Friday, October 9, 2009

Maximizing Methylation: The Key to Healthy Aging

Maximizing Methylation: The Key to Healthy Aging: "

Taking just a few vitamins CAN optimize the function of ALL your body's systems. It’s true. But you have to know what to take and you have to know why these supplements work ...


That’s why, in this week’s blog, I am going to discuss one of the most important biochemical processes for long-term health and how you can keep it running at its very best with supplements and other measures.


Unfortunately, many people suffer from one or more of the 8 factors that negatively impact this biochemical process, so problems in this area are widespread though many don’t realize they are suffering.


The good news is that there are MANY things that you can do right now to optimize this critical biochemical process that may have a dramatic impact on your health. In today’s blog I will review the 8 factors that can lead to problems in this area, and outline 12 tips that will help you optimize this essential part of your biology.


But first, I'd like to tell you about two of my patients with seemingly unrelated health problems that were actually caused by a breakdown in this biochemical process. And I want to share a study done on Chinese babies who had a birth defect known as spina bifida.


You'll be amazed at how all three -- my two patients and these Chinese babies -- were affected by the exact same thing ...


What an Elderly Golfer, a College Professor, and Chinese Babies have in Common


One of my patients, Mr. Roberts, was an 88-year-old businessman who didn't let his age slow him down. He still golfed three times a week, worked two days a week, flew around the world in his private jet, and was 'romantic' once a week with a wife 30 years his junior. He also loved his 6 ounces of Grey Goose vodka every night.


Of course, he did have some health problems. Mr. Roberts had been treated well for mild heart disease. His doctor even recommended 800 mcg of folic acid and 250 mcg of vitamin B12 -- megadoses by any standard.


Mr. Roberts also had a check-up at the Mayo Clinic and was told that he was healthy, despite having mild anemia and large red blood cells. Yet he still complained of mild fatigue and trouble with his short-term memory. Plus, I noticed a slightly wide gait common in someone with poor balance.


Then there was Mr. McNally, a Boston college professor who was 50 years old, fit, and lean but wore a worried look as he walked into my office.


He recounted the sad tale of his 7 brothers. Four had died of a heart attack and three others had had bypass operations at a young age. Concerned about his own fate, he ate a low-fat diet, exercised regularly, didn't smoke, had normal blood pressure and cholesterol levels, and took antioxidants and a multivitamin. Perhaps his only vice was the multiple Starbuck's grande lattes he downed each day. Living under a constant state of impending doom, Mr. McNally came to me asking for a stress test to see how his heart was doing.


Strange as it may seem, these two men reminded me of my time in China. When I lived in Beijing, a study was done on a group of women in Harbin, the northern most industrial city in the Gobi desert, just north of Beijing. It seemed that there was an unusually high rate of birth defects in the area, specifically spina bifida.


The Chinese have a tradition of holding weddings during the Chinese New Year in February. In Harbin, many of the babies born 9 months later had birth defects. This study sought to determine what the link was and found that the major factor was the lack of fresh greens or vegetables in the Gobi desert in the middle of winter.


Interestingly, these Chinese babies, Mr. Roberts, and Mr. McNally all have something very important in common. They all have inadequate levels of specific vitamins, either acquired or genetic, and their methylation systems are not working properly as a result. I'll explain more about what 'methylation' is in a second. First let’s analyze the similarities in these cases.


Take Mr. Roberts. Our romantically active 88-year-old took high doses of B vitamins. But he still had very high levels of homocysteine and methylmalonic acid -- indicators of folic acid and B12 deficiency.


Mr. McNally had similar problems. Our college professor had a genetically sluggish metabolism of homocysteine which caused extremely high levels of this toxic amino acid to build up in his blood. This was the likely cause of all the heart disease in his family.


Again we see a similar set of problems in those Chinese babies. Their mothers were conceiving in the middle of winter -- when their folate intake was low from the absence of fruits and vegetables. This is what triggered such a high rate of birth defects.


