All entries tagged with “cholesterol”
Four Foods Proven to Lower Cholesterol
People frequently ask me what foods they can eat to help lower cholesterol. A recent study in the Journal of the American Medical Association tested two diets for their ability to lower cholesterol, providing patients with some much needed guidance on the subject. While several foods and food groups have been known to favorably impact cholesterol, these researchers put together a “portfolio” of some of the most effective foods. Patients were either placed on a control diet which was described as “low saturated fat” or a diet that included a portfolio of plant sterols, soy protein, viscous fibers and nuts. The plants sterols were ingested in the form of an enriched margarine such as Smart Balance. The soy proteins were consumed both as soy beverages and tofu. The psyllium was consumed though oats, barley and as psyllium itself (Metamucil). The nuts (tree nuts and peanuts) were typically eaten with the morning and afternoon snacks. The patients were followed for 6 months with their cholesterol measured at baseline and at the end of the study. In addition, their blood pressure and body weight were followed. All patients in the study were instructed to eat 6 times daily – 3 meals and 3 snacks. Each of the meals and snacks in the study group incorporated some of the portfolio components. At the end of the study, both groups lost about 5 pounds. The control group had a reduction in the LDL (bad cholesterol) of 3.5% while the study group had a 14% reduction in the LDL. There was no significant change in the HDL (good cholesterol) or triglycerides. I think there are several take home points from this study- first, dietary changes can significantly reduce LDL cholesterol. Further, this study shows that a diet rich in specifically plant sterols, soy protein, viscous fiber and nuts is considerably more effective at reducing cholesterol than a typical low saturated fat diet. However, the magnitude of the change in LDL (14% reduction) is modest in comparison to medications like statins, some of which can reliably lower LDL by over 50%. Nonetheless, there are patients whose LDL cholesterol is borderline and dietary changes such as these may be all that is needed. Also, it is estimated that every 1% reduction in LDL translates into a 1% reduction in the risk for heart disease, so even patients already on cholesterol medication could benefit from these dietary changes. For more information on the specifics of the dietary components, feel free to email me at meimer@cagemedical.com 
Simplifying Cholesterol Numbers: “All that is not good is bad”
Those of you that have been checking and following your cholesterol numbers over the years have probably felt confused at some point about what the optimal values are or even what values to follow. The basic components of the cholesterol panel have not changed- total cholesterol is a sum of HDL (good cholesterol) + LDL (bad cholesterol) and Triglycerides. What has changed is which of these entities is the primary focus of our attention and where to set the goals for these values. Initially, patients were told that an ideal cholesterol level meant a total cholesterol less than 200. This approach fell out of favor as it was then appreciated that HDL cholesterol was protective and that high levels of HDL (which raised the total cholesterol) was associated with a lower risk of heart disease. Likewise, patients with low HDL (which would result in a lower total cholesterol) were at increased risk of heart attack. The focus then shifted to primarily worrying about the level of LDL cholesterol as many large studies suggested that the level of LDL cholesterol was the most important predictor of a person’s risk for heart disease. Once there was general consensus that the LDL was the most important measure, researchers sought to define the optimal level of LDL cholesterol. The optimal level of LDL for patients with heart disease has dropped from 130 to 100 and now to 70 based on data that each subsequent reduction further reduces the risk for heart attack. However, there are several problems with an “LDL-centric” approach to cholesterol. First, patients with low LDL are still at some risk of heart attack which has been termed “residual risk” suggesting that LDL is not the whole story. Second, there is currently an epidemic of patients who are overweight with diabetes (“metabolic syndrome”) who are clearly at high risk for heart disease, despite a relatively normal LDL. In addition to normal LDL these patients will typically have elevated triglycerides and low HDL. An idea that is gaining traction in the cardiovascular prevention community is to simply dichotomize cholesterol into good and bad. In other words, if HDL is the only good cholesterol then everything else (termed “non-HDL” cholesterol) must be increasing the risk of heart attack. Non-HDL also includes cholesterol particles that are not routinely assessed like very low density LDL or VLDL. In fact, many large studies have already proven that non-HDL is actually better than LDL at predicting the risk of heart disease. In terms of what the ideal non-HDL level should be, guidelines suggest that a level 30 points higher than your goal LDL (which can be determined by your doctor) is probably optimal.
Study Proves Benefit of Neck Ultrasound in Predicting Risk of Heart Disease
Predicting and reducing a patient’s risk of having heart disease is the cornerstone of preventive cardiology. Doctors have many options on how to do this including tabulating risk factors like diabetes, smoking, high blood pressure, high cholesterol and family history. However, some patients will go on to develop heart disease with few or no risk factors. In fact, the majority of heart attacks occur in patients who would be deemed “low risk”. A recent study in the New England Journal of Medicine examined the ability of carotid ultrasound (an ultrasound study of the main artery in the neck) to predict an individual’s risk of developing heart disease. Nearly 3000 healthy patients with an average age of 58 underwent an ultrasound examination and then were followed for seven years. The ultrasounds were evaluated for the presence or absence of plaque as well as the thickness of the arterial wall (cIMT). Patients with even minimal plaque in the neck arteries were noted to have double the risk of heart disease compared to those who did not have plaque. A similar relationship was also found with patients who had thickening of the arterial wall which is a very early sign of plaque build up. Carotid ultrasound testing can be performed in a doctor’s office, is relatively inexpensive and involves no radiation. This study demonstrates that the findings of a carotid ultrasound gives doctors a powerful tool to predict, and thus reduce, a patient’s future risk of heart disease.
eat those eggsAccording to the U.S. Government's latest guidelines, one egg per day does not result in increased blood cholesterol levels. Nor does it increase the risk of cardiovascular disease in normal people. What... More »
fat is good for youThis comes from spacedoc.net which I think is a great blog: Does the thought of a steak, bacon and eggs, or real milk make you cringe thinking you're instantly clogging up your arteries? How many... More »
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