Is Fructose Really That Bad For You? (Ronald Hoffman, MD)

I remember a time in the 70s and 80s when I was just getting started in the field of nutrition when fructose was considered a harmless sweetener for diabetics. Marketed as “diabetic sugar,” fructose syrup was dispensed in clear plastic containers and consumed with impunity by persons with blood sugar problems.

The embrace of fructose as an alternative to glucose was fostered by the observation that it evoked a lower blood sugar response than other sweeteners. Fructose was found to have one of the lowest glycemic index (GI) values—20, as compared to glucose, and its disaccharide maltose—100 and 105 respectively.

One putative advantage of fructose was that it seemed to get “under the radar” of the body’s insulin responses. Fructose—unlike sucrose, glucose, malt sugars and starches—not requiring insulin for its metabolism, did not appear to stoke the insulin surges which could lead to insulin resistance, a pathway to metabolic syndrome and Type 2 Diabetes.

This led the American Diabetes Association to endorse fructose as a preferable alternative to other sugars from 1979 to 2001—albeit with a caution about high intakes.

All this changed in 2004 with the publication of a landmark review—one of the most frequently cited in nutrition literature—entitled “Consumption of high-fructose corn syrup beverages may play a role in the epidemic of obesity.”

Read rest of article.


Source: Integrative Health Network: Ronald Hoffman, MD

Stop Osteoporosis!

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Source: Integrative Health Network: Jonathan Wright, MD

Histamine intolerance: A new way of looking at allergies

By Ronald Hoffman, MD

Do you have allergies? Sneezing, wheezing, burning eyes, or flushing, itchy skin with hives? Do certain foods trigger stomach cramps or diarrhea? Or do you suffer from frequent headaches or migraines, bouts of nausea, severe menstrual cramps, or panic attacks characterized by a racing heart?

You’ve dutifully tried allergy shots—sometimes for years!—to no avail. Antihistamines work for you, but only partially. Food allergy tests keep coming up negative. There seem to be no clear dietary precipitants—your food reactions seem to be all over the map. But your doctor insists your allergy blood tests and skin tests don’t come up positive for foods. Still, you try popular gluten-free, dairy-free or candida diets, but they only make minor dents in your symptoms.

The answer may lie in a new understanding of something called histamine intolerance. Histamine, of course, is what antihistamines are supposed to suppress. Histamine is part of our bodies’ natural response to insults or invaders. It prompts blood vessels to swell and fluid to leak from capillaries, causing swelling. Think of the itching you get at the site of a mosquito bite, in response to the foreign proteins deposited by the insect’s saliva.

Histamine intolerance is actually a “pseudo-allergy,” which is why it’s not picked up by conventional allergy blood tests that measure IgE. It results when histamine levels soar in the body.

To use a bathtub analogy, there are two ways a tub can overflow: 1) If the faucet is turned on too high, or 2) If there’s a stopper in the drain. It’s the same with your body. If either occurs, or both simultaneously, your allergy “tub” can overflow, resulting in symptoms of histamine overload.

The discovery of an enzyme called diamine oxidase (DAO) has helped to unlock the key to histamine intolerance. DAO is normally present in the intestine to control excess histamine. It acts to break down histamine in the gut.

Research indicates that certain individuals are genetically prone to low levels of DAO. It can be measured via a blood test, but requires processing by specialty labs that are not licensed in certain states. More readily available are blood tests that can reveal high levels of histamine, presumably resulting from insufficient DAO activity.

To summarize—and it gets a little complicated here, so bear with me—there are 6 ways that foods can send your histamine past the threshold where you experience allergic symptoms:

  1. The old fashioned way—a direct measurable food allergy, say to casein from dairy (to return to the bathtub analogy, “faucet”).
  2. Foods that are rich in histamines (“faucet”). These include alcohol (especially red wine), aged meats; shellfish or spoiled fish; fermented products like sauerkraut, soy sauce, Worcestershire sauce, yeast extracts and vinegar; and beans and pulses.
  3. Foods that are rich in biogenic amines, which don’t directly trigger allergies, but compete with histamine for degradation by DAO (“stopper”). These include pineapple; bananas; raspberries; peanuts and wheat germ.
  4. Other foods that don’t contain histamine but trigger mast cells to release histamine (“faucet”). These include fruits like kiwi, lime, lemon, pineapple, papaya and plum; additives like MSG, sulfites, benzoate, nitrites and artificial food dyes; and tomatoes.
  5. Foods or beverages that inhibit DAO (“stopper”): Alcohol; black, green and mate tea.
  6. Foods that can cause “leaky gut” (“faucet”). They make the intestines leak, allowing passage of histamine or macromolecules from food into the body, triggering IgE or IgG food allergies. These include alcohol and hot spices like chili peppers.

Finally, certain commonly-used medications inhibit DAO (stopper): These include Elavil, Tagamet, NSAIDs, aspirin, aminophylline, Reglan, verapamil, and Moduretic.

Can you be “allergic” to your own hormones? Many women report a surge in their symptoms of bloating, diarrhea, nasal congestion and wheezing corresponding with their periods—not to mention intense menstrual cramps.

This may not be coincidental. Histamine has been shown to enhance the production of estradiol, making women feel more “hormonal”; conversely, higher levels of estrogen can potentiate the action of histamine, exacerbating allergy symptoms including premenstrual headaches and migraines.

