Your cholesterol

Lower it without drugs

Is this you?  No heart disease or diabetes. No family history of early heart disease … and maybe you don’t even smoke (well done!).

Perhaps you can’t tolerate cholesterol lowering drugs… or just refuse to take them. But you do have the dreaded high cholesterol! I see lots of  low risk folks like this.

Here’s a safe, simple way to take care of your cholesterol. It’s backed by good science and offers general  health benefits:

Step 1: Food and fish oil
Clean up  your stuff. Eat wisely. But make sure you enjoy your food! Healthy eating is happy eating. Stay away from unsupervised diets! The guidelines  below are an excellent start.

Then  add fish oil. Three grams a day. Keep your capsules in the freezer so you don’t burp fish.

Fish oil will slightly increase or lower your LDL “bad” cholesterol.  More important, it ups HDL “good” cholesterol and lowers triglycerides (blood fats) for an overall healthier cholesterol picture.

Step 2: Plant sterols
Not at goal in 3 months? Cut out those cupcakes! Just kidding. Now add plant sterols — 2 grams a day. Derived from plants, in capsule form, they interfere with cholesterol’s absorption. They’re safe,free of side effects and supply all-round health benefits. Both sterols and fish oil reduce inflammation …

What Is Inflammation?
It’s the immune system doing its job, helpful short term in disease and injury. Chronic inflammation, however, increases the risk of heart disease and most cancers. Common causes are stress, poor diet and too much body fat. Lots of fruits and vegetables, plant sterols and good fats like fish oil can all help reduce chronic inflammation.

You Can Do It!
Meet Brian, a 50s schoolteacher. He started  with an LDL (“bad”) cholesterol of 189. However, he doesn’t smoke or have diabetes and there’s no heart disease in his family. Brian got busy and cleaned up his diet, exercised more (mostly walking) and lost 10 pounds. In six months his LDL dropped to 127, using fish oil and plant sterols. That’s a 32% improvement!

” Take-Home Message
If you’re low risk but have high cholesterol, you can probably manage quite well  without drugs.

See issue insert for additional guidelines and information.

Next Month: Who really needs cholesterol lowering drugs and why.

HEALTHY EATING GUIDELINES

• Increase good fats*
• Reduce saturated animal fats*(<10% total calories)
• Eliminate trans fats*
• Increase whole grains
• Less refined starches and sugars
• Increase fiber (>25 grams/day)
*See article on FATS  this issue.
• Increase micronutrients (Multivitamin, fruits & veggies)
• Control portion size and calories
• Increase physical activity (30-60 minutes 5X week)
• Enjoy your food!

Mind/body medicine part 1
Understand and beat stress — a simple approach

Are you “stressed out”? If so, you’re in good company. Over 60% of doctor visits are for stress-related conditions. I see that in my own practice every day. I’m going to show you how to reduce stress in just a few minutes a day.

What is stress?
Let’s keep it simple. Stress is too much to do and not enough time. People literally lose control of their lives. Too much stress causes weight gain, poor memory, irregular sleep and indigestion. It can  worsen any disease, including heart disease and arthritis, and increase pain.

Enter mind/body medicine
For good health, emphasize self care. Drugs and surgery aren’t enough. Take command of  your diet, your beliefs … and how you manage stress.

Mind/body approaches to stress can improve blood pressure, abnormal heart rhythms, pain, depression and premenstrual syndrome. They’ll also brighten your mood and give you more energy.

Reverse stress starting now
Start with deep breathing to soften  your reaction to stress. It’s easy!  And it’s no accident that every major religion practices its own form of deep breathing.

How deep breathing reduces stress
When you breathe deeply and slowly you calm your nervous system. The more you practice, the calmer you  get, the better you feel. It’s safe, costs nothing — and takes a few minutes a day. It may be the best stress buster there is!

What about prayer and meditation?
Try deep breathing first (unless of course you already pray or meditate). Folks who plunge directly into serious meditation may stir up thoughts and feelings they’re not ready for.

Take-Home Message
Give deep breathing a three month trial and see if you don’t feel better.

Breathe deeply and beat stress
Try these simple techniques

Exercise #1:  The sigh of relief
Slow down, close your eyes and take a deep breath through your nose. Hold for a count of four while you picture a favorite restful place. Now release your breath gently with a sigh. Ahhhhhh! Feels better, doesn’t it? Use this simple technique anytime, anywhere. Make it a habit!

