Disease Proof

• A new study claims air pollution raises the risk of deep vein thrombosis—blood clots. More from WebMD:

Harvard researcher Andrea Baccarelli, MD, PhD, and colleagues in Italy studied 870 people diagnosed with DVT from 1995 to 2005. They compared their particulate air pollution exposure in the year before their diagnosis to that of 1,210 matched people without DVT.

They found that DVT risk goes up 70% for every 10 microgram-per-cubic-meterrise in particulate air pollution above 12 micrograms per cubic meter of air (the lowest pollution level measured in the study).

The U.S. EPA standard for particulate air pollution is 150 micrograms per cubic meter of air. However, it's likely that fine and very fine particles cause most of the health risks linked to particulate air pollution.

• Surprise-surprise, drugs alone don’t lower heart disease risk for overweight Americans. Via HealthDay News:

The simple truth, experts say, is that pounds must also be shed to keep cardiovascular trouble away.

"There is a debate out there about whether this generation is going to live as long as their parents, and the truth is they probably won't," said study author Dr. Gregory L. Burke, director of the division of public health sciences at Wake Forest University School of medicine in Winston-Salem, NC.

"My ultimate worry is that we've seen a 50-year decline in cardiovascular disease mortality, but if you begin to look at recent trends, it's beginning to plateau," he added. "And my fear is that because of the increase in obesity we're going to begin to see a reversal of that trend where heart disease rates begin to go up."

• The tornados that blew through the Midwest are leaving toxic lead in their wake. The Associated Press reports:

On Saturday, a tornado with the second-strongest rating killed six people, destroyed a 20-block area, and blew dust off mountains of mining waste, or chat piles.

"You can look at the chat piles and see that a lot of the material has blown off," said John Sparkman, head of the Picher housing authority. "We went up on a chat pile an hour and a half after the tornado hit, and you could see dust blowing fine material all over the place from that vantage point."

Long-term exposure to lead dust poses a health risk, particularly to young children.

• Kevin McKeever of HealthDay News reports that hypertension and cholesterol are being associated with eye disease. Take a look:

The two conditions appear to increase one's risk for retinal vein occlusion, a condition that leads to vision loss. It results from one or more veins carrying blood from the eye to the heart becoming blocked and causing bleeding or fluid build-up, according to background information in the report published in the May issue of the Archives of Ophthalmology.

The Irish study found that people with high blood pressure had more than 3.5 times the risk of developing retinal vein occlusion than those without it. People with high cholesterol levels had an approximately 2.5-fold higher risk of retinal vein occlusion.

The findings come from an analysis of 21 previously published studies involving 2,916 people with retinal vein occlusion and 28,646 people without the condition. It found that 63.6 percent of patients with retinal vein occlusion also had hypertension, compared with 36.2 percent of people without the eye condition. High cholesterol levels were more than twice as likely to be found in those with retinal vein occlusion as those without (35.1 percent vs. 16.7 percent).

• Fairbank Farms has recalled some of its ground beef products. EMaxHealth is on it:

Fairbank Farms is issuing a voluntary recall of selected ground beef products produced at its Ashville, N.Y., facility and sold through Price Chopper, Shaw's, BJ's, and Wilson Farms retail outlets and C&S Wholesale distributor.

The affected product may contain small pieces of hard plastic. All recalled products have either a "sell-by" date of 05/13/08, 05/15/08, or a "Julian date 124" on the package's label.

• United States obesity rates continue to bloat at an alarming pace. Megan Rauscher of Reuters reports:
  

New research shows "alarming levels" of obesity in most ethnic groups in the United States, principal investigator Dr. Gregory L. Burke, of Wake Forest University, Winston-Salem, North Carolina told Reuters Health. The study also confirms the potentially deadly toll obesity exacts on the heart and blood vessels.

"The obesity epidemic has the potential to reduce further gains in U.S. life expectancy, largely through an effect on cardiovascular disease mortality (death)," Burke and colleagues warn in the latest issue of Archives of Internal Medicine.

