Cholesterol Lowering Diet

Homocysteine -- A Serious Heart Risk Factor

Friday, January 29, 2010 by Stephen Sinatra

Historically, it was assumed that if you couldn’t keep good cholesterol levels, you were at risk for coronary artery disease and other cardiovascular problems. But there is now evidence that elevated homocysteine levels is another serious heart risk factor.

Multiple studies have confirmed the connection between high-plasma homocysteine levels and occlusive artery disease, including coronary atherosclerosis, peripheral vascular disease, and carotid artery disease. In fact, some research shows that 42 percent of strokes, 28 percent of peripheral vascular disease, and approximately 30 percent of premature cardiovascular disease are directly related to excessive levels of homocysteine.

High homocysteine levels can be caused by foods—red meat, avocados, sunflower seeds, wild game, poultry, and ricotta cheese. These foods contain the amino acid methionine. If you don’t get enough B vitamins, your body cannot break down methionine, resulting in homocysteine.

These deficiencies can be further exacerbated by caffeine and alcohol, which cause excessive urination and wash out precious B vitamins from our bodies. (That’s why it is so important to adhere to the healthy heart nutrition tips I often share here in this blog.)

Research also shows that five percent of the population may have inherited a rare genetic enzymatic defect that leads to higher homocysteine levels and premature heart disease (which can lead to heart attack and stroke). Because of this new genetic data, the evaluation of serum homocysteine levels should become standard in preventive cardiology, especially in anyone with a family history of premature heart disease.

When Should You Get Your Homocysteine Tested?

If you eat a healthy diet, supplement with vitamins and minerals, exercise, and have no family history of heart disease and or other heart risk factors, then you don’t need to be tested for homocysteine. But if there was a sudden death of a family member at a young age from stroke or heart disease, or if you have heart disease (especially if you are under age 60), you should be tested for homocysteine.

Research has shown that 400 mcg of folic acid a day will help prevent high homocysteine levels. However, to be safe, I recommend 800 mcg folic acid and 20 mg of vitamin B6 per day. Natural sources of folate include dark green leafy vegetables, beans, legumes, oranges, orange juice, and fortified cereals.

Your Cholesterol Lowering Diet Should Include Flaxseed

Thursday, December 31, 2009 by Stephen Sinatra

Crushed flaxseed is a perfect food for a cholesterol-lowering diet. It contains essential fatty acids, high-quality protein, vitamins, precious phytonutrients, and lignans, as well as soluble fiber and insoluble fiber, all of which promote healthy cholesterol. In fact, research on soluble fiber shows that total cholesterol can be reduced by 11 percent and LDL cholesterol by 18 percent over a two- to three-week period.

For now, I hope all of you—even those of you whose cholesterol levels are in the normal range—will drink one flax shake a day. Many of my patients have lowered their cholesterol and lost weight when I 've put them on a flax shake. Give it a try!

Boost Your Cholesterol Lowering Diet with Apples

Wednesday, October 14, 2009 by Jan Sinatra

Fall is one of my favorite times of the year. I love the crisp, cool weather and the changing leaves on the trees. I also love the abundance of one of my favorite fall foods—apples! While we know apples have numerous health boosting qualities; remember the saying “an apple a day keeps the doctor away?” Did you know apples are actually one of the best foods you can add to a cholesterol lowering diet?

In fact, apples are a cholesterol lowering diet—super food! That’s because they’re loaded with phytonutrients and fiber, which have been shown in studies to help lower blood cholesterol. There’s no question that apples should be a staple of any cholesterol lowering diet. One of my favorite ways to eat apples is to slice them up, sprinkle a little cinnamon on top—and enjoy!

But an apple snack is only one way to enjoy them. You can also add apples to your cholesterol lowering diet by making them for dinner. Try placing boneless, skinless chicken breasts in a casserole dish, along with chopped onions, apples, and a few raisins. Sprinkle cinnamon with cinnamon, curry (and any of your favorite “apple pie spices”)—and bake in the oven at 350 degrees until the chicken is done.

Plus, who says a cholesterol lowering diet can’t include dessert? Try making a healthy apple brown betty by layering apple slices in a casserole dish and sprinkling them with oatmeal. Then, add a “swizzle” of raw honey and a sprinkle of cinnamon. Bake at 350 until the apples soften (about 20 minutes).

Do you have a favorite apple recipe? I’d love to hear about it, so I can add it to my cholesterol lowering diet.

