Lessons From Ötzi, the Tyrolean Ice Man. Part II

Otzi's Diet

Otzi's digestive tract contains the remains of three meals.  They were composed of cooked grains (wheat bread and wheat grains), meat, roots, fruit and seeds (1, 2).  The meat came from three different animals-- chamois, red deer and ibex.  The "wheat" was actually not what we would think of as modern wheat, but an ancestral variety called einkorn.

Isotope analysis indicates that Otzi's habitual diet was primarily centered around plant foods, likely heavily dependent on grains but also incorporating a variety of other plants (3).  He died in the spring with a belly full of einkorn wheat.  Since wheat is harvested in the fall, this suggests that his culture stored grain and was dependent on it for most if not all of the year.  However, he also clearly ate meat and used leather made from his prey.  Researchers are still debating the quantity of meat in his diet, but it was probably secondary to grains and other plant foods. It isn't known whether or not he consumed dairy.

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Lessons From Ötzi, the Tyrolean Ice Man. Part I

This is Otzi, or at least a reconstruction of what he might have looked like.  5,300 years ago, he laid down on a glacier near the border between modern-day Italy and Austria, under unpleasant circumstances.  He was quickly frozen into the glacier.  In 1991, his slumber was rudely interrupted by two German tourists, which eventually landed him in the South Tyrol Museum of Archaeology in Italy. 

Otzi is Europe's oldest natural human mummy, and as such, he's an important window into the history of the human species in Europe.  His genome has been sequenced, and it offers us clues about the genetic history of modern Europeans.

Otzi's Story

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Fast Food, Weight Gain and Insulin Resistance

CarbSane just posted an interesting new study that fits in nicely with what we're discussing here.  It's part of the US Coronary Artery Risk Development in Young Adults (CARDIA) study, which is a long-term observational study that is publishing many interesting findings.  The new study is titled "Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis" (1).  The results speak for themselves, loud and clear (I've edited some numbers out of the quote for clarity):
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Obesity and the Fluid-in, Fluid-out Therapy for Edema

I recently attended a lecture by Dr. Arya M. Sharma here at the University of Washington. Dr. Sharma is a Canadian clinician who specializes in the treatment of obesity. He gave the UW Science in Medicine lecture, which is a prestigious invited lecture.

He spent a little bit of time pointing out the fallacy behind conventional obesity treatment. He used the analogy of edema, which is an abnormal accumulation of fluid in the body.

Since we know that the amount of fluid contained in the body depends on the amount of fluid entering the body and the amount of fluid leaving the body, the treatment for edema is obvious: drink less, pee more.

Of course, this makes no sense. It doesn't address the underlying cause of edema and it will not help the patient. Yet we apply that exact same logic to fat loss. Since the amount of energy contained in the body (in the form of fat) depends on the amount entering and the amount leaving, the solution is easy: eat less, move more. Well, yes, if you can stick to that program it will cause fat loss. But that's equivalent to telling someone with edema to drink less water. It will cause a loss of fluid, but it won't correct the underlying problem that caused excessive fluid retention in the first place.

For example, if you have edema because your heart isn't pumping effectively (cardiac insufficiency), the heart is the problem that must be addressed. Any other treatment is purely symptomatic and is not a cure.

The same applies to obesity. If you don't correct the alteration in the system that causes an obese person to 'defend' his elevated fat mass against changes*, anything you do is symptomatic treatment and is unlikely to be very effective in the long term. My goal is to develop a method that goes beyond symptomatic treatment and allows the body to naturally return to a lower fat mass. I've been doing a lot of reading and I have a simple new idea that I feel confident in. It also neatly explains the results of a variety of weight loss diets. I've dropped a few hints here and there, but I'll be formally unveiling it in the next couple of months. Stay tuned.


* The body fat homeostasis system. The core element appears to be a negative feedback loop between body fat (via leptin, and insulin to a lesser degree) and the brain (primarily the hypothalamus, but other regions are involved). There are many other elements in the system, but that one seems to set the 'gain' on all the others and guides long-term fat mass homeostasis. The brain is the gatekeeper of both energy intake and energy expenditure, and unconscious processes strongly suggest appropriate levels for both factors according to the brain's perceived homeostatic needs. Those suggestions can be overridden consciously, but it requires a perpetual high degree of discipline, whereas someone who has been lean all her life doesn't require discipline to remain lean because her brain is suggesting behaviors that naturally defend leanness. I know what I'm saying here may seem controversial to some people reading this, because it's contrary to what they've read on the internet or in the popular press, but it's not particularly controversial in my field. In fact, you'll find most of this stuff in general neuroscience textbooks dating back more than 10 years (e.g., Eric Kandel and colleagues, Principles of Neuroscience).

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Safflower Oil Study

A few people have sent me a new study claiming to demonstrate that half a tablespoon of safflower oil a day improves insulin sensitivity, increases HDL and decreases inflammation in diabetics (1). Let me explain why this study does not show what it claims.

It all comes down to a little thing called a control group, which is the basis for comparison that you use to determine if your intervention had an effect. This study didn't have one for the safflower group. What it had was two intervention groups, one given 6.4g conjugated linoleic acid (CLA; 50% c9t11 and 50% t10c12-CLA) per day, and one given 8g safflower oil. I have to guess that this study was originally designed to test the effects of the CLA, with the safflower oil group as the control group, and that the interpretation of the data changed after the results came in. Otherwise, I don't understand why they would conduct a study like this without a control group.

Anyway, they found that the safflower oil group did better than the CLA group over 16 weeks, showing a higher insulin sensitivity, higher HDL, lower HbA1c (a marker of average blood glucose levels) and lower CRP (a marker of inflammation). But they also found that the safflower group improved slightly compared to baseline, therefore they decided to attribute the difference to a beneficial effect of safflower oil. The problem is that without a control (placebo) group for comparison, there's no way to know if the improvement would have occurred regardless of treatment, due to the season changing, more regular check-ups at the doctor's office due to participating in a study, or countless other unforeseen factors. A control group is essential for the accurate interpretation of results, which is why drug studies always have placebo groups.

What we can say is that the safflower oil group fared better than the CLA group, because there was a difference between the two. However, what I think really happened is that the CLA supplement was harmful and the small dose of safflower oil had no effect. Why? Because the t10c12 isomer of CLA, which was half their pill, has already been shown by previous well-controlled studies to reduce insulin sensitivity, decrease HDL and increase inflammatory markers at a similar dose and for a similar duration (2, 3). The safflower oil group only looked good by comparison. We can add this study to the "research bloopers" file.

It's worth noting that naturally occurring CLA mixtures, similar to those found in pastured dairy and ruminant fat, have not been shown to cause metabolic problems such as those caused by isolated t10c12 CLA.

