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Introducing the New Cooper Complete Supplement: MVP

By Vitamin Expert Todd Whitthorne

Imagine this: It’s a beautiful sunny day–perfect baseball weather. You’re in the batter’s box facing Texas Rangers pitcher Yu Darvish. Nerves aside, you’re wondering what type of pitch will be hurled your way. Will it be a 97 mile-an-hour fastball or a 64 mile-an-hour curve ball? Since it takes a mere half-second for a pitch to reach home plate, your decision to swing will be made in the blink of an eye.

In that fraction of time, your eyes must evaluate the speed, direction and anticipated path of the pitch. That visual “data” is passed through the optic nerve, into the brain, which then sends a signal through your nerves to your muscles to immediately react to the information being processed. This all hinges on your hand-eye coordination which can mean the difference between a game-winning base hit or game-ending strikeout. The start of this entire process is obviously highly dependent on vision.

He Did What?
On a recent trip to Brazil I met with “Professor” Oscar Erichsen, the head trainer of Atletico Paranaense, one of the country’s premier soccer teams. He recalled in great detail a moment during the 1970 World Cup in Mexico City. Pele, arguably the best soccer player in history, took a shot on goal from midfield. The shot sailed wide but the mere fact that Pele had even attempted such a feat sent shock waves throughout the soccer world. Professor Oscar explained that the shot attempt was significant for two reasons. One was the obvious leg strength that it took to launch such a blast. The other was more subtle.

Pele had an incredible ability to constantly evaluate data while in the throes of competition. For instance, how were his teammates positioned in comparison to the competition? How fast was Defender A compared to Defender B? How did the length of the grass and the direction of the wind impact the flight of the ball? On this particular play, Pele sensed the defenders nearest him were out of position and that the opposing goalie had drifted away from the net. In an instant he made the decision to take a shot that, despite being off-line, fans still talk about over 40 years later.

Scientifically this ability to read one’s external environment is known as “exteroception” and Professor Oscar said no one has ever had it better than Pele. This is similar to what we hear about great point guards, “He has eyes in the back of his head,” or about outstanding quarterbacks, “The game just seems to slow down for them.”

MVPSee Stronger with Cooper Complete MVP
Vision is a key performance factor in just about every sport. The ability for an athlete’s eyes to adapt to varying light conditions, whether from artificial indoor light or bright sunshine outside, has a direct impact on performance.

I’m very excited that we have added a new product to our Cooper Complete line of nutritional supplements: Cooper Complete MVP (Maximum Vision & Performance). This product is scientifically formulated to improve tolerance to glaring light by 58% and reduce glare recovery time by 5 seconds performance, as well as improve contrast sensitivity–the ability to distinguish a white ball against a blue sky. The ingredients in MVP are pure, potent and supply the proper nutritional levels that research shows are most beneficial to athletes of all levels looking for a competitive edge.

I encourage you to visit our website to learn more or purchase Cooper Complete MVP.

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.

Are you Getting Enough Vitamin D?

February 12, 2013 Leave a comment

By Todd Whitthorne,  Vitamin Expert

Today’s Healthy Living Section of the Dallas Morning News featured a story on healthy ways to make your face more beautiful, which included protecting your skin from the sun’s UV rays. As a guy that works at Cooper and oversees our vitamin and nutritional supplement line, I spend a great deal of time following the literature on this topic.

I obviously agree that the sun can do tremendous damage (aging and increased risk of skin cancer). But I also I think it’s always important to remind folks that when it comes to sun screen you should be careful “not to throw the baby out with the bath water.” That same UVB light that accelerates aging and increases cancer risk is also the same light that generates vitamin D.

We have a vitamin D deficiency epidemic in this country. An article published in the 2009 Archives of Internal Medicine found that 77 percent of U.S. adults and adolescents were insufficient in vitamin D (90 percent of Mexican-Americans and 97 percent of all non-Hispanic blacks). At Cooper Clinic we have been measuring vitamin D levels in our patients since 2006, and we find approximately 80 percent of our first time patients have levels lower than we like to see (<40 ng/ml).

