Natural Eradication of Cardiovascular Disease

Natural Eradication of Cardiovascular Disease

Every second man and woman in the industrialized world dies from the consequences of atherosclerotic deposits in the coronary arteries (leading to heart attack) or in the arteries supplying blood to the brain (leading to stroke). The epidemic spread of these cardiovascular diseases is largely due to the fact that, until now, the true nature of atherosclerosis and coronary heart disease has been insufficiently understood.



Conventional medicine is largely confined to treating the symptoms of this disease. Calcium antagonists, beta-blockers, nitrates and other drugs are prescribed to alleviate angina pain. Surgical procedures (angioplasty and bypass surgery) are applied to improve blood flow mechanically. Rarely does conventional medicine target the underlying problem: the instability of the vascular wall, which triggers the development of atherosclerotic deposits.

Cellular Medicine provides a breakthrough in our understanding of the underlying causes of these conditions and leads to the effective prevention and treatment of coronary heart disease. The primary cause of coronary heart disease and other forms of atherosclerotic disease is a chronic deficiency of vitamins and other essential nutrients in millions of vascular wall cells. This leads to the instability of the vascular walls, lesions and cracks, atherosclerotic deposits and, eventually, heart attacks or strokes. Since the primary cause of cardiovascular disease is a deficiency of essential nutrients in the vascular wall, the daily optimum intake of these essential nutrients is the primary measure to prevent atherosclerosis and help repair artery wall damage.

Scientific research and clinical studies have already documented the particular value of vitamin C, vitamin E, beta-carotene, lysine, proline and other ingredients in Dr. Rath’s Cellular Health recommendations for preventing cardiovascular disease and improving the health of patients with existing cardiovascular disease.

Vitamins and Other Nutrients Can Halt and Reverse Coronary Heart Disease

Millions of people die every year from heart attacks because no effective treatment to halt or reverse coronary heart disease has been available. Therefore, we decided to test the efficacy of Dr. Rath’s Cellular Health recommendations for the number one health problem of our time: coronary atherosclerosis, the cause of heart attacks. If these Cellular Health recommendations were able to stop further progression of coronary atherosclerosis, the fight against heart attacks could be won and the goal of eradicating heart disease would become a reality.

To measure the success of this program, we did not primarily look at risk factors circulating in the bloodstream. We focused directly on the key problem, the atherosclerotic deposits inside the walls of the coronary arteries. A fascinating new diagnostic technique had just become available that allowed us to measure the size of the coronary deposits non-invasively: Ultrafast Computed Tomography (Ultrafast CT).

Ultrafast CT measures the area and density of calcium deposits without the use of needles or radioactive dye. The computer automatically calculates their size by determining the Coronary Artery Scan (CAS) score. The higher the CAS score, the more calcium has accumulated, which indicates more advanced coronary heart disease.

Compared to angiography and treadmill tests, Ultrafast CT is the most precise diagnostic technique available today to detect coronary heart disease already in its early stages. This diagnostic test allows the detection of deposits in the coronary arteries long before a patient notices angina pectoris or other symptoms. Moreover, since it directly measures the deposits in the artery walls, Ultrafast CT is a much better indicator of a person’s cardiovascular risk than measurements of cholesterol or other risk factors in the bloodstream.


Before following Dr. Rath’s Cellular Health recommendations, the patient had developed atherosclerotic deposits in the walls of his left coronary artery (white circled area in the left picture). The scans below are magnifications of the heart scan taken with Ultrafast CT.

We studied 55 patients with various degrees of coronary heart disease. Changes in the size of the coronary artery calcifications in each patient were measured over an average period of one year without vitamin supplementation, followed by one year with Dr. Rath’s Cellular Health recommendations. In this way, the heart scans of the same person could be compared before and after the vitamin program. This study design had the advantage of patients serving as their own controls.

The results of this study were published in the Journal of Applied Nutrition. The full text of this landmark study is documented at the end of this book. The most important findings can be summarized as follows: This study measured, for the first time, how aggressive coronary heart disease progresses until eventually a heart attack occurs. Without the use of Cellular Health recommendations, the coronary calcifications increased at an exponential rate (very fast) with an average growth of 44% every year. Thus, without vitamin protection, coronary deposits increased approximately half their size every year.

When patients followed the Cellular Health recommendations, this trend was reversed and the average growth rate of coronary calcifications actually slowed down. Most significantly, in patients with early stages of the disease, this essential nutrient program stopped further progression of coronary heart disease within one year. This study also gives us valuable information about the time it takes for the Cellular Health recommendations to show a repair effect on the artery wall.

While for the first six months the deposits in these patients continued to grow, albeit at a decreased pace, the growth essentially stopped during the second six months with the vitamin program. Of course, any therapy that stops coronary heart disease in its early stages prevents heart attacks later on.

It is not surprising that there is a delay of several months until the healing effect of these Cellular Health recommendations on the artery wall becomes noticeable. Atherosclerotic deposits develop over many years or decades, and it takes several months to control this aggressive disease and start the healing process. More advanced stages of coronary heart disease may take still longer before the vascular healing process is measurable. To determine this, we are continuing our study.

Can already existing coronary deposits be reversed in a natural way? The answer is yes. In individual patients, we documented the natural reversal and complete disappearance of early coronary artery deposits approximately within one year. The ongoing study will tell us how long the natural reversal takes in patients with advanced coronary artery disease.

The complete natural disappearance of atherosclerotic deposits with Dr. Rath’s Cellular Health recommendations confirms that this vitamin program contains the essential ingredients needed to start the natural healing process of the artery wall.

In patients with early coronary heart disease, this healing of the artery wall can lead to the complete, natural disapearance of atherosclerotic deposits.

In patients with advanced coronary artery disease, these Cellular Health recommendations can stabilize the artery walls, halt the further growth of coronary deposits, reverse them, at least in part, and contribute to the prevention of heart attacks.

Scientific Publications on Nutrients and Cardiovascular Disease
Learn more about Cellular Health
Abstract from Dr Rath Health Foundation

Coronary Heart Disease Is an Early Form of Scurvy

Dr. Rath’s Scientific Discovery in Heart Disease

Dr. Rath’s research reveals that coronary heart disease occurs exactly for the same reason that clinical (early) scurvy does – a deficiency of vitamin C in the cells composing the artery wall. Humans, unlike animals, develop heart disease because their bodies cannot produce vitamin C. The average diet provides enough vitamin C to prevent scurvy, but not enough to guarantee stable artery walls. As a consequence of vitamin C deficiency, millions of tiny cracks and lesions develop in the artery walls. Subsequently, cholesterol, lipoproteins and other blood risk factors enter the damaged artery walls to repair these lesions.

In the case of chronic vitamin deficiency, this repair process becomes continuous. Over the course of many years, atherosclerotic deposits develop. Deposits in the arteries of the heart eventually lead to heart attack; deposits in the arteries of the brain lead to stroke.

Dr. Rath identified and our research has proven that atherosclerosis is nature’s plaster cast for weak and cracked arterial walls that are chronically deficient in vitamin C and other essential nutrients. One of these nutrients is the amino acid lysine. Lysine is called an essential amino acid because, similar to vitamin C, it cannot be produced in the human body. Lysine, together with another amino acid, proline, is the main component of collagen. These two amino acids comprise about 25% of all amino acids in the collagen molecule. A deficiency of lysine and proline can also trigger blood vessel wall weakness and instability.

Research and clinical studies conducted by Dr. Rath confirm that the most important function of vitamin C in preventing heart attacks and strokes is its ability to increase the production of collagen, elastin, and other reinforcement molecules in the body. This groundbreaking discovery in heart disease should be taught in every medical textbook and school and explains why other cardiovascular conditions, including heart failure, irregular heartbeat, high blood pressure and circulatory problems in diabetes, occur in the case of long-term vitamin deficiencies.

http://www.drrathresearch.org/sci_discoveries/heart_disease.html

The Cholesterol Myths

UFFE RAVNSKOV
author of The Cholesterol Myths

UFFE RAVNSKOV is radical. He is so radical that, on a television show in Finland, his critics set his book on fire!

His website (or a website about him) says: If you think this is written by another internet crackpot, take a look at Dr Ravnskov's credentials and the reviews of his book.

The book in question is titled The Cholesterol Myths. Its main argument is that cholesterol is not harmful to health but, in fact, healthy. Its author is certainy no internet crackpot. His credentials are, indeed, impressive.
Uffe Ravnskov graduated with a medical degree in 1961 and, in 1973, obtained a PhD in Chemistry. Between 1975 and 1979, he was Assistant Professor at the Department of Nephrology, University Hospital, in Lund, Sweden. Ravnskov went into private practice in 1980 and, in 2000, retired to become a full-time independent researcher.

More significantly, Uffe Ravnskov has published over 80 scientific papers and letters in peer-reviewed journals criticizing what is commonly called the Lipid Hypothesis of heart disease – the belief that dietary saturated fats and cholesterol clog arteries and cause atherosclerosis and heart disease.
Uffe Ravnskov began studying cholesterol in 1989, the year Sweden launched an anti-cholesterol campaign.

“Very soon I realised that the scientific evidence behind the campaign was non-existing,” he writes.

Among the many research findings published in scientific journals, Uffe Ravnskov discovered that:

lowering cholesterol did not result in lower death rates from heart disease, but in HIGHER death rates from all causes.

drug trials with an allegedly positive outcome was cited almost only by the trial directors, although the numbers of trials with an allegedly positive and a negative outcome were identical.

the successful dissemination of the diet-heart idea is due to authors systematically ignoring or misquoting discordant studies.
Uffe Ravnskov also discovered that LDL, commonly called “bad cholesterol”, actually protects against infections. This led him to put forward the hypothesis that high cholesterol, rather than promoting atherosclerosis, in fact may protect against it.

Uffe Ravnskov first summarised his research findings in a book, first published in Sweden in 1991, whose title translates to The Cholesterol Myths.

In 1992, the book was published in Finland. That was when his critics burned the book during a television show about it.

In 2000, an updated and expanded English edition of The Cholesterol Myths was published in the United States.

