Obesity IS a disease–not caused by lack of self-control, but rather by consumption of highly processed low nutrient density “foods”

Written by admin on July 25, 2013 – 9:34 pm -

Obesity and Addiction: Introduction

Bret S. Stetka, MD, Nora D. Volkow, MD

Editor’s Note: In June 2013, the American Medical Association (AMA) declared obesity a disease, a move championed by many clinicians and derided by others. Debate aside, the announcement reinforced that the understanding and appreciation of obesity is evolving, and that in this era of soda bans and school lunch reform, obesity is high in the consciousness of both the public and the medical community.

One area of obesity research receiving a great deal of attention lately is the considerable neurobiological overlap between addiction and some forms of obesity. Nora D. Volkow, MD, Director of the National Institute on Drug Abuse (NIDA), has studied this association extensively. Medscape recently spoke to Dr. Volkow about her ongoing research into the relationship between weight and addiction.

Medscape: Hi, Dr. Volkow. Before we get to the relationship between obesity and addiction, how does human appetite control normally work?

Dr. Volkow: Eating behaviors are obviously necessary for survival, and we’ve evolved complex and redundant systems to ensure that the behaviors necessary to eat occur. The brain receives peripheral signals that relate to the body’s nutritional status: for example, the concentration of glucose, lipids, and certain nutrients. These signals are conveyed to the brain via the plasma and peripheral nerves in the gastrointestinal tract — a process known as “homeostatic regulation” of feeding — and help indicate whether the body needs to consume more food or not and whether there is a need for a specific nutrient. Parallel reward systems in the brain respond to the pleasantness of food and motivate our behaviors to consume them, a process described as “hedonic regulation” of food intake.

It was believed for many years that these peripheral signals were predominantly received by the hypothalamus, and it was initially thought that there were only a few signals (eg, glucose, insulin, leptin). However, in the past 10 years, many other signals (eg, hormones, peptides) have been identified that work in part by acting on and altering the sensitivity of reward systems in the brain to food.

For example, normally the hormone leptin is secreted from adipose cells to tell the brain that enough energy is stored; this decreases appetite and increases energy expenditure. There is a very rare genetic condition where individuals are born without the gene that encodes for leptin, and these individuals overeat and become obese from childhood. In these individuals, brain imaging studies have shown that reward systems in the brain are hypersensitive to the rewarding properties of food. Leptin treatment in these individuals decreases the sensitivity of the reward system, resulting in a decrease in the motivation to eat and a marked reduction in weight.

When peripheral signals — such as leptin or insulin — are not released, or your brain becomes tolerant to them, you don’t have a mechanism to counter the drive to eat. It’s like driving a car without brakes.

Medscape: Which brain regions make up our reward centers?
Dr. Volkow: We describe them as a reward circuit, because there are multiple connected regions involved. A central node in the circuit is the nucleus accumbens (NAc), a region regulated by dopamine, which we always hear about being responsible for the rewarding and addictive effects of drugs. The rewarding effects of drugs result from their ability to activate the NAc through increased dopamine release. Similarly, rewarding effects of food are linked to dopamine release in the NAc.

Before we get to food addiction, I should say that how effective food is at activating these dopamine pathways, and the NAc, is modulated by homeostatic peripheral signals. If you don’t have insulin and leptin, which decrease dopamine signaling in the NAc, the reward circuit will go into overdrive when you eat or are exposed to food; this is because signaling in the reward pathway triggers the motivation to eat. This can result in obesity. As people become obese, they become insulin- and leptin-resistant, thus removing the normal peripheral signals that help inhibit the rewarding effects of food; the more severe the obesity, the worse the brain becomes at preventing excess food intake.

The Addiction Overlap

Medscape: What neurophysiologic changes occur resulting in addiction?

Dr. Volkow: I, along with my colleagues at Brookhaven National Laboratory and the National Institutes of Health, have been studying the changes in the brain dopamine system in people who are addicted and also in morbidly obese individuals. Generally speaking, when dopamine activates D1 receptors in the reward system, it increases the drive to participate in a rewarding behavior (eg, eating), whereas D2-receptor stimulation helps dampen and regulate this response, allowing us to exert control over the behavior. What we are seeing in addictive behaviors and in obesity is that signaling through the D2 receptor system is markedly attenuated. As a result, you lose your brakes while the engine just keeps going.

What is very interesting is that addicted patients seem to be hypersensitized to stimuli related to, for example, food or drugs. A surge in dopamine activity occurs in anticipation of the reward but drops markedly with actually participating in the behavior. So it’s the anticipation that is rewarding, and not so much the reward itself.

Medscape: Very interesting. Presumably, this is only one of multiple potential causes of obesity, correct?

Dr. Volkow: Yes. Obesity can also result from lack of physical activity or from enhanced energy efficiency, such that little energy is required by the cells of the bodies to perform their functions. Even if your peripheral homeostatic signals are working fine, if you live a completely sedentary lifestyle, you still may become obese if you are consuming a greater quantity of calories than you need. So the potential addictiveness of food can contribute to or cause obesity, because it drives our consumption of food even when we are not hungry and our body has all of the nutrients it needs.

Medscape: In your mind, then, would the subset of obesity caused by addictive mechanisms qualify as an addiction?

Dr. Volkow: It’s interesting, because in the past we would always say either you have something or you don’t; either you’re addicted or you’re not. However, the new classification system in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)[1] has a dimensional component that assesses addiction on a continuum. I think the exact same concept applies to food.

