Brown Rice Finally Joins Whole

The FDA has me scratching my head again. Last month they deemed brown rice to be whole grain. Um, who ever thought it wasn’t a whole-grain food?

From 1991 until now, the FDA, which regulates food labels for all U.S. packaged products, didn’t allow brown rice to use the official whole-grain health claim that oats, barley, popcorn, whole-wheat bread, and other chosen grains have been putting on their packages and in advertising: “Diets rich in whole-grain foods and other plant foods and low in total fat, saturated fat and cholesterol may help reduce the risk of heart disease and certain cancers.”

To be a whole grain in the eyes of the FDA, a food must contain bran, germ, and endosperm (bran and germ are stripped away in products such as in white flour). Brown rice has all these components. The snag? When the FDA made its initial ruling, there was a minimum fiber content requirement that kept brown rice out of the club. Now research shows that the health benefits of whole grains are independent of their fiber content.

So on May 6 the FDA finally approved the whole-grain health claim for brown rice, recognizing brown rice as a 100% whole-grain food despite its lower fiber content.

Eight in 10 Americans know that whole grains are beneficial, but about two-thirds of us aren’t meeting our quota of at least three servings a day, according to a USA Rice Federation survey. Take note: Just one cup of cooked brown rice provides two of three daily whole-grain servings.

Here are a few ways I include brown rice in my diet, wherever I am. Let me know how you get yours.

1. At home: The Zojirushi Neuro Fuzzy Rice Cooker and Warmer prepares perfect brown rice. I simply add rice and water and set the timer it the a.m., and the rice is ready for whatever time I need it in the p.m.

2. At work: Uncle Ben’s Ready Rice Whole Grain Brown are a quick, mess-free option. Just microwave the rice in its pouch for 90 seconds and you’ve got a warm, healthy snack.

3. Out and about: The P.F. Chang’s China Bistro chain, selected as one of America’s Healthiest Restaurants by Health magazine, serves brown rice standard with their excellent dishes.

By Julie Upton


Statin Study: Cholesterol Drug's Muscle

WEDNESDAY, July 23, 2008 — Cholesterol-lowering drugs like simvastatin (Zocor) and atorvastatin (Lipitor) are one of the great health breakthroughs of the 20th century—they’re safe and can dramatically lower LDL, the bad cholesterol. But they’re not risk-free: Some people experience muscle pains, known as myopathy, which can make taking the drugs unpleasant and, in rare cases, lead to a life-threatening condition.

Now a new study suggests that 15% of the population may have a specific genetic variant that increases their risk of experiencing statin-related muscle aches.

In the new research, a University of Oxford team sequenced the genes of 85 people who developed myopathy after taking high-dose simvastatin (80 mg) in a larger trial of 12,000 people. They compared the DNA of those subjects with 90 people in the same study who did not develop myopathy.

What they discovered was that one small change in a gene that is responsible for transporting drugs in the liver was associated with myopathy.

People who inherit a single copy of the genetic variant from a parent were 4.5 times as likely to develop myopathy, and those with two copies (one from each parent) were almost 17 times as likely to develop the condition when taking a high-dose statin compared with those without a copy, according to the study in The New England Journal of Medicine.

It’s a common problemAbout 1 in 10,000 people per year who take regular doses of statin drugsdevelop myopathy, according to the study, though the risk goes up with higher doses. According to Merck spokesperson Ronald Rogers, the incidence can be as high as half of 1% (roughly 1 in 200) for those taking large, 80 mg doses of Zocor for at least four years.

However, Leslie Cho, MD, director of the Women’s Cardiovascular Center at the Cleveland Clinic in Ohio, says a higher percentage of patients in the real world may complain of muscle aches.

“Muscle aches on statins is rarely reported in [clinical] trials because drug companies don’t want to look for that, but it’s a very common thing that clinicians hear every day,” she says. “It’s especially common in the elderly and we are always trying to look for ways to make that better. If there is a predisposing genetic thing for it, that would be a good thing.”

Gene test could be used in the clinic, but not likelyIf further research confirms the findings, and a cheap enough gene test is developed, doctors could one day use it to help determine if a patient who is a candidate for a statin might be at risk for developing myopathy.

However, those are some big “ifs,” and such a test may not be cost-effective for every patient, according to experts.