In 2002, a German edition of The Cholesterol Myths was published.

In his book, Uffe Ravnskov critically analyzes and demolishes the nine main myths of the Lipid Hypothesis:

High-fat foods cause heart disease
High cholesterol causes heart disease
High fat foods raise blood cholesterol
Cholesterol blocks arteries
Animal studies prove the diet-heart idea that diet affects heart disease
Lowering your cholesterol will lengthen your life
Polyunsaturated oils are good for you
The cholesterol campaign (to have people reduce their cholesterol levels) is based on good science
All scientists support the diet-heart idea.
All the above statements, Uffe Ravnskov maintains, are NOT TRUE. And he backs his assertions with solid scientific research.

Ancel Keys' Seven Countries Study

Uffe Ravnskov starts off with a critical analysis of the original 1950s research that gave rise to the idea that saturated fats and cholesterol cause heart disease – Dr Ancel Keys Six Countries Study, which later became the more famous Seven Countries Study published in 1980.

The Seven Countries Study – which gathered data on heart disease of some 13,000 men in Greece, Italy, Croatia, Serbia, Japan, Finland and the Netherlands over several decades – is widely considered to be one of the greatest epidemological studies ever undertaken.

Ancel Keys' Seven Countries Study showed that countries with the highest animal fat intake have the highest rates of heart disease. And this is frequently cited as “proof” that saturated fats and cholesterol cause heart disease.

Uffe Ravnskov informs us, however, that Ancel Keys had deliberately hand-picked the countries he included in his studies. In other words, Ancel Keys chose to study only those countries that supported his hypothesis.

Yet there are many other countries where high consumption of animal fat DID NOT cause heart disease. But, Ufee Ravnskov points out, Ancel Keys ignored those countries.

Dangers of statins and other cholesterol lowering drugs

Uffe Ravnskov is also highly critical of statins, the cholesterol-loweing drugs that are widely hailed as miracle “wonder drugs”.

He presents scientific evidence that show:

drug trials involving statins produced only neglible reductions in the rates of heart disease
lowering cholesterol did not reduce the death rate from heart disease but INCREASED the overall death rate from all causes
whatever positive benefits associated with the use of statins are due to factors other than cholesterol-lowering.
statins are probable carcinogens and women on statins have reported higher rates of breast cancer.
Uffe Ravnskov warns that exposure to carcinogens may result in cancer only after 20 or more years. And since there has not been controlled studies on statins over such long periods, we do not know whether the use of statins will lead to increased rates of cancer in the coming decades.

"“Millions of people are being treated with medications the ultimate effects of which are not yet known.”
– Uffe Ravnskov

Of course, it is not just Uffe Ravnskov saying all this and more. What he tells us about saturated fats and high cholesterol foods comes mainly from studying the reports of other scientists. He further tells us that…

The reason why laymen, doctors and most scientists have been misled is because opposing and disagreeing results are systematically ignored or misquoted in the scientific press.

Cholesterol sceptics

Myth Number 9 in Uffe Ravnskov's book is that “All scientists support the diet-heart idea.”
This certainly is not true and Uffe Ravnskov has gathered a large – and growing – group of doctors, scientists, academics and science writers in The International Network of Cholesterol Skeptics (THINCS).

Members of the group may disagree about what causes heart disease. But they share one thing in common.

The website of THINCS state:
"For decades, enormous human and financial resources have been wasted on the cholesterol campaign, more promising research areas have been neglected, producers and manufacturers of animal food all over the world have suffered economically, and millions of healthy people have been frightened and badgered into eating a tedious and flavorless diet or into taking potentially dangerous drugs for the rest of their lives.
As the scientific evidence in support of the cholesterol campaign is non-existent, we consider it important to stop it as soon as possible."


http://www.stop-trans-fat.com/uffe-ravnskov.html

Saturated Fat - The misunderstood nutrient

by by Vreni Gurd | Fri, 04/06/2007 - 11:15pm

We are told that saturated fat and trans fat are terrible for us. The distinction must be made. Saturated fats are healthy, trans fats are not.
Saturated fats have been vilified as being the cause of heart disease, some cancers, and the obesity epidemic. Although heart disease and cancer were rare before 1920, the incidences of these diseases have increased dramatically since then. By as early as 1950, heart disease was the leading killer of Americans. However, contrary to what one would expect if the saturated fat/heart disease hypothesis were true, the consumption of animal fat between 1910 and 1970 DECREASED by 21% and the consumption of butter DECREASED from eighteen pounds per person per year to only four, according to the research of Sally Fallon and Mary Enig. Furthermore, over that same time span the consumption of refined vegetable oils much of it consumed as partially hydrogenated or trans fat, INCREASED by 400%, and the consumption of sugar and processed foods INCREASED by 60%. Current Canadian 2006 data (thank you Chris Williams!) suggest that those trends are continuing, with a continued decrease in the consumption of high saturated- fat foods like full-fat milks, eggs and red meat between 1970 and 2006. Since 1981, butter consumption (a saturated fat) has decreased by a third, while the consumption of salad oil (refined and therefore rancid polyunsaturated vegetable oils) has more than tripled. Shortening consumption (a trans fat) has remained relatively constant. So considering the continued decline in saturated fat consumption, blaming heart disease on saturated fat makes no sense (see this study published in the Lancet). To fully understand how it is possible that we find ourselves in this position where we are being told to eat refined polyunsaturated vegetable oils which are disease-causing and avoid saturated fats which are health promoting, read The Oiling of America by Mary Enig, PhD, fats and oils researcher, and Sally Fallon. The insight into the politics of food is scary.

All fats and oils are made up of a mixture of saturated, mono and polyunsaturated fatty acids. Calling animal fats "saturated fats" is very misleading, as many animal fats are actually more than 50% unsaturated, and chicken fat is actually 70% unsaturated. If a fat were completely saturated it would be very solid with the consistency of hard wax. For example, beef fat or tallow is made up of about 50% saturated fatty acids (25% palmitic acid, 22% stearic acid and others), 40% monounsaturated fatty acids (oleic acid, the main fatty acid in olive oil), and the balance polyunsaturated fatty acids (linoleic and linolenic, the ratio depending on the diet of the cattle).

Saturated fatty acids are critical to maintaining the structure and rigidity of our cells by making cell membranes out of phospholipids and cholesterol, and they act as enzyme and hormone regulators thereby playing an integral role in cell messaging. When the body is fooled and incorporates trans fats into the cell membrane instead of saturated fats, cell messaging no longer works, which is one of the reasons trans fats are so dangerous.

Saturated fats are necessary for calcium to be incorporated into our bones, so no-fat or skim milk won't work as a calcium source, unless you eat some saturated fat in your meal. Saturated fats are needed to boost immune function, and to build a healthy nervous system and digestive tract. Saturated fats are the base material out of which the body makes cholesterol, which is the precursor to such critical hormones as vitamin D, cortisol, testosterone, estrogen and progesterone, as well as bile acids which are necessary for the digestion of fats. Fats also are needed as carriers for the fat soluble vitamins (the antioxidant vitamins), like vitamin A, E, D, K, and a low fat diet can lead to deficiencies in these nutrients. Saturated fats are also needed to be able to utilize omega 3 fatty acids easily. Breast milk is high in saturated fat for a reason - it is vital for the healthy development of the baby! Does it make sense that saturated fats which are vital for a baby are suddenly poison for an adult?

Fat is also needed to feel satisfied after a meal. Mary Enig says in her book Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils, and Cholesterol that "as a result of the presence of fat in the small intestine, special hormones are produced that prevent hunger contractions. ... Too much fat in the diet and the loss of weight is thwarted; too little and the hunger pangs play havoc with good intentions and usually lead to overeating carbohydrates."

Saturated fatty acids can be broken down into three groups - short chain, medium chain and long chain. The short and medium chain saturated fatty acids don't turn into body fat unless consumed in very large quantities, but rather are utilized immediately by the body for energy. Therefore fats that contain more short to medium chain fatty acids have less calories than the same amount of longer chain fatty acids. According to Mary Enig, in her book Know Your Fats: the Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol, a pound of coconut oil has 100 kilocalories less than a pound of soybean oil. And yes, butter has less calories than margarine, although not much less.

If you are eating high quality fats, such as pasture fed, non-medicated, organic eggs, dairy, poultry, and meat, you are doing your body good. If you are eating conventionally raised poultry and meat, it is a good idea to cut off the fat, as the medications, hormones and pesticides consumed by the animal will be concentrated in the fat, which will in turn be concentrated in your fat. Cook only with pasture-fed organic butter, ghee, tallow or chicken fat, or organic coconut oil, or unrefined or cold pressed extra virgin olive oil (low to medium temperatures only), as these fats are stable and won't oxidize and go rancid when heated. To find out what ratio of fat, protein and carbohydrates are appropriate for you according to your own personal biochemistry, get yourself metabolically typed at Healthexcel, and receive a food list of appropriate foods for you. Some people require more quality fats to be healthy than others.

High Cholesterol does NOT cause heart disease

by Vreni Gurd | Fri, 04/13/2007 - 11:48pm

The lipid hypothesis needs to be re-evaluated - it has very serious flaws.
First of all, it is important to understand that that "risk factor" does not mean the same thing as "cause". A risk factor is a characteristic that is associated with a diagnosis. For example, for women, being tall is associated with breast cancer. Does that mean that being tall causes breast cancer? Of course not.

It is also important to understand cholesterol is an essential component of our cell membranes, it acts as an anti-oxidant, it is a precursor for the synthesis of vitamin D as well as bile for digesting fats, and is the only source out of which our steroid hormones, such as cortisol, as well as estrogen, progesterone and testosterone which are key to reproduction, can be made. Therefore it is safe to say that without cholesterol we would not survive. Cholesterol is also the precursor to calcitrol, the steroid hormone that regulates calcium levels in our bodies by helping us absorb calcium from our food, thus playing a key role in the mineralization of our bones and teeth. Cholesterol is also manufactured in the glial cells of the brain to aid with synapses.

