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Old 08-15-2012, 10:58 AM   #41
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Do you have to get these tests from the doctor's office?
SInce Medicare pays for this test, I got it at my MD's. However, the first time I got it my then doctor was not interested, so I bought it myself from privatemdlabs.com. You can buy almost any test, from this place or many others. I think the demand really got going when people wanted to be anonymously tested for STDs.

They give you a chit for a local lab; often it is LabCorp. In the case of the nmr test, the sample is sent to Liposcience in Raleigh, as this is the only lab that does this test. The results are emailed within a couple days.

Often the LDL particle count is concordant with LDL-C, but not always.

Ha
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Old 08-15-2012, 11:44 AM   #42
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Even more than niacin I would wonder why not just take a low dose of lovastatin since that is what this stuff allegedly contains?
I found some mention of Lovastatin here: Red yeast rice - Wikipedia, the free encyclopedia
Quote:
Lovastatin became the patented, prescription drug Mevacor for Merck & Co. Red yeast rice went on to become a contentious non-prescription dietary supplement in the United States and other countries.
So is Lovastatin a lower risk alternative to Red Yeast Extract? I have an open mind on this one so am just trying to get more info. The Wiki article above does make me wonder now. Or maybe I should just drop the Choleast and see how the next cholesterol count looks. Hmmm.
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Old 08-15-2012, 02:05 PM   #43
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Originally Posted by haha View Post
...

Often the LDL particle count is concordant with LDL-C, but not always.

Ha
Here is an example of a discordant nmr lipid test:
================
LDL Particle Number
LDL-P 2311 H nmoi/L <1000

Lipids
LDL-C 138 H mg/dL <100
HDL-C 63 mg/dL >=40
Triglycerides 65 mg/dL <150
Cholesterol, Total 214 H mg/dL <200
LDL and HDL Particles
HDL-P (Total) 38.5 umoi/L >= 30.5
Small LDL-P 826 H nmoi/L <= 527
LDL Size 20.9 nm > 20.5

Insulin Resistance Score 19 <= 45
Hep B Surface Ab 9.43 H Index Value 0.00-0.99
Vitamin D, 25-Hydroxy 45.5 ng/mL 30.0-100.0
===============

5'2" 120lb 60 year old female with good blood pressure, healthy and active. Her LDL-C (138) is at about 50% (expected non-medicated value) while her LDL-P (2311) is about 95% (higher than 95% of the population), hence the discord. (She tests at 50% via one measurement method and 95%+ using a different method purportedly measuring the same thing.) In this case, her normal lipid panel doesn't look too bad (TC 214, LDL 138, HDL 63, Trigs 65) but her nmr profile looks dismal (LDL-P is off the charts @2311and small LDL-P is a little high).

I don't think there is enough data available yet to know what this means to an individual for the long haul; however, being in the 95% percentile should be unsettling.
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Old 08-15-2012, 02:49 PM   #44
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Here is an example of a discordant nmr lipid test:
================
LDL Particle Number
LDL-P 2311 H nmoi/L <1000

Lipids
LDL-C 138 H mg/dL <100
HDL-C 63 mg/dL >=40
Triglycerides 65 mg/dL <150
Cholesterol, Total 214 H mg/dL <200
LDL and HDL Particles
HDL-P (Total) 38.5 umoi/L >= 30.5
Small LDL-P 826 H nmoi/L <= 527
LDL Size 20.9 nm > 20.5

Insulin Resistance Score 19 <= 45
Hep B Surface Ab 9.43 H Index Value 0.00-0.99
Vitamin D, 25-Hydroxy 45.5 ng/mL 30.0-100.0
===============

5'2" 120lb 60 year old female with good blood pressure, healthy and active. Her LDL-C (138) is at about 50% (expected non-medicated value) while her LDL-P (2311) is about 95% (higher than 95% of the population), hence the discord. (She tests at 50% via one measurement method and 95%+ using a different method purportedly measuring the same thing.) In this case, her normal lipid panel doesn't look too bad (TC 214, LDL 138, HDL 63, Trigs 65) but her nmr profile looks dismal (LDL-P is off the charts @2311and small LDL-P is a little high).

I don't think there is enough data available yet to know what this means to an individual for the long haul; however, being in the 95% percentile should be unsettling.
Wow! How did you get this?

