LDA-A Medical Breakthrough

One of the most gratifying experiences I have had during my medical career was visiting Dr. Len McEwen in London in the 1990’s at his office on Wimpole Street (next to famous Harley Street and the Royal Society of Medicine). Dr. McEwen, an immunologist and allergist and a brilliant clinician, has helped countless patients with complex medical problems. Most importantly he was the originator of a form of allergy treatment called enzyme potential desensitization, or EPD.

Today, the American version of EPD is LDA, or low dose antigen therapy. I have used LDA with my patients for the past 20 and have seen it dramatically help problems from food allergy, hay fever and asthma to colitis, IBS, arthritis, fatigue, migraine headaches, eczema, ADD and even autoimmune disorders.  What these conditions have in common are immune and allergic aspects contributing to the cause of the illness.  

The reason I call LDA a medical breakthrough is both its effectiveness for so many conditions and the way it works in the body. LDA uniquely builds tolerance in the immune system by targeting what are called T reg cells. Through the use of beta glucuronidase, (a lymphokine which is normally found throughout the body), the T reg cells are instructed to become tolerant to the antigens (extracts of food, pollens etc. that one can react to) in the LDA.  The antigens are extremely dilute and include over 100 foods, molds, pollens, dust mites, environmental chemicals and gut bacteria (which have been associated with auto-immune diseases like rheumatoid arthritis, Sjogrens, lupus and ulcerative colitis).

Compared to other allergy treatments, LDA can be more precise at targeting the T reg cells to train the body not to react to substances, which in reality cause no harm. Through a series of doses given every 2 months, LDA instructs immune memory cells to stop producing inflammatory molecules leading to recovery from a multitude of symptoms. Though this can take many months to accomplish, a study we did on EPD in the early 2000’s with over 10,000 patients showed significant improvement in over 80% of patients. There is no other form of allergy treatment that has this level of success with so many diverse conditions.

Thank you Dr. McEwen for introducing us to this valuable therapy.

The Microbiome and the Leaky Gut: How to Take Control of Your Gut and Your Health

The gut microbiome consists of over 10 trillion organisms including bacteria, yeast, viruses and parasites. We know now the microbiome is one of the key determinants of our health, having a powerful effect on weight gain, diabetes, depression and digestive problems. In addition, an unhealthy microbiome can contribute to inflammatory bowel disease like ulcerative colitis and Crohn’s, arthritis and other autoimmune disease and even heart disease.

A healthy microbiome creates a healthy immune response in the gut wall which contains 70% of the entire immune system. Bacteria in the gut create neurotransmitters, enhance immunity, control gene expression aid in absorption of nutrients, and protect the gut wall from damage. A healthy microbiome is dependent on a diet rich in fiber, low in sugar and chemical additives,  and avoidance of drugs like antibiotics, acid blockers and anti-inflammatories.

The average Western diet and use of these medications leads to an unhealthy microbiome in many people. The consequence of bacterial and yeast imbalance is often increased with intestinal permeability (leaky gut), leading to inflammation, obesity, depression, anxiety, food allergy and fatigue. Gluten (the protein in wheat, rye and barley) exposure often makes it all worse.

Repairing this problem has helped our patients regain vibrant health. We assess the microbiome through stool, blood and urine tests and institute a program of a diet rich in fiber and fermented foods, probiotics and specific nutritional supplements. Prebiotics and probiotics can aid in weight loss, improved energy and better mood. In addition, our food allergy treatment program and detoxification techniques will lead to a healthier microbiome and resolve many symptoms, help weight loss and improve mood.

Losing Weight by Improving Your Digestive Tract Good Bacteria

Want to Lose Weight?  Help Your Friendly Intestinal Bacteria Thrive!

Why are livestock given low levels of antibiotics to fatten them up? One way of adding more fat to an animal (or to a person for that matter), is to alter the gut bacteria, which the antibiotics do very well. It turns out that there is intimate connections between the bacteria that populate your digestive tract, how much fat you have in your belly and what your risks are for diabetes and other maladies.

Obesity is more than calorie consumption

Obesity is not just about consuming too many calories; it is also about how you treat your friendly digestive tract inhabitants. There is a scientific revolution occurring in understanding the enormous impact the bacteria in the digestive tract plays in obesity and overall health. Studies in animals have found that altered gut microbiota (bacteria) contributes to low grade inflammation, impact the permeability of the digestive tract leading to higher levels of cell wall fragments from certain gut bacteria (lipopolysaccharides) and have a huge effect on obesity and risk for diabetes. It appears that gut bacteria can determine the physiology of adipose (visceral fat) tissue and directly impact obesity. Gut microbes also influence the metabolism of cells in tissues outside of the intestines (in the liver and adipose tissue) and thereby modulate lipid and glucose balance, as well as systemic inflammation.

