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How to Stop Diarrhea From Antibiotics

Introduction:

Antibiotic-associated diarrhea (AAD) is caused by alteration in bacterial flora which changes carbohydrate metabolism, reduces absorption of fats, and results in osmotic diarrhea. AAD may lead to Clostridium difficile (C. difficile) colitis following proliferation of this organism in the colon which can cause abdominal pain and life-threatening inflammation of the colon. Antibiotic therapy is the key factor predisposing patients to C difficile infection. Research suggests that some probiotics have a protective effect for antibiotic associated diarrhea and C difficile infection.

Specific probiotic reduces risk of antibiotic-associated diarrhea:

Researchers analyzed 5 randomized clinical trials (n=1076) of Saccharomyces boulardii (S boulardii) and found a significantly protective effect for antibiotic-associated diarrhoea (AAD). Compared with placebo, S boulardii was associated with a 57% risk reduction in AAD. Saccharomyces boulardii reduced the absolute risk of antibiotic-associated diarrhea (AAD) from 17.2% to 6.7%. (1)

Several probiotics are effective for antibiotic-associated diarrhea (AAD):

Probiotics such as Saccharomyces boulardii and lactobacillus may have a protective effect against antibiotic-associated diarrhea (AAD) caused by bacterial flora alteration in the gut. A review of the literature by Cremonini, F et al found 3 randomized, double-blind, controlled clinical trials that reported beneficial effects of S boulardii in AAD. Two separate double-blind controlled studies showed the benefits of Lactobacillus acidophilus and bulgaricus. Some other studies, not double-blind, report beneficial effect of Lactobacillus rhamnosus GG, Bifidobacterium longum and Enterococcus faecium SF68. (2)

A meta-analysis reviewed controlled trials on probiotics:

McFarland, LV et al reviewed 25 randomized controlled trials, and found that S. boulardii and L. rhamnosus GG, or 2 strains of Lactobacuillus species or a combination of  Lactobacillus acidophilus and Bifidobacterium at an average dose of 3×10^9 for about 2 weeks resulted in a 57% reduction on antibiotic associated diarrhea (3).  However,the higher doses of organisms in probiotics (over 1010/day) had a higher efficacy rate for ADD. McFarland, LV et al also reviewed 6 randomized controlled trials of oral vancomycin or metronidazole plus probiotic therapy (or placebo) with average dose of 5×1010 at a duration of 3-5 weeks for the treatment/prevention of clostridium difficile colitis (CDD). S. boulardii significantly decreased the recurrence of CDD with a relative risk reduction of 41% but no other types of probiotics were effective for prevention or recurrence of CDD. (3)

Summary: Antibiotic Associated Diarrhea and Clostridium difficile Colitis

• Szajewska, H et al published that compared with placebo, Saccharomyces boulardii reduced the absolute risk of antibiotic-associated diarrhea (AAD) from 17.2% to 6.7% (1).

• Cremonini, F et al found 3 double-blind controlled trials which showed improvement of AAD with Saccharomyces boulardii, and 2 additional trials found Lactobacillus acidophilus and bulgaricus to be beneficial (2). He also found other non-blinded trials showing beneficial effect of Lactobacillus rhamnosus GG, Bifidobacterium longum, and Enterococcus faecium SF68 (2).

• McFarland, LV et al reviewed 25 randomized controlled trials, and found that S. boulardii and L. rhamnosus GG, or 2 strains of Lactobacuillus species or a combination of  Lactobacillus acidophilus and Bifidobacterium at an average dose of 3×10^9 for about 2 weeks median duration resulted in a 57% reduction on antibiotic associated diarrhea. The higher doses of organisms in probiotics (over 1010/day) had higher efficacy for ADD. (3)

• McFarland, LV et al reviewed 6 randomized controlled trials of oral vancomycin or metronidazole plus probiotic therapy (or placebo) with average dose of 5×1010 at a duration of 3-5 weeks for the treatment/prevention of clostridium difficile colitis (CDD). S. boulardii significantly decreased the recurrence of CDD with a relative risk reduction of 41% but no other types of probiotics were effective for prevention or recurrence of CDD. (3)

References:

1.Szajewska H, Mrukowicz J. Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2005 Sep 1; 22(5): 365-72. http://www.ncbi.nlm.nih.gov/pubmed/16128673

2.Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea. Dig Liver Dis. 2002 Sep;34 Suppl 2:S78-80. http://www.ncbi.nlm.nih.gov/pubmed/12408447

3.McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease.  Am J Gastroenterol. 2006 Apr;101(4):812-822. http://www.ncbi.nlm.nih.gov/pubmed/16635227

 

 

Best Options for Seasonal Allergies

Introduction:

An allergy occurs following an oversensitive immune system response to a foreign substance or allergen. After the body comes in contact with an allergen, the immune system triggers release of inflammatory chemicals such as histamine from mast cells. In allergic rhinitis, allergies result from exposure to an allergen such as dust mites, pollen, pet dander, and pollen resulting in nasal drainage, sinus pressure/pain, tearing of the eyes, and sneezing. Symptoms correlate with seasonal release of pollen.

 

 

Common treatments for allergic rhinitis.

Allergic rhinitis and nasal rinsing:

One of the most safe and effective treatments for allergic rhinitis is nasal lavage. This method consists of a saline solution expressed by a squeeze bottle or “Netty Pot” to wash out adherent secretions, pollen, dust and other allergens. The saline solution is placed in both nares twice per day and allowed to drain down the back of the throat and then the remainder is gently blown out into tissue.

 

 

Over the counter medicines for allergic rhinitis:

Common over the counter medications include the antihistamines Benadryl (diphenhydramine) and Claritin (loratadine), and the vasoconstrictor Afrin (oxymetazoline). Commonly prescribed medications include antihistamines and nasal steroids. Be aware that the antihistamine Benadryl (diphenhydramine) is stronger than Claritin (loratadine) and most prescription antihistamines. It is also less expensive. Please note that if the diagnosis of allergic rhinitis is incorrect, the treatments being used for the false diagnosis of allergic rhinitis may not be effective. For instance, vasomotor rhinitis with nasal drainage that occurs after a stimulus of cold or spice is treated more effectively with Atrovent nasal spray (Ipratropium Bromide).

 

Potential herbal treatments and dietary changes for allergic rhinitis:

Butterbur and allergic rhinitis:

Butterbur herbal preparations may contain pyrrolizidine alkaloids (PAs), which have been known to result in toxic damage to the liver. Butterbur products should specifically state that the product is free of  pyrrolizidine alkaloids (PAs).

Butterbur (Petasites hybridus) helps symptoms in allergic rhinitis patients and was compared to an antihistamine:A randomized controlled trial including 125 participants shows that the herbal agent butterbur (Petasites hybridus) has beneficial effects in patients with seasonal allergic rhinitis possibly comparable to the antihistamine Zyrtec (cetirizine). For two weeks, patients were randomized to either one tablet butterbur (petasites carbon dioxide extract ZE 339 standardised to 8.0 mg of total petasine per tablet), four times daily herb extract 4 times per day (n=61) or one tablet cetirizine (n=64) in the evening. The SF-36 questionnaire, a medical outcome health questionnaire, was used as a self-assessment tool. The questionnaire also includes the physician\’s clinical global impression scale (CGI) with a five-point score for comparing current severity of the condition with that of the previous year. Improvements in both the SF-36 and CGI scores were similar in both groups. The overall incidence of adverse events was similar for the two treatment groups. However, two-thirds of the adverse events for the cetirizine group were drowsiness and fatigue — symptoms not reported in the butterbur group. Fatigue occurred less in the butterbur group than the cetirizine group, headache occurred in two patients of each group, and elevated liver enzymes occurred in 1 patient of the butterbur group. (1)

Butterbur leaf extract Ze 339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) was given to 580 patients with seasonal allergic rhinitis or nasal allergies responsible for sneezing, congestion, runny nose, and itchy nose. Participants were treated with an average of 2 tablets of Ze 339 daily for 2 weeks. At the end of the study, symptoms (rhinorrhea, sneezing, nasal congestion, itchy eyes and nose, red eyes, and skin irritation) of seasonal allergic rhinitis significantly improved in 90% of patients. Additionally, effectiveness, tolerability, and quality of life improvement was reported by 80%, 92% and 80% of patients, respectively. Antiallergy medication given in combination with Ze 339 showed no improvement compared to Ze 339 alone. Side effects were reported in 3.8% of patients with mostly gastrointestinal complaints. (2)

 

 

Spirulina may improve allergic rhinitis:

Karkos P.D et al produced a review of many studies explaning that spirulina is a type of blue-green algae that is rich in protein, vitamins, minerals, carotenoids, antioxidants that can help protect cells from damage, B complex vitamins, beta-carotene, vitamin E, manganese, zinc, copper, iron, selenium, and gamma linolenic acid (an essential fatty acid). The review also covered studies revealing that spirulina increases healthy lactobacillus in the intestine which enables production of Vitamin B6. (6)

 

 

Spirulina reduces inflammatory cytokines in allergic rhinitis patients.

A study by Mao TK et al showed that the blue-green algae, Spirulina, has been linked with improved immune health benefits in prevention of allergic rhinitis. In a random double-blinded crossover 12-week study, one group was provided with 1,000 mg/day or 2,000 mg/day of Spirulina, while the other group took a placebo. The study used peripheral blood mononuclear cells which were isolated before and after Spirulina. It was found that the cells developed a reduction in the IgE mediated inflammatory substance interleukin-4 (IL-4) by 32%. IL-4 is a substance resulting in inflammation following exposure to allergy stimulus. Results showed that Spirulina taken at 2,000 mg/day resulted in reduced cytokine production in immune cells which is protective toward allergic rhinitis. (3)

Kim HM et al found in a study that spirulina also inhibits the release of histamine from mast cells (4).

A double-blind placebo controlled trial evaluated the effectiveness and tolerability of spirulina for treating patients with allergic rhinitis. Spirulina at a dose of 2000 mg per day was taken by 150 patients between 19 and 49 years old for 6 months. Spirulina consumption significantly improved the symptoms and physical findings compared with placebo (P < .001), including nasal discharge, sneezing, nasal congestion and itching. (5)

Beware of spirulina products containing anatoxin-a: The recent increase in popularity of food supplements containing blue-green algae such as Spirulina or scientific names Arthrospira and Aphanizomenon presents a potential for exposure to anatoxin-a contained in spirulina products. Anatoxin-a is a potent neurotoxin that may cause fatal intoxication if enough is ingested and if adequate quality control measures are not undertaken. Tests were conducted on a sampling of 39 supplements and found that 3 of the samples, or 7.7% contained anatoxin-a. 1 out of the 3 samples intended for human consumption detected 11 micrograms per gram of anatoxin-a. The brand name of this product was not mentioned but the origin was Australia. 2 out of the 3 samples with significant anatoxin-a were intended for bird and fish consumption at concentrations of 33 and 2.5 micrograms per gram respectively but the origins of these samples were not known. There were 3 samples in addition to those mentioned above with anatoxin-a detected but were below the level of detected to determine concentration. 2 of these brands were from Australia with unnamed brand and 1 sample was named Swiss Natural Sources Spirulina. The following brands at the time of testing did not contain anatoxin-a as reported by this study: Lalco Laboratory Mega Spirulina, Phytovie Spirulina, Exact™ Spirulina, Health-Wise Natural Sources Spirulina, Nature’s Fingerprint Spirulina, Gandalf Nu-Greens Spirulina, Organika® Spirulina, Compare Spirulina, Jean-Marc Brunet, Le Naturiste, Spirulina 500, Nu-Greens Spirulina, Herbal Factors Spirulina, Root of Life Brand Spirulina, Personnelle Spirulina + Ginseng, Adrien Gagnon Spirulina plus Chlorella, Jamieson Natural Sources Spirulina, Lalco Laboratory Florasun Spirulina, Fingerprinted™ Spirulina, Earthrise® Spirulina, Herbal Select Spirulina, and Bio Nutrition Micro Algaes. (8)

 

 

Allergic Rhinitis and Diet:

There are few studies which link diets as a treatment for nasal allergies. However, when comparing the rates of disease between non-vegetarian and vegetarians, non-vegetarian females were 1.15 times more likely to report allergic rhinitis, and were also more likely to report many different kinds of other allergies compared to vegetarians. (7)

 

 

Pycnogenol and allergic rhinitis:

French pine bark extract, may help with allergy health. Participants (n=39) were given either Pycnogenol or placebo 5-8 weeks before the start of birch allergy season in 2009. They provided feedback on their symptoms on a scale from 0 (no symptoms) to 3 (severe; symptoms completely prevent normal activity). By the end of the allergy season, those in the Pycnogenol group had 35% lower eye symptoms and 20.5% lower nasal symptoms, compared to the placebo group. Additionally, the placebo group had a greater increase in the levels of IgE compared to the Pycnogenol group (19.4% vs. 31.9% increase), indicating that those in the placebo group had a greater allergic response. (9)

 

 

Summary: Allergic Rhinitis

• One of the most safe and effective treatments for allergic rhinitis is nasal saline lavage twice per day (not saline nasal spray).

 

• Butterbur (1,2), or spirulina (3,4,5), may improve symptoms of allergic rhinitis.

 

• Spirulina taken at 2,000 mg/day resulted in reduced cytokine production in immune cells which is protective toward allergic rhinitis (3). Kim HM et al found in a study that spirulina inhibits the release of histamine from mast cells (4). There are some safety concerns and approval from the primary physician should be obtained prior to taking spirulina especially along with other medications or supplements. Spirulina is approved as a food additive by the FDA.

 

• Spirulina products may not have adequate quality control but may be safe if the product is tested free of anatoxin-a, a neurotoxin (8). Spirulina products from Australia or the Swiss Natural Sources Spirulina brand should be avoided (8).

 

• Butterbur has been reported to cause liver enzyme elevation in 1 out of 61 patients when used for 2 weeks (1). Butterbur herbal preparations may contain pyrrolizidine alkaloids (PAs), which have been known to result in toxic damage to the liver. Therfore, butterbur products should specifically state that the product is free of  pyrrolizidine alkaloids (PAs).

 

• Vegetarian diet may result in lower risk of allergic diseases than non-vegetarians (7).

 

• In a study during the allergy season, those in the Pycnogenol group had 35% lower eye symptoms and 20.5% lower nasal symptoms, compared to placebo (9). Please discuss risk and benefit of taking this agent with your primary physician prior to taking and please see the section on pycnogenol adverse reactions and interactions prior to considering this agent.

 

 

References :

1.Schapowal A. Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 2002 Jan 19;324(7330):144-6. http://www.ncbi.nlm.nih.gov/pubmed/11799030

 

 

2.Kaufeler R, Polasek W, Brattstrom A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv Ther. 2006 Mar-Apr;23(2):373-84. http://www.ncbi.nlm.nih.gov/pubmed/16751170

 

 

3.Mao TK, van de Water J, Gershwin ME. Effects of a Spirulina-based dietary supplement on cytokine production from allergic rhinitis patients. Journal of Medicinal Food. 2005;8(1):27–30. http://www.ncbi.nlm.nih.gov/pubmed/15857205

 

 

4.Kim HM, Lee EH, Cho HH, Moon YH. Inhibitory effect of mast cell-mediated immediate-type allergic reactions in rats by spirulina. Biochem Pharmacol. 1998 Apr 1;55(7):1071-6. http://www.ncbi.nlm.nih.gov/pubmed/9605430

 

 

5.Cingi C, Conk-Dalay M, Cakli H, Bal C. The effects of spirulina on allergic rhinitis. European Archives of Oto-Rhino-Laryngology. 2008 Oct;265(10):1219-23. http://www.ncbi.nlm.nih.gov/pubmed/18343939

 

 

6.Karkos P.D, Leong SC, Karkos CD, Sivaji N, Assimakopoulos DA. Spirulina in Clinical Practice: Evidence-Based Human Applications. Evidence-Based Comp and Alt Med; 2011: 1-4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136577/

 

 

7.Knutsen SF. Lifestyle and the use of health services. Am J Clin Nutr. 1994 May;59(5 Suppl):1171S-1175S. http://www.ncbi.nlm.nih.gov/pubmed/8172119

 

 

8.“First detection of anatoxin-a in human and animal dietary supplements containing cyanobacteria.” Departamento de Química Analítica y Alimentaria, Facultad de Química, Edificio de Ciencias Experimentales, Campus Universitario, Universidad de Vigo, Vigo, Spain. Food Chem Toxicol. 2009 Sep;47(9):2189-95. Epub 2009 Jun 9. http://www.ncbi.nlm.nih.gov/pubmed/19520132

 

 

9.Wilson D, Evans M, Guthrie N, Sharma P, Baisley J, Schonlau F, Burki C. A randomized, double-blind, placebo-controlled exploratory study to evaluate the potential of pycnogenol for improving allergic rhinitis symptoms. Phytother Res. 2010 Aug;24(8):1115-9. http://www.ncbi.nlm.nih.gov/pubmed/20549654

 

 

Ordinary Fatigue or Chronic Fatigue Syndrome?

Introduction:

Fatigue requires a medical evaluation with history, physical, and diagnostic testing. If one has experienced severe fatigue for 6 or more consecutive months that interferes with daily tasks, tiredness after activity lasting for over a day, or poor concentration, they may be experiencing chronic fatigue syndrome. Chronic fatigue syndrome is a disorder that limits a person’s ability to do regular daily activities due to lack of energy over an extended period of time. The main symptoms of chronic fatigue syndrome, in addition to sever fatigue lasting for 6 months or more, may include muscle pain, memory problems, headaches, pain in multiple joints, sleep problems, sore throat, and tender lymph nodes. No one knows what causes chronic fatigue syndrome but it can accompany fibromyalgia and can last for years. Treatment is focused toward the improvement of energy levels. Medicine may treat pain, sleep disorders, and other problems. Lifestyle changes, coping techniques, and a special, gradual exercise program may improve the symptoms. Several Integrative Medicine options are provided below.

 

Meta-analyses on yoga therapy:

A meta-analysis of 7 randomized controlled trials (n=362) that compared meditative movement therapy interventions (including yoga, tai chi and qigong) to controls found patients with fibromyalgia experienced improvements in sleep, fatigue, depression, and overall quality of life. When yoga was analyzed separately, it was found to be the only therapy that significantly reduced pain, fatigue, depression and limitations to health-related quality of life (HRQOL) at final treatment, demonstrating yoga’s positive impact. No serious adverse events were reported for any of the therapies. (1)

A meta-analysis of 13 randomized controlled trials examining yoga for patients with cancer, specifically breast cancer patients, found yoga was associated with reduced stress, anxiety, depression, and fatigue. Furthermore, among participants, yoga moderately increased quality of life, emotional and social function, and functional well-being. Physical function and sleep were not significantly affected. (2)

 

Natural treatment for fatigue in the elderly:

Levocarnitine is produced within the body from amino acids and is necessary for fatty acid transport and energy production. It is a widely available nutritional supplement which was shown to reduce total fat mass, increase total muscle mass, and have a beneficial effect on fatigue and lipid levels in healthy elderly subjects with rapid muscle fatigue. Participants (n=84) were equally randomized to receive either levocarnitine 2g twice daily or placebo. At the end of the 30-day treatment period, compared to placebo, levocarnitine patients had significant improvement in total fat mass (-3.1 vs -0.5 kg), total muscle mass (2.1 vs 0.2 kg), total cholesterol (-1.2 vs +0.1 mmol/L), LDL cholesterol (-1.1 vs -0.2 mmol/L), HDL cholesterol (0.2 vs 0.01 mmol/L), and triglycerides (-0.3 vs 0.0 mmol/L). Physical and mental fatigue was reduced by 40% and 45%, respectively, in the levocarnitine group. Corresponding reductions in the placebo group were only 11% and 8%. No serious side-effects were reported in either group. (3)

 

Small study showed natural treatment relieved chronic fatigue:

High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Results of a small double-blind, randomized crossover study with 10 individuals indicate that daily consumption of high cocoa liquor/polyphenol rich chocolate (HCL/PR) in the form of a 15 gram bar of 85% cocoa 3 times daily significantly improved symptoms of chronic fatigue, as measured using the Chalder Fatique Scale, after 8 weeks, compared with simulated iso-calorific chocolate (cocoa liquor free/low polyphenols [CLF/LP]). (4)

 

 

Assessment and Plan:

• A meta-analysis reviewed 7 randomized controlled trials which compared meditative therapy to controls and found that fibromyalgia patients receiving the therapy experienced improvements in sleep, fatigue, depression, and overall quality of life but yoga was the only treatment which significantly reduced pain, fatigue, depression and limitations to health-related quality of life (1).

 

• Another meta-analysis of 13 randomized controlled trials found that yoga reduced stress, anxiety, depression, fatigue, and also increased quality of life, emotional/social function, and well-being (2).

 

• Levocarnitine (L-carnitine) at a dose of 2 grams twice daily taken by elderly subjects compared to placebo not only reduced physical and mental fatigue by 40% and 45%, respectively, it improved body fat, increased muscle mass, and improved the lipid profile without serious side-effects were reported (3).

 

• Results of a small double-blind, randomized crossover study indicated that consumption of a 15 gram bar of 85% cocoa, 3 times daily significantly improved symptoms of chronic fatigue (4).

 

 

References:

1.Langhorst J, Klose P, Dobos GJ, Bernardy K, Hauser W. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International 2013; 33(1): 193-207. http://www.ncbi.nlm.nih.gov/pubmed/22350253

 

2.Buffart LM, van Uffelen JG, Riphagen II, et al., Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012 Nov 27;12:559.  http://www.ncbi.nlm.nih.gov/pubmed/23181734

 

3.Pistone G, Marino A, Leotta C, Dell’Arte S, et al. Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue. Drugs Aging. 2003;20(10):761-7. http://www.ncbi.nlm.nih.gov/pubmed/12875611

 

4.Sathyapalan T, Beckett S, Rigby AS, Mellor DD, Atkin SL. High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Nutr J. 2010 Nov 22;9:55. http://www.ncbi.nlm.nih.gov/pubmed/21092175

 

 

 

Preventing Unsightly Varicose Veins

Introduction:

Varicose veins are the result of damaged one way valves that help push the blood through the veins and forward to the heart.  When the valves become damaged, the blood is able to pool within the veins and decreases the ability of the body to remove toxins and oxygenate the tissues (16). The first sign of a varicose vein is swelling along the path the vein takes down the leg.  After this most people notice bluish or reddish tinged coloring to the area as well as a swelling along the vein.

 

How to Prevent Varicose Veins

Varicose veins are unsightly and uncomfortable. They affect both men and women and appear to have a genetic predisposition.  If family members suffer from varicose veins, other family members may have weak valves and have the same experience. Varicose veins occur when the one way valves that stop blood from pooling in the feet are damaged.  When the blood leaves the heart it is pumped throughout the body by the force of the heart muscle.  When it comes to the end of the route and has delivered all of the oxygen available, it turns around and heads for home, the heart and lungs.  On the return trip there is no heart muscle to pump the blood back against gravity.  Instead, there are a series of one-way valves in the venous system that work with muscle contraction to force the blood through the legs, up to the inferior vena cava which then delivers the blood to the heart and lungs.

