Cardiovascular Disease

  • 10 Tips for Preventing Heart Disease

    10 Tips for Preventing Heart Disease Elson M Haas, MD

    Cardiovascular disease (CVD) is the most common interference with healthy aging and long life in the modern world. Here are a number of proactive ideas and tips to help you prevent the problems associated with heart disease. The triad of primary risk factors is smoking (nicotine addiction), high blood pressure, and high cholesterol. Even if your parents had high cholesterol or early heart disease, you can override, or at least delay, these influences with a proactive, healthy lifestyle.

    There is a cholesterol controversy between integrative medicine and Western-focused doctors. All believe now that inflammation is the key, and oxidation of cholesterol molecules is really the underlying concern. Most docs believe that statin drugs are the answer to CVD troubles, yet PREVENTION is truly the answer. So, let’s take a look at some ideas and actions for preventing these common problems.

    1. Maintain your ideal weight as closely as possible. If you smoke, do everything in your power to stop.

    2. Minimize your intake of saturated animal fats, especially excessive dairy products, as they seem to raise cholesterol more than other foods. Also avoid hydrogenated oils that clog and stress the cardiovascular system. All of these fats increase both total cholesterol and the harmful form of cholesterol (LDL), especially when oxidized.

    3. Minimize your intake of high-calorie, low-nutrient foods like baked goods, chips, boxed sugared cereals, and other processed foods, as well as the salty snacks from chips to cured meats. These foods contribute to obesity, a leading risk factor for CVD. Avoiding chemical exposure as much as possible will lessen the irritation/inflammation of the blood vessels, believed to be the main starting point of plaque formation and arteriosclerosis of blood vessels, the beginning of cardiovascular disease.

    4. Exercise regularly with a balanced program that includes stretching for flexibility, aerobics for endurance, and weight training for strength. This can help to lower body weight, blood pressure, and cholesterol. Exercise also lowers your harmful cholesterol (LDL) and raises your good cholesterol (HDL). And exercise makes your body, mind, and heart happy.

    5. Eat more high-fiber, high-nutrient, lower-calorie foods, such as vegetables, whole grains, legumes, and fruits. This diet can help you to live longer.

    6. Get good-quality oils by eating nuts and seeds (ideally raw, unsalted, and organic), such as almonds, walnuts, sunflower seeds and pumpkin seeds, as well as omega-3 oily fishes that include salmon and sardines (good with green salads). Use olive oil as your main vegetable and cooking oil.

    7. Nutritional supplements to consider for protection against cardiovascular disease include: antioxidant vitamins C and E, omega-3 fatty acids, and the B vitamins (especially B-6, B-12, B-3, and folic acid) to maintain normal cholesterol metabolism and minimize homocysteine levels.

    8. Special nutrients that can be helpful in preventing and treating early disease include L-carnitine, Co-enzyme Q-10, chromium, and higher levels of niacin, mainly the regular flushing niacin as this may work better to metabolize blood fats, although many people use the non-flushing (but not time-released) inositol hexanicotinate.

    9. Learn to manage your stress, let go of anger and frustrations, and communicate your feelings in a safe and non-aggressive way. Practice forgiveness and moving forward in life, still being aware of what you have learned from your life experiences (to avoid repeating mistakes in behavior).

    10. Develop close personal relationships that you can count on for support. Continue to expand your ability to give and receive in your friendships/loving relationships. Love is healing at many levels.

  • A Natural Approach to Cholesterol Reduction & Heart Health

    Heart and blood vessel (cardiovascular) disease is the number one killer of Americans, and study after study points to elevated cholesterol as a major contributor to the problem. Some authorities have indicated that for every one-percentage point that cholesterol levels are reduced, the risk for cardiovascular disease is reduced by two points. In addition, most people with diabetes have increased risk for heart disease and stroke, due in part to high cholesterol and triglyceride levels, which can result in death. In fact, more than 65 percent of people with diabetes die from heart disease or stroke. By managing diabetes, and blood lipids (cholesterol and triglycerides), however, diabetics can greatly reduce this risk.1

    The current conventional medical treatment is cholesterol- lowering prescription drugs, along with low saturated fat diets. In addition, it makes sense to work with your doctor in trying one or more of the following relatively risk-free dietary supplement approaches as part of your total program for lowering cholesterol and reducing risk of cardiovascular disease.

    Plant Sterols And Stanols
    Plant sterols are natural substances found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils, and other plant sources. Research has demonstrated that taking plant sterols orally significantly reduces total and low-density lipoprotein (LDL) cholesterol levels, but has little or no effect on high-density lipoprotein (HDL) cholesterol levels. LDL is considered to be the “bad cholesterol,” while HDL is considered to be the “good cholesterol.” The way it works is that plant sterols block cholesterol absorption in the intestines, which in turn results in lowered LDL cholesterol in the bloodstream. Plant sterols has been reported to decrease LDL cholesterol levels nine to 20 percent, and usual doses have ranged between 800 mg to six grams per day and given before meals. Plant sterols are typically given in conjunction with a low-fat diet.2,3,4,5,6,7,8,9,10,11 Orally, plant sterols are usually well tolerated. Ezetimibe (Zetia), a medication used to lower cholesterol levels, inhibits intestinal absorption of plant sterols.

    Similar to sterols, plant stanols are natural substances that occur in even smaller quantities in many of the same sources. Like sterols, stanols block the absorption of cholesterol in the intestines. Taking plant stanols orally is effective for reducing total and LDL- cholesterol in about 88 percent of adult patients when used alone or in combination with a low-fat diet or statin drug (drug that inhibits the production of cholesterol in the body).12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27 When used alone it can reduce total and LDL cholesterol levels by 10 to 15 percent. When added to statin drugs, sitostanol reduces total cholesterol and LDL cholesterol by an additional three to 11 percent and seven to 16 percent, respectively. Clinical studies have used from 800 mg to four grams per day.28 Orally, plant stanols seem to be very well tolerated. Plant stanols can reduce absorption and blood levels of beta-carotene, so it should be used at a different time if you are taking beta-carotene supplements.

    Inositol Hexanicotinate High amounts (several grams per day) of niacin lower cholesterol; an effect recognized in the approval of niacin as a prescription medication for high cholesterol.29 At such intakes, however, acute symptoms (flushing, headache, stomachache) may be severe. In an attempt to avoid the side effects of niacin, alternative health practitioners increasingly use inositol hexanicotinate (aka, “no-flush niacin”), recommending 500 to 1,000 mg, taken three times per day, instead of niacin.30,31 This special form of niacin has been reported to lower serum cholesterol but so far has not been found to cause significant toxicity.32

    Omega-3 Fatty Acids From Fish Oil Including fish as a regular part of the diet has been shown to increase HDL cholesterol33 and is linked to a reduced risk of heart disease in the majority of studies.34 One reason that it has this effect is its oils contain the omega-3 fatty acids (O3FA) which appear to protect against heart disease.35 When used supplementally, however, there is contradictory evidence about the effects of fish oil on blood fat levels. Some clinical research shows fish oil supplementation can decrease elevated triglyceride levels, and decrease LDL cholesterol and increase levels of HDL cholesterol.36,37,38 However, other clinical research did not show beneficial effects on cholesterol levels.39 Nevertheless, fish oil from supplements or from dietary sources has been shown to reduce triglyceride levels by 20 to 50 percent. This effect appears to be dose-dependent.40,41,42,43Fish oil preparations providing 465 mg of eicosapentaenoic acid (EPA) and 375 mg of docosahexaenoic acid (DHA) is particularly effective in conjunction with dietary modifications.44

    In addition, research suggests that fish oil supplementation may be superior to the cholesterol-reducing drug rosuvastatin (Crestor®) for patients with heart failure. In a study published in The Lancet,45 researchers gave 1,000 mg of omega-3 fatty acids from fish oil to about 3,500 patients with heart failure, while another 3,500 heart failure patients received a placebo. After four years researchers found that those taking the omega-3 fatty acids had a nine percent relative risk reduction of dying, and an eight percent relative risk reduction for being hospitalized. The researchers concluded their study demonstrated that long-term administration of 1,000 mg daily omega-3 fatty acids effectively reduced all-cause mortality and admissions to hospital for cardiovascular reasons.

    The same researchers conducted a parallel study, giving rosuvastatin to 2,285 heart failure patients, and placebos to 2,289 heart failure patients. After four years researchers found little difference in heart failure rates between those given omega-3 fatty acids and those given rosuvastatin. In comparing the results, the researchers concluded that the omega-3 fatty acids were slightly more effective than rosuvastatin.46

    Dietary Considerations
    I would be remiss if I did not briefly recount the incredibly important role that diet plays in cardiovascular health. Specifically, the Mediterranean diet has extensive patient-oriented outcome data showing a significant risk reduction in mortality rates and in rates of fatal and nonfatal heart attack.47 Strong evidence support Mediterranean dietary patterns, including intake of vegetables and nuts, as protective against coronary heath disease.48


    The Mediterranean Diet

    The Mediterranean diet is based upon the diets of at least 16 countries that border the Mediterranean Sea. Although there are many differences in culture, ethnic background, religion, economy and agricultural production which result in variations in food intake among the population groups, there is still a common Mediterranean dietary pattern which includes:

    • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
    • Olive oil is an important monounsaturated fat source
    • Dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
    • Eggs are consumed zero to four times a week
    • Wine is consumed in low to moderate amounts

    In addition, there is strong evidence for the protective effect of monounsaturated fatty acids and prudent dietary patterns.49 Research clearly demonstrates that the people at low risk for CVD eat lots of vegetables, fruits, beans, whole grains and fish: a prudent diet.

    Those at high risk for CVD eat the typical Western pattern diet loaded with red meat, processed meat, refined grains, sweets and desserts, fried foods and high-fat dairy products.50,51 Furthermore, strong evidence has also shown a clear and harmful relationship between CVD and the intake of trans-fatty acids and foods with a high glycemic index or load.52

    In 2006 the American Heart Association released guidelines that integrate recommendations from a variety of diets into a single plan. The emphasis should be on diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake. A stepwise individualized approach may be a practical way to help reduce your cardiovascular disease risk.53 Visit www.americanheart.org for more information.

    Conclusion
    There are many dietary supplements that may be used as part of your total program for lowering cholesterol and/or otherwise help in reducing risk of cardiovascular disease. Good choices include plant sterols/stanols, inositol hexanicotinate, and omega-3 fatty acids from fish oils. In addition, a healthy dietary program such as the Mediterranean diet should be the first line of defense for reducing the risk of cardiovascular disease.

    References:

