Monday, June 13, 2016

The most important nutritional factor in healthy aging

Fat used to be the bad guy, but recently carbs have become the dietary villain.  Low carb diets have convincingly shown more benefit than low fat diets for weight loss . But WHAT KIND of carbs we are talking about matters a lot.  A doughnut is a carb, but so is broccoli! 

In an effort to reduce the starchy carbs in our diet (which is a a good thing to do!) we need to be careful that we don't end up eating less fiber.  

A recent Australian study looked at 1,600 adults aged 50 years and older and evaluated their dietary risks for long-term sensory loss and systemic diseases, related to their carbohydrate consumption. Out of all the factors they evaluated,  including total carbohydrate intake, total fiber intake, glycemic index, glycemic load, and sugar intake - fiber intake resulted in the biggest difference in "successful aging.  

"Essentially, we found that those who had the highest intake of fiber or total fiber actually had an almost 80 percent greater likelihood of living a long and healthy life over a 10-year follow-up. That is, they were less likely to suffer from hypertension, diabetes, dementia, depression, and functional disability."

Here are a few possible reasons behind these important findings.   

1. Bowel regularity.    Insoluble fiber helps to keep you regular by "sweeping out" your colon.  Having regular bowel movements is an important part of detoxification.  We are all exposed to environmental chemicals and natural waste compounds from our own bodies that we need to eliminate.  Many of these compounds are excreted into the digestive tract.  If you aren't moving your bowels regularly, there is a greater opportunity for these compounds to be reabsorbed and result in increase health risks.

2.  Stable blood sugar levels.  Fiber in your meal also helps to slow the rate that your blood sugar rises as you digest your meal.  A slower rise in blood sugar is healthier - it allows the body to make an appropriate amount of insulin to handle the sugar load.  A meal high in sugar or refined carbohydrates (like white bread) and low in fiber results in a rapid spike in blood sugar and the body has to scramble to gain control over the metabolic situation.  Over time, this can lead to insulin resistance and diabetes.

3.  Prebiotics.  You have probably heard that the healthy bacteria in your digestive tract is very important to your health and disease prevention.  Probiotics are the healthy bacteria (for example found in yogurt) that you need to stay well.  Have you heard of Prebiotics?  This is the food source for the probiotics!  It is not enough to simply take a probiotic supplement - you need to nourish your gut bacteria by feeding them plenty of prebiotics.  And can you guess what your probiotic bacteria eat?  Fiber, of course!  So a diet rich in fiber is a diet rich in prebiotics, which help to nourish your healthy gut bacteria.

4.  Healthy cholesterol levels.  Soluble fiber does not dissolve in water (think about how oatmeal becomes gelatinous when you mix it with water).  Soluble fiber binds to cholesterol and helps you to clear it from your system.  We know that the actual AMOUNT of cholesterol is not really what is important - it matters much more whether or not the cholesterol is inflamed or oxidized.  But eating enough soluble fiber helps to maintain cholesterol levels in the normal range.  

5.  Estrogen metabolism.  Another factor to consider is the very important role that fiber plays in hormonal balance, and this is important in women AND men.  Each day you excrete estrogen into your digestive tract to clear it from your system (whether you made the estrogen in your own body or whether you are on estrogen replacement or birth control pills).  The insoluble fiber in your diet helps to keep you regular so you can excrete estrogen.  Soluble fiber helps carry estrogen out in your stool, and helps prevent it from being reabsorbed into the blood stream.  This makes sense when you remember that many of your hormones (including estrogen) are made from cholesterol!  So just as fiber is important for lowering your cholesterol, it is also important for clearing estrogen.  

This is especially important in women who have "estrogen dominance" with symptoms like heavy periods, PMS symptoms, breast tenderness, weight gain, insomnia, anxiety, fibroids, fibrocystic breast disease, or ovarian cysts.  Estrogen dominance is a risk factor for breast cancer, and a high fiber diet can help reduce the risks (we have lots of research to support this).  Too much estrogen is also a risk factor for prostate cancer.  As men age, they often convert more of their testosterone into estrogen, and an increase in fiber can help minimize the amount of estrogen that accumulates.

How much fiber do you need?  Many studies have looked at a goal of 30gram of fiber per day.  One challenge in trying to achieve this goal is that I typically recommend eating "whole" foods that do not come in a package (and therefore don't have a label to tell you how many grams of fiber per serving).   But here are some foods that are good sources of fiber, especially soluble fiber which is the best for balancing hormones.  

Fruits including citrus fruit, berries, apples, apricots, dates, prunes, and pears.  
Vegetables including asparagus, brussels sprouts, squash, zucchini, broccoli and root veggies like carrots, turnips and sweet potatoes.  
Legumes including lentils, chickpeas and pinto beans
Nuts such as almonds and walnuts
Seeds like ground flax seeds, chia seeds, hemp seeds, raw pumpkin seeds

While you are eating these terrific foods to make sure you get enough fiber, you will also be benefitting from the antioxidant vitamins, trace minerals and abundant "phytonutrients" (plant compounds) that will help keep you heathy.  Perhaps higher fiber intake was not the only reason the people in the study had reduced rates of disease - it may have been because fiber tends to come packaged by nature along with the other important nutrients you need to stay well!  So eat more fiber today to help maximize your chances for a healthy tomorrow.  