Interestingly, production of DAO by the placenta in pregnancy soars by as much as 500-fold; increased DAO pulls the stopper on excess histamine accumulation. This may explain, in part, why pregnant women often enjoy a temporary respite from allergies.

So what are the practical consequences for you?

If you have symptoms of histamine intolerance (nasal congestion, asthma, hives, headaches, abdominal cramps, diarrhea, etc.);

And your symptoms are partially relieved by antihistamines, or brought on by consumption of any of the above histamine-releasing or DAO blocking foods or medications;

Or, if you’re a premenopausal woman, and your allergic symptoms seem worse at certain times of the month;

Or, your blood tests show high levels of histamine or low levels of DAO;

You should:

  1. Redouble your efforts to avoid histamine-boosting foods
  2. Avoid DAO-blocking drugs
  3. Use natural anti-histamines (C, B6, quercetin)
  4. Take DAO with each meal

Most importantly, seek professional guidance from a health practitioner well-versed in histamine intolerance. Other medical problems can mimic histamine intolerance, and sometimes need to be ruled out before simply following the protocol outlined above. It’s early in our understanding of the complex phenomenon of histamine intolerance, and we’re only just now refining our approach to this challenging disorder. But its discovery finally spells hope for many patients afflicted with a bewildering array of symptoms

Additional Resources:

Maintz L and Novak N, “Histamine and histamine intolerance”, Am J Clin Nutr 2007;85:1185-96http://ajcn.nutrition.org/content/85/5/1185.long 

DAO inhibitor www.histame.com

http://www.histamineintolerance.org.uk

http://www.histamine-intolerance.info

http://thelowhistaminechef.com/histamine-enzyme-testing/

http://www.histaminintoleranz.ch/en/introduction.html

– See more at: http://drhoffman.com/article/histamine-intolerance-a-new-way-of-looking-at-allergies/#sthash.Pl5wUjfO.dpuf


Source: Integrative Health Network: Ronald Hoffman, MD

Histamine intolerance: A new way of looking at allergies

By Ronald Hoffman, MD

Do you have allergies? Sneezing, wheezing, burning eyes, or flushing, itchy skin with hives? Do certain foods trigger stomach cramps or diarrhea? Or do you suffer from frequent headaches or migraines, bouts of nausea, severe menstrual cramps, or panic attacks characterized by a racing heart?

You’ve dutifully tried allergy shots—sometimes for years!—to no avail. Antihistamines work for you, but only partially. Food allergy tests keep coming up negative. There seem to be no clear dietary precipitants—your food reactions seem to be all over the map. But your doctor insists your allergy blood tests and skin tests don’t come up positive for foods. Still, you try popular gluten-free, dairy-free or candida diets, but they only make minor dents in your symptoms.

The answer may lie in a new understanding of something called histamine intolerance. Histamine, of course, is what antihistamines are supposed to suppress. Histamine is part of our bodies’ natural response to insults or invaders. It prompts blood vessels to swell and fluid to leak from capillaries, causing swelling. Think of the itching you get at the site of a mosquito bite, in response to the foreign proteins deposited by the insect’s saliva.

Histamine intolerance is actually a “pseudo-allergy,” which is why it’s not picked up by conventional allergy blood tests that measure IgE. It results when histamine levels soar in the body.

To use a bathtub analogy, there are two ways a tub can overflow: 1) If the faucet is turned on too high, or 2) If there’s a stopper in the drain. It’s the same with your body. If either occurs, or both simultaneously, your allergy “tub” can overflow, resulting in symptoms of histamine overload.

The discovery of an enzyme called diamine oxidase (DAO) has helped to unlock the key to histamine intolerance. DAO is normally present in the intestine to control excess histamine. It acts to break down histamine in the gut.

Research indicates that certain individuals are genetically prone to low levels of DAO. It can be measured via a blood test, but requires processing by specialty labs that are not licensed in certain states. More readily available are blood tests that can reveal high levels of histamine, presumably resulting from insufficient DAO activity.

To summarize—and it gets a little complicated here, so bear with me—there are 6 ways that foods can send your histamine past the threshold where you experience allergic symptoms:

  1. The old fashioned way—a direct measurable food allergy, say to casein from dairy (to return to the bathtub analogy, “faucet”).
  2. Foods that are rich in histamines (“faucet”). These include alcohol (especially red wine), aged meats; shellfish or spoiled fish; fermented products like sauerkraut, soy sauce, Worcestershire sauce, yeast extracts and vinegar; and beans and pulses.
  3. Foods that are rich in biogenic amines, which don’t directly trigger allergies, but compete with histamine for degradation by DAO (“stopper”). These include pineapple; bananas; raspberries; peanuts and wheat germ.
  4. Other foods that don’t contain histamine but trigger mast cells to release histamine (“faucet”). These include fruits like kiwi, lime, lemon, pineapple, papaya and plum; additives like MSG, sulfites, benzoate, nitrites and artificial food dyes; and tomatoes.
  5. Foods or beverages that inhibit DAO (“stopper”): Alcohol; black, green and mate tea.
  6. Foods that can cause “leaky gut” (“faucet”). They make the intestines leak, allowing passage of histamine or macromolecules from food into the body, triggering IgE or IgG food allergies. These include alcohol and hot spices like chili peppers.

Finally, certain commonly-used medications inhibit DAO (stopper): These include Elavil, Tagamet, NSAIDs, aspirin, aminophylline, Reglan, verapamil, and Moduretic.

Can you be “allergic” to your own hormones? Many women report a surge in their symptoms of bloating, diarrhea, nasal congestion and wheezing corresponding with their periods—not to mention intense menstrual cramps.

