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How Drug Companies Manipulate Data to Make False Claims

Both patients and doctors are being manipulated to the tune of billions of dollars.

The information in this blog post may shock you, but it is information that the public needs to be made aware of. The exploitation discussed here centers on the effectiveness of drug trials, and some of the ways big pharmaceutical companies manage to make health claims which are, in many cases, false.

The first thing to examine is how drug efficacy is calculated by pharmaceutical manufacturers. How do they arrive at their numbers in the first place? It’s not actually that complicated although most of us have been led to believe we need a PHD to make sense of their statistics. When a drug actually works, (think of the dramatic benefits of discovering insulin or penicillin), the results are so obvious that statistics or percentages quickly become secondary to the observable benefits. However, the math games begin when a new drug doesn’t work as well as hoped, when its benefits are not so obvious, or when profits may be in jeopardy.

The illusion of percentages

Imagine you were given a choice been two prizes. Prize one is 10% of a mystery amount of money, and prize two is 90% of a mystery amount of money. All things being equal, 90% seems like the better choice. However, there is a catch. What if prize one was 10% of a million dollars, ($100, 000), and prize two was 90% of a hundred dollars ($90)? Does that change your mind about what the better choice is? Of course it does.

What is missing in this scenario is something called an absolute number. Both of the percentage values presented are accurate; 10% of a million is $100, 000 and 90% of one hundred is 90$. But, if we want to know which is the better choice, we need to know something called an absolute value. It is with the absolute value that we determine if a result is significant. Otherwise any number you come up with is only useful (in this case) as a marketing tool. It is completely useless for the purposes of comparing the real benefits of choices. If we don’t know what the real benefits are then who cares about percentages? This factor particularly important when evaluating treatments that could be beneficial but which are associated with risks of significant negative side-effects. Without it, there is no way to assess a risk-benefit ratio.

Remember these words, absolute and relative. Absolute numbers or values are the real/precise numbers. Relative numbers or values are dependent on other numbers. In other words, they are relative to other (absolute) numbers. Percentages are relative. With a percentage in isolation, you do not know a precise number. You only know one half of the available data and it is the one advertiser companies want you to focus on. Ninety percent improved or effective sounds like a significant number. However, until you know the absolute value of what it represents or what it is compared to, it could mean nothing at all (or worse!).

If you walked into a medical clinic and you were given a piece of paper saying that you were facing a 100% increase in your risk of contracting a given disease it would sound really terrifying! That is because it sounds like a guarantee that you will get sick. However, discovering that it is actually just a percentage of a larger number means it could very well be a paper tiger. What if that 100% risk represents an increase from one to two out of a thousand in the general population? Would you still be terrified now that you know the absolute number being compared to?

Let’s step away from medicine for a moment and look into really clear example of stacking the odds … gambling … what if someone told you could increase your odds at winning the lottery by 100%? Pretty good deal right? Whoa, … not so fast …

Canada’s biggest lotto jackpot was won by a group of oil workers in our province of Alberta. This lucky group of 17 took home $54.3 million in October of 2005. Not bad for a day’s purchase. The truly impressive number in this equation was actually the odds of winning: one in 13,983,816. So, if you increased your odds of winning the lottery by 100%, in this case it would mean … drum roll …TWO in 13,983,816!

Not quite worth a lot of risk once you know the absolute numbers, even when the likelihood of winning is increased by a whopping 100%.

It might seem juvenile to put it in the terms above, but prescription drugs and risky surgeries are encouraged this way all the time. The data is accurate, but its value is not being accurately portrayed. This is like 90% of 100 dollars versus 10% of a million; the percentages mean nothing without the full  picture.

My favourite example of this kind of trickery was the Lipitor ads that boldly told us that the drug would reduce heart attack risk by 36%. Now that you know that percentages by themselves are useless because they are relative, it leads us to ask what the real numbers are.

Here’s how they got the data they are bragging about:

The 36 percent relative risk reduction figure came from a study published in Drugs called Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.

This research was a subcategory from a larger study that looked at 20,000 subjects with high blood pressure as well as three other cardiovascular risk factors. The study participants were randomized into two groups. Each group took one or the other of two blood pressure lowering medications. From within the larger group, around 10,000 subjects were selected who also had cholesterol levels at or below 250 mg/dl (6.5 mmol/l). In addition to the blood pressure medications, half of this group got 10 mg of Lipitor (atorvastatin) per day while the other half got a placebo along with their blood pressure medication. Note: high blood pressure is itself a major factor in the risk of a heart attack. Further note that the results of this work can only be applied to people who already have high blood pressure and two other risk factors for heart disease. If you don’t have those risks, the drug has no benefit. Most prescribing doctors forget or don’t mention that part of the study.

In the Lipitor/placebo arm of this research, the endpoint for an individual’s participation was defined as a non-fatal heart attack or death from heart disease.

After around 3 ½ years, this section of the project was discontinued because there were a noteworthy number of either heart attacks of deaths from heart disease in the placebo group. As a result, the researchers felt it was unethical to prolong the study.

When the data were assessed, it turned out that the group taking Lipitor experienced a 36 percent decrease in relative risk for heart disease. Thus, the outpouring of advertisements for Lipitor ensued.

Lipitor_vs_placebo_graph

These results sound awesome, but they are not actually that impressive. 36% is the relative risk reduction. Look at the graph from the study, the vertical axis tells you that the absolute percentage difference is a drop from 3.0% to 1.9%. That’s only a difference of 1.1%!! According to Liptor’s own webpage at the FDA absolute reduction is only 1.2%!!

Dr. Michael Eades MD has an excellent way of illustrating this difference with the following image:

LIpitor_vs_Control_MI.

The side effects from statin drugs include: muscle pain & muscle wasting, liver damage, rashes, elevated blood sugar/type 2 diabetes, as well as nerve damage. Considering that these drugs are 98.8% ineffective, what the heck are we taking them for?

This is why you always, always want to know the absolute risk before you make a decision on anything based on relative risk. Because absolute risk numbers are usually pretty low in drug studies, the pharmaceutical industry typically uses them \to sell their medicines. When someone tells you to take a drug, ask about the absolute risk associated with its research.

According to a review published in the Expert Review of Clinical Pharmacology, other studies of statins show similarly unremarkable results. In absolute terms, statin users had between 1.2 and 1.5 percent fewer cardiovascular complications than those taking placebo. The authors believe that for statins, “…their modest benefits are more than offset by their adverse effects.” Statin drugs have over 300 listed side-effects with the FDA, which include heart failure and the progression of heart disease. Yes, you read that correctly; this is a heart medication approved by various international health agencies which actually promotes heart disease. That sure is an amazing business model. It involves creating a solution, which is really exacerbating a problem, so you need to keep buying more of the supposed solution, which is actually making the problem even worse. The potential for profit is amazing!

In March of 2015, Okuyama and colleagues at Nagoya City University published a report called Statin Drugs Stimulate Atherosclerosis and Heart Failure: pharmacological mechanisms. In this report they explain the biochemical basis for their claim that statins may contribute to clogged arteries and heart muscle failure. The researchers in question cite several mechanisms by which statin drugs promote heart disease. They close by saying that, “…the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs.” My! Oh My! It sure is a good thing that statins decrease heart attack rates by 33% (relative) on paper or this entire category of very profitable drugs would be totally useless. The impact on Big Pharma would be catastrophic. (Please note the sarcasm here!)

Primary prevention vs. secondary prevention

If that wasn’t shocking enough, there’s more! If we want to get to the real efficacy rates behind these magical prescription drugs, we also need to understand primary vs. secondary prevention. Primary prevention aims to prevent disease or injury before it occurs at all, while secondary prevention aims to reduce the impact of a disease or injury that has already occurred. There are huge differences between these two groups, as well as their relationship to risk benefit ratios.

