1. FAMILY HOME REMEDIES By Nadeem Y. MuftiHIGH BLOOD CHOLESTEROL - 21 Heart-Healthy Ways to Lower It Heart attacks are the leading cause of death in the United States. In 1989 alone, says theAmerican Heart Association (AHA), heart attacks claimed the lives of 497,850 Americanmen and women. What causes a heart attack? In most cases, an attack occurs when theblood supply to part of the heart muscle is severely reduced or stopped, according to theAHA. This stoppage is caused when one of the arteries that supply blood to the heart isobstructed, usually by the fatty plaques that characterize atherosclerosis, a result ofcoronary-artery disease. Although its not clear where the plaques come from in eachindividual case, the most common causes are a blood cholesterol level thats too high, ahereditary tendency to develop atherosclerosis, and increasing age (55 percent of all heartattack victims are 65 or older, 45 percent are under 65 years of age, and 5 percent areunder 40). Other factors that contribute to the likelihood that heart disease will developare cigarette smoking, high blood pressure, and male sex (although after menopause, awomans risk rises to almost equal that of a man), according to the AHA. You cantchange your age, your gender, or your genes, but you can make positive lifestyle changesthat can sharply reduce your risk of developing heart disease. Getting your bloodcholesterol down to a level thats considered low risk (see Extra! Extra! - "Low,Borderline, High--What Do the Numbers Mean?") is an important first step. Thefollowing tips are designed to help you take that step.Adopt a new lifestyle. Making acommitment to lowering blood cholesterol and improving your heart health requires achange of mind-set, not a temporary fad diet, according to Henry Blackburn, M.D., MayoProfessor of Public Health and a professor of medicine at the University of Minnesota inMinneapolis. "You need to adopt a healthy lifestyle, a familywide lifestyle," he says."Even if one member of your family has a low risk of developing heart disease, thatdoesnt mean his or her risk will stay low. Our risk rises as we get older, and it takes alifetime to establish good habits." Lifetime good habits also mean avoiding "yo-yo"dieting--losing weight and gaining it back repeatedly. Yo-yo dieting has been shown tocause cholesterol levels to rise. Know its never too early to act. Although much of theemphasis on heart disease risk is placed on people with a total blood cholesterol levelover 240, the numbers can be a bit misleading, says William P. Castelli, M.D., director ofthe Framingham Heart Study in Massachusetts, the oldest and largest heart disease studyin the United States. "Most heart attacks occur in people with a total cholesterol levelbetween 150 and 250," he says. "Many doctors dont understand that. That group up at thetop, the highest-risk group (with cholesterol levels above 240), only produces about 20percent of the heart attacks." Even if youre in a low or borderline group, you still need topay attention to your lifestyle habits, he advises.Ignore the magic bullets. This week itsrice bran, last week it was oat bran and fish oil. All were touted as the solution to yourcholesterol problem. While its the American way to search for shortcuts, such anapproach just doesnt cut it when youre dealing with your health, according to Basil M.Rifkind, M.D., F.C.R.P., chief of the Lipid Metabolism and Atherogenesis Branch at theNational Heart, Lung, and Blood Institute in Bethesda, Maryland. "We are very
2. cautionary about these magic-bullet remedies," he says. "If someones cholesterol is high,we know that it comes about by eating a bunch of foods that are higher than the optimumin fat and cholesterol. We need to address the source of the problem, instead of payingattention to garlic, fiber, or fish oil."Stay away from saturated fats. Many people makethe mistake of believing that if their blood cholesterol level is high that its because theyate too many foods containing cholesterol. Not exactly true, says W. Virgil Brown, M.D.,past president of the AHA and professor of medicine and director of the Division ofArteriosclerosis and Lipid Metabolism at Emory University School of Medicine inAtlanta. The number-one cause of high serum cholesterol is eating too much saturatedfat, the kind of fat that is found in full-fat dairy products and animal fat, he says. Anotherculprit is partially hydrogenated vegetable oil, which contains trans fatty acids,substances that increase the cholesterol-raising properties of a fat. The best rule of thumbis to stick with fats that are as liquid as possible at room temperature, according toBrown. "For example," he says, "if you are going to use margarine, use the most-liquidkinds, such as the tubs or squeeze bottles."Read