Condition Afflicts Millions: Do you have “YBS”?

After one of the harshest winters, spring has finally arrived.  The welcomed warmer temperatures and longer daylight hours infuse us with a sense of renewal and new beginnings.   Low and behold we begin to come out of hibernation and start the mad dash to engage in positive lifestyle changes such as eating better, exercising, proper sleep and taking appropriate nutritional supplements.  But invariably, life happens.  

Yep, just when you were about to get started, it happens.  YBS sets in.   I see this “condition” all too often with clients attempting to enter or re-enter into any number of behavior changes.  I will go so far as to say we all have been afflicted at one point or another in our lives.  I call this condition Yeah But Syndrome, or “YBS”.    It is often paralyzing and prevents those afflicted from moving into action, instead remaining in a state of inertia.  

There are many symptoms of YBS but the following are some of the most common.  

• Yeah I planned to go to the gym today BUT, the kids needed a ride to practice.  
• Yeah I really want to eat better BUT I don’t have the time.   
• Yeah I didn’t plan to eat the cake BUT my husband wanted too, so I did also.   
• Yeah I really meant to go to the grocery shopping BUT I was too tired, so I hit the drive- thru.  
• Or this is a good one. Yeah I meant to start today BUT, I’ll start tomorrow.  

But tomorrow never comes.  You get the drift.  We can all come up with a million yeah buts, in other words, excuses.    The good news is the treatment for YBS is simple--just do it!  Take action.  The reality of today’s 24-7 planet is there will always be something.  The kids, work commitments, family obligations and various projects that need your attention will perpetually be present in some shape or form.  The difference to make the difference is to learn to dance in the rain, not wait for the rain to pass.  When will all the stars align so that your world will be “just right” to start?  If not NOW, WHEN will you begin?  

The key word here is begin.   Far too frequently, I coach clients that shoot themselves in the foot before they start.   Instead of consuming yourself with all the barriers to entry, select reasonable, low-hanging fruit that is “doable.”    The art of lifestyle change is to avoid all-or-nothing thinking and begin to appreciate what you CAN do, versus focusing energy on what you can’t do.  What is one action you can do TODAY to move toward your wellness goal(s)?  Start to focus on what you can do in the mist of your existing life demands. This mantra is a friendly reminder: BE-DO-HAVE.  Be committed.  Do what it takes.  And you will have results.  

Lastly, if you think removing cereal from your morning routine it is too difficult and you can’t do it. Guess what-- you’re likely right.   What you think is what you get!   But what if you think instead, “I can do this.  There are many truly healthy options for breakfast to replace cereal such as eggs and veggies that will help me look and feel my best.”  Then guess what--you will!  This simple change in mind-set can start a tidal wave of change and prevent you from abandoning ship when life tosses you into rough waters.  Ongoing support is hugely important to sustain lifestyle changes.  Join the conversations in the Cureality Forum to engage the support of health coaches and Cureality Members to stay on track. 

We Need More.....Kettlebell

You either love them or you hate them.

When you are in love with kettlebells, like I am, you enjoy the multi-muscle group movements.  Kettlebell workouts are fluid, like a dance, putting together a chain of movements that leave your heart pounding and sweat pouring.  Yes, there’s some sneaky cardio component to a kettlebell workout.   A great blend of aerobic and anaerobic conditioning.

If you hate kettlebells it’s because kettlebell exercises keep you honest with proper exercise execution.  Form is imperative to moves like the kettlebell swing or the kettlebell snatch.  Do it incorrectly and you’ll be either sore or have bruised wrists the next day.  But this is no reason to shy away from the kettlebell.  You have way too much to gain from this odd looking piece of exercise equipment.  

You will get a mega -caloric burn.  The American council on Exercise states that the average kettlebell workout burns 20 calories per minute.  That’s 1200 calories in just one hour.   Kettlebell workouts utilize many muscle groups to give you an efficient, total body conditioning workout.  

If you’re looking for a toned back side get a kettlebell.  The classic kettlebell swing works all the posterior muscles like your glutes, hamstrings, and lower back.  But only if you use correct form.  Otherwise you'll find yourself with nagging back pain, instead of a better butt.  

Kettlebell exercises are functional movements that will allow you to play hard without getting injured.  If you are an athlete, a nature enthusiast, or just want to keep up with the kids then you need to give kettlebells a try.  During a workout, the exercises will target movements that will make getting up and down off the floor easier, as well as bending over to pick something up.

If you are interested in doing kettlebell workouts start with a coach or take class.  You can’t fake form with kettlebell exercises or you could end up hurt.  I’m not trying to scare anyone away because good form is easy to learn.   Your body will memorize the correct movement pattern and you’ll be on your way to a successful kettlebell workout.  

Thyroid and the gut: Hidden health partners

Though I have personally dealt with both auto-immune thyroiditis (Hashomoto’s) and several gut issues (wheat sensitivity, gastritis, etc.), it was not until recently that I discovered how close the thyroid and gut work together to keep you healthy – and how problems with one can affect the other along with your overall health.
 
Most of us understand that the primary function of the gut, that 25 to 30 feet of “tubing” that includes everything from your stomach to your large intestines, is to process the food we eat and allow the “good stuff” (essential nutrients) to pass into our blood stream while keeping the “bad stuff” (harmful proteins) out. However, it may surprise some that the gut also holds as much as 70% of all the immune tissue in the body.
 
Now, imagine all the health havoc that could ensue if, suddenly, the gut stopped doing its job – particularly if it failed to stop toxic proteins from entering the blood stream and then mounted an overzealous immune response against them.  Sometimes, those overzealous immune responses reach beyond their intended targets to attack otherwise healthy tissues and organs – like the thyroid gland.
 
Recent studies indicate that thyroid hormones play a significant role in maintaining gut integrity, preventing leaky gut that can, in some cases, lead to auto-immune attacks against the thyroid.  A properly functioning gut also aids the production of thyroid hormones by converting some of the inactive “T4” thyroid hormone into the functional “T3” hormone.  Failure to simultaneously maintain both a healthy gut and a healthy thyroid can create a vicious cycle leading to chronic health problems and declining vitality.
 
What it all means is that to enjoy optimal health, you must promote good thyroid health to promote good gut health and vice versa.  Unfortunately, traditional medicine tends to focus on one issue to the exclusion of others.  A typical endocrinologist may treat your under active thyroid without spending a moment to address underlying gut issues.  A gastroenterologist will work alleviate a gut problem but will rarely address a potential thyroid problem.
 
