Reducing Cholesterol

I am often asked what the best exercise is. I answer that the best exercise is the one you will do.

There’s no point recommending an exercise if the person you’re recommending it to won’t do it. I also tell people to think of it as “movement” rather than “exercise.” That doesn’t sound like so much work, and, after all, the whole goal of exercise is to get out and get moving.

You can’t be truly healthy without exercise, and it is great for people who are dealing with circulatory problems, need help reducing cholesterol levels, or are trying to maintain healthy triglycerides.

Exercise also is just what this doctor orders when it comes to lowering blood pressure naturally. As you know, maintaining healthy blood pressure levels is one of the smartest things you can do to reduce your risk of risk for heart attack and stroke.

Two of the best forms of movement are also the most pleasant—walking and dancing. Research, including some of my own, has continued to reinforce this view.

Studies have shown that exercise reduces the incidence of coronary heart disease, diabetes, depression, and osteoporosis. Now we can add stroke to the list. In a study reported in the Journal of the American Medical Association (JAMA), 4,065 nurses ages 40 to 65, without cardiovascular disease or cancer, completed detailed physical activity questionnaires. The surveys revealed that walking was associated with reduced risk of stroke.

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.

HMG-CoA reductase inhibitors, more commonly known as statins, are among 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 good job of reducing cholesterol levels, while also decreasing the number of deaths from heart attack and stroke. However, they do come with a host of side effects, including a slight increased risk of breast cancer for women taking statin drugs. Because of the studies, I prefer to err on the side of caution when it comes to their use.

In my next blog post, I’ll share safe, natural solutions that can help you maintain healthy cholesterol levels.

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.

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.

I can’t say enough about the health benefits of exercise. It strengthens the heart and circulatory system, builds stamina, and improves mood. It’s also an effective means for lowering blood pressure levels, increasing HDL cholesterol, and improving poor blood circulation.

I’m often asked what the best form of exercise is. I say it’s the one you will consistently do! Walking, dancing, cycling, lifting weights—it doesn’t matter. The goal of exercise is simply to get out and get moving.

That said, I have to admit I’m a big fan of walking. It’s simple, doesn’t require special equipment or a gym membership, and it can help reduce your risk of heart attack and stroke. In a study reported in the Journal of the American Medical Association (JAMA), 4,065 nurses ages 40 to 65, without cardiovascular disease or cancer, completed detailed physical activity questionnaires. The surveys revealed that walking was associated with reduced risk of stroke.

Walking is easy to incorporate in your day. Walk up and down stairs instead of taking elevators. Steadily increase the distance while walking your dog. Instead of parking in the closest space to the store or office entrance, park at the far end of the parking lot. Consider walking short distances for errands instead of driving.

If you’ve been inactive for a while, start slow. Walk 10 minutes every other day for one week. Each week, increase your time by increments of 5 or 10 minutes. Within a month, you’ll be taking 30-minute strolls. Do this every other day, and you’ll have a good workout routine. Five days a week is optimal.

As for speed, you don’t have to maintain a brisk pace. Actual walking speed isn’t as important as we’ve been led to believe. In fact, researchers in the JAMA study I mentioned found that speed didn’t matter; it was the length of time women walked that was significant.

Simple, right? If you agree, lace up those sneakers and get out there. It’s one of the simplest—and most effective—steps you can take (literally) to prevent heart attack, stroke, and other cardiovascular problems.

 

With all of the unnecessary attention lavished on HDL and LDL cholesterol levels, the importance of healthy triglycerides has been largely lost. And that’s too bad—because keeping them in a healthy range is essential to heart health.

Triglycerides are the chemical form of most fats in the body. The triglycerides in your blood come from dietary sources, primarily fats and carbohydrates. I consider a healthy triglyceride level to be 50–150 mg/dL. Levels above that have been linked to coronary artery disease and metabolic syndrome.

Given that the typical American diet is laden with processed and fast foods, it’s no surprise that high triglyceride levels are a problem for many people. To bring them down, cut back on the amount of sugar and carbohydrates in your diet, and eat more protein. I would also strongly recommend that you exercise regularly. Lifestyle changes such as these are very effective in keeping triglycerides in the healthy zone. Remember, the lower your weight, the lower your triglycerides, so weight loss and weight management are KEY to success!

Another good option for lowering triglycerides is a high-quality fish oil supplement. Start with 2–3 grams daily in divided doses, and let me know how it works for you.

 

It’s one thing to say “eat more soy” to help maintain good cholesterol levels or as part of a plan for reducing cholesterol. It’s quite another to actually put that advice into action. So here are my top recommendations of soy-based foods and how to use them.

Soy is known to be one of the two most genetically modified foods in the United States (corn is the other). Given this, I strongly recommend sticking with “true” soy foods, meaning edamame (the beans themselves), tofu, and tempeh (fermented soy). And always, always choose organic.

