“In our practice, it is common to see patients treated with vitamin D supplements who do not achieve an appreciable rise in their serum 25OHD level after therapy despite large prescribed doses.

A consistent increase of 50% or greater was seen in the serum 25OHD concentration when patients consumed the vitamin with the largest daily meal.”

-Drs. Angelo Licata, MD, PhD. and Guy B. Mulligan, MD., Cleveland Clinic Foundation Metabolic Bone Clinic, “Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D”, J Bone Miner Res Feb. 8, 2010 (ahead of print)-

Click Here for the web version of this post (and all the links) if you’ve received post this via email.

OK, we all know by now how important it is to raise our vitamin D levels to “optimally” around 50 ng/mL–or at the very least to 32 ng/mL.  If you need a refresher in the importance of vitamin D, click here, here, and here.

But guess what?  It’s easier said than done.  I, for one, have found out how slowly those levels really do rise. So what’s a person to do–especially if you aren’t able to get out into the sun 3 times a week?

All I can say is, “Thank you Dr. Angelo Licata for devising this simple, straightforward research project that’s provided an answer for all of us!  From now on, I’m taking my vitamin D with my dinner.  No more taking it on an empty stomach, on the fly, in between meals!”

Licata and Mulligan figured that since vitamin D is fat-soluble, absorption just might improve if patients took their supplements with their largest meal of the day!  How simple is that?  See the Iowa State salad dressing/vitamin absorption study

Who participated in this study?  There were 17 patients, a mix of men & women, with an average age of 64.5, and an average 25OHD level of 30.5.  All were being seen at the clinic for vitamin D deficiency, and they were selected for this study because they were unable to achieve adequate increases in their vitamin D levels despite taking vitamin D supplements.  Turns out, all of these patients were taking their vitamin D either on an empty stomach, or with a small meal, usually breakfast or lunch.

This was great mix of patients.  Because of different factors, some were on “average” doses of vitamin D, and some were on megadoses.  Some were taking D2.  Some were taking D3.  Some were taking an oil preparation.  Some were taking a solid preparation.  And all were having difficulty getting their levels up to optimal levels.

• One group was taking about 1,400 IUs of vitamin D3 (either oil or solid capsule) a day, with a baseline 25OHD averaging 28.9
• One group was taking 50,000 IUs of vitamin D2 (oil preparation) per week with a baseline 25OHD averaging 31.3
• One small group of 3 was taking >50,000 (average dose of 183,333 IUs a week) IUs of vitamin D2 (an oil preparation) per week with a baseline 25OHD averaging 32.4

What were the participants asked to do?  All 17 participants were told to keep taking their usual vitamin D supplement, but take it with their largest meal of the day, usually dinner. 

And the envelope, please.  After 2-3 months the participants had their 25OHD levels measured, and everyone ended up with an amazing average increase of around 50% over baseline in their vitamin D levels. 

• The 1,400 IUs of D3 folks went from 28.9 before to 45.4 ng/mL after.
• The 50,000 IUs of D2 folks went from 31.3 before to 48.3 ng/mL after.
• The >50,000 IUs of D2 folks went from 32.4 to 48.7 ng/mL after.

Big point:  the type of vitamin D preparation taken made no difference–whether it was D2 or D3–oil or solid.  All three groups achieved increases over baseline of around 50%.

Why concerns about taking high doses of vitamin D are unfounded.  Why a Doctors’ Care is Critical.

According to Drs. Licata and Mulligan, some patients clearly require very large doses of vitamin D to achieve a mid-range  level.  They recognize that many physicians are concerned about vitamin D toxicity at such high levels.

“However, it is not the dose prescribed alone which should be considered, but how much is actually absorbed.  Some patients require very large doses to achieve mid-normal levels.  Monitoring the serum level is critical. 

A recent study (click here) indicates that serum concentrations of 25OHD only in the high-normal reference interval prevents non-vertebral fracture.  (normal range: 31-80 ng/ML)

Hence, striving to achieve this level (i.e. ~50 ng/mL) may be optimal, rather than a level at the low-end of the normal range.“

Thoughts about Citracal:  In light of Dr. Licata’s study, I couldn’t help but think about how many women depend upon getting their vitamin D from Citracal–the calcium/vitamin D capsule that prides itself on being easy-to-take-and-absorbable on an empty stomach!

Limitations to the study:  This study was small, there wasn’t a control group, and there wasn’t a way for the researchers to “know exactly how the patients took their supplements.” 

“But despite of these limitations, “the results are striking, and consistent across a heterogeneous group of patients (ie different disease states and different preparations and doses of vitamin D).  

It therefore seems reasonable to ask patients to take vitamin D supplements with their largest meal, as it may be a cost-effective strategy that could very well help patients achieve optimal serum levels of 25OHD.”

“About twenty years ago, researchers found the missing link.

They discovered
that colorful plant foods in their natural state were also rich in
thousands of compounds with important health properties for
humans—phytochemicals.

Only by eating an assortment of natural foods that
are micronutrient-rich can you get enough of these compounds to protect
yourself from the common diseases that afflict Americans.”

-Dr. Joel Fuhrman, author of “Eat to Live–

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On the long drive to New York City 2 weeks ago I brought along some light reading and listening material to fill my time:

• The March issue of The Oprah Magazine.  I zoned right into: Nina Planck’s brilliant article: “Are Organics Worth Their Price”
•  Keri Glassman’s The O2 Diet: The Cutting Edge Antioxidant-Based Program That Will Make You Healthy, Thin, and Beautiful  OK– I agree, this is a terrible title, and I could care less about the thin & beautiful part (not going to happen)–but her user-friendly ORAC (oxygen radical absorbance capacity) rankings of common foods–and her easy-to-understand plan to kick up our daily intake of health-giving antioxidants makes this book definitely worth your while.  
• NPR’s Your Health Podcast from 7/27/09 The Nutrient Detectives–How Do They Know?  I had listened to this 7 months ago–and what a serendipitous surprise that I chose to give it a “re-listen”!

A magazine, a popular book, and a podcast.  End result:  I increased my understanding of the benefits of antioxidants and organic produce, I learned the best way to eat my fruits and veggies (who knew?), and I now have Glassman’s terrific cheat sheet for plotting a way to get her recommended 30,000 ORAC points a day–it’s an easy method to make sure I get the most bang for my nutritional buck.

Because of my car ride “entertainment“–O, NPR, & the O2 Diet–I’ve added, subtracted, and rejiggered some of my daily diet routines.  I’ve added 3 cups of green tea, for one–and I’m following up tough work-outs with an antioxidant-rich smoothie & extra sleep.  Plus, I’m making an effort to include lots of cinnamon, curcumin, and oregano into my cooking.

Lots of info to share–so I’ll just cover the “what’s new to me” highlights.

NIna Planck is both a food writer, and an advocate of “real food”, farmer’s markets, and organic produce.  She wrote her article in O in response to a report released last year by the British Food Standards Agency that pronounced organic food to be no more nutritious than the conventional variety.  Organic advocates claimed the report was flawed, incomplete, and biased.

Here’s Planck’s case for organic produce:

• The French Agency for Food Safety:  organics have more antioxidants, heart-healthy polyunsaturated fatty acids, iron and magnesium than conventionals
• The British Food Standard’s Agency:  organics have more magnesium, zinc, antioxidant phytochemicals, like polyphenols & flavonoids than conventionals
• A 5-year 33 university study sponsored by the European Commission–believed to be the largest study of its kind–found organic cabbage & potatoes have more vitamin C–and organic tomatoes have more nutrients overall. 

My eye-opening finding from Planck’s article:  How Using No Pesticides Increases the Antioxidant Content of Fruits & Vegetables

“A lack of pesticide exposure is an important reason organic produce has higher levels of beneficial antioxidants like vitamin C–which fight the free radicals implicated in aging, cancer, and heart disease.

Antioxidants are actually part of a plant’s own defenses.  In fruits and vegetables, these bitter elements help fend off attacks by bugs and fungi.

Organic crops contain more of these compounds because they have to work harder to protect themselves–with no man-made pesticides to the rescue.

In addition, organic produce is free of synthetic nitrogen fertilizer, which can also weaken plants’ health.  Nitrogen produces a watery, sugary cell sap that compromises the plant’s ability to build its immune system.

Plants that come to rely on the chemical can no longer fend off pests naturally.  Crops that are treated with the synthetic fertilizer also have overly leafy growth and poor flavor, as farmers have long known.  That’s because the plants’ natural immune system of antioxidants is what makes produce aromatic and savory.

In other words, a healthy plant makes a healthy meal–and a tastier one.”

Bottom Line:  Plants do a better job of building up their own immune systems with antioxidants to fight of disease, fungus, and pests when they’re grow organically–without synthetic fertilizers and pesticides.

I don’t usually buy organic–but Planck’s article is making me rethink that habit.

What I Learned From NPR’s  “Your Health” Podcast, “The Nutrient Detectives–How Do They Know?”

1.  The Beta-Carotene Fat Connection:  (Yes–I already mentioned this in the olive oil post) To best absorb antioxidant carotenoids we need a little fat in the form of some nuts, seeds, or olive oil when we eat our fruits & vegetables–according to  Wendy White, a professor Human Nutrition at Iowa State University.

Carotenoids are the pigments responsible for red-, yellow- and
orange-colored fruits and vegetables. And carotenoids are also found in
dark green vegetables such as spinach. The compounds convert to Vitamin
A in the body, and studies have found that carotenoids have
antioxidant activity which may help protect our cells from damage caused
by free radicals.

Human studies have linked high consumption of fruits
and vegetables to reduced risk of cancer.   White’s salad study at Iowa State found that volunteers who ate  full-fat dressing absorbed the most
beta-carotene.  The reduced-fat dressing eaters had substantially less
absorption of beta-carotene.  And the fat-free dressing salad eaters
had no absorption of the beta-carotenes. American Journal of Clinical Nutrition 2004 Aug;80(2):396-403.

“When we chew a salad, we often don’t do an efficient  job of crushing every cell;  about 70-90% of the cells are not broken open.  As a result most of the valuable nutrients contained within those cells never enter our bloodstream and are lost.

An even more efficient way to ensure you receive these needed nutrients is using a blender (think VitaMix) to puree raw, leafy greens.  The blending process aids your body in the work of breaking down and assimilating nutrients.  It guarantees that a higher percentage of nutrients will be absorbed into your bloodstream.”

-Dr. Joel Fuhrman, Eat For Health–

3.  Raw Isn’t Always Better.  Heat isn’t always destructive to antioxidants.  When it comes to absorbing fruits & vegetables with beta-carotene and lycopene–think carrots and tomatoes–cooking actually aids absorption, because it softens the plant material, and releases their nutrients.  It just so happens that lycopene & beta-carotene are very stable antioxidants that aren’t harmed by heat.

4.  What’s the best cooking method to retain antioxidants?  According to a recent study in the Journal of Food Science click here  microwaving is the winner when it comes to preserving nutrients–because it’s mild, quick, and it preserves the water soluble nutrients like vitamin C & B.  Boiling is the worst method–water is definitely not the cook’s “best friend”.

5.  Measuring the antioxidant content of fruits & vegetables at the USDA Research Center in Beltsville Maryland.  James Harnly is the guy who measures the phytonutrients for the USDA ORAC Index–using a complicated freezing, drying, grinding, liquid chromatography process.   It turns out–and most of us already know this–the fruits and vegetables with the highest antioxidant content are blueberries for their flavonoids; the Brassica family vegetables, like kale, cauliflower, and broccoli; the deep purple vegetables like eggplant for their anthocyanins; and apples for the flavonols in their skin. 

