This column is the third in a series on heart disease – the number one cause of death among both men and women in the US and a leading cause of disability. Nearly all heart attacks are preventable, and in February (“heart month”), Compass Peak Imaging in Glenwood is offering a reduced price for FDA-cleared heart disease screening, using carotid IMT. There will also be a powerpoint presentation on preventing heart attacks on February 15 at 7 p.m. at the Third Street Center in Carbondale.
Cholesterol is important in the formation of bile acids and some hormones, and is a component of cell membranes. It is synthesized by cells throughout the body, but mainly by liver cells. Some also come from dietary sources. While cholesterol is necessary for human life, high levels can cause gallstones and hardening of the arteries (atherosclerosis) – the cause of heart attacks, strokes and several other problems.
A “cholesterol test” (also known as a “lipid test”) includes the level of total cholesterol; HDL (good cholesterol); LDL (bad cholesterol) and triglycerides. Think of your LDL as waste in your arteries, so if you have too much waste, you have a problem with your arteries. Think of HDL as garbage trucks, so you also have a problem if you don’t have enough garbage trucks.
There are caveats to HDL, because some people have low garbage truck counts (low HDL), but those who have them are supercharged, and these people have normal arteries. Other people have a lot of garbage trucks (high HDL), but their garbage trucks are dysfunctional and cause rather than prevent disease.
There are also some caveats to LDL:
1. The number of LDL particles is more meaningful than the commonly measured level of LDL;
2. There is a particularly harmful form of LDL called Lp(a) (called “LP little a”) that is often present in families with many early heart disease;
3. The size of LDL particles matters – small, dense, BB-like LDL particles are particularly harmful compared to large, fluffy, ping pong-like particles. Blood tests that measure these things are cheap, but often not done.
National cholesterol guidelines specify that ideal lipid levels are: total cholesterol less than 200; HDL greater than 40 in men and postmenopausal women, greater than 50 in premenopausal women; LDL less than 100 and less than 70 in people with a history of heart attack, stroke, or diabetes; triglycerides less than 150.
However, half of people with heart attacks and strokes meet these guidelines. Heart attack prevention doctors believe that since 20% of heart attack victims die, atherosclerosis in a patient can be demonstrated by tests such as a coronary calcium score (CT scan of the heart) or carotid IMT (ultrasound of the carotid arteries). ). in the neck), LDL should be less than 70.
Plant-based providers believe that normal lipid levels should be seen in people who never develop atherosclerosis and who are therefore heart attack resistant, such as people in the Blue Zones. These people have a total cholesterol level of less than 150; LDLs in the 30s and 40s; and triglycerides less than 70.
All animal products, especially eggs and also seafood, contain cholesterol, so to achieve optimal cholesterol levels, these foods should be avoided. In addition, the saturated fat present in all animal products, in palm and coconut products and in vegetable oils causes the liver to produce more LDL. More than 30 years ago, Dr. Dean Ornish that heart disease can not only be prevented, but also reversed with a whole plant-based diet with no salt, sugar or added oil. This diet is also one of the few things that lowers Lp(a).
Plant foods that are especially good at lowering cholesterol include high-fiber fruits and vegetables; legumes; unprocessed grains; and ground linseed. The following herbs and spices also lower cholesterol: Amla (1/2 teaspoon powder daily, which also lowers Lp(a)); and ground black cumin 1/4 teaspoon per day. Red yeast rice contains a weak, natural statin that lowers cholesterol. little, but being a supplement is not regulated, so you’re not sure what you’re getting.
Diet always helps to lower lipid levels in everyone, but for genetic reasons, in some people diet is not enough to achieve ideal lipid levels because their liver produces too much LDL no matter what they eat. Medications are available for these people, and for people who don’t want to change their diet: statins prevent the liver from making so much cholesterol; ezetimibe prevents absorption of cholesterol; and for people who can’t tolerate statins, there are the newer but more expensive PCSK9 inhibitors, which are given by injection every two to four weeks.
Atherosclerosis can begin in childhood, and the National Heart, Lung, and Blood Institute recommends that all children have cholesterol screening between ages 9 and 11, and again between ages 17 and 21. Obese children, children with a family history of very high cholesterol (called familial hyperlipidemia), and children with a family history of early heart disease are advised to get screened earlier than age 9. Adults should have their cholesterol checked every five years starting at age 20 — more often if their lipids are abnormal. Eating prior to a cholesterol test results in higher triglyceride levels, so heart attack prevention doctors recommend fasting (water only) for at least six hours before drawing blood to check lipids.
Dr. Feinsinger is a retired family physician with a special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: hour-long consultations, shopping with a doctor at Carbondale City Market, and cooking classes. Call 970-379-5718 for an appointment or email [email protected]
Dr. Feinsinger is a retired family physician with a special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: hour-long consultations, shopping with a doctor at Carbondale City Market, and cooking classes. Call 970-379-5718 for an appointment or email [email protected].