You may already know that diabetics are at risk for neuropathy, congestive heart failure, and vision problems. But you might be surprised to learn that people with type-2 diabetes are also at high risk of dying from liver disease. Their livers look just like the livers of alcoholics even though they don't drink. These people have non-alcoholic fatty livers. Non-alcoholic liver disease affects 25-75% of diabetics.

In fact, this progressive liver disease is the most common reason for elevated liver enzymes (ALT and AST). Since most people with nonalcoholic fatty liver disease have no symptoms, a yearly blood test can help identify any problem. In addition to looking at your liver enzymes, pay close attention to elevated triglycerides as well. I'll tell you why shortly.

A fatty liver means that fat has accumulated in liver cells. When inflammation is also present, and it frequently is, it can destroy liver cells and progress to serious degenerative diseases, such as cirrhosis and liver cancer. Cirrhosis means "scarring." Healthy tissues are replaced by scar tissue, preventing your liver from functioning properly. This is a serious problem because your liver performs literally hundreds of separate functions every day. It removes toxins, controls infections, and produces bile that helps you use fats and fat-soluble vitamins (vitamins A and E, for example), to name just a few.

NASH (nonalcoholic steatohepatitis) is the most widespread form of progressive fatty liver disease in this country. Steato means "fatty," and hepatitis means "liver inflammation." So NASH is a condition where the liver becomes both fatty and inflamed from conditions other than from drinking alcohol. Insulin resistance most frequently causes it. Eating too many sugars and fats, the same foods that contribute to obesity and diabetes, causes this.

Control your blood sugar

Insulin resistance, the inability to produce the right amount of insulin to lower high amounts of sugars in your bloodstream, allows fats to be stored in liver cells. Triglycerides are fats made from dietary fats and sugars that get stored in your liver. So elevated triglycerides are a sign of these stored fats.

Check your triglyceride levels. Lab norms are under 150 mg/dL, but I like to see them lower than 105. If they're high, lower them immediately by reducing your sugar consumption.  Eliminate all refined sugars, alcohol, and honey. They are quickly absorbed and raise triglycerides. Next, lower your intake of other sweets including fruits and fruit juices. Limit yourself to one or two pieces of fresh fruit a day. Too much fruit juice can also raise your triglycerides. For more information, read my article "The Ignored Fat That Harms Your Heart and Raises Your Blood Sugar" from last April's newsletter. It's available on my website.

Reduce inflammation

Inflammation is another key component of the NASH puzzle. It occurs when there are too many free radicals — usually from a high-fat diet — and too few antioxidants. These free radicals trigger a damaging cycle that causes more oxidation (rancidity) from stored fats, which results in ... more inflammation. This inflammation leads to cirrhosis. You need to lower your intake of all dietary fats and increase antioxidants to protect yourself from NASH.

Consider taking an anti-inflammatory supplement for four to six months. Here are some I particularly like: turmeric or curcumin, bromelain, Padma Basic (800-728-2288), and InflaThera (888-488-2488). My personal favorite is Padma. Have your doctor or other health care practitioner monitor you to make sure that whatever you're doing is effective. Treating NASH

There's no way around it. If you're overweight, your first steps are to lose weight and manage your diabetes. Here are some specific tips that have been found to reduce liver disease.

Lose Weight: The only treatment for non-alcoholic liver disease known to traditional doctors is weight loss. I know it's difficult, but weight loss decreases cirrhosis. Warning: Lose weight slowly! Rapid weight loss can have a negative effect by increasing inflammation and scarring. Studies show that you can get the most benefits and the least side effects by losing no more than 3.5 pounds a week. You may find that you can accomplish this at first by just reducing sugars and fats. Eventually you'll need to include exercise.

Concentrate on toning your muscles. This increases the rate at which you burn calories. Try exercising your arms for five minutes every other day while holding a can of beans in each hand. Even building arm muscles will help you burn calories faster.

Eventually increase the amount of time you exercise. Ask your doctor or a physical therapist for more suggestions if you have any physical limitations.

