Natural Health Advisory

I was recently reviewing the labs of an 83-year-old patient and was pleasantly surprised to see that his primary care provider had ordered C-reactive protein (CRP) and hemoglobin A1C (HbA1c) tests. These tests aren’t commonly included in standard blood work, but many experts agree that they should be.

They are simple, relatively inexpensive ways to give key insight into some of the most common underlying causes of illness and accelerated aging: inflammation, blood sugar dysregulation, and glycation.

High Sensitivity C-Reactive Protein (hs-CRP)

High sensitivity C-reactive protein (hs-CRP) is one of the most common and useful tests for evaluating low-grade, chronic, body-wide inflammation.

Chronic inflammation is the common denominator of many age-related diseases, including metabolic syndrome, diabetes, heart and lung diseases, cancer, osteoporosis, arthritis, and dementia. We now use the term inflammaging to refer to that state of chronic, low-grade, body-wide inflammation related to these inflammatory conditions.

CRP is a type of protein made in response to inflammation. The high sensitivity (hs) test for CRP can detect even very small amounts of systemic inflammation, such as that which occurs at the very small level of the blood vessel wall and leads to atherosclerosis. This is why hs-CRP testing is so good at predicting your chance of having a heart attack or stroke.1

The normal hs-CRP range is 0-3 mg/L. When hs-CRP is used as an independent predictor of risk for coronary artery disease, the cut-off points are:

• Low risk: less than 1.0 mg/L
• Average risk: 1.0 to 3.0 mg/L
• High risk: greater than 3.0 mg/L

Most natural medicine practitioners help their patients strive for levels less than 1.0 mg/L to reduce inflammaging as well as risk for many chronic diseases, not just heart disease.

Hemoglobin A1c (HbA1c)

Hemoglobin A1C (HbA1c) evaluates long-term blood sugar control and a process called glycation, which is one of the leading theorized causes of aging. ­Glycation occurs when blood sugar (serum glucose) reacts with important protein and lipid molecules in your body. The reaction damages the molecules and can render them nonfunctional.

Glycation also causes the formation of advanced glycation end products (AGEs), which cause inflammation and oxidative stress and are implicated in a host of age-related chronic diseases.2

HbA1C is a reflection of this detrimental reaction.

Measuring glycated hemoglobin (HbA1c) reflects average blood glucose levels over eight to 12 weeks, providing a useful longer-term gauge of blood glucose control compared to measuring glucose directly. Think of HbA1C as a way to track how well your body has been keeping your blood sugar levels under control over the past two to three months.

HbA1c reference ranges and ideal levels:

• Normal: less than 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher
• Ideal: less than 5.0%

If your level is 5.7% or higher, your body’s sugar levels have been too high for too long. Elevated long-term glycation levels are associated with accelerated aging and other chronic diseases. A high HbA1c is not just about diabetes and its complications, it’s also about premature aging and your risk for other chronic age-related diseases, including cardiovascular disease, cancer, dementia, kidney disease, osteoporosis, cataracts and macular degeneration.2

Natural Approaches to Reduce Chronic Inflammation and Glycation

Much can be done to naturally lower your hs-CRP and/or HbA1c and to decrease your body’s levels of chronic inflammation, excess glucose, and the damaging effects of glycation. Many natural therapies even tackle all these issues simultaneously. The following are some of the most important, best-researched treatments.

Improve your diet

Many radically different healthy diets can be used to lower inflammation and improve blood sugar regulation, including Paleo,3 vegan,4,5 and Mediterranean diets.6,7 Different healthy diets work for different people because of their individual health challenges, lifestyles, beliefs, preferences, genetics, and more.

One shared key between all these diets is the total elimination or drastic reduction in sugars, highly refined carbo­hydrates, and processed foods, and a switch to fresher meals made from whole, unprocessed ingredients. Another commonality is the focus on phytonutrient-rich plant foods. Many phytonutrients, such as flavonoids, exert well-evidenced anti-inflammatory properties.

Even if, instead of adopting a strict Paleo, vegan, or Mediterranean diet, you simply focused on decreasing sugars and refined carbs while increasing plant foods, you would go a long way towards regulating blood sugar and lowering inflammation.

Decrease your consumption of AGEs

AGEs aren’t only formed by having too much glucose in your bloodstream; they come from foods too.8 When food is heated to high temperatures, the characteristic “browning” generates AGEs, as does deep-frying, broiling, roasting, grilling, and high-temperature processing of pasteurized dairy products, cheeses, sausages, and processed meats.2 Eating more raw, steamed, and gently cooked foods can make a positive difference.9

Exercise

People who are weaker and/or more sedentary have higher levels of chronic inflammation, whereas those who report more physical activity have lower CRP levels.10,11

While exercise initially results in an increased inflammatory state, it paradoxically lowers systemic inflammation. Both aerobic exercise and strength training have powerful anti-inflammatory and blood-sugar-lowering benefits, and the combination of strength training and cardiovascular training has better effects than either type alone.12

No matter what your current fitness level, there’s an exercise program out there that’s right for you and that will lower your levels of chronic inflammation and excess blood sugar. The key is to find what you like to do regularly.

