed Maine Herbs has  had 25 years of women bringing their red clover babies to her and writes Red Clover Is Not Just for Healthy Women Who Want to Conceive, It Is for ALL Women Who Want to Conceive. She recommends that men with low sperm count smell roses too.  Note you must have Facebook access to read the piece.

Karen Vaughan has written Staging Herbal Formulas to Enhance Fertility, taking the stance that the yin and yang parts of the cycle deserve different formulas, since women have cyclical tides of hormones and discusses how menstrual charting can be used for more than finding fertile days.

Rosalie de la Foret’s very comprehensive Holistic Herbal Perspectives for Challenges With Fertility discusses preparing yourself for conception, nutrition, dosing and herbs.

Angela Ferri’s piece on Herbal Fertility Support Within A Mayan Abdominal Practice discusses herbs for vata imbalance and boggy uterine tissue.  She brings the experience of a body worker who looks at physical connections with the internal chemistry.

Darcey Blue of Gaia’s Gifts wrote Nutrition for Pregnancy which looks at nutrient dense foods and micronutrient requirements from a combined Paleo-diet and modern nutrition perspective.

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Staging Herbal Formulas to Enhance Fertility

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Red Clover (Trifolium pratense)
Red Clover  Image via Wikipedia

Many women respond to single herbs or single formulas in their quest to get pregnant.  A strong overnight infusion of red clover, or red clover mixed with nettles and oatstraw has pushed many women over the brink from infertility to fertility.  This seems to work best when a little extra nourishment is needed in an otherwise healthy woman.   But hormones are complex, and the reasons why they may be out of balance are varied.

But before giving targeted formulas , the first thing I suggest to women is that they check their nutrition.  While I believe that women with a variety of fruits, vegetables and meat in their diets probably do not need to supplement most vitamins, minerals are another thing entirely.  Between the mid 1970s and mid 1990’s the USDA tested the nutritional content of food and found most minerals declined by a third due to soil depletion.  Magnesium is one of the most important, but zinc, boron and a number of trace minerals are also significant.  I suggest at least 500mg of magnesium plus a multi-mineral or trace concentrate supplement.   Fish oil sufficient to provide 1000mg of DHA (several capsules) will help keep the cell membranes of your egg responsive to the sperm.   Vitamin D is not really a vitamin, but a pro-hormone and  you probably need 5000-10,000 iu (a quarter to half of a physiological sun dose.)  If you live north of Atlanta, are fat, have diabetes or have dark skin, you probably need more.  Folic acid is very important to prevent birth defects and is found in a good quality prenatal formula which you should take in anticipation of getting pregnant.

It is important to know how to use herbs for fertility since there are so many causes.  Missing minerals, insulin resistance, lack of essential fats, lack of protein, strong fears of motherhood or pregnancy, low quality menstrual cycles, silent infections like chlamydia or gonorrhea, blocked fallopian tubes, PCOS, aging eggs and sperm, and many other factors affect fertility and the remedies are all different.

The menstrual cycle has clearly defined parts as you can see on the bottom of this article (click to enlarge).  The first part of the cycle, from bleeding to ovulation is ruled by Yin and is characterized by climbing estradiol (one of the estrogens) which rises to spike just before ovulation.  That is followed by short spikes in FSH and LH during ovulation, which trigger progesterone for the Yang luteal phase.  The pattern must be balanced to have enough Yin for a high estrogen spike, to have a good temperature differentiation between the Yin and Yang phases of the cycle and to have a high enough transition to allow the egg to be released.

Basal Body Thermometer and Chart

How would you tell if your menstrual cycle is not well balanced?  In Chinese medicine we always normalize the menstrual cycle of the woman to get her pregnant. I find that it is easier to get pregnant if you actually follow your cycle by charting your basal body temperature and check your cervical mucous.  To do this you keep a basal body thermometer (a digital thermometer that has an extra decimal place) by your bed and take your temperature before you start moving around.  You plot the temperature on some graph paper or a chart You can find instructions for taking your temperature and making a chart here.  Typically you see a low fairly steady temperature until about 12 days after you start menstruating.  The temperature dips slightly, spikes high at ovulation and finishes higher.  You can see an example on the chart at the bottom of the page, in the second band.

