Tag Archives: Cholesterol

Better Than Before: The Highs and Lows of Cholesterol

cholesterol“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.


6 Steps to Healthy Cholesterol

Contrary to conventional wisdom, cholesterol is not the enemy.

The question on the lips of many Americans these days is, “How do I lower my cholesterol?” We’ve all been told that the secret to living a long, healthy, heart-disease free life is lowering your cholesterol. And believing that a low cholesterol count is the best way to prevent heart disease, doctors often prescribe medications like statins to keep these levels low. But these drugs can introduce a whole host of problems and may not even work.

The truth is, your body needs cholesterol in order to function properly. So, it’s not about having lower cholesterol; it’s about having the right type of cholesterol.

The important questions we should ask are:

  • How do I get the right type of cholesterol?
  • How do I lower my triglycerides and raise my good cholesterol or HDL?
  • What’s the best way to prevent heart disease without drugs?

Originally posted on DrHyman.com

How to Make Nut and Seed Milk – 3 Ways

almond-milk-set-shot-1024x768If you’re interested in finding an alternative to dairy and soy milk – or just want a delicious, creamy beverage to sip on or use for smoothies and hot chocolate – then look no further than these homemade nut and seed milk recipes!

I’m outlining almond, cashew, and sunflower seed milk, to start off, though there are certainly others you can explore. Enjoy!

1. Almond Milk

I resisted making almond milk for years. I kept hearing it was easy, but somehow, I couldn’t get my head around it. I don’t like processed almond milk, so I thought, “how good can it be?” Wow! Not only is it simple, it is delicious. To me it tastes like melted vanilla ice cream. Does it get any better than that?

Yes, it does, because it is actually really good for you too. Almonds are a rich source of Vitamin E, calcium, folic acid, as well as the minerals magnesium, selenuim, phosphorus and zinc. Almonds are wonderful for maintaining skin elasticity as well as helping to lower cholesterol and being a good source of protein. Dates play a big role here too. They are a rich source of vitamins and minerals including iron, potassium and calcium and are a awesome natural sweetener.


  • almonds – 1 cup, raw
  • water – 4 cups
  • vanilla extract – 1 tsp
  • himalaya salt – a pinch
  • medjool dates – 5
  • raw cacao powder – 1 tsp (optional; for chocolate milk)
  • honey – 1/2 tsp (optional)


Put 1 cup of raw almonds in a bowl, Fill with water.

In a separate bowl put 5 medjool dates. Fill that with water.

Soak them both overnight (or for at least 4 hours)

Rinse the nuts in cool water a few times. Do NOT use the water that the nuts have been soaking in. It will make the milk taste bitter. Rinse the nuts until all of the frothy bits are gone.

Put the nuts, the dates AND the date water into the blender. Make sure to take the pits out of the dates before blending.

Add 4 cups of water, 1 teaspoon of vanilla and a pinch of himalaya salt.


Strain the almond milk though a cheesecloth, a strainer with a paper towel, or a nut bag (yes, there actually is something called a ‘nut bag’. I can’t help but giggle when I say it) . That gets out all of the almond bits, so your milk is silky smooth.

This recipe yields approximately 4 cups of almond milk. The almond milk separates naturally, so give it a quick shake before you drink it. It will last for for 3-4 days in the fridge.

2. Cashew Milk

I think that cashews are a perfect food. They are so packed with essential minerals it hard to think of something they don’t do to benefit your health. These awesome nuts support your heart, brain, bone and nerve health. They are also good for skin elasticity as well as hair and nail strength. The best part is that they are a natural anti-depressant. In short, they make you feel good and look good. Did I mention they also happen to be delicious? Lucky us.

Cashew milk is the closest to whole milk in taste and texture. The thickness comes from the fact that this milk does not need to be strained the way that almond milk does. That also makes it much easier to make with less mess.


  • cashews – raw -1 cup, soaked overnight
  • medjool dates – 4 cups pitted, soaked overnight
  • water – 4 cups
  • himalaya salt – dash
  • vanilla extract – 1 tsp


Rinse the nuts under cold water until the water runs clear. Add all the other ingredients (including the water that the dates were soaked in). Blend until completely smooth.

Drink it, use it in smoothies or on cereal.

