Topics: Cholesterol, Atherosclerosis, and Fish Oil

Name:
Location: Cherry Hill, New Jersey, United States

The author of this blog is a primary care internal medicine physician. Since 2005 he has ordered over 9,000 25-hydroxyvitamin D levels and treated over 7,000 patients with vitamin d insufficiency. He has follow-up of 1 to 8 years on a large percentage of these patients. The 7,000 figure is higher than most vitamin D studies.

Saturday, November 04, 2006

Lowering Cholesterol To 160 mg.,
Reversing Heart Disease and Atherosclerosis.
What Works And What Doesn’t.


Lowering Cholesterol

A high cholesterol level can lead to atherosclerosis (hardening of the arteries), heart attacks, or strokes. We’re all born with a cholesterol level of about 100 mg. As an adult, the ideal cholesterol level is higher, but still below 160 mg.

The Framingham Study is the largest study of cholesterol levels ever done. It has shown over 40 years that a prolonged blood cholesterol level of less than 160 mg. in a non-smoker leads to a near immunity against heart attacks.

Other studies have shown that every 20% drop in the cholesterol level will lead to a 40% drop in the risk of getting a heart attack.

Giving up red meat-
IT JUST DOESN’T WORK


Most people cut down or eliminate red meat as a first step in reducing
cholesterol, but continue eating a large portion of chicken or fish.

Chicken and fish have just less fat than red meat, but just as much cholesterol. Studies of those who just give up red meat but continue to eat a large amount of chicken and fish show that their cholesterol drops only a small amount.

The American Heart Association recommends reducing meat, fish, and chicken intake to a maximum of 6 oz. a day; and substituting complex carbohydrates. This diet represents a definite improvement. Cutting down to below 6 oz. a day is even better, and has been shown to lead to much larger drops in cholesterol within a short period of time, compared to just cutting down or eliminating red meat.


Switching from butter to margarine-
IT JUST DOESN’T WORK


Many people switch from butter to margarine to lower their cholesterol. In fact, they feel it is important to eat a lot of margarine, since they heard that margarine lowers cholesterol.

The American Heart Association actually recommends using very small amounts of margarine instead of butter. They emphasize small quantities.

Most margarine contains 2 types of fat; polyunsaturated fats, and trans-fatty acids. Polyunsaturated fats sometimes can lower cholesterol levels a small amount; but trans-fatty acids raise cholesterol. Some margarines have no trans-fatty acids, but big drops of cholesterol just don’t occur by using margarine instead of butter. Remember, margarine, like butter, is 100% fat.

The medical studies done using diets using polyunsaturated fats show that the cholesterol is lowered an average of only 10%, but more importantly, it has never lowered the incidence of heart attacks.

Cutting down to 2 eggs a week.
IT JUST DOESN’T WORK

The American Heart Association recommends eating a maximum of 2 egg yolks a week, but only for someone who has a normal cholesterol. Another words, if you are trying to lower a high cholesterol, they feel you should eat only an occasion egg yolk. This includes egg yolks added as an ingredient in foods, such as cakes.

What about dairy food?

Regular milk has 46% of its calories as fat. Low fat milk is actually over 20% fat. Because milk contains a lot of water, the dairy industry is allowed to label regular milk as 4% fat and low fat milk as 2% fat by weight. This makes it seem not as bad as it really is.

The dairy industry has convinced most of us that dairy products are healthy foods essential for good health. Studies actually show the opposite. Eating dairy foods raise the blood cholesterol an average of 30%, and raise the chance of a heart attack by 60%. Dairy foods are a contributing cause of a wide variety of other illnesses also.


What about osteoporosis?

Osteoporosis – one of the most complicated subjects in medicine today.

The average American eats twice as much dairy food as was eating in the early 1900’s, even though more people lived on farms then. But osteoporosis is far more common now then in the past. The China study showed that eating less dairy food, not more, but more fruits and vegetables, was associated with far less osteoporosis. In fact, it has never been shown that any population has had less osteoporosis by eating dairy foods.

What is the explanation for this? Eating a lot of meat, fish, and chicken leads to a loss of calcium in the urine; and then osteoporosis. The calcium eating in dairy products never makes up for the lost calcium in the urine.

