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Topics - croaker24

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1
Interesting read.    Not sure how much I agree with it - essentially classifying obesity as a disease.   Genetics may be part of it - but a bigger part I think is our processed/fast food culture/industry.   However, the main thrust of this article is that what works for one person will not work for another. 

http://www.nytimes.com/2016/12/12/health/weight-loss-obesity.html?smid=tw-nythealth&smtyp=cur&_r=0

If you want to make a great discovery,” he tells them, figure out this: Why do some people lose 50 pounds on a diet while others on the same diet gain a few pounds?  Then he shows them data
from a study he did that found exactly that effect.  Dr. Sacks’s challenge is a question at the center of obesity research today. Two people can have the same amount of excess weight, they can be
the same age, the same socioeconomic class, the same race, the same gender. And yet a treatment that works for one will do nothing for the other.

2

https://www.sciencedaily.com/releases/2016/11/161123141436.htm
http://sydney.edu.au/news-opinion/news/2016/11/24/major-finding-identifies-nitrogen-as-key-driver-for-gut-health.html

The researchers' new model suggests that while high-carbohydrate diets were the most likely to support positive interactions in the microbiome, such benefits were relative to the protein intake of the host animal.   Researchers hope the new findings will lay the foundations for more accurate computer simulations to test hundreds of different diet variants, helping to better predict which dietary combinations lead to optimal gut health.   "There are many ways to achieve a good diet, and the same diet won’t work in the same way in each person," said co-author Professor Stephen Simpson, Academic Director of the Charles Perkins Centre.






3
This is the best review of the book I've seen:   http://www.skeptic.com/reading_room/the-ultimate-trade-off-why-men-die-first/     

I'm still reading the book - which is a strictly scientific summary, with some speculation, of male aging from an evolutionary context.     Hormones play a big role in the book.   
There are implications - while admitting that the robust evidence is not all there - that higher levels of T as you get older may not be a good thing, as viewed from an evolutionary lens.

So far, a few things -

The assumption that T levels decline as you age is not some universal truth.   He discusses one hunter-gather society where they start with lower levels in general but these levels
don't change much as they age - but they tend to be lean their whole life.

In Japan, they have the same general pattern initially - their T levels peak in the 20's and drop off until the 40's where they stabilize, but here in the US they continue to drop.   Not entirely sure why, but I'm betting the men in Japan stay lean as they age.   We in the US get fat.   

T suppresses immune systems.  Women have more robust immune systems at the cost of being far more prone to autoimmune diseases (estrogen).   I'm gathering that estradiol in particular plays a big role in immune system's robustness.    Does that mean for us on TRT, we might want to see lower levels of T with estradiol running toward the higher end of the range for a better balance (immune-system wise)?  Yet - he says that it not seem to be true that as our T declines as we age that we develop an increased ability to fight off infections, the decline in the ability to fight infections happens in spite of of the T levels.    So I'm not clear on that.

Having big muscles as you age is costly, the energy expenditure diverted could be better used to fight infections.    So you guys bulking up to impress the females or out of vanity might be increasing your risk for infections down the road. 

Higher levels of T appear to make men act more stupid - taking more risks.   Being the macho type is dumb in the long run.

 

4
This is not the same test as the cardiac CRP(which I understand is more sensitive and specific to measuring cardiovascular risk.)    In the never-ending testing to assess whether either I have celiac or
gluten sensitivity my dietician recommended taking the  quantitative CRP test to see if we could detect any inflammation in the body that might be caused by eating gluten.   

The reference range is 0.0 - 4.9  mg/L, and my score was  "< 0.3" which I believe indicates low/minimal inflammation.

Is it of value to do both the cardiac CRP (high sensitivity) and the quantitative CRP?   



5
I came across his name in a book I'm reading, apparently he is one of the top researchers in the field of vascular aging.   He believes that flexible, unclogged arteries are *the* key to
successful aging.     He says there is a poor man's indicator of arterial health as you age, and that is whether the systolic goes up and if there is a widening gap between it and the diastolic.   He also
mentions LDL.   

Looking him up I find this site:  http://www.colorado.edu/intphys/people/seals.html  and scrolling down, you can find a number of papers/articles/videos, including one video about
optimal longevitity; I did not have the patience to sit through the entire video, but it was all about arterial function.