3. Sunflower Seed Milk

This one might not be for everyone. The sunflower seeds have a slightly bitter after-taste similar to that of sunflower seed butter. I tend to use it more in smoothies and on cereal. I drink it plain sometimes but my kids won’t touch it like that. “So why should I make this?” You’re probably asking. Because it is really easy, it is incredibly good for you and when you feel like it, you can turn it into a magical potion called Chocolate Cardamom Sunflower Seed Milk. For that, you will thank me.

Sunflower seeds are very high in trace minerals like selenium and magnesium. These minerals are an essential part of what keep our bones strong and our nerves calm. These seeds are also filled with Vitamin E which, like an internal sunblock, protects your skin from UV radiation. Sunflower seeds also help to sweep accumulated radiation out of your system.

I tend to leave my nuts and seeds to soak overnight. As part of my bedtime ritual, I soak whichever ones I plan to use the next day. It doesn’t take much time. You just have to remember to do it which is a task in itself. Once you’re in the habit, it is like second nature. Nuts and seeds tend to be difficult for your body to break down. Soaking them makes them infinitely more digestible.


  • sunflower seeds – 1 cup, raw (soaked for at least 4 hours)
  • medjool dates – 4 large (soaked for at least 4 hours)
  • water – 4 cups
  • vanilla extract – 1/2 tsp
  • himalaya salt – pinch


Rinse the seeds under cold water until the water runs clear. Put them and all of the other ingredients (including the water the dates were soaked in) into a high speed blender. Blend until smooth. It should be thick and creamy, like a milkshake.

What’s your favorite nut/seed milk? Let me know in the comments section and share your recipes!


Originally published on my website, Tapp’s Tips.

Why You Should Not Stop Taking Your Vitamins

pale-woman-taking-vitamins_123rf.com_Do vitamins kill people? How many people have died from taking vitamins? Should you stop your vitamins?

It depends. To be exact, it depends on the quality of the science and the very nature of scientific research. It is very hard to know things exactly through science. The waste bin of science is full of fallen heroes like Premarin, Vioxx and Avandia (which alone was responsible for 47,000 excess cardiac deaths since it was introduced in 1999).

That brings us to the latest apparent casualty, vitamins. The recent media hype around vitamins is a classic case of drawing the wrong conclusions from good science.

Remember how doctors thought that hormone replacement therapy was the best thing since sliced bread and recommended it to every single post-menopausal woman? These recommendations were predicated on studies that found a correlation between using hormones and reduced risk of heart attacks. But correlation does not prove cause and effect. It wasn’t until we had controlled experiments like the Women’s Health Initiative that we learned Premarin (hormone replacement therapy) was killing women, not saving them.

New studies “proving” that vitamins kill people hit front pages and news broadcasts across the country seemingly every day.

Paul A. Offit’s recent piece in The New York Times, “Don’t Take Your Vitamins,” mentioned a number of studies that suggested a correlation between supplementation and increased risk of death. Offit asserts, “It turns out … that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.” The flaws in the studies he quoted have been well documented. Giving large doses of a single antioxidant is known to set up a chain reaction that creates more free radicals.

But many studies do not prove anything. Science is squirrelly. You only get the answers to the questions you ask. Many of the studies that are performed are called observational studies or epidemiological studies. They are designed to look for or “observe” correlations. Studies like this look for clues that should then lead to further research. They are not designed to be used to guide clinical medicine or public health recommendations.

All doctors and scientists know that this type of study does not prove cause and effect.

Why Scientists Are Confused

At a recent medical conference, one of most respected scientists of this generation, Bruce Ames, made a joke. He said that epidemiologists (people who do population-based observational studies) have a difficult time with their job and are easily confused. Dr. Ames joked that in Miami, epidemiologists found everybody seems to be born Hispanic but die Jewish. Why? Because if you looked at population data in the absence of the total history and culture of Florida during a given time, this would be the conclusion you would draw. This joke brings home the point that correlation does not equal causation.

Aside from the fact that they fly in the face of an overwhelming body of research that proves Americans are nutrient deficient as a whole and that nutritional supplements can have significant impact in disease prevention and health promotion, many recent studies on vitamins are flawed in similar ways.

