James O'Keefe, MD and
Joan O'Keefe, RD

by James O’Keefe, MD, FACC

Headlines on the morning news TV shows, newspapers, etc. concerning a study published in this week’s New England Journal of Medicine may have caused unnecessary concern about the effectiveness of omega-3 oils. Please be aware that this study did not involve typical DHA and EPA omega-3 supplements, but rather margarines. Researchers assigned 4,837 patients, aged 60-80 (78% men), who had had a myocardial infarction and were receiving state-of-the-art care, to four trial groups. Each group was given one of four margarines, one supplemented with 400 mg EPA and DHA, one with 2 g ALA (alpha-linolenic acid) , one supplemented with EPA+DHA and ALA, and one placebo margarine.

The end result showed no benefit from any of the supplemented margarines. Please note that 400 mg of EPA+DHA falls far below the American Heart Association’s guidelines of 1,000 mg DHA-EPA per day for individuals with diagnosed heart disease. The AHA does not recommend ALA supplementation. Additionally, margarine is high in calories, and is a food to be used sparingly, if at all. Encouraging the liberal daily use of margarine is not a good idea if one is trying to improve health.

Bottom Line: If you have diagnosed heart disease or other risk factors, follow the American Heart Association’s guidelines and aim for 1,000 mg DHA+EPA per day. The AHA recommends 500 mg DHA+EPA daily for those without heart disease. If you have high triglycerides you may need much higher daily doses of DHA+EPA, and you should discuss this with your physician.

Let the Music Play – De-Stress and Get Moving

It’s early afternoon and I’m getting ready for a small dinner party with some dear old friends. I love to entertain, but I’m just no good at it. I get stressed out about the house being messy, worry if the bath towels are folded, is there kid “stuff” all over the house, etc. Of course, my husband, who shares none of my worries, has eaten the avocados I had hidden in the back of the refrigerator for this evening and has mysteriously disappeared. These are very good friends and deep down I know that they could care less about how my house looks or if the bath towels are folded, but I’m still really stressed.

Now, you should know that I’m also a self-professed news junkie. I have Headline News on ALL DAY when I’m home. Of course, Headline News replays the same stressful stories all day long on repeat, so by about 2:00, I’d heard the same stressful stuff over and over again. I finally realized that this is doing nothing for me but adding more stress. I turned the TV off and turned on MIX 93.3, my favorite radio station and on came Train, Katy Perry, and Pink and some really fun music. To the chagrin of my family, I’m moving, twisting, twirling and jumping. I am mortifying my kids because this is the music that THEY listen to and here’s mom with a slotted spoon for a microphone TOTALLY embarrassing my kids!

I am having fun and not only am I relieving stress, but I’m burning some serious calories. This was no planned exercise session, just an impromptu deal. Not only was all the work done by the time our company arrived at 5:30, but I was stress-free and had burned more than 300 calories per hour!

The moral of my story is that the next time you’re stressed or need some exercise, just put your favorite music on – I DARE YOU not to move!!!!

What kind of exercise does your cardiologist do? Exercise doesn’t have to involve a treadmill or weights. In fact, some of the best work outs are things you’d never consider “exercise.” Check out this article about a unique workout James O’Keefe, MD, Chief Medical Officer of CardioTabs loves.

via Working out with spare tires can help you get rid of your spare tire – KansasCity.com.

Osteoporosis is a condition of decreased bone mass. You may have had a bone density screening in the past to test for signs of osteoporosis. Normal bones have small holes throughout, but an osteoporotic bone has large holes or appears “porous.” These large holes or pores are caused by insufficient amounts of calcium in the bones and many factors contribute to this. Inadequate calcium intake is one factor, but other lifestyle habits can be leeching calcium from your bones as well. Even if you already have osteoporosis or are at risk for the condition, there are lifestyle changes that you can make now that will help make your bones stronger and help you prevent the bone fractures all too common with osteoporosis.

8 Simple Lifestyle Steps for Preventing Osteoporosis

1. Adequate Calcium Intake – You’ve heard it time and time again and this one is never going to change. You’ve got to get enough calcium folks! Calcium in milk has a greater bioavailability than calcium in supplements, but if you can’t do milk products, supplements will suffice. If you simply don’t prefer milk products, please at least split the difference. I recommend taking your calcium plus vitamin D supplement with milk. This is a simple way to try to fool the body into thinking that the calcium supplement is as bioavailable as the calcium in milk.

