Laughter is the Best Medicine

How delightful to learn that laughter really is the best medicine and will perhaps add as many good years to your life as other familiar health tips.  Could it be so simple that a positive attitude reduces heart disease and stress-related hormones, improves the immune system and leads to a longer life?  The scripture teaches that “A joyful heart is good medicine, but a crushed spirit dries up the bones” (proverbs 17:22) and it turns out science is supporting this notion. 

Happy people tend to live longer and experience better health than their unhappy peers according to a review of more than 160 studies of human and animal studies.  The lead author, University of Illinois professor emeritus of psychology Ed Diener, summarized “the general conclusion from each type of study is that your subjective well-being - that is, feeling positive about your life, not stressed out, not depressed - contributes to both longevity and better health among healthy populations."

The cardiovascular system is our “Achilles heel” when it comes to health and the leading cause of death is heart disease.  Studies of artery health focus on how well the cells that line the arteries function – like the “canary in a coalmine” they are the sentinels of health and disease in the system.  These cells are called endothelial cells and they control blood pressure and keep cholesterol from oxidizing and making plaque.  Many cardiac studies look at endothelial function as the marker for arterial health.

Japanese research printed in the American Journal of Cardiology shows the effect of mirthful laughter increases beneficial endothelial function.  Participants watching a comedy had positive markers of endothelial health while those watching a documentary had a decline in artery health.

A study from the Journal of Biobehavioral Medicine called “The Divergent effects of joyful and anxiety-provoking music on endothelial vasoreactivity” showed that listening to joyful music was good for artery health while anxiety-inducing music was bad for the arteries.  Self-selected joyful music was associated with increased endothelial function to a magnitude previously observed with aerobic activity or statin drug therapy!  Their conclusion was that listening to joyful music may be an adjunctive life-style intervention for the promotion of vascular health.

An interesting study titled “Effects of laughing and weeping on mood and heart rate variability” points out that laughing has strong but transient effects on the autonomic nervous system, while weeping or feeling sad has moderate but sustained effects on it.  It would seem that having a “heavy heart” really does have physiological significance.

Laughter has been shown to benefit the immune system by increasing protective natural killer cells that help fight infection while lowering both the stress hormone cortisol and the inflammatory marker interleukin-6.  Laughter will increase beneficial growth hormone, the anti-aging hormone that helps keep us young.  Patients with cancer and other terminal illnesses benefit by laughter and show improved outlook, less pain and longer survival.

A study looking at the effect of humor on well being of nursing home residents showed that upon completion of a humor therapy program, there were significant decreases in pain and perception of loneliness, and significant increases in happiness and life satisfaction for the experimental group, but not for the control group. The use of humor therapy appears to be an effective non-pharmacological intervention.  The authors suggest that nurses and other healthcare professionals could incorporate humor in caring for their patients.

As science continues to tease out the exact mechanisms of how laughter improves health we can rest assured that it works.  In the bleakest of times, with both psychological and physical stress, good humor and positive attitude are potent tools to help us along.  While happiness might not by itself prevent or cure disease, the evidence that positive emotions and enjoyment of life contribute to better health and a longer lifespan is stronger than the data linking obesity to reduced longevity. 

Eat right, exercise, maintain a healthy weight, and don’t smoke, but most importantly, remember that attitude determines thought, thought determines action, and apparently thought determines health.  Good humor is good medicine.  So dance like no one is watching, sing like you are the star, whistle while you work, and laugh until your eyes water, your belly shakes and you gasp for air!

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Monday, August 5^th at 6pm

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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, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com).  Call (970) 245-6911 for an appointment or more information. 

Anti-Aging Powerhouses

Would you like to increase muscle mass, lose weight, build stronger bones, lower your risk for heart disease and diabetes, improve your immune system and preserve memory?  Two adrenal hormones are able to do all of this, but with normal aging the production of these health-promoting powerhouses naturally declines.