Addiction is characterized by loss of control in relation to a substance or behavior. Now, I lose control over certain foods all the time; however, I am not obese. You could say I have a vulnerability to the rewarding effects of certain foods. But is it severe enough to be called a disease? Probably not. So I would say that in extreme cases of obesity — in which patients want to stop eating but they just can’t, even with awareness of all the adverse physical and psychological consequences (obese people are stigmatized, which is a powerful social stressor) — then yes, I would say there is an addictive dimension to their behavior.

The DSM, Video Games, and DC Traffic

Medscape: On a related note, I know it was somewhat controversial that DSM-5 included specific addictive behaviors, such as Internet gaming addiction. Do you feel that calling out specific addictions like this is warranted? Or in theory, aren’t there an infinite number of behaviors one could be addicted to?

Dr. Volkow: There actually appear to be a limited number of behaviors which can result in addiction, much like drugs. There are only a few chemical compounds that can produce addiction. You can’t get addicted to antibiotics, or antidepressants. Only chemical compounds that increase dopamine activity in reward pathways can produce addiction. Similarly, only behaviors that increase dopamine in the NAc (ie, gambling) can result in addiction with repeated exposures in those that are vulnerable. The same is true with food; as a result, not all foods are equally rewarding.

If you eat an overboiled piece of chicken, it can be rewarding, but only if you are hungry. But if you are not hungry, it may not be inherently rewarding. On the other hand, many would find a chocolate chip cookie inherently rewarding, even in the absence of hunger. This makes some foods much more dangerous in promoting reward-system activation and causing compulsive eating behaviors.

The same goes for such behaviors as video gaming, which is inherently reward-based. You get the reward of winning, or beating your enemy. And gambling is obviously reward-based. But driving a car, for example, in the middle of rush hour in Washington, DC, will never generate an addictive behavior!

Medscape: I know you were a proponent of including obesity caused by addiction in the DSM-5. In the end, it wasn’t included in the revised manual, but do you still feel it should have been? And do you think ultimately it will be included as more data come to light?

Dr. Volkow: During the DSM-5 development, Chuck O’Brian and I brought forward the similarities between addiction to drugs and obesity from overconsumption of palatable food, both in terms of clinical presentation and neurocircuitry. We saw it as an opportunity for psychiatrists to consider the addictive component of obesity and help in developing therapeutic interventions. Specifically, we thought psychiatry could play an important role in the behavioral element of overeating behaviors, but obesity didn’t get incorporated into the DSM-5. Some were concerned that including obesity as a mental illness would increase its stigmatization. On the other hand, I was delighted when the AMA declared obesity a disease.

Medscape: Is there much support in the medical community for one day including obesity in the DSM?

Dr. Volkow: I don’t know. Societies that develop diagnostic criteria have committees with long-standing procedures and opinions regarding the diseases they are classifying. There is a section in the DSM on eating disorders, which includes bulimia and anorexia nervosa. Of note, DSM-IV (and DSM-5) consider binge eating disorder a mental illness, but not obesity. But I do foresee that eventually — and particularly now that the AMA considers obesity a disease — perhaps in the next round of revisions, certain types of obesity (ie, that not associated with endocrine dysfunction) may be considered for inclusion in DSM.

Medscape: Do you have any sense as to what percentage of obesity is caused by addictive pathology?

Dr. Volkow: I do not have any data, but I would predict that most of the problems of being overweight and obesity in our country are driven by excessive consumption of rewarding food. However, just as is the case for drugs, for which most of the consumption is not by people who are addicted, I would predict that most cases of overeating are in people who are not addicted to food.

Therapeutic Implications and Future Directions

Medscape: What does the improved understanding of addictive obesity mean for treatment? Are there therapies under investigation targeting the reward pathways in obesity?

Dr. Volkow: In animal models, there are medications that, for example, interfere with the consumption of high quantities of food. In many instances, these same drugs are useful in interfering with drug consumption. This is not surprising, as these drugs work by acting on the reward system. People are looking for drugs that can act on this system and decrease their addictive behaviors.

As the Director of NIDA, this is an area of great interest to me, because there has been very limited interest by the pharmaceutical industry in developing medications for drug addiction, whereas there is much more interest in developing obesity medication treatments.

Medscape: What antiaddiction medications have shown efficacy?

Dr. Volkow: One is naltrexone, a new opioid receptor antagonist that is very useful in treating heroin addiction and alcoholism. A combination of sustained-release bupropion/naltrexone therapy is currently being reviewed by the US Food and Drug Administration for obesity. There has also been a lot of interest in cannabinoid receptor antagonists.
Rimonabant — a drug that was approved in Europe for the treatment of obesity, and then removed from the market because it caused suicidal thinking in some patients — had been shown to interfere with the administration of drugs in animal models of addiction. It also showed potential benefits in treating marijuana abuse. Unfortunately, its side effects will preclude its clinical use.

More researchers are working on the neurobiological overlap between drug and food reward, and the adaptions that ensue with repeated use, as a strategy to help identify molecular targets for addiction medications.

Medscape: What are you and your group at NIDA currently working on?

Dr. Volkow: We are studying many facets of obesity. We are interested in understanding the mechanism by which glucose and other peripheral signals (including vagal stimulation) activate the reward system. We are also studying the neurocircuitry overlap between food and alcohol consumption; this has generated a lot of clinical interest, because bariatric surgery for the treatment of obesity is associated with a higher risk for developing an alcohol use disorder. Specifically, we are studying the mechanisms by which bariatric surgery modifies the rewarding effects of alcohol and other drugs.

