Great Smokies Medical Center of Asheville

Archive for August, 2005

Hypothyroidism: Stoking the Metabolic Fire

Monday, August 22nd, 2005

The thyroid is a butterfly shaped gland that sits just below and behind the larynx (Adam’s apple) and in front of the trachea (windpipe). Thyroid hormone regulates the metabolic rate – – the sum of cellular processes that create cellular energy. If you were a car, your rate of metabolism could be described as the gear you are in.

Imbalances in thyroid function can result from either deficient or excessive hormone production. The pituitary gland produces thyroid-stimulating hormone (TSH) that directs the thyroid gland to make more thyroid hormone.

Deficiency of thyroid hormone is called hypothyroidism and can range from mild to severe. Inasmuch as thyroid hormone affects every organ, tissue, and cell in the body, disturbances in thyroid function results in many and varied symptoms. An excess of thyroid hormone is called Graves Disease, or hyperthyroidism. It is less common than hypothyroidism.

This discussion of thyroid disease is restricted to hypothyroidism, a much more common disease than hyperthyroidism.

Signs and Symptoms of Thyroid Hormone Deficiency

  • Low body temperature
  • Tiredness and fatigue
  • Slow to waken in the morning
  • Weight gain and difficulty losing weight
  • Depressed mood
  • Poor mental function
  • Constipation
  • Cold hands and feet
  • Obesity
  • Dry skin
  • Orange discoloration of palms and soles
  • Goiter
  • Thinning or disappearance of outer eyebrows
  • Edema (swelling) of face, tongue, ankles, and fingersDry, brittle hair
  • Migraines
  • Hair loss
  • Fibrocystic breasts
  • Altered menstrual periods and ovarian cysts

Signs and Symptoms of Thyroid Hormone Excess

  • Anxiety
  • Tremulousness
  • Difficulty sleeping
  • Difficulty gaining weight
  • Voracious appetite
  • Heart palpitation and bounding, rapid heart rate
  • Moist skin
  • Frequent bowel movements
  • Heat intolerance
  • Muscle cramps
  • Jittery feeling
  • Hyperventilation
  • Facial expression of anxiety
  • Eyes appear wide open or startled (exophthalmus)

Because many of the symptoms of low thyroid hormone levels are of a general nature (fatigue, obesity, constipation, dry skin), the diagnosis can be overlooked, often for years. If a person is deficient in thyroid hormone, the symptoms of deficiency will not respond satisfactorily to anything but the replacement of what is missing. Thyroid replacement therapy is usually given long term.

Subclinical Hypothyroidism
Subclinical hypothyroidism is a condition that occurs when many of the above signs and symptoms of deficient thyroid hormone are present, but laboratory measurements of thyroid hormone commonly performed at doctors’ offices, are within the normal range. Some patients with hypothyroidism have been wrongly labeled as having psychosomatic illness because their blood tests appear normal. Special thyroid laboratory blood tests will often, however, detect thyroid deficiencies in these individuals.

Years ago, before blood tests and synthetic drugs were available, doctors relied on patients’ histories and physical exams to diagnose and treat them. If patients presented with symptoms and physical findings that fit the clinical picture of hypothyroidism, they would then be prescribed the only agent available at that time, whole glandular thyroid from pig thyroid. This preparation, still available as a prescription drug, is known as Armour Thyroid, contains mostly T4 (a mostly inactive form of thyroid hormone that needs to be converted to T3 in the body) and, in addition, T3 (the biologically active form of thyroid hormone).

A small but growing group of doctors have continued this tradition of listening to patients’ symptoms and performing a careful physical examination in addition to using blood tests. They have continued to treat hypothyroidism with natural, whole, desiccated thyroid gland. This natural time-tested approach more often results in improvement in mood and mental functioning-symptoms often not improved by the more commonly used prescription drugs.

A low basal body temperature raises suspicion of subclinical hypothyroidism. A basal body temperature is determined by taking the temperature in the armpit for ten minutes the very first thing in the morning before getting out of bed, using an “old fashioned” mercury thermometer that has been shaken down the night before. Do this for four or five consecutive mornings and record the results. A temperature consistently below 97.6 is suggestive of hypothyroidism.

Laboratory Testing
In Hypothyroidism: The Unsuspected Illness, Broda Barnes, M.D., states: “It may seem incredible that scientists can sit quietly on earth and follow the activity of the heart of a man walking on the moon and yet they have had so much difficulty in measuring the amount of thyroid hormone necessary for health and in developing effective and reliable tests to determine when thyroid function is inadequate.”

Many laboratory tests for measuring thyroid hormone have come and gone since Dr. Barnes made that statement in 1976. The fact remains that the road one travels while treating hypothyroidism based on laboratory tests can be strewn with potholes. Every doctor who treats hypothyroidism has seen discrepancies when comparing blood test results with how patients report feeling.

There has been a reliance among doctors on measuring TSH levels to ascertain what the pituitary is telling the thyroid to do, knowing that a high TSH results when the pituitary tries to stimulate a low functioning thyroid gland. True enough.

However, a low TSH is not as specific. It could mean that there is excessive thyroid hormone resulting in the pituitary stopping the stimulation of more thyroid hormone. Or it could be low as a result of a person being appropriately treated with thyroid hormone, as the pituitary senses that it need not stimulate the thyroid to make more hormone.

Some physicians are concerned with a low TSH level in a patient on supplemental hormone, believing that it is evidence that there is interference with a sophisticated finely tuned feedback system that naturally regulates thyroid hormone production. The mere fact that a person requires hormone replacement implies that the feedback system, regardless of its sophistication, has failed to create homeostasis, or balance. Careful prescribing of thyroid replacement hormone through monitoring of specific laboratory tests can remove the burden of making hormone on an already exhausted thyroid gland, and do not rely solely on TSH levels to determine dosing of thyroid hormone.

Treatments to Address Hypothyroidism
Thyroid hormone replacement therapy requires a doctor’s prescription. And for good reason. A person on the wrong dose of thyroid hormone can feel terrible and have anxiety-producing, even life-threatening, symptoms. Periodic physical exams and monitoring of blood levels of thyroid hormone must be continued on a regular basis.

Two people taking the same dose of thyroid hormone can have greatly differing responses. In fact, the same person taking the same dose of thyroid hormone for years can suddenly react very differently to that same dose with the changes of aging, stress, or the addition of other hormones to his therapy. And a person may episodically need a different replacement dose of thyroid during times of increased stress.

