Monday, November 19, 2018

Preserve muscle and bone mass with healthy weight loss.

Healthy Weight Loss Preserves Muscles and Bones
Weight loss, even a modest amount, leads to numerous health benefits for individuals with overweight or obesity. But pursuing weight loss without considering the science of whole body composition is a lopsided approach that can lead to unintended, negative outcomes. This is because weight loss is not strictly relegated to loss of adipose tissue but will also net lean muscle and bone mass losses if proper, targeted nutrition and physical activities are not included with intentionality in the weight loss approach.

Healthy Weight Loss Preserves Muscles and Bones
Weight loss, even a modest amount, leads to numerous health benefits for individuals with overweight or obesity. But pursuing weight loss without considering the science of whole body composition is a lopsided approach that can lead to unintended, negative outcomes. This is because weight loss is not strictly relegated to loss of adipose tissue but will also net lean muscle and bone mass losses if proper, targeted nutrition and physical activities are not included with intentionality in the weight loss approach.

Healthy Weight Loss Preserves Muscle and Bone Mass

by Bianca Garilli, ND
Globally, 39% of adults aged ≥18 years were classified as overweight and 13% obese in 2016, totaling a jaw-dropping 1.9 billion adults overall.1 With obesity rates soaring, tripling worldwide since 1975, most of the Earth’s population now lives in countries where overweight and obesity cause more morbidity and mortality than being underweight.1
Keeping pace with these gains in adiposity is the behemoth weight loss and weight management market, which consists of fitness centers, slimming centers, consulting services, online weight loss programs, and associated products.In the US alone, the weight loss and weight management market is expected to reach USD 246.51 billion by the year 2022, a sharp increase from 2017 when this number was USD 175.94 billion, representing a compound annual growth rate (CAGR) of 6.9%.Although North America has historically taken the lead on weight loss and maintenance expenditure, Europe is a close second, and Asia is expected to register the highest CAGR by 2022 due to their rising incidence of overweight, obesity, and related chronic illnesses.2
Weight loss leads to numerous health benefits for individuals with obesity or overweight, including improved glycemic indices and cardiovascular health, in addition to reduced inflammation and a lower risk of all-cause mortality.3-4 In fact, modest weight loss (e.g. losing 5-10% of body weight) has been shown to improve fasting glucose, triglycerides, and total cholesterol, while losing >10% of total body weight ameliorates the previously mentioned biomarkers in addition to reducing LDL cholesterol levels.
Nonetheless, striving for “weight loss” as the primary goal without properly integrating the total concept of body composition into the equation is a lopsided approach that may lead to unintended, negative outcomes. This is because weight loss is not strictly relegated to loss of adipose tissue but will naturally, in fact, also net lean muscle and bone losses if proper nutrition and physical activities are not included with intentionality in the weight loss approach.
 Weight loss and reduced muscle mass 
Weight loss, without appropriate focus on maintenance of healthy lean body mass, can result in lower muscle mass and consequently, reduced muscle strength.5 Over time, reduced muscle mass and strength have been shown to be predictors of reduced mobility, slower walking speed, long-term risk of disability, and lower rates of survival.5-6 It is critical then, that a healthy weight loss program includes methods aimed at maintaining a healthy level of muscle mass and strength for each individual. Regular moderate-to-vigorous physical activity and an exercise regimen that includes strength training helps maintain and even improve muscle mass and strength by stimulating muscle protein synthesis in the body.7-8
Maintaining healthy muscle mass levels is also influenced by nutritional inputs when undergoing calorie-restrictive weight loss programs. Several studies have confirmed findings that elderly individuals with obesity lose less muscle mass with hypocaloric weight loss programs that include exercise and a diet higher in protein than the control group; one of these studies recommended 1.2 g of protein per kg body weight.8-9
 Weight loss and reduced bone mass
A similar situation can be seen with concurrent weight and bone mass losses. In fact, many healthcare professionals are reluctant to recommend weight loss in the elderly or in frail individuals who are overweight for fear that the weight loss will also result in a bone mineral density (BMD) reduction. However, the relationship between weight loss and bone is much more nuanced.10-11
Weight loss is more likely to impact hip and lumbar spine BMD (hip > spine losses), but usually does not net total BMD loss.11 Furthermore, bone density is more closely linked to lean mass than total body and fat mass; in fact, moderate weight loss accompanied by an age- and condition-appropriate exercise approach, particularly including strength training and high impact loading activities, can mitigate BMD loss and even result in BMD gains.10 Interestingly, in a review of 32 randomized controlled trials, BMD effects varied with the weight loss approach – calorie restriction, calorie restriction + exercise training, or exercise training alone:11
  • Calorie restriction induced weight loss: ↓ hip BMD
  • Calorie restriction + exercise induced weight loss: ↓ hip BMD
  • Exercise induced weight loss: ↑ hip BMD
Think ‘whole body’ when it comes to weight loss
Achieving and maintaining a healthy weight is a prudent goal associated with significant health gains. The caveat is that weight loss can occur in a multitude of ways – both healthy and unhealthy. It’s less about the number on the scale and much more about overall, strategic body composition changes. Current literature seems to indicate that healthy weight loss should include a structured, individualized dietary and exercise program complete with aerobic and strength training components and sufficient or higher (than the age- and gender-specific IOM RDAs) daily protein consumption. Programs including both aspects (exercise and nutrition) will support healthy muscle mass, muscle strength, and bone mineral density, which together encourage long-term mobility, strength, wellness, and survival.
  1. WHO. Obesity and overweight. Accessed September 26, 2018.
  2. Business Wire. Global weight loss and weight management market analysis & forecast to 2022, with an expected CAGR of 6.9%. Accessed September 26, 2018.
  3. Brown J et al. Effects on cardiovascular risk factors of weight losses limited to 5–10 %. Transl Behav Med. 2016;6(3):339–346.
  4. Kritchevsky S et al. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS One. 2015;10(3):e0121993.
  5. Kim B et al. Changes in muscle strength after diet-induced weight reduction in adult men with obesity: a prospective study. Diabetes Metab Syndr Obes. 2017;10:187–194.
  6. Volpato S et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diab Care. 2012;35(8):1672-1679.
  7. Weiss E et al. Effects of weight loss on lean mass, strength, bone, and aerobic capacity. Med Sci Sports Exerc. 2017;49(1):206-217.
  8. Cava E et al. Preserving healthy muscle during weight loss. Adv Nutr. 2017;8(3):511–519.
  9. Weijs PJM et al. Exploration of the protein requirement during weight loss in obese older adults. Clin Nutr. 2016;35(2):394-398.
  10. Hunter G et al. Weight loss and bone mineral density. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):358–362.
  11. Soltani S et al. The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int.2016;27(9):2655-2671. 
Bianca Garilli, ND
Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.

