Fight Fire With Veggies

The image of rough and tough firefighters swapping war stories over tofu burgers and steamed greens may seem alarming, but for members of Firehouse 2 in Austin Texas it's vegan or bust. Deborah Bluementhal of The New York Times explains what prompted these "dinosaurs" to abandon their carnivorous ways:

A routine cholesterol test left Specialist Rae, 37, shaken. The American Heart Association ranks anyone with a level of 240 or more high risk; Specialist Rae's hit 344.

"I was floored, scared," he said. "I had no clue."

Spooked by the outcome of his test. Specialist Rae asked fellow Firefighter Esselstyn for advice. Esselstyn, 43, a former professional triathlete explained that meat isn't necessary for optimal health. Esselstyn a vegan had good reason to make his claim:

Firefighter Esselstyn knew through his father's work that a strict vegan diet would help. His father, Dr. Caldwell B. Esselstyn Jr., had been a general surgeon at the Cleveland Clinic and still conducts research there.

Dr. Esselstyn's 12-year trial with patients with what looked like terminal heart disease showed that a very-low-fat, plant-based diet with cholesterol-lowering medicine could bring striking improvement.

Heart disease "never need exist," Dr. Esselstyn said, but if it does, "it never need progress."

How could someone with a bad ticker drag me out, Esselstyn explains. This concern attracted other members of Engine 2 to veganism as well. The switch seems to be working. Recently Specialist Rae achieved a cholesterol score of under 200.

Austin is taking notice of their herbivorous firemen. Shouting terms of endearment as the red engine drives by. A local eatery even named a sandwich after them, "The Engine 2 Veggie Sandwich." They even have their own goofy website promoting their diet, with links to several articles about their efforts.

You might recognize the name of one of the firefighters. Firefighter Esselstyn's father Caldwell B. Esslestyn Jr., M.D. is a leading advocate of a consuming a vegetable-based diet to prevent and reverse heart disease. Dr. Esseltyn's work has been discussed here before. To learn more about his research click here, or check Dr. Fuhrman's book Cholesterol Protection For Life.

Gina Kolata's Video Assault on Your Good Sense

New York Times reporter Gina Kolata's work has come up again and again on DiseaseProof.

We just happened across a feature on The New York Times website that has video of Kolata discussing some of her recent work.

Her "Health Minute" video piece about the relationship between diet and cancer is shocking. Here are some quotes:

  • "You might have assumed that what you eat makes a big difference in whether you get cancer... "
  • "Many scientists say that there is still a reason to eat a healthy diet, but cancer prevention is probably not one of them. If there are effects, they are likely to be small, and swamped by other factors."
She also urges those with cancer not to feel guilty about what they ate--which is surely generous and kind, but not supported by research that I have seen.

The basis of her story is the Women's Health Initiative study that was wholly flawed. "Look closely and you will see that the researchers compared a typical, disease-causing American diet, with one that was just marginally better, but still terribly unhealthy," says Dr. Fuhrman.

He likens it to studying those who smoke 50 cigarettes a day, and comparing them to those who some 60 cigarettes a day. If you find little difference in their cancer rates, does that mean cigarettes don't affect cancer?

What's more, the study merely assessed the efficacy of "low-fat foods" which is not the most important designation in determining cancer-fighting potential. Some high-fat foods like nuts, seeds and avocados contain heart disease and cancer fighting compounds, points out Dr. Furhman, who adds that "eating more low-fat foods such as egg whites, chicken, and pasta does not expose us to the disease-fighting compounds in berries, seeds, nuts, cruciferous vegetables, tomatoes and carrots."

If you haven't read it yet, please do check out the still relevant longer response to Gina Kolata's original article--complete with references to medical studies etc.

Doubt About Omega-3 Fatty Acids

A recent study published in the British Medical Journal doubts the benefits of consuming omega-3 fatty acids. Despite vast research showing a reduced number of deaths from cardiovascular disease due to consumption of omega-3. Dr Mike Knapton of the British Heart Foundation isn't convinced. Reuters reports:

"People should not stop consuming omega-3 fats or eating oily fish as a result of this study," he said in a statement issued by the foundation.

