I smiled politely, hushed my children and bit my tongue. The latter was done to refrain from suggesting that the laughter of children might be far better for the patients' hearts than the creamy linguini and mud cake with double cream that was on the hospital menu and being offered to the patients that day. As one patient commented afterwards while looking at the menu, "I thought this was how I got here in the first place."
For years now there has been the idea that physicians need to be implementing more lifestyle changes with the goal of lowering society's reliance on cholesterol lowering medications. This is why I am horrified when I read about suggestions by the American Academy of Paediatrics that kids as young as eight are prescribed cholesterol lowering medications as a preventative approach to the goal of reducing future heart disease. Is society failing so badly that we cannot help these poor children without the aid of such a downstream healthcare approach? Even in individuals with a genetic predisposition towards extremely elevated cholesterol, the problem can often be effectively addressed through significant lifestyle changes or naturopathic medicine or a combination of both.
But let me throw the cat among the pigeons and ask you, "What's more important, lowing your cholesterol level, or lowering your heart disease risk?" They are not necessarily the same thing and different approaches are needed depending upon your genetic tendencies, your good to bad cholesterol ratio, and several other modifiable biochemical factors such as your level of inflammation, oxidation, methylation and glycation.
Confused? This is probably why the focus has been predominantly kept on one drug-modifiable factor, which is to lower the "bad cholesterol", LDL, through the use of statin drugs.
Research even suggests that increasing blood levels of HDL cholesterol (the good one that is anti-inflammatory and strips away atheromas) may be more important than lowering LDL for cardiac risk reduction.
For most people, lowering dietary cholesterol minimally affects blood cholesterol, as the liver tends to just make more of it. For the others, the dietary approach can be helpful in lowering total cholesterol - which is clearly not the be all and end all of heart disease risk.
When I show my patients their blood on the screen as we examine it microscopically during a hemaview analysis, many are horrified to see cholesterol floating around freely in their blood, linking its presence to heart disease risk. The truth is that we actually need cholesterol for the production of hormones and vitamin D, as an essential component of cell membranes, nerve coatings, bile acid, and for its part in the maintenance and repair process for normal circulatory tissue.
This last point is where the trouble lies. When the circulatory walls are damaged by an inflammatory or traumatic assault caused by any number of factors - including elevated blood levels of homocysteine, insulin, infections, allergies, free radical excess and stress - these all trigger the repair response which involves cholesterol. When oxidised LDL cholesterol is involved in this process, the development of atherosclerotic plaques begins and, in the heart, a process known as cardiovascular disease.
In our not too distant ancestors, their total cholesterol levels tended to be around an astounding 3mmol/dL, not to mention the fact that their ratio of good to bad cholesterol was also far better than in people today. This is pretty much due to the sedentary lifestyle (too much sitting) and poor dietary choices that are so common today.
So what do you need to have a low cardiac risk? It's really simple - cover your bases and try to address all of the risk factors by adopting a healthy lifestyle and diet. This tends to dramatically reduce all of the risk factors by lowering your LDL, your oxidation, your homocysteine, your blood pressure, your insulin and blood sugar, while raising HDL. There are many specific dietary supplements and lifestyle changes that have enough of an evidence base to justify implementation, but to get you started try going for a jog, quickly followed by a good fish, almond, mushroom and bean curry, rich in turmeric, garlic, cinnamon and chilli, washed down with a small glass of red wine.
However, if you do have a known increased risk (through you or your family having a history of coronary disease or diabetes), or if you cannot or will not quit smoking, then you will definitely need a more comprehensive approach to lowering your risk than my run, curry and wine suggestion.
Good Health, Jeremy