New York Buyers’ Club - The Blog

We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.

In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).

Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.

Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).

The Linus Pauling Institute at Oregon State University provides a good review of research on fish oil (omega-3 fatty acids) and Type 2 diabetes (see excerpt below). Although there was some concern that fish oil supplements might interfere with glycemic control (= control of blood sugar levels) in diabetics, that does not seem to be the case. Moreover, fish oil supplementation can significantly lower triglycerides in people with diabetes, and there is good epidemiological evidence that over the long term higher omega-3 fatty acid intakes may also decrease the risk of cardiovascular disease in diabetics.
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Cardiovascular diseases are the leading causes of death in individuals with diabetes mellitus (DM). Hypertriglyceridemia [...] is a common lipid abnormality in individuals with type 2 DM, and a number of randomized controlled trials have found that fish oil supplementation significantly lowers serum triglyceride levels in diabetic individuals. Although early uncontrolled studies raised concerns that fish oil supplementation adversely affected blood glucose (glycemic) control, randomized controlled trials have not generally found adverse effects of fish oil supplementation on long-term glycemic control. A systematic review that pooled the results of 18 randomized controlled trials including more than 800 diabetic patients found that fish oil supplementation significantly lowered serum triglycerides, especially in those with hypertriglyceridemia. A more recent meta-analysis that combined the results of 18 randomized controlled trials in individuals with type 2 DM or metabolic syndrome found that fish oil supplementation decreased serum triglycerides by 31 mg/dl compared to placebo, but had no effect on serum cholesterol, fasting glucose or hemoglobin A1c concentrations. Although few controlled trials have examined the effect of fish oil supplementation on cardiovascular disease outcomes in diabetics, a prospective study that followed 5103 women diagnosed with type 2 DM, but free of cardiovascular disease or cancer at the start of the study, found that higher fish intakes were associated with significantly decreased risks of CHD over a 16-year follow up period. Thus, increasing EPA and DHA intakes may be beneficial to diabetic individuals, especially those with elevated serum triglycerides. Moreover, there is little evidence that daily EPA + DHA intakes of less than 3 g/day adversely affect long-term glycemic control in diabetics. The American Diabetes Association recommends that diabetic individuals increase omega-3 fatty acid consumption by consuming two to three 3-oz servings of fish weekly.

See also the NYBC entry on DHA Max, a DHA/EPA supplement from Jarrow.

The people at the AIDS Treatment Data Network (ATDN) have developed a series of “Simple Fact Sheets” about treatment and management of HIV. Their fact sheet on “Nutritional Management of Lipodystrophy,” written by an HIV nutritionist at Cabrini Medical Center in New York, covers diet (the right mix of carbohydrates, protein, fruits and vegetables, the right kinds of fats), exercise, and supplements, beginning with a good multivitamin, preferably one that includes a good set of antioxidants. There’s also a description of some supplements that may be useful in reducing lipodystrophy: L-carnitine, NAC, chromium, alpha lipoic acid, B-complex vitamins (niacin may be key among the B vitamins, but the recommendation is to always supplement using a B-complex, since the different B vitamins support one another’s action), and omega-3 fatty acids (fish oil and/or flaxseed).

 To read the entire fact sheet, go to

http://www.atdn.org/simple/nutrlip.html

Several antiretroviral drugs for people with HIV can cause elevated blood fats, which may increase the risk for cardiovascular disease. One of the therapies that has been tested for managing high cholesterol and triglycerides is fish oil, which has a long history of use to counter cardiovascular disease.

From the March 1, 2007 Journal of Acquired Immune Deficiency Syndromes: French researchers conducted a prospective, double-blind trial to assess the effect of N-3 polyunsaturated fatty acids — better known as omega-3 fatty acids — found in fish oil.The study included 122 HIV positive patients on HAART who still had elevated triglyceride levels (between 2 and 10 g/L) after a 4-week diet. Participants were randomly assigned to receive 2 capsules containing 1 g of fish oil (Maxepa) or else placebo capsules 3 times daily for 8 weeks, followed by an open-label phase during which all participants received fish oil. Ten individuals with baseline triglyceride levels above 10 g/L were not randomized and received open-label fish oil from the outset.