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Chronic Exertional Compartment Syndrome: A Review

Written by admin on July 15, 2013 – 10:00 pm -

Active individuals, including athletes or people with highly active jobs, have a risk of sustaining an orthopedic condition. While a lot of the focus remains on the traumatic, or acute, injuries, a vast majority of conditions may result from overuse. The body can only take so much before these overuse injuries begin to create dysfunctions and inflammation in the body, thus causing chronic pain syndromes. One syndrome that results due to overuse is a condition to the lower legs called chronic exertional compartment syndrome.
Chronic exertional compartment syndrome (CECS) is the direct result of increased pressure within one or more of the four compartments of the lower leg. These compartments include the anterior, lateral, superficial posterior, and deep posterior. This increase in pressure causes compression of the muscular and neurovascular structures located in each compartment. The anterior compartment is the most common compartment for this syndrome to occur in, however, any or all compartments may be involved (Blackman, 2000). The condition is activity related as symptoms are generally felt only during activity. These symptoms may include a deep aching pain, tightness, and swelling of the involved compartments. These same symptoms will resolve fairly quickly with rest.
One such case involving CECS involved a 22 year old male soccer athlete who reported to clinic with insidious, yet sudden, onset of bilateral lower leg tightness. This pain was felt consistently about 50 minutes into soccer activities and would resolve within 15 minutes of rest. Examination of lower legs revealed firmness to the bilateral anterior and lateral compartments which is a common finding in this condition. To confirm that CECS is present, the best method is by measuring the compartment pressure. Compartment pressure measurements were taken in this patient. These measurements revealed resting compartment pressures well above average in bilateral anterior and lateral compartments. It was determined that this patient was suffering from CECS.
Once CECS is identified, treatment and management of the condition is the next barrier that needs to be addressed. This patient was given options for both non-operative and operative interventions. Upon consideration, the patient elected to receive bilateral anterior and lateral compartment release by fasciotomy.
Surgical intervention involving fasciotomy compartmental release remains the main form of management for this condition, particularly in younger, athletic individuals such as the soccer player described above. The American Journal of Sports Medicine recently published an article that investigated functional outcomes and patient satisfaction after fasciotomy for CECS. In this investigation, the authors identified patients between 1998 and 2008 that presented with CECS that had failed non-operative management and presented them with the option of either continuing to receive non-operative treatment or to receive referral to orthopedic surgeon for fasciotomy release. Patients with a minimum 2-year follow-up were provided a questionnaire describing their pre-treatment and post-treatment conditions. This questionnaire included quality and duration of symptoms, analog pain scale, symptomatic and functional responses to treatment, and satisfaction with treatment. All medical records and patient outcomes were then reviewed. After interventions were implemented, the operative group had a much higher rate of success and patient satisfaction rate at 81% in both categories compared to the non-operative group with success and satisfaction rates of 41% and 56%, respectively. Patients that received combined anterior and lateral compartment release had a much higher failure rate (31%) than those receiving an isolated anterior compartment release (0%). Also, the data analyzed revealed that those patients who were college-aged or younger had a higher satisfaction rating when compared to patients post-college. The authors concluded that patients 23 years old or younger with isolated anterior compartment syndrome are excellent candidates for fasciotomy release. Furthermore, they conclude that lateral compartment release should be avoided unless clearly indicated by symptoms and compartment pressure measurements (Packer, Day, Nguyen, Hobart, Hannafin & Metzl, 2013).
In the case of this 22 year old soccer player, he elected to receive bilateral anterior and lateral compartment fasciotomy for CECS. Despite the conclusions of Packer et. al., this particular patient responded favorably to both anterior and lateral compartment releases. Factors that likely attributed to the success of this individuals surgery were the fact that he was younger and fell into the group of people that respond more favorably. The athlete was able to return to soccer activities and has not had any recurrence of symptoms.
Additional studies supporting the use of compartment fasciotomy include one study published in 2010 that concluded compartment release is a cosmetic, safe, and effective means of treating CECS (Wittstein, Moorman & Levin 2010). Another study later concluded that, for athletes, a meticulous surgical intervention for CECS will yield good outcomes and return to play can be expected in as quickly as 8-12 weeks (Murray & Heckman, 2012).
Despite the overall support for the implementation of surgical intervention for patients suffering from CECS, many patients wish to avoid surgical interventions by means of more conservative management. For athletes, particularly those involved in intense aerobic activities such as soccer or track athletes, conservative management is a realistic option to pursue.
One key component that must be addressed is analyzing the athletes running mechanics to identify a possible cause for why the condition became a problem. In 2012, the American Journal of Sports Medicine published an article investigating the effects of forefoot running on pain and disability associated with CECS. The investigators identified 10 individuals that were clinically indicated for surgical compartment release. Once these individuals were identified, surgical intervention was postponed and conservative management was implemented in the form of a six week forefoot strike running intervention. Multiple variable were measured before and after the six week intervention including compartment pressures at rest and post-running, running distance, and reported pain. The results showed that after the six-week intervention, mean post-run anterior compartment pressures significantly decreased from 78.0 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Additionally, running distance significantly increased and reported pain while running decreased. No subject involved in the study needed surgical intervention (Diebal , Gregory, Alitz & Gerber, 2012).
Based on the results of this study, any high caliber athlete wishing to avoid surgical intervention should strongly consider a running gait analysis from a qualified professional to determine if forefoot running is a viable option to remain off the operating table.
While the surgical intervention of the 22-year old soccer athlete was a success, the question must be raised: would the athlete have been able to avoid a surgery by altering his running gait? Future research and clinical trials must be implemented in order to draw more support towards successful non-operative interventions for CECS. For some patients, this may be viable substitute to surgical intervention.


