Diabetes results from an inability to produce enough insulin or an inability to respond appropriately to the insulin that already exists in your body. In many cases, but not all, diabetes develops when you are overweight.
When untreated, diabetes dramatically increases the risk of heart disease, strokes, kidney disease, blindness, and circulation problems. Well-controlled diabetes, however, will have a much more limited impact on your long-term health.
Dr. Nabli works with diabetic specialists in nutrition, ophthalmology, podiatry, and kidney diseases. If you develop diabetes Dr. Nabli and these specialists will work with you to limit any complications from diabetes.
Many people develop high blood pressure, or hypertension, as they get older. The cause of high blood pressure is unknown in most cases, though it tends to run in families. Hypertension does not cause symptoms, but over many years it will damage blood vessels leading to an increased risk of stroke, heart disease, kidney disease, dementia, and circulation problems.
Healthy weight, regular exercise, and limited salt in your diet can help control blood pressure. When these lifestyle changes do not adequately control blood pressure, there are many medications that can be used.
Like blood pressure, cholesterol tends to rise as we get older. The tendency toward high cholesterol is inherited, though a high-fat high-cholesterol diet and being overweight will further increase cholesterol. High cholesterol increases the risk of heart disease, strokes, and circulation problems.
Healthy weight, regular exercise, and a balanced diet will help control cholesterol. When these lifestyle changes do not adequately control cholesterol, a number of medicines can be used.
Allergies to things in our environment like pollen, dust, and pet dander are very common. Treatment of allergies begins by limiting exposure to the offending agent when possible. Medications, including antihistamines, corticosteroids, and cromolyn in the form of pills, nose sprays, and eye drops will dramatically limit allergy symptoms. Immunotherapy ("allergy shots") can also help control allergy symptoms. Untreated or persistent, severe allergy symptoms can increase the risk of developing asthma.
For someone who has asthma, allergies often make the asthma worse. Other common asthma precipitants include viral respiratory infections, exercise, changes in weather, and emotional stress.
All people with asthma should have bronchodilator inhalers. Many people with asthma benefit from inhaled corticosteroids, inhaled cromolyn, or leukotriene inhibitors. Severe episodes of asthma may also require corticosteroid pills, like prednisone.
Everyone has bad days when stress builds up. These times come and go as a natural part of life.
Sometimes, however, the stress of life seems too much to bear. Depression or anxiety may develop during family troubles, a recent death, relationship problems, a job loss, financial difficulties, or any other overwhelming situation. Sometimes you may feel emotionally paralyzed by a problem you cannot even identify or explain.
Treatment of anxiety and depression can have a dramatic impact on your ability to enjoy life and work.
There are a number of treatment options, including medications and psychotherapy, that can help you feel better.
Weight management is an increasingly prominent problem for people with and without other medical problems like diabetes, high cholesterol and high blood pressure.
The initial approach to weight management requires attention to one's diet and regular exercise. Traditional low-fat diets, high-fat low-carbohydrate diets (Atkins), and diets in between (South Beach) have all helped people lose weight. Ongoing medical studies will determine which of these diets is safest.
Dr. Nabli works with an excellent nutritionist who will help you think about how you eat, what you eat, when you eat, and why you eat.
In addition to diet and exercise a number of prescription medications safely promote and maintain weight loss.
Dr. Nabli will discuss how to combine lifestyle changes with medications to develop the best plan for you
The ultimate goal is to prevent men from developing prostate cancer. Although significant progress has been made and genetic and environmental risk factors for prostate cancer have been identified, the evidence is not strong enough for conclusive recommendations.
Studies with finasteride and dutasteride, which are typically used to treat men with the noncancerous condition BPH, have shown that these drugs may reduce the chances that a man will be diagnosed with prostate cancer. The Prostate Cancer Prevention Trial was one of the largest prostate cancer trials ever and involved more than 18,000 men followed for over a decade. This study showed that finasteride therapy reduced the risk that a man would be diagnosed with prostate cancer by 25%. The study did find a slightly higher rate of aggressive prostate cancers in men who took finasteride, which other studies have suggested may be due to artifact or greater ability to find more aggressive cancers due to a smaller gland size (ie a biopsy needle can more easily hit a cancer in a smaller gland than a larger gland). Given that this agent is well tolerated, current recommendations call for a discussion about the risks and benefits of these agents in the prevention of prostate cancer, for treatment of other conditions, such as BPH.
