Statins – To Take or Not to Take?

And the controversy rages on. If you followed the article Experts Reshape Treatment Guide for Cholesterol and the editorial Don’t Give More Patients Statins in the New York Times in the last two days, you’d see the breadth of the issue.

The problem is that, while heart disease is the number one cause of death in the US, most heart disease is not necessarily caused by an elevated cholesterol or abnormal cholesterol pattern. The number one cause of premature heart attacks (and overall mortality) is smoking!

It is quite clear that people who have already had a heart attack are at a high risk for a subsequent heart attack, and those with type 2 diabetes carry a similar risk. These people should be treated with statins, if possible. Most experts agree.

But...
What is one to do with the healthy person who has a high LDL (“bad cholesterol”), a family history of heart attacks, and faulty lifestyles such as eating the wrong foods and not exercising? Some people simply get away with it – without statins. According to the new guidelines, these people should still get statins, even if in retrospect they should not have had them. So how do you know who will “get away with it?” You don’t know for sure, but you try to better assess their risks.

Besides the usual physical examination and lab results, additional testing may be in order. This may include more sophisticated blood tests, such as those done by Berkeley Heart Lab or Boston Heart Diagnostics, and a variety cardiac stress testing (simple, radionuclear, or ECHO).

When there’s still a question, a non-invasive CT scan of the coronary arteries can be performed. This test determines the amount of calcium in the major coronary arteries. The higher the “calcium Score” the greater the risk of a future heart attack.

In my practice, I’ve had a fairly large number of patients with very high total cholesterol  and “bad cholesterol” levels who lived, or still living, with no statins and no heart attacks to a ripe old age.

So, my take is that statins are not for everyone, and a reasonable attempt should be made to identify those who are at an increased risk for a heart attack. And then treat.

Low Glycemic Index Foods – Why Bother?

After a meal blood sugar levels usually rise. To keep the blood sugar in check, insulin levels rise, and then return to normal, in order to bring blood sugar levels back to normal.. There are many reasons to keep both blood sugar and insulin levels within acceptable limits, but most important are the control of diabetes, cholesterol, and weight.

Keeping you sugar under control helps curb appetite- that’s how it helps you lose weight.

The foods that raise your blood sugar the most, the culprits, are “simple carbohydrates” (or simple carb’s): Sugar, high fructose corn syrup, and highly processed wheat products (mainly white flour).

The “good carbohydrates” are complex carbohydrates such as whole wheat products and a host of vegetables, legumes and some fruits (don’t forget the grapefruit, the season is approaching…).

The Glycemic Index (GI)is a measure of the blood sugar rise after a test amount of a given food is ingested. The Glycemic Load (GL) is a measure of the sugar level rise after a regular portion size amount of the same food is ingested.  The lower the numbers, the better the food.

You can find many GI and GL tables on the internet. A reliable source is the one by Berkeley Labs. Use it.

Any question? You know where I am.

Curb Your Sweets

I need not tell you the dangers of dietary sweets/sugars, especially if you have, or are at risk for, diabetes. Here are some hints for curbing your sweet-craving:

• Start the day with a balanced meal of protein, vegetables (yes, vegetables for breakfast) and complex carbohydrates. This will allow your blood sugar to rise slowly and gradually, as it should, and avoid a “sugar rush.”
• Avoid eating “light bread” made of wheat flour, which is made of simple carbohydrates. Have whole wheat bread instead of light bread, sweetened crackers, white rice, or potatoes.
• Incorporate into your meals complex carbohydrates: whole wheat products, corn, beans, peas, lentils, whole grain rice.
• Try to eat something as frequently as every three hours, in order to not deplete your energy stores, and to avoid sugar craving. A piece of fruit or whole wheat cracker may do.
• Get enough sleep. Tired bodies demand immediate energy in the form of simple carb’s.
• Have some sun exposure. Avoid staying in dark environments most day (as you may do in the office). Lack of sun exposure causes a decrease in serum serotonin, which causes relative depression and an increase in sugar craving. A little bit of Chocolate (70% cocoa, please) will increase serotonin level, and may elevate the mood.
• A boring lifestyle, associated with low serotonin, drives sweet craving. So keep busy. Exercise, yoga, or spending  quality time with someone will help a lot.
• You don’t have to totally abstain from sweets. Have a measured amount of your favorite candy periodically – every day, two days, or a week. Don’t eat it all at once, leave some for tomorrow.

Have a great day, without the sweets...