According to Harnly, when it comes to most fruits–the flavonoids are mostly in their skins–think apple & orange peels.  Whatever you do–don’t throw away the peels.   Although researchers know that antioxidants are beneficial, how they work to prevent and neutralize free-radical damage is still an unknown.  Harnly guesses that it will likely turn out to be part of some sophisticated cascading effect going on in the body–that needs antioxidants to get started.

Using Keri Glassman’s O2 Diet and Her ORAC Lists to Fine-Tune Your Diet

I just happened upon Glassman’s book while browsing the New Book shelf at my local public library.  She’s a registered dietitian with a New York City nutrition practice, and she’s also a nutrition contributor to the CBS Early Show.

What’s the ORAC Index anyway?  The ORAC Index was
developed by the U. S. Department of Agriculture with the help of the
top nutrition scientists in the country.  It ranks 277 foods by
antioxidant content–their ability to either destroy or neutralize
disease-causing free radicals.  Since oxidative stress caused by free radicals is likely to be one of the factors which plays an important role in the development of chronic and degenerative diseases, such as cancer, heart disease, and neuronal degeneration–the ORAC Index is definitely a number to pay attention to
when choosing your foods.  Click here for the USDA ORAC Index Fact Sheet

But if you took a look at the USDA’s ORAC Index of foods you would scratch your head and wonder, “OK, so now what am I supposed to do with this?”  It definitely ranks the foods–but all the foods are ranked using a quantity of 100 grams–a meaningless measurement–nothing close to normal people portions.  It doesn’t give us a clue about how to compare blueberries to apples to spinach in terms of portion size.  But Glassman spells it all out.

Keri Glassman made the ORAC Index usable because she took the USDA numbers and converted them into ounces and then converted them into normal people portions.  Thank you, Keri Glassman!

I love her game plan of using the ORAC Index points to shoot for 30,000 points a day to make sure you’re eating a variety of “high-achieving” fruits, vegetables, legumes, carbohydrates, beverages, and spices everyday.

Why 30,000 Points a Day, You Ask?  Here’s What Glassman Has to Say:

“Researchers have just begun to scratch the surface of antioxidant research; there are now literally hundreds of studies linking antioxidant-rich foods to better health, including everything from reduced heart disease to a decreased likelihood of cancer.

And while taking too many antioxidant supplements in pill form may be harmful, there’s absolutely no downside to consuming more nutrient-dense fruits and vegetables.  Although the current recommendations are that we eat between 3,000 and 5,000 ORAC points a day for optimum health, why not get all you can?

Eating
30,000 ORAC points will boost the antioxidant power of your blood at
least 10 to 25% percent according to some of the original ORAC
research.  Click here

Don’t forget that you still need to eat a balanced diet.  Sure you could get to 30,000 easily on nothing but artichokes, blueberries, and hot cocoa.  But that’s not a balanced diet, and you’d be cheating yourself out of the wide variety of nutrients out there.”

• Drink a Green Smoothie!  I calculated that my daily smoothie made with 1/2 an apple, 1/2 a grapefruit, 3 cups of kale, 1/2 cup of blueberries, 1/2 of a kiwi, 1/4 cup of pomegranate juice, and 2 carrots, comes to about 17,710 points!  Who knew?

• Add 3 cups of green tea a day for 9,000 more points.  I’ve never been a tea drinker until now & the scientific research on the benefits of green tea is extensive.

• Add a cup a black beans for 15,600 additional points.  Kidney beans, pinto beans, & lentils–they’re all outrageously high in ORAC points.

Great tips from the O2 Diet

• Intense exercise actually weakens your immune system, putting you at risk for getting sick for a full 72 hours  after each workout–so, to counteract the effect of an intense workout– Glassman recommends increasing your antioxidant intake to 50,000 points and getting an extra half hour of sleep.  Sounds like a plan.

• Oatmeal is brain food.  This complex carbohydrate helps to produce the feel-good chemical serotonin which has antioxidant properties, and helps ease that “stress-out” feeling.  Studies show that kids who eat oatmeal (with 600 ORAC points) for breakfast stay sharper throughout the morning.  No wonder I love my morning crockpot steel cut oats–made with dried fruit that kick up the ORAC points another notch!  Click here for the recipe

• Turmeric/Curcumin, the spice that gives curry its yellow color is a well-known antioxidant--which not only helps in the prevention of Alzheimers, it’s recently been shown to reverse impaired cognition and neuronal plasticity caused by stress.  Click here  Turmeric clocks in at 3,500 ORAC points per teaspoon.  I’ve been taking a 500 mg capsule of curcumin daily, ever since a Columbia University neurologist specializing in Alzheimers told me he takes a teaspoon of turmeric a day.

“The weight-bearing yoga training had a positive effect on bone by slowing down bone resorption which was a very essential indicator for human health because it reduced the osteoporosis risks in this group of postmenopausal women.”

-Phoosuwan, M. et al.  “The Effects of Weight Bearing Yoga Training on the Bone Resorption Markers of the Postmenopausal Women”  J Med Assoc Thai 2009; 92(Suppl. 5):S102-8

“Physical activity is profoundly beneficial to bone health & every study that has looked at this has shown a much lower risk of fracture among people who are physically active.”

“This really applies to the bones that are exercised–the bones that are stressed.  Walking & other weight-bearing exercise reduce rates of hip fracture–but may not do much for wrist fracture, so we need other exercises for our upper body bones to keep them strong.”

—Walter Willett, MD, DrPH, is Chairman of the Department of Nutrition
and Frederick John Stare Professor of Epidemiology and Nutrition at
Harvard University’s School of Public Health—

Click here if you’ve received this post via email to get to the web version with all the links.

I’ve been wondering for awhile about the connection between yoga & bone-strengthening.  Here’s why.  

• My high school friend Sheila is petite, small-boned, very thin, and osteopenic.  She’s sees a rheumatology/osteoporosis specialist, takes bone-strengthening meds and yet she still continued to lose bone density.  When she switched her exercise routine to include a power-sculpt class & yoga she started to see improvements.  She doesn’t know if it’s because of the yoga or the weights, so she’s not about to stop either.

• My college friend Cindy is small-boned, thin, and osteopenic.  She sees an endocrinology/osteoporosis specialist, takes bone-strengthening meds, and recently noticed improvements in the bone density of her wrists–while here hip and spine remained stable.  She wondered if her more regular attendance at yoga classes could be responsible–and the downward-facing dog pose, in particular.

• My yoga teacher mentioned 3 weeks ago that before she started to practice yoga regularly her bone density scan put her in the osteopenic range.  After a few years of regular yoga practice she  moved solidly into the normal bone density range.

Is it really possible that a regular yoga practice can improve one’s bone density?  I decided to see if I could find a yoga/bone strength connection in the medical literature. 

Makes sense to my lay-person understanding of bones. 

“Bones are similar to muscles.  Use muscles, and they become bigger and stronger.  Stop using them, and they weaken and atrophy.  Like muscles, when bones are used–when they support weight or carry a load (within reason)–they get stronger.

When bones bear weight, they experience strain.  Strain produces microscopic weak spots.  As those weak spots develop, the bone cells in the vicinity release chemicals that signal the body:  Weak spot!  Send help! 

Bone-clearing osteoclasts converge on the problem area and dissolve the weakened bone.  Then osteoblasts migrate from nearby bone marrow, enter the tiny breach, and create new bone. 

Normal strain stimulates the creation of new, strong robust bone.  In other words: weight-bearing activities give bones a reason to thrive.

–Amy Lanou, PhD & Michael Castleman, Building Bone Vitality.  NY:McGraw-Hill, 2009.  pgs. 154-155.–

Full Disclosure:  Lanou & Castleman are huge advocates of walking outdoors–up & down hills, or up & down stairs, or carrying a load–as a dynamic bone-strengthening exercise.  Dr. Walter Willett is also a big fan of walking for bone health–but he says it strengthens the hip primarily, and we need to stress all the bones in the body.  That’s where yoga enters the picture.

Searching the Medical Literature for the Yoga/Bone Strengthening Connection

As crazy as it sounds there is next to nothing written on this subject.  But, I did come across one well-constructed preliminary report published in 2009 in the Journal of the Medical Association of Thailand, of all places.  Click here for the article

Before writing this post, I went back to PubMed and bingo, there’s a brand new pre-publication article–hot-off-the-press, called, “Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis,”  Tuzun, S. et al,  European Journal of Physical and Rehabilitation Medicine.  Click here to read the full article.

If you are reading this post you will probably be one of the few people in the country who will have heard about this article.  The Journal of the Medical Association of Thailand can be found in only 12 libraries in the U.S.  With over 5000 medical journals currently competing for attention the odds are slim that this preliminary report will get much notice by anyone.

The Cliff Notes on the Thailand Study

What happens to the bones of women once estrogen walks out of their lives?   Bone resorption begins, and new bone formation decreases.  And we all know what that means.

Knowing that weight-bearing exercises like jogging, walking, and aerobic dancing benefit bone, the author’s of this study set out to see if 5 yoga poses would have a similar positive effect.

• Tree Pose
• Downward Facing Dog Pose
• Warrior III Pose
• Triangle Pose
• Half Moon Pose

Who was in the study:  33 healthy, postmenopausal women, between the ages of 50-60 years old.  None of them smoked, drank alcohol, used hormone replacement therapy, or drank more than 2 cups of coffee a day.  No one exercised more than twice a week.  No one had osteoporosis, or a bone mineral density of -2.5

Who did what in the study:  19 women chose to take the weight-bearing yoga training class.  14 women preferred to join the control group, and just continue with their “normal lives.”

The Before & After Tests:  Everyone had a blood tests to measure measure their biochemical bone markers.  This included the Beta-CrossLaps Test, which measures bone resorption and is used to monitor antiresorptive therapies (eg, bisphosphonates (click here to learn more), and the P1NP Test, which measures bone formation markers.  Quality of life was also measured with the SF-36 questionnaire, but that isn’t my interest here.

The yoga routine for the study:  10 minutes of stretching before and after yoga, to prevent injury.  The group practiced for 50 minutes, 3 times a week, for 12 weeks.  They performed 3 sets of 6 yoga poses. 

This description seems unclear to me, since the authors only discuss 5 poses–but that’s how it’s written up in the article.

The Results:  After 12 weeks the bone resorption markers (Beta-CrossLaps) of the control group & the yoga group were significantly different (p = .0003).  More importantly, the bone resorption marker of the yoga group was significantly reduced by -26.939% from when they started, compared to the control group’s reduction of only -0.77.1%  That means, the markers for bone loss of the yogis was significantly reduced and those yoga poses were clearly having a positive effect on the control group’s bones.

What does the improvement in the yoga group mean?  It implies that weight-bearing yoga training could reduce the rate of bone loss in postmenopausal women, and decrease the risk of osteoporosis.

Why does it work?  The poses (postures) used in this study put appropriate and equal stress on a variety of bones throughout the body–the hips, the wrists, the spine, and the arms.  For example, in some poses the participants had to stand on one leg, forcing that leg to bear all the weight of the body–using more leg-muscle contraction to obtain better balance.  That muscle force stresses the bone and kicks in the whole bone remodeling process that is so well explained above by Lanou & Castleman.

