Our roundup of timely preventive health related news stories from around the web.

• Losing Weight When Obese Can Prevent or Cure Diabetes, Whatever the Initial BMI, Study Suggests – sciencedaily
• Role of Vitamin D Deficiency in Cardiovascular Disease – medscape today
• Comorbidities increase risk of mortality in COPD patients – eurekalerts.org
• New ESC Cardiovascular Disease Guidelines Emphasize Primary Prevention – theheart.org
• War on Smoking Offers Some Lessons for Obesity Fight – kaiser health news
• Sedentary Behavior: one definition to rule them all – PLoS Blogs
• Five Common Mistakes You’re Making at the Gym – time/healthland
• Rising Obesity Rates Might Mean More Rheumatioid Arthritis – health.com
• Joggers live much longer – medical news today

Do you take a daily vitamin or supplement? Perhaps you should. Research suggests that supplement users are healthy people who tend to eat a better diet than most and who consider nutritional support one of several ways to protect their health. The primary reasons cited for taking a daily multiple vitamin include:

• Enhance energy and well-being
• Help defend against degenerative diseases such as cancer, heart disease, osteoporosis, and dementia
• Help manage existing health conditions such as arthritis and diabetes
• Slow the aging process

In fact, although we can’t make specific claims about nutritional supplements, a growing body of evidence shows a correlation between supplemental multivitamins and other nutrients and improved health, including the following:

• Reduced incidence of heart disease and stroke
• Protection against certain kinds of cancer
• Decreased incidence of certain birth defects
• Improved immune functioning
• Decreased number of sick days caused by infections among the elderly
• Delayed onset or progression of vision-robbing macular degeneration
• Reduced incidence of hip fractures from osteoporosis

A study undertaken by The Lewin Group found that given the myriad potential protective benefits, daily use of a multivitamin is a relatively inexpensive yet potentially powerful way to improve one’s health. They also noted that within a health insurance context, the five-year estimate of potential net savings resulting from daily multivitamin intake for adults over 65 is approximately 1.6 billion dollars.

Research shows that 80 to 90 percent of the population does not achieve the recommended daily value (RDV) for each vitamin and mineral, nor do they even come close. As if it weren’t hard enough to get the nutrients through our diet, 12 of the top 20 medications prescribed in the United States are drugs that can cause nutrient depletion — a situation exacerbated by the pace and stress of a daily multi-tasking lifestyle. In fact, marginal nutritional deficiencies are present in about 50% of the non multiple vitamin and mineral using population. And, keep in mind that the RDV levels for each nutrient are intended to guard against only severe nutrient deficiency diseases like Scurvy (vitamin C), but are not intended to serve as levels of vitamin and mineral intake that are optimal in regard to supporting biological functions, preventing degenerative diseases, and maximizing our well-being and longevity.

I advise my patients to take a simple  multivitamin/multimineral that contains USP Pharmaceutical Grade Quality ingredients, chelated minerals that enhance absorption and bioavailability and a coating that avoids lead and other heavy metals. A daily multivitamin should be independently assayed for purity and content and contain 100% of the recommended daily value (RDV) for all the essential vitamins and minerals.

In my interview (below) on WPTV’s “Ask the Doctor” segment I discuss non-invasive heart testing, women’s preventive cardiology, as well as the positive impact proper diet and moderate exercise can have on heart health.

Read the label. Good advice if you know what to look for. Most of us have learned to examine a nutrition label and pay attention to calories, saturated fat content, sugars, sodium, and the latest hot topic for good reason, trans fats. But, that’s old news. When it comes to nutritional supplements you owe it to yourself to learn more.

