Cholesterol Drugs Increase Risk of Diabetes; Diabetes Drugs Increase Risk of Heart Attacks

In the age of medical specialists,  we can find ourselves being treated as a collection of conditions.   Our whole health can get lost.   You may find yourselves taking a variety of medications,  perhaps one for cholesterol,  another for high blood pressure and yet another to regulate blood glucose levels. These medications each may be appropriate,  but they also may works against each other.
Two studies regarding cholesterol lowering medications and a diabetes drugs are cases in point.

Lipitor, Crestor and other statin medications taken to lower cholesterol also increase the risk of diabetes,  by about a 9 percent, according to a study that quantified a complication that doctors only recently discovered.

Meanwhile, hundreds of people taking Avandia, a diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

The statin study analyzed 13 studies undetaken after a 2008 trial from London-based AstraZeneca unexpectedly found patients given its drug Crestor had a 25 percent higher risk of diabetes. The new analysis involving more than 90,000 patients, published in the journal Lancet, shows the actual increase in diabetes is 9 percent, the risk is tied to the entire class of medications and the danger increases with age. As a class,  statins are the leading class of drugs sold in the world today,  with annual sales exceeding $35 billion.

Avandia, the diabetes medication,   was once one of the biggest-selling drugs in the world. Driven in part by a multimillion-dollar advertising campaign, sales were $3.2 billion in 2006. But a 2007 study by a Cleveland Clinic cardiologist suggesting that the drug harmed the heart prompted the F.D.A. to issue a warning, and sales plunged. A committee of independent experts found in 2007 that Avandia might increase the risk of heart attack but recommended that it remain on the market, and an F.D.A. oversight board voted 8 to 7 to accept that advice.

Yes, medications may be approrpriate based on overall risk factors,  but they also are powerful chemicals that can negatively effect on our whole health.  A solution optimizing the power of nutrition to significantly improve whole health and prevent heart disease can be used in many cases --- either to avoid the intake of medications or significantly reduce the dosages required to achieve target health result. kardea nutrition - heart healthy and inspired - defining statin alternatives. kardea gourmet - great science, fantastic foods and cardiovascular health.

Lifestyle & Heart Health: Important 2009 Studies

January 4, 2009 Dallas, TX - The American Heart Association (AHA) chooses important 2009 research papers on heart health and lifestyle choices. One provides insights into obesity prevention and the "best diets." The other cautions that cardiovascular risk-factor control isn't just for older people. A third reviews the significant role of laws restricting smoking in public places to sharply lower the incidence of hospital admissions for heart attacks.

These selections emerged from a process led by the AHA immediate past president, president and president-elect. The choices were based on nominations from the organization's scientific councils. The chairs of the councils had been charged with recommending the year's "most meritorious, most substantial, most significant" papers in cardiovascular medicine, according to AHA current president Dr Clyde W Yancy (Baylor University Medical Center, Dallas, TX). Several of the studies in the final cut, he told heartwire, had been backed by multiple scientific councils.

No Best Diet

In a randomized comparison in more than 800 overweight adults of four "reduced-calorie" dietary interventions consisting of fat, protein, and carbohydrate intake in different proportions, such as 40%, 15%, and 45%, respectively, or 20%, 25%, 55%, respectively(1).

Participants lost about the same amount of weight over six months, an average of 6 kg, regardless of which group they were in; in general, metabolic risk factors also improved in all four groups.

In its coverage when the study was published, Dr Robert Eckel (University of Colorado Health Sciences Center, Denver) stated that the study affirms that people who are successful at losing weight are those who stick to a specific program. "Ownership, by the patient, of the weight-loss program is what proves successful, not the type of diet you chose," he said.

It really dismissed the notion that there's something clever about weight loss, showing that it really is about calorie consumption. "We all thought the statement made in that study was pretty profound," Yancy said. "It really dismissed the notion that there's something clever about weight loss, and that it really is about calorie consumption or, to make it even more straightforward, portion control. You can spend a lot of time wringing your hands about which diet and the composition of which diet, but it really is a simple equation of calories in and calories out."

Another analysis based on multiple studies that together indicated a 17% drop in estimated one-year risk of hospital admissions for acute MI in North American and European communities that adopted strong laws restricting smoking in public places, compared with rates in those communities before implementation of the restrictions (2). The risk declined steadily with increasing follow-up time.

And a combined analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study and Multi-Ethnic Study of Atherosclerosis (MESA) suggested that young adults with a low risk of developing heart disease over the short term (within 10 years) by conventional measures can be classified into high- and low-lifetime-risk groups [4]. Those with low short-term but high long-term risk were described as having a greater degree of atherosclerotic disease progression (3).

"This study is an important look at how the presence of risk factors early in life can be crucial to the lifetime risk of cardiovascular disease," according to the AHA. In its coverage of the analysis, heartwire quoted lead author Dr Jarett Berry (University of Texas Southwestern, Dallas), who said that even at younger ages, less than 50 years, "the clock is ticking" for many adults who are unaware that they already have progressive atherosclerosis.

Kardea Nutrition Serious Nutrition for Cardiovascular Health

Reference

(1)Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360:859-873.

(2)Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke. Circulation 2009; 120:1373-1379.

(3)Berry JD, Liu K, Folsom AR, et al. Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the Coronary Artery Risk Development in Young Adults study and Multi-ethnic Study of Atherosclerosis. Circulation 2009; 119:382-386.

Vitamin D Deficiency-A Potential Role in Cardiovascular Disease Prevention

Inadequate levels of vitamin D are associated with an increase in the risk of cardiovascular disease and death, a new observational study has found. Dr Tami L Bair (Intermountain Medical Center, Murray, UT) reported the findings here at the American Heart Association 2009 Scientific Sessions.