“Now would I use this on every patient before I started statins? I don’t think I would,” says Dr. Cho, who was not involved in the new research. “To get this test on every single patient before they start statins would not be cost-effective unless it is incredibly cheap.”

Donna Arnett, PhD, a spokesperson for the American Heart Association, confirmed that the findings are important, but a long way from being used routinely in doctors’ offices.

“There are a lot of steps until we get to that clinical testing in your doctor’s office,” says Arnett, a chair and professor of epidemiology at the University of Alabama at Birmingham who does research in genetic epidemiology. The new findings need to be replicated in other patients and with other statins, but if it holds true, it could result in a useful test, according to Arnett.

How serious is myopathy?Dr. Cho says that many statin-taking patients who experience some pain think they have myopathy, but the condition is more than minor aches and pains. Doctors look for pain and weakness in large muscle groups on both sides of the body, such as the buttocks, upper arms, and upper legs.

And many people don’t know that a host of other things can increase their chances of myopathy in combination with statins—including excessive alcohol intake and drugs such as cyclosporine (an anti-rejection drug), fibrates (a cholesterol-lowering drug), macrolide antibiotics (such as erythromycin), antifungals (like fluconazole), protease inhibitors (used to treat HIV), and colchicine (used to treat gout).

Patients can often reduce their risk by talking with their doctor about possible drug interactions.

Gene’s link to more serious side effect is unknownWhile myopathy is a relatively common side effect, it can progress to a rare and potentially life-threatening side effect called rhabdomyolysis, which occurs when muscle actually breaks down and leads to kidney failure.

“The thing we worry about the absolute most is rhabdomyolysis, which is life-threatening,” says Dr. Cho. In contrast, myopathy is “very benign but it’s obviously lifestyle-limiting for patients.”

The incidence of rhabdomyolysis is estimated to be 44 events per 1 million statin users per year, according to an editorial accompanying the study. It’s not clear if the gene variant is linked to rhabdomyolysis, but testing for a link should begin “as soon as possible,” writes Yasuke Nakamura, MD, of the University of Tokyo.

While more research is needed, Dr. Cho says she could see a gene test being useful in patients who develop myopathy after taking the drugs.

“But I think that to have a carte-blanche statement that every patient that gets started on statins should have this test is kind of overkill.”

The study was funded by a research grant from Merck to the University of Oxford.

By Theresa Tamkins



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Cholesterol Drug Confusion: Is the Cancer Risk Real?

THURSDAY, Sept. 4 ( — The news hit this week that a cholesterol-lowering drug called Vytorin was linked to a possible risk of cancer. If you’re one of millions of Americans who take a cholesterol-lowering drug—and possibly even unsure which type you are taking—you may be concerned.

So what is Vytorin? You’re probably familiar with the drug from TV ads (you get your cholesterol from your Grandma Barbie and barbecued ribs). Check out this YouTube video for a refresher or see our previous blog for a picture. If you don’t remember seeing one of those ads lately, it’s because they stopped running.

Vytorin’s troubles started in January, when a study found that the drug—a combination of a new medication, ezetimibe, and an older statin drug, simvastatin (Zocor)—was no more effective than simvastatin alone for treating patients with high cholesterol.

Although the difference was not statistically significant, patients treated with the pricier Vytorin had more narrowing of the arteries than the group treated with Zocor, which is sold in a cheaper generic form.

It’s not like other cholesterol drugsVytorin is not like other cholesterol-lowering drugs. It’s a relatively new way of lowering cholesterol that was first approved by the Food and Drug Administration (FDA) in 2004. (Ezetimibe on its own is sold under the name Zetia, which was first approved in 2002.)

Vytorin lowers LDL, or bad, cholesterol by blocking its absorption in the intestines, while other drugs work in different ways. So Vytorin’s issues don’t necessarily apply to other classes of drugs.

Researchers are concerned about Vytorin right now because study results released in July had an unexpected finding. Known as the SEAS trial, it looked at whether Vytorin could reduce heart attack, strokes, and heart-valve surgery in 1,873 people with aortic stenosis. It didn’t. However, they also found that Vytorin-treated patients seemed to have a greater risk of getting certain cancers—such as prostate, gastrointestinal, and skin cancers—than those treated with a placebo.

