Telomeres are sections of DNA at the end of each chromosome that serve as a cap to your genetic material.  Every time a cell replicates, its telomere will become shorter.  Shorter telomeres imply a short life span for a cell.

We utilize a test from Spectracell Laboratory, that calculates a patient telomere score, based on a patient’s telomere length of T-lymphocytes.  This average is compared to the telomere length on lymphocytes from a sample of the American population in the same age range.  The higher the score the “younger” the cells. The lifestyle changes that need to be made to change cellular aging are a big part of the work I do in clinical practice. The lifestyle interventions I offer, are aimed at reducing oxidative stress, correcting micronutrient deficiencies; especially vitamin D, getting patients back in action by treating spinal and joint problems so they get the exercise they need to be healthy, and correcting insulin resistance, and working on healthy body composition by increasing lean body mass, and losing fat mass. Here’s a bit more on the science on this below.

The work of Dr. Elizabeth Blackburn at University of California, San Francisco, who is a biologist and a co-discoverer of telomeres and telomerase and a study by Dr. Dean Ornish have stimulated interest in measuring aging using telomeres as an indicator. In July of 2008 a study of 780 people was published in a journal by the American Heart Association; Journal of Arteriosclerosis, Thrombosis and Vascular Biology.  It was determined that in a group of patients with stable heart disease, those with the shortest telomeres in their immune cells (white blood cells) had 2x the risk of death than those with the longest.  In the highest risk group, the telomeres were 1/2 the length of those in the lowest risk group.  Telomeres are now thought to be a good measure of biologic age.  High levels of stress hormones, inflammation, insulin, high blood pressure, high blood sugar, smoking, fatty diets, obesity, and sedentary lifestyle have all been linked shorter telomeres.

Dr. Robert Sapolsky at Stanford School of Medicine has discussed that telomere measures are a good time-integrated marker of bad news, as opposed to those other bio-markers of aging being indicative of conditions that are more acute.  Telomere measurement indicates overall systemic wear and tear.

Telomeres are more sensitive to oxidative stress ( caused by smoking, fast food, etc. causing and increased free radical load) than the rest of the genome. When under stress, adrenal glands release hormones, glucocorticoids, that kill T-cells in the immune system, so that the cells remaining have to divide more often to replace them.  The greater the cell division, the more wear and tear on telomeres. In “Aging”s inaugural issue, a study was cited that suggests that even before people manifested life threatening disease they already had shortened telomeres.  The immune system becomes more inflamed as one ages, and subsequently, damaged.

A study in Lancet in November 2008 showed that one can elevate levels of telomerase and reverse the ill effects on telomeres causing them to lengthen.  In this article, the conclusions were that comprehensive lifestyle interventions, to decrease fat in the diet, get regular exercise, reduce stress (through meditation, prayer, yoga) can increase telomerase activity by as much as 30% in just 3 months.

I encourage people to establish a baseline by getting conventional lab testing done as well as some other more targeted innovative tests like telomere, or other genetic testing. There are other functional biomarkers that we regularly use in our clinic that indicate inflammatory load; such as C reactive Protein, HbA1C; which is a measure of how your body is managing blood sugar and is used as an indicator of diabetes.  Once a baseline is established, and changes are made in diet and exercise as well as other lifestyle factors, the re-testing can show us we’re making progress, and going in the right direction

The link between the intake of sugar-sweetened drinks and weight gain is an obvious one, but the other association is with markers of insulin resistance. A prospective summary of middle school students over two academic years, showed the risk of becoming obese increase by 60% for every additional serving of sugar-sweetened drinks per day.  There is mounting evidence that the extra calories ingested from soft drinks does not displace other caloric intake, but adds to it. On average the extra calories were 172-200 calories or more a day. Unfortunately, there were also to be considered the associated changes in taste preferences, especially in children, when they find the sugar-sweetened beverages more satisfying than water and less sweet foods; like fruits and vegetables, with the result that their diet may become poorer in quality over time.

In September an article of the topic appeared in the New England Journal of Medicine.

Metabolic consequences that are well known, include elevated triglycerides, raising blood pressure, and lowering the heart protective high-density lipoprotein cholesterol levels, which would raise the risk of coronary artery disease.

