Asthma is a disease of the small airways in the lungs that become over-reactive to a number of triggers. (Asthma has been described as “twitchy lungs.”) This can cause obstruction leading to cough, shortness of breath, chest tightness, and wheezing. Any new onset of wheezing should be evaluated by a physician as there are other causes, including cardiac problems. Over 1 in 20 Americans have been diagnosed with asthma. The prevalence of asthma has increased 61%, and death 31%, since 1980.
Multiple environmental factors contribute to asthma attacks. They include respiratory infections (bronchitis,sinusitis, and pneumonia), breathing in cold air, drinking cold liquids, humidity, dust, allergies especially to cats or other animals, GERD, emotional stress, ingesting sulfites added to food, and of course smoking and other inhaled irritants. Air pollution is certainly linked to asthma, but in spite of public misconceptions, because of clean air laws in the United States, the important types of gas and particulate pollution have been reduced 50 to 80% from 1970 to 2006.
Dietary factors have been neglected. Many studies using elimination diets have shown various food items can precipitate an asthma attack. Cow’s milk and dairy foods in general has been shown to be the worst offender. Peanut allergy has been well publicized but is far less common, and there is a long list of foods that affect some people occasionally. Beer, wine, and liquor contains histamine, the chemical that sets off allergy symptoms, and studies have verified this connection. Wine and beer also contain sulfites. Bologna, some hot dogs and other prepared meats also contain sulfites, and I remember the patient years ago who got a severe asthma attack every time he ate a bologna sandwich. A high fat diet fuels the inflammatory component of asthma. Vitamin D has been shown to lessen inflammation in asthma and enables steroids to work better. It has been shown that asthma medications lower vitamin D levels, therefore making the asthma worse. (2/3rds of us have vitamin D insufficiency if it hasn’t been diagnosed and treated).
Treatment usually starts with inhaled bronchodilators such as Albuteral on an as needed basis. This is an adrenaline type of drug and side effects include rapid heart rate and palpitations. Steroids (prednisone) are the most powerful dilators of bronchial tubes known, given either orally or by inhalation. Chronic oral steroids have well known side effects, but your doctor may prescribe frequently a 5 day course of Medrol dospak (a steroid) that does wonders for an asthma flare-up without the long term side effects. Inhaled steroids (sometimes given chronically in severe cases) also are very effective with a lower incidence of side effects. Intal by inhalation is an anti-inflammatory sometimes prescribed especially for children. Singulaire is a leukotrien antagonist (leukotriens are inflammatory white cells) and is a potent drug for lessening symptoms of allergies and asthma. Long acting Albuteral type inhalers are also useful, some in combination with inhaled steroids.
Even though most asthma should be able to be controlled or even cured, the statistics remain sobering. Elimination diets are often effective but under recommended. Any asthmatic can try it themselves by eliminating one class of common foods for several weeks, and see the results. Eliminate any obvious triggers, and dairy is the first class of foods that should be tried.
Why should the incidence and death rate from asthma be so much higher just since 1980? Smoking and air pollution are decreased. But changing diets more likely to worsen asthma and lower vitamin D levels now compared to 30 years ago are the most likely explanations.
6/1/10
5/1/10
7) UPDATE ON VITAMIN D - 2010
(Revised 9/20/10 with the addition of the information on heart failure.)
Last year’s update on vitamin D mentioned studies that documented various benefits of correcting the recently recognized pandemic of vitamin D insufficiency. There have been additional dozens of important studies since the 2009 update. However instead of writing about the individual studies, this column will give an overview of vitamin D and will try to answer the question, “How can one substance have so many beneficial effects on humans?”
First, vitamin D is not a vitamin. A vitamin is something that is supplied to humans from food. Vitamin D is not supplied by food in a significant amount, it is produced in the skin by sunlight. There is NO vitamin D naturally found in cow’s milk; the practice of adding 100 units to every 8 oz. of cow’s milk started almost a century ago was done to stop rickets in children. This dose does prevent rickets, but does little else. 400 units of Vitamin D a day only raises the level 5 nanograms (ng). Most Americans have levels that are 10 to 20 ng. below the “normal” level of 32 ng. and way below an ideal level, We’ve all seen people with high levels of vitamin D. Lifeguards in August have levels frequently have levels over 100 ng.
Vitamin D increases calcium absorption taken in from the diet. With insufficiency, only 10-20% of calcium is absorbed. With proper vitamin D levels, 60-80% of calcium is absorbed. Since calcium goes to the bones, this explains the prevention of rickets. However now it is known that virtually all osteoporosis is associated with a level of vitamin D below 32 ng. Prior to 10 years ago, almost every study done on osteoporosis used a dose of 400 units a day, and most showed no effect on osteoporosis or fractures. As late as a few years ago, newspapers trumpeted the wrong information that vitamin D didn’t prevent fractures. However all studies using larger doses of vitamin D have shown a large reduction in fractures. In fact, one critical study showed that large doses given to elderly hip fracture patients reduced further fractures and reduced falls within 6 months. (Muscles also contain vitamin D receptors and correction of insufficiencies increases muscle strength in the elderly).
