Thumb your nose at swine flu

Judging from what we know about vitamin D, it is highly probable that it confers substantial protection from viral infections, including swine flu.

Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com) first connected the dots, identifying the possibility of an influence of vitamin D on incidence of flu.

In 2006, Dr. Cannell reports noticing that the patients in his psychiatric ward in northern California were completely spared from the influenza epidemic of that year, while plenty of patients in adjacent wards were coming down with flu. Dr. Cannell proposed that the apparent immunity to flu in his patients may have been due to the modest dose of 2000 units vitamin D per day he had prescribed that the patients in other wards had not been given. (Since the hospital was run by the state of California, Dr. Cannell apparently had only so much leeway with vitamin D dosing.) While it’s not proof, it’s nonetheless a fascinating and compelling observation.

A similar conclusion was reached in a recent analysis of the National Health and Nutrition Examination Survey demonstrating that the higher the vitamin D blood level, the less likely respiratory infections were.

Personally, I used to suffer through 2 or 3 episodes of a runny nose, sore throat, hacking cough, fevers and feeling crumby every winter. Over the last 3 years since I’ve supplemented vitamin D, I haven’t been sick even once. The past two years I didn’t bother with the flu vaccine, since I suspected that my immunity had been heightened: no flu either winter.

And so it has been with the majority of my patients. Since I began having patients supplement vitamin D to achieve normal blood levels (we aim for 60-70 ng/ml), viral and bacterial infections have become rare.

New research is uncovering myriad new ways that vitamin D enhances natural immune responses to numerous infections, including tuberculosis, bacteria such as those causing periodontal disease and lung infections, and viruses like the influenza virus. Enhanced immunity against cancer is also an intensive area of research on vitamin D.

Will vitamin D supplementation sufficient to achieve desirable blood levels confer sufficient immunity to swine flu should it come to your door? From what we know and what we’ve seen in the few years of vitamin D experience, I think it will in the majority. But I do believe that we should still heed public health warnings to avoid contact with others, minimize exposure to crowds, avoid travel to affected areas, etc.

Will the real LDL please stand up?

The results of the latest Heart Scan Blog poll are in.

The question: How has your LDL been measured? The 187 responses broke down as:


I have only had a conventional calculated value
108 (57%)

NMR LDL particle number
35 (18%)

Apoprotein B
21 (11%)

Direct LDL cholesterol
21 (11%)

Non-HDL cholesterol
8 (4%)

I don't know what you're talking about
23 (12%)


Remember the TV game show, To Tell the Truth? Celebrities would have to guess which of three guests represented the real person, such as the notorious con man, Frank Abagnale, Jr., or Mad Magazine publisher, William M. Gaines (who stumped celebrity Kitty Carlisle, heard to exclaim, "I never figured it was him. I mean look at the way he's dressed. I was looking for someone who ran a very successful magazine, so I thought it couldn't be him!")

The celebrities playing the game were permitted to ask the three guests a series of questions, hoping to discern who was the real person vs. the two impostors. At the end, each celebrity had to guess who was truly the person of interest. "Will the real Frank Abagnale, Jr. please stand up!"

If we were to act as the celebrities in our LDL game, we quickly discover some telling facts:

--Conventional LDL cholesterol (the only value 57% of our poll respondents have had) is calculated, not measured. LDL is calculated using the 40-year old Friedewald calculation.

--Directly measured LDL cholesterol (the value 11% of respondents had) is just that: directly measured. It eliminates some of the uncertainties of calculated LDL.

--Apoprotein B-Every LDL and VLDL particle produced by the liver contains one apoprotein B molecule. ApoB therefore provides a crude particle count measure of LDL and VLDL particles. Of course, it includes VLDL and is not completely the same as just an LDL measure. Some lipid authorities Like Dr. Peter Kwiterovich have advocated that apoB replace calculated LDL, and that calculated LDL essentially be discarded.

--Non-HDL cholesterol--I mention this more for completeness. Hardly anybody uses this crude value in practice--Indeed, only 4% of our poll respondents had this measure/calculation. Non-HDL is simply total cholesterol minus HDL cholesterol = Non-HDL cholesterol. It is thus a combination of cholesterol in LDL and VLDL (triglycerides), similar to apoprotein B. While, like apoB, it is a bit different in that it includes VLDL, it has proven a superior measure of risk.

--LDL particle number--In my view, this is the gold standard for LDL and risk measurement, obtained by only 18% of our poll respondents. LDL particle number is proving superior for discriminating who is truly at risk for a cardiovascular event, particularly when metabolic syndrome or diabetes is part of the picture, i.e., when HDL and triglycerides are considerably distorted, leading to substantial corruption of calculated LDL.


While 18% is a minority, it still represents growth in recognition that conventional calculated LDL cholesterol is an unreliable, inaccurate, and outdated value. If the real LDL were to stand up, I believe that it is LDL particle number that would spring to its feet.

Vitamin D and inflammation

We already know that vitamin D reduces inflammatory processes, since several markers, including c-reactive protein and IL-6 have previously been shown to drop substantially with vitamin D. Inflammation underlies coronary atherosclerotic plaque growth, as well as plaque rupture that triggers heart attack.

A German group has now shown that the important inflammatory marker, tumor necrosis factor (TNF), is also reduced by vitamin D supplementation. Many studies have implicated increased TNF levels in promoting cancer.

In this study, a modest vitamin D dose of 3320 units (83 micrograms) was given vs. placebo. The 25-hydroxy D level reached in the treated group was 34.2 ng/ml (85.5 nmol/L), which resulted in a 26.5% reduction in TNF compared with 18.7% reduction (?) in the placebo group.


Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers.

Zitterman A, Frisch S et al.

BACKGROUND: High blood concentrations of parathyroid hormone and low concentrations of the vitamin D metabolites 25-hydroxyvitamin D [25(OH)D] and calcitriol are considered new cardiovascular disease risk markers. However, there is also evidence that calcitriol increases lipogenesis and decreases lipolysis.
OBJECTIVE: We investigated the effect of vitamin D on weight loss and traditional and nontraditional cardiovascular disease risk markers in overweight subjects.
DESIGN: Healthy overweight subjects (n = 200) with mean 25(OH)D concentrations of 30 nmol/L (12 ng/mL) received vitamin D (83 microg/d) or placebo in a double-blind manner for 12 mo while participating in a weight-reduction program.
RESULTS: Weight loss was not affected significantly by vitamin D supplementation (-5.7 +/- 5.8 kg) or placebo (-6.4 +/- 5.6 kg). However, mean 25(OH)D and calcitriol concentrations increased by 55.5 nmol/L and 40.0 pmol/L, respectively, in the vitamin D group but by only 11.8 nmol/L and 9.3 pmol/L, respectively, in the placebo group.


(Calcitriol = 1,25-dihydroxy vitamin D.)


Knowing your vitamin D blood level is crucial, as individual need for vitamin D varies widely from one person to the next. You can get your vitamin D tested at home by going to Grassroots Health or the Track Your Plaque Marketplace.

Even monkeys do it


It all started back in the 1960s, when ape-watching anthropologists, Drs. Jane Goodall and Richard Wrangham, observed chimps foraging for a specific variety of leaf, which they consumed whole while wrinkling their noses in presumed disgust. Subsequent study showed that the leaves contained a powerful anti-parasitic compound.

A similar observation followed in 1987 by Dr. Michael Huffman from the University of Kyoto. During his year of living in the jungles of Tanzania, he observed chimpanzees in their native habitat. On one unexpected morning, he observed a female chimp, Chausiku:

“Chausiku goes directly to and sits down in front of a shrub and pulls down several new growth branches about the diameter of my little finger. She places them all on her lap and removes the bark and leaves of the first branch to expose the succulent inner pith. She then bites off small portions and chews on each for several seconds at a time. By doing this, she makes a conspicuous sucking sound as she extracts and swallows the juice, spitting out most of the remaining fiber. This continues for 17 minutes, with short breaks as she consumes the pith of each branch in the same manner.”

Dr. Michael Huffman’s description of Chausiku documents a fascinating example of animal self-medication what some call "zoopharmacognosy."
In this instance, the chimpanzee, weak, clutching her back in pain, and listless, was ingesting the leaves of the plant, Vernonia amygdalina, to purge an intestinal parasite. She recovered by the next morning.

Vernonia leaves have since been found to contain over a dozen potential anti-parasitic compounds. Chimps in this region commonly suffer infestations of parasites like Strongyloides fuelleborni (thread worm), Trichuris trichiura (whip worm), and Oesophagostomum stephanostomum (nodular worm). They have somehow stumbled onto a treatment that they administer themselves.

Chimpanzees have inhabited earth for over 6 million years. Who knows how long they and other primates have practiced some form of self-medication.

If chimpanzees can do it, I believe that we, as human primates, can also practice a similar form of self-directed health--homopharmacognosy?



Image courtesy Wikipedia

Cath lab energy costs

In honor of Earth Day, I thought I'd highlight the unexpectedly high carbon costs of activities in hospitals, specifically the cardiac catheterization laboratory.

A patient enters the cath lab. The groin is shaved using a plastic disposable razor, the site cleaned with a plastic sponge, then the site draped with an 8 ft by 5 ft composite paper and plastic material (to replace the old-fashioned, reusable cloth drapes). A multitude of plastic supplies are loaded onto the utility table, including plastic sheaths to insert into the femoral artery (which comes equipped with a plastic inner cannula and plastic stopcock), a multi-stopcock manifold that allows selective entry or removal of fluids through the sheath, a plastic syringe to inject x-ray dye, plastic tubing to connect all the devices (total of about 5 feet), and multiple plastic catheters (3 for a standard diagnostic catheterization, more if unusual arterial anatomy is encountered).

All these various pieces come packed in elaborate plastic (polyethylene terephthalate or other polymers) containers, which also come encased in cardboard packaging.

Should angioplasty, stenting, or similar procedure be undertaken, then more catheters are required, such as the plastic "guide" catheters that contain a larger internal lumen to allow passage of angioplasty equipment. An additional quantity of tubing is added to the manifold and stopcock apparatus, as well as a plastic Tuohy-Borst valve to permit rapid entry and exit of various devices into the sheath.

Several new packages of cardboard and plastic are opened which contain the angioplasty balloon, packaging which is usually about 4 feet in length. The stent likewise comes packaged in an 18-inch or so long package with its own elaborate cardboard and plastic housing.

At the conclusion of the procedure, another cardboard/plastic package is opened, this one containing the closure device consisting of several pieces of plastic tubes and tabs.

If the procedure is complicated, the number of catheters and devices used can quickly multiply several-fold.

By the conclusion of the procedure, there are usually two large, industrial-sized trash bins packed full of cardboard, plastic packaging, and discarded tubing and catheters. The trash is so plentiful that it is emptied following each and every procedure. None of it is recycled, given the contamination with human body fluids.

That's just one procedure. The amount of trash generated by these procedures is staggering, much of it plastic. I don't know how much of the U.S.'s annual plastic trash burden of 62 billion pounds (source: EPA) originates from the the cath lab, but I suspect it is a big number in total.

So if you are truly interested in reducing your carbon footprint and doing your part to be "green," avoid a trip (or many) to the cath lab.

Wag the Dog

What if the system to provide heart care has already gotten as big as it should be?

Worse (for hospitals), what if it’s already far larger than it needs to be? Can the system continue to increase revenues if they’ve already attained titanic proportions and outgrown demand? After all, darn it, there are only so many sick people around.

Hospital administrators might have to face an unpleasant choice: downsize to strip excess capacity and suffer the consequences in a competitive market, or . . . fabricate demand for their services.

Like the Dustin Hoffman and Robert DeNiro characters in the movie, Wag the Dog, about how two media-manipulators divert public attention away from a Presidential sex scandal by fabricating a war, spin is everything. It’s enough to sidetrack public attention from a scandal, obscure a truth, send us on a useless detour.

If healthcare for the heart isn’t driven by need, but many still desire to reap the benefits of the procedure-focused system, why not increase the perceived need?

That’s precisely the course that many hospital systems have chosen to follow. If the market you serve has been tapped to its full potential, then grow the market.

Imagine if a company like General Motors were to operate this way. In 2006, for instance, GM sold 9.1 million automobiles. If GM executives were to decide that they’d like to outstrip Toyota by boosting sales by 10% to 10 million, how would they do it? They would first have to determine whether it was feasible to grow demand for their product. If deemed possible, the company would need to ramp up manufacturing capacity to anticipate increased demand. If they miscalculate, GM could be stuck with a costly surplus and have to swallow the costs, maybe selling leftovers at a loss. (We don’t mean to pick specifically on GM; they’re a fine company as far as we’re concerned. This is just a hypothetical illustration.)

But what if a company could concoct some sort of scheme to persuade the car-buying public that they just had to have their cars or trucks? In other words, they could, in effect, create demand for their products.

As perverse as it sounds, that is exactly what occurs in healthcare for heart disease. The system long ago exceeded the necessary level of infrastructure to maintain a high-quality level of care accessible to most Americans. Instead, it continues to grow through a distortion of perception, delivering more services of increasing complexity to larger and larger numbers of people.

The size of the market is therefore a manipulable thing, something that can be massaged and cultivated. There are a variety of clever ways to exaggerate the need for heart procedures.

Why not raise the alarm for heart disease every chance you get? When a local sports figure survived a heart attack here in Milwaukee, St. _____ marketing department was right there, broadcasting the process in TV ads after his recovery. What could be more American than baseball, apple pie . . . and St. _____ Hospital? After his hospital discharge, the 57-year old local icon was shown on the sidelines with his team, back on the job, and at home with family, all beaming, just three months after a bypass operation. “I received only the very best care at St. _____ Hospital. They treated me like family. St. _____ doctors and nurses are the best!” Predictably, a two-month long spike in hospital testing followed filled with people worried whether they, too, might be in imminent danger. Several local cardiologists boasted of the many sports figures who came through the stress testing and heart catheterization labs, though virtually all checked out to be fine.

Though it can serve a legitimate purpose in some situations, stress tests are the ultimate example of a heart scam built on the perception of danger. Pull people in with promises of reassuring them whether or not they have heart disease, only to provide murky results that usually do no such thing. The pitfalls of the test are turned to advantage. The all too common equivocal or mildly abnormal result can be converted into a hospital procedure. (Imagine you could perform such alchemy on the uncertain calculations on your income taxes.)

With millions of stress tests performed every year and the push to perform more and more screening tests, the market has, in effect, been expanded—even though no increase in the disease itself has actually occurred.

Beware: As the scramble for heart patients intensifies, you are going to feel like you are being pulled closer and closer into the jaws of this hungry monster called the American cardiovascular healthcare machine.

Heart scan book



There are only two books on heart scans available.

One, of course, is Track Your Plaque.

The other is the basic book on heart scans, What Does My Heart Scan Show?

Lost in the navigation column to the left on this blog is the link to get the electronic version of the book. In case you didn't know, we make this available for free.

If you're interested, just go here. This book can provide many basic answers to the questions that often arise regarding heart scans, such as the expected rate of increase in score, how your score compares to other people, when should a stress test be considered. Many heart scan centers use this book for educational purposes to help patients understand the importance of their heart scan scores.

(The sign-up for the book requires that an e-mail address be entered.)

The hard copy of What Does My Heart Scan Show? is available from Amazon, also, for $12.99.

Lies, damned lies, and statistics

In the last Heart Scan Blog post, I discussed the question of whether statin drugs provide incremental benefit when excellent lipid values are already achieved without drugs.