Among 6,814 middle-age or older adults participating in the Multi-Ethnic Study of Atherosclerosis, or "MESA" study, researchers found that more than two thirds of white, African American and Hispanic participants were overweight and one third to one half were obese.

• We know cigarettes are bad for your health, but cigarettes butts are bad for the environment. From the Better Planet Blog:

The question is loaded and points to a really interesting diagnosis: What IS the biggest environmental problem on the planet? The answer is subjective, of course. If you are talking about global warming then coal plants are the biggest problem on the planet. If you are talking about natural resource preservation then deforestation is the biggest problem. Insert water for life sustainability and disease, or plastics for waste. To be sure, cigarettes are no one’s friend: Neither health nor the environment. In fact, in terms of litter, they are the biggest source of it: More than two billion pounds of cigarette butts are discarded worldwide – more than two pounds for every person in China. I use that country as an example because as I traveled from Beijing southward along the Silk Route, people still smoked a lot – everywhere. In Southeast Asia too people light up.

Smokers’ waste is rather easy to calculate. Figure out how many cigarettes are smoked and you’ll find out how many butts are tossed. You can’t recycle ‘em. One thing I’d like to know is the emission factor, or pollution due to smoking.

• Thanks to Rae for finding this one. Research has determined that popular shampoos contain toxic chemicals. From NaturalNews:

The experiments were conducted with the brain cells of rats and they show that contact with this ingredient called methylisothiazoline, or MIT, causes neurological damage.

Which products contain this chemical compound MIT? Head and Shoulders, Suave, Clairol and Pantene Hair Conditioner all contain this ingredient. Researchers are concerned that exposure to this chemical by pregnant women could put their fetus at risk for abnormal brain development. In other people, exposure could also be a factor in the development of Alzheimer's disease and other nervous system disorders.

The chemical causes these effects by preventing communication between neurons. Essentially, it slows the networking of neurons, and since the nervous system and brain function on a system of neural networks, the slowing of this network will suppress and impair the normal function of the brain and nervous system.

Okay, I go to admit. I couldn’t remember what the DASH diet is, so, I ran it through Wikipedia and here’s what came up:

Dietary Approaches to Stop Hypertension or the DASH diet is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH, an organisation part of the government of the USA) to control hypertension. A major feature of the plan is limiting intake of sodium, and it also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while lowering the consumption of red meats, sweets, and sugar. It is also "rich in potassium, magnesium, and calcium, as well as protein and fiber."

The DASH diet is based on NIH studies that examined three dietary plans and their results. None of the plans were vegetarian, but the DASH plan incorporated more fruits and vegetables, low fat or nonfat dairy, beans, and nuts than the others studied. Not only does the plan emphasize good eating habits, but also suggests healthy alternatives to "junk food" and discourages the consumption of processed foods.

Doesn’t sound too bad—pretty Fuhrman-friendly—maybe that’s why the DASH diet has been shown to cute the risk of heart disease. Ed Edelson of HealthDay News reports:

The DASH -- Dietary Approaches to Stop Hypertension -- study, reported in the same issue of Archives of Internal Medicine, is the first to look at the diet's effect on the incidence of heart disease and stroke, said study author Teresa T. Fung, an associate professor of nutrition at the Simmons College School for Health Studies in Boston.

"Previously, the benefits that were reported were for hypertension [high blood pressure]," Fung said. "No previous study looked at cardiovascular endpoints such as heart disease and stroke."

The study reported on 88,517 female nurses aged 34 to 59 who started with no evidence of cardiovascular disease or diabetes in 1980. In the 24 years that followed, the one-fifth of women in the group whose diets were most similar to that recommended in DASH -- low in animal protein, moderate in low-fat dairy products and high in plant proteins -- were 24 percent less likely to develop coronary heart disease and 18 percent less likely to have a stroke than the one-fifth of women with the lowest DASH scores.

While the study was not the kind of carefully controlled trial that gets the highest regard in research, it carries a message, Fung said. "This report actually shows that those people whose diet resembles the DASH diet reduce the risk of actual cardiovascular disease," she said.