Most physicians who treat hypothyroidism do so with synthetic T4 (Synthroid, Levoxyl, or Unithroid). In the body, T4 has to be converted into triiodothyronine (T3), the biologically active form of the hormone. For several reasons, many people can’t convert T4 to T3, which may result in the symptoms of hypothyroidism. Unfortunately, in this situation, the blood tests that many doctors routinely use to check thyroid status may be normal, which would cause a physician to rule out the diagnosis.

An article in the New England Journal of Medicine reported research suggesting Synthroid use resulted in no improvement in 17 parameters measuring memory, mood, language, and learning. The use of Armour thyroid however, resulted in improvement in 6 of the 17 parameters. (NEJM 1999;340:424-429, 469-470.)

The Oxidata™ Test

Monday, August 22nd, 2005

The Oxidata™ Test enables us to determine the level of stress on your body caused by free radical activity. People of all ages can benefit from knowing if they are getting enough antioxidants in their diets and nutritional supplements to effectively counteract free radical cell damage.

Free radicals play an important role in, both in health and disease. They have been implicated in countless human disease processes, but are also vital to human health. These molecules (Reactive Oxidant Species) are extremely important to human metabolic processes according to a growing body of scientific literature.

Any molecule can become a free radical by either losing or gaining an electron. Molecules containing these uncoupled electrons are very reactive. Once free radicals are initiated, they tend to propagate by becoming involved in chain reactions with other less reactive species. The chain reaction compounds generally have longer half-lives and therefore extend the potential for cellular damage.The life of a free radical has three stages: the initiation stage, the propagation stage, and finally the termination stage. Free radicals are terminated or neutralized by antioxidants, enzymatic mechanisms, or by recombining with each other. The quest is to find that delicate balance between free radical activity and optimum antioxidant therapy- thus achieving a healthy homeostasis.

The Oxidata™ Test is a technological breakthrough which has been developed by researchers in a major university hospital to help in this important quest. This test measures the distant end of the polyunsaturated fat chain where aldehydes form as a result of free radical attacks. It is particularly valuable because it test urine where aldehyde activity is much more concentrated and therefore can provide a more accurate representation of cell damage.

Neurotransmitters Play a New Role in Health

Monday, August 22nd, 2005

During the past several decades, some people who suffer from depression, anxiety, obesity, migraines, insomnia, obsessive compulsive disorders, PMS, and ADD/ADHD have benefited from pharmacological treatments, including the well known brand name drugs Prozac, Valium, Paxil, Fen-Phen, Imitrex, and Ritalin. On the other hand, some other similarly afflicted people have not experienced benefit or have experienced significant adverse side effects from drug therapies, finding that the promise of drug treatment falls short of relief. Research in neurotransmitter biochemistry during the last 30 years is bringing new hope to many such sufferers.

Nerve cells, called neurons, don’t physically connect with each other but have a gap called a synapse between them. Neurotransmitters, made by nerve cells from amino acids and vitamin and mineral co-factors, are chemicals that relay messages across this gap. By attaching to the receptor sites of neurons, neurotransmitters profoundly affect mood and metabolism. Serotonin, dopamine, norepinephrine, epinephrine (adrenalin), and gamma-aminobutyric acid (GABA) are some examples of neurotransmitters.

Because nerves affect the functioning of all cells in the body, neurotransmitter-related disorders are common. An estimated 84 percent of the population has some degree of neurotransmitter deficiency or imbalance. Prolonged stress, poor diet (especially protein deficiency or malabsorption), genetic predisposition, and some prescription drugs can contribute to neurotransmitter imbalances. For example, antidepressants in the class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Paxil, and Celexa, while often effective in the short-term treatment of depression, have been proved by extensive laboratory testing to cause further lowering of the already depleted neurotransmitters serotonin and norepinephrine when used long term.

For years, the only way that a doctor could manipulate neurotransmitters was by the use of prescription drugs. Occasionally, a doctor would get lucky and hit a home run with a drug that happened to specifically address an individual’s imbalances. However, recent scientific advances in the ability to measure neurotransmitters have taken much of the guesswork out of treating these imbalances, allowing doctors to more effectively address a person’s health problems. Research has also defined what to measure, when to measure, how to measure, and how to go about a nutritional program of conditioning, therapy, and maintenance. A urine sample is the preferred specimen, since obtaining a blood specimen is a stressful, invasive procedure that increases some neurotransmitters. The optimum time for specimen collection is between 9 a.m. and 11 p.m. Optimizing neurotransmitter function is best accomplished by the supplementation of the indicated amino acids and vitamin and mineral co-factors in specific ratios, at specific times of day, and in particular sequences.

Measuring and optimizing neurotransmitter levels provides a cutting edge approach for patients suffering from a variety of ailments. For example, serotonin has an ability to constrict blood vessels. During a migraine, serotonin levels drop significantly, causing blood vessels to dilate, resulting in the intense pain that is so characteristic of these headaches. Once the migraine sufferer’s neurotransmitters are measured, treatments that optimize serotonin production can provide a preventive approach that minimizes both migraine occurrence and thus the need for repeated drugs to treat recurring acute episodes.

Many people who have not yet been diagnosed, but are the “walking wounded,” find themselves less tolerant of stress than they once were, not sleeping as well as they once did, and having mood disorders including depression or anxiety. The physician who suspects and confirms an underlying neurotransmitter-related disorder can often greatly improve the quality of life for such people.

Infraspinatus Respiratory Reflex (IRR)

Monday, August 22nd, 2005

By John L. Wilson, Jr., M.D.

After noting that virtually 100% of his patients with asthma had exquisite tenderness when he palpated (applied pressure to) their infraspinatus muscle (a muscle which attaches to the shoulder blade or scapulae) and is located on the upper back near the shoulder), the curiosity of a physician from Louisiana, Harry Philibert, M.D., resulted in discovering a particularly significant tool in the treatment of asthma and other acute or chronic respiratory ailments. Dr. Philibert has since taught his technique to hundreds of physicians across the nation.

These early observations eventually resulted in determining that the infraspinatus muscle is the location of a special autonomic nerve center which is very significant in respiratory health. The autonomic nervous system regulates body functions that are not under our conscious control or on “auto-pilot”, such as breathing, heart rate, perspiration, dilation or constriction of blood vessels, etc.

