Thursday, December 29, 2011

Make A New Year’s Commitment to Your Health

New Year’s resolutions are commonly made and broken within weeks. We all know the story: ‘I will do this…’, ‘I will stop doing that…’, ‘I need to learn how to…’ Unfortunately, most of us make a resolution, expect immediate results, and are discouraged when we don’t see the results we want.

As far as I know, no one keeps stats on New Year’s resolutions (thankfully), but one that I hear commonly is a resolution to lose weight. A lot of people overdo it during the last two (or three) weeks of December and so head into January with a little bit of extra weight. Others have struggled with their weight for some time, but take the New Year as a chance to commit to losing the weight once and for all.

Weight loss, however, is no easy feat for most people, especially when the excitement and enthusiasm of New Year’s has you setting the bar high. A healthy rate of weight loss is generally rated to be 1-2 pounds per week, a rate that is hardly awe-inspiring – if you’re looking to lose 20 pounds, and after a few weeks of challenging diet and exercise changes, you’ve only lost 3 or 4 pounds, it can be easy to get discouraged.

Find someone with whom you can form a therapeutic alliance. Weight loss is a challenge, but there are strategies that are proven to work. However, though these strategies are effective in taking weight off and keeping it off, they require consistent, ongoing work – there are no quick fixes where weight loss is concerned. As a result, it’s important to have someone you can work with, whether that’s a health professional, a personal trainer, a friend, or a family member. I think I harp on this just about every week, and I’ll continue to do so – when working with chronic health concerns or long-term health projects, don’t go it alone. In times of difficulty or discouragement, it helps to have someone to lean on.

Exercise is key, even if the weight doesn’t seem to be coming off. A recently published study showed that in the long run, staying active reduces mortality from all causes, regardless of weight change. These reductions were not small potatoes, either – staying fit reduced all-cause mortality by 30%, and an even larger drop was seen in those who improved their fitness. I don’t think this study shouldn’t diminish the health benefits of attaining a healthy weight, but should serve as encouragement to those who exercise without seeing the immediate benefits. Here’s a great video to give you some more encouragement, and here’s a little entry I wrote about what ‘counts’ as exercise. A lot of people, especially around the New Year, rush into vigorous exercise regimens they can’t keep up, but I recommend starting closer to home – go for a walk, get in the garden, take a bike ride. The key to exercise is to be regular about it, not to be vigorous.

To sum it all up, here’s my invitation to you – make a New Year’s resolution to your health. Losing weight has tremendous benefits, but equally important is to get active. Weight loss improves your cardiovascular health (a big issue among us Americans), and exercise is good for just about everything under the sun. And as always, work with others in achieving your goals – when I was in school, one of the mottos they taught us when preparing us for 4 years of school was this, ‘If you want to walk fast, walk alone. If you want to walk far, walk together.’ Nowhere is this truer than with weight loss – if you want to achieve your goals, find someone who will support you in doing so.

I wish you all health and happiness in 2012.

Monday, December 26, 2011

Do You Know Your Vitamin D Level?

There's a campaign in Scotland at the moment to have more foods fortified with vitamin D, on the premise that it would reduce incidence of multiple sclerosis (MS), a neurodegenerative condition that can have crippling effects. Though the drive to fortify foods is unique to Scotland, the issue of low vitamin D levels is common throughout the Northern Hemisphere.

Seattle, where I went to naturopathic school, has a climate fairly similar to Scotland, with similarly low levels of sunlight throughout much of the year, and with similarly high incidence of MS. In my time there, I don't know if I saw one patient with a healthy blood level of vitamin D who wasn't actively supplementing it. In fact, researchers believe that most Americans aren't able to make adequate vitamin D throughout much of the year, due to weather, indoor lifestyles, and seasonal changes in the angle of the sun's rays to the earth below.

The good news is - vitamin D is inexpensive and effective at raising blood levels. It's an easy test with an easy fix, and the health benefits are significant. So the question is, do you know your vitamin D levels?