The chart is often used by women to decide when to have intercourse (just before and after ovulation) but a skilled practitioner can use it to choose herbs and to rebalance the cycle.  For instance if the temperature is sawtooothed there may be Liver Qi Stagnation and herbs to move the liver and release emotions may stabilize it.  The follicular (Yin, estrogen) phase may be too short or the luteal (Yang, progesterone) phase too long, so you may tonify Yin with herbs like rhemannia.  The ovulation spike may occur but not be high enough to actually release the egg and vitex may be helpful.  The progesterone phase may not produce a high enough temperature to prevent miscarriage so Yang tonics like walnuts and red meat are needed.  The entire cycle may be too short or too long.   Different herbs would be selected for different conditions and for different constitutional types.

Shatavari tonifies Yin

There are many reasons to consider giving different formulas during different phases of the menstrual cycle in order to enhance fertility.   A simple way is to give Yin-tonifying herbs (with a touch of Yang) from menstruation to ovulation (the follicular phase) and Yang tonifying herbs during the luteal phase.  Typically  the Yin tonifying formula Rhemannia 6 (Liu wei di huang wan) is given up until ovulation and a pregnancy-safe version of the Yang tonifying formula Rhemannia 8 (Jin gui shen qi wan) post ovulation.  The formulas are identical except that the yang tonifying formula has two extra warming herbs and they can be mixed and matched for partial conditions.   Sometimes a third formula will be given during the few days of ovulation, especially if there is a FSH or LH defect in the cycle.

However a woman goes through more than two different hormonal processes during her menstrual cycle. In the first phase she ripens the egg and builds the endometrium in her womb, which depends upon  Kidney Yin and Blood.  In the second , Liver Q and Blood movement govern ovulation.  In the third phase  Kidney Yang and Spleen Qi regulate the luteal stage or hold the pregnancy if it occurs.  In Phase 4, when PMS is most prevalent, Liver Qi helps the premenstrual transformation.  And Phase 5 is menstruation, covered by Blood and a little Qi to keep it moving.

It is not necessary to come up with five formulas unless the cycle is seriously disturbed.   If only one part of the cycle is not functioning well, you can target it.  This is not only done by, say giving vitex which increases progesterone during the luteal phase.  Instead I might use magnesium and zinc throughout the cycle as these help the body form progesterone itself.  Or I might add a little warming cinnamon and maca to the Yin phase of the formula in order to give the yin enough oomph to transform to yang at ovulation.

Menstrual Phases and Herbs

Phase

Ruled By

Supportive Herbs

Lifestyle

Follicular

 Kidney Yin Rhemannia Sleep
Blood Goji berries Nourishing conditions
Slippery elm Water
Peony root Walks by Streams
Black sesame seeds Dark red and green foods
Seaweeds Black and Blue Foods
Shatavari (Asparagus root) Gelatinous foods
Dang gui (Chinese angelica) Black beans, kidney beans
Butter
Nuts, seeds

Ovulation

 Liver Qi Milk thistle Aerobic exercise
Blood Chai hu (bluperum) Sexual activity
Goji berries Expressing emotions
Peony root Beet greens
Damiana Butter

Luteal

 Kidney Yang Black beans Warm baths
Spleen Qi Cinnamon or Maca Avoiding chills or cold food
Dried ginger l Red meat
Walnuts Yellow, orange and black foods
Yams Carrot juice
Vitex Magnesium and zinc

Premenstrual

 Liver Qi Free and Easy Wanderer Movement
(Xiao yao san) Expressing emotions
Cilantro Walks in green forests
Licorice

Menstrual

 Blood Topical frankincense Warmth
San qi (notoginseng) Moonlight walks by sea
Turmeric Mild movement
Rest
Beets
Menstrual Cycle
Image via Wikipedia

Now normally I wouldn’t go for simple herbs given as examples in the chart above.  I give herbs in formulas that are individualized for the client.  The client may have a pattern of phlegm or dampness or yin deficiency which would need addressing in all stages.  In formulas for all stages I would probably include an appropriate adaptogen to balance the HPA-Ovarian axis like ginseng or shatavari or eleuthero. The body will do better overall if its own balancing is engaged rather than being just pushed, but since women tend to come to me towards the end of their reproductive cycle, I don’t rely upon adaptogens alone.