Health Policy discussion is taking place on dietary issues like these, and involve the promotion of the idea of excise taxes on sweetened beverages, calculated based on

the number of grams per ounce of added sweetener. The tax is proposed to be levied on producers not consumers.  These tend to have greater effect on lowering consumption levels; much like those levied on tobacco and alcohol.  Polls are showing increasing trends in support for a soda tax, such as in New York State, whose residents were in favor by 52%.

The money paid by the consumer for the soft drinks does not begin to cover the escalating health care costs from the related diseases.  One study of nurses who were followed for 8 years, the risk of diabetes in the group drinking one or more servings of sugar-sweetened beverages per day, was nearly double the risk of those drinking one or less. For increased risk of heart disease by the first group, was 35%.

A suggested national tax of 1 cent per ounce, would generate $14.9 billion in the first year alone. The use of revenues for teaching childhood nutrition, obesity interventions or health care for uninsured would make lasting and long range changes in large populations.  State tax revenues of the same kind would generate additional funds to improve health education, and decreasing health costs and economic burdens associated with the rising burden of diseases.  Many feel this logically justifies the government’s right to repay itself some of the costs.

Of course there will be a hue and cry from the soft drink industry, just like there was from the tobacco and alcohol producers.  The relation between sales, and illnesses, as well as the obvious self-serving promotion of unhealthy habits to kids and teenagers, would make the “selling” the tax reasonable, and a solution to some social ills going forward.

The fact that a world wide Vitamin D deficiency pandemic is a reality has been recognized by just about every major health organization including the WHO; World Health Organization, the NIH (National Institutes of Health) and many others. The far reaching implications of the deficiency which affects millions of adults and children in just about every country has finally  attracted media attention. Articles have appeared repeatedly in professional medical journals, magazines, in the press and other media for more than the last five years. One of the best articles can be found in the New England Journal of Medicine, July 19, 2007 by Dr. Michael Holick. Why has it taken so long? In 1997 The Institute of Medicine that set the RDA decided there was insufficient evidence at that time to raise it from 400 i.u per day.

How much is enough? The RDA is the “recommended daily allowance” and the FDA regulates the amounts that can be put into nutrients; you’ll find them listed on a label of vitamins. Although the RDA for Vitamin D is still only 400 i.u. per day, that is only an amount that will keep you from showing the effects of an actual deficiency, but it is not an amount that will guarantee optimal well-being. It may still be too low to prevent deficiency disease in many people; such as those with poor absorption of oil soluble vitamins. Many people who are getting 400 i.u. are at risk for developing long latency diseases, and auto-immune diseases like diabetes, multiple sclerosis, cardiovascular disease, and have an increased risk of cancer. Though research back into the 90’s showed that that RDA is woefully low,  it has not yet been changed.  Federal agencies are slow to change even in light of new, well-documented scientific information. It’s also true that new information does not always change the beliefs of educated people and  doctors may still cling to what they learned years ago, despite the fact that the old scientific information has already been refuted. This doesn’t just apply to Vitamin D, but to surgical procedures, pharmaceutical agents, and protocols for treating different diseases.

Unfortunately what that means to you, the patient, is that many medical and other health care providers including prominent newspaper columnists, are still promoting the wrong dosages. They are still scaring people about safe sunlight exposure or the possible toxicity of Vitamin D.  An excellent reference every one should read is Dr. Michael Holick’s book,  THE UV ADVANTAGE.  He is one of the foremost researchers on Vitamin D, having discovered the circulating form of the active hormone form of the vitamin;  1, 25 (OH) D3.  In this book, which is worthwhile for doctors and patients alike, he goes over the dosages, safe sunlight exposure, and explores the real risk of hidden cancers that is much higher, than those that are only related to visible skin cancers alone when D levels fall too low.

The new recommendations by the foremost researchers on Vitamin D are saying that 1,000-2,000 i.u per day is what adults need for maintaining well being. The low risk of toxicity and the signs of it are also gone over in Holick’s book above, but it is exceedingly rare.  At the end of this blog, you can click on the url’s and sites for more information, find articles, and references to satisfy your curiosity.  Printing it and taking it with you to your next doctor visit, might help inform your health care provider about the new findings.   The serious consequences of Vitamin D deficiency is now coming to light.  They include not just bone health/osteomalacia, brittle bone disease and osteoporosis, but increased risk of many kinds of cancer, depression, auto-immune diseases like diabetes, and multiple sclerosis.

