“Low T”… myth or reality?

If you ever turn on your TV, no doubt you have seen the commercials for treatment of “Low T” or low testosterone in men. Is this another disease created by the drug companies or is this something men need to worry about?

Low testosterone is more common today than in decades past, especially in younger men. The reasons for this trend are many and include:

  • The Standard American Diet (S.A.D.): If you eat a typical American diet, you may not be getting the nutrients you need for your body to produce optimal amounts of testosterone. Vitamins A,D and Zinc are needed for normal testosterone production. Foods high in these nutrients include orange vegetables and fruits such as sweet potatoes, apricots, carrots (Vit A); oily fish like herring, salmon, and sardines (Vit D); and oysters, nuts/seeds and wheat term (Zinc).
  • Obesity – men with obesity have a much higher incidence of low testosterone levels. The relationship between these conditions is not yet understood but as our country gets fatter, the incidence of low testosterone goes up. Low testosterone is also associated with diabetes and metabolic syndrome which are also associated with obesity.
  • Stress – Our high stress lifestyle leads the body to produce higher levels of cortisol. Cortisol and testosterone are both steroid hormones that are produced within the same pathway. It is thought that because those common building blocks are being used up to produce more cortisol, the testosterone production declines. Relaxation and stress reduction are very important to allow the body to produce more testosterone.
  • Lack of exercise – Exercise boosts testosterone production. Need I say more?
  • Lack of sleep: Testosterone levels increase during sleep, peaking in the early morning hours. Lack of sleep is associated with low testosterone. Get at least 7 hours of sleep per night.
  • Lack of sunshine – our primary source of vitamin D is sunshine. I would recommend having your vitamin D level checked with a blood test to determine how much vitamin D you need to take (you can overdose on vitamin D). If you don’t have your level checked, I would recommend taking no more than 2,000 IU of vitamin D per day.
So how do you increase testosterone levels naturally? I have seen men double their testosterone levels by making the following changes.
  • Eat a healthy diet – whole foods, lots of veggies and fruits, healthy fats like fatty fish and shellfish, nuts and seeds and lean proteins.
  • Exercise at least 5 days per week.
  • Get at least 7 hours of sleep per night.
  • Do relaxation activities such as controlled breathing, prayer, yoga, listening to music, etc…
  • Get out in the sun for at least 15 minutes each day, have your vitamin D level checked and take a supplement if necessary.
  • Get your weight down if you are overweight.
Read more detail about lifestyle changes to balance your hormones.

If your testosterone continues to be low despite appropriate lifestyle changes, you might want to consider a testosterone supplement. The most natural way to accomplish this is using daily testosterone cream in the morning which mimics the body’s own testosterone production.  I do not recommend testosterone injections which expose the body to a large amount of testosterone at one time which does not mimic the body’s normal production. Testosterone injections have more side effects and often lose its effectiveness over time.

When it comes to testosterone supplementation, the key is to start low and increase slow. When testosterone is given at a higher dose than the body is accustomed, the body’s reaction is to decrease the number of testosterone receptors, resulting in decreasing effectiveness over time, usually after 9-12 months of use.

So the answer is yes, Low T is common and increasing in frequency. Low testosterone levels can cause fatigue, depression, and low sex drive. If you have these symptoms, make sure to get your testosterone checked with a simple blood test. Just remember though, testosterone supplementation isn’t always the answer. You can increase your levels by getting back to the basics of health with good nutrition, sleep, exercise and sunshine.

 

10 Things You Need to Know about Menopause and Bio-Identical Hormones

  1. Contrary to what the drug companies want you to believe, menopause is not a disease that needs to be treated. It is true that some women have severe symptoms of menopause and often benefit from treatment with hormones to get them through this life stage.

  2. In my experience, women who eat healthy, exercise, and have low stress are less likely to have severe symptoms of menopause so it is always important to start with the basics of nutrition, exercise and stress reductionSome studies show that exercise is more effective than hormones for hot flashes. Read more about what you can do prior to considering hormone treatment.

  3. If hormone replacement is needed, it is very important that you understand the difference between bioidentical and non-bioidentical hormones. Bioidentical hormones are simply hormones that are identical in chemical structure to the hormones that are produced by the human body. Taking these hormones either by mouth or through the skin via patch, gel or cream is referred to as bioidentical hormones therapy (BHRT).

