Mixing Meds---Another Alert

Cholesterol managing medications remain the single largest class of drugs sold in the world. High blood pressure medications are not far behind. The reason: unlike a medication to treat an acute and passing infection, these medications are often taken for a lifetime.

Here at Kardea, we look to the power of therapeutic nutrition and other lifestyle changes to allow an individual achieve healthy heart results either without the medications or at least with lower dosage levels.

Our interest is motivated less by the potential power of a given medication to achieve the specific result. Rather, our interest lies with the fact that a given drug is likely to be appropriate for one health concern. Yet, as we age, we often will face multiple condition --- and we take multiple medications for each condition---sometimes simply to treat the side effects of the first medications. I certanly have been watching my 83 year old mother and 90 year old father add an another medication with each passing birthday. It is the cocktail of medications that I find alarming. The long term interactions among these drugs are uncertain....but each drug is a powerful chemical agent.

Here is a case in point:

On November 17, 2009, the Food and Drug Administration warned consumers not to take popular heartburn medications Nexium or Prilosec if they use Plavix, a widely prescribed blood thinner that guards against heart attack and stroke.

The two heartburn formulations can reduce the protective blood-thinning effect of Plavix, a medication widely advertised directly to consumers, by nearly one-half, according to a study undertaken at the request of the FDA.

Heartburn medications are commonly used with Plavix because it can cause upset stomach.

A leading medical industry watchdog welcomed the FDA's action, but said it's late and not forceful enough. The FDA should have required a more prominent "black box" warning, said Sidney Wolfe, director of Public Citizen's Health Research Group. "You're getting a less effective dose of a potentially life-saving drug," said Wolfe, who also is a member of the FDA's Drug Safety and Risk Management Committee. "This is a serious issue."

Kudos to Dr Wolfe and the FDA...but one can only guess that more than one patient taking both Plavix and on these heartburn medications was prescribed a higher dosage or this Plavix or treated with yet another medication.

Strategies to Increase Good HDL Cholesterol

When it comes to cholesterol, most people think lower is better. But when we're talking about the cholesterol in our blood, it's a bit more complicated.

Low-density lipoprotein, or LDL, is known as the "bad" cholesterol and high-density lipoprotein, or HDL, is known as the "good" cholesterol. LDL optimally should be less than 100 mg/dL (milligrams per deciliter)---above this level, some amount of arterial plaque (the stuff that causes blocks in the arteries that can lead to heart attacks and stroke) is likely to develop. You and your doctor may or may not seek to lower your cholesterol levels if they are higher. This depends on a variety of risk factors. To assess your maximum LDL targets, click to the Kardea LDL Cholesterol Calculator based on the recommendations of the National Cholesterol Education Program. And if you are at high risk of heart disease, you and your doctor may seek to drive your cholesterol below 70mg/dL.

HDL cholesterol removes excess cholesterol from the blood, which slows the build-up in the arteries and ultimately lowers heart disease risk. Since estrogen increases HDL, women tend to have higher levels than men. Women should strive for an HDL above 50 mg/dL and men above 40 mg/dL. While genetics plays a role in your HDL level, there are some things you can do to modestly boost a sagging HDL:

• Lose weight if you're overweight. Exercising and cutting a few calories can give HDL a little boost, especially if you carry most of your excess weight in your abdomen.
• Quit smoking. Smoking, as well as secondhand smoke, can lower HDL.
• Recognize that different types of fats affect your HDL levels. Healthy fat choices such as omega-3s found in fish and monounsaturated fats found in olive oil and canola oil, nuts, seeds and avocados should be used---replacing the satured and trans fats found in processed foods, certain meats and dairy products.
  • Alcohol can raise HDL. If you can safely fit alcohol into your eating plan, keep it moderate -- no more than one drink a day for women and two drinks for men.

Also, you can consider the use of niacin as nicotinic acid. Available as both a supplement and a prescription medication, this form of niacin can significantly raise your HDLs. For an overview on niacin, read Kardea's discussion paper. And remember, in developing a program that optimizes your heart health and cholesterol profiles, it is best to collaborate with your health care professionals.

