Most of us have been exposed to Epstein-Barr virus (EBV). We were probably exposed as a kid or teen since it’s transmitted by saliva, kissing, shared drinks or utensils and even coughing or sneezing. It is the primary causative agent in infectious mononucleosis. So what’s the big deal? And why is there a vaccine in progress against this innocuous “kissing disease”?

What you may not know is that EBV causes about 200,000 cases of cancer (nasopharyngeal and gastric cancer, Burkitt and Hodgkin lymphomas) and about 140,000 deaths annually. It’s also a co-factor in other serious illnesses, including multiple sclerosis. Symptoms of infectious mono include extreme fatigue, sleep abnormalities, pain and other symptoms that worsen with activity. These symptoms can last for over 6 months which makes it debilitating and difficult to work.

An international team identified the specific antibodies that block binding of the virus to epithelial and B cells (EBV molecules attach to specific B cell receptors). This team developed a vaccine using nanoparticles that enhanced the immune system’s production of these blocking antibodies. The vaccine potentially neutralized EBV’s ability to infect the epithelial and B cells in both mice and nonhuman primates.

The next step would be to perform randomized clinical trials and safety studies in humans. Both of these are planned for the next few years.

References: Komaroff, A. Progress in developing a vaccine against Epstein-Barr virus. JWatch.org June 15, 2019; p. 95.Photo by The U.S. National Archives

Almost 3/4 of adults older than 70 have some form of hearing loss. It effects about 37.5 million Americans, yet most people don’t do anything about it. Among those younger than 70, fewer than one in five use hearing aids. Those older than 70 aren’t much better with only 1 in 3 using these devices.
When hearing starts to go, many people feel they are losing their memory. Research shows that more than half of people who see their doctor about memory concerns have a hearing problem. Even though these people may not have any memory loss, hearing difficulty can be a precursor for a decline in memory and thinking skills.

In a study that followed 1,164 adults (average age 73) for 24 years, 70% had some degree of hearing impairment at the start of the study. Follow up consisted of these adults taking tests of their brain function. Those with severe hearing loss since the start of the study got the lowest scores on the test. Any hearing difficulty was linked to a quicker decline in thinking than those whose hearing held steady, but education helped make up for mild impairment. Another study of older adults indicated that those that had even minor loss were twice as likely as their fully hearing peers to have signs and symptoms of depression.

Another important development of this last year according to Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer’s Association, is that hearing loss has been added to the list of significant modifiable risk factors for dementia. We don’t really know what links hearing loss to dementia but it is speculated that hearing problems force the brain to work harder to understand what’s being said. Over time, that extra burden may cause harm. The other theory is that dementia may come from social isolation. If your poor hearing does not allow you to socialize and participate fully in conversations, you may lose the brain benefits that come from that type of mental stimulation.

As with sleep, it’s not yet known whether correcting hearing loss (with hearing aids) will reduce the risk of dementia. But most hearing loss occurs outside the brain and is not related to the brain at all. Mental stimulation and socialization is huge and appears to offer protection against dementia.

The good news is that age-related hearing loss is reversible. Hearing aids can help. The problem has been cost, lack of insurance coverage for hearing devices and a required medical appointment that has kept people from pursuing treatment. A new federal law is designed to bring lower-cost, over-the-counter hearing aids to market by the end of 2020. Preliminary studies have shown that these devices available under the new law are just as good and work just as well as their more expensive prescription counterparts.

Reference: Collins, S. “The latest: New research on hearing loss”. WebMD, June 2019, p. 67.
McMillen, M. “Guarding the mind: The latest research points to ways you can lower your odds of developing dementia”. WebMD, June 2019, p. 50-53.Photo by The U.S. National Archives

Photo by The U.S. National Archives

There have been many dietary recommendations to reduce the risk for cancer throughout the years. Most include a reduction in sugar, processed foods, alcohol, and food allergens. This study stems from the federally funded Women’s Health Initiative which is a long-term health study launched back in 1993. The study enrolled women in their 50’s, 60’s and 70’s at the time it started.
About 20,000 women were coached to change their diets for at least 8 years. Women were asked to reduce their total fat intake and to increase their intake of fruits, vegetables and grains. A comparison study of 30,000 women were asked to continue their normal diet. The results showed that women in both groups were diagnosed with breast cancer, but the women who changed their diets had a 21% lower risk of dying from breast cancer.