  4. In the past, the most common hormone therapy in the United States was Premarin and Provera (Prempro) which ARE NOT bioidentical. The 2002 Women’s Health Initiative Study, a study looking at the risks/benefits of hormone therapy in 160,000 women, reported that in women taking Prempro (non-bioidentical hormones), the risks outweighed the benefits. Since the WHI study was published, much of the mainstream medical community has shied away from treating women with hormone therapy. Many doctors are concerned that any form of hormones may have the same risks. European medical studies suggest that bioidentical hormones are safer than synthetic versions; however, because they have not been well studied, especially for long-term use, I recommend that women never think of BHRT or any drug as completely safe. If women choose to take BHRT, I only recommend bioidentical hormones at the lowest dose required to alleviate symptoms. I believe that it is very important to give your body what it recognizes and knows what to do with it AND in an amount that the body is accustomed.

  5. Biodentical hormones that are commonly prescribed include estrogen (estradiol and estriol), progesterone, testosterone and DHEA. Patients who have a decrease in hormones levels AND related symptoms may benefit from replacing these hormones. There is no evidence that replacing these hormones is beneficial for general wellness and longevity (“anti-aging”).

  6. Bioidentical estrogen can be given orally or through the skin via a cream, gel or patch. Bioidentical estrogen (estradiol) is available by prescription from both compounding and retail pharmacies (CVS, Walgreens, etc…). If you are using estrogen, it is important to make sure it is bioidentical.

  7. Progesterone can be given orally or through the skin via a cream but bioidentical progesterone IS NOT currently available by prescription through retail pharmacies. Provera (Medroxyprogesterone) is a commonly used oral form of progesterone but it IS NOT bioidentical. There are other progesterone like drugs, such as norethindrone, that are available in combination with estrogen in a patch. Bioidentical progesterone cream is available over the counter and cream/capsules are available by prescription from compounding pharmacies.

  8. Many of the symptoms women experience are due to low progesterone, not lack of estrogen. Women who are going through peri-menopause often get relief from simply using progesterone cream alone which balances out the estrogen fluctuations that cause menopausal symptoms.

  9. Low testosterone is a common problem during menopause. Women with low testosterone and decrease in energy or libido can sometimes benefit from low-dose topical testosterone.

  10. Bioidentical hormones can be formulated by a compounding pharmacy that makes the capsules or creams “from scratch” for each patient. The benefit of a compounding pharmacy is that creams can be made in any strength and the hormones can also be combined together, providing a very individualized treatment.  It is important that the compounding pharmacy is reputable and follows high quality manufacturing practices.

Does your breakfast look like this?

When you think of breakfast, what foods do you think about? Do you think of cereal, breakfast bars, bagels, toast, and pancakes? These processed carb-laden foods that are lacking in nutrients are an important culprit in our struggle to become healthy. We might think of eggs for breakfast but our egg breakfast usually consists of eggs, bacon and toast. Sometimes we think of fruit as part of our breakfast but do we ever think of veggies?

We don’t eat enough veggies. Veggies, especially greens, are so important to our health. When your mom told you it was important to “eat your greens”, she was right. When you omit this key component of your health from an entire meal on a daily basis, it will have a long-term impact on your health. Simply replacing processed foods (like cereal) with a variety of colorful veggies is probably one of the most important changes that you can make today.

I have to give a shout-out to Front Porch Pickings, an organic produce delivery service, for helping me add more veggies to our table. This morning I could have had a piece of toast or skipped breakfast all together but when I opened the fridge and saw that wilting purple kale, I knew that it would be a crime to let it go to waste. What came from this thought was a beautiful breakfast that helped me start the day off right. You could do this with any veggies that you have on hand.