Supplements

Fish oil. Omega-3 polyunsaturated fatty acids (PUFAs) have beneficial effects on chronic inflammation. Over the last 20 years, the anti-inflammatory action of omega-3 PUFAs from oily fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been demonstrated in many studies.13 Regular use of fish oil supplements is associated with significant reductions in hs-CRP concentrations.14,15

A recent analysis of 68 randomized controlled trials involving more than 4,000 subjects found that supplementing with marine-derived EPA and DHA lowers CRP levels in healthy people as well as in people with all kinds of chronic diseases.15

Supplementation may also lower HbA1c levels, improve blood insulin sensitivity and reduce the risk for diabetes and its complications.16

Berberine. One of the most potent natural medicines for lowering HbA1c is berberine, a compound found in the roots and barks of several plants, such as berberis, goldenseal (Hydrastis canadensis), and Coptis chinensis. ­Berberine significantly improves glucose tolerance and insulin action, lowering HbA1c levels in people who are obese and/or have metabolic syndrome or type 2 diabetes.17-19 The recommended dose of berberine HCl is 500 mg two to three times a day.

Curcumin, from the spice turmeric, is one of the most powerful and well-researched anti-inflammatory plant compounds.20 Curcumin supplementation has been found to substantially lower hs-CRP levels in people with cancer, osteoarthritis, and several other conditions associated with chronic inflammation.21-23

Because it is notorious for being very poorly absorbed, many manufacturers have created curcumin supplements that enhance bioavailability so that more curcumin can enter the bloodstream and decrease inflammation. Two such curcumin supplements with research supporting their increased bioavailability and effectiveness are Meriva (curcumin phytosome) and curcumin combined with piperine (black pepper extract). The recommended dose is 500 mg curcumin phytosome or 500 mg curcumin combined with 20 mg piperine two to three times daily.

Summary

Knowing your hs-CRP and HbA1c levels is a simple, convenient, and relatively inexpensive way to monitor chronic inflammation and excess blood sugar levels, two of the most powerful causes of major age-related chronic diseases.

If you need to work on improving these markers, you have many natural therapies to choose from. The treatments discussed here—decreasing sugar and refined carbs, increasing phytonutrients, decreasing dietary AGEs, exercise, and supplementing with fish oil, berberine, and curcumin—are just a few of the literally hundreds of ways to naturally decrease inflammation and control blood sugar and glycation.

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1. BMC Cardiovasc Disord. 2014; 14: 25.
2. J Gerontol A Biol Sci Med Sci. 2010 Sep;65(9):963-75.
3. Eur J Clin Nutr. 2015 Apr 1.
4. Crit Rev Food Sci Nutr. 2015 Dec 6;55(14):2004-13.
5. Complement Ther Med. 2015 Feb;23(1):32-7.
6. Prog Cardiovasc Dis. 2015 Jul-Aug;58(1):50-60.
7. Diabetes Metab Res Rev. 2015 Jun 24.
8. Adv Nutr. 2015 Jul 15;6(4):461-73.
9. Am J Clin Nutr. 2010 May;91(5):1220-6.
10. Physiol Behav. 2015 Oct 1;149:199-202.
11. PLoS One. 2013 Oct 29;8(10):e78350.
12. Diabetologia. 2014 Sep;57(9):1789-97.
13. Biochim Biophys Acta. 2015 Apr;1851(4):469-484.
14. Am J Epidemiol. 2012 Dec 1; 176(11): 1002–1013.
15. PLoS One. 2014; 9(2): e88103.
16. Lipids Health Dis. 2014 Dec 16;13:196.
17. Metab Syndr Relat Disord. 2013 Oct;11(5):366-9.
18. Metabolism. 2010 Feb;59(2):285-92.
19. Metabolism. 2008 May;57(5):712-7.
20. Food Chem Toxicol. 2015 Sep;83:111-24.
21. Phytother Res. 2014 Oct;28(10):1461-7.
22. Ann Clin Biochem. 2012 Nov;49(Pt 6):580-8.
23. Panminerva Med. 2010 Jun;52(2 Suppl 1):55-62.
24. AAPS J. 2013 Jan; 15(1): 195–218.

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Natural Health Advisory

Sarcopenia, the loss of skeletal muscle mass and strength, is a major problem as people age. It can lead to disability, osteoporosis, falls, hospital stays, and even death.1 Taking a few natural steps now can improve muscle health and help maintain autonomy and well-being into old age.

What causes sarcopenia?

Two of the most preventable and treatable factors that contribute to sarcopenia are lack of exercise and poor nutrition.

• Older adults spend most of their waking hours engaged in sedentary activities. Inactivity accelerates muscle breakdown and dysfunction, often leading to a vicious cycle of muscle loss, injury, and inefficient repair, causing elderly people to become increasingly sedentary over time.2
• Many older Americans fail to consume the current recommended dietary allowance (RDA) of protein, which may not even be high enough for their needs.3-5 Older people require more protein than younger people to stimulate the same amount of muscle growth.6

Diagnosing sarcopenia

Sarcopenia is diagnosed using the criteria of low muscle mass and low muscle function (either low strength and/or low physical performance).1 The three most important tests for diagnosing sarcopenia are appendicular lean body mass, grip strength, and gait speed.7

Appendicular skeletal muscle mass. Imaging techniques used for estimating muscle mass include computed tomography (CT scan), magnetic resonance imaging (MRI) and dual energy X-ray absorptiometry (DXA). CT and MRI are gold standard methods but are rarely used because of their high cost, limited access, and concerns about radiation exposure. DXA is the method most often used in research because it is less expensive and exposes the patient to minimal radiation.

