2010 Vitality tips

February 2010 Vitality Tips

Welcome to February, America’s Heart Month. The majority of deaths from cardiovascular disease are preventable, yet heart disease remains the #1 killer in America today with a death every 37 seconds. We have seen a decline in cardiovascular deaths over the last 20 years, but death rates are projected to increase again through 2020.  This resurgence relates in particular to declining fitness and expanding waist lines across America.

Yet, at the Masley Optimal Health Center, we are witnessing the opposite—a clear decline in cardiac risk. What’s more, many of our patients have documented an improvement in their arterial plaques scores each year. How can this be? Simply, most of our patients show greater fitness, better weight control, in addition to improved blood pressure, blood sugar, and cholesterol levels.

We are currently preparing to publish our data analyzing cardiovascular risk factors with 400 baseline carotid IMT scores; IMT scores reflect the thickness of your arteries, allowing you to see your artery age. Intriguing is our initial insight that baseline fitness and body fat measures are stronger predicts of arterial plaque growth than cholesterol.

How can you document what is happening in your arteries? The first step is to start measuring the thickness of your artery plaque. The good news is that there is ultrasound technology, called carotid IMT testing, that is affordable, safe, and motivating. Once you know what’s happening within your arteries, you can adopt a program that has been proven to both prevent and reverse growth in arterial plaque.

How do you measure artery plaque?

The carotid artery is the large artery that carries blood from the heart to the brain and can be measured with only a touch of gentle pressure on the neck, very similar to using ultrasound to assess a fetus in the womb. Studies have shown that the carotid arteries, the heart arteries, and even the arteries in your legs all grow plaque at the same rate 95% of the time. Thus measuring carotid artery plaque growth reflects plaque growth everywhere else in the body, including the heart and brain. Studies have already measured and collected average carotid artery plaque thickness in thousands of men and women, so once the thickness is calculated, your doctor can also give you the average age of your arteries. A 50 year-old man might have the plaque of a 40, 50, or 60 year old, but never know it. Once you know the thickness and age of your arteries, you can monitor this over time to see if they are growing plaque, staying the same, or by modifying lifestyle, shrinking.

Can you reverse arterial plaque growth? The answer is “absolutely, yes!”

What about people who already have heart disease? If you or a loved one had advanced arterial plaque growth, wouldn’t you want to know if they had stopped plaque growth? If they haven’t, then likely their health and vitality will continue to dwindle away. Sadly, our current health care insurance system doesn’t monitor plaque growth. Now you can.  But while you can stop further plaque growth, you can’t always reverse the damage and scarring done by a previous heart attack. The sooner we stop the buildup and the damage, the better the outlook for the future.  In some patients with earlier heart failure, remarkable recoveries have been achieved with dramatic lifestyle changes alone or with a combination of lifestyle changes and medications combined.

How do you prevent and reverse arterial plaque growth?

Ideally, we would identify plaque growth at least 10-20 years before a person would have a cardiovascular event. Advance notice allows us to create a plan that can stop the plaque from growing and optimally prevent an event and heart damage from ever occurring.  For details on steps to take, visit www.tenyearsyounger.com and read Ten Years Younger, Broadway Books.

For a brief summary of what is required to succeed, there are four simple steps to revitalize your heart:

• Enjoy Dr. Masley’s 16 Vitality Foods daily.
• Strengthen your heart with an age-busting fitness plan.
• Calm your heart with stress management.
• Support your heart with revitalizing supplements.

To Your Health!

Steven Masley, MD, FAAFP, CNS 

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January 2010 Vitality Tips:

We are back with Vitality Tips for the New Year. This month’s theme will focus upon building muscle mass for a fitter, better, calorie-burning you.