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Gluten-Free January Survey Data, Part II: Health Effects of a Gluten-Free Diet

GFJ participants chose between three diet styles: a simple gluten-free diet; a "paleo light" diet diet that eliminated sugar and industrial seed (vegetable) oils in addition to gluten; and a "paleo full monty" diet that only included categories of food that would have been available to our pre-agricultural ancestors. The data in this post represent the simple gluten-free diet group, and do not represent the other two, which I'll analyze separately.

To get the data I'll be presenting below, first I excluded participants who stated on the survey that they did not adhere to the diet. Next, I excluded participants who were gluten-free before January, because they would presumably not have experienced a change from continuing to avoid gluten. That left us with 53 participants.

For each of these graphs, the vertical axis represents the number of participants in each category. They won't necessarily add up to 53, for several reasons. The most common reason is that for the questions asking about changes in health conditions, I didn't include responses from people who didn't have the condition in question at baseline because there was nothing to change.

Question #1: What is your overall opinion of the effect of gluten free January on you?

Participants had a very positive experience with the gluten-free diet. Not one person reported a negative overall experience.

Question #2: Did you note a weight change at the end of gluten free January?

And here are the data for people who described themselves as overweight at baseline:

Two-thirds of people who were overweight at baseline lost weight, and only one person out of 37 gained weight. That is striking. A number of people didn't weigh themselves, which is why the numbers only add up to 37.

Question #3: Before January 2011, did you have a problem with intestinal transit (frequent constipation or diarrhea)? If so, did your symptoms change during the month of January?


Responses are heavily weighted toward improvement, although there were a few instances where transit worsened. Transit problems are one of the most common manifestations of gluten sensitivity.

Question #4: Before January 2011, did you have frequent digestive discomfort (pain, bloating, etc.)? If so, did your symptoms change during the month of January?


Digestive discomfort was common, and the gluten-free diet improved it in nearly everyone who had it at baseline. I find this really impressive.

Question #5: Before January 2011, did you have acid reflux? If so, did your symptoms change during the month of January?

Acid reflux responded well to a gluten-free diet.

Question #6: Before January 2011, did you have a problem with tiredness/lethargy? If so, did your symptoms change during the month of January?
Lethargy was common and generally improved in people who avoided gluten. This doesn't surprise me at all. The recent controlled gluten study in irritable bowel syndrome patients found that lethargy was the most reliable consequence of eating gluten that they measured (1, 2). That has also been my personal experience.

Question #7: Before January 2011, did you have a problem with anxiety? If so, did your symptoms change during the month of January?

Anxiety tended to improve in most participants who started with it.

Question #8: Before January 2011, did you have a problem with an autoimmune or inflammatory condition? If so, did your symptoms change during the month of January?

Autoimmune and inflammatory conditions tended to improve in the gluten-free group, although one person experienced a worsening of symptoms.

Question #9: If you ate gluten again or did a gluten challenge after gluten free January, what was the effect?

Just under half of participants experienced moderate or significant negative symptoms when they re-introduced gluten at the end of the month. Two people felt better after re-introducing gluten.


Conclusion

I find these results striking. Participants overwhelmingly improved in every health category we measured. Although the data may have been somewhat biased due to the 53% response rate, it's indisputable that a large number of participants, probably the majority, benefited from avoiding gluten for a month. At some point, we're going to compile some of the comments people left in the survey, which were overwhelmingly positive. Here's a typical comment in response to the question " In your own words, how would you describe your January 2011 experience" (used with permission):

Amazing! I would recommend the experiment to anyone. I felt completely more alert, and less bloated. When I ate some gluten at the close of the experiment, I felt gross, bloated, and lethargic.

I think it's worth mentioning that some participants also eliminated other starches, particularly refined starches. Judging by the comments, the diet was probably lower in carbohydrate for a number of participants. We may try to assess that next year.

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Flu Season is Here

I've noticed everyone around me getting sick lately (I seem to have become mostly immune to colds and the flu in the last couple of years), so I took a look at Google Flu Trends. Lo and behold, the United States is currently near peak flu incidence for the 2010-2011 season. Here's a graph from Flu Trends. This year's trend is in dark blue:


Flu Trends also has data for individual US states and a number of other countries.

It's time to tighten up your diet and lifestyle if you want to avoid the flu this year. Personally, I feel that eating well, managing stress effectively, and taking 2,000 IU of vitamin D3 per day in winter have helped me avoid colds and the flu.

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Polyphenols, Hormesis and Disease: Part II

In the last post, I explained that the body treats polyphenols as potentially harmful foreign chemicals, or "xenobiotics". How can we reconcile this with the growing evidence that at least a subset of polyphenols have health benefits?

Clues from Ionizing Radiation

One of the more curious things that has been reported in the scientific literature is that although high-dose ionizing radiation (such as X-rays) is clearly harmful, leading to cancer, premature aging and other problems, under some conditions low-dose ionizing radiation can actually decrease cancer risk and increase resistance to other stressors (1, 2, 3, 4, 5). It does so by triggering a protective cellular response, increasing cellular defenses out of proportion to the minor threat posed by the radiation itself. The ability of mild stressors to increase stress resistance is called "hormesis." Exercise is a common example. I've written about this phenomenon in the past (6).

The Case of Resveratrol

Resveratrol is perhaps the most widely known polyphenol, available in supplement stores nationwide. It's seen a lot of hype, being hailed as a "calorie restriction mimetic" and the reason for the "French paradox."* But there is quite a large body of evidence suggesting that resveratrol functions in the same manner as low-dose ionizing radiation and other bioactive polyphenols: by acting as a mild toxin that triggers a hormetic response (7). Just as in the case of radiation, high doses of resveratrol are harmful rather than helpful. This has obvious implications for the supplementation of resveratrol and other polyphenols. A recent review article on polyphenols stated that while dietary polyphenols may be protective, "high-dose fortified foods or dietary supplements are of unproven efficacy and possibly harmful" (8).

The Cellular Response to Oxidants

Although it may not be obvious, radiation and polyphenols activate a cellular response that is similar in many ways. Both activate the transcription factor Nrf2, which activates genes that are involved in detoxification of chemicals and antioxidant defense**(9, 10, 11, 12). This is thought to be due to the fact that polyphenols, just like radiation, may temporarily increase the level of oxidative stress inside cells. Here's a quote from the polyphenol review article quoted above (13):

We have found that [polyphenols] are potentially far more than 'just antioxidants', but that they are probably insignificant players as 'conventional' antioxidants. They appear, under most circumstances, to be just the opposite, i.e. prooxidants, that nevertheless appear to contribute strongly to protection from oxidative stress by inducing cellular endogenous enzymic protective mechanisms. They appear to be able to regulate not only antioxidant gene transcription but also numerous aspects of intracellular signaling cascades involved in the regulation of cell growth, inflammation and many other processes.