Breakfast Veggie Scramble

  • 1/2 cup chopped kale or other greens
  • 1 garlic clove
  • 2 eggs
  • 2 tbls whole milk
  • 1 tbls olive oil
  • 1/4 cup feta cheese
  • 1 radish
  • 1 scallion or a few chives
  • 1 tbls balsamic vinegar
  • sea salt and pepper
  • 1/2 cup plain greek style yogurt

Saute chopped kale with minced garlic and olive oil and set aside. Wisk eggs with a couple tablespoons of whole milk and scramble. Fold in kale/garlic mixture and feta cheese then top with julienned radishes and minced scallions or chives. Add a drizzle of balsamic vinegar and a dollop of greek style plain yogurt. Don’t forget to season with sea salt and fresh ground pepper. Enjoy!

What are probiotics and why are they important?

What are probiotics? Probiotics simply refer to the good bacteria that live inside the human body. Approximately 100 trillion good bacteria live inside a healthy human being. The number of good bacteria in our GI tract normally outnumber our own cells by a ratio of 10:1. These good bacteria serve a variety of functions to keep us healthy.

What do probiotics do for us? These bacteria actually support our health, serving a variety of functions including:

  • Digestion of food and absorption of nutrients – poor digestion can be caused by imbalance of gut bacteria, leading to bloating, abdominal pain, constipation or diarrhea
  • Production of vitamins – certain vitamins are actually produced by the bacteria that live in our gut.
  • Immunity  - 70% of our immune system resides in our gastrointestinal tract, in part because these good bacteria provide a barrier to keep the bad guys out, bad guys being infectious agents and also environmental triggers that can cause an immune reaction leading to inflammation and autoimmune disease.
  • Inflammation – good bacteria help reduce inflammation which is the common denominator in all of the diseases highlighted below.

Why do we need to take probiotics?

  • Good health starts in the gastrointestinal tract where these bacteria live. Because of all the important functions these tiny organisms provide, good bacteria plays a key role in our health.
  • Imbalance of gut bacteria has been liked to cancer, asthma, allergies, obesity, diabetes, autoimmune diseases and even brain, behavioral and emotional problems like ADHD, autism, Alzheimer’s disease and depression. All of these diseases are on the rise.
  • The Standard American Diet (S.A.D) of processed sterile food with few fresh vegetables and fruit does not support growth of these good bacteria that protect us from disease.
  • I recommend that everyone take a probiotic supplement for health promotion and disease prevention. For those with the above medical conditions, it is even more important.

What do you need to know before you buy probiotics? I recommend taking a probiotic with at least 15 billion CFU (colony forming units) but I usually recommend more for patients with health problems or those who have taken repeated courses of antibiotics in the past. And contrary to popular belief, most yogurts do not supply enough bacteria and most of these yogurt brands contain added sugar, additives, and preservatives. Other foods that contain probiotics are sauerkraut, kimchi, miso, and tempeh. Here are some tips to choosing quality probiotic supplements:

  • Look on the ingredient list and make sure that the bacteria has a code (made up of letters and numbers) after the name. This means that the bacteria comes from a source that has proven beneficial in human studies.
  • To ensure the probiotics are effective, they should be either refrigerated or in a blister pack or a sachet (pouch) so that they have minimal exposure to air, heat and light.
  • They should be from company that produces high quality products. Read more about how to choose quality supplements.
Read more about how to improve the health of your gastrointestinal tract.

 

 

How to get healthy in 2013…

As the New Year is upon us, it is again time to assess our health and set goals for the coming year. Stress, lack of exercise, and poor nutrition are killing us slowly. Always remember that truth is timeless. There is no magic pill or potion for health. Spend your time, money, and energy focusing on the following eight essentials of health and you will feel better and live longer.

  1. Breathe properly: breathing is one of the most powerful tools to counteract the body’s reaction to stress, decreasing muscle tension, lowering blood pressure, increasing good hormones such as Human Growth Hormone, and lowering stress hormones.
  2. Drink more water. Your body is 60% water so make sure to replenish it. Water helps to cleanse and filter the toxins out of your system. Drink water throughout the day and eliminate sodas, colored water (Gatorade, etc…), and energy drinks.
  3. We literally become what we eat. Eat whole foods. In other words, eat foods in their natural state and avoid foods that come from a box or a bag.
  4. Sleep 7-8 hours per night. Lack of sleep accelerates the aging process and is associated with cancer, heart disease, obesity, osteoporosis and diabetes.
  5. Move more: exercise is one of the best and most simple tools for health. Lack of exercise increases risk of obesity, diabetes, heart disease, cancer, and dementia.
  6. Get 10 minutes of sunshine per day: sunshine is our primary source of vitamin D, essential to our health.
  7. Relax: Take time each day for an activity such as meditation, deep breathing, yoga, Tai Chi, music, laughter, or prayer. Relaxation techniques decrease stress hormones, which cause high blood pressure, diabetes, cancer, obesity, and osteoporosis.
  8. Attitude is everything: strive to have a positive attitude every day. Be grateful, forgive, let go of the things you can’t control, and love each other.

