For the sake of convenience: Commercial sources of prebiotic fibers

Our efforts to obtain prebiotic fibers/resistant starches, as discussed in the Cureality Digestive Health Track, to cultivate healthy bowel flora means recreating the eating behavior of primitive humans who dug in the dirt with sticks and bone fragments for underground roots and tubers, behaviors you can still observe in extant hunter-gatherer groups, such as the Hadza and Yanomamo. But, because this practice is inconvenient for us modern folk accustomed to sleek grocery stores, because many of us live in climates where the ground is frozen much of the year, and because we lack the wisdom passed from generation to generation that helps identify which roots and tubers are safe to eat and which are not, we rely on modern equivalents of primitive sources. Thus, green, unripe bananas, raw potatoes and other such fiber sources in the Cureality lifestyle.

There is therefore no need to purchase prebiotic fibers outside of your daily effort at including an unripe green banana, say, or inulin and fructooligosaccharides (FOS), or small servings of legumes as a means of cultivating healthy bowel flora. These are powerful strategies that change the number and species of bowel flora over time, thereby leading to beneficial health effects that include reduced blood sugar and blood pressure, reduction in triglycerides, reduced anxiety and improved sleep, and reduced colon cancer risk.

HOWEVER, convenience can be a struggle. Traveling by plane, for example, makes lugging around green bananas or raw potatoes inconvenient. Inulin and FOS already come as powders or capsules and they are among the options for a convenient, portable prebiotic fiber strategy. But there are others that can be purchased. This is a more costly way to get your prebiotic fibers and you do not need to purchase these products in order to succeed in your bowel flora management program. These products are therefore listed strictly as a strategy for convenience.

Most perspectives on the quality of human bowel flora composition suggest that diversity is an important feature, i.e., the greater the number of species, the better the health of the host. There may therefore be advantage in varying your prebiotic routine, e.g., green banana on Monday, inulin on Tuesday, PGX (below) on Wednesday, etc. Beyond providing convenience, these products may introduce an added level of diversity, as well.

Among the preparations available to us that can be used as prebiotic fibers:

PGX

While it is billed as a weight management and blood sugar-reducing product, the naturally occurring fiber--α-D-glucurono-α-D-manno-β-D-manno- β-D-gluco, α-L-gulurono-β-D mannurono, β-D-gluco-β- D-mannan--in PGX also exerts prebiotic effects (evidenced by increased fecal butyrate, the beneficial end-product of bacterial metabolism). PGX is available as capsules or granules. It also seems to exert prebiotic effects at lower doses than other prebiotic fibers. While I usually advise reaching 20 grams per day of fiber, PGX appears to exert substantial effects at a daily dose of half that quantity. As with all prebiotic fibers, it is best to build up slowly over weeks, e.g., start at 1.5 grams twice per day. It is also best taken in two or three divided doses. (Avoid the PGX bars, as they are too carb-rich for those of us trying to achieve ideal metaobolic health.)

Prebiotin

A combination of inulin and FOS available as powders and in portable Stick Pacs (2 gram and 4 gram packs). This preparation is quite costly, however, given the generally low cost of purchasing chicory inulin and FOS separately.

Acacia

Acacia fiber is another form of prebiotic fiber.  RenewLife and NOW are two reputable brands.

Isomalto-oligosaccharides

This fiber is used in Quest bars and in Paleo Protein Bars. With Quest bars, choose the flavors without sucralose, since it has been associated with undesirable changes in bowel flora.

There you go. It means that there are fewer and fewer reasons to not purposefully cultivate healthy bowel flora and obtain all the wonderful health benefits of doing so, from reduced blood pressure, to reduced triglycerides, to deeper sleep.

Disclaimer: I am not compensated in any way by discussing these products.

How Not To Have An Autoimmune Condition


Autoimmune conditions are becoming increasingly common. Estimates vary, but it appears that at least 8-9% of the population in North America and Western Europe have one of these conditions, with The American Autoimmune Related Diseases Association estimating that it’s even higher at 14% of the population.

The 200 or so autoimmune diseases that afflict modern people are conditions that involve an abnormal immune response directed against one or more organs of the body. If the misguided attack is against the thyroid gland, it can result in Hashimoto’s thyroiditis. If it is directed against pancreatic beta cells that produce insulin, it can result in type 1 diabetes or latent autoimmune diabetes of adults (LADA). If it involves tissue encasing joints (synovium) like the fingers or wrists, it can result in rheumatoid arthritis. It if involves the liver, it can result in autoimmune hepatitis, and so on. Nearly every organ of the body can be the target of such a misguided immune response.

While it requires a genetic predisposition towards autoimmunity that we have no control over (e.g., the HLA-B27 gene for ankylosing spondylitis), there are numerous environmental triggers of these diseases that we can do something about. Identifying and correcting these factors stacks the odds in your favor of reducing autoimmune inflammation, swelling, pain, organ dysfunction, and can even reverse an autoimmune condition altogether.

Among the most important factors to correct in order to minimize or reverse autoimmunity are:


Wheat and grain elimination

If you are reading this, you likely already know that the gliadin protein of wheat and related proteins in other grains (especially the secalin of rye, the hordein of barley, zein of corn, perhaps the avenin of oats) initiate the intestinal “leakiness” that begins the autoimmune process, an effect that occurs in over 90% of people who consume wheat and grains. The flood of foreign peptides/proteins, bacterial lipopolysaccharide, and grain proteins themselves cause immune responses to be launched against these foreign factors. If, for instance, an autoimmune response is triggered against wheat gliadin, the same antibodies can be aimed at the synapsin protein of the central nervous system/brain, resulting in dementia or cerebellar ataxia (destruction of the cerebellum resulting in incoordination and loss of bladder and bowel control). Wheat and grain elimination is by far the most important item on this list to reverse autoimmunity.

Correct vitamin D deficiency

It is clear that, across a spectrum of autoimmune diseases, vitamin D deficiency serves a permissive, not necessarily causative, role in allowing an autoimmune process to proceed. It is clear, for instance, that autoimmune conditions such as type 1 diabetes in children, rheumatoid arthritis, and Hashimoto’s thyroiditis are more common in those with low vitamin D status, much less common in those with higher vitamin D levels. For this and other reasons, I aim to achieve a blood level of 25-hydroxy vitamin D level of 60-70 ng/ml, a level that usually requires around 4000-8000 units per day of D3 (cholecalciferol) in gelcap or liquid form (never tablet due to poor or erratic absorption). In view of the serious nature of autoimmune diseases, it is well worth tracking occasional blood levels.