He's got a lot of papers, especially this one, which looks like a fairly exhaustive summary, including suggestions for preserving or improving arterial functioning:

"You're only as old as your arteries" -  http://physiologyonline.physiology.org/content/29/4/250








6
Testosterone, Hormones and General Men's Health / Injecting Every Five Days
« on: November 14, 2016, 07:40:10 pm »
[MODERATOR SPLIT FROM HERE: http://www.peaktestosterone.com/forum/index.php?topic=11397.0 ]

If you want a compromise, my doctor recently switched me to every five days.  It has been working great for me..

Isn't that a little awkward to remember?   With 2x weekly,it's routine,  Sat night/Wed morning.   

7
http://press.endocrine.org/doi/10.1210/jc.2016-2141

Objective:  Evaluation of suppression of spermatogenesis and contraceptive protection by coadministered im injections of progesterone and testosterone.
Participants: Healthy men, aged 18–45 years, and their 18- to 38-year-old female partners, both without known fertility problems.
Intervention:  Intramuscular injections of 200-mg norethisterone enanthate combined with 1000-mg testosterone undecanoate, administered every 8 weeks.
Main Outcomes Measures:  Suppression of spermatogenesis by ejaculate analysis, contraceptive protection by pregnancy rate.
Results: Of the 320 participants, 95.9 of 100 continuing users (95% confidence interval [CI], 92.8–97.9) suppressed to a sperm concentration less than or equal to 1 million/mL within 24 weeks (Kaplan-Meier method). During the efficacy phase of up to 56 weeks, 4 pregnancies occurred among the partners of the 266 male participants, with the rate of 1.57 per 100 continuing users (95% CI, 0.59–4.14). The cumulative reversibility of suppression of spermatogenesis after 52 weeks of recovery was 94.8 per 100 continuing users (95% CI, 91.5–97.1). The most common adverse events were acne, injection site pain, increased libido, and mood disorders. Following the recommendation of an external safety review committee the recruitment and hormone injections were terminated early.
Conclusions: The study regimen led to near-complete and reversible suppression of spermatogenesis. The contraceptive efficacy was relatively good compared with other reversible methods available for men. The frequencies of mild to moderate mood disorders were relatively high.   



8
Testosterone, Hormones and General Men's Health / Celiac Genetic Test
« on: October 31, 2016, 09:01:06 pm »
To make a long story short - I had some GI issues 3.5 years ago, and after a battery of various tests came back negative, my dietician put me on a gluten-free / dairy-free diet.    I've pretty much stuck to that diet all this time.    However, I never had a diagnosis of celiac disease from any GI doc.   I cannot say the diet helped per se, it was another 1.5 years before I actually got that much better, and only after I started with cypionate shots and got my overall T from the 300/400's to over 700.    Because I've been GF for so long, the only test I can now do is the genetic test - you must have DQ2 or DQ8 markers to have celiac.   Even then, it's still a very rare risk, unless you have a family member with celiac (and that is something I will never know for sure.)     Any other tests requires you to be eating gluten.

So I have the DQ2 gene and I have to decide what to do.    The likelihood of having celiac is still small.   If I want to pursue this, I have to resume eating gluten, then do the antibodies test, and if that is positive, I have to undergo a biopsy. 

THE PATIENT IS POSITIVE FOR DQ2.  CELIAC DISEASE RISK FROM THE HLA DQA/DQB GENOTYPE IS APPROXIMATELY 1:35 (2.9%) ALLELE INTERPRETATION FOR ALL LOCI BASED ON IMGT/HLA GREATER THAN 95% OF CELIAC PATIENTS ARE POSITIVE FOR EITHER DQ2 OR DQ8 (SOLLID AND THORSBY, (1993)  GASTROENTEROLOGY 105:910-922). HOWEVER THESE ANTIGENS MAY ALSO BE PRESENT IN PATIENTS WHO DO NOT HAVE CELIAC DISEASE.
                     
IN ORDER FOR CELIAC DISEASE TO DEVELOP, HUMAN LEUKOCYTE ANTIGEN (HLA) MOLECULE DQ2 (ENCODED BY ALLELES DQA1*0501 OR *0505 PLUS DQB1*0201 OR *0202), HALF OF THE DQ2 MOLECULE, OR DQ8 (ENCODED DQA*03 PLUS DQB1*0302) MUST BE PRESENT. THESE MOLECULES CONFER SUSCEPTIBILITY TO CELIAC DISEASE BY BINDING TO GLUTEN AND INTERACTING WITH INTESTINAL T CELLS, LEADING TO A PATHOLOGIC IMMUNE RESPONSE INVOLVING AUTOIMMUNITY. THE FAMILIAL NATURE OF SUSCEPTIBILITY TO CELIAC DISEASE IS SHOWN BY AN 11-18% PREVALENCE OF THIS DISORDER IN SIBLINGS OF INDIVIDUALS WITH CELIAC DISEASE AND A 70% CONCORDANCE RATE BETWEEN IDENTICAL TWINS.
 