Thursday, December 22, 2011

Managing Stress During The Holidays

Last year, I posted a little tidbit about managing stress during the holidays, recommending to you, my dear readers, that you treat yourselves gently in stressful times. Holiday events with friends and family can be joyous occasions, but for many of us, they can also be laden with stress. The advice to ‘treat yourself gently’ is an aphorism for healthy living I learned from a psychologist who was one of my teachers. The basic meaning is to give yourself space for self care in times of stress, when others are making demands of you and your time. Treat yourself gently – don’t be hard on yourself, give yourself time and space, and above all, pay attention to what you need to feel well.

This year, I return to the topic, with some more recommendations based on what I’ve learned from working with my patients. A large proportion of my patients are stressed out for a variety of reasons. In working with chronic stress, I’ve learned two important lessons from my patients.

1. Stress is not stress is not stress. We all respond to stress in our own unique ways. Some of us become sad, others angry, others fatigued, and others eat when stressed. The variability of own unique responses to stress makes it hard to make general recommendations about stress. There are a whole host of supplements out there that purport to treat stress, including herbs, vitamins, and even minerals, but because stress is so individual, it takes a trained professional to recommend one treatment over another. I’ve found a number of herbs and supplements that help people find relief from stress, but it takes an office visit to determine what’s helpful. For example, l-theanine would help someone who become nervous with stress, but would aggravate someone who responded to stress by becoming fatigued. Similarly, rhodiola might help someone who became fatigued with stress, but worsen symptoms for someone who was irritable or nervous.

Before I move on to the second point, let me interject here to say that supplements don't fully answer the problem of stress. Supplements and medications help people cope with stress, but it’s the changes to their diet and lifestyle that will help keep them healthy in the long run. After all, supplements don’t get rid of stress, they only help us deal with it better. Which brings me to my next point…

2. When treating stress, you can either reduce the external stress or improve your response to the stress. We all know what causes us stress – our jobs, our family, our partner, our parents, schoolwork, the economy, Christmas shopping, our budget, the government… the list goes on and on. Some of these things we have power over and can change, thus reducing our stress. Other things, we have less power over, and so it falls to us to improve our response to the stresses we face. Used properly, herbs and supplements can help us achieve an improved response to stress, but as I said earlier, these are a means to an end, not an end unto themselves. They may relieve symptoms, but in the long run, cannot achieve the resilient mental attitude that comes from exercise, yoga, meditation, tai chi, or other lifestyle practices.

In managing stress, herbs and supplementation require individualized attention, but the lifestyle factors that can help improve our response to stress are applicable to nearly everyone. These sorts of things include regular exercise (and I’m not talking about triathalons), adequate sleep, a healthy diet, meditation, yoga or tai chi. These practices feed our core so that we are able to deal with stresses from a place of strength, not weakness. Encountering stress from a place of strength allows us to deal with it without allowing it to affect us.

A healthy response to stress also takes some mental work – to deal with stress effectively, I find that a person often has to cultivate a resilient mental attitude. We often hear about a positive mental attitude, and while positive thinking is by all means excellent, I find that people who are very stressed are more helped by adopting a resilient mental attitude – one that allows them to deal with the stress, not let it touch them too strongly and then bounce back. There are a wide variety of books for people to read on the topic of dealing with stress, and people have been writing books on the topic of stress management for millennia, though these books did not always deal explicitly with ‘stress management’. The Tao Te Ching and Bhagavad Gita, for example, deal with the topic of how to act wisely and live happily. Within the context that I am writing, I might say that they teach us how to act effectively to deal with stress, and without letting stresses affect us to strongly. Even The Bible (parts of the Old Testament and especially the New Testament) deals with the eternal conflict of how to deal with the stresses we encounter in life. A spiritual practice of whatever tradition speaks to you can be helpful in developing the resilient mental attitude that serves us in time of stress.

