Tag Archives: cardiovascular disease

The Knock On Niacin – Big Pharma At It Again

Two new reports recently came out that said niacin, vitamin B3, is not effective for the prevention of heart disease or stroke. And, in fact, it might be dangerous. The studies also concluded that it might be so dangerous is shouldn’t be recommended at all. This is not an uncommon response when nutrients are studied, especially ones that reduce the market share for billion dollar statin medications.

Two studies recently published in the New England Journal of Medicine found that while niacin does reduce triglycerides, raise “good” (HDL) cholesterol, and reduce “bad” (LDL) cholesterol, it did not reduce the risk of heart attack or stroke.

Big PharmaI have several problems with the new information that’s been plastered all over the media recently about the recent studies:

Problem #1:

While two studies were performed, the largest of the two was funded by Merck Pharmaceuticals. It had over 25,000 participants while the other study, funded by the NIH, had just over 3,000 people. Merck clearly has an interest in driving down the sales of niacin as it would likely increase the sales of their cholesterol lowering drugs Zocor and Zetia. As an added note, niacin sales have tripled since 2002. Wouldn’t it be a perfect time to get a study that shows it’s dangerous or ineffective?

Problem #2:

These published trials do not reflect the clinical experience of doctors around the country who’ve been recommending niacin for decades. Research and a doctor’s clinical observations are often different. Which one do you believe?

Problem #3:

These trials focused on high-risk patients, almost all of whom were already taking statins and had low LDL levels. Would you see more benefit in clinical trials if these patients had different lipid profiles, or in those who did not already have heart disease? The populations they studied were already being treated intensively. It’s unlikely they were going to benefit by just one more treatment (niacin in this case).  As a matter of fact, in the Merck funded study they clearly state they cannot say whether niacin might be beneficial for patients at even higher risk of having a heart attack or stroke or those with higher LDL levels.

Problem #4:

Statins are particularly ineffective with potentially serious side effects, yet we don’t see reports on the news telling us to stay away from them. This is likely the powerful pull Big Pharma has on media and medicine. A full 98% of people who take statins see no benefit. Zero percent avoid death by taking a statin and only 1.6% avoid a survivable heart attack, and 0.4% are helped by preventing a stroke. Compare that to the side effects where 2% develop diabetes and 10% develop muscle damage as a result of taking that statin and the numbers don’t add up.

I think the real lesson of these studies (both on niacin and ones published on statins) is that inflammation, not necessarily the cholesterol itself, is the problem. If you address those factors, you will live a long, cardiovascular disease-free life.

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Why Your Pants Shouldn’t Fit!

Have you heard about a metric used by health professionals called the waist to hip ratio? It’s a measure of abdominal obesity. Abdominal obesity is strongly associated with an increased risk of type 2 diabetes, cardiovascular disease and death, even after controlling for other factors like overall weight. In the waist to hip ratio, waist circumference and waist size are compared to hip size. Several organizations have defined cut points for abdominal obesity with different cut points for men and women. 

According to the World Health Organization (WHO) the waist circumference should be measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, using a stretch‐resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. Practically, however, the waist is more conveniently measured simply at the smallest circumference of the natural waist, usually just above the belly button, and the hip circumference may likewise be measured at its widest part of the buttocks or hip. The WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.86 for females. In layman’s terms, if your belly is bigger than your butt, you’ve got a problem.

I recently measured my waist to hip ratio. It was about 0.83 – well within the healthy range. Here’s how I found it. My waist measures about 34 inches. My hips measure about 41 inches. If you divide 34 by 41 you get 0.82926 repeating or about 0.83. For reference I’m about 5’11”, 187 pounds and about 18% body fat.

So what the heck does this have to do with my pants?

Everything! It’s a quick, down and dirty way to assess your waist to hip ratio. When I buy pants, the waist NEVER fits. It’s ALWAYS too big. This is a good thing. The reason it’s too big is I have to be able to fit them over my legs and butt. If you talk to anyone who works out or is athletic, they’ll tell you the same thing. If a pair of pants fits on the waist, it’s super tight in the legs and butt. If it fits the butt and legs, the waist is enormous. It’s a good, if not maddening, problem to have. Here’s what I mean:

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

This is what you don’t want:

This man's waist is clearly larger than his hips.

This man’s waist is clearly larger than his hips.