Low D levels are associated with the lack of normal immune response which leaves children and adults vulnerable to upper respiratory illnesses and allergy. Every cell in the body has a vitamin D receptor on it, including brain cells.  We now know that what used to be referred to as Seasonal Affective Disorder is more likely to be caused by the decrease in D levels that occurs in the dark days of the year, for those who are not appropriately supplementing.

The fear of melanoma and the American Dermatology Association’s crusade against skin cancer, although admirable, has made all of us tend to cover up, stay out of the sun, and use sunscreen which prevents us from making D from sunlight.  Let’s put this all in perspective and get numbers on the real risks. The risk of hidden cancers, like colorectal, breast, prostate and others is acutally much higher than that of melanoma.  Read on and read up.

Keep in mind that because we are genetically unique individuals, have different metabolic needs, and our activities vary; such as how much we eat from one day to the next, what we eat, the vitamin content of the food we’ve taken in,  how much sunlight we’re getting, where we live, at what latitude we live, even if the RDA was changed, your personal needs still might not have been addressed.  Your genetic inheritance may or may not predispose you to cancer, but without Vitamin D on board, your risks are still higher.

Working with a Funtional medicine health care practitioner ( www.functionalmedicine.org) who stays up on new scientific publications, and who can write up a lab test for your current D status, is a good place to start.  A Vitamin D blood test is inexpensive.  The lab slip should be written; 25 (OH) D assay. The test should be done fasting. The interpretation of the result, suggestions about safe sunlight exposure, how much to replete and for how long, should be managed by your doctor.

I recommend annual testing to make sure your levels are where they should be and you shouldn’t settle for having your levels at the low end of normal which is 30 ng/ml but seek to raise it to optimal levels between 60-100.  After taking vitamin D under your doctor’s supervision, you should be retested in 3-6 months, and have your blood levels of calcium checked at the same time.  For those with celiac disease or other malabsorption syndromes, it may take longer and be much harder to correct a deficiency.  People who live in northern latitudes, and places that are foggy or cloudy all the time, should be particularly vigilant. It is very difficult to get enough D from the foods we eat.  Really even in cold water fish, the amounts are small. If you are dark complected, you have more melanin ( pigment) in your skin which can very effectively keep you from making D when exposed to sunlight.  Many African Americans cannot make D at all at some of the northern latitudes. The higher incidence of high blood pressure, cancers, kidney disease, MS, cardiovascular disease, diabetes and many other long latency diseases in this population are associated with D deficiency.

The research on D, and the cites are too numerous to list. Magazines like TIME, NEWSWEEK, SCIENCE, etc. have all had articles.  Medline, PubMed, and many others can provide recent papers.  ALTERNATIVE THERAPIES Journal had a “conversations” interview with Dr. Holick May/Jun 2008, VOL. 14, No. 3  pages 65-75.

Here are a few cites:

1. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials.  Arch Intern Med 2007 Sept 10;167(16):1730-7

2. Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007 June; 85(6):1586-91

3. Pittas AG, Lau J. Hu FB, et al. The role of vitamin D and calcium in type 2 diabetes.  A systematic review and meta-analysis. J Clin Endocrinol Metab 2007 June;92(6):2017-29.

4. Wagner DL, Hulsey TC, Fanning D, et al. High-dose vitamin D3supplementation in a cohort of breastfeeding mothers and their infants; a 6-month follow-up pilot study.  Breastfeed Med 2006 Summer1(2):59-70

5. Holick MF.  Vitamin D deficieny.  N Engl J Med 2007;357:266-81 PubMed abstract

6. Hayes, CE, Hashold FE, Spach KM, Pederson LB. The immunological functions of the vitamin D endocrine system.  Cell Mol Biol 2003;49:277-300.  PubMed abstract.

