Rx drugs not necessarily first option for high cholesterol
Jane Brody’s column today in the NY Times, “Cutting Cholesterol, an Uphill Battle,” is an excellent overview of the lifestyle changes that one should make to lower high cholesterol, BEFORE resorting to prescription statins (Lipitor, Crestor, Zocor, etc).
In addition to the very useful specific advice that she offers (below), perhaps the more important message of her column is “don’t turn to a pill first.” The ubiquitous TV ads for statins, including the ones featuring Dr. Robert Jarvik, have convinced millions of people that all they need to do to lower their cholesterol is take a statin — and an expensive brand-name one at that. Statins can be very helpful and there are no doubt millions of people who can and do benefit from them. But our culture of a “pill for every ill” has given short shrift to the important — but often harder — changes in diet and exercise. The upside is that a better diet and increased exercise have countless other benefits beyond just reducing cholesterol. But when was the last time you saw an ad that said “Ask your Doctor if Broccoli is right for you.”
Even people who do need statins don’t necessarily need the most expensive, newest brand-name ones. Visit Consumer Reports Best Buy Drugs’ report on statins to see which statins are the “Best Buy” and right for different types of patients. Best Buy Drugs reviews a number of different categories of drugs, including drugs of heartburn, migraines, depression, diabetes and others.
Here’s Jane Brody’s advice:
These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.
Alcohol. Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.
Exercise. Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.
Weight loss. When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.
Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.
Smoking. An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided. Modifying Your Diet
About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.
There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.
Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.
For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole — 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.
Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.
Cook with canola or olive oil, and use margarine made from plant stanols.
And enjoy a glass of wine with dinner.
Equally important are the foods to limit or avoid: organ meats like liver, egg yolks, most fried and fast foods, doughnuts and pastries, full-fat cheeses and ice cream, processed meats like salami, bacon and other fatty cuts of pork, and untrimmed red meats.