Making billions by using a dangerous unproven drug for prevention

Originally, statin drugs were prescribed only for secondary prevention. They were used in the prevention of a second heart attack or stroke if a patient had already suffered one and had clear signs of heart disease. In other words, clear and present risks justified risks. But, this was not a good way to expand markets and make more money. To help promote the use of these drugs to otherwise healthy people, AstraZeneca, the maker of the cholesterol lowering drug Crestor, funded the JUPITER study, which was published in the New England Journal of Medicine in 2008. This should already be sending up huge red flags, since the authors of the study stand to make billions of dollars based on its results. In fact, regarding conflicts of interest in this article, the Institute of Science in Society voiced their concerns that:

“The lead author is a co-holder of the patent for the hsCRP test used, which became the standard method of measurement at $50.00/test. Nine of the 14 authors had significant financial ties to AstraZeneca, whose investigators also collected, controlled, and managed the raw data and monitored the collection sites. It is well established from other drug company sponsored studies that bias can creep in, such as the preponderance in the placebo group of patients with a family history of heart disease or metabolic syndrome, both of which significantly increase risk.”

In other words the deck was stacked in advance of the study. The placebo group (representing the general population) had a higher proportion of subjects likely to develop heart problems. They would have done more poorly that the test group even if medications were not being administered. Even the smallest results in the test group would appear much more significant than they really were.

The JUPITER study boasted that statin drugs could lower the risk of heart attack by 54 percent, the risk of stroke by 48 percent, the risk of needing angioplasty or bypass surgery by 46 percent, and the risk of death from all causes by 20 percent. But remember they are using relative statistical numbers to boost their results. If you look at absolute risk, statin drugs benefit just 1 percent of the population. This means that out of 100 people treated with the drugs, one person will have one less heart attack.

According to Dr. David M. Diamond, a professor of psychology, molecular pharmacology and physiology at the University of South Florida, “In the Jupiter trial, the public and healthcare workers were informed of a 54 percent reduction in heart attacks, when the actual effect in reduction of coronary events was less than 1 percentage point…

Is this all beginning to sound familiar? Have you noticed that it all adds up to billions in profits?

According to a May 29th 2013 article in the very pro-business Forbes magazine:

Statin drugs, already the most-prescribed drug category, saw their use climb 17% to more than 214 million monthly prescriptions annually, according to data provided by IMS Health, a consulting firm that can track drug prescriptions at the pharmacy level.” The article continues and uses the manipulated risk information mentioned above to push the drug even more. It uses statements like “These drugs have been shown, with quite a lot of evidence, to reduce the risk of heart attacks and deaths in a wide range of patients. Those taking statins have about a 20% lower risk of a heart attack.” These statements are a far cry from the 1 percent improvement (absolute) cited by Dr Diamond and by the Institute of Science in Society. However, it is probably worth mentioning that Forbes’ interest is in profit not efficacy.

According to an article in The Telegraph, (Statins: the drug firm’s goldmine) Pfizer’s Lipitor was the world’s top-selling medicine last year, according to IMS, raking in sales of $13.3 billion. Take a deep breath before you read the following … people spent 13.3 billion dollars for a drug that is likely to do nothing, and is even more likely to cause significant side-effects like cancer, erectile dysfunction and muscle wasting. Worst of all, many of these prescriptions, tests and appointments are paid for with tax/insurance dollars, meaning that every single one of us was being robbed that year by Pfizer.

Chemotherapy: The 2% Gamble

A paper entitled Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies, published in 2004 in the Australian Journal of Clinical Oncology, analyzed the accuracy of the actual benefit claimed by chemotherapies in the treatment of adults with the most common forms of cancer. The mainstream media completely ignored the findings of this extremely important paper. It was a meta-analysis. A meta-analysis is a statistical technique for combining the findings from independent studies. It is the form of research most often used when assessing the clinical effectiveness of healthcare interventions. It does this by combining data from multiple randomized control trials. This is a gold standard method for determining the absolute effectiveness of a given medical treatment. Let’s see what they found out regarding the true effectiveness of chemotherapy.

This carefully detailed Australian study was based on an analysis of results from all of the randomized, controlled clinical trials (RCTs) performed in Australia and the US which reported a statistically significant increase in 5-year survival due to the use of chemotherapy in adult malignancies. Survival data was obtained from the Australian cancer registries and the US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) registry. The research covered the period of January 1990 until January 2004.

In those cases in which the data were uncertain, the authors intentionally erred on the side of over-estimating the assistance of chemotherapy. Despite this statistical benefit of the doubt, the study determined that overall  chemotherapy still contributed to a mere 2 percent improved survival in cancer patients (when compared to the absolute total number of subjects).

Yet despite the mounting evidence of chemotherapy’s lack of effectiveness in prolonging survival, oncologists continue to present chemotherapy as a rational and promising approach to cancer treatment.

One of the papers examined in the meta-analysis referenced above was from 1998. In this clinical trial, out of a total of 10,661 women who were newly diagnosed with breast cancer, 4,638 women were assessed as eligible for chemotherapy. Of these 4,638 women, only 164 (3.5 percent) actually gained some survival benefit from chemotherapy. As the authors point out, even the use of newer chemotherapy regimens for breast cancer, including the taxanes and anthracyclines, may only raise survival by an estimated additional one percent. However, this minor benefit is achieved at the expense of an increased risk of cardiac toxicity and nerve damage.

Woah … those are some pretty heavy statements! What credentials do the authors of this paper have in order to make these types of judgements? Well, all three of the paper’s authors are oncologists. Lead author & Associate Professor Graeme Morgan is a radiation oncologist at Royal North Shore Hospital in Sydney; Professor Robyn Ward is a medical oncologist at University of New South Wales/St. Vincent’s Hospital. The third author, Dr. Michael Barton, is a radiation oncologist and a member of the Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Health Service, Sydney. It should also be noted that Prof. Ward is also a member of the Therapeutic Goods Authority of the Australian Federal Department of Health and Aging. This is the official body that advises the Australian government on the suitability and efficacy of drugs to be listed on the national Pharmaceutical Benefits Schedule (PBS). It is roughly the equivalent of the US Food and Drug Administration. These men are hardly lightweights in the field of cancer research.

Given education about statistics painting this form of treatment as achieving only a two percent improvement in survival rates, would the general public opt for chemotherapy as a rational approach to cancer treatment? Shouldn’t we at least be given accurate information so as to make decisions which are rational and fact based?

A Third Method of Manipulation: Selective Publication

The third, and in many respects most un-nerving, way that drug data is manipulated to inflate benefits is the selective publishing of studies to show a majority of positive results. If the results are not positive, or if they show significant side-effects that should be kept quiet, they are simply not published!

Consider the following findings. Researchers reported the findings of a meta-analysis in the New England Journal of Medicine. They conducted an analytical look at all the work done on antidepressants, both published and unpublished.

To begin with, the unpublished studies were very difficult to find. The researchers needed to search the FDA databases, call other researchers and hunt down hidden data under the Freedom of Information Act. What they eventually found was stunning.

After examining 74 studies relating to 12 drugs and involving over 12,000 people, they found that 37 of 38 trials with positive results were published. That is very nearly all of them. Only 14 of the 36 negative studies were published or in other words, less than 40%. Those negative findings which did get published were, in the words of the investigators, “…published in a way that conveyed a positive outcome.

That leaves no question. The results were twisted to show the drugs to be more effective than they actually were!

As a closing comment, if we could describe the behaviours of the pharmaceutical industry in one word it would be “shameless!!” We are being sold a lie to the tune of billions of dollars a year, much of it coming out of everyone’s pockets in the form of insurance premiums and taxes. Though this article talks specifically about cholesterol, chemotherapy agents, and antidepressant medications, it is clear that these practices are also common in the dealings of the drug industry at large.

Feeling cheated? You should be …

The Critical Importance of Fat Soluble Vitamins – Vitamin K2

A Quick Primer

One of the major benefits of being on a high-fat/ketogenic diet is that the intake of fat-soluble vitamins increases dramatically. Consuming a variety of dietary fats is not just important for creating healthy cells and optimal hormone levels. Fat is also needed for the absorption of fat-soluble vitamins.

What is a fat soluble vitamin? Vitamins are categorized as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). The distinction between these two types of nutrients is very important. It governs how each one acts inside the body.

Fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed into fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood supply. These fat soluble vitamins, especially vitamins A and E, are subsequently stored in the body’s tissues.

