In March of 2006, T.K., a 63 year old woman, came to see me for help with high cholesterol. Having read about the side effects of many prescription medications, and deciding to try to take a more natural approach to her health, she had stopped taking her prescription medicine – two of the most popular, most advertised, cholesterol-lowering drugs – a few months before, and felt much better overall after discontinuing them.

However, just before she came in, having been off the medication for a few months, her cholesterol was 343. By any measure, this is a dangerously high level, and one that would prompt most conventional physicians to insist on medication – and, no doubt, to insist that at that level, diet, exercise, and natural remedies are ineffective. T’s ratio of Total Cholesterol : HDL Cholesterol was 5.6, which is above the recommended 4.4 (I prefer a number below 4, and the lower the better) and her Triglycerides were an unacceptably high 192. Normal is under 150, and I prefer Triglycerides to be under 100.

T. and I discussed many things: her smoking; her lack of motivation and depression, largely related to family matters; the need for diet and lifestyle changes; and how to use nutritional supplements to improve her health and bring her cholesterol and lipids back into line. (An important note here – I have ended every appointment with T by reiterating in the strongest terms the need for her to quit smoking, by any means possible.)

Change in lipids and glucose with naturopathic treatment

After 3 months, we repeated T’s blood work to monitor her progress. While her cholesterol was down by nearly 10%, to 308 (still unacceptably high), her triglycerides dropped to 157. However, we also did tests that her M.D. had failed to do: her glucose was 114, which qualifies as pre-diabetes; her liver enzymes were at the high end of normal, possibly as a lingering effect from statin medication for cholesterol; and her vitamin D was a deficient 13 – over 20 is sufficient, while over 40 is optimal.

To her credit, T kept coming back and kept trying – as I have said before, the best chance of success is for those who keep trying! T does not have a perfect diet; she does not exercise in the way I’ve asked her to; and she has not managed to quit smoking. However, we kept working with the supplements and diet and lifestyle, and in December 2006 repeated the bloodwork. Her Total cholesterol had dropped to 236, 30% lower than when she came in, and within hailing distance of the medically acceptable norm; her TChol:HDL ratio dropped to 3.4, a good level; her glucose dropped to 104, indicating that she was reversing the march towards diabetes; and her liver enzymes had dropped back into the middle of the normal range.

Of course, her battle isn’t over – these numbers mean she has a lower risk for cardiovascular disease than she did when she came in, but still not a low risk – but the change is still quite remarkable. She has a long way to go with diet and lifestyle changes, especially smoking. But it is enlightening to realize that nutritional supplementation is powerful and effective, and rather than having side effects (like higher liver enzymes and lower energy level), supplements have side benefits. For example, the flax seed fiber T takes helps lower cholesterol, and is also associated with lower risk of breast and colon cancer.

One of my clients, who became a close family friend, passed away a couple of weeks ago. He was also the inspiration for the book I’m currently working on. He will be missed, but after 89 years on this planet, he probably needed to move on.

There was an article written in the British Medical Journal last summer, stating that taking calcium supplements may increase the risk of heart disease. I don’t buy it. There are too many studies previously done on calcium supplementation that found no such problem. Recommendations are for 1000-1500 mg/day.

To avoid or control osteoporosis, in addition to calcium, Dr. Julian Whitaker also recommends Bioidentical Hormone Replacement (requires a prescription), Vitamin D3 2000-5000 IU/day, Vitamin K2 (MK-7) 150-300 mcg/day (talk with your doctor if you’re on blood thinners), and Strontium Citrate 680 mg/day (take two hours after taking the calcium). 

I mentioned remedies for high cholesterol a few days ago. I neglected to mention Niacin (high-dose Niacin is best used under a doctor’s care), Plant Sterols (plant sterols are part of the membrane of the plant cell, they appear naturally in fruits, vegetables, legumes, and certain vegetable oils like corn and soybean)1,500-2,000 mg/day, Fiber (from flaxseed, glucomannan, or psyllium) 30-35 g/daily, including any dietary fiber you are currently eating.

Please enjoy your last few days of the first decade of the new millennium, and have a great New Year.

Stay well, John R Blilie, M.S.

HaveItHealth.com

Meadow writes: “while I was on Lipitor I was totally disabled, in pain, especially my feet, which I’d never had before”

Cholesterol and Your Heart: Where Do We Stand? –

Cholesterol. You’ve heard it’s “bad for you,” but why? Where does it come from? Does it do anything besides clog your arteries? This article will explain the relationship between high cholesterol and heart disease, describe the different types of cholesterol, and review several ways to lower a high cholesterol level, including exercise, a low-fat diet, and medication.

