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Nutrition Corner
by Theresa Tsingis, DCMS

Bread: Staff of Life, or Slice of Illness?

Wheat is an integral part of most cultures. Breaking bread with loved ones is a satisfying ritual. We strive to be good breadwinners, work to put bread on the table, and save dough for a rainy day. Memories of fresh bread baking are "ingrained" in us. You've got the idea. Why then, are there health problems involving wheat and other gluten-containing grains, which have been consumed for thousands of years?

The answer is – that for many, intolerance to gluten proteins found in wheat, barley and rye can lead to autoimmune disease. Recent medical research points to a process in which gluten leaks out of the gut, causing an allergic type of response and a cascade of inflammatory and autoimmune reactions. Over time, tissues and organs become slowly damaged and autoimmune conditions develop. This process can occur even without noticeable gastrointestinal symptoms.

As gluten is allowed to escape out of the digestive tract and into the general circulation, it is perceived as a foreign invader by the immune system. Normally this entry into blood would not occur, but a protein called zonulin transports the gluten in genetically susceptible individuals. Zonulin seems to draw gluten proteins out of the gut and the ensuing immune response can further damage the intestines.

Some of the conditions that have begun to be viewed as originating from an asymptomatic intestinal reaction to gluten are: eczema, asthma, diabetes, thyroid disease, osteoporosis, anemia, irritable bowel syndrome, and attention deficit disorder. In fact, the reclassification of many common conditions as autoimmune produces a large laundry list, with over 150 diseases in tow.

If there are autoimmune conditions in the family gene pool, it may well be worth determining if prevention merits a gluten free approach. In Part 2 of this article I will address the topics of testing for gluten sensitivity and how to begin a gluten-free life. Thousands have done it, and the awareness of the need for a wider variety of gluten free products is expanding, as are available food choices. Stay tuned!

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To Buy or Not to Buy? That is, Organic ...

The Dirty Dozen, Clean Fifteen and Others

Lamorinda has attracted wonderful food purveyors, and some of the finest grocery shops are available minutes from home. My patients have often inquired if buying organic foods is necessary for good health. There are many opinions about this topic. Mine is that certain foods are healthier when organically grown, and others can safely be purchased as conventionally grown. I'll explain further and then share some lists to help both your budget and health guide you through the grocery aisles.

In 2009 and 2011, The Center for Disease Control released the results of studies on chemical exposure and wrote the Fourth National Report on Human Exposure to Environmental Chemicals. They found that most Americans tested positive for the presence of 212 chemicals and heavy metals.

The six most widespread chemicals were: PDE (flame retardant), BPA (food-related plastics), Acrylamide (fried foods), PFDA (nonstick cookware), Mercury (seafood), and MTBE (gasoline).

Studies show these toxins to be correlated with allergies, diabetes, infertility, and neurological and autoimmune conditions. Some, for example dioxin, are no longer used but are still found in dairy products, farm-raised fish and beef. (Dioxin is a known contributor to the development of type 2 diabetes – see reference 5).

There are nutritional approaches which aim to decrease the toxin burden on the liver which I think are helpful but are a topic for another article. Regarding future exposure to toxins, I think that the "cleaner" the food eaten, the less the body is burdened over time. Below are lists I have developed and those adopted from other food educators. I dubbed the first list the "Scary Six" because they are highest on the food chain and are high-fat (toxins concentrate in fat tissue). The other lists describe fruits and vegetables according to their average amounts of pesticide and fertilizer residues. Load these lists on your cell phone so you'll have them handy when grocery shopping):

THE "SCARY" SIX *(Buy Organic)

1. Dairy products
2. Eggs
3. Farm-raised Fish
4. Meat
5. Peanut butter/nuts
6. Poultry

THE DIRTY DOZEN *(Buy Organic)

1. Apples
2. Bell peppers
3. Blueberries
4. Celery
5. Cherries
6. Grapes
7. Kale/ other greens
8. Nectarines
9. Peaches
10. Potatoes
11. Spinach
12. Strawberries

THE CLEAN FIFTEEN *(Okay to Buy Conventional)

1. Asparagus
2. Avocado
3. Cabbage
4. Cantaloupe
5. Corn
6. Eggplant
7. Grapefruit
8. Honeydew/ melons
9. Kiwi
10. Mangoes
11. Onions
12. Pineapple
13. Sweet peas
14. Sweet potatoes
15. Watermelon

While these lists aim to consider both budget and health factors, it is true that organic foods are still more expensive. My recommendation regarding where to spend, is to pay the most attention to the Scary Six (food sources higher on the food chain). As organic and local foods gain in popularity, prices will lower and everyone will benefit. Bon appétit and To Your Health!