A practical alternative for measuring muscle mass, and one you can even use on your own at home, is bioelectrical impedance analysis (BIA). When used in clinics, BIA has been found to correlate well with body imaging techniques like MRI and is considered by experts to be an appropriate alternative to DXA in the diagnosis of sarcopenia.8

Home BIA machines are commonly called “body fat scales” or “body composition analyzers.” Most devices display some measurement of muscle mass, such as muscle mass percentage or muscle mass in weight.

Handgrip strength is currently the most popular, well-studied, and best-accepted way of assessing muscle strength and diagnosing sarcopenia.9

Grip strength accurately measures general upper body strength, and reflects overall strength, lower-limb strength, and performance.11 It is positively and significantly associated with cognition, functional status, mobility, cardiovascular disease, and death.12-14 Even in middle-aged people, grip strength is an accurate and consistent predictor of all causes of death.15

To measure hand grip strength, a person squeezes a dynamometer as hard as they can three times, with a one-minute rest between measurements. A highest value of <30 kg for men or <20 kg for women is the cut-off for diagnosing sarcopenia.8 These values identify weakness associated with limitations in mobility.16

Dynamometers are available for personal purchase but are fairly expensive. If you don’t have access to your own, many doctor’s offices, health clinics, and fitness centers have dynamometers available for assessing strength.

Gait speed is a simple, well-documented marker of physical performance. To assess gait speed, mark off a six-meter course. Measure the time, in seconds, it takes to complete the walk at your usual pace. Walking aids are allowed.

Gait speed <0.8 meters per second denotes mobility impairment.17 Gait speed ≤0.8 m/s is the recommended cut-off value in the diagnosis of sarcopenia and predicts subsequent disability, falls, cognitive decline, institutionalization, and mortality.11,17

Sarcopenia treatment and prevention

Protein supplementation, exercise, and vitamin D are the established, basic treatments for sarcopenia, even within the conventional medical system.

Protein

Consuming more protein from diet and supplements can help prevent and treat age-related muscle loss. Older adults who eat more protein have greater muscle mass than those who eat less,18 and middle-aged adults with higher protein intake have a significantly lower long-term risk of developing sarcopenia as they age.19

Many nutrition experts want the current protein RDA of 0.8 grams per kg of body weight to be increased20 to at least 1.2 grams per kg of body weight.21 People who exercise or have chronic disease need even more—around 1.5 grams per kilogram of body weight.21

The type of protein and the timing of ingestion matter too. Spreading protein intake throughout the day is more beneficial for boosting muscle.22 Older adults should consume around 25 to 30 grams of protein with each meal.23

Types of protein

Different proteins have different amounts of amino acids. The amount of the amino acid leucine determines whether skeletal muscle protein stimulation can occur or not.25 In general, animal proteins and whey protein contain more leucine than plant proteins.26

Proteins that are more quickly digested and absorbed, such as whey, stimulate muscle growth better than proteins such as casein and soy. Liquid proteins are generally better for maximizing muscle growth due to faster digestion.

Whey protein is typically consumed in a beverage, offers quick digestion, and has high leucine content, making it particularly good at promoting muscle synthesis. It is superior to soy protein27 and, when used with strength training, consistently increases muscle mass.28 Pea protein is another promising option. A study found it to be nearly equivalent to whey protein.29

Leucine

Leucine supplementation can significantly increase muscle mass in the elderly and works particularly well in people with sarcopenia.30 A study showed that a supplement containing just 6.25 grams of total protein plus 5 grams of leucine was as effective as 25 grams of whey protein at maximally stimulating increased muscle protein synthesis after resistance exercise.31 At least 2.5 grams of leucine is typically needed to exert beneficial effects on muscle mass.1 Combining leucine with other essential amino acids or protein sources is more effective than taking free leucine on its own.

Exercise

Both aerobic/endurance and strength/resistance exercise help older adults improve their muscle health and overall health. While aerobic/endurance exercise is most helpful for ­maintaining and improving cardiovascular and respiratory function, strength/resistance exercise improves muscle strength, power, and function.2 A combination of the two is recommended.

Progressive resistance exercises, where participants exercise against an increasing load, can prevent or even reverse age-related loss of muscle mass and strength. A review found that progressive resistance exercise performed two or three times per week improved muscle strength, gait speed, physical ability, and functional limitation.32

Adults over age 50 gain an average of 2.4 pounds of lean body mass with resistance exercise.33 Even very old and frail people benefit greatly from progressive resistance training; one study showed that eight weeks of progressive weight lifting was associated with an average 174% gain in muscle strength, a 9% increase in the mid-thigh muscle area, and a 48% increase in gait speed.34
Resistance training can be accomplished with traditional free weights and dumbbells, weight machines, body weight, elastic tubing, medicine balls, or even common household products like milk jugs filled with sand or soup cans.

The American College of Sports Medicine (ACSM) recommends that older individuals who are less fit focus primarily on machine-based exercises as they are safer to use compared to more complex free-weight exercises.35 A personal trainer is an excellent resource for establishing a progressive weight training program. Aim for two non-consecutive days per week.