Dr. Ed Giovannucci, a highly respected researcher from Harvard, wrote in the Journal of the National Cancer Institute in 2006 that “sunlight might prevent 30 deaths for each one caused by skin cancer. I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D. The data are really quite remarkable.”

Of course, then the question comes up of whether physicians prefer that their patients get vitamin D through supplementation, as opposed to directly from the sun. That really depends on whom, and what type of doctor, you ask. Most of the research indicates that there is really very little difference between the two.

Most physicians feel supplements are the most logical choice because of ease, cost, accuracy of dosing, etc. Dermatologists clearly like to steer folks away from the sun. However a few, including Dr. John Cannell, Founder of the Vitamin D Council, feel that the sun is the preferred method since that’s the way we were “designed” to get vitamin D (listen to a podcast with Dr. Cannell).

Obviously no one, including Dr. Cannell, recommends getting a sun burn, but for most folks 10-15 minutes of unprotected sun exposure seems to be a logical, and safe, dose. The problem is how often do most people go out in a bathing suit, or shorts and a tank top, between 10 a.m. and 2 p.m. when the UVB light is most available? Clearly if the weather is gloomy and overcast that wouldn’t be practical.

Something else to keep in mind is that there is a huge variability in how much vitamin D we synthesize from the sun, or absorb from supplements. There clearly is no such thing as “one size fits all.” Cooper Clinic physicians recommend starting with 2000 international units (IU) of vitamin D-3 per day and go up in dose as needed. The ideal method to determine how much vitamin D you need is to get a blood test. But from a practical standpoint, most people aren’t going to take the time or spend the money to do that. 2000 IU per day may not get them to an “optimal” blood level, but for most individuals it will at least help them avoid “deficiency” (less than 20 ng/ml).

Even though I run and ride my bike outside quite a bit, I have found that I need to take 5000 IU of Vitamin D-3 per day for me to maintain a blood level of 60 ng/ml (my ideal target). But remember, everyone is different. The main takeaway is to make sure to get your vitamin D. Whether it’s from the sun or supplements….just get it.

Is it True that Birds of a Feather Flock Together?

January 29, 2013 Leave a comment

By Vitamin Expert Todd Whitthorne

WSJ Image

Image from The Wall Street Journal

There was a recent article in the Wall Street Journal  I found very interesting. It was about “mixed-weight couples” where one partner is overweight and the other isn’t.  Researchers from the University of Puget Sound and the University of Arizona studied 43 heterosexual couples and found those in the “mixed-weight” category experienced more relationship conflict, including resentfulness and anger, than so-called “same-weight” couples.  The results were published in the December 2012 issue of the Journal of Social and Personal Relationships.

Results also indicated that those couples with the most conflict involved a healthy-weight man and an overweight woman.  When just the man was overweight it wasn’t much of an issue.

Hmmmm!

It’s not news that men and women are different. John Gray made that very clear in his famous book, Men Are From Mars, Women Are From Venus: The Classic Guide to Understanding the Opposite Sex. Weight is a very touchy subject and when it comes to relationships, one should always tread lightly. However, while they certainly exist, “mixed-weight” couples are not the norm. We know that those in our “warm circle,” which obviously includes spouses, have a huge influence on our behaviors and habits, and ultimately our weight. A study in the July 2007 issue of the New England Journal of Medicine found that if your spouse is obese then you are 37 percent more likely to be obese. It might be surprising to learn that if your friends are obese you are 171 percent more likely to be obese! As I often say, when if comes to your health, which includes your weight, you are NOT the Lone Ranger!

In the Cooper Wellness Program we don’t often see “mixed-weight” couples. Usually those that come with their spouse have similar Body Mass Indexes and their overall health is fairly comparable. What we do see quite often though is a spouse motivated to improve his or her health that comes through the program solo. Then, after they spend six days getting Cooperized they leave campus completely convinced they will return home and “motivate” their spouse to hop on the wellness bus and embrace a healthy lifestyle. “Whoa, slow down!” In cases like this you need to be careful.