This illustrates, once again, how our bodies work as a system and why it is necessary to bridge the “healthcare gaps” in traditional medicine by becoming personally responsible for your health.  I encourage everyone to consult the Cureality Program Guide and online Cureality Diet and Thyroid Health Tracks to learn more about how to optimize both your gut and thyroid health on your journey to realizing complete, whole-body health.

Omega-3 fatty acids likely NOT associated with prostate cancer

A weakly constructed study was reported recently that purportedly associated higher levels of omega-3 fatty acid blood levels and prostate cancer. See this CBS News report, for instance.

Lipid and omega-3 fat expert, Dr. William Harris, posted this concise critique of the study, exposing some fundamental problems:

First, the reported EPA+DHA level in the plasma phospholipids in this study was 3.62% in the no-cancer control group, 3.66% in the total cancer group, 3.67% in the low grade cancer group, and 3.74% in the high-grade group. These differences between cases and controls are very small and would have no meaning clinically as they are within the normal variation. Based on experiments in our lab, the lowest quartile would correspond to an HS-Omega-3 Index of <3.16% and the highest to an Index of >4.77%). These values are obviously low, and virtually none of the subjects was in “danger” of having an HS-Omega-3 Index of >8%. So to conclude that regular consumption of 2 oily fish meals a week or taking fish oil supplements (both of which would result in an Index above the observed range) would increase risk for prostate cancer is extrapolating beyond the data.

This study did not test the question of whether giving fish oil supplements (or eating more oily fish) increased PC risk; it looked only a blood levels of omega-3 which are determined by intake, other dietary factors, metabolism and genetics.


The authors also failed to present the fuller story taught by the literature. The same team reported in 2010 that the use of fish oil supplements was not associated with any increased risk for prostate cancer. A 2010 meta-analysis of fish consumption and prostate cancer reported a reduction in late stage or fatal cancer among cohort studies, but no overall relationship between prostate cancer and fish intake. Terry et al. in 2001 reported higher fish intake was associated with lower risk for prostate cancer incidence and death, and Leitzmann et al. in 2004 reported similar findings. Higher intakes of canned, preserved fish were reported to be associated with reduced risk for prostate cancer. Epstein et al found that a higher omega-3 fatty acid intake predicted better survival for men who already had prostate cancer, and increased fish intake was associated with a 63% reduction in risk for aggressive prostate cancer in a case-control study by Fradet et al). So there is considerable evidence actually FAVORING an increase in fish intake for prostate cancer risk reduction.

Another piece of the picture is to compare prostate cancer rates in Japan vs the US. Here is a quote from the World Foundation of Urology:


"[Prostate cancer] incidence is really high in North America and Northern Europe (e.g., 63 X 100,000 white men and 102 X 100,000 Afro-Americans in the United States), but very low in Asia (e.g., 10 X 100,000 men in Japan).”

Since the Japanese typically eat about 8x more omega-3 fatty acids than Americans do and their
blood levels are twice as high, you’d think their prostate cancer risk would be much higher...
but the opposite is the case.


Omega-3 fatty acids are physiologically necessary, normalizing multiple metabolic phenomena including augmentation of parasympathetic tone, reductions of postprandial (after-meal) lipoprotein excursions, and endothelial function. It would indeed make no sense that nutrients that are necessary for life and health exert an adverse effect such as prostate cancer at such low blood levels. (Recall that an omega-3 RBC index of 6.0% or greater is associated with reduced potential for sudden cardiac death.)

I personally take 3600 mg per day of EPA + DHA in highly-purified, non-oxidized triglyceride form (Ascenta Nutrasea liquid) that yields an RBC omega-3 index of just over 10%, the level that I believe the overwhelming bulk of data suggest is the ideal level for humans.

Are statins and omega-3s incompatible?

French researcher, Dr. Michel de Lorgeril, has been in the forefront of thinking and research into nutritional issues, including the Mediterranean Diet, the French Paradox, and the role of fat intake in cardiovascular health. In a recent review entitled Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3?, he explores the question of whether statin drugs are, in effect, incompatible with omega-3 fatty acids.

Dr. Lorgeril makes several arguments:

1) Earlier studies, such as GISSI-Prevenzione, demonstrated reduction in cardiovascular events with omega-3 fatty acid supplementation, consistent with the biological and physiological benefits observed in animals, experimental preparations, and epidemiologic observations in free-living populations.

2) More recent studies (and meta-analyses) examining the effects of omega-3 fatty acids have failed to demonstrate cardiovascular benefit showing, at most, non-significant trends towards benefit.

He points out that the more recent studies were conducted post-GISSI and after agencies like the American Heart Association's advised people to consume more fish, which prompted broad increases in omega-3 intake. The populations studied therefore had increased intake of omega-3 fatty acids at the start of the studies, verified by higher levels of omega-3 RBC levels in participants.

In addition, he raises the provocative idea that the benefits of omega-3 fatty acids appear to be confined to those not taking statin agents, as suggested, for instance, in the Alpha Omega Trial. He speculates that the potential for statins to ablate the benefits of omega-3s (and vice versa) might be based on several phenomena:

--Statins increase arachidonic acid content of cell membranes, a potentially inflammatory omega-6 fatty acid that competes with omega-3 fatty acids. (Insulin provocation and greater linoleic acid/omega-6 oils do likewise.)
--Statins induce impaired mitochondrial function, while omega-3s improve mitochondrial function. (Impaired mitochondrial function is evidenced, for instance, by reduced coenzyme Q10 levels, with partial relief from muscle weakness and discomfort by supplementing coenzyme Q10.)
--Statins commonly provoke muscle weakness and discomfort which can, in turn, lead to reduced levels of physical activity and increased resistance to insulin. (Thus the recently reported increases in diabetes with statin drug use.)

Are the physiologic effects of omega-3 fatty acids, present and necessary for health, at odds with the non-physiologic effects of statin drugs?

I fear we don't have sufficient data to come to firm conclusions yet, but my perception is that the case against statins is building. Yes, they have benefits in specific subsets of people (none in others), but the notion that everybody needs a statin drug is, I believe, not only dead wrong, but may have effects that are distinctly negative. And I believe that the arguments in favor of omega-3 fatty acid supplementation, EPA and DHA (and perhaps DPA), make better sense.