    1. Diabetes: Heart Disease and Stroke. American Diabetes Association. Retrieved October 4, 2008 from http://www.diabetes.org/diabetes- heart-disease-stroke.jsp.
    2. Becker M, Staab D, Von Bergmann K. Treatment of severe familial hypercholesterolemia in childhood with sitosterol and sitostanol. J Pediatr 1993;122:292–6.
    3. Oster P, Schlierf G, Heuck CC, et al. [Sitosterol in familial hyperlipoproteinemia type II. A randomized, double-blind, cross-over study]. [Article in German]. Dtsch Med Wochenschr 1976;101:1308–11.
    4. Schlierf G, Oster P, Heuck CC, et al. Sitosterol in juvenile type II hyperlipoproteinemia. Atherosclerosis 1978;30:245–8.
    5. Schwartzkopff W, Jantke HJ. [Dose-effect of beta-sitosterin in type IIa and IIb hypercholesterolemias]. [Article in German]. MMW Munch Med Wochenschr 1978;120:1575–8.
    6. Becker M, Staab D, Von Bergman K. Long-term treatment of severe familial hypercholesterolemia in children: effect of sitosterol and bezafibrate. Pediatrics 1992;89:138–42.
    7. Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334 –43.
    8. Anon. FDA authorizes new coronary heart disease health claim for plant sterol and plant stanol esters. FDA. 2000. Available at: www. fda.gov/bbs/topics/ANSWERS/ANS01033.html.
    9. Lichtenstein AH, Deckelbaum RJ. Stanol/sterol ester-containing foods and blood cholesterol levels: a statement for healthcare professionals from Nutrition Committee, Council on Nutrition, Physical Activity, Metabolism of American Heart Association. Circulation 2001;103:1177–9.
    10. Matvienko OA, Lewis DS, Swanson M, et al. A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 2002;76:57–64.
    11. Neil HA, Meijer GW, Roe LS. Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread. Atherosclerosis 2001;156:329–37.
    12. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterollowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial. Mayo Clin Proc 1999;74:1198–206.
    13. Vuorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterolemia caused by the FH-north karelia mutation. Arterioscler Thromb Vasc Biol 2000;20:500–6.
    14. Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334 –43.
    15. Gylling H, Miettinen TA. Cholesterol reduction by different plant stanol mixtures and with variable fat intake. Metabolism 1999;48:575–80.
    16. Gylling H, Puska P, Vartiainen E, et al. Serum sterols during stanol ester feeding in a mildly hypercholesterolemic population. J Lipid Res 1999;40:593–600.
    17. Gylling H, Radhakrishnan R, Miettinen TA. Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine: women and dietary sitostanol. Circulation 1997;96:4226–31.
    18. Gylling H, Miettinen TA. Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholesterolaemic NIDDM patients before and during sitostanol ester-margarine treatment. Diabetologia 1994;37:773–80.
    19. Gylling H, Miettinen TA. Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res 1996;37:1776–85.
    20. Gylling H, Puska P, Vartiainen E, et al. Retinol, vitamin D, carotenes and alpha-tocopherol in serum of a moderately hypercholesterolemic population consuming sitostanol ester margarine. Am J Cardiol 1999;145:279–85.
    21. Hallikainen MA, Uusitupa MI. Effects of 2 low-fat stanol estercontaining margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. Am J Clin Nutr 1999;69:403–10.
    22. Jones PJ, Ntanios FY, Raeini-Sarjaz M, et al. Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. Am J Clin Nutr 1999;69:1144 –50.
    23. Gylling H, Siimes MA, Miettinen TA. Sitostanol ester margarine in dietary treatment of children with familial hypercholesterolemia. J Lipid Res 1995;36:1807–12.
    24. Miettinen TA, Puska P, Gylling H, et al. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. N Engl J Med 1995;333(20):1308-12.
    25. Vanhanen HT, Kajander J, Lehtovirta H. Serum levels, absorption efficiency, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in hypercholesterolaemic subjects. Clin Sci (Colch) 1994;87:61-7.
    26. Plat J, van Onselen EN, van Heugten MM, Mensink RP. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 2000;54:671–7.
    27. Hallikainen MA, Sarkkinen ES, Gylling H, et al. Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet. Eur J Clin Nutr 2000;54:715–25.
    28. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861–4.
    29. Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177–84.
    30. Head KA. Inositol hexaniacinate: a safer alternative to niacin. Alt Med Rev 1996; 1:176–84.
    31. Murray M. Lipid-lowering drugs vs. Inositol hexaniacinate. Am J Natural Med 1995; 2:9 –12.
    32. Dorner Von G, Fisher FW. Zur Beinflussung der Serumlipide undlipoproteine durch den Hexanicotinsaureester des m-Inositol. Arzneimittel Forschung 1961; 11:110–3.
    33. Santos MJ, Lopez-Jurado M, Llopis J, et al. Influence of dietary supplementation with fish on plasma total cholesterol and lipoprotein cholesterol fractions in patients with coronary heart disease. J Nutr Med 1992;3:107–15.
    34. Kromhout D, Bosschieter EB, Coulander CdL, The inverse relation between fish consumption and 20-year mortality from coronary heart disease. N Engl J Med 1985;312:1205–9.
    35. Albert CM, Manson JE, O’Donnoell C, et al. Fish consumption and the risk of sudden death in the Physicians’ Health Study. Circulation 1996;94 (suppl 1):I-578 [abstract #3382].
    36. Petersen M, Pedersen H, Major-Pedersen A, et al. Effect of fish oil versus corn oil supplementation on LDL and HDL subclasses in type 2 diabetes. Diabetes Care 2002;25:17048.
    37. Chan DC, Watts GF, Barrett PH, et al. Regulatory effects of HMG CoA reductase inhibitor and fish oils on apolipoprotein B-100 kinetics in insulin-resistant obese male subjects with dyslipidemia. Diabetes 2002;51:2377–86.
    38. Friedberg CE, Janssen MJ, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes. A meta-analysis. Diabetes Care 1998;21:494–500.
    39. Balestrieri, G. P., Maffi, V., Sleiman, I., Spandrio, S., Di Stefano, O., Salvi, A., and Scalvini, T. Fish oil supplementation in patients with heterozygous familial hypercholesterolemia. Recenti Prog Med 1996;87(3):102–5.
    40. Roche HM, Gibney MJ. Effect of long-chain n-3 polyunsaturated fatty acids on fasting and postprandial triacylglycerol metabolism. Am J Clin Nutr 2000;71:232S–7S.
    41. Deslypere JP. Influence of supplementation with N-3 fatty acids on different coronary risk factors in men--a placebo controlled study. Verh K Acad Geneeskd Belg 1992;54:189–216.
    42. Simons, L. A., Hickie, J. B., and Balasubramaniam, S. On the effects of dietary n-3 fatty acids (Maxepa) on plasma lipids and lipoproteins in patients with hyperlipidaemia. Atherosclerosis 1985;54(1):75–88.
    43. Nikkila, M. Influence of fish oil on blood lipids in coronary artery disease. Eur J Clin Nutr 1991;45(4):209–13.
    44. Reliant Pharmaceuticals. Omacor package insert. Liberty Corner, NJ; December, 2004.
    45. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebocontrolled trial. Lancet; Published online ahead or print, 31 August 2008, doi:10.1016/S0140-6736(08)61239–8.
    46. Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet; Published online ahead or print, 31 August 2008, doi:10.1016/S0140-6736(08)61240–4.
    47. Walker C, Reamy BV.Diets for cardiovascular disease prevention: what is the evidence? Am Fam Physician 2009;79(7):571–8.
    48. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    49. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    50. Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 2000;72(4):912–921.
    51. Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC, Buring JE. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. Am J Clin Nutr 2000; 72(4):922–928
    52. Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169(7):659–69.
    53. Walker C, Reamy BV.Diets for cardiovascular disease prevention: what is the evidence? Am Fam Physician 2009;79(7):571–8.
  • Aged Garlic Extract For Overweight, Metabolic Syndrome and Heart Disease

    Overweight, often diagnosed as obesity, has become a major health issue in the United States as well as other countries. During the last four decades the prevalence of obesity has been growing at alarming rates, increasing risk factors that constitute the cluster of metabolic syndrome (MS), a condition characterized by, and rise in the risk of a variety of ailments, notably heart disease, stroke, inflammation, diabetes and certain cancers.

    Hallmarks of the metabolic syndrome include abdominal obesity, increased blood pressure, (hypertension), elevated triglycerides and LDL cholesterol, that are harmful lipids, a reduction in plasma high density lipids, HDL cholesterol (the good cholesterol), and insulin resistance, a condition in which the body cannot use its insulin to move sugar into cells for energy, resulting in high blood sugar and diabetes. Studies now show that metabolic syndrome or its components, such as overweight, are associated with increased risk of cardiovascular disease as well as the development and progression of cancers of the breast, endometrium, colorectal, pancreas, liver and kidney.

    Overweight And Health Problems
    Both clinical and experimental studies have established that overweight increases the risk of a variety of detrimental health conditions, including oxidative stress, high blood pressure, high LDL and triglycerides, promoting atherosclerosis, coronary heart disease and stroke. Overweight can harm other aspects of health. It is a major cause of gallstones, can worsen degenerative joint diseases, play a role in cancer and sleep apnea. Lowering weight to a healthy level reduces these risk factors and causes blood to circulate more effectively. Overweight and frank obesity can lead to low-grade inflammation that is associated with the fat tissue that produces and secretes a variety of inflammatory molecules, increasing the risk of CVD and other pathological conditions.

    Adiponectin
    Adiponectin is the most abundant protein secreted by fat tissue into the bloodstream. It is considered a protective protein and has anti inflammatory, anti atherogenic as well as insulin sensitizing properties. Ironically, and contrary to expectations, despite being produced in fat tissue, adiponectin is decreased in obesity and its levels are inversely correlated with the percent of body fat; that is, the fatter the person the lower adiponectin levels. Adiponectin has regulatory functions that help combat risk factors associated with metabolic syndrome, including regulation of metabolic changes that occur in persons with conditions of type 2 diabetes, obesity, and atherosclerosis; adiponectin protective effects include increased insulin sensitivity and a lowering of the risk of cardiovascular disease. In cases of overweight and obesity, where adiponectin is low, an enhancement of adiponectin levels would be of therapeutic value.

    The search to reduce the risk of the adverse effects of metabolic syndrome and overweight discovered garlic (Allium sativum L.). Garlic has been used as a nutrient with beneficial cardiovascular effects. However, fresh garlic is not for everyone, as its beneficial effects are offset by its pungent odor that lingers on breath and skin and its ability to often cause indigestion. An alternative source of garlic that is odorless and rich in antioxidants is the natural supplement Kyolic Aged Garlic Extract (AGE), having a wide range of health effects, that are often more effective than the fresh bulb.

    Kyolic Aged Garlic ExtractTM (AGE)
    Kyolic Aged Garlic Extract (AGE), is an odorless natural garlic supplement, manufactured by Wakunaga of America, from organically grown garlic that has been extracted and aged for 20 months, at room temperature. Rich in water-soluble organosulfur compounds, such as S-allyl cysteine and S mercaprocysteine, that has antioxidant activity; AGE is found, in experimental and clinical studies, to help prevent a wide range of ailments, notably coronary plaque formation and atherosclerosis, thereby reducing the risk of heart disease and stroke. Other health benefits include anti-inflammatory effects, boosting immunity, lowering blood pressure, reducing the risk of certain cancers, notably colorectal cancer, and preventing the toxic effects of radiation and certain drugs, such as acetaminophen, that when taken in high doses can cause liver failure. AGE is highly bioavailability and its wide range of health effects have been proven in clinical and experimental studies, reported in over 700 peer reviewed scientific and medical publications.

    AGE And Adiponectin
    A clinical trial, by D. Gomez-Arbelaez and colleagues, set out to investigate the effects of AGE on adiponectin and metabolic risk factors that constitute the metabolic syndrome. The clinical trial was a double blind, placebo controlled, randomized, crossover study, carried out on a Colombian urban population with metabolic syndrome.

    The Study
    The study selected 46 men and women over 18 years old with a metabolic syndrome diagnosis, a diagnosis based on obesity (waist circumference larger than 90 cm for males and greater than 80 cm for females).

    Other hallmark characteristics included: triglycerides above 150 mg/dL, HDL lower than 40 mg/dL (male) and 50 mg/dL (female), blood pressure higher or equal to 130/85 mmHg, and fasting plasma glucose levels higher than 100 mg/dL. The investigators divided the subjects into two groups of 23, with each group being randomly assigned to ingest either 1.2 g/day of AGE (Kyolic) or placebo; Following 12 weeks of supplementation, treatment was reversed for another 12 weeks; that is, the ones who received AGE now received a placebo and those who were on placebo received AGE. The subjects received AGE or placebo as identical capsules, taken twice day, with breakfast and dinner. All subjects received recommendations for a lifestyle that included a diet lower in fat and sugar and exercise, and an exercise regimen of 30-minutes/day moderate walking. The subjects were followed every four weeks to evaluate clinical endpoints. At the beginning and end of each phase of the study (week 12 and week 24), investigators assessed weight, height, body mass index (BMI), that measures body fat, depending on height and weight, waist and hip circumferences and blood pressure.

    The Findings
    Results from the study showed that AGE intake for 12 weeks increases adiponectin levels. The increase in adiponectin, following AGE, was statistically significant, an important finding, since decreased adiponectin levels (4 µg/mL) are associated with doubling the frequency of coronary heart disease, independent of other cardiovascular risk factors, as well as insulin resistance, diabetes type 2, atherosclerosis and hypertension.

    This first demonstration of AGE enhancement of adiponectin has a wide range of potential results; adiponectin increases cellular glucose uptake by cells and prevents excess blood glucose levels; adiponectin inhibits inflammation and oxidative stress, protecting blood vessels against oxidative damage that can cause cell death. AGE-induced increase in adiponectin would result in AGE influencing the improvement of insulin resistance and increasing sensitivity, thus playing an important role in helping prevent diabetes.

    Another mechanism which can be linked to AGE increasing adiponectin levels and AGE protection against cardiovascular disease, is the regulatory mechanism associated with nitric oxide (NO). Nitric oxide is a regulator of blood pressure and is important in cardiovascular protection. AGE enhances NO production, and NO regulates adiponectin levels, which, as shown above is critical in modulating risk factors in metabolic syndrome.

    AGE Improves Metabolic Parameters In Obese Models
    While AGE, by enhancing the levels of adiponectin helps protect obese individuals against heart disease and other pathological aspects of metabolic syndrome, an experimental study from Korea, by Seo and colleagues studied the effects of AGE in experimental models fed a high fat diet, and made to exercise. AGE proved to have an additive anti-obesity and cardio-protective effect, reducing body fat, lowering cholesterol and triglycerides and reducing inflammation.

    The Bottom Line
    The study by Arbelaez adds to the wide range of important AGE health effects. The clinical study shows for the first time that AGE, added to the diet of overweight men and women with metabolic syndrome (MS), for 12 weeks, increases adiponectin, lowering their risk against heart disease, stroke, insulin resistance, diabetes type 2 and other conditions associated with metabolic syndrome. In addition, the study by Seo et al shows that AGE has anti-obesity properties.

    Putting the two studies together, AGE can reduce body fat and potentially prevent the onset of MS; moreover, in the situation where a person is already overweight or frankly obese and diagnosed with metabolic syndrome, AGE added to the diet can, within a short period of 12 weeks, help protect against the symptoms of MS by increasing adiponectin production.

    References:

    Diego Gomez Arbelaez, Vicente Lahera, Pilar Oubina et al Aged Garlic Extract Improves Adiponectin Levels in Subjects with Metabolic Syndrome: A Double Blind, Placebo Controlled, Randomized, Crossover StudyMediators Inflamm. 2013;2013:285795. doi: 10.1155/2013/285795. Epub 2013 Feb 28.

    Weiss N, Papatheodorou L, Morihara N, Hilge R, Ide N. Aged garlic extract restores nitric oxide bioavailability in cultured human endothelial cells even under conditions of homocysteine elevation. J Ethnopharmacol. 2013;145:162 7.

    Seo DY, Lee S, Figueroa A, Kwak YS, et al. Aged garlic extract enhances exercise mediated improvement of metabolic parameters in high fat diet induced obese rats. Nutr Res Pract. 2012: 6; 513 9. doi: 10.4162/nrp.2012.6.6.513. Epub 2012 Dec 31.

    Ahmadi N, Nabavi V, Hajsadeghi F, et al. Aged garlic extract with supplement is associated with increase in brown adipose,decrease in white adipose tissue and predict lack of progression in coronary atherosclerosis Int J Cardiol. 2013;168:2310-4. doi: 10.1016/j.ijcard.2013.01.182. Epub 2013 Mar 1.

  • BEETing Down Cholesterol Levels

    November 25, 2015, doi: 10.3945/ajcn.115.116244 Am J Clin Nutr ajcn116244

    Dietary nitrate improves vascular function in patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled study.

  • CO-ENZYME Q10 (CoQ10) Prevents and Reverses Disease

    We each have about 60 trillion cells in our bodies and every one of them needs energy in order to perform the important tasks they need to carry out every day. Our body needs nutrients in order to help cells to grow and repair when they become damaged, make biochemical's such as neurotransmitters and hormones, as well as make our immune system strong enough to avoid the development of chronic diseases. Co–enzyme Q10 plays a crucial role in this process as we can see from the following basic benefits of this nutrient.