The last lecture of the Wellness Week is called “Managing Expectations” and its placement is intentional. We know that if you are willing to invest a reasonable chunk of change and six days of your life to come through the Wellness Program you are most likely in a “stage of change” that vastly improves your odds of success. More simply, you are ready to change. Remember, “When the student is ready, the teacher will appear.” But ONLY when the student is ready.

It’s human nature that once you participate in a positive experience you want to share it with those you love. The problem however is if your loved one isn’t ready to change then your unbridled enthusiasm will most likely not be received as you intend it. In fact, it might completely backfire which could then potentially extinguish your flame. I’m not saying this always happens…just don’t be surprised if it does.

Change is difficult and when a spouse or close friend decides to change, even if it’s a positive change, then it often is viewed as a threat to the one being “left behind.” “What’s wrong with the way we’ve been ____________(fill in the blank…living, eating, exercising, etc.) for all these years? Am I suddenly not good enough for you?” It can lead to some very difficult, but necessary, conversations.

Stanford’s Dr. BJ Fogg teaches that as humans we are lazy, social and creatures of habit. Overcoming the status quo is often very hard but relying on the experience of experts can dramatically improve your odds of success. Human “energy” can be phenomenally helpful but remember that we are all unique and when it comes to change, those we love don’t always move at the same speed.    

No Apologies!

October 3, 2012 1 comment

Bob Proud and Todd Whitthorne finishing the Run Proud 5K. Photo provided by Jerry Glover Photography. 

By Todd Whitthorne, CEO and President of Cooper Complete Nutritional Supplements and Cooper Wellness.

Written on September 29, 2012.

I ran a 5K this morning.  Actually “jogged” is a much more accurate description than “ran.”  It was the Run Proud race to help raise money for ALS/MDA.  The race started and finished on the campus of Cooper Aerobics Center and is named after our former running pro, Diane Proud, who passed away last year from ALS (Lou Gehrig’s Disease).  She was 59.  Diane was one of the nicest, most sincere individuals I ever met.  She loved helping all runners and triathletes, but she had a special fondness for beginners.  Sharing her passion for fitness allowed Diane to impact the lives of hundreds of people in a very positive way.

It was a perfect day for running…temps in the low 70s with a cool, steady drizzle.  Wet, but not enough to get in the way.  Just enough to let you feel “connected.”

Before the race I saw Bob Proud, Diane’s husband.  He was actually the reason I got up early today.  During Diane’s extended three-year illness, I often crossed paths with Bob and was always awed by his unwavering, upbeat spirit.  He knew, as did Diane, that a diagnosis of ALS is always, not sometimes, not usually, but ALWAYS fatal.  That didn’t deter Bob.  He knew that maintaining a high-energy, optimistic attitude was exactly what Diane needed most.

I had not seen or talked to Bob since Diane’s funeral last year and wanted to shake his hand.  I did that about 15 minutes before the race, and we talked briefly.  I would have liked to talk more, but just about everyone involved in the race had known Diane and Bob, and like me, they wanted to say hello.  I didn’t want to monopolize his time.

At the starting line I saw friend who is a longtime member of Cooper Fitness Center.  We decided to run together, although he warned me he was having issues with his I.T. band and wasn’t sure how he would hold up.  Normally, he wouldn’t have even considered running, but like many of us, he was there because of his love and appreciation of Diane.  Sure enough, after less than a quarter of a mile into the run my buddy had to pull out.  Doing that is never fun, but it was clearly a smart move.