This may not be coincidental. Histamine has been shown to enhance the production of estradiol, making women feel more “hormonal”; conversely, higher levels of estrogen can potentiate the action of histamine, exacerbating allergy symptoms including premenstrual headaches and migraines.

Interestingly, production of DAO by the placenta in pregnancy soars by as much as 500-fold; increased DAO pulls the stopper on excess histamine accumulation. This may explain, in part, why pregnant women often enjoy a temporary respite from allergies.

So what are the practical consequences for you?

If you have symptoms of histamine intolerance (nasal congestion, asthma, hives, headaches, abdominal cramps, diarrhea, etc.);

And your symptoms are partially relieved by antihistamines, or brought on by consumption of any of the above histamine-releasing or DAO blocking foods or medications;

Or, if you’re a premenopausal woman, and your allergic symptoms seem worse at certain times of the month;

Or, your blood tests show high levels of histamine or low levels of DAO;

You should:

  1. Redouble your efforts to avoid histamine-boosting foods
  2. Avoid DAO-blocking drugs
  3. Use natural anti-histamines (C, B6, quercetin)
  4. Take DAO with each meal

Most importantly, seek professional guidance from a health practitioner well-versed in histamine intolerance. Other medical problems can mimic histamine intolerance, and sometimes need to be ruled out before simply following the protocol outlined above. It’s early in our understanding of the complex phenomenon of histamine intolerance, and we’re only just now refining our approach to this challenging disorder. But its discovery finally spells hope for many patients afflicted with a bewildering array of symptoms

Additional Resources:

Maintz L and Novak N, “Histamine and histamine intolerance”, Am J Clin Nutr 2007;85:1185-96http://ajcn.nutrition.org/content/85/5/1185.long 

DAO inhibitor www.histame.com

http://www.histamineintolerance.org.uk

http://www.histamine-intolerance.info

http://thelowhistaminechef.com/histamine-enzyme-testing/

http://www.histaminintoleranz.ch/en/introduction.html

– See more at: http://drhoffman.com/article/histamine-intolerance-a-new-way-of-looking-at-allergies/#sthash.Pl5wUjfO.dpuf
Source: Integrative Heath Network

Natural Strategies for Keeping Your Vision: Cataracts

By Jonathan V. Wright, MD

I’ve written about an effective, well-researched cataract treatment previously:
N-acetylcarnosine eyedrops. Another option for treating cataracts is a combination of Chinese botanicals called “Hachimi-jio-gan,” or Ba-wei-wan. This treatment has been used for centuries in China to treat cataracts, and even has a bit of clinical evidence to support it. In a human study of early cataracts conducted in Japan, Hachimi-jio-gan was associated with lessening of cataracts in 60 percent of the volunteers. In the USA, Hachimi-jio-gan is available as a (much easier to pronounce) formula called “Clinical Nutrients for the Eyes”, which is available from natural food stores, compounding pharmacies, and the Tahoma Clinic Dispensary (www.TahomaDispensary.com).

Rounding out the natural treatment options for cataracts is a single, simple nutrient: Vitamin A. Decades ago, an honest ophthalmologist with a sense of humor wrote a letter to the editor of a medical journal “complaining” that his income from cataract surgery had gone down by over 2/3 since he started recommending vitamin A to all his patients with any degree of cataract at all. I recommend 30,000 IU of vitamin A (not beta-carotene) for anyone who wants to prevent or treat cataracts. In fact, the only people who shouldn’t use this amount are very small children (who don’t get cataracts anyway) and pregnant women.

And while we’re on the topic of cataract prevention, one of the most important things you can do is to eliminate all sources of sugar and refined carbohydrates from your diet! Researchers have found that part of the cause of cataracts is the lens of the eye trying to “help” the body lower high blood sugar by “packing it away” within the lens, which gradually obscures the vision, which explains why individuals with type 2 diabetes have a much greater incidence of cataracts than people with normal blood sugar levels. So even though not eating sugar and refined carbohydrates is better for everyone’s health, it’s especially important for cataract prevention if you have diabetes—type 2 or type 1—in your family. Eliminating all sources of the milk sugar lactose (milk, ice cream, cottage cheese, and many soft cheeses) will reduce your risk of cataract, too.

In addition to eliminating refined sugar and carbohydrates, you may also want to consider incorporating some cataract-preventing nutrients (other than just vitamin A) into your daily supplement regimen. Riboflavin, vitamin C, quercitin, zinc, and carotenoids have all been associated with cataract risk reduction. And one study found that people with higher serum vitamin E levels had 50 percent less risk of developing cataracts than people with lower levels. (When you’re supplementing with vitamin E, remember to use mixed tocopherols, not just alpha-tocopherol.)

As a side note, patent-medicine “cortisone” preparations that are prescribed to suppress symptoms of asthma, severe allergies, rheumatoid arthritis, and other more severe inflammatory conditions always increase cataract risk. So if you’re using prescription patent-medicine “cortisone,” check with a physician skilled and knowledgeable in nutritional and natural medicine for effective alternatives.

Thanks for reading!


Source: Integrative Health Network: Jonathan Wright, MD

Natural Strategies for Keeping your Mental Capacity

By Jonathan V. Wright, MD

Your guide for beating cognitive decline (a.k.a “keeping your marbles”)

According to health authorities, Alzheimer’s disease is slated to become the next epidemic. In fact, current estimates state that nearly half of people over the age of 85 have Alzheimer’s, whether it’s obvious or not. There are non-Alzheimer’s forms of dementia, too, most notably “multi-infarct” dementia, which is thought to be caused by a series of small strokes, and mild cognitive decline, which likely has many causes that have yet to be identified.