AMONG CELIAC DISEASE PATIENTS, >90% CARRY DQ2, 5-10% CARRY DQ8, AND THE REMAINING CARRY HALF DQ2. THE PRESENCE OF DQ2, HALF DQ2, OR DQ8 ALONE IS NOT SUFFICIENT FOR A DIAGNOSIS OF CELIAC DISEASE. CLINICAL SYMPTOMS, POSITIVE TEST RESULTS FOR ENDOMYSIAL, TISSUE TRANSGLUTAMINASE OR DEAMIDATED GLIADIN PEPTIDE ANTIBODIES, OR ABNORMAL SMALL BOWEL BIOPSY RESULTS ALL SUPPORT A DIAGNOSIS OF CELIAC DISEASE. MOST INDIVIDUALS WITH A POSITIVE GENETIC RESULT DO NOT DEVELOP CELIAC DISEASE. THE RISK FOR DEVELOPING CELIAC DISEASE IN INDIVIDUALS WITH A POSITIVE GENETIC RESULT APPROACHES 40% IF THERE IS A KNOWN FIRST DEGREE RELATIVE WITH CELIAC DISEASE.
 
TABLE: GENETIC RISK FROM HLA-DQA/DQB GENOTYPES
______________________________________________________________
                GENOTYPE                         RISK
 ________________________________________ ___________________
                DQ2 + DQ8                                                   1:7 (14.3%)
 ________________________________________ ___________________
      DQ2 + DQ2 OR DQ2 HOMOZYGOUS *02               1:10 (10%)
 ________________________________________ ___________________
                 DQ8 + DQ8                                                  1:12 (8.4%)
 ________________________________________ ___________________
               DQ8 + DQB1*02                                            1:24 (4.2%)
 ________________________________________ ___________________
             HOMOZYGOUS DQB*02                                   1:26 (3.8%)
 ________________________________________ ___________________
                  DQ2 ALONE                                                  1:35 (2.9%)
 ________________________________________ ___________________
                  DQ8 ALONE                                                  1:89 (1.1%)
 ________________________________________ ___________________
    POPULATION RISK (GENOTYPE UNKNOWN)               1:100 (1%)
 ________________________________________ ___________________
               1/2 DQ2:DQB1*02                                           1:210 (0.5%)
 ________________________________________ ___________________
               1/2 DQ2:DQA1*05                                           1:1842 (0.05%)
 ________________________________________ ___________________
   NO HLA-DQA/DQB SUSCEPTIBILITY ALLELES            1:2518 (<0.04%)
 ________________________________________ ___________________      

9
After being on pure l-citrulline for a while, I decided to try the malate version.   Big mistake.    The malic acid seemed to have triggered some allergic response.   My nose got swollen,
I got congested, and had sneezing fits every evening; along with some dry, itchy eyes. 

Gave it two weeks before going back to the pure l-citrulline version.    And almost immediately my allergy symptoms ceased.   

Anyone else have issues with the malate form?


11
Found this from Consumer Reports OnHealth - http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002087

These findings may help inform scientists, clinicians, and the public on dietary priorities related to dietary fats and carbohydrates and metabolic health.

This investigation suggests that consuming more unsaturated fats in place of either carbohydrates or saturated fats will help improve blood glucose control. Sole emphasis on lowering consumption of carbohydrates or saturated fats would not be optimal.

Translated to foods, these findings support benefits of increasing consumption of vegetable oils and spreads, nuts, fish, and vegetables rich in unsaturated fats (e.g., avocado), in place of either animal fats or refined grains, starches, and sugars.

12
Denise Minger:    https://authoritynutrition.com/4-reasons-some-do-well-as-vegans/

Put me in the fail camp.  I feel much better since adding the fish, a little chicken and bison in there.   And while I'm not entirely sure about these
points, I agree that genetics/gut health can dictate what type of diet is best for you.