I’ve reviewed many medical articles that have discussed the benefits of using protein after a workout to build muscle mass. In the past, these studies were limited to people exercising more than 20 hours per week, true athletes. We now have data that want-a-be athletes (like me) working out 5-10 hours per week may also benefit, especially after a strength training session. Ideally, you’d have a balance of healthy protein, carbs, and fats before you exercise, such as a light breakfast meal, hydrate during exercise, and then after exercise add 15-20 grams of protein within 30 minutes of a strenuous workout that included strength training.

Many commercial products sell protein drinks with extra sugar and bad fat to make them taste better, and if you are an athlete exercising 20+ hours per week you don’t care about an extra 100 calories from junk calories. Yet, if you are trying to lose weight and build some muscle, adding an extra 100 calories daily over a year can result in an extra 10 pounds of extra fat.

More…………….

Before a workout, have a light meal with healthy protein, carbs, and healthy fat. A good example would be a light breakfast, such as non fat yogurt and fresh fruit with a couple spoonfuls of granola, nuts, or ground flax seed, or a veggie omelet, or a whole grain cereal with non fat milk (or soy milk) and fruit.

Within 30 minutes of completing a workout with strength training, add 15 to 20 grams of protein. A good food source would be 3 ounces (a generous handful) of edamame. Soy protein and whey protein are both good sources of protein, and they contain branched amino acids that are great for building muscle mass too.

A couple commercial brands I like are PaleoMeal by Designs for Health, one scoop has 96 calories and 17 grams of protein. Another is Perfect Protein by Metagenics with 80 calories and 16 grams of protein. They come in nice flavors which is a plus. They can be served with water, or a beverage such as non fat milk too.

Adding a protein surge after a workout provides amino acids for muscle repair and muscle building at the time muscle needs the extra building blocks. Athletes focused upon performance will also want to add some carbs after their workout to replenish muslce glycogen stores. Want-a-be athletes aiming to shed a few pounds of fat mass and build muscle mass can stick to just protein.

Happy New Year!

Steven Masley, MD, FAAFP, CNS

Fitness Tip:

          Do you want to be leaner and have more energy this year?  There’s one surefire way to do it: build muscle!  By this I do not mean getting bulky; the time and energy it would take to do this is more than most of us would commit to.  However, increasing the amount and diameter of your muscle fibers will give you a nice toned look.  In addition, more muscle fibers mean more energy and a faster metabolism (The bigger the engine, the more fuel you burn.)             Doing a full-body strength training routine 2-3 days a week is sufficient for reaching this goal.  If you are not currently exercising, you should begin with a routine of higher repetitions and lower weight (for example: 1-3 sets, 12-15 repetitions.)  For those of you who are more conditioned and have an understanding of maintaining good form, you can try slightly heavier weights and fewer repetitions (Ladies, this means you too!  You can try 2-4 sets at 10-12 repetitions.)  Each exercise should feel pretty tough at the end of the set.  Working with a Personal Trainer is a good way to ensure good exercise form and keep your workouts fresh.  Combine this with good nutrition and an adequate cardiovascular routine, and you’ll become a fat-burning machine!            If you would like any more information about how to design a workout routine or need the services of a Personal Trainer, please send me an email!Liz Kimpan, BS, ACSM-HFS, Exercise Physiologist/Personal Trainer

elizabeth@drmasley.com

April Vitality Tips: Elevated Blood Sugar Levels Increases Risk for Alzheimer's Disease--Tips to Prevent Cognitive Decline

Multiple medical publications this month highlight how diabetes and elevated blood sugar levels increase your risk for cognitive decline and Alzheimer’s Disease. The April cover story for Nutrition Action focuses on how to keep your brain young. The good news is that the most effective way to enhance brain function (cognition) and prevent diabetes is the same step, daily exercise! So if you want to maintain good health and good brain function—keep moving.

The type of exercise seems to matter too. In our Ten Years Younger study, we didn’t see any cognitive improvement from strength training and stretching, although they have obvious other benefits. What showed a big boost in brain function was aerobic activity, exercise that keeps your heart rate elevated for at least 30-45 minutes 5-6 days per week. Daily aerobic exercise increased attention by 40% and executive performance by 25-30%.