The common link in all three of these cases is a problem with methylation. Let me tell you more about that that actually means.


Methylation is a key biochemical process that is essential for the proper function of almost all of your body's systems. It occurs billions of times every second; it helps repair your DNA on a daily basis; it controls homocysteine (an unhealthy compound that can damage blood vessels); it helps recycle molecules needed for detoxification; and it helps maintain mood and keep inflammation in check.


To keep methylation running smoothly you need optimal levels of B vitamins. Without enough B vitamins methylation breaks down, and the results can be catastrophic. In these cases we see more birth defects like spina bifida (as with the Chinese babies), more cases of Down's syndrome, and more miscarriage.


A breakdown in methylation also puts you at higher risk for conditions like osteoporosis, diabetes, cervical dysplasia and cancer, colon cancer, lung cancer, depression, pediatric cognitive dysfunction ( mood and other behavioral disorders), dementia, and stroke. And like Mr. Roberts and Mr. McNally, you may be at higher risk for cardiovascular disease.


To avoid all of these problems, the key is to maximize methylation. That means avoiding the things that cause your methylation to break down, testing to find out how well your methylation is working, and including the things that support proper methylation. Let’s look at how to do that.


8 Factors that Affect Your Methylation Process


8 major factors negatively impact methylation. They are:



    1. Genetics. Like an estimated 20 percent of us, you could be genetically predisposed to high homocysteine.

    2. Poor diet. The word 'folate' comes from 'foliage.' You need to eat plenty of leafy greens, beans, fruit, and whole grains to get adequate levels of vitamins B6 and B12, betaine, and folate. Egg yolks, meat, liver, and oily fish are the main dietary sources of vitamin B12 -- so long-term vegan diets can be a problem. Plus, certain compounds can raise levels of homocysteine and deplete the B vitamins. These include excess animal protein, sugar, saturated fat, coffee, and alcohol. Irradiation of food depletes nutrients, so foods treated this way may be lower in B vitamins, too.


    3. Smoking. The carbon monoxide from cigarette smoke inactivates vitamin B6.


    4. Malabsorption. Conditions like digestive diseases, food allergies, and even aging can reduce absorption of nutrients.


    5. Decreased stomach acid. Aging and other conditions can reduce stomach acid -- and therefore absorption of vitamin B12.


    6. Medications. Drugs like acid blockers, methotrexate (for cancer and arthritis and other autoimmune diseases), oral contraceptives, HCTZ (for high blood pressure), and Dilantin (for seizures) can all affect levels of B vitamins.


    7. Other conditions. These include hypothyroidism, kidney failure or having only one kidney, cancer, and pregnancy.


    8. Toxic exposures. Some toxins can interfere with vitamin production.


Watch out for these factors and you will go a long way toward protecting your methylation.


Measuring Your Own Methylation Process


To find out if your methylation process is optimal, ask your doctor for the following tests:



    1. Complete blood count. Like our friend Mr. Roberts, large red blood cells or anemia can be a sign of poor methylation. Red blood cells with a mean corpuscular volume (MCV) greater than 95 can signal a methylation problem.

    2. Homocysteine. This is one of the most important tests you can ask for. The normal level is less than 13, but the ideal level is likely between 6 and 8.


    3. Serum or urinary methylmalonic acid. This is a more specific test for vitamin B12 insufficiency. Your levels may be elevated even if you have a normal serum vitamin B12 or homocysteine level.


    4. Specific urinary amino acids. These can be used to look for unusual metabolism disorders involving vitamins B6 or B12 or folate, which may not show up just by checking methylmalonic acid or homocysteine.


12 Tips to Optimize Your Methylation Process


Just as there are many causes of poor methylation, there are lots of things that support its proper functioning. Here's how to maximize methylation -- and prevent conditions like heart disease, cancer, dementia, depression, and more.



    1. Eat more dark, leafy greens. You want to eat l cup a day of vegetables like bok choy, escarole, Swiss chard, kale, watercress, spinach, or dandelion, mustard, collard, or beet greens. These are among the most abundant sources of the nutrients needed for optimal methylation.

