All Gender Cardiology

Posted on September 10, 2024 by Masina Wright ND

I am giving a webinar this week to a group of cardiologists on all gender cardiology. Spoiler alert, there is no difference between cis and trans gender heart health. The differences lay in access to health care, stereotypes about hormone therapy, and minority stress. For cardiology, once you have a sick heart, regular physician follow up is crucial to your care – multiple medications are sometimes needed to improve or preserve heart function and imaging is needed over a lifetime to track structure and function. If a person does not feel safe at their cardiologist’s office because they are constantly called the wrong name or experience microaggressions about their body, that person will avoid going back or drop out of care all together. Therefore, the first and most important point of all gender cardiology is creating a safe medical home with dedicated staff and physician training in transgender and gender diverse specific health care.

https://www.youtube.com/watch?v=S3eDKf3PFRo

Documentation matters. Medical charts are living documents of a patients experience and how we represent someone matters both for the patient and for all the people who read the document. Safety, Dignity and Respect are basic human rights which are not always upheld for gender diverse individuals, even in a doctors office. Do not be afraid to ask an individual what terms, names, pronouns they would like used in their chart. Asking is consent and consent is powerful. Some terms have fallen out of favor over the last 2 decades that I frequently hear used in the hospital such as Male-to-Female (MTF) and Female-to-Male (FTM). These have been replaced with assigned gender at birth attached to current gender presentation, or just gender presentation. Assigned gender at birth includes Assigned Female at Birth (AFAB) and Assigned Male at Birth (AMAB.) These can be helpful in a medical setting bc they may signify reproductive organs present ( or they may not depending on surgical interventions.) Some gender diverse folks feel passionately against AMAB/AFAB as well because they focus more on the assigned birth gender than the current gender. Therefore, in documentation, either ask the patient how they would like to be represented, or consider using a hybrid like AMAB transwoman, or just transwoman in your notes.

Cardiology and IM are frequently consulted for assessment prior to surgery. Treat gender diverse folks the same as you would anyone else. For a long time gender affirming hormones were stopped prior to surgery, especially estrogen for transfeminine patients due to the heightened risk of venous thromboembolism. This practice is no longer recommended. We would not put a cisgender person on hormone blocking agents for a surgery; therefore, stopping all hormone treatment for transgender individuals does not make sense. In fact, continuation of hormone treatment is beneficial for withdrawal prevention, mental health and for prevention of side effects of hypogonadism including osteoporosis. Continue the current therapy through surgery and risk stratify/ treat perioperatively as you would any other patient with RCRI, MINS screening and DVT prophylaxis.

For more on gender and plastic surgery see this collection of 11 special topics on gender surgery from the Journal of the American Society of Plastic surgeons.

“Hontscharuk and Schecter assemble the most
comprehensive review of literature from plastic sur-
gery, gynecology, and endocrinology to consider the
risk profile of transgender hormones and surgical
venous thromboembolism. One surprise of their
well-sourced study is that the risk of perioperative
estradiol may be lower than commonly thought.
High rates in early series are attributed to the use
of oral ethinyl estradiol and high doses, with newer
regimens showing lower rates. One area where the
literature is limited, however, is in quantifying cur-
rent practices in hormone cessation. In a survey of
six high-volume vaginaplasty centers (unpublished
data), all surgeons still stopped estradiol 2 to 4 weeks
before surgery.”

Ok, now we can finally start talking about the heart and gender affirming hormones, starting with testosterone. This topic applies to anyone who has testosterone including cisgender men but is specifically for transmen and nonbinary people using testosterone. As the rise of ‘andropause” or mens antiaging medicine came into the public eye, the medical assumption was that because men had more cardiovascular disease (CVD) and men had testosterone, therefore testosterone increased heart disease risk. This was pure conjecture and has not held up in any evidence based investigations. A 2014 JAMA article was published from VA data-mining that stated that hypogonadal men starting testosterone had increased risk of MI, with the declaration that therefore testosterone was not indicated in anyone with increased cardiac risk or cardiac disease. The article was quickly retracted and amended as the data was corrupted (multiple patients with MI’s had not started the testosterone, ciswomen not on testosterone were included in the MI population.) The damage was done, and many people still believe the false claims a decade later.

Testosterone therapy is vital for gender diverse patients who need masculinization. Even if it did carry a CVD risk, the beneficial effect of mental and physical wellness for gender congruence would be worth the possible risk. Because of its importance in transgender medicine, this is an ongoing hot topic of research to better understand the nuances and possible risks of testosterone therapy.

“A large 2018 case control study from several US centers that used 10:1 cisgender matched controls found no statistically significant difference in rates of MI or stroke between transgender women and cisgender men, a rates of MI, stroke, or venous thromboembolism (VTE) between transgender men and cisgender men or women. There was a statistically significant hazard ratio of 1.9 for VTE among transgender women when compared with cisgender men.” CH 15 WPATH SOC

The relationship between testosterone and trans health is important enough that the American Heart Association investigated and released a scientific statement in 2021, because trans and gender diverse folks of all genders HAVE consistently had worse cardiovascular morbidity and mortality than age matched peers.

The bottom line ” Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). ”

However, in the anti-aging and cisgender mens health community the question of cardiac safety with testosterone hormone replacement lingered. In 2015 after the original data debacle, the FDA required companies making approved testosterone products to participate in clinical trials to elucidate the evidence. The Testosterone Replacement Therapy for Assessment of Longterm Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial was created and just published in 2023.

Bottom line? Testosterone repletion to biological levels for cisgender men did not increase cardiovascular risk, with primary endpoints of the study being **first occurrence of any component of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke**. A secondary cardiovascular end point was the first occurrence of any component of the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization, assessed in a time-to-event analysis.

Testosterone HAS been repeatedly shown to decrease HDL, the protective scavenging cholesterol and increase triglycerides. It evidences variable effects on total cholesterol and LDL . This could be a piece of the puzzle for increased CVD risk in trans men, but has not been definitively proven yet. Regardless, exercise is the best way to increase HDL in all genders, so as health care providers we need to continue motivational interviewing for active lifestyles, 150minutes of exercise weekly and lipid-conscious nutrition for all our patients including trans men.

So why are transmen more likely to have cardiovascular disease? The the answer is multifactoral and boils down to lifestyle and and health care access which crosses many intersections of class, and race, minority stress and more (which is another important conversation). Heart disease is a cumulative pathology. Unless one has a congenital heart condition, it takes decades of uncontrolled alcohol use, dysregulated blood sugar, nicotine toxicity, low nutrient and high fat foods and sedentary lifestyle to generate atherosclerotic coronary disease. Prevention is the best medicine for a healthy heart and vasculature, but prevention also means having a doctor to work with for things like blood work and blood pressure measurement. If you are someone who has a bad experience in the medical world, or worse, someone who is denied care due to your gender or sexuality, that person will often have worse outcomes with age.