Soy Promotes Healthy Cholesterol Levels

Thursday, August 20, 2009 by Kimberly Day

More than 30 clinical studies have shown that soy is highly effective as part of a cholesterol-lowering diet. Case in point, an August 1995 meta-analysis from the New England Journal of Medicine found that people who ate an average of 47 grams of soy protein per day had a 13 percent decrease in LDL cholesterol levels, a 10.5 percent decrease in triglycerides, and a nine percent decrease in total cholesterol levels.

A November 2001 issue of Archives of Internal Medicine also found that a high consumption of legumes, including soybeans, meant a lowered risk of coronary heart disease (CHD). They concluded that increased legume intake may be an important part of a dietary approach to preventing CHD.

Additionally, a report in the August 2002 issue of Arteriosclerosis, Thrombosis and Vascular Biology found that a diet rich in tofu and other soy products may help protect postmenopausal women from arterial disease. According to researchers, phytoestrogens were associated with less arterial stiffness among more than 400 postmenopausal women. The benefit was most pronounced among the oldest women, or those who had been postmenopausal the longest.

Surprisingly, even the FDA agrees that soy is beneficial for maintaining good cholesterol levels. In 1999, they authorized of the use of health claims on the labeling of foods containing soy protein, based on research which shows that soy foods may reduce risk of coronary heart disease by lowering blood cholesterol levels. According to the FDA, foods must contain 6.25 grams per serving of soy protein in order to qualify for the claim, and a daily intake of 25 grams is recommended in order to achieve a significant cholesterol-lowering effect. Now that's healthy heart nutrition!

Two Birds, One Stone: Niacin Increases HDL and Lowers Lp(a)

Tuesday, July 28, 2009 by Stephen Sinatra

You’ve heard me say time and again that reducing cholesterol is not the magic bullet that will prevent heart attack and stroke. I stand by this statement wholeheartedly—but I don’t want you to interpret it to mean that cholesterol is unimportant.

Optimum cardiovascular health requires maintaining a healthy cholesterol ratio—that is, keeping your LDL cholesterol levels (the so-called “bad” cholesterol) in proper balance with your HDL levels (the “good” type of cholesterol). It also calls for minimizing the amount of Lp(a) in your blood, and not letting your triglyceride levels get out of hand.

Although regular exercise and a cholesterol lowering diet will go a long way toward helping you achieve these goals, I also recommend that you try some targeted nutritional supplements for an extra boost. One of them is niacin (vitamin B3). It’s a fantastic nutrient that can help you increase HDL cholesterol, as well as lower both triglycerides and the dangerous subtype of cholesterol known as Lp(a).

These are huge benefits. For me, keeping HDL levels high and Lp(a) down are more significant than lowering LDL or even total cholesterol. Elevated Lp(a) is a serious, widespread, and underemphasized problem, and niacin is probably one of the best nutrients to lower it. And the higher your good cholesterol levels, the more protection you have in your blood vessels.

The only downside to niacin is the flushing sensation it generates. This hot, tingly, pins-and-needles feeling is disconcerting to a lot of people, but it usually lasts no more than 30–60 minutes, and it is most pronounced during the first week or so that you take the supplement (it can also occur when you increase your dosage). You can find no-flush forms of niacin, but they’re not as effective. I would stick with the regular kind.

I recommend taking 1–2 g a day in divided doses with meals. Start with 250 mg and slowly work your way up to minimize the flushing effect. Let me know how it works for you!

10 Must-Know Facts About Cholesterol

Monday, June 1, 2009 by Stephen Sinatra

One of the most important parts of maintaining healthy cholesterol is understanding how your body uses and manages this essential lipid. Why? Because having a cholesterol level that is too low is just as dangerous as having a cholesterol level that is too high. Most people don't realize it, but blindly following the cholesterol guidelines put forth by pharmaceutical companies (whose primary interest is to sell you their drugs, not to make you healthy) could put your long-term health in jeopardy.

To help you get some perspective on what constitutes a good cholesterol level, I've identified 10 vital facts about cholesterol in the body. Keep them in mind the next time your doctor raises the issue of reducing cholesterol, and make sure that any decision to do so is truly in your best interest (and if you must improve your numbers, opt for natural therapies such as a cholesterol lowering diet, as well as lifestyle changes and nutritional supplements that can help increase HDL cholesterol and reduce LDL cholesterol levels).

