Niacin Vitamin B3 for Cholesterol - The Revolutionary Cholesterol Breakthrough: How to Eat Everything You Want and Have Your Heart Thank You for It ( Orthomolecular Medicine ) [1 ed.] 0836210441, 9780836210446

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CHOLESTEROL BREAKTHROUGH How to Eat

Everything You VChnt and Have Your Heart Thank ¥)ufor It

Robert E. Kowakki Author of the#l

New York Times Bestseller

The 8-Week Cholesterol Cure

Rmlutiomrv CHOLESTEROL BREAKTHROUGH Robert E. Kowalski The man who

talked the nation into eating oat

bran for breakfast in the '80s now shows readers and how to once again enjoy bacon and eggs a bit. them bother cholesterol never have the fat and .

.

.

At the same time, the author of the phenomenal bestseller, The 8-Week Cholesterol Cure, cuts through all the confusion on diet and the heart. You and yom heart are going to love this book! A medical writer trained in both journalism

and

Kowalski was himself a victim of heart

science,

disease.

attack

By

the age of 41, he'd suffered a heart

and two bypass

surgeries.

Not wanting

to

leave his small children without a daddy, Kowalski made it his life's work to defeat heart disease. Now in this early fifties, the

by

heart attack.

author has been declared free of the risk of

be virtually

his doctors to

he says that everyone can do the

And

same, without denial and deprivation. Two revolutionary products, both completely natural and harmless, effectively block the

^m

absorption of

This

fat

and

cholesterol, respectively.

allows us to enjoy the foods

forbidden

1

we thought were

forever.

New food products allow us to return to the "comfort" foods we've missed for years. Kowalski invites us into his "Magic Kitchen" to share his recipes for gravy,

meadoaf with mashed potatoes and a la king, and juicy rare

creamy chicken

beefsteaks with

fat as

low

as fish.

^m

Missing links in the diet-heart-cholesterol pur/le have been filled in, and Kowalski provides the solutions to the newly discovered risk factors. Kowalski cuts through the public confusion,

wm

providing definitive answers to the questions all have on our minds: red wine? garlic? salt?

we

sugar? iron? "good" cholesterol? accurate testing? antioxidants? exercise? stress? And every word is

backed up by the world) top authorities.

scientific

and medical

.oi6 i2u5 Kuw Kowalski, Robert E. The revolutionary cholesterol breakthrough .

Branch Libier 107 E. 2nd St.

Rifle \

Bfle,CO 81650

DISCARDED FROM GARFIELD COUNTY PUBLIC LIBRARY SYSTEM

Digitized by the Internet Archive in

2010

http://www.archive.org/details/revolutionarychoOOkowa

The Revolutionary Cholesterol Breakthrough

Other Books by Robert

E.

Kowalski

The 8-Week Cholesterol Cure The 8-Week Cholesterol Cure Cookbook Cholesterol

& Children

The Endocrine Control Diet 8 Steps

to a

(with Calvin Ezrin, M.D.)

Healthy Heart

^iflo Dranc

f

Jjif

i

E 2nd St.

107 Rifle»

CO

•T h

81650

e

•

Revolutionary

Cholesterol Breakthrough -^ How

to

Eat Everything

You Want

and

Have Your Heart Thank You for

It

Robert E. Kowalski

Andrews and McMeel A UNIVERSAL PRESS SYNDICATE COMPANY

Kansas City

The Revolutionary Cholesterol Breakthrough:

How

Eat Everything You

to

Copyright

©

Want and Have Your Heart Thanh You for 1996 by Robert E. Kowalski.

It.

All rights reserved.

Printed in the United States of America.

No

part of this

book may be used or reproduced

in

any manner whatsoever

except in the case of reprints in the context of reviews.

For information write to

Andrews and McMeel, a Universal Press Syndicate Company, 4520 Main Street, Kansas City, Missouri 641 11.

-^hiI j

Library of Congress Cataloging-in-Publication Data

Kowalski, Robert E.

The revolutionary

cholesterol breakthrough

have your heart thank you for p.

it

/

how

:

to eat everything

you want and

Robert Kowalski.

cm.

Includes bibliographical references and index.

ISBN 0-8362-1044-1 (hd) 1. I.

Hypercholesteremia

— Prevention.

2.

Hypercholesteremia

—

Diet therapy.

Title.

RC632.H83K68 1996 616.r205— dc20

95-51772 CIP

Attention: Schools and Businesses

Andrews and McMeel books

are available at quantity discounts

with bulk purchase for educational, business, or sales promotional use.

For information, please write to Special Sales Department,

Andrews and McMeel, 4520 Main

Street,

Kansas

City,

Missouri 641

1 1.

Dedication

For Dawn, with

whom

I

look forward to enjoying

many hundreds and thousands

of dehcious meals

together in the years to come.

Here's a toast to dinner

number one

million!

Contents

r Foreword by Charles M. Keenan, M.D.

Acknowledgments Introduction

Part

I

1

Cholesterol, Fat, and Your Heart Charged

1

Cholesterol: Guilty as

Eggs, Cholesterol, and You: Unscrambling the

3

11

26

30

Fats in the Fire

Putting the Program Together

II

39

4

Good

5

Meet and Defeat the Newest Bad Guys

6

The Soluble Solution

Good

Food: The Cornerstone of

Health

7

Blocking Fat and Cholesterol Absorption

8

ACFS

9

Niacin and Your Heart:

of Hearts

J

A Lifesaver Revisited

11

Happy

12

The Ultimate Solutions

13

Does

14

The Diet-Heart Newsletter

It

Work?

for

144

Weight Control

157

177

Here's Proof! J

84

185

15

Trans Fatty Acids: The Fly in the Margarine

16

Fish and Fish Oil: Don't Let This I

18

A

Love Coffee,

17

Love Tea

I

Spoonful of Sugar ...

191

197

200

19

Take Sodium Advice with a Grain of

A

Loaf of Bread,

187

One Get Away

20

Heart

116

132

Heart, Healthy Heart

Cutting Through the Confusion

III

84

00

Fxercise Your Heart, Exorcise Your

Cholesterol

41

48

61

10

Part

9

2

Facts

Part

ix

xiii

A Jug of Wine, and

Salt

a

203

Healthy

210

A Clove

Day Keeps Heart Disease Away

21

Garlic:

22

Iron and Heart Disease:

a

A Rusty

Proposition

219

217

Conlcnls

Part IV

Food As You

Like It

223

23

The Magic Kitchen

24

Lunch with

25

Dinner with the Kowalskis

26

Dining Smart

References

Index

333

a

225

Punch, Not

for

323

a

Paunch

Your Heart

272

307

260

Foreword -¥

It is

with a great deal of pleasure and enthusiasm that

ing this foreword. Bob and I

I

it's

variations

on

take

on the task of writ-

many new ideas and

have always been impressed with the

Sometimes

I

have a long and happy affiUation. Over the years

his

own

therapy.

therapies he finds.

Other times

it's

from scouring

the medical literature or from frequently attending postgraduate medical sem-

He has always been

inars.

me

very kind in bringing

his latest findings in the

field of heart health. I

might digress a moment.

When

I

had

my own

cardiac concern in the

form of a needed coronary bypass operation, the person

He

Kowalski.

very succinctly

should be doing in

my best interest.

apy was extremely successful, thanks largely edge. to

I

Bob

had access for his

Who swer

and

is

to the best cardiologist in

should read Bob's all

those

for those close to

Bob has

a

remarkable

latest

who want clarity,

is

book?

add

southern California, but

I

turned

Who

will benefit

is like

a recipe.

a pinch of

style for simplicity

from

life

for

The an-

it?

themselves

Take a number of con-

humor, and cut into chapters.

and writing understandably. His de-

worth the price of admission. His explanations of the pathology

of hyperlipidemia, the role of fats

which

experience and knowl-

a longer, fuller, healthier

them. This book

simmer with

scriptions are

to Bob's

profound knowledge and understanding.

simple:

fusing facts,

consulted was Robert

I

me in on what he felt the cardiologist And he was entirely on the mark. My ther-

filled

and cholesterol

normally extremely complex,

weight loss alone

is

is

in heart health

remarkably

clear.

and

disease,

His chapter on

extremely valuable.

who would benefit from, or should read, this book? There are very of us who don't have some type of risk factor, be it blood pressure elevaSo

few

tion,

hyperlipidemia or high cholesterol, diabetes, obesity,

inactivity, stress,

or even smoking. These factors coupled with family or genetic problems affect

more than 80 percent

of the population.

Knowledge allows one

proper choices. The information in Bob's book certainly

knowledge and

will offer a reasonable, rational

will

approach

to

make

improve anyone's to longevity. This

X

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

book

gives everyone a very flexible, workable approach to a

most

all

problem

that al-

of us have in varying degrees.

Even those who read Bob's very popular previous book, The 8-Week Cholesterol Cure, will find a vast

introduces a tremendous

amount

number

of

new knowledge. In this new book, Bob new concepts regarding heart

of significant,

and even some variations on old

disease protection

niacin, his ideas are the point of the lance, this

therapy wholeheartedly, as does

cine at the University of

my

Mmnesota who

both

and

effective.

1

endorse

brother Joseph, a professor of medi-

doing

is

good deal of research

a

in the

use of niacin preventively Bob emphasizes the practical and safe ways to lize

some remarkable and valuable new

the therapy, with

The chapter on weight

means

a very usable

on

theories. In the section

safe

loss is essentially a

uti-

twists.

book unto

itself.

Bob explains

of manipulating one's diet so that weight loss

easy and

is

effective. This chapter also includes an excellent description of insulin resis-

tance and

its

links to obesity. Bob's

approach

and the use of revolutionary

rather substitution

ternative choices that

make

not denial or sacrifice but

is

new

and

dieting successful

He

agents.

many

gives

practical for everyone.

As Bob has stressed, he wants to make his program workable and Part of his motivation has

been

livable.

to enable people to eat the foods that they

minimize the undesirable

enjoy and to

cessful in this area of his venture. This

His program

effects.

book

makes

actually

is

extremely suc-

dieting easier by

eliminating the mental gymnastics that prior diets outline. His approach

provide some good generalities that will help you

supermarket and

in the 1

if

his

concepts

there can be 1

must

pump,

no question

purpose

the heart. that

said that prior to this,

have another risk

me

If

is

my brother's

at the hospital

we had no

number

of

ways

to

He

at large.

has sincere

the vascular system

on

a

much

reaction to

my second

my

he does and

lifestyle,

I

do,

treatise.

and

in par-

followed,

and longer

having a

day

human-

and

book are

fuller

life.

triple

after surgery

Now, he

family history of heart disease.

factor." 'Well,

modify our

book. He really be-

the measures in Bob's

than ever for us to enjoy the principles of this a

make wise food choices both

for writing this

one would lead

relate the story of

pass. In jest, he called

to

eliminate cardiac disease and vascular disease

mind. They key to longevity

ticular the system's

"I

real

may help

measures are accepted by the population

itarian goals in

is

in restaurants.

have to mention Bob's

lieves that his

al-

that

is

said,

more reason

Not only does Bob

but every concept

is

by-

and

offer

also well

docu-

work,

think

mented. 1

must now

reflect

on

a bit of history. Prior to Bob's first

1

Foreword

doctors

knew about

heart disease risk factors, but they didn't take an active

stance with their patients. There

was very limited knowledge by

public regarding the consequences of totally

new emphasis was

The

cholesterol

nity.

I

to the fore

it

became

talents in the past.

With

problem has been researched in 1987.

much greater detail since like HDL, LDL, Lp(a), from the medical commu-

in

had ever heard of oat bran prior

the rage of the country. This

Now

the advent of his book, a

Concepts

and got much respect

don't believe that anyone

book. Then

lifestyle.

the general

placed on preventive medicine.

The 8-Week Cholesterol Cure came out

and others came

xi

•

is

to that

a credit to Bob's literary

he has crafted an exceptional work of new principles

and ideas and new therapies

for eliminating the

scourge of heart disease.

be well worth your while to invest some time in carefully reading

and following the advice

1987

it

contains for the sake of your

own

this

It

will

book

future health.

Charles M. Keenan

Jr.,

M.D.

Santa Monica, California

November 1995

Acknowledgments -v

Where does one begin to

thank the many people

to

complete another book? The

who

have enabled

this

author

which spans the years since I became

list,

a cru-

sader for heart health, in 1984, must, by limitations of reaUty, be limited. But

must

generic way, by thanking the

start, at least in a

other health professionals without whose care

Next

must thank

I

in the kitchen, a families, I

my

family, all of

work and

travel

and the ups and downs

thank

who

those

all

I

many doctors,

nurses,

I

and

simply wouldn't exist today.

my experiments

them, for putting up with

schedule that would have unraveled most

that only they have

have helped

me

endured with me.

gather information over the years,

culminating in this book. None has been as cooperative and supportive as the

now

retired

Howard Lewis and

all

his staff at the

news

division of the Ameri-

can Heart Association.

During

my

research, literally dozens of highly respected researchers

have contributed their time generously tions.

I

thank

And for

all

and

to

answer

my ques-

of you.

a special thanks to everyone

accuracy and to add those

Tulane University in

who

agreed to review the manuscript

final touches. Dr.

tar Institute in Philadelphia. Dr. at

for interviews

David Heber

New Orleans.

David Kritchevsky of the Wis-

at

UCLA.

Dr. Gerald

Berenson

Dr. Calvin Ezrin at Cedars-Sinai Medical

Center in Los Angeles. Dr. Jeff Gero of Success Over Stress in Los Angeles. Dr. Joseph

M.D,

Keenan

at the

Santa Monica,

University of Minnesota. His brother Charles Keenan,

my

friend

and physician. Jennifer Jensen, R.D, of Santa

Monica. Dr. Jack Sternlieb of the Heart Institute of the Desert, and members of his

staff,

Barbara Crouse, R.D., and Luke Seth, M.S.,

these pages diligently.

It's

Institute of the Desert

the Institute in

proved

with great pride that

California.

has enriched

my

life.

of

whom reviewed

serve as president of the Heart

Foundation, and as director of

Rancho Mirage,

my book and

I

all

lifestyle

Working with

all

modification of

at

you has im-

Before beginning this or any other medical or nutritional regimen, consult

your physician

The information is

in this

to

be sure

book

it is

appropriate for you.

reflects the author's experiences,

not intended to replace medical advice.

Any

questions on

and

symp-

toms, general or specific, should be addressed to your physician.

The Revolutionary Cholesterol Breakthrough

Introduction

t

celebrated the Fourth of July in

I

1994

never done before. The Decla-

like I'd

ration of Independence had brought America

— and winning— my own health

fighting

day, ten years prior, that

nary bypass surgery

revolution.

You

lay in the hospital recovering

I

age of forty-one.

at the

the risk of heart disease, feeling better than

and

to its revolution,

A decade ever

I'd

see,

from

later,

in

felt

I'd

been

was on

it

that

my second coro-

there

my

was: free of

I

and eating

life,

a thick, juicy steak!

That's right. I've completely beaten heart disease, controlled

ously high cholesterol

of pork. Delicious foods

knov^ng

my life

had

eat steaks. Also

thought

1

and

a

mere

had

have to give up

I'd

a heart attack

me

told

my

And

lots

forever. All the while

heart.

then that

1

and bypass surgery

at

age thirty-five

had nothing to worry about,

that they

But they were wrong. The disease continued to pro-

six years later,

complications, had

sunnyside-up eggs.

previ-

thought back again and again to the events that had

I

my problem.

"fixed"

gress,

today. I'd

The doctors

in 1978.

I

that those foods wouldn't jeopardize

That day in 1994 led to

and

level,

my

five to six

I

needed

a "re-do," which,

times the risk of death as the

owing

first

to potential

operation.

I

was

only forty-one.

Motivated by I

swore

I'd

my little children, whom

some way

find

to

be

I

refused to leave v^thout a daddy,

free of heart disease.

nearly two decades of experience at the time,

researching ways to save trol

my

As

a

medical writer, with

gave myself the assignment of

my own life. Most notably, had to I

find a

way

to

con-

elevated cholesterol level.

And referred to

I

did

it,

it!

I

came up with

a plan, as

showed

a

cardiologist then laughingly

40 percent reduction

169, in just eight weeks. Together the

gram worked in

my

based on cereal and vitamins. But he wasn't laughing when

laboratory results

world

I

as effectively for others as well.

1987

Ten years

in

my book

after the

in cholesterol,

two of us demonstrated I

my

from 284

to

that the pro-

shared that regimen with the

The 8-Week Cholesterol Cure.

second bypass,

my own cure had become a way of life

2

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

for

me as well as for my entire

best-seller

list

for

The book had been on the New York Times

Though

twenty-three languages.

tries in

recommended

tinely

family.

more than two years and was published

it

to their patients.

was good. And even

declared

me

better since

1

swelled with letters and

files

knew

that

xirtually free of the risk of heart disease.

showed abundant flow

the mtervening years

to

me of their successes. my own doctors had

The

my heart

tests

my

in

tistics

would have predicted an But as

contemplated

I

program had ple

life

many

underwent

better than

Mercedes-Benz with

a

I

realized that

It

my own

was no longer a sim-

Researchers had discov-

a low-fat diet.

evolved along with that knowledge.

was now

like

plays in heart disease in the arteries.

and how heart attacks happen, had

My approach

comparing

Our view

totally

down

a

to

brand-new

the role cholesterol

of the clogging of those vessels,

changed. The revolutionary idea that

once cholesterol counts come down, and plaques within the it

little

Model T Ford.

For openers, medical investigators had nailed

brings with

I

had beaten the odds.

that Fourth of July,

cholesterol control and heart health

in

the medical sta-

of the missing links in the development of heart disease, and

my program had

little

1

evolved significantly in the past ten years.

approach of oat bran mufhns and

ered

by

my

early death.

felt

I

whom

twenties and thirties. Not bad for a guy for

I

through those once-

diseased vessels, and the bypass vessels were totally clear.

had

coun-

physicians rou-

initially skeptical,

And my

laboratory results from readers and their doctors telling Life

in thirty-five

arteries stabilize,

the promise of total freedom from the fear of heart attacks. Never

Wow, what a revolutionary concept. we don't even have to live a life of deprivation, not many years ago. Not only were new products available in

have a heart attack!

For frosting on the cake, as

had been

true

and nonfat versions but

low-fat

the absorption of fats

and cholesterol from the foods we

of heart disease risk and eating steaks

But outside

knew about medical

all

my own

and

I'd

eat.

made over

my

I

standings.

Is

free

I

had been reading

the

I

needed

to

com-

men and women whose lives could be my new approach. needed to write a

findings to the millions of

1

not a mere revision but an entirely

also

am,

attending research conferences regularly, and reporting the

dramatically improved by following

new book,

I

and acquaintances, few people

the years.

progress to the readers of my quarterly Diet-Heart Newsletter

municate

So here

eggs.

circle of physicians

the changes

literature,

were products that could prevent

also there

needed

to correct a

number

cholesterol really the culprit?

new book.

of misconceptions

Does

diet

make

and misunder-

any difference?

Can

Introduction

cholesterol? Should

some foods provide "good"

we

switch back to butter from

How

margarine? Does red wine really protect the French? Does oat bran work?

And

about antioxidants?

The public ular, as

is

fish oils?

And

garlic?

and heart health

interested in health in general,

never before, but the public

cheeseburger and

hands

high

levels of cholesterol despite their best efforts at dietary controls.

for the nearest

To make matters even worse, many people

tors resort to prescription drugs,

in partic-

confused. Too often people throw

is

and head out

their

in frustration

3

•

continue to manufacture

will

but those drugs

berg, often leaving people at continued risk

treat

owing

up

fries.

only the

Their doc-

tip of the ice-

such drugs

to factors that

cannot change. I've

always believed in getting to the roots of problems in order to ftnd

their solutions.

When

it

comes

tion remains the same: to save

to fighting heart disease,

my own

life.

my

original motiva-

This book, then,

my

is

opportu-

nity to share the collected findings of the past ten years. Quite literally,

own

was on the

life

recommendation lives in

terms of

medicine had to Here's a

•

line.

didn't

I

numbers.

statistical offer,

sampHng

of

what

Yes, a low-fat diet

(AHA) and

might be a good

do much •

take

by

is

to help those

I

and

pages.

itself

probably won't be

fat

back

to

30 percent of

nation as a whole, but

who need

it

fat

total calories

reduction alone won't

most. Don't be misled!

your

fat in-

50 percent as compared with the average consumption. Yet

you'll

Critics

pointless.

far

that science

The recommendations of the American Heart

There are foods and products that can enable you a full

as a blanket

by those who often see

coming

important but in and of

all

the typical family favorites that

to slash

Americans

love.

contend that since many people have heart attacks when

cholesterol levels are quite normal, the is

what passed

wanted the very best

you'll learn in the

others to cut

start for the

continue to enjoy •

to settle for

and so should you!

sufficient to ensure heart health.

Association

want

for the entire population, given out

my

We now know

more important than

their

whole concept of cholesterol reduction

that the individual

the total number. This

components

of cholesterol are

program takes care of all those

components. •

The combination of low

levels of the

with slightly elevated amounts of triglycerides

good is

cholesterol,

often a

dictor of heart disease than total cholesterol or even the

An

inexpensive vitamin can raise

HDLs

more accurate

bad LDL

to healthier levels.

HDL, along pre-

cholesterol.

4

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

A simple blood

•

lest

can detect

tein (a), usually abbreviated as Lp(a)

who

can predict

will

levels of a

blood

and pronounced

have a heart attack even

if

fat

known

as lipopro-

"el-pee-little-a,"

there are

no other

which

risk factors.

known about Lp(a) for a few years, but the information down to the practicing physicians and their patients.

has

Researchers have not trickled

Will dietary changes, even the most radical ones, influence Lp(a) levels? Unfortunately, no.

How

about those expensive prescription drugs

No, those have no

terol reduction?

effect either.

The

best solution

for cholesis

a simple

one: an inexpensive daily dose of vitamins.

Prescription, cholesterol-lowering drugs can be very effective, but

•

work even

they

program. In

better

fact,

when combined with

the elements of this revolutionary

most people won't even need these drugs. Considering

very high cost and the fact that heart disease

money should •

It

is

an equal-opportunity

their

killer,

not be a factor in prevention.

has been estimated that up to 80 percent of

all

physicians arecur-

rently taking antioxidants to protect themselves against heart disease.

They are

very aware of the compeUing data demonstrating the benefits to heart health. Yet those

same doctors

You need the

fail

to

recommend

details regarding

these supplements for their patients.

both dietary sources of antioxidants (which

provide protective substances not found in

One

•

piece of flawed research,

pills)

much

will

and supplements.

ballyhooed by the media, de-

stroyed the public's confidence in oat bran. That erroneous information has

subsequently been put into proper perspective in the medical over,

we now have

a "next generation" of

tential of the soluble fiber,

which has the cholesterol-reducing

such product has been proven to slash erage of 25 percent.

how you •

and

can get

You

can't find

it

levels of the

A

terol

in the

virtually fat-free diet literally

•

It all

bad LDL cholesterol an av-

supermarket allow you

I'll

tell

you

still

way back on

fat

contain a few of those two cul-

mighty boring. Fortunately, today fat

a few

new

and the choles-

eat.

comes down

test, you'll

is

to cut

block your body from absorbing the

from the foods you

cholesterol

One

it.

Food choices

products can

More-

capability.

in your health food store, but

cholesterol. But an enjoyable diet will

prits.

literature.

products that concentrates the po-

to the

numbers. Depending on the

know just how much improvement you

results of

your

have to make.

(We'll talk later about testing in the laboratory as well as in your

own home.)

Introduction

Then

program

you'll learn to tailor a

that will achieve the

5

•

improvement you

know (1) how many grams of fat you should have in your foods; (2) how many grams of fat and milligrams of cholesterol you can block with the new products now on the market; (3) how much cholesterol can be removed from your blood by way of soluble fibers; (4) what dosage of antioxidants of all sorts will prevent the bad LDL cholesterol from doing its damage; (5) how much exercise will raise the levels of your good cholesterol, lower seek. You'll

need

to

more

those of triglycerides, and help burn the calories you eat (6)

how much

of the special B vitamin you'll need to control

and

efficiently;

of your body's

all

production of good and bad cholesterol components. Other B vitamins will

eUminate completely the risk posed by elevations of a particular amino acid the blood that

But

I

is

I've

program blindly. You should have

don't want you to simply follow a

a complete understanding of just

why

structured this

In the

part

first

I

book

how

that

program works and why. That's

into four parts.

provide the basis for the program

itself.

Perhaps

first

time, you'll have a solid grasp of the total cholesterol/fat/saturated

ture

and how those and other

process,

I'll

factors

for the

pic-

fat

have an impact on your health. In the

up many misunderstandings about

clear

in

responsible for 10 percent of heart attacks.

testing, dietary influences,

and just how your body works.

The chapters

in part 2 outline the

program

Limiting

itself.

tion without deprivation. Blocking the absorption of

fat

fat

consump-

and cholesterol

in the

foods you eat so they can't do your body harm. Eliminating cholesterol from the bloodstream by that the

way

of potent soluble fibers.

bad LDL cholesterol

can't clog

combination of the vitamin niacin

good and bad components you'll learn just

how

the

your

to control

to take antioxidants so

And how to

put

it all

take a unique

your body's manufacture of both each chapter,

in the cholesterol/lipid profile. In

numbers work

Finally, in part 2 we'll

How

arteries.

for you:

Do

this,

expect that.

together as one, unified program includ-

ing dietary measures, supplements, vitamins, exercise, weight control, and stress control.

In part 3,

1

address the

and controversy regarding

many

alcohol good for the heart, and

much iron in the diet lead And sugar? I'm sure many I've

issues that have caused so

a heart-healthy lifestyle.

to

if

so, is

much

Does garUc

confusion

really

work?

Is

one kind better than another? Will too

problems?

What about

coffee

and

tea?

And

salt?

of your questions will be answered.

devoted part 4 of the book to the subject

that's

near and dear to

my

6

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

own

heart: food!

never ily.

If

family and

burritos. Grilled cheese sandwiches.

pork spareribs and T-bone

The bottom

rot sticks.

lust for lasagna,

1

a blessing and a joy of

life

I

love food!

and

and

so to speak, have I've

want

made

to eat

a

I

1

As

it,

cake and eat

the past few years since

all

sorts of foods that

it,

1

in

is

truly

I

eat.

could,

too.

dietitian tells

me

I

should eat all

to eat

— and

still

what

keep

1

my

over the country during

my books launched me into coronary celebrity, audiences my menus and explained how achieve the perfect I

your books?" they'd ask. Unfortunately, until

A

Food

could no longer

detailed

I've

passionate

kept searching for ways that

I

balance between fun and flavor, between heart and health, all

feel

I

prefer potato chips over car-

given lectures and presentations

I've

have drooled as

1

hobby out of figuring out and discovering ways

— not what some

heart happy.

don't just like

salivate for hot fudge sundaes.

sure did miss them.

my

I

living.

During the 1980s, there were gave them up, but

Pot roast. Tacos

ribs.

Macaroni and cheese dinners. Even

cheer for cheeseburgers.

I

Short

steaks.

line is that

about every mouthful.

eat every day, you'd

I

anything different from any other American fam-

We enjoy meatloaf, mashed potatoes, and gravy.

and

I

my

you could see the way

know we were doing

now

information

'is that

the answer

was

no.

healthy diet must be for Ufe, not for just a few weeks or months.

show you how you can eat all your favorites and

still

keep your

than you thought possible without feeling any deprivation

fat

I'll

intake lower

at all.

MY PROMISE TO YOU I'm not a doctor. in

many

ways.

I

I

am a

medical journalist, but

I

feel that

fervently believe that Providence has led

near death and then brought son. That reason

is

me back

to share with

it

me down

the path to

good health

to spectacularly

you the information

can help you

I

has taken

me

for a rea-

ten years

to accumulate. It

this

seems, in retrospect, that

book.

My

love of food

science and journalism. health.

robustly as one can If

My

And probably most

I

I

have spent

and cooking.

my

preparing to write

health problems.

neady

my

passionate love of

My

training in

life

and Uving

it

enjoying exuberant wellness.

could be granted one supernatural power,

have you "step into

life

three decades of writing exclusively about

important,

do only when

My

my whole

moccasins"

for a

day

I

would ask

to experience

for the ability to

what

it

feels like to

Introduction

be in vibrant good health. Most people

and conversely, being so

filled

to

be not

•

7

know what it's like to be sick, to be ill, know the feeling of being well, of

But very few

sick.

with energy that

almost makes you

it

though you're ready

feel as

to burst!

So here's the day, but wellness.

I

my promise to you.

can

tell

you

all

I

can't, of course, let

Not just avoiding heart

disease, but feeling terrific.

those steps. Follow the program. Soon you'll start to

Some

of your

improvement and

lesterol, triglycerides,

you step

my skin for

that

than you ever have.

be measurable. Your levels of bad cho-

will

new

Read the book. Take

feel better

risk factor Lp(a) will

drop while your good

HDLs will go up. Your weight will come down with less effort possible.

into

the steps I've learned to take to achieve that state of

Your blood pressure

will

than you thought

come down. Your stamina and

physical ca-

pabilities will increase.

be more subtle, but just as

real. You'll fall

and awaken more rested and ready

to face the day.

Other improvements asleep faster, sleep better,

be more productive

You'll

will

at

your work and have more energy. You won't ex-

when you yawn and

perience those midafternoon slumps

more and

You'll enjoy recreational activities

your sex

life

improve! You'll

will

become an advocate, your family and

if

yolks.

And

not a zealot, of this

about yourself. Very lifestyle,

you'll eat all the foods

Not those

wanting

likely, you'll

to share

it

with

you

love!

substitutes but real eggs with their delicious, golden

I'll

tell

you about.

Real beef! Steaks, roasts, ribs,

way you

love

it

all

your

but without the

favorite cuts. Rare, juicy, real beef

fat.

Imagine enjoying those previously forbidden sorption of their

fats

and

cholesterol.

terol of foods after you've eaten it is

Even

better at them.

not a bit of the cholesterol will get into your bloodstream, thanks

to the blockers

just the

you do

friends.

Most amazingly, Real eggs!

feel better

find

feel like quitting.

You

literally

treats

and blocking the ab-

remove the

fat

and choles-

them! That's never been possible before, but

now.

Meanwhile your cholesterol

will actually

drop

to

normal, and as that hap-

pens, the risk of heart disease and the fear of heart attack drop to practically zero.

For the

first

time ever,

we have dramatic proof that

eradicate the risk of heart disease

can

—

effectively, easily,

stabilize the factors that precipitate heart disease.

actly

what causes

Welcome

a heart attack

and

to the revolution!

how

to stop

it.

practically

anyone can

and permanently. You

Doctors have learned ex-

So don't wait.

Start

now!

Part

I

Cholesterol, Fat,

and Your Heart

•

•

1

Cholesterol: Guilty as Charged

Probably no single word in science or medicine has caused as versy and confusion as cholesterol. But certain:

Those with an elevated

when

all

the

smoke

much

clears,

level of cholesterol in their

of that coin

equally clear:

is

When

is

bloodstreams are

increased risk of heart disease and of suffering a heart attack.

at

contro-

one thing

The

flip side

cholesterol levels are low, the risk of that

disease practically disappears.

There can be no argument about those

facts. Period.

When

group of

a

people are tracked over a period of time, those with the elevated cholesterol els

develop heart disease. The higher the

those

who have low

levels, the greater the risk.

cholesterol counts rarely

Not only does excessive cholesterol velop, bringing those levels

progress, rectly

and

in

many

on getting

down

in the

normal

to

if

life.

blood cause the disease

Every

year,

L5

is

cholesterol.

million American

hundred thousand

succumb some time

lower your cholesterol

di-

life,

and

far

too often

men and women have

die immediately.

a

The other

bomb is a heart attack, and its that bomb for yourself, you'll want to

later.

To defuse

level starting

That

today and keep

it

low

for the rest of

your

Ufe.

the cholesterol in your blood that does the damage, not necessarily

the cholesterol in the diet. etary link, is

to de-

go away. Reversing heart disease depends

cases, to

their hearts. Five

explosive element

It's

killer.

results in the disease ceasing to

Heart disease begins in childhood, continues through

million typically

Conversely,

ever encounter this

the cholesterol out of your bloodstream.

prematurely ends

bomb go off in

lev-

While there may be controversy regarding

no one questions the

that di-

role of cholesterol in the arteries. But just

what

the stuff?

THE CHOLESTEROL PROFILE Cholesterol that are

found

in

is

one member of a

large family of chemicals called sterols

both animal and plant

tissues.

The

isolated substance

is

12

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

whitish-yellow without odor and with a slightly

must be

cholesterol

cules of

fat

and protein

called lipoproteins.

cholesterol/lipoprotein

waxy

Insoluble in water,

feel.

through the bloodstream courtesy of other mole-

ferried

complex and

its

More than

cholesterol

itself, it is

the

variations that pose the risk of heart

disease. In

an ideal situation, the

liver

through the body

a lipoprotein molecule, shuttled

and then brought back

tions,

produces cholesterol that

is

then bound by

to carry out

func-

its vital

proper disposal. The lipoprotem

to the liver for

molecules vary by size and density, hence the names high density lipoprotein

and low density lipoprotein,

HDL and

typically abbreviated

cholesterol out from the liver through the bloodstream,

LDL. LDL carnes

HDL

and

brings

it

back. Scientists refer to this as a "reverse transport system."

The problem occurs when not enough

bound

HDL to haul

the cholesterol

cholesterol builds

up

much LDL-bound

there's too

in the

back

to the liver.

bloodstream where

it

As

cholesterol

LDL-

a result, the

can do

its

and

damage

to

the lining of arteries. We're concerned mostly about blockage in the arteries that supply

blood

muscle, but the disease process also occurs else-

to the heart

where, clogging arteries in the abdomen, the

legs,

and even

in the penis

the result can be impotence. Within recent years we've learned that lesterol

is

most

and when they Scientists

ging,

hoping

likely to

do

damage when

its

More about

are oxidized.

have focused a

that

lot

the molecules are small

where

LDL

cho-

and dense

that later.

of their efforts

on

the process of arterial clog-

by understanding that process, they can work on ways

prevent, treat, or even reverse

blockage does not occur

like a

it.

Contrary

lump on

to popularly

to

held perceptions, the

the lining of the artery, but rather

under

that lining.

Blockage

our

teeth, as a

is

referred to as a plaque, in the

same way we form plaque on

composite of materials including cholesterol. The result

bulge inside the artery that interferes with bloodflow. That bulge "atheroma," while the concommitant hardening of the artery

Hence

the

name

a

"sclerotic."

to us

from the Greek, meaning

a

tumor formed of

a

components. We're not sure what exactly precipitates the formation

of the plaque.

It

may be an

injury to the lining of the artery and the body's

damage.

We

subsequent

effort to heal that

cells called

macrophages and monocytes

forms termed "foam gruel,

is

is

termed an

of the disease, atherosclerosis.

Atheroma comes "gruel" of

is

much

cells."

LDL

as a construction

do know

that types of white

arrive at the site

brings in cholesterol that

worker makes

blood

and develop into is

mixed

into the

concrete to build a wall. At

first

Cholesterol: Guilty as

the plaque

is soft

and loose but eventually hardens

Over

time, the size of the plaque

look

at

how

on page

Research has

18.

is

profile.

LDL

choles-

predictive of heart disease than total choles-

That information should be part of a cholesterol or lipid,

fat,

known

along with a

test,

as triglyceride,

used by the body as energy from food consumed. Until rather

modest increases above normal,

especially

which

is

recently, doctors

weren't too concerned about a small elevation in triglycerides. Today

HDL

3

increase. We'll

that the ratio of total cholesterol or

more

measurement of another blood

that even

1

calcium enters the mix.

as

and the blockage of bloodflow

But now, back to the

shown us

HDL cholesterol

terol itself.

•

rupture of the plaque, rather than growth of that plaque, results

in heart attacks

terol to

Charged

we know

when combined with low

counts, can indicate future problems.

Taking the Test

The only way and

triglycerides

—

to get a

the lipid profile

clinical laboratory to

you'll

need

complete analysis of your

—

which he or she

is

LDL, HDL,

through your doctor's

refers you.

to fast for twelve to fourteen

total,

To

ratio,

office or at a

get an accurate reading,

hours prior to the

test.

Fasting

means

not only no food but also no beverages with any nutrient value, including sugar.

Only water,

tea,

or black coffee will not interfere with the results.

foods and beverages you consume just before the lesterol

measurements, only the triglyceride

within twenty-four hours.

you can

Armed

are; don't settle for "everything's fine."

counts and keep an ongoing record in your Total cholesterol

United liter

levels. Test results are

is

States. Virtually

measured

everywhere

files for

specific

future reference.

m

the

else the designation is in millimoles

per

by

38.67.)

National Cholesterol Education Program (NCEP), which

recommend

what the exact

Take notes on the

in milligrams per deciliter (mg/dl)

(mmol/l). (To convert mg/dl to mmol/1, divide

Institutes of Health,

usually back

with the information I'm about to provide,

interpret the readings along with your doctor. Find out

numbers

The

don't influence the cho-

test

is

The

AHA and the

part of the National

that for the entire population adult readings

should be no higher than 200 mg/dl. Levels between 200 and 239 are considered borderline high, and those 240 and above are high. The vised

its

keeping

recommendations levels to less

for those

with a

1994

re-

history of heart disease and advised

than 180 to prevent progression.

extend that recommendation to everyone

AHA in

who wants

It

would seem

to

logical to

prevent future heart

14

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

problems.

My own

recommendation

180, ideally at the bottom end of that range. That's where mine nience, and to remain

more conversational,

the most part

for

number throughout

"mg/dl" designation and use only the

160

to shoot for a target range of

is

I've

to

For conve-

is.

dropped the

book.

this

LDL cholesterol, termed "bad" cholesterol, should be no more than 130 mg/dl according

to

NCEP and AHA.

For those with a prior history of cardiac

events or demonstrated disease, they drop that number that

number

is

more prudent

to 100. Again,

for the entire population, especially

if

think

I

other risk

factors are present.

HDL cholesterol, mg/dl

for women and

the protective "good" cholesterol, should be at least

35 mg/dl

for

men. The resulting

40

ratio of total cholesterol

HDL cholesterol, sometimes referred to as the risk ratio, should be no higher

to

than 4.5 for

women and

HDL of 50

and an

4.0 for

men. For example,

a total cholesterol of

200

gives a ratio of 4.0.

Triglycerides have a

normal range of 50

to

150 mg/dl. (To convert

to

mmol/1 divide by 88.5.) Doctors previously were concerned only about elevations

beyond 500, which were associated with

pancreatitis that can lead to se-

emergency and eventual deficiency

rious abdominal

in the ability of the

is

an important aspect of a heart-healthy lipid

pan-

normal range

creas to function. Today's research indicates that maintaining a profile, especially

if

HDL

levels

are lower than desired. In

my previous books,

lipid values for

both

book simply because today

an

is risk,

a total cholesterol level

HDL less than

increasing ages. I've not

and

there's

no point

beyond 180, an LDL

40, or a triglyceride count of

it

total cholesterol level of

230

having a heart attack. But

at

it's

age twenty-four

age seventy

still

is at less

greater than

listing all the

As

when

I've

if

risk

stated previously, risk

other risk factors exist

at

lack cardiovascular risk factors.

owing

the

1

developing in his un-

woman. But

that risk

is

won't belabor the point by

it's all

there.

to elevated cholesterol counts

same

a

with a cholesterol of 250

than a fifty-five-year-old

her cholesterol were under 200.

of risk varies

young man with

not in immediate danger of

woman

supportive medical literature, but

are at increased

The degree

likely that the disease is

suspecting arteries. Statistically speaking, a at

is

beyond

greater than 100 or so,

risk nonetheless. Obviously, a

is

in this

m providing excuses.

more than 200

risk of heart disease regardless of sex or age. Period.

through the years, but

done so

believe that those lipids shouldn't change

1

seventeen years of age. Risk

Those with

published charts showing cholesterol and other

I

men and women at

time. But the fact

is

is

greater

that few adults

The 1992 Behavioral Risk Factor Surveillance

Cholesterol: Guilty as

Charged

•

1

5

System polled ninety thousand Americans over the age of seventeen, asking about six factors

for heart disease:

smoking, physical

inactivity, excess

weight,

high blood pressure, elevated cholesterol, and diabetes. Only 18 percent reported having none of the six risk factors; 35 percent had one; 29 percent

ported two; 13 percent had three; and 5 percent indicated four to If

you have your cholesterol

somewhere

of

count of

triglyceride profile

work

risk. If you're

aware of other

exercise or quit smoking. But there's

about your

ticularly different

no reason not

week. Also,

fat

to

affair.

diet.