Easy Edamame

Edamame is the easiest of the three to work with! For a delicious finger food (and great alternative to greasy, unhealthy chips), steam edamame, toss with sea salt, and enjoy!

I also like to toss edamame into my salads for a quick hit of protein. In fact, 1/2 cup of edamame gives you 150 mg soy isoflavones a day.

Turn Up Your Tofu

Let’s face it, tofu is rather bland. But that doesn’t have to be the case! Tofu is like a culinary chameleon, meaning that whatever you add to tofu, it magically “becomes.” Therefore, the secret to tofu is marinade and spice.

The easiest tofu recipe I know is to mix 2/3 cup tamari sauce, 2/3 cup olive oil, and 1/3 cup balsamic vinegar. Add 2-3 tablespoons of your favorite spice mix and blend well. Cut tofu block into five slices. Add to marinade and refrigerate (covered) for at least four hours. Lightly sauté and you have a delicious meal that can be pair with virtually any side dish!

You can also “soak” tofu in your favorite barbeque sauce, cut into slices, and grill. So delicious! Pair with a salad and some roasted vegetables and you have an easy, delicious, healthy meal in no time. And, just one cup of tofu provides 70 mg soy isoflavones as part of a healthy cholesterol loweing diet.

Tempting Tempeh

This one seems to baffle even the most devout soy lover. The simplest answer? Treat like ground meat. Simply crumble tempeh and lightly sauté with onions and peppers. Add some diced tomatoes and your favorite blend of Italian spices and you have a delicious pasta sauce!

Another favorite? Add tempeh to chili to give it a protein-powered boost without altering the flavor of your favorite recipe. Again, crumble the tempeh to achieve the best texture and mouth feel. And, like tofu, just one cup of tempeh gives you 70 mg soy isoflavones.

If you have any recipes, tips, or questions regarding healthy heart nutrition, please send them in so we can share them with other healthy epicures!

Years ago, high blood pressure was something adults developed as they got older. But given our modern day lifestyles—filled with fast-food based, high fat diets, and sedentary activities—record numbers of children have hypertension. 

As caretakers for our children during their early lives, it’s really up to adults to help our children maintain healthy blood pressure. After all, we’re the ones prepping their meals, supervising their out-of-school hours, and taking them to the pediatricians. And moms, dads and grandparents call all team up together to help the children we love.

So, how can we help our children achieve healthy blood pressure?

Keep Them Active: Studies show that more active kids tend to have healthy blood pressure. So, the best thing we can do is keep our kids physically active. When I raised my children, all we had to monitor was television viewing.  Now we have the internet, cell phones, and electronic games to contend with. So, get the whole family off the couch and go out for a walk, bike ride, or toss the ball around in the yard. 

 

Now that the summer is in full force, you are likely hooking up the barbeque and gathering with friends to enjoy dinner in the great outdoors. As enjoyable as these get-togethers can be, research has shown that grilling meat at high temperatures can create a number of harmful compounds.

High heat from an open flame creates COPs, highly carcinogenic compounds that are similar to the oxidized cholesterol found in your bloodstream. Along with the COPs, high heat creates other groups of harmful compounds, including heterocyclic amines (HCAs), compounds that have been found to increase your risk of several of the most common kinds of cancer, including breast, prostate, colon, and stomach cancers.

Tasty Ways to Protect Your BBQ

Fortunately, a marinade consisting of 10 percent plain soy sauce and one percent sugar has been found to cut the production of COPs by more than 60 percent. Plus, additional research also shows that adding tart cherries, red grapes, or plums (all good sources of pigmented antioxidants) to hamburger meat can cut HCA formation by 94 percent.

While it’s easy enough to mix some soy sauce or a handful of crushed cherries or grapes into a pound of lean hamburger or ground turkey, I prefer to use a marinade for my favorite fish. Not only do you get delicious protection from the potentially harmful side effects of grilling, but you get the heart-health benefits of omega-3s, including increased HDL cholesterol and LDL cholesterol levels, improved blood circulation, and reduced risk for heart attack and stroke.

So eat up and enjoy how delicious healthy heart nutrition can taste!

A Taste of the Orient

This taste delight combines the protection of soy sauce with the essential fatty acid and fiber benefits of nuts. I find this marinade works best with a mild fish such as halibut.

1/2 cup organic almond butter

1/3 cup soy sauce

2 tablespoons lime juice

1 tablespoon raw honey

1/2 teaspoon powdered ginger

1/8 teaspoon cayenne pepper

1. Warm almond butter in small saucepan over medium low heat.
2. When slightly softened, add soy sauce and remaining ingredients and blend well.
3. Remove from heat and pour into large, shallow bowl.
4. Add your fish and marinate in refrigerator for one to three hours.
5. Can also be used as a sauce.
    

