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  • (Lack of ) Quality of nutritional supplements

    In my last post, I blogged about how we must not confuse marketing with truth. They are often two different things.

    A patient I saw today was absolutely convinced that his fish oil was the best available in the world: purer, uncontaminated by mercury or pesticides--"not like that other crap on the shelves." I asked him how he knew this. "They say so," he proudly declared.

    Do you recognize this? He fell for the marketing. While there may be some truth in the manufacturer's claims, you can't believe it from the mouth of the manufacturer. True judgements about quality and purity have to come from an independent source like Consumer Reports, Consumer Lab, or the FDA.

    But the FDA doesn't regulate the quality and purity of nutritional supplements. On the positive side, this has allowed supplement manufacturers to keep costs down, not having to navigate arcane and complex regulatory restrictions.

    On the negative side, a fair number of supplement manufacturers get away with 1) producing supplements that fail to contain the stated amounts of ingredients, occasionally containing none of the essential ingredient(s), 2) contain contaminants like lead, and 3) make extravagant and often unfounded claims like "superior", "more effective", and "purer". (DHEA, for instance, is a particular landmine of poor quality. I recently suggested that a patient take DHEA; despite consistently taking 50 mg of a specific brand for several months, the blood level of DHEA-S didn't budge one bit--there was likely little or none in the capsule.)

    The Fanatic Cook at http://fanaticcook.blogspot.com has posted some very insightful discussions on this issue and the proposed FDA regulations of supplements. They're worth perusing.

    I really wish regulation weren't necessary and that the industry could have policed itself. But it clearly has failed and perhaps federal oversight is not such a bad thing, as long as the FDA regulations restrict themselves to oversight over quality and purity and not to efficacy. It's the efficacy regulation that could hogtie innovation in supplement development.

    Marketing and truth are not the same

    I often remind people: Don't confuse marketing with the truth.

    Today, I spent a total of probably an hour and a half dissuading patients that some crazed piece of marketing trying to sell them something was not the same as truth.

    I spent approximately 40 minutes alone with a woman who was absolutely convinced that:

    --Nattokinase would cure her of all heart disease. It does not. Despite the promising health benefits of natto and vitamin K2 supplementation, nattokinase is a scam with no basis in science nor logic.

    --Niacin destroys your liver and homeopathic remedies are superior. Quite simply, homeopathy = quackery. No rational thinking scientist endorses the utter nonsense practiced in this strange and outrageous set of practices that requires you to suspend all reason.

    --Sufficient vitamin D is obtainable through a "potent" multivitamin. I know of no multivitamin preparation that even begins to provide the dose of vitamin D that is actually required by adults, nor is it absorbed since these D preparations are powder based.

    --Fish oil will poison you with mercury. Accordingly, one brand of fish oil claims to be the only safe form. Those of you following these posts, or the reports of the USDA and FDA, as well as the reports of Consumer Reports and Consumer Lab (www.consumerlab.com) know that, unlike fish itself, there is no mercury in fish oil capsules.

    --All coronary atherosclerotic heart disease is caused by heavy metal poisoning. Thus chelation with EDTA represents a cure for heart disease.


    People are inundated with marketing that promise extravagant cures, remove need for any medication, make you smarter, sexier, thinner, and on and on.

    If you see a TV ad for Ford that says they make the best cars in the U.S., do you immediately run out and put a For Sale sign on your GM car and buy a Ford? No, of course not. You recognize the ad for what it is: marketing. It may be true, but a TV commercial is not enough to convince you.

    Then why would an ad promising extraordinary cures for cancer or heart disease convince you that this is true? It should not. Marketing ads should only serve to alert you to the possibility of value or benefit, but should never-- never--stand alone as proof. Take marketing for what it is: marketing of a product or service, not a scientific report, not a factual report, not news.

    Marketing is advertising. Period.

    More on erectile dysfunction

    Several facts on erectile dysfunction and coronary plaque:


    If you have erectile dysfunction, there's at least a 50% chance you also have coronary plaque.

    If you have coronary plaque by a CT heart scan, there's a 50% chance you have erectile dysfunction.

    If you have symptomatic coronary disease (chest pains, breathlessness, prior heart attack), there's a 90% chance you also have erectile dysfunction.


    Coronary disease is characterized by a dysfunctional state of the "endothelium", or inner lining of the coronary arteries. Erectile dysfunction is characterized by dysfunction of the endothelium of the penile circulation. Same phenomenon, different territories. (There are other differences, of course, but the two conditions share this fundamental phenomenon.)


    If you have any doubts about the physiologic effects of the supplement, l-arginine, just give it a try if you have erectile dysfunction. The erection enhancing effects alone should convince you that a genuine artery-dilating effect is exerted by this very powerful nutritional supplement.

    If l-arginine fails by itself to restore full erectile capacity, there are additional strategies, both nutritional and medical, that you can consider.

    Our newest Track Your Plaque Special Report on erectile dysfunction is coming out any day now.

    High LDL cholesterol--only

    As a sequel to my last post, just how often can we blame an isolated high LDL cholesterol as the cause of coronary plaque and a heart scan score?

    In other words, how often does someone prove to have only LDL cholesterol as the cause of a heart scan score . . . and nothing else? No low HDL, small LDL, lipoprotein(a), a post-prandial (after-eating) intermediate-density lipoprotein, inflammatory responses, phospholipase A2, high triglycerides, vitamin D deficiency, etc.

    Rarely. In fact, I can truly count the number of people who have only LDL cholesterol as their sole cause of coronary atherosclerotic plaque on one hand. It is really an infrequent situation.

    Far more commonly, people have 5, 6, 7 or more reasons for coronary plaque.

    Thus, the idea that a statin drug to reduce LDL will cure heart disease is completely folly. It does happen--but rarely. I think I've seen it happen twice. Much more commonly, a program that addresses all the causes of coronary plaque yields far superior benefits.

    In my view, an effort to identify all the causes is relatively easy, makes far better sense, and provides you much greater assurance that you will succeed in conquering heart disease and removing its evil influence from your life.

    Heart disease = statin deficiency

    Judging from the conversations I hear from colleagues, what I hear from the media, and drug company advertising, you'd think that heart disease has one cause--a deficiency of statin drugs.

    As their thinking goes, if you have coronary disease, you need a statin drug (Lipitor, Zocor, Crestor, pravachol, etc.). If you have progressive coronary disease, you need more statin drug. If you have a heart attack while on a statin drug, you need even more statin drug.

    Some "experts" have even proposed that we do away with LDL cholesterol and we just give everybody a statin drug at high doses.

    Does this make any sense to you?

    Doesn't it make better sense that if someone has progressive heart disease or heart attack while on a statin drug, then target the other causes largely unaffected by a statin drug? Perhaps if LDL cholesterol remains high on the statin drug, then a higher dose is justified. But more often than not, it's not a high LDL on statin drugs that responsible, it's other causes. And there's many of them: low HDL, VLDL, IDL, Lp(a), deficiency of omega-3 fatty acids, inflammatory processes, vitamin D deficiency, among others. (An important exception to this is when the conventional calculated LDL substantially underestimates true LDL as measured by LDL particle number by NMR, apoprotein B, or 'direct' LDL.)

    Imagine someone has pneumonia. After 2 weeks of antibiotics, they are only partly better. The solution: a higher dose of the same antibiotic--but never question if it was the right antibiotic in the first place. That's what is going on in heart disease.

    The doctors have been brainwashed into believing this $22 billion dollar per year bit of propaganda. The drug companies actively try to recruit the public into believing the same. Don't fall for it.

    The statin drugs do indeed have a role. But they are not the complete answer. More of the same when disease progresses makes no sense at all.

    Fish oil and mercury

    I often get questions about the mercury content in fish oil. I've even had patients come to the office saying their primary care doctor told them to stop fish oil to avoid mercury poisoning.

    Manufacturers of fish oil also make claims that this product or that ("super-concentrated", "pharmaceutical grade", "purified", etc.) is purer or less contaminated than competitors' products. The manufacturers of the "drug" Omacor, or prescription fish oil, have added to the confusion by suggesting that their product is the most pure of all, since it is the most concentrated of any fish oil preparation (900 mg EPA+DHA per capsule). They claim that "OMACOR is naturally derived through a unique, patented process that creates a highly concentrated, highly purified prescription medicine. By prescribing OMACOR® (omega-3-acid ethyl esters), a prescription omega-3, your doctor is giving you a concentrated and reliable omega-3. Each OMACOR capsule contains 90% omega-3 acids (84% EPA/DHA*). Nonprescription omega-3 dietary supplements typically contain only 13%-63% EPA/DHA."

    How much truth is there in these concerns?

    Let's go to the data published by the USDA, FDA, and several independent studies. Let's add to that the independent (and therefore presumably unbiased) analyses provided by Consumer Reports and Consumer Labs (www.consumerlab.com). How much mercury has been found in fish oil supplements?

    None.

    This is different from the mercury content of whole fish that you eat. Predatory fish that are at the top of the food chain and consume other fish and thereby concentrate organic methyl mercury, the toxic form of mercury. Thus, shark, swordfish, and King mackerel are higher in mercury than sardines, herring, and salmon.

    The mercury content of fish oil capsules have little to do with the method of processing and much more with the animal source of oil. Fish oil is generally obtained from sardines, salmon, and cod, all low in mercury. Fish oil capsules are not prepared from swordfish or shark.