DHA: the crucial omega-3

Of the two omega-3 fatty acids that are best explored, EPA and DHA, it is likely DHA that exerts the most blood pressure- and heart rate-reducing effects. Here are the data of Mori et al in which 4000 mg of olive oil, purified EPA only, or purified DHA only were administered over 6 weeks:



□ indicates baseline SBP; ▪, postintervention SBP; ○, baseline DBP; •, postintervention DBP; ⋄, baseline HR; and ♦, postintervention HR.

In this group of 56 overweight men with normal starting blood pressures, only DHA reduced systolic BP by 5.8 mmHg, diastolic by 3.3 mmHg.

While each omega-3 fatty acid has important effects, it may be DHA that has an outsized benefit. So how can you get more DHA? Well, this observation from Schuchardt et al is important:

DHA in the triglyceride and phospholipid forms are 3-fold better absorbed, as compared to the ethyl ester form (compared by area-under-the-curve). In other words, fish oil that has been reconstituted to the naturally-occurring triglyceride form (i.e., the form found in fresh fish) provides 3-fold greater blood levels of DHA than the more common ethyl ester form found in most capsules. (The phospholipid form of DHA found in krill is also well-absorbed, but occurs in such small quantities that it is not a practical means of obtaining omega-3 fatty acids, putting aside the astaxanthin issue.)

So if the superior health effects of DHA are desired in a form that is absorbed, the ideal way to do this is either to eat fish or to supplement fish oil in the triglyceride, not ethyl ester, form. The most common and popular forms of fish oil sold are ethyl esters, including Sam's Club Triple-Strength, Costco, Nature Made, Nature's Bounty, as well as prescription Lovaza. (That's right: prescription fish oil, from this and several other perspectives, is an inferior product.)

What sources of triglyceride fish oil with greater DHA content/absorption are available to us? My favorites are, in this order:

Ascenta NutraSea
CEO and founder, Marc St. Onge, is a friend. Having visited his production facility in Nova Scotia, I was impressed with the meticulous methods of preparation. At every step of the way, every effort was made to limit any potential oxidation, including packaging in a vacuum environment. The Ascenta line of triglyceride fish oils are also richer in DHA content. Their NutraSea High DHA liquid, for instance, contains 500 mg EPA and 1000 mg DHA per teaspoon, a 1:2 EPA:DHA ratio, rather than the more typical 3:2 EPA:DHA ratio of ethyl ester forms.

Pharmax (now Seroyal) also has a fine product with a 1.4:1 EPA:DHA ratio.

Nordic Naturals has a fine liquid triglyceride product, though it is 2:1 EPA:DHA.





Krill oil: Do the math

The manufacturers of krill oil claim that the phospholipid form of omega-3 fatty acids, EPA and DHA, enhance their absorption. There are indeed some data to that effect:


Here are some representative krill oil preparations available on the market:


MegaRed Krill Oil:
EPA 50 mg
DHA 24 mg
Total omega-3s (EPA + DHA + other forms) 90 mg
Price: $28.99 for 60 softgels

Source Naturals (a fine company otherwise, by the way):

EPA 150 mg
DHA 90 mg
Total omega-3 fatty acids 300 mg
Price: $24.99 for 60 softgels

Alright, let's do some simple math:

Average volume of blood in the human body (all components): 5000 cc
Percentage of red blood cells (RBCs) by volume: 45%
Total volume RBCs: 2250 cc
Percentage of total volume RBCs occupied by fatty acids:

What tests are MORE important than cholesterol?

In the conventional practice of early heart disease prevention, cholesterol testing takes center stage. Rarely does it go any further, aside from questions about family history and obvious sources of modifiable risk such as smoking and sedentary lifestyle.

So standard practice is to usually look at your LDL cholesterol, the value that is calculated, not measured, then--almost without fail--prescribe a statin drug. While there are indeed useful values in the standard cholesterol panel--HDL cholesterol and triglycerides--they are typically ignored or prompt no specific action.

But a genuine effort at heart disease prevention should go farther than an assessment of calculated LDL cholesterol, as there are many ways that humans develop coronary atherosclerosis. Among the tests to consider in order to craft a truly effect heart disease prevention program are:

--Lipoprotein testing--Rather than using the amount of cholesterol in the various fractions of blood as a crude surrogate for lipoproteins in the bloodstream, why not measure lipoproteins themselves? These techniques have been around for over 20 years, but are simply not part of standard practice.

Lipoprotein testing especially allows you to understand what proportion of LDL particles are the truly unhealthy small LDL particles (that are oxidation- and glycation-prone). It also identifies whether or not you have lipoprotein(a), the heritable factor that confers superior survival capacity in a wild environment ("The Perfect Carnivore"), but makes the holder of this genetic pattern the least tolerant to the modern diet dominated by grains and sugars, devoid of fat and organ meats.

--25-hydroxy vitamin D--The data documenting the health power of vitamin D restoration continue to grow, with benefits on blood sugar and insulin, blood pressure, bone density, protection from winter "blues" (seasonal affective disorder), decrease in falls and fractures, decrease in cancer, decrease in cardiovascular events. I aim to keep 25-hydroxy vitamin D at a level of 60 to 70 ng/ml. This generally requires 4000-8000 units per day in gelcap form, at least for the first 3 or so years, after which there is a decrease in need. Daily supplementation is better than weekly, monthly, or other less-frequent regimens. The D3 (cholecalciferol) form is superior to the non-human D2 (ergocalciferol) form.

--Hemoglobin A1c (HbA1c)--HbA1c represents glycated hemoglobin, i.e., hemoglobin molecules within red blood cells that are irreversibly modified by glucose, or blood sugar. It therefore provides an index of endogenous glycation of all proteins of the body: proteins in the lenses of the eyes that lead to cataracts; proteins in the cartilage of the knees and hips that lead to brittle cartilage and arthritis; proteins in kidney tissue leading to kidney dysfunction.

HbA1c provides an incredibly clear snapshot of health: It reflects the amount of glycation you have been exposed to over the past 90 or so days. We therefore aim for an ideal level: 5.0% or less, the amount of "ambient" glycation that occurs just with living life. We reject the notion that a HbA1c level of 6.0% is acceptable just because you don't "need" diabetes medication, the thinking that drives conventional medical practice.