Exercise #2:
Square breathing
Dare to breathe square! Eyes closed. Four counts in through the nose. Hold for four. Four counts out. Then  hold for another four before your next breath. Simple. Imagine inhaling sunlight and exhaling dark smoke (that’s all that stress leaving your body!). Start with four breaths, morning and night. Build up to 20 breaths over the next month. Twenty too many? Four or more is still worth it.

BREATHING, The Master Key to Self Healing
Andrew Weil, M.D.
This fascinating, easy-to-use program teaches eight breathing techniques. Highly recommended. From Sounds True (800) 333-9185.

10 Facts you should know about Fats
The Misundersood Food Group

How many times have you heard “fat is bad”? Well, the “fat is bad” warning is an  oversimplification  based on bad science. Unfortunately, the medical profession shares some of the blame for this misinformation. Here are some facts — based on good science:

The fats you eat
You need fat — for energy and for your body to function properly. Too little fat can cause fatigue, emotional imbalance and illness.

Fats taste good! They add joy to eating, when balanced with protein and plenty of healthy, nutritious fruits and vegetables.
There are good fats and bad fats. Natural fats from plants, fish and animals that have not been injected with hormones and antibiotics are healthy, when part of a balanced diet. Man-made fats found mainly in shortening (packaged baked goods, margarines) are unhealthy.

Fats and cholesterol
Fat isn’t cholesterol. Your body needs cholesterol. For most people dietary cholesterol has very little effect on cholesterol levels in the body!

Become a fat expert! Check out these 10 key facts about healthy omega-3 and monosaturated fats:

Friendly fats help:
#1 Calm inflammation. Inflammation is a revved up immune system. In the short term, inflammation is protective. Long term, it causes disease. Good fats balance your immune system and calm inflammation.

#2 Lower Your Blood Pressure.  Good evidence supports the use of fish oil to lower blood pressure up to five points.

#3 Prevent sudden cardiac death.   Good fats help stabilize the heart muscle, preventing fast and irregular rhythms that can lead to sudden death.

#4 Reduce triglycerides, improve cholesterol. Reduce triglycerides by as much as 15% (take note if you have diabetes). Increase HDL cholesterol (“good”) by 5% or more. Improve overall cholesterol picture.

#5 Improve mood. DHA, a healthy omega-3 fat, is found in large amounts in brain cells. Andrew Stoll, M.D., a Harvard psychiatrist, has had success treating depression and bipolar disorder (“manic depression”) with fish oil, using up to 10 grams a day.

#6 Prevent dementia. A recent well-designed study suggested that fish just once a week reduced the risk of dementia by over 50%. What drug can match that?

#7 Treat arthritis. Arthritis is an inflammatory process. Good fats reduce inflammation and are a helpful addition to most treatments.

#8 Improve dry skin. Dry skin, eczema and even psoriasis get better when you increase your healthy omega-3 fats.

#9 Aid weight loss. Adequate intake of healthy fats reduces cravings and prevents bingeing on sweets. Good fats in moderation can actually help burn calories.

#10 Balance your hormones. Healthy fat intake supports women during menopause. It also reduces inflammation from too much stress and supports thyroid health, essential for balanced energy production.

We Americans don’t get enough healthy fat. Why? Mainly because of food processing methods, feed lot meat production and our own poor food choices.

”I Recommend:

• Fatty fish 1-2x  a week. Salmon, mackerel, herring and sardines. Canned fish has less mercury.
• Animals fats in moderation from healthy sources: pasture fed beef, free range chicken, organic dairy.
• Nuts like almonds and walnuts make great snacks.
• Enjoy olive oil (OK for cooking);  some butter, too!
• Add  ground flax seed to your salads.
• Fish Oil Supplement: 1 to 3 grams a day.”

IMPORTANT:  If you’re on aspirin or the blood thinner coumadin, discuss with your doctor. Fish oil can have a mild blood thinning effect.

READ this book
Eat, Drink and Be Healthy
By Walter Willet M.D.
From Harvard Medical School. Clear and easy-to-read with practical suggestions. Read the chapter on fats. Excellent!