How Vitamins Save Money and Save Lives

Overwhelming basic science and experimental data support the use of nutritional supplements for the prevention of disease and the support of optimal health. The Lewin Group estimated a $24 billion savings over five years if a few basic nutritional supplements were used in the elderly. Extensive literature reviews in the Journal of the American Medical Association and the New England Journal of Medicine also support this view. Interventional trials have proven benefit over and over again.

The concept that nutritional supplements “could be harmful” flies in the face of all reasonable facts from both intervention trials and outcome studies published over the past 40 years. For example, recent trials published within the last few years indicate that modest nutritional supplementation in middle age women found their telomeres didn’t shorten. Keeping your telomeres (the little end caps on your DNA) long is the hallmark of longevity and reduced risk of disease. A recent study found that B12, B6 and folate given to people with memory loss prevented brain atrophy that is associated with aging and dementia. In fact, those who didn’t take the vitamins had almost ten times loss of brain volume as those who took the vitamins.

A plethora of experimental controlled studies–which are the gold standard for proving cause and effect–over the last few years found positive outcomes in many diseases. These include the use of calcium and vitamin D in women with bone loss; folic acid in people with cervical dysplasia (pre-cancerous lesions); iron for anemics; B-complex vitamins to improve cognitive function; zinc, vitamins C and E and carotenoids to lower the risk of macular degeneration; and folate and vitamin B12 to treat depression. This is but a handful of examples. Fish oil is approved by the FDA for lowering triglycerides and reduces risk of heart attacks and more. There are many other studies ignored by Offit in his New York Times piece.

Stay tuned for Part 2!


Originally published on my website, DrHyman.com.

Why George W. Bush’s Stent Should Get Us Talking About Heart Disease

george-w-bushAs you may have heard, former president George W. Bush underwent a heart procedure today to treat a blocked artery. In line with common procedure, doctors inserted a stent, a small mesh tube, to open the blockage and return normal blood flow to the heart. Bush is expected to be up and kicking by tomorrow.

Roughly half a million people in the United States every year have stents inserted, and just over 11% of non-institutionalized adults have diagnosed heart disease. It is the number one cause of death in the United States, claiming nearly 600,000 lives every year.

Bush is 67 years old, a year older than the average age for men’s first heart attacks. Men, in general, tend to have a higher risk for coronary artery disease and heart attacks earlier in life, though genetics, weight, and other heath conditions play a larger role in determining risk. “Metabolic syndrome” is a pre-diabetic condition heavily associated with heart disease, and it is diagnosed when three of the following are present:

  • Abdominal obesity
  • Low HDL cholesterol
  • High triglyceride levels
  • High blood pressure
  • Insulin resistance

Given all of this, are the measures that can be taken to reduce the risk of heart disease? The American Heart Association recommends the following lifestyle changes:

  1. Stop smoking – For more reasons than one, of course!
  2. Maintain a good diet – Including plenty of vegetables, whole grains, lean meats, and high-fiber foods
  3. Reduce blood cholesterol – Through diet, exercise, and, as a last resort, medication
  4. Stay active – To lower blood pressure, blood cholesterol, and maintain a healthy weight
  5. Reduce stress – Important at all ages!
  6. Limit alcohol – Too much can raise blood pressure and add to weight gain

We wish George W. a quick recovery, and we hope this very public incident helps raise awareness about the prevalence and dangers of heart disease. Take measures now to reduce your risk, and stay healthy everyone!

Antioxidants: The Superheroes of the Food World (Plus Recipes!)

chocolateWho loves chocolate? The best thing about dark chocolate is that it’s very rich in antioxidants. You’ve probably heard a lot about antioxidants, and many of you know what they do – but I wanted to take a closer look at why they are so essential to good health.

What is an antioxidant?

It may sound more like politics than nutrition, but antioxidants are like the superheroes of the food world, rounding up and shutting down the bad guys. The bad guys are called free radicals.

So what exactly are “free radicals” and why are they the bad guys? Simply put, “free radicals” are partial, destructive molecules. Molecules are supposed to be made up of pairs of electrons, but when a molecule has been damaged as a result of pollution, poor nutrition, pesticides, infection, stress, or just plain aging, it loses one of its electrons. These incomplete molecules wreak havoc on your system. They race through your body trying to steal an electron from complete molecules in order to complete themselves. The free radicals do an enormous amount of damage on their rampage. This is called oxidation.