I hope this blog finds you some peace during the holiday stresses. As I said last year, be gentle with yourself. Give yourself the space and time you need, despite the demands that others make on you. Additionally, the lifestyle recommendations I made this year can help keep you healthy and stress-free, not only through the holiday season, but throughout the year. And as always, working with a professional, be it an MD, ND, counselor, psychotherapist, acupuncturist, or psychiatrist can be an important step. Building a therapeutic alliance with another person helps to build core strength and resilience.

Sunday, December 18, 2011

A Solstice Gift

Many of you may be familiar with Gluten-Free Girl and The Chef, a blog devoted to gluten-free cooking, and especially gluten-free baking. Recently, I was searching for a recipe to adapt to making piparkukas, a traditional Latvian Christmas cookie which features a formidable mixture of nine spices that makes even curry look simplistic. The key to piparkukas is that they must be really light and crispy, like a ginger snap, but even more so. As a kid, I would spend hours in the kitchen, baking piparkukas and listening to Christmas music with my mom. Needless to say, the bar was set high as I attempted to recreate them.

Considerable searching yielded this (totally fantastic) recipe. I was amazed to find a gluten-free cookie recipe that was so simple, and yet yielded such fantastic results. The taste and consistency are spot-on - you would never know that these were gluten-free unless someone told you. The recipe calls for the dough to be set in the freezer overnight, so I'm posting this a few days before the Solstice, so that you can have them ready to go on the big day.

Cookies play an integral role in the holiday season, and I ache for all of the kids who can't take part in this essential childhood experience. Not having cookies is like not playing baseball, not losing teeth, or not going to summer camp - it's just part of the package. Hopefully this recipe gives some kids some holiday delight.

And the piparkukas spices... Normally, these things are closely-guarded family secrets, but in the age of the Internet, there are no such things as family secrets. Rather than having you go out trying some of those other recipes, here's mine:

1/2 tsp white pepper
2 tsp cardamom
2 tsp cinnamon
1 tsp cloves
2 tsp coriander
2 tsp ginger
1 tsp allspice
1/2 tsp nutmeg
1/2 tsp mace

The final step to making these authentic piparkukas is to glaze them with egg white and press an almond sliver into the center of each cookie before baking.

Priecigus Ziemassvetkus!

Thursday, December 15, 2011

The Three Most Important Non-Science Classes A Physician Will Ever Take

Recently, I was chatting with a cardiologist of about 30 years experience. He’d lived in Israel for several years, and went to all four years of college there. He considered pursuing his MD at an Israeli medical school, but through circumstance, he ended up back in the US. In the course of our discussion, he mentioned that Israel follows a European model for medical education, one which features a truncated pre-med program consisting solely of science classes, rather than a four-year college education which balances the sciences and humanities. We agreed that while the sciences comprise the core of a pre-med education, the education shouldn’t start and end there. This week I’m devoting my column to three non-science courses that every physician should take.

Contrary to the opinion of some, a physician is not merely a scientist. A physician is a scientist who communicates that information to his or her patients, relates it to the life they live, and tries to help them put it in context. While this a role well-known to pediatricians, primary care docs, naturopathic doctors, and other healthcare providers who work in a primary care environment, this is equally important for surgeons and other specialists. The ability to communicate to a patient about their health is especially important when that patient’s health is in acute distress.

Last year, the New York Times ran an article about a program run by Mount Sinai School of Medical, the Humanities and Medicine Program, which accepts a small number of students every year who have not taken some of the traditional pre-requisite classes (physics and organic chemistry) nor taken the dreaded MCAT exam. Instead, students are encouraged to major in a humanities subject of their choice, and so long as they maintain a high GPA, they matriculate along with all of the other students. While I myself believe in the value of physics and organic chemistry, I like the fact that this program encourages study in the humanities. A well-rounded education creates a well-rounded doctor, and with that, here’s my list of the three humanities classes that every physician should take.

