Heart Health

A host of recent studies examine the role of diet in the risk for heart diseases, including high blood pressure, heart attack and stroke.  Some may confirm what you already knew, but others might surprise you!

An observational study of over 70,000 middle age Americans found that a vegetarian diet was associated with a 12% reduction in overall mortality during a 6-year period, with a significant decline in heart disease for the men in the study (Orlich, 2013). 

Lead author Dr Michael J Orlich states, "This research gives more support to the idea that certain vegetarian dietary patterns may be associated with reduced mortality and increased longevity" and can be used to guide food choices.

The Mediterranean diet is in the news, again, with the results of the PREDIMED study showing a 30% reduction in heart disease amongst the study group following the diet of mostly fresh fruits and vegetables with limited red meat and plenty of olive oil.  This study also showed that walnuts were a comparable substitute for the healthy olive oil.

Take note of the summary provided by lead author Dr Ramon Estruch, who states "people should know that the Mediterranean diet is a diet healthier than others and should know the key components of this food pattern. The plan should be to increase the intake of the key foods (vegetables, fruit, nuts, fish, legumes, extra virgin olive oil, and red wine in moderation), also increase the intake of white meat, and decrease the intake of red and processed meat, soda drinks, whole dairy products, commercial bakery goods, and sweets and pastries.”

Not all meat is bad?  More research is teasing out the real issues with red meat consumption and it appears in part that the type of red meat plays a role in development of heart disease.  Increased consumption of the beloved, and processed meats, such as bacon, sausage and ham, are linked to a 70% increase in heart disease and 18% increase in all cause mortality, according to the EPIC study, involving 10 countries and almost half a million men and women.

The EPIC study also showed that modest consumption of non-processed red meat was not associated with a significant health risk.  However, data from the Health Professionals Follow-Up Study and the Nurses Health Study did not distinguish a benefit of non-processed meat, showed that eating one additional serving of any red meat daily was associated with a 16% increase in the risk of cardiovascular mortality and a 10% increased risk of death from cancer. 

Just this week, the European Society of Hypertension came out with new guidelines for salt intake, recommending individuals consume no more than 5 to 6 grams of salt per day.  But, the salt debate is not settled with experts trying to determine if lowering the recommended intake of salt will really lead to less high blood pressure and less heart disease. 

The PURE study examined the prevalence and control of high blood pressure worldwide by measuring blood pressure in 153,000 individuals from 528 urban and rural communities in 17 countries from five continents.  Most of the study participants consumed more that the recommended 5 grams of salt daily and lower levels did not seem to have much effect on blood pressure.  Only salt intake of higher levels started to correlate with higher blood pressure.

Conversely, the DASH study showed a stepwise improvement in blood pressure when lowering daily salt intake from 12 grams to as low as 3 grams per day.  The NOMAS study showed individuals double their risk of stroke by consuming more than 10 grams of salt per day compared with people who took in only 3,750mg daily.

How about some really good news!  Your morning cup of coffee is associated with lower blood pressure.  From France, Dr Bruno Pannier presented data showing that drinking tea or coffee was associated with a small but statistically significant reduction in systolic and diastolic blood pressure.  The study did not distinguish between green, black or herbal teas, and was not able to estimate caffeine concentrations. 

There are numerous studies that show positive artery health effects from the various anti-oxidant chemicals called “flavonoids” that are found in coffee beans, tea leaves, and cocoa beans. 

A Simple Solution to Heart Health

Lower your risk of death 80% by following four simple healthy lifestyle behaviors.  Eat right, exercise regularly, maintain a good weight, and don’t smoke.  These from the MESA trial that included 6229 US adults aged 44 to 84 years old.  All patients were given a lifestyle score, ranging from 0 to 4, based on whether or not they followed a Mediterranean-style diet, their exercise habits (achieving 150 minutes of moderate-intensity physical activity per week), body-mass index (BMI), and smoking status. One point was awarded for each healthy lifestyle behavior.

Over a seven-year period the patients who adopted all four healthy behaviors had an 80% decrease in death rate compared with those who followed zero of the health behaviors.  Turns out that smoking is worse than not doing the other three health habits.