Now, I’m certainly not going to abandon my nutritarian lifestyle for the DASH, but, the benefits of cutting salt, limiting saturated fat, and eating lots of fruits and veggies are truly undeniable. From Dr. Fuhrman’s book Eat for Health:

As the consumption of animal products, saturated fat, and processed foods drops down to low levels in a population’s diet, heart disease goes to lower and lower levels, reaching less than one percent of the total cause of death. Eating a diet lower in saturated fat and higher in fruits and vegetables dramatically reduces the occurrence of the clots that cause heart disease and embolic strokes. However, hemorrhagic strokes are not caused by atherosclerosis—the buildup of fatty substances in arteries—and the resultant clots. These strokes are caused by a hemorrhage or rupture in a blood vessel wall that has been weakened by years of elevated blood pressure as a result of chronic high salt intake. The weakened wall ruptures and lets blood flow into and damage brain tissue…

…When a diet is high in fatty animal products and high in salt, the thickened blood vessel walls caused by the unhealthful, heart-attack-promoting diet actually protect against the occurrence of this more uncommon cause of strokes. In medical studies, higher cholesterol levels are associated with increased risk of other strokes…

…A recent study looked at the effects of a diet with more fruits and vegetables combined with a low saturated fat intake. It showed a 76 percent reduction in heart-disease-related deaths for those consuming more than five servings of fruits and vegetables per day and less than 12 percent of calories from saturated fat, compared to those with less vegetation and more saturated fat.1 Even this small increase in vegetation and mild reduction in saturated fats showed a dramatic reduction in heart-disease-related deaths.

I’ll think of the DASH as just that, a short little burst of health, but eating a vegetable-based nutrient-dense diet—THAT’S FOR THE LONG HAUL!

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According to new research stroke risk in the United States is higher than that of Europe. Julie Steenhuysen of Reuters reports:

U.S. women are twice as likely to have a stroke as European women, and American men have a 61 percent higher chance compared with European men.

"What we find is, especially in the very poor, Americans have a much higher prevalence of stroke than Europeans," said Mauricio Avendano of the Erasmus Medical Center in Rotterdam, who presented his findings at the American Stroke Association's International Stroke Conference in New Orleans.

He said Americans have more preventable risk factors such as diabetes, high blood pressure and obesity.

And, it seems Americans are having a really bad flu season this year. This time Maggie Fox of Reuters reports:

Influenza is widespread in 49 states, and this year's epidemic has killed at least 22 children, the U.S. Centers for Disease Control and Prevention reported on Friday.

On Thursday the U.S. Food and Drug Administration agreed to completely change next year's flu vaccine mix because all three strains included in the flu shot cocktail have mutated. But companies have a head start on working with two of the three, the CDC's Dr. Nancy Cox said.

FDA advisers agreed with the World Health Organization recommendations made last week on changing the vaccine to match the drifting flu viruses.

These would probably be non-stories if we all ate and lived healthier—I know, I’m quite the daydreamer.

Not good. Apparently strokes have tripled among middle-aged women in the United States. And it appears obesity is to blame. Marilynn Marchione of the Associated Press reports:

Nearly 2 percent of women ages 35 to 54 reported suffering a stroke in the most recent federal health survey, from 1999 to 2004. Only about half a percent did in the previous survey, from 1988 to 1994.

The percentage is small because most strokes occur in older people. But the sudden spike in middle age and the reasons behind it are ominous, doctors said in research presented Wednesday at a medical conference.

It happened even though more women in the recent survey were on medicines to control their cholesterol and blood pressure — steps that lower the risk of stroke.

Women's waistlines are nearly two inches bigger than they were a decade earlier, and that bulge corresponds with the increase in strokes, researchers said.

