Dr.
Frank Shallenberger’s
Vol. 7, No. 11
The Hidden Cause of Fatigue,
Hypertension, High Cholesterol,
and Diabetes
Anita had a bad problem. She was tired
every day; often to the point of complete
exhaustion. She had been this way for sever-
al years, and now it seemed that there was
no relief in sight.
In this Issue
Q You don’t have to visit the doctor
to find out if you have sleep apnea.
This easy test can tell you in a
matter of minutes........................ p. 2
Q What’s the best way to lose
weight? Low carb, high carb, low fat,
or vegetarian? The answer might
surprise you ................................ p. 4
Q There’s a simple way to avoid
the most deadly forms of
prostate cancer ............................ p. 6
Q Why women with breast cancer
shouldn’t avoid soy — even though
their doctor told them to ............ p. 8
Coming Next Month
• Your risk for this type of cancer has
skyrocketed in recent years — but it’s
easy to prevent. I’ll show you how.
• The secret to great sleep you can get
from your dentist.
November 2008
At first her doctors thought it was just
because of her age. After all, she was 64
years old. And all of her blood tests were nor-
mal. But the problem just kept getting
worse.
After two years of this, Anita had
another complete physical examination,
along with all the standard blood tests. Her
blood pressure was slightly elevated. So were
her blood sugar and cholesterol levels. But
her doctor couldn’t find anything to account
for her fatigue. He was stumped. So he sent
her home with a prescription for a blood
pressure pill, but admitted it wouldn’t help
her feel better.
Then something happened that broke
the case apart. She passed out. She was just
standing in the kitchen when she suddenly
and without warning passed out. Her hus-
band immediately called the paramedics.
In the emergency room, a very astute
emergency room doctor told her that he
knew what had been causing not only her
fatigue, but also her elevated blood pressure,
cholesterol, and blood sugar. He thought she
had sleep apnea.
Now Anita was not typical of most peo-
ple with sleep apnea. She wasn’t overweight,
and she didn’t snore. But the emergency doc-
tor insisted that her symptoms indicated
sleep apnea.
The Most Common Kind
Because it is so common, you probably
know a lot about sleep apnea already. More
than four million Americans have it. People
with sleep apnea literally stop breathing
during their sleep. This may happen as
many as hundreds of times during a single
night. And each episode may be as long as a
minute or even longer.
There are three different forms of sleep
apnea: obstructive sleep apnea (OSA), cen-
tral sleep apnea (CSA), and complex sleep
apnea. Complex is a combination of central
and obstructive. OSA is the most common
Do You Have Sleep Apnea?
The symptoms of sleep apnea are many.
They include fatigue, forgetfulness, intellectu-
al impairment, depression, headaches, morn-
ing dry mouth or sore throat, drowsiness dur-
ing the day, falling asleep inappropriately,
impotence and decreased libido, gastro-
esophageal reflux, carbohydrate craving, and
constant hunger. Sleep apnea can cause all of
these conditions.
Sleep apnea can also cause serious
health problems and disease. It can cause car-
diovascular disease, strokes, high blood pres-
sure, heart failure, diabetes, metabolic syn-
drome, and weight gain. If you have any of
these symptoms or conditions, you may have
sleep apnea. You can also use the Epworth
Sleepiness Scale to determine the likelihood
of having sleep apnea.
The Epworth Sleepiness Scale
Use this “chance of dozing” scoring sys-
tem to see if you have sleep apnea. Simply
choose the most appropriate number for each
of the following situations:
0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
REF: Johns, Murray W. (1991). “A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.” Sleep 1991 (14):
540-5.
—2—
kind. Statistics show that it accounts for
about 84% of all cases.
In OSA, the reason that breathing
stops is that the airflow through the upper
airway becomes obstructed or blocked.
CSA is completely different than OSA.
