Cholesterol Concerns and Management Through Diet

[BeeZee]

Well, saw Doc today and he wasn't overly concerned with the numbers. I told him my intent to better watch my diet and try the natural plant sterol supplements, he thought it sounded like a good idea. Scheduled a follow up for 3 months out, check blood work again to see how it's going. Easier to nip it in the bud early.

[Bantams]

The body also produces cholesterol. Depending on how much is consumed through your diet, your body will produce more or less. I have a feeling that when someone consumes very little cholesterol, the body may actually over-compensate and produce too much.

From my family members' experience, the very best way to improve your cholesterol levels is to completely cut all hydrogenated oils from your diet, stop eating commercial feedlot meat, and never limit your consumption of healthy, grassfed animal products, especially fats - eat lots of real pastured butter, eggs, beef, whole milk (raw is best), cheese, etc, and enjoy it! This is how humans have been eating for thousands of years. Only in the past 50-60 years have we started eating heavily processed foods and tried to cut down on fat - and look at the health of our nation now...

[BeeZee]

The interesting byproduct is that this has made me really think about what I've been eating. I eat more healthfully than most people, but I have "fallen off the wagon" with not paying attention to whether the sandwich I grabbed off the platter had mayo and/or cheese, not getting enough fiber and drinking enough water. Since I spend so much time in my car (I don't work out of an office) I've gotten healthier items which I can keep in the glove box for my "emergency" snack stash. Sometimes a wake up call (or gentle reminder) is a good thing.

[Gail CDM]

All this crap of counting calories, or carbs is not the way to good health. That is the western way of thinking.... Go to the East my friend.... they know nutrition. Stay away from the 3 deadly whites... white sugar...white flour and white iodized salt... That leaves whole grains....natural raw sugars....and natural salts.

If God didn't make it....don't eat it. The further you get away from the food God made, the worse the quality gets. Remember God did not make margarine....God did not make processed foods, or food that comes in a box... God didn't make vitamin tablets....eat the foods that contain the vitamins and minerals your body needs...

Shop only the parameter of the grocery store and you will be healthier.

Did you know margarine is one molecule from plastic? ICK!!

[pen_h]

I'm not sure that there's a single set of food rules that is going to work for everyone. Eastern medicine has different recommendations for different people who have what appears to be the same condition, depending on their body type and personality - this method was used for thousands of years in the West, until only a couple hundred years ago.

Some people may benefit from lowering saturated fat intake. Some might even benefit from low-fat dairy products, although it's possible that the body doesn't recognize them as low fat and sends funny signals to the brain. Some may benefit from general weight loss, or more exercise, or reducing processed foods, or...

And some might even benefit from adding a supplement or eating a lot of a specific ingredient. But supplements are processed and don't necessarily contain everything that the original ingredient has - something may be missing. And single ingredients as "heal-alls" go in and out of fashion. Oh, except garlic, which has been called a cure for all kinds of things for at least 3,000 years!

[Cim Ryan]

You might find this dense, but if you can wade through it, it's informative:

High cholesterol may protect against infections and atherosclerosis

Q J Med 2003; 96: 927-934

© Association of Physicians 2003; all rights reserved.

http://qjmed.oxfordjournals.org/cgi/content/full/96/12/927?ijkey=172mwKXqzgmtE&keytype=ref

[Doc]

As a Chef and an Interventional Cardiologist I have been silently following along this very interesting thread. I thought I might share a few thoughts with all of you.

*Cholesterol is produced naturally in everyone's body as well as being consumed from the diet

*Genetics do play a strong role determining your total cholesterol level, LDL (or "bad") cholesterol level and HDL (or "good") cholesterol level.

*Everyone is quite correct in commenting that the pathology is actually quite complex. In fact, it does not even directly involve cholesterol. The culprits are what are known as lipoproteins; these are molecules that our bodies manufacture (again with genetic predispositions) that consist of different pieces of proteins and fats. Cholesterol is a component of these molecules. These molecules, as a result of both size and number, can get into the walls of the arteries. Here they can become "oxidized"; a process by which they undergo a chemical transformation. These oxidized particles cause inflammatory changes, which over time can lead to plaque being built up and the arteries both narrowing due to plaque encroachment or the plaque can rupture and cause a clot to form in the artery obstructing blood flow.