This 30-minute daily routine is a way to multitask for better health. And it is a great way to start the day. This routine addresses 7 of the 8 essentials of health:

Take a brisk walk in the sunshine while listening to music and/or praying. When you return home from your walk, perform the four controlled breaths (see below) while focusing on positive thoughts and/or prayer. Follow this by a big glass of water and a high protein, healthy breakfast (see below). These foundation elements of health when practiced regularly are more powerful than any medication. I guarantee that this routine practiced daily will transform your health and your life.

Controlled breathing (the 4-7-8 breath):

  • Exhale completely through your mouth, making a whoosh sound.
  • Close your mouth and inhale quietly through your nose to a mental count of four.
  • Hold your breath for a count of seven.
  • Exhale completely through your mouth, making a whoosh sound to a count of eight.
  • This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Healthy breakfast ideas: ditch the cereal, bagels, and breakfast bars. Processed breakfast foods are devoid of the protein and nutrients that we need to maintain optimal health. Instead, start your day with protein, healthy fats, whole grains, and fruits or veggies.

  • Greek style yogurt with organic seeds, nuts, and fruit (fresh or dried)
  • Ezekial bread toasted with peanut or almond butter topped with thinly sliced apple and a drizzle of raw honey
  • Hard or soft boiled or poached eggs with fruit
  • Omelet with veggies topped with a little feta or goat cheese with or without a slice of Ezekial bread
  • Steel cut oatmeal topped with nuts (pecans, almonds, or walnuts), berries, and honey
  • Smoothie (make sure it is high in protein with fruits and veggies)

 

Eggs… quite possibly one of the most perfectly nutritious foods on the planet

Over the last several blogs, we have been dispelling some food myths that have been around for decades. You learned that cholesterol is good, fat doesn’t make us fat, and canola oil is not real food.

A review of food myths would not be complete if we don’t address the vilification of the egg. Eggs are quite possibly on of the most perfect foods we have on this earth.

  • Eggs are one of the healthiest and most affordable sources of protein.
  • An egg breakfast can help with weight loss.
  • Eggs DO NOT have a negative impact on cholesterol levels.
  • Eggs are essential to the health of the eye and maintenance of good vision. Egg yolks contain lutein and zeaxanthin which prevent macular degeneration and cataracts. Supplements containing lutein and zeaxanthin are prescribed by ophthalmologists but these nutrients are much better absorbed when they are obtained from the diet and the egg yolk is a perfect source.
  • Eggs may reduce the incidence of heart attack and stroke by preventing clotting and inflammation.
  • Eggs support a health brain and nervous system. Eggs contain choline which is so important for the health of our cells, especially in the brain and nervous system.
  • DO NOT throw away the yolk. The yolk is the healthiest part of the egg. That is where all the nutrients are packed. Egg beaters are a marketing gimmick that takes advantage of the myth that the fat and cholesterol in the egg is bad for your health. This couldn’t be further from the truth. They remove the yolks then add in mass produced, poorly absorbed vitamins, additives, and preservatives.
FYI – (ingredients of egg beaters): Egg Whites, Less than 1%: Natural FlavorColor (Includes Beta Carotene), Spices, Salt, Onion Powder, Vegetable Gums (Xanthan Gum, Guar Gum), Maltodextrin. Vitamins and Minerals: Calcium Sulfate, Iron (Ferric Phosphate), Vitamin E (Alpha Tocopherol Acetate), Zinc Sulfate, Calcium Pantothenate, Vitamin B12, Vitamin B2 (Riboflavin), Vitamin B1 (Thiamine Mononitrate), Vitamin B6 (Pyridoxine Hydrochloride), Folic Acid, Biotin, Vitamin D3

 

What you will not hear during the presidential debates: 3 inevitable consequences of Obamacare…

With the election coming up a a few weeks, I think this subject is worth another re-visit. Let me just preface this blog by saying that I am not opposed to Obamacare. Back in July after Obamacare passed, I wrote about my perspective as a physician of the reform. There are many good things about Obamacare. However, there will be repercussions that we can’t ignore.