I’m referring to pregnenolone and DHEA (de-hydro-epi-androsterone).  Made directly from cholesterol these steroid hormones are primarily created by the adrenal glands.  Reaching their peak levels about age 30 they then decline about 1-2% each year in men and women.  Even under ideal conditions about half of people have levels below optimum by age 50 and by age 60 it is rare to find someone who has a healthy blood level of these hormones.

Pregnenolone is known for its role in mental processing and memory.  It is also produced in the brain and has been shown to play a role in the creation of memory but also protecting the nerve circuits that preserve memory.  Scientists believe that the hormone pregnenolone has vast potential for maintaining healthy cognitive function and may be “the most potent memory enhancer yet reported.” 

Research shows that low pregnenolone correlates with Alzheimer’s dementia.  Pregnenolone stimulates the growth of new nerves in the brain and increases a memory enhancing neurotransmitter called acetylcholine.  Further studies show that supplementing pregnenolone can reverse memory deficits.  It also has the amazing ability to stimulate nerve transmission while some of its metabolites actually calm over-excited nerve tissue. This makes pregnenolone sharpen memory and cognition while helping conditions such as anxiety.

DHEA is made from pregnenolone and has a wealth of benefits including musculoskeletal support, promotion of mental health, immune system regulation and maintaining cardiovascular health. 

Good for bones, muscle and metabolism, DHEA has been shown to increase bone mineral density, increase muscle mass and stimulate breakdown of fat leading to weight loss.

Improved mental function, memory and mood are also associated with DHEA.  Healthy DHEA levels improve even sex drive.  Like pregnenolone, DHEA is a potent neurosteroid hormone that has protective and stimulatory affects in the brain.

The past several years have witnessed extraordinary advances in our understanding of DHEA’s cardio protective power.  A 2009 study of 153 diabetic men with stable coronary heart disease (CHD) found that 77% were DHEA-S deficient, significantly more than in healthy peers.  Over the next 19 months of follow-up, 43 of those men died of CHD; the data showed that low DHEA and low testosterone levels were two of the four most significant predictors of death.

Another 2009 study of 247 men with an average age of 76 years revealed that those with low DHEA had a 96% increased risk of diabetes and a 48% increased risk of heart disease. 

The immune boosting effects of DHEA are well known.  It boosts antibody production; enhances the activity of monocytes, immune cells that attack cancer cells and viruses; activates natural killer cells, immune cells that attack and destroy viruses and other foreign invaders; and maximizes the anti-cancer function of immune cells known as T lymphocytes.

Even the skin benefits from DHEA.  In 2008 Canadian scientists found more than 50 DHEA-responsive genes in the skin.  DHEA “switched on” multiple collagen-producing genes and reduced expression of genes associated with production and cornification (hardening) of the tough keratinocytes that form calluses and rough skin. The researchers concluded, “DHEA could exert an anti-aging effect in the skin through stimulation of collagen biosynthesis, improved structural organization of the dermis while modulating keratinocyte metabolism.”

Anti-Aging Benefits

Whether or not adrenal hormones extend the life span, they clearly improve the quality of life.  Studies show people who supplement pregnenolone and DHEA have more energy, sleep better, and handle stress better.  They report an increased “well-being and overall vitality”. 

Adrenal supplements are available over-the-counter, without a prescription.  I strongly encourage obtaining blood levels of pregnenolone and DHEA-sulfate (the more stable form for measuring) prior to supplementing and then again to insure proper dosing.  As with other steroid hormones there is no benefit, and usually harm, in taking too large a dose of hormone replacement.  Optimal dosing of adrenal hormones is only obtained through testing.

The adrenal hormones do not cause cancer, but those with active hormone sensitive cancers should not take DHEA or pregnenolone due to concerns of stimulating the already existing cancer.  Taking too much DHEA will usually cause excess hair growth, oily skin, acne, or lead to agitation.  I’ve seen many men taking huge doses of DHEA thinking it would boost testosterone levels – not so – and in fact it leads to more estrogen, which is not healthy.  Again, optimal dosing based on labs.