As always, I try to keep things simple for myself and for my patients.  In the case heart disease and overall mortality, doing a few simple things will do more to promote good health than any medication. 

Eat a balanced diet free from sugar and low in high-glycemic carbohydrates and processed meats.  Increase your intake of fresh, preferably organic, fruits and vegetables, with plenty of nuts and healthy fats such as olive oil.  I try to keep red meat intake to once/week, avoid processed meats altogether, and get mostly venison or grass-finished beef.  Chicken and fish are good alternatives to red meat.  Eggs are ok.  Keep from overdoing it on the salt.  Enjoy your coffee, tea or alcohol, all in moderation.

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Hair Today Gone Tomorrow

Are you are sick and tired of shaving, waxing or plucking unwanted hair?  Summer is here and skin is back in the daylight.  Now is the time to consider laser hair removal as advanced technology has made this procedure simple, effective and affordable. 

The history of hair removal goes back to the Greeks and Romans who used pumice stones to remove unwanted hair.  The Native American Indians used sharpened stones or shells to tweeze or abrade, while the ancient Turks invented the first “Nair” product using a combination of rose water, arsenic, quicklime and yellow sulfate. 

Modern men and women continue to desire the removal of unwanted hair for various reasons.  Most are simply tired of shaving underarm, leg and bikini areas.  Some wish to be rid of pesky facial hair or general body hair.  Whatever the reason, it is now available for just about anyone to safely and quickly remove unwanted hair.

Today’s methods of hair removal are much more effective and gentler than those of our ancestors!  Removing hair above the skin is called depilation and includes shaving, chemical hair removal (e.g. Nair) and bleaching solutions.  Removing hair below the skin surface is called epilation and includes plucking, waxing, electrolysis and laser hair removal.

Laser Hair Removal

Epilation is much more effective than depilation for long lasting or even permanent hair removal and the lasers rule!  To know what makes lasers so awesome at hair removal I need to explain how hair grows and what makes lasers tick.

The hair follicle growth starts 2-6 mm below the skin surface in the bulb, which is surrounded by a nourishing matrix.  The bulge, located above the bulb, houses the stem cells that are required for hair follicle regeneration.  These critical areas (bulb and bulge) must be destroyed for successful hair reduction. 

Laser energy (light) works to remove hair because the energy is selectively absorbed by the melanin (pigment) in hair follicles.  The light energy is converted to heat which diffuses to and injures the bulb and the bulge without damaging the surrounding tissue. 

The best candidates for laser hair removal have dark hair and light skin, and the hair needs to be darker than the skin color.  Red hair is difficult to remove and blonde hair is very difficult.  White or gray hair lacks the necessary melanin thus laser hair removal is not possible.  Since the laser light energy is absorbed by the dark melanin pigment, dark or tanned skin is at more risk of absorbing the energy which can cause burns, scarring and pigment changes. 

Terminal hair is the coarse hair that grows on our head, beard, underarm, groin, arms and legs.  Velus hair is the soft, downy hair that covers our entire body.   Laser hair removal is best for terminal hair because it will absorb the laser energy well due to its more typical thick and dark characteristics.

Hair growth occurs in three cycles, anagen (growth), catagen (transition) and telogen (resting).  Laser energy only works to eliminate hair during the anagen phase, which at any given time is occurring in about 70-80% of the hairs on the upper lip and beard, and only about 20-30% of the hairs on the other body areas.  Anagen phase lasts several years, catagen a few weeks, and telogen a few months.

Multiple treatments are necessary for hair removal because only a portion of the hair is in anagen phase at any given time.  The different growth phases explain why some body areas can be treated every 4-6 weeks and others every 6-8 weeks, and why some body areas need more treatment than others.  Lighter skin types typically need 3-5 treatments while darker skin types may need 6-10 treatments.  Beware of clinics that offer hair removal treatments too frequently – the only thing they are removing is money from your pocket.