Friday, November 16, 2018

Another reason to love lavender essential oil

Lavender's Antianxiety Effects Nothing to Sniff At

The scent of lavender has long been thought to have calming, antianxiety effects, but the biological mechanism behind this phenomenon has been something of a mystery — until now.
Researchers in Japan found that the vaporized lavender compound linalool triggers a relaxing effect by directly stimulating olfactory sensory neurons.
For linalool to be used clinically in humans, the mechanism of linalool's anxiolytic effects need to be established. Findings from a new study provide a "foundation towards clinical application of linalool odor for anxiety disorders," the investigators write.
The study was published online October 23, 2018 in Frontiers in Behavioral Neuroscience.
"We confirmed the anxiolytic effects of linalool odor in normal mice," the authors write. The effects were "triggered by olfactory input evoked by linalool odor. Absorption to blood flow is not necessary," study investigator Hideki Kashiwadani, PhD, from Kagoshima University, Japan, told Medscape Medical News.
Notably, there was no anxiolytic effect in anosmic mice, whose olfactory neurons had been destroyed. This confirmed that the calming effect seen in normal mice was triggered by olfactory signals generated by smelling the lavender compound.

Soothing Scents 

The researchers say it is notable that the animals' movements did not become impaired after the animals smelled linalool. By contrast, benzodiazepines and linalool injections had effects on movement that were similar to those caused by alcohol.
Kashiwadani noted that the site of action of linalool had not been addressed in prior studies. It has been assumed that absorption into the bloodstream via the airway leads to direct effects on gamma-aminobutyric acid A (GABAA) receptors, which are also the target of benzodiazepines.
Kashiwadani and colleagues found that in normal mice that had been pretreated with flumazenil, there was no anxiolytic effect from smelling linalool. Flumazenil blocks benzodiazepine-responsive GABAA receptors.
"When combined, these results suggest that linalool does not act directly on GABAA receptors like benzodiazepines do but must activate them via olfactory neurons in the nose in order to produce its relaxing effects," Kashiwadani said in a news release.
The researchers note that the anxiolytic effects induced by the odor of linalool "may be applicable for preoperative patients because pretreatment with anxiolytics can alleviate preoperative stress and thus contribute to place patients under general anesthesia more smoothly. In addition, for patients who may have difficulties with oral or suppository administration of anxiolytics, such as infants, utilizing linalool odor to help reduce anxiety may be a convenient and promising alternative," they add.
Kashiwadani believes that linalool may have effects in humans that are similar to the effects seen in mice "because the olfactory system of humans has basically quite similar structure with that of mice," he told Medscape Medical News. He added, "in the near future, I'll undertake the human study."
The study was supported by the Japan Society for the Promotion of Science. The authors have disclosed no relevant financial relationships.
Front Behav Neurosci. Published online October 23, 2018.

Wednesday, November 14, 2018

Household chemicals and how they affect our kids....

Another reason to “Detoxify”, especially before pregnancy…

Common Household Chemicals Tied to Language Delays in Kids 

~Joel Evans MD

Early prenatal exposure to phthalates — the synthetic chemicals commonly found in household items and personal care products — has been tied to language delays in children, new research shows.
In the first study of its kind, the collaboration between investigators from the Icahn School of Medicine at Mount Sinai, New York City, and Karlstad University, Sweden, showed that the risk for language delay was as much as 30% greater in children whose mothers were exposed to twice the levels of dibutyl phthalate and butyl benzyl phthalate, two chemicals commonly found in such everyday items as cosmetics, plastic toys, and food.
"The bottom line here is that the phthalates that a mother is exposed to in early pregnancy can affect the development of the brain in her children, particularly in this area of language development," principal investigator Shanna Swan, PhD, professor of environmental and public health at the Icahn School of Medicine at Mount Sinai, told Medscape Medical News. 
"Unfortunately, these results point to different phthalates than we've found to be bad actors in the past. We've previously observed negative associations with di-ethylhexyl phthalate, which is more commonly found in food. Now we have more phthalates to worry about," said Swan.
The study was published online October 29, 2018 in JAMA Pediatrics. (JAMA Pediatr. Published online October 29, 2018. doi:10.1001/jamapediatrics.2018.3115)

Onus on Regulators, Manufacturers

Phthalates — high-volume semivolatile synthetic chemicals that make plastic soft and flexible — are used in a variety of industrial products, including polyvinyl chloride flooring, food packaging, personal-care products, medical supplies, and even toys. Their chemical structure precludes them from leaching, which is why they are often found in indoor air, dust, food, and water.
Global biomonitoring data show that most phthalate metabolites are ubiquitous in the urine of children and adults alike. It is also present in blood, breast milk, and amniotic fluid.
Previous research in both animals and humans has demonstrated that phthalates are endocrine disruptors with antiandrogenic properties. Indeed, prenatal phthalate exposure has been associated with male genital defects. Moreover, studies found inverse associations between phthalate metabolite level in prenatal urine and subsequent child neurodevelopment, behavioral outcomes, mental and psychomotor development, and neurologic status.
Given that language-development delays can affect academic achievement later in life, such delays serve as an important indicator of later neurodevelopmental impairment.
With that in mind, the investigators sought to examine the association between metabolite phthalate level in first-trimester urine samples and subsequent language development in early childhood.
The researchers used data from two independent pregnancy cohort studies for the analysis — the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy study (SELMA; 963 pregnant women and their children) and the Infant Development and Environment Study (TIDES; 370 women and their children). The latter study was conducted in the United States.
In both trials, phthalate levels were obtained from the women at their first prenatal visit (median, 10th week of pregnancy). After their children were born and had begun acquiring language, the women were asked how many words their children understood (at 30 months in SELMA and 37 months in TIDES) through use of a screening questionnaire. The questionnaire is routinely used in Sweden and was translated into English. Responses were categorized as <25 25="" 50="" and="" to="">50 words. Children who understood <50 as="" classified="" delay.="" having="" language="" span="" were="" words="">
Both studies found that 10% of children used 50 words or fewer; 2.7% understood fewer than 25 words. Interestingly, language delay was more common among boys than girls in both studies.
Raw analyses of the data demonstrated that metabolites of two chemicals — dibutyl phthalate and butyl benzyl phthalate — were statistically significantly associated with language delay.
After adjusting for potential confounders, a doubling of prenatal exposure to these two metabolites increased the odds ratio of language delay by 25% to 40%. These adjusted findings were significant in the Swedish study but not in the American study. The researchers attribute this difference to the smaller sample size in the US study.
The investigators note that the current study is one of the first to examine the association between early language development and first-trimester phthalate exposure. The findings have far-reaching implications, given the ubiquity of phthalates in modern society.
"Until there's some testing of chemicals before they're put into products, we're not going to get around this," Swan said. "I don't think consumers can do very much, because these things aren't labeled. You don't know what's in your furniture, and you certainly don't know which foods have phthalates in them.
"So the consumer is at a loss," Swan added. "It really is the responsibility of the regulators and the manufacturers."

