Fish Oil and Heart Health

Cardiovascular disease is the leading cause of death in the United States, and most of us know someone whom heart disease has affected in one way or another. In honor of heart health month (February) I interviewed Dr Aimee Gould Shunney medical advisor for Nordic Naturals and Naturopathic Physician. We talked about how fish oil supplementation can have a positive effect on the cardiovascular system, lowering risk of stroke, high blood pressure, heart attack and blood clots and improving lipid profiles (TG, LDL, HDL).

Omega 3 Are Essential
Omega 3 fats, found in fish oil, are long chain fatty acids which the human body cannot produce- thus essential. Omega 6 is also an essential long chain fatty acid; however we get plenty of this through our diet. Omega 3, found in certain nuts, fish and grass fed beef is commonly missing from the typical American diet.

Omega 3’s Keep Cell Membranes Healthy
Omega 3 fats play many roles in the health of our bodies, one of which is to keep cell membranes fluid and flexible. When the cell membrane becomes rigid from poor fats in the diet, receptors can’t functions well, movement of fluid and nutrients in and out of the cell is hampered and the cell is unable to its job optimally. This is very important in cardiovascular health. The blood vessels, like cell walls, need to be flexible. Rigidity of the blood vessel indicates plaque formation and can lead to hypertension and other cardiovascular problems.

Omega 3’s Improve Lipid Profiles
I fondly think of my physiology professor every time I look at a patient’s lipid profile. She taught us that the LDL acts as a Litter bug in the blood, depositing cholesterol throughout that the cardiovascular system, while HDL is working as the Highway patrol picking up the littered cholesterol and triglycerides and bringing them back to the liver where it is excreted or re-utilized. Omega 3 fats in fish oil increase HDL effectively increasing the Highway patrol and reducing LDL and triglycerides (Litter bugs) therby reducing the risk for heart disease, MI, atherosclerosis and stroke.

As for LDL, the litter bugs of the cholesterol milieu, omega 3 fatty acids do not seem to simply reduce number of circulating LDL particles. However, it does change the subtypes of LDL cholesterol, for the better. LDL type A- the lighter fluffier type of LDL is increased by omega 3 fats , and LDL type B- the denser, stickier subtype that is atherogenic, is decreased. In combination with the increase in HDL (highway patrol) and reduction in triglycerides, the total LDL number becomes less of a risk factor. These sub types are available when you look at an expanded cholesterol panel like the VAP test which measures cholesterol, HDL, LDL, LDL size patterns and subtypes of cholesterol.

Omega 3's Reduce C Reactive Protein:
C reactive protein is increased in the blood as a results of inflammation in the body. It has also been implicated as a risk factor for cardiovascular disease for those individuals who have high levels and do not have a genetic variation which increases CRP. Omega 3 fatty acids have been shown to decrease CRP- and therefore reduce risk of cardiovascular disease.

Get Omega 3’s From Fish Oil
How do we get more omega 3 fats? Take FISH OIL! As a clinician I use fish oil as a basic supplement because everyone can benefit from fish oil. According to Dr Shunney, you can get enough omega 3 fats from your diet if you are eating a serving of omega 3 -rich fish each day (like sardines). However, the problems of wild fish toxicity (mercury, PCBs, ) and farmed fish toxicity (have fewer omega 3 fats, are full of pesticides, antibiotics and food dye and also toxins like PCBS! ) make that difficult to do! http://www.ewg.org/reports/farmedpcbs If you are interested in learning which fish are safest and healthiest for you and your family check out this list of safe fish to eat provided from the Monterrey Bay Aquarium. SEAFOOD WATCH

For those of us (and I think there at least a few of us out there) who can’t or won’t eat a serving of healthy, non toxic, omega 3 rich fish daily, there are fortunately great fish oil supplements out there. My favorite is Nordic Naturals Arctic D Cod liver oil. I use the liquid form because I have found it to be more cost effective and easier to tolerate (no fish burps). However, if a teaspoon of fish oil daily is not your cup of tea- Nordic also carries plenty of capsulated fish oils too. Also, Dr Shunney tells us that Nordic naturals has a policy that if any of their products produce a fishy burp, you can return the bottle and get your money back. She says that a fishy after taste is a tell –tale sign of a rancid fish oil.