There is no obstruction. It’s simply a prob-
lem with how the brain controls breathing
during sleep. The brain does not respond
normally to changes in your blood levels of
oxygen and carbon dioxide. It is often the
result of taking alcohol, sedatives, or sleep-
ing pills before bed. It can also be caused by
other medications, especially the combined
effect of several different medications. And
Situations
• Sitting and reading
• Watching TV
• Sitting inactive in a public place
(e.g. a theater or a meeting)
• As a passenger in a car for an hour
without a break
• Lying down to rest in the afternoon
when circumstances permit
• Sitting and talking to someone
• Sitting quietly after a lunch without
alcohol
• In a car, while stopped for a few
minutes in traffic.
To check your sleepiness score, total the
points.
If you score less than 6, congratulations,
you are getting enough sleep.
If your score is between 7-8, this is the
average response.
A score of 9-12 is borderline.
However, if your score is greater than
12, you have an 80% chance of having sleep
apnea, and you should ask your doctor for
further testing.
lastly, it can be a side effect of a serious ill-
ness, such as encephalitis or a neurodegen-
erative illness like Parkinson's.
A Deadly Condition
Whether you have OSA or CSA (or
both) the final result is the same – the brain
is starved of oxygen during sleep. But most
people don’t realize just how damaging that
is. When the brain doesn’t get enough oxy-
gen, it is not able to enter into the deeper,
restorative stages of sleep that are so impor-
tant for health.
Additionally, many studies indicate that
each apneic event causes a “fight or flight”
reaction in the body. This causes harmful
hormonal imbalances, such as excessive cor-
tisol production. Those changes, coupled
with the low oxygen saturation level of the
blood, can cause significant damage – even
disease – to the body over time.
A Better Test – And It’s Free!
Most data you’ll read about CSA say it’s
rare, less than one out of every 200 cases of
sleep apnea. But I think that’s mostly because
it’s under-diagnosed. Under-diagnosed for
two reasons.
First, because doctors and patients usu-
ally don’t think of it. Everyone knows about
the symptoms associated with OSA, such as
weight gain and snoring. But CSA can occur
without these symptoms.
Second, many doctors think that the
only way to accurately diagnose sleep apnea
is in an overnight sleep lab. Overnight sleep
labs are very expensive, often costing from
$4,500-$6,000 per test. So many doctors
won’t recommend them.
There’s no doubt that overnight sleep
studies are the most comprehensive evalua-
tion for sleep disorders. But in most cases,
they are not needed. There’s an equally
effective way to diagnose both CSA and OSA
that does not require a night spent in a
sleep lab – or the extreme expense. The test
is overnight home oximetry. Researchers
recently documented the effectiveness of
overnight home oximetry.
—3—
In this study, researchers evaluated 68
patients for sleep apnea. All of them had
symptoms of sleep apnea, as well as elevated
Epworth Sleepiness scores. All of their doc-
tors considered them to be “highly likely” to
have sleep apnea. And half of the partici-
pants had this confirmed using an overnight
study in a sleep lab. The other half used
only overnight home oximetry. The
researchers found that overnight home
oximetry is just as accurate and easier to
obtain than a formal sleep lab study.
But the best part about overnight home
oximetry is that most oxygen supply compa-
nies will provide it free of charge! And this
means that doctors can easily screen for
apnea in virtually everyone they suspect of
having the problem. I have been able to
diagnose all three kinds of sleep apnea many
times simply with a free overnight home
oximetry. And I believe that CSA would not
be considered so rare if more doctors used
this test.
Overnight home oximetry is so easy to
do. All it involves is wearing a small clip
that fits over the end of one of your fingers.
You put it on before you go to sleep and take
it off the next morning. A small wire con-
nects it to a measuring device known as an
oximeter. The system continually monitors
and records the level of oxygen in your tis-
sues during the night. The next morning, it
prints out the minute-by-minute results,
graphed and analyzed. OSA causes intermit-
tent episodes of decreased oxygen levels on
the graph. CSA, on the other hand, shows a
much more continuous pattern. Complex
sleep apnea shows a little of both.
The Wrong Way to Treat
Sleep Apnea
After the emergency room doctor sug-
gested sleep apnea, Anita went to an overnight
sleep lab. Fortunately for her, her insurance
company paid for it. And the test successful-
ly diagnosed CSA.
To treat her CSA, her doctor prescribed
C-PAP. C-PAP stands for “continuous posi-
tive airway pressure.” C-PAP is the most

What’s the Best Way
to Lose Weight?