Supplement omega-3 fatty acids

While omega-3 fatty acids, EPA and DHA, from fish oil have proven only modestly helpful by themselves, when cast onto the background of wheat/grain elimination and vitamin D, omega-3 fatty acids compound anti-inflammatory benefits, such as those exerted via cyclooxygenase-2. This requires a daily EPA + DHA dose of around 3600 mg per day, divided in two. Don’t confuse EPA and DHA omega-3s with linolenic acid, another form of omega-3 obtained from meats, flaxseed, chia, and walnuts that does not not yield the same benefits. Nor can you use krill oil with its relatively trivial content of omega-3s.

Eliminate dairy

This is true in North America and most of Western Europe, less true in New Zealand and Australia. Autoimmunity can be triggered by the casein beta A1 form of casein widely expressed in dairy products, but not by casein beta A2 and other forms. Because it is so prevalent in North America and Western Europe, the most confident way to avoid this immunogenic form of casein is to avoid dairy altogether. You might be able to consume cheese, given the fermentation process that alters proteins and sugar, but that has not been fully explored.

Cultivate healthy bowel flora

People with autoimmune conditions have massively screwed up bowel flora with reduced species diversity and dominance of unhealthy species. We restore a healthier anti-inflammatory panel of bacterial species by “seeding” the colon with high-potency probiotics, then nourishing them with prebiotic fibers/resistant starches, a collection of strategies summarized in the Cureality Digestive Health discussions. People sometimes view bowel flora management as optional, just “fluff”–it is anything but. Properly managing bowel flora can be a make-it-or-break-it advantage; don’t neglect it.

There you go: a basic list to get started on if your interest is to begin a process of unraveling the processes of autoimmunity. In some conditions, such as rheumatoid arthritis and polymyalgia rheumatica, full recovery is possible. In other conditions, such as Hashimoto’s thyroiditis and the pancreatic beta cell destruction leading to type 1 diabetes, reversing the autoimmune inflammation does not restore organ function: hypothyroidism results after thyroiditis quiets down and type 1 diabetes and need for insulin persists after pancreatic beta cell damage. But note that the most powerful risk factor for an autoimmune disease is another autoimmune disease–this is why so many people have more than one autoimmune condition. People with Hashimoto’s, for instance, can develop rheumatoid arthritis or psoriasis. So the above menu is still worth following even if you cannot hope for full organ recovery

Five Powerful Ways to Reduce Blood Sugar

Left to conventional advice on diet and you will, more than likely, succumb to type 2 diabetes sooner or later. Follow your doctor’s advice to cut fat and eat more “healthy whole grains” and oral diabetes medication and insulin are almost certainly in your future. Despite this, had this scenario played out, you would be accused of laziness and gluttony, a weak specimen of human being who just gave into excess.

If you turn elsewhere for advice, however, and ignore the awful advice from “official” sources with cozy relationships with Big Pharma, you can reduce blood sugars sufficient to never become diabetic or to reverse an established diagnosis, and you can create a powerful collection of strategies that handily trump the worthless advice being passed off by the USDA, American Diabetes Association, the American Heart Association, or the Academy of Nutrition and Dietetics.

Among the most powerful and effective strategies to reduce blood sugar:

1) Eat no wheat nor grains

Recall that amylopectin A, the complex carbohydrate of grains, is highly digestible, unlike most of the other components of the seeds of grasses AKA “grains,” subject to digestion by the enzyme, amylase, in saliva and stomach. This explains why, ounce for ounce, grains raise blood sugar higher than table sugar. Eat no grains = remove the exceptional glycemic potential of amylopectin A.

2) Add no sugars, avoid high-fructose corn syrup

This should be pretty obvious, but note that the majority of processed foods contain sweeteners such as sucrose or high-fructose corn syrup, tailored to please the increased desire for sweetness among grain-consuming people. While fructose does not raise blood sugar acutely, it does so in delayed fashion, along with triggering other metabolic distortions such as increased triglycerides and fatty liver.

3) Vitamin D

Because vitamin D restores the body’s normal responsiveness to insulin, getting vitamin D right helps reduce blood sugar naturally while providing a range of other health benefits.

4) Restore bowel flora

As cultivation of several Lactobacillus and Bifidobacteria species in bowel flora yields fatty acids that restore insulin responsiveness, this leads to reductions in blood sugar over time. Minus the bowel flora-disrupting effects of grains and sugars, a purposeful program of bowel flora restoration is required (discussed at length in the Cureality Digestive Health section.)

5) Exercise

Blood sugar is reduced during and immediately following exercise, with the effect continuing for many hours afterwards, even into the next day.

Note that, aside from exercise, none of these powerful strategies are advocated by the American Diabetes Association or any other “official” agency purporting to provide dietary advice. As is happening more and more often as the tide of health information rises and is accessible to all, the best advice on health does not come from such agencies nor from your doctor but from your efforts to better understand the truths in health. This is our core mission in Cureality. A nice side benefit: information from Cureality is not accompanied by advertisements from Merck, Pfizer, Kelloggs, Kraft, or Cadbury Schweppes.

Cureality App Review: Breathe Sync



Biofeedback is a wonderful, natural way to gain control over multiple physiological phenomena, a means of tapping into your body’s internal resources. You can, for instance, use biofeedback to reduce anxiety, heart rate, and blood pressure, and achieve a sense of well-being that does not involve drugs, side-effects, or even much cost.

Biofeedback simply means that you are tracking some observable physiologic phenomenon—heart rate, skin temperature, blood pressure—and trying to consciously access control over it. One very successful method is that of bringing the beat-to-beat variation in heart rate into synchrony with the respiratory cycle. In day-to-day life, the heart beat is usually completely out of sync with respiration. Bring it into synchrony and interesting things happen: you experience a feeling of peace and calm, while many healthy phenomena develop.

A company called HeartMath has applied this principle through their personal computer-driven device that plugs into the USB port of your computer and monitors your heart rate with a device clipped on your earlobe. You then regulate breathing and follow the instructions provided and feedback is obtained on whether you are achieving synchrony, or what they call “coherence.” As the user becomes more effective in achieving coherence over time, positive physiological and emotional effects develop. HeartMath has been shown, for instance, to reduce systolic and diastolic blood pressure, morning cortisol levels (a stress hormone), and helps people deal with chronic pain. Downside of the HeartMath process: a $249 price tag for the earlobe-USB device.