Once this nerve center called the Infraspinatus Respiratory Reflex (IRR) becomes irritated, it can become a broadcasting station of sorts, sending distress signals to the paraspinal autonomic ganglia (those autonomic nerves that rundown our spine parallel to the spinal cord). When these signals are received, the result is tightness or spasm of the muscles that regulate air flow in our lungs, resulting in chest tightness, wheezing, coughing, difficulty breathing, etc. Many existing pharmaceutical drug therapies for asthma address the resulting constriction of airways, but stop short of addressing this underlying source of irritation of the autonomic nervous system in the IRR.

If a tender or irritated IRR can be associated with respiratory problems then, theoretically, reducing that irritation could ease the resulting respiratory symptoms. Reduction of IRR irritation is accomplished by the safe and simple injection of the IRR with Lidocaine, a local anesthetic commonly used by dentists and physicians. The duration of the local anesthetic is twenty minutes or so, yet the effects on the autonomic nervous system can last for many months, so the benefits are apparently more than just the pharmacological effect of the local anesthetic. The effect is as if the autonomic nervous system had been reset.

Clinical studies on the effects of IRR injections on a series of over 4,000 asthmatic patients over the course of many years, resulted in substantial improvement of symptoms in approximately 85% of asthmatic patients, in addition to improvement of commonly occurring associated shoulder pain. Approximately half of those patients reported themselves “cured” after a series of injections, stating that they didn’t have symptoms of asthma and didn’t require any medicine.

Although initial speculation was that cigarette smoke exposure resulted in irritation of the IRR, we now suspect that some metabolic conditions and other environmental incitants including chlorine and other chemicals, inhalant allergens including mold, food, food additives, etc. can also result in IRR irritation. It only makes sense to reduce exposure to any identified contributing factors.

Although some patients may experience significant benefit from a single IRR injection, a series of four to eight injections given over a period of many months is more typically administered to produce and/or maintain benefits. The injections are repeated while the infraspinatus muscle is sore upon palpation by the physician, and are stopped when tenderness to palpation is no longer present.

IRR injections are an important tool in the treatment of asthma and the other chronic or acute respiratory conditions including pneumonia, bronchitis, emphysema, chronic cough, as well as some cases of shoulder and neck pain. We have found the injections to be helpful to the majority of patients who have received them as part of a comprehensive treatment plan including environmental controls.

Neural Therapy

Monday, August 22nd, 2005

Too much stress and stimuli (including chemicals, radiation, pesticides, drugs, etc.) has overtaxed humans’ life preserving regulating mechanism–the autonomic nervous system. The autonomic nervous system is the vast network of the nervous system which is not subject to the will. The total length of its micro fibers is twelve times the circumference of the earth. The autonomic nervous system controls such activities as breathing, circulation, body temperature, cellular respiration and waste removal, activities of digestive glands, metabolism, hormonal formation and distribution, etc.

Neural therapy is a name given to a therapy by injection which effects the autonomic nervous system. It was discovered, as many valuable medical treatments are, by serendipity, by two German brothers, Drs. Huneke, in 1925. Neural therapy is a holistic treatment which can eliminate autonomic regulatory dysfunctions be reestablishing normal electrical conditions in nerves and the tissues supplied by them. Neural therapy can restore regulation through the injection of local anesthetics either on the skin superficially, creating a slight bubble or wheal on the skin, or occasionally injected deeper into other indicated tissues. It can be used to treat a wide variety of symptoms, including pain of most varieties, chronic headaches, neuralgia, rheumatism, sciatica, lumbago, inflammations of the joints, disorders of the middle ear such as partial deafness, eye disease, eczema, lower abdominal disorders, certain cardiac disorders, asthma, enlarged prostate, gastric disorders, and disorders of the liver and gallbladder.

The extremely fine endings of the autonomic nervous system fibers and blood vessels (capillaries) terminate in the fluid that surrounds every cell, and it is here where all vital functions in the body occur–cell respiration, energy balance, metabolism, temperature regulation, etc. Inflammatory conditions, injuries, bacterial infections, foreign bodies and scars can produce disturbances in this crucial regulating system. Every cell in the body is a tiny battery with a charge of 40-90 millivolts. One can think of an injured or affected cell as acting like a radio transmitter, transmitting false information to the body. This disturbance can also be likened to a burned out fuse in the basement which causes a malfunctioning light bulb, even though the light bulb itself is normal.

Such interference fields can place the entire human body under strain far beyond the immediate vicinity of the original disturbance. Hence a scar on one’s abdomen can be a cause of acute or chronic ankle pain or gallbladder dysfunction or poor equilibrium or virtually any symptom, depending on that individual’s inherited or acquired weaknesses. Studies have found differences in the two sides of the body resulting from such interference fields, reflected in differences in temperature, blood flow, electrical resistance of the skin and bio-electric potential. All of these parameters returned to normal after elimination of the interference field by skillful injection of procaine as taught by the Huneke brothers.

For example, a typical scenario of dysfunction can start with a simple back strain. The resulting pain produces muscle spasm, so blood flow is compromised to that area of the back. Waste products of those cells cannot be transported to the organs of elimination, so toxins build up, creating more one-sided swelling and pain, which can cause displacement on the vertebrae, eventually causing severe sciatica. Insomnia can result from the now chronic condition, and drug therapies for pain or inflammation can increase the work for the organs of detoxification which are already stressed. One can easily understand the vicious cycle of such a scenario. Neural therapy can intervene in this situation, effectively resetting the body’s autonomic nervous system to once again function properly and effect a cure.

Any cell in the body is capable of producing an energetic interference, as evidenced by the fact the ten individuals with the same clinical diagnosis will likely have ten different and unique focal disturbances causing their common maladies. So the skilled interview by a neural therapist of an observant patient can hasten the likelihood of successful neural therapy. A chronological review of events including tooth extractions, tonsillectomies, injuries, war wounds, sports injuries, any trauma, scars, fractures, pregnancies, chronic infections, any surgeries, puncture wounds, etc. can be invaluable to pinpoint the most likely causation of dysfunction. Neural therapy is safe and relatively free of side effects, but will only be effective when the proper focal disturbance is identified.

Some conditions cannot be expected to respond to neural therapy either at all or when a primary disturbance in the autonomic nervous system is not causative. These include: Mental illness, emotional disease, deficiency diseases, parasitic infestations, hereditary or genetic diseases, neurological diseases involving scarring such as Parkinson’s Disease and Multiple Sclerosis, and cancer (cancer cells become disconnected from the autonomic power grid and thus is not amenable to treatment by neural therapy, though treatment can be directed to removing the noxious stimuli which led to the autonomic nervous system dysfunction). Cortisone, tranquilizers and sleeping pills taken long term inhibit the body’s ability to respond to many therapies, including neural therapy.