Results

• The median triglyceride level decreased by 25.5% in the fish oil group, while rising by 1% in the placebo group.
•At week 8, the mean triglyceride levels were 3.4 and 4.8 g/L, respectively.

• Triglyceride levels normalized in 22.4% of subjects in the fish oil arm compared with 6.5% in the placebo arm (P = 0.013).

• 58.6% and 33.9%, respectively, experienced at least a 20% reduction in triglycerides (P = 0.007).

• Patients in the fish oil group experienced a slight decline in total cholesterol level, compared with a small increase in the placebo arm. • During the open-label phase, the decrease in triglycerides was sustained at week 16 for patients in the fish oil group, while those initially in the placebo group experienced a 21.2% decrease after switching to fish oil.

• The patients with baseline triglyceride levels above 10 g/L experienced a 43.6% decrease by week 8.

• No significant differences in adverse events were observed between the fish oil and placebo arms.

Conclusion “This study demonstrated the efficacy of [polyunsaturated fatty acids] to lower elevated triglyceride levels in treated HIV-infected hypertriglyceridemic patients. [N-3 polyunsaturated fatty acids] have a good safety profile.”“The place of polyunsaturated fatty acids in the armamentarium of treatment of metabolic disorders in HIV-infected patients needs to be further investigated with future prospective studies…” 

Thought we’d draw attention to a great online resource for getting the basics on a supplement, and for checking on potential interactions among supplements, drugs, food, alcohol:  Physicians’ Desk Reference (PDR) Health.
Below is an excerpt from the entry for EPA (fish oil), which includes the usual warning about interaction with blood-thinnning medications like Coumadin.

See also the entry on fish oil on the NYBC website.

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EPA

What is it?
EPA is an oil that comes from fish. It is used to treat asthma, cancer, arthritis, Lupus, blood clotting, gingivitis (gum disease), high cholesterol, hypertension (high blood pressure), colitis (inflammatory bowel disease), Crohn’s disease, and psoriasis. EPA is also used as an antiinflammatory (help with pain and swelling), to stimulate the immune system, and for cardiovascular health, to help prevent heart disease and stroke. It may also be used to prevent Alzheimer’s disease.

Other names for EPA include: Eicosapentaenoic Acid, Fish Oil, Omega-3 Fatty Acid, Essential Fatty Acid. 
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Drug and Food Interactions:
Do not take omega-3 fish oils such as EPA without talking to your doctor first if you are taking:

Blood thinning medicines (examples: warfarin (Coumadin(R); dicumarol (Dicumarol(R))

Here’s a Jan. 2, 2008 post on the www.sciencedaily.com website reporting on new findings on the mechsnism of action of fish oil as a deterrent to Alzheimer’s Disease.

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Greg Cole, professor of medicine and neurology at the David Geffen School of Medicine at UCLA and associate director of UCLA’s Alzheimer Disease Research Center, and his colleagues report that the omega-3 fatty acid docosahexaenoic acid (DHA) found in fish oil increases the production of LR11, a protein that is found at reduced levels in Alzheimer’s patients and which is known to destroy the protein that forms the “plaques” associated with the disease.

The plaques are deposits of a protein called beta amyloid that is thought to be toxic to neurons in the brain, leading to Alzheimer’s. Since having high levels of LR11 prevents the toxic plaques from being made, low levels in patients are believed to be a factor in causing the disease.

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The researchers examined the effects of fish oil, or its component DHA, in multiple biological systems and administered the oil or fatty acid by diet and by adding it directly to neurons grown in the laboratory.

“We found that even low doses of DHA increased the levels of LR11 in rat neurons, while dietary DHA increased LR11 in brains of rats or older mice that had been genetically altered to develop Alzheimer’s disease,” said Cole, who is also associate director of the Geriatric Research Center at the Veterans Affairs Medical Center.

To show that the benefits of DHA were not limited to nonhuman animal cells, the researchers also confirmed a direct impact of DHA on human neuronal cells in culture as well. Thus, high levels of DHA leading to abundant LR11 seem to protect against Alzheimer’s, Cole said, while low LR11 levels lead to formation of the amyloid plaques.

