Monday, July 14, 2008

TYPs: Success To Regress

Sometimes it does not hurt to hear the fundamentals repeated because we can be bogged down by advanced discussions on treatment, sophisticated lab testing or diagnostics.

Boiled down Track-Your-Plaque tips for success:

1. BMI -- achieve normal BMI. Advantages -- loss of toxic belly fat and increased metabolism. May take 3-6mos depending on degree of toxic belly fat.

2. Vitamin D3 -- obtain blood 25(OH)D to 60-70 ng/ml -- and Vitamin B3 Niacin (Slo-Niacin or NIASPAN) to raise HDLs. Clinical event reduction and plaque regression with these 2 powerful 'vitamins' cannot be overemphasized. The importance of raising HDL is reviewed here: TYP HDL Report. And we reviewed already here (at the end of the post).

3. Eliminate wheat, cornstarch and grains; Paleo diet RULES

4. Exercise/play/move -- increases metabolism, reduces inflammation, reduces mental stress, and prevents diastolic heart failure -- very common in people with NASH/NALFD and insulin resistance (like Metabolic Syndrome) and Type 2 Diabetes.

5. Do you exhibit elevated Lp(a) (or ultra low HDL)? If so, consider ultra high dose fish oil 8.5 g EPA+DHA daily (studies show only works when combined with moderate exercise/weight loss). Use high potency caps or liquid.

6. Strength training + Intermittent Fasting -- accelerates loss of toxic belly fat.
(However, if you have diabetic retinopathy, please avoid and discuss with your doctor. Extra cerebral pressures (like straining, Valsava, heavy weight lifting) can increase risk of retinal tears and subsequent vision changes/loss.)

7. For the first 1-2yrs of the TYP program, consider L-arginine. Benefits incl increasing NO in the vasculature which lower BP (goal (WSJ Joe Morgenstern's movie review 7/11/2008)? Do you need a trainer? As Wesley bluntly puts it at the end...after his 6 week-long life transformation toward purposeful, elite living... 'so wtf have you done lately...?'



Unknown said...

great post, full of great information!

Dr. B G said...

Thank you kindly!

Anonymous said...

Regarding l-arginine and increasing NO, how does the current theory of chronic fatigue (and others) fit in with this?
This is from Martin Palls' website:
1.Short term stressors that initiate cases of multisystem illnesses act by raising nitric oxide synthesis and consequent levels of nitric oxide and its oxidant product peroxynitrite.
2.Initiation is converted into a chronic illness through the action of vicious cycle mechanisms, through which chronic elevation of nitric oxide and peroxynitrite and other cycle elements is produced and maintained.
3.Symptoms and signs of these illnesses are generated by elevated levels of nitric oxide and/or other important consequences of the proposed mechanism, i.e. elevated levels of peroxynitrite or inflammatory cytokines, oxidative stress and elevated NMDA and vanilloid receptor activity.
4.Because the compounds involved, nitric oxide, superoxide and peroxynitrite have quite limited diffusion distances in biological tissues and because the mechanisms involved in the cycle act at the level of individual cells, the fundamental mechanisms are local.
4.Therapy should focus on down-regulating NO/ONOO- cycle biochemistry."
This is all at the level of the mitochondria. Is there a resolution between your #7 and Dr Palls' theory?
I have had some heart issues and also fatigue issues which have not been resolved. Thanks for all the great info.

Dr. B G said...

Hi Jean,

There is a little disconnect from the micro-cellular level to macro-vascular level. I don't understand biochem that well (sorry) but I do agree Palls' take on chronic stressors and use of 'broad spectrum' antioxidants in these 'inflamed' individuals. Definitely I'd agree that mitochondrial metabolism is KEY to many chronic conditions -- we throw them off by overconsuming carbs/fructose! Or by not exercising (which is a 'free' source of antioxidants) or not consuming enough dietary antioxidants when mitochondria combust fatty acids (the most potent energy source)!

It's funny the 3 protocols listed (below) include many of the elements found in TYP as well. He does mentioning
'lowering iNOS' with several antioxidants incl omega-3 and phosph...choline which we use often at TYP. Many brilliant minds converge at the same spot!

For CAD, consider the value of EBT heart scan to get a baseline and help you to target aggressiveness of targeted therapy.

My review of the literature shows that chronic fatigue and fibromyalgia are related partly to vitamin D (and fish oil) deficiency. Have you ever had your 25(OH)D level assessed? We target 60-70 ng/ml at TYP.

Hope that helps... G
High dose hydroxocobalamin (B12) injections— potent nitric oxide scavenger
Whey protein—glutathione precursor
Guaifenesin—vanilloid antagonist?
NMDA blockers
Magnesium—lowers NMDA activity
Taurine—antioxidant and acts to lower excitotoxicity including NMDA activity
Betaine hydrochloride (HCl)—Betaine lowers reductive stress, the hydrochloride form should only be used in those with low stomach acid.