Exercise is most effective when coupled with proper nutrition, especially when resistance exercise is combined with higher amounts of protein.36

Whey protein combined with resistance exercise leads to significant improvements in muscle mass, with average increases in lean body mass of 4.9 pounds.37

Vitamin D

Another crucial component of sarcopenia treatment is vitamin D.38 Vitamin D deficiency is associated with muscle atrophy, low handgrip strength, weakness and sarcopenia.39-41 Vitamin D supplementation alone and combined with a leucine-enriched whey protein supplement significantly increases strength and improves muscle mass and function in older adults with sarcopenia, even when no exercise is part of the intervention.42,43

Vitamin D is best dosed according to your blood levels of vitamin D as measured by the 25-hydroxyvitamin D test. Most natural and integrative practitioners suggest that most people maintain blood levels of 25-hydroxyvitamin D between 50 and 80 ng/mL for optimal health. The daily dose needed to maintain these levels is 2,000 to 5,000 IU per day.

What to try first

If you are worried about losing muscle mass and strength as you age, good nutrition, plenty of protein, and a regular strength training program are essential therapies that will not only help to prevent sarcopenia, but will help keep you healthier, leaner, and free from chronic disease.

1. Make sure you’re getting enough dietary protein. Eat more fish, eggs, poultry, and lean red meat. If tolerated, also include fermented dairy, milk, and legumes.
2. Next, focus on strength training. The combination of increased protein and strength training will increase muscle mass and strength more than either therapy alone.

These simple steps will provide the foundation for keeping you strong, mobile, and independent. Extra supplementation with protein powder such as whey protein (25-30 grams twice a day, including after exercise), leucine (2.5-5 grams per day), and vitamin D (to achieve and maintain blood levels of 50 to 80 ng/mL) can be added for even more powerful sarcopenia support.

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1. Age Ageing. 2014;43(6):748-759.
2. Oxid Med Cell Longev. 2015; 2015: 917085.
3. J Acad Nutr Diet. 2013 Jun;113(6):809-15.
4. Biomed Res Int. 2015; 2015: 524948.
5. Curr Opin Clin Nutr Metab Care. 2015 May;18(3):248-53.
6. J Gerontol A Biol Sci Med Sci. 2015 Jan;70(1):57-62.
7. J Gerontol A Biol Sci Med Sci. 2014 May; 69(5): 584–590.
8. Age Ageing. 2010;39(4):412-423.
9. J Musculoskelet Neuronal Interact. 2014 Dec;14(4):425-31.
10. BMC Res Notes. 2011; 4: 127.
11. Arq Bras Endocrinol Metabol. 2014 Jul;58(5):464-9.
12. Lancet. 2015 May 12. pii: S0140-6736(14)62000-6.
13. J Am Geriatr Soc. 2015 Jan;63(1):136-41.
14. Geriatr Gerontol Int. 2015 May 28.
15. Am J Med. 2007 Apr;120(4):337-42.
16. J Appl Physiol (1985). 2003 Nov;95(5):1851-60.
17. J Gerontol A Biol Sci Med Sci. 2014;69(5):591-594.
18. Food Nutr Res. 2014; 58: 10.3402/fnr.v58.23364.
19. FASEB. 2015 Apr;29(1):S737.1.
20. Am J Clin Nutr. 2008 May;87(5):1562S-1566S.
21. Clin Nutr. 2008 Oct;27(5):675-84.
22. Am J Clin Nutr. 2011 Feb;93(2):322-31.
23. J Gerontol A Biol Sci Med Sci. 2015 Jan;70(1):55-6.
24. J Nutr. 2014 Jun;144(6):876-80.
25. Am J Clin Nutr. 2015 Apr 29. pii: ajcn084053.
26. Am J Clin Nutr. 2015 Apr 29. pii: ajcn084061.
27. J Int Soc Sports Nutr. 2015; 12: 6.
28. J Am Coll Nutr. 2014;33(2):163-75.
29. J Int Soc Sports Nutr. 2015 Jan 21;12(1):3.
30. J Nutr Health Aging. 2015 Apr;19(4):437-46.
31. Am J Clin Nutr. 2014 Feb;99(2):276-86.
32. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD002759.
33. Med Sci Sports Exerc. 2011 Feb;43(2):249-58.
34. JAMA. 1990 Jun 13;263(22):3029-34.
35. Amer Coll Sports Med. Brochure. Resistance Training. 2013.
36. Am J Clin Nutr. 2012 Dec;96(6):1454-64.
37. J Am Coll Nutr. 2014;33(2):163-75.
38. Calcif Tissue Int. 2015 Jun 23.
39. Nutrition. 2015 Jul-Aug;31(7-8):931-4.
40. Mol Cell Endocrinol. 2015 Jul 15;410:3-10.
41. Clin Endocrinol (Oxf). 2014 Feb;80(2):169-81.
42. J Am Med Dir Assoc. 2015 Jul 10. pii: S1525-8610(15)00388-6.
43. Osteoporos Int. 2015 May 9.

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Natural Health Advisory

Want vegetables packed with nutrients? Look no further than the Brassica family. Cruciferous vegetables, which include things like broccoli, cauliflower, cabbage, bok choy, and even rutabaga, are some of the most nutrient-rich powerhouses you can feed your body. These delicious and nutritious veggies should hold a permanent, starring role on your plate; try eating them at least five times per week to help prevent cancer, lower cholesterol, and more.

Which vegetables are cruciferous?

