Nighttime Blood Pressure Risk

Congestive heart failure (CHF) risk has been linked to nighttime blood pressure. High blood pressure is a risk factor for CHF, in which the heart pumps blood inadequately. In a study of 951 men, those whose blood pressure did not drop at night (as typically occurs in healthy adults)—or whose pressure rose—were 2.3 times more likely to develop CHF over a nine-year period than those whose blood pressure fell at night.

If you have high blood pressure: Ask your doctor whether your nighttime blood pressure should be checked.

Cholesterol Mania—Millions of Americans Are Taking Drugs They Don't Need

Cholesterol-lowering "statin" drugs are big business. Atorvastatin (Lipitor), one of the most popular drugs in this class, is among the most commonly prescribed medications in the US. With approximately 12 million Americans using it, US sales of Lipitor totaled about $6 billion in 2008.

Why are so many people taking these drugs? It's long been known that elevated cholesterol levels are associated with an increased risk of heart disease, but nou/ consumers are being given an additional incentive to use these drugs. The National Institutes of Health's National Cholesterol Education Program (NCEP) Adult Treatment Panel III released updated guidelines for cholesterol drug therapy. According to these guidelines, 37 million Americans—or one in five adults—are eligible for cholesterol-lowering medication. Previous guidelines recommended these drugs for 13 million Americans. I find the new guidelines very suspect. Read on, and you will understand why.

The updated recommendations are based on a review of five clinical trials using statins. One of the key changes in the new guidelines involved lowering the optimal range for LDL "bad" cholesterol in the blood in all adults to less than 100 milligrams per deciliter (mg/dL). People with cardiovascular disease or other risk factors, such as diabetes, smoking or hypertension, are told to aim for the same level-with an "optional target" of less than 70 mg/dL. It is rare for any of the patients I test—whether they are healthy or not—to have LDL levels below 100 mg/dL. I encourage my patients to strive for an LDL level of 100 mg/dL to 130 mg/dL with an HDL "good" cholesterol level of 50 mg/dL or higher.

The evidence for the new NCEP guidelines was challenged in a letter from the Center for Science in the Public Interest (CSPI), a nonprofit consumer advocacy group that conducts research in health and nutrition.

The CSPI letter, which was signed by more than three dozen physicians, epidemiologists and other scientists, urged the NIH to convene an independent panel to conduct a second review of the studies. They wrote, "There is strong evidence to suggest that an objective, independent reevaluation of the scientific evidence from the five new studies of statin therapy would lead to different conclusions than those presented by the current NCEP. The studies cited do not demonstrate that statins benefit women of any age or men over 70 who do not already have heart disease."

The letter also cited concerns that were raised after one study showed that statin therapy significantly increases the risk of some types of cancer in the elderly. (Research has, indeed, shown that statins can increase risk of nonmelanoma skin cancer and breast cancer. Other research, however, has linked statin use to a decreased risk for some types of cancer such as colon and prostate malignancies.)

There was another alarming discovery. Eight of the nine authors of the new LDL recommendations had financial ties to statin drug manufacturers, including Pfizer, Merck, Bristol-Myers Squibb and AstraZeneca. In response to the CSPI letter, the NIH declared that the scientific basis for the new guidelines was adequate and there was no conflict of interest for panel members.

No conflict? Is it pure coincidence that most of the authors of the guidelines had financial ties to statin manufacturers? Now millions of Americans are following these misguided recommendations for statin therapy instead of using natural treatments.

STATIN DANGERS

Statins first became available in the US in the late 1980s and were marketed as a unique treatment for elevated cholesterol—they inhibit an enzyme called 3-hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase, which is involved in the production of cholesterol in the liver. In addition to Lipitor, other statins include rosuvastatin (Cresto), lovastatin (Mevaco), and pravastatin (Pravachol).

The most common side effects of statins are headache, nausea, vomiting, constipation, diarrhea, rash, weakness, muscle and joint pain, and increased liver enzymes. The most serious, but rare, side effects are liver failure and rhabdomyolysis, a life-threatening condition that causes extensive damage to muscles.

In addition, statins deplete the body of coenzyme Q10 (CoQ10), a naturally occurring substance that your body needs to create energy in cells, particularly heart cells. In one study, the CoQ10 blood levels of Lipitor users were reduced by 50% after 30 days of statin use. To prevent a deficiency of CoQ10, I recommend that my patients who use statins take 100 mg to 200 mg daily of CoQ10.

CHOLESTEROL-LOWERING THE NATURAL WAY

The general medical community pays lip service to diet and lifestyle changes as a first line of therapy for abnormal cholesterol levels—but many patients are pressured to begin drug therapy right away, while diet and lifestyle changes are only an afterthought. Conventional doctors often tell patients that they have a genetic cholesterol problem and that cholesterol-lowering medication is their only option because diet and lifestyle changes would not be sufficient. Some people, such as those who have acute cardiovascular issues or extremely high total cholesterol levels (above 350 mg/dL) and/or significantly elevated LDL levels (above 200 mg/dL) are usually not able to control their cholesterol levels through diet and lifestyle changes alone. However, many people can bring their cholesterol and lipid levels into normal range by watching what they eat, exercising and reducing their stress levels. Nutritional supplements also are an option.