Flavonoids, including “bioflavonoids,” olive leaf extract, organic botanicals, hawthorn extract
Vitamin E (forms not listed)
Coenzyme Q10—acts both as antioxidant and to stimulate mitochondrial function
a-lipoic acid
Omega-3 and –6 fatty acids
Melatonin—as an antioxidant that may act in the brain
Pyridoxal phosphate—improves glutamate/GABA ratio
Folic acid—lowers uncoupling of nitric oxide synthases

Magnesium as magnesium glycinate and magnesium malate—lowers NMDA activity—often uses magnesium injections
a-Lipoic acid—important antioxidant helps regenerate reduced glutathione
Vitamin B 12 IM injections, 3 mg injections (does not state whether this is hydroxocobalamin)—may act as potent nitric oxide scavenger
Eskimo fish oil—excellent source of long chain omega-3 fatty acids. Lowers iNOS induction, anti-inflammatory
Vitamin C
Grape seed extract (flavonoid)
Vitamin E, natural—does not state whether this includes g-tocopherol or tocotrienols
Physician’s protein formula, used as glutathione precursor
Zinc—antioxidant properties and copper/zinc superoxide dysmutase precursor
Acetyl-L-carnitine—important for restoring mitochondrial function
Coenzyme Q10—both important antioxidant properties and stimulates mitochondrial function
D-ribose—acts to increase rate of ATP and reduced glutathione regeneration

Polyunsaturated phosphatidyl choline—predicted to lower reductive stress
Other phosphatidyl polyunsaturated lipids—this and the phosphatidyl choline are predicted to help restore the oxidatively damaged mitochondrial inner membrane
Magnesium—lowers NMDA activity, may aid in energy metabolism

Taurine—antioxidant activity and lowers excitoxicity including NMDA activity
Artichoke extract—as flavonoid source?
Spirulina—blue-green alga is a highly concentrated antioxidant source
Natural vitamin E—does not tell us whether this includes g -tocopherol or tocotrienols
Calcium ascorbate—vitamin C
a -Lipoic acid—important antioxidant, key role in regeneration of reduced glutathione, but also has role in energy metabolism
Vitamin B 6—balance glutamate and GABA levels, lowers excitotoxicity
Niacin—role in energy metabolism
Riboflavin—important in reduction of oxidized glutathione back to reduced glutathione; also has important role in mitochondrial function
Thiamin—role in energy metabolism
Vitamin B 12—as nitric oxide scavenger?
Folic acid—lowers nitric oxide synthase uncoupling

Dr. Neboysa (Nash) Petrovic

Valine and isoleucine—branched chain amino acids known to be involved in energy metabolism in mitochondria, and may be expected,therefore, to stimulate energy metabolism; modest levels may also lower excitotoxicity
Pyridoxine (B 6)—improves balance between glutamate and GABA, lowers excitotoxicity
Vitamin B 12 in the form of cyanocobalamin—cyanocobalamin is converted to hydroxocobalamin in the human body but the latter form will be more active as a nitric oxide scavenger, since it does not require such conversion
Riboflavin—helps reduce oxidized glutathione back to reduced glutathione
Carotenoids (alpha-carotene, bixin, zeaxanthin and lutein)-lipid (fat) soluble peroxynitrite scavengers
Flavonoids (flavones, rutin, hesperetin and others)
Ascorbic acid (vitamin C)
Tocotrienols—forms of vitamin E reported to have special roles in lowering effects of excitotoxicity
Thiamine (aneurin)—B vitamin involved in energy metabolism
Betaine hydrochloride (HCl)—lowers reductive stress, hydrochloride form should only be used by those deficient in stomach acid

Essential fatty acids including long chain omega-3 fatty acids
Phosphatidyl serine—reported to lower iNOS induction (35,36)

Dr. Ziem

Nebulized, inhaled reduced glutathione
Nebulized, inhaled hydroxocobalamin (some use sublingual)
Mixed, natural tocopherols including g -tocopherol
Buffered vitamin C
Magnesium as malate
Four different flavonoid sources: Ginkgo biloba extract, cranberry extract, silymarin, and bilberry extract
Selenium as selenium-grown yeast
Coenzyme Q10
Folic acid
Carotenoids including lycopene, lutein and b -carotene
a -Lipoic acid
Zinc (modest dose), manganese (low dose) and copper (low dose)
Vitamin B 6 in the form of pyridoxal phosphate
Riboflavin 5’-phosphate (FMN)
Betaine (trimethylglycine)