"Until now, medical research has demonstrated a benefit from omega-3 fats in protecting people from heart and circulatory disease. This systematic review of numerous studies concludes that there is no clear evidence either way," he added.

Dr. Fuhrman says this does little to alter his conviction that for those who are deficient in omega-3 fatty acids, getting more from diet or supplementation is beneficial:

Interesting study, it shows that higher fish intake or use of fish oil did not significantly affect mortality one-way or the other. I guess we would expect to find that. Fish and fish oil are over-hyped as being such wonder foods that will make everyone live longer.

But now let's put this in perspective. Giving B12 to the entire population will not have a significant effect on lifespan either, but give B12 to those B12 deficient people and it will be very significant for them.

This study specifically excluded those studies that checked and monitored blood levels of omega-3 fats. Those studies that do monitor such levels definitely show a strong relationship between fatal heart attacks and omega-3 fatty acid levels in the blood.1

Since most people are not deficient in these fatty acids, taking more is not protective, but in a vegan population who does not eat any fish, a certain percent will be deficient in DHA. DHA deficiency is an important thing to avoid; it can lead to depression, dementia and later life neurological deterioration. And this study did not show fish or fish oil would not increase lifespan in a vegan population or a group documented to be low in omega-3 fatty acids, which has already been demonstrated in other studies.

So this finding takes the edge off all the high intake of fish and fish oil hype, but it does not make it less important to make sure that a deficiency does not exist in anything (including long chain omega-3's) and it is still important to take a supplement or to have ones blood drawn to make sure your level is adequate.

So even if this study is correct and that eating fish or taking fish oil or (vegan) DHA supplement does not have a significant effect on longevity for most people, there are still other good reasons to assure nutritional adequacy with supplementation. Epidemiological data indicate decreased plasma DHA interacts with genetic and other environmental influences to predispose people to dementia. Approximately 40% of fatty acid phospholipids in the brain are DHA. Individuals with dementia have lower plasma phospholipid DHA levels in the brain compared to controls. Prospective studies have reported consumption of at least 1 fish serving per week decreases risk of Alzheimer's disease by 60%. Preliminary data suggest that after adjustment for age, gender, apoE genotype, and homocystine levels, the top quartile of plasma DHA of approximately 2.7 or more servings of fish/week or 180 mg or more DHA/day is associated with 50% decreased risk of dementia.

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Less Risk in Your Diet?

According to the results of a national telephone survey Americans are consuming less undercooked ground beef, raw fish, oysters, and runny eggs. The study examined consumption of foods linked to E. coli, vibrio, salmonella and other food-borne illnesses. The LA Times reports:

The report, made public Tuesday at the International Conference on Emerging Infectious Diseases in Atlanta, found that the percentage of people eating risky foods dropped from 31% in 1998 to 21% four years later. It was based on results of telephone surveys of 15,000 to 20,000 people conducted by the Foodborne Diseases Active Surveillance Network, known as FoodNet.

It seems "risky food" only refers to short term risk in terms of this study. Dr. Fuhrman says animal products like hamburger, milk, and certain seafood can have long-term risks that are equally dangerous. Consider this excerpt from Eat to Live:

The link between animal products and many different diseases is as strongly supported in scientific literature as the link between cigarette smoking and lung cancer. For example, subjects who ate meat, including poultry and fish, were found to be twice as likely to develop dementia (loss of intellectual function with aging) than their vegetarian counterparts in a carefully designed study.1 The discrepancy was further widened when past meat consumption was taken into account. The same diet, loaded with animal products, that causes heart disease and cancer also causes most every other disease prevalent in America including kidney stones, renal insufficiency and renal failure, osteoporosis, uterine fibroids, hypertension, appendicitis, diverticulosis, and thrombosis.2

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Research: Magnesium Does a Body Good

According to Ed Edelson of the HealthDay News a recent study published in the March 28 issue of Circulation links high intake of magnesium with a reduced incidence of metabolic syndrome. Metabolic syndrome refers to the cluster of conditions that contribute to heart disease and diabetes. Edelson explains:

The components of metabolic syndrome include high blood pressure, high blood sugar levels, elevated blood fats and low levels of HDL cholesterol, the "good" kind that helps keep arteries clear. Having at least three of these factors increases the risk of cardiovascular disease and diabetes.

