Differences Between the Sexes on Cholesterol?

For a long time, medical studies didn’t include women because researchers were afraid that their menstrual cycle would skew results or that the subjects would become pregnant and have to stop taking a medication. Younger women were also less likely to have heart disease, which meant more participants would have to be included to be able to show a difference in outcomes if women were involved. More study subjects means more money to do the study, so leaving women out was a practical decision that wasn’t as sexist as it sometimes appears.
Fortunately, once the benefit of a particular therapy was shown in men, the economics made it favorable to study women as well, and later studies have shown that women benefit just as much as men do from cholesterol-lowering interventions, whenever the risk is equivalent. By the time women are in their midsixties, their risk of new coronary events is similar to that of similarly aged men, so there should be little difference in treatment at that point. In younger, premenopausal women, the risk for heart disease is less than that of men, so fewer women in this age group require treatment. However, when all risk factors are taken into account, men and women of equivalent risk for heart disease get treated to the same LDL target goals.

Low HDL

Recommendations for people with low HDL levels are a little less cut-and-dried than those for the other lipid problems. That’s because we don’t have any studies showing specifically that if we raise HDL levels, heart disease risk goes down. We know HDL is good for the heart, so we believe that the higher the levels the better, but no studies have unequivocally proved that. Why? Because all the drugs we employ to raise HDL levels typically lower the LDL or triglyceride values at the same time. This makes it hard to tell which change caused the benefit of fewer heart problems. Recent animal studies have also shown that there may be good ways to raise an HDL cholesterol level and bad ways to do that, so without knowing how a drug has led to a change in HDL, one can’t readily predict if its effects would be beneficial or detrimental.
None of the statins alter HDL levels very dramatically (about 4 percent to 10 percent increase), whereas the fibrates and niacin do a better job of raising HDL levels (about 10 percent to 15 percent). Despite the unanswered questions about treating HDL, it is a very important blood value, with some studies indicating it predicts coronary disease risk better than any other single lipid value. The large observational study called the Framingham Heart Study suggests that every 1 mg/dL decrease in HDL increased the risk of having a heart attack by 2 percent to 3 percent. And the NCEP classifies an HDL level below 40 as a major risk factor for developing heart disease.
Most doctors don’t often prescribe medications to raise HDL levels, because the drug that works best—niacin—can be hard to take and may have side effects that are particularly undesirable in
the population most likely to have low HDL levels: diabetics. More options should become available in the near future, as the study of HDL metabolism is the most active area of cutting-edge research in the lipid field, and several new approaches are currently in early clinical trials. Luckily, though, there are a lot of lifestyle changes that raise HDL levels that are also beneficial to the rest of your cholesterol profile, your heart in general, and just about every other part of your body. The following can help you raise your HDL level:
• Exercising
• Not smoking
• Avoiding foods with trans fats (a lot of margarines, fried foods, some commercial baked goods)
• Losing weight if you’re overweight
• Drinking a small amount of alcohol every day (typically one drink for women, two for men)
Again, while we don’t know if raising HDL through these changes will help prevent heart disease, we do know that their other benefits will definitely decrease heart disease risk.

Reductase Inhibitors (Statins)