Seek brands that are “micronized” for better absorption and sustained blood levels.  Usual DHEA doses are 10-25mg daily for women, and 25-50mg daily for men.  Optimal blood levels are around 200 mcg/dL for women, and 300-350 mcg/dL for men.  Usual doses of pregnenolone are 25-100mg daily for men and women with optimal blood levels around 200 mcg/dL.  I recommend brands from Life Extension or Douglas Labs.

With the wealth of science showing the powerful benefits of adrenal hormones in disease prevention and improved quality of life these safe and simple supplements should be part of every adult’s health maintenance plan.

FREE SEMINARS

“Food Allergies and Gut Health”

Monday, August 5^th at 6pm

“Detoxification Made Simple”

Monday, August 26^{th at} 6pm

RSVP @ 245-6911 or rsvp@imcwc.com

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, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com).  Call (970) 245-6911 for an appointment or more information.  

Don't Fall for Brittle Bones

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to fragile and brittle bones that are prone to fracture, especially at the hip, spine and wrist, although any bone can be affected.

It is important to understand that bone is not a hard and lifeless structure; it is, in fact, complex, living tissue.  Our bones provide strength for muscles, protect vital organs, and store the calcium essential for bone density and strength.

Think of your bones as a savings account.  There is only so much in your account as you deposit.  The critical years for building bone mass are from prior to adolescence to about age 30.  Some experts believe that young women can increase their bone mass by as much as 20 percent—a critical factor in protecting against osteoporosis.

Because bones are constantly changing, they can heal and may be affected by diet and exercise.  Until the age of about 30, you build and store bone efficiently.  Then, as part of the aging process, your bones began to break down faster than new bone can be formed. 

Health Risks

Osteoporosis is a major public health threat for an estimated 44 million Americans or 55 percent of the people 50 years of age and older.  In the US, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.

Of the 10 million Americans with osteoporosis, 80% are women.  Risk is for people of all ethnic backgrounds.  While osteoporosis is often thought of as an older person’s disease, it can strike at any age.

One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his lifetime.  Osteoporosis is responsible for more than 1.5 million fractures annually, mostly in the spine, then hip, wrist, and other sites.

The estimated national direct care expenditure, including hospitals, nursing homes and outpatient services, for osteoporotic fractures is $18 billion per year (in 2002) and rising.

The most typical sites of fractures related to osteoporosis are the hip, spine, wrist, and ribs.  The rate of hip fractures is 2-3 times higher in women than men; however, the one year mortality rate following a hip fracture is nearly twice as high for men.  A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.

           

In 2001 about 315,000 Americans over 45 were admitted to hospitals with hip fractures.  An average of 24% of patients over age 50 will die in the year following the fracture and one in five will require long-term care afterward.  Six months after hip fracture only 15% can walk across a room unaided.  One in five hip fracture patients ends up in a nursing home.

Screening

Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body.  A BMD test can detect osteoporosis before a fracture occurs, help predict chances of future fracture and determine rate of bone loss and/or monitor the effects of treatment.

Another useful test is the urine N-telopeptide or urine NTX.  A simple urine sample can measure the amount of bone collagen lost in the urine, giving an indication of how much bone turnover is happening and how much bone is being lost.  A low score is good.  I use this test to help further stratify risk with the BMD test as well as monitor ongoing therapy. 

Risk Factors

Osteoporosis is often called a “silent disease” because bone loss occurs without symptoms.  People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse.  Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture. 

Risk factors for osteoporosis are many and include a personal history of fracture after age 50 or current low bone mass, history of fracture in first degree relative or family history of osteoporosis, being female, being thin and/or having a small frame, advanced age, estrogen deficiency as a result of menopause, low testosterone, anorexia nervosa, low calcium intake, vitamin D or K deficiency, inactive lifestyle, certain medications (steroids, chemo, seizure drugs, etc), certain chronic medical conditions, cigarette smoking and excessive alcohol intake.