This particular system is called the venous pump.  The pump part of this system works through muscle contraction in the lower legs and thighs.  When the muscle strength has been decreased for any reason it can cause pooling of the blood in the lower extremities.  People may notice some swelling in their feet and legs after having stood for several hours during the day.  This is a result of the blood not returning in an effective and efficient manner to the heart. Researchers know the types of things that can cause damage to the venous valves and trigger the development of varicose veins.  By avoiding these triggers you can also help to prevent the development of any varicose veins or help to decrease the progression of the ones you already have.

One of the biggest factors is weight, in a combination with other criteria.  For this reason, those who are overweight, obese or put on a significant amount of weight in a short period of time will find that they are more prone to varicose veins.  Individuals who are overweight will also find that by losing weight they reduce their risk and decrease the progression of the disease they may already have.  Women who are pregnant may find that they are at an increased risk for developing varicose veins but that these veins may resolve after the baby has been born.

There are several ways of reducing the risk of developing varicose veins, including weight loss.  Individuals who find that they sit or stand for several hours during the day also increase their risk of developing varicose veins because of the lack of muscle contraction in the lower extremities which drives the venous blood back to the heart. If employment entails long periods of time sitting or standing, it is important to reduce risk by moving around several times an hour.  People who are in a position of traveling in planes or cars for long periods of time will find that contracting and relaxing their calf muscles, ankles and feet every 10 minutes will also help to reduce their risk.

Many individuals have found that doing calf raises, or rising up onto their toes, while in the standing position will help to reduce their risk of varicose veins.  Women who are pregnant who must stay in a standing position can also rest their venous system and lower back by alternately placing one leg and then another on a short stool or box. When seated for any length of time it is important not to cross your legs at the knees.  This increases the pooling in the lower extremities and cuts off the return route for the venous blood to the heart and lungs.

Consistent and regular exercise helps to increase the muscle strength in the lower extremities and therefore keep the venous pump working throughout the day.  It is advised to walk for a mile and a half every day, rain or shine, will help reduce risk or progression. Even if there is not a genetic predisposition to the development of spider veins or varicose veins it is helpful to perform these minor preventative measures in order to reduce overall risk.

 

Treatments for Varicose Veins

At this time, traditional Western medicine believes that sclerotherapy is the gold standard for treating varicose veins.  However, some insurance companies do not cover this expense if there are no other underlying medical symptoms.  And, some women would like to try other more natural remedies in order to treat their varicose veins and prevent any further from occurring.

Many women find their varicose veins have a genetic predisposition.  In other words, there were other men or women in the family who suffered from varicose veins in years past.  This meant that the valves in the veins were predisposed to being weaker and giving them trouble.  However, by using some of the preventative measures outlined below many times men and women are able to significantly reduce their risk of developing spider veins or varicose veins.

Prior to trying any alternative medicine treatments, it is important to check with the primary care physician to ensure there is no negative impact any other underlying medical condition.

One of the reasons that varicose veins and spider veins will form is because the muscle contractions required to move the blood through the venous system are not strong enough, and the blood begins to pool.  In response to this, many women and men find that doing calf raises and other exercises for the lower extremities throughout the day will help to improve muscle strength and therefore the venous pump system.

Calf raises are done either on a stair or on a set of stacked books. Stand with the ball of your foot on a couple of stacked books and raise and lower your entire body using only the ball of the foot.  This exercise works the calf muscle which plays a significant role in the venous pump system.

Up to 50 to 100 calf raises each day as well as raising up on the toes from time to time throughout the day should enhabce the venous system of the legs.  In response to the development of these calf muscles, they should also be stretched.  This can be accomplished by placing one leg behind the other approximately 6 to 8 inches from a solid wall.  Hands should be placed on the wall, with the knee of the extended leg straight and the other knee bent, while leaning into the wall.  The calf area will begin to stretch.

Walking is another exercise that can be done, rain or shine, every single day, in order to improve muscle development in the lower extremities.  Walking aids the return of the venous blood, not only during the walk but also for several hours afterwards.

When one will be sitting or standing for any length of time they should be sure to make it a point to get up every 10 to 15 minutes and move around.  If employment entails standing in one place, then have the patient do some calf raises and move the legs at least every 10 minutes.  After working, legs should be elevated up above the level of the heart for at least 30 minutes to help improve the flow of blood through the venous system.

Compression stockings are another means of improving circulation and have been the mainstay of treatment for varicose veins for decades.  Compression stockings can also be used to prevent the formation of varicose veins, especially when you know there is a genetic predisposition to the condition. Individuals who suffer from varicose veins will also experience some relief from symptoms using compression stockins. (17,18)

Excess weight is another risk factor that significantly changes the percentage of individuals who will develop varicose veins or spider veins.  By exercising and controlling weight, the circulation will also improve and decrease the amount of pressure placed on the valves.

Another way of maintaining an appropriate weight is to eat a balanced diet.  The nutrients may also help prevent varicose veins.  For example, vitamin C and protein are both components of the production of collagen.  Collagen, while a significant factor in anti-aging products, is also one part of the development of veins and valves.  If you have enough collagen in your veins and valves and in good shape, you are more likely to be resilient to varicose veins.

While standing for too long can be an issue, so can sitting.  Some experts theorize that even sitting for extended periods can contribute to the development of varicose veins.  The theory is that the bending of knees and hips will slow the return of blood to the heart.  So, it is important to routinely move the legs during any long car ride, plane ride, or sitting at a desk.

While sitting can create greater pressure in the lower extremities, crossing your legs will slow the circulation even further.  If legs want to be crossed, they should be crossed at the ankles only.  Crossing at the knees not only causes increased pressure and increases the risk of closing the veins, but it also negatively impacts any problems with the knees and hips.

Those with a genetic predisposition to varicose veins, or have some chronic swelling in the lower legs already, it is helpful to sleep with a few pillows under the feet in order to keep them elevated above the level of the heart.  One should look for shoes that have lower heels that require the calf muscles to do more work.  Some of the new tennis shoes, now being produced for women who want to increase their caloric burn while walking, are also helpful for women and men who want to treat and prevent varicose veins.

Patients should not wear underwear that are tight at the waist or in the groin.  This acts as a tourniquet that restricts blood flow and can not only increase your risk of developing varicose veins, but can also increase your risk of developing cellulite.

Some women find that the use of vitamin E, witch hazel or Apple cider vinegar can help reduce the effects of varicose veins or spider veins when applied to the skin in the morning or evening.  The herb horse chestnut is another of the most widely used natural treatments for spider or varicose veins.  The active compound appears to block the release of enzymes that damage the capillary walls.

Researchers in a 2006 study found that individuals who used horse chestnut had improvements in the signs and symptoms of venous insufficiency, including spider veins and varicose veins.  There were some adverse events which were usually mild and infrequent and included nausea, vomiting, diarrhea, headache.  Individuals who choose to take horse chestnut should do so from a reputable dealer since there is a toxic component which must be removed prior to sale and can cause circulatory and respiratory failure or even death. (19)

Grape seed extract and pine bark both contain anti-oxidants that appear to strengthen the connective tissue and reduce inflammation.  The most common side effects are digestive complaints such as nausea and upset stomach.  But people who have an autoimmune condition, such as rheumatoid arthritis or Crohn’s disease, should not take either grape seed extract or pine bark because of its effects on the immune system. (20,21)

Lastly, Reflexology is a form of therapy that focuses primarily on the feet.  This form of medical treatment was studying with pregnant women and showed significant reduction in leg swelling.  Reflexology has little adverse side effects but must be applied by a a trained practitioner in order to receive maximum benefits.

 

References:

1.Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers, and hemorrhoids. Drugs. 2003;63(1):71-100. http://www.ncbi.nlm.nih.gov/pubmed/12487623

 

2.Guilhou JJ, Dereure O, Marzin L, et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind randomized, controlled versus placebo trial in 107 patients. Angiology. 1997;48:77-85. http://www.ncbi.nlm.nih.gov/pubmed/8995348

 

3.Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012 Nov 14;11:CD003230. http://www.ncbi.nlm.nih.gov/pubmed/23152216

 

4.Siebert U, Brach M, Sroczynski G, Uberla K. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency: a meta-analysis of randomized controlled trials and large observational studies. International Angiology 2002 Dec; 21(4): 305-315. http://www.ncbi.nlm.nih.gov/pubmed/12518108

 

5.Diehm C, Vollbrecht D, Amendt K, et al. Medical edema protection – clinical benefit in patients with chronic deep vein incompetence. A placebo controlled double blind study. Vasa 1992;21(2):188-92. http://www.ncbi.nlm.nih.gov/pubmed?term=1621440

 

6.Ruffini I, Belcaro G, Cesarone MR, Dugall M. Efficacy of topical treatment with aescin + essential phospholipids gel in venous insufficiency and hypertension. Angiology. 2004 May-Jun;55 Suppl 1:S19-21. http://www.ncbi.nlm.nih.gov/pubmed/15156253

 

7.Petrassi C, Mastromarino A, Spartera C. Pycnogenol in chronic venous insufficiency. Phytomedicine. 2000 Oct;7(5):383-8. http://www.ncbi.nlm.nih.gov/pubmed/11081989

 

8.Arcangeli P. Pycnogenol in chronic venous insufficiency. Fitoterapia. 2000 Jun;71(3):236-44. http://www.ncbi.nlm.nih.gov/pubmed/10844161

 

9.Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res. 2002 March;16 Suppl 1:S1-5. http://www.ncbi.nlm.nih.gov/pubmed/11933130

 

10.Belcaro G, Cesarone MR, Rohdewald P, Ricci, A, et al. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clin Appl Thromb Hemost. 2004 Oct;10(4):373-7. http://www.ncbi.nlm.nih.gov/pubmed/15497024

 

11.Incandela L, De Sanctis MT, Cesarone MR, Ricci A, Errichi BM, Dugal M, Belcaro G, Griffin M. Treatment of superficial vein thrombosis: clinical evaluation of Essaven gel–a placebo-controlled, 8-week, randomized study. Angiology. 2001 Dec;52 Suppl 3:S69-72. http://www.ncbi.nlm.nih.gov/pubmed/11775653

 

12.Cesarone MR, De Sanctis MT, Incandela L, Belcaro G, Griffin M. Microvascular changes in venous hypertension due to varicose veins after standardized application of Essaven gel–a placebo-controlled, randomized study. Angiology. 2001 Dec;52 Suppl 3:S11-6. http://www.ncbi.nlm.nih.gov/pubmed/11775643

 

13.Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277–83. http://www.ncbi.nlm.nih.gov/pubmed/3048951

 

14.Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol . 2003;22:250-262. http://www.ncbi.nlm.nih.gov/pubmed/14612852

 

15.Delacroix P. Double-blind study of Endotelon in chronic venous insufficiency (translated from French). La Revue de Medecine 1981;31(27-28):1793-1802. http://www.veinpc.com/pdf/TreatingChronicVenoCC522.pdf

 

16. WomensHealth.gov: Varicose Veins and Spider Veins Fact Sheet, www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm

 

17.Mayoclinic.com: Varicose Veins, www.mayoclinic.com/health/varicose-veins/ds00256/dsection=treatments-and-drugs

 

18.Phlebology: A Systematic Review of Compression Hosiery for Uncomplicated Varicose Veins, www.rsm.ac.uk/academ/downloads/vein1_3.pdf

 

19.Medline Plus: Horse Chestnut, www.nlm.nih.gov/medlineplus/druginfo/natural/1055.html

 

20.University of Maryland Medical Center: Grape Seed, www.umn.edu/altmed/articles/grape-seed-000254.htm

 

21.MedlinePlus: Pycnogenol, www.nlm.nih.gov/medlineplus/druginfo/natural/1019.html

 

 

Vitamin D Deficiency, Insufficiency, and Sufficiency

• Moore et al found as of 2007 that neither children nor adults in the US were obtaining the RDA for vitamin D (20).
• A vitamin D level is recommended for patients suspected of vitamin D deficiency which is assessed by physicians using a blood test for the concentration of the compound 25(OH)D.
• Based on a literature review by Bischoff-Ferrari et al, the current intake of vitamin D for adults seen across the nation (200 to 600 IU) is insufficient to achieve optimal health outcomes and 1000 IU daily or greater is needed to achieve the optimal level of vitamin D (6).
• To bring half of adults to 25(OH)D levels above 75 nmol/L (considered an adequate level) an intake of 1,000 IU/d is required, and to bring 85%-90% of the adult population to 25(OH)D levels above 75 nmol/L, 2000 IU/d is required (3).
• A significant proportion of children studied in Pittsburgh, PA by Rajakumar K et al were found to have insufficient levels of vitamin D during the summer and the winter. This was despite having a mean daily intake of vitamin D above the current American Academy of Pediatrics (AAP) recommended intake of 400 IU/day(11). African American children may need a higher intake of vitamin D compared to Caucasian children (11). It remains to be seen if this is consistent across all darker skin races.
• Prevention of rickets in children and osteomalacia (softening of the bones due to vitamin D deficiency) in adults was found at a dose of 400 IU/d, but this dose is insufficient to achieve adequate levels of vitamin 25(OH)D, the precursor to active vitamin D (3).
• Caution with vitamin D intake in chronic granuloma forming disorder or lymphomas which may result in hypercalcemia (4).
• If vitamin D insufficient or deficient, a patient should obtain adequate vitamin D using a vitamin D3 supplement if inadequate sun exposure did not occur during the previous day. A fair skin person going outside for 10 minutes in the sun will allow the skin to produce about 10,000 IUs of vitamin D. A person would need to be south of Atlanta, GA in the winter, otherwise sun exposure would need to be longer and may be inadequate. Sun exposure should be minimized because it is associated with the risk of skin cancer and therefore a vitamin D3 supplement taken according to guidelines below.
• The Institute of Medicine (IOM) and the Endocrine Society’s Clinical Practice Guidelines defined vitamin D deficiency as a 25(OH)D < 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml and sufficiency as a 25(OH)D of 30–100 ng/ml (4) :
  • For preventing and treating vitamin D deficiency their guidelines recommended vitamin D intake should be the following to maintain 25(OH)D concentrations of 40–60 ng/ml:
  • children < 1 y: 400-1,000 IU/d
  • children 1-18 years old: 600-1,000 IU/d
  • adults: 1,500-2,000 IU/d
• Upper limits of vitamin D intake were also set as follows:
  • 2000 IU/day for children up to age 1 year
  • 4000 IU/day for children aged 1 – 18 years
  • up to 10,000 IU/day for adults aged 19 years and older.
•  To see vitamin D content of foods: Adapted from: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: (19) https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w324.pdf

 

References:

1.Ross CA, Taylor CL, Yaktine AL, Del Valle HB, eds; Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2011. Accessed at http://www.nap.edu/catalog.php?record_id=13050 on 31 May 2012 and World Health Organization and Food and Agriculture Organization of the United Nations. Vitamin and Mineral Requirements in Human Nutrition. 2nd ed. Geneva, Switzerland: World Health Organization; 2004. Accessed at http://www.who.int/nutrition/publications/micronutrients/9241546123/en/index.html on 31 May 2012.

 

2.Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May; 69:842–856. http://ajcn.nutrition.org/content/69/5/842.long

 

3.Bosomworth NJ. Mitigating epidemic vitamin D deficiency: The agony of evidence. Can Fam Physician. 2011 Jan;57(1):16-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024150/

 

4.Holick MF. Evidence-based D-bate on health benefits of vitamin D revisited. Dermatoendocrin. 2012;4(2):183-190. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427198/

 

5.Report Brief, Dietary Reference Intakes for Calcium and Vitamin D, Food and Nutrition Board, Institute of Medicine, National Academy Press, Washington, D.C., November 30, 2010. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx

 

6.Bischoff-Ferrari HA,Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B 2006 Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28. http://www.ncbi.nlm.nih.gov/pubmed/16825677

 

7.Prevention of Falls in Community-Dwelling Older Adults, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsfalls.htm

 

8.Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJOpens in New Window. 2009; 339:b3692. http://www.ncbi.nlm.nih.gov/pubmed/19797342

 

9.Von Geldern G, Mowry EM. The influence of nutritional factors on the prognosis of multiple sclerosis. Nat Rev Neurol 2012 Oct 2. http://www.nature.com/nrneurol/journal/vaop/ncurrent/full/nrneurol.2012.194.html#B153

 

10.Michaëlsson K, Baron JA, Snellman G, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010 Oct;92(4):841-8. http://ajcn.nutrition.org/content/92/4/841.long

 

11.Rajakumar K, Holick MF, Jeong K, Moore CG, Chen TC, Olabopo F, Haralam MA, Nucci A, Thomas SB, Greenspan SL. Impact of season and diet on vitamin D status of African American and Caucasian children. Clin Pediatr (Phila). 2011; Jun;50(6):493-502. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296802/

 

12.Sun Q, Shi L, Rimm EB, et al. Vitamin D intake and risk of cardiovascular disease in US men and women. Am J Clin Nutr. 2011 Jun 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142728/

 

13.Goel RK, Lal H. Role of vitamin d supplementation in hypertension.Indian J Clin Biochem. 2011 Jan;26(1):88-90. http://www.ncbi.nlm.nih.gov/pubmed/22211023

 

14.Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001;86:1633–1637. http://www.ncbi.nlm.nih.gov/pubmed/11297596

 

15.Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012 Oct;164(2):127-32. http://www.ncbi.nlm.nih.gov/pubmed/22771225

 

16.Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients 2012; 4: 208-203. http://www.mdpi.com/2072-6643/4/3/208

 

17.Lappe JM, Travers-Gustafson D, Davies KM et al. Vitamin D Supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85:1586–1591. http://www.ncbi.nlm.nih.gov/pubmed/17556697

 

18.Jung Re Yu, Sang Ah Lee, Jae-Geun Lee, Gil Myeong Seong, Seong Joo Ko, Gwanpyo Koh, Mi-Hee Kong, Keun-Young Park, Byung-Joon Kim, Dong-Mee Lim, and Dae Ho Lee. Serum Vitamin D Status and Its Relationship to Metabolic Parameters in Patients with Type 2 Diabetes Mellitus. Chonnam Med J. 2012 August; 48(2): 108–115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434790/

 

19.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w324.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf

 

20.Moore NL, Kiebzak GM. Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population. J Am Acad Nurse Pract. 2007 Dec;19(12):642-51. http://www.ncbi.nlm.nih.gov/pubmed/18042130

 

21. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001 Nov 3;358(9292):1500-3. http://www.ncbi.nlm.nih.gov/pubmed/11705562

 

 

When the client states, “I Have Poor Circulation”

Introduction

Chronic venous insufficiency (CVI) is a condition that occurs from partial occlusion of a vein or malfunctioning valves of the veins. CVI does not pose a serious health threat, but the condition can be disabling and cause pain. Symptoms of chronic venous insufficiency may include chronic leg swelling, leg pain, itching, a tight feeling calves, brown-colored skin of the lower legs, varicose veins, and leg ulcers. In CVI, the veins do not return blood from the legs to the heart well. Treatment for CVI may include compression stockings, medication, or surgery. Several Integrative medicine options are provided here for the treatment of CVI.

• Daflon, a widely available natural flavonoid agent containing 90% diosmin and 10% hesperidin has had excellent results in treatment of chronic venous insufficiency (CVI):

 

• In two randomized, double-blind, 2-month studies, Daflon 500 mg twice daily significantly decreased ankle and calf circumferences, discomfort (nocturnal cramps and sensations of leg heaviness, swelling, or heat), and more leg ulcers were healed in patients with chronic venous insufficiency (CVI) compared to placebo or standard care alone (1).

 

• Compression therapy with either Daflon 500 mg (two tablets daily) or placebo for 8 weeks showed during an 8-week period significantly shorter time to complete healing in the Daflon 500 mg group (32%) compared with placebo (13%)(2).

 

• Horse chestnut for chronic venous insufficiency (CVI):

 

• Seven clinical trials and concluded that horse chestnut seed extract was effective for CVI, reduced leg pain and was safe without severe adverse effects vs. placebo including a study reviewed by the author showing it to be as effective as compression stockings (3).

 

• Another review of 13 randomized controlled trials showed that horse chestnut seed extract compared to placebo reduced leg volume by 46.4 ml, increased the chances of improving leg pain by 4.5 times, edema/swelling by 1.5 times, and itching by 1.7 times without serious side-effects (4).

 

• Compared to placebo, horse chestnut extract, escin at a dose of 75 mg oral twice daily, significantly reduced edema (5).

 

• Aescin (contains horse chestnut) combined with essential phospholipids (AEPL) topical gel for chronic venous insufficiency (CVI): Treatment with AEPL in areas of diseased blood vessels improved skin perfusion and appeared to prevent venous ulcerations (6).

 

• Pycnogenol for chronic venous insufficiency (CVI):

 

• Swelling (edema), leg ‘heaviness’, and pressure in the veins were significantly reduced in a study with 40 patients after the use of Pycnogenol at a dose of 100 mg, 2-3 times per day for 2 months and no side-effects were reported (7).

 

• Pycnogenol 100 mg oral 3 times daily or placebo for 3 months showed that 60% of subjects had disappearance of swelling/pain, almost all had less leg heaviness, and 33% had resolved leg heaviness compared to placebo (8).

 

• Pycnogenol appeared to protect against deep vein thrombosis (DVT) and superficial vein thrombosis (SVT) on flights over 8 hour average time after a dose of 200 mg 2-3 hours before flying, 200 mg six hours later and 100 mg the day after flying (10). No subjects on pycnogenol developed thrombosis vs. 5.15% of placebo patients (10).

 

 

• Pycnogenol vs. Venostasin (horse chestnut seed extract) for chronic venous insufficiency (CVI): A 4-week study compared Venostasin (horse chestnut seed extract) at 600 mg oral daily against Pycnogenol (pine bark extract) at 360 mg oral daily both treated groups showed improvement, but Pycnogenol was more effective for CVI and improved the lipid profile over Venostatin (9).

 

• Essaven gel (EG) used for superficial vein thrombosis and venous hypertensive microangiopathy:

 

• For superficial vein thrombosis: Authors investigated the effect of Essaven gel (EG) with the active ingredient, aescin, (or escin) a horse chesnut extract in comparison with placebo over 8-weeks which found that reductions in the signs and symptoms of SVT were significantly greater in the EG treatment group and no serious side-effects were reported (11).

 

• For venous hypertensive microangiopathy : A randomized, placebo-controlled study with Essaven gel (EG) showed that compared with placebo, EG significantly improved microcirculation in patients with VHM, even with a single application (12).