References:

1. http://www.cdc.gov/exposurereport/
2. www.foodnews.org
3. JAMA (Journal American Medical Association) 2008;300:1353-54.
4. Bland, Jeffery, PhD. "Nutritioneering"
5. Environmental Health Perspectives; Vol. 114/#11/Nov 2006

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Dietary Fat: Friend or Foe?

Most people crave fats to some degree. This makes sense because the brain is approximately 60% fat! Which fats keep us healthy....which cause disease? If you understand some basic facts, it becomes easier to know which are good to eat, and which ones to avoid.

Fats "wear out" in cell structures and must be replaced, usually through diet. Some fats are "essential fats", ones which must be consumed because the body cannot make them. Fats are classified according to their chemical bonding structures, and this is important because the structure of the fat determines how it behaves in the body. For example, some fats increase inflammatory states in the body, while others act in the opposite way and decrease inflammation.

Generally, it is best to eat fats which reduce inflammation. Polyunsaturated omega 3 fats are in this category. They can be found in fish, nuts, flaxseeds, and greens such as arugula. Beware of eating too much fish, because many studies have found high levels of mercury and other heavy metals. Limiting fish consumption to twice a week and supplementing the diet with fish oil capsules, may be best. Fish oils contain EPA and DHA (the names of the most beneficial omegas). Studies recommend an adult dosage between 600-1200 mg. EPA and 400-800 mg. DHA.

Omega 6 fats when eaten in excess, can cause inflammation. They are found in plant oils such as safflower, sunflower, corn, and soy, and are commonly in packaged baked goods. For most people, it is healthier to consume more omega 3's than omega 6's.

Monounsaturated fats have been found to lower cholesterol. Avocados and olives contain those fats as well as naturally occurring vitamin E, which helps to protect cells.

What about saturated fats? Found in meats and dairy products, they have a more rigid chemical structure than plant and fish oils. Saturated fats are best eaten in moderation. Think of it this way - flexibility is good for cells, not just muscles. Saturated fats can lead to cellular rigidity if eaten in excess, and also induce inflammation and high cholesterol levels.

Trans fats promote inflammation and become free radicals, damaging cells and tissues. They are common ingredients in packaged, canned, and frozen pre-made foods. They are found in deep-fried foods and margarine. Although many packaged snacks are now marketed as "0 grams trans fat", don't let that fool you into believing there are no trans fats in them. The FDA currently allows companies to advertise a product using that quote, if there is less than one-half gram of trans fat in it.

To sum up, most people benefit from reducing trans, saturated, and omega 6 fats in their diets, and increasing omega 3 fats. Enjoy walnuts, filberts, pumpkin seeds, fish, avocadoes, olives and greens. Take it easy on the meat and dairy products. You may find that some of your aches and pains lessen, and other aspects of your health start to improve.

I'd be happy to answer questions you have about this or any other nutrition topic. Have a great summer!

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The Importance of Probiotics

What exactly are probiotics? They are beneficial bacteria of certain species which are supposed to reside in the human body.

These organisms, which have been estimated to weigh approximately 2 pounds in the normal large intestine, produce substances which help the immune system, heal the gut lining, deter harmful bacteria, help with hormonal balance, and according to the latest research, aid in the prevention of obesity and diabetes. In fact, a deficiency of probiotic organisms has recently been found to be an "obesogenic" factor – that is, linked to a promotion of obesity.

If you have any of the following, a low level of probiotics may be linked to your condition:

• Difficulty losing weight
• Slow metabolism
• GERD (gastric reflux)
• Chemical sensitivities
• Constipation
• Diarrhea
• Gallstones
• Colitis
• Gastritis or ulcers
• High cholesterol
• Hormonal imbalances
• Food allergies
• Irritable bowel syndrome
• Periodontal disease
• Diabetes
• Metabolic Syndrome

From the above list, let's discuss difficulty with weight loss. I have counseled many patients who were discouraged after trying a regimen of their own of exercise and healthy eating who still did not lose weight. It's frustrating to observe body fat increase while trying to maintain a healthy lifestyle.