Earlier this week, a new study by Kaiser Permanente reported an association between high cholesterol levels and increased risk of Alzheimer’s disease or dementia. Researchers followed close to 10,000 people for 40 years and found that people who had high or borderline high cholesterol levels at ages 40–45 had much greater chances of significant mental decline later in life. Risk was 66 percent higher for people with high cholesterol (>240 mg/dL), and 25 percent higher for people with borderline high levels (200–239 mg/dL).

Alzheimer’s is a frightening condition, and these results are provocative. I have no doubt whatsoever that somewhere there’s someone saying, “This is another reason why we need to keep reducing cholesterol.”

But when it comes right down to it, these results merely show that people with high cholesterol tended to have a higher incidence of dementia. They don’t prove that reducing cholesterol will prevent future illness.

If there’s one point I want you to take away from this study, it’s this: Cholesterol is no more than a biological marker that can reveal what’s going on in the body. When it’s high, it usually means there’s usually an underlying problem somewhere—and in this case, those problems also may have had an effect on brain health.

For example, the study provided no information about the general health of the participants, so it’s impossible to know if they had health conditions—such as diabetes, metabolic syndrome, or being overweight—that would predispose them to inflammation and higher LDL cholesterol levels. (Inflammation has also been linked to Alzheimer’s, and more closely.) We also don’t know about their lifestyle habits. Did they eat diets high in carbohydrates, sugar, or trans fats? These, too, stoke inflammation, and trans fats, specifically, have been shown to destroy brain cells.

If you have high cholesterol, rest assured that you’re not destined for Alzheimer’s. However, I would encourage you to address the risk factors that are causing your LDL cholesterol levels to rise above the optimum level. Avoid excess sugar by following an   organic Mediterranean-style diet rich in fish, DHA-fortified eggs, whole grains, fruits, and vegetables; keep your blood pressure in check by better managing stress; and lose weight by exercising every day. If you are a man, keep your waistline to less than 40 inches, and if you are a woman, to less than 36 inches (this helps prevent metabolic syndrome). When these fundamental issues are taken care of, not only will your cholesterol level fall, but you will reduce your risk for all age-related disease.

 

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!

 

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).

It’s Week Two of my four-week challenge to begin lowering your blood pressure. And now that you’re on my eating plan to control high blood pressure, let’s take it a step further—literally—and add exercise to your regimen.

But before you make the same face that you probably had last week when you read my dietary recommendation for seaweed, you need to know that I don’t believe in exercise that’s strenuous or painful. I’ve learned from my patients that a more moderate approach not only gets the same results, but is much easier to maintain.

Exercise is one of my favorite healthy blood pressure therapies because of three specific benefits it has on cardiovascular health. First, increased blood flow during exercise dilates the tiny blood vessels known as capillaries, encouraging better circulation. This effect persists long after you’ve stopped being active, which in turn reduces the resistance in arteries. Second, regular exercise can help you achieve and maintain a healthy weight. Finally, exercise helps burn glucose and improves insulin sensitivity. This last point is crucially important because high insulin levels signal the body to produce inflammatory chemicals that constrict blood vessels, promote clotting, and stoke the development of plaque. Independently, each of those responses can raise your blood pressure—not to mention your risk of heart attack and stroke.
 
The following types of activity make up a well-rounded exercise program. Although I don’t believe that any one type is best (the best kind of exercise is the kind you’ll stick with), I do encourage you to do all of them because their benefits build on each other.

Aerobic activity. This type of activity raises your heart rate, causes blood vessels to dilate, and increases oxygen levels in the blood. Specific activities include walking, bicycling, dancing, and swimming. Aim for 20–30 minutes at least three days a week.

Strength training. This type of exercise—which you can do at a gym or at home with dumbbells or simple household products like canned food or gallon jugs filled with water or sand—helps you build strength and muscle. When your muscles are stronger, your body can do virtually everything with less effort, and that includes your heart. Do strength training every other day at most. Your body needs at least 48 hours of rest between workouts. Added bonus: Resistance training has also been shown to be effective in reducing cholesterol!

Flexibility exercises. These allow you to move with ease and to more fully participate in other forms of exercise. Correct technique is important. Hold each stretch for about 30 seconds—do not bounce, do not hold your breath, and do not stretch so far that you feel pain. The most effective stretching warms up and cools down the same muscles used during exercise. Try side and neck stretches, shoulder rolls, half rolls, knee bends, and calf, hamstring, and inner-thigh stretches. Flexibility exercises also help reduce stress, which is also essential for healthy blood pressure. I’ll talk more about that in a couple weeks.

Now, let’s get moving!