Hyper-proliferation of cells is what occurs with cancer. Vitamin D has repeatedly been shown to prevent this. Many large studies have now shown that various types of cancers are associated with very low vitamin D levels. In a well publicized cancer study that spanned 8 years, the lowest levels of vitamin D were associated with the worst outcome and highest mortality in breast cancer. Many other studies have measured vitamin D in various types of cancer, and the results have always shown lower levels with the cancer. One study showed the incidence of breast cancer continued to decrease up to levels of 52 ng. Some vitamin D experts have predicted that the breast cancer rate would be reduced 50% if every woman’s vitamin D level was only 40 ng. Similar studies exist with prostate cancer and colon cancer. PSA levels in prostate cancer were shown to decrease with Vitamin D over 20 years ago. Thyroid cancer cells stop multiplying in a test tube when vitamin D is added. Lung cancer in smokers is less common the higher the vitamin D level, and in fact prognosis is better with higher vitamin D levels once lung cancer occurs. No one should misunderstand this data; it does not invalidate the many known causes of some various cancers. It is simply a factor that prevents the formation of a cancer in the presence of various known causes.
It was known in the 1970’s that MS and juvenile diabetes were less common the closer to the equator (more sunlight, more vitamin D). A study in Finland showed that giving a large number of infants high doses of vitamin D cut down the incidence of juvenile diabetes by a remarkable 80% a decade later. A recent study showed an 85% improvement in MS. These diseases, along with rheumatoid arthritis, lupus, and many other autoimmune diseases,involve cells within the body becoming modified by unknown factors and attacking the body, causing the illness. Vitamin D has been shown to keep our important immune system normal, and prevent any harmful changes to it.
Vitamin D has been shown to stimulate the production of antimicrobial peptides, a class of natural antibiotics. These have activity against bacteria and viruses. Think about it; why do flu epidemics occur during the winter and not the summer? Why do these epidemics occur in June and July in the southern hemispheres where the seasons are reversed? (Answer -lower vitamin D levels). In fact, the horrible pandemic of swine flu epidemic in the few years before 1920 tapered off in the summer before restarting. There are many published studies demonstrating this property of vitamin D.
Vitamin D levels have been shown to correlate with survival many years after bypass surgery.
In September, 2010, an 8 year study showed that deaths from heart failure were 3.4 times higher in patients with vitamin D levels less than 20 ng. and 2.0 times higher with levels 20 to 29 ng. vs.>30 ng.
Although much more research is being done, the existing research is convincing and totally unlike the anti-oxidant research (Vitamin C and B's)that has been called into question. Granted, it sounds too good to be true. Vitamin D is very inexpensive, so there are no advertising budgets to help spread the word. Vitamin D could have a profound effect on health care expenditures; it has been called a national health care plan in itself. It makes sense that Vitamin D is so basic to life and health. Scientists agree that life began near the equator. Early humans had unlimited access to sunlight, and didn’t have sunscreen or a wardrobe, so at one time humans’ vitamin D levels were very high.
The understanding of the importance of Vitamin D remains the most important preventive medicine development in over a century.
Last year’s update on vitamin D mentioned studies that documented various benefits of correcting the recently recognized pandemic of vitamin D insufficiency. There have been additional dozens of important studies since the 2009 update. However instead of writing about the individual studies, this column will give an overview of vitamin D and will try to answer the question, “How can one substance have so many beneficial effects on humans?”
First, vitamin D is not a vitamin. A vitamin is something that is supplied to humans from food. Vitamin D is not supplied by food in a significant amount, it is produced in the skin by sunlight. There is NO vitamin D naturally found in cow’s milk; the practice of adding 100 units to every 8 oz. of cow’s milk started almost a century ago was done to stop rickets in children. This dose does prevent rickets, but does little else. 400 units of Vitamin D a day only raises the level 5 nanograms (ng). Most Americans have levels that are 10 to 20 ng. below the “normal” level of 32 ng. and way below an ideal level, We’ve all seen people with high levels of vitamin D. Lifeguards in August have levels frequently have levels over 100 ng.
Vitamin D increases calcium absorption taken in from the diet. With insufficiency, only 10-20% of calcium is absorbed. With proper vitamin D levels, 60-80% of calcium is absorbed. Since calcium goes to the bones, this explains the prevention of rickets. However now it is known that virtually all osteoporosis is associated with a level of vitamin D below 32 ng. Prior to 10 years ago, almost every study done on osteoporosis used a dose of 400 units a day, and most showed no effect on osteoporosis or fractures. As late as a few years ago, newspapers trumpeted the wrong information that vitamin D didn’t prevent fractures. However all studies using larger doses of vitamin D have shown a large reduction in fractures. In fact, one critical study showed that large doses given to elderly hip fracture patients reduced further fractures and reduced falls within 6 months. (Muscles also contain vitamin D receptors and correction of insufficiencies increases muscle strength in the elderly).
Hyper-proliferation of cells is what occurs with cancer. Vitamin D has repeatedly been shown to prevent this. Many large studies have now shown that various types of cancers are associated with very low vitamin D levels. In a well publicized cancer study that spanned 8 years, the lowest levels of vitamin D were associated with the worst outcome and highest mortality in breast cancer. Many other studies have measured vitamin D in various types of cancer, and the results have always shown lower levels with the cancer. One study showed the incidence of breast cancer continued to decrease up to levels of 52 ng. Some vitamin D experts have predicted that the breast cancer rate would be reduced 50% if every woman’s vitamin D level was only 40 ng. Similar studies exist with prostate cancer and colon cancer. PSA levels in prostate cancer were shown to decrease with Vitamin D over 20 years ago. Thyroid cancer cells stop multiplying in a test tube when vitamin D is added. Lung cancer in smokers is less common the higher the vitamin D level, and in fact prognosis is better with higher vitamin D levels once lung cancer occurs. No one should misunderstand this data; it does not invalidate the many known causes of some various cancers. It is simply a factor that prevents the formation of a cancer in the presence of various known causes.
