Tips On Improving Your Cholesterol Profile

The beneficial effects on the heart and circulatory system of a having a low blood level (below 130) of LDL cholesterol and a high blood level (above 55) of HDL cholesterol are well established. It is also good to have a ratio of total cholesterol to HDL cholesterol of no more than 4.0. If your levels don’t meet these criteria, you might benefit from the recommendations listed in an online Men’s Health Magazine article by Bill Phillips dated September 13, 2011. It presents the following ways, purportedly based on scientific studies, of improving your cholesterol profile without drugs:

Raise Your HDL Level

• Eat at least 2 oz (57 gm) of nuts per day.
• Do endurance exercise at least 20 min/day
• Do 3 sets of 6-8 reps of the half squat, leg extension, and leg press, with 2 min max rest between sets, 2x/wk
• Take a 1000 mg calcium supplement daily with 400 IU of Vitamin D-3
• Eat fresh, not processed, white fish (e.g. cod, sole, flounder)
• Take a daily 10-20 mg polycosanol supplement
• Drink cranberry juice
• Eat 2.5 oz of dark chocolate daily

Lower Your LDL Level

• Eat a grapefruit daily
• Eat several small meals a day
• Eat food fortified with oat bran
• Switch from a margarine containing trans fats to a spread that doesn’t
• Drink Concord grape juice
• Take phytosterol or phytostanol supplements in pills or margarine form
• Add whole grains, nuts, and beans to your diet

Bottom Line

These seem like good recommendations. Just observe the following precautions:

• Don’t overdo the calories by adding these items to your diet. Remove other items when you add these.
• Endurance exercise is important for everyone. Weight training alone is not optimal for health.
• Do not exceed 1000 mg of calcium/day from all sources (1200 mg/day if you're over 70) because of a possible increased risk of prostate cancer.
• Don’t eat only white fish, because darker, fattier fish like salmon and mackerel are high in beneficial omega-3 fish oil.
• Don’t overdo the juice because even natural juices contain a lot of sugar, especially fructose, which can increase fatty deposits in the liver and around the midsection.
• Look for brands of dark chocolate without added milk fat.
• Several small meals means SMALL.
• The margarine brands that contain phytosterols and phytostanols contain some trans fats that are not listed because they're less than 0.5 mg per serving. So you may prefer getting these supplements in tablet form.

　

Omega-3 Fats from Fish Oil Raise Risk of High-Grade Prostate Cancer

It has been increasingly evident that there are trade-offs in the quest to get and stay healthy. In other words, there are actions we can take that will reduce the risk of one health problem, but increase the risk of another. One example is playing high-impact sports such as basketball, which is great for improving and maintaining physical fitness while having fun, but also increases the risk of sprains, strains and other musculoskeletal problems. Now, an article by Brasky et al. in the American Journal of epidemiology (published online April 24, 2011)  points up a trade-off involved in taking fish-oil supplements, which have been widely recommended for reducing the risk of cardiovascular diseases and other health problems.

The researchers analyzed blood samples of 3,461 men to measure levels of omega-3 fats (DHA and EPA from fish consumption), omega-6 fats (from common vegetable oils), and trans-fats (from hydrogenated oils in margarine, shortening, and processed foods). The men were then followed over a 7-year period in order to see the association of the different fat types to the incidence of prostate cancer. The hypotheses were that:

• Because of the anti-inflammatory effect of the omega-3 fats, men with the highest blood levels of them would have a lower incidence of prostate cancer
• Because of the inflammatory effect of the trans- fats, men with the highest blood levels of them would have a higher incidence of prostate cancer

Results
The statistical analysis produced the following surprising results:

   > There were no effects of any of the fat types on overall incidence of prostate cancer.
   > When looking at the high-grade form of prostate cancer that progresses rapidly and is the most lethal:

• Those men with the highest blood levels of DHA from fish oil had more than twice the risk of contracting high-grade prostate cancer as men with the lowest blood levels of DHA.
• EPA from fish oil had no effect on the incidence of high-grade prostate cancer.
• Those men with the highest blood levels of trans-fats had about half the risk of contracting high-grade prostate cancer as men with the lowest blood levels of trans-fats
• Blood levels of the type of omega-3 fat from vegetable sources (e.g. flax seeds, walnuts) had no effect on the incidence of high-grade prostate cancer.

Bottom Line
The results of highly surprising, given the widespread view of fish oil as all-good and trans-fats as all-bad. Here is a clear case of trade-off. There is considerable evidence that fish-oil is good for the heart and cardiovascular system and reduces the incidence of heart attacks. Yet, here we see that it increases the risk of high-grade prostate cancer. Eating omega-3 fats from flax-seeds or other vegetable sources is not a solution because that type of omega-3 fat has not been proven to reduce the risk of cardiovascular disease. The good news is that most prostate cancer is of the low-grade variety. Given that heart disease remains the number one killer of both men and women, it doesn’t appear that fish and fish-oil be abandoned as a health-promoting dietary elements. Yet men must be aware of the trade-off in risk of eating fatty fish or taking fish-oil supplements in order to make an informed decision about how best to promote their health.