For more information on healthy hormone balance and healthy aging, please see our website or contact the office at 704-752-9346 or

Yours in health,


1.  Association Between Carbohydrate Nutrition and Successful Aging Over 10 YearsThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2016

2.  High fiber diet reduces serum estrogen concentrations in premenopausal women.  American Society of Clinical Nutrition.  1991

P.S.:  New testing allows us to measure your estrogen metabolites.  Would you like to know whether you are metabolizing estrogen in a way that increases your breast cancer risk (and then do something to correct the problem?)  Please contact the office for more information.  The test is $200 and is not covered by health insurance.  

Sunday, June 5, 2016

How to reduce your risk for breast (or prostate) cancer

Are you worried about breast cancer?  (Or prostate cancer?) You certainly, aren’t alone!  This is the number one concern I hear about when I am talking to patients about hormone balance.  Many men are not aware that their estrogen level can affect their risk for prostate cancer (high estrogen levels may increase the risk).   

Estrogens are essential for health and well being in both women and men. Estrogen plays a role in mood, energy, memory, sleep and sexual function.   Estrogen is important for bone health, brain health, heart health, breast health and prostate health.  

Every day, the body has to clear today’s estrogen to make way for tomorrow’s estrogen.  This is true whether you are making your own estrogen or whether you are taking estrogen replacement (synthetic or bio-identical).  If you are not clearing the estrogen properly, levels can climb and lead to symptoms.  Another factor to consider is HOW your body is clearing the estrogen.

Some estrogen metabolites (or “breakdown” products) have been shown to be harmful and increase risk for breast cancer in women, and prostate cancer in men.  On the other hand, some estrogen metabolites are protective, and associated with a REDUCED risk of breast cancer.  Wouldn’t you like to know which ones you are making?

The levels of the various metabolites can be measured, and we can use this information to help assess breast cancer (and prostate cancer) risks.  The good news is that armed with this information, there are many steps we can take to CHANGE the risks.  

How does it work?

There are 2 main estrogens we need to consider here.  Estrone,  also called E1, is the predominant postmenopausal estrogen.  Estradiol, also called E2, is the predominant pre-menopausal estrogen and the one that we replace in estrogen replacement therapy.   Men also have these estrogens, and estrogen levels tend to increase in men with age.

In “Phase One” of detoxication of estrogen, the liver metabolizes these estrogens into 3 different possible metabolites:

2-hydroxyestrogen (2-OH) is breast protective, so we want the most of your estrogen to go down this pathway.

16-hydroxyestrogen (16-OH) is bone protective (reduces the risk of osteoporosis) but is not breast protective.  We used to think that the ratio of 2 to 16 hydroxyestrogen (or the “2 to 16 ratio”) was a good predictor of breast cancer risk, but the current research does not support this.

4-hydroxyestrogen (4-OH) is the metabolite that you really don’t want.  This one has been associated with an increase in the risk for breast cancer.   This is also the one that breast cancer cells release into the bloodstream, so an increased level of 4-OH is concerning.  This is a newer test, and was not available in the past.   If the level of 4-OH is too high, we can help correct this with cruciferous vegetables (like broccoli, cauliflower,  kale, brussels sprouts), ground flax seed and fish oil.  We can also use a nutritional supplement called DIM.

In “Phase Two” of estrogen detoxification, the metabolites are altered further:

2-methoxyestrogen (2-Me) and 4-methoxyestrogen (4-Me) are made when 2-OH and 4-OH estrogens are “methylated” into methoxyestrogens.  This is a biochemical event where a “methyl” molecule is attached to the estrogen.  Even if estrogen has been converted into the “bad”  4-OH, once it is “methylated”  into 4-Me,  it becomes harmless.  Some people have a genetic variation resulting in reduced ability to methylate, and this leaves more 4-OH.  If the level of 4-OH is too high, we can help reduce it with supplements such as folate, B12 and SAMe which help methylation.

If the 4-OH is not methylated, it can be “oxidized” to a quinone-estrogen which can damage DNA and cause cancer.  But here too, we can intervene to prevent this!  Anti-oxidants, including glutathione (an important anti-oxidant produced in your liver), protect the 4-OH from being oxidized into a quinone-estrogen.  We can help clear the 4-OH safely by increasing your levels of glutathione.  This can be done by eating foods such as garlic, onions and beets, and with a supplement called N-acetylcysteine (NAC).  

Where should you start?

Previously we could only test for 2 and 16 estrogen metabolites, which didn’t give us the whole picture.  Now we can also measure for the 4 estrogen metabolites, which allows us to map out your personal estrogen metabolism  pattern.  We can also test for genetic variations that may be pushing your estrogen metabolism in the undesirable direction, as well as test for levels of anti-oxidants such as glutathione which help to clear the “bad” estrogen metabolites.   With this information we are able to make recommendations to alter your pattern so you make more of the protective estrogen 
metabolites and less of the harmful ones.  Then we can repeat the test to make sure we got it right! 

There are many other factors that are important for reducing cancer risk, including maintaining a healthy weight, eating a whole foods diet rich in fruits and vegetables of many colors, getting regular exercise, coping with stress in a healthy way, avoiding environmental toxins and making sure your estrogen is balanced with progesterone.  

Knowing your estrogen metabolism pattern, and optimizing it, is an example of how emerging medical science can help guide our nutritional recommendations to help you reduce your risk for hormone sensitive cancers.  The test is not covered by health insurance, and the cost is $200 or less, depending on the lab.  I recommend this test be done at least once in all patients.  If it is abnormal, we can talk about further testing for the gene variants, so we can compensate for any genetic weaknesses.  
If you are interested in being evaluated for your estrogen metabolism pattern, please contact the office for more information, 704-752-9346 or email us at   You can find more information at

Yours in health,