    Thus, concerns about mercury from fish oil--regardless of brand--are generally unfounded, according to the best information we have. Eating whole fish--now that's another story for another time. But you and I can take our fish oil to reduce triglycerides, VLDL, IDL, small LDL, and heart attack risk without worrying about mercury.

    How much omega-3s are enough?

    The basic dose we advocate for the Track Your Plaque program is 1200 mg per day of EPA + DHA, the essential omega-3 fatty acids.

    1200 mg EPA+DHA is generally obtainable by taking 4 capsules of 1000 mg of fish oil, since the majority of preparations contain 180 mg EPA and 120 mg DHA per capsule.

    But how will you know if a higher dose wouldn't be even better?

    The principal parameter to look at is triglycerides. If triglycerides remain above 60 mg/dl, we usually consider increasing fish oil.

    Another measure that's very important is intermediate-density lipoprotein, or IDL, also called "remnant lipoproteins" on a VAP panel. Persistence of any IDL or remnant lipoproteins is reason to consider more fish oil. Most commonly, if there is some persistence of either, we increase fish oil to 6000 mg per day of a standard preparation, or 1800 mg/day of EPA+DHA.

    The only time we see persistence of IDL or remnant lipoproteins with this higher dose is when triglycerides are really high. If starting triglycerides are, for instance, 500 mg/dl, then even this higher dose may be insufficient. This is when more highly concentrated preparations of fish oil may be necessary, occasionally even the prescription form, Omacor. (We currently use Omacor only when high doses of EPA+DHA are required, most because of its outrageous cost. Two capsules per day costs around $120 per month; three capsules per day to provide 1800 mg/day of EPA+DHA costs $180 per month. I think this is outrageous and so we use it only when absolutely necessary.)

    You might even argue that a higher dose of 1800 mg EPA+DHA, or 6000 mg of a standard capsule, might be preferable for more assured reduction of heart attack risk--even when triglycerides and IDL are perfectly under control. I wouldn't argue with you. But you won't observe any measurable feedback that tells you that a heightened effect is being obtained. I take that dose myself, in fact, despite the fact that elimination of wheat products and weight loss was sufficient to drop my triglycerides to the target level. I figure it's a small additional effort for added peace of mind.

    Repentance for past sins

    If you are new to the Track Your Plaque program and would like to jump start your effort, or if you are struggling with losing weight and excess weight is a part of the situation that created your CT heart scan score, then don't forget about fasting.

    Fasting is the cessation of eating. However, recall from the Track Your Plaque Special Report, Fasting: Fast Track to Control Plaque at http://www.cureality.com/library/fl_04-012fasting.asp, there are many variations on fasting that permit some intake of healthy foods. (Thus, they are not, in the strict sense, "fasting". Accurate or no, there are variations that may be more palatable or do-able in the real world by real people.)

    My personal favorite method to fast is to use a low-sugar, low-fat soy milk such as Light Silk, available at most major grocery stores. This high-protein, low-fat, low-sugar soy milk takes the edge off hunger and provides a minimal quantity of calories. A minimum of 72 hours is required for substantial results. (My one reservation about this brand of soy milk is that the Fanatic Cook claims that the manufacturer, Dean Foods, is a factory farm operation that abuses livestock--a discussion for another day.)

    Fasting yields more than weight loss. It refreshes your appreciation for food. It reawakens you to the amount and quality of food you've been putting in your body. Fasting also allows you to recognize just how bad you might feel from the diet you were eating.

    You also emerge from a fast with a reduced appetite and a renewed sense of appreciation for food. It makes the discipline of healthy eating a lot easier when you break your fast.

    I tell people that fasting is not punishment. It is a form of enlightenment, of re-experiencing food and life. Fasting allows you to "catch up" on all the indiscretions you've been guilty of over the years.

    It also provides enormous advantage in gaining control over coronary plaque.

    A fanatic for Fanatic Cook

    If you haven't already done so, I'd urge you to peruse the wonderfully insightful, sophisticated, and biting commentary provided by the Fanatic Cook Blog at http://fanaticcook.blogspot.com.

    She (I assume it's a she) has been discussing the proposed Safe Food Act recently, an effort to address all the dangers in foods that have come to attention lately, like melamine in pet food and E. coli in bagged spinach. Her most recent post is:

    Nebraska Farm Bureau Thinks Food Safety Act Bad Idea, the latest in a series of posts exploring this issue.

    I'd like to know who the Fanatic Cook is, or "Bix" as she calls herself. (I assume it's a "she" but I don't really know that for a fact.) I've corresponded with her and she prefers to remain anonymous for unspecified reasons. I'd like to know who this person is both for a more secure sense of credibility, as well as I'd simply like to know who can write so intelligently and why. I suspect that she's a professional nutrition scientist or something along those lines, since the level of insight into many scientific issues is quite impressive. Her Blogs will make great material for a book, if compiled and organized. Watch out for this one.

    Erectile dysfunction and coronary plaque

    Erectile dysfunction (ED), previously known as "impotence," and coronary atherosclerotic plaque go hand in hand.

    A recent study in men with advanced coronary disease showed that 93% experienced ED. The participants in the Track Your Plaque program, for the most part, do not have advanced coronary atherosclerosis, but have an earlier form detected by a CT heart scan.

    What proportion of men with asymptomatic coronary plaque as measured by a CT heart scan have ED? Around 50%. In other words, it's not a rare occurrence.

    The conversation about ED (and even its renaming from impotence) really gained momentum with the development of ED-drugs like Viagra and Cialis. The drugs are reasonably effective and safe. However, you will hear little about all the strategies that can either precede your need for these drugs and/or enhance your response to these drugs if the response is partial. That part of the conversation, of course, doesn't yield loads of drug company revenues.

    One of the most helpful and specific nutritional supplements available that can partially restore the nitric oxide-deficiency of ED is l-arginine. L-arginine is the body's source of nitric oxide (NO), the master dilator (relaxing agent) for all arteries of the body. NO dilates penile arteries, it dilates coronary arteries. Lack of NO disables the penile capacity for erection and encourages growth of coronary atherosclerotic plaque. Track Your Plaque Members are already familiar with l-arginine as a facilitator of coronary plaque regression.

    We will detail the supplements that you can use safely in your Track Your Plaque program to both enhance erectile function if you suffer ED, as well as impact positively on coronary health, in an upcoming and detailed Special Report on the www.cureality.com website.
    Cureality | Real People Seeking Real Cures

    More on the American Heart Association Check Mark program

    Take a look at the list of foods on the American Heart Association's (AHA) Check Mark endorsement program (below). After I saw the list, I was convinced either that the people who designed the program are either startlingly ignorant, or the AHA simply does this for money.

    Many of these foods have nothing to do with health, heart or otherwise. In fact, many of these foods are prominent culprits that contribute to the American epidemic of obesity. There are cured meats with sodium nitrite (a potent cause of colon cancer). Some of these companies have been accused of unhealthy food manufacturing practices. Tyson Foods, for instance, has been in court many times defending their brutal factory farm practices and were the focus of a federal investigation for paying bribe money to USDA Secretary, Mike Espy. (Espy was acquitted but two Tyson executives were convicted, only to be later pardoned by then President Bill Clinton.)

    This is a smarmy list to be included on. Though there are some rare healthy exceptions on the list, from the Track Your Plaque viewpoint, this is a list of shame, foods that have no place in a genuinely heart healthy nutrition program.



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    California Giant
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    Campbell's Chunky Healthy Request Hearty Beef Barley
    Campbell's Chunky Healthy Request New Englad Clam Chowder
    Campbell's Chunky Healthy Request Old Fashioned Vegetable Beef
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    Campbell's Low Sodium Tomato Juice
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    Campbell's Select Healthy Request Savory Chicken and Long Grain Rice
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    Campbell's V8 Regular Vegetable Juice
    Campbell's V8 V.Fusion Light Peach Mango
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    Essential Antioxidants V8 100% Vegetable Juice
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    Prego Heart Smart Mushroom Italian Sauce
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    Cargill Meat Solutions
    96/4 All Natural Extra Lean Ground Beef
    Excel's Tender Choice 97% Fat Free Pork Tenderloins
    Excel's Tender Choice Extra Lean Boneless Pork Loin
    Our Certified 100% Pure All Natural Ground Beef 96/4
    Sterling Silver Extra Lean Pork Tenderloins - 12% Marination
    Sterling Silver Lean Boneless Pork Loin - 12% Marination

    Chiquita Brands Company, N.A.
    Chiquita Bananas

    Clearwater Seafoods Limited Partnership
    Clearwater Frozen Arctic Surf Clams

    Cliffstar Corporation
    Deerfield Farms No Sugar Added 100% Grape Juice (Purple)
    Safeway 100% Grape Juice (Purple)
    Sam's Choice 100% Grape Juice (Purple)
    Walgreens 100% Grape Juice (Purple)

    Clougherty Packing Company
    Farmer John® California Natural® 4% Fat Extra Lean Ground Pork
    Farmer John® California Natural® Premium Extra Lean Boneless Pork Tenderloins


    Minute Maid Premium Blends - Orange Passion Calcium Juice-Frozen
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    Colleen Strawberries, Inc. / EKT Farms
    Colleen Strawberries

    ConAgra Dairy Foods
    Egg Beaters 99% Real Eggs-Frozen
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    Egg Beaters Cheese & Chive
    Egg Beaters Egg Whites
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    Egg Beaters Southwestern