--RBC Omega-3 Index--The average American consumes very little omega-3 fatty acids, EPA and DHA, such that a typical omega-3 RBC Index, i.e., the proportion of fatty acids in the red blood cell occupied by omega-3 fatty acids, is around 2-3%, a level associated with increased potential for sudden cardiac death (death!). Levels of 6% or greater are associated with reduced potential for sudden cardiac death; 10% or greater are associated with reduced other cardiovascular events.

Evidence therefore suggests that an RBC Omega-3 Index of 10% or greater is desirable, a level generally achieved by obtaining 3000-3600 mg EPA + DHA per day (more or less, depending on the form consumed, an issue for future discussion).

--Thyroid testing (TSH, free T3, free T4)--Even subtle degrees of thyroid dysfunction can double, triple, even quadruple cardiovascular risk. TSH values, for instance, within the previously presumed "normal" range, pose increased risk for cardiovascular death; a TSH level of 4.0 mIU, for instance, is associated with more than double the relative risk of a level of 1.0.

Sad fact: the endocrinology community, not keeping abreast of the concerning issues coming from the toxicological community regarding perchlorates, polyfluorooctanoic acid and other fluorinated hydrocarbons, polybrominated diphenyl ethers (PDBEs), and other thyroid-toxic compounds, tend to ignore these issues, while the public is increasingly exposed to the increased cardiovascular risk of even modest degrees of thyroid dysfunction. Don't commit the same crime of ignorance: Thyroid dysfunction in this age of endocrine disruption can be crucial to cardiovascular and overall health.


All in all, there are a number of common blood tests that are relevant--no, crucial--for achieving heart health. Last on the list: standard cholesterol testing.

Cranberry Sauce

Happy Thanksgiving 2012, everyone, from all the staff at Track Your Plaque!

Here’s a zesty version of traditional cranberry sauce, minus the sugar. The orange, cinnamon, and other spices, along with the crunch of walnuts, make this one of my favorite holiday side dishes.

There are 31.5 grams total “net” carbohydrates in this entire recipe, or 5.25 grams per serving (serves 6). To further reduce carbs, you can leave out the orange juice and, optionally, use more zest.

1 cup water
12 ounces fresh whole cranberries
Sweetener equivalent to 1 cup sugar (I used 6 tablespoons Truvía)
1 tablespoon orange zest + juice of half an orange
½ cup chopped walnuts
1 teaspoon ground cinnamon
½ teaspoon ground nutmeg
¼ teaspoon ground cloves

In small to medium saucepan, bring water to boil. Turn heat down and add cranberries. Cover and cook at low-heat for 10 minutes or until all cranberries have popped. Stir in sweetener. Remove from heat.

Stir in orange zest and juice, walnuts, cinnamon, nutmeg, and cloves.

Transfer mixture to bowl, cool, and serve.


Apple Cranberry Crumble

Apple, cranberry, and cinnamon: the perfect combination of tastes and scents for winter holidays!

I took a bit of carbohydrate liberties with this recipe. The entire recipe yields a delicious cheesecake-like crumble with 59 “net” grams carbohydrates (total carbs – fiber); divided among 10 slices, that’s 5.9 grams net carbs per serving, a quantity most tolerate just fine. (To reduce carbohydrates, the molasses in the crumble is optional, reducing total carbohydrate by 11 grams.)

Other good choices for sweeteners include liquid stevia, stevia glycerite, powdered stevia (pure or inulin-based, not maltodextrin-based), Truvía, Swerve, and erythritol. And always taste your batter to test sweetness, since sweeteners vary in sweetness from brand to brand and your individual sensitivity to sweetness depends on how long you’ve been wheat-free. (The longer you’ve been wheat-free, the less sweetness you desire.)


Crust and crumble topping
3 cups almond meal
1 stick (8 tablespoons) butter, softened
1 cup xylitol (or other sweetener equivalent to 1 cup sugar)
1½ teaspoons ground cinnamon
1 tablespoon molasses
1½ teaspoons vanilla extract
Dash sea salt

Filling
16 ounces cream cheese, softened
2 large eggs
½ cup xylitol (or other sweetener equivalent to ½ cup sugar)
1 Granny Smith apple (or other variety)
1 teaspoon ground cinnamon
1 cup fresh cranberries

Preheat oven to 350° F.

In large bowl, combine almond meal, butter, sweetener, cinnamon, molasses, vanilla, and salt and mix.

Grease a 9½-inch tart or pie pan. Using approximately 1 cup of the almond meal mixture, form a thin bottom crust with your hands or spoon.

In another bowl, combine cream cheese, eggs, and sweetener and mix with spoon or mixer at low-speed. Pour into tart or pie pan.

Core apple and slice into very thin sections. Arrange in circles around the edge of the cream cheese mixture, working inwards. Distribute cranberries over top, then sprinkle cinnamon over entire mixture.

Gently layer remaining almond meal crumble evenly over top. Bake for 30 minutes or until topping lightly browned.

For the sake of convenience: Commercial sources of prebiotic fibers

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

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

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

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

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

PGX

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

Prebiotin

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

Acacia

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

Isomalto-oligosaccharides

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

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

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

How Not To Have An Autoimmune Condition


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

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

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

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


Wheat and grain elimination

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

Correct vitamin D deficiency

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

Supplement omega-3 fatty acids

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

Eliminate dairy

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

Cultivate healthy bowel flora

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

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

Five Powerful Ways to Reduce Blood Sugar

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

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

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

1) Eat no wheat nor grains

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

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

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

3) Vitamin D

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

4) Restore bowel flora

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

5) Exercise

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

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

Cureality App Review: Breathe Sync



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

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

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

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

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

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

Amber’s Top 35 Health and Fitness Tips

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

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

Amber B.
Cureality Exercise and Fitness Coach

To Change, You Need to Get Uncomfortable

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

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

I want to lose weight but….

I want a six pack but…

I want more energy but….

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

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

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

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

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

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

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

The 3 Best Grain Free Food Swaps to Boost Fat Burning

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

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

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

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

2. Swap potatoes and rice for cauliflower

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

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

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

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

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

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

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

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

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

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

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

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

3 Foods to Add to Your Next Grocery List

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

Microgreens

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

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

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

Cacao Powder

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

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




Shallots


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

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

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

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

3 Band Exercises for Great Glutes

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

Band Step Out

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

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



Band Kick Back

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

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



Band Resisted Hip Bridge

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

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

All posts by william-davis

Vitamin D increased my cholesterol

A friend told me this story.