A Literature Class – The poet in me sometimes likes to say that a physician must deeply feel and understand the human condition. While this is perhaps more poetry than practice, it is absolutely true that a doctor has to understand the character of the patient who comes to see him/her. It’s important to be able to anticipate the emotional or mental needs of our patients, so that we can communicate in ways that are appropriate to our patients’ needs. Good literature, especially but not exclusively good modern literature, explores human needs, motivations and behaviors in a profound way that educates us about the people around us. In our culture, we rarely give each other true insight into our inner lives, but books thrive on this. A well-read doctor reads and learns, and then understands his patients better, being able to both relate compassionately and cater individually.

A History, Anthropology or Sociology Class – In the same way that a patient doesn’t start and end at an injured body part, a patient extends beyond the individual person who presents in the exam room. A patient’s health is determined by a whole host of factors in the world around them, including their work, their home environment, their ethnicity, their economic status, and their culture – in short, their place in the world around them. These factors play important roles in an individual’s health by influencing factors such as their diet and ability to access healthcare, and yet they are rarely discussed in biology, chemistry or other pre-med science classes. A well-rounded education, in which the student learns about the individual’s place in the broader world helps that future physician to understand what factors may be influencing a patient’s health, and to make recommendations that fit within that patient’s real-life experience.

A Foreign Language – As I said earlier, a physician is not merely a scientist, but a communicator. Learning a foreign language has important philosophical and practical value for a physician. On the one hand, a doctor should have a broad mind and flexible way of thinking, two attributes that come with studying a foreign language and the culture that created it. On the other hand, in a multicultural society such as the United States, it is increasingly important that a physician be able to speak a second language in order to serve his or her community. Certain languages thrive in certain parts of the United States (such as French, German, Chinese, Vietnamese, and others), but Spanish in particular is now becoming a clinically important language, with at least 10% of American families primarily speaking Spanish at home. Speaking a patient’s native language allows for better communication, not only by allowing the patient to better describe their situation, but also by giving them the confidence and comfort of knowing that they are being understood.

Being a physician is not merely being a scientist. Being a physician is being a translator, an intermediary between the concepts of science and the human experience. In order to fulfill that role successfully, a physician has to have a strong grasp of the world beyond the sciences, and so these courses must be a part of his or her education. A physician needs to understand his or her patients’ inner life and character, the social forces that affect them, and needs to be able to communicate to them in a language they understand. As I said earlier, a well-rounded education creates a well-rounded physician, and a better servant of his or her community.

Tuesday, December 13, 2011

Watch This Video And Then Go For A Walk

For the most part, this blog is a once-a-week affair written by yours truly. However, this week, in addition to my usual, weekly blog entry, I'm including a presentation made by someone else. This video is a great presentation of a simple message, and one that is echoed in this post I wrote about living longer, and this post about exercise. My colleague Dr Liz Kaltman, ND brought it to my attention. Take the next ten minutes out of your day to watch this video by Dr Mike Evans, MD and then go out for a walk.

Friday, December 9, 2011

Lowering Your Cholesterol Using Supplements Part 2

Welcome to Part 2 of this blog entry. As I said last time, the point of this blog is never to take the place of professional medical advice – if anything, it’s to encourage you to seek out a medical professional to work with. High cholesterol, like high blood pressure, is a chronic complaint that needs professional monitoring. And of course, like any long-term project, don’t try to do it all yourself – a professional healthcare provider can help you chart a course and guide you along the way, redirecting you where it’s necessary and praising your success when you get it right.

Another reason to work with a provider (like a naturopathic physician) that sort of came up yesterday, but will come up even more so today, is this: garlic is not garlic is not garlic. What do I mean by this? I mean that quality and potency of supplements can vary considerably, not to mention that preparation methods of various supplements dictate their effects. As a result, it's important to work with a practitioner who has done his or her homework regarding supplements.