    • CoQ10 works in the energy centers in our cells called the mitochondria to facilitate the energy production process. Most enzymes play this role as facilitators.
    • CoQ10 acts as an antioxidant to protect the nucleus of the cell and the mitochondria from free radical damage from toxins like pesticides and air pollution.
    • CoQ10 helps in the replacement of old or damaged mitochondria so that our cells can stay healthy for as long as possible.

    CoQ10 for the prevention and reversal of disease

    Some organs in our bodies need more energy than others because they are required to work 24/7: the brain, the heart, the liver and the kidneys are good examples. Other body parts like skin, muscles and bones get a chance to rest and thus need much lower levels of mitochondria and energy. If there is not enough energy being produced for the most important organs then they can become weak and damaged over time. Here are some examples from clinical studies about how CoQ10 has been able to play a key role in the prevention and even the reversal of certain illnesses.

    • In a very famous clinical trial 50 percent of patients with kidney disease were able to be taken off of their dialysis after taking 180 mg of CoQ10 for three months.
    • Several clinical trials have been shown to help patients prevent and even reverse heart disease using CoQ10 as part of a nutritional protocol.
    • Several clinical studies have been able to prove that Parkinson's disease can be significantly slowed down using high doses of CoQ10.

    These, and other similar studies, have proven the ability to reduce the need for surgery, replace or reduce the need for prescription medications as well as reduce the need for expensive medical treatments. Although these studies appear in many medical journals there is still resistance for the use of CoQ10, and other proven nutrients, due to lack of education, influence from the drug industry, and resistance from insurance companies and hospitals.

    It is difficult to achieve therapeutic levels of CoQ10 from food alone because the best sources are red meat and dairy. The Harvard Food Pyramid does not support high amounts of these foods, so the best source for CoQ10 is usually supplementation.

    Doctors like Stephen Sinatra recommend the ubiquinol form as apposed to the ubiquinone form due to its superior absorption. And Life ExtensionMagazine has published an article in their October 2016 issue indicating that selenium is a good partner for CoQ10 because it helps to produce and accumulate more of this impressive nutrient. Perhaps CoQ10 should be part of your nutritional supplement program.

  • February 2017

    Total Health Magazine February 2017

    Dear Readers,

    Welcome to the February 2017 issue of TotalHealth. February is National Heart Month, there are several articles on heart health in this issue.

    In our Studies section this month we report Kyolic Aged Garlic’s Hypertension Benefits Confirmed.

    Dallas Clouatre, PhD, in "Three Pillars Of GI-Tract Health" gives us a look inside at our GI tract. He describes the workings of the this body system, what can go wrong and how we can influence the GI-track to healthy working order. You'll be impressed with how complicated the whole operation is—even without much consideration from us.

    Elson Haas, MD, presents "Self Care And Stress Reduction." Guiding us on a tour by looking at ways to protect our body and heart from the negative effects of stress and to create better health. Beginning with a self-inventory, included is an explanation of the three major areas of stress for most of us and goes on to describe seven types of stress. You'll find this educational and healthful.

    In "Sugar Addiction and Fibromyalgia," Jacob Teitelbaum MD addresses the pitfalls of sugar and its influence on all of us, our heart health and hypertension. Included are suggestions on dealing with "sugar cravings."

    Gloria Gilbère, CDP, DAHom, PhD, shares her recipe for "Salsa Jovan—Nightshade Free." She suggests using it in place of salsa and salad dressing, using it with eggs, on burritos or to accompany chips and vegetables as a dip. It is a healthy and easy to make recipe. Gilbère includes all the health benefits of the ingredients for her natural health recipes.

    Stephen T. Sinatra, MD, FAAC, presents "For A Healthier Heart, Try the Mother Earth Rx." In this article, it's explained—"a well-established, but little known scientific fact that the surface of the Earth contains a subtle, natural, negative electric charge. You may have felt it sometime when walking along the wet sand at the beach and noticed a bit of tingling or warmth in your feet. That's it. You were getting charged up by Mother Earth." Read on for the heart benefits it offers and become familiar with the Mother Earth Rx.

    In "A Healthy Heart At Any Age," Ann Louise Gittleman, PhD, CNS, tells there are over 250 risk factors for heart disease that have been identified. However, you'll be relieved to know that a large number of these factors—including many that are especially dangerous—can be lowered with lifestyle choices and changes. Covered are effects of smoking, obesity, diabetes, and a sedentary lifestyle. Your daily choices have a significant influence on your health.

    Gene Bruno, MS, MHS, RH(AHG), in "Pros and Cons of Coffee and Caffeine" includes the sources of caffeine, how much is in each source and how it can effect various health issues. He also lists contraindications for caffeine intake and reminds those who are sensitive to caffeine to forego it.

    Charles Bens, PhD, in "Lowering Blood Pressure Naturally," defines high blood pressure, lists the causes, includes prevention using nutrition, which foods to favor and which to avoid and suggestions on exercise.

    In Pet Care, Shawn Messonnier, DVM, presents Part 2 of a four part series on cancer, many pet owners are seeking this information for their pets.

    Best in health,

    TWIP The Wellness Imperative People

    Click here to read the full February issue.

    Click here to read the full February issue.

  • Kyolic Aged Garlic Extract helps protect against heart disease

    Garlic, a popular culinary herb, has been used as a medical remedy in traditional medicine, for centuries and confirmed for its protective health benefits in current medical science. The intake of fresh garlic, in amounts needed for its health efficacy is accompanied by side effects of unpleasant odor that lingers on the breath and skin and potential gastrointestinal adverse effects of diarrhea and flatulence. Thus, many shun this important herb and are deprived of its benefits.

    An important and effective alternative was developed by the Wakunaga Company, originally in Japan and now also as Wakunaga of America, in California. The company manufactures Kyolic® Aged Garlic Extract (AGE™), an odorless supplement that has been shown in over 700 peer reviewed scientific and medical publications to have the health benefits of fresh garlic and often even a higher efficacy, without any of the side effects of the fresh bulb.

    While the health benefits of AGE are many, helping protect against cardiovascular disease, neurodegenerative disease, some forms of cancer, and has anti-aging and anti-inflammatory effects, this article will focus on the cardiovascular benefits as proven in research and in the clinic.

    Aged Garlic Extract
    Aged garlic extract is manufactured from organic fresh garlic, by extraction and aging for 20 months at room temperature. The result is a highly bioavailable odor-free supplement, rich in organosulfur compounds, largely water soluble, such as S-allyl Cysteine and S-allyl meractocysteine (unique to AGE), as well as other substances with antioxidant activity, including oil soluble organosulfur compounds, allixin, selenium, saponins and flavonoids. AGE is a supplement with high quality control, standardized by S-ally cysteine, its key compound.

    Risk Factors for Cardiovascular Disease
    Risk factors for cardiovascular disease include oxidative stress, elevated LDL cholesterol and triglycerides, low HDL (the good cholesterol), hypertension and high homocysteine; being overweight also increases risk.

    High LDL cholesterol promotes inflammation in the arteries, causing further accumulation of cholesterol in the arterial walls; this in turn produces more inflammation. Eventually the deposited cholesterol hardens into a plaque, which can rupture and lead to blood clots that cause heart attacks and strokes.

    Oxidant Stress
    Reactive oxygen species and oxidant stress are implicated in cardiovascular diseases. Oxidative damage to DNA, proteins, lipids, and other molecules rank highly as a major cause in the onset and development of these diseases. Reactive oxygen species, including free radicals, that are the cause of oxidant stress, in the absence of enough antioxidants, are byproducts of normal metabolism and increase during infection and inflammation, elevated homocysteine and exposure to exogenous sources, including environmental pollutants, smoking, certain drugs (e.g., acetaminophen), and radiation.

    AGE and Cardiovascular Disease
    AGE, with its antioxidant activities, has been shown to modulate cardiovascular risk factors in both clinical and preclinical settings. AGE has been found to reduce blood pressure, inhibit platelet aggregation and adhesion, lower LDL and elevate HDL cholesterol, reduce smoking-related oxidative damage, inhibit the production of prostaglandins involved in inflammation, and lower homocysteine. S-allyl cysteine has been found to lower cholesterol by deactivating the enzyme involved in cholesterol synthesis (3-hydroxy-3-methylglutaryl-CoA) by as much as 41 percent. AGE efficacy in reducing cholesterol synthesis is additive with statins. Other possible contributors to protection against cardiovascular disease are the effects of AGE in increasing microcirculation and protecting the lining of arteries, (endothelial cells) from oxidative damage, a factor notably important in diabetes, where microvasculature is damaged and the risk of heart disease is high. AGE can also temporarily increase, by 30–40 percent, the synthesis of cellular nitric oxide that helps regulate blood pressure. Major findings have shown that AGE inhibits the progression of coronary-artery calcification, thus reducing the risk of a myocardial infarct.

    Calcification and Heart Disease
    Calcium deposition in the walls of coronary arteries is an active process. Calcification is an early feature of atherosclerotic plaque formation, beginning with fatty-streak formation and continuing throughout the development of the plaque, resulting in a narrowing of the arteries.

    Studies by Dr. Matthew Budoff and colleagues at the University of California (UCLA) have shown repeatedly in a number of placebo-controlled randomized clinical studies, that AGE significantly reduces the progression of plaque formation compared to placebo, as determined by serial coronary artery calcium measurements, as described below. Other findings in patients taking AGE showed improved endothelial function, reduced LDL cholesterol, a lowering of an inflammation marker C reactive protein, and homocysteine and improving HDL cholesterol. The investigators concluded that the study, “helps establish garlic therapy as an anti-atherosclerosis therapy in patients with, and without coronary artery disease.”

    The early one year study by the Budoff group on the role of AGE in plaque progression, was a placebo-controlled, double-blind, randomized pilot study to determine if atherosclerotic plaques, detected by electron beam tomography, will progress at a different rate with the intake of AGE, as compared with a placebo. 19 patients (14 men, five women, mean age of 59.9 ± 10.5 y) completed the study. Subjects received either 1200 mg AGE a day or the equivalent amount of placebo. The patients were on statin therapy and aspirin during the study. The blood marker used for compliance was S-allyl cysteine, the major active compounds in AGE, considered the only reliable human compliance marker in studies on garlic consumption.

    The results of this yearlong study showed that patients taking AGE had an absolute change in the calcium score, (indicating plaque progression) of 45.2 +/-57.2, while the placebo group was 129.0 ± 102.1, significantly greater than the AGE group. All patients in this study were on statin therapy, meaning that the improvement seen by the intake of AGE was additive to the benefit of statin therapy. Plaque progression was at a rate of 22.2 percent per year in the placebo group, while the intake of AGE reduced progression to 7.5 percent. In the most recent study, presented by Dr. Budoff's group at the American College of Cardiology's 64th annual scientific meeting, in May 2015, the investigators pooled four placebo-controlled, double-blind, randomized studies to examine AGE's effect on blood pressure as well as progression of calcification. The studies involved 161 people, randomized to take, daily, either 1000 mg AGE or placebo, for one year. Blood pressure was checked at the beginning and end of the study. Testing was done to examine coronary artery calcification.

    One year later, the UCLA researchers found a reduction in blood pressure in the subjects taking AGE; AGE also inhibited the progression of coronary artery calcification by 1.78 fold, compared with placebo, over the course of the study. The principal investigator, Dr. Matthew Budoff, stated, "these new findings provide cardiologists and internists with an additional tool for patients who are at a high risk of cardiovascular disease. It also gives patients with mild to moderate cardiovascular disease a proactive way to reduce those risk factors."

    Homocysteine
    Elevated homocysteine damages endothelial cells that line blood vessels and induces thrombosis that can lead to heart attacks and stroke. Homocysteine produces breaks in DNA and induces apoptosis, a programmed cell death. Consumption of AGE has been shown to reduce homocysteine levels. In a preclinical study, levels of homocysteine in a 4-week folatedeficient diet containing AGE were compared with a folatefortified diet containing AGE. Plasma homocysteine was 30 percent lower in the folate-deficient models that received AGE, but not in those with adequate folate. The results suggest that AGE may serve as an added treatment in hyperhomocyteinemia. A clinical study, showing that AGE inhibits the progression of coronary artery calcification, also showed a trend in lowering homocysteine levels.

    Age And Inflammation
    Prostaglandins, play a key role in Inflammation, a risk factor in heart disease as well as other pathological conditions, including neurodegenerative disease and cancer. In a study by Rahman and colleagues the role of AGE in modifying prostaglandins was tested in smokers and non smokers. At the start of the trial, the plasma concentration of prostaglandin 8 iso PGF2ƒ¿ was about 58 percent greater in smokers than in nonsmokers. A 14 days supplementation with AGE resulted in a 35 percent reduction in the plasma prostaglandin in smokers, and a 29 percent reduction in non smokers.

    The prostaglandin studied plays a role in cardiovascular disease by increasing the stickiness and adhesion of platelets, thus increasing the risk of plaque formation, constriction of arteries and atherosclerosis; the prostaglandin has been shown to be present in increased amounts in human atherosclerotic vascular tissue compared with healthy tissue. The decrease in 8 iso PGF2ƒ¿ following AGE intake supports earlier findings of AGE decreasing platelet aggregation. This study further confirmed that dietary supplementation with AGE with its powerful antioxidant capabilities, can protect against heart atherosclerosis and heart disease, which are associated with increased oxidative stress and inflammation.

    Bottom line
    Kyolico Aged Garlic Extract (AGE), a natural odorless supplement produced from organically grown fresh garlic, by Wakunaga of America has a wide range of health effects including the ability to lower the risk of heart disease. AGE has been shown in clinical studies to reduce atherosclerotic plaque formation, lower LDL cholesterol and triglycerides, decrease hypertension, prevent platelet aggregation, lower levels of homocysteine, and other inflammatory factors, including a critical prostaglandin. AGE taken daily can help reduce the risk of heart disease that is a major cause of death in our society.

