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    Archive for the ‘HDL’ Category

    Numbers Game: Answer

    sad-little-heart-wahh-wahhA gain of twenty pounds (of fat, not muscle) over one’s ideal body weight results, on average, in a 30 percent increase of triglycerides and an average decrease of HDL cholesterol of 8 percent.

    I always find statistics like these to be quite powerful since they illustrate the health consequences of carrying excess weight, regardless of the type of foods that led to said weight gain.

    Continue Reading »


    Numbers Game: What Twenty Extra Pounds Really Mean

    use-scale-weigh-yourself-200X200A gain of twenty pounds (of fat, not muscle) over one’s ideal body weight results, on average, in a _____ percent increase of triglycerides and an average decrease of HDL cholesterol of _____ percent.

    a) 5/13
    b) 15/15
    c) 30/8
    d) 12/23

    Leave your guess in the “comments” section and come back on Tuesday for the answer.


    Numbers Game: Answer

    nurse taking blood pressureCardiovascular disease risk doubles for every 10-point increase in diastolic blood pressure (the bottom number) and every 20-point increase in systolic blood pressure (the top number).

    This serves as a perfect reminder of the domino effect of poor health.

    It also illustrates why maintaining a healthy weight is important.  It deeply frustrates me when people argue that weight gain should not be demonized, and that all body shapes should be accepted.

    I certainly back up that argument from a social and body-image standpoint.  No one should be made to feel inferior — by others as well as themselves — because of their waist size.  The fact that you’re ten or fifteen pounds overweight doesn’t negate the fact that you can be — and feel — sexy.

    From a health standpoint, however, getting rid of excess weight is crucial.

    Not only does excess weight increase cellular inflammation (THE most important factor behind the development of a number of degenerative diseases like cancer, heart disease, and Alzheimer’s disease), it also sets off a chain of symptoms and conditions.

    Excess weight increases blood pressure, lowers HDL cholesterol levels, and increase LDL cholesterol levels, thereby increasing cardiovascular disease risk.

    It also increases arthritis risk and puts excessive force on joints, often making exercise painful and difficult (thereby creating a powerful barrier against regular exercise).


    You Ask, I Answer: Plant Stanols

    006347A few days ago I was reading a pamphlet on heart-healthy eating, which recommended eating 2 grams of plant stanols every day.

    What are they? What foods are they in?

    I’ve never heard of them before or seen them on a food label, so how do I know how many grams I’m eating?

    — Mike Appenbrink
    New York, NY

    Plant stanols are naturally-occurring compounds in fruits, vegetables, whole grains, legumes, nuts, and seeds.

    Stanols are closely linked to sterols; they both fall under the “phytosterol” umbrella (phytosterols have a similar molecular structure to cholesterol, and compete with it for absorption).

    Phytosterols have been clinically shown to lower LDL (unhealthy) cholesterol while keeping HDL (healthy) cholesterol levels steady, thereby improving our LDL:HDL ratio. Here’s the catch — in order to get those health benefits, you need to consume two grams of them a day. They are present in hundreds of plant-based foods, but in miniscule amounts.  You would need to eat an excessive amount of calories to consume two grams.

    Cue companies like Finland’s Raisio Group, which formulated Benecol, a proprietary (ka-ching!) blend of stanols that can now be found in handful of processed products — from margarines and corn chips to orange juice and cereal.

    So, yes, long-term daily intake of two grams of stanols can help reduce LDL cholesterol by an average of fifteen percent, but I don’t consider stanol/sterol-fortified margarines and milks a necessity in a heart-healthy diet.

    There are many other things you can do to improve blood lipid profiles: consume at least 25 grams of fiber a day, prioritize monounsaturated fats and omega-3 fatty acids, limit added sugars and refined flours, and avoid trans fats.

    Whole foods may contain negligible amounts of sterols, but they contain many heart-healthy phytonutrients.

    Something tells me the educational materials you read were written or sponsored by one of the big stanol companies. My advice? Eat real food — there are plenty of benefits to be reaped.


    You Ask, I Answer: Nuts & Cholesterol

    nuts1240705690Are there any nuts that help lower cholesterol, or are they all bad?

    They are high in fat, right?

    — Greg (Last name withheld)
    Los Angeles, CA

    When it comes to lowering cholesterol with food, there are three particular nutrients to keep in mind:

    • Soluble fiber
    • Omega-3 fatty acids
    • Monounsaturated fats

    The above nutrients are ones you want to consume more of.  Ideally, you don’t want to simply add them to what you are already eating, but rather eat them in place of less-healthy foods (i.e.: refined carbohydrates, foods made with corn and cottonseed oil, etc.).