2. Vitamin D – Calcium is not absorbed as well without vitamin D available in the system. Those with low Vitamin D levels do not absorb calcium well. Make sure you get your vitamin D levels checked and keep them up. Make sure you take your calcium with vitamin D.

3. Watch Your Sodium Intake.  Sodium will leech calcium from your bones. Keep your sodium intake to less than 1500 mg per day. The salt shaker is completely off limits, folks. Strictly limit processed foods and limit eating out – both are terrific sources of sodium. Sodium does occur naturally in milk and meats; however, you need these in your diet (see #1). Meats are complete protein sources and they are necessary to build and rebuild muscle mass broken down with exercise. Try whey protein isolate (I like CardioWhey ). Whey protein is not only a complete protein with every amino acid, but is a terrific way to build muscle and contains very little to no fat and sodium.

4. Alcohol.  Limit your alcohol consumption to one drink per day at the most. Consuming more than one drink per day is a risk factor for bone loss.

5. Pump Some Iron.  Weight lifting is very important for preventing osteoporosis, but why? When you work your upper body and build a strong core, you are building a strong, stable body. The more muscle you have, the more your bones have to carry around all day – and this is a good thing! More muscles lead to stronger bones.

6. Skip the Elliptical and Stair Climbing Machine.  Instead, run walk or jump. Good “pounding” exercises like these will strengthen your bones while whittling your weight. Jumping is the most effective bone building cardiovascular exercise that we know. Jump rope, do jumping jacks, jump on the kids’ trampoline, anything will work.

7. Follow exercise with whey protein.  Use whey within one hour of your workout (before or after). Working out breaks down muscles and whey protein gives the body the tools it needs to rebuild those muscles.

8. Eat Your Fruits and Vegetables.  Fruits and veggies are incredibly important as they help to prevent the leeching of calcium from your bones. Fruits and vegetables help balance the acid: base ratio in your body. Junk foods like cookies, donuts and potato chips make your body more acidic and this promotes calcium leeching from the bones. Excess sodium, junk food, and even meats will increase the acidity of your body’s fluids, but colorful fruits and vegetables will help to balance it and in turn help keep calcium in your bones where it belongs.

For more information about osteoporosis click here.

Be Picky about Your Protein

James O’Keefe, MD, FACC

Lean protein cranks up your metabolism and keeps you full longer after a meal. However, you must be very particular about your protein. The two highest quality protein sources are egg whites and whey protein. Nature designed both of these foods so they contain the precise amino acid building blocks needed to nurture young and developing animals and help them grow strong new tissues.
Fish, seafood, chicken or turkey breast meat, and non-fat dairy foods, are other great sources of animal protein. Even red meat is fine if it’s lean (92 to 100 percent fat free), fresh, and is not burned or over-processed. Also, consider nuts or legumes, like soybeans, lentils or red beans, for one of your protein sources each day.

Portion Sizes
Portion size is important also; an ideal protein serving size is about the size of the palm of your hand, with a width about as wide as your little finger at the middle joint. Fatty meats like full-fat hamburger and prime rib are off limits, as are over-processed meats like bacon and sausage. Jerky and deli meats, although often low in fat, are too high in salt and preservatives to eat on a daily basis.

Fruits and Veggies
Ideally, for each meal, you should be eating about three servings of colorful, fresh or fresh frozen vegetables and fruits to go along with your serving of healthy protein. Remember to start downing those fruits and veggies at breakfast, or you’ll have a tough time hitting your daily target of nine. Beverages should predominantly consist of non-caloric options like water, tea and coffee, or low-calorie, high-nutrient choices, such as low sodium V-8 juice, skim milk or soy milk.

You Are What You Drink
As important as what you choose to eat and drink is what you choose to avoid consuming. Pass up processed foods, especially those containing sugar, white flour, trans fats or high fructose corn syrup. Avoid products with long lists of ingredients and those bearing health claims like low fat or low carb–they are usually full of other bad stuff!

Go for Vegetables, Not Vegetarianism Part 1
By James H. O’Keefe, M.D.

America today is a land that indulges our freedom of choice. You can choose to have green hair and blue eyes, or to watch Sponge Bob Square Pants around the clock, or for your morning coffee you can choose to have a vanilla, half-caf, 1 percent, extra-hot, no-foam latte—but you can’t yet choose your genes. Those genes, the blueprint your cells use to build and maintain you, specify the kinds of foods upon which you will either thrive or decay. That’s why not all diets are created equal, and why food cannot be like fashion fads that come and go.