It was known in the 1970’s that MS and juvenile diabetes were less common the closer to the equator (more sunlight, more vitamin D). A study in Finland showed that giving a large number of infants high doses of vitamin D cut down the incidence of juvenile diabetes by a remarkable 80% a decade later. A recent study showed an 85% improvement in MS. These diseases, along with rheumatoid arthritis, lupus, and many other autoimmune diseases,involve cells within the body becoming modified by unknown factors and attacking the body, causing the illness. Vitamin D has been shown to keep our important immune system normal, and prevent any harmful changes to it.
Vitamin D has been shown to stimulate the production of antimicrobial peptides, a class of natural antibiotics. These have activity against bacteria and viruses. Think about it; why do flu epidemics occur during the winter and not the summer? Why do these epidemics occur in June and July in the southern hemispheres where the seasons are reversed? (Answer -lower vitamin D levels). In fact, the horrible pandemic of swine flu epidemic in the few years before 1920 tapered off in the summer before restarting. There are many published studies demonstrating this property of vitamin D.
Vitamin D levels have been shown to correlate with survival many years after bypass surgery.
In September, 2010, an 8 year study showed that deaths from heart failure were 3.4 times higher in patients with vitamin D levels less than 20 ng. and 2.0 times higher with levels 20 to 29 ng. vs.>30 ng.
Although much more research is being done, the existing research is convincing and totally unlike the anti-oxidant research (Vitamin C and B's)that has been called into question. Granted, it sounds too good to be true. Vitamin D is very inexpensive, so there are no advertising budgets to help spread the word. Vitamin D could have a profound effect on health care expenditures; it has been called a national health care plan in itself. It makes sense that Vitamin D is so basic to life and health. Scientists agree that life began near the equator. Early humans had unlimited access to sunlight, and didn’t have sunscreen or a wardrobe, so at one time humans’ vitamin D levels were very high.
The understanding of the importance of Vitamin D remains the most important preventive medicine development in over a century.
2/1/10
6) TREATMENT OF GERD (GASTROESOPHAGEAL REFLUX DISEASE)
GERD is a common condition caused by gastric acid reflux into the esophagus. This irritates the esophagus and frequently causes heartburn and other symptoms including belching, coughing, wheezing, heartburn, nausea, vomiting, regurgitation of food, rarely hoarseness, and even occasionally major gastrointestinal bleeding. The chest pain can sometimes simulate symptoms of a heart attack, and on occasion a sufferer ends up spending several days in a coronary care unit before a heart attack is ruled out. On the other hand, I have run into cases of individuals self-medicating with over the counter drugs for GERD, but later it turned out it was angina and a precursor for a heart attack. Hiatal hernia, (a condition in which part of the stomach moves above the abdomen) can also pecipitate symptoms.
Basic common sense treatments for GERD that have been used for decades include avoiding food that commonly causes symptoms. (common precipitators of pain include chocolate, spicy foods such as pizza, caffeine, alcohol, and even peppermint), avoiding aspirin and Motrin type drugs (as they can increase gastric acid), avoiding lying down after meals, sleeping with the head of the bed elevated, taking all medicines with a 8 ounces of water, and even weight reduction (which reduces intra-abdominal pressure that pushes up on the stomach).
Many drugs can worsen symptoms including anticholinergics for seasickness, beta blockers and calcium channel blockers for hypertension and heart disease, bronchodilators for asthma, some Parkinson drugs, sedatives, and tricyclic antidepressants. However if you suspect you’re being affected, don’t stop the medicine on your own; talk it over with your doctor.
Tests to confirm diagnosis range from barium swallow x-ray to upper GI endoscopy by a gastroenterologist. A stool guaiac test (for blood) is a good idea, but is underused.
Occasionally GERD can have serious complications. Chronic exposure of the lower esophagus to acid sometimes transforms the normal esophageal cells to abnormal cells called “Barrett’s esophagus”. These cells have a small but definite risk of turning into cancer.
Treatments of GERD: Antacids such as Maalox, Mylanta, and Tums neutralize stomach acid and usually provide quick relief. Side effects include diarrhea or constipation. Milk used to be recommended to neutralize acid. It does relieve pain temporarily, but results in an acid rebound, and is not recommended.
H-2 receptor blockers such as Tagamet, Pepcid, Axid, and Zantac reduce acid production. They don’t work as quickly as antacids but provide longer relief. Side effects are rare but Tagamet can sometimes act as an anti-androgen, so men should choose an alternative drug.
Proton pump inhibitors block acid production and allow the damaged esophageal tissue to heal. PPI’s include Prevacid, Prilosec, Nexium (the famous little purple pill), Protonix, and Aciphex. In the test tube, all PPI’s are equal, but many people feel that one of them consistently work better than the others. I wish I could tell you side effects are rare, but there is one underpublicized serious effect. Several years ago it was discovered that chronic maintenance use of PPI’s decreases calcium absorption and is associated with an increase in hip fractures in young people. Many Fantastic Fifties members are aware of the pandemic of vitamin D deficiency present in North America. Use of PPI’s is another reason to get a 25-hydroxyvitamin D level, and aggressively correct low levels with supplements. The vitamin D would increase calcium absorption and help counteract this side effect of the PPI’s.
Medications to strengthen the muscular barrier between the esophagus and stomach are occasionally used in severe cases. Surgery is used only in the most intractable cases, but is frequently unsuccessful.
The generics of these drugs for GERD are very inexpensive. For example, some of the OTC PPI’s can be obtained for $6 a month. Treatment should result in a relief of symptoms in almost all cases.