The list of cruciferous vegetables is long and extensive. Some of the more commonly consumed cruciferous vegetables include:

• Broccoli
• Cauliflower
• Kale
• Cabbage
• Bok choy
• Brussel’s sprouts
• Collard greens
• Arugula
• Turnip
• Rutabaga
• Radish
• Daikon
• Wasabi
• Kohlrabi
• Watercress

Vitamins, minerals, and antioxidants

Cruciferous vegetables offer some incredible health-promoting qualities due to the many important nutrients that are packed into each serving of these super foods. In fact, studies show that dark-green, leafy vegetables like cruciferous vegetables rate highest in tests measuring nutrient density.1 Cruciferous veggies are very high in vitamin C, vitamin E, vitamin K, folate, selenium, glucosinolates, flavanoids, polyphenols, and much more.2-7

Health benefits of eating cruciferous vegetables

Cruciferous vegetables contain several nutrients that have a whole host of beneficial effects in the body, including anti-inflammatory, antioxidant, antibacterial, antifungal, neuroprotective, hypoglycemic and lipid-lowering effects.2,3,8,9 And this translates into some pretty remarkable results, especially in terms of cancer and heart disease prevention.

Cancer

There have been several studies linking high cruciferous vegetable intake to lower rates of cancer, as well as higher rates of cancer survival.3,10 Some of the particular types of cancers affected include lung, ovarian, breast, and prostate.4,11-14 Cruciferous vegetables may be more effective at protecting against cancer in some people compared to others, due to genetic factors.10

Cruciferous vegetables contain glucosinolate, which degrades into isothyocionates, strong antioxidants known to fight cancer in numerous ways. They seem to help detoxify carcinogenic compounds before they can do damage in the first place, alter cell-signaling pathways that lead to cancerous cell proliferation, impact epigenetic regulation (newly discovered as an important factor in cancer prevention), and lower inflammation.3,4

Heart disease

Cruciferous vegetable intake also seems to help lower the risk of heart disease, partly because these vegetables are great cholesterol-lowering foods. They are high in fiber and are potent sources of antioxidants. Additionally, compounds in cruciferous vegetables bind to bile acids, which is important for cholesterol control. Bile is used to help digest and absorb fats that we eat. When cruciferous vegetables bind these bile acids, they are excreted from the body. To replace the lost bile acids, our bodies must use cholesterol stores, which helps lower our cholesterol levels.15

Studies have shown that intake of certain cruciferous vegetables, such as kale, cabbage, broccoli, and more, can improve cholesterol scores. For example, in one study, men with high cholesterol who supplemented with 120 mL of kale juice daily for 12 weeks saw a 10% reduction in LDL (bad) cholesterol and a 27% increase in HDL (good) cholesterol.16

Recommended intake

Researchers recommend eating at least five servings of these tasty super foods per week.10 The most nutrient-dense parts of these vegetables tend to be the florets (like the flowering head of broccoli), although the leaves and stalks are healthy choices as well.17 The darker and more colorful the veggies are, the higher the antioxidant capacity as well. Try purple cabbage or kale to get the most out of your servings.

So get started piling broccoli, bok choy, kale, cabbage, and more onto your plate today. Fortunately, the Brassica family is quite versatile; try making a fresh cabbage coleslaw, roasted broccoli and cauliflower with herbs and oil, a green smoothie with kale, bok choy stir fry, and much, much more.

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1. J Acad Nutr Diet. 2013 Sep;113(9):1182-7.
2. Rocz Panstw Zakl Hig. 2012;63(4):389-95.
3. Oxid Med Cell Longev. 2013;2013:964539.
4. Curr Pharmacol Rep. 2015 Feb 1;1(1):46-51.
5. Crit Rev Food Sci Nutr. 2014;54(8):1076-91.
6. Arch Latinoam Nutr. 2014 Mar;64(1):59-68.
7. Food Sci Technol Int. 2012 Dec;18(6):503-14.
8. Asian Pac J Cancer Prev. 2014 Jan;14(11):6657-62.
9. Chin J Nat Med. 2014 Sep;12(9):648-53.
10. Pharmacol Res. 2007 Mar;55(3):224-36.
11. Sci Rep. 2015 May 19;5:10306.
12. Asia Pac J Clin Nutr. 2015;24(1):101-9.
13. Breast. 2013 Jun;22(3):309-13.
14. Int J Urol. 2012 Feb;19(2):134-41.
15. Nutr Res. 2008 Jun;28(6):351-7.
16. Biomed Environ Sci. 2008 Apr;21(2):91-7.
17. Molecules. 2015 Jan 13;20(1):1228-43.

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Natural Health Advisory

Most people understand the importance of protecting their hearts and brains as they age, but muscle health is often forgotten. This is a dangerous mistake, as good muscle health is crucial for our ability to remain healthy and independent with advancing age. Up to one-third of older adults are at risk because they suffer from age-related muscle loss, or sarcopenia.1

What is muscle health?

Your skeletal muscle powers your body movements, is essential to maintaining stability, and helps maintain blood sugar balance. Without good muscle health, strength, mobility, and function all decrease, while fatigue, falls, fractures, and metabolic disorders like obesity and diabetes increase.

The total weight of your skeletal ­muscle is called your muscle mass. Having adequate muscle mass ensures that you can move, but is also essential to basic survival. Muscle is made primarily of protein, which is made of individual amino acids. Many tissues and organs, such as the skin, brain, heart, and liver, need these amino acids to function.