Her friend, Linda, had added vitamin D to her daily supplements. Because she'd had a vitamin D blood level of 22 ng/ml, she was taking 6000 units per day.

However, Linda also had a high cholesterol value with a total cholesterol of 231 mg/dl. After several months on the vitamin D, she had another cholesterol panel. Total cholesterol: 256 mg/dl.

"It must have been the vitamin D! So I stopped it right away."

Is this true? Does vitamin D raise the level of blood cholesterol? Yes, it does. But it's a good thing. Let me explain.

Followers of The Heart Scan Blog know that total cholesterol is really a mix of 3 other factors:

Total cholesterol = LDL cholesterol + HDL cholesterol + triglycerides/5

This is the Friedewald equation, still used today in over 95% of cholesterol panels. So, by the Friedewald equation, anything that increases LDL, HDL, or triglycerides will increase total cholesterol.

One of the spectacular changes that develops over a year of taking vitamin D is that HDL cholesterol skyrockets. While sensitivity to this effect varies (probably on a genetic basis), HDL increases of 10, 20, even 30 mg/dl are common. A starting HDL, for instance, of 45 mg/dl can jump up to 65 or 70 mg/dl, though the effect requires up to a year, sometimes longer.

Vitamin D can also reduce triglycerides, though the effect is relatively small, usually no more than 20 mg/dl or so. Likewise, the effect on LDL is minor, with a modest reduction in the small type of LDL.

So the dominant effect of vitamin D from a cholesterol standpoint is a substantial increase in HDL. Looking at the equation, you can see that an increase in HDL is accompanied by a commensurate increase in total cholesterol. If HDL goes up 25 mg/dl, total cholesterol goes up 25 mg/dl.

So Linda is absolutely correct: Vitamin D increases cholesterol--but it's a good thing that reduces risk for heart disease and is an important part of a coronary plaque-reversal program.

This is yet another reason why I advocate elimination of total cholesterol on lipid panels. There is no useful information in the total cholersterol value, only the potential for misinformation.

Nutrtional ignorance is not unique to the U.S.

Heart Scan Blog reader from Australia, Michaela, also a mother of a son with a complex congenital heart defect, wrote this series of e-mails to me. (Published with Michaela's permission.)


I've been reading the article, Valve disease and Vitamin D from April '07, by Dr William Davis. I'm hoping you may have some information on the topic. I'm hoping someone will have time to help me.

I have been supplementing my 15 year old son with Vit D for 4 months but only 1000 (U) per day. I would like to increase the dosage but am not sure if I would do him more harm than good.

I have been researching vitamins and supplements on the net for a few months and have been amazed at what I have found. I only wish I had done it years ago. My son has been let down by the Australian Medical Profession and it's a race against time now to keep him well and avoid a heart transplant.

My son was born with aortic stenosis and had a valvotomy at 4 weeks of age. This damaged the aortic valve and he had a Ross Repair procedure at aged 3. This left him with a damaged heart muscle and leaking aortic & pulmonary valves. In May '08, his heart grew more enlarged, causing the mitral & tricuspid valves to also leak.

I took him to Bangkok in Feb this year where he had 70 million of his own Adult Stem Cells directly injected into his heart muscle with the hope of strengthening the muscle and eventually valve replacement.

My son has recovered from the surgery and is once again symptom-free, thanks to the wonderful advice followed by the Author & Cardiologist, Stephen T. Sinatra. I have followed his supplement regime and what a difference! Of course, this won't last while my son's valves continue to leak.

My son has also developed secondary hyperparathyroidism, bone thinning and hypothyrodism. Vit D & Calcium have something to do with this I believe.

My Australian Doctors have never made mention of any vitamins or supplements .... EVER! Transplant is all they will consider and we are not having it.

If you have any info or links to any sites which may be useful to me, could you email them to me? I would be grateful for any help I could get.

Sincerely
Michaela



I responded to Michaela's e-mail:

Hi, Michaela--

Vitamin D is extremely important. Sometimes, hyperparathyroidism and calcium derangements are caused by vitamin D deficiency. You might be able to get help with this from an endocrinologist, since they are the ones who deal with hyperparathyroidism. An endocrinologist might even be familiar with several recent studies that document this phenomenon:

Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

Vitamin D deficiency and primary hyperparathyroidism

Also, see the discussions at www.vitamindcouncil.org from Dr. John Cannell.

Because of the complexity of your son's health, it might be hazardous to stray too far away from conventional care though you and I know that there are limitations to that perspective. For that reason, I would urge you to press for answers from a knowledgeable endocrinologist.

I hope you find the answers you need.

William Davis, MD



Several months later, Michaela provided this update:

Hi Dr Davis,

I wrote to you back in July regarding my 15 year old son's need for a Heart Transplant through a failed Ross Repair and the possible Vitamin D connection. You sent me some valuable links and I thank you again for that.

I just wanted to let you know, I think you have given me the answers. I increased Lee's Vitamin D supplement to 6000U a day and, along with the recommended nutritional supplements of US Cardiologist Dr Stephen T Sinatra, there have been remarkable improvements! Lee also had 70 million of his own Adult Stem Cells injected into his heart in February. As we know, Stem Cell Therapy takes time and Lee was looking like time was quickly running out.

I have removed him from the transplant list. He is now reading normal Kidney function, the BNP (Brain Natriuretic Peptide, a measure of heart failure] has dropped by 7000 and his liver size has reduced to where it no longer causes him discomfort. The liver tests show it's still affected but it's function is improving each month. His last Echo was in early July and there had been a reduction in the size of his heart, which is so important.

To the Doc's, Lee can't get better, there is only transplant or death so you can imagine the surprise on their faces to see him looking and feeling so well with their tests to back it up. Still, even though it's staring them in the face, they don't want to know about it. They have no interest in what supplements he is on or Stem Cell therapy. God help their other patients. I view them in the waiting room and think of them as lambs to the slaughter.

We are not spoiled for choice with Doc's here in Western Australia. I have to take what I can get and there is not many who would take on Lee's case. He was number 1 on the transplant list and a most urgent case. Not many were willing to even look at him with his cardiac history and all I had to help was the arrogant Doc's at the Advanced Heart Failure Unit. They were not at all interested in his secondary hyperparathyroidism. I suppose it didn't matter what else he had compared to his heart problems.