Cholesterol is used by our bodies to repair lesions in the arteries. Dr. Mary Enig, fat researcher, suggests that blaming cholesterol for heart disease is something like blaming firefighters for starting fires. Is it really a good idea to reduce our arteries' firefighters? The key to stopping heart disease is to stop the lesions (fires) in the arteries from occurring in the first place, by minimizing glycation by eating less sugar and high fructose corn syrup, and minimizing free radical damage by not consuming refined and therefore rancid vegetable oils AND by reducing systemic stress.

Our bodies consider cholesterol to be so essential to our survival, that every cell in our body can manufacture it as needed. If we eat little or no cholesterol, our bodies manufacture more, and if we eat a lot, our bodies don't manufacture as much. This way our cholesterol levels maintain homeostasis irrespective of our diet, and this is the reason it is so difficult to reduce or raise cholesterol levels much with diet alone.

Dr. Uffe Ravnskov, MD, PhD, who wrote the book The Cholesterol Myths, goes through study after study destroying the idea that high cholesterol levels are the cause of heart disease. In the Framingham heart study done near Boston that spanned 30 years , the researchers concluded that high cholesterol was a risk factor for heart disease, but when one really dissects the data, one must question how they came to that conclusion. For example, when the participants of the study are plotted on a graph it clearly shows that those with cholesterol levels between 182 and 222 did not survive as long as those with higher cholesterol levels of between 222 and 261. The study shows that about half the people with heart disease had low cholesterol, and half the people without heart disease had high cholesterol.

Most studies have found that for women, high cholesterol is not a risk factor for heart disease at all - in fact, the death rate for women is five times higher in those with very low cholesterol. In a Canadian study that followed 5000 healthy middle-aged men for 12 years, they found that high cholesterol was not associated with heart disease at all. And in another study done at the University Hospital in Toronto that looked at cholesterol levels in 120 men that previously had heart attacks, they found that just as many men that had second heart attacks had low cholesterol levels as those that had high. The Maoris of New Zealand die of heart attacks frequently, irrespective of their cholesterol levels. In Russia, it is low cholesterol levels that are associated with increased heart disease. The Japanese are often cited as an example of a population that eat very little cholesterol and have a very low risk of heart disease. But the Japanese that moved to the US and continued to eat the traditional Japanese diet had heart disease twice as often as those that maintained the Japanese traditions but ate the fatty American diet. This suggests that it is something else, like stress perhaps, that is causing the heart disease.

Dr. Malcolm Kendrick noticed that in the MONICA study that has been going on for about 40 years, there is no association between high cholesterol levels and heart disease. See the graph for yourself at the bottom of the article. (Dr. Kendrick wrote another interesting piece about the "disappointing results" of low fat diets in the Women's Health Initiatives heart intervention study, and the lack of association between death rates from CVD and saturated fat consumption based on the MONICA study).

These are but a small sample of the studies that contradict the idea that cholesterol is the villain in heart disease. So why has this idea held on so long? Perhaps pharmaceutical companies and the processed-food industry have a lot to gain by keeping this belief alive. Statin drugs (Lipitor, Mevacor, Zocor etc.) are mega money makers, and they definitely do lower cholesterol, but if high cholesterol does not cause heart disease, why are they necessary?

Furthermore, statin drugs may not lower overall mortality rates, as lower cholesterol levels seem to be associated with higher rates of cancer. Statin drugs work by blocking the synthesis of mevalonate, which is a vital step in the body's
synthesis of cholesterol. By blocking this step, every following step is also blocked, and this is a problem, because the synthesis of Coenzyme Q10 (ubiquinone) and squalene, both precursors to cholesterol, is also blocked. Coenzyme Q10 is very important for heart function, it acts as an antioxidant in conjunction with Vitamin E, and it is important in energy metabolism in the mitochondria of muscles, which is why muscle pain is a common side effect of statin drugs. Coenzyme Q10 is important for healthy brain function as well, and when Coenzyme Q10 levels are low, through statin use or otherwise, memory is affected. Squalene is also an antioxidant and is a potent cancer fighter. If you are on statin drugs, supplementing with Coenzyme Q10 and squalene may be very helpful.

I realize that suggesting that cholesterol levels are not associated with heart disease goes against current dogma. I am not making this suggestion in order to create controversy. After looking at the evidence, I am convinced that we are going down the wrong path. I am not alone in thinking this way - there are more and more scientists and physicians that believe that cholesterol and saturated fat stand wrongly accused. For me, the epidemiological evidence is most convincing. If we ate saturated fat and cholesterol in the form of animal fats, eggs, and full-fat dairy liberally for millennia and were heart-disease free up until the early 1900s, and just as we reduced our consumption of these foods and replaced them with sugar, vegetable oils and processed food, heart disease rates began to climb - to me it seems rather obvious that we are putting the blame on the wrong thing. Feel free not to believe this idea, but please don't simply dismiss it out of hand, either. If you have high cholesterol and you are taking, or thinking about taking cholesterol-lowering drugs, please read The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease so that you can make an informed decision regarding this important issue. Two other very well researched books worth reading, written by scientists but geared to the lay person are Nutrition and Physical Degeneration, by Dr. Weston A. Price, on primitive cultures, their health and their eating habits versus more modern cultures, their health and their eating habits (probably the most important book on nutrition ever written), and Mary Enig's book on lipid chemistry, Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils and Cholesterol. These books are each very different from the other, but they will open your eyes to the other side of the argument, and only then will you be able to come to an informed conclusion on this issue.

Vitamin E Deficiency

The Untold Epidemic Vitamin E Deficiency by Ladd McNamara, M.D.

It is clear that there is an epidemic vitamin D deficiency (see posting about vitamin D below). Few people are aware that there is also a serious epidemic deficiency of vitamin E. An editorial that accompanied the largest study on vitamin E in medical history (Am J Clin Nutr 2006 Nov;84(5):1200-7) stated 93% of American men and 96% of American women do not obtain the [pathetically low] recommended dietary allowance of 15 IU of vitamin E per day. It is clear that we should be taking at least 30 to 50 times that level (400 to 1000 IU/day) to reduce the risk of chronic diseases. Taking this much vitamin E in the correct form and balance with other vitamins, is both safe and effective; more than the pharmaceutical companies would have you believe. However, it is in the economic interest of pharmaceutical companies to dissuade the public from taking supplements so that they can be on medications which often do little to nothing to reverse disease. Other health practitioners make their living by “educating” others that they can get everything they need from their food alone. The medical research indicates otherwise. The amount of vitamin E, as well as other important vitamins, required to reduce the risk of chronic diseases can only be obtained through supplementation.

Tragically many doctors and the lay person have the misconception that vitamins, such as vitamin E supplementation may be harmful. There seems to be continued misinformation put out in news media and health magazines, regarding the “dangers” of supplementation. Either they are not aware of the medical research, or they are purposefully misleading the public for their own gain. This non-stop attempt to persuade people not to supplement, but to get all their antioxidants from their food alone is at minimum unethical, at worst dangerous. Vitamin E seems to be in these detractors line of fire more than any other nutrient, probably because it is the most common supplement used today. With the thousands of medical studies showing the benefits of supplemental vitamin E, how is it that there is still controversy and confusion? The doses of vitamin E that research has shown to be of benefit can ONLY be obtained through proper supplementation.

Almost weekly a new study about the benefits of vitamin E is published. Almost all show health benefits or potential health benefits. Because vitamin E is one of the most popular supplements, it is only when a medical study or report showing a possible negative effect it is reported by the media, either to make headlines, and/or to scare people away from taking this incredible vitamin. The negative findings regarding vitamin E of a few medical reports have either shown to be excessively biased, restricting other important vitamins that work synergistically with vitamin E, poorly designed, or bearing no cause and effect of vitamin E to a detrimental health impact. The studies of vitamin E that have shown a true potential negative impact are few, but of more importance it has given us clarity regarding the synergistic impact of various vitamins as well as the importance of the formulation of vitamin E.

Vitamins must work together for optimal benefit:

Studies published many years ago showed that for vitamin E to continue to function as an antioxidant within the body, adequate levels of vitamin C must be present to regenerate (donate more electrons) to vitamin E so that it can continue to prevent oxidation of lipids. Any study about vitamin E that restricts the participants from also taking vitamin C is setting up the study to show nothing more than how vitamin E is quickly “used up,” and not regenerated to continuously provide an antioxidant benefit. It tells us nothing about the real benefits that can be obtained from proper supplementation.

The correct formulation of vitamin E is critical:

Vitamin E is a family of nutrients; alpha, delta, and gamma-tocopherols and tocotrienols. There is a difference between the synthetic (petroleum-derived) vitamin E, dl apha-tocopherol , and the natural (food-based ) vitamin E, d alpha-tocopherol. Gamma-tocopherol is a critical form of vitamin E needed to reduce the oxidation of lipids (cholesterol) in conjunction with alpha-tocopherol. (J Am Copll Cardiol. 1999 Oct:34(4):1208-15, Pro Natl Acad Sci USA, 1993 Mar 1:90(5):1771-5) In addition, studies have shown that people who supplement solely with vitamin E in the alpha-tocopherol form are at risk to lower the blood levels of a critical form of vitamin E, gamma-tocopherol. (J Nutr. 2003 Oct:133(10):3137-40; J Nutr.1985 Jun:115(6):807-13 ) The average American’s blood-stream is five times more rich in alpha-tocopherol than gamma-tocopherol, and that difference jumps 20-fold among people who take vitamin E as alpha-tocopherol without gamma tocopherol.

In 2007, a negative study about vitamin E (that lingers as the “justification” for the case against vitamin E) highlights the way the public can be mislead to make some poor decisions about supplementation. (JAMA Feb 27, 2007). This was a flawed study with flawed data that concluded that vitamins A and E “significantly increased the risk of mortality.” This meta-analysis (report) did very little to help us understand the benefits of vitamin E, but showed us just how data, and the public’s opinion, can be manipulated. The authors of this meta-analysis (which is not a study per se, but a review of previous published studies) considered 815 prior studies regarding antioxidants, but included the results of only 68 of these studies for analysis. Some of the studies excluded from their report showed significant benefits and reduction of mortality from taking supplements. Selection bias was glaringly evident. The authors essentially “cherry-picked” the studies they wanted, and ignored others, so that they could come to their desired conclusion: vitamin E can kill you!