I may use Yang-supporting herbs during the Yin phase since Yin engenders Yang.  And I never tonify Yang without also tonifying Yin.  If you look at the chart on the right you see that there is some level of progesterone during the follicular, estrogen-dominant phase and quite a bit of estrogen during the progesterone-dominant luteal phase.  (This fits Yin/Yang theory quite well.)

The other reason for staging formulas is that certain formulas useful for fertility may be contraindicated in pregnancy.  For instance if a woman has blocked fallopian tubes or phlegm stasis PCOS, I would want to use herbs that would be too strongly moving to be used in pregnancy.  The best way to do this is to have the woman use a barrier method of birth control for two to three cycles.  However in women who fear that they have few cycles left, we may only give the formula up until ovulation then stop during the time that she might get pregnant, starting up again as menstruation begins.

Women are cyclic creatures, with hormonal tides.  It makes sense that we follow those tides when treating herbally, ensuring that there is enough Yin, Yang, Jing and Blood to support a healthy pregnancy.  And staging herbal formulas to support those tides can give a woman what she  needs to nourish a healthy baby.

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Full Fat Dairy Helps Ovulation in the Infertile

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Women who eat at least one portion of high-fat dairy food per day have more productive ovulation, by 27% than women who eat low-fat dairy. Women who eat 2 servings or more of low fat dairy have 85% more ovulation-related infertility.  Is it the dairy, the fat, or a combination?

‎”The risk of anovulatory infertility was found to be 27 percent lower in women who ate at least one portion of high-fat dairy food per day compared with women who had one high-fat serving of dairy per week, or even less. Women who ate two or more portions of lowfat dairy foods a day increased their risk of ovulation related infertility by 85 percent.”      Human Reproduction 2007;doi:10.1093/humrep/dem019.

Butter, A Source of CLA
Butter, A Source of CLA

We live in a world where low fat is treated as the holy grail of health, yet we forget that fats and fats alone contain certain essential nutrients, including those used to form hormones used in reproduction.  The fat from pasture-raised cows contain  has as much as five times the CLA (a fatty acid which is a potent anti-cancer agent, muscle builder, and immunity booster) as fat from grain-fed cows.  The Omega 3 essential fatty acids are found in similar proportions to deep sea fish.  Grass-fed milk contains rumenic acid (a CLA), DHA, vaccenic acid, branched chain fatty acids, butyric acid, lecithin, cysteine-rich whey proteins, calcium, iodine and vitamin D all of which have value from reducing cancer to increasing fertility.

Butterfat contains glycospingolipids, a special category of fatty acids that protect against gastro-intestinal infection, which would be protective during pregnancy.  Raw butter is the only source of an anti-stiffness factor which prevents hardening of the arteries, cataracts, and calcification of the pineal gland- and which may prevent stiffness and adhesions of the fallopian tubes.

There is a case to be made that one should not take milk, and by milk I mean organic grass-fed milk, unless it comes with all of its fat. The balance of the drink is quite different, and there are constituents that mimic insulin and can stimulate insulin-resistance about which I have written before.  Insulin resistance may affect the ability of sperm to penetrate the egg more than anovulatory infertility. Butterfat in the milk will slow insulin spikes, since we know that having some fat in the meal will lower an insulin curve after eating. The second statistic about two servings or more of nonfat dairy causing 85% more anovulatory infertility may indicate that there is an additional mechanism.