Blackman, P. (2000). A review of chronic exertional compartment syndrome in the lower leg. Medicine and Science in Sports and Exercise, 32(3 Suppl), S4-10. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10730989
Diebal , A., Gregory, R., Alitz, C., & Gerber, J. (2012). Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. The American Journal of Sports Medicine, 40(5), 1060-1067. Retrieved from http://ajs.sagepub.com/content/40/5/1060.short
Murray, M., & Heckman , M. (2012). Chronic exertional compartment syndrome: Diagnostic techniques and management. Techniques in Orthopaedics, 27(1), 75-78. Retrieved from http://journals.lww.com/techortho/Abstract/2012/03000/Chronic_Exertional_Compartment_Syndrome__.15.aspx
Packer, J., Day, M., Nguyen, J., Hobart, S., Hannafin, J., & Metzl, J. (2013). Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. The American Journal of Sports Medicine, 41(2), 430-436. Retrieved from http://ajs.sagepub.com/content/41/2/430.short
Wittstein, J., Moorman, C., & Levin, L. (2010). Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. The American Journal of Sports Medicine, 38(8), 1661-1666. Retrieved from http://ajs.sagepub.com/content/38/8/1661.short

Matt Rongstad is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com.

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Dr. Galland Featured in American Council on Exercise Article

Written by admin on July 8, 2013 – 4:10 pm -

Dr. Mark Galland was recently featured in an article published by the American Council on Exercise, titled “Muscular Imbalances Increase Your Client’s Risk for Injury.” In the article, Galland provides insight on muscular imbalances, their causes and how exercise helps prevent them.

To read the full article, visit:


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Dr. Mark Galland Named Team Physician And Medical Director Of Rolesville High School Athletics

Written by admin on July 3, 2013 – 9:31 am -

RALEIGH, N.C. – Dr. Mark Galland, orthopaedic surgeon and sports medicine specialist at Orthopaedic Specialists of North Carolina (OSNC) (http://www.orthonc.com), has been named team physician and medical director of Rolesville High School’s athletic teams. In this position, Galland will be responsible for leading and coordinating the medical staff and medical services for all of the school’s sports teams and student-athletes.

Rolesville High School will open in August 2013 with an anticipated enrollment of 600 to 700 students, with a maximum capacity of approximately 2,300 students. The school will offer football, volleyball, soccer, basketball, softball, baseball, track, tennis, golf, swimming, wrestling, cheerleading and lacrosse programs.

Since joining Orthopaedic Specialists of North Carolina, Galland has continued his commitment and dedication to the treatment of injured athletes. He currently serves as team physician and Orthopaedic consultant to the Carolina Mudcats, the Advanced A affiliate of the Cleveland Indians Major League Baseball team; medical director and orthopaedic consultant to the Louisburg College Athletic Program, medical director of the Barton College athletic program, adjunct clinical professor at Marietta College and team physician and Orthopaedic consultant to several area high schools.

“I am honored to be named team physician and medical director of Rolesville High School,” said Galland. “I look forward to providing orthopaedic care to the school’s student athletes to ensure they are able to compete to the best of their ability and enjoy a safe and healthy sports season.”

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Dr. Mark Galland is an orthopaedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina. Galland received his medical degree from Tulane University’s School of Medicine and completed his residency in the university’s Department of Orthopaedic Surgery. He began his career in orthopaedic surgery and sports medicine while serving in the United States Navy at a naval hospital at Camp Lejeune, N.C. There, he served as chief of orthopaedic surgery and was the recipient of numerous awards for both leadership and excellence in treating injuries common to sailors and marines. Since beginning with Orthopaedic Specialists of North Carolina, Galland has continued to treat injured athletes. He currently serves as a team physician and orthopaedic consultant to the Carolina Mudcats, the High-A affiliate of the Cleveland Indians Major League Baseball team, and as medical director and orthopaedic consultant to the Louisburg College athletic program. He also serves as the team physician and orthopaedic consultant to several local high schools, as well as on the board of directors for the Trentini Foundation, a nonprofit scholarship organization. For more information, visit http://www.orthonc.com or http://drmarkgalland.com.

Jordan Smith
MMI Public Relations
(919) 233-6600




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Statin Nation: The Great Cholesterol Cover-Up

Written by admin on June 29, 2013 – 10:09 pm -

Visit the Mercola Video Library
By Dr. Mercola

There’s serious confusion about cholesterol; whether high cholesterol levels are responsible for heart disease, and whether statins — which are cholesterol drugs — are really the appropriate solution to reduce heart disease risk.
The documentary above, Statin Nation — The Great Cholesterol Cover-Up, sheds much needed light on this topic. The film is available for free viewing for only seven days, so please share it widely as soon as possible.
As noted in the film, heart disease is the leading cause of death worldwide, the most common form of which is coronary heart disease (CHD). CHD affects the blood vessels supplying blood to your heart, causing them to narrow, thereby restricting the amount of oxygen supplied to your heart.
The conventional view is that high cholesterol is a major risk factor for this condition — even children “know” that cholesterol forms plaque and is bad for your heart.
The focus on cholesterol has created an enormous market for statins; drugs that act by blocking the enzyme in your liver that is responsible for making cholesterol.
Statins are now among the most widely prescribed drugs on the market, and are the number one profit-maker for the pharmaceutical industry, largely due to relentless and highly successful direct-to-consumer advertising campaigns.
Meanwhile, as of 2010, there were no less than 900 studies proving their adverse effects, which run the gamut from muscle problems to increased cancer risk! Besides the fact that statins are dangerous to your health, they also do not reduce your risk for heart disease, because high cholesterol does NOT increase heart disease risk…
The idea that high cholesterol causes heart disease can be traced back to Rudolph Virchow (1821-1902), a German pathologist who found thickening in the arteries in people he autopsied, which he ascribed to a collection of cholesterol.