Basic common sense treatments for GERD that have been used for decades include avoiding food that commonly causes symptoms. (common precipitators of pain include chocolate, spicy foods such as pizza, caffeine, alcohol, and even peppermint), avoiding aspirin and Motrin type drugs (as they can increase gastric acid), avoiding lying down after meals, sleeping with the head of the bed elevated, taking all medicines with a 8 ounces of water, and even weight reduction (which reduces intra-abdominal pressure that pushes up on the stomach).
Many drugs can worsen symptoms including anticholinergics for seasickness, beta blockers and calcium channel blockers for hypertension and heart disease, bronchodilators for asthma, some Parkinson drugs, sedatives, and tricyclic antidepressants. However if you suspect you’re being affected, don’t stop the medicine on your own; talk it over with your doctor.
Tests to confirm diagnosis range from barium swallow x-ray to upper GI endoscopy by a gastroenterologist. A stool guaiac test (for blood) is a good idea, but is underused.
Occasionally GERD can have serious complications. Chronic exposure of the lower esophagus to acid sometimes transforms the normal esophageal cells to abnormal cells called “Barrett’s esophagus”. These cells have a small but definite risk of turning into cancer.
Treatments of GERD: Antacids such as Maalox, Mylanta, and Tums neutralize stomach acid and usually provide quick relief. Side effects include diarrhea or constipation. Milk used to be recommended to neutralize acid. It does relieve pain temporarily, but results in an acid rebound, and is not recommended.
H-2 receptor blockers such as Tagamet, Pepcid, Axid, and Zantac reduce acid production. They don’t work as quickly as antacids but provide longer relief. Side effects are rare but Tagamet can sometimes act as an anti-androgen, so men should choose an alternative drug.
Proton pump inhibitors block acid production and allow the damaged esophageal tissue to heal. PPI’s include Prevacid, Prilosec, Nexium (the famous little purple pill), Protonix, and Aciphex. In the test tube, all PPI’s are equal, but many people feel that one of them consistently work better than the others. I wish I could tell you side effects are rare, but there is one underpublicized serious effect. Several years ago it was discovered that chronic maintenance use of PPI’s decreases calcium absorption and is associated with an increase in hip fractures in young people. Many Fantastic Fifties members are aware of the pandemic of vitamin D deficiency present in North America. Use of PPI’s is another reason to get a 25-hydroxyvitamin D level, and aggressively correct low levels with supplements. The vitamin D would increase calcium absorption and help counteract this side effect of the PPI’s.
Medications to strengthen the muscular barrier between the esophagus and stomach are occasionally used in severe cases. Surgery is used only in the most intractable cases, but is frequently unsuccessful.
The generics of these drugs for GERD are very inexpensive. For example, some of the OTC PPI’s can be obtained for $6 a month. Treatment should result in a relief of symptoms in almost all cases.
11/3/09
WELCOME TO NEW READERS
First, some people may be coming to this web site to read "Getting Vitamin D Results." The web site is http://GettingVitaminDResults.blogspot.com. To view the article, it's necessary to copy and paste it on your browser. An easier way is to just goggle "Getting Vitamin D Results," but it has to be in quotation marks. The link for the article should appear on top of the list.
As of July 29, 2010, the blog for this newsletter has been accessed by people from 40 states and 17 countries. Specifically entry #9, the report on complete remission of MS with vitamin D alone, has been accessed by a large number of people who have MS or know someone with MS.
Welcome to the members of the Fantastic Fifties of South Jersey, the Taproom Luncheon Club of Haddon Township, NJ, the Henry Raich Senior Group of Cherry Hill, NJ, the St. Mary's Breast Cancer Support Group of San Francisco, and members of other groups that visit this site. Tips of the hat go to my cousin in San Francisco and friends in Florida, Massachusetts,and South Jersey who are spreading the word about Vitamin D, As a result many more people who never would have heard the message have gotten tested and discovered they were Vitamin D insufficient.
Welcome to some of the 400 followers of http://www.twitter.com/robertbakermd
and http://www.twitter.com/VitaminDWebSite
who have clicked onto this blog.
This Health Newsletter is about a variety of subjects, but I want to stress Vitamin D here. The evidence continues to mount that the realization of the pandemic of Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least 40 years..
Since I first said this in 2008 I have come to learn that I understated the benefit. Easily treated Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least a century
As of July 29, 2010, the blog for this newsletter has been accessed by people from 40 states and 17 countries. Specifically entry #9, the report on complete remission of MS with vitamin D alone, has been accessed by a large number of people who have MS or know someone with MS.
Welcome to the members of the Fantastic Fifties of South Jersey, the Taproom Luncheon Club of Haddon Township, NJ, the Henry Raich Senior Group of Cherry Hill, NJ, the St. Mary's Breast Cancer Support Group of San Francisco, and members of other groups that visit this site. Tips of the hat go to my cousin in San Francisco and friends in Florida, Massachusetts,and South Jersey who are spreading the word about Vitamin D, As a result many more people who never would have heard the message have gotten tested and discovered they were Vitamin D insufficient.
Welcome to some of the 400 followers of http://www.twitter.com/robertbakermd
and http://www.twitter.com/VitaminDWebSite
who have clicked onto this blog.
This Health Newsletter is about a variety of subjects, but I want to stress Vitamin D here. The evidence continues to mount that the realization of the pandemic of Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least 40 years..
Since I first said this in 2008 I have come to learn that I understated the benefit. Easily treated Vitamin D insufficiency is the most important medical discovery in preventive medicine in at least a century
11/1/09
5. TREATMENT OF HIGH CHOLESTEROL
MEDICAL TREATMENT OF HIGH CHOLESTEROL
High cholesterol is present in a high % of American adults. Lowering the LDL cholesterol has been proven in many studies to greatly cut the incidence of illnesses caused by atherosclerosis,such as heart attacks, some strokes, and peripheral artery disease. It does this by preventing the formation, progression, and even causing regression, of atherosclerosis. The goal should be an LDL cholesterol of less than 100 mg.,and in diabetics and those that have already have atherosclerosis, a better goal is less than 75 mg.