*Cholesterol is used because it can be measured easily and cheaply, lipoprotein measurements are much more expensive

*LDL cholesterol levels, in general and for populations, do seem to predict adverse events

Cholesterol can be reduced with diet. In many studies the amount achievable by diet was 10-15%, which often does not reach the targeted levels. We have seen many patients who can get their levels to guideline recommendations through diet alone, but they often had a very poor diet to start. Likewise, many people who do not have a terrible diet to start can not reach target levels without medication due to genetic predisposition. As a chef, I abhor a lot of those diets because it's like eating cardboard (I tried one and it was gastronomic water boarding)

*The high cholesterol no heart disease Italian reference refers to what is known as the Milano gene. It is a naturally occurring variant which was used in some clinical trials (genetic engineering of cells). Unfortunately for most of us, the rules for that family do not apply.

*Exercise, as mentioned, is an excellent way to increase HDL. Niacin is used to help with low HDL and heart disease, and is of course a naturally occurring vitamin.

*I agree with everyone on the more natural dietary choices. As I mentioned, the equation is complex but I suspect that consuming a lot of processed foods invokes the Law of Unintended Consequences, which may result in producing these oxidized compounds; hence many of the reductions seen in heart disease, stroke, etc. by consuming foods rich in anti-oxidants. Having also studied martial arts for many years, I have been exposed to both Eastern Medicine and cuisine. Western medicine has its strengths, when your artery is blocked you want it open fast. Eastern medicine tends to look at why your artery got blocked in the first place. It they are complentary processes, you need not choose between them. I think a generally wise health choice with respect to diet means cutting out as much processed stuff as you can. Eat fresh but eat well. Your diet should not be a source of pain, but pleasure. As a chef I just can't abide eating or serving things that don't taste good-and in the end over the long haul people won't eat them either. A little "dietary indiscretion" every now and then will not kill you-just don't go Tiger Woods over the top doing it 6 out of 7 days and nights. As I tell my patients, you can have your cake and eat it too-you just can't eat the whole damn cake at once.

*Hope this was informative-great thread!

[haresfur]

Thank you for the clear and informative post.

Your diet should not be a source of pain, but pleasure. As a chef I just can't abide eating or serving things that don't taste good-and in the end over the long haul people won't eat them either.

I agree but want to point out that healthier food can be an acquired taste. I now much prefer olive oil to butter. Low fat and low saturated fat food can be really nice. I have been to "nice" restaurants where the fat content of the food made the experience unappealing. Food often seems overly salty to me and I haven't been too strict about limiting salt intake. I'm not a vegetarian but I have found that, for me, I usually prefer highlighting vegetables through meatless meals than sticking them on the side of a slab of animal.

[Fat Guy]

I tried for two years to reduce cholesterol through diet. Even radical dietary moves did so little as to be ludicrous in my case. Some people respond better than others to diet. A small dose of Zocor, however, reduced my cholesterol 100 points very quickly and with no noticeable side effects. Not that I'm convinced that lowering cholesterol matters. But the studies do seem to show that statins, for one reason or another, do improve longevity.

[paulraphael]

Contrary to what doctors and the American Heart Association would lead you to believe, this is a very controversial topic. High cholesterol is correlated with heart disease, but it has not been proven to cause it (or plaque build up for that matter.)

This is true; lot of the research literature is new, quickly evolving, and confusing. One of the more recent twists is a long-term study of a cholesterol drug that dramatically reduced arterial plaque, but had no significant effect on mortality. Conclusion: we don't quite know what's going on.

The suspicion remains that it's probably best to go easy on saturated fats and especially trans fats. But regardless of diet, for many people with high cholesterol the main culprit is their body's own cholesterol production. The only way we know to control this is with drugs, and the benefits of doing so are still unclear.

[Pam Brunning]

Who is to say what your cholesterol level should be? We are all different, I believe constitutions vary, what, according to the medics is high, could well be normal for some people. As far as statins are concerned I wouldn't touch them you may live forever on them but in what condition, there is plenty of evidence that they rot the brain. I would rather enjoy a balanced diet and take my chance on a heart attack.

[llc45]

Ch Ch Ch Chia! (seeds)

[Doc]

You're welcome haresfur. The salt/fat thing you decribe is often not necessarily a bad thing. The salt/fat cravings can be a physiologic response that becomes addiction. SOunds like you've broken the food crack stranglehold.