Anyway, I'm writing to thank you. Lee would be transplanted or dead now if it wasn't for Dr's like you sharing their knowledge online. I wish I had researched things years ago, Lee might not have sunk so low if I had. I don't know if the transplant can be held off indefinitely, but like I tell Lee, "Stay well. There are amazing people out there doing amazing things, if you can just hang on. The miracle is around the corner." He's so well, you'd have to see him to believe it. But I have 7 kids and Lee is as physically active and as well as the other 6! For how long he can stay like this, I don't know but if his ejection fraction [a measure of left ventricular strength] can keep climbing and his body gets stronger, I have hope for another attempt at valve replacement.

I'm still shocked and angry that nutritional supplements have never been mentioned in the 15 years I've been dealing with cardiologists. Surely they know about them. I have read through dozens of reports online of the benefits of them--Why haven't they?! Thank God for the online Doc's such as yourself, the valuable info would never make it out of a Doctor's office in Western Australia! I've had to leave my country for Stem Cell therapy and then implore overseas Doc's for advice and information. What does that say for the Australian Medical Profession? Not a lot! They put him in the position he is in yet don't want to help get him out.

I'm so very grateful to you, thank you and God bless.

Michaela



Note: The above is not meant to be an implicit endorsement of stem cell therapy. This was just part of Michaela's story about her son.

Eat cranberries

Most people already know that cranberries are useful for preventing urinary tract infections. Cranberries can also be useful for preventing other sorts of infections, such as dental cavities and stomach ulcers because of cranberry's ability to block bacterial adhesion.

Cranberries can also be a useful component of a heart healthy program.

Several unique properties of cranberries contribute to various aspects of heart health:

• Cranberries are a rich source of pectin--Pectin is a soluble fiber, the sort that binds bile acids in the intestinal tract and naturally reduces LDL cholesterol.
• Cranberries are a rich source of polyphenols and flavonoids--Including the wonderfully fascinating anthocyanins, the flavonoids that confer the beautiful red color. Surprisingly, cranberries are richer in polyphenols and flavonoids than blueberries, strawberries, and grapes. Cranberry juice is also rich in these compounds. However, beware of cranberry juice "cocktail," which is diluted with other liquids such as high-fructose corn syrup. Like grapes, cranberries are a source of resveratrol, the polyphenol also found in red wines that some believe is responsible for reduced risk for heart disease and extending life.
• Cranberries have high antioxidant activity--Cranberries are among the highest in antioxidant capacity against superoxide radicals, hydrogen peroxide, and hydroxyl radicals, oxidizing factors believed to underlie heart disease, cancer, and aging. Cranberries also reduce the oxidation of LDL cholesterol particles.
• Cranberries block uric acid production--Cranberries have the unique ability to block the activity of an enzyme, xanthine oxidase, that converts xanthine to uric acid. Uric acid is believed to add to heart disease risk and is the factor responsible for gout.
• Cranberries increase HDL cholesterol--Cranberry juice increases HDL by 3-4 mg/dl.

Cranberries are only modest sources of sugars, with 7.19 grams “net” carbohydrates (total carbohydrates minus fiber content) per cup of whole raw cranberries.

The best way to eat cranberries is to consume the real thing: eat the whole berry, as in sugar-free cranberry sauce or added to baked dishes like chicken. Second best are dried cranberries. However, be careful of the overly-sweetened dried cranberries that contain added sugar (for a total of 78 grams sugar per cup--far too much). Unsweetened dried cranberries can be purchased, or you can dry them yourself.

Cranberry juice is another way to obtain the health benefits of cranberries; the unsweetened juice, while quite tart, is the best with 30.5 grams sugar per 8 oz--so don't drink more than 4 oz at a time. The more common cranberry juice “cocktails” are generally too sugary and/or too dilute for full health benefit.

The cranberry harvest season in Wisconsin, Michigan, Oregon, Massachusetts, and New Jersey is just getting underway, so we should be seeing fresh cranberries on store shelves or farmers' markets any day now.

Procedures 'R Us

Kay came to the office for an opinion.

Over the past 8 months, she'd received a stent to the left anterior descending coronary artery and, during a separate procedure, a stent to the left subclavian artery.

"My cardiologist was very capable doing procedures. But when I asked, 'What do I do now?' he barely said a word and handed me a presciption for Crestor."

This kind of incredible neglect is the norm: Write a prescription for statin drug, delegate dietary advice to the hospital dietitian who advocates a heart disease-causing low-fat diet, followed by hospital discharge. You are expected to report any recurrent symptoms (which are inevitable), at which point you might "qualify" for another procedure.

It would be malpractice if it were not the prevailing standard in the community. Yes, the prevailing standard is neglect--neglect to identify, quantify, and correct all the identifiable causes of heart disease; neglect to discuss the nutritional methods that actually correct the abnormal patterns that cause heart disease; neglect to discuss nutritional supplements or medications beyond statins that further reduce heart disease risk and "need" for more procedures. In other words, the prevailing community standard is to stent, bypass, prescribe statin. It is not to understand why the disease occurred in the first place, correct the causes and minimize or eliminate any future danger or need for procedures.

I see consultation after consultation involving stories just like Kay's. People are frightened and they sense intuitively that nobody raised the question of why they have a potentially fatal disease.

Don't allow yourself to fall victim to this incredibly neglectful mode of practice, the one that has enriched hospitals, the drug industry, many cardiologists, but does little to address the actual disease.

Unexpected effects of a wheat-free diet

Wheat elimination continues to yield explosive and unexpected health benefits.

I initially asked patients in the office to eliminate wheat because I wanted to help them reduce blood sugar and pre-diabetic tendencies.

A patient would come to the office, for example, with a blood sugar of 118 mg/dl (in the pre-diabetic range) and the other phenomena of pre-diabetes or metabolic syndrome (high blood pressure, high inflammation/c-reactive protein, low HDL, high triglycerides, small LDL), and the characteristic wheat belly. Eliminate wheat and, within three months, they lose 30 lbs, blood sugar drops to normal, blood pressure drops, triglycerides drop by several hundred milligrams, HDL goes up, small LDL plummets, c-reactive protein drops.