Let’s say you’re one of the more than 50%
of Americans who is overweight. And let’s say
that you already know that being overweight is
a bad idea. It’s one of the best ways to make
sure you die earlier, and suffer more doing it.
So let’s say that you have finally decided to
lose that weight once and for all. After all, if you
are like the majority of Americans who are over-
weight, you have already lost and regained the
same weight over and over again. But this time
it’s going to be different. This time the National
Institute of Health (NIH) has made it easy for
you. They compared the four major weight loss
programs to see which one worked the best.
commonly prescribed treatment for all
forms of apnea. And that’s unfortunate.
While C-PAP is usually very effective at cor-
recting apnea, many patients consider it
worse than the condition it’s treating. Here
are a few reasons why:
• C-PAP is incredibly awkward.
Imagine having to sleep with an appliance
strapped over your face that’s continuously
shooting pressurized air into your nose.
How well do you think you would sleep?
• The noise from the pump is enough
to wake up even the heartiest sleeper,
including anyone else trying to sleep in the
same room.
• It’s almost impossible to sleep on
Real Cures (ISSN 1062-4163) is published monthly by
Soundview Publishing, LLC. Publisher: Wallis W. Wood;
Editor: Frank Shallenberger, MD. Subscriptions $49 per
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770-399-5617. Real Cures is a newsletter containing gen-
eral comments on health, nutrition, and medicine. Readers
are advised to consult with their own physician before
implementing any health idea they read about, whether
here or in any other publication. Copyright © 2008 by
Soundview Publishing, LLC. All rights reserved.
Unauthorized reproduction of this newsletter or its con-
tents by xerography, facsimile, or any other means is illegal.
—4—
Clinical
Researchers at Stanford University
Medical School assigned 311 overweight women
to follow one of four diets: The Atkins diet (very
low in carbohydrate), The Zone diet (moderately
low in carbohydrate), The Ornish diet (high in
carbohydrate), and the LEARN diet (high in
carbohydrate, low in fat, based on national
guidelines). The women followed the various
diets for one year.
The winner? The Atkins diet. Women on
the Atkins diet lost about twice as much weight
as those on the other diets.
“Well what about their cholesterol levels?”
you might ask. “I bet they went sky high on
that diet because it’s so high in fat and protein.”
Actually, the reverse happened. The lead author
said that blood-fat levels were lower on the
your side. You have to sleep on your back.
And sleeping on the back tends to worsen
most cases of sleep apnea.
• The continuous pressure of air in
the nose and pharynx tends to dry out the
upper airway. This results in a dry, stuffy,
congested nose, which can then lead to
allergies and cause sinus infections.
• It can also cause problems when you
travel or go anywhere that electricity is not
available, like camping.
Overall, even though C-PAP usually
does successfully correct sleep apnea,
patients still feel tired and rundown. So it’s
not surprising that many patients stop
using the device and just accept their symp-
toms. That was certainly the case with Anita.
The Solution
When I first met her, Anita had
stopped using her C-PAP for over six
months. And she still complained of fatigue,
sleepiness, and depression. I performed an
overnight home oximetry, and it was the
worst tracing I had ever seen. It showed
that when she was awake, her oxygen levels
were normal. But when she fell asleep, they
l Pearls
Atkins diet than on any of the other diets.
So is the Atkins diet is the best way to lose
weight? Well, yes, and no.
When you break down the data, you find
that results were different for different people.
Although on average the Atkins diet was the
most effective, some people actually lost more
weight on the other diet programs.
The bottom line is this: For the average
person, the best way to lose weight, and to avoid
regaining it, is to cut back on carbohydrates.
This may very well mean cutting way back —
forever! But for other people with different
genetic make ups, it may be better to use a more
moderate reduction in carbohydrates. It all has
to do with whether or not a person has “fast oxi-
were low 100% of the time! This is a clear
indication of CSA.
So how do you fix CSA? First, always
remember that God designed the body to
heal itself. And most of the time it will do
just that as long as it has all the tools it
needs to do the job, and as long as you
remove any impediments to healing.