Many vital nutrients are found predominantly in meat, fish, eggs, dairy, and other animal by-products.   These include:

• essential amino acids
• DHA (an omega-3 fat)
• Vitamin B12
• Vitamin A
• Vitamin D
• Calcium
• Zinc

So paradoxically, while fresh produce (vegetables and fruits) is the single most important component of a healthy diet, strict vegetarianism does not foster optimum human health. The traditional vegetarian diets, as in India, always included eggs, dairy, and/or fish, which provided these nutrients.

Unfortunately, most animal-based foods in our modern diet are over-processed and unhealthy due to unnaturally high levels of saturated fats, sodium, nitrites, preservatives, and other additives; giving meat a bad reputation in many nutritional circles. Yet if you want a strong body, a sharp mind, and a powerful and vigilant immune system, you should try to consume lean, healthy, fresh protein three times a day.

Next week:  Part 2: Be Picky About Your Protein

Whole Foods discontinues krill, citing ’sustainability issues’.

Read about the sustainability of CardioTabs Ocean Safe Omega-3.  http://www1.cardiotabs.com/oceansafefaq.asp

You can get a free sample of Ocean Safe Omega-3 from CardioTabs.  Simply send an email requesting yours to info@cardiotabs.com.

Good Things are In-Season Now.

If you haven’t been through the produce section of your local supermarket lately, now is your time to get there!  Move away from the frozen fruits and vegetables and check out what’s fresh.  I try to buy organic whenever possible, but realistically, this is still expensive to do.  Even more important than organic on my list: buying local.  

Locally grown produce is available at your neighborhood supermarket or farmers’ market.  The benefits of buying local are many fold.

• Buying locally grown produce helps your local economy.
• When grown locally, transportation time is null.  Your fruits and veggies get from the farm to your plate in a much shorter time than if they’re grown somewhere in South America.  Travel time is huge for retaining nutrients.  The lesser the time in transit, the more nutrient dense your produce will be.  (Less time in transit also equals less gas used – you’re benefitting the environment!)

The most important thing when buying produce is to buy a variety of colors as every color is associated with a different type of antioxidant behavior.  Again, I buy organic when possible, but ultimately, it’s the look and firmness of the fruit or vegetable that sells me.  Just always make sure to wash your fresh produce thoroughly.

Springtime Fresh Fruits and Veggies You’ve Got to Try:

Have you noticed the strawberries this spring?  They’ve been gorgeous this year.  It’s only Tuesday and our family is on our second case this week!  We cut them up and serve with dinner – a giant bowl is gone in minutes at our house.  They taste great and are loaded with antioxidants.  They’re a power food!

Clementine oranges are affordable by the case right now.  They’re easy to peel and you can eat two or three at a pop.  A plus – kids love them!

Asparagus is everywhere this month.  We brush it with olive oil and a little Mrs. Dash or other salt-free seasoning and grill it on foil outside.  Grill it just enough so that it’s a little soft outside and crunchy on the inside.  This is another kid favorite and is high in vitamin C, and has a ton of antioxidant behavior. 

Artichokes are another seasonal veggie that are often overlooked.  They’ve looked great lately, too.  We simply steam them, pull off the leaves and eat the bottoms.  Then be sure to pull the ends of the leaves and eat the heart.  At dinner, we make two artichokes and everyone shares (except the heart – there is always a fight for that at our house)!

More doctors focus on vitamin D deficiencies – KansasCity.com.

By: James O’Keefe

Here is an interesting article written by Shelley Wood on theheart.org regarding Vitamin D abstracts presented at the American College of Cardiology, (ACC). I have highlighted two major points from the article. I have also attached the story.

Two major points:

• Among 9491 individuals with Vitamin D deficiency (≤30 ng/mL) those who subsequently normalized their vitamin D level during follow up had a substantially lower risk of CV events, and all-cause mortality was reduced by 30%. This was not a randomized trial, but is pretty compelling observational data.

• Ideal vitamin D level for reducing risk of CV risk was at least 43 ng/mL.. Most of the emerging data point to an ideal target Vit D level of 40 to 60 ng/mL. Most Americans have levels in the mid 20’s which means the typical American adult will need about 2000 iu per day to get into the ideal range. This is quite variable however, and I have found that 25-OH vit D levels are very helpful in directing therapy.