It used to be that if you ate a healthful diet, you might say that you didn’t need nutritional supplements, but we now know that’s not accurate. Research shows that 80 to 90 percent of the population does not achieve the recommended daily value (RDV) for each vitamin and mineral each day, nor do they even come close. In fact, marginal nutritional deficiencies are present in as much as 50 % of the non-multivitamin-mineral using population. And, keep in mind that RDV levels for each nutrient are only intended to guard against severe nutrient deficiency diseases like scurvy (vitamin C) or beriberi (vitamin B1), but are not intended to serve as levels of vitamin and mineral intake that are optimal in regard to supporting biological functions, preventing degenerative diseases and maximizing our well-being and longevity. Consider the new bottom line: commit to a high quality multivitamin-mineral supplement that provides 100% of the RDV which is intended to be a good base. Then build on that strong foundation with good dietary choices incorporating a variety of foods aimed to achieve even higher levels of vitamins and minerals that are optimal for supporting biological functions, preventing degenerative diseases and maximizing our well-being and longevity.

The following examples looking at several of the most frequently used supplements will give you some idea of what you need to look for in a product. VitalRemedyMD provides top quality pharmaceutical grade supplements that are independently assayed for content, quality and purity. All formulations are designed by Dr. Seth Baum; based on sound scientific evidence and clinical experience, incorporating ongoing research findings when they deserve merit. VitalRemedyMD provides you the peace of mind of knowing that you are receiving products that reflect state of the art in science with unsurpassed quality and safety.

The daily multivitamin-mineral

A daily multivitamin-mineral supplement is essential in addition to a healthful varied diet, avoiding processed foods and fast foods that are either lacking in nutritional value or are flat out working against you to promote better health. It is not necessary to customize a daily multi; it should simply provide the vitamins and minerals truly proven essential to human health in a balanced formulation that provides 100% of the daily recommended value (RDV).

Some of the more common problematic nutritional deficiencies include vitamin B12, magnesium (Mg), calcium and vitamin D. Symptoms of low levels of vitamin B12 may present as subtle cognitive and neurological changes; more serious shortages can result in dementia or anemia because B12 is essential for the production of red blood cells in the bone marrow. Dietary sources are animal derived: meat, fish, poultry, and to a lesser degree, eggs and milk products. Vegetarians can eat tempeh made of fermented soybeans (the bacteria produce B12). The RDV set by the FDA is 6 mcg.

Magnesium is required for 350 enzymes in the body to function, and for healthy maintenance of bones, arteries, heart, nerves, and teeth. A staggering 80% of the population is deficient in this mineral! Dietary sources include dark green vegetables, nuts seeds, and whole grains. The RDV is 400 mg.

Central to the prevention of osteoporosis is adequate daily intake of calcium, vitamin D, magnesium, copper and zinc which work together to strengthen bones. Calcium is essential for bones as well as teeth, blood and muscle contraction. Dietary sources include tofu, sardines, salmon, broccoli, kale, grains, nuts, and seeds. The RDV is 1,000 mg; taken in divided doses of 500mg or less. Vitamin D is essential for absorption of calcium in the body; the RDV is 600 mg. Requirements for calcium and vitamin D are higher in adolescents and the elderly.

A note on vitamin A: it can come from retinol (often called vitamin A palmitate or acetate) or from beta-carotene, or a combination of both. The label should specify. Optimally, vitamin A would be supplied as beta-carotene since the body can convert it to vitamin A on an as needed basis and high levels of retinol have been linked with weaker bones.

Look for things like USP Pharmaceutical Grade Quality products, chelated minerals which enhance absorption and bioavailability, natural color coating which avoids lead and other toxins, and independent assays to ensure safety, purity and content. Vitamin E should be should be natural (specified as d-alpha/mixed Tocopherols) NOT synthetic (dl-alpha Tocopherols). The natural form of vitamin E is better absorbed and retained by the body, but because it is more expensive it may be substituted by synthetic alternatives. Lycopene, an antioxidant found in tomatoes, is often added to a daily multi because of its association with cardiovascular and prostate health. Studies have shown these benefits with doses of 6 mg daily.

Finally, don’t take “one-a-day” multivitamin-mineral formulas seriously; you simply can’t pack in decent amounts of all the necessary nutrients in one tablet or capsule. A good product cannot be packaged in less that 2-4 tablets per day, taken in divided doses with two meals. Many of these details will of course increase the cost of the product, but as an educated consumer you will know just why it may be worth it.