Diet and lifestyle modifications have also been shown to reduce the risk of prostate cancer development and progression, and can help men with prostate cancer live longer and better lives.
More information about how dietary and lifestyle changes can be incorporated into everyday life can be found in the Nutrition, Exercise and Prostate Cancer guide.
Top 10 Considerations for Preventing Prostate Cancer
To understand how to prevent prostate cancer, one must first understand what causes it. There are four major factors that influence one's risk for developing prostate cancer.
Age: The average age at diagnosis of prostate cancer in the United States is 69 years and after that age the chance of developing prostate cancer becomes more common than any other cancer in men or women.
Race: African Americans are more likely to develop prostate cancer and have more than twice the risk of dying from it. Conversely, Asian men who live in Asia have the lowest risk; however when they migrate to the west, their risk increases.
Family history: A man with a father or brother who developed prostate cancer has a twofold-increased risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected three or more family members.
Where you live: The risk of developing prostate cancer for men who live in rural China is 2% and for men in the United States is 17%. When Chinese men move to the western culture, their risk increases substantially; men who live north of 40 degrees latitude (north of Philadelphia, Columbus, Ohio, and Provo, Utah) have the highest risk for dying from prostate cancer of any men in the United States – this effect appears to be mediated by inadequate sunlight during three months of the year which reduces vitamin D levels.
The factors above are difficult or impossible to change, however, there are many things that men can do to reduce or delay their risk of developing prostate cancer. Why is prostate cancer so common in the Western culture and much less so in Asia, and why when Asian men migrate to western countries the risk of prostate cancer increases over time? We believe the major risk factor is diet – foods that produce oxidative damage to DNA. What can you do about it to prevent or delay the onset of the disease?
1- Eat fewer calories or exercise more so that you maintain a healthy weight.
2- Try to keep the amount of fat you get from red meat and dairy products to a minimum.
3- Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
4- Eat more fish – evidence from several studies suggest that fish can help protect against prostate cancer because they have "good fat" particularly omega-3 fatty acids. Avoid trans fatty acids (found in margarine).
5- Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial, and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy and green tea are also potential dietary components that may be helpful.
6- Avoid smoking for many reasons. Drink alcohol in moderation, if at all.
7- Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer
8- What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may “fuel the cancer”, and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.
9- Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
Finally, eating all of the broccoli in the world does not take away your risk of having prostate cancer right now. If you are age 50 or over, if you are age 40 or over and African-American or have a family history of prostate cancer, you need more than a good diet can guarantee. You should consider a yearly rectal examination and PSA test, and you should discuss the risks and benefits of these screening procedures with your doctor.
How does diet affect the risk of developing kidney stones?
Kidney stones can form when substances in the urine-such as calcium, oxalate, and phosphorus-become highly concentrated. The body uses food for energy and tissue repair. After the body uses what it needs, waste products in the bloodstream are carried to the kidneys and excreted as urine. Diet is one of several factors that can promote or inhibit kidney stone formation. Certain foods may promote stone formation in people who are susceptible, but scientists do not believe that eating any specific food causes stones to form in people who are not susceptible. Other factors that affect kidney stone formation include genes, environment, body weight, and fluid intake.
What are the types of kidney stones?
Four major types of kidney stones can form:
* Calcium stones are the most common type of kidney stone and occur in two major forms: calcium oxalate and calcium phosphate. Calcium oxalate stones are more common. Calcium oxalate stone formation may be caused by high calcium and high oxalate excretion. Calcium phosphate stones are caused by the combination of high urine calcium and alkaline urine, meaning the urine has a high pH.
* Uric acid stones form when the urine is persistently acidic. A diet rich in purines-substances found in animal protein such as meats, fish, and shellfish-may increase uric acid in urine. If uric acid becomes concentrated in the urine, it can settle and form a stone by itself or along with calcium.
* Struvite stones result from kidney infections. Eliminating infected stones from the urinary tract and staying infection-free can prevent more struvite stones.
* Cystine stones result from a genetic disorder that causes cystine to leak through the kidneys and into the urine, forming crystals that tend to accumulate into stones.
Why is knowing which type of kidney stone a person has important?
