Cholesterol Lowering Diet

Maintaining good cholesterol levels is  important, but, contrary to popular belief, cholesterol is not a villain. Your body needs cholesterol to synthesize certain nutrients and hormones, construct the semi-permeable membranes around each of the 100 trillion cells that make up your body, and facilitate cell communication and memory in the brain.

Cholesterol moves through the body with the help of two proteins: LDL, or low-density lipoprotein, and HDL, or high-density lipoprotein. LDL carries ready-to-use cholesterol molecules that can be absorbed by cells that need it, and HDL picks up excess cholesterol and carries it back to the liver for recycling and excretion.

Healthy LDL cholesterol levels are always of great concern, as they should be, but few people know that it’s impossible for your cells to absorb too much of it. LDL becomes unsafe only when it interacts with molecular fragments called free radicals. The effect of such interaction is that the LDL becomes oxidized. Unlike normal LDL, oxidized LDL has toxic effects on the cells it attaches to.  

When you get down to it, though, the real problem is not cholesterol—it’s whether your body’s antioxidant system can effectively neutralize the free radicals that damage LDL molecules.

Here’s what you need to remember about cholesterol: It’s a relative heart risk factor and it’s influenced by other factors. You should also keep in mind that good cardiovascular nutrition and a cholesterol lowering diet can go a long way to helping you keep good cholesterol levels.

For more information on cholesterol guidelines, reducing hypertension, and overall heart health, visit www.drsinatra.com. While there, sign up for FREE e-letters or subscribe to Dr. Sinatra’s monthly newsletter, Heart, Health & Nutrition.

In my newsletter, Heart, Health, and Nutrition, I’ve written a lot about inflammation as being a chief cause of cardiovascular problems, even more critical than the difficulty many Americans have with maintaining healthy cholesterol.

But, the good news is that a lot can be done to combat this potential killer. For example…

In a coronary arteriography study of nearly 400 Japanese men, those who loved their traditional green tea enough to drink at least a cup every day had a risk of heart attack significantly lower than men who were down­ing other beverages.

This study from the other side of the globe was extremely interesting. Researchers looked at green tea, black tea, cocoa, coffee, and red wine consumption and the heart. While investigators were hard-pressed to find any relationship between identifiable coronary artery disease and the dietary intake of any of these beverages, there was definitely a statistical association between green tea and heart attack; more of the former meant less of the latter.

The important property you get from a soothing cup of green tea is its natural COX-inhibiting effect, which translates to an anti-inflammatory effect.

Other natural COX-2 inhibitors that you can easily add to your diet include healthy spices like ginger, curcumin, oregano, onion, and garlic. These remarkable spices make for good overall cardiovascular nutrition.

For more information on good cardiovascular nutrition, visit www.drsinatra.com.

Lipoprotein A, or Lp(a), is a component of LDL or “bad” cholesterol and high levels of it in your blood can be a serious heart risk factor.  

According to an article in the 1997 Journal of the American Medical Association (JAMA), Lp(a) appears to regulate clot formation (thrombosis) and inhibit blood thin­ning, which can lead to blood circulation problems.

We know that Lp(a) increases in unstable diabetics and menopausal women with elevated levels due to lowered estrogen levels. This may be why the incidence of heart disease among menopausal women quadruples.

Conversely, Lp(a) decreases with estrogen replacement therapy. For this reason, it’s imperative that all menopausal and perimeno­pausal women with a strong family history of heart disease have their Lp(a) levels checked by their doctor. Further, postmenopausal women with multiple heart risk factors should consider natural, topical estrogen replace­ment therapy, particularly if their Lp(a) is elevated.

Research shows that elevated Lp(a) levels appear to be even stronger predictors for the development of premature heart disease in men. JAMA reported a study of 2,191 men confirming this.

Statin Drugs Will Not Reduce Lp(a)

Statins, drugs commonly prescribed to help you keep good cholesterol levels, are not effective for lowering Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While cholesterol-lowering drugs can reduce LDL, they can’t reduce Lp(a). If you find that a high Lp(a) level runs in your family, you must attack it with an alter­native approach.

Here’s what I recommend:

• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date and you can increase the dose to 500 mg a day, twice a day for further protection, or reduce it by no less than 100 mg daily if you have side effects. Twinlabs’ quick-acting Niacin is a good product.
• Follow my Pan-Asian Modified Mediterranean (PAMM) diet.
• Take 1–2grams of vitamin C and 100–200 mg of standard coenzyme Q10.
• Take 1–2grams of fish oil daily.
• Take 50mg of nattokinase twice a day.
• Take 100mg of delta tocotrienols twice a day.
• Exercise regularly.