So how can osteoporosis be prevented? Eating less meat, chicken, and fish will cut down the loss of calcium. Caffeine also leads to a loss of calcium in the urine.

The National Institute of Health (NIH) has recognized the connection between excessive protein and osteoporosis.

The key to preventing and treating osteoporosis is stopping the loss of calcium from the body, not trying to flood the body with excess amounts of calcium from tablets that are poorly absorbed and also contains lead.

80% of Americans have low levels of Vitamin D, and normalizing this level will greatly reduce the chance of developing osteoporosis.

What about the Adkins diet?

The Adkins diet is sometimes promoted as allowing you to eat all the fats you want.

If you do this, it won’t work.

When one eliminates carbohydrates from the diet in the initial stages of the Adkins diet, you are also eliminating cakes, cookies, large quantities of bread, and many other high carbohydrate AND high fat items. So some people do lose weight, especially initially, on the Adkins diet.

But they are not cutting down not only carbohydrates, but high fat desserts.

Some people continue to lose weight by eating no more than 6 ounces of chicken, fish, and meat a day as entrees, along with limited quantities of salad and fruit. As diets go, this ISN”T a high fat diet. It’s actually similar to diets the American Heart Association recommends.

In spite of an attempt of a cover-up of the facts, the late Dr. Adkins had severe heart disease in the last few years of his life caused by atherosclerosis (hardening of the arteries). The Adkins diet didn’t prevent atherosclerosis in Dr. Adkins, and DOES NOT prevent atherosclerosis in general, and may promote it in many cases.

What about HDL Cholesterol?

The main components of total cholesterol are LDL cholesterol (the “bad” cholesterol), and HDL cholesterol (the “good” cholesterol). LDL cholesterol causes atherosclerosis by building up on the artery wall. HDL cholesterol carries LDL cholesterol away from the artery wall and eliminates it from the body.

The ratio of LDL to HDL cholesterol is important. However as the total cholesterol is lowered toward 160 mg., and the LDL cholesterol is 100 mg. or lower, the ratio becomes less important. (If there is no LDL cholesterol that is attached to the artery wall in the first place, HDL is not needed to carry it away).

So what is the normal cholesterol?

The answer to that question depends on what year it was asked, and to who.

In the 1970’s, a total cholesterol of up to 250 mg. was considered normal. However, even back then, it was known by some medical experts that the true normal cholesterol was up to 150 mg.

The state of knowledge of cholesterol by the general public can be appreciated by a question that was asked me by an intelligent educated patient in the early 1980’s when I informed him that his blood work showed his cholesterol was 250 mg., and he should try to lower it. He asked me, “What is cholesterol?” After 20 years of publicity, virtually every American knows what cholesterol is.

An ideal LDL cholesterol (the bad cholesterol) is now recognized by the medical profession to be 100 mg. or less. If someone already has atherosclerosis or diabetes, an LDL of 75 mg. or less is considered ideal. In order to attain these levels, the total cholesterol usually is
170 mg. or less.

The first study that proved that atherosclerosis can be reversed was done by Dr. Dean Ornish. He did not use statin drugs – he used a very low fat diet, along with exercise. In his studies, angina (chest pain due to blockages) was reduced by 80% in only one month. After a year, repeat cardiac catheterization showed reversal of the blockages.

Dr. Ornish’s studies done on the diet based on substituting fish and chicken for meat, margarine for butter, and low fat dairy products, showed to not improve atherosclerosis and angina; in fact it continued to get worse after a year.


Do you have to eat a “perfect diet” in order to lower your cholesterol level?

The studies have shown that reversal of atherosclerosis begans in diets less than 28% fat, and the less the fat, the higher percentage of people have reversal. So the benefits of diet on cholesterol and health are not an all or none situation. However, eating margarine, chicken, and fish, instead of butter and red meat simply doesn’t work because the fat content of this type of diet is still well over 30%.

Is there an alternative to statins?

Is we all ate a perfect diet, we’d all have a cholesterol of less than 150 mg., and heart attacks would be extremely rare. It would be nice to live in such a perfect world; but it’s not going to happen. However everyone has in their power to take simple steps that will immediately lower or eliminate the chance of a heart attack, or other medical event due to atherosclerosis.