    ConAgra Food Service
    Lamb Weston Sweet Things Mashed Sweet Potatoes, Frozen

    ConAgra Frozen Foods
    Healthy Choice Café Selections Apple Glazed Pork Medallions
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    Healthy Choice Old Fashioned Chicken Noodle Microwavable Bowl Soup
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    Hunt's Organic Pasta Sauce Roasted Garlic
    Hunt's Organic Whole Tomatoes
    Hunt's Tomatoes Crushed in Thick Tomato Puree
    Hunt's Tomatoes Diced
    Hunt's Tomatoes Diced in Sauce
    Hunt's Tomatoes Diced with Mild Green Chilies
    Hunt's Tomatoes Diced-Green Pepper, Celery & Onions
    Hunt's Tomatoes Petite Diced
    Hunt's Tomatoes Stewed-No Salt Added
    Hunt's Tomatoes Whole
    Hunt's Tomatoes Whole-No Salt Added
    Orville Redenbacher's Mini Bags Smart Pop Butter Microwave Popcorn
    Orville Redenbacher's Mini Bags Smart Pop Butter/Kettle Corn Microwave Popcorn Variety Pack
    Orville Redenbacher's Mini Bags Smart Pop Kettle Corn Microwave Popcorn
    Orville Redenbacher's Organic Kernal Jar
    Orville Redenbacher's Organic Smart Pop Butter Microwave Popcorn
    Orville Redenbacher's Original Kernal Jar
    Orville Redenbacher's Original Kernal Jug
    Orville Redenbacher's Smart Pop Butter Microwave Popcorn
    Orville Redenbacher's Smart Pop Kettle Corn Microwave Popcorn
    Orville Redenbacher's Smart Pop Movie Theater Butter Microwave Popcorn
    Orville Redenbacher's White Kernal Jar
    Rosarita Diced Green Chilies
    Rosarita Green Chilies Strips
    Rosarita Whole Green Chilies

    ConAgra Refrigerated Foods
    Healthy Choice Deli Thin Baked Cooked Ham
    Healthy Choice Deli Thin Honey Ham
    Healthy Choice Deli Thin Honey Ham & Honey Roasted & Smoked Turkey Breast Variety Pack
    Healthy Choice Deli Thin Honey Roasted & Smoked Turkey Breast
    Healthy Choice Deli Thin Mesquite Turkey Breast
    Healthy Choice Deli Thin Oven Roasted Chicken Breast
    Healthy Choice Deli Thin Oven Roasted Turkey Breast
    Healthy Choice Deli Thin Pastrami
    Healthy Choice Deli Thin Smoked Ham
    Healthy Choice Deli Thin Smoked Turkey Breast
    Healthy Choice Deli-97% Fat Free Honey Ham
    Healthy Choice Deli-97% Fat Free Honey Maple Ham
    Healthy Choice Deli-97% Fat Free Medium Cooked Roast Beef-20% Marination
    Healthy Choice Deli-97% Fat Free Mesquite Smoked Honey Ham
    Healthy Choice Deli-97% Fat Free Roast Beef-20% Marination
    Healthy Choice Deli-97% Fat Free Smoked Ham
    Healthy Choice Deli-97% Fat Free Virginia Brand Ham
    Healthy Choice Deli-98% Fat Free Browned Chicken Breast
    Healthy Choice Deli-98% Fat Free Chicken Breast
    Healthy Choice Deli-98% Fat Free Golden Oven Roasted Turkey Breast
    Healthy Choice Deli-98% Fat Free Honey Roasted & Smoked Turkey Breast with Broth
    Healthy Choice Deli-98% Fat Free Mesquite Smoked Chicken Breast
    Healthy Choice Deli-98% Fat Free Mesquite Smoked Turkey Breast
    Healthy Choice Deli-98% Fat Free Smoked Turkey Breast
    Healthy Choice Deli-98% Fat Free Southwest Grill Turkey Breast
    Healthy Choice Deli-Honey Cured Ham
    Healthy Choice Deli-Honey Roasted & Smoked Turkey Breast
    Healthy Choice Deli-Oven Roasted Chicken Breast
    Healthy Choice Deli-Oven Roasted Turkey Breast
    Healthy Choice Deli-Roast Beef-20% Marination
    Healthy Choice Deli-Virginia Brand Cooked Ham
    Healthy Choice Deluxe Thin-Sliced Baked Cooked Ham
    Healthy Choice Deluxe Thin-Sliced Honey Ham
    Healthy Choice Deluxe Thin-Sliced Honey Ham/Oven Roasted Turkey Breast Variety Pack
    Healthy Choice Deluxe Thin-Sliced Oven Roasted Turkey Breast
    Healthy Choice Honey Ham
    Healthy Choice Low Fat Smoked Sausage
    Healthy Choice Pre-Sliced Sandwich Solutions Roast Beef
    Healthy Choice Pre-Sliced Sandwich Solutions Skinless Oven Roasted Turkey Breast
    Healthy Choice Pre-Sliced Sandwich Solutions Skinless Smoked Turkey Breast
    Healthy Choice Pre-Sliced Sandwich Solutions Virginia Brand Ham
    Healthy Choice Virginia Brand Ham
    Healthy Choice Zip Pack Cooked Ham
    Healthy Choice Zip Pack Honey Ham
    Healthy Choice Zip Pack Oven Roasted Chicken Breast
    Healthy Choice Zip Pack Oven Roasted Turkey Breast
    Hebrew National 97% Fat Free Beef Franks

    ConAgra Retail Foods
    Healthy Choice Hearty 100% Whole Grain Bread
    Healthy Choice Hearty 7-Grain Bread

    Coolham Holdings, Inc. DBA SunMilk Dairy Co.
    SunMilk-Fat Free Milk with Sunflower Oil (The Taste of 1%)
    SunMilk-Fat Free Milk with Sunflower Oil (The Taste of 2%)

    Cooper Farms
    Cooper Farms All Natural Turkey Breast Fillet

    Crider, Inc.
    Kirkland Signature Premium 99% Fat Free Chunk Chicken Breast

    Dare Foods Incorporated
    Breton Reduced Fat & Sodium Wheat Crackers

    El Aguila Food Products, Inc.
    El Aguila Stoneground Corn Tortillas

    Eurofresh Inc.
    Eurofresh Campari Tomatoes

    FPL Foods, LLC
    96/4 All Natural Extra Lean Ground Beef

    Farmland Foods
    Farmland 97% Fat Free Fresh Ground Pork
    Farmland Nutrition Wise 97% Fat Free Boneless Center Cut Pork Loin Filet
    Farmland Nutrition Wise Boneless Butterfly Cut Pork Loin Chops
    Farmland Nutrition Wise Boneless Center Cut Pork Loin
    Farmland Nutrition Wise Boneless Center Cut Pork Loin Chops
    Farmland Nutrition Wise Boneless Center Cut Pork Loin Roast
    Farmland Nutrition Wise Boneless Pork Chops - America's Cut
    Farmland Nutrition Wise Boneless Pork Tenderloin
    Farmland Nutrition Wise Boneless Pork Top Round Roast
    Farmland Nutrition Wise Boneless Pork Top Round Steak
    Farmland Nutrition Wise Boneless Sirloin Tip Pork Roast
    Farmland Nutrition Wise Pork Cube Steak
    Farmland Nutrition Wise Pork Cubes
    Farmland Nutrition Wise Pork Scallopini
    Farmland Nutrition Wise Pork Strips

    Fieldale Farms Corporation
    Jewel All Natural 99% Fat Free Boneless Skinless Chicken Breasts with Rib Meat
    Jewel All Natural 99% Fat Free Chicken Breast Tenders
    Our Premium 98% Fat Free Boneless Skinless Breast with Rib Meat - 15% Marination
    Springer Mountain Farms All Natural 98% Fat Free Boneless Skinless Breasts

    Florida's Natural Growers
    Florida's Natural Calcium & Vitamin D No Pulp Orange Juice
    Florida's Natural Growers Style Most Pulp Orange Juice
    Florida's Natural Home Squeezed Calcium & Vitamin D with Pulp Orange Juice
    Florida's Natural Home Squeezed with Pulp Orange Juice
    Florida's Natural Original No Pulp Orange Juice

    FoodTech International
    Veggie Patch California Veggie Burgers

    Foster Poultry Farms
    Foster Farms 98% Fat Free Honey Roasted & Smoked Breast of Turkey
    Foster Farms 98% Fat Free Oven Roasted Breast of Turkey
    Foster Farms 98% Fat Free Oven Roasted Chicken Breast
    Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Fillets
    Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Steaks
    Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breast Tenders
    Foster Farms 99% Fat Free Honey Roasted & Smoked Turkey Breast
    Foster Farms 99% Fat Free Oven Roasted Turkey Breast
    Foster Farms All Natural 99% Fat Free Boneless & Skinless Chicken Breast Tenders (8% Marination)
    Foster Farms Fresh & Easy 99% Fat Free 100% Natural Boneless & Skinless Breast Fillets
    Kirkland Signature/Foster Farms 99% Fat Free 100% Natural Boneless & Skinless Breasts
    Kirkland Signature/Foster Farms All Natural 99% Fat Free Boneless & Skinless Chicken Breasts (8% Marination)