WHAT ABOUT LOW FAT DIETS?
Low fat diets (under 20% of total calories) are a drag … and they don’t work. Study after study shows they fail over the long term. Eat  enough healthy fat (20% to 30% of calories), minimize unhealthy fats and enjoy your fruits and vegetables.

Good Fats, Bad fats
MAKE GOOD FATS YOUR FRIEND!
Omega-3 Fats  These are “essential” fats. Our bodies can’t make them, so we need to eat them.

• Found in fatty fish: salmon, mackerel, sardines and herring.
• Also in flax seeds and walnuts.
• Monosaturated Fats: In olive oil and nuts of all kinds.
• Almonds lower LDL cholesterol.

ANIMAL FATS — GOOD OR BAD?
Animal fats = heart disease? Unlikely, if on moderation. Favor “natural” or “organic” meat and dairy products, without the hormones or antibiotics.

SHOW “TRANS” FATS THE DOOR!
Trans fats = heart disease? A resounding YES! So-called “trans” fats are man-made. They’re added to many margarines, baked and other processed goods to increase shelf life. Unfortunately, they shorten human life. (Is that why they’re called “shortening?”) Look for hydrogenated or partially hydrogenated oils on the food label. Then avoid them… like the plague!

WHATS NEW

Supplements
Vitamin E
Taking vitamin E but hear it doesn’t work or is harmful?
My advice: if you’re going to take a supplement, take a fullspectrum vitamin E, which is really eight  related substances that work together for a better overall effect.  Recent studies show mixed results for the heart  and longevity.  Other studies suggest that extra vitamin E may help prevent dementia and respiratory illness in the elderly. None of these studies are the last word. The best  source of vitamin E? Food!  Wheat germ, seed and nut oils and leafy green vegetables.  Foods  have smaller  amounts but  the vitamin is better utilized. Taking a supplement?  Make sure you get all 4 “tocopherols” and all 4 “tocotrienols,” don’t take over 400 units a day, and let your doctor know, because vitamin E has mild blood thinning effects.

Medicine chest
Vioxx off the market
Take  25 mg Vioxx for a year and you have an increased risk of a heart attack. No longer, because it’s off the market. Now Celebrex and Bextra, which are similar,may also be risky. In addition, both Naprosyn and Aleve, its over-the-counter version, are under suspicion.
What to do? Some doctors may decide to continue these drugs intermittently, a few days at a time as needed, if nothing else works.  Much safer alternatives include acupuncture, biofeedback, glucosamine and chondroitin (with or without MSM), omega-3s, and SAMe.  The key?  Work with a doctor who has experience with these treatments.

Pain update
New treatment for migraines
Get migraine headaches more than twice a month? Try Migralief, a new formulation with the herb Feverfew, vitamin B2 (riboflavin), and the mineral magnesium. Devised by Alexander Mauskop, M.D., director of the New York Headache Clinic.  It works for his patients and has worked for mine.  Thomas, a 54-yr- old patient, enjoyed a 50% drop in frequency and a 50% reduction in intensity.  He’s sold!  Try it first before drugs, which have more side effects.  The best drug may be Topomax, newly approved for migraines. A side effect some of you may find desirable  — weight loss.

Recommended Reading:
What Your Doctor May Not Tell You About Migraines. By Alexander Mauskop, M.D. and Barry Fox, Ph.D.

Your brain Good news for your memory
Protect yourself against dementia and memory loss in old age.  Reading, dancing, playing musical instruments and board games were all associated with a reduced risk of dementia in a recent New England Journal of Medicine study. Looks like a case of “use it or lose it.” Turn off that TV and have some fun! Dancing can be a great way to get your exercise. It’s certainly more sociable than exercise machines.

Integrative medicine
The best of conventional and alternative medicine. Based on good science, with your
safety always in mind.

FOR WOMEN ONLY
Hormone replacement therapy: Yes or No?  Here’s a safe approach to menopause

Fact: Hot flashes are the most common complaint driving requests for hormone replacement at menopause.  Others include sleep difficulties, brain fog and moodiness.
Bad news: Premarin and Prempro, from the urine of pregnant mares, increase the risk for heart disease, stroke, and breast cancer, and dementia.

Bioidentical hormones

My message is simple. Consider bioidentical hormones. They’re designed to match human hormones. Their effects are more natural to the human body, with fewer unpredictable side effects. Premarin and Prempro may be “natural” for horses, but not for humans.