When dietary protein intake is insufficient, muscle protein serves as the principal reservoir to replace used-up amino acids. This protein reservoir also supports the immune system and other bodily systems during healing or recovery from exercise, illness, surgery, or traumatic accidents.

Muscle function

Sufficient muscle mass, however, is just the beginning. Good muscle function is even more significant. Three primary factors determine good muscle function.

1. Quality muscle has more mitochondria. These are the powerhouses within your cells that use oxygen to turn glucose and fat into adenosine triphosphate (ATP). ATP is the gasoline for your muscle cells. More mitochondria means more energy and better capacity to burn fat. Further, in healthy muscles, the mitochondria are more active and efficient, generating less oxidative stress.2
2. Quality muscle has less fat. The more fat-laden your muscle tissue, the more you’re likely to succumb to age-related declines in strength, mobility, and functioning. In fact, fatty muscle is more likely to cause weakness and loss of mobility than loss of muscle, so in some ways it’s worse to have fatty muscle than dwindling muscle. Furthermore, fat muscle tissue is less responsive to the hormone insulin, so it can’t control blood sugar as well as lean muscle can. This can lead to weight gain and diabetes.
3. Quality muscle has a healthy balance of fibers. Muscle is made up of bundles of two types of fibers: slow twitch and fast twitch. Slow twitch are responsible for long-duration, low-intensity activities such as walking. Fast twitch are responsible for short-to-moderate duration, moderate-to-high intensity activities, such as most weight training and sprinting. With insufficient fast-twitch fibers, actions as basic as rising from a chair, climbing steps, or regaining balance can become difficult or impossible.3

Age-related declines in muscle health

As we age, muscle mass and all three factors of healthy muscle function decrease. The end result is diminished strength and physical performance, which lead to:

• mobility impairments
• weakness
• fatigue
• increased risk of death, infection, and falls
• slower healing
• overall diminished quality of life.

The decline in muscle health associated with aging is known as sarcopenia and it increases the risk of “physical disability, poor quality of life, and death.1,4-6

As your muscle health declines, you’re much more likely to die of any cause. In fact, your muscle health may be more (or just as) important for predicting death than many other common risk factors, including your weight, diet, and smoking.

Preserving independence

Muscle health is also intricately linked to your ability to continue to do the things you want to in your 60s, 70s, and beyond. It is one of the strongest indicators for functionality and quality of life.7,8 Just think about how important it is to be able to get up out of a chair to do what you need to do, like go to the bathroom, dress yourself, shop, or cook.

Muscle health also helps prevent falls. People of all ages fall, of course, but those with poor muscle health are both more likely to fall and more likely to be severely injured.9,10 If you have good muscle mass and strength, at the very worst you will break your hand or wrist when your hands immediately come out to break the fall. Without good muscle mass and strength, particularly in the upper body, it is not possible to protect yourself and break the fall. The result is often a broken hip. While a broken wrist is an inconvenience, a broken hip can be a death sentence.

What to do about sarcopenia

The good news is that sarcopenia is very effectively treated with nutrition and exercise. At any age, you can re-gain muscle health for improved vitality and quality of life. This month’s Home Remedy Snapshot on page 5 will show you how to determine the state of your muscle health for yourself and give you the best evidence-based strategies for preventing and treating sarcopenia.

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1. Age Ageing. 2014 Nov;43(6):748-59.
2. Biochim Biophys Acta. 2014 Apr;1840(4):1276-84.
3. Osteoporos Int. 2010 Apr; 21(4): 543–559.
4. Am J Med. 2014 Jun;127(6):547-53.
5. Geriatr Gerontol Int. 2015 May 28.
6. J Am Med Dir Assoc. 2015 Jul 1;16(7):607-13.
7. Arch Gerontol Geriatr. 2012 Sep-Oct;55(2):e9-13.
8. Exp Gerontol. 2015 May 13;69:103-110.
9. Clin Rheumatol. 2015 Apr 26. [Epub ahead of print]
10. J Bone Joint Surg Am. 2015 Mar 4;97(5):429-37.

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Natural Health Advisory

Nearly one-third of Americans have non-alcoholic fatty liver disease (NAFLD)—now the most common chronic disease of the liver.1 Although rarely discussed in conventional medical offices and even less in the media, NAFLD is epidemic.

This stealthy condition can go undetected for years—with deadly consequences. Once advanced, NAFLD cannot be reversed. It is crucial to detect and treat NAFLD with lifestyle therapies and natural medicines as early as possible.

What is NAFLD?

The liver carries out several necessary functions, including detoxifying harmful substances in the body, cleaning the blood, and making vital nutrients. In NAFLD, fat deposits accumulate inside the liver. Early on, there are typically no signs or symptoms, although the accumulating fat is already starting to block the inflow of nutrients to liver cells, while simultaneously blocking the outflow of toxins.

The accumulation of fat and toxins inside the liver can cause liver inflammation and oxidative stress. If this happens, NAFLD is considered to have progressed from simple fatty liver disease to a more advanced stage of the disease called non-alcoholic fatty hepatitis or NASH.

The inflammation and damage caused by excessive free radical production associated with NASH can injure liver cells, causing scarring and, eventually, fibrosis, an advanced form of liver scarring known as cirrhosis. This further impairs the liver’s ability to efficiently detoxify and perform its vital functions. Eventually, cirrhosis can become so advanced and liver function so impaired that a liver transplant is needed to sustain life. Cirrhosis can also lead to liver cancer (hepatocellular carcinoma).