Even though this study may be significant in the reduction of deaths from breast cancer, it goes against the most recent research about eating plenty of healthy fats such as fish, olive oil, avocados and other plant based oils. Remember that this study was conducted in the 1990’s when the low-fat boom was at its peak. A lot has changed since then…healthy fats=good; refined carbs and sugars=bad! Notice I said “good fats”. As mentioned in this article, lollipops and lentils are both low fat, whereas avocados and butter are both high fat. The women in this study were asked to achieve a low-fat diet through eating more fruits, veggies and whole grains which would increase their fiber and nutrient intake.

Also, the women in the study who modified their diet lost on average about 3% of their starting body weight. Obesity is a risk factor of breast cancer so shedding weight may have also reduced cancer risk.

I believe weight reduction has a bigger impact on breast cancer risk reduction than we once thought. Dr. Ruth Patterson, Ph.D professor and cancer researcher at UCSD was involved in a recent study of 2500 breast cancer survivors. In this study, WHAT you ate was not as important as WHEN you ate. The results showed that women who fasted at least 13 hours had a reduced recurrence of breast cancer by 40%!!! Fasting also lowered the risk of diabetes, non-alcoholic fatty liver disease and gastroesophageal reflux.

The concept behind this is that women that are overweight or obese produce too much insulin. Estrogen is stored in adipose (fat) tissue. Both estrogen and insulin are growth factors, which means it increases the growth rate of tumors. We also know that fat causes more inflammation. So you can see the effect of this trio…more estrogen, more insulin and more inflammation. Insulin also decreases sex hormone binding globulin (SHBG) which allows estrogen and testosterone to be unbound and more freely available to again increase estrogen and inflammation.

Intermittent fasting is becoming very popular for many health conditions. If weight loss is your goal then I would increase your fasting times so that your eating window is 5-6 hours. I know…thats like 17-18 hours fasting, so move the fasting times by 1 hour and try it slowly. If that is difficult, then fast for at least 13-14 hours and stop eating earlier at night. In the study, women fasting for 13 hours may not have lost weight but they did reduce inflammatory markers if they stopped eating earlier.

My opinion, is not to reduce fats but to increase fruits and vegetables and eat small portions of whole grains. Aim to eat dinner early and then wait a full 13-14 hours (or more) before eating breakfast. Avoid smoking and alcohol and exercise regularly. Don’t forget a good night’s sleep. Sleep repairs a lot more damage when fasting and can help DNA repair and “autophagy”-clearing away damaged cells, which has the potential to increase further inflammation. Work towards these daily goals and your breast cancer risk as well as other diseases will be significantly reduced.

https://www.npr.org/sections/thesalt/2019/05/18/724309081/calories-carbs-fat-fiber-unraveling-the-links-between-breast-cancer-and-diet
Stephens, G. “Delay, don’t deny: Living an intermittent fasting lifestyle.” 2017.
https://www.foundmyfitness.com/episodes/ruth-patterson

Many of you may know of melatonin as the hormone supplement to be used for sleep. Although that’s true, there is so much more that this hormone can do. Some researchers feel that even if you sleep well, melatonin is still worth taking for other reasons.

One thing to note is that Melatonin, like many other hormones, starts to decline in our 40’s. It is a hormone produced not just in the brain but in many other tissues throughout the body: the most abundant production being in the intestine. Researchers have also found that it is produced in the retina, the skin, the bone marrow, the thymus and in white blood cells which makes it an important regulator of the immune system.
Here are the many effects of Melatonin:

1. Protects against viral and bacterial infections-Studies have shown that melatonin reduces the ability of bacteria to reproduce, provides a non-conducive environment for bacteria to live, and decreases inflammation. It has also shown to be effective in treating viral infections, and in treating premature infants suffering from respiratory distress syndrome and septic shock. This is where melatonin can have a profound effect in strengthening our immune system.