Fish oils contain omega-3 fats. At one time, humans ate a high amount of omega-3 fats, not necessarily from fish, but from a wide variety of foods.

Omega-3 fats drastically lower triglycerides. They have a lesser effect to lowering cholesterol. They also have a potent anti-inflammatory effect similar to the Motrin type drugs, without the side effects. The dose of omega-3 for a marked effect is 4.8 grams a day, divided into a morning and evening dose. Beneficial effects can occur at lower doses, and in fact many people take a much lower dose by taking a few capsules a day by buying them from their local drug store.

Red yeast rice has been taken for thousands of years in Chinese society for circulation problems. It is a wonder that before cholesterol could be measured in the blood, how could anyone know of the beneficial effect of red yeast rice? It has a potent effect on lowering cholesterol. The dose is 1.2 grams twice a day. Red yeast rice works because it has a natural ingredient which is very similar to the statin type drugs. However there has never been a case of liver damage, liver enzyme elevation, or muscle damage by taking red yeast rice.

In an unfortunate irony of medical practice, the statin drugs, which cost over $100 a month, are covered by insurance prescription plans, whole fish oil and red yeast rice are not. Currently the cost of fish oil for the full 4.8 grams of omega-3’s is $30 a month at the most, and the cost of red yeast rice for 2.4 grams a day is $20 a month maximum; some sites on the internet sell it for less than $10 a month. However with these, contrary to the statin drugs, it is NOT necessary to get liver enzyme tests every 3 months for several years, and this should be taken into account when comparing the costs. At the full doses of omega-3’s and red yeast rice, most people are able to lower their total cholesterol and triglyceride to below 150 mg.

The statins, fish oil, and red yeast rice work in conjunction with dietary changes. Target levels of cholesterol and triglycerides can be reached with lower (and less expensive) doses. Sometimes it takes surprising small and simple measures to have an effect on blood values. Oatmeal for breakfast 2 or 3 times a week (without butter) has been shown to have a significant effect on total and LDL cholesterol. A weight loss of as little as 5% can lead to significant decreases in triglycerides.


Sample Daily Selection of Foods

Breakfast Foods

Oatmeal
Fresh fruit
Whole wheat toast with a fruit spread
Shredded wheat
Puffed wheat and rice

Lunch and Dinner Foods

Past dishes
Rice dishes
Bean dishes
Bean enchiladas
Baked potato
Salads
Fruits salads
Whole wheat bread
Whole wheat pita bread
No-fat crackers

Snacks and Desserts

Air-popped popcorn
Grape nuts
Fresh fruit
Frozen blended fruits
No-oil pretzels
Desserts made with carob

Toppings and Seasonings

Low-oil tomato sauce
Low-fat salad dressings, limited quantities
Herbs and spices


Liquids

Fruit juices - no sugar added
Vegetable juices
Herbal tea
Water

Robert Baker, M.D.
Internal Medicine

Vitamin D and hypovitaminosis D (low vitamin D level). (revised 3/29/08)

Robert C. Baker, M.D

Vitamin D is a vitamin that has to do with building bones. It also has many functions regarding cancer prevention and in the prevention of many other diseases. Vitamin D also greatly increases the absorption of calcium from the gastrointestinal tract. If the blood level of Vitamin D is 50 nanograms, this means the vitamin D is present in the ideal amount in every cell including the gastrointestinal tract, and the absorption of Vitamin D in the diet is greatly increased. Numerous studies from the United States and other countries have shown that normal vitamin D levels mean a much lower incidence of osteoporotic fractures.

Sunshine increases Vitamin D. At certain levels north or south of the equator,the production of vitamin D is limited and during the winter, no vitamin D production occurs.



Medical studies have shown that the incidence of low vitamin D levels is very high, regardless of age. 67% of women presenting with fracture of the hip (non-blunt trauma) had low vitamin D levels. Studies of school children of various ages, and various parts of the world, have shown low vitamin D levels in a very high percentage of individual.