As

gobs of

fat,

especially saturated

Now what

if

fat

fat,

hovers somewhere

level

that of family history, then

you most

likely

many

at the

other

200 count?

factors, especially

at least five years' time. If

one or

loom, however, you'd be well advised to get that count

180 range. As you

recommendations

not a

have nothing to be concerned about.

Be sure to have another lipid profile done in risk factors

is

this as a license to

with impunity. There are

you have no other risk

your

there's cer-

and cholesterol elevation

find that

to

7,

Hmit yourself to four per

to

and

160

and

we'll see in chapters 2

intake.

your cholesterol

you take inventory

If

means

all

do anything par-

to

you can or should take

level that

health reasons to moderate

to the

by

This doesn't mean, of course, that just because you

have a normal cholesterol

more

a

intake should correspond to caloric needs rather than to the

cause-and-effect

If

total

40 HDL, and

a

risk factors,

no reason

Hmit the eggs you want, not

desire to prevent heart disease. Again: Diet

eat

no lower than

reducing them. For example, you might need to lose some weight or

at

do more

tainly

checked and the doctor reports a

to 180,

than 200, congratulations. This means your lipid

less

shows no present

level

160

in the range of

re-

six.

will read, that's easier to

do

down

today, with the

book, than ever before.

in this

total cholesterol is in

are at high risk. You'll also

want

excess of 200, there's

to take

any other

little

question that you

risk factors into consideration.

Small elevations of cholesterol over a longer period of time are equal in risk to greater elevations

nary heart disease

at thirty-hve

risk is slight at that age;

age seventy. There

is

years

but that risk

never a time in

evations of cholesterol the

during a lesser time period. Twice the risk of coro-

Framingham Heart

do not pose

is still is

life,

quite small for

most people since

significantly higher for the person at

either too

young or too

a risk, according to Dr.

old,

when

el-

William Kannel of

Study.

Cholesterol levels fluctuate, so

it's

best to take the average of

two or even

three tests over time. Things affecting the count include the season of the year,

emotional stresses, colds and

flu,

women's menstrual

periods,

and normal day-

16

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

to-day swings.

would be but

If

comes

a test

in quite low,

warrant another

sufficient to

unlikely that such fluctuations results are high,

midrange, routine vanances might be enough

for findings in the

decision from "do nothing" to

"make

The new home cholesterol

significant lifestyle changes"

test kits are

You read the

for total cholesterol.

it's

The same holds if the

test.

and

test

Home

thermometer.

a

vice versa.

remarkably accurate but

results like a

swing

to

only

testing

should not be a substitute for initial analysis in the doctor's office or laboratory.

The

to time.

kits are

handy, however, to

test to test, I

know how

home

use the

a vacation splurge

tests regularly as

useful

might

HDL level is unlikely to change significantly good overview.

monitoring total cholesterol provides a

They were enormously fat

you know how you're doing from time

For example, you might want to

have affected your count. Since the

from

let

when

I

I

expenment with vanous approaches.

began testing the concepts of blocking

and cholesterol absorption described

in this

My

book.

family and

would

I

take our cholesterol counts, then do our dietary experiments, and remeasure

how we

to see

As

did.

The CholesTrak

we

you'll read,

did beautifully!

cholesterol testing kit consists of a

reads the cholesterol in a few drops of blood

much

little

thermometer. Prick

like a

your finger with the device supplied, follow the directions in the

minutes

The CholesTrak's accuracy has been demonstrated To

kit,

and

fifteen

have your numbers.

later you'll

ical studies.

cassette that

see for myself,

terol

measurements

right

on

in

my

1

used the

kits

on the days

doctor's office. CholesTrak's

in a I

number

went

of clin-

in for choles-

numbers were always

target.

The

kit costs

no more than what you'd pay

have the convenience of doing

it

in

your

own home, whenever you

course, since you're not measuring triglycerides, there's

CholesTrak order directly

is

available in

and you

for a laboratory test,

no need

want.

most drugstores and pharmacies. You can

from the company

for delivery to

Of

for fasting.

also

your home. Discounts are

available for quantity purchases. Call (800) 927-7776.

IMPROVING YOUR

LIPID

PROFILE

The program and suggestions provided

make

significant

improvements

in

all

in this

aspects of your

book

you

to

lipid profile in a relatively

short period of time and without radical lifestyle changes. ier to do.

will enable

It's

never been eas-

Cholesterol: Guilty as

But

put

why

One

bother?

•

1

7

of the world's leading heart disease researchers

quite simply. According to Dr. Lars

it

Sweden, of 100 percent of heart

sity in

Charged

Wilhelmsen of Gotenburg Univer-

attacks,

80

to

90 percent can be

ex-

plained by the presence of high cholesterol levels. The remaining percentage is

combined

the

result of other risk factors that are also

considered in this

book, things you probably have never heard of but that have put you in jeop-

—

ardy

until

now!

you have an elevated cholesterol

If

oping heart disease or having

you

will slash or

overwhelming

Research

•

ducing

and

both

at

are at greater risk of devel-

risk.

by lowering

The data proving

that level

be true

this to

is

men and women.

Stanford University published in 1994

showed

that re-

men

diagnosed with heart disease.

British scientists

•

you

prevented the development of additional blockages in

risk factors

women

studies

even eliminate that

for

level,

a heart attack. Conversely,

and found

combined and reviewed

that even

modest improvements

the results of ten major

in cholesterol readings

big dividends. Looking at the results for nearly a half million

pay

men and women,

the reductions in risk from just a 10 percent drop in total cholesterol led to declines in the incidence of heart disease of

age

fifty,

eighty. •

27 percent

at

age

sixty,

The data were published That same

54 percent

20 percent

at

at

age

forty,

39 percent

at

age seventy, and 19 percent at age

in the British Medical Journal in 1994.

year, U.S. scientists at the University of CaHfornia at Berke-

ley also analyzed ten previously

conducted

studies.

They concluded

gressively lowering cholesterol counts resulted in fewer heart attacks

that ag-

and even

regression of the disease. •

The

benefits of cholesterol reduction are linear.

that ideal range of

160

the greater the payoff.

to 180,

Owing

along with normalized

to the limitations of the

in current studies done, cholesterol reductions have

Even

so, vast

it's

closer

you

LDL and HDL

get to

readings,

methods of intervention been small

improvements were noted. By bringing your

mal, you can wipe heart disease out of your future.

pen? While

The

to moderate.

lipid profile to nor-

How quickly will that hap-

taken a lifetime to develop the heart disease that currently

blocks your arteries, recent data strongly suggest that in just six months to two years risk can be virtually eUminated.

Let's

look

at that

statement one piece

tionary the promise truly

is.

First,

we know

at a

time to see just

how

revolu-

that heart disease develops

from

— 18

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

childhood. Autopsies done on soldiers during the Korean and Vietnam Wars,

on children

as well as

nod

young

as

and twelve years old examined over a pe-

as ten

show

of time during the Bogalusa Heart Study in Louisiana,

of the disease. The higher the levels of cholesterol during

the beginnings the greater the

life,

degree of heart disease found after death. Horribly simple and direct evidence.

Second, blockages in the form of atherosclerotic plaques continue to develop and grow as long as excessive cholesterol remains

Some

of the most

has taken place

exciting research in heart disease

at the

cepts of stabilized

level.

the bloodstream.

New information takes the

arcane con-

plaque and healthy endothelium from the laboratory into

the practical arena.

why

microscopic

m

during the past few years

Those concepts explain how heart disease develops and

heart attacks happen.

Forget the image of arterial clogging likened to old plumbing getting

blocked by mineral deposits. Rather, picture a sort of tumor forming under the artery, the endothelial cells

innermost lining of the

Those tumors injuries

start at

throughout the

arterial

and monocytes enter the

bloodstream. little

or not at

all.

are

an

effort to

termed foam

what

there isn't

very

system. White blood cells

site in

into a matrix of If

comprising the intima.

a very early age, probably the result of routine microscopic

mend

known

the injury.

as

phagocytes

They next turn

cells that attract cholesterol

from the

much cholesterol in the blood, the tumor grows However, when LDL cholesterol, especially the oxidized

form, abounds, the tumor grows and grows, gradually limiting blood

New, soft,

relatively small, cholesterol-rich

have a

and

fragile cap,

are

hardened with smooth muscle open.

A

prone

tissue

tumors, called atheromas, are quite

Older atheromas become

to rupture.

and calcium and

are less hkely to break

rupturing atheroma produces a blood clot that

bloodstream.

blood flow

If

arterial

to the

blockage prevents

flow.

its

travel

muscle of the heart stops and

is

released into the

and eventual reabsorption,

this event is a heart attack or

myocardial infarction (MI). Picture the starting out in

there

lumen

life

nice

of the artery

and

clear,

—

the hole in the doughnut,

Ironically, older

will

artery's lining.

blockages or stenoses aren't as dangerous because the body

for the

compromised blood flow by

creating collateral arteries,

natural bypasses that bring blood to the heart's muscular wall. ercise

you

but eventually becoming narrowed here and

by new and old plaque formations pushing out from the

compensates

if

one does and the

develops. So even

when

less

one smokes, the more

The more

this collateral circulation

the artery might be completely blocked off at

point, those collateral artenes prevent a problem.

ex-

some

cholesterol: Guilty as

While the their

more sohd atheromas

older, larger,

narrowing of the lumen of the artery

risk that a clot will

That rupture,

it

results in

become lodged when one

Charged

•

1

9

are less likely to rupture,

reduced flow and increased

of the smaller plaques ruptures.

turns out, can be precipitated by shear force of the blood rush-

ing through the artery, emotional stress, high blood pressure, or physical exertion in individuals

who

poor physical condition. Thus the presence of

are in

large blockages serves as a marker,

an exercise

stress test, that

when

seen in an angiogram or detected by

numerous smaller atheromas

exist

and place the

patient in jeopardy. All this site

damage

takes place over a lifetime. Cholesterol

of the atheroma via

want more of the rowing of the

latter

arteries,

LDL and and

taken away by

less of the former.

more and

In the old days, doctors

was then, and

this is

That's

to the

why we

leads to further nar-

The

natural history of heart disease

is

to pro-

larger plaques that eventually cause a heart attack.

saw heart disease

timately terminal disease. That that

Smoking

brought

HDL counts, and stiffening of the endothelium,

reduced

that cellular lining of the arteries.

gressively develop

is

way of the HDL.

to say,

is

you

as a progressive, chronic, ul-

get

worse and then you

But

die.

now!

For one thing, physical exertion no longer need be a precipitating factor in heart attacks.

strenuous

Those

activity,

in

good physical condition needn't

even including

have the protection conferred by physical

You'll

ing the suggestions in chapter

with

a "cardiac killer"

lifestyle

10. Similarly,

modifications, and

tions. Relaxation

when

fear

even the most

such as snow shoveling.

fitness

we can

by reading and follow-

control blood pressure

necessary in severe cases, with medica-

techniques can also help reheve periods of emotional

stress.

But what about the underlying causes of those heart attacks? Well, one

amino acid homocysteine, excessive amounts of which

such cause

is

blood lead

to scarring of the artery

the

in the

and thus formation of another plaque,

as

well as precipitating the rupture of the atheroma. Fortunately, as you'll see

m

more diet

detail in chapter 5, the cure is

and supplementation.

simply a daily intake of B vitamins through

In that chapter, we'll also cover a

risk factor called lipoprotein

(a),

which can

newly discovered

also be controlled

by simple

vita-

min supplementation. You'll

Do

that

want

to haul as

much

cholesterol out of those plaques as possible.

by slashing the amount of cholesterol floating around

stream and getting socked into those arteries by creasing

book.

HDL levels

as

much

as possible

LDL

in

your blood-

molecules and by

through the means discussed

in-

in this

20

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Oxidized

LDL packs

the cholesterol into those plaques far

when LDL is protected by antioxidants. ommendations

in chapter

8 but

for

and

You'll get lots of details

now

more than

specific rec-

note that an article in the June 21,

1995, issue of the Journal of the American Medical Association reports that antioxidant intake reduces progression of the disease in terms of plaque devel-

opment

in patients previously studied in regard to cholesterol lowering. Yes,

whose

those

levels

dropped

counts stayed up. But those also taking vitamin E did the best of

at least

is

when

cholesterol levels

100 lUs (international units) of

fall.

In fact, decreased risk

any regression.

show regression

Even more important,

the vastly decreased incidence of heart attacks

duced counts.

is

when

is

for those

soft,

New York says reducing

rupture-prone plaques and healing the

cholesterol levels, along with homocysteine

an

LDL count no more

and Lp(a) counts,

than 100 and the

total

to raise

dangerously low

Shoot

fall.

is

who

colleagues

years, the indi-

at the

May

1995.

are friends,

electrifying.

and we

left

I

attended along with two physician

smiling from ear to

Then

in late

no

1995

The data were to eradicate

John Farquhar of Stanford Univer-

stated unequivocally that heart disease today

of that: a world with

ear.

been doing and recommending

heart disease. In fact, another speaker, Dr.

is

largely preventable.

Think

heart; attacks! at the

annual meeting of the

AHA we

got the defini-

no-doubt-about-ii proof of how lowering cholesterol levels can save

The West six

two

and he presented an outstanding overview

a validation of everything we've

tive,

to

International Heart Health Conference in Barcelona, Spain, in

That presentation was

sity,

months

completely out of the woods. Dr. Fuster's research has been pub-

lished serially in Circulation,

2nd

treat-

HDL levels. Once the lipid profile improves, the

healing begins, and he believes that within six vidual

and

total cholesterol into a

range under 180, ideally around 160. Dr. Fuster also advocates aggressive

ment

re-

Now we know why.

a matter of stabilizing those

for a goal of

with

doctors haven't seen

endothelium. Both those changes occur, he says, in a linear fashion as

LDL

of heart

in a practical sense,

and deaths

typical even

Dr. 'Valentin Fuster of Mt. Sinai Medical Center in risk

cholesterol

all.

For years we've been hearing about studies that disease

whose

fared far better than those

of Scotland Study,

hundred men aged

as having an

LDL

headed by

Dr.

James Shepherd, looked

forty-five to sixty-four for five years. All

cholesterol

was 272. None had had

more than

155,

a heart attack or

disease. All received information

and the average

lives.

at sixty-

were identified

total cholesterol

had been diagnosed as having heart

on low-fat

diets,

and half received

a single,

Cholesterol: Guilty as

40 -mg dose of the cholesterol-lowering drug

men

Charged

2

•

1

pravastatin (Pravachol). Treated

had a drop of 20 percent in total cholesterol, 26 percent in LDL, 12 per-

cent in triglycerides, and a 5 percent increase in

HDL.

Diet alone didn't get the

job done. Here's the payoff: Those with lowered cholesterol counts experienced 31

percent fewer cardiac events including heart attacks, 28 percent fewer heart attack deaths, 37 percent fewer bypass surgeries, tality.

and 22 percent

less total

mor-

There was no increase in noncardio vascular deaths such as suicide, acci-

dents, or cancer.

This

is

the

first

study to definitively prove the effectiveness of cholesterol

reduction for primary prevention, that

is,

to treat those

who

have no present

disease. Previous studies had not achieved a sufficient cholesterol reduction to result in significant benefits.

Importantly, those benefits were noted as early as after just six of cholesterol lowering. This study

once and tion offers

for all silence the critics

no

was the proof of the pudding and should

who

have held out that cholesterol reduc-

benefits.

While the drug pravastatin was credited thorities

concur

for the benefits.

to

months

it

was the reduction

Any approach

itself,

to getting the

for cholesterol lowering, au-

not the drug, that was responsible

numbers down would be expected

have the same payoff, and the revolutionary cholesterol breakthrough de-

tailed in this

book

will get

your numbers

down

safely

and

effectively

without

the use of those expensive medications.

Every time you follow one recommendation or another in sualize ing,

your

arteries

becoming more

elastic, their

and your plaques being drained of

lized. That's revolutionary.

HOW DANGEROUS

this

book,

vi-

endothelium healed or heal-

their cholesterol

and becoming

stabi-

Never before have such promises been possible.

IS

CHOLESTEROL REDUCTION? The New York Times published Uons; ing.

it

warned readers

The author

a story that scared the bejesus out of mil-

that lowering cholesterol levels could be Ufe threaten-

cited a threefold increase in suicides but failed to note that

there were just six cases

m

the thousands of

men and women studied. The when one considers

doubling of accidental deaths doesn't sound as dramatic that there

were just

four, again

out of several thousand persons studied. Prob-

22

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

ably merely statistical coincidences. But to be absolutely certain that cholesterol

reduction

is

indeed safe as well as

number

effective, a

of careful studies

have been undertaken by a number of researchers.

Does

lowered cholesterol

a

The

level increase the risk of cancer?

first

servation that cancer patients had lower cholesterol counts than healthy

and

women

caused alarm. Closer analysis revealed that cancer

cholesterol reductions as the diseased cells metabolize

matter of which comes

cells. It is a

the cancer occurs

first,

first,

Cigarette smokers are

Heavy drinkers

terol level.

anyone

for

vent heart disease.

It's

more prone

to

to

lower his or her

really a matter of

More killer of

liver cancer.

both

S

really

moot. There's

an

in

effort to pre-

diminishing returns after reaching the

why worry about

we know

that heart disease

men and women. And we know The

is

beyond 150

level

dangers associated

15 or 120?

1

to the point,

slash that risk.

IT

like

likely the cul-

lung cancer, regardless of choles-

develop more

will

more

habits are

lifestyle

heart-healthy range of 160 to 180. So

with numbers

than normal

it

the chicken or the egg. In this case,

Moreover, concern over very low cholesterol levels

no reason

of

men

leads to

then cholesterol levels drop.

Other analyses show that other prit.

more

itself

ob-

that

is

number one

lowered cholesterol counts

The

benefits are overwhelming.

the nation's

risks are nil.

YOUR CHOICE Some

skeptics

still

thumb

ifications

They

their noses at the "diet-heart connection."

point to flaws in studies. They note that those

who

attempt cholesterol

mod-

through dietary changes don't see improvements. They question

whether the

entire population

should change

its

eating habits.

Frequently those criticisms have a nugget of truth.

two things

that even the

most strident

with elevated cholesterol

critics

levels, especially

It all

comes down

won't argue about.

First,

to

people

those with additional risk factors,

face a greater risk of developing heart disease

and having heart

attacks. Sec-

ond, reducing those levels to where they should be will prevent the progression of disease, often result in regression, and vastly improve the odds against

having a cardiac event.

As

to that first point,

only a

lesterol reduction, including

broke, don't

fix

it.

test will tell

who will

really benefit

any dietary changes and other

Only those with

a

problem

will benefit

from cho-

efforts. If

from

it

ain't

a solution.

Cholesterol: Guilty as

Blanket recommendations for the entire population, even

might

benefit, aren't completely logical. If

your cholesterol

enjoy that cheeseburger with no guilt and remember

if

Charged

23

•

the vast majority

under 180,

level is

me when you

toast with

your chocolate malt. Regarding the second point: You just won't succeed simply by following a diet that doesn't get the job done.

good on paper when group, but

statistically

A

sUght cholesterol reduction might look

analyzing results for an entire population or

doesn't get you, individually and personally, out of the woods.

it

have no doubt that a small reduction will produce a small

ment

in odds. But

deck in your

favor. You'll

program

180. This

Of course, ease

is

you want

do

will let

you'll

better than that. that

it is

I

improve-

completely stack the to less

than

that.

to consider the other

a "polygenic" disorder;

to

by getting your cholesterol down

you do just

want

You want

statistical

nsk

factors as well. Heart dis-

caused by a large number of risk

factors, all

of which intensify the effect of cholesterol.

High blood pressure, family history, and a

tire

heart disease picture. little

smoking, emotional

It's

interesting to note that the

to

brings

population.

tire

back on

their

fat,

up

The

AHA

and have

Not

of them.

all.

and others have taken the population approach.

arguments and recommendations on

cholesterol,

number of heart

Some

diet,

the question of whether to treat individuals or the en-

and sodium, they

and blood pressure measurement would the

paint the en-

heavy-smoking Japan-

America, eat a high-saturated-fat

their cholesterol levels soar, they develop that disease.

They base

obe-

heart disease while living in Japan and eating a traditional diet.

However, when they come

Which

stress, diabetes,

number of recently discovered risk factors

sity,

ese suffer

cigarette

attacks

fall

say, the

who

everyone cut

average cholesterol level

in the population as a

and strokes would

cause within that population are those

statistics. If

whole and

decline. True. But true only be-

are actually at risk; they are the

only ones to benefit. While on average, one person within that population gams a couple of

months of

begin with; others

life,

may

Scientific facts

some

gain a day because they were never at risk to

gain decades because they were at tremendous risk.

cannot be denied. About 80 percent of the cholesterol

present in everyone's bloodstream was produced by the person's

way

of the

liver.

Only 20 percent

versely, those at risk

owing

results

that

I

you have

think a

It's

habits. Per-

to elevated cholesterol levels will achieve,

age, only 5 to 6 percent reductions

mendations.

own body by

from the person's dietary

important

by following the

to realize that

high cholesterol count

—

if

it's

on

typical dietary

aver-

recom-

not necessarily your fault

you actually

do.

It's

a matter of ge-

24

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

Some people simply produce more

netics.

less efficient in

cholesterol than others

do and

are

terms of the body's elimmation of cholesterol from the blood-

stream. Ironically, cholesterol itself is absolutely vital to

body produces

the

its

don't eat, we'll have sential for the

tion of

supply

enough

—

'When we're

is

terol builds

up

fire

programmed

by consuming

down

By looking

fibers.

to

'We couldn't

high in saturated

who

actively

is

es-

for diges-

with-

live

fat,

arteries.

work

choles-

Those cho-

to bring

don't have that problem.

at the

data gathered over the decades in Framingham,

seldom

see that people with cholesterol counts of 155 or less attacks.

used

bile

produce excessive amounts, and

a diet

blessed by nature with low counts and those lesterol levels

what we

to satisfy certain basic needs. Cholesterol

bloodstream and eventually clogs the

in the

eat or

not better.

genetically

then throw fuel on the

no doubt why

That's

manufacture of sex and adrenal hormones,

But more

stuff.

life.

no matter what we

so that

and protective sheaths around nerve

fats,

out the

own

Other research done

if

ever have heart

Northwestern University reveals

at

range of 160 to 180 in which heart disease

is rare;

we can

other risk factors

a healthy

come

into

play for those having heart attacks with lifelong cholesterol levels in this range.

'When counts inch above the 180 mark, heart

attack incidence begins to rise,

slowly but perceptibly. Levels over 200 are marked with a significant increase in heart disease risk.

That

risk is linear,

attack victims have counts of about

cians

would

ing from the

The

get

under 180. So why do we hear so often

little bit,

that

high risk? Again

at

200

is

is

to

safe

we come

keep choles-

and

to the

that only

AH As re-

1

same

have read. In fact, they themselves shoot

their if

recommendations

in a

number

of ways. First, as pre-

the average cholesterol level for the population drops just

there will be fewer heart attacks.

Some

better than none, they say. Second, they feel

all

most heart

more prudent numbers.

viously explained,

tire

that

lower than most physi-

the population approach. Certainly researchers are aware of the

They justify

a

far

concerned about based on recommendations currently com-

medical literature that others and for the

worth noting

—

AHA.

counts of 239 or more place one

on

it is

230

to

astute reader will conclude that the logical goal

terol levels

liance

but

220

it's

lives will

be saved, and

too difficult to educate the en-

public on the nuances involving cholesterol and

its

variations along with

the other risk factors; people just won't understand, they say.

everyone would be willing

to

do what

it

that's

might take

And

third,

not

to bring cholesterol levels

Cholesterol: Guilty as

down

where they pose no

to

faith in the ability of diet

work

what you

eat

AHA

ommended by might

—

friends

the

them

that place

willmg

has put so

25

much

alone to do the trick. But diet alone simply won't

does influence cholesterol

levels, especially

be genetically prone to elevations because your

to

and your body doesn't

that

because the

•

most people.

for

Yes,

pen

risk. That's

Charged

clear out the excess. But the

AHA won't

at risk.

result in

do the job

makes too much

30 percent-fat

for the majority of those

diet rec-

with levels

adequate control are not very practical. Not everyone

—

relatives,

you hap-

Conversely, the kind of radical lifestyle modifications

or should be willing

and

liver

if

to

abandon

is

restaurants, avoid eating with

and consume only foods best suited

to a rabbit

warren.

Moreover, there are subfractions of cholesterol as well as other risk factors that

must be taken But able

you

lesterol

into consideration.

fear not, you're

reading the book that v^ll both educate you and en-

to virtually eliminate the risks of heart disease associated

and other considerations.

You'll

with cho-

be empowered to use the tools and

techniques that will achieve total control vvlthout deprivation.

Eggs, Cholesterol, and You: Unscrambling the Facts

Eating a

from such foods as egg yolks

lot of dietary cholesterol

will raise the

cholesterol levels in your blood.

Or maybe

back on dietary cholesterol

lower cholesterol levels in your blood. Or

maybe

will

not. Totally confused? Let's see

if

Chemically, the cholesterol in food

we can no

is

Confused? Try

not.

different

your blood and throughout your body. Since there levels of cholesterol in the

to get is

them down

low.

blood pose a risk

And common

with the cholesterol in the

diet.

believed. But a nasty fact got in the

is

from the cholesterol

in

that elevated

makes sense

it

dictate that the place to start

For quite a few years,

way of this

Cutting

out.

no doubt

for heart disease,

would

sense

mess

sort this

this.

that's

lovely theory.

restrict dietary cholesterol, levels of cholesterol in the

what

scientists

When people did

blood did not always go

down.

Then more to

researchers learned that dietary

recommend Well,

we do know

recommendations

that saturated fat

to restrict. In fact,

etary cholesterol won't

A

especially saturated

far

if

you don't do

make much

is the

most important dietary com-

that, first

difference at

and foremost, limiting

di-

all.

study in the American Journal of Clinical Nutrition showed just that in

fat is

On

fall

when

sat-

not reduced, regardless of restriction of dietary cholesterol.

when one limits saturated fat and cholesterol, choblood do come down. That has been demonstrated in

the other hand,

lesterol levels in the

both

was

valid?

1992. Researchers found that blood levels of cholesterol do not urated

fat,

restricting cholesterol in the diet as well, as part of a total cho-

lesterol-lowering program. But are those

ponent

fat,

However, the authorities continued

influential than dietary cholesterol.

men and women

with high levels of

total

and LDL

two rather famous cholesterol researchers attached

their

cholesterol. In fact,

names

to

formulas

predicting cholesterol improvements. The Keyes equation and the Hegstead

equation, developed by Ancel Keyes of the University of Minnesota and

Mark

Hegstead of Harvard University, quite accurately anticipate cholesterol reductions in the blood

when one

restricts total fat, saturated fat,

and

cholesterol.

Eggs, Cholesterol, and You: Unscrambling the Facts

The equations

who

apply primarily to people

really

27

•

have a cholesterol

problem, as compared to those with numbers in the normal range. In 1994,

Bowman Gray

searchers at

fed either restricted cholesterol

coming from

amounts or

four eggs daily For those lucky

LDL cholesterol hardly rose

at all,

enough

a diet rich in cholesterol

to

have the right gene pat-

even with the four eggs a day But those

LDL

with the more typical gene showed a very significant

The North Carolina researchers estimate in

individuals can eat

blood

remain

will

at

about the same

In 1995, researchers at results

when

and

the cholesterol they want,

all

they gave as

States.

Those lucky

levels of cholesterol in

levels.

Columbia University

many

elevation.

that the favorable gene occurs

about 12 to 15 percent of the population of the United

their

re-

that

They worked with twenty- three medical students

cholesterol in the blood.

tern,

North Carolina showed

gene largely determines whether dietary cholesterol influences

a particular

who were

School of Medicine

in

in

New York

found similar

as four eggs daily to thirteen

women

ages

twenty-one to twenty-five. Cholesterol levels in the blood just did not go up as

much

as

would be expected.

Now, before you dust are not affected

off

your egg poacher, keep in mind that those

by dietary cholesterol

mal blood cholesterol enables them to

levels to

in eggs

and

who

other foods either have nor-

begin with and/or have the gene pattern that

consume those yolks with impunity. Some

put

this

men and women

will

statistics

into perspective. First,

about half the American population of both

succumb

eventually

to heart disease.

Second, about half the people in the

United States have a higher-than-optimal other risk factors. Third, those

who do die

level of

blood cholesterol along with

of heart attack have arteries clogged

with plaques composed largely of cholesterol. Fourth, the vast majority of those victims also had elevated cholesterol levels

when

they were

alive. Fifth,

those whose cholesterol levels are in the 150 range are virtually never victims of heart disease. Sixth, heart attack victims with cholesterol levels under are

now known to have other lipid abnormalities that put them What all that means is that about half of us have a problem and

us do not. Half of us can eat egg yolks not.

200

at risk.

The gene contributes The

till

we're sick of 'em, and

to part of that half but obviously not to

AHA came up with a recommendation

than four per week. That

such that the milligrams

number was based on

total cholesterol

daily. That's the

consumed, on

recommendation

to limit

half of

half of us canall.

egg yolks to no more

dietary estimates of other foods

average,

would be

less

than 300

for the general population.

But

28

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

some people need even more

restriction

yolk. Others, as we've seen, can eat

How can you

tell if

you

down

and

Washington

no such

all

from 48

test

to

250 and

triglycerides in a study

terol,

who

ate that

The bottom

not the other

been that way

lipids,

your

all

done

at the

life.

elevated

University of

consuming two eggs

daily for a

many

may

termed

eggs saw their triglycerides go from

were on an other-

to 162. All subjects

line here is that

eggs

is

HDL

and LDL cholesterol

total

your problem

if

is

just choles-

not matter that much.

your cholesterol has tested out on the high

If

comes

it

increase in cholesterol but also found their

LDLs go from 149

their

diet.

who had

52 on average. Conversely, those with what

to

as well as triglycerides,

238

cholesterol sensitive?

currently exists. So

"combined hyperlipidemia," with elevations of both

wise low-fat

it,

take so that our dietary needs

error.

in Seattle in 1995. In fact, those

month not only saw no

levels rose

we can

raise cholesterol levels for individuals

who had normal

counts but

full

tailored. But

to a matter of trial

Eggs didn't

test

an egg

at

four.

are, as the scientists call

Eventually there will probably be a

can be more precisely

and should not even look

many more than

side,

you can be sure

moment

That tendency shows up from the

it's

of birth.

In fact, doctors can even

check the blood

that cholesterol level

elevated in the blood, the disease progresses from

is

in the umbilical

cord before birth:

If

childhood on through adulthood.

you have an elevated cholesterol

If

the other lipids,

numbers down. and

this

book

it

We know

is filled

lesterol influence

bly

so.

maybe

Maybe

behooves you

level,

with or without elevations in

terms to get your

in the strongest possible

for sure that the place to start is

with saturated

fat,

with other recommendations as well. Does dietary cho-

your blood cholesterol? Probably

you're sensitive only to saturated

so.

fat

Maybe

and not

not, but proba-

cholesterol.

And

not.

So here comes the trial-and-error

part. If

you

really

can determine whether you are cholesterol sensitive. The

your blood cholesterol cholesterol diet

to

normal.

Do

low

for a

Then challenge

first

to

do

step

so,

is

you

to get

so by following a low-fat, low-

and the other recommendations

that the count stays terol tests.

down

want

period of time, as

in

my

program. Make sure

shown by

repeated choles-

yourself by eating a few extra eggs weekly for two

or three weeks, perhaps a month.

The next

cholesterol test will

tell

you

whether those yolks made

a difference.

most Ukely

be sensitive and that your cholesterol will go up

that

you

will

Based on the research done so

far, it's

Eggs, cholesterol, and You. Unscrambling the Facts

when you

•

29

Then

again,

you may be one of the lucky ones. No

that the

whole

issue

eat those eggs.

one knows.

You may decide

is

moot

after

reading about the

wonderful effectiveness of phytosterols to block the absorption of cholesterol in the diet. to

It's all

m chapter

7.

Whether

you're sensitive or not, you'll be able

enjoy those eggs again whenever you want.

Fats

Fai tastes good, true,

and added

no one would make

spite all the

some

other foods taste better.

diet.

De-

at least

the positive side of the ledger, fats carry the fat-soluble vitamins in-

A and

its

precursor beta-carotene, and vitamin K,

assists the blood-clotting process. Fat also

many

source of energy and keeps

tissues of the

provides a concentrated

body

healthy.

and

the diet can lead to dry, scaly skin; diminished growth

and reproductive problems. An absolute minimum of ries

that weren't

If

about reducing the amount in the

bad things you've read and heard about them, we need

cluding vitamin E, vitamin

which

make

a big deal

stay healthy.

fat to

On

fats

the Fire

in

must come from

Too

little fat

tissue replacement;

5 percent of total calo-

prevent such problems, which collectively

fat to

in

is re-

ferred to as essential fatty acid deficiency.

On a

the other side of that ledger,

number

Saturated

we now know

much

re-

h?ve been implicated

Paradoxically,

in elevated cholesterol levels

fat

and have been linked

leads to obesity, hypertension,

some people

in the

world appear

to a

number

fish rich in fat,

and Greeks often

eat far

more

and diabetes.

total fat

mammals

than even Americans.

Nevertheless, both Eskimos and Greeks have low rates of heart disease. ever, all that fat Scientists

still

calorically,

have been tinkering with

and people, trying

fused.

adds up

to

come up with

How-

and those people are often obese.

facts

and

oils for

decades

in

both animals

healthy recommendations. Despite the vast

of data accumulated, the public for the most part remains terribly con-

Owing to

the philosophy of

many

health authonties that the public cannot

be expected to understand complex issues, the attitude held by is

of

to eat vast quantities of

without problems. Eskimos get most of their calories from marine

amount

poses

and the

fats

cancers. Excess of total

and

fat

fat.

sulting increases in risk of heart disease

fat

that too

of health problems. That's particularly true for certain kinds of

bad and

ihat the only foods

When bathwater.

I

It

comes

to

fat,

many is that all

worth purchasing must be reduced

we have thrown

have spoken with dozens of

the proverbial

fat

or

fat

fat free.

baby out with the

men and women who

smile and brag

Fats in the Fire

no

that they eat "practically

And

add no

fat to

the

For nothing. All pain, no gain.

fat.

the foods they prepare.

By reading and understanding

many

subtleties that

stand.

Your reward

diet! Let's start

Best-selling

fat at all."

books

you

will

1

advise people to

ill

the joy of eating gets

this chapter,

3

•

thrown out with

be able to grasp the

authorities appear to think you're too ignorant to under-

will

much

be not only improved health but also a

tastier

with the basics.

TAKING FATS APART All fats are

composed

of chains of carbon atoms.

some

linked with hydrogen atoms, and

(COOH) istry,

one end and

at

a

methyl group (CH3)

the important parts are

has and

Some carbon atoms

are

are linked with a carboxyl molecule

how many

Of all

at the other.

that

carbon atoms a particular

chem-

fatty acid

how many spaces are left without hydrogen atoms. These components

of fats are fatty acids. the carbon atoms are linked with hydrogen atoms and

If all left,

the fatty acid

said to be saturated.

is

cupied by a hydrogen atom, that

unoccupied spaces All fats are a fatty acids

polys). is

exist

If

fatty acid is

on the molecule,

medley of saturated

(MUFAs

a space

is left

If

monounsaturated

(PUFAs or

enormously, and

fatty acids varies

at

many such

polyunsaturated.

fatty acids (SFAs),

tend to be solid or semisolid

are

could be oc-

or monos), and polyunsaturated fatty acids

However, the percentages of these

fats

is

no spaces

that

monounsaturated.

the fatty acid

the differences that indicate healthfulness. For the

saturated

open

most

it

part, foods rich in

room temperature, while

those

rich in unsaturated fatty acids are liquid.

Take

a

look

positions of fats

at the

and

chart

oils.

on page 37

to see the

Even the healthful

spectrum of fatty acid com-

olive oil has

some saturated

fat,

while butter and lard have some polys and monos.

Now the plot thickens.

Not

all

saturated fatty acids are equally bad. Their

compositions vary considerably, notably in the number of carbon atoms in

Some

their chains.

some appear

to

raise cholesterol levels in the

have

little effect

blood

on cholesterol counts

myristic acid, found in coconut oil

and

butterfat,

is

found

at all.

little

or

no

effect at all.

others;

For example,

fatty acids as well.

in a variety of fatty foods including beef

pears to be neutral, having

more than

a real artery dogger,

both of those foods contain other cholesterol-raising stearic acid,

far

and But

and chocolate, ap-

32

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

The problem, of course, The same chocolate bar with

that

is

we

can't pick

and choose our

comes with

stearic acid

fatty acids.

complement of those

a

nasty SFAs as well. At least that's the case today; tomorrow's food scientists

may

engineered foods with hand-picked

offer specially

THE EFFECTS OF FATS

When

ON

fatty acids.

HEALTH and heart disease came

the link between diet

into focus in the

1960s and 1970s, dietary cholesterol was targeted as the bad guy. Cholesterol in food

plistic sense.

blood and in clogged

It

was much

For If

levels

many

is

would have one conclude

later that scientists

learned that saturated

people, dietary cholesterol

Even

in

makes

little

sim-

that reduc-

ratio of

adding quantities of PUFA-rich corn

fat is

the real vil-

or no difference.

SFAs with those high

one changed the

if

made

the prudent thing to do.

one replaced foods rich

fell.

It

chemically the same as cholesterol in the

arteries, so logic

ing cholesterol in the diet

lain.

is

in

PUFAs, cholesterol

SFAs and PUFAs

in the diet

those cholesterol counts

oil,

by

So the

fell.

big push from the American Heart Association, with a nice assist from the corn oil

industry,

oil

and other

was

for the

oils

But there was a diets high in

term

came

developed

far

along.

ointment, or

fly in that

More

had

little

experience with

1980s, olive

oils.

later laboratory

And

PUFAs

low-fat diets enriched with

have shown that PUFAs contribute

oil

The long-

HDL as well as the total and LDL choles-

making the development

in the

MUFAs and

of plaques in arterial walls

came

into

vogue owing

to its

to the oxi-

more

likely.

high content

the fact that Mediterranean peoples, including the Greeks,

been consuming Moreover,

We

that rodents fed diets high in

anticipated.

levels of the protective

recently, researchers

dation of LDL,

Then

oil.

were unknown, and then some

The reports showed

more cancers than

PUFAs lowered terol.

consumption of corn

to increase its

PUFAs, since no previous cultures consumed those

effects of shifting fat intakes

findings

of

American public

high in PUFAs.

it

MUFAs

in large quantities

appeared to have

and staying very

far less effect

on

healthy,

HDL

had

thank you.

than PUFAs. So

where do we stand today?

