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Lifestyle Changes Lengthen Telomeres

A study led by Dr. Dean Ornish followed 35 men with low-risk prostate cancer for five years. Ten of the men were given a special lifestyle plan with weekly instructions for several months, while 25 were informed of the lifestyle changes but not put in special discussion groups or lectures. The lifestyle-change group increased their telomere length by an average of 10 percent, while the control group had a telomere shrinkage of three percent (The Lancet Oncology, published online September 17, 2013).

The program followed by the lifestyle-change group included:
• A low-fat, low-refined carbohydrate diet, with unprocessed, plant-based whole foods;
• Walking for thirty minutes six days a week;
• Managing stress with yoga, meditation, stretching, breathing and relaxation; and
• Attending a support group for one hour each week.

Telomere Length Predicts How Long a Cell Will Live
How long a cell in your body lives is guided by information supplied by chromosomes, a rope-like chain of genetic material called DNA. Single cells reproduce by dividing everything inside them to form two cells. That means that the chromosomes have to split in two to supply a new chromosome for each of the two new cells formed by cell division.

The ends of each chromosome have a cap called a telomere to protect the chromosome ends from being destroyed by sticking to each other. Telomeres are like the tips of shoelaces that are placed there to keep the ends of shoelaces from fraying. Every time a cell divides to form two cells, pieces of telomere break off to shorten the telomere. Eventually the telomere becomes so short that it does not protect the ends of the DNA in chromosomes from sticking together and destroying each other to kill the cell. So the longer the length of a telomere, the longer the cell can live and divide.

Dr. Ornish’s Healthful Diet
Dean Ornish recommends that you:
• eat natural and unprocessed foods;
• eat plenty of fruits, vegetables, whole grains, beans, seeds and nuts;
• restrict fat, calories, and sugar;
• restrict meat and all fried foods;
• restrict processed foods.

He ranks foods from most healthful (Group 1), to the least healthful (Group 5), and recommends staying as close as possible to the top group for all of your meals while restricting foods in the lower groups.
Group 1: Fruits, fresh vegetables, whole grains, legumes, nonfat dairy, egg whites, soy products.
Group 2: Avocados, seeds, nuts, oils, canned vegetables, low-fat dairy, decaffeinated beverages.
Group 3: Seafood, refined carbohydrates, concentrated sweets, oils higher in saturated fats, margarine.
Group 4: High-fat animal products, whole-fat dairy, mayonnaise, pastries, cookies, pies.
Group 5: Red meat, egg yolks, fried foods, hot dogs, organ meats, butter, cream, tropical oils.

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Why Diabetes Increases Risk for Osteoporosis

We have known for many years that diabetics are at significantly increased risk for breaking bones. Now a study from UCLA shows why. High fasting blood insulin levels, a marker for pre-diabetes and diabetes, are associated with having weak bones (Journal of Bone and Mineral Research, published online August 28, 2013). This study is revolutionary because it used a special test for bone strength to show that diabetes weakens bones, even when the bone density tests remained normal.

Standard Bone Density Tests Are Not Dependable
The standard bone density test used by doctors all over the world measures the ability of bone to block X rays which is not a very dependable test for bone strength. A bone-density test sends X rays through bone to see how much of the X ray is blocked by bone. It does not measure how strong a bone is. Bone density tests are used because there is a relation between bone density and bone strength. However, some people can have dense bones that are extremely weak and likely to break. Previously, the only way to measure bone strength was to put pressure on a bone until it breaks and measure how much pressure it took to break that bone. Naturally doctors do not go around breaking bones to see if they are weak.

How to Calculate Bone Strength
This study used a mathematical formula to measure bone strength, and showed that bone density is a poor measure of bone strength. For those of you who are mathematically inclined, here are the formulae used in the present study to measure bone strength (X means times; / means divided by):
• Compression strength = (bone mineral density X femoral neck width)/ weight
• Bending strength = (bone density X neck width) squared/(femoral neck axis length X weight)
• Impact strength index = (bone density X femoral neck width X axis length)/ (height X weight).
Another study showed that diabetics have weaker bones than non-diabetics, even though they may have normal bone densities (Diabetes Care, 2013;36(6):1619-1628).

How High Blood Insulin Levels and Blood Sugar Levels Could Weaken Bones
When blood sugar levels rise, the pancreas responds by releasing insulin to lower blood sugar levels by driving sugar from the bloodstream into cells. So having high fasting blood insulin levels is a very sensitive marker that shows that your blood sugar is too high, even if you are not diabetic. When blood sugar levels rise too high, sugar sticks to cell membranes. Once there, sugar can never get off. It is eventually converted to a sugar-alcohol called sorbitol that destroys the cells. The most likely explanation for weakened bones in diabetics is that this process damages the bone matrix, the framing on which calcium attaches.