It's worth noting that this is essentially the opposite of what you'll hear on the evening news, that polyphenols are direct antioxidants. The scientific cutting edge has largely discarded that hypothesis, but the mainstream has not yet caught on.

Nrf2 is one of the main pathways by which polyphenols increase stress resistance and antioxidant defenses, including the key cellular antioxidant glutathione (14). Nrf2 activity is correlated with longevity across species (15). Inducing Nrf2 activity via polyphenols or by other means substantially reduces the risk of common lifestyle disorders in animal models, including cardiovascular disease, diabetes and cancer (16, 17, 18), although Nrf2 isn't necessarily the only mechanism. The human evidence is broadly consistent with the studies in animals, although not as well developed.

One of the most interesting effects of hormesis is that exposure to one stressor can increase resistance to other stressors. For example, long-term consumption of high-polyphenol chocolate increases sunburn resistance in humans, implying that it induces a hormetic response in skin (19). Polyphenol-rich foods such as green tea reduce sunburn and skin cancer development in animals (20, 21).

Chris Masterjohn first introduced me to Nrf2 and the idea that polyphenols act through hormesis. Chris studies the effects of green tea on health, which seem to be mediated by polyphenols.

A Second Mechanism

There is a place in the body where polyphenols are concentrated enough to be direct antioxidants: in the digestive tract after consuming polyphenol-rich foods. Digestion is a chemically harsh process that readily oxidizes ingested substances such as polyunsaturated fats (22). Oxidized fat is neither healthy when it's formed in the deep fryer, nor when it's formed in the digestive tract (23, 24). Eating polyphenol-rich foods effectively prevents these fats from being oxidized during digestion (25). One consequence of this appears to be better absorption and assimilation of the exceptionally fragile omega-3 polyunsaturated fatty acids (26).

What does it all Mean?

I think that overall, the evidence suggests that polyphenol-rich foods are healthy in moderation, and eating them on a regular basis is generally a good idea. Certain other plant chemicals, such as suforaphane found in cruciferous vegetables, and allicin found in garlic, exhibit similar effects and may also act by hormesis (27). Some of the best-studied polyphenol-rich foods are tea (particularly green tea), blueberries, extra-virgin olive oil, red wine, citrus fruits, hibiscus tea, soy, dark chocolate, coffee, turmeric and other herbs and spices, and a number of traditional medicinal herbs. A good rule of thumb is to "eat the rainbow", choosing foods with a variety of colors.

Supplementing with polyphenols and other plant chemicals in amounts that would not be achievable by eating food is probably not a good idea.


* The "paradox" whereby the French eat a diet rich in saturated fat, yet have a low heart attack risk compared to other affluent Western nations.

** Genes containing an antioxidant response element (ARE) in the promoter region. ARE is also sometimes called the electrophile response element (EpRE).

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The Diabetes Epidemic

The CDC just released its latest estimate of diabetes prevalence in the US (1):

Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes—7 million Americans—do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older.

Wow-- this is a massive problem. The prevalence of diabetes has been increasing over time, due to more people developing the disorder, improvements in diabetes care leading to longer survival time, and changes in the way diabetes is diagnosed. Here's a graph I put together based on CDC data, showing the trend of diabetes prevalence (percent) from 1980 to 2008 in different age categories (2):

These data are self-reported, and do not correct for differences in diagnosis methods, so they should be viewed with caution-- but they still serve to illustrate the trend. There was an increase in diabetes incidence that began in the early 1990s. More than 90 percent of cases are type 2 diabetics. Disturbingly, the trend does not show any signs of slowing.

The diabetes epidemic has followed on the heels of the obesity epidemic with 10-20 years of lag time. Excess body fat is the number one risk factor for diabetes*. As far as I can tell, type 2 diabetes is caused by insulin resistance, which is probably due to energy intake exceeding energy needs (overnutrition), causing a state of cellular insulin resistance as a defense mechanism to protect against the damaging effects of too much glucose and fatty acids (3). In addition, type 2 diabetes requires a predisposition that prevents the pancreatic beta cells from keeping up with the greatly increased insulin needs of an insulin resistant person**. Both factors are required, and not all insulin resistant people will develop diabetes as some people's beta cells are able to compensate by hypersecreting insulin.

Why does energy intake exceed energy needs in modern America and in most affluent countries? Why has the typical person's calorie intake increased by 250 calories per day since 1970 (4)? I believe it's because the fat mass "setpoint" has been increased, typically but not always by industrial food. I've been developing some new thoughts on this lately, and potentially new solutions, which I'll reveal when they're ready.


* In other words, it's the best predictor of future diabetes risk.

** Most of the common gene variants (of known function) linked with type 2 diabetes are thought to impact beta cell function (5).

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Eating Wheat Gluten Causes Symptoms in Some People Who Don't Have Celiac Disease

Irritable bowel syndrome (IBS) is a condition characterized by the frequent occurrence of abdominal pain, diarrhea, constipation, bloating and/or gas. If that sounds like an extremely broad description, that's because it is. The word "syndrome" is medicalese for "we don't know what causes it." IBS seems to be a catch-all for various persistent digestive problems that aren't defined as separate disorders, and it has a very high prevalence: as high as 14 percent of people in the US, although the estimates depend on what diagnostic criteria are used (1). It can be brought on or exacerbated by several different types of stressors, including emotional stress and infection.

Maelán Fontes Villalba at Lund University recently forwarded me an interesting new paper in the American Journal of Gastroenterology (2). Dr. Jessica R. Biesiekierski and colleagues recruited 34 IBS patients who did not have celiac disease, but who felt they had benefited from going gluten-free in their daily lives*. All patients continued on their pre-study gluten-free diet, however, all participants were provided with two slices of gluten-free bread and one gluten-free muffin per day. The investigators added isolated wheat gluten to the bread and muffins of half the study group.

During the six weeks of the intervention, patients receiving the gluten-free food fared considerably better on nearly every symptom of IBS measured. The most striking difference was in tiredness-- the gluten-free group was much less tired on average than the gluten group. Interestingly, they found that a negative reaction to gluten was not necessarily accompanied by the presence of anti-gluten antibodies in the blood, which is a test often used to diagnose gluten sensitivity.

Here's what I take away from this study:

1. Wheat gluten can cause symptoms in susceptible people who do not have celiac disease.
2. A lack of circulating antibodies against gluten does not necessarily indicate a lack of gluten sensitivity.
   