But I admit that I was guilty of oversimplification.

One peculiar phenomenon is that, when plaque-causing small LDL particles are reduced or eliminated and leave relatively benign large LDL particles in their place, conventional calculated LDL overestimates true LDL.

In other words, eliminate wheat from your diet, lose 25 lbs. Small LDL is reduced as a result, leaving large LDL. Now the LDL cholesterol from your doctor's office overestimates the true value.

Anne raised this issue in her comment on the discussion:

I eliminated wheat - and all grains - from my diet nearly three years ago (I eat low carb Paleo). My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John's or Sam's:

LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl

My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.



However, if we were to measure LDL, not just calculate it from the miserably inaccurate Friedewald equation, we would likely discover that her true LDL is far lower, certainly <100 mg/dl. (My preferred method is the bull's eye accurate NMR LDL particle number; alternatives include apoprotein B, the main apoprotein on LDL.)

So Anne, don't despair. You are yet another victim of the misleading inaccuracy of standard LDL cholesterol determination, a number that I believe should no longer be used at all, but eliminated. Unfortunately, it would further confuse your poor primary care doctor or cardiologist, who--still believe in the sanctity of LDL cholesterol.

By the way, the so-called "ratios" (i.e., total cholesterol to HDL and the like) are absurd notions of risk. Take weak statistical predictors, manipulate them, and try to squeeze better predictive value out of them. This is no better than suggesting that, since you've installed new brakes on your car, you no longer are at risk for a car accident. It may reduce risk, but there are too many other variables that have nothing to do with your new brakes. Likewise cholesterol ratios.

Aspirin, Lipitor, and a low-fat diet

Despite all the hoopla heart disease receives in the media, I continue to marvel at how many people I meet who still think that aspirin, Lipitor, and a low-fat diet constitute an effective heart attack prevention program.

It doesn't. No more than washing your hands prevents all human infections. It helps, but it is a sad substitute for a real prevention program.

Of course, aspirin, Lipitor, and a low-fat diet is the same recipe followed by the unfortunate Tim Russert and his doctors. You know how that turned out. Mr. Russert's experience is far from unique.

What is so magical about aspirin, Lipitor and a low-fat diet?

There is a simple rationale behind this approach. Aspirin doesn't reduce atherosclerotic plaque growth, but it inhibits the propagation of a blood clot on top of a coronary plaque that has "ruptured," thereby reducing likelihood of heart attack (which occurs when the clot fills the artery). So aspirin only provides benefit if and when a plaque ruptures.

Lipitor and other statin drugs reduce LDL cholesterol, promote a modest relaxation of constricted plaque-filled arteries (normalization of endothelial dysfunction), and exerts other effects, such as inflammation suppression.

A low-fat diet is intended to reduce saturated fat that triggers LDL cholesterol formation and to encourage intake of whole grains that reduce cardiovascular events and LDL cholesterol.

If that is the extent of your heart disease prevention program, you will have a heart attack, bypass surgery, or stent--period. It may not be tomorrow or next Friday, or even next month. Aspirin, Lipitor, and a low-fat diet may delay your heart attack or procedure for a few years, but it will not stop it.

Some flaws in the aspirin, Lipitor, low-fat program:

--Aspirin can only exert so much blood clot-blocking effect. It can be overwhelmed by many other factors, such as increased blood viscosity, increased fibrinogen (a blood clotting protein that also triggers plaque), and plaque inflammation.
--Lipitor reduces LDL, but does not discriminate between the relatively harmless large LDL and the truly plaque-triggering small LDL--it reduces all LDL, but small LDL can still persist, even at extravagant levels since neither aspirin nor Lipitor specifically reduces small LDL, while a low-fat diet increases small LDL.
--Low-fat diet--A diet reduced in fat and loaded with plenty of "healthy whole grains" will trigger increased small LDL (an enormous effect), c-reactive protein, high blood sugar, resistance to insulin, high blood pressure, and an expanding abdomen ("wheat belly").


Aspirin, Lipitor and a low-fat diet do not address:

--Vitamin D deficiency
--Omega-3 fatty acid deficiency and the eicosanoid path to inflammation
--High triglycerides
--Small LDL particles
--Distortions of HDL "architecture"
--Lipoprotein(a)--the worst coronary risk factor nobody's heard of
--Thyroid status

In other words, the simple-minded, though hugely financially successful, conventional model of heart disease prevention is woefully inadequate.

Don't fall for it.

Statin drugs for everybody?

Who is better off?

John takes Crestor, 40 mg per day:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl




Or Sam:

LDL cholesterol 60 mg/dl
HDL cholesterol 60 mg/dl
Triglycerides 60 mg/dl
Total cholesterol 132 mg/dl


who obtained these values through vitamin D normalization (to increase HDL); wheat elimination (to reduce triglycerides and LDL); and omega-3 fatty acids (to reduce triglycerides).


Believe the drug industry (motto: If some statin is good, more statin is better!), then John is clearly better off: He has obtained all the "benefits" of statin drugs. They refer to the "pleiotropic" effects of statin drugs, the presumed benefits that extend outside of cholesterol reduction. The most recent example are the JUPITER data that demonstrated 55% reduction in cardiovascular events in people with increased c-reactive protein (CRP). Media reports now unashamedly gush at the benefits of Crestor to reduce inflammation.

However, on Sam's program, elimination of wheat and vitamin D both exert anti-inflammatory effects on CRP, typically yielding drops of 70-90%--consistently, rapidly, and durably.

So which approach is really better?

In my experience, there is no comparison: Sam is far better off. While John will reduce his cardiovascular risk with a statin drug, he fails to obtain all the other benefits of Sam's broader, more natural program. John will not enjoy the same cancer protection, osteoporosis and arthritis protection, relief from depression and winter "blues," and increased mental and physical performance that Sam will.

If our goal is dramatic correction of cholesterol patterns and reduction of cardiovascular risk, for many, many people statin drugs are simply not necessary.

Are Your Cosmetics Safe?



If you are reading The Cureality blog chances are you care about your health. You care about what you eat. You want to remain healthy, free of disease, feel good and possibly even want to look and feel as vibrant as you were when you were 20. Many of us think of food all day long. Many of us love to eat. We plant gardens so we know our food is free of pesticides and other toxic chemicals. Food can be a cause of disease and it can minimize our chances of disease. We try and take care of our insides but did you ever wonder what in the world you apply to your skin on a daily basis? What do these products contain and are they safe? Why are there more endocrine disorders popping up. Could it be that some of things we apply to our skin every single day may be harmful to our insides?

A portion of the skin health section of Cureality will take a look at skincare products and cosmetics. Are the products we apply to our skin gluten-free, paraben-free and free of other harsh chemicals that can cause skin irritations and possible other unwanted diseases. I came across Mirabella cosmetics and I wanted to learn more about this particular product line so I tracked down John Maly, founder and CEO of Mirabella Cosmetics. Mr. Maly was gracious enough to take time out and answer my questions.This is what Mr. Maly has to say about Mirabella:

DD: Tell us about some key features about Mirabella, gluten-free cosmetics. What made you get started in a gluten-free line?

JM: We didn't start as gluten-free. Over time we have continued to make our line more beautiful AND more healthy for women. First we began with a mineral foundation. Then as we introduced new products, we made sure they were as clean and healthy, while still being fashion forward. We saw the benefits to our clients to take out those ingredients that didn't help them look and feel their best such as glutens, parabens and talcs.

DD: Some cosmetic companies carry partially gluten-free cosmetics. Are all of Mirabella products gluten-free, paraben-free and talc-free?

JM: Everything is paraben-free and talc free. And our brand is all gluten-free except our Skin Tint Creme foundation. That is a product that women love and we just cannot make the formula without a wheat protein to perform as well...yet! We will continue to work on it!

DD: Are there other ingredients in cosmetics that women should be cautious of using if they have skin sensitivities or allergies?

JM: Some women are sensitive to fragrance as well.This is another thing that we avoid with our brand. The biggest ingredients that women find that helps with their skin health is mineral products. They are natural and very breathable on a woman's skin.

DD: I think your velvet lip pencils are by far the most extraordinary lip pencil on the market. What are some of your other standout products your customers love?

JM: Pure Press Mineral Foundation is still our #1product. But the fastest growing product is Magic Marker Eyeliner. It is easy to use, doesn't smudge and lasts all day.

DD: Anything new on the horizon for Mirabella that you can share with us?

JM: In August we launch CC crème. This product has all the good for you ingredients to help with Anti-Aging like avocado oil, argan oil and Acai (Assai) berry. Plus it is a mineral formula, gluten-free, and paraben-free. And it has an SPF of 20. One of the biggest issues that women have with aging is lips. That is why we put Litchi Chinesis Fruit Extract in our Colour Vinyl lipstick. Then in your favorite Velvet Lip Pencil, we put Pomegranate Extract, Vitamin C and E in to assist with in Anti-Aging.

DD: Is Mirabella only sold in the US or do you have international distribution as well.

JM: We are sold in Canada, Australia, Finland and Russia.

DD: Where can we purchase your cosmetics?

JM: Our products are available at www.mirabellabeauty.com and at over 1,500 of the finest salons and spas. Go to our salon locator to find a retailer near you.

Top 5 Tips to Get Ready for Tough Mudder


When it comes to mud runs, Tough Mudder is a big deal.  This event covers ten to twelve miles of muddy running interspersed with challenging obstacles.  Using the word “challenging” when describing the obstacles along the course is an understatement.  Obstacles include getting an electrical shock, running through ice-cold water, jumping over fire, climbing over walls, and things you’ve seen when watching American Ninja Warrior.  Plus these obstacles are all done on a rugged, muddy terrain.  So, maybe the word dirty-insane-challenging would be a better fit to describe the Tough Mudder.

Don’t let this description lead you to think that this is an impossible feat.   The Tough Mudder website states that 1.3 million people have completed this event since it’s inauguration.  If Tough Mudder is on your bucket list, know that if they can do it so can you.  Here are 5 tips to get you ready to tackle the Tough Mudder.

1) Train: This tip seems obvious, but it’s not.  Many people are standing at the start line hoping for the best.  This strategy puts you at high risk for injury and not completing the event.  You need to train anywhere from 8 to 12 weeks for the Tough Mudder.  Use this guideline if you have a regular workout routine established.  If you’re new to exercise or have been on a workout hiatus you may need 4 to 6 months to get ready.  Carve out time in your schedule to train 3 to 5 days a week to prepare for this event.  If you need some guidance, join a training program to provide a road map to Tough Mudder success.

2) Run:  Tough Mudder is like a half-marathon on steroids.  Running is critical component when you find that you’re traveling up to a mile between obstacles.  Incorporate running intervals, hills, and fartleks into your training program.  Start your training off with a new pair of running or minimalist shoes so that by the time your Tough Mudder comes around your shoes are ready to get trashed.

3) Simulate Obstacles:  To feel confident at the start line of Tough Mudder, you need to practice skills that can help you with the obstacles.  This will reduce your risk of obtaining any injuries during the event.  Utilizing stairs, fences, playgrounds, rock climbing walls, football fields, lakes, and beaches are great places to start when looking to simulate obstacles.  Check out the Tough Mudder website to see a list obstacles.  Use your imagination to find ways to incorporate obstacle training in your workouts.   

4) Simulate Terrain: Running covered in mud with wet shoes is much different from running on the treadmill.  Running in the grass, on the sand and through the water is much different from running on asphalt.  Get ready to be a little uncomfortable.  Your shoes will begin to slide around on your feet and your clothes will cling to your body.  Get ready to work a little harder.  Your stride will be affected by the changes in terrain.  Practice running on the grass, in the water, and in the sand.  Make sure you get wet and run with soaked shoes and clothes. You’ll realize what shoes and clothes to wear on race day to be the most comfortable and effective.

5) Team: Teamwork is what Tough Mudder is about.  Teamwork is what keeps drawing people back to the Tough Mudder venue.  From the start to the finish, it’s about getting everyone across the finish line.  If you’re struggling to get over a wall, a hand is there to help pull you up.  When fatigue is setting in, another person is there to bring up your spirits.  You’re not alone out there.  At other races you find you’re left in the dust.  At Tough Mudder you are overcoming challenges with your muddy buddies. Get together with friends or a training group to form a team bond that will keep you accountable with your training and support you to the finish line.

Want personalized training???  Schedule a virtual appointment with Amber.

Keeping Up with the Kids



On Saturday my husband and I took our niece Anna out her annual birthday date. That date started with a trip to the Humboldt park playground. As with most kids, Anna ran straight to the spider-web jungle gym which I have to admit it looked pretty cool. Just before she began to climb up, she turned to look at me and said “Auntie Amber, climb up too!”

I was not wearing my playground apparel on Saturday. I had a cute pair of pink loafers on, skinny jeans, tank and a jean jacket. But it did look like fun so I decided to climb. No problems yet. I was good to go climbing around on the ropey, spider web apparatus. But of course, just climbing around was not enough. Anna suggested that we should race. Not just to the top, but to the top of the jungle gym over the side, across the rope bridge and down the slide. This is when my skill was put to the test.

As you could have guessed, Anna smoked me during our race. Not only that, but the jean jacket was off and I was working up a sweat. Was I getting a workout from my 9-year-old niece? I think so. But we both were having so much fun. We continued to climb up and down the fake rock wall, monkey bars and run around the playground. It was a blast.

But as I looked around the playground, I was the only adult climbing around the playground and playing. The other adults were sitting on park benches watching. One parent near by had to decline the request of a child they were with to join them on the playground equipment. I felt really good that I could be there with my niece running around, climbing and swinging.

Keeping up with our kids, grandkids, nieces and nephews is really important as we age. Otherwise we sit on the sidelines. How do you train for the playground? Get in the weight room. Lift heavy things, jump, pull yourself up, move side ways, and challenge your body to do movements beside sitting or standing. If it’s been awhile or you’re just not sure where to start then get a trainer and join some group workouts.

It’s time to get moving. Because it starts out at the playground now but soon it will be mud runs, Frisbee, triathlons and weekend football games. You need to keep up!

4 Tips to Boost Kids Veggie Intake



Vegetables are arguably the most important food group, the key to any healthy diet. They are one of the most nutrient dense food groups and serve the foundation to healthy meals and snacks. A frequent comment from people enjoying the Cureality way of eating is, “I am eating more vegetables than I ever have in my life!”

This is great because plentiful consumption is associated with decreased heart disease, reduced weight, lower blood pressure, glowing skin and decreased risk of some cancers. However, perhaps you’re reading this and feeling great that you eat your veggies but struggle to get your kids to do the same. If you are a parent, who is simply trying to provide nutritious options to your kids, give these tips a try.

1. Add cheese or butter to enhance flavor and increase the absorption of fat soluble vitamins A, D, E and K. Younger kids like to dip foods, so often pairing with a dip, such as hummus, can increase intake.

2. Try the “rule of 15” — putting a food on the table at least 15 times to see if a child will accept it. Don’t give up after a few attempts. This can indeed be frustrating, but have patience and continue to offer a small portion to expose children to veggies without forcing intake. Often parents feel like it’s their job to just make their children eat something. I suspect most children will always select apple pie over an apple. It is important to set the stage, at an early age, with what is offered. In addition, being a good food model is important. You can’t expect your child to try broccoli, if you make negative comments about its taste, texture or smell.