With CSA, what might the body need
that it isn’t getting? Here’s an interesting
statistic that might offer a clue.
Approximately one in five people who suffer
from depression also suffer from sleep
apnea, and people with sleep apnea are five
times more likely to become depressed. So
while it’s not clear whether the apnea caus-
es the depression or vice-versa, I decided to
treat Anita’s depression using the amino
acid tyrosine. At the same time. I also start-
ed her on a general program of healthy eat-
ing combined with a vitamin, mineral, and
hormonal supplements.
I then looked for heavy metals because
I know that heavy metal toxicity is very
common. It also can poison the body’s sys-
tem that maintains normal sleep breathing.
Her results came back confirming excessive
levels of both lead and cadmium. So I start-
dizer” or “slow oxidizer” genetics.
I’ll explain all about how to determine the
right diet for permanent weight control, and
how to find out whether you are a fast or slow
oxidizer in a future issue of Real Cures. Until
then, here’s a clue. You know those skinny peo-
ple who can eat all day and never gain a pound?
They’re the fast oxidizer type. Knowing where
you are on the fast-slow oxidizer spectrum
makes it a lot easier to know how you should be
eating for the best possible weight control.
REF: Gardner CD, Kiazand A, Alhassan S, et al. “Comparison of
the Atkins, Zone, Ornish, and LEARN diets for change in weight
and related risk factors among overweight premenopausal
women” Journal of the American Medical Association, 7 March
2007, Volume 297, Pages 969-977.
ed her on weekly intravenous chelation
therapy to pull these out of her body. Now
all of this is very good, but the main thing
the body needs to heal is oxygen.
An Alternative to C-PAP
Several years ago, I discovered that
there was a very effective, inexpensive, safe,
and easy way to treat all three kinds of sleep
apnea. It’s called overnight oxygen per nasal
cannula. A nasal cannula is one of those
under-the-nose oxygen tubes that you see all
the time in the hospital. Unlike the C-PAP
setup, it is lightweight, comfortable, and
allows you to sleep on your side. It also does-
n’t use any pressure, so there are none of
the other complications of C-PAP.
A device that generates oxygen from
room air, called an oxygen concentrator, sup-
plies the oxygen. Oxygen concentrators do
make some noise, but they are much less
noisy than C-PAPs. And unlike C-PAPs, you
can position them across the room, reducing
the noise.
The rationale for using overnight oxy-
gen per nasal cannula to treat apnea is obvi-
ous. If your breathing is decreased to the
point that your oxygen levels fall, then
—5—
breathing a higher concentration of oxygen
should raise the levels to normal. And here’s
the best news — it works really well.
I gave Anita about three weeks to get
used to sleeping with the oxygen cannula,
and then rechecked her overnight home
oximetry. Her second tracing came back
completely normal! I knew that we were on
the right track.
When I saw her six weeks later, she
told me that her energy levels were also nor-
mal. She was driving, staying up late, and
pretty much doing whatever she wanted to
do. A repeat check of her lab tests showed
that her blood sugar and her cholesterol were
now in the normal range. She was sleeping
well, and was no longer feeling depressed.
Several months later, I was able to
wean her off of her blood pressure medica-
tion, as it returned to normal.
So don’t assume that you don’t have
sleep apnea just because you’re not over-
weight and don’t snore. If you’re seriously
fatigued, do the overnight home oximetry.
Most oxygen supply companies will supply
one free of charge. If there’s any chance at
all that you or someone you love might have
sleep apnea, ask your doctor to order one. If
Eliminate Your Risk of the Most
Deadly Forms of Prostate Cancer
You probably already know that testos-
terone causes prostate cancer to grow faster.
In fact, the first treatment doctors use to
fight prostate cancer involves reducing the
body’s testosterone production. And yet
prostate cancer usually progresses despite
testosterone reduction. This points to the
fact that other factors are at work.
One of these factors is surprising. It’s
the female hormone estradiol. And a new
study now shows that estradiol fuels up to
one half of all prostate cancers. That’s more
than testosterone fuels. This information is
vitally important for both the prevention
—6—
it turns out positive, forget C-PAP, and go
straight to using the overnight oxygen per
nasal cannula system.