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 Quite an interesting supplement, fish oil. The first focus on its health benefits was directed at heart health and cardiovascular concerns. However, more recently there has been a lot of investigative energy devoted to the effect of omega-3 fatty acids on cognitive function and mood.

See, for example, the posts on “Depression” on this blog, which detail some of the recent findings about fish oil’s potential for addressing mood.

The New York Buyers’ Club stocks

DHA Max (Jarrow). See description here.

Here’s an excerpt from a 2006 New York Times article, which points out some of the resistance to supplements that is a feature of US medicine–in this case, rather clearly to the detriment of American cardiac patients.

Note: the American Heart Association’s recently updated guidelines on fish oil / omega-3’s are posted on this blog under “Omega-3″ - Oct. 23, 2007.

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In Europe It’s Fish Oil After Heart Attacks, but Not in U.S.

by ELISABETH ROSENTHAL

ROME — Every patient in the cardiac care unit at the San Filippo Neri Hospital who survives a heart attack goes home with a prescription for purified fish oil, or omega-3 fatty acids.

“It is clearly recommended in international guidelines,” said Dr. Massimo Santini, the hospital’s chief of cardiology, who added that it would be considered tantamount to malpractice in Italy to omit the drug.

In a large number of studies, prescription fish oil has been shown to improve survival after heart attacks and to reduce fatal heart rhythms. The American College of Cardiology recently strengthened its position on the medical benefit of fish oil, although some critics say that studies have not defined the magnitude of the effect.

But in the United States, heart attack victims are not generally given omega-3 fatty acids, even as they are routinely offered more expensive and invasive treatments, like pills to lower cholesterol or implantable defibrillators. [...]

“Most cardiologists here are not giving omega-3’s even though the data supports it — there’s a real disconnect,” said Dr. Terry Jacobson, a preventive cardiologist at Emory University in Atlanta. “They have been very slow to incorporate the therapy.”

[...]

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Note: Full article appeared in NYT Oct. 3, 2006 and was accessed from the online edition by us on Nov. 11, 2007.

In its annual bibliography of significant advances in dietary supplement research for 2006, the National Institutes of Health focused on two studies in the category of “cognitive health.” One, involving gingko biloba, found that a component of this botanical may have therapeutic potential for the prevention and treatment of Alzheimer’s disease. This research on gingko provides further background information for of two large randomized controlled investigations that are now underway: the Gingko Evaluation of Memory study, and the GuidAge study.

A second study in the “cognitive health” category was a clinical trial that followed patients with mild to moderate Alzheimer’s disease who took omega-3 fatty acid supplements, as compared to those taking placebo. A significant reduction in cognitive decline was found in those with very moderate dysfunction who took the omega-3.

This investigation also was undertaken in support of a wider investigation on Alzheimer’s and omega-3s, which is being funded by the National Institutes of Health.

This recommendation appears on the website of the American Heart Association:  
Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of — or who have — cardiovascular disease. We recommend eating fish (particularly fatty fish) at least two times a week.  Fish is a good source of protein and doesn’t have the high saturated fat that fatty meat products do.  Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).To learn about omega-3 levels for different types of fish — as well as mercury levels, which can be a concern — see our Encyclopedia entry on Fish, Levels of Mercury and Omega-3 Fatty Acids.We also recommend eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These contain alpha-linolenic acid (LNA),  which can become omega-3 fatty acid in the body. The extent of this modification is modest and controversial, however. More studies are needed to show a cause-and-effect relationship between alpha-linolenic acid and heart disease.The table below is a good guide to use for consuming omega-3 fatty acids.Summary of Recommendations for Omega-3 Fatty Acid Intake

And we add some general dietary advice about fat:

Remember that the balance of fats you eat is the first, most important step to consider. Dump the hydrogenated fats (found in cookies, margarine and lots of things; read labels!), limit saturated fat intake (dairy, red meat, fried stuff) and increase good fat intake (deep sea fish like salmon, tuna; olive oil, hemp oil, etc.) Lastly: in controlling cholesterol through modifications in diet, it’s not always emphasized enough that sugar intake will also influence your cholesterol levels!