1) Cholesterol is a raw material made by your liver, brain, and almost every cell in your body. Enzymes convert it into vitamin D, steroid hormones (including the sex hormones estrogen, progesterone, and testosterone, and stress hormones), and bile salts needed for digesting and absorbing fats. Cholesterol is a major part of the membranes surrounding cells and the structures within them.

2) The body makes cholesterol as needed. When you eat more in your diet, the body makes less. If you eat less, the body makes more. On average, 85 percent of blood cholesterol is made in the body, and the rest comes from food.

3) You can have different levels of cholesterol at different times of the day.

4) Cholesterol tends to go up in the winter and down in the summer.

5) Cholesterol soars after any surgery, and it increases when you have an infection, mental stress, or have suffered a heart attack. The reason for this is that cholesterol is a healing agent needed to help create new cells, and it’s produced whenever healing is required. Your cholesterol level will also rise and fall depending on exposure to environmental agents and toxins.

6) When a doctor finds a high level of cholesterol, instead of reaching for the prescription pad, he or she should look for the reason the cholesterol is high and treat the cause. If the cause is successfully addressed, cholesterol often comes down.

7) It’s interesting to note that the herbs, antioxidants, and nutraceuticals that reduce cholesterol do so by neutralizing damaging agents in the blood stream. Thus, the liver doesn’t have to produce as much cholesterol. Moreover, the supplements support other biochemical processes necessary to heal wounds.

8) The endothelium is the razor-thin lining of blood vessels. The damaging agents we are exposed to—toxic chemicals, pathogens, free radicals, and inflammatory substances—wind up in our blood stream and damage this thin layer of cells. When this happens, the liver sends LDL to the site to make repairs. As the healing process concludes, the spent LDL particles are carried back to the liver by HDL and removed from the body.

9) The brain is particularly rich in cholesterol and accounts for about one-quarter of all the cholesterol we have. About 20 percent of the fatty myelin sheath that coats every nerve cell and fiber is made of cholesterol, and neuron function depends on it. It’s not surprising that a connection has been found between naturally occurring cholesterol and mental function, and that lower cholesterol levels are linked to poorer cognitive performance.

10) Some research suggests that doctors should be extremely cautious about prescribing statin drugs to the elderly, particularly those who are frail. I agree. I have seen frail individuals become even weaker and more prone to infections after taking these medications. Many of these patients later told me that their strength, energy, appetite, and vitality returned when they discontinued the statins. These folks clearly need their cholesterol—as do the very young.

Mediterranean Eating for a Healthy Heart

Monday, April 20, 2009 by Stephen Sinatra

There was more news out last week that was no news to me. You probably heard about it, too--a study published in the Archives of Internal Medicine showed that the Mediterranean diet is the only diet associated with lower risk of heart disease.

Readers of my newsletter, Heart, Health & Nutrition, know that I've been recommending the Mediterranean way of eating for years. I believe it's the cornerstone of good cardiovascular nutrition, and an absolute must if you want a vitamin rich, cholesterol lowering diet that can help prevent heart attack and stroke.

Now, technically I prefer to combine the Mediterranean diet with a taste of Asia to create what I call the Pan Asian Modified Mediterranean (PAMM) diet. PAMM emphasizes fruits, vegetables, legumes, nuts, lean protein, and healthy fats at every meal. For best results, here's how I recommend you put together your menu:

40 percent low-density carbohydrates, mostly low-glycemic vegetables and fruits.
25-30 percent lean protein, such as chicken, fish, tofu, or egg whites.
30-35 percent monounsaturated fats, including but not limited to olive oil, nuts, and avocado.

It's very important to limit lean protein to 25-30 percent of a meal. This portion size can be gauged as a piece of lean chicken breast, fish, or meat (about 6 ounces and 200 calories). That's roughly the same size as the palm of your hand, or one-quarter of a full-sized dinner plate. I emphasize that the protein be lean because you'll get a whopping dose of saturated fat if your meats are marbled.

I know that some of you are skptical of healthy heart nutrition plans, so let me tell you something else about the PAMM diet. It's not just scientifically sound. I've tested it myself--along with a lot of other diet plans--and it's delicious! I challenge you to give it a try. To get you started, here are some of my favorite recipes. Let me know what you think!

Everyday Foods Can Reduce Cholesterol

Thursday, March 19, 2009 by Stephen Sinatra

You know that I don't believe cholesterol is the serious heart risk factor that the drug companies make it out to be in their advertising. However, I also don't believe that it's healthy to let cholesterol go unchecked. As I've said before, research shows there is a healthy range for cholesterol. If you go too far above it or below it, you're asking for trouble.