This news is not to be taken lightly, and, this graphic really drives it home:

Now, improving your diet can help. Here Dr. Fuhrman talks about stroke-preventing monounsaturated fats and essential fats from plants:

There is no longer any question about the importance of fruits and vegetables in our diet. The greater quantity and assortment of fruits and vegetables consumed, the lower the incidence of heart attacks, strokes, and cancer.1

The best fats are monounsaturated fats and essential fats (omega-3 and omega-6) present in whole, natural plant foods, including avocados, olives, and raw nuts and seeds. Studies continue to show that consumption of raw nuts protect against both heart attack and stroke, without the risks of increasing heart disease and cancer, as is the case with the high consumption of animal-origin fats.2 When the fats you consume are from whole food, rather than oil, you gain nature’s protective package: a balance of vitamins, minerals, fibers, and phytonutrients.

So come on ladies—shape up your diet! We need you. We—I mean men—can’t be trusted to run the world by ourselves. Eat your veggies!

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Dr. Fuhrman’s got a question for you, “How can diabetics safely lower the high glucose levels that are slowly destroying their bodies?” Oh, that’s simple you—wait, lets explore this—what about gastric surgery? It was recently reported to be a good idea. From The New York Times:

Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery.

Yeah, I don’t know about this. I mean, maybe it’s a good idea, if you consider serious complications a key component of success. Hopefully this chart will help you think twice before you run out and get your tummy sliced open. Take a look:

Okay, in our age of modern medicine, drugs, drugs, and more drugs must be the answer! Yeah, if you don’t mind THE DYING! Recently, a diabetes study had to be halted because aggressively driving blood sugar levels towards normal was found to increase the risk of death in some diabetics. The Washington Post reports:

The startling discovery, announced yesterday, prompted federal health officials to immediately halt one part of the large trial so thousands of the Type 2 diabetes patients in the study could switch to less-intensive treatment.

"As always, our primary concern is to protect the safety of our study volunteers," said Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute, which is sponsoring the study.

Although the reason for the increased risk remains a mystery, Nabel and other experts stressed that the benefits of blood sugar control have been well established for diabetics and said patients should not make any changes in their care without consulting their doctors.

But the findings cast doubt on a major hope about diabetes treatment -- that pushing levels below current targets would be beneficial -- and would force experts to rethink how to treat one of the nation's leading health problems.

"It's profoundly disappointing," said Richard Kahn, chief scientific and medical officer for the American Diabetes Association. "This presents a real dilemma to patients and their physicians. How intensive should treatment be? We just don't know."

The findings are the second major blow to widespread assumptions about how to protect against heart disease -- the nation's leading killer. Another recent major study found that driving blood cholesterol levels as low as possible did not necessarily slow the progression of heart disease.

As you can imagine, Dr. Fuhrman was less than surprised by these results. Here’s what he had to say about it. Have a look:

It basically illustrates that giving diabetics more medication to better control their glucose numbers leads to more heart attacks; more medicine equals more heart attacks. Diabetes is a disease arising out of nutritional ignorance, obesity and lack of exercise and activity. The prescription must be nutritional excellence for an excellent outcome. Most diabetics who follow a nutrient-dense vegetable-based diet not only reduce their medication use, but they actually get rid of their diabetes and become non-diabetic.

So, back to Dr. Fuhrman’s original question, “How can diabetics safely lower the high glucose levels that are slowly destroying their bodies?” Well—as we just found out—nutritional excellence is a huge part of it. More form Dr. Fuhrman:

I have achieved marked success with diabetic patients and the success at becoming "non diabetic" or almost "non-diabetic" regularly occurs on the nutritarian program whether the patient follows a strict vegan diet or not. I describe the diet-style as a "vegetable-based" diet because the base of the pyramid is vegetables, not grains. Even though most animal products are excluded, it is not necessary to adopt a completely vegan diet to achieve the goals.

I offer patients the choice of adding two servings a week of low-fat fish, such as tilapia, flounder, sole, and scrod, as well as an egg-white omelet, once or twice each week. A few servings of very low-saturated-fat animal products each week can be interspersed with the vegan meals without diminishing the results achievable from the vegetable-based diet.