Later, Ancel Keys (1904-2004), a well-known physiologist, published his seminal paper known as the “Seven Countries Study,” which served as the basis for nearly all of the initial scientific support for the Cholesterol Theory.
The study linked the consumption of saturated fat to coronary heart disease. However, what many don’t know is that Keys selectively analyzed information from only seven countries to prove his correlation, rather than comparing all the data available at the time — from 22 countries.
As you might suspect, the studies he excluded were those that did not fit with his hypothesis, namely those that showed a low percentage fat in their diet and a high incidence of death from CHD as well as those with a high-fat diet and low incidence of CHD. When all 22 countries are analyzed, no correlation at all can be found.

And that is what mounting research now confirms. There really is NO correlation between high cholesterol and plaque formation that leads to heart disease.

Why Do You Need Cholesterol?

Missing from the cholesterol-CHD hypothesis is the holistic understanding of how cholesterol operates inside your body, and why arterial plaques form in the first place, which is clearly described in the film. Cholesterol is actually a critical part of your body’s foundational building materials and is absolutely essential for optimal health. It’s so important that your body produces it both in your liver and in your brain.
There’s no doubt that your body needs cholesterol. In fact, we now have evidence showing that cholesterol deficiency has a detrimental impact on virtually every aspect of your health. One of the primary reasons is because cholesterol plays a critical role within your cell membranes.

Your body is composed of trillions of cells that need to interact with each other and cholesterol is one of the molecules that allow for these interactions to take place. For example, cholesterol is the precursor to bile acids, so without sufficient amounts of cholesterol, your digestive system can be adversely affected.
Cholesterol also plays an essential role in your brain, which contains about 25 percent of the cholesterol in your body. It is critical for synapse formation, i.e. the connections between your neurons, which allow you to think, learn new things, and form memories. In fact, there’s reason to believe that low-fat diets and/or cholesterol-lowering drugs may cause or contribute to Alzheimer’s disease. Low cholesterol levels have also been linked to violent behavior, due to adverse changes in brain chemistry.
Furthermore, you need cholesterol to produce steroid hormones, including your sex hormones. Vitamin D is also synthesized from a close relative of cholesterol: 7-dehydrocholesterol.
To further reinforce the importance of cholesterol, I want to remind you of the work of Dr. Stephanie Seneff, who works with the Weston A. Price Foundation. One of her theories is that cholesterol combines with sulfur to form cholesterol sulfate, and that this cholesterol sulfate helps thin your blood by serving as a reservoir for the electron donations you receive when walking barefoot on the earth (also called grounding). She believes that, via this blood-thinning mechanism, cholesterol sulfate may provide natural protection against heart disease. In fact, she goes so far as to hypothesize that heart disease is likely the result of cholesterol deficiency — which of course is the complete opposite of the conventional view.

Identifying Risk Factors for Heart Disease

As mentioned in the film, if you want to understand what causes heart disease, you have to look at what causes damage to your artery walls, interferes in disease processes, and causes blood clotting. When the endothelial wall is damaged, repair mechanisms are set into motion, creating a “scab.” To prevent this scab from dislodging, the endothelial wall grows over it, causing the area to become thickened. This is what is called atherosclerosis. There’s no fat (cholesterol) “clogging the pipe” at all; rather the arterial wall is thickened as a result of your body’s natural repair process. So what causes damage to your arteries?
One of the primary culprits is sugar and fructose in particular. So eating a high sugar diet is a sure-fire way to put heart disease on your list of potential health problems. Meanwhile, total cholesterol will tell you virtually nothing about your disease risk, unless it’s exceptionally elevated (above 330 or so, which would be suggestive of familial hypercholesterolemia, which, in my view, would be about the only time a cholesterol-reducing drug would be appropriate).

Two ratios that are far better indicators of heart disease risk are:

  • Your HDL/total cholesterol ratio: HDL percentage is a very potent heart disease risk factor. Just divide your HDL level by your total cholesterol. This percentage should ideally be above 24 percent. Below 10 percent, it’s a significant indicator of risk for heart disease
  • Your triglyceride/HDL ratios: This ratio should ideally be below 2

Additional risk factors for heart disease include:

  • Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat and makes it more difficult for your body to shed excess weight, and excess fat, particularly around your belly, is one of the major contributors to heart disease
  • Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increase higher risk of having coronary heart disease than people with a level below 79 mg/dl
  • Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body