The best way to combat any and all of these cognitive problems is to prevent them from occurring in the first place. You keep reading about it over and over again, but an excellent diet is truly the most important aspect of preventing most—if not all—health problems, including cognitive decline. In fact, more and more research is being reported linking blood sugar problems (such as diabetes) and potential blood sugar problems (such as metabolic syndrome and insulin resistance) with a higher risk of Alzheimer’s disease. So here we go: Eliminate the sugar and refined carbohydrates! Make sure to eat several non-starchy vegetables and a wide array of colorful vegetables every day, too. (You want a varied palette on your plate because each color signals a different and necessary-to-good-health group of nutrients.)

It’s also a good idea to “eat organic” as much as possible, since organically raised foods have significantly more minerals and vitamins than “commercially” grown varieties, not to mention a much lower risk of being contaminated with pesticides, herbicides, and miscellaneous non-food chemical additives.

When you can, I encourage you to even go beyond organic produce and also opt for organic, free-range meat and poultry as well. The essential fatty acid ratio in free-range protein is anti-inflammatory, while the essential fatty acid ratio found in grain-fed animal protein actually promotes inflammation, and inflammation is also being implicated more and more as raising the risk of Alzheimer’s and other cognitive malfunction.

Along these same lines, one of the best “brain foods” you can eat is fish. (Low-mercury fish, that is.) Not only are the omega-3 fatty acids in fish anti-inflammatory, but they’re also essential components of the membranes of every brain cell we have. And since our bodies can’t make them on their own, it’s critical to get enough omega-3s and other essential fatty acids from supplements (like cod liver oil) and foods (like free-range meat and fish).

Phospholipids are another key component of brain cells. While our bodies can make them, as with many other things (co-enzyme Q10 and glutathione are two prominent examples) our bodies make less and less with age. Eggs—specifically the yolks—are excellent sources of phospholipids, as is the lecithin found in soy. Supplemental lecithin—another good source of phospholipids—is available in any natural food store and is an excellent idea for anyone over 40.

Boost your brain—and your sex life

I can’t tell you how many men I’ve seen at the Tahoma Clinic who have the idea that testosterone is mostly for sexual function. I always let them know that its most important job is maintaining cognitive function. The sex part is important, no doubt, but who cares about sex if you can’t remember who you’re with or what you’re doing with her?

Unfortunately, thanks to this misunderstanding word hasn’t gotten around that—just like estrogen replacement for women—bio-identical testosterone replacement for men is extremely important for significantly reducing the risk of Alzheimer’s disease and cognitive decline. I’ll just mention a few of the highlights:

  • Higher serum estrogen levels in women in their 60s are directly correlated with lower incidence of Alzheimer’s in those same women decades later. (And the reverse is true too: Lower estrogens equal higher incidence of Alzheimer’s in later years.)
  • The 15-year Princeton men’s study determined that men who had higher serum free testosterone in 1983 had less risk of Alzheimer’s disease in 1998. (Once again, the reverse was also true: Lower serum free testosterone corresponded with higher risk of Alzheimer’s.)
  • Researchers observing neurons found substantially less accumulation of beta-amyloid, neurofibrillary tangle, tau protein, and other “neuronal garbage” associated with Alzheimer’s when those neurons were exposed to “physiologic quantities” of either estrogen or testosterone (depending on whether the neuron was from a woman or a man).
  • In numerous controlled experiments, elderly men without Alzheimer’s disease do better on tests of cognitive function when given testosterone than men given placebo.
  • Testosterone for men and estrogen (that’s real, bio-identical estrogen—not horse estrogen) for women is very protective for the entire cardiovascular system, including the blood supply to the brain. (Remember that cognitive decline due to repeated small strokes?)

The bottom line is, if you want to “keep your marbles” for as long as you live, consider bio-identical hormone replacement when it’s appropriate for you. Just make sure to be working with a physician who is skilled and knowledgeable in all aspects of this therapy. If you’re not sure if your doctor is, one way to find out is to ask the physician’s office whether they do routine monitoring of therapy with the 24-hour urine steroid determination. This test is the very best way to check not only the levels of the bio-identical hormones being replaced but also their metabolization (the natural transformation of the starting hormones into pro- and anti-carcinogenic metabolites). Blood and/or saliva testing just doesn’t cut it when it comes to bio-identical HRT. See other posts for detailed discussion of bio-identical hormone replacement (and, rest assured, if safety monitoring does indicate that there’s an imbalance in the “wrong” direction, it’s almost always correctable with nutrients or botanicals).

Small dose, big protection

No matter what neurotoxin your brain is exposed to, lithium protects against it.

Not only that, but lithium actually promotes the growth of new brain cells, even in individuals past age 50. So far, no other nutrient has been found to do that.

Yes, high-dose prescription lithium can be toxic, but low quantities like the ones used for boosting cognitive function and protecting brain cells (20 milligrams daily and under) are not associated with toxicity. In over 30 years, I’ve only encountered two or three individuals who reported a possible reaction to low-dose lithium: These people thought that it might have given them a slight tremor (which went away when the lithium was discontinued). But on the flip side of that same coin, I’ve also encountered dozens of individuals who reported improvement in benign tremors with the use of low dose lithium.