But this is the age of emerging smartphone apps, including those applied to health. Smartphone apps are perfect for health monitoring. They are especially changing how we engage in biofeedback. An app called Breathe Sync is available that tracks heart rate using the camera’s flash on the phone. By tracking heart rate and providing visual instruction on breathing pattern, the program generates a Wellness Quotient, WQ, similar to HeartMath’s coherence scoring system. Difference: Breathe Sync is portable and a heck of a lot less costly. I paid $9.99, more than I’ve paid for any other mainstream smartphone application, but a bargain compared to the HeartMath device cost.

One glitch is that you need to not be running any other programs in the background, such as your GPS, else you will have pauses in the Breathe Sync program, negating the value of your WQ. Beyond this, the app functions reliably and can help you achieve the health goals of biofeedback with so much less hassle and greater effectiveness than the older methods.

If you are looking for a biofeedback system that provides advantage in gaining control over metabolic health, while also providing a wonderful method of relaxation, Breathe Sync, I believe, is the go-to app right now.

Amber’s Top 35 Health and Fitness Tips

This year I joined the 35 club!  And in honor of being fabulous and 35, I want to share 35 health and fitness tips with you! 

1.  Foam rolling is for everyone and should be done daily. 
2.  Cold showers are the best way to wake up and burn more body fat. 
3.  Stop locking your knees.  This will lead to lower back pain. 
4.  Avoid eating gluten at all costs. 
5.  Breath deep so that you can feel the sides or your lower back expand. 
6.  Swing a kettlebell for a stronger and great looking backside. 
7.  Fat is where it’s at!  Enjoy butter, ghee, coconut oil, palm oil, duck fat and many other fabulous saturated fats. 
8.  Don’t let your grip strength fade with age.  Farmer carries, kettlebells and hanging from a bar will help with that. 
9.  Runners, keep your long runs slow and easy and keep your interval runs hard.  Don’t fall in the chronic cardio range. 
10.  Drink high quality spring or reverse osmosis water. 
11.  Use high quality sea salt season food and as a mineral supplement. 
12.  Work your squat so that your butt can get down to the ground.  Can you sit in this position? How long?
13.  Lift heavy weights!  We were made for manual work,.   Simulate heavy labor in the weight room. 
14.  Meditate daily.  If you don’t go within, you will go with out.  We need quiet restorative time to balance the stress in our life. 
15.  Stand up and move for 10 minutes for every hour your sit at your computer. 
16. Eat a variety of whole, real foods. 
17.  Sleep 7 to 9 hours every night. 
18.  Pull ups are my favorite exercise.  Get a home pull up bar to practice. 
19.  Get out and spend a few minutes in nature.  Appreciate the world around you while taking in fresh air and natural beauty. 
20.  We all need to pull more in our workouts.  Add more pulling movements horizontally and vertically. 
21. Surround yourself with health minded people. 
22. Keep your room dark for deep sound sleep.  A sleep mask is great for that! 
23. Use chemical free cosmetics.  Your skin is the largest organ of your body and all chemicals will absorb into your blood stream. 
24. Unilateral movements will help improve symmetrical strength. 
25. Become more playful.  We take life too seriously, becoming stress and overwhelmed.  How can you play, smile and laugh more often?
26.  Choose foods that have one ingredient.  Keep your diet simple and clean. 
27.  Keep your joints mobile as you age.  Do exercises that take joints through a full range of motion. 
28. Go to sleep no later than 10:30pm.  This allows your body and brain to repair through the night. 
29. Take care of your health and needs before others.  This allows you to be the best spouse, parent, coworker, and person on the planet. 
30.  Always start your daily with a high fat, high protein meal.  This will encourage less sugar cravings later in the day. 
31. Approach the day with positive thinking!  Stinkin’ thinkin’ only leads to more stress and frustration. 
32. You are never “too old” to do something.  Stay young at heart and keep fitness a priority as the years go by. 
33. Dream big and go for it. 
34.  Lift weights 2 to 4 times every week.  Strong is the new sexy. 
35.  Love.  Love yourself unconditionally.  Love your life and live it to the fullest.  Love others compassionately. 

Amber B.
Cureality Exercise and Fitness Coach

To Change, You Need to Get Uncomfortable

Sitting on the couch is comfortable.  Going through the drive thru to pick up dinner is comfortable.  But when you notice that you’re out-of-shape, tired, sick and your clothes no longer fit, you realize that what makes you comfortable is not in align with what would make you happy.   

You want to see something different when you look in the mirror.  You want to fit into a certain size of jeans or just experience your day with more energy and excitement.  The current condition of your life causes you pain, be it physical, mental or emotional.  To escape the pain you are feeling, you know that you need to make changes to your habits that keep you stuck in your current state.  But why is it so hard to make the changes you know that will help you achieve what you want?  

I want to lose weight but….

I want a six pack but…

I want more energy but….

The statement that follows the “but” is often a situation or habit you are comfortable with.  You want to lose weight but don’t have time to cook healthy meals.  So it’s much more comfortable to go through the drive thru instead of trying some new recipes.   New habits often require a learning curve and a bit of extra time in the beginning.  It also takes courage and energy to establish new routines or seek out help.  

Setting out to achieve your goals requires change.  Making changes to establish new habits that support your goals and dreams can be uncomfortable.  Life, as you know it, will be different.  Knowing that fact can be scary, but so can staying in your current condition.  So I’m asking you to take a risk and get uncomfortable so that you can achieve your goals.  

Realize that it takes 21 days to develop a new habit.  I believe it takes triple that amount of time to really make a new habit stick for the long haul.  So for 21 days, you’ll experience some discomfort while you make changes to your old routine and habits.  Depending on what you are changing, discomfort could mean feeling tired, moody, or even withdrawal symptoms.  However, the longer you stick to your new habits the less uncomfortable you start to feel.  The first week is always the worst, but then it gets easier.

Making it through the uncomfortable times requires staying focused on your goals and not caving to your immediate feelings or desires.  I encourage clients to focus on why their goals important to them.  This reason or burning desire to change will help when old habits, cravings, or situations call you back to your old ways.
Use a tracking and a reward system to stay on track.  Grab a calendar, journal or index card to check off or note your daily successes.  Shoot for consistency and not perfection when trying to make changes.  I encourage my clients to use the 90/10 principle of change and apply that to their goal tracking system.  New clothes, a massage, or a day me-retreat are just a few examples of rewards you can use to sticking to your tracking system.  Pick something that really gets you excited.  