Antioxidants are complete molecules that fly through your system with their little red superhero capes on, donating electrons to the incomplete molecules and stopping the free radicals in their path of destruction. No matter how many electrons these antioxidants give away, the remain stable, complete molecules. Is that a cool superhero power or what?

Think of an apple slice. It turns brown when it is exposed to the air. That is naturally occurring oxidation. If you squeeze some lemon juice on the apple slices the browning process slows down. That is because lemons contain a lot of Vitamin C which is a powerful antioxidant. The antioxidants significantly slow down the oxidation process.

Where are antioxidants found?

Antioxidants are present in varying degrees in all fresh fruits and vegetables as well as meats, dark chocolate, whole grains, nuts, and even red wine. The more variety you eat, the greater your antioxidant levels will be. Eating a wide variety of foods including different  colors of fruits and vegetables will give you the best array of antioxidants.

Avoid dairy when eating antioxidant-rich foods; it can interfere with antioxidant effectiveness. Dairy is like kryptonite to antioxidants; it binds with them and reduces their potency. To ensure you get the full benefit of antioxidants, it is best to eat antioxidant rich foods away from any dairy. Have lemon or almond milk in your tea instead of milk, combine your fruit with a coconut kefir instead of dairy yogurt, and use a non-dairy milk in your smoothies to make sure these powerful little molecules have a clear and healing path.

Here are 3 antioxidant-loaded recipes – Enjoy!


Originally published on my blog, Tapp’s Tips.

Deepak Chopra: Fat Doesn’t Make You Fat

The whole issue of fat in the diet should be simple. Doctors have long followed the dictum of “fat puts on fat,” assigning blame for overweight on a fatty diet. Of the three major sources of calories – fats, proteins, and carbohydrates – the one with the most calories per gram (8) is fat. It only makes sense that cutting back on this component should lead to weight loss. But to say so is like time traveling back to 1950, before the great cholesterol revolution.

In the 1950s, America was in the midst of an epidemic of heart attacks. Lacking any effective drug treatment for prevention – indeed, lacking any real model for risk factors – and without the emergency room trauma care that we now take for granted, medicine scrambled to find answers to the sudden upsurge in heart attacks and strokes. A consensus built around the notion that cholesterol was the primary villain, and so a vast public campaign against fat was put forth that hasn’t subsided ever since.

The problem with the cholesterol story is that it complicated matters far more than it clarified them. To begin with, high cholesterol in the diet has never had a strong correlation with premature heart attacks. In fact, the strongest correlation has to do with psychological factors, but these were thought to be too “soft” to present to the public. Cholesterol was simpler and easy to communicate.

But there was yet another major problem with the simplistic story that fat makes people fat. The cholesterol you eat isn’t the same as the cholesterol that winds up in your bloodstream, so-called serum cholesterol. In between eating a fatty food and raising your serum cholesterol, there’s the process of digestion. In particular, fats are processed in the liver, and it’s the liver ability to select various fats that determines how high or low your serum cholesterol is.

In their zeal to deliver a simple story, heart experts demonized basic foods like eggs and milk when there was no evidence that either leads to increased heart attacks. Fifty years on, the anti-cholesterol campaign has become a billion-dollar juggernaut, thanks to the involvement of drugs that are supposed to correct imbalance in blood fats. We’ve been indoctrinated to think in terms of LDLs, HDLs, and triglycerides, yet the actual cause of heart disease is unknown. In addition, the simple formula that the “good” HDLs will rise as a drug lowers the “bad” LDLs has been proven wrong.

As with all disorders, the story of heart disease involves all the messages being sent to and from every cell in your body. Invisible factors like stress are just as important, if not more so, than the fats you eat, along with psychological factors like the difference between tense, perfectionist Type A personalities and relaxed, easy-going Type Bs.  The only natural way that is proven to reduce the risk of heart attack combines meditation, exercise, and a low-fat diet.