No matter what kind of sleep apnea
you may have, it’s also important to abstain
from alcohol and tranquilizers, get regular
exercise, and lose any unnecessary weight.
Once this is done, if you primarily have
OSA, the chances are good that you will be
able to stop the oxygen eventually. But for
some, especially those who have a high cen-
tral apnea component, it may be necessary
to use it indefinitely.
But That’s Not All
Although most cases of apnea will
respond completely to overnight oxygen
per nasal cannula, more serious cases of
OSA may not. These cases often require the
use of a plastic dental appliance that fits
in the mouth.
In next month’s issue, I’ll tell you all
about the splint that I use. And I’ll tell you
how to find a doctor or dentist in your area
that can make one for you. Q
REFS: Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and
initial management of obstructive sleep apnea without
polysomnography: a randomized validation study. Ann. Intern.
Med. 146 (3): 157-66.
and the treatment of this common cancer.
In the study, researchers at Weill
Cornell Medical College used a new technol-
ogy to examine prostate cancer tissue. They
studied the prostate cancer tissue from 455
different cases. They discovered that half of
the prostates had special estradiol receptors
on the surface of their cells. The receptors
made these cancers especially sensitive to
estradiol. But there’s more!
They also found that the cases of
prostate cancer that had these receptors
were the most deadly forms. This helps to
explain why prostate cancer is so mild in
some cases, while being so aggressive in
others. It also sheds some light on how to
best prevent and treat this most deadly
form of prostate cancer.
What Every Man Needs to Know
Estradiol is the primary sex hormone
for women. But men also make it. Their
bodies use an enzyme called aromatase to
convert testosterone into estradiol. And as
men get older, the action of this enzyme gets
stronger, causing them to have higher levels
of estradiol. And although estradiol is great
for women, it is no friend to men.
In fact, an increase in estradiol can
cause gynecomastia. With this condition,
older men actually start to develop breast
tissue. It’s also a common cause of many
other problems. These can include the
weight gain, decreased sex drive, impotence,
depression, and muscle weakness that hap-
pens to men as they get older.
No one knows for sure why the estradi-
ol increases as men age. But we do know
that drinking alcohol and gaining weight
can contribute.
No matter what the cause, here’s the
point. As estradiol levels get higher, the risk
for estrogen-stimulated prostate cancer
becomes stronger. This fact leads to three
important considerations that every man
should know about.
First, when it comes to fighting the
threat of prostate cancer, it’s not enough
just to check PSA levels. In addition to
checking PSA, all men over the age of 50
should also have their estradiol levels and
their testosterone levels checked. They
should do this at least every two years.
The most accurate way to do this is
with a saliva specimen. But your doctor can
also use blood levels. A healthy level of
estradiol is less than 1/50th of the testos-
terone level. The lower, the better. If the
ratio is higher than 1/50, there are specific
herbs, as well as medications that will
diminish the effect of aromatase.
One herbal preparation that has
worked for my patients is an extract of the
—7—
passion flower plant called Chrysin. This
extract contains the bioflavonoid 5,7 dihy-
droxyflavone. You can find Chrysin at most
health food stores. The usual dose is 500-
1,000 mg per day.
Another natural preparation is a pro-
prietary Chinese herbal combination that
comes from Chi's Enterprises called
Myomin. The dose is from one to two cap-
sules, taken two to three times a day. You
can reach Chi's at 714-777-1542.
Another way to reduce elevated estra-
diol levels is with a medication called anas-
trozole. It also goes by the trademark name
of Arimidex. The tablets come in 1 mg
strength. The usual dose to reduce estradiol
levels is one half a tablet (½ mg), taken twice
a week. Taken at this dose, this medication is
almost always without any side effects.
The result is a reduction in estradiol,
along with an increase in testosterone.
Next, older men should avoid excessive
alcohol consumption and weight gain. These
are the two most common lifestyle causes of
high estradiol to testosterone ratios.
Man’s Best Friend Is Not a Dog
— It’s Phytoestrogens
Third, as men get older, they should
eat progressively more flaxseeds, soy foods,
hummus (chick peas), and garlic. Why?