And lets not forget an obvious—but often overlooked—component of preventing and fighting diabetes is exercise. Let’s check back in with Dr. Fuhrman:

The most effective prescription for diabetes is exercise. An essential component of my prescription for diabetes is daily exercise; it is more important than daily medication. Two hundred calories a day of formal exercise on an incline treadmill and an elliptical machine are a great goal to shoot for. It is not an official recommendation of anyone except me.

Seriously, it’s a win-win situation for diabetics. You get to eat delicious food, stay active, lose weight, feel good, and, kick your diabetes in the butt. Can’t get much better than that!

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I once heard a chubby comedian say, “Men are like lasagna, we dress in layers.” And for a longtime this was my dress code; two layers of t-shirts, polo-shirt with t-shirt underneath, button-down shirt over t-shirt. Yup, I seldom left the house wearing only one layer. So you can imagine how much I dreaded the warmer summer months. How I’d yearn for winter!

But winter does have its drawbacks. Sure you can cover up those extra pounds with a little more clothing, but for many snuggling into a turtleneck and sweater, also means gobbling up more calorie-rich comfort food, especially around the holidays. Jane E. Brody of The New York Times insists this can be the beginning of a continuous weight-gaining cycle:

Then there’s the coming holiday season, replete with the stress of too much to do, high-calorie temptations at every turn and, it seems, not enough time to expend those extra calories.

The inevitable result for many of us? A few extra pounds that we must struggle to lose when the weather warms up and the days get longer next spring. Unfortunately, though, too often those pounds remain, only to increase further the next winter, and the next, until they undermine our health as well as our psyche.

For help preventing the cold weather weight-gain Brody enlists the aid of Dr. Michael D. Ozner, who as it turns out is a major advocate of the Mediterranean diet. Now, while you won’t hear Dr. Fuhrman singing the praises of Mediterranean diet anytime soon, Ozner does make a couple useful suggestions that might help you avoid winter/holiday weight-gain.

For starters, Ozner is not big on red meat, claiming it contains too much saturated fat , which can lead to an increased risk of cancer, heart attack, and stroke. He also encourages people to avoid processed foods because many of them are loaded with saturated fat, sugar, salt, trans fat, and high-fructose corn syrup. Dr. Fuhrman would definitely agree. Dr. Ozner’s recommendation to get plenty of exercise is another sound piece of advice. Although I can’t say the same for his tip about adding whey to food, according to Dr. Fuhrman whey isn’t exactly a wonder-food.

Adapted from Dr. Fuhrman's book Disease Proof Your Child:

Although a low-saturated-fat vegan diet may markedly reduce risk for coronary heart disease, diabetes, and many common cancers, the real Achilles' heel of the low-fat vegan diet is the increased risk of hemorrhagic (vessel rupture leading to bleeding) stroke at a late age. Apparently the atherosclerotic (plaque-building) process that creates a local intravascular embolism (traveling clot) may be protecting the fragile blood vessels in the brain from rupture under years of stress from high blood pressure. Admittedly, hemorrhagic stroke causes a very small percentage of deaths in modern countries. It still is worth nothing that if strict vegetarians are to have the potential to maximize their lifespan, it is even more important for them to avoid a high salt intake because salt intake increases blood pressure. Almost all of the soy-based meat analogues and many other health food store (vegan) products are exceptionally high in sodium.

A number of studies both in Japan (where the high-salt had made stroke a leading cause of death) and in the West have illustrated that fewer animal products and a low serum cholesterol were associated with increased risk of hemorrhagic stroke.1 Keep in mind, stoke mortality is significantly higher in Japan and exceptionally high in certain areas of China where salt intake is high, in spite of low-fat diets. It is also well established that Third World countries that do no salt their food are virtually immune to hypertension, the age-related rise in blood pressure we see in 90 percent of Americans, and they are immune to the incidence of strokes.