Water soluble vitamins, on the other hand, dissolve in water when they are ingested. Then they go in to the blood stream. The body keeps the amount of water soluble vitamins we need at any one time, and any excess amount is excreted in the urine. Since they can’t be stored, everybody needs to consume a continuous supply of water soluble vitamins in order to stay healthy.

The fact that certain vitamins are retained and kept in storage while others are not gives us a hint regarding their relative importance. With this in mind, our next four blog posts will discuss the importance of the four fat soluble vitamins: A, D, E and K.

With ALL fat soluble vitamins, there is a minimum requirement for the consumption of dietary fat. These levels are necessary to ensure correct amounts of the vitamins in question. Unfortunately, the intake of fat recommended by various first-world government organizations is generally well below what is needed for optimal utilization of fat-soluble vitamins. It is important to note that saturated fat must be consumed in adequate amounts,(and in higher levels than those often recommended), in order to properly provide fat-soluble vitamins to required tissues.

Vitamin K2

logoIt’s not often that we hear anything about a “new” vitamin, at least not one that stands up to its media generated hype. Vitamin K2 has been in our diets for thousands and thousands of years, but with the rise of low-fat and fat phobic diets, it has all but disappeared from our daily food choices.  This lost nutrient disappeared as a result of being mis-identified, and so it was overlooked for almost a century.

Get ready because this powerful nutrient is changing the way we look at everything from diet, to drugs, to dental health … let’s do it!

What is Vitamin K?

Vitamin K is a fat-soluble vitamin that is best known for the important role it plays in blood clotting. However, vitamin K is also absolutely essential to building strong bones and preventing heart disease. Vitamin K also has appears to have potent anti-cancer properties. Vitamin K is sometimes referred to as “the forgotten vitamin” because these major benefits are so often overlooked.

Why were these benefits overlooked?

k2Vitamin K comes in three different forms, vitamin K1, K2 and the synthetically manufactured K3. These variations have drastically different effects on the body. When vitamin K was discovered over 70 years ago, it was assumed that all forms of vitamin K have the same action in the human body. There was no distinction made between the three. This generalization and overemphasis on one form of vitamin K led to a lack of vitamin K2 in our diets. Significantly, it has the most powerful health promoting effects of all three forms.

The Three K’s

Vitamin K1, or phylloquinone, is found naturally in plants, especially green vegetables. K1 goes directly to your liver and helps you maintain healthy blood clotting.

Vitamin K2, also called menaquinone, is produced internally by the bacteria that line the gastrointestinal tract. K2 goes straight to blood vessel walls, bones, and tissues other than the liver.  Vitamin K2 can be obtained by consuming full-fat dairy products, certain cheeses and organ meats. Most supplements are based on a fermented form of soy called natto. Please note that there is a strong link between many forms of natural fermentation and the production of vitamin K2. There is a similar connection to the presence of probiotics in the gut.

Vitamin K3, or menadione, is a synthetic form I do not recommend. It’s important to note that toxicity has occurred in infants injected with this synthetic vitamin K3.

The presence of vitamin K1 alone was thought to be sufficient to provide health benefits since the differences between all three forms was not initially understood. That narrowing of emphasis on all these forms coupled with the misguided war on dietary fat and dairy in the 20th century caused a drastic decrease in K2 intake relative to consumption of K1. As we will see later in this blog post, these are two very different vitamins.

What are the differences in benefit between vitamin K1 and K2?

AAEAAQAAAAAAAAL8AAAAJDZjOTAyNDQ4LWVjMmYtNDMzNC1iMDk1LWZiZmZiNjU5ODIxMQAlmost 90% of all vitamin K in the modern diet occurs in the form of K1. Modern technology has allowed its quantification in food for several decades. However, it was only 11 years ago that it became possible to accurately analyze foods for their K2 content. A report by Schurgers et al estimated our vitamin K2 intake in multiple cohort studies.

The first study, called the Rotterdam Study, differentiated between the health benefits of dietary K1 and K2 studied in a group of 4,500 elderly men and women (> 55 years old). The participants’ dietary habits were analyzed using food frequency questionnaires coupled dwith regular medical examinations during a follow-up period of over 10 years. The results were striking. Dietary vitamin K1 intake had no effect on cardiovascular health. However, there was a solid inverse association between K2 intake and several serious circulatory indicators including: the amount of aortic calcification, the incidence of myocardial infarction, and cardiovascular mortality (50% lower in those consuming 45 µg/day of K2 or more). Also all-cause mortality was reduced by 25% where levels of K2 were higher.

At the time of the Rotterdam study, the mechanism causing these outcomes was not understood. This was likely to have been because vitamin K2 is fat soluble, and fat was so strongly believed to promote heart disease. The results caused much consternation in the scientific community. This study was replicated by a different research group, in an independent and much larger group known as the Prospect study. This time, the total number of subjects was above 16,000 and again the observation period was 10 years or more. Just as in the Rotterdam Study – no effect on cardiovascular health by K1 was observed while there were major effects attributed to K2. Because of a much larger sample size than the Rotterdam study, the researchers were even able to calculate that each extra intake of 10 µg/day of K2 resulted in a 9% decreased risk for cardiovascular mortality.

How does Vitamin K2 work?

Vitamin K keeps calcium in the right places.

vitamin_k_mgp_calcificationVitamin K2 helps to prevent hardening of the arteries, which is a common factor in coronary artery disease and heart failure. Research suggests vitamin K2 works by keeping calcium out of your artery linings as well as other body tissues. As discussed above, it is vitamin K2, not K1, which prevents calcification in your coronary arteries. This calcification is commonly referred to as “hardening of the arteries”.

Vitamin K2 Helps Prevent Osteoporosis

The absolute best way to achieve healthy bones is a diet rich in fresh, raw whole foods that maximizes the processing of natural minerals so that your body has the raw materials it needs to do what it was designed to do. Given appropriate levels of these minerals, Vitamin K2 functions as one of the most important nutritional agents for improving your bone density. It serves as the biological “glue” that helps plug calcium and other important minerals into your bone matrix. There have been some remarkable research studies about the protective effects of vitamin K2 against osteoporosis:

A number of Japanese clinical studies trials have shown that vitamin K2 entirely reverses bone loss and in some cases actually increases bone mass in people with osteoporosis. A published study by Shiraki and colleagues found that Vitamin K2 effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.  A study by Knapen found that Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal women. A systemic review of multiple clinical trials published in the Journal of the American Medical Association has found that vitamin K2 supplementation reduces bone loss.

Vitamin K Helps Prevent Cancer

A number of studies have shown that both vitamins K1 and K2 are effective against cancer. Consider the following:

A study published in September 2003 in the International Journal of Oncology, found that treating lung cancer patients with vitamin K2 slowed the growth of cancer cells, and previous studies have shown benefit in treating leukemia. An August 2003 study published in the Alternative Medicine Review involved 30 patients with a type of liver cancer called hepatocellular carcinoma. They took oral vitamin K1. The disease stabilized in six patients; seven patients had a partial response; and seven others had improved liver function. In 15 patients, abnormal prothrombin normalized.

In 2008, the American Journal of Clinical Nutrition published a study showing that vitamin K2 provides substantial protection against prostate cancer. According to the report, men taking the highest amounts of K2 had about 50 percent less prostate cancer.

How does vitamin K2 protect against cancer?

Vitamin K2 activates a protein called Gas6, which is short for growth arrest sequence 6 protein. It is a powerful regulator of cell growth. This makes vitamin K2’s activation of Gas6 a powerful ally in the fight against cancer, both in its prevention and its treatment. This nutrient can cause cancer cells to die. As well, it can encourage certain types of cancers to turn back into healthy non-cancerous cells.

Dosage

high_vitamin_k2_intakeVitamin K2 supplementation is very safe for both adults and children. It has no known toxic effects, even at dosages much higher than those recommended in this post. Current research shows that 200 mcg daily is an optimal dose. That is a couple of small softgel s since they generally contain 100 to 120 mcg per capsule. If you are looking for maximal absorption take your K2 with some form of fat, since it is fat soluble. If you are looking for maximal effect, please be sure to take this vital nutrient along with 3000-5000 iu of vitamin D.