3. Once a food is accepted, parents should use “food bridges,” finding similarly colored or flavored foods to expand the variety of foods a child will eat. If a child likes pumpkin pie, for instance, try mashed sweet potatoes and then mashed carrots. If a child loves corn, try mixing in a few peas or carrots. Even if a child picks them out, the exposure to the new food is what counts.

4. Allow children to engage, as able. When grocery shopping or offering a snack, ask your child which option they would like to eat (e.g. ask which healthy foods they would prefer, blueberries or strawberries, cucumbers or carrots, etc.). When children are included in more food decisions it can decrease resistance. Include children in age appropriate preparation, as well, for example cutting produce, making a vegetable soup, or selecting produce at the grocery store.

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

When is the Best Time of Day to Workout?



There are various theories about the best time of day to workout. At the personal training studio I own, training sessions start as early as 5:45am and the latest sessions start at 8pm. We have people that get up early and get their workout done first thing in the morning. We also have other people that get it done after work to release the stress of the day.

So which group is getting the better workout?

If you’re an early bird or have too many evening commitments then a morning workout is ideal for you. Here are some benefits to training in the morning.

1. Very few things can get in the way when you workout in the morning. (Except for the snooze button.) Later in the day extra phone calls, meetings and tasks can get in the way of getting your workout done.

2. After a strength or interval training session, your metabolism is elevated for hours after your workout. Enjoy these post exercise benefits while you are awake and active instead of when you are at rest.

3. Exercise will boost your energy. Use the momentum from a morning workout to arrive at work energized, present and focused instead of feeling sluggish because you just got out of bed.

4. Exercise on an empty stomach before breakfast is a great way to burn more body fat. Upon waking, the body is in a fasted state. Without ready available glucose in the bloodstream, the body is forced to use fat as an available fuel source for the workout.

However, some of us need our sleep or need to burn off the steam of a hectic workday. Here are some of the benefits of working out in the evening.

1. Getting enough sleep is crucial for health and recovery. If you have to skimp on regular sleep to get up for an early workout, the benefits of the workout start to diminish.

2. Instead of taking that stress of work home, you hit the gym after work. Even after the worst workdays, exercise will boost your mood. Friends and family will be grateful that you get your workouts (aka therapy session) completed.

3. Often people feel stronger when they workout in the evenings. When performing strength tests people tend to lift heavier during evening workouts. This could be due to the fact that they are more awake or that they have food fuel to utilize during their exercise session.

4. Research shows that you can build more muscle with evening workouts because cortisol levels are lowest in the evening. The result of this will be a higher testosterone to cortisol ratio leading to a less catabolic workout.

So which time of day comes out on top for the best workout time? In my opinion, it’s the time that you can do consistently. It’s the time that works best with your natural energy rhythms, work schedule, and family commitments.

Experiment working out at different times to see what works best for you. When you find the right fit, schedule your workouts on your calendar to build the exercise habit.

What is Cureality all about?


“Looking over your medical record, Nancy, I’m a bit concerned about your risk for osteoporosis and hip fracture. It looks like your mom had a hip fracture at age 67. Is that right? ”

“Yes, she did,” Nancy responded. “And her life was never quite the same for the 15 years she lived after that.

“You’re 53 year old. Bone thinning develops over many years. Let’s get you scheduled for a bone scan.”

Two weeks later:

“Your z-score is 1.5, Nancy. This means you’ve got a mild form of osteoporosis called ‘osteopenia.’ Here: This is a prescription for alendronate, what used to be called Fosamax.”

“Aren’t there side-effects with that drug? A friend of mine said that her mom had a leg fracture from it.”

“Well, yes. All prescription drugs have potential side-effects. They’re rare, but they can happen and we can’t predict it. Besides leg fracture, there’s something called jaw osteonecrosis in which the jawbone dies and has to be surgically replaced. But would you rather run the risk of a hip fracture?”

“Before we jump to drugs, aren’t there natural things I could do first?”

(Big sigh.) “You can take calcium, but that only helps a bit. You’ve got to make a choice: Take the drug or risk a hip fracture.”

“I’m going to explore some natural remedies on my own first.”

Nancy’s dialogue with her doctor is fictional but based on similar encounters that occur thousands of times every day nationwide. Identify a problem, prescribe a drug. Natural remedies? “They don’t work.” “I don’t know anything about that.” “None of that is proven.” “I only practice evidence-based medicine.” You’ve probably heard a few of these explanations yourself if you ever question the wisdom of conventional medical care.

Each of Nancy’s fictitious interactions were no more 10 minutes long. If she is like most people, she will have one or two such interactions over the course of a year, unless she develops some acute illness. So she’s got something like 20-30 minutes per year to compress all of her “health” advice into the time allotted. 20-30 minutes per year to discuss bone health, nutrition, blood sugar issues, cholesterol issues, blood pressure, female issues, and all the other facets of health. Perhaps she has developed some chronic gastrointestinal complaints, too, and an odd rash on her elbows, maybe headaches a few times per week that she didn’t have before. Regardless, she’s going to have to make do with those few minutes, likely receiving one or more prescriptions or imaging procedures for each.

Such is the nature of modern healthcare: Provide the minimum interaction, address only a few, perhaps no more than one, problem, then prescribe a drug. This is, more often than not, wrong. Plain wrong. Tragically, awfully, unethically, unnecessarily wrong.

Let’s pick up again with Nancy. Upon learning of her osteopenia and long-term risk for hip fractures of the sort that changed her mom’s life and health irretrievably, Nancy started searching for solutions. Not only did she discover that, yes, there are indeed a number of safe and effective ways to deal with osteopenia. She also learned that such strategies have even been examined in clinical trials, some of the strategies pitted head-to-head with drugs and performed on a par, sometimes better, than prescription drugs. She also found that there are online communities that she could join and discuss her health situation with people all sharing the same health interests. During one such interaction at the start of her effort, when she was still a bit unsure and tentative, a woman she didn’t know but who shared a similar interest in restoring bone health, commented to Nancy, “Don’t sweat it, Nancy. I was in your shoes a little over a year ago. I followed a program for bone health: vitamin D, vitamin K2, magnesium, I made sure that I included leafy green vegetables at least once or twice per day, and I added strength training for a few minutes twice per week. I started with osteoporosis. My most recent bone density test showed that I reversed it completely—it’s entirely normal! So hang in there and be sure to share your questions and concerns with us here.”

THAT is what Cureality is all about. Cureality fills the gap of knowledge in health that is not being provided in a few minute-long medical interaction. Cureality reveals the astounding amount of credible, safe, scientific information that allows you to participate, sometimes take over completely, various aspects of health. You don’t have to fire your doctor; these efforts supplement the information and advice you obtain (or don’t obtain) in the doctor’s office. While critics may sometimes say that this can be dangerous or that misdiagnoses and dangerous treatments might be risked, our experience is the exact opposite: People do better by taking the reins of health themselves, choosing to use the health care system for acute or catastrophic illness—but not necessarily for health.

Our fictional woman, Nancy, returns to her doctor one year later after undergoing a repeat bone scan. The doctor opened her chart, clearly expecting to scold her for her foolhardy and careless attitude. Instead, he was speechless. After a pause, he said, “I don’t know how you did it, but your bone density is now normal, the density of a healthy 30-year old woman. Just continue doing what you’re doing.” He closed the chart and walked out.

Yes: “Just continue what you are doing”—not “Please tell me what you did so that I might learn something new,” or “Where did you learn about such strategies? I knew nothing about this!” Just “do what you’re doing.” Too often, that is the response you get that defines what modern health care has become.

You don’t want that kind of health care. Sure, it’s reassuring to know that the doctor and hospital are there in case you injure yourself or develop pneumonia. But obtain day-to-day health advice of the sort that keeps you slender, keeps blood pressure normal, maintains normal insulin and blood pressure responses, helps keep bowel health ideal, can even be used to reverse conditions such as autoimmune joint pain, diabetes, osteoporosis, or skin rashes, while costing next to nothing and yielding health care benefits for you and your family in multiple areas of health? That is the kind of health care you want.

That’s why we developed Cureality.


William Davis, MD
Author of 
#1 New York Times Bestseller Wheat Belly: Lose the wheat, lose the weight and find your path back to health, The Wheat Belly Cookbook, and Wheat Belly 30-Minute (or Less!) Cookbook published by Rodale, Inc.  
Author, Track Your Plaque: The only heart disease prevention program that shows how the new CT heart scans can be used to detect, track, and control coronary plaque

How Can I Lose Weight Eating Fat?


For new comers to the Cureality nutrition approach, this question may invariably pop up. For many years, fats and oils, whether classified as good or bad, were demonized because they contain 9 calories per gram. Meaning, they contain more than twice the 4 calories per gram of carbohydrate or protein.

So this familiar logic stated, if you eat less fat, which by default meant more carbohydrate, you would eat fewer calories and lose weight. This misguided logic was based on the assumption that caloric density was the primary reason people either gained or lost weight. The result - obesity rates have climbed and low-fat diet recommendations have proven unsuccessful in thwarting the battle of the bulge.

Why? There are a multitude of reasons, as discussed in the Cureality Diet Track. The following two explanations are important to to avoid needlessly suffering on a low-fat diet.

1) Appetite satiation is drive by insulin response, not calorie density.

Meals that trigger a substantial insulin response trigger increased appetite and fat storage. Carbohydrates, such as whole grain bread, whole wheat waffles, and fruit juice trigger insulin release. Continuous insulin provocation equates to one heck of a time trying to lose weight, as insulin is a fat-storage hormone. In comparison, oils and fats are the least insulin provoking with protein a close second. Consuming adequate fat intake is essential to quench appetite and avoid the insulin surges and crashes that are the result of eating plenty of “healthy whole grains”.

2) Modern wheat increases appetite thereby increasing intake.

Portion control becomes a major challenge because the gliadin protein in modern wheat stimulates appetite to the tune of 400 calories more per day, 365 days per year. That’s a recipe for weight gain, not loss.

The Cureality nutrition approach encourages the generous use of healthy fats and oils to support healthy weight loss and cardiovascular health. These topics are discussed in much more detail in the Cureality Member Forum.

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

Drowning in a Sea of "Endocrine Disrupter Toxins"


In my previous post I spoke about the close connection between gut health and thyroid health. Of course, as someone who lives with Hashimoto’s Thyroiditis I have a keen interest in anything related to the thyroid.

Just today, I came across an article revealing the 100 most-prescribed drugs in America and was stunned at what drug topped the list with more than 23 million prescriptions in 2013 – levothyroxine – the most commonly prescribed drug for treating hypothyroidism (but not necessarily the best in my opinion).

Some observers have warned about a pending epidemic of thyroid disorders. I believe the revelation of a thyroid drug as the most prescribed drug in America suggests that this epidemic is already a “fait accompli” (that’s French for the more colloquial expression “it’s a done deal!”).

I also believe it is due, in part, to the grim observations of experts like Dr. Davis who warn that we are literally “swimming in a sea” of endocrine disruptors, toxins that disrupt our hormonal glands such as the thyroid, adrenals, pancreas, ovaries, and testes. I would go farther to say we are drowning in that sea. Here are just a few examples of how ubiquitous and pervasive these toxins are.

Bisphenol A (BPA) in plastic containers has gotten a lot of bad press recently yet it still considered by the FDA to be safe in certain applications even though it has been shown to disrupt the sex glands and bind to thyroid receptors.

Triclosan is commonly used in hand-sanitizers and similar applications. Triclosan is known to decrease circulating levels of the thyroid hormone thyroxine (T4).

Polybrominated diphenyl ether (PBDE) is common used to make flame retardant clothing. PBDEs have been shown to disrupt both estrogen and thyroid hormones. The effects of PBDE exposure both in utero and shortly after birth can persist into adulthood.

Perfluorooctanoic acid (PFOA) in Teflon coated pots and pans and even microwave popcorn bags has been detected in the blood of more than 98% of the general US population. PFOA has implicated as both a carcinogen as well as an endocrine disruptor associated with thyroid disruption.

With all these “thyro-toxins” floating about it might not seem you like have a fighting chance to achieve thyroid health. But, the first step is to educate yourself - then take action. It is the essential sequence in what I call “Informed, Self-directed, Healthcare” (ISH).

Now that you have a better understanding of how to navigate the “thryo-toxin minefield” there are also positive steps you can take to stack the odds in favor of a healthy thyroid. If you participate in the Cureality program make certain to check out the Thyroid Health Track for a powerful list of proactive steps you can take.

Chris K. (aka HeartHawk)
Cureality Member Advocate


Source: IMS National Prescription Audit, IMS Health.

Italian Food the Cureality Way


100% grain elimination is the theme that drives the Cureality nutrition approach. A common mistake made when eliminating grains is replacing wheat-based foods with gluten-free foods. Most gluten-free foods, as they are currently available in the supermarket, are made with rice starch, tapioca starch, cornstarch, and potato flour. These dried pulverized starches generate more insulin and blood sugar surges than wheat. Gluten-free foods made with these undesirable ingredients are free of the appetite stimulating gliadin protein and wheat germ agglutinin, a lectin protein unique to wheat that causes direct intestinal damage. However, at best they can be referred to as “less bad” or unwelcome additions to the diet. Increasing your intake of these junk carbohydrates is a recipe for weight gain, inflammation and sky high blood sugar.

When removing grains from the diet, the goal is to replace them with truly healthy alternatives that do not contribute to negative health consequences. There are several reasonable substitutions available that allow your favorite sauce and protein combos to shine in tasty pasta-like dishes. People following the Cureality nutrition approach frequently comment that they do not miss “real” pasta because of the available healthy replacements they have learned about and incorporated into their lifestyle.

Our nutritionist, Lisa G., is the champion at helping navigate this lifestyle. In this video, she demonstrates how to prepare spaghetti squash, which can be used to replace wheat-based pasta. In another video zucchini noodles are the star. Homemade meatballs, a zesty tomato sauce and zucchini “pasta” combine for a delicious meal. Who needs grains when you can enjoy meals that support increased energy and less joint pain? 


Traveling, while being wheat-free and dairy-free. Can it be done?

Summer vacation is right around the corner. The temptation to deviate from your normal healthy eating habits may occur… but resist. So how in the world do you continue to eat The Cureality way when you're traveling internationally? Let me tell you how I do it. I would also like to add I am allergic to dairy and I avoid all wheat containing foods. This has been my way of life for years and actually is extremely simple for me to manage while away from my own kitchen.

I decided to pay Italy a visit. I knew I would be overwhelmed with wonderfully fresh smelling bakery, pasta, cheese, gelato, and pizza. All foods I either can't consume due to my dairy allergy or foods I choose to avoid because of their health effects.

I was correct in my food assessment: the grains, bakery, and gelato were in every nook and cranny I encountered. Food choices can be difficult while traveling but I ask numerous questions regarding ingredients and I am certainly not afraid to swap out french fries for grilled vegetables.

Here's what I did the first few days on vacation with my diet routine to minimize dietary booby traps:

Day 1: 

Breakfast, Hmmmm….Italians like their bakery. WOW. Tough when most of the foods being served are grains and eggs with dairy mixed in. I had two hard boiled eggs, tomatoes, sausage and espresso.

Lunch: Arugula lettuce topped with a chicken breast, roasted peppers and tomatoes. A side of salmon and lots and lots of olive oil on top. Very tasty and filling with the olive oil.

Dinner: Hamburger (no bun) with tomato, mayo, lettuce topped with a mountain of sauteed spinach. Water and yes…Italian wine found it's place at the table.