 

• Ruscus aculeatus (extract of an evergreen shrub also known as butcher’s broom), hesperidin (citrus flavonoid), and ascorbic acid (vitamin C) combination for the treatment of chronic venous insufficiency (CVI):

 

• A double-blind, placebo-controlled trial using 16.5 mg Ruscus aculeatus, 75 mg hesperidin, and 50 mg ascorbic acid, 2 capsules or placebo administered 3 times daily was better than a placebo for treating CVI in both symptoms and measures of plethysmograph circulatory capacity, and treatment was well tolerated (13).

 

• Cyclo 3 Fort (each capsule contains 150 mg Ruscus aculeatus, 150 mg hesperidin methyl chalcone, and 100 mg ascorbic acid) was found to be superior to placebo in reducing severity of pain, cramps, heaviness, paraesthesias, swelling, and leg circumference (14).

 

• Endotelon®, (A brand name product produced from grapeseed containing Procyanidolic Oligomers, Sanofi-Labaz Laboratories, Sanofi Winthrop) used for chronic venous insufficiency: 50 females were treated with either Endotelon® dosed at 150 mg per day or diosmine (semi-synthetic flavonoid) dosed at 450mg per day for 30 days. Endotelon faired better than diosmine for heaviness, sluggishness, cramps and swelling with 65% of the patients responding to Endotelon vs. 45% for diosmine with 15 days of extended treatment effect (15).

 

References:

1.Lyseng-Williamson KA, Perry CM. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers, and hemorrhoids. Drugs. 2003;63(1):71-100. http://www.ncbi.nlm.nih.gov/pubmed/12487623

 

2.Guilhou JJ, Dereure O, Marzin L, et al. Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind randomized, controlled versus placebo trial in 107 patients. Angiology. 1997;48:77-85. http://www.ncbi.nlm.nih.gov/pubmed/8995348

 

3.Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012 Nov 14;11:CD003230. http://www.ncbi.nlm.nih.gov/pubmed/23152216

 

4.Siebert U, Brach M, Sroczynski G, Uberla K. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency: a meta-analysis of randomized controlled trials and large observational studies. International Angiology 2002 Dec; 21(4): 305-315. http://www.ncbi.nlm.nih.gov/pubmed/12518108

 

5.Diehm C, Vollbrecht D, Amendt K, et al. Medical edema protection – clinical benefit in patients with chronic deep vein incompetence. A placebo controlled double blind study. Vasa 1992;21(2):188-92. http://www.ncbi.nlm.nih.gov/pubmed?term=1621440

 

6.Ruffini I, Belcaro G, Cesarone MR, Dugall M. Efficacy of topical treatment with aescin + essential phospholipids gel in venous insufficiency and hypertension. Angiology. 2004 May-Jun;55 Suppl 1:S19-21. http://www.ncbi.nlm.nih.gov/pubmed/15156253

 

7.Petrassi C, Mastromarino A, Spartera C. Pycnogenol in chronic venous insufficiency. Phytomedicine. 2000 Oct;7(5):383-8. http://www.ncbi.nlm.nih.gov/pubmed/11081989

 

8.Arcangeli P. Pycnogenol in chronic venous insufficiency. Fitoterapia. 2000 Jun;71(3):236-44. http://www.ncbi.nlm.nih.gov/pubmed/10844161

 

9.Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res. 2002 March;16 Suppl 1:S1-5. http://www.ncbi.nlm.nih.gov/pubmed/11933130

 

10.Belcaro G, Cesarone MR, Rohdewald P, Ricci, A, et al. Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol. Clin Appl Thromb Hemost. 2004 Oct;10(4):373-7. http://www.ncbi.nlm.nih.gov/pubmed/15497024

 

11.Incandela L, De Sanctis MT, Cesarone MR, Ricci A, Errichi BM, Dugal M, Belcaro G, Griffin M. Treatment of superficial vein thrombosis: clinical evaluation of Essaven gel–a placebo-controlled, 8-week, randomized study. Angiology. 2001 Dec;52 Suppl 3:S69-72.

http://www.ncbi.nlm.nih.gov/pubmed/11775653

 

12.Cesarone MR, De Sanctis MT, Incandela L, Belcaro G, Griffin M. Microvascular changes in venous hypertension due to varicose veins after standardized application of Essaven gel–a placebo-controlled, randomized study. Angiology. 2001 Dec;52 Suppl 3:S11-6. http://www.ncbi.nlm.nih.gov/pubmed/11775643

 

13.Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277–83. http://www.ncbi.nlm.nih.gov/pubmed/3048951

 

14.Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol . 2003;22:250-262. http://www.ncbi.nlm.nih.gov/pubmed/14612852

 

15.Delacroix P. Double-blind study of Endotelon in chronic venous insufficiency (translated from French). La Revue de Medecine 1981;31(27-28):1793-1802. http://www.veinpc.com/pdf/TreatingChronicVenoCC522.pdf

 

16. WomensHealth.gov: Varicose Veins and Spider Veins Fact Sheet, www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm

 

17.Mayoclinic.com: Varicose Veins, www.mayoclinic.com/health/varicose-veins/ds00256/dsection=treatments-and-drugs

 

18.Phlebology: A Systematic Review of Compression Hosiery for Uncomplicated Varicose Veins, www.rsm.ac.uk/academ/downloads/vein1_3.pdf

 

19.Medline Plus: Horse Chestnut, www.nlm.nih.gov/medlineplus/druginfo/natural/1055.html

 

20.University of Maryland Medical Center: Grape Seed, www.umn.edu/altmed/articles/grape-seed-000254.htm

 

21.MedlinePlus: Pycnogenol, www.nlm.nih.gov/medlineplus/druginfo/natural/1019.html

 

 

Reasons to Eat a Vegetarian Diet

• Vegetarian diet and cancer:
  • T J Key et al found that cancer among meat eaters was 3.8%, among fish-eaters, 0.5%, and among vegetarians, 1.3%. The authors also found that compared to meat-eaters, vegetarians had a 53%, 45% and 74% reduced risk in bladder, leukemia, lymphoma, and stomach cancers, respectively. Looking at all cancers combined, vegetarians were 12 per cent less likely to develop cancer than meat eaters, while fish eaters were 18 percent less likely to develop cancer. (1)
  • The risk of colon cancer was higher in individuals with a high meat consumption, a low legume consumption, and a high body mass index (2).
  • High consumption of red meat was associated with an increased cancer risk of the oral cavity and pharynx (odds ratio [OR]= 3.65), esophagus (OR= 3.36), larynx (OR=2.91), stomach (OR= 2.19), colorectum (OR= 3.83), lung (OR= 2.17), breast (OR= 1.97), prostate (OR= 1.87), bladder (OR= 2.11) and kidney (OR= 2.72). Lamb was also associated with increased cancer risk. Eating a lot of processed meat was also linked to an increased risk of cancers of the esophagus (OR= 1.63), larynx (OR= 1.84), stomach (OR= 1.62), colorectum (OR= 2.15), lung (OR= 1.70) and breast (OR= 1.53). (3)
  • Men with the highest intake of allium vegetables (>10 g day of garlic, scallions, onions, chives, and leeks) had a 49% risk reduction of prostate cancer than did those in the category of lowest intake (4).
  • Eating fruits and vegetables, as well as vitamins A, C, and carotenoids from food was linked with a reduced risk of kidney cancer in men (6).
• Vegetarian diet and mortality:
  • Campbell emphasized that a high consumption of animal-based foods were more likely to have had higher death rates and those with plant based diets had less. Also as a result of Campbell’s research with casein milk protein showed that cancer risk was increased as casein intake was increased. Therefore, avoid excessive milk protein intake until more research is completed. (5)
  • A meta-analysis found that all-cause mortality, mortality from circulatory diseases, and mortality from cerebrovascular diseases in vegetarians was lower than non-vegetarians by 9%, 16%, and 12%, respectively. Researchers also found a statistically reduced rate for vegetarians in ischemic heart disease mortality (29%) and cancer incidence (18%). (30)
• Vegetarian diet and gastrointestinal health
  • Vegetarians with a reported average fiber intake of 41.5 g/day had a diverticular disease rate of 12%. In contrast, non-vegetarians had an average fiber intake of 21.4 g/day had a diverticular disease rate of 33%. (7)
  • For patients with Crohn’s disease, a semi-vegetarian diet with daily portions of brown rice, miso soup, brown rice, plain yogurt, eggs, vegetables, fruits, legumes, potatoes, algae and other plant foods with fish once per week and meat once every two weeks, resulted in remission from symptoms of Crohn’s disease in about 94% of patients over 2 years (8).
• Vegetarian diet and weight loss:
  • A group which ate a low-fat vegan diet for 22 weeks lost on average 5.1 kg vs a gain of 0.1 kg in the control group and an average of 4.7 cm from their waist vs gain of 0.8 cm in the control group. Among the intervention group, 48.5% had a weight loss of 5% body weight compared to only 11.1% among the control group. (9)
  • Regular consumers of various types of beans had lower body weights, lower rates of obesity, and a smaller waist size (10).
• Vegetarian diet and diabetes mellitus type 2:
  • Vegetarian diets are associated with reduction in diabetes incidence compared to non-vegetarians (11).
• Vegetarian diet, weight loss, and cholesterol:
  • A vegetarian diet over a period of 74 weeks reduced bodyweight (-4kg), HbA1C (-0.34), total cholesterol (-20.4 mg/dL ), and LDL(-13.5 mg/dL) which was slightly better than a conventional American Diabetic Association diet (12).
  • The intake of flavonoids from mainly vegetables (72.3%), fruits (15.6%), green tea (5.4%), potatoes (3.8%) and pulses (tofu) (2.9%) was found to be inversely related to LDL levels (33).
• Vegetarian diet and hypertension: Following a diet rich in fruits, vegetables, and low fat dairy products, bp in subjects without hypertension improved from an average bp of 131.3/84.7 at baseline to an average of 125.8/81.7, and in those with hypertension (bp over 140/90), systolic and diastolic bp improved by 11.4 and 5.5 points respectively over the control diet (13).
• Vegetarians and nutritional concerns:
  • Vegetarians and vegans have a higher risk of iodine deficiency and should ensure that they are obtaining the recommended iodine intake (14). Iodine recommendations according to age may be found at: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf and http://www.ars.usda.gov/Services/docs.htm?docid=22769 (38).
  • The Food and Nutrition Board Institute of Medicine expressed that vegetarians should double the following recommended daily allowance of iron since the non-heme iron found in plant foods is not as well absorbed as heme-iron found in meats: infants 0-6 months, 0.27 mg; 7-12 month olds, 11 mg; children 1-3 years old, 7 mg; 4-8 year olds, 10 mg;  9-13 year olds, 8 mg; males 14-18 years old, 11 mg; females 14-18 years old, 15 mg; all males over 18 years old, 8 mg, females age 19-50, 18 mg; females over age 50, 8 mg; all pregnant women, 27 mg; lactating females under age 18, 10mg; and lactating females over age 18, 10 mg (16). Hunt, JR mentioned that the exception may be in vegetarian men, who were able to obtain enough iron from diet alone (17). This author also expressed the importance in being screened for excess iron stores by your physician before starting iron supplements as well as to attempt using iron-rich vegetarian foods instead of iron supplements due to the unknown risk of using iron supplements long term (17). Daily allowance of iron may be found at the following link for all ages:
  • Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf (19)
  • Hunt JR suggested that vegetarians may require 50% more zinc than non-vegetarians (18), and the Food and Nutrition Board Institute of Medicine recommended to double the following amount of zinc intake due to reduced absorption from a higher amount of phytate contained in plant tissues (19): infants 0-6 months, 2 mg; 7-12 month olds, 3 mg; children 1-3 years old, 3 mg; 4-8 year olds, 5 mg;  9-13 year olds, 8 mg; all males over 14 years old, 11 mg; females 9-13 years old, 8 mg; females age 14-18, 9 mg; females over age 18, 8 mg; all pregnant women under 18 years old, 12 mg, all pregnant women age 19-50, 11 mg; lactating females under age 18, 13mg; and lactating females over age 18, 12 mg. Daily allowance of zinc may be found at the following link for all ages: Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf (19)
• Vegetarian diet and beta-carotene:
  • A blood beta-carotene concentration less than 0.28 micromol/L has been linked with a higher risk of several cancers, while a concentration of more than 0.28 to 0.37 micromol/L have been associated with a reduced risk of several cancers in prospective blood concentration studies. Eating a variety of 5 fruits and vegetables per day provides the individual with about 5.2 to 6 mg/day of food based beta-carotene. This allows plasma carotenoid levels to rise above a range represented in studies which were associated with a lower risk of cancer and all-cause mortality compared to those with a lower food based carotenoid levels. (22)
  • To see concentrations of beta-carotene in foods, please see: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. This may be accessed at: (39) https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w321.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf
  • The U.S. Preventive Services Task Force (USPSTF) recommends against the use of beta-carotene supplements, alone or in combination (40). Intake of vegetables containing beta carotene was associated with a lower risk for all causes of death including cancer but no benefit was seen with taking beta-carotene supplements (42). An increased risk of mortality was associated with use of beta-carotene and vitamin E supplements (43).
• Vegetarian diet and B12 deficiency:
  • In vegetarian women, supplementation of vitamin B12 is required due to the lack of this vitamin in vegetarian foods. (20)
  • In a study involving 816 subjects (368 with coronary artery disease [CAD] and 448 controls) in India, levels of vitamin B12 were found to be significantly lower in patients with CAD, as compared to controls. In this study interestingly, vegetarians who were found to have lower levels of vitamin B12 were noted to have a higher incidence of coronary artery disease compared to non-vegetarians. (21)
• Vegetarian diet and vitamin C: A cohort study in the U.K. by Khaw KT et al found that people with the highest ascorbic acid levels (vitamin C levels) had half the risk of dying from all causes, and a 20 micromol/L increase in blood ascorbic acid level was equivalent to a 50 g per day increase in fruit and vegetable intake, was associated with about a 20% reduction in risk of all-cause mortality. (29)
• Vegetarian diet and heart disease:
  • A vegetarian diet group compared to a control diet starting 24-48 hours after an acute myocardial infarction (acute MI) showed a 34.5% decrease in total cardiac disease events which included fatal acute MI, non-fatal acute MI, and sudden cardiac death. (44)
  • A study in Denmark revealed that the maximum benefit of eating fruits and vegetables toward reduction of ischemic heart disease was reached at a maximum intake of 800 grams of fruits and vegetables per day (31).
• Vegetarian diet and skin health: Decreased skin wrinkling around the corners of the eyes was observed in women with higher intakes of green and yellow vegetables (32).
• Vegetarian diet and mood: Among subjects on a low calorie diet, mood was significantly better in a vegetarian group verses a mixed diet group (34).
• Vegetarian diet and AAA: Kent et al found that consumption of nuts, vegetables, and fruits were associated with a reduced risk of abdominal aortic aneurysm (35).
• Vegetarian diet and rheumatoid arthritis: In patients with rheumatoid arthritis, subjects which fasted for 7-10 days, followed by an individually adjusted gluten-free vegan diet for 3.5 months, followed by a 9-month lactovegetarian diet showed improvement in all clinical variables, and positively influenced measures of inflammation and disease activity even after a year of follow up (36).
• A vegetarian diet may reduce the number of hospitalizations, surgeries, rates of allergic disease, and use of medications (37).

 

 

References:

1.T J Key, P N Appleby, E A Spencer, R C Travis, N E Allen, M Thorogood and J I Mann. Cancer incidence in British vegetarians. Br J Cancer. 2009 Jun 16. http://www.ncbi.nlm.nih.gov/pubmed/19536095

 

2.Singh PN, Fraser GE. Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol. 1998 Oct 15:148(8):761-774. http://www.ncbi.nlm.nih.gov/pubmed/9786231

 

3.Aune D, et al. Meat consumption and cancer risk: a case-control study in Uruguay. Asian Pac J Cancer Prev. (2009). http://www.ncbi.nlm.nih.gov/pubmed/19640186

 

4.Hsing AW, Chokkalingam AP, Gao YT, Madigan MP, Deng J, Gridley G, Fraumeni JF Jr. Allium vegetables and risk of prostate cancer: a population-based study. J Natl Cancer Inst. 2002 Nov 6;94(21):1648-51. http://www.ncbi.nlm.nih.gov/pubmed/12419792

 

5.Campbell, T. Colin. “The China Study”, The Huffington Post, June 28, 2008. http://www.thechinastudy.com/

 

6.Lee JE, Giovannucci E, Smith-Warner SA, Spiegelman D, Willett WC, Curhan GC. Intakes of fruits, vegetables, vitamins A, C, and E, and carotenoids and risk of renal cell cancer. Cancer Epidemiol Biomarkers Prev. 2006 Dec;15(12):2445-52. http://www.ncbi.nlm.nih.gov/pubmed/17164369

 

7.Gear JS, Ware A, Fursdon P, Mann JI, Nolan DJ, Brodribb AJ, Vessey MP. Symptomless diverticular disease and intake of dietary fibre. Lancet. 1979 Mar 10;1(8115):511-4. http://www.ncbi.nlm.nih.gov/pubmed/85104/

 

8.Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010 May 28;16(20):2484-95. http://www.ncbi.nlm.nih.gov/pubmed/20503448

 

9.Ferdowsian HR, Barnard ND, Hoover VJ, Katcher HI, Levin SM, Green AA, Cohen JL. A multi- component intervention reduces body weight and cardiovascular risk at a GEICO corporate site. Am J Health Promot. 2010 Jul-Aug;24(6):384-7. http://www.ncbi.nlm.nih.gov/pubmed/20594095

 

10.Papanikolaou Y, Fulgoni VL, 3rd. Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008;27:569-76. http://www.ncbi.nlm.nih.gov/pubmed/18845707

 

11.“Vegetarian diets and incidence of diabetes in the Adventist Health Study-2.”  Loma Linda University School of Public Health, Department of Health Promotion and Education, Loma Linda, CA 92354, USA. Nutr Metab Cardiovasc Dis. 2011 Oct 7. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/21983060

 

12.Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89(5):1588S-96S. http://www.ncbi.nlm.nih.gov/pubmed/19339401

 

13.“A clinical trial of the effects of dietary patterns on blood pressure.  DASH Collaborative Research Group.”  Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.  N Engl J Med. 1997 Apr 17;336(16):1117-24.  http://www.ncbi.nlm.nih.gov/pubmed/9099655?dopt=Abstract

 

14.Remer T, Neubert A, Manz F. Increased risk of iodine deficiency with vegetarian nutrition. Br J Nutr. 1999 Jan;81(1):45-9. http://www.ncbi.nlm.nih.gov/pubmed/10341675

 

15.Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5. http://www.ncbi.nlm.nih.gov/pubmed/12748410

 

16.Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf

 

17.Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78(3 Suppl):633S-639S. http://ajcn.nutrition.org/content/78/3/633S.full

 

18.Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr. 2003;78(3 Suppl):633S-639S. http://ajcn.nutrition.org/content/78/3/633S.full

 

19.Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://iom.edu/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.pdf

 

20.Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012 Oct;164(2):127-32. http://www.ncbi.nlm.nih.gov/pubmed/22771225

 

21.Kumar J, Garg G, Sundaramoorthy E, Prasad PV, Karthikeyan G, Ramakrishnan L, Ghosh S, Sengupta S. Vitamin B12 deficiency is associated with coronary artery disease in an Indian population. Clin Chem Lab Med. 2009;47(3):334-8. http://www.ncbi.nlm.nih.gov/pubmed/19676146

 

22.Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids : a report of the Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Washington, D.C. : National Academy Press, c2000. http://www.ncbi.nlm.nih.gov/nlmcatalog/100938980

 

23.Greenberg ER, Baron JA, Karagas MR, Stukel TA, Nierenberg DW, Stevens MM, Mandel JS, Haile RW.Mortality associated with low plasma concentration of beta carotene and the effect of oral supplementation. JAMA. 1996 Mar 6;275(9):699-703. http://www.ncbi.nlm.nih.gov/pubmed/8594267

 

24.Goodman GE, et al. The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements. J Natl Cancer Inst. 2004;96(23):1743-50. http://www.ncbi.nlm.nih.gov/pubmed/15572756

 

25.Martini MC, Campbell DR, Gross MD, Grandits GA, Potter JD, Slavin JL. Plasma carotenoids as biomarkers of vegetable intake: the University of Minnesota Cancer Prevention Research Unit Feeding Studies. Cancer Epidemiol Biomarkers Prev. 1995 Jul-Aug;4(5):491-6. http://www.ncbi.nlm.nih.gov/pubmed/754980410

 

26.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. This may be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w321.pdf  and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf

 

27.Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev, 2012 Mar 14;3:CD007176. http://www.ncbi.nlm.nih.gov/pubmed/22419320

 

28.Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease, Topic Page. June 2003. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvita.htm

 

29.Khaw KT, Bingham S, Welch A, Luben R, Wareham N, Oakes S, Day N. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet. 2001 Mar 3;357(9257):657-63. http://www.ncbi.nlm.nih.gov/pubmed/11247548

 

30.Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li D. Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians: A Meta-Analysis and Systematic Review. Ann Nutr Metab. 2012 Jun 1;60(4):233-240. http://www.ncbi.nlm.nih.gov/pubmed/22677895

 

31.Ovesen LF. Increased consumption of fruits and vegetables reduces the risk of ischemic heart disease. Article in Danish. Ugeskr Laeger. 2005 Jun 20;167(25-31):2742-7. http://www.ncbi.nlm.nih.gov/pubmed/16014256

 

32.Nagata C, Nakamura K, Wada K, Oba S, Hayashi M, Takeda N, Yasuda K. Association of dietary fat, vegetables and antioxidant micronutrients with skin ageing in Japanese women. Br J Nutr. 2010 May;103(10):1493-8. http://www.ncbi.nlm.nih.gov/pubmed/20085665

 

33.Arai Y, Watanabe S, Kimira M, Shimoi K, Mochizuki R, Kinae N. Dietary Intakes of Flavonols, Flavones and Isoflavones by Japanese Women and the Inverse Correlation between Quercetin Intake and Plasma LDL Cholesterol Concentration. J Nutr. 2000 Sep;130(9):2243-50. http://www.ncbi.nlm.nih.gov/pubmed?term=10958819

 

34.Schweiger U, Laessle R, Kittl S, Dickhaut B, Schweiger M, Pirke KM. Macronutrient intake, plasma large neutral amino acids and mood during weight-reducing diets. J Neural Transm. 1986;67(1-2):77-86. http://www.ncbi.nlm.nih.gov/pubmed/3783150

 

35.Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G.Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals.   J Vasc Surg. 2010; 52(3): 539-48. http://aje.oxfordjournals.org/content/171/3/312.long

 

36.Kjeldsen-Kragh J. Rheumatoid arthritis treated with vegetarian diets. Am J Clin Nutr. 1999 Sep;70(3 Suppl):594S-600S. http://www.ncbi.nlm.nih.gov/pubmed/10479237

 

37.Knutsen SF. Lifestyle and the use of health services. Am J Clin Nutr. 1994 May;59(5 Suppl):1171S-1175S. http://www.ncbi.nlm.nih.gov/pubmed/8172119

 

38.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf and http://www.ars.usda.gov/Services/docs.htm?docid=22769

 

39.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. This may be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w321.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf

 

40.Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease, Topic Page. June 2003. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvita.htm

 

41.Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids : a report of the Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Washington, D.C. : National Academy Press, c2000.  http://www.ncbi.nlm.nih.gov/nlmcatalog/100938980

 

42.Greenberg ER, Baron JA, Karagas MR, Stukel TA, Nierenberg DW, Stevens MM, Mandel JS, Haile RW.Mortality associated with low plasma concentration of beta carotene and the effect of oral supplementation. JAMA. 1996 Mar 6;275(9):699-703. http://www.ncbi.nlm.nih.gov/pubmed/8594267

 

43.Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev, 2012 Mar 14;3:CD007176. http://www.ncbi.nlm.nih.gov/pubmed/22419320

 

44.Singh RB, Rastogi SS, Verma R, Bolaki L, Singh R.Indian experiment with nutritional modulation in acute myocardial infarction. Am J Cardiol. 1992 Apr 1;69(9):879-85. http://www.ncbi.nlm.nih.gov/pubmed/1550016

 

45.American Institute for Cancer Research: The New American Plate
http://preventcancer.aicr.org/site/DocServer/NAP_Brochure.pdf?docID=3261

 

46.Obesity A Research Journal: Benefits of a Low-Fat Plant-Based Diet
http://www.nature.com/oby/journal/v9/n11/full/oby2001100a.html

 

47.The American Journal of Clinical Nutrition: Plant-Based Foods and Prevention of Cardiovascular disease
http://www.ajcn.org/content/78/3/544S.full

 

 

Do This to Enhance ACE Inhibitors

Introduction:

A natural treatment added to Ace inhibitor ramipril improved blood pressure, kidney function, proteinuria, and blood glucose over ramipril alone.