The first step in preventing kidney stones is to understand what is causing the stones to form. This information helps the health care provider suggest diet changes to prevent future kidney stones. For example, limiting oxalate in the diet may help prevent calcium oxalate stones but will do nothing to prevent uric acid stones. Some dietary recommendations may apply to more than one type of stone. Most notably, drinking enough fluids helps prevent all kinds of kidney stones by keeping urine diluted and flushing away materials that might form stones.
How does a health care provider determine the type of kidney stone?
If a person can catch a kidney stone as it passes, it can be sent to a lab for analysis. Stones that are causing symptoms can be retrieved surgically or with a scope inserted through the urethra into the bladder or ureter, then sent to a lab for analysis.
Blood and urine can also be tested for unusual levels of chemicals such as calcium, oxalate, and sodium to help determine what type of kidney stone a person may have had.
Dietary Changes to Help Prevent Kidney Stones
People can help prevent kidney stones by making changes in fluid intake and, depending on the type of kidney stone, changes in consumption of sodium, animal protein, calcium, and oxalate.
Drinking enough fluids each day is the best way to help prevent most types of kidney stones. Health care providers recommend that a person drink 2 to 3 liters of fluid a day. People with cystine stones may need to drink even more. Though water is best, other fluids may also help prevent kidney stones, such as citrus drinks.
Calcium Oxalate Stones
* reducing sodium
* reducing animal protein, such as meat, eggs, and fish
* getting enough calcium from food or taking calcium supplements with food
* avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran
Calcium Phosphate Stones
* reducing sodium
* reducing animal protein
* getting enough calcium from food or taking calcium supplements with food
Uric Acid Stones
* limiting animal protein
How much fluid should a person drink to prevent kidney stone formation?
People who have had a kidney stone should drink enough water and other fluids to produce at least 2 liters of urine a day. People who have had cystine stones may need to drink even more. The amount of fluid each person needs to drink depends on the weather and the person's activity level-people who work or exercise in hot weather need more fluid to replace the fluid they lose through sweat. A 24-hour urine collection may be used to determine the volume of urine produced during a day. If the volume of urine produced is too low, the person can be advised to increase fluid intake. Drinking enough fluid is the most important thing a person can do to prevent kidney stones.
Some studies suggest citrus drinks like lemonade and orange juice protect against kidney stones because they contain citrate, which stops crystals from growing into stones.
How does sodium in the diet affect kidney stone formation?
Sodium, often from salt, causes the kidneys to excrete more calcium into the urine. High concentrations of calcium in the urine combine with oxalate and phosphorus to form stones. Reducing sodium intake is preferred to reducing calcium intake.
How can a person limit sodium intake?
Learning the sodium content of foods can help people control their sodium intake. Food labels provide information about sodium and other nutrients. Keeping a sodium diary can help a person limit sodium intake to 2,300 mg. When eating out, people should ask about the sodium content of the foods they order.
Some foods have such large amounts of sodium that a single serving provides a major portion of the RDA. Foods that contain high levels of sodium include
* hot dogs
* canned soups and vegetables
* processed frozen foods
* luncheon meats
* fast food
People who are trying to limit their sodium intake should check labels for ingredients and hidden sodium, such as
* monosodium glutamate, or MSG
* sodium bicarbonate, the chemical name for baking soda
* baking powder, which contains sodium bicarbonate and other chemicals
* disodium phosphate
* sodium alginate
* sodium nitrate or nitrite
How does animal protein in the diet affect kidney stone formation?
Meats and other animal protein-such as eggs and fish-contain purines, which break down into uric acid in the urine. Foods especially rich in purines include organ meats, such as liver. People who form uric acid stones should limit their meat consumption to 6 ounces each day.
Animal protein may also raise the risk of calcium stones by increasing the excretion of calcium and reducing the excretion of citrate into the urine. Citrate prevents kidney stones, but the acid in animal protein reduces the citrate in urine.
How does calcium in the diet affect kidney stone formation?
Calcium from food does not increase the risk of calcium oxalate stones. Calcium in the digestive tract binds to oxalate from food and keeps it from entering the blood, and then the urinary tract, where it can form stones. People who form calcium oxalate stones should include 800 mg of calcium in their diet every day, not only for kidney stone prevention but also to maintain bone density. A cup of low-fat milk contains 300 mg of calcium. Other dairy products such as yogurt are also high in calcium. For people who have lactose intolerance and must avoid dairy products, orange juice fortified with calcium or dairy with reduced lactose content may be alternatives. Calcium supplements may increase the risk of calcium oxalate stones if they are not taken with food.