Bair and colleagues followed more than 27 000 people 50 years or older with no history of cardiovascular disease for just over a year and found that those with very low levels of vitamin D (<15 ng/mL) were 77% more likely to die, 45% more likely to develop coronary artery disease, and 78% more likely to have a stroke than those with normal levels (>30 ng/mL). Those deficient in vitamin D were also twice as likely to develop heart failure as those with normal levels.

"We concluded that even a moderate deficiency of vitamin D was associated with developing coronary artery disease, heart failure, stroke, and death," said coauthor Dr Heidi May (Intermountain Medical Center). However, "it is not known whether this is a cause and effect relationship," she told heartwire. Because this study was observational, more research is needed "to better establish the association between vitamin D deficiency and cardiovascular disease," she noted.

Evidence so far suggestive of benefit of vitamin D

Vitamin D was the subject of much discussion in a general session on vitamins at the AHA scientific sessions. While there is strong evidence supporting the benefits of vitamin D in cardiovascular disease, there have been only a few randomized clinical trials, and previous observational studies "show no robust effects," said Dr Harald Dobnig (Medical University of Graz, Austria). The latter suffer from limitations, such as doses of vitamin D supplementation that are too low, low compliance rates, and short study duration, he noted.

There are some large randomized trials underway looking at outcomes with vitamin D; it is hoped that they will provide definitive answers in five to seven years, Dr Eric Rimm (Harvard School of Public Health, Boston, MA) explained.

"I think there's promise for vitamin D. We know that most people have insufficient vitamin D levels in their blood," Rimm says. "So although it will take five years until some of the trials that are adequately powered to look at cardiovascular disease with vitamin D will report, the epidemiology right now is suggestive that people should have 1000 or 2000 IU of vitamin D a day," he said.
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Kardea Nutrition, guided by the recommendations fo the National Cholesterol Education Program, enables each of us optimize the power of therapeutic nutrition to advance cardiovascular health, naturally and deliciously.

High Cholesterol Under Treated in Many Americans

NEW YORK (Reuters Health) - A US study on cholesterol released today contains both good and bad news:

The good news: Between 1999 and 2006, the number of adults in the US with high levels of artery-clogging LDL cholesterol, the "bad" cholesterol, decreased by about one-third.

The bad news: A high percentage of adults still are not being screened or treated for high cholesterol levels, putting their health in jeopardy.

Adults at greatest risk for heart attack and other heart-related "events" continue to have the highest prevalence of high LDL cholesterol, Dr. Elena V. Kuklina and associates at the US Centers for Disease Control and Prevention in Atlanta found.

The researchers studied trends in the prevalence of screening, current use of cholesterol-lowering medication, and high LDL cholesterol levels across four periods: 1999-2000, 2001-2002, 2003-2004, and 2005-2006. Overall, there examined data on more than 7,000 adults.

Between 1999-2000 and 2005-2006, the prevalence of high LDL cholesterol levels fell from about 32 percent to 21 percent, the investigators report in Wednesday's edition JAMA (Journal of the American Medical Association).

The prevalence of high LDL cholesterol varied significantly by risk category, however. In 2005-2006, the prevalence high LDL-cholesterol was 59 percent in individuals at high risk for heart-related events, namely those with a history of heart disease, chest pain, heart attack, stroke or diabetes.

The prevalence of high LDL cholesterol was 30 percent in those at medium risk for heart problems and 11 percent in those at low risk. Individuals were stratified as medium or low risk depending on their number of such risk factors as cigarette smoking, high blood pressure, family history of heart problems, and LDL and "good" HDL cholesterol levels.

In the high-risk group, more than 35 percent had not been screened for high cholesterol in the last 5 years and nearly 40 percent were either untreated or inadequately treated for high cholesterol. Roughly 20 percent of high-risk subjects were candidates for statins or other cholesterol-lowering therapy but were not receiving it.

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Kardea Nutrition-enabling a scientifically-validated nutritional approach to cholesterol management and cardiovascular health---works alone or as a complement to conventional pharmaceuticals. See Kardea White Paper.

Wilted Spinach from Kardea Nutrition

1 Pound Fresh Spinach
2 Medium Cloves Garlic, chopped.
1.5 Tablespoon Kardea Extra Virgin Olive Oil with Added Plant Sterols

Wash the spinach carefully. Often, spinach comes with bits of dirt that are really unpleasant when grinding between your teeth. To clean, fill a pot with water and drop leaves in. The heavier dirt particle will fall to the bottom while the leaves float. Leaving the water in the pot, remove the spinach, place in a colander, rinse and drain.

Heat a larger frying pan on a medium-low to medium heat. Add 1.5 tablespoons of olive oil. When oil is hot, add garlic and then quickly add the spinach to the pan. Cover tightly. After the spinach has wilted, stir to assure that oil and garlic lightly coat all the leaves.

Salmon with Caper Berries, Vermouth & Apricot Preserve

Serves 4

When it comes to heart healthy Omega-3s, not all fish are created equal. Salmon remains one of the the best source of these heart healthy fatty acids. Lighter, whiter fish like sole, flounder and cod have substantially less. Even then, different types of salmon can deliver significantly different amounts. According to the United States Department of Agriculture, some types can deliver nearly twice as much omega-3s as others:

Atlantic, farmed: 2.5g
Atlantic, wild: 2.1g
Chinook: 2.0g
Coho: 1.5g
Sockeye: 1.4
USDA Nutrient Data Laboratory Database, Release 18

The cooking method also can substantially alter the Omega-3 content. If you broil or grill, you are likely to lose more of the Omega-3s than if you poach. There are two reasons here. First, when grilling or broiling, more of the Omega-3 will drain out of the fish. Moreover, in poaching, the broth is typically consumed. Any Omega-3s that do drain out of the fish are still eaten. The lower cooking temperatures associated with poaching also preserve the benefits of the Omega-3s.