Downward Facing Dog Pose and Half Moon Pose stress the bones of the upper body, such as the chest, the back, arms, and wrists.  Tree Pose and Warrior III stress the leg and hip bones.  Triangle Pose stresses the back, hip, and legs.  Doing all 5 poses continuously, and repetitively 3 times a week was enough to wake up the the body’s bone remodeling system–resulting in a significant reduction of bone resorption/loss.

Anyone who regularly practices yoga would probably agree that there are far more than 5 poses that put stress on one’s bones, muscles, and balance–and often far more than a free weight work-out.  Plank pose, Chaturitanga, Up Dog, Eagle Pose, and toe balances–to name a few.

The Yoga Poses Used in the Study

Take Away Point:  This was just a preliminary study, but certainly the results seem promising to me.  Combined with the N=3 experience of my 2 friends & my yoga teacher–maybe yoga has real promise as a way to stave off osteoporosis, de-stress, and improve balance all at the same time.  A 3-for-one exercise.

Don’t Miss This Story of “How a Bone Disease Grew to Fit the Prescription”, by NPR’s Alix Spiegel.  Click here to read or listen to the story.  You can even read the full transcript if you don’t want to miss any of it. 

This first class piece of journalism will open your eyes to the whole controversy of whether or not osteopenia is a disease that needs to be treated with a drug.  I’m choosing treatment with yoga, walking, weight-training, vitamin D, and lots of vegetables, especially the greens, and fruit.  More on this later!

Do any yogis out there have some positive bone density scans to add validity to the Thailand study?  I’d love to hear about it.

“What looks to me now, based on the science we have, what really counts in your 40’s  is to maintain a well integrated life of moderation, intellectual growth, and physical activity and you will probably reduce your risk substantially for Alzheimer’s Disease.”

-Dr. Randolph Schiffer, Director, Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, NV-

If you’re receiving this via email click here to get to the web version of this post and all the links.

Lucky me.  If I hadn’t switched my work schedule, and decided to go to that early Monday morning yoga class I never would have had the chance to hear Dr. Randy Schiffer’s NPR/WCPN interview on the Prevention of Alzheimer’s Disease and Dementia.  Anything I can do to protect my brain is something I want to hear about.   Click here if you’d like to listen to the interview.

The Lou Ruvo Center for Brain Health was built as a center for the research, treatment, and prevention of brain diseases–and Schiffer is at the forefront of treating the earliest stages of dementia–what’s known as Age-Associated Cognitive Impairment (AACI) and Mild Cognitive Impairment (MCI)–and preventing their escalation into Alzheimer’s Disease and dementia.

If I Have Alzheimer’s Disease in My Family History What Can I Do Now to Prevent It?

The best thing you can do is work on improving your cardiovascular risk factors

• Get regular physical exercise
• Get your blood pressure under control
• Get your cholesterol levels to a healthy number
• Get your blood glucose levels to a healthy number
• Improve your diet with lower fat, increased fruits & vegetables, increased anti-oxidants and phytonutrients

What’s the connection between cardiovascular risk factors and brain health?

Cardiovascular diseases and the Alzheimer/brain diseases share similar blood vessel pathologies.  OK, Schiffer admits we lack the exact kind of science we’d like to have concerning this connection–but the science is extensive showing that risk factors like elevated blood pressure, elevated blood glucose, and elevated cholesterol are all robust predictors of cognitive impairment.  What the Ruvo Center hopes to determine is a direct correlation between lowering these risk factors and lessening dementia.

Tell me more?  What’s the connection between the tiny blood vessels in the brain & Alzheimer’s?

In the old days doctors said dementia was caused by “hardening of the arteries”, and then that went out of fashion.  In fact, years ago, Schiffer snickered at that explanation.  He’s not snickering anymore.  We now know that Alzheimer’s is partly driven by the pathology of the tiny blood vessels of the brain. 

Here’s what happens.  Think inflammation & oxidative stress in the brain.  In early Alzheimer’s there are a number of changes in the brain that are caused by the body trying to fight off free-radical damage and oxidative stress–and this results in inflammation of the blood vessels of the brain–which leads to brain cell damage.  And the causes of this inflammation in the brain’s blood vessels are the same as the causes of inflammation in the cardiovascular system.  What’s good for the heart is good for the brain.  Think exercise, blood glucose control, blood pressure control, and eating foods high in antioxidants.  Click here to read more about lowering inflammation.

What else can I do to control the risk of getting dementia or Alzheimer’s in addition to controlling cardiovascular risk factors?

• Keep physically active
• Keep mentally active in a way that causes you to learn new tricks & new information
• Avoid depression–or get it treated.  Depression later-in-life correlates with twice the risk of developing Alzheimer’s
• Maintain your social networks  Click here to read more
• Drink some red wine in moderation  (OK red wine is high in polyphenols, and there is lots of research to back this up, but I’m wondering if it’s a bit of a coincidence that this is the only “food” Dr. Schiffer mentions, and the fact that the Ruvo family is Nevada’s largest wine, spirits, beer, and beverage distribution company)

Is there any connection between toxins in the environment and Alzheimer’s?

Schiffer says no.  The old aluminum theory originated by Linus Pauling over 30 years ago is history.  Turns out that yes, there is increased aluminum in some of the plaques and tangles of the Alzheimer’s brain–but now we know that aluminum just “goes into areas of injury”.  It isn’t the cause of the injury.  It also appears in the brains of stroke patients, and in brain tumors.

Schiffer also doesn’t think it’s likely that BPA from plastics is a player in Alzheimer’s.  I have heard Alzheimer’s expert Dr. Peter Whitehouse propose the theory of lead as a cause of Alzheimer’s, and the research is compelling.  Click here to read more.

What about the “plaques and tangles” theory of Alzheimer’s?  Isn’t that the cause of dementia?

Yes, plaques and tangles were the oldest objective evidence that Alzheimer’s was a neurological disease, and they’ve seen for years.  But, even though they are a partial marker of “risk” for Alzheimer’s–here’s the problem with the “plaque-and-tangle” theory.   Many people will die and have a brain full of plaques and tangles, and still have normal cognition.  Some people will have full-blown Alzheimer’s and have very few plaques and tangles.  According to Schiffer, the relationship between those traditional Alzheimer neuro-pathologies and the clinical disease is not very strong.

Tell me more about how learning new things can help prevent Alzheimer’s?

Schiffer says you need to make sure you engage in some kind of lifelong learning process–learning new tricks causes the brain to add new synapses, it produces new brain cells, and it enables new regions of the brain to acquire new functions.

Here’s a big tip:  If the the learning isn’t difficult it won’t work.  So quit complaining & stretch yourself outside of your comfort zone.  

Here’s how learning something new changes the brain:  The 2nd Nobel Prize ever won in the field of psychiatry was awarded a few years ago for the discovery of how the brain cells in snails change when they learn something new.  Now snails only have 8-12 brain cells, but when they learn something new the firing pattern of their brain cells changes in a structural way–just like putting a new software program  into a computer.

There are fixed measurable changes that occur when you learn new things, and it’s thought that in the earliest stages of Alzheimer’s these network connections of brain patterns–how the cells talk to one another–are the first brain connections to start failing.  The theory is that strengthening these connections, and building new networks will stave off cognitive decline

Read my “Stretching in St. Louis” post to see what Dr. Schiffer is talking about.   And Dr. Norman Doidge’s quote about middle-age that I posted 2 weeks ago bears repeating:

“We rarely engage in tasks in which we must focus our attention as closely as we did when we were younger, trying to learn a new vocabulary or master new skills.

Such activities as reading the newspaper, practicing a profession of many years, and speaking our own language are mostly the replay of mastered skills, not learning.

By the time we hit our seventies, we many not have systematically engaged the systems in the brain that regulate plasticity for fifty years.

That’s why learning a new language in old age is so good for improving and maintaining the memory generally.  Because it requires intense focus, studying a new language turns on the control system for plasticity and keeps it in good shape laying down sharp memories of all kinds.  And it keeps up the production of acetylcholine and dopamine.

Anything that requires highly focused attention will help that system–learning new physical activities that require concentration, solving challenging puzzles, or making a career change that requires that you master new skills and material.”

How far do you have to go with learning new things?  What about learning a short poem, or learning about science from an interview like this?

According to Dr. Schiffer, we know it has to be something challenging, but everyone is different.  The key thing is that it has to be “active” learning, and it has to be in a new area–you have to push your brain to learn something new.  Right now the Ruvo Center is working on research to figure out which learning tasks are the best to improve specific memory deficits.  They’re now using prescriptive learning tasks in visual memory, word recall, auditory recall, and in complex story reading.  To learn more about “cognitive training” check out the work of Dr. Michael Merzenich–a leader in the study of brain plasticity & a developer of “brain training” software–click here.

What’s Different About the Treatment Approach at the Lou Ruvo Center?

The Center takes a multi-modal approach to treating early dementia.  It’s dedicated to the proposition that cognitive brain disorders of later life are treatable–and the Center’s purpose is to improve upon those treatments.

• Medication when appropriate
• Lowering cardiovascular risk factors like high blood pressure, cholesterol levels, obesity, elevated blood glucose levels
• Incorporating physical exercise
• Targeted cognitive strengthening exercises based on an individual’s particular weaknesses–similar to strengthening weak quadriceps.
• Treatment of depression when appropriate
• Nutritional counseling

What’s the Typical Work-up When Someone Comes to the Center Complaining of Some Memory Loss?

• The first step is determine a correct diagnosis, even though Alzheimer’s is the most common cause of memory loss.
• The standard evaluation is an old-fashioned clinical history and physical examination.  This also includes a cognitive assessment battery, and some screening laboratory tests.
• According to Dr. Schiffer, even though the Center makes use of advanced brain imaging & technologies, in the early stages of Age-Associated Cognitive Impairment and Mild Cognitive Impairment, imaging will unlikely show any changes.  This is a slow acting disease, and imaging falls far short of the sensitivity of a good history and physical examination.
• When the diagnostics are complete, the staff has a consensus meeting to determine the diagnosis and the best approach to treatment.
• Schiffer believes that these disorders are treatable & there’s ample evidence to support treatment with a multi-modal approach.

How do you know when an aging parent–or yourself–is having “abnormal” memory problems?

By the way, Schiffer says that now that he is losing his keys & cellphone, he doesn’t consider that to be abnormal behavior.  So, how do we know what’s going to become dementia, or what’s going to just “stay the same”?  The short answer–we don’t know yet.  When you run cognitive tests on  someone in the category of AACI (Age-Associated Cognitive Impairment) they’re going to come out as “normal”.  But, they are having changes in their thinking. 

Schiffer tells his younger physicians that a good rule of thumb is, “Anyone who comes in to see us–by definition, if they cross that threshold & complain about their memory–they’re not normal.  We are not yet able to “see or detect” what’s going on in their brains–but people don’t come in unless something’s going wrong.”

Lest you get worried about this comment, remember, Schiffer is a believer in a multi-modal approach to improving brain health, and preventing unnecessary decline.  You can’t argue with that! 

You’ll have to excuse me now, while I down a glass of wild blueberry juice, and take off for my Spinning Class.  I’ve already exercised my brain enough, listening to Schiffer, and writing this post!!!!

“Researchers have begun to focus on a different, often more subtle kind of wordless communication: Physical contact.  Momentary touches, they say–whether an exuberant high five, a warm hand on the shoulder, or a creepy touch to the arm–can communicate an even wider range of emotion than gestures or expressions, and sometimes do so more quickly and accurately than words.”

“It is the first language we learn, our richest means of emotional expression throughout life.”