I continued on at a very comfortable (read slow) pace.  Soon, as the course extended down a long stretch through a beautiful neighborhood, I looked up and saw Bob running by himself.  His pace was right in sync with mine, so I gradually began to narrow the gap and after a minute or two, we were side by side.  We started talking and it wasn’t long before Bob encouraged me to, “Feel free to run ahead.  Don’t let me slow you down.”  Little did he know, I was delighted to be running at such a moderate pace.  Even though I’ve been lifting consistently and cycling on a pretty regular basis, my running mileage has been down so I wasn’t in a great position to take Bob up on his offer.  Besides, for me the opportunity to run with Bob and talk about life far exceeded the need to foolishly push myself to meet some arbitrary 5K time.  From a very selfish standpoint, this was a great chance to spend about 30 minutes one-on-one with a guy that I had really come to respect but had not taken the time to let him know that.

As often is the case when running, we talked about all sorts of things; the radio business, The Rangers’ pennant race and why a relatively flat neighborhood suddenly felt like the Newton Hills in Boston!  More than once Bob apologized for his slow pace, “My 5K time is now beginning to approach my 10K PR.”  I assured him not to worry about it, “No need to apologize.”  I reminded him that the fact we were out running early on a Saturday morning, regardless of the speed, probably put us in the top half of one percent of most Americans as it relates to physical activity!  All the research shows that the vast majority of benefit from exercise comes from just getting off the couch.  A little bit, on a consistent basis, goes a long way in improving health and quality of life.

Diane Proud with Cooper teammates at the 2011 Run Proud 5K

As we neared the end of the course and came back onto the Cooper campus, there were all sorts of folks cheering us on: friends, family, volunteers and many runners who had finished before us.  Most recognized Bob and were very supportive and enthusiastic.  Last year, less than a week before she died, Diane was at the finish line passing out cupcakes to every single runner that crossed the finish line, despite the fact that she could no longer talk and was so weak that she was confined to a golf cart.  This year there was no Diane.  I was glad it was raining hard enough to mask the fact I was tearing up a bit.  Bob was quickly surrounded by a crowd of well-wishers, so I gave him a high-five and began my post-race recovery, which included all sorts of wonderful fare provided by the race sponsors.  That’s always one of the great bonuses of finishing an endurance event…all the fun treats!

I felt great afterwards.  I had gone on a nice run, seen a lot of friends and co-workers, and it was early enough so that most of my Saturday was still before me.  Most importantly though, I appreciated the wonderful time I had spent with Bob and promised myself I would reach out to him soon to schedule a dinner or a workout.

And guess what? This afternoon I got an email from Bob THANKING ME for running WITH HIM! How great is that?  I told him the pleasure was all mine…and I meant it!

Interview with Cooper Clinic Head of Cardiology Dr. Nina Radford about Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

September 18, 2012 2 comments

Dr. Nina Radford, Cooper Clinic

Todd Whitthorne talked with Dr. Nina Radford, about the systematic review and meta-analysis Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events published in the JAMA September 12, 2012, Vol 308, No 10 issue. Click here if you would prefer to listen to the interview.

Todd:  Hello once again this is Todd Whitthorne with another healthy living podcast and I’m joined today by Dr. Nina Radford, the Head of Cardiology for the Cooper Clinic and we’re going to talk about a recent article in JAMA that discussed a meta-analysis of omega-3 as it relates to the cardiovascular benefits.  So Dr. Radford, this can be a rather complicated topic because we’re talking about statistics and scientific research, but I do know we have a very educated and inquisitive listening audience, so let’s walk through this paper because the headlines we’ve seen in the newspapers or heard on the radio basically came out and said that “omega-3, or fish oil, did not show benefit for cardiovascular health.” Can we dig a little deeper and explain really what this paper was investigating, and what the results showed?

Dr. Radford: Absolutely! I’m just delighted to discuss this with you because as we both know, sometimes these very important papers get condensed into a single, simple sentence or headline that may peak an individual’s attention but doesn’t always tell the whole story…, and this paper I think is a good example of that.

