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Trying to lose weight? Let’s talk salad dressing.

November 13, 2014 Leave a comment

Spare 100 calories per day to lose 10 pounds in a year…some of those small choices like “dressing on the side” matter!

Quick! Raise your hand if you know someone whose strategy for losing weight is to eat a salad for lunch every day. If you’re like me, you probably know multiple people who have decided to conquer their ever tightening pants by eating an entrée-sized salad each day for lunch. Sadly, for a lot of those folks, this strategy doesn’t work.

Here’s the deal: lettuce, spinach and other salad greens are all incredibly low-calorie and so are all the fresh fruits and vegetables that top salads—carrots, celery, tomato, cucumber and peppers, along with pear, apple, orange and berries. Then we add the extras—chopped nuts, dried fruit, cheese, bacon, olives and croutons with a big ladle or two of dressing. All of a sudden, that healthy salad isn’t healthy and the number on the scale doesn’t budge.

For example, a Dallas chain of Tex-Mex restaurants offers a popular salad that is a large plate of crisp romaine lettuce, topped with two or three baby cherry tomatoes, aged cheddar cheese, fried tortilla strips, a handful of bacon and about 3.5 ounces of sliced Fajita chicken or beef. The house dressing is a spicy blue cheese. The lettuce and cherry tomatoes are terrific salad options and the sliced grilled chicken breast is a great source of lean protein. However, the rest of the salad is full of extra fat and calories! Even with “dressing on the side,” this type of salad isn’t going to help you fit in those snug pants. Sadly, if we pull the salad back to the lettuce, tomato and chicken (with dressing on the side), we are going to be ravenous, which leads us to devour the accompanying basket of chips.

Chicken Caesar Salad is probably one of the most popular salads and is available at most restaurants, from fast food to upscale gourmet. Again, the salad starts with a large plate of crisp romaine lettuce and is topped with grilled chicken, Parmesan cheese and croutons (which are chunks of bread tossed in butter or oil, salt and spices and toasted). If you’ve ordered the dressing on the side, the serving is likely about 1/2 cup. This salad, which many dieters describe as “another (boring) day of chicken and romaine lettuce” can easily have 800 to 900 calories and an amazing amount of heart-clogging saturated fat from the cheese, croutons and dressing.

At Cooper Healthy Living, our goal is to make healthy eating simple and that includes a conversation about the nutrition of salads. A salad that’s a healthy salad is going to start with a plate of greens and then be topped (hopefully) with vegetables and/or fruit every color of the rainbow. This type of salad is a wonder in the world of healthy eating—full of flavor, fiber and the healthy benefits that at least five servings of fruits and vegetables per day provide. Our rules for salad dressing follow:

  1. Order salad dressing on the side, as this gives you full control over the amount of dressing that goes onto your plate. This rule includes vinaigrettes, which we tend to think of as healthier. While vinaigrettes typically contain healthy plant-based oil, oil has 120 calories per tablespoon and a normal vinaigrette recipe is typically three parts of oil to one part vinegar—so that serving of vinaigrette likely has around 400 calories in it.
  1. Ask for balsamic, red or white wine vinegar on the side. Several squirts of vinegar adds freshness and zest to a salad, which can then be augmented with a drizzle of oil, or whatever other salad dressing you have ordered.
  1. At Tex-Mex restaurants, boost salad dressings with salsa. A lot of salsa, which is low-calorie, plus a small bit of your favorite dressing tastes delicious and has far fewer calories than straight dressing. (Tip: with a thicker dressing, either dip your fork tines into the dressing first and then spear the vegetables, or use your fork to deposit a bit of the dressing strategically on your salad.)
  1. Bottled low-calorie dressings are generally pretty dismal, so at home, consider making salad dressings—they take mere minutes, cut calories and are wonderful! Our favorite all time dressing is this Rice Wine Vinaigrette, where we start with a package of Good Season’s Dry Italian Dressing Mix and then substitute water and dried parsley (for thickening) in place of some of the oil. This same recipe is also great switching out rice wine vinegar for balsamic! And this Caesar Salad Dressing, a semi-homemade combination of the low calorie bottled ranch dressing that’s not too tasty, full-fat bottled Caesar dressing, Worcestershire and Tabasco, to quick to make and is really delicious. In addition to using on your salad, the dressing is also terrific smeared on a sandwich or wrap.

This is Cooper Healthy Living, a series of baby tweaks and adjustments that help us live better and longer (and in pants that fit and fulfill our best vision of who we are)!

NEW Vitamin D-3 Drops and Vitamin D-3 Softgels

October 22, 2014 Leave a comment
Cooper Complete Vitamin D-3 Softgels

Cooper Complete Vitamin D-3 Softgels

This Fall Cooper Complete® Nutritional Supplements has given our Vitamin D consumers an extra dose of attention. Cooper Complete Vitamin D-3, our vitamin supplement, has changed forms from an orange colored tablet to a softgel. If you’ve been taking Vitamin D-3 in tablet form, the item number (and SKU) remain the same.

Why the change? The softgel allows us to provide the same 1,000 IU Vitamin D-3 in a form that has fewer “other ingredients” which provides a more pure supplement.