Even though risk of toxicity from low-dose lithium is very small, I always recommend you work with a physician skilled and knowledgeable in nutritional and natural medicine if you decide to supplement with lithium. And to be on the extra-cautious side, I always recommend using supplemental essential fatty acids when using even low-quantity lithium supplements. Essential fatty acids are the primary treatment for toxicity caused by high-dose prescription lithium, so using them in conjunction with low-dose treatment helps avoid that possibility altogether.

Spicing up your brain-boosting regimen

There are many, many more supplemental items that can help you maintain cognitive function. Although no one is entirely sure how it works, the research on curcumin’s ability to protect against Alzheimer’s (as well as its many other beneficial effects) has been more than a little exciting. Areas of the world in which the spice turmeric (which has a high concentration of curcumin) is routinely used have very little—if any—Alzheimer’s compared with areas that don’t. Perhaps the best aspect of curcumin is that you don’t need to take yet another pill to get its brain-boosting benefits. Just use turmeric in your cooking, perhaps an average of 1/4 to 1/2 teaspoonful daily. (For those of us who just can’t stand the taste of turmeric, it is available in capsules, too. If you’re using it for long-term cognitive maintenance, consider taking two 200-milligram capsules a day.)

Ginkgo has been used for the brain for thousands of years, and (like lithium) has been found to be neuroprotective. More and more natural substances are coming on the scene with promising effects—these are just a few of the ones that currently come to mind! I’ll continue to write more about this in the future—stay tuned!

-Jonathan V. Wright, MD


Source: Integrative Health Network: Jonathan Wright, MD

Is gluten intolerance bullsh*t?

by Ronald Hoffman, MD

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

Arthur Schopenhauer, German philosopher (1788 – 1860)

To this we might add, in this era of click-bait journalism, a fourth stage: “Then it is ridiculed again.”

Such is the case with gluten intolerance, a real phenomenon that is suddenly taking a shellacking in certain less-enlightened segments of the media.

Articles with lurid titles like these are appearing with greater frequency:

“Does it Even Matter if Gluten Sensitivity is Bogus?” –PLOSblogs

“Gluten Intolerance is Apparently Bullsh*t” –Jezebel

“Your Gluten Allergy is Fake and I Hate You” –Redditt

“Being Gluten-free is Dumb—And Gluten Intolerance May Not Even Exist” –Muscle-for-life

“Calling Bullsh*t on a Fake Gluten Allergy” –LocalBizComedy

“Why a Gluten-Free Diet is Unnecessary and Even Unhealthy” –XoJane

If you haven’t heard of many of these pop culture outlets, don’t worry. The stories aren’t written by health professionals who’ve ever seen a patient. Their snarky, sensationalistic style typifies a new genre of health reporting that’s been unleashed by the democratization of the Internet and social media. The name of the game is to garner the most “clicks” – he who trends most wins.

It’s not surprising that a recent survey showed that only 6% of the population has a “high degree of trust” in the media.

Even Presidential contender Ted Cruz took a swipe at gluten correctness: He pledged not to provide gluten-free MREs to military personnel, signaling his disdain for effete, “PC” liberalism. (Cruz needn’t worry—the military already takes a dim view of gluten intolerance, and provides no special accommodation for soldiers who claim the affliction)

I get that “gluten-free” has become a fashion statement in certain pretentious precincts, and it’s spawned a growth industry for opportunistic food manufacturers who offer a plethora of (often not very nutritious) products. Many people who claim a gluten “allergy” do so with no objective evidence. They’ve never undergone testing, but claim to feel subjectively “better” when they skip wheat and related grains. Undoubtedly, some of the benefits they experience are due to the placebo effect.

So let’s drill down on the scientific study that has all the gluten skeptics exulting. The trial was published in the August 2013 edition of Gastroenterology. It involved 37 subjects with irritable bowel syndrome, all of whom were given a preliminary “FODMAPs” diet for 2 weeks. None of them had tested positive for celiac disease, the uncontroversial “classic” form of gluten intolerance.

The FODMAPs diet is designed to reduce intestinal bloating and gas by eliminating fermentable carbohydrates (fructans, oligosaccharides, disaccharides, monosaccharides, and polyols). That means no grains, no milk products, no sugars, and elimination of certain fruits, nuts and vegetables. While highly restrictive, this diet often yields superb results in sufferers of IBS.

No surprise: The subjects felt much improved. Then they were challenged with either a high-gluten, low-gluten, or no-gluten meal plan and the effects were assessed.

All 3 diets—whether or not they included gluten—produced identical symptoms in the testers: they reported feeling worse.

This was interpreted by the researchers as evidence that gluten intolerance—outside of celiac disease—does not exist. That the subjects felt worse during the challenge period was attributed to the “nocebo” effect—the opposite of a placebo. In other words, gluten intolerance was a figment of their imaginations, since the presence—or non-presence—of gluten made little difference to their subjective responses.