Foods Highest in Vitamin K2 include:

  • Natto
  • Hard cheese
  • Soft cheese
  • Egg yolk
  • Butter
  • Chicken liver
  • Salami
  • Chicken breast

Stay tuned for our last post on fat soluble vitamins … VITAMIN E!

The Vital Importance of Fat-Soluble Vitamins – Vitamin D

Vitamin-DA Quick Primer

One of the major benefits of being on a high-fat/ketogenic diet is that the intake of fat-soluble vitamins increases dramatically. Consuming a variety of dietary fats is not just important for creating healthy cells and optimal hormone levels. Fat is also needed for the absorption of fat-soluble vitamins.

What is a fat soluble vitamin? Vitamins are categorized as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). The distinction between these two types of nutrients is very important. It governs how each one acts inside the body.

Fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed into fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood supply. These fat soluble vitamins, especially vitamins A and E, are subsequently stored in the body’s tissues.

Water soluble vitamins, on the other hand, dissolve in water when they are ingested. Then they go in to the blood stream. The body keeps the amount of water soluble vitamins we need at any one time, and any excess amount is excreted in the urine. Since they can’t be stored, everybody needs to consume a continuous supply of water soluble vitamins in order to stay healthy.

The fact that certain vitamins are retained and kept in storage while others are not gives us a hint regarding their relative importance. With this in mind, our next four blog posts will discuss the importance of the four fat soluble vitamins: A, D, E and K.

With ALL fat soluble vitamins, there is a minimum requirement for the consumption of dietary fat. These levels are necessary to ensure correct amounts of the vitamins in question. Unfortunately, the intake of fat recommended by various first-world government organizations is generally well below what is needed for optimal utilization of fat-soluble vitamins. It is important to note that saturated fat must be consumed in adequate amounts,(and in higher levels than those often recommended), in order to properly provide fat-soluble vitamins to required tissues.

Vitamin D

Vitamin D
Vitamin D

Vitamin D is a fat-soluble vitamin that rarely occurs naturally in food, though it is available as a dietary supplement. It is also produced naturally by the body when sunlight reaches the skin and activates vitamin D synthesis from cholesterol. Vitamin D acquired from sun exposure, food, and supplements is biologically inactive. It needs to undergo two hydroxylations in the body to become activated. The first happens in the liver where vitamin D is converted into to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs principally in the kidneys where it forms the physiologically active form of Vitamin D (1,25-dihydroxyvitamin D [1,25(OH)2D]), also known as calcitriol.

b-vitamin-d

Vitamin D and Bone Health

Vitamin D supports calcium absorption in the gut and keeps adequate blood levels of calcium and phosphate stable. This allows for normal mineralization of bone. Vitamin D is also required for bone growth and bone remodelling by osteoblasts and osteoclasts. Without enough vitamin D, bones can become thin, weak, or deformed. Sufficient vitamin D prevents rickets in children and osteomalacia in adults. Osteomalacia is a condition involving softening of the bones of the body. There is a difference between osteoporosis and osteomalacia. Osteomalacia is characterized by a decreased ratio of bone mineral to matrix. In osteoporosis, there is decreased bone mass with a normal ratio of mineral to matrix. Together with appropriate levels of calcium, vitamin D can help protect older adults from both osteoporosis and osteomalacia.

Why do people become deficient in Vitamin D?

cubicle-office-workVitamin D deficiencies were extremely rare 100 years ago. This was a time when most of us worked outside in the sun. But as work moved from the farm to the big city, that level of exposure changed. Because skin pigmentation actually reduces the production of vitamin D  by around 90%, non-white populations are at particular risk. Deficiencies are also frequent in patients with digestive disorders that limit the absorption of fat, as well as in people with kidney or liver diseases that interfere with the conversion of vitamin D to its active form, calcitriol (1,25(OH)2D). In addition, certain medications reduce the availability or activity of vitamin D. Most of these medications effect cholesterol and dietary fat. Here, again, we see the vital importance of sufficient dietary fat in nutrient status.

A number of factors can play a role in activated vitamin D deficiency. Inadequate contact to sunlight heads the list. According to Harvard medical school, except during the short summer months, people who live at latitudes above 37 degrees north or below 37 degrees south of the equator simply do not get enough UVB energy from the sun to make all the vitamin D they need. The same is true for people who spend most of their time indoors and for those of us who avoid sunshine and use sunscreens to protect our skin from the supposed harmful effects of ultraviolet radiation. Balance is the key. Too much sun is damaging, but too little can also hurt you. Health is about harmony, not extremes generated by unsupported fear mongering.

Vitamin D and Sex Hormones

vitamin-d-deficiency-fbAccording to this 2000 study published in the journal Endocrinology, Vitamin D deficiency can cause low estrogen levels, which in women will result in a low sex drive.  According to this journal article, deficiency in this vital fat-soluble hormone also causes low testosterone in men.  So, there is a good reason why you may feel more vital during the summer, or while on vacation, than you do in the depths of winter.  Elevated vitamin D causes your hormones, and your libido, to spike during summer months.  In fact, according to this paper, reviewed at Medscape, men with adequate vitamin D – 30.0 mcg/L or more – have significantly more testosterone than men whose vitamin D levels range from 20.0-29.9 mcg/L.

Understand as well that testosterone and estrogen levels do not simply regulate sex drive. These important hormones also have enormous influences on mood in both women & men.  Low testosterone can cause depression, anxiety, and irritability. Similarly, estrogen helps boost serotonin and GABA, critical neurotransmitters, which help keep you calm and happy. Vitamin D also has other, more direct, effects on your mood.  It activates the genes that release dopamine and serotonin. The lack of these neurotransmitters is commonly linked to depression.

Vitamin D is also crucial in the fight against heart disease. An article published in 1996 found that the farther north you live, the more likely you are to suffer from heart problems. That realization directs us to the possibility that vitamin D may somehow have a causal association with an increased risk of heart disease. The implication is that sunlight exposure may deliver a protective influence, conceivably through vitamin D.

An early tip that deficiency of vitamin D may be related to heart disease started with a New Zealand study of 179 people who presented with heart attacks. Heart attack sufferers were associated with lower vitamin D blood levels (25-hydroxyvitamin D) compared to people without heart attacks. A supporting observation arose from an examination of 259,891 heart attack patients kept by the National Registry of Myocardial Infarction. In this nationwide report, heart attacks surged by 53% during sun-deprived winter months compared to summer.

Optimal Vitamin D Levels

The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test. A level of 20 nanograms/milliliter to 50 ng/mL is considered adequate for healthy people. A level less than 12 ng/mL indicates vitamin D deficiency.

According to a report at the Institute of Medicine, Food and Nutrition Board (link here), the following constitutes optimal blood vitamin D levels:

Table 1: Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health*
nmol/L** ng/mL* Health status
<30 <12 Associated with vitamin D deficiency, leading to rickets in infants and children and osteomalacia in adults
30–50 12–20 Generally considered inadequate for bone and overall health in healthy individuals
≥50 ≥20 Generally considered adequate for bone and overall health in healthy individuals
>125 >50 Emerging evidence links potential adverse effects to such high levels, particularly >150 nmol/L (>60 ng/mL)

* Serum concentrations of 25(OH)D are reported in both nano-moles per liter (nmol/L) and nano grams per millilitre (ng/mL).
** 1 nmol/L = 0.4 ng/mL

When the sun isn’t available you can use vitamin D3 supplements. According to this study, blood levels of 30 nanograms per millilitre have been achieved during winter by supplementing with 3000 to 5000 IU of vitamin D3.

Remember to eat enough real dietary fat in the form of saturated and mono unsaturated fats. A report in Nature found that Vitamin D absorption might be affected by the type of dietary fat a person consumes. After supplementation with vitamin D3, the increment in plasma 25-hydroxyvitamin D was positively associated with monounsaturated fatty acids, and negatively associated with polyunsaturated fatty acids. Stay away from those vegetable oils!!

