Some people are reluctant to take statins even though their cholesterol is running high. This article discusses ways to reduce the risk of high cholesterol but is not a comment on the wisdom of taking or not taking statins.
Cholesterol is used to make steroid hormones (estrogen, testosterone, aldosterone, cortisol, vitamin D and more) and to make bile that is needed to digest fats in our diet. Cholesterol is incorporated into
cell membranes to maintain stability. It is an important and essential fat but, in excess, cholesterol can end up deposited on blood vessel walls eventually leading to heart attacks and stroke. LDL carries cholesterol out to the cells, HDL brings back excess or oxidized cholesterol, preventing plaque build up. High cholesterol and LDL and/or low HDL are used to evaluate the risk of heart disease and stroke.
So what is considered high? Cholesterol levels over 240 are high; ideally they should be under 200. LDL levels over 160 are considered high, levels under 100 as optimal. HDL should be over 60 with levels under 40 considered too low.
Interestingly despite the focus on these numbers, neither high cholesterol nor high LDL is actually all that predictive of risk. “It is clear that heart disease occurs in a substantial number of people with normal cholesterol levels” and “some people with very high LDL do not develop heart disease, while some with very low LDL do.” In fact, high triglycerides (another important fat) can cause more problems than high cholesterol, so track that value as well. Triglyceride levels are best kept be under 150. The HDL:LDL ratio is useful at assessing risk but is still not the best test. Instead, anyone with high cholesterol should get a highly sensitive C-reactive protein test (hs-CRP). CRP measures inflammation and if inflammation is low, there is a low risk of heart problems even when cholesterol runs high.
Vitamin D, B6, folate, and B12 levels are also important. Vitamin D helps lower LDL and triglycerides, and also helps prevent plaque build up. Some MDs simply assume our D levels are low and recommend supplements instead of testing. That approach, however, ignores that occasionally unusually high doses of supplemental D are needed to raise blood levels and it is important to know if you fall into that category. Suboptimal B6, folate, and/or B12 levels tend to raise homocysteine levels, another risk factor for heart disease and stroke.
If any of your blood fats are off, whether taking a statin or not, you should use diet to protect your heart.
Added sugars, and especially added fructose, need to be eliminated. Many scientists think that sugars are a bigger player in heart disease than saturated animal fats. “A diet high in added sugars has been found to cause a 3-fold increased risk of death due to heart disease.” So be vigilant about avoiding sugars not just in sweets but also in salad dressings, mayos, sauces, mustards, breads, etc., a challenge if you eat out a lot but well worth the effort. Anything with added fructose must go. This means none of those “healthy, natural sweeteners” (e.g. agave nectar, coconut sugar, yacon syrup) so often used as a white sugar substitute in health food. Excess fructose leads to high triglyceride levels, a real problem for the heart, as noted above. This does not mean you need to quit eating fruit but fruit should not dominate your diet and you should avoid juices and smoothies that entice you to consume more fructose than is good for you.
Dietary cholesterol from moderate amounts of good quality animal products actually is not a big problem but trans fats definitely are. While not frequently discussed, there is NO safe amount of trans fats. This means you should avoid all deodorized, refined oils. All “high-heat” cooking oils, from canola to high oleic oils, contain trans fats. Make a habit of using extra virgin olive oil instead. Olive oil is trans fat free and contains antioxidants and plant sterols that are heart healthy.
Enjoy nuts! Tree nuts have been shown to lower cholesterol, LDL, and triglycerides. In one study, replacing three meals of red meat, processed meat, or eggs a week with tree nuts lowered CRP and risk of heart problems. The type of nut does not matter but the amount does. At least 2 ounces of nuts a day produced the best results. This is not a huge amount of nuts: Two breakfast muffins and a handful of cashews provides that amount. A proportionate diet filled with lots of leafy greens, nuts, seeds, and legumes will provide both fiber and needed minerals, such as magnesium. Currently, some 60% of Americans are lack sufficient magnesium. Inadequate magnesium linked to atherosclerosis, heart attacks, arrhythmias, and stroke.
If you are following the TQI Diet yet continue to have high CRP, LDL, and/or triglycerides, you should test for food sensitivities. I have had students on the TQI Diet eat eggs daily yet lower their cholesterol enough to be taken off statins. But egg and nut sensitivities are common, and if those foods trigger inflammation in your body, they will stall your progress. Do remember, any food can be a trigger food so if you, for instance, eat a lot of garlic for heart health but are not seeing improvement, you should test the garlic family. To test, while on the elimination phase, remove the potential trouble food for no less than a week and then add it back over two days to see how your body reacts to that food.
For most, however, simply eating proportionately, avoiding all bad fats and sugars, while eating more nuts and legumes than animal products is all that is needed to reduce your risk of a heart attack or stroke by some 80%!
Picture: C-reactive protein by Astrojan
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