“I’ll have the steak,” my husband with the three coronary artery stents announced to the waiter. “A fillet mignon, medium rare,” he added, with a look of self-satisfaction on his face. He was obviously proud of himself because he didn’t order what he really wanted—the marbled prime rib.
“While you’re at it, dear, why don’t you have cheesecake for dessert,” I suggested, “just in case you have any arteries left unclogged.”
I should say, however, that The Lawyer — dietary deviations aside – is in very good shape for a man his age and is extremely aware of what constitutes a healthy lifestyle. But that doesn’t always mean he makes the wisest menu choices when it comes to his heart. Indeed, out of my sight and left to his own devices he may just grab a hamburger — or horrors! — that deadly croissant-doughnut hybrid known as “cronut!”
He, of course, swears that a genetic predisposition—and my constant nagging—are the primary culprits for his coronary clogs. Therefore, I must remind him (always, of course, in calm, constructive tones), that while genetics may load the gun, lifestyle still pulls the trigger.
The reason I worry about what he eats, is cholesterol, a big component of all those unhealthy foods he likes to eat, and a known factor in heart disease. And while my husband’s cholesterol isn’t particularly high, every journal article I read seems to say that it should be lower! It seems, too, as if practically everyone I know, the Lawyer included, is on a statin of some sort or another – 25% of all Americans over age 45, according to the National Center for Health Statistics. But do statins lower all cholesterol? How do you keep the HDL (high density lipoproteins — think “happy” ones) level high while lowering the LDL (low density, think “lousy”). So my intent for this column is to help readers have a cholesterol ratio that is Better Than Before.
To advise, I turn to an expert, Ed Dannemiller, a specialist pharmacist, in the Cardiovascular Therapeutic Resource Center at Express Scripts and a recent guest on my new show for Clear Channel’s iHeartRadio Talk. I started by asking just how bad is bad cholesterol.
Turns out it is very bad. “High cholesterol levels are the major controllable risk factors that contribute to hardening and narrowing of the arteries,” he says. “This is known as Atherosclerosis and it is the most common cause of cardiovascular disease, heart attacks and strokes. And as blood cholesterol levels rise, so does the risk of coronary heart disease, which is the Number one killer in America. “
But not all cholesterol is bad, and Dannemiller adds, it is important to understand the differences between the two types. High levels of HDL’s actually protect against heart attack and stroke, while low levels increase their risk. Too much of the “lousy” one circulating in the blood form thick hard deposits called plaque that narrows the arteries and makes them less flexible. Plaque that suddenly ruptures forms clots can result in and heart attacks and strokes because of the arterial blockage.
I have always been a firm believer in lifestyle modifications and Dannemiller agrees that for most people, those can help attain a healthy cholesterol balance.“LDL cholesterol is especially affected by diet,” he stresses. “Eat a heart healthy diet rich in fresh fruits and vegetables, and low in salt, fat, and cholesterol.”
He points to a Florida State University research study that found that eating an apple a day can reduce LDL cholesterol an average of 23%. “Apples are rich in pectin, a soluble fiber that blocks cholesterol absorption and prevents the body from storing it. Other LDL-lowering foods include oats, barley, beans, unsalted nuts and seeds, eggplant, okra, and fatty fish such as wild salmon.”
The main culprits for high cholesterol, he says, are fat. Hmm. What do you suppose they fry Cronuts in to make them so tasty? The Lawyer would obviously like to think it’s first-press, extra virgin olive oil! “Avoid saturated fat,” Danemiller cautions. “This includes fats from red, processed and organ meats, dairy products, and some plant products like coconut and palm oils.”
Processing liquid vegetable oil to make a solid fat creates the dreaded trans fats found in stick margarine, vegetable shortening, and some cookies, crackers, cakes, fried foods, breads and snack foods like chips, candy, and microwave popcorn, he explains. “Read your labels closely: Monounsaturated and polyunsaturated are the ‘good ones!”
Danemiller has a few other tips:
• Trim all visible fat from meat before cooking
• Broil rather than pan fry meats
• Prepare stews and soups a day ahead of time and refrigerate. Skim off the hardened fat from the top.
• Choose white meat chicken, lower cholesterol organic eggs and low-fat cheeses, milk, and yogurts.
• Lose some weight. As little as 5 to 10% of body weight can significantly reduce LDL levels.
And here’s the one The Lawyer particularly dreads — exercise. “Exercising is essential,” Dannemiller insists. “Just thirty minutes of moderate intensity aerobic activity, like brisk walking, five days a week, or 25 minutes of the more vigorous jogging or running three times a week, can help your body to produce more HDL’s.”
Sometimes, though, lifestyle modifications just aren’t enough, and genetics may have a lot to do with it. “Cholesterol comes from two sources,” Damemiller continues. “The body itself makes about 75% of blood cholesterol, and the rest comes from food ingested. That means that some people are more prone to high cholesterol levels based on genetics. For them, medication treatment can be essential. Drugs like niacin are effective in raising HDL levels, but the workhorses in the medication class are the statin drugs which can decrease cholesterol by 30% to 40% or more, decreasing heart attack and stroke risk by 45% to 60%.”
Statins have some side-effects, including muscle pain. But Danemiller contends that statin drugs are so effective that it is worth working through these issues. “A lower dose of the same medication, a switch to another drug in the class, or changing the frequency of administration can help. If the statin drug is stopped, the muscle pains should subside within two weeks. If it persists after that, it may be caused by unrelated activities like other medical conditions such as arthritis, or possibly even low vitamin D levels or too much exercise.”
But didn’t I read somewhere that statins have been linked to memory loss?
“Studies found no evidence of this. In fact, long-term statin use can have a protective effect on memory and cognition.” Dannemiller says.
Also in the news last year, were reports that statin drugs increased the chance of developing type 2 diabetes, I challenged.
“While data suggests some statins may increase the risk of diabetes this risk is outweighed by the cardiovascular benefits for most patients.”
Lifestyle modifications and statin medication, if needed, are important elements to achieve optimal cholesterol levels. Just watch out for those Prime Rib and Cheesecake combos.