What is Cholesterol?
Cholesterol, judging from the thousands of food labels and TV commercials boasting “zero cholesterol” has quite a bad reputation. Much of it is not deserved. Cholesterol is a vital component of all cell membranes. It protects nerve cells and is the backbone for many hormones, among them cortisol, estrogen, progesterone, and testosterone. It is also used to make vitamin D and bile, a substance that helps digest fat.

Unfortunately, too high a concentration of cholesterol in the blood is associated with an increased risk of heart disease. Coronary heart disease (CHD) remains the #1 killer of both men and women in America. A high cholesterol level is one of many risk factors for developing heart disease.

Where Does Cholesterol Come From?
Most of the cholesterol circulating in your blood is made in the liver from fat metabolism. The rest, about 20%, comes from the foods you eat. Dietary cholesterol comes from animal products such as meat, milk, cheese and butter. It can also be made in the liver from saturated fat, which is found in animal products and some vegetable sources.

Types of Cholesterol

Cholesterol and fat are transported through the bloodstream in particles called lipoproteins, which are so named because they contain different proportions of lipid (fat) and protein molecules. Chylomicrons are the largest lipoproteins, and they have the highest content of fat. Chylomicrons carry triglycerides (fat from the foods you eat) from the intestine to body tissues, where they are used for energy or stored as fat.
VLDLs (Very Low Density Lipoproteins) have a little bit more protein than chylomicrons. They carry triglycerides made by the liver to their destination in body tissues.
LDLs (Low Density Lipoproteins) are stuffed full of cholesterol. They hold about two-thirds of all the cholesterol in the blood. These particles, nicknamed “bad” cholesterol, are partially responsible for forming plaque (debris) along blood vessel walls. The more LDLs you have, the greater your risk of getting coronary artery disease or a heart attack.
HDLs (High Density Lipoproteins) are known as “good” cholesterol. They’re the protective counterparts to LDLs. HDLs contain a high proportion of protein, and their function is to scour the bloodstream, collecting excess cholesterol and transporting it back to the liver to be recycled or disposed of.
Cholesterol and Heart Disease
Increased levels of cholesterol in the blood can contribute to atherosclerosis, which is the gradual build-up of cholesterol, fat, and fibrous debris along the walls of your arteries. This build-up, called plaque, can accumulate enough to narrow the artery and stiffen the arterial wall. If the plaque is severe enough it can impair blood flow past the blockage. In the heart arteries called coronary arteries this can lead to chest pain or angina when someone exerts themselves.

Part of the plaque can also break off or the plaque can become unstable and rupture. When this occurs blood is exposed to the inner material of the plaque which causes a clot, known in medical terms as a thrombus. Thrombus can form rapidly and completely obstruct an entire artery, or it can be released into the circulation. Once released, clots can travel through the bloodstream through smaller and smaller vessels until they either dissolve or reach a point where they can’t squeeze through, causing a blockage. When this blockage, called an occlusion, occurs in a coronary artery (one of several arteries that supplies the heart tissue with blood), the result is often a myocardial infarction, or heart attack. If the occlusion occurs in a cerebral (brain) artery, a cerebrovascular accident (stroke) takes place. The extent of the damage depends on the size of the blood vessel that is blocked.

What’s Your Risk?
A high level of blood cholesterol is associated with an increased risk of heart disease. But unlike other risk factors for heart disease that you can’t change or modify, such as age, sex, or a family history of heart disease, you can lower a high cholesterol level. That’s why it is monitored so closely.

Check the risk factors below to see if they apply to you. The more risk factors you have, the greater your chances of developing heart disease.

Unmodifiable Risk Factors
Modifiable Risk Factors

Men over age 45
Family history of heart disease
Women over age 55
High blood pressure
Cigarette smoking
Inactive lifestyle
Obesity
Type 2 diabetes
High cholesterol

Know Your Numbers
Cholesterol levels can be measured with a simple blood test. The table below shows the ranges that have been defined as “desirable,” “borderline,” and “high risk” for total cholesterol and the different types of cholesterol particles. However, the most important number is actually the ratio between total cholesterol and HDL cholesterol. The higher the ratio (high total cholesterol, low HDL cholesterol), the greater your risk for coronary heart disease. It is important, therefore, to know all the levels of your cholesterol and not merely the total cholesterol.