NAFLD complications

NAFLD increases the risk of type 2 diabetes mellitus, cardiovascular diseases, and chronic kidney disease. It is strongly associated with a number of conditions that lead to these diseases, including obesity, insulin resistance, high blood pressure, and abnormal lipids (high total and LDL cholesterol, low HDL cholesterol, and/or high triglycerides).2,3 NAFLD increases the risk of overall death by 57% and most people with NAFLD die of cardiovascular disease rather than direct liver complications.2,4

How to tell if you may have fatty liver disease

Since one-third of Americans have this serious condition and many doctors don’t even check for its presence, it is critical that you become aware of those factors that might suggest you have the disease yourself. Early detection is a key to a complete recovery.

Here are some factors that indicate increased risk of NAFLD:

• Are you overweight or obese?
• Is your diet poor, with too much sugar and too many processed carbohydrates?
• Do you regularly drink sugar-sweetened beverages?
• Do you not eat fish regularly or take a fish oil supplement containing omega-3 fatty acids?
• Do you experience fatigue and occasional nausea or stomach upset?
• Do you occasionally experience some vague pain in the right upper abdominal area?
• Have you had a recent blood test that showed elevated liver enzymes?

If several of these indicators apply to you, waste no time in getting an appointment with your doctor and ask him to specifically test for NAFLD.

A doctor skilled with palpation, a method of diagnosis by manual examination and pressure, can distinguish a normal liver from an abnormal one by touch alone. Ultimately, an ultrasound test is required to diagnose NAFLD in the vast majority of patients, and your doctor may want to order that test immediately.

What causes NAFLD?

In the past, fatty liver was seen in alcoholics with end-stage cirrhosis and liver disease. Now, however, it is common to see fatty liver in people who drink little or no alcohol because their livers are overburdened with unhealthy substances from diet or the environment. NAFLD is chiefly caused by poor dietary and lifestyle choices: eating too much of the wrong foods and not enough of the right foods and not exercising enough.

The most dangerous foods

Eating any kind of food in excess of the body’s energy needs can lead to NAFLD. However, research indicates that some categories of foods may be worse than others for causing fatty liver.
Highly processed carbohydrate foods, particularly those containing added sugar, are the biggest dietary culprits. Sugar, whether common table sugar (sucrose) or fructose, is highly associated with NAFLD.5

Sugar-sweetened beverages (including those sweetened with high-fructose corn syrup) are particularly dangerous. People who drink one or more servings of sugar-sweetened beverages per day have a 61% greater risk of having fatty liver disease compared nonconsumers.6 The tight association between regular consumption of sugar-sweetened beverages and fatty liver disease remains even after adjusting for body mass index, indicating that it’s the sugar responsible, not increases in body weight.

When sugar is combined with excess intake of fats, particular trans-fats and fried foods, the risk of fatty liver may be amplified. In general, however, fats, including saturated fat, do not cause fatty liver if the diet does not exceed your body’s energy needs.7 Likewise, the combination of sugar with certain nutrient deficiencies appears to amplify NAFLD.8 Nutrient deficiencies are more common in people with fatty liver disease, making a high-fat, high-sugar diet particularly damaging.

Nutrient deficiencies and fatty liver disease

Even though people with NAFLD tend to consume too many calories, they have nutrient deficiencies that are directly associated with their liver disease and likely contribute to the progression of NAFLD. People with NAFLD take in too few antioxidant vitamins and minerals such as selenium, vitamin C, vitamin A, and vitamin E.9-11 They also consume insufficient amounts of other vitamins and minerals including vitamin D, calcium, vitamin K, vitamin B6, and folate. Furthermore, even though people with NAFLD often consume lots of fat, they consume too few mono- and polyunsaturated fatty acids, particularly the omega-3 fatty acids found in fish (EPA and DHA).12-15

Dietary treatment of fatty liver disease

It is imperative that anyone with NASH permanently switch to eating a whole-foods, nutrient-dense diet that is low in sugars (even natural ones) and other highly processed carbohydrates, especially refined grains such as white flour.16

Absolutely no sugar-sweetened beverages should be consumed. Fruit juice and alcoholic beverage consumption should also be kept to a minimum. Foods containing flour, even whole-grain flour, should be eliminated or minimized. The focus should be on vegetables, nuts, seeds, fish, and leaner cuts of grass-fed meats, along with moderate amounts of whole grains, legumes, dairy, and fruit.

Learning to love fresh, whole foods prepared from scratch can be a challenge when our palates are so accustomed to processed foods that have been specifically designed to be highly palatable. But with time, patience, and persistence, the commitment to eating a less refined, more natural diet always pays off. You will start to crave healthier, fresher foods and they will be able to completely satisfy you.