Getting support system in place can help you feel more comfortable with being uncomfortable.  Hiring a coach, joining an online support group, or recruiting family and friends can be very helpful when making big changes.  With a support system in place you are not alone in your discomfort.  You’re network is there for you to reach out for help, knowledge, accountability or camaraderie when you feel frustrated and isolated.  

I’ve helped hundreds of people change their bodies, health and lives of the eleven years I’ve worked as a trainer and coach.  I know it’s hard, but I also know that if they can do it, so can you.  You just need to step outside of your comfort zone and take a risk. Don’t let fear create uncomfortable feelings that keep you stuck in your old ways.  Take that first step and enjoy the journey of reaching your goals and dreams.  

Amber Budahn, B.S., CSCS, ACE PT, USATF 1, CHEK HLC 1, REIKI 1
Cureality Exercise Specialist

The 3 Best Grain Free Food Swaps to Boost Fat Burning

You can join others enjoying substantial improvements in their health, energy and pant size by making a few key, delicious substitutions to your eating habits.  This is possible with the Cureality nutrition approach, which rejects the idea that grains should form the cornerstone of the human diet.  

Grain products, which are seeds of grasses, are incompatible with human digestion.  Contrary to what we have been told for years, eating healthy whole grain is not the answer to whittle away our waists.  Consumption of all grain-based carbohydrates results in increased production of the fat storage hormone insulin.  Increased insulin levels create the perfect recipe for weight gain. By swapping out high carbohydrate grain foods that cause spikes in insulin with much lower carbohydrate foods, insulin release is subdued and allows the body to release fat.

1. Swap wheat-based flour with almond flour/meal

  • One of the most dubious grain offenders is modern wheat. Replace wheat flour with naturally wheat-free, lower carbohydrate almond flour.  
  • Almond flour contains a mere 12 net carbs per cup (carbohydrate minus the fiber) with 50% more filling protein than all-purpose flour.
  • Almond flour and almond meal also offer vitamin E, an important antioxidant to support immune function.

2. Swap potatoes and rice for cauliflower

  • Replace high carb potatoes and pasta with vitamin C packed cauliflower, which has an inconsequential 3 carbs per cup.  
  • Try this food swap: blend raw cauliflower in food processor to make “rice”. (A hand held grater can also be used).  Sautee the “riced” cauliflower in olive or coconut oil for 5 minutes with seasoning to taste.
  • Another food swap: enjoy mashed cauliflower in place of potatoes.  Cook cauliflower. Place in food processor with ½ a stick organic, grass-fed butter, ½ a package full-fat cream cheese and blend until smooth. Add optional minced garlic, chives or other herbs such as rosemary.
3. Swap pasta for shirataki noodles and zucchini

  • Swap out carb-rich white pasta containing 43 carbs per cup with Shirataki noodles that contain a few carbs per package. Shirataki noodles are made from konjac or yam root and are found in refrigerated section of supermarkets.
  • Another swap: zucchini contains about 4 carbs per cup. Make your own grain free, low-carb noodles from zucchini using a julienne peeler, mandolin or one of the various noodle tools on the market.  

Lisa Grudzielanek, MS,RDN,CD,CDE
Cureality Nutrition Specialist

Not so fast. Don’t make this mistake when going gluten free!

Beginning last month, the Food and Drug Administration began implementing its definition of “gluten-free” on packaged food labels.  The FDA determined that packaged food labeled gluten free (or similar claims such as "free of gluten") cannot contain more than 20 parts per million of gluten.

It has been years in the making for the FDA to define what “gluten free” means and hold food manufactures accountable, with respect to food labeling.  However, the story does not end there.

Yes, finding gluten-free food, that is now properly labeled, has become easier. So much so the market for gluten-free foods tops $6 billion last year.   However, finding truly healthy, commercially prepared, grain-free foods is still challenging.

A very common mistake made when jumping into the gluten-free lifestyle is piling everything labeled gluten-free in the shopping cart.  We don’t want to replace a problem: wheat, with another problem: gluten free products.

Typically gluten free products are made with rice flour (and brown rice flour), tapioca starch, cornstarch, and potato flour.  Of the few foods that raise blood sugar higher than wheat, these dried, powdered starches top the list.

 They provide a large surface area for digestion, thereby leading to sky-high blood sugar and all the consequences such as diabetes, hypertension, cataracts, arthritis, and heart disease. These products should be consumed very rarely consumed, if at all.  As Dr. Davis has stated, “100% gluten-free usually means 100% awful!”

There is an ugly side to the gluten-free boom taking place.  The Cureality approach to wellness recommends selecting gluten-free products wisely.  Do not making this misguided mistake and instead aim for elimination of ALL grains, as all seeds of grasses are related to wheat and therefore overlap in many effects.

Lisa Grudzielanek MS, RDN, CD, CDE
Cureality Health & Nutrition Coach

3 Foods to Add to Your Next Grocery List

Looking for some new foods to add to your diet? Look no further. Reach for these three mealtime superstars to encourage a leaner, healthier body.

Microgreens

Microgreens are simply the shoots of salad greens and herbs that are harvested just after the first leaves have developed, or in about 2 weeks.  Microgreen are not sprouts. Sprouts are germinated, in other words, sprouted seeds produced entirely in water. Microgreens are grown in soil, thereby absorbing the nutrients from the soil.

The nutritional profile of each microgreen depends greatly on the type of microgreen you are eating. Researchers found red cabbage microgreens had 40 times more vitamin E and six times more vitamin C than mature red cabbage. Cilantro microgreens had three times more beta-carotene than mature cilantro.

A few popular varieties of microgreens are arugula, kale, radish, pea, and watercress. Flavor can vary from mild to a more intense or spicy mix depending on the microgreens.  They can be added to salads, soup, omelets, stir fry and in place of lettuce.  

Cacao Powder

Cocoa and cacao are close enough in flavor not to make any difference. However, raw cacao powder has 3.6 times the antioxidant activity of roasted cocoa powder.  In short, raw cacao powder is definitely the healthiest, most beneficial of the powders, followed by 100% unsweetened cocoa.

Cacao has more antioxidant flavonoids than blueberries, red wine and black and green teas.  Cacao is one of the highest sources of magnesium, a great source of iron and vitamin C, as well as a good source of fiber for healthy bowel function.
Add cacao powder to milk for chocolate milk or real hot chocolate.  Consider adding to coffee for a little mocha magic or sprinkle on berries and yogurt.