    Endnotes
    1. Varshney R, Budoff MJ. Garlic and Heart Disease. J Nutr. 2016 Jan 13. pii: jn202333. [Epub ahead of print] Review.
    2. Budoff M. Aged garlic extract retards progression of coronary artery calcification. J Nutr. 2006 Mar;136:741S.4S.
    3. Allison GL, Lowe GM, Rahman K. Aged garlic extract inhibits platelet activation by increasing intracellular cAMP and reducing the interaction of GPIIb/IIIa receptor with fibrinogen. Life Sci. 2012 Dec 17;91(25.26):1275.80. doi:10.1016/j.lfs.2012.09.019. Epub 2012 Oct 13.
    4. Dllon SA, Lowe GM, Billington D, Rahman K. Dietary supplementation with aged garlic extract reduces plasma and urine concentrations of 8-iso-prostaglandin F(2 alpha) in smoking and nonsmoking men and women. J Nutr. 2002 Feb;132:168.71.
    5. Ide N, Keller C, Weiss N. Aged garlic extract inhibits homocysteine-induced CD36 expression and foam cell formation in human macrophages. J Nutr. 2006 Mar;136:755S.8S
    6. Borek C. Garlic reduces dementia and heart-disease risk. J Nutr. 2006 Mar;136: 810S.812S.
  • Kyolic Aged Garlic Extract Shown to Reduce Arterial Plaque Buildup and Other Cardiovascular Risk Factors

    FOR IMMEDIATE RELEASE

    LOS ANGELES, Calif. (October 1, 2016) - Kyolic Aged Garlic Extract (AGE) has long been known to offer a bevy of cardiovascular benefits. Now 13 new studies published in The Journal of Nutrition provide credible proof of AGE's capacity for preventing the progression of cardiovascular disease (CVD). The studies, which appeared in the February 2016 issue of the journal, give evidence of AGE's ability to lower blood pressure, regulate cholesterol levels, slow the progression of arterial calcification in people with coronary artery disease, reduce non-calcified plaque buildup in arteries, and inhibit platelet aggregation. What's more, AGE was also found to stimulate a healthy immune response.

  • Macronutrients Part 2 - Carbohydrates and Fiber

    Carbohydrates are the most abundant biomolecules on our planet and in our food supply. They exhibit some of the largest differences in their metabolism by different members of the animal kingdom. At one extreme, herbivores can almost completely break down dietary plant material with the help of beneficial bacteria that dwell within their gastrointestinal tract; at the other extreme, true carnivores can’t process most dietary carbohydrates. Humans fall somewhere in between; we derive a great deal of nutrition out of some dietary carbohydrates, but are unable to process others.

    In our diets, digestible carbohydrates consist of sugars and starches, while the indigestible carbohydrates are the fibers and resistant starches1. Dietary sugars are predominantly monosaccharides (sugars consisting of a single unit, such as glucose and fructose) or disaccharides (sugars consisting of two monosaccharides linked together, such as sucrose and lactose). Starches are long chains (polymers) of many linked monosaccharide molecules, usually glucose.

    Monosaccharides are the preferred form by which sugars are absorbed from the intestines, therefore, starches and disaccharide sugars (sucrose, lactose) must be broken down by digestive enzymes before assimilation. Starches are fairly easily digested by the action of pancreatic enzymes, while disaccharide sugars are degraded by enzymes that dwell on the surface of the small intestines. The familiar lactose maldigestion (“lactose intolerance”) experienced by many individuals actually results from the lack of one of these intestinal enzymes (lactase, the enzyme that breaks down lactose into glucose and galactose).

    Fibers and resistant starches are carbohydrates as well. Like starches, fiber is composed of polymers of linked monosaccharide sugars. Unlike starches, however, fibers and resistant starches are not used as a source of calories; humans lack the necessary enzymes to break down resistant starches and fibers, therefore, they are not absorbed. Some soluble fiber and resistant starch is broken down by intestinal bacteria, the rest passes through the gastrointestinal tract intact.

    The majority of dietary carbohydrates are obtained from plant sources (fruits, vegetables, grains). In contrast to animal tissues, which are held together by mostly proteins, plants cells are held together by cellulose and lignin, two types of dietary fiber. The edible portions of plants are usually those that contain large amounts of storage carbohydrates, such as the kernels of grains (which store starches) or fruits (which store sugars). Smaller amounts of carbohydrates are found in animal products; carbohydrates constitute only about one percent of the mammalian body2.

    ROLES OF DIETARY CARBOHYDRATES AND FIBER IN NORMAL METABOLISM
    Although they do not have the diversity in human metabolism as do proteins, dietary carbohydrates and fibers still have a number of fates:
    Fuel Source and Fuel Storage.

    As versatile as humans are in obtaining energy from a variety of macronutrients, the preferred energy source in our metabolism is the carbohydrate glucose. Under normal conditions, the brain uses glucose as an energy source almost exclusively, and most other tissues rely heavily on it. To accommodate the body’s need for glucose, most sugars and starches can be converted into glucose as they are absorbed and distributed amongst various tissue following a meal. Additionally, some amino acids from digested protein can also be converted into glucose (in true carnivores like cats, this is where most glucose comes from).

    Unlike other cellular energy sources (amino acids and fatty acids), glucose can be converted into energy in the absence of oxygen (anaerobic glycolysis). This makes glucose a critical source of quick energy during times when oxygen is scarce, such as during intense exercise.

    Glucose can also be stored for later usage, in the form of glycogen (“animal starch”). Glycogen is abundant in the liver, which stores about a day’s worth of glucose in order to provide enough energy to fuel the brain during periods between meals. Glycogen is also used to store glucose for use in muscles, which rely on it for quickly generating energy. If the dietary intake of carbohydrates exceeds what is needed for immediate energy and glycogen reserves, then the excess is converted to fat for long-term storage.

    Precursors to other biomolecules. Carbohydrates are used to make other important biomolecules. These include: glycosaminoglycans (such as chondroitin, keratin, and hyaluronic acid), important constituents of joints and connective tissues; nucleic acids (DNA and RNA are partially constructed from the sugar ribose); as well as other amino acids and fatty acids for making new cellular proteins and cell membranes.

    Stimulation of digestion. Fiber, despite its non-nutritive value, still has evolved important roles in human physiology. The bulk of insoluble fibers helps digested food to move more easily through the intestines and be readily eliminated from the body. Soluble fibers and resistant starches can provide a source of energy for intestinal bacteria, which themselves provide a number of health benefits, including the stimulation of immunity, protection from pathogenic bacteria, and enhanced absorption of minerals from the diet. Prebiotics, a subset of soluble fiber, have gained attention in recent years in their ability to be selectively fermented by gut flora for a diversity of potential health-promoting benefits3.

    SPECIFIC HEALTH BENEFITS OF CARBOHYDRATES AND FIBER
    Many of the health benefits realized by modifying carbohydrate intake involve altering patterns of consumption: reducing intake of sugars, and increasing intake of fiber. For example, recent emphasis on increased intake of whole grains (which contain significantly more fiber, phytonutrients, and protein than do refined cereal flours) has resulted from several studies which suggest that its consumption may reduce the risk of certain cancers, diabetes, and cardiovascular disease4. Fiber intake, in particular, has been the subject of thousands of studies in humans and animals, in part for its ability to successfully reduce the risk of several diseases by different mechanisms:

    Reducing Chronic Low-level Inflammation. In contrast to the conspicuous inflammation that is characteristic of an injury or infection, chronic low-level inflammation can progress unnoticed. This potentially silent affliction has been associated with the progression of several diseases, including cancer, diabetes, cardiovascular, and kidney diseases. In an analysis of 7 studies on the relationship between weight loss and inflammation, increased fiber consumption correlated with significantly greater reductions in C-reactive protein (CRP), one indicator of low-level inflammation5. In these studies, daily fiber intakes ranging from 3.3 to 7.8 g/MJ (equivalent to about 27 to 64 g/day for a standard 2000 kcal diet) reduced CRP from 25–54 percent in a dose-dependent fashion. The Women’s Health Initiative Study also found significant inverse relationships with dietary soluble and insoluble fiber (over 24 g/day) and certain markers of chronic inflammation6.

    Promoting Healthy Blood Pressure. It is not clear how dietary fiber reduces blood pressure, but many studies have observed this trend. Fiber, when taken with a meal, may by reducing the glycemic index of foods and lowering the response of insulin following a meal (insulin may play a role in blood pressure regulation). Soluble fibers may also increase mineral absorption (such as calcium, magnesium, and potassium; all important for healthy blood pressure) by feeding intestinal flora, which lowers intestinal pH and establish a favorable acidic environment for mineral absorption7. Whatever the cause, at least thirty randomized, controlled clinical trials examined the effects of fiber in both hypertensive and normotensive patients. Across all participants, increased fiber intake demonstrated modest average reductions in systolic (1.13–1.15 mm Hg), and diastolic (1.26–1.65 mm Hg) blood pressure89. Amongst hypertensive patients, the average blood pressure reductions were much larger: A significant average reduction in both systolic (-5.95 mm Hg) and diastolic (-4.20 mm Hg) blood pressure was observed over 8 weeks in trials where hypertensive participants increased their daily fiber intake9.

    Promoting Healthy Levels of Blood Lipids. High-fiber diets have been associated with lower prevalence of cardiovascular disease (10). When included as part of a low-saturated fat/low cholesterol diet, dietary fiber can lower low-density lipoprotein cholesterol (LDL-C) by 5–10 percent in persons with high cholesterol, and may reduce LDL-C in healthy individuals as well10. Dozens of controlled clinical trials have shown the cholesterol-lowering potential of dietary fibers including soluble oat fiber, psyllium, pectin, guar gum, b-glucans from barley, and chitosan3,12,13.

    Soluble fibers lower cholesterol by several potential mechanisms (3). They may directly bind cholesterol in the gut, preventing its absorption. The high viscosity of soluble fiber and its ability to slow intestinal motility may help to limit cholesterol and fat uptake as well. Fiber can also increase satiety, which can limit overall energy intake14,15. Lowering Uric Acid. Elevated blood uric acid (hyperuricemia) is a risk factor for kidney disease, cardiovascular diseases, and diabetes; it is also a primary cause for gout16. Fiber intake may lower blood uric acid levels. A significant inverse relationship between fiber intake and hyperuricemia risk was established by analyzing dietary fiber intake data from over 9000 otherwise healthy adults participating in the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Based on these data, participants with high fiber diets (over about 19 grams fiber/day for the average 2000 kcal diet) had a 55 percent reduction in hyperuricemia risk compared to those on lower fiber diets (<9.2 g fiber/day)17. While these mechanisms for this reduction is unknown, dietary fiber may reduce the absorption of purines from the diet, one of the inciting factors for hyperuricemia.

    HOW MUCH CARBOHYDRATES AND FIBER SHOULD I BE GETTING?
    The amount and composition of carbohydrates in the “ideal” diet is amongst the most heavily debated topics in nutrition. There are scientifically-substantiated merits to both the “low-carb” and “low-fat, high-carb” diets in terms of reducing disease risk and maintaining a healthy body mass index (these will be discussed in greater detail in a future article). The common ground between the two schools of thought is that the average Western diet probably contains too little fiber, and too much refined grains and added sugar. A low-fiber/high-sugar diet, when coupled with excessive caloric intake, has been associated with significant increases in the risk for a number of ailments, including obesity, insulin resistance/type II diabetes, and cardiovascular disease.

    As mentioned previously, the benefits of dietary fiber are numerous. The average daily fiber intake in the American diet, based on data from 2007–2008 NHANEs survey, is about half of the 28 grams/day recommendation by the Institute of Medicine (IOM). Significant numbers of people consume even less than the national average. The highest intakes of dietary fiber are associated with the lowest disease risks; for several observational studies, the greatest risk reductions required intakes exceeding the IOM recommendations.

    In contrast, the American diet contains no shortage of refined grains or sugars. The U.S. Department of Agriculture estimates average grain consumption at about 33 percent more than 6 oz./day recommended in its Dietary Guidelines for Americans. Most of this grain is refined; the same group estimates Americans consume only one-third of the recommended 3 oz./day of whole grains18,19.

    Analysis of data from the last NHANEs survey (2007–2008) determined that Americans consume an average of 120 grams/day of total sugars (about 30 teaspoons), most of which are added sugars. This amounts to approximately 480 kilocalories of energy per day. Most of these sugars come from sweetened carbonated beverages (~37 percent); other top sources include desserts and fruit drinks (fruitades and fruit punches). While arguments can be made that it is the added fructose or corn syrup are particularly dangerous to health (there is evidence that supports and refutes this hypothesis), or that sugar is additive and contributes to overeating (animal models may support this claim), added sugar clearly contributes a significant amount of calories to the average diet, and in many cases displaces essential nutrients20,21.