The study began in 1985 and monitored more than 4,600 Americans. The conclusion showed that individuals consuming increased amounts of magnesium had a 31 percent lower chance of developing metabolic syndrome than those who did not.

According to researchers good sources of magnesium are halibut, dry roasted almonds, cashews, spinach, whole-grain cereals, avocados, bananas and raisins. Although, Dr. Fuhrman contends you should avoid halibut due to mercury contamination. (More on mercury.)

Dr. Ka He, an assistant professor of medicine at Northwestern University encourages people to incorporate nutritious food into their diet when they are young so that can enjoy better health as they age. He urges that eating magnesium-rich food is only part of being healthy:

Magnesium is just a small part of the healthy heart story, He said. The standard recommendations for avoiding smoking, getting more physical activity, eating more fruits and vegetables and fewer fatty foods are essential for health.


Gina Kolota of The New York Times reports that cloned pigs may be the nutritional holy grail. Recently researchers from three major universities genetically modified a group of swine to make pork that's rich in omega-3 fatty acids.

Harvard professor of clinical medicine Alexander Leaf says:

"People can continue to eat their junk food," Dr. Leaf said. "You won't have to change your diet, but you will be getting what you need."

The article glosses over the important point: even with beneficial omega 3 fatty acids pork meat still contains saturated fats and cholesterol. This is from Dr. Fuhrman's book Eat to Live, in which he discusses the risk of heart disease as it relates to the consumption of animal products:

Poring through nation-by-nation mortality data collected by the World Health Organization, I found that most of the poorer countries, which invariably consume little animal products, have less than 5 percent of the adult population dying of heart attacks.1 The China Project confirmed that there were virtually no heart attacks in populations that consume a lifelong vegetarian diet and almost no heart attacks in populations consuming a diet that is rich in natural plant foods and receives less than 10 percent of its calories from animals.

For more of Dr. Fuhrman's thoughts about meat, read his post from Friday.

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Lower LDL, Lower Chance of Coronary Heart Disease

A study in The New England Journal of Medicine concludes that long-term lower levels of low-density lipoprotein (LDL) cholesterol are associated with a dramatically reduced risk of coronary heart disease (CHD).

The Meat and Butter Diet

This post is part of an on-going review of the recommendations of celebrity doctor Joseph Mercola, M.D. D.O. For an overview, see Monday's post.

Keep in mind, I am not arguing that a vegan diet is healthier or will lead to a longer life compared to someone who eats a small amount of animal products, such as a little fish or eggs in their diet. But I am arguing that as the amount of animal products increases in a diet-style forcing natural plant foods off the plate to become a smaller percentage of total caloric intake, the modern diseases that kill over 80 percent of Americans (heart disease, stroke, cancer, diabetes) will occur in greater and greater likelihood in every genetic type. My review of over 60,000 articles in the scientific literature supports the conclusion that animal products if consumed should be held to a maximum of ten percent of total caloric intake, reduced from 40 percent in America today and certainly significantly reduced from 60 percent on the Zone and South Beach diets and 80 percent of total caloric intake on the Atkins type diets, and somewhere in between these level on Dr. Mercola's high protein type diet. Dr. Mercola's recommendation are somewhat similar to the Weston Price Foundation, another group that advocates a diet rich in meats based on distorted science and old scientific views that have been disproven by the preponderance of the evidence. The difference is that the Weston Price Foundation does not use a questionnaire to determine if you are the type that deserves a diet rich in high saturated fat animal products, they just teach that everybody is healthier eating a diet chock full of animal products.