Possible adverse effects of neural therapy should be mentioned, though they are not serious and temporary. Some local discomfort at the site of injection may be noted and is experienced differently by different people. Becoming dizzy (after any treatment involving needles) may occur and is temporary and harmless. The patient is advised to remain lying for a short time after a treatment, and assess their ability to drive before leaving the clinic and doing so. Inasmuch as cellular detoxification is enhanced when tissue function is restored, symptoms of toxicity (aching, headaches, fatigue, etc.) may occaionally be noted as cellular toxins are released into general circulation for eventual excretion from the body. Treatment of this temporary toxicity can be accomplished by treatments which facilitate detoxification including: Vitamin C, massage, mild exercise as tolerated, drinking adequate water, rest, and possibly a mild analgesic, though even over-the-counter analgesics further stress your liver’s detoxification burden. Some people are allergic to various “caine” drugs–local anesthetics–and often manifest in a local itchy skin rash. We find that many reported adverse reactions to “-caine” drugs are in fact reactions to the preservatives that are part of many of them. Patients should report a known sensitivity to novocaine, lidocaine, etc. to their physician and the selection of a different substance for neural therapy will be made in their situation.

The positive effects of neural therapy can be immediate or delayed. The patient is advised to report the duration of the effect of a neural therapy treatment to the physician on a return visit, and to report any change which has occurred in the interim. This will be most valuable in helping your physician help you. Of course, not every neural therapy session hits the bull’s eye on the first attempt, and the patient is well advised to have patience and persevere. Even a treatment which has failed to produce relief of symptoms is valuable to the physician, as a progressive search and elimination process may lead to the correct site of treatment. Rarely, one treatment will be all that is required; more often, a series of treatments will be necessary to restore normal function.

In summary, neural therapy is a safe treatment which, in a review of 25 practitioners treating 639 cases, resulted in 34% cures, 37% substantial improvements, 14% improvements, and 15% failures.

Nutrients Slow Rate of Macular Degeneration

Monday, August 22nd, 2005

It seems that scientists are continually rediscovering that nutrition can affect health.

A recent clinical trial by the National Eye Institute reported in the journal Archives of Ophthalmology, October 2001 found that supplementation of vitamins and minerals slowed vision loss associated with intermediate and severe age-related macular degeneration (AMD) by 25%. The six-year long trial involved 3,600 participants aged 55-80 at high risk for AMD. One group was administered 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta-carotene; 80 mg of zinc and 2 mg of copper daily. Other groups took only antioxidants, only zinc, or a placebo.

90% of AMD is called “dry” AMD and it occurs when the deterioration of light sensitive cells in the back of the eye results in vision loss. In the less common “wet” variety of AMD, blood and fluid seep into the tissues in the back of the eye between the retina and the blood vessels behind it. The resulting scarring affects the retinal nerve supply and results in loss of central vision. AMD is the leading cause of blindness in an aging population. An estimated 2 million Americans have AMD.

Additional studies also suggest that there are other nutrients that likely have even greater effectiveness in the treatment of AMD. These include selenium, lutein, zeaxanthin, DHA and EPA, and vitamin B12. Selenium is a powerful antioxidant. Lutein and zeaxanthin are naturally occurring yellow pigments called carotenoids that are abundant in the retina. They are abundant in egg yolks, kale, collards, and swiss chard, but can be taken as a dietary supplement. DHA and EPA are essential fatty acids that are rich in fatty fish such as salmon or mackerel and are critical for eye health. Vitamin B12 offers important nutritional support for the nerve supply to the eye. Use caution when choosing nutritional supplements. I have found that less expensive look-a-likes may be of questionable quality that appeal to a consumers who have no way of assessing their quality. Buyer beware.

Since it is difficult to obtain adequate nutrients in food grown on soil depleted by non-organic farming, I suggest the following for sensible dietary support for AMD: an abundance of fresh organic vegetables in the diet, blueberries and blackberries that are rich in beneficial proanthocyanadins, 3-4 meals of fatty fish per week, drinking about 3 quarts of water per day if not on medical restriction of fluids, in addition to eliminating sugar, margarine and other hydrogenated oils, and chemical additives from the diet.

Avoidance of direct sunlight in the eye by wearing sunglasses with ultraviolet protection may be of benefit, as are stopping smoking and tight control of diabetes. Regular dilated eye exams are recommended for those with loss of vision or for anyone over age 55.

Interestingly, a similar clinical trial on the impact of nutrients on cataracts, a clouding on the lens of the eye, found no benefits in nutrient supplementation. In my experience, the use of the antioxidants glutathione and superoxide dismutase are effective in reducing cataracts in some individuals when supplied by eye drops. This is likely because it is difficult to get nutrients to the cataract through nutrients taken by mouth as the lens has a poor blood supply, especially in an aging population.

Just Say No to NSAIDs

Monday, August 22nd, 2005

The easy availability of over-the-counter and prescription drugs classed as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) combined with the increase of chronic degenerative diseases in our nation make it a strong likelihood that any individual, especially as they age, will utilize NSAID therapy to treat pain and inflammation. NSAIDs include aspirin, plus numerous other over-the-counter and prescription drugs such as Ibuprofen, Feldene, Motrin, Advil, Indocin, Orudis, Aleve, Naprosyn, etc.

Well-known side effects of NSAIDs include gastrointestinal ulceration and liver toxicity. (Do not drink alcohol while on NSAIDs treatment.) The statistics are impressive.

  • More Canadians bleed to death from NSAID use than from gunshot wounds.
  • The annual use of aspirin in the US is estimated to exceed ten thousand tons.
  • Between an estimated 10,000-20,000 people die annually from NSAID use.

The average cost of an uncomplicated gastric ulcer hospitalization is $15,000. For active, concurrent ulcers the cost averages $86,000.In light of the fact that 70 million prescriptions for NSAIDs are written every year in the US, it is suggested that over $100 million are spent treating this one side effect of NSAID use annually.

This does not include the more insidious but equally significant and costly complications of NSAIDs such as those disrupting adequate absorption of nutrients which profoundly impacts health over time. NSAIDs enteropathy masquerades as inflammatory bowel disease, which leads to changes in the permeability of the intestines, thereby encouraging malabsorption, food allergy and bleeding.