If you tend to overeat, you may want to read my book, Overcoming the Legacy of Overeating (Lowell House, 1999). Excerpts from this book have appeared in past newsletter articles, available on my website. It explains some of the physiological and emotional reasons for our food choices.

Magnesium: Insulin resistance refers to your body's ability to produce insulin appropriately to lower high amounts of blood sugar. Magnesium is related to insulin resistance in people with type-1 and type-2 diabetes, and in non-diabetics as well. Without enough magnesium, you are likely to have too much sugar in your bloodstream.

Unfortunately, ordinary blood tests don't measure magnesium accurately. I suggest you eat more foods high in magnesium (whole grains, nuts, seeds, beans, dark green leafy vegetables) and consider taking magnesium supplements — as much as you can without having loose stools (up to 1,000 mg per day). Magnesium glycinate and amino acid chelate are two well-tolerated forms.

Magnesium has an added benefit. It increases the production of an enzyme that reduces free radicals, making it a valuable nutrient in reducing inflammation.

Vitamin E: All antioxidants are helpful, but this one helps improve insulin sensitivity and reduces liver inflammation in the obese. A study of overweight adults with NASH found that their liver enzymes normalized after taking 300 IU of vitamin E a day for one year. It also increased weight loss. Many multivitamins contain 300-400 IU of vitamin E. Make sure you're taking one of them, and avoid any with dl-alpha tocopherols. The "l" means "lousy," or "synthetic."

Marchesini, G., MD, et al. "Nonalcoholic fatty liver, steatohapatitis, and the metabolic syndrome," Hepatology, December 2003.

McCullough, A.J., MD. "Update on nonalcoholic fatty liver disease," Journ of Clin Gastroent, March 2002.

Ogawa, et al. "Tamoxifen-induced fatty liver in patients with breast cancer," The Lancet, March 1998.

Patrick, L., ND. "Nonalcoholic fatty liver disease: relationship to insulin sensitivity and oxidative stress," Alt Med Rev, vol. 7, no. 4, 2002.

Why the Flu Strikes in the Fall and Winter -- And how to Permanently Avoid It

I was a sickly child. Each year between October and March, I caught every cold or flu that was going around. Consequently, I missed weeks of school each year. Spring brought a slow recovery, and by summer I was busy riding my bike and taking long walks with my father along the reservoir, watching the ducks and lying in tall grasses in the warm sun. All summer I remained well.

But I dreaded the fall with its cold weather. I knew I would get sick again. Now, although I'm a "senior" and at an increased risk for serious influenzas, I no longer get the flu. Ever!

I'll tell you my secret and it's not the flu shot. It should not only keep you free from colds and flu, it does more.

Doctors know that there's a single common nutrient deficiency that contributes to osteoporosis, cancer, immune problems, and heart disease. Now some believe this same deficiency may explain why more people get the influenza virus during the fall or winter months. Their theory is backed up with good observational studies. And it makes a lot of sense.

Vitamin D deficiency and the flu

The nutrient is vitamin D and there are a number of reasons why you may be deficient. As you know, your skin produces vitamin D from exposure to ultraviolet (UVB) sunlight. But there's not much sun in the fall and winter months. And in some parts of the world, the ozone layer filters out UVB radiation and the skin can't make any vitamin D at all!

Sunscreen blocks the production of vitamin D. So if you're using it whenever you go outdoors, you may be contributing to a deficiency. In addition, year-round vitamin D deficiencies are common in people who stay indoors too much and don't get enough sun even during the summer.

Hundreds of years ago, people lived closer to the equator and spent more time outdoors. Their bodies could convert sunlight into 50,000 IU of vitamin D within 15-30 minutes on hot summer days. You'd think that the RDI (recommended daily intake) for vitamin D would be similarly high. It's not. The RDI for women is a paltry 600 IU and many people fail to get even this small amount — only 1-3% of women over 50.

In the 1980s, British doctor, R. Edgar Hope-Simpson found an association between influenza and vitamin D. Just a few years ago, the role of vitamin D in flu prevention re-emerged during a flu epidemic. Dr. John Cannell, a psychiatrist at Atascadero State Hospital in California, noticed that the patients in his ward stayed healthy, while patients in other wards got sick with the influenza A virus. The only difference was that he had given his patients 2,000 units of vitamin D a day for several months or more.