Statins inhibit the formation of cholesterol, and are the most effective drugs in lowering cholesterol. They also lower triglycerides somewhat. Frequently companies claim superiority of their product, but all statins are effective and generally well tolerated. The main side effects are well known. Less than 1 person out of 200 develops muscle soreness and weakness, which is reversed quickly with stopping the medicine. Rarely when the medication is continued in spite of these warning signs, more serious side effects occur. Probably everyone has heard that statins can affect the liver. Less than 2% of people taking higher doses of statins develop elevated liver enzymes, which also is quickly reversed by stopping the medicine. It’s recommended that liver enzymes be rechecked after 3 months of treatment, and yearly after; however in practice most doctors test more frequently. Statins that are available now are Mevacor (Lovastatin), Lipitor, Lescol, Pravachol, Crestor, and Zocor (Simvastatin). The dose of various statins varies.
Fibric Acid Derivatives (Lopid and Tricor) lower triglycerides usually 25% to 50%. Triglycerides are a different fat in the blood that is also a risk factor for atherosclerosis and is frequently treated at levels over 300 mg. High triglycerides are especially more common in diabetes. Adverse effects are rare. Lopid, although less expensive than Tricor, can rarely cause gallstones. Both of these drugs have shown a reduction in heart attacks in those that have elevated triglycerides.
Niacin (nicotinic acid) has a favorable effect on LDL cholesterol, triglycerides, and increases HDL cholesterol (the good cholesterol) as much as 35%. Niacin can cause skin flushing and itching, which is a very annoying side effect that keeps it from being used more often. Extended release niacin and taking an aspirin or Advil before a dose sometimes reduces the side effects. In my experience in practice, niacin is a difficult drug to take because of the flushing.
Zetia prevents the absorption of cholesterol that we eat in our diet. A combination of Zetia and Simastatin (Zocor) is available as Vytorin. It lowers LDL cholesterol up to 65%, and is often very effective when people are resistant to a statin alone.
Before statins were available in 1987, resins like Questran, Colestid , and Welchol were used These drugs bind bile acids in the intestine, and increase clearance of cholesterol from the blood. They can lower LDL cholesterol by 20%. Severe constipation is a side effect that prevents more widespread use.
Fish oil (omega-3’s) can decrease triglycerides up to 50%, and have many other beneficial effects. It is available over the counter, or in the form of Lovaza. Patients often buy fish oil capsules and take 1 or 2 a day; they are underdosing. 2 to 4.8 grams of omega 3’s is considered a therapeutic dose. If you take fish oil, discuss the dose with your doctor.
The combination of long acting niacin and lovastatin (Mevacor) is available as Advicor.
Statins are the drugs of first choice for most people with a problem of elevated cholesterol. They can decrease coronary events and deaths, and are a major reason why the incidence of heart attacks has gone down in the United States over the past few decades. Several of the statins are on the generic drug lists of Walmart, Target, Walgreens, and Wegmans; so they are very affordable.
THE NON-DRUG TREATMENT OF HIGH CHOLESTEROL
The non-drug treatments of elevated cholesterol are many. Virtually all newborns are born with a blood cholesterol of less than 150 mg, and it is a “rich diet” in combination with genetics that elevates the values as we get older.
Loss of excess weight, control of diabetes, and physical activity can lower cholesterol and triglyceride values. Adequate treatment of hypothyroidism can lower an elevated cholesterol. Cholesterol responds to reduction in dietary fat and cholesterol; triglycerides respond quite well to decreasing intakes of fat, sugar, and alcohol.
Both dietary cholesterol and dietary fat raise the serum cholesterol. Don’t be tricked by food labeling; some foods are labeled low in fat but are high in cholesterol, and vice versa. Egg yolks are very high in cholesterol, whereas potato chips are high in fat. Some special interest industries have falsely promoted over the years the idea that their products are part of a healthy diet. The egg industry in particular has financed research considered “junk science” by medical authorities. Egg yolks raise cholesterol, no matter that quantity or type of egg. Cow’s milk and most meats are very high in fat, ranging frequently from 50 to 80%.
Both soluble and insoluble fiber products lower cholesterol. One study showed that eating oatmeal 3 times a week for 6 months lowers cholesterol 10%, however that means no butter in the oatmeal. Bran products provide insoluble fibers, however bran muffins are often mixed with much fat, negating the positive effects. Fruits and vegetables provide soluble fiber (although fruits should be limited to 2 a day in the treatment of elevated triglyceride).
Adjuncts to dietary therapy can be included. Psyllium in doses of 5 grams twice a day, oat bran, pectin, and guar gum, can produce a 5-10% decrease in LDL cholesterol.
The 30% fat promoted by the American Heart Association for decades has been shown in studies to lead to no significant drop in cholesterol. Another words, it doesn’t work. 20% fat diets have a significant effect on lowering cholesterol. The Pritikin regression diet, the McDougall diet, and the Ornish diet, all high carbohydrate, low fat (HCLF diets), all less than 10% fat, have a major effect in achieving reductions of total cholesterol below 150 mg, and LDL cholesterol (bad cholesterol) below 100 mg. Nathan Pritikin published scientific studies in the 1970's showing that 85% of type II diabetics on oral medication and 50% on insulin can be off those medications within one month on the Prikin regression diet, and the figures remained similar at one year follow up. Dr. Dean Ornish published studies using cardiac cathaterizations showing that atherosclerosis in the coronary arteries can regress on the Ornish program. (Both programs include daily exercise, and the Ornish program includes relaxation anti-stress techniques).