Laser hair removal is safe and effective only in the hands of an experienced specialist.  There are numerous details that go into making laser so effective for hair removal, such as considering skin type, hair color, body area, laser power and wavelength.  Making laser safe and comfortable depends on all of the above plus understanding how to cool the skin during and after treatment to avoid burns. 

What does laser hair removal feel like?  Does it hurt?  A good answer is to imagine a light snap of a rubber band on the skin – really not a big deal.  The heat generated by lasers can build up and cause warmth in the skin which is why using the correct settings in the first place and adding cooling is so important. 

The newest generation of laser delivers energy only in a therapeutic range, precisely heating the target with little or no damage or discomfort.  “In-motion” technology is another advance that allows the laser to always be on the move while treating, making it quicker and virtually pain-free.  The result is safe, quick and effective hair removal that lasts.  Involving no downtime, you can continue with all your regular activities immediately after treatment.  See www.almalasers.com for more info on hair removal technology.

Also important with hair removal is to consider whether hair growth is excessive and reflects an underlying hormone disorder.  I often get referrals from our laser center to investigate the cause of excess hair growth.  Removing the hair with laser is great but more important is to fix the original disorder, which makes the treatment that much more successful and also improves the general health of our patients!

Our laser specialists are certified with Alma lasers and have ongoing training in order to stay up to date with the latest in laser technology and treatment techniques.  We offer free consultations with any of our specialists.  The cost of hair removal depends on the size of area treated and most areas need 3-5 treatments.

FREE SEMINARS

“Low Thyroid:  Misunderstood, Misdiagnosed, Missed!”

Monday, June 24^th

Seminars are at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Don’t Cast Away the Fish Oil

 

Are Fish oil supplements not helpful?  Reporting in the New England Journal of Medicine last week Italian researchers came to the conclusion that in a group of patients with existing artery disease taking fish oil did not lower the risk of a subsequent heart attack.  Dr. Eric Topol, MD, cardiologist at Scripps Institute and editor-in-chief of Medscape, opines, “Fish oil is a no-go”.  Have the omega-3 fatty acids found in fish oil lost their luster?

The Risk and Prevention Study Collaborative Group, a collective of Italian researchers led by Maria Carla Roncaglioni, looked at the effect of 1 gram of fish-oil versus placebo in over 12,000 patients with multiple cardiovascular risk factors or atherosclerotic disease.  They found no difference in death or hospitalizations from cardiac events.  There was an 18% reduction in adverse events in the female subgroup.

Two other recent studies fail to show much support for low doses of fish oil in patients that have already had a heart attack and are on multiple medications.  The ALPHA-OMEGA TRIAL used 400mg of fish oil, and the OMEGA study used 1 gram of fish oil, with both studies looking for benefit in well-treated patients after heart attack.  The bottom line is that with excellent medical therapy after a heart attack the risk of a recurrent heart attack is already low and adding fish oil did not lower that risk any further.

Too Little Too Late?

The above studies are good examples of “secondary prevention” trials in which a disease is already present and the study is designed to see if a therapy will lower the chance of the disease progressing.  This is in contrast to “primary prevention” studies that look to see if a therapy will prevent a disease from starting in patients that do not yet have the disease.

Adding a low dose of fish oil to patients with existing artery disease is a bit like trying to put out a raging house fire with a garden hose.  Obviously, with the garden hose analogy, a small fire would easily be extinguished while it would be of little help with the full-blown house fire.  Thus, one could conclude that a garden hose of water does not put out fire.  Clearly it would depend on whether it was a primary or secondary prevention effort.

The dose of fish oil used in the above-mentioned studies is quite low and numerous studies show that higher doses of fish oil are associated with less cardiovascular disease (Singh, 1997; Yokoyama, 2007; Svensson, 2006; von Schacky, 1999).

Still other secondary prevention studies simply conflict by showing that fish oil does lower the risk of heart disease (Bucher, 2002; Leon, 2008; Zhao, 2009; Marik, 2009).  Consider the GISSI-Prevenzione study (a large, randomized, controlled trial) which found that 1,000 mg/day of fish oil in patients with a history of recent myocardial infarction reduced the risk of total mortality by 20% and sudden death by 45%.