We’ve also added a new product, Cooper Complete Vitamin D-3 Drops. Why another Vitamin D from Cooper Complete? The team of physicians at Cooper Clinic made this recommendation. If you’ve been to Cooper Clinic any time since 2008, you know that vitamin D testing is part of the laboratory analysis. Because food forms of vitamin D are pretty limited and prescribing prolonged sun exposure can be problematic for most folks, individuals with vitamin D levels that are less than optimal (anything less than 30 ng/mL) get supplements.

Unlike a prescription Z-Pak (Zithromax) where one-size-fits-all, this is not the case for Vitamin D—the amount I need compared to what you need may be wildly different. For some, the 2,000 IU Vitamin D that’s in each of the Cooper Complete Multivitamin is plenty, for others, an extra 1,000 IU Vitamin D does the trick. And then there are the rest of us—who may need an additional, 2,000-5,000 or more per day! So, enter Vitamin D-3 Drops, a multi-size solution.

Cooper Complete Vitamin D-3 Drops

Cooper Complete Vitamin D-3 Drops

The Vitamin D-3 Drops bottle looks like an over-sized bottle of dry eye moisturizer. Unlike dye eye “tears” that are very runny, the D-3 Drops are a thick emulsion and it requires a bit of pressure and squeeze of the bottle to get a single drop dispensed. Each drop is 1,000 IU of Vitamin D-3, so depending upon how much vitamin D-3 your doctor has prescribed; you simply squeeze out the required number of drops. The bottle contains a whopping 750 droplets.

Vitamin D-3 Drops are perfect for:

  • Those who dislike or have difficulty swallowing pills
  • Those who need significant levels of vitamin D

This product is not ideal for:

  • Those who have manual dexterity or weak motor skills
  • Those who like to have their prescriptions and supplements organized in pill containers (as there is nowhere to put the bottle)

The official dosing instructions for Cooper Complete Vitamin D-3 Drops are to squeeze as many drops as needed directly onto the tongue. The drops are not completely flavorless, but the flavor is honestly not off-putting. Because vitamin D is fat-soluble, for optimal absorption, you should take this (and all multivitamin and mineral supplements) with a meal that contains some fat. If squeezing drops onto the tongue is difficult or off-putting, we offer these alternatives:

  • Dispense on top of a cracker or Saltine.
  • Dispense on top of a spoonful of yogurt, applesauce, or other cool or room temperature food
  • Do not add to water—vitamin D is fat-soluble and will sink to the bottom of the cup where it will stay.
  • Do not add to coffee or other hot beverages—vitamin D will dissolve and will also be lost in the process.

The shelf life of Vitamin D-3 Drops is one year and our existing supply is good through July, 2015.

Whether you choose to take Vitamin D-3 Softgels or Vitamin D-3 Drops, both forms are equally absorbed in the body. Visit coopercomplete.com to purchase or call 888.393.2221 today.

Taco Soup, Our All-Time Favorite Recipe

October 4, 2014 Leave a comment

So have you heard that October 4 is National Taco Day? According to the National Taco Day people, last year we ate more than 4.5 billion tacos. While taco is essentially the synonym for a sandwich in a tortilla, I want to take this one step further and talk about a sandwich in a bowl, what we call Taco Soup.

If you’re like me, a soup named “Taco Soup” sounds a little spooky—it connotes Tex-Mex flavors, but then I have images of previously crisp taco shells mixed with lettuce, tomato and cheese floating around! However, this poorly named soup is actually the number one, hands down favorite “go-to” recipe for legions of people who have attended our week long Cooper Healthy Living program over the years. It’s a workhouse of a dish exactly like all the various kinds of soft tacos. We incorporate leftover bits of protein with fresh crisp vegetables and salsa! But I digress.

Nutrition is a huge interest for most people, and in the Cooper Healthy Living program we spend about a third of our time either talking about food, or eating! In addition to workshops on optimal nutrition, stocking your pantry and refrigerator and dining out, each session includes two cooking schools and numerous healthy eating cooking demonstrations. This soup often turns up sometime throughout the week and so far, everyone loves this soup!

The recipe makes serious cooks scoff—definitely a semi-homemade recipe, if ever there was one! And yet it tastes delicious, healthy and somehow unhealthy all at once. You know what I’m talking about when I say it tastes “unhealthy”—it’s so delicious it’s hard to believe it’s really a terrific option when you’re trying to eat well and maybe even lose a few pounds!

When we talk with all the folks who have come to Cooper to live a healthier life, a concern for most is that they just don’t have time, or are simply too overwhelmed to figure out how to get a great, good-for-you meal on the table every night. Enter Taco Soup, dinner in a bowl.

Director of Nutrition for Cooper Healthy LivingKathy Duran-Thal, RDN, LD, was thinking about the harried home cook when she concocted this soup. This recipe is quick and easy and it’s adaptable, exactly like building individual tacos. Do you like things hot and spicy? Add a can of green chilies or a can of Ro*Tel®. Hate bell pepper? No problem, just leave it out! Does your kid think they really only like corn? Add an extra can! Want to expand the recipe as you’re having more people for dinner than expected? Again, not a problem!—Add a couple more cans of beans, corn and/or hominy.

All of us on the Cooper Healthy Living team make this recipe and we all make it a bit differently. At my house, I always use two cans of fire roasted tomatoes, a big can of green chilies and three cans of beans (usually one each of pinto, red kidney and black). I sometimes add a second can of hominy (and yes, the yellow and white taste the same). All of us like to make as big a pot of soup as possible as, sans the garnishes, it freezes beautifully.