There are terrific poaching recipes, but if you prefer the taste and texture of the broiled salmon, here is a Kardea Gourmet recipe that blends the great taste of broiling with the benefits of poaching.

2.0 Pounds Salmon Filet (skin on)
½ Cup Dry Vermouth (or White Wine)
2 Tablespoons Apricot Preserve
12 Caper Berries (or 2 teaspoons of capers)

In your oven, heat a heavy pan under the broiler. When the heavy pan is hot, place in the salmon with the skin side down. After 3-4 minutes under the broiler, turn oven to 325 degree.

While fish is broilng, heat vermouth in a sauce pan and then stir in the apricot perserve. Pour vermouth/apricot mixture over fish when you reduce the oven heat. Bake uncovered for 5 minutes. Add caper berries and cover. Bake fish until done, typically another 7-8 minutes depending on the thickness of the fillet. Serve with Kardea's wholesome barley pilaf--great for soaking up the sauce---and a wilted spinach.

Cardiovascular Disease: The Number 1 Killer of Women

So you think that cardiovascular disease is primarily a problem for men. Think again: More than 500,000 women in the U.S. die each year of cardiovascular disease, making it their No. 1 killer.

In fact, for a variety of complex reasons, the condition is more often fatal in women than in men and is more likely to leave women severely disabled by a stroke or congestive heart failure.

True, women don't usually start showing signs until their 60s--about 10 years after men first develop symptoms. And hormones seem to play a protective role in women before menopause.

But the common belief that premenopausal women are immune to heart problems is just plain wrong. Heart attacks strike 9,000 women younger than 45 each year.

The more scientists learn about a woman's heart and what can go wrong with it, the more they realize that females aren't just small males. There are subtle but important differences in how women's cardiovascular systems respond to stress, hormones, excess saturated fat and toxins like tobacco. There are also some pretty big differences in how aggressively doctors treat women with heart trouble--even in the emergency room when they are in most desperate need of help.

"The vast majority of heart attacks in women could be prevented with a combination of lifestyle modifications and medication," says Dr. JoAnn Manson at the Brigham and Women's Hospital in Boston. "Just making use of existing information could nearly eradicate the disease."

Of course, neither men nor women can do anything about their age or the genes they were born with. (If your father had a heart attack before 55 or your mother had a heart attack before 65, you should pay special attention to your heart health.) And it's still unclear why heart disease seems to strike men and women so differently. Structurally, their hearts and arteries are basically the same; women's hearts are smaller, but in proportion to their bodies. So doctors are pretty sure that any differences are matters of degree rather than kind.

Cardiologists are confident that they understand how heart attacks occur in men. The trouble usually begins when a fatty deposit or plaque, which has taken decades to build up on the inside of a coronary artery, becomes unstable and bursts, triggering a clot that blocks a blood vessel. Doctors can see these plaques during a fairly invasive procedure called an angiogram, in which a catheter is threaded through an artery in the groin or leg up to the arteries of the heart and a dye is then released to make any blockages easier to spot.

Although the research is controversial, some evidence suggests that bursting plaques may not be as important for women as for men. Doctors have long puzzled over the fact that some of their female heart-attack patients--usually those who have not yet gone through menopause--show few signs of artery-clogging plaques on their angiograms. Perhaps their blockages don't occur in the major arteries of the heart, where angiograms are performed and bypasses are most effective. Perhaps blood flow is restricted in the smaller vessels that branch off the coronary arteries. And perhaps the problem isn't plaques at all but the fact that these smaller blood vessels are somehow more prone to spasm, snapping shut at the slightest stress or trigger, cutting off the flow of blood to parts of the heart.

It's also possible that plaques--whether in the main coronary arteries or the smaller vessels--behave differently in women. Unlike men, women tend to distribute all the "garbage" associated with atherosclerosis--such as saturated fat and oxidized waste products--more evenly throughout the arteries. The process is analogous to the way men and women gain weight, says Dr. Noel Bairey Merz of the Cedars-Sinai Medical Center in Los Angeles. "When men get fat, it all goes to their belly," she says. "When women get fat, they tend to get fat all over--fat at the ankles, fat in the sides, fat in the upper arms." So although women generally avoid the monster plaques that kill so many men in early middle age, the continuing buildup in women's arteries may come back to haunt them in their 50s, 60s, 70s and 80s.

Plaques are another reason for women to throw away their cigarettes, as smoking seems to turn stable plaques into unstable ones. "If you look at the plaque under a microscope, it doesn't appear to be the kind of plaque that can become unstable and rupture," says Dr. Robert Bonow of the American Heart Association. "But the surface has become eroded, exposing the material beneath the surface to the blood, which causes blood clots. And it turns out that the women who have this plaque erosion tend to be women who smoked." Those clots can travel through the bloodstream, wreaking havoc in the heart or the brain.

Kardea Nutrition--Delivering Therapeutic Nutrition for Cardiovascular Health, Naturally.

Plant Sterols & Omega-3s Combine To Boost Heart Health

A combination of fish oil and plant sterols demonstrated over a 22% reduction in overall cardiovascular risk. In the September 2008 publication in Atherosclerosis, the researchers reported that they failed to demonstrate similar result for individuals taking fish oil alone.