The importance of these finding can’t be overstated. Human studies have found significant differences in the bacterial populations in obese or diabetic individuals compared to normals. The complexity of the microbiota system with over a trillion bacteria and one hundred times the genomic information than the human body, has presented a great challenge to scientists that is only now being unraveled.

Impacting digestive-tract microbiota with diet

The good news is that you can have a significant impact on your digestive tract microbiota through diet and avoidance of certain over the counter medications, thereby controlling your risk for obesity and diabetes.  A good first step is following the suggestions in The Adaptation Diet.

Put simply, to control your weight and reduce risk for diabetes and other major disease, you want to eat not only for yourself, but also for your helpful probiotic friends residing in your intestines.  Odd as this may seem, we have evolved with this enormous ‘organ’, (the same weight as the liver), over the generations to provide us with vitamins like Vitamin K and B vitamins and fatty acids like butyrate which are crucial for the health of every cell. In addition, these good bacteria help us detoxify our own hormones including estrogen and other sex hormones protecting us against cancer triggered by excess sex hormones. Maybe of most importance, the good bacteria serve as another barrier to protect us against the thousands of toxic substances found in food and water.

How to maintain a healthy gut

The question is, how do we make these friends happy? No surprise, the most important thing we can do is to have a high fiber diet. 30-35 grams of fiber a day including soluble fiber from beans, broccoli and other chewy vegetables, and oatmeal, provide what is called "prebiotics", to stimulate growth of good bacteria. Next is to limit the simple carbohydrates, sugars, and white flour which induce excess yeast growth in the gut and impact the microbiota. High fat and high sugar diets have been shown in several animal studies to alter gut microbiota and induce inflammation and obesity. Many medications are not the friends of the good bacteria-antibiotics and directly reduce the gut bacteria allowing for overgrowth of inflammatory bacteria; acid blocking medications (PPI’s H2 Blockers) inhibit the normal defense of stomach acid and trigger abnormal gut bacteria growth; anti-inflammatories (ibuprofen, aspirin, acetaminophen) can increase intestinal permeability and add to inflammation and excess visceral fat growth.

In addition to fiber, the use of fermented foods with active probiotics including yogurts (organic is best), kimchee, sauerkraut and Kombucha is beneficial. In a recent study of 36 healthy women using active culture yogurt, it was found that compared to women not using fermented foods there was less emotional reactivity and a more balanced brain activity (functional MRI) in the yogurt eating group. The connection between the brain and gut is another example of how we can control weight gain by being less stressed through the consumption of fermented foods.

The power of probiotic supplements

Beyond these food choices most people would benefit from supplementing with probiotic capsules. I use a multi-strain formula with my patients that include many of the best studied species: Lactobacillus rhamnosus, Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus salivarius, Bifidobacterium longum, Lactobacillus bulgaricus, Bifidobacterium lactis. Choose probiotics with these species that have a guaranteed count of at least several billion organisms.

Losing weight and preventing weight associated disease like diabetes can be achieved through easy to follow dietary suggestions found in The Adaptation Diet leading to not only a healthier gut microbiota, but also a healthier you.

Food Allergy, Weight, and Health

Susan was typical of many of my patients. She ate pretty well, watching her intake of calories and fats, but she could not budge the weight around her middle. She had been on a variety of diets, they worked to some degree, but the weight always came back. Even though she counted her calories, something was holding her back.

Connections between diet and adaptation

That something was poor adaptation to the foods in her diet. Unknown to her, she had multiple food allergies to which her body responded with increased cortisol, the main stress hormone. The cortisol increased the visceral abdominal fat which made further weight loss impossible. Poor adaptation also occurred from her lack of fiber rich foods, flavonoid rich foods (darkly colored vegetables and fruits such as cherries, berries, broccoli, kale, chard) and skipping meals to keep her caloric intake down. All of these patterns increased cortisol and stopped the weight loss.

Susan read my book, The Adaptation Diet, followed the program to a tee, identified her food allergies, added in the right foods and turned around not only her weight, but her energy level and sense of well-being. It is possible to stop weight gain in its tracks with a few simple dietary changes as outlined in The Adaptation Diet.