Vitamin D collects in fat cells, but is unavailable to the body. So an obese individual who eats a lot of dairy food, thinking they are getting a lot of vitamin D, can be more likely to have a vitamin D deficiency than a slim individual who doesn’t eat dairy foods. (Vitamin D is not naturally present in cow’s milk – milk is fortified with vitamin D.) Vitamin D is present naturally in fruits and vegetables.

I have measured 25-hydroxy vitamin D levels in 800 patients over the past 3 years. 2/3rds of the results are below normal.

The deficiencies are found in all age groups. I have obtained levels in a dozen teenagers; ten were low; three were in single digits. I have seen the results in one eight year old; the result was less than 10 ng.

TRUE NORMAL VALUE OF 25-HYDROXY VITAMIN D

The normal value is considered 32 to 100 ng., but the ideal value is 50 to 70 ng. There are even some studies that indicate a higher value might have additional benefits.

TREATMENT:

There are very few studies in MEDLINE regarding treatment of low vitamin D levels. Rheumatologists are recommending the following and this have been proven to be completely safe. There have been no cases of excess vitamin D giving this dose:

1. One vitamin D 50,000 Unit capsule a week for 3 months (this is by prescription only. A 50,000 Unit capsule contains 125 times more vitamin D than a 400 unit capsules that is available over the counter).

2. Repeat the blood test in 3 months.

3. If the level is close to 50 ug. then a 50,000 Unit capsule once a month should be taken indefinitely. If the value is much less than 50 ug. then the once a week capsule can be continued for up to another 3 months, depending on the level. The final goal is to maintain a level of 50 ug.


CALCIUM

The idea that Americans have a lot of osteoporosis because of insufficient calcium intake has always been suspect. It is widely promoted by the dairy industry. Most countries in Africa have an extremely low rate of osteoporosis but the population drinks no milk after infancy. Eskimos eat a large amount of calcium in the form of fish bones, and have a very high rate of osteoporosis (they eat double the protein that Americans eat, and high protein diets are associated with osteoporosis. Proteins, especially animal proteins are acidic and wash calcium out of the bone) No animals in nature who have an adequate food supply develop osteoporosis, and they don’t drink milk after weaning, and of course, never drink the milk of another species. Only calcium or dairy intake studies in humans sponsored by the dairy industry have been the only ones showing any positive results, and the results are minimal. Many of these studies over the years have been proven to be fraudulent.


CONCLUSIONS

Vitamin D levels represent in my opinion the largest epidemic in America since the recognition of the epidemic of elevated cholesterol levels. The treatment is very simple and very inexpensive.

The expected results of aggressive intake of Vitamin D in keeping the level 50 ng., or higher, is the drastic reduction of osteoporosis.

Rheumatologists and some primary care doctors are getting 25-hydroxy vitamin D levels in those having osteopenia or osteoporosis. Very few if any vitamin D levels are being ordered on those who haven’t been diagnosed with these conditions.
I expect that getting routine 25-hydroxy vitamin D levels is going to take years to catch on in this country. It may never catch on.

What does paying attention to your vitamin D level mean? (WHAT EXACTLY IS AT STAKE?)

It means the difference between getting osteoporosis and a broken hip of vertebrae in the 60’s, 70’s, and 80’s, and not getting such a fracture. A fracture at this age frequently necessitates a nursing home admission, bedrest, decubitous ulcers, poor nutrition, and FREQUENTLY RESULTS IN DEATH, OR A LIFE THAT IS WORSE THAN DEATH.

An ounce of prevention is not worth a pound of cure; in the case of vitamin D, it’s worth a ton of cure.


Friday, November 03, 2006

AN APPLE A DAY - for the 21st Century

The saying is, an apple a day keeps the doctor away. An apple symbolizes fruits and vegetables.

The saying is still true, but has to be expanded.

In view of what has been learned about the action of fiber, anti-oxidants, and vitamins in fruits and vegetables, the updated saying should be -

An apple a day keeps the Neurologist, Endocrinologist, Pulmonologist, Cardiologist, Gastroenterologist, Urologist, Rheumatologist, Surgeon, Gynecologist (for women), Oto-Laryngologist, Dermatologist, Nephrologist, Chiropractor, and yes, frequently the Psychiatrist, away.