Now that issue,

When

it

seems

the dust has settled that both

and

a

number of studies have looked

PUFAs and MUFAs lower

used to replace SFAs

of 25 mg/dl on average. That

at the

cholesterol equally well.

in the diet, either results in cholesterol reductions

was the case when Stanford University researchers

Fats in the Fire

pooled the data from fourteen

clinical trials reported

But those investigators saw no

or olive

oil

statistically significant difference in the effect

would be equally healthy

compared

diets rich in

degree of oxidation of

LDL

consuming PUFA-rich

diets

more

which means they

tles

of corn

oil just yet.

gelatin capsule or

researchers in Spain and at

MUFAs and PUFAs

with regard to the

They found

that those

had more oxidation than those on MUFA-rich

probably because corn

easily,

effort,

cholesterol in the blood.

diets. That's

the potential to oxidize

that either corn

choices.

But there's more. In a collaborative Tufts University

33

between 1983 and 1994.

on HDL. The conclusion from studying those data would be oil

•

and other PUFA-rich

oils

turn rancid

more oxidized and they carry

are themselves

LDL into You can

oil

the bloodstream. But don't toss out your botlargely prevent that oxidation

two of vitamin E into the

oil

when you

by squeezing

bring

it

a

home from

the supermarket.

Speaking of vitamin

E, doctors at the University of California at

San

to know if it would protect against the oxidation of the worst of LDL cholesterol, the so-called small, dense LDL. (See details on this type of LDL on page 54.) They found that while vitamin E did a hne job as an antioxidant for most types of LDL, it was effective on small, dense LDL only when the diet included monounsaturated fats. Moreover, MUFAs alone pro-

Diego wanted the

vided some protection, while vitamin E alone did not. The best approach,

though, was the combination of vitamin E and a diet rich in MUFAs.

OILS

ON

THE SHOPPING

LIST

What can we conclude from

all

this? Let's review.

SFAs

levels in the blood, increasing the risk of heart disease.

MUFAs some

lower those levels

when used

distinct advantages over

diet rich in

MUFAs

to replace SFAs.

raise cholesterol

Both PUFAs and

MUFAs seem

have

to

PUFAs. Mediterranean peoples have enjoyed a

for centuries

and have one of the world's lowest

heart disease. Asian peoples have prepared their foods with a

number

rates of

of

oils,

including peanut and sesame, for hundreds of years with similar good health.

The sible

logical conclusion, then,

while enjoying

moderation. By that

you

fat,

would be

PUFAs and MUFAs, I

mean not

eating so

to

reduce SFAs as

much

as pos-

especially the latter, in reasonable

much

of those fats that they

make

since that's not very healthy either.

In terms of protection against heart disease, there

is

no

logical reason to

34

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

severely limit

then,

consumption of

one

as long as

total fat

other than to keep caloric intake down,

much

restricts saturated fat as

you might

as reasonably possible.

Why,

ask, not completely eliminate saturated fats? First, that's not

really possible, since all fats contain at least

some SFAs. Second,

the enjoyment

of food should not be denied.

Many less love

it.

who wag angry

of those

They

fingers at us really don't like food,

see food, quite literally, as a necessary evil, fuel for the engine

and nothing more. Moreover, they

This will sound

A

in olive oil,

sprinkle

1

makes

olive oil

ters

on foods

In

salad, or

end of

at the

two

and has

on the

the calories,

eating a Mediterranean

a bit of feta cheese for

wonderful

its

flavor.

a salad of sliced tomatoes, fresh basil,

and

my

this

diet.

go into

I'll

book. But

far

now back

more

detail in the

to those oils.

chap-

Which ones

a

oils tie for first-place

number

of uses.

I

honors. Olive

use

monos,

oil is rich in

to saute garlic, to toss

it

with a

table to dip bread instead of using butter or margarine. (To cut

I'll

around cooking Canola

when

m your kitchen and in your diet?

my house,

delicious,

painted in black and white.

given meal and for the entire day, the percentage of

extremely low in

is still

should you put

is

on

make adequate

the dish sing. Yes, cheese has a lot of SFAs. But looking at the

total fat intake for that

SFAs

is

heresy to some, but

like

crumbled blue cheese on

bit of

people will not

fear that

Hfestyle modifications unless everything

meal rich

much

oil

mix oil.

Canola

olive oil with balsamic vinegar.)

Also rich in monos,

it

is

particularly

low

has another distinction, shared by no other

alpha-linolenic acid than

all

the rest. That fatty acid

may

our

oil is

all-

in SFAs. oils. It

has more

help lower the risk

of stroke. Researchers at the University of California at San Francisco found in

1995

that individuals with the highest levels of alpha-linolenic acid

incidence of stroke. Soybean

least

Personally, that If

I

I

don't use corn

or the other

oil

had the

the second-richest source.

PUFA

oils

very much.

It's

not

think they're unhealthful, but rather, olive and canola are better choices.

you do

adding

a

like

one of the

also

oils in this class,

be sure to prevent oxidation by

few drops of vitamin E by piercing and squeezing a gelatin capsule.

But our shelf has a

Peanut I'll

oil is

oil

works

add

number

of other oils as well as olive and canola.

particularly well in stir-frying

a splash of

berry vinegar, walnut

sesame oil

oil for a

makes

a

and imparts

flavor boost.

Mixed

a delicious flavor.

fifty-fifty

wonderful salad dressing.

It

with rasp-

also contains

quite a bit of the stroke-preventing alpha-linolenic acid.

such,

We

use

my

indispensable kitchen companion

all

our

oils in

moderation, mainly to limit our is

total calories.

a can of butter-flavor

As

cooking

Fats in the Fire

oil spray.

Scarcely a day goes

hnd plenty

FATS

by

that

of examples of that in

1

my

don't use

it

in

35

•

one way or another.

You'll

recipes.

WITH A FUTURE

Two cooking

oils that

show tremendous preliminary promise

of health

and rice bran oil. Grapeseed oil is as common in Auscom oil is here; you'll fmd it in some specialty and health food stores, and

benefits are grapeseed oil tralia as

you can order grapeseed 858-7477. Rice bran

by

oil

calling the Lifestyle mail order

principal cooking

oil is a

company at (800)

and deep-frying

oil in

Japan and

elsewhere in Asia. Not found in most supermarkets, you can locate rice bran in specialty

Why

and health food

stores or

by calling Ener-G Foods

at

oil

(800) 331-5222.

go out of your way to find and use these two exotic

oils?

Because

New

York

early research indicates potential health benefits for both. Dr.

David Nash,

a cardiologist at the State University of

Syracuse, started the interest in grapeseed nal of Arteriosclerosis that in just

A

than 13 percent.

second

oil

two weeks the

article, in the

oil

raised

1994 Journal

HDL

of the

levels

by more

American College

oj Cardiology, confirmed Dr. Nash's findings. Participants in the study used

ounce

daily,

one

replacing other oils in the diet.

Grapeseed

oil

cooking a breeze. with rancidity;

has a very high smoke point (485°F) and makes high-heat

Massachusetts

can

it

at

high level of vitamin E means you won't have a problem

Its

The champion

terol levels

in

with his 1991 report in ihe Jour-

on

sit

a shelf for a couple of years without oxidizing.

of rice bran oil

Lowell.

down by 20

When

to

is

fed to

Dr. Robert Nicolosi of the University of

monkeys,

rice

bran

30 percent without decreasing

oil

brought choles-

HDL counts.

colosi believes that the so-called unsaponifiable oils in rice bran

responsible for the cholesterol-lowering

and

Dr. Ni-

its oil

are

effect.

PROCESSED FOODS, FAST FOODS,

AND

THEIR FATS

If

Americans were

could enjoy

all

to eliminate

the oils they

some notable healthy

most processed foods and

wanted and be much

fast

foods, they

healthier. Certainly there are

exceptions, but they are just that: exceptions to the rule.

Sure they're convenient, but you pay a high price for most processed, high-

36

fat

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Tm

foods. Obviously,

not talking about canned peas or the low-fat frozen

dinners and entrees. Read some of the labels on the foods in the supermarket.

Not only are the

The ter to

starting

It

transform

contents high, but the type of

fat

issue of trans fatty acids

on page

Manufacturers

187.

into a type that has

it

all

start

I've

poses health

risks.

devoted an entire chap-

with perfectly good

and

oil

the cholesterol-raising abilities of saturated

Dr. David Kritchevsky of the Wistar

In fact.

fat itself

so important that

is

fat.

Institute in Philadelphia feels that

trans fatty acids should be considered the equivalent of SFAs. Processed foods

have

parading as innocent soybean or cottonseed

lots of those trans fatty acids

Let's

examine the cottonseed

oil in

processed foods a

little

more

oil.

closely.

one of the worst of the vegetable

oils,

with 27 percent

SFAs. Hydrogenation converts at least 50 percent of an

oil's

PUFAs and con-

To begin with,

verts

them

this is

to saturated

and

trans fatty acids. For cottonseed oil that's

50 per-

cent of 54 percent, adding another 27 percent to the original 27 percent for a

54 percent SFAs or trans

total of

Cottonseed

oil is

The next time you're

peanut

tional

When

oil. It's

it

french

Chinese restaurant, ask what kind of

when

fries.

they say cottonseed rather than the tradi-

to deep-fried foods at

bliss.

local fast-food outlet, ignofor their

Instead, the tubs are filled with hydrogenated oils that are used

have a serving of

Once

fries? Sure.

fats

with each reheating.

in a while, because,

issues in the arena of heart disease

for certain that

doggone

no more than once or twice

that's a rare treat,

Some

your

most places no longer use beef suet

Sure,

over and over again, creating more trans

good! But

they use for

oil

cheaper.

comes

rance seems to be

That's worse than lard!

sneaking into the American diet in other ways as well.

in a

Don't be surprised

stir-frying.

fats.

both saturated

fats

and trans

a

it,

Do

they taste

month.

remain cloudy. But we

fats raise

the

ever

I

know

bad LDL cholesterol

we know that reducing the amounts of those fats LDL counts down. Happily, we know that monounsaturated

levels in blood. Conversely,

we

eat will bring

and polyunsaturated eration. if

for

them

However,

if

fats

do not

raise cholesterol levels

we go beyond

when enjoyed

that moderation, cholesterol levels

no other mechanism than weight gain because the

—

are rich in calories.

One might

Moderation

rightly ask.

enjoy large amounts of olive

If

is

and

and

mod-

oils

—

rise,

all

of

the key.

Greeks and

oil

fats

in

v^U

Italians

and other Mediterraneans

are virtually free of heart disease,

why

practice moderation? Indeed, stories are told of Mediterranean shepherds actually drinking a glass of olive oil for their

morning breakfast and drenching

pieces of bread with

also true that their cholesterol lev-

it

during meals. But

it's

37

Fats in the Fire

els rise as a result, often

averaging as high as 250 as was determined in an on-

going project called the Seven Countries Study. Obviously, something else operates to keep those people healthy despite cholesterol levels that put Americans at high risk.

Some

might be the very low content of saturated

the diet or the heavy con-

fat in

sumption of fruits and vegetables along with wine tioxidants lesterol

and other substances

from oxidizing

In any case,

it's

and other healthful

a

good idea

to

keeping

it

from clogging the

hedge your bet when

Again, moderation. Keep total

levels, since total fat intake is

second only

it

as a beverage. Perhaps the an-

in the heavily vegetarian diet prevents the

in the blood, thus

oils.

authorities believe

fat

it

comes

down

cho-

arteries.

to olive oil

to reasonable

tendency

to saturated fat in its

to

raise cholesterol levels in the blood.

COMPARISON OF TYPE

DIETARY FATS

AND

SATURATED

MONOUNSATURATED

FATTY ACIDS

FATTY ACIDS

(%

OF total) *

Canola

oil

6

Walnut

oil

9

(%

OF total) *

62 23

OILS POLYUNSATUARTED FATTY ACIDS

(%

OF total) *

32

64 77

Sofflower

oil

10

13

Sunflower

oil

11

69 62 9

18

20 25 77 24 49

18

47

31

20 27

39

41

19

54

27

21

30

26 45

31

47

22

Shortening (can)

31

51

14

Lard

40 47 49 50

45

11

Corn

oil

13

Olive

oil

14

Soybean Peanut

oil

Margarine

Sesame

oil

(tub) oil

Cottonseed

Tuna

oil

fat

Cfiicken fat

Margarine

Mutton

(stick)

fat

Palm

oil

Beef

fat

Butterfat

Palm kernel

Coconut

oil

oil

15

61

33

11

41

8

62

37 42 29

9 4 4

81

11

2

86

6

2

percentages are averaged and thus may not total exactly 100 PERCENT.

Good Food: The Cornerstone of

Years ago that's

Good Health

someone came up with

been modified

the notion that "you are

"you are as healthy as what you

to

what you

eat."

eat."

Today

Dietary practices

have a direct connection with practically every degenerative disease including

and cancer

diabetes, hypertension,

While terol in

It's

as well as heart disease.

true that our bodies

our bloodstreams, we can

choosing the foods

we

produce the vast majority of the choles-

still

control

eat. Paradoxically,

it

to a great extent

by wisely

while dietary modifications result in

when undertaken

only small percentages of cholesterol improvement

alone,

those same changes synergize the effects of other efforts. For example, those taking prescription cholesterol-lowering drugs have vastly better success

they also limit the intake can

amount

of

undermine such

fat

when

they consume. Conversely, failure to lower

fat

efforts.

Moreover, there's no question that dietary component. Cut back

on

fat

fat

packs more calories than any other

consumption and you're

virtually assured

of weight loss. In this part of the book, I'm going to introduce

olutionary substances.

One

you

blocks the absorption of

fat,

to

been on the forbidden

list

rev-

and the other blocks

the absorption of cholesterol. These products will allow that have long

two absolutely

you

to enjoy foods

for heart-healthy people.

In other chapters in part 2, you'll learn about soluble fibers that can help

remove excess cholesterol from the bloodstream. Then there will defeat

newly identihed

risk factors for heart disease

are vitamins that

and antioxidants

that

and enjoy every

day.

offer special protection.

But the starting point

Food should be for

it

to

is

the diet, the foods

we

eat

the cornerstone of any healthy lifestyle, but there's

no reason

be the millstone around our necks. There are those whose philosophy

can be summarized by saying,

"If

it

tastes

good, spit

it

out." That's absolute

nonsense. Food was meant to be enjoyed, and there are hundreds of absolutely delicious foods that are naturally

not to enjoy them to the

fullest.

low

in fat

and

cholesterol. There's

no reason

42

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Today, the availability of wonderful low-fat and nonfat foods in super-

markets

revolutionary in

is

its

own

right. If

you had

told

me

ten years ago that

be eating hot fudge sundaes for dessert following a dinner of steak and

I'd

baked potato with sour cream,

would do

etary compliance

my

quest for

can have

I

you shopping

gravy, rare steaks

and so can you.

it all,

foods.

aisles

my

and

roasts, tacos

The Kowalski family

on.

food could possibly tempt

strict di-

me

to forgo

In part 4 of the

It's

as close as

book

I'd like

can get to per-

I

with you and your shopping

family and

enjoy

I

all

the dishes

list.

most

Not tofu and bean sprouts but meatloaf vvdth mashed potatoes

enjoy.

and on and

No

some wonderful

share with you the ways

I'll

Americans

and

for

down supermarket

sonally walking

Then

the trick.

vibrant health.

total,

But today to take

have called you nuts. In 1984 only

I'd

and

burritos, grilled cheese sandwiches,

loves food,

and

we'll invite

you into the

kitchen for breakfast, lunch, and dinner as well as to a variety of restaurants

where you can dine

As trol that

I

one

and have your heart thank you

the biggest dietary offender

1,

and you can pretty much

factor,

even

a certain extent,

foods;

like royalty

detailed in part

total fat in the diet.

no plant foods have any

at all.

is

for

it!

saturated

fat.

Con-

forget about cholesterol and, to

Cholesterol

is

As you graduate

found only in animal to

lower

and even

fat

nonfat animal foods, you automatically slash your cholesterol intake. In addition,

you can block the absorption of the cholesterol

terol-rich foods with phytosterols. Really, there's not

in eggs

even

and other choles-

much

point in read-

ing the cholesterol information on the Nutrition Facts label on foods in the

supermarket.

But what about

total fat?

which have been enjoyed

in

Much

of the

good health

cholesterol levels in the blood.

fat in

the foods

for centuries

we

— has no

The monounsaturated

enjoy

— and

direct effect

fats in olive oil,

oil,

avocados, and cashews and other nuts are considered "neutral" in their

fect

on

take

is

in

moderation, no problem. But

excessive, even the healthiest fats

You can for

Enjoyed

cholesterol.

example,

pily, its fat is

forget

good

Eskimos healthy

oils

about paying any attention

one of the

is

and

for

you

fattiest

—

of ftsh

rich in the

for generations.

can

when

at all to certain fats.

fatty acids that

for barley

and

all

fat

grams.

to restrict

The same holds

other grains. Think of those foods as free of

fat.

Hap-

have kept the

Oat bran has two grams of fat per ounce, but you sure wouldn't want fat!

Salmon,

delicious!

Don't even bother to count those

your use of that cholesterol-lowering cereal because of the

think about the

ef-

total fat in-

raise cholesterol levels.

and one of the most

omega-3

on

canola

fat;

don't even

Good Food: The Cornerstone

As

Good Health

of

a practical matter, limiting the total day's fat intake

limiting calories. Dipping your bread into a

healthier alternative to slathering

spoon, the calories can add up quickly. Total

comes down

saucer of olive

little

with butter, but

it

to

oil offers a

120 calories per

at

43

•

table-

intake can also contribute to

fat

the cholesterol levels in the blood, especially for hypersensitive individuals,

though not nearly So

as

how much

much as saturated and

fat is

cent of calories taken as of 30 percent

fat.

trans

fats.

But

enough? The average American

fat.

The

total fat

does count.

diet contains

36 per-

AHA has long recommended a healthier intake

At the other end of the spectrum, some individuals, includ-

ing Pritikin and Ornish, have advocated a diet of less than 10 percent That's simply unpalatable; there's

no need

to

be a martyr. Since 1985

suggesting a 20 percent-fat diet as the perfect compromise, and a authorities including the

The 20 percent-fat gram such

al-

I've

fat.

been

number

of

American Health Foundation concur.

when

diet, especially

as mine, really

produces

part of a total heart-health pro-

terms of both cholesterol and

results in

weight control. You just can't argue with success, and hundreds of thousands of

men and women

have succeeded beautifully with

Remarkably, as part of diet to

is

my

revolutionary

this

new program,

count the let's

fat

from

shellfish, fish,

try skiing, indulge in extra fat

and

grains. Next,

if

from

olive oil

same way you'd allow yourself an extra serving of

percent! Third, the use of products to block a lot of fat over

and above the 20 percent

finally, as we'll

see in the

rants eUminate

much

fat

we used really

into proper perspective. But

tention to teaspoons of

course not.

No

as 20 percent

and others

fat

fat,

to

becomes it

are virtually zero fat (fruits is folly.

It's

never been easier!

a starting point, helping us really

mean? Do we pay

In fact,

fat.

and

no foods

at-

are listed fat (oils)

vegetables), calculating the

The only thing that matters

consumed over the course

One day

And

supermarkets and restau-

in

either! Moreover, since some foods are 100 percent

tent of individual foods

high, another low.

just doesn't count!

one organization would have us believe? Of

as

foods are labeled in teaspoons of

as fat

it

worry about.

what does

grams into the 20

fat

absorption can accommodate

level so that

coming chapters, foods

of the

The 20 percent-fat concept fat

you burn some extra

and the other sources of monoun-

potatoes or slice of bread. You don't count those extra

fat

20 percent-fat

say during a day's heavy gardening, garage cleaning, or cross-coun-

saturated fatty acids in the

of

a

actually easy to achieve. First of all, as discussed above, don't even bother

energy,

put

approach.

of the day, the week,

is

the total

fat

con-

amount

and the month. One food

high, another low. All in moderation.

The most convenient way

to get a

handle on

this, especially for

our

in-

44

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

dividual needs,

count

terday?

which

know whether If

With

grams of in

Note that

fat.

1

say be aware

by experience over the

are low; you've learned that

weight. ries.

be aware of grams of

to

is

not

of,

Do you know exactly how many calories you ate today or yesOf course not. But you do know which foods are rich in calories and

slavishly.

your

you

consuming allow you

the calories you're

gain,

own

to

you cut back on those foods you know

just the slightest effort, you'll develop that

fat in

certain foods,

and

you'll

years.

And you do

maintain healthy

to be

high

in calo-

same awareness of

the

apply that awareness to food decisions

situation.

For a 150-pound person

means about

fifty

grams of

market and the information for those fifty

grams

who

is

fat daily. I'll

daily, give

moderately

With

active, a

on foods

the labels

all

20 percent-fat

provide in the coming chapters,

it's

in the super-

easy to shoot

how do we come up with

or take. So

That moderately active 150-pound person needs about

diet

that figure?

fifteen calories

per pound daily to maintain weight, to neither lose nor gain. The more you weigh, the more calories you need. The more active you are, the more calories

you can burn.

On

average, though, most of us getting exercise at least three

days a week, and hopefully more than that, can accommodate to

fifteen calories

maintain each pound of weight. That 150-pound person will thus burn

2,250 calories daily (150 pounds multiplied by hfteen Since fat,

we do

calories).

we want no more than 20 percent of those calories to come from come up with 450 calories from fat (2,250

the simple calculation to

divided by 20 percent). Fat provides nine calories per gram. So those

from

fifty

Fifty fat If

grams of

grams

fat

for a

fat

come

calories will

(450 calories divided by nine). That's

all

there

is

to

it.

150-pound person.

you weighed

1

10 pounds you'd need thirty-seven grams of

weighed 190 pounds you'd

on page 47 saves you

450

calculate sixty-three grams.

the effort of doing your

And

fat. If

you

so on. The chart

own number-crunching;

it

shows

fat-gram allowances for persons of varying healthy weights and levels of activity.

Keep your personal allowance

chapters, and you'll see just

how

in

mind

easy

it'll

as

you read through the following

be to stay on

But what about that all-important saturated fat

we consume,

as possible.

The

the goal

on

a practical level

healthiest ideal

would be

monounsaturated and polyunsaturated ing from the saturates. Avoid the tropical

Choose

is

fat?

target.

Of

the total

amount

to concentrate those fat

fats,

oils:

of

to include as little saturated fat

grams on

with no more than a third comcoconut, palm, and palm kernel.

low-fat or nonfat dairy foods. Select the leanest cuts of meats.

Opt

for

Good Food: The Cornerstone

oils

lowest in saturated

Buy

fats.

soft

of

Good Health

45

•

margarine instead of butter or stick mar-

garine. In recipes replace the saturated fats with unsaturated fats. That's

there

is

to

it.

No need

to concentrate

on

specific

numbers

all

of grams.

Don't be confused, and don't be discouraged. As you read through the

coming pages,

the total picture will

To be honest, grams I

for the day.

do want

I

Nothing

become completely

remember

the last time

I

clear to you. Promise.

bothered

to

count

my

fat, I

make

it

avocados or

olive oil or

a

fat

when

handful of nuts.

enjoy some cheese or a doughnut or a Butterfinger candy bar,

cancel out the fat.

can't

just pick the foods that don't pose the problems. But

more

a bit

And when

1

I

with a product that blocks the absorption of

fat

to

much

I

of that

it.

REPLACING FAT WITH PROTEIN

We

all

know

that

especially saturated

fat,

lesterol level in the blood, resulting in

mains

is.

What

clogged

does one use to replace the

from only three sources:

fat,

fat,

fat,

contributes to a high cho-

The question

arteries.

sometimes lead Dr.

to

come

carbohydrates, and protein? Most authorities

have suggested a high-carbohydrate approach, but that approach has itations, since excessive

that re-

recognizing that calories

its

lim-

carbohydrates raise triglycerides, lower HDLs, and

weight gain. That leaves us with protein.

Bernard Wolfe of the University of Western Ontario in Canada sug-

gests that a heart-healthy diet

exclusively

should emphasize protein rather than focusing

on carbohydrates. He notes

in

an

article in the

October 1995 issue

of the Canadian Journal of Cardiology that the Masai tribe of Africa has a very

low cholesterol

level,

averaging 130, and virtually no heart disease. Yet these

people consume a diet in which protein provides about one-third of calories.

Some have questioned

the safety of relatively high

amounts of protein

in

the diet. Dr. Wolfe points out that studies indicate that such diets are safe, in

terms of the point of concern, that

is,

the "stress"

on

the kidney that processes

protein wastes. In a study comparing a high-protein diet with a low-protein vegetarian diet, there In his

drate

and the

constant

with to

own

1 1

at

was no

study. Dr.

difference in kidney function.

Wolf looked

effect of that substitution

24 percent of calories. In one

at substituting

on

lipid levels. Fat intake

diet,

carbohydrate was

percent of calories from protein. In the other

23 percent of

calories with

protein for carbohy-

diet,

at

remained

65 percent

protein was increased

53 percent as carbohydrate.

46

•

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH In the higher protein diet, total cholesterol

Triglycerides in the high-protein group were 150,

low-protein group. In addition,

carbohydrate

line:

in a heart-healthy

program

etarian approach.

And

a

Using low-fat is

ture,

it.

and

joy, a gift,

as safe

whole

Nature designed food plenty of

levels, rather

than

diets, actually rose significantly for those

The bottom

tein diet.

HDL

was lower by 6 percent.

compared with 212

lot

and

more

to taste

fish, poultry,

falling as

we

give thanks

a true blessing.

And now

meat, and dairy foods

probably more effective than a veg-

is

appetizing!

good so

when we food

with high-

enjoying the high-pro-

all

God's creatures would eat

Throughout history people have included food

rightly so;

is

as part of their cul-

partake of that food. Food

is

a

part of the healthy revolution that

can eradicate heart disease in the twenty-first century. But don't wait Start today!

for the

till

then.

DAILY FAT-GRAM SLIGHTLY

MODERATELY

ACTIVE

ACTIVE

WEIGHT

PERSON

(lbs)

ALLOWANCE

PERSON

(1)

HIGHLY ACTIVE

PERSON

(2)

no

32

37

42

115

33

38

43

120

35

125

36

45 47

130

38

135

39

140

40

145

42

150

43

155

45

160 170

46 48 49

175

51

180

52

40 42 43 45 47 48 50 52 53 55 57 58 60

185

53

70

190 195

55 56

62 63 65

200

58

67

76

165

49 51

53 55

57 59 60 62

64 66 68 72

74

day required

to

maintain

1

pound

of weight.

(2)

Based on 15 calories per day required

to

maintain

1

pound

of weight.

(3)

Based on 17 calories per day required

to

maintain

1

pound

of weight.

(1

)

Based on

1

3 calories per

Examples: 1)

110

Weight Slightly active person

— daily calories

Total calories required per

2)

3)

allowable

allowable

,430

fat

0.20

288

Divide fat calories Total

1_3 1

fat calories

Allowable calories from Total

day

fat

Rounded amount

to

get fat

grams

grams per day

9 31 .78

32

(3)

Meet and Defeat the Newest Bad Guys

For

many

years the cholesterol critics have carped that

were truly the

levels

heart disease,

and conversely, everyone having

high cholesterol. But

MI have

perfectly

normal

surements goes on It

that's

to

Those pieces

a heart attack

levels.

And

some important

pieces of the puzzle have been missing.

m the gaps of previous explanations of and efforts to prevent what we Ve known about

from the western world's number one

Do

risk factors for quite

killer of

to protect ourselves

men and women.

elevated cholesterol levels, high blood pressure, and cigarette

smok-

factor in as risks? Absolutely so, as seen in the vast majority of those

who do succumb factors offers

to that disease.

tremendous success

And in

certainly the elimination of those risk

both primary and secondary prevention

Recognizing and eliminating the newly researched factors

efforts.

exhibit

not everyone with high cholesterol mea-

some time, the newest bad guys offer us an opportunity

still

would

not the case. About 20 percent of those having an

heart disease. Together with

ing

elevated cholesterol

develop heart disease.

turns out that fill

if

then everyone whose counts are up would get

culprit,

now

fine-

tunes our protection, providing the opportunity for practically everyone to re-

move

not only the potential but also the possibility of having heart disease.

Think of the enormity of dented

ability to

render ourselves invincible

that claims the lives of nearly

walking through let,

bomb, or So,

that statement.

blast can

harm

us.

What an

ratios,

and

men and women. that

It's

like

no bul-

incredible talisman!

and how do we defeat them?

Six previously missing pieces complete the puzzle.

LDL,

have the unprece-

and certain knowledge

these newest enemies,

(2) lipoprotein(a), (3) small, dense

I

from the onslaughts of the enemy

one out of every two

a battlefield with the sure

who and what are

You and

They

are (1) homocysteine,

(4) fibrinogen, (5) unbalanced lipid

(6) slight tnglyceride elevations in the

presence of HDL depressions.

Never heard of such things? Most people, even most practicing physicians, have not. By the end of are

and mean but

also

this chapter, you'll

how

to eliminate

know

them

not only what

as risks.

all

these things

Meet and Defeat the Newest Bad Guys

•

49

HOMOCYSTEINE Amino

acids are the building blocks of proteins

when one

bodies, essential for growth and maintenance. But acids, homocysteine, isn't properly metabolized

up

and of

tissues of

amino

of these

and excessive amounts build

in the bloodstream, the risk of cardiovascular disease, including heart at-

tacks

and

strokes, soars.

The

first

person to associate homocysteine with heart disease did so more

than a quarter of a century ago. Dr. Kilmer McCulley noted in the medical erature that an infant with a genetic metabolic

the link between homocysteine

Assuming

B vitamins:

and heart

utilizing

for

breaking

down amino

them, the body requires adequate supplies of three

and

folic acid, B^,

studies have con-

disease.

one has a normal metabolism

that

and properly

acids

that led to a rise in ho-

more than twenty

after the child's death. Since that time,

hrmed

problem

causes homocysteine to build

Bi2-

up

Consuming

in the blood.

little

of these nutrients

Men more

frequently exhibit

too

elevated levels, but the condition afflicts both sexes. Certainly there

component

that determines just

acid, but the principal ficiencies.

And

as

we

how

efficiently

problem appears

to

one breaks

a genetic

is

down

amino

the

be dietary insufficiencies

if

not de-

age homocysteine levels tend to climb. Nearly one-third

patients followed in the long-term

all

lit-

m the blood had severe atherosclerosis when an autopsy was done

mocysteine

of

our

Framingham Heart Study who were

over the age of sixty-seven had a high level of the substance in the blood.

The study

that really

blew the

lid off this issue

cians participating in a long-term health project. levels

involved 27 1 male physi-

Men whose homocysteine

were in the highest 5 percent had more than three times the

ing a heart attack, even after eliminating data from

all

all

risk of hav-

other risk factors. Pooling the

recent investigations indicates that homocysteine concentra-

tions are about

30 percent higher than normal

in people

who

develop heart

disease.

Similar data

show

that

homocysteine also puts

men and women

at vastly

increased risk of stroke, and European research leads to the same conclusion. In a

1995

editorial in the

New

England journal of Medicine, two homocysteine

researchers state unequivocally that elevated homocysteine levels present a

cause-and-effect relationship with heart disease. In

fact,

when baboons were

infused with homocysteine for just three months, atherosclerotic plaques developed.

High

levels of

homocysteine lead

to trouble in a

number

of ways.

Dam-

50

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

age

is

done

to the

endothelium lining of the

arteries,

leading to the formation

of plaques. Homocysteine stimulates the proliferation of

And

causing the plaques to grow. ture of plaques

the stuff

and the subsequent

smooth muscle

cells,

frequently responsible for the rup-

is

blood

release of the

clot,

which precipi-

tates the heart attack.

How

bad

homocysteine

are elevated

Worse than previously

levels?

thought. Researchers reporting from the Cleveland Clinic in the journal Cir-

November 1995

culation in five

said that mdividuals with high levels

had almost

times the risk of developing coronary artery disease. Utah investigators

wrote in

Arteriosclerosis, Thrombosis,

that those with the highest levels of

and Vascular Biology

in

homocysteine had up

September 1995 to fourteen times

the risk as those with the lowest counts.

Homocysteine

is

Fortunately, sufficient

a

metaboUc product of another amino

amounts of the B vitamins

the blood levels of homocysteine

Utah

back

the homocysteine. Both

cysteine levels

men and women

How much

up

folic acid,

The

the lower

when homo-

are at increased risk

rise.

does homocysteine contribute to the nation's heart disease

problem? Reviewing thirty-eight separate studies, in the

and Bj2 reduce

to methionine, thus cutting risk.

found that the higher the concentrations of

scientists

acid, methionine.

folic acid, Bg,

Seattle researchers reported

October 1995 issue of the Journal of the American Medical Association that

to 10 percent of all heart disease

The University

of

Washington

can be traced

investigators

to

homocysteine elevations.

concluded that reducing homo-

cysteine elevations with folic acid "promises to prevent arteriosclerotic vascular disease."

Interest in

homocysteine extends around the world.

published in the November tion

15, 1995, Journal of the

A

Norwegian study

American Medical Associa-

linked high levels with other, well-established risk factors. In other words,

smokers had higher cholesterol levels

levels of

homocysteine than nonsmokers; those with high

had higher homocysteine

people had

levels as well; older

higher counts; and sedentary individuals had higher homocysteine elevations

than those didn't sible,

who were

physically active. Just

know. Obviously, we want

and

this

reduce

our

that

was

so, the

risk factors as

levels is not routine practice,

not limited to certain centers of research.

through your doctor's oratory.

why

all

researchers

much

as pos-

study provides one more motivation.

Measuring homocysteine is

to

Reading the

office;

results

It is

possible for

although the

you

test

to get tested

he would send the sample to an appropriate lab-

is

the trickier part.

Homocysteine

is

measured

in

1

Meet and Defeat the Newest Bad Guys

micromoles per

ten

liter;

in the

is

5

•

"normal" range, while higher levels

of, say,

fourteen have been associated with heart disease.

The University of Washington researchers wrote intake of approximately two

hundred micrograms

that increased folic acid

daily reduces

homocysteine

RDA

by about four micromoles/liter. That has been the recommended but

cently,

represents a reduction instituted in 1989 from previously rec-

it

ommended

re-

daily intakes of four

hundred micrograms/day. Many

are

now say-

ing that the recommendation should be returned to those higher levels.

But

it's

not just

Clinic investigators reported an

The Cleveland

folic acid.

"independent increased risk of coronary disease" in patients with vitamin Bg

Such low

deficiency.

levels

were noted in 10 percent of patients entering the

clinic

with heart disease but only in 2 percent of individuals acting as "con-

trols"

who

did not have the disease. Vitamin B^2 ^^so enters the total equation.

This whole area of investigation becomes philosophically interesting.

know

that sufhcient

amounts of

lower homocysteine levels vitamins

at the

low

to

folic acid,

where they pose no

levels at

which they

women

consuming much meat and from

of reproductive age. So

why even

risk.

Obviously, taking those

are effective poses

other potential benefits, not the least of which those not

is

no

risk

Start

which of

is

protection from anemia for

bother to have homocysteine levels if it

ever ex-

gone.

with the

diet.

Make

sure that you eat lots of fruits and vegetables,

are excellent sources of foUc acid.

all sorts.

and has

the birth defect spina bifida in

measured? Just take the B-vitamin supplements, and the problem, isted for you,

But those of us

who have

The same goes

cut back

for

beans and

lentils

on animal foods miss some

tamin Bg and Bi2- To make absolutely sure that you're getting enough B

mins

to

completely eliminate the risk factor of elevated homocysteine

supplementation ligrams),

and Bi2

cal B-vitamin

We

vitamin B^, and vitamin 6^2 ^i^l

is

the

way

to go: folic acid

I

take

amounts and more is

called

Oregon. The quality

Endur-B Complex,

in

very reasonable.

you can receive an order form by

interested,

is

in typi-

high and the price

made by Endurance Products If

vita-

levels,

(400 micrograms), B^ (2 mil-

(6 milligrams). You'll find those

supplements. The supplement

vi-

is

calling (800)

438-2532.

EVEN IF YOU BELIEVE YOUR DIET IS VIRTUALLY PERFECT AND THAT YOU'RE GETTING PLENTY OF B VITAMINS, RECOMMEND A DAILY SUPPLEMENT TO GUARANTEE FREEDOM FROM THE THREAT OF AN ELEVATED HOMOCYSTEINE LEVEL. REMEMBER: HOMOCYSI

TEINE KILLS.

52

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

lipoprotein(a)

Next on the

list

of bad guys to eliminate

a lipid floating

is

around

in

your

bloodstream that goes by the name of lipoprotein(a), typically abbreviated as Lp(a) and pronounced "el-pee-little-a." Never heard of

your doctor, even

This substance just hasn't gotten the attention Lp(a) cally

it is

like

how much

LDL with

Probably neither has

an extra protein molecule.

it

faithfully.

deserves.

Chemi-

cholesterol LDL.

Our genes largely determine

of the stuff will be found in the bloodstream.

with elevated levels produce more and break ficiently.

it

more well-known bad

a variant of the

is

it?

he keeps up with the medical literature rather

if

down and

Those individuals

dispose of

it

less ef-

Diseases of the kidney and diabetes tend to be associated with high

Lp(a) counts. That

may

be one reason those particular patients have

signifi-

women have higher levels, men and women have an elevated

cantly greater risk of heart disease. Postmenopausal as

do heavy drinkers. About one-third of all

level of Lp(a). Diet

make

appears to have virtually no

worse, and attempts

it

at diet don't

make

effect; it

what you

eat doesn't

None

of the pre-

better.

scription cholesterol-lowering drugs have any impact.

The research data pointing factor for heart disease have

to Lp(a) elevations as

been building

for the past

an independent

risk

few years. Tufts Uni-

found high Lp(a) in 42 percent of patients with premature

versity investigators

heart disease. At the University of Virginia, doctors noted that patients suffer-

ing reblockage of arteries after balloon angioplasty had significantly higher

counts of Lp(a). Looking

at

consecutive patients having an angiogram, physi-

cians at Auvergne University in France found that

men and 60 arteries

percent of

had elevated

than normal Lp(a)

women who showed

more than 50 percent

of

the presence of blockage in the

Lp(a). At the University of Cincinatti, tests revealed higher

in children

whose parents

suffered an early heart attack.

Analysis of data from the Lipid Research Clinics Coronary Primary Prevention Trial,

which involved nearly four thousand middle-aged white men, showed

significantly higher Lp(a)

count

perienced a heart attack than In every single

in

who developed who did not.

in those

those

heart disease

a

and ex-

one of those studies, Lp(a) remained a strong predictor

of heart disease after statistically eliminating the effects of other risk factors in-

cluding smoking, high blood pressure, age, diabetes, and other lipid abnormahties.

port

is

The conclusion

the same: Lp(a)

of heart disease.

is

that has a strong,

been stated

at the

independent

bottom of report

risk factor in the

after re-

development

Meet and Defeat the Newest Bad Guys

Lp(a)

by

partly

kills in a

number of ways.

53

•

contributes to the formation of plaque,

It

short-circuiting the substance that normally inhibits proliferation of

smooth muscle

fibers.

It

gets in the

way

of normal dissolving of blood clots, a

process termed "fibrinolysis," by reducing the formation of a substance called plasmin. tion

And

Lp(a) precipitates the rupture of plaques, leading to clot forma-

and heart

attacks.