    To read the series on Macronutrients:

    References:

    1. Fardet A. New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr Res Rev 2010 Jun.;23(1):65–134.
    2. Engelking L. Textbook of Veterinary Physiological Chemistry. Updated 2nd ed. Burlington, MA: Academic Press; 2011.
    3. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999 Jan.;69(1):30–42.
    4. Higgins JA. Whole grains, legumes, and the subsequent meal effect: implications for blood glucose control and the role of fermentation. J Nutr Metab 2012;2012:829238.
    5. North CJ, Venter CS, Jerling JC. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Eur J Clin Nutr 2009 Aug.;63(8):921–33.
    6. Ma Y, Hébert J, Li W, Bertone-Johnson E. Association between dietary fiber and markers of systemic inflammation in the Women’s Health Initiative Observational Study. Nutrition 2008;
    7. Greger J. Nondigestible carbohydrates and mineral bioavailability. J Nutr 1999.
    8. Streppel MT, Arends LR, van t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005 Jan.;165(2):150–6.
    9. Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J. Hypertens 2005 Mar.;23(3):475–81.
    10. Badimon L, Vilahur G, Padro T. Nutraceuticals and atherosclerosis: human trials. Cardiovasc Ther 2010 Aug.;28(4):202–15.
    11. Anderson J, Randles K. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr 2004.
    12. AbuMweis SS, Jew S, Ames NP. -glucan from barley and its lipid-lowering capacity: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr 2010 Dec.;64(12):1472–80.
    13. Baker WL, Tercius A, Anglade M, White CM, Coleman CI. A meta-analysis evaluating the impact of chitosan on serum lipids in hypercholesterolemic patients. Ann Nutr Metab 2009;55(4):368–74.
    14. Brighenti F, Casiraghi M, Canzi E. Effect of consumption of a ready-to-eat breakfast cereal containing inulin on the intestinal milieu and blood lipids in healthy male volunteers. Eur J Clin Nutr 1999; Pages 726–33.
    15. Li S, Guerin-Deremaux L, Pochat M, Wils D, Reifer C, Miller LE. NUTRIOSE dietary fiber supplementation improves insulin resistance and determinants of metabolic syndrome in overweight men: a double-blind, randomized, placebo-controlled study. Appl Physiol Nutr Metab 2010 Dec.;35(6):773–82.
    16. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum 2011 Oct.;63(10):3136–41.
    17. Sun SZ, Flickinger BD, Williamson-Hughes PS, Empie MW. Lack of association between dietary fructose and hyperuricemia risk in adults. Nutr Metab 2010;7(1):16.
    18. Grotto D, Zied E. The Standard American Diet and its relationship to the health status of Americans. Nutr Clin Pract 2010 Dec.;25(6):603–12.
    19. U. S. Department of Agricuture USDOHAHS. Dietary Guidelines for Americans 2010. 2011 Jan.;:1–112.
    20. Avena NM, Rada P, Hoebel BG. Sugar and fat bingeing have notable differences in addictive-like behavior. Journal of Nutrition 2009 Mar.;139(3):623–8.
    21. Berner LA, Avena NM, Hoebel BG. Bingeing, self-restriction, and increased body weight in rats with limited access to a sweet-fat diet. Obesity (Silver Spring) 2008 Sep.;16(9):1998–2002.

  • Nutritional Needs of Men

    You don’t need to believe that “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As is often observed, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. Women are not only the fairer sex, but when it comes to health, they are in general, also savvier. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. For example, whereas calcium and iron are good for women, these minerals may not be good supplement choices for men.

    For men, the primary health issues today probably are cardiovascular disease and conditions affecting the prostate. Heart disease is the leading cause of death in men and prostate cancer is the seventh. Are matters improving? It is hard to tell. For instance, the incidence rate of prostate cancer went up in the period from 1995 to 2000, although the death rate appeared to have stabilized. Fortunately, the rate of lung cancer continues to decline. As for heart disease, our current emergency medical interventions are so effective that the death rate is declining. However, actual cardiovascular health is not improving—the rate of occurrence of first heart attacks is going up. How could it be otherwise? Obesity, diabetes and hypertension are all increasing. Diabetes in adults males over the age of 20 is estimated to now occur at a rate of 9.3 percent (data for 1999–2000) compared to 7.9 percent in the period from 1988 to 1994. For men aged 60 or over, the rate in 1999–2000 was roughly 19 percent. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

    Cardiovascular Disease
    Cardiovascular health is a common topic of conversation. The reason, of course, is that heart disease in its various forms is the leading cause of death in adults and is especially prevalent in males. By age 60, one in five men will have already suffered a heart attack. The conditions to watch usually have been taken to be dysregulated blood lipids, homocysteine levels, hypertension, and obesity. More recently, it has been suggested that chronic low-level inflammation is a major causal factor in cardiovascular disease and that the Metabolic Syndrome (insulin resistance) is the actual underlying condition responsible for many or even most of the risk factors traditionally treated as indicators of heart and circulatory health.

    Antioxidants, Essential Fatty Acids and Minerals
    So-called “bad” cholesterol, low-density lipoprotein (or LDL), according to much current thinking, is only harmful if it has been damaged by oxygen and/or free radicals. Therefore, a protective program might include vitamin C (500 mg—2 grams daily) taken along with vitamin E as gamma-tocopherol (200 IU daily) and plant antioxidants. Tocotrienols, compounds from the same family as vitamin E, may be even more protective. A spate of studies have shown that the beneficial effects of vitamin E are much more pronounced in the gammatocopherol form and that vitamin E should not be supplemented alone, but rather in conjunction with vitamin C and the other antioxidants mentioned here. Indeed, many researchers now believe that the vitamin antioxidants are much more effective if used together and along with a variety of plant-derived antioxidants.

    Grape seed extract (100–300 mg daily) is commonly used in Europe by individuals who experience vascular and general circulatory problems. According to epidemiological data, safe and effective means of reducing heart disease risks include the ingestion of many such flavonoids, catechins and other polyphenols found in fruit extracts and tea. With regard to tea, these benefits come not just from green tea, but also from the theaflavins found in black and oolong teas. Another set of plant compounds that support heart health are lignans. Flax is especially rich in lignans. Tea, of course, is a beverage and flax is a food. Other food sources being mined for special antioxidants include olives and various highly colored berries.

    Similarly useful nutrients include the combination of L-carnitine (500–1,500 mg daily) and coenzyme Q-10 (30– 300 mg daily). Specialty forms of L-carnitine include L-carnitine fumarate, GPLC (glycine propionyl L-carnitine hydrochloride) and acetyl L-carnitine. Alpha-Lipoic acid (100–300 mg daily) is another good choice, and one with a particularly broad range of benefits. Minerals to supplement are chromium (200–600 mcg daily), magnesium (400 mg daily, preferably as magnesium aspartate) and selenium (200 mcg daily). A good broad-spectrum mineral supplement containing the Reference Daily Intake of copper should be considered if using the higher recommendation of vitamin C or if elevated triglycerides are a problem. Emerging evidence also supports supplementation with the lesser-known mineral silicon in the form of orthosilicic acid.

    Of great importance, for instance, in controlling inflammation, is the right balance of fats in the diet. It is accepted by most researchers that the modern Western diet is very poor in the essential fats known as omega-3 fatty acids. Sources of omega-3 fatty acids are flaxseed oil (1–2 tablespoons daily) and fish oil capsules (follow manufacturers’ recommendations). Just how important are these oils? Well, when the fish-supplemented trials are removed from statistical analyses of the standard low-fat dietary interventions routinely touted in medical circles, the benefits with regard to heart disease are marginal and overall mortality rates actually increase! Gamma-linolenic acid (GLA, 100–300 mg daily) can be taken in conjunction with omega-3 fatty acids for further protection against inflammation and to maintain immune balance when large amounts of fish oils are ingested. Finally, to protect against elevated blood homocysteine levels, supplement with vitamin B-6 (15–50 mg daily), vitamin B-12 (250 mcg daily) and folic acid (400 mcg daily).

    Prostate Health
    What can go wrong with the prostate? Plenty. Prostate problems typically can be catalogued under four headings: prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and prostate cancer. Prostatitis is really a catch-all term for several types of prostate problems. It always involves inflammation of the prostate and may also include considerable pain, whereas BPH may not involve any pain (as opposed to discomfort). Prostatitis is fairly common in adult males. It sometimes has a bacterial infectious component, but it often has no clear cause. Abstaining from alcohol and spicy foods helps in some cases. Prostatodynia, which is most common in young and middle-aged men, often appears as pain and/or discomfort in the groin, perineum, testicles, lower back, and penis. Smooth muscle spasms in the prostatic portion of the urethra and in the neck of the bladder are at work here. Fatigue in the muscles in the pelvic region and emotional stress appear to be powerful contributory factors in prostatodynia.

    Benign prostatic hyperplasia (formerly called hypertrophy) involves the renewed growth in the number of prostate cells late in life. Unfortunately, nearly 60 percent of men age 40 to 59 are likely already to suffer from BPH. This usually does not present a noticeable problem until after age 50, but by the age of 80, some 85 percent of all men suffer from one or more symptoms of BPH. The primary effect of BPH is a progressive decrease in the ability to empty the bladder as the prostate enlarges and applies pressure to the urethra. BPH should not be confused with prostate cancer,although there is an overlap of symptoms between the two. Men over age 50 should regularly visit their urologists to discover and distinguish between these two conditions. Fortunately, prostate cancer is one of the slowest growing of all cancers. Antioxidants, Essential Fatty Acids and Minerals

    Prostate problems are far easier to prevent than to deal with after they have manifested. Moreover, especially in the case of prostate cancer, epidemiological studies routinely find that eating more fruit and vegetables is strongly protective, whereas consuming large amounts of milk (especially more than two glasses per day) appears to have a strongly negative effect upon prostate health. Studies suggest that supplementing with vitamin E (200 IU daily), lycopene (5–10 mg daily), and the minerals selenium (400 mcg daily) and zinc (15 mg daily) are good protective measures. Flaxseed oil (1–2 tablespoons daily) can be quite beneficial, as can the regular consumption of pumpkin seeds. Men should avoid margarine, hydrogenated vegetable oils and fried foods whenever possible. The jury is still out with regard to the effects of calcium supplementation in men. Some epidemiological studies indicate that higher intakes of calcium are correlated to higher risks of prostate cancer, perhaps through a negative effect upon the levels of active vitamin D in the body or through some other mechanism. The work of E. Giovannucci of Harvard Medical School has been instrumental in uncovering the calcium/prostate cancer connection and the protective effects of fruit consumption nd an adequate intake of vitamin D (but not more than 400 IU daily).

    Isoflavone Herbal Preparations
    Although it may surprise most men, many of the same isoflavones and phytoestrogens that are helpful to women are also helpful to men. Men and women both produce estrogen. As males age the ratio of testosterone to estrogen is reduced. This reduced ratio of testosterone to estrogen appears to be the key cause of prostate problems. Plant estrogens, which are very weak in comparison with the estrogen itself, can actually reduce the impact of hormonal estrogen at the level of cell receptors. Isoflavones found in soybeans and red clover represent a promising approach to prostate health management. Also useful are extracts of saw palmetto berries and flower pollen. Indeed, specialty flower pollen extracts (from mostly rye pollen) have an unusually broad range of benefits for the prostate in that they have proven to be useful not only in cases of BPH, but also in prostatitis and prostatodynia.

    Stress
    Prolonged stress poses a very real health risk, one with which men are less physiologically equipped to cope than are women. Higher rates of heart disease and high blood pressure are but two results. In the pre-modern world, many or even most threatening or challenging situations (“fight or flight” situations) led to a physical response which consumed and directed the energy made available by the release of hormones such as epinephrine into the blood stream. Physical responses, however, are not usually possible or even desirable in the face of stalled traffic or office frustrations. In such cases, the released energy is “bottled up,” as it were. This results in disturbances in sleep, immune function, blood pressure regulation and other bodily systems. As the “fight or flight” reference suggests, the best responses to stress are often physical. Try to get some vigorous physical exercise every day, but also consider practicing yoga or some similar form of relaxing physical therapy.

    Nutrients and Herbs for Relaxation
    Generalized emotional and physical stress leads to oxidative stress. Therefore, a broad-spectrum antioxidant mixture is an excellent countermeasure. Be sure to include in the diet, as well, the recommended daily intake of all of the B vitamins. The amino acids taurine (500 mg to 1 gram daily) and glutamine (750 mg to several grams daily) play important roles in the body’s response to stress. These are best utilized if taken between meals with a small carbohydrate snack. The bioflavonoid known as chrysin (1–3 grams daily) is an important stress-reducing compound, as are theaflavin, valerian and skullcap (see manufacturers’ directions). Also useful are calming herbal teas. The best known of these is chamomile.

    Sports Aches and Pains of the Weekend Warrior
    Exercise is important. In some studies, men who exercised regularly had a 70 percent reduced risk of death from all causes and a 39 percent reduced risk of death from heart attack. This is the good news. The bad news is that those of us who are sedentary for five days out of the week and then try to make up for this in the remaining two days of the weekend may find that we end up with more than our share of aches and pains. The body responds best to regular exercise, which is to say, exercise at least every other day. Cramming a week’s worth of exercise into the weekend is asking for trouble. And, of course, as we get older our ability to “bounce back” from strenuous physical exertion diminishes. Fortunately, there are some ways to prevent problems and to help make them go away once they develop.

    Antioxidants
    Conditioned athletes are actually able to produce more of certain antioxidant enzymes within their bodies to cope with this heightened demand, and this fact indicates that training may produce a type of “reserve capacity” for antioxidants. However, it is still true that exercise puts oxidative stress on the body. In various studies, athletes who ingested an antioxidant “cocktail” before working out experienced faster recovery and fewer aches and pains than those who did not take the antioxidants. The daily antioxidant intake might include vitamin C (500 mg–2 grams), vitamin E (100–200 IU as gammatocopherol), coenzyme Q-10 (30–300 mg), alpha-lipoic acid (100–300 mg), plus a number of plant antioxidants, such as mixed citrus bioflavonoids (1,000–3,000 mg). Individuals who are involved in contact sports might consider either grape seed or pine bark extracts (200–300 mg) to help prevent bruising. Glutamine (750 mg to several grams daily) recently has become one of the favored supplements by serious athletes because of its benefits in recovery and in sparing the destruction of lean tissues due to excessive exertion.

    Nutrients for Repair
    Ligament and cartilage injuries are common in sports. Glucosamine and chondroitin sulfate are often recommended in osteoarthritis to improve the repair of cartilage, and these compounds can also be used to speed up repair—or to improve general resilience—of the joints, ligaments and tendons in sports. (Follow manufacturers’ directions.) Sadenosylmethionine (SAMe) is another nutrient that improves tissue repair and indirectly reduces pain and inflammation; the dosage is typically 400–800 mg of SAMe per day. Expect to wait from one to four weeks to experience the benefits of these supplements if you are just starting to use them. These items improve the body’s ability to heal itself and are not directed at symptoms as such.

