Each year, your doctor carefully measures your cholesterol level. If it's too high, he or she may suggest dietary changes and medications to bring it down. Meanwhile, a silent killer goes overlooked. A minimum of 10 large studies have found it to be at least as important a predictor of heart disease and stroke as cholesterol. I expect that it will be found to be a much more accurate risk marker for heart disease than cholesterol. But most doctors don't pay any attention to it. Oh, they're aware of its dangers, all right. They ignore it because they don't know what to do about it!

I talked about this danger last September when I found out that I had this problem myself. It's high fibrinogen, a protein that makes blood thicker, stickier, and causes it to clot. Fibrinogen is caused, in part, by inflammation, and it becomes elevated in the presence of inflammation. This creates a cycle that has to be broken if you want a healthy heart.

Fibrinogen levels tend to increase as we age, so it's not surprising to find so many people having heart attacks,

Natural solutions abound

In September, I talked about a natural solution to pharmaceutical blood thinners — nattokinase, an enzyme found in a fermented soy food called natto. It's being touted as an answer to high fibrinogen. Nattokinase can lower fibrinogen, but yours may rise at first. This is because it's dissolving blood clots and releasing trapped fibrinogen. In time, your fibrinogen should go down. Still, I think there are better, less expensive solutions.

Last March, I told you about a Tibetan herbal formula called Padma Basic that has been used throughout Europe to clean clots from veins and arteries. It also reduces inflammation, an important factor in high fibrinogen. Fibrinogen is a protein that can become elevated when there's inflammation. Padma can prevent fibrinogen from being made, and it can dissolve any clots that may have already formed. You can order Padma Basic from Women's Preferred (800-728-2288).

Here are some additional ways to lower fibrinogen.

Bromelain

The pineapple plant may hold the key to lowering fibrinogen. It contains a complex of proteins called bromelain that breaks down proteins. Take it with meals and it helps you digest the proteins in your food. Take it between meals and it helps break down fibrin, the form of fibrinogen that produces clots! Bromelain also activates plasmin, an enzyme that digests fibrinogen.

Bromelain works by slowing down fibrinogen production, as well as by breaking it down. Its effects are dose-dependent. The more you take, the better the results. Bromelain is extremely safe to take. There's no way you can overdose. Because it breaks down quickly in the body, it's best to take bromelain three or four times a day rather than all at once.

If you think that eating more pineapple can have a similar effect, you're wrong. Commercial bromelain comes from the stem of the fruit, not the fruit itself. You can find bromelain supplements in any health food stores. NOW Foods sells 180 tablets of bromelain (500 mg) for $18 online (www.iHerb.com). This is a 60-day supply if you take one, three times a day. Be sure to take it on an empty stomach.

Turmeric (Curcumin)

Powdered turmeric root (Curcuma longa) is a spice found in curry powder. It's sometimes used to make rice yellow. But turmeric, and its active ingredient curcumin, has additional value. It has strong medicinal properties. It's antibacterial, reduces inflammation, and inhibits the formation of fibrinogen. There aren't a lot of studies using this herb to reduce fibrinogen, but those that have been conducted are promising. In one study, a group of people with high fibrinogen was given 200 mg of curcumin extract a day for two weeks. Every single person lowered their fibrinogen.

Studies say that 200 mg of curcumin a day works. But the more you take, the better, says Tim Smith, MD. He's currently writing a book on natural solutions to heart health and has used both bromelain and curcumin successfully with his patients.

You can find curcumin in your local health food store, or order 665 mg capsules (NOW Foods) for $10/60 capsules from www.iHerb.com. Turmeric's anti-inflammatory properties also help arthritis. See the enclosed insert for more details.

What about aspirin?

So, your doctor wants you to take an aspirin a day for your heart. What will it do for you? No one really knows because most trials were conducted on men. One large study that gave 100 mg of aspirin every other day found that it reduced the risk for heart attacks, but not stroke, in women.

Another found it reduced stroke, but not heart attacks. Among women aged 65 or older, aspirin reduced heart attacks, strokes, and deaths from heart disease, but they had more intestinal bleeding that required transfusions. In fact, the dangers from taking aspirin, especially in people over 50, outweigh its benefits.

Here's another problem with aspirin: Like curcumin and bromelain, aspirin is dose-dependent. So the more you take, the faster and better it works. If you take enough aspirin to lower your fibrinogen, you'll likely irritate your stomach lining and risk intestinal bleeding. The irritation is a sign of inflammation. Inflammation creates fibrinogen. Enough said?

Lowering my fibrinogen

When my doctor originally checked my fibrinogen, it was 439. I quickly decided that I wanted to dissolve any clots that may have been forming and lower my risk for stroke. So I began to take large quantities of Padma (two tablets, three times a day) and one 500 mg capsule of curcumin. Three months later, my fibrinogen was 401. That was good, but not good enough. (Remember, we're shooting for 200!)