Unfortunately, doctors don't typically test patients for Lp(a) elevations,

but that test

is

particularly important in cases of family history of premature

heart attacks and death. Excuses given usually include the fact that testing for

Lp(a)

is

rather difficult

know what normal

treat elevations

think that's a

I

if

or abnormal levels are,

revealed.

Why? As mentioned

smoke

screen. Lp(a),

and wouldn't know how

earlier,

none of the prescribed

they did, an army of -.phar-

company salesmen would be trooping

into doctors' offices touting

Lp(a).

the ability of their drugs to reduce this major risk factor. Simply enough,

one

word out

getting the

is

to

If

on

anticholesterol drugs have any effect

maceutical

to do.

most practicing physicians simply have never heard of

In reality,

don't

and expensive

cardiovascular threat.

It's

on

to doctors

one of those

tween the cracks. Except that

the dangers

little

and treatment

details that

happens

to

no

for this fall

be-

this little detail kills.

Levels of Lp(a) from one person to another vary tremendously, from a

low of

1.0

mg/dl (0.03 mmol/1)

to

210 mg/dl (5.25 mmol/1). In the case of the

doctors participating in the Physicians Health Study, those with heart disease

averaged 23.7 mg/dl (0.59 mmol/1), while healthy individuals had an average of 19.5 mg/dl (0.49 mmol/1).

Many more with

heart disease

had values above

30.0 mg/dl (0.75 mmol/1). In a similar study in Sweden, those with an Lp(a)

measurement

greater than 36.5

mg/dl

(0.91

mmol/1) were twice

as likely to de-

velop heart disease. The risk presented by Lp(a) appears to be linear; the higher the level, the greater the risk. Especially

disease or

if

if

you have

you have already been diagnosed

a family history of heart

as having

it,

you'll

want

to

have

your Lp(a) measured.

Then diet

it's

a question of just

what

to

do about an elevated count. Neither

changes nor prescription drugs lower Lp(a). Suggestions that high doses

of vitamin

C work

have proven worthless in research done with Framingham

Study patients.

We know

that

ease than younger

have higher after

postmenopausal

women, and

levels of Lp(a).

That

it

women

are at greater risk of heart dis-

turns out that postmenopausal

may

partly explain

why

women

also

heart disease risk nses

menopause. Fortunately, hormone replacement therapy (HRT)

results in

54

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

significant Lp(a) reductions

you or

a loved

one

and has been proven

to slash the risk of heart dis-

that stage of

please discuss the matter of

ease.

If

HRT

with your doctor to evaluate and balance the risks and benefits.

Smokers

is at

life,

are also at greater risk of heart disease,

and one reason may be

That was especially true in

that their Lp(a) levels are higher.

a survey

done

at

Johns Hopkins with both black and white men. The researchers concluded that Lp(a) was strongly influenced by smoking, particularly for the black population.

One more

reason to quit.

The only proven Lp(a) normally supplemented

fighter

levels.

the vitamin niacin taken in larger than

is

In a report

from the National

Institutes of

Health published in ihe journal oj the American Medical Association in February 1992, niacin was called "the best pharmacologic option for treating elevated

plasma

levels of Lp(a)." Happily, the

do the same

levels

same dosages of niacin

LDL

for total cholesterol,

cholesterol,

while often dramatically raising protective levels of heart-saving vitamin, see chapter

Speaking

at the

in 1995, researchers

that lower Lp(a)

and

HDL. For

triglycerides

details

on

this

9.

annual meeting of the American College of Cardiology

from the University of Washington had good news and

bad news. The bad news

hrst. In

men

studied for

more than 2.5

years, the de-

gree of progression of heart disease and the incidence of cardiac events, in-

cluding heart attacks, were significantly worse in those whose Lp(a) counts

were high. But the good news was

by

substantially lowering

LDL

that the influence of Lp(a)

was eliminated

cholesterol.

SMALL, DENSE LDL

Niacin also comes to the rescue in correcting a condition only recently

found

to

be associated with heart disease

small and dense are

whose

more

particles are larger

likely to

and

less

Those whose LDL

risk.

particles are

develop heart disease than individuals

dense.

New

sity of California (Berkeley) investigators in

research presented by Univer-

1994 indicated

that those with

the smallest particles are at three times the risk as those with the largest particles.

Other work from the same campus but from

a different laboratory

posed

the solution. Dr. Robert Superko found that a daily dosage of 1,500 milligrams

of niacin resulted in a significant increase in

Prevalence of small, dense

LDL

LDL

particles

is

particle diameter.

typically associated with a

Meet and Dejeat the Newest Bad Guys

•

when

concurrent elevation in triglycerides, and the two factors, particularly

combined with

HDL

lowered

a

your

level, raise

Remarkably, as noted in chapter

ease.

9,

risk of

niacin corrects

55

developing heart disall

three.

FIBRINOGEN Fibrin tion of the

is a

protein found in the bloodstream that forms the essential por-

blood

Levels of fibrin,

clot.

which

are correlated with the degree of

clotting an individual exhibits, are determined

by

gen. Obviously, the ability to form blood clots

is

we'd bleed

to

be bad, and

a precursor called fibrinoessential to

death from the slightest injury But too

that's the case

much of a good

thing can

with fibrinogen.

Several studies have confirmed the link

between high fibrinogen

and the development of heart disease and precipitation of heart ers at Tufts University

otherwise,

life;

attacks.

found elevated fibrinogen in 70 percent of

all

levels

Work-

cases of

heart disease they studied. French investigators reported in Circulation that patients

with elevated fibrinogen levels were

far

more

likely to suffer reblockage

2nd

of arteries following balloon angioplasty. Those attending the

International

Heart Health Conference in Barcelona, Spain, in 1995 unanimously concurred that too

more

much hbrinogen

traditional factors,

Once ically

places one at risk over

and above

such as elevated cholesterol

measure fibrinogen

again, the test to

performed. Certainly,

I

levels

that

levels in the

would not recommend

posed by the

and smoking. blood

is

not typ-

that everyone learn his or

her fibrinogen status, but for those with a family history or a current diagnosis of heart disease, every piece of the puzzle can be critical. Levels of fibrinogen

higher than 300 mg/dl definitely stack the deck against you.

The body has functions,

a built-in

and blood

clotting

we have

action of fibrinogen, latter is triggered

by

tissue

system of checks and balances in is

no exception. To counter

all

physiologic

the clot-encouraging

the clot-dissolving function of plasminogen.

plasminogen activator (TPA), the same

The

stuff that

doctors inject into the arteries of heart attack victims to dissolve the clot blocking the flow of blood and causing the MI. The process of dissolution of those clots

is

how can we assist that process of checks and baladequate supply of TPA and plasminogen to allow for

called fibrinolysis. So

ances to assure an healthy fibrinolysis?

One hol.

part of the effective approach calls for the moderate intake of alco-

As detailed on page 210, alcohol has long been associated with longevity

— 56

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

and protection against heart

TPA

creased levels of

many

It

turns out that alcohol favors fibrin-

in

both sexes. Their findings have been confirmed by

others. In addition to

have

disease.

Researchers in Glascow found that alcohol intake was related to in-

olysis.

improving the

a heart-saving function of

chapter

lipid profile, the vitamin niacin

appears to

improving hbrinolysis. More about that

in

9.

Today most physicians and health authorities concur

m the recommen-

dation that daily or every-other-day doses of aspirin provide tremendous protection against heart attacks for both

creased as to

risk.

The only question

whether the dosage should be

tablet.

men and women, a

baby aspirin or

increases the body's fibrinolysis

It

no consensus

a full-strength

How does aspirin

Talk with your doctor about that.

ture heart attacks?

particularly those at in-

involves the ideal dosage. There's

325-mg

protect against fu-

and provides an

anti-

clotting action.

The Eskimos of Greenland have long benefited from properties of their diet.

salmon,

is

ease.

may

Salmon

You say

be the reason

for

UNBALANCED

fat

omega-3

rich in the

fibrinolysis

The

the anticlotting

of marine animals, from seals to whales to

fatty acids that facilitate fibrinolysis.

why

these people suffer virtually

Increased

no heart

dis-

dinner tonight sounds mighty delicious.

RATIOS

LIPID

a friend of yours

had

a heart attack despite having a perfectly ac-

ceptable cholesterol level and following a heart-healthy lifestyle of low-fat diet

and plenty of exercise? Maybe the doctors didn't look closely enough her lipid

ratios.

We

covered

this aspect a bit in the last chapter,

cept bears repeating and clarifying.

The

of either factor alone.

and the con-

predictive ability of the ratio of total

The most recent guidelines published by

strongly advocate the inclusion of this critical bit of information in

For

gives

you

that ratio should be

a variety of ways.

a ratio of 4.0.

be no higher than with an

the

NCEP

making rec-

for patients.

women,

number in

or

HDL is now generally recognized to be greater than that

cholesterol divided by

ommendations

at his

4.5.

A

So does 240

A TC of 220

HDL of 30 equates to a

One can

attain that

(TC) of 200 and an

HDL of 50

no higher than

total cholesterol

TC and 60 HDL.

— not

4.0.

For men, the ratio should

typically considered to be alarming

ratio of 7.3

and puts

that person at distinct risk.

Meet and Defeat the Newest Bad Guys

Sometimes the

women,

ratio of

LDL

HDL is

to

number should be

the resulting

sured

directly. Rather,

erides divided

by

it is

For example, 240 five

equals an

LDL

was

eride count

than

TC minus 40 HDL minus 250 -

40

250/5 =

-

40

-

150).

HDL plus

mea-

the triglyc-

triglyceride divided

However,

LDL

equation and

a healthier 150, the -

typically not

total cholesterol.

of 150: (240

change considerably: (240

if

LDL

by

the triglyc-

would

calculation

150/5 = 180). Thus the presence of a

higher triglyceride can actually result in an

sirable,

However, the

3.0.

LDL is most

calculated by subtracting the

from the

five

less

men and LDL/HDL

used instead. For both

using TC.

ratio is not as accurate a predictor as

57

•

less de-

calculation that ap-

pears to be healthier. Direct

making

the

measurements of LDL will become more available in the future, LDITHDL ratio more valid. Until then, however, the TC/HDL ratio

the better predictor.

is

many women,

For

learning the

taking cholesterol-lowering drugs.

sometimes prescribe such drugs

TC/HDL

It

is

an unfortunate

for female patients

down after dietary efforts.

have not come

can eliminate the need

ratio

But a look

reality that

whose

for

doctors

cholesterol counts

TC/HDL ratio could woman with TC comes down only to

at the

reveal that medication isn't indicated. Let's consider the case of a

a

TC

of 260. After

250 and

months of watching her

itoring for the rest of her ratio of

about

can

Obviously,

most

But

life.

3.0, actually

Now how woman? for the

diet,

the physician prescribes an expensive it

her

drug

turns out that her

lower than the 4.0 we'd

we improve our we need

to

that calls for routine

work

ratios

at

if

to

We

ratio.

HDL levels are,

nothing to do with

little

from day

HDL

in

tip the

our bloodstream

balance

to

in

our favor by

in-

shutde cholesterol back to

the liver to be properly disposed of. Here's a checklist of what's been to

to day,

to year.

can do a number of things to

creasing the levels of

women.

we're not as fortunate as that

both sides of the

part, genetically determined. Diet has virtually

month, year

80, giving her a

like to see for

whether they are high or low, and counts vary very

month

HDL is

mon-

shown

work:

•

Quit smoking cigarettes. Smoking definitely reduces

HDL levels.

'Nuff

said about that. •

body weight. Obese individuals tend

to

have lower

moderation. Unless there are reasons not

to,

and

Attain healthy

HDL counts. •

Drink

in

if

you

58

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

enjoy

it,

drinking in moderation raises levels of protective HDL. Details in

chapter 20.

Do

•

plenty of aerobic exercise. There appears to be a linear relation-

ship between exercise and

HDL

levels,

with competitive athletes enjoying the

You probably won't become

highest counts.

a

marathon runner, but the more

rigorous and regular your workouts, the better.

Consider some outside help.

•

you're at significantly increased risk.

drug Lopid (gemfibrozil)

may be

levels

raises

If

HDL

drop below 35 mg/dl,

levels

The prescription cholesterol-lowering

HDL levels appreciably.

In fact, increased

the principal reason for the success of a study

with that drug. But the vitamin niacin

is

even more

done

HDL

in Finland

effective in raising

HDL

measurements.

Let

me

confusing point that comes up over and over as

clarify a

I

presentations around the country and answer mail from readers. There

HDL is a

food you can eat to get "good cholesterol." shuttles cholesterol

around

make is

no

lipoprotein molecule that

in the bloodstream. Cholesterol in food has noth-

ing to do with these lipoproteins, either good or bad.

And now

TC/HDL

ratio

other side of the equation. You can improve your

for the

immensely without changing your

the level of total cholesterol. Certainly that's the

and program.

In fact,

if

HDL

becomes

measure the Upids of various populations ease, they often find that along with

HDLs

the range of 120 to 130,

els that

that's

down

by reducing

When

that suffer practically

remarkably low

book

scientists

no heart

dis-

total cholesterol levels in

are also very low.

should be stated and understood. As the

go

iota

low enough, say under

important.

one perverse aspect of dietary efforts

HDL counts

cally

file,

is

less

one

thrust of this entire

the total cholesterol level drops

160, then the importance of

There

HDL

main

also.

lowering cholesterol lev-

at

total cholesterol falls, typi-

Most of the time the

ratio will

improve, but

not always the case. To ensure an improved ratio as part of the lipid pro-

keep a few points

•

A

in

mind.

very-low-fat diet tends to drive

Enjoying a moderate amount of olive

ously.

but also maintains

HDL counts.

down HDLs and LDLs oil

makes

for a

more

simultane-

palatable diet

Greeks, Italians, and other Mediterranean peo-

ples have savored a diet rich in olive oil for centuries.

We can learn much

from

them. •

If

your

ratio is

good

to begin with, dietary

changes

may

yield nega-

•

59

more

dra-

Meet and Defeat the Newest Bad Guys

I

Women,

live results.

in particular, frequently see their

HDLs

fall

matically than their TCs, resulting in adversely affected ratios. Unless you have a very

high

total cholesterol level to

begin with, or have been diagnosed with

heart disease, dietary modifications other than to

maintam

a healthy

weight

probably aren't warranted. Initial

•

dietary efforts often

rary basis.

Keep

total stays

down.

it,

and

probably see the

you'll

HDLs go back up

a

tempo-

while the

Be sure to get plenty of vigorous aerobic exercise during your efforts

•

to

at

brmg HDLs down but only on

reduce the

tendency

for

fat

When

•

and cholesterol content of your

HDI^

diet.

Exercise will offset the

to drop.

total cholesterol

HDL de-

and LDL come down

favorably, but

m your ratios,

be wise to consider in-

clines offset the benefits as seen

it

may

cluding some niacin in your regimen. Talk with your doctor about this and read all

about

in chapter

it

9.

HIGH TRIGLYCERIDES AND LOW HDLS: A NASTY COMBINATION up

Right

until the early 1990s, doctors paid almost

triglyceride levels.

were shrugged cerned only

off,

when

The normal range

is

from 50

when counts came

even

triglycerides

to 150,

no

attention to

but slight elevations

in over 200. Physicians

went over 500 or 600, posing

a

were con-

hazard from

pancreatitis.

But closer scrutiny of the data changed files

all that.

from those suffering heart attacks showed

triglycerides. Finally the evidence

sued by the this

analysis of lipid pro-

between

and the combination of low HDLs with even moderately elevated

the disease

about

The

a distinct correlation

NCEP

became overwhelming, and

a report

was

is-

through the National Institutes of Health warning doctors

deadly duo.

It's

too bad that not every physician paid attention to

the guidelines. Dr.

Anthony Gotto

of Baylor University

ton was the author of the report. bination and proclaims all

it

to be

and Methodist Hospital

He adamantly

an independent

m Hous-

states the

danger of the com-

risk factor

above and beyond

individual aspects of the lipid profile. Fortunately, there are efficient

ways of dealing with the problem. We've

already examined approaches to raising HDLs. Triglycerides are, actually, a bit

60

•

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

easier to control. Excessive

amounts of sugars and alcohol can drive counts

Often first-time cholesterol watchers eschew

and

their triglycerides

fats in

up.

favor of sugar-laden treats,

go way up. Moderation, not elimination,

is

the watch-

word. Obesity frequently results in high triglycendes; attaining a healthy weight routinely lowers triglycerides. Exercise burns off excessive triglycerides, are the body's storage units of energy.

And,

if all

else fails, the use of either

Lopid or niacin can bring those triglycerides tumbling order.

more

As

you'll read in

chapter

9,

which

down to normal in short

the immediate-release form of niacin

efficient for triglyceride control

is far

than sustained-release types.

what's more important? For most people,

m

most instances, the big three

cholesterol levels, high blood pressure,

and smoking

—

risk factors

— elevated

largely determine their

potential for developing heart disease. Despite the information regarding the

new bad guys covered would be ridiculous

in this chapter,

to take a

our emphasis shouldn't

really shift.

few B vitamins to control homocysteine levels

while ignoring one's other risk factors.

When

it

comes

to heart health,

should want 100 percent protection. Filling in the pieces of the puzzle lows us to get just

that.

It

we

now al-

The Soluble Solution

"Don't eat fer to

this,

don't eat that." Dietary advice tends to be negative. Instead,

focus on what

should

many others

the blood,

As

I

eat.

While some foods do

I

documenting the

surrounded by stacks of

effectiveness of foods

There's no question about

it:

and supplements

New

— we've come We

recommend

and insoluble

does not.

rich in soluble fibers.

way

And

we're

ones are better than

since oat bran muffins!

often hear that Americans should increase their hber consumption.

Authorities ble

a long

these.

scientific articles

Soluble fibers effectively lower cholesterol.

not limited to just one or two choices any more. ever

more emphasis on

actively lower them. Let's put

write this chapter, I'm

pre-

I

raise cholesterol levels in

Some

fiber.

thirty-five

grams of

fiber daily,

combining both solu-

Soluble fiber dissolves in water, while insoluble fiber

foods are particularly rich in one, while others contribute pri-

marily the other.

Wheat and most

for insoluble fiber.

I'll

fruits

and vegetables are principally known

detail all the foods

and supplements

to seek out for sol-

uble fiber in this chapter.

We need a balance of both hber types daily. trointestinal tract healthy

Soluble fibers,

and speed up the passage of food through the

on the other hand, form

slowly through the GI

Insoluble fibers keep the gas-

a gel

when

gut.

dissolved in water and pass

tract.

Both fiber types prevent constipation, but soluble fibers must be taken with plenty of water and other fluids in order to be soluble fibers can actually be constipating

if

water. That's even true for products such as Metamucil,

Uum and I

is

which contains

book

way back

in

1987

that popularized oat bran,

in The

8-Week Cholesterol Cure.

one of the best sources of soluble

Back then, oat bran became ubiquitous, and manufacturers began

into

psyl-

introduced the concept of soluble fibers and their protection against

That's the

it

sufficient

sold primarily to promote regularity.

heart disease to the world

fiber.

those

effective. Ironically,

one does not consume

all

sorts of food products.

provement

in the

American

diet.

Many

to

put

health authorities applauded the im-

62

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Then

mass media got wind of a

the

concluded erroneously

become

time oat bran had

knew about and

respected.

new

dians reveled in the itously. We'll

that oat bran

examine

— and

In fact, a

do

that oat

a sort of cultural icon,

The media

something

For now, suffice

little later.

shown

of studies have

exactly

their cholesterol-lowering trick. Essentially, the

—

how

really

soluble fibers (SF)

mechanism comes down

It is

gestion.

a

to

and

liver

out through the bowel movement.

it

Cholesterol sure.

to say

it

does work.

preventing the body from efficiently recycling cholesterol in the

shunting

come-

of oat bran declined precip-

the other foods rich in soluble fibers

number

at that

that everyone

love to be iconoclastic. Stand-up

The popularity

material.

that study in detail a

all

flawed research study that

tragically

bran did not work. Bear in mind that

is

critically

important

major ingredient In making

Unused

bile acids are sent

not have to turn to

its

back

to the body, bile acids,

and

it

which

is

guarded

like trea-

needed

for fat di-

are

body does

to the liver for recycling so the

cholesterol reserves. That's

where the SF comes

into play.

Soluble fibers are bile sequestering agents. They bind onto and hold bile acids as they pass through the gastric tract like a gelatinous glacier. Those se-

questered bile acids are then eliminated in the bowel movement. As a result, the

body has

to

make more

bile acids,

and

to

do so

it

uses cholesterol that

otherwise pile up in the bloodstream and ultimately clog our

nod

arteries.

Over a pe-

of time, a matter of weeks, the cholesterol count in the blood goes

Now,

amount ant task,

that

if all

is

true,

1

would imagine,

a

we should be

then

of bile acids in the bowel

would

down.

able to measure an increased

movement. Though not

a particularly pleas-

number of researchers have done just

that. In

1991

researchers published in ihe Journal of the American Medical Association a report that beta-glucan, the soluble fiber els

and increased

amined the

found

in oat bran,

fecal excretion of bile acids. In

lowered cholesterol

elimination of patients with ileostomies

fecal

bran. Such patients

must empty

showed an increased amount

their

ostomy bags

of bile acids.

And

lev-

1992, Swedish doctors ex-

daily,

who consumed and

oat

their contents

in 1994, investigators

from the

University of Wisconsin and Purdue University published definitive evidence of this effect of soluble fibers.

Soluble fiber in the

may also

have a second mechanism of action.

colon to form a particular form of

portal vein in the

abdomen and

fatty acids that are

It is

fermented

absorbed by the

are then transported directly to the liver

where

they inhibit cholesterol synthesis.

Soluble fiber also helps us control weight in two ways. lizes the level of

First,

SF

stabi-

sugars in the bloodstream; consequently, blood sugar doesn't

The Soluble Solution

drop

and one doesn't

as quickly,

get

hungry

•

63

while after a SF-rich

for quite a

meal. Second, SF promotes a feeling of satisfaction, termed satiety,

owing to the

slow movement of the gel formed by SF with water while going through the digestive system.

Okay, SF works. But gle

how much can we

element in a heart-smarter

lifestyle?

Studies from

over the world, work-

all

shown

ing with a wide variety of foods and supplements, have

much

ductions of as low as 3 percent to as are

m the 9 to Both

fibers are

HDL

1 1

to the diet.

commonly advocated

HDL

decline.

But

it's

critical to

Now

low-fat diet,

cholesterol re-

typically,

drops

note that the levels of protective

that's quite different from the effects of a

which inevitably

HDL up

By keeping the

results in a significant

and getting the TC and LDL down,

a

much more effective in improving the vital risk of TC/HDL and LDL/HDL than a standard low-fat diet. (See page 14 for

low-fat diet with ratio

More

and LDL cholesterol come down when soluble

do not drop.

cholesterol

as 25 percent.

percent range.

total cholesterol

added

expect from this sin-

realistically

more about

added SF

is

the risk ratios.) Moreover, you'll find

it

to the diet rather than to restrict that diet.

something

whole

a

lot easier to

add

There's even research

at

Syracuse University proving that to be true.

Our since

1

choice of foods and supplements rich in SF has grown significantly

started baking oat bran muffins in 1984. Variety

mixing those choices makes success I

could

fill

the entire

book with

is

the spice of

life,

and

a certainty. a recitation of the

dozens

if

not hundreds

of research studies that have unequivocally proven the effectiveness of SF in cholesterol reduction. Instead, potential fibers

you might want

I'll

give

you just

to try Since oat

a sampling of data about

bran was the

first to

all

the

show ben-

efits, let's start there.

OAT BRAN DOES WORk!

YES, VIRGINIA,

REALLY

Back in patients

daily

—

m

1963, Dutch researchers

first

noted an

consuming an enormous amount

for three

weeks. However, no one

oat that did the trick.

That finding

is

1 1

of oatmeal

knew

it

percent

TC

— almost

decrease

five

ounces

was the bran portion of the

credited to Dr. James Anderson

at

the

University of Kentucky. In the early 1980s, Dr.

Anderson was interested

in the ability of certain

64

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

Wondering which

cereals to control glucose levels in diabetic patients.

might work

best,

he systematically fed patients one

time. Ultimately, oatmeal

became

incidentally, the researchers

was

time for periods of

the star blood sugar stabilizer,

noted that cholesterol

levels

and rather co-

Now what

as well.

fell

about oatmeal that did thai? Dr. Anderson identified oat brans soluble

it

fiber,

at a

cereal

beta-glucan, as the magic ingredient.

From

that point forward,

search has concentrated on the bran rather than on the oatmeal.

much

to three times as

It

most

re-

takes two

oatmeal to do the job of the same amount of oat bran.

Since the days of those early research findings, the data have continued to pile up. Here's a

•

cent

fall

Anderson saw

In 1991, Dr.

New

•

TC and

a 12.1 per-

TC

daily.

decline with a

And

at

Northwestern University

LDL

after eight

weeks of consum-

(There are twenty-eight grams in an ounce.)

oats.

Ready-to-eat cold oat bran cereal also works. Anderson found a 5.4 per-

fifty-six

TC and

12.1 percent decline in

LDL

after

twenty-one days of eat-

grams, the serving size listed on the box. That's just two ounces. Re-

searchers saw a

more impressive

14.9 percent

eaten by participants in the famed •

daily.

9.2 percent lower

grams of instant

cent drop in

ing

TC and

noted nutrition researcher Dr. Linda Van Horn demonstrated a 6.25

percent drop in fifty-six

in

10 grams of oat bran

HDL in indi\1duals after four weeks of eating forty-four

grams of oat bran baked into bread eaten

ing

1

Zealand researchers found an 11.6 percent

of 10.3 percent in

in Chicago,

drop

a 12.8 percent

LDL after twenty-one days of consuming

in

That year rise

sampling of studies from around the world.

German

fall

in

TC

with the same amount

Framingham Heart Study

in Massachusetts.

researchers in 1992 found that sixty grams of oat bran daily

TC down by 9.7 percent in just three weeks. Australians that same year 5.7 percent decline in LDL and a 75 percent improvement in the LDL/HDL ratio in subjects consuming sixty grams of oat bran as muffins. And the positive findings continue to come in. In 1993 a Louisiana State University study showed a 10 percent reduction in TC with a 13.5 percent fall in LDL in three weeks of eating one hundred grams of oat bran. That same amount achieved an 8.2 percent decline in TC and a 9.9 percent drop in brought

reported a

•

LDL,

as reported in ihe journal of the

Good

American

Dietetic Association in 1994.

research has been published by outstanding investigators from

all

over the globe in very well respected scientific and medical journals. So where did the idea that oat bran doesn't work

On January

18, 1990,

an

come from?

article in the

New England Journal

of Medicine

The Soluble Solution

proclaimed that oat bran did not lower cholesterol of

Wheat,

no

a cereal with virtually

based on a study done with twenty

any better than Cream

levels

The conclusion was

fiber whatsoever.

women whose

65

•

cholesterol levels

initial

were perfectly normal, averaging 186. After eating either oat bran or Cream of

Wheat

for six

weeks, both groups' levels averaged 172. Thus, the Harvard

re-

search group stated unequivocally, the oat bran was no better than any other

and cholesterol reductions were probably owing

cereal,

Normally nothing much would have come of consequence. But

ticular

also served, lic

and

still

happened

it

serves,

had been embroiled

in

advocacy group

done

their job,

for a virtual

What was even worse, In reality, that

media

blitz.

the

Washington, D.C. CSPl, months. And

at its disposal,

CSPl joined

Within days, the

interest in heart health

had

"cereal killers" their

po-

public confidence in oat bran.

m general declined terribly.

Harvard study was horribly flawed,

Unfortunately, newspaper and

TV

a conclusion that

was

and medical community.

reporters typically

do not have

the exper-

read original papers. They put their faith in statements and news re-

from organizations that have

leases

Pub-

for

eventually agreed to by virtually the entire scientific

tise to

for Science in the

the public concluded that even the scientists were con-

and the national

fused,

in

Frank Sacks,

and oat bran's reputation was destroyed. For whatever

purposes. Sacks and CSPl undermined

litical

study with no par-

arguments with Quaker Oats

with the enormous media resources and clout

hands with Sacks

a little

that the senior author, Dr.

on the board of the Center

Interest (CSPI), a rather radical

in turn,

replacement of

to

any special quality of oat bran.

other, fattier foods rather than

New England journal

of Medicine

prestige,

such as Harvard University and

and ignored the dozens of studies demon-

strating the efficacy of soluble fiber in general

The

story of the cereal killers has

and oat bran

become

a classic.

m particular. As recently

as late

1994, students at the Wistar Institute in Philadelphia studied the episode in a

seminar dealing with science,

politics,

and pubhc

policy.

Even undergraduate

how

it all

women

with

students were able to poke holes in the flawed study and wondered

could have happened.

What was wrong •

with the Harvard study?

Conclusions were based on a group of uniformly healthy

perfectly normal cholesterol levels to begin with.

What about men? What about

people with elevated cholesterols? Even aspirin won't work a

headache

to begin with.

with exemplary

lifestyles.

And

those twenty

women

if

one doesn't have

were health professionals

66

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

The authors claimed

•

fat.

came from

In truth,

was remarkable

levels terol.

fat to

at the

data shows

which 35 percent of

CW group's diet contained only 30 percent

that oat bran

consumption would allow

those

all

that there

were no differences

in cholesterol

CW groups. But that was true only for total cholesEating the low-fat, high-carbohydrate diet, the CW group experienced a HDL

from an average of 54 from the

That difference

•

risk ratio of

in

initial

HDLs

the researchers

sour grapes. Sure,

I

average of 54 to 54.2 for

translates to a distinct

I

to be fought

pain

feel

when

I

far

those assisting

Actually, there fiasco. After a

see

their motives

were

have come

eats.

for

to

I

in the

isn't a

mat-

fight a

to

very

view that disease

myself but

as

for all others as

a cigarette or not exercising or

That research and

their health,

its

a lot of anger in the scientific

subsequent

and those researchers and

their public lies are responsible for that

harm.

community about

the oat

study published in autumn 1992 in ihe Journal ojthe Amer-

ican Medical Association unequivocally

sequent

1

someone smoking

and undermined

is

readings.

CW group's risk was worsened.

and defeated, not only

them with

HDL

OB group

improvement

beyond merely selling books.

not caring about the foods he or she publicity hurt people

The

and whatever

personal fight against heart disease, and

The Enemy

to 50.9. Conversely, the

was the man who personally introduced oat bran

my intentions are

the world. But

down

to HDL for the OB group.

TC

My anger at

bran

a diet in

both the oat bran

be enjoyed while keeping cholesterol levels low!

a slight increase

well.

in

OB and

between the

decline in

ter of

group consumed

while the

fat

was equal

groups, but a closer look

The authors also claimed

•

had

it

grams of

extra

OB

The

that claim isn't true.

the calories

that everything

(CW)

(OB) and Cream of Wheat

letter to the editor

bemoaned

showed

the benefits of oat bran, a sub-

the fact that the "exhaustive analysis did

not receive the same media blitz ... as that accompanying the flawed study." Dr.

Roger Brumback, of the University of Oklahoma Health Sciences Center,

wrote that

show

"it

only takes one negative story to

undo much

of this effort (to

the benefits of oat bran)."

Even more ironic study. Dr.

is

the fact that even the senior author of the flawed

Frank Sacks, had become convinced of oat bran's effectiveness by

1992, according to the CSPI publication Nutrition Action Healthktter In an article in

the

September 1994

lowers cholesterol. blitz or

admit

On

its

Of

issue,

CSPI grudgingly admitted

course, CSPI didn't bother to repeat

its

that oat bran

original

media

mistakes and apologize to the public.

the bright side, millions of people

still

do

eat oat bran regularly

and

The Soluble Solution

Other foods rich in soluble fiber as well. Years

from people

telling

me

And

test

Back

in

tirely.

terol level

and have avoided the need

eating

it

save

as hot cereal,

I

came on it

marketed

you

in a red

can't find

it

I

letters

Many

my own

life

—

but found that

And

as

was on

the emphasis

far

from

a

gourmet

later the ready-to-eat

continue to enjoy that

box

and adding

fat

medications en-

for prescription

started

recipes for oat bran muffins.

the market.

continue to receive

my own heart's health remains excellent. my search for ways to improve my choles-

have shown that

1984 when

— and

I

of their terrific successes in cholesterol reduction.

done nothing more than cutting back on

of those writers have that soluble fiber

later,

67

•

RTE

oat bran.

treat.

So

I

(RTE) oat bran

cereal regularly.

company

at

(800) 570-8718.

cereal

You can

Quaker Oat Bran High Oat Bran Fiber

readily, call the

tried

I

developed

It's

find

Cereal.

If

worth the

effort.

But don't limit yourself to oat bran by any means. In to

boredom. Almost no one can

out, for the rest of one's

ety

when

ment

it

comes

life.

eat the

definitely

I

to soluble fiber.

And

same food every

recommend today

GOOD

BEANS, BEANS,

—

and day

in

the research to docu-

FOR YOUR HEART

into your diet regularly

Research studies have

day

day,

and supplements.

Probably the easiest way to get soluble fiber as well

can lead

the widest possible vari-

we have

the effectiveness of a wide variety of foods

fact, that

shown

is

that a

— and

lots of insoluble fiber

by eating a variety of dried beans and peas.

cup of beans provides the cholesterol-low-

ering effect of a half cup of oat bran. And, as with oat bran, studies have strated cholesterol reductions of

anywhere from 3 percent

more. Importantly, only the bad

LDL

levels intact, thus

improving the

and peas, one of the

them out treat,

All

to 10 percent

goes down, leaving the protective

risk ratio significantly.

richest sources of soluble fiber

of a can, drained

demon-

is

Of all

and

HDL

the dried beans

the black-eyed pea. Try

and rinsed, or prepared from

scratch. For a real

look for fresh black-eyed peas in your supermarket's produce section.

you have

to

do

is

simmer

the peas in water for about fifteen minutes. Serve

with a drizzle of extra-virgin olive

oil,

and

you'll experience

one more exam-

ple of the ultrahealthy Mediterranean diet.

Think about fried beans, black

the variety: pinto beans in chili, white beans in soups, re-

beans with roasted chicken Cuban

style,

red beans with

cajun cooking, kidney beans in minestrone, three-bean salads, and garbanzo

68

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

beans (chick peas) mashed into hummus, that staple of Middle Eastern

—

ing

the

Concerned about the potential gas from beans? beans in the same water they soaked

you

eat-

goes on and on.

list

That product

eat beans.

is

in.

cook the

First, don't

Second, consider trying Beano

when

very effective in preventing the formation of gas

from undigested beans fermenting

in the digestive tract.

Like oat bran, beans really work. Dr. James Anderson at the University of Kentucky has studied

them

extensively. In

one study, he found that

a daily

cup of pork and beans from which the pork had been removed (you could choose vegetarian-style baked beans) cut cholesterol levels by 13 percent. The

men

made no

study

in his

38 percent- fat

diet. Dr.

other dietary changes, continuing to eat a standard,

Anderson beUeves

canned beans are good,

that while

dried beans appear to be better. His study with the latter produced a 19 per-

cent reduction in cholesterol levels.

BARLEY

S

GOOD, THAT

Once upon ally too

bad

S

NO

a time, barley

BLARNEY

was

a staple grain in the

American

diet. It's re-

consumption has declined, since barley has always been an ex-

that

cellent source of

good

national Conference

nutrition

and

fiber.

on Heart Health

in

2nd

In a paper delivered at the

May

Inter-

1995, Dr. Joseph Keenan reported

that pearl barley effectively lowers cholesterol levels, thanks to the content of

soluble fibers. In his study at the University of Minnesota, Dr. Keenan fed sev-

men and women

enty-five

with elevated cholesterol levels a low-fat diet

four weeks. That diet produced a cholesterol reduction from 245 to 234.

he added four muffins daily

made from

barley. Levels

While ordinary barley does, indeed,

offer a

fell

by another 10 mg/dl.

modicum

lowering benefit, a newly developed strain of the grain does called

waxy

hull-less barley contains

ble fiber beta-glucan (the

the

new

barley

which works gives

you

a

same found

to three times as

in oat bran) as

of cholesterol-

far

more. The so-

much

normal

rich in a chemical cousin of vitamin

of the solu-

barley.

Moreover,

E (d-alpha-tocotrienol),

in the liver to actually inhibit cholesterol

double health

NuWorld a

is

two

for

Then

manufacture. Barley

whammy!

Nutrition in Fargo, North Dakota, produces the

new

barley in

form that can be made into a very satisfying hot cereal and used recipes

baking such goodies as cookies, muffins, and pancakes. Currently

it's

for

avail-

able only through mail order, but unlike other mail-order products this one

The Soluble Solution

is

You can

quite inexpensive.

call

NuWorld

at

69

•

(800) 950-3188 to place an

order.

The waxy

hull-less barley has

University and North Dakota diet in a

•

number

of

Replace

all

ways beyond

making

just

at

Montana

You can incorporate

it

into

State

your

a tasty hot cereal.

of the flour in muffin recipes with barley cereal. For a

lighter, cakelike •

been extensively studied

State University.

muffin, add one-fourth cup of flour.

Prepare quick breads by replacing up to one-half of the flour with barley cereal.

•

Replace up to one-fourth of the flour in biscuit recipes, coffee cakes,

and yeast breads and up

to one-half of the flour in cookie recipes

with barley cereal.

This product

heard of if

you

it,

is

not available in supermarkets, and few people have

even in the research community. But, boy, does

two or three times

eat the barley cereal only

ference in your

regularity.

And

a

week,

it

ever work! Even

you'll notice the dif-

as part of the total cholesterol-lowering pro-

gram, you'll see significant lipid improvements.

BRAN, BRAN, SEEDS,

AND

PECTIN

We know all about oat bran; now it turns out that other types of bran have similar cholesterol-controlling capabilities. Both corn bran

and

racked up data demonstrating their effectiveness. In 1993,

rice

for

bran have

example,

re-

searchers from Louisiana State University in Baton Rouge published their findings that rice bran

was

as effective as oat

bran in controlling cholesterol

levels.

Neither type of bran, however, attained the popularity of oat bran, and

you might have some stores

—

difficulty locating either one.

the type that sells food, not just pills

these alternative brans,

Ener-G Foods

number

is

at

Look

and powders.

you can order them by phone

(800) 331-5222.

If

you

first

for

live in the state

If

in health food

you

home

can't find

delivery. Call

of Washington, the

(800) 325-9788.

While you're

in the health

food stores looking for bran, you might

come

across flax seed, which also has a cholesterol-lowering characteristic. As re-

ported in the Journal ojthe American College of Nutrition, eating flax seed baked into six slices of bread daily for

two months yielded

a 10 percent cholesterol

70

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

reduction. Additionally, flax seed

found

that are also

without eating the

in fish. So,

a

is

another type of soluble

to pectin,

an apple a day keeps the doctor away pectin.

A

good source of

fiber.

Fiber.

amount

it is

amount

to

have as

change of

a nice

into really delicious cookies

of

named, aptly

While apple pectin does not appear

The Tastee product bakes up

and cakes,

re-

of flour in a recipe. Tastee Apple Fiber can be

ordered directly from the company

ANOTHER REASON TO

fish oil

the reason

that apples contain a small

is

strong a cholesterol-lowering effect as oat or rice bran,

placing half the normal

fatty acids

Maybe

richer source of apple fiber can be found in a product

enough, Tastee Apple

pace.

omega-3

the

you want the anticlotting benefits of

seed might be for you.

fish, flax

Next we come

if

at

(800) 262-7753.

EAT FRUITS

AND VEGETABLES I

my

have

serious doubts that vegetarians tend to be healthier because

they avoid meat.