Here are some good places to look for other articles and information resources:

http://nccam.nih.gov/news/newsletter/2006_spring/cal.htm

http://ana-jana.org/jana_journal.cfm

http://health.nih.gov/

]]> http://karenkrahldc.wordpress.com/2009/10/06/the-vitamin-d-controversy/feed/ 0 karenkrahldc http://karenkrahldc.wordpress.com/2009/10/06/plastics-are-they-safe/ http://karenkrahldc.wordpress.com/2009/10/06/plastics-are-they-safe/#comments Tue, 06 Oct 2009 00:17:22 +0000 karenkrahldc http://karenkrahldc.wordpress.com/?p=16 ]]> Plastics are not particularly stabile compounds.  Some are more volatile than others.   The fad of carrying drinking water in plastic bottles is not just environmentally unsound, it’s unhealthy.  Besides polluting our planet, the Bisphenol-A and the PVC that’s in plastic wraps may“outgas” into fluids or foods kept or cooked in plastics, may mimic your body’s own hormones and can disregulate the very delicate biochemical pathways in the human body.  BPA’s are found in many plastic substances, including some baby bottles.  The good news is that they can be excreted over time, once you stop consuming them. Although the FDA may seem to think our ingesting 50 micrograms per kilogram of weight daily is safe,  scientific experiments on mice showed problems with obesity, liver problems, thyroid dysfunction. Both human and animal research showed that the chemical mimics estrogen.  A recent article in the Journal of the American Medical Association has shown an association between BPA and  type 2 Diabetes as well as heart disease. “Higher BPA exposure , reflected in a higher urinary concentration of BPA, may be associated with avoidable mortality in the community- dwelling adult population.” JAMA 2008; 300: 1302-08  Further “Based upon analysis of date frmo teh NHANES report a strong relationship between urine concentrations of Bisphenol A and the incidence of CVD, type 2 diabetes, and liver-enzyme abnormalities in a representative sample of the adult US population.” JAMA 2008; 300: 1353-54.

To lower your risk of ingesting these toxins, take food packaged in plastic material out of the package before cooking in the microwave. Decline fluids or foods packaged in styrofoam or other plastics. Avoid drinking from plastic bottles or cups, eliminate plastic baby bottles, or look for labeling indicating BPA free. L.L. Bean, and several other companies make nice stainless steel containers that can be washed, sanitized, and reused.  It turns out that in most cases, drinking tap water is preferable to drinking from plastic. New research from the Endocrinology Association, has linked BPA’s to causing infertility in laboratory animals.

Here’s some more information below comes from the National Geographic’s Green Guide.  I hope you find this helpful and healthful!

Plastics are classified by their “resin identification code”—a number from #1 to #7 that represents a different type of resin. That number is usually imprinted on the bottom of your container; flip it upside down, and you’ll see a recycling triangle with the number in the middle.

Here’s a quick breakdown of plastic resin types:

#1 polyethylene terephthalate (PET or PETE)
Examples: Disposable soft drink and water bottles

#2 high density polyethylene (HDPE)/
Examples: Milk jugs, liquid detergent bottles, shampoo bottles

#3 polyvinyl chloride (V or PVC)
Examples: Meat wrap, cooking oil bottles, plumbing pipes

#4 low density polyethylene (LDPE)
Examples: Cling wrap, grocery bags, sandwich bags

#5 polypropylene (PP)
Examples: Cloudy plastic water bottles, yogurt cups/tubs

#6 polystyrene (PS)
Examples: Disposable coffee cups, clam-shell take-out containers

#7 other (plastics invented after 1987; includes polycarbonate, or PC, and polylactide, or PLA, plastics made from renewable resources as well as newer plastics labeled “BPA-Free”)
Examples: Baby bottles, some reusable water bottles, stain-resistant food-storage containers

What To Buy:

#2 HDPE, #4 LDPE and #5 PP: These three types of plastic are your best choices. They transmit no known chemicals into your food and they’re generally recyclable; #2 is very commonly accepted by municipal recycling programs, but you may have a more difficult time finding someone to recycle your #4 and #5 containers.

#1 PET: Fine for single use and widely accepted by municipal recyclers; avoid reusing #1 water and soda bottles, as they’re hard to clean, and because plastic is porous, these bottles absorb flavors and bacteria that you can’t get rid of.

PLA: plastics made from renewable resources such as corn, potatoes and sugar cane and anything else with a high starch content; although you can’t recycle these plant-based plastics, you can compost them in a municipal composter or in your backyard compost heap.