In response, the FDA announced it was taking a closer look at the drug. And a group of researchers at Oxford University analyzed early data from a couple of other big studies (20,000 patients, combined), called SHARP and IMPROVE-IT, which are ongoing.

While there were slightly more cancer deaths in the Vytorin-treated patients in these two trials, it was not statistically significant and most likely due to chance, according to the report in The New England Journal of Medicine. However, other experts are not so sure. When data from all three trials are combined, it looks like there may be a real increase in cancer mortality.

So that means the jury is still out on the issue. The results were not strong enough to halt the trial and the FDA did not remove the drug from the market, notes Gordon F. Tomaselli, MD, a Johns Hopkins University professor of medicine, and program chair of scientific sessions for the American Heart Association.

“I still think there’s a signal there, and I think it’s a signal we need to pay very careful attention to,” says Dr. Tomaselli. “I certainly don’t think it should stop patients who are in the two other trials from being in those trials, or from enrolling new patients.”

Fewer people taking Vytorin than in the pastDon’t know what drug you’re taking? Don’t be embarrassed, it’s not uncommon. But it’s probably not Vytorin.

In the United States, the “vast majority [of heart patients] are taking statins and statins alone,” says Douglas Zipes, MD, past president of the American College of Cardiology, and a distinguished professor at Indiana University School of Medicine in Indianapolis.

Statins include drugs such as Lipitor, Zocor, and Crestor. Other cholesterol-lowering, non-statin drugs include niacin, a type of vitamin, and fenofibrate, which is a fibric-acid derivative.

In the past, cancer-risk questions were raised about statins too. But an analysis of long-term data from 90,000 patients found it wasn’t true.

And when statins debuted more than a decade ago, it was feared they might raise the risk of suicide or mental instability, because cholesterol is important for normal brain function, says Dr. Zipes. Those fears didn’t turn out to be true, either.

Statins now have a long safety record (though some people have to stop taking them due to muscle aches). In fact, it has been suggested in recent year that statins are safe enough to be sold without a prescription, although that hasn’t happened yet.

”It was felt that statins were so safe that indeed they should go over-the-counter,” says Dr. Zipes.

It is possible that future research will show that Vytorin is no more likely to cause cancer than statins or any other drug. However, experts don’t really have enough information at this point to say one way or another.

“It’s not entirely settled by all of the data,” says Dr. Zipes. It’s been raised as a “very important issue but it has to be addressed more prospectively,” he says.

If you are taking VytorinGiven the attention to the drug this year, it’s not surprising that sales have slumped; you’re probably less likely to be prescribed this drug if you have high cholesterol.

“It’s dropped off significantly,” says Dr. Zipes.  “Many of the cardiologists with whom I interact are no longer prescribing it.”

If you are taking Vytorin, your course of action depends on why you were given the drug, says Dr. Tomaselli. He says most patients with elevated cholesterol should be given a statin first, and if that doesn’t do the trick, they should try a higher dose of statins.

If they can’t tolerate higher doses of statins, and need a different type of medication, there are many other options besides Vytorin, including niacin and fibrates.

“I would say to those folks, for the time being, if you’re on Vytorin for the reason of intolerance to higher-dose statins and/or failing to get to target on other drugs, then they should just stay on the drug for now,” he says.

Dr. Zipes also says, “There may be reasons why Vytorin might be used in a very small percentage of people.”

If you are taking the drug, experts recommend—as always—that you consult your doctor and don’t decide to stop taking it on your own.

“The number of deaths of coronary artery disease and stroke will be far greater if people stop their [medication] than if they continue on Vytorin in my opinion,” says Dr. Tomaselli.

By Theresa Tamkins


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Eating to Control Your Cholesterol: Everyday Diet Strategies to Lower LDL

It’s National Cholesterol Education Month, and clearly, many of us need a refresher: About half of Americans have high or borderline blood levels, a major risk factor for heart disease and a serious threat to overall health.

I’m a strong believer in trying dietary solutions before—or, if needed, in conjunction with—pharmaceutical approaches. Compared with a daily pill, lifestyle changes can be cheaper and just as effective, without the fear of unwanted side effects. This is especially relevant now, as scientists speculate on the safety and effectiveness of Vytorin, a popular cholesterol-lowering drug. 