It should not be surprising that high blood sugar levels increase dementia risk. Not only do high sugar levels stick to your blood and brain proteins and cause your proteins to burn and decay more quickly, but high blood sugar levels are also associated with heart attacks, strokes, high blood pressure, and elevated inflammation, all of which increase brain cell injury and demise.

There are several nutrition tips that may slow cognitive loss. Fish oil intake has been shown to improve some aspects of mental performance and is associated with a decrease in Alzheimer’s rates. Not only does fish oil decrease inflammation and enhance blood sugar control, but the brain is 40% fish oil by weight and provides a critical source of nutrition for the brain. Vitamin B 12 deficiency has been known for ages to cause permanent injury to the brain, especially the memory center. B 12 deficiency is much more common today as people use medications to block stomach acid, lowering B 12 absorption substantially. Perhaps the most surprising information from recent studies is that coffee intake seems to reduce the risk for Alzheimer’s disease. The pigments in coffee seem to protect brain cells, both by lowering brain inflammation and by blocking beta-amyloid production. So 1-3 cups per day seems health friendly, assuming you don’t have anxiety, heartburn, or insomnia.

Simple laboratory tests can also predict your risk for memory loss. Blood testing should include mercury, high sensitivity-C Reactive Protein (hs-CRP), and blood sugar levels. Ultrasound testing can assess artery age and arterial plaque growth, which is strongly related to loss in cognitive function. Perhaps most important is to measure cognitive function directly every 1-2 year to ensure you have optimal mental performance. Computerized testing will also identify early signs of memory loss, while it is still early enough to prevent further loss. In our office, we use computerized testing to measure mental speed, memory, reaction time, attention, and executive function and is very useful in identifying cognitive decline 10-20 years before dementia is finally diagnosed and often the problem is too late to treat.

The bottom line to prevent cognitive decline and optimize cognitive performance is to stay active, meet your nutrient needs, and do preventative testing to measure cognitive performance directly and to test for causes of memory decline that can be prevented. Our goal is that you’ll have good cognitive function into your 80s and 90s.

To Your Health!                        Steven Masley, MD, FAAFP, CNS

March 2009 Tips: Supplements for Weight Loss.

           “Dear Dr. Masley.  Are there any dietary supplements you would recommend as part of my weight loss program?”

           There are several supplements that help with weight loss. None are as effective as eating well, exercising, and managing stress, but supplements can help.

          Green tea contains catechins, which have anti-aging properties and its epigallocatechinn gallate (EGCG) component has been shown to increase your metabolic rate, which is the rate you burn calories at rest. The effective dosage of green tea is 8-10 cups daily—too much caffeine for most people, but you can take EGCG as a supplement in dosages of 300 to 500 mg daily, or drink decaffeinated green tea. While caffeine is known to help with modest weight loss, caffeine can cause side effects such as anxiety, insomnia, heart palpitations, and heartburn. So unless you have no symptoms from caffeine intake, stick with decaf. As a supplement, EGCG usually comes as a green tea leaf capsule and it should be standardized to contain 50% EGCG.

         Carnitine is an amino acid (protein building block) that transports fuel to be burned as energy. Supplementing with carinitine has been shown to help to lower triglyceride cholesterol levels and to help with fat burning. Typically dosing would be 500 mg to 1,000 mg twice daily.

          Chromium is a mineral that has received extensive publicity in the media for weight loss, but likely more coverage than it deserves. In people who are chromium deficient, giving chromium supplements helps to improve blood sugar control and weight control. While the weight loss appears small, 2-3 pounds, most of the weight loss is fat loss, which is good. Studies to date have used 400-800 micrograms (mcg) of chromium daily. I prefer chromium nicotinate as a supplement source, and recommend avoiding chromium picolinate. Good food sources of chromium include salmon, whole grains, legumes, green leafy vegetables, yet more than half of Americans have been noted to be low in chromium. Taking a high quality multi-vitamin longterm with 400 mcg of chromium would prevent chromium deficiency.