    2. Get more Bs in your diet. Good food sources include sunflower seeds and wheat germ (vitamin B6); fish and eggs (vitamin B6 and B12); cheese (B12); beans and walnuts (vitamin B6 and folate); leafy dark green vegetables; asparagus, almonds, and whole grains (folate); and liver (all three).


    3. Minimize animal protein, sugar, and saturated fat. Animal protein directly increases homocysteine. Sugar and saturated fat deplete your body's vitamin stores.


    4. Avoid processed foods and canned foods. These are depleted in vitamins.


    5. Avoid caffeine. Excess amounts can deplete your B vitamin levels.


    6. Limit alcohol to 3 drinks a week. More than this can deplete your B vitamin levels.


    7. Don't smoke. As noted above, smoking inactivates vitamin B6.


    8. Avoid medications that interfere with methylation. See notes on this above.


    9. Keep the bacteria in your gut healthy. Take probiotic supplements and use other measures to make sure the bacteria in your gut are healthy so you can properly absorb the vitamins you do get.


    10. Improve stomach acid. Use herbal digestives (bitters) or taking supplemental HCl.


    11. Take supplements that prevent damage from homocysteine. Antioxidants protect you from homocysteine damage. Also make sure you support methylation with supplements like magnesium and zinc.


    12. Supplement to help support proper homocysteine metabolism. Talk to your doctor to determine the best doses and forms for you. Here are a few suggestions:



      • Folate (folic acid): Amounts can vary based on individual needs from 200 mcg to 1 mg. Some people may also need to take preformed folate (folinic acid or 5 formylTHF) to bypass some of the steps in activating folic acid.

      • Vitamin B6: Take 2 to 5 mg a day. Some people may need up to 250 mg or even special 'active' B6 (pyridoxyl-5-phosphate) to achieve the greatest effect. Doses higher than 500 mg may cause nerve injury.


      • Vitamin B12: Doses of 500 mcg may be needed to protect against heart disease. Oral vitamin B12 isn't well absorbed; you may need up to 1 or 2 mg daily. Ask your doctor about B12 shots.


      • Betaine: This amino acid derivative is needed in doses from 500 to 3,000 mg a day, depending on the person.



By working to optimize your methylation you can protect yourself from virtually all the so called 'diseases of aging.' When you do, you will be well on the road to lifelong vibrant health.


Now I'd like to hear from you ...


Do you have symptoms of poor methylation?


What are you doing to optimize this process?


Do you take B-vitamin supplements? Have you noticed any results?


Please share your thoughts by adding a comment below.


To your good health,


Mark Hyman, M.D.



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Thursday, October 8, 2009

Vitamin D: What You Need To Know

Vitamin D: What You Need To Know: "Hardly a day goes by without some groundbreaking news about Vitamin D. Originally known for it's crucial role in maintaining calcium levels for bone health, it is rapidly becoming apparent that we have vastly underestimated Vitamin D's significant importance for our overall health and wellbeing. In short, judging by what I see in my practice and speaking with colleagues around the country, it's looking very much like we're facing an epidemic of Vitamin D deficiency, with potential grave consequences. This Vitamin D FAQ will help to get you up to speed on this important topic.



What diseases are associated with Vitamin D deficiency?



Vitamin D deficiency has been shown to play a role in almost every major disease, including:





Osteoporosis and Osteopenia

17 varieties of Cancer (including breast, prostate and colon)

Heart disease

High blood pressure

Obesity

Metabolic Syndrome and Diabetes

Autoimmune diseases

Multiple sclerosis

Rheumatoid arthritis

Osteoarthritis

Bursitis

Gout

Infertility and PMS

Parkinson's Disease

Depression and Seasonal Affective Disorder

Alzheimer's Disease

Chronic fatigue syndrome

Fibromyalgia

Chronic Pain

Periodontal disease

Psoriasis





What is vitamin D?