Some of my clients come to me thinking that diet and lifestyle changes are just too difficult or not worth the hassle. But I learned firsthand the impact of sudden death from a heart attack when my father passed away at the age of 62—and you’ve likely had a personal experience with the disease, considering the following:

•    One American dies every 37 seconds from heart disease•    In the United States, someone has a heart attack every 26 seconds•    The annual U.S. health-care costs to treat heart disease are more than $450 billion

That’s why I’m passionate about daily, drug-free adjustments you can make to help lower your cholesterol. I’ve written about these changes as part of’s in-depth cholesterol center. Check out my tips here, and let me know your own heart-healthy strategies.

By Julie Upton, RD

Statins: Can Cholesterol

By Anne HardingMONDAY, Oct. 27 ( — People who take statins and end up in the hospital with pneumonia are more likely to survive than those who are not taking a cholesterol-lowering drug, according to a study in Archives of Internal Medicine.

It’s possible that statins, some of the most commonly prescribed medications in the world, may help fight lung infections. On the other hand, people who take them may be in better health to begin with, which could explain their ability to survive a serious infection.

If statins are shown to fight infection, they could prove to be “a cheap and effective way of treating pneumonia, which would be wonderful,” says Reimar W. Thomsen, MD, PhD, of Aarhus University and Aalborg Hospital in Aalborg, Denmark, who led the study. “We really need new treatment options for pneumonia because it’s a great burden on health-care systems.”

Animal research has shown that statins reduce inflammation and fight blood clotting, so it’s scientifically plausible that they could help treat infections too. There have been studies showing benefits of statins in patients with sepsis, a life-threatening blood infection, as well as pneumonia.

However, the study could also be picking up on a so-called healthy-user effect. Healthy users tend to see their doctors regularly, take their medications as prescribed, exercise, eat their fruits and veggies, and avoid smoking.

Such people also tend to be prescribed medications like statins—or, if they were menopausal women a few years ago, estrogen. In that case, the healthy-user effect made it look like these women were getting benefits like stronger bones and healthier hearts from the hormone—until the Women’s Health Initiative study demonstrated that estrogen was actually harmful.

In the new study, Dr. Thomsen and his team looked at 29,900 people who had been hospitalized for pneumonia between 1997 and 2004. Overall, 1,371, or 4.6%, of the people were taking statins. Denmark has universal health care, so they were able to gather information on virtually every hospitalization in the region they were studying, as well as every prescription filled.

Thirty days after being hospitalized, 10.3% of the statin users had died, compared to 15.7% of the nonusers; 90-day mortality rates were 16.8% for statin users and 22.4% for nonusers. Dr. Thomsen and his colleagues used several statistical techniques to account for the healthy-user effect—for example, adjusting for other illnesses such as diabetes or kidney disease, age, socioeconomic status, and other medications patients took. The reduced risk for mortality with statins remained, and it was particularly strong for people over 80.

“This particular study is very rigorously done; also, it’s quite elegant,” says Sumit R. Majumdar, MD, an internist and associate professor of medicine at the University of Alberta in Edmonton, Canada, who has also studied statins and pneumonia, but wasn’t involved in the current research. “It’s as good a study as you can do using observational data.”

In their own research, Dr. Majumdar and his colleagues found that the relationship between lower mortality and statins disappeared after they accounted for whether patients had gotten recommended flu and pneumonia shots, lived in a nursing home or on their own, could walk without assistance, and other factors.

In Dr. Thomsen’s study, Dr. Majumdar points out, statins cut mortality risk by 5%; however, the best available drug for treating severe infections in intensive care patients, known as activated protein C, only cuts mortality by about one-third as much.

“I always worry a bit when things are too good to be true, because it usually means they’re too good to be true,” Dr. Majumdar says. He is also skeptical because clinical trials comparing statins to placebo, which included 40,000 to 50,000 patients, did not find an infection-fighting benefit. And, he notes, similar research has linked statins to a lower risk of dementia, hip fractures, and diabetes as well as infection-related diseases, which further supports that the healthy-user effect is at work.

Dr. Majumdar and Dr. Thomsen agree that the only way to answer the question of whether statins fight infection will be to conduct a clinical trial, in which patients with an infection are randomly assigned to take a statin or a placebo.