But I see several problems with this study, and its appropriation by gluten-intolerance skeptics:

  • The selfsame researcher—Dr. Peter Gibson at Monash University in Australia—had previously demonstrated the very opposite in a 2011 double-blind placebo-controlled study in which sufferers of non-celiac gluten intolerance showed strong reactions to gluten feeding. Why the discrepancy? Was the first study wrong?
  • Even if gluten-intolerance isn’t really a specific reaction to gluten, but instead is a form of FODMAPs intolerance, isn’t that moot? Patients with fatigue, brain-fog, gas, bloating, diarrhea, constipation and many other baffling symptoms get better with gluten-free diets. I can certainly attest to that based on over 30 years of clinical experience. What difference does it make whether they have candida, wheat allergy, gluten-intolerance, or SIBO (small intestine bacterial overgrowth) when the net result is that they improve when they eliminate gluten? Does that make self-reported gluten intolerance any less “real”?
  • The re-challenge control meals consisted of whey protein—a known precipitant of GI symptoms for a high percentage of IBS sufferers! Isn’t it unfair to conclude that reactions to the gluten were “imagined” because they were indistinguishable from those experienced with whey?
  • In any case, the authors note that “only 8%” of symptoms reported by study participants could be attributable to gluten, which they dismiss as trivial. But, while not statistically significant in this small study, isn’t it worth considering as a trend supporting gluten intolerance?
  • The reintroduction of gluten lasted only 3 days. In my experience, people who benefit from gluten elimination may get away with a little gluten for a short time before symptoms recur. I would’ve liked to see longer term follow up during which time I’m pretty certain that gluten intolerance would have re-emerged in a way that would clearly distinguish itself from the symptoms reported by control subjects who consumed only whey.
  • Finally, if gluten really didn’t make a difference for the folks in this study, you might expect that its reintroduction wouldn’t provoke the adverse reactions the subjects reported. But it did. And maybe it wasn’t just their overactive imaginations at work (Just sayin’!).

BOTTOM LINE: I’m sure even Dr. Peter Gibson would downplay gluten intolerance deniers’ attempts to use his study to call BS on gluten avoiders who aren’t diagnosed with full-blown celiac disease. He’s a FODMAPs guy, having written many papers on the subject, and maybe his message is that some are claiming gluten intolerance when what they’re actually reacting to are fermentable carbohydrates.

I’m not certain it really matters, because many people are obtaining relief from a wide variety of symptoms when they stop eating bread, cookies, and pasta. Of course, it’s dumb to skip gluten just because it’s trendy; on the other hand, don’t let the detractors daunt you if your gluten avoidance has delivered you from bothersome complaints.

– See more at: http://drhoffman.com/article/is-gluten-intolerance-bullsht/#sthash.IT0jm7my.dpuf


Source: Integrative Heath Network

Natural Strategies for Keeping your Hearing

By Jonathan V. Wright, MD

“Eh? What’s that you say? Louder, please. No, don’t bother writing it down, can’t see very well, either! Oh, never mind…I probably won’t remember it, anyway!”

If you chuckled when you read that, it’s probably because it sounds familiar—whether it’s something you remember your parents or grandparents saying, or whether you’ve uttered similar things yourself. And while it sounds funny on the surface, the unfortunate truth underlying phrases like these is that varying degrees of failing hearing, vision, and mental function are still considered to be “normal” with advancing age.

But they need not be “normal” for you! You’ve read before about prevention and treatment of “age-related” hearing, vision, and cognitive function problems. This time, we’ll review them all in one place, while you—and I—can still remember to how to lower your chances of going deaf, blind, or losing your mind!

The hormone deficiency that could be destroying your hearing Dennis Trune, Ph.D., of Oregon Health Sciences University, pioneered the research showing that the naturally occurring adrenal steroid hormone aldosterone can often reverse hearing loss in animals.

Based on Dr. Trune’s work, I’ve had aldosterone levels tested in many individuals with hearing loss (most of them “older”), and a significant number turned out to have low or “low normal” measurements. But after taking bio-identical aldosterone in “physiologic” quantities—amounts that would normally be present in adult human bodies—more than half of these individuals have regained a significant proportion of their “lost” hearing.

I’ve been surprised by two aspects of bio-identical aldosterone treatment for hearing loss. First, when it works, it works relatively rapidly, restoring a significant degree of hearing within the first two months. In fact, a few of the people I’ve worked with have literally heard improvement within just two to three weeks.

The other thing that surprised me about aldosterone therapy is that it’s capable of restoring a significant degree of hearing even years after the hearing loss initially occurred. So far, the longest interval I’ve witnessed was in an 87-year-old man who’d lost his hearing 13 years prior to regaining a significant degree of it using aldosterone.

None of the people I’ve worked with have had any adverse effects from aldosterone therapy, likely because the use of bio-identical, physiologic-dose aldosterone restores levels to those that would be found in the body anyway.

I’ve focused this treatment on individuals with hearing loss and low or low-normal aldosterone levels, but I do know of one individual—an M.D.—who decided to try this approach for his hearing loss even though his aldosterone levels were quite normal. His hearing did improve, but unless you too are an M.D., D.O., or N.D. who can prescribe bio-identical aldosterone and order lab tests for sodium and potassium (sodium and potassium regulation are two of aldosterone’s major responsibilities), please don’t take aldosterone, bio-identical or not, if your measured levels are perfectly normal!

That’s all for now!

-Jonathan V. Wright, M.D.


Source: Integrative Health Network: Jonathan Wright, MD

Is gluten intolerance bullsh*t?

by Ronald Hoffman, MD

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

Arthur Schopenhauer, German philosopher (1788 – 1860)

To this we might add, in this era of click-bait journalism, a fourth stage: “Then it is ridiculed again.”

Such is the case with gluten intolerance, a real phenomenon that is suddenly taking a shellacking in certain less-enlightened segments of the media.