The study's authors', Michelle A Micallef, University of Newcastle, and Manohar L, Garg, Hunter Medical Research Institute, write, "to date, this is the first study to investigate the combined cardioprotective effects of these two functional foods" in individuals with high cholesterol but without history of heart disease. The authors' conclude that the combine use of fish oil and plant sterol therapy is "an ideal alternative or adjunct to pharmacological treatments, for maximum cardioprotection ih high risk individuals."

Kardea Nutrition delivers a system of products that enable combination therapy, offering delicious foods and quality supplement. The Kardea system extends beyond fish oils and plant sterols to include cholesterol-lowering fiber and monounsaturated-rich extra-virgin olive oil.

Looking Beyond Lowering LDL Cholesterol

The risk of developing cardiovascular diseases is typically assessed based on a standard cholesterol test measuring LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels and then factoring advanced age, gender, family history of heart disease, high blood pressure, diabetes, and smoking. Taking these factors into account, LDL lowering targets can then be established, and a program of therapeutic changes in lifestyle and nutrition can be established. If these changes are unable to bring cholesterol levels in line, medications are routinely provided.

However, studies indicate that these risk factors can account for only a portion, perhaps 50%, of the incidence of coronary artery disease. The scientific community has continued its investigations, and is finding that a number of other risk factors can be identified through blood test. On its website, Berkeley Health Lab, a leading medical lab with an integrated program for cardiovascular treatment, identifies many of these important factors including:

Size of LDL Particles: Some LDLs Are Worse Than Others

• Small LDL particles can cause plaque build up to progress much faster because they can enter the artery wall easier than large LDL particles
• Too many small LDL particles can increase your risk for a heart attack beyond any other risk factors you may have, such as smoking, high blood pressure, diabetes, etc.
• Certain medications, proper nutrition, and regular exercise can help your body produce fewer small LDL particles

Size of HDL Particles: Some HDLS Are Better Than Others

• HDL helps to protect against progression of plaque build-up in the artery wall
• HDL2b is the workhorse of all of the HDL particle types. It has the ability to pick up and remove cholesterol
• Certain medications, improved nutrition, loss of body fat, stopping tobacco use, and increased physical activity are some ways that HDL-C and HDL2b can be improved

Apolipoprotein B: Accurate LDL Particle Number

• ApoB is a direct measurement of the amount of LDL ("bad" cholesterol) particles
• A high apoB number indicates increased risk for heart disease
• Improved eating habits, increased physical activity, and loss of body fat are some lifestyle changes that improve apoB
• Your physician uses apoB to determine if certain medications are needed and to monitor their effectiveness

C-Reactive Protein-hs (CRP)

• High levels of CRP indicate inflammation within the body due to infection or tissue injury; it can also predict heart disease risk levels
  Certain medications may help reduce this risk
  Certain foods have anti-inflammatory benefits

ApoE Genotype

• ApoE is a genetic test that plays a role in helping to identify how people respond to different amounts of dietary fat. Your body's response to dietary fat impacts the formation of small or large LDL particles
• There are 3 types of apoE genotypes: apoE2, apoE3 and apoE4
• People with an apoE4 have a greater risk for heart disease
• ApoE can be used to help guide the right nutrition plan for you

Other risk factors measurable through blood tests also are discussed on this site.

Overall, most of us typically receive the standard test for cholesterol, with these more thorough tests reserved for those individuals at high risk. Yet, for those of us interested in the information needed to optimize our long term health, this more complete assessment can be very useful. Check with you healthcare provider about obtaining these more extensive blood test to better direct your unique course for optimizing your health.

Kardea Nutrition Links Dietitians & Natural Foods Retailers with Natural Cholesterol Management Speakers’ Bureau

Lifestyle changes emphasizing therapeutic nutrition offer significant opportunities to positively affect a range of interconnected health issues --- including cholesterol management, metabolic syndrome, diabetes and hypertension. Generally, where these multiple issues occur, the importance of cholesterol management is amplified.

The challenge: consumers are often confused or misinformed in regard to the best ways to use nutrition to naturally improve cholesterol levels. Numerous studies, including those reviewed by the Food & Drug Administration, the American Heart Association and the National Institutes of Health, have shown that a 20-30% reduction in LDL cholesterol levels is readily achievable with nutritional therapy.

As part of an initiative to enhance consumer understanding, Kardea Nutrition is developing a program to link food retailers, particularly natural foods retailers, with registered dietitians.

Among the components of this Kardea initiative is the creation of a Natural Cholesterol Management Speakers’ Bureau. As part of this program, dietitians with proven expertise in cholesterol management will be providing in-store classes that address the integrated roles of fiber, plant sterols, niacin, omega-3s, and monounsaturated fats.

Nutritional health professional and natural foods retailers interested in participating in this program should contact Kardea Nutrition directly at customerservice@kardeanutrition.com.

Kardea Gourmet Bars: What Dietitians Are Saying

Here at Kardea Nutrition, we are on a mission to enable cholesterol management through a nutritional, natural approach. For some, this approach allows the individual to avoid the need for prescription medications. For others, it allows for sharply lower doses of these medication to achieve targeted cholesterol levels. For all, it offers an opportunity to optimize our longer term health.

While we are here to provide the products that better enable this lifestyle, the dietitians and nutritionists are in the field working with individuals each day to change lifestyles and create healthful eating habits. We are reaching out to these health profressionals across the country. Here are some responses that we have received:

"Thanks so much for sending the samples of the Kardea bars. The bars are great and the breakdown is just perfect - especially since I've been trying to find more products we can carry here with sterol esters."—Susan, MS, RD, LDN, Urbana, IL.