3. People with mysterious digestive problems may want to try avoiding gluten for a while to see if it improves their symptoms**.
4. People with mysterious fatigue may want to try avoiding gluten.
   

A previous study in 1981 showed that feeding volunteers a large dose of gluten every day for 6 weeks caused adverse gastrointestinal effects, including inflammatory changes, in relatives of people with celiac disease, who did not themselves have celiac (3). Together, these two studies are the most solid evidence that gluten can be damaging in people without celiac disease, a topic that has not received much interest in the biomedical research community.

I don't expect everyone to benefit from avoiding gluten. But for those who are really sensitive, it can make a huge difference. Digestive, autoimmune and neurological disorders associate most strongly with gluten sensitivity. Avoiding gluten can be a fruitful thing to try in cases of mysterious chronic illness. We're two-thirds of the way through Gluten-Free January. I've been fastidiously avoiding gluten, as annoying as it's been at times***. Has anyone noticed a change in their health?


* 56% of volunteers carried HLA-DQ2 or DQ8 alleles, which is slightly higher than the general population. Nearly all people with celiac disease carry one of these two alleles. 28% of volunteers were positive for anti-gliadin IgA, which is higher than the general population.

** Some people feel they are reacting to the fructans in wheat, rather than the gluten. If a modest amount of onion causes the same symptoms as eating wheat, then that may be true. If not, then it's probably the gluten.

*** I'm usually about 95% gluten-free anyway. But when I want a real beer, I want one brewed with barley. And when I want Thai food or sushi, I don't worry about a little bit of wheat in the soy sauce. If a friend makes me food with gluten in it, I'll eat it and enjoy it. This month I'm 100% gluten-free though, because I can't in good conscience encourage my blog readership to try it if I'm not doing it myself. At the end of the month, I'm going to do a blinded gluten challenge (with a gluten-free control challenge) to see once and for all if I react to it. Stay tuned for more on that.

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Dairy Fat and Diabetes

Introduction

Having access to embargoed news from the Annals of Internal Medicine is really fun. I get to report on important studies at the same time as the news media. But this week, I got my hands on a study that I'm not sure will be widely reported (Mozaffarian et al. Trans-palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in US Adults. Ann Internal Med. 2010). Why? Because it suggests that dairy fat may protect against diabetes.

The lead author is Dr. Dariush Mozaffarian, whose meta-analysis of diet-heart controlled trials I recently criticized (1). I think this is a good opportunity for me to acknowledge that Dr. Mozaffarian and his colleagues have published some brave papers in the past that challenged conventional wisdom. For example, in a 2005 study, they found that postmenopausal women who ate the most saturated fat had the slowest rate of narrowing of their coronary arteries over time (2). It wasn't a popular finding but he has defended it. His colleague Dr. Walter Willett thinks dietary fat is fine (although he favors corn oil), whole eggs can be part of a healthy diet, and there are worse things than eating coconut from time to time. Dr. Willett is also a strong advocate of unrefined foods and home cooking, which I believe are two of the main pillars of healthy eating.

Let's hit the data

Investigators collected two measures of dairy fat intake in 3,736 Americans:

1. 24 hour dietary recall questionnaires, six times. This records volunteers' food intake at the beginning of the study.
2. Blood (plasma phospholipid) content of trans-palmitoleate. Dairy fat and red meat fat are virtually the only sources of this fatty acid, so it reflects the intake of these foods. Most of the trans-palmitoleate came from dairy in this study, although red meat was also a significant source.

After adjustment for confounding factors, trans-palmitoleate levels were associated with a smaller waist circumference, higher HDL cholesterol, lower serum triglycerides, lower C-reactive protein, lower fasting insulin and lower calculated insulin resistance. Furthermore, people with the highest trans-palmitoleate levels had 1/3 the risk of developing diabetes over the three years volunteers were followed. Keep in mind, however, that this is an observational study and does not prove that dairy fat prevents diabetes.

Even though certain blood fatty acids partially represent food intake, they can also represent metabolic conditions. For example, people on their way to type II diabetes tend to have more saturated blood lipids, independent of diet (3, 4)*. So it's reassuring to see that dietary trans-palmitoleate intake was closely related to the serum level. The investigators also noted that "greater whole-fat dairy consumption was associated with lower risk for diabetes," which increases my confidence that serum trans-palmitoleate is actually measuring dairy fat intake to some degree. However, in the end, I think the striking association they observed was partially due to dairy fat intake, but mostly due to metabolic factors that had nothing to do with dairy fat**.

Here's a nice quote:

Our findings support potential metabolic benefits of dairy consumption and suggest that trans-palmitoleate may mediate these effects***. They also suggest that efforts to promote exclusive consumption of low-fat and nonfat dairy products, which would lower population exposure to trans-palmitoleate, may be premature until the mediators of the health effects of dairy consumption are better established.

Never thought I'd see the day! Not bad, but I can do better:

Our findings support eating as much butter as possible****. Don't waste your money on low-fat cream, either (half-n-half). We're sorry that public health authorities have spent 30 years telling you to eat low-fat dairy when most studies are actually more consistent with the idea that dairy fat reduces the risk obesity and chronic disease.

What are these studies suggesting that dairy fat may be protective, you ask? That will be the topic of another post, my friends.


*Probably due to uncontrolled de novo lipogenesis because of insulin resistance. Many studies find that serum saturated fatty acids are higher in those with metabolic dysfunction, independent of diet. They sometimes interpret that as showing that people are lying about their diet, rather than that serum saturated fatty acids don't reflect diet very well. For example, in one study I cited, investigators found no relationship between dietary saturated fat and diabetes risk, but they did find a relationship between serum saturated fatty acids and diabetes risk (5). They then proceeded to refer to the serum measurements as "objective measurements" that can tease apart "important associations with diabetes incidence that may be missed when assessed by [food questionnaires]." They go on to say that serum fatty acids are "useful as biomarkers for fatty acid intake," which is true for some fatty acids but not remotely for most of the saturated ones, according to their own study. Basically, they try to insinuate that dietary saturated fat is the culprit, and the only reason they couldn't measure that association directly is that people who went on to develop diabetes inaccurately reported their diets! A more likely explanation is that elevated serum saturated fatty acids are simply a marker of insulin resistance (and thus uncontrolled de novo lipogenesis), and had nothing to do with diet.

**Why do I say that? Because mathematically adjusting for dairy and meat fat intake did not substantially weaken the association between phospholipid trans-palmitoleate and reduced diabetes risk (Table 4). In other words, if you believe their math, dairy/meat fat intake only accounted for a small part of the protective association. That implies that healthy people maintain a higher serum phospholipid trans-palmitoleate level than unhealthy people, even if both groups eat the same amount of trans-palmitoleate. If they hadn't mentioned that full-fat dairy fat intake was directly associated with a lower risk of diabetes, I would not find the study very interesting because I'd have my doubts that it was relevant to diet.