 

Ace inhibitor plus ramipril:

This combination improved blood pressure, kidney function, proteinuria, and blood glucose over ramipril alone in 2 similar studies. Pycnogenol, French maritime pine bark extract, may be helpful to those suffering from metabolic syndrome. Study participants (n=58) were split into two groups.  Both groups were being treated with ramipril (5mg twice daily), an anti-hypertensive medication, and were instructed to follow a healthier lifestyle.  One group was given Pycnogenol (50 mg 3 times/day) in addition to ramipril. Results show that Pycnogenol plus ramipril significantly further lowered blood pressure (BP) when compared to the group taking ramipril alone. After 6 months of treatment, average BP in the ramipril group was lowered to an almost high value of 128.2/90.2 mmHg, while the value in the group taking Pycnogenol with ramipril reached near normal levels (122.2/85.3 mmHg). Kidney function improved in both groups. With ramipril alone, urinary protein decreased by 22% but with the addition of Pycnogenol it decreased by 52.7%.  The group taking Pycnogenol also had a lowered fasting blood glucose level, which was reduced from high values to healthy values after 6 months of treatment.  Only the group taking Pycnogenol was found to significantly lost weight after 6 months from average BMI 26.5 to 25.0. (1)

Researchers reported the benefits of adding Pycnogenol, French maritime pine bark extract, to a standard medical treatment of hypertensive (high blood pressure) patients with deteriorating kidney function. The participants (n=55) were randomly assigned to receive either Pycnogenol plus the blood pressure-lowering drug ramipril (ACE inhibitor) or ramipril (10 mg) alone for 6 months. Urinary albumin was used as a measure of kidney function – albumin is the most abundant protein in people with kidney problems which leaks from the kidney into the urine. The authors found that albumin levels in the urine decreased significantly in the Pycnogenol group (-52 mg/day) compared to ramipril alone (-23 mg/day only). Pycnogenol also improved systolic and diastolic flow by 12% and 8%, respectively. (2)

 

 

Summary: Ace Inhibitor and Pycnogenol

• Pycnogenol plus ramipril significantly further lowered blood pressure (BP), improved kidney function, improved proteinuria, and reduced fasting blood glucose when compared to the group taking ramipril alone.

 

 

References:

1.Stuard S, Belcaro G, Cesarone MR, et al. Kidney function in metabolic syndrome may be improved with Pycnogenol®. Panminerva Med. 2010 Jun;52(2 Suppl 1):27-32. http://www.ncbi.nlm.nih.gov/pubmed/20657531

2.Cesarone MR, Belcaro G, et al. Kidney Flow and Function in Hypertension: Protective Effects of Pycnogenol in Hypertensive Participants—A Controlled Study. J Cardiovasc Pharmacol Ther. 2010 Mar;15(1):41-6. http://www.ncbi.nlm.nih.gov/pubmed/20097689

 

 

 

Preventing Acne- My Dermatologist Didn’t Tell Me This

Introduction:

Acne is the most common skin disease of teenagers and young adults, sometimes persisting into adulthood.

The condition can result from occlusion of pores in the skin. Acne includes pimples of several types including whiteheads, blackheads, cysts and can result in scarring. Acne may cause individuals to become self-conscious and develop social anxiety.

Anyone with acne should obtain referral from their primary physician to see a Dermatologist and seek as much information and treatment options as early as possible to treat the condition.

 

Basic acne prevention:

Wash the skin: Wash with a mild moisture conserving soap such as Dove once or twice per day especially before bed and after perspiration or physical activity.

Do not scrub as this can worsen acne and inflammation.

Also, do not prick or squeeze pimples which can cause infection, enlargement or scarring.

A warm moist cloth (compresses) can be used to pat the area to help drain pores.

 

Habits for acne avoidance:

Prevent occlusion of pores by avoiding headbands or hats, and by washing off makeup at night. Avoid touching or wiping the face as much as possible. A small amount of sun exposure may help, but excessive amounts will worsen acne.

 

Dietary associations associated with acne:

Acne and milk consumption: Adebamowo et al performed an observational study linking milk consumption to acne after reviewing the dietary habits of 47,355 adolescent women. Among participants who had been diagnosed with severe acne as teenagers, those with the highest level of total milk intake (>3 servings per day) reported having acne more frequently, when compared with individuals with the lowest level of intake (≤1 serving per week). Skim milk was associated with the highest risk of acne when comparing it to intake of whole milk and low fat milk. Therefore the study concluded that fat content was not the determining factor for acne risk. Researchers also hypothesized that the hormones found in milk played a role in acne risk (1).

More about acne and milk consumption: The same author Adebamowo et al also examined the association between intake of milk products and acne among 4,273 teenage boys. Results indicated that young men were more likely to experience severe acne if they consumed ≥2 servings of milk per day, when compared with boys who consumed ≤1 serving of milk per week. Researchers again found a positive association between skim milk and acne (p=0.02) (2). Adebamowo et al also looked at 6,094 girls aged 9 to 15 years who were followed for up to 3 years. An acne outbreak was found to be positively associated with the consumption of total, whole, low-fat and skim milk (3)

 

Acne and phototherapy:

Home blue light therapy: Use of home-use blue-light light-emitting diode (LED) therapy is an effective treatment for inflammatory acne. Participants (n=30) received blue-light therapy on a lesion on one side of the face and then placebo on another lesion on the opposite side of the face. Compared to placebo, lesions receiving blue-light therapy had a significant better response in terms of size reduction, redness of the skin (erythema), and overall skin condition. Benefits of blue-light therapy were reported after just 2 treatments. Signs of improvement were observed as early as post 2 treatments. Blue-light therapy was also associated with a shorter time to clearance of acne lesions than placebo. (4)

 

Home-use of light and heat energy devices:

In a placebo controlled study, home light and heat therapy was shown to be effective and safe for the treatment of mild-to-moderate inflammatory acne. Participants received either treatment (n=29) or placebo (n=32).  In patients receiving treatment, an improvement was reported in 92.24% of lesions in a median time of 1 day. In the placebo group only 75.78% of lesions improved in a median time of 2 days. After 24 hours, improvement rates were at 76.72% and 15.63% for treatment and placebo, respectively. Lesions were reported to be resolved in 51.7% in the treatment arm compared to 36% in the placebo group. (5)

 

Systematic review on light therapy:

A systematic review on treating acne by using  light therapy or light therapy plus topical cream activated by light (otherwise known as photodynamic therapy) was done by Hamilton FL et al on 25 randomized controlled trials. These trials including over 600 subjects using light and laser therapies for acne vulgaris concluded that some forms were beneficial for treating acne. The authors compared the results from trials of light therapy alone, trials of blue light and trials of photodynamic therapy (PDT). Red-blue light was found to achieve better results in the near term over 5% benzoyl peroxide. Most trials of PDT showed some benefit especially in those suffering from non-inflammatory acne lesions. However, when compared to topical 1% adapalene gel (a topical retinoid prescription medication), no significant difference in improvement of acne lesions was reported for PDT. Additionally, side-effects of PDT therapy were not well tolerated. (6)

 

Acne and probiotic supplements:

Results of a randomized, placebo-controlled clinical trial with 139 acne patients demonstrated that Saccharomyces cerevisiae Hansen CBS 5926 (Perenterol) also known as Saccharomyces boulardii healed or substantially improved acne in over 80% of the treatment group, compared to 26% in the placebo group. Doctors rated the results as very good/good in 74.3% of the patients receiving the treatment, as compared with 21.7% in the placebo group. There were no serious adverse side effects reported in the 5-month study. (7)

 

Summary: Acne Treatment and Prevention

• Prevent occlusion of pores by washing with a mild moisture conserving soap such as Dove once or twice per day before bed and after perspiration or physical activity.

 

• Do not scrub, prick or squeeze and avoid contacting the face with hands and hair

 

• Warm moist cloth (compresses) to help drain pores as needed.

 

• Avoid drinking milk and consider elimination of all milk products.

 

• Saccharomyces boulardii yeast is a probiotic available in oral capsule seen in one study was found to heal or improve acne. The dose used in the study is unclear. Saccharomyces boulardii should not be used by immunocompromised patients, patients who are chronically ill, or hospitalized patients. See the section on Saccharomyces boulardii for more information.

 

• Home phototherapy using red and blue light together or blue light alone was effective for inflammatory acne.

 

• Dermatology referral for review of all options based on type and severity of acne.

 

References:

1.Adebamowo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol 52(2):207-14 (2005 Feb). http://www.jaad.org/article/S0190-9622%2804%2902158-9/abstract

 

2.Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 58(5):787-93 (2008 May). http://www.jaad.org/article/S0190-9622%2807%2902402-4/abstract

 

3.Adebamowo CA et al. Milk consumption and acne in adolescent girls. Dermatol Online J 2006;12(4):1. http://www.ncbi.nlm.nih.gov/pubmed/17083856

 

4.Gold MH, Sensing W, Biron JA. Clinical efficacy of home-use blue-light therapy for mild-to moderate acne. J Cosmet Laser Ther. 2011 Dec;13(6):308-14. http://www.ncbi.nlm.nih.gov/pubmed/22091799

 

5.Sadick NS, Laver Z, Laver L. Treatment of mild-to-moderate acne vulgaris using a combined light and heat energy device: home-use clinical study. J Cosmet Laser Ther. 2010 Dec;12(6):276-83. http://www.ncbi.nlm.nih.gov/pubmed/21142737

 

6.Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: systematic review. British Journal of Dermatology 2009; 160(6): 1273-1285. http://www.ncbi.nlm.nih.gov/pubmed/19239470

 

7.Weber G, Adamczyk A, Freytag S. [Treatment of acne with a yeast preparation]. [Article in German] Fortschr Med. 1989 Sep 10;107(26):563-6. http://www.ncbi.nlm.nih.gov/pubmed/2530145

 

AAA Can Be There Without Knowing

 

Clinical Presentation:

The AAA may be present as a pulsatile mass within the abdomen and cause abdominal or back pain. An AAA causes severe onset of pain upon rupture and may result in death if not detected. Upon rupture the AAA produces symptoms such as lightheadedness, fast heart rate, shock and has a high rate of mortality.

 

Prevention of AAA:

According to the U.S. Preventive Services Task Force (USPSTF) men aged 65 to 75 who have ever smoked are recommended to have a one-time ultrasound screening for AAA. No recommendation for or against screening for AAA is made for men aged 65 to 75 who have never smoked. Routine screening for AAA among women is not enforced as a recommendation by the USPSTF(1).

 

Risks of AAA:

Kent et al retrospectively analyzed medical and questionnaire data from 3.1 million patients screened with ultrasound for abdominal aortic aneurysm (AAA) from 2003 to 2008. The analysis found that excess weight was associated with increased risk, whereas exercise and consumption of nuts, vegetables, and fruits were associated with reduced risk. Blacks, Hispanics, and Asians had lower risk of AAA than whites and Native Americans. The study also found that the risk of AAA increased with more years of smoking and total cigarettes smoked (based on packs-per-day estimates), while the risk went down the longer the patient lived after quitting smoking. Based on their findings from the database, Kent et al created a new scoring system that would assign points to different risk factors, with negative points for factors that decrease AAA risk. (2)

 

Summary: Abdominal Aortic Aneurysm (AAA)

• According to the U.S. Preventive Services Task Force (USPSTF) men aged 65 to 75 who have ever smoked are recommended to have a one-time ultrasound screening for AAA.

 

• If there is a known AAA, for prevention of an AAA, or for family history of AAA: Patients should be advised to quit smoking, control blood pressure, reduce weight, reduce total cholesterol, reduce LDL, and reduce triglycerides. Please see these sections in Preventive Health Advisor for more information.

 

• Teach others to avoid smoking to reduce risk of AAA.

 

• A handful of walnuts or Brazil nuts per day may assist in improvement of cholesterol and artery health if not allergic to nuts and 5 servings or more of a variety of vegetables and fruits daily.

 

• Please see sections on weight loss, hyperlipidemia, and aerobic exercise if overweight and not obtaining enough exercise.

 

• Additional Screening recommendations by the U.S. Preventive Services Task Force (USPSTF): Guide to Clinical Preventive Services, 2012 Recommendations of the U.S. Preventive Services Task Force: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section1.html

 

References:

1.Screening for Abdominal Aortic Aneurysm, Topic Page. February 2005. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm

 

2.Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G.Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010; 52(3): 539-48. http://www.ncbi.nlm.nih.gov/pubmed/20630687

 

Vision Distortion and Age-Related Macular Degeneration

Introduction:

Age-related macular degeneration (AMD) definition:

AMD is an irreversible central vision loss occurring in the macula. The macula is the central part of the retina responsible for a sharp, clear, and straight visual field. Symptoms consist of central visual field haziness, distortion or wavelike images which reduce visual detail. In general, AMD is caused by fatty yellow colored deposits called drusen, atrophy, and choroidal neovascularization (abnormal formation of new blood vessels of the macula). The condition may occur as early as age 50 and incidence increases with age. AMD is divided into dry and wet types: Dry AMD is much more common and is characterized by fatty yellow colored deposits called drusen. Wet AMD occurs with abnormal blood vessel formation. AMD may be graded as early, intermediate, or advanced. It also may be staged by category 1, (low severity) with a small amount of drusen then higher categories are used to describe increasing amounts of drusen in categories 2 and 3. Category 4 (most severe) consisting of new abnormal blood vessel formation and retinal atrophy.

 

Preventive data on age-related macular degeneration (AMD):

Antioxidants and age related macular degeneration (AMD):

Antioxidants have been shown to reduce the progression of AMD once it occurs. The antioxidants taken as part of the Age-Related Eye Disease Study (AREDS) included vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg; and zinc, 80 mg as zinc oxide with 2 mg of cupric oxide. Copper was added to prevent copper deficiency which can occur with high dose zinc intake. Subjects were followed for almost 7 years. A beneficial reduction of AMD progression was observed among subjects with Categories 3 and 4 AMD. There was no significant change seen in mild AMD subjects (Category 1 or 2) compared to placebo. The highest protective effect was seen the supplement treatment groups taking zinc plus antioxidants. OR=0.63 (99% CI; 0.44-0.92). The antioxidants have not yet been shown to prevent the development of AMD nor did they have any benefit in development of cataracts. (1)

 

A systematic review on antioxidants and age related macular degeneration (AMD):

A systematic review by Kansagara D et al evaluated seven randomized controlled trials which studied nutritional supplements in patients with AMD. The authors believed that studies with the longest duration and largest group of subjects were able to better identify benefit of the antioxidants because AMD occurs slowly. The smaller studies might have been of insufficient duration or power to detect a treatment effect. The author reinforced that antioxidants prevented functional vision loss in the Age Related Eye Disease Study (AREDS) and that lutein, zeaxanthin, B vitamins, and omega-3 fatty acids have been reported to decrease AMD progression, while vitamin E and β-carotene where found to increase the risk of late AMD. (2)

 

Vitamin C and eye disease:

Those individuals with a high intake of vitamin C have been shown in general, to have a decreased incidence of eye diseases (3).

 

The Age-Related Eye Disease Study (AREDS) and mortality:

This study also found that subjects with AMD had an increase in mortality risk. After following patients for 6.5 years, 11% or 534 participants had died. This marked an increased mortality risk among participants with advanced AMD. However, participants randomly assigned to receive 80 mg zinc with 2 mg cupric oxide, whether alone or combined with antioxidants, had lower mortality than those not taking the mineral. In these AMD patients, they reported a 27% lower relative risk of mortality for zinc alone, and a 12% lower relative risk for those who took zinc combined with beta-carotene, vitamin C and vitamin E. The beneficial effect of zinc on mortality was associated with less death from respiratory causes. (4)

 

Lutein plus zeaxanthin and the AREDS study:

Currently, the Age-Related Eye Disease Study 2 (AREDS2) results on lutein plus zeaxanthin were pending. This study is evaluating lutein plus zeaxanthin with or without polyunsaturated fatty acid in reduction of advanced AMD. This study will also look at the results of removing beta carotene and reducing zinc used in the previous AREDS study. Beta-carotene may increase risk of late AMD and is also currently being investigated. (5)

 

Lowering progression of age related macular degeneration (AMD):

Diets including higher DHA, EPA, and a lower glycemic index showed a lower rate of advanced AMD progression in patients which are part of the AREDS. DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) are the major constituents of omega-3 fatty acids in fish oil and algae oil. (6)

 

The National Eye Institute (NEI) recommendations:

NEI recommendations are published online at http://www.nei.nih.gov/amd/summary.asp which are based on the Age Related Eye Disease Study (AREDS). The NEI recommends that the eye care professional evaluate your eyes for signs of AMD using a dilated eye exam and ask your physician whether you would benefit from these antioxidants. The NEI does not recommend a particular age to start surveillance for AMD. The NEI reviewed The Selenium and Vitamin E Cancer Prevention Trial (SELECT) published in The Journal of the American Medical Association back in October of 2011. The NEI states that men should be aware that vitamin E of 400 IU per day was associated with an increased risk of prostate cancer, but those who took selenium with vitamin E did not show increased risk. Additionally, the NEI reviewed the Alpha-Tocopherol, Beta Carotene Trial (ATBC) and The Physicians Health Study II (PHS II) which showed that lower doses of vitamin E did not affect prostate cancer incidence. The NEI also reveiwed large clinical trials sponsored by the National Cancer Institute which showed that beta-carotene supplements increase risk of lung cancer in smokers. The NEI concludes that after review of the studies, beta-carotene use not only increases risk of lung cancer, but also may slightly increase risk of lung cancer for at least a period of several years after quitting smoking. (7)

 

 

Summary: Age-Related Macular Degeneration:

• Upon any sign of new or worsening vision problems: As recommended by the National Eye Institute, have an eye care professional evaluate the eyes for signs of Age-related Macular Degeneration (AMD) using a dilated eye exam. If you are high risk for AMD or have signs of AMD, ask your physician whether or not if you would benefit from the antioxidants taken as part of the Age-Related Eye Disease Study (AREDS) including vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg; and zinc, 80 mg as zinc oxide with 2 mg of cupric oxide. Contraindications to beta-carotene supplements include smoking or previous smoker, and possible contraindications to vitamin E supplements include prostate cancer of increased risk of prostate cancer. Of note, beta-carotene may increase risk of late AMD and is currently being investigated.

 

• If any prior diagnosis of AMD, consider enhancement of dietary intake of vitamin C, vitamin E, beta carotene, zinc, copper, omega 3 fatty acids, lutein, and zeaxanthin from foods. A reference which shows foods containing high amounts of these nutrients is available at: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w421.pdf  and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf

 

• For any previous diagnosis of AMD, consider a zinc supplement after discussing it with your primary physician or eye physician for possible reduced risk of mortality from respiratory causes. In the AREDS study, 80 mg of zinc oxide was taken. Cupric oxide, 2 mg oral once per day should be taken to prevent copper deficiency which can occur with high dose zinc.

 

• Please see “longevity” section for research in reduction of mortality as AMD may be associated with other diseases.

 

 

References:

1.Age-Related Eye Disease Study Research Group. A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8. Arch Ophthalmol. 2001 Oct. http://www.ncbi.nlm.nih.gov/pubmed/11594942 and http://www.nei.nih.gov/news/pressreleases/101201.asp

 

2.Kansagara D, Gleitsmann K, Gillingham M, Freeman M, Quiñones A. Nutritional Supplements for Age-related Macular Degeneration: A Systematic Review. VA-ESP Project #05-225; 2011. http://www.ncbi.nlm.nih.gov/books/NBK84269/

 

3.Jacob RA, Sotoudeh G. Vitamin C function and status in chronic disease. Nutr Clin Care. 2002 Mar-Apr;5(2):66-74. http://www.ncbi.nlm.nih.gov/pubmed/12134712?dopt=Abstract

 

4.AREDS Research Group. Associations of mortality with ocular disorders and an intervention of high-dose antioxidants and zinc in the Age-Related Eye Disease Study. AREDS Report No. 13. Arch Ophthalmol. 122:716-726, 2004. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473208/?report=abstract

 

5.AREDS2 Research Group, Chew EY, Clemons T, SanGiovanni JP, Danis R, Domalpally A, McBee W, Sperduto R, Ferris FL. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1). Ophthalmology. 2012 Nov;119(11):2282-9. http://www.ncbi.nlm.nih.gov/pubmed/22840421

 

6.Chiu CJ, Klein R, Milton RC, Gensler G, Taylor A. Does eating particular diets alter the risk of age-related macular degeneration in users of the Age-Related Eye Disease Study supplements? Br J Ophthalmol. 2009 Sep;93(9):1241-6. http://www.ncbi.nlm.nih.gov/pubmed/19508997

 

7.National Institutes of Health, National Eye Institute. The AREDS Formulation and Age-Related Macular Degeneration. Are These High Levels of Antioxidants and Zinc Right For You? Revised November of 2011. Accessed March 17, 2011. http://www.nei.nih.gov/amd/summary.asp

 

Authorities on Lowering Cholesterol Say This..