"They are fantastic! Love the fiber content and that you are using psyllium. … Many thanks." Stacey RD, CPT, Santa Monica, CA

"I love the bars. Thanks."---Jennifer MS, MPH, RD, Massachusetts (Corporate Wellness Manager)

"I received your samples, and tried one myself. It was very good. Will recommend to my patients. Thank you."---Vickie , MS, RD, CDE, Maryland

"I spoke with you earlier about your great product. I work for in the Employee Wellness Department at a major insurance company and we are actively seeking better for you products for our cafeteria. Additionally, we offer cholesterol screenings, health fairs, diabetes classes, etc. I am sure you will find great opportunities for both you and our company." ---Judith RD, LDN, CDE, Texas

"We are selling your bars like hot cakes."--Sarah, RD, LD, Iowa, In-store dietitian.

"Hi-I am a registered dietitian working for a company whose mission is to personalize the treatment of patients threatened with cardiovascular disease. A colleague of mine in NY mentioned she had sampled your product and was recommending it to her patients. I wondered if you might supply me with a sample as well. Thank you."--Stacey, RD, LD, Alabama

"Even as I write this I am preparing a presentation on the ‘role of foods and a sensible diet to manage cholesterol and heart health’ for an elite group of ADA spokespersons. I intend to showcase Kardea bar and oil in my presentation."---Kantha, PhD, Illinois.

Juvenile Diabetes & Cholesterol Management

Diabetes is not simply a challenging and chronic disease in its own right, but it also is a leading risk factor for cardiovascular diseases.

As a consequence, those with diabetes, including children and teenagers, are encouraged to take a more active approach to managing cholesterol levels. The American Academy of Pediatrics, for instance, recently recommended wider cholesterol screening for children. Underpinning these recommendations is the understanding that elevated LDL (bad) cholesterol in kids can lead to an onset of cardiovascular disease earlier in adulthood. It recognizes that the plaque in an adult's arteries may have begun developing very early in life.

The AAP also suggested that for a selected group of children, prescribing a statin medication might be appropriate. Drug treatment, according to these recommendations, should be considered for children 8 and older who face multiple risk factors for developing heart disease.

Yet, statins are not typically considered the first line of treatment. Instead, medical nutrition therapy is recommended. Medical nutrition therapy includes the following: decreasing saturated fat (less than 7% total daily calories), avoiding trans fatty acids, decreasing dietary cholesterol to less than 200 mg daily, increasing soluble fiber from oats, beans, psyllium or fruits, and adding plant sterols daily.

In a recent study published in Diabetes Education, the role of medical nutrition therapy was evaluated in a patient with Type II diabetes. The patient achieved a desired LDL cholesterols level through nutrition alone. Medications were not required.

The Study's author concluded that evidence-based nutrition guidelines have been evaluated and reviewed to demonstrate the effectiveness of heart-healthy eating for children with hyperlipidemia and type 1 diabetes.

Cardiovascular Disease Prevention: Between Healthy Habits and Prescription Medications

With cardiovascular disease the largest cause of death and disability in the United States, the scientific community continues intense investigations into approaches for prevention. In the New England Journal of Medicine, Doctor Mark Hlatky of Stamford University School of Medicine, writes, "The aphorism 'prevention is better than cure' makes perfect sense when applied to healthy habits such as following a sensible diet, maintaining an ideal body weight, exercising regularly, and not smoking. But increasingly, prevention of cardiovascular disease includes drug therapy, particularly statins to lower cholesterol levels."

In this editorial, Dr. Hlatky is reponding to the growing interest in prescribing cholesterol-lowering medications to a much larger segment of the American population---including those with cholesterol levels well below the risk standards established by the National Cholesterol Education Program of the National Institutes of Health. These medications already are the single largest class of drugs sold in the U.S. today, exceeding $30 billion/year.

There is mounting evidence that lowering LDL cholesterol below the NCEP risk-adjusted standards is reducing the incidence of cardiovascular events such as heart attack and strokes. Further, recent studies, notably the JUPITER study published in the New England Journal of Medicine, reinforces the evidence that statin medications not only favorably alters cholesterol levels but also reduce the level of inflammation in the arteries. In addressing inflammation, the medication may reduce a root cause of arterial plaque development.

Yet, what remains lost in the discussions between healthy habits and drug treatment is the positive, therapeutic power of nutrition. Nutritional solutions extends beyond the restriction of saturated fats, trans fats and cholesterol to nutrients that actively improve cholesterol levels and reduce inflammation. For many, these nutritional tools can allow the individual to achieve target cholesterol levels and serve as an effective statin alternative. For others, the nutritional approach offers an opportunity for reductions in the dosages and number of medications required to achieve heart healthy targets.

The tragedy: compared with the funding for pharmaceutical studies, an incredible small amount of money is being spent to advance the nutritional science. With few major studies reporting on the benefits of nutritional cholesterol management, the news media reports on the pharmaceutical studies. The extensive and widely reviewed understanding of the nutritional solution is then overshadowed.

Here at Kardea, we are working to provide you with both the knowledge and the natural products that advance heart health. We are only one source. For others, discuss with your medical providers. Also, check out our the resource page on the Kardea Nutrition website or for great recipes for cholesterol management, click over to Kardea Gourmet .

Another good source of information: http://cholesterol.about.com/od/treatments/u/Treatments.htm

Kardea Nutrition, Heart Healthy & Inspired.

Cholesterol Education Month A Good Time to Consider Statin Alternatives

September is National Cholesterol Education Month.

The stakes are high. Cardiovascular disease remains the leading cause of death and morbidity in the U.S. Cholesterol management is a leading focus for disease prevention. Sales of related medications now exceed $30 billion in annual sales.