These diets can be difficult to adhere to in the age of convenience stores and eating out. I have seen cases of a cholesterol level of 300 mg. dropping to 200 mg. in one month on this type of diet. The terms “high carbohydrate” if very misleading. They require almost exclusively complex, not simple carbohydrates and are also high in soluble and insoluble fibers. Many published studies publish misleading conclusions by comparing the Adkins diet (high in protein, low in all carbohydrates), or the Mediterranean diet (high in olive oil) with a diet that is high in all kinds of carbohydrates, complex and sugars, and then erroneously draw the conclusion that they are superior to the HCLF diet. There have been accusations and evidence that some of these misleading studies have been financed by the olive oil manufacturers.
In the 1960’s, the concept of lowering cholesterol by eating a lot of polyunsaturated fats (vegetable oils) was promoted by the American Heart Association. The studies showed it lowered cholesterol only 10% but increased the incidence of various cancers. Some of these fats we now know as “trans-fats” and they have gone from being recommended by health authorities to being banned in many areas. Nathan Pritikin was an early voice in pointing this out to the public in the 1970’s that substituting vegetable oils for saturated oils doesn’t work.
Vegetarian diets tend to be lower in fat or cholesterol SOMETIMES. Some vegetarians eat a lot of oils and dairy products, which negate the beneficial effects.
Olive Oil: Olive oil is a monounsatured fat, different from the polyunsaturated and saturated fats. There is evidence that it is better than saturated or poluunsastured fats. However in a direct comparison with true HCLF diets, they are second best.
Adkins diet: The debate about the Adkins diet goes back almost 4 decades. Dr. Adkins got a lot of attention when he promoted his products by saying you can eat all the eggs and butter, etc. you wanted. Although the Adkins diet does allow significant amounts of fat and is high protein, it severely restricts simple sugars, sharing in common an important characteristic of the HCLF diets. The publicity associated with the Adkins diet often says eat all the meat you want. The actual Adkins program as detailed in the various books gives examples of dinner meals consisting of 4 or 5 ounces of chicken or fish, and very insignificant amounts of whipped cream included in desserts. By eliminating ALL simple sugars, the diet is also eliminating a lot of products that are very high not only in fats but in salt – cakes, pies, cookies, etc. So the initial success of the Adkins diet is due to eliminating most sugar and a lot of fat from the diet, despite its reputation as a high fat diet. A lot of the initial weight loss is water weight because of the reduction in salt. Short term total cholesterol can be reduced; long term it depends on what type of foods one eats on the Adkins diet. If one truly eats large amounts of meat and fat, that type of diet has been proven rerpeatedly to be unhealthy in terms of both atherosclerosis and cancer. Long term studies of the Adkins diet and weight loss are not convincing.
Vegan or Vegetarian diets: In general, vegetarians and vegans have lower cholesterols and lower atherosclerosis disease rates than non-vegetarians and vegans. It really depends on the degree of adherence. If the diet includes more oils than the non-vegetarian or vegan, the benefit of the diet is partly negated. The inclusion of dairy products by some vegetarians is a story in itself. Of the HCLF diets mentioned above, the McDougal diet is a very low fat vegan diet with the addition of no oils and very limited sugars. The Ornish and Pritikin regression diet approaches this type of diet, but does include relatively small amounts of non-vegan products.
WHAT DOESN’T WORK:
Cutting down to 3 eggs a week doesn’t work. An egg contains over 225 mg. of cholesterol. Decades ago a cardiologist in Richmond, Virginia, experimented on himself and drew daily cholesterol levels while eating 6 eggs a day. There was a 50 mg. increase in cholesterol within a few weeks, at which point he quit the study. I know about this because he was my instructor in medical school.
Substituting polyunsatured fats (as the American Heart Association recommended for a few decades) not only doesn’t work; it causes an increase in cancer. This was known in the early 1970’s. To this day, a significant portion of the public thinks polyunsaturated fats such as various vegetable fats are healthy.
Cutting fat but continuing to eat high amounts of simple sugars will prevent weight loss and tends to keep the cholesterol level up.
GENETIC CONDITIONS AND CHOLESTEROL
One in 500 Americans have a gene for dominant hypercholesterolemia. This frequently leads to cholesterol levels of over 300 mg, and if not corrected, a high incidence of atherosclerosis and heart attacks. Studies have shown that the gene does interact with diet. Their grandparents may have had levels in the 200’s, whereas they have levels in the 300’s. If a person has a double dose of the gene (usually one from each parent), a very rare condition, his or her cholesterol can exceed 1000, and yes, it does interact with the diet, but other measures have to be taken to prevent early illness.
IT "ONLY" TOOK 6 DECADES
The pathologist Dr. Aniltsichkow first discovered that role of cholesterol in atherosclerosis in 1914. His studies were prominently published in Germany. In spite of that, it took 6 decades to receive increasing attention, to the point now that many heart attacks are now avoided by lowering cholesterol levels.
The scientist Nathan Prikin accelerated this awareness in the 1970’s with his research.
Conclusion: The scientific discoveries about atherosclerosis first made in 1914 are now proven beyond any doubt. The potential remains that most atherosclerosis, a leading cause of death, can be prevented.
High cholesterol is present in a high % of American adults. Lowering the LDL cholesterol has been proven in many studies to greatly cut the incidence of illnesses caused by atherosclerosis,such as heart attacks, some strokes, and peripheral artery disease. It does this by preventing the formation, progression, and even causing regression, of atherosclerosis. The goal should be an LDL cholesterol of less than 100 mg.,and in diabetics and those that have already have atherosclerosis, a better goal is less than 75 mg.