The authors were unable to establish any cause and effect between supplementation with vitamin E and an increased risk of death, making this a poorly designed study. The elderly people who died could have just as easily died from accidents, medications, surgery, etc. …who knows? One noted researcher described this report a kin to “doing a cholesterol-lowering study without ever measuring cholesterol levels.” Furthermore, the average duration of the reviewed studies was 2.7 years, so the ridiculous conclusion that the authors wanted the public to believe was that vitamin E could kill you (somehow) in less than 3 years!

The others ignored many studies showing significant benefits derived from supplemental vitamin E. One such study that was ignored by these researchers was the November 10, 2006 study published in the American Journal of Clinical Nutrition which is the largest study on vitamin E in medical history measuring alpha-tocopherol in male smokers. (Am J Clin Nutr 2006 Nov;84(5):1200-7) This study followed 29,000 patients for over 19 years, and included over 13,000 deaths, …making possible a significant and fair analysis of vitamin E and the risk of death.

This study showed a significant reduction in overall mortality in those patients with the highest blood levels of alpha-tocopherol. Specifically, over a 19-year period men with the highest blood levels of alpha-tocopherol showed the following reduction in causes of death:
Prostate Cancer 32% Reduction of Death
Ischemic Stroke 37% Reduction of Death
Hemorrhagic Stroke 35% Reduction of Death
Lung Cancer 21% Reduction of Death
Respiratory Illness 42% Reduction of Death
The authors of this significant and powerful study stated: “As a primary fat-soluble antioxidant that protects lipids from peroxidation, alpha-tocopherol is able to scavenge mutagenic free radicals and inhibit the oxidation of LDL-cholesterol, and the abilities have important implications for the prevention of carcinogenesis and atherosclerosis ….alpha-tocopherol also has several important functions that are independent of its antioxidant activity, including modulation of gene expression, enhancements of immune responses , an suppression of tumor angiogenesis.”
The researchers further elaborated that although the patients who enjoyed the greatest health benefits had higher blood levels of alpha-tocopherol, these same subjects also had the highest levels of gamma-tocopherol, meaning that these people were taking the natural formulation of vitamin E, not dl-alpha-tocopherol without gamma-tocopherol and the tocotrienols. This study, and other significant studies are ignored by the media, and obviously by doctors who are continually visited and educated by pharmaceutical companies.

Certainly, there are tens of thousands of studies reporting the benefits of various nutritional supplements. They are both safe and effective. If doctors and the public were simply made aware of the poorly designed analyses that denigrate vitamin E supplementation, and the significant studies about the benefits of taking vitamin E, in the form of alpha-tocopherol and gamma-tocopherol (along with delta-tocopherol and the mixed tocotrienols) along with vitamin C and vitamin K, which replenishes the antioxidant abilities of vitamin E, then I believe that not only would people need less medication and reduce the economic crisis in the health care industry, but more importantly people could enjoy the true health and happiness that can be obtained by eating right, exercise, and proper supplementation with a full spectrum of quality vitamins and minerals.

Vitamin E, in the natural form (as described above), appears to be safe up to at least 2000 IU per day. I personally take 800 IU per day of the full spectrum of vitamin E. When I was in medical practice, I recommended at least that much (if not up to 1200 IU of vitamin E) to patients with diabetes. The natural form of vitamin E, along with co-enzyme Q10, the red grape extract (grape seed extract and resveratrol) and a full spectrum of other antioxidants (quercetin, alpha lipoic acid, turmeric extract, olive extract, green tea extract, etc.), vitamins (B, C, D, and K), and minerals in the chelated form, all contribute to safely and significantly reduce the risk of heart disease, stroke, cancer, Alzheimer’s disease, lung diseases, and almost every other chronic degenerative disease, as well as slow the aging process, all without the side-effects of drugs.

Posted by Ladd McNamara at 12:10 PM

Cataracts: Reduced Risk with Vitamin E, Lutein, Zeaxanthin and Grape Seed Extract

In recent study published in the Archives of Ophthalmology (Arch. Ophthalmol. 2008;126:102-9) gathered from the Women's Health Study, vitamin E and the carotenoid lutein were both found to be associated with a reduced risk of cataracts.

The Women's Health Study (WHS) was a randomized, placebo-controlled trial involving nearly 40,000 women health professionals aged 45 years and older at inception of the study in 1993.

In this recent study gathered from the WHS, the researchers assessed the antioxidant intake (from food and supplements) of 35,551 women and followed them for an average of ten years. They divided the women's intake into 5 groups, ...groups with the lowest intake, to the next highest intake, to the next highest intake, etc. When women with the highest intake of lutein/zeaxanthin (mean intake of 6.7 mg/day) were compared to the group with the lowest intake (mean of 1.2 mg/day) they found an 18% decrease in the risk of cataracts.

Similarly, when women in the highest intake group of vitamin E (mean 262 mg/day, or 390 IU/day; 1 mg alpha-tocopherol = 1.49 IU) were compared to women in the lowest intake group of vitamin E (mean 4.4 mg/day, or 6.5 IU/day), there found a 14% decrease in cataracts.

This study adds to existing observational studies that xanthophyll carotenoids lutein (and its stereo-isomer, zeaxanthin) may delay cataract formation. (BTW, in animal studies, grape seed extract has been found to reduce the formation of cataracts as well.) Lutein and zeaxanthin concentrate in the tissues of the eye, ...including the lens and retina.

Personally, I take a broad spectrum multi-antioxidant and minerals in chelated form, fish oil, grape seed extract, and additional lutein/zeaxanthin and bilberry extract supplement (for a total lutein intake of 13 mg per day, ...well above the mean intake of the top fifth group of this study). In addition, I take an additional vitamin E supplement, that has the full family of vitamin E (d-alpha tocopherol, d-gamma tocopherol, delta tocopherol, and the tocotrienols), for a combined total of 600 IU/day.

For optimal eye health of the lens and retina (macular degeneration is the number one cause of blindness after the age of 40), as well as maintaining health in a time of increasing risk of chronic degenerative disease, I recommend an optimal intake of various antioxidants, vitamins, minerals, and essential fatty acids.

Posted by Ladd McNamara at 9:05 AM

Rebuttal to the Recent FLAWED Report that Antioxidants Shorten Lifespan

Here we go again. It was predicted and expected ....more "bad news" for those taking supplements in the form of a recent "study" indicating that vitamins (antioxidants) may decrease your lifespan. ....Well, not so fast! I have included an article from Life Extension Foundation (see below) addressing the flawed analysis of this study ...and more importantly the lack of "cause and effect" between antioxidants and premature death. (What is so absurd about all this is that the opposite truly exists, ... that is, an association between antioxidants and the reduced risk of premature death.) Before I get to that, I have my own editorial.

Believe it or not, there is a war of information regarding the supplement industry and the pharmaceutical industry. This was not the first, and it will not be the last that some "study" comes out telling us that we, who take supplements, are going to die, or in this case not live as long due to taking antioxidant supplements. Our alternative is not to take any supplements, and therefore become eligible to take prescription drugs (which course, have side effects, incluing death ....over 100,000 people die each year in the U.S. alone DIRECTLY FROM TAKING PRESCRIPTION MEDICATIONS ....and this is under the supervision and management of doctors and nurses).

This is NOT the case for nutritional supplements. People are not dying of premature deaths from their nutritional supplements, ...but, somehow we accept that drugs are more "acceptable" than supplements in maintaining health. It makes no sense at all. It is true, that the formulation and amounts of vitamins, minerals, and antioxidants matter .... not in their risk of death, but in regard to the true benefits they can provide. For example, there is a BIG difference between taking 60 to 120 mg of vitamin C in the ascorbic acid form, and 1300 mg per day of vitamin C in the vitamin C ascorbate form. With the first, one will do little more than prevent scurvy, whereas with the later, one may prevent the onset of chronic degenerative disease and possibly extend one's longevity.

There is a difference between taking 15 to 30 IU/day of vitamin E in the dl-alpha tocopherol form, vs. 400 to 800 IU/day of vitamin E in the mixed tocopherol (d-alpha tocopherol, gamma tocopherol, delta tocopherol) and tocotrienol formulation. The first will ....well, I'm not sure what 15 to 30 IU of vitamin E does, but I do know what the studies on using the natural mixed tocopherol form of vitamin E indicates ....less risk of many types of cancer, decreased risk of heart disease, AND decreased mortality.

In regard to extending one's lifespan, the single BEST way to increase longevity is NOT TO DIE!

I have studied the medical literature, and one of the biggest frustrations regarding studies on supplements (vitamins, minerals, and antioxidants) is that they were never meant to be taken in isolation. Supplements are meant to be taken in the proper ratios, amounts, and balance. Formulations make a difference; and most of these "reports" (meta-analyses) are comparing apples and oranges.

The authors of this latest round of anti-supplement propaganda (like prior anti-supplement reports) cherry picked their studies, leaving out some powerful studies showing a decrease in heart disease, cancer, and death from any cause. Again, if we are to live longer we must not die of a chronic degenerative disease. The studies exist, but they weren't included because it did not support the aim of this meta-analysis.

My hope is that people will not be so swayed by the sensationalism of a poorly designed and selectively biased report, or meta-analysis (summary of selected studies) that in the end will NOT hold up to true medical research scrutiny. Sometimes I believe that these researchers know that their report will not hold up to scrutiny, but in the war of information it ultimately does not matter. The damage will be done because the media has already announced the "bad news," creating doubt in the minds of the less informed, ...including the minds of many doctors who do not take the time to look at the solid studies on the benefits of supplements, but rather listen (and believe) all the information doled out to them by the pharmaceutical reps who visit their office on a daily basis.