your meat. The small orange labels stuckto packages of meat at the grocery store arent advertisements or promotions; theyreactually grades of meat, says Castelli. "Prime," "Choice," and "Select" are official U.S.Department of Agriculture shorthand for "fatty," "less fatty," and "lean," he explains."Prime is about 40 percent to 45 percent fat by weight, Choice is from 30 percent to 40percent fat, and Select, or diet lean, is from 15 percent to 20 percent fat," he says. Youcould have a hamburger made from Select ground beef for breakfast, lunch, and dinnerand still not exceed your daily saturated fat limit, he adds.Learn to count grams of fat.The AHAs dietary guidelines outline the percentages of daily calories that should comefrom fat (see Extra! Extra! - "The American Heart Association Diet"). However, sincemost package labels show grams of fat, not percentages, it can be difficult to figure outexactly what youre eating, Castelli says. Instead, he recommends counting grams of fat.How many grams of fat, and how many grams of saturated fat, can you have each day?Multiply your total number of calories per day by .30, then divide by 9 to find the numberof grams of total fat allowed. (You divide by 9 because each gram of fat provides 9calories.) Multiply your total number of calories per day by .10 and divide by 9 to findthe number of grams of saturated fat allowed each day. "If youre on a 2,000-calorie-per-day diet, you should eat no more than 22 grams of saturated fat a day," Castelli says."The average American eats twice as much." What can you eat for 22 grams of fat? Oneserving of Choice beef contains from 12 to 15 grams of fat, whereas a serving of Selectcontains 4 to 10. One tablespoon of butter is just under seven grams, while many brandsof low-fat margarine contain only one gram per tablespoon. Whole milk has a whoppingfive grams per cup; skim milk just one. You add it up. After all, if you choose the lower-fat versions of each item, maybe youll have enough saturated fat calories left in yourdaily budget to indulge in some low-fat frozen yogurt, a cup of which may contain aslittle as two grams of saturated fat.Go to the extreme. Although the AHA recommendsderiving 30 percent or fewer of your daily calories from fat, some heart specialistsbelieve its not only safer, but better, to go even lower than that. (The average Americanderives about 37 percent to 40 percent of his or her calories from fat.) "Its quiteappropriate for a person with a high degree of risk for heart disease to go to these sort ofextremes," says Blackburn. "That means reducing fats way down. You can go down evento five percent of your calories from fat without hurting yourself. Weve examined
3. populations in Japan who consume 9 percent to 12 percent of their calories from fat andthey are perfectly healthy and have very low cholesterol. Its worth the effort."Eat asmuch like a vegetarian as possible. Dietary cholesterol is found only in animal products;animal products also tend to be higher in fat (skim-milk products are exceptions),especially saturated fat. Foods derived from plant sources, on the other hand, contain nocholesterol and tend to be lower in fat. The fats they do contain tend to bepolyunsaturated and monounsaturated, which are healthier than the saturated kind, saysPeter F. Cohn, M.D., chief of cardiology at the State University of New York at StonyBrook. (The exceptions are coconut oil, palm oil, palm kernel oil, and partiallyhydrogenated oils, which contain higher amounts of saturated fatty acids.) Youll bedoing your arteries a favor if you increase your intake of vegetable proteins, such asbeans, whole grains, and tofu, and keep servings of high-fat animal products to aminimum.Increase your carbohydrate intake. Adding extra servings of complexcarbohydrates into your diet will fill you up and make you feel more satisfied, leavingless room for fatty meats and desserts, says Cohn. Complex carbohydrates include fruits,vegetables, pasta, whole grains, and rice.Grill it. Grilling, broiling, and steaming areheart-smart ways to cook food, says Brown. Unlike frying, they require no added fat.Skina (dead) chicken. The skin of chicken (and turkey, too, for that matter), is an absolute"no-no" for people who are watching their fat intake, according to Cohn. The skincontains high amounts of saturated fat, he says.Skip the pastry. One hidden source ofsaturated fat is pastry--donuts, Danishes, piecrust, clairs, and so on, says Brown. Theseconfections are often made with shortening or butter--two things that should be limitedby people who are working to reduce their saturated fat intake. Stick with whole-grainbread and rolls, and read labels to be sure you know whats in the package, hesuggests.Eat fish. Fish oil, as a cholesterol reducer, has