Elise Schroeder ND

• For more information on sustainable fish check out Fish Wise or Nordic Naturals website which includes plenty of scientific references for the fish oil’s effect on health.



• If you are a ZRT provider, log in to the website here and check out our interview- it’s in the media vault on page 8.

HEALTH SCREENING UPDATES

Over the past several years there have been a number of changes in the recommendations for cancer screening tests. Cervical, breast and prostate are just a few of the cancers where recommendations for screening tests have been modified, although not without controversy.
The governmental agency involved in developing recommendations for disease prevention is the U.S. Preventive Services Task Force (USPSTF). Comprised of an independent panel of experts in primary care and prevention, this agency reviews the evidence of effectiveness for existing screening tests. Based on the current data, a decision is made to keep the present recommendation or to suggest changes. Some of the more common screenings performed that have had changes made are the PAP, mammogram and PSA tests.

The PAP test screens for cervical cancer and was performed on an annual basis for all women. Current clinical guidelines still strongly recommend routine screening for high risk individuals. However, for women who are not high risk, testing is now suggested every two years for ages 21-30 and for over 30, every three years, with the provision of three consecutive, negative results. Research suggests women above the age of 70 can discontinue cervical cancer screening altogether.

Similarly, there have been some changes in recommendations for breast cancer screening with mammography. Previous guidelines were annual mammograms. Evidence shows current modifications from annual to biennial mammograms for women aged 40-59 are enough to reduce the harm and still provide benefit. And, the age group that may benefit the most is 60-69. The harm encountered includes false-positive test results leading to unwarranted biopsies, repeated imaging and doctor’s visits, not to mention causing worry and anxiety for many women. Even though breast cancer is more prevalent in women as they age, according to the task force, there is uncertain benefit for screening mammograms in women 75 years or older. And the breast self-exam (BSE) is being discouraged where previously it was thought monthly exams were crucial.

Additionally, the benefit of measuring PSA (prostatic specific antigen) to screen for prostate cancer has come into question. Initially, annual PSA testing was thought to help detect prostate cancer in the earlier stages, therefore providing a better chance for successful treatment. However, there are reasons for high PSA levels other than cancer, which can cause the patient anxiety. Prostatitis, benign prostatic hyperplasia (BPH) and recent ejaculation are just a few. Moreover, the research is inconclusive showing that a decline in deaths can be attributed to PSA screening. With positive PSA tests comes the decision of ‘watchful waiting,’ or active surveillance. More invasive procedures may be considered such as biopsy, radical prostatectomy or radiation therapy. So, according to the USPSTF, screening for prostate cancer in men younger than 75 years may not offer any better outcome than not screening. And for men 75 years and older PSA testing is not recommended, as the harm seems to outweigh the benefit. If PSA testing in men younger than age 70 is continued, the suggestion is for every 4 years, along with a discussion of the ambiguity of the benefits and drawbacks.

Sherry LaBeck, ND

Environmental Toxins and Hormone Health

You may not be aware of the effects some chemicals commonly found in our homes and our environment have on our health and wellbeing, but these so-called endocrine disruptors are all around us and can interfere with hormone balance and the immune system. While it’s becoming common knowledge that the chemicals in our foods can affect our health, the lesser known environmental exposures may be even more ubiquitous.

Here are some examples:
• Pthalates- found in beauty products, plastics and also in new shower curtains. You know that “icky” smell of a new shower curtain? That’s the airborne phthalates. Tip: To disperse the chemical, Air the curtain outside for 24 hours prior to hanging in your bathroom to disperse the chemical.
• Bisphenol A (BPA)- found in plastic drinking bottles, baby bottles, and cash register receipts
• Dioxins- found in all bleached paper products: toilet paper and tampons are particularly problematic as they come in contact with our skin (mucous membranes)
• Chemicals used in dry cleaning will off-gas from the clothing for days after we bring them home.
• Cleaning supplies that we use to wash our kitchen counters, floors and ovens put endocrine disrupting chemicals into the air and can remain on these surfaces
• Many pesticides that are used for repelling ants, roaches and other insects can be also harmful to humans

This is a short list; the ways we are exposed are many. To read more see Dr Marianne Marchese’s book 8 Weeks to Women’s Wellness. Her book outlines the environmental links to 10 common women’s health conditions, the various ways we are exposed to these chemicals on a daily basis and provides an 8 week detoxification program that is both informative for the doctor and useful for patients.