To really know what causes heart attacks and strokes, we would have to discover why the tiny cracks develop inside the smooth, slick lining of blood vessels. An answer to that mystery is far from clear. So for the time being, we should utilize the following basic principles when considering the fat in our diets:

1. Eliminate the hydrogenated fats or trans fats and reduce saturated fats in our diet, preferring fats like vegetable oil, omega-3 oils in fish, and olive oil.

2. Whatever fat you eat, don’t demonize it. Fear isn’t part of wellness.

3. Don’t rely on drugs to change your serum cholesterol until you have given prevention a chance.

4. Forget so-called diet foods and processed foods with reduced fats. You don’t need the added chemicals. In addition, it has never been shown that eating diet foods helps reduce obesity.

5. If you are overweight, make it a top priority to get your weight back in control.  Reducing total calories is more important than fine-tuning the kind of fat you eat.

6. Body fat appears to be more active in a harmful way than we used to think. To offset the hormonal effect of body fat, the easiest counter is regular, moderate exercise.


I’ve deliberately avoided going into detail about the war over dietary fat, because singling out one factor misses the holistic point: wellness is never about one villain who needs to be vanquished. It’s about changing the entire mind-body picture. There will always be fads and controversy swirling around America’s weight problem.  One year the magic bullet is a high-protein, high-fat diet, while the next year it’s gluten allergies or switching to a vegan lifestyle.  For healthy adults, these fads are harmless. In the end, they offer short-term benefits to almost everyone who flirts with them and long-term benefits to a very small minority. There is no replacement for holistic wellness.

Stay tuned for Part 2, in which we will delve into the physiological nature of fats.


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photo by: Alan Cleaver

Deepak Chopra: Heart Attack Myths and the Missing X Factor

Some epidemics are hard to treat because medicine has no cure, while others, more insidiously, are hard to treat because people latch on to the wrong cure. Heart disease is a prime example of how a half truth turned into a partial cure, with many people being led down the wrong path, either by themselves or by their doctors.

Heart attacks turned into an American epidemic after World War II, and doctors were baffled to know why.  Intensive research was conducted, and as often happens when the cause of a disease is complex, there was no single reason why men in the vulnerable range for premature heart attacks, from age 40 to 60, were suddenly dying in greater numbers. What had changed in modern society to cause hundreds of thousands of heart attacks a year when in the past, before World War I, a physician might see one patient a month, or fewer, with the symptomatic chest pain known as angina pectoris? An X factor was missing and needed to be identified.

The physical evidence was plain enough when the victims’ hearts were examined after death. The coronary arteries that feed oxygen to the heart were no longer healthy. Healthy arteries are flexible, smooth, and resilient. But pathologists were seeing hardened arteries filled with tough fatty plaques even in men as young as their early twenties. This condition, known as atherosclerosis, is still the leading cause of death worldwide. Unfortunately, for the most part atherosclerosis is being treated the wrong way, based on mistaken assumptions about what causes the disease and its many complications.

In atherosclerosis, arteries become thickened and narrowed by arterial plaques. It’s a process that takes place over years and can occur in arteries anywhere in your body. Often there are no symptoms. No symptoms, that is, until an artery becomes so clogged that it can’t deliver adequate blood to your organs or tissues. If blood flow is reduced in the coronary arteries, the symptoms can include angina (chest pain), shortness of breath, and fatigue. If flow to the brain is curtailed, then stroke-like symptoms may occur, such as sudden numbness or weakness in the arms and legs, difficulty speaking, or drooping facial muscles. If the arms and legs don’t get enough blood, then numbness can develop and walking may become painful.

Sometimes, for reasons we don’t totally understand, plaques rupture and a blood clot forms. The clot can become stuck in an artery and block flow altogether. In a coronary artery, this can cause myocardial infarction—a heart attack. In the arteries that provide blood to the brain, the result can be a stroke.

If you ask most people—including many doctors—what causes atherosclerosis, they’ll tell you it’s having high blood cholesterol levels from eating a fatty, cholesterol-laden diet, plain and simple. The solution, they say, is to lower blood cholesterol levels, often by taking expensive cholesterol-lowering drugs (with dangerous side effects). Specifically, the goal is to lower levels of the “bad” cholesterol, LDL, and raise levels of the “good” cholesterol, HDL.


