The bottom line for staying ahead of heart disease:

Cholesterol counts—but not as much as you might think

We’re a nation obsessed with cholesterol. For years, it’s been blamed as the main culprit in heart disease—clogging your arteries and causing massive heart attacks. Thanks to these frightening images, the powers that be in the National Cholesterol Education Program keep nudging the guidelines for what’s considered a “healthy” cholesterol level lower and lower. And as a result the use of cholesterol-lowering statin medications has skyrocketed over the past few years. In fact, Lipitor was the first $10 billion-a-year drug in history (and it actually made $12 billion this year).

They’re so common, no one bats an eye anymore when the doctor pulls out his prescription pad. In fact, when I see patients who’ve been diagnosed with high cholesterol, the first thing they want to know is if they need a drug. But the answer is usually “no.”

Don’t get me wrong—there are some instances where statins come in handy. But it’s important to know when you need them—and what you can do when you don’t.

Here’s the thing: Just because you have what might be considered high cholesterol doesn’t mean you have heart disease—or even that you’re at significant risk for it.

In fact, nearly half the people who have heart attacks actually have “normal” cholesterol levels. And the prestigious Framingham Heart Study showed that high cholesterol levels correlate with an increased risk of death from all causes only up to the age of 40. Above the age of 50, risk of death from all causes actually increases significantly with lower cholesterol levels!

I like to break down heart disease risk into three categories: low, moderate, and high. Take my quick quiz to see which category you’re in:

Rank your risk

Check off any of the following risk factors that apply to you:

• Cigarette smoking
• High blood pressure
• Family history of early heart disease
• Age (over 45 for men, over 55 for women)
• Low HDL cholesterol levels (under 40)

If you checked only one of the risk factors, you’re in the low-risk group. If you checked two or more, you’re in the moderate-risk group.

To be classified as high risk, you’d need to already have heart disease or an equally serious condition like peripheral artery disease, carotid artery disease, or diabetes.

If you’re in the high-risk group, the horse is already out of the barn and you probably do need a statin drug. But if you’re in either of the other two groups, you want to prevent heart disease from happening in the first place.

The use of cholesterol drugs for prevention is “iffy” at best.

One study showed you’d have to treat 100 people for 25 years with statin drugs to avoid even one death from heart disease.

The “cure” that’s making the problem worse

Contrary to the impression the statin drug ads give, your body needs cholesterol. In fact, your liver makes its own supply. (Dietary cholesterol—the kind in all those foods the American Heart Association warns you against eating—actually has little impact on cholesterol levels.) Cholesterol is a waxy, fatty substance that helps hold cells together and is a building block for hormones. It’s also the most common organic molecule in the brain.

Cholesterol comes in two forms: high density lipoprotein, or HDL, which is the “good” kind, and low density lipoprotein, or LDL, which is the “bad” kind.

Cholesterol has been implicated in heart disease because it can change into a harmful form that blocks arteries. But it’s not the cholesterol itself causing this problem. The bigger issue is inflammation, which contributes to the transformation of healthy cholesterol into an unhealthy form and can trigger a sudden complete blockage that results in a heart attack.

In most cases, inflammation is a sign that the immune system is doing its job, and it’s helpful with short-term problems. But chronic long-term inflammation increases the risk of heart disease and most cancers. One major marker of inflammation in the body is a substance called C-reactive protein (CRP).

I recommend the newer High Sensitive CRP test to measure inflammation. Its level is a reliable indicator—probably more so than cholesterol—of heart attack risk. Ideally, you want yours less than1.0.

Statins interfere with the production of cholesterol in the liver. But when you start taking drugs that mess with the body’s natural cholesterol production, you’re at risk for problems with the systems that rely on that cholesterol. In other words, statin drugs end up causing more problems than they could ever hope to solve.

Plus, statins aren’t much good at boosting good HDL cholesterol. There’s actually a stronger association between low HDL  cholesterol and heart disease risk than there is between high cholesterol levels and cardiovascular disease.

Now for the good news: There are better ways to achieve the same goals. They cost less, are less dangerous, and they confer general health benefits the statins can’t hope to match. In fact, the right foods may be more than twice as effective as drugs at preventing heart attacks.

Eat, drink, and be healthy

When you’re talking about foods to prevent heart disease, you have to start with the basics: fruits, vegetables, and whole grains. Everyone agrees these are good for you. They contain just about every nutrient you could need, including flavonoids, which not only help maintain healthy cholesterol levels but also lower blood pressure and quiet inflammation—two of the other big risk factors for heart disease.