OR log in to our provider website and listen to my interview with her on Let’s Talk, ZRT’s teleconference series where we discuss how hormone health is affected by environmental toxins.

And check out the environmental working group which has a great cosmetic database and other great info on toxins in the home and elsewhere

Elise Schroeder ND

Vitamin D and Pregnancy

Before you get pregnant, or right when you get pregnant, blood tests are done to check for anemia, certain viruses, blood type and others. Increasingly, doctors are now also testing a woman’s vitamin D level. Vitamin D has been a hot topic in the medical world for a few years, but why and how is it affecting conception, pregnancy and the health of the newborn? That's the question scientists have been working on for almost a decade now. Let’s start by understanding what vitamin D is.

Viatmin D is a misnomer. This so- called vitamin is actually a hormone. For those of you chemically inclined- the 4 carbon ring backbone of this molecule makes it more of a steroid hormone than a vitamin. It is structurally similar to estrogen, testosterone, progesterone and all the steroid hormones. Technically speaking- for those more word inclined- a vitamin is a catalyst to a reaction in body, and a hormone is a chemical messenger that actually sends messages to cells that causes them to change. There is a distinct difference between the two, and vitamin D falls into the hormone category.

Because of its steroid structure and function, vitamin D plays an important role in priming cells for other hormones to do their job properly. This is why being sufficient in Vitamin D is so important for conception. Its not just the most well known hormones estrogen or progesterone that need to be balanced and functioning optimally, but the second string players as well- thyroid hormone, cortisol, dheas, testosterone and VITAMIN D too. These all need to be well balanced with each other in order for the miracle of ovulation and conception to occur.

Having enough vitamin D circulating through your system can increase your chances of fertility whether you’re struggling with poly cystic ovarian syndrome (PCOS), lack of ovulation or general fertility problems. This “hormone” also plays a role in male reproduction. Both sperm motility and production are increased when levels of vitamin D are normal. SO get your men tested too- as we all know it takes two to tango (so to speak).

Once pregnant, the focus shifts to the developing fetus who is dependent on maternal vitamin D levels. The placenta- which provides nutrition and oxygen to the growing fetus, requires vitamin D to function. In this study , the authors indicate that vitamin D may play a role in implantation of the pregnancy, normal placental development and the development and prevention of eclampsia. All imperative to a healthy full term pregnancy

Some studies have also looked at childhood health as related vitamin D levels in utero. Healthy maternal levels of vitamin D have been shown to decrease the likelihood of wheezing in their children. It is also implicated in the prevention of respiratory infections, type one diabetes and MS (multiple sclerosis).

With all this information stacking up, it makes sense that vitamin D levels should be monitored pre conception and during the pregnancy. It’s a simple test that your doctor can order or you can get an at-home finger stick test through the Vitamin D council or ZRT Lab.

Elise Schroeder ND

Precocious Puberty

Anyone else concerned that young girls are entering puberty earlier that a generation or two ago? It's made the news lately and seems to be getting more attention although attentive physicians have been concerned for a long time.

In 1999, the American Academy of Pediatrics published guidelines revising what defined precocious puberty based on a study looking at 6-8 year olds in 1997. This guideline did 2 things. It separated out African-American and Caucasian girls and lowered the "OK" range of what 'normal' puberty ages were to as young as age 6. Interestingly, they did not find a change in boys puberty ages. According to these guidelines, it is considered "OK" for girls to develop breasts or pubic hair as young as 7 for Caucasian girls and as young as 6 for African-American girls. It is only considered precocious puberty if there are 2 signs under the age of 8 in girls.