Fortunately, reducing cholesterol is relatively easy and doesn't usually require medication. It just takes a little discipline, some patience, and a cholesterol lowering diet. To start, try the three nutritional recommendations below. If done daily, they will reduce your cholesterol level in about four weeks--even with no other changes to what you eat.

1) Eat a breakfast that includes a serving of oat bran, raisin bran, shredded wheat, or bran flakes with a fresh fruit such as blueberries, strawberries, raspberries, bananas, peaches, etc. Add two tablespoons of organic flaxseed, grind it up in a coffee grinder, and serve with 6-9 oz. of organic skim or 1% milk.

2) Eat one pear or one apple, and one medium-sized carrot.

3) For a snack, or as a dessert with any meal, eat one half of a grapefruit, including all of the white pulp. This is loaded with pectin, a soluble fiber. Please note, however, that there's a very important warning that goes along with this recommendation. You should only eat grapefruit (or drink grapefruit juice) after talking with your doctor to confirm that none of the medications you're taking will interact with it. The effects of many cardiovascular drugs, including statins, can be intensified when combined with grapefruit or grapefruit juice. This is because grapefruit affects enzyme systems in the liver and increases the amount of the drugs in your blood. So, if you're taking one of these drugs, I don't advise that you eat grapefruit or drink grapefruit juice. Just stick with the first two recommendations instead.

By eating these foods every day, you'll get 15-20 grams of fiber, which will help you achieve healthy cholesterol levels and bring you many other health benefits.

Lp(a): The Most Dangerous Form of Cholesterol

Thursday, March 5, 2009 by Stephen Sinatra

A few weeks ago, I posted some thoughts on why I don't believe that reducing cholesterol is the magic bullet that will prevent or cure heart disease. For starters, cardiovascular problems just aren't that simple, and on top of that, most cholesterol is completely harmless.

There is, however, one form of cholesterol that always requires aggressive treatment. It's called lipoprotein(a), or Lp(a), and it's one of the most dangerous heart risk factors.

Lp(a) is a subtype of LDL cholesterol that is highly inflammatory and thrombotic, which means it causes the blood to thicken and clot. Everyone has some Lp(a) in their blood stream--but when it increases abnormally, Lp(a) can raise your risk of having a heart attack up to 25 times.

Finding out if you have high Lp(a) is relatively simple. Just ask your doctor for one of the new-generation blood lipid tests that measure your cholesterol subtypes. There are two of them on the market, one called the Lipoprotein Particle Profile, or LPP, and another called the Vertical Auto Profile, or VAP. I prefer the LPP because I think the measurements are more precise, but both will tell you how much Lp(a) is circulating in your blood. As a general rule, you want your score to be less than 10 mg/dL.

Unfortunately, treating high Lp(a) is a little bit more complicated. One challenge is that there are no drugs with the ability to reduce it. Another is its genetic nature. High Lp(a) is often hereditary and is not the result of a poor diet or lack of exercise--which means you can't cure the problem through lifestyle changes, either.

That leaves just one genuinely good option, and that's to use natural therapies that offset the toxic effects of Lp(a) in the blood. Since Lp(a) causes inflammation and thickening of the blood, you want to look for products that have the opposite effect. I like fish oil (1-2 g daily) and nattokinase (50-100 mg daily). Fish oil is a natural blood thinner and has been shown to reduce inflammation, while nattokinase helps break down fibrin in the blood--one of the components that lead to clots. I also like high doses of vitamin C (1-2 g daily) for its antioxidant effects, as well as niacin (500 mg), which helps lower blood pressure.

Another option that I like is delta tocotrienol. Tocotrienol compounds occur naturally in plants and protect the carotenoids in plants from degradation. New research shows that delta tocotrienol is an effective means for reducing cholesterol overall, and it may be effective specifically on Lp(a). I recommend 100 mg daily.

Though it's somehwat less effective than targeted nutritional supplementation, you can also attack Lp(a) through a heart-healthy, cholesterol lowering diet. The PAMM eating plan (Pan Asian Modified Mediterranean) is a good place to start. It emphasizes healthy fats such as olive oil, along with whole grains, beans, legumes, nuts, fresh fruits and vegetables, and very small servings of meat (preferrably fresh, wild fish--not farm raised). This will help keep your ratio of HDL cholesterol to LDL cholesterol in proper balance, and the fresh fruits and legumes--such as chickpeas and lentils--indirectly help to reduce Lp(a) by lowering insulin levels.

