Lub Dub Boot Camp Step One
Welcome to Lub Dub Boot Camp!
A patient recently suggested I include a step-by-step guide on how to prevent heart attacks on my website. So I’m happy to introduce my LUB DUB BOOT CAMP (LDBC) series! In LDBC you will learn the twelve steps to prevent a heart attack. I’m going to tell you what I tell my patients. But let’s keep this stuff between you and me, because if everyone did these things, I’d be out of a job. Onward to step ONE!
Is Lowering Cholesterol Important?
Heck yes. Cholesterol levels are the #1 risk factor for heart disease. The higher your cholesterol, the more likely you are to have a heart attack. More importantly, lowering cholesterol has ABSOLUTELY been shown to prevent heart attacks. Everyone should lower cholesterol with food, exercise, getting rid of your belly, and by not smoking. Cholesterol lowering medications are reserved for 4 groups of people:
1) Those who’ve had a heart attack, stroke, peripheral arterial disease or who have heart stents or had bypass surgery.
2) Diabetics
3) Those with an LDL > 190mg/dl (genetic cholesterol problem).
4) Those who have a 10 year risk of heart attack >7.5%. You can calculate your own risk here.
The average LDL in the United States is about 130mg/dl. If you’ve had a heart attack, you should try to get your LDL <70mg/dl with medications. Many people without heart attacks are taking statin drugs as well. I recommend if that’s you to lower your cholesterol <70mg/dl as well. Go big or go home.
First, Lower Cholesterol With Diet
Food is where you get the most bang for your buck in lowering cholesterol. What foods have been shown to lower cholesterol? Here’s a list of daily foods with super-powers to lower cholesterol:
- High fiber, plant based diet with nuts: 60 points (No Joke -download the study to see what they ate here).
- Handful of nuts (especially almonds and walnuts): 5 points.
- Beans: 7 points
- Berries: 2 points
- Entire avocado: 19 points (See it’s an avocado a day, not an apple that keeps the doctor away! For more about avocados read my post here).
- Clove of garlic: 11 points
- Dark chocolate/cacoa: 6 points (Awesome right!)
- Ground flaxseed (35-50grams or about 4 Tablespoons): 15 points (add to smoothies or yogurt)
Other foods that really lower cholesterol are:
- Whole grains (especially oats and barley)
- Fruits like apples, oranges, and grapes
- Soy
- Fatty fish like salmon, mackerel, herring, tuna, trout (NOT fried – read more that I wrote about fish here)
- Peas
- Lentils
- Vegetables like eggplant (Barf!), okra (Double barf!), carrots, potatoes)
- Dark leafy green vegetables like kale and spinach
- Olive oil. I wrote about this here.
What foods raise your cholesterol?
- “Southern diet” (fried foods, sugar sweetened drinks, egg dishes, and processed red meats).
- Saturated fats like whole-fat dairy and meats (Although these foods may not cause heart attacks as I talked about in a prior post.)
- Trans fats found in foods that contain hydrogenated vegetable oils. (Store bought cookies/crackers/cakes and foods that have been cooked in re-used oil.)
- Sugary foods. Avoid foods with added sugars as well as corn syrup, high fructose corn syrup, honey, malt sugar, molasses, syrup.
- Refined grains like Doritos, white breads, white rice, pastries, etc…
Second, Exercise
Exercise will lower your cholesterol a little. If you do vigorous activity 3-4 times a week for 20-30 minutes you can expect about a 5-10 point drop in total cholesterol and a 4-5 point increase in your good cholesterol. Surprisingly, training for a marathon won’t change it much more than that. Lifting weights or doing calisthenics 2-3 times a week can lower cholesterol by about 5 points. I personally exercise on an elliptical 3-4 times a week. One of my sons has recently begun training with calisthenics and looks like a superhero. Inspired, I sold my Bowflex home gym and now do pushups, pull-ups, planks, knee raises and stuff like that two times a week as well. I now look like this guy, but with less hair.
Third, Lose Weight
Weight loss is the third thing you can do to lower cholesterol. Your ideal weight is when your belly is gone. Weight loss is great at lowering cholesterol if you shop for “big” at the big and tall store. The closer you are to a normal weight, the less your cholesterol is affected by weight loss. Weight loss in really obese people can lower cholesterol by up to 30 or 40 points. Weight Watchers as well as smart phone apps like Lose It! and Myfitnesspal are excellent for weight loss.
Fourth, Stop Smoking
If you stop smoking, your good cholesterol will increase.
Some Supplements CAN Lower Your Cholesterol
Seriously, there’s only a few supplements that may be worth taking. Fiber supplements like Metamucil are effective at lowering cholesterol and keeping you regular. Ground Flaxseed (38-50 grams) really can lower cholesterol and I would add it to smoothies, yogurt, and baked breads.
Plant Stanols and Sterols are added to certain foods like yogurt and margarine but can be taken as supplements (one company even puts them in a caramel candy). Red Yeast Rice is the source for a natural statin called lovastatin. It does reduce cholesterol but you don’t know how much of the statin you’re getting in each pill and it may cause liver, kidney and muscle problems. Fish oil supplements reduces triglycerides at 4 grams daily but I’m not a big fan of fish oil supplements as you can read in a prior post. Garlic supplements don’t lower cholesterol. Niacin (500-1500mg) raises HDL and lowers LDL by turning your face red (you know what I’m talking about if you’ve taken them).
What Medications Lower Cholesterol?
Statins are the most studied medication to lower cholesterol AND prevent heart attacks. If you’re going to take one medicine to prevent a heart attack take a statin. Aspirin is not the best medicine to prevent a heart attack. You can read who should take an aspirin in this post.
Here’s the data – in statin users without heart disease, one in every 56 people will avoid a heart attack over 5 years. In statin users with a heart attack the odds are better in that one of every 20 people will avoid a heart attack or heart attack death over 5 years.
Of the seven statins available, the two best are atorvastatin (Lipitor) or rosuvastatin (Crestor). I favor rosuvastatin because it causes less muscle aches and cramps. The higher the dose, the greater the benefit. The only other medicine to prevent heart attacks when taken with a statin is Ezetimibe (Zetia). Ezetimibe is very well tolerated.
There’s also a new injectable medication to lower cholesterol. These medications are going to be game changers. They are Repatha and Praluent. The science so far is really good. If you can’t take a statin, these are fantastic options.
Step One Summary
To lower your bad cholesterol, everyone should eat a diet high in fiber, plant products, and fish. I would avoid processed and sugary foods. Eggs, red meats, and dairy products may raise your cholesterol slightly but are not associated with heart attacks. However, eating a lot of saturated fat means you’re not eating enough of the foods that we know lower cholesterol. Exercise vigorously 3-4 times a week with aerobic exercise and do some sort of weight activities 2-3 times weekly. Work on losing your belly with Weight Watchers or smart phone apps. Stop smoking. Take medicines if you have heart disease, diabetes, high cholesterol, or are higher risk for a heart attack.
Welcome to Lub Dub Boot Camp!
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