Day 2: 

Breakfast: I devoured two hard boiled eggs with lettuce, cucumbers, shredded carrots, tomato and pineapple slices. Two cafe Americanos and water.

Lunch: Lunch was spectacular: Beef tips, arugula, lettuce, shredded carrots, tomatoes, olive oil and raw salmon. Yes, I mixed it all together and it was fabulous. Plenty of water with the "frizzle."

Dinner: I'll be honest: I had a difficult time with this meal due to our location and choice of foods, but I managed. Another hamburger with no bun, salad with mixed vegetables, and a few potato wedges. Wine and water.

Day 3: 

Breakfast: Hardboiled eggs were getting old. Nonetheless, I had two of them chopped with tomato. Deli meat--Italians love their deli meat as well. Cafe Americano and water.

Lunch: Seafood salad-shrimp, octopus and squid mixed with argulua, fresh tomatoes, cucumbers and olive oil. Water.

Dinner: One hefty salad with shrimp, pear slices, ginger, tomatoes, avocado and olive oil. Wine and water.

Day 4:
Breakfast: Scrabbled eggs/sauage and pineapple slices. Cafe Americano and plenty of water.

Lunch/Dinner: I had to combine these two meals today. I had a delicious meal of curried shrimp (I made sure there was no dairy in the curry sauce) and a very large plate of grilled vegetables. Wine and water.

My diet may not be the most lavish to some but I enjoy my choices. I'm confident I will have no troubles with the remainder of my vacation. I haven't eaten wheat for a number of years so I don't experience the craving for bakery, pasta, or pizza. Dairy, I simply have to avoid, because I truly experience ill-effects from consuming it. My experience with travel and food choices have always worked in my favor. Ask questions and resist putting on that 5-10 pounds of vacation weight.

Ciao-Ciao~

Protecting the right to use bio-identical hormones in your heart disease prevention program

If you've been following the Track Your Plaque program, you know that we are advocates of "bio-identical hormones", i.e., hormone replacement using forms that are identical to the naturally-occuring human form.

In other words, we find it criminal that pharmaceutical manufacturers continue to promote use of non-identical hormones despite a probable increased side-effect and complication profile (a la Premarin). This unhappy situation persists because bio-identical hormones cannot be patent protected, meaning profits cannot be protected. Synthetic hormones can be patented and profits protected, thus their popularity among drug companies.

If that's not bad enough, Wyeth Pharmaceuticals--maker of synthetic hormone preparations, Premarin and Prempro--has filed an FDA petition to disallow the use of bio-identical hormones as prepared and dispensed by "compounding pharmacies". These are specialty pharmacies that mix and dispense hormones like estrogens (human estradiol, estriol, and estrione) and testosterone. They do so only with a doctor's prescription. Most are members of the Professional Compounding Centers of America (www.pccarx.com), a professional organization devoted to promoting quality-control over compounding practices.

Compounding pharmacies are occasionally guilty of compounding some suspect preparations. Witness the Fentanyl lollipops of 2002 in which the pain medication, Fentanyl, was put into lollipops for patients with chronic pain. This posed obvious dangers to any children who unsuspectingly ate the lollipops.

But the majority of compounding pharmacies are not guilty of such exotic practices. Most are simply pharmacies who might, for instance, mix a specific dermatologic preparation according to the orders of a dermatologist. Likewise with bio-identical hormones.

We have extensive experience with such a pharmacy in Madison, Wisconsin, the Women's International Pharmacy. They have filled hundreds of hormone prescription for us. They are responsible in their dispensing practices, in our experience. In fact, they have been at least as good, if not better, than other pharmacies we've dealt with.

We believe in protecting our rights to prescribe and you to use the choice of hormone preparations you and your doctor desire. This should include bio-identical hormones. The transparent profit motive from Wyeth should raise the hairs on your neck.

If you would like to post your comment to the FDA, there's a little time left. The folks at Womens' International Pharmacy have made it easy by posting links on their website. Go to http://www.womensinternational.com and just follow the instructions.



Here's a sample of some of the objections citizens have raised to Wyeth's petition:


I have been taking bioidentical hormones for two years. Bioidentical Hormones have been a great relief to me without the risk. I consult with my Physician who prescribes bio-identical hormones specifically for me, and my pharmacist prepares them. Without this medication and I would not be able to sleep; I would not be able to work due to the constant hot flashes. Without this medication, I find that I have less tolerance and I am considerably disagreeable. I also have problem with my memory without them. I want the bioidentcial hormones for the health benefits they provide. I urge you to not be swayed by Wyeth's petition. The product Premarin made by Wyeth, is made from pregnant horses not natural sources. Wyeth's hormones have been shown to cause cancer. I would not expect my government and its officials to submit to the highly funded petitioning of a pharmaceutical company who product is threatened by bioidentcial hormones. I do not expect my government to approved Wyeth's petition and leave me no choice of bioidentcial hormones and only the choice of Wyeth's cancer causing drugs Preamrin and Prempro. I ask that the FDA reject Wyeth's petition Docket #2005P-0411.

Another petitioner writes:

As a woman I take exception to Wyeth accusing the Compounding Pharmacy industry of unsafe practices. As a citizen of the United States I expect the FDA to stand up for my rights and the rights of all women who have found or in the future may seek consistent, safe and effective treatment with bioidentical hormones. Eliminating options by bowing to a large pharmaceutical company like Wyeth is not in the public interest and would deprive hundreds of thousands of American women from access to bioidentical hormones. Synthetic hormone replacement has been proven unequivocally unsafe in a government sponsored study and should not be forced as the sole treatment option for women. I hereby request the FDA rule against Wyeth's request. The FDA should not close down the bioidentical option of healthcare. I welcome studies of bioidentical hormones even though they are already FDA-approved and have been working effectively for decades. We already have the proof - hundreds of thousands of women, who over the past two decades have chosen bioidentical hormones based on their physicians' assessments. They are living proof that bioidentical hormones are safer and more effective and reliable than synthetic hormone drugs.

A physician and user of bio-identical hormones writes:

Wyeth, the filer of this complaint, is trying to prevent women from being able to choose less expensive compounded options for hormone replacement. There is medical evidence that in modifying the structure of their drugs (such as Premarin and Prempro) so that they could be patented, they may have introduced factors that cause the health risks identified in the Women's Health Initiative. This complaint appears to be filed for commercial purposes because of the market share that has shifted from Wyeth's products to bio-identical products from compounding pharmacies. If the complaint were upheld, patients and their doctors would not have a choice in hormone treatments. Wythe's commercial strategy of trying to eliminate the 'competition' from compounding pharmacies is against the public interest and in the interest of its own corporate profits. Women and their doctors should be able to choose between patented formulations such as those offered by Wyeth, bioidentical formulas available from compounding pharmacies, and no hormone treatment. I have been taking bio-identical hormones for several years and have had excellent results in improving my symptoms. I have been unable to take other synthetic hormones in the past, and am very concerned that my best treatment option will be taken away.

If you get a 64-slice CT coronary angiogram

With new 64-slice CT scanners popping up everywhere nowadays, be sure to get your heart scan with it.

The new scanners do indeed provide wonderful images of the coronary arteries. But, say you have a 20% blockage in one artery by a coronary angiogram generated on one of these devices. What will you do in 1, 2, or 3 years when you want to know if you have progressed? Should you have the CT angiogram repeated?

Well, if you did you'll be exposed to a large dose of radiation--appropriate for a diagnostic test, but not for a screening test. The radiation exposure is not that different from undergoing a full conventional cardiac catheterization, or up to 100 chest x-rays.

"20% blockage" is also, contrary to popular opinion, not a quantitative measure. It is just an estimate of the diameter reduction at one spot. That number says nothing about the lengthwise extent of plaque. It also says nothing about the potential for "remodeling", the phenomenon of artery enlargement that occurs as plaque grows. In other words, if you had another CT coronary angiogram a year later and was told that your blockag was still 20%, in reality you could have had substantial plaque growth but it would not be reflected in that value.

People will come to me after having a CT angiogram for an opinion. Unfortunately, I send them back to their scan center to get a simple coronary calcium score. That measure is easy, quantitative, precise, and can be repeated yearly if necessary to track progression. (Track Your Plaque--I hope most of you get this by now.) Some physicians poke fun at the heart scan, or calcium, score--it's old, boring, only a measure of hard plaque. None of that's true. The coronary calcium score is a measure of total plaque (hard and soft). And when you are empowered to learn how to control and reduce your score, then it's the most exciting number in your entire health program!

Don't fall for the hype. If you go to a scan center and they insist on a 64-slice CT scanner, or if your doctor orders one, you should insist on getting a calcium score out of the test. Just ask. If they refuse, go somewhere else. Centers that refuse to generate a score have one thing on their mind: identifying people with severe blockages sufficient to obtain the downstream financial bonanza--angioplasty, stents, and bypass surgery.

If you have hypertension, think Lp(a)

Clair has coronary disease.

Clair first came to attention at age 57 when she suffered a large heart attack involving the front of her heart (the "anterior wall") two years ago. Her cardiologist implanted a drug-coated stent. Her doctors advised her to "cut the fat" in her diet, exercise, and take Lipitor.

One year later, she required a stent to another artery (circumflex). At this point, Clair was thoroughly demoralized and terrified for her future. Her first heart attack left her heart muscle with only 50% of normal strength.

She came to my office for another opinion. Of course, one of the first things we did was to identify all causes of her heart disease. No surprise, Clair had 7 new causes not previously identified, including low HDL (37 mg/dl), a severe small LDL particle pattern (75% of all particles were small), and Lp(a).

Her blood pressure was also 190/88, despite her relatively slender build and 3 medications that reduced blood pressure. That's a Lp(a) effect: Exagerrated coronary risk along with unexpected hypertension that often seems inappropriate.

In fact, I saw several patients just this week with lipoprotein(a), Lp(a), and exagerrated high blood pressure (hypertension). It's not that uncommon.

Though it has not been described in the medical literature, our experience is that hypertension is a prominent part of the entire Lp(a) "syndrome".

Lp(a) is responsible for much-increased potential for coronary disease (coronary plaque). It increases in importance as estrogen recedes in a woman (pre-menopause and menopause) and testosterone in a man, since both hormones powerful suppress Lp(a) expression (though why and how nobody knows).

I believe that Lp(a) is also responsible for hypertension that most commonly develops in a persons mid-50s and onwards, often with a vengeance. 3 or 4 anti-hypertensive medications and still not controlled.



Role of l-arginine

L-arginine may be more helpful in this situation than others. L-arginine, recall, is the supply for your body's nitric oxide, a powerful dilator of the body's arteries and thereby reduces blood pressure. We use 6000 mg twice a day, a large dose that requires use of powder preparations rather than capsules.

More reading about l-arginine and nitric oxide is available through Nobel laureate, Dr. Louis Ignarro's book, NO More Heart Disease : How Nitric Oxide Can Prevent--Even Reverse--Heart Disease and Stroke, available at Amazon.com ( http://www.amazon.com/gp/product/0312335814/104-1247258-6443909?v=glance&n=283155).




Will l-arginine truly reverse heart disease on its own? No, I don't believe so. Contrary to Dr. Ignarro's extravagant claims, I find l-arginine a facilitator of plaque regression, i.e, it helps other strategies achieve regression, but it does not achieve regression or reversal by itself. (Note that Dr. Ignarro is a lab researcher who studies rats and has never treated a human being.)

But l-arginine may have special application in the person with lp(a), particularly if hypertension is part of the syndrome.


Note: As always, please note that I talk frankly about l-arginine and other supplements and medications but have no hidden agenda: I am not selling anything, nor am I affiliated with any source/website/store etc. that sells these products. If I advocate something, I do so because I truly believe it, not because I'm trying to sell something. I make this point because so much nonsense is propagated in the media because of profit-motive. That's not true here.

Dr. Ornish: Get with the program!


In the era up until the 1980s, most Americans indulged in excessive quantities of saturated fats: fried chickem, spare ribs, French fries, gravy, bacon, Crisco, butter, etc.

Along came people like Nathan Pritikin and Dr. Dean Ornish, both of whom were vocal advocates of a low-fat nutritional approach. In their programs, fat composed no more than 10% of calories. This represented a dramatic improvement--at the time.


In 2006, a low-fat diet is a perversion of health. It means over-reliance on breads, breakfast cereals, pasta, crackers, cookies, pretzels, etc., the foods that pack supermarket shelves and that now constitute 70-80% of most Americans' diet.

Dr. Ornish still carries great name recognition. As a result, his outdated concepts still gain media attention. The June, 2006 issue of Reader's Digest, in their RDHealth column, carried an interview with Dr. Ornish in which he reiterates his fat-phobia.

However, on this occasion he takes a different tack. This time he rails against the "dangers" of fish oil and omega-3 fatty acids. "I've recently learned that omega-3s are a double-edged sword...In some cases, omega-3s could be fatal."

He goes on to say that, while he believes that fish oil may prevent heart attacks, it has fatal effect if you already have heart disease.

Does this make sense to you?

He's basing his views on a single, obscure study published in 2003 conducted in rural England that showed an increase in death and heart attack on fish oil. Most authorities have not taken these findings seriously, since they are wildly contrary to all other observations and because the study had some design flaws.

Despite the fact that this isolated study runs counter to all other, better-conducted studies seems not to matter to Dr. Ornish.

Clinging to the low-fat concept is like hoping 8-track tapes will make a comeback. It's not going to happen. We enjoyed the benefits while they lasted, appropriate for the era. But now, they're woefully outdated.

The overwhelming evidence is that fish oil provides tremendous benefits with little or no downside. In the Track Your Plaque program, fish oil remains a crucial supplement to gain control over your coronary plaque and stop or reduce your heart scan score. Ignore the doomsday preachings of Dr. Ornish.

(Watch for an article I wrote updating the benefits of fish oil for Life Extension magazine.)

The cholesterol fallacy

Evan spotted the kiosk set up in the middle of the local mall. "Free cholesterol screenings. Know your heart health!" the sign declared.

It was a free cholesterol screening being offered by a local hospital.

The friendly nurse behind the kiosk had Evan fill out a form, then pricked his finger. Five minutes later, she reported to him with a smile, "Sir, your cholesterol is 177--your heart's fine! We get concerned when cholesterol is over 200. So you're in a safe range."

What the nurse failed to recognize is that Evan's HDL was 30 mg, a low value that actually places him at high risk for heart disease. Low HDL also signifies high likelihood of the small LDL particle pattern, a marked predisposition towards pre-diabetes and diabetes, a probable over-reliance on processed carbohydrates in his diet, a dramatically increased probability of hidden inflammation (e.g., elevated C-reactive protein), increased tendency for high blood pressure. . .

In other words, Evan's "favorable" total cholesterol is, in truth, nonsense. It's misleading, falsely reassuring, and provided none of the insight that a real effort might have yielded. Like hippies, tie-dye, other relics of the 1960s, total cholesterol needs to be put to rest. It has served many people poorly and been responsible for countless deaths.

When you see a kiosk or other service like this, even if it's free, run the other way.

"Heart disease a growth business"





So announced a Boston newspaper recently, featuring a story about new heart program at a local hospital.

They were announcing how a hospital had entered the cardiovasculare procedure game and how it would boost their bottom line. The article discussed how the hospital administration was anticipating "a surge in patients from the baby boom generation."

To justify this new program, the article quoted an administrator from another hospital: "Cardiovascular issues is [sic] the number one cause people sought treatment at our hospital."