Everyone should have an idea of what their waist to hip ratio is. It’s a simple and easy metric for assessing your general health. Don’t want to take the time to measure it? Fine, how do your pants fit? Are the waists too big but legs and butt just fine? GREAT. Are you having trouble finding pants to fit your waist because when they fit your waist they fall off the rest of you? Uh-oh. Time to make some lifestyle changes and get healthy!

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The Miracle of Magnesium!

Magnesium

Magnesium (Photo credit: Wikipedia)

 

Magnesium is an incredible mineral. It is involved in over 300 reactions in the human body. Magnesium actually accounts for 1% of our body weight so clearly it is important. Most of the magnesium in our bodies is found in our bones and soft tissues. Only about 1% is found in the fluid compartments of the body.

 

What does it do?

 

As stated above, magnesium is critically important in many systems in the body. It is involved in regulating DNA synthesis, energy production, protein synthesis, muscle contraction, and blood sugar regulation. Additionally, it is critical for a process called vascular reactivity. Without vascular reactivity our vessels cannot adapt to changes in the internal environment and that’s the first step to the formation of plaques in the arteries. If this continues, our vessels become blocked and heart attack or stroke is the result. Similarly, magnesium inhibits the formation of clots. If you are low in magnesium, you may easily develop heart disease.

 

Are you low?

 

Symptoms of low magnesium include nausea, vomiting, headache, low appetite, muscle weakness, spasms and tremor, mental confusion or personality changes. Additionally, if severe, balance and gait problems, cardiac arrhythmias, rapid heart rate and seizures may occur.  Poor intake of magnesium has been associated with high blood pressure, diabetes and cardiovascular disease.

 

How to test your levels

 

There are several ways to test for magnesium levels. I will discuss two of them. The first is called serum magnesium. This measures the amount of magnesium in the serum (fluid) part of the blood. Remember, blood is made of two part – fluid (mostly water) and cells. This measurement is not always reflective of total magnesium stores. As a matter of fact, normal serum levels may be present despite severe cellular deficits. So what is one to do? You must check red blood cell (RBC) levels of magnesium. This is also a blood test, but it is far more reflective of your true magnesium status than serum levels are. Essentially this test measures the magnesium that your cells have, not simply what’s in the fluid part of your blood.

 

Sources

 

Magnesium is found in a variety of foods. Below is a list of magnesium-rich foods.

 

  •  Navy beans
  • Pinto beans
  • Garbanzo beans
  • Nuts
  • Spinach
  • Halibut
  • Brown rice

 

Magnesium is very important. If your intake is low, you are putting yourself at risk for heart disease. Consider adding the above foods to your diet or the possibility of a magnesium supplement.

 

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National Nutrition Month

As the first of a two-part infographic series, below are some of the scary, yet changeable, statistics we are facing in this country regarding health. March is National Nutrition Month so it’s a great time to make a change for yourself. Check it out!

We need to make some changes, and quickly!

We need to make some changes, and quickly!

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Genes, Alzheimer’s Disease and Your Choice

PET scan of a human brain with Alzheimer's disease

Image via Wikipedia

New genes have been discovered that seem to be linked to Alzheimer’s Disease (AD).  AD currently affects over 5 million Americans and that number is expected to increase substantially by the year 2029.

This year the first baby boomers will reach their 65th birthdays. By 2029, all baby boomers will be at least 65 years old.  Ninety-five percent of all AD is in people 65 and older.

The discovery of new genes linked to AD is a step in the right direction.  Every bit of information that help scientists unlock the mystery of why this occurs puts us closer to being able to effectively treat AD.

Let’s pretend that we know every gene that is involved in the production of AD.  Let’s also pretend a test that exists to specifically detect all of these genes in you.  Would you want to find out?  What would you do if you had all of the genes linked to AD?

The truth of it is, there is nothing you could do to change your genes.  Your genes are your genes.  They are there and you can’t remove them.  What you can do, however, is change how they are expressed.  Just because a person has a specific gene does not mean it has to be expressed.  The expression of many of our genes is closely related to our environment.  Diet, exercise, smoking, pollution and stress are just a few things that can negatively or positively affect the expression of our genes.

So back to my first question.  What would you do if you had all the genes linked to AD?  You can’t change your genes, but you can change your risk factors.

There are many known risk factor that increase the risk of AD, independent of your genetic potential.  The number one risk is aging.  Unfortunately, there isn’t much that can be done about that.  We are all going to get older which is not necessarily a bad thing.  It is much better than the alternative!