The different types of food allergy

Studies show that up to one of every two Americans could have some food allergy or intolerance. There are two types of food allergy: immediate and delayed. Immediate food allergy involves symptoms such as hives, breathing problems and bowel symptoms occurring within a few minutes of ingesting a food. Typically, this is limited to certain foods such as shellfish, peanuts, strawberries and tree nuts like Brazil nuts. The mechanism of immediate food allergy, which can be life threatening, is release of histamine triggered by IgE antibodies. These allergies are fixed, meaning they don’t change much over a lifetime.

A much more common form of food allergy and intolerance is delayed hypersensitivity where symptoms might not occur for up to 24 hours after ingesting a food. Symptoms can include fatigue, digestive problems, headaches, joint pain, muscle pain, urinary problems, skin rash and nasal congestion and asthma. The most common food triggers are wheat, dairy, sugar, beef, soy, tomatoes, citrus and corn. Many people have developed masking where frequent use of an allergic food prevents the person from seeing the connection between the food and symptoms. These allergies are mediated by IgG antibodies and often do not include major histamine release.

Next steps: How YOU can identify food allergies

If your physician is not able to order the proper blood or skin tests, one way to identify if foods are contributing to symptoms and unwanted weight is to do an avoidance and challenge diet. Simply avoid the most food triggers, wheat, dairy, corn, soy, tomatoes, beef and sugar for at least a week then reintroduce them one per day. This approach is detailed in The Adaptation Diet as well as information on rotation diets and reducing cortisol to enhance weight loss.

Preventing Dementia

A recent study by Bredesen from the UCLA Alzheimer’s Disease Research (Aging September 2014, Vol 6) program has turned the concepts of preventing and treating Alzheimer’s and other dementia on their heads. He used a comprehensive nutritional, hormonal and cognitive program to reverse symptoms of dementia in 8 of 10 patients with Alzheimer’s disease. Much of his approach is similar to what I do in my practice: optimize diet, use specific nutrients for brain health, remove toxins including metals like lead and mercury and improve hormonal status with bio-identical hormones.

Recommended treatments for dementia

Here are some of the key recommendations from Bredesen’s study;

• Employ a 12 hour fast between dinner and breakfast with minimum 3 hours between the last food intake and sleep to allow the brain to perform its detoxification function called autophagy

• Assess and treat through chelation (using DMSA and EDTA) elevated lead, mercury or cadmium levels

• Supplement with curcumin, folate, bacopa, citicoline, DHA, green tea, ashwagandha

• Diet is based on large amounts of vegetable and fruits, fats from olive oil, protein from fish and seafood and fruit as dessert, little simple carbohydrates, in other words, a Mediterranean diet similar to what I have described in The Adaptation Diet

• Exercise 30-60 minutes 4-6 days a week mix of resistance and aerobics

• Lower homocysteine, a marker of vascular damage through the use of B 12, folate and B6 in the proper forms (methylated)

• Optimize thyroid, estrogen, progesterone, testosterone and especially pregnenolone

• Control excess cortisol through stress reduction and botanical adaptogens like ashwagandha

• Optimize mitochondrial function with CoQ10, ALA, PQQ

• Brain stimulation techniques

• Adequate sleep

Connections between sleep behavior and memory

Sleep behavior is especially important in preserving memory, as sleep disturbance is associated with reduction in task related working memory. Obesity is another major risk for dementia since it impairs vascular function and leads to greater inflammation. In a study of 400 adults ages 20-82, the higher the BMI (measure of obesity) the greater the cognitive decline as they aged. Exercise, including yoga, also has a major influence on risk for dementia. 26 of 27 studies showed an association between exercise and either preservation or improvement of cognitive function in subjects over 60 years of age.

There is a growing awareness that Alzheimer’s, like diabetes and heart disease, is related to an unhealthy lifestyle with some experts even calling Alzheimer’s type 3 diabetes. Though this current study was with people already in dementia, every principle he discusses is even more applicable to prevention. I have found many of these ideas relatively easy to implement with my patients and urge everyone to change what they can in their self care to reduce the risk of this terrible disease.

Magnesium- A Mineral You Can’t Live Without

Even though magnesium is found in whole grains, nuts and seeds, bananas, dark leafy greens and even dark chocolate, it is widely deficient in many people. This occurs for two reasons: many soils have been depleted of this critical mineral and it is lost from the blood when we consume too much sugar. When I measure magnesium levels in red blood cells (a much better indicator than the usual serum levels) I often find low readings. More important than the lab results are the number of symptoms associated with magnesium deficiency.

Common symptoms of magnesium deficiency

The most common symptoms of low magnesium include migraine headaches, high blood pressure, heart arrhythmias, muscle tension and cramps, fatigue, constipation, bronchospasm (often see in asthma), anxiety and cognitive issues. The range of these problems points to how important depleting magnesium can be.