The hospital featured in the story had spent $13.5 million dollars to develop their program.

Do you think they'll make it back?

You bet they will--many times over. Hospitals are businesses, complete with a bottom line, an expectation of profit and an eye towards growth.

The hospitals in the city where I live (Milwaukee, Wisconsin) are, as in Boston and elsewhere, very aggressive--expanding into new territories, hiring new "salesmen" (physicians), all to capture more marketshare and produce more "product" (your coronary angioplasty, stent, bypass surgery, defibrillator, etc.).

The equation for hospital profits is tried and true. Ignore your heart disese risk and you can help your local hospital grow its business. Neglect to get your heart scan and you can help your hospital pay down its debt. Get a heart scan, then do nothing about it, and you may even justify a pay raise for the hospital administrators for record revenue growth and profit.

Hospitals are a growth business because of the failure of most people and their doctors to 1) identify hidden coronary disease (CT heart scan to obtain your heart scan score), then 2) seize control over it (the Track Your Plaque program or, at least, your doctor's guidance along with your efforts at prevention).

Unless you do so, you are highly likely to help your hospital boost its annual goal for procedures.

The myth of small LDL

Annie's doctor was puzzled.

Despite an HDL cholesterol of 76 mg (spectacular!) and LDL of 82 mg, her CT heart scan showed a score of 135. At age 51, this placed her in the 90th percentile.

Not as bad, perhaps, as her Dad might have had, since he died at age 54 of a heart attack.

So we submitted blood for lipoprotein testing. Surprise! over 90% of all her LDL particles were small. (By NMR, they're called "small". By gel electropheresis, or the Berkeley Lab test, or VAP (Atherotech) technique, they're called "HDL3".)

What gives? Traditional teaching in the lipid world is that if HDL equals or exceeds 40 mg/dl, then small LDL will simply not be present.

Well, as you can see from Annie's experience, this is plain wrong. Yes, there is a graded, population-based effect--the lower your HDL, the greater the likelihood of small LDL. But small LDL is remarkably persistent and prevalent--regardless of your HDL.

We've seen small LDL even with HDLs in the 90's! I call small LDL the "cockroach" of lipids. If you think you have it, you probably do. Getting rid of small LDL requires a specific bug killer. (Track Your Plaque Members: Read Dr. Tara Dall's interview on small LDL.)

Don't let anybody blow off your request for lipoprotein testing just because your HDL is high. That's just not acceptable. Loads can be wrong even with a favorable HDL.

My stress test was normal. I don't need a heart scan!

Katy had undergone a stress test while being seen in an emergency room, where she'd gone one weekend because of a dull pain on the right side of her chest. After her stress test proved normal, she was diagnosed (I believe correctly) with esophageal reflux, or regurgitation of stomach acid up the esophagus. She was prescrbed an acid-suppressing medication with complete relief.

But Katy also had coronary plaque. Three years ago, her CT heart scan score was 157. She'd made efforts to correct the multiple causes, though she still struggled with keeping weight down to gain full control over her small LDL particle pattern.

I felt it was time for a reassessment: another heart scan. After three years, without any preventive efforts, Katy's score would be expected to have reached 345! (That's 30% per year plaque growth.) It's a good idea to get feedback on just how much slowing you've accomplished.

But Katy declared, "But I didn't think another heart scan was necessary. My stress test was normal!"

What Katy was struggling to understand was that even at the time of her first scan, a stress test would have been normal. Plaque can be present with a normal stress test.

Plaque can even show explosive growth all while stress tests remain normal. Just ask former President, Bill Clinton, how much he should have relied on stress tests. (Mr. Clinton underwent annual stress nuclear tests. All were normal and he had no symptoms--all the way up 'til the time he needed urgent bypass surgery!)

Of course, at some point even a crude stress test will reveal abnormal results. But that's years into your disease and a lot closer to needing procedures and experiencing heart attack.

So, yes, Katy would benefit from another heart scan despite her normal stress test.

The message: Don't rely on stress tests to gauge whether or not plaque has grown, stabilized, or reversed. Stress tests can be used to gauge the safety of exercise, blood pressure response, and the potential for abnormal heart rhythms. Stress tests can be used as a method to determine whether blood flow in your coronary arteries is normal through an area with plaque.

But a stress test cannot be used to gauge whether plaque has grown. It's as simple as that. Gauging plaque growth requires a heart scan.

Patient-napping: Yet another reason to stay clear of hospitals!

When I started practicing medicine around 20 years ago, it was common practice to alert a physician when their patient was seen in an emergency room.

If John Smith, for example, went to the emergency room with chest pain, the physician who had an established relationship with the patient--knew their history, had managed their health and illnesses, etc.--was notified, even if the hospital ER had no relationship with the physician. It was not uncommon for the patient to then be transferred to the hospital where their own doctor practiced.

Though cumbersome at times, it preserved the relationship of the patient with their doctor.

Over the past few years, this practice has crumbled. Nowadays, hospitals and their employed physicians (and other unscrupulous physicians acting in the name of profit) "fail" to notify the physician with an established relationship.

Guess what happens? The patient all too often ends up being put through the gamut of testing and procedures.

Why? For hospital profit, of course. If failure to notify a doctor who's had a 10-year long relationship with the patient is "overlooked" or, even more commonly, it's "unsafe" to transfer the patient because the patient is too "unstable" to be transferred, then this patient becomes ripe for picking--heart catheterization, stents, bypass surgery, etc. Ten's, if not hundreds, of thousands of dollars can be reaped by this deception. I call it "patient-napping".

I see this at least several times every month. As hospitals are becoming increasingly competitive, and as they put pressure on their physicians to churn patients for revenues, you're going to see more and more of this.

As always, what is your protection from this expanding influence of hospitals and the doctors too meek to stand up to them? Education and information. Arm yourself with an understanding of what is accomplished in hospitals, when you truly need them, and when you don't.

Take it one step further. At least from a heart disease standpoint--the #1 profit-maker for hospitals--aim to 1)identify your coronary plaque, then 2) seize control over your coronary plaque and reduce your risk for heart attack and heart procedures as much as humanly possible. That's the goal of the Track Your Plaque program.

Don't believe the negative press on fish oil



A British Medical Journal study released in March, 2006 has prompted a media flurry of reports on the worthlessness of fish oil. (Hooper L, Thompson RL, Harrison RA et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: a systematic review. BMJ March,2006)

Don't believe it for a second.

First of all, the study was a re-analysis of the existing published scientific literature. It was not a new study. It included a wild conglomeration of different clinical observations, as the studies examining fish oil over the years have been extraordinarily heterogeneous--in populations examined, omega-3 supplement (e.g., fish vs. capsule), period of observation, endpoints measured.

The results were skewed by inclusion of a moderate-sized British study by Burr et al in men with angina. In this study, no benefit was demonstrated and, in fact, a negative effect--more heart attack and death--was observed with fish oil. This was not news, since the study was published in 2003. It's results have been a mystery to everyone, since its unexpected negative result for fish oil was so starkly different from virtually every other study that preceded it (suggesting a study flaw or statistical fluke).

Nonetheless, the Burr study served to throw off the overall analysis. It diluted the dramatic and persuasive outcome of the GISSI-Prevenzione Study of 11,000 people in which a 28% reduction in heart attack and 45% reduction in cardiovascular death was observed. Note that the substantial numbers of the GISSI make the study's outcome nearly unassailable.

Another important fact: fish oil is among the most powerful tools available to correct elevated triglycerides. Drops of 50% are common. Recall that triglycerides are a necessary ingredient to create the nasty LDL, as well as VLDL, Intermediate-density lipoprotein, and an undesirable shift from large to ineffective small HDL. Reducing triglycerides is therefore crucial for your plaque control program.

This re-analysis serves to prove nothing. Such analyses can only pose questions for further study in a real study like GISSI: a randomized (random participant assignment), controlled (treatment vs. placebo or other treatment) study.

The weight of evidence remains heavily in favor of fish oil, not only as helpful, but fabulously beneficial, particularly for anyone aiming to reduce coronary plaque.

Vitamin D Newsletter-Autism and Vitamin D

Although Dr. John Cannell's most recent Vitamin D Newsletter concerns the connection between autism and vitamin D, and has nothing to do with coronary plaque reversal, this fascinating discussion between a mother of an autistic boy and Dr. Cannell is so enlightening that I thought that it was still worth passing on.

I also feel very deeply for parents with autistic children, who I see struggle with the developmental difficulties their children encounter. (I even have several patients who are parents of 2 or 3 autistic children.)

As always, Dr. Cannell is at the cutting-edge of converting hard scientific information into practical use. You will note several points or questions raised:

1) Dr. Cannell advocates a powdered capsule form of vitamin D. In my experience, most powdered or tablet forms do not work. But some do. He apparently has success with the brand he specifies.

2) Are there vitamin D-receptor (VDR) genotypes that respond differently? Should there be different 25 (OH) vitamin D blood level targets for different VDR genotypes? Nobody knows yet, but it will be an important question to explore in the future.

3) Is heavy metal toxicity, at least in its milder forms, a surrogate for vitamin D deficiency? (Are chelationists unwittingly treating vitamin D deficiency?)

4) If this is a genuine association, and vitamin D replenishment exerts profound neurologic effects in autistic children, does a similar, though less marked effect, hold in non-autistic children? Will children perform better, learn more effectively, etc. with vitamin D supplementation to normal levels?

5) Vitamin A--Is vitamin A with vitamin D good or bad? This one I do not have an answer to. Reading the literature Dr. Cannell cites didn't help much. (Dr. BG--Any comments? Dr. BG is a vitamin A advocate.)


Perhaps, should the association between autism and vitamin D hold, it raises more questions than it settles. But, true to my experience with vitamin D, every day I stumble on some unique, fascinating effect, all beneficial. We continue to learn new lessons about vitamin D and Dr. Cannell's insights as a practicing psychiatrist deeply concerned with vitamin D issues have helped enormously.

(Sorry, but I did not copy the links to the literature Dr. Cannell cites. To obtain the links, go to the original Vitamin D Newsletter.)

The Vitamin D Newsletter
June 2008




This month we feature a remarkable series of letters from a mother of an autistic son who treated her child with vitamin D. It is the first case report in the medical literature suggesting vitamin D has a treatment effect in autism.

First, a brief case report and then a more detailed exchange of emails between the mother and me.

Case Report:

John is a seven-year old boy living in the northeastern U.S. with a long-standing diagnosis of autism. Symptoms include temper tantrums, repetitive self-stimulatory behavior, impaired language, mood swings, fear of being alone, toileting problems, dysbacteriosis, and impaired muscle strength. John spends a lot of time outdoors starting in the spring and his mother noticed a distinct seasonal variation in his symptoms in that he improved in the summer and regressed in the winter. A 25-hydroxy-vitamin D in April of 2008 was 25 ng/ml and obtained after John had begun to play outside. Due to the seasonality of John's symptoms the mother consulted me. I advised the mother to stop all products containing vitamin A including cod liver oil and begin John on 5,000 IU of vitamin D3 per day for two weeks followed by 2,000 IU per day in the form of powdered vitamin D dissolved in juice. Within a week of starting the vitamin D, John's language began to return and he was no longer as fearful of being alone. At the end of two weeks his language showed further improvement, he began to toilet himself, counted to 10 and knew the spelling of his name. After three weeks language continued to improve and some improvements were noted in his dysbacteriosis. After four weeks of vitamin D treatment, the mother noted improvements in muscle strength as well as continued improvements in language. A repeat 25-hydroxy-vitamin D is pending while John continues taking 2,000 IU of vitamin D per day.

Before you read the series of emails between the mother and me, I'd like to caution that this is only a case report of sorts and does not prove a treatment effect. Spontaneous remissions, while rare in autism, have been reported, thus the supplemental vitamin D may have had nothing to do with his improvement. If the response is due to vitamin D, there is no assurance it will prove lasting. I think it unlikely that older autistic children or individuals with severe autism will show these sorts of apparent improvements. Furthermore, autism is a multifactorial disease with strong genetic roots and it is highly unlikely that treatment of vitamin D deficiency in all autistic children will result in similar improvements. Finally, I did not examine this child, and I am relying on the child's mother to report both his condition and his apparent response to vitamin D treatment. However, the mother agreed to speak with the press about her son and allow for independent confirmation of the apparent treatment response.

Below are the emails, edited for brevity, clarity, and confidentiality.



Dear Dr. Cannell:

I am writing because I believe my son John is strongly affected by vitamin D and I need some advice. John is seven and autistic and weighs 50 pounds. We live in the northeastern part of the United States . He starts spending lots of time outside in May and continues until September. Every year, like clockwork, he has the same patterns of behavior and ability. After about six weeks of sun exposure, every July, he begins feeling much better, seems to be comfortable in his skin, does not have as much self-stimulatory behavior, can eat a variety of foods and has language. This past summer, he was using 14-word sentences. By the end of November, he can't even ask you for a cup of juice. He becomes more exclusive, has emotional highs and lows, has tantrums and is easily frustrated.

His 25(OH)D level on April 15th was 25 ng/ml but he had already been going out in the sun so his level must have been lower in the winter. I have had his genetics tested (Nutrigenomic) and he has mutations in his vitamin D receptors:

VDR Bsm/Taq ++
VDR Fok --
VDR Taq ++

My first question, does it sound like the changes in his behaviors and abilities could be caused by lack of vitamin D? Could you elaborate on the time it would take to get adequate amounts of vitamin D to start seeing positive results? For example, even if he starts going out in the sun in May, it's usually not until July that I see positive changes. Then would it take a month or two to go back to being deficient, thus explaining his 'regression' by the time November comes around. Secondly, I am looking at different forms of vitamin D therapy: a vitamin D lamp, vitamin D3 cream, or oral vitamin D. Can you tell me what might be the best form during the winter months?

Thank you very much for your time and attention.

Jane, Boston MA



Dear Jane:

Yes, it is possible your son's autism is related to vitamin D. Such seasonality has been reported before in autism, both in an individual and in autistic children at a summer camp. Although suggestive, such seasonality does not prove a vitamin D connection. Sun exposure, unless it is full body, takes several months to get vitamin D levels up. If sunblock or clothes are worn sun exposure will not get 25(OH)D levels much above 30 ng/ml. As far as the "mutations" you list, they are actually vitamin D receptor (VDR) polymorphisms and not referred to as mutations although all such changes occurred through mutations at some time in the past. VDR polymorphisms are simply the different structures of the vitamin D receptor that different people have and they are widely distributed. A pilot study of actual VDR receptor mutations did not detect VDR mutations in 24 autistic individuals but they did not assess for VDR polymorphisms. However, a highly significant association exists between one VDR polymorphism and larger head size. Mean head circumference is larger in autism.

Yan J, et al. Vitamin D receptor variants in 192 patients with schizophrenia and other psychiatric diseases. Neurosci Lett 2005;380(1-2):37-41.

Handoko HY, et al. Polymorphisms in the vitamin D receptor and their associations with risk of schizophrenia and selected anthropometric measures. Am J Hum Biol 2006;18(3):415-7.

Lainhart JE, et al. Head circumference and height in autism: a study by the Collaborative Program of Excellence in Autism. Am J Med Genet A 2006;140(21):2257-74.

Lainhart JE, et al. Macrocephaly in children and adults with autism. J Am Acad Child Adolesc Psychiatry 1997;36(2):282-90.