We need a primary prevention trial in an average population that examines whether fish oil supplementation will lower the risk of ever developing artery disease.  The VITAL trial is one such study that is looking at the effects of vitamin D or fish oil (1 gram) on multiple outcomes, including risk for diabetes, high blood pressure, cognitive decline and depression, osteoporosis and autoimmune disorders.

About Fish Oil

Fatty acids called eicosapentanoic acid and docosahexanoic acid, abbreviated EPA and DHA, are the primary health promoting portion of fish oil, and are found in darker oily fish such as salmon, halibut, anchovies or sardines.  They are also found in krill oil.  EPA/DHA are made from another fatty acid called alpha-linolenic acid, which is found in flax and hemp seeds.  These are the familiar “omega-3” oils.

In the body DHA plays a key role in development of the brain and retina and may help with nerve transmission.  EPA is well documented to lower inflammation, reduce the tendency of blood to clot, and lower the risk of abnormal heart rhythms.  It is the “drug of choice” to lower heart disease promoting triglycerides.  There is ongoing research teasing out the differences between DHA and EPA.

The American Heart Association recommends eating 2-3 servings per week of fish.  Based on the bulk of research showing benefits of fish oil supplements, it has been recommended that we consume 1 gram per day of EPA/DHA for general prevention, 2 gram per day or more for treating existing diseases such as heart disease or inflammatory conditions.  Doses as high as 10 grams per day are sometimes used.   At higher doses the blood thinning effects need to be watched, especially if patients are taking other blood thinners. 

A key point on dosing of fish oil...  Most capsules are listed as 1 gram; however, the portion of EPA and DHA is only part of that 1 gram.  Look on the label and you will see something like EPA 240mg and DHA 120mg, totaling 360mg EPA/DHA.  That is the number to look for and the amount actually taken.  In this example the fish oil has about a 36% concentration of the EPA/DHA.  One would need to take 3 capsules to get a total of 1080mg EPA/DHA.

Note that cheaper brands of fish oil will only have about 10-20% EPA/DHA concentration, and the remaining oils tend to smell fishy and go rancid quickly.  Better quality oils will be 50-60% concentrated.  One of the best I’ve come across is Quell Fish Oil from Douglas Labs, which has about 80% concentration of EPA/DHA.  Nordic Naturals and Life Extension are two other excellent brands.  The better quality translates to taking less capsules and little to no fishy aftertaste.

To Fish or Not? 

I recommend increased consumption of foods that contain more of the healthy omega-3 fatty acids, such as venison and fish.  Grass finished beef and free-range poultry also have higher omega-3 levels.  Based on decades of research in dozens of health areas I think it is clear that supplementing fish oil is a good idea. 

In the late stages of disease, such as the first study noted above, simply adding a low dose of fish oil does not appear to add much benefit.  A much more complex process is well underway and a much more aggressive combination of supplements would be more helpful.  Just as one medication is seldom enough for advanced disease, similarly it is myopic to expect one supplement alone would turn the course of disease.

Don’t cast away the fish oil just yet.

FREE SEMINARS

“Low Thyroid:  Misunderstood, Misdiagnosed, Missed!”

Monday, June 24^th

Seminars are at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Hormones that Pack on the Pounds

 

There are several hormones that conspire to help “pack on the pounds” in both men and women.  Understanding these hormones is an essential step in helping with weight loss.  Here is a quick review of our fat producing hormones and some tips on how to control them. 

Cortisol is the first troublemaker.  As our main “stress” hormone cortisol is made by the adrenal gland and readies the body for battle, by increasing our blood pressure and blood sugar, and controlling inflammation.  It helps the body react to our “fight or flight” hormone adrenaline.  These are good things cortisol does to help us adapt to stressful situations.

Chronic stress, however, allows cortisol to start wreaking havoc with the body.  It starts to cause the break down of muscle and high blood sugar spikes which leads to higher insulin levels (more on that later).  It will impair metabolism by lowering or interfering with other hormones such as thyroid, testosterone and growth hormone.  It will depress serotonin leading to a low mood, fatigue and increased appetite, while messing up sleep patterns. 

