Thursday, April 28, 2011

Can you cut your risk of heart attack without using risky statins?

Can you reduce your risk of heart attack by improving your blood cholesterol, without the use of risky statin drugs?
I don’t know.

But I know this. I’ve stopped using statins for a full year and I have significantly improved my blood cholesterol. I did it by diet and exercise. I want to improve my cholesterol readings a bit more, but I’m definitely on the right track. Progress isn’t fast, but I’m not that far from my goals.

We’ve been told often enough about the two types of cholesterol in our blood and how they affect our chances of heart attack—even a cardiac arrest that can kill you within three minutes.

There’s the “bad” LDL cholesterol, the low-density lipoprotein stuff. Then there’s the good HDL—the high-density lipoprotein cholesterol. The LDL can stick to the walls of your arteries, building up plaque that can choke your flow of blood.  HDL can help prevent that by helping clear away the LDL. So the trick is to keep the LDL in your cholesterol down and HDL up.

Untold millions of people have risky cholesterol levels. The most common way to improve cholesterol levels is with a chemical pharmaceutical known as statins. First statin on the market was Pfizer’s Lipitor. With 2008 sales of US$12.4 billion, it is the world’s biggest selling pharmaceutical.

But statins can have side effects. These can include diarrhea and upset stomach, Pfizer’s consumer literature warns. More ominously, it also warns that “…any new muscle pain or weakness… could be a sign of rare but serious muscle side effects.” AstraZeneca warns that its Crestor statin can cause stomach pain, dizziness, headache, constipation, jaundice, hepatitis, joint pain, memory loss, and muscle pain and weakness.

Many of these conditions are said to be temporary, and the worst—particularly muscle weakness and pain—are said to be very rare. I’m not sure just how rare that might be. I was not reassured last year when I Googled “Lipitor and muscle pain” and got 3.5 million hits. I was even less reassured when we met a friend whom had not seen in some time, and who is now walking with a cane, as a result of muscle loss caused, she told us, by taking Lipitor.

I had been taking Lipitor since my cardiac arrest in 1989, but in the past couple of years I began to feel my leg muscles ache. Of course, muscle pain is what you get when you exercise vigorously enough to improve muscle strength and conditioning. “No pain, no gain,” as Jane Fonda famously proclaimed. And I had stepped up my exercise to prepare for a couple of challenges I wanted to meet: in 2009, a fund-raising climb to the top of one of the world’s tallest buildings, Toronto’s CN Tower; and last year, my first marathon, a 42-km walk, followed by a 128-km, four-day, fund raising walk for our local hospital.

I’m still not sure whether my aching muscles had anything to do with statins, or whether they’re just due to exercise and old age, as I approach my 80th birthday in less than a month. But I do feel less pain after stopping Lipitor.

Regardless, if I could improve my blood cholesterol without the use of a chemical drug, that seemed like a good thing to do. Surely no one doubts that, if you can get the needed benefits, diet and exercise are healthier than drugs.

Joan and I sharpened our diet, not only to minimize heart risk, but also cancer risk. We stick to plain and simple, easy-to-make food. We never (or as little as we can) eat these foods: trans fat; saturated fat, refined carbohydrates; egg yoke, high-cholesterol foods; red meat; potatoes and other starchy food. We eat every day: seven or more servings of fruits and vegetables; canola or olive oil; fish, low-fat poultry, or soy-based simulated ground beef; ground flax seed; whole grains. We eat very often: tomatoes (best cooked with a little oil), legumes (including peanuts), skimmilk, no-fat yogurt; sunflower, pumpkin or other seeds. For a more detailed description of our diet, see my January 8 blog, “With no statin drugs, will this diet lower my LDL cholesterol.” More recently, we put a little more emphasis on eating fish and a little less poultry following publication of the outstanding 100-page Dietary Guidelines for Americans 2010, (see my blog March 2, “A fish story and a disgustingly healthy casserole.”

As for exercise, I do about 5 to 10 hours a week, occasionally more. The longest workout weeks are when I go for long walks. I do four regular exercises on different days. Walking is my favourite. Considering ease, enjoyment and health benefits, I think it’s the world’s best exercise. If the weather’s not good, or if I’m pressed for time, I try to get at least as much benefit in less time by riding my stationary bicycle, on which I pumped both arms and legs. About twice a week I walk up and down our basement steps 25 to 50 flights (325 to 650 steps). And I try to do at least 10 pushups every day—the old man’s type, from the knees rather than the toes up.

So how much has all this improved my blood cholesterol?

First, let’s look at some target levels, as recommended by the College of Family Physicians of Canada. In Canada, cholesterol readings are measured in millimoles per litre (mmol/L); in the United States, in milligrams per decilitre (md/d). To convert Canadian data to U.S. readings, multiply by 38.5. But you don’t need to do the conversion to see the effect of diet and exercise on my cholesterol: just note the changes over the past year and how they compare with the target levels.