Exposure Difficult to Avoid 

Commenting on the findings for Medscape Medical News, Susan Schantz, PhD, professor of toxicology and neuroscience at the University of Illinois in Urbana, who was not involved in the study, said the findings are very much needed.
"We did a review a couple of years back looking at environmental chemicals and language development, and I was shocked to see how little research there was on this really important aspect of neurodevelopment," said Schantz.
"Phthalates are present in many different consumer products," Schantz added. "So it's very hard to avoid exposure. I think studies like this are important because we need to start phasing phthalates out of products and find better, less toxic solutions."
"I don't know what the answer is," Swan concluded, "but I know we'd be doing pregnant women and their children a service if we could keep some of these chemicals out of their bodies."
The studies were supported by grants from the National Institute of Environmental Health Sciences, the Swedish Research Council Formas, and the County Council of Varmland, Sweden.

Dr. Evans - Joel M. Evans, MD, a board-certified OB/GYN and international lecturer, is the Director of The Center for Functional Medicine in Stamford, CT. His book on the holistic approach to pregnancy, The Whole Pregnancy Handbook, has received widespread critical acclaim and media attention. He is currently the Medical Director of the Association for Prenatal and Perinatal Psychology and Health. Dr. Evans is a Founding Diplomate of the American Board of Holistic Medicine and is recognized as the first physician in Connecticut to be Board Certified in both Integrative Medicine and Obstetrics and Gynecology.

He is a member of the senior faculty of two of the most recognized and prestigious teaching institutions in integrative medicine: The Institute for Functional Medicine and the Center for Mind/Body Medicine. He continues to serve as the “external lead” of the IFM Advanced Practice Module in Hormone Health since its inception in 2011. Dr. Evans also helped create a clinical study at Columbia University Medical Center on the use of the herb black cohosh in breast cancer, which was presented at the 2001 Annual Meeting of the American Society of Clinical Oncologists and later published in their journal.

Monday, November 12, 2018

What is health really?

I heard a really interesting podcast and it made me think....

Health isn't just about affordable healthcare or diet and exercise, it is about feeling safe, having a roof over your head and being able to afford food and your rent.
It is about being able to care for your family and being able to work and provide.

We are all responsible for shifting the focus from affordable healthcare to affordable housing, healthy food and safety for all. Being healthy depends on feeling safe and cared for and supported.
Many people out there do not feel supported or heard. There is so much discrimination and fear and hatred in our world and this is creating an overall energy of ill health.

Being healthy is also about your brain...thinking healthy thoughts and having healthy feelings. When you are struggling to survive, it's hard to have healthy feelings and healthy thoughts as you are constantly flooding your body with stress hormones and some are sinking deeper into depression. Deeper down the rabbit hole of being alone and scared.

When we spout out our political beliefs and continue to separate ourselves from each other we continue to spread the seeds of unhealthy energy.
When we keep hoarding our stuff and fight to protect it, we forget the fundamental truth, that none of the stuff will keep our bodies and minds healthy. A lack love and compassion for the world we live in and all it's inhabitants is UNHEALTHY.

Take a moment to put yourself in the shoes of those that have two jobs and still cannot afford to pay their rent or buy the basics things needed in life...shelter, food, warm clothes. (The ones you pass on the street and know nothing about, but still judge and sometimes condemn) Our humanity demands that we start realizing that we are all on this planet together and we are all capable of helping and supporting each other and demanding that our leaders start paying attention to the basic needs of its citizens. The basics that will improve their health and wellbeing.