According to Dr. Majumdar, two or three such studies are now underway to investigate statins for treating infection, which means there will be a definitive answer soon. Then it will be clear if it’s the statins—or the healthy person taking them—that fight infection.

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Gene Mutation Protects Against Milk Shakes and Other Fatty Fare


By Patrick SauerTHURSDAY, Dec. 11, 2008 ( — Some people have all the luck. A new study shows that certain individuals with a gene mutation can slurp down milk shakes or other high-fat food and drink without a nasty jump in cholesterol.

It’s almost like being born with a built-in cholesterol-lowering drug. The gene is called APOC3, and researchers found that 5% of the people they studied—who were all Amish, in this case—had the protective mutation, according to the report in Science.

The researchers haven’t tested a lot of people so far, but they think the gene mutation is relatively rare. (The Amish sometimes have higher or lower levels of mutations than those found in the general population.)

They do know that it seems to work by speeding up the breakdown of triglycerides, a type of fat. In the study, Toni Pollin PhD, an assistant professor of medicine at the University of Maryland School of Medicine, in Baltimore, and colleagues gave 809 members of the Old Order Amish community in Lancaster County, Penn., a super-high-fat milk shake (78% of calories from fat), and then tracked them for the next six hours.

They monitored how volunteers’ arteries coped with the fatty drink and checked for calcium deposits in their coronary arteries, a sign of heart disease.

The researchers tested the participants’ DNA and found that those who coped with the fatty drink better than others had an APOC3 mutation. The mutation carriers had less artery calcification, indicating that they had healthier hearts as well as higher HDL (good cholesterol), and lower triglycerides and LDL (bad cholesterol).

Next: How the discovery might help the rest of us

If you’re not one of the lucky gene carriers, it’s still good news. The gene mutation ends up causing lower-than-normal production of a protein called ApoCIII. You may have heard of some of the other factors that indirectly lower ApoCIII: weight loss, cholesterol-lowering drugs, and fish oil.

The discovery that directly lowering ApoCIII via the mutation is not harmful—and indeed, might be beneficial—could help researchers develop new therapies to fight heart disease, says Pollin.

Pollin adds that the gene variant is rare in the general population, but the effects of reducing the amount of ApoCIII can be universally beneficial. “Over a lifetime, having less ApoCIII confers a favorable lipid profile, which appears to be cardio-protective,” Pollin says.

Karol Watson, MD, PhD, codirector of preventative cardiology at the University of California, Los Angeles, cautions that although some cholesterol-lowering drugs decrease ApoCIII, it is an indirect effect and not the primary reason they protect against cardiovascular disease. She did say that the new study and others like it could have important implications for fighting heart disease in the general population.

“In the last few years, a couple of different genetic mutations have been discovered that confer lifelong beneficial positive lipid levels and protection from heart disease,” she says. “It’s a great starting point for possible drug development or public health measures. Hopefully, understanding and researching this small Amish group will help us find broader approaches that can do the same thing for us genetically unlucky people.”

The study, part of the University of Maryland’s larger Heredity and Phenotype Intervention Study that examined how genes and lifestyle factors influence the risk of developing cardiovascular disease, was funded by the National Heart, Lung, and Blood Institute.

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FDA Says Cholesterol Drug Vytorin OK for Patients

By Theresa TamkinsTHURSDAY, Jan. 8, 2009 ( — The U.S. Food and Drug Administration (FDA) said Thursday that it’s OK for patients to continue taking the cholesterol-lowering drug Vytorin.

The federal agency made the announcement after completing a review of the results of a controversial study, known as the ENHANCE trial. The trial found that the drug—a combination of a relatively new medication, ezetimibe, and an older statin drug, simvastatin (Zocor)—was no more effective than simvastatin alone for treating patients with high cholesterol.

Patients treated with the pricier Vytorin had slightly more narrowing of the arteries—a sign of cardiovascular disease—than the group treated with Zocor, although the difference was not statistically significant.

The FDA said that the study may not have been long enough to demonstrate a benefit, and noted that patients taking Vytorin in the study had a 56% drop in LDL, or bad cholesterol, compared to 39% in those taking simvastatin.

Elevated LDL levels are associated with a risk of heart attack, stroke, and sudden death.