Statins are the most widely used class of cholesterol-lowering drugs. Large, randomized clinical trials have shown—and continue to show—that people who use statins have a 20 percent to 40 percent reduction in death from incidents of major cardiac events in studies lasting two to six years.
The study that really brought statins into the limelight was called the Scandinavian Simvastatin Survival Study, or the 4S trial. It involved 4,444 men and women, ages thirty-five to seventy, who had preexisting heart disease and high total cholesterol levels. Half took the cholesterol-lowering drug simvastatin for five years, and half took placebo tablets containing no medication. By the end of the trial, LDL levels in the treatment group had fallen by 35 percent and total cholesterol dropped by 25 percent, while no change took place in the placebo group. The treatment group also had a 30 percent lower chance of dying during the trial and a 34 percent lower chance of having a major coronary event (a nonfatal heart attack or death from coronary heart disease).
Other studies that proved statins’ effectiveness in other populations followed in relatively short order. While the 4S participants all had preexisting heart disease, the 6,595 men who volunteered for the West of Scotland Coronary Prevention Study did not, though they did have high cholesterol. Those who took a statin (this time one called pravastatin) lowered their LDL and total cholesterol levels by 26 percent and 20 percent, respectively, and their risk of having a major coronary event by 31 percent, compared with those who took placebo tablets.
Then came the Cholesterol and Recurrent Events (CARE) trial. This study of pravastatin therapy involved 4,159 people who had recently had heart attacks but whose LDL cholesterol levels were only modestly elevated (the average was 140–150 mg/dL). Compared to subjects in the control group, those taking pravastatin for five years were less likely to have a stroke or a second heart attack or need a procedure to open a clogged artery In the space of just four years, these large studies marshaled powerful evidence of the value of statin drugs in lowering cholesterol.
And more studies continue to confirm this. The Heart Protection Study published in 2002, for example, studied the effect of simvastatin versus placebo in more than twenty thousand people in Great Britain with heart disease or diabetes, but with low enough LDL levels that statins would not necessarily be prescribed. Half were randomly chosen to receive simvastatin, the other half placebo. The ten thousand people receiving simvastatin had 18 percent fewer deaths from cardiovascular events and a 25 percent reduction in first heart attacks and stroke over the five years of the study. Even more recently, other studies have shown the benefit of lowering cholesterol levels lower than was previously recommended.
These and other studies demonstrated that statins reduce the risk of having a heart attack or other major coronary event for almost everyone—people with and without preexisting heart disease and those with high cholesterol, borderline-high cholesterol, and even normal cholesterol. This has prompted some to suggest that almost everyone should be taking a statin, and the United Kingdom has recently approved the sale of a statin as an over-the counter drug. Should everyone be on a statin? The answer is no. First, statins are not approved for use in women who are pregnant because they may cause fetal damage. Second, statins have side effects that, while rare, are serious. Third, statins are expensive, and many people can achieve acceptable levels of coronary disease risk without using medications at all. So, I think the message physicians should be bringing to their patients is not that everyone should be on a statin but rather that everyone should know their heart disease risks and be treated if those risks warrant it. A lot more people should probably be on statins than are currently taking them, but these drugs are definitely not for everyone.

Proteins !!!!!