Shallots


Shallots have a better nutrition profile than onions. On a weight per weight basis, they have more anti-oxidants, minerals, and vitamins than onions. Shallots have a milder, less pungent taste than onions, so people who do not care for onions may enjoy shallots.

Like onions, sulfur compounds in shallot are necessary for liver detoxification pathways.  The sulfur compound, allicin has been shown to be beneficial in reducing cholesterol.  Allicin is also noted to have anti-bacterial, anti-viral, and anti-fungal activities.

Diced then up and add to salads, on top of a bun less hamburger, soups, stews, or sauces.  Toss in an omelet or sauté to enhance a piece of chicken or steak, really the possibilities are endless.  

Lisa Grudzielanek,MS,RDN,CD,CDE
Cureality Nutrition & Health Coach

3 Band Exercises for Great Glutes

Bands and buns are a great combination.  (When I talk about glutes or a butt, I use the word buns)  When it comes to sculpting better buns, grab a band.   Bands are great for home workouts, at gym or when you travel.  Check out these 3 amazing exercises that will have your buns burning. 

Band Step Out

Grab a band and place it under the arch of each foot.  Then cross the band and rest your hands in your hip sockets.  The exercise starts with your feet hip width apart and weight in the heels.  Slightly bend the knees and step your right foot out to the side.  Step back in so that your foot is back in the starting position.  With each step, make sure your toes point straight ahead.  The tighter you pull the band, the more resistance you will have.    You will feel this exercise on the outside of your hips. 

Start with one set of 15 repetitions with each foot.  Work on increasing to 25 repetitions on each side and doing two to three sets.



Band Kick Back

This exercise is performed in the quadruped position with your knees under hips and hands under your shoulders.    Take the loop end of the band and put it around your right foot and place the two handles or ends of the band under your hands.  Without moving your body, kick your right leg straight back.  Return to the starting quadruped position.  Adjust the tension of the band to increase or decrease the difficulty of this exercise. 

Start with one set of 10 repetitions with each foot.  Work on increasing to 20 repetitions on each side and doing two to three sets. 



Band Resisted Hip Bridge

Start lying on your back with feet hip distance apart and knees bent at about a 45-degree angle.  Adjust your hips to a neutral position to alleviate any arching in your lower back.  Place the band across your hipbones.  Hold the band down with hands along the sides of your body.  Contract your abs and squeeze your glutes to lift your hips up off the ground.  Stop when your thighs, hips and stomach are in a straight line.  Lower you hips back down to the ground. 

Start with one set of 15 repetitions.  Work on increasing to 25 repetitions and doing two to three.  Another variation of this exercise is to hold the hip bridge position.  Start with a 30 second hold and work up to holding for 60 seconds.

Cureality | Real People Seeking Real Cures

200 point drop in heart scan score

Some of the math-savvy will have noticed that we often report drops in CT heart scan scores on a percentage basis. Unfortunately, it this were a competition (which, of course, it is not), this would be unfair.

A score of 50, for instance, that drops "only" 25 points would represent a 50% drop in score.

But someone with a score of 1050 who drops his or her score the same quantity, or 25, will have dropped their score less than 5%.

In other words, the magnitude of your starting score determines how large a percentage drop you achieve, even when the absolute, or real, quantity of plaque reversal is the same as someone who begins with a lower score.

I qualify this discussion in this vein because of Grady's story. Grady, a soon-to-retire attorney, started with a heart scan score of 1151. On the Track Your Plaque program, he saw his score drop nearly 200 points--200 points!

But, if we gauged Grady's success just on a percentage basis, he dropped his score only a measly 17% or so. (Imagine the headlines if this program were sponsored by a drug manufacturer. The Track Your Plaque program proudly has nothing to do with the drug industry.)

Of course, the Track Your Plaque program is not a competition. It is an effort to help everyone possible, the more the better. Even if Grady failed to set a new Track Your Plaque record gauged on a percentage basis, he will have achieved an extraordinary advantage in health: the virtual elimination of the dangers of heart disease.

With this drop in score, Grady's risk for heart attack plummets from a spine-chilling 25% per year to nearly zero. (I know of NO other program that can claim such a track record.)

Grady's full story will be reported in the August, 2007 Track Your Plaque newsletter. To subscribe or to just view when it is posted, go to www.cureality.com website, click on the upper right hand corner What Does My Heart Scan Show? graphic, which then takes you to the page to view the newsletter. Or, Track Your Plaque Members can just go to the Library and click on newsletter archives.

How tough is the Track Your Plaque 60-60-60 target?

One of the basic requirements that stack the odds in your favor of stopping or dropping your CT heart scan score is to achieve basic lipid targets of 60-60-60.

In other words, we generally see best results when LDL is reduced to 60 mg/dl, HDL raised to 60 mg/dl, triglycerides reduced to 60 mg/dl. Now, these are not absolute requirements. Someone can have a spectacular drop in heart scan score even with an HDL of 56, LDL of 71. But the "Rule of 60" provides a useful target that is easy to remember, packs real power, and is clearly beyond that achieved with conventional approaches.

People often ask, "Just how tough is it to get to these targets?"

It's really not that tough. Interestingly, whenever I tell my cardiologist or primary care colleagues that I advocate these 60-60-60 targets, they declare that it's tough, perhaps impossible, except for the most highly motivated.

I agree that it requires motivation. A cigarette-smoking, TV-addicted, 70-lb overweight, chip- and pretzel-eating couch potato is not going to achieve them.

On the other hand, you don't have to be a marathon running vegetarian to do it, either.

Most people, in fact, engaged in the Track Your Plaque program achieve the 60-60-60 targets---or exceed them. It's not uncommon, for instance, for HDL to skyrocket to 80 or 90 mg/dl with many of our strategies. (Of course, if your starting HDL is 20 or 25 mg/dl, 80 or 90 is not possible with current technology.)

But it certainly does require more than the "Take Lipitor and stick to your low-fat diet" approach that is the mantra repeated in the vast majority of medical offices across the U.S. For instance, reducing LDL to 60 mg/dl when starting at 170 mg/dl will require addition of oat bran and other soluble or viscous fibers; raw almonds and walnuts; perhaps the use of Benecol butter substitute; reduction or elimination of wheat products if small LDL comprises a substantial proportion of LDL particles. Reducing triglycerides requires the generous use of omega-3 fatty acids from fish oil. Attention to vitamin D must be a part of the effort.

So, yes, it is not as simple as the conventional approach. But the results are far superior in reducing or eliminating heart attack and in dropping your heart scan score.

But it can be done. We do it every day.