This narrow focus on lowering cholesterol levels has been promoted for the last three decades as the solution to our cardiovascular woes—and it hasn’t worked. Atherosclerosis and cardiovascular disease continue to be epidemics in this country and all over the globe. Atherosclerosis is a complicated disease, and much more is involved than simple cholesterol levels. As evidence, note that nearly three quarters of patients hospitalized for heart attacks had LDL levels within the recommended targets, and half of them had LDL levels that were considered optimal. What’s more, some people with sky-high cholesterol levels have no trace of cardiovascular disease.


Some salient facts have emerged that reveal the over simplification of the cholesterol approach.

1. The liver plays a key role in turning the fat in your diet into blood fats. For some people, a small amount of dietary fat can lead to high fats in the blood. For other people, a very high-fat diet can lead to normal fat levels in the blood. There is no simple correlation between the fat you eat and the fat than can damage your heart.


2. Stress plays a major factor in heart attacks. Indeed, several wide studies that are considered among the best in the world found stronger psychological correlations to early heart attack than physical ones. Strikingly, men who deal with their psychological issues in their twenties are less likely to suffer premature heart attacks. This was known fifty years ago but was slow to catch on, since cardiologists are experts in drugs and surgery, not psychology.


Since the early postwar era, many studies have found that being chronically stressed greatly increases your risk of heart disease, in part by raising circulating levels of cortisol, one of a number of “stress hormones.” In fact, one study found that people with high levels of cortisol had five times the risk of dying from cardiovascular disease


3. The body is listening to non-physical changes in one’s lifestyle. Things like meditation, stress reduction, and exercise may seem far removed from the lining of a coronary artery, yet every thought, feeling, and action gets turned into physical signals sent to every cell in your body. Positive lifestyle changes are the natural way to prevent atherosclerosis.


Yet the search for a pharmaceutical holy grail continues. In 2007 a new cholesterol-lowering drug, torcetrapib, was evaluated in clinical trials. It was found to have exactly the desired effects: it dramatically lowered LDL-cholesterol and raised HDL-cholesterol levels. But the trial was cut short. Why? Because the drug was killing the people using it. Deathsincreased by 58% among patients taking torcetrapib. Cardiovascular events, including heart attacks, increased by 25%. Now, a similar drug, anacetrapib, is being touted as our new savior from cardiovascular disease. When there’s a possibility of making spectacular profits, drug companies have a very short memory.


To understand why current treatment is ineffective, we need to look at why plaques form in the first place. Arterial plaques are the body’s healing response to injury to the arteries—only in this case, the “healing response” can do a great deal of damage. For the most part, we injure our arteries through having unhealthy lifestyles—by being chronically stressed, consuming too many refined carbohydrates, eating processed foods and fast foods full of trans fats, having a sedentary lifestyle, smoking, drinking too much, and being overweight. All these bad habits injure the delicate, thin inner layer of the arteries and create lesions—wounds.


When an arterial lesion forms, macrophages—cells of the immune system—come to the site of injury as part of the body’s inflammatory (healing) response. Together with cholesterol and other lipids, connective tissue, calcium, and various other substances, they form a plaque inside the wall of the artery. An arterial plaque is essentially a scab formed to prevent blood loss, just like a scab on the surface of your skin.


 The chemistry of cholesterol is far from understood completelyThere’s increasing evidence that overall cholesterol numbers don’t matter: what matters is the size of the cholesterol particles. Large cholesterol particles are fluffy, buoyant, and unlikely to penetrate into the blood vessel wall. Small cholesterol particles are tiny, dense, and able to penetrate into the arterial wall. They are more atherogenic—more likely to form arterial plaques in a blood vessel that’s been damaged. They are also more likely to become oxidized, becoming what’s termed oxLDL. OxLDL may well play a significant role in the formation of plaques. Having a high level of small-particle LDL-cholesterol increases your risk of having cardiovascular disease and is associated with insulin resistance, diabetes, and obesity.


Fatty diets aren’t always the culprit. One factor is eating too many refined carbohydrates and starches. These high-glycemic-index foods raise your blood glucose level, which has the overall effect of increasing the number of small LDL- and HDL-cholesterol particles in your blood.