TBC in the next post – ESTRADIOL! – because this one is getting long!

Intermittent Starving vs Fasting

Posted on March 13, 2020 by Masina Wright ND

My IG and twitter feeds keep sending me promoted ads for intermittent fasting and young thin women in my Internal Medicine residency program keep telling me they are doing it. As someone with an inherent red flag signal for anorexia and eating disorders, I am triggered. As someone with a 4 year nutrition degree and as a gal raised with a spiritual practice of fasting, I do understand the value behind the concept. The problems start when restriction/binging/restriction patterns are overlayed on the foundational evidence.

This is the best nutritional protocol and evidence I found to implement intermittent fasting into a food plan for weight loss or for longevity. There is good reasoning and practice behind the idea that the liver stores glycogen for storage, and that this “immediate use” supply needs to be used up before the body creates new glucose from adipose cells and muscle. This is reasonable: fasting uses up the supplies . Then fasting decreases fat or muscle from stores.

Some fasting articles I’ve read suggest 16 hours between eating every day. This sounds alot like the “don’t eat food after 7” rule that has quite a few generations of folks waking up covered in cookies from night eating.

Some articles suggest 16 hours between meals twice a week. This seems more reasonable to me as it allows for some pre-planning to have restful, quiet time during the fasting period. Our human bodies are not designed to “run on empty.” I grew up in a yoga community where fasting was part of the practice towards enlightenment, but work was not done during the fast. One’s time in the fasting state is to be spent meditating, reflecting, and processing (like while we sleep.) Yoga is also an acceptable practice during this time as it stimulates glands and organs as well as the musculoskeletal body to return to homeostasis. Fasting is designed as a parasympathetic state to rebalance CYP liver enzymes and clear the intestines. Pushing through fasting with sympathetic, highly motivated activity like mental or physical labor requires the adrenal glands to overachieve and drive metabolism through adrenaline and sheer will aka cortisol.

The one place where hard work on a fasting belly IS indicated is for anyone looking to lower insulin resistance by using the biochemistry of exercise. This could be someone requiring huge doses of insulin for only moderate blood glucose control, or someone trying to beat type 2 diabetes in the pre-diabetic state. Exercising on an empty stomach is one of the few ways to upregulate cellular receptors called GLUT_4 for insulin to bring blood sugar into cells. I have tried this and its oddly satisfying. Nerd out on biochemistry and GLUT-4 here.

I don’t intermittent fast intentionally myself. Some weekend days I wont eat food until 2-3 in the afternoon, just based on my natural appetite; however, I do have black coffee and water and sometimes juice during that time. To be my best self, I need frequent and regular fuel to keep this brain and body going for the intense work weeks I do. Not allowing myself to eat when I am hungry in not helpful for my mental health either – not only do I get edgy or feel anxious, my own disordered eating and body dysmorphia can easily be motivated towards restrictive eating patterns.

Aside from mental health, some people also have genetic metabolic imbalances if their lineage experienced a traumatic food restriction. This has been researched in Irish descendants as well as Jewish folks. Caloric restriction can actually trigger a survival metabolism where minimal resources are burned and every morsel of fat possible is stored. This is ancestral trauma that has caused permanent alterations in the genome that get triggered by environmental circumstances.

The science is compelling: improved metabolism, destruction of cancer cells, immune regulation, cortisol balancing, cellular rejuvenation…. benefits are numerous!

Here is what I would do if I was either doing a period of cleansing/detox and intentionally working on restoring health or if I was committed to a defined period of intentional weight loss (8 months from this algorithm.)

Style 1: two mornings a week, fast until 12-1pm depending on your 16 hour window. On these mornings drink warm water, organic green tea or herbal tea, stretch and do yoga or go for a gentle walk, get into nature, rest/ meditate, write or reflect. Eat a Mediterranean style diet the remainder of the time.
Style 2: For a more intensive weight loss experience, follow the algorithm for 2 days a week of restricted caloric intake from the JAMA article referenced at the beginning of this post. I would not also follow the time restricted feeding patterns myself as I find this too rigid for modern life and overrides the natural appetite instincts which are essential. Eat a Mediterranean type diet or Paleo. Consider pairing this with the Whole 30 protocol or an elimination diet for true restorative food as medicine. Follow the above guidelines for your calorie restricted days with rest, nature, reflection, massage, acupuncture or other healing practices, whole organic foods, teas and water. Once you have completed month 4, return back up the protocol until you are back at full weekly caloric intake and reassess.

Insulin Resistance

Posted on February 9, 2020 by Masina Wright ND

Insulin is a hormone that is produced by the pancreas that helps cells to absorb glucose in the blood. When we eat a lot of sugar or carbs, there is a rush of glucose (sugar) absorbed into the bloodstream and the pancreas responds by releasing insulin, signaling the cells to allow the sugar in. When blood sugars dip low from chronic hunger or lack of food, there is very little insulin produced.

A lifetime of sugar rushes and sugar deficits can lead to Type II Diabetes, a blood sugar disorder that is characterized by insulin resistance. Insulin resistance happens when your cells stop being able to efficiently respond to the presence of insulin. Imagine you live next to a train track, or by a fire station. Eventually the constant trains or sirens become background noise – we stop hearing them out of habituation. Insulin resistance is kind of like this – chronically elevated blood glucose results in cellular apathy. Each little cell stops posting the GLUT4 receptors in the presence of insulin and the glucose cannot be absorbed. This results in a starvation state for the cells with an overabundant state in the blood, with resulting nerve damage from high blood sugar and cellular aging from nutritional deficit. Can you imagine how this could be improved with nutritional regulation of blood glucose?

The good news is it is possible to improve insulin sensitivity at a cellular level, especially at the pre-diabetes stage. The first step is to adjust your eating habits and diet. The chronically elevated blood glucose needs to stop happening as it is the flooding of the system and causing the habitual “resistance.” This can be achieved with high protein and vegetable meals with abundant healthy fats eaten every 6 hours or so.

Our cells like a slow, steady amount of glucose and insulin in the blood. The logic is as follows: protiens and fats and high fiber carbs like vegetables and grains break down slowly in the digestion, giving a slow steady stream of nutrients and building blocks. Processed carbs, sugar and fruits are broken down quickly and result in a rush of glucose. Therefore, to slow the rush of blood sugar one needs fiber, fat and protien present with each meal. This makes sense – it is always easier to handle any situation in life when things come at us in a moderate, orderly fashion. The microcosm is the macrocosm.

look up healthy fats and high protein foods!

The ginseng family including Panax Ginseng and American Ginseng are also used to lower blood sugar while increasing the ability to adapt to stress. This adaptogenic action exhibits effects across multiple endocrine organs including reproductive, adrenal and pancreas, making it a great herb for modern medicine. The ginsengs work at the plasma membrane level as well as improving steroid hormone receptor sites, which may explain their benefit and use in improving insulin resistance. http://www.ncbi.nlm.nih.gov/pubmed/10571242. There are many other botanicals that have a history of use in blood sugar management including bilberry, cinnamon, gymnemna and more.