One of the solutions could well be a high quality probiotic. The new research indicates that not only intestinal but overall health depend on good bacteria in the digestive tract. They seem to interact with both body tissues and incoming nutrients in a way that balances metabolism, especially fat metabolism.

What types of probiotics are effective and worth the expense? This is important to know because many products on drugstore and health food store shelves are not viable nor the right species or potency to effect positive changes (ie. a waste of money). For example, most yogurts and advertised probiotic drinks do not effectively increase probiotic growth in the body.

The best formulas include Lactobacillus (NCFM strain) acidophyllus, Bifidobacterium bifidis, and beneficial E. coli organisms. These organisms are the most widely used in research and they aggressively colonize the intestine and flourish when the correct prebiotic (which is probiotic food) is also taken. A good probiotic formula should list the numbers of organisms (look for tens of billions), the species (see above), be refrigerated and list date of packaging, to mention a few. Regarding probiotics, you get what you pay for. General cost of a quality supplement is approximately $35-$40.

Ever take antiobiotics for an infection and wind up with digestive upset? We give our patients beneficial yeast along with probiotic bacteria after they have used antibiotics and certain symptoms are present.

With chronic conditions, addressing other factors is also important. As the research unfolds it will be exciting to discover how to unravel the killer diseases through lifestyle changes, nutraceuticals and the latest findings in genetics. I think most of the answers will point to the basics of good living – healthy food and nutrients, exercise, and relationships. I hope your life is moving in that direction.

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Losing Weight After Forty

"If you look at body fat, it seems to increase with age, even though your weight does not. That's a physiological fact of aging, they say. Heck it is. It is an adaptive effect of aging." — Kenneth H. Cooper

Many of my patients have told me that after forty it seems more difficult to lose weight. Here are some guidelines for weight loss that work:

1. Get enough rest and drink enough water. Water and rest are required by the body to burn fat. How much water is enough? Pale yellow or clear urine indicates that your hydration is adequate. Regarding sleep, seven to eight hours facilitate the metabolic enzyme production needed for weight loss. Studies show that insomnia and lack of adequate sleep are predisposing factors for weight gain.

2. Eating breakfast revs up metabolic engines. Eating every 4 hours keeps blood sugar levels normal. In addition, protein intake is important to "feed" muscles. Skipping meals causes the liver to break down muscle tissue for blood sugar, resulting in a loss of lean mass.

3. Eat like a hunter-gatherer, most of the time. Our DNA is coded to break down natural foods in the environment. Factory made foods contain ingredients that our bodies were not designed to digest. Food additives, dyes, and colors are detoxified by the liver, which also has the important functions of metabolism and hormone balance. If you want to feel and look better, decrease the processed foods in your life. Hunter-gatherers ate nuts, seeds, vegetables, fruits, berries, fish, eggs and meat.

4. Surprise your muscles. Changing your workouts periodically can increase muscle mass and burn fat. One hour of activity daily is recommended by national health associations. Think about it - we were hunter-gatherers and spent many hours moving around. Nowadays people spend time eating, sitting, and watching television. As people became more sedentary, diseases increased proportionately.

5. Keep track of your body composition. "Nancy", a forty five year old client of ours, came in for a nutrition workup for high cholesterol and arthritis. She looked a trim size 6 and did not list weight loss as one of her goals. To her surprise, the body composition reading showed that she had too much body fat. Body composition is what counts when it comes to weight. Too much body fat can lead to inflammation. It's possible to be an "overly fat" normal weight person, which impacts health in fundamental ways by predisposing to disease.

6. Work with a nutritionist. There are many types of nutritionists, with varying levels of education. I am a chiropractic physician with a Masters degree in Nutrition. My approach is a research-based program with easy-to-follow guidelines, and I address metabolic imbalances and long term positive health changes with my patients. In addition, I work as a nutrition specialist with medical groups and am a provider for some insurance plans.