Ha
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Old 08-15-2012, 05:08 PM   #45
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I wonder if the guys taking niacin could mention the dose, and the form. Just regular flushing niacin?
Nictonic acid is the form that's been shown to work. At first, DW was prescribed Niaspan® -- an extended release prescription form -- 500 mg. at bedtime (some folks don't notice the flushing if it occurs while asleep). After paying an exorbitant amount, we found that the exact same thing (extended release nictonic acid) can be gotten OTC for about 1/10 the price of Niaspan. The doctor didn't know it was available OTC until we advised him, but he's on board (he hates Big Pharma).

After her numbers came back as improved as they did, she's dropped the dosage to 250 mg.

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Old 08-15-2012, 05:49 PM   #46
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On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

The flushing can make your skin redden and possibly feel warm to the touch. While annoying, this flushing isn't harmful. If you have flushing, talk to your doctor about taking an aspirin shortly before you take your niacin. Aspirin can counteract this flushing effect. Also, avoiding hot drinks and alcohol can decrease flushing. Versions of niacin with reduced flushing effects also are available by prescription.
Other possible side effects include:

[*]Upset stomach[*]Headache[*]Dizziness[*]Liver damage[*]Increased blood sugar

However, your doctor may be able to find the right dose and form of niacin that minimizes side effects

Most people don't notice side effects from statins especially at low doses. Most people do experience flushing with niacin and need to treat that effect to be satisfied with the drug. For Ha the safest approach would appear to be the dietary changes he has made if the LDL reduction holds up over time.

Edit: and why the insistence that the flushing isn't harmful? Has that been carefully studied or just assumed? Something significant is going on here.
I also wonder about this, too. If you are taking niacin to avoid statins but have to take aspirin to counteract symptoms, doesn't aspirin sometimes cause symptoms, too? For that matter many people just take the aspirin to prevent heart attacks. So skip the niacin and go straight to aspirin? I take krill oil, but that is it. Working on a disciplined diet is my main priority. Lucky for me, yesterday I turned on the news just in time to hear people with AB blood type have more heart attacks than other blood types. Really made my day.
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Old 08-15-2012, 05:55 PM   #47
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On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:
If you consider vitamin B3, an essential human nutrient, to be just another drug, then I won't argue that point.

Mayo cites statins as having similar side effects, and more, but Mayo is known to be one of the more conservative medical sources.

WebMD lists statin side effects as:
Quote:

The most common statin side effects include:
  • Headache
  • Difficulty sleeping
  • Flushing of the skin
  • Muscle aches, tenderness, or weakness (myalgia)
  • Drowsiness
  • Dizziness
  • Nausea and/or vomiting
  • Abdominal cramping and/or pain
  • Bloating and/or gas
  • Diarrhea
  • Constipation
  • Rash
Statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take.
(and more).
Statins have also been linked to being a cause, and factor in, neuropathies:
Quote:
Numerous studies have reported that peripheral neuropathies often developed in subjects that used statin drugs for a period of one to seven years. The incidence rate is one in 2200 persons and is often permanent even after stopping the statin drug.
Researchers studied over 500,000 individuals taking statin drugs. They found that taking statin drugs for one year increased their risk of developing neuropathies by 15%, after two years the risk rose to 26%.
Statins Linked to Peripheral Neuropathies: Cholesterol Drugs Linked to Peripheral Neuropathies | Suite101.com
(Also Google: statins peripheral neuropathy)
Much more can be found by Googling: statins adverse effects
Much more can be found by Googling: dangers of statin drugs
Much more can be found by Googling: statin drugs liver disease

Given my DW's cholesterol, my own peripheral neuropathy (NOT due to statins), and our other medical concerns, we've researched this matter (statins vs. niacin) fairly thoroughly, and both concluded that niacin is the preferred (safer) way to go for us. YMMV.

Tyro
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Old 08-15-2012, 06:22 PM   #48
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If you are taking niacin to avoid statins but have to take aspirin to counteract symptoms, doesn't aspirin sometimes cause symptoms, too?
That's a valid point. There are some things to keep in mind about niacin flush. First, not everyone experiences it. It depends on the dosage and release rate; ER formulations produce less flush than IR formulations. It's often recommended taking at bedtime; flush is less noticed while asleep. Once the body acclimates, the flush usually abates, so countering it with another agent is often a temporary situation. If aspirin is a problem, niacin flush can also be countered with vitamin C (either ascorbic acid or Ester C).