Broad-based benefits of magnesium

Research has shown another important effect of magnesium, it can reduce plaque in arteries, blow lowering inflammation and slowing down the progression of heart disease. It was shown in a study measuring carotid artery thickness, only 200 milligrams a day was enough to reduce thickened arterial walls.  Adequate blood levels of magnesium can also reduce the risk of a stroke, probably by reducing the likelihood of heart arrhythmias. In addition, it lowers blood pressure by affecting the hormones angiotensin and aldosterone.

How to treat magnesium deficiency

Unfortunately, fixing a magnesium deficiency is not always an easy task. Many people do not absorb the usual magnesium supplements very well, like magnesium oxide, while others can easily get diarrhea from magnesium, especially the citrate form (which is found in milk of magnesia used for constipation). To overcome these issues I have found that many of my patients benefit from a series of intramuscular shots or intravenous infusions of magnesium to prime the pump and improve absorption by mouth.

Recently, I have started to prescribe a new form of magnesium, Opti-Mag Neuro TM  which contains magnesium-L-threonate and other forms of magnesium. This patented supplement, researched at MIT, raises brain levels of magnesium (the only form that does this) and affects neural synapses leading to a significant lessening in anxiety, improving memory and promoting healthy sleep. It improves the plasticity of the hippocampus, the part of the brain most affected by elevated cortisol and stress, studies showing enhanced memory and brain signaling. Taken before sleep, I have seen consistent benefit from Opti-Mag in improving sleep and lessening anxiety.

No matter what method you use, raising magnesium levels is a must if you have any of the problems ranging from fatigue to migraines or are at risk for heart disease or stroke.

Chocolate and other Foods to Reduce Stress, Blood Pressure and Cholesterol

I was recently interviewed for an upcoming book by Bill Gottlieb on drug free healing. We focused on four food groups that studies have shown reduce stress by lowering cortisol levels. The first is dark chocolate (at least 70% cocoa). I’m sure many people will be thrilled to learn the benefits of chocolate. Studies have shown that dark chocolate is one of the strongest antioxidant foods. In addition, in a study comparing subjects listed as high anxiety compared to low anxiety individuals, dark chocolate reduced the levels of stress hormones cortisol and epinephrine while improving the overall metabolism.

Other cortisol-taming foods

In addition to chocolate, other foods that are stress hormone tamers include fatty fish containing omega 3 fatty acids. When college volunteers were put through stressful tasks, those that had taken supplements of EPA-DHA, the key fats in fish like salmon and sardines, they performed much better than those who did not supplement. Other foods we discussed include green tea which contains theanine an amino acid that improves brain chemistry and flaxseed powder which improve the feedback mechanism in the brain which controls cortisol production.

Other foods that are critical for controlling biochemical stress and cortisol First among these are legumes which include soybean, split peas, lentils, navy and other beans. These foods are rich in soluble fiber, protein and complex carbohydrates leading to improved markers of biochemical adaptation. Use one-half cup a day and your cells will be happy.

In addition, consumption of one-quarter cup per day of almonds, hazelnuts, pecan, walnuts and other tree nuts was found to improve levels of fiber, Vitamin E, calcium, magnesium, and potassium and lower intake of sodium.  Nuts should be consumed raw and organically grown. They can reduce total cholesterol, and LDL cholesterol and are a great source of protein. The high potassium and low sodium found in nuts can help with hypertension as well.

Reducing stress with the detoxification diet

My clinical experience has shown me how much food and diet impact the level of stress a person can have. I remember Bob, a patient that I first saw last year, who had terrible insomnia and anxiety. Even sleeping medications had failed to do him much good. When I looked at what he was eating, it appeared to me that he was setting himself up for his mood issues through his eating habits.

I put him on a detoxification diet with no simple sugars, caffeine, dairy, red meat or wheat products and asked him to come back in three weeks. He was a different person, less fidgety, more focused and much more at ease. In his words his mind had stopped running at 100 mph and he was feeling back to himself.

Next steps: How YOU can lower your stress levels

His story is not unusual. The function of the brain is dependent on good eating habits as much as the heart or any other organ and yet most of the time the first approach to treating emotional issues is a prescription, not a food diary investigation.  The bottom line is that you can eat your way to being less stressed, even using dark chocolate if you want. Increasing foods that reduce inflammation like organic dark-colored vegetables and fruits and eating a diet lower in animal protein will reduce cortisol and improve well-being. In The Adaptation Diet I have detailed not only how to change eating habits but specific nutrients such as EPA-DHA and flaxseed powder that help the brain reset the stress mechanism and recover adaptation.