    In regards to your question: nuts are an absolutely wonderful food that I encourage everyone to have a serving of every single day.

    Almonds and Brazil nuts are the nuts with highest amounts of soluble fiber per ounce.  Walnuts, meanwhile, have more omega-3 fatty acids (in the form of Alpha-Linolenic Acid) than any other nut.  The monounsaturated fat category is dominated by peanuts.

    This is not to say other nuts are inferior; others have certain phytonutrients and compounds that have been shown to help lower cholesterol levels.

    While we’re discussing these three nutrients, check out this list of best sources (which includes some foods not mentioned above):

    • Soluble fiber: barley, figs, kidney beans, oat bran, oatmeal, pears, psyllium husk
    • Omega-3 fatty acids: chia seeds, hemp seeds, flaxseeds, halibut, sea vegetables, scallops, walnuts, wild-caught salmon
    • Monounsaturated fatty acids: almonds, avocado, macadamia nuts, peanuts olive oil

    Great news about soluble fiber — every gram of soluble fiber (when consumed in a consistent, daily basis) is linked to a 1 or 2 point reduction in total and LDL (“bad”) cholesterol.

    Above all, please undo the “fat is bad” mantra that has pervaded the American dietary landscape for the past two decades.  Omega-3 fatty acids and monounsaturated fats not only lower total and LDL cholesterol, they also increase HDL (“good”) cholesterol.


    In The News: Cardiovascular Precociousness

    Troubling news courtesy of the latest National Health and Nutrition Examination Survey: “overweight children as young as age 3 can begin to show signs of cardiovascular disease risk factors.”


    The study specifically analyzed levels of HDL (“good”) cholesterol and C-reactive protein (an inflammation marker that accurately predicts cardiovascular disease) in 3,098 children between the ages of 3 and 6.

    Results? Low HDL and high C-reactive protein levels were found in children with high BMIs and large waist circumferences.

    This is particularly disturbing since 24 percent of children in the United States between the ages of 2 and 5 are overweight, and 12 percent classify as obese.

    Additionally, while it is common knowledge that heart disease is a “pediatric” disease in the sense that the damage often begins in childhood, many people don’t see clinical markers until later in life. This certainly begs for a different viewpoint.

    One also can’t help but wonder about possible health consequences when obesity begins as early as age three.


    You Ask, I Answer: Hydrogenated/Interesterified Fats

    Thanks for explaining all about trans fats.

    I have a question, though.

    I have recently seen hydrogenated oils on Crisco food labels (not “partially hydrogenated”, but “hydrogenated”.)

    Are these also trans fats?

    — Patrick Altug
    Boulder, CO

    No, they are not.

    Whereas the partial hydrogenation of a liquid oil transforms its chemical structure in such a way that yields a solid, yet pliable texture (i.e.: easy to spread on toast,) full hydrogenation results in a solid mass that you can’t do much with.

    So, in an attempt to remove trans fat from their formulations, many products will interesterify fats.

    In this process, solid oils and liquid oils are combined in vats, hydrogenated, broken down to their most basic form (triglycerides) and later manipulated/reconstructed in order to achieve a desired consistency.

    Unfortunately, these fats come at a price.

    Recent research studies in the United Kingdom and Malaysia have found that interesterified fats decrease HDL (“good” cholesterol), raise blood sugar, and, perhaps more worrying, suppress the secretion of insulin.

    Why the worry?

    Raising blood sugar while lowering levels of insulin (the hormone that moves glucose out of the bloodstream and into cells) is certainly a rather powerful risk factor for the development of Type 2 diabetes.

    Although many people roll their eyes at this bit of news and often make statements like, “Are these dietitians EVER satisfied with anything? If it’s not trans fats, it’s something else,” there is an important lesson in all of this — stick with unadulterated fats!

    Whether partially or fully hydrogenated, those fat molecules have been chemically altered.

    A diet rich in minimally processed foods (whole grains, vegetables, fruits, lean protein, and heart-healthy fats) won’t include either type of hydrogenated oils.


    Numbers Game: Answer

    After controlling for confounding variables, the HDL (protective cholesterol) levels of women who smoke a pack of cigarettes a day are, on average, 17 percent lower than those of their non-smoking counterparts.

    Source: The National Heart, Lung, and Blood Institute Family Heart

    “Controlling for confounding variables” means that, in this study, cigarette smoking was isolated as a singular factor.