Please refer to the following article for an accurate rebuttal (the first of others to follow):

http://www.lef.org/featured-articles/Rebuttal-to-Allegation-That-Certain-Vitamins-May-Shorten-Lifespan.htm?source=eNewsLetter2008Wk16-2&key=Article+Exclusive

Big Pharma: Statin Drugs vs. Antioxidants

I was concerned several years ago as the American Heart Association, backed by the pharmaceutical companies, continued to make and revise recommendations regarding how low doctors should reduce their patients' LDL cholesterol levels. At first LDL cholesterol levels were "normal" if they were 130 or below, then the standard was 100 or below, and finally, 70 or below became what we now consider medically "acceptable." With each recommendation the number of people who instantly had the made-up disease of "high cholesterol" increased, and more and more patients were prescribed statin drugs to lower their LDL cholesterol levels. Statin drugs are the top-selling drugs in the world, bringing in more money for Big Pharma than any other class of drugs. It was this con of convincing the public that high cholesterol was the cause of atherosclerosis, heart disease, and stroke that caused me to write the first edition of my book, The Cholesterol Conspiracy, in 2004. It has since been updated (2006) and is in its Second Edition; however, after the latest news from the American Heart Association conference in New Orleans on Nov. 8th, 2008 it appears that I will need to update my book again.

My contention has always been that it is NOT high cholesterol that is the main cause of plaque formation, heart disease, and stroke, but rather it is the OXIDATION of LDL cholesterol and the INFLAMMATION of the arterial lining (called the endothelium) that is the culprit to the number one cause of death for both men and women. As I discuss in my book, more than half of people who die of heart disease have NORMAL LDL cholesterol levels, ...thus it is NOT high cholesterol that is killing them, but the CONDITION of the LDL cholesterol and the inflammation of the endothelium that leads to the deadly disease. Likewise, there are cases of people with high cholesterol levels who show no signs of arterial plaque due to their high intake of vitamins, minerals, antioxidants, and the essential fatty acids that reduce the oxidation to LDL cholesterol and inflammation to the endothelium. What's more, antioxidants reduce endothelial inflammation an LDL oxidation better than any drug, ...and without the side effects.


The recent study reported at the American Heart Association in New Orleans, known as JUPITER, proved my case: if you reduce oxidation and inflammation you can reduce the risk of death from heart disease and stroke! However, unlike the JUPITER study, which proposed the way to do it is with statin drugs, I believe the best course to reduce LDL oxidation and arterial inflammation is with nutritional supplements.


If you were to believe the JUPITER study and what is being suggested by the doctors who spoke at the American Heart Association conference on Nov. 8, 2008 in New Orleans you would have to believe that "EVERYONE," young and old, sick and healthy, those with high cholesterol and those with normal cholesterol levels ALL should be on the "life-saving, miracle drugs of this or any other generation" …the statin drugs!


The JUPITER (Justification for the Use of Statins in Primary Prevention) Study, funded by AstraZeneca, makers of Crestor, was unveiled to the delight and awe of doctors and pharmaceutical companies. The study showed that 20 mg of Crestor cut in half one’s risk of heart attacks and stroke, whether they had high cholesterol or not! In other words, healthy people without elevated cholesterol levels ... could now be "saved" by the statin drugs, and like the IRS, the pharmaceutical companies are "here to help."


Doctors and pharmaceutical representatives got on the stage to proclaim that because statin drugs have been shown (in this study of just under two years) to reduce the risk of heart attack and stroke in HEALTHY people (those without signs or symptoms of heart disease and normal cholesterol levels) that governments around the world should push the campaign to put every single person on statin drugs.


As has been proposed earlier (documented in my book), they again proposed at this conference that we "drip statin drugs into our water supply" as the best way to get everyone on these "all-important" drugs. They want to take the decision out of our control and force these drugs, which ...oh, by the way, have dangerous, even deadly side effects, upon us ....and of course, run up a huge national medical cost.


Statin drugs are already the number one-selling drug in the world with over $18 billion dollars in sales, and now due to this study, they will likely double in sales. USA Today calculated that the ever-increasing prescribing of statin drugs which this study will generate would add $10 billion a year to the U.S. national debt. (http://www.usatoday.com/news/health/200 )


BUT, what are the facts of this study; what about the risks of such widespread use of statin drugs, particularly in healthy people? …and, more importantly, what about alternatives to statins? Interestingly enough, one of the authors of this study also appeared as an author on another study released the same week of the announcement of this study, showing that vitamin E and vitamin C did NOTHING to reduce the risk of heart disease; ....in fact vitamin E, they reported, might increase the risk for hemorrhagic stroke. So, in a one-two punch knock out …. Big Pharma apparently established that statin drugs are the ONLY salvation for the number one cause of death.


Now, not only are antioxidants NOT the answer, according to Big Pharma, they are the problem. It must be that we, as human beings, are born deficient of statin drugs, ….some kind of an "inborn error of metabolism," and that it is not nutrients that we lack today, but drugs! Apparently Big Pharma is not satisfied with treating the sick, they want to provide “therapy” to the healthy, by actively putting more drugs into our drinking water …as if there are not enough drugs swirling around in the water supply already.


Again, I would like to point out that this JUPITER study proves my point made in my book, The Cholesterol Conspiracy , ....that heart disease (atherosclerosis) is not caused by high cholesterol, but rather oxidation of LDL cholesterol and inflammation of the arterial lining. In my book, I make a case (backed up by medical research) that oxidized LDL cholesterol and homocysteine-induced nicking and inflammation of the arteries leads to arterial plaque and inflammation.
C reactive protein (CRP) is an indirect measure of arterial inflammation (or any inflammation). The more oxidation and inflammation of the arteries, NO MATTER WHAT THE LDL CHOLESTEROL LEVEL (normal or not), the more plaque will build within the arterial lining (known as the endothelium). By reducing oxidation and inflammation (which can be measured directly with lipid peroxides, or indirectly with CRP levels) there is less damage to the LDL cholesterol and the endothelium, and less plaque will form. Less plaque means less heart disease and death.


Vitamins, minerals, antioxidants, and omega-3 essential fatty acids have all been shown to decrease CRP, homocysteine, and lipid peroxides levels, and in some cases restore endothelial function ….without any toxic side-effects (unlike statin drugs).


Although I discuss CRP in The Cholesterol Conspiracy, as a review, CRP is a protein produced by the liver in response to inflammation. Any condition that leads to inflammation will cause the production and release of CRP. Smoking, genetics, stress, arthritis, diabetes, obesity, rheumatoid arthritis, dementia, high blood pressure colorectal cancer, the aging process, and damaged and an inflamed arterial endothelium will all cause an elevation of C reactive protein. It is an indirect, non-specific measurement of inflammation and oxidation. Statin drugs have been shown to exert an anti-inflammatory effect, and it is the modest anti-oxidant, anti-inflammatory effect that is responsible for a reduction in oxidized LDL cholesterol and arterial inflammation. Less oxidized LDL cholesterol and less arterial inflammation, the less plaque that will build up within the arterial endothelium.


However, natural antioxidants, vitamin C, turmeric extract, essential fatty acids (fish oil) do more to reduce oxidized LDL cholesterol and arterial inflammation and lower CRP than cholesterol-lowering statin drugs, AND without the dangerous side-effects of statins (liver, nerve, muscle, and heart damage, ….let alone death). The B complex vitamins and betaine (tri-methly-glycine) lower homocysteine levels, which means less “scratching up” of the endothelium, i.e., less arterial inflammation, and lower CRP levels.


The JUPITER study showed how important it is to lower inflammation of the arteries in order to reduce the risk of heart disease and stroke, ….as measured by CRP levels, and that people are susceptible to heart attack and stroke even with normal LDL cholesterol levels because oxidation and inflammation. So, let’s look at the facts and my concerns of the JUPITER Study:


Facts of the JUPITER STUDY:


1. Nearly 18,000 men and women with low LDL cholesterol levels (median 108 mg/dL), and C reactive protein levels (CRP) greater than 2.0 mg/L were placed on 20 mg of Crestor or a placebo, and followed for just under 2 years.

2. The group on 20 mg of Crestor decreased their cholesterol levels EVEN FURTHER (to as low as 53 mg/dL), reduced their triglyceride levels, and cut their risk of nonfatal heart attacks by 55%, a 48% reduction in nonfatal strokes, and a 47% reduction in hard cardiac “events” (a composite of nonfatal and fatal heart attack and stroke).


Concerns about the JUPITER STUDY:


1. What are the long-term effects of lowering one’s LDL cholesterol to such low levels? There is already concern about depression, violent behavior, suicide, etc. from lowering one’s LDL cholesterol below 70 (see my book, The Cholesterol Conspiracy). However, what other problems may arise from such low LDL cholesterol, given that the body REQUIRES LDL cholesterol to function properly? Having high LDL cholesterol levels in and of itself is not a problem, it is the oxidation of LDL cholesterol and triglycerides (lipid peroxides) and the inflammation of the endothelium (from homocysteine) that leads to plaque formation.

2. With the study only being 2 years long, AstraZeneca virtually eliminated discovering the long-term effects of such low LDL cholesterol levels AND the long-term effects of statin drugs in this population. However, we do know the long-term of statin drugs, and they are not pretty, ….dangerous and severe side-effects; occasional deadly.

3. Was the study designed to yield the desired results and minimize negative outcomes that would have been revealed had it gone on longer?

4. There was a higher incidence in insulin resistence and type 2 diabetes among those who took Crestor than in the control group. And, this was all happened within 2 years. As mentioned, what other complications would we have seen had the study gone longer than 2 years, ...especially since now all people, even those with normal cholesterol levels, are "supposed" to be on statin drugs for the REST OF THEIR LIVES? It would be good to know what people can expect.4. According to Stanford University cardiologist Dr. Mark Hlatky, about 120 people would have to take Crestor for two years in order to prevent a single heart attack, stroke or death; and how many people would then suffer moderate to severe side-effects over the long-term? Again, as people would be encouraged to be on these drugs for the rest of their lives!