Although it's called a vitamin, vitamin D is really a hormone not a vitamin. Vitamins cannot be produced by your body, we get them from dietary sources, whereas hormones like vitamin D are made in your body. It's your body's only source of calcitrol (activated vitamin D), the most potent steroid hormone in the body.



What does vitamin D do?



Like all steroid hormones, vitamin D is involved in making hundreds of enzymes and proteins, which are crucial for preserving health and preventing disease. It has the ability to interact and affect more than 2,000 genes in the body. It enhances muscle strength and builds bone. It has anti-inflammatory effects and bolsters the immune system. It helps the action of insulin and has anti-cancer activity. This is why vitamin D deficiency has been linked with so many of the diseases of modern society. Because of its vast array of benefits, maintaining optimal levels of D is essential for your health.



Where do I get vitamin D from?



The only 2 reliable sources of vitamin D are the sun and supplements. Sunlight exposure is the only reliable way for your body to generate vitamin D. Vitamin D is produced by your skin in response to exposure to ultraviolet radiation from the sun. In fact, this is such an efficient system that most of us make approx. 20,000 units of vitamin D after only 20 minutes of summer sun without suntan lotion (or clothes!) That's 100 times more than the government recommends per day! There must be a good reason why we make so much in so little time.



You do not generate vitamin D when sitting behind a glass window, whether in your car or at home because these UV rays cannot penetrate glass to generate vitamin D in your skin Also sunscreens, even weak ones, almost completely block your body's ability to generate vitamin D.



The other reliable source is vitamin D3 supplements (not vitamin D2)



Only about 10% of your vitamin D comes from diet, so it is nearly impossible to get adequate amounts of vitamin D from your food.



What are the food sources of vitamin D?



1. Fish liver oils, such as cod liver oil. 
Fatty wild fish like mackerel, salmon, halibut, tuna, sardines and herring

2. 
Fortified milk, orange juice and cereal

3. Dried Shitake mushrooms

4. Egg yolks



But to get adequate amounts of vitamin D from food, you would have to eat at least 5 servings of salmon a day or drink 20 cups of fortified milk



My Doctor told me to avoid the sun, what do you think?



There is an old Italian saying 'Where the sun does not go the doctor does.'



For about the last 25 years, doctors (dermatologists in particular) have demonized sun exposure and repeatedly told us it is bad for you and causes cancer. But is that true? In the last few years, numerous studies have shown that modest exposure to sunlight may actually be good for you, helping the body produce the vitamin D it needs to keep bones healthy and protect against cancer, including skin cancer. Though repeated sunburns--in children and very fair-skinned people--have been linked to melanoma, there is no credible scientific evidence that moderate sun exposure causes it. Since it's almost impossible to get adequate amounts of vitamin D from food alone (including fortified milk and fatty wild fish), the sun is your best source. I'm not suggesting you go bake in the sun with your suntan oil or go to tanning salons. But getting some sun without getting sunburned makes healthy sense.




We evolved in the sun; we were made to get some sun, not to live our lives indoors and slather on sunscreen every time we go outside. If the sun is shining where you are today, get out and enjoy it, talk about a free natural treatment! All you need is a little common sense when heading outdoors, do it gradually and always avoid sunburn. 




Special Note: Remember to take antioxidants when you sit in the sun, as these can help prevent skin cells from sun damage.



How much sunshine do I need?



All living things need sun, the key is balance. Too much sun exposure can cause melanoma and skin aging, while too little creates an inadequate production of vitamin D. The amount needed depends on the season, time of day, where you live, skin pigmentation and other factors. As a general rule, if you are not vitamin D deficient, about 20 minutes a day in the spring, summer and fall on your face and arms or legs without sunscreen is adequate. It doesn't matter which part of the body you expose to the sun. Many people want to protect their face, so just don't put sunscreen on the other exposed parts for those 20 minutes.