         Low calcium intake (less than 1,000 mg daily) is also associated with weight gain. So ensure you get at least 1,000 mg of calcium from your diet and supplement regimen combined daily. You can calculate your calcium intake from the index table in Ten Years Younger.

          Ephedra, also called Ma Huang, was a prominent ingredient in weight loss pills until recently. Ephedra is a chemical compound used for centuries and has been shown to be effective for weight loss. Unfortunately, it increases blood pressure, heart rate, and is associated with fatal heart rhythm abnormalities. Ephedra made national news after several prominent athletes died using the product.
Although banned in most stores, it is still available on some websites. I do NOT recommend using ephedra because of these complications.

         If just exercise, healthy eating, and proper stress management don’t yield the results you want, consider EGCG, carnitine, and a multivitamin containing adequate chromium for optimal weight loss. As usual, if you need help selecting brands or you have other supplement questions, please feel free to call our office for assistance. 727-299-9222.

FEBRUARY 2009 TIPS: Physician Assisted Weight Loss.

The Ten Years Younger Program has achieved tremendous weight loss for our participants, but not everyone has succeeded. One of the key roadblocks to meaningful weight loss is related to low basal metabolic rates. Basal Metabolic Rate (BMR) refers to how you burn calories at rest. If you have a high BMR, it makes it easy to lose weight, but many people have low calorie burning capacity and don't even know it. Give them a 1,600 calorie diet and they still gain weight--that just isn't fair!

Several issues can lower BMR, including low calcium intake, inactivity, mercury toxicity, and problems with high inflammation, and high blood sugar levels. Correcting these underlying problems will often lead to success.

Many weight loss clinics use drugs like phentermine to help with weight loss, although these drugs have rare cardiac side effects, they do suppress appetite and they also increase BMR. When used appropriately under expert guidance, they make it easier to lose weight. Once you've lost the weight with drug therapy, you still need help to not gain the weight back. The Ten Years YOunger Diet plan and our Age Busting Fitness plan has been very successful in preventing weight regain, especially if we help you to restore your Basal Metabolic Rate back to normal.

Please contact us if you need help with weight loss and would like to discuss treatment options in more detail, including medication therapy when indicated.

JANUARY 2009 TIPS: Choosing Health Goals for the New Year

January is an excellent month to make yearly health goals. The gyms are full, the office candy bowls have usually disappeared, and typically they will stay that way until at least Valentine’s day.

Aim for something that is both a challenge, but also realistic in light of your time and responsibilities. Write down at least two goals you want to achieve. These could vary from being able to run for three miles in under thirty minutes, reaching a cholesterol target, quitting smoking, not drinking alcohol 3 days per week, or losing 10-20 pounds. Once you’ve picked your goals, share them with close friends and/or family and outline the steps you’ll take to achieve them. Lastly put dates into your calendar or electronic planner every 2-3 months to assess how you are doing over the year. Of course if you don’t meet with success, please let us know at the Masley Optimal Health Center—we are here to help.

DECEMBER 2008 TIPS: Measuring High Sensitivity C-Reactive Protein (hs-CRP)

C-reactive protein is an excellent measure of overall inflammation. When the body is excessively inflamed it has a tendency to attack itself and cause harm. Many diseases are associated with inflammation. What is new is a study showing that lowering hs-CRP levels with medication can decrease the risk of heart attacks and strokes, implying that everyone should at least know their hs-CRP level.

When a part of the body becomes irritated or attacked, the body increases the production of chemical compounds called cytokines that can attack or destroy microscopic invaders. The liver produces C-reactive protein (CRP) in response to the body’s level of inflammation. The higher the level of inflammation in the body, the higher your CRP level.