If you’ve had your cholesterol measured recently, see how it compares to the assessments below. Remember that the categories of desirable, borderline and high risk apply to persons at average risk for heart disease and may not be appropriate for you. Your doctor can help assess the degree of risk associated with your particular cholesterol values:

Lab Test
Desirable
Borderline
High Risk

Total Cholesterol
less than 200 mg/dL
(5.2 mmol/L)
200-239 mg/dL
(5.2-6.1 mmol/L)
more than 240 mg/dL
(6.2 mmol/L)

LDL Cholesterol
less than 130 mg/dL
(3.4 mmol/L)
130-159 mg/dL
(3.4-4.0 mmol/L)
more than 160 mg/dL
(4.1 mmol/L)

HDL Cholesterol
More than 39 mg/dL
(1.0 mmol/L)
n/a
less than 40 mg/dL
(1.0 mmol/L)

Triglycerides
less than 250 mg/dL
(2.8 mmol/L)
n/a
more than 250 mg/dL
(2.8 mmol/L)

Ratio of total Cholesterol:HDL
less than 3.5
3.6-4.9
more than 5

Ways to Lower Cholesterol
Is your cholesterol or ratio of cholesterol to HDL too high? The most effective ways to lower cholesterol and reduce your risk of heart disease include exercise, a low-fat diet and medication.

Exercise keeps your heart and blood vessels healthy. It can also help change some of the other risk factors that lead to heart disease, such as obesity, an inactive lifestyle and elevated blood sugar. Exercise raises HDL, the “good” cholesterol.

The National Cholesterol Education Program’s (NCEP) dietary guidelines for lowering cholesterol have focused on lowering total fat, which often ends up increasing carbohydrate in the diet. These guidelines are somewhat controversial. Some nutrition experts have demonstrated that certain people on this diet may actually lower their HDL cholesterol, the “good” cholesterol. This often leaves the ratio of cholesterol to HDL unchanged. Studies also demonstrate that the most favorable blood cholesterol concentrations have occurred when the NCEP diet is combined with an exercise program.

Other dietary guidelines include lowering cholesterol intake, changing the type of fat you eat, and increasing fiber.

General Tips for a Cholesterol-Conscious Diet

Reduce Total Fat
Depending on your cholesterol profile, a reduction in total fat may be beneficial. Less fat in the diet means that there is less “raw material” for the liver to use in making cholesterol. Fat should represent about 30% or less of your daily diet.

Reduce Saturated Fat
The type of fat you eat is just as important as how much you eat. Since the liver makes cholesterol more efficiently from saturated than unsaturated fat, changing the type of fat you eat can help to lower your cholesterol. You should get no more than 7%-10% of your daily calories from saturated fat, about one-third of your 30% goal for total fat calories.

Saturated fats are mostly solid at room temperature and can be found in fatty meats like bacon and sausage, butter, cheese, lard, palm oil and coconut oil. A careful look at nutrition labels will also help you identify how much saturated fat is in a particular food.

Reduce Partially Hydrogenated Fats or Trans Fats
To prolong the shelf life of foods, particularly margarine, snack foods and baked products, manufacturers use liquid vegetable oils, which have been partially hardened to form trans fats. Eating a diet containing these products has been associated with an increased risk of cardiovascular disease. Many foods now specify their content of trans fats; reading food labels can help you avoid these substances

Increase Polyunsaturated Fats
The type of fat found in fatty fish like salmon, mackerel and tuna is particularly healthful. Eating fish has consistently been associated with a decrease in sudden death from heart attack. Unsaturated fats are also found in liquid vegetable oils and raw or dry roasted nuts and seeds.

Increase Monounsaturated Fats
For people whose triglyceride level increases or HDL decreases on the NCEP diet, replacement of some of the carbohydrate calories with olive oil (or some other monounsaturated oils) may be beneficial. Your doctor can refer you to a nutritionist who can help you make the wisest food selections.

Increase Your Fiber Intake
Soluble fiber, which dissolves in water, can trap bile in the intestine and excrete it along with other waste. Since bile, a substance that helps digest fat, is made primarily of cholesterol, excreting it will help lower total cholesterol levels. Soluble fiber is found in fruits, oats and dried beans (legumes); it’s also present in ingredients like pectin and guar gum.

When increasing your fiber, you might also want to try soy. This legume, found in products made from soybeans like soy milk, tempeh, tofu and TVP (Textured Vegetable Protein), has received a lot of attention lately. Intriguing research has shown that the vegetable protein in soy may be able to lower blood cholesterol.
A registered dietitian (RD) can help you plan a cholesterol-modifying diet that’s appropriate for your weight, height, activity level, and blood cholesterol profile.