Use the lowest dose necessary for symptom relief; only as long as necessary, often less than five years. Creams can bring relief at even lower doses, with lower harm potential. Work with a doctor who has experience with them.

We have good results with Biest (80% estriol/20% estradiol). 100 mg. of micronized progesterone can help, whether or not you have a uterus. Consider the cream.
Black cohosh and soy

Some women have milder symptoms or decide not to take estrogen of any type. Studies show that the herb black cohosh can relieve hot flashes, cramps and vaginal dryness. Get over-the-counter Remifen, a high quality German formulation. Safety beyond six months hasn’t been studied, so caution is advised if using it for longer.

Soy foods may help reduce symptoms. Do you like soy? Try it for a while. It works as a food, so you don’t necessarily need a capsule or powder supplement. Favor fermented soy products like tempeh and miso. I suggest you avoid large amounts of soy milk and tofu.

Less  stress …no more hot flashes!

During a three week holiday, one of my patient’s hot flashes simply vanished — without any hormones or supplements.  Too bad insurance doesn’t cover vacations!

IMPORTANT: Family history of breast cancer? Hormone therapy is probably not for you.

Take-home message
Bioidentical hormones are effective alternatives, more “natural” for humans. Black cohosh and soy foods are sensible non-hormone options. Work with an experienced practitioner, as the scientific evidence is still evolving.

Read this Book
The Wisdom of Menopause by Christiane Northrup, M.D., a prominent outspoken women’s health expert and advocate.

Recommended resources
The Natural Hormone Pharmacy (800-522-6692) and Women’s International Pharmacy (800-279-5708)

Your Questions Answered

Virtual Colonoscopy

Q: I just turned 50 and my doctor recommends a colonoscopy. What is virtual colonoscopy? How does it compare to conventional colonoscopy.

A: Most doctors recommend a colonoscopy at age 50 to screen for colon cancer.

This is good preventative medicine, since age is the major risk for colon cancer, the most common cancer. Many people balk at this, since it involves an unpleasant cleansing preparation and insertion of a 3-foot flexible scope through the rectum into the colon.

Virtual colonoscopy uses a CT scanner (a fancy X-ray machine) and computer software to view the colon. A recent study suggested that it may do a better job of detecting polyps, small growths which can be pre-cancerous. Most experts agree, however, that more research is necessary before it’s ready for “prime time.”

Advantages? No risk of perforation or bleeding. It takes less times and sedation is not required, though some of my patients (usually women) tolerate regular colonoscopy without any sedation. One, a social worker, didn’t want to miss a day of work!

Disadvantages? You still have to go through the same bowel cleansing. A soft tip is placed into the rectum to slowly inflate the colon, which is just as uncomfortable as the regular colonoscopy for some. And if a polyp is found, you have to undergo the regular procedure. Another problem: it is so new that many radiologists’ skills may not yet be up to speed.

At this time it’s a reasonable alternative if you can’t come off a blood thinner or  have a colon obstruction. More studies are needed before it will become a first-line test for screening the colon.

Toenail Fungus

Q: Help! I have ugly toenail fungus. I don’t want to take an antifungal pill as I’m afraid of toxic side effects. Is there a natural alternative?

A: I see lots of toenail fungus in the office. It’s a common problem that increases with aging!

The preferred conventional oral treatment is Sporanox pulse therapy  daily for a week followed by a three week rest, repeated for three months. A clipped nail sample should be sent for culture before treatment. Expect a 60% to 70% cure rate. It’s unsafe for people with heart disease, may damage the liver, and interacts with other drugs. So your doctor has to watch carefully!

Consider tea tree oil, a safe natural over the counter remedy. It’s a powerful antibacterial and antifungal agent. Apply  with a clean Q-tip twice a day. Use for three to six months. Be sure to keep your nails trimmed.

Tea tree oil may not have as high a cure rate as Sporanox and it’s not as well studied …  because it’s not a drug! However, if it works for you, you’re in business.

A safe but pricier topical treatment available by prescritpion is Penlac.  Apply twice a day for eight to twelve months.

To prevent toenail fungus, avoid tight fitting shoes. Wear flip flops in communal showers and dry thoroughly. Apply antifungal powder to soles of feet and in between toes.