13
Testosterone, Hormones and General Men's Health / GI Issues - - and ABX
« on: August 30, 2016, 09:51:28 pm »
After nearly 2 years of great digestion with nary a trace of any issues, I finally ran into a road-block.    About a month ago, I fell sick like a slight flu/cold coming on for about 2 days, ran a slight temperature on and off, and then suffered from diarrhea for 5 days - then it cleared up.    I resumed my old probiotic and thought it was helping to recover, and started getting back to normal.  Fast forward 3 weeks, then boom, I get hit again; no sickness/fever, just the diarrhea.   I had gone out of town however so maybe I'm very sensitive to disruptions at that point, or ate some food that disagreed with me.

This time visited the PCP, and they decided to do stool tests for various bacteria/parasites, and recommended a narrow-spectrum ABX.     After 2 days, it looked like the ABX was working, then gradually it started getting to me and I got worse, a sick feeling, and really bad diarrhea; increasingly less energy.

Test results started coming back - c diff/parasites were negative.    The other tests were for e coli/shigella/salmonella.   Still waiting on that.   The thing is, everything I read says you are NOT to take an ABX for the latter 3 bacterial infections, only for c diff/parasites.   You can get yourself in big trouble taking an ABX for e coli/shigella/salmonella. 

So I stopped the ABX on my own (after 5 days) but it has a half-life such that it will not clear out of my system for another 48 hours (and I'm one of those very sensitive to medications.)      I'm
really pissed at the PCP for putting me on the ABX *before* all the test results were in, and kicking myself for allowing him to do so.   

Probably I should not have stopped the ABX w/o notifying the PCP, but knowing them, they will insist on staying on 'just in case'.    No one has a clue as to what could have happened, whether it could be viral, fungal, or bacterial.     I do feel better, a day after stopping, but my diarrhea is persisting, and I've read where it will for a few more days.     

Anyone else gone through something like this?

14
I'm a skeptic of supplements in general - but I really do think that probiotics have helped to restore my gut health.   A number of years ago, I suffered from major GI issues, including bloating,
constipation, and absorption issues to the point where I ended up losing a ton of weight.   A dietician worked with me to clean up my diet, but even then, it took a long time to restore some
semblance of gut health to the point where I was able to gain weight.   It seems to me that once I added a probiotic to my regimen, specifically Metagenics Ultra Flora (which contributes
Lactobacillus Acidophilus NCFM and Bifidobacterium Lactis Bi-07)  that things really started to improve.

I had done some research on the various strains of bacteria and there appears to be a number of clinical trials establishing the efficacy of these 2 strains.     Fast forward 2 years, and for whatever
reason, I decided to try some Garden of Life brand starting a month ago, and my gut health gradually started to slip, where a few weeks ago I was suffering from loose bowels, losing weight, and so forth.    It could have simply been some bad food, or some bacterial or viral infection I admit.   

But once I added the Metagenics back in and within 3 days, I'm virtually back to normal.    I cannot say for certain that the Metagenics brand helped, it could be placebo, or just getting over something.   

Consumerlab has a chart identifying various strains and the benefits of these strains.   I think, instead of just randomly trying a probiotic, you really need to identify why you want to take one, and
find the product that supplies the strain(s) that could help the condition you are trying to solve.

15
[MODERATOR SPLIT FROM HERE: http://www.peaktestosterone.com/forum/index.php?topic=10549.0 ]

Anthony - just for your reference (and this is a common finding), had a patient today taking finasteride 1.25mg daily (1/4 of a 5mg tablet) longterm from another provider (to prevent hair loss). Despite his T levels ranging 600-800's, his DHT has ranged from 9-18...in other words, VERY low and he is taking 1/4 of your current dosage of finasteride.

(1.)  Yes, I am getting (very) concerned.  I see my new doctor on Friday (in two more days).  I will ask about this, and I will seek a DHT blood test.

(2.)  So, in the situation you found yourself in -- the patient with the very low DHT -- what was your advice?

I convinced him that his health and quality of life was more important than his exaggerated concern about his hair. Got him to discontinue the finasteride, substituted with a hair loss preventative scalp treatment, and will monitor DHT levels and *hope* they recover (I have some tricks of the trade to utilize if they don't). Ideally we can achieve a BALANCE of DHT levels whereby he will not likely have acceleration of male pattern baldness, but at the same time can begin to realize some of the benefits of this vital hormone.

What kind of hair loss treatment are you advising?

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