How does oxalate in the diet affect kidney stone formation?
Some of the oxalate in urine is made by the body. However, eating certain foods with high levels of oxalate can increase the amount of oxalate in the urine, where it combines with calcium to form calcium oxalate stones. Foods that have been shown to increase the amount of oxalate in urine include
* wheat bran
Avoiding these foods may help reduce the amount of oxalate in the urine.
What diet plan should a person follow to prevent future kidney stones?
A dietitian can help a person plan meals that lower the risk of forming stones based on the type of stone the person formed in the past. A person with a history of kidney stones may want to talk to a dietitian who specializes in kidney stone prevention or nutrition for people with kidney problems.
A dietitian can also help overweight people plan meals to help them lose weight. Studies have shown that being overweight increases the risk of kidney stones, particularly uric acid stones. Diets that are low in carbohydrates have been shown to further increase the risk of uric acid stones and should be avoided.
Studies have shown the Dietary Approaches to Stop Hypertension (DASH) diet can reduce the risk of kidney stones. The DASH diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein. More information about the DASH diet can be found on the National Heart, Lung, and Blood Institute.
Points to Remember
* Kidney stones can form when substances in the urine-such as calcium, oxalate, and phosphorus-become highly concentrated. Diet is one of several factors that can promote or inhibit kidney stone formation.
* Four major types of kidney stones can form: calcium stones, uric acid stones, struvite stones, and cystine stones.
* Drinking enough fluid is the most important thing a person can do to prevent kidney stones.
* People who have had a kidney stone should drink enough water and other fluids to make at least 2 liters of urine a day.
* Sodium, often from salt, causes the kidneys to excrete more calcium into the urine. High concentrations of calcium in the urine combine with oxalate and phosphorus to form stones. Reducing sodium intake is preferred to reducing calcium intake.
* Meats and other animal protein-such as eggs and fish-contain purines, which break down into uric acid in the urine.
* Calcium from food does not increase the risk of calcium oxalate stones. Calcium in the digestive tract binds to oxalate from food and keeps it from entering the blood, and then the urinary tract, where it can form stones.
* A dietitian can help a person plan meals that lower the risk of forming stones based on the type of stone the person formed in the past.
Among those 20,000 genes is the MTHFR gene. Most people have two copies of it. It provides instructions for making methylenetetrahydrofolate reductase (MTHFR). When you eat foods that contain folic acid (vitamin B9), MTHFR converts it into methyl-folate, folate's active form.
Although researchers still aren't entirely sure which diseases and disorders an MTHRF mutation might contribute to most, evidence exists that the following health problems are tied to one of two primary forms of genetic MTHFR mutation:
The severity and type of symptoms that someone experiences depends on the variant of the mutation the person has, along with much how the ability to carry out methylation and make MTHFR enzymes is impacted. Some people produce up to 70 percent to 90 percent fewer enzymes than those without MTHFR mutations. Other experience much less drastic drops in enzyme levels, around 10 percent to 30 percent
MTHFR C677T mutations are tied to cardiovascular problems, elevated homocysteine, stroke, migraines, miscarriages and neural tube defects.
MTHFR A1298C are tied to higher levels of fibromyalgia, IBS, fatigue, chronic pain, schizophrenia and mood-related problems.
The MTHFR gene instructs the body to make an enzyme necessary to convert vitamin B9 into a usable form. This enzyme is also important in the process of converting homocysteine into methionine — an amino acid the body needs for growth and metabolism
The first step in treating MTHFR mutations is to accurately test for all MTHFR mutations, as well as other related single-nucleotide polymorphisms (SNPs). Genetic testing is the only reliable method to test for MTHFR mutations. Thankfully, genetic testing is now very affordable and convenient via home saliva testing.
Your results will indicate whether you are homozygous or heterozygous for any mutations. Homozygous mutations are more severe than heterozygous mutations and often require additional treatment. If you see a +/+ for any mutation, this means you are homozygous for that mutation. If you see +/- for a mutation, this means you are heterozygous for that mutation. A -/- means you do not have that mutation.