    Although it is common knowledge that smoking contributes to atherosclerosis (hardening of the arteries), its HDL cholesterol-lowering properties are not as widely publicized.

    The best news? As the Harvard Medical School so effectively summarizes it,every 1% increase in HDL is associated with a 1%–3% reduction in heart attack risk.”


    Numbers Game: Pack Attack

    After controlling for confounding variables, the HDL (protective cholesterol) levels of women who smoke a pack of cigarettes a day are, on average, _________ lower than those of their non-smoking counterparts.

    Source: The National Heart, Lung, and Blood Institute Family Heart Study

    a) 25
    b) 8

    c) 17

    d) 10

    Leave your guess in the “comments” section and come back on Friday for the answer.


    In The News: For A Healthy Heart, Watch Your Waist

    Tim Russert’s death last week was shocking on many levels.

    From a health standpoint, the NBC news anchor — who had been diagnosed with coronary artery disease — certainly didn’t appear to be a high-risk patient.

    He didn’t have any troubling symptoms and, as The New York Times reports, “he was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight.”

    Pay special attention to the last six words of that quote.

    As much as Mr. Russert was medicated and his LDL cholesterol was kept in check, the main risk factor here was, simply, his weight.

    Dr. Michael A. Newman, Mr. Russert’s internist, tells the Times that “if there’s one number that’s a predictor of mortality, it’s waist circumference.”

    Thank you, thank you, thank you.

    This is why weight control is at the pinnacle of health promotion.

    It’s simple. Plenty of evidence supports that when overweight people reduce those excess pounds, they also lower the risk and prevalence of a variety of diseases, including diabetes, certain cancers, and heart disease.

    What is frightening is that many people with heart disease appear to incorrectly think that taking cholesterol-lowering medications are “sufficient,” forgetting that reaching their desirable body weight is crucial.

    Also, although many cardiologists — and their patients — become fixated on lowering LDL’s (the “bad” cholesterol), many of them forget that increasing HDL’s (protective, “good” cholesterol) is just as important.

    In Mr. Russert’s case, autopsy findings revealed that his HDL figures were low.

    The procedure also concluded that there were “significant blockages in several coronary arteries.”

    This is why heart disease, in my opinion, should be in parents’ minds as they help develop their children’s eating habits.

    These conditions develop over decades. Mr. Russert’s health was not the product of the last 5 years, but of 25, 30, 35 years of consistent dietary patterns.

    Many people often comment that nutrition and health are complicated subjects, full of rules, numbers, facts, and figures.

    However, the best dietary advice is usually quite simple. In my case, one of the best recommendations I can make is to always be mindful of your ideal body weight and stay as close to it (no more than 5% above or below) as possible while consuming little junk food.


    Survey Results: Nutrition Labels, Part Deux

    The latest Small Bites survey asked readers what values they paid most attention to when reading food labels.

    The most important figure on a label relates to calories per serving — at least that’s how seventy-five percent of respondents voted.

    The ingredients list (32%), fiber content (30%), and serving size (29%) also received a good deal of votes.

    While saturated fat was considered important by 23% of readers, total fat content received a significant 40% of votes.

    I’m not too sure why this is the case.

    Fat content in and of itself doesn’t tell us much about the food that we can’t already gauge by taking a look at calories per serving (since fat contributes 9 calories per gram, foods with higher fat contents provide more calories than lower-fat ones).

    If you only look at total fat values, wonderfully healthy foods like guacamole or walnuts appear no different than brownies or ice cream sandwiches.

    When it comes to fat content, saturated fat (and trans fat, although once food companies were mandated to display trans fat figures on their products they miraculously found new trans-fat-free formulas for their products) is the value to keep your eye on.

    Remember, high intakes of saturated fat are linked to higher risks of heart disease and a decrease in HDL (or “good”) cholesterol.

    Guacamole, though, is mostly composed of monounsaturated fats (the kind that help lower LDL — or “bad” — cholesterol).

    This is why fat content — without a more specific breakdown — isn’t an appropriate factor to base food purchases on (unless, as previously mentioned, you are trying to gauge calories).

    I was surprised to see that vitamin and mineral values are largely considered irrelevant. Only 5 percent of respondents consider vitamin content to be important, and a measly 4 percent feel that way about mineral figures.

    A huge thank you to those of you who took a minute to participate!

    Please leave comments and thoughts on the results in the “comments” section.


    You Ask, I Answer: Cholesterol

    No one can explain WHY cholesterol builds up in our arteries around the heart and not in other veins in the body – after all aren’t they all the same thing, just different sizes?