    Fresh Express Incorporated
    Chiquita Apple Bites
    Fresh Express American Salad
    Fresh Express Hearts of Romaine Salad
    Fresh Express Italian Salad
    Fresh Express Triple Hearts Salad

    GFA Brands, Inc.
    Smart Balance Smart 'N Healthy Deluxe Microwave Popcorn
    Smart Beat Healthy Fat Free Non-Dairy Slices - American Flavor
    Smart Beat Healthy Fat Free Non-Dairy Slices - Lactose Free
    Smart Beat Smart Squeeze Nonfat Margarine Spread

    General Mills, Inc.
    Apple Cinnamon Cheerios
    Berry Berry Kix
    Berry Burst Cheerios-Strawberry Banana
    Berry Burst Cheerios-Triple Berry
    Berry Lucky Charms
    Cheerios
    Cheerios Crunch
    Chocolate Lucky Charms
    Cocoa Puffs
    Cookie Crisp
    Count Chocula
    Dora The Explorer
    Frosted Cheerios
    Fruity Cheerios
    Heart Smart Bisquick
    Honey Nut Cheerios
    Kix
    Lucky Charms
    Multi-Grain Cheerios
    Oatmeal Crisp Crunchy Almond
    Oatmeal Crisp Hearty Raisin
    Oatmeal Crisp Maple Brown Sugar
    Pillsbury Oven-Baked Whole Wheat Dinner Rolls
    Progresso Healthy Favorites Chicken & Wild Rice Soup
    Progresso Healthy Favorites Chicken Gumbo Soup
    Progresso Healthy Favorites Chicken Noodle Soup
    Progresso Healthy Favorites Garden Vegetable Soup
    Progresso Healthy Favorites Italian-Style Wedding Soup
    Progresso Healthy Favorites Minestrone Soup
    Total Cranberry Crunch
    Total Honey Clusters
    Total Raisin Bran
    Total with Strawberries
    Trix
    Whole Grain Total
    Yogurt Burst Cheerios Strawberry
    Yogurt Burst Cheerios Vanilla

    Hain Celestial Group, Inc., The
    DeBoles Organic Ancient Grain Penne
    Health Valley Empower Cereal
    Hodgson Mill, Inc.
    Hodgson Mill Oat Bran All Natural Hot Cereal
    Hodgson Mill Whole Wheat Angel Hair
    Hodgson Mill Whole Wheat Fettuccine
    Hodgson Mill Whole Wheat Lasagna
    Hodgson Mill Whole Wheat Penne
    Hodgson Mill Whole Wheat Spinach Spaghetti
    Hodgson Mill Whole Wheat Whole Grain Elbows
    Hodgson Mill Whole Wheat Whole Grain Spaghetti

    Indiana Packers Corp.
    Indiana Kitchen All Natural Boneless Pork Sirloin Roast
    Indiana Kitchen All Natural Pork Tenderloin

    Interstate Brands Corporation
    Home Pride Whole Grains 100% Honey Whole Wheat Bread
    Home Pride Whole Grains 100% Whole Wheat Bread
    Merita Country Whole Grains 100% Whole Wheat Bread

    KFP International, Ltd.
    Kedem 100% Pure Concord Grape Juice-No Sugar Added

    Kansas City Steak Company
    Kansas City Seasoned Beef Chuck Tender Steak
    Kansas City Seasoned Beef Medallions

    Kashi Company
    Kashi Heart to Heart Honey Oat Waffles
    Kashi Heart to Heart Honey Toasted Cereal
    Kashi Heart to Heart Instant Oatmeal - Apple Cinnamon
    Kashi Heart to Heart Instant Oatmeal - Golden Brown Maple
    Kashi Heart to Heart Instant Oatmeal - Raisin Spice
    Kashi Heart to Heart Oat Flakes & Wild Blueberry Clusters

    Kellogg USA, Inc.
    Kellogg's All-Bran Bran Buds
    Kellogg's All-Bran Extra Fiber
    Kellogg's All-Bran Original
    Kellogg's Frosted Mini-Wheats - Strawberry Delight
    Kellogg's Frosted Mini-Wheats - Vanilla Creme
    Kellogg's Frosted Mini-Wheats Big Bite
    Kellogg's Frosted Mini-Wheats Bite Size
    Kellogg's Frosted Mini-Wheats Maple & Brown Sugar
    Kellogg's Smart Start Antioxidants - Original
    Kellogg's Smart Start Healthy Heart - Maple & Brown Sugar
    Kellogg's Smart Start Healthy Heart - Original
    Kellogg's Smart Start Healthy Heart Cinnamon Raisin

    King Soopers
    Ground Beef 96/4 Extra Lean

    Kroger Company, The
    Kroger Moist & Tender Silver Platter Pork Tenderloin

    Laura's Lean Beef Company
    Laura's Lean Beef - Beef Pot Roast Au Jus
    Laura's Lean Beef - Shredded Beef with Barbecue Sauce
    Laura's Lean Beef 4% Fat Ground Round
    Laura's Lean Beef 4% Ground Sirloin
    Laura's Lean Beef Sirloin Steak

    LiDestri Foods, Inc.
    Francesco Rinaldi No Salt Added Traditional Pasta Sauce

    Lido Veal & Lamb Inc.
    Veal USA Boneless Veal Shoulder Roast from Lido Veal
    Veal USA Low Fat Ground Veal from Lido Veal
    Veal USA Veal Leg Cutlets from Lido Veal
    Veal USA Veal Stew from Lido Veal

    M & I Seafood Manufacturing Inc.
    Chesapeake Bay Gourmet Crab Cakes

    MW Polar Foods
    Polar All Natural Chunk Light Tuna in Water
    Polar All Natural Solid White Albacore in Water
    Polar Chunk Light Tuna in Water
    Polar Solid White Albacore Tuna in Water

    Malt-O-Meal Company
    Malt-O-Meal Balance
    Malt-O-Meal Crispy Rice
    Malt-O-Meal Frosted Mini Spooners
    Malt-O-Meal Honey & Oat Blenders
    Malt-O-Meal Honey Nut Scooters
    Malt-O-Meal Hot Wheat Cereal - Chocolate
    Malt-O-Meal Hot Wheat Cereal - Maple & Brown Sugar
    Malt-O-Meal Hot Wheat Cereal - Original
    Malt-O-Meal Maple & Brown Sugar Mini Spooners
    Malt-O-Meal Mom's Best 100% Natural Quick Oats
    Malt-O-Meal Mom's Best Instant Oatmeal - Apples & Cinnamon
    Malt-O-Meal Mom's Best Instant Oatmeal - Maple & Brown Sugar
    Malt-O-Meal Mom's Best Instant Oatmeal Variety Pack - Maple & Brown Sugar/Apples & Cinnamon/Cinnamon & Spice
    Malt-O-Meal Raisin Bran
    Malt-O-Meal Scooters

    Maple Leaf Consumer Foods
    Maple Leaf Sodium Reduced 98% Fat Free Cooked Ham with Natural Juices

    Maverick Ranch Association
    Maverick Ranch 96/4 Extra Lean Grass Fed Organic Ground Beef
    Maverick Ranch 96/4 Extra Lean Natural Ground Buffalo
    Maverick Ranch 96/4 Extra Lean Natural Ground Pork Sirloin
    Maverick Ranch Free-Range Chicken-All Natural Air Chilled Boneless Skinless Chicken Breast
    Maverick Ranch NaturaLite 96/4 Extra Lean Ground Beef Round
    Maverick Ranch NaturaLite Beef - 96/4 Extra Lean Ground Beef Chuck
    Maverick Ranch NaturaLite Beef - 96/4 Extra Lean Ground Beef Sirloin
    Maverick Ranch Natural Beef Cubed Steak
    Maverick Ranch Natural Beef Top Sirloin Steak
    Maverick Ranch Natural Buffalo Top Sirloin Steak
    Maverick Ranch Natural Center Cut Pork Loin Chops
    Maverick Ranch Natural Lite 96/4 Extra Lean Natural Ground Beef
    Maverick Ranch Natural Pork 4% Fat Extra Lean Pork Tenderloin
    Maverick Ranch Natural Skinless Chicken Drumsticks
    Maverick Ranch Natural Skinless Chicken Thighs
    Maverick Ranch Organic Air-Chilled Boneless Skinless Chicken Breasts

    Mayoli Inc.
    Mayoli All Natural Reduced Fat Mayonnaise Dressing with Pure Olive Oil

    McNeil Nutritionals, LLC
    LACTAID® Calcium-Fortified Fat Free Milk
    LACTAID® Fat Free Milk

    Meijer Distribution, Inc.
    Meijer Purple Grape Juice

    Michael Foods, Inc.
    All Whites Egg Whites - White Cheddar
    Better 'n Eggs Ham & Cheese
    Better 'n Eggs Plus
    Better 'n Eggs Three Cheese
    Kirkland Signature Egg Starts
    Kroger Break-Free 100% Liquid Egg Whites
    Kroger Break-Free Real Egg Product
    Papetti Foods All Whites - 100% Liquid Egg Whites
    Papetti Foods Better 'n Eggs