A paper published in the journal Nature explained why. Researchers found that vitamin D is a very strong antibiotic with an unusual activity. It doesn't work like most antibiotics by killing bacteria and viruses. It increases the production of antimicrobial peptides — substances that damage the cell walls of the influenza virus. Scientists also found that it reduces inflammation in infected lung tissues.

We've known about the association between lung problems and vitamin D for quite a while. Studies have shown that children with a vitamin D deficiency are more likely to develop respiratory infections. And either artificial or natural ultraviolet light reduces this risk.

The amount of vitamin D you have in your system may determine whether or not you get the flu. Just how much do you need? More than the 400 IU you'll find in a heavy duty multivitamin. Dr. Cannell recommends at least 2,000 IU a day, especially in the winter.

The best way to find out how much vitamin D you have and how much more you need to take is to get a blood test for 25 hydroxy-vitamin D, known as 25(OH)D. Your level should be 50 micrograms/ml throughout the year, so this means getting tested in the summer and winter months. You could need as much as 4,000 IU during the winter, and less or none in the summer. If you decide not to get tested, you might want to take 2,000 IU a day. Dr. Cannell has found no toxicity at 10,000 IU a day.

High in sunlight; low in foods

There's not much vitamin D in most foods. Fatty fish are highest. You'd have to eat three servings of fatty fish every day to come close to getting enough. Insignificant amounts (100 IU per glass) have been added to milk, but this won't ward off colds and flu. Your choices are to get enough exposure to sunlight or to take supplements. Or both.

If you sunbathe on a summer's day for 20 minutes, you can get 20,000 IU of vitamin D into your system within two days. Just remember not to use sunblock until you get your vitamin D first.

You can find 1,000 IU capsules of vitamin D in health food stores from Solgar. Or call ProThera (888-488-2488) and get 100 capsules for just $8. Boosting your vitamin D to 2,000 IU in the fall and winter could end your risk of getting the flu ever again. You may want to stock up on a few extra bottles of vitamin D in case you hear that a flu pandemic or a bad case of the flu is on its way.

The vitamin D/flu connection is a theory based on sound science. And since it's safe to take, you may not want to wait for more studies. Especially if you're prone to winter colds and flu.

If you're worried about the association between skin cancer and the sun, read my article, "Avoiding the Sun? Sunlight Actually Prevents Cancers" (April 2005). It will end the confusion perpetrated by well-meaning, but mistaken, dermatologists.

Cannell, J.J., et al. "Review Article: Epidemic influenza and vitamin D," Epidemiol Infect, 2006.

Kobasa, D., et al. "Enhanced virulence of influenza A viruses with the haemagglutinin of the 1918 pandemic virus," Nature, 2004.

Practice Random Acts of Kindness -- It's Good for Your Health

I've noticed in over 25 years of clinical practice that some people hold on to their illnesses, while others live a full and happy life in spite of them. What's the difference? Thinking about someone else! There's no better way to stay healthy than to do something nice and unexpected for a friend, family member, or stranger. It makes you feel better and does wonders for the other person

Actually, it does much more. Dean Ornish, MD, who specializes in heart patients found that showing people your love and compassion can enhance your immune system. In fact, when a group of people watched a film about Mother Theresa, they had a significant increased production of protective antibodies. Doing something for others can even increase endorphins, the "feel good" chemicals that keep runners running and exercisers exercising.

You may not have the energy to volunteer every week at a food bank or senior center, but all of us have the time and energy to do something nice for someone else from time to time. And these little random acts of kindness take us away from our own problems. The more of them you do, the more likely they are to have a positive impact on your physical and emotional health.

When I think of my trip to China last summer, I immediately think of numerous little acts of kindness that were showered on us. This one still lives vividly in my mind.