gotten a lot of play in the mediain the past few years. And it is true that the slimy stuff contains high levels of omega-3fatty acids, substances that have been associated with lower cholesterol levels, accordingto Blackburn. However, the greatest benefit has been achieved in people who frequentlysubstitute their intake of higher-fat meats with fish. Also, fish oil itself tends to be high infat, Blackburn says. His advice is to add more servings of fish into the diet (as substitutesfor some of the meat dishes) and reap the oils benefits naturally.Go easy on yolks. Youcan have all the eggs you like, as long as you leave the yolks behind. Egg yolks are morethan 50 percent fat and also contain high amounts of cholesterol. Egg yolks may also behidden inside processed foods, so be sure to read labels carefully. The AHA recommendslimiting egg yolks to no more than three per week, including those found in processedfoods or used in cooking.Eat smaller meat portions. One way to cut down on saturated fatwithout giving up steaks is to keep your portions small, says Brown. "Reduce the size ofthe meat portions, even chicken, to about three ounces per serving," he advises. "Try tohave a vegetarian lunch. Then you can have six ounces at dinner." A three-ounce servingis about the size of a deck of cards, Brown says.Give up organ meats. Like eggs, organmeats are something best left behind as a memory of foods gone by, says Brown.Although rich in iron and protein, these meats are also tremendously high in fat andcholesterol. And remember--pat is made from liver, so it, too, should berestricted.Increase your fiber intake. Soluble fiber, the kind found in fruits and brans, hasbeen shown to be effective in lowering cholesterol levels, says Brown. However, to exertthis effect, it must be consumed in high amounts; a bowl of oatmeal a day probably wont
4. make much difference. "You have to eat about a quarter pound of oatmeal per day to getten grams of soluble fiber a day, the amount that can lower cholesterol," he says. Herecommends a daily one-teaspoon dose of a psyllium-husk powder, such as Metamucil,which provides a lot more bang for your buck. "For the person whose cholesterol is stillborderline high after changing their diet, psyllium may give them another eight percent toten percent reduction in their LDL," he says. And no need to go overboard, either. Morethan ten grams a day wont make much more of a difference, he says. Its also prudent toincrease your fiber intake gradually in order to give your system time to adjust.Eat likethe rest of the world. "Four billion of the 5.3 billion people on this earth eat 15 grams ofsaturated fat or less each day," says Castelli. "Where do they live? Asia, Africa, and LatinAmerica. They are the four billion people that never get atherosclerosis. We want our 250million people to eat like those 4 billion. If we accomplished this, we could get rid ofheart attacks, stroke, and other manifestations of cardiovascular disease. We could livefive years longer, which isnt much. However, we wouldnt have heart attacks in our 40s,50s, 60s, 70s, or 80s. That is the vision for America."Quit smoking. Most of us are awarethat smoking can cause lung cancer and raise the risk of heart attack, but few peopleknow that smoking can actually affect your cholesterol levels, says Brown. "When youstop smoking, your HDL levels rise significantly," he explains. "A two-pack-a-daysmoker who quits may have an eight-point rise in their HDL cholesterol."Add exercise toyour daily routine. Studies have shown that regular aerobic exercise can boost levels ofHDL, says Brown. "Exercise can be very useful in reducing body weight, which can helpcholesterol levels," he says. "When you engage in even modest amounts of exercise, yourtriglycerides come down, your LDL comes down, and your HDL goes up after severalmonths." He recommends 30 to 45 minutes of moderate exercise, such as walking, fivedays per week. It is important to accelerate your heart rate and keep it up for at least 20minutes, he says. However, he adds, it is not necessary to do your exercise all at once.Try parking your car a quarter mile from work and walk it twice a day. Take the stairsinstead of the elevator. It all adds up.Know its never too late. Even if youve had a heartattack or have other evidence of heart disease, changing your lifestyle can stilldramatically reduce your risk of a recurrence, says Rifkind. In the past, heart specialiststhought that lifestyle changes couldnt make much of a difference for people who alreadyhad heart disease. They now believe differently. "We want the cholesterol to be muchlower in these people than in their healthy counterparts," he says. "For these people, thetarget levels of total serum [blood] cholesterol are between 160 and 170."