    Mills Family Farms
    Mills Family Farms Green Cascade Mix-Baby Romaine & Baby Green Leaf
    Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Green Leaf
    Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Red Leaf
    Mills Family Farms Wholeaves Sandwich & Salad Lettuce - Romaine
    Milton's Baking Company
    Milton's Baking Classics Cinnamon Raisin Wheat Bread
    Milton's Baking Classics Corn Bread
    Milton's Baking Classics Oat Bran Bread
    Milton's Baking Classics Wheat Bread
    Milton's Healthy Multi-Grain Plus Bread
    Milton's Healthy Whole Grain Plus Bread
    Milton's Original Healthy Multi-Grain Bread
    Milton's Whole Grains 100% Whole Wheat Bread

    Motts LLP
    Yoo-hoo Lite Chocolate Drink

    Murray's Free Roaming Chicken, Inc.
    Murray's Extra Lean 99% Fat Free Boneless & Skinless Chicken

    New World Pasta Company
    Ronzoni Healthy Harvest Multi-Grain Pasta-Fusilli
    Ronzoni Healthy Harvest Multigrain Pasta - Spaghetti Style
    Ronzoni Healthy Harvest Whole Wheat Blend Extra Wide Noodle - Style
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Linguine
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Penne Rigate
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Rotini
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Spaghetti Style
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta - Thin Spaghetti
    Ronzoni Healthy Harvest Whole Wheat Blend Pasta-Lasagna
    Ronzoni Healthy Harvest Whole Wheat Blend Wide Noodle - Style

    Nonna's Kitchen, Inc.
    Columbus Reduced Sodium Turkey Breast

    North American Beverage Company
    Chocolate Moose - All Natural Premium Milk Chocolate Drink
    Chocolate Moose - Cookies & Cream Premium Milk Chocolate Drink
    Mega Moose Energy Drink-Strawberry Blast

    Nulaid Foods Inc.
    Nulaid ReddiEgg Real Egg Product

    Oberto Sausage Company
    Kirkland Signature Premium Brisket Roast Beef

    Old Orchard Brands LLC
    Old Orchard 100% Grape Juice
    Old Orchard 100% Grape Juice - Frozen Concentrate

    POM Wonderful, LLC
    POM Wonderful Fresh Pomegranate Arils
    POM Wonderful Frozen Pomegranate Arils
    POM Wonderful Pomegranates

    Packerland Processing Co., Inc.
    Meijer Extra Lean Ground Beef 96/4

    Peco Foods, Inc.
    Member's Mark All Natural Boneless Skinless Chicken Breasts with Rib Meat
    Member's Mark All Natural Boneless Skinless Chicken Tenderloins

    Pepperidge Farm, Inc.
    Pepperidge Farm 100% Natural 100% Whole Wheat Bread
    Pepperidge Farm 100% Natural 9 Grain Bread
    Pepperidge Farm 100% Natural German Dark Wheat Bread
    Pepperidge Farm 100% Natural Honey Flax Bread
    Pepperidge Farm 100% Whole Wheat Bagels
    Pepperidge Farm 100% Whole Wheat English Muffins
    Pepperidge Farm 100% Whole Wheat Hearty Texture Whole Grain Bread
    Pepperidge Farm 100% Whole Wheat Mini Bagels
    Pepperidge Farm 15 Grain Hearty Texture Whole Grain Bread
    Pepperidge Farm Farmhouse Soft 100% Whole Wheat Bread
    Pepperidge Farm Golden Harvest Grains Hearty Texture Whole Grain Bread
    Pepperidge Farm Light Style 7 Grain Bread
    Pepperidge Farm Light Style Soft Wheat Bread
    Pepperidge Farm Oatmeal Hearty Texture Whole Grain Bread
    Pepperidge Farm Soft Honey Oat Smooth Texture Whole Grain Bread
    Pepperidge Farm Soft Honey Whole Wheat Smooth Texture Whole Grain Bread
    Pepperidge Farm Very Thin Soft 100% Whole Wheat Bread
    Pepperidge Farm Whole Grain Multi-Grain Bagels
    Pepperidge Farm Whole Grain Swirl Bread - Cinnamon
    Pepperidge Farm Whole Grain Swirl Bread - Cinnamon with Raisins

    Perdue Farms, Inc.
    Perdue Individually Frozen All Natural 99% Fat Free Chicken Tenderloins
    Perdue Tender & Tasty 99% Fat Free Individually Frozen Boneless Skinless Chicken Breasts
    Perdue Tender & Tasty 99% Fat Free Individually Wrapped Boneless Skinless Chicken Breasts
    Perdue/Kirkland Signature Individually Frozen All Natural 99% Fat Free Boneless Skinless Chicken Breasts

    Pilgrim's Pride Corporation
    Eat Well Stay Healthy Chicken Breast Salad
    Eat Well Stay Healthy Fresh Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
    Eat Well Stay Healthy Fresh Boneless Skinless Chicken Thin Sliced Breasts with Rib Meat (15% Chicken Broth)
    Eat Well Stay Healthy Fresh Chicken Breast Tenderloins (15% Chicken Broth)
    Eat Well Stay Healthy Fully Cooked Rotisserie Skinless Chicken Split Breasts - Garden Herb
    Gold Kist Farms 100% Natural 99% Fat Free Boneless Skinless Chicken Breast
    Gold Kist Farms All Natural 99% Fat Free Boneless Skinless Breasts
    Gold Kist Farms/Kirkland Signature All Natural 99% Fat Free Boneless Skinless Breasts
    HyVee/Country Pride 97% Fat Free Boneless Skinless Chicken Breast Fillets with Rib Meat (15% Chicken Broth)
    HyVee/Country Pride 97% Fat Free Skinless Split Chicken Breasts with Ribs (12% Chicken Broth)
    HyVee/Country Pride 99% Fat Free Boneless Skinless Chicken Breast Tenderloins (15% Chicken Broth)
    Meijer Fresh Boneless Skinless Chicken Breast Tenderloins (15% Marination)
    Meijer Fresh Boneless Skinless Chicken Breasts with Rib Meat (15% Marination)
    Pilgrim's Pride Eat Well Stay Healthy Grilled Chicken Breast Fillets
    Pilgrim's Pride Eat Well Stay Healthy Grilled Chicken Breast Strips
    Pilgrim's Pride Eat Well Stay Healthy Italian Style Grilled Chicken Breast Fillets
    Pilgrim's Pride Eat Well Stay Healthy Key Lime Flavor Chicken Breast Fillets
    Pilgrim's Pride Eat Well Stay Healthy Kids Fully Cooked Breaded Chicken Nuggets
    Pilgrim's Pride Eat Well Stay Healthy Kids Fully Cooked Breaded Popcorn Chicken
    Pilgrim's Pride Eat Well Stay Healthy Lemon Herb Chicken Breast Fillets
    Pilgrim's Pride Eat Well Stay Healthy Savory Chicken Breast Fillets
    Pilgrim's Pride Eat Well Stay Healthy Szechwan Chicken Breast Tenderloins
    Pilgrim's Pride Fresh Boneless Skinless Chicken Breasts with Rib Meat Individually Wrapped (15% Chicken Broth)
    Pilgrim's Pride Fresh Chicken 100% Natural Boneless Skinless Breasts with Rib Meat
    Pilgrim's Pride Fresh Chicken 100% Natural Boneless Skinless Breasts with Rib Meat (15% Chicken Broth)
    Pilgrim's Pride Fresh Chicken 100% Natural Breast Tenderloins
    Pilgrim's Pride Fresh Chicken 100% Natural Breast Tenderloins (15% Chicken Broth)
    Pilgrim's Pride Fresh Chicken 100% Natural Skinless Split Breasts with Ribs
    Pilgrim's Pride Fresh Chicken 100% Natural Skinless Split Breasts with Ribs (12% Chicken Broth)
    Pilgrim's Pride Fresh Chicken Breast Tenderloins Individually Wrapped (15% Chicken Broth)
    Pilgrim's Pride Individually Frozen Fully Trimmed 99% Fat Free All Natural Boneless Skinless Chicken Breasts (15% Chicken Broth)
    Schnucks 99% Fat Free Chicken Breast Tenderloins
    Schnucks 99% Fat Free Skinless Chicken Breast Fillets
    Schnucks 99% Fat Free Thin Sliced Skinless Chicken Breast Fillets