–Mind: Evidence That Little Touches Do Mean So Much, by Benedict Carey, New York Times, February 23, 2010-

If you are receiving this via email, click here to go to the web version of this post to get all the links.

A few weeks ago one of the research psychologists where I work told me that everyone in her department is convinced about the power of massage.  And not for relieving muscle aches.  She said massage produces so many positive hormones–like oxytocin–and lowers negative ones–like cortisol, that she considers it preventive medicine, not a luxury. 

She has a monthly standing appointment for herself–having seen the tremendous benefits of massage on patients with chronic pain and heart failure.

I’ve been sharing her story with all my friends–and after reading Benedict Carey’s story on the benefits of touch in yesterday’s New York Times–I’m sharing both, with you.  Read Carey’s short piece, and I guarantee you won’t think about a hand on the shoulder in the same way ever again.

The Research on Touch

• Students who receive a supportive touch on the back or arm from a teacher are nearly twice as likely to volunteer in class than those who were not touched.
• A sympathetic touch from doctors leaves patients with the impression that the visit lasted twice as long compared to those who were not touched.
• A massage from a loved one can ease pain, soothe depression, and strengthen a relationship.
• The best basketball teams tend to touch more than the worst teams.  The “touchiest” teams are currently the best: the Boston Celtics and the LA Lakers.  And the “touchiest” player in the NBA is Kevin Garnett of the Celtics.  “Within 600 milliseconds of shooting a free throw, Garnett has reached out and touched four guys,”  according to Dr. Dacher Keltner, whose paper on touch in the NBA will be published in May 2010.  And in case you’re wondering–it’s not that the best teams touch more because they are winning–the researchers controlled for this in their study.  But they’re aren’t ready yet to conclude that touch improves performance. 
• Touch  releases oxytocin, the hormone that creates a sense of trust–and it reduces cortisol, the hormone of stress.   Exactly what the research psychologist told me a few weeks ago!
• Couples who touch more have more satisfying relationships.  Take note!   But, it’s not clear yet if there’s a causal effect.

The Science Behind Why We Touch–Why We’re Wired For Touch

• Touch reduces stress–oxytocin is released, we relax, we feel good, we feel bonded. 
• When stress is reduced, the brain is better able to think & problem-solve.
• When we receive a supportive touch, we unconsciously think, “OK, I can share the load.”  Who knew?
• According to psychologist James A. Coan of the University of Virginia, “We think that humans build relationships precisely for this reason, to distribute problem-solving across brains.  We are wired to literally share the processing load, and this is the signal we’re getting when we receive support through touch.”
• Check out the latest research at the January 2010 meeting of the Society for Personality and Social Psychology, “Gimme Five!”  Tactile Communication and its Prosocial Consequences”
  

Now
go out there today and hand out some supportive touches, high-fives,
and hugs.  You just may unwittingly find some volunteers to help you
solve your problems!

"You know you’re getting old when you look up and Judy Collins is 70.  The singer-songwriter, who released her first album at age 22, still performs, almost constantly."   But performing isn’t all Judy is doing!

-"Sunday Routine: She Always Cooks with Onions", by Corey Kilgannon, New York Times February 18, 2010

If you are viewing this via email click here to get to the web version and all the links.

I loved Judy Collins back in 1970.  And I still do.  Both Sides Now.  Send in the Clowns.  And then, what about Crosby, Stills, and Nash’s, Suite: Judy Blue Eyes? 

When I read this delightful glimpse into Judy Collins’ life I thought, "I can’t believe it!  I’m just like Judy Collins." 

Yes, I know,  I can’t sing.  I don’t perform.  I’m not famous.  And I don’t travel 40 weekends out of the year.  But, Judy & I both pack our breakfast, lunch, and dinner when we go to work.  We both love to see movies on the big screen–in theaters–and we’re both fans of Morgan Freeman and Denzel Washington. 

Plus, we both really like cooking dinner–especially on Sundays–and we always start it with browning an onion.

And on Sunday evenings–we both like to just relax, maybe watch a little TV and chill at home.  That’s when Judy also gets in her 60 minutes of exercise.  I do mine in the morning.

Judy Collins’ Secrets to Staying Healthy

"I have a strict food plan and I always prepare my meals, no matter where I am. 

I travel with my meals prepacked in insulated bags, and I carry a scale with me and I’ll weigh and measure my portions. It’s a big enterprise, but it’s necessary. 

I don’t have cravings and I’m never hungry. I only eat what I’m supposed to be eating, because in this line of work, you have to live like an athlete.

(For Sunday movie matinees) I pack my lunch: measured amounts of fruit and yogurt, or cheese and vegetables and dip.

I’ve had a 50-year career and I’m working more than ever.  The word retire is not in my lexicon.

I love that my work has increased rather than decreased.  I can’t find enough hours in the day."  (Judy is also releasing a new CD, "Paradise" in May, and she’s in the middle of writing her memoir.)

My Sunday Supper – Bulgur with Swiss Chard, Chickpeas, and Feta

While Judy was browning onions on Sunday, I was making this easy, delectable, hearty, healthy dish. 

Truth be told, I really made it on Saturday afternoon–because my husband & I went out to eat on Sunday–with some of the same college gang who were also listening to Judy Collins back in 1970.

Back to the recipe.  This is a variation of Martha Rose Shulman’s "Recipes for Health".   It cooked up in a flash, and I made sure that my husband didn’t touch the leftovers so we had supper ready to go after work on Monday.

This casserole has it all!  It’s got bulgur, made from whole grain wheat that’s loaded with fiber–as in 7 grams a serving.  Add in the anti-oxidant vitamin-packed Swiss chard and chickpeas and you’ve got an award-winner. 

*OK–it does have feta, and if you’re a purist you could leave it out–but, honestly, the feta gives this dish  pizazz!   I used a low-fat version from Trader Joe’s (and there’s only 1/2 ounce a serving), but if you want to try your hand at a vegan version, Bryanna Clark Grogan has a recipe for vegan feta.  I even checked with her and she says it’s a winner.  But, that’s for me to try at another time.

photo by Andrew Scrivani for The New York Times

Serves 6

Adapted from Martha Rose Shulman’s recipe in the New York Times, February 8, 2010

1 cup bulgur (medium or coarse grade)

Salt to taste

2 TBS. extra virgin olive oil 

1 pound Swiss chard,  2 inches of the stem ends removed, washed well, and chopped

4 large garlic cloves, finely chopped

One 15-ounce can chickpeas, drained and rinsed (or 1 1/2 cups cooked chickpeas)

1/4 generous cup chopped fresh dill (you can use parsley, but dill is fabulous)

Freshly ground black pepper to taste

3 ounces reduced-fat feta cheese, crumbed or cut in small squares

1. Bring
2 cups water to a boil in a medium saucepan. Add the bulgur and salt to
taste, reduce the heat, cover and simmer 20 minutes or until the water
is absorbed. Remove from the heat and uncover. Place a clean dish towel
over the pan, then replace the lid. Allow to sit undisturbed for 10
minutes.

2. Preheat the oven to 350
degrees. Lightly oil spray a 2-quart baking dish. Toss the cooked bulgur with 1
tablespoon of olive oil and spread in the baking dish in an even layer.

3. Heat
another tablespoon of the olive oil in a large frying pan. Add the
garlic. Cook, stirring, just until fragrant and translucent, 30 seconds
to a minute.  Add the chopped Swiss chard to the pan and lightly saute until wilted and tender.  Don’t overcook.

4. Add the chickpeas and dill into the pan.  Season with salt
and pepper, and toss together.

5. Lay
the chard mixture over the bulgur, gently mixing it lightly into the bulgur. Top with the feta, and gently push
the feta cheese down into this mixture.

6.  Bake covered for 30 minutes or until
sizzling. Serve hot.

Advance preparation: Reconstituted
bulgur keeps well in the refrigerator for three or four days and can be
frozen. Reheat in the oven (350 degrees for 20 minutes), in a pan on
top of the stove or in the microwave. Sauteed chard & garlic will keep for three
days in the refrigerator. You can assemble the dish several hours
before baking. Cover and chill if holding for more than an hour.

Enjoy!  We did!

If you prefer to try Martha’s version with 1/4 cup of oil, click here.

Nutrition Facts HL adapted-Martha Rose Shulman’s Bulgur with Swiss Chard, Chickpeas & Feta
Serving Size: 1 serving
Amount Per Serving
Calories	234
Total Fat	7.8g
Saturated Fat	2.2g
Trans Fat	0g
Cholesterol	5mg
Sodium	374mg
Carbohydrate	33.2g
Dietary Fiber	8.2g
Sugars	1.6g
Protein	10.9g
Vitamin A 73% Vitamin C 30% Calcium    12% Iron 13%

“These preliminary memory findings are encouraging and suggest that consistent supplementation with blueberries may offer an approach to forestall or mitigate neurodegeneration.”

-Robert Krikorian, PhD, University of Cincinnati Academic Health Center, lead author of “Blueberry Supplementation Improves Memory in Older Adults” J Agric Food Chem 2010.

“We now know that exercise activity in animals generate and sustain more brain cells, and we have many studies confirming that humans who lead mentally active lives have better brain function.  But, not all activities are equal in this regard.  Those that involve genuine concentration–challenging mental activities will increase the likelihood that hippocampal neurons will survive.”

–Dr. Norman Doidge, “The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science”

Back in August I wrote a post about the many virtues of blueberries, and discussed Dr. Robert Krikorian’s promising  “not-yet-published” study on the positive effects of blueberry juice on memory.  Click here

• Berry protection for the brain in animal studies.
  Rats who feasted on blueberries and strawberries were able to protect
  their brains when they were irradiated to simulate the kind of
  cognitive & memory damage the brain sustains through normal aging. 
  The interesting point:  the blueberries and strawberries actually
  protected different parts of the brain–so diversify your berry
  munching.
• Blueberries & humans.  Once more, Dr. Robert
  Krikorian is the man doing the research on people.  He has recently
  shown that a number of learning and memory skills improve when humans
  supplement with blueberry juice.  He’s planning to also assess the
  effects of blueberries on behavioral skills.

In January 2010, Robert Krikorian’s blueberry and memory study was published online ahead-of-print and I just had a chance to read through it yesterday.  You’ll find it in the Journal of Agricultural and Food Chemistry  DOI:10/1021/jf9029332

Why it’s a big deal?  It is the first human trial to look at the effects of blueberry supplementation on memory. 

Who was in the study?  This was a small study–it compared nine older adults against a control group of seven, whose average age was 76,  and who had age-related memory decline, like forgetfulness and memory lapses, that put them at risk for dementia.

What kind of blueberry supplement did they take & for how long?  For 12 weeks the trial group drank from 2 to 2 1/2 cups of wild blueberry juice–the amount was based on their body weight.  During the test period everyone had to avoid any additional berries, cherries, grapes, pomegranates, grape juice, or wine to make sure that only blueberry juice was affecting the results.

How were their memories tested?  All the participants took  pre and post tests that measured their memory function–the Verbal Paired Associate Learning Test (V-PAL) and the California Verbal Learning Test (CVLT).  Both tests are good measures of progressive neurodegeneration and are sensitive to both age-related memory changes, as well as early and more advanced Alzheimer’s disease.