    Hair Loss
    Roughly one half of the men in Western industrialized countries suffer from Male Pattern Baldness (MPB), and this syndrome accounts for some 90 percent of all cases of hair loss. However, the presence of MPB does not mean that other factors are not at work, such as reduced circulation. For instance, increases in hair loss in certain areas of the scalp correlate with the development of heart disease. For example, extreme thinning specifically on top of the head (rather than merely receding from the front) appears to be more strongly associated with circulatory disease than is balding elsewhere on the head. Hence, this problem is not always cosmetic and concern may not be limited to vanity.

    Hair Nutrients
    Deficiencies in the B vitamins biotin, inositol, pantothenic acid, and PABA are particularly linked to hair loss and to premature graying. A number of nutritionists have suggested that high-potency supplementation with the entire range of B vitamins, with special attention paid to biotin, inositol and pantothenic acid, may prove to be helpful. Vitamin C (1–2 grams daily) is important for the circulation, but also for the production of collagen, a component of the hair. Coenzyme Q-10 (30–300 mg daily) is another antioxidant often suggested to improve scalp circulation. Alpha-lipoic acid (100–300 mg daily) similarly appears to be effective and seems to be useful in hair loss if supplemented for at least six months. The amino acid cysteine (1–3 grams daily), also supplemented as Nacetyl-cysteine (NAC, 500–750 mg daily), can help to increase the speed at which the hair grows. A new and really interesting item that improves the quality of the hair is choline-stabilized orthosilicic acid (BioSil)—it is worth a shot. No major improvements in scalp health or hair loss should be expected in less than three months’ time (the hair follicles need to be activated and the hair must grow out). For many men, increasing protein in the diet may also prove useful in increasing the rate at which the hair grows. This may reflect an effect upon thyroid function, in which case, adding omega-3 fatty acids to the diet is also a good idea.

    Conclusion
    Men’s nutritional needs differ from those of women. It is not difficult however, to meet these special needs. A well-structured program of nutritional insurance should include as a foundation a balanced multivitamin/mineral supplement. Then plan in advance to provide nutritional support for any special needs. As always, it is recommend that you tell your doctor or health care provider what supplements or herbs you are taking. Even if he or she is not overly familiar with them, this knowledge is useful for monitoring your health.

  • The Controversy over Fish Oils and Omega-3s

    Today, most people know that the omega-3 fatty acids, such as are found in cold-water fish, are good for us. In fact, these are among the “stars players” of health supplements. The omega-3 fatty acids eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA) have been widely studied in connection with cardiovascular, joint, immune and brain health. Numerous scientific findings have demonstrated that omega-3 fatty acids are important for a healthy inflammatory response. In fact, research on omega-3s is so compelling that the FDA has granted a qualified health claim to the effect that consuming omega-3s reduces the risk of heart disease. For more than a decade, many of the benefits of omega-3 fatty acids have been largely beyond reasonable doubt. This year, that certainty has been called into question.

    Publications from early 2015 challenge, or at least appear to challenge, two of the most important assertions often made for omega-3 fatty acid supplementation. These are the assertion that fish oils are valuable assets in reducing key components of cardiovascular disease and the assertion that these oils are useful supplements for preventing cognitive decline. The first shoe fell on March 31 with the publication in the New York Times of the essay, “Fading claims on fish oils.” This article was quite direct in judging that “no evidence that fish oil lowers risk for heart attack or stroke” has been found according to the majority of clinical trials that have been conducted on the topic.

    The second shoe fell on August 26 in the form of a Newsweek article entitled “Omega-3 Supplements Are a Waste of Money.” The basis of this judgment was a medical study published in August 2015 in which the authors Chew et al. concluded, “oral supplementation with LCPUFAs (long-chain polyunsaturated fatty acids) … had no statistically significant effect on cognitive function.” 1 The same research group the previous year, based on the same trial design and data, had concluded that omega-3 supplementation “did not reduce the risk of CVD in elderly participants with age-related macular degeneration.” 2 This study, dubbed AREDS2, was a large double-blinded randomized study involving more than 4,000 subjects in its overall design and lasting approximately five years. On the surface, the results appear to be definitive. As often is the case, however, appearances can be deceiving.

    The latest studies are not always the best or the most definitive studies despite the breathless hype so often found in the popular press. As usual, the devil is in the details with both of the negative judgments in the above paragraphs. The following sections provide a bit of guidance for the perplexed.

    Omega-3s versus Cardiovascular Disease

    In evaluating the findings of clinical trials, it is necessary to consider a range of questions regarding the basis and the aims of the trials in question. For instance, was a given trial performed in the right subject population to support its conclusions? The AREDS2 study mentioned above for its CVD conclusions used a population of participants who were “primarily white, married, and highly educated, with a median age at baseline of 74 years” that included “participants with stable, existing CVD (>12 months since initial event)” to determine a “composite outcome of myocardial infarction, stroke, and cardiovascular death…” “Approximately 19% had a history of CVD; 44% reported taking a statin medication; and 14% reported taking any type of medication for congestive heart failure, CVD, or cerebrovascular disease.” Several issues should be flagged immediately with this study population.

    First, it was a group that might be expected to already have adopted dietary changes, such as eating fish two or more times per week and preferring olive oil for cooking and salads, that would have reduced the impact of supplementation with additional omega-3 oils. The average American may eat a diet highly unbalanced in the ratio of omega-3 to omega-6 fatty acids, high in saturated fats and low in magnesium, low in vegetables and fiber, etc., but the study population would have been much less likely to be following the standard American diet. Did the researchers check? Not as far as I could tell from reading the methods section. My suspicion is that a substantial percentage of the subjects already were consuming considerable omega-3 fatty acids in their diets and already had adopted a more healthful ratio of omega-3 to omega-6 fatty acids than is true of most Americans.

    Second, 44 percent of the study group already was taking a statin medication and 14 percent (whether overlapping the statin takers is not indicated, but the implication is “not”) were taking other CVD medications. In other words, this was not a medically “naïve,” i.e., pharmaceutically untreated, starting population. The researchers in AREDS2 did try to control for some of these issues (see Figure 3 in the study), yet their data in this regard are a bit odd. Despite the non-significance of the statistics regarding the number of cardiac events between omega-3 and non-omega-3 arms with regard to, say, statin use, there were statistically significant differences between the arms involving hypertension history (a proven benefit of omega-3 supplementation, P = 0.02) and cardiovascular disease history (P = 0.04) implying a medical treatment effect not captured in the write-up. The authors, by the way, do admit the data that I mention imply potential benefit from omega-3 supplementation, but then try to explain this away without pursuing the implications regarding their collected data and its reliability regarding the impact of medications and lifestyle changes.

    Another issue involves the endpoints selected for evaluating the outcome of a study. Surely, the meta-analyses have been conducted to evaluate the quite massive volume of clinical research, which has been performed with omega-3 fatty acids. This research consistently has found that fish oil consumption reduces cardiac death risk between approximately 10 and 30 percent with a low of nine percent and a high of 35 percent.3 These figures surely are not bad for a simple and safe dietary supplement!

    With regard to other important CVD risk factors, omega- 3s have been found to consistently perform well. Omega-3 supplementation reduced blood pressure in studies in the general population approximately 4.5 mm Hg, which similar to lifestyle changes, including reduced intake of dietary sodium, increased physical activity and a reduction in excessive alcohol consumption. High fasting triglycerides were reduced by 30– 40 percent, yet another healthful change.4

    Again, it must be remembered that study populations are important for outcomes. If one focuses on populations with advanced cardiovascular disease, this will be quite misleading with regard to the benefits of taking a nutrient, in this case, omega-3 fatty acids, over a significant period of time starting before the disease has manifested. This, of course, is precisely the role of supplements as opposed to drugs. The New York Times article applied the wrong model and created a controversy by doing so.

    Omega-3s and Cognition

    Let’s return to the citation above in which Chew et al. concluded, “oral supplementation with LCPUFAs (long-chain polyunsaturated fatty acids) … had no statistically significant effect on cognitive function.” The authors actually state in another spot, “Contrary to popular belief, we didn’t see any benefit of omega-3 supplements for stopping cognitive decline.”

    The study by Chew et al. refers to its experimental supplementation as a “high dose,” yet the truth is that only 350 mg of the dose was DHA and the other 650 mg was EPA. This matters because these two omega-3 fatty acids do different things. To combat depression, which the AREDS2 study did not examine, EPA is the more significant nutrient. Trials using a mixture of the two mostly have been successful.5 Nevertheless, in a face-off of the two omega-3 fatty acids, EPA is the stronger anti-inflammatory in the brain and may deliver better results against depression.6

    For cognition, the reverse is true: DHA outperforms EPA. This should not come as a surprise given that DHA plays a major structural role in brain cellular membranes and in the neurologic system more generally. In a study of 22 healthy adults, 12 weeks of daily dietary supplementation with either 1 g DHA-rich or 1 g EPA-rich fish oil (FO) or placebo (1 g olive oil) were assessed with the result being that DHA consumption leads to greater blood flow and activity in the prefrontal cortex during cognitive tests than does EPA.7 In older adults, episodic memory outcomes in adults with mild memory complaints are improved with the intake of greater than 1 gram DHA/EPA per day.8 In other words, the study by Chew et al., focused on the wrong omega-3 fatty acid to better influence cognition and was below an accepted threshold for the dosage for some aspects of cognition and memory.

    To be fair to Chew et al., their trial was designed before papers became available that demonstrated that higher dosages of DHA and/or DHA/EPA improved cognition and memory, whereas lower dosages did not. A clarifying discussion of the issues involved has been published under the title “Omega-3s and Cognition: Dosage Matters.”9 For those interested in pursuing this issue further, a table of relevant papers can be downloaded from http://goedomega3.com/files/download/334/memory-and-cognitive-functionpapers-table.pdf.

    Conclusion
    The misleading conclusions of the New York Times article on fish oils and cardiovascular disease and the Newsweek article on DHA and cognition are cautionary tales regarding the interpretation of studies. In reality, adequate intakes of omega-3 fatty acids reduce CVD mortality by 10 to 30 percent, although supplementation may not deliver this same degree of benefit in populations already suffering from active CVD, already taking numerous medications or already having adopted appropriate diet and lifestyle modifications. Similarly, DHA supplementation significantly improves some aspects of cognition and memory, but only at intake levels above 1 gram per day in older individuals. Younger adults may benefit from 1 gram mixed DHA/EPA with the proviso still in place that for this purpose DHA is more active than is EPA whereas for depression, the opposite is true.

    Endnotes:

    1. 1. Chew EY, Clemons TE, Agron E, Launer LJ, Grodstein F, Bernstein PS; Age-Related Eye Disease Study 2 (AREDS2) Research Group. Effect of Omega-3 Fatty Acids, Lutein/Zeaxanthin, or Other Nutrient Supplementation on Cognitive Function: The AREDS2 Randomized Clinical Trial. JAMA. 2015 Aug 25;314(8):791.801.
    2. 2. Writing Group for the AREDS2 Research Group, Bonds DE, Harrington M, Worrall BB, Bertoni AG, Eaton CB, Hsia J, Robinson J, Clemons TE, Fine LJ, Chew EY. Effect of long-chain ƒÖ-3 fatty acids and lutein + zeaxanthin supplements on cardiovascular outcomes: results of the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA Intern Med. 2014 May;174(5):763.71.
    3. 3. Ismail A. The real story of omega-3s in heart health. April 3, 2015. http://goedomega3.com/index.php/blog/2015/04/the-realstory-of-omega-3s-in-heart-health
    4. 4. Ibid.
    5. 5. Yang JR, Han D, Qiao ZX, Tian X, Qi D, Qiu XH. Combined application of eicosapentaenoic acid and docosahexaenoic acid on depression in women: a meta-analysis of double-blind randomized controlled trials. Neuropsychiatr Dis Treat. 2015 Aug 10;11:2055.61.
    6. 6. Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 Oct;28(5):525.42.
    7. 7. Jackson PA, Reay JL, Scholey AB, Kennedy DO. DHA-rich oil modulates the cerebral haemodynamic response to cognitive tasks in healthy young adults: a near IR spectroscopy pilot study. Br J Nutr. 2012 Apr;107(8):1093.8.
    8. 8. Yurko-Mauro K, Alexander DD, Van Elswyk ME. Docosahexaenoic acid and adult memory: a systematic review and meta-analysis. PLoS One. 2015 Mar 18;10(3):e0120391.
    9. 9. Ismail A. Omega-3s and Cognition: Dosage Matters. August 31, 2015. http://goedomega3.com/index.php/blog/2015/08/omega-3s-and-cognition-dosage-matter
  • The Missing Pieces of the Weight Loss Puzzle

    Obesity has gone prime time. We Find evidence of its presence where ever we look: in every neighborhood, every mall, every school and every workplace. Hardly a day goes by without the news reporting on some aspect of the looming obesity crisis. However, the epidemic is not confined to just the wealthy developed world. Even desperately poor countries such as Nigeria and Uganda are wrestling with the dilemma of obesity. China, which was once one of the world’s leanest countries, is not immune. In fact, it has one of the fastest-growing obesity rates in the world and one quarter of its urban youth is presently overweight. It is projected that by 2015, 200 million Chinese will be not just obese, but morbidly obese. The looming obesity epidemic is sending chills through the global community. Worldwide, more than 1.3 billion people are overweight, whereas only 800 million are underweight—and these statistics are diverging rapidly.

    The problem of expanding waistlines is more than merely a vanity concern. There are serious health consequences from sporting that beer belly. Being overweight can radically change the course of a person’s life. Fat is toxic and potentially lethal. Just carrying as few as an extra 4.5 kilos (10 pounds), over your ideal weight is considered a serious risk factor for heart disease, diabetes, high blood pressure, dementia and Alzheimer’s disease, liver disease, hormonal imbalances depression and cancer. In fact, at least 30 different diseases are related to being overweight. So, what’s going on here? If people were to follow the advice offered by medical professional, public health officials and the experts from the weight loss industry, the problem should be easily solved. Their call to action basically involves turning your back on all those sugary, high carbohydrate, processed, junk foods and switch to a low calorie diet fortified by plenty of exercise. They say it all boils down to a very simple equation: take in fewer calories and burn more.