OK, and now on to the meat of the article. (Here’s that cholesterol labs cheat sheet in case you need it)

Garlic – Why not start with garlic, having mentioned it so recently? Garlic has long been promoted as a cholesterol-lowering treatment, but the jury is still out on whether or not it’s effective. Some studies have shown significant cholesterol-lowering effect from certain garlic preparations, (1, 2, 3, 4) and at least one has shown that a preparation of garlic slows coronary artery disease. Other studies and meta-analyses (analyses which collect data from multiple separate studies) have shown no effect on cholesterol (1, 2, 3). As I said earlier, the jury is still out on garlic. One of the confounding issues in this discussion is the fact that there are a wide variety of garlic preparations being used in these studies, some of which appear to work, others of which appear not to do so – thus when taken all together, the data is inconclusive. Garlic still deserves an important place on your table as a ‘functional food’, but don’t rely on it exclusively to lower your cholesterol.

Niacin – Niacin has been used to lower cholesterol since at least the 1950’s, both by mainstream doctors as well as integrative ones. Its true claim to fame is that it has been shown to raise HDL significantly, an effect that statin drugs are not capable of producing. Niacin comes in a variety of forms – in the form of nicotinic acid, its ability to improve blood levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides is formidable to say the least. A therapeutic dose of niacin can reduce LDL by as much as 22%, total cholesterol by as much as 16%, triglycerides by as much as 44%, all while boosting HDL by as much as 35%. But as with many good things in the world, there is a down side, namely the ‘niacin flush’. Doses of niacin high enough to have therapeutic effect inevitably cause flushing of the skin, accompanied by intense itching. On the plus side, many people are able to adapt to the sensation, or are able to time their doses such that they don’t interfere with daily living.

Niacin has lately received a lot of attention from the conventional medical community for a few reasons. One is the development of a prescription form of niacin (Niaspan) with a fairly low incidence of flushing side effects. Second is an increased interest from cardiologists in being able to increase HDL cholesterol because of HDL’s protective effect. Prescription niacin has been shown to reduce LDL cholesterol both alone and in concert with statin medications, though only niacin has the added benefit of raising HDL. At the beginning of the article, I recommended working with a healthcare provider when addressing cholesterol. This is especially important with niacin – it’s effective, but don’t try this at home folks. Make sure you have a doctor on board. And of course, the recently-developed prescription niacin (Niaspan) is only available by prescription.

Red Yeast Rice – Last but not least, red yeast rice. I’m often asked what red yeast rice is made from – red yeast rice is rice that has been fermented with the Monascus purpureus fungus for use in traditional Chinese foods and medicine. More recently, however, it was discovered that this fermented rice contained naturally occurring statins, a class of medication used to lower both total cholesterol and LDL cholesterol. Since this discovery, red yeast rice has gained popularity as a treatment for lowering cholesterol levels, but it’s not been without controversy. Because red yeast rice contains a compound, monacolin K, which is identical to lovastatin, there was an effort by the FDA in the late 1990s to ban red yeast rice in the United States. Most companies voluntarily withdrew the product from store shelves.

Since then, however, red yeast rice has begun reappearing on the market as a dietary supplement. In some cases, red yeast rice is now being embraced by conventional medical doctors, who are now recommending it to a newly defined class of ‘statin-intolerant’ patients, patients with high cholesterol who were started on statin medications, but were unable to follow a full course of medications because they suffered side effects. Recent studies have shown that certain red yeast rice preparations have significant cholesterol-lowering effects, in some cases comparable to statin medications, and are more easily tolerated by patients, even those who were previously unable to tolerate the side effects of statin medications (1, 2). Additionally, data has recently shown that red yeast rice extracts prevent serious cardiovascular events comparably to statins. The quality of commercial preparations of red yeast rice remains mixed, so it’s important to work with a professional who has done his or her homework in finding a high quality product. The take home message is that certain red yeast rice products are as effective as statins in lowering cholesterol and preventing disease, though this shouldn’t be a surprise, as red yeast rice contains naturally-occuring statins.

