CHOLESTEROL – IS IT THE KEY?
The story of how fat became unfairly demonised is a long and fascinating one that has been covered by American science writer Gary Taubes in A Big Fat Lie as well as by British GP Malcolm Kendrick.5 You know the official story: cholesterol blocks the arteries; if you stop eating cholesterol-rich foods you will lower blood cholesterol and stop heart attacks. Yet, every single piece of this story is unquestionably wrong. Eating a low cholesterol diet doesn’t make much difference to either your blood cholesterol level or your risk of a heart attack. Study after study has repeatedly failed to find any increased risk of heart disease from eating six eggs a week versus one.6
One study finds that seven eggs or more a week confers a very slightly increased risk, but this is not confirmed by other studies, whereas two studies find that the risk is slightly higher in diabetics either eating lots of eggs or having a very high cholesterol intake in their diet. So, if you are not diabetic you can assume that it is certainly safe to have six eggs a week. If you are diabetic it may be wise to limit your total cholesterol by having no more than three eggs a week and fewer other cholesterol-rich foods such as prawns; however, it is likely that if your overall diet is heathy even this is unnecessary.
Furthermore, the odds are that if you have a heart attack you won’t have high cholesterol. A massive US survey of 136 905 patients found that more than half of those hospilatised for a heart attack had perfectly normal cholesterol levels, and almost half had optimal cholesterol levels (LDL cholesterol less than 1.8 mmol/L, below that recommended to GPs by the National Institute of Clinical Excellence).7 So, what is all this hype about cholesterol?
TAKE Co-Q-10, WHETHER YOU’RE ON A STATIN OR NOT
Although the mainstream view is that statins benefit virtually everyone, there is good reason to believe that if you are a man aged over 69, or a women of any age, they are not going to do you much good, if you haven’t already had a heart attack.
If you have decided to take statins because you have already had a heart attack or because you are at high risk and feel it is worth it anyway, you really ought to take a supplement of the antioxidant Co-Q-10. (Although always check with your doctor if you are taking other medication.) That’s because as well as reducing cholesterol production in the liver, statins also interfere with this vital antioxidant. Among other things, Co-Q-10 is vital for proper functioning of the mitochondria. There’s plenty of evidence to suggest that this could explain why muscle fatigue and pain are major statin side-effects.
Fifty patients who had been on statins for two years were taken off the drug because they were complaining of muscle pains and other side-effects. Giving them Co-Q-10 dramatically improved their symptoms.8 A warning on statin packets is now mandatory in Canada, saying that the induced Co-Q-10 deficiency ‘could lead to impaired cardiac function in patients with borderline congestive heart failure’.
This may be because there are many studies showing that Co-Q-10 has a positive effect on heart and artery health.9 Controlled trials have shown that it has a remarkable ability to improve heart function and it is now the treatment of choice in Japan for congestive heart failure, angina and high blood pressure, especially among older people. Together with carnitine, Co-Q-10 helps the heart to function more efficiently.
Co-Q-10, at a daily dose of 90 mg, has also been shown to reduce oxidation damage in the arteries, therapy protecting fats in the blood, such as LDL cholesterol, from becoming damaged and contributing to arterial blockages.10 So, statins seem a curious choice for heart protection as you get older, when many of the non-drug options covered below – such as omega-3 fatty acids, B-vitamins and vitamin D – will not only cut your risk but will also help you to age well.
WHY OMEGA-3 FATS ARE GOOD FOR YOU
The Inuit have a high intake of cholesterol and saturated fat, yet they have the lowest risk of heart disease because of their exceptionally high intake of omega-3 fats, which are now known to be very effective in reducing the risk of cardiovascular disease. Walnuts, chia and flax seeds are the best vegetable sources. The American Heart Association (AHA) suggest that patients with documented coronary heart disease consume approximately one gram of EPA and DHA (combined) per day, from oily fish or fish-oil capsules. This means either eating a serving of oily fish, or taking two fish oil capsules. Omega-3 fats lower cholesterol and triglycerides, raise HDL, prevent blood thinning and lower blood pressure.