Vitamin and mineral deficiency can also worsen existing insulin resistance and exacerbate high blood sugar. The trace minerals chromium and vanadium are both cofactors in the glucose-insulin complex and deficiencies in either of these will worsen blood sugar issues. Chronic magnesium deficiency is also commonly found in people with insulin resistance. This could be due to a deficient dietary intake as magnesium is found in leafy green vegetables and broccoli as well as fish, raw nuts and seeds, avocados, bananas and dark chocolate.

Finally, high intensity, short-term exercise is essential for improving insulin resistance. This kind of exercise shifts metabolism into fuel-burning mode, instead of fuel saving mode. Being active multiple times a day is even better for shifting into glucose utilization mode and improving cell receptor activity. http://www.thebloodcode.com/type-2-diabetes-recovery-needs-daily-exercise/ . Exercise is the only thing that will independently stimulate individual cells to produce those Glut 4 insulin-regulated glucose transporters found primarily in fat and muscle cells, instantly improving insulin resistance and decreasing blood sugar.

In summary, insulin resistance is a complicated condition that is essential to address in the treatment of diabetes. Fundamental nutritional changes and lifestyle basics are essential starting points for anyone interested in improving blood sugar parameters and taking an empowered stance towards metabolic recovery.

I Always Bring My Lunch

Posted on October 6, 2018 by Masina Wright ND

I was in NYC in August this summer, doing a short 4th year medical elective at the Center for Transgender Medicine and Surgery. I did some couch surfing, and stayed at an Air BnB in Williamsburg my last week. Medically it was an outstanding experience, and in my dream future, I will get to be a physician working at this clinic in Manhatten. Being away from home, I realized how much I rely on having my own kitchen! Making my lunch is I keep my body feeling good despite spending most of my time working in a hospital or relaxing in bed.

What do you do for lunch every day? By lunchtime every day, I will eat basically anything. I sometimes eats my lunch at 10:30 AM I am so hungry. The more glucose my brain is burning, the more I need that hit of fat, phytonutrients and fiber.

Therefore, my cunning plan is to eat super healthy sometimes boring basics for lunch – lots of veggies, good quality fats, high fiber fruits, raw vegetables and very few processed carbs. Then, I dont have to think as hard about what’s for dinner and still maintain a good nutrient balance.

So, what do I actually eat? Greens and grains, with cheese, avocado or nuts/seeds and random chopped veggies like carrots, cucumber, tomato, radish. In summer I love to put flowers in my food. A grain free diet is popular with the keto crowd, but I advocate to have at least a few cups of whole grains in the diet per week. The fiber, magnesium, B vitamins and serotonin release metabolically help keep the mind-gut axis regulated. We rotate our grains between short grain brown rice, wild rice, quinoa, and millet to maintain variety of flavor and nutrient profiles.

I heard once in a conference lecture that nutritional studies were done evaluating T4 –> T3 conversion activation (active thyroid hormone.) Subjects were fed fat based diets, protein based diets or carbohydrate (CHO) based diets. Only the diets with carbohydrates evidenced thyroid hormone conversion. Since I am a huge fan of having optimized T3 production for an effective metabolic mileau, I advocate for having a moderate amount of whole grains in ones basic nutritional foundation.I wish I had the study in-hand to back this up but I dont; maybe once I am out of medical school I will have time to research these things more fully. The bottom line is that whole grains are good for health and tasty and I like them in my lunch. They are filling and delicious and beneficial.

I like to layer the grains on the bottom, then a huge handful of greens – whatever has the latest expiry date when I am shopping! We rotate spring mix with herbs, arugula, baby spinach, crispy green leaf lettuce, and occasional kale salad (leftover.) I need fat with my lunch to feel satisfied, so I douse the whole thing with yummy olive oil and a delicious vinegar like balsamic or umeboshi or fire cider vinegar. Then, I add some protein: cheese is the easiest and I love cheese. Tuna, egg or chicken salads are always a win too.

I also love toasted walnuts, pecans, pumpkin seeds or sunflower seeds. I buy them raw, and toast them in a dry cast iron pan until they are warm and smell nutty but not burnt. Make sure to stir! I store these in glass jars in the cupboard. The pumpkin seeds are best toasted with some Chalula hot sauce and cumin! Yum. These add a crunch, some richness, protein, and delicious essential fats. Finish the lunch with 2 chopped veggies for color, fiber, and variety: an organic carrot, cucumber spears with pepper, pepper slices, whatever floats your boat.

If you are a hard paleo and refuse grains, or if you are like me and sometimes need a second lunch or a hearty snack then organic nitrite free salami is a good addition. It is filling, savory, and works well with olives, carrot rounds and other veggies for finger snacks. Just veggies is not enough for me.

Lunch Plan B: huge leftovers fan here. If I go out to dinner, I almost always save half for lunch the next day. This is a win-win, because I stop eating when I am full (or save room for dessert) AND I have a pre-made meal to go. I hate waking up extra early to deal with lunch, so I usually get lunch ready the night before. We generally also cook for more than two, planning a lunch or two and maybe even a supper into every meal we co-create. Leftovers are exciting to me because these are usually rich yummy comfort foods like pasta, steak, curries and other “real meals”.

Finally, making lunch saves me money. The first day of my August rotation I went to the nearby Whole Foods for lunch. I wasted 15 minutes wandering around the hot and cold bars, trying to figure out what to eat. My $15 salad ended up being an awkward mish-mash of flavors that did not blend well. That day after work I went and bought $40 worth of groceries (almond flour crackers, apples, greens, cheese, nuts, yogurts and paleo granola for breakfast) and brought my lunch to work every day for the next week, supplementing with enchilada leftovers.

Bringing your lunch ensures you know exactly what you are eating. It keeps you committed to your intentions with food, and lines up the healthy choices for you in moments of “Im Starving” brain meltdowns that would otherwise allow for easy Trash. It is also a great way to plan your daily insulin for diabetics! Finally, it frees up dinner for more social food activities that may be less greens and grainy.

Oh, and bring a snack, maybe two. For Fall and Winter I find an apple is the hardiest fruit. Combined with nuts and raisins, it’s a great choice. Someone once said, if you dont want to eat an apple, you are not actually hungry. This holds true as long as your teeth are in good shape. In winter and summer, cut up fruit like citrus or stone fruits an berries are refreshing and delightful. I also love dried mango slices from Trader Joe’s. If you crave yogurt and aren’t having it for breakfast, it’s a good option too. I love the dairy-free yogurts too like soy, almond and coconut singles, which are far better choices than anything a vending machine or a cafeteria might offer.