Father's Day Gourmet & Cholesterol Management

The science is clear and convincing. Therapeutic nutrition---that incorporates 2g of plant sterols, over 10g of soluble fiber, monounsaturated fats replacing saturated and trans fats, and reduced animal sources of protein-- can achieve cholesterol reductions comparable to many of the widely prescribed medications.

With my daughter, we have created a delicious, natural, cholesterol-lowering Father’s Day menu.

We recommend recipes for lunch, a snack and dinner. With a single serving of each dish, you will enjoy:

• 2g of natural plant sterols from foods and taken through the course of the day.
• 30g of total fiber
• 7 grams of heart healthy soluble fiber.
• 1g Omega-3 fatty acids (EPA/DHA)
• Only 150mg of dietary cholesterol (from the chicken and salmon)
• Saturated fat is below 7 percent of total calories.
• Monounsaturated fats equal about 23% of total calories.

Overall, we are nearly in-line with the recommendations of the National Cholesterol Education Program, but we fall a bit short on the heart healthy soluble fiber.

So look to breakfast to finish your therapy. Here are some simple guidelines. A good morning start would be an oat cereal and fruit. If you are looking for something a bit more interesting, there are a number of oat pancake recipes that can be found online. Stay away from the ones with butter and lots of eggs in the ingredients. Either way, you should get you to the 10g minimum recommendations for soluble fiber.

In my life, I actually shoot for the higher, 20-25g recommendation. The only way I have been able to achieve this goal is with psyllium husk or concentrated oat bran. I dissolve a tablespoon of one of these fibers into my morning juice. A heaping tablespoon of the psyllium husk, for instance, delivers 9g of heart health soluble fiber. Most people can tolerate such a dosage, but it is probably something you need to work up to.

The Menu

Luncheon
Mediterranean Salmon Salad
Chick Peas with Oregano
Roasted Asparagus
Whole Grain Bread or Whole Wheat Roll

Snack
Kardea Gourmet Nutrition Bar with 1g plant sterols, 7g fiber, and 7g protein.

Dinner
1st Course
Gazpacho: Quick, Bold & Delicious

2nd Course
Chicken Balsamic Reduction
Steamed Broccoli
Barley Pilaf

Dessert
Sorbet of Your Choosing
Fresh Berries or Sliced Ripe Peaches.

Polyunsaturated Fatty Acids: Recommendations from the National Cholesterol Education Program

NCEP Evidence: Linoleic acid*, a polyunsaturated fatty acid, reduces LDL cholesterol levels when substituted for saturated fatty acids in diets (Strength of Evidence: A1,B1). Polyunsaturated fatty acids can also cause a small reduction in HDL cholesterol when compared with monounsaturated fatty acids (B2). Controlled clinical trials indicate that substitution of polyunsatuarated fatty acids for saturated fatty acids reduces risk for CHD (coronary heart diseases) (A2,B2).

NCEP Recommendations: Polyunsaturated fatty acids are one form of unsaturated fatty acids that can replace saturated fat. Most polyunsaturated fatty acids should be derived from liquid vegetable oils, semi-liquid margarines, and other margarines low in trans fatty acids. Intakes of polyunsaturated fat can range up to 10 percent of total calories. (Note: recommendation for monounsaturated fatty acid is a higher at up to 20 percent of total calories).

*Linoleic acid is a colorless to straw-colored, polyunsaturated fatty acid that is liquid at room temperature and of the omega-6 series. Good sources of linoleic acid from vegetarian sources are sunflower oil, and safflower oil.

Sources of Good Fats for Natural Cholesterol Management

Natural cholesterol managers seek to obtain 25-35% of their calories from fats, striving for zero trans fats, less than 7% from saturated fats, and no more than 10% and 20% of their calories from polyunsaturated and monounsaturated fats respectively. We have extolled the virtures of extra-virgin olive oil , but many people are asking us for more information on the levels of these fatty acids in the products they consume. Here is a good chart from the Harvard School of Public Health:

And if you are looking to build a framework for natural cholesterol managementt, consider our extra-virgin olive oil with added plant sterols (.5g plant sterols from plant sterol esters).