Two long-term studies comparing the side- effects of giving patients with heart failure cholesterol-lowering statin drugs or omega-3 fish oils found that those taking one gram a day of omega-3 fats cut their risk of premature dying by 9% and their risk of admission to hospital by 8% compared to placebo. Those taking statins had no reduction in risk.11,12
AT A LOW-GL DIET
The most important way to lower cholesterol is to eat a low-GL diet. The big myth about high blood cholesterol is that it is caused by eating too much cholesterol in food. This has repeatedly been proven to be untrue. The body makes cholesterol, but when the cholesterol in your blood is damaged, by sugar (glycation) or by oxidation, it accumulates. When your blood sugar level goes high it raises insulin levels, and both high blood sugar and high insulin raise cholesterol. The solution is a low-GL diet, which balances blood sugar levels.
To keep blood sugar levels balanced you need to eat less carbohydrates overall, and choose the right kinds of slow-releasing carbohydrates (for example, oat flakes rather than cornflakes), and always combine protein with carbohydrate, which slows down the release of sugars in food even more. As your blood sugar level stays even by eating this way, less insulin is released. This not only lowers cholesterol but it also lowers blood pressure and it is also the easiest way to lose weight or control your weight.
THE MAGIC OF MAGNESIUM
It has been shown that magnesium lowers blood pressure by about 10%,13 as well as reducing cholesterol and triglycerides.14 Unfortunately, a lot of us are deficient in magnesium. An ideal amount is probably 500 mg, especially if you have high blood pressure. The richest sources of this mineral are dark green vegetables, nuts and seeds, especially pumpkin seeds. These are all good foods to eat, but if you have high blood pressure or any type of heart disease we recommend supplementing 300 mg of magnesium a day. A good multivitamin might give you 150 mg, so you’ll need at least an extra 150 mg. It is cheap, safe and highly effective.
CUT BACK ON SODIUM
Cutting back on sodium (salt), which tightens up the vessel wall, is part of official advice. We recommend not adding it to foods as a general rule and staying away from salted foods, such as most crisps. Potassium, which is found mainly in fruits and vegetables, also relaxes arteries.
THE VITAMIN NIACIN
Like all the other risk factors for heart disease, though, there are non-drug ways of improving HDL levels. Many of them will be familiar: taking exercise, losing weight, stopping smoking, cutting back on alcohol, having some omega-3 fatty acids. A high-glycemic diet brings HDL levels down; a low-glycemic diet raises them. But according to a major review of what works, in the New England Journal of Medicine,15 ‘the most effective way’ is with the B-vitamin niacin (also called B3).
A number of studies show that it is effective not only in raising HDL by as much as 35%, but also in reducing LDL by up to 25%. By way of comparison, statins only raise HDL by between 2% and 15%. Niacin also reduces levels of two other markers for heart disease: lipoprotein[a] (a fat that is related to cholesterol) and fibrogen, which promotes blood clotting.
The most obvious side-effect of taking fairly high doses of niacin is a blushing effect, which is diminished by taking it with food, but ‘non- blush’ or ‘extended-release’ niacin is now easily available. Other reported side-effects include dyspepsia (indigestion), raised plasma glucose and uric acid levels, although these last two have not been confirmed in recent studies.
CHECK YOUR ‘H’ SCORE
As you are now probably well aware, knowing your homocysteine level is a vital statistic in understanding your risk of a number of illnesses. One of the most exciting discoveries in the prevention of heart disease and strokes over the last decade has been the importance of a raised level of this amino acid in the blood and how it increases your risk of these and other diseases. High levels of homocysteine are a risk factor for heart disease quite independent of cholesterol. In fact, studies have found that homocysteine is a better predictor of cardiovascular problems than either blood pressure or smoking.
According to a study published in the British Medical Journal, the best predictor by far is your homocysteine: a level above 13 predicted no fewer than two-thirds of all deaths five years on.16 The obvious implication is that lowering these high levels – which you can do with B vitamins – will lower your risk. With over 10 000 studies now published on homocysteine, there’s a lot of circumstantial evidence that this is a sensible strategy.