Statin Drugs Place Millions of Americans at Risk of Serious Health Problems

It’s important to note that statins are classified as a “pregnancy Category X medication” meaning, it causes serious birth defects, and should NEVER be used by a woman who is pregnant or planning a pregnancy. If it is prescribed it is simply gross negligence and malpractice as many doctors are ignorant of this important piece of information as it is relatively recently identified.
Statins have also been shown to increase your risk of diabetes, via a number of different mechanisms. The most important one is that they increase insulin resistance, which can be extremely harmful to your health. Increased insulin resistance contributes to chronic inflammation in your body, and inflammation is the hallmark of most diseases. In fact, increased insulin resistance can lead to heart disease, which, ironically, is the primary reason for taking a cholesterol-reducing drug in the first place. It can also promote belly fat, high blood pressure, heart attacks, chronic fatigue, thyroid disruption, and diseases like Parkinson’s, Alzheimer’s, and cancer.
Secondly, statins increase your diabetes risk by actually raising your blood sugar. When you eat a meal that contains starches and sugar, some of the excess sugar goes to your liver, which then stores it away as cholesterol and triglycerides. Statins work by preventing your liver from making cholesterol. As a result, your liver returns the sugar to your bloodstream, which raises your blood sugar levels.
Drug-induced diabetes and genuine type 2 diabetes are not necessarily identical. If you’re on a statin drug and find that your blood glucose is elevated, it’s possible that what you have is just hyperglycemia — a side effect, and the result of your medication. Unfortunately, many doctors will at that point mistakenly diagnose you with “type 2 diabetes,” and possibly prescribe another drug, when all you may need to do is simply discontinue the statin in order for your blood glucose levels to revert back to normal.
Statin drugs also interfere with other biological functions. Of utmost importance, statins deplete your body of CoQ10, which accounts for many of its devastating results. Therefore, if you take a statin, you MUST take supplemental CoQ10, or better, the reduced form called ubiquinol. A recent study in the European Journal of Pharmacologyshowed that ubiquinol effectively rescued cells from the damage caused by the statin drug simvastatin, thereby protecting muscle cells from myopathies. Another study evaluated the benefits of CoQ10 and selenium supplementation for patients with statin-associated myopathy. Compared to those given a placebo, the treatment group experienced significantly less pain, decreased muscle weakness and cramps, and less fatigue.
Statins also interfere with the mevalonate pathway, which is the central pathway for the steroid management in your body.

How to Optimize Your Cholesterol Levels Naturally

The most effective way to optimize your cholesterol profile and prevent heart disease is via diet and exercise. Remember that 75 percent of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin level, you will automatically optimize your cholesterol and reduce your risk of both diabetes and heart disease.
There is NO drug to cure heart disease, as the underlying cause is insulin resistance and arterial wall damage — both of which are caused by eating too many sugars, grains, and especially fructose. So, my primary recommendations for safely regulating your cholesterol and reducing your risk of heart disease include:

  • Reduce, with the plan of eliminating grains and fructose from your diet. This is one of the best ways to optimize your insulin levels, which will have a positive effect on not just your cholesterol, but also reduces your risk of diabetes and heart disease, and most other chronic diseases. Use my Nutrition Plan to help you determine the ideal diet for you, and consume a good portion of your food raw.
  • Get plenty of high-quality, animal-based omega 3 fats, such as krill oil, and reduce your consumption of damaged omega-6 fats (trans fats, vegetable oils) to balance out your omega-3 to omega-6 ratio.
  • Include heart-healthy foods in your diet, such as olive oil, coconut and coconut oil, organic raw dairy products and eggs, avocados, raw nuts and seeds, and organic grass-fed meats.
  • Optimize your vitamin D levels by getting proper sun exposure or using a safe tanning bed.
  • Optimize your gut flora, as recent research suggests the bacterial balance in your intestines may play a role in your susceptibility to heart disease as well
  • Exercise daily. Make sure you incorporate Peak Fitness exercises, which also optimizes your human growth hormone (HGH) production.
  • Walk barefoot to ground yourself to the earth. Lack of grounding has a lot to do with the rise of modern diseases as it affects inflammatory processes in your body. Grounding thins your blood, making it less viscous. Virtually every aspect of cardiovascular disease has been correlated with elevated blood viscosity. When you ground to the earth, your zeta potential quickly rises, which means your red blood cells have more charge on their surface, which forces them apart from each other. This action causes your blood to thin and flow easier. By repelling each other, your red blood cells are also less inclined to stick together and form a clot.
  • Avoid smoking or drinking alcohol excessively.
  • Be sure to get plenty of good, restorative sleep.

Ninety-Nine Out of 100 People Do Not Need Statin Drugs

The odds are very high — greater than 100 to 1 — that if you’re taking a statin, you don’t really need it. From my review, the ONLY subgroup that might benefit are those born with a genetic defect called familial hypercholesterolemia, as this makes them resistant to traditional measures of normalizing cholesterol.
Remember, your body NEEDS cholesterol for the production of cell membranes, hormones, vitamin D and bile acids that help you to digest fat. Cholesterol also helps your brain form memories and is vital to your neurological function. There is also strong evidence that having too little cholesterol INCREASES your risk for cancer, memory loss, Parkinson’s disease, hormonal imbalances, stroke, depression, suicide, and violent behavior.
Statins really have nothing to do with reducing your heart disease risk. In fact, this class of drugs can increase your heart disease risk — especially if you do not take Ubiquinol (CoQ10) along with it to mitigate the depletion of CoQ10 caused by the drug.
Knowing that high cholesterol is NOT the cause of heart disease finally frees you to take a serious look at what does cause this potentially lethal condition. And as described above, poor lifestyle choices are primarily to blame, such as too much sugar, too little exercise, lack of sun exposure and never grounding to the earth. These are all things that are within your control, and don’t cost much (if any) money to address.


Posted in Cardiac, Health and Fitness | No Comments »

Dr. Mark Galland To Discuss Injury Prevention And Treatment On WRAL News’ Rex On Call Segment

Written by admin on June 19, 2013 – 9:28 am -

RALEIGH, N.C. – Dr. Mark Galland, orthopaedic surgeon and sports medicine specialist at Orthopaedic Specialists of North Carolina (OSNC) (http://www.orthonc.com/galland.html), has announced that he will appear on WRAL News’ Rex On Call segment on Monday, June 17 at 1:00 p.m.

The Rex On Call segment is a monthly half-hour program airing and streaming live the third Monday of every month on WRAL-TV and WRAL.COM, and features Rex Health Care physicians who answer questions from the general public. On Monday, Galland will discuss orthopaedic injury prevention and treatment for people of all ages. For more information or to submit a question for Galland, visit http://www.wral.com/rex-on-call/10230666/?navkeyword=rex+on+call.