There are pros & cons with any remedy or treatment. If niacin flush (or any other side effect of any medication or supplement) is intolerable, then of course it makes sense to investigate alternatives.

Everyone is different, and should decide the best thing for themselves. Information and knowledge are power, so I would encourage anyone to research this themselves -- being proactive in their own medical care.

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Old 08-15-2012, 08:19 PM   #49
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haha, sounds like you are really committed to getting those numbers in line. I am glad that they are at a level you and your doctor are pleased with. I go in with another couple of families on a grass fed organic yearling each fall and we stock our freezers. So much more affordable that way. Wish it was as easy for me to get raw milk...it's a hassle.

I find it unsettling how little modern medicine knows about cholesterol. It is the building blocks for all hormones in our body and absolutely essential. There is evidence to suggest there is a lot more to it than we know. It's pretty common knowledge that statins are bad news and was glad to see it mentioned in this thread. Plenty on Merola.com about that. I have found this thread really interesting.

Because we know so little, that's why i like to fall back on traditional wisdom and diets...unfooled around with foods. Chuckanut, if you were referring to my summary post from the Weston A. Price foundation as an "anecdotal story", please see the link I provided and the science there.
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Old 08-15-2012, 09:11 PM   #50
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On this niacin vs stain question why would I take niacin instead of statins unless I already tried and had problematic side effects from statins and wanted to try another drug? Niacin is, after all, just another drug. Here is a description of side effects from a Mayo site:

The flushing can make your skin redden and possibly feel warm to the touch. While annoying, this flushing isn't harmful. If you have flushing, talk to your doctor about taking an aspirin shortly before you take your niacin. Aspirin can counteract this flushing effect. Also, avoiding hot drinks and alcohol can decrease flushing. Versions of niacin with reduced flushing effects also are available by prescription.
Other possible side effects include:
  • Upset stomach
  • Headache
  • Dizziness
  • Liver damage
  • Increased blood sugar
However, your doctor may be able to find the right dose and form of niacin that minimizes side effects

Most people don't notice side effects from statins especially at low doses. Most people do experience flushing with niacin and need to treat that effect to be satisfied with the drug. For Ha the safest approach would appear to be the dietary changes he has made if the LDL reduction holds up over time.

Edit: and why the insistence that the flushing isn't harmful? Has that been carefully studied or just assumed? Something significant is going on here.
Niacin has been taken in medicinal doses for 50 years or so. Although the possibility of liver damage is always mentioned with niacin, in fact, it seems to be very rare. As for flushing every piece of advice I have read from Mayo and elsewhere suggests that it is not harmful and I have never read even an anecdote that suggests otherwise. So, I am not worried about flushing. If new evidence were to appear I would reconsider. However, some people who take niacin stop taking it because they can't stand the flushing. So, it might indeed be a problem for you. For most of us, including myself, the flushing largely disappeared after the first month anyway.

In considering the full risk profile it is well to enumerate the possible side effects as you have done, but then you also have to consider their frequency. As far as I am aware, none of the side effects from niacin have frequencies that approach statin-induced myopathy which, according to the Times article, affects 10% of users unless they are physically active in which case it is 25% or more. None of the doctors I discussed niacin with ever offered even a single case of side effects from niacin, other than flushing.

Niacin also has additional benefits that statins do not have, such as raising HDL and improving lipoprotein a. Parson's large study in the 70's with niacin had as its endpoint a 10% reduction in mortality. At the time of his book in the late 90's that was the only study of anti-cholesterol that showed a reduction of mortality rather than a reduction of cholesterol.

Because statins are newer drugs the extent of the side effects may still offer unpleasant surprises such as the research I referenced above that finds an incidence of muscle pain/weakness in 25% of statin users who also exercise. The muscle pain may last for years after stopping the statin. Further side effects of long term use may be shown in the future for all we know.

We manage cholesterol levels in the hope of reducing risk of serious illness in the future. So, it is a preventative, not a treatment for an actual illness that is present. In my own case the painful side effects of statin-induced myopathy turned out to be the more serious medical problem I have actually experienced as an adult, in terms of severity, duration, and unavailability of treatment. That is a pretty unfortunate outcome for a medicine that is only a preventative.