On nights when we get home late, or are just too tired or busy to think about dinner, I pull out a dinner-for-two sized container from the freezer and pop it into the microwave. As the soup heats, I set out bowls and dig through my pantry and refrigerator for garnishes. While fresh lime, chopped cilantro and a dollop of sour cream are my favorites, fresh diced raw onion (any type) and pickled jalapenos are also wonderful.

In Cooper Healthy Living we teach the science of nutrition, but within the framework that healthy food should taste good and be easy and attainable. And this soup fills that bill. With a little bit of lean protein, beans for fiber, corn and tomatoes as vegetables, and a little bit of fat, this magic combination makes for an entree that will keep you full for the next 5 or 6 hours. It’s truly a perfect example of healthy eating.

If you need help in making sense out of your health and incorporating some healthier habits into your routine, think about coming to spend the week with us. Until then, enjoy a delicious bowl of Taco Soup. Share in the comments how you and your household adjust this recipe to make it your favorite soup, too!

Ingredients

  • 1 yellow onion, diced
  • 1 bell pepper, any color, diced (we like red)
  • 2 tsp olive oil
  • 1 lb lean (97/3) ground beef or turkey
  • 15 oz. can low sodium pinto beans, undrained
  • 15 oz. can low sodium corn, undrained
  • 15 oz. can yellow hominy, drained
  • 15 oz. can Muir Glen fire roasted diced tomatoes
  • 1/4 cup low sodium chicken broth
  • 1 package reduced sodium taco seasoning mix
  • 1 package (dry) Hidden Valley Ranch salad dressing mix
  • Fresh lime (optional as garnish)
  • Chopped Cilantro (optional as garnish)
  • Light Sour Cream (optional as garnish)

Directions

  1. Saute yellow onion and bell pepper in olive oil. Set aside.
  2. Cook ground beef and drain.
  3. Combine vegetables and meat into a medium soup pot. Add beans, corn, hominy, tomatoes, and chicken broth (optional).
  4. Stir in taco seasoning and Hidden Valley Ranch mix. Cook until warm and combined, about 10 minutes.
  5. To serve, fill bowl and garnish with fresh lime, chopped cilantro and a dollop of sour cream.

Nutritional Analysis
One Serving | One Cup

Calories: 134
Protein: 6 g
Fat: 1 g
Sodium: 650 mg
Carbs: 28 g

Fitness Trends

September 23, 2014 Leave a comment
Mary Edwards, MS, Fitness Director at Cooper Fitness Center

Mary Edwards, MS, Fitness Director at Cooper Fitness Center

One of the things I enjoy most about working at Cooper is the opportunity to keep learning! To that end, I try to attend as many lectures and presentations as possible, with the idea that it broadens my base of health and wellness information, and stretches my mind to learn and think about new and different ideas. (For all of us worried about dementia and Alzheimer’s, there seems to be some research that our brain, just like our other muscles is one that we need to “use or lose”!) This month, Mary Edwards, MS, fitness director and professional trainer at Cooper Fitness Center, presented the continuing education session held for the Cooper Clinic physician team.

Patients who come to Cooper Clinic are typically more physically active than the general population, so it’s not unusual for the physicians to be asked specific questions about fitness and exercise. So Mary’s presentation goal was to educate the physicians on some of the top fitness trends for 2014. As a basis for her talk, Mary referenced the American College of Sports Medicine (ACSM) survey completed by 3,815 health and fitness professionals worldwide. Here are some of the highlights:

High Intensity Interval Training (HITT)is the number one trend of the year. In a HITT workout, there are short bursts of high intensity work, followed by a period of recovery. The heart rate is typically at 80 to 95 percent of maximum, and the goal is to drive the heart rate quickly up, and then back down. There are all kinds of HITT programs in the marketplace – P90X (the 90-day home workout plan); Circuit Training with 10- or 15 stations that also includes cardio; CrossFit; and outdoor boot camps, are all examples that incorporate HITT.

Twenty minutes of HITT is enough time for a workout, so Mary says this exercise is great for busy people! There’s also the bonus that science shows this type of exercise helps reduce abdominal fat, an issue for many of us. The downside of HITT is that it is potentially dangerous for non-conditioned people – taking an ill-conditioned heart rapidly up and down is a recipe for disaster, so you should discuss your interest in this type of exercise program with your doctor before diving in.

Number two on the list is Body Weight Training. Exactly like it sounds, body weight training requires little (if any) equipment and is strength training that can be done anywhere. In addition to squats, lunges, push-ups, and the like, modern day body weight training typically includes core conditioning – where there’s a focus on strengthening the “core” or trunk of our body. Total Resistance Exercise (TRX) classes, which use a suspension system for exercise, are an example of a popular body weight training program. Mary provided the factoid that TRX classes were started by a U.S. Navy SEAL who wanted to stay fit in a small, confined space, so he sewed together pieces of parachute material and made straps (which he suspended) for exercise. The exerciser uses their body weight and the suspended straps for an all-over body workout. Initially called “suspension training”, the former Navy SEAL came home and built the TRX business on this initial concept.

Cooper Fitness Center members posed for a fun group shot after a ViPR workout.