Now I'm also taking high doses of bromelain (500 mg, three times a day) and doubling my curcumin. When my fibrinogen gets around 200, I'll take one or the other. I'll keep you posted on my progress. Based on all the studies, and conversations with doctors of integrative medicine, this program works.

Get yourself tested!

Get a baseline fibrinogen blood test and have it re-checked each year. If it's high or begins to rise, take fibrinogen-lowering supplements. High fibrinogen is a silent time bomb. Insist that your doctor perform this simple and inexpensive blood test for you immediately. It could prevent a heart attack or stroke. Even if your doctor doesn't know what to do about high fibrinogen, now you do.

Lotz-Winter, H. "On the pharmacology of bromelain: an update with special regard to animal studies on dose-dependent effects," Planta Med, June 1990.

Potron, G., et al. "Fibrinogen, arterial risk factor in clinical practice," Clinical Hemorrheology, 1994.

Ramirez-Bosca, A., et al. "An hydroalcoholic extract of Curcuma longa lowers the abnormally high values of human-plasma fibrinogen," Mech Ageing Dev, April 14, 2000.

Ridker, Paul M., MD, et al. "A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women," NEJM, March 31, 2005.

Are Your Headache Medications Giving You a Headache?

Last March, I talked about some natural remedies for migraines. If you have this type of headache, you'll want to re-read the article. It explains how a change in diet and specific nutrients can often reduce or even eliminate migraines.

But not everyone with headaches has migraines, nor is it common to reach for a natural solution. The most popular answer is to take a pharmaceutical headache medication, such as aspirin, Tylenol, or Advil. But recent studies indicated that the side effects from headache medications could not only cancel out their benefits, they may actually cause more headaches!

Which medications cause headaches?

Many classifications of headache remedies do. Like triptans. Triptans are drugs (such as Imitrex, Relpax, and Frova) used specifically to treat migraine headaches. And they work. However, triptans don't prevent or reduce the intensity of future headaches. Nor are they the only drugs that can cause more headaches. Analgesics, such as aspirin, ibuprophen, and acetaminophen, used for common everyday headaches, can, too. So can ergots, such as Migracet-PB and Cafergot.

This condition, where headache remedies cause headaches, is called "medication overuse headaches." Your doctor — the same doctor who prescribed your headache medication — should be aware of this side effect.

Headache remedies don't cause more headaches immediately. This side effect occurs only after you've taken your medications frequently over time. The time it takes for a headache medication to begin causing daily headaches varies depending on the type of medication you're using.

It takes less than two years of taking low doses of triptans (two or more tablets a day, five days a week) before they tend to cause more pain than they're relieving. Analgesics take longer — nearly five years — while ergot-derived medications fall in between. So if you've been using traditional medications for your headaches for only a year or two, you may not have experienced this side effect yet. But be aware that it could happen. And if you've been taking headache remedies for many years and getting less relief than you did originally, this may explain why.

The type of headaches a medication causes depends on which one you take. Triptans can cause migraine-like headaches, while analgesics and ergots tend to lead to chronic tension headaches.

Here's what you can do

The idea is to prevent these rebound headaches from occurring and to have safer options for pain remedies. Since it takes from two to five years before medications cause headaches, it stands to reason that this is due, at least in part, to a toxic buildup. Your first step is to get rid of some of the toxins from over-the-counter and prescription drugs.

In a study conducted at the Albert Einstein College of Medicine in New York, 456 migraine patients went through a detoxification program. Nearly 70% of them were successful in completing it. At the end of a year, they had a 73.7% decrease in headache frequency, and they were able to reduce the quantity of their pain meds.

I wrote an in-depth article on deep detoxification in May's issue. You can use some of this information for your own detox program or take one of the many detoxification supplements available. But make sure you take one that will work in this situation. I like HepatoThera Forte from ProThera (888-488-2488) because it contains nutrients that are known to specifically remove toxins from drugs, as well as from chemicals, heavy metals, and viruses. Always remember to drink plenty of water and eat a lot of fiber during any detoxification program.

Natural remedy update

In addition to the natural headache remedies I talked about in March, there's a new herbal extract for migraines that's recently been in the news. It's made from the Butterbur root (Petasites hybridus). This herb reduces inflammation and relaxes muscles, making it a good choice for all types of headaches.

But please, be very careful. Butterbur root naturally contains carcinogenic alkaloids. ONLY use the standardized extract called Petadolex, which was used in the studies. All carcinogens have been removed from it.

The effectiveness of Butterbur depends on the amount you take. Researchers of the extract Petadolex found that 75 mg taken twice a day prevents migraines. In fact, they discovered that this amount worked as well as prescription drugs. Fifty mg twice a day wasn't any more effective than a placebo, they found.