So, how did the blueberry juice folks do compared to the fake blueberry juice folks?  Turns out that the blueberry juice definitely improved their memories.  There was significant improvement in the post test of the blueberry juice drinkers, and at the end of the 12-weeks, the blueberry juice group tested significantly better against the placebo group.  After 12 weeks the blueberry group’s  V-PAL cumulative learning test scores went from 9.3 points to 13.2 points.  The scores on their CVLT word list recall improved from 7.2 points to 9.6 points. 

Memory wasn’t the only thing that improved with the blueberry juice.  The researchers also did pre and post tests on depression and fasting glucose levels.  After 12 weeks the blueberry juice drinkers had notable reductions in their depression symptom scores, and their fasting glucose levels were reduced. 

Both of these changes further support the neurocognitive benefit of blueberry juice.  It turns out that the anthocyanins (the polyphenols in blueberries) are not only anti-inflammatory, but they help to “get rid of” excess glucose, which is known to damage the brain–and just might be one of the reasons that blueberries help to improve memory.

How do blueberries benefit the brain?  They contain polyphenolic compounds, most prominently anthocyanins, that have antioxidant and anti-inflammatory properties.  Anthocyanins are known to increase the signaling between neurons in the brain, improve memory function and slow down neurodegeneration.

What happens next?  This was just a first step.  It’s a small study, but the results were encouraging and suggest that consistent supplementation with blueberries may offer an approach to prevent or slow down neurodegeneration.    As every researcher says at the end of their articles–“Replication of the findings in a larger, controlled trial will be important to corroborate and amplify these data.”  Stay tuned.

What am I going to do?  When I was at Trader Joe’s on Sunday, instead of picking up my usual pomegranate juice for my green smoothies, I decided to try a bottle of their Just Blueberry Unfiltered 100% Juice.  It’s not made from wild blueberries, but what the heck.  I think I may also start throwing in some of the Wyler’s Frozen Wild Blueberries into my smoothies as well–alternating with TJ’s Frozen Black Raspberries.  A memory is a terrible thing to lose!

Brain Plasticity in Older Adults.  Why We Need to Continue to Learn New Things

One of the perks of my job is that I get to see what all the top researchers are reading.  A few weeks back one particularly interesting book crossed my desk, “The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science,”  by Dr. Norman Doidge. The book is about neuroplasticity–  how our brains are not static, but can change and improve, even as we age.  Much of this research is credited to Dr. Michael Merzenich who has pioneered computer-learning activities for children, and has recently developed memory-training programs for adults.  Click here to learn more.

Writing this blog has given me a chance to take time out to study, learn, and concentrate on new areas of research–and to understand it well enough to be able to write about it.  Without undergoing any “brain testing” I can tell you that my learning skills and memory have definitely sharpened and improved through blogging.  I’m now a believer in neuroplasticity.

So, in light of my 2 year blogging experience, I was really struck when I read this quote by Merzenich in Doidge’s book:

Merzenich:“We have an intense period of learning in childhood.  Every day is a day of new stuff.  And then, in our early employment, we are intensely engaged in learning and acquiring new skills and abilities.  And more and more as we progress in life we are operating as users of mastered skills and abilities.”

Doidge: “Psychologically, middle age is often an appealing time because, all else being equal, it can be a relatively placid period compared with what has come before.  Our bodies aren’t changing as they did in adolescence; we’re more likely to have a solid sense of who we are and be skilled at a career.  We still regard ourselves as active, but we have a tendency to deceive ourselves into thinking that we are learning as we were before.

We rarely engage in tasks in which we must focus our attention as closely as we did when we were younger, trying to learn a new vocabulary or master new skills.

Such activities as reading the newspaper, practicing a profession of many years, and speaking our own language are mostly the replay of mastered skills, not learning.

By the time we hit our seventies, we many not have systematically engaged the systems in the brain that regulate plasticity for fifty years.

That’s why learning a new language in old age is so good for improving and maintaining the memory generally.  Because it requires intense focus, studying a new language turns on the control system for plasticity and keeps it in good shape laying down sharp memories of all kinds.  And it keeps up the production of acetylcholine and dopamine.

Anything that requires highly focused attention will help that system–learning new physical activities that require concentration, solving challenging puzzles, or making a career change that requires that you master new skills and material.”

So, yes, maybe go ahead and add blueberry juice to your daily diet, but better yet, find something that’s really interesting to you and start learning all about it–even though there won’t be a test on it in 2 weeks!

If you’ve received this via email click here to get to the web version and all the links.

I’m not much of a “just-listen-to-music”  kind of person.  I wish I was.  I figure I’m about the only person in the world whose IPOD is filled only with podcasts and books instead of music.

When I cook I love to listen to NPR. Science Friday.  All Things Considered.  The Car Talk Guys.  Fresh Air with Terry Gross.

But I’m changing my ways.  I finally get it.  Today I found my long lost Ellis Paul CD with one of my all-time-makes-me-feel happy songs. I wasn’t even looking for it.  It just turned up.

Way back in November when my friend Cheri returned from her Livestrong week at Canyon Ranch she explained to me why music is especially important for left-brained language-driven people like me. 

If most of your time is spent with left-brained activities like reading and writing, you need to balance yourself out–and slow down all that left-brained stimulation with right-brained activities, like exercise (check), painting, or music. 

The Canyon Ranch folks advise left-brainers to sometimes just take a break and turn off the words and language in the evening–yes, that means the computer, TV, and even reading books–and just sit in a chair and listen to music. But that sounds so hard to do!

Or, they say, turn off the news or NPR when you’re driving, and just listen to music. It calms that over-loaded over-stimulated sympathetic nervous system–and balances us out.

Here’s an additional medical benefit of listening to music.

Music, like laughter benefits the heart. 
According to Dr. Michael Miller of the University of Maryland, if
you’re listening to a song that makes you feel “joyful or euphoric”,
your blood vessels will dilate 26%, improving blood flow–which is an
effect similar to that of exercise. 

Miller says:  “The inner lining of
the blood vessels–the endothelium–serves as the gatekeeper to
vascular health.”   Keep them dilated & keep them healthy.

Just
don’t listen to the same songs all the time, or it won’t work.  Mix up
your play list–2 week intervals are best.

What’s on my play list? 
Right now “The World Ain’t Slowing Down” has moved to the number one spot.  But, it also includes,  “Shaggy’s “It Wasn’t Me” & Springsteen’s “Dancing in the Dark” & about a million others.  I think I’m finally ready to start alternating joyful music with my NPR fix.

So here it is Sunday night.  It’s 9:00 pm and I’m prepping beets and squash and brussels sprouts to roast in the oven with maple syrup, a little salt, and pepper.  The house it completely still.  No background TV or radio.

Ellis Paul is singing “The World Ain’t Slowing Down” and I’m feeling as happy as a kid on a merry-go-round. Downright euphoric.  Give a listen.  See what you think.

The World Ain’t Slowin’ Down.  Ellis Paul

You gotta get gone
You gotta get going
Hey, the world ain’t slowin’ down
For no one

It’s a carnival calling out to you
And it sounds like a song
It hits you like scripture
You paint the picture
With colors squeezed from your hand
Weren’t you the kid
Who just climbed on a merry-go-round
Hey, look, the world ain’t slowin’ down

Click here if you aren’t seeng the video

Lyrics | Ellis Paul – The World Ain’t Slowin’ Down lyrics

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Yesterday morning as I was about to leave the house I heard the last 2 minutes of an NPR Valentine story that sounded like a love story with a cosmic/scientific twist.

Something about compressing the impulses of the brain and nervous system of a person "newly in love", and then putting that sound on a record and hurtling it out into space–a billion miles away–to one day be discovered by another civilization.  What?

The story ended with narrator Renee Montagne almost speechless, saying:  "Gosh that is so romantic.  I mean…your brain and body in love, hurtling through the cosmos for the next billion years."

I had to know "the rest of the story".

So, with a little hunting I found this Valentine story of love, and outer space, and this tiny gold record that is the ultimate sound mix of love: the sound of a kiss, a mother's first words to her newborn child, music
from all over the world, Mozart, Beethoven, greetings in 59 different languages (Bonjour, Shalom), a "hello" from the children of planet Earth, and even non-human language–the greetings of the humpback whale.

As Ann Druyan, the creator of this cosmic mix that's aboard the Voyager says, "And it was a sacred undertaking, because it was saying we want to be citizens of the cosmos.  We want you to know about us.

The 12-inch gold-plated records contain greetings in 59 languages,
samples of music from different cultures and eras, and natural and
human-made sounds from Earth. One record is currently 16.89 billion km
from Earth, the other is over 13 billion km away.

To hear and see everything on these golden records–that are still hurtling through space, click here.

For a montage of Sagan and Druyan's golden record–aka Carl & Annie's Earth Guide for Aliens, watch the video below.  If you aren't seeing it on the screen, just click here.

Ann Druyan and Carl Saga circa 1977

by Soren Wheeler and Jad Abumrad  click here for the NPR site

My suggestion:  Listen to the story.  Hearing Annie Druyan tell it herself beats reading it–hands-down!

This is a love story. And, oddly enough, it starts with an interstellar space mission and a golden record.

Toward the end of the summer of '77, NASA launched two spacecraft as part of the Voyager Interstellar Mission. On board each craft was a golden record
that included, among other things, the sound of a kiss, a mother's
first words to her newborn child, music from all over the world, and
greetings in 59 different languages. The spacecraft were designed to
take close-up pictures of Jupiter and Saturn, then continue into the
great expanse of space beyond our solar system. The records on board
were meant to survive for a billion years, in the hope that some day,
against enormous odds, they might cross paths with an alien
civilization.

So how do you decide what to put on the ultimate
mix tape of the human experience? What do you do if you have one shot
at describing humanity to an unknown life form? That was the charge of
Carl Sagan — astronomer, astrophysicist and famed popularizer of
science. Of course, Sagan had a lot of help, including the creative
director of the project, Ann Druyan.

It was a chance to tell something of what life on Earth was like to
beings of perhaps 1,000 million years from now," Druyan says. "If that
didn't raise goose bumps, then you'd have to be made out of wood."

For
Druyan, though, the summer of 1977 and the Voyager project carry a
deeply personal meaning, too. It was during the Voyager project that
she and Sagan fell in love.

After searching endlessly for a
piece of Chinese music to put on the record, Druyan had finally found a
2,500-year-old song called "Flowing Stream." In her excitement, she
called Sagan and left a message at his hotel. At that point, Druyan and
Sagan had been professional acquaintances and friends, but nothing
more. But an hour later, when Sagan called back, something happened. By
the end of that call, Druyan and Sagan were engaged to be married.

"We both hung up the phone, and I just screamed out loud," says
Druyan, "It was this great eureka moment. It was like a scientific
discovery." The first of the Voyager project's two spacecraft launched
on Aug. 20, 1977. Druyan and Sagan announced their engagement two days
later. They married in 1981, and were together until Sagan's death in
December 1996.

But the evidence of their love has taken on a
life of its own. Not long after that serendipitous phone call, Druyan
had an idea for the record: They could measure the electrical impulses
of a human brain and nervous system, turn it into sound, and put it on
the record. Then maybe, 1,000 million years from now, some alien
civilization might be able to turn that data back into thoughts.

So,
just a few days after she and Sagan declared their love for each other,
Druyan went to Bellevue Hospital in New York City and meditated while
the sounds of her brain and body were recorded.

According to Druyan,
part of what she was thinking during that meditation was about "the
wonder of love, of being in love." And the gold records?
They're still out there with their offer, to whomever might stumble
across them, of a human body newly in love.