It was drizzling outside, but Judith, a fellow traveler, and I decided to take a walk anyway along the busy streets of ChongQuing. We put on our rain jackets and began to walk, looking in small shops and watching people on their way to work. The streets were filled with people carrying their umbrellas and walking past clothing stores and food stands. Suddenly, out of nowhere, a Chinese woman appeared at our sides holding an umbrella over us. We smiled at her in thanks for her gesture of friendship and continued walking with her. Then, without warning, she handed the umbrella to Judith and walked off in another direction. We were dumbfounded by her generosity. Nothing she could have said could have had more meaning to us. It was a simple act of kindness to two foreigners she would never see again.

When did you last do something unexpected for someone else without wanting or expecting anything in return? When have you put a quarter in someone's expired parking meter? Or brought a bouquet of flowers to someone for no reason at all? There are dozens of possible acts of generosity all of us can perform every day. For the next 24 hours, stop thinking of your pain, your disease, and your next doctor's appointment.

Do something for someone else today, and then whenever you can. It can be simple and cost nothing, like telling the cashier at a local store that she has a lovely smile. Clean out your cupboards and take canned goods or unopened toiletries to a homeless shelter. Knit some hats from scraps of yarn for a local charity that provides clothing to those in need.

Professor Chuck Wall at Bakersfield College started a movement based on random acts of kindness and senseless beauty in 1993. Since then, the idea has spread to on-line websites and numerous schools, where teachers are giving their students assignments to do something nice for someone else for no particular reason at all. We should all have this assignment. It should be part of our lives.

Begin now and see what effect it has on your physical and emotional health. Most health practitioners know that their patients need to do more with their lives than fixate on their problems. Make a difference in someone else's life. It will improve yours.

Ornish, Dean, MD. Love and Survival: The scientific basis for the healing power of intimacy, HarperCollins, 1998.

www.actsofkindness.org

Does Policosanol Work?

When researchers recently released the results of their study on policosanol, the media made it front-page news. The study, published in the Journal of the American Medical Association, concluded that policosanol does not lower cholesterol or affect HDL or LDL levels. This directly opposed other studies on policosanol.

In fact, the same primary author of this study headed a review on policosanol four years ago. That review found that 10 mg of policosanol a day lowers cholesterol by 17-21%, and low-density (LDL) cholesterol by 21-29%. In addition, it raises healthy (HDL) cholesterol by 8-15%. Now, that was news! But the media ignored the results.

Simply put, the media and conventional scientists are quick to discredit supplements — and do so more often than with pharmaceuticals. There are numerous studies showing that policosanol protects the heart by reducing the harmful, sticky cholesterol and increasing the beneficial, slick cholesterol. I've used it for years with many of my patients, and let me tell you, the results have been excellent! In fact, it's as good as the best statins.

Atorvastatin (Lipitor), for example, has been one of the most effective statins to ever lower cholesterol. I was interested in a study comparing 10 mg of policosanol with the same amount of atorvastatin. After taking one or the other for two months, the researchers found that policosanol — but not atorvastatin — significantly increased healthy HDL levels. Atorvastatin reduced cholesterol and LDL more. But this isn't the end of the story. Policosanol's effects went way beyond its actions on cholesterol. It lowered blood sugar and reduced high liver enzymes as well!

If your doctor has recommended statins, show him or her this article. Then ask your doctor to monitor your transition to more natural, safe, and effective solutions using policosanol or other natural cholesterol-lowering substances. If you already have a heart problem, be smart. Make changes with your doctor's knowledge.

There are many products containing policosanol on the market. Some may be better than others. The one I have used the most is Women's Preferred Advanced Cholesterol Formula (800-728-2288). I've gotten good results with it. In addition to policosanol, it contains guggul and green tea, other nutrients that have a similar action.

Berthold, H., et al. "Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia," JAMA 2006.

Health Detective

Women who need reconstructive breast surgery now have another implant option. The FDA recently reversed its 14-year ban on silicone breast implants. You'd think this means they're safe. Well, I don't agree. Silicone breast implants can cause serious health problems. Their manufacturers — and the FDA — know it.

This is just one more example of the FDA giving its okay to unsafe products. The FDA admits you'll probably need additional surgeries because implants don't last forever. But there's much more you're not hearing.