People also felt better, with flat tummies and more energy. But they also developed benefits I did not anticipate:

--Improved rheumatoid arthritis--I have seen this time and time again. Eliminate wheat and the painful thumbs, fingers, and other joints clear up dramatically. Many former rheumatoid sufferers people tell me that one cracker or pretzel will trigger a painful throbbing reminder that lasts a couple of hours.

--Improved ulcerative colitis--People incapacitated with pain, cramping, and diarrhea of ulcerative colitis (who are negative for the antibodies for celiac disease) can experience marked improvement. I've seen people be able to stop all their nasty colitis medications just by eliminating wheat.

--Reduction or elimination of irritable bowel syndrome

--Reduction or elimination of gastroesophageal reflux

--Better mood--Eliminating wheat makes you happier and experience more stable moods. Just as wheat is responsible for a subset of schizophrenia and bipolar illness (this is fact), and wheat elimination generates dramatic improvement, when you or I eliminate wheat, we also experience a "smoothing" of mood swings.

--Better libido--I'm not sure whether this is a consequence of losing a belly the size of a watermelon or improvement in sex hormones (esp. testosterone) or endothelial responses, but more interest in sex typically develops.

--Better complexion--I'm not entirely sure why, but various rashes will often dissipate, bags under the eyes are reduced, itching in funny places stops.


It's also peculiar how, after someone eliminates wheat for several months, re-exposure of an errant cracker or sandwich results in cramping and diarrhea in about 30% of people.

Obviously, people with celiac disease, who can even die of exposure to wheat, are even worse. What other common food do you know of that makes us sick so often, even occasionally with fatal outcome?

Is Lp(a) part of your legacy to your children?

If you have lipoprotein(a), Lp(a)--the most aggressive known cause of heart disease that no one has heard of--then you need to tell your children.

Lp(a) is a "cleanly" inherited genetic pattern: If either parent has it, there's a 50% chance that you have it. If you have it, then there's a 50% likelihood that each of your children has it. (Note that each child experiences a likelihood of 50%, not 50% of your children. This is because each child is conceived as an independent statistical event. So much for romance!)

The atherogenicity (plaque-causing potential) of Lp(a) also tends to get transmitted. In other words, if your Dad had a heart attack at age 50 due to Lp(a) and you share Lp(a), then you likely share a similar magnitude of risk as your Dad. If your Mom had Lp(a), though passed quietly at age 89 without any overt evidence of heart disease, then you are likely to share the relatively benign form of Lp(a).

For most of us with Lp(a), however, it is best to assume that it has at least some potential for causing heart disease, being the most aggressive cause known. (That is, until we have the ability in everyday clinical practice to characterize Lp(a) by assessing such factors as the size of the apoprotein(a) molecule, the number of kringle "repeats" on the tail, etc. Until then, we need to rely on the crude, though helpful, observation of family history.)

At what age should you inform your children? There's no hard-and-fast rule. However, I generally suggest to patients that they talk about Lp(a) with their children when they reach their 20s or 30s, old enough to begin to understand the implications and begin to think about adopting healthier lifestyles. Is treatment required at, say, age 35? That depends on the pattern of Lp(a)-related heart disease in the family: With exceptionally aggressive forms, it might be reasonable to begin treatment at this relatively early age.

Do "Heart Healthy" sterols cause heart disease?

The sterol question continues to pop up.

Sterols are an ingredient widely added by food manufacturers that allows a "heart healthy" claim, since sterols have been shown to reduce LDL cholesterol (at least transiently). HOWEVER, sterols have also been implicated in possibly increasing risk for heart disease. After all, people with the genetic condition called sitosterolemia absorb sterols into the blood and develop coronary heart disease in their teens and twenties. Those of us without sitosterolemia who increase sterol intake with sterol-enriched foods increase blood levels of sterols several-fold. Is this healthy, or does it contribute to coronary plaque as it does in people with sitosterolemia?

Below, I've reprinted a previous Heart Scan Blog post on sterols.


Sterols should be outlawed

While sterols occur naturally in small quantities in food (nuts, vegetables, oils), food manufacturers are adding them to processed foods in order to earn a "heart healthy" claim.

The FDA approved a cholesterol-reducing indication for sterols , the American Heart Association recommends 200 mg per day as part of its Therapeutic Lifestyle Change diet, and WebMD gushes about the LDL-reducing benefits of sterols added to foods.


Sterols--the same substance that, when absorbed to high levels into the blood in a genetic disorder called "sitosterolemia"--causes extravagant atherosclerosis in young people.

The case against sterols, studies documenting its coronary disease- and valve disease-promoting effects, is building:

Higher blood levels of sterols increase cardiovascular events:
Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study.

Sterols can be recovered from diseased aortic valves:
Accumulation of cholesterol precursors and plant sterols in human stenotic aortic valves.

Sterols are incorporated into carotid atherosclerotic plaque:
Plant sterols in serum and in atherosclerotic plaques of patients undergoing carotid endarterectomy.




Though the data are mixed:

Moderately elevated plant sterol levels are associated with reduced cardiovascular risk--the LASA study.

No association between plasma levels of plant sterols and atherosclerosis in mice and men.




The food industry has vigorously pursued the sterol-as-heart-healthy strategy, based on studies conclusively demonstrating LDL-reducing effects. But do sterols that gain entry into the blood increase atherosclerosis regardless of LDL reduction? That's the huge unanswered question.

Despite the uncertainties, the list of sterol-supplemented foods is expanding rapidly:




Each Nature Valley Healthy Heart Bar contains 400 mg sterols.












HeartWise orange juice contains 1000 mg sterols per 8 oz serving.













Promise SuperShots contains 400 mg sterols per container.














Corozonas has an entire line of chips that contain added sterols, 400 mg per 1 oz serving.














MonaVie Acai juice, "Pulse," contains 400 mg sterols per 2 oz serving.














Kardea olive oil has 500 mg sterols per 14 gram serving.










WebMD has a table that they say can help you choose "foods" that are sterol-rich.

In my view, sterols should not have been approved without more extensive safety data. Just as Vioxx's potential for increasing heart attack did not become apparent until after FDA approval and widespread use, I fear the same may be ahead for sterols: dissemination throughout the processed food supply, people using large, unnatural quantities from multiple products, eventually . . . increased heart attacks, strokes, aortic valve disease.

Until there is clarification on this issue, I would urge everyone to avoid sterol-added "heart healthy" products.