So this paper is a meta-analysis, and what that means is it is combining information from multiple studies, and why would you want to do that? Well, if you combine studies together your population will grow, so for example in this meta-analysis they combined the data from 20 studies so it included almost 69,000 patients.  When you have a larger patient population, it’s easier to see small effects that may occur that may be statistically significant. The problem with combining studies is that all studies are a little bit different… the ages of the patient may be different; the formulation of the omega-3 being used may be different; they time they use the omega-3 may be very different; it may be in a different country where native foods are very different for example, from the United States. So, one of the problems is that when you combine studies that are very different, and you reach conclusions from them, your house is sort of built of rickety wood, so you have to be careful in terms of how you interpret it. That being said, what we have are this combination of 20 studies. The median age is 68, and I’ll remind you median means that 50% or below that age, and 50% are above, and in these studies the age range was 49 to 70. In these studies, the median dose of omega-3 was about a gram, and that’s probably less than most people consider taking daily today.

Todd:  I’m sorry. That’s a gram of EPA plus DHA, not a gram of fish oil, correct?

Dr. Radford: That’s correct. And the range was from .53, so half a gram, which most of us would consider on the lower side, to 1.8 grams per day. The treatment duration was about two years and spanned from one to six, and the important thing about these studies is that 13 of the 20 were secondary prevention studies.  What that means is those participants had already been diagnosed with heart disease. They had heart attack, bypass, heart failure, sudden death, stents, but they were not people who were taking it to prevent the first event. Rather, these were people who were put on fish oil to prevent a second cardiovascular event or death. Four of the studies were mixed primary secondary, you couldn’t really sort out which was which, and three of the studies had to do with preventing sudden death in people who had implantable cardiac defibrillators (those are the internal defibrillators that shock you if you have a potentially life-threatening heart rhythm abnormality). So again, these are patients who are older, they have known heart disease, and they’re taking EPA plus DHA at a median of a gram for about two years.

Now, one of the things that we have to remember in all of this is that there’s pretty good reason to think that fish oil may help when we look at basic science. There have been studies that suggest it lowers blood pressure, lowers triglycerides, may stabilize heart rhythms, may reduce the stickiness of the blood to form to form blood clots, so there’s some good rationale from which these studies were conducted, and that’s always sort of reassuring to know there’s some basic science that underlies these. So in this analysis, they looked at five major outcomes  – all cause mortality (that’s the risk of dying of anything); cardiac death (dying of heart attack); they looked at sudden death (which is a heart rhythm abnormality); rather than having a heart attack and then having heart failure, for example; having a nonfatal heart attack; or stroke.

When we look at whether or not a result is statistically significant, we look at something called the P value, and the P value helps us decide if this result that could happen by chance, or is this the result that can withstand rigorous statistical testing? And we rely on that P value as readers of medical science, to let us know yes, that’s statistically significant, or no it’s not.  We don’t just rely on the number that we see, we have to rely on the statistics to back it up, so in this population is that meaningful.

Now, in most studies that I read, a P value of significance is a P value less than 0.05. When you know that the P value is less than that, you know it’s statistically significant. And when we look at that range of P value in this study, there was actually a demonstrated benefit in terms of reducing cardiac death. It reduced it by about 9 percent. Now, what’s made this somewhat controversial is these authors have decided to make a much more limited P value of .0063, and that’s rather usual, and that requires that the effect be more robust if you will, in order to prove that it’s present.

And when we look at studies – for example you may remember testing hormone replacement, and did hormone replacement reduce the risk of death for example? In all of those studies the P value is 0.05. If you look at whether statin medications reduce the risk of dying from heart disease, the P value is 05. So the use of this very, very small P value, is a little unusual and not everybody is accepting it when we look at this study. So certainly, what I would conclude from this study, based on a P value I think is reasonable, is that there is likely a small reduction in cardiac death in the studies of patients who are older and already had advanced heart disease.