This is what will happen if we continue with the current healthcare reform as it is written:

1: Although you will have insurance, it will be very difficult to see a primary care physician: In 2014, 32 million more people will have insurance coverage. To understand how difficult it will be to find a primary care doctor after 2014, look no further than Massachusetts. In 2006 the state passed a health care law mandating that everyone obtain insurance and for those unable to afford the cost, subsidies were made available. Within weeks, the “uninsurance” rate in Massachusetts dropped precipitously. Commensurate with that was a rise in both the number of “closed” office practices and the length of time it took to get a new patient appointment. Nearly six years after the law passed, more than half of the family practice and internal medicine offices in the state are closed to new patients and the average wait for a new patient to be seen by an internist is 48 days. Turns out insurance doesn’t guarantee access after all.

2) A large number of physicians will quit practicing or stop taking insurance: It is estimated that there will be a shortage of 30,000 physicians in 2014. However, the reality may be much worse. When you analyze how healthcare reform will affect access to healthcare, you must also look at how physicians will react to it.

  • 50% of physicians plan to reduce their patient volume, work part-time, switch to concierge medicine, retire, or take other steps what would reduce access to their services.
  • Over 52% of physicians have limited or plan to limit Medicare patients’ access to their practice
  • 26.7% of physicians have already closed their practices to Medicaid patients.
  • 57.9% would not recommend medicine as a career to their children or other young people
3) The cost of insurance premiums will continue to rise, threatening the promise of affordable insurance: I have not heard any politician address the issue of how to keep insurance premiums affordable. Premiums are rising and the insurance industry is warning of higher rates. How else will they continue to be profitable and pay their CEO’s? Here are a sampling of the 2011 compensation of insurance company CEO’s in case you are interested:
  • Cigna CEO, David Cordani – $19 Million (this is 94x the average pay of a primary care physician)
  • Humana CEO, Michael McAllister –  $7 Million
  • BCBS of Illinois CEO, Patricia Hemingway Hall –  $12.9 Million
And the above are only compensation of the top earners in each company. Check out the 2009 insurance industry executive compensations. In 2009Aetna paid its 6 top executives a total of $47 million dollars. Why isn’t anyone talking about this? Why aren’t people outraged?
There is a collective “burying of heads in the sand” in Washington when it comes to repercussions of Obamacare. The inevitable outcome of health reform is that coverage DOES NOT equal access to care and the only losers in this situation are doctors and patients.

Is canola oil really good for us?

Have you ever eaten a canola plant? I didn’t think so. So what is this canola oil that we are eating?

  • The word canola originated from “Canadian oil”. Canola was bred from the Rapeseed plant by crossing with other plants in order to reduce a toxic component, erudic acid, that was not safe to consume. Its seeds were produced to provide an edible oil suitable for consumption by humans and livestock. Rapeseed oil has been used as a lamp fuel, lubricant and biodeisel.
  • Canola oil is made at a processing facility by heating and then crushing the seed then refining using hexane. The oil is bleached and deodorized.
  • Canola oil is very low in saturated fat and high in monounsaturated fats which are thought to be healthier because saturated fats have been associated with heart disease. Since it was produced, it has been marketed by the food industry as the healthiest fat.
  • The consumption of canola oil is” generally recognized as safe” by the United States Food and Drug Administration, as are many additives, preservative, and artificial colors/sweeteners that have been linked to various medical conditions.
  • In 2011 96% of the canola oil was made with genetically modified organisms (GMO).

I do not cook with canola oil and avoid eating foods with canola oil. This is why:

Canola oil is an industrial product, not a food. It is similar to high fructose corn syrup. It was produced by the food industry in order to produce food cheaper.