With a passion for natural health, we know well that therapeutic nutrition---based on balanced diets incorporating good fats, viscous soluble fiber, plant sterols and selected other nutrients---can achieve significant improvements in blood lipid profiles. We can lower LDL (bad) cholesterol and triglycerides. We can raise HDL (good) cholesterol. We can reduce the inflammation that trigger arterial plaque development.

The science is more than solid. It is endorsed by the National Institutes of Health, the American College of Cardiology and the American Heart Association. The FDA endorses health claims associated with these nutritents. Overall, therapeutic nutrition can deliver results comparable to many cholesterol-lowering medications.

Yet, the new Lipitor ad campaign eclipses any public education promoting the natural alternatives.

We certainly are not opposed to the medical solution, but as a matter of public policy, our society would be far better served by an extensive therapeutic nutrition campaign than by the Pharma consumer campaigns.

Perhaps we should insist on equal time---for every dollar Big Pharma spends to promote a cholesterol-lowering medication, it should be required to spend an equivalent amount on a separate therapeutic nutrition campaign. In the meantime, raising consumer awareness remains an important function of the natural and health food retailers, and the nutritional health professionals.

Kardea Nutrition--hearty health and inspired---enabling natural cholesterol management.

Cholesterol Management: Beyond Disease Prevention

The guidelines of the National Cholesterol Education Program define LDL cholesterol below 100mg/dl as optimal for otherwise healthy people. Yet, as a matter of disease prevention, these same guidelines suggest that substantially higher levels of LDL cholesterol may be acceptable. These standards are used as a baseline for determining the appropriateness of cholesterol-lowering medications.


Many doctors also are well aware that the non-optimal LDL standards are only a baseline. These doctors are apt to prescribe a cholesterol-lowering medication to achieve the more optimal level.

Here at Kardea, we look to natural cholesterol management to achieve the more optimal levels. Yes, medications may be needed by some, but a nutritional approach has proven as potent as many pharmaceutical therapies. And we recognize that cholesterol management extends well beyond simply lowering LDLs. Our prior blog posts and the numerous links and articles found on our resources page explore this more comprehensive approach.

The important point: cholesterol management is consistent with good health, not simply disease prevention. Whatever your currents levels ---- even if you believe that your cholesterol is not at risky levels ---- consider the benefits of pursuing a more integrated and comprehensive approach.

Intermediate Dose Niacin and Natural Cholesterol Management

Niacin, also known as Vitamin B3, is vital for good health. Niacin helps convert food into energy, build red blood cell counts, and synthesize hormones.

For basic good health, a relatively small amount of niacin, about 20mg/day, is needed. Americans typically obtain this level from a balanced, healthy diet. Our bodies also can manufacture niacin.

At substantially higher levels—1000-2500mg/day--- a specific type of niacin significantly improves cholesterol levels. Niacin as nicotinic acid can lower LDL cholesterol by up to 25%, raise HDL cholesterol by as much as 35%, and lower triglyceride levels by 20% to 50%.[i] The medical community[ii] generally defines these high dosages as a drug that should be taken under a physician’s care. The primary concerns relate to potential liver complications. A doctor will monitor liver function as part of a routine blood test. As a practical matter, the very real and sometimes intense flushing side-effects associated with nicotinic acid at these levels may make a “buffered” prescription nicotinic acid the only viable option.

Nonetheless, nicotinic acid supplements are approved for sale by the Food and Drug Administration. Further, the intake of niacin at intermediate dosage levels --- 100-1000mg/day---has been shown to significantly improve the levels of both HDLs and triglycerides. Coupled with other elements of natural cholesterol management, intermediate dosage of niacin in the form of supplements may provide a meaningful contribution in long term cardiovascular health.

Cholesterols Management: Beyond LDL Reduction

LDL cholesterol reduction has been the primary focus of the medical and pharmaceutical community. This focus is supported by the significant and extensive research confirming the positive health effects of lowered LDL, including reduced heart attacks, strokes and other cardiovascular diseases.

Increasingly, medical science recognizes that LDL reduction alone is only part of cholesterol management and cardiovascular health and wellness.

Researchers are assessing the composition of cholesterol and triglycerides in our blood. For instance, the NIHs’ National Cholesterol Education Program (NCEP) reports that “strong epidemiological evidence links low levels of serum HDL cholesterol to increased CHD (coronary heart disease). High HDL-cholesterol conversely conveys reduced risk.”[iii] The NCEP identifies having HDLs less than 40mg/dl as a risk factor for heart disease. Levels above 60mg/dl are associated with a reduced risk of heart disease.

Statins, the leading medication for LDL reduction, have been associated with some HDL increases. Yet, under the NCEP guidelines, statins are typically recommended only when LDL levels are elevated.

Low HDL levels without elevated LDL levels are nonetheless fairly common. Up to 50% of patients not typically candidates for LDL-lowering medications have low levels of HDLs. In patients with premature coronary artery disease, low HDL levels are the most common abnormality in blood lipids.[iv]

A number of recent studies indicate that small increases in HDLs can significantly reduce the incidence of cardiovascular-related death. A 1mg/dl increase in HDL has been associated with a 2%-3% reduction in coronary artery disease.[v] Another extensive study concluded that increasing HDLs by 6% in patients with low HDL cholesterol decreased heart-related deaths and non-fatal heart attacks by 22%.[vi]

Intermediate Daily Dosages of Niacin as Nicotinic Acid

Between the 20mg recommended for basic health and the 100x greater levels used to manage at-risk patients lies a potential role for niacin for promoting cardiovascular health. In one study, patients took 50mg of niacin as nicotinic acid twice per day for 3 months. The patients on the niacin experienced an average 5% increase in HDLs, or an average of 2.1mg/dl.[vii] In another study, 500mg/day of niacin as nicotinic acid raised HDLs by 10% (close to 5mg/dl) and lowered LDLs by 5% and Triglycerides by 5%.[viii] At 1000mg/day, improvements were 15%, 7% and 11% for HDL, LDL and triglycerides respectively.