Statins inhibit the formation of cholesterol, and are the most effective drugs in lowering cholesterol. They also lower triglycerides somewhat. Frequently companies claim superiority of their product, but all statins are effective and generally well tolerated. The main side effects are well known. Less than 1 person out of 200 develops muscle soreness and weakness, which is reversed quickly with stopping the medicine. Rarely when the medication is continued in spite of these warning signs, more serious side effects occur. Probably everyone has heard that statins can affect the liver. Less than 2% of people taking higher doses of statins develop elevated liver enzymes, which also is quickly reversed by stopping the medicine. It’s recommended that liver enzymes be rechecked after 3 months of treatment, and yearly after; however in practice most doctors test more frequently. Statins that are available now are Mevacor (Lovastatin), Lipitor, Lescol, Pravachol, Crestor, and Zocor (Simvastatin). The dose of various statins varies.
Fibric Acid Derivatives (Lopid and Tricor) lower triglycerides usually 25% to 50%. Triglycerides are a different fat in the blood that is also a risk factor for atherosclerosis and is frequently treated at levels over 300 mg. High triglycerides are especially more common in diabetes. Adverse effects are rare. Lopid, although less expensive than Tricor, can rarely cause gallstones. Both of these drugs have shown a reduction in heart attacks in those that have elevated triglycerides.
Niacin (nicotinic acid) has a favorable effect on LDL cholesterol, triglycerides, and increases HDL cholesterol (the good cholesterol) as much as 35%. Niacin can cause skin flushing and itching, which is a very annoying side effect that keeps it from being used more often. Extended release niacin and taking an aspirin or Advil before a dose sometimes reduces the side effects. In my experience in practice, niacin is a difficult drug to take because of the flushing.
Zetia prevents the absorption of cholesterol that we eat in our diet. A combination of Zetia and Simastatin (Zocor) is available as Vytorin. It lowers LDL cholesterol up to 65%, and is often very effective when people are resistant to a statin alone.
Before statins were available in 1987, resins like Questran, Colestid , and Welchol were used These drugs bind bile acids in the intestine, and increase clearance of cholesterol from the blood. They can lower LDL cholesterol by 20%. Severe constipation is a side effect that prevents more widespread use.
Fish oil (omega-3’s) can decrease triglycerides up to 50%, and have many other beneficial effects. It is available over the counter, or in the form of Lovaza. Patients often buy fish oil capsules and take 1 or 2 a day; they are underdosing. 2 to 4.8 grams of omega 3’s is considered a therapeutic dose. If you take fish oil, discuss the dose with your doctor.
The combination of long acting niacin and lovastatin (Mevacor) is available as Advicor.
Statins are the drugs of first choice for most people with a problem of elevated cholesterol. They can decrease coronary events and deaths, and are a major reason why the incidence of heart attacks has gone down in the United States over the past few decades. Several of the statins are on the generic drug lists of Walmart, Target, Walgreens, and Wegmans; so they are very affordable.
THE NON-DRUG TREATMENT OF HIGH CHOLESTEROL
The non-drug treatments of elevated cholesterol are many. Virtually all newborns are born with a blood cholesterol of less than 150 mg, and it is a “rich diet” in combination with genetics that elevates the values as we get older.
Loss of excess weight, control of diabetes, and physical activity can lower cholesterol and triglyceride values. Adequate treatment of hypothyroidism can lower an elevated cholesterol. Cholesterol responds to reduction in dietary fat and cholesterol; triglycerides respond quite well to decreasing intakes of fat, sugar, and alcohol.
Both dietary cholesterol and dietary fat raise the serum cholesterol. Don’t be tricked by food labeling; some foods are labeled low in fat but are high in cholesterol, and vice versa. Egg yolks are very high in cholesterol, whereas potato chips are high in fat. Some special interest industries have falsely promoted over the years the idea that their products are part of a healthy diet. The egg industry in particular has financed research considered “junk science” by medical authorities. Egg yolks raise cholesterol, no matter that quantity or type of egg. Cow’s milk and most meats are very high in fat, ranging frequently from 50 to 80%.
Both soluble and insoluble fiber products lower cholesterol. One study showed that eating oatmeal 3 times a week for 6 months lowers cholesterol 10%, however that means no butter in the oatmeal. Bran products provide insoluble fibers, however bran muffins are often mixed with much fat, negating the positive effects. Fruits and vegetables provide soluble fiber (although fruits should be limited to 2 a day in the treatment of elevated triglyceride).
Adjuncts to dietary therapy can be included. Psyllium in doses of 5 grams twice a day, oat bran, pectin, and guar gum, can produce a 5-10% decrease in LDL cholesterol.
The 30% fat promoted by the American Heart Association for decades has been shown in studies to lead to no significant drop in cholesterol. Another words, it doesn’t work. 20% fat diets have a significant effect on lowering cholesterol. The Pritikin regression diet, the McDougall diet, and the Ornish diet, all high carbohydrate, low fat (HCLF diets), all less than 10% fat, have a major effect in achieving reductions of total cholesterol below 150 mg, and LDL cholesterol (bad cholesterol) below 100 mg. Nathan Pritikin published scientific studies in the 1970's showing that 85% of type II diabetics on oral medication and 50% on insulin can be off those medications within one month on the Prikin regression diet, and the figures remained similar at one year follow up. Dr. Dean Ornish published studies using cardiac cathaterizations showing that atherosclerosis in the coronary arteries can regress on the Ornish program. (Both programs include daily exercise, and the Ornish program includes relaxation anti-stress techniques).