One of the things I think is very interesting in this paper is that they provide sort of a chronologic history. They start with studies done in the mid- 1995’s and they go through the studies that were published more recently in 2012.  And what’s interesting is in the studies that were published in the in the mid-to-late 90s until 2005, there was a benefit of omega-3 in terms of all cause mortality. But when you look at the most recent studies that were published in 2010 or 2012 you did not see that effect. So does that mean that the studies that were done early on were wrong? Absolutely not!  What we see is an effect of improving medical science and improving technology. Compared to 1995, patients who are treated after a heart attack today are treated with much more sophisticated medications. Their lipids are much more aggressively lowered compared to patients in 1995, so if I add a therapy like omega-3 fatty acids, which have a small benefit compared to those other therapies, it may be hard to see that benefit unless you have an extraordinarily large number of patients in the trial. And so, I don’t see this as being a call to throw away all your fish oil.  Rather, I see this as a recommendation that there is likely is benefit, but it’s small, compared to the other known therapies that we have for patients treated after a heart attack.  Now let me be very clear that this has no bearing on patients who haven’t heart disease yet; who haven’t had their first heart attack yet. Maybe they have high cholesterol.  Maybe they have a strong family history of developing heart disease and they want to prevent their first event.  This paper doesn’t address population all.

Todd:  Clearly, what’s interesting about omega-3, is that there are literally thousands of studies that have been done looking at the various and assorted benefits and in a variety of areas, but in particular cardiovascular disease.  So for someone healthy, someone that is just looking to improve their overall cardiovascular risk profile, omega-3 still make sense from your perspective as a cardiologist?

Dr. Radford: I think that they definitely ought to be offered to patients. I think that they definitely may have some benefits in terms of reducing death from cardiovascular disease. I think compared to their other therapies, like statin medications or low dose daily aspirin, that effects may be small, but every little bit helps if we’re talking about reducing your risk of dying of heart disease.

Todd:  And that main benefit as we hear so much about inflammation, that seems to be the benefit of omega-3, as an anti-inflammatory?

Dr. Radford: And there may be benefits well beyond that, that we simply don’t have enough knowledge about.

Todd:  Very good. Well Dr. Radford, as always I appreciate your insight.  It’s like going to Paul Harvey for the rest of the story, to break it down and simplify something that is very, very complex, so we appreciate it.

Folks, if you want more information, you can sign up for The Cooperized Newsletter. As always, we’ll keep you updated with whatever we can here on the podcast and on the website. Until next time, this is Todd Whitthorne. Have a great day. Be healthy.

Interview with Cooper Clinic head of cardiology Dr. Nina Radford about HDL Cholesterol

August 27, 2012 3 comments

Todd Whitthorne recently sat down with Dr. Nina Radford, and discussed HDL Cholesterol. Click here if you would prefer to listen to the interview.

Todd:  Hello, and welcome to another Healthy Living podcast from Cooper Aerobics Center. This is Todd Whitthorne, and I’m joined today by Dr. Nina Radford the head of cardiology at the Cooper Clinic, and Dr. Radford we have a topic today that I think is going to interest a lot of our listeners. Generally when it comes to health, we like to distill things down to takeaways, and when it comes to cholesterol we have a tendency to think that LDL is lousy and the HDL is healthy. There’s a recent study published in May of 2012 in the Lancet that says, well maybe raising HDL is not all that beneficial.  What do we need to know about that?

Dr. Radford: Well Todd, that’s a great question. Historically, when we talk about cholesterol parameters, as you described, we look at LDL, and when it’s high it’s bad for us – it increases the risk of heart attack…, and when we look at HDL, if it’s too low, it increases our risk of heart attack. And those are associations – if we look at a group of people who’ve had heart attacks versus a group of people who haven’t, and you find that high LDL is associated with heart attacks and low HDL is associated with heart attack, but that doesn’t necessarily prove causation.

Now with LDL cholesterol, there have been a number of studies that have gone on from “association” to proving “causation,” and how do we do that? Well first we say “Gosh, if high LDL is associated with heart attack, if we lower it with drugs does that lower the risk?”, and in fact there have been many, many studies showing if you lower LDL cholesterol with diet or medication, you reduce the risk of subsequent heart attacks.