Articles with lurid titles like these are appearing with greater frequency:

“Does it Even Matter if Gluten Sensitivity is Bogus?” –PLOSblogs

“Gluten Intolerance is Apparently Bullsh*t” –Jezebel

“Your Gluten Allergy is Fake and I Hate You” –Redditt

“Being Gluten-free is Dumb—And Gluten Intolerance May Not Even Exist” –Muscle-for-life

“Calling Bullsh*t on a Fake Gluten Allergy” –LocalBizComedy

“Why a Gluten-Free Diet is Unnecessary and Even Unhealthy” –XoJane

If you haven’t heard of many of these pop culture outlets, don’t worry. The stories aren’t written by health professionals who’ve ever seen a patient. Their snarky, sensationalistic style typifies a new genre of health reporting that’s been unleashed by the democratization of the Internet and social media. The name of the game is to garner the most “clicks” – he who trends most wins.

It’s not surprising that a recent survey showed that only 6% of the population has a “high degree of trust” in the media.

Even Presidential contender Ted Cruz took a swipe at gluten correctness: He pledged not to provide gluten-free MREs to military personnel, signaling his disdain for effete, “PC” liberalism. (Cruz needn’t worry—the military already takes a dim view of gluten intolerance, and provides no special accommodation for soldiers who claim the affliction)

I get that “gluten-free” has become a fashion statement in certain pretentious precincts, and it’s spawned a growth industry for opportunistic food manufacturers who offer a plethora of (often not very nutritious) products. Many people who claim a gluten “allergy” do so with no objective evidence. They’ve never undergone testing, but claim to feel subjectively “better” when they skip wheat and related grains. Undoubtedly, some of the benefits they experience are due to the placebo effect.

So let’s drill down on the scientific study that has all the gluten skeptics exulting. The trial was published in the August 2013 edition of Gastroenterology. It involved 37 subjects with irritable bowel syndrome, all of whom were given a preliminary “FODMAPs” diet for 2 weeks. None of them had tested positive for celiac disease, the uncontroversial “classic” form of gluten intolerance.

The FODMAPs diet is designed to reduce intestinal bloating and gas by eliminating fermentable carbohydrates (fructans, oligosaccharides, disaccharides, monosaccharides, and polyols). That means no grains, no milk products, no sugars, and elimination of certain fruits, nuts and vegetables. While highly restrictive, this diet often yields superb results in sufferers of IBS.

No surprise: The subjects felt much improved. Then they were challenged with either a high-gluten, low-gluten, or no-gluten meal plan and the effects were assessed.

All 3 diets—whether or not they included gluten—produced identical symptoms in the testers: they reported feeling worse.

This was interpreted by the researchers as evidence that gluten intolerance—outside of celiac disease—does not exist. That the subjects felt worse during the challenge period was attributed to the “nocebo” effect—the opposite of a placebo. In other words, gluten intolerance was a figment of their imaginations, since the presence—or non-presence—of gluten made little difference to their subjective responses.

But I see several problems with this study, and its appropriation by gluten-intolerance skeptics:

  • The selfsame researcher—Dr. Peter Gibson at Monash University in Australia—had previously demonstrated the very opposite in a 2011 double-blind placebo-controlled study in which sufferers of non-celiac gluten intolerance showed strong reactions to gluten feeding. Why the discrepancy? Was the first study wrong?
  • Even if gluten-intolerance isn’t really a specific reaction to gluten, but instead is a form of FODMAPs intolerance, isn’t that moot? Patients with fatigue, brain-fog, gas, bloating, diarrhea, constipation and many other baffling symptoms get better with gluten-free diets. I can certainly attest to that based on over 30 years of clinical experience. What difference does it make whether they have candida, wheat allergy, gluten-intolerance, or SIBO (small intestine bacterial overgrowth) when the net result is that they improve when they eliminate gluten? Does that make self-reported gluten intolerance any less “real”?
  • The re-challenge control meals consisted of whey protein—a known precipitant of GI symptoms for a high percentage of IBS sufferers! Isn’t it unfair to conclude that reactions to the gluten were “imagined” because they were indistinguishable from those experienced with whey?
  • In any case, the authors note that “only 8%” of symptoms reported by study participants could be attributable to gluten, which they dismiss as trivial. But, while not statistically significant in this small study, isn’t it worth considering as a trend supporting gluten intolerance?
  • The reintroduction of gluten lasted only 3 days. In my experience, people who benefit from gluten elimination may get away with a little gluten for a short time before symptoms recur. I would’ve liked to see longer term follow up during which time I’m pretty certain that gluten intolerance would have re-emerged in a way that would clearly distinguish itself from the symptoms reported by control subjects who consumed only whey.
  • Finally, if gluten really didn’t make a difference for the folks in this study, you might expect that its reintroduction wouldn’t provoke the adverse reactions the subjects reported. But it did. And maybe it wasn’t just their overactive imaginations at work (Just sayin’!).

BOTTOM LINE: I’m sure even Dr. Peter Gibson would downplay gluten intolerance deniers’ attempts to use his study to call BS on gluten avoiders who aren’t diagnosed with full-blown celiac disease. He’s a FODMAPs guy, having written many papers on the subject, and maybe his message is that some are claiming gluten intolerance when what they’re actually reacting to are fermentable carbohydrates.

I’m not certain it really matters, because many people are obtaining relief from a wide variety of symptoms when they stop eating bread, cookies, and pasta. Of course, it’s dumb to skip gluten just because it’s trendy; on the other hand, don’t let the detractors daunt you if your gluten avoidance has delivered you from bothersome complaints.