The two most common MTHFR mutations are C677T and A1298C. Treatment options for both are similar, but it is important to know the subtle differences between each type of mutation in order to most effectively address each mutation. Here is a brief overview of each type of mutation:
If you are either heterozygous or homozygous for the MTHFR C677T mutations, your body has trouble converting folic acid into the active form of folate in the body. The nutritional implications of this are twofold. First, you do not tolerate folic acid well. Consuming large amounts of foods fortified with folic acid or supplements containing folic acid may cause adverse reactions. Long-term, excessive folic acid in someone with MTHFR C677T may increase risk of cancer. Second, you are more likely to be folate deficient. This means you should make sure you regularly eat foods containing natural folate, such as leafy green vegetables. Furthermore, a MTHFR C677T mutation may cause elevated levels of homocysteine in the body. Homocysteine contributes to oxidative stress and increases risk of heart disease when elevated.
MTHFR A1298C mutations affect conversion of methylfolate into BH4, or tetrahydrobiopterin. BH4 plays an important role in neurotransmitter production, which is why MTHFR A1298C mutations are often associated with psychological disorders. The particular neurotransmitters affected include serotonin, dopamine, epinephrine, and norepinephrine. MTHFR A1298C mutations may also affect melatonin production, which often leads to sleep disturbances. Additionally, BH4 is important for heart health and deficiency may play a role in the development of cardiovascular disease.
The treatment of MTHFR mutations is often a two-pronged approach. First, supplemental methylfolate and methylcobalamin directly address dysfunction in methylation pathways. Second, it is important to adopt appropriate lifestyle habits to down-regulate epigenetic expression of MTHFR mutations.
The two most common supplements used to treat MTHFR mutations are methylfolate and methylcobalamin, both of which are methylated forms of B vitamins. The forms of these B vitamins found in typical multivitamins and supplements are not methylated. It is important to choose methylated forms to ensure adequate absorption and utilization.
As more and more research emerges on treating MTHFR mutations, the benefits of methylfolate supplementation becomes increasingly obvious. Methylfolate is the most active form of folate in the body. By taking methylfolate, the body is able to bypass any methylation defects affecting folate metabolism. This means the negative health effects of MTHFR mutations are lessened. If you have MTHFR mutations, you should strongly consider taking methylfolate supplements.
Dosing requirements for methylfolate vary from person to person. Homozygous mutations often increase methylfolate requirements compared with heterozygous mutations. A good strategy is to start with a modest dose and monitor how you feel as you increase the dose every few days.
It is also important to consider the form of methylfolate you take, as some forms are much more bioavailable than others. Metafolin and Extrafolate-S are two highly bioavailable forms. That’s not to say other forms won’t work, but you may need to take at least twice as much of other forms to have the same benefit. Here are a few options that contain either Metafolin or Extrafolate-S:
Methylcobalamin, or methyl-B12, is an important complement to methylfolate. This is due to vitamin B12 acting as a cofactor for folate in the body. Taking the methylated form of both vitamins allows them to act in a synergistic manner. This will also help to ensure you have a balance of these two important vitamins. When choosing a methylcobalamin supplement, the main thing to look out for are artificial colors, flavorings, and sweeteners. Here are two good options from Jarrow that contain only natural flavoring, no added coloring, and are naturally sweetened with xylitol:
While methylfolate and methylcobalamin play a big role in MTHFR treatment, they are not the only pieces to the puzzle. It is also important to understand the role of epigenetics. Epigenetics looks at how environmental factors influence gene expression. In other words, if you lead a healthy lifestyle, you can minimize the expression of MTHFR mutations. Two good resources for learning how to lead a healthy lifestyle are Cold Dark Keto: Winter Simulation for Optimal Health by Steven Thomas and The Primal Blueprint by Mark Sisson.
The treatment of MTHFR mutations is multifaceted. The first step is to correctly identify which mutations are present. Once the mutations are identified, utilization of methylated forms of folate and vitamin B12 are primary treatment options. Dosing requirements will vary from person to person, so careful monitoring of supplementation response is important. Finally, addressing epigenetic problems may alleviate symptoms by down-regulating MTHFR gene expression
My job is to help people recover from illnesses while employing not only traditional but also alternative methods of treatment. Over the years, such approach proved to be the most functional.
Dr. Sam Nabli