Prevention and Treatment

Think of bone as being much like a concrete wall.  The concrete is strong, but brittle, and the metal rebar that runs through the concrete is what gives the wall tensile strength, or the ability to resist tension.  Bone is much the same and the calcium is similar to the concrete, while flexible collagen is laid out in a grid throughout the bone.  The collagen, called the bone matrix, provides the tensile strength.

There is a sequence of activity needed to make strong bone.  First, hormones such as estrogen, testosterone, thyroid and growth hormone act to “turn on” bone development.  Vitamin D is needed to absorb calcium from the gut while Vitamin K allows calcium to be deposited in the bone matrix and keep it from building up in artery walls.  Of course proper nutrition provides the calcium, and other vitamins and minerals necessary to build strong bone. 

Calcium is in the news lately, with questions about increased heart disease in folks taking supplemental calcium, particularly a large amount.  At this point the ongoing studies are suggesting we not supplement calcium if we are getting enough in our diet, and then not to supplement more than about 500mg daily.  There will be conflicting guidelines on this so stay tuned. 

Hormone replacement therapy is the mainstay of treatment for my patients.  Strong muscle equal strong bones, so weight bearing and strength building exercises are key.  Good nutrition is essential, along with targeted supplements including calcium, vitamin D3 and K2, and minerals such as boron and magnesium.  As an example, one of my favorites is Bone Restore from life extension.  I also use a milk protein isolate called “enriched lactoferrin” and a mineral called “strontium citrate”, both of which promote bone formation.

I don’t routinely find any need for the prescription drugs such as Boniva or Fosamax which build bone density by inhibiting the cells that cause bone breakdown.  There are common side effects, serious risks, and questions of efficacy.   Frankly, by implementing the previously mentioned treatments osteoporosis is becoming a rare thing in my practice.

FREE SEMINARS

“Food Allergies and Gut Health”

Monday, August 5^th at 6pm

“Detoxification Made Simple”

Monday, August 26^{th at} 6pm

RSVP @ 245-6911 or rsvp@imcwc.com

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, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com).  Call (970) 245-6911 for an appointment or more information. 

Tracking Your Plaque

The Cardiac CT Scan Could Save Your Life

Cardiovascular disease (CVD) consisting of cardiac death continues to be the leading cause of death for American men and women, surpassing all cancers, stroke, accidents and diabetes.  Traditional risk factors including cholesterol, high blood pressure, smoking and diabetes don’t identify the majority of people dying from heart disease.   About 64% of individuals already diagnosed with heart disease present with 0 to 1 of these major risk factors.  Despite better treatment and recognition we are still not very good at predicting whom among us is at risk. 

Coronary Artery Calcification (CAC) as measured by a cardiac CT scan is an accurate assessment of the total amount of plaque in the coronary arteries.  The general relationship between the CAC and the total amount of plaque or atherosclerosis has been studied over the years in large groups of patients and autopsy studies.  Studies in cardiology journals describe the risks of having a heart attack with various CAC scores and the probabilities of having artery blockages. 

The CAC score is a much more powerful predictor of an individual’s risk of having heart disease than any conventional risk factor such as cholesterol.  The score needs to be interpreted in the context of age, as it is normal for some calcium to accumulate over time.  The CAC score is not perfect in predicting risk as the amount of calcium does not predict the amount of inflamed soft plaque overlying the calcium or the amount of artery blockage. 

CAC testing is a “window of opportunity” that can alert the unsuspecting that artery disease is present and allow for more thorough screening and more aggressive treatment.  It can also reassure someone with higher risk that the amount of plaque is not as bad as they might have guessed.  CAC can also be used to “track your plaque” by reassessing every 3-4 years or so and making sure the CAC score is stable or declining.

How is CAC Performed?