If

that

were the

case, the lacto-ovo-vegetarians

who also enjoy

dairy products and eggs wouldn't share the benefits. Rather than avoiding this

food or that,

1

think vegetarians have a lower rate of heart disease and other

degenerative diseases because they eat a lot of fruits and vegetables.

Throughout

this

book you'll read about

the advantages of fruits

They contain

etables. They're a source of antioxidants.

and veg-

flavonoids. In addition,

they probably have beneficial chemicals scientists have yet to identify, and they deserve a mention in this chapter because ble

—

as well as insoluble

—

fiber.

many

are an excellent source of solu-

Take another look

at

the chart

But don't just read and nod your head in agreement.

on page 82.

Make

a decision to

consciously increase your daily intake. Figs and prunes are the real winners in the soluble fiber

showdown.

Why

not have them readily available for

when watching TV? Keep some single-serve the car

and

in

your

them along on

office

a bike

According

desk drawer

Anderson, not

aren't very effective,

oat's

bela-glucan

fiber

we

all

when you need a snack in a

nde or when you're out

to Dr.

and some may not lower the ample

for

fiber.

But

all

hiking.

all

Or

fishing.

hurry.

Or

Take

golfing.

the soluble fibers are equally effective,

levels of cholesterol at

and

munching

packets in the glove compartment of

all.

String beans, for ex-

as we've seen, apple pectin isn't as potent as

contnbute

to the total intake of

both types of

need.

Moreover, a combination of the different types of fiber achieved by eat-

1

The Soluble Solution

may be

ing a wide variety of fruits and vegetables regularly tive.

that

Each has

its

more

effective

particularly effec-

distinctive profile of nutrients. Medical research has

combinations of different agents meant

to achieve the

7

•

same

shown

effect are often

than merely increasing the dosage of a single substance. Cer-

tainly that's true for the prescription-only, cholesterol-lowering drugs.

SUPER-POTENT SUPPLEMENTAL

SOLUTIONS Okay,

it's

not always possible to whip up a batch of muffins or a bowl of

bean soup. And what about those times when you

happens

to

bowl of

breakfast, for example, or even a

Cream

of 'Wheat.

Or when

tention to grams of

ments

fiber.

more

you'll get in

are the times to reach for

reliable source, since

any given dose.

NOTHING

S

a

meal that just for

that notorious virtually fiber- free

And

one of the suppleTruth be

told,

you know just how many grams of

fiber

wonderful sources of soluble

out question to dramatically

THERE

want

you're traveling and not paying a whole lot of at-

Those

that are particularly

they're a

really

be relatively low in fiber? Like an omelette with white toast

fiber.

those supplements have been proven with-

whack

cholesterol counts.

SILLY

ABOUT PSYLLIUM That's the active ingredient in Metamucil and other brands of products

marketed list

to

maintain bowel

movement

regularity

breakfast cereals also

psyllium as an ingredient, boosting their fiber content. The good news

that psyllium provides a very efficient, effective

In

one of the early studies with

ticipants 3.4

men

method

this fiber, Dr.

is

of cholesterol control.

James Anderson gave par-

grams of psyllium three times daily with meals. That's the amount

found in one rounded teaspoonful, which six

Some

is

mixed with water or juice. Twenty-

followed the program, which included no changes in diet whatever, for

eight weeks. Total cholesterol levels

came down about 20

percent. Dr.

fell

by nearly 15 percent, and LDL counts

Anderson noted

that cholesterol measure-

ments improved throughout that time period, reaching the peak

Not

all

at eight

weeks.

studies have achieved such excellent results. Reporting in the An-

nals of Internal Medicine, Dr. D.L.

Sprecher and his associates found reductions

72

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

of about 6 percent after giving participants 5.1 grams of psyllium twice daily

weeks. Other investigations have turned up reductions from 6 to 10

for eight

percent.

Psyllium-containing breakfast cereals have also been studied. Dr. Anderson

saw an

8.4 percent decline in total cholesterol after six

weeks of a

cluding four ounces of cereal. Reductions continued

in

daily diet in-

subsequent weeks,

with one subject enjoying a cholesterol decline of more than 20 percent.

Why are is

done

there such differences in results? First, Dr. Anderson's research

wards of hospitals where every

in metabolic

last

ounce of food

may

ob-

is

served and measured. Other investigations rely on free-living populations

who

not strictly adhere to the dietary regimen in question. Your results, of

depend on just how

course, will

religiously

Just buying a canister of psyllium

much good is

it

trition in

and putting

it

to follow the

on the back

program.

shelf won't

do you

at all.

Another reason

when

you decide

taken.

An

for variance in

success with psyllium

comes down

to

important report in the American Journal oj Clinical Nu-

1994 proved what many

of us

had suspected

for

some

cholesterol of 8

and

sumed between

meals, there was

1 1

when

percent, respectively. But

no

time.

When

total

and LDL

the psyllium

was con-

psyllium was taken with meals, participants had a reduction of

difference in cholesterol counts from the

control group receiving a placebo. Finally, the duration of the studies has varied

positive result within

tinues in subsequent If

you decide

ularly with meals.

teaspoonful with any fluid three times daily

the same.

one tablespoonful once

Always wash

Remember

produce the desired

after just

it

a day,

even though the

total

it

reg-

amount

with an extra glass of water for greatest is

water soluble, and

it

ef-

takes water to

Give yourself plenty of time to determine effective-

you can expect more reduction

after

two months than

two weeks. be fooled by advertisements

alike products. Citrucel, for its

down

that psyllium

effect.

case;

Finally, don't

citing

weeks, but the decline in cholesterol con-

weeks and even months. should be a part of your program, take

better than taking

own

sees a

that psyllium

is

ness in your

to three

One

One rounded

is

fectiveness.

two

enormously.

example, compares

for

non-psyllium-based, look-

itself directly

with Metamucil,

superior solubility, taste, and texture. Although both Metamucil and

Citrucel are high-fiber supplements that

promote

regularity, Citrucel contains

melhylcellulose, not psyllium, and has absolutely no effect

duction. Read the labels.

on cholesterol

re-

The Soluble Solution

guar: the

73

•

gum you don't chew

You'll find

guar

gum listed on many fat-reduced

foods, such as yogurt

and

custards. This additive provides thickening and texture to replace the missing fat.

You might

xanthan

also see a

gum and

list

of other foreign-soundmg ingredients, including

carrageenan. All these are soluble fibers, which, rather than

being harmful, are actually quite beneficial.

Guar

gum comes

from the cluster bean plant

grows

that

in arid regions

such as India, Pakistan, and parts of the U.S. Southwest. As with both oat bran's

when

beta-glucan and psyllium, this soluble fiber forms a gel

When

contact with water.

it

comes

to cholesterol reductions,

comes

it

it's

into

one of the

best agents.

Data have been collected

gum. The principal researcher

all

over the world showing the benefits of guar

m the United States has been Dr. John Farquhar been uniformly

of Stanford University His results have In a typical study, fifteen

grams of guar

positive.

gum were consumed

in three

doses with meals. Each dose, about a teaspoonful, was mixed with water or

down from 244 to 2 18.

juice. After three

weeks, average cholesterol levels came

HDL levels were

not affected, thus greatly improving the risk

ratios. It

would

be expected that improvement would continue in subsequent weeks and

months, based on similar research

Guar gum has

results.

certain advantages over oat bran

you know exactly how many grams of fiber content varies

from brand

to

and other

As with

fiber you're getting.

brand and crop

foods. First,

to crop.

all

foods,

Second, as with

psyllium, one needn't do any special preparations or planning. Either can be

consumed with any meal. The recommended dosage grams) three times

the

it

gum experienced some bad publicity. A

way down, and to

maker you

entirely. is

warn consumers

Now

it

fiber.

(5

to learn

a bit.

Mix

gum

at

these capsules

all

The obvious solution

call the

is

were taken

available.

One

most health food

company

where guar gum

the guar

few individ-

be certain to drink plenty of water, as

find their products in

from Ener-G Foods

Experiment

wash

Instead, the capsules

guar gum, you can

Ronkonkoma, New York, can also order

to

only the powdered guar

Twin Labs; you can

can't locate the

to

the capsules stuck in their throats.

they should do with any soluble

market

enough water

as capsules didn't drink

would have been

one teaspoonful

daily.

Like oat bran, guar uals taking

is

is

at

off the

reliable

stores. If

(516) 467-3140

sold in your area.

in

You

(800) 331-5222.

gum

with various juices to see what you

7A

.

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH Try making what

like best.

call

1

an "orange guarius," which

is

a frothy

one teaspoon of guar gum, one egg white, and one

ture of orange juice,

spoonful of honey blended together with

ice chips.

mix-

table-

actually delicious.

It's

take advantage of guar gum's thickening properties to concoct shakes

Add one

smoothies.

A

OF

LITTLE

THIS,

A DAB OF THAT food store you might see products

aisles of the health

combination of two, three, or more types of soluble

they work? Absolutely. Let's look

sisted of psyllium, pectin, guar

their results in

made by

gum, and

the Shaklee

locust

and

1993

drop

a 14 percent

in the Journal oj the

company

that con-

bean gum. Subjects consumed

in

LDL. The researchers published

American College oj Nutrition.

A blue-ribbon group of researchers at the

University of Minnesota looked

another fiber supplement product in 1994. During a fifteen-week period, par-

took either ten or twenty grams

ticipants

daily.

The smaller dose produced

percent drop in total cholesterol and an 8 percent larger dose yielded a smaller

cent and

LDL declined just

Yes, to

Do

dose three times daily and experienced a 10 percent decrease in

total cholesterol

at

fiber.

two examples.

at

Researchers tested a product

a five-gram

and

teaspoonful to chocolate milk, and you have a thick shake.

Walking down the that contain a

Or

LDL.

fibers

for fibers

a

6

Interestingly, the

improvement: Total cholesterol was

combinations of different soluble

NOT

in

down

over 7 percent. We'll look at that paradox a

pay significantly more per gram

BUT

fall

5 per-

bit later.

do work, but you can expect

purchased

this

way.

ALL SOLUBLE FIBERS

ARE CREATED EQUAL

I've

already noted that methylcellulose found in Citrucel

regular but won't cut cholesterol.

duce

And

unfortunately, not

all

may keep you

soluble fibers pro-

When studying the Shaklee product, for example, researchers gum as the placebo. As expected, that fiber did not affect choles-

that effect.

used acacia terol levels

one

bit.

Another soluble

has been speculated, viscosity cholesterol are

is

fiber loser is tragacanth

gum. Perhaps,

the critical factor. Those fibers

known

to

it

lower

much more viscous than those that don't. That is to say, they when mixed with water. Fortunately, I've not found any

create a thicker gel

•

75

for

cho-

A few years ago

a researcher at the University of Florida got a lot of

pub-

when he found

that pectin derived

The Soluble Solution

products that include acacia or tragacanth gums in formulas intended lesterol control.

MOOD

IN THE

FOR SOME

GRAPEFRUIT RINDS?

Ucity

cholesterol-lowering

Of

effect.

from grapefruit rinds had

many

course, not too

a

powerful

people started eating

grapefruit rinds! Dr.

James Cerda continued

results with the

and blood

his research

and found some

truly

amazing

swine he used as experimental animals because their hearts

vessels are so similar to ours.

When

those pigs developed severe atherosclerosis.

amining the msides of the

pigs' aortas

which would be impossible

to

and

they were fed a high-fat diet,

The research included

arteries after they

directly ex-

were slaughtered,

do with humans. Not many humans

will vol-

unteer for that!

Then they conducted what could eventually be project. Dr.

Cerda and

The

results

After arteries

swine a diet sup-

as the placebo. You'll re-

plemented with either grapefruit pectin or cellulose call that cellulose

a milestone research

his associates fed the artery-clogged

does not have the heart-protecting qualities of other

were nothing short of amazing.

consuming

the fiber for

270 days, pigs getting pectin had coronary

with 24 percent blockages, while those getting the cellulose had 45

percent clogging. All the pigs had been eating a very high-fat diet

and

had soared. Looking

their cholesterol levels

vessel leaving the heart, Dr.

ting pectin as

Does

opment

On

Cerda found one-third the blockage

compared with

pectin,

the pessimistic side, this

is

predict

remarkably similar

maybe even

to ours,

it

trial,

in

Based on

in those get-

humans as well

in

for us.

human

the success of his research. Dr.

as swine?

and no similar studies have pig's cardiovascular sys-

and swine have been used

what dietary influences might mean

a fiber

main

fibers as well, retard the devel-

reverse

was an animal

swine have turned out to be similar

oped

along,

the placebo group.

and perhaps other soluble

of atherosclerosis or

all

at the pigs' aortas, the

been done with humans. Optimistically, however, the

tem

fibers.

Most

for

decades

to

typically, findings in

studies.

Cerda and his associates devel-

supplement product called Pro-Fibe, which combines grapefruit

76

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

gum. They

pectin with that other proven soluble fiber guar

protein that

makes

One scoop

of Pro-Fibe provides five grams of fiber,

dosage for

is

three scoops daily.

other fibers,

when

easily dissolved in

One would expect

it

to be

also

added some

water or other

fluids.

and the recommended

most

effective, as is true

taken with meals rather than in between. Pro-Fibe can

number

be incorporated into a

scoop into a

more

the product

of cooking and baking recipes. I've

bowl of Cream of Wheat,

for

example, turning

mixed

a

otherwise

this

fiber- free cereal into a high-fiber breakfast.

Unpublished data from

This time

lesterol reductions as well.

consuming

Want

to try

in

fell

by

in Florida

by

is

mixed with water or and

that's a lot easier

100.

Manufactured

di-

all

work,

taking them. All produce a thick, sludgy fluid

when

juice. Fortunately there's tastier.

A

small

company

extreme secrecy

in

powder

another way to ingest them

Oklahoma named

in

100%

call

to protect

its

after the

Soluble Fiber or SF-

exclusivity,

SF-100

is

a

that dissolves completely in water or other fluids. Be-

cause of that 100 percent dissolution, there's no thickening and clear

it

FIBER

owner's wife produces what they accurately

plant-derived

7 per-

]

calling (800) 756-3999.

Psyllium, guar, pectin, and the Pro-Fibe combination product

but the downside

days of

your heart-smarter program? Order

WAY TO INCREASE

THE EASIEST

thirty

percent on average.

some Pro-Fibe

from the company

rectly

was with humans. After

it

three doses of Pro-Fibe daily, total cholesterol levels

LDL came down 25

cent and

Dr. Cerda's laboratories indicate significant cho-

and drinkable even

after hours.

it

remains

Try that with Metamucil, and you'd have

a glass of goo.

The Nanci Company

punch

flavors.

It

comes

sells

SF-100 as Fruity Fiber

in individual

compared with any other

fiber

in

orange and

packets or canisters and, especially

fruit

when

supplements, actually tastes good, rather

like

Tang or Hawaiian Punch. Each packet or one-teaspoon serving contains two grams of soluble

fiber.

You can

mix with any beverage. soda pop.

Stir

it

also get

SF-100

Now you can have

into milk

and turn any

in

whether

at

offers the easiest

home,

way

in the office, or

pure form, which you can

high-fiber juice, fruit nectar, or even

cereal into a high-fiber breakfast.

packet contains a whopping six grams of soluble

SF-100

its

to boost

Each

fiber.

your soluble

fiber intake daily,

while traveling. Nanci also makes shakes that

The Soluble Solution

77

•

meal replacements. But do these prod-

are ideal for use in weight control as

ucts really work?

Nanci's SF-100 was tested ter in

San Antonio.

group got

at

the University of Texas Health Science Cen-

Two groups received the

by way of Nanci shakes. One

fiber

grams of soluble

a total of fourteen

fiber,

and the other received

seven grams. Both used the shakes as daily meal replacements. Neither

any other dietary or exercise changes

made

in their lives.

After six weeks, the group drinking

two shakes containing seven grams

of fiber daily experienced a reduction in total cholesterol of 6.2 percent; their

LDLs

fell

by

8.1 5 percent.

Those drinking two shakes

daily with a total of four-

teen grams of fiber had a 9.68 percent drop in total cholesterol and 12.17 percent drop in LDLs.

When the company wanted to ernment there required pital in

its

own

introduce

clinical trials. Physicians at the University

to place

Tulsa,

OK,

MORE

IS

an order,

call

(800) 985-2582 or write to P.O. Box 700867,

NOT

BETTER

no question

that

most Americans need more

that soluble fiber in particular

enough? Can one

The average

get too

fiber

much

can lower cholesterol

many people,

that's quite a stretch.

and the majority of processed and

is

a

good many people

about ten grams

is

eat

few

to thirty-five

grams

a day.

For

and

oils,

sorts, dairy foods, fats

foods contain absolutely no hber fiber are grains, fruits, to

none of these

at all.

and vegetables,

foods, their total fiber

close to zero. Sad but true.

Especially

if

you're currently

increase your intake gradually. a

Meats of all fast

The only foods with

Zip.

how much

includes both soluble and insoluble types. Author-

consumption should be closer

and since

But

levels.

in the United States

ities feel that

None. Nada.

fiber in their diets

fiber?

consumption

number

or less daily. That

intake

pure SF-

74170.

There's

is

fiber as Fruity Fiber drinks, the

be mixed with a beverage of your choice, or as shakes. For more infor-

mation or

and

Hos-

in those taking the

fiber products.

You can order SF-100 soluble to

m Mexico, the gov-

products

Mexico City found similar cholesterol reductions

Nanci soluble

100

its

day back

in the

1980s when

consuming very

Going from zero

little fiber,

you'll

fiber to four oat

my book came out caused a

lot

want

to

bran muffins

of gas! Start with

78

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

bowl of cereal. Maybe next day

a small

can work up to stick

to the totals

with

for

life,

I'll

a side dish of beans. Little

recommend

shortly. This

by

little

a decision you'll

is

you

want

so you don't want any unpleasant experiences of gassi-

ness, bloating, or other forms of gastric distress.

know

I

I've

mentioned

this before, but

bears repeating: Drink plenty

it

up water

of water throughout the day. Soluble fibers soak

need plenty

you'll

to

form the

out with your bowel movement. Too

When ical

soluble fibers

bind the

gel that will

first

like a

sponge, and

and move them

bile acids

water can lead to constipation.

little

caught the attention of the

and med-

scientific

communities, some nutritionists were concerned about the potential of

those fibers to interfere with proper absorption of minerals. Those worries were intensified

by early research

in

animals and then in

when

absorption of calcium and other minerals to the diet.

But subsequent studies showed

dition; the

hpdy soon adapts

to the fiber,

humans showing declined

soluble fibers were introduced

this decline to

be

temporary con-

a

and mineral absorption quickly

re-

turns to normal. To be extra cautious at the start of this program, you might

want

any mineral supplements during meals when you're not con-

to take

suming fiber-containing foods or supplements. Again,

concern applies

that

only to the hrst two or three months of increased intake of soluble But by soluble

means you won't want

all

fiber.

to limit

There are distinct health benefits

your

In the 1980s,

fruits,

a

meta

Dr.

fibers.

Again, wheat and most

everyone assumed that since soluble

more one

ate, the

combining the data of dozens of studies

now

reduced choles-

is

effect, after

may

which appears

to

is

look

to say,

known

as

them

as

at

more

is

better.

reaching that threshold, cholesterol

reduction becomes a matter of diminishing returns. In soluble fiber

to

go.

appears that while a certain threshold of intake must be

achieved to see the greatest

fiber

fiber

fiber.

lower the levels would

one, he concluded that the benefits were linear. That it

only

from bal-

to derive

Joseph Keenan of the University of Minnesota did what

analysis,

But

want

and vegetables are good sources of insoluble

terol levels in the blood, the

When

efforts to increasing

you'll

ancing your diet with both soluble and insoluble other whole grains,

fibers.

fact,

consuming more

consuming

actually cause poorer results than

less fiber,

be the case whether considering foods such as oat bran or

supplements. In 1991

Chicago researchers reported data

in \he journal oj the

American

84 grams

of oatmeal,

56 grams of oat bran, and 84 grams of oat bran. Oatmeal contains

less soluble

Medical Association comparing the effects of consuming

fiber

than oat bran;

it

takes about three bowls to get the

same amount

as

found

The Soluble Solution

in

79

•

two bowls of bran. Predictably, then, the oatmeal reduced LDL cholesterol

by about 10 percent while the smaller amount of oat bran brought nearly 16 percent.

Not

of oat bran.

mum

it

down by

Now you'd expect even better results from the larger amount With 84 grams, LDL

so!

amount appeared

fell

by 11.5 percent. Thus the

opti-

56 grams of oat bran, just two ounces. While

to be

success has varied significantly in terms of cholesterol reduction, anywhere

from 4

21 percent reductions (typically 6 to 10 percent), other studies have

to

confirmed that

wind out enough

less is

more when

who had

of the sails of those

oat bran "to

comes

it

choke a horse"

The same seems

to

be true

for

That certainly takes the

to oat bran.

previously said that

it

would

take

to see cholesterol benefits.

supplements. For example, in the

New

En-

gland journal of Medicine in 1994, doctors with stellar reputations in cholesterol research reported their findings comparing ten- and twenty-gram doses of a sup-

plement contaming well as

some

a

combination of

insoluble

gram dosage and

fiber.

fifteen

The two

grams

in the

terol

and It's

as

7.3

percent

amazing

soluble fibers totaled 7.5 grams of the ten-

falls in

produced only

LDL.

to think that

and

8.1 percent in

Why take twice as much to get lesser results?

a

number

might influence cholesterol

uble

fibers,

fiber

supplements such as guar

for

you

is

for you!

question that has never been researched

wide variety of foods, including

LDL,

4.9 percent declines in total choles-

moderation in things that are "good"

prudent as in things that are "bad"

One

pectin as

twenty-gram regimen. The ten-gram dosage

resulted in reductions of 5.8 percent in total cholesterol

but the twenty-gram dosage

gum and

guar

fibers including

is

how

a

combination of

of types of both soluble

insol-

Researchers have combined

levels.

gum and

and

a

pectin,

and they have compared

foods such as oat bran and beans. But the real question might be whether the

whole

will equal

fiber- rich I

lars

to

more than

the

sum

think that would be the case

such

of

its

parts

if

one were

to

seek a variety of

foods and supplements.

a

if

anyone were

comprehensive study would

work because

of

its

cost.

for

but

it

also works.

prunes, barley, and rice bran. Yet each has

each lowers cholesterol because of

Now we know that when

its

And its

fiber.

so do pectin, guar

Psyllium

gum,

distinctive chemical profile,

and

doctors combine two or more cholesterol-low-

more response than when they simply use more

its

figs,

particular composition.

or another. There appears to be a synergistic action. And, these drugs, each has

example, appears

beta-glucan, a distinctive type of soluble

fiber is quite different,

ering drugs, they get

to invest the millions of dol-

Oat bran,

own mechanism of action.

Literally

when

it

of one

comes

to

dozens of articles

80

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

have been published over the past few years demonstrating the efficacy of such

combination therapy. Perhaps combining the fiber-rich foods and supplements might achieve similar synergy.

I

don't

know

that synergy

would occur

for certain in the strict

because a definitive study has never been done. However,

scientific sense

offer a lot of testimonial or anecdotal evidence, including

and those of hundreds of readers

Makmg

who have written

to

me

can

over the past decade.

and supplements

the effort to seek out a wide variety of foods

1

my own case history rich in

soluble fibers appears to be the thing to do. Again, look at the chart on page 82.

1

had

can honestly say that scarcely a day has gone by since 1984 that

one source of soluble

at least It

may be

haven't

of oat bran might actually

impede

and usually

fiber,

amount

that eating twice the

I

the cholesterol reduction achieved

by enjoying half

clude other fiber-rich foods in your

diet.

strone soup with

I

have more.

that

gum

in-

of mine-

beans before a serving of pasta? Or red beans and nee

its

lunch? Consider a serving of one of those supplements

guar

amount. Instead,

What about enjoying a bowl

— with an evening meal or

poor. That's the approach that

a breakfast that

would otherwise be

have personally been taking

I

for

— Pro-Fibe, psyllium, for years,

fiber-

my

and

cholesterol has remained comfortably in the safety zone.

Will everyone see a cholesterol reduction by including soluble fibers in their diet?

It

appears that people with the highest cholesterol elevations to

begin with will have the largest responses.

one should not expect

a lot of

If

counts are normal

at the start,

change. Although some studies have

shown

a

nice response even without dietary improvements, others have demonstrated

the need to cut back

hber to have

its

tion rather than

on

fat in

general,

impact. Does that

and saturated

mean

from the addition of

fiber?

Intake along with fiber in the diet have a

than those simply limiting

Not

much

at all.

the

fat in particular, for

that the effect

is

from the

fat

reduc-

Individuals reducing

fat

greater cholesterol reduction

fat.

Conversely, adding fiber rather than just worrying about subtracting this

food or that

becoming of

little

is

a lot easier than

undertaking a

a complete vegetarian.

steps that

all

add up

to

life

of total deprivation, such as

The heart-smarter approach

Soluble fiber has been a part of

my

my

arteries clear

spectacular. Let

is

and flowing and essential for

me

to take a lot

personal program since 1984. Cer-

tainly I've reaped the benefits of cholesterol control,

increased fiber

is

an incredible journey!

my

in turn,

has kept

risk of heart disease virtually zero.

good health

share a wonderful

which

little

in general,

story.

and

my own

But

health

is

The Soluble Solution

In October 1995,

when we

I

around

finally got

reach the age of

fifty.

had

I

doing what

to

sigmoidoscopy, a

a

all

of us should

test to

moidoscopy while.

is

The doctor had no

concluded the

test

idea

he said,

"1

ear

and said

that

was

I

a

and Fd put

it

A

sig-

off for a

1

my

was

I

fifty-three at the time.

interest in a high-fiber diet.

I

then intro-

He grinned

ear to

walking advertisement of how one can protect against

cancer as well as heart disease, that rioration, polyps, or

do

who was as he probed my insides. When he don't know what you Ve been doing, but you

have the insides of a forty-year-old."

duced myself and explained

to,

1

examine the m-

side of the colon to detect any cancers, polyps, or precancerous states.

not something anyone looks forward

8

•

was

I

free of

any signs of age-related dete-

precancerous conditions. Certainly that experience was a

terrific "fringe benefit."

American Medical Association pub-

In February 1996, \ht Journal of the

lished the ultimate valentine for all of us who eat a high-fiber diet. A long-term study invoking thousands of men and women showed that diets high in fiber,

those containing about thirty grams daily, slashed the risk of heart disease by

40

percent. Each

gram produced up

to a 2 percent

decUne

in risk.

Comment-

ing on the study, Dr. Ronald Kraus of the University of California said that a high-fiber diet might even be a diet

low

in

at all

to the urgent

fiber eaten daily

As

although

looked

in question

once again

fat,

more important

would be

it

in preventing heart disease than

better to have both, of course.

and insoluble, pointing

dietary fiber, both soluble

need

by way of

to

make

a real effort to increase the

fruits, vegetables, cereals,

The study

amount

of

and whole-grain breads.

I've detailed in this chapter, there are a lot of ways to increase the fiber

content of your diet every day. Personally

I

begin most mornings with a bowl

of Quaker ready-to-eat oat bran cereal with sliced banana and skim milk.

Lunch might be

a

sandwich made with whole-wheat bread. At dinner

choose a side dish of beans of some sort or some bean soup. Or ley.

Two

or three times a day

with juice;

I

fiber

fame agrees with is

amounts. And, of course,

throughout the day as snacks and

for

me, and I'm sure

it'll

I

at

whole-grain breads to complete the

worked

often

drink some of the Nanci SF-100 fiber mixed

types of fibers daily almost certainly in larger

I

might be bar-

think these are the best of the commercial fiber supplement prod-

Anderson of

ucts. Dr.

I'll

it

me

combining these many

enjoy plenty of

total fiber

for you.

fruits

and vegetables

make my sandwiches with tell you? It's factor. What can

meals, and

work

that

better than taking just one fiber source

I

I

It's

the soluble solution!

1

FINDING THE

FIBER IN

GRAMS TOTAL

SOURCE

(PER

FIBER

372OZ)

FOODS GRAMS

SOLUBLE FIBER

(PER 372

CEREALS All

30.8

Bran

3.5

18.0

6.5

Bran Buds

36.0

10.0

Cheerios

9.1

4.2

Barley (waxy,

Cream

5.1

14.0

Barley (regular, pearled)

of

hull-less)

Wheat

Fiber

(uncooked)

One

Oat Bran (uncooked) Oat Bran

(cold cereal)

Oat Bran Crunch

(Kolln)

Oat Meal (uncooked) Raisin Bran

Rice Krispies

Shredded Wheat

Wheaties

3.8

1.6

42.4

3.0

14.4

7.2

10.3

5.2

16.4

9.3

9.5

4.9

13.5

2.4

1.2

0.3

12.5

1.6

8.3

2.4

FRUIT

Apple

2.0

0.6

Apricots (dried)

7.9

4.4

Banana

1.9

0.6

Dates (dried)

4.4

1.2

Figs (dried)

8.2

4.0

Orange

2.0

1.0

Pear

3.5

1.3

Prunes (dried)

6.6

3.8

Raisins (dried)

2.3

1.1

Asparagus

2.0

0.8

Beets

2.6

1.2

Broccoli

3.1

1.5

Brussels Sprouts

S7

3.0

Carrots

3.2

1.5

.8

0.9 0.5

VEGETABLES

Cauliflower

1

Corn

2.9

Potato (sweet)

2.5

Potato (white w/skin)

2.0

1.0

.8

0.6

Spinach (cooked)

1

1 1

1 .

OZ)

FINDING THE

FIBER IN

GRAMS

TOTAL FIBER

SOURCE

(PER V/i

FOODS GRAMS

OZ)

SOLUBLE FIBER

(PER y/t

OZ)

DRIED BEANS & PEAS

Black Beans (cooked)

7.1

2.8

Black-Eyed Pecs (canned)

3.9

0.4

7.3

2.9

Chick Peas (cooked)

5.3

1.6

Kidney Beans (canned)

6.2

1.6

6.9

2.2

4.2

2.0

3.2

1.1

Almonds

8.8

1.1

Peanut Butter

6.1

1.6

Sesame Seeds

9.1

1.9

Sunflower Seeds

6.1

2.1

Walnuts

4.2

1.5

Butter

Pinto

Pork

Beans (cooked)

Beans (cooked)

& Beans

Split

(canned)

Peas (cooked)

NUTS

SUPPLEMENTS Citucel

(1

tbsp)

2.0

2.0

S.b

5.5

Flax Fiber (2 tbsp)

5.7

2.2

Metomucil

2.7

2.1

Citrus Pectin

(1

(1

tbsp)

tsp)

Metamucil, Sugar Free

(1

tsp)

ProFibe(l scoop)

Excerpted by permission from Plant Fiber Foundation, Lexington, KY. 1990.

And

in

3.0

2.6

5.0

5.0

Foods by James W. Anderson, M.D.,

other sources.

HCF

Nutrition Research

Blocking Fat and

Cholesterol Absorption

How much aromas.

I

do you

happen

really like food?

to love food.

remember

in restaurants.

I

cations. Eating

is

a joy of

fat,

for

life

mean,

really savor the flavors at

and the

home

as

me. But

that's

or

on va-

not true for everyone.

nothing more or

less

than fuel for the body.

certamly true for some of the advocates of an ultra-low-

is

During

virtually vegetarian diet.

Dr. Michael

I

look forward to dinner, whether

special meals eaten at special occasions or

Some people view food That point of view

I

a radio interview in

which

Jacobson of the CSPI was asked what he'd had

for

I

participated.

dinner the past

evening. His meal consisted of a baked potato, a piece of squash, and a slice of bread.

The host was not impressed with

son said he believed that food ever, consider eating to

Happily,

many

that kind of deprivation. Dr. Jacob-

isn't all that

important to him. Most of us, how-

be a pleasure.

wonderful, delicious foods are naturally low

in fat.

Food

manufacturers keep coming up with more and more low-fat and nonfat ver-

company

sions of dozens of favorites. There's even a ucts that are lower in

book provides

fat

the details

that

produces beef prod-

than chicken breast without the skm. Part 4 of

on easy and delicious ways

this

to enjoy a low-fat diet

without deprivation. Certainly the

first

goal

is to

choose low-fat foods. But some foods just

can't be duplicated or easily replaced. Sure, the at

McDonalds

is tasty,

and

only eleven

at

what happens when you have

that Big

fat

Mac

McLean Deluxe hamburger

grams

it's

a great choice.

Attack? Wouldn't

it

But

be great

if

we could eliminate the fat from such foods, especially after enjoying them? And what about cholesterol? Sure, those egg substitutes are pretty good, but wouldn't you

like a nice

sunnyside-up egg breakfast

at least

once

in a

while? Well,

both

fat

it

turns out that there's a

and cholesterol

in the foods

olutionary breakthrough!

way you

to literally

really

want

block the absorption of to eat. Talk

about a rev-

Blocking Fat and Cholesterol Absorption

BLOCKING

FATS IN THE

FOODS YOU

wanting

EAT

from one of

started with a letter

It all

to

85

•

know my

opinion of a

my

new weight

Diet-Heart Newsletter readers, loss

product called SeQuester.

A phone call to the company led to an interview with the company's president, "Buzz" Holcomb, who started that company, KCD Incorporated, because of his

own marvelous

results with the product,

which had been invented by

a

physician.

me how

Buzz told

he personally

and changing none of his eating It

was

no question

mind

in his

habits. His wife

which

a gradual process,

that

lost fifty

pounds by taking SeQuester

went from 142

to

company

files.

man

that, as a

medical journalist,

remember

telling the

ble skeptic, because of both in his product,

was

SeQuester worked. Moreover, he pointed to

sults of clinical studies kept in the I

18 pounds.

1

did not give results overnight, but there

my

science and

Holcomb challenged me

along with reading everything

I

was

I

it

myself.

And

I

dou-

a

Confident

journalism training.

to test

re-

did just that,

could dealing with the product

and

its

ingredients.

SeQuester

is

lation with soluble

gestion of fats you'll see

it

and

a tablet

composed

and insoluble is

listed as

sodium

liver

On

from cholesterol.

the package

choleate.

tablet breaks

the bile but gets caught in the

up

fibers. Bile, of course, is essential to the di-

produced by the

As the SeQuester

builds

of bovine (cow) bile in a special formu-

up

mesh

in the microscopic particle

in the digestive tract, fat

attracted to

and insoluble

of those soluble

mesh,

is

fibers. Fat

forming a larger particle that can-

not pass through the walls of the intestine into the bloodstream. The

then

fat is

eliminated in the bowel movement. Right off the bat you should tion has reviewed the product

know

that the

and has issued

Food and Drug Administra-

a letter of

out a prescription. All ingredients in SeQuester are

and

are

on the generally-regarded-as-safe (GRAS)

As determined by animal research

approval for sale with-

deemed

list

to

be "nondrug"

issued by the

FDA.

studies, each SeQuester tablet

pable of immobilizing or sequestering about 6.0 grams of

fat,

5.8

grams

is

to

ca-

be

exact. This fat reduction has the potential for significant weight control or

cholesterol

management.

Weight

loss in those

using SeQuester exceeds that predicted by the se-

86

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

questering of fat alone. Multiplying those six grams of fat by nine calories each,

every tablet should remove fifty-four calories. Calorie removal

and insoluble

cant, but the soluble

fiber

itself is signifi-

complex encapsulatmg the

bile ap-

pears to further influence weight reduction. Interestingly, SeQuester sup-

who need

presses appetite in those to be the case in

my own situation

in the

I

first

as part of

place.

to lose weight, although

I

hnd

did not

who had no

or that of others

that

weight to lose

learned that the Oakland Raiders football team uses SeQuester

its total

nutntion and traming program. The Raiders trainers hnd

helps build muscle tissue rather than

fat in

it

those athletes eating huge amounts

of food.

But

be the

effect of

KCD's

of

my immediate

to

FDA

SeQuester was not weight

SeQuester consumption on cholesterol,

on weight

clinical studies

enough, cholesterol

owing

interest in

levels

fell

regulations, the

ing claims. SeQuester

is

loss,

KCD I

my

company cannot make any

494-6687

If

to

you cannot

hnd

My

for the past several years,

personal interest, then, was not so

rather, to see

if I

couldn't relax

1994

my

free coffee cake,

experiment.

in each.

fat

much

but

I

My own

to

my cooking or a

New York,

I

I

cholesterol levels have

lowering but,

a bit. its

reduced- fat doughnuts,

would have opted

tablet to balance out

for a piece of fat-

a

good part of the

one doughnut.

similarly calculated a bit of extra fat

from extra

piece of cheese in a restaurant and so forth.

On

oil

a trip

gave in to the temptation of a corned beef sandwich and a bowl

splurges with SeQuester. Even

"cheating" on

newsletter and

to seek additional

of chicken soup at the famous Stage Delicatessen. tle

my

hgured that the doughnuts would be

One SeQuester

For three months

used in

I

you can

averaging between 165 and 175.

fat restriction

Normally

find the product,

issue of

Just about that time, Entenmann's introduced

with six grams of

cholesterol-lower-

a location near you.

findings in the October

began experimenting with SeQuester myself. been quite stable

wondered? In some

were measured and, sure

lipids

sold exclusively as a weight-loss aid, available in most

directly at (805)

reported

What would

along with the pounds and inches. However,

major drug stores and supermarkets. call

I

loss.

my

my

friends

I

and

preceded each of those relatives

noted

how

1

lit-

was

usual low-fat diet.

my cholesterol level. Imagmy test revealed a wonderfully low 1 5 1 TC, with similarly good measurements of the rest of my lipids. SeQuester has been part of my personal program ever since. Remember

ine

that

all

my pleasant surprise

1

wanted was

to learn

from

to

maintain

Dr.

Keenan

that

Blocking Fat and Cholesterol Absorption

Then for

from

started getting letters

I

my

newsletter readers, thanking

me

introducing them to this product. L.S. reported from Zephyr Cove, Nevada,

months my

that "In the past three

with similar improvement

Long

J.W. of

took

my

m HDL, me

Island told

me

SeQuester with

cholesterol has

LDL, and

dropped from 221

eggs, 5 pancakes,

to try

it.

and 6 small sweet

wedding cake with

had

my

icing

on

cholesterol checked.

would go

up.

To

my surprise

to the store to get

I

it

it

triglycerides."

put

really

I

rolls.

and

was

a

it

After the

managed

to

I

wedding

afraid to hear

my

I

"I

ate

about 2 scrambled

ate

ate a large piece

1

results.

I

just

later

knew

was 176 down from 204. Unbelievable!

I

it

went

I

more SeQuester."

been an overweight person (118 pounds) but

With

That night

to the test.

lunchmeat sandwich. Five days

were amazing.

D.S. of Odessa, Florida, said her results

lesterol.

to 178,

about attending a wedding out of town.

2 large pieces of pizza. For breakfast the next morning

of

87

•

a very stringent diet

reduce

it

from 300

for

20 years I have had high cho-

and 40 milligrams of Mevacor

to 230.

have never

"I

a

day

I

have

have been on SeQuester approxi-

I

now and my last cholesterol test was 195. have even permitted myself to relax my diet a bit." R.P. of Somerville, New Jersey, keeps detailed records of his cholesterol tests and sent me a copy along with a letter. "From the enclosed data you will mately 4 months

I

see that the baseline cholesterol

Mevacor

daily the

was 243. After 30 days on 5 milligrams of

number dropped

to 202.

During the second 30 days

I

con-

tinued using the Mevacor, but added SeQuester. Cholesterol dropped to 174." S.H.

is

a registered nurse in Hawaii.