Because these foods have the highest levels
of phytoestrogens. Phytoestrogens are a spe-
cial class of molecules in plants. They react
with the estradiol receptors on cells. This
includes the receptors on prostate cells that
cause cancer.
That means phytoestrogens can signifi-
cantly reduce the effects of estradiol on the
prostate. In essence, that’s how you stop
prostate cancer. Simply eat more foods that
are high in phytoestrogens. These include
flaxseed (and other seeds), soy, garlic, and
olive oil. Doing so can prevent up to half of
all prostate cancers. Q
REFS:
http://www.medaus.com/p/337,7996.html
http://ki.se/ki/jsp/polopoly.jsp?d=5607&l=en
 LETTERS TO THE
Q. I’m a breast cancer survivor (estro-
gen receptor positive). My doctor told
me not to eat anything with soy in it.
What do you think of soy? — Betty S.,
via e-mail
Dear Betty,
I’ve heard this advice many times
before, and it is just plain misdirected. I’ve
never seen any evidence that eating soy
contributes to breast cancer in any way. If
your doctor can send me a study that shows
that in women who have a history of breast
cancer those who eat soy have a greater inci-
dence of recurrence, please ask him/her to
do so. I don’t think that study exists. In fact,
there are several population studies that say
just the opposite — that eating soy is protec-
tive against breast cancer.
I think this false alarm comes from
the fact that soy contains phytoestrogens.
Phytoestrogens are molecules that are simi-
lar enough to estrogen to bind to the estro-
gen receptor sites on a cancer cell. And
there’s evidence that when they bind to a
cancer cell, they can cause a weak estrogen
effect. So many doctors assume this means
that soy can promote the growth of cancer
cells with estrogen receptor sites. But this
is not what happens.
When phytoestrogens bind to estrogen
receptor sites, they take up the whole site,
and real estrogen is not able to work. That’s
a good thing. Here’s why:
Postmenopausal women still do make
estrogen. Even though their ovaries aren’t
making estrogen, she is still getting it from
fat cells and from the adrenal glands. So it’s
still there. And it’s all too happy to bind to
breast cancer cells.
But when phytoestrogens use up the
estrogen receptor sites, they block real
estrogen from binding to them. And even
though they have a weak estrogen effect,
they are blocking the much stronger effect
of real estrogen. This is why phytoestrogens
not only don’t stimulate estrogen positive
breast cancer growth, they actually block it.
—8—
EDITOR
The other thing to remember is what I
described in this month’s article on prostate
cancer in men. There are two kinds of estro-
gen receptors, the alpha and the beta. The
alpha receptor stimulates the effects of
estrogen on a cell, while the beta receptor
decreases its effect. Phytoestrogens selec-
tively interact with the beta receptors. This
is a second reason they will decrease, not
increase the effect of estrogen on breast
cancer cells.
Also, don’t forget that soy isn’t the only
food that has phytoestrogens. So do almost
all other beans and vegetables. So there’s no
reason to avoid soy for this reason. In fact,
more is usually better. Please see page 7
for more information on foods that contain
phytoestrogens.
Your GABA question is a big one!
GABA is the brain chemical that acts to
calm us down. Chronic worry and anxiety
tends to deplete GABA. To make matters
worse, because God made us all so different,
many people have naturally low levels of
GABA in the first place. These would be the
people that tend to feel tense and anxious
even when there doesn’t seem to be a signif-
icant cause. GABA supplements can help to
increase GABA levels, and in this way
decrease feelings of anxiety and tension.
Betty, this is a great question, and I will give
you a much more complete answer in an
upcoming issue. It will include how to diag-
nose, who will benefit from GABA supple-
ments, what kinds of supplements work,
and what the correct doses are.
Got a Question?
Do you have a question for Dr.
Shallenberger? If so, please send it (typed
only) to him c/o Soundview Publications,
P.O. Box 8051, Norcross, GA 30091-8051 or
feedback@RealCuresLetter.com. While he
won’t be able to respond personally, he’ll try
to answer as many questions as he can in
these pages.