But is it the lack of milk fat or the lack of fat altogether that causes a reduction in ovulation?  The study was not clear.  Women who tend to drink low fat milk also tend to reduce fat overall in their diets.  And I see women all the time who are thin, cold and infertile who have very little fat in their bodies or in their diets, usually of non-animal origin. Fat is needed for reproduction.

Among hunter-gatherers, fat is the preferred part of meat.  Inuit hunters will frequently eat the vitamin-rich fatty organs and fat, giving the muscle meat to their dogs.  Fat is what forms your brain, your hormones and allows your cell membranes to function.  And animal fat like the important Omega 3s, DHA and EPA, are not easily converted from plant-based forms- in fact a significant portion of people lack the genetic mechanism to convert plant fats to these essential animal fats, which is why flaxseed oil is not a good substitute for fish oil.

DHA Molecule
Image via Wikipedia

I think that fats, particularly animal fats, are an important factor in fertility.  Fat is the substance of  the phospholipid bilayer that surrounds cells, including eggs, and lets nutrients and sperm through the membrane.  Fat in the form of cholesterol makes up the building blocks of hormones needed to trigger ovulation and implantation.   Young women who have very low fat in their diets and very little body fat frequently lose their menstrual periods and suffer bone loss due to lack of estrogens.  This of course leads to fertility problems.

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Insulin Resistance and Infertility

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infertility
Infertility

It is well known that insulin resistance is the basis of polycystic ovarian syndrome (PCOS) which is a major cause of infertility, but insulin resistance affects other infertility conditions as well.

Many infertility doctors are aware of this.  I had one, non PCOS, client whose fertility doctor prescribed Metformin, a diabetes drug that improves insulin sensitivity, but failed to suggest to her that she had blood sugar problems  (at a stage in her life where she might be able to make changes to avoid diabetes.) Doctors routinely suggest weight loss for infertility which is also known to correct insulin resistance.

But drugs are not the first resource for insulin resistance.  Diet is.  In this piece we will discuss insulin resistance, inflammation and how it affects fertility.

First of all, when you eat sugar- and by sugar I mean not only refined sugar, but starches like bread (even whole grain), pasta, and potatoes and even sweet fruit.  All of these cause blood sugar to significantly rise, which causes an insulin spike.  In a person with normal metabolism, the elevated blood glucose level causes beta (β) cells in the Islets of Langerhans located in the pancreas to release insulin into the blood.  Insulin ferries sugar into the cells under normal conditions and when the sugar is delivered, is broken down.  The beta cells then sense the lower blood glucose and stop producing insulin.

Normal cell
Normal Cell
Insulin Resistant Cell

The cells in our bodies are surrounded by a membrane made up by fats and watersolube compounds called the phospholipid bilayer.  The overdose of Omega 6 fats compared to Omega 3 fats makes that layer stiff.  In the bilayer are receptors and gates which require minerals in the form of enzymes to ferry in nutrients like sugar, neurotransmitters and even sperm into an egg.  Our diets are bereft of most minerals, chiefly magnesium and trace minerals.  As a result, the sugar/insulin compound cannot easily get into the cell.

With sugar in the modern diet, we have a second problem.  There is just too much for the cells to absorb.  So the cell starts shutting down GLUT4 receptors, creating insulin resistance.  And the sugar and insulin builds up in the blood vessels.  The pancreas, which senses high blood sugar, sends out more insulin.

fibroids
Fibroids stimulated by insulin growth factor can interfere with fertility

The problem is, that insulin and other carriers can be very caustic and inflame the blood vessels, further shutting down receptors.  As a result the level of inflammation grows in endothelial tissue in a vicious cycle.  This causes the body to “bandage” the inflammation with cholesterol.  And that reduces circulation which is necessary for proper development of sex cells, and fetal development.

Insulin also promotes Insulin Growth Factor, which causes things to grow- like cysts, fibroids and even cancer cells.  This can further promote problems with fertility.

Elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis as well.  This affects hormone levels.  Adaptogens can be used to rebalance the HPA axis after insulin sensitivity is regained.