“The results from ENHANCE do not change FDA’s position on the benefits of lowering LDL cholesterol,” a statement released by the FDA said. “Based on currently available data, patients should not stop taking Vytorin or other cholesterol-lowering drugs and should talk to their doctor or other health-care professional if they have any questions about Vytorin, Zetia, or the ENHANCE trial.”

Vytorin is a relatively new way of lowering cholesterol that was first approved by the FDA in 2004. (Ezetimibe on its own is sold under the name Zetia, which was first approved in 2002.) Vytorin lowers LDL cholesterol by blocking its absorption in the intestines, while other drugs work in different ways.

Results of a second trial, known as SEAS, were also released in 2008. It looked at whether Vytorin could reduce heart attack, strokes, and heart-valve surgery in 1,873 people with a condition known as aortic stenosis. It didn’t. However, researchers also found that Vytorin-treated patients seemed to have a greater risk of getting certain cancers—such as prostate, gastrointestinal, and skin—than those treated with a placebo.

In response, the FDA announced that it was taking a closer look at the drug. And a group of researchers at Oxford University analyzed early data from a couple of other big studies (20,000 patients, combined), called SHARP and IMPROVE-IT, which are ongoing.

While there were slightly more cancer deaths in the Vytorin-treated patients in these two trials, it was not statistically significant and most likely due to chance, according to their analysis, which was published in the New England Journal of Medicine.

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American Heart Association Says Omega


By Kate StinchfieldMONDAY, Jan. 26, 2009 ( — For the first time, the American Heart Association has issued an advisory urging Americans to make sure they get an adequate intake of omega-6 fatty acids.

Omega-6 fatty acids are found vegetable oils, nuts, and seeds, and often don’t get as much attention as omega-3 fatty acids, which are found in fatty fish such as tuna, mackerel, and salmon. Increasing intake of omega-3 fatty acids can lower the risk of coronary heart disease; the AHA is concerned that there’s a public perception that omega-6 fatty acids aren’t as healthy as omega-3s and should be limited in the diet.

Both omega-3 and omega-6 are polyunsaturated fatty acids, or PUFAs, and are particularly beneficial when used to replace saturated fat or trans fatty acids in the diet, according to a science advisory published Monday in Circulation: Journal of the American Heart Association. The AHA recommends that people get 5% to 10% of daily calories from omega-6 polyunsaturated fatty acids, although most people in the United States already consume this amount via corn oil, cooking oil, nuts, and salad dressings. (Read more about the 10 best foods for your heart.)

The AHA issued the guidelines to counter the perception that omega-6 fatty acids may promote inflammation and possibly lead to increased cardiovascular risk, says William S. Harris, PhD, the advisory’s lead author.

“We think that’s just a bad message,” says Harris, a senior scientist at Sanford Research at the University of South Dakota. “Our current intake of omega-6s is good for heart health. It wouldn’t hurt for us to get more, but we shouldn’t be decreasing our intake.”

The team examined a wide variety of research studies in animals and humans before making the recommendation. They say having 5% to 10% of daily calories from omega-6 fatty acids, or 12 to 22 grams per day, is safe, and higher intakes “appear to be safe and may be even more beneficial.” The most commonly consumed omega-6 fatty acid is linoleic acid.

“There’s been some controversy in the nutrition community that omega-6 fatty acids—which have always been considered essential for heart health—are not actually good for the heart, and it’s been spilling out to the general public,” says Harris. “Science just doesn’t support that message.”

Next: Should you take a supplement?

The AHA recommends getting an adequate intake of omega-6 through diet, rather than from supplements.

“It’s not really possible to get too much omega-6. Don’t be concerned with this idea that you’re going to give yourself  heart disease,” says Dennis Goodman, MD, clinical associate professor at the University of San Diego and the former chief of cardiology at Scripps Memorial Hospital. “The evidence is much more in favor of the fact that omega-6 lowers your risk of heart disease. A theoretical disadvantage has never been shown clinically.” (Read more about how dietary fats can help—or harm—your heart.)

But not all experts agree with the AHA’s recommendation. The American diet is already packed with omega-6, says Fred Pescatore, MD, the author of The Hamptons Diet and the medical director of Medicine 369, a complementary medical center in New York. “Our foods are full of corn oil and grapeseed oil, both of which contain a ton of omega-6s,” he says. “We really need to be increasing our omega-3 intake.”