I'm not talking about lupus or other autoimmune diseases. Or the hundreds of women who allege they got sick after getting these implants. I'm talking about the side effects the manufacturers of these implants, Mentor and Allergan, recognize. These include Toxic Shock Syndrome and other infections. Or deformities of the chest wall. Or having the existing breast tissues atrophy (shrink). These are just a few of the side effects you risk if you choose silicone implants for reconstructive surgery. And there are many more.

I've been writing about the dangers of sil i- cone implants for years. You can read my past articles and a recent health alert on this subject on my website, www.womenshealthletter.com. The health alert discusses safer choices for reconstructive surgery, such as muscle flap reconstruction. And if you already have implants that are more than nine years old, you may want to have them replaced before they deteriorate and leak. Oncologists I've talked with say that 10 years is too long to have any implant. After that time, they can rupture more easily. Saline implants aren't much safer. Their coverings are made with silicone. When these covers deteriorate, silicone can get into your tissues, increasing your risk for health problems.

The FDA continues to give the okay on new pharmaceutical products with side effects. At the same time, they're bashing natural products. I'm working on an article that explains how their decisions are negatively affecting the health of diabetics. Look for it in a few months.

"Summary of safety and effectiveness data, silicone gel-filled breast implants, www.fda.gov/cdrh/pdf2/p020056b.pdf.

Ask Dr. Nan

Q: I began taking four capsules of PectaSol Chelation Complex a day for six weeks. When should I go on the two-caps-per-day maintenance dosage? — H.M., e-mail

A: It’s hard to know since I don’t know your exposure to mercury, pesticides, and other heavy metals. If you eat or ate fish regularly at any time in your life — including tuna — you want to make sure you take it long enough to remove mercury. If you’ve had silver amalgam fillings in your teeth, they may have exposed you to mercury leakage over the years. Have you ever smoked or been around a smoker? That increases your exposure to cadmium. And driving in heavy traffic regularly will expose you to heavy metals. And the list goes on.

Over our lifetimes, most of us have been exposed to numerous heavy metals and other toxins. Many of them remain in our tissues unless we take some kind of chelating substance to remove them. So the longer you use the full dose of a chelation formula the more toxins you’re likely to remove.

I suggest that people take the full dose of PectaSol Chelation Complex for at least six months, then drop down to the maintenance dose. Personally, I took the full amount for more than a year and intend to take a lower dose indefinitely. Whenever I’m exposed to heavy metals and other environmental toxins, I increase this chelation formula for a week or two. There’s no way to avoid exposure to heavy metals. The reason I take PectaSol is that there’s good scientific research that shows it works.

Q: I exercise more vigorously on weekends than during the week. Consequently, Mondays are painful. Is there anything I can do to prevent this pain and still do heavy weekend workouts? — H.F., e-mail

A: First, check with your doctor to make sure that you’re not doing more exercise than your body can handle. Your weekend workouts could be a little too vigorous. Then, be sure to drink at least one liter of water every day. If the water isn’t enough, try taking some Pycnogenol. Pycnogenol is an extract made from the bark of a pine tree that you can find in any health food store. It’s an antioxidant, but it does much more than destroy damaging free radicals. It is a natural anti-inflammatory that helps dilate blood vessels.

In a recent study conducted with normal people, athletes, diabetics, and people with intermittent claudication (a buildup of plaque in veins), Pycnogenol (100 mg twice a day) proved to be the answer to their pain.

Athletes had a reduction in cramping and muscle pain both during and after exercising. In fact, all participants noticed an improvement in their symptoms. So whether you get pain from exercising or have pain in your legs when you walk, this nutrient may be the answer. For more severe cases of intermittent claudication, I suggest taking Padma Basic, a Tibetan herbal formula that has numerous studies showing its effectiveness for leg pain (800-728-2288).

Magnesium helps muscles relax and calcium causes them to contract. Make sure you’re taking more muscle-relaxing magnesium than calcium. Too much calcium can also be responsible for your cramps.

Finally, make sure you’re stretching before and after your workouts. If some of your muscles are tight, it can cause pain in other muscles. Ease into an exercise program for best (and least painful) results.