Vitamin D2 belongs in the garbage

It happened yet again.

Mel came to the office. CT heart scan score: 799--quite high, enough to pose a real threat very soon. Thus, no time to lose in instituting an effective prevention program.

We do the usual--identify the six causes of coronary plaque; begin fish oil, show him how to correct his plaque causes. You've heard it before.

Vitamin D blood level in March: 17 ng/ml--severe deficiency.

Vitamin D replacement needs to be a part of his coronary plaque control program. So I suggested 6000 units per day of an oil-based preparation of vitamin D3 (cholecalciferol). Conveniently, there is a Vitamin Shoppe outlet across the street from my office. I just point and tell people to go across the street.

Mel did just that. However, he also informed his primary care physician about his vitamin D deficiency. His primary physician promptly told him he needed to take a prescription form of vitamin D and not to bother with just a supplement.

So Mel stopped his vitamin D capsules and started taking vitamin D prescription "medication." Mel figured, naturally, that if it requires a prescription, it must be better. Unfortunately, Mel and his doctor failed to pass the change in strategy onto us.

So, four months later, Mel got repeat vitamin D blood level: 19 ng/ml.

I've seen this too many times. The prescription form of vitamin D is nonsense. There's hardly any effect on blood levels of vitamin D3 at all. The body's conversion of this non-human form of D is extremely inefficient and therefore virtually useless. While it raises the blood level of vitamin D2 (ergocalciferol) and thereby total D (D3 + D2), there is negligible effect on the real human and active form, D3.

How and why this preparation got through the FDA process to obtain approval as a drug is beyond me, though I am not a defender of FDA practices and politics.

This notion that "if it's a prescription, it must be better" is a fiction perpetuated by the drug industry. The same principle gets tossed around with fish oil, hormones like estrogens and testosterone, and others. Often, the principal difference between prescription and non-prescription is patent protection. Patent protection provides profit protection. Selling a product without patent protection can be risky business. It's certainly less profitable.

As always, getting at the truth is sometimes the most difficult job of all. Prescription vitamin D belongs in the garbage. Vitamin D capsules (gelcaps) do the job and do it well, over and over, with reliable, consistent and substantial rises in blood levels of 25-OH-vitamin D3. I take 6000 units per day (3 2000 unit capsules) that cost me $5.99 for a bottle of 120 capsules, or about $4.50 a month.

And nobody--nobody--pays me to say this. I say it because I believe it's true.

Angioplasty vs. Track Your Plaque

What does angioplasty have over the Track Your Plaque program?

Well, first of all, the Track Your Plaque program has a lot to boast about. What other approach can claim to have reduced heart disease 30, 40, 51, and now 63%? That's as close to a cure that's ever--EVER--been achieved. Statin drug manufacturers can talk about an occasional 1, 2, or 5% reversal. We're talking 10 times more.

The Track Your Plaque program also uses as little prescription medication as necessary. Fish oil, vitamin D, coenzyme Q10, niacin--some of the frequent tools used for plaque reversal in our program. Yes, we do use prescription medications, but only when there is truly a benefit and nutritional strategies have failed to achieve the goals we're seeking. We do not endorse shotgun prescription approaches conceived of by some marketing department at a pharmaceutical company.

So what possible advantage can coronary angioplasty have? Why don't more people embrace a program like Track Your Plaque that has already proven itself enormously effective?

Because angioplasty is easy. There's little worrying ahead of time. Just wait for the symptoms or other problem to appear, go to the hospital and get your procedure. You can live the free and easy life beforehand--no exercise, no diet efforts, no nutritional supplements. Just be sure to go to the hospital when suspicious symptoms strike. (Of course, you gamble that you survive the appearance of symptoms, a process 30-50% of people fail to survive.)

That means you can eat all you want, drink all you want, save the money you otherwise might have thrown away on supplements, pocket the monthly costs of an exercise club membership, etc. Go to the hospital when you experience the sensation of an anvil on your chest or of suffocation, let the emergency room do their thing, meet your cardiologist, go to the catheterization laboratory, get two or three stents, go home the next day!

Why bother with a prevention program, especially one that requires involvement, learning, and effort like Track Your Plaque?

Because it's your way to stack the odds enormously in your favor of 1) surviving the appearance of symptoms, 2) avoiding the prospect of heart procedures, which are not as clean and easy as they often seem, 3) have a longer lasting durability than a stent which could buy you a couple of years before your next procedure or heart catastrophe, and 4) it's the right thing to do for the sake of the huge societal cost of heart disease.

Many of you have the equivalent of a cure for heart disease at your fingertips. Unless you have a soft spot in your heart for hospitals, cardiologists, or the pharmaceutical or medical device industry, there isn't a choice.

Plaque is like money

In case anyone missed this in the June, 2007 Track Your Plaque Newsletter, I'm again posting how we calculate the annual rate of score increase, should it occur.

For instance, say your score in January, 2005, is 100. In November, 2006, you undergo another scan and the score is 140. Obviously, your score has increased an undesirable 40%. But what is the annual rate of score increase, the amount of increase per year?

In this example, the annual rate of score increase is 19%--not anywhere near as bad as the 40% that can scare the heck out of you.

Obviously, the best rate of heart scan score increase is a negative number, i.e., a drop in score from, say 100, to 60. You might even eliminate the need for this calculation altogether if you drop your score.

Nonetheless, whenever there is a score increase over an uneven period of time, a fraction of year(s), this is the method we use to annualize the calculation. The equation we use is a modified form of the annual compound interest equation using continuous compounding, since that’s how coronary atherosclerotic plaque grows--just like money. The difference is, of course, is that while you might want more money, you certainly don't want more plaque.

You will need a calculator for this calculation, one with an exponential “y to the power x” function. For ease, calculate "1/t first, then use it as the “x” exponent on your yx function and "(score 2 / score 1)" as the "y".


Annual rate of plaque growth (APG) = ( score 2 / score 1 ) 1/t - 1

Multiply the result by 100 to yield a percent.


“Score 1” is your 1st heart scan score, “score 2” is your 2nd (or any subsequent heart scan score); “t” is the amount of time between the two scans expressed in years in decimal form. Time between scans should be expressed in years or fractions of years. To obtain the time interval in fractions of years, simply divide the number of months between scans by 12 (e.g., 18 months / 12 = 1.5 years ; 22 months / 12 = 1.83 years).