Update (May 8, 2011):
Consumerlab.com, a company that tests the quality of supplements from various companies, contacted Dr. Theodore Brasky, the lead author of the study described herein. He stated that the blood levels of DHA and EPA measured in the study were largely based on fish consumption rather than fish-oil supplements. However, a recent study of his, soon to be published, shows no link between fish oil supplementation and risk of prostate cancer. He also noted another study (Szymanski, Am J Clin Nutr 2010) that found fish consumption associated with a large reduction in late state or fatal prostate cancer.

Fatty Liver Disease: Another Reason to Avoid Obesity

An article in the January 2011 issue of the Harvard Health Letter reveals that the epidemic of obesity has increased the occurrence of fatty liver disease. Previously, most cases of fatty liver disease were related to excess alcohol consumption, but now, many cases are related to excess body fat, which can lead to Type II diabetes. Fatty liver disease affects 70-90% of those who are obese and/or have diabetes.

Abdominal obesity can lead to metabolic syndrome (elevated blood pressure and levels of triglycerides and blood sugar, and low HDL (good cholesterol). Overfilled fat cells become resistant to insulin (which lowers blood sugar by storing it in the cells) resulting in excess fatty acids in the blood. Fat then accumulates in liver cells, which can lead to inflammation and liver tissue damage.  This can in turn bring about liver fibrosis (buildup of fibrous tissue) or cirrhosis (buildup of scar tissue). Cirrhosis increases the risk of liver cancer.

Fatty liver disease increases the risk of heart attack and stroke because a fatty liver produces inflammatory factors that can promote the deposition of plaque in the arteries, leading to arterial narrowing.

The only effective treatment for fatty liver disease is to lose weight.

Bottom Line
If you want to avoid or reverse fatty liver disease, avoid gaining unnecessary body fat or lose existing excess body fat through a program of good nutrition and exercise. Both caloric restriction and exercise are essential parts of any weight-loss program.

As We Age, Cholesterol Level Loses Its Value as a Risk Factor

Because both a high total cholesterol level and a high LDL-cholesterol level are risk factors for heart disease, statin drugs, which lower both levels, are widely prescribed. In the U.S., more prescriptions are written for Lipitor, the most popular statin, than for any other drug. Estimates for the number of people who take statins range between 11 million and 30 million. But should so many people be taking statins? A recent analysis, in which scientists reviewed 14 studies that included data from over 34,000 patients, showed little evidence that statins prevent heart trouble in patients with no history of cardiovascular disease. And because there is some evidence linking low cholesterol levels with increased risk of death from other causes, the study authors feel that doctors should be more cautious about prescribing statins.

An important factor to consider when deciding whether or not to prescribe statins is the patient’s age. A study by Kronmal et al., entitled, “Total Serum Cholesterol levels and mortality risk as a function of age” in the Archives of Internal Medicine (vol. 153, pp. 1065-1073, 1993) examined how age affected the ability of cholesterol level to predict the risk of dying, and it showed that the predictive value declined with age.
The most important consideration when judging mortality risk is the overall likelihood of dying from any cause. In that regard, at age 40, those people with higher total serum cholesterol levels had a significantly higher all-cause mortality risk. However, the relationship declined with age, and by age 60, the relationship between total cholesterol level and all-cause mortality had vanished. By age 80, the relationship actually reversed, so that those with higher cholesterol levels were at significantly lower risk of dying.

Looking specifically at the risk of death from coronary heart disease, the death risk at ages 40, 50, and 60 years was greater for those with higher cholesterol levels, although the effect got smaller with age. By age 70, the relationship was still positive but weak, but by age 80 the relationship reversed, and those with higher cholesterol levels actually had less chance of dying.

Looking at death due to causes other than heart disease, (e.g. cancer), from age 50 on, there was a lower risk of dying as cholesterol levels rose. This apparent protective effect of cholesterol against non-heart-disease death increased with age. Seventy-three percent of 80 year-old men with cholesterol levels above 240 survived for 5 years, while only 49% of those with levels below 240 did. The effect was in the same direction but weaker for women, with a 74% and 70% 5-year survival rates for women with cholesterol levels respectively above and below 240 mg/dl. In regard to cancer alone, higher cholesterol level was associated with lower death risk.

Bottom Line
The current practice of the medical establishment of prescribing statins to anyone with a total cholesterol level above 200 appears to be unjustified. For patients with elevated cholesterol levels and a history of heart disease, statins provide a proven reduction in risk. However, for patients with mildly elevated levels and no history or heart disease, the evidence in favor of prescribing statins is weak or nonexistent. And for men above age 70, even those with cholesterol levels above 240, statins could very well increase the risk of death.