Many medical laboratories can measure CRP levels, but new special techniques allow laboratories to measure this test in an ultra sensitive way. High sensitivity C-reactive protein (hs-CRP, also called cardio-CRP) levels may be elevated when usual CRP testing reports are normal. This is especially important in measuring inflammation in the lining of your arteries, such as to the brain and heart. Regular CRP testing may not be sensitive enough to identify early inflammation in these critical arteries, which is why we only measure hs-CRP.

As an upper respiratory infection initiates inflammation, even a cold can temporarily increase CRP levels. If your CRP levels are elevated, it is always important to repeat the test after several weeks to see if your levels returned to normal or stayed elevated.

Many factors can increase inflammation, from both internal and external sources. Internal causes often relate to lifestyle and can be related to diet choices, lack of exercise, and to obesity. Fat cells produce cytokines and increase inflammation levels. Overexertion with strenuous physical activity can cause a sudden increase in inflammation, discernible by pain in your joints and muscles. The typical American diet which is low in long chain omega-3 fats (found in seafood) and high in animal fats (fatty red meats, butter, and cream) will also increase inflammation significantly.

Many lifestyle changes decrease inflammation, including weight loss, controlling blood sugar regulation, modifying food choices, and adding specific dietary supplements, such as fish oil. Dietary choices that lower inflammation include seafood products, nuts, soy products, ginger, and rosemary.

As inflammation is an important assessment for your health and your risk for many illnesses, monitoring your hs-CRP levels yearly makes sense to identify early signs of disease. A normal hs-CRP level is <1.0. Elevated is 1.0 to 3.0. >3.0 is considered high risk for heart attacks and strokes.

In the study published in the November 2008 New England Journal of Medicine article, the average initial hs-CRP level was 4.0 (in the high risk range). At this high level treating people with a statin drug (they used Crestor in this study but other statin medications should work similarly) decreased the risk for heart attacks and strokes in a short 1.9 year interval with minimal adverse side effects, and was similar to the benefit noted previously for treating high cholesterol levels to reduce the risk for heart attacks and strokes. The implication is that people with high hs-CRP levels should at least discuss drug therapy options with their physician. With my own patients, first I'll see if we can lower hs-CRP levels with healthy lifestyle changes (most often we can), and if those changes don't succeed, then we'll discuss drug therapy options during follow up.

NOVEMBER 2008 TIPS: INFLUENZA SHOTS AND VITAMIN D

INFLUENZA SHOTS —Should you have one? What do you need to know?

In the United States, influenza epidemics occur typically from November to April. Influenza can infect any age group, but rates of infection are highest among children. Rates of serious illness and/or death are highest among people aged >65 years, children aged <2 years, and people of any age who have medical conditions such as diabetes, heart or lung disease. Approximately 36,000 deaths occur in the US from influenza epidemics yearly.

Hopefully executives and other people with high levels of responsibility won’t have medical conditions that put them at risk for serious illness and/or death, but they are still at risk of missing a week or more of work during an epidemic when many co-workers are also out ill. Most people with high responsibilities can’t afford this. People with increased airline travel are even at higher risk for illness with the likelihood of infecting other co-workers and family members.

Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications. Influenza vaccine can be administered to any person aged >6 months (who does not have contraindications to vaccination) to reduce the likelihood of becoming ill with influenza or of transmitting influenza to others.

Effectiveness and Side Effects.

          If you have a flu shot and you are exposed to the influenza virus, you are 70-75% less likely to acquire the flu and if you do it would be less severe. The flu shot offered at the Masley Optimal Health Center is not a live virus, just dead viral protein grown in egg yolks, so it won’t cause the flu.