For healthy people, the Family Physicians recommend an LDL level of less than 3.0 mmol/L; HDL of more than 1; and a ratio of total cholesterol to HDL of less than 6:1.

But better numbers are recommended for those considered at high risk—and that includes all heart attack survivors, like me. I assume all who take statins are also at risk: why else would they need the drug? For those of us at high risk, the Family Physicians recommend an LLD of less than 2.0 mmol/L;  HDL of more than 1.0 mmol/L (the higher the better), and a ratio of total cholesterol to HDL of less than 4:1.

So how have I done since I stopped taking statins? From April last year to April 26 this year, my bad LDL dropped from 3.21 to 2.46 mmol/L; the good HD remained unchanged, at 1.68 mmol/L; and the total  cholesterol to HDL ratio improved from 3.17 to 2.46 mmol/L. So without statins, I’m fine on two of the three levels recommended by the Family Physicians for we folk at high risk. My LDL fell 75 mmol/L in the past year, and now I need to make it fall another 50 mmol/L.

In my eXerlog book you’ll find recommended cholesterol targets, and a “bloody table” where you can enter your specific targets then record your numbers from blood tests as you progress to those targets by diet and exercise. You’ll also find much more in eXerlog: a great primer on exercise, fitness and health; a logbook to record daily exercises; a grid to set fitness goals and track progress. All for as little as $8.95. Click to order.

I hope to do that by doing what I’m already doing, with a couple of diet adjustments. We’ve already made the first adjustment, by eating eight to 12 ounces of fish per week, as recommended by Dietary Guidelines for Americans—especially salmon and tuna, fish that are high in heart-healthy Omega 3 fatty acids.

And just today, I have added plant sterols to the diet, hopefully to speed the fall of LDL levels.

Plant sterols are one of the phytochemicals found in some fruits, vegetables and grains that can help improve your blood cholesterol, or keep it healthy. Sterols do that by blocking the absorption of dietary cholesterol in your blood. They also “have other positive effects on cholesterol regulations,” according to a report from the University of California, Berkeley. The report describes taking sterols as “a middle step” between diet and exercise or drugs “to improve your [cholesterol] numbers.”

Sterol supplements and food “fortified” with sterols have been approved for use by the U.S. Food and Drug Administration and recommended by the American Heart Association. The recommended dose is two milligrams a day, taken in two servings, perhaps with breakfast and supper. This, it is claimed, can reduce that bad LDL cholesterol by 9 to 20%. “Results may be seen in as little as two weeks,” while “older people tend to have larger drops,” according to the Berkeley report.

You can’t, however, get enough sterols to have that effect simply by eating the plants from which they come. One website tells me you would have to eat 80 oranges, or 22 kg (48 pounds) of broccoli every day. You can get the recommended daily dose eating about two tablespoons of fortified margarine or two glasses of fortified orange juice, or by taking supplements. I’ve chosen sterol-fortified, non-homogenous, canola-based margarine. Even without the plant sterols, it’s a heart-healthy choice.

I doubt that by themselves, plant sterols would get my LDL down to where it should be. But with diet and exercise, it might get me there quicker. We’ll see.

Know your numbers. “More than 80% of people who have had heart attacks have high cholesterol,” Pfizer claims in a magazine ad for its Lipitor. That tells you why you need to know your cholesterol numbers.

If your cholesterol needs improving, should you follow my example?

Not on my recommendation!

I have no qualifications to make any recommendations. I write about my own experience, and simply parrot what I’m able to find out from the best health authorities. More importantly, what works for me won’t work the same for everyone. Our genetics are all different. Joan and I are good examples. We both eat exactly the same foods, but because of her disability, exercise doesn’t play a role in keeping Joan’s cholesterol levels healthy. Yet Joan’s LDL level is consistently less than even the 2.0 mmol/L level recommended for those at risk, while I have to struggle to drop mine down from more than 3 mmol/L.

 “For 2 out of 3 people with high cholesterol, diet and exercise may not be enough,” says that Pfizer ad.. Or could it be that the diet isn’t rigid enough or the exercise isn’t consistent enough? Could it be that diet, exercise and plant sterols could do the trick without statins for a greater number of people?

If you need to improve your blood cholesterol, it seems inevitable that you will face one of two risks: either the side-effect risks of statins, or the risk that diet and exercise won’t do the job. Which risk you take should surely be a conscious and deliberate choice made by each individual, preferable after consultation with a doctor.

I’ve made my choice. I think it’s the healthiest choice.  Statins were my fallback if diet and exercise didn’t work. But they’re working. And I hope to never again have to take statins.

TAGS. Cardiovascular disease. LDL [low-density lipoprotein] cholesterol. HDL [high-density lipoprotein] cholesterol. Pfizer. Lipitor. AstraZenac. Crestor. Muscle weakness. Dietary Guidelines for Americans. College of Family Physicians of Canada. Phytochemicals. Plant sterols.


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