• Hyperlipidemia leads to atherosclerosis, which is the primary disease process of the coronary arteries leading to coronary heart disease. Atherosclerosis was described by a world renowned Cardiologist, William C. Roberts, MD as the leading cause of heart attacks, stroke, and peripheral vascular disease. This author described that cholesterol intake causes atherosclerosis. (1)

 

• Individuals age 20 -79 are recommended by the American Heart Association to have cholesterol levels checked every four to six years as part of a cardiovascular risk assessment. The lipid profile should be monitored by the primary care physician who should work with the patient to achieve ideal lipid profile goals:

 

• Achieve LDL, HDL, triglyceride and total cholesterol goals. The Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol has established that the following lipid profile is optimal (as cited in Lichtenstein, 2006)(3):
  • LDL optimal under 100 mg/dl, near optimal 100-129 mg/dL, borderline high 130-159 mg/dL, high 160-189 mg/dL, and very high over 190 mg/dL.
  • Total cholesterol is recommended to be under 200 mg/dL.
  • An HDL goal of over 40 mg/dL for men and over 50 mg/dL for women is generally supported, but no specific official goals for HDL cholesterol and triglycerides exist. The  goal for triglycerides is generally supported to be under 150 mg/dL. An HDL under 40 mg/dL for men and under 50 mg/dL for women as well as a triglyceride level of over 150 mg/dL are all associated with metabolic syndrome.

 

• Roberts views of the lipid profile goals are more strict than the AHA and recommends the following (1):
  • LDL cholesterol goal <100 mg/dL and ideally <70 mg/dL.
  • Total cholesterol goal <150 mg/dL, and the high-density lipoprotein (HDL) cholesterol >20 mg/dL.
  • The low HDL goal is rationalized by the author that levels below 20 are not dangerous if LDL and total cholesterol is also low.

 

• In addition to improvement of the lipid profile, modifying other risk factors reduces the risk for cardiovascular disease. For further information on weight loss, hypertension, diabetes mellitus, aerobic exercise, resistance training, or smoking cessation, please see these individual sections in Preventive Health Advisor.

 

• According to the American Heart Association (AHA) Scientific Statement, Diet and Lifestyle Recommendations: Revision 2006 by Lichtenstein, AH et al, the key to the prevention of coronary heart disease (CHD) or improvement of the CHD course is the emphasis of the following goals for cardiovascular disease risk reduction (3):
  • Diet recommendations by the AHA:
    • Eat a healthful diet the majority of the time including vegetables, fruits, whole grains, fat-free or low fat dairy, beans, lean meat, poultry, and oily fish at least twice weekly. Limit total cholesterol to 300 mg per day for healthy adults and for patients with LDL cholesterol under 100 mg/dl. Limit cholesterol to 200 mg per day for patients with coronary artery disease.
    • Total fat intake limited to under 25–35 percent of total calories per day.
    • Saturated fat intake limited to under 7 percent of total calories per day.
    • Trans fat intake should be under 1 percent of total calories per day.
    • Other fat in the diet should come from monounsaturated or polyunsaturated oils from unsalted nuts, seeds, oily fish, and vegetable oil such as canola or olive oil.
  • Maintain a healthy bodyweight: Patients should strive for a body mass index (BMI) between 18.5-24.9 kg/m²: Preventive Health Advisor recommends a diet focused on weight loss for body mass index over 25 kg/m² for control of lipid levels, and then continued weight loss to reach ideal body weight. Overweight and obese individuals run a much higher risk of developing type 2 diabetes, elevated cholesterol, and high blood pressure. Patients have the ability to reverse this risk by losing 8%-10% of initial body weight, an even a 5% weight loss maintained long term can have beneficial effects on cholesterol and glucose control (4).
    • The AHA defines overweight as 25-29.9 kg/m², and obesity as greater than or equal to 30 kg/m². BMI can be calculated from the basic formula: [Weight (lb) / (Inches of height)²] x 703. BMI may also be calculated using a commonly available BMI calculator such as that available here: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm from the NIH National Heart, Lung and Blood Institute.
    • Weight loss leads to an improved lipid profile. Please see weight loss in Preventive Health Advisor. To reach ideal body weight, Preventive Health Advisor recommends a low calorie diet with fat intake about 30% of calories with mostly monounsaturated fat and at least 1 gram of protein per kilogram of bodyweight plus an exercise program to maintain a higher metabolic rate.
  • Blood pressure:
    • Focus on achieving normal blood pressure.
    • According to the AHA, the lifetime risk of hypertension is about 90% and any elevation above a normal blood pressure of 120 systolic over 80 diastolic increases risk of coronary heart disease even if elevated into pre-hypertensive levels.
  • Blood glucose levels:
    • Keep blood glucose in normal range:
    • According to the AHA, normal fasting blood glucose is less than or equal to 100 mg/dL and a fasting blood glucose of of greater than or equal to 126 is diagnostic of diabetes.
    • Weight loss, exercise, and avoidance of concentrated sweets can greatly improve control of glucose and insulin resistance.
  • Exercise goals: Maintain a physically active lifestyle as regular activity promotes cardiovascular fitness and helps control cholesterol levels.
  • Smoking: Patients should be counseled to stay away from tobacco.

 

• The American Heart Association metrics were applied by Artero, EG et al in The Aerobics Center Longitudinal Study. The authors described that in order to reduce the risk of cardiovascular mortality over the course of 11 years by 50-60% goals must meet at least 3 out of 4 of the following (2):
  • 1) Total cholesterol lower than 200 mg/dL
  • 2) Blood pressure lower than 120/80 mm Hg
  • 3) Not having diabetes
  • 4) Free of heart disease
  • AND meet at least 2 out of 4 of the following:
  • 1) No smoking
  • 2) Normal body mass index (BMI)
  • 3) Engaging in physical activity
  • 4) Eating healthfully

 

• Preventive Health Advisor views both dietary changes and an exercise program of vital importance for control of hyperlipidemia. We believe that striving for an ideal diet alone will have a greater health benefit than exercise alone, but if both aspects are combined, then these health benefits will be greatly potentiated.

 

• Preventive Health Advisor recommends a diet focused on weight loss for body mass index over 25 kg per meter squared for control of lipid levels, then continued weight loss to achieve ideal body weight. For adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease, the U.S. Preventive Services Task Force (USPSTF) recommends intensive behavioral dietary counseling, and primary care clinicians or other specialists such as nutritionists or dietitians are qualified to provide this counseling (5). Lowering serum cholesterol involves much more than simply lowering cholesterol in the diet. The most effective diet intervention for lowering cholesterol is to replace saturated and trans-fat with monounsaturated and polyunsaturated fats. Additional goals include increasing soluble fiber intake, include soy protein in the diet, and including a fruit and vegetable with every meal.

 

• The Therapeutic Lifestyle Changes Diet for coronary heart disease (6,7):
  • Saturated fat below 7% of the total calories.
  • Total fat intake 25-35% of daily total calories.
  • Cholesterol intake below 200 milligrams each day.
  • Sodium intake under 2400 mg per day.
  • Calorie intake should be kept to a level needed for maintaining healthy weight but reduce blood cholesterol level.

 

• Schaefer, S et al found that after dietary fat intake was decreased by 58% and intensive risk factor reduction was implemented, the following benefits were observed after 24 months (8):
  • LDL levels dropped from 120 mg/dL to 104 mg/dL (p = 0.05).
  • Net increase in arterial diameter of 0.05 mm to 2.81 mm (p = 0.01) was seen.
  • 1 out of 8 mild coronary disease lesions < or = 20% regressed, and 4 progressed.
  • Severe lesions with over 50% initial stenosis regressed, but mild lesions under 20% continued to progress, showing that modifying risk factors improves severe lesions.

 

• Weickert reviewed the following dietary changes and described the expected results from some of these changes (9):
  • Fat intake: Reduction in total fat intake (<30%) has a modest benefit on weight loss but is less effective than low-carbohydrate, high-protein diets and probably reduces insulin resistance, diabetes risk, lowers LDL cholesterol and reduces the risk of cardiovascular disease (CVD).
  • Dietary monounsaturated fatty acids: An increase in monounsaturated fatty acids (>10%) lowers LDL cholesterol, triglycerides, and blood pressure.
  • Low carbohydrate diets, a.k.a. ketogenic diet: Low-carbohydrate diets with a minimum of 130 grams of carbohydrates daily have a modest benefit on weight loss, improves HDL cholesterol and lowers triglycerides.
  • High protein diets: A high protein intake was reported to increase satiety, result in short term weight loss, plus results in beneficial effects on HDL, LDL cholesterol, and blood pressure.
  • Low glycemic index diets: Low glycemic index diets, such as the American Diabetic Association Diet commonly includes foods without concentrated sweets to avoid causing spikes in blood glucose. This diet has a modest benefit on weight loss, improve LDL cholesterol, and probably reduce cardiovascular risk.
  • Soluble fiber: Soluble fiber from fruit and vegetables has a modest benefit on weight loss, lowers glycemic index, LDL cholesterol, and triglycerides.
  • Insoluble fiber: Insoluble cereal fiber including cereals, wheat bran and whole grain products has a modest benefit on weight loss and a strong benefit on insulin resistance.
  • Mediterranean style diets: Mediterranean style diets have a modest benefit on weight loss and have beneficial effects on insulin resistance and diabetes risk. Mediterranean style diets are associated with reduced risk for cardiovascular disease, lower inflammatory cytokines, improved lipid profiles and increased survival.

 

• Dietary changes for diabetes patients with hyperlipidemia:
  • Low glycemic index diets with a 500 kcal restriction have been known to improved glycemic control, lower hemoglobin A1C by 0.5%, help reduce diabetes medication, and result in a weight loss of 6.9 kg (10).
  • A low carbohydrate diet without restriction other than 20 grams of carbohydrates per day for 24 weeks was known to improve glycemic control, reduce/eliminate medication, reduce hemoglobin A1C in diabetics by as much as -1.5%, reduce body weight by -11.1 kg, and increase HDL by 5.6 mg/dL (10).
  • American Diabetes Association diet vs. vegan diet: Type 2 diabetes. Participants consumed a low-fat vegan diet or a standard American Diabetes Association diet for 74 weeks showed the following outcomes (11):
    • Weight significantly decreased by 4.4 kg and 3.9 kg in the vegan and conventional groups, respectively.
    • The vegan diet resulted in a total and LDL cholesterol decrease by 20.4 mg/dL and 13.5 mg/dL, respectively. Corresponding values for those on the conventional diet was a decrease of 6.8 mg/dL and 3.4 mg/dL. In conclusion changes in overall lifestyle that include a vegan or nearly-vegan diet may be effective in improving the health of people with diabetes.

 

• Avoid high cholesterol containing foods:
  • Preventive Health Advisor recommends consuming as low an amount of cholesterol as possible.
  • See common foods with high cholesterol content at: Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at (12): https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w601.pdf

 

References:

1.Roberts, WC. Atherosclerosis: Its Cause and Its Prevention. Comment in Am J Cardiol. 2007 Jul 1;100(1):138-42. http://www.ncbi.nlm.nih.gov/pubmed/18849550   http://ncp.sagepub.com/content/23/5/464.long

 

2.Artero EG, Espana-Romero, Vanesa, Lee, Duck-chul, Sui, Xuemei, Church, Timothy S., Lavie, Carl J. and Blair, Steven N. Ideal Cardiovascular Health and Mortality: Aerobics Center Longitudinal Study. Mayo Clin Proc. October 2012; 87(10):944-952. http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2900765-3/fulltext

 

3.Lichtenstein, Alice H., Lawrence J. Appel, Michael Brands, Mercedes Carnethon, Stephen Daniels, Harold A. Franch, MD, Barry Franklin, Penny Kris-Etherton, William S. Harris, Barbara Howard, Njeri Karanja, Michael Lefevre, Lawrence Rudel, Frank Sacks, Linda Van Horn, Mary Winston, Judith Wylie-Rosett. AHA Scientific Statement: Diet and Lifestyle Recommendations Revision 2006. Circulation. 2006; 114: 82-96. http://circ.ahajournals.org/content/114/1/82.short

 

4.Ditschuneit J et al. (1999) Metabolic and weight-loss effects of a long-term dietary intervention in obese patients.  Am J Clin Nutr 69: 198-204. http://www.ncbi.nlm.nih.gov/pubmed/10968732

 

3.Calle, Eugenia E. Overwieght, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults; April 24 (2003) 348, 17, 1625-1638.

 

5.Behavioral Counseling in Primary Care to Promote a Healthy Diet in Adults at Increased Risk for Cardiovascular Disease, Topic Page. January 2003. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiet.htm

 

6.Welty FK., Stuart E., O’Meara M., Huddleston J., Effect of addition of exercise to therapeutic lifestyle changes diet in enabling women and men with coronary heart disease to reach Adult Treatment Panel III low-density lipoprotein cholesterol goal without lowering high-density lipoprotein cholesterol. The American Journal of Cardiology. May 2002; 89(10): 1201–1204. http://www.sciencedirect.com/science/article/pii/S0002914902023056

 

7.National Heart, Lung and Blood Institute. “Therapeutic Lifestyle Changes (TLC) Diet”. http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi

 

8.Schaefer S, Hussein H, Gershony GR, Rutledge JC, Kappagoda CT. Regression of severe atherosclerotic plaque in patients with mild elevation of LDL cholesterol. J Investig Med. 1997 Dec;45(9):536-41. http://www.ncbi.nlm.nih.gov/pubmed/9444880

 

9.Weickert, Martin O. What dietary modification best improves insulin sensitivity and why? Clin Endocrinol (Oxf). Oct 2012; 77(4):508-512. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2012.04450.x/full

 

10.“The effect of a low-carbohydrate, ketogenic diet versus a low- glycemic index diet on glycemic control in type 2 diabetes mellitus.” Department of Medicine, Duke University Medical Center, Durham, NC, USA.  Nutr Metab (Lond). 2008 Dec 19;5:36.  http://www.ncbi.nlm.nih.gov/pubmed/19099589

 

11.Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89(5):1588S-96S. http://www.ncbi.nlm.nih.gov/pubmed/19339401

 

12.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w601.pdf

 

 

Without Vitamin D, This Can Happen…

 

• Vitamin D and cardiovascular-related, cancer-related, and all-cause mortality: In a study on adult men, Michaëlsson K et al found that a vitamin D concentration of 24 to 34 ng/ml (60 to 85 nmol/L) approximately translates to a vitamin D dose of 2000 IU/d and corresponded to the lowest cardiovascular-related, cancer-related, and all-cause mortality (10). Overall mortality was increased by 50–60% among subjects in the lowest 10% and highest 5% of the vitamin D level distribution, whereas cardiovascular mortality was increased only in the bottom 10%. Vieth reported that the ideal level of vitamin D intake for adults should be 50 mg (2000 IU) per day (2). Bosomworth NJ conducted a review of multiple studies, and determined that 500-1500 IU/d of vitamin D reduced cancer mortality and all-cause mortality (3). After Sun Q, et al followed 74,272 women and 44,592 men over 20 years, 9,886 cases of coronary heart disease and stroke occurred, and a 16% reduction in heart disease was seen among men with an intake of 600 IU or more per day of vitamin D, compared with those with an intake of 100 IU (12).
• Vitamin D and hypertension:
  • Goel RK found that subjects taking 33,000 IU of vitamin D every 2 weeks for 3 months plus standard therapy were noted to have a reduction in systolic blood pressure (BP) of 7.5 mm Hg compared to a 3.6 mmHg reduction in the standard therapy group, but diastolic BP in both groups increased by 2.1 mmHg and 1.3 mmHg, respectively. (13).
  • A double-blind randomized controlled trial of 148 women with a mean age of 74 years tested 1200 mg calcium plus 800 IU vitamin D(3) and found that systolic blood pressure (SBP) decreased by 9.3% and heart rate by 5.4% compared with 1200 mg/day of calcium alone. 81% in the vitamin D3 and calcium group compared with 47% in the calcium group showed a decrease in SBP of 5 mm Hg or more. (14)
• Vitamin D needs in pregnancy: According to Wagner CL, et al, the pregnant mother converts twice the normal amount of active vitamin D by the end of the first trimester, and more than three times the normal amount by birth, with her calcium levels remaining normal. The current recommended intake of 400 – 600 IU per day was ineffective at raising the mother’s levels and provided sufficient levels to her baby at birth. The author believes that vitamin D levels in pregnancy should be 40 ng/mL (100 nmol/L), but his concern is that 80% of pregnant women are well below this level, and showed that a daily dose of 4000 IU of vitamin D3 per day, starting at 12-16 weeks gestation, was effective in raising the mother’s 25(OH) D levels. (16)
• Vitamin D and the elderly: To prevent falls in adults aged 65 years or older who are at increased risk for falls, the U.S. Preventive Services Task Force (USPSTF) recommends exercise or physical therapy and vitamin D supplementation (7). Among the elderly, the minimum intake required to reduce risk of a falling and risk of fracture is 700-1000 IU/d and 400-800 IU/d, respectively (3). Vitamin D at a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19%. Less than 700 IU of vitamin D per day or concentrations of vitamin D under 60 nmol/L may not reduce the risk of falling among older individuals. (8)
• Vitamin D and type I diabetes: In a study done in an area with a high prevalence of vitamin D deficiency, the incidence of type 1 diabetes in young children was reduced by vitamin D at a dose 2000 IU/d (21). This dose exceeds the safe upper limit of vitamin D daily intake for this age group and is not recommended. 
• Vitamin D and Multiple Sclerosis: In a review study, von Geldern and Mowry determined that sufficient vitamin D levels are likely protective against the development of MS and reduces progression of the disease, but vitamin D supplements have not yet been directly proven to change the course of MS. (9)
• A randomized 4-year study in Nebraska followed 1179 women over 55 years old without known cancer. Participants were randomly assigned to placebo, 1400 mg calcium citrate or 1500 mg calcium carbonate plus vitamin D placebo, or calcium + 1000 IU of vitamin D. After 12months, the relative risk reduction was 0.232 (confidence interval [CI], 0.09–0.60; P<.005) for the vitamin D plus calcium group, 0.587 (95% CI, 0.29–1.21; P=.147) for the calcium-only group compared to placebo. Increasing the dose of vitamin D from the current standard of 400–600 IU per day to 1000 IU per day lowers future risk of cancer in women older than age 55 who do not get adequate vitamin D from sun exposure or diet. (17)
• Vitamin D and diabetes mellitus type 2: The incidence of vitamin D insufficiency was found to be higher among type 2 diabetics than controls. A study in Korea found that 87% of type 2 diabetics were deficient in vitamin D (<20 ng/ml), and 11% were insufficient (20-29 ng/ml). Healthy subjects were 20% insufficient and 70% deficient. The study also found that high levels of triglycerides, LDL, and hemoglobin A1C were associated with vitamin D deficiency in type 2 diabetes patients. (18)
• In addition to vitamin D, it has been determined important to consume adequate calcium for bone health and these nutrients are often found together as an over the counter combination (5) :
  • The RDA for calcium for children ages 1 through 3 is 700 milligrams.
  • One thousand milligrams daily is appropriate for children ages 4 through 8.
  • Adolescents need higher levels to support bone growth: 1,300 milligrams per day.
  • For practically all adults ages 19 through 50 and for men until age 71, 1,000 milligrams covers daily calcium needs.
  • Women over 50 and both men and women 71 and older need no more than 1,200 milligrams per day.
  • Once intakes surpass 3,000 milligrams per day for calcium, the risk for harm increases.

 

References:

 

1.Ross CA, Taylor CL, Yaktine AL, Del Valle HB, eds; Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2011. Accessed at http://www.nap.edu/catalog.php?record_id=13050 on 31 May 2012 and World Health Organization and Food and Agriculture Organization of the United Nations. Vitamin and Mineral Requirements in Human Nutrition. 2nd ed. Geneva, Switzerland: World Health Organization; 2004. Accessed at http://www.who.int/nutrition/publications/micronutrients/9241546123/en/index.html on 31 May 2012.