The Essential Fatty Acids: Omega-3s

Essential fatty acids (EFAs) have become best known for their anti-inflammatory effects associated with decreased risk of inflammation based degenerative diseases (like arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus, multiple sclerosis, migraine headaches, heart disease and cancer. EFAs belong to a class of healthful lipids known as polyunsaturated fatty acids and are unfortunately consumed far less than unhealthy fats in the typical American diet. Polyunsaturated EFAs include omega-3s, omega-6s, omega-7s, and omega-9s. These occur naturally in vegetables, fruits, nuts, grains, seeds, and various animal sources. Popular sources of omega-3s include fish oil, flaxseed, and hemp, while omega-6 supplements are frequently sourced from evening primrose oil, black currant, and borage. Meanwhile omega-7s are present in palm kernel oil and coconut oil, and omega-9s occur naturally in avocado oil and olive oil.

The omega-3s are comprised by alpha-linoleic acid (ALA) abundant in nuts, flaxseed, and vegetable oils is converted in the body into two other omega-3s derived from marine sources (fish oils): docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Omega-3s and omega-6s must be consumed in a certain ratio for optimal health. An excess of omega-6s promotes the pathogenesis of cardiovascular, cancerous, inflammatory and autoimmune diseases. Because the average American diet provides a greater amount of the omega-6s we need to supplement our intake of the omega-3s. Because of the heart protective benefits of omega-3s DHA and EPA the American Heart Association currently recommends that people with coronary heart disease consider 1,000 mg of combined EPA and DHA daily.

When you compare VitalRemedyMD’s VitalOils with others ask the following:

• Does it contain 1,000 mg combined EPA and DHA; not just 1,000 mg “fish oils”?
• Do I need to take more than 1 soft gel to achieve that goal?
• How does the cost compare based on the amount of EPA and DHA?
• What is the source of oils? (small ocean fish are optimal)
• Do they talk about enhanced purification using supercritical fluid technology?
• Are soft gels enteric coated to enhance absorption and eliminate indigestion?
• Is the product independently assayed for content accuracy and purity?

The JOINT Formulas

Did you know that each knee can bear up to four times your body weight? As strong as it is, injuries occur commonly, both from overuse and from under use. Be proactive and prevent injury by maintaining appropriate body weight and exercising 3-4 times a week. Begin with at least 10 minutes of cardiovascular activity like a stationary bike with the seat positioned so that your leg is almost fully extended on the down pedal, or the elliptical machine which allows for a challenging aerobic workout at a variety of levels while minimizing direct impact to the knee joint. Appropriate stretching should follow along with a few exercises that target the quadriceps and hamstrings and surrounding muscles that stabilize the knee. Seek out a personal trainer for advice on a regimen that suits your needs and capability.

Formulations that include glucosamine and chondroitin flood the market. If you pay careful attention to a few key points when choosing a product, you will find out how beneficial they can be. Studies have shown benefit, including both reduced symptoms and decreased joint space narrowing on x-ray exam with the sulfate forms of these supplements (not HCL). In our experience our formulation has been most effective for arthritis involving knees and hands, usually within 1-3 months; it must be taken at the correct dosage as directed.
Look for:

• Sulfate form of glucosamine (NOT HCL); daily dose of 1500 mg
• Chondroitin sulfate 1200mg daily
• Addition of omega-3s DHA and EPA for their anti-inflammatory effect
• Additional vitamins and minerals that are essential for maintenance of healthy cartilage and joints, including: B6, E, C, B5, zinc, and copper
• Enteric coating for increased absorption

The EYE Formulas

Are you looking for a nutritional supplement created to support eye health? Go to any supermarket or health food store, or do an on-line search and you’ll quickly find yourself overwhelmed by choices. Some popular companies even have six or seven of their own products for you to consider. Which one should you chose? As Age-Related Macular Degeneration (AMD) is the leading cause of blindness in the western world, most ocular formulations focus on this disorder. We at VitalRemedyMD have spent two years analyzing the medical literature in order to produce the safest and most scientifically validated formulation for preserving eye health: RetinGuard®.