***I find it highly doubtful that trans-palmitoleate entirely mediates the positive health outcomes associated with dairy fat intake. I think it's more likely to simply be a marker of milk fat, which contains a number of potentially protective substances such as CLA, vitamin K2, butyric acid, and the natural trans fats including trans-palmitoleate. In addition, dairy fat is low in omega-6 polyunsaturated fat. I find it unlikely that their fancy math was able to tease those factors apart, because those substances all travel together in dairy fat. trans-palmitoleate pills are not going to replace butter.

****That's a joke. I think butter can be part of healthy diet, but that doesn't mean gorging on it is a good idea. This study does not prove that dairy fat prevents diabetes, it simply suggests that it may.

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Choline and Fatty Liver

I've been writing about non-alcoholic fatty liver disorder (NAFLD) since the early days of this blog, because it's an alarmingly common disorder (roughly a quarter of Americans affected) that is typically undiagnosed. It often progresses into its more serious cousin non-alcoholic steatohepatitis (NASH), an inflammatory condition that causes liver damage and can progress to cancer. In a number of previous posts, I pinpointed excess sugar and seed oil consumption as culprits in NAFLD and NASH (1, 2, 3, 4, 5).

Chris Masterjohn recently published two very informative posts on NAFLD/NASH that add a major additional factor to the equation: choline (6, 7). Choline is an essential nutrient that's required for the transport of fat out of the liver (8). NAFLD can be caused, and cured, simply by removing or adding dietary choline, and it appears to be dominant over other dietary factors including fat, sugar and alcohol. Apparently, certain researchers have been aware of this for some time, but it hasn't entered into the mainstream consciousness.

Could that be because the richest dietary sources are liver and eggs*? Choline is also found in smaller amounts in a variety of whole animal and plant foods. Most people don't get the officially recommended amount. From a recent review article (9):

Mean choline intakes for older children, men, women, and pregnant women are far below the adequate intake level established by the [Institute of Medicine]. Given the importance of choline in a wide range of critical functions in the human body, coupled with less-than-optimal intakes among the population, dietary guidance should be developed to encourage the intake of choline-rich foods.

I've dubbed beef liver the Most Nutritious Food in the World, Nature's Multivitamin, and I'll probably invent other titles for it in the future. Add yours to the comments. Learn to love liver! I think it's an excellent food to eat on a weekly basis.

Head over to Chris's blog and read about the classic studies he unearthed. And add The Daily Lipid to your RSS reader, because there's more interesting material to come!

The Sweet Truth about Liver and Egg Yolks
Does Choline Deficiency Contribute to Fatty Liver in Humans?


* For the brave: brain is actually the richest source of choline.

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DIPHTHERIA

Diphtheria is an infectious disease caused by bacteria (Corynebacterium diphtheriae). Diphtheria occurs worldwide. The pathogen is spread mainly by droplet or contact infection or by dust. The diseases are piling up in the winter months. The time from infection to onset of the disease (incubation period) is 2-5 days. The infection is usually localized in the throat.

Symptoms:
The diphtheria pathogens produce a toxin (poison) that is responsible for the actual disease.

Localized diphtheria:
The bacteria remain localized to the throat, nose and throat area. The venom produced by them out at these points to a mucous membrane inflammation with formation of sweet-smelling, gray-white surfaces. Once the documents are rejected and they persist in the mucous membrane ulcers. Diphtherieart This is mostly benign, which means it is cured without leaving any significant damage.

Toxic diphtheria:
The inflammation and the formation of the gray-white documents is spreading to the trachea and bronchi. Breathing is difficult or even impossible hampered made so threatening that the sufferers of suffocation. The toxic effects are evident not only locally, but the poison attacks vital organs. It comes to the heart muscle damage that can lead even weeks after the disease to sudden cardiac death. Due to the damage of the nervous system can paralysis of eye muscles, leading to vision impairment, paralysis in the area of the soft palate, which lead to change hands, and later can form even paralysis of the neck muscles and arms.

Therapy:
As early as possible to the diphtheria antitoxin (antidote) to be administered. The bacteria themselves are fought by means of antibiotic.

Prophylaxis (prevention):
1. Vaccination:
* Against the poison of the diphtheria bacteria can you protect yourself by a vaccination. This consists of a toxoid, which rendered harmless poison the bacteria against which it is formed by the vaccine antibody. If you later come in contact with diphtheria bacteria, the body can immediately defend themselves against the bacterial toxin.
* In infants, the first Vaccination is administered at 3 months, usually in combination with a vaccination against tetanus. At 18 months, he is the 2nd Vaccination. At enrollment and at age 10, a booster dose should be performed. The vaccinations will be about 10 years, and receive should be re-refresh. The vaccine can be made up at any age.
* In recent years, occurred more frequently on diphtheria epidemic in the countries of the former Soviet Union. Should also remain vaccination fatigue persist, in the years to expect a rise in diphtheria disease.

2. Treatment of the bacteria carrier:
* Homemade diphtheria leaves a protection against the poison of the bacteria, but not against the bacteria itself this can spread the disease further support healthy bacteria. It is important to isolate the bacteria carrier and treated until they are free from bacteria.

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OSTEOARTHRITIS - joint pain.

Osteoarthritis refers to the wear of the joints. Every joint is covered by a protective layer of cartilage that prevents bone rubs on bone and stress buffers. In osteoarthritis this cartilage is damaged. If the disease progresses, the protective layer is eventually lost altogether. Damaged cartilage is not able to regenerate itself again. This is also the reason why violations of the joint where the cartilage is affected, can lead to premature arthritis. The wear of the bone is increasingly overloaded. He responded with the formation of new bone tissue, leading to compaction and extractions around the affected sections. Symptoms of osteoarthritis are pain and limited mobility. Typical complaints are at the beginning of a movement (known as "start-up pain") and during exercise. They are worse in cold or wet weather. Usually hurts a joint osteoarthritis is not at rest or at night.

The most affected are the spine, hips, knees and fingers. In the course of the disease can cause inflammation of other episodes with Disabilities, swelling and tightness. In the long run to deform the joints. 50% of all people over the age of 35 Age already show arthritic changes and from 60th Years have almost all men more or less pronounced - often barely noticeable osteoarthritis.

Common causes:
* Cartilage wear with age.
* Overweight.
* Repeated and severe mechanical stress.
* Past injuries.
* Deformities of the joints.
* Genetic factors (heredity).
* Metabolic disorders.