 

2.Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May; 69:842–856. http://ajcn.nutrition.org/content/69/5/842.long

 

3.Bosomworth NJ. Mitigating epidemic vitamin D deficiency: The agony of evidence. Can Fam Physician. 2011 Jan;57(1):16-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024150/

 

4.Holick MF. Evidence-based D-bate on health benefits of vitamin D revisited. Dermatoendocrin. 2012;4(2):183-190. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427198/

 

5.Report Brief, Dietary Reference Intakes for Calcium and Vitamin D, Food and Nutrition Board, Institute of Medicine, National Academy Press, Washington, D.C., November 30, 2010. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx

 

6.Bischoff-Ferrari HA,Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B 2006 Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28. http://www.ncbi.nlm.nih.gov/pubmed/16825677

 

7.Prevention of Falls in Community-Dwelling Older Adults, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsfalls.htm

 

8.Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJOpens in New Window. 2009; 339:b3692. http://www.ncbi.nlm.nih.gov/pubmed/19797342

 

9.Von Geldern G, Mowry EM. The influence of nutritional factors on the prognosis of multiple sclerosis. Nat Rev Neurol 2012 Oct 2. http://www.nature.com/nrneurol/journal/vaop/ncurrent/full/nrneurol.2012.194.html#B153

 

10.Michaëlsson K, Baron JA, Snellman G, et al. Plasma vitamin D and mortality in older men: a community-based prospective cohort study. Am J Clin Nutr. 2010 Oct;92(4):841-8. http://ajcn.nutrition.org/content/92/4/841.long

 

11.Rajakumar K, Holick MF, Jeong K, Moore CG, Chen TC, Olabopo F, Haralam MA, Nucci A, Thomas SB, Greenspan SL. Impact of season and diet on vitamin D status of African American and Caucasian children. Clin Pediatr (Phila). 2011; Jun;50(6):493-502. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296802/

 

12.Sun Q, Shi L, Rimm EB, et al. Vitamin D intake and risk of cardiovascular disease in US men and women. Am J Clin Nutr. 2011 Jun 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142728/

 

13.Goel RK, Lal H. Role of vitamin d supplementation in hypertension.Indian J Clin Biochem. 2011 Jan;26(1):88-90. http://www.ncbi.nlm.nih.gov/pubmed/22211023

 

14.Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001;86:1633–1637. http://www.ncbi.nlm.nih.gov/pubmed/11297596

 

15.Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012 Oct;164(2):127-32. http://www.ncbi.nlm.nih.gov/pubmed/22771225

 

16.Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients 2012; 4: 208-203. http://www.mdpi.com/2072-6643/4/3/208

 

17.Lappe JM, Travers-Gustafson D, Davies KM et al. Vitamin D Supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85:1586–1591. http://www.ncbi.nlm.nih.gov/pubmed/17556697

 

18.Jung Re Yu, Sang Ah Lee, Jae-Geun Lee, Gil Myeong Seong, Seong Joo Ko, Gwanpyo Koh, Mi-Hee Kong, Keun-Young Park, Byung-Joon Kim, Dong-Mee Lim, and Dae Ho Lee. Serum Vitamin D Status and Its Relationship to Metabolic Parameters in Patients with Type 2 Diabetes Mellitus. Chonnam Med J. 2012 August; 48(2): 108–115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434790/

 

19.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w324.pdf and http://www.nal.usda.gov/fnic/foodcomp/Data/HG72/hg72_2002.pdf

 

20.Moore NL, Kiebzak GM. Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population. J Am Acad Nurse Pract. 2007 Dec;19(12):642-51. http://www.ncbi.nlm.nih.gov/pubmed/18042130

 

21. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001 Nov 3;358(9292):1500-3. http://www.ncbi.nlm.nih.gov/pubmed/11705562

 

 

What Lifestyle Changes Do to Hyperlipidemia

• Aerobic Exercise: Preventive Health Advisor recommends a combined aerobic and resistance exercise program for all ages, but patients should seek approval by the primary physician prior to starting an exercise program.
  • Individuals of all ages capable of aerobic exercise should do so most days of the week for the following benefits: heart and lung conditioning, improved pumping efficiency of the heart, improved circulatory system (14), weight control and less obesity (15), cholesterol reduction (15,16), triglyceride lowering (15), lowering of blood pressure (17), lower rate of smoking (20), control of diabetes (18,19), lower cardiac mortality (20), and reduced all-cause mortality (20).
  • Benefits of aerobic exercise, 1 hour per day, 5 days per week, over 10 years (15):
    • With exercise alone: Decrease body mass index about 11.5 kg/m^2, reduce total cholesterol by about 11 points, and reduce their triglycerides by about 105 mg/dl.
    • With exercise plus low fat, high fiber, complex carbohydrate diet: Decrease in body mass index about 16.5 kg/m^2, lower total cholesterol about 33 points, reduction of LDL about 20 points, and reduction of triglycerides about 109 mg/dl.
  • Aerobic exercise done along with or without a cardiac rehab program reduces cardiac and all-cause mortality in coronary artery disease.
  • Starting exercise in apparently healthy adults: According to the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), older adults need moderate-intensity (between 5-6 on a 10-point scale) aerobic endurance activity for a minimum of 30 min which can be achieved in short 10 minute sessions on five days each week or vigorous-intensity aerobic, (rated a 7-8 on a 10-point scale) activity for a minimum of 20 min on 3 days each week.
  • Exercise cardiac stress testing referral is required in patients with (31):
    • Patients with suspected or known coronary artery disease, typical and atypical angina or prior heart attack.
    • Healthy patients without symptoms with multiple heart risk factors (high cholesterol, high blood pressure, family history, obese, diabetes mellitus) or concurrent chronic diseases or those in a high-risk stressful occupations
    • Men over age 40 and women over age 50 who have been inactive but plan to start vigorous exercise.
    • Evaluation of exercise capacity in patients with heart disease involving one or more of the valves of the heart, those with heart rhythm disorders, and those with pacemakers.
  • Cardiac Rehab Programs:
    • Silberman and colleagues reported that 2974 patients participating in an intensive cardiac rehabilitation program reported significant improvements in body mass index (BMI), triglycerides, low density lipoprotein cholesterol, total cholesterol, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, depression, hostility, exercise, and functional capacity at 12 weeks and 1 year. (22)
    • A systematic review and meta-analysis of randomized controlled trials by Taylor et al found that exercise based cardiac rehabilitation for a duration of 0.25–30 months reduces risk of all cause and cardiac mortality by 20% amd 26% respectively, and improves a number of cardiac risk factors in patients with coronary heart disease (20).
  • For further information about exercise in apparently healthy adults or in chronically ill patients, please see aerobic exercise and resistance training sections.

 

• Resistance training, protein supplements, and hyperlipidemia: Preventive Health Advisor recommends a combined aerobic and resistance exercise program with or without a protein supplement for patients of all ages if approved by the primary care physician. Denysschen, CA et al studied overweight men with a cholesterol level over 200 mg/dl and given 26 grams of whey protein, soy protein, or placebo (23). The subjects were supervised during resistance training for 12 weeks, and total cholesterol reduction of 10.4 mg/dL for placebo, 11.2 mg/dL for soy, and 15.9 mg/dL for whey was noted (23). See resistance training section for further information.

 

• Evidence-based diet and exercise combination programs for hyperlipidemia and coronary artery disease:
  • The Pritikin Program evidence-based benefits after 12-15 days (25,26,27):
    • Body mass index, 3% reduction
    • Blood pressure, glucose and LDL, all with 10%-15% reduction
    • Triglycerides, 36% reduction
    • Slowed or reversed progression of coronary heart disease and reduce the need for coronary artery bypass grafts (CABG), rates of angioplasty procedures and percutaneous interventions.
    • Usually program is done for 3-4 weeks allowing additional benefit.
  • Pritikin Program includes (24,25,26):
    • Very low fat, less than 10% of calories.
    • Low sodium and avoid salty foods.
    • High fiber with at least five ½-cup servings of whole grains daily (wheat, oats, and brown rice or starch vegetables such as potatoes, and dried beans and peas.
    • Refined grain products (white flour, regular pasta, white rice) are limited to two servings daily.
    • At least four 1-cup servings of raw vegetables daily or ½-cup servings of cooked vegetables. Dark green, leafy, and orange or yellow vegetables are preferred
    • At least three servings of fruit, one of which can be fruit juice.
    • Two servings daily of calcium-rich foods such as nonfat milk, nonfat yogurt or fortified and enriched soymilk.
    • No more than one caffeinated drinks daily. Instead drink water, low-sodium vegetable juices, grain-based coffee substitutes or caffeine-free teas.
    • No more than four alcoholic drinks per week for women and no more than seven for men, with red wine preferred over beer or distilled spirits.
    • No more than seven egg whites per week.
    • No more than 2 ounces (about 1/4 cup of nuts) daily.
    • Moderate amounts of fish, nonfat dairy, and lean meat with no more than one 3.5 cooked serving of animal protein per day with fish and shellfish are preferred. Lean poultry should optimally be limited to once a week and lean beef to once a month.
    • Adapted to vegetarians by replacing animal protein with protein from soy products, beans, or lentils.
    • Avoid fried foods, dressing with fat, and fatty sauces, animal fats, processed meat, dairy products not made with non-rat milk, egg yolks, salty snacks, cakes, cookies, and similar high-calorie choices.
    • Eat frequently with three meals a day plus two snacks.
    • Artificial sweeteners such as Splenda are okay.
    • 45 minutes of moderate exercise daily such as walking.
    • Medicare may approve coverage for qualifying individuals with a history or risk of cardiovascular events. The program has been approved for coverage under Part B of Medicare. Medicare will reimburse eligible beneficiaries for up to 72 one-hour ICR sessions, up to 6 sessions per day, at the Pritikin Longevity Center & Spa.
  • The Dean Ornish Program for Reversing Heart Disease (27):
    • The Ornish program evidence-based benefits:
    • Weight loss of 13.3 pounds in the first 12 weeks and 15.9 pounds after 1 year.
    • Significant reductions in systolic blood pressure (BP), diastolic BP, total cholesterol, triglycerides, and LDL-cholesterol after 12 weeks were still significant after 1 year.
    • Exercise capacity increased by 18% after 12 weeks and 24% after one year.
    • Reductions in depression were still significant after 1 year.
    • Hemoglobin A1C in diabetics continued to decrease after one year.
    • Improvement in severity of angina after 1 year.
  • Ornish Program includes (27):
    • Plant-based, meatless diet, meditation, and regular exercise with adherence to the program between 85 to 90% after one year in hospitals and clinics that have offered it.
    • Medicare Part B covers The Dean Ornish Program for Reversing Heart Disease, under Intensive Cardiac Rehabilitation (ICR). Eligibility includes acute myocardial infarction within the preceding 12 months, a coronary artery bypass surgery, current stable angina pectoris, heart valve repair or replacement, percutaneous transluminal coronary angioplasty or coronary stenting, a heart or heart-lung transplant, or other cardiac conditions as specified through a national coverage determination. (27)

 

• Effect of adding 30 minutes of daily exercise at 50-75% of age-predicted maximum heart rate, to a Therapeutic Lifestyle Changes Diet (TLC) in 6 months (6):
  • Assisted 89% of participants to reach an LDL cholesterol goal of under 130 mg/dL without lowering HDL levels or needing to add or increase lipid lowering therapy.
  • Mean total cholesterol, LDL cholesterol and triglycerides decreased by 9.2% (p=0.08), 9.3% (p<0.018), and 18.8% (p<0.05), on average respectively.
  • HDL cholesterol increased 2.6% on average (p=0.41).
  • Women: 12.3% reduction in LDL cholesterol and an 11.4% increase in HDL cholesterol
  • Men: 7.9% reduction in LDL cholesterol and no change in HDL
  • Systolic and diastolic blood pressure (BP) decreased 9% (p<0.001) and 13%, respectively (p <0.0001).
  • BP reductions were two-fold greater than in the Diet and Systolic Hypertension study (DASH).
  • 50% reduction in angina.

 

References

6.Welty FK., Stuart E., O’Meara M., Huddleston J., Effect of addition of exercise to therapeutic lifestyle changes diet in enabling women and men with coronary heart disease to reach Adult Treatment Panel III low-density lipoprotein cholesterol goal without lowering high-density lipoprotein cholesterol. The American Journal of Cardiology. May 2002; 89(10): 1201–1204. http://www.sciencedirect.com/science/article/pii/S0002914902023056

 

7.National Heart, Lung and Blood Institute. “Therapeutic Lifestyle Changes (TLC) Diet”. http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi

 

8.Schaefer S, Hussein H, Gershony GR, Rutledge JC, Kappagoda CT. Regression of severe atherosclerotic plaque in patients with mild elevation of LDL cholesterol. J Investig Med. 1997 Dec;45(9):536-41. http://www.ncbi.nlm.nih.gov/pubmed/9444880

 

9.Weickert, Martin O. What dietary modification best improves insulin sensitivity and why? Clin Endocrinol (Oxf). Oct 2012; 77(4):508-512. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2012.04450.x/full

 

10.“The effect of a low-carbohydrate, ketogenic diet versus a low- glycemic index diet on glycemic control in type 2 diabetes mellitus.” Department of Medicine, Duke University Medical Center, Durham, NC, USA.  Nutr Metab (Lond). 2008 Dec 19;5:36.  http://www.ncbi.nlm.nih.gov/pubmed/19099589

 

11.Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89(5):1588S-96S. http://www.ncbi.nlm.nih.gov/pubmed/19339401

 

12.Nutritive Value of Foods, United States Department of Agriculture, Agricultural Research Service, Home and Garden Bulletin Number 72. May be accessed at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w601.pdf

 

13.Walter R. Thompson, American College of Sports Medicine, Neil F. Gordon, Linda S. Pescatello. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, Feb 1, 2009.

 

14.Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G.Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010; 52(3): 539-48. http://aje.oxfordjournals.org/content/171/3/312.long

 

15.Barnard , James R., Tung H. Ngo, Pak-Shan Leung, William J. Aronson, and Lawrence A. Golding. A Low-Fat Diet and/or Strenuous Exercise Alters the IGF Axis In Vivo and Reduces Prostate Tumor Cell Growth In Vitro. The Prostate 56:201-206 May 2003. http://www.ncbi.nlm.nih.gov/pubmed/12772189

 

16.Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007 Aug;39(8):1435-45. http://circ.ahajournals.org/content/116/9/1094.full.pdf

 

17.Rod S. Taylor, Allan Brown, Shah Ebrahim, Judith Jolliffe, Hussein Noorani, Karen Rees, Becky Skidmore, James A. Stone, David R. Thompson, Neil Oldridge. Exercise-Based Rehabilitation for Patients with Coronary Heart Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Med. 2004;116:682– 692. http://exerciseprescription.wiki.umt.edu/file/view/Taylor+et+al,+2004.pdf

 

18.Klare WR. More physical activity in patients with diabetes. Article in German. MMW Fortschr Med. 2007 May 10;149(19):36-9; quiz 40. http://www.ncbi.nlm.nih.gov/pubmed/17668790

 

19.Li J, Zhang W, Guo Q, Liu X, Zhang Q, Dong R, Dou H, Shi J, Wang J, Yu D. Duration of exercise as a key determinant of improvement in insulin sensitivity in type 2 diabetes patients. Tohoku J Exp Med. 2012;227(4):289-96. http://www.ncbi.nlm.nih.gov/pubmed/22850594

 

20.Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004 May 15;116(10):682-92. http://exerciseprescription.wiki.uml.edu/file/view/Taylor%20et%20al,%202004.pdf

 

21.Mendes R, Sousa N, Barata JL. [Physical activity and public health: recommendations for exercise prescription]. [Article in Portuguese]. Acta Med Port. 2011 Nov-Dec;24(6):1025-30. Epub 2012 Feb 20. http://www.ncbi.nlm.nih.gov/pubmed/22713198

 

22.Silberman A, Banthia R, Estay IS, Kemp C, Studley J, Hareras D, Ornish D. The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. Am J Health Promot 2010;24:260–266. http://www.ncbi.nlm.nih.gov/pubmed/20232608

 

23.Denysschen CA, Burton HW, Horvath PJ, Leddy JJ, Browne RW. Resistance training with soy vs whey protein supplements in hyperlipidemic males. J Int Soc Sports Nutr. 2009 Mar 11;6:8. http://www.ncbi.nlm.nih.gov/pubmed/19284589

 

24.Sullivan S, Samuel S. Effect of short-term Pritikin diet therapy on the metabolic syndrome. J Cardiometab Syndr. 2006 Fall;1(5):308-12. http://www.ncbi.nlm.nih.gov/pubmed/17679787

 

25.The Pritikin Longevity Center. 19735 Turnberry Way Aventura, FL 33180. Telephone: (800) 327-4914 or (305) 935-7131. Fax: (305) 935-7371. http://www.pritikin.com     http://www.pritikin.com/pritikin-center-explore-the-resort/specials-a-reservations/medicare-coverage/1382-pritikin-program-approved-by-medicare-in-landmark-decision.html

 

26.The Pritikin Longevity Center. 19735 Turnberry Way Aventura, FL 33180. Telephone: (800) 327-4914 or (305) 935-7131. Fax: (305) 935-7371. http://www.pritikin.com

http://www.pritikin.com/pritikin-center-explore-the-resort/specials-a-reservations/medicare-coverage/1382-pritikin-program-approved-by-medicare-in-landmark-decision.html

 

27.Preventative Medicine Research Institute (PMRI). Ornish Programs Reimbursed by Medicare. http://www.pmri.org/certified_programs.html

 

 

Yoga Does Amazing Things

• 65% of patients with hypertension who performed yoga for 6 months were able to control their bp with Shavasana without using of medication but the high bp returned after yoga was stopped. (1)

 

• Blood-pressure was reduced from 168/100 to 141/84 mm Hg in a study with 34 patients doing yoga for 6 weeks. (2)

 

• A meta-analysis of 13 randomized controlled trials examining yoga for patients with cancer, specifically breast cancer patients, found yoga was associated with reduced stress, anxiety, depression, and fatigue. Anxiety was relieved by the breathing techniques used in this type of exercise

 

• Yoga was found to increase quality of life, emotional health, social function, and well-being.

 

• For the women who practiced yoga, birth weights of 2,500 grams or more were higher, preterm labor was lower, intrauterine growth retardation (IUGR) and pregnancy induced hypertension (PIH) associated with IUGR was also lower in the yoga group. (3)

 

• A study showed less pregnancies with induced hypertension, preeclampsia, gestational diabetes and intrauterine growth restriction (IUGR) cases in those performing yoga. There were also fewer Small for Gestational Age (SGA) babies and fewer newborns with low APGAR scores in the yoga group. (4)

 

• Yoga improved breathing parameters in patients with asthma (5, 6). There was a significantly greater improvement in the group who practiced yoga in the weekly number of attacks of asthma, scores for drug treatment, and peak flow rate. (6)

 

• Attending a twice-weekly 90-minute yoga class for two months led to a significant decrease in anxiety. (11)

 

• Yoga moderately increased quality of life, emotional and social function, and functional well-being. Physical function and sleep were not significantly affected. Yoga was associated with reduced stress, anxiety, depression, and fatigue in breast cancer patients. (7)

 

• Patients with fibromyalgia experienced improvements in sleep, fatigue, depression, and overall quality of life. (8)

 

• At the end of a 6-month study, compared to a waiting-list control group, multiple sclerosis patients taking yoga class or exercise class reported significant improvements in fatigue. (9)

 

• Yoga decreased migraine intensity, frequency, and duration compared to the self-care group, and yoga-practicing participants also reported less anxiety and depression. (10)

 

• After four months of yoga, insomnia severity of post-menopausal women performing yoga was lower than in the passive stretching or control group. Yoga also improved stress, anxiety and depression in this group. (12)

 

References:

1.Sundar S, Agrawal SK, Singh VP, Bhattacharya SK, Udupa KN, Vaish SK. Role of yoga in management of essential hypertension. Acta Cardiol. 1984;39(3):203-8. http://www.ncbi.nlm.nih.gov/pubmed/6331698

 

2.Patel C, North WR. Randomised controlled trial of yoga and bio-feedback in management of hypertension. Lancet. 1975 Jul 19;2(7925):93-5. http://www.ncbi.nlm.nih.gov/pubmed/49737

 

3.Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005 Apr;11(2):237-44. http://www.ncbi.nlm.nih.gov/pubmed/15865489

 

4.Rakhshani A, Nagarathna R, Mhaskar R, Mhaskar A, Thomas A, Gunasheela S. The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: a randomized controlled trial. Prev Med. 2012 Oct;55(4):333-40. http://www.ncbi.nlm.nih.gov/pubmed/22884667

 

5.Singh, V, Wisniewski, A, Britton, J, et al Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet 1990;335,1381-1383. http://www.ncbi.nlm.nih.gov/pubmed/1971670

 

6.Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. Br Med J (Clin Res Ed). 1985 Oct 19;291(6502):1077-9. http://www.ncbi.nlm.nih.gov/pubmed/3931802

 

7.Buffart LM, van Uffelen JG, Riphagen II, et al., Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012 Nov 27;12:559. http://www.ncbi.nlm.nih.gov/pubmed/23181734

 

8.Langhorst J, Klose P, Dobos GJ, Bernardy K, Hauser W. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International 2013; 33(1): 193-207. http://www.ncbi.nlm.nih.gov/pubmed/22350253

 

9.Oken BS, Kishiyama S, Zajdel D, et al., Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004 Jun 8;62(11):2058-64. http://www.ncbi.nlm.nih.gov/pubmed/15184614

 

10.John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007 May;47(5):654-61. http://www.ncbi.nlm.nih.gov/pubmed/17501846

 

11.Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009 May;15(2):102-4. http://www.ncbi.nlm.nih.gov/pubmed/19341989

 

12.Afonso RF, Hachul H, Kozasa EH, et al., Yoga decreases insomnia in postmenopausal women: a randomized clinical trial. Menopause. 2012 Feb;19(2):186-93. http://www.ncbi.nlm.nih.gov/pubmed/22048261

 

 

Eat Well to Lower Cholesterol

• Nut consumption, high cholesterol, and risk of coronary events according to Fraser (28):
  • Consumption of almonds and walnuts may result in an 8% to 12% reduction in LDL.
  • Frequent consumption of nuts has been linked with a 30% to 50% decreased risk of coronary heart disease.

 

• Tree nuts, peanut consumption, and the lipid profile according to Kris-Etherton PM et al (29):
  • Four most recent U.S. studies reviewed by this author estimates that Americans who eat five or more servings of nuts per week have a 35% reduced risk of developing coronary heart disease.
  • Improve CHD related oxidation, inflammation, vascular reactivity.
  • Lower total and LDL cholesterol based on their fatty acid profile plus contain other bioactive compounds with cholesterol-lowering properties.

 

• Oats for treatment of high cholesterol:
  • Consumption of 100 grams of instant oat cereal for 6 weeks resulted in a lower total cholesterol by 6.2% and reduction of LDL cholesterol by 8.4% (30).
  • A review of studies on oat β-glucan, soluble fiber found in oats, found that 3g oat β-glucan daily lowers LDL cholesterol by about 5%-10% in individuals with normal or high cholesterol, and the effect of this agent is supported by the US Food and Drug Administration  and the UK Joint Health Claims Initiative (31).
  • A randomized controlled trial tested a diet low in saturated fat with 1.8 grams of oil-based phytosterols and 2.8 g beta-glucan daily lowered total and LDL cholesterol by 3.7% and 2.3 % respectively without a significant change in controls after 6 weeks (32).
  • A 6-week randomized controlled trial on hypertensive and hyperinsulinemic subjects by Keenan et al, tested an oat cereal group on 5.52 grams daily of β-glucan or a low-fiber cereal daily and found these results (33):
    • Systolic blood pressure decrease of 7.5 points and a diastolic pressure reduction of 5.5 points
    • Decrease in both total cholesterol of 9% and LDL cholesterol of 14%
    • Trend toward improved insulin sensitivity.
  • Another study showed that 10 grams daily of β-glucan rich oat bran or wheat bran only improved total cholesterol temporarily (34).

 

• Soy isoflavones, flavonoids, and cholesterol:
  • In total 115 women participating in a cross-sectional study on flavonoid consumption from vegetables (72.3%), fruits (15.6%), green tea (5.4%), potatoes (3.8%) and tofu (2.9%) found that the intake of flavonoids was inversely related with LDL cholesterol, intake of other phytochemicals was not correlated with lipid levels, and  there was no correlation between green tea consumption and plasma lipids seen (35).
  • Crouse et al found that subjects with high LDL cholesterol levels on a diet of 25 grams of isolated soy protein with 62 mg of isoflavones showed significant decreases in LDL cholesterol by 6% vs 4% with a diet including 25 grams of casein (36).
  • Soy protein and hyperlipidemia: The FDA supports that soy protein may reduce the risk of coronary artery disease by lowering cholesterol levels when included in a diet low in saturated fat and cholesterol (37).