Insulin is our second fat producing hormone.  Normally insulin is made in response to food intake and allows blood glucose to enter our cells for energy production.  It will also instruct glucose to be stored for quick use later in the form of glycogen.  Beyond that insulin directs glucose to be stored as fat, which is our most efficient long-term energy storage. 

Problems with insulin arise when we starting losing our sensitivity to insulin’s positive effects, which is known as “insulin resistance”.  Our body compensates by making increasing amounts of insulin, which leads to impaired ability to break down fat and increased fat storage around the hips and abdomen.  Insulin will also turn off a friendly hormone called leptin, which is made by fat cells and tells our brain we are not hungry. As one might imagine, insulin resistance makes losing weight nearly impossible. 

The third fat promoting hormone is estrogen and it affects both men and women.  Specifically, too much estrogen is the problem, but too little can also be an issue.  Many women go through life with estrogen dominance, characterized by heavy cycles, with premenstrual symptoms such as water gain, breast tenderness, irritability and anxiousness.  This is usually due to not producing enough progesterone to balance estrogen, overproduction of estrogen or exposure to foreign estrogens.  At any rate, the excess estrogen will promote fat accumulation, especially around the hips and abdomen, leading to the “pear” shaped body. 

For men, excess estrogen occurs commonly with aging.  As a man’s testosterone level falls the normal byproduct of estrogen often rises.  This will cause fat accumulation around the abdomen.  At menopause estrogen levels in women plummet and the body tries to make more estrogen from, guess where, fat cells.  This is part of reason so many women pack on 20 pounds the first year after menopause.

Ghrelin is the last fat promoting worth mention.  This appetite stimulator is made in the stomach and pancreas and tells the brain we are hungry, slows metabolism and increases fat accumulation in the abdominal area.  Interestingly, ghrelin stimulates the same pleasure areas in the brain as sex, drugs and chocolate - one can appreciate why food can be such a powerful reward!  With weight gain people become more and more sensitive to ghrelin leading to a vicious cycle of constantly feeling hungry.

So how do we get control of these fat-promoting hormones?  There are some simple changes in lifestyle that can make a huge difference and help with weight loss.

Cortisol elevations can be caused by any stress, be it physical or mental.  Learning to manage stress is a critical part of a weight loss program.  Many techniques are effective, such as casual exercise, meditation, acupuncture, or mellow activities such as yoga or tai chi.  Simply taking a few 5 minute “breathers” during the day can measurably lower cortisol levels.  We often recommend herbal supplements that help modulate the cortisol stress response and heal overly taxed adrenal glands.

High cortisol levels in the evening, when cortisol is supposed to be at its lowest, will lead to poor sleep.  Poor sleep and stress will also increase ghrelin levels leading to hunger.  Ironically, we need ghrelin to help enter the restful stage 3 of sleep.  The summary point is “go to bed calm and with an empty tummy”.

Insulin resistance is best treated by eliminating foods and food combinations that cause insulin to spike.  Cut out sugar and high-glycemic foods.  Mix complex carbohydrates with a little fat and protein, at every meal.  Get some protein within 30 minutes of awakening and never skip breakfast.  I suggest 20 grams of whey protein isolate within 15 minutes of awakening.  This will help stabilize insulin and blood sugar as well as providing essential amino acids for optimal brain function.

If you have estrogen dominance or see physical signs of estrogen with aging, find help from a professional that is well trained to analyze and correct these hormone imbalances.   Be sure to get restful sleep, manage stress, insure proper gut and liver health, and optimize diet to make you hormones work better.

Our weight loss program addresses all these issues and many others.  I have found that successful weight loss depends on more than wishful thinking and the old “calories in = calories out” mentality.  Certainly proper nutrition and exercise are essential, but without hormone balancing weight loss is an uphill battle for many. 

FREE SEMINARS

“Bioidentical Hormone Replacement for MEN

Monday, June 10^th

“Low Thyroid:  Misunderstood, Misdiagnosed, Missed!”

Monday, June 24^th

Seminars are at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.