I suggest a daily intake of 20 percent lean protein. Good sources of protein are chicken breasts, all types of fish, beef with a low fat content (in moderation), and soy products. Protein is a stabilizing food that assists in insulin management, as well as serves other vital roles in normal body function. Because protein is not stored, a person requires three balanced meals and two or three snacks that include protein per day to suppress their hunger and mobilize their body fat for burning during physical exercise. A good protein to ingest as a snack would be soy-based foods such as Personal Edge soy protein powder, which you can find in many health food stores or General Nutrition Center stores in your area. Research has shown the greatest benefits occur from ingesting at least 20 to 25 grams per day. I suggest adding your soy powder to low-fat milk or unsweetened fruit juice and having it as a midmorning and midafternoon snack.
Soy products have always been a part of my nutrition programs because of their many benefits. Research studies have shown that an overabundance of the amino acid lysine increases the level of bad cholesterol in the body, while the amino acid arginine decreases it. Compared to animal protein, soy has a more favorable ratio of arginine to lysine. This lower ratio decreases the body’s production of insulin and increases its production of glucagon. What this means is that eating soy every day helps you to shift your metabolism from fat storage to fat mobilization.
Soy products also help to lower the risk of coronary disease. And when used in conjunction with a properly balanced nutrition and aerobic exercise program, they are an important tool for lowering your body fat and cholesterol levels. Studies have shown that soy foods also lower the risk of hormone-related cancers.
In addition to soy-based powders, there are many delicious soy food products available, including soy burgers and hot dogs, many delicious varieties of tofu, soy cheeses, and soy milk. Soy products can be a nutritional mainstay for vegetarians faced by the challenge of getting sufficient protein in their daily diet.
When choosing other protein sources, always choose lean meats and low-fat dairy. First-choice protein sources include skim milk; fatfree cheese and cottage cheese; yogurt made from skim milk; 95 percent lean ground beef, turkey, or encased meats (e.g., sausage and bologna); white-meat, skinless chicken; white-meat tuna in water; egg whites; and nonfried fish and seafood.
According to the American Journal of Clinical Nutrition, eating fish daily decreases insulin levels, increases glucose production, lowers triglyceride (bad fat) production, and increases the level of HDL cholesterol (good cholesterol), reducing your risk of cardiovascular disease. For this reason, it is important to eat cold-water fish such as salmon, mackeral, and halibut at least twice a week.
The current RDA recommendation for protein is 0.8 grams per kilograms of body weight, but this does not provide enough for the dietary needs of individuals involved in regular exercise. Dr. E. C. Henley, who designed the food program in this chapter, suggests 60 to 100 grams of protein daily. If you want to know how many grams of protein are in a food source such as packaged meats or fish, nut butters, or soy products, simply read the label.
Getting your proper daily protein allotment is important for another reason. Based on a study of men between the ages of forty and seventy published in the Journal of Clinical Endocrinology and Metabolism, a diet with adequate amounts of protein helps stop the decrease in testosterone levels that many men experience as they age. The article goes on to say, “Diets low in protein lead to increases in sex hormone-binding globulin in older men, potentially reducing the availability of testosterone and causing loss of muscle mass, red cell mass and bone density.”

Essential Fatty Acids Decrease Health Risks

Two kinds of unsaturated fats are necessary for your very survival. These are the essential fatty acids omega-6 (linoleic acid) and omega-3 (linolenic acid). Since your body cannot manufacture these fatty acids, they must be obtained from the foods you eat. Omega-6 is fairly common and is found in most of the vegetable oils sold in the grocery store. I suggest, however, that you try to buy your vegetable oils in health foods stores, if possible. Most typical grocery store oils, which are processed for mass distribution, are often filled with free radicals and bad fats called trans-fatty acids. Omega-3 is found in soy oil, walnut oil, flax oil, and canola oils and in dark green, leafy vegetables. I suggest that you purchase all oils in dark-colored green or amber bottles, since clear bottles tend to make the oils go rancid after a time due to chemical changes caused by exposure to sunlight.
It is especially important to make sure that you supplement your food plan with enough omega-3 fats, since the American diet is usually deficient in this nutrient. While the ideal ratio of omega-6 oil to omega-3 should be between 3:1 and 4:1, a recent study showed that for most people their level of omega-6 is 20 times their level of omega-3.
The benefits of ingesting the proper amount of unsaturated fats and essential fatty acids include:

• Lowering cholesterol levels
• Lowering high blood pressure
• Decreasing symptoms of heart palpitations and angina
• Preventing significantly the risk of heart attacks and strokes
• Decreasing the symptoms of multiple sclerosis
• Decreasing the pain and swelling of rheumatoid arthritis
• Correcting or markedly improving skin conditions such as psoriasis and eczema
• Lowering the risk of cancer