For More Information: Click Here

RESOURCES:
American Heart Association

http://www.americanheart.org/

Dietary Guidelines for Americans
US Department of Agriculture, US Department of Health and Human Services

http://www.health.gov/

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada

http://ww2.heartandstroke.ca

Heart Healthy Kit: Public Health Agency of Canada

http://www.phac-aspc.gc.ca/

REFERENCES:

Castelli WP. The new pathophysiology of coronary artery disease. Am J of Cardiol . 1998;82:60T-65T.

Choice of lipid-lowering drugs. The Medical Letter on Drugs and Therapeutics . 1998;40:1042.

Grundy SM, Cleeman JI, et al. Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004;44(3):720-732.

Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 237 trials. Arteriosclerosis, Thrombosis and Vascular Biology . 1992;12:911-916.

Stefanic ML, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med . 1998;339:12-20.

Whitney EN, Rolfes SR Understanding Nutrition. 6th ed. Minneapolis/St. Paul: West Publishing Co.; 1993.

Willet WC. Diet and health: What should we eat? Science . 1994;264:532-537.

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

I went to the doctor today.

That sentence alone sounds deadly serious, and while I didn’t discover that I had some life-threatening disease, the news I had was still a bit unpleasant.  My bad cholesterol is high, my good cholesterol is low, and I’m overweight.  I knew the last one, and feared the first two.  The doctor was going to put me on cholesterol medication (something my father, aunt, and uncle already use), but she was hesitant, and for one very large reason: no one at the age of 29 should really be in need of cholesterol medication.  I should be able to control this with diet and exercise, and I’m simply not doing a good enough job.

And so, we have an ultimatum of sorts.  I have four months before my next blood test to drop some pounds and change the direction that my cholesterol is taking me.  It means 3-5 hours of exercise every week for the rest of my life, admittedly something that’s pretty difficult for me these days.  It’s not physically difficult, exactly, but rather mentally challenging, as I don’t like exercise, and have never had very much skill at sports outside of swimming.  It also means no red meat past once a week, tops, and it means cutting out fried foods as much as possible.  It also means intense portion control, making vegetables the main ingredient in all of my meals while limiting starches and making sure that I’m consuming a good amount of protein without overdosing on meat, arguably my favorite of all the food groups.  Additionally, I’ll have to bid a fond adieu to sugary snacks like cookies, and avoid snacking so much in between meals.  When I do snack, it will have to be fruits or vegetables, avoiding unnecessary starches and fats.

Years ago, I lost 20 pounds.  I felt better and looked better.  Now, in my later years, where laziness and malaise have turned me into the lump of goo I am today, I need to lose closer to 50 in order to be at the weight that’s proper for a person of my height.

I expect this to be incredibly hard, and it will likely make me miserable until I start seeing some actual results.  Again, I don’t particularly enjoy working out, even though I like the feeling I get from it. Sweating from your labor can feel very gratifying, but knowing that I won’t see any real weight loss for awhile is going to be tough.  Likewise, watching what one eats, frankly, sucks.  Watching people devour burgers and not gain a pound has always irked me, but now, as my portions really need to be controlled and my dietary choices need to be much more carefully regulated, I imagine that the constant growling of my stomach will be less Winnie the Pooh and more starving jungle cat.

Well, fat starving jungle cat.

April 1st, I have my next blood test which will determine the success of this new plan on beating back the tidal wave of my bad cholesterol.  Of course, a potential reduction in my waistline will also give a decent picture of the potency of my new lifestyle, if I have indeed adopted one.

Failure in this endeavor would mean a number of things, none of which are pleasant: a lifetime of medication, constant worry over the state of my heart and arteries, concern over the ability to run around with my children…and a personal failure of my own willpower.  If I cannot accomplish this, something that, literally, my life depends on, then what is the likelihood that I can accomplish anything that I set my mind to?  What would be the point of setting my mind to anything if I cannot do something so incredibly important and vital to my own well-being.

While my diet over the next few days will not accurately reflect this change (Christine and I are going to a New Year’s party in two days, and it will be incredibly difficult to eat well there outside of simply drinking water all night and consuming nothing else), I begin my new exercise routine tomorrow.  I’ll be at the gym for an hour and change from Monday through Thursday, spending an hour doing cardio and around 15 minutes each day doing different weight work and, occasionally, some abdominal work as well.  Friday through Sunday will be days off, but if I’m able to stick to that routine, I should be fine as far as physical activity.  Dieting, and everything already mentioned that relates to it, will start in earnest this Sunday.

I suppose that’s all for now.  Hopefully, I’ll be able to look back at this blog post as the beginning of something bigger or, rather, the beginning of me turning into something not quite so big at all.