NSAIDs act by blocking the effects of a natural substance produced by the body called Prostaglandin 2 (PGE2) which promotes inflammation in the body. Unfortunately, this blocking action is not very discriminating, as NSAIDs also block the effects of Prostaglandins 1 and 3 (PGE1 and PGE3) which are powerful anti-inflammatory substances produced by the body. This lack of selectivity of drug action is responsible for the effects of long term chronic use of NSAIDs: increased pain and inflammation. Chronic NSAID use results in increased pain and inflammation because their use blocks the body’s ability to treat inflammation with its own internal pharmacy.

Many biochemists rate the importance of prostaglandin synthesis as the single most important factor determining occurrence of degenerative illnesses including but not limited to: arthritis, diabetes, asthma, gastrointestinal ulceration, cancer, schizophrenia, learning disabilities, and virtually any medical condition ending in the suffix “-itis” which is Latin for inflammation.

Understanding this action of NSAIDs allows one to opt instead for therapies which promote the production of the body’s own anti-inflammatory PGE1 and PGE3 as a strategy to block inflammation instead of inhibiting our natural anti-inflammatory pharmacy. Knowing how prostaglandins are formed leads to potential solutions . . . read on.

Prostaglandins are produced as a direct result of eating Essential Fatty Acids (EFAs). EFAs are called essential because they cannot be manufactured by the body as are all other fats are including cholesterol, triglycerides, monounsaturated fats, etc. We must depend on external food sources for essential oils.

There are two types of EFAs: Omega 3 and Omega 6. The synthesis of our natural anti-inflammatory PGE1 results from the intake of Omega 6 oils, and is most easily promoted by eating Evening Primrose Oil (EPO). The synthesis of our natural anti-inflammatory PGE3 results from the intake of Omega 3 oils. Flax seed oil and fish oils (EPA and DHA) are rich in Omega 3 fats and therefore promote PGE3 formation.

The recommended ratio between Omega 6 and 3 oils for health maintenance is roughly 4-8:1, respectively. Other ratios are used therapeutically for shorter periods of time and/or for specific clinical situations or documented need based on EFA analysis-a blood test which measures levels of greater than forty individual fatty acids.

Food sources of these delicate, beneficial EFAs include raw, unroasted seeds (sunflower, sesame, flax, poppy, and pumpkin seeds) and unroasted nuts (walnuts, almonds, pistachios, brazil nuts, cashews, pecans, macadamias, filberts,) and their oils, in addition to fish and their oils. EFAs occur in other cold pressed oils such as corn, safflower and soy to some extent.

Unfortunately, modern oil extraction methods destroy these heat-sensitive oils. Due to their tendency to become rancid quickly, they are virtually stripped out of foods in our supermarkets in deference to long-lived but harmful fats including trans fatty acids and hydrogenated oils which have very long shelf lives: margarine, shortening and most commercial vegetable oils.

GSMC has carefully selected from the highest quality oils available on the market and have chosen Omega, Flora, or Efamol brands. We also use Cardiovascular Research, Allergy Research Group and Thorne Research brands for other selected oils. Freeze these oils until opened, then refrigerate after opened. If you take oils in gel caps, taste the contents of the caps weekly to be certain they are not rancid. Ingesting high quality oils is so critical that this is one instance where we ask you to use the specific products we recommend or their exact duplicates from another source. Taking poor quality, rancid or damaged oils will in fact promote inflammation.

Elevated levels of the pro-inflammatory PGE2 can be identified through EFA analysis, a blood test available at GSMC. Elevated PGE2 levels can be lowered in three ways. First, by correcting deficiencies of the nutrients Vitamin B3 and B6, zinc and magnesium which, when present in adequate amounts, limit the production of PGE2. Second, by limiting intake of eggs, beef, pork and shrimp as they are high is arachidonic acid which converts into PGE2. And third, by eating sesame oil or sesame seeds which can be effective in decreasing PGE2.

The optimal functioning of our cells depends on the ability of our cells to create energy. Using a car engine as an analogy, the presence of the spark of energy that occurs in an engine is critical to an engine’s performance and depends on the spark plug, the proper gap, delivery of the fuel from the carburetor, properly functioning valves, and timing. If any part of the energy production is not working right, your engine will miss and may stall or die. Similarly, each cell’s ability to make energy depends on optimal supply and timing of vitamins, minerals, fats, protein, carbohydrates, enzymes, neurotransmitters, and ultimately, the vital “spark” of energy produced from all of the above. Disruption of this “spark” of energy leads to the chronic illnesses of our modern world-heart disease, arthritis, hypertension, diabetes, etc.

Strive to address the following known factors which can disrupt the formation of that critical spark of energy :

  • the ingestion of harmful fats (especially trans fatty acids),
  • chronic infections (including dental) and infestations (parasites, etc), · nutritional deficiencies characteristic of modern Western diets,
  • heavy metal toxicity,
  • chronic alcohol ingestion and tobacco use, drug exposure (especially NSAIDs, steroids, and antibiotics)
  • chemical exposures including pesticides and solvents,
  • insufficient digestion,
  • malnutrition (notably sugar excess), and
  • chronic stress.

Reduction of inflammatory symptoms via nutritional intervention may take weeks to months as one replenishes EFA deficiencies.

In summary, NSAID use presents serious risks and inhibits the production of beneficial anti-inflammatory prostaglandins whose presence is critical to health. Identification and removal of the true causes of inflammation is the optimal therapy. EFA and adequate nutrient intake are two well tolerated and safe ways to naturally favor one’s internal anti-inflammatory pharmacy, as is the avoidance of less healthful altered fats such as hydrogenated oils (margarine and shortening) and commercially processed oils which interfere with the production of the spark of life itself.

Chronic Sinusitis

Monday, August 22nd, 2005

By John L. Wilson, Jr., M.D.

Sinuses are hollow cavities in facial bones that are connected to nasal passages by narrow tubes that allow drainage. Sinuses help moisten, filter and warm the air we breathe. Symptoms of sinusitis (inflammation of the sinuses) may include a feeling of pressure, congestion and pain in the face particularly when bending over, headaches often just above or below the eyes, bad breath, fatigue, fever, toothache in upper jaw, post nasal drip, cough, and colored thick nasal secretion. Sinusitis becomes chronic when it lasts longer than 12 weeks. Antibiotics are prescribed in 84% of physician visits for sinusitis. In addition, decongestants, antihistamines, pain relievers, expectorants, and surgery are commonly prescribed to help patients obtain relief of their symptoms in the 46 million physician-visits annually for sinusitis.