 

References:

30.Zhang J, Li L, Song P, Wang C, Man Q, Meng L, Cai J, Kurilich A. Randomized controlled trial of oatmeal consumption versus noodle consumption on blood lipids of urban Chinese adults with hypercholesterolemia. Nutr J. 2012 Aug 6;11:54. doi: 10.1186/1475-2891-11-54. http://www.ncbi.nlm.nih.gov/pubmed/22866937

 

31.Othman RA, Moghadasian MH, Jones PJ. Cholesterol-lowering effects of oat β-glucan. Nutr Rev. 2011 Jun;69(6):299-309. http://www.ncbi.nlm.nih.gov/pubmed/21631511

 

32.Maki KC, Shinnick F, et al. Food products containing free tall oil-based phytosterols and oat beta-glucan lower serum total and LDL cholesterol in hypercholesterolemic adults. J Nutr. 2003 March;133(3):808-13. http://www.ncbi.nlm.nih.gov/pubmed?term=12612157

 

33.Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. J Fam Pract. 2002 Apr;51(4):369. http://www.ncbi.nlm.nih.gov/pubmed/11978262

 

34.Uusitupa MI, Miettinen TA, Sarkkinen ES, Ruuskanen E, Kervinen K, Kesaniemi YA. Lathosterol and other non-cholesterol sterols during treatment of hypercholesterolaemia with beta-glucan-rich oat bran. Eur J Clin Nutr 1997;51:607–11. http://www.ncbi.nlm.nih.gov/pubmed?term=9306087

 

35.Arai Y, Watanabe S, Kimira M, Shimoi K, Mochizuki R, Kinae N. Dietary Intakes of Flavonols, Flavones and Isoflavones by Japanese Women and the Inverse Correlation between Quercetin Intake and Plasma LDL Cholesterol Concentration. J Nutr. 2000 Sep;130(9):2243-50. http://www.ncbi.nlm.nih.gov/pubmed?term=10958819

 

36.Crouse JR III, Morgan T, Terry JG, Ellis J, Vitolins M, Burke GL. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999;159:2070–6. http://archinte.jamanetwork.com/article.aspx?articleid=485126

 

37.Food labeling: health claims; soy protein and coronary heart disease. Food and Drug Administration, HHS. Final rule. Fed Regist.1999 Oct 26;64(206):57700-33. http://www.ncbi.nlm.nih.gov/pubmed/11010706

 

 

Does Eating Fiber Do Anything for LDL?

Fiber supplements for treatment of hyperlipidemia: Fiber supplements add volume to the stomach to curb hunger, bind fats and cholesterol to reduce absorption, and promote weight loss by overall reduction of calorie density in the gastrointestinal tract. Guar gum, glucomannan, or psyllium husk fibers are recommended as a fiber supplement to reduce HbA1C, fasting blood glucose, improve the lipid profile, lowered blood pressure and assisted in weight loss by providing fullness to reduce hunger.

• Guar gum has been taken at a dose of 10 grams per day for 8 weeks (39), 20 grams per day for 4 weeks (40), 15 grams per day for 42 weeks (42), or 30 grams per day for 6 weeks (43). Benefits of guar gum include:
  • Reduction in fasting blood glucose of 16.9 mg/dL (38)
  • Improvement of HbA1C by 0.5-1% (38,39,42)
  • Total cholesterol reduction in one study of 21% (40), another study showed cholesterol reduction of 13% (42), and a third study showed total cholesterol was lowered by 0.6 mmol/L (43).
  • Lowered post-prandial blood glucose (40,49)
  • Reduced insulin requirement (40,49)
  • Weight loss (41)
  • LDL reduction of 8% (42)
  • Decreased systolic and diastolic blood pressure by 6 mmHg and 3 mmHg, respectively (43)
  • Increase in insulin sensitivity (43).
  • One study showed no improvement of total cholesterol, triglycerides, HDL, or LDL (38).
  • One study showed no improvement of insulin sensitivity or HbA1C (40).
  • Guar gum adverse reactions and interactions: 62.5% of patients receiving guar gum experienced side effects including abdominal cramps, diarrhea (most common), and skin itching (38). Another study noted flatulence, loose stools, and a feeling of stomach discomfort (42).
• Psyllium fiber and hyperlipidemia: Psyllium fiber at a dose of 10.2-21 grams daily for at least 3 weeks lowers total cholesterol by 4-6 % or 30mg/dL, lowers LDL cholesterol by about 7% or 15 mg/dL, may slightly increase or decrease HDL cholesterol, and has also shown significant reductions in fasting blood glucose, and lowering of HbA1c.
  • Psyllium fiber at a dose of 5.1 grams twice daily for 8 weeks improved total cholesterol 5.8%, LDL cholesterol 7.2% on a high fat diet and 4.2% and 6.4%, respectively for those on a low-fat diet (44).
  • A meta-analysis with 8 studies and 656 subjects on a low fat diet plus 10.2 grams of psyllium daily for at least 8 weeks was well tolerated, reduced total cholesterol by 4%, lowered LDL cholesterol by 7%, and decreased the ratio of apolipoprotein B to apolipoprotein A-I by 6%, but change in HDL or triglycerides was not seen. (45)
  • 26 weeks of treatment with 5.1 g psyllium twice daily lowered total and LDL-cholesterol levels by 4.7% and 6.7% respectively compared to placebo. (46)
  • A study followed 7 men on 21 g/day of psyllium fiber for 3 weeks reduced total cholesterol, by 30mg/dL, LDL cholesterol by 15 mg/dL and HDL by 4 mg/dL (47).
  • Psyllium enriched cereal lowered total, and LDL cholesterol more than cereal or pectin enriched cereal (48).
  • Patients taking metformin and experiencing side effects of flushing, may obtain relief of these symptoms from psyllium fiber (50).
• Konjac glucomannan and hyperlipidemia: Glucomannan is a water-soluble dietary fiber that is derived from the konjac root.
  • Glucomannan taken at a dose range of 1.2 to 15.1 grams per day for 3-16 weeks yielded the following average benefit across 14 studies (51):
    • Decreases in total cholesterol by -19.28 mg/dL
    • Lowered LDL cholesterol by -15.99 mg/dL
    • Triglycerides reduced by -11.08 mg/dL
    • Reduction in body weight by – 0.79 kg (-1.74 lbs)
    • Lowered fasting blood glucose by -7.44 mg/dL.
    • No effect on HDL or blood pressure was seen.
  • Glucomannan at a dose of 10 grams per day plus plant sterols at a dose of 1.8 grams per day was more effective than glucomannan alone (52):
    • LDL was 2.95 mmol/L after glucomannan plus plant sterols vs. 3.60 mmol/L after placebo.
    • Total cholesterol was also lower after glucomannan plus sterols at 4.72 mmol/L vs. placebo of 5.47 mmol/L.
  • Glucomannan at a dose of 3.6 grams per day for 28 days reduced LDL by 20.7% and fasting glucose levels by 23.3% (53).
  • Glucomannan-enriched biscuits with 0.7 grams glucomannan daily or placebo of wheat bran fiber biscuits taken by subjects on medication and a low cholesterol diet every day for three weeks lowered systolic blood pressure by 6.9% but body weight, HDL, LDL, and total cholesterol, triglycerides, glucose, insulin, and diastolic blood pressure were unchanged (54).
  • Glucomannan at a dose of 1240 mg to 4320 mg per day plus a low-calorie diet (1200 kcal) was more effective than placebo and a low calorie diet for improvement in body weight, total cholesterol, and hunger/satiety (55). Weight loss contributes to improvement of hyperlipidemia. Weight loss over 5 weeks was 3.8–4.4 kg with the doses of glucomannan mentioned above (55)
  • Glucomannan and a low-calorie diet (1200 kcal) was more effective than placebo and a low calorie diet for improvement in body weight, total cholesterol, and hunger/satiety in a 60-day study that included 30 participants (56).
• Fiber adverse reactions and interactions.
  • Dry powdered fibers are generally safe when mixed with adequate water or another liquid, but are not without health risks.
  • At least 8 ounces of fluid is recommended when taking dry fibers such as glucomannan, Konjac root, guar gum, Citrucel, and psyllium (Metamucil).
  • Health Canada issued a warning that glucomannan fiber has resulted in choking, obstruction of the throat, esophagus or bowels according to reports when not consumed with an adequate amount of fluid (57).
  • The warning also stated that the fiber should not be taken before bed (57).
  • Less flatulence occurred in a psyllium treatment group compared to a placebo group, and also experienced similar diarrhea and constipation in both groups (50).
  • Fibers may also bind medications and interfere with absorption resulting in a reduction in the desired effect of the medication. Therefore, medications should be taken at least 2 hours before or after the fiber.

 

References:

39.Jones DB, Slaughter P, Lousley S, et al. Low-dose guar improves diabetic control. J R Soc Med. 1985 Jul;78(7):546-8. http://www.ncbi.nlm.nih.gov/pubmed/2989516

 

40.Ebeling P, Yki-Järvinen H, Aro A, Helve E, Sinisalo M, Koivisto VA. Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum. Am J Clin Nutr. 1988 Jul;48(1):98-103. http://www.ncbi.nlm.nih.gov/pubmed/3291601

 

41.Chow J, Choe YS, Noss MJ, Robinson KJ, Dugle JE, Acosta SH, Garleb KA. Effect of a viscous fiber-containing nutrition bar on satiety of patients with type 2 diabetes. Diabetes Res Clin Pract. 2007 Jun;76(3):335-40. http://www.ncbi.nlm.nih.gov/pubmed/17023088

 

42.Groop PH, Aro A, Stenman S, Groop L. Long-term effects of guar gum in subjects with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993 Oct;58(4):513-8. http://ajcn.nutrition.org/content/58/4/513.long

 

43.Landin K, Holm G, Tengborn L, Smith U. Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. Am J Clin Nutr.1992 Dec;56(6):1061–5. http://ajcn.nutrition.org/content/56/6/1061.long

 

44.Sprecher DL, Harris BV, Goldberg AC, et al. Efficacy of psyllium in reducing serum cholesterol levels in hypercholesterolemic patients on high- or low-fat diets. Ann Intern Med 1993 Oct 1;199 (7 Pt 1):545–54. http://www.ncbi.nlm.nih.gov/pubmed/8363164

 

45.Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 2000 Feb;71(2):472–9. http://www.ncbi.nlm.nih.gov/pubmed/10648260

 

46.Anderson JW, Davidson MH, Blonde L, et al. Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr. 2000 Jun;71(6):1433-8. http://www.ncbi.nlm.nih.gov/pubmed/10837282

 

47.Abraham ZD, Mehta T. Three-week psyllium-husk supplementation: effect on plasma cholesterol concentrations, fecal steroid excretion, and carbohydrate absorption in men. Am J Clin Nutr. 1988 Jan;47(1):67-74. http://www.ncbi.nlm.nih.gov/pubmed/2827455

 

48.Bell LP, Hectorn KJ, Reynolds H, Hunninghake DB. Cholesterol-lowering effects of soluble-fiber cereals as part of a prudent diet for patients with mild to moderate hypercholesterolemia. Am J Clin Nutr 1990 Dec;52(6):1020–6. http://www.ncbi.nlm.nih.gov/pubmed/2173390

 

49.Sierra M, Garcia JJ, Fernández N, et al. Effects of ispaghula husk and guar gum on postprandial glucose and insulin concentrations in healthy subjects. Eur J Clin Nutr. 2001 Apr;55(4):235-43. http://www.ncbi.nlm.nih.gov/pubmed/11360127

 

50.Ziai SA, Larijani B, Akhoondzadeh S, et al. Psyllium decreased serum glucose and glycosylated hemoglobin significantly in diabetic outpatients. J Ethnopharmacol. 2005 Nov 14;102(2):202-7. http://www.ncbi.nlm.nih.gov/pubmed?term=16154305

 

51.Sood N, Baker W L, Coleman C I. Effect of glucomannan on plasma lipid and glucose concentrations, body weight, and blood pressure: systematic review and meta-analysis. American Journal of Clinical Nutrition 2008; 88(4): 1167-1175. http://www.ncbi.nlm.nih.gov/pubmed/18842808

 

52.Yoshida M, Vanstone CA, Parsons WD, Zawistowski J, Jones PJ. Effect of plant sterols and glucomannan on lipids in individuals with and without type II diabetes. Eur J Clin Nutr. 2006 Apr;60(4):529-37. http://www.ncbi.nlm.nih.gov/pubmed/16391591

 

53.Chen HL, Sheu WH, Tai TS, Liaw YP, Chen YC. Konjac supplement alleviated hypercholesterolemia and hyperglycemia in type 2 diabetic subjects–a randomized double-blind trial. J Am Coll Nutr. 2003 Feb;22(1):36-42. http://www.ncbi.nlm.nih.gov/pubmed/12569112

 

54.Vuksan V, Jenkins DJ, Spadafora P, Sievenpiper JL, Owen R, Vidgen E, Brighenti F, Josse R, Leiter LA, Bruce-Thompson C. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care. 1999 Jun;22(6):913-9. http://www.ncbi.nlm.nih.gov/pubmed/10372241

 

55.Birketvedt GS, Shimshi M, Erling T, Florholmen J. Experiences with three different fiber supplements in weight reduction. Med Sci Monit. 2005 Jan;11(1):PI5-8. http://www.ncbi.nlm.nih.gov/pubmed/15614200

 

56.Cairella M, Marchini G. Evaluation of the action of glucomannan on metabolic para-meters and on the sensation of satiation in overweight and obese patients. Clin Ter. 1995 Apr;146(4):269-74. Italian. http://www.ncbi.nlm.nih.gov/pubmed/7796558

 

57.Health Canada Advises Canadians that Natural Health Products containing Glucomannan May Cause Serious Choking if Used with Insufficient Fluid. January 29, 2010. Labelling and Packaging, Product Safety. Accessed December 28, 2013. http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2010/13439a-eng.php

 

 

If Their HDL is Low, Fix It

• Increasing HDL- A regimen which may assist to raise HDL includes the following:
  • Recheck lipid panel in 3-6 months. If not at goal, then can increase policosanol to 10 mg.
    • Sustained release Niacin, 500 mg daily.
    • Policosanol 5mg daily
    • 2 kiwifruits daily.
    • 250 ml of red wine nightly.
    • Cardiovascular exercise 30 min daily and resistance training three times per week.

 

• Increasing HDL cholesterol with niacin:
  • Niacin may be used with or without statin medications. Niacin is not a benign supplement, but is used more like a standard medication as one of the strongest acting agents known to increase high-density lipoprotein (HDL). Niacin is the recommended treatment to lower lipoprotein (a) which helps reduce the risk of heart disease (58,59), and result in less cardiac events (62). Niacin also lowers LDL cholesterol a small amount (60).
  • We recommend immediate release niacin over sustained release niacin due to a lower risk of hepatotoxicity, especially since niacin is often considered for use with statins which further increases this risk.
  • Niacin dose:
    • Immediate release niacin is generally started at a dose of 250 mg -1000 mg twice daily, may be increased to up to 1000 mg three times daily as tolerated, and is safe if monitored appropriately (65).
    • Sustained release niacin dose should be limited to 1000 mg daily because it is tolerated well and has less hepatotoxicity than higher doses (64).
  • A study compared both immediate release and sustained release niacin therapy starting at 500 mg daily with a dose escalation every 6 weeks up to 3000 mg daily yielded the following results (61):
    • Immediate release niacin increased HDL cholesterol more than the sustained release form.
    • Sustained release niacin lowered LDL better than immediate release niacin at a dose of 1500 mg per day.
    • Triglycerides were decreased to similar levels with both forms of niacin.
    • According to the author, sustained release niacin was unsafe since hepatotoxicity occurred in over 50% of this group, but did not occur in any subjects taking the immediate release form.
  • The ADMIT study (Arterial Disease Multiple Intervention Trial), evaluated immediate release niacin at a dose escalation up to 3000 mg daily in a large study group for 48 weeks and found the following results (65):
    • Significant lowering of total cholesterol, LDL, and triglycerides.
    • Significant increase in HDL.
  • Sustained release niacin at 500 mg daily for 4 weeks followed by 1000 mg daily for 4 weeks resulted in compliance of over 90%, increased HDL by 17%, LDL decreased by 11%, and did not result in any significant transaminase elevations (64).
  • Use of niacin was associated with a 31% increase in high-density lipoprotein (HDL), at a dose of 1g low-dose long-acting niacin daily but did not change total cholesterol or triglyceride levels (58).
  • Extended-release niacin 1000 mg/day added to statin therapy in a double-blind randomized placebo-controlled trial over 1 year had the following results (62):
    • Slowed the progression of atherosclerosis among patients with known coronary heart disease plus low HDL cholesterol.
    • Carotid intima-media thickness increased significantly in the placebo group and was unchanged in the statin plus niacin group.
    • 21% increase in HDL cholesterol in the niacin group.
    • Cardiovascular events were reported in 3.8% and 9.6% of patients in the niacin group and placebo group, respectively.
  • In a 3-year double-blinded, placebo-controlled trial by Brown et al, treatment with sustained release niacin added to simvastatin dramatically reduced cardiac events, improved stenosis of coronary arteries, and reduced LDL cholesterol (LDL-C) levels in coronary heart disease (67).
  • Extended-release niacin (500-3000 mg/day) reduced LDL cholesterol 5.7-11% in women and had a greater effect than in men at all doses, and triglycerides were also decreased greater for women than for men but was only significant at the 1500 mg/day dose (60).
  • Niacin adverse reactions and interactions:
    • The most common adverse effects of niacin include flushing, hyperglycemia, and hyperuricemia (67,59), which results in about 40% of subjects to discontinue the drug (58).
    • Niacin may cause hepatotoxicity in sustained release and immediate release forms, but at a much higher rate when taken in the form of sustained release niacin (67,61). Both forms require monitoring of transaminases.
    • Higher creatine kinase levels, uric acid, and insulin (67).
    • If switching from immediate to sustained release niacin, begin at a much lower dose. A case report showed that when switching from 3 g/daily of immediate-release niacin to same dose slow-release niacin an individual developed hepatitis (63).
    • Niacin has been known to induce overt diabetes (58), increase plasma glucose (130), but has left hemoglobin A1C unchanged (65).
    • Niacin may cause fatigue, elevation in liver function tests, hepatotoxicity, gastrointestinal complaints, and acanthosis nigricans (61).
    • Niacin administration long term is associated with increased plasma homocysteine levels of 17-55% (66).
    • Blood pressure is decreased by use of nicotinic acid (Niacin).

 

References:

58.Luria MH. Effect of low-dose niacin on high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol ratio. Arch Intern Med. 1988 Nov;148(11):2493-5. http://www.ncbi.nlm.nih.gov/pubmed/3190381

 

59.Gouni-Berthold I, Berthold HK. The role of niacin in lipid-lowering treatment: are we aiming too high? Curr Pharm Des. 2013;19(17):3094-106. http://www.ncbi.nlm.nih.gov/pubmed/23317400

 

60.Goldberg AC. A meta-analysis of randomized controlled studies on the effects of extended-release niacin in women. Am J Cardiol 2004;Jul 1, 94(1):121-124. http://www.ncbi.nlm.nih.gov/pubmed/15219522

 

61.McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA. 1994 Mar 2;271(9):672-7. http://www.ncbi.nlm.nih.gov/pubmed/8309029

 

62.Taylor  A.J., Sullenberger  L.E., Lee  H.J., Lee  J.K., Grace  K.A.;  Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation. 2004 Dec 7;110(23):3512-7. http://www.ncbi.nlm.nih.gov/pubmed/15537681

 

63.Bassan M. A case for immediate-release niacin. Heart Lung. 2012 Jan-Feb;41(1):95-8. http://www.ncbi.nlm.nih.gov/pubmed/21414665

 

64.Kim SH, Kim MK, Lee HY, Kang HJ, Kim YJ, Park BJ, Kim HS. Efficacy and tolerability of a new extended-release formulation of nicotinic acid in Korean adults with mixed dyslipidemia: an 8-week, multicenter, prospective, randomized, double-blind, and placebo-controlled trial. Clin Ther. 2011 Oct;33(10):1357-64. http://www.ncbi.nlm.nih.gov/pubmed/15537681

 

65.Elam MB, Hunninghake DB, Davis KB, Garg R, Johnson C, Egan D, Kostis JB, Sheps DS, Brinton EA. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial. JAMA. 2000 Sep 13;284(10):1263-70. http://www.ncbi.nlm.nih.gov/pubmed/10979113

 

66.Garg R, Malinow M, Pettinger M, Upson B, Hunninghake D. Niacin treatment increases plasma homocysteine levels. Am Heart J. 1999 Dec;138(6 Pt 1):1082-7. http://www.ncbi.nlm.nih.gov/pubmed/10577438

 

67.Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, Dowdy AA, Marino EK, Bolson EL, Alaupovic P, Frohlich J, Albers JJ. Simvastatin and Niacin, Antioxidant Vitamins, or the Combination for the Prevention of Coronary Disease. N Engl J Med. 2001 Nov 29;345(22):1583-92. http://www.nejm.org/doi/full/10.1056/NEJMoa011090#t=articleDiscussion

 

130.Cunningham E. Is red yeast rice safe and effective for lowering serum cholesterol? J Am Diet Assoc. 2011 Feb;111(2):324. http://www.sciencedirect.com/science/article/pii/S0002822310019917

 

 Red Wine + LDL = ?