I emailed the world's foremost expert on VDR polymorphisms asking him about your son's polymorphisms and his reply, quite technical, is below.



Dear John:

I apologize for the delay in getting back to you regarding VDR polymorphisms. Initial studies by Eisman and coworkers many years ago suggested that several of the polymorphs identified above in the VDR gene (Bsm/Tag) correlated strongly with osteoporosis. Despite the hoopla, subsequent analyses by many different investigators did not really confirm these results, i.e. only a very modest (3%) correlation. This spawned multiple studies searching for correlations between VDR polymorph's and cancer, autoimmune disease and so forth. It is fair to say from all of these studies that the correlation is at best weak, and in most cases non-existent. Part of this may be due to the fact that the Bsm and Taq polymorphs are located in VDR gene introns and as a first approximation cannot affect the VDR protein's function. This is not an absolute statement, however, as our work is now showing that regulatory regions that control the VDR's expression are located within introns as well as upstream. Therefore the possibility exists that these polymorphs could affect expression, although we have not found these regions to contain enhancers yet. This is clearly where gene and disease studies are going. The only polymorph that could affect function is the Fok1 site, which we identified many years ago following our initial cloning and structural analysis of the human VDR gene. The presence of this site leads to the expression of a shorter VDR protein (424 aa) that is purported to have a slight increase in transcriptional activity (10%?) vs the large protein (427 aa). The above analysis suggests that this polymorph is absent, leading to production of the larger perhaps less active protein. On a single patient basis, it is really difficult to conclude anything regarding this finding. Indeed, despite large numbers of patients, the VDR polymorph have not really revealed any significant insight. Given the summer correlations, it is probably more likely that the individual is low in vitamin D3 in winter.

Sincerely,

Professor John Doe




Thus, one of your son's polymorphisms may have less functionality but that should be easily overcome by higher vitamin D levels. The first thing to do is stop all vitamin A, multivitamins containing vitamin A, or cod liver oil and start vitamin D. As you will see below, vitamin A antagonizes the action of vitamin D and he should have plenty of vitamin A if he eats colorful vegetables, colorful fruit, eggs and fortified oatmeal. As far as vitamin D, I think the easiest way to give vitamin D is powdered capsules, not a cream. You can open the capsule and put the powder in about anything, such as juice. To buy the capsules, go toBio Tech Pharmacal and buy both a bottle of the 5,000 and the 1,000 IU capsules. He should take one 5,000 IU capsule a day for two weeks then take 2,000 IU per day. After a month, go to the doctor and have another 25-hydroxy-vitamin D blood test. Do not let your doctor order a 1,25-dihydroxy-vitamin D as it will give you and your doctor false information about your son's vitamin D status. The other option is buying a Sperti vitamin D light. Daily use of the light on both sides of his trunk will raise levels fairly quickly but he should still have a 25(OH)D blood test every month to assure his levels rise to the mid level of normal ranges, about 70 ng/ml. Vitamin D is very safe. Your son would have to take more than 10,000 IU a day for more than a year to have any risk of toxicity. If he improves and his level is 50 ng/ml, the next question is would he improve even more if his level was 70 ng/ml? Some lifeguards have levels of 80-100 ng/ml; normal ranges in the labs in the USA are 30 -100 ng/ml (ideal ranges are 50 -100 ng/ml.) If you have any more questions, let me know. I certainly want to know how he is doing.

Sincerely,

John Cannell



Dear Dr. Cannell:

It has been one week on 5,000 IUs of vitamin D3 daily and already we're getting some language back! We haven't had original language since probably around the end of November. The only language we have had in the past five months has been verbal scripting. Today John has already told me "turn off the TV" and "clean up the water". This is all very exciting. Will it last? I will continue to keep you updated on progress and change in behavior. One more thing, all winter long he was afraid to be by himself anywhere. Now he is starting to be able to be in another room or outside by himself.

Thanks so much,

Jane



Dear Jane:

I can't tell you how happy I am for you. I suspect John will continue to improve. Do you have any parent rating scales or does his treating pediatrician have any objective rating scales? If you have before and after rating scales or his treating doctor does then it becomes important to track his progress on an objective measure. Jane, if you are a member of any autism discussion groups, you should post about this, including doses used. If your son's case is typical, then hundreds of thousands of autistic children may be helped with vitamin D.

John Cannell



Dear Dr. Cannell:

It has been two weeks on 5,000 IU per day and I want to inform you that we are having continued success with language. Continued in the sense that it is consistent, it wasn't just a one day fluke. In addition, he is taking himself to the bathroom; this is another thing that goes away in winter months. I usually have to catch him holding it in and then suggest he go, but now he is going completely by himself. In therapy last week, he started drawing again. He drew a bee and then ran around the room buzzing. His toileting is consistent with his therapists, not just mommy. Last night, I asked him to count to 10 for me and he did - quite enthusiastically. Then I said what does J-O-H-N spell? It took him a bit but then he said "John."

Unfortunately, the last scale taken was when he was 3 when he had his first developmental evaluation. But we do track behavior and language on a weekly basis. The forms we fill out give a good indication as to how he is doing.

I belong to a parent forum. It was created by a doctor named Amy Yasko. She's a PhD, a researcher, not a medical doctor. It was through her that I got John's genetics tested. She advocates vitamin D as being very crucial. I will post something on her forum for the parents there. However, if the parents on the forum are following her recommendations, they should be taking it already - 2000 IUs in winter and 1000 IUs in summer is her recommendation. I will post something on the forum to really emphasize how important vitamin D is.

Jane



Dear Jane:

I'm glad the improvements are continuing. I see Dr. Yasko recommends 10,000 IU of vitamin A/day as well as cod liver oil. I strongly disagree. Make sure your son is taking neither vitamin A nor cod liver oil. Rather, make sure he eats colored fruits and vegetables as well as fortified oatmeal. Vitamin A interferes with vitamin D's function, especially at the doses Dr. Yasko recommends.

Vitamin A antagonizes the action of vitamin D. In humans, even the vitamin A in a single serving of liver impairs vitamin D’s rapid intestinal calcium response. Furthermore, the consumption of preformed retinols, even in amounts consumed by many Americans in both multivitamins and cod liver oil appears to be causing low-grade, but widespread, bone toxicity, perhaps through its antagonism of vitamin D. In a recent dietary intake study, Kyungwon et al found high retinol intake completely thwarted vitamin D’s otherwise protective effect on distal colorectal adenoma and they found a clear relationship between vitamin D and vitamin A intakes as the women in the highest quintile of vitamin D intake also ingested almost 10,000 IU of retinols/day. As early as 1933, Hess et al warned about vitamin A consumption, concluding, “as to a requirement of thousands of units of vitamin A daily, the unquestionable answer is that this constitutes therapeutic absurdity, which, happily, will prove to be only a passing fad.”

Rohde CM, Deluca HF. All-trans retinoic acid antagonizes the action of calciferol and its active metabolite, 1,25-dihydroxycholecalciferol, in rats. J Nutr. 2005;135(7):1647-1652.

Johansson S, Melhus H. Vitamin A antagonizes calcium response to vitamin D in man. J Bone Miner Res. 2001;16(10):1899-1905.

Penniston KL, Tanumihardjo SA. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006;83(2):191-201.

Oh K, Willett WC, Wu K, Fuchs CS, Giovannucci EL. Calcium and vitamin D intakes in relation to risk of distal colorectal adenoma in women. Am J Epidemiol. 2007;165(10):1178-1186.

Hess AF, Lewis JM, Barenberg LH. Does our dietary require vitamin A supplement? JAMA. 1933;101:657-663.

Unfortunately, Hess’s prophecy of a passing fad proved premature and many Americans continue to consume “absurd” and dangerous quantities of vitamin A. For example, multivitamins, until recently, had small amounts of vitamin D (200 to 400 IU) but high amounts of preformed retinols (5,000 to 10,000 IU). This pales in comparison to a tablespoon of modern cod liver oil, which contains sub-physiological amounts of vitamin D (400 to 1200 IU) but supra-physiological amounts of completely preformed retinols (5,000 to 15,000 IU or in some cases 30,000 IU).

John Cannell



Dear Dr. Cannell:

It has been three weeks and he went from 5,000 IU of vitamin D per day to 2,000 IU per day a week ago. His language is increasing. He's now back to saying the things he wants with some prompting. He also has gut dysbiosis and I'm sure the D is helping with microbes in his gut. He has a lot of problems with his immune system and bacteria and viruses. Also, doesn't vitamin D aid in the production of glutathione? I feel that could be a big part of his increased language.

Jane



Dear Jane:

Yes, abnormal immune responses are associated with both autism and vitamin D deficiency. For example, autistic individuals have immune abnormalities that show a striking similarity to the immune functions affected by vitamin D. Animal evidence indicates some vitamin D deficiency induced brain damage may be malleable, that is, vitamin D may partially reverse the brain damage, if given early enough. These studies offer hope that sunlight or oral vitamin D, especially in young autistic children, may have a treatment effect.

Ashwood P, et al. The immune response in autism: a new frontier for autism research. J Leukoc Biol 2006;80(1):1-15.

Cantorna MT, et al. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr 2004;80(6 Suppl):1717S-20S.

Burne TH, et al. Combined prenatal and chronic postnatal vitamin D deficiency in rats impairs prepulse inhibition of acoustic startle. Physiol Behav 2004;81(4):651-5.

Both the brain and the blood of autistic individuals show evidence of ongoing chronic inflammation and oxidative stress. That is, the disease process is probably increasingly destructive. Further hope for a treatment effect rests in activated vitamin D's powerful anti-inflammatory properties. Its administration reduces production of inflammatory cytokines in the brain, which have consistently been associated with cognitive impairment. Furthermore, activated vitamin D is remarkably neuroprotective by stimulating neurotropin release, reducing toxic cellular calcium levels in the brain, inhibiting the production of nitrous oxide, and by its immunomodulating properties, especially in reducing inflammatory cytokines and by increasing brain glutathione.

Moore ME, Piazza A, McCartney Y, Lynch MA. Evidence that vitamin D3 reverses age-related inflammatory changes in the rat hippocampus. Biochem Soc Trans 2005;33(Pt 4):573-7.

Cohen-Lahav M, Shany S, Tobvin D, Chaimovitz C, Douvdevani A. Vitamin D decreases NFkappaB activity by increasing IkappaBalpha levels. Nephrol Dial Transplant 2006;21(4):889-97

Kalueff AV, Eremin KO, Tuohimaa P. Mechanisms of neuroprotective action of vitamin d(3). Biochemistry (Mosc) 2004;69(7):738-41.

This last function of vitamin D, increasing cellular levels of glutathione, may explain the purported link between heavy metals, oxidative stress, and autism. For example, activated vitamin D reduces iron-induced and zinc-induced oxidative injuries in rat brain. The primary route for the neurotoxicity of most heavy metals is through depletion of glutathione and subsequent generation of reactive oxygen and nitrogen species. Besides its function as a master antioxidant, glutathione acts as a chelating (binding) agent to remove heavy metals. Several studies indicate autistic individuals have difficulty excreting heavy metals, especially mercury. If vitamin D deficient brains are unable to utilize glutathione properly, and thus unable to remove heavy metals, they may be oxidatively damaged by heavy metal loads normal children easily excrete. The amount of activated vitamin D in the brain directly depends on how much vitamin D is made in the skin or put in the mouth.

Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab 2002;13(3):100-5.

Chen KB, Lin AM, Chiu TH. Systemic vitamin D3 attenuated oxidative injuries in the locus coeruleus of rat brain. Ann N Y Acad Sci 2003;993:313-24.

Lin AM, Chen KB, Chao PL. Antioxidative effect of vitamin D3 on zinc-induced oxidative stress in CNS. Ann N Y Acad Sci 2005;1053:319-29.

Valko M, Morris H, Cronin MT. Metals, toxicity and oxidative stress. Curr Med Chem 2005;12(10):1161-208

Kern JK, Jones AM. Evidence of toxicity, oxidative stress, and neuronal insult in autism. J Toxicol Environ Health B Crit Rev 2006;9(6):485-99.

Sincerely,

John Cannell



Dear Dr. Cannell:

It has been a month now and John's Improvements are continuing. In the last week, he has been using his muscles more, he goes on the swing outside and lifts his legs and bends in ways that take core muscle strength. This is yet another skill or interest that left and is returning. I will report more next week.
Jane




Conclusion:

It is too early to say vitamin D has a treatment effect in autism. However, a simple risk/benefit analysis suggests that autistic children should be diagnosed and aggressively treated for vitamin D deficiency. If readers want to learn more about vitamin D and autism, they can obtain the entire paper on the link below. Unfortunately, Elsevier charges $31.50 to download it. You can read a similar document for free on the website, where we first published the theory a year ago.

Cannell JJ. Autism and vitamin D. Med Hypotheses. 2008;70(4):750-9.

http://vitamindcouncil.org/newsletter/2007-may.shtml

In summation, autistic children should be given enough vitamin D to get their 25(OH)D levels up to the mid to high range of normals, that is, 70 ng/ml (175 nmol/L in countries that use the metric system). In the absence of sun exposure, this usually requires long-term administration of about 1,000 IU/day per 20 pounds of body weight with a loading dose of 2,000 IU of vitamin D/day for every 20 pounds of body weight for the first two weeks. As individual variation in response is very high, they should have 25(OH)D blood tests every month until their level has stabilized around 70 ng/ml. They should stop all products containing preformed retinols (vitamin A), especially cod liver oil.

John Cannell, MD
The Vitamin D Council

This is a periodic newsletter from the Vitamin D Council, a non-profit trying to end the epidemic of vitamin D deficiency. If you don't want to get the newsletter, please hit reply and let us know. As we are a 501(3)(c) non-profit corporation, dedicated to ending vitamin D deficiency and not making money, the Vitamin D Council does not copyright this newsletter. Please reproduce it and post it on Internet sites. If this newsletter proves useful to a child you know with autism, the Vitamin D Council asks for a donation as we have not been able to secure a grant and our bank account balance is again below $5,000. Send your tax-deductible contributions to:

The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422

"Make big money fast with CT scans"

Rather than the headline New Study Could Change Heart Disease Diagnosis And Treatment being run in Utah TV and newspapers, instead it should read:


Make big money fast with CT scans!

Is your bottom line shrinking? Have you fallen on hard economic times? Is competition from other hospitals and providers threatening your financial health?

Then we have a solution: Do a CT coronary angiogram on everybody! Look for disease in people with no symptoms, scare the heck out of them, and voila! Instant need for bypass surgery!

Ka-ching!! That'll be $100,000, please.

Do it again, and again, and again, and your hospital will be quickly in the black in no time!

And, for the savvy marketer, tell the newspapers that you're going to conduct a study to see if this approach works--even before the study gets started! Even if the study pans, you'll come out a winner because you did it in the name of "research"!




Apparently a group of cardiologists at the Intermountain Medical Center and LDS Hospital in Salt Lake City, with the financial assistance of Siemens, a manufacturer of CT scanners, is funding a 1000-patient study of diabetics, all without symptoms of heart disease, half of whom will undergo "screening" CT coronary angiograms (not heart scans) followed by bypass surgery, if "needed". The other half will receive conventional, "aggressive" medical therapy. "Aggressive" means cholesterol treatment, blood pressure control, and blood sugar control (no kidding).

The outcomes of the two groups will be compared after two years.

