- All meats have cholesterol, but the highest content is found in pork. Start with trying to eliminate/limit pork -bacon, sausage, pepperoni, salami etc. Remember, it may be "hidden" in things like pasta sauce and ravioli. Beef has the next highest, and chicken and turkey a little less if you remove the skin.
- Limit/eliminate egg yolks. The white of the egg is cholesterol free. The 2015-2020 Dietary Guidelines for Americans concluded that "individuals should eat as little dietary cholesterol as possible" in response to the Advisory committee statement supporting egg consumption. I endorse the Dietary Guidelines position.
- All seafood contains cholesterol. Generally shellfish had been felt to be higher in cholesterol than fish. The picture was confused in the past because sterols in the shellfish were being measured as part of the total cholesterol content. Additionally, the health benefits of the omega fatty acids and phytosterol content somewhat offsets the negative effects of the saturated fat content. Oily fish have only modestly lower cholesterol levels, generally speaking. Mollusks like clams and some oysters have less cholesterol than many fish. My preference, if you consume fish somewhat regularly, is to look for less oily white fish filets. The tables of cholesterol content of seafood are for 3oz fish. If you double this to a more realistic 6oz portion, you are consuming close to 200mg cholesterol, the amount recommended for individuals who have suffered a cardiovascular event; those that have not are allowed 300mg. If you are not careful, you can overrun the daily recommendations before dessert!
- Milk is an animal product with animal protein and saturated fat. Transition to low fat and non-dairy alternative products. You could start by transitioning to 1% then 0% milk and yogurts, using low fat cheese; then try to step out and try alternative products like almond or soymilk (non GMO) and "milk and yogurt" alternatives such as: Ben & Jerry's almond milk non-dairy frozen dessert or So Delicious soy based frozen desserts. I discourage coconut cooking oil/coconut milk based products because coconut oil is a saturated fat, albeit not an animal fat. As a general rule, we want to lower all fat intake, mostly "bad" cholesterol fats, but we are learning to be mindful of of even "good fats".
- Modest but consistent physical activity such as a 30 minute walk at least 5 days a week raises good HDL cholesterol, lowers blood pressure, improves glucose metabolism, boosts the immune system and lowers overall mortality rates 30%. If we have discussed moderately vigorous physical activity such as bicycling, then 3 times weekly has been shown to achieve these benefits; again, consistency is the key.
The over the counter supplements below are appropriate for moderately elevated cholesterol in that individual who has not had a cardiovascular event (myocardial infarction, angina, stroke, tia, or evidence of peripheral vascular disease) nor for those with multiple cardiovascular risk factors such as hypertension, diabetes, family history, tobacco use history and "middle age"(post menopausal women without protective effects of estrogen). These agents offer a modest addition, not replacement for, the dietary lifestyle changes.
Plant Phytosterols are substances found in various vegetable oils, seeds, nuts and fruits with a chemical structure similar to cholesterol, explaining one of its properties: blocking some of the cholesterol absorption from the intestines. It is also available in various supplements. Consumption of between 2,000 to 3,000mg of plant sterols daily can be expected to reduce LDL (bad) cholesterol by 10-15%. A common locally available brand is NatureMade (“Original”) CholestOff; a serving twice a day provides 1,800mg. Puritans Pride manufactures “Phytosterol Complex” (item #13981) at puritan.com.
RED YEAST RICE
Red Yeast Rice is a fermented product that grows on rice that contains monacolin K, the active component in the prescription “statin” Lovastatin. Although there are several reports of statin type side effects such as muscle pain, and elevated liver enzymes, a 2009 study found it is generally well tolerated even in statin intolerant patients; supplementing CoQ10 (Coenzyme Q10) which can be depleted by statins and red yeast rice, can limit adverse effects. There are many brands of Red Yeast Rice available. Puritan.com has one mixed with CoQ10 (item #17045). There is concern that some brands have been found to contain Citrinin – a toxic fermentation by product. The usual preventative dose of CoQ10 is around 50mg a day. The therapeutic dose of CoQ10 used to treat statin toxicity is much higher and will be counseled in the office if indicated.
Niacin is a B vitamin that has a beneficial effect on all lipid parameters, especially Triglycerides. It has to be the actual niacin and not the “no flush” alternatives. The flush can be avoided by following a slowly increasing dose over 3-4 weeks before moving over to Niacin 500mg, the usual “prescription strength” starting dose. Generally, preceding the Niacin with aspirin 81mg or ibuprofen OTC 200mg and then taking the Niacin after a meal also helps prevent the flush, or reduce it to minimal amount. The “flush” is not an allergic reaction. Generally, I should be guiding you before you start this treatment, as it is usually reserved for those who can’t tolerate other therapies or for add on for very high Triglycerides, as the evidence for lower cardiovascular events is very limited. The lowest starting dose of Niacin I have found in the Killeen area is KAL Niacin 50mg tablets at Natural Grocer in Temple. Starting ½ tablet twice a day and increasing by ½ tablet every two days brings you up to around 500mg by 3 to 4 weeks; then swap in the once daily Niacin 500mg (prescription dose if covered by your insurance); again the Niacinamide and Inositol “No Flush” varieties do not have the same benefits. The dose can be increased, depending upon response, up to 2,000mg and rarely to 3,000mg maximum a day.
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