She wrote twice, once

was going

as director of education at a health clinic, she

periment before recommending SeQuester to her patients. I

got a second note:

pounds to 206!

easily, I

"I

my total cholesterol

from

a

to tell

me

month and

'normar

that,

a personal ex-

A few months

personally took SeQuester for one

and lowered

do

to

(for

later

lost

4

me) of 220

didn't even diet as such."

When it came

time to do

my research with

Dr.

Keenan

in Santa

Monica,

SeQuester was part of the program. You can check out the results of that study in chapter 13.

Additional studies are being conducted

Los Angeles with Dr. David Heber and

at the

at the

University of California at

Wistar Institute in Philadelphia

with Dr. David Kritchevsky. Both of those men, recognized as international experts in weight loss, cholesterol,

prospects for SeQuester.

and

nutrition, are

examining the long-term

88

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

How

Take SeQuester

to

You'll find

SeQuester

in the

weight loss section of your drugstore or super-

market. Each box contains ninety tablets in three blister-pack cards.

keep a card of

to

tablets in

your kitchen,

office, car,

Make

a point

purse, and attache case.

Doubtless other companies will try to infringe on the SeQuester patents

and produce "copycat" products. While ingredients may sound the same, one cannot be sure of manufacturing processes and one cannot

tell

whether the

copycats would work as well.

For the

first

The package

amount

that

two or three weeks, take one

directions suggest taking

tablet

thirty

it

with

all

three daily meals.

minutes before

of time allows the tablet to disintegrate before

a meal.

you

eat,

While

you may

not always remember. Just be sure to take the tablet either before you take the

if

during the meal. Each tablet

bite or

first

of

and food remains

fat,

in the

you take the SeQuester

Why take

it

with

all

stomach

at the

is

a "fat

for a

sponge"

for

about six grams

few hours, so you'll benefit even

end of the meal.

meals, even

if

those meals are extremely low in

fat?

This regimen gives the body an opportunity to acclimate to the SeQuester and to build tric

up

a tolerance.

Taking too many

tablets right off the bat leads to gas-

upset.

After the

first

few weeks, increase to two tablets before each meal for an-

other few weeks. Please don't "jump the gun" and take more. Again, you might

develop gastric upsets or even diarrhea. Give your body a chance to get ac-

customed

to the bile/hber formulation.

After the acclimation period of about six weeks,

meal and perhaps drop down

dosage to three tablets before a

fatty

two

less fat.

tablets prior to a

way up

to

even

five

meal with

you can increase the to

one or

As time goes on, you may work your

or six tablets preceding a particularly rich indulgence.

Conversely, be sure to take the tablets regularly, without skipping a day or two

even

if

tomed

your meals are especially low to the SeQuester.

If

you do

in fat, so that

your body remains accus-

lay off the tablets for a while, for

reason, don't return to multiple-tablet doses; instead, build your to avoid

whatever

way back up

stomach upset.

For most people, six tablets as a daily average will provide excellent results.

You

will

proving your

have sequestered about thirty-five grams of

diet.

And,

now and

then,

you may want

to

fat,

vastly im-

succumb

to the

siren call of the dessert cart after a festive meal or give in to that "Big

Attack."

Mac

Blocking Fat and Cholesterol Absorption

Test SeQuester as part of this complete

then have your cholesterol level checked.

I

program

for

89

•

about ninety days,

think you'll be in for a wonderful

surprise!

How

Safe

SeQuester

SeQuester?

Is

is

remarkably

a

safe

product with

if

perience

taken properly.

some

tablets at the beginning, lest

queasy

feeling. Just

you then might want

fats in

bowel movement. Stools Not enough, though,

color and fact,

may

float.

these changes

re-

it,

you might ex-

many

be sure not to take too

most people, no problems. For a very to take

some

to counteract that effect. Again, taken properly

fat.

any adverse

if

to

you develop a bilious sensation and bloating in

the evening or late at night. For

SeQuester binds

in-

As your body becomes accustomed

slight gassy or

gassiness persists;

any downside. The

you should expect few

gredients are completely natural, and actions

little if

you

the foods

SeQuester poses no

and passes

eat

few,

activated charcoal tablets difficulty.

that fat out in the

have a higher than normal amount of

will, therefore,

to turn the stools greasy. Stools

may

turn a yellowish

That's completely normal and nothing to worry about. In

show

that the tablets are working.

On

the other hand,

some

people see no difference in the stools, and yet the tablets are doing their job. If

you develop any

significant gastric upset or diarrhea, simply cut

on your dosage. Symptoms

will disappear.

There

is

no potential

for

back

any per-

manent injury or serious damage. Studies have

shown no problems

in terms of

SeQuester interfering with

the absorption of either vitamin/mineral supplements or medications. Actually,

as part of this complete program, you'll be taking vitamin

detailed in

coming chapters, and

Remember,

too, that

SeQuester

a part of the total fat

there's

will

no chance

bind about

six

content of any given meal.

I

supplements as

that you'll not get

grams of fat per mention

this

enough.

tablet,

of the antioxidants you'll be interested in are fat-soluble vitamins with a fat sequestrant like

SeQuester might

interfere;

only

because some

which

but that effect would be so

small as to be negligible.

Currently there

is

no indication

that

SeQuester interferes with any med-

ications or cholesterol-lowering agents, including niacin.

If

you

are

concerned

about SeQuester interfering with your medications, simply take SeQuester and

your medications

at different times.

There are no contraindications

for

using SeQuester as part of a healthy

90

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

lifestyle

even

for those

with existing illnesses or conditions including

kidney, or digestive problems.

Nor is age

her

uses SeQuester and

late seventies,

count,

much

it

to her physician's delight.

Both elderly individuals and

a barrier.

The company

teens can benefit from taking SeQuester.

ily

men, and neither

given

I've

would

to

it

in

my

to

teenage chil-

be elevated, and Jenny's

Both Buzz Holcomb and

at times.

of us

president's mother, in

has greatly improved her cholesterol

And

dren without concern. Ross's cholesterol tends weight can be a concern

liver,

are devoted fam-

I

any way jeopardize our loved ones.

SeQuester as Part of Your Program

Let's say you're a

150-pound, moderately

follow a 20 percent-fat diet. Achieving that level

grams of

but perhaps that sounds

fat daily,

percent-fat diet, allowing ier.

SeQuester allows you

Remember Take four you're

enty fifty

to the fat

grams of

grams

to seventy five

as

it

would allow

grams of

fat daily,

fat,

from

Maybe

20 percent-fat

diet.

a

would be

were, have your cake and eat

it

grams of

30

eas-

too.

fat

per

adhering to an otherwise 30 percent- fat a

to

a total of fifty

you.

a bit difficult to

that SeQuester immobilizes about six

tablets daily, while

down

five

up to,

who wants

active individual

tablet.

diet,

and

Although you're eating sev-

about twenty- five grams are sequestered, leaving only

to be absorbed.

You can look

at

SeQuester in two ways.

First

you might want

you lower your cholesterol further than you've been able that case, stay with

your current

to "squeeze" the fat

down

further.

diet a bit, allowing yourself to daily. Either

ANOTHER Might

diet plan

to

do

to help

it

until

now. In

and just take some SeQuester

tablets

Second, you might want to liberalize your

have that occasional indulgence or a

bit

more

fat

way, SeQuester can be a revolutionary cholesterol breakthrough!

FAT

I

BLOCKER TO CONSIDER

interest

you

in

an appetizer of

shellfish shells?

It

turns out that

crushed exoskeletons, the shells, of crustaceans such as lobsters and shrimp taken

in

capsules can actually block the absorption of

The product,

called chitosan,

is

a type of animal fiber,

related chemically to plant cellulose.

nipulated to give

it

fat in

the foods

you

eat.

amino polysaccharide,

The chitosan has been chemically ma-

a positive charge, allowing

it

to attract negatively

charged

1

Blocking Fat and Cholesterol Absorption

fats

and

the

toilet.

bile acids.

Chitosan States

is

Thus trapped,

marketed by

number

a

NuSkin, and thus

tionals, a division of

not in drug stores or other

and wind up

the fats are not absorbed

in

of companies worldwide. In the United

company

sold by the multilevel marketing

it is

9

•

is

retail outlets.

Interior

Design Nutri-

available only through distributors,

The brand name

Articles published in the journals Lipids

and

FibreNet.

is

Bioscience, Biotechnology,

and

Biochemistry in 1993 and 1995, respectively, have reported research indicating that chitosan blocks the absorption of four to six times

recommends taking

four capsules with lunch

Those eight capsules contain

a total

block eight to twelve grams of

nearly six grams of

much

fat

per

IDN

fat.

and another four with dinner.

Obviously, that would

make

it

And

a

much

less

has the fat-blocking potential of

Moreover, the cost of FibreNet

tablet.

as three dollars per day.

with seafood

weight in

of two grams of chitosan, which would

blocker than SeQuester, which

efficient fat

as

fat.

its

FibreNet

quite high,

is

contraindicated for anyone

is

allergies.

FibreNet does have certain advantages, however. Clinical studies find virtually

no

gastric upset.

And

the chitosan takes care of any problems with

regularity.

Again, the only

way you can

m

utor. If you're interested

487-2121

to

this

obtain FibreNet

product, you can

through an IDN

is

call the

company

be given the name and number of a distributor in your

distrib-

at

(800)

area.

BLOCKING THE CHOLESTEROL IN THE

FOODS YOU

EAT

For eleven years, since the time of

had not eaten one egg arteries

when

yolk.

It

seemed

my

second bypass surgery

a small price to

pay

from clogging, and the egg-yolk substitutes were a

they

first

came

out. But

I

have to admit that

I

in 1984,

I

keep those

to

lot better

than

missed those poached,

sunnyside-up, boiled, basted, and other eggs. There's just no substitute for those yolks! 1

sales

haven't been alone in

my

avoidance of eggs and their cholesterol. Egg

and consumption have plummeted

the egg industry has tossed in the towel

to a fraction of their

and now recommends the

of four eggs a week. Sensitive persons should eat

While other foods

1960s

none

level.

Even

AHAs limit

at all.

are rich sources of cholesterol, the

egg has come

to

92

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

A very

symbolize that deadly dietary component.

nutritious,

mexpensive food

come

that nutritionists use as the gold standard of protein quality has

But enough of that! The terrihc news

in

we

want

all

our blood nse not a

to stay

is

way

those eggs as you like them. There's a the cholesterol

to

be

wishing to avoid heart disease.

politically incorrect for those

you can go back

to enjoying

block the body's absorption of

away from so

wonderful

bit. It's a

that

to

that the cholesterol levels

story, so let

me

start at the

very

beginning. Cholesterol, of course,

which

a

is

member

are present in every animal tissue.

tain sterols,

You'll

which

It is

an animal

sterol. Plants also

con-

termed phytosterols. Sort of the yin and yang of nature.

are

remember

having very high

of the chemical family called sterols,

that

many years ago

condemned

dietitians

Those

levels of cholesterol.

early

shellfish for

measurements were

totally

inaccurate because they were counting not only cholesterol but also the phytosterols

from the plants those animals

sea. In truth, certain shellhsh

mal food; scallops contain ple.

ate.

Shellhsh are the vegetarians of the

have the lowest cholesterol content of any ani-

a third of that

found in chicken breast,

But those early measurement devices just couldn't

tell

exam-

for

the difference be-

tween cholesterol and phytosterol. Well, neither can your body! Cholesterol

is

of your intestine by cell receptors that then pass

Those receptor they'll

fill

is

no room

that for

tion of plant sterols

with phytosterols,

absorption of cholesterol, which simply passes along

is

all

from

plants,

fat,

as

is

fruits to vegetables to

down

seeds to

cholesterol, the principal concentra-

in vegetable oils of all kinds.

But plant sterols cause these

be cloudy, and food manufacturers remove them to provide the clear

product that consumers

prefer.

Thus, there

concentrated phytosterols in our Interestingly, the

to

filled

this fluke

and ultimately out with the bowel movement. Bingo!

Because they are soluble in

oils to

one-third

be available. The phytosterols, how-

those cellular docking sites are

if

Phytosterols are found in oils.

to

absorbed into the bloodstream. The wonderful part of

of physiology

the intestine

first

along into the bloodstream.

discern between cholesterol and phytosterols, and

up on whichever happens

ever, are not

there's

sites can't

absorbed in the it

produce the white

Japanese

Maybe

no readily available source of

diet.

make

oil

from

rice they, too, prefer.

tosterols in that rice oil.

is

that's

rice bran,

which they remove

But they leave the clouding phy-

one reason the Japanese have

a

low

rate

of heart disease.

The term phytosterols

is

generic, including

all

plant sterols.

The

princi-

Blocking Fat and Cholesterol Absorption

pal phytosterols in nature are campesterol, stigmasterol,

Often the

simply called

latter is

and

beta-sitosterol.

most potent phy-

sitosterol. Sitosterol is the

tosterol for blocking the absorption of cholesterol. That discovery was

in the late

1940s

at the laboratories

of the

93

•

made

Upjohn pharmaceutical company

in

Kalamazoo, Michigan.

During ical

that time, steroid

hormones were coming mto vogue

community. Cortisone was the miracle drug of

hormones could be made from

that those steroid terol.

As

in the

med-

day Upjohn discovered

its

the soybean sterol stigmas-

part of his laboratory investigations at the time, Dr.

Dury Petersen

fed

the soybean sterols to chickens. To his surprise he found that the chickens' cho-

not

lesterol levels did

was not

rise,

even

when

particularly interested in that discovery; they

So Upjohn bought crude soybean

sterols

wanted

sitosterol, to the Eli Lilly

to sell cortisone.

from food companies such

General Mills, extracted the stigmasterol, and sold the campesterol and

Upjohn

fed a cholesterol-rich diet. But

Company in

rest,

as

consisting of

Indiana. Lilly then con-

cocted a cholesterol-lowering drug called Cytellin. Cytellin

was ahead of

most people and

its

their doctors

time.

levels;

it

it

did lower cholesterol levels,

were not particularly aware of cholesterol

risk factor in heart disease. Cytellin

blood cholesterol

Though

had no influence on the

as a

effect of fat

on

only blocked the absorption of cholesterol. More-

over, according to reports I've read, the stuff

was

a foul-tasting fluid.

Research with phytosterols continued through the 1970s and into the 1980s. Probably the most definitive study

Fred Mattson and Scott Grundy, then Diego.

They

came from

at the

University of California at San

fed hospitalized patients scrambled eggs

that the phytosterol

the laboratories of Drs.

and

sitosterol

and found

blocked absorption of cholesterol, resulting in reduced

cholesterol levels in the blood.

Often researchers used phytosterols as a general cholesterol-lowering agent rather than to specifically block the absorption of cholesterol in a particular meal.

than needed,

This meant that

when

not

much

at

one meal there would be more phytosterol

cholesterol

was present

in the foods, while at

other times there wouldn't be enough to block the absorption of

Even

lesterol available.

so, studies

showed

total cholesterol

all

the cho-

reductions of 12

percent on average. Dr.

now

Mattson

now

professor emeritus at U.C. San Diego. Dr.

a world authority in diet, cholesterol,

of Texas in Dallas. tion,

is

I

asked him

While attending

why

a

and

Grundy

is

heart disease at the University

meeting of the American Heart Associa-

the interest in phytosterols

had dropped

off.

He

felt

that

94

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

Other agents available as cholesterol-lowering prescription drugs were more

by the way, has done much of the research with

potent. Dr. Grundy,

scription cholesterol-lowering

No doubt that

a

drug Mevacor.

major factor in the decline of research comes from the

no major company produces

The only study

that

showed no

from another Texas laboratory.

a plant substance,

fact

no one

in patented products.

is

came

benefits in cholesterol lowering

Margo Denke studied

Dr.

men

thirty-three

already following a low-fat, low-cholesterol diet as well as taking

prescription cholesterol-lowering drugs.

produce

As

phytosterols.

can hold an exclusive patent, and the money

who were

the pre-

statistically

The addition

of phytosterols did not

signihcant additional cholesterol lowering for the average

participant.

None

of Dr. Denke's patients ate any eggs.

Whatever small

effect

they

achieved came from blocking the cholesterol in meats consumed. Even

some

men saw

of the

ence the

significant

statistics of the entire

improvements, though not enough

so,

to influ-

group.

Finnish researchers shared their plant sterols results

1995

at the

AHA

meeting and published them in the November 1995 New England journal of Medicine. For a one-year period, 153 subjects continued with their usual diet

and

lifestyle

and used

either regular margarine or a specially prepared

garine laced with phytosterols. Those subjects taking the sterols

with

TC and LDL levels lowered by

1 1

and 15 percent,

respectively,

mar-

wound up when com-

pared with those consuming the regular margarine.

Reading through

all

the old

by the idea of using phytosterols

and new research to liberalize

reports,

my own

diet.

1

was fascinated

But

I

found that

the plant sterols, once marketed widely in health food stores, were not available.

There was never a clear focus as

weren't spectacular

when

to

how

them, and results

to best use

the plant sterols were taken as a general cholesterol-

lowering agent. Moreover, the dosages of phytosterols sold in the past were

way

too low to be effective. And, as

often the purity

1

learned through the industry grapevine,

was poor, with some products containing

little if

any active

phytosterols.

To be least a

effective,

one has

one-to-one basis.

And

to counteract cholesterol that's

assuming

preparation. Since one egg contains about takes at least that I

much

with phytosterols on

220 milligrams

phytosterol to block

its

in

Oregon makes

of cholesterol,

it

absorption.

turned to the company in the supplement industry

The Endurance Products Co.

at

a really high-quality phytosterol

I

knew could I

trust.

the niacin formulation Endur-

Blocking Fat and Cholesterol Absorption

acm and

knew

owner of

that the

m

frustrated

we could

and recommending

the antioxidants I've been taking the

company

his efforts to find a really

for years.

a stickler for quality. Indeed,

is

good supply

95

•

1

he was

which

of phytosterols with

experiment. But finally he did locate a source of absolutely pure, po-

tent material.

Phytosterols

m the pure state are a white, slightly waxy substance. They

are not soluble in water, so

one could not mix them with orange juice or other

beverages. In addition, they

too tightly packed, they to

do

At hrst

their job.

My

first

1

must be

carefully tableted, since

may not break up in the made my own capsules.

my own

experiments were done with

known

for its

headed

off for

French foods!

My

high

summer

after a

friends.

a few

My

of picnics, parties,

the leisurely

a bit higher than usual,

Before each

that

at the

I

an island

to

French cuisine and level

was

rather

his high school

wife

Dawn's

all

was

level

level.

took tablets of

must admit the food was

Then came

those eggs were wonderful!

and the timing

healthy 165 to 170

and cholesterol-rich meal, we

fat-

they're

perfectly normal, but she'd gained

summer months. My

and mine remained

SeQuester and capsules of phytosterols.

And

all

and hanging out with was

where

measured and then

son Ross's cholesterol

daughter Jenny's cholesterol

pounds during

family,

cholesterol levels

two weeks of indulgence, including

egg breakfasts three times a week.

phytosterols are

on vacation

couldn't have been better. 'We were scheduled to go

'We had our

if

digestive tract

delicious.

the marvelous results

when we

returned and retested those cholesterol measurements. Ross's cholesterol

normal, healthy count

the

fell all

— and

way down

to normal. Jenny's

she actually lost three

remained

pounds along

Dawn's cholesterol came down, while her weight remained the same even those rich

meals. And my own numbers stayed

the same.

at a

the way. after

The eggs had no neg-

ative effect.

time.

me hasten to say that Back home we quickly returned

tered

around low-fat foods, as

Please

you

let

to enjoy

1

I

don't endorse eating that

to

way

all

the

our usual healthy eating habits, cen-

detail in part 3 of this

book. In

fact,

I

invite

"Dinner with the Kowalskis" by way of the month of family

now regularly eat real, delicious eggs every week, usually on weekends. But let me go on with the phytosterol story. My most dramatic proof of effectiveness came courtesy of my friend and financial adviser Gerry Gersten. This is a man who has had seven angioplasrecipes in the book. However,

ties

we

all

before "getting religion" regarding his health.

and he and

his wife Claudia read

my books and

I

worked with him

closely,

followed the program to the

96

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

Gerry took a combination of cholesterol-lowering drugs

letter.

In addition,

under

his cardiologist's supervision. His

finally his cholesterol level

with an

LDL around

suggested that he

100.

normalized

He

was

about 165

at

stayed that

a particularly difficult case.

way

for

to

But

170 on a regular basis,

about two years, and then

I

start eating eggs!

To say that Gerry was shocked would be an understatement, and his wife

was absolutely appalled

cal.

that

I

would have him take such

who knows my work,

his cardiologist,

Gerry assumed that the experiment would

problem

tant cholesterol

would

to begin with,

month

after a

fail,

was such

since his

and he wanted

take to get the count back to normal

would go up

Even

a chance.

after

gave his permission, Gerry was skepti-

to

— assuming

know how

a resis-

long

it

numbers

that the

of eating eggs.

For one month, Gerry ate eggs three times a week. Sometimes

McMuffin, though he told them

to

it

was Egg

hold the cheese. Sometimes he'd have pan-

cakes and eggs, or Canadian bacon and eggs, and a few times he cheated with a little

regular bacon,

a couple of

of truth,

crisp the

way he

likes

it.

Before each meal, Gerry took

SeQuester tablets and phytosterol capsules. Then came the

and

"Well,

done

1

must

tell

you

that

Gerry was more than a

little

moment

concerned.

he need not have worried. Total cholesterol was lower than ever

before at 156,

LDL

cholesterol

was down

to 90,

which had never been lower than 225, were

and Gerry's

triglycerides,

He's enjoyed those eggs

at 175.

ever since, typically once or twice a week, mostly on weekends.

By

now you must

be asking, but

safe?

is it

Can

I

use phytosterols often

or just once in a while? This sounds too good to be true; what's the downside?

The good news one of the

is

safest

downside

that there simply isn't any

at all.

Phytosterols are

substances you could possibly ingest. To quote Dr. Grundy,

"Phystosterols have the

added advantage

of causing

necessary property where lifetime therapy

little

or no side effects, a

often necessary."

is

And

Dr.

Denke

concurs, saying that, "Except in patients with sitosterolemia, plant sterols are

poorly absorbed and have been associated with no

That one exception, sitosterolemia,

which

afflicted

much

the

toxicity."

a very rare metabolic disorder in

persons absorb phytosterols and are not able to excrete

those cases, sitosterol builds in

is

known

same way

up

in tissues

and could lead

to health

it.

In

problems

as cholesterol does. But people with this disorder de-

velop problems eating a normal diet containing fruits and vegetables, sources of phytosterols in small amounts. it.

If

The bottom

line, then, is

you have sitosterolemia, you'd have known long

ago.

don't worry about

Blocking Fat and Cholesterol Absorption

For if

the rest of the millions of us, phytosterols pose

all

much

eaten in huge quantities,

less the

of foods

and phytosterols,

would

no problems even

again: "By the judicious choice

a proper balance of cholesterol

takes could be achieved. This

97

small amounts needed to block the

Grundy

absorption of cholesterol. To quote Dr.

•

and plant

sterol in-

mitigate one reason for restricting the

consumption of eggs, dairy products, and meat." Put simply, balance out the absorption of cholesterol with phytosterols and enjoy the foods you really

You can use SeQuester for

example, have

SeQuester

Take

to

to

m

fat

fat

that those foods also

per yolk in addition to the cholesterol. Use

on page 98

to see just

the foods you've probably

block that cholesterol with

The phytosterols

1

how much

been avoiding or

at least a

in

400-milligram

if

the total

amount

tablets, so cal-

one capsule

will ef-

of the cholesterol found in those

foods are equal. For eggs, then, to be on the safe side,

egg yolk. Perhaps all

and cho-

block the cholesterol. Eggs raise cholesterol levels more than other

foods such as shrimp, even

zap

fat

limiting. You'll

one-to-one dose of phytosterols.

recommend you use come

culate accordingly. For meals containing any kind of meat, fectively

like.

contam. Eggs,

it.

a look at the chart

lesterol lurk

want

block out the

grams of

five

block

to

less

would be okay, but

this

I

amount

advocate one tablet per is

absolutely certain to

the cholesterol out of those delicious yolks. Take the tablets thirty

min-

utes before meals. I

stores,

noted

an

will bring

book, but

ineffective

level. I've

were previously available

but that the dosages and purity were a problem.

companies this

earlier that phytosterols

I

have no idea

safe side,

my own

You can order rectly to

No doubt

how

number

effective they'll be. I'd hate to see

I

of

you take

suggest you stick with the same phytosterols that

research and that

directly

I

personally take and give to

from the company, and

your home. Because

there's

they'll

no advertising or

Phytosterols

Endurance Products Company Post Office

Box 230489

OR 97281-0489

(800) 483-2532

my

family.

ship the phytosterols diretail store

phytosterols are actually less expensive that way. Write or

Tigard,

a

back the phytosterols when the word gets out by way of

product to deal with something as important as your cholesterol

To be on the

used in

in health food

call:

markups, the

CHOLESTEROL AND FOOD

FAT

CONTENT OF

CHOLESTEROL (MILLIGRAMS)

COMMON FOODS FAT

(GRAMS)

CHEESE (one ounce)

27 29 30

American Brie

Cheddar EGGS

One

220 94 260

16

Mac

83

35

Wendy's Double Hamburger

150

30

92 96

35

lean

86

17

Tenderloin, lean only

84

9

92 93 84 85 89

16

large chicken

Coviar

(1

egg

tbsp/40g)

Egg McMuffin

(with cheese)

5 2.9

FOODS

FAST

Big

MEATS (3.5 OZ, cooked) Beef brisket,

fat

&

lean

Round steak

&

Tenderloin, fat

15

POULTRY

Chicken, dark w/skin Chicken, dark wo/skin Chicken,

Chicken,

w/skin

light

wo/skin

light

Turkey, dark w/skin Turkey, dark

wo/skin

Turkey, light w/skin

Turkey, light

Chicken

wo/skin liver

SHELLFISH (3.5

10 11

4.5 11.5

85

7.2

76 69

3.2

631

5.5

29 35

0.5

8.3

OZ RAW)

Clams

Crab

0.7

Crayfish

118

0.9

Lobster

81

0.8

28

0.6

130

0.6

Scallops

Shrimp

CHOLESTEROL AND FAT CONTENT OF FOOD

COMMON FOODS

CHOLESTEROL (MILLIGRAMS)

FAT (GRAMS)

VARIETY MEATS (3.5

OZ, COOKED) Brains

2,000-2,500

Heart

193

Kidneys

387 389 43 95

Liver

Pate

oz)

(1

Tripe

You can

also obtain the

retail outlets.

The

Endurance Products

vouch

for the

to

3.4

4.9

5-12 4.0

drug

stores,

KCD company

that

but

to

all

it

be

more

low-fat diet should

lifestyle.

For example,

as high-fiber breads

retail outlets.

The use

flexible with

For years,

I

still

may

I

can't

appear.

of SeQuester

and

our diets than ever be-

we

and

used

all

that

then. That

all

was

a

I

still

need

lots of fresh fruits

straight

it

can be

habits.

and vegetables

as well

and narrow path of low- fat fat

and cholesterol

—

eating.

difficult,

I

but

considered the alternative. Then the food industry

sorts of low-fat

and nonfat versions of foods

once in a while.

I'd

avoided until

And now we have SeQuester and phyand cholesterol in the foods we want That's a revolutionary breakthrough. And for

marvelous evolution.

tosterols to block the absorption of fats

to enjoy at least

good eating

cereals.

walked the

bad when

came up with

to replace

be the goal and the centerpiece of a truly healthy

chose the foods that were naturally low in

you

and

Truly this represents a twenty- first-century revolution in nutrition and

health. But these products should not be

not

marketed

makes SeQuester arranged with

bears repeating.

far

tablets

large supermarkets,

quaUty or performance of other products that

phytosterols allows us

The

some

market phytosterols through

I've said this before,

fore.

5.6

same high-quality phytosterol

as SeQuester 4: Phyiosterols in

other

10-16

a revolutionary reality!

8

•

•

ACES OF Hearts

It

s

no surprise

that

many

health professionals have a negative knee-jerk reac-

tion to the concept of vitamin

and mineral supplementation. For

the initial discovery of vitamins

and

made

in the 1920s, charlatans

have

megadoses of

and the other

food store

The

starting

wild, unsubstantiated snake-oil claims for thing.

Even today,

a trip to the health

a lesson in unscientific thinking.

traditional thinking has

good health by eating

sary for levels

is

this, that,

years, since

and deficiencies

their functions

have been

set for

a

been that one can get

wide variety of foods

all

in a

the nutrients neces-

balanced

diet.

Intake

vitamins and minerals based on amounts determined

to prevent deficiency states in

most people. Take any more, the established

consensus stated, and you'd simply have expensive urine.

So when some researchers universities tific

and research

journals,

ings

who were not in the mainstream of certain who did not publish in the "correct" scien-

and who did not attend the "recognized" conferences and meet-

came up with

radicals," they said,

centers,

the

first

suggestions of harmful substances

were dismissed as "the lunatic

fringe."

were unstable chemicals that could damage

The process was likened diseases

to

oxygen rusting

and aging, and the solution was

iron.

Those

cells

The

known

as "free

free radicals, they

throughout the body.

results

were degenerative

to take antioxidant vitamins

and

chemicals.

Fast-forward to the present: The mainstream researchers are publishing data in the correct journals and presenting

them

at

"recognized" scientific meet-

ings around the world that validate the concepts of oxidative

body But

to the

unlike their maverick predecessors, most of these established re-

searchers are not willing to

You need

to

recommend supplementation

I'll

for the general public.

understand the research that has been done so that you can

make decisions based on your own ing pages

damage

needs.

The data

are compelling. In the

com-

share benefits in terms of prevention of heart attack, stroke,

angina pains, and the clogging of the arteries in the legs that leads to the pain

known

as intermittent claudication.

The underlying mechanism by which an-

ACES tioxidants appear to

work

oj Hearts

101

•

LDL and

involves the prevention of oxidation of

Lp(a) in the bloodstream which, in turn, prevents arterial clogging.

To

really get a

handle on that mechanism of antioxidants' action,

how and why arteries clog in

take a brief look at

the body's natural attempt to stay healthy.

the

When a

bloodstream, bacteria for example, white blood attack like Pac-Man. Usually the as

normal

body views

in the bloodstream. But

white blood

known

cell

gobble up the oxidized

termed foam

the

LDL and

place.

It all

come

is

stressed,

such as

cholesterol, both

LDL becomes it

and

LDL and HDL,

oxidized, a type of

Macrophages

as foreign.

Lp(a) voraciously and turn into what are

cells,

at twists

let's

with

to the rescue

bloated with

fats

and

cholesterol, enter the

walls of the arteries, usually at sites of microscopic injuries artery

starts

foreign intruder enters the

cells

macrophage views

as the

Those foam

cells.

when

first

and

and where the foam

turns. Eventually these

com-

cells

bine with the blood's clotting material called fibrinogen to form a soft plaque that

is

subsequently hardened by calcium. You can read about

detail in chapter

The important point here are not

this in greater

L is

that

if

LDL and

Lp(a) are not oxidized, they

sucked into the plaque-forming process. Of course

as few molecules of

LDL and

it's

better to have

Lp(a) as possible to keep the clogging from hap-

pening. But everyone has at least small amounts of these particles stream. So the next best thing the antioxidants

One

come

is

to

m the blood-

keep them from oxidizing. That's where

into the picture.

Do we

have evidence? Tons of

Texas Southwestern Medical Center in Dallas. There Dr. Ishwarlal the foundation for vitamin E's ability to prevent

presented

it!

of the leading research centers for antioxidant investigation

at the

AHA's annual

LDL

the

is

Jialal laid

oxidation. In a study he

scientific session. Dr. Jialal

explained that

800

lUs of vitamin E reduced oxidation by 62 percent. At the same meeting, he

re-

ported on work showing benefits of beta-carotene as well in preventing

macrophage gobbling of LDL and thus Publishing in the AHA's

official

in stopping the clogging process.

publication Circulation in 1994, Dr. Jialal

wrote of thirty-six healthy male volunteers sisting of

800 lUs

of vitamin E, 1,000

carotene. Again, the oxidation of

Very importantly. Dr. dosages of vitamin

E.

I'll

As any reputable

Jialal

given a "cocktail" con-

of vitamin C,

and 30

mg

of beta-

effectively prevented.

has noted no side effects with antioxidant

cover the safety issue in more detail on page

scientist will tell you,

necessarily prove a concept to be true. ducibility."

mg

LDL was

who were

The

107.

one study or even two does not

acid test for truth

is

termed "repro-

Simply enough, do other researchers get the same

results

when

Branch ilbrc: 107 E. 2nJ

fUfle ^\ I

RrflG.

CO

8I60Q

102

they test

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

test the

concept

at their laboratories.

The antioxidant theory passes

that

with flying colors. At the University of Minnesota's School of Public Health, laboratory

studies of blood samples from ten volunteers daily for just

two weeks showed up

lesterol's resistance to oxidation.

Arteriosclerosis

As

who

took 800 lUs of vitamin E

LDL

to a threefold increase in their

Dr.

and Thrombosis, elevated

John Belcher reported levels of

cho-

in the journal

vitamin E in the blood ap-

peared to prevent or reduce the toxicity of oxidized LDL, that

is, its

ability to

injure the endothelial cells that line blood vessel walls.

Benefits of antioxidants have been demonstrated for both

men and

women. The Nurses' Health Study

women

87,000 States.

aged thirty-four

Over the course of eight

supplements

at least

some

is

long-term project involving more than

a

from across the United

to fifty-nine years

years, 17 percent of the nurses took vitamin

of the time.

During

552 cases of heart

that time,

E

at-

tack were diagnosed in the test group. But after adjusting for age, smoking, obesity, exercise,

and other

risk factors, the nurses

who

took vitamin E had

only two-thirds the risk of cardiovascular disease compared with those not taking the supplements.

had about

Women who

took vitamin E

for

more than two years

half the risk.

Meir Stampfer, M.D., associate professor

at

Harvard's School of Public

Health, was one of the principal investigators of the Nurses' Health Study. results surprised

when

the study

even him.

was presented

I'm skeptical by nature hut didn't

seem plausible

such a profound

ejject.

worth

It's

at the

1

directly quoting

AHA

meeting

was even more

that a simple

in 1993:

skeptical going into this study.

maneuver

like

So even though there was a

taking vitamin lot

A

that this

parallel

was not

in fact

just

I

expected

to

a true association.

study was performed with participants in the ongoing Health

Professionals Follow-Up Study involving nearly 46,000 enty-five years. Again, after adjusting for tors,

It

E would have

of sound scientific basis for

the hypothesis that antioxidant vitamins can reduce heart disease,

show

The

him from an interview

men who had

men

ages forty to sev-

major cardiovascular disease

risk fac-

taken vitamin E for more than two years had a 26 percent

lower risk of heart disease than those not taking the vitamin.

most vitamin E also had a

Men

taking the

significant reduction in overall mortality Benefits of

taking beta-carotene were also seen.

ACES

The research continues from Scotland reported

to

in the

pour

m

from

all

who

didn't.

atherosclerosis in thirty-five

103

•

over the world. Researchers

American Journal of Clinical Nutrition that both

smokers and nonsmokers who took vitamin E had dation than those

of Hearts

less

LDL

cholesterol oxi-

Swedish workers linked the severity of coronary

men

surviving heart attacks with the susceptibility

LDL to oxidation in the British journal Lancet. Finnish investigators also LDL oxidation in sixty men correlated with the amount of plaque clogging the carotid arteries in the neck. And at the 2nd Inof their

reporting in Lancet found that

on Heart Health

ternational Conference

in 1995, Indian researchers told of

linking levels of antioxidant vitamins in the blood with coronary artery disease.

Not only has there been mternational validation of the benefits of antioxidants but also investigators have demonstrated these benefits in a

num-

ber of different cardiovascular conditions.

Blood

clots frequently precipitate a heart attack

flow in a clogged

artery.

prevent heart attacks.

It

by stopping the blood

Preventing the formation of these clots could, in turn, turns out that antioxidants do just that. Writing in the

journal Blood, doctors found that clotting was reduced 75 percent after two

weeks of taking 200 lUs of vitamin E 82 percent. They reported that

"it

daily.

was

A

dose of 400 lUs cut clotting by

especially gratifying that 'reasonable'

doses of vitamin E that had no untoward side effects were able to accomplish

such reduction."

Did others find similar benefits of antioxidants Researchers

at

identical results tors

in terms of blood clotting?

Boston University School of Medicine came up with virtually

and reported them

in Circulation in 1994. Scottish investiga-

wrote in the American Journal of

tioxidant intake

was responsible

for

Clinical Nutrition that

decreasing the

same year

number

that an-

of platelets re-

sponsible for clotting in the blood.

Angina pains following exercise are the tioxidants

would prevent such blockage,

more antioxidants in of that theory

their

them with

levels in

could be theonzed that people with

bloodstreams would experience

was published

mins A, C, and E and

it

result of arterial blockage. If an-

in Lancet.

beta-carotene in

394 control

Authors of that 110

men

less angina.

article

The

measured

test

vita-

with angina and compared

subjects without angina. Sure enough, the

more

antioxidants in the blood, the greater the protection against angina.

Stroke occurs owing to blockage of the carotid arteries in the neck that

supply blood to the brain. Three separate teams of researchers reporting

1993 epidemilogy conference sponsored by the of beta-carotene

and vitamin E with

at the

AHA correlated consumption

a reduced risk of stroke.

A

Harvard study

104

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

women

demonstrated that

mins had

less

regularly eating foods containing antioxidant vita-

women who

than half the risk of stroke compared with

ate

such

foods infrequently. Beta-carotene was associated with the greatest risk reduction.

A

Texas study, on the other hand, found the greatest risk reduction in

consuming

those

the

most vitamin E rather than beta-carotene. Researchers

measured the impact of antioxidant consumption on the wall thickness of carotid arteries. Thickening of the arterial walls signifies increased stroke risk.

More than The

men and women were

ten thousand third study

came from Finland where

included in the study. scientists

found low

levels of

antioxidants in the blood associated with increased arterial wall thickness.

Both vitamin E and beta-carotene were linked to the stroke

risk.

Peripheral artery disease refers to clogging of vessels in the legs, result-

ing in pain

when

exercising. In the

and vitamin C showed

women

aged

Edinburgh Artery Study, both vitamin E

a protective effect

shown

men and

about sixteen hundred

seventy-four years. Those with higher vitamin intakes

fifty-five to

suffered less peripheral artery disease. pally

m

which comes

in smokers,

the levels of antioxidants

m

The

princi-

surprise, since

smoking depletes

for heart patients

but also places a

no

as

C were

the blood.

Bypass surgery can be a lifesaver

tremendous burden on the

benefits of vitamin

heart. That's because free radicals

form

in the heart

or any other organ temporarily deprived of oxygen, as happens during surgery.

Those

free radicals play

havoc on the heart

s tissues.

Vitamin

E, given for

weeks before bypass surgery provided protection against those as

shown

in a

study

at the

human

where

free radicals

do

their

Strenuous exercise, good icals.

cals

is

the major,

and perhaps

only, fat-soluble an-

He explained that vitamin E is the only antioxidant membrane around the heart muscle cell to reach the

tissue.

that penetrates the fat sites

free radicals,

University of Toronto. Researcher Terrence Yau,

M.D., pointed out that vitamin E tioxidant in

damage.

for the heart,

can induce formation of

Stop doing the exercise? Absolutely not. Instead, prevent those

from doing

two

their

damage

in oxidizing

free radfree radi-

LDL. Supplementation with 300

lUs of vitamin E effectively prevented exercise-induced oxidation, as reported

by researchers

m

the International Journal oj Biochemistry.