My basic formula is eating good quality food 65% of the time. Then I can easily process about 35% cheeseburgers, nachos, pizza, sweets, and other junk. To change your body composition this may need to become more like 75:25 and exercise has to be added in. I eat at least 60% of my daily food at work between 9-5pm. If I make sure these foods are healthy, wholesome and invigorating to my brain and bowels, my nutritional work is done for the day. Yay!

Heartbreak and Heart Failure

Posted on November 25, 2016 by Masina Wright ND

Sometimes life, work and study all seem to dovetail and everything makes sense for just a few glorious moments. Cardiology was like that for me, in between the Frank Starling curves.

Last year we had a case study of a woman with congestive heart failure (CHF.) Her husband had renal failure and needed dialysis, and she worked at a job she didnt love. She slowly developed worsening heart failure over the course of the case, with shortness of breath, edema, high blood pressure, and poor circulation, eventually dying from it. I was impacted by the apathy she displayed in her efforts to recover – unwilling to eat more grains and greens, decrease salt, get outside, exercise regularly, investigate psychotherapy, or better her personal life in any way. Instead, she just declined in health, adding a new prescription per year to mange her symptoms until she – drowned. In her grief. Of heart disease.

This. Story. Happens. Every Day.

And not only in the US, or Canada or Europe. World-Wide.

The multitudes of meta-analysis risk factor evaluations like the Framingham, Whitehall and Rekjavic studeis have concretely illustrated important evidence about the facts of heart disease: atherosclerotic fatty streaks in arteries, high blood sugar, and inflammation are the undeniable Holy Trinity of heart disease. What is not being avidly reported is the rate of divorce, or mood disorders in these same subjects. The sexual dissatisfaction. The childhood trauma. Socioeconomics and race are sometimes studied, and African Americans and Latinos have higher rates of heart disease. Nobody is surprised. Russia has the highest rate of ischemic heart disease in the world, along with some African nations and Indonesia. These countries also have horrible human rights records, with well documented transphobia, homophobia and police brutality.

If we are going to turn around heart disease, do we not need to acknowledge the humanity of the heart? The same epidemiological study quoted deep within the content:

“Additional reports from this study have shown inverse associations between fair and respectful treatment at work and CHD [Congestive Heart Disease],and job control with future CHD risk.“

Similarly, hypertension, which is the harbinger of heart disease through its effect on cardiac structure and function, is hugely mediated by the stress response.

I was talking to Dr. Stein, an internist specializing in HIV and also our OMS II course director, about this theory that heart failure is so rampant because we have no real medicine for soul-problems like dissatisfaction, grief, sorrow, envy, loneliness and such. He said the links between depression, elevated cortisol, hypertension and CHF are well documented and clearly evidenced.

He reiterated that it is known that People of Color have higher blood pressures because their lives are more stressful due to systemic and personally experienced racism aka “stress.” It is also well evidenced that African Americans with CHF respond better to different medications than other races – Hydralazine, a vasodilator that decreases resistance, improves survival with isosorbide dinitrate rather than the ACE inhibitors and Beta Blockers commonly used. Ha, decreasing [systemic institutionalized] resistance as a keystone in improving survival? I need to know more about the MOA of these drugs to understand why decreasing the catecholamines isnt enough for this population; maybe its because of the deleterious and constant push and pull the sympathetic blockers have on the heart receptors of someone living in the actual adrenergic rut of an unsafe society.

Our cardiologist professor Dr. Glass stated that the average person with hypertension is on 3.4 medications to manage it. These are usually layers of diuretics to decrease the blood volume and drain edema (decreasing preload), and beta blockers to decrease cardiac work and improve cardiac output, and/or other meds like diphydropyridines and nitrates. But guess what – it just came out recently that hypertensive medications may be CAUSING depression/ mood disorders while working to decrease blood pressure. What a double whammy. This was a big study from a database of a single hospital containing 525,046 patients over 5 years. This 2016 article stated:

“Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders.”

Patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions
those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk
those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference.

To summarize the findings, calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders. (Hypertension. 2016;68:1132-1138. DOI: 10.1161/HYPERTENSIONA HA.116.08188.)

It appears, the drugs that most directly affect the heart muscle itself are thus linked to more mood disorders, while those that work indirectly and decrease the work for the heart seem to have less impact on mood.

This is such a broad topic and there are so many layers to heart failure – blood pressure, kidney regulation of blood pressure, nutritional effects, blood lipids, blood volume, inflammatory mediators, free radicals and antioxidants, sleep quality and more – but I think that too often we lose sight of some of the most basic truths of happiness and heart health. And we also forget the deeply sensitive creatures that most of us are and fool ourselves that pharmacy could possibly be enough to cure a heart that is systemically broken, or the effects of a chronically hypervigilant nervous system.

I am going to need to become proficient at cardiology as an Internal Medicine doc. But without a degree in psychiatry, or soul medicine, or archangel intervention, how can I possibly hope to help people recover their failing hearts when the intersections cut so deep? I am scared of all of those people that have no willingness, or ability, to look deep within and make the simple and profound choices towards life. This is the part of being a physician I most fear. The medical failures; the broken hearts.

Gluten Free Living

Posted on September 23, 2015 by Masina Wright ND

How to Eat Gluten Free

Gluten Free is the new Vegetarian – almost every grocery store now has gluten free breads and products in their freezer sections, and crackers and baking mixes in the aisles. Websites abound on not only celiac disease resources (a disease caused by severe gluten allergy) but also on gluten sensitivity, a mlder form of systemic immune response to the gluten molecules. It is easy to find gluten free recipes, resources, and restaurants in almost any geographical area.

So, what is all the hype? The bottom line is that gluten sensitivity begins with the immune system of the digestive tract becoming hypersensitive to gluten proteins like gliadin. The body creates antibodies to the sequence of amino acids, which enter the bloodstream and travel throughout the body. Whenever these antibodies see that same sequence (which is repeated as a small part of many tissues of the body exposed to blood i.e. thyroid, joints, brain, lungs, skin) they attack that tissue as if it was gluten. This creates “auto” or “self” antibodies, which are then produced in greater and greater numbers causing symptoms in a diverse set of body systems.

Therefore, gluten has been linked to autoimmune diseases such as lupus, rheumatoid arthritis, Hashimotos thyroid disease and multiple sclerosis. These are end stage conditions that develop years after smaller warning signals such as headaches, digestive disturbance, asthma, allergies, psoriasis, alopecia, insomnia and various “undiagnosible” ailments. Eliminating the offending foods or doing tests to assess your body’s immune response is the only way to assess if food is an underlying factor in your ill health.

Gluten is a protein that is found in the following Grains:

Wheat
Rye
Barley
Kamut
Spelt
Oats is technically gluten free but very often contaminated in manufacturing.

Therefore, people with a gluten sensitivity or allergy cannot eat any of these grains, or products that contain them such as soy sauce, gravy, doritos or other gluten based products. Oats are technically not a gluten containing grain, but should be avoided unless it states “gluten free” on the package.