What are you going to do today to improve the health and wellbeing of the people and planet you are a part of?

Wednesday, October 31, 2018

Fish oils and Cardiovascular Disease.

Don't Give Up on Fish Oil for CVD Prevention Just Yet

Hello. I'm Dr Arefa Cassoobhoy, a primary care internist, Medscape advisor, and senior medical director for WebMD. Welcome to Medscape Morning Report, our 1-minute news story for primary care.
You'd be forgiven if you were skeptical that fish oil could have a practice-changing role in preventing major adverse cardiovascular events (MACE). The data have been, at best, conflicting.
But now, recent topline results from the REDUCE-IT trial (see attached below), suggest that high doses of at least one omega-3—EPA (eicosapentaenoic acid)—could resurrect faith in fish oil for cardiovascular health.
The global study involved more than 8000 patients whose LDL levels were controlled on a statin. They also had risk factors, including persistently high triglyceride levels, cardiovascular disease, or diabetes with another risk factor.
The patients received either 4 g of EPA daily or placebo. After about 5 years, the EPA group saw a 25% relative risk reduction in MACE. And the results were highly statistically significant. MACE included death, nonfatal myocardial infarction or stroke, coronary revascularization, or unstable angina requiring hospitalization.
It's thought that the higher dose of pure EPA used in this study is the reason that they saw a stronger effect from fish oil compared with previous studies. Look out for more information when the data are presented at the 2018 American Heart Association meeting.