But before you start thinking I’m no fun at all, there are some other sources of flavonoids that you’ll probably be glad to add to your repertoire: tea, red wine, and chocolate. (Just don’t rely on them instead of fruits and vegetables.)

Now, moving past the obvious, there are a few more food options that can help you keep your cholesterol in check, starting with nuts. Walnuts and almonds in particular can lower cholesterol. Because they’re filling and naturally sweet, they make great snacks for people with a sweet tooth.

The next one on the list—soy—is a bit more controversial. But according to some studies, daily soy intake can lower cholesterol by up to 10 percent. This finding has led to a “more is better” mindset, encouraged no doubt by the soy bean industry’s massive publicity machine. The consumption of large amounts of tofu, soy milk, and soy powders isn’t really necessary. As little as 3 tablespoons of soy powder a day in a smoothie can bring LDL cholesterol down by 12 percent. Or, I like to see people use fermented soy products like miso and tempeh They’re actually better utilized by your body.

Just like fruits and vegetables, no discussion of heart health and cholesterol is complete without mentioning fats. The saturated fats in animal products will increase good and bad cholesterol. But they’ve been given a bum rap: The association between animal fats and heart disease is actually relatively small. I tell patients a moderate amount of animal fats from dairy and meat in a diet rich in whole grains, fruits, and vegetables is fine.

However, please avoid trans fats, which are the kind in the hydrogenated and partially hydrogenated oils found mainly in packaged baked goods and many margarines. They wreck your body. There is a very clear and lethal association between these man-made fats and heart disease. Read those labels!

But it’s not just about what you eat. What you drink can impact your cholesterol levels, too. I mentioned flavonoid-rich tea and wine above, but there’s a new heart-healthy beverage of choice you may want to consider: pomegranate juice. A few small studies suggest pomegranate juice not only lowers cholesterol but can reverse heart disease—in just a few months. It’s too early to say for sure, but it’s a tasty, safe food that certainly won’t hurt you while we’re waiting to see if it lives up to its promise. Try 4 to 8 oz. a day. Just make sure its all-natural pomegranate juice and that it doesn’t contain high fructose corn syrup. High fructose corn syrup is man-made junk that bypasses the body’s usual regulatory mechanisms. It’s found in soft drinks and all sorts of packaged goods, and you should avoid it at all costs.

5 supplements your heart will thank you for

Once you’ve got your nutritional bases covered, you can start thinking about supplements. They can help boost the positive effects of a healthy diet and exercise—without the downsides of statins.

1. Fiber supplements such as Metamucil are OK. They’ll drop your cholesterol by at least 5 to10 percent––if you can choke them down. But why not get your daily fiber from those  seven to 11 helpings of fruits and vegetables instead? They definitely taste a whole lot better.

2. Then there are plant sterols, which are derived mainly from soy. They interfere with the absorption of cholesterol and can reduce it by 5-15 percent. More importantly, they’re absorbed into the body where they lower inflammation.

A new drug called Zetia works in a similar way, but the body doesn’t absorb it, so it only lowers cholesterol. This excites some people, but not me. It has not yet been shown to prevent heart disease.

There are also a few brands of margarine out there claiming to contain plant sterols, but they contain synthetic forms with no anti-inflammatory benefit. Skip the Zetia and the special margarines and take 2 grams of regular plant sterols a day. I recommend a formula called ModuChol.

3. Policosanol is another good supplement to try. It’s derived from sugar cane and can lower LDL cholesterol up to 20 percent and increase HDL by 10-20 percent. It also has mild beneficial blood-thinning effects and is an antioxidant. I usually recommend taking 10-20 mg at night.

4. If your HDL is low, taking fish oil supplements that contain 2-3 grams of DHA and EPA every day can do the trick. I’ve seen HDLs jump up to 20 points this way. But it takes time—up to a year or longer.

5. Vitamin B3 (niacin) is useful, especially in diabetics, who often have low HDL levels. Niaspan, the prescription form, is pricier but less likely to cause the flushing and liver toxicity that can occur with regular niacin.

You might have heard rumors that niacin can cause problems in diabetics, but it actually has minimal effects on blood sugar levels.

Guiding you through the guidelines

It’s easy to get tied up in knots when talking about cholesterol. I like to keep it simple and safe.

Even though I don’t believe that the numbers are all that important, they do give patients something to aim for with their efforts. So I use the guidelines to get my patients to take better care of themselves.

If you’re low risk and your cholesterol is high, stay away from drugs. You want to try to keep your LDL level below 160, but do it by cleaning up your diet. And get moving—30-60 minutes five times a week.