The high salt ? high blood pressure ? stroke causation chain may be more likely a late-life event in a vegetarian successfully maintaining excellent heart health. So avoiding excess sodium may be even more important for a vegetarian than for an omnivore. Of course, excess sodium increases both heart attack and stroke death in all diet styles, but in a vegan, the high-salt diet is even more likely to rear its ugly head as a cause of late-life morbidity and mortality, especially since they will often live longer and not have a heart attack first.

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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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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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Yesterday DiseaseProof received an interesting comment. Paul had some concerns about the information discussed in a previous post, Study Suggests Mechanism of Vegetables' Anti-Cancer Activity. Dr. Fuhrman offered this response:

You can always reduce your risk of lung cancer by quitting smoking at any point before cancer begins. We can look at dropping lung cancer rates comparing smokers who start smoking young and then quit compared to those who keep smoking. If you quit after 30 years of smoking your risk of lung cancer is half that of a person who continues to smoke (after 10 years), but it does not drop to zero where it would be if you never smoked. Likewise, you can reduce your risk of a variety of cancers with nutritional excellence, even if it is too late to maximally protect yourself or totally eliminate the risk at this age. It is important to note that a much more radical change to nutritional excellence is needed to see a significant reduction in risk at this later age.

But don't forget, even people who have cancer have been shown to live longer eating the healthful, anti-cancer dietary style I recommend in my books. Beneficial dietary changes have been shown in studies to prolong life for people with breast and prostate cancer.

It is important to keep in mind that heart disease and stroke (clots) are the leading cause of death in the modern world. It kills more individuals than all those cancers added up together. If you are still alive you can make a decision right now to never have a heart attack or stroke and make sufficient changes in your eating habits to guarantee this never happens. Utilizing medications to lower cholesterol into the favorable range or utilizing natural substances to lower cholesterol to that favorable range (LDL below 100) is not enough. That will only reduce your risk of a heart attack about 30 - 40 percent. To really knock out the possibility of heart disease you must combine effective cholesterol management with nutritional excellence. Furthermore, when you follow my nutritional guidelines you should protect yourself against dementia as well.

I don't know about you, but it is not enough for me to lower my risk of sudden cardiac death by a mere 30 to 40 percent. I want to drop that risk down one hundred percent if possible. If you study my dietary advice I claim you can achieve dramatic reduction in cholesterol levels, triglycerides and cardiac risk that simply cannot be achieved by (medical) cholesterol lowering alone.

You can retard the aging process now, maintain a healthy weight, lower your blood pressure, prevent or reverse diabetes, protect yourself against stroke and the so-common mental decline seen with aging and overall live a better quality, healthier and longer life from making these improvements in your eating habits. Too many people suffer and die needlessly, and I'm sure millions of people at all ages would adopt a healthier diet-style if they learned the profound benefits they would receive.

For more information on this topic check out Dr. Fuhrman's book Disease Proof Your Child.

Reuters London reports that new studies conclude a quantitative relationship between consumption of fruits and vegetables and reducing risk of stroke. Professor Graham MacGregor of St George's medical school at the University of London commented on the studies:

For the first time we have shown a quantitative relationship between fruit and vegetable consumption and stroke.

It has been known that fruit and vegetables seem to reduce stroke but it wasn't known how much they did it by.

It is a very important finding because it really shows that the quantity of fruit and vegetables you should be eating is more than five a day.

In this excerpt from his book Eat to Live Dr. Fuhrman talks about healthfully getting stroke preventing monounsaturated fats and essential fats from plants:

There is no longer any question about the importance of fruits and vegetables in our diet. The greater quantity and assortment of fruits and vegetables consumed, the lower the incidence of heart attacks, strokes, and cancer.1

The best fats are monounsaturated fats and essential fats (omega-3 and omega-6) present in whole, natural plant foods, including avocados, olives, and raw nuts and seeds. Studies continue to show that consumption of raw nuts protect against both heart attack and stroke, without the risks of increasing heart disease and cancer, as is the case with the high consumption of animal-origin fats.2 When the fats you consume are from whole food, rather than oil, you gain nature's protective package: a balance of vitamins, minerals, fibers, and phytonutrients.

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