    There is a growing body of evidence to suggest that cholesterol is actually a healing agent – cholesterol is building up at points in the arteries because they are DAMAGED.

    Why are they damaged? What causes this damage in the arteries?

    If cholesterol is viewed as a healing agent to heal the damage points in the arteries, then the risk levels associated with high total cholesterol levels seems to diminish, if not disappear.

    There is also a growing body of evidence to suggest that LOW cholesterol levels in the body is a risk factor for cancers and other diseases since the body is depleted of cholesterol as a healing agent.

    Interested in your views on this.

    — David (last name unknown)
    Via the blog

    Great questions, David. Let’s take them one at a time.

    Since this answer involves the nitty gritty, and often convoluted, world of nutritional biochemistry, I will try my hardest to make it easy to follow.

    Let’s start at the beginning.

    You are right; cholesterol is absolutely necessary.

    We need it for arterial protection as well as vitamin D synthesis and the production of hormones, including testosterone and estrogen.

    However, cholesterol is not essential. If we were never to get it from our diet it wouldn’t be an issue because our body produces it.

    Just like with vitamins and minerals, though, a certain amount is beneficial and health-promoting, but excess amounts are detrimental.

    The large majority of cholesterol is produced in the liver.

    Since cholesterol is not water soluble, it can not freely travel to other tissues through the blood.

    Remember, cholesterol needs to be transported to other tissues so it can help repair membranes and aid in hormone production and vitamin D synthesis.

    Instead, it has different “cars” to choose from.

    These “cars” are called lipoproteins. As the name states, they are proteins that carry lipids (fats) inside of them.

    The two most famous lipoproteins are HDL (high-density lipoprotein, commonly referred to as ‘good cholesterol’) and LDL (low-density lipoprotein, commonly referred to as ‘bad cholesterol’).

    What determines whether a lipoprotein is high or low in density is the amount of cholesterol it contains in relation to its protein content.

    Low-density lipoproteins carry lots of cholesterol.

    As low-density lipoprotein travels through the blood, it looks for LDL receptors (since we are using the car analogy, think of LDL receptors as designated parking spaces or garages).

    In the same way that you can’t park your car where you please, LDL receptors can’t drop off cholesterol wherever they please.

    It just so happens that one of the main sites of LDL receptors – other than the liver — is coronary (“heart”) artery endothelial tissue.

    There’s more.

    Just like a parking garage has a “maximum capacity”, LDL receptors can only take up so much cholesterol.

    Once LDL finds appropriate receptors, the liver knows to stop producing LDL.

    Here’s another twist.

    High intakes of saturated fat decrease the number of LDL receptors.

    A lack of receptors consequently increases hepatic (liver) production of LDL.

    In turn, more LDL floats around in the blood, having nowhere to go.

    High amounts of LDL in the blood have a propensity to build up in the inner walls of damaged arteries that feed into the heart and brain.

    Why do arteries get damaged in the first place?

    That is something that isn’t entirely known, but the main theories are cigarette smoke, high blood pressure, and high triglyceride levels.

    For some reason, coronary arteries are more susceptible to damage.

    When there is damage to an artery wall, LDL deposits, coalesces into liquid droplets, and becomes oxidized.

    Macrophages (a type of white blood cell) take in the cholesterol and form fatty streaks.

    As time goes on, more LDL collects, and the area grows in size.

    Smooth muscle cells begin slipping into the area, forming a cap over the deposited LDL. This cap is what we know as plaque (the yellow substance you see in the photo accompanying this post; notice how clogged that artery is!).

    With time, the cholesterol crystallizes, calcium starts to deposit at the area, and the vessel becomes rigid, thereby blocking blood flow.

    Here’s another twist.

    HDL (“good cholesterol”) can also bind to these LDL receptors.

    This is why increasing your HDL levels (through exercise, consuming monounsaturated fats and soluble fiber, not smoking, and eliminating trans fat consumption) is so crucial.

    Not only does HDL transport excess cholesterol back to the liver for excretion (via bile acids), it also — and this is crucial — prevents macrophages from engulfing LDL and saves LDL from oxidation (and thereby reducing plaque formation).

    Thus, if not genetically predisposed to high cholesterol (due to insensitive LDL receptors), the healthier your diet and lifestyle, the higher your HDL — and the more protection against plaque you have.

    Research has provided strong evidence that weight loss itself increases HDL levels!

    Hope this has shed some light on your questions.


    Numbers Game: Answer

    A 2007 Internet survey of 20,000 adults in the United States by the National Lipid Association found that three percent were able to identify the desired values for total cholesterol, HDL (“good”) cholesterol and triglycerides.