The best exercise is any exercise you’ll do on a consistent basis. A brisk walk is fine. Or dancing. Or gardening. For pete’s sake, just get out of doors if you can! Or, if you prefer, join the local health club, YMCA, or community center and swim, join an aerobics class, or whatever you like. Just do it!

What else? Take fish oil—2-3 grams gram total DHA plus EPA (it’s on the label). Few of us get enough of these healthy fats, but they protect your heart, improve your overall cholesterol picture, and support your brain, mood, and joint health.

If you’re in the moderate risk group and have controllable risk factors such as smoking, a weight problem, or high blood pressure, take care of them first, then worry about your cholesterol. Fixing these problems almost always means less worry about cholesterol levels, but you should be aiming for an LDL of 130 or less.

However, if you have a family history of early heart disease, I often recommend getting a coronary artery calcium score, which involves a simple noninvasive CAT scan. This provides an accurate measure of the amount of atherosclerotic plaque buildup (if any) in your arteries. Depending on the seriousness of your condition, it may merit a multidisciplinary approach––even including a “statin” drug.

It’s in high risk people––those who already have heart disease or its equivalent––that lowering LDL cholesterol below 100 or even 70 has been shown to prevent further heart problems. Here’s where the statin drugs may come in handy––although that doesn’t mean you have to take them if they give you trouble. I have plenty of folks who can’t tolerate statin drugs who are working with diet, exercise, and supplements and achieving good results—without the side effects.

What you can do right now to lower your cholesterol

Your mom was right! Eat your basics: fruits, vegetables, and whole grains (like oatmeal). Each includes vital nutrients and flavonoids that maintain healthy cholesterol levels, lower blood pressure, and quiet inflammation.

Enjoy your tea, red wine and chocolate! They too contain flavonoids. Just don’t rely on them and skip your fruits and vegetables.

Not so obvious solutions: Try 4-8 oz. a day of pomegranate juice. Be sure the juice is all-natural and doesn’t contain high fructose corn syrup.

Walnuts and almonds will work. Soy can also reduce cholesterol by up to 10 percent. Just 3 tablespoons of soy powder in a smoothie a day is perfect. Or, try fermented soy products like miso and tempeh.

Avoid trans fats found in hydrogenated and partially hydrogenated oils. Buyer beware: These substances find their way into some products you might not expect, including many packaged snack foods, crackers, baked goods, and margarines. Check the labels.

Lower your risk in 2 steps––no matter which group you’re in

Low-risk?

1. Exercise––any exercise will do. Just do it consistently.

2. Take fish oil-2-3 grams total DHA plus EPA. Examples: Nordic Naturals, Carlson’s, and Spectrum Naturals.

Moderate-risk?

1. First, take care of your risk factors (i.e., smoking, overweight, high blood pressure).

2. Get a coronary artery calcium score if you have a family history of early heart disease.

High-risk?

1. Lowering LDL cholesterol below 100––or even 70–– can prevent further problems, so a statin drug may come in handy .

2. If you can’t take statin drugs, a combination of diet, exercise, and supplements can be highly effective too.

Statins need a sidekick

If you’re already taking a statin or you and your doctor decide you do need to be on one, make sure you’re taking 50 to 100mg of coenzyme Q10 (coQ10) each day.

It’s an important player in your body’s energy production, but statins suppress its production in the liver.

Plus, the muscle aches and pains commonly caused by statins usually go away when you take coQ10.

10 Facts you should know about CHOCOLATE

Chocolate is receiving plenty of praise in the medical and nutritional news these days. But there’s nothing new about this news.

Chocolate was first used by the Olmecs, an ancient native American people (1500 BC-400 BC).

It was treasured by the Mayans and Aztecs, then by the Spaniards, who added sugar and brought it to Europe in the 1500s. Folks (including doctors) back then used it to treat fatigue, restore normal body weight, calm jangled nerves, and improve digestion. It was also cherished as an especially effective aphrodisiac.

The recent studies on chocolate show that it’s chock full of important nutrients that benefit everything from your heart to your mood. But keep in mind that the research touting all these benefits was on premium dark chocolate, not the highly processed, mass produced, cheap, sugary junk you find in most supermarkets and movie theater concession stands.

A lot of chocolate’s benefits are due to the fact that it contains flavonoids, which are powerful antioxidants. (See the article “Cholesterol counts––but not as much as you think,” starting on page 1, for more about flavonoids.)