Enzymatic Therapy is one of a handful of supplement companies selling Petadolex extract (available at most health food stores). The problem is that all of the current products contain 50 mg of extract, not the more effective 75 mg. Since the extract is a liquid in softgel capsules, it's not possible to take just half a capsule. I expect the manufacturers to remedy this shortly. When they do, I'm sure that Enzymatic Therapy will be one of the first companies to have it. Meanwhile, try taking 50 mg three times a day. If that doesn't work, take two capsules twice a day until new higher-dose capsules are developed.

Bigal, M.E., et al. "Transformed migraine and medication overuse in a teriary headache center—clinical characteristics and treatment outcomes," Cephalalgia, June 2004.

Fritsche, G. and H.C. Diener. "Medication overuse headaches – what is new?" Expert Opin Drug Saf, November 1, 2002.

Katsarava, Z. and G. Fritsche. "Gordian knot: medication overuse headache," Schmerz, August 19, 2004.

Limmroth, V., et al. "Features of medication overuse headache following overuse of different acute headache drugs," Neurology, October 8, 2002.

Lipton, R.B., et al. "Petasites hybridus root (butterbur) is an effective preventive treatment for migraine," Neurology, 2004;63.

The Unregulated Killer You Eat Every Day ... And How to Avoid It

We all need sodium. It's an essential element our bodies use to maintain blood pressure and blood volume, to keep fluids balanced, to help nerves send messages to one another, and to help our muscles contract.

Don't get confused between sodium and salt. They're not the same. Sodium is just one component in salt. In fact, salt is 40 percent sodium and 60 percent chloride. Along with potassium, these three minerals are called electrolytes, because they have a mild electrical charge when they dissolve in the blood. This allows them to send nerve impulses throughout your body.

But to do this, they need to be in the proper balance. If you eat too much salt, your sodium and chloride will be too high and your potassium too low. The majority of the sodium we eat is in processed foods. Salt makes foods taste better to most people.

As a result, many of us get twice as much as the 1,200-2,300 mg a day we need. This excess can lead to more problems than high blood pressure. It can contribute to osteoporosis, kidney stones, and acid reflux.

It is estimated that too much salt leads to around 150,000 premature deaths each year from high blood pressure alone. Yet the FDA doesn't seem to care. It refuses to tell us how much sodium we're getting in our foods.

Salt is not a food additive

You'd think that salt is just another additive in foods. And you'd be wrong. Salt is one of many substances the FDA has determined is "generally recognized as safe" (GRAS), and thereby escapes any regulation (additives are regulated). FDA officials believe we can monitor our own intake of salt and that we don't need any agency to do this for us.

In principle, I agree with this. The problem is, there's no way we can know how much salt is in the foods we eat in restaurants. And high-sodium foods, such as processed foods, chips, and cheeses, have no warning labels on their packages to help us make better choices.

No wonder we're eating too much salt. It tastes good and we don't know how much we're getting.

Changing your preference for salt

Not everyone is drawn to salty foods. One reason is that it seems to be an acquired taste. If you grew up in a household where a lot of salt was used, you probably like and use more salt than if you were raised in a low-sodium family.

This means you can eat less salt and, in time, acquire a taste for less salty foods. It takes two to three months for your taste buds to adjust to a low-sodium diet. But the big problem was that major food manufacturers found that low-sodium foods don't sell well enough to keep them on the market. If Kraft, General Mills, and Campbell can't make a profit on low-sodium cheeses or soups, they're simply not going to market them.

There are no substitutions for salt. None, at least, that we find tasty enough to eat. So we're caught in the middle of a dilemma: We need to reduce our salt intake and neither the food companies nor government agencies are about to help us. What, then, can you do?

How to reduce your sodium

Read labels: Processed foods have the most sodium. Cut back on them and you'll reduce your sodium intake. Make soups and freeze them, rather than buying canned soups. Read the labels on all foods you buy (bring a magnifying glass to the supermarket, like I do, so you can read the ingredients list).

Here are some of the hidden sources of sodium you'll find on labels. Avoid them whenever possible: Sodium benzoate (prevents yeasts and bacterial growth), sodium bicarbonate (baking soda), sodium propionate (preservative and mold inhibitor), sodium saccharin (saccharin), sodium nitrate/nitrite (preservative that inhibits bacteria), monosodium glutamate (MSG), and sodium caseinate (ingredient in non-dairy creamers, processed meats, and desserts).

Exercise more: There's a lot of sodium in perspiration. If you exercise regularly and perspire, you're keeping your sodium levels lower. Steam rooms and saunas have the same effect.

Increase your potassium: High potassium increases sodium excretion.

Balance high sodium foods with low sodium foods. Want something salty every once in a while? That's fine, if you're eating plenty of fresh produce. Just limit the salt in the rest of your foods.