Many small studies that have evaluated nutrition and supplementation for maintaining eye health, but one that has caught the eyes of many people is AREDS (Age Related Eye Disease Study). This trial was published in 2001, and found that individuals with advanced macular degeneration had a 25% reduction in the progression of disease when taking a high dose antioxidant and mineral formulation. As there were a number of worrisome “issues” with the consumption of such high dose supplementation, AREDS II, an ongoing re-examination of this matter, has altered the doses of key ingredients in an attempt to establish optimal effective dosage ranges. Thus, in formulating RetinGuard™ both AREDS and AREDS II had to be duly thought-out. Another major trial to be considered was LAST (Lutein Antioxidant Supplementation Trial). In this study, lutein (10 mg daily) was found to significantly halt the progression of AMD in study participants.

• Beta-carotene is not necessary since beta-carotene is found only minimally in the retina and because of the association with lung cancer in smokers at higher doses.
• Lutein 10 mg and zeaxanthin/ mesozeaxanthin (4 mg/6 mg) in a 1:1 ratio as they are found naturally in the retina; these carotenoids function to protect our eyes from damaging sunlight.
• NAC a precursor for glutathione, which itself is poorly absorbed, protects against free radicals.
• Vitamin C 500 mg
• Natural vitamin E 100 IU
• Riboflavin (vitamin B2) 3.4 mg for maintaining eye health
• Zinc/Copper 25 mg/ 2 mg in proper ratio; important for maintaining eye health, but at lower doses than AREDS I because of untoward side-effects at higher doses
  
• Pure USP Pharmaceutical Grade Quality Independently assayed by FDA registered laboratories for safety and purity

Americans are eating too much salt. A recent study published by the Center for Disease Control found that the many Americans consume way too much salt. The study, based on surveys of more than 7,200 people in 2007 and 2008 (including nearly 3,000 children), found that approximately nine out of 10 persons in the United States ingest more sodium than recommended. Daily dietary sodium intake, excluding sodium added at the dinner table, averages 3,266 mg/day. The Dietary Guidelines for Americans recommends a daily sodium intake 2,300 mg overall and 1,500 mg for specific at-risk populations comprising about half of the population. Those numbers indicate that many Americans may be consuming up to twice their daily-recommended intake of sodium per day.

Health problems related to high sodium consumption include high blood pressure, or hypertension, which in 2008 was reported as a primary or contributing factor in approximately 348,000 deaths in the U.S. Hypertension is widespread, with thirty-one percent of adults in the United States being afflicted and fewer than half of those having their blood pressure under control. A mere 33% reduction in the average American’s daily sodium intake would potentially avert up to 81,000 deaths, and save an estimated $20 billion health-care dollars annually.

Sources of Dietary Sodium
Contrary to popular opinion, the problem with salt over-consumption lies not in the use of a salt shaker, but in eating the wrong foods. Americans get approximately two-thirds of their dietary sodium from processed foods and drinks purchased at their local supermarket or convenience store, and about one fourth from restaurant food — a source that has the highest per-calorie dietary sodium level.

Results of the CDC’s study indicate that a whopping 44% of sodium intake comes from 10 common foods (highest to lowest):

• Bread and rolls
• Cold cuts/cured meats
• Pizza
• Poultry
• Soups
• Sandwiches such as cheeseburgers
• Cheese
• Pasta mixed dishes
• Meat mixed dishes
• Savory snacks like chips and pretzels

What Can Be Done?
People must be more careful about their food choices. And food manufacturers need to make reducing the sodium content in their food products a top priority. Consumers need to become more proactive – demand that manufacturers and restaurants strive to reduce excess sodium added to foods. States and localities can implement policies to reduce sodium in foods served in institutional settings like schools, child-care centers, and government cafeterias.

Six simple tips:

• NEVER use a salt shaker (it goes without saying, but I had to say it anyway).
• Cooking fresh food at home is the best way to reduce sodium intake. It is also the best way to stay lean.
• Do the math — monitor your daily sodium intake and try to keep that number under 2,300 mg.
• Avoid high salt content processed foods and those on the list above — a typical frozen 5 oz. turkey dinner can contain over 700 mg of salt!
• Read those supermarket food labels — choose low sodium alternatives. Watch out for misleading food labels that claim “low sodium’ but really mean slightly “less” sodium.
• Avoid salty items at restaurants. For instance, Red Lobster’s Admirals’ Feast packs a staggering 7,106 mg of sodium and a McDonald’s Chicken Club Sandwich contains roughly 1,690 mg of sodium. Ouch!