Death, CVD risk declines in people who “normalize” vitamin-D levels

Atlanta, GA – Adding heft to the hypothesis that vitamin-D deficiency is linked to cardiovascular disease, a new study has found that people with low vitamin-D levels who managed to normalize their levels were significantly less likely to develop cardiovascular events over up to six years of follow-up.

The study was presented as a poster by Dr Tami L Bair (Intermountain Medical Center Heart Institute, Murray, UT) earlier this week at the American College of Cardiology (ACC) 2010 Scientific Sessions.

According to coauthor Dr Joseph B Muhlestein (Intermountain Medical Center Heart Institute), the study looked at baseline and subsequent vitamin-D levels in 9491 subjects with known vitamin-D deficiency, rechecked their vitamin D, then compared subsequent rates of death, coronary artery disease, MI, heart failure, stroke, and renal failure among those who managed to bring up their vitamin-D levels with those who remained vitamin-D deficient. A cut point of <30 ng/mL was used to define vitamin-D deficiency.

“This wasn’t a randomized trial, but all of these patients started with low vitamin D, and then the question is, if they treated their vitamin D, did it have an effect? We don’t know what they did . . . the presumption is that they were told their vitamin D was low, then started supplementation or got their swimsuit out and went into the sun a lot to treat it.”

Getting to normal

After a mean of one-year of follow-up, those who had normalized their vitamin-D levels were significantly less likely to have died, developed heart failure, or developed coronary artery disease. A composite end point, looking at all outcomes combined, showed a highly statistically significant reduction among those with normalized vitamin-D levels.

Muhlestein drew particular attention to the 30% reduced risk of death in the normalized vitamin-D group. “A 30% reduction in risk is about the same you could hope to get from taking a statin or treating your blood pressure, so we thought it was certainly promising. It doesn’t eliminate the need for a real randomized trial, although I’m trying to figure out a good way to do one.”

There are a number of vitamin-D trials under way, most notably VITAL, a National Institutes of Health (NIH) study, launched in January.

But Muhlestein is concerned that the NIH trial may come up empty-handed for two reasons. For one, the trial, he says, is not measuring baseline levels or checking whether patients actually reach the optimal vitamin-D range in the intervention arm. “I can see why they aren’t [measuring vitamin D at baseline], because if they find vitamin D is deficient is it ethical to say, ‘I want you to stay vitamin-D deficient’?”

Vitamin-D deficiency is already known to increase the risks of skeletal disease, he notes. But without knowing if participants actually normalize their levels, it will be impossible to link normalization with an effect on events.

His second concern is with the dose chosen in VITAL: 2000 international units (IU) per day. “What I’ve found is that there are lots of my patients who don’t become normalized with 2000 units, so 2000 units may not be enough to treat the really deficient patients.”

But what’s normal?

In fact, Muhlestein and colleagues conducted a second study, also presented as a poster during the ACC meeting, trying to identify the optimal level of vitamin D by categorizing over 31 000 patients into three levels of vitamin D. When those levels were then linked to rates of 10 adverse outcomes (most of them cardiovascular), the authors demonstrated decreasing risk of adverse outcomes with increasing vitamin-D levels, with a vitamin D level >43 ng/mL to be the cutoff point for optimal.

Currently, they point out, a level of 30 ng/ML is considered “normal”—that cut point may be too low, based on their analysis.

But also of note, “above 43 ng/mL there was no added benefit,” Muhlestein observed. “So if your level was 70 ng/mL, you were good, but you weren’t any better than if [your level] was 43 ng/mL.”

As for whether vitamin D can be too high, Muhlestein noted that there are problems with vitamin-D toxicities typically associated with hypercalcemia, but these tend to arise in people with levels higher than 100 ng/mL, and many people believe the level must be well over 150 ng/mL. “The only way I know of that people can get vitamin D that high is by overdosing on prescription vitamin D, which is supposed to be taken once a week. If someone were to make a mistake and take it once per day, they might get vitamin-D toxicity.”

The findings from both studies have convinced Muhlestein that vitamin-D deficiency is worth treating, but he urges physicians to make sure they check to see what a patient’s vitamin-D levels are to begin with and to adjust the dose accordingly. Individualization is essential, he noted, which is one reason he’s worried about the blanket 2000-IU approach being used in VITAL.

“Effective dose varies from patient to patient, which is one of the problems with the NIH trial. No one is going to become toxic on 2000 IU per day, but there will be lots who are at the highest risk who are not going to become normalized.”

here is a link to the Web site