As you can see from this post, vitamin D plays a major role in our health. Just like all the other fat soluble vitamins, low fat diets negatively impact our utilization of this crucial nutrient!

Stay tuned for the next post on Vitamin K!

The Vital Importance of Fat-Soluble Vitamins – Vitamin A

Definition, Benefits, and Sources of Vitamin A - RealtipspediaOne of the major benefits of being on a high-fat/ketogenic diet is that the intake of fat-soluble vitamins increases dramatically. Consuming a variety of dietary fats is not just important for creating healthy cells and optimal hormone levels. Fat is also needed for the absorption of fat-soluble vitamins.

What is a fat soluble vitamin? Vitamins are categorized as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). The distinction between these two types of nutrients is very important. It governs how each one acts inside the body.

Fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed into fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood supply. These fat soluble vitamins, especially vitamins A and E, are subsequently stored in the body’s tissues.

Water soluble vitamins, on the other hand, dissolve in water when they are ingested. Then they go in to the blood stream. The body keeps the amount of water soluble vitamins we need at any one time, and any excess amount is excreted in the urine. Since they can’t be stored, everybody needs to consume a continuous supply of water soluble vitamins in order to stay healthy.

The fact that certain vitamins are retained and kept in storage while others are not gives us a hint regarding their relative importance. With this in mind, our next four blog posts will discuss the importance of the four fat soluble vitamins: A, D, E and K.

With ALL fat soluble vitamins, there is a minimum requirement for the consumption of dietary fat. These levels are necessary to ensure correct amounts of the vitamins in question. Unfortunately, the intake of fat recommended by various first-world government organizations is generally well below what is needed for optimal utilization of fat-soluble vitamins. It is important to note that saturated fat must be consumed in adequate amounts,(and in higher levels than those often recommended), in order to properly provide fat-soluble vitamins to required tissues.

Vitamin A

18096Vitamin A is a general term that refers to fat-soluble compounds such as preformed vitamin A (retinol) in animal products, and pro-vitamin A carotenoids in fruit and vegetables. The three active forms of vitamin A in the body are retinol, retinal, and retinoic acid. Plant-based vitamin A must be converted into an active form before it can be used in the human body. The active form of vitamin A can be consumed more efficiently in the form of animal products which do not need to be converted. Active forms of vitamin A participate in regulating the growth and specialized differentiation of almost every cell in the human body. Among many other critical roles, vitamin A features significantly in embryonic development, organ structure during fetal development, normal immune functions, eye growth and vision.

Animal food sources rich in activated vitamin A include dairy products, meats and poultry (with the fat included!), liver, and fish oils. Rich sources of pro-vitamin A carotenoids include orange and green vegetables, such as sweet potato, kale and spinach. However, according to a paper published in the American Journal of Clinical Nutrition conversion rates vary widely, from 3.6:1 to 28:1. Though active vitamin A (retinol) can be toxic at extreme doses, pro-vitamin A conversion to an active form is clearly unreliable.

Vitamin A Deficiency Symptoms

23916952Some of the major deficiency symptoms of Vitamin A include keratinization of the skin, night blindness, a burning sensation or itching in the eyes, inflammation of the eyelids, xerophthalmia (dryness of the conjunctiva), dull lusterless hair, dandruff, brittle nails that break easily, and sexual disorders. A deficiency of Vitamin A can also result in fatigue, insomnia and depression.

Vitamin A Toxicity

vitaminaThere are potential dangers of overdosing on Vitamin A but they are often overblown and based on a poor understanding of what it is and how it works.

WebMD.com provides an example of the typical view regarding Vitamin A Toxicity: “Vitamin A can be very toxic when taken in high-dose supplements for long periods of time and can affect almost every part of the body, including eyes, bones, blood, skin, central nervous system, liver, and genital and urinary tracts. Symptoms include dizziness, nausea, vomiting, headache, skin damage, mental disturbances and, in women, infrequent periods. Severe toxicity can cause blindness and may even be life-threatening. Liver damage can occur in children who take RDA-approved adult levels over prolonged periods of time or in adults who take as little as five times the RDA-approved amount for seven to ten years. In children, chronic overdose can cause fluid on the brain and other symptoms similar to those in adults. Pregnant women who take amounts not much higher than RDA levels increase the risk for birth defects in their children. High consumption of vitamin A may also increase the risk of gastric cancer and the risk of osteoporosis and fractures in women.”

The Merck Manual defines vitamin-A toxicity in a less feverish way:

50339“Acute vitamin-A poisoning can occur in children after taking a single dose of synthetic vitamin A in the range of 300,000 IU or a daily dosage of 60,000 IU for a few weeks. Two fatalities have been reported from acute vitamin-A poisoning in children, which manifests as increased intracranial pressure and vomiting. For the vast majority, however, recovery after discontinuation is spontaneous, with no residual damage.”

The references used in the Merck Manual state that vitamin-A toxicity has been reported in arctic explorers who developed drowsiness, irritability, headaches and vomiting, with subsequent peeling of the skin, within a few hours of ingesting several million units of vitamin A from polar bear or seal liver. Again, according to the Merck Manual, said symptoms resolved quickly with the discontinuation of vitamin-A rich food.

These reports are alarming at face value. But, given that most of us don’t consume polar bear or seal liver, this is an unusual and somewhat irrelevant example.  However,  supplemented vitamin-A from poorly formulated tablets containing very high and unbalanced levels of vitamin A (retinol) that have been consumed for extended periods of time have induced acute toxicity. To put a number on such levels, we’re talking about 100,000 IU synthetic vitamin-A per day taken for several months. All of this begs the question, “Is there a significant risk of Vitamin A in balanced or even supplemented diets?”

In another post we will be discussing the synergy of the various fat-soluble vitamins and minerals. But, for the time being, understand that unless you are an arctic explorer with unbalanced and rather exclusive dietary preferences, it is practically impossible to acquire vitamin-A toxicity from food. The alleged toxic dose of 100,000 IU per day would be contained in 6 tablespoons of regular cod liver oil, two-and-one-half 100-gram servings of duck liver, about three 100-gram servings of beef liver, seven pounds of butter or 309 egg yolks. You’d need to consume any one of those substances at the given amount daily, for months. It is clearly impossible to achieve vitamin A toxicity with food. Furthermore, even with the standard supplement dosages used in the creation of natural health products, it would still be quite a task to consume overdose levels. Maximum dosages for the active retinol form of vitamin A in Canada are 10, 000 IU. So that’s 10 pills per day of vitamin A alone for several months.

The Health Benefits of Vitamin A

Hopefully, we have taken some of the fear out of consuming vitamin A rich foods. Let’s take a look at some of their scientifically supported health benefits.

The following is a list of health benefits afforded by Vitamin A from the Weston A. Price Foundation written by Mary G. Enig, PhD, FACN, CNS (link here).

Vitamin A — The Miracle Nutrient

Vitamin A supplementation of children in Asia and Africa has been extremely effective in reducing the rates of infection, diarrhea, anemia and blindness (Reuter’s 2/12/01). African and Asian children receiving vitamin-A supplements grow faster, have better hemoglobin values and die 30-60 percent less frequently than non supplemented peers (J Nutr Jan 1989 119(1):96-100).

Vitamin A supplementation can reduce the incidence of malaria. Children in Papua New Guinea given high doses of vitamin A had a 30 percent lower incidence of malaria than those receiving a placebo (The Lancet, 1999, 354:203-9).

Vitamin A plays a vital role in regulation of the immune system. Vitamin A deficiency leads to a loss of ciliated cells in the lung, an important first line defence against pathogens. Vitamin A promotes mucin secretion and microvilli formation by mucosa, including the gastrointestinal tract mucosa. Vitamin A regulates T-cell production and apoptosis (programmed cell death) (Nutrition Reviews 1998;56:S38-S48).

Treatment with megadoses of vitamin A (100,000 IU per day) resulted in a 92 percent cure rate of menorrhagia (excessive menstrual bleeding) at Johannesburg General Hospital in South Africa (S Afr Med J 1977).