They can also look at from another angle, and that is the genetic angle. There are some people who are actually born with genes that cause their LDL to be low. So, they look in those families who have those genes that cause low LDL, and they ask the question “In those families, is there a reduced risk of having a heart attack?”, and in fact there is. So, whether or not your LDL is low because you take medicine, or you follow specific lifestyles, or it’s low because low LDL happens to run in your family…, either way, both of those situations are associated with a lower risk of heart attack. So you make the transition from “association” to “cause.”

Now investigators are trying to do the same thing with HDL. So we say “Gosh, having a low HDL is associated with heart attacks – having a high HDL must be good for you then!” So we look at studies: If I give you a drug that causes your HDL to increase – something like niacin, for example, will that reduce the risk of having heart? And in fact, there was a recent trial called the Aim-High Trial that took patients who already had a low LDL (so that is they were already on medicine to lower their LDL because they have heart disease), but their HDL was low. Researchers treated patients with a drug that causes the HDL to go and see if it would lower their risk of having another heart event even more! The study did not demonstrate any benefit from increasing the HDL with the medication. So, then all of a sudden, people started to wonder if raising HDL is a good thing, “Is high HDL really protective?” because we didn’t see it in this study. So, what these investigators did in the Lancet study was they looked at people who have a genetic cause of having high HDL – they had genes that ran in their family that actually blessed them with very HDL levels.

Todd:  Dr. Cooper calls that the Methuselah factor. I’ve heard him say that many times.

Dr. Radford: They’re just lucky they were born with a high HDL. Investigators looked at 21,000 people in one study and 12,000 people in another group, so they combined those groups and were looking at over 30,000 individuals who had this gene, and they predicted that the risk of having a heart attack should be lower in these people because they have HDL, and in fact they did not see that the risk was lower.

So here we have this Genetic Study, right on the heels of this Drug Trial, and all a sudden people are saying “Hey, I thought having a high HDL was good for you! What’s going on here?” Well, you have to be careful about dismissing decades of historical data based on a couple of studies.

For example, in this study where they gave a drug to increase the HDL to see if it would reduce risk, well we know that LDL, the bad cholesterol, is a bigger driver of risk than HDL. So if I lower your LDL and get it super low with a drug, plus you’re on an aspirin, and an ACE inhibitor, and fish oil, and you’re meditating, and you’re doing all the right things…, and on top of all those really good things, I add another good thing, it may be that the effect is not big enough that you can see it. Because you’re doing six other good things, and when you add the seventh the benefit isn’t big enough. And so, that may be part of.

But then when you look at this Genetics Study, and you add it to the Drug Study, what’s the story? Well, the story is this: It may be that having a high HDL is a marker for some other thing that you’re doing that’s good. So, for example, we know that if you want to increase your HDL and you exercise, you can do it. But what if exercise causes another thing to happen? So, and I’m going to make it up….. Let’s say exercise increases your “Todd” factor. So, if you’re a regular exerciser, your “Todd” factor goes sky high. Now, your HDL also goes sky high, and we can measure the HDL, but we don’t know how to measure the “Todd” factor.

Todd:  At least not yet!

Dr. Radford: So, it may be that HDL is kind of going along for the ride and the real benefit of exercise is the “Todd” factor that we’re not smart enough to measure yet. So, that’s what we’re not clear about.

Now, should you stop doing things we know will raise HDL? Like being at your ideal body weight, taking some fish oil, exercising regularly? Absolutely not! But whether or not you should take medications to raise your HDL, beyond the other good heart healthy things that you’re doing, is not clear, and what most physicians are doing is taking it on a case-by-case basis.

If you’re taking a medication to raise your HDL don’t stop it, because we’ve only got that one Trial that’s raised some questions…, but it’s a good thing to ask your doctor when you see them next. You’re reviewing all your meds – it’s a good thing to do every year – and say you’re taking this for your blood pressure, taking this for cholesterol, this for prostate, this to make your hair shiny, etc. Every year you’ll want to look at all those meds and talk with your doctor and say “Do I need to take each of these (medications)?” And, if you happen to be on a drug for raising HDL, it’s a good time to review (taking it) and decide if you still need it.