Mary reported that many outdoor boot camps focus on body weight training, with potentially the addition of terrain, and/or a few pieces of equipment. Boot camp classes cover the gamut – everything from “Mommy & Me” classes to military-style classes where participants use sandbags, truck tires and logs as their exercise equipment!Another general trend is Strength Training. Mary reports that strength training has been popular since the first ACSM survey in 2007, and that this exercise is appropriate for all ages and athletic and/or conditioned ability. In traditional strength training, exercisers use their body weight plus all kinds of toys – dumbbells, kettle bells, TRX, Sandbells and ViPR equipment. Sandbells are neoprene discs filled with sand that can be used as one would typically use a free weight, but they can also be thrown, caught, slammed and gripped. ViPR, which stands for Vitality, Performance and Reconditioning, is a weighted rubber tube with built-in handholds that looks much like an oversized “pool noodle,” and is used to perform task-oriented movement patterning – for example, scooping the ViPR across and up and over the body, or potentially holding the ViPR to do a squat and then overhead raise. Watch video demonstrations from our trainers with the Sandbells and ViPR equipment. Mary also told us about how kettle bells, a weighted metal device that looks like a small purse (with handle) to me, were created in Russia back in the 1700s!

With the numbers of aging baby boomers it’s no surprise that Fitness Programs for Older Adults is another trend. In addition to balance, yoga, Pilates and resistance training (AKA strength training), fitness programs for older adults also purposefully include “brain fitness” exercises, that focus on coordinated movements. So, for example, I might hold the ViPR in front of me and do a Romanian deadlift (RDL) combined with an overhead raise and a leg raise when I do the overhead raise. If my description sounds complicated, I think that’s the point – the idea is that the exerciser really has to focus and think about what they’re doing!

Good fitness programs for older adults also incorporate lots of functional exercises, designed specifically to help us prevent from turning a “trip” into a “fall”, or building muscle strength so if we’re down on the ground we can get back up. So, it’s not a surprise that Functional Fitness was another big trend. Mary shared how the trainers at Cooper Fitness Center have been focusing on functional fitness for years – the whole focus of conditioning in the gym is to support a great life outside the gym!

Yoga class in Cooper Fitness Center’s Mind/Body Studio. Hard work happens in this calm and serene environment. The accordion doors open for fresh air and cool breeze during seasonal weather.

The economy is likely influencing the trend towards  Group Personal Training. Like it sounds, two to four people share a trainer and work out together in group personal training. Larger than one-on-one personal training, but much smaller than a traditional group exercise class, group personal training allows the exercisers to have interaction and glean support from one another, but also reduces the cost of personal training. Here at Cooper, we launched Small Group Training in February, 2014. Professional Fitness Trainers conduct the classes, and are adept at customizing exercises based on specific injuries, limitations or disability. Mary reports that Small Group Training is perfect for those who are cost-conscious as well as anyone seeking the camaraderie and support of a group. Small Group Training allows for more personalized service than in a larger traditional group exercise and many of the sessions are targeted to specific exercise goals, be it weight loss, or being lean and toned for skinny jeans!

Mary mentioned that Yoga, another trend for 2014, is part of a 7 billion dollar mind/body business segment! Some classes are technically difficult, while others focus more on the breathing and relaxing, meditative aspects of the practice. The most popular type of yoga in the United States is Iyengar, where individual poses are held.

Mary talked too, about how the fitness industry continues to evolve, with more and more focus being put on certifications and credentials. At Cooper Fitness Center, Professional Fitness Trainers hold a college degree in an exercise related field and have a minimum of two years’ work experience in addition to industry certifications. (Many of the trainers also have graduate degrees.) When the gym adds a new member, the on-boarding process includes a physician supervised exercise Treadmill Stress Test at Cooper Clinic. From there, a Professional Fitness Trainer conducts a functional movement screening developed by Gray Cook of seven tests to assess movement of the body. The seven tests are squatting, stepping, lunging, reaching, leg raising, push-up and rotary stability. Each movement is scored between zero and three points. A zero is assessed if the movement causes pain, and a three is assessed if the person performs the movement perfectly. Anyone with pain gets immediately referred out to a medical specialist for treatment before continuing any exercise. The research shows that a score under 14 is a prediction of injury if the person just jumps into exercise, without undergoing corrective work first. Gray Cook, the founder, says “first move better, then move often.”

The old advice “don’t start an exercise program without first seeing your physician” is still good advice, and all the more important if you’re committed to re-engaging aggressively with physical activity.

H-E-B Slim Down Showdown

Kathy Duran-Thal, RDN, LD, has been the Director of Nutrition for Cooper Wellness for more than 25 years and all who interact with her praise her extensive knowledge, ability to relate and fun personality. In January, Kathy helped kick off the H-E-B Slim Down Showdown, a 12-week health and fitness program for H-E-B grocery store partners (employees) and customers. She spent a week teaching 30 program participants nutrition the Cooper way.

In the weeks since then, participants have had individual phone coaching with Kathy, logged their food, exercised and shared their journey in personal blogs. Kathy recently traveled to San Antonio for the H-E-B Slim Down Showdown finale.

Elizabeth Sandoval, a quality assurance technician at H-E-B’s bakery in Corpus Christi, and Richard Arrington, an H-E-B shopper from Aransas Pass, Texas, were two of the participants Kathy coached. Each of them won a $5,000 “Healthy Hero” prize for their involvement and dedication to the program. Richard, who originally weighed in at 385 pounds, improved his cholesterol by 75 percent, decreased his body fat by 36 percent and lost a total of 66.6 pounds. And Elizabeth improved her cholesterol by 28 percent, decreased her body fat by 36 percent and dropped 46.8 pounds. Read the news release and watch the video below to celebrate their success in their journey to live longer, healthier lives.