    Quaker Oats Company/Tropicana Products, Inc., The
    Crystal Wedding Oats
    Old-Fashioned Quaker Oats
    Quaker Cinnamon Life
    Quaker Essentials Oat Bran
    Quaker Essentials Oatmeal Squares - Brown Sugar
    Quaker Essentials Oatmeal Squares - Cinnamon
    Quaker Essentials Toasted Oatmeal - Brown Sugar
    Quaker Essentials Toasted Oatmeal - Honey Nut
    Quaker Honey Graham Life
    Quaker Instant Oatmeal - Apple Crisp
    Quaker Instant Oatmeal - Apples & Cinnamon
    Quaker Instant Oatmeal - Cinnamon & Spice
    Quaker Instant Oatmeal - Cinnamon Roll
    Quaker Instant Oatmeal - Flavor Variety
    Quaker Instant Oatmeal - Maple & Brown Sugar
    Quaker Instant Oatmeal - Raisins & Spice
    Quaker Instant Oatmeal - Regular Flavor
    Quaker Instant Oatmeal Bakery Favorites Variety Pack (Apple Crisp/Cinnamon Roll/Banana Bread)
    Quaker Instant Oatmeal Crunch - Apples & Cinnamon
    Quaker Instant Oatmeal Crunch - Magicolor Cinnamon
    Quaker Instant Oatmeal Crunch - Maple & Brown Sugar
    Quaker Instant Oatmeal Crunch - Mixed Berry
    Quaker Instant Oatmeal Lower Sugar - Apples & Cinnamon
    Quaker Life
    Quaker Life Chocolate Oat Crunch
    Quaker MultiGrain Hot Cereal
    Quaker Oat Bran Hot Cereal
    Quaker Take Heart Instant Oatmeal - Blueberry
    Quaker Take Heart Instant Oatmeal - Golden Maple
    Quick 1 Minute Quaker Oats
    Tropicana Pure Premium Calcium + Vitamin D No Pulp Orange Juice
    Tropicana Pure Premium Fiber Some Pulp Orange Juice
    Tropicana Pure Premium Golden No Pulp Grapefruit Juice
    Tropicana Pure Premium Grovestand Calcium + Vitamin D Lots of Pulp Orange Juice
    Tropicana Pure Premium Grovestand Lots of Pulp Orange Juice
    Tropicana Pure Premium Healthy Heart No Pulp Orange Juice with Omega 3
    Tropicana Pure Premium Homestyle Some Pulp Orange Juice
    Tropicana Pure Premium Light 'n Healthy Calcium No Pulp Orange Juice
    Tropicana Pure Premium Light 'n Healthy Calcium No Pulp Orange Juice
    Tropicana Pure Premium Low Acid No Pulp Orange Juice
    Tropicana Pure Premium Original No Pulp Orange Juice
    Tropicana Pure Premium Ruby Red Some Pulp Grapefruit Juice

    R.A.B. Food Group LLC
    Manischewitz Premium 100% Grape Juice

    Rader Farms, Inc.
    Rader Farms Nature's Three Berries

    Red Gold, LLC
    Sacramento Tomato Juice from Concentrate with Enhanced Tomato Flavor

    Ruprecht Company
    Sommers 100% Organic Extra Lean Beef Burgers

    Sal & Judy's Products, LLC
    Sal & Judy's Heart Smart Italian Sauce

    Sealord North America, Inc.
    Sealord Deep Sea Dory Fillets
    Sealord Orange Roughy Fillets

    Setton International Foods, Inc.
    Setton Farms Heart Healthy Mix

    Simmons Foods, Inc.
    Member's Mark All Natural 99% Fat Free Boneless Skinless Chicken Breast

    Smithfield Lean Generation Cuts
    SLG: All Natural Pork Tenderloin
    SLG: Marinated Hickory Sweet Center Cut Boneless Pork Loin
    SLG: Marinated Hickory Sweet Pork Chops
    SLG: Marinated Hickory Sweet Pork Loin Filet
    SLG: Marinated Hickory Sweet Pork Tenderloin
    SLG: Marinated Peppercorn & Garlic Pork Tenderloin
    SLG: Marinated Pork Loin Fillet - Peppercorn & Garlic
    SLG: Self-Basting Boneless Pork Loin Center Cut Chops
    SLG: Self-Basting Boneless Whole Pork Loin
    SLG: Self-Basting Pork Tenderloin

    Smithfield Lean Generation Deli
    SLG Deli: 98% Fat Free Canadian Brand Maple Ham
    SLG Deli: 98% Fat Free Cooked Ham
    SLG Deli: 98% Fat Free Honey Cured Ham
    SLG Deli: 98% Fat Free Tavern Ham
    SLG Deli: 98% Fat Free Virginia Brand Ham

    Smithfield Premium Cuts
    Smithfield: Self-Basting Pork Tenderloin

    Solis Brands, Inc.
    ZOIC Belgian Chocolate Nutrition Drink
    ZOIC French Vanilla Nutrition Drink

    Springerhill Ranch Meat Products
    Springerhill Ranch Brand All Natural 98% Fat Free Beef Tenderloin Steaks
    Springerhill Ranch Brand All Natural Ground Beef-98% Lean 2% Fat

    StarKist Seafood Company
    StarKist Chunk Light Tuna in Water
    StarKist Chunk White Albacore Tuna in Water
    StarKist Gourmet Choice Albacore Tuna Fillet in Water
    StarKist Gourmet Choice Chunk Light Tuna in Water
    StarKist Gourmet Choice Solid Light Tuna Fillet in Water
    StarKist Low Sodium Chunk Light Tuna in Water
    StarKist Solid White Albacore Tuna in Water
    StarKist Very Low Sodium Chunk White Albacore Tuna in Water

    Sunrise Growers, Inc.
    Sunrise Growers California Strawberries

    Swift Foods dba Swift & Company
    Extra Lean Ground Pork
    Swift Boneless Pork Sirloin Cutlets
    Swift Natural Fresh Pork-Boneless Pork Center Cut Loin Chops
    Swift Natural Fresh Pork-Boneless Pork Leg for London Broil
    Swift Natural Fresh Pork-Boneless Pork Top Loin Roast
    Swift Natural Fresh Pork-Pork Strips for Barbecue
    Swift Pork Center Cut Loin
    Swift Pork Sirloin Tip Roast
    Swift Pork Tenderloin
    Swift Premium Guaranteed Tender Pork-Boneless Bottom Round
    Swift Premium Guaranteed Tender Pork-Boneless Center Cut Loin Chops
    Swift Premium Guaranteed Tender Pork-Boneless Pork Loin Filet
    Swift Premium Guaranteed Tender Pork-Boneless Pork Tenderloin
    Swift Premium Guaranteed Tender Pork-Boneless Sirloin Cutlets
    Swift Premium Guaranteed Tender Pork-Boneless Strips for Barbecue
    Swift Premium Guaranteed Tender Pork-Pork Top Round
    Swift/Kirkland Signature Pork Sirloin Tip Roast
    Trader Joe's Butcher Shop - Pork Sirloin Tri Tip
    Trader Joe's Butcher Shop Boneless Center Cut Pork Loin Cutlets
    Trader Joe's Butcher Shop Natural Pork-Boneless Pork Loin Chops
    Trader Joe's Butcher Shop Natural Pork-Pork Shoulder Boneless Strips
    Trader Joe's Butcher Shop-Pork Tenderloin

    T. J. Kraft, Ltd.
    Hawaiian Pacific Ahi Tuna Steaks

    Taylor Packing Co., Inc.
    Century Farm 96/4 Extra Lean Ground Beef

    The Baker
    The Baker 7-Grain Sourdough Whole Wheat Bread

    Thumann's Inc
    Thumann's All Natural Black Forest Brand Ham
    Thumann's All Natural Capless Roast Beef
    Thumann's All Natural Oven Roasted Gourmet Chicken Breast
    Thumann's All Natural Oven Roasted Gourmet Turkey Breast
    Thumann's Buffalo Style Oven Roasted Chicken Breast
    Thumann's Capless Roast Beef
    Thumann's Golden Roasted Filet of Turkey - Rotisserie Flavor
    Thumann's Golden Roasted Gourmet Turkey
    Thumann's Our Short Cut Deluxe Cooked Ham - Lower Sodium
    Thumann's Oven Roasted Premium Chicken Breast

    Tony Downs Foods Company
    Member's Mark 98% Fat Free Premium Chunk Chicken Breast in Water

    Topco Associates, LLC
    Food Club Individually Frozen Boneless Skinless Chicken Breasts-15% Seasoned Chicken Broth
    Food Club Individually Frozen Chicken Tenderloins-15% Seasoned Chicken Broth

    Tumaro's Inc.
    Tumaro's Chipotle Chili & Peppers Healthy Flour Tortillas
    Tumaro's Garden Spinach & Vegetables Healthy Flour Tortillas
    Tumaro's Honey Wheat Healthy Flour Tortillas
    Tumaro's Jalapeno & Cilantro Healthy Flour Tortillas
    Tumaro's Pesto & Garlic Healthy Flour Tortillas
    Tumaro's Premium White Healthy Flour Tortillas
    Tumaro's Sun-Dried Tomato & Basil Healthy Flour Tortillas

    Tyson Foods, Inc.
    Tastybird Individually Frozen Chicken-Boneless, Skinless Breast Portions with Rib Meat
    Tastybird Individually Quick Frozen Chicken-Boneless, Skinless Tenderloins
    Tyson 100% All Natural Thin 'N Fancy Boneless Skinless Chicken Breasts with Rib Meat (<3% Water)
    Tyson 100% All Natural Boneless Skinless Chicken Breasts with Rib Meat (<1%/,2% Water)
    Tyson 100% All Natural Boneless Skinless Chicken Thighs (15% Natural Chicken Broth)
    Tyson 100% All Natural Chicken Breast Tenderloins (15% Natural Chicken Broth)
    Tyson 100% All Natural Chicken Breast Tenderloins (<1% Water)
    Tyson 100% All Natural Premium Boneless Skinless Chicken Breasts with Rib Meat (15% Natural Chicken Broth)
    Tyson 100% All Natural Skinless Split Chicken Breasts with Ribs (12% Natural Chicken Broth)
    Tyson 100% All Natural Skinless Split Chicken Breasts with Ribs (>3% Water)
    Tyson 100% All Natural Thin 'N Fancy Boneless Skinless Chicken Breasts with Rib Meat (15% Natural Chicken Broth)
    Tyson Ice Glazed Chicken Individually Frozen 99% Fat Free Boneless, Skinless Breast Tenderloins (8% Seasoned Chicken Broth)
    Tyson Individually Fresh Frozen All Natural 99% Fat Free Boneless Skinless Chicken Tenderloins (8% Water & Kosher Salt)
    Tyson Individually Fresh Frozen Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
    Tyson Individually Fresh Frozen Chicken Tenderloins (15% Chicken Broth)
    Tyson Individually Frozen 100% All Natural Individually Wrapped Boneless Skinless Chicken Breasts (15% Natural Chicken Broth)
    Tyson Individually Frozen All Natural 99% Fat Free Boneless Skinless Chicken Breast Tenderloins (8% Chicken Broth)
    Tyson Individually Frozen All Natural Boneless Skinless Chicken Breasts with Rib Meat (8% Broth Glaze & 15% Seasoned Chicken Broth)
    Tyson Individually Frozen All Natural Extra Lean Boneless Skinless Chicken Breast with Rib Meat (8% Chicken Broth)
    Tyson Individually Frozen Boneless Skinless Chicken Breasts with Rib Meat (15% Chicken Broth)
    Tyson/Kirkland Signature All Natural 99% Fat Free Boneless Skinless Chicken Breast (8% Water & Kosher Salt)
    Tyson/Tastybird Individually Frozen Boneless Skinless Breasts with Rib Meat (10% Seasoned Chicken Broth)
    Tyson/Tastybird Individually Frozen Chicken-Boneless Skinless Breasts with Rib Meat (10% Natural Chicken Broth)