Sinuses are lined by mucous membranes that can be sensitive to environmental exposures, including chemicals, fumes, smoke, pollens, animal danders, dust, dust mites, molds, and changes in atmospheric pressure, humidity, and temperature. Once irritated, the lining produces mucous in an effort to separate the irritant from the mucous membrane. The tissues become inflamed and swell, resulting in blocking the drainage of mucous from the sinuses and the stage is set for infection to develop. Serial Dilution Endpoint Titration, a method of allergy skin testing, can identify such allergic triggers, and sublingual (under the tongue) allergy serum is used in place of allergy shots to desensitize to those allergens. Neural therapy, a German form of acupuncture, as well as traditional Chinese acupuncture can be used to reduce the swelling and congestion of sinus membranes. Irrigating the nose and sinuses with a weak saline solution can be soothing and helpful in easing reactions to environmental triggers such as mold and dust. Allow the saline solution to flow passively-never use forceful irrigation. Adding a weak anti-microbial silver solution or antifungal drug such as nystatin to the irrigating saline solution can be helpful.

A recent study by Mayo Clinic found that 93% of sinus infections are caused by fungal infections, which makes sense as fungus or mold prefers a moist, dark, unventilated environment. Treating a fungal infection with antibiotics, which kill bacteria, can actually make a fungal infection worse. Instead, addressing the sinusitis with a decrease in dietary sugar intake, environmental control of molds, and antifungal herbs or drugs may likely be more successful.

Both indoor and outdoor air pollution can contribute to sinusitis. So much is known and apparent in the media about outdoor air pollution, that the fact that indoor air is often more polluted than outdoor air is forgotten. Wherever chemical exposures come from, one’s exposure can often be determined by identifying one’s work or home exposures. Although avoidance is the preferred treatment to the problem of poor air quality, HEPA air filtration and masks can be very helpful when avoidance is not possible. Air filtration is especially important and effective in the bedroom where most people spend roughly a third of their lives.

Imbalances in the microbes living in the intestine (overgrowth of yeast or harmful bacteria, or lack of beneficial healthy bacteria) can also contribute to sinusitis by stressing the immune system. A stool test, Comprehensive Digestive Stool Analysis, identifies such imbalances. The use of antifungal herbs and drugs can be used when combined with dietary sugar reduction and other steps to improve the quality of the diet. Boosting the immune system with nutritional supplements such as Vitamin C, transfer factor, thymus, or herbs such as Echinacea, Goldenseal, or Astragalus can also be helpful.

One of the hidden causes of chronic sinus congestion is food allergy. Many people will develop sinus symptoms as a result of an allergic reaction to foods-especially dairy products, wheat, corn (including corn starch, corn sugars, etc), or yeast. Adverse reactions to foods are often “masked” so the sinusitis sufferer is clueless to what may be keeping them sick. Click on Elimination/Challenge Diagnostic Diet for a simple at-home method for testing food allergies.


Monday, August 22nd, 2005

Hypoglycemia, literally translated as “low blood sugar”, was first described in 1924, though it was called hyperinsuliism at that time. It can be definitively diagnosed by a 4 hour Glucose-Insulin Tolerance Test (GITT), which consists of giving a fasting patient a prescribed amount of glucose, then measuring blood sugar and insulin levels at specified intervals. A 4 hour GITT is considered the state-of-the-art method for early detection of glucose/insulin regulation abnormalities. The condition can be diagnosed clinically through a high degree of suspicion by a knowledgeable physician obtained through careful history taking and response to an appropriate trial of treatment. Symptoms characteristic of hypoglycemia include, but are not limited to: weakness, irritability, internal trembling, palpitations, mental confusion, perspiration, mood swings, ravenous hunger, faintness, obesity, feelings of going crazy and sweet cravings. Hyperinsulinemia is a preferred term to hypoglycemia, inasmuch as the term “low blood sugar” brings to mind the possibility that one needs more sugar, while hyperinsulinemia brings to mind the possibility that one needs to make less insulin. The latter is more appropriate as it addresses the cause of low blood sugar.

The inability of the body to maintain a more constant blood sugar level without fluctuating highs and lows is caused by many influences. Over-processing of foods and the resulting excess amount of refined carbohydrates (all refined sugars. corn syrups. white flour, white rice. sodas. etc.) and the resulting nutrient depletion in the diet is the major cause of hypoglycemia in the United States. This denatured diet contributes to a fluctuating blood sugar by overtaxing the pancreas, which is then stimulated to produce more and more insulin in response to rising blood sugar levels. Insulin is a hormone secreted by the pancreas which allows the blood sugar glucose to be used as energy in our cells. Complex carbohydrates such as whole wheat, brown rice, oats, potatoes–foods that have not had the nutrients and fiber stripped out of them by refining–are converted into glucose more slowly than refined carbohydrates, but nonetheless are all converted to glucose. The resulting roller coaster of high and low blood sugar is in motion, and you can’t get off until you figure out how to break this vicious cycle.

Other factors contributing to hypoglycemia are:

  • Stress. Stress, whether physical, emotional, or environmental, results in a physiological response from your body which utilizes nutrients and can deplete our stores of vitamins and minerals quite quickly. Adrenalin is the “fight or flight” hormone secreted by the cortex of the adrenal gland and is secreted when our blood sugar gets too low as adrenalin mobilizes a stored form of glucose called glycogen as an emergency measure to correct low blood sugar. Adrenalin is responsible for many of the symptoms of hypoglycemia–tremors, rapid heart beat, hunger, etc. Insulin and adrenalin are both stress hormones, and thus are elevated during increased stress.
  • Nutrient deficiencies contribute to hypoglycemia. We especially see chromium, pyridoxine, zinc, magnesium, niacin and Pantothenic acid deficiencies contribute to the likelihood of low or fluctuating blood sugars. Dimethylglycine (DMG) taken sublingually can be of great help in dealing with symptoms of low blood sugar quickly. Brewer’s yeast is an excellent source of trace minerals which help one’s body cope with hypoglycemia
  • Drugs and beverages containing caffeine (coffee and sodas mainly) contribute greatly to hypoglycemia, by stimulating the adrenal glands, thereby encouraging the liver to release glycogen, the body’s stored form of glucose, into the circulation. (Note that the symptoms listed above are very similar to caffeine overdose.)
  • Undiagnosed allergies to any food, but especially to corn and its by-products, can contribute to hypoglycemia also.
  • Alcohol can contain significant carbohydrate such as beer or wine and is often served with fruit juices, sodas or ice cream and can thus cause rapid rising (and subsequent falling) of blood sugar. Those who use alcohol to excess chronically often suffer from severe nutritional deficiencies.