To learn about Cooper Wellness, click here or call 972.386.4777.

Prevent Fractures From Falls With Vitamin D Supplementation

October 23, 2013 1 comment

Sunshine vitamin DNews reports have picked up the story about a recent meta-analysis on vitamin D, and headlines have read: “Vitamin D doesn’t aid the prevention of Osteoporosis.” A meta-analysis (Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis) conducted by researchers at the University of Auckland in New Zealand and published in The Lancet earlier this month looked at 23 vitamin D studies. The studies totaled 4,082 generally healthy people (92 percent female) with an average age of 59 years. Bone mineral/density was studied at one to five sites in each study, with the sites being lumbar spine, femoral neck, total hip, femur, total body or forearm. Participants took 500-800 International Units (IUs) of vitamin D per day. Results of the meta-analysis showed a small benefit at the femoral neck in bone density, but no other areas. The lead author of the study, Dr. Ian R. Reid, said “for healthy people focused on osteoporosis prevention, vitamin D does not make a positive contribution.”

While this meta-analysis didn’t find vitamin D to be helpful in managing osteoporosis, the study doesn’t review vitamin D levels and the potential for falls. In May, 2012, the U.S. Preventive Services Task Force (USPSTF) recommended exercise or physical therapy and vitamin D supplementation to prevent falls in community dwelling adults 65 years or older who are at increased risk for falls.

Falls are the leading cause of injury in community dwelling adults 65 years or older, and 30-40 percent of adults 65 years or older fall at least once per year! Fractured bones are the result of approximately 5 percent of these falls, and two meta-analyses have found that vitamin D prevents fractures. Low vitamin D levels increases fracture risk. It has been estimated that as many as half of the older adults with hip fractures could have vitamin D levels below 30 ng/mL. (Optimal vitamin D is 30-100 ng/mL; suboptimal is 20-29 ng/mL and lower than 20 ng/mL is insufficient. Dr. Cooper likes to see levels 40-60 ng/mL in patients.)

Adult Cooper Complete multivitamins contain 2,000 IU vitamin D, and a standalone 1,000 IU Vitamin D tablet for individuals who need higher supplementation to get to an appropriate level.

Since falling is such a risk for older adults, it makes sense to stay aware of vitamin D levels through an annual blood test and to supplement as appropriate to get levels where they need to be. In addition, as Dr. Cooper has long advocated, it makes sense to commit, at every stage of life, to move and exercise like your life depends on it.

For our latest recommendations subscribe to our free e-newsletter The Cooperized here.

Podcast: Does Calcium Consumption Make Sense? Dr. Nina Radford Weighs In

Dr. Nina Radford, Cooper Clinic

Dr. Nina Radford, Cooper Clinic

Nina Radford, MD, Director of Clinical Research and a cardiologist at Cooper Clinic, talks with Vitamin Expert Todd Whitthorne, about research reported in February 2013 by BMJ that calcium supplements are linked to significantly increased heart attack risk. Dr. Radford, board certified in Internal Medicine and Cardiovascular Disease, gives her opinions about calcium consumption (in both food and supplements) for women who are concerned about both bone health and heart health.

Click here to listen to the interview.

Vitamin D and Calcium Researcher, Robert Heaney, MD, is Interviewed

March 15, 2013 Leave a comment
Robert Heaney, MDDepartment of Medicine at Creighton University | Vitamin D & Calcium Researcher

Robert Heaney, MD
Department of Medicine at Creighton University | Vitamin D & Calcium Researcher

Below is a transcript from Todd Whitthorne’s interview with Dr. Robert Heaney, professor in the Department of Medicine at Creighton University in Omaha.  Dr. Heaney has spent over 50 years in the study of osteoporosis, vitamin D, and calcium physiology; he’s authored three books and has published over 400 scientific papers, so when it comes to the world of vitamin D, and calcium in particular, Dr. Heaney is one of the leading gurus, literally, in the world!  Click here to listen to the interview, or continue reading for the transcript.

Todd Whitthorne

This is Todd Whitthorne and I’m very pleased today to be joined once again by Dr. Robert Heaney, who is a professor in the Department of Medicine at Creighton University in Omaha.  Dr. Heaney has spent over 50 years in the study of osteoporosis, vitamin D, and calcium physiology; he’s authored three books and has published over 400 scientific papers, so when it comes to the world of vitamin D, and calcium in particular, Dr. Heaney is one of the leading gurus, literally, in the world!  So Dr. Heaney thanks again for joining us.

Robert Heaney, MD

My Pleasure.

Todd Whitthorne

It’s certainly a pet peeve of mine, and I know it is one of yours as well, and that’s primarily the media – how they love to focus on harm, or potential harm, as opposed to the overwhelming benefits of certain topics, and what I’m primarily referencing is the of the recent headlines from the US Preventive Services Task Force saying that postmenopausal women should avoid taking low daily doses of vitamin D   and calcium to ward off bone fractures. They say that those amounts have no benefit for the primary prevention of fractures, but there is evidence that taking them could increase the likelihood of kidney stones. I know they released this last summer, and then it suddenly got another whole round of headlines, and I’m getting calls and e-mails with all sorts of questions about it and it drives me a little bit nuts! What about you?