Non Gluten Grains which are safe for gluten allergies & sensitivities include:

amaranth: highly nutritious, tiny seeds available whole or as a
rice: including brown and white rice, Arborio, basmati and rice flour
corn: including cornmeal, cornstarch and corn flour
millet: small seeds, eaten whole or combined with other gluten-free flours
quinoa: small seeds that can be eaten whole, as a hot cereal or ground into flour
buckwheat: used whole, cracked or ground into flour
oats: gluten free oats and oat bran
tapioca: made from cassava root, often combine with gluten-free flours
teff: very small black grain, contains symbiotic yeast
arrowroot: a starch used as a thickener, superior to cornstarch, blends well with gluten-free flours

Potatoes, sweet potatoes, squash, and other starchy vegetables can also be enjoyed by those who are gluten free.

For more information on gluten allergy, see http://www.thedr.com./store.html and order Unlocking The Mysteries of Wheat and Gluten Intolerance for yourself. Dr. Tom DC offers eloquent and thorough evidence based information on why it is worth at least trying gluten free living for one month and then reassess.

Many people have a wheat sensitivity or allergy, but can tolerate other gluten grains like spelt and kamut. Some people with a wheat, but not gluten sensitivity will later develop a gluten sensitivity. Corn, potato, dairy and/or soy sensitivities are also common in people with gluten sensitivities. For this reason, it is best to start food eliminations by eliminating all of the above products, and slowly reintroducing each gluten grain as well as corn, potatoes, and soy separately to judge your individual reactions.

AVOID FOR GLUTEN -FREE SHOPPING:

look for labels that say – wheat (or whole wheat) flour, wheat germ, bran, farina, graham flour, semolina, gluten, modified food starch, wheat starch, vegetable starch, vegetable gum
Pastas – spaghetti, vermicelli, macaroni….. buy rice pasta, corn pasta, or some of the newer legume (bean) based pastas. Must say “gluten free”
Soups – commercially canned – read labels for “flour” or wheat
Desserts – most contain wheat – so read labels carefully
Cereals and breads – as with desserts – read labels carefully
It’s probably best to go to health food store in order to find alternatives. Most breads, bagels, wraps, pizza doughs, etc are kept in the freezer sections
For persons allergic to wheat, but not to gluten, you can use flour substitutes such as spelt or kamut (these are the most similar to wheat); rye, oats and barley can also be eaten.

TIPS FOR A GLUTEN-FREE DIET:

focus on protein, vegetables, fruits, and healthy fats like avocado
Lots of delicious gluten free options abound: Tray various pasta, breads, crackers, etc until you find what your taste buds prefer.
Avoid any food that contains wheat, barley, rye, oats – as well as spelt and kamut. Also, remember that gluten can be found in most processed foods, including soups, sauces, gravies, and of course in breads, cereals, and desserts.
40% of people allergic to gluten are also allergic to soy and/or corn – which are often found in “gluten-free” breads, etc.
READ LABELS on everything the first few months to find hidden sources of gluten.

Eating Out and Travelling:

Most cream based soups and chowders are made with a gluten base. Boone’s in Portland has a gluten free chowder, bisque, crab cakes etc if you are craving those.

It is pretty easy being gluten free in restaurants once you get the hang of it. Focus on protein and vegetables, fancy salads and avoid gravies, pasta, gnocchi and sandwiches. If you are craving a burger, ordering it without the bun is pretty standard in today’s low carb world. Steak and arugula salad is always a good choice.

Sadly, fried treats are out the window like calamari, fried clams, fish and chips… once it gets battered it is almost always a wheat base. French fries are also often battered. Best to ask ahead of time instead of getting a delicious plate of inedible fries. Frontier restaurant in Brunswick has delicious GF fish and chips, and rice flour calamari. Not cheap but delicious!

Fish options and mussels or raw oysters rarely have gluten unless they are fried or pan fried. Eating fish at home with rice and salad is a great nutritious option too.

Some places have gluten free sandwich bread but most places don’t. In a pinch on the road, subway will make a “chopped salad” which is basically a sub in lettuce/salad. Planning your food and having fruit, yogurts, nuts & seeds or trail mix, protein bars, and even leftovers or sandwiches on GF bread you make yourself before you leave become important while travelling.

What else? Gluten free breads and crackers abound. I personally like Millet breads the best – available in Whole Foods GF freezer section. Rice breads tend to be very dense and gummy, but are easy to find. Mary’s Gone Crackers are a great GF crackers, followed by Nut Thins and Glutino brand. Glutino also makes a great pretzel. Rice cakes can have a bad reputation but are a quick tasty snack and great vehicle for dips, cheese, avocado and almond butter.

Sweets: Lots of gluten free cookies and treats are available! Any ice cream or candy without “cookie dough” or brownies or cones is usually GF. Many coffee places have at least one GF option. Flourless chocolate torte, chocolate mousse, crème brule or pannacotta are restaurant dessert options that are usually safe.

Namaste company also makes a “Perfect Flour” gluten free mix of flours that you can buy and use with any recipe. Makes cookies really easy!! They also have a great pancake mix if you love pancakes.

Tips for substituting wheat flour:

do not be concerned if batter appear thinner than wheat batters, this is common
add 1/2 tsp baking powder per cup of substitute flour; add just before cooking because it loses its potency when mixed with liquid and allowed to sit
refrigerating dough 1/2 hour helps improve texture
do not bake anything thicker than 4 inches
when baking, lower the temperature a little
baking time is usually longer, especially if egg or milk is eliminated from the recipe
experiment with your options – buy small quantities from a bulk food store and make half recipes first

For thickening, the following quantities equal 1tbsp of wheat flour:

*Arrowroot 1 tbsp = 2 tbsp wheat flour

*Corn starch 1 tbsp

*Potato flour/starch 1/2 tbsp

*Rice flour 1/2 tbsp

*Tapioca flour 1/2 tbsp – my favorite

Mediterranean Diet Explained

Posted on July 21, 2015 by Masina Wright ND

The Mediterranean Diet (and Lifestyle)

This post was originally written for Apothecary by Design.

There is a lot of conflicting opinions about what style of diet individuals should choose for best health. Eating patterns can be based on ethics, habits, familial patterns, disease states, weight loss, convenience and more. The Mediterranean Diet is specifically known to correct heart disease, high blood pressure and high cholesterol. It is also used in cancer recovery. It is not a prescribed regimen of foods, but rather a way of eating based on the local foods of indigenous cultures that live around the Mediterranean Sea. People from this region tend to live longer, and have less chronic disease and obesity than the rest of Europe and North America. To understand why, scientists looked at the foods and lifestyle of the region which has been proven time and time again as superior for cardiovascular health and wellness.