Dr. Theresa Tsingis, DCMS specializes in functional medicine, a branch of nutrition focused on prevention, medical research and therapeutic lifestyle change. She can be reached at Lamorinda Nutrition, 251 Lafayette Circle, Lafayette CA. (925)-283-WELL

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Good Nutrition On A Budget

"To eat is a necessity, but to eat intelligently is an art."
— La Rochefoucauld

Shocked that a decent gallon of milk costs more than gasoline?
Here are 5 ways to cut your costs and still eat healthy:

1. Cook one to several meatless meals a week. Meats and some cheeses are usually the most expensive items in a shopping cart. They should be organic whenever possible because of relatively higher concentrations of pesticide residues compared to other foods.
2. Beans, peas, lentils, nuts, and seeds cost less and contain protein, fiber, minerals and vitamins. To prevent gas or bloating try "Beano"or similar products that reduce those symptoms. (For a tasty recipe, see below.)
3. Make one of your meat meals turkey-based. Turkey costs less, contains less saturated fat, and is a ready substitute for ground beef. Chili, Sloppy Joes, tacos, enchiladas, and many other dishes can be made using turkey meat without compromising on flavor or texture.
4. Shop seasonally. Supermarkets, health food stores and farmers markets usually offer their best prices on fruits and vegetables which are in abundance at the time. These foods are also at their ripest and most nutritious. If you want ideas for how to use parsnips for instance, search internet recipe sites such as Epicurious.com for healthy ideas. You will be adding new ratios of vitamins, minerals and antioxidants to your diet and saving money at the same time. Eating seasonally also supports a "green" economy, since consuming local produce saves energy.
5. Get to know where your favorite healthy foods cost less. Shop at large membership stores for organic products. Organic milk can cost about 25% less at these stores. On the other hand, local shops also carry organic products such as eggs, at lower prices and in this economy vendors are rising to the challenge due to competition.
6. Another way to save money, time and effort in the kitchen and eat well is to buy in bulk, cook and then freeze several meals. It takes a bit of planning, but saves you time and money in the long run. The key is to not overcook, and when you reheat the dish, add fresh snips of herbs, cheese or other condiments for zip and flavor. Examples of family-typs freezable meals are stuffed shells, enchiladas, quesadillas, chili, lasagna, teriyaki salmon, pasta sauce, minestrone and other soups.

Recipes On A Budget

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Fabulous Foods for Fall

"For man, autumn is a time of harvest, of gathering together. For nature, it is a time of sowing, of scattering abroad." ˜ Edwin Way Teale

Autumn isn't fall at all – when it comes to delicious foods, it rises to the top of culinary lists. The colorful fruits, roots, tubers and vegetables of harvest time also contribute to make us healthier as we go towards winter. They're loaded with phytochemicals – pigmented antioxidants and vitamins that support immune system health during the change of seasons and influx of "germs".

Taking vitamins is no replacement for treating yourself to the produce we are lucky to have in farmers markets and grocery stores. As you can see below, there are many fabulous foods in fall. Venture into these when dreaming up "what's for dinner":

• Apples, pears, figs
• Beets, orange, red, yellow
• Carrots, Turnips, Parsnips
• Cabbage, Brussel sprouts, Broccoli
• Cranberries, Pomegranates, Persimmons
• Sweet potatoes or yams
• Pumpkins, winter squash (acorn, butternut, etc.)

A tasty and smart way to benefit from these natural foods is to combine several colors in recipes. Plenty of mouth-watering fall recipes exist and have wide appeal. Let yourself wander through websites and cookbooks and have some fun. Here are several recipe ideas:

• Tri-color beet salad with feta, toasted walnuts & oregano
• Figs braised with cabbage, apples & balsamic vinegar
• Greek stuffed cabbage with turkey meat & avgolemono sauce
• Pumpkin soup with shrimp*
• Cauliflower Marranca*
• Tunisian Vegetable Stew*
• Gluten-free Pasta Fagiole (pasta & bean soup)
• Dr. T.'s Special Chard Saute' (See below)
• Pears Poached in Red Wine

The poet George Eliot wrote of fall, "Delicious autumn! My very soul is wedded to it, and if I were a bird I would fly about the earth seeking successive autumns." Enjoy your seasonal bounty and you will be healthier!

*For more recipes visit:

www.whats4eats.com/seasons/fall-recipes

pnwmg.org/pdf/mgfallveg.pdf

epicurious.com

"Moosewood Cookbook", Mollie Katzen, Tenspeed Press, Berkeley

"Moosewood Collective Cooks at Home", Moosewood Collective, Simon & Schuster, N.Y.