REDUCE-IT: 25% Reduction in MACE With High-Dose EPA

High doses (4-g daily) of the omega-3 oil eicosapentaenoic acid (EPA) have shown a large benefit on cardiovascular events in the randomized, double-blind REDUCE-IT trial.
Top-line results of the trial were announced yesterday in a press release by the sponsor, Amarin, which manufactures the high-dose EPA product under the brand name Vascepa.
The study involved 8179 patients from 11 countries who were at elevated cardiovascular risk (had a previous cardiovascular event or diabetes with one additional risk factor) and had raised triglyceride levels. All participants, who were already taking a statin, were randomized to 4 g of the pure EPA product daily or placebo.
After a median follow-up of 4.9 years, there was an approximately 25% relative risk reduction in the primary endpoint of first occurrence of a major adverse cardiovascular event — any one of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization — in the EPA group, which was highly significant (P < .001), the company reported.
There were also "robust demonstrations of efficacy across multiple secondary endpoints," the company's statement said.
In terms of safety, the high-dose EPA was said to be "well tolerated," with similar proportions of patients experiencing adverse events and serious adverse events in the active and placebo treatment groups.
More details of REDUCE-IT will be presented by principal investigator Deepak L. Bhatt, MD, Brigham and Women's Hospital, Boston, Massachusetts, at the American Heart Association (AHA) Scientific Sessions 2018 on November 10, 2018 in Chicago, Illinois.
During a company conference call, John Thero, president and chief executive officer of Amarin, referred to the benefit of the high-dose EPA as "huge" and "exceeding all expectations."
"The 25% relative risk reduction in major cardiovascular events seen with Vascepa is comparable to that seen with atorvastatin, one of the most successful drugs of all time," he said, "and the benefit of Vascepa was seen on top of statin therapy therefore is addressing an unmet medical need."
"Clearly, lowering low-density lipoprotein cholesterol (LDL-C) alone is not enough," he said. "That can give a relative risk reduction of 25% to 35%, but this leaves a residual risk of 65% to 75%. The additional 25% relative risk reduction seen in this study is the single most impressive advance for preventative cardiovascular drug therapy since the advent of the statins."
The product is also easy to use, taken orally, safe, and inexpensive compared with other branded cardiovascular drugs, Thero added, "and it now has the potential to be used in millions of patients on top of statin therapy for additional cardiovascular risk reduction.”
500 mg/dL. The company plans to apply to the US Food and Drug Administration for this new indication based on results of REDUCE-IT in early 2019. 
In an interview with Medscape Medical News, REDUCE-IT investigator Christie Ballantyne, MD, Baylor College of Medicine, Houston, Texas, said it was very important to understand the patient population enrolled in the study.
He noted that "70% of patients were secondary prevention and 30% high-risk primary prevention (had diabetes and one additional risk factor). All patients had baseline triglycerides over 150 mg/dL on statin therapy. This is very different from other studies which did not include elevated triglycerides as an entry criterion.”
"It's hard to believe that in this era of precision medicine there has never been a study before specifically addressing whether the lowering of triglycerides is beneficial in patients with elevated levels," Ballantyne commented. 
He also pointed out that the dose of EPA used was probably a key factor in the benefit seen. "We used a high dose (4-g daily) of EPA alone, whereas most previous studies of omega-3 oils (most recently in the ASCEND trial) have used much lower doses of mixed oils. The only prior study that used EPA alone at higher doses was the Japanese JELIS trial, which used 1.8-g daily and also showed benefit."