I hope you’ve enjoyed my review of supplements and cholesterol. As I said at the beginning of the article, lowering your cholesterol isn’t something that you should do alone – work with a practitioner. However, being equipped with information is important to getting the best outcome. As I said in last week’s entry, sometimes medication is the best route to take, but never is it the one and only answer. Through diet and exercise, as well as the use of some supplements, many people can limit their need for or dose of medications.

Thursday, December 8, 2011

Lowering Your Cholesterol Using Supplements, Part 1

After last week’s blog entry about lowering cholesterol through diet and exercise, a fellow naturopathic physician, Dr. Melanie Trowbridge, emailed me asking about the supplement side of lowering cholesterol. I mentioned it last week, but it really warrants a longer discussion. So long, in fact, that I’m going to have to split it up into two entries to cover everything!

There are a number of supplements out there that claim to lower cholesterol, and it can be hard for consumers and practitioners to assess what does and doesn’t work. I’ve searched the medical literature to try to generate an accurate picture of what’s effective, and what to expect from these supplements.

At the risk of sounding like a lawyer, I’m going to state here that by no means is this meant to constitute medical advice or otherwise take the place of a consult with a healthcare provider. Unlike, say, seasonal allergies, you can’t tell if your cholesterol is improving unless you have it tested by a healthcare provider – this is part of the importance of working with someone. Additionally, high cholesterol is a chronic condition that requires long-term work. Don’t go it alone. Get some assistance along the way, someone who can assess your current situation, help you set goals, figure out a plan to reach those goals, and help you weather the inevitable challenges. I'd be remiss if I didn't mention the AANP's Find a Naturopathic Doctor Service here.

One last thing before we dive in – here’s an entry I wrote on understanding cholesterol/lipid lab tests, just in case you need a refresher as we go.

Plant sterols (including beta-sitosterol) – I’m including this first because plant sterols are actually recommended by the ATP III as a way to lower cholesterol. So what are they? Plant sterols are molecules found in fruits and vegetables that resemble cholesterol, but are not used by the human body in the same way as cholesterol, and don’t appear to have the same harmful effects. They act by competing with cholesterol for absorption in the small intestine, thus reducing the amount of dietary cholesterol absorbed into the blood. They have been documented to reduce cholesterol, LDL cholesterol and triglycerides, in a manner that appears to be dose-dependent; moderate doses produce a 10-14% reduction in LDL cholesterol, whereas higher doses can generate larger reductions in LDL cholesterol. In addition to lowering cholesterol in therapeutic doses, amounts of sterols that occur naturally in food appear to have a protective effect, helping to keep cholesterol in a healthy range. Plant sterols generally appear to be safe, though at least one study I read suggests potential side effects, which have yet to be fully described and documented – all that much more reason to work with a professional.

Green tea – Regular readers of this blog will know how much I love tea – it’s healthy, it’s delicious, and it’s endlessly varied. So what about cholesterol and green tea? A few studies I found demonstrated that either green tea or a green tea extract lead to a mild decrease in total cholesterol and LDL cholesterol (1, 2, 3), though at least one other found no benefit. The decrease is mild, less than 10% change in total cholesterol or LDL cholesterol. For some, this might be enough to bring their cholesterol into a healthy range, though for many, this change is too little to control cholesterol adequately. What sets green tea apart from the other supplements I’m discussing today is that it has been demonstrated to reduce LDL oxidation (1, 2). Here’s why this is important: While doctors generally test total LDL to assess a patient’s cardiovascular risk factors, it’s becoming more and more clear that it’s oxidized (damaged) LDL that accumulates in artery walls, forming plaques and obstructing blood flow – this is part of the reason that smoking is so bad for you. Thus, while green tea’s ability to lower cholesterol is only moderate, it has the ability to prevent that cholesterol from becoming a potently harmful form of cholesterol.