“Whether on the course, court, field or back yard, you should not let an injury slow you down,” said Galland. “I am excited to share my expertise and knowledge with the program’s viewers and to answer any questions that they have.”

Dr. Mark Galland Blog


Dr. Mark Galland YouTube Channel


Dr. Mark Galland is an orthopaedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina. Galland received his medical degree from Tulane University’s School of Medicine and completed his residency in the university’s Department of Orthopaedic Surgery. He began his career in orthopaedic surgery and sports medicine while serving in the United States Navy at a naval hospital at Camp Lejeune, N.C. There, he served as chief of orthopaedic surgery and was the recipient of numerous awards for both leadership and excellence in treating injuries common to sailors and marines. Since beginning with Orthopaedic Specialists of North Carolina, Galland has continued to treat injured athletes. He currently serves as a team physician and orthopaedic consultant to the Carolina Mudcats, the High-A affiliate of the Cleveland Indians Major League Baseball team, and as medical director and orthopaedic consultant to the Louisburg College athletic program. He also serves as the team physician and orthopaedic consultant to several local high schools, as well as on the board of directors for the Trentini Foundation, a nonprofit scholarship organization. For more information, visit http://www.orthonc.com or http://drmarkgalland.com.

Jordan Smith
MMI Public Relations
(919) 233-6600




Posted in Around the office, News Releases | No Comments »

What you eat and how you exercise can prevent foot and joint pain

Written by admin on June 18, 2013 – 5:44 pm -

Joint pain is the most common complaint for the patients visiting an orthopedic surgeon. Many common causes of pain can be managed with a few easy and inexpensive strategies. Here is some simple advice to help you maintain a healthy, pain-free lifestyle.

•change your shoes when showing signs of wear
•obtain custom shoe inserts to correct flat-footedness or collapsed arches
•regularly engage in a low-impact, cardiovascular fitness regimen
•allow sufficient time to recover following a period of intense exercise

•engage in excessive, high-impact exercise when you are in pain
•forget to stretch
•exercise at a higher intensity than you are used to
•eat too many highly-processed foods or beverages


Do change your shoes when showing signs of wear:
A great deal of technology and research goes into the construction of today’s athletic footwear, and this has led to improved comfort and stability for active people. For best results, opt for a professional fitting to find the right shoe for your foot and for the activity in which you will engage. When your shoes show signs of wear, your feet and arches will not receive the cushioning and support that are necessary to prevent joint pain. Change your shoes frequently, especially when they are showing signs of wear.

Do obtain custom shoe inserts to correct flat-footedness or collapsed arches:
Shoe inserts redistribute weight and relieve pressure on sensitive areas of the feet, and can reduce the stress on the lower body, correct an improper gait, and compensate for structural abnormalities, which may also prevent or alleviate knee, hip, and lower back pain. Pick up some shoe inserts at your local store or speak with your physician about getting custom shoe inserts to help you correct flat-footedness or collapsed arches.

Do regularly engage in a low-impact, cardiovascular fitness regimen:
Joint stiffness and pain are often caused or exacerbated by inactivity. By keeping the muscles and joints active, you can lessen the incidence of pain. Regular exercise also strengthens the muscle groups surrounding the joints, providing support that can reduce the likelihood of injury.

Do allow sufficient time to recover following a period of intense exercise:
Rest is important following activity to enable the tissues comprising the muscles and joints to regenerate, and to allow any minor swelling to dissipate. Not resting properly between workouts may intensify any pain you may experience and contribute to further injury.


Do not engage in excessive, high-impact exercise when you are in pain:
The basis of a conservative approach to pain treatment is rest. When pain occurs, suspend activity for a couple of days and consider over-the-counter, anti-inflammatory medication. Resume activity gradually and stop as soon as any pain returns.

Do not forget to stretch:
Muscles that have not been properly warmed up and stretched are much more prone to injury and pain from exertion. To be sure that you prevent injury, even if you are just going for a walk, make sure that you stretch and warm-up sufficiently before and after your activities.

Do not exercise at a higher intensity than you are used to:
It is not wise to begin from a state of relative inactivity to participating in an event such as a 5K run or an hours-long bike ride. The inflammation and pain that can result from such an immoderate activity can last several days and can lead to injury. It is important to train properly for such events.

Do not eat too many highly-processed foods or beverages:
A growing body of evidence suggests that processed wheat flours and sugars contribute to the incidence of musculoskeletal pain. The best diet for preventing joint pain is one that is balanced and includes sufficient protein, and fresh fruits and vegetables.


Always consult your physician if you have questions about preventing joint pain. Sore joints can have a significant negative effect on your life and prevent you from doing the things you love. Maintaining healthy joints is a tough task, but your physician can provide you with helpful advice that will keep your joints in great shape.

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Posted in Foot & Ankle, Health and Fitness, Injury Prevention | No Comments »

Prevention of Anterior Cruciate Ligament Injury in Athletes

Written by admin on June 9, 2013 – 7:16 pm -

A Review
Thomas Trojian, MD, Lindsay DiStefano, PhD, ATCDisclosures

Clin J Sport Med. 2013;23(2):120-121.

Abstract and Introduction

Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769–776.

Objective: To investigate whether anterior cruciate ligament (ACL) prevention programs reduce risk of injury in athletes, and which prevention program is most effective, by means of a review of the literature and meta-analysis of the results.

Data Sources: PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched online using the terms anterior cruciate ligament, knee, injury, prevention, and control. The reference lists of relevant studies were searched for further trials.