  • I prefer to use oils from plants that are meant to be eaten, such as olive, avocado, peanut, grapeseed, coconut and walnut oils. I recommend oils that are organic (therefore no GMO or pesticides) and first cold-pressed (not chemically extracted or filtered of nutrients).
  • I am concerned about consuming GMO foods. Almost all canola oil (96%) is GMO. I believe that genetic modification is an unnatural process and likely has unintended health consequences. Although there isn’t solid proof that it is unsafe to consume, there isn’t proof that it is safe for long term consumption.
  • Canola oil is highly processed and refined using hexane, bleach, and deoderizers. Health is achieved by eating food in its natural state and this processing robs food of its nutrients.


“Fat doesn’t make us fat… Who knew?”

I borrowed the title quote from David Perlmutter, MD, a neurologist and expert on the role of nutrition in brain health and neurological disease.

Like cholesterol, fat has been vilified by the media for decades (if you missed it, read last week’s blog “Cholesterol is a good thing”). One of the biggest health misconceptions is that fats need to be avoided in order to lose weight, prevent heart disease and lower cholesterol. The truth is that fats are essential to your health, especially your heart and brain.

Here is some evidence that fat is good:

  • When head to head studies were done comparing low fat, Mediterranean, and high fat diets, it was actually the high fat diets that had the greatest improvement in weight loss, blood pressure, triglycerides, and cholesterol.
  • Other studies have shown that high fat diets do not increase risk of colon and breast cancer as previously thought and that women eating low fat diets actually had a higher incidence of breast cancer.
  • Since the 1970′s, when low-fat diets were recommended by “experts” and there was an explosion of low-fat and non-fat foods, the rate of increase in diabetes and obesity has more than doubled.
  • Studies show that intake of olive oil, a healthy monounsaturated fat, decreases risk of stroke, blood pressure, LDL, and inflammation.

Here are my recommendations:

  • Bad fats=trans-fats which are fats that are chemically altered and added to packaged and processed foods to increase shelf life and thus increase profits for food manufacturers. Stop eating foods that come in a box and a bag. Do not eat foods containing “partially hydrogenated or hydrogenated” oils. Stop eating fake butter – 99% of the butter substitutes contain hydrogenated fats. As Dr. Perlutter says, “I Can’t Believe It’s Not Butter? I can’t believe people are eating it.” Remember a food package can be labeled “no trans-fats” and still contain up to 1/2 gram of trans-fats per serving so always read the ingredient list. Better yet, eat more foods that don’t have an ingredient list.
  • Good fats come from nuts, seeds, (wild) fatty fish, and oils made from from seeds, vegetables, and nuts (avocado, walnut, olive, coconut oils – to name a few).
  • Avoid canola oil. Canola oil has been touted as one of the healthiest fats. Have you ever eaten a canola (not cannoli) or a rapeseed? Canola oil is an industrial product benefitting only the food industry. In my opinion, canola oil IS NOT food. Stay tuned for next week’s blog for the truth about canola oil.
  • Do not buy packaged “low-fat” and “non-fat” foods. These are fake foods that substitute fats with sugars, additives, and fillers (what I call “food like substances”) in order to trick you into thinking you are eating healthy while they make a profit.
  • When you increase good fats in your diet, you MUST decrease sugar and white flour which are the primary culprit of the increase in obesity, metabolic syndrome, heart disease, dementia, and other chronic disease. Adding fat to a diet high in refined carbohydrates is not a good combination.

 

Cholesterol is a good thing (yes, you heard that right)…

Forget everything you have ever heard about cholesterol and let me give you some facts:

Here are some reasons why cholesterol is good:

  • Cholesterol is a building block of every cell in your body.
  • Cholesterol is important for your brain function.
  • Cholesterol is the building block for hormones like estrogen, testosterone, progesterone and DHEA.
  • Vitamin D, a powerful hormone essential to your health, is made from cholesterol.
  • Cholesterol is important for digestion of fats.
  • 80% of your cholesterol is produced by your body because your body needs it.