          In placebo-controlled studies among adults, the most frequent side effect of vaccination was soreness at the vaccination site (affecting 10%--64% of patients) that lasted <2 days. These local reactions typically were mild and rarely interfered with the recipients' ability to conduct usual daily activities. Placebo-controlled trials demonstrate that among older persons and healthy young adults, the flu shot is not associated with higher rates for systemic symptoms (e.g., fever, malaise, myalgia, and headache) when compared with placebo injections. In the past, older versions of the flu shot were associated with an increased risk for Guillain-Barré Syndrome, but there is no evidence that this is true with the newer flu shots given today.

          Flu shots given in work settings and grocery stores provide multiple injections from the same vial. To prevent bacterial growth in the vial, mercury (thimerosal) is added. Because 30% of the patients in our medical practice already have high mercury levels, we use single dose patient vials which cost a few dollars more but are mercury free.

Who Should Get the Flu Shot?

Anyone with significant medical problems, anyone who can’t afford to miss work when everyone else at the office is sick, and those who travel and want to want to avoid exposing co-workers and loved ones to the flu. If you do get the flu, consider a doctor’s visit and getting Tamiflu (an anti-viral medication) during the first 48 hours of your illness to decrease the severity and duration of the illness. After 48 hours, Tamiflu is no longer effective.

You should not have the flu shot if you are allergic to eggs or have had a previous adverse reaction to the shot.

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VITAMIN D

Vitamin D is a fat-soluble prohormone that plays a critical role in human health. Vitamin D can be produced in the skin with exposure to sunlight and is also obtained from specific foods and supplements. The benefits from achieving adequate vitamin D intake are substantial. Vitamin D:

• Increases calcium absorption and improves bone health. It can also decrease bone pain when deficient.
• Decreases the risk of auto-immune diseases, in particular multiple sclerosis.
• Is associated with better BP control and lower heart attack and stroke rates.
• Blocks progression of pre-cancerous cells to cancer cells, and vitamin D deficiency is associated with higher cancer rates (Prostate, breast, colon, and pancreas)

Unfortunately, most people in American today have low vitamin D levels and are at elevated risk for hip fractures, multiple types of cancer, and cardiovascular disease. Sun screen blocks the skin from making vitamin D, so the most practical way to obtain vitamin D is through flood and/or a supplement.

How Much Do We Need?

Optimal intake is around 1,000 IU of vitamin D daily, although some people with osteoporosis or auto-immune disease may need more.

What are sources for Vitamin D?

• Multi-vitamin: 200-500 IU per dose
• Cod liver oil 1 tsp: 100 IU
• Fatty fish (salmon, mackerel, sardines): 200-350 IU per serving (Fish oil often has the vitamin D removed & may not be replaced)
• Calcium food (milk or soy milk) or 1 calcium supplement pill: 100-150 IU
• 1 Egg Yolk: 25 IU
• Sunshine exposure mid morning: 20-30 minutes short shirt & pants 3 times / week: Provides an average of 200 IU / day. But:
• North of Atlanta, your skin produces vitamin D only 6 months per year
• 70 y/o skin makes 25% of vit D as 20 y/o skin

Which form of Vitamin D should be used, Vitamin D2 or D3?

• Both are converted into 25-hydroxyvitamin D.
• Vitamin D2 (ergocalciferol) is derived from irradiating yeast with ultraviolet light (Kosher)
• Vitamin D3 (cholecalciferol) is produced in the skin from ultraviolet light exposure and found in egg yolk and fish, plus produced from lanolin (fat of lambs wool)
• I recommend D3, but either work. Keep in mind that Vitamin D3 and is about 5 times more potent than Vitamin D2  so you’d need 5,000 IU taking Vitamin D2.

When should I measure my Vitamin D Level?

• Indications would include:
• suspicious of rickets, severe osteoporosis, multiple sclerosis, or other poorly controlled auto-immune disorder
• To measure vitamin D levels, order a 25-0H vitamin D level
• The 1,25-OH level is not an appropriate measure
• Expert opinion goal is a 25-OH vitamin D level of at least 40 ng/ml, 70-90 is likely optimal