To understand the absurdity of this study, note that they are proposing what amounts to "prophylactic" bypass surgery, since the participants are without symptoms. Since there are no stress tests, a measurement of flow or functional capacity (exercise tolerance) cannot be factored in. Decisions will be made on the basis of severity of "blockages" in asymptomatic people, a hazardous notion that has never been shown to provide benefit. No doubt: Some diabetics with extensive disease may obtain benefit from screening, but many more will undergo what amounts to unnecessary bypass that provides no benefit. We already know from studies dating back over 20 years to the days of the original CASS (Coronary Artery Surgery Study) that putting asymptomatic people through bypass surgery willy-nilly does not reduce mortality.

Of course, the "aggressive" preventive treatment they propose is more like the least common denominator level of treatment. In fact, I would characterize the "aggressive" preventive treatment as ridiculous. Doing less would be malpractice. Much more could be done, but doing a lot more would pose a real challenge to the bypass arm of the trial.

But the smell of money drives such efforts: More CT angiograms, more hospitalization for bypass surgery. The payoff to the hospitals from this effort is likely to exceed $5 to $10 million, all money that they might not have otherwise seen. The ill-informed people in the local media gush with enthusiasm, the hospital acts like they are at the cutting edge of medical technology, the doctors pose as saviors.

All this time, real preventive efforts go unmentioned. No fish oil (28% reduction in heart attack, 45% reduction in sudden death from heart attack), no genuine diet efforts (i.e., not the diabetes-promoting American Diabetes Association diet), no effort to identify sources of coronary risk beyond LDL cholesterol (low HDL,small LDL,and postprandial or after-eating abnormalities, for instance, are prominent sources of risk in diabetics), no vitamin D. In my view, the preventive arm of the study amounts to doing virtually nothing beyond prescribing statin drugs.

Don't fall for it.

Is DHEA dangerous?

















The Fountain of Youth, Louis Cranach the Younger (1546)




In the Track Your Plaque program, we sometimes use the adrenal hormone, DHEA. It is a fascinating and--surprisingly--an over-the-counter hormone that can be useful and safe when used properly.

DHEA can be useful for:

--Reduction of Lp(a)--Though more effective in females, it can also be useful in males. In the women, DHEA often reduces Lp(a) 15-18%, somewhat less in males. The lower the starting DHEA, the greater the Lp(a) reduction.

--Improved libido--in both men and women. The effect is modest. It's magnified when used with other strategies. Although this is not specifically a goal in the program, it sure helps to get side-benefits like this, rather than unwanted side-effects.

--Increased energy and mood--The boost in mood is, for many, the most perceptible effect: More ambition, more stamina, greater staying power in work and exercise.

--Reduction in abdominal (visceral) fat--A modest effect, but one that, over a long period of use (>6 months) can yield improved insulin responses.


Most commonly, I will suggest DHEA supplementation when blood levels allow. Some people, however, Google "DHEA" and come back horrified that I would suggest such a dangerous supplement.

"I read that it makes women grow mustaches and makes their voices deeper!"

And it does--if you take a lot.

10-15 years ago, when the benefits of DHEA became apparent, some people wanted to believe that DHEA was the fountain of youth. People interested in the anti-aging potential for DHEA figured that, if 50 mg per day made you feel energized and vigorous, what would be the effect of 1000 mg, 2000 mg, or 3000 mg per day? A number of clinical trials were conducted using these doses and, interestingly, depression can lift, men and women increase muscle mass, there is a slight increase in bone density, even pain symptoms from rheumatoid arthritis and lupus may improve. But . . . women grow mustaches, become sexually aggressive, and develop deep voices. Men can become hyperaggressive or overly emotional.

No wonder: Any hormone taken in extraordinary, supraphysiologic doses will exert wacky effects. Imagine taking testosterone or estrogen at 50 times the usual dose.

The doses we use for the above benefits, including Lp(a) reduction, range from 25-100 mg per day; most people do fine with 50 mg. We also adjust doses to starting blood levels. In this dose range, I have never seen any of the above side-effects.

The only side-effects I see at these doses are 1) excessive assertiveness or crabbiness, and 2) insomnia if taken at bedtime.

In my experience, DHEA is a benign hormone, provided it is taken in limited doses and not abused. An occasional female younger than 55 years old will be able to tolerate only 10-20 mg per day before developing the edgy side-effects, but I've never witnessed masculinizing side-effects at these low doses, nor have I ever seen excessive increases in testosterone in men or women. (Women can raise testosterone levels slightly, but almost never enough to exert much effect beyond modestly increased libido.)



Copyright 2008 William Davis, MD

Wheat addiction: 140 lbs lost

Here is detailed comment from a reader who figured out the wheat (and dairy) issue on her own with impressive results.

Though it seems an unpardonable over-simplification of diet, this concept of eliminating wheat-based products (along with obvious unhealthy foods like candy and soda) yields unexpectedly large results, as our reader relates.


Hi Dr. Davis,

Several years ago, chronic untreated asthma infections hospitalized me. I thought it was recurring bronchitis as I'd never had asthma in my life. Killed much of the alveoli... took awhile to de-crap the lungs and regrow the alveoli. Got assigned a cardiologist sort-of by accident while in the hospital for that (couple days of constant heated steroid, stress, a pain + situation combined, elevated my heart rate to 298 for a brief time). When I went to see him, he wrote me a prescription for the Eades' PPLP [Protein Power LifePlan] book.

It's taken awhile, since it's required radical gradual changes in most aspects of my overly Type-A life, but I'm now about 140 lbs lighter, and hopefully much more in the future.

Miraculously, after 10 days on a hard meat-eggs-cheese-veggie-berry approach (which I sadly confess was mostly pepperoni & mozz nuked... I was busy! ;-)), all my medical symptoms disappeared too. Acid reflux, acne, brain-fog, rashes, 'severe asthma', allergies, etc. etc. By trial and error I realized I wrongly attributed that to lowcarbing when it was getting off gluten that actually did it for me. Which since I'm lowcarb also means all the crap my celiac boyfriend can eat, I can't. Lowcarb does many great things for me (just dropping all the bloating and increasing the energy level are awesome), but getting off wheat was critical.

I've since found that a single tablespoon of "milk" in the morning, or something with wheat (say a tortilla), will make me ravenous *specifically for milk and wheat* all day. Conversely, I can be eating lowcarb and then eat total junk--but something without gluten--and not have it bother me much at all. But one pumpernickel slice at Outback and I am DOOMED. It doesn't always happen that instant; will-power has some sway; but the odds of my making a 'poor decision that leads to cascade failure and totally abandoning my eating plan' in the next 48 hours is astronomically higher if milk or wheat were involved. Oddly, cheese does not seem to affect me this way.

When I was younger (I'm 42 now) I had to stop drinking milk. If I drank some I wanted more. If I drank more I needed more. If I drank more, that was it: I'd be stumbling to the kitchen in the dark at 3am, drinking out of the carton, falling gasping against the refrigerator after several long gulps, like a heroin addict who just got a fix. I finally realized that since I'd lived on a ton of milk my whole life, maybe this was a milk problem; so I usually stayed away from it. So then it turned out wheat/gluten were an issue too. Which made me realize how much of my life was filled with not-eating most of the time (very busy, workaholic, but very sedentary), but when I did eat, ingesting amazing amounts of wheat products. I'm astounded that my whole life I mostly ate things I am apparently intolerant to "or something." Sometimes I wonder how much different even my brain would be if it'd been different.

This might contribute to my ending up weighing 500# at one point. The only amazing thing is that I didn't get a disease. (Well I did--obesity--but I mean any others.) I'm from a family of people who are mostly fat, mostly alcoholic, and mostly dead of cancer. I'm just fat, worse than the others but otherwise seemingly ok. Now I'm starting to think that maybe my whole family may have some 'issue' with the primary foods of our culture.

I tell friends that my horrible chronic acid reflux was solved merely by getting off gluten. They nearly all say, "I could never give up bread!" (Isn't it funny, you never hear people say, "Oh man, I could never give up broccoli!") I tried to convince one young friend to try it; her doctor told her eating more protein and fat was unhealthy, and gave her a prescription (this is lifetime--it doesn't cure it, merely treats the symptom) to a drug to help with acid reflux. I said you're kidding me, you think taking a drug the rest of your life is healthier than trading your pasta for a steak?? Go figure.

I still haven't figured out the milk connection (or why I seem ok with cheese for some reason; maybe there is a dosage-difference, or the sugar combined with it has some effect), but I think it's pretty clear that dropping milk and wheat has very radically changed my life for the better. I may actually live, which being a single mom to an awesome 11 year old girl, is a good thing.

Best,
P.

Diet: Don't be angry, be GRATEFUL


Given the confusion over what constitutes the "ideal" diet, a discussion that has been hotly debated for decades, some people become very angry that we still don't agree on what is truly healthy.

"Why should I even try if the experts don't agree? They say something is bad one day, then say it's okay the next!"

But that's a short-sighted half-truth born of frustration. We have certainly zigzagged in our understanding of diet over the years. The grand national experiment in low-fat eating, for instance, clearly failed to improve our health. In fact, the opposite occurred: The largest epidemic of obesity and diabetes in world history. You could get angry from this failed experiment . . . or you could learn from it, take what lessons we can and improve on it.

Step back for a moment and consider: In what other age could we even have this discussion?

If we lived in a world where you were hungry, your children were hungry, and you didn't know where the day's food was to be found, we would have no need whatsoever for this conversation: You would take whatever you could find, kill, or steal.

Say you woke up this morning and your cabinets and refrigerator were empty. The stores were far away or non-existent. You and your family would have to improvise, to forage or hunt your day's food. It would require hours. You wouldn't fuss about glycemic index, or saturated fat, or whether or not sugar or wheat was present. You would just eat whatever you could get your hands on. When caloric deprivation threatens, we take what is available.

But we live in a world of plenty--of enormous excess--that allows us choices. It is a world that encourages eating more than is required for existence, a world tailored more to indulgence than to simple satiety or sustenance. That's when distinctions among food types and quality make a difference. But it is a dilemma born of riches.

Starvation and caloric deprivation would settle the argument for us very quickly. It doesn't mean that we shouldn't continue to debate the finer points of diet. But don't do it with anger or frustration. Do it GRATEFULLY, recognizing that we are lucky to be able to have such a conversation in the first place.


Image courtesy Food and Agriculture Organization of the United Nations.

HDL for Dummies

I frequently peruse conventional health websites to keep track of their message. One painfully conventional (read "drug company-supported") website that echoes the standard advice on heart disease and heart health is Everyday Health .

Since I subscribe to the newsletters for many conventional sites, I received an e-mail that took me to this Q & A about HDL cholesterol:

Q: I'm 36 years old and my good cholesterol is too low. What can I do?
– Nilsa, Florida

Dr. Lori Mosca of New York-Presbyterian Hospital responds:

A: A woman's HDL goal should be greater than 50 mg/dL (greater than 40 mg/dL in men). You can raise your HDL levels by eating a diet low in saturated fat and trans fat but high in monounsaturated fats. Lose weight if you need to and get at least 30 minutes of moderate-intensity exercise on a minimum of four days per week. If you smoke, quit. Despite positive lifestyle changes, though, some individuals may still be candidates for HDL-raising drug therapy because they are at increased risk for cardiovascular disease. Discuss your options with your health care provider.


Are you satisified with that answer? I certainly am not.

First of all, is this something you've never heard before? "Eat right, exercise, cut your unhealthy fats." Then why do people who follow this sort of conventional advice often still fail? Is the next step always medication?

Here's the part that Dr. Mosca and other conventional, drug-minded "authorities" have left out:

To raise HDL powerfully--not to 40 mg/dl for males or 50 mg/dl for females, but to 60, 70 or 80 mg/dl--think about the following strategies:

--Eliminate wheat and cornstarch products. I have droned on endlessly about this concept, but it is enormously effective. While the weight loss that inevitably follows elimination of these foods adds to the HDL-raising effect, there is also an independent effect, as well.

--Fish oil--The omega-3 fatty acids in fish oil reduce triglycerides. Triglycerides accelerate the destruction of HDL. Remove triglycerides, HDL goes up. (Though krill oil may share, even surpass this effect, we need more data than the single manufacturer-sponsored study.) Of course, this requires real doses, not the namby-pamby doses you often read about.

--Vitamin D--Achieving normal levels of 25(OH) vitamin D raises HDL with power I have never witnessed from any other strategy before, barring weight loss of 30+ lbs. Readers of the Heart Scan Blog know that just taking vitamin D is not enough. Verification with blood levels is an absolute necessity, particularly if raising HDL maximally is among your goals.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

--Dark chocolate--Or other cocoa prepartions. What a cool way to raise HDL! Reach for the lowest-sugar, highest cocoa preparations.

--Alcoholic beverages--I am partial to the red wine/flavonoid-rich concept, being a wine drinker. Although all alcoholic beverages raise HDL due to the ethanol content, for benefits beyond alcohol (as well as to avoid wheat-based drinks like beer), I do believe that the bulk of data argue for flavonoid-rich red wines from southern France, Italy, and California.

--Achieve ideal weight--The toughest of all. But eliminating wheat and cornstarch makes it far easier.


Follow the conventional advice of those like Dr. Lori Mosca, and the majority of people will fail. ("It just so happens that I have a prescription drug just for that purpose!")

Buck the conventional advice, adopt strategies that won't be found in the drug ads, nor be provided by the conventionally-thinking, and you can succeed to heights you never thought possible.


Copyright 2008 William Davis, MD

"I gained 30 lbs from one cracker"


Let me tell you a story, a tale of a woman who gained 30 lbs by eating one cracker.

At age 50, Claire's health was a disaster. Her initial lipoprotein patterns were a mess, including HDL 36 mg/dl, triglycerides 297 mg/dl, blood sugar 122 mg/dl (pre-diabetic range), blood pressure 155/99. Small LDL comprised over 90% of all LDL particles.

At 5 feet 3 inches, she weighed 210 lbs--90 lbs over her ideal weight. Her face was flushed and red, her eyes swollen and weighted down with bags, her eyes dull. While interested in hearing about how to improve her health, I would hardly call her enthusiastic.

We talked about how removing wheat products entirely from her diet could result in weight loss--enormous weight loss--yet with reduced appetite, increased energy, less daytime sleepiness and fogginess, improved sleep quality. Removing wheat would also allow substantial correction of her lipoprotein patterns with minimal medication.

At first, she seemed confused by this advice. After all, it ran directly opposite to what she'd been told by her family doctor, not to mention the advice from TV, food ads, and food packages.

To my surprise, Claire did it. She didn't return to the office for another 5 months. But she came in, a big beaming smile on her face.

Even at 167 lbs--still overweight--Claire looked great. She glowed. She'd already dropped nearly 2 1/2 inches from her waist. She felt lighter on her feet, discovered energy she thought she'd lost 10 years earlier. Her blood results matched, with dramatic shifts in each and every pattern.

I quizzed Claire on her diet, and she had indeed made substantial changes. In addition to eliminating all foods made of wheat flour, she also eliminated foods made with cornstarch, rice flour, snacks, and other sweets. She ate her fill of vegetables, fruits, raw nuts, lean meats, and healthy oils. She was less hungry while eating less. Even her husband, skeptical at first, joined Claire after the first two months and her initial 20 lbs of weight loss. He, too, was well on his way to dropping to ideal weight.

But a dinner party invitation came. In the few that Claire and her husband had gone to over the few months, she had religiously stuck to her program, choosing cheese, pickles, olives, vegetables that she dipped, but avoided the pretzels, breads, Doritos, potato chips, and others.