If your cholesterol is mildly or moderately elevated (total cholesterol 200 mg/dL to 239 mg/dL...and/or LDL above 130 mg/dL), get a baseline cholesterol test if your levels haven't been tested in the last six months. Then try the diet and lifestyle changes described in this article for eight to 12 weeks. If you don't see at least a 10% reduction (based on a repeat blood test), add targeted nutritional supplements.

People who are unable to reduce their cholesterol levels through diet and exercise and/or who have family members with high cholesterol are likely to be genetically predisposed to the condition. Such people should not rely on lifestyle changes alone.

Better: They should combine the healthful practices described here with regular supplement use.

Important: There are times when I recommend statin therapy—immediately after a heart attack to reduce inflammation and when there is extreme elevation in total cholesterol (400 mg/dL or higher) and/or LDL cholesterol (210 mg/dL or higher), usually due to genetics.

DIET AND LIFESTYLE CHANGES

My suggestions for improving cholesterol levels...

1. Reduce saturated fat in your diet to less than seven percent of daily calories. Saturated fat is found mainly in beef, veal, pork and poultry (especially in dark meat and the skin of any meat). Saturated fat is plentiful in most dairy products, except nonfat yogurt, reduced-fat cheese and skimmed milk. Small amounts are found in coconut and palm oils, so consume these sparingly. To monitor your saturated fat intake, keep a daily record based on food label information.

Avoid products that contain trans fatty acids, which often are found in deep-fried foods, bakery products, packaged snack foods, margarines (except those with cholesterol-reducing plant stanols or plant sterols), crackers and vegetable shortening. If a product contains more than 0.5 grams of trans fat per serving, the label will list the trans fat content. Avoid foods that "hide" trans fats by using the term "partially hydrogenated" on their labels and claiming 0 grams (g) of trans fat. Common offenders include baked goods, crackers and packaged mixes. Cardiovascular disease is linked to trans fat intake because this unhealthful fat raises levels of LDL cholesterol and blood fats known as triglycerides, while lowering beneficial HDL cholesterol. Cook with organic olive or canola oil. Macadamia nut oil also is healthful.

2. Consume two weekly servings of foods rich in heart-healthy omega-3 fatty acids. Sources include some types of fish—anchovies, Atlantic herring, sardines, tilapia and wild or canned salmon. For a list of fish not contaminated with mercury or polychlorinated biphenyls (PCBs), check www.oceansalive.org, the Web site of The Environmental Defense Fund, a Washington, DC-based, nonprofit group dedicated to solving environmental problems.

3. Eat five to seven daily servings of fruits and vegetables. Produce contains antioxidants that prevent oxidation (cell damage from negatively charged molecules known as free radicals) of cholesterol, as well as fiber that helps lower cholesterol.

4. Consume foods that contain soluble (dissolves in liquid) fiber, such as beans, barley, oats, peas, apples, oranges and pears. Soluble fiber reduces the absorption of cholesterol from the intestines into the bloodstream. For example, a daily bowl of oatmeal can reduce total cholesterol by as much as 23%. Oatmeal also has been shown to curb LDL cholesterol levels without lowering beneficial HDL cholesterol.

5. Eat nuts, such as walnuts and almonds, which are rich in healthful monounsaturated fatty acids. A study conducted in Barcelona, Spain, showed that a walnut-rich diet reduces total cholesterol by 4.4o/o and LDL cholesterol by 6.4o/o. Macadamia nuts, pistachios, almonds, hazelnuts and pecans also have been shown to reduce cholesterol levels. Eat a handful of walnuts or any of the nuts listed above daily.

6. Add ground flaxseed (up to one-quarter cup daily, taken in two doses) to protein shakes, cereal and/or salads. Flaxseed has been shown to reduce total and LDL cholesterol. Drink 10 ounces of water for every two tablespoons of flaxseed you consume, to prevent intestinal blockage.

7. Consume 20g to 30 g of soy protein daily (in food or protein powder form). Some studies suggest that soy protein may lower cholesterol levels in some people with high cholesterol. Because soy protein has a potential estrogen-like effect, it should be avoided by women who have breast cancer or a family history of the disease.

8. Reduce daily intake of simple sugars, such as those in crackers, cookies and soda. Found in abundance in processed packaged foods and many baked goods, they have been shown to decrease HDL cholesterol. By cutting back, you also reduce risk of elevated insulin levels, which lead to increased production of cholesterol by the liver.

9. Exercise regularly. Thirty minutes of exercise, such as brisk walking, swimming, biking or tennis, three to five times a week is effective for lowering elevated cholesterol.

10. Lose weight and body fat. 'Weight loss by people who are overweight reduces cholesterol levels and prevents insulin resistance, a blood sugar problem that can lead to high cholesterol.

11. Don't smoke. Smokers have lower levels of HDL cholesterol and an increased risk of heart attacks.

12. Adopt stress-reduction techniques, such as deep breathing and biofeedback. Stress has been shown to elevate cholesterol in most individuals.