Robert Heaney, MD

Well, yes, it was originally published in draft form in June of last year and that elicited a lot of media reaction because as you correctly point out the media love controversy, and if this seems to contradict the accepted wisdom then that’s considered newsworthy. However, it tends to get exaggerated. The current recommendations, which are essentially the same as the draft form nine months ago. The current recommendations are really quite confusing because they do recommend taking calcium and vitamin D for the prevention of falls in the elderly, but they don’t recommend it for the prevention of fractures.  Well, so what’s a person to do?  Well obviously what the person should do is continue to take calcium and vitamin D supplements.

What they mean when they say they don’t recommend is not saying you shouldn’t do this,  it’s saying we don’t have the evidence to permit us to recommend this to you, and the kind of hidden subtext is “well it could be helpful, but we just don’t know.” Now in fact a lot of experts in the field feel they do know as a matter of fact…

Todd Whitthorne

I was going to say! What they know is not what you know, is it?

Robert Heaney, MD

Exactly, or right! And it’s worth pointing out  that the Preventive Services Task Force consists of public health people, not one of whom, to my knowledge, and I recall I checked his last June, not one of them has ever published a scientific paper on calcium or vitamin D.  I mean, they’re given a task, and the task is apply a certain set of rules to a set of published papers, and see if that constitutes evidence to make a formal recommendation, and if it doesn’t meet the standards of those rules, then they say “well, we can’t recommend.” But it’s very important that they’re not recommending against something, they’re simply saying they can’t recommend “for” it and there’s a big difference.

Todd Whitthorne

I understand. From a controversy standpoint, going back looking at PSA (Prostate-Specific Antigen Test) or mammograms, it’s not the first time that the US Preventive Services Task Force seems to be in conflict with a lot of the research world. But let me ask you in general, can calcium and vitamin D supplements increase the risk of kidney stones? What are your thoughts?

Robert Heaney, MD

No. No. No. I’m glad you asked that question. The truth is exactly the opposite. It’s been shown in good experimental studies, that increasing calcium intake decreases the risk of kidney stones. Now, I’m sure many people find it counterintuitive because kidney stones are made from calcium, and I must have too much calcium in my body and so I should cut down my calcium intake. Well, it’s been shown that if you do this you’ll double your risk of getting a recurrence of the kidney stone.  There was a wonderful study from Italy published eight to ten years ago now published in the New England Journal of Medicine describing the results of precisely such a study, and they had a set of male kidney stone formers and half of them were put on a low calcium diet, and the other half were asked to increase their intake of calcium, cheese and stuff you know, and those who increased their intake had half the recurrences of those who restricted their intake, and that fits the biology. The reason for that, as we may have discussed previously Todd, is that one of the principal risk factors for kidney stones is a chemical compound called oxalic acid or oxalate, the salt form of oxalic acid, and some of that comes into us into our body through our diet, through food. Well, oxalate is a very potent stone former, it’s a more important stone former than calcium, and if you have a high calcium intake by mouth, much of that calcium stays in your intestinal tract and combines with oxalate in food and prevents the oxalate from being absorbed into your body, and therefore doesn’t have to be excreted to the kidney…, and therefore it’s not in the urine to predispose to kidney stone formation.

Todd Whitthorne

I see.

Robert Heaney, MD

There’s very  good biology behind this, and lots of experimental data, and it does seem kind of counterintuitive, and many doctors don’t know what to tell you to do if you have kidney stones, so they say well you better cut out your milk or dairy or calcium supplements, or whatever the source may be.  But that’s actually bad advice, and we have to try to counter that, so no, it does not cause kidney stones.

The reference there is a single paper that came out of the Women’s Health Initiative in which in the group receiving calcium and vitamin D supplements there was a seventeen percent increase in risk of kidney stones. Seventeen percent – not very big.  But in fact if you look at the other segments of the Women’s Health Initiative Study, they had exactly the same kidney stone risk as this group that got the calcium and vitamin D supplements. So there really is no strong evidence there, and all the other evidence is in the other direction. It’s also worth noting that the vitamin D dose prescribed in the Women’s Health Initiative was only 400 IU (international units ) per day, and it’s worth noting that the compliance with the medication in the Women’s Health Initiative is only fifty percent.

Todd Whitthorne

Goodness.

Robert Heaney, MD

So that means on average, these people were getting only 200 IU (international units) of vitamin D –  that’s not capable of doing anything, good or bad! That’s such a tiny dose, that it couldn’t possibly make any difference. But that’s the only evidence they had to go on.  The point is that it was a big government study, and the US Public Services Task Force has these strong government connections so one talks to the other and they kind of feed off of one another. But the data points in exactly the opposite direction.

Todd Whitthorne

Well that’s very helpful, and you’re very clear in allowing us to understand exactly how that happens. One other headline Dr. Heaney, that I want to mention, and I’m sure many people have asked you about is the risk of calcium supplementation in terms of increasing the risk of heart attacks. What are your thoughts on that?