Dr. Pescatore says the high ratio of omega-6s to omega-3s in the American diet is one reason for the higher rates of cardiovascular disease compared to Japan, where a low ratio of omega-6 to omega-3 is more common.

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1 in 3 Americans Has High Triglycerides


By Anne HardingMONDAY, March 23, 2009 ( — What the heck are triglycerides? If you don’t know, you have plenty of company. The fatty particles found in your blood are important for heart health, but don’t get nearly as much attention as, say, cholesterol.

Now a new study suggests that there’s a good chance that your triglycerides are in the unhealthy zone, whether you know what they are or not. About one-third of American adults have triglyceride levels that are borderline or too high, according to a Centers for Disease Control and Prevention (CDC) report published Monday in Archives of Internal Medicine.

“I see it as a major problem that we’ve completely ignored this problem so far,” says Børge Nordestgaard, MD, DMSc, of the University of Copenhagen, in Denmark. Dr. Nordestgaard has conducted research linking high triglyceride levels to cardiovascular disease and early death, but was not involved in the CDC research. “Everyone in clinical practice seemed to be so focused on LDL, LDL, LDL [bad cholesterol], people tended to forget triglycerides.”

Being too heavy, getting too little activity, drinking lots of alcohol, and eating lots of saturated fat can all add up to higher triglyceride levels because the body stores excess calories as triglycerides. Triglycerides are a third type of fatty particle found in the blood, along with LDL cholesterol and HDL (aka good) cholesterol. People taking certain medications or those who have diabetes or a genetic condition can have high triglycerides.

Next page: How dangerous are high triglycerides?

Dr. Nordestgaard says that high triglycerides are as dangerous as high cholesterol levels as a risk marker for heart disease and early death. “There’s a really big potential for further prevention of heart disease and strokes by getting more focused on that.” The problem: Right now, the best way to attack high triglycerides is by losing weight, eating more healthily, and becoming more active—a tall order for many of us.

In the new report, Earl S. Ford, MD, of the CDC, and his colleagues looked at a nationally representative group of 5,610 people 20 and older. They found that 33.1% had triglyceride levels above 150 mg/dL, while 17.9% had levels above 200 mg/dL, 1.7% had levels of 500 mg/dL or above, and 0.4% had levels higher than 1,000 mg/dL.

Triglycerides of 150 to 199 mg/dL are considered borderline high and anything above 200 mg/dL is considered too high. Men were more likely than women to have high triglycerides, while whites were at greater risk than African Americans and Mexican Americans.

Very high triglyceride levels can cause inflammation of the pancreas. Although there’s increasing evidence that elevated triglycerides are associated with cardiovascular disease and early death, no one has yet shown that treating high triglyceride levels reduces cardiovascular disease, according to an editorial by Warren G. Thompson, MD, and Gerald T. Gau, MD, of the Mayo Clinic College of Medicine, in Rochester, Minn.

Next page: How to lower triglycerides

Lifestyle changes—exercising, losing weight, swapping healthy fats for unhealthy ones, and the like—are the treatment of choice right now for people with triglyceride levels between 150 mg/dL and 500 mg/dL. According to the National Cholesterol Education Panel, higher-risk people with triglyceride levels falling in this range may also need medication.

Beyond lifestyle changes, treatments for high triglycerides include statins, fibrates, niacin, and fish oil. But while fibrates reduce the risk of cardiovascular events like stroke and heart attack, Dr. Thompson and Dr. Gau note, they don’t reduce mortality—and actually increase the risk of death from non-heart-related causes; they are only recommended for people with triglycerides above 1,000 mg/dL.

“What we really need scientifically, we need companies to come up with drugs that are more efficient at particularly reducing triglycerides,” says Dr. Nordestgaard. He usually recommends that people try statins first if lifestyle changes are not enough—as do Dr. Thompson and Dr. Gau.

“People with hypertriglyceridemia should talk to their physician about appropriate steps to take to bring their levels of triglycerides down,” says Dr. Ford. “For people with levels in the 150-500 mg/dL range, therapeutic lifestyle change is recommended.”

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By Denise MannMONDAY, April 20, 2009 ( — When Lana Phillip, now 45, decided to breast-feed her baby, she never imagined she would continue for three whole years. “I was living in Jamaica at the time where we say ‘breast is best,’ but I continued for so long mainly because my daughter wouldn’t take anything else,” she recalls. Sure, she knew that breast-fed babies tended to be healthier, but she didn’t know that she also might be doing her own heart a favor—an added bonus, as Phillip has a strong family history of heart disease and diabetes.