Lifestyle choices remain the best way to prevent heart attacks and strokes.  Avoid eating high-glycemic-index foods like potatoes, white rice, sugar, and white flour, which raise your glucose and triglyceride levels and ultimately increase small-particle cholesterol. Eat plenty of whole grains, fruits, and vegetables instead. Be sure to eat foods rich in unsaturated fatty acids, especially those with omega-3 fats, such as fatty fish and extra-virgin olive oil. They have been shown to reduce your risk of cardiovascular disease.


Aerobic exercise does wonders for your body, including optimizing your cholesterol levels and decreasing small-particle cholesterol. Anerobic exercise (like weight training) complements aerobic exercise and improves glucose uptake, further aiding small-particle cholesterol reduction.

Yoga is well known as a stress-reducer, and studies have found that doing yoga measurably reduces cortisol levels. Meditation has been found to have similar effects. One study found that meditating 20 minutes a day for just 5 days measurably lowered anxiety and cortisol levels.


Prevention is the great cure that Americans continue, by and large, to ignore. Therefore, nothing I’ve said will come as a great surprise or groundbreaking news.  But there’s no alternative to repeating the cure that works. One by one, each person can then decide how and when to make the changes in lifestyle that spell the end of the epidemic, so far as a single individual is concerned.

For more information go to deepakchopra.com

PHOTO (cc): Flickr / colourized

Should There Be a Cholesterol Registry? What Should It Do?

Love of food is important, like love of self.  And you can have and should have both.

The National Weight Control Registry (NWCR) has documented exactly what

 people do who have lost weight and kept it off.  Over 5000 people have lost an average of 66 lbs and kept it off for 5.5 years.

The research of the weight control registry helps me coach my clients to lon

g term weight loss too. I use it every day both in ChefMD online and Chef Clinic.

Because so many of my patients have lowered their LDL cholesterol levels by 50% and raised their HDLs by 40% with diet and lifestyle changes, I thought it might be helpful to create a site like NWCR which told the stories of people who have been successful, including changing the shape and size of their cholesterol, from unhealthy to healthy.

Chef Clinic is teaming up with nutrition firm Provident Clinical Research to work together to make this a reality.  If you’re in the Chicago area, Provident is offering free cholesterol screenings currently.

I mention the idea of a cholesterol registry in my first PBS Special, raising money for public TV. It airs this month beginning Saturday March 5 (it’s called "Eat and Cook Healthy with Dr John La Puma"); follow @EatCookHealthy for local #PBS broadcast times a few hours before air time’ pledge gifts include Super Healthy Combo package; 75 second video/pledge link preview here: http://vimeo.com/20618658).

What should a cholesterol registry do? Should it do research, offer testing, tell best stories, create or rank supplements, give best recipes, or give discounts on meds and tests? What would be your intent?


Weekly Health Tip: What Do My Cholesterol Numbers Mean?

Brought to you by Deepak Chopra, MD, Alexander Tsiaras, and TheVisualMD.com

Every complete medical checkup includes an analysis of the fats in your blood–mainly, your cholesterol levels. The balance of "good" and "bad" cholesterol in the blood is an important factor in your risk of cardiovascular disease.  A combined cholesterol total of less than 200 milligrams per deciliter of blood is desirable. Even more important is having enough helpful HDL (high-density lipoprotein) cholesterol and not too much unstable LDL (low-density lipoprotein) cholesterol. You need fat. Your body uses it to build cells and hormones, and as a source of energy. Cholesterol’s job is to bundle up with proteins and fat, in the form of triglycerides, to travel through the bloodstream to the places where fat is needed or stored. HDL molecules are good travelers, densely packed and stable. They can even tidy up potential blockages in the blood vessels as they pass through. LDL molecules, though, are more loosely put together. As they ramble through vessels, they can cause trouble by sticking to arteries’ walls. If other cells, platelets and calcium build up at the site to create arterial plaque, the artery can become blocked. If plaque breaks free from the artery’s wall, it could travel to the brain or heart, causing a stroke or heart attack. People with unhealthful cholesterol levels have no symptoms. A blood test is the only way to diagnose cholesterol problems. Yet, the Centers for Disease Control and Prevention finds that about 20% of U.S. adults have never had their cholesterol checked.


Learn more about the importance of regular medical tests: The"VisualMD.com: Baseline Your Health

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