In my opinion given the effectiveness, lower risk profile and substantially lower cost of niacin, the appropriate question is why isn't it the first-line treatment for cholesteremia?
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Old 08-15-2012, 09:17 PM   #51
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Niacin has been taken in medicinal doses for 50 years or so. Although the possibility of liver damage is always mentioned with niacin, in fact, it seems to be very rare. As for flushing every piece of advice I have read from Mayo and elsewhere suggests that it is not harmful and I have never read even an anecdote that suggests otherwise. So, I am not worried about flushing. If new evidence were to appear I would reconsider. However, some people who take niacin stop taking it because they can't stand the flushing. So, it might indeed be a problem for you.

Niacin also has additional benefits that statins do not have, such as raising HDL and improving lipoprotein a. Parson's large study in the 70's with niacin had as its endpoint a 10% reduction in mortality. At the time of his book in the late 90's that was the only study of anti-cholesterol that showed a reduction of mortality rather than a reduction of cholesterol.

Because statins are newer drugs the extent of the side effects may still offer unpleasant surprises such as the research I referenced above that finds an incidence of muscle pain/weakness in 25% of statin users who also exercise. The muscle pain may last for years after stopping the statin. Further side effects of long term use may be shown in the future for all we know.

We manage cholesterol levels in the hope of reducing risk of serious illness in the future. So, it is a preventative, not a treatment for an actual illness that is present. In my own case the painful side effects of statin-induced myopathy turned out to be the more serious medical problem I have actually experienced as an adult, in terms of severity, duration, and unavailability of treatment. That is a pretty unfortunate outcome for a medicine that is only a preventative.

In my opinion given the effectiveness, lower risk profile and substantially lower cost of niacin, the appropriate question is why isn't it the first-line treatment for cholesteremia?
If this is in fact true, my guess as to the reason would be that there are no drug reps pushing it, and little industry sponsored research doing the same, and no cushy positions and honoraria for investigators extolling niacin's wonders.

Ha
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Old 08-15-2012, 11:53 PM   #52
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Hey ha,

Sorry to hear you had to give up beef/butter, but congratulations that your chicken/fish with minumal saturated fat did the trick for you. I love my saturated fats!! I hope I won't have to give it up. I am now moving toward coconut oil (saturated but medium chain instead of long chain like beef), but coconut oil does raise LDL (but it is supposed to raise HDL even more). I will see...

One thing I want to know... You mention you ate grassfed beef - was it most of the time? And it still raised your LDL compared to chicken/fish? I am a little surprised, because my understanidng is that the amount of saturated fat in grassfed beef (about 10% of fat is saturated) is as low as what's in a chicken breast. And grassfed beef contains more omega-3 than chicken. This is not to say I'd rather eat grassfed beef than pasture fed chicken though. (I don't really like grassfed beef.)
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Old 08-16-2012, 12:12 AM   #53
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One thing I want to know... You mention you ate grassfed beef - was it most of the time? And it still raised your LDL compared to chicken/fish? I am a little surprised, because my understanidng is that the amount of saturated fat in grassfed beef (about 10% of fat is saturated) is as low as what's in a chicken breast. And grassfed beef contains more omega-3 than chicken. This is not to say I'd rather eat grassfed beef than pasture fed chicken though. (I don't really like grassfed beef.)
I'm sleepy now, and I wil answer this more completely tomorrow. But here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.

As far as I am concerned, although I am still not fully into chicken, as I have said earlier I could be happy eating only organisms that got pulled out of the ocean! I think the Japanese and the Norwegians have pretty well shown that if you avoid toxic species, you can live fine on fish. I always get wild, fresh when I can and frozen or canned otherwise, Today I had fresh wild shrimp salad for lunch, and rockfish curry for dinner.

Ha
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Old 08-16-2012, 12:29 AM   #54
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I'm sleepy now, and I wil answer this more completely tomorrow. But here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.

As far as I am concerned, although I am still not fully into chicken, as I have said earlier I could be happy eating only organisms that got pulled out of the ocean! I think the Japanese and the Norwegians have pretty well shown that if you avoid toxic species, you can live fine on fish. I always get wild, fresh when I can and frozen or canned otherwise, Today I had fresh wild shrimp salad for lunch, and rockfish curry for dinner.