Dr. Mercola and the Weston Price Foundation flood the internet with their saturated fat is good for you message. They produce articles with supposedly scientific references that either quote the same bunch of people (each other), ignore a ton of modern reputable research, or distort what was said in the study, claiming saturated fat is okay and not related to heart disease. They all use the same distorted logic that it is the consumption of trans fats that are responsible for heart attacks, not saturated fats. They didn't inform the reader that the reason trans fats are bad is because they have been processed to saturate their carbon bonds so they behave in the body as saturated fats. Because trans fats are bad or worse, does not make saturated fats good. It is similar to the twisted logic of the Weston Price crowd who present the work of this dentist who traveled around the world showing that populations who did not eat processed foods had good teeth, to argue that because some of these cultures ate lots of animal products that must mean diets rich in animal products are good. Because processed foods, sugar, corn syrup and white flour are bad, does not make a diet high in animal products lifespan promoting. Weston Price used some very short-lived people as examples of good health, just because their teeth looked good. Fortunately, we know more today than we did in the early 1900's. We know which foods contain the full spectrum of nutrients that resist aging and we know that the diseases that afflict modern civilization are not the consequence of aging; they are the consequence of nutritional ignorance. And we also know that saturated fat raises cholesterol and is an important cause of heart disease, but not the only cause. Too bad so much nutritional ignorance is promoted on the internet, in books and in the media, it only leads to more people being confused.

Quoting Dr. Mercola's website:

Some of you might be watching your weight and be rather hesitant to add butter into your diet. Have no fear. About 15% of the fatty acids in butter are of the short and medium chain variety which are NOT stored as fat in the body, but are used by the vital organs for energy.

Once you get into these high zones of animal product intake there is no genetic type that is not going to have their health damaged by such a high consumption of animal products. There is an overwhelming amount of evidence in the scientific literature to support this (about 1500 references alone in my book, Eat To Live), but that is just the tip of the iceberg. Dr. Mercola's comments on the studies linking meat to colon cancer is to protect yourself with high quality grass-fed beef or high quality butter. I remember once a patient told me that they can't get lung cancer because they use high quality tobacco, farmed without pesticides, that's a good one!

People who are fixated to their rigid views, especially addicts will look to rationalize their behavior even if the excuse can't withstand scientific scrutiny. Dr. Mercola has to overlooks all the data that shows that it is not merely the barbequing of meat, processed or commercial meats that are linked to heart attack and cancer it is other important features that are also present in grass-feed beef.

Let's review a few of these scientific studies on colon cancer to illustrate:

Chao A. Thun JT. Connell CJ. Et al. Meat Consumption and Risk of Colorectal Cancer JAMA. 2005;293:172-182.
This study concludes that examining meat consumption over many years prior to the diagnosis of cancer illustrates that prolonged high consumption of red and processed meat increases (more than doubles) the risk of colon cancer. In this study even two to three ounces of red meat or processed meats a day increase risks significantly.

Sesink AL; Termont DS; Kleibeuker JH; Van der Meer R Red meat and colon cancer: dietary haem-induced colonic cytotoxicity and epithelial hyperproliferation are inhibited by calcium.Carcinogenesis. 2001; 22(10):1653-9

Hughes R; Cross AJ; Pollock JR; Bingham S Dose-dependent effect of dietary meat on endogenous colonic N-nitrosation.Carcinogenesis. 2001; 22(1):199-202
These two studies go into the mechanism via which red meat promotes colon cancer. Since red meat contains no fiber, it remains in the gut much longer than fiber-filled foods.They describe the biochemical effects of this slower transit time, including heightened exposure to red meat's nitrogenous metabolites. In other words, red meats' slower transit time in the bowel promotes prolonged exposure to these carcinogenic compounds (naturally occurring N-nitroso compounds) when a larger percentage of the diet is made of animal products rather than plant materials. Another important mechanism reported was the high haem content of red meat, because dietary haem increased cytolytic (cell-killing) activity and colonic epithelial proliferation, thus explaining why red meat is more colon cancer promoting compared to fish or chicken.

Heart disease also occurs not just because of the processing of meats or the fact that beef is grain fed and not grass fed, but because of other intrinsic properties of animal foods, and the fact that we require a significant exposure to a full symphony of natural antioxidants and phytochemicals in unprocessed plant matter that we are not getting as animal products increase and the percentage of vegetation decreases.

Tomorrow, DiseaseProof will feature a look at the real cause of Dr. Atkins' death, while on Friday I will discuss the healthy way to integrate some meat into your diet.