It’s not as tricky as it looks. For example, if your first heart scan score is 300 and your next scan 16 months later (or 16/12 = 1.33 years) is 372, then:

Annual rate of plaque growth (APG) = ( 372 / 300 ) 1/1.33 - 1 = 0.175

Multiply 0.175 x 100 = 17.5% annual rate of plaque growth


Some scan centers will do the calculation for you as part of a repeat scan. However, the equation can be used if you're left on your own, or if you go to a different scan center. If this is too much effort, perhaps it's just another reason to add to the list of reasons to drop your heart scan score!

Triglycerides: What is normal?

In The Track Your Plaque program, we advocate decreasing triglycerides to 60 mg/dl or less.

That's the level of triglycerides that minimize the presence of triglyceride-containing undesirable lipoproteins causing plaque, such as small LDL, VLDL, and the after-eating persistence of IDL (intermediate-density lipoprotein, a bad player). (The enzyme, cholesteryl-ester transfer protein, or CETP, is responsible for exchanging one triglyceride molecule for one cholesterol molecule between HDL and other lipoprotein particles. Thus, an excess of triglyceride availability permits CETP to operate unrestrained, creating more undesirable lipoproteins. This was the basis for Pfizer's now defunct CETP inhibitor, torcetrapib.)

Of course, this triglyceride target is far below that of the conventional guidelines. The Adult Treatment Panel-III of the National Cholesterol Education Panel suggests a triglyceride level of 150 mg/dl is okay.

In my view, a level of 150 mg/dl is highly abnormal, permitting the persistence of multiple lipoprotein particles and virtually guarantees plaque growth. In short, triglycerides of 150 are awful.

Curious thing: Successful participants in our program, i.e., people who achieve desirable weight, reduce processed carbohydrate junk foods and saturated fat sources, and aim for the 60-60-60 targets for conventional lipids, commonly end up with triglyceride levels of 25-50 mg/dl.

We have seen many people drop their heart scan scores just by achieving a triglyceride level of 60 mg/dl or less. So achieving a lower level below 60 is not necessarily a requirement for coronary plaque regression.

But it makes me wonder if a triglycere level of 30s or 40s is the level for perfect health. These are levels ordinarily regarded as impossibly low. When colleagues see the numbers we readily and routinely achieve, they declare that the numbers are spurious, temporary, or just flukes. "No way you can do that all the time!"

This level also seems to, in virtually all cases, eliminate the triglyceride-containing undesirable lipoproteins small LDL, IDL, etc., and allow full conversion of HDL into the healthy, large fraction.

Should we move the Track Your Plaque triglyceride target to below 45 mg/dl or even lower? I don't think so, but it makes me wonder.

The processed food battlefield

If you have any remaining doubts that the processed food industry is a cutthroat, go-for-the-jugular, organized effort to extract every possible penny from your pocket, even at the expense of health, take a gander at a quote from Marion Nestle's wonderful book, Food Politics.

In Nestle's description on how food conglomerate, Archer Daniels Midland (ADM), conspired to fix prices on some basic agricultural compounds, she quotes an ADM executive captured on videotape and presented in court:

"We have a saying at this company . . . our competitors are our friends and our customers are our enemies."

In other words, ADM's competitors help establish what prices should be charged for basic foodstuffs, while its customers are the ones to do battle with.

Food is a necessary commodity. You and I only need so much of it. So how does a 40 billion dollar food manufacturer extract greater and greater profits and grow their market? Motivate people to eat more. It's that simple.

Eat less? Are you kidding? Eat spinach, green peppers, beets, and other low-margin products? Get real.

Why not take 8 cents worth of wheat flour, add some sugar, food coloring, and some other enticing flavorings like high fructose corn syrup? Put it all in a cleverly illustrated package, maybe even develop an entire story line about the product, complete with clever slogans and songs and . . . ouila! You now have a food that sells for many, many times its intrinsic value.

How to make the health nuts happy? Easy: Add some fiber. Now it's healthy! And it's now part of a "balanced diet".

What if it's full of corn starch, wheat flour, and sugar of the sort that make HDL cholesterols plummet, fan the flames of small LDL, increase inflammatory measures like C-reactive protein, push people closer and closer to diabetes, and make them fat? Then be sure it's low in saturated fat! It might even qualify as "Heart Healthy" by the American Heart Association!

Processed foods have no role in the Track Your Plaque program. If you want to see your CT heart scan score skyrocket, go to your grocery store and stray into the aisles outside of the produce aisle.

But stick to the produce aisle and watch your wallet grow, your health improve, your appetite shrink, all while food processor profits plummet.

Heart Scan debate

A few years back when the book form of Track Your Plaque was first released, I did a bunch of radio and interviews to raise awareness of the book and of CT heart scanning in general.

I'd forgotten about this interview I did for National Public Radio (NPR), in which I debate Dr. Graboys from Harvard. Though I've had this debate countless other times, usually on a less formal basis, I didn't know what to expect at the start of the interview. After all, I knew of Dr. Graboys' reputation as a respected Harvard cardiologist. So I was expecting that at least he would argue that, being relatively new at the time, CT heart scanning was largely unproven in large clinical trials. (This was not entirely true then, however, as at least 1000 trials had already been performed, many of them involving thousands of participants. However, despite that much validation, the concept of CT heart scanning had still not entered the consciousness of most practicing physicians. After all, heart scanning is not part of the "crash and repair" equation that most have invested their career in.)

Heart Hawk re-discovered the debate, still on the NPR website. So here it is. When I re-listened to the debate, I was surprised at how little Dr. Graboys had to offer. He argues that examining left ventricular function should suffice as an important measure of mortality. In other words, if you have experienced a drop in the strength of heart muscle, that can be used to stratify your risk of death.

I tried to convey to the audience (NOT convince Dr. Graboys to believe, as most of my colleagues are stubbornly adherent to their way of thinking until someone tosses a big carrot in front of them) that CT heart scanning provides a means to detect coronary atherosclerosis years, even decades, before questions of mortality (death) became necessary. Heart scanning identifies disease in its early stages so that a program of prevention can be followed and tracked.

Dr. Graboys expressed concern that heart scanning devices could be mis-used to increase hospital procedures. He's absolutely right here. By that same line of thinking, say your crooked auto mechanic on the corner scams most of his customers by doing unnecessary car repairs. Does this mean that we should ban all auto mechanics from repairing cars? I hope not. I believe it does mean that we should all be educated on distinguishing scams from an honest businessman.

Same with heart scans. The key is not to ban heart scanning. We should try to educate the public and physicians to prevent these sorts of scams and decisions based on ignorance from occurring.

Nonetheless, make your own judgments.