2. Cardiovascular health- Studies in mice as well as humans have shown a reduction in blood pressure when taking melatonin. As we age, the risks of coronary disease, high blood pressure, heart failure and stroke increase and melatonin decreases. Melatonin can prevent and treat heart disease and high blood pressure due to its anti-inflammatory and anti-oxidant effects.

3. Alzheimer’s and neurodegenerative diseases- Melatonin is the major antioxidant in the brain and nervous system. Since oxidative stress is the primary destructive force on our brain cells, having enough melatonin is essential to preserving brain cells and function, especially over the age of 60. Melatonin acts directly on the DNA and mitochondria in our cells allowing them to behave more like our younger selves.
When our brain cells die (due to poor health, drugs, malabsorption, sedentary lifestyle and aging), we rely on brain stem cells to replace them. But these cells diminish as we get older and they are harder to replace. Melatonin can help this process of neurogenesis (brain stem cells replacing dead cells). It also stimulates hippocampal neurogenesis, which is important because the hippocampus is the region in the brain that regulates short-term memory and spatial orientation.

4. Menopause- Melatonin has been shown to help menopausal symptoms including mood and reducing depression. There seems to be a recovery of pituitary and thyroid functions in melatonin-treated women.

5. Ionizing radiation- X-rays, CT and PET scans are the main sources of ionizing radiation which with repeated and prolonged exposure increases the risk of cancer. Children are especially at risk. Melatonin in human studies has been able to cancel the potentially damaging effects of ionizing radiation. The doses used in research are 300 mg of melatonin which seems quite high but the effects were amazing. Lymphocytes (WBC’s) in blood samples were taken from men and women. After exposure of the equivalent of 1000 CT scans (I know…that’s alot!) all the samples had a degree of genetic damage due to the radiation. The cells that were taken an hour and two hours after the melatonin dosing had significantly less genetic damage. Something to think about if you need these procedures done.

6. Macular degeneration- Melatonin is produced in the retina, the part of the eye that is affected by macular degeneration. People with macular degeneration (MD) have lower levels of melatonin. Oxidative stress is the primary cause of this condition. Studies have shown that it can prevent and slow the progression for either dry or wet MD.

7. Cancer- There are several published studies on the use of melatonin and cancer. Researchers have reported that not only has melatonin been shown to have an anti-cancer effect but it also has an immune reaction against cancer. It protects healthy cells from the negative effects of chemotherapy and radiation. Some studies showed that adding melatonin to chemotherapy enhanced the treatment effect of the drug while at the same time decreasing the side effects. Melatonin has been used in breast cancer studies since it has SERM (selective estrogen receptor modulator) and SEEM (selective estrogen enzyme modulator) properties. This means it has anti-estrogen and anti-aromatase actions. Melatonin also stimulates apoptosis (programmed cell death). Melatonin has shown cancer prevention and benefits in the treatment of prostate cancer whether cancer cells were sensitive to hormones or not. The anti-cancer properties of melatonin include colorectal, breast, prostate, pancreas, liver and brain cancer.

Choose a pure melatonin in a powder or use capsules free of additives. If side effects occur (ie. waking up with vivid dreams) try a different brand. Also, there is no negative feedback inhibition with melatonin. This means that there is no concern with taking melatonin that it can cause the body to stop making its own. You can take as much as you want and it will not interfere with your own production of melatonin.

Just a side note…I have used melatonin for teens with great success. I find it especially good for kids with sensory integration issues. So it’s not just for people older than fifty. By the time you are 20 years old, you have some deficiencies, but even those with alot of stress, inflammation, malabsorption, food sensitivities and repeated infections, melatonin may be a part of your healing program.