Fish oil – Omega-3 fatty acids, like those found in fish oil, have received a lot of attention recently for their cardiovascular benefits. So what does the data say? Well, my research into the topic is by no means exhaustive, but clear trends started to emerge fairly quickly. According to the studies and reviews available, fish oils either have no effect on cholesterol levels, or slightly raise them – across the board, including total cholesterol, LDL cholesterol and HDL cholesterol (1, 2, 3). So how do we reconcile this? Isn’t fish oil supposed to be good for your heart?

The answer is yes, fish oil is good for your heart, and without going into a full discussion of fatty acid metabolism and transport, I should point out that there is good news buried in this elevation of cholesterol. Firstly, HDL cholesterol is ‘good cholesterol’, and the fact that it fish oil increases it is good news. Secondly, though fish oils apparently raise blood levels of LDL cholesterol, it has been observed in some studies that the size and shape of LDL is modified towards less disease-causing forms, (1, 2) though this was not universally observed (1, 2). Additionally, there is reason to believe that the slight increase in LDL levels is linked to a significant decrease in VLDL levels (1, 2). Like with green tea, the emphasis is not on the change in the LDL levels, but rather on the health of those LDL molecules – green tea makes the LDL less oxidized/damaged, and fish oil makes the LDL larger, more buoyant, and less likely to cause damage to arteries.

In assessing fish oil, we should also remember that cardiovascular disease isn’t all about cholesterol. Several studies have demonstrated that fish oil has a significant protective effect when it comes to cardiovascular disease itself, including angina, stroke, heart attacks and other disease. A large Italian study in the 1990s showed that fish oil given to heart attack survivors significantly reduced their chance of having another heart attack, having a stroke, or dying from other causes. A similarly large Japanese study found that patients with high cholesterol taking EPA (an omega-3 fatty acid found in fish oil) in addition to statin medications had a significant reduction in non-fatal heart problems compared to patients on statins alone, though LDL levels did not significantly differ between the groups.

The take-home message is this: fish oil may not lower cholesterol, but it is clearly good for your heart. Fish oil is one of the few supplements I recommend to nearly all of my patients. But for those of you out there who have taken it and not seen a lowering of cholesterol levels, this may go some of the way to explanation. Even so, it’s still good for you!

Phew! I think that’s enough for the day. Tune in again next time for Part 2, which will feature discussion of garlic, niacin and red yeast rice.

Thursday, December 1, 2011

Lowering Your Cholesterol Through Diet and Lifestyle

It’s no secret that one of my main passions in life is preventing disease through natural management of cholesterol and blood pressure. Nerdy I may be, but I’ve written in the past about how to interpret your cholesterol labs and how to lower your blood pressure through diet and exercise, and will continue to do so in the future. The evidence is clear that eating a healthy diet and pursuing a healthy lifestyle works not only to prevent but also treat high blood pressure and high cholesterol, so it’s probably about time that I devoted a weekly blog to the cholesterol side of the story. (If at any point you need a refresher, here’s an explanation of LDL, HDL, Cholesterol and all the rest.)

The ATP III was published by the NIH in 2004 to be a guide for clinicians to diagnose, evaluate and treat high cholesterol in adults. Like the JNC 7, which I blogged about a few months ago, the proposed guidelines include recommendations for treatment using diet, lifestyle, and pharmaceuticals. While the ATP III focuses heavily on pharmaceuticals, it makes strong recommendations for lifestyle changes, or as it refers to them, TLC (Therapeutic Lifestyle Changes). Unsurprisingly, these lifestyle recommendations look remarkably similar to the ones suggested to lower blood pressure.