Robert Heaney, MD

Well, thank goodness that you don’t have to rely on my thoughts – that’s been clearly refuted in papers and major scientific journals in the last six months to twelve months, but mostly since last fall, and there’s always lag time because when those things came out, this was a group of New Zealand investigators who had seemingly found this kind of an effect in the study they did, and they’ve gone around the world with kind of an evangelistic  fervor to tell people to be careful this could be making them worse by giving them heart attack.  Well is a total re-analysis of big studies like the Women’s Health Initiative in this case, again, shows that this simply wasn’t true. It’s not just that it wasn’t found in the Women’s Health Initiative, but the New Zealand investigators had gone into the NIH database and had kind of cherry picked or preferentially selected some of the cases from the Women’s Health Initiative and used that to support their thesis. So, it was very important, therefore, that the people who had access to, and in a sense control of, the entirety of the data of the Women’s Health Initiative, repeat their analysis and they did, and they published that last fall and the answer is there’s nothing there.

Todd Whitthorne

That’s great news.

Robert Heaney, MD

So, the problem is that if you eat if you stopped taking calcium because of fear of a heart attack then the chances are you’ve increased your risk of a hip factor, and so more harm has been done. And I think it’s very important to say we all need more calcium and we all need more vitamin D and there are some ways to get that, but you mustn’t worry about an increased risk of heart attack because the evidence shows it’s not there. It’s not just that there isn’t any evidence to show it is there, it’s actually the opposite, it’s not there at all – there is no reason to believe that.

Todd Whitthorne

One more question Dr. Heaney. I know you’ve spent a great deal of your life studying these topics. The recommendations now seem to be at least 2000 IU of vitamin D per day is a pretty good starting point for most people. I know you have commented and lectured frequently about the dosage of 2600 IU reduce risk of falls and fractures, as well as other medical issues, but still, there is a huge variability between a three and six fold variance in terms of how we as individuals react to vitamin D.  So what are your recommendations for both vitamin D and calcium for men and women?

Robert Heaney, MD

Well, I tend to swim against the stream a little bit here, and in this connection I should alert you to the fact that the US Preventive Services Task Force is once again looking at this vitamin D issue and raising the question of whether we should screen for vitamin D deficiency, and I’m quite sure that they’re going to come up with a “No, we shouldn’t.”  I know the American Society of Clinical Pathologist, in trying to be good citizens, but I think bending over backwards, have identified five tests that physicians should think twice about ordering because, they, in their judgment, are probably not very helpful, and one of them is measuring vitamin D status…, and I think that’s wrong. But that’s all kind of preamble to the answer to your question. The only way to tell whether you’re getting enough vitamin D is by measuring. You have to measure what’s in the blood, because as you pointed out, the response to a given dose varies over six-fold range. We think that that’s because  we think that that’s because different people have different capacities of the enzyme, probably mostly in their livers, that is responsible for converting vitamin D into the form that we measure in the blood stream, that is 25-hydroxyvitamin D. Some people are what I call very slow hydroxylaters, and others are every fast hydroxylaters, which means they have a lot of the enzyme necessary to do it, and in the other case means they don’t have much of the enzyme, so they don’t get as much for their vitamin D dose as somebody else does, and that means they need twice as much, or three times as much, or maybe even six times as much as the other person. We can’t tell that from looking at their forehead – there isn’t any UV or invisible ink on the backs of their hand you can scan with a UV lamp and see whether this person will need more or less.  A good place to start, as you say, is at 2000 IU (international unit) per day, and once you’ve done that we like to measure them three to six months later. If they’re up in a good range, we stick with 2000 (IU); if they’re not then we double it until we get them where we want them. But you can’t tell that without measuring, so I’m strongly in favor measuring.

Todd Whitthorne

Okay. How about (recommendations) for calcium?  Is there a difference between men and women? I know calcium is more challenging because there’s not a blood test for calcium like there is for vitamin D.

Robert Heaney, MD

There’s no way to assess calcium by a simple test. Vitamin D is really a wonderful nutrient in that regard as it permits measurement the status, and of the compound that the body is actually looking at and needs and uses. But we don’t have that for calcium as you correctly point out. Actually, this is a bit of a digression, but in all of these nutrient controversial areas, I take as my benchmark ancestral intake; that is, what did humans take before the agricultural revolution, surely before the Industrial Revolution, but before the agricultural revolution which was a giant change in the kinds of foods we ate. The natural vitamin D level under ancestral conditions would’ve been between 40 and 60 ng/ml. We know that because it is been measured in East African tribes that are following ancestral lifestyle, so I take as my benchmark, well I’m back in my blood level up to where it would have been had I been living under the more primitive circumstances.

Todd Whitthorne

Sure.