Obesity's High Threat Level

Earlier this month U.S. Surgeon General Richard Carmona stated that America's obesity epidemic may pose a bigger threat than terrorism.

It's more than a little ridiculous how practically everything in Washington is likened to some form of terrorism these days. But there's no point in pretending the obesity epidemic isn't on a massive and deadly march straight through the heart of America.

Dr. Fuhrman reacts to the Surgeon General:

We graduate from high school, college, even graduate and professional schools and we never gain the most knowledge we need to be in control of our health destiny. We live in a society that believes that we protect our health with access to medical care and drugs; it doesn't work.

We can win the war on cancer and heart disease, not with more money put into medical interventions and drugs, but by unleashing the big artillery found in our kitchens; berries, green vegetables, beans and seeds to name a few. The science is important and motivating because we are eating ourselves into a tremendous amount of needless and tragic diseases in this country and our cancer rates have increased unrelentingly each year for the last seventy years. But aside from all the convincing scientific data, it is just as important to show people how they can deal with their picky eaters, get their family to like the healthful foods at the family table and make healthy eating great tasting and fun. My experience has been that after gaining the knowledge, people can transition their family over to a disease-preventive lifestyle and enjoy the change.

Here's a tool to consider: Dr. Fuhrman's free podcast will help parents succeed in introducing healthy foods to your children.

European Research: Restricting Animal Products Reduces Weight Gain, Cancer

In Eat to Live Dr. Fuhrman warns against eating regular quantities of animal products, refined grains, and oils, urging you instead to get most of your calories from vegetables, fruits, legumes, seeds, and raw nuts:

Vegetable and fruits protect all types of cancers if consumed in large enough quantities. Hundreds of scientific studies document this. The most prevalent cancers in our country are mostly plant-food-deficiency disease. Raw vegetables have the most powerful anti-cancer properties of all foods.

Research shows that those who avoid meat and diary have lower rates heart disease, cancer, high blood pressure, diabetes, and obesity.1

Studies have confirmed that individuals consuming a vegetarian diet (one based on plant matter and not dairy or refined grains) live longer than non-vegetarians and almost never get heart attacks.

With this in mind, consider this recent weight loss study from the European Prospective Investigation into Cancer and Nutrition. The eating habits of 22,000 people, meat eaters and vegetarians, were tracked over five years. In the end results found that all participants gained a few pounds, but individuals who adopted a vegetarian or vegan diet gained the least. Reuters reports:

"The weight gain was less in the vegans than in the meat-eaters and somewhere in between in the other groups," said Tim Key, of Britain's Cancer Research UK charity and the University of Oxford, who conducted the study.

"The lowest weight gain was in people who changed their diet to eat fewer animal products," he told Reuters.

In addition to stressing the importance of physical activity for sustained health, the study also comments on the link between diet and cancer:

[The study] also showed that diet is second only to tobacco, as a leading cause of cancer, and, along with alcohol, is responsible for nearly a third of cancer cases in developed countries.
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Caffeine Freaks: Get Tested

Following up on last week's news linking coffee consumption with risk of heart attacks Dr. Fuhrman provides some additional thoughts on the study printed in The Journal of the American Medical Association:

This article notes that some people are homozygous for a gene that controls caffeine elimination in the liver and others are heterozygous. So, similar to the genes for eye color, in this case a person who inherits only one dominant gene will detoxify caffeine slower--and therefore be more at risk for its heart attack promoting properties.

Of interest was the strong association with the non-fatal heart attacks occurring in younger people. Noting that some individuals who metabolize caffeine slower, and thus eliminate it slower, have double the heart attack risk compared to non-caffeine drinkers or those who metabolize caffeine quickly.

Bottom line, if you drink coffee, and are unwilling to cut back to one cup a day or less, at least get this test to see if you are a slow caffeine metabolizer.

Of course, I would prefer people not engage in addictive habits in general, because that inevitably leads to eating more food to treat their addictive withdrawal symptoms, and continues their addictive relationship with food and drink contributing to their ill health in general.