Plastics to Avoid:

#3 PVC: Used frequently in cling wraps for meat, PVC contains softeners called phthalates that interfere with hormonal development, and its manufacture and incineration release dioxin, a potent carcinogen and hormone disruptor.

#6 PS: Polystyrene-foam cups and clear plastic take-out containers can leach styrene, a possible human carcinogen, into food.

#7 PC: The only plastic made with bisphenol A, polycarbonate is used in baby bottles, 5-gallon water-cooler bottles and the epoxy linings of tin food cans. Bisphenol A has been linked to a wide variety of problems such as heart disease and obesity.

Plastics are classified by their “resin identification code”—a number from #1 to #7 that represents a different type of resin. That number is usually imprinted on the bottom of your container; flip it upside down, and you’ll see a recycling triangle with the number in the middle.

When purchasing cling-wrapped food from the supermarket or deli, slice off a thin layer where the food came into contact with the plastic and store the rest in a glass or ceramic container or wrap it in non-PVC cling wrap.

Avoid storing fatty foods, such as meat and cheese, in plastic containers or plastic wrap.

Hand-wash reusable containers gently with a nonabrasive soap; dishwashers and harsh detergents can scratch plastic, making hospitable homes for bacteria.

A “microwave-safe” or “microwavable” label on a plastic container only means that it shouldn’t melt, crack or fall apart when used in the microwave. The label is no guarantee that containers don’t leach chemicals into foods when heated. Use glass or ceramic containers instead.

Don’t cook your foods in plastic, careful how you preserve them, and switch to drinking your water from glass, ceramic or stainless steel containers.

What are the symptoms of celiac disease?

The following is from the website of the American College of Gastroenterology:

The symptoms or signs of disease will depend on how much and how badly the intestine is inflamed. Some people have mild inflammation with few symptoms. Even though they may feel quite well there is still damage occurring to the lining of the bowel. Other people have more severe inflammation, which causes symptoms that may be severe enough to lead them to visit their doctor. Occasionally individuals will not have any symptoms even though their small intestine is severely inflamed.

A partial listing of gastrointestinal symptoms (from the National Library of Medicine):

• Abdominal pain

• Abdominal distention, bloating, gas, indigestion

• Constipation

• Decreased appetite (may also be increased or unchanged)

• Diarrhea, chronic or occasional

• Lactose intolerance (common upon diagnosis; usually resolves following treatment)

• Nausea and vomiting

• Stools that float, are foul smelling, bloody, or “fatty”

• Weight loss, unexplained (although people can be overweight or of normal weight upon diagnosis)

A partial listing of non-intestinal symptoms (from the National Library of Medicine):

• Anemia (low blood count)

• Bone and joint pain

• Bone disease (osteoporosis, kyphoscholiosis, fracture)

• Breathlessness (due to anemia)

• Bruising easily

• Dental enamel defects and discoloration

• Depression

• Fatigue

• Growth delay in children

• Hair loss

• Hypoglycemia (low blood sugar)

• Irritability and behavioral changes

• Malnutrition

• Mouth ulcers

• Muscle cramps

• Nosebleed

• Seizures

• Short stature, unexplained

• Skin disorders (dermatitis herpetiformis)

• Swelling, general or abdominal

• Vitamin or mineral deficiency, single or multiple nutrient (for example, iron, folate, vitamin K)

Someone with Celiac Disease may have a variety of symptoms and different people with Celiac Disease may have completely different symptoms.

What is celiac disease and how is it diagnosed? It is an allergy to the proteins found in certain grains. Because it causes inflammation of the intestine, and the wall becomes more “porous” when inflamed, the condition allows larger sized molecules from the intestine to pass through, retaining enough of their “identity” to be recognized as foreign invaders by the gastrointestinal associated lymph tissue ( or GALT) surrounding the gut.  This upregulates an immune response that can contribute to allergies of other kinds; such as lactose intolerance, asthma, etc. The chronic inflammation of the gut damages the delicate villi of the intestine which are responsible for the absorption of micronutrients, and over time leads to nutritional deficiencies; markedly iron, B vitamins and in some cases oil soluble vitamins like D, A, and E.  Lacking D can contribute to development of osteoporosis. Gluten intolerance is linked to Hashimoto’s Hypothyroiditis, so if your thyroid is beginning to fail; i.e. you are feeling fatigue, experience weight gain, coldness in the extremities and a rise in your TSH levels, laboratory testing may also show the presence of Anti-TPO antibodies. If so you have probably been gluten intolerant for awhile.