Ballantyne noted that the JELIS trial did not stipulate that patients had to have raised triglyceride levels but the most benefit was seen in those who did. "The REDUCE-IT trial confirms the results of the JELIS trial but REDUCE-IT has a more rigorous design and a different patient population."
Ballantyne was reluctant to speculate on the clinical implications of the results at the present time. "I will let the clinicians at the AHA meeting decide on the clinical relevance of the data when they see it for themselves in more detail."
But he did say that "the study was powered for a 15% relative risk reduction, and we achieved a 25% relative risk reduction. Whenever you exceed the benefit aimed for, you get excited by the results."
"I have been in this field for a long time and witnessed many failures of drugs aiming to reduce cardiovascular risk. It will be great to get these data out to the cardiology community at AHA."
Commenting for Medscape Medical News, Henry Ginsberg, MD, University of Columbia, New York City, who was not involved in the study, said the reported results are "fascinating and important."
"I really didn't think that fish oils would show such a strong effect. I was guessing they might achieve a 10% to 12% benefit at the most. So this is terrifically exciting," he said. "It will change practice."
He agreed that the dosage was probably a key issue. "Previous fish oil studies have mainly used doses of around 1 g daily of mixed omega-3 oils and have not shown benefits. This trial has used 4 g of pure EPA," he noted. "The JELIS trial used 1.8-g daily of EPA, which showed a 19% benefit and was significant for secondary prevention but not for primary prevention."
"The JELIS study did not stipulate raised triglycerides for entry and the drop in triglycerides was modest," he noted, "but a post-hoc analysis showed a greater benefit in those patients with raised triglycerides at baseline."
Although lowering triglycerides with high-dose EPA was the main focus of the REDUCE-IT trial, Ballantyne noted that high doses of EPA have been shown to have other beneficial effects.
"Previous studies have suggested that in addition to lowering triglycerides, EPA has a favorable effect on inflammation and several other markers of atherosclerosis," he said. "Basically we don't know the mechanism. It may be the reduction in triglycerides but it also appears to do lots of other good things."
Thero added, "We view the JELIS results as supportive for using EPA to benefit patients without raised triglycerides as well as those with raised triglycerides. It suggests that the benefits of EPA are not brought about by triglyceride reduction alone."
Ginsberg estimated that about 30% of the US population have triglyceride levels above 150 mg/dL. "This percentage would be higher in a secondary prevention population — possibly 40%," he said.   
Another trial of high-dose omega-3 oils for cardiovascular event reduction is underway. The STRENGTH trial is using a combination EPA/docosahexaenoic acid product with a total of 4-g omega-3 oils daily in patients with triglycerides over 200 mg/dL. Results are due out next year.
"The REDUCE-IT trial has shown a strong result," lead investigator of the STRENGTH trial, Steve Nissen, MD, Cleveland Clinic, Ohio, commented to Medscape Medical News.
"I am not surprised that it was successful," Nissen said. "Prior studies used small dosages of fish oil (1 g) and studied a broad group of patients. Both REDUCE-IT and STRENGTH treated patients with high triglycerides with full doses (4 g)."
The authors have reported no relevant financial relationships.
Reference: "A Study of AMR101 to Evaluate Its Ability to Reduce Cardiovascular Events in High Risk Patients With Hypertriglyceridemia and on Statin. The Primary Objective is to Evaluate the Effect of 4 g/Day AMR101 for Preventing the Occurrence of a First Major Cardiovascular Event. (REDUCE-IT)” - Identifier: NCT01492361

Tuesday, October 30, 2018

Emotional Wellbeing...