Introduction: It is estimated that over 600 million people have high blood pressure. Heart disease is still one of the leading causes of death in the United States, and dietary interventions are first line therapies for prevention and treatment. The Mediterranean Diet, so called because it mimics classic eating patterns and ingredients from countries like Spain, Italy and Greece, has proven itself time and again as an effective therapy for hypertension and cardiovascular disease. A quick search of Medscape will show you that other conditions like Type 2 Diabetes, Weight loss, Alzheimer’s disease, Metabolic Syndrome, and Cancer are also being improved by adherence to this style of eating.

What it entails: The Mediterranean Diet is modeled after a traditional European “local” diet. Think small servings of homemade pasta or polenta, with fresh local herbs and vegetables like rosemary, basil, tomato, fennel, mushrooms and onions sautéed in liberal amounts of extra virgin olive oil. Add some white beans or fresh local cheese and handfuls of fresh arugula. Small fish like sardines and anchovies are added to meals regularly or served as a snack with walnuts, flatbread and cut up raw vegetables like cucumbers, cabbage, carrots, and broccoli. Fish is a regular staple, always cooked with olive oil and often marinated with lemon and fresh herbs. A couple times a week you may have free range eggs or chicken, again with liberal amounts of greens, cooked vegetables, beans and fresh herbs. And steak or lamb is eaten a couple times a month. Red wine is served with dinner most nights, and small amounts of homemade dessert like tiramisu or gelato a couple times a month.

Many people use a triangle to depict the major Food groups for the Mediterranean diet.

Grains and pastas while frowned on by the low-carb crowd, are important for feeling full, serotonin production, daily fiber and vitamins and minerals. They are also essential for T3 thyroid hormone production. Grains are commonly used in their whole form for optimal nutrition although some homemade pasta and bread are implemented. Suggested Mediterranean grains include barley, buckwheat, bulgur, cous cous, farro, millet, polenta, rice, and wheat berries. Whole grain salads and porridges are great ways to have a daily grain in your menu. Portion sizes are conservative, with emphasis on the vegetable and olive oil.

Vegetables are an important staple in the eating patterns of all countries bordering on the Mediterranean, providing essential plant nutrients, vitamins, minerals and fiber. Cook with virgin olive oil, and drizzle whole pressed plant oils on raw vegetables. These plant nutrients and plant oils are thought to be the foundation of the beneficial effect from this way of eating as they provide essential fats and omegas daily. Commonly used vegetables include: artichokes, arugula, beets, broccoli, Brussel sprouts, cabbage, carrots, celery, celeriac, cucumber, dandelion greens, eggplant, fennel, greens of all kinds including collard, kale, Swiss chard and more, leeks, lemons, lettuce, mache, mushrooms, okra, onions, peas, peppers, potato, pumpkin, radish, rutabaga, scallion, spinach, turnips, yams and zucchini.

Whole fresh fruit provides sweetness and important nutrients, with juicy sweetness. Include apples, apricots, avocado, cherries, clementines, dates, figs, grapefruit, pomegranate, strawberries and tomatoes. Avoid juices, jams, and jellies as these are high in sugar without the antioxidants and fiber of whole fruit.

Nuts and Seeds are another key to the healthful oils that improve cardiovascular health. One study added only walnuts to a standard diet and exhibited cardiac disease improvement just from the omega 3 fats naturally contained in these nuts. Twenty raw almonds daily have also been suggested as a natural way to lower blood pressure. All raw nuts and seeds and raw nut butters except peanuts contain beneficial oils and add richness and flavor to vegetable based dishes. Once you “dry roast” or roast the nuts and seeds, the beneficial oils are lost or made into inflammatory trans-fats. If you prefer the taste, buy raw nuts and toast them yourself in a cast iron pan or a low heat oven for 10-20 minutes. You can add spices, soy sauce or honey before toasting for additional delicious taste!

Beans and Legumes are great source of protein and fiber and have a rich creamy texture. Cook with cannellini beans, chickpeas, fava beans, and green beans. Kidney beans, lentils, and split peas are also common ingredients in Mediterranean meals. Legumes provide a protein rich flavor note and nutritional support; in moderate amounts they are less likely to cause digestive upset. Think: brothy bowls of rich soup, light summer salads with olive oil and beans, or a Spanish fabada with pork and sausage. Use a digestive enzyme if needed to improve digestion and reduce side effects.

Fish and seafood are prominent in the way of eating as it is based around sea cultures. Fish and shellfish are incorporated almost daily, providing high amounts of omega three fats essential for heart health. Little fishes like sardines, anchovies and mackerels are cheap and abundant and very high in omega 3 oils. Next time you are at a grocery store, pick up a tin of boneless, skinless sardines. Try eating them with crackers and sour cream, or top a nicoise-style salad with them (potatoes, olives and arugula.) They are quite delicious! Bigger fish like tuna, salmon and sea bass are featured regularly, as well as all shellfish, octopus and eel varieties. Fish and seafood are rarely battered and friend. They are often grilled, baked, steamed or pan-fried with olive oil.

Eggs, dairy, meats, wine and sweets are also part of this way of life, but in modest amounts, For example, cheese and yogurt may be eaten daily as tatziki yogurt dip, manchego , romano or feta; you do not see the consumption of large amount of industrialized cheese like a Domino’s pizza. Red meat is enjoyed every couple weeks as are cured meats like salami, carpaccio or prosciutto – used sparingly on homemade pizzas with a cheese like ricotta, or served antipasti with olives and vegetables.

As you can see, there is great diversity in this way of eating. There are no “bad” foods and “good” foods, but there is a plethora of vegetarian and pescatarian eating that results in high vitamin C, E and selenium, high levels of glutathione, balanced omega 6 and 3 oils, high fiber, and abundant antioxidants from fruits and vegetables including resveratrol from red wine and polyphenols from olive oil. These are the basic foundations of a heart healthy diet that any nutritionist or integrative doctor will recommend!

Longevity Lifestyle: There is more than just food to the Mediterranean success though. Lifestyle is almost equally as important for the longevity and happiness that contributes to this regions wellness. Meals are enjoyed in a social atmosphere, contributing to slower eating and improved digestion. Naps in the form of “siestas” are built into the regions lifestyle, allowing valuable down time and relaxation as well as sleep! Movement, in the form of daily walking and gardening, is an inherent part of an active lifestyle that also improves cardiovascular fitness. And finally, there is a strong sense of community, often centered around religion, which fulfills the esoteric or spiritual needs at an individual level.

Implementing Changes: The biggest hurdle to changing your nutrition is what you put in your grocery cart. As long as you have frozen meals and industrial cheese in your cupboards, that is what you and your family will eat. Start by purchasing olive oil, fruits, vegetables, raw nuts, and whole grains, and planning simple meals like soups and salads. Scope out your local Italian grocery store like Micucci’s in Portland, and go to the farmers market and fish market for inspiration. Classic Italian, Spanish, Middle Eastern or Greek cookbooks or cooking classes can provide inspiration; however, this is inherently a simple style of eating. Some convenience may be lost as you cook a cannellini bean soup, but the preparation time can be made up by the abundance of delicious, easy leftovers and lunches. Enjoy your preparation time with music and a glass of wine and have your kids help – community and relaxed eating environments are two of the secrets to happiness! Get inspired by these simple recipes.