While prevention of heart disease

is

preferred,

we can

regression. Years ago doctors believed that heart disease

the arteries were blocked, that

ease go away.

And

As usual, the

was

that.

all

benefit

from

was permanent; once

Today we know we can make the

dis-

antioxidants can help. first

indications of antioxidant benefit in heart disease re-

ACES gression

came from animal

monkeys vitamin arteries.

age,

ate regular

E.

of Hearts

105

•

research. In a study at the University of Mississippi

chow, a high-fat

diet, or a high-fat diet

supplemented with

Chow-chomping monkeys developed no blockages

Those eating a high-fat

diet

showed an average

and those given vitamin E along with the high-fat

in their carotid

of 87 percent block-

diet

had

a lesser (61 per-

cent) blockage.

After completion of that phase of the Mississippi research, the

continued

to

consume supplemental vitamin

had diminished

to

Two

years

later,

monkeys

the blockages

35 percent.

That study was published

man

E.

in 1992,

with the authors concluding that hu-

research was needed to confirm their results. That confirmation

came

in

1995, reported in the Journal oj the American Medical Association. Data were collected from

156

men

aged forty to

surgery performed and

with the vitamin niacin

fifty-nine

who were engaged

who had

previously had bypass

in a test of cholesterol reduction

m combination with the prescription drug cholestipol.

Indeed, those with lowered cholesterol levels were demonstrated by angio-

gram

to

have experienced either no further progression of the disease or even

regression.

Investigators at the University of Southern California

data to learn which of the

went back

to the

men might have been taking antioxidants during the

course of the study. Indeed, those taking vitamin E supplements of at least 100

lUs daily had a

much

better

outcome than those not taking the vitamin. An-

tioxidant vitamin intake reduced progression of coronary artery disease

was

and

signficantly associated with regression of the disease.

WILL THE BEST ANTIOXIDANT

PLEASE STAND UP?

Many antioxidant

researchers refer to combinations of vitamin E, vitamin

C, beta-carotene, and the trace mineral selenium as a "cocktail." That reminds

me

of a bartender asking, "What'U

you have?"

Is

one better than the others, or

should we take some of everything? The answer, paradoxically, to both questions

is

yes.

Beta-carotene

is

the best

known

of a group collectively

carotenoids, nutrients found in orange vegetables, and

amin A. While vitamin

A is a

potent antioxidant

itself,

is

known

as

the precursor of vit-

consuming

large doses,

especially through supplementation, can have significant adverse effects. Beta-

106

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

convened

carotene

is

parent

effects.

ill

to vitamin

But can

it

A

and

in the body,

large doses have

no ap-

protect against heart disease?

Preliminary data indicating beta-carotene's worth were brought to the public in 1990 by researchers at Brigham and

Women's

Hospital in Boston. In

333 patients with documented coronary disease were given

that study,

fifty-milligram tablets of beta-carotene or a placebo every other day.

many

ceiving the beta-carotene suffered about half as

Two

Those

re-

cardiac events such as

heart attacks or the need for surgery as those getting the fake

were no significant side

either

pills.

Again, there

effects.

years later Dr. Ishwarlal Jialal at Southwestern Medical Center in

LDL oxidation. The nutrient also macrophages from gobbling up the LDL m the atherogenic process.

Dallas found that beta-carotene inhibited

prevented

At the scientific sessions of the

AHA

in 1994, three papers

were pre-

LDL

oxidation.

sented showing the benefits of beta-carotene in preventing

Two

showed

of those papers also

a correlation

between the amount of beta-

carotene in the blood and the risk of heart attacks. Late in article

1994 (he Journal

American Medical Association published an

from the University of North Carolina

and coronary heart scale, those

disease." Considering

to 0.28.

titled

normal

For

to

Vitamin C, also

dropped

rich in the carotenoids in gen-

in particular.

known as ascorbic

acid,

is

the

plement in America. Linus Pauling believed that cold, but docs

at the

the risk

be drawn was to quit smoking and start

and consuming supplements

and beta-carotene

done

be 1.0 on the study's

men who had never smoked,

The obvious conclusion

eating vegetables

common

simply "Serum carotenoids

risk to

with the highest level of carotenoids in the blood had a relative

risk of heart disease of 0.64.

eral

oj the

it

most popular vitamin sup-

it

would protect

against the

provide protection from heart disease? Research

University of California at Los Angeles and published in 1992 re-

vealed a much lower death rate among those who took \1tamin C supplements when compared with those who, although consuming plenty of the nutrient

supplement

in various foods, did not

their diets. Dr.

James Enstrom studied

more than eleven thousand men and women. The more \Ttamin C they consumed, the fewer deaths they Frankly, vitamin

C

vitamin E, but the protection

does

It

do

Human

that? Research

suffered, particularly

from heart disease.

doesn't appear to be as potent an it

LDL

conveys against heart disease

sponsored by the National

is

antioxidant as

very

real.

How

Institutes of Health at the

Nutrition Research Center in Belts\ille, Maryland, points to \atamin

C's influence

on the good

cholesterol,

HDL.

After adjusting for other risk fac-

ACES tors, investigators

found

less heart disease in those

recommended amounts of vitamin

of Hearts

consuming well above

men and women

C. In both

pulls cholesterol out of artery walls rather than depositing

Selenium

a trace mineral

is

men and women,

found

to

it

HDL, which

there.

m the

be inadequately represented

despite an otherwise balanced diet. Like the vita-

mins we've been studying, selenium

acts as

an antioxidant.

It is

a vital

com-

ponent of the enzyme glutathione peroxidase, which neutralizes harmful

free

Those consuming inadequate amounts of selenium have been found

radicals.

to

the

mechanism

the

of action involved appeared to be an elevation of the protective

majority of

107

•

have reduced glutathione peroxidase activity and thus

may

be more sus-

ceptible to the effects of free radicals. Also, selenium appears to act in concert

m

with vitamin E

Two

its

separate studies in 1989, one

and the other

trition

antioxidant activity protecting LDL.

pubUshed

in Free Radical Biology

benefits of selenium in protecting against

The action It

of selenium

defends the endothelial

LDL and

also increases

is

LDL

oxidation.

from

a bit different

cell lining

in the British Journal of Nu-

and Medicine, demonstrated the

that of other antioxidants.

of arteries against the assault of oxidized

production of prostacyclin, a hormonelike substance

that protects the heart while inhibiting production of

thromboxane, which

has been strongly implicated in the development of atherosclerotic plaques. Therefore, while most people don't hear to

much

about

be part of the antioxidant protection package. There

it,

selenium ought

we have

it:

ACES

of

hearts.

SAFETY OF ANTIOXIDANT THERAPY The term "megadose" used by those

who

still

takes

on negative connotations,

nutrients you need from a balanced diet."

lowance (RDA)

more

certainly

C with many

its

vitamin E

for

prevent deficiency

symptoms

falls

into the

is

15 lUs,

all

the

The Recommended Dietary

Al-

which

is

in healthy adults.

megadose

RDA of sixty milligrams.

That

when

especially

doggedly stick with the ancient advice to "get

category.

considered to be adequate to

Taking 100, 400, 800 lUs or

The same

is

true for vitamin

much may prevent scurvy,

but

it

takes

times more than sixty milligrams per day to provide antioxidant pro-

tection.

Are such doses safe?

In double-blind studies of vitamin side effects have

been seen, even

at

E with adult subjects,

doses up to 3,200 lUs

relatively

daily.

Are side

few ef-

106

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

converted to vitamin

carotene

is

parent

effects.

ill

But can

it

A

and

in the body,

large doses have

no ap-

protect against heart disease?

Preliminary data indicating beta-carotene's worth were brought to the public in 1990 by researchers at Brigham and

333

that study,

patients with

Women's

documented coronary

Hospital in Boston. In

disease were given either

fifty-milligram tablets of beta-carotene or a placebo every other day.

many

ceiving the beta-carotene suffered about half as

heart attacks or the need for surgery as those getting the fake

were no significant side

Two

Those

re-

cardiac events such as pills.

Again, there

effects.

years later Dr. Ishwarlal Jialal at Southwestern Medical Center in

LDL oxidation. The nutrient also macrophages from gobbling up the LDL in the atherogenic process.

Dallas found that beta-carotene inhibited

prevented

At the scientific sessions of the

AHA

m

sented showing the benefits of beta-carotene

Two

showed

of those papers also

were pre-

in 1994, three papers

a correlation

LDL

preventing

oxidation.

between the amount of beta-

carotene in the blood and the risk of heart attacks. Late in article

1994 ihe Journal

from the University of North Carolina

and coronary heart scale, those

disease." Considering

to 0.28.

in

vealed a

to

the study's

the risk

dropped

be drawn was to quit smoking and

start

rich in the carotenoids in gen-

ascorbic acid,

is

the

America. Linus PauUng believed that

cold, but does

at the

on

in particular.

known as

Vitamin C, also

common

simply "Serum carotenoids

risk to be 1.0

men who had never smoked,

consuming supplements

and beta-carotene

done

For

The obvious conclusion

eating vegetables and

plement

titled

normal

an

with the highest level of carotenoids in the blood had a relative

risk of heart disease of 0.64.

eral

of the American Medical Association published

it

most popular vitamin sup-

it

would protect

against the

provide protection from heart disease? Research

University of California at Los Angeles and published in 1992 re-

much lower death

when compared with

rate

among those who took vitamin C supplements

those who, although consuming plenty of the nutrient

supplement

in various foods, did not

their diets. Dr.

James Enstrom studied

more than eleven thousand men and women. The more vitamin C they consumed, the fewer deaths they Frankly, vitamin

C

vitamin E, but the protection

does

It

do

Human

that? Research

suffered, particularly

from heart

doesn't appear to be as potent an it

conveys against heart disease

sponsored by the National

disease.

LDL antioxidant is

very

real.

as

How

Institutes of Health at the

Nutrition Research Center in Beltsville, Maryland, points to vitamin

C"s influence

on

the

good

cholesterol,

HDL.

After adjusting for other risk fac-

ACES tors, investigators

found

men and women

C. In both

the

pulls cholesterol out of artery walls rather than depositing

Selenium

is

a trace mineral

men and women,

found

to

it

mechanism

HDL. which

of action involved appeared to be an elevation of the protective

majority of

107

•

those consuming well above the

less heart disease in

recommended amounts of xitamin

of Hearts

there.

be inadequately represented

m the

despite an otherwise balanced diet. Like the \ita-

mins we've been studying, selenium

acts as

an antioxidant.

It is

a \ital

com-

ponent of the enzyme glutathione peroxidase, which neutralizes harmful

Those consuming inadequate amounts of selenium have been found

radicals.

to

free

have reduced glutathione peroxidase

acti\ity

and thus may be more sus-

ceptible to the effects of free radicals. Also, selenium appears to act in concert

with \itamin E in

Two

its

separate studies in 1989, one published in the British Journal of Nu-

and the other

trition

antioxidant activity protecting LDL.

in Free Radical Biology

benefits of selenium in protecting against

The action of selenium It

defends the endothelial

LDL and

is

and Medicine, demonstrated the

LDL

cell lining

oxidation.

from

a bit different

that of other antioxidants.

of arteries against the assault of oxidized

also increases production of prostacyclin, a

hormonelike substance

that protects the heart while inhibiting production of

thromboxane, which

has been strongly implicated in the development of atherosclerotic plaques. Therefore, while most people don't hear to

much

about

it,

selenium ought

be part of the antioxidant protection package. There we have

it:

ACES

of

hearts.

SAFETY OF ANTIOXIDANT THERAPY The term "megadose" takes on negative connotations, used by those

who

still

doggedly stick with the ancient advice

nutrients you need from a balanced diet."

lowance (RDA)

more

certainly

vitamin E

for

prevent deficiency

symptoms

falls

into the

is

15 lUs, which

megadose That

when

to "get all the

The Recommended Dietary is

in healthy adults.

C with its RDA of sixty milligrams. many

especially

category.

Al-

considered to be adequate to

Taking 100, 400, 800 lUs or

The same

is

true for vitamin

much may prevent scurvy, but it

takes

times more than sixty milligrams per day to provide antioxidant pro-

tection.

Are such doses safe?

In double-blind studies of \itamin side effects have

been seen, even

at

E with adult

subjects, relatively few

doses up to 3,200 lUs

daily.

Are side

ef-

.

ML)

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

The

richest sources of

amount

lesser

in seafood

selenium

and

still

less in plant foods.

foods varies considerably, based on the

While

s likely that

it

many

adults will

and kidneys, with a

in the diet are liver

amount

The selenium content

of

of the mineral in local soils.

consume only small amounts, supple-

mentation with from 50 to 100 micrograms can't do any harm and very well

may it

provide the edge in antioxidant protection. Don't worry about

would

toxicity, as

take at least 5 milligrams to do harm. That's the equivalent of 5,000

micrograms. (One milligram

is

1/1000 of a gram; one microgram

is

1/1,000,000

of a gram.)

CONVERTING MEASUREMENTS OF VITAMIN

E

AND BETA-CAROTENE

Beta-carotene

is

measured

precursor of vitamin A, which

is

terms of vitamin

in

A

always listed in lUs.

activity, since

One

the

it is

milligram of beta-

carotene equals 1,667 lUs. Thus a 25,000 lU tablet or capsule would contain 15 milligrams. The actual conversion to milligrams from lUs varies a

pending on the beta-carotene's actual vitamin

you can

A

activity.

de-

bit,

Roughly, however,

calculate that 6 milligrams of beta-carotene equals 10,000 lUs.

Vitamin E

is

typically

measured

milligrams. Conversion depends

on

in lUs

but

now and

the form of vitamin

then you'll see

it

in

E involved. Natural

d-

alpha tocopherol converts as 1.49 lUs per milligram. The natural vitamin E in its

acetate form converts as 1.36 lUs per milligram. For synthetic acetate the

equation

is

1.0 lU to 1.0 milligram.

tamin E converts as

1.1

And

the

seldom seen synthetic alcohol

vi-

lUs per milligram. Synthetic vitamin E will be listed as

dl-alpha-tocopherol

You might

also see

"mixed tocopherols" on

1.25 IDs per milligram. Alpha

is

more

a label; in that case, figure

potent.

NATURAL VERSUS SYNTHETIC VITAMINS

No one

in a health

food store or selling supplements as a distributor of

some multilevel-marketing company you, but

whether

it

happens

a vitamin

will agree

to be the truth. For the

comes from some

most

with what I'm about to part,

it

makes no

tell

difference

natural source or has been manufactured

ACES synthetically.

The body recognizes and

utilizes

of Hearts

111

•

vitamin C, vitamin E, and beta-

carotene just the same, whether natural or synthetic.

One

milligram of natural vitamin

C

or beta-carotene has the

same po-

tency as one milligram of the synthetic form. However, the natural form of

tamin E (designated by the

letter

d as in d-alpha-tocopherol)

than the synthetic form (designated by the

The claims made by

certain

for their

matter of marketing than science. Think about

this:

On

is

the other hand, a bargain brand

doesn't deliver the dosage of nutrient listed released properly as the tablet dissolves intestinal tract. Stick

—

products are more a

Scientists

different

may

on the

it's

more

not be a good buy

label or

if

if it

that nutrient isn't

or doesn't dissolve

—

in the gastro-

with middle-of-the-road-priced products by recognized

my

personally get I

stores.

antioxidants by mail from Endurance Products, a

company know to produce at

over the

companies.

better just because

companies or distributed by major health food stores or drug I

all

in their research, yet the

and capsules they use have come from dozens of

Don't believe that a bottle of vitamins expensive.

vi-

more potent

letters dl.)

companies

world have gotten similar results with antioxidants tablets

is

the best quality at very reasonable cost. Call

them

(800) 483-2532 or write to P.O. Box 230489, Tigard, OR, 97281-0489 to

obtain order forms.

THE FINAL DECISION

No

official

IS

YOURS

medical organization such as the

AHA or AMA has come out

with a recommendation to take antioxidants. They say that definitive evidence is

not yet available. Frankly, the kind of study that would be definitive would

takes to

It would mean tracking men and women over the entire length of time heart disease develop. One group would be given antioxidants, another placebos.

Then

the variables

require millions of dollars and

would span decades.

thousands of

all

would have

to

be considered. The group would have to

be large enough to ensure representation of

men and women. And

all

sorts of healthy

and unhealthy

the dosages of this, that, or the other antioxidant

would

have to be decided. Then one would need the consensus of committees of researchers and organizations. they'd get

it

together,

if

Good

luck. We'll

all

be long gone by the time

they ever do.

Asked whether they personally take supplements themselves, the antioxidant researchers typically say yes.

Asked whether they would recommend

112

•

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

antioxidants for friends or family members, especially for those at risk of heart disease, the response

is

almost always yes.

has taken a stand on the issue. The Alliance for Aging Re-

One group

group comprised of researchers,

search, a nonprofit

sumer advocacy organizations, has made to vitamins lines are ies

E and C and beta-carotene

specific

recommendations

to prevent age-related disease.

based on more than two hundred

done over the past two decades,

of

all

and con-

nutritionists,

clinical

in regard It

s

guide-

and epidemiological stud-

which have shown

a correlation be-

tween antioxidants and disease prevention. The Alliance recommends these daily

amounts:

Vitamin C: 250 Vitamin

E:

400

to

1,000

to

800

mg

lUs

Beta-carotene: 10,000 to 25,000 lUs

These guidelines came out prior

to a

study by Dr.

Jialal at the

South-

western Medical Center in Dallas, which found benefits of going up to 1,200 lUs of vitamin E

daily.

The Texas research showed

that doses of

200 lUs

to

1,200 lUs of vitamin E provided increasing protection against oxidation of

LDL and

development of heart

potential for

ishing return, with

no additional

of research data to back to decide to take only

is

him up from

a

dimin-

probably 800 lUs, and there's plenty

other investigators. In

one antioxidant,

it

lU twice daily with meals containing fat-soluble vitamin as

was

benefits seen for doses over 1,200 lUs. Dr.

optimal dosage

Jialal believes that the

disease. But there

fact, if

one were

probably should be vitamin E,

at least a bit

of

fat,

compared with vitamin C, which

since vitamin

is

at

E

400 is

a

water soluble.

While most discussions of antioxidants focus on vitamins C and E and beta-carotene,

regimen.

A

I

fifty-

As we

believe there

is

good reason

to include

or one-hundred-microgram tablet

selenium

in the daily

is sufficient.

have seen in reviewing the antioxidant literature, both

women have

been included

in studies,

and both show

men and

benefits of antioxidant

consumption, definitely as part of the diet and probably through supplementation. Since heart disease begins in childhood, teach youngsters good

vegetables each and every day.

min/mineral advisable.

pill,

With

supplementation

it's

never too early to

which means eating plenty of

dietary habits,

fruits

and

the exception of a one-a-day type vita-

in

childhood doesn't seem warranted or

ACES Your doctor should be aware of bad. By

all

means

let

all

him or her know

if

of Hearts

113

•

your health habits, both good and

you

are taking antioxidants so that

information can be included in your chart and considered in decisions re-

garding your health care.

my second bypass in my active efforts to save my own life. consider them to be an integral part of my personal program. Even though my LDL chohave personally been taking antioxidants since

1

when

1984, the time

lesterol

I

count remains

began

I

at a safe,

low

level,

don't want that

I

LDL

oxidizing in

my arteries and doing damage. How much protection those antioxidants have given me over the years don't know for certain. do know that my heart health is excellent, far better that of most others with my health history, and I

I

I

want

to

keep

that way.

it

But what about that study indicating that beta-carotene provided no

you might ask? In January 1996,

benefit,

results of the Physicians' Health

Study showed that doctors taking the antioxidant not any better off than those not taking

harm, but ers

it

So

I

the fruits

"So

fact, that

number

was the only one which did

of years were

not

It

did no

Many

oth-

show ben-

continue to take beta-carotene, both as supplements and by way of

and vegetables

that are rich sources.

how much do you

take. Bob?" That's a question

speak to groups around the country. While be the standard

for everyone, here's

the day: 1,000

mg

carotene; and 100 dietary intake,

of vitamin C;

meg

fruits

I

don't say that

my daily intake,

800 lUs

I

hear every time

spread over the course of

of vitamin E; 25,000 lUs of beta-

significantly more, since

and veggies every

1

my regimen should

(micrograms) of selenium. That's over and above

which provides

enjoying lots of of hearts.

for a

terms of heart disease.

in

apparently did no good. Well, that was just one study.

have shown benefit. In

efit.

it,

day.

I

do make

Those antioxidants

are

my

a point of

my ACES

GOOD SOURCES

OF VITAMIN C

The following foods oil have at least 20 milligrams of vitamin third of the U.S. RDA. All nutrient levels are approximate, and

FOOD

SERVING

SIZE

C

per serving, a

will vary.

VITAMIN C (mg)

FRUITS

Papaya

'A

Orange, California navel

1

Cantaloupe

'/3

Kiwi

Orange,

1

Florida

1

94 80 7S 75 68

Currants, black

'A cup

51

Grapefruit, pink or red

'A

47 46

Watermelon

1

slice

Strawberries

'A cup

41

Grapefruit, white

'A

Mango

'A 1

39 29 27

'A cup

95

(carambola)

Storfruit

VEGETABLES* Bell

Chili

peppers, sweet red, raw

peppers, hot red or green, raw

'A cup

91

Broccoli

'A cup

Brussels sprouts

'A cup

58 48 45 45 38 28 28 27 26 26 24 22 20

peppers, sweet green, raw

Bell

'A cup

Kohlrabi

Snow peas

'A cup 'A cup

(edible pod)

Sweet potato, baked Cauliflower

'A cup

Kale Potato,

medium

1

'A cup

baked with

skin

1

Cabbage, red Tomato, row

large

'A cup

medium

1

Cabbage, bok choy

'A cup

Turnip greens

'A cup

JUICES

Orange

juice

Grapefruit juice

Cranberry

juice cocktail

Tomato

juice

"Cooked, unless otherwise So\){ce.

ESHA

specified.

Research, Salem, Oreg.

6

fl.

oz.

93

6

fl.

oz.

6

fl.

oz.

70 67

6

fl.

oz.

34

GOOD

SOURCES OF BETA-CAROTENE

The following foods all hiave at least one milligram of beta-carotene per serving, a significant amount. While there is no official U.S. RDA for beta-carotene, three milligrams trient levels

is

equivalent to

5,000

are approximate, and

FOOD

lU, the U.S.

RDA

for vitamin A. All nu-

will vary.

SERVING

BETA-CAROTENE (mg)

SIZE

FRUITS

Apricots, dried

1

Cantaloupe

halves

6.2

'A

4.8

Apricots, fresh

2

2.5

Grapefuit, pink or red

'A

1.6

Mango

72

1.4

slice

1.1

medium

10.0

cup

6.2

Watermelon

1

VEGETABLES*

Sweet potato

1

raw

Chicory,

1

medium

b7

Spinach

'A cup

4.9

Turnip greens

'A cup

3.9

Pumpkin

'A cup

3.7

Collard greens

'A cup

3.4

Swiss chard

'A cup

3.2

Kale

'A cup

3.0

Winter squash

'A cup

2.9

raw

Carrot,

1

Spinach, raw

1

Spaghetti squash

A

Mustard greens

Bell

cup

2.3

cup

1.9

'A cup

1.9

Beet greens

'A cup

1.8

Dandelion greens

'A cup

1.4

peppers, sweet red, row

'A cup

1.1

Romoine

lettuce,

raw

cup

1.1

'A cup

Broccoli

JUICES

1

1.0

AND SOUPS

Carrot juice

1

cup

24.2

Gazpacho

1

cup

11.7

1

cup

2.2

1

cup

1.9

Manhattan clam chowder

1

cup

1.9

Vegetable and beef stew

1

cup

1.7

1

cup

1.4

Tomato

juice

Vegetable soup

Split-pea

soup

*Cooked, unless otherwise Soiifce: United States

specified.

Department of Agriculture/National Cancer

Institute

Niacin and Your Heart:

A Lijesaver Revisited

Eighty percent of the cholesterol in your bloodstream got there through the

body's while

own a

it's

production in the

good idea

Diet

liver.

is

responsible for only 20 percent. So,

many

to control those dietary factors,

not most of us

if

with cholesterol elevations will need help with that 80 percent. For

me and

for

thousands of others that help has come from the vitamin supplement niacin. I

first

learned about niacin in 1984

when

I

desperately needed something

my own numbers under control to save my own life.

to get

pass surgery,

As

a

I

knew

that cholesterol

medical journalist,

scientific literature. That's

stopped

yet.

I

was

when

as well with others,

I

Something had

the culprit.

I

started to read about niacin, I

to

be done.

169

and

I

haven't

put together, which included daily sup-

plementation with large doses of that vitamin, to

my second by-

gave myself the assignment of reviewing the

Following the program

from a dangerously high 284

Facing

my cholesterol level plummeted

in only eight

weeks. The regimen worked

wrote The 8-Week Cholesterol Cure, and soon niacin got

international attention.

"The Amazing Story of Niacin," as began

in

I

titled the

m

chapter

that

book,

1955 with the discovery by two Canadian physicians, Drs. Hoffer and

Altschul, that the vitamin effectively lowered cholesterol readings. That

before

many

people paid

disease. For the next

ducted.

Then

much

attention to cholesterol

twenty years or

so,

the data started trickling in,

much

not

and the

continues to pour through the medical journals

Today niacin

is

recommended

Cholesterol Education Program for those for

Even

after the introduction of

deals with

all

its

first

whom

became

after

was con-

a flood that

month.

choice by the National

diet alone isn't

enough.

potent prescription-only drugs, niacin alone

aspects of the lipid profile. According to one of niacin's pio-

neering researchers. Dr. William Parsons of Scottsdale, Arizona, tor in the

was

link with heart

niacin research

trickle

month

as the agent of

and

country were good

medications, probably

90%

at

niacin

or

more

and would use

it

"If

every doc-

in preference to other

of patients needing cholesterol control

could take the drug successfully. This would

literally

save billions every year."

Niacin and Your Heart:

A

Lifesaver Revisited

What makes niacin so superior over every prescription drug on

Why

ket?

doesn't every doctor

you

niacin be the lifesaver for

Niacin, also a vitamin

found

known

in a

as

recommend

it

for his or

as nicotinic acid,

is

the mar-

her patients? Will

has been for me? Let's start

it

at the

beginning.

sometimes called vitamin

wide variety of foods, niacin has an

117

•

RDA

B3.

As

of only twenty

milligrams to prevent the deficiency state pellagra. These small amounts of niacin found in the diet have

on

effect

termed "pharmacologic doses," niacin

are ter

no

than any prescription drug. In

niacin as a drug because of

its

cholesterol, but

when used

what

in

battles cholesterol as well as or bet-

doctors writing in the Uterature refer to

fact,

dramatic effects on the body.

When niacin enters the bloodstream, the liver proceeds to break it down first

work fully

niacinamide and hnally to nicotinuric acid, which

to a derivitive called

excreted in the urine. its

It is

during

is

metabolic process that niacin appears to

this

magic. There in the liver niacin interferes in

some way

that

not yet

is

understood with the formation of very-low- density lipoprotein (VLDL)

cholesterol

and subsequently with the manufacture of low-density-lipoprotein

(LDL)

cholesterol. At the

tein(a)

and

dangerous

triglycerides. larger, looser

same It

time, niacin decreases the

transforms small, dense

oil, scientific

•

HDL molecules

proper disposal. While

fall

into less

back

that shuttle cholesterol

at first all this

and LDL cholesterol

levels fall

might sound Uke snake

by an average of 20

has been documented again and again

ifornia, the University of

Health Sciences Center University,

LDL subparticles

research documents every capabiUty of niacin.

Total

cent. This

of lipopro-

molecules, and for good measure, results in often dra-

matic increases in the protective to the liver for

amount

to

40

per-

the University of Cal-

Southern California, the University of Minnesota, the

at the

and research

at

University of Texas, the

institutions

Oregon Health Sciences

around the world. Used

in

combination

with the prescription drug colestipol, niacin produced Upid improvements that

were associated with reversal of heart disease

Dozens of studies have confirmed •

Lipoprotein(a) counts were

niacin in research done at tionally

age of 33 percent in

all

down

Institute in

National Institutes of Health reported

as part of the

in

Los Angeles.

The

down an

aver-

Clinical Center of the

m the Journal of the American Medical As-

should be given

pharmacologic regimen"

University. At the interna-

Sweden, Lp(a) came

patients treated with niacin.

sociation that "strong consideration

USC

35 percent with administration of

Oregon Health Sciences

renowned Karolinska

at

niacin's effectiveness.

to including nicotinic acid

for treating Lp(a) elevations.

A case

his-

lis

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

tory presented in the three

months

Triglyceride

•

NIH

report demonstrated a patient's Lp(a) cut in half in

of niacin treatment.

measurements

fall

precipitously with niacin.

Only one

prescription drug, Lopid (gemfibrozil), can lower triglycerides effectively

higher the

initial triglyceride levels,

triglycerides

down

is

the greater the response.

The

Coronary Drug

Patients participating in the

bring

ability to

most

directly proportional to the dosage used in

The

cases.

Project, a long-term, nationwide,

double-blind study, experienced anywhere from 15 to 30 percent triglyceride reductions. In an NIH-sponsored study, triglycerides

to

normal even

if

one begins

LDL

Small, dense

•

at

an average of 52 per-

fell

improvement, niacin can bring triglycerides

cent. Regardless of percentage of

very high levels of triglyceride elevation.

particles are

improved

by taking

significantly

niacin, resulting in larger, less dense molecules. Research at the University of

California at Berkeley found that those with the smallest particles are at three

times the risk as those with the largest the

same

was found

Protective levels of the

•

niacin.

center, niacin

Improvements

in

LDL

particles.

And

in another study at

to significantly increase

good

cholesterol,

HDL,

LDL

diameter.

rise in

those taking

HDL occur m both patients with elevated and patients

with normal triglycerides, whereas the drug Lopid works primarily triglycerides are up. Often

niacin dosages, as in Israel.

documented by physicians

They used

HDL

nificant

HDL improvements can be

less

than

five

Hadassah University Hospital

hundred milligrams of niacin

Mayo

gains. At the

at

when

achieved even with low

to

produce

Clinic in Rochester, Minnesota,

63

sig-

partici-

who had low HDL levels experienced niacin. An increasing number of physi-

pants in a cardiac rehabilitation program

an average of 18 percent increase with cians

and researchers

risk of heart disease,

Clinic in •

New

are concluding that raising

and niacin does

it

most

HDL levels can decrease

effectively.

Doctors

Orleans achieved a 32 percent improvement in

Platelet aggregation

and resulting blood

at the

HDL

the

Ochsner

levels.

clotting are inhibited

by

niacin via production of the prostaglandin called prostacyclin (PGIj). Pros-

taglandins are hormonelike substances present throughout the quantities.

ance

is

They have both

positive

and negative

effects,

want more of the prostaglandin prostacyclin harm. Niacin does just

The

risk of

in tiny

their bal-

crucial. Prostacyclin counteracts the negative prostaglandin

boxane, which adversely influences blood clotting and

•

body

and hence

throm-

arterial clogging.

We

to offset thromboxane's potential

that.

dying of heart attack dropped significantly

ing niacin. Those taking niacin as part of the Coronary

in patients tak-

Drug

Project, the

Niacin and Your Heart:

A

Lifesaver Revisited

119

•

longest running such study, were far less likely to suffer a myocardial infarc-

Which

tion.

of the

many

beneficial effects niacin offers

one knows, but researchers do not dispute

No

•

newest

match

prescription drug can

was responsible? No

niacin's stellar performance.

The

niacin's total performance.

termed the "statins," can bring total and LDL down but do not compare with niacin's effectiveness in raising

class of drugs, collectively

cholesterol levels

HDLs and vastatin),

lowering triglycerides and Lp(a). These drugs include Mevacor (lo-

Zocor (simvastatin), Lescol

Lopid (gemfibrozil) has an

effect

(fluvastatin),

on

nearly as well in controlling total and

and Pravachol

(pravastatin).

triglycerides and HDLs but does not do LDL cholesterol. The resin drugs, includ-

ing Colestid (colestipol) and Questran (cholestyramine), have only small effects

on

cholesterol

when

taken alone, and they actually raise triglyceride

Doctors can prescribe niacin in combination with one of the drugs

•

for patients

with particularly

difficult lipid

problems. As reported

ican Journal of Cardiology in 1994, for example, niacin

a

40 percent LDL reduction;

tive

levels.

Cardiology that

and

m the Amer-

fluvastatin

produced

niacin alone yielded a 25 percent drop. Preven-

same year reported

bination of niacin and pravastatin.

a

And

49 percent drop

in

LDL with the com-

niacin has been used for years in

com-

bination with the resin drugs, resulting in lipid improvements associated with reversal of heart disease. Arteries

clogged

after

treatment

at

photographed by angiography were

less

both the University of Southern Cahfornia and the

University of Washington.

Niacin vastly improved lipids

•

when combined with

m a University of Kansas study presented m

statin

Pravastatin alone, in a

and no change

in

to the

percent,

LDL

mg

the

at the

drug prava-

AHA meeting.

dose, achieved a 14 percent reduction in

HDL, along with

of total cholesterol to

added

20

1995

a 15 percent

drop

in triglycerides.

The

LDL ratio

HDL fell 15 percent. When three grams of niacin were HDL rose by 29 percent, triglycerides came down 42

program, fell

25 percent, and the cholesterol/HDL

ratio

plummeted by 41

percent. •

safe

and

Combining

niacin and the statin drugs has been

effective. It's the "extra

cially difficult cases. In

whammy"

another presentation

at the

John Guyton of the University of North Carolina

weapon" •

against elevated cholesterol

So

why

don't doctors

and heart

recommend

shown

to

be both

doctors sometimes need for espe-

1995

AHA

meeting. Dr.

called niacin his "secret

disease.

niacin

more

often? Since niacin

a relatively inexpensive vitamin supplement, available at any

is

pharmacy or

health food store, manufacturers do not send salesmen into doctors' offices.

120

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Conversely, pharmaceutical companies enjoy huge profits from drug sales and

deluge physicians with information about their products. In

honesty, far

all

more

begun

practicing physicians have

niacin in recent years. That's the

combined

result of

my books

to prescribe

along with the

information directed at doctors by the National Cholesterol Education Pro-

gram

in

Washington.

NCEP

strongly

patients with elevated cholesterol

But doctors

still

recommends considering

do not understand niacin

scription drugs. That's because niacin requires

and communication, owing Is

•

to

some

niacin a vitamin or

as well as they

do the pre-

more doctor-patient

interaction

of the potential side effects of the vitamin.

is it

a drug? In the scientific literature, re-

searchers refer to niacin in large doses as a drug. in those large,

niacin to treat

levels.

pharmacologic doses niacin has

They use

effects

on

that

the

term because

body beyond

its

benefit as a vitamin in preventing pellagra. In that respect, researchers also call large doses of vitamin

C

— or any other supplement—

Certainly niacin should be used with respect

•

detail shortly, large

it

is

and caution. As

I

will

doses of niacin have the potential for certain adverse reac-

tions or side effects. Since

and

a drug.

it

works

in the liver to correct cholesterol

problems,

metabolized there, niacin does place a certain extra load on that

organ. As a result, those taking their liver functions checked.

it

should see their doctors regularly

And because

cations, not everyone should take

it,

niacin has a

to

have

number of contraindi-

and everyone should discuss niacin with

his or her physician before starting treatment.

NIACIN S SIDE EFFECTS ADVERSE REACTIONS

AND

Virtually everyone taking standard, unmodified, crystalline niacin expe-

riences the "niacin flush."

the reaction

is

Some people

totally harmless,

it is

react

more

as a reddening of the skin along with a prickly,

twenty to thirty minutes

strongly than others.

While

uncomfortable. Flushing can be described

after taking a

burning sensation that occurs

dose of niacin and

lasts ten to

twenty

minutes on average. Flushing typically diminishes as one continues to take niacin and the

One can

body becomes accustomed lessen the niacin flush in a

to

it.

number of ways.

First,

it's

best to take

niacin with food at meals with plenty of fluids. Second, taking an aspirin tablet prior to the niacin eliminates or at least

weakens the

flush. Third,

one can take

Niacin and Your Heart:

A

Lifesaver Revisited

One such

modified niacin in slow-release or sustained-release formulations. preparation that

Some

discuss

I'll

individuals

bances with niacin.

more

may

slow

down

wipes out the niacin

to

who

be the case mostly in those

which include other ingredients

the niacin's release.

It

take cer-

in the

formu-

appears to be those other agents,

termed "excipients," which present the problems. However, any niacin or capsule can produce Gl upset occasionally. Not often, but

Many ically

on

the chest

and

niacin,

it

its

its

use. In rare instances

and shoulders. Such

Dry skin oc-

one may develop

a rash indicates

an

tablet

does happen.

niacin users report itching to one degree or another.

casionally accompanies

flush.

experience a variety of gastrointestinal distur-

found that

I've

tain slow-release preparations,

lation to

fully later practically

121

•

a rash, typ-

inability to tolerate

use should be discontinued.

Niacin lowers glucose tolerance, the body's ability to maintain constant blood sugar levels, to a certain extent. This mal, healthy individuals but

may

is

fairly

not a problem for nor-

limit the use of niacin in those

with diabetes.

On the other hand, some physicians may simply wish to monitor patients with diabetes

more

carefully rather than depriving

He

them

Keenan

That's certainly the case for Dr. Charles

of the benefits of niacin.

of Santa Monica, California.

has successfully used niacin with his diabetes patients for years.

Although literature, I've

loss of appetite

listed as a possible side effect in the

is

never heard of this happening either from

corresponded with

me

medical

my readers who have who

over the years or from physicians

routinely pre-

scribe niacin.

Development of

a vision

problem termed maculopathy has been

re-

ported to occur in approximately 0.67 percent of patients taking niacin. The condition

is

completely reversible

when one

report

on macin-induced maculopathy

visual

symptoms need

to

stops treatment.

stated that "only those

The authors

who

be ophthalmologically evaluated." This

experience

is

truly rare

and has been associated with doses higher than most authorities needed

for cholesterol control.

develop blurred vision;

if

niacin

Check with your doctor is

if

of a

feel are

you do happen

to

responsible, your doctor will either modify

your dosage or suggest you discontinue usage. Niacin

may slightly increase

the production of uric acid in the blood. For

the vast majority of people, this poses

main comfortably within normal

no problem, since

limits.

However, even

uric acid can result in episodes of gout in individuals

uric acid levels reslight elevations of

who

have that disorder

to begin with.

Doctors should routinely monitor

liver

function by testing for liver en-

122

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

zymes

blood of those taking niacin. Slight elevations

in the

and

are not cause for alarm

are rather

common

torial

enzymes

in niacin takers.

Dr. Robert Kreisberg of the University of

put the matter of niacin and

in those

Alabama School

of

Medicme

function into a clear perspective in an edi-

liver

appearing in the October 1994 issue of the American journal oj Medicine.

Increased liver enzymes become an indication for stopping niacin therapy only

when

they are

more than

three times the upper-normal-limit. In

have found that physicians are too quick

to

discontinue niacin,

my

and

experience,

I

mat-

for that

other hypolipidemic drugs, because of mild or trivial changes in liver enzymes

ter,

and explain

to patients that the

derstandable

in

our

really a

is

perhaps

their liver";

un-

this is

litigious society.

In practical terms,

of flushing

drug was "hurting

how many people will be able to

take niacin?