Fairly recently, Dr Biro repeated this study, comparing the results to those found in the 1997 study. What he found was startling. Link to abstract of the article here.
• 10.4% of Caucasian girls had breast development - double the 1997 study.
• 23.4% of African-American girls had breast development vs. 15.4% in 1997. That is almost 1/4 of all African-American little girls.
These are 6-8 year olds!

So, what are a few of the causes behind this situation and more importantly what can we do right now for our children and our young patients?

1. There is no doubt that the increasing obesity numbers in young children is dramatically increasing. Children today are heavier. Even the non-obese children are heavier than they were one to two generations ago. If you look back at your elementary school photos, there probably were one or two children that were heavier. Now, start watching children today walking around. The thinner children often stand out because they are the more unusual in the community. There are many reasons for this situation of course, changing social structures, changing food quality and quantity and social acceptance. A growing proportion of our children are sadly also becoming insulin resistant; crossing that line between "baby fat" and into obesity. Obesity and the associated hyperinsulinemia, increases the stimulation on DHEAS production from the adrenal glands. As a result, the zona reticularis, becomes hypertrophied setting up an anatomical problem leading to higher androgens life-long. Higher androgens lead to development of early pubic hair and breast development, but long term contribute to hirsutism, acne and infertility. Yikes.

2. Bisphenol A or BPA is a recognized environmental estrogen receptor agonist. In fact, BPA was discovered when researching hormone replacement, but instead, they stumbled upon the wonders of DES instead. BPA is found in can linings (including powdered baby formula) and plastic containers (unless noted BPA free: 2, 4, and 5 plastics are considered “safe”). BPA has been found by major university studies to contribute to health problems both at low doses and at high doses, but different problems at each titration. And if that wasn't bad enough, BPA has been found to cause problems in-utero for the reproductive tract of the offspring. BPA is bad; try to avoid it.

3. Other environmental estrogens have been found in normal household products. One that has been identified as more commonly used in the African-American population is protein enriched shampoo - enriched with placenta. Since the placenta makes hormones, the hormones get into the shampoo and cause precocious puberty. Cases have been reported of infants being washed with placenta containing shampoos and developing pubic hair. Of course, family members using topical hormones may also contribute to environmental exposure.

4. Pituitary tumors may also cause early sexual development. These are always considered, but generally found with rapid and extreme precocious puberty and are more common in boys.

Testing recommended for precocious puberty: MORNING levels (bloodspot works great)
o Testosterone
o Estradiol
o DHEAS
o LH
o FSH
o Thyroid - especially with additional symptoms

o Additional testing that may be recommended afterwards includes MRI and/or ultrasound.

So what to do if you suspect that your patient/daughter/son has precocious puberty?
First, assess whether they fit the guidelines, then, follow-up with a pediatrician who can examine them thoroughly. For instance, don't assume that it's the drinking from the BPA-filled water bottle is the cause until a pituitary tumor has been ruled out. Certainly avoid environmental estrogens, eat organic, don't shampoo with estrogen, but make sure you are doing that while waiting for your appointment. That way, when you are told it's idiopathic (i.e. “unknown cause”) you'll be well on your way to helping the situation.

Treatment for precocious puberty depends on finding the cause. If a cause is not found, depending on the age, no treatment may be suggested. However, it is common that children who are young will be offered Lupron or another medication to cause the LH and FSH to shut down the testicles and ovaries until the appropriate time for development. Since they shouldn't have hormones already, this does not cause the problems and side effects that you see with adults. Using hormone blockade allows for a normal childhood and attainment of full height which may be blunted by high hormone levels.

Some children will always be the early bloomers and some children will always be late. But if we can watch for those that are negatively been affected by the world around us and rather than just accept this new baseline and instead take action to educate others and change what we can, perhaps our children have a better chance of reaching their full potential.

Best Wishes

Dr Alison McAllister

For more information on precocious puberty see http://emedicine.medscape.com/article/924002-overview OR http://www.nichd.nih.gov/health/topics/precocious_puberty.cfm

Barriers to Hormone Absorption

Lower than expected lab results with supplementaion is something that almost everyone will see. There are several reasons for this:

• Not using the full dose prescribed


• Skipping a dose before collection


• Showering too soon after hormone application


• Applying moisturizers, creams or lotions prior to dosing with topical hormones. Moisturizers and body lotions can act as a physical barrier that delays or prevents transdermal hormone absorption.