As far as strokes are concerned, lowering homocysteine by taking folic acid makes a big difference. If taken for three years, it can lower stroke risk by 31%, according to an analysis of trials published in the Lancet.17
VITAMIN C AND THE LIPOPROTEIN(a) FACTOR
Two proteins that normally accumulate at injury sites to effect repair are fibrogen and apoprotein. Lipids and apoprotein combine to produce lipoprotein(a) which, in excess, is a very good predictor of impending cardiovascular disease.18 You want to have a level below 30 mg/dl (a level that would be checked by your cardiologist). Above 50 mg/dl your risk for cardiovascular disease increases quite substantially.
A study from the University of Arkansas for Medical Sciences, reported 35% decrease in lipoprotein(a) after 26 weeks on niacin,19 which proves even more effective in combination with high-dose vitamin C and the amino acid lysine.
Vitamin C is one of those all-round health heroes, certainly for heart disease. The higher your intake, the lower your risk.20 Having a higher intake also lowers your homocysteine level,21 and reduces inflammation.22 I take at least two grams a day and recommend you do the same.
THE IMPORTANCE OF SUNLIGHT
Just a few years ago, vitamin D was thought to be only really important for bones, but now, it’s emerging as the new supplement superstar that looks like playing a major role in your overall health and reducing the risk of cancer, among other illnesses.
A number of studies have also found that people with more exposure to the sun or more vitamin D in their blood are less likely to suffer from heart disease.
A few years ago, James O’Keefe of the Mid America Heart Institute in Kansas City, commented in a journal article that: ‘Vitamin D deficiency is an unrecognised, emerging cardiovascular risk factor, which should be screened for and treated.’23 Then, in 2011, he reported that testing the vitamin D levels of 239 patients arriving in hospital with a heart attack revealed that 96% had ‘abnormally low’ levels.24
LEARN HOW TO HANDLE STRESS
A major factor that is usually overlooked in conventional approaches to heart problems is stress – both physical and psychological. Of course, stress in the form of exercise or a challenging job can be very good for you, but chronic stress from poor working conditions, a bullying boss or too many deadlines can damage your health and your heart. Studies have shown that those of us who are regularly stressed have a five-fold increased risk of dying from heart-related problems.25
Stress affects the heart because you respond to it by producing adrenalin, which pushes up blood sugar levels, raises blood pressure and increases both blood clotting agents and LDL cholesterol. Meanwhile, extra amounts of the stress hormone cortisol encourage the storage of dangerous ‘visceral’ fat in the abdomen. Visceral fat is strongly connected to metabolic syndrome, which, as you know, is a big risk factor for diabetes and heart disease.
Although there are practical steps you can take to reduce your risk of heart disease, reducing your stress level, is one of the most important skills to learn. Master your own stress response the moment it occurs, or in preparation for a potentially stressful situation.