Edited March 23, 2010 by Doc (log)

[Doc]

Hi Fat Guy,

Statins seem to alter the compositionof plaque and reduce inflammatory changes independently of their effect on cholesterol levels.

[Doc]

Who is to say what your cholesterol level should be? We are all different, I believe constitutions vary, what, according to the medics is high, could well be normal for some people. As far as statins are concerned I wouldn't touch them you may live forever on them but in what condition, there is plenty of evidence that they rot the brain. I would rather enjoy a balanced diet and take my chance on a heart attack.

You are correct that in individuals the course of any therapy is unique and difficult to predict. The algorithms used in medicines are derived from populations and then extrapolated to individuals. In general, this approach has worked well in populations and for most individuals. Genetic tailoring based on genes and DNA holds promise for a more tailored therepeutic regimen. Till then, this is the best we got!

As for statins, they have been shown to reduce strokes and potentially reduce Alzheimer's dementia as wee; but then again red wine has shown the same (albeit lower rates of prevention)reductions

-Doc

[ErinM]

I'd like to pose a question to Doc - my cholesterol numbers are basically good, but have me a tad worried. I eat a fairly low fat vegetarian diet (it may even be low fat, but it just tends to happen that way) and while my total cholesterol level went down a few points, so did my HDL, while still be being high enough to help prevent heart disease. One of the nurses I work thinks that my body is over compensating because I'm not eating enough fat. What do you think about this? I'm a little skeptical, but haven't studied cardiology yet (I will be in a few years!)

In the meantime, I'm wondering what I can do to make my numbers even better. Certainly exercise is a part of that and I tend to get more of that as the weather gets better, it's just happened that my numbers are always tested in the winter when I'm doing nothing. I'm planning to increase my intake of avocados/nuts/flax to get the good fats. Is there anything else worthwhile? Also, when your cholesterol is tested, are the numbers based on what you've been putting in your body over a certain period of time? I wonder if the changes I saw are based on what I'd been eating over Christmas/New Year's, which is a bit different than what I do the rest of the year.

[egale]

Doc, I'd like to thank you for your post. Excellent information.

And I would like to strongly second Haresfur. Healthy food is definitely an acquired taste. When I first changed my diet I thought oatmeal tasted like cardboard. After three days of it I began to like it. Now I love it. My husband used to love butter on vegetables; now he actually PREFERS pesto made with olive oil. He also used to love baked potatoes smothered with sour creme. Now the sour creme is too rich for him and he begs me to make wheat berries flavored with argan oil.

Since we changed our diet both my husband and I have found that we don't really care for most restaurant food any more due to its high fat and salt content. We have both come to prefer the "healthy" food we make at home. Now we limit our restaurant outings to Thai and Vietnamese.

It is hard to make these changes at first. You have to decide that you are going to eat to live, not live to eat. But once you do, you come to love healthy food as much as you used to love the crappy high fat processed American stuff.

Haresfur, you are so right.

[angevin]

"Now we limit our restaurant outings to Thai and Vietnamese."

I don't want to stop going to French bistros. For me, I adore butter, rich cheeses, offal... and "healthy eating" was more a matter of preferring small protions.

Nothing kills my appetite more than a plate set in front of me, overflowing with a portion fit to feed my entire family.

[Pam Brunning]

Thank you Doc for your comments. I will certainly keep up the red wine medicine - I have been on it for many years!

Having lived on a farm for over 50 years I have indulge in cream, butter, cheese, eggs, all types of meat with a good proportion of fat to give it good flavour - in fact all the things, that according to the medics, are bad for me. BUT I have never had a Big Mac.

I believe that if you eat proper food and not processed junk that is full of trans fats and chemical additives and that you are also careful to buy your raw materials from reliable sources, it must be the right way to live. I try to make every thing we eat, and then if we eat out occasionally it won't matter if a dish contains something nasty!

As for salt - wars were fought over salt - it is one of the most maligned substances around today.

Remember Salt is the policeman of taste, it keeps the various flavours of a dish in order and restrains the stronger from tyrannising over the weaker Malcolm De Chazal.

Salt is essential not only to life but to good health. You have around 250 grams, a cup full, of salt in your body, working to keep you alive human blood contains 0.9% salt.