Reference:
Shallenberger, F. Melatonin isn’t just for sleeping-from cardiovascular disease and cancer to aging and macular degeneration the research will shock you. Townsend Letter. Feb/March 2019. pp.50-57.
Sanchez-Barcelo EJ, et al. Melatonin uses in oncology: breast cancer prevention and reduction of the side effects of chemotherapy and radiation. Expert Opin Investig Drugs. 2012 June, 21(6):819-31.

Spring is a common time for people to start moving more and thinking about doing a gentle detox. Here are some general recommendations and information about modified citrus pectins.

Food is one of the most important medicines we can use to re-energize and help detoxify. When we start eating more nutrient dense foods such as lean proteins, fruits, vegetables and legumes (high in fiber), it helps to balance blood glucose and insulin levels and removes those sugar cravings. Avoiding refined foods, sugars, cooked oils and trans-fats, alcohol, caffeine and preservatives reduces inflammation that make us feel sluggish and foggy headed. Keeping that healthy gut flora happy is a must so choose sauerkraut, kimchi, natto and green tea to help colonize good bacteria and aid in detoxification. Let’s not forget about water. Filtered or spring water is best. The general rule is to drink half your body weight in ounces. Also, when we feel better, it motivates us to exercise and to stick with our program.

Now let’s talk about binding those toxins so they can be eliminated in the body. Modified citrus pectin (MCP) from citrus peels is a unique dietary fiber that is metabolized by intestinal bacteria to short-chain fatty acids in the colon. MCP also removes toxic metals, environmental toxins, and even radioactive isotopes from the circulatory system and digestive tract. It is a safe gentle chelating agent and does not remove essential minerals due to its structure. When you combine it with alginates, you get a more powerful effect because the alginates from seaweed prevent the reabsorption of heavy metals.

MCP is also one of the most powerful immune enhancers according to a study by Dr. Isaac Eliaz. In healthy volunteers MCP showed a healthy increase in blood cytotoxic T-cells (which fight cancer) by 160%, and it activated natural killer cells (NK-cells) 10-fold which changes the activity of cancer.

Researchers have also shown that MCP binds to Galectin-3 (Gal-3) to reverse inflammation and fibrotic changes to the heart, kidney, liver, nervous system and other tissues. Gal-3 is recognized as a predictive biomarker and therapeutic target for heart disease. It is easily measured in the blood and is covered by most insurance companies. It can also be used to assess cancer risk and progression.
For those with no risk factors, 5 grams per day is recommended. This will help reduce toxic heavy metals, enhance the immune system, reduce inflammation and tissue damage. Also, as we age Gal-3 naturally goes up, so MCP will help with maintenance. If you have any chronic illness, cardiovascular disease, cancer, hepatitis or elevated Gal-3 (over 15), then 15 grams a day is recommended.
Start a healthy cleanse this spring. It’s worth the investment!

References:
Dr. Eliaz, I. 3-Step Spring Detox Diet. Amazingwellnessmag.com. March 1 2017
Komen, S. Modified citrus pectin. Komen.org. 2014.
Desaulniers, V. How can modified citrus pectin halt cancer cell growth? Thetruthaboutcancer.com. June 9, 2016.
Natural Medicines Comprehensive Database 2013. Published by Therapeutic Research Faculty, Stockton CA.
Isaac Eliaz, MD, MS, L.AC., www.modifiedcitruspectin.org

It is not uncommon for me to see aspirin on the medication list of many of my older patients. It is most common with my well-controlled hypertensive or hyperlipidemia clients whom have no history of clinically evident cardiovascular (CV) disease. So when I ask them why they are on aspirin, the common reply is, “I read that it prevents heart attack and stroke so I started it on my own”, or “My husbands cardiologist suggested I take it after I took him in for a check up”. Two new studies in 2018 might shed some light on the subject.