Research: Vitamin B Ineffective Against Heart Disease

Gina Kolata writes in The New York Times:

A widely promoted B-vitamin regimen for the prevention of heart attacks and strokes has shown no beneficial effects in people at high risk, researchers are reporting in two new studies.

The widely accepted hypothesis was that B vitamins -- folic acid, vitamin B12 and vitamin B6 -- could protect against homocysteine, an amino acid that some doctors said was as important and dangerous a risk factor for heart disease as cholesterol.

Studies of populations had shown that the higher the homocysteine level in the blood, the greater the risk of heart attacks and strokes. And studies of animals had indicated that homocysteine could actually damage the tender linings of arteries, setting the stage for atherosclerosis.

B vitamins, however, reduce blood levels of homocysteine. The vitamins, which are found in a variety of foods, have no known harmful effects. And if people take the vitamins as supplements, their homocysteine levels plummet. About 35 percent of Americans take B vitamins, mostly in the form of multivitamin pills, according to the Council on Responsible Nutrition, a trade group.

So it seemed reasonable that taking the vitamins would be protective. It might be even better than taking statin drugs, some said, which are well established to prevent heart disease by lowering cholesterol levels.

It was not, the new studies found.

This is another example of the blind leading the blind. The problem is the way research is conducted in general and our typical medical approach in trying to give every patient some cookbook response to their high homocysteine level, rather than treating every patient as an individual.

High Homocysteine Levels Are Markers for Poor Diet
In my experience, a high homocysteine level is mainly important as a marker indicating a diet low in vegetables, especially the folate rich greens. In other words, it is one of the blood signs of a poor diet.

Fixing the homocysteine level without fixing the diet shouldn't be expected to do much because it is hundreds of important nutrients and factors that are missing not just the folate. A pill can't take the place of the symphonic effect of a diet that is naturally folate and nutrient rich.

One of the researchers quoted in The New York Times, Dr. Salim Yusuf of McMaster University in Hamilton, Ontario, has a similar, but vaguer idea. Again, Gina Kolata:

The most likely explanation for the studies' results, Dr. Yusuf said, was that homocysteine levels were not the cause of disease. Instead, he said, they are probably a sign of heart disease, much like fever is a sign of infection. Treating a fever with aspirin does not cure the infection, and lowering homocysteine levels with B vitamins does not cure disease either.

The Bottom Line For Your Health: High Homocysteine Levels Still Must be Addressed These studies show that homocysteine lowering therapies do not work on a gross scale to reduce heart attack deaths---but that does not mean that a person who has a significant homocysteine elevation should not address the cause of such an elevation.

I am in the process of revising my book Cholesterol Protection For Life (the new version will be available in about a month) and recently wrote about this issue. Here are some relevant excerpts:

Is homocysteine an important indicator of heart disease?

Maybe and maybe not, it depends on how high your homocysteine level is and the cause of the elevation. Homocysteine is an independent risk factor for heart disease. That means even if your cholesterol is favorable, heart disease can sometimes be caused by an elevated homocysteine.

A high homocysteine can also be a contributory cause of high blood pressure and place you at higher risk of stroke. Homocysteine can be elevated secondary to increased need for B12, B6 or folate. It is rare, but still possible for a person with a perfect diet and ideal cholesterol levels to develop chronic disease from an elevated homocysteine level.

Theoretically, most people eating a plant-based diet rich in vitamins, especially folate, only have to be concerned with consuming adequate B12 to assure a normal homocysteine level. However, there are other causes. Some uncommon cases of individuals who have a very high homocysteine level, normal B12 (documented by a methylmalonic acid, MMA test) and also normal folate levels on blood tests. These people should be instructed to take extra folate as they likely have a genetic defect converting folate to its more active form.

After reviewing scores of medical studies on the relationship between high homocysteine and the increased risk of Alzheimer's, stroke, heart attack and dementia one has to conclude that there is a clear cut relationship between high homocysteine and serious disease. However, this is a complicated subject, where confusion abounds, and the right way to lower homocysteine or whether we should attempt to lower it at all is still debated. Clearly we have more to learn as more time and further research is revealed in years to come.