Finally, there are certain people for whom an Lp(a) test is an absolute must. The first group includes anyone with a family history of heart disease. Lp(a)'s tendency to run in families means that these folks, above everyone else, need to find out if their levels are in the normal range. The test is alo essential if you're a postmenopausal woman or you have diabetes, because we know that Lp(a) increases in both of those groups. Women, it is hypothesized, experience elevated levels due to falling estrogen levels. This may be why the incidence of heart disease quadruples among menopausal women.

Of course, I urge the rest of you to have your Lp(a) level tested, too. The best way to prevent cardiovascular problems is to know your risk factors--and act accordingly.

A Simple Truth: You Control Your Health

Thursday, January 22, 2009 by Stephen Sinatra

For the past few months, I've tried to stay out of the political fray as much as possible. It's not that I'm uninterested. It's just that I've seen too many presidents come and go, and too many promises made and broken, to get especially excited about those things anymore. But while I listened to Mr. Obama's inaugural address on Tuesday, I was encouraged by his call for increased discipline and responsibility. I felt hopeful about what that kind of attitude could mean for health care.

The system could use some updating, to be sure. But the real crisis in health care isn't about recordkeeping or access or insurance--it's our atrocious habits. And it's high time that people are called to account for them.

The truth is, we eat too much and we eat the wrong things. We don't exercise. We lack the skills to manage anger, heartbreak, and stress. Too often, we depend on caffeine, nicotine, or alcohol to help us get through the day.

As a holistic health practitioner, I'm lucky. I see patients who already understand that making good lifestyle choices is the best way to maintain good health, minimize heart risk factors, and prevent heart attacks. When I look at the rest of the population, though, I see a completely different picture. I see aging baby boomers, overweight young people, and a crush of obesity, diabetes, and cardiovascular problems that could easily overwhelm our ability to treat them.

If I could say one thing to our new president, it would be this: Please begin a national campaign about taking responsibility for your health. Too many people believe that their problems are beyond their control when, in fact, the opposite is true. Many health conditions can be reversed or avoided with proper nutritional support, a heart-healthy diet, exercise, and mind/body awareness.

The message may be a tough sell, but it's one that we literally can't afford to ignore.

Need suggestions for where to start? Tell people to stop eating processed and packaged foods. They're loaded with sodium and preservatives that drive up blood pressure. Ask them to pour out high-fructose corn syrup-laden sodas, which serve up empty calories and wreak havoc with insulin levels. Warn them that sugar contributes to arterial inflammation and the growth of cancer cells. Implore them to exercise--not only does it burn calories, it increases strength and mobility, strengthens the heart and lungs, helps you think more clearly, and works off stress and other negative emotions. Finally, publish guidelines for grocery shopping that emphasize whole foods, healthy fats, and other principles of good cardiovascular nutrition.

You see, the problem with health care isn't the system. The problem is that we rely too much on the system to treat problems that are nearly 100 percent preventable if only we make better, more responsible choices. I urge you to be part of the solution. Replace your bad habits with healthy ones. The change may not be easy, but your improved health will be well worth it.

Drugs are not the only way to lower your cholesterol

Tuesday, December 30, 2008 by Stephen Sinatra

For years I've been telling patients and subscribers to my newsletter, Heart, Health&Nutrition, that there are natural ways of reducing cholesterol. You see, as a holistic health practitioner, I know that prescription drugs aren't the only method people should use and a recent research study further proves my case.

This study, conducted by Dr. David J. Becker of the University of Pennsylvania Health System's Chestnut Hill Hospital and colleagues, found that people with high cholesterol who took red yeast rice and fish oil daily and who got help with diet, exercise and relaxation techniques enjoyed the same 40% drop in LDL obtained by people taking 40 milligrams of the popular cholesterol drug, simvastatin, each day.

Please don't use this information to justify getting off of your statin drug. You should never do that without first talking with your doctor.

The results of this study are simply shared to help illustrate how a healthy lifestyle, one that includes the right supplements (like fish oil, rutin, and garlic), exercise, and a cholesterol lowering diet full of fresh fruits and vegetables and cold water fish, can have a phenomenal affect on your cholesterol levels and your overall health.

I have lots to tell you about cholesterol and how it’s really not the villain in the heart disease story, so please stay tuned and visit my blog often. The story may surprise you.