    A shockingly low figure.

    I’m willing to bet that the remaining ninety-seven percent not only do not know what ideal values they should have, but are also unaware how nutrition affects those numbers!

    As far as figures go, when it comes to total cholesterol, you want to be at less than 200 mg/dL.

    A number between 200 and 239 is considered a moderate risk (this risk is lowered if the number is a result of low ‘bad’ cholesterol — LDL — and very high ‘good’ cholesterol — HDL), and anything over 240 significantly increases your risk of developing coronary heart disease.

    Moving on to HDL (‘good cholesterol’, which sucks up cholesterol in the body and transports it to the liver for processing), a value of at least 60 mg/dL is required for it to serve as a protective force against heart disease.

    Anything below 40 men and 50 for women is considered low and another risk factor for coronary heart disease.

    Although triglycerides are a lipid, high values are linked with excessive intake of refined carbohydrates (processed flours, sugar, etc.)

    Anything below 150 mg/dL is great, while a number between 150 and 199 should raise the “Caution!” flag.

    Triglyceride levels are considered high at anywhere between 200 and 499 mg/dL, and anything above 500 is cause for serious concern.


    All-Star of the Day: Peanuts

    Although almonds often take the “super nut” title, the peanut also needs to be recognized for its tremendous health benefits.

    Peanuts are an excellent source of heart-healthy monounsaturated fats, the same ones that make olive oil and salmon such powerfoods. Remember, diet high in monounsaturated fats and low in saturated fats has been proven to reduce the risk of cardiovascular disease by as much as 20 percent. “Low-fat” is not the answer; “smart fat” is!

    An ounce of peanuts contains 164 calories, 7 grams of protein, 10 percent of our daily folate recommendation, 29 percent of our managenese needs, and 19 percent of our suggested niacin (vitamin B-3) intake.

    Although those figures themselves might not be groundbreaking, peanuts’ antioxidant level is extremely high, rivaling that of many fruits.

    In fact, resveratrol (the antioxidant found in grapes — and, thus, red wine — that boasts tremendous heart-healthy properties) is found in significant quantities in peanuts!

    A plant compound known as beta-sitosterol also exists naturally in peanuts, and recent research links it to reductions in rates of breast and prostate cancer.

    A 10-year study in Taiwan involving over 20,000 subjects (published in the January 2006 issue of the World Journal of Gastroenterology) found that the average participant who ate an ounce of peanuts twice a week lowered their risk of colon cancer by 34 percent!

    Additionally, studies at Pennsylvania State University’s nutrition department found that regular consumption of foods high in monounsaturated fats — such as peanuts — lowered triglycerides while keeping heart-healty HDL cholesterol stable, whereas a low-fat diet LOWERED HDL levels.

    Yes, peanuts are high in fat (one ounce provides 14 grams of fat), but this has proven to be a positive attribute.

    Studies at Harvard, Penn State, and even countries like Israel and Papua New Guinea all came to the same conclusion. When subjects were allowed to eat an ounce of peanuts as a snack twice a day, they reported feeling fuller and therefore eating less total calories a day!

    So, yes, you can most certainly enjoy peanut butter as a grown adult. However, be sure to buy “natural” peanut butter (Smuckers is my favorite). The ingredients? Just two – peanuts and salt.

    Most conventional peanut butter adds “partially hydrogenated oils” (the always evil trans-fats) and added sugars, which turn this all-star into a fallen celestial body.


    Simply Said: Cholesterol (Part 2)

    Part One introduced the main concept; now let’s talk figures. If you have your last bloodwork results handy, pull them out before continuing.

    When it comes to total cholesterol, you ideally want a number below 200. If you are between the 200 and 240 mark, you are in the “caution” zone. Anything above 240 is cause for concern.

    When it comes to HDL (the “good cholesterol” that takes extra cholesterol lingering around in places where it shouldn’t be back to the liver for processing), you want as high a number as possible. Anything below 40 is low (and indicates a higher risk of developing heart disease), whereas a number between 40 and 60 is OK. For maximum heart-healthy benefits, though, you want a number above 60.

    Onto the “bad cholesterol” (LDL). You definitely want this low, since high numbers up the risk of heart attacks and strokes.

    Less than 100? Perfection! Between 100 and 130? You’re still in safe territory. If you are between 130 and 160, consider yourself warned. If between 160 and 190, you are just a few numbers away from real trouble. If your LDL is above 190, this is a threat to your cardiovascular health that needs to be addressed.

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