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A Dozen Ways to Age Well

"The idea is to die young as late as possible." – Ashley Montagu

To further the chances of the above occurring, here are ways to stay vibrant, strong, flexible, and slow down the incidence of disease. My following suggestions are simple and can be added to your daily life with a minimum of expense:

1. Improve absorption of the food you eat – After age 50, digestive enzyme production decreases, and supplementation may be wise. When food passes through the digestive tract, the opportunity for nutrient absorption is brief. If food is not digested, nutrients aren't absorbed and deficiencies can occur. Full-spectrum digestive enzymes can be taken at low doses with large meals of the day to prevent this.
2. Lower blood pressure – This can be done through stress reduction, exercise, the intake of omega 3 fats, lower salt intake, biofeedback, and medication. It's important to lower blood pressure in order to decrease strain to the cardiovascular system. In a recent meta-analysis, garlic was found to decrease systolic blood pressure. Consult with your doctor.
3. Lower cholesterol – Besides statin drugs, there are a number of ways to lower cholesterol. Fiber can help, since it pulls cholesterol out of the body during digestion. Ground flax and psyllium are good forms of fiber. Flax has been shown to reduce the incidence of colon cancer.
4. Prevent vitamin B deficiencies – Deficiencies occur from age, alcohol intake, stress, and enzyme defects. Vitamin B12 can be given in the form of inexpensive injections, and can be helpful with maintaining cognitive function during and after stressful incidences. B complex is helpful for a variety of conditions.
5. Increase omega 3 fat intake – These fats help mood, memory, cardiovascular health, reduce inflammation, and they beautify skin, hair and nails. 1,200 mg. of EPA and 800 mg. DHA are standard adult dosages; this may vary depending on your personal history.
6. Monitor vitamin D levels – This fat-soluble vitamin is essential for bone quality, and has antidepressant and anti-cancer functions. Many people have low Vit. D levels, and it is common over age 50. The name of the blood test is 25-hydroxy Vitamin D. Also, there are genetic tests which can detect low Vit. D receptors. A person low in receptors can benefit from higher than average doses of Vitamin D. (Do not take high dosages of D if you have kidney disease.)
7. Add fiber – Fiber helps lower cholesterol, and can prevent constipation and colon cancer. Fruits, vegetables, beans, peas, lentils and unrefined grains are the best source of fiber; refined foods made of wheat and sugar are not.
8. Avoid/Limit refined carbohydrates – While I was earning my master's degree in nutrition, I learned that there are no "essential carbohydrates". The "3 whites" – white flour, white sugar, and salt, promote deterioration, not nutrition.
9. Exercise – This is one of the main ways to stay young in later years. There are many ways to stay active – walking, hiking, yoga, weight lifting, swimming, classes in dance, jazzercise, aerobics. The choice is up to you, and depending on your level of ability and interests, they are abundant.
10. Stretch – Staying flexible is probably one of the main pursuits ignored until it is significantly decreased. Stretching improves coordination, which can save one from falling, losing grip of objects, and strains and sprains.
11. Manage stress – Find an avocation; take a vacation. Stay connected to others by volunteering, become a mentor, call and email friends and family often. In essence, do not isolate. Don't underestimate your value and the importance of connection with others.
12. Have adventures – Outdoor travel, indoor exploration – it's up to you. Be creative. Express yourself. Try new things. Research shows that those who continue to learn keep brain cells healthy.

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Summer Heat, Sports and Nutrition

"When you're thirsty it's too late to think about digging a well" – Japanese Proverb

Summer includes outdoor activities, but the fun can fade if some basic mistakes observed. Headaches, heat stroke, sunburns, dehydration, muscle cramps and fatigue are just some side effects of sun exposure.

These symptoms can easily be avoided with the following precautions:

Drink Water & Fluids
Most people are slightly dehydrated, especially when coffee and alcohol are consumed daily. It's a little known fact that fluid losses of as small as 2% of body mass cause changes in body temperature. Unfortunately, the sensation of thirst often lags behind the hydration levels needed for health and good athletic performance.

Water may be an adequate replacement fluid for shorter events, but for longer ones a good electrolyte, carbohydrate and protein replacement drink is best. Studies show that "pre-exercise hyper-hydration" can improve endurance and performance. (However it is also harmful to drink excessive water, which can cause a dangerous condition known as hyponatremia.)