If you’re concerned, you and your family members should have your Lp(a) and other risk factors (homocysteine, fibrinogen, and serum ferritin) evaluated by your doctor. And be aware of other heart disease risk factors, includ­ing smoking, high blood pressure, obesity, glucose intolerance, and repressed emotions, all of which can cause cardiovascular problems.

For more information on LDL cholesterol levels and ways to lower them, visit www.drsinatra.com.

Vitamin and mineral supplements are not substitutes for a proper diet, but even the rare American who eats a balanced diet does not get the amount of nutritionals needed to combat the toxins and heart risk factors that threaten his/her health. This is why it’s critical that you take a quality multivitamin/mineral supplement with antioxidants every day with your meals. It’s just smart cardiovascular nutrition.

Hundreds of studies have shown that antioxidant nutrients protect cells from free radicals, neutralizing these molecular marauders before they do serious damage. Antioxidants protect your genetic DNA, cellular membranes, and even the enzyme systems that support cell metabolism. These activities have implications far beyond daily health. They can be found at the heart of aging itself.

Additionally, there are some key nutritional allies that reduce your risk for many of the cardiovascular problems out there today, including heart attack and stroke.  For example, taking the right supplements is one of the best natural ways to lower blood pressure levels, improve poor blood circulation, and maintain healthy cholesterol and healthy blood pressure. Check out my previous postings, then consult with your doctor or holistic health practitioner to find out what’s best for you.

To read more on how to fight heart risk factors, visit www.drsinatra.com.
 

HMG-CoA reductase inhibitors, more commonly known as statins, are the most aggressively marketed drugs for producing good cholesterol levels. In clinical studies statins achieved a striking reduction in cardiovascular problems such as heart attack, bypass, and hospitalization.

Statins are potent anti-inflammatory drugs that have been shown to be able to do a phenomenal job of reducing cholesterol levels, while also decreasing the number of deaths from heart attack and stroke.

Interestingly, these drugs are particularly effective for men, but less so for women. And, there’s a slight increased risk of breast cancer for women taking statin drugs. Because of the studies, and the fact that statins are still relatively new, I prefer to err on the side of caution when it comes to their use.

Common Statin Drugs

Some of the most commonly prescribed statin drugs include Zocor (simvastatin), Lipitor (avorastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Lescol (fluvastatin).

These drugs can be dangerous if taken with high levels of long-acting niacin (vitamin B3).   Side effects also include dizziness, headache, extreme fatigue, swelling of the ankles, muscle weakness, and liver toxicity.

In both men and women, statins may weaken the heart muscle because they lower CoQ10 levels. In women especially, statin drugs may deplete levels of CoQ10, contributing to a weakened immune system.

Still, if you have moderate to severe heart disease involving multiple vessels, I recommend statin drugs to help you obtain and maintain good cholesterol levels.  In addition:

• Make sure you take a minimum of 150 mg of standard CoQ10 per day, or 50–60 mg of the hydrosoluble form, to offset the drug’s depleting effect. 
• Niacin is one of my favorite cholesterol-lowering agents if you are not on a statin drug, because of its ability to increase HDL cholesterol (the “good” cholesterol) and lower LDL cholesterol levels (the “bad” cholesterol). Low doses in the range of 100–300 mg three times daily are often effective without resulting in side effects of flushing, heartburn or gout attacks.  A prescription form called Niaspan (750–1,500 mg) appears to be well-tolerated by most people with minimal side effects. 
• Tocotrienols are antioxidants in the vitamin E family. Research suggests that they act much like statin drugs, minus the adverse side effects, by interfering with the liver’s ability to produce cholesterol. As little as 50 mg per day can have a positive effect.
• My Pan-Asian Modified Mediterranean-type diet (PAMM) is rich in fiber, healthy fats (omega-3s from fish and fish oil), garlic and onions (two potent cholesterol-busters), and fresh fruits and vegetables. Fiber helps soak up cholesterol and cleanse the colon, preventing rapid absorption of cholesterol.
• Flaxseed is high in alpha linolenic acid and fiber, vital for healthy heart function.
• Soy helps prevent the oxidization of LDL and subsequent buildup of artery-clogging plaque. Soy also can help with reducing cholesterol levels, help ease menopausal symptoms, and may help protect against cancers of the breast and prostate.
• L-arginine—2–4 grams three times a day. TwinLab and Great Earth make good supplements that are widely available in health food stores.     