Lack of vitamin A interferes with optimal function of the hippocampus, the main seat of learning. Scientists at the Salk Institute for Biological Studies in San Diego, California, found that removing vitamin A from the diets of mice diminished chemical changes in the brain considered the hallmarks of learning and memory (Proc Natl Acad Sci, Sep 25, 2001 98(20):11714-9).

Natural vitamin A helps reconnect retinoid receptors critical for vision, sensory perception, language processing and attention in autistic children. Use of Vitamin A rich cod liver oil helps children recover from autism caused by the DPT vaccine. The pertussis toxin interferes with retinoid receptors in the brain (Med Hypothesis, Jun 2000 54(6):979-83).

Vitamin A can be helpful in the treatment of psoriasis. Researchers found that patients suffering from severe psoriasis had low blood levels of vitamin A (Acta Derm Venereol Jul 1994 74(4):298-301).

In stroke victims, those with high levels of vitamin A are more likely to recover without damage (The Lancet, Mar 25, 1998, pp 47-50).

Vitamin A protects against lung and bladder cancers in men (Alt Cancer Inst Monogr Dec 1985 69:137-42). Fourteen out of 20 patients with prostate cancer achieved total remission and five achieved partial remission using vitamin A as part of a natural cancer therapy in Germany (Drugs Exp Clin Res 2000;26(65-6):249-52).

Vitamin A was used successfully by Dr. L. J. A. Loewenthal, to combat tropical ulcers in Uganda (S Afr Med J Dec 24 1983 64(27):1064-7).

Vitamin A has also been used successfully to treat a skin condition called Kyrle’s disease (Cutis Dec 1982 30(6):753-5, 759). Elderly persons who consume adequate vitamin A are less prone to leg ulcers (Veris Newsletter Dec 1999;15(4):5).

Chronic vitamin-A deficiency causes degeneration of the structures of the ear. Decreased auditory function in humans is associated with low vitamin-A levels. (Arch Otorhinolaryngol 1982;234(2):167-73).

Vitamin A inhibits the effects of phytic acid and increases absorption of iron from whole wheat. (Arch Latinoam Nutr Sep 2000;50(3):243-8). Vitamin A supplementation increases absorption of iron and folic acid in women in Bangladesh (Am J Clin Nutr Jul 2001;74(1):108-15).

Use of vitamin A supplements reduces the risk of cataracts (Am J Ophthalmol Jul 2001;132(1):19-26).

This is an impressive list which points to wide ranging therapeutic applications using Vitamin A in foods and as a supplement.

Sources of Vitamin A

l60565625During the process of researching this blog post, the bias against animal sources of vitamin A (retinol) became clear. The first several pages of google only listed plant sources of vitamin A (carotenoids), with most of the “authorities” (Health Canada, FDA, NIH, ETC …) issuing stern warnings against consuming retinol.

Listed below are approximate levels of vitamin A in common foods, in IUs per 100 grams:

Food (100 grams) Activated Vitamin A (retinol)
High-vitamin cod liver oil 230,000
Regular cod liver oil 100,000
Duck liver 40,000
Beef liver 35,000
Liverwurst sausage (pork) 28,000

slide02If you were to take the top 5 listed forms of plant-based vitamin A (carotenoids), and applied the best conversion rate listed above at 3.6 to 1, (from nutritive value of inactive plant forms of Vitamin A to active animal based forms), you can see that it’s not exactly a good trade off. Keep in mind that the conversion rate of plant-based vitamin A can reach up to 28:1, which would be almost 7 times lower the usable amount listed below.

Food (100 grams) Vitamin A (carotenes) Conversion
Sweet Potato 19,218 IU 5338 IU
Carrots 17,033 IU 4731 IU
Kale (cooked) 13,621 IU 3783 IU
Squash (cooked) 11,155 IU 3098 IU
Cantaloupe 3,382 IU   939 IU

Conclusion

Vitamin A in the form of retinol is vital to optimal human health. A host of important functions in the body, from healthy reproductive growth, to immune function, to bone health, absolutely require adequate supplies of this vitamin in the form of retinol. Retinol has been unreasonably labelled as toxic. This has caused authorities to promote plant-based vitamin A in the form of carotenoids. These plant-based sources have a wide range of conversion into the active usable form of vitamin A (retinol). These conversion rates make it very difficult to achieve optimal vitamin A levels with plant sources alone.

Stay Tuned for the next Crane Medicine post on Vitamin D!

Gut Bacteria, Irritable Bowel Syndrome (IBS ) and Starch – Prebiotics and Probiotics in Health and Disease

Rob-Keller-MD-GI-HealthIrritable bowel syndrome (IBS) is a disorder characterized by abdominal pain or discomfort, and altered bowel habits (chronic or recurrent diarrhea, constipation, or both – either mixed or in alternation). IBS is an incredibly difficult and painful medical condition. Dealing with it is a complex process as it affects so many of our daily routines. In many ways, our social lives revolve around food and digestion.

To make matters worse, a positive diagnosis confirming this particular condition can take years to establish. Nearly 2,000 patients with IBS reported in a survey by the International Foundation for Functional Gastrointestinal Disorders, that a diagnosis of their IBS was typically made 6.6 years after the symptoms began. These are years spent suffering from a debilitating condition. This report also illustrates some important points regarding IBS.

  • Pain: Pain is a dominant symptom for IBS sufferers. Seventy-eight percent report having continuous or frequently recurring abdominal pain during the previous six months. Of those who experience pain, one-fourth describes the pain as constant.
  • Loss of control: More than 40% of these respondents felt that they were losing a great deal of control over their lives due to their IBS.
  • Quality of life impacts: Respondents reported an average of more than 73 days (20% of the calendar year) when they needed to restrict their usual activities due to their health.
  • Assuming risks for symptom relief: Respondents were asked how much risk they would assume to take a medication providing total relief from IBS symptoms despite serious adverse side effects. Their quest for symptom relief is striking: 8% would accept a 1 in 100 chance of death to be symptom-free while another six percent (6%) would accept a 1 in 100 chance of serious and disabling side effects to be symptom-free. Such risk acceptance is a marker for the severity of symptoms which were experienced.

Girl with stomach cramps or pains

Irritable Bowel Syndrome is serious business, and it can have a crippling effect on people’s lives. Since the symptoms related to IBS include so many digestive issues, understanding this affliction can teach us a lot about how to promote proper digestion. As we proceed with this post, we will be referencing IBS as a bench mark for poor digestion.

Gut Bacteria & Digestion

bacteriaBacteria are present normally in the gut. In this case, we are mainly referencing the small and large intestines. The presence of bacteria in the gut is especially important in the lower parts of the intestine. These bacteria reach concentrations of several billion in the large intestine. These “normal” bacteria have important functions in life & health, including:

  • Defending against infection originating with disease-promoting bacteria
  • Facilitating the growth and effective functioning of the immune system
  • Generating a range of nourishing substances that have significant nutritional value

These varied amounts of healthy intestinal bacteria are often collectively called gut flora (or in technical terms microbiota). Several factors may upset the mutually beneficial connection between the flora and our bodies. When this happens, the bacteria that promote disease may out-number the bacteria that promote health.

Do bacteria play a role in healthy digestion?

There is substantial evidence to support the idea that disturbances in our intestinal bacteria effect healthy digestion in fundamental ways.

This evidence from observations or studies can be summarized as follows:

  • Antibiotic use, which is well known to disturb the flora, may predispose individuals to IBS
  • Some people may develop IBS suddenly following an episode of stomach or intestinal infection (gastroenteritis) caused by bacteria (a condition called post-infectious IBS or PI-IBS) (Maroon T, 2009).
  • A very low level of inflammation may be present in the bowel wall of some IBS patients, which could have resulted from an abnormal interaction with bacteria in the gut (Hirotada A, 2010).
  • Small intestinal bacterial overgrowth (SIBO) is strongly associated with IBS (Sachdeva S, 2011).
  • Alteration of bacteria in the gut using antibiotics or probiotics may improve symptoms in IBS (Basseri R, 2011 , Hungin A, 2013)

In Post Infection IBS, people who have had previously healthy bowel function, develop IBS-like symptoms after a bout of gastroenteritis. Though most people will recover completely from an infection, the link between an intestinal infection and the development of IBS symptoms is a clear. There is a demonstrable connection between exposure to a bacterial infection (such as E.Coli from contaminated food or water) and IBS in those who seem at risk.