Robert Heaney, MD

And the reason for that is that our physiology has been fine tuned to what the environment provided during the millions of years in which the human body was developing, and human physiology was evolving. Different animals have different requirements everything. For example, rats and mice are primarily nocturnal animals and therefore don’t get vitamin D from the sun in usual way. They have very low requirements and they metabolize vitamin D very differently. But we grew up in equatorial East Africa that’s how we developed, so we were getting sun every day of the year, and of course we didn’t wear clothing and didn’t have a lot of fur, so we got a lot of vitamin D. Now when it comes to calcium, the best guess is that we probably were getting from 1500 to 2500 mg of calcium per day, and again, I’d like to take that as my benchmark. Now that doesn’t have to come in, in the form of supplements, it’s probably better if it’s taken in as food, but the important thing is to get it in.  The reason that it’s better as food is that with the decreased physical activity of the modern urbanized human,  we can’t consume as much food as we did before, and many of the foods available to us are calcium poor, and micronutrient poor, and if we provide just the calcium in the form of the supplements then we’re not taking care of the other micronutrients that are probably deficient in the same individuals. So, I’m a strong advocate of natural food sources of calcium, but there’s definitely a role for supplements and that’s to be what their name says they are – supplements. But there’s a lot of sense to people take nutrients in and in the sense of taking medicine for a specific endpoint all nutrients are necessary for all body tissues, and it’s a mistake to think of a single end point because what with both calcium and vitamin D, I can name dozens of systems that are adversely affected by inadequate intake of either or both nutrients, so the goal is our bodies need these things, all of our organs, and all of our tissues need these things, and we should be focusing on this as nutrition, and not as medication.

Todd Whitthorne

Very Good. Well Dr. Heaney, I want to thank you for your time.  I want to point out to our listeners that Dr. Heaney has several wonderful scientific presentations available on YouTube (http://www.youtube.com/).  If you like to really dig deep and hear about some of Dr. Heaney’s research, and the things he’s been involvement there are three or four really good presentations available on YouTube. Continued success, and as always, I appreciate your time very much.

Robert Heaney, MD

Thank you very much.

Todd Whitthorne

Dr. Robert Heaney our guest today on our healthy living podcast.  As always you can get more information at www.CooperAerobics.com

Podcast: Jorn Dyerberg, MD, the Father of the Omega-3 Movement, Interviewed

March 14, 2013 2 comments
Jorn Dyerberg, MDFather of the Omega-3 Momvement

Jorn Dyerberg, MD
Father of the Omega-3 Momvement

Todd Whitthorne interviews Jorn Dyerberg, MD, the father of the omega-3 movement. Dr. Dyerberg was studying the Eskimos, who ate a high fat diet, and had very low rates of heart disease, and discovered the protective effects of omega-3 fatty acids (EPA and DHA) in marine sources. Dr. Dyerberg talks about advances in the science of omega-3 fatty acids from 1970 to present day, and a bit about the 25,000 studies that have been conducted during this time period. Once studied primarily for cardiovascular health, researchers have also studied the impact of omega-3 fatty acids on inflammatory disorders, brain health, eye health, etc. Dr. Dyerberg discusses the protective effects of omega-3 fatty acids, and how much of the nutrients we need for optimal health.

Dr. Dyerberg is also the co-author (with Richard Passwater and Cheryl Hirsch) of  the book The Missing Wellness Factors: EPA and DHA: The Most Important Nutrients Since Vitamins?

Click here to listen to the interview.

Vitamin K Supplements

March 13, 2013 2 comments
Jill Turner

Jill Turner

We had a question this morning about Vitamin K supplements. The writer asked for information on vitamin K-2 (supplementation from MK-7), along with calcium and vitamin D for bone health, and wanted to know about the form of vitamin K used in Cooper Complete Original multivitamin and mineral formulations.

Vitamin K is an essential nutrient the liver uses to form proteins that promote blood clotting (and prevent abnormal bleeding). There are three basic forms of vitamin K:

  • Vitamin K1 (which includes phytonadione, the form in our multivitamin) is a natural nutrient found in green leafy vegetables, and in smaller amounts, some oils (oil, soybean and canola).
  • Vitamin K2 (menaquinones or MKs) include MK4 which is found in meats and dairy products. MK7 is found in some fermented foods, like cheese. This form of K is also found in a Japanese soy product called “natto”. (There’s a website where you can purchase “nattomoto powder” to use with soybeans to make natto. Some say it smells strong, pungent and cheesy, and others say it doesn’t have a lot of smell.)
  • Vitamin K3 (menadione) is a man-made form of vitamin K. This form isn’t sold as a supplement for humans, ut is sometimes used in feed for life stock.

Healthy adults eating plenty of leafy green vegetables typically get all the vitamin K they need through their diet. Food provides the body with about half the normal supply of the vitamin needed, and intestinal bacteria produces the rest.

A deficiency can occur in individuals who are on antibiotics for extended periods, have liver damage, or intestinal disorders such as celiac disease. Alcoholism can also contribute to a vitamin K deficiency.

In humans, vitamin K supplements may increase bone mineral density and bone strength. The majority of studies have been conducted on patients in Japan using the menatetrenone form (vitamin K2) of vitamin K as fermented soybeans (Natto) are part of breakfast for many Japanese. Epidemiological studies suggest that decreased vitamin K intake is associated with increased risk of hip fracture, but not decreased bone density, although the association between low intakes of vitamin K and decreased bone density was seen in women in some studies. More research is needed on the potential impact of vitamin K on bone health. We also need research on the subject in the US – with the Japanese studies we don’t know what other foods or lifestyle habits might be different than those of the typical American and yet affect the outcome of the studies.

With its role in blood clotting, consumption of vitamin K is a major issue for individuals on Warfarin (blood thinners), and has to be closely watched as increases in vitamin K make warfarin less effective. For this reason, the Basic One multivitamin and mineral formulations do not contain vitamin K.

It appears that consumption of vitamin K2 (through food or supplementation) can last days longer than vitamin K1, the form found in plants and plant-based supplements, so keep this in mind if you decide to add vitamin K2 to your diet or supplement regimen.