5. Crestor gave clear benefit in the study, but with so few heart attacks and deaths occurred among these low-risk people that treating EVERYONE in the U.S. alone with statin drugs would cost up to $10 billion a year.

6. Big Pharma presents statin drugs as the only choice to reduce CRP levels, when this is not the case.



What We Can Learn From This Study:


1. It is important to lower C Reactive Protein levels as a means to lower inflammation, which in turn reduces the risk of heart disease and stroke.

2. This study confirms that it is NOT the lowering of LDL cholesterol that is key to reducing the risk of heart attack and stroke, but the reducing of inflammation, as is evident by the lowering of C reactive protein (CRP). Therefore, what about all the studies that show alternative means (vitamins, minerals, antioxidants, and essential fatty acids) for lowering CRP, inflammation, and lipid peroxidation without any adverse effects?


What Can You Do?

1. Know, and lower your high-sensitivy CRP levels (as mentioned in my book): a. CRP less than 1.0 mg/L = Low Risk for CardioVascular Disease (CVD) b. CRP of 1.0 – 2.9 mg/L = Moderate Risk for CVD c. CRP greater than 3.0 = High Risk for CVD 2. Know, and lower your Homocysteine levels: a. Homocysteine less than 6.5 = Low Risk for CVD b. Homocysteine 6.6 to 8.0 = Low-Moderate Risk for CVD c. Homocyseine 8.1 to 10.4 = Moderate-High Risk for CVD d. Homocysteine greater than 10.4 = High Risk for CVD 3. Know, and lower your Lipid Peroxides a. This test is not commonly performed by most labs, but can be obtained. b. Keep Lipid Peroxidation low (according to print out on lab results)


How You Can Lower CRP, Homocysteine, and Lipid Peroxidation to Reduce Heart Attack & Stroke:

1. Statin Drugs: expensive; dangerous and sometimes deadly side-effects. a. See list of side-effects in The Cholesterol Conspiracy.
OR, .... even BETTER:
2. Lifestyle Changes: inexpensive, non-dangerous, …and it promotes health! a. Maintain a Healthy Weight b. Maintain a Low-Glycemic Diet (plenty of vegetables) c. Exercise d. Don’t Smoke e. Reduce Stress f. Adequate Sleep g. Drink Plenty of Pure Water h. Maintain Gum Health (brush, floss, and use Co-Q10) i. Use Full-Range Vitamins, Minerals, Antioxidants, and Omega-3 Essential Fatty Acids: (a few examples of many vitamins and antioxidants are shown below, though I personally recommend a full-range of vitamins, minerals, antioxidants, and essential fatty acids):

Vitamin C 2000 mg/day (vitamin C alone reduces CRP similar to statins)

B Complex Vitamins

Fish Oil (4000 mg per day)

Vitamin D (1000 to 5000 IU/day)

Turmeric Extract (400 to 800 mg/day)

Olive Extract (75 to 200 mg/day)

Grape Seed Extract and Resveratrol (200 to 400 mg/day)

Co-Enzyme Q10 (200 to 400 mg/day)

Betaine (TMG) (1800 to 3000 mg/day)

Magnesium (400 mg/day)


To see references (please see http://www.laddmcnamara.com/)
Posted by Ladd McNamara at 7:51 AM

Soy vs. Whey Protein: Which is Better?

Although I get asked, “Which is better, soy or whey protein?” …my question back is, “Better for what?” Each one is an excellent sources of protein, and each one has its own benefits. I suggest to use at least both sources of protein in order to obtain the benefits each provide. We need to consume protein in order to make and replace protein; and athletes and body-builders are very familiar with whey protein as an excellent source of “bio-available” protein.

Protein is essential for producing antibodies, hormones, new muscle tissue, and the oxygen-carrying protein in blood, hemoglobin. All protein lost or destroyed within the body must be replaced by bio-available protein in order for new tissue to be constructed.

Our bodies are able to manufacture many of the amino acids that are used to produce protein; however, there are nine “essential” amino acids that we cannot manufacture, but must obtain from the protein in our food. Not all protein sources provide these essential amino acids. For example, whey is an excellent source of glutathione and the branched chain essential amino acids L-leucine, L-valine and L-isoleucine.

The protein in most beans and vegetables may contain all the essential amino acids, but they are not naturally concentrated in foods, and thus vegans often do not readily obtain adequate amounts of protein, particularly the branch-chained amino acids. However, this can be compensated for by consuming concentrated protein sources, such as found within quality meal-replacement drinks.

Almost daily, I drink one or two nutritious meal-replacement drinks. These drinks not only contain a blend of both soy and whey proteins, they also contain protein from two additional sources, that of rice and pea. By obtaining a blend of proteins from these four sources one is obtaining all the essential amino acids and the benefits that each provide.

Soybeans contain high amounts of protein. Soy protein and soy isoflavones have been found to help reduce the symptoms of menopause, help reduce the risk of osteoporosis, and to help prevent a number of hormone-related diseases, such as endometrial cancer, breast cancer, and prostate cancer. (Neither soy nor soy isoflavones increase the risk of breast cancer; in fact quite the opposite, they help maintain breast health.)

In addition, soy has been observed to help maintain heart health. Even the Food and Drug Administration (FDA) has stated 25 grams of soy protein per day can reduce the chances of developing heart disease.

Soy protein has also been shown to help the thyroid, which can help with obtaining a leaner body. In the case of a soy allergy, the opposite would be true …reduced metabolism and weight gain.

If you are not allergic to soy, there are very few side effects to including soy in your diet. The most common side-effect of soy is the production of intestinal gas. Flatulence is a common side-effect of all beans (including soy), due to the bowel bacteria’s fermenting effect on the indigestible sugars contained within beans. Humans do not have the enzyme alpha-galactosidase necessary to break down the sugars that the bowel bacteria feast upon and produce gas.

Beano, purchased over-the-counter, contains alpha galactosidase, and regular use may be able to reduce gas production by breaking down the oligosaccharides (bean sugars) before the bacteria in the large bowel has a chance to ferment the sugar.

For those who are allergic to soy, gas would not be the only problem present, but significant diarrhea and abdominal bloating, hives, skin rash, and worst case, breathing problems. Soy isoflavones are not the same as pure soy protein; and even if one is allergic to soy it wound not mean they were allergic to soy isoflavones, as soy protein (the allergen of the allergy) is not found in soy isoflavones.

Whey protein is used by athletes and body builders because of the higher level of essential amino acids, particularly the branched chain amino acids that are metabolized in the muscle not the liver. Protein is critical in repairing not only muscle, but many other body tissues. Whey is helpful for weight loss and building muscle in those who work out, but will do little to help build muscle in those with sedentary lifestyles.

Whey protein affects the digestive tract in much the same way as yogurt. Therefore, it is considered to be a natural remedy for many intestinal issues. In fact, it is often used in Sweden to help prevent bowel problems, gas, and constipation. However, since whey is obtained from a dairy source (it is the liquid by-product of curdled milk … the solid becomes cheese, and the liquid protein part is dried as a source for whey). Therefore, those who are lactose intolerant should avoid whey protein, and steer towards soy protein only, as gas, constipation, and bloating can be significant. Over-the-counter Lactaid is available to help provide the enzyme necessary to break down dairy-derived lactose sugar found in whey products.

Since both soy and whey protein may lead to constipation, it is important to find a meal-replacement drink that provides adequate fiber to overcome this side-effect.

Whey protein makes a good alternative to those who are allergic to soy, and vice-versa, but the blend of soy and whey will render the user with the benefits of each, particularly if blended with adequate fiber, as mentioned. While companies selling protein supplements tout the benefits of whatever they’re selling as “the best,” whether it is soy, whey, or a combination of rice and pea protein, which together the last two alone hit numbers between 85 to 90% bioavailable protein, it is good to know that at least one company was wise enough to combine all four protein sources in their meal-replacement drinks, along with fiber, low-glycemic sugar, and vitamins and minerals. The balance is its greatest strength as a perfect meal replacement.
A summary of the benefits of Soy and Whey Proteins, and that you can have BOTH:

Soy Protein


Soy protein has been found to be higher in non-essential amino
The consumption of 25-50 grams of soy protein daily may enhance production of thyroid stimulation hormones that regulate the metabolic rate, thereby making it easier for us to lose both body weight and fat and create a leaner body
Soy is good for athletes: in a study from Romania endurance athletes experienced lean body mass, increased strength, and decrease fatigue while training. (Revue Roumaine de Physiologie 29, 3-4:63-70, 1992)
It contains more protein by weight than beef, fish or chicken, and contains less fat (especially saturated fat than meat).
The FDA has approved the following statement: ”Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease.”
Other studies show that soy protein isolate has the ability to effectively lower LDL cholesterol and triglyceride levels in the blood
Soy may improve kidney functioning
Whey Protein

Whey protein assists in losing excess weight and maintaining optimal weight
Whey protein, combined with resistance training, even those who have immunosuppressive disorders (AIDS) can increase body cell mass, muscle mass and muscle strength, according to a study in AIDS (15, 18:2431-40, 2001).
Whey protein is superior to other proteins when it comes to anabolic response. It has consistently been shown to stimulate the anabolic hormones after a workout. In other words, whey protein improves athletic performance
Whey mixes well and is low in fat and lactose, and has a superior amino acid profile
Whey protein lacks no essential amino acids. It needs no fortification or additive to make it complete. It is complete in its natural form
Whey enhances the immune system because it raises glutathione levels. Glutathione is a powerful antioxidant that helps our immune cells stay charged to help ward off cancer, bacterial infection and viruses. In other words, it helps improve the immune system.
Whey is also very high in glutamine and the branch chain amino acids L-leucine, L-valine and L-isoleucine, important aminos for repairing muscle
Whey acts as a natural antibacterial or anti-viral
Whey reduces the symptoms of Chronic Fatigue Syndrome
Whey reduces liver damage
Whey improves blood pressure
Whey improves the function of the digestive system
Whey reduces gastric mucosal injury seen in ulcerative colitis
Posted by Ladd McNamara at 8:04 AM:

Calcium and vitamin D enhance heart health benefits of weight loss

Weight loss and reduced waist circumference are related to an improvement in heart health and factors related to metabolic syndrome. According to a new study, supplementing with calcium and vitamin D during weight loss enhances heart health benefits in women with typically low calcium intake.