What can you do?
* To reduce weight.
* Adequate and regular low-impact exercise such as cycling or swimming.
* Strong single-sided loads and avoid overloading the joints.

When you need a doctor?
* If you have time and again pain in the joints that get better after a short duration of movement, especially if the affected joint was injured before and / or are overweight.
* If a joint swelling and / or is heated.

What your doctor can do?
Even the exact description of your symptoms may be indicative of osteoarthritis. The most important investigation to confirm the diagnosis, the X-ray. Here the narrowed gap shows in the joint as a result of the damaged cartilage. In advanced stages are also the bone reactions (condensation, extractions) are identifiable. The visible changes must in no way related to the actual problems in context. May be present at low X-ray signs of arthrosis in severe pain and vice versa.
Osteoarthritis is unfortunately not curable. The goal of treatment is to relieve pain and prevent infection relapses. These are prescribed:

* Anti-rheumatic drugs (e.g. diclofenac, coxibs)
* Pain-relieving medications (for example, ibuprofen)
* Cortisone drugs, often given as an injection into the affected joint.
* Injections of hyaluronic acid into the affected joint.
* The application of heat in the inflammation-free period, cold in inflammation.
* Physiotherapy

In advanced osteoarthritis, surgery is usually necessary. In the knee joint often reflections (arthroscopy) are performed in which the joint is flushed and cleaned it of abraded cartilage and bone particles is. At the same time smoothing of the articular surface is possible. If there are deformities of the joints such as X-or O-legs, give it the possibility of surgical correction, which can prevent the progression of osteoarthritis in logs. If the joint is completely destroyed, only the replacement is with prosthesis. Most often this procedure is performed at the hip, followed by knee prostheses.

Prevention:
* To reduce weight.
* Adequate and regular exercise.
* Unilateral avoid stress. Repeated and severe mechanical stress avoided.
* There is evidence that a healthy diet reduces the risk of developing osteoarthritis.

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NECK PAIN - ANGINA

Neck pain as a symptom of an isolated, caused by viruses or bacteria causing infection, usually but they are symptoms of a cold. By pathogens causes inflammation of the mucous membrane in the neck. Depending on where the pathogen colonizes a distinction between throat infections (pharyngitis), vocal cord or laryngeal inflammation (laryngitis) or tonsillitis (tonsillitis or tonsillitis). When symptoms occur redness, scratching and pain in the neck and difficulty swallowing. In an angina become swollen and red and can infected tonsils. There is often a fever. If the larynx or vocal cords inflamed, it comes in addition to hoarseness. Often, swollen as a sign of alerted immune system, the lymph nodes, lower jaw and neck. Apart from bacteria and viruses, neck pain or inflammation in the throat may also overuse of the voice and irritation of the respiratory system is triggered (e.g. by chemical or dust).

Important: Most tonsillitis is caused by specific types of streptococcal bacteria. These should be treated by a doctor with antibiotics to prevent possible complications such as diseases of the joints, heart or kidney.

Common causes:
* Colds, flu, tonsillitis.
* Overuse of the voice through singing, shouting, long speeches.
* Respiratory irritation from smoke or dusty, dry air.
* Other diseases, e.g. Glandular fever, croup, mumps.

What can you do?
* Drink plenty.
* Keep warm, particularly in the throat and chest, but do not sweat.
* In winter, the air humid.
* Disinfectant gargles, mouth sprays and lozenges (eg hexetidine or cetylpyridinium chloride) can help.
* In mild redness and pain are anti-inflammatory lozenges or rinses (such as chamomile or sage extracts to flush, dexpanthenolhaltige tablets to suck).
* If there is pain and difficulty swallowing help lozenges or sprays with superficial narcotics.
* If pain is stronger anti-inflammatory painkillers to be taken with aspirin or paracetamol sense they reduce fever.
* The local application of antibiotics is usually not useful.

When you need a doctor?
* If the symptoms get worse or do not improve after three days.
* If fever occurs.
* If you suspect tonsillitis.
* If you experience difficulty breathing.

What your doctor can do.
* Determine the cause.
* When a bacterial infection is treated with antibiotic drugs.
* For frequent tonsillitis, it may be advisable to remove the tonsils surgically.

Prevention:
* As for colds (colds and flu).

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ALZHEIMER'S DISEASE - DISEASE

In Alzheimer's disease or Alzheimer's disease causes progressive memory and concentration problems, and disorientation to orientation. The brain of the patients has a decrease in volume and usually deposits on certain proteins. Initial symptoms are often nonspecific, such as headaches, dizziness and general inefficiency. Gradually the patient forgetful, confused and can only cope with familiar tasks. Difficulty in speaking, reading writing and arithmetic to connect. Personality and attitude have remained outside often get surprisingly long time. With increasing duration of the disease leads to a slow deterioration of the personality, can also be adjusted depression, delusions and aggressive behavior. Patients are more and more nursing care. Particularly for the families, the disease is often a great mental and physical stress. The onset usually between 7 and 8 Decade of life. In rare cases, even younger people over the age of 40 Age affected.

Common causes:
The exact cause is still unknown. Are discussed inter alia hereditary metabolic disorders and stress.

What can you do?
* Keep your mind fit, wear contacts with others, maintaining interest and participation in the events of the day to this.
* Various preparations to improve the performance offered, the benefits are disputed.

When you need a doctor?
* If the symptoms of Alzheimer’s disease (above) show, you should go to the doctor.

What your doctor can do?
* The doctor may first determine whether it is Alzheimer's disease.
* The brain training and movement therapy can be, especially in the initial stage, reach a certain performance.
* There are several medications for the treatment of Alzheimer's disease are available that can slow the disease and alleviate symptoms are helping. The disease is not yet curable.

Prevention:
Is not possible.

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WEIGHT PROBLEMS - ABOUT WEIGHT - OBESITY

If the man is more energy in the form of food is actually consumed than he, he will over time be overweight. To lose weight, eat less than he must be either consumed or its energy consumption, eg increase significantly due to sport or physical work. Of obesity is when the weight is above normal weight. Reference for the normal weight, the body mass index, which represents the body weight in relation to body length: BMI = body mass index = weight (kg) / Height (m2). With a BMI (kg / m2) 18.5 to 24.9 you are normal. At a BMI of 25-30 is referred to as overweight, a BMI of 30 is obesity (obesity) in front.

The energy supply and energy consumption of the body are measured in kilocalories (kcal) or kilojoules (kJ). A kilocalorie equivalent to 4.184 joules. The daily calorie requirement of an adult depends on body size and daily work. For a desk worker he is about 2500 kcal or 10 500 kJ, a forest worker needs about 3700 kcal or 15400 kJ. The need for food energy is increased during exercise, in growth and in pregnancy and lactation. The diet should consist ideally of 15% protein, 30% fat and 55% carbohydrates. With the help of tables, the calorie content of food energy are detected.