In the ARRIVE trial, some 12,000 non-diabetic patients were randomized to 100mg of daily aspirin or placebo. Enrolled men were 55 years or older with 2 or more CV risk factors. Women in the study were at least 60 years old and had 3 or more CV risk factors. After a 5 year follow up aspirin had no CV benefit in reducing CV-related death, heart attack, unstable angina, stroke or transient ischemic events anymore than placebo. Those in the aspirin group had a slightly higher risk for gastrointestinal bleeding.

In the ASCEND trial, 15,000 middle aged or older diabetic patients were randomized to 100mg of aspirin daily or placebo. During average follow up of about 7 years, aspirin prevented 1 vascular event but caused 1 serious hemorrhage for every 100 treated patients.

So what does this mean…

Maybe we shouldn’t use aspirin as the magic prophylactic bullet for primary prevention that we once thought. Among diabetic patients, the trade off between a small benefit and harm are razor thin. And balancing one adverse event (CV event) against another adverse event (gastrointestinal bleed) is not straightforward. We cannot predict which of those outcomes would apply to any given patient. The other consideration is that a large proportion of patients in both studies were taking statins and antihypertensive drugs, and only a small proportion were current smokers. So you could conclude that these studies examined the incremental benefit of aspirin, added to other standard preventative treatments.

I like to individualize my healthcare with patients since outcomes in studies give us associations and not cause-and-effect results. One additional way to determine if a patient would benefit from aspirin is by performing a random urine test known as Aspirin Works. This measures 11-Dehydrothromboxane B2 in the urine which is produced from the breakdown of thromboxane A2. It is released by activated platelets (that cause our blood to clot) and urine levels can be used to monitor the response to aspirin therapy. This test may determine that you don’t need aspirin, or if on aspirin that your dose needs to be changed.

Ask your doctor or practitioner to perform this simple urine test to see if a daily aspirin would specifically benefit you.

Reference: Brett, A. Aspirin for primary prevention of cardiovascular events; JWatch.org, Oct 1, 2018, Vol. 38, No. 19.
NEJM JW Cardiol Oct 2018 and N Engl J Med 2018 Aug 26; [e-pub]

All medications have risks, whether they be a supplement or prescription drug. One example would be non-steroidal anti-inflammatory (NSAID) drugs such as Advil, Naproxen, Celebrex, or Diclofenac. Many people use these drugs long-term for menstrual cramps, headaches, aches and pains, arthritis or injuries. Long-term use can increase the risk for acute kidney injury or chronic kidney disease progression. They also raise the risk for cardiovascular events such as myocardial infarction (heart attack) and stroke. So it’s been suggested to avoid use of these medications for those with hypertension, heart failure or chronic kidney disease. This is difficult, especially for the elderly who typically have these health conditions but also need pain relief for treatment of osteoarthritis.

In a recent U.K. study, Diclofenac was associated with excess risk for myocardial infarction as opposed to Naproxen. Also, Ketorolac, another NSAID, can adversely affect kidney function more than other NSAIDs. Factor in dehydration, nausea, activity limitations especially after surgery, and acute kidney injury and you can see that the use of these meds can be a real danger.

With the opioid crisis in the forefront, nonnarcotic alternatives for pain control are in high demand. If you need to use an NSAID, there are some like Diclofenac that pose a higher risk for cardiovascular events and GI bleeding compared with other NSAIDs or Tylenol. There is little justification to use Diclofenac before trying other traditional NSAIDs. Better yet, it’s worth trying herbs such as Ginger, Curcumin and Boswellia (AKBA). Combining Boswellia’s activity with Curcumin and Tumeric can offer even higher levels of pain relief. CBD is also an amazing pain reliever if monitored well.
I always advocate plenty of fluids, avoiding food allergens and other inflammatory triggers and getting healthy sleep as the foundation for reducing pain and optimal wellness.

References: Dubreuil M et al. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis 2018 Aug; 77: 1137.
Schwenk, T. NSAID use in patients with hypertension, heart failure, or chronic kidney disease. Journal Watch 2018 Nov; Vol. 38 No. 22 p. 180.
Myers, C. Plants for pain relief. Health and Happiness 2019 Feb; p 12.