Supplements for treatment of NAFLD

Because of all the nutrient insufficiencies associated with NAFLD, a high-potency, high-quality multivitamin is recommended for ongoing, daily intake. In addition, the following natural supplements are recommended:

Vitamin E. Vitamin E significantly improves liver function in patients with NAFLD/NASH. The results of five randomized controlled trials found that vitamin E significantly reduces circulating liver enzymes, a chemical marker of liver cell injury. Vitamin E supplementation lowers aspartate transaminase (AST) by -19.4 U/L, alanine aminotransferase (ALT) by -28.9 U/L, and alkaline phosphatase (ALP) by -10.4 U/L.17 Vitamin E supplementation also significantly lowers the accumulation of fat in the liver (steatosis), inflammation, liver cell death, and fibrosis.17

These startling results are explained by vitamin E’s role as a powerful antioxidant. It is the major chain-breaking antioxidant in body tissue and is the body’s first line of defense against the oxidation of fats. As you learned, excess free radical production (oxidative stress) plays a key role in the initial development and progression of NAFLD, and people with the disease have depressed levels of vitamin E in their blood due to all the increased oxidation.18,19

Although the recommended dietary intake of vitamin E is only around 12 IU, the therapeutic dose needed to prevent the oxidation of fats and free radical damage in NAFLD and NASH is generally thought to be 800 IU per day. Choose a natural vitamin E supplement; synthetic vitamin E is not biochemically equivalent to the natural forms and is not as effective.

In addition, because natural vitamin E is actually a family of compounds, four tocopherols and four tocotrienols, choose a supplement that contains all of the natural forms of vitamin E as mixed tocopherols and tocotrienols. Research shows specific health benefits of the individual natural forms.20 One recent study used only tocotrienols and found that 200 mg mixed tocotrienols twice daily normalized the appearance of the liver after one year of treatment.21

EPA & DHA. Similar to vitamin E, EPA and DHA, the most important omega-3 fatty acids, fight the oxidant and inflammatory components of NAFLD, decreasing the toxic effects of excess fat accumulation in the liver.22 In addition to suppressing the production of new fat molecules in liver cells, omega-3 rich fish oil improves insulin sensitivity, reduces triglycerides, and stimulates liver tissue and skeletal muscle to use fat.

People who don’t consume enough fish and other sources of omega-3 fats in their diets are prone to NAFLD.23,24 In one recent study, taking a fish oil concentrated in EPA and DHA per day significantly decreased liver fat in patients with NAFLD.25 The fish oil product used in the study contained approximately 465 mg of EPA and 375 mg of DHA per 1-gram capsule and subjects took a total of four capsules (4 g) per day.

Many other studies have tested both lower and higher doses of EPA and DHA and all show beneficial results for people with NAFLD.26 Omega-3 supplementation can significantly decrease liver cell damage and triglycerides levels, and improve the appearance and blood flow of the subjects’ livers on ultrasound. The exact dose of EPA and DHA needed to optimally affect NAFLD outcomes, however, is not known.27

Try to eat oily fish, like salmon, at least twice per week, and take 1 to 4 grams of supplemental omega-3s daily. Watch for worsening glucose levels or LDL cholesterol levels on high doses of fish oil and decrease your dose if you experience either of these side effects.28

Milk thistle extract. Milk thistle extract has a long history of medicinal use for liver disorders and for good reason—the active compounds in milk thistle, a group of flavonoid compounds called silymarin, are exceptional antioxidants and anti-inflammatories with an affinity for the liver. Of all the silymarin compounds, silybin is the most potent. Silybin substantially boosts the liver’s resistance to toxic insults, protecting the liver by conserving glutathione, the liver’s most important self-made antioxidant.

On its own, silybin has poor bioavailability, but the addition of phoshphatidylcholine improves absorption.29 This combination, known as silybin phytosome, may be superior to regular milk thistle extract (standardized for silybin) for treating NAFLD. Furthermore, taking silybin phytosome along with vitamin E may offer even greater effectiveness.

The combination of silybin, phospholipids such as phostphatidylcholine, and vitamin E has been studied and found to be very effective for improving liver structure and function in patients with NAFLD. The three compounds appear to work synergistically to protect liver cells from damage. The combination significantly improves liver function and structure and decreases insulin resistance in patients with NAFLD.30 A formula containing 376 mg silybin, 776 mg phosphatidylcholine, and 360 mg vitamin E reduces liver fat accumulation and liver scarring and improves insulin resistance.31,32

You can now find silybin phytosome through a number of supplement manufacturers. Take 360 mg per day.

What to try first

Non-alcoholic fatty liver disease is a serious condition that affects one out of every three Americans and often goes undiagnosed until it’s too late. Therefore, it is imperative that you are alert to certain factors that indicate you or your loved one may have the disease. Early diagnosis and treatment with the natural protocols described here can often reverse this deadly condition.

Cooperation and close monitoring by a physician is recommended because the liver metabolizes many nutrients and drugs and could become overwhelmed if the right dosages and combinations of quality supplements are not used.

The natural medicines and dietary strategies outlined here, however, should be safe for the majority of patients with NAFLD but without other serious health conditions.

The most important natural treatment for fatty liver disease is dietary therapy.

• Eliminating added sugars and refined grains from your diet is the number one priority.
• Increasing whole, fresh foods and increasing your intake of vegetables, nuts, seeds, fish, and fresh, lean, grass-fed meats is second.

For supplements:

• Take a good multivitamin along with 1 to 4 grams of fish oil per day.
• If your liver function has not improved within three months, add in extra natural vitamin E as mixed tocopherols and tocotrienols to achieve the dosages suggested above, along with 360 mg of silybin phytosome.

These treatments are the most evidence-based natural strategies for fatty liver disease. Following this treatment plan will help to return your liver to a healthy state. Taking care of your liver is a crucial piece of optimal health and wellness.

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