    Sounds logical. The only problem is that this decades old approach is a dismal failure. For the vast majority of people, it doesn’t work. In fact, long-term success for attaining permanent weight loss is only achieved by a mere 2–5 percent of those very determined and lucky dieters.

    A definition of insanity is doing the same thing over and over again and expecting a different outcome. It certainly appears that the traditional approach to winning the battle of the bulge does indeed, seem insane.

    If there are answers and successful strategies to stem the tide of this serious health epidemic, they will need to be sought elsewhere.

    It’s time to discover some of the missing pieces of the weight loss puzzle.

    Secrets of the Brain-Belly Connection
    Do you value your brainpower? Certainly the one faculty that everyone wants to hold onto throughout a life’s lifetime is a fully functioning, intact brain. Unfortunately belly fat can deliver a serious blow to your aspirations.

    Overwhelming evidence now reveals that your expanding waistline will put a serious crimp on your brain size as well as brainpower.

    Researchers set out to discover if being overweight posed a danger to the brain. They scanned the brains of 94 people over the age of 70. They were looking to see the differences in the brains of people who were of normal weight (BMI under 25), overweight (BMI 25–30), and obese (BMI over 30). (BMI stands for body mass index, an approximation of body fat based on height and weight.)

    Their results were quit shocking. Overweight people have 4 percent less brain tissue than people of normal weight. And, for obese people, the findings were even worse. They had 8 percent less brain tissue than people of normal weight.

    The study not only showed that carrying extra weight degenerated the brain but it also accelerated its aging. Researcher Paul Thompson shared his observation, “The brains of overweight people looked eight years older than the brains of those who were lean, and 16 years older in obese people. Type 2 diabetes, which is common in the overweight, is known to accelerate the aging of the brain and the onset of dementia. But the relationship between brain size and weight still stood when the researchers accounted for this, suggesting it is the fat itself that is causing the problem. It is thought that high levels of fat raise the odds of the arteries clogging up, cutting the flow of blood and oxygen to the brain. This could cause brain cells to die and the organ to shrink.” The high demands put on these brain areas may make them more sensitive to changes in oxygen levels.

    Another study used magnetic resonance imaging to compare the brains of 44 obese individuals with those of 19 lean people of similar age and background. The obese individuals had more water in the amygdale—a part of the brain involved in eating behavior. It also showed smaller orbitofrontal cortices in obese individuals, important for impulse control and also involved in eating behavior. These findings strengthen the “slippery slope” theory of obesity. The neural changes that occur when you are overweight, affects the parts of your brain that influence and control so many behaviors necessary to make healthy choices.

    Further studies indicate that those with the most belly fat (visceral fat mass) suffer the greatest mental declines over time—and that central or abdominal obesity, in particular, accounts for more than a three-fold increase in dementia risk.

    What’s even more worrying is that increased belly fat is linked to decreases in total brain volume, independent of BMI. This can cause changes in another area of the brain, called the hippocampus, which is responsible for long-term memory, spatial memory and navigation. Finally, excess belly fat also appears to contribute to lesions in the brain’s white matter, especially in diabetic patients—linking it not just to memory loss, but also to increased risk of stroke.

    Obesity is also causes changes to the immune system, which are fanning the flames of inflammation throughout the body. This increased inflammation can impact the brain and lead to a vicious cycle of gaining more and more weight: obesity leads to inflammation, which damages certain parts of the brain, which in turn leads to more uncontrolled eating and more obesity.

    There are many areas of the brain that are affected by being overweight.

    • Frontal and temporal lobes—critical for planning, memory and impulse control
    • Anterior cingulate gyrus—responsible for attention and executive functions
    • Hippocampus—important for long-term memory, spatial memory and navigation
    • Basal ganglia—essential for proper movement and coordination

    Here is the catch-22. Those extra kilos impair brain function and compromise the particular areas of brain that impact a person’s ability to have a keen memory, control impulses and follow through on any kind of planning. It, therefore, becomes more difficult to successfully commit to any kind of program, especially a weight loss program. Since the impulse control part of the brain is affected, controlling those urges to help yourself to another donut or a second helping of mashed potatoes is a Herculean effort and generally doomed to fail.

    Vitamin D —A Key to a Healthy Metabolism
    There is one really important nutritional player when it comes to our health. This superstar nutrient is the sunshine hormone, vitamin D. (Vitamin D is really a steroid hormone rather than an actual vitamin.)

    Vitamin D truly deserves the title of superstar. Each year, vitamin D research discovers additional health benefits conferred by this sunshine vitamin. Vitamin D receptors are found throughout the body including the brain. Optimal levels are absolutely necessary to insure healthy bones, healthy arteries, a robust immune system, balanced moods, optimal cognitive function, protection from hypertension, allergies, multiple sclerosis, Alzheimer’s disease, autoimmune conditions, and fertility and PMS. Most significantly, vitamin D has been proven to be protective against 13 different kinds of cancer.

    Optimal Levels of Vitamin D Are Critical for Health Here are some basic facts you need to know about vitamin D. It is a fat-soluble steroid hormone that is both made by the body and from our diet. In order for the body to produce vitamin D (cholecalciferol), the skin must be exposed to ultraviolet light, primarily from the sun. Vitamin D is further metabolized in the liver and kidneys to create the fully active form of vitamin D. Thus variations in sun exposure due to latitude, season, time of day, sunscreen use, skin pigmentation, and age will determine how much vitamin D the body makes.

    Although it is known that vitamin D play a vital role for the well-being of infants, children, adults and the elderly, we presently have a global pandemic of chronically low vitamin D levels. It’s estimated that 85 percent of the American public are deficient, and as much as 95 percent of all its senior citizens. Vitamin D deficiencies are also widespread throughout the UK, with 86 percent of the population deficient in the winter and 57 percent in the summer.

    Even though Australia’s is described as “sun burnt” country and is one of the sunniest countries in the world, a surprising number of its citizens are severely lacking in vitamin D. A recent report stated that as many as 1 in 3 Australians may have low vitamin D levels.

    For all those on a weight loss quest, vitamin D is one of those missing pieces you have been searching for. There is overwhelming evidence that confirms the importance of keeping your vitamin D levels up to get your extra kilos down. Not only does it help achieve weight loss, it also improves other risk factors such as insulin resistance, metabolic syndrome and blood sugar imbalances. If you are feeling hungry all the time no matter how much you eat, you might want to have your vitamin D levels checked. What drives insatiable hunger is the relationship between low vitamin D levels and a hormone called leptin. Leptin is a messenger molecule made in fat cells that communicates to the hypothalamus, letting it know how much fat is stored in the body. It is the hormone that communicates that you are full.

    Low vitamin D levels interfere with the effectiveness of leptin. Researchers at Aberdeen University, Scotland found that obese people produced 10 per cent less vitamin D than people of average weight. The study discovered that low levels of the vitamin in blood interfered with the function of leptin, which tells the brain when the stomach is full. The study also found that excess body fat absorbs vitamin D, stopping it from entering the bloodstream. Dr Helen MacDonald, of Aberdeen University’s department of medicine and therapeutics, said: “Obese people had less vitamin D and the link between obesity and vitamin D deficiency was statistically significant.” Overweight people, shirking the sun or not taking adequate vitamin D supplementation thwart their dieting efforts in another way. Low vitamin D levels have been shown to increases fat storage. A 2009 Canadian study found that weight and body fat were significantly lower in women with normal vitamin D levels than women with insufficient levels.

    It seems that fat people may be less able to convert vitamin D into its hormonally active form. A Norway study found that the more participants weighed, the lower their vitamin D levels tended to be. The researcher, Zoya Lagunova, MD, believes that obesity is associated with lower vitamin D levels since vitamin D is a fat-soluble vitamin. “Much of the vitamin D produced in the skin or ingested is distributed in fat tissue, so obese people may take in as much vitamin D from the sun, food, or supplements as people who are not obese, but their [blood] levels will tend to be lower. Obese people may need more vitamin D to end up with the same levels as a person whose weight is normal.”

    How much less vitamin does an overweight person make? As it turns out, increased fatty cells can decrease the ability to make vitamin D by a factor of 4. That means that if you are carry extra weight, you may make only one quarter the amount of vitamin D compared to a leaner person. Vitamin D is also an important factor in diabetes. Low levels of vitamin D has been linked to an increased risk of developing type 2 diabetes. After following more than 5,000 people for five years, an Australian research team found that those with lower than average vitamin D levels had a 57 percent increased risk of developing diabetes, compared to those within the recommended range.

    Low levels of vitamin D are also known to nearly double the risk of cardiovascular disease if you already have diabetes. Diabetics, who are deficient in vitamin D and cannot process cholesterol normally, tend to have it build up in their blood vessels, hence increasing the risk of heart attack and stroke.

    Vitamin D also helps keep blood sugar levels under control. In type 2 diabetes the body can’t use insulin it produces efficiently to control blood sugar levels. Vitamin D plays a role by increasing the release of insulin. In one study, researchers evaluated the vitamin D levels and the chance of developing unbalanced blood sugar metabolism. In this study, subjects were evaluated for serum vitamin D levels and followed for 7 years to determine the effects on blood sugar metabolism. The study showed that the subjects with the highest vitamin D levels had a 40 percent increase in supporting optimal future blood sugar balance.

    If you want to lose weight and keep it off, it is critical to check your vitamin D levels. The higher your vitamin D levels the higher your leptin levels and the more your blood sugar will remain balanced. Vitamin D helps your body respond to the correct metabolic messages. High vitamin D levels increase your ability to lose weight and losing weight will increase your vitamin D levels. All of which will reduce your risk of metabolic syndrome, insulin resistance, diabetes, and cardiovascular disease, not to mention most chronic illnesses.

    While it is important for most people to take vitamin D supplementation, especially the overweight, children and elderly, it is critically important to check your vitamin D levels. Taking a vitamin D supplement may not get you into optimal range, which is where you want to be. Its optimal blood vitamin D levels that count. The proper blood test is called 25-hydroxyvitamin D (25-OH), which is included in the basic blood workup. In Australia optimal levels should be 150–200 nmol/L. In the U.S., optimal levels should be between 70–100 ng/mL. Do not settle for less than optimal levels if your goal is the best health possible.

  • The Sinatra Solution, Metabolic Cardiology Part II

    For many years, I have been teaching patients, and doctors, about the life-giving benefits of Coenzyme Q10 and L-carnitine. Looking back, using them in my practice represented our first steps into the world of metabolic cardiology—the treatment of heart disease on a cellular level by improving individual cell function and energy production. The effect of these nutrients on cellular energy has now been experienced by thousands of heart patients, who improved the quality of their lives by the simple supplementation with these “Twin Pillars” of cardiac health.

    Now a new nutrient, D-ribose, has arrived on the scene, heralding a second generation of metabolic cardiology. In combination, these nutrients provide the metabolic support hearts and other body tissues need to generate and maintain the energy required to promote health and vitality. I’ve watched nutritional interventions improve and literally save lives when traditional medicine just wasn’t enough. Now, I employ them as my first line approach whenever I can.

    One of the most important discoveries physicians and scientists have made in recent years is the evolving study of cellular energy, or bioenergetics, and the impact cellular energy metabolism has on heart function. In her recent book, ATP and the Heart, Dr. Joanne Ingwall writes about the role of ATP (adenosine triphosphate, a biochemical required for cellular energy) in heart function:

    “A major clinical challenge today is to develop strategies to preserve or improve [heart] pump function while maintaining cell viability. To achieve this goal, an understanding of the metabolic machinery for ATP supply and demand is required . . . Every event in the cell, directly or indirectly, requires ATP. Myocytes [heart cells] need ATP to maintain normal heart rates, pump blood and support increased work, i.e., recruit its contractile reserve. The myocyte needs ATP to grow, to repair itself, to survive. The requirement for ATP is absolute.”

    Dr. Ingwall's credentials are impressive, and she is particularly well qualified to make these statements. As a professor of medicine (physiology) at Harvard Medical School, and senior biochemist and director of the nuclear magnetic resonance (NMR) laboratory in the cardiovascular department of Boston's Brigham and Women’s Hospital, Dr. Ingwall has spent her professional life studying the role of energy metabolism in the heart. Her book, published in 2002, supports the need for understanding the complex mechanisms of cellular energy metabolism when devising therapies for treating cardiovascular disease. ATP and the Heart should be required reading for any professional working in this field.

    To supply this absolute and continuing need for energy, the body’s many complex systems rely on a variety of nutrients that are used within the cell to drive, control, and facilitate the myriad biochemical reactions that provide energy to the cell. Because none of these nutrients works independently, a “synergy” of nutrients is oftentimes what’s needed to offer results superior to that of any single nutrient. Improving the function of one cog in the wheel of metabolic machinery for energy production increases overall efficiency when the other cogs in the machinery are also working at their peak. It’s not “fuzzy math” at all.

    Think of it this way: in simple math, things are additive; one plus one clearly equals two. But when you combine the right nutrients together to work synergistically, the advanced math results can be exponential; one plus one can equal five or even ten! You don’t merely add up the benefits of each nutrient in sequential fashion. Instead, these synergistic effects mean that an explosive combination of nutrients can have an exciting, positive impact on one’s well-being, and even on life itself.

    Unfortunately, the understanding of the metabolic role of energy in heart function is not well-known by medical practitioners, and the impact of supplementing the heart with energy-supplying nutrients is not appreciated. Here is an example of how this lack of understanding caused one man unnecessary despair, as well as a delay in treatment.

    Jim was a 76-year-old living with congestive heart failure and ischemic heart disease. In 2003, his disease worsened to the point that he could hardly walk. Jim’s examination and testing at his cardiologist revealed an ejection fraction of only 14 percent.