Reduce sodium in packaged foods. If you're making pre-packaged soups, rice, or pastas, use only half of the seasoning. Add other herbs and spices for more flavor without the sodium. Rinse off any canned foods, such as beans.

Talk to your pharmacist. Some antacids, laxatives, and NSAIDS are high in sodium. Check your medications with your pharmacist and ask if there are similar drugs with lower sodium.

Ellison, Sarah. "Despite health concerns, food industry can't shake salt," The Wall Street Journal, February 25, 2005.

IFIC Review. "Sodium in food and health," January 2005, Internet.

Wolfe, Elisabeth. "Lawsuit asks FDA to regulate salt use," Associated Press, February 25, 2005.

Nutrition Detective

Paraben-Free Products

Still looking for lotions and hair care products free from potentially dangerous parabens? Here are a few more companies to choose from: Aubrey Organics, Terressentials (www.terressentials.com), Avalon, and my favorite skin care company, Z Mei (800-576-0232). Mention my name and the folks at Z Mei will give you a discount. Meanwhile, keep reading labels. Other products are heading in this direction.

Can With Stevia

If you're into canning summer fruits, one reader points out you can use Stevia as a sweetener along with LM no-sugar pectin. She uses it to make jams, jellies, and canned fruits. Now, if only the food manufacturers would do this!

Lower Your LDL Naturally

If your LDL cholesterol (the bad kind) is too high, don't reach for a cholesterol-lowering medication. The solution may simply be eating more salads and fruit. There are two kinds of cholesterol: HDL (think of it as "healthy") and LDL (or "lousy"). Plenty of HDL keeps your cholesterol slick and unable to stick to artery walls where it can cause a buildup of plaque. LDL is sticky.

Nearly 4,500 people in their 50s were studied to see if there was an association between diet and LDL. There was. The more fruits and vegetables they ate, the lower their LDL.

This is a perfect time of year to eat more veggies. Eat a salad a day along with a second helping of vegetables — cooked or raw. If you can't digest raw foods easily, eat a roasted vegetable salad, or slightly blanched green beans, broccoli, and squash. Have one or two pieces of fruit. Remember, berries are low in sugar and are an excellent choice when they're in season. Djousse, L., et al. "Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study," Am J Clin Nutr, February 2004.

Bad Breath Follow-Up

Several readers took the time to send me their thoughts on eliminating bad breath, a question I answered in May. One woman has chewed one Ennds Chlorophyll tablet every day for 25 years and has no bad breath as long as she does this. This is a good Band-Aid, but not a good solution. The problem is still there. A strong probiotic, and possibly enzymes, plus chewing very, very well are all more likely to give permanent solutions.

Another woman suggested food combining. This means not eating proteins with carbohydrates (fruits, sugars, starches). It also means not ever having a sandwich (bread and protein). I say this is a good first step. But if you have a weak digestion, I'd rather you strengthen it.

Thank you both for your input. While I prefer addressing the cause of any problem, I think your suggestions are excellent first steps. They can work on the unpleasant symptom while you address the real cause at the same time.

Ask Dr. Nan

Q: I’ve had a fungus under several toenails for approximately five years. When I asked my family doctor about what I could do about it, the answer I got was “either take an anti-fungal that can hurt your liver or live with it.” I chose to live with it. But I hope you have a safe cure for my problem. What do you suggest? — E.B., via e-mail

A: A fungus that you can get to can often be treated topically with over-the-counter anti-fungal medications or with essential oils, such as oregano and salvia.

However, a long-time, chronic fungal infection like yours that’s hard to reach may actually require a heavy dose of an oral anti-fungal prescription drug, such as nyzerol or nystatin. Nyzerol can affect liver function. So make sure you have your liver function tested before, during, and after treatment.

Before you try these, though, I suggest you give caprylic acid a try. Caprylic acid is a natural fatty acid that kills fungi. And it’s available in health food stores. I’ve found it to be a safe and often effective alternative. For tough fungal infections, I recommend you take 500 mg twice a day.

Q: I just read about a powder for asthma called Yamoa from Africa. Can it really help asthma sufferers cut back on their inhalers? — D.C., via e-mail

A: No one knows. The hoopla around Yamoa, a powder made from the bark of a West African gum tree, comes from a PhD, Dr. Nyjon Eccles, in London, who sent out a questionnaire to 70 asthma patients who were given Yamoa powder. Their need for asthma medication dropped from nearly four times a day to around two times a day.

Dr. Eccles admits that “research has not yet uncovered the exact mechanism of action.” Perhaps that’s because there hasn’t been any. At around $50 for a one-month supply, I want to know the botanical name of this product and see some solid research on its safety and efficacy. So far, all we have are testimonials. By the way, someone on high blood pressure medicine did have a reaction to Yamoa. We don’t yet know who can safely take it, and who may have a bad reaction. When I find out all this information, you’ll read about it first in these pages.