A note on olive oil. Americans spend about 700 million dollars on olive oil per year. Low grade olive oil is rampant, and many cheap versions are cut with soybean oil or other inferior vegetable oils. Products branded as Extra Virgin Olive Oil (EVOO) are often not extra virgin (first press) and often not 100% olive. Choosing organic olive oil is a higher price, but ensures the quality and manufacturing guaranteed by organic standards. There are no regulations in place for non-organic oils at the moment. Using liberal amounts of soybean oil or other low grade, low quality oils, especially when stored in plastic, will NOT have the same beneficial properties like polyphenol antioxidants that real olive oil has. When I was recently in Spain, a good quality bottle of organic olive oil was about 15-20 Euros. I saw the same bottle of organic Spanish oil that I brought home from Spain in Williams-Sonoma this past weekend for $25 US. This is about the price that a liter or more of high quality extra virgin olive oil goes for (unless you find some on sale.) If you are paying significantly less, you are probably getting adulterated oils.

Consider shopping at an olive oil specialty store that lets you taste before you buy ~ Le Roux in Portland, Maine offers this option plus delicious balsamic vinegars to pair it with! Buying olive oil in larger amounts, like the metal cans sold at Italian grocery stores, often allows for improved quality and a lower volume price. Transfer some of the oil into a smaller table-friendly vessel for cooking and dressing raw greens! Read More about Olive Oil’s dark side.

References:

http://www.medscape.com/viewarticle/502409_5

http://www.ncbi.nlm.nih.gov/pubmed/24050803

http://www.medscape.com/viewarticle/504600

http://www.medscape.com/viewarticle/750564#vp_2

http://www.medscape.com/viewarticle/785895#vp_2

http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid/traditional-med-diet

http://www.ciaprochef.com/northarvest/mediterranean.html

http://www.today.com/health/live-100-sardinias-secrets-longevity-blue-zones-2D80590693

https://www.bluezones.com/

DETOX 2015: Start the New Year With A Clean Metabolic Slate

Posted on December 10, 2014 by Masina Wright ND

tabula rasa – the latin term for “erased slate” referring to the emptiness of a slate sheet that was previously written on by chalk.

To start the New Year with a fresh clean slate we need to erase the old clutter from our internal metabolic “chalk board”, which means DETOXIFICATION.

Why detoxify? Intermediate metabolites build up like desk clutter from all of the work that our liver has to do to break down hormones, pesticides, pollution, cholesterol, medications, bacteria, viruses, alcohol, caffeine, and everything else that we inhale or ingest. Symptoms of this “clutter” include allergies, skin disorders, constipation or diarrhea, heartburn, irritability, fuzzy thinking, headaches, low energy, fatigue and many more low grade but uncomfortable signs of poor health.

I do not believe in crazy diets, water fasting, purges, enemas, or other “heroic” efforts. An effective detoxification process can be simple, inexpensive, easy to accomplish and leave you feeling fresh, renewed and in many cases with less weight! The focus is on fresh, whole foods, clean water, daily smoothies and supplements to improve liver detoxification.

I will be offering an all-inclusive program for one week in January – The tentative dates are January 10-17, 2015. One week is enough time to begin the detoxification process in the liver, but not so much time as to interrupt our busy lives. This program will be a group event, with individual introductory sessions to troubleshoot potential obstacles during the detoxification process. This program will consist of:

A 30 minute detox interview and consultation to assess your personal needs. (The interview can be bypassed for Dr. Wright’s current patients.)
A 60 minute group meeting to introduce the program, review the basics of detoxification, and get you ready to start!
One week of detoxification with daily email support and a Facebook group for recipe sharing, troubleshooting and cheerleading.
A 30 minute group program review at the end to assess the effects, with suggestions on supplements and lifestyle options to maintain the beneficial effects of the detox.

Some people may choose to repeat the detox cycle for 1-3 more weeks in order to really delve into metabolic restoration; however this is an independent option.

Call Age Management Center today at 207-774-1356 or email Dr. Wright at thewrightnd@gmail.com and find out how our New Years Metabolic Detox program can help improve focus, increase energy, decrease allergies and enhance metabolic balance.

Cost: $250 inclusive, prepaid new patients or those needing individualized 30 minute support session.

Cost breakdown: 30 minute consultation: $75, Core Restore Detox Kit $100, 60 minute initial group consultation $50, 30 minute review session $25. Administration, daily emails during the detox program, Facebook group monitoring and detox troubleshooting included.

Current patient & friend/family rate: $175. (Does not include the 30 minute individual consultation.)

Some patients may choose additional Integrative Medicine consultations for more personalized care; individuals who choose to become patients of Dr. Wright’s during or after the program will have $75 taken off her initial consultation fee.

Foods to Enhance Detoxifcation

Posted on October 10, 2014 by Masina Wright ND

What you eat and how well you take care of yourself will affect how well your liver works. Therefore it’s important that you choose foods that will help maintain and support your liver. Good nutrition can also help to rebuild some damaged liver cells and help the liver form new cells.

The liver has two detoxification pathways called Phase One and Phase Two. To work, each of these phases requires specific vitamins and minerals. These in turn need other nutrients called phytochemicals and amino acids to help them. The liver has a big job to do and as you will see, it requires a team effort.

Phase One changes a toxic chemical to one that is less harmful, and free radicals are formed. Free radicals are unstable particles that react within the body and damage cells. If too many free radicals are made, they can hurt liver cells. In order to get rid of or reduce free radicals, our bodies need foods high in antioxidants and phytochemicals. Antioxidants are beta carotene, vitamins C and E, and selenium; phytochemicals are found in fruits, vegetables and whole grains. One of the most important antioxidants is an amino acid called glutathione that cannot be taken as an oral supplement. Glutathione is made by the body and is also found in some foods. B vitamins including folate are also very important in the Phase One process.

In Phase Two the liver adds a substance to the now less harmful chemical to make it water soluble. It can then be moved out of the body in urine or feces. During Phase Two, sources of sulphur compounds are needed. Some of the foods with a lot of sulphur compounds are (you know the kind, they smell when you cook them) cabbage, brussel sprouts, and broccoli.

Following is a list of foods that have the nutrients needed to help Phase One and Phase Two work as well as they can.

Foods to Help Phase One Detoxification (choose 2 per meal)

Beets contain antioxidants such as beta-carotene, other carotenoids and healing flavonoids. They also contain folic acid which is necessary for Phase One detoxification. Enjoy these as fresh vegetable juice, grated raw on salads, boiled or roasted.