    Tyson Fresh Meats, Inc.
    100% Pure Extra Lean Ground Beef 96/4
    96/4 All Natural Extra Lean Ground Beef

    United Food Group, LLC
    Miller's 100% Pure Ground Beef - 4% Fat
    Moran's All Natural 4% Fat 100% Ground Beef Hamburger Patties
    Moran's All Natural 4% Fat Ground Beef
    Trader Joe's Butcher Shop 4% Fat Ground Beef

    Welch Foods, Inc.
    Welch's 100% Grape Juice (Purple)
    Welch's 100% Grape Juice (Purple) - Frozen Concentrate
    Welch's 100% Grape Juice (Purple) - Pourable Concentrate
    Welch's 100% Grape Juice Calcium (Purple)
    Welch's 100% Grape Juice with Fiber
    Welch's Organic 100% Concord Grape Juice
    Welch's Organic 100% Concord Grape Juice - Frozen Concentrate

    West Liberty Foods, LLC
    Honey Roasted & Smoked Breast of Turkey - 98% Fat Free
    Kirkland Signature All Natural Fully Cooked Sliced Turkey Breast
    Oven Roasted Breast of Turkey Browned in Soybean Oil - 98% Fat Free

    More on the American Heart Association

    I'm very troubled by the American Heart Association's (AHA) willingness to lend its logo and stamp of approval to a multitude of garbage foods like Cocoa Puffs and Berry Kix cereals.

    So I contacted the AHA and spoke to the manager of the Food Certification Program, Ms. Linda Rupp. Ms. Rupp proved very helpful in helping me to understand.

    I originally called her to find out just how many products were turned down. In view of 768 products on the approved list, I wondered how many had been rejected to generate this "select" group.

    Unfortunately, she said that the number of products rejected was not tracked, though she did intimate that it was not a lot. Sometimes, she added, a rejected product will undergo a few "improvements" to help it achieve the criteria necessary for AHA approval.

    What exactly is considered in an application for the Food Certification Program?

    A food must have 1)total fat 3.0 grams or less, 2) saturated fat 1.0 gram or less, 3) 20 grams or less cholesterol, 4) 480 mg or less sodium, all per serving.

    She also pointed out that, given the fact that a food as useless and lacking in health qualitites as jelly beans could meet this criteria, the AHA employs a special "Jelly Bean Rule" that stipulates that 10% of the Daily Value of 6 nutrients (e.g., fiber, vitamins A and C, etc.) must also be contained in a serving.

    So those are the startlingly lax requirements to gain the privilege of affixing the AHA Heart Check Mark on your product and informing the public that your box of Cocoa Puffs, Cookie Crisp cereal, or Berry Kix is "heart healthy."

    There is an epidemic of obesity in the U.S. I don't believe that the AHA endorsement helps. In fact, I believe that it has been a contributor to obesity.

    Pardon me while I eat this bag of M&M's for my heart.

    Exercise and blood pressure

    Stan did everything right.

    He followed the Track Your Plaque "Rule of 60". He was slender, had run a marathon a few months earlier, in fact. He included fish oil at therapeutic doses. He replenished vitamin D to a blood level of 57 ng/ml 25-OH-vitamin D3. Though ambitious and hard-working, he was a generally happy, optimistic person.

    Yet his CT heart scan score increased 28% in one year, from a starting score of 379 to 485.

    What did he do wrong?

    Well, Stan did nothing wrong. But I suggested to him that one "hole" in his program could be exercise-induced high blood pressure. I've witnessed this effect many times. Blood pressure normal or "borderline" high while seated and relaxed, sky-high with exercise.

    So we put Stan on a treadmill. Starting blood pressure: 123/76. Blood pressure with exericse (13 mets): 220/78--sky high. That's why Stan's heart scan score went up. A good pressure with this level of exercise: 150/70, but certainly no higher than 170/80.

    If blood pressure is high with exercise, it's probably high with emotional upset, anxiety, being in a hurry, etc., also, all the irritations and pressures of life.

    We'll see in future how much of a role reducing Stan's blood pressure will play in gaining better control over his heart scan score. A practical difficulty will be in assessing the adequacy of blood pressure control in Stan, since its full potential only becomes evident with exerise. It means that future blood pressure assessments are more likely to be on a treadmill.

    It would also explain why Stan's thoracic aorta was mildly enlarged and his aortic valve was mildly leaky when I met him, both potential consequences of intermittent high blood pressure.

    Cheese and vitamin K2

    If you've been following the Track Your Plaque conversation, you know that, contrary to prevailing opinion among many cardiologists, there is an emerging notion that coronary calcification is an active process, a true part of the disease.

    Vitamin D3 is an important aspect of this question. So is vitamin K2. Not to be confused with K1 that plays a role in blood coagulation, K2 has an important role in calcium metabolism. Thus, vitmain K2 deficiency is related to osteoporosis and to coronary calcification.

    Getting K2, like getting D, is difficult from food sources. The choices for K2 sources includes:

    --Natto--generally, an impalatable choice. I've had it and it was intolerably gooey and weird-tasting. It is, nonetheless, the most concentrated food source of K2.

    --Pate--Though liver products have the potential for containing many other unhealthy things, like pesticide residues, since the liver acts as a filter for the blood.

    --Fermented cheeses--Since K2 is a product of fermentation of cheese, as it is in Natto.


    For years, we've advised people to avoid or minimize cheese because of saturated fat or cholesterol content. I think that there's reason to re-think this advice based on the emerging data.

    How can you tell the difference between fermented and non-fermented cheese? First, look for the holes in the cheese. The holes are the remnants of gas pockets created during fermentation. Second, look for the word "cultures" on the label, meaning organisms for fermentation were added. If "processed cheese" is anywhere on the label, this is a dairy product that has been chemically coagulated and is not fermented.

    Fermented cheeses are generally "gourmet" cheeses, not eaten a pound at a time on a pizza, but meant to be eaten in small portions.

    How much fermented cheese is necessary for its presumed inhibitory benefits on coronary calcification and osteoporsis? Are some fermented cheeses better than others? These issues remain unsettled. Stay tuned.

    Vitamin D disappointment ahead

    Anyone following the Track Your Plaque conversation know that we are rabid fans of normalizing blood vitamin D blood levels (25-OH-vitamin D3).

    A wonderful report on vitamin D was aired this morning on the NBC Today show. The interviewed guests did a good job of describing the health effects of vitamin D, thought the focus was on some new data on the use of vitamin D for breast and prostate cancer.

    I learned that shiitake mushrooms have some vitamin D--I didn't know that! (They contain 260 units per 4 mushrooms.)

    Unfortunately, the closing comments from the guests, among whom was nutritionist and author, Joy Bauer,MS, was that you should get vitamin D from your multivitamin or your calcium with vit D.

    That is absolutely wrong. When you check blood levels of vitamin D, as we do in everybody we see, you quickly learn what works and what doesn't.

    Vitamin D in multivitamins is very poorly absorbed, if at all. Likewise, about 90% of the D in most calcium preparations is not absorbed. The vast majority of tablet or powder preparations, such as those in calcium tablets, are not absorbed to any significant extent. Take all you want and you remain vit D-deficient with osteoporosis, growing coronary plaque, low HDL, and exposed to risk for prostate and colon cancer.

    If you take vitamin D in supplement form, it must--MUST--be in an oil-based capsule. The tablets are simply much too poorly and erratically absorbed to be reliable. There's nothing more frustrating to take, for instance, 4000 units of vitamin D in tablet form, only to have a blood level of 12 ng/ml--severe deficiency. Take the same 4000 unit dose in capsule form and blood level skyrockets to 58 ng/ml. And it's no more expensive.

    One other thing: If you want to waste time and money, take the prescription vitamin D prescribed by many doctors. This is vitamin D2, also known as "ergocalciferol". Why use the synthetic vitamin D2 when D3 is the form your body needs? Because the D2 is patent-protectable and profitable to the drug manufacturer, similar to using Premarin (horse estrogens) when human preparations would suffice--or be superior. I saw a woman today taking 50,000 of prescription D2 once per week. Her blood level of 25-OH-vitamin D3? 17 ng/ml--severe deficiency. Don't waste your time with this garbage.