"Whenever I'm down,
" says Druyan, "I'm thinking: And still they move, 35,000 miles an
hour, leaving our solar system for the great open sea of interstellar
space."

Story postscript:  In 1990 Carl Sagan convinced NASA to turn the Voyager around after Pluto, before it ventured into empty space, and take one last picture of our galaxy.   And what was that day?  Valentines' Day!

What Would Go Into Your Valentine's Day Mix?

After listening to Annie and Carl's story I'm thinking about the 8mm home movie mix and the accompanying audio-cassette musical mix my husband played for me in December 1970 when he proposed. 

I really want to see it again!  The 8mm movie was converted to a videocassette many years back–but now we no longer have a videotape player.  And the audio-cassette which was filled with the music of the Moody Blue's and who knows what else from 40 years ago just might be buried in a box in our attic–or not.  Hope it didn't get pitched when my husband cleaned out the attic 2 months ago.

Right now my husband is in Honduras doing volunteer dental work.  He returns late tomorrow night–on Valentine's Day.  I hope I can dig up that video and audio-cassette–or was it an 8-track tape?

Now that would be some Valentine's Day gift!

And I almost forgot, this sage advice comes from Rhett Ellis' wacky book, How I Fell in Love with a Librarian and Lived to Tell About It:

"We've
all got our good and bad sides.  If you want to find love and joy in
this lifetime you've got to live by mercy.  Focus on the best in people
and ignore all the bad that you can ignore.  It's really that simple."

Happy Valentine's Day!!

Best Advice–Stay Away From the Chocolates (nah, go ahead, it's just one day)

Mexican Hot Chocolate

It’s no secret that I try to eat healthy. 

But, there’s only so much time in the morning to prepare something that’s as tasty as it is healthy.

And I’m no saint.  I love chocolate, but I have to keep it far away from my kitchen cupboards.  There’s no way I can stop at a tiny square of a dark chocolate bar.

And in the evening, when I’m watching TV or a video, I sometimes want something tastier than an apple for a snack.  I want a little crunch.  And yes, a bit of salt.  A tiny bit.

This is going to sound crazy, but these three simple, delicious, time-saving food tweaks have made my mornings a breeze, brought me a mid-day boost, and satisfied my snack cravings at night.  You’ve got to give them a try!

And the best part.  Each of these foods comes with impeccable research credentials.  But frankly, they taste so good, I wouldn’t care if they didn’t.

1.  Steel cut oats.  Put up a double-batch of crock-pot fruited steel cut oatmeal on Sunday night, and have breakfast ready-to-go all week.

2.  Spicy Mexican Hot Chocolate.  Late afternoon or in the evening make my gourmet Mexican cocoa with cayenne & cinnamon & you won’t miss high-cal chocolate bars.

3.  Popcorn.  Get yourself a hot-air popcorn popper, and hit the popcorn with 4 or 5 sprays of canola or olive oil and as it fills up a huge bowl–sprinkle with a few shakes of super-fine popcorn salt, and you won’t miss the microwave or oil-made popcorn at all.

Overnight Crock-Pot Fruited Steel Cut Oatmeal

After making this oatmeal for months, it finally dawned on me that if I doubled the recipe, I’d have enough for breakfast 7 mornings a week–in a microwave minute!

If you are used to making steel cut oats on the stove, let me tell you–the taste doesn’t even come close to the crockpot version that slowly cooks for 8 hours.

As for the health benefits–Dr. David Jenkins’ 2008 JAMA study found that high fiber low-glycemic foods–like steel-cut oats–were superior to
even whole grains, like whole-wheat bread and brown rice when it comes
to keeping the blood sugar stable. 

Stable blood sugar not only keeps you full, is great for preventing type-2 diabetes, but it also prevents the kind of spikes that damage the dentate gyrus–the memory center of the brain.  Click here

And for added measure throw in the benefits of the soluble fiber of oatmeal that removes damaging cholesterol–and the dried fruit that is great for bone health.  If you’re scratching your head over the fruit-thing–read Dr. Amy Lanou’s research.

And here’s a new one to me.  Oatmeal also enhances the body’s immune system, is anti-inflammatory, and has more protein than most cereals.  (according to Jonny Bowden, Ph.D. in The 150 Healthiest Foods on Earth)

Cooker:  3 quart
Setting and Cook Time:  Low for 8-9 hours. 

1 1/2 cups steel-cut oats
1/2 cup chopped dates
1/2 cup chopped dried cherries
1/4 cup dried currants
1 tsp. Trader Joe’s pumpkin or apple pie seasoning (or a little cinnamon & nutmeg)
5 1/2 cups water 
1 cup almond, hazelnut or soy milk

1. Lightly spray your cooker with cooking oil spray to prevent sticking.
2. Combine all the ingredients in the slow cooker. Mix up well.  Cover and cook on LOW for 8-9 hours, until thick & creamy.
3. Wake up to delicious cooked oatmeal.  The smell is amazing!  Refrigerate the leftovers for later in the week.  Just scoop out a serving from the the fridge & microwave for a couple of minutes.

A happy oatmeal surprise.  My entire life I’ve never eaten breakfast first thing in the morning.  I’d get up at six, and never eat breakfast until 8:30 or 9.  With this oatmeal I’ve started to eat breakfast first thing in the morning, and to my surprise, I’m actually less hungry throughout the entire day.  It keeps me full and energetic until lunch-time.  I can’t explain that one!

Spicy Sweet Mexican Hot Chocolate

About 3 years ago my husband, my college friend Babs, and I went to New York City chocolate shop called The Chocolate Bar and indulged in hot chocolate with chili peppers.  I loved it!   So, a couple months ago when I spotted this Aztec Hot Chocolate Mix at Whole Foods I decided to give it a try.  Of course it was delicious, but who needed the sugar in it?  Certainly not me.

I decided to try my hand at making my own, and it tasted even better.  I tested it on my non-hot-chocolate drinking 26 year-old son & husband, and they both gave it a big thumbs up.

And the health benefits are almost too good to be true!

• Cocoa powder lowers inflammation, increases HDLs, and has the potential to slow or prevent atherosclerosis.  This comes from straight from a 2009 Spanish study published in the American Journal of Clinical Nutrition.  Cocoa has more flavonoids than tea or red wine and they improve lipid profiles and insulin sensitivity, lower blood pressure (click here), reduce platelet activity, and keep the lining of blood vessels flexible and healthy.
• In a 12 week study the skin of women drinking a daily cup of cocoa containing 2 TBS of high-flavonoid cocoa powder was significantly smoother, retained more moisture, and had better circulation.  Click here for the article
• Cocoa gives you all the benefits of chocolate without the fat & calories.  Dr. Susan Kleiner, author of the Good Mood Diet is a big fan of drinking hot cocoa in the evening.
• Drinking 8-10 ounces of hot cocoa fills up your tummy far better than 1 ounce of chocolate can, and nips hunger in the bud.
• Cayenne pepper contains a phytochemical called capsaicin that’s linked to weight loss, pain relief, & cardiovascular health.  A 2009 Danish study even confirmed that it suppresses appetite by creating feelings of satiety.
• Cinnamon is known to lower blood glucose and LDL cholesterol.

Spicy Mexican Hot Chocolate   Serves one

1 heaping TBS. of high quality non-dutched (it retains the flavonoids) unsweetened cocoa.  I like Ghiradelli’s, & Scharffen Berger’s

1 packet of stevia (I like Stevia in the Raw) or sweetener of your choice

1 tiny (or not so tiny) pinch of cayenne powder.  The best way to do this is to shake some in the palm of your hand and then pinch some.

A few shakes of cinnamon

About a tablespoon of very hot water

1 1/4 cups of hazelnut, almond, or soy milk

Mix the cocoa, stevia, and spices in a nice-sized mug.  Add some very hot water and mix it all up.

Add the milk and mix.  A tiny whisk works great for this.

Microwave until nice and warm.

A happy cocoa surprise.  This is so satisfying as a late afternoon snack or an evening dessert.  I was completely surprised at how tasty and satisfying this cocoa can be, and I’m not even missing chocolate.

Hot-Air Popper Popcorn

About 6 months ago I decided to pick up an Orville Redenbacher Hot Air Popcorn Popper for $20 at Bed, Bath, and Beyond with a 20% off coupon.

Frankly, I ditched my original hot air popper in the 70’s because the popcorn it made was so bland.  But, my friend Howie told me about his technique of grinding up salt in a coffee grinder to get a powdery mix that sticks just fine to the popcorn if you spray it a few times with canola or olive oil spray.

Then my husband perfected the whole technique, and he picked up some Morton Super Fine Popcorn Salt, so we could ditch the “grinding step”.

Here’s the Snack-Maven’s technique

1.  Measure 1/4 or 1/2 cup of popcorn & pour it into your popper

2.  Use the largest bowl you have–and if it has a lid it’s a plus for better “salt distribution”

3.  As the popped corn starts to fill the bowl spray it with a quick shot of “oil spray”, and then a quick shake of the salt.  We usually end up with about 5 sprays and 5 shakes.  I actually measured out how much salt comes out, and it ends up less than 140 mgs of salt, which is 6% of your daily recommended intake–and that’s if you eat a whole bowl yourself. 

4.  If you have a lid, give the bowl a nice shake.

Six cups of hot-air popcorn is about 120 calories, 1.5 grams of fat, 4 grams of protein, 6 grams of fiber, and 10% iron.

Health Benefits:

• Rich in insoluble fiber to keep your digestive system moving
• Eating 3 cups of air-popped popcorn (not microwaved) twice a week can reduce your risk of diverticular disease by 28%.  Click here for the study
• Popcorn has THE HIGHEST LEVELS of healthy antioxidants of all whole grain snack foods.  Click here for the study

Happy popcorn surprise:  Who knew how satisfying and tasty hot-air popped popcorn could be–not to mention how healthy it is.

Target tissues for Vitamin D–Curr Opin Clin Nutr Metab Care 10:12-19, 2007

If you are receiving this via email click here for the full web version.

“Since the Human Genome Project, we now know that
Vitamin D is responsible for regulating over 10% of our genes.  It’s
not just responsible for skeletal health–but cells throughout the
entire body are dependent on Vitamin D in order to work properly.

I’m talking  about brain function, nerve function, immune function,
skeletal function–all dependent on adequate supplies of Vitamin
D–including its important role in preventing 14 types of cancer, heart
disease, autoimmune disease, diabetes, inflammation/inflammatory
diseases, infection, and osteoporosis.”

Happy Healthy Long Life post on Dr. Bruce Hollis’ Vitamin D Research, Dec. 10, 2009

It’s February!  By this time of the year if you live in the Northern half of the U.S. most of the vitamin D you’ve stored from the sunshine is long gone and you’re at your lowest level of the year.  You haven’t made a drop since October.  The average American’s blood level in the winter is 15-18 ng/mL.

If you read the February 1, 2010 New York Times article, “The Miracle of Vitamin D: Sound Science, or Hype” you might be tempted to dismiss the recent research on Vitamin D.  I wouldn’t advise it.  If you want to wait to get your “sunlight fix” or down your Vitamin D supplements until the gold standard randomized control Vital Study is complete–go for it. 

I wouldn’t count on its results being conclusive.  The study group is too old-women over 65 & men over 60. The dose is the same for everyone which makes no sense when it comes to vitamin D–because everyone has a different base level of vitamin D–and vitamin D doses are weight dependent.  Plus, much of the benefit of taking vitamin D occurs years before disease may surface.