The CAC score is obtained with a quick CT scan of the chest with focus on the heart.  A CT scan is essentially a 3-dimensional x-ray that involves very limited radiation and is done very fast taking only a few minutes for the scan.  Immediately after the test a computer analyzes the results and comes up with a “calcium score” for each of the individual coronary arteries and in total.  This total score is the basis for risk prediction.  A radiologist later reviews the scan for further interpretation and notes any incidental findings such as a lung nodule, etc.

CAC Results and Risk

Patients with higher CAC scores have a higher risk for cardiac disease than those with lower scores.  However, the CAC score is not a perfect prediction tool as there are many people with high scores who do not go on to have a heart attack, and some people with favorable CAC scores who will go on to have a heart attack.  The value of the test is in determining whether an individual has much more calcification than would have been anticipated by standard risk factors. 

A score of zero or negligible (0-1) indicates that no calcified plaque was detected and the likelihood of artery narrowing or a cardiac event in the near term is extremely low.  Health advice includes continuing good health habits such as eating a healthy diet, exercising regularly, maintaining ideal weight and avoiding tobacco.  Retesting would be recommended no sooner than 5 years if at all depending upon age.  Studies suggest that 98% of individuals with a zero score will not have a cardiac event in the next decade.

A score that indicates minimal (1-10) plaque is reassuring and generally needs no special treatment.  Health advice as above and retesting in 4-5 years may be recommended.

A score that indicates mild (11-100) plaque is an early sign that the process has really begun.  Health advice should now add a more thorough search for risk factors and treatment with supplements, aspirin or medications.  Retesting should be considered in about 3 years.

A score that indicated moderate (101-400) plaque suggests the process is further along and it is time for the above advice plus more “aggressive risk factor modification”.  This is the chance to stabilize and stop the plaque process before it is too late.  Increased treatment and very close attention to risk factors (especially smoking, high blood pressure and diabetes) is warranted.  Sometimes a cardiac stress test may be ordered to reassure there is no silent blockage.  Retesting in 2-3 years is recommended.

A severe score (over 400) or a score greater than 75% for your age and gender warrants special attention.  Immediate and aggressive intervention is indicated as studies suggest that 30-50% of individuals with a severe score will proceed to have a cardiac event within the next 3-5 years.  Cardiac stress testing and referral to a cardiologist are often indicated.  Retesting in 2-3 years is recommended.

The cardiac CT scan has a margin of error of about 5-10% and studies show the average calcium score increases about 20 points per year in progressive disease.  This is why there is not much sense in repeating the test on a yearly basis.  And though the radiation exposure is considered minimal there is no sense in overdoing it.

Further Testing

If the CAC score that is higher than anticipated I recommend more thorough testing to precisely identify the risk factors leading to plaque formation.  The traditional lipid panel focuses on only three markers – the total, LDL (bad) and HDL (good) cholesterol.  My “cardiovascular risk” panel has 22 markers including a more sophisticated analysis of the lipid components, inflammatory markers, vitamins D and K, fatty acids and hormones such as testosterone, estrogen and insulin.

The cardiac CT scan is available at Community Hospital for a cash price of about $130 (last I heard) and can be scheduled only with a doctor’s order.   After getting the ok from your doctor, simply call 256-6216 to schedule.  The folks at Community do a great job and patients routinely report how easy the study was.  I encourage you to get the test and then make a visit with your doctor to review the results.

Atherosclerosis, once detected, does not have to lead to heart problems or an early death.  There are tests and treatments that lead to an effective strategy to stop the process.  In many cases, the plaque buildup measured by the cardiac CT is the only clue to alert you and your physician that there is life-saving work to be done.

FREE SEMINARS

“Food Allergies and Gut Health”

Monday, August 5^th at 6pm

“Detoxification Made Simple”

Monday, August 26^{th at} 6pm

RSVP @ 245-6911 or rsvp@imcwc.com

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, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com).  Call (970) 245-6911 for an appointment or more information. 

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.