Some more info on sterols in a previous Heart Scan Blog post: Are sterols the new trans fat? .

Why obese people can't fast

Why do obese people claim it is impossible to fast?

Most overweight people are terrified at the prospect of facing any period of time without ready access to food. Persuading them to begin a program of intermittent fasting is a hopeless cause. They just refuse.

Contrary to popular opinion, this is not just glutonny at work. It is the effect of what I call "the cycle of hunger," the 2-hour up and down cycle of rising sugar and insulin, followed by their inevitable fall. The precipitous fall of sugar and insulin triggers mental fogginess, fatigue, and insatiable hunger. (By the way, this is the same phenomenon underlying the silly notion of "grazing.")

According to an LA Times article, fasting may be difficult to impossible for some people:

"Ruth Frechman, a registered dietitian in Burbank and spokeswoman for the American Dietetic Assn., says she frequently sees such extreme strategies backfire. 'You're hungry, fatigued, irritable. Fasting is not very comfortable. People try to cut back one day and the next day they're starving and they overeat.'"
(Not surprising, coming from the American Diatetic Assn. They, along with such agencies as the American Diabetes Association, are vocal proponents of low-fat, high-carbohydrate, "healthy whole grain" diets--you know, the diets that make us fat and diabetic.)

Ms. Frechman is correct: Having someone engage in a period of fasting, no matter how brief, when the diet leading up to the fast is filled with "healthy whole grains" and other carbohydrates will result in painful hunger that eventually overcomes any effort. A period of overeating typically follows the aborted attempt.

Fasting cannot work as long as the 2-hour cycle of hunger continues. The first step: Eliminate the 2-hour cycle of hunger by dramatically reducing or eliminating carbohydrates. Our preferred method is to eliminate wheat, cornstarch, and sugars. (Just be aware of wheat withdrawal, the fatigue that develops in the first 5 days after wheat elimination that affects up to 30% of people.)

Once wheat, cornstarch, and sugars are eliminated, hunger reverts to that of physiologic need--appetite will be smaller and less intense, since it is driven by your body's needs, not by abnormal stimulation from wheat, cornstarch, and sugar. The fear of not having food dissolves, the 2-hour cycle of mental fogginess, fatigue, and hunger will be gone.

Intermittent fasting is a wonderful strategy for reducing weight; gaining control over lipids, lipoproteins, and coronary plaque; regaining appreciation for food; reducing appetite. But it's not even worth trying unless you've already eliminated the unnatural appetite triggers that will booby-trap any fasting effort.

Test your own thyroid

134 people responded to the latest Heart Scan Blog poll:


When I ask my doctor to test my thyroid, he/she:

Accommodates me without question 45 (33%)

Questions why, but orders the tests 49 (36%)

Refuses because you seem "healthy" 20 (14%)

Refuses without explanation 4 (2%)

Ridicules your request 16 (11%)



That's better than I anticipated: 69% of physicians complied with this small request. After all, you're not asking for major surgery. You're just asking for a very basic test, as basic as a blood count or electrolytes. 36% of respondents said that their doctor asked why, but still complied; this is simply practicing good medicine--If there is a problem, your doctor would like to know about it.

However, the remainder--31%--were refused in one way or another. Incredibly, 11% were ridiculed.

Although this was not asked in the poll, I believe that it is a safe assumption that you asked with good reason: you're abnormally fatigued, you have been gaining weight for no apparent reason or can't lose weight despite substantial effort, or you feel cold at inappropriate times.

Let's say you're tired. Ever since last summer, you've suffered a gradual decline in energy.

So you ask your doctor to assess your thyroid. He refuses. "You're just fine! There's nothing wrong with you."

You disagree. In fact, you are quite convinced that there is something physically wrong. What do you do?

You could:

--Drink more coffee
--Exercise more in the hopes that it will snap you out of your lethargy
--Sleep more
--Take stimulants of various sorts

Or, you could get your thyroid assessed and settle the issue. But how can you get this done when your doctor won't accommodate you, even though you have perfectly fine health insurance and are simply interested in feeling better and preserving your health?

You could test your thyroid yourself. This is why we're making self-testing kits available. Test kits are available here.

This is yet another facet of the powerful revolution that is emerging: Self-directed health.

Trains, planes, and heart scans

A Heart Scan Blog reader posted the following question:

It is not clear to me why getting a cardiac scan is the necessary first step, if in fact the next step would be to bring down small LDL particles which is revealed on a NMR lipoprofile or VAP test. Why isn't the NMR or VAP test the first thing?

Good question. Think of it this way:

Lipoproteins, as measured via VAP (Vertical Auto Profile) or NMR (Nuclear Magnetic Resonance), provide a snapshot of risk from a metabolic viewpoint at that moment. Lipoproteins shift with the tides of age, menopause, weight changes, even what you ate last evening for dinner (especially small LDL). There are also other factors that cause coronary plaque, as well, not revealed through lipoprotein testing, such as vitamin D deficiency, smoking, high blood pressure, phosopholipase A2, lipoprotein(a), inflammatory factors, thyroid dysfunction, omega-3 fatty acid deficiency, etc.

A heart scan, providing a coronary calcium score, provides an indirect measure of coronary plaque that is the sum total of lipoprotein and other plaque-causing factors that have accumulated up to the time of your scan--regardless of the cause.

It means that two females, each 60 years old, with 70% small LDL, HDL 42 mg/dl, triglycerides 150 mg/dl, and mild hypertension, have identical markers for potential coronary risk, but can have widely different heart scan scores. One might have a score of zero, while the other might have a score of 300.

Why would the same panel of causes measured at one moment yield wildly different quantities of plaque? Several reasons:

1) The lifestyles, eating habits, and weight of each woman differed during their earlier years, not currently reflected in this moment's lipid or lipoprotein patterns. Perhpaps one experienced several years of extraordinary stress from a failed marriage, or suffered through two years of depression that caused her to smoke and overeat.

2) There are hidden factors that affect coronary plaque growth that we are presently not able to detect, e.g., vitamin D receptor genotype, cholesteryl-ester transfer protein variants, variation in inflammatory factors. If we can't measure it, we won't know whether it might influence coronary plaque risk.


With all the changes that occur over a person's life, with the uncertainties of yet-to-be-identified causes for coronary plaque, how can you possible know what your risk for heart disease truly is? Yup--a heart scan. Do it and you will know.