Known risk factors for AD that are controllable are as follows:

You will notice that these risk factors significantly overlap with one another.  You will also notice that when you control one risk factor you will impact another.  If you can control these risk factors in your life you will significantly reduce your risk of developing AD regardless of your genetic potential.
Cardiovascular health is perhaps the most important.  Cardiovascular disease causes a chronic, low grade reduction in blood delivery to the brain.  This is known as hypoperfusion.  This hypoperfusion is responsible for protein synthesis defects that later result in the classic AD neurodegenerative lesions.

To keep your cardiovascular system as healthy as possible make sure you eat an anti-inflammatory diet and exercise.  Fish oil is also something you should consider.  Fish oil, which contains omega-3 fatty acids, has been shown to reduce cardiovascular disease mortality better than any other substance known.

Reduction of high blood pressure is also very important.  When blood pressure is too high it fuels a kind of scarring linked to later development of Alzheimer’s disease and other dementias.  Controlling your blood pressure is actually very simple.  You must maintain a healthy weight first and foremost.  This, of course, means diet and exercise.  Increasing waistlines mean more tissue and blood vessels for your heart to push blood through. This puts a strain on the heart and increases the resistance the heart must push against.

Keeping a healthy cholesterol profile is essential.  However, the traditional tests from your doctor are probably not enough to tell whether you are at risk or not.  Traditional tests examine total cholesterol, HDL (“good”), LDL (“bad”) and triglycerides.  These are of some value, but they don’t tell the whole story.  What you must find out is the particle size.  In a nut shell, large and buoyant molecules of cholesterol are not as problematic as small and dense particles.  Your traditional test does not distinguish between the two.  Your traditional test might look very good, but a more advanced test may show that you are still very much at risk.  See my blog entry from last summer for more detailed information.

Diabetes is also extremely important to control.  Some references are referring to Alzheimer’s as Type III diabetes because of the biochemical similarities. Even being borderline diabetic raises the risk of developing Alzheimer’s or dementia by 70%!  Diabetes’ hallmark is high blood sugar.  This high blood sugar leads to a phenomenon called advanced glycation end products or AGEs.  AGEs adversely affect the structure and function of proteins. In combination with oxidative stress brain function is easily affected.  Advanced glycation end products have been found to be much more prevalent in the brains of Alzheimer’s patients than in healthy controls. This process begins early on in the course of Alzheimer’s and there is also evidence that AGEs assist in the formation of plaques seen in AD.  Diet and exercise are the best ways to prevent diabetes and reduce your risk of AD.

While the study for a purely genetic link to AD will continue, a cure is likely many years away if one can even be found.  What we can control, however, are our lifestyle choices that activate our genes.  If we choose poorly, we are much more likely to activate unfavorable genes that cause disease.  If we choose wisely, we are more likely to activate genes that are favorable and reduce our risk of further disease.  The choice is yours.  Make the right one.

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6 Blood Tests Everyone Should Ask Their Doctor For

At the Vreeland Clinic we use nutrition and diet to manipulate health.  Our main goal is to improve overall health and help people feel energetic and youthful.  To know if we’ve achieved our goal we rely, in part, on our patients to inform us on how they are feeling.  This is not, however, the only marker we use to “check up” on our patients.  We use a wide variety of blood work to make sure that along with feeling great, our patients are protected from the dangers of aspects of disease that do not always manifest in overt symptoms until it’s too late.

This blood work is a huge part of our practice and today I am going to share with you the blood work that you should be asking for when you go to your doctor.

1. Particle Size Cholesterol Test

Now, cholesterol is an interesting subject.  Knowing the total number is useless.  Knowing the breakdown of the “good” cholesterol (HDL) versus the “bad” (LDL) is a little more revealing but still is far from telling the whole story.  What you need is to find out the particle break down.

Cholesterol testing has historically been used as the standard indicator for cardiovascular disease classified as HDL (good) or LDL (bad). However, it is actually the lipoprotein particles that carry the cholesterol throughout the body, not necessarily the cholesterol within them, that are responsible for key steps in plaque production and the resulting development of cardiovascular disease.

It is the particle size that is important.  Small, dense and hard lipoproteins are dangerous while light and fluffy particles are not quite as worrisome.  We know that just as many people with low cholesterol have heart attacks as people with high cholesterol.  If total cholesterol was a good indicator of heart disease then why do people with “healthy” levels have heart attacks? It’s because your total cholesterol doesn’t tell the whole story.  You must know the particle breakdown to have any real idea about your cardiovascular risk.