As one might speculate from reading about the causes of hypoglycemia, it is a nutritional illness and its treatment is thus nutritionally based. Choices in diet exist which are palatable and very effective in managing the symptoms of hypoglycemia, at the same time reducing the stress on the body and allowing it to heal. Generally, one can follow the diet recommended in the handout Pro-Metabolic Nutrition available from the Medical Center. Some additions, clarifications and comments will be made here to aid in your understanding and success in reclaiming your health.

The frequency of eating needs to be increased. You are advised to initially eat several small “meals” daily. This avoids drops in blood sugar and the symptoms resulting from it. Generally five meals per day are indicated, although some may consider three of these meals to be snacks. Skipping meals is experienced by a person with low blood sugar as fasting and greatly increases symptoms. Avoid fasting.

The key to success in treating hypoglycemia is to avoid all refined or simple carbohydrates and the foods they are in–candies, cakes, cookies, ice cream, white breads, white rice, sodas, etc., and a reduction of complex carbohydrates such as bread, potatoes, pasta, biscuits, cereals, etc. All forms of sugar, including honey, corn syrup, fructose, glucose, mannitol, sorbitol, molasses, dextrose, malt, cane sugar, beet sugar, lactose, sorghum, maple syrup, syrups, date sugar, brown sugar, turbinado, etc. are prohibited. Avoid processed foods which contain these forms of sugar. Eat these foods and you win a non-stop ticket on the roller coaster of rising and falling blood sugars. Avoidance means you will have to read food labels. For instance, “100% natural” is not reassuring to someone who must avoid sugars–most sugars are refined from natural sources. If you return to a diet high in refined or complex carbohydrates, you can expect to recreate the same situation from which you once sought relief.

Artificial sweeteners may aggravate symptoms of hypoglycemia due to the fact that a sweet taste on the tongue, and not only a high blood sugar level, can cause the pancreas to secrete insulin into the bloodstream, and due to the fact that they are chemical stressors that need detoxification. Detoxification requires the presence many nutrients, so can deplete nutrients over time. The pancreas can be tricked by the mere taste of sugar and reacts in the way it is programmed to, and that leaves some sensitive persons plummeting on that roller coaster once again. Avoid foods and beverages that are artificially sweetened. Read the supplemental information on Nutrasweet available from the Medical Center. Stevia is a natural sweetener which is available at the Medical Center and health food stores. Once you get off the roller coaster, your taste and cravings for that sweet taste will likely lessen and “real” food without refined sugars can taste unbelievably sweet and flavorful.

Avoid overeating. Overeating, regardless of the content of the food, stimulates the production of insulin, as a result of stretching the stomach. Continued overstimulation of any gland or tissue leads to eventual inability of that gland or tissue to function at normal levels-inability to function.

Although fresh fruits are a source of fiber and nutrients, they simply contain too much sugar for those trying to find relief from hypoglycemia. Fruit juices are prohibited as they contain too much sugar and will undermine success. Initially avoid all fruit which trying to rest the pancreas and adrenal glands. After symptom relief is attained, you may try introducing very small quantities of less sweet fruits. Eat only fresh and whole fruit. Slightly green fruits don’t contain as much sugar as rip or overripe fruits. Cranberries, limes, lemons, cherries, and berries in general are not as sweet as others. Avoid dried fruits, as their sugars are concentrated through drying.

Protein either from animal or vegetarian sources needs be eaten as a beneficial part of a diet for hypoglycemia, inasmuch as protein does not contribute greatly to excess blood sugar. Protein is necessary for the maintenance and repair of our tissues. Balance this animal protein with ample amounts of “leaner” vegetables such as asparagus, broccoli, cauliflower, romaine, spinach, bok choy, green beans, radishes, mushrooms, turnips, etc. These are nutrient dense foods needed to compensate for the nutritional deficiencies characteristic of the Standard American Diet (SAD).

Fat is an essential part of the diet necessary to heal from hypoglycemia, inasmuch as it is a source of calories that does not contribute to insulin or adrenalin excess. Essential fatty acid depletion is characteristic of the SAD and its repletion is necessary to recover from hypoglycemia Refer to Pro-Metabolic Nutrition available from the Medical Center for further information on the avoidance of “bad” fats and definition of healthful fats.

Lastly, don’t think of yourself as having a disease. Your body is simply doing what it is designed to do, miraculously so, and it is not the problem. The problem is that your body is receiving a low octane fuel (sugar), when it is designed to run on high octane (fat). This situation is more similar to a poisoning than a disease. Remove the cause and enjoy improved health.

Syndrome X (Hyperinsulinemia)

Monday, August 22nd, 2005

All hormones including thyroid, testosterone, insulin, growth hormone, melatonin, cortisol, etc. are powerful regulators of the body’s metabolism and cellular functions. It has been observed that hormones can cause health problems when occurring either in deficient or excess quantities. For example, when thyroid hormone is deficient, depression, dry hair, dry skin, constipation, lassitude and weight gain may occur. When thyroid hormone occurs in excess, anxiety, heart palpitations, moist skin, and inability to gain weight may result. It is a most curious observation that until very recently, no one has considered the effects on human health of excess insulin secretion, even though the deficiency of insulin, diabetes, has been recognized for decades. This is because the effects of elevated insulin levels are often silent for years.

Insulin is a hormone secreted by specialized cells of the pancreas. One of insulin’s main functions in human biochemistry is to transport blood sugar (glucose) across the cell membrane to ultimately be burned as fuel in the energy making part of the cell called the mitochondria. This function of insulin is critical to human health, as evidenced by Type I Diabetes, a condition in which the pancreas is unable to produce insulin-the affected person must take insulin by injection. However there are other lesser known but very important effects of insulin in human biochemistry that will be addressed in this article.

In a 1988 article in the journal Diabetes, Dr. Gerald Reaven of Stanford University, described a cluster of metabolic disorders, including but not limited to adult onset diabetes, typically found in association with insulin resistance. The term insulin resistance implies the inability of insulin receptor sites on one’s cell membranes to take up insulin, whether that insulin is secreted by the pancreas or taken by injection. He dubbed this cluster Syndrome X.