How much is enough and not too much? If urine output is low and the color is dark, dehydration is probably occurring. If it is light yellow and there is no weight loss of more than 2% after exercise, fluid intake is probably adequate. Weight gain after exercise and symptoms such as nausea, vomiting, headache and malaise are symptoms of hyponatremia, which demands medical attention. Electrolyte sports drinks can balance body fluids and help maintain energy. Some of those drinks are healthier than others (Hint – look for ingredient lists without dyes, artificial flavors and colors). The key here is moderation.

Take Magnesium
Magnesium plays a critical part in over 300 chemical reactions in the body! Most people don't consume enough to optimally maintain those metabolic processes. Some symptoms of magnesium deficiency are: migraines, muscle cramps, joint pain, palpitations, premenstrual tension and anxiety. Exercise further depletes magnesium stores, but most drinks don't include it. Furthermore, the average American diet is deficient since magnesium is found in only small amounts in nuts, seeds, vegetables and whole grains.

The solution? – supplement with an absorbable form such as magnesium glycinate, aspartate or chelated magnesium. When inspecting a supplement, note that "elemental magnesium" is the relevant ingredient. Taking 400 to 600 mg. of elemental magnesium in divided doses can prevent deficiencies. Please consult with a nutritionist or medical doctor if you have any pre-existing conditions.

Eat Protein
When necessary, muscles break down during exercise and are converted to sugar for the brain's energy supplies. Muscle tissue can provide up to 10% of the energy for exercise if not prevented. To avoid this, supplement with small amounts of amino acids in a sports beverage, for example.

Among the preferred forms are "branched-chain amino acids" (valine, leucine, and isoleucine) which readily convert into fuel and help spare muscle breakdown. In the critical 2-hour period after exercise, studies have shown that refueling with both carbs and protein results in significantly greater muscle gain and recovery than with carbs alone.

Other considerations regarding muscle building and repair include the body's ability to digest protein. If one of your exercise goals is muscle building and you aren't getting results, digestive enzymes may help. Nutrients can't help if they're not digested.

Summer fun makes for great memories. "Summertime and the living is easy" will apply to your next 8 weeks if you keep yourself healthy with these nutrition pointers. Enjoy!

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Cholesterol and the Liver

Ever since cholesterol levels became associated with heart disease, it has gotten a bad name. Cholesterol is vitally important to the body for sex hormone production, fat digestion (it makes bile), membrane structural support and nerve impulses. Cholesterol helps cells to communicate and retain their shape and function. Low cholesterol is dangerous to physical and mental health, as witnessed by early cholesterol-lowering studies which resulted in increased suicide levels.

So why the bum rap?
Since it is waxy and acts as a protective coating, cholesterol is laid down in inflamed arteries. The liver makes more than 80% of the body's cholesterol, and diet usually plays a minor contribution compared to the liver's own intrinsic cholesterol production. The underlying problems regarding cholesterol and heart disease are actually the inflammatory states which the arteries developed via lifestyle, diet and genetic inheritance.

Lifestyle directly affects the liver. How does it do this?
Your lifestyle influences which enzymes and hormones the liver must make in response to the stimuli from the outside environment. You liver's one mission is to keep you living, and in order to do that it must maintain brain blood sugar levels and produce the hormone cortisol in response to stress.

Remember fright, flight or fight responses? – they can be in response to "paper tigers", "lay-offs", deadlines, the economy ... When the body perceives a threat the liver responds accordingly and shunts its energy towards survival, increasing heart rate, decreasing digestion, limiting detoxification of unwanted molecules, and lowering sexual function. Because of these "threats" the liver sends signals to the immune system, gut, nervous and circulatory systems to ensure high survival-related vigilance.

In my opinion this shunts liver function away from maintenance of cholesterol and sex steroid levels. In addition, cortisol inflames blood vessels amongst other effects, so the cholesterol that is produced must travel to the vessel, coating it in a protective gesture. This goal of protection eventually backfires in the form of plaque breakage, clot formation and vessel obstruction, leading to heart attacks and chronic heart disease.

So, when considering nutrition and lifestyle, consider your liver.
A sound nutrition program includes an approach that improves liver function when it is found to be imbalanced. A functional medicine practitioner takes liver function into account whenever there are symptoms and especially with high cholesterol and triglyceride levels. It may not be enough to eat well and exercise, even though that is a good start.