Over the years, numerous studies have hinted at the effects of alterations in the variety of gut flora in people with IBS. These alterations in intestinal flora may lead to the growth of particular bacterial species which themselves create extra gas (such as methane) and other by-products through metabolism. This could be a large contributor to symptoms like gas, bloating, and diarrhea.

Which symptoms indicate gut flora problems?

gut_flora_infographic-2000Some symptoms pointing to gut flora imbalances include obvious digestive problems such as: acid reflux / heartburn, an irritable bowel, abdominal bloating, alternating constipation and/or diarrhea, and an inflammatory bowel condition called colitis. According to Dr. Mark Hyman, digestive problems account for over 200 million doctor’s visits and billions in health care costs annually. An important factor when discussing gut flora problems is that the symptoms of this imbalance can extend well beyond just matters of digestion.

Patients with bowel problems like colitis can also have inflamed joints. Patients with liver failure can be cured of delirium by taking antibiotics that kill the toxin-producing bacteria in their gut. It is clear that body systems (digestive, circulatory, respiratory, etc …) are not entities which are isolated from each other. They are connected through mediators like hormones and bacteria. When one of these systems or mediators goes out of balance a multitude of symptoms can arise.It seems remarkable, but the microscopic bacteria living within you have been linked to everything from autism (Stilling RM, 2015) to obesity (Willis C, 2014), from allergy (Jiang K, 2014) to autoimmunity (Wein H, 2014), from fibromyalgia (Pimentel M, 2004) to restless leg syndrome (Weinstock LB, 2011), from emotional well-being (Burnet J, 2015)to asthma (Potera C, 2005). In fact, the research links between chronic illness and gut bacteria continues to grow daily

How do I create a healthy environment for gut bacteria?

Scientists compared gut flora or bacteria from children in Florence, Italy who ate a diet high in meat, fat, and sugar to children from a West African village in Burkina Faso who ate beans, whole grains, vegetables, and nuts (De Flippo C, 2010). The bacteria in the guts of the African children were healthier, more diverse, and better at regulating inflammation and infection. They were also better at extracting energy from fiber. The flora in the guts of the Italian children were strains that produced by-products that create inflammation, promote allergy, asthma, autoimmunity, and lead to obesity.

Why do the people of Africa have healthier gut bacteria than the people of Italy? The answer lies in the foods, and fibers, they are feeding to the bacteria in their guts. In a previous post titled Good Carbs, Bad Carbs, Smart Carbs, we discussed the science behind soluble fiber in detail. The largely condensed version of this post is that the bacteria in our guts live on soluble fiber.

slide02Soluble fiber should not to be confused with insoluble fiber which is essentially like a rough-bristled-broom that pushes food and nutrients through your digestive system. As a result, this type of fiber can lead to nutrient malabsorption. It should generally be avoided. On the other hand, feeding your gut bacteria soluble fiber enhances digestion and gives you extra energy, extra nutrients, and an extra boost to your metabolism!

Probiotics – the “good bacteria” in your gut.

Probiotics are live bacteria and yeasts that are good for your health, in particular your digestive health. We usually think of bacteria as something that causes diseases. But your body is full of bacteria, both good and bad. Probiotics are often called “good” or “helpful” bacteria because they can keep your gut healthy.

Prebiotics – the fuel for the “good bacteria” in your gut

Prebiotics are fiber-based carbohydrates that cannot be digested by the human body. In stead, they are food for probiotics.

The primary benefit of probiotics and prebiotics is the help they offer in maintaining a healthy digestive environment. Feeding your gut an effective combination of prebiotics and probiotics can resolve digestive issues while at the same time drastically increasing overall health. We truly are what we eat. If we eat packaged foods made with bizarre seed oils, sugars and unrecognizable forms of protein we risk altering the healthy balance of gut flora. Health and energy supplies are almost certain to dwindle.

The traditional way in which we consumed probiotics was in the form of fermented foods, (think yogurt and sauerkraut). All cultures (pun intended) have a history of consuming these power-house foods. Consuming traditionally fermented foods provide the body with a number of benefits, which include:

  • Boosting the immune system. It is estimated that 80 percent of what comprises the  immune system resides in your gut. Probiotics play a critical role in the growth and function of the mucosal immune system in your digestive tract. They also assist in the production of antibodies to fight infectious pathogens. Having healthy gut bacteria is a major element in supporting optimal health.
  • Important nutrients. Many fermented foods are exceptional sources of essential nutrients such as vitamin K2. This fat-soluble vitamin is almost non-existent in the modern low fat Standard American Diet (S.A.D.). Vitamin K2 can help prevent arterial plaque buildup and reduce the risk of heart disease. Cheese curd is an excellent source of both probiotics and vitamin K2. Just half an ounce (15 grams) of the fermented bean paste natto can also provide all the K2 you need in a day. Fermented foods also produce many of the B vitamins we need to stay healthy.
  • Natural varieties of microflora. As long as you vary the fermented and cultured foods you consume, you will get a considerable variety of beneficial bacteria, much more than you could ever get from taking a supplement.
  • Cost-effectiveness. Adding a small amount of fermented food to each meal will give you the biggest bang for your buck. Why? Because they can contain much, much, more probiotic bacteria than a supplement!
  • Fermented foods are some of the best cleansing-chelators available. The valuable bacteria in these foods are extremely effective detoxifiers. They are excellent at dealing with a wide variety of toxins and heavy metals.

What about carbohydrates? Don’t they feed gut bacteria?

The majority of the carbohydrates in our diets are starch. Starches are long chains of glucose that are found in grains, potatoes and various foods. Though many of the starches we consume in modern foods convert rapidly into blood sugar, thus promoting issues like heart disease and cancerous tumor growth, some do not. In some cases, a small amount of starch we consume can pass through the digestive tract undigested. These carbs, which are resistant to conversion into glucose, are called resistant starch. This type of starch functions like soluble fiber (more on soluble fiber HERE).

A multitude of clinical studies have shown resistant starch to have some very desirable health benefits, including:

Improved insulin sensitivity (Johnston KL, 2010)

Lower blood sugar levels (Robertson D, 2005)

Better digestion (Guarner F, 2003)

How does resistant starch work? Why should I include it in my diet?

Resistant starch passes through the stomach and small intestine undigested, this allows it to reach the colon and feed the friendly bacteria residing there. The bacteria in the colon outnumber the cells in our body 10 to 1 (Sears C, 2005). In a way, this means that our digestive tracts are actually only 10% human! Most of the food we eat, packaged foods in particular, gets converted into blood sugar and very little passes (no pun intended) along to the lower intestinal tract. This leaves the vital friendly flora near the end of the digestive process starved. Since they give us so much in the way of health, WE lose when THEY lose! There are hundreds of different species of bacteria in the intestine. In the past few decades, researchers have found that the number, type and variety of bacteria in our guts can have a profound impact on health (Guarner F, 2003).

How do I include resistant starch in my diet?

There are two ways to add resistant starches to your diet, you can consume them in your diet  or you can supplement with them. Several commonly consumed foods are high in resistant starch. This includes raw potatoes, cooked and then cooled potatoes, green bananas, various legumes, cashews and raw oats. For an extensive list of foods and their resistant starch content CLICK HERE. From the list you can clearly see that these are all high-carb content foods. Remember, if it’s resistant starch you are counting it won’t convert into blood sugar so being “high carb” sources is not an issue. Don’t think that this simply a list of “healthy foods”. Rather, it should be used as a guide for selecting foods that will nourish your gut bacteria which in turn will lead to better health.