If you live north of 37 degrees latitude (approximately a line drawn horizontally connecting Norfolk, Virginia to San Francisco, California) sunlight is not sufficient to create Vitamin D in your skin in the winter months, even if you are sitting in the sun in a bathing suit on a warm January day! The further you live from the equator, the longer exposure you need to the sun in order to generate vitamin D



How much vitamin D do I need?



How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and - probably - how ill you are.



As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, dark-skinned people need more than fair skinned people, northern people need more than southern people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.



What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution...vitamin D supplementation.



How much vitamin D should I supplement with?



Most important is that you take vitamin D3, (cholecalciferol) the active form of vitamin D. Do not take vitamin D2 as it is not as biologically active nor as effective, and nor as safe as vitamin D3. And taking the right amount is crucial, most doctors tend to under dose. The current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: from 200 to 600 IU/day depending on one's age, are way too low.
These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets



Here are some guidelines



If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels



In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.



If your blood level is 30-45 ng/ml, I recommend you correct it with 5,000 IU of vitamin D3 a day for 3 months under a doctor's supervision and then recheck your blood levels.



If your blood level is less than 30 ng/ml, I recommend you correct it with 10,000 IU of vitamin D3 a day under a doctor's supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you're deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 - 4,000 IU a day.



What are the symptoms of vitamin D deficiency?



There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are some of the more common symptoms:





Fatigue

General muscle pain and weakness

Muscle cramps

Joint pain

Chronic pain

Weight gain

High blood pressure

Restless sleep

Poor concentration

Headaches

Bladder problems

Constipation or diarrhea






What about vitamin D toxicity?



It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.




What blood test should I have to check my vitamin D levels?





The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.



Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.



If you don't want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.



What is the ideal blood level of 25 hydroxy vitamin D?



The current ranges for 'normal' are 20 to 55 ng/ml. These are much too low!!! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.



How often should I have a 25 hydroxy vitamin D blood test?



At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months



My doctor prescribed Drisdol, 50,000 IU per week. What is it?





Drisdol is a prescription of 50,000 IU tablets of vitamin D2 or ergocalciferol. Ergocalciferol is not vitamin D but it is similar. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as (cholecalciferol or vit D3) does. If you are vitamin D deficient, the best thing to do, is to take vitamin D3.



Can I take cod liver oil to get my vitamin D?





Although Cod liver oil contains a fair amount of vitamin D, it also contains high amounts of vitamin A. Vitamin A antagonizes the action of vitamin D and can be toxic at high levels.



Why is there an epidemic of vitamin D deficiency?



It is estimated that anywhere from 30 to 100% of Americans, depending upon their age and community living environments, are deficient in Vitamin D. More than half of all American children are vitamin deficient. Supposedly almost 3/4s of pregnant women are vitamin D deficient, predisposing their unborn children to all sorts of problems. Worldwide, it is estimated that the epidemic of vitamin D deficiency affects one billion people. In my practice over 80% of patients whose vitamin D levels I check are deficient. No one is exactly sure why this is happening apart from the fact that we spend too much time indoors and when we go out into the sun, we lather sunscreen on ourselves. I think it must be more than that. But whatever the reason, the reality is we have a major epidemic on our hands.



What about the use of tanning beds to get my vitamin D?



I tend not to recommend them because we don't really know if they are safe. Because the light sources vary with different tanning beds, it makes them unpredictable and possibly unsafe. In addition, most commercial tanning beds emit an unknown amount of EMF and because one is so close to the actual bed, it may be an unnecessary high dose. Theoretically both these problems could be overcome, but in reality they usually are not. 





For more information on vitamin D, go to http://www.vitamindcouncil.org/



Frank Lipman MD, is the founder and director of the Eleven Eleven Wellness Center in NYC a center whose emphasis is on preventive health care and patient education. His personal blend of Western and Eastern Medicine combined with the many other complimentary modalities he has studied, has helped thousands of people recover their energy and zest for life. He is the author of the recent SPENT: End Exhaustion and Feel Great Again (2009) and Total Renewal; 7 key steps to Resilience, Vitality and Long-Term Health (2003).



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