Ha
I am getting sleepy too, so I will read your article tomorrow, but I know!! (about good eating!) You were mentioning sea urchin and salmon roe in another thread and you were making me hungry! I bought 30lbs of fresh frozen sashimi-quality sockeye salmon (my fav) along with 10 lbs of scallops from a WA fishery a while back and they are sooo good. I only need to sear the salmon on the surface and I eat my scallops raw as sashimi. MMMmmmm!! I got about 5 lbs of Hake at Trader Joe's the other day too (I like them better than Cod since Heke is more tender and even flakier.) Maybe I eat more fish to counteract the other crap I eat...

Maybe all the fish you've been eating are doing you good, which actually wouldn't even be a bit surprising.
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Old 08-16-2012, 07:05 AM   #55
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We manage cholesterol levels in the hope of reducing risk of serious illness in the future.
I'm not convinced there is any validity to the hypothesis that elevated cholesterol levels are harmful, so put me firmly in the skeptics' camp.

Thanks for the niacin information, though. Interesting even if not tempting.
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Old 08-16-2012, 07:22 AM   #56
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here is an interesting interview with a very distinguished researcher, that suggests it may be more complicated than just saturated fat. After all, this beef = saturated fat identity was never proven by anyone, just assumed. There is a lot more to beef than just saturated fat, and as you well understand there are many types of saturated fat. Lots of different fatty acids make the chains.

Ron Krauss – Saturated Fat? Red Meat? It Depends . . . | Me and My Diabetes.
Very good interview Ha. Krauss largely exhibits the traits you want to see in a scientist - an open mind and enthusiasm at the learning impact of contrarian results. I'm looking forward to the follow-on studies he references.

One sad takeaway -- the bacon, blue cheese burgers I have been gleefully gobbling down may be the poster child of bad practices. But a bacon, blue, turkey-burger could be just the ticket (with low carb toast instead of a bun).
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Old 08-16-2012, 07:47 AM   #57
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Nictonic acid is the form that's been shown to work. At first, DW was prescribed Niaspan® -- an extended release prescription form -- 500 mg. at bedtime (some folks don't notice the flushing if it occurs while asleep). After paying an exorbitant amount, we found that the exact same thing (extended release nictonic acid) can be gotten OTC for about 1/10 the price of Niaspan. The doctor didn't know it was available OTC until we advised him, but he's on board (he hates Big Pharma).

After her numbers came back as improved as they did, she's dropped the dosage to 250 mg.

Tyro

I am using Niacin (Inositol hexanicotinate) 500 Mg. non flush per doctor’s recommendation. I asked about increased dosage and he said it was OK to increase as much as I could tolerate. To date, I have not increased dosage and have not noticed any side effects with 500 Mg. other than possibly aggravating gout which may have been aggravated to due sugar consumption.

Not convinced that high LDL is really a problem, but if figure a vitamin is a much lesser of an evil than a drug, recognizing that a vitamin could be just like a drug. I am convinced, that for me, statins are poison.
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Old 08-16-2012, 09:44 AM   #58
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The study criteria would allow fairly unhealthy individuals, so they are not necessarily studying a healthy population

The baseline diet is very high in carbohydrate (50% E).

The study diet is high in carbohydrate (31% E)

The study diet is very high in protein (31% E)

The trial periods are short (21 days).

I think the study is more likely to be showing the effects of ingesting high protein (17% more than baseline) in a high carbohydrate diet.
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Old 08-16-2012, 10:05 AM   #59
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Ha got me to thinking about my lunches. I am going to focus more on healthy lunches now. Some fish lunches that come to mind:
1) tomato packed sardines with piece of bread
2) small shrimp sandwich
3) smoked salmon with soft (whipped) cream cheese on bagel
4) tuna sandwich

For meat oriented sandwiches, I could switch to just eating a half sandwich. I never liked too much meat on the sandwich anyway. Would then supplement with more vegetables like carrots, pickles, lettuce, tomatoes.

Is the cream cheese in moderate quantity a no-no?

Any other easy to prepare ideas?
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Old 08-16-2012, 10:37 AM   #60
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For what it is worth, here is video of a talk about saturated fat given by a doctor who is a professor of cardiothorasic surgery at a distinguished (IMHO) school of medicine.

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