So, just in time to satisfy your post-holiday, pre-Valentine’s Day sweet tooth, here are 10 practical reasons to enjoy your chocolate:

#1: High in antioxidants

Ounce for ounce, it’s one of the richest food sources of these crucial substances. Antioxidants neutralize free radicals—rogue oxygen molecules that promote heart disease and cancer and accelerate aging.

#2: Rich in valuable micronutrients

Chocolate supplies meaningful amounts of potassium, zinc, magnesium, and iron. Most Americans don’t get enough of these nutrients.

#3: Good for cholesterol

The fat itself in chocolate is “cholesterol neutral,” meaning that it doesn’t have a negative effect on cholesterol levels. But it has been found to lower bad LDL cholesterol (5-10 percent) while leaving good HDL cholesterol the same.

#4: Lowers blood pressure

People who ate just over 3 ounces of premium quality dark chocolate each day reduced their blood pressure by as many as 10 points in just two weeks, according to a 2003 study published in the Journal of the American Medical Association. Chocolate helps relax blood vessels so blood can flow through them easier.

#5: Helps prevent clots

Chocolate makes platelets, important for clot formation, more slippery. This protects the heart by helping prevent artery blockage.

#6: Anti-cancer effect

The high flavonoid content may have a protective effect against some cancers, based on the more extensive research on flavonoids in tea.

#7: A safe, mild stimulant

Chocolate actually has relatively little caffeine, but many people notice a quick increase in alertness and improvement in mood that can last hours after eating it.

#8: Calms coughs

A recent small study from England showed that chocolate is a highly effective cough suppressant—at least as good as codeine!

#9: Prevents cavities

Yes, you read it right! High quality dark chocolate can help prevent cavities by fighting common mouth bacteria.

#10: Doesn’t cause acne

Certainly not in most people. No connection between chocolate and acne has ever been proven.

Does chocolate have  a dark side?

As good as it can be for you, too much chocolate means too many calories. A 3.5-ounce bar can tack on 500 or more calories to your daily diet. Of course, that may mean you eat less later in the day, so let’s not be too quick to condemn it.

Premium dark chocolate actually has little sugar in it, much less than most so-called energy and granola bars, which are mostly expensive junk. Plus, the fat in chocolate slows the sugar’s absorption so it won’t spike your blood sugar.

What about “chocoholics”? Some may be self-medicating for mild depression. But perhaps this isn’t such a bad thing. It’s certainly safer than a lot of prescription antidepressants, and I have yet to treat a patient for a chocolate overdose.

On the down side, chocolate can worsen acid reflux and trigger migraines. If you suffer from either of these problems, you probably already know this.

For most people, I recommend 1 to 2 ounces high delicious, high-quality, dark chocolate a few days a week as a healthy treat and pick-me-up. (How’s that for a prescription!)

Combine it with a dollop of natural peanut butter for a smart “peanut butter cup” snack.

You can also make your own cocoa by mixing unsweetened cocoa powder with milk (I always prefer organic milk, which doesn’t have the hormones and antibiotics you get in most milk). Sweeten to taste with a little honey.

Some mass-produced products include chocolate from Ivory Coast plantations, which still rely on child slavery, so I just can’t recommend them. But some of my favorite brands of chocolate are Del Rey, Dagoba, Scharffen Arter, Rapunzel, Green and Black, and Valrhona. These are either organic or from small plantation sources of known quality.

Chocolate tops the list of Antioxidant Foods

Chocolate’s health properties are no joke. Check out its ranking on the following list, which shows various foods’ antioxidant activity in oxygen radical absorption capacity units per 100 grams (just over 3 oz).

Dark chocolate: 13,120

Milk chocolate: 6,740

Prunes: 5,770

Raisins: 2,830

Blueberries: 2,400

Blackberries: 2,036

Kale: 1,770

Strawberries: 1,540

Spinach: 1,260

Raspberries: 1,220

Brussels sprouts: 980

Plums: 949

Alfalfa sprouts: 930

Broccoli: 890

Oranges: 750

Red grapes: 739

Red bell peppers: 710

Cherries: 670

Onion: 450

Corn: 405

HOMETOWN HEALING

One simple, inexpensive supplement solves 2 big health problems

Meet Charlie. He’s 52 and loves to fish for bass. At the end of the day he takes home his catch and fries ‘em up with potatoes. He washes it all down with a couple of beers or some coffee, then tops it off with a piece of chocolate cake his wife bakes. And guess what? Heartburn city. Big time.

When I started to care for Charlie, he was on one of those stomach acid-blocking proton pump inhibitor drugs you see ads for all the time. They can definitely stop heartburn dead in its tracks––by totally turning off stomach acid, the body’s natural response to a meal.

Now I’m not saying acid blockers don’t have their uses, because I do use them with some patients—usually shorter term for ulcer healing. But I prefer not to tinker with the body’s natural functions if I don’t have to.

Back to Charlie. I started by telling him that some of the things he was eating and drinking—alcohol, caffeine, and chocolate—were actually making the problem worse. They all promote the reflux of stomach acid up into the esophagus by loosening the lower esophageal sphincter, where the stomach and esophagus meet.

Charlie had another problem, though—constipation. Pretty common problem, right? Enough fiber from plenty of fruits, vegetables, and whole grains takes care of most folks’ constipation. But getting Charlie to add more fruits and vegetables was kind of like trying to talk a hungry dog off a meat wagon.

Enter magnesium. It’s an important mineral that lives inside cells and participates in hundreds of important reactions in the body. It has all sorts of therapeutic uses—treating leg cramps, palpitations, preventing migraines, and you guessed it, fixing constipation. But many people don’t get enough, since it’s found mainly in leafy green vegetables. Plus, Charlie was at an added disadvantage because he had been taking the proton pump inhibitor, which was suppressing his stomach acid. Stomach acid helps your body absorb important minerals. Basically, he didn’t have enough acid to absorb what little magnesium he was getting.

So I had Charlie take simple, cheap, over-the-counter magnesium oxide—400, then 800 milligrams a day. I actually prefer magnesium citrate capsules, because they’re better absorbed, but magnesium oxide is usually a bit cheaper and easier to find.

Now his constipation’s history. What’s more, his heartburn cleared up, so he was able to stop taking his acid-blocking drug. Turns out that getting things moving down below kept things from backing up higher up in the whole system. Charlie’s happy and so am I. Anytime I can get the body to heal without harsh drugs, I know I’ve done my job.

I’m still trying to persuade Charlie to boost his fruit and vegetable intake—so we can get him off the magnesium. After all, why take a pill when you can get what you need from food?

Safe, natural solutions for heartburn and the other “big C”

Suppressing stomach acid long-term is rarely the right solution for heartburn. If you’re on a proton pump inhibitor, reduce your intake of alcohol, chocolate, caffeine, and fried foods. Try it for a couple of days to see if you notice a difference.

For a safe, natural solution to constipation, try over-the-counter magnesium oxide or citrate—400-1,200 mg a day. If you’re going to supplement with magnesium long term, you should also take calcium citrate with it, in a 2:1 calcium/ magnesium ratio.

And while you’re at it, have some cooked oatmeal with raisins or chopped up prunes for breakfast. Still not there yet? Add 1-2 tablespoons a day of flax oil, a healthy fat that can definitely help keep things moving smoothly. Or try including 1 or 2 servings of raspberries (they have the highest fiber content of all fruits) into your diet each day.

YOUR QUESTIONS ANSWERED

The cancer test that could be causing more harm than good

Q: I’ve heard mixed messages about the PSA blood test for prostate cancer. What is your take on it? Does it really benefit men to get one every year?

––G.A., Dover, DE

A: Some experts insist the PSA is useless. Fact is, a high PSA level doesn’t always mean cancer (usually doesn’t), and a low PSA (even normal) doesn’t always mean absence of cancer.  An elevated PSA can be due to a lot of different things: BPH (an enlarged prostate), prostatitis (inflammation or infection), ejaculation within the last 48 hours, trauma, bicycle riding, a urinary tract infection, and prostate cancer.

Since we started testing PSA levels over 15 years ago, nearly three times as many cancers have been picked up. True, some men have been spared a miserable death from prostate cancer. But the overall mortality rate has dropped only 6-8 percent. And many of these cancers are being treated unnecessarily. As a result, many men have suffered incontinence, impotence, and emotional stress.

PSA screening is especially useful in high-risk groups—African American men and men with family histories of prostate cancer, who should be tested starting at age 40. Men ages 50 to 65 benefit the most from screening, men over 70 the least. (Cancers in older men are unlikely to cause problems before something else causes death.)

If you do decide to get a PSA test, don’t rush into biopsy or surgery if your level is elevated. Most prostate cancers are slow-growing, which means a watchful waiting approach is often a much better option than invasive, possibly debilitating procedures or surgeries. Also, be sure to get a digital rectal exam yearly. Any palpable nodules should be biopsied.

As always, it’s best to individualize your own treatment approach with a doctor who’s willing to spend time discussing the fine details of your own situation.

The text contained herein does not constitute medical advice. America’s Country Doctor advises that you consult your own physician before acting on any recommendations contained within this publication.