Below is a schematic from SpectraCell Laboratories that illustrates why this type of test is important.  They are a national lab that runs these tests and their panel is called an LPP panel.  There are many other companies that can do these tests.  The other lab I am familiar with is Atherotech Diagnostics Lab.  They call their test the VAP panel.  Either test works.  Your doctor can order these tests easily. (Please click the picture to enlarge it).

2. Fibrinogen

Fibrinogen is an important factor in blood clotting and increases in response to tissue inflammation.  Fibrinogen can help predict the risk of heart disease and stroke.  Fibrinogen will not only be high in people with heart disease, but it’s also high in other inflammatory conditions such as rheumatoid arthritis.  High levels of fibrinogen also increase the risk of venous thrombosis (blood clots).  Blood clots are silent killers that are often discovered too late.  This is a simple test that almost all labs are capable of running.  If you take appropriate steps, lowering fibrinogen can lower your risk of many inflammatory diseases.

3. Hemoglobin A1C

Having your fasting blood sugar tested is very valuable, but it’s just a spot shot.  It only tells you what your blood sugar was at the moment your blood was drawn.  And if you followed the instructions, you fasted before that test so your blood sugar is likely as low as it’s going to get.  (Remember with blood sugar, lower is better than higher).  High blood sugar leads to diabetes.  A hemoglobin A1C (or HbA1c) checks your blood sugar control over the last 2-3 months.  A much better check!  High HbA1c is an independent risk factor for heart disease for people with or without diabetes.  Higher HbA1c leads to an increased risk of heart disease and vice versa.  HbA1c is another test that every lab can perform and is easily ordered by any physician.

4. DHEA

Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands and is a precursor to the sex hormones estrogen and testosterone.   Blood levels peak in one’s twenties and decline significantly as we age.  They reach a level of about 20%-30% of one’s youthful peak between the ages of 70 and 80.  Healthy levels of DHEA supports immune function, bone density, mood, libido and a healthy body composition.  This is another easy test to order and almost all labs can perform it.

5. Homocysteine

Homocysteine is formed in the body from the metabolism of the amino acid methionine.  It is inflammatory in nature.  High levels have been associated with an increased risk of heart attack, bone fracture and poor cognitive function.  Other studies have linked high homocysteine to macular degeneration and gall stones.  Some patients, because of a genetic defect in the way they metabolize folic acid, have very high homocysteine.  Lowering this is critical for long term health.  It is easily lowered with activated B12, activated B6 and activated folate.  Homocysteine is easily performed at any lab.

6. C-Reactive Protein

CRP, as it is abbreviated, is another inflammatory enzyme.  CRP is a powerful predictor of systemic inflammation and is a great indicator of risk for heart disease and stroke.  It may predict heart disease years before it becomes problematic.  It identifies at risk populations while they are still healthy.  This truly is a great tool.  A review of epidemiological data shows that CRP was able to predict heart attack, stroke, peripheral artery disease and sudden cardiac death in healthy individuals with no history of cardiovascular disease.  Again, this is a simple test and can easily be ordered by your doctor.

This list is by no means comprehensive, but it’s a good start.  Each individual person may require more testing depending on their specific condition.  These are, however, a great way to evaluate your overall health and predict disease that might await you years down the road.  Once you have found your specific risk factors appropriate steps can be taken to avoid the consequences in your later years.

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5 Natural Ways to Lower Cholesterol

In my clinic people come to see me for all kinds of reasons.  One of the reasons people often see me is because they have high cholesterol.  High cholesterol has been linked to heart disease and is seen as one of the main causes of preventable death in this country.

This theory that high cholesterol actually causes heart disease by itself has many holes in it.  However, the pharmaceutical companies would like you to believe that if you lower your cholesterol you will significantly reduce your risk of having a heart attack or a stroke.  The evidence does not support this statement.

Cholesterol is not an independent risk factor for heart disease.  So what does that mean?  It means that high cholesterol alone is not enough to cause heart disease.  There are many other factors that must be present in order for heart disease to occur.  The main risk factor is inflammation.  This inflammation can be measured in a simple blood test.  The tests you should request from your doctor are called hs-CRP and homocysteine.  Both of these are inflammatory markers and they give a good indication of your risk factor for a future cardiovascular event or heart attack/stroke.

The theory that high cholesterol alone causes heart disease is flawed.  For example, there are large populations of people that have very high cholesterol and heart disease is almost nonexistent in their culture.  The Eskimo tribes of the Arctic are great examples of this.  Also, research shows that 50% of people that have heart attacks have cholesterol that is considered too high (>200 mg/dl).  That means that the other 50% have cholesterol numbers that are within the normal ranges!