What You Should Learn from This Study
If you have any signs of diabetes, you are at increased risk for osteoporosis and all of its consequences: bone fractures, prolonged bed rest and weakened muscles. Therefore, if you store fat primarily in your belly, are pre-diabetic or diabetic, or have fasting blood insulin levels greater than 4 uIU/mL, you can assume that your bones are weaker than they should be. Fasting insulin levels greater than 4 uIU/mL also make you fatter by preventing fat from being released from your fat cells. Check with your doctor and realize that the most effective treatment for weak bones is lifting weights or pushing on special strength training machines.

More Data Not to Take Calcium Pills

Taking 800 mg/day in calcium pills increased major markers for risk of a heart attack (blood cholesterol and plaques in arteries) of 50- to 60-year-old post-menopausal women (Am J Clin Nutr., published online Sept 18, 2013). More than 60 percent of North American women over 60 take calcium supplements to help prevent bone fractures (U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, 2011).

Calcium Pills Have Not Been Shown to Prevent Bone Fractures
Half of post-menopausal women will suffer an osteoporosis-related fracture in their lifetimes. The U.S. Preventive Services Task Force analyzed studies on the effects of vitamin D and calcium pills on bone strength (Annals of Internal Medicine, published online February 26, 2013). They found no evidence that taking pills with 400 international units of vitamin D and 1000mg of calcium help to prevent bone fractures. They advise healthy older women not to take calcium supplements.

Calcium Pills Not Necessary
Adult men and women need 1,000 to 1,200 milligrams of calcium daily, according to the National Institutes of Health. You get that amount from a cup of yogurt, a glass of milk and a slice of cheese. If you avoid dairy products, you could meet your calcium requirement with a bowl of enriched cereal, a glass of fortified orange juice, half a cup of tofu and a piece of salmon.

The prestigious Institute of Medicine issued a report recommending that adult North Americans need only 1000 mg of calcium, and that most people do not need supplements. Taking too much calcium may cause kidney stones, and taking calcium without also taking vitamin D may increase risk for heart disease. Very large amounts of vitamin D may increase risk for fractures. The authors believe that adolescent girls may be the only group that is getting too little dietary calcium (Report from the Institute of Medicine of the National Academies, November 30, 2010).

Studies Showing Calcium Pills Increase Heart Attack Risk
• A German study followed 24,000 men and women, ages 35 to 64, for 11 years and found that those who took calcium supplements were 86 percent more likely to suffer heart attacks than those who do not (Heart, published online May 23, 2012).
• Another study showed that calcium pills can increase risk for heart attacks by 25 percent (British Medial Journal, published online July 2010). Thus if 1000 people were given calcium for five years, there might be 26 fractures prevented but there would also be 14 heart attacks, 10 strokes and 13 deaths more than in people not taking calcium pills.
• Eight studies followed more than 10,000 patients, average age of 68 years, for an average 3.8 years, taking 500 to 1400 mg calcium daily. They had 1.3 times the chance of suffering a heart attack as people taking no calcium pills. (British Medical Journal, 2010;341:3691).

Calcium and Prostate Cancer
Increased risk for both benign prostate cancer and aggressive prostate cancer is associated with high blood calcium levels (Cancer Epidemiol Biomarkers Prev, 2012;21:1768-1773). The risk for death from prostate cancer triples in men with high blood calcium levels, greater than 10.1 mg/dL (Cancer Epidemiol Biomarkers Prev, 2008;17:2302-2305).

Men who take in more than 600 mg/day of calcium have increased risk for both prostate cancer in general and for the aggressively malignant type of prostate cancer that can kill them (Cancer Epidemiol Biomarkers Prev, 11/07/2012). Men who have the gene, VDR Cdx2, that reduces calcium absorption, are at reduced risk for prostate cancer (J Bone Min Res, 2012;27:187-194), and men with this genetic defect who restrict calcium intake are less likely to develop prostate cancer.

How Too Much Calcium May Harm
We do not know how high levels of calcium in the blood increase risk for prostate cancer and heart attacks. A possible explanation may be that high levels of calcium prevent your kidneys from converting vitamin D from its inactive to its active form. Low levels of vitamin D appear to increase risk for both heart attacks and prostate cancer.

Calcium supplements raise blood calcium levels which increases chances of forming clots, a major cause of heart attacks and strokes (J Bone Miner Res. 1997;12:1959-70). Calcium supplements can thicken neck artery plaques (Atherosclerosis, 2007;194:426-32) and calcify main arteries (J Bone Miner Res, 2010;25:505-12). Taking calcium without also taking vitamin D increases heart attack risk even further, because calcium blocks the activation of vitamin D to cause a relative deficiency of that vitamin.

This week's medical history:
Wilma Rudolph, Polio Survivor

For a complete list of my medical history biographies go to Histories and Mysteries

Recipe of the Week:

Baked Fish with Portobello Mushrooms

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

September 29th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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