    In search of truth

    I am continually amazed at the amount of time and energy we all expend in the search for truth.

    Rely on your hospital and you will be steered towards strategies that, at worst, aim to increase your use of hospital procedures. At best, they steer you towards physicians who are often under their employ.

    How about your doctor? This is a source of immense frustration. Doctors remain interested in treating the catastrophic illness. They remain lukewarm towards prevention and self-empowerment. Thus, supplements are dangerous, everything requires a doctor's endorsement.

    Drug companies? That's like relying on a used car salesman for truth. Exagerration, slick talk, and plain deception might be better descriptions of what you can count on from the drug manufacturers.

    The internet? Perhaps, if you're selective. WebMD? An obvious voice-box for the drug industry. Just look at the proliferation of drugs ads that accompany each report. In fact, the majority (80%) of WebMD's revenues come from drug manufacturers.

    The profit motive has created a mountain of good information. It has also created a sea of mis-information, all created to provide personal financial enrichment.

    But I continue to be optimistic that the internet will also become a forum for truth, particularly through its capacity for networked interaction among participants. As our collective wisdom permits us to more effectively separate the wheat from the chaff in looking for the truth, I believe that we will zigzag towards a system of healthcare that is self-empowering, self-directed, and resorts to hospitals and procedures only in the most dire circumstances, saving billions of dollars every year.

    American Heart Association stamp of approval

    The American Heart Association (AHA) has a program called the Heart-Check Mark, an "approval" process that permits a food manufacturer to affix the AHA logo and stamp of approval on various food products.

    A company simply makes application to the AHA. The application and product details are reviewed and then approved or turned down.

    To date, 106 companies have obtained the AHA stamp of approval on 768 products. What kinds of products are on the approved list? Here's a sample:

    --Honey Bunches of Oats

    --Kellogg's Frosted Mini-Wheats

    --Cocoa Puffs cereal

    --Cookie Crisp cereal ("The great taste of chocolate chips in every bite!")


    There are 764 others. If you doubt this, just go to the store and take a look at the product containers.

    What the heck is going on here? Most of us with any judgment know that these products are pure sugar. They may contain "no more" than 15-40 grams sugar per sugar, but the principal products--corn, wheat, fructose--mean that these products are, in effect, nearly pure sugar. Yet they carry the AHA stamp of approval.

    What do products like this cause? It's a long list but the major effects include:

    --Obesity

    --Diabetes

    --Drop in HDL

    --Rise in triglycerides

    --Small LDL particles

    --Heightened inflammation (i.e., C-reactive protein)

    --Mental cloudiness


    Need I go on? Why are products like these and many others deserving of the AHA heart-check approval? Because they lack high fat and saturated fat (3.0 grams, 1.0 grams respectively, by AHA criteria). In other words, just lacking these ingredients means that, to the AHA, they qualify as "heart healthy."

    By that same line of reasoning, many candy bars are "heart healthy", as are many cookies and cupcakes.

    What's the reason behind this extraordinary absurdity? Is the AHA stupid?

    There may be many reasons, but one very suspicious fact becomes immediately obvious when you realize these endorsements product a substantial revenue source for the AHA, since companies must pay for the right to use the heart-check approval mark. Also, just look at the major contributors (millions of dollars) to the AHA: ConAgra, General Mills, Kraft, etc.) You get the picture.

    Does this make the AHA evil? Not necessarily. But it seriously erodes credibility. it also should make you very leery of any advice that comes from such an agency that is reluctant to bite the food manufacturer hands that feed it.

    In my view, we simply cannot rely on the AHA for genuine, unbiased heart health advice.

    "Your heart scan score means nothing"

    Charles was visibly confused.

    He'd gotten his CT heart scan after hearing one of the local scan center's ads on the radio. His score 2773, obviously in the 99th percentile for any age.

    "Do you think the score means anything? My primary doctor said that it was meaningless because it was all in the deep wall of the artery. He said that it has nothing to do with risk for heart attack. As long as I feel good, he says don't do anything."

    What exactly did his doctor mean, in the "deep wall of the artery"?

    What the doctor is referring to is the fact that some people with a long history (many years) of diabetes or kidney failure (also for many years) tend to develop calcium deposits in the media, or muscular layer of arteries. The media is the tissue thin layer just below the intima, the most inner layer of arteries that we usually associate with atherosclerotic plaque and the layer that is most prone to calcium accumulation that we score on heart scans.

    Aging, generally into your late 70s, 80s, and onwards, also increases the likelihood of medial calcification. Lastly, longstanding deficiency of vitamin D encourages medial calcification.

    Is there any way to distinguish intimal vs medial calcification on a heart scan? No, there is not. Having read many thousands of CT heart scans, I can tell you that there is no practical way in 2007 to tell the difference.

    Then how did this doctor "know" that Charles' calcium was "deep walled" or medial? Simple: He didn't. This was yet another example of ignorance based on old thinking. Unfortunately, he did Charles a serious disservice by dismissing his heart scan score that predicted a 25% per year risk for heart attack.

    Interestingly, whether calcium is intimal as in atherosclerotic plaque, or medial, both are strongly associated with risk for heart attack. In other words, if calcium is confined to the intima, heart disease risk is present. If calcium is limited to the media, risk is still present.

    In all practicality, the only difference we make of the intima vs. media argument (that is, when the distinction has been made by some other means like intracoronary ultrasound, the test that is truly necessary to distinguish the two patterns) is that medial calcification may be more powerfully related to vitamin D deficiency. Thus, someone with heavy medial calcification may require closer attention to maintaining a perfect year-round blood level of 25-OH-vitamin D3. But that's the only practical difference.

    Vitamin D toxicity?

    "My primary care doctor said to stop the vitamin D because it's toxic. So I stopped it and I just take a multivitamin. He said that a multivitamin and two glasses of milk a day was all I needed."

    So proclaimed Eleanor to me. This happens around once every week by doctors frightened of the vitamin D.

    So I reminded Eleanor that, before starting vitamin D supplementation, her blood level of 25-OH-vitamin D3 had been 17 ng/ml--severe deficiency.

    On 4000 units per day (oil-based gelcap), her blood level had been 37 ng/ml--still deficient, below the desirable range of 50-60 ng/ml. That's the dose Eleanor's doctor had declared "toxic."

    When exactly does deficiency develop? There's not full agreement on this, but Dr. Michael Holick of Boston University, among the most experienced and insightful authorities on vitamin D, states that toxicity is more likely when blood levels exceed 150 ng/ml (Nutr Clin Pract. 2007 Jun;22(3):297-304).

    In other words, Eleanor and her doctor should not be concerned with toxicity, but with the persistent levels of deficiency she is suffering.

    Some authorities call the behavior of vitamin D "bi-phasic": Deficiency is toxic, excessive levels are toxic. We're really just trying to achieve a middle ground in vitamin D levels that are above deficiency but below toxicity.

    In reality, deficiency is exceptionally common. In fact, it's the rule around here (northern U.S.), with >95% of everybody we check severely deficient in winter, mildly-moderately deficient in summer. Very few people approach normal levels year round without supplementation.

    Toxicity, on the other hand, is exceedingly rare. I have seen it once in a woman who was taking a toxic dose of 50,000 units a day on the instructions of her (mis-guided) doctor. Thankfully, no ill-effects developed from this little "experiment."

    So, it's not toxicity that is the overwhelmingly common worry, but deficiency, severe and sustained.

    Non-profit hospitals

    Take a look at your local hospital and you're likely to notice several curious things:

    1) It is likely non-profit, meaning it enjoys a non-profit status with the Internal Revenue Service and enjoys the tax benefits of not paying taxes on profits. This provides an advantage to tax-protected hospitals. 70% or more of hospitals in the U.S. are "non-profit."

    2) Non-profit or no, many hospitals operate under the guise of a religious affiliation, e.g., St. Mary's Hospital, Trinity Hospital, All Saints', Jewish Hospital, etc.

    3) Executives in non-profit hospitals can make capitalistic salaries. One CEO of a Milwaukee hospital took home $3.7 million dollars in salary last year. That's not including the very substantial perks and business interests in the spin-off businesses the hospital owns, including pharmacies, drug and medical device disitributors, even a venture capital division. "Non-profit" does not have to mean that executives within the operation can't benefit handsomely.

    That same hospital system spends over $10 million dollars in a year in local marketing for TV ads, print advertising, etc. Ads are slick and professionally produced.

    Make no bones about it: These are "non-profit" for tax purposes only . They are for-profit in every other sense of the phrase, including rich rewards for the insiders.

    Guess how those fat executive salaries and large marketing budgets are paid for? That's right: the 12-inch incision in your chest; the four stents, defibrillator, and repeated nuclear stress tests; the revolving door of hospitalization after hospitalization that typifies the "heart patient" experience.

    See the hospital for what it is: In the 21st century, it is no longer a charitable operation worthy of your volunteer time and donations. It is a business no different than Home Depot, IBM, or--Enron. Yes, they do perform needed services, as well. But the perverse equation that often determines who needs hospitalization and who doesn't, who needs a heart procedure and who doesn't, is not always based on necessity but on financial return. Just ask the CEO.