Killer Fat / Ray D. Strand, M.D.

Central weight gain is a hallmark sign of insulin resistance. Even though not everyone who develops insulin resistance will also have central weight gain, approximately 85 to 90% Her will gain a significant amount of weight around their middle. This is why physicians are beginning to take out their tape measure during an annual physical exam, instead of just weighing their patients. Central weight gain is associated with elevated blood pressure, elevated triglyceride levels, low HDL or good cholesterol, high total and LDL or bad cholesterol, along with an increase risk of developing clots (increased fibrinogen levels).

Another hallmark sign of central weight gain is a tremendous increase in the amount of inflammation you have in your arteries. Central fat releases a tremendous amount of inflammatory products. Your highly sensitive C - reactive protein (hsCRP), which measures inflammation in your arteries and is a very good indicator of having a higher risk of a heart attack, can rise significantly. You can see why I am so concerned when a patient who comes into my office for their annual physical and is showing signs of an expanding waist size. All you have to do is take out a tape measure and measure 1 inch below your belly button and over the top of your hips. This is the best measurement for central abdominal fat. Women should become concerned when this gets above 32 to 33 inches and men should become concerned when it gets above 36 to 37 inches.

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine

Lowering Homocysteine Levels / Ray D. Strand, M.D.

Most people seem to know their cholesterol level; however, they rarely know their homocysteine levels. Physicians just do not order this test routinely. The homocysteine level should be below 7, and higher levels cause greater risks of developing cardiovascular disease. Even though physicians may tell you that a homocysteine level of 12 or lower is fine, I would encourage you to try to get this level below 7. First, I would recommend taking 1,000 mcg of folic acid, 50 to 150 mg of vitamin B12, and 25 to 50 mg of vitamin B6. If you are one of those individuals who does not totally respond to B vitamins, you can consider adding Betaine (Trimethylglycine or TMG) to reduce your homocysteine levels. I recommend starting with 1 gram daily and building up to as much as 5 to 6 grams if necessary to get your homocysteine level down below 7, or at least below 8.

There have now been over 50 clinical trials that have shown that those individuals who have elevated homocysteine levels are not only at higher risk of developing cardiovascular disease but also Alzheimer’s dementia and various cancers. Yet, there have not been any good studies showing that lowering your homocysteine levels actually decreases your risk of heart disease and stroke. My personal feeling is that they do not lower the homocysteine level enough and that there is very little difference between the control subjects and the treated group. Since we know that elevated homocysteine levels are definitely a risk factor for patients, wouldn’t it be best to lower their homocysteine levels to the safe range?

If you would like to know your homocysteine level and your doctor will not order it, members of my “Online Medical Practice” located at http://www.drraystrand.com/ can order this blood test in the US through my web site.

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine

Should I be Taking a Statin Drug to Lower my Cholesterol? / Ray D. Strand, M.D.

About 2 years ago, a panel of 11 cardiologists met (as reported in USA Today) to lower the recommended level of LDL cholesterol from 130 to 100. Obviously, the pharmaceutical industry was ecstatic with these new recommendations. However, it should not have come as a surprise to them, since 10 of the 11 cardiologists were on the payroll of one of the pharmaceutical companies. The problem with this recommendation is that nearly 98% of the population in the US and Canada has an LDL cholesterol level greater than 100. These recommendations would mean that nearly the entire population should take statin drugs. The New York Times reported that maybe statin drugs should be placed in our drinking water.

Several clinical trials show that individuals who are at risk of developing heart disease can decrease this risk by taking statin drugs. The problem is that researchers are not really sure if it is the lowering of cholesterol that lowers the risk or if it is the anti-inflammatory properties of the statin drugs. I believe that it is probably a combination of both of these effects. If you lower LDL cholesterol, there is just less that is available to become oxidized. Just like aspirin has been shown to decrease the risk of cardiovascular disease due to its anti-inflammatory qualities (it all starts to make sense doesn't it), the statin drugs do the same. However, I have always believed that we should use drugs as a last resort and not a first choice. Statin drugs are truly over prescribed.

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine

Oxidized or Modified LDL Cholesterol / Ray D. Strand, M.D.

Native or natural LDL cholesterol is not a concern when it comes to heart disease. It acts as a transport vehicle of cholesterol. However, when this LDL cholesterol becomes modified or oxidized by excessive free radicals, it causes a tremendous amount of inflammation of our arteries. Fat soluble antioxidants like vitamin E, beta carotene, and alpha lipoic acid have the ability to incorporate themselves within the wall of the LDL cholesterol and offer protection against this oxidative process. The medical literature shows that the higher the level of antioxidants within the wall of the LDL cholesterol, the more it is able to resist this damage by excessive free radicals.

Dr. Daniel Steinberg reported in the New England Journal of Medicine in 1989 that if enough antioxidants were on board, LDL cholesterol levels would not be a concern.

The problem is that physicians are not able to measure "Oxidized" LDL cholesterol levels in the lab. This is primarily research done in clinical trials. Physicians just measure total LDL cholesterol. This is why I believe it is so important to supplement all of these antioxidants and their supporting nutrients at optimal levels (cellular nutrition) to best protect your LDL cholesterol and decrease inflammation of your arteries.

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine

What Causes Inflammation of Our Arteries? / Ray D. Strand, M.D.

The first question people should ask themselves is "What actually causes inflammation of my arteries?" If heart disease and aging of my arteries are results of low-grade inflammation over a prolonged period of time, then it would make logical sense to try to avoid those things that cause that inflammation.

• Dr. Ross listed several different causes of inflammation of our arteries in his review article found in the New England Journal of Medicine:
  "Oxidized" or "Modified" LDL cholesterol-NOT native LDL cholesterol

• Excessive free radicals created by high blood pressure, diabetes, central obesity, elevated or rapidly rising blood sugars, and from a fatty meal.


• Elevated homocysteine levels (this is a byproduct of protein metabolism that is primarily the result of vitamin B deficiency).


• Elevated levels of insulin due to insulin resistance.
  

When I treat a patient who has suffered a heart attack or has had coronary by-pass surgery, my goal is to eliminate all the causes of inflammation. The next several "Health Nuggets" will discuss this health concept.

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine

Heart Disease-an Inflammatory Disease / Ray D. Strand, M.D.

Dr. R. Ross wrote a review article in the New England Journal of Medicine in 1999 titled "Atherosclerosis: An Inflammatory Disease." Atherosclerosis is simply hardening of the arteries. This leads to heart attacks and strokes. He states in this article that heart disease is not caused by too much cholesterol in your blood stream, but, instead, is the result of a prolonged, low-grade inflammation of your arteries. In fact, over 50% of the patients suffering from a heart attack actually have normal cholesterol levels. We have been told for nearly a generation that the problem is really just cholesterol. Certainly, this is what the pharmaceutical industry hopes you believe. The medical literature clearly indicates that heart disease is NOT a disease of cholesterol.

There are over 1.5 million heart attacks and over 750,000 deaths due to heart attacks in the US each year. Heart disease remains the number one killer in the US and the industrialized world, even though we are spending billions of dollars each year on cholesterol-lowering drugs. While there are several studies that prove taking statin drugs can lower your risk of having a heart attack, researchers are not sure whether this is the result of lower cholesterol levels or the anti-inflammatory properties of the statin

RAY D. STRAND, M.D.
Specialist in Nutritional Medicine