Women who breast-feed for longer than one year seem to be 10% to 15% less likely to develop high blood pressure, high cholesterol, diabetes, and cardiovascular disease after menopause than women who don’t breast-feed, according to a study in the May issue of Obstetrics and Gynecology.

“At my last physical, I had no signs of any heart problems,” says Phillip, who has been living in Brooklyn, N.Y. since 2000.

The U.S. Surgeon General currently recommends that babies be fed exclusively with breast milk for the first six months of life, but “the longer women nurse their babies, the better for both of their health,” says lead study author Eleanor Bimla Schwarz, MD, an assistant professor of medicine, epidemiology, obstetrics, gynecology, and reproductive sciences at the University of Pittsburgh Center for Research on Health Care in Pennsylvania.

Next page: Do the best you can, experts say

In the study, the researchers looked at 139,681 women with an average age of 63 who had at least one child. Those who had a lifetime history of more than 12 months of breast-feeding had a lower risk of high blood pressure, high cholesterol, diabetes, and heart disease than women who also had at least one child, but did not breast-feed. What’s more, the longer they breast-fed, the greater the apparent benefit to their hearts—even after the researchers adjusted for factors that could affect heart disease risk, such as obesity.

Among women who breast-feed for more than one year, the researchers estimate that  38.6% will develop high blood pressure, 12.3% high cholesterol and 9.1% cardiovascular disease. In comparison, 42.1% of women who don’t breast-feed may develop high blood pressure, 14.8% high cholesterol, and 9.9% cardiovascular disease.

According to Dr. Schwarz, these new findings should help tip the scale for women who are considering breast-feeding as well as encourage those who already are breast-feeding to do so for longer periods of time. “Heart disease is the leading killer of U.S. women,” she says. “To prevent heart disease, I recommend that all my patients exercise regularly, watch their diet, avoid cigarettes, and breast-feed their babies,” she says.

“All of these health behaviors are hard for some people, so my message is always ‘do the best you can; the more you can do, the better for you’” she adds, “and when we’re talking about breast-feeding, of course women get double credit, because breast-feeding is good for mom and good for the baby.”

Donnica Moore, MD, president of the Sapphire Women’s Health Group in Far Hills, N.J. and an author of Women’s Health for Life, advocates breast-feeding for infants, but points out that one year is a long time.

“We know that breast-feeding has numerous benefits for the baby, and this study is one more piece of information that suggests it also has benefits for the mother,” she says.

However, the study does have its weaknesses, she points out. For starters, the women were about 63 years old, which means they breast-fed a long time ago. A women’s memory may not be all that accurate 30-plus years later, says Dr. Moore. In addition, the study was not specifically designed to look at breast-feeding and heart disease risk; these results were part of a secondary analysis from another study.

Next page: Oxytocin may be reason for heart benefit

That said, “it’s interesting that women who breast-fed more than 12 months showed risk reduction for heart disease, but that may say more about the health choices made by women who are going to breast-feed for that long,” says Dr. Moore. These women may simply lead healthier lives, she adds. Those who choose to breast-feed tend to be better educated and have a higher socioeconomic status than women who do not—factors that can also affect the risk of heart disease. (The researchers did take these factors into account.)

However, hormones may also be at play. Breast-feeding produces a surge in oxytocin, the so-called love hormone, which may help protect the heart.

Some women and infants do have trouble with breast-feeding. “Breast-feeding is like riding a bike: It can be tricky at first, and almost everyone needs a little bit of help getting started, but it’s really important to learn how to do it,” Dr. Schwarz says. “Don’t hesitate to ask for help, and don’t doubt your body’s abilities to continue to provide for your baby the way it did throughout pregnancy.”

Calling the findings “dramatic and persuasive,” Edward R. Newton, MD, a professor and chair of obstetrics and gynecology at East Carolina University in Greenville, N.C., stresses that “it is imperative that health care providers and our society support and educate women concerning the maternal benefits of prolonged breast-feeding as well as the documented benefits of breast-feeding for the children.” Dr. Newton wrote an editorial that accompanied the new study.

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