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.

It’s back to school time and nothing can ruin teens’ confidence (or adults for that matter) like acne can. We know that your diet affects your complexion. My teenage son is the perfect example. He is so sensitive to the wrong things in his diet that even a piece of bread shows up on his skin. He’s so acutely aware of this that he won’t even go near starches – and he’s a seventeen year old boy!

Believe it or not, the same dietary issues we talk about as the roots of diabetes and heart disease also cause acne in our kids (and adults). When you eat junk, aka pop tarts, soda pop, chips and cookies, sugary cereals, etc. you are eating what dietitians call easily digested carbohydrate (EDC). EDC are such small molecules that when you eat them, they go straight to the stomach and barely any digestion is needed. EDC causes an immediate blood sugar spike. And guess what? That spike feels good. You get a sugar rush and a serotonin release, but then your blood sugar crashes and when you take that turn, you get irritable and crabby and low energy and that makes you want to eat more EDC and spike that sugar again. Spiking and crashing goes on all day from morning until night. Every spike and crash causes inflammation and inflammation leads to disease. In teens and even some adults, that inflammation manifests itself as acne.

When you stop spiking and crashing your sugar, your skin clears. How do you do that? By eating a diet of fruits and vegetables and lean protein. Replace the morning pop tarts with lean protein and two colors from fruits or vegetables. In fact, two colors and a lean protein choice should be the rule morning, noon and night. This keeps your blood sugar nice and even and prevents those inflammation-causing spikes. Remember, nothing tastes that good to be worth having really bad skin. Why resort to potentially dangerous drugs like Accutane and others if you don’t have to?

Remember,
Fruits and Vegetables
+
Protein
=
Clear Skin.

Next week – My teenage daughter tests our spiking and crashing theory – and the results aren’t pretty!

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)!

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

Every once in a while a reader will ask us our opinions about whole body, colon cleanses, or detox cleanses. This is a great question and one that I’d like to share the answer with everyone.

Do I recommend cleanses? NO! Absolutely not.

First, know that cleansing is an ongoing process. It’s not something that should happen once or twice a year. The body does a very good job of cleansing itself when given the right tools. If you are following an anti-inflammatory diet like Forever Young, your body is cleansing itself regularly. A good diet will help your body cleanse daily. An anti-inflammatory diet full of colorful fruits and vegetables will sweep any toxins from your body and also sweep your colon. Fruits and vegetables are full of antioxidants, which help reduce inflammation-causing free radicals, thereby reducing toxins in the body that cause disease.

Should you consider a cleanse prior to starting your new anti-inflammatory diet and lifestyle? No! Consider your diet your cleanse. Following a good anti-inflammatory diet is not only perfectly safe (unlike some cleansing systems), but will cost you no extra money. A once yearly cleanse is not going to reduce your chance of disease, but following a good diet (your body’s natural daily cleanse) certainly will.

Many people are also under the assumption that so-called detox cleanses will undo all the damage caused by a poor diet and lifestyle. Not so. Only a healthy diet and lifestyle followed every day will keep your body running clean and efficiently.

By: Dr. James O’Keefe

We’ve fielded a lot of questions lately about mercury and other toxins in fish oils. Mercury and other contaminants are commonly found in the fish richest in omega-3 fats, like salmon and tuna. That’s why the Environmental Protection Agency recommends limiting your fresh fish intake. At the same time, the American Heart Association and other national and international health organizations recommend we get more omega-3 fats from fish in our diets.

Both CardioTabs Omega-3 Fish Oil and CardioTabs Ocean Safe Omega-3 undergo extensive purification processes, including molecular distillation, which is the only method that removes PCBs, heavy metals (such as mercury, lead, and cadmium), DDT and other contaminants to below detectable levels for human consumption. Our omega-3 products are manufactured to the Global Organization for EPA and DHA (GOED) standards. CardioTabs is also an active member of the Council for Responsible Nutrition and participates in the Natural Products Association’s True Label Program. Our products are independently tested for purity by 3rd party laboratories. CardioTabs Ocean Safe Omega-3 is Gold Certified for purity by an independent, nationally recognized third-party laboratory.

By: Joan O’Keefe

The health of your arteries is critically important to virtually every aspect of your health. Too much salt (sodium) ages your cardiovascular system by raising your blood pressure and hardening, stiffening and thickening your arteries and the walls of your heart. You want to keep your blood vessels soft, smooth and supple like they were when you were a child and a teenager and avoid developing the rigid, inflamed and crusty pipes that can lead to a heart attack, stroke and congestive heart failure.

As an American adult, your chances of developing high blood pressure during your lifetime are 90 percent. If you continue to follow your current lifestyle, sooner or later you will probably get hypertension-the medical term for high blood pressure. Why? For starters, the average American consumes about 4000 mg of sodium daily, which is about six to ten times more salt than we were designed to eat. Add the fact that blood pressure rises in response to too much body fat, stress, and sugar and too little sleep and exercise, and you have the recipe for high blood pressure. In February 2005, the Center for Science in the Public Interest estimates that too much sodium kills 150,000 Americans each year. Excess sodium does much more that just raise your blood pressure. A study by David Calhoun, MD, reported in February 2005 Cardiology News showed that high-sodium intake reduced blood vessel wall function. In addition, salt leaches the calcium from your bones, making you prone to osteoporosis and fractures, and also appears to increase cancer risk- especially in the GI tract. A recent study found that extra salt in the diet increased the likelihood of heartburn (also known as esophageal reflux) by as much as 70 percent.

A good place to start lowering the sodium in your diet is by removing the salt shaker from the table and hiding it in an inconvenient spot. But only about 5 percent of the salt in our diet comes from the salt shakers; 75 percent comes from processed and restaurant foods. Most people do not choose to eat high-sodium products- they just eat foods that are readily available in our culture. Salt is everywhere in our modern diet, even in foods such as bread that don’t taste salty. Processed foods are loaded with salt to help preserve freshness, and the more sodium you eat, the more you will crave salt. When you eliminate highly processed, high- sodium foods from your diet, you will take a huge step toward a healthier more vigorous life.

Fresh fruits and vegetable contain virtually no sodium and thus are great for lowering your blood pressure along with your weight. We recommend at least nine servings of fresh produce daily. Unprocessed meat, poultry and fish contain only small amounts of sodium, but the more highly processed versions like deli meats, smoked, or barbecued meats, beef jerky and other commercially modified meats are usually very high in salt. The processed snack foods are generally also high in sodium. Try to get used to eating nuts that are unsalted or only lightly salted. Look for the sodium content on food labels and avoid items that have more than 400 mg per serving. Limit your daily intake to not more than 2300 mg (about one teaspoon) – the average American eats almost two times this much. One glass of regular V8 vegetable juice has over 1000 mg by itself. (low-sodium V8 or tomato juice is great) and a single dill pickle has 440 mg. A high potassium-to-sodium ratio is one of the most important parameters of a healthy diet. We are designed to take in much more potassium than sodium, but the ratio is reversed and sodium dwarfs the potassium consumption. So how do you get more potassium? You guessed it-lots of fruits, vegetables, lean protein and other Forever Young natural whole foods.

A Rainbow of Salt Varieties to Avoid
White salt: table salt
Red salt: ketchup
Yellow salt: mustard
Black salt: soy sauce
Green salt: pickles and olives