CLICK HERE to listen (this is a .ram file so you will need the free RealPlayer to play)

Break the addiction

"But, doc, I can't lose my cereal! Pretzels--you've got to be kidding me! I eat 'em every night! I can't do it. I'll be hungry all the time!"

This is a discussion I have every day. The usual suspect: A 50-some year old with HDL in the 30s or 40s, small LDL, borderline high blood sugar approaching the pre-diabetic cut-off, highish blood pressure, excess tummy. They usually struggle with energy, feelings of sleepiness, use lots of caffeine to stay alert even in the middle of the day after a sufficient night's sleep.

Not as obvious as the tremulous, pinopint-pupil drug addict, but I recognize it nonetheless: The processed food addict.

Breaking this addiction can be as difficult for some people as breaking a smoking addiction. Instead of nicotine cravings, they get insatiable hunger. Just 3 or 4 hours without their processed food "fix," and they are ravenous to satiate their impulse. Most give in and go right back to the vicious cycle.

But break the cycle--eliminate processed foods like breakfast cereals, whole wheat crackers, pretzels, cookies, granola bars, fruit drinks, low-fat salad dressings, bran muffins . . .70+% of the foods in your supermarket---and you will make an interesting discovery:

You no longer crave these foods.

Just think about it: The addictive properties of processed foods are a food manufacturer's dream. What other product besides cigarettes has an addictive quality that ensures you come back for more... and more and more.

It it just too creepy that much of the processed food industry is, in reality, owned by the tobacco industry (Altria, previously known as Phillip Morris) and RJ Reynolds. Perhaps that is the modus operandi of these corporations: Identify products that have an edge, foods or other products that possess an addictive quality. This is not true of cucumbers, for instance. What a lousy investment a cucumber grower would make!

Be smarter than Phillip Morris. Outsmart the people looking to empty your pocket and corrupt your health. Break the addiction.

Hang around the produce aisle of your grocery and use the farmer's market or your local equivalent. Look for locally grown foods. Try to keep your food as unprocessed as possible.

You will be impressed with the results.

Are we done here?

Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.

Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy.

Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart.

Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before.

I explained to Les that having normal coronary blood flow was just one aspect of the issue.

"But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"

I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack.

"With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."

So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him.

Now, if we could only transform Les into an optimist . . .
  • 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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    Healthy Choice Complete Selections Glazed Chicken
    Healthy Choice Complete Selections Grilled Chicken Monterey
    Healthy Choice Complete Selections Grilled Turkey Breast
    Healthy Choice Complete Selections Grilled White Meat Chicken with Smokehouse BBQ Sauce
    Healthy Choice Complete Selections Honey Balsamic Chicken
    Healthy Choice Complete Selections Lemon Pepper Fish
    Healthy Choice Complete Selections Meatloaf
    Healthy Choice Complete Selections Mushroom Roasted Beef
    Healthy Choice Complete Selections Roasted Chicken
    Healthy Choice Complete Selections Salisbury Steak
    Healthy Choice Complete Selections Sweet Bourbon Steak
    Healthy Choice Complete Selections Sweet and Sour Chicken
    Healthy Choice Complete Selections Traditional Turkey Breast
    Healthy Choice Low Fat Premium Sorbet & Cream Bars-Orange or Strawberry
    Healthy Choice Premium Caramel Swirl Sandwich
    Healthy Choice Premium Fudge Sandwich
    Healthy Choice Premium Fudge Swirl Sandwich
    Healthy Choice Premium Low Fat Ice Cream Bar
    Healthy Choice Premium Vanilla Sandwich
    Healthy Choice Simple Selections Breaded Chicken Breast Strips with Gravy
    Healthy Choice Simple Selections Cheese French Bread Pizza
    Healthy Choice Simple Selections Cheesy Chicken and Rice
    Healthy Choice Simple Selections Chicken Enchilada
    Healthy Choice Simple Selections Chicken Fettuccini Alfredo
    Healthy Choice Simple Selections Chicken Rigatoni
    Healthy Choice Simple Selections Four Cheese Manicotti
    Healthy Choice Simple Selections Glazed Chicken
    Healthy Choice Simple Selections Grilled Chicken White Meat Chicken & Pasta
    Healthy Choice Simple Selections Grilled White Meat Chicken & Gravy
    Healthy Choice Simple Selections Lasagna Bake
    Healthy Choice Simple Selections Macaroni & Cheese
    Healthy Choice Simple Selections Mandarin Chicken
    Healthy Choice Simple Selections Pepperoni French Bread Pizza
    Healthy Choice Simple Selections Roast Turkey Breastin Savory Sauce with Mushrooms
    Healthy Choice Simple Selections Salisbury Steak
    Healthy Choice Simple Selections Sesame Chicken
    Healthy Choice Simple Selections Slow Roasted Turkey Breast with Gravy
    Healthy Choice Simple Selections Spaghetti
    Healthy Choice Simple Selections Supreme French Bread Pizza

    ConAgra Grocery Foods
    ACT II 94% Fat Free Butter Microwave Popcorn
    ACT II 94% Fat Free Butter Mini Bags Microwave Popcorn
    ACT II 94% Fat Free Kettle Corn Microwave Popcorn
    Healthy Choice Bean & Ham Soup
    Healthy Choice Beef Pot Roast Microwavable Bowl Soup
    Healthy Choice Chicken & Dumplings Soup
    Healthy Choice Chicken Tortilla Soup
    Healthy Choice Chicken with Rice Microwavable Bowl Soup
    Healthy Choice Chicken with Rice Soup
    Healthy Choice Country Vegetable Microwavable Bowl Soup
    Healthy Choice Country Vegetable Soup
    Healthy Choice Fiesta Chicken Soup
    Healthy Choice Garden Vegetable Soup
    Healthy Choice Garlic & Herb Pasta Sauce
    Healthy Choice Hearty Chicken Soup
    Healthy Choice New England Clam Chowder Soup
    Healthy Choice Old Fashioned Chicken Noodle Microwavable Bowl Soup
    Healthy Choice Old Fashioned Chicken Noodle Soup
    Healthy Choice Split Pea & Ham Soup
    Healthy Choice Traditional Pasta Sauce
    Healthy Choice Vegetable Beef Soup
    Healthy Choice Zesty Gumbo with Chicken & Sausage Soup
    Hunt's Family Favorites Seasoned Tomato Sauce for Lasagna
    Hunt's Organic Crushed Tomatoes
    Hunt's Organic Diced Tomatoes
    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.

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