There are several other ways to increase the amount of essential fatty acids in your diet. For example, cold-water fish such as salmon, mackerel, and trout are rich sources of the essential fatty acid metabolites DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). These have been shown to help lower blood pressure, improve cholesterol levels, and lower one’s risk for cardiovascular disease. Aside from simply eating fish a minimum of twice per week, you can supplement your diet with omega-3 by taking fish oil capsules (taken with a meal), available at most pharmacies or health food stores.
Flax oil is another rich source of omega-3 and all essential fatty acids, which is why body builders mix it into their protein drinks so often. It is best taken not in capsules but in liquid form to make sure that it is fresh and of high quality. The next time you are fixing a green salad, try using a tablespoon of flax oil as a dressing, or half a tablespoon mixed with sunflower oil or a little vinegar. You may also lightly brush it over meat after it has been cooked.
Other acceptable oils or products containing oils include corn oil, Hellmann’s Light Mayonnaise, Kraft Light Mayonnaise, Smart Balance Soft Spread (no trans-fatty acids), and unsaturated corn oil. Products such as Promise, Take Control, Fleischmann’s Margarine, and I Can’t Believe It’s Not Butter! (spray, not solid) are excellent butter alternatives. If real butter is your only alternative when dining out, use it in moderation.
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Exercise for Heart Health

Be aware that doing the right kind of exercise is one of the best prescriptions for gaining and maintaining a healthy heart and cardiovascular system. According to an excellent ten-year study done at the Ochsner Heart and Vascular Institute:

• Regular exercise is associated with marked reductions in the long-term risks for major cardiac events such as heart attack or stroke, and death from heart disease.
• People who exercise regularly, at least three times per week, reduced their chance of a cardiac event from 30 to 50 percent.
• A study from the Cooper Clinic shows that physical fitness is directly correlated with increased life span and fewer deaths from cardiovascular causes and cancer.
• Even for obese individuals or for people with several coronary heart disease risk factors, physical fitness strongly decreases the chance of developing symptoms of heart disease.

The Ochsner Heart and Vascular Institute has found that the following types of exercise are most effective in treating people with cardiovascular disease, or for people wishing to avoid developing cardiovascular disease:

• Dynamic or aerobic exercises, which include walking, running, cycling, swimming, aerobic dancing, cross-country skiing, and using elliptical machines.
• Light isotonic exercises such as using handgrips or weight lifting (frequent repetitions with low amounts of weight).

The Pro Circuit Exercise Program,fills this prescription perfectly in that it alternates periods of aerobic exercise with periods of isotonic (weight training) exercise.
But before beginning any exercise program, if you are a healthy but sedentary woman over the age of fifty or a man over the age of forty, remember that the American College of Sports Medicine recommends that you should always consult with your physician and have a preexercise medical examination. This is even more important if you have high blood pressure, chest pains, high cholesterol, or any serious risk factors for heart disease, or if you are a smoker.

Reduce Your Health Age to Increase Your Performance Levels

All of us have a chronological age and a health age. One of the hardest tasks we face in the workplace and in life is learning how to manage our health and performance so that the wear and tear of the job doesn’t make us old before our time.
We have all seen men and women who slow down and become old before their time, with a health age much greater than their chronological age. The person who burns the candle at both ends might be fifty but looks and feels like he’s seventy.
On the other hand, we all know incredibly youthful and energetic individuals who might be fifty, but look, feel, and perform like a thirty-year-old. Their health age—their general level of fitness—is below their chronological age. The factors that determine our health age include body fat percentage, resting heart rate, upper body and lower back strength, metabolic rate (normal thyroid), cholesterol, fasting glucose, and triglyceride levels. Those in our society who have a lower health age are the new elite because they have the energy to perform dynamically while others are struggling to maintain the status quo. For example, I have one sixty-seven-year-old
client, Alvin Edinburgh, who is so fit he was chosen to be one of the Olympic torchbearers.
When I turned fifty, my doctor told me I had the health age of a nineteen-year-old. This is not just luck or good genes. It has everything to do with how you manage your greatest asset, your health. Achieving and maintaining optimum health in your thirties, forties, and fifties are governed by very specific lifestyle choices—as are maintaining physical vitality, a good mental outlook, and passion during your last decades of life. The best news is that it is never too late to start.
Doctors used to say that our health was 50 percent heredity and 50 percent environment. They have since revised those percentages to 33 percent heredity and 66 percent environment. So aside from serious injuries or inherited health problems, you have a tremendous amount of control over your health age and, therefore, your performance age.