Study Selection: Prospective controlled studies of humans, in any language, that reported on proprioceptive neuromuscular training techniques for ACL injury prevention compared with usual training programs were selected if they reported clinical outcomes and had an attrition rate of <20%. Three independent reviewers selected the studies and resolved differences by consensus. After duplicates were eliminated, the search identified 723 reports. Eight studies met the selection criteria.

Data Extraction: Details of the study design, participant characteristics, the intervention, the number of ACL injuries at follow-up, the duration of follow-up, and the sport played were extracted. Study quality was scored 0 to 3, according to use of randomization and blinding and adequacy of follow-up of participants. Pooled risk ratios (RRs) were calculated in random-effects models.

Main Results: Participants in the studies were predominantly women or girls who played soccer, basketball, or volleyball. The interventions included proprioceptive neuromuscular training and agility skills as well as strength, flexibility, and cardiovascular training, done either preseason or for 30 days to 12 weeks during the season. With 1 exception, the results of the interventions were positive, with the number needed to treat to prevent 1 ACL injury varying from 5 to 187 in those 7 studies. The pooled RR favoring the interventions was 0.38 (95% confidence interval [CI], 0.20–0.72). This included 34 ACL injuries among the 3905 intervention participants and 181 ACL injuries among the 6703 control participants. The pooled RR among female athletes was 0.48 (95% CI, 0.26–0.89) and among male athletes was 0.15 (95% CI, 0.08–0.28). The mean quality score for the studies was poor (mean, 1 point; 95% CI, 0.43–1.57 points). No variable such as type of intervention, timing of the program, or length of the program was clearly related to effectiveness.

Conclusions: Neuromuscular-focused exercise training programs to prevent ACL injuries were effective among both female and male athletes. Despite the poor methodological quality of the studies, the results were consistent.

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Posted in Knee, Sports Medicine | No Comments »

New Study Reveals the Obese More Likely to Require Knee Replacement

Written by admin on June 6, 2013 – 7:10 pm -

BMC Musculoskeletal Disorders
Obesity and Increased Burden of Hip and Knee Joint Disease in Australia
Results From a National Survey
Ilana N Ackerman, Richard H OsborneDisclosures
BMC Musculoskelet Disord. 2012;13(254)


Background Research involving more representative samples is needed to extend our understanding of the broader impact of obesity in hip or knee joint disease (arthritis and OA) beyond clinical settings. Although population-based research has been conducted in the United States, how these findings translate to other countries is unclear. Using a national approach, this study explored associations between obesity and the burden of hip and knee joint disease in Australia (in terms of prevalence, pain, stiffness, function, Health-Related Quality of Life (HRQoL) and disease severity).


A random sample of 5000 Australians (≥39 years) from the federal electoral roll was invited to complete a mailed questionnaire to identify doctor-diagnosed hip arthritis, hip OA, knee arthritis and knee OA and evaluate the burden of these conditions. Validated questionnaires included the WOMAC Index, Assessment of Quality of Life instrument and Multi-Attribute Prioritisation Tool. Body Mass Index (BMI) was classified into underweight/normal weight (≤24.99 kg/m2), overweight (25–29.99) or obese (≥30). Multiple logistic regression was used to estimate odds of arthritis and OA, with demographic and socioeconomic variables included in the models. Associations between BMI and other variables were investigated using analysis of covariance, with adjustment for age and sex.


Data were available from 1,157 participants (23%). Overweight participants had increased odds of knee arthritis (adjusted OR (AOR) 1.87, 95%CI 1.14–3.07) and knee OA (AOR 2.11, 95%CI 1.07–4.15). Obesity was associated with higher prevalence of hip arthritis (AOR 2.18, 95%CI 1.17–4.06), knee arthritis (AOR 5.47, 95%CI 3.35–8.95) and knee OA (AOR 7.35, 95%CI 3.85–14.02). Of those with arthritis or OA, obese individuals reported more pain (for hip arthritis, hip OA and knee OA), greater stiffness (for hip arthritis, knee arthritis and knee OA), worse function (all diagnoses), lower HRQoL (for hip arthritis and hip OA) and greater disease severity (all diagnoses).


This national study has demonstrated that the odds of arthritis and OA was up to 7 times higher for obese individuals, compared with those classified as underweight/normal weight. Concurrent obesity and joint disease had a marked impact on several key aspects of wellbeing, highlighting the need for public health interventions.


Posted in Health and Fitness, Joint Replacements, Knee | No Comments »

Bone density key to success of hip resurfacing. Osteoporosis need not apply

Written by admin on June 3, 2013 – 8:07 pm -

Histological, Histomorphometric and Microtomographic Analyses of Retrieval Hip Resurfacing Arthroplasty Failed at Different Times
Francesca Salamanna, Milena Fini, Annapaola Parrilli, Matteo Cadossi, Nicolò Nicoli Aldini, Gianluca Giavaresi, Deianira Luciani, Sandro GianniniDisclosures

BMC Musculoskelet Disord. 2013;14(47)

The objective of the study was to examine the characteristics of bone quality and its microarchitecture in retrieved metal-on-metal HR by a specific quantitative histomorphometry and μCT method. The results showed that the morphometric parameters considered were crucial for a good understanding of the mechanical properties of HR and may be of significant and essential importance in the pathogenesis of HR failure particularly in the development of late fractures. Although there are several good reports on the survival rate of HR at mid-term follow up, the biological changes of the femoral head underlying the implant over time should always be considered. It remains to be seen whether other late failures will occur. HR is still a good indication for young and active patients; nevertheless good bone quality remains the crucial element to support the implant at longer follow-up.

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Posted in Health and Fitness, Hip, Joint Replacements | No Comments »