In discussing a patient’s low hormone levels with one practitioner, we went over the common reasons as described above. None seemed to apply as the practitioner was diligent with her instructions before giving out the test kit. However, these are very common mistakes, so i suggested re-checking with the patient. With further investigation the practitioner called back to report that the patient had been using a moisturizing body wash (aka shower gel).

Now, you would think that body wash should not pose a problem. After all, like soap it's supposed to "wash" the body, right? Yet, the product's website claims that it contains special moisturizers that don't just sit on top of the skin. New technology enables the moisturizers to be absorbed deeper into the skin. It seems likely that the deeper absorption would create a barrier which could interfere with hormone absorption. The patient will discontinue the body wash for several days, continue to apply her topical hormones as prescribed and then recollect for a retest. The new results should be interesting!

For more information on how to collect the best sample and best the most accurate test result, see ZRT's handout on the web: ZRT handouts
OR watch a video on saliva or blood spot collection

Sherry LaBeck ND

GOT IODINE? How to get enough Iodine through your diet

Iodine is an essential component of thyroid hormone (T3 & T4) and important for normal thyroid functioning. It also functions as an antioxidant, an anti infective agent and is protective in certain cystic conditions like fibrocystic breast disease and ovarian cysts. Iodine is found in the soil and the oceans, however the iodine content in soil varies from region to region. Subsequently, foods grown in different regions vary in iodine content as well.

How much Iodine is needed each day?

The Recommended Daily Allowance (RDA) for iodine is 150 ug/day for proper thyroid functioning. It is important to note that many other tissues of the body need iodine for good health as well.

• Adults 150 ug day
• Children 90-120 ug /day
• Pregnancy 220 ug/day
• Breastfeeding 290 ug/day

Higher levels of iodine intake have been shown to be protective against benign breast changes such as fibrocystic breast disease. Studies show a daily intake of 3000- 6000 ug/day to be helpful and tolerable for this condition. These higher levels are similar to the typical daily intake seen in Japan.

To be certain our bodies are sufficient in iodine, we can eat foods high in iodine and/or take an iodine supplement. Below is a list of the amount of iodine found in foods. Many people assume that all seaweeds have a lot of iodine. But if you look closely at the table, you will notice a great deal of variability in the amount of iodine found in different types of seaweed. Kelp has the most and nori has the least. This means that your weekly nori roll at the sushi restaurant may not be giving you enough iodine to be sufficient!

Dietary sources of Iodine in ug

SEAWEEDS
Kelp 3400 1 tsp
Arame 730 1 Tbs
Wakame 80 1 Tbs
Nori 32 1 sheet

FISH
Cod 341 3 ounces
Shrimp 79 3 ounces
Halibut 56 3 ounces
Herring 56 3 ounces
Sardines 30 3 ounces
Tuna 17 3 ounces

SALT
Iodized salt 76 1 tsp

DAIRY
Cow’s milk (US) 56 1 cup
Mozzarella cheese 10 1 ounce
Yogurt 87 1 cup

OTHER FOODS
Turkey breast 34 3 ounces
Strawberries 12 1 cup
Egg 23 1egg

SUPPLEMENTS
Iodoral TM 12,000 1 tab
Lugol’s TM 5% 6250 Per drop
Typical multi vitamin 150 Per serving

References
Medical Nutrition from Marz 2nd edition. Russell Marz ND MAcOP C 1999 Omni Pennington JAT, Schoen SA, Salmon GD, Young B, Johnson RD, Marts RW. Composition of core foods of the U.S. food supply, 1982-1991. III. Copper, manganese, selenium, iodine. J Food Comp Anal. 1995;8:171-217.

http://www.whfoods.com/genpage.php?tname=nutrient&dbid=69#references

Teas, J., Pino, S., Critchley, A., Braverman, L.E., 2004. Variability of iodine content in common commercially available edible seaweeds. Thyroid 14, 836–841.