– See more at: http://drhoffman.com/article/is-gluten-intolerance-bullsht/#sthash.IT0jm7my.dpuf


Source: Integrative Health Network: Ronald Hoffman, MD

Supplement of the week: DIM

by Ronald Hoffman, MD

Every now and then, I like to highlight a particular supplement that my audience may not be aware of, and go in-depth about its uses, benefits, and potential drawbacks.

This week, I’d like to talk to you about DIM.

Diindolylmethane (DIM) is a versatile nutraceutical for which I find many uses in my practice. It is naturally obtained via dietary consumption of cruciferous vegetables. Brussel Sprouts, Garden Cress, Mustard Greens, 
Turnip, and Kale are rich sources of glucobrassicans, the mother compounds of beneficial glucosinolates like indole-3-carbinol, which is metabolized into DIM. However, heat treatment, particularly boiling and microwaving, degrades
myrosinase, the plant compound responsible for bio-transformation of glucobrassicans into useful molecules like DIM and sulforaphane.

An advantage of supplementation with DIM over consumption of large amounts of raw cruciferous vegetables is avoidance of goitrogenic isothiocyanates. These compounds compete with iodine for binding in the thyroid, potentially contributing to hypothyroidism. DIM is thought not to have goitrogenic properties. To obtain the benefits of DIM contained in just two capsules per day, it is estimated that the average person would have to consume two pounds of raw cabbage family vegetables per day, an intake that might court the danger of thyroid suppression.

DIM possesses hormone-modulating effects. It may do so in several ways. Studies suggest it protects the body from xenoestrogens, compounds that mimic and intensify the effects of estrogen. DIM has also been shown to favorably alter the ratios of “good” to “bad” estrogen. In the prostate, DIM has been found to antagonize the effects of dihydrotestosterone (DHT), an excess of which is associated with risk of enlarged prostate and prostate cancer.

Thus, DIM’s application to hormone-dependent cancers (breast and uterine in women, prostate in men), as well as to the condition of “estrogen dominance”, wherein high estrogen levels promote symptoms like breast pain, fibrocystic breasts, uterine fibroids, endometriosis, PMS, bloating, anxiety, fat accumulation, and heavy menstruation.

Because DIM combats excess estrogen in females, it might help as a diet aid for women who struggle with a pear-shaped fat distribution.

Another theoretical benefit of DIM may be to offset the potential risks of hormone-dependent cancers in patients taking hormone replacement therapy with estrogen or testosterone.

In addition to its hormone-modulating effects, DIM has been found to exert direct anti-cancer effects via a variety of mechanisms: It may promote DNA repair; accelerate the death of cancer cells by restoring apoptosis (programmed cell death); it stimulates the activity of natural killer (NK) cells, the immune system’s surveillance against cancer; and some studies suggests it has anti-angiogenesis effects, depriving growing cancers of their blood supply.

Is DIM compatible with conventional therapy for cancer? Some studies suggest that, not only does it not interfere, but instead may protect normal tissue from the harmful effects of radiation while reinforcing cancer cell destruction. Other research suggests DIM may prevent drug resistance, a major cause of chemotherapy failure.

As a corollary to DIM’s anti-androgen effects, some have proposed its application to conditions of hormone dysregulation like acne, androgenic alopecia, and polycystic ovarian syndrome (PCOS).

Less certain is DIM’s effect on Human Papilloma Virus (HPV). I have long used it successfully as part of a nutritional protocol for women with abnormal Pap smears desirous of preventing progression to invasive cervical cancer. Belief in DIM’s antiviral properties is based on research demonstrating its efficacy against a rare vocal cord disease, recurrent respiratory papillomatosis (RRP), caused by HPV. Preliminary studies and anecdotal reports once suggested that DIM was able to retard the progression of CIN2 and 3 PAP smears, but the latest, most definitive study yielded disappointing findings.

While specific clinical proof is lacking, I have long used DIM as part of my protocol for Barrett’s esophagus, another pre-cancer, along with other targeted supplements, with good results.

A controversy rages in the supplement industry over the relative merits of indole-3-carbinol (I3C) versus DIM. While it is true that I3C has documented intrinsic activities apart from its role as a precursor to DIM, after much research, I sided with the DIM camp. For one, much higher amounts of I3C are required to achieve therapeutic benefits; additionally, concerns have been raised over the safety of I3C; and I3C is said to be less stable than DIM.

Some of DIM’s detoxifying effects may be attributable to its ability to up-regulate cytochrome P450 activity. For this reason, it is advisable to exercise caution whenever using certain medications whose effects might be weakened by co-administration with DIM. And, because of its hormonal effects, it is advisable to refrain from using DIM during pregnancy or lactation, or in infants or small children.

The optimal dosage of DIM for various indications is unclear. I generally administer one or two 75 milligram capsules of Dimpro twice daily. The efficacy of doses greater than 300 milligrams per day has not been established, and some reports of nausea or headache have been reported above that threshold.

What form of DIM is preferable? Researchers prefer standardized BioResponse DIM; to date, most clinical trials have used this formulation. To overcome obstacles to bio-availability, BioResponse DIM is micro-encapsulated in a patented delivery system that is said to guarantee predictable absorption and clinically effective blood levels.

– See more at: http://drhoffman.com/article/supplement-of-the-week-dim/#sthash.wcpGIKiW.dpuf


Source: Integrative Health Network: Ronald Hoffman, MD