• Red wine both increases HDL cholesterol and decreases LDL cholesterol significantly at doses of 150-400 ml daily.
• Drinking red wine has significantly better cardiovascular disease risk reduction compared to beer, vodka, whiskey, gin, tequila, or rum (71).
• Red wine appears to provide cardiovascular disease benefit by both increasing HDL cholesterol from the alcohol content, and by inhibiting platelet aggregation (68).
• Moderate red wine consumption has been associated with an improved cholesterol profile including an increase in HDL cholesterol and reduction of both mortality risk and risk of cardiovascular disease (69).
• At the end of a 4-week study period, results showed that drinking red wine in moderation increased HDL cholesterol by 11–16%, decreased fibrinogen by 8–15% and according to the authors was associated with beneficial changes in blood lipids and fibrinogen that may help to reduce the risk of CVD (70).
• De Gaetano and Cerletti reported that after red wine consumption (30 g alcohol daily for 4 weeks) as compared to the same amount of alcohol given as spirit such as vodka, whiskey, gin, tequila, or rum resulted in a significant increase in HDL cholesterol levels and a decreased oxidation of LDL cholesterol. The authors reviewed a meta-analysis which indicated a significant negative relationship between moderate wine drinking of 150-300 ml daily and the risk of cardiovascular events. In conclusion, moderate wine consumption is linked with prevention of cardiovascular disease. (71)
• 400 mL/day of red wine for 6 weeks significantly decreased LDL cholesterol concentrations by 8% and increased HDL cholesterol concentrations by 17% and reduced cardiovascular disease risk compared to no effect for placebo (72).
• Andrade, AC et al found that subjects with baseline triglycerides under 139 mg/dL taking 250 ml of red wine nightly for 15 doses had the following results (73) :
  • Subjects with hypercholesterolemia
    • Total cholesterol reduction by 17 mg/dL
    • HDL decreased by 4 mg/dL
    • LDL decreased by 17 mg/dL
    • Triglycerides increased 13 mg/dL
  • Subjects with hypertension
    • Total cholesterol reduction by 7 mg/dL
    • HDL increased by 1 mg/dL
    • LDL decreased by 14 mg/dL
    • Triglycerides increased 31 mg/dL
  • Healthy control subjects
    • Total cholesterol increased by 22 mg/dL
    • HDL increased 7 mg/dL
    • LDL increased 13 mg/dL
    • Triglycerides increased 11 mg/dL

 

References:

68.Ruf JC. Alcohol, wine and platelet function. Biol Res. 2004;37:209–15. http://www.ncbi.nlm.nih.gov/pubmed/15455649

 

69.Alfredo C Cordova and Bauer E Sumpio. Polyphenols are medicine: Is it time to prescribe red wine for our patients? Int J Angiol. 2009 Autumn; 18(3): 111–117. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903024/

 

70.Hansen AS, Marckmann P, Dragsted LO, Finne Nielsen IL, Nielsen SE, Gronbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005 Mar;59(3):449-455. http://www.ncbi.nlm.nih.gov/pubmed/15674304

 

71.de Gaetano G, Cerletti C. Wine and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2001 Aug;11(4 Suppl):47-50. http://www.ncbi.nlm.nih.gov/pubmed/11894753

 

72.Naissides M, Mamo JC, James AP, Pal S. The effect of chronic consumption of red wine on cardiovascular disease risk factors in postmenopausal women. Atherosclerosis. 2006 Apr;185(2):438-45. http://www.ncbi.nlm.nih.gov/pubmed/16095600

 

73.Andrade A.C., Cesena F.H., Consolim-Colombo F.M., Coimbra S.R., Benjo A.M., Krieger E.M., Luz P.L. Short-term red wine consumption promotes differential effects on plasma levels of high-density lipoprotein cholesterol, sympathetic activity, and endothelial function in hypercholesterolemic, hypertensive, and healthy subjects. Clinics (Sao Paulo) 2009;64:435–442. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694248/

 

How to Fish for Triglycerides

• American Heart Association (AHA) fish, fish oil, and oil intake recommendation (75):
  • All adults are recommended to eat fish (particularly fatty fish) at least two times per week.
  • AHA also recommends eating plant-derived omega-3 fatty acids, tofu and other forms of soybeans, walnuts and flaxseeds and their oils.
  • For patients with coronary heart disease, it is recommended they consume about 1 gram of the two kinds of omega-3 fatty acids shown to be cardio-protective, EPA and DHA
  • Omega-3 fish oil is beneficial for treatment of elevated triglycerides. Patients needing triglyceride-lowering, should have fish oil prescribed by a physician. The AHA recommends a daily intake of 2-4 grams of EPA+DHA for elevated triglycerides, but a patient should only be prescribed over 3 grams of omega-3 fish oil from a physician due an increased risk of bleeding.
  • Expected triglyceride lowering effect by omega-3 fish oil (dose range 0.045 to 5.9 grams of EPA and DHA per day) in a meta-analysis that included 21 (76):
  • Total average decrease in triglycerides of 27 mg/dL.
  • Increase in HDL cholesterol of 1.6 mg/dL.
  • Increase in LDL cholesterol of 6 mg/dL.
  • Total cholesterol was not affected by fish oil intake.
  • The more fish oil consumed, the greater the reduction in triglycerides by a dose-dependent effect.
  • Patients with higher triglyceride level prior to starting fish oil experienced a greater response.
  • For every 1 gram of fish oil intake, triglycerides were reduced about 8 mg/dl.
  • Benefit of plant-based omega-3 fatty acids (ALA) were inconclusive.
• 3g daily fish oil for 5 weeks had lowered blood pressure and plasma triglyceride levels with omega-3 compared to placebo (77).
• In a randomized controlled trial called the GISSI-Prevenzione trial done in Italy, 11,324 patients with pre-existing coronary heart disease (CHD) were randomly allocated to either 300 mg vitamin E, 850 mg omega-3 fatty acid ethyl esters (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]), both, or no treatment and followed for 3.5 years noted the following results (78):
  • 15% reduction in mortality, nonfatal myocardial infarction, and nonfatal stroke was seen in participants taking 850 mg omega-3 fatty acid alone.
  • Participants taking omega-3 fatty acid after 6-months experienced a 2.5% increase in HDL cholesterol and a 4% reduction in triglycerides.
  • 20% reduction in all-cause mortality and a 45% reduction in sudden death.
• A review of 14 randomized clinical trials reported that fish oil is associated with a reduction in total mortality and sudden death, but not nonfatal heart attacks (79).
• A 3.5-year study including 11,324 myocardial infarction (MI) survivors with an MI occurring within 3 months) showed that fish oil supplementation at a dose of 1 gram daily, but not vitamin E at a dose of 300 mg daily, significantly reduced the total rate of all-cause death, nonfatal MI, and nonfatal stroke (80).
• Omega-3 fish oil adverse reactions and interactions:
  • A total of 10 studies were reviewed by Villani AM et al to determine potential serious adverse effects of fish oil at a dose of under 1.86 grams per day (98). It was found that there were no serious adverse effects reported in 994 adults over 59 years of age and other non-serious adverse effects were not significantly different from placebo (81).
  • Fish oil has been reported to affect platelet aggregation, reduce vitamin K dependent factors which may be associated with an increased anticoagulation (reduce blood clotting) effect. Consumption should be avoided when taking anticoagulants like aspirin, warfarin, or ticlopidine because of the potential increased risk of bleeding (82).
  • A case of a 67-year old woman taking warfarin (1.5 mg/day), an increase in her fish oil intake from 1 g/day to 2 g/day was associated with an increase in time for blood to clot as measured by the international normalized ratio (INR) which went from 2.8 to 4.3 within 1month, and decreased to 1.6 after the fish oil dose was reduced (83).
  • An intake of 6 grams per day of docosahexaenoic acid (DHA) found no significant difference found in blood coagulation, platelet function, or thrombotic parameters including prothrombin time, activated partial thromboplastin time, antithrombin-III levels, and platelet aggregation (84).
  • Fish oil may contain harmful contaminants such as heavy metals including mercury, dioxins, and polychlorinated biphenyls (PCBs). This risk can be reduced by purchasing fish oil that has undergone a purification process specified on the label (approved by the FDA, EPA, or US Pharmacopeia) (85)

 

References:

75.Kris-Etherton PM, Harris WS, Appel LJ. AHA Scientific Statement: Fish consumption, fish oil, omega-3 fatty acids and cardiovascular disease. Circulation. 2002; 106: 2747–2757. http://circ.ahajournals.org/content/106/21/2747/T5.expansion.html

 

76.Balk EM, Lichtenstein AH, Chung M et al. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: A systematic review. Atherosclerosis. 2006 Nov;189(1):19-30. http://www.ncbi.nlm.nih.gov/pubmed/16530201

 

77.Nilsson A, Radeborg K, Salo I, Björck I. Effects of supplementation with n-3 polyunsaturated fatty acids on cognitive performance and cardiometabolic risk markers in healthy 51 to 72 years old subjects: a randomized controlled cross-over study. Nutr J. 2012 Nov 22;11:99. http://www.ncbi.nlm.nih.gov/pubmed/23173831

 

78.Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999; 354: 447–455. http://www.ncbi.nlm.nih.gov/pubmed/10465168

 

79.Harper CR, Jacobson TA. Usefulness of omega-3 fatty acids and the prevention of coronary heart disease. Am J Cardiol. 2005 Dec 1;96(11):1521-9. http://www.ncbi.nlm.nih.gov/pubmed/16310434

 

80.Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999 Aug 7;354(9177):447-55. http://www.ncbi.nlm.nih.gov/pubmed/10465168

 

81.Villani AM, Crotty M, Cleland LG, James MJ, Fraser RJ, Cobiac L, Miller MD. Fish oil administration in older adults: is there potential for adverse events? A systematic review of the literature. BMC Geriatr. 2013 May 1;13(1):41. http://www.ncbi.nlm.nih.gov/pubmed/23634646

 

82.Ramsay NA, Kenny MW, Davies G, Patel JP. Complimentary and alternative medicine use among patients starting warfarin. Br J Haematol. 2005 Sep;130(5):777-80. http://www.ncbi.nlm.nih.gov/pubmed/16115136

 

83.Buckley, M. S., Goff, A. D., and Knapp, W. E. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38(1):50-52. http://www.ncbi.nlm.nih.gov/pubmed/14742793

http://www.ncbi.nlm.nih.gov/pubmed/19566923

 

84.Nelson GJ, Schmidt PS, Bartolini GL, Kelley DS, Kyle D. The effect of dietary docosahexaenoic acid on platelet function, platelet fatty acid composition, and blood coagulation in humans. Lipids. 1997 Nov;32(11):1129-36. http://www.ncbi.nlm.nih.gov/pubmed/9397397

 

85.Bays HE. Safety considerations with omega-3 Fatty Acid therapy. Am J Cardiol. 2007;99(6A):S35-43. http://www.ncbi.nlm.nih.gov/pubmed/17368277

 

 

Co-enzyme Q10 and Statins- “Like 2 Peas in a Pod”

• Although there is no standard for co-enzyme Q10 replacement, and monitoring, we recommend a co-enzyme Q10 supplement with statin medications to keep the level over 0.70 micromol/L, closer to healthy controls. As a guidance for dosing, a trial used co-enzyme Q10 to control blood pressure gradually over months by using doses of 75–360 mg daily to attain a therapeutic level of CoQ10 over 2.0 mcg/ml (89).

 

• This recommendation is due to depletion of co-enzyme Q10 by statins, its association with improvement in endothelial function, it’s inverse association with coronary artery disease, and it’s favorable effect on blood pressure:
  • For further information about co-enzyme Q10, please see the coenzyme Q10 section of Preventive Health Advisor.
  • Both hyperlipidemia and hypertension are risk factors for coronary artery disease which have been treated with some success using coenzyme Q10 supplementation.
  • Patients beginning treatment with 80 mg oral atorvastatin were noted to have an average drop of coenzyme Q10 level by 50% after 30 days of treatment, and lower CoQ10 levels appeared to contribute to muscle pain, exercise intolerance and myoglobinuria (90).
  • On standard doses of atorvastatin 10 mg and 20 mg, simvastatin 10 mg and 20 mg, or pravastatin 20 mg and 40 mg not only lowered cholesterol, but also decreased production of coenzyme Q10. (91).
  • Yalcin et al. indicated that a relation between low plasma coenzyme Q10 (CoQ10) concentration and coronary artery disease (CAD) exists, and CoQ10 concentrations in patients with CAD was different from healthy individuals (0.41 vs. 0.77 micromol/L, respectively) (93). Additionally, compared to healthy individuals, patients with CAD had a significantly lower ratio of CoQ10 to low density lipoprotein (LDL) (p < 0.01). (93)
  • Coenzyme Q10 and vascular endothelial function: Supplemental coenzyme Q10 resulted in a clinically significant, 1.7% increase in flow-dependent endothelial-mediated dilation (94).
  • Coenzyme Q10 at 50 mg twice daily for 10 weeks decreased systolic blood pressure from an average of 164.5 mmHg to 146.7 mmHg, and diastolic blood pressure decreased from an average of 98.1 mmHg to 86.1 mmHg (92).
  • Coenzyme Q10 levels should be monitored to achieve desired therapeutic level while monitoring for response. Rosenfeldt FL et al expressed that co-enzyme Q10 levels are patient dependent based on variable absorption, use of other medications, and patient response. As cited by Rosenfeldt, FL et al, a large trial used co-enzyme Q10 to control blood pressure gradually over months by using doses of 75–360 mg daily to attain a therapeutic level of CoQ10 over >2.0 g/ml. (89)

 

References:

89.Rosenfeldt FL, Haas SJ, Krum H, Hadj A, Ng K, Leong JY, Watts GF. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens. 2007 Apr;21(4):297-306. http://www.ncbi.nlm.nih.gov/pubmed/17287847

 

90.Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 2004 Jun;61(6):889-92. http://www.ncbi.nlm.nih.gov/pubmed?term=15210526

 

91.Passi S, Stancato A, Aleo E, Dmitrieva A, Littarru GP. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. Biofactors. 2003;18(1-4):113-24. http://www.ncbi.nlm.nih.gov/pubmed?term=14695926

 

92.Digiesi V, Cantini F, Oradei A, et al. Coenzyme Q10 in essential hypertension. Mol Aspects Med. 1994;15:S257-S263. http://www.ncbi.nlm.nih.gov/pubmed/7752838

 

93.Yalcin A, Kilinc E, Sagcan A, Kultursay H. Coenzyme Q10 concentrations in coronary artery disease. Clin Biochem. 2004 Aug;37(8):706-9. http://www.ncbi.nlm.nih.gov/pubmed/15302616

 

94.Gao L, Mao Q, Cao J, Wang Y, Zhou X, Fan L. Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis. 2012 Apr;221(2):311-6. http://www.ncbi.nlm.nih.gov/pubmed/22088605

 

 

Foods That Improve or Worsen Lipid Profiles

• Kiwi fruit, HDL, and trigycerides:
  • Consuming 2-3 kiwi fruit per day may lower blood triglycerides levels by about 15% and may reduce platelet aggregation as a benefit in cardiovascular disease (86).
  • A small study on men with high cholesterol who ate 2 kiwi fruit per day for 8 weeks experienced the following (87):
    • No change was seen in total or LDL cholesterol.
    • HDL cholesterol increased significantly.
    • Ratio of LDL cholesterol to HDL cholesterol and the ratio of total cholesterol to HDL cholesterol decreased significantly.
    • Levels of vitamin C and vitamin E increased significantly.

 

• Areca-nut associated with higher triglyceride levels: Areca-nut chewing has been associated with hyperglycemia, type 2 diabetes, metabolic syndrome, obesity, increased body mass, and higher triglyceride levels (88).

 

• Garlic and hyperlipidemia:
  • 12 weeks of garlic supplementation in a double-blind randomized, placebo-controlled trial, (with 9.6 mg allicin-releasing potential) reduced total cholesterol by 4.2%, decreased LDL cholesterol by 6.6%, and reduced HDL cholesterol by 0.9% (95).
  • In a review of 29 randomized controlled trials, Garlic in comparison with placebo was associated with a significant reduction in levels of total cholesterol by 0.19 mmol/L and trigycerides by 0.11 mmol/L, but garlic had no effect upon LDL cholesterol or HDL cholesterol (96).
  • A separate review of 13 randomized controlled trials with 1,056 subjects taking garlic for 12-24 weeks showed no significant change compared to placebo in levels of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides or apolipoprotein B (97).
  • Allicor, hyperlipidemia, and risk of ischemic heart disease (98):
    • After 1 year of Allicor treatment, a long-acting garlic drug, the 10-year absolute risk of IHD was reduced by10.7%, and the 10 year risk of both acute myocardial infarction, and sudden death were reduced 22.7%.
    • A reduction in total cholesterol and LDL cholesterol for men (by 27.9 and 22.5 mg/dl, respectively) and women (by 11.4 and 10.8 mg/dl, respectively) was reported.
    • Allicor used by women was also reported to prevent age-related cardiovascular risk.

 

References

86.Duttaroy AK, Jørgensen A. Effects of kiwi fruit consumption on platelet aggregation and plasma lipids in healthy human volunteers. Platelets. 2004 Aug;15(5):287-92. http://www.ncbi.nlm.nih.gov/pubmed/15370099

 

87.Chang WH, Liu JF. Effects of kiwifruit consumption on serum lipid profiles and anti-oxidative status in hyperlipidemic subjects. Int J Food Sci Nutr. 2009 Dec;60(8):709-16. http://www.ncbi.nlm.nih.gov/pubmed?term=effects%20of%20kiwifruit%20on%20serum%20lipid%20profiles

 

88.Eng. A. B. “Areca-nut chewing habit is a significant risk factor for metabolic syndrome: a systematic review.” J Nutr Health Aging. 2012 May;16(5):445-8. http://www.ncbi.nlm.nih.gov/pubmed/22555788

 

95.Kannar D, Wattanapenpaiboon N, Savige GS, Wahlqvist ML. Hypocholesterolemic effect of an enteric coated garlic supplement. J Am Coll Nutr. 2001 Jun;20(3):225-231. http://www.ncbi.nlm.nih.gov/pubmed/11444418

 

96.Reinhart KM, Talati R, White CM, Coleman CI. The impact of garlic on lipid parameters: a systematic review and meta-analysis. Nutrition Research Reviews 2009 Jun; 22(1): 39-48. http://www.ncbi.nlm.nih.gov/pubmed/19555517

 

97.Khoo Y S, Aziz Z. Garlic supplementation and serum cholesterol: a meta-analysis. Journal of Clinical Pharmacy and Therapeutics 2009 Apr;34(2): 133-145http://www.ncbi.nlm.nih.gov/pubmed/19250134

 

 

Plants Do It Again to Lower LDL

• Plant sterol-esters and hyperlipidemia: Plant sterol-esters, chemical name β-sitosterol, are additives to butter, margarine or other spreads with a chemical structure similar to cholesterol, which take the place of cholesterol in the intestines and result in reducing cholesterol absorption (99). When purchasing a spread product for lowering cholesterol, Preventive Health Advisor recommends a product which specifies that it contains at least 8 grams of plant stanol esters, plant sterol esters, or phytosterols per 100 grams of product. Most studies showed a benefit in lowering total cholesterol, LDL cholesterol, and triglycerides. The recommended dose is 2-9 grams of the phytosterols per day which has been taken in studies for 3 weeks to 1 year.
  • Phytosterols were found to be safe, tolerated well, and was not associated with any adverse effects at a dose of 3.4 grams per day (105), and up to a dose of 9 grams per day for 8 weeks (103,100).
  • In general, stanol ester in margarine at a dose of 2-3 grams daily of stanols is associated with a reduction in total and LDL cholesterol of about 15% and 20% respectively (102).
  • Davidson, MH et al found that 3 grams daily reduced triglycerides about 13%, and 9 grams daily reduced the ratio of total cholesterol to HDL by about 10% , but in this trial, there was no significant changes in LDL cholesterol (103).
  • Ayesh et al found a reduction in total and LDL cholesterol of 18% and 23%, respectively, after 21–28 d consumption of 8.6 g plant sterols, provided through margarines in a study of 24 healthy individuals (50% male) (100).
  • 20 grams of spread taken daily with 1.6 grams of plant sterols in a 1-year double-blind, placebo-controlled trial reduced total cholesterol by 4% and LDL cholesterol by 6% on average (101).

 

References:

99.Moreau R A, Whitaker B D, Hicks K B. Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and health-promoting uses. Prog Lipid Res. 2002 Nov;41(6):457-500. http://www.ncbi.nlm.nih.gov/pubmed/12169300

 

100.Ayesh R, Weststrate JA, Drewitt PN, Hepburn PA. Safety evaluation of phytosterol esters. Part 5. Faecal short-chain fatty acid and microflora content, faecal bacterial enzyme activity and serum female sex hormones in healthy normolipidaemic volunteers consuming a controlled diet either with or without a phytosterol ester-enriched margarine. Food Chem Toxicol. 1999 Dec;37(12):1127–38. http://www.ncbi.nlm.nih.gov/pubmed/10654588

 

101.Hendriks HFJ, Brink EJ, Meijer GW, Princen HMG, Ntanios FY. Safety of long-term consumption of plant sterol ester-enriched spread. Eur J Clin Nutr 2003, 57:681-692.http://www.ncbi.nlm.nih.gov/pubmed/12771969

 

102.Miettinen TA, Gylling H. Regulation of cholesterol metabolism by dietary plant sterols. Curr Opin Lipidol. 1999 Feb;10(1):9-14. http://www.ncbi.nlm.nih.gov/pubmed/10095984

 

103.Davidson MH, Maki KC, Umporowicz DM, et al. Safety and tolerability of esterified phytosterols administered in reduced-fat spread and salad dressing to healthy adult men and women. J Am Coll Nutr. 2001 Aug;20(4):307-19. http://www.ncbi.nlm.nih.gov/pubmed/11506058

 

104.Castano G, Fernandez L, Mas R, et al. Effects of addition of policosanol to omega-3 fatty acid therapy on the lipid profile of patients with type II hypercholesterolaemia. Drugs R D 2005;6:207–19. http://www.ncbi.nlm.nih.gov/pubmed/16050054

 

105.Chen JT, Wesley R, Shamburek RD, Pucino F, Csako G. Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 2005;25:171–83. http://www.ncbi.nlm.nih.gov/pubmed/15767233

 

 

Powerful Supplement Kills Cholesterol!

• Policosanol and high cholesterol: Policosanol is a natural therapy derived from sugar cane which is effective for hyperlipidemia, is superior to policosanol, and has an excellent safety profile .
  • Castano, G. et al found that 1 gram omega-3 fatty acid plus policosanol, at a dose of 5 mg or 10 mg  improved lipids significantly in 8 weeks compared to 1 gram omega-3 fatty acid plus placebo (104):
    • Reduction of total cholesterol 12.7% and 15.3% respectively.
    • Reductions in LDL cholesterol, 21.1% and 24.4% respectively.
    • Increase in HDL cholesterol 14.4% and 15.5%, respectively.
    • Lowered triglycerides by 13.6% and 14.7%, respectively.
    • Placebo reduced triglycerides 14.2%, but did not improve total, LDL, or HDL.
  • A meta-analysis by Chen, JT et al evaluated 23 plant sterol/stanol and 29 policosanol RCTs which found that this supplement is not only more effective than plant sterol supplements, but also nearly as effective as common cholesterol lowering medications.

 

References:

104.Castano G, Fernandez L, Mas R, et al. Effects of addition of policosanol to omega-3 fatty acid therapy on the lipid profile of patients with type II hypercholesterolaemia. Drugs R D 2005;6:207–19. http://www.ncbi.nlm.nih.gov/pubmed/16050054

 

105.Chen JT, Wesley R, Shamburek RD, Pucino F, Csako G. Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 2005;25:171–83. http://www.ncbi.nlm.nih.gov/pubmed/15767233

 

106.Castano, G., Mas, R., Fernandez, L., Gamez, R., and Illnait, J. Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study. Angiology 2003;54(1):25-38. http://www.ncbi.nlm.nih.gov/pubmed/12593493

 

107.Arruzazabala, M. L., Valdes, S., Mas, R., Fernandez, L., and Carbajal, D. Effect of policosanol successive dose increases on platelet aggregation in healthy volunteers. Pharmacol.Res.1996;34(5-6):181-185. http://www.ncbi.nlm.nih.gov/pubmed/9076841

 

108.Castaño G, Mas R, Gámez R, Fernández J, Illnait J, Fernández L, Mendoza S, Mesa M, Gutiérrez JA, López E. Concomitant use of policosanol and beta-blockers in older patients. Int J Clin Pharmacol Res. 2004;24(2-3):65-77. http://www.ncbi.nlm.nih.gov/pubmed/15689053