One reason there is such contradictory information in the scientific literature is because the researchers appear to have such poor working knowledge of excellent nutrition and are not targeting the therapy to match the corresponding cause(s) of the homocysteine elevation. Instead, both researchers and most physicians are simplistically giving the same conventionally-designed, nutritional supplement to a cohort of patients with different causes for the high homocysteine.

Physicians think about high homocysteine as only one problem, like high cholesterol, when there could be multiple reasons for the abnormality, so often the solution does not fit the problem. There should not be a one size fits all solution to an elevated homocysteine.

Homocysteine levels above 20 micro mol/l are associated with a 10 fold increased risk of heart attack compared to levels below 9 micro mol/l. 1 These high elevations of homocysteine should not be ignored. Doing so could result in an easily avoidable medical tragedy.

For example, homocysteine can be elevated from:

  • A poor diet, low in folate-containing vegetables.
  • A B12 deficiency
  • An uncommon defect in conversion of folate to the active form (even in a person eating a healthy diet)
  • Kidney disease

Address High Homocysteine Levels With Recommendations Targeted to the Cause
Consider an abnormal homocysteine that may require treatment above 15, not above 10. Levels between 10 and 15 have not been consistently associated with worse outcomes.2
If one homocysteine is elevated above 15, make sure a blood level of B12, and MMA (methlymalonic acid) and a folate level is drawn.

Mild elevations of homocysteine between 10 and 15 do not appear to place people at higher risk. In most of these cases, the mild elevation is just a marker for a low nutrient diet in general and the correct treatment is the improvement of the entire diet, not just a supplement to lower homocysteine. Folate alone in these cases cannot compare with the value of actually eating a diet rich in folate and gaining all the other essential cardio-protective compounds that are found in natural plant foods. It is similar to taking a cholesterol-lowering drug instead of eating healthfully; a pill cannot take the place of the full symphony of dietary elements that contribute to heart and vascular health.

When the abnormality (elevated homocysteine) is due to B12 deficiency it is wise to take more B12. Whether you are consuming sufficient B12 or not is best ascertained by a normal MMA (methylmalonic acid) because a B12 level in the 200 to 400 range, which is considered in the normal range could still be abnormal. Paradoxically, MMA is actually a better marker for B12 deficiency than B12 itself. If the MMA is elevated a B12 deficiency exists, even if the B12 is in the normal range. When this is the case, extra B12 is the correct treatment for the elevated homocysteine.

If the folate level is excellent (15 - 25) and the B12 level is normal (as documented with a normal MMA) and the homocysteine is still significantly elevated,then the cause of the elevation is most likely a genetic defect in folate conversion. In this case, folate (or folic acid) supplementation may not be totally effective; because the patient is just taking more of the folate that they don't convert effectively to begin with. They don't need more folate, rather they need more of the biologically active form of folate that they don't make well (called methyl tetrahydrofolate or formyl tetrahydrofolate.)

So if the B12 is normal and the folate is normal, and the homocysteine is still significantly elevated, it may make more sense to take a supplement containing additional tetrahydrofolate, and not just pile on huge doses of folate (folic acid) attempting to drive the homocysteine down with overwhelming high doses of folate.

In conclusion, it is wise to target therapy based on known deficiencies and not just blanket patients with high dose supplements that they do not need. Nevertheless, an attempt to uncover the cause of the homocysteine elevation and lower it accordingly may be an important intervention for patients with unique needs.

Medical Research Still Has a lot of Questions to Answer About Homocysteine.
In the meantime, it should be recognized that a vegetable-based diet rich in fresh produce with fruit, beans, raw nuts and seeds, naturally low in saturated fat and in sodium is our most powerful protection against disease. It lowers blood pressure as much as drugs and, in heart patients, is at least twice as effective at reducing death rates and heart attacks as drugs.3 The day may come when a physician, who does not offer such a diet to his heart patients is himself at high risk for being sued for malpractice.