Recent research has shown that overweight individuals with low calcium and dairy consumption are at increased risk of developing metabolic syndrome. The findings suggest that adequate calcium intake could create a healthier metabolic profile similar to a balanced diet and regular exercise. In a new study, researchers investigated this issue by testing cardiovascular benefits of long-term calcium supplementation in women with usual low calcium intake. Healthy, overweight or obese women with a daily calcium intake of less than 800 mg/day were randomly assigned to 1 of 2 groups: the group consuming 2 tablets/day of a calcium + vitamin D supplement (600 mg elemental calcium and 200 IU vitamin D/tablet) or the group consuming placebo. Both groups completed a 15-week reduced calorie weight-loss program. Significant decreases in LDL cholesterol levels, as well as the ratios of Total to LDL and LDL to HDL were seen the calcium +D group. These changes were independent of the changes due to fat loss and reduced waist circumference. A tendency for more beneficial changes in HDL cholesterol, triglycerides, and total cholesterol was also observed in the calcium +D group.This was the first study to show that consumption of calcium +D during weight- loss enhances the beneficial effect of body weight loss on cardiovascular risk factors in overweight women with typically low calcium intake.

Source: Supplementation with calcium + vitamin D enhances the beneficial effect of weight loss on plasma lipid and lipoprotein concentrations, Geneviève C Major, Francine Alarie, Jean Doré, Sakouna Phouttama and Angelo Tremblay, American Journal of Clinical Nutrition, Vol. 85, No. 1, 54-59, January 2007

Supplemental vitamin D and calcium reduces risk of diabetes

The incidence of type-2 diabetes is lower among women who get adequate calcium and supplement with vitamin D. Researchers used data from the Nurses Health Study, which includes over 83,000 women, to study the relationship of calcium and vitamin D intake to type-2 diabetes.


After 20 years of follow-up, it was concluded that a combined daily intake of over 1,200 mg of calcium and more than 800 IU of vitamin D was associated with a 33 percent lower risk of type-2 diabetes. Interestingly, dietary vitamin D intake did not appear to provide any statistically significant benefit. But the women who supplemented with at least 400 IU of vitamin D had a 13% lower risk of diabetes when compared to those who took less than 100 IU per day. Both dietary and supplemental calcium resulted in decreased risk of type-2 diabetes, and those with overall intakes above 1,200 mg had a 21% lower risk than those who got less than 600 mg per day. Elevated intakes of calcium and vitamin D, especially from supplements, are significantly associated with lower incidence of type-2 diabetes.


Source: Vitamin D and Calcium Intake in Relation to Type 2 Diabetes in Women, Anastassios G. Pittas et al, Diabetes Care 29:650-656, 2006

My recommendation: Active Calcium

Vitamin D and calcium supplementation reduces cancer risk

A four year clinical was done that involved nearly 1200 women. This is the kind of study physicians love and always talk about when it comes to pharmaceutical trials. However, very few of them realize that there are these kinds of studies regarding the health benefits of taking supplements. Subjects were assigned to take 1400 mg of calcium alone, or 1400 mg of calcium plus 1100 IU of vitamin D, or a placebo. After only 4 years, the risk of developing any type of cancer was 60% lower in the vitamin D group. If you excluded the cancers diagnosed in the first year because these cancers were most likely already present before the study, there was a 77% reduction in all types of cancer in the vitamin D group.

The researchers pointed out that vitamin D has an effect on at least 200 human genes and is critical in the normal functioning of our immune system and cell division. When there is less than an optimal level of vitamin D, the regulatory process involving cell proliferation and differentiation becomes defective. This can lead to abnormal cell division and thus cancer growth. However, if individuals simply supplement their diet with 1100 IU of vitamin D, they can significantly decrease their risk of all cancers.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Vitamin D prevents and improves several diseases

Vitamin D has been shown to suppress inflammation in diseases like rheumatoid arthritis, congestive heart failure, and even stroke. Clinical studies have also shown that there is a decrease in the risk of both type 1 and 2 diabetes in individuals who supplement with vitamin D. There are far fewer falls in those elderly patients who supplement with vitamin D at this optimal level. Another important aspect is the fact that vitamin D is required for proper immune function. It is also known that those individuals who live in higher latitudes contract multiple sclerosis at far higher rates than those who obtain more sunshine throughout the year. Studies with supplementing even 400 IU of vitamin D have shown significant reduction in the risk of developing multiple sclerosis. The question is now arising that we need to actually be providing our bodies with much more vitamin D than we previously thought.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Inflammation and Vitamin D

Oxidative stress and inflammation is an underlying factor in the development of numerous age-related diseases. In clinical trials, vitamin D has been shown to suppress what is referred to as pro-inflammatory cytokines. This offers additional protection against conditions ranging from rheumatoid arthritis, prediabetes, heart failure, stroke, and heart disease.
It has become evident that those individuals who live in higher altitudes contract multiple sclerosis at much higher rates than those living where they get sunshine throughout the year. Scientists have identified specific vitamin D receptors in the white matter of the brain. The reduction in inflammation, which is the result of adequate vitamin D, may play a role in protecting you against developing multiple sclerosis.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Low Vitamin D levels increase cardiovascular risk

A report in the Archives of Internal Medicine (June 11,2007) added more evidence in the link of low vitamin D levels and heart disease. These researchers measured the 25-Hydroxy Vitamin D levels in over 15,000 women. Those women who had the lowest levels of vitamin D had significantly higher prevalence of hypertension, diabetes, and elevated triglyceride levels (the other fat in the blood other than cholesterol). These are all risk factors for heart disease and strokes.
These researchers again pointed out the fact that low vitamin D levels carry a significant risk factor to our health. They concluded that current intake of vitamin D is far to low for optimal health. This is why I recommend that my patients should get their vitamin D levels checked and act accordingly. First, to bring their vitamin D levels back up to the recommended level (at least greater than 50 ng/ml) and second, to maintain these levels by taking at least 1,000 to 1,200 IU of vitamin D in supplementation.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Carotenoids decrease risk of macular degeneration

One of the most concerning age-related disease is referred to as age-related macular degeneration. It is the leading cause of blindness in the elderly. This leads to the degeneration of an area in our eye called the macula, which is responsible for our central vision. When they look at someone, they are not able to see their face, but are able to see the area around their face.

Researchers have identified that the cause of this disease is oxidative stress. Several studies have been done that show that supplementation with a host of antioxidants including two carotenoids called lutein and zeaxanthin significantly decreases your risk of developing age-related macular degeneration.

Source: Neelam K, Hogg Re, et al. Carotenoids and co-antioxidants in age-related maculopathy. Ophthalmic Epidemiology. 2008 Nov-Dec;15(6):389-401.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Lycopene and other antioxidants decrease risk of heart disease

As you have been learning, oxidized LDL cholesterol and not native LDL is our enemy because it causes such inflammation of our arteries. Fat soluble vitamins are important because they can actually incorporate themselves into the LDL particle. They have been shown to have the ability to then make this LDL cholesterol less likely to be oxidized by excessive free radicals.

Lycopene and other fat soluble vitamins have been shown to protect our LDL cholesterol from becoming oxidized in epidemiological studies and human trials. Therefore, these studies show a decreased risk of developing cardiovascular disease.

Source: Riccioni G, Mancini B, et al. Protective effect of lycopene in cardiovascular disease. Eur Rev Med pharmacol Sci. 2008 May-June;12(3):183-90.

Vitamin B6 may sharply reduce the incidence of colon cancer

A large Scottish study has shown that increased intake of dietary and supplemental vitamin B6 is associated with a significant decrease in colon cancers. The investigators found that the higher the level of vitamin B6 intake the lower the risk of colon cancer. Subjects with the highest level of vitamin B6 were about 20% less likely to develop colon cancer than those individuals who had the lowest levels of vitamin B6.

Source: Dietary vitamin B6 intake and the risk of colorectal cancer, Theodoratou E, et al, Cancer Epidemiol Biomarkers Prev, 2008 Jan; 17(1):171-82

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

High Vitamin C level helps to prevent stroke

Investigators noted that high vitamin C levels may reflect healthy lifestyles and possible supplementation. They followed 20,649 men for nearly 10 years. People with the highest levels of vitamin C had a 42% lower risk of stroke when compared to those with the lowest levels of vitamin C. All other factors were accounted for in this study.

This is just another study that shows that the higher your level of antioxidants and in this case vitamin C, the lower your risk of having a cardiovascular even like a stroke. Eating a healthy diet that contains 6 to 8 servings of fruits and vegetables along with supplementation is certainly a good idea.

Source: Myint PK, Luben RN, et al. Plasma vitamin C concentrations predict risk of incidence of stroke over 10 years. Am J Clin Nutr. 2008 Jan;87(1):64-9

Vitamin D protects against stroke

Stroke is the fourth leading cause of death (140,000 per year in the US) in the US and Canada. Adverse drug reactions are the third leading cause of death (180,000 deaths per year in the US) in the US and Canada. Everyone is very concerned about having a stroke because of the major disability it can cause.
A study published in September 2008, revealed that for every small decrease in blood levels of vitamin D there was a startling 86% increase in fatal strokes. The researchers concluded that low levels of 25 hydorxyvitamin D levels are independently predictive of fatal strokes and they suggest that vitamin D supplementation is a promising approach in the prevention of strokes.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Sunlight exposure along with low antioxidant levels increases the risk of macular degeneration

A recent study suggests that protecting the eyes from sunlight exposure (using hats or protective sunglasses) and consuming high levels of dietary antioxidants may significantly reduce the risk of developing age-related macular degeneration. The researchers looked at lifetime sunlight exposure and measured blood antioxidant levels of vitamin C, vitamin E, zeaxanthin, and zinc. They evaluated 4,400 older people and found that individuals with the lowest antioxidant levels and greatest sunlight exposure significantly increased the risk of macular degeneration.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Low antioxidant levels associated with hardening of the arteries

A study looked at 220 men and women without a history of hardening of the arteries. Vitamin A, vitamin E, and Lycopene were decreased by over 50% in the participants who were found out to have hardening of the arteries (atherosclerosis) when compared to those who did not have any hardening of the arteries. The researchers concluded that regular intake of foods rich in antioxidant vitamins (nutritional supplementation) may slow the progression of hardening of the arteries and its consequences (heart attack or stroke).