Additional information is available at www.cdc.gov/vitalsigns

Reading a fish oil supplement label can be a daunting task. Understanding the difference between DHA and EPA, the active ingredients in fish oil, is even more complex. The reason for this complexity resides in the fact that our understanding of these two fatty acids is in its infancy. Still, let’s try to make some sense of what we’ve learned over the past decade or so.

Fatty acids are comprised of just three different atoms, carbon (the long backbone or skeleton of the fatty acid), hydrogen, and oxygen.  That’s it. The difference among the various fats lies in the length of the backbone (how many carbon atoms there are) and the number of “double bonds” between carbon atoms. Other than these two distinctions, the fatty acids are really the same. So, then why are there such great differences among the fats if they’re so similar, you might ask? It turns out that longer chains tend to be more biologically active, and more double bonds results in more twisted and misshapen molecules which can then take on characteristics akin to complex locks or keys. As signaling and communication between cells often occurs through a lock and key mechanism, the fatty acids with many double bonds turn out to be great candidates for this task.

EPA is shorter than DHA (perhaps a bit less biologically active) and has fewer double bonds (less effective as a lock or key). EPA tends therefore to serve more as a precursor for other molecules that can diminish inflammation, clotting, oxidation, and cell death. DHA is also a precursor for some wonderful molecules that cause reversal of inflammation and tremendous protection of nerve tissue. Additionally, DHA is actively incorporated in our cell membranes where it can help cells communicate with other cells.

Other attributes shared by these two omega-3s include: Lowering triglycerides; raising HDL: and lowering the risk of lethal heart rhythms during and following heart attacks. Our bodies contain far more DHA than EPA, and DHA lasts longer in our bodies than does EPA, but both of these fatty acids have very important roles to play, and should be emphasized in our diets.

So, now that you understand the different forms that fish oils come in, it would be helpful to know what you’re putting in your mouth when you swallow a fish oil soft gel.  To do this, you have to develop the skill of label-reading.  At first blush this may seem to be a simple task, one not worthy of a blog, but in truth deciphering labels can at times be anything but easy.  I am not suggesting that companies intentionally mislead consumers with marketing and catchy phraseology, but at times they certainly don’t go out of their way to clarify what’s being sold to you.  For instance, what does it mean when a label catches your attention with the bold statement, “1,000 mg of fish oil”? Are you to be comforted knowing that taking just one of these pills meets the American Heart Association’s recommendation for heart patients to take 1,000 mg of the essential omega-3s EPA+DHA daily? More often than not, the answer is NO.  That’s because fish oil does not equal EPA+DHA.  And it’s EPA+DHA that you’re after.  EPA and DHA are the active and beneficial ingredients in fish oil, not the other fats (which include saturated fats as well).  To be sure you are getting what you want and deserve, follow these few steps:

1. Pay attention to only the “Supplement Facts”
2. Read the “Serving size” – how many soft gels does it take to get one serving? Mark that # down.
3. Read the “Amount per serving” – how much EPA is there, and how much DHA is there in a single serving? Add the amounts of EPA + DHA per single serving. Write that # down. Ignore “other omega-3s’ or “Total omega-3s”
4. Let’s say your goal is to get 1,000 mg daily of DHA+EPA. Take “1,000” and divide it by the number you got in step 3. For instance, if the number you arrived at is “500 mg”, then 1,000/500 is 2.  You must take 2 servings to get your 1,000 mg of DHA+EPA daily.
5. But you must be sure how many soft gels make up a single serving! So, now multiply the answer you got in step 4 by the # you got in step 2. For our current example, this will give you the # of pills needed to get your 1,000 mg of DHA+EPA daily. As the serving size can be 1, 2 or even 3 pills, in the case we’ve constructed you might need to take 2, 4, or even six pills to get what you want! That is why this process is so important.