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Coffee is Not for Everyone

Lindsey Tanner of the Associated Press reports a new study is claiming that some coffee drinkers may be at greater risk for nonfatal heart attacks. Research found a genetic trait that splits coffee drinkers into two groups, those with a reduced risk of heart attack or those at an increased risk:

Research on more than 4,000 people in Costa Rica found that about half had the trait and were considered "slow caffeine metabolizers." The other half had the opposite trait, which caused their bodies to rapidly break down or metabolize caffeine, and coffee-drinking in this group appeared to reduce heart attack risks.

Among slow-metabolizers, those who drank two or more cups of coffee daily were at least 36 percent more likely to have a nonfatal heart attack than those who drank little or no coffee. Even higher risks were found for younger slow metabolizers -- those under 50. They were up to four times more likely to have a heart attack than slow metabolizers in their age group who drank little or no coffee.

University of Toronto researcher and co-author of the study, Ahmed El-Sohemy remarks:

The new study "clearly illustrates that one size does not fit all," El-Sohemy said. "Perhaps in the future we'll be making different (dietary) recommendations based on people's genetic makeup."

Here are Dr. Fuhrman's thoughts on consumption of caffeinated beverages from his book Eat to Live:

Clearly, excessive consumption on caffeinated beverages is dangerous. Caffeine addicts are at higher risk of cardiac arrhythmias that could precipitate sudden death.1 Coffee raises blood pressure and raises cholesterol and homocysteine, two risk factors for heart disease.2

Besides increased risk of heart disease, there are two other problems. First caffeine is a stimulant that allows you to get by with less sleep and reduces the depth of sleep. Such sleep deprivation results in higher levels of the stress hormone cortisol and interferes with glucose metabolism, leading to insulin resistance.3 This insulin resistance, and subsequent higher baseline glucose level, further promotes heart disease and other problems. In other words, caffeine consumptions promotes inadequate sleep, and less sleep promotes disease and premature aging. Adequate sleep is also necessary to prevent overeating. There is no subsidence for adequate sleep.

The second issue is that eating more frequently and eating more food suppresses caffeine-withdrawals headaches and other withdrawal symptoms. When you are finally finished digesting the meal, the body more effectively cleans house; at this time people experience a drive to eat more to suppress caffeine-withdrawal symptoms. You are prodded to eat again, eating more food than you would if you were not a caffeine addict.

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Delving Into the Archives

Even though it's only a few months old, DiseaseProof has already accumulated a pretty big library posts and podcasts on various health topics. If you ever feel like searching through those archives (either by clicking on a topic at the left and then scrolling through relevant results, or better yet typing a keyword in the search box at the upper left) you'll see there's all kinds of interesting stuff.

Here's a rundown of some of the more popular posts from our first few months:

Childhood Obesity: Growing In The Wrong Direction

Obesity is rapidly becoming one the nation's worst epidemics. A dangerous trend considering the variety of diseases linked to obesity, such as heart disease and type 2 diabetes. The growing number of overweight children is especially concerning. This article on discusses the issue and provides tips to help kids beat the bulge:

Overweight children are at risk for serious health conditions like type 2 diabetes, high blood pressure, and high cholesterol - all once considered exclusively adult diseases. But overweight children may also be prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Overweight children are often the last to be chosen as playmates, even as early as preschool. Children who are unhappy with their weight may be more likely than average-weight children to develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia, and they may be more prone to depression, as well as substance abuse.

Dr. Fuhrman's book Disease Proof Your Child is devoted to helping parents keep their children free of disease through proper nutrition. In the book he offers this stern warning about childhood obesity:

Obesity is the most common nutritional problem among children in the United States. On in three kids in America are overweight, and the problem is growing. The number of children who are overweight has more than doubled during the past decade. Social forces, from the demise of cooking to the rise of fast food, as well as dramatic increases in snack food and soda consumption, have led to the most overweight population of children in human history. Added to this dietary disaster is television, computer, and video technology that entertains our youngsters while they are physically inactive. Unless parents take a proactive role in promoting and assuring adequate nutrition and an active lifestyle, you can be sure the children of American will continue this downward spiral into obesity and ill health. Obese children suffer physically and emotionally throughout childhood and then invariably suffer with adult heart disease, and a higher cancer incidence down the road.