1444c244_potatostarch_f_1800If you want to be exact in how you consume your starch, you can add resistant starch to your diet without adding any digestible carbohydrates. Many people are using Bob’s Red Mill Raw Potato Starch. Raw potato starch contains around 8 grams of resistant starch per tablespoon, and it has almost no usable carbohydrate. 4 tablespoons of raw potato starch will provide about 32 grams of resistant starch. It is important to start slowly and work your way up, because too much, too soon can cause flatulence and discomfort. It may take time (2-4 weeks) for the production of short-chain fatty acids (more on these powerful intestinal helpers over at our post Good Carbs, Bad Carbs, Smart Carbs) to increase and to notice all the benefits, so be patient.

Four Steps to a Healthy Gut

  1. Eat lots of leafy green veggies; they are full of soluble fibers that can help feed your “good” gut bacteria. A moderate to small amount of starch from yams, sweet potatoes and taro will also help feed your gut bacteria. You can also supplement with resistant starches.
  2. Take a quality probiotic supplement daily and/or eat fermented foods. These actions promote healthy & friendly flora that can improve your digestive health and reduce inflammation and allergic reactions.
  3. Limit sugar, processed foods, (in fact eliminate them all together if possible). Avoid excessive protein consumption. These are habits which provide an environment that promotes unhealthy bacteria and suppresses healthy gut bacteria. Note: we did not say avoid protein consumption entirely or that proteins are “unhealthy”. In the context of a diversified diet they are absolutely essential. Animal fats and proteins are vital to a healthy body (covered in our blog post The Primal Origins of the Human Diet). Keep in mind however that they must be balanced within an overall framework of health promoting pre & probiotics. The amino & fatty acids contained in meat, which are so vital to optimal well-being, cannot be digested fully without appropriate levels of healthy bacteria in the gut.
  4. Avoid the frequent use of antibiotics (long-term in particular), antacid medications, and anti-inflammatory medications. These drugs change gut flora and digestion in a negative way, making a healthy gut much more difficult to achieve and maintain.

16632229-Abstract-word-cloud-for-Gut-flora-with-related-tags-and-terms-Stock-Photo

A healthy digestive system contains healthy bacteria. These healthy bacteria, also referred to as “probiotics”, give us many health benefits. If we are following an ancestral diet we need to make sure we are including probiotic supplements and/or fermented foods in our diets in order to effectively digest our foods. Many of the digestive problems that negatively impact people’s lives are rooted in an unhealthy gut. Take control of this vital axis of energy and nutrient absorption and you’ll be healthier, sharper, and more energetic … the last question for this post is … what are you waiting for?

The Biology of Stress and Depression Pt. 7: What you can do to increase levels of Brain Derived Neurotrophic Factor (BDNF)

(These are all of the posts we have on this topic)
1st Post on Stress and Depression: Why the Current Theory Fails So Often
5th Post on Stress and Depression: BDNF
6th Post on Stress and Depression: The Cholesterol/Dopamine Connection
7th Post on Stress and Depression: Increasing levels of Brain Derived Neurotrophic Factor (BDNF)
(This blog post is an excerpt from the book Never Give Up: Conquer Stress & Depression by David R. Hastings Lloyd – if you would like to purchase the book in print or in Kindle format CLICK HERE)

0028Hello again and welcome to our 7th and final post on the biology of stress and depression. In this post we will be discussing what types of exercise have been shown to increase levels of Brain Derived Neurotrophic Factor (BDNF). As stated in a previous post (click here to go to the post), BDNF is like fertilizer for your brain’s neural circuits. If you want to learn something new, you need BDNF to help you pave those new neuro-pathways. These pathways can control something physical like how to throw a perfect spiral with a football, or something psychological like a new mindset or attitude. Either way you need to grow new circuits for your nerves in order to wire yourself for a new task. This process of creating these neurological structures or networks to adapt to new psychological, physiological, or emotional needs is called neuroplasticity.

In his book, Evolve Your Brain, Dr. Joe Dispenza eloquently described the neural network as, “.literally millions of neurons firing together in diverse compartments, modules, sections, and subregions throughout the entire brain. They team up to form communities of nerve cells that act in unison as a group, clustered together in relation to a particular concept, idea, memory, skill, or habit. Whole patterns of neurons throughout the brain become connected through the process of learning, to produce a unique level of mind.”
So the term “neural network” describes a unique arrangement of connections of neurons that fire in a specified sequence. These networks allow you to perform tasks like tapping your feet, or recalling the lyrics to your favorite song as well as “learning” new tasks as required. Neuroplasticity is the ability of the brain to adapt and change. This flexibility in our nervous systems is based on the modification of existing neural networks and the creation of new ones. A key player in our ability to adapt to new nerve stimulus is a steady supply of BDNF.
If can keep optimal levels of BDNF ready to feed and develop new circuits in your brain the process of developing new skills, knowledge, and attitudes becomes much easier. So, BDNF helps you be the “you” that you want. You build yourself from the inside out firing and re-wiring new pathways based on what you choose to focus on. The implication here is that each of us an unexpected degree of control over who we are and how we feel.
The previous post on the stress hormone cortisol discussed the inverse relationship with cortisol has with cortisol production. If stress hormone and cortisol levels go up levels of BDNF go down. Cortisol also decreases the body’s ability to deal with stress. It does this though damaging the hippocampus, a major contributor in the body[s ability to adapt to stress. As a result we feel stress more acutely even as the body has become even less able to cope!  It’s a really strong feedback loop that encourages us all to be stressed. The good news is this nasty little equation can be reversed. By increasing BDNF we can decrease damaging levels of cortisol. This is how you re-wire to the new you that you want to be.
Our first look at increasing BDNF is exercise.
While our muscles pump iron, our cells pump out something else: particles that nourish a strong brain. For years scientists have struggled to explain the well-known mental benefits of exercise. These benefits include a variety of paybacks, including: offsetting depression and aging, to fighting Alzheimer’s and Parkinson’s disease. And, a team of researchers may have finally discovered a solid molecular link between how a good workout promotes a healthy brain.
Muscle cells increase the production of a protein called FNDC5 while you are exercising. A portion of this protein, called irisin, gets cut off and released into the bloodstream. Spiegelman and his colleagues at Harvard Medical School suspected that FNDC5, and the irisin created from it, are responsible for exercise-induced benefits to the brain. In particular they were interested, (as are we!), in increased levels of BDNF.
To sort out how exercise relates to BDNF, Spiegelman and his colleagues performed a series of experiments in living mice and cultured mouse brain cells. They put an experimental group of mice on a 30-day endurance training regimen. They didn’t have to coerce their subjects, because running is part of a mouse’s natural foraging behavior. The mice with access to a running wheel ran the equivalent of a 5K every night. Next, they compared them to a group of mice who lived like couch potatoes.
Aside from physical differences between wheel-trained mice and sedentary ones, (not surprisingly, the sedentary group had more body fat), the groups also showed significant neurological differences. The runners had more FNDC5 in their hippocampus, an area of the brain responsible for learning and memory. A happy hippocampus is also associated with better stress management and less depressed states.
Using mouse brain cells developing in a cell culture, the group next showed that increasing the levels of the co-activator PGC-1α boosts FNDC5 production, which in turn drives BDNF genes to produce more of the vital neuron-forming BDNF protein. They report these results in the journal Cell Metabolism. Spiegelman says it was surprising to find that the molecular process in neurons mirrors what happens in muscles as we exercise. The processes parallel each other! The mind and body are not separate after all.
How is the brain getting the signal to make BDNF? Some have theorized that neural activity during exercise (as we coordinate our body movements, for example) accounts for changes in the brain. But it’s also possible that factors outside the brain, like those proteins secreted from muscle cells, are the driving force. To test whether irisin created elsewhere in the body can still drive BDNF production in the brain, the group injected a virus into the mouse’s bloodstream that causes the liver to produce and secrete elevated levels of irisin. They saw the same effect as in exercise: increased BDNF levels in the hippocampus. This suggests that irisin could be capable of passing the blood-brain barrier, or that it regulates some other (unknown) molecule that crosses into the brain. This research finally sheds light on how exercise relates to BDNF and other so-called neurotrophins that keep the brain strong and healthy.
best-time-to-workout-We have come a long way in the past twenty-five years in our understanding of the brain, from a generally accepted perception of the brain as being a hard-wired, fixed and immutable organ to one that celebrates its dynamism. Now get out there and move it!