Broccoli contains B vitamins and vitamin C both of which help Phase One detoxification; it also is a source of folic acid. Use raw as a snack with dips, lightly steamed or stir fried.

Brown Rice provides B vitamins and the antioxidant selenium.

Carrots contain beta-carotene and other carotenoids that help to protect the liver. Enjoy as freshly juiced (with beets!) grated raw on salads, steamed, roasted, or in soups and stews.

Eggs supply B vitamins.

Garlic has selenium and glutathione, both of which act as antioxidants.

Spinach provides folate and other B vitamins.

Tomatoes have vitamins C and E which are both needed for Phase One detoxification. They are also a good source of the antioxidant lycopene.

Wheatgerm contains selenium and vitamin E and is an excellent source of phytochemicals.

Melons and peppers are good sources of vitamin C.

Tomatillos, papaya, plantains, carambola and guava are good sources of the antioxidants beta-carotene and vitamin C.

Foods to Help Phase Two Detoxification (choose 2 per meal)

Broccoli contains natural sulfur compounds needed to enhance Phase Two detoxification.

Cabbage like broccoli, contains natural sulfur compounds.

Eggs contain methionine, a sulfur-containing compound needed for detoxification.

Brazil Nuts contain selenium, an antioxidant needed for detoxification.

Garlic has high levels of methionine which is needed for detoxification; also contains glutathione, a powerful antioxidant.

Onions have sulfur compounds which are important in both detoxification pathways; also a source of glutathione.

Asparagus and Watermelon are rich, natural sources of glutathione.

Papaya and Avocado help the body to produce glutathione.

Mushrooms are high in glutamic acid which is needed to produce glutathione and aids in detoxification pathways.

Counter-Response to the Multivitamin Controversy

Posted on December 22, 2013 by Masina Wright ND

This post was originally written for Apothecary By Design in December 2013 http://www.apothecarybydesign.com/blog/

Stop Wasting Money on Vitamin and Mineral Supplements! 5 medical doctors cried out in an editorial piece first released in the Annals of Internal Medicine, and then circulated through all major newspapers and social media outlets early this week. The articles released in the New York Times, Wall Street Journal, LA Times, and countless other newspapers pointed out that multivitamins have failed to show benefit in several large scale studies; however, the evidence reviewed was not as clear as we were led to believe. As with every evidence based study, it is important to look at the information behind the research, the studies cited, and the actual information the studies gathered.

The quality of multivitamins IS a true concern for consumers. The studies supporting multivitamins have been mixed, and we acknowledge this. If you are going to take a multivitamin it is not an effective use of money to buy a low quality product (like the one illustrated below) that is not well absorbed and/or is coated in toxic chemicals and fillers. A very good diet may reduce or eliminate the need for a daily dose of essential nutrients. Some multivitamins may be a waste of money, not because studies illustrate a lack of benefit, but because of the abysmal quality of the product itself. Choosing an appropriate multivitamin is another question – one that Apothecary by Design’s wellness specialists welcome.

The following studies were used to support the evidence that multivitamins are not worth taking:

1. Multivitamins and cognitive decline in men 65 or older

For example, in the first study on cognition, the multivitamin assessed was a well-known common multivitamin that provides low level nutrients in the cheapest, least bioavailable forms. These poor quality minerals generally include oxides and sulphates. For example, magnesium sulfate is epsom salt, like you would use in a bath. Magnesium citrate is a better quality, more absorbable mineral. (See label) Check out the “other ingredients” as well – 3 artificial colors including the noxious FD&C Red #40.

Regardless of the supplement quality, cognition issues are not primarily related to vitamin/ mineral deficiencies, but are a long term response to heavy metal toxicity, poor cerebral perfusion (not enough blood to the brain), omega 3 deficiency, hormone deficiency, environmental contamination, stress and elevated cortisol levels, head trauma, prescription medication side effects and many more individual variants.

For example, how many of the physicians studied were also taking statin drugs? These ubiquitous prescription medications are known to have memory impairment, loss of memory and amnesia as potential side effects.

When presenting strong statements like multivitamins are a waste of money, it is responsible to use evidence that considers a straighter line between cause and effect.

2. Multivitamins failed to reduce cardiovascular events in men and women with previous myocardial infarction

The second study cited as proof that multivitamins are a waste of money was a 2012 study evaluating the effects of chelation therapy on men and women over 65 with history of a heart attack.

This study had significant setbacks. Chief among them were the high drop-out rates due to the strenuous protocol of 30 weekly chemical chelation infusions followed by 10 maintenance infusions two to eight weeks apart.

It is difficult to assess the effect of a multivitamin on long term health with such invasive chemical and vitamin therapies being administered at the same time, and it certainly clouds what is presented as a black and white result.

Antioxidants, nutritional counseling and botanical therapies are also first line treatments in the Integrative health world to repair myocardial function. Once again, the true nature of the study being cited is obscured by the dramatic headlines.

2. Multivitamins did not prevent the development of chronic disease or death.

If only a simple, cheap, low dose, poor quality multivitamins could save the world from chronic disease….

Quality matters in the food we eat, the medications we take and the supplements we buy. Chronic disease is a complex, multifactorial health concern whose cure cannot be reduced to oversimplified statements like these.

Finally – the original article states “….beta carotene, vitamin E and possible high dose vitamin A supplements increase mortality.” What they leave out, is that high dose beta-carotene increases risk of … lung cancer in smokers (only.) And alpha-tocopherol vitamin E increases the risk of heart disease …but full spectrum vitamin E with both tocopherols and tocotrienols reduce the risk. Limiting the information sensationalizes the story, obscures the evidence and limits its relevance.

The great thing about this editorial is that it exposes the poor quality multivitamins out there for what they can be: a sense of false security. No one can eat fast food regularly, take a poor quality low dose multivitamin, not practice any preventative measures, and not develop chronic disease eventually. That much IS true.

A multivitamin needs to be able to be absorbed, with high quality minerals and therapeutic dosages of vitamins at the very least to offer prevention and protection. These remain a worthwhile investment for people wanting to maximize their nutritional value. Furthermore, high quality children’s multivitamins remain a good nutritional adjunct for picky eaters and kids with behavioral or health issues. Multivitamins are not a substitute for a healthy lifestyle with good quality food choices, exercise, and stress reduction.

http://www.mayoclinic.org/medicalprofs/trial-to-assess-chelation-therapy-cvuv10n4.html

http://www.ncbi.nlm.nih.gov/pubmed/10359235

http://www.medscape.org/viewarticle/501471

http://www.nleducation.co.uk/resources/reviews/the-next-generation-vitamin-e-how-tocotrienols-benefit-the-heart-brain-and-liver/

Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, Phd p. 850

The Wright Doctor

Modern Medicine, Old Fashioned Care

Tag Archives: nutrition