    Jim had heard about D-ribose, L-carnitine, and Coenzyme Q10, so he asked his doctor if he should try these supplements to improve the energy in his heart. Jim was told, “No. There simply isn’t enough science to show that these work.” Undaunted, Jim made an appointment with a second, and then a third, cardiologist to seek advice on taking these important, life-giving nutrients.

    In every case, Jim’s request was refuted and he was either advised that there was “insufficient science” to show their effectiveness, or that “these supplements don’t work,” by physicians who just weren’t doing their homework. Clearly, these strongly biased doctors failed to understand the vital role that energy metabolism plays in heart function.

    Still skeptical, but anxious about going against the advice of these medical professionals, Jim contacted me for an appointment and was evaluated by my associate, Dr. Sun King Wan, an invasive interventional cardiologist. Following a complete cardiovascular workup, my “first-knight” nurse, Rosie—who’s been with me for thirty years—started Jim on a cocktail of nutrients, including D-ribose, L-carnitine, Coenzyme Q10, and a mixture of B vitamins. Jim simply mixed what he refers to as “Rosie’s cocktail,” in orange juice three times per day. Within four days, Jim could walk farther than he’d been able to in months. A couple of weeks later, Jim was painting the rails on his porch, and within four weeks his ejection fraction had improved to 24 percent.

    While there’s still improvement for Jim to make, within a month his heart function had improved by over 50 percent simply because his heart was able to restore the energy—on a cellular level—that was being sapped by his disease. Following Jim’s progress, my clinic partner, with his modest prior understanding of the importance of energy metabolism in heart function, was so impressed that he now recommends these nutrients to all his heart patients, too.

    When it comes to heart disease, D-ribose, L-carnitine, and Coenzyme Q10 have become the triad of nutrients we rely on for healing and prevention. You will soon see that these nutrients can rocket your heart and muscle energy to new heights. They do this by maximizing the amount of oxygen that your heart and skeletal muscle can extract from your blood, by accelerating the rate at which the food you eat is converted to energy in your cells, and by keeping your cellular energy pool healthy.

    This book reflects a twenty-year learning curve in my practice of integrative cardiology. I’ve been using Coenzyme Q10 during that entire twenty year period, L-carnitine for the past ten years, and D-ribose these last couple of years.

    The synergistic combination of D-ribose, L-carnitine, and Coenzyme Q10 has been a tremendous breakthrough in the treatment of heart disease, and has become my personal nutritional arsenal for boosting the heart’s energy. You see, whatever the patient’s cardiac condition, getting back to a healthy heart is about supporting each individual heart cell and encouraging them to join forces and strengthen the heart as an energy pump. So the bottom line for your heart is always about ENERGY!

    Because L-carnitine and Coenzyme Q10 both work in the inner mitochondrial membrane, the clinical purpose of these nutrients is to complement one another in accelerating energy supply to heart cells. D-ribose works to maintain the healthy pool of energy substrates needed by L-carnitine and Coenzyme Q10 to work effectively. Clinically, working together these nutrients can help assuage cardiac arrhythmia, reduce the risk of heart failure, overcome the severe weakness and fatigue of coronary artery disease, increase exercise tolerance, relieve cramping and soreness in the lower extremities (claudication), T and improve the quality of life for patients suffering with these conditions.

    This triad is not only remarkably effective in preserving heart health, but is also outstanding in the treatment of neuromuscular diseases, such as fibromyalgia, that are also affected by failures in cellular energy metabolism.

    Although hundreds of scientific papers have been published in noteworthy scientific and medical journals describing the individual roles of these naturally occurring compounds in preserving the energy health of your heart, skeletal muscle, and other tissues, you've probably never heard or read about the exciting combination of D-ribose, L-carnitine, and Coenzyme Q10.

    Nor are you likely to have heard about these revolutionary treatments from your doctor. Why? Because even though the scientific literature clearly presents the science, and thousands of clinical applications have documented that these compounds have proven beneficial for treating a wide variety of clinical cardiac conditions, therapies like D-ribose, L-carnitine, and Coenzyme Q10 are still largely ignored by a majority of clinical cardiologists as well as most of the conventional medical establishment. Despite the fact that these three nutrients are used by many board-certified cardiologists in the United States, Europe, and Japan, most clinical cardiologists generally remain biased by ignorance or a deep-rooted reliance on pharmaceuticals. Unfortunately, the many patients who are not helped by conventional treatments alone or whose treatment could be greatly enhanced by the addition of D-ribose, L-carnitine, and Coenzyme Q10 will never be offered the chance to receive them.

    Besides the widespread ignorance about supplemental treatment with this triad, it is equally tragic that there is so much negative bias against these nutritional therapies. One of the major obstacles to evaluating the benefit of nutritional therapies is the claim by many physicians that there is a lack of scientific data on the subject. Although most conventional wisdom is subject to the current "gold standard" of evidence-based scientific controlled studies, there are literally scores of studies on Coenzyme Q10, L-carnitine, and D-ribose demonstrating this exact rigorous standard of controlled analysis. For example, if you go to the Internet and type in “Coenzyme Q10” as a search word on the Pub Med site, you will see 1,254 published articles in various scientific and medical journals. Type in Q10's generic name “ubiquinone,” and the count rises to 5,769, most of which represent sound science-based inquiry. L-carnitine and D-ribose will bring up thousands of results. So, I'm confused when my peers say “there's no data.”

    The rejection of D-ribose, L-carnitine, and Coenzyme Q10 as potent, nonprescription treatment defies imagination. It's apparently difficult for highly trained medical personnel, well versed in pharmacology and technology, to believe that anything so simple and so natural could be as effective as the highly engineered drugs modern medicine has to offer.

    Most American cardiologists cannot acknowledge that a natural substance not manufactured by pharmaceutical industry giants could be so valuable. These factors have rendered therapies including D-ribose, L-carnitine, and Coenzyme Q10 victims of politics, bias, insufficient marketing, economics, and ignorance regarding the results of real science.

    That is not to say that the nutritional supplement industry is blameless. Too many dietary supplements—claiming to treat everything from heart health to weight loss to male sexual enhancement—have hit the market with major media campaigns, plenty of claims, and a host of promises, with little, if any, science behind them. There can be no doubt that this “hype versus science” attitude in the nutritional supplement industry has placed major roadblocks in the path of acceptance of those natural therapies that do have solid science and demonstrable clinical benefit, and has encouraged many morethan- skeptical attitudes among health care providers.

    Another dilemma is the not-all-are-created-equal issue regarding nutritional supplements. While many products are pure, many others fail to live up to the ingredients and dosages listed on their labels. The FDA monitors our pharmaceuticals, but not the supplement industry. While FDA involvement would spuriously skyrocket the cost of many vitamins and supplements and place them outside the affordability range for many people, it is not easy to know which products are worthy of your financial investments at present. This darkens the cloak of suspicion for many physicians. For now, I can only advise you on the products I've tested and found to be of high quality, and hope for some standards to be developed in the future.

    It is also true that manufacturers and distributors of D-ribose, L-carnitine, and Coenzyme Q10 do not have the financial and physical resources to “detail” these products to physicians as major medicinals, as the pharmaceutical companies do with their new drugs. These companies have thousands of sales representatives on the street visiting doctors everyday, and they are able to start and run campaigns to educate physicians about new products. Such campaigns can cost tens, or even hundreds, of millions of dollars. This effort is simply too costly for smaller companies trying to reach the broad and highly diverse audience of health care professionals suffering from a complete lack of knowledge about these revolutionary treatments.

    This book will specifically discuss the importance of energy metabolism for cardiovascular health and the impact of these three nutrients on the cardiovascular system. But the story should not end there. All three of these miracle ingredients—D-ribose, L-carnitine, and Coenzyme Q10—are being used right now in a wide variety of serious degenerative diseases, including heart disease, high blood pressure, cancer, periodontal disease, chronic obstructive pulmonary disease, diabetes, neurological disorders, neuromuscular disease, male infertility, and even aging itself.

    Part three of the series from The Sinatra Solution, Metabolic Cardiology will appear in the next issue of totalhealth.

  • The Special Nutritional Needs of Men

    Solving the Mystery of the Multivitamin Part III

    This article is the third in the series begun with “Solving the Mystery of the Multivitamin” and continued with “The Special Nutritional Needs of Women.” Here it is observed again you do not need to believe “men are from Mars, women are from Venus” in order to accept that men and women have different nutritional needs. Men lead in eight of the top ten causes of death in the United States. As it is often remarked, because men are more reluctant than women to seek medical care, when they do so, their illnesses typically have advanced to a more serious degree. It would seem that men, even more than women, would do well to adopt defensive measures to preserve their health. However, men should not depend on the supplements used by their wives or women friends. Some preventative measures are strictly gender-specific. The following suggestions are designed to help men take charge of their health while the ball is still in their court.

  • Vitamin K2: The Missing Nutrient for Heart and Bone Health

    “If calcium is so bad for my heart, why should I be taking a calcium supplement for my bones?”

    This is a question I hear frequently in my office and one that causes me great concern.

    Bone health is important throughout your life. Osteoporosis and bone fractures, similar to cardiovascular disease, are not just the problems of old age. Like the heart and the blood vessels, the health of our bones is something we usually do not think about much. Then, a problem arises—such as a hip fracture—and just like the cardiovascular system, it is too late to make any real impact.

    The one thing most people will do to support their bone health is take a calcium supplement, which is important due to the fact our bodies cannot produce calcium on their own, and calcium plays a role in many of the body’s systems. But too much calcium in the body left unattended can have a negative effect, such as depositing in the arteries and blood vessels causing calcification. This calcification causes stiffening that puts a strain on the cardiovascular system.

    When my friend, an integrative general practitioner, asked if I was recommending vitamin K2 to my patients, I was surprised. What is vitamin K2? I decided to find out. I was shocked—and excited—at how much good research supported this nutrient for bone and heart health.

    The discovery of this amazing body of research was the motivation behind my new book, “Vitamin K2: The Missing Nutrient for Heart and Bone Health.” It is important that patients as well as health care professionals understand the benefit of this important nutrient and the scientific evidence supporting it.

    What is Vitamin K2?
    Vitamin K2 is part of the vitamin K family, a group of fatsoluble vitamins. Vitamin K is split into two groups: vitamin K1 and vitamin K2. The difference lies on a molecular level. Vitamin K1 has one molecule, so it is a phylloquinone. The K2 group has multiple molecules and known as menaquinones.

    While K vitamins are crucial for blood clotting, vitamin K2, unlike K1, is utilized by the liver and then is available to tissues beyond the liver, such as the bones, arteries and blood vessels. So why is vitamin K2 so valuable?

    Simply put, vitamin K2 is the body’s light switch. It activates or “turns on” important proteins in the body such as osteocalcin for strong bones and the matrix Gla protein (MGP) in the arteries and blood vessels. By turning on these vitamin K2 dependent proteins, calcium is kept out of the arteries (where it can cause hardening of arteries and blockages) and transported and kept in the bones where it belongs.

    Although vitamin K2 is a relative newcomer to the supplement arena, I believe there is now enough scientific evidence to make you take notice and add it to your list of essential nutrients. While I will focus on vitamin K2’s proven cardiovascular benefits, a multitude of studies have also demonstrated vitamin K2’s effectiveness for bone health and children’s health. And more research is being done every day to support its benefits in these crucial areas to the general population.

    Undeniable Evidence
    Let’s start with the evidence of vitamin K2’s role in calcification. The landmark Rotterdam population cohort study examined vitamin K2 in a normal human population, and was the first large clinical study to suggest the huge impact vitamin K2 may play in reducing cardiovascular events and mortality. Results among 4,807 healthy individuals (at the start of the study) age 55 and older, suggested a strong protective effect of the highest dietary vitamin K2 intake on arterial calcification. The study showed a reduction in risk for cardiovascular diseases and cardiovascular disease-related deaths by as much as 50 percent for subjects who ingested more vitamin K2. High intakes of vitamin K2 also reduced the all-cause mortality by 25 percent.

    Dietary vitamin K1, obtained from green vegetables, had no influence on excessive calcium accumulation, even when consumed in much larger quantities than K2.

    Another study in Nutrition, Metabolism, & Cardiovascular Diseases looked at the effect of vitamin K2 on arterial function, or the ability to contract and relax blood vessels. A group of 16,057 women (all free of cardiovascular diseases at baseline) aged 49–70 years were followed for eight years. The final results were again really promising: K2 vitamins were shown to reduce the risk of cardiovascular diseases. The risk of coronary heart disease dropped nine percent for every 10 micrograms of vitamin K2 (MK-7, MK- 8, and MK-9) subjects consumed. Vitamin K1 intake had no effect.

    If you are still not convinced that vitamin K2 delivers important cardiovascular benefits, there is one exciting clinical study that has really captured my attention recently and was published this year in the journal Thrombosis and Haemostasis. It shows a nutritional dose (180 mcg) of specific vitamin K2 called MenaQ7 taken daily for three years not only inhibited age-related stiffening of the artery walls, but also made significant improvements in artery flexibility—meaning calcification was actually regressed, leaving arteries healthier and more flexible.

    This study is a breakthrough because it is the first intervention trial where the results confirm the association made by previous population-based studies: that vitamin K2 intake is linked to cardiovascular risk. According to the researchers, the data demonstrated that a nutritional dose of vitamin K2 can in fact promote cardiovascular health.

    Completing the Health Picture
    The four keys to good health for everyone are nutrition (including supplements), exercise, stress management and sleep. Pills alone are not the solution, but I feel very strongly that supplements fill the nutritional gaps our diets are lacking. Vitamin K2 should be taken along with vitamin D and calcium, and it’s best to look for one supplement that contains all three ingredients combined, especially the clinically studied MenaQ7 form of vitamin K2 that can be found listed as such on the nutritional label.

    Finally, I want to emphasize that you must be proactive with your health, and I encourage you to make your doctor an active partner in your pursuit of well-being. Discuss your health goals and concerns with your physician for a personal roadmap on how to get there.