Remember, the more DHA+EPA there is per gram of fish oil, the more concentrated and pure the oil is.  The more pure the oil, the fewer unnecessary fats you are consuming.  Try to get the purest oils. Extra fat gives you extra and unnecessary calories, something most of us do not need these days.

I hope this has been clear and helpful for you. The next blog, Differentiating Fish Oils Part 3, will discuss the different ways our bodies utilize DHA and EPA.

This series will succinctly describe various aspects of the omega-3 fish oils that cause doctors and their patients a great deal of confusion and consternation. We will begin with the form of the oil.

Fish oils come in four forms: Ethyl Ester (EE), Triglyceride (TG), Phospholipid (PL), and Free Fatty Acid (FFA). Most fish oils (including the prescription, Lovaza) come in the EE form.  In fact, the largest and most profound scientific studies to date have used EE omega-3s.  In nature, omega-3s are found in the TG and PL forms.  The problem is that in order for manufacturers to develop pills with highly concentrated important omega-3s, EPA and DHA (also known as the active ingredients in fish), they must first convert the omega-3s to the EE form.  Then these health-promoting omega-3s can be highly concentrated, and depending upon one’s preference, either EPA or DHA can be emphasized (to be discussed in a future blog). Some manufacturers chose to convert the oils back to the TG form (a process that requires the oils to be subjected to high temperatures for long periods of time – not good for the oils in some experts’ opinions).  Others convert the oils into the FFA form to try to enhance absorption.  The Krill oil producers leave the oil in its original PL form with the drawback being that only very small amounts of the key ingredients EPA and DHA can be delivered in each pill.  The Krill and TG contention is that these forms of omega-3s are more “natural” and thus better.  The reality is, however, that all the oils must be changed in our gut to FFA in order to be absorbed.  Thus, they are no longer PL, TG, or EE when they’re absorbed by our bodies.  They are all FFAs. Studies to date have shown this conversion to be an efficient process and up to 95% absorption can be expected when any of the forms are taken with food. In fact, the lion’s share of the current literature indicates that the form of the oil is probably not nearly as important as companies would like you to believe. The most important issue is how much EPA and DHA you are receiving when you swallow a pill or eat a fish.  That is what you need to look for (also the subject of another blog).

A Preventive/Integrative Cardiologist’s blog: topical, trustworthy, vital, and concise information, so you can spend less time searching for answers and more time enjoying life.

As a cardiologist practicing and teaching a blend of conventional, complementary, and integrative medicine for the past two decades I have learned what people desperately yearn for – trustworthy, even-handed, open-minded, scientifically-sound, appraisals of the vast and oftentimes blinding volume of data at our fingertips.  And people need the answers to be concise. The internet is flooded with information, but what is real and what is apocryphal?  Even for well-studied physicians and scientists, separating the wheat from the chaff can be a herculean task.  This blog is something I have dreamt of starting for quite some time.  It begins now.  I vow to assess issues relating to health and wellness as well as prevention in the cardiovascular and other realms in a clean and unbiased fashion.  I promise to do my research – when called for, obtaining input from other experts in various disciplines – to provide you with relevant, vital, and concise information that will enable you to make more healthful and sound choices so that you can live longer, healthier, happier, and better lives.  I encourage your participation.

According to findings published in the journal Clinical Cancer Research, the fatty acids may work by modifying a specific variant of the COX-2 gene,a known inflammatory gene.  The variant is linked to a five-fold increased risk of advanced prostate cancer, report the researchers, but individuals with high intakes of omega-3 may have a reduced risk, even if they carried the COX-2 variant.

The COX-2 increased risk of disease was essentially reversed by increasing omega-3 fatty acid intake by a half a gram per day.

“Previous research has shown protection against prostate cancer, but this is one of the first studies to show protection against advanced prostate cancer and interaction with COX-2,” said lead researcher Professor John Witte. “The COX-2 increased risk of disease was essentially reversed by increasing omega-3 fatty acid intake by a half a gram per day.” This study adds to a growing body of evidence linking fish consumption and omega-3 to potential cancer benefits.