What is emotional wellbeing and what does it look like for you? It is an interesting question to ponder and our health has become very dependent on emotional wellbeing.
More and more research is now linking our emotions to our overall health.

Emotional wellbeing is all about digesting our emotions and feelings in a healthy way. It is not about suppressing how we feel or avoiding our emotions. Our emotions are also linked to our thoughts and beliefs, and I say this because in many situations what we think and believe will trigger an emotional response. These emotional responses may not always be positive and when a belief system or though pattern in held for long enough it become imprinted in our cells.

We need to detoxify from our negative thoughts, feelings and beliefs just like we must detox from harmful chemicals, to obtain and maintain perfect health. Holding on to old grudges or emotions does extensive harm to your biology and physiology.

Many of our emotions and wounds and belief systems are formulated in childhood by our experiences and they tend to shape our lives. Some do so immediately, offering us challenges to overcome and builds character in the process,  and some take many years to surface. Usually in adulthood when our close relationships help to bring out the deepest aspects of ourselves. This is when deeply suppressed childhood wounds may make themselves known in a call for healing.

In adulthood issues of trust and abandonment and co-dependancy (to name a few) come up,  we may also find ourselves mirroring actions form our past instinctively.  It is then that we consider our emotional wellbeing and are in a position to nurture and heal our inner child. We have the power within us to be the loving parent or guardian we needed as a child. We are whole spiritual beings and we can nurture ourselves from that wholeness.

It is important to recognize the wounds and old emotions/patterns coming up and working toward healing/resolving them. We can visualize the situation and try on different outcomes. Using our wisdom born from age and experience we may be able to view them form a different perspective, bringing new understanding and being able to free ourselves from the hold they may have on us.

Life offers us many opportunity to clear the weeds in the garden of our soul (as Madisyn Taylor says)
Clearing these weeds are not always easy or comfortable and choosing to ignore them or find easier ways to move through life means these wounds continue to drain our energy and emotional wellbeing. They destroy the beauty and resilience of our garden. They corrupt the soil.

Sometimes we need to turn to a trainer professional to assist us in facing the events of the past, to weeding and clearing our souls garden. They can offer us tools and support through different healing modalities. Remember the child we were still lives on within us and we are always free to go and love and nurture that child and correct mistakes, perceptions, right old wrongs and forgive, thus beginning anew.

I highly recommend healing the wounds and recreating a life you desire with emotions, thoughts and feelings that support your dreams. You have the power within you to change your world and change your internal vibration to support overall health and wellbeing. Your thoughts and feelings become the things you manifest in your world. They attract the people and events in your life. Your life and it's creation is totally within your power and absolutely your responsibility.

There are a few books that I recommend that shed some light on how your emotions affect your cells and health...Molecules of Emotion by Candice Pert, Biology of belief by Bruce Lipton (to name just a few)

Good or bad cholesterol...

HDL-C: Is It Time to Stop Calling It the 'Good' Cholesterol?

Nearly every consumer story on high-density lipoprotein cholesterol (HDL-C) will include the phrase "good cholesterol." Yet HDL-C–raising drugs, including niacin[1] and cholesterylester transfer protein inhibitors,[2] failed to show a benefit in cardiovascular disease outcomes and multiple population studies show a U-shaped curve indicating a higher risk for all-cause mortality in people with very high levels.
Is it time to retire the phrase "good cholesterol"? "Absolutely," responded Robert Rosenson, MD, Mount Sinai Icahn School of Medicine, New York City, who has chaired four international working groups on the biology of the misunderstood particle. "HDL can be a good, bad, or neutral particle," he said, explaining by phone that it is the surface proteins that confer the cardioprotective effects. Loading up HDL particles with cholesterol in a bid to lower cardiovascular risk was a mistaken therapeutic strategy, he added.