PCOS and Insulin Resistance
PCOS and Insulin Resistance

Insulin resistance leads to abdominal fat.  Visceral fat tissue possesses aromatase, an enzyme that converts androstenedione to estrone and testosterone to estradiol. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for unwanted hair growth and virilization) and estrogens (which inhibits FSH via negative feedback.)

So if you suspect the begining of any sort of blood sugar problem, there are things you  can do.  Weight loss will lower aromatase levels and reduce insulin resistance.  Exercise reverses the loss of GLUT4 receptors.  At least alter your diet so that most of your calories come from leafy vegetables, protein and fat, as lower carbohydrate diets lower insulin resistance.  Exercise after eating to bring your blood insulin levels down and don’t eat between meals.  And have a very low carbohydrate breakfast- say a vegetable omelet- so that you have the long stretch between dinner and lunch when blood insulin is low.  When blood insulin is low, you can lose weight, build muscle and balance hormones.  Take anti-inflammatory fish oil (with enough DHA to make 1000mg/day), Vitamin D to get your levels up above 50ng/ml of 25 Hydroxy D, magnesium, chromium and vanadium.  And get enough sleep since lack of sleep is known to increase insulin resistance.

Red clover (Trifolium pratense), Wellington, N...
Image via Wikipedia

Acupuncture and herbs can be quite useful in dealing with insulin resistance and infertility issues.  From cinnamon and fenugreek for insulin sensitivity, to bitter herbs to stimulate proper digestion, to adaptogens and hormonally balancing herbs like shatavari and red clover, your herbalist can find an individualized treatment that addresses your underlying issues.

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What is the Right Vitamin D Level?

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Vitamin D
Vitamin D

The symptoms of low vitamin D levels are subtle and difficult to distinguish, given that receptors are found in most organ systems in the body and affect genetic transcription in cells. For chronic pain the Mayo clinic suggests that Vitamin D deficiency is the first thing that should be considered. Vitamin D deficiency contributes to depression, osteoporosis, osteopenia, osteomalacia, rickets, periodontal disease, seasonal affective disorder, increased susceptibility to colds and flu, colon cancer, lung cancer, ovarian cancer, malignant melanoma, recurrence of all cancers, cardiomyopathy, cardiovascular disease, fibromyalgia, hypertension, asthma, psoriasis, MS, type 1 diabetes and it probably plays a role in type two diabetes as well.  At least 78% of Americans suffer from D hypovitaminosis.

People vary widely in their absorption and use of Vitamin D which is why there is no RDA.  It is more important to know how much is circulating in your blood.  Why?   If you are light skinned, live south of Atlanta and spend time out of doors during midday without sunscreen, you will need less supplementation than if you are dark skinned in the same situation.  People with dark skin need three times the sun exposure as people with light skin to get the same benefit.  If you are elderly you do not absorb or convert the vitamin as well and should take care to consume the vitamin with fat, magnesium and Vitamin K2. If you have celiac, IBS, Crohn’s or leaky gut, your absorption may be impaired. If you  lack a gallbladder or have impaired fat absorption you will absorb less orally supplemented Vitamin D and may need a dry form.   If you are overweight you need more because you will sequester Vitamin D in your fat, leaving less circulating in your blood.  If you have cancer, diabetes or autoimmune disease, you use your Vitamin D stores faster and need to supplement more.  So the best way to see if you have enough Vitamin D is to get the right blood test.

If your doctor isn’t up on the latest research, he may not be aware of which Vitamin D blood test to order.  There are two common tests, only one of which is useful.  The test you want is a 25 Hydroxy D test, also called 25 (OH)D.  This measures the active form circulating in your blood.  There is also a 125 Dihydroxy D test, also called a or 1,25(OH)(2)D. Studies show that the Vitamin D, 1,25 Dihydroxy level does not significantly change until the normal Vitamin D level, or 25(OH)D, drops to severely low levels.  If you get the wrong test, it will look like your levels are normal until you are severely deficient.