A malfunction of the appetite-regulating saturation can also lead to obesity as satiety is not perceived. Certain eating patterns are already instilled in childhood. In addition, it has been found in animal experiments that there are different assessments. One is more inclined to save their energy surplus in fat deposits (fat cells), while the other converts it into heat. Rare behind obesity put a serious disease or hormonal disorders.

Consequences of obesity.
* Metabolic disorders (diabetes, gout, high cholesterol).

* The risk of developing high blood pressure, heart attack, stroke, arteriosclerosis, fatty liver, thrombosis, joint disease, gall stones is increasing significantly.

* The risk of accidents and the risk of complications during surgery are increased. Life expectancy is shortened.

What can you do?
* You should take more time for eating. Chew well and perform any other activities on the side.

* It should be taken in the top five small meals a day.

* Before eating always drink a large glass of liquid, which reduces appetite.

* Each diet should you drink a lot (at least 2l) best calorie-free beverages such as Mineral water.

* Any diet should be accompanied by regular, physical activity.

* The only sensible diet consists of a reduced-calorie mixed diet, a balanced diet with plenty of fresh products (such as Brigitte diet). * One-sided diets (e.g., rice diet, Hollywood diet) are not recommended because they produce most of a deficiency of certain nutrients, vitamins or minerals and do not lead to permanent changes in diet habits.

* Dietary-ready meals can replace a meal now and then.

* Formula diets are powders, granules or drinks with a well-defined nutrient, vitamin and mineral content. They are suitable only for short diets by 2-3 pounds to lose or to replace some meals in a diet.

* Laxatives (e.g. senna), diuretics (e.g., algae extract, birch leaves, pineapple enzyme) and Purification (e.g., senna leaves and birch leaves) only lead to a short-term, increased water excretion. It can permanently important minerals are lost. In addition, the regular use of laxatives leads to constipation. A real weight loss is not the case.

* Appetite suppressants appetite-dampening effect of chemical substances on the brain. Because of side effects, many patients take these drugs do not (e.g., increases in blood pressure in hypertension). Even in healthy patients themselves can have side effects, often nervous.

* Plant (e.g., mate tea) or homeopathic medicines (e.g., Helianthus tuberosus drops) should also reduce the appetite.

* So-called Fat Blocker from the USA do not contain any fundamentally new substances for losing weight, but mainly vitamins.

* Fasting recommended only under medical supervision. Wrong fasting or fasting in existing underlying diseases can have serious consequences, e.g. Kidney stones, heart damage, gout attacks every day drinking, etc. In any case at a diet at least 3 liters. Despite approximately 400 g weight loss per day is also here: long-term success is rare, if not also the diet is changed.

* Together to decrease with others (e.g. Weight Watchers) can strengthen the will to weight loss.

* Keeping a food diary may be the beginning of a weight reduction therapy a means to control their own eating habits.

* It is important to a permanent change of diet to avoid in the future and to maintain the lower weight.

When you need a doctor.
* If you get your excess weight is not even in the handle.

* If have set sequelae of obesity.

What your doctor can do.
* You advise on the nutritional and life change.

* A prescribed drug that triggers an increased feeling of satiety.

* Recently, a new drug containing the active ingredient orlistat on the market, which inhibits the digestion of fat. Thus about 30% of dietary fats are not absorbed by the intestine. It comes to the elimination of high fat chairs. At the same time the recording is the fat-soluble vitamins A, E, D and K decreased. Therefore it makes sense to also take a multivitamin themselves. Since taking orlistat experience different changes and side effects, medical monitoring is important.

* In extreme cases of obesity can be caused by a stomach operation that occurs even with small amounts of food satiety.

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ULCERATIVE COLITIS

Ulcerative colitis is a chronic inflammatory disease of the colon, which usually runs in batch mode. It often begins in the rectum and can continuously from there spread throughout the large intestine. The exact cause is unknown. As with Crohn's disease but there is evidence that it is an autoimmune disease. This means the body's immune system is directed against its own for unknown reasons and causes intestinal inflammation. There are also some hereditary predisposition for ulcerative colitis. May also play a role in bacteria or viruses. In some patients will deteriorate over also to inflammation of other organs, particularly the joints, biliary tract and skin.

In Germany around 170,000 people suffering from ulcerative colitis, the disease usually begins between the 20th and 40 years of age. Both sexes are equally affected often. The disease is highly individual and can not be predicted. Patients with ulcerative colitis have an increased risk of colon cancer. This risk increases with duration of disease and the extent of the inflammation.

The following symptoms may occur in ulcerative colitis:

* Severe diarrhea, often with blood in
* Painful bowel movement (tenesmus)
* Weight loss
* Tiredness, fatigue, loss of appetite
* Fever
* Painful joints
* Dermatitis
When such symptoms occur, you should consult a doctor.

What complications are possible

* Hemorrhage: Is the loss of blood through the intestines too large may be needed blood transfusions. Also is a surgical procedure required

* Intestinal perforation (perforation): If the intestinal wall breaks through, the intestinal content reaches the abdominal cavity, where it can cause acute life-threatening infections.

* Toxic megacolon: The toxic megacolon is an acute, maximum expansion of the large intestine, which can by a severe attack of ulcerative colitis can be triggered. The toxic megacolon resulting in a life-threatening bowel obstruction and to threaten a breakdown of the intestinal wall. Symptoms include severe pain, fever and massive circulation problems.

How your doctor makes the diagnosis.

* Laboratory tests: are ulcerative colitis in the acute episode of increased inflammation in the blood values (e.g., increase in white blood cells). Often the same is anemia (anemia) before.
* Ultrasound: Some intestinal changes show up in ulcerative colitis as early as ultrasound, for example, a thickening of the bowel wall
* Colonoscopy: Here are the altered areas clearly visible. At the same time, samples can be taken for microscopic examination.
* X-ray / MRI: After administration of a contrast agent in the intestine can be considered X-ray or MRI. Thus, the inflamed areas are made visible.

Especially important is the differentiation of ulcerative colitis compared to the second major chronic inflammatory bowel disease, Crohn's disease. In spite of all diagnostic procedures, this distinction does not succeed in all patients. Here, only the future course of the disease shed.
What your doctor can do.
Basically, between the treatment of active ulcerative colitis and treatment differences in relapse-free interval.

* Cortisone-containing preparations: they dampen the acute inflammatory effective one. If only the rectum is affected, as can cortisone enema may be used. By the local effect the cortisone out there to fewer side effects throughout the body.
* Immunosuppressants: suppressing drugs such as cyclosporine, the immune system and may additionally be required in severe exacerbations.