Source: Plasma antioxidants and asymptomatic carotid atherosclerotic disease.http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=164691&Ausgabe=240434&ProduktNr=223977 Riccioni G et al. Ann Nutr Metab, 2008;53 (2):86-90

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Running for health

Running for health

FOR those of you who already belong to the club where you leap out of bed before dawn for a trot round the park with an ensuing healthy, rosy glow that gets friends and colleagues asking what your secret is, thumbs up to you.

It isn’t easy to drag one’s self from a warm bed at the crack of dawn to fit in a morning run, but here are some good reasons to give it a try.

Let’s take a look at the physical and health benefits of running first.

There is no doubt running has a load of great physical benefits. According to local sports physician and marathon runner Dr William Chan, running is one of the most effective ways to lose weight and tone up.

Runners get a great cardiovascular workout which is fantastic for the heart and lungs, allowing a person to burn an average of 70 to 80 calories for each kilometre run. Of course the number of calories burnt depends on your weight, fitness level and running pace.


Local sports physician and marathon runner Dr William Chan: ‘Running helps lower blood pressure by maintaining the elasticity of the arteries.’
Running also helps reduce body fat, thus allowing for an increase in lean muscle. Compared to other popular activities, such as biking and walking, running burns far more calories.

Dr Chan explains that whilst the average human being burns about 2,000 to 2,500 calories a day by simply existing, running 5km a day can burn an additional 350 to 400 calories, making weight loss a natural result.

Regular runners also claim that the activity suppresses appetite so you would feel less inclined to eat after a good exercise. But it is also a fact that whilst beginners lose weight quickly at first, the body soon gets used to the workouts and the weight stabilises after an initial period.

Losing weight is just one of the obvious health benefits. Unseen health benefits prove to be a form of motivation as well.

“Running helps lower blood pressure by maintaining the elasticity of the arteries. Whilst running, the arteries expand and contract more than usual, which keeps them elastic and the blood pressure low,” says Dr Chan.

It is a fact that many serious runners have unusually low blood pressure. Running also helps maximise the lungs’ potential, as it keeps them strong and powerful. While deep breaths force the lungs to use more tissue, the 50% of normally unused lung potential is utilised.

Running also serves to strengthen the heart and helps prevent heart attacks. The large muscle exercise it provides helps keep the cardio system efficient and strong. In fact, the heart of an inactive person beats 36,000 more times each day than that of a runner, as running keeps the arteries open and the blood flowing smoothly.


Running makes you healthy, but can it also make you happy?

According to Avanti Kumar, author of the recently published The Science of Happiness, it can!

“In these times of increasing turmoil, it’s crucial to make moments for both internal and external aerobics. The opportunity to do good things on both an inner and outer level needs to be grasped. While you run, your big dreams will come back to you.

“Try to use your run as a session to meditate and you will find that while running, plans will form, even while the blood races around your body. When you’ve finished your run, put these plans into action,” says Kumar.

The effect of happiness that running has on your body comes from endorphins, which are powerful hormone-like substances produced in the brain that function as the body’s own natural painkillers. During exercise, there is a release of endorphins in the body that are capable of producing feelings of euphoria and a general state of well-being. The feelings produced can be so powerful that they can actually mask pain.

Proving the point, Newton Yap from Runners Malaysia says: “Running is intoxicating in a good way unlike alcohol or cigarette addiction. When the endorphins course through my veins, I get ‘high’ but without the hangover. Running calms and cleanses what even the best drug or sedative and soaps cannot get at – the mind, heart and soul. Satisfaction guaranteed almost every time I do it.

“Running keeps me sane in this insane world. Running makes me want to be a better person. Running is living.”

This article was contributed by Standard Chartered KL Marathon 2009. This article was published in The Star online on 29th Apr 2009

Boosting bone density

By DR MILTON LUM

 

Taking vitamins, minerals and hormonal therapy are some of the ways to prevent brittle bones.

THE treatment goal in the management of osteoporosis is to increase bone density. The medicines available include vitamins, minerals, calcitriol, hormone therapy (HT), selective oestrogen receptor modulators (SERMS), bisphosphonates and recombinant parathyroid hormone.

A high calcium intake plays a crucial role as an adjunct to the other treatment options. Calcium intake has a synergistic bone protective effect along with hormone therapay in post-menopausal women, allowing a doubling or even tripling of the effect of the therapy.

Supplements

Hormones by themselves do not provide substances to form bone – they need to come from the diet. As such, the first step is to ensure that an adequate amount of calcium and vitamin is consumed daily.

Most people, particularly women, should get sufficient vitamins and minerals in their diet. A recent study found that 49% of post-menopausal Malaysian women have vitamin D levels below the normal range, despite the fact the sun is shining throughout the year. This, together with lower rates of calcium absorption and increased bone loss in post-menopausal women, contribute to the development of osteoporosis.

The daily requirement of vitamin D is 400 IU. If one is never in the sun, 800 IU of vitamin D is recommended. This has been shown to reduce fracture in the elderly who are vitamin D deficient. If calcium cannot be obtained from the diet, a calcium supplement may be required to attain the recommended daily requirement of 1,000 to 1,500mg of elemental calcium.

The risk of urinary tract stones is not increased if the calcium consumed does not exceed 1,500mg per day. It is advisable to drink plenty of water. Calcium should not be taken with fibre or iron supplements.

Calcitriol is a synthetic form of vitamin D used to treat osteoporosis. It is one of the most important active metabolites of vitamin D, which is needed for calcium absorption. Calcitriol increases intestinal calcium absorption, regulates bone mineralisation and the production of bone proteins. It prevents bone loss and increases bone mass thereby reducing fractures.

Alfacalcidol is converted in the liver to a metabolite of vitamin D3. It has a rapid onset of action and is safe and effective. It increases bone mineral density, improves biochemical markers and is effective in preventing osteoporotic fractures in the spine and those with mild to moderate osteoporosis.

Hormones

The oestrogen levels in a post-menopausal woman are about 10% that in the reproductive age group and progesterone is almost absent. Post-menopausal oestrogen is produced by the adrenal glands and fat.

Hormone therapy usually involves treatment with either oestrogen alone or in combination with progestogen to help compensate for the decrease in natural hormones. Its use only doubles the oestrogen level of a post-menopausal woman. Hence, even with hormone therapy, the oestrogen and progesterone levels of a post-menopausal woman do not reach the natural levels of a pre-menopausal woman.

The medicines used in hormone therapy are similar in certain aspects yet different in others, with different modes of action, side effects and adverse events. Hormone therapy is the only effective method for the management of menopausal symptoms..

The long-term use of hormone therapy, like all other medicines, has risks as well as benefits. It is beneficial in the prevention and treatment of osteoporosis but it is not the first line medicine as alternatives are available.

When hormone therapy is used for the treatment of menopausal symptoms, it will also decrease bone loss and prevent osteoporosis. Hence, during its intake, the alternatives need not be taken. Hormone therapy is also recommended in women who have premature menopause, that is, menopause below 40 years.

Hormone therapy is an effective method to prevent post-menopausal osteoporosis. It increases bone density at the spine, hip and peripheral sites, and reduces the risk of fractures. The beneficial effects of hormone therapy have been consistently reported in many studies. The potential risks must be weighed against the benefits.

As breast tissue is sensitive to hormones, there has been concern about breast cancer risk among hormone therapy users. Short-term use of less than five years does not appear to increase the risk of breast cancer.

There is some evidence that long-term hormone therapy use may be associated with a small increase in the incidence of breast cancer (with best evidence for combination of oestrogen and progestogen).

The Collaborative Group on Hormonal Factors in Breast Cancer, in an analysis of over 90% of breast cancer studies worldwide, estimate that there are 45 cases of breast cancer in 1,000 women at aged 50 in non-hormone therapy users.

It is estimated five years of hormone therapy use will result in two extra cases per 1,000 users; after 10 years of use, six extra cases per 1,000 users; and after 15 years of use, 12 extra cases per 1,000 users. The extra risk of developing breast cancer on hormone therapy does not persist beyond about five years after stopping its use.

There is good evidence that hormone therapy increases the risk of blood clots (venous thromboembolism) from one in 10,000 people a year to three. Most people who get a blood clot make a complete recovery with treatment. There is fair evidence that hormone therapy use is associated with a small increase in stroke incidence due mainly to an increase in thromboembolic stroke.

Unopposed oestrogen increases the development of endometrial hyperplasia and the risk of endometrial cancer. The addition of progestogen reduces the risk of endometrial cancer.

Oestrogen-only products are prescribed for women who have had a hysterectomy. All other women on hormone therapy will be prescribed an oestrogen-progestogen combination.

Prior to the commencement of hormone therapy, one needs to be assessed by the doctor particularly for conditions which would make hormone therapy unsuitable: current pregnancy, hormone dependent cancers, endometrium, venous thromboembolic disease, pulmonary embolism, severe liver disease, undiagnosed breast lump and uninvestigated abnormal vaginal bleeding.

Oestrogen is usually taken in hormone therapy unless there are contraindications. Various types of progestogens are added for endometrial protection in women with an intact uterus.

Tibolone is a synthetic steroid with mixed oestrogenic, progestogenic and androgenic actions. It is a prescribed for postmenopausal women and has to be taken continuously. It is used to treat vasomotor, psychological and libido problems, and also possesses bone protection.

Hormone therapy should be used under medical supervision. Long term use, such as more than five years, require close monitoring and a regular evaluation (at least annually).

·                                 Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

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·                                 This article was published in the Star online 29 Apr 2009