These diets can be difficult to adhere to in the age of convenience stores and eating out. I have seen cases of a cholesterol level of 300 mg. dropping to 200 mg. in one month on this type of diet. The terms “high carbohydrate” if very misleading. They require almost exclusively complex, not simple carbohydrates and are also high in soluble and insoluble fibers. Many published studies publish misleading conclusions by comparing the Adkins diet (high in protein, low in all carbohydrates), or the Mediterranean diet (high in olive oil) with a diet that is high in all kinds of carbohydrates, complex and sugars, and then erroneously draw the conclusion that they are superior to the HCLF diet. There have been accusations and evidence that some of these misleading studies have been financed by the olive oil manufacturers.
In the 1960’s, the concept of lowering cholesterol by eating a lot of polyunsaturated fats (vegetable oils) was promoted by the American Heart Association. The studies showed it lowered cholesterol only 10% but increased the incidence of various cancers. Some of these fats we now know as “trans-fats” and they have gone from being recommended by health authorities to being banned in many areas. Nathan Pritikin was an early voice in pointing this out to the public in the 1970’s that substituting vegetable oils for saturated oils doesn’t work.
Vegetarian diets tend to be lower in fat or cholesterol SOMETIMES. Some vegetarians eat a lot of oils and dairy products, which negate the beneficial effects.
Olive Oil: Olive oil is a monounsatured fat, different from the polyunsaturated and saturated fats. There is evidence that it is better than saturated or poluunsastured fats. However in a direct comparison with true HCLF diets, they are second best.
Adkins diet: The debate about the Adkins diet goes back almost 4 decades. Dr. Adkins got a lot of attention when he promoted his products by saying you can eat all the eggs and butter, etc. you wanted. Although the Adkins diet does allow significant amounts of fat and is high protein, it severely restricts simple sugars, sharing in common an important characteristic of the HCLF diets. The publicity associated with the Adkins diet often says eat all the meat you want. The actual Adkins program as detailed in the various books gives examples of dinner meals consisting of 4 or 5 ounces of chicken or fish, and very insignificant amounts of whipped cream included in desserts. By eliminating ALL simple sugars, the diet is also eliminating a lot of products that are very high not only in fats but in salt – cakes, pies, cookies, etc. So the initial success of the Adkins diet is due to eliminating most sugar and a lot of fat from the diet, despite its reputation as a high fat diet. A lot of the initial weight loss is water weight because of the reduction in salt. Short term total cholesterol can be reduced; long term it depends on what type of foods one eats on the Adkins diet. If one truly eats large amounts of meat and fat, that type of diet has been proven rerpeatedly to be unhealthy in terms of both atherosclerosis and cancer. Long term studies of the Adkins diet and weight loss are not convincing.
Vegan or Vegetarian diets: In general, vegetarians and vegans have lower cholesterols and lower atherosclerosis disease rates than non-vegetarians and vegans. It really depends on the degree of adherence. If the diet includes more oils than the non-vegetarian or vegan, the benefit of the diet is partly negated. The inclusion of dairy products by some vegetarians is a story in itself. Of the HCLF diets mentioned above, the McDougal diet is a very low fat vegan diet with the addition of no oils and very limited sugars. The Ornish and Pritikin regression diet approaches this type of diet, but does include relatively small amounts of non-vegan products.
WHAT DOESN’T WORK:
Cutting down to 3 eggs a week doesn’t work. An egg contains over 225 mg. of cholesterol. Decades ago a cardiologist in Richmond, Virginia, experimented on himself and drew daily cholesterol levels while eating 6 eggs a day. There was a 50 mg. increase in cholesterol within a few weeks, at which point he quit the study. I know about this because he was my instructor in medical school.
Substituting polyunsatured fats (as the American Heart Association recommended for a few decades) not only doesn’t work; it causes an increase in cancer. This was known in the early 1970’s. To this day, a significant portion of the public thinks polyunsaturated fats such as various vegetable fats are healthy.
Cutting fat but continuing to eat high amounts of simple sugars will prevent weight loss and tends to keep the cholesterol level up.
GENETIC CONDITIONS AND CHOLESTEROL
One in 500 Americans have a gene for dominant hypercholesterolemia. This frequently leads to cholesterol levels of over 300 mg, and if not corrected, a high incidence of atherosclerosis and heart attacks. Studies have shown that the gene does interact with diet. Their grandparents may have had levels in the 200’s, whereas they have levels in the 300’s. If a person has a double dose of the gene (usually one from each parent), a very rare condition, his or her cholesterol can exceed 1000, and yes, it does interact with the diet, but other measures have to be taken to prevent early illness.
IT "ONLY" TOOK 6 DECADES
The pathologist Dr. Aniltsichkow first discovered that role of cholesterol in atherosclerosis in 1914. His studies were prominently published in Germany. In spite of that, it took 6 decades to receive increasing attention, to the point now that many heart attacks are now avoided by lowering cholesterol levels.
The scientist Nathan Prikin accelerated this awareness in the 1970’s with his research.
Conclusion: The scientific discoveries about atherosclerosis first made in 1914 are now proven beyond any doubt. The potential remains that most atherosclerosis, a leading cause of death, can be prevented.
10/10/09
Vitamin D Quiz #1
http://vitaminddeficiency.blogspot.com/2009/10/vitamin-d-facts-and-fallacies.html
Take a 3 minute quiz on vitamin D; know more than most medical personnel about Vitamin D. It's necessary to copy and past the above internet address.
Take a 3 minute quiz on vitamin D; know more than most medical personnel about Vitamin D. It's necessary to copy and past the above internet address.
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