* Diet: In addition to any drug therapy is recommended during an acute episode of low-fiber diet with liquid food, severe flares can also be an artificial diet is required.

Chronic active history:
In this course, despite a long-term drug therapy of ulcerative symptoms persist.

* Immunosuppressants: Here comes mainly azathioprine, the substance used, which also suppresses the immune system.
* Infliximab: In some cases, used this drug, which is among the biologics. It is an antibody that is directed against the body's own TNF-alpha (tumor necrosis factor). TNF-alpha plays an essential role in triggering inflammation. All immune-regulating drugs may be associated with serious side effects and are therefore used only with extreme caution and close monitoring. However, it is especially in severe cases with infliximab achieved today are often successful treatment, which seemed in earlier times hard to reach. The use of biologics in ulcerative colitis leads - this was demonstrated in studies - for sustainable healing of the intestinal mucosa. The focus is on this type of treatment, the intention of the aggressive disease activity crucial to counteract. The main goal is ultimately to avoid extensive surgery of the digestive tract, which almost always take an irretrievable loss of bowel segments for security.

Intermittent therapy

In ulcerative colitis and in relapse-free interval, a long-term therapy is recommended.
* Aminosalicylates (mesalazine, sulfasalazine,): they block is the impact of endogenous substances that are responsible for the inflammatory process reactors, on the other they also their production. They also reduce the risk of cancer. Depending on the location of the infestation, they are used as tablets, suppositories or enemas. Cancer screening should because of the increased risk of colon cancer from 8 Year of illness once a year, a colonoscopy with removal of samples are carried out.

Treatment of complications
In case of serious complications, an operation is unavoidable. The type of surgery depends on the present findings. In very severe cases, doctors will have to take even the entire removal of the colon into consideration. Since biologics can be used, can often prevent these situations.

What can you do.
Basically, your diet should mainly consist of light food. It includes whole-grain breads, rice, pasta, vegetables, fresh fruits and salads, low-fat dairy products and low-fat meats. Any form of dietary fiber promotes healthy digestion. Sugar-containing products and those should be avoided rather high in white flour.

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Heart disease.

Coronary heart disease (CHD) and angina pectoris.

The heart is through several small arteries - known as coronary arteries or coronary arteries - supplied with blood. In the course of years and decades, can form deposits in these vessels, leading to narrowing. Through these Coronary heart diseases (CHD), the heart will be congested. In the worst case threatens the complete blockage of a coronary vessel and thus the heart attack. CHD and its consequences in industrialized countries are among the most common causes of death. With increasing age deposits in vessels are almost inevitable. There's also a genetic predisposition to CHD. In addition, women with up to the menopause their estrogen production some protection, so that the CAD in them usually occurs later. Besides these non-changing circumstances, there are also factors favoring the occurrence of CHD and can be managed by it, or at least influenced.

Risk factors for coronary heart disease:

* Smoking
* Poor diet
* Lack of exercise
* Obesity
* Stress
* Metabolic disorders, for example elevated cholesterol levels.
* Diabetes
* High blood pressure

Coronary heart disease is insidious because it can progress for a long time without any complaints. Often make the first contractions felt when the heart has an increased oxygen demand, eg during exercise. Then the typical symptom angina pectoris (literally, "chest tightness"). It manifests itself by a strong feeling of pressure or tightness and pain in the chest area. Sometimes this pain also radiate to the left arm, shoulder, neck or in the stomach and are then brought immediately to the heart related. These "attacks" usually last only a few seconds to minutes. Other possible symptoms include dyspnea on exertion or significant arrhythmia of the heart like an extra beat or dropouts. Connect to one or more of these symptoms, you should absolutely see a doctor.

What your doctor can do.

The normal ECG can be completely normal in a coronary heart disease. Much more information provides a stress test. This is often seen that the oxygen supply is no longer the heart during exercise enough. The safest method for the detection of coronary artery disease is cardiac catheterization. Over the bar a small plastic tube (catheter) into the heart is advanced. Then doctors inject contrast medium into the coronary arteries, thus narrowing are clearly visible. Confirmed the diagnosis, various drugs are used to improve blood flow and / or relieve the heart. In addition, possible accompanying diseases such as hypertension, diabetes and lipid disorders are treated. For acute angina pectoris attack, the doctor will prescribe nitroglycerin preparations, e.g. as a spray. They cause an immediate enlargement of the vessels. If the narrowing progressed very far, it is possible to dilate the affected artery mechanically, for example using a balloon. For security a stent (stent) may be used. As the last remaining opportunity for a bypass operation. Here, small replacement vessels - mostly veins from the legs - is removed and sewn as a bridge of the narrowed vessels.

What can you do.

* Give up smoking
* Lose weight
* Do you move enough
* Eat a low fat
* Reduce Stress
* Carry your emergency medication with you at all
* If you are diabetic, watch out for the good attitude of your blood sugar levels
* Do you suffer from high blood pressure, take your medication faithfully

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CHOLERA

Causes / spread

Cholera is a bacterial (Vibrio cholerae) caused disease. The pathogens enter the human waste in the waste water and from there into the water and in certain foods (milk, shellfish). About one fifth infected diseased, malnourished people are particularly vulnerable. All those infected, including the non-diseased part, the cause of, however, and can thus promote the spread of the disease.

Cholera occurs where there is poor hygiene, poverty, famine or war. Their last cholera epidemic in Germany about 100 years ago in Hamburg and it could be contained only when it had provided clean drinking water and the rehabilitation of the poor hygienic conditions.

Symptoms:

A few days after infection there are massive watery diarrhea and severe vomiting. That last for almost a week. The patients can lose up to 10 liters of fluid a day. If the liquid, and the lost electrolytes (salts) are not replaced, there is dehydration phenomena. At lift off the skin wrinkles remain, there is a strong thirst, muscle cramps and it connect to it eventually can cause a life-threatening circulatory collapse. The disease leaves only a partial immunity. This means that you can once again become ill with cholera.

Therapy:

First and foremost, to replace the lost water and electrolytes by appropriate infusions. Antibiotics against the pathogens are shown.



Prophylaxis (prevention):

1. Good sanitation.
The best prevention is good sanitation, clean water and good nutrition. In countries with dubious hygiene should pay attention to proper water and avoid eating raw foods.

2. Vaccination.
Vaccination against cholera is possible, but does not provide complete protection. So you can fall ill, despite the vaccination, even if the disease is then attenuated. Even if you are not sick, the vaccine can not prevent that you are infected, eliminated the pathogen and thus contributes to the spread of cholera.

3. Isolation.
The separation of the cholera pathogen must be isolated until they are pathogen free.

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