Eat less saturated fat. There’s a longstanding rumor out there that cholesterol in foods causes high blood levels of cholesterol, a rumor that lays a lot of blame on eggs in particular. The truth of the matter is that saturated fat plays a much more important role in causing high cholesterol, as it stimulates the body to raise blood levels of cholesterol, especially LDL (“bad cholesterol”). As a result, it’s much more important to avoid saturated fat than cholesterol in your diet.

To help decrease your cholesterol levels and prevent future disease, the ATP III recommends that fewer than 7% of your calories for the day come from saturated fat. As a practicing physician, I know that this number means very little to most people, and even I can’t tell you what percentage of my daily calories come from saturated fat, so here are clearer instructions. Most if not all saturated fat comes from animal sources, like milk and meat, so to limit your saturated fat, limit your intake of animal-source foods, and choose low fat options, like fish, lean poultry or game. Also note that individual people vary in their individual dietary needs, so discussing your diet with a doctor or other healthcare professional can help you to assess your current situation, set goals for the future, and work out a plan for getting there.

Get more fiber in your diet. When I was in naturopathic school, we had to learn the details of the many ways that dietary fiber reduces cholesterol, an activity that many of my colleagues worked into mnemonics, songs, and other memory aids. I don’t have any songs to share with you, but I can tell you the most important part of the story – dietary fiber helps the body rid itself of excess cholesterol.

Without going into all of the gory details, here’s how it works: The body releases cholesterol into the digestive system every day as part of the digestive process. When there is fiber present in the digestive tract, it picks up that cholesterol and carries it out of the body as part of normal elimination. If there is not adequate fiber in the digestive tract, however, it is reabsorbed into the blood stream and continues to circulate, thus keeping cholesterol levels high. Here too, we have some numbers from the ATP III, which recommends 10-25 grams of fiber a day. While this can be a little easier to figure out, I always find that making recommendations about the food you eat is more helpful than number crunching. Fiber primarily comes from fruit, vegetables, legumes and grains, so boosting these will boost your fiber intake. While all of these plant-based foods are good sources of fiber, I especially recommend beans, lentils, and other legumes, as their fiber content far outpaces that of even high-fiber veggies like cabbage and broccoli.

Get regular exercise. Regular exercise helps with a number of things, including weight loss, stress management, blood pressure and cancer prevention, so it’s no shock that it helps with cholesterol too. Importantly, regular exercise not only lowers LDL (“bad cholesterol”), it raises HDL (“good cholesterol”). While the exact mechanism by which this occurs is not fully understood, it is currently believed that at least part of the action is by encouraging the LDL cholesterol to be taken out of circulation by the liver, and put into the digestive tract for elimination. The ability to raise HDL is very important, as there are no drugs currently available that raise HDL, and HDL exerts a strongly protective action on the cardiovascular system. For further reading on what ‘counts’ as exercise, and how much to get, read this blog which I wrote a few months ago. The most important thing about exercise is to get out there and start moving – many Americans lead very sedentary lives, and it’s important to note that even some exercise is better than none.

Watch your weight. If you follow the above recommendations, it should help you lose weight. That said, weight loss is a challenge to most people who attempt it. Because the benefits of maintaining a healthy weight are so great (including lowering blood cholesterol levels), it’s important to commit to weight loss, and for most people, that means getting some assistance from a healthcare professional, personal trainer, or other provider. Weight loss, even when it proceeds steadily, rarely happens quickly, and so it’s important to build a therapeutic alliance in order to help you stay committed and persevere through the inevitable challenges.

Let me close by saying that, naturopathic physician or not, I believe that medications are sometimes necessary to help reduce the risk of future disease. However, medications are never the only answer. Some people are able to bring their cholesterol into a healthy range through diet and exercise alone, some through diet and supplements, some through a combination of diet, exercise and medications. In my practice, I find that many people are able to limit the number and dose of medications they require through diet and exercise. Not only is this a more sustainable and effective treatment, but being able to take control of one’s health also empowers people in a way that medications cannot, and will never be able to.