Mediterranean Diet, Cortisol and Inflammation

When I wrote The Adaptation Diet, the focus of the book was on controlling cortisol, the main stress hormone through diet. By lowering cortisol, the risk for many chronic diseases, including diabetes, heart disease and cancer can be reduced. The secret to lower cortisol is reducing inflammation. My research led me to use the Mediterranean diet as the best long term diet to control cortisol. Since the book was first published in 2010, a slew of studies have been done that proves this dietary approach is the one most people should adopt.    

How the Mediterranean diet affects chronic illness

A 2014 study of over 7000 people who were placed on a Mediterranean diet made headlines around the world. The study reported in the New England Journal of Medicine, found that people with high risk for heart disease, smokers, overweight people, diabetics and those with other risk factors, who were placed on a Mediterranean diet had over a 30% lower incidence of heart disease than those people on a control diet, either low fat or the usual modern diet of with high amounts of red meat, sodas and baked goods. Those with the lower heart disease rate ate 4 tablespoons of olive oil per day, or a handful of nuts such as walnuts, almonds or hazelnuts. In addition they consumed fish at least three times per week, legumes three times a week and drank seven glasses of red wine a week.

The connection between diet and cognitive function

In addition, when the researchers looked at a subgroup of people in this study that had cognitive dysfunction, those on the Mediterranean diet had significant improvement in memory and focus. This prospective study was the first to show that foods that are anti-inflammatory such as nuts and olive oil, rich in omega 3 and omega 9 oils, cold water fish rich in omega 3 oils, as well as large amounts of antioxidant rich plant based foods is good for your heart, brain and blood sugar. And going back to the core idea of The Adaptation Diet, another study showed that the Mediterranean diet lowers cortisol levels and leads to less activation of the hypothalamic-pituitary-adrenal axis compared to a control diet.  

In a study done at the University of Navarra in Spain, 41 obese subjects were placed on a low calorie Mediterranean style diet and followed for 8 weeks. Those who adhered most closely to the diet not only had the greatest weight loss, but also had a marked reduction in blood levels of inflammation including CRP, complement C3 and TNF alpha. The conclusion of the researchers was that this type of diet, not only helps with weight loss but also can markedly reduce inflammation and improve.

The Mediterranean diet, rich in fruit and vegetables and high in monounsaturated fats, reduces features of the metabolic syndrome, including high blood pressure, insulin resistance, truncal obesity (fat around the waistline), high triglycerides and blood sugar, and low HDL cholesterol. It is a major risk factor for heart disease and diabetes. Some recent studies, including one done by Balbio in Spain, have demonstrated a 25 percent net reduction in the prevalence of metabolic syndrome following lifestyle changes mainly based on nutritional recommendations.

Controlling cortisol with the Mediterranean diet

The bottom line is that there is greater evidence than ever before that the Mediterranean diet can control inflammation, the underlying process in nearly all chronic disease. Controlling cortisol through diet is the natural outcome of a plant based and healthy fat diet, especially one rich in olive oil as the main fat, cold-water fish, legumes, vegetable and fresh fruits. The diet used in this groundbreaking study is almost identical to the maintenance diet I present in The Adaptation Diet. Making dietary choices based on a traditional Mediterranean diet used for many generations of people with lower incidence of cancer, heart disease, obesity and diabetes seems to be an obvious choice we can all make. The payoff is greater adaptation, lower cortisol levels, less inflammation and a smaller waistline.

The main components of the Mediterranean diet

The Mediterranean Diet has the following characteristics:

• Low-glycemic-index carbohydrates such as whole grains, fruits, and vegetable in large amounts, more than 50% of every meal is vegetables or fruit

• Minimal snacking between meals and no fast foods

• Moderate consumption of red wine (5 ounces per day)

• Olive oil as the principal fat, with significant amounts of fish, nuts, and seeds and a balanced omega 6 to 3 ratio

• Significant intake of fish, especially salmon and small fish like sardines rich in EPA-DHA fatty acids

• Little saturated fats from butter, cream, full-fat dairy, or red meats

• Protein primarily as beans and lentils with moderate amounts of fish and poultry

• Dairy consumed as low-fat yogurt, kefir, or cheese

• Fat consumption is 25–35 percent of calories, with saturated fat less than 8 percent

• Desserts are fresh fruits

• Use of local produce, fish, and poultry with minimal importation from distant sources

• Slow food approach, eating leisurely meals in a social setting with family and friends

These are some of the principles included in The Adaptation Diet, and what I recommend to my patients every day.