In December 2009 I reported on Dr. Bruce Hollis’ research on the effects of Vitamin D in pregnancy and breast-feeding.  This post is the continuation of my summary of his interview with Joe and Terry Graedon on the People’s Pharmacy, November 19, 2009. 

For my previous posts on vitamin D, click here:

• Dr. Bruce Hollis’ NIH Vitamin D in Pregnancy
  Study is Now Complete. High Dose Vitamin D (4000 IUs) Significantly
  Improved Health & Outcomes for Moms and Babies. And Harvard
  Researchers’ Theory of a Vitamin D – Autism Connection
• Everything You Ever Wanted to Know About
  Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why
  Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So
  Important for Good Health?
• Why is Vitamin D my favorite? Let me count the reasons.
• Caroline Adams Miller’s Ten Non-Negotiable
  Pearls to a Life Well-Lived – Successful Balanced Happy. And the
  Possible Dementia Vitamin D Connection

Who is Dr. Bruce W. Hollis?

He’s one of the leading authorities on vitamin D, as well as Professor of Pediatrics, Biochemistry and
Molecular Biology, and the Director of Pediatric Nutritional Sciences at the
Medical University of South Carolina in Charleston, SC.

If this vitamin is so important, why are so many of us deficient?

This potent hormone is made through the skin–we were designed to get it from the sun, not through food or supplements.  Most of us spend much of our time indoors, and when we are outside we’re covered in clothing and sunscreen.  If you live above the 37th parallel (Richmond, VA-St. Louis, MO-Sacramento, CA) you can’t make enough vitamin D from the sun for almost 6 months out of the year!

Why are the RDIs (recommended daily intakes) for Vitamin D so low – at 200 or 400 IUs?  Why is the normal blood level for Vitamin D set so low, at 31?

According to Hollis, the federal guidelines for vitamin D–set at 200-400 IUs/day are 100% absolutely incorrect!  They don’t even begin to touch what we need.  The 400 IU recommendation was based on the amount needed to prevent
rickets–based on no real data–and Hollis believes that for those recommendations to continue today, is medical malpractice.  Hollis’ own recent safety & outcomes pregnancy study recommends 4000 IUs during pregnancy.  

We’ve known for over 30 years that
if you get 15 minutes of sun exposure in a bathing suit between 10 and 2
o’clock, in the middle of the summer, your body will produce 20,000 IUs
of vitamin D within 24 hours.  The body can make and release huge
amounts of vitamin D–and yet national guidelines are still recommending only 400 IUs a day.

According to Hollis, most adults need 2000 IUs or more/day, and he takes 4000 IUs.  He monitors his blood levels with the 25-hydroxy vitamin D test, and tries to keep his levels at 50-60 ng/mL. 

4000 IUs would replete (maintain at the optimal level) almost all adults unless they were obese or had a high BMI.  In obese patients, Hollis has even found that 10,000 IUs was not be enough to adequately raise their blood levels.  There really is no rule of thumb for “the right dose” of vitamin D for obese individuals–you just have to monitor the blood levels and make adjustments through trial and error.

Why are doctors now testing for vitamin D levels?  If 31 ng/mL is normal, why would I want to go over that level?

The history of the 25-hydroxy-Vitamin D test.  Dr. John Haddad of Washington University School of Medicine developed the first test for measuring vitamin D in the blood back in the 1960s.  To figure out what a “normal” level of Vitamin D was–a level that prevents rickets–he measured a huge number of people, like office workers, physicians, and people of color.  Their average blood level was 27 ng/mL–and to prevent rickets you only needed to be above 10 ng/mL. 

Back in the 1970s, it looked like most everyone was “normal” if they were over 10 ng/mL.  Today, we know so much more–and rickets is the least of vitamin D deficiency diseases.  Fortunately, Haddad also tested lifeguards–and their levels were at 50-100 ng/mL.  Dr. Hollis believes that those are the optimum levels for good health–the physiological level one would reach if he were fully sun-exposed. 

Studies continue to show that the higher the vitamin D level, the lower the risk of diabetes, heart disease, multiple sclerosis, osteoporosis, infections, breast, prostate, and colon cancers, and rheumatoid arthritis.  31 ng/mL has now become the lowest normal level.

Classification of 25 OH Vitamin D status:

Insufficiency/Moderate Deficiency: < or = 30 ng/mL
Sufficiency/Optimal Levels: 31 to 80 ng/mL
Toxicity: > 100 ng/mL

What have we learned from new research on Vitamin D?

The Human Genome Project has opened our eyes.  10% of our genes are influenced by Vitamin D–and very few of these have to do with the skeleton or bone health.  Important processes like cell maintenance, cancer immune function, autoimmune function, infection and inflammation control–to name a few–are all affected by our levels of vitamin D. 

Around 2000 research began to surface about the optimal health effects of higher blood levels of vitamin D.  In Dr. Hollis’ recent pregnancy study he found immune function improved significantly–and infection rates dropped–when vitamin D was supplemented in pregnant women to 4000 IUs.  He saw absolutely no adverse effects at this level.

How about some examples of how vitamin D supplementation has helped people in everyday medical practices?

An elderly home-bound population.  Dr. S of Getzville, NY is a geriatrician treating home-bound elderly with multiple chronic conditions.  “The medical community doesn’t understand the physical limitations caused by vitamin D insufficiency.  The muscle and bone pain from low vitamin D can be considerable.”

Here’s just one example of how increasing a patient’s level of vitamin D to an “robust level” benefited one of Dr. S’s patients. He resolved a patient’s debilitating limb pain–which was poorly responsive to narcotics–just by increasing the patients’ vitamin D to optimum levels.  He has even helped patients who have stopped walking–when they were identified as having very low Vitamin D levels. 

To determine the best way to increase his patients’ vitamin D levels,  he takes into account their current level and their weight, and uses a table (see below) that can be found in Dr. James Dowd’s book, The Vitamin D Cure.  The table is based on the research of Dr. Michael Holick and Dr. Robert Heaney.

For those at moderate/average vitamin D deficiency Dr. Dowd recommends supplementing at 20 IUs/per pound and for those at highest risk (African Americans or a BMI over 30) he recommends a vitamin D dose of 25 IUs/pound.  In real life: a 185 lb. man might supplement at 3700 IUs.  A 300 lb. man might supplement at 7500 IUs.  A 125 pound woman might supplement at 2500 IUs.

According to Dr. S, this has revolutionized his practice.  By increasing his elderly patients’ levels to the “best practice robust levels” of experts like Dr. Michael Holick and Dr. Bruce Hollis, he has seen “clinically satisfying success in a practice where there isn’t a lot of success”–the chronically ill geriatric home-bound population. He sees the quality of life improve for both patients and their families, with improvements in functional mobility, walking, transfers, and mood–all without having to go to other prescription medicines.  He has also seen improvements in chronic arthritis pain.   Source: #749 Vitamin D Update Nov. 19, 2009 People’s Pharmacy podcast

Source: James E. Dowd, M.D. The Vitamin D Cure.  2008

What’s Dr. Hollis’ reaction to Dr. S’s Vitamin D experience with his elderly patients?

Hollis says he get emails and comments every week with similar positive effects of vitamin D. Resolved muscle pain, and reports of people who couldn’t walk, or had to use a walker, and once they were put on adequate vitamin D they were able to walk.  (my comment: this sounds almost like a faith-healing story–but who knows?)  For Hollis, results such as Dr. S’s are not uncommon. 

As for a vitamin D/mood connection–Hollis says there’s some evidence to suggest it’s possible.  There are vitamin D receptors in the brain and enzymes that metabolize vitamin D in the brain.  Vitamin D definitely has neuro-functions, and Australian researchers studying its effect on rodents know that offspring born from vitamin D deficient mothers have dramatic brain deficits that are both physical and biochemical–and these deficits are never resolved.  To Hollis this is a very scary prospect–thinking about  humans raised in a vitamin-D deficient environment.  He wonders about the potential for profound brain development deficits? 

What about vitamin D toxicity?

Normal blood levels are 31ng/mL (lowest acceptable level) to 100 ng/mL.  The optimum level would be 50-70 or 80 ng/mL, or whatever your physiological maximum level would be if you were fully sun-exposed–as are field workers or life guards.  Hollis says he doesn’t even know what vitamin D toxicity is–he’s never seen it, and never saw any adverse effects in his pregnancy study where women took 4000 IUs/day.  According to Hollis, there’s little evidence of adverse effect under 10,000 IUs a day.

What about the effect of Vitamin D on rheumatoid arthritis?

Since vitamin D is an immune regulator, and has a profound influence on autoimmune processes, it may be possible to see improvements in rheumatoid arthritis and a slowing of disease progression.  However, vitamin D deficiency is more likely a trigger in developing autoimmune diseases like RA–not a cure for the disease.

The Iowa Women’s Health Study found women taking vitamin D supplements were less likely to develop RA.  And in a recent article a surprisingly high incidence of vitamin D deficiency was found in inflammatory joint patients even in a sunny Mediterranean country. Animal studies have shown reduced joint inflammation with vitamin D supplementation.

There are just a few clinical studies on vitamin D for treatment of RA–but in 3 of 5 studies researchers saw improvements in symptoms.

Vitamin D and osteoarthritis

From Dr. James E. Dowd of The Vitamin D Cure: “The Framingham Study found a 2-3 fold faster rate of osteoarthritis progression in people who were in the lowest 20% of vitamin D levels compared to those in the highest.”  Boston researchers found that when vitamin D levels rise, people with osteoarthritis function better, and the severity of symptoms and disability are reduced. 

Non-specific aches & pains in bones and muscles can be confused with osteoarthritis or fibromyalgia–but if it’s  caused by osteomalacia it will improve dramatically (may take 3-6 months) with adequate vitamin D.

Can adequate levels of Vitamin D really prevent colds & the flu?

The higher the vitamin D level the lower the risk of upper respiratory tract infections.  According to Hollis there are ongoing studies on using vitamin D as an immune booster, and there is incredible evidence to show just how this works. 

Vitamin D activates the “Rapid Response” component of our immune system, called the innate immune system which  controls the production of natural “antibiotics” that attract bacteria & viruses.  These processes aren’t activated if someone is vitamin D deficient.  And Hollis’ pregnancy study offered conclusive proof that increasing levels of vitamin D absolutely controlled infection.  “The vitamin D  immune boost is a very real thing!”

What about the cancer connection? It seems so far-fetched.

Dr. Hollis has collaborated with Dr. Walter Willett and the Harvard School of Public Health for over 15 years, studying epidemiologic data on the effects of vitamin D on cancer.  These studies have routinely shown that an adequate vitamin D status protects against 13 or 14 different cancers, including breast, prostate, and colon cancer. 

Hollis is skeptical that vitamin D could treat cancer once you get it–its benefit is in preventing it in the first place–and having adequate levels will lower your risk.  Researchers in Nutrition Reviews project that a vitamin D blood level over 52 ng/mL would reduce breast cancer by 50%, and levels over 34 ng/mL would prevent 50% of the colon cancers.

Here’s how it works: Vitamin D helps control cell growth and that’s why we think that it
will reduce the risk of many deadly cancers like prostate, breast, and
colon by as much as 50 percent.  In its role as a hormone, vitamin D travels all over our body
delivering messages to activate genes and control cell growth. 

If a
cell turns cancerous, vitamin D delivers the instructions for that cell
to self-destruct. Not enough vitamin D and that cancer cell might keep
reproducing.  According to Hollis,  “vitamin D acts as a brake” when it comes to cancer.  It prevents cells from growing wildly out-of-control–and this mechanism has been studied for years.