Then there are two ways to express the results of the test.  In the US, results are expressed as nanograms/mililiter.  In other countries the results are expressed in nanomoles/liter. 1 ng/ml = 2.5 nmol/L    25 hydroxy D lab ranges of 20-56 ng/ml are the equivalent of 50-140 nmol/L.

When you get your lab values back, they tend to have reference ranges labeled “high,” “medium,” and “low.”  Ignore those and ask for the number.  These are average ranges of people who are apparently in good health and get blood tests.  If you have a population where most people are deficient, the average reference ranges are too low. Based upon the newest research, you want levels that are at least 50ng/ml or 140 nmol/L.

According to vitamin D researcher Carole Baggerley, research shows that if we could get Americans to increase their Vitamin D3 levels to 50-80 ng/ml, we could virtually eliminate Type 1 diabetes, reduce breast and co-rectal cancer deaths by 75%, reduce psoriasis by 65%, significantly reduce MS, heart attacks, lymphoma, fibromyalgia and pain and a host of other diseases. This is based on research that did not even look at some of the higher levels indicated by newer research. As you can see in the chart below, only rickets is prevented by the relatively low amounts found in multivitamins.  (You can click on the picture to enlarge the chart.)

vitamin D Deficiency Diseases by Blood Level
Vitamin D Deficiency Diseases by Blood Level

Across the top are increasing blood levels of 25 Hydroxy D.   Down the rows are diseases that were shown to be affected by Vitamin D.  The vertical black line is 25ng/ml, which is the level at which most diseases show some improvement.  Most Americans have levels below 25,  far below those needed for cancer and autoimmune disease prevention on the right side of the line.  This will not protect you.

Various researchers have suggested different levels, although they seem to be climbing over time. Most just look at deficiency without suggesting optimal levels.  John Cannel of the Vitamin D Council suggests a 25 Hydroxy D level of 50-80 ng/ml.  Bruce Hollis defines deficiency under 32 ng/ml although he has suggested higher levels in recent speeches.  So does Ferrari Bishoff.   Dr. Mercola who is not a scientific researcher, suggests 50-65 ng/ml.  The lab reference range that some of my patients are bringing in is between 50-100ng/ml. No credible studies show danger with levels under 200ng/ml and toxicity is often much higher.

It should be noted that there is an innate conservatism about changing reference levels too fast from what most everyone realizes were grossly inadequate levels from the past. But too many people are suffering.

My recommendation, based on the 2007 chart and newer research is that you keep your blood levels of 25 Hydroxy D between 50 and 100 ng/ml ( 125-250 nM/L.)

The amount you would get from a day in the sun, a physiological dose is approximately 25,000 iu.  Because there is so much difference in absorption and use of stores, oral doses for adults can vary from 5,000 iu to 50,000 iu.  You probably need levels over 10,000 iu (under half of a physiological sun dose) to budge deficiency levels, but can taper off after your stores are built up. I personally found that 10,000 iu daily doses of Vitamin D3 in an oil form did not raise my levels above the mid 30s  so take 50,000 iu in the winter, at least until my goal of 60ng/ml can be reached.  Maintenance doses can be considerably lower so long as the person does not have a condition that increases use or impairs absorption into the blood stream. But that is why we test periodically.

Although there is a theoretical possibility of toxicity from a fat soluble vitamin, this is virtually never seen with Vitamin D in people without specific diseases.  You cannot overdose on Vitamin D from the sun because your body will break down the excess.  Aside from people who suffer from hyperparathyroidism, sarcoidosis, lupus or abnormal calcification, problems from too much Vitamin D are not found under levels of 200ng/ml.  (A single study which is widely believed implausible because it is out of range of other studies showed kidney stones at 150ng/ml, but most researchers disregard it.) And in one case where someone took a million iu per day because he had undiluted powder, a month of sunblock, a diuretic and ceasing the supplementation took him out of toxicity without lasting problems.  Researchers believe that Vitamin D3 (cholecalciferol) may be less likely to cause problems than D2 (ergocalciferol) in large doses.