Salt enhances the inherent flavour of foods and magnifies their aromas. There is always an optimal amount of salt required to bring the flavour of any ingredient to its peak, this is where the experience of the chef comes to the fore in well crafted dishes. It takes years of knowledge to be able to add just the right amount of salt so that it cannot be individually identified.

The three main ingredients in murdering beautiful food are salt, fat and sugar, says Raymond Blanc. All enhance flavour but when they are overused, they slaughter it.

Salting of vegetables is a very precise art as the length of cooking time is relative to the amount of salt taken up. Potatoes boiled for 20 minutes will take up much more salt from the water than green beans, which only take 5 minutes.

My point is that if you dont eat processed foods that are full of salt, the amount of salt used to just enhance flavours wont overload your system to excess.

I agree angevin a large plate of food is a complete turn off. I cant come to terns with your Thai and Vietnamese theory though - surely you will be loading on MSG to start with??

Edited March 27, 2010 by Pam Brunning (log)

[egale]

Pam -- I think you make a number of good points. Salt is certainly not poison in appropriate amounts. Without it food is bland. But since you say you've never had a Big Mac (or other junk food I would assume) you might not realize how very salty a lot of junk food or even regular restaurant food really is -- at least here in LA.

I think it's important to remember that food and health should not become a religion (or rather a cult). Listening to your body is what's important. If someone can eat high fat meat and dairy on occassion -- or even daily -- and still have cholesterol levels that please you and your doctor, then indulge away lucky you!

But as for us, we couldn't. We had to cut out high fat meats and dairy and increase healthy fats (such as nuts, alvocados, and olive oil) as well as make other changes. And the changes were very effective improving our health. People do have different metabolisms.

And by the way, I make Thai and Vietnamese dishes all the time and none of them include MSG. The ethnic Thai and Vietnamese restaurants we frequent do not use it either -- I've watched them cook. I think MSG is used more in Chinese food. But anyway, isn't MSG a natural ingredient that's been used for hundreds of years in China and is not harmful in reasonable amounts?

[Pam Brunning]

Egale that is the whole point I am making - yes I know processed foods are laden with salt. They are also laden with MSG to an alarming amount. They are both natural products but poison in a large quantity. That is the reason I stick to making everything myself.

See

http://www.laleva.org/eng/2005/05/obesity_epidemic_caused_by_monosodium_glutamate.html

[HowardLi]

Has there ever been a study that proved than just a correlation between dietary cholesterol intake and bodily levels of cholesterol? As far as I know, cholesterol in the body has its own control mechanism.

[BeeZee]

3 months later...I watched what I ate a little more carefully, increased fiber intake, and have taken a natural plant stanol/sterol supplement every day. Cholesterol dropped from 210 to 203, not huge, but a move in the right direction. My "good" cholesterol level is good, so I'm fine for now.

[Caruso]

So I was recently diagnosed with high cholesterol and told I needed to rehaul my diet or else face the prospect of drug intervention. I'm in my mid thirties with a fast metabolism and slim physique, thus am not particularly concerned about overall calories. So does that mean I can go hog wild on good fats like olive oil, salmon and avocado?

[andiesenji]

Back in March I wrote about my opinions and they have not changed. Friends of mine who are vegans are trying to cope with a diagnosis of high cholesterol. They are both very thin (too thin in my eyes) but one guy has very high cholesterol and the other is normal, and they have essentially the same diet. The guy with the high cholesterol says his mom (86) also has high cholesterol and refuses to take medication for it.

I am firmly convinced that it is genetics and some of the studies that were done early on were, in my opinion, somewhat skewed. They were not exactly "pure" research, they were paid for by drug companies - guess what? The same drug companies who sell the drugs for lowering cholesterol.

As Darienne wrote, there is no guarantee that lowering cholesterol is going to equate to a longer life (just one that seems longer.....)

I'll be 72 in March. I'm a diabetic but it is in good control. I'm obese but slowly losing weight with no backsliding in more than two years. I can't take any of the drugs for high triglycerides or for cholesterol so it is a good thing mine is normal.

I wouldn't take them anyway.

My diet is high in supposedly cholesterol laden foods but as most in my family consumed the same diet and lived to great ages, I'm not going to tinker at this time.