This section of the website allows a flow of information. Questions that are of potentially general interest to everyone who visits the website will be answered as soon as possible. I cannot answer personal questions regarding individual health regimens, prescriptions and recommendations from physicians, or other such matters. Bob Kowalski

 

I've read that farmed salmon is dangerously polluted. Do you still advise eating it?

An article in Science got a lot of media attention. Researchers at the University of Albany in New York found higher levels of contaminants including PCBs in farmed salmon than in wild fish. They called for limits on consumption of the tainted fish.

Why the difference in contaminants? Mostly because of the fish oils and fish meal fed to farmed salmon, further concentrating the PCBs that are fat soluble.

The question comes down to the comparing of risk of contamination with the benefits of heart-protecting omega-3 fatty acids so abundant in salmon (and other fatty fishes). There's no doubt about the value of those omega-3 fats, so what about PCBs?

The degree of contamination depends on whose standards you look at. PCB levels in farmed salmon do not exceed limits set by the FDA, but are on the radar screen for the Environmental Protection Agency (EPA). George Blackburn, MD, PhD, of Harvard put it best, I think, in saying that simply being able to detect a contaminant does not mean it poses significant harm. U.S. farmed salmon is lower than foreign fish.

Personally, I haven't curtailed my own consumption of farmed salmon. Most of the salmon available in supermarkets is farmed in the U.S. Even those concerned about those PCBs can eat a serving of the fish weekly. And don't forget other fatty fish choices including herring, sardines, and mackerel.

Canned salmon is almost exclusively wild fish, usually from Alaska. Try it in place of tuna for sandwiches.

Bottom line: don't give up on fish and their omega-3 fatty acids.

ˆ top

As an older guy, I'm interested in the idea of taking testosterone to reduce some of the downsides of aging. I'm 58. What do you think?

Testosterone is touted to regain lost muscle, increase energy, and, most important to guys, probably, improve sexual performance. Once administered by injection, it's now available in gels and patches. But there's a lot of concern. Testosterone raises risk of prostate cancer. And it might speed up the development of heart disease. Most doctors take a cautious approach to testosterone, limiting its use to those men with particularly low levels of the hormone as determined by a simple laboratory blood analysis. I agree.

ˆ top

Can CLA (conjugated linoleic acid) help me lose weight?

Yes, but only if you're a mouse. Seriously, studies with mice showed a reduction of body fat when feeding CLA, a type of oil. But none of the human studies done subsequently have shown a significant fat-lowering effect, and only two showed even a nonsignificant result. Similarly, while mouse studies demonstrated an ability to affect cholesterol, none of the human studies panned out with CLA.

ˆ top

My heart-related numbers, from homocysteine to CRP to cholesterol are terrific. Thanks for your program. But my Lp(a) is up at 59. My doctor is not encouraging. What can I do?

The most effective agent in reducing levels of Lp(a), a particularly nasty form of LDL cholesterol, is niacin. None of the prescription cholesterol-lowering drugs have any effect. Neither does diet. Start with a dosage of Endur-acin (sustained-release SR niacin) of 1500 mg daily, taken as one 500-mg tablet three times daily. If that doesn't bring your levels down, try adding some immediate-release IR niacin. Do it gradually so you can get your body accustomed to it and to avoid the flush that accompanies the regular niacin. Endurance Products Company, the makers of Endur-acin, also produces a regular-release niacin that has a lessened flush. Bear in mind that when you increase niacin dosage beyond 1500 mg of SR, the equivalent of 3000 mg of IR, you risk an elevation in liver enzymes. Work closely with your doctor on this, having your liver enzymes checked periodically.

ˆ top

Here in British Columbia, they sell Quest Flush-Free Niacin in 500 mg tablets. What do you think?

Quest is a terrible example of deliberate consumer fraud. The label reads 500 mg of niacin and 150 mg of inositol. Sounds like you're getting niacin combined with inositol. But what you're really buying is inositol hexanicotinate, which has no effect on cholesterol, as I've said time and time again.

Here's the reality: when one takes inositol hexanicotinate, no niacin whatsoever shows up in the blood. Many studies have shown the complete ineffectiveness of inositol hexanicotinate in lowering cholesterol.

ˆ top

Where do you stand on the low-carb diet craze?

I'm smack-dab in the middle. I think it would be a good idea for anyone wanting and needing to lose weight to cut back or completely eliminate the nutrient-free carbs such as sugar, candy, white bread, white potatoes, rice, and pasta. But don't throw the baby out with the bathwater. Stick with plenty of fruits and vegetables as well as whole-grain breads and cereals. And as for the protein foods to replace the carbs, make your choices low in saturated and trans-fatty acids: choose lean meats and nonfat or lowfat dairy. That's a diet that will reduce calories, help with weight loss, and maintain a healthy weight permanently.

ˆ top

If your question was not answered please email it to theforum@thehealthyheart.net.


©2007 Robert E. Kowalski. All rights reserved.