The

issue

matter of nuisance. Unpleasant, sure, but such flushing

tends to dissipate quickly after one's body gets used to the niacin. Moreover, as discussed, there are

ways

to effectively deal

with flushing. Increases in uric

acid and decreases in glucose tolerance are problems only for those with either

gout or diabetes. Gastrointestinal disturbances can be eliminated by switching brands. Blurred vision occurs only rarely, as does loss of appetite. In the Clinic study

1

referred to earlier,

all

sixty-three participants

were able

niacin without intolerable side effects, according to the authors.

Mayo

to take

Some

re-

searchers report a small drop-out rate during studies designed to investigate niacin's benefits,

zona put

ucated as to

How

owing

to side effects.

its

three months. later.

thereafter.

be drawn

If all's

to

well, as

want it

Most physicians

The

properly ed-

test is easily

check your

to test

most

will

enzymes? After your doctor approves your

liver

enzymes

in

likely will be, the next test

want

to

run

liver

enzyme

about two to

should be

cholesterol levels,

which you'd want

traindications to niacin usage.

They include

Pregnancy

•

Severe cardiac arrhythmias

•

Active peptic ulcer

at all.

six

tests twice a year

performed with the same blood sample that

But some people should not take niacin

•

when

use.

often should one check liver

niacin for you, he or she will

months

But as niacin expert Dr. Parsons of Ari-

probably 90 percent of patients can take niacin

it,

to

will

do anyway.

There are definite con-

Niacin and Your Heart:

•

Gout

•

Prior liver disorders, including hepatitis

A

Lifesaver Revisited

123

•

and cirrhosis

Previous inability to tolerate niacin as evidenced by severe skin rash

•

enzymes

or greatly elevated liver to

dosage modifications possible subclinical liver damage,

Heavy alcohol use/abuse and

•

those conditions did not respond

if

would not normally be detected

until the liver

is

which

further challenged

by niacin

Why bother

and adverse reactions? Well,

Of

the

all

will

when

to take niacin

of

first

men and women whose

all

I

possible side effects

don't think everyone should take

need modification, many

lipids

if

it.

not most

be able to slash their risks by employing the other aspects of the program book. Dietary improvements, soluble

in this

will dramatically help

duce the

risk of heart disease, especially

stress reduction

fibers,

and

faL^'cholesterol

most cholesterol problems and

can and

blockers

will greatly re-

when combined with regular exercise,

and relaxation techniques, antioxidants, and other dietary

supplements such as the B vitamins

Such individuals wouldn't need tial

many

there are so

to prevent

accumulation of homocysteine.

to take niacin

even

was

if it

as free of poten-

problems as water. But as one

who

has

come

literally

to the precipice of death,

I

view heart

me to express my strong emotions when think of the millions of people who will needlessly suffer heart attacks and die because of coronary heart disease. am firmly convinced that disease as a personal enemy. There

is

no way

for

I

I

niacin has helped to save

my life

Bringing cholesterol levels

240

is

this

—

still

exists.

that

it's

Quite often

to bring lipids into the

it

can save the

to 215, let's say,

but

a step in the right direction,

reduced, but risk agent

and

down

if

a previous level of

just not enough. Yes, risk has it

will take niacin

completely safe zones

book. That's particularly true

lives of others.

from

you have other

been

— or some other

detailed throughout

I've

risk factors,

such as hyper-

tension, diabetes, family history, or certainly a previous diagnosis of heart disease. Don't just cut that risk, eradicate

While it

I

it!

A Uttle

flushing

is

further believe that niacin should be one's

a small price to pay.

first

choice and that

has enormous advantages over the prescription-only cholesterol-lowering

drugs, not everyone can take

cussed

earlier.

it,

Other niacin users

owing will

to

extent that their doctors suggest that niacin In those cases, one

must be

one of the contraindications

develop abnormal

practical

isn't for

liver

enzymes

dis-

to the

them.

and Machievellian and accept the

124

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

need

for the prescription

drugs

when other lifestyle

adequate cholesterol control. The safety of the lished in the millions of patients

who

modifications don't achieve

drugs has been well estab-

statin

have used them since the

such agent,

first

Mevacor, was approved in 1987. The importance of controlling the profile

is

so vital that

I

think one should do whatever

those risks. And, of course,

drug, simply use

it

if

is

you and your doctor do decide on

to replace the niacin in this

heart disease risk. By doing so

you

will

ensure

full lipid

necessary to eliminate a prescription

complete program to eliminate

maximum

impact on

all lipid-

involved risks, and you will also limit the amount of drugs you'll have to take.

Neither niacin nor prescription drugs should ever be viewed as an alternative to lifestyle improvements, both dietary changes

well as other risk-reducing suggestions I've

HOW

made

may have

book.

to

it

with your physician.

suggestions regarding appropriate dosages.

lowing information as reference

wish

in this

as

TO TAKE NIACIN Before taking niacin, be certain to discuss

she

and exercise routine,

photocopy

this entire

for

I

provide the

both you and your doctor. In

chapter for

him or

He

a

(CLAS)

fol-

you may

fact,

her.

To achieve cholesterol reductions, doses of niacin have ranged up grams

or

to

8

day and more. In the Cholesterol Lowering Atherosclerosis Study at

the University of Southern California,

which documented

reversal

of heart disease, researchers gave patients an average of 4.3 grams of niacin daily.

in

However,

much

lower doses have been shown to be

effective, especially

combination with other approaches.

The maximum

niacin dosage daily should not exceed 3,000

grams) of standard, immediate-release (IR) niacin or 1,500 slow-release (SR) niacin.

mg (1.5

SR niacin formulations have been noted

twice the effectiveness and twice the toxicity of IR preparations. therefore, a

maximum more

benefits while resulting in

minimal side

effects.

likely to result in adverse reactions, including

When

(3

grams) of have both

to

SR

double-edged sword. These dosages have been shown

mg

niacin

is,

to provide

Larger dosages are

abnormal

liver

enzymes.

used exclusively for the purpose of raising abnormally low levels

of the protective

HDL cholesterol,

in Israel has indicated that a daily

can significantly

raise

To be most

lower dosages are often

dose of

five

effective.

Research

hundred milligrams of IR niacin

HDLs.

effective, niacin

doses should be

dmded and

taken three

Niacin and Your Heart:

times

daily, preferably

venient,

it is

A

Lifesaver Revisited

with meals. While twice-a-day

125

•

dosmg may be more con-

not as effective.

To be sure

that

bathroom, kitchen,

I

my

don't forget to take

car, office, attache case,

vided containers found in

all

pharmacies

niacin,

and

1

keep

a

supply in

travel toiletry case.

to store

I

my

use di-

both the niacin and antiox-

idant and vitamin supplement dosages for the week. Traditionally, niacin therapy

is

begun

at

low doses and gradually

creased to minimize the flush and to allow the body to it.

in-

become accustomed

to

While your physician may have other recommendations, which you should

follow, the following

dosage schedule has been suggested frequently in the

medical literature to achieve a

final

dosage of 3,000

mg (3

DOSAGE SCHEDULE FOR INITIATING NIACIN THERAPY First three days:

one 100

mg

Next three days:

two 100

mg tablets

Next three days:

three

Next three days:

four 100

mg tablets

Next three days:

one 500

mg tablet

Next three days:

one 500 times

Next three days:

100

one 500

Next three days:

one 500

mg tablet

on:

two 500

mg

100

900

two 100

mg tablet

mg mg

mg

three

mg tablets

three

mg

plus three 100

mg tablets

mg

plus four 100

times daily = 2,700

From then

mg

three times daily = 1,200

three times daily = 2,400 .

600

three times daily =

tablet plus

mg tablet

mg

three times daily = 1,500

times daily = 2,100

Next three days:

300

three times daily =

mg tablets

mg

(ir)

tablet three times daily =

mg tablet plus one daily = 1,800 mg

one 500

grams) of IR niacin.

mg

tablets three

mg

tablets three times daily =

3,000

mg

Slow-release and sustained-release niacin formulations are an effective

way

to

reduce or even eliminate the niacin flush. Again, the

should be 1,500 mg. Although flushing to gradually increase the

allows the

body

Compare

mg

his

not be a problem,

dosage

it is still

better

dosage of SR niacin. The following dosage schedule

to acclimate to the niacin. Dr.

an accelerated schedule, with 500

and 1,500

may

maximum

mg

the

William Parsons suggests that

first

week, 1,000

mg

the second,

the third, might reduce the potential for flushing even further.

approach with the following.

126

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

DOSAGE SCHEDULE FOR INITIATING NIACIN THERAPY First

one 250

week:

mg

mg tablet

Next week: two 250

mg

morning, noon, and evening = 750

tablets

one 500

mg tablet

mg

morning, noon,

and evening = 1,500

mg

Slow-Release Niacin Safe?

Is

Beginning in 1990 ards of

SR

number

a

niacin preparations.

involving a

man

dose of 6,000

warned about the

potential haz-

The concerns were based upon

a case history

of reports

had been taking

who, at his physician's prescription,

mg (6 grams)

of IR niacin.

He then switched

to

doubled

his dosage to

tragic: liver failure

That was an extreme

shown by

mg

12,000

and the need

elevated liver

Normally niacin-induced

case.

sales of

took a massive dose of niacin.

He took

Practically

There was only one

SR

No

four times the

amount needed

stores over-

urged banning the

be sold. In truth, the

responsible person

man

for-

in question

would recommend such

for cholesterol control.

taken in excess. Overdoses of aspirin can be

and reasonable care

Slow-release niacin

is

a physician.

1

of IR niacin daily.

My

the normal zone.

The

1988

I

liver

is

taken

completely safe

and

for the

fatal,

yet the benefits of as-

when using

when

began taking niacin

cholesterol levels. At that time,

acin.

to

Many

for the liver failure?

niacin; reports

any substance can do severe damage and even cause death

pirin are recognized

in

problems are

a person actually experienced liver failure.

mulation and allowing only IR niacin

Then

liver

enzymes and symptoms including nausea and vomit-

reacted and discontinued

monitored by

for-

effectively

(12 grams) of niacin daily The result was

But was the SR niacin responsible

dosages.

man

for liver transplant.

ing, typically reversible after ceasing to take the niacin.

case in which

a daily

an SR niacin

mulation he purchased at a health food store. By doing so, the

when

mg

morning, noon,

and evening = 1,500 Thereafter:

mg

morning and evening = 500

tablet

Next week: one 250

(sr)

in

it.

taken properly and

1984

next four years,

to control I

when

my own

took three grams

enzymes were always monitored and remained

in

flush didn't bother me.

learned about a newly developed

The maximum dosage was

to

SR niacin

called

Endur-

be 1,500 mg, and the product was said to

Niacin and Your Heart:

be

free of

A

Lifesaver Revisited

127

•

nuisance side effects including flushing and Gl upset sometimes

seen with other SR preparations. Endur-acm was thought to be more effective than IR niacin. So for years

1

tried

it.

Sure enough, the slight flushing that had persisted

with IR niacin was gone, and

my cholesterol levels were my friend and physician, Dr.

actually

Charles

lower than they had been before.

I

Keenan of Santa Monica, about

and he subsequently prescribed Endur-acin

for his patients

with fabulous

ever since and takes Dr.

Keenan

also physicians.

it

is a

One

it,

told

results.

He's been using

to help control his

member

own

in his

own

practice

cholesterol.

of a medical family. Three of his brothers are

of them. Dr. Joseph Keenan,

researcher at the University of Minnesota.

about Endur-acin and the

it

terrific results

is

and

a professor of medicine

The two brothers spoke together

seen,

and Joe became intrigued. That

led to a series of research studies at the University of Minnesota exploring the

potential of Endur-acin as a cholesterol-reducing agent. Dr.

Joseph Keenan's

first

was published

research with Endur-acin

Archives oj Internal Medicine in July 1991.

Working with

m

the

201 men and women

ages twenty to seventy years v^th elevated cholesterol levels, he found that

1

,500

mg of Endur-acin lowered total cholesterol by 13.3 percent, LDL cholesterol by 19.3 percent, and the important TC/HDL ratio by 19.4 percent. HDLs rose, and triglycerides also

fell.

The drop-out

and participants had no problem Dr.

Keenan

a matter of

HDLs, and

due

to side effects

HDL levels began

diminishing returns. Although the

my book

Keenan

to collaborate

LDL

levels

than

in

rise. It

so did the

fell,

therefore, that

effective.

The 8-Week Cholesterol Cure began

around the world, medical authorities Dr.

to fall rather

He concluded,

the ratio did not appreciably change.

interest in

3.4 percent,

2,000 mg/day resulted in

also reported that higher doses of

1,500 mg/day of Endur-acin was both safe and

As

was only

complying with the niacin dosage.

in

elevated liver enzymes. Moreover,

was

rate

to spread

the Russian government approached

with research in the then Soviet Union.

He and Dr. Moscow

D. Aronov of the National Research Centre for Preventive Medicine in

subsequently published cholesterol-control

a series of

program

papers reporting the effectiveness of the

utilizing

1,500

mg

has continued, and most recently was presented

Health Conference in Barcelona

Thus

SR

of Endur-acin. That research at the

2nd

International Heart

in 1995.

the credentials for Endur-acin are quite impressive. But

niacin preparation better than any other? Endur-acin

pure niacin impregnated

in a

wax matrix

acin gradually releases niacin as

it

is

tablet.

is

why is

this

a formulation of

Rather than dissolving, Endur-

leached from the

tablet.

The emptied wax

128

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

tablet typically

crumbles but sometimes passes through the digestive

Sometimes people have been concerned,

m

their

bowel movement

Owing

especially

But by the time

stool.

to the very precise delivery

Endur-acin delivers

a predictable niacin

leaches out at a time, the niacin flush

is

it

when

tract intact.

they've seen the tablet

passes,

no niacin remains.

system afforded by the wax matrix,

dosage day

after day.

Because so

experience even the slightest flush. In addition, because the niacin

uously available to the

Do

liver, it

not forget, however, that Endur-acin

recommended

dosages, higher dosages

3,000

contin-

is

an SR niacin and as such

MG/dAY for

1R

its

tox-

doubled. While clinically proven safe

may lead to problems.

while the maximum dosage of endur-acin

note:

is

controls cholesterol levels very effectively.

icity potential, as well as its effectiveness, is

at

little

Very few people

virtually eliminated.

is

Don't experiment! 1,500

gm/day and

NIACIN PREPARATIONS, NOT ALL INDIVIDUALS

WILL REQUIRE THAT AMOUNT. YOU MAY FIND THAT LOWER DOSAGES ARE SUFFICIENT.

WORK WITH YOUR DOCTOR TO DETERMINE

EX-

ACTLY THE RIGHT DOSAGE FOR YOUR AS PART OF THIS COMPLETE

CHOLESTEROL CONTROL PROGRAM. It is

important to note that

Endur-acin. best

SR

I

simply believe

I

have no financial or other vested interest in

that, in

niacin available. Endur-acin

Company

in

Oregon and sold

to

mg and 500 mg strengths. Osco

my experience and is

Walgreen Drugs, which

Drugs and Savon Drugs

labeled as such. In Vancouver, Canada, Endur-acin ley less

Drug

label.

You can

that of others,

it is

the

produced by the Endurance Products

is

sells

available

also obtain Endur-acin directly

it

in

both 250

also sell Endur-acin

under the Stan-

from the company;

it's

expensive that way. Endurance also produces an excellent IR niacin as well

as antioxidants. Write or call for order forms:

Endurance Products Co. P.

0.

Box 230^^89

Tigard,

OR 97281

(800) 483-2532

Combination

Through

IR

and SR Niacin Regimen

the years I've continued to monitor the medical hterature re-

garding niacin and

its

benefits for cholesterol control

and prevention of heart

A

Niacin and Your Heart:

Reading

disease.

early 1994,

a report in ihe journal oj the

better job of increasing

more than IR

HDLs and

similar.

We

came up with an approach

that

was

my HDL counts

HDL in

an independent

this report,

that

cholesterol levels

had been

than wonderful. Typical measurements

less

my

LDL

triglycerides

remained

And was very aware I

180

in the

to

230

of the research show-

the presence of even slightly elevated triglycerides posed

months on

an improvement in tests

and he indicated

risk.

After three

sequent

in

LDL

experimented with myself, using both SR and

I

range; not that bad, but not great.

ing that low

niacin lowered

discussed possible combination regimens and

were

were in the very low 30s, and

SR

29

niacin did. Conversely, IR niacin did a

IR niacin. In the past, although the total and quite good,

1

lowering triglycerides.

spoke with Dr. Joseph Keenan about

his experience

•

American Medical Association

learned that researchers had found that

1

cholesterol significantly

I

Lifesaver Revisited

HDL to

the combination IR/SR schedule,

38 and

triglycerides at

test

showed

an even 100. Terrihc! Sub-

demonstrated continued improvement with

as high as 42, which, for

my

HDL measurements

me, was tremendous. Triglycerides remained com-

fortably low. I

my

reported

hndings

to the readers of

my

page 184) and asked for feedback from readers themselves. Inspired by

Diet-Heart Newsletter (see

who

tried the

combination

A number responded, and their findings were similarly positive. my success. Dr. Joseph Keenan plans to research the IR/SR com-

bination.

Talk with your doctor about this combination. it's

worth

trying,

you might want

to consider the

If

he or she agrees that

regimen that

I've

found suc-

cessful.

DOSAGE SCHEDULE FOR Morning:

1R/SR

One 500 mg SR one 500

mg

One 500 mg

Evening:

One 500 mg SR

I've

niacin (Endur-acin) plus

IR niacin

Afternoon:

Note that

NIACIN COMBINATION

IR niacin

substituted

niacin (Endur-acin)

my

previous afternoon dosage of one 500

SR niacin (Endur-acin) with two 500 morning and afternoon. Remember

mg

mg IR niacin tablets, which take in the 500 mg of SR equals ,000 mg of IR.

that

Therefore, the effective dosage remains the same.

I

1

130

•

1

RHVOLUTIONARY CHOLESTEROL BREAKTHROUGH

hi:

But These Niacin Substitutes

Don't

Work on ihe subjeci begins with words

Virtually every medical report effect that

"Niacin

an

is

effective treatment for

lowering cholesterol

to the

levels."

Fortunately, as an over-the-counter supplement sold in pharmacies, health

food stores, and by mail order, niacin remains very inexpensive, especially

compared with

the prescription drugs, but be cautious about choosing from

the niacin preparations

Niacinamide plements,

you see

satisfies one's

it

amide has no

effect

it

Not

who

them work.

sometimes

is

labeled as "no-flush niacin," but like

Do

not believe any salesperson in

argues to the contrary. There

that inositol nicotinate has

in sup-

cholesterol.

does not lower cholesterol.

a health food store

of

all

breakdown product of niacin. Used

vitamin requirement for niacin. However, niacin-

on lowering

Inositol nicotmate

niacinamide,

for sale.

the metabolic

is

any

effect

Combination niacin products

on

is

no

clinical

evidence

cholesterol.

are frequently found in health food stores.

These products may also include dietary

and other sup-

fibers, antioxidants,

plements. The amounts of niacin and the other ingredients are typically too

low

to

have an

effect

on

cholesterol.

If

a

combination includes,

say,

50

mg of

niacin, you'd have to take a lot of those capsules or tablets to reach an effective

dosage.

The same

applies to a soluble fiber that might be included. Not

only are such preparations ineffective as such, but they also are horribly expensive

when compared with

and take them

similar doses of the individual

components. Buy

separately.

Should Niacin Be a Prescription Drug?

Niacin

is

available without prescription in the United States as a "nutri-

tional supplement."

Noting the potential toxicity of niacin, especially

FDA

without any medical supervision, some doctors have urged sales to prescription only. lieve niacin

cost,

I

can understand such caution, but

should remain available without prescription.

which would double,

triple,

or

more

if

niacin had to

main reason

ease

is

is

available to everyone, regardless of

an equal-opportunity

killer.

economic

is

be regulated by and

relegated to the bureaucracy required for prescription drugs.

niacin

used

personally be-

I

My

if

to restrict

status,

As

it

is

and heart

now, dis-

Niacin should not be restricted to only

Niacin and Your Heart:

who can

those

for the individual.

said,

You

1

must

medical supervision.

and only

feel

now

more

reiterate

You need

a doctor

to

to time,

let it

when having

liver

tests for

to take a pre-

a niacin supply.

feeling that niacin

have those

can perform the

should be used under

enzymes checked now and

you. Actually, that's not

all

the

measurements

fact a Ufesaver, in

our

at

one time. Niacin

fight against heart disease.

hurt you in the process.

In the decade since

I

wrote The 8-Week Cholesterol Cure, niacin therapy

has become more medically utilized. During that time thousands of ers

at all

know how your lipid profile is coming along

and you can check

can be an enormous help, in Don't

than

in control

my

inconvenient, since you'll want to

from time

131

•

has provides a certain degree of freedom

pharmacy every time you need

scription into the

then,

Lifesaver Revisited

afford the higher prices of prescription drugs. Additionally, the

over-the-counter status niacin

That

A

have written

their results

to express their

my

read-

thanks and to share the wonderful news of

with me. Those results have been dramatic and have signaled un-

precedented heart disease protection

know

that niacin has benefits well

began

my

for those

men and women. Today we

beyond those recognized

personal experience with

it.

in

1984 when

I

Niacin will be an integral part of our

battle

with heart disease well into the twenty-first century. I'm glad you

about

it.

know

— 10

•

•

Exercise Your Heart,

Exorcise Your Cholesterol

Even

if

you're absolutely set against exercise and define yourself as the ultimate

sofa spud, please bear with

As

really relate to you.

me through

this short chapter.

To begin with,

elementary school in the '50s

a kid in

1

president's physical fitness test while almost everyone else passed.

ways the

one picked

last

been an athlete with

any team sport. No,

for

a natural attraction to htness

To make matters worse,

No one

structive era.

assume

went

I

exercised.

cop was

that a

I

not

and

was

1

now nor have

I

al-

ever

exercise.

to college in the 1960s, a truly self-de-

anyone was running on campus, you could

If

him!

after

am

can

1

flunked the

And

after college

1

became

Ameri-

a typical

can, sedentary office worker.

Looking back on those days

teresting ones.

Not sleeping well

in the mornings. to

do the

'When

I'd

was always

tired

and never

Lousy

at

sports

at

—

up

night and having a tough time getting tried skiing

I

but just couldn't get

my body

turns.

der age of

I

had

my heart

thirty-five, there

no advice about

got

I

good. Yawning every afternoon. Nodding off in meetings, even in-

really

felt

realize that

I

attack

and

first

bypass surgery in 1978

was no such thing

exercise.

So

if

I

at

the ten-

as cardiac rehabilitation,

did anything strenuous,

I

and

was scared

I

that

have another attack.

Then ation, in a

in

1984

rehab program.

mill, riding

slowly. But

could

my

and three weeks

Little

On July 3 had my second bypass opermy cardiologist had me much against my will

changed.

by

I

—

httle

1

came

to

life:

slowly on the bicycle. Everything

by the end of just

recall.

enjoying a

life

later

six

weeks,

was

I

walking slowly on the treadI

did

life

of fitness that

you

are.

I'd

beginning

feeling better than at

By the end of the twelve-week program,

So, there

at the

I

I

did

any time

was well on my way

1

to

never experienced before.

You're not reading the advice of

or a wild-eyed fanatic. Simply enough,

if

I

some Olympic

athlete

could make the transformation,

anyone can!

Looking back

at things, it's

too bad

it

took such a near-catastrophic

ill-

Exercise Your Heart, Exorcise Your Cholesterol

ness to turn

me

around.

think of

I

all

Sooner would have been better than

And now swear I

those years

later,

but

you have the energy

to

enjoy

could have enjoyed more.

I

later

never go back to the old ways.

I'll

133

•

was way

better than never.

Life is a lot

more fun when

it.

ACTIVATE YOUR HEART

Certainly this

isn't a

book

vent problems and for those the one thing that cise

program

for

who want

It's

for those

who want and

to enjoy their health

to pre-

their Ufe. But

learned in cardiac rehabilitation that applies to an exer-

everyone

sedentary

level of

I

for sick people.

lifestyle,

is

the

and

word

it'll

"slowly."

took years to get to your

It

some time

take

to get going.

How

long?

Ninety days. Give yourself just ninety days. Make a promise, a commitment, to follow the advice in this chapter,

of that time you'll be converted for

you

and

1

promise, in turn, that by the end

You won't want

life.

to give

up

the

way

feel!

AHA

Sidney Smith, president of the

Dr. office to

in 1995, dedicated his year in

encouraging other doctors to urge their patients

heart disease prevention.

He

to

adopt a

lifestyle

of

strongly criticized the fact that only one out of

every three patients gets the guidance he or she needs to prevent a second heart attack or bypass.

Whether you're ercise just has to be self is

to

enough

know

that

trying to prevent a

first

heart attack or a second one, ex-

an integral part of the program. Yet the word "exercise"

to turn off

most people.

you don't need

If

to exercise in the

Jane Fonda or Susan Powter

move your

sense of the term. You just need to get active, to just

Researchers fit

at the

it-

you're one of those, you'll be pleased

Aerobics Institute in Dallas wanted to

body.

know just how

people had to be to prevent degenerative illnesses such as heart disease. Dr.

Steven Blair and his associates studied thousands of

them

into

one of

five categories of fitness

men and women,

and regular

activity.

putting

He expected

to

see a Unear increase in health, a bigger payoff, with every increment of exercise.

The

results

were amazing.

To no one's

surprise, those in the top category of fitness

But those

tary

couch potatoes who did absolutely nothing, got almost

from a doesn't

were the health-

m the second-from-the-bottom level, just above the truly seden-

iest.

minimum of activity as those in the top tier. The take much effort to protect your health adequately

as

much

benefit

lesson learned:

It

134

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

tality

But

how

and

to prevent heart

can one measure the activity needed to achieve health and

In the past, people

were forever talking about heart

Who

ing their pulses. That's really not practical.

wants

with measuring heartbeats while exercising? And,

The

necessary.

many

vi-

and other diseases?

become obsessed

turns out, that's not at

it

comes down

trick to effective exercise

and measur-

rates

to

to a

concept

known

all

for

years by exercise physiologists, but seldom shared with the rest of the

world.

a

It's

way

of thinking about activity

known

METs, and

as

really

it's

simple.

When you're completely relaxed, just sitting in a chair quietly or lying in bed or on

a

couch watching

television, you're

burning enough energy

your internal organs operating and your body ergy, regardless of

one MET.

tivity:

chair to

And

alive.

your age, sex, height, or weight,

is

open the window

keep

of en-

one metaboUc unit of ac-

up from

the lowest metabolic level of activity. Get

It's

to

amount

that

that

or find a snack, and you've stoked up your body's

furnace to two METs.

The thinking behmd 'When we engage

pump

in

the

MET

any physical

out the amount of

others

Again,

air out.

scientific

of oxygen

maximal

capacity.

term

we have maximal

for this is

we can accomodate.

VO2 max,

That's

all

sure of physical performance or level of

to the effort this

required, measured

that

1

you need

will

forming

in

to

rate, together,

activity.

4

human

METs. Take

to agree that

60 percent.

burn from four

to six

Maybe

it's

a very

METs

maximum volume

and you have

activity

is

a

mea-

termed the

can be broken

is

MET ratings.

the key to health

and fit-

for thirty to forty

min-

sufficient daily exercise.

That

METs. You can

activities requiring half the

thirty- to forty-minute

is

and carbon

a look at the table at the

walking briskly

to 4.5 miles per hour,

air in

This measure

said that activity, not exercise,

Anyone would have

utes a day, at about

walk

call for

know.

chapter for a listing of daily activities and their

Remember ness.

to

activities re-

capacities for vigorous breath-

referring to the

"metabolic equivalent," or MET. 'Virtually every

end of

Others

pumping oxygen-rich

Put the two, heart rate and breathing

down

match demand,

may need even more.

dioxide-laden

The

beats to

oxygen-carrying blood needed. Some

At the same time, our lungs are

ing.

very logical and easy to understand.

activity, the heart

quire 50 percent of an individual's Still

is

get the

same

benefit

by per-

for twice the time.

busy day, and you just don't have the time

to take that

walk. Instead, concentrate on activities that require the

same METs: climbing the

stairs instead of

using the elevator; picking up the

Exercise Your Heart, Exorcise Your Cholesterol

pace of your housework; stepping

whether from your car

to another,

lively

to

an

when you need

office

to get

135

•

from one place lot or down shoppmg and

through the parking

the hallway from one office to another or doing your grocery getting the dry cleaning. Yes,

measuring your heart

said that

point, put your finger

prove a

some

I

of those relatively

low-MET

ing faster and you're breathing

Of of a

activities. You'll find that

low-MET

activity

by doing

also true,

hour

for forty

miles per hour for twenty minutes.

It's

are doing is

beat-

are at rest.

^bu can

activities requiring twice the

time. Instead of walking at four miles per at five to six

is

you

your heart

more deeply than when you

course, the flip side of that coin

But just to

rate isn't necessary.

to the side of your neck while

get the benefit

METs

for half the

minutes, you can jog

your choice. Hate

jog

to

but love to dance? Get into the habit of square dancing or folk dancing on a regular basis. Ronald Reagan actually enjoyed chores

and spent

a lot of his free time clearing brush.

Clinton's jogging,

Bill

and since Reagan

really

on

his California ranch

That was just as beneficial as

enjoyed himself, probably a

lot

healthier.

Most people think

that

apply that same thinking to tasteful efforts to

on

medicine has activities,

to taste

bad

be

to

effective.

them, what they would

call "exercise." Instead,

concentrate

the things that are fun for you, whether that might be riding a horse, ped-

aling a bicycle, or clearing brush.

You can

kill

two birds with one stone by

picking up the pace of active work, thus increasing the

shown

WHY

METs you

use, as

in the table.

BOTHER TO MAKE THE EFFORT?

I

could

cite

chapter and verse from the scientific Uterature to try to

a convincing argument for the health benefits of exercise. Just lifting the

volumes of books and journals tails,

is

a lot of exercise in itself.

but here are the healthful effects of regular physical

You'll feel better.

•

Whatever

activity

I'll

little

perspiration, your

body produces

spare you the de-

you choose, when

a soothing

make many

activity.

the heart

breathing rate increase to a point that you're breathing deeply and have a

They

concentrating on what might be dis-

and

at least

chemical called beta-en-

dorphin. The calming effect of the substance, chemically related to morphine,

can

last

the entire day.

136

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Most psychologists recognize exercise stress. Especially

when done on

you

stress

to

cope with

one

one of the best ways can and

a regular basis, exercise

to

reduce

will enable

effectively.

promotes the

You'll sleep better. Exercise

•

this

more

as

release of another chemical,

known

in the family of neurotransmitters,

as serotonin. In fact, phar-

maceutical companies keep trying to develop drugs that mcrease serotonm levels to sell as tranquilizers. Exercise

ensure better sleep You'll

•

a natural

way

to

produce serotonin

to

at night.

be more productive

afternoon. Those

is

who

at

work. Most people

hnd

regularly exercise

that

feel

sleepy by mid-

midday letdowns

are a thing

of the past. Their stamina increases along with their ability to concentrate. In a survey of highly successful Dr.

Kenneth

men and women

ular schedule of physical activity

and

in a

number

of professions,

found that virtually

Pelletier of Stanford University

all

had

a reg-

that they credited their productivity to

their exercise habits. You'll enjoy sports

•

and

leisure recreation

golf or tennis or any other sport, you'll find that a lot

more when you

rior." That'll

ting even

more

And

sociation in it

Two

•

more

detail that

scientific

that the

—

•

weight

your weight more

for

is

England jour-

one's physical activity

likely to live.

easily

and be able

hours afterward. In addition, as

—

call

The same study

to eat

More about

all

this in

re-

burn

calories, act-

gain-

chapter 12's discussion of weight control.

blood sugar

II,

metabolism

consume more food without

levels

and control diabetes. Along with

regular physical activity can virtually eliminate the

health hazards of type

more. Not only

fitness levels increase, you'll

lean muscle tissue. Since only muscle tissue can

You'll stabilize loss,

New

find at least

proof that physical fitness pro-

more strenuous

the longer one

ing as the body's furnace, you'll be able to ing weight.

most people

calories during physical activity, but also the body's

mains revved up build

"weekend war-

even nonvigorous activity prevented heart disease.

You'll control

do you burn

it

another one reported in the Journal ojthe American Medical As-

1995 showed

that

little

large studies published in the

1993 provided the

exercise or sport or play

showed

and enjoy

exercise.

nal oj Medicine in life.

better

get regular exercise rather than being a

moderately interesting.

longs

it

probably result in your playing those sports more often and get-

You'll live longer. Here's a

•

more. Whether you play

you do

symptoms and

non-insulin-dependent diabetes. Exercise has an in-

sulinlike effect. •

Your blood pressure

will

fall.

While

scientists

were

initially skeptical,

Exercise Your Heart, Exorcise Your Cholesterol

now

data

demonstrate the incredible effectiveness of

lifestyle

137

•

modifications,

including exercise, to control mild to moderate hypertension without the need

Even patients with severe blood pressure elevations

for drugs.

lessen their •

Your cholesterol

cholesterol

the

drug requirement when they regularly

exercises

Triglycerides

exercise, while

and the more strenuous as well.

fall

LDL

improve across the board. The bad

comes down with regular

more one

HDL gain.

levels will

are likely to

exercise.

HDL

levels rise. In fact,

that exercise, the greater the

LDL and total cholesterol come down with

the weight loss that typically results from exercise. •

You'll

be

less likely to

tacks. In sedentary individuals,

That

ting.

may

explain

usual activities such as

form blood

can precipitate heart

sudden bursts of activity can cause blood

why some snow

clots that

people have heart attacks

clot-

when doing un-

who do exercise on a

shoveling. But those

at-

basis are protected against this tendency of the blood platelets to

regular

form

clots.

Again, the more one exercises, the greater the protection. •

You may develop

provide a kind of "natural bypass" around clogged

lateral arteries that

Many believe that vigorous new arterial pathways. •

ity a

Doctors have found tiny col-

collateral circulation.

arteries.

exercise can contribute to the formation of those

You'll prevent heart attacks.

week, and you can reduce your

as 70 percent. Both strenuous

Do

two hours of vigorous

activ-

having a heart attack by as

much

at least

risk of

and nonstrenuous

activity provide protection,

to be as much as previously thought, New England Journal of Medicine in 1994.

and the amount of time spent doesn't have as

shown

The

in research

published in the

benefits of exercise in that study

such as cholesterol

level or

blood pressure. In other words, even

smoked, he would benefit from tivity

were over and above any other factors

exercise.

And, again, while low

were protective, the most active and physically

fit

if

a

person

levels of ac-

men enjoyed the great-

est protection. •

You'll recover

event. Data have cise

program

come

a heart attack faster

from

all

over the world.

after suffering a heart attack, his or if

been measured

in a

number

a

a

subsequent

person begins an exer-

her recovery will be

of ways. Less anxiety and depression.

second attack. Faster return

outlook. Better sex

lives.

Exercise

for the recovering heart patient.

ommended

and prevent If

far

more

he or she remains sedentary. That success can be and has

successful than

risk of a

from in

physical activity

is

to

regular activities.

Reduced Improved

the best prescription a doctor can write

Those

do very

work and

who do

well; those

minimum amount of who do more do better.

the

rec-

138

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

HOW MUCH TWO

ENOUGH?

IS

THEORIES Looking

at

the

remains that

fact

cle

if

and physical

of benefits of exercise

list

provided, one might wonder

if it

isni too

good

exercise could be "bottled,"

be true. The documented

to

it

would be

drug of all time. But what should be the dosage of

good,

more

is

I

the typical couch potato will convey

and

will

provide the benehts

The American College for shorter periods that

said earlier. Just being

a

If

little is

moderate

more

active than

tremendous protection against heart

dis-

listed.

I

of Sports Medicine prescribes moderate exercise

add up

to thirty

minutes or more,

week. Unfortunately, only 22 percent of get even that

the greatest mira-

that "drug"?

better?

No, I'm not reneging on what

ease

activity I've just

level of activity,

all

days per

at least five

American men and

women now

according to data from the Centers for

Disease Control and Prevention (CDC). In the past, experts' guidelines called for vigorous, for at least

twenty minutes or more, three

to five times

ommendations come mostly from epidemiological moderate exercise or physical

activity

continuous exercise

new

per week. The

studies

showing

rec-

that even

associated with reduced risks of

is

chronic disease, especially heart disease. Steven

Blair,

of the Institute for Aerobics Research in Dallas says that he

and others made a mistake used to be on sustained

demonstrated that

how many

So

recommended tion

fall

Then research done

it

all

Call

it

at

Stanford and elsewhere

here, fifteen minutes there,

adds up.

people actually are engaged in physical activity

levels?

Very darned

CDC survey.

250,000 deaths

recommendations. The emphasis

added up: Ten minutes

into the category of true

cording to a

ally

activity.

activity

minutes another time,

five

in their earlier

few.

those

Nearly 60 percent of the U.S. popula-

couch potato,

Sedentary

at

lifestyle

living a sedentary Ufestyle, ac-

alone

is

said to be responsible for

a year.

"exercise

or anything you wish, but the

lite"

new guidelines are

easy to achieve. Ultimately the physical activity should add

up

re-

to the

equivalent of walking briskly two miles a day. Again, whether that activity

comes during one

stint

or two or three

take the form of any physical activity do.

Things you

Activities

like

may

you choose

to

makes no

you

difference at

like to do,

choose

all,

and

to do, or

it

can

have to

include gardening, dancing, tennis, or other sports.

do might be riding an Exercycle or walking on

a tread-

Exercise Your Heart, Exorcise Your Cholesterol

done" efficiendy and

mill in order to get "the job

or at home.

things you have to

waxing the

the house, ities all

And

add up

Maybe

in a

gym

do might be housework, chores around

or whatever.

car,

whether

regularly,

.139

•

Of course

all

three categories of activ-

together.

it's

our Puritan background, but Americans tend

ercise in the strictest terms.

Most would not think of golf as

to think of ex-

exercise. But

when

Purdue University exercise physiologist Darlene Sedlock studied the work output of a

1

50-pound

golfer

walking and carrying his or her clubs rather than

riding in a cart, she found that the eighteen-hole of running six miles. That golfer will

were just

sitting

William

own lawn

as

game was

the equivalent

more than

calories

if

he or she

around. Digging in the garden, Sedlock learned, took 540

Pushing

calories per hour. fact, Dr.

burn 660

lawnmower required 470

a

Castelli of the

calories per hour. In

famous Framingham Heart Study

one of the ways he stays

mows

Getting back to those things you have to do; they can really use ries fast.

Carrying groceries up the

same

running

ing.

as

at

at

5

moving

for

Scrubbing floors takes

wood, digging

stairs

means you're working

mph. Shoveling snow

5

The same holds

5.5

nificantly reduce

your

so, is there a limit, a

it,

a 5

MET

get thirty

to

Institute for Aerobics

fire-

with children, you're operating

go to the gym!

minutes of activity every day and

risk of heart disease. But, again,

is

more

you'll sig-

better?

And,

if

point of diminishing returns?

week

Research in Dallas says that

— walking,

if

you're doing

do

fifteen miles a

more than

running, or whatever equivalent

sons to do more, but fighting heart disease

week. Far from

In a very real way, the science hasn't

Dr.

lawn mower.

that

getting any additional protection from heart disease. There

just the

calo-

equal to hik-

activity,

and pushing

up

8 METs, the

Kenneth Cooper, who coined the term "aerobics" and founded the

teen miles a

ple don't

at

METs. Whether you're carrying and stacking

METs. And here you thought you had

Dr.

is

furniture

in a garden, or actively playing

No doubt about

his

fit.

isn't

may

one of them.

—

you're not

be other rea-

Still,

most peo-

it.

changed much

in the past years,

ways of interpreting the data from an increