Tag Archive for: cholesterol

Review: That Sugar Film

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Summer gives us a chance catch to up on reading or binge watch a television series, so I thought I’d watch some of the nutrition documentaries that I’ve been asked about. I’ve done some in the past such as Forks Over Knives. It gives me a chance to check the facts on what’s said and how true or relevant it is. That’s the case with the film titled That Sugar Film. It was written, directed, and starred in by an Australian filmmaker Damon Gambeau. Hugh Jackson even performed the opening scene.

The premise of the movie is that all sugar is bad. There was at least one anti-sugar and ketogenic diet proponent in Gary Taubes author of Good Calories, Bad Calories. The filmmaker also assembled a team of experts who were going to provide information and medical supervision during an experiment he wanted to conduct on himself. The experiment was to see how a high-sugar diet, one typical of the average Australian, would impact him. Based on what he claimed to eat, he was somewhere between the paleo diet and the ketogenic diet before that.

There was the requisite discussion of the cholesterol hypothesis and how fat was chosen as the demon to avoid instead of sugar as they relate to heart disease. The sugar industry conspiracy was also talked about in the same vein as the tobacco industry. But it’s what he did to himself that was by far the most interesting: switching to a diet that contained 40 teaspoons of sugar a day for 60 days. What happened to him? That’s coming on Thursday.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on the 2018 Cholesterol Guidelines

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In Thursday’s Memo, I talked about the 2018 Cholesterol Guidelines and evidence-based medicine, focusing on the physician side of the treatment discussion. But I believe that’s not the most important part of the discussion; I think the critical part is the patient side. Here’s why.

The Cholesterol Guidelines focus on lifestyle changes first: a healthier diet, exercise, quitting smoking, and weight loss. That’s supposed to be the initial part of the potential treatment plan—lifestyle first. In other words, what will the patients do for themselves before the discussion leads to medications, especially statins?

The guidelines aggressively focus on the use of statins and other medications to get the LDL-cholesterol to desirable levels, so we have a dilemma during the discussion of a treatment plan. Do the physicians assume, based on experience, that the patients won’t do what they’re supposed to do to lower their risk of CVD and immediately prescribe medications? Or do the patients take the lifestyle route seriously and do what’s necessary to change their health?

To be blunt, we patients haven’t done our part. We lose weight and gain it back. We start to eat healthier and don’t sustain it. We start to exercise, but we let life get in the way and stop, or we push too hard and get injured and stop, or the weather turns colder or hotter and we stop. When we agree to change our health habits and then don’t follow through, we make our health issues worse—they’re still in there eating away at our lifespan and not being treated.

Don’t make promises you know you won’t keep; notice I didn’t say can’t keep, I said won’t keep. If you know in your heart you’ll never change your diet or keep up with exercise, the best thing you can do for your health is don’t delay: start taking the meds and start taking care of the problem.

Although I disagree with it, I get why physicians jump to meds. There’s only one way to change that: we have to prove them wrong when they assume we won’t stick to a healthier lifestyle.

The Bottom Line

The 2018 Cholesterol Guidelines put the responsibility for lowering the risk of CVD without medications in our hands—the patients. Work out a timeline with some concrete goals for each lifestyle area with your physician. It won’t be easy: regular exercise for life, eating better from now on, quitting smoking, plus getting to a normal weight and staying there will all take time and consistent effort. That’s okay because even if your risk of CVD is high, it doesn’t mean you drop dead tomorrow. Even if you fall into an at-risk scenario, I know you can do it. There are many tools to help you keep at it: an app, a workout buddy, a Facebook group, and more.

Instead of looking at your health challenge as an obstacle, look at it as an opportunity for better health. If you say you don’t want to take medications, this is your chance to prove whether you really mean it. I can’t guarantee you’ll never need the meds, but you can work your way down to a smaller dosage with fewer side effects.

It all depends on your answer to one question: what are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

AHA’s 2018 Guidelines on Cholesterol

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Here’s what the American Heart Association announced this past weekend: a 120-page research-based paper on new cholesterol guidelines and how the guidelines were developed. The paper was five years in the making, involved twelve medical and physician associations, and includes ten documents to explain and summarize what the guidelines say. For the foreseeable future, these will be the guidelines used by physicians trying to reduce the risk of cardiovascular disease.

The guidelines focus on control of LDL-cholesterol in combination with the state of the individual: those with and those without diagnosed disease. Primary prevention is for those who’ve not been diagnosed with atherosclerotic cardiovascular disease (ASCVD). Secondary prevention applies to those who have been diagnosed with ASCVD. The flow charts for treatment plans are complicated, even when isolated and presented on individual pages.

What I liked the most is that management of CV risk begins with a conversation between the physician and patient. The discussion revolves around risk factors, both lifestyle and the test results. The goal is to come to a consensus for treatment if a person’s CVD risk is high. What does that treatment involve? We’ll take a look on Thursday.

The Insiders Conference Call is tomorrow night. If you’re not an Insider yet, you still have time to join and take part in the call. I’ll be covering the latest research on omega-3s and vitamin D as well as answering your questions.

What are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

Why Do Statins Fight with Grapefruit?

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One of the most complicated medication-food interactions is grapefruit and statins, the popular cholesterol-lowering drug. The goal of this Memo is to make sense of the research to date by answering a couple of questions.

Before I begin, let me briefly explain how a statin works. One of the many enzymes required to produce cholesterol in the body is called HMG CoA reductase. In fact, it’s the rate-limiting enzyme; it controls how much cholesterol is made. Interfere with the enzyme, and you can block the production of cholesterol. That’s what most types of statins do; they block HMG CoA reductase, thus limiting the amount of cholesterol made. If your cholesterol is too high, it goes down.

How Does Grapefruit Juice Interact with Statins?

While this is some complicated biochemistry, let’s see if I can explain it simply. There’s a series of naturally occurring enzymes produced in the small intestine called CYP 450 3A4 that modifies the statin before it’s released into the bloodstream; it controls the amount and the form of the statin that gets into your body. Grapefruit juice contains phytonutrients that interfere with the CYP 450 3A4 action, letting more of the statin get into the bloodstream more quickly. Rather than fighting, it was more of a case of helping too much.

Is that good or is it bad? The research never really specifies. The logical expectation is that it would lower cholesterol too much or because it’s not in the correct form, maybe not enough. I couldn’t find an answer to that question. The original research on grapefruit juice began in the late 1980s and seemed to end about 2004. Since then, the recommendation is if you take a statin, no grapefruit juice.

What Is the Real Concern with the Interaction?

This question perplexed me for years, but I finally found an answer: with too much of the statin available due to the interference of the phytonutrients with the CYP 450 3A4, the overabundance could lead to an increased risk of rhabdomyolysis, a breakdown of muscle tissue. Muscle pain is a frequent side effect of taking statins, so the concern makes sense. The problem is that it was never really tested in any research I could find.

On top of that, the primary studies on grapefruit juice and statins used double-strength grapefruit juice in high amounts and a high dose of statins in healthy subjects. Yes, they found that the statin levels increased. But no other measures were checked such as impact on cholesterol production or markers of muscle damage. That was the state of research for the past decade.

What If You Wanted to Boost Your Statin?

In a recently published review paper, researchers theorized on the impact of grapefruit juice on cholesterol levels and the risk of cardiovascular disease. They found that if a statin such as simvastatin was taken at the same time as grapefruit juice, it increased the absorption 260% but if taken 12 hours apart, absorption was up only 90%. With atorvastatin, the increase was 80% no matter when the grapefruit juice was taken.

Calculating the effect on benefits and hazards, when simvastatin or lovastatin are taken at the same time as grapefruit juice, the estimated reduction in LDL cholesterol is 48%, and therefore, the decrease in heart disease is 70%. If the juice is taken 12 hours before these statins, the reductions are, respectively, 43% and 66%. For atorvastatin, the reduction in LDL cholesterol is 42% and in reducing the risk of CVD by 66% (1). Without the grapefruit juice, the reduction in LDL cholesterol is 37% with a decrease in risk of CVD of 61%.

This paper uses published data from many studies to perform these calculations. It doesn’t change the message in their conclusions. The benefits from the additional reduction in cholesterol may be worth the slight risk of rhabdomyolysis, but that doesn’t mean you’ll find any change in the grapefruit juice recommendation any time soon. But at least you now know the issues and why grapefruit is not the demon it’s been made out to be.

The Bottom Line

It’s important to understand that the drug, the statin, is the abnormal thing here, not the fruit. It doesn’t seem to make any sense to modify properties of a healthy diet just to be able to take a medication. But we live in the real world. Until the pharmaceutical industry can find a way to make medications that can help us and work with a healthy diet, be prudent. If you take a statin, talk with your cardiologist about finding a way to fit citrus in your diet. You may have to limit the amount or limit the times of day you eat or drink grapefruit, but as long as the net effect is getting your lipid levels in the desirable range, there has to be a way, especially since most statins should be taken at bedtime. The research is far from clear, so it’s a case by case basis.

What are you prepared to do today?

Dr. Chet

 

Reference: http://dx.doi.org/10.1016/j.amjmed.2015.07.036.

 

PQQ: Miracle in a Bottle

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The latest cure for your health problems has arrived. I know—I just watched the online infomercial. Or do they call it advertainment now?

It was presented by a cardiologist who is well respected in his field. The topic was arterial inflammation, AKA the cardiac killer, and what you could do about it. I was in.

What I saw were the “facts” about heart disease. Using an artist printing and drawing on a whiteboard with a voice over, I learned:

  • Cholesterol is not the cause of heart disease, the number one killer.
  • The Framingham Study gave . . .

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Raising HDL: Weight Loss

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Before I finish up this week’s look at HDL cholesterol, I want to wish every mother a Happy Mother’s Day. I hope it’s a great day with your children.

The number one way to increase HDL cholesterol is to lose weight. Losing fat helps increase HDL levels while simultaneously lowering LDL cholesterol. We still don’t know precisely why, but there’s really nothing debatable about it.

I’ll give you my theory of why weight loss helps raise HDL cholesterol. In order to lose weight, you have to eat less and/or move more; more than . . .

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Raising HDL: Exercise

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For many years—even back when I was a graduate student—we’ve known that one of the benefits of regular aerobic exercise is increased levels of HDL cholesterol, AKA the healthy cholesterol. If you want to increase your HDL, you should exercise regularly.

There are still many questions that need to be answered. What is the best type of exercise: aerobic or resistance training? How intense does the exercise have to be? Is walking intense enough or does it have to be faster? There are more questions, but you get the idea.

The reason we don’t know is . . .

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Why You Should Raise Your Cholesterol

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Would you like to have a vacuum cleaner that sucks out the cholesterol from the plaque in your arteries? You would? Well, all right! That vacuum cleaner is called HDL-cholesterol, AKA the good or the healthy cholesterol. The problem is that most people, especially men, don’t have enough. Before we get to ways you can improve it, let me explain how it works as simply as possible.

HDL stands for high-density lipoprotein and indicates that the molecule is denser than other lipoproteins such as LDL. Adding the word cholesterol means that it carries cholesterol. The question is . . .

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Health Habits: Just Do Better

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Let’s finish up our look at the recent paper that concluded we’re doing poorly when it comes to our health habits (1). If you thought smoking and exercise were underwhelming, today we’ll look at diet and body fat.

When it comes to following the U.S. Department of Agriculture Dietary Guidelines, just under 38% hit that goal. I’ve talked about this a lot over the years, and this isn’t a debate over what constitutes a good diet. While we are doing somewhat better, adults do not eat enough vegetables, fruits, or beans, and we still . . .

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Why Now?

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In the last two messages, I’ve challenged you not to waste the entire month of December before changing to a healthier lifestyle after January 1st. Why now? Why didn’t I just wait until the New Year when everyone is “ready”? Maybe the latest report from the CDC will put things in perspective.

Researchers from the CDC and Emory University analyzed data from NHANES studies conducted between 2005 and 2012. They were interested in finding out how many people with high LDL cholesterol were taking medication and making lifestyle changes. There were a lot of results reported in the . . .

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