Early Clues

Ironically, one of the early trials of a HDL-C–raising drug suggested as much. The Veterans Affairs High-Density Lipoprotein Intervention Trial showed a reduction in coronary artery disease events when gemfibrozil was given to men with low baseline HDL-C levels.[3] Back in 2006, a case-control substudy using nuclear magnetic resonance (NMR) spectroscopy revealed that the modest increase in HDL-C masked a higher increase in total HDL particles, particularly the small HDL particles that are relatively cholesterol-poor.[4] The authors speculated that "higher numbers of HDL particles might promote greater cholesterol efflux and protection of LDL [low-density lipoprotein] from oxidative changes." This theory was met with doubt by editorialists.[5]
Recent data from two population-based cohorts in Copenhagen of over 100,000 people showed that all-cause mortality rates increased significantly for men with HDL-C levels above 97 mg/dL and for women above 135 mg/dL.[6]This mirrored findings from a Canadian big data cohort of more than 630,000 individuals that saw higher risk for noncardiovascular death at fasting levels above 70 mg/dL for men and 90 mg/dL for women.[7] The researchers hypothesized that extremely high levels may reflect dysfunctional HDL-C.
Rosenson cautions against focusing on HDL-C levels at all. "It is the number of HDL particles and not the cholesterol content that is important," he said. By phone, Matthew Budoff, MD, Los Angeles Biomedical Research Institute, agreed that total HDL particles are a better measure of the antiatherogenic features. He doesn't believe that very high HDL-C levels are necessarily bad, using the analogy of a barrel that is filled with ping-pong balls or basketballs to represent volume of HDL-C. "Some people will have very high levels of HDL-C and a lot of particles, so they're protected, but others will have high HDL-C and very few particles." Dysfunction appears to be independent of the HDL-C level.[8]
Budoff isn't ready to give up on the terms "good cholesterol" and "bad cholesterol"; he finds that they help patients realize that total cholesterol alone is not a good metric. "For 95% of people, it [HDL-C] is good," he said.

The "Good"

The inverse association of HDL-C with coronary artery disease[9] sparked research on agents to boost low levels, typically defined as < 40 mg/dL in men or < 50 mg/dL in women. However, Rosenson sees HDL-C as little more than a marker of lifestyle: Levels tend to be higher in people who exercise more, weigh less, and don't smoke.
HDL got its good name primarily because of its role in reverse cholesterol transport as the body's Roomba®, vacuuming up cholesterol from macrophages. In addition, HDL has anti-inflammatory[10] and antithrombotic[11]properties, and may ameliorate endothelial dysfunction.[12]
This has led to calls to focus on measuring HDL function, not HDL-C.[13] Assays that measure HDL efflux capacity have been shown to better predict cardiovascular events than HDL-C level.[14] However, such tests are not clinically available, and there are no international standards for them or others that aim to measure various aspects of HDL function.
What triggers dysfunctional HDL? It has long been known that such conditions as acute coronary syndrome,[15] diabetes, or systemic inflammation can alter HDL from a cardioprotective particle to one that promotes inflammation and LDL oxidation.[16] Budoff and fellow investigators for the MESA study suggest that the transition to menopause should be added to that list. In the main MESA cohort, HDL-C was inversely associated with CAD and carotid intima-media thickness (cIMT).[17] In contrast, in almost 1500 postmenopausal women, HDL-C was positively associated with increased cIMT.[18] NMR analysis suggested that small HDL particles are less susceptible to adverse modification at menopause than larger particles. HDL particles were inversely associated with cIMT for men and women—a relationship that held even after adjustment for atherogenic particles.

What to Measure?

If tests for HDL function are not ready for prime time, could measuring the size of the subfractions be the way to go, because very small cholesterol-depleted HDL particles are the main players in cholesterol efflux?[19] This, too, is overly simplistic for Rosenson, who cautioned that there are many subclasses of HDL and they're not just differentiated by density. There are more than 60 different proteins associated with HDL, but most particles will only carry a few. Which proteins confer which properties is not fully understood either. The flaw with HDL-C–raising therapies, he noted, is that loading up the particle with cholesterol led to the loss of some surface proteins important in cardioprotection.
Both Budoff and Rosenson like non–HDL-C because it captures all atherogenic particles. But what about patients with very high levels of potentially dysfunctional HDL-C? Budoff explained that when he has a patient of uncertain risk with high LDL-C and very high HDL-C, he will get the HDL particle number; such tests are commercially available. He might also suggest she (he can't remember seeing a man with HDL-C > 100 mg/dL) get a calcium score. "If the coronaries are clean, the HDL is working," he said.
The HDL hypothesis, on the other hand, is not. As a recent editorial put it: "There remains a high degree of ignorance regarding the role of HDLs as either protectors or causes of disease."[13] Rosenson for one would like to hit the reset button and begin anew by focusing on the particle rather than the so-called "good" cholesterol.
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