• If you’re as concerned about good cardiovascular nutrition as I am, I hope you’ll follow my Pan-Asian Modified Mediterranean diet.  You’ll eat fresh fish (cold-water fish such as salmon, sardines, and mackerel) and fish oils at least two to three times a week.  You’ll also want to omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed and flaxseed oil. (Visit me here on the Web for additional details on my Pan-Asian Modified Medietrranean diet.)
• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date, then slowly increase the dose to 500 mg a day, twice a day for further protection. TwinLabs' quick-acting Niacin is a good product.
• Take 1–2 grams of vitamin C and 100–200 mg of CoQ10 each day.
• Policosanol—20 mg daily at bedtime.
• Exercise regularly.
• Ask your doctor about screening techniques to assess your risk factors for heart disease. If you’re concerned, you and your family members should have your Lp(a) and other risk factors (homocysteine, fibrinogen and serum ferritin) evaluated by your doctor.
• Be aware of other risk factors for heart disease, including smoking, high blood pressure, circulatory problems, high triglycerides, obesity, glucose intolerance and repressed emotions, which can have a harmful effect on the health of your heart.

Some of the most commonly prescribed drugs for maintaining good cholesterol levels are statins like Zocor (simvastatin), Lipitor (avorastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Lescol (fluvastatin).

These drugs can be dangerous if taken with high levels of long-acting niacin (vitamin B3). Side effects also include dizziness, headache, extreme fatigue, swelling of the ankles, muscle weakness, and liver toxicity.

In both men and women, statins may weaken the heart muscle because they lower CoQ10 levels. In women especially, statin drugs may deplete levels of CoQ10, contributing to a weakened immune system.

Still, if you have moderate to severe heart disease involving multiple vessels, I recommend statin drugs to help you obtain and maintain healthy cholesterol levels. In addition, I recommend the following natural solutions:

• Make sure you take a minimum of 150 mg of standard CoQ10 per day, or 50–60 mg of the hydrosoluble form, to offset the drug’s depleting effect.
• Niacin is one of my favorite cholesterol-lowering agents if you are not on a statin drug, because of its ability to increase HDL cholesterol (the “good” cholesterol) and lower LDL cholesterol levels (the “bad” cholesterol). Low doses in the range of 100–300 mg three times daily are often effective without resulting in side effects of flushing, heartburn or gout attacks. A prescription form called Niaspan (750–1,500 mg) appears to be well-tolerated by most people with minimal side effects.
• Tocotrienols are antioxidants in the vitamin E family. Research suggests that they act much like statin drugs, minus the adverse side effects, by interfering with the liver’s ability to produce cholesterol. As little as 50 mg per day can have a positive effect.
• My Pan-Asian Modified Mediterranean-type diet (PAMM) is great for this and for overall cardiovascular nutrition. It’s rich in fiber, healthy fats (omega-3s from fish and fish oil), garlic and onions (two potent cholesterol-busters), and fresh fruits and vegetables. Fiber helps soak up cholesterol and cleanse the colon, preventing rapid absorption of cholesterol.
• Flaxseed is high in alpha linolenic acid and fiber, vital for healthy heart function.
• Soy helps prevent the oxidization of LDL and subsequent buildup of artery-clogging plaque. Soy also can help with reducing cholesterol levels, help ease menopausal symptoms, and may help protect against cancers of the breast and prostate.
• L-arginine—2–4 grams three times a day. TwinLab and Great Earth make good supplements that are widely available in health food stores.

Drugs typically prescribed for reducing cholesterol have no impact on Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While drugs prescribed to help you attain and maintain healthy cholesterol can reduce LDL, they can’t alter Lp(a). If you find that Lp(a) runs in your family, you must attack it with an alternative approach. Here’s what I recommend:

• Follow my Pan-Asian Modified Mediterranean diet, making sure to eat fresh fish at least two to three times a week. Eat fresh fruits, legumes, cold-water fish such as salmon, sardines, and mackerel or fish oils, particularly docosahexaenoic acid (DHA), which blocks the inflammatory and blood-clotting capabilities of Lp(a). Omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed and flaxseed oil.   (These are excellent tips to adhere to for overall cardiovascular nutrition.)
• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date, then slowly increase the dose to 500 mg a day, twice a day for further protection. TwinLabs' quick-acting Niacin is a good product.
• Take 1–2 grams of vitamin C and 100–200 mg of CoQ10 each day.
• Policosanol—20 mg daily at bedtime.
• Exercise regularly.
• Ask your doctor about screening techniques to assess your heart risk factors. If you’re concerned, you and your family members should have your Lp(a) and other risk factors (homocysteine, fibrinogen and serum ferritin) evaluated by your doctor.
• Be aware of other risk factors for cardiovascular problems, including smoking, high blood pressure, obesity, glucose intolerance and repressed emotions, which can have a harmful effect on the health of your heart.

Drugs typically prescribed for reducing cholesterol have no impact on Lp(a) levels. In fact, a study involving these drugs showed an increase in Lp(a) levels! And therein lies the dilemma.