In order to understand what happens when someone becomes resistant to insulin, we must review the role insulin and its balancing hormone, glucagon, play in the body. When we eat, our bodies break down the food into its basic components – protein (amino acids), carbohydrate (glucose), fat (fatty acids), which are then absorbed into the bloodstream. It is important to realize that carbohydrate has a far greater effect on raising blood sugar (glucose) than fat or protein. A rise in blood sugar signals the pancreas to make and release insulin. Insulin secretion should promptly return blood sugar levels to a normal fasting level within two hours after eating. This occurs as insulin transports glucose out of the blood stream, across the cell membrane, and into cells where it is either burned for energy, stored as fat in fat cells or stored as glycogen (a storage form of glucose) in muscle. Fat travels in the blood in the form of a molecule called triglyceride. A triglyceride is composed of three fatty acid molecules. When a triglyceride in the blood reaches a cell, enzymes at the surface of the cell break down the molecule and the fatty acids can enter the cell. Once inside the cell, an amino acid, L-carnitine helps shuttle the fatty acids into a fat burning factory inside the cell called the mitochondria. Although fat is able to enter the cell without using insulin to transport it like glucose must, insulin blocks this fat-carnitine system and thereby keeps the fat from entering the mitochondria where it would be burned for energy production. Insulin pushes the fatty acids back into triglycerides and out of the cell encouraging the storage of fat in adipose (fatty) tissue. In short, excess insulin directly creates obesity.

When there is no insulin secretion (as in Type I Diabetes) blood sugar rises dramatically and glucagon activity is unopposed by insulin, allows fat to pour into the blood stream. This fat has to be burned in the body’s back-up fat burning system in liver cells. The end result of this “default” process is the production of excessive amounts of acidic ketone bodies, a by-product of fat burning in the liver. Diabetic ketoacidosis, a life threatening condition may result. (It should be noted that while diabetic ketoacidosis is a serious problem, the mere presence of ketones in the blood in a non-diabetic, simply called ketosis, is not serious and in fact provides proof of fat burning for dieters.)

Years of high dietary carbohydrate intake, especially in genetically predisposed individuals, stresses insulin receptors which in turn malfunction. The normal amount of insulin then cannot maintain a normal blood sugar, and the body must then produce more and more insulin to keep blood sugar in the normal range. This higher level of insulin can often control blood sugar levels adequately, at least for a while, but the other lesser-known effects of insulin now come into play. These effects include:

* encouraging storage rather than burning of fat, thus leading to obesity
* enhancing the synthesis of cholesterol, especially LDL, increasing the risk of vascular disease
* thickening arterial walls making blood vessels more stiff leading to increased blood pressure and increased risk of vascular disease
* retention of sodium (salt) and fluid with subsequent rise in blood pressure
* increased secretion of norepinephrine increasing blood pressure as well as pulse rate.

These effects explain all the abnormalities Dr. Reaven described in his article on Syndrome X years ago.

Some individuals will eventually lose the ability to keep their blood sugar levels normal even in the presence of very high levels of insulin. This is the cause of adult onset, Type II or non-insulin dependent diabetes. This type of diabetes when treated early can be completely controlled with dietary intervention and need never lead to dependence on blood sugar lowering pills or insulin injections. Controlling Type II diabetes by diet can also prevent, to a large degree, many complications of the disease. These include heart disease, peripheral vascular disease (which can lead to amputation of extremities), peripheral neuropathy (burning and numbness in the hands and feet), retinopathy (which can lead to blindness) and kidney disease.

Some insulin resistant individuals may never lose enough control over blood sugar levels to be considered diabetic. These individuals represent another population group at risk for Syndrome X: American adults in their 40’s, 50’s and 60’s who may feel well, yet have elevated insulin levels which, unfortunately are rarely measured at screening exams. Their elevated insulin levels put them at much higher than average risk for high blood pressure, obesity, heart disease, elevated triglycerides and “bad cholesterol” (LDL). The sooner a problem with insulin resistance or excess insulin is diagnosed, the sooner it can be remedied with appropriate dietary changes. It is for this reason that glucose tolerance tests (GTTs) (which measure blood glucose response to carbohydrate ingestion) are inadequate for assessing the risk of diabetes.

Years before blood sugar measurements are clearly abnormal, the problem that leads to Type II diabetes can be diagnosed by measuring an individual’s blood insulin response to carbohydrate ingestion, a glucose/insulin tolerance test (GITT). Such evaluation is indicated in anyone with a family or personal history of high blood pressure, obesity, diabetes, heart disease, vascular disease in the legs, cerebrovascular disease, high blood triglycerides or cholesterol. It is important to remember that someone having elevated insulin levels in response to carbohydrate ingestion need not have all the side effects associated with high insulin levels. Because we are each individually unique, one person may only have high blood pressure and fluid retention, another may only have obesity and high triglycerides. They may look different and feel different from each other and yet the underlying cause of their problems may be the same. Likewise, not everyone with high blood pressure or high cholesterol or obesity has insulin resistance. The only way to know is to be tested.

Government figures released in 1994 indicate that despite reduced consumption of fat, the incidence of Americans who are significantly overweight jumped by 30% in one ten year period. This should be a hint that decreasing fat in the diet is not the answer for being overweight. The information reviewed above reveals that for those whose obesity is related to elevated insulin levels (hyperinsulinemia), the solution is to drastically reduce carbohydrate in the diet since carbohydrates stimulate insulin and suppress glucagon.

(Glucagon, the other hormone secreted by the pancreas, stimulates the opposite effect of insulin: the movement of fatty acids out of adipose tissue and into the mitochondria for burning.)

Interestingly enough, even for those who are not insulin resistant but want to lose weight and keep it off, decreasing carbohydrate intake is still necessary. Long ago in the history of man, it was probable that weight loss stimulated activity of an enzyme, LPL, which was protective against starvation. Weight loss via dieting in modern times still stimulates this enzyme and encourages the storage of fat. We are well designed for famine, but poorly designed for affluence. In our presently over-fat society this is a metabolic reality that makes it easier to re-gain weight shortly after it is lost. Therefore, no matter what approach someone takes to losing weight, they need to do whatever they can to suppress this enzyme activity. This is accomplished by three strategies:

* Eating meals lower in carbohydrate and richer in fat and protein
* Eating protein to supply amino acids which stimulate glucagon production (a reason to have adequate fat and protein in every snack)
* Stimulating norepinephrine activity by exercise, which in turn stimulates glucagon production. Exercise is important in controlling obesity, hypertension and elevated blood fats.

A metabolic evaluation to define glucose/insulin tolerance is necessary for anyone with a family history of diabetes or any of the health problems mentioned above that are associated with hyperinsulinemia.

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