The medical community has refrained from endorsing the use of nicotinic acid supplements at these dosage levels as part of a more natural, statin-free solution to blood lipid management. The medical community’s reticence flows, in part, from doctors’ distrust of nutritional supplements. Supplements are subject to fewer regulations than pharmaceuticals, but the industry also is not without regulatory requirements, and many high quality and reliable supplement manufacturers and retailers exist.

Another issue surrounding niacin relates to the potential for consumer confusion. There are three types of niacin available---nicotinic acid, niacinamide, inositol hexanicotinate. Only nicotinic acid has been shown to be effective for cholesterol management.

Further, there are three forms of nicotinic acid—immediate release, sustained release and extended release.

Immediate release nicotinic acid often causes a very uncomfortable flushing of the skin accompanied by an intense feeling of heat, tingling and itching---even at relatively low levels of niacin. The flushing can start a few minutes or a few hours after taking niacin. Flushing typically subsides within 30 minutes, often much sooner.

At the intermediate dosage levels, flushing can be managed by gradually increasing the levels of nicotinic acid. You can start by trying 50mg with lunch and dinner. As your body grows accustomed to these levels, you can try raising your niacin intake with these meals. You might also try taking nicotinic acid before bed.

For individuals who cannot overcome the flush or for those looking to move to higher a dosage level, nicotinic acid is sold as a supplement in a sustained release version. The sustained releases version reduces the intensity of flushing, but at higher levels, it has been associated with liver damage.

The third form of nicotinic acid, extended release niacin, is available as a prescription. This form has typically been used at high level and only to treat harmful cholesterol levels that cannot be remedied through nutrition, certain lifestyle changes and statins.

Integrating Niacin into Natural Cholesterol Management

Intermediate doses of niacin as nicotinic acid may be meaningful for raising HDL cholesterol for cardiovascular health promotion, since the corresponding 5-10% increase in HDLs can significantly lower the risk of heart attack. The impact at these dosage levels alone may fall short of achieving more optimal cholesterol and triglyceride levels. When coupled with other nutrients, however, these niacin dosages may enable an individual to achieve optimal targets. Substantial LDL reductions can be further achieved through the restricted intakes of saturated and trans fats, higher intakes of monounsaturated fats, and therapeutic levels of plant sterols and selected types of fibers (including soluble fiber from oats, barley, psyllium, beans and certain fruits) .[ix] While Omega-3s have not been proven to lower LDL cholesterol, they lower triglycerides and may positively alter other factors leading to the build-up of arterial plaque. Modest weight loss and increased physical activity can further raise HDLs.

With many Americans suffering from the side-effects of statins and others preferring to minimize a lifetime of prescription drugs, it seems appropriate for the medical community to take a greater interest in the role of intermediate dosages of niacin, particularly as a component of broader therapeutic nutrition efforts.
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[i] Anne Goldberg, M.D. et al, Multiple-Dose Efficacy and Safety of an Extended-Release Form of Niacin in the Management of Hyperlipidemia. The American Journal of Cardiology, Vol. 85, pp 1100-1105 May 1, 2000.

[ii] Detection, Evaluation & Treatment of High Blood Cholesterol in Adults, Third Report of the National Cholesterol Education Program Expert Panel National Institute of Heart, Lung and Blood Institute, National Institutes of Health, September 2002. www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

[iii] Ibid ”II Rational for Intervention”.

[iv] Ibid.

[v] DJ Gordon et al., High Density Lipoprotein Cholesterol and Disease: Four Prospective American Studies, Circulation 1989

[vi] HB Robins et al., Gemfibrozil for the Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein Cholesterol, The New England Journal of Medicine 1999.

[vii] Jennifer Wink, MD et al., Effect of Very-Low-dose Niacin on High-Density Lipoprotein in Patients Undergoing Long-Term Statin Therapy, American Heart Journal, Volume 143, Number 3, March 2002.

[viii] Goldberg Op Cite, p1102

[ix] Ibid

Statins for Our Kids?

The American Academy of Pediatrics is recommending wider cholesterol screening for children. Underpinning these recommendations is the understanding that elevated LDL (bad) cholesterol in kids can lead to an onset of cardiovascular disease earlier in adulthood. It recognizes that the plaque in an adult's arteries may have begun developing very early in life.

The recommendations call for cholesterol screening of children and adolescents, starting as early as the age of 2 and no later than the age of 10, if they come from families with a history of high cholesterol or heart attacks before 55 for men and 65for women.

Screening is also recommended for children when family history is unknown, or if they have other risk factors, like being at or above the 85th percentile for weight, or have diabetes. If the child’s cholesterol level is normal, retesting is suggested in three to five years.

The report also suggests that for a selected group of children, prescribing a statin medication might be appropriate. Drug treatment, according to these recommendations, should be considered for children 8 and older who have very elevated LDLs, or when family history or weight indicate multiple risk factors for developing heart disease.

Not surprisingly, these recommendations raised an outcry.

“When you have a kid whose cholesterol looks like an overweight 65-year-old, what do you do?” asks Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston and quoted in The New York Times. In developing the recommendations, we "had to balance the risks of treating children with powerful drugs, about which there is limited long-term data, with the risks of not treating children with unprecedented cardiovascular disease risk factors.”

Dr Ludwig also is reflective about these recommendations. Quoted in the Times, he comments “my concern is what this is saying about society when we are so quick to prescribe drugs for these conditions before having systematically attacked the problem from the public health perspective”.