Todd:  So, where are we from your perspective – historically, it’s the question that comes up all the time – “Is at HDL? Is it LDL? Is it the combination, that atherogenic index, of total cholesterol divided by HDL?” Dr. Nina Radford, head of cardiology at the Cooper Clinic, what you think is the most important component? Or, is there a magic number we need to be thinking about, as the average patient?

Dr. Radford: Well, that is a great question! It depends a little bit on what your other risk factors are; what your age is; and what your gender is. So, for example, compared to men, HDL is probably a bigger driver of risk in women. But that has to do with probably differences in our hormones. LDL is still a driver of risk in women – it doesn’t mean you can willy-nilly have your LDL be high and super size your fries, but it looks like some studies suggest in women before they’re had their first heart attack or heart disease HDL is a big driver of risk.

In men, LDL appears to be a bigger driver. When you talk about patients who already had their first heart attack; had a stent; have heart disease…, LDL is a very big driver of risk, and needs to be very specifically controlled.

Todd:  In both men and women?

Dr. Radford: Absolutely! In both genders! So it depends a little bit on the age and the clinical background in terms of which factors I’ll be more concerned about.

Todd:  So the takeaway is case-by-case, patient-by-patient, one size does not fit all?

Dr. Radford: Absolutely.

Todd:  Very good. Dr. Nina Radford, the head of cardiology at Cooper Clinic, great information as always! We appreciate your time Dr. Radford.

Folks, if you want more information, you can always sign up for the Get Cooperized Newsletter. We’ll have more podcasts in the very near future. Stay with us. We’ll see you soon.

Podcast: Eye expert, Ophthalmologist Robert Abel, Jr., MD, is interviewed

August 15, 2012 Leave a comment

Todd Whitthorne recently interviewed eye expert, Ophthalmologist Robert Able, Jr., MD. Dr. Abel is the author of The Eye Care Revolution and The DHA Story. In the interview Dr. Abel explains how nutrition and lifestyle impact our eye health. Click here to listen to the interview.

In the world of supplementation, mirtogenol, a combination of pycnogenol and bilberry, is discussed. Pycnogenol is French maritime pine bark, that’s like a powerful vitamin C, and it’s extremely helpful in diabetics and protecting the cross-linking of their blood vessels. In glaucoma patients, pycnogenol helps protect the nerve fibers. Bilberry helps peripheral vision and night vision. Mirtogenol helps lower intraocular pressure.

Dr. Abel also discusses an herbal blend called Ifolia, and how it may positively impact glaucoma by reducing intraocular pressure.

There’s a new Optical Coherence Tomography (OCT) device that uses optical imaging to assist in diagnosing physiologic and pathologic conditions of the eye. The scanner is hand-held, so can be used in all patients, and comes with interchangeable lenses that allow various parts of the eye, from cornea to retina, to be examined.  Using the device and looking at the eye, there’s the potential to detect early stage Alzheimer’s, and Parkinson’s. The device is also used for MS detection too, as the thickness of the retina is changed in individuals who have MS. Dr. Abel says retinal testing may also pick up depression, because the eye and brain are so intimately connected.

Our eyes need at least five hours of darkness every day (or night) in order to rest and replenish. Sleep is needed mechanically and functionally. Stroke, increased glaucoma risk, cornea warping, and stroke in the eye, the sudden loss of vision that can occur during sleep, are all discussed.

Dr. Abel identifies the primarily culprits that make our vision worse – they include explosure to Ultra-Violet (UV) light; poor dietary choices; poor lifestyle choices; and stress.

Sunglasses aren’t just for fashion. Dr. Abel make recommendations on what kind of glasses to select.

Finally, Dr. Abel discusses eye exams, and make recommendations for how often each of us should make an appointment to get our eyes checked.

In addition to his traditional books on eye health, Dr. Abel has written two thrillers, Lethal Hindsight, and Last Sighting. He is also the author of Lumi’s Book of Eyes, a book for children about eye health. The book has QR (Quick Response) codes sprinkled throughout it, with each one teaching a different lesson.