Editor’s Note: Dr Maureen Allem shares her tips to reduce daily stress: Stress & Anxiety Accelerate Ageing
- Coronary heart disease statistics in England, February 2011, British Heart Foundation. Available at: www.bhf.org.uk
- Tunstall-Pedoe, et al., ‘Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease’, Lancet, 1999;353(9164):1547-5
- Willetts, ‘The great fat debate: Total fat and health’, Journal of the American Medical Association, 2011;111(5)660-2
- Hooper, et al., ‘Reduced or modified dietary fat for preventing cardiovascular disease’, Cochrane Database Systematic Reviews, 2011;(7):CD002137
- Kendrick, The Great Cholesterol Con: The Truth about What Really Causes Heart Disease and How to avoid it, John Blake, 2008
- I. Qureshi, et al., ‘Regular egg consumption does not increase the risk of stroke and cardiovascular diseases’, Medical Science Monitor, 2006;13(1):CR1-8; also L. Djoussé and J. M. Gaziano, ‘Egg consumption and cardiovascular disease and mortality, The Physicians’ Health Study’, American Journal of Clinical Nutrition, 2008 Apr:;87(4):964-9; also D. K. Houston, et al., ‘Dietary fat and cholesterol and risk of cardiovascular disease in older adults: The Health ABD Study’, Nutrition, Metabolism and Cardiovascular Disease, 2011 Jun.;21(6)430-7; also C Scrafford, et al., ‘Egg consumption and CHD and stroke mortality: A prospective study of US adults’, Public Health, 2011 Feb.;14(2):261-70
- L. Harman, et al., ‘Increased dietary cholesterol does not increase plasma low density lipoprotein when accompanied by an energy-restricted diet and weight loss’, European Journal of Nutrition, 2008;47(6):287-93
- H. Langsjoen, et al., ‘Treatment of satin adverse effects with supplemental Coenzyme Q10 and statin drug discontinuation’, Biofactors, 2005;25(1-4):147-52
- Jones, et al., ‘Coenzyme Q-10 and cardiovascular health’, Alternative Therapies in Health & Medicine, 2004;10(1):22-30; see also M. Dhanasekaran and J. Ren, ‘The emerging role of coenzyme Q-10 in aging, neurodegeneration, cardiovascular disease, cancer and diabetes mellitus’, Current Neurovascular Research, 2005;2(5):447-59
- Langsjoen and A. Langsjoen, ‘Overview of the use of CoQ10 in cardiovascular disease’, Biofactors, 1999;9(21-4);273-84
- Gissi-HF, et al., ‘Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial’, Lancet, 2008:372(9645):1223-30
- De Caterina, ‘n-3 Fatty Acids in Cardiovascular Disease’, New England Journal of Medicine, 2011;364(25):2439-50
- J. Mroczek, et al., ‘Effect of magnesium sulfate on cardiovascular hemodynamics’, Angiology, 1977;28:720-4
- T. Altura and B. M. Altura, ‘Magnesium in cardiovascular biology an important link between cardiovascular risk factors and atherogenesis’, Cellular & Molecular Biology Research, 1995;41(5)25-36
- D. Ashen and R. S. Blumentahl, ‘Clinical Practice. Low HDL cholesterol levels’, New England Journal of Medicine, 2005;353(12):1252-60
- De Ruijter, et al., ‘Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: Population based observational cohort study’, British Medical Journal, 2009;338:a3083
- Wang, et al., ‘Efficacy of folic acid supplementation in stroke prevention: A meta-analysis’, Lancet, 2007;369(9576):1876-81
- G. Nordestgaard, et al., ‘Lipoprotein(a) as a cardiovascular risk factor: Current staus’, European Heart Journal, 2010;31(23):2844-53
- A. Lysend-Williamson, ‘Niacin Extended Release (ER)/Simcastatin (Simcor) (Simcor®): A guide to its use in lipid regulation’, Drug in R&D, 2010;10(4):253-60
- Kubota, et al., ‘Dietary intakes of antioxidant vitamins and mortality from cardiovascular disease: The Japan Collaborative Cohort (JACC) study’, Stroke, 2011;42(6):1665-72
- Breilmann, et al., ‘Effect of antioxidant vitamins on the plasma homocysteine level in a free-living elderly population’, Annals of Nutrition and Metabolism, 2010;57(3-4):177-82
- Mah, et al., ‘Vitamin C status is related to proinflammation responses and impaired vascular endothelial function in healthy, college-aged lean and obese men’, Journal of American Diet Association, 2011;111(5):737-43
- H. Lee, et al., ‘Vitamin D deficiency: An important, common and easily treatable cardiovascular risk factor?’, Journal of the American College of Cardiology, 2008;52(24):1949-56
- H. Lee et al., ‘Prevalence of vitamin D deficiency in patients with acute myocardial infarction’, American Journal of Cardiology, 2011;107(11):1636-8
- Vogelzangs, et al., ‘Urinary cortisol and six-year risk of all-cause and cardiovascular mortality’, Journal of Clinical Endocrinology & Metabolism, 2010;95(11):4959-64