For many, the systematic solution focuses on addressing childhood obesity. No doubt, an extraordinarily important challenge in its own right. Yet, cholesterol management in children go beyond issues associated with obesity. Elevated cholesterol can be found in otherwise fit and thin adults and children alike.

Between weight loss and medication lies therapeutic nutrition as outlined by the National Cholesterol Education Program (NCEP) of the National Institutes of Health. Eating a balanced diet that replaces saturated fats and trans fats with monounsaturated fats (e.g. fats in olive oil, nut butters), adds high levels of soluble fiber from oats, beans, high-pectin fruits, and psyllium) and adds plant sterols can significantly improve cholesterol and blood lipid profiles. Other nutrients, including Omega-3s from fish oils, also have been found useful.

The NCEP asserts that therapeutic lifestyle changes with a particular emphasis on what we eat (not simply how much we eat) can deliver results comparable to many cholesterol-lowering medications. For links to the NCEP reports, clinical research and other educational materials advancing natural cholesterol management: Kardea Nutrition http://www.kardeanutrition.com/. For recipes: http://www.kardeagourmet.com/

Red Yeast Rice: Statin Alternative or Natural Statin

A study recently published in the Mayo Clinic Proceeding has confirmed the power of natural alternatives for cholesterol management. The study, authored by group of doctors and researchers associated with University of Pennsylvania, found that a combination of the Therapeutic Lifestyle Changes (TLC) recommended by the National Cholesterol Education Program (NCEP) of the National Institutes of Health coupled with red yeast rice and fish oil supplements led to a more substantial reduction in LDL (bad) cholesterol than did simvastatin, a statin medication sold by Merck Drug under the brand name Zocor.


The authors wrote “our study was designed to test a comprehensive and holistic approach to lipid lowering…. These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition, hyperlipidemia”

Statin Alternative or Natural Statin

The media reported the study as an “alternative to statins.” In reality, the choice is between a prescription, controlled statin and a natural source of statins. The active ingredient in red yeast rice supplements is a naturally occurring statin. It is chemically similar to the prescription lovastatin sold by Merck under the brand name of Mevacor. In short, red yeast rice does not represent a statin alternative, but rather a natural source of statins.

For those of us with a predisposition to natural products, this may seem like an intriguing option, but red yeast rice supplements face some important challenges. The authors of this study outlined the issues:
• In 2001, the US Food and Drug Administration determined that red yeast rice with a controlled level of the lovastatin was a drug, not a dietary supplement.
• As a result, the supplement manufacturer cannot control or test for the active compounds in red yeast rice supplement. While the chemical composition of the red yeast rice supplement used in the study was known and controlled, the composition of various products and the batch consistency between lots from the same source make recommending red yest rice supplements difficult.
• Taking red yeast rice without a physician’s supervision could also have unknown risks. The lovastatin component can cause the same side effects as any statin, and a potentially dangerous metabolite, citrinin, can form in poorly manufactured preparations.

Statin Alternative Do Exist

The American Heart Association, the American College of Cardiology, the American College of Preventive Medicine and many other health and medical organization participated in developing the NCEP recommendations. The recommendations emphasize that “many people will be able to lower their LDL enough” with lifestyle and nutritional changes alone. The NCEP reports that “if your LDL needs more lowering, you may have to take a cholesterol-lowering drug” in addition to the lifestyle changes . “However, by staying on the TLC Program, you’ll be keeping that drug at the lowest possible dose. “

The Kardea website provides an extensive amount of information about TLC. It also addresses some of the nutrients not specifically recommended by the NCEP, but widely reviewed by the medical community. The important point: before taking a statin----from a prescription or an herbal supplement---consider your alternatives.

WebMD Addresses Natural Cholesterol Management

WebMD has recently released an online video addressing natural cholesterol management. View Video.

In the accompanying artcle, WebMD reports, "To lower your cholesterol, ...a handful of some "functional foods" have been shown to make a big impact on your cholesterol levels."

"These foods may not be magic, but they're close to it," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association quoted in the WebMD article.

The article continues that "studies have shown that a diet combining these "superfoods" may work as well as some cholesterol-lowering medicines to reduce your "bad" LDL cholesterol levels." This is great news for the 105 million adults in the U.S. with high cholesterol, particularly for the many people that can't handle the side effects from cholesterol drugs.

The Kardea website provides an excellent overview of how these key nutritions fit into a heart health diet. And for recipes enabling therapeutic nutrition for cholesterol management, click to Kardea Gourmet.

Plant Sterols: What Are They? How Do They Work?

Plants produce plant sterols. Animals produce cholesterol. Structurally similar, both bind to sites in our intestines where the cholesterol produced in our livers and consumed in our foods are absorbed into our blood.

Yet, our bodies have evolved the ability to distinguish between these types of sterols. On average, we absorb about 55% of cholesterol and less than 1% of the plant sterols. Plant sterols work to lower cholesterol by filling the "absorption gateways," thus blocking the cholesterol from entering the blood stream. Blocked cholesterol is execreted along with most of the plant sterols.

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils (sources of plant sterols). The average plant sterol intake in the U.S. is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods are typically required to obtain these levels.

The effectiveness of plant sterols will vary from person-to-person. Many people absorb cholesterol more effectively than others. For these individuals, the impact of plant sterols may be more significant.

Overall, plant sterols are an important component of a nutritional system designed to promote healthier cholesterol and blood lipid levels. Achieving maximum benefits from natural cholesterol management may require other nutrients---including the soluble fibers found in oats, beans, fruit and psyllium, certain types of niacin, Omega-3s, monounsaturated fats in place of saturated fats----all in the context of balanced nutrition, calorie-mindfulness and physcial activity.