With that said, cholesterol does increase your risk for heart disease in the presence of other risk factors like inflammation.  It does not make sense to lower cholesterol alone and expect to be protected from heart disease.  It does make sense, however, to work on those levels in conjunction with reducing your other risk factors.  Today I will tell you of the best natural ways that you can lower your cholesterol.

For a quick reference here are the current medical guidelines for cholesterol.

  • Total cholesterol: Less than 200 milligrams per deciliter
  • LDL (“bad”) cholesterol: Less than 100 milligrams per deciliter
  • HDL (“good”) cholesterol: 40 milligrams per deciliter or higher (the higher the better!)
  • Triglycerides: Less than 150 milligrams per deciliter

The Best Natural Ways to Lower Cholesterol

1. Low Carbohydrate Diet

In my opinion everything should start with diet.  Study after study has confirmed that eating a low carbohydrate diet is much more effective in the short term and long term in managing cholesterol levels.  It sounds counter intuitive that eating a diet that is higher in fat reduces cholesterol levels but the data is there.  The mantra that eating fat raises cholesterol levels does not hold true.  It is actually the sugar (carbohydrate) that causes cholesterol levels and triglyceride levels to sky rocket.  I routinely put my patients on low carbohydrate diets to reduce cholesterol and have yet to see it fail.  The only problem is that sometimes their cholesterol levels become too low!  Low cholesterol is just as problematic as high cholesterol.

2. Exercise

This one might be a no-brainer, but it must be incorporated.  Exercise has many benefits, but specifically it is known to raise the HDLs and lower the LDLs.  It also improves heart muscle function, mood, cognitive performance, bone strength and many other factors associated with overall wellness.  I can’t stress exercise enough.

3. Plant Sterols

Also known as phytosterols, these naturally occurring substances are found in high amounts in vegetable oils.  They are mostly undigested and act by inhibiting your absorption of cholesterol in the following way – they prevent cholesterol from being emulsified in the gastrointestinal track.  When fats, like cholesterol, are not emulsified the body cannot absorb them.  Because plant sterols are not absorbed, they have very little, if any, side effect.  They work wonders for people with high cholesterol.  My advice would be not to purchase these over the counter.  In speaking with some nutrition companies I have found that these are rather difficult to put into supplement form so buying them over the counter from a discount brand is unlikely to produce the results you are looking for.  Purchase them from a doctor trained in functional medicine and who works with a reputable nutrition company.  They may be slightly more expensive, but you get what you pay for.  Here is a link to my website and the companies that I use.

4. Niacin

Niacin, or vitamin B3, is another great natural way to lower cholesterol numbers.  It is found in red meat, chicken, turkey and beans among other things.  It is extremely safe with the only side effect being a temporary flushing effect in the skin shortly after taking it.  This can be avoided by purchasing a non-flush niacin.  It has been shown to reduce LDL (bad) cholesterol and increase the HDL (good) cholesterol.  Doses are different for everyone and can range from 500 to 5,000 mg per day taken one to two times per day.  It has been shown to reduce heart attacks by 27% and stroke by 26%.

5. Fish Oil

Fish oil is great for a lot of things.  While it does not directly impact total cholesterol levels, it does reduce triglyceride levels in the blood and raise the HDL level.  Triglyceride is a measure fat in the blood.  It usually has implications on total cholesterol levels.  Fish oil is so effective it has been made into a drug by GlaxoSmithKline called Lovaza.  It is ridiculously expensive at $175 for a one month supply.  (Read my blog about it here.)  The dose offered from Lovaza is also much too low at 1 gram per day.  An effective dose is about 4-6 grams per day.  You should also buy this through a reputable nutrition company as many cheap brands contain mercury, PCBs and other toxins.  (Read my blog about that here.) A one month supply of a quality fish oil will probably cost between $25-$35 depending on how much you need to take.  Much better than $175!

Lowering cholesterol by itself is not a full proof plan for protection against heart disease.  It must be part of a total approach because high cholesterol by itself is not dangerous.  However, it is useful if you lower your other risk factors. My advice to my patients is not to rely solely on a pill if you want to reach your goal.  You must change your diet as well.  Low carb, as mentioned above, is the way to go.  If you combine the best of these two approaches you should be able to hit your target cholesterol in no time.

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