While drugs prescribed to help you attain and maintain healthy cholesterol can reduce LDL, they can’t alter Lp(a). If you find that Lp(a) runs in your family, you must attack it with an alternative approach. Here’s what I recommend:

• Follow my Pan-Asian Modified Mediterranean diet, making sure to eat fresh fish at least two to three times a week. Eat fresh fruits, legumes, cold-water fish such as salmon, sardines, and mackerel or fish oils, particularly docosahexaenoic acid (DHA), which blocks the inflammatory and blood-clotting capabilities of Lp(a). Omit saturated fats. Instead, choose monounsaturated fats like olive oil and polyunsaturated fats like alpha-linolenic acid, found in flaxseed and flaxseed oil.
• Take 100 mg of niacin, twice a day. If you experience side effects like flushing, headache, and diarrhea, follow the diet and stop the niacin. You can try a lower dosage at a later date, then slowly increase the dose to 500 mg a day, twice a day for further protection. TwinLabs' quick-acting Niacin is a good product.
• Take 1–2 grams of vitamin C and 100–200 mg of CoQ10 each day.
• Policosanol—20 mg daily at bedtime.
• Exercise regularly.
• Ask your doctor about screening techniques to assess your risk factors for heart disease. If you’re concerned, you and your family members should have your Lp(a) and other heart risk factors (homocysteine, fibrinogen and serum ferritin) evaluated by your doctor.

Let’s take a look at how women’s risk factors for heart disease are different from men’s.

Diabetes. Diabetic women have a higher risk for heart disease than diabetic men. This is because the incidence of diabetes and its complications (including heart disease) is much higher in women. If you are a diabetic woman, your risk for heart disease is five to seven times normal, compared with a risk of only two to three times normal for a diabetic man. For you, proper heart sense means you should increase your physical activity and watch your diet to maintain a healthy body weight.

Overweight. Women have a higher heart disease risk from being overweight than men do. Recent studies indicate that being only 20 pounds overweight doubles your risk of heart disease. If you are overweight, I don’t want you to go on a diet. Instead, get physically active—it’s your most powerful weapon against fat—and begin eating more fresh fruits and vegetables, pasta, fish and lean poultry.  Eating this way is what I call “healthy heart nutrition” and it just makes sense. (See other blog entries for additional advice on cardiovascular nutrition.)

Cholesterol. Women have a higher risk for heart disease than men if they don’t have good cholesterol levels. More specifically, if they have have low levels of HDL (“good” cholesterol) they increase their heart risk factors.

You probably already know that there are two types of cholesterol. LDL is the “bad” cholesterol, which oxidizes in your blood and forms the plaque that clogs arteries. HDL carries LDL out of your blood vessels before it can do its damage. Volumes of data have shown that a high LDL is a powerful risk factor for heart disease in men. But for women, the story is different. Recent research indicates that a low HDL, not a high LDL, is the more significant risk factor for a woman to develop heart disease. (This means that some women may need to increase HDL cholesterol levels.)

The good news is that HDL is sensitive to factors such as smoking, obesity and lack of exercise. If your HDL is low (less than 35 mg/dL) you can raise it by quitting smoking and dropping excess weight through a combination of smart eating, healthy heart nutrition, and physical activity such as walking and dancing. If you are postmenopausal, you might also consider estrogen replacement therapy (ERT), which raises HDL, lowers LDL, and has other beneficial effects on your heart. Have your HDL level checked six weeks after you start an HDL-raising program. Chances are you will see a change for the better.

High Triglycerides. When you get your cholesterol checked, I also want you to have your doctor check to see if you have healthy triglycerides levels. Triglycerides are another type of blood fat. A high triglyceride level is more dangerous for women than for men, so if your triglycerides are elevated (above 200 mg/dL), I want you to put some effort into lowering them, especially if you are a diabetic. This is because if you are a diabetic woman who also has high triglycerides, your risk of developing heart disease increases to 200 times normal. Please stop and think about this. You can lower your triglycerides using the powerful combination of exercise and weight control.

For more information on heart risk factors for women, visit www.drsinatra.com.

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.

For more information on other heart risk factors, visit www.drsinatra.com.

Ground flaxseed has the ability to lower your blood pressure levels and to help you to reach good cholesterol levels. It can also reward you with healthier skin, improved digestion, and a cleaner bowel, which results in less energy drain on the liver – the most important filter of the body.

You see, you can get two key types of essential fatty acids from flaxseed because it contains 19 percent activated omega-6s and 48 percent of an omega-3 precursor, alpha linolenic acid. This makes it a perfect food for people who are looking for natural ways to lower blood pressure and maintain overall good health.

In general, freshly ground flaxseed is better than flax oil because you’re assured the oil in the seed is fresh, plus you’re getting extra fiber and plant lignans. Simply grind two tablespoons of flaxseed and sprinkle on food or blend in a breakfast drink three to four times per week.

Click here for a delicious smoothie recipe using flaxseed and here for the recipe for a heart healthy flaxseed bran muffin to go with it!

For more tips on cardiovascular nutrition, visit www.drsinatra.com.