Here are some important facts that you need to know about cholesterol testing:

  • When it is was discovered in the early 1900′s that plaques in the coronary arteries contained lots of cholesterol, it was assumed that cholesterol was the culprit. We now know that cholesterol is an innocent bystander NOT the villian.
  • You have all heard about “good cholesterol” (HDL) and “bad cholesterol” (LDL). This is actually a misnomer. LDL and HDL are not types of cholesterol but are actually lipoproteins, “vehicles” that transport cholesterol (“passengers”) around the body. A standard lipid panel (Total, LDL, HDL, and Triglycerides) measures the amount of cholesterol carried by these “vehicles”. Although elevated LDL cholesterol is a risk factor for heart disease, there are now even more specific markers to determine risk.
  • The smaller and more dense the “vehicle” (dense LDL), the higher the risk that it can enter the wall of the blood vessel and form plaque. The more inflammation in the body, the more likely that plaque will become unstable, break off and cause a heart attack or stroke. Measuring the size and types of these “vehicles” (advanced cholesterol testing) as well as markers of inflammation, tells you much more about your risk.
  • If you have risk factors for heart disease (high LDL cholesterol, high blood pressure, diabetes, smoking, obesity, family history of heart disease) you should have advanced cholesterol testing.
  • I would not start a patient on cholesterol lowering medication until I have fully evaluated all these markers.
  • I would not start a patient on medication until I have encouraged them to improve their numbers with lifestyle changes such as nutrition, exercise, stress reduction, weight loss, and smoking cessation. I have seen a patient lower their LDL by over 100 points by ONLY changing what they eat (and it was not a low-fat, low-cholesterol diet). Food is a much more powerful medicine than anything a drug company can produce.

Here are some important facts about diet and lifestyle that you need to know in relation to cholesterol:

  • For decades doctors have been recommending a low-fat, low-cholesterol diet as a treatment of high cholesterol; however, there is not strong evidence that the amount of cholesterol or fat in the diet contributes significantly to cholesterol levels or risk of heart disease.
  • There is more and more evidence that the “Standard American Diet” (S.A.D.), high in refined flour, sugar, trans-fats, and additives/preservatives is the culprit in addition to lack of healthy components of the diet including vegetables and fruits, nuts and seeds, fatty fish, and healthy fats (yes FAT).
  • Other contributors to elevated dense LDL and inflammation are chronic stress and lack of exercise.
Here is why I am not quick to prescribe cholesterol lowering statins (Lipitor, Zocor, Crestor, etc…).
  • I am concerned that we are overtreating with these drugs without knowing the long-term consequences and without adequately assessing the patients risk for heart attack and stroke.
  • There is mounting evidence that cholesterol is essential for optimal functioning of the brain. The FDA just added a warning that statins can cause cognitive problems (poor memory and difficulty concentrating). Studies show that higher levels of total cholesterol reduce risk of dementia (by up to 80%), depression, parkinson’s disease, and death from all causes and that those with higher levels of total cholesterol have better memory.
  •  Statins reduce levels of CoQ10 (ubiquinol). CoQ10 is a vital substance that is produced by your body and used by every cell for energy production, cell growth, muscle contraction. Statins can cause fatigue and muscle pain likely due to the interference of your body’s production of CoQ10.
  • Statins increase risk of developing diabetes in women. It is ironic that we are treating one risk factor for heart disease (high cholesterol) and at the same time increasing the risk of another condition (diabetes) that causes the very condition that we are attempting to prevent (heart attack).
  • I am concerned that we are not providing adequate, up-to-date advice on the role of nutrition in treating abnormalities of cholesterol and inflammation.
  • Although statins have been shown to reduce the risk of heart attack, they do not fix the underlying cause of the problem which is usually the everyday personal health choices we are making.
  • Keep in mind that statins are a billion dollar business for the pharmaceutical industry. The majority of studies are funded by this industry and unfortunately, this is where doctors get their information, from studies largely funded by those directly benefitting from the sale of the drugs.
Important note for those taking cholesterol lowering medications.
  • If you are taking a stain drug, DO NOT stop the medication.
  • Talk to your doctor about whether you need it. Ask for advanced cholesterol testing.
  • If your lipid profile is bad, you may need to stay on the medication.
  • Take control of your health and make changes you need to make to improve your health. Once your numbers improve, you can address whether you can discontinue the medication. For more about eating for health, read more