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How to Make the Most (Vitamin D) from the Summer Sun

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Hamasaka Kenmin Sun-beach in Shinonsen, Hyogo ...
Image via Wikipedia

Sun has been rehabilitated.  It isn’t the great killer you thought it was.  In fact, despite 40 years of contrary messages from the dermatological society, it helps protect you from cancer.  And more important, sunlight is the  main way we humans get Vitamin D, the lifesaving hormone that is used to prevent cancer, heart disease, MS, diabetes, fibromyalgia, osteomalacia and rickets.

We make the Vitamin D in oils on our skin when the sun is directly overhead.  That means you don’t want to block the sun then, or to wash it off.  A SPF15  sunscreen blocks 99% of all vitamin D production.  And it is usually filled with chemicals, nanoparticles and other things you don’t want to absorb through your largest organ.  Most sunscreens have avobenzone, benzphenone, ethoxycinnamate, PABA and similar chemicals that are known free radical generators and believed to damage DNA or lead to cancers.  They often contain phthalates which are endocrine disruptors.
But you don’t want to burn, because that IS as dangerous as your dermatologist says.  So what to do?

  • The Vitamin D is made between 11 and 1:00, or when your shadow is shorter than you are.  In the south you have a longer time than the north.  Before that time, if you are out, cover your skin with clothing.
  • Don’t wear makeup, even mineral makeup, because virtually all of them have a skin protection factor that blocks the sun. Ditto the daytime moisturizers.  Use a night cream or a pure oil like coconut or sesame oils to moisturize.  Yes, you can wear eye makeup if you feel unglamorous without foundation.  And if enough skin is exposed to get your Vitamin D, you can protect your face.
  • Remove the clothing when your shadow gets short.  Spend 10-20 minutes in the sun, not enough to tan or burn, but enough to slightly pink up.  If you have dark skin you may need three times as long to get enough Vitamin D.  The same goes if you block more than 40% of your skin with clothing.  But don’t try to get it all on the first day.
  • At this point you can use a safe natural sunblock, or rely upon clothing to cover your skin.  Find one with zinc oxide or a similar barrier in a natural oil.  You do NOT want to get burned.  And yes, you can put on your makeup now.
  • If you are getting your sun on a city street, be aware that the angle of the sun may be cut off by tall buildings, reducing your Vitamin D production to high noon.
  • If you are swimming at the beach, don’t immediately wash off the salt water.  Let your skin absorb trace minerals while it makes the Vitamin D.  The longer you go without rinsing the skin exposed for making Vitamin D, the more you will make.
  • Wash with water only in the exposed areas.  You can wash under your arms, around your groin and skin folds with some soap, but try to keep it from dripping on your legs and arms.  Keep the soap off for 48 hours.
  • If your hair is frizzy after a day in the sun, you can use a tiny amount of oil, conditioner or a hair masque and rub it through your hair.  Shampoo after the 48 hours have passed.
  • Your body will not make too much vitamin D.  You can overdose on oral vitamin D, although it is really hard, but not from the sun.  You can get sunburn on the other hand, and you really do not want to.
  • While squamous cell cancer, the most common and most easily removed cancer is more prevalent with sun exposure, malignant melanoma usually occurs in areas hidden from the sun and is more common in indoor workers than outdoor workers.  The rest of the cancers, the ones that can kill you, have lower incidence rates and recurrence rates if the blood level of Vitamin D is over 50ng/ml, which shows “high” in most lab reference ranges, but is the preferred  base level according to the new research.
  • Enjoy your summer.  You are building up your Vitamin D reserves to take you through the winter.  And getting other inputs from colors in the light spectrum that we usually miss indoors.  So get some sun before you block it.

See Related Posts:

Vitamin D Regulates the Immune System

Nursing Mothers, Infants and Vitamin D

How to Get Vitamin D from the Sun

And More On Vitamin D

Vitamin D Prevents Cancer, Type 1 Diabetes, MS, Heart Attack and Pain

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