This time, a tray of whole wheat crackers was laid on the buffet table, covered with some sort of sweetened cheese. She had just one. She savored the taste that she'd missed. "Maybe one more. I'll be extra good this weekend,'" she told herself.

Now Claire was hungry. The bruschetta covered with tomatoes and mozzarella looked awfully good. "It's got some good things on it, too!" she thought. She had three.

The floodgates opened. I saw Claire three months later, weighing just shy of 200 lbs. "I almost cancelled this appointment," she whispered quietly, tears at the corner of her eyes. "I don't know what happened. I just lost control. After losing all that weight and feeling so good, I blew it!"

I've seen it before: Fabulous success eliminating the foods that created the situation--the insatiable appetite, the endless cycle of hunger, brief satiety, the rolling, rumbling hunger--followed by temptation, then disaster. The weight lost comes right back.

It's experiences like Claire's that have absolutely, positively convinced me: Wheat products are addictive. It's not true for everybody, but it's true for many people, certainly most people who have weight struggles. It triggers some sort of appetite button, a signal to eat more . . . and more, and more. Keep it up long enough, and you have drops in HDL, increases in triglycerides, upward jumps in blood sugar and blood pressure, diabetes, etc. It doesn't matter if it's whole grain, 7-grain, or 12-grain. Yes, the whole grains contain more fiber and more B vitamins. But they all share one characteristic: They trigger a desire for more.

So that's the story of how one whole wheat cracker caused one woman to gain 30 lbs.


Next week's story:

California woman claims: My children are aliens!


Just kidding.


Copyright 2008 William Davis, MD

Wheat-free is not gluten-free

Eliminate wheat from your diet and wonderful things happen:

--Lose 15-20 lbs, sometimes in the first 1-3 months. (More or less, depending on your prior dietary habits, weight, age, etc.)
--HDL cholesterol goes up, triglycerides go down
--Blood sugar drops
--Small LDL is reduced
--C-reactive protein is reduced
--Pre-diabetics often convert to non-diabetics
--Diabetics gain far better control over blood glucose. Some even become non-diabetic (as long as they maintain the wheat-free, low-glycemic index diet and weight control).
--You feel better: Less mental fogginess, more energy, better sleep.
--Appetite shrinks dramatically.


(Many diet programs makes lots of money promising similar results. Prescription medications like the pre-diabetes drugs, Actos and Avandia, and the fibrates, Tricor and Lopid, nearly--nearly--reproduce the effects of eliminating wheat. Of course, these medications do not lead to weight loss or make you feel better. In fact, Actos and Avandia usually trigger a weight gain of 8 lbs in the first year of use.)


All of these wonderful effects develop with elimination of wheat. . . unless you confuse wheat-free with gluten-free. There's a difference.

Remove wheat from your diet, but discover the world of gluten-free products made for people with celiac disease, or gluten enteropathy, and you can regain the weight and recreate many of the phenomena associated with wheat. I've talked about this in past, but it trips up so many people that it's worth talking about again.

The concept that I am advocating is really low-glycemic index (or low glycemic load, actually). Foods that trigger a substantial rise in blood sugar, whether immediate (like whole wheat crackers) or delayed (like whole wheat pasta) are the culprits. The same effects develop with candy, cookies, fruit drinks, pizza, chips, table sugar, and other junk foods.

However, I pick on wheat specifically because it so dominates the American diet. It has grown to fill so many processed food products. It is also a food ingredient that is falsely advertised as healthy. In reality, pretzels, whole wheat crackers, whole grain bread, high-fiber cereals, etc. exert the same effect on blood sugar as candy or white table sugar. They also generate all the "downstream" phenomena listed above.

But wheat is hardly the only food that makes us fat, diabetic, and unhealthy. This is true for foods made with cornstarch (taco shells, cornbread, tortillas, chips, breakfast cereals); rice flour, puffed rice, and polished rice; and potatoes, particularly pulverized potato starch (potato chips). There are others.

These are the gluten-free products that are marketed to the gluten enteropathy (celiac disease) market. Yes, you can make muffins with cornstarch and no wheat gluten, but is it good for you?

No. It is nearly as bad as wheat. It can still skyrocket blood sugar, drop HDL, raise triglycerides, create small LDL, heighten inflammation, etc.

Ground flaxseed, oat bran, barley, quinoa, are some of the alternatives that do not create these effects. But not the majority of gluten-free products on the market.




Ingredients: Potato starch, rice flour, modified corn starch, olive oil, yeast, vegetable protein(lupine), corn syrup, sugar, salt, hydroxypropyl methylcellulose, sodium bicarbonate, ammonium bicarbonate, diacetyltataric acid esters of mono- and diglycerides of edible fats, natural flavor.

". . . only naturally gluten-free and wheat-free ingredients and adhere to the strictest quality processes, testing every batch for gluten using the ELISA assay."

NUTRITION FACTS
Serving Size 7 bread sticks (31g)
Servings per container 5

Calories 120 Calories from fat 25
Amount per serving
Total Fat 2.5g
Saturated Fat 0.5g
Trans Fat 0g
Cholesterol 0mg
Sodium 310mg
Total Carb 24g
Dietary Fiber 1g
Sugars less than 1g
Protein less than 1g

Death to chelation?


Does chelation work?

It's a question I get asked fairly frequently. Although I have never performed chelation, IV or oral, and therefore have no direct experience, my concerns for this purported therapy have included:

1) The concept of extracting calcium from atherosclerotic plaque by removing it first from the blood is absurd. Early chelationists believed that this was the means by which EDTA might reverse coronary atherosclerosis. However, removing calcium from blood would more likely lead to osteoporosis or calcium extraction from bone, since bone is a more ready repository for calcium. Blood calcium levels are also tightly and narrowly controlled; any significant reduction in calcium ("hypocalcemia") can be life-threatening. And, indeed, there have been deaths from hypocalcemia in people receiving chelation.

More recently, chelationists have argued that removal of heavy metals like lead and mercury are responsible for the purported benefits of chelation. And, indeed, blood levels of these heavy metals can be reduced by chelation. That alone may be a benefit. But to then make the leap to say that it also regresses atherosclerotic plaque by the same mechanism has no basis in science.

2) Practitioners associated with chelation tend to be shady. I have seen homeopathic therapies (among THE most ridiculous of concepts), "energy balance" therapies, desiccated organ extracts ("applied kinesiology"), and a variety of other fringe treatments offered by practitioners offering chelation. This doesn't necessarily mean, of course, that chelation is also fringe or suspect, but it tends to be offered by practitioners who engage in generally unscientific, unfounded practices.


The few people I've seen go through multiple courses of chelation (usually 30 or so infusions) have shown no impact on heart scan scores or any other measure of heart disease.

In response to the many questions I receive on chelation, I had been answering that, if we would simply wait for the publication of the NIH-sponsored trial of IV chelation therapy, perhaps we'd know once and for all.

However, in a lengthy criticism, four expert authors argue that the TACT trial to assess chelation study is doomed to failure for an entire list of reasons and should therefore be abandoned. The discussion is available on Medscape Cardiology. (Free sign-in required.)



Why the NIH Trial to Assess Chelation Therapy (TACT) Should Be Abandoned
We investigated the social and the scientific histories of chelation therapy beginning in the 1950s. We examined TACT protocols and consent forms, which, in response to Freedom of Information Act (FOIA) requests, the NIH provided to us with curious redactions. We examined the existing RCTs and the numerous case series cited by the TACT protocols. We examined evidence for risks, including information that is not in the standard medical literature. We examined various hypotheses that advocates have offered to explain how chelation "works."

We present our findings in 4 parts. First, we provide a brief history of the use of disodium EDTA as a treatment for CAD. Next, we describe the origin and nature of the TACT. Next, we discuss the evidence for chelation as a treatment for CAD and for atherosclerosis in general, and place it in the context of other proposed treatments that have been ineffective after an initial period of enthusiasm. Finally, we discuss the risks. For each topic, we contrast our findings with relevant statements in the TACT literature, to the extent that such statements exist.



Among the highlights:

--Since the mid-1970s, court documents and newspapers have reported at least 30 deaths associated with IV disodium EDTA, most of it administered by ACAM members.

--Early chelation investigators had chosen the disodium salt of EDTA, reasoning that if it could remove calcium from atherosclerotic plaques, it might shrink them. That notion was soon demonstrated to be invalid. It has largely been replaced by a "toxic heavy metals" antioxidant hypothesis, which is based on the potential for metal ions to produce free radical damage. Chelationists now cite "removing heavy metals" as the basis for their claim that chelation is effective for approximately 70 conditions, ranging from schizophrenia and autism to cancer. This provides them with numerous reasons to ignore any trial that finds chelation ineffective for CAD.

--Biochemical literature, either not cited or misrepresented in the TACT protocols, has demonstrated that the heavy metals hypothesis is implausible. Antithetically, it also demonstrates that the chelation mixture used in the TACT has pro-oxidant effects in vitro.

--In our opinion, TACT literature -- including 2 versions of the protocol, the consent form, information posted on the NCCAM Web site, and 2 editorials co-authored by the PI -- has misrepresented chelation, its risks, and the facts of the study. It has exaggerated the value of supportive case series, not only by ignoring evidence of bias and incompetence, but by misrepresenting citations and reporting erroneous data. It has minimized the dangers, both by understatements and by omissions of specific, published complications. It has not acknowledged the deaths mentioned above. It has repeatedly conflated disodium EDTA and a different drug, calcium-sodium EDTA.

--The TACT includes nearly 100 "chelation site" co-investigators who, in our opinion, are unsuitable to care for human subjects or to report trial data. Most espouse implausible health claims while denigrating proven methods; several have been disciplined, for substandard practices, by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons. Several were members of the ACAM or GLACM IRBs mentioned above. Few appear to have real expertise, required by TACT literature, in treating patients with CAD or in conducting clinical trials. Most continue to promote chelation while the TACT is in progress, contrary to good science, to human studies ethics, and to US Federal Code.


While the criticism itself does not prove the point one way or another, as a clinical trial should, anyone contemplating chelation therapy would be well-advised to read the document first. Another reference: EDTA chelation therapy for cardiovascular disease: a systematic review.


The authors of the exhaustive discussion are:
Kimball C. Atwood IV, MD, Anesthesiologist, Newton-Wellesley Hospital, Newton, Massachusetts; Assistant Clinical Professor, Tufts University School of Medicine, Boston, Massachusetts; Associate Editor, Scientific Review of Alternative Medicine
Author's email: katwood@partners.org

Elizabeth Woeckner, AB, MA, President, CIRCARE (Citizens for Responsible Care and Research), Columbia, Maryland

Robert S. Baratz, MD, DDS, PhD, Medical Director, South Shore Health Center, Inc., Braintree, Massachusetts; Assistant Clinical Professor of Medicine, Boston University School of Medicine, Boston, Massachusetts; President, National Council Against Health Fraud, Inc.

Wallace I. Sampson, MD, Clinical Professor of Medicine (Emeritus), Stanford University, Stanford, California; Senior Attending Physician and formerly Chief of Medical Oncology, Santa Clara Valley Medical Center, San Jose, California; Editor-in-Chief, Scientific Review of Alternative Medicine



The authors provided the following disclosures:


Disclosure: Kimball C. Atwood IV, MD, has disclosed no relevant financial relationships in addition to his employment.

Disclosure: Elizabeth Woeckner, AB, MA, has disclosed that she has received compensation for consulting in civil litigation and professional disciplinary actions.

Disclosure: Robert S. Baratz, MD, DDS, PhD, has disclosed that he has been retained by state licensing boards, the Office of the US Attorney, and plaintiff counsel as an expert in disciplinary proceedings and litigation with regard to chelation therapy and associated matters. He is compensated only for his time and has no commercial interest in the outcome of the proceedings or litigation.

Disclosure: Wallace I. Sampson, MD, has disclosed no relevant financial relationships in addition to his employment.

American Diabetes Association


These are actual quotes from the American Diabetes Association website:


Myth #2 (from list of Diabetes Myths): People with diabetes can't eat sweets or chocolate.
If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes, than they are to people without diabetes.



Myth #5: If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.
Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portions. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.





How can I have sweets and still keep my blood glucose on target?
The key to keeping your blood glucose on target is to substitute small portions of sweets for other carb-containing foods in your meals and snacks. Carb-containing foods include bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, and peas. For many people, having about 45 to 60 grams at meals is about right. Serving sizes make a difference. To include sweets in your meal, you can cut back on the other carb foods at the same meal.

For example, you’d like to have cookies with your lunch. Your lunch is a turkey sandwich with two slices of bread. Your first step is to identify the carb foods in your meal. Bread is a carb. You decide to swap two slices of bread for two slices of low-calorie bread and have the cookies -- it’s an even trade. Your total amount of carbohydrate remains the same for the meal.



Can I eat foods with sugar in them?
For almost every person with diabetes, the answer is yes! Eating a piece of cake made with sugar will raise your blood glucose level. So will eating corn on the cob, a tomato sandwich, or lima beans. The truth is that sugar has gotten a bad reputation. People with diabetes can and do eat sugar. In your body, it becomes glucose, but so do the other foods mentioned above. With sugary foods, the rule is moderation. Eat too much, and 1) you'll send your blood glucose level up higher than you expected; 2) you'll fill up but without the nutrients that come with vegetables and grains; and 3) you'll gain weight. So, don't pass up a slice of birthday cake. Instead, eat a little less bread or potato, and replace it with the cake. Taking a brisk walk to burn some calories is also always helpful.


Or take a look at the recipes for breads, muffins, cakes, pies, cookies, and pizza.


My point? As I often say, while the "official" organizations like the American Diabetes Association, the American heart Association, and the USDA dominate the message provided to mainstream Americans, to those of us who know better, they have become irrelevant. You can see how obviously boneheaded their advice is. I'd go so far as to say that, if you want diabetes, follow the American Diabetes Association diet. If you have diabetes, and you'd like to accelerate complications like kidney disease, heart disease, and neuropathy, then follow the American Diabetes Association diet.

I'm going to bet that American Diabetes Association sponsors like Lilly, Novo Nordisk, Merck, Pfizer, Abbott ($1 million or more annual contributions) and Cadbury Schweppes (3-year, multi-million dollar support for Weight Loss Matters program) will continue to charge full-speed ahead to maintain the status quo. Cadbury Schweppes are the proud makers of Dr. Pepper, Hawaiian Punch, Snapple, Motts' Apple Juice, and Hires Root Beer--you know, the foods and drinks that you can have as long as you adjust your insulin dose or talk to your doctor about adjusting your diabetes medications. And if you gain, say, 30 or 40 lbs eating these foods. . . well, we've got a treatment for that. Merck's Januvia , for instance, can help you out for only about $200 a month!

Looking at the facts this way, and it seems like some cheap conspiracy theory: They're all out to get us. Dispense information that virtually guarantees propagation of the disease, and all your friends and cronies profit. I don't know if it is or it isn't, but it sure smells like it sometimes.

More on the American Heart Association Check Mark program

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

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

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



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California Giant
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California Strawberry Commission
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Campbell Soup Company
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Chiquita Brands Company, N.A.
Chiquita Bananas

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

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ConAgra Dairy Foods
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ConAgra Food Service
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ConAgra Frozen Foods
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El Aguila Food Products, Inc.
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Eurofresh Inc.
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FPL Foods, LLC
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Farmland Foods
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GFA Brands, Inc.
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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.