The diagnosis can be made with a Celiac Profile test, by Genova Diagnostics, or a Comprehensive Digestive Stool Analysis.  Generally an Anti-Gliadin A test is run, but a patient may get a false negative, and still have the disease. There is a genetic  link between the HLADQ  2.5 gene and celiac, and HLA DQ gene and autoimmune diseases and Diabetes Mellitus Type 1. Another fairly reliable test is a several site surgical biopsy of the small intestine.  Flattened, scarred or inflamed villi are considered a positive test.

If you have celiac disease what can you eat?

Rice, buckwheat, soy, quinoa, kasha, in some cases corn, however if you have been gluten intolerant for a long time, you may still mount an allergic response to soy or corn.  When patients go gluten free for even as short a time as 3-4 weeks, they notice less joint pain, decreased bloating, less abdominal pain, solid stools, less trouble with concentration, improved mood. Getting nutrient levels tested at the same time is a good idea, using a test like the FIA from Spectracell Labs for instance, will allow you to see exactly which nutrients you are deficient in. They have an add on test called a Spectrox, to determine if your anti-oxidants from your normal diet, or nutritional supplements are being absorbed sufficiently to protect your cells from free radical damage. Repleting these along with healing the gut, will move you quickly in the direction of better overall health and function.

This serotype is most prevalent in Spain and Ireland, Western Europe, and North and West Africa, and those descended from people from those areas.

For more information go to the  www.celiaccenter.org

There is a celiac research center at University of Maryland Medical School in Baltimore, Maryland

The First Line Therapy program I use in my clinic, as well as the Functional Medicine approach to treating gut dysbiosis, is very effective in detecting the problem and helping a patient map out a plan for a gluten free diet, and learn how to eat healthfully even at restaurants. After nutrients have been restored and all other gut imbalances are addressed, such as digestive enzymes, better gut ecology with probiotics will over time heal the injured intestinal lining, and better vitamin and nutrient absorption will resume.

]]> http://karenkrahldc.wordpress.com/2009/10/05/celiac-disease-and-gluten-intolerance-more-people-have-it-without-knowing-it/feed/ 0 karenkrahldc http://karenkrahldc.wordpress.com/2009/10/02/low-choline-levels-associated-with-high-levels-of-anxiety/ http://karenkrahldc.wordpress.com/2009/10/02/low-choline-levels-associated-with-high-levels-of-anxiety/#comments Fri, 02 Oct 2009 17:54:12 +0000 karenkrahldc http://karenkrahldc.wordpress.com/?p=8 ]]> A recent study in the American Journal of Clinical Nutrition, a study looked at the relationship between low choline levels and anxiety or depression.  The greatest association was between choline deficiency and anxiety.

Choline is not a vitamin, but is an essential nutrient.  Although we can synthesize it in small amounts, it has to be consumed to maintain the right levels. Choline is found in fat molecules known as phospholipids and one source of it, which is phosphatidylcholine is the most common also known as lecithin.  A good source of this is soy.

Choline is used in the synthesis of the phospholipids, phosphatidylcholine and sphingomyelin, which are structural components of all human cellular membranes. It is also a precursor for acetylcholine, a neurotransmitter which has effects and duties related to muscle memory, memory in general and many other functions. Phosphatidylcholine is a required component of VLDL particles. Without adequate phosphatidylcholine, fat and cholesterol accumulate in the liver.

Phosphatidylcholine, phosphotidylethanolamine, and phosphatidylserine, have been shown in numerous studies to improve cognition, mood, and memory taken in doses of 100mg to 800 mg or more per day. It has been tested in a number of studies in Italy on Alzheimer’s patients and those with Mild Cognitive Impairment; MCI.

Exercise can drive HDL levels up, and LDL levels down. Niacin is a very helpful therapy for affecting these levels.  Red Yeast Rice, which the Chinese have been using as a seasoning for thousands of years, has a similar molecular structure to Lovostatin, without the side effects that lower levels of CoQ10 if you are taking it, causing muscle weakness, aches, and generalized fatigue