Explain the difference between D2 and D3.  Is D3 superior?

D2 was commonly used in the U.S. because it was approved as a pharmaceutical in 1911.  But Hollis doesn’t like to use it.  It’s unnatural.  It comes from yeast.  It’s functional, but D3 is preferable, and it’s very easy to get these days.  If you have the option–Hollis says, “Use D3”.

How do you get enough vitamin D if you have a severe malabsorption syndrome, colitis or celiac disease?

If you can’t absorb vitamin D supplements adequately, you clearly need to get your vitamin D from the sun.  There are no vitamin D injections. When it comes to winter-time, dermatologists won’t approve, but one option is short twice weekly visits to a sun tanning bed–10-15 minutes with face & neck covered with sunscreen.  It is effective.  Or play it safe and find out about getting controlled UV treatments in a medical setting.

What are normal vitamin D blood levels for children?

Hollis says normal levels for children are the same as for adults.  “Do you think a rapidly growing child needs less vitamin D than a staid (no-longer-growing) adult?”  A colleague of Hollis’ in S. Africa recently measured blood levels of active-outdoor-playing children, both Black and Caucasian.  Both had similar levels–around 50 ng/mL.

Please explain how vitamin D affects cardiovascular health.

There is a 142% increased risk of heart attack in vitamin D levels under 15ng/mL.  According to Hollis, important recent research has shown that vitamin D acts as a natural statin, by decreasing inflammation.  It doesn’t lower cholesterol.  It also prevents the infection-inflammatory processes and lowers blood pressure–both of which can contribute to damaged blood vessels, atherosclerotic plaque build-up, and clot formation.

Once you start taking vitamin D supplements how long will it take to increase your blood levels?

Hollis said most physicians should assume that their patients are vitamin D deficient, especially every person of color,  and order a base-line blood level test–the 25-hydroxy-vitamin D test.  For most people, supplementing with 2000-4000 IUs of vitamin D should be adequate.  1000 IUs will do very little except for a small child.

You’ll need to wait 3 months before getting retested.  If someone is very low, and depending upon their size, it could take months to get their levels up to optimal–50 ng/mL-70mg/mL.  

What research on the horizon looks the most exciting?

Hollis is most excited about the current research on the effect of vitamin D on infections, as well as the multiple sclerosis/vitamin D research of Dr. George Ebers of Oxford University.  Ebers recently discovered that vitamin D deficiency is an environmental trigger for multiple sclerosis. 

“The Oxford University-led research, published in PLoS Genetics,
suggests that vitamin D deficiency during pregnancy and the early years
may increase the risk of offspring developing MS later in life.” Click here to read more.

How about some “practice-based evidence” from primary care or internal medicine physicians?

Two comments from physicians in response to the Feb. 1, 2010 New York Times Vitamin D article were of particular interest to me.

Dr. Robert Baker 

 “The major problem with the proposed study is that it will give 2000
units of vitamin D a day without testing levels to determine an end
point. 400 Units daily has been shown to raise levels only 5 ng., and
2000 Units daily has been shown in some studies to raise levels less
than 20 ng.

I have tested 1800 people in primary care practice since 2005.
2/3rds are below 32 ng. but 1/3rd are below 20 ng., and 10% have levels
in single digits. These figures are duplicated with published studies.
So for many people raising the level even 20 ng. will not be enough.

The human body from sun alone will not make a level over 150 ng. A
feedback mechanism breaks down vitamin D in the skin once this level is
reached.

Lifeguards in August have been shown to have levels
approaching this level. Humans evolving near the equator wearing scant
clothing would also have had this level.

Sufficient vitamin D does not
come from diet – amounts are small and several glasses of milk only
have the small amount of 400 units of vitamin D because manufacturers
add it.

So the wisdom of nature is already telling us the maximum level.“  Click here for the NYT link

Robert Baker MD
Primary Care Internal Medicine
Cherry Hill, NJ
[email protected]

Dr. Greg Plotnikoff

Vitamin D and Pain

Most clinicians who have read the literature and who prescribe
vitamin D for patients based on their blood tests will affirm that
replenishing vitamin D to a serum level of greater than 40 ng/ml can
make a huge difference in chronic pain, muscular weakness and a wide
range of non-specifc complaints.

The most impressive reports come from woman with muscle or bone pain
on an aromatase inhibitor or persons with undiagnosed, chronic,
non-specific musculoskeletal pain or unexplained significant muscular
weakness.

No one with symptoms has fibromylagia or somatoform disorder until vitamin D deficiency has been ruled out or replenished.

Testing and replenishment is incredibly cost-effective.

The clinical effectiveness of D replenishment can be so profound, so
unforgettable, that for practicing physicians there is no need for
randomized controlled trials to assess the value of normalizing low
vitamin D in persons who suffer.

Simply, test, replenish, monitor.

Why wait five years for a publication when one can have results of a
blood test in a few days and results of replenishment in 2-6 months?

Asking this crucial question frustrates well-meaning researchers: Failing to ask this question frustrates patients.

— Greg Plotnikoff, MD

The Great Joe Rollino at 103

The Great Joe Rollino as a young man.

Joe Rollino, was 104, just 2 months shy of turning 105, when he was fatally injured by a minivan in Brooklyn on January 11, 2010.  He was on his daily early morning walk to pick up coffee, a tabloid, and a lottery ticket.  Until the end he was strong, healthy, and a picture of health!

If not for the New York Times, I would never have heard of Joe Rollino.  He was man from a different time. Growing up near the turn of the century, quitting school at 10 years old to join the carnival.  He led a career as a Coney Island strongman, a boxer, and a trainer, who billed himself as “The Strongest Man in the World”.  

At 5-feet-4-inches 122 pounds, in his prime he once lifted 475 pounds with his teeth, 675 pounds with just one finger, and moved 3200 pounds with his back.  He bent quarters with his teeth and fingers and continued to demonstrate his coin-bending skills into his 100’s.

“Pound for pound, in the feats that he practiced, he was one of the greatest performing strongmen we’ve ever had, if the lifts he’s credited with are accurate.   For his size, Joe was apparently one of the strongest men who ever lived.”

-Terry Todd, co-director of the Stark Center for Physical Culture and Sports at the University of Texas, who knew Joe for 40 years-

This is a reposting of my September 24, 2008 post.  I can’t get it out of my mind.  And I can’t get this week’s devastation of Haiti out of my mind. 

So eerie that this post was written after the Sept. 14, 2008 hurricane that hit Haiti over a year ago.  How does this country get the strength to keep getting up again and again? 

Strange that I woke up the morning of Sept. 24th, 2008 with a nightmare.  Same thing happened again last night.  And I don’t often have nightmares.

If anyone plans to make contributions to Haiti, please consider Partners in Health, the organization founded by Dr. Paul Farmer.  Tracy Kidder wrote about him in the award-winning book: Mountains Beyond Mountains.  Healing the World.  The Quest of Dr. Paul Farmer.   

Farmer is one of the most courageous, self-less, inspiring, remarkable people in this world.  His story is a must-read.

To read what Tracy Kidder says about Partners in Health and the plight of Haiti in today’s New York Times, “Country Without a Net”, click here.

September 24, 2008

Ramadan – Rabbi Heschel – Rosh Hashanah – What’s Our Responsibility in Repairing the World?

I can’t stand to fly
I’m not that naive
I’m just out to find
The better part of me

–Superman, Five for Fighting-

The cure of the soul begins with a sense of embarrassment,
embarrassment at our pettiness, prejudices, envy, and conceit;
embarrassment at the profanation of life.

–Rabbi Abraham Joshua Heschel–

There must be a thin line between feeling grateful and feeling guilty.

-Shiraz Janjua, Associate Producer of Speaking of Faith-

September 1, 2008 marked the start of Ramadan for Muslims. 
It’s a month of fasting, introspection and giving.  It’s the month to
become aware of one’s spiritual weaknesses.

September 1, 2008
marked the start of the Jewish month of Elul, the month that precedes
the High Holy Days.  It’s a month of intensive personal preparation for
the New Year. A time of self-examination of one’s spiritual, physical,
interpersonal and communal responsibilities.

It’s odd how my life sometimes just nudges me to PAY ATTENTION exactly when I need it the most.

I had my recurring nightmare again last night–the one that reminds me I have responsibilities greater than myself, and I need to PAY ATTENTION.

So…I
woke up pretty shaken after this nightmare.  I sat down with the
newspaper & a cup of coffee, and from there I clicked on American
Public Media’s  Speaking of Faith website.  I had listened to a mind awakening piece on The Origins and Impact of Pentecostalism during my walk yesterday and I wanted to learn more.

Instead,
I ended up reading Shiraz Janjua’s powerful essay about fasting for
Ramadan with Rabbi Heschel’s words echoing in his head, Of Veggie Omelets and Cognitive Dissonance.

Shiraz
asks, “How do we live our lives when part of us is so grateful for all
our blessings, and the other is so guilty about all we have in the
midst of all the brokenness in this world?” 

How do we watch the news or read the newspaper and see something so
horrible happening to someone else, and then just go on with our day?

Of Veggie Omelets and Cognitive Dissonance

Shiraz Janjua, Associate Producer, Speaking of Faith

I woke up this morning around 4:45 a.m. to eat before my day of
fasting. To keep myself from passing out into my leftover veggie omelet
from the night before, I turned on the TV. It was about 4:55 a.m. The
first thing that confronted me as I scooped food into my mouth was the
destruction of Haiti. People standing in mud, broken. Helicopters
dropping off bags of food, long lines, the complete absence of
buildings. The government has apparently stopped counting the death
toll. Without numbers, the reporting on Haiti is going to end up even
further down from where I found it: the last report of the hour.

Following the report, the beautiful, dark-haired host smiles with
her moist lips and signs off, wishing me a good day. A good day? Are
you mad?! I’m ready to intentionally deny myself food to try vainly to
understand where I stand in this world. As I’m eating, there are people
on the other side of the glass who are traumatized after three (or
four?) hurricanes. And the host has the gall to wish me a nice day? Did
she even watch the segment that just aired? The cognitive dissonance
was a bit much, but there I sat with my leftover veggie omelet, my
juicy organic yellow peach, my full glass of milk, and my disgust of
the human race, cursing at the screen. I heard Heschel blaring at me, at the newscaster: “Some are guilty, but all are responsible.”

At 5:30 a.m., I went back to bed, to catch a few more hours of sleep
before heading off to work. I lay there wishing for a red cape and blue
tights and the chance to fly across the continent and do something. But
you never see Superman fighting systemic poverty, or downgrading
hurricanes by flying in a counter-Coriolis trajectory. He fights Lex
Luthor.

It’s the afternoon now. I’m still hungry, but come 7:23 p.m.
tonight, I’ll eat. I can. Yet today, my life feels like the platitudes
of that news anchor. I saw something horrible, yet I got on with my day.

In conversations I’ve had with friends on this subject, the answer
is invariably that it’s my duty to live my life more fully and more
appreciatively, that the more tempting response of sullenness isn’t
going to help anyone. Instead, bring your earnestness into whatever
else you do. Working here is important to me because I can integrate my
skills and energy toward something that is, in my view, part of some
larger solution. And that’s good. Still, every time my cheeks stick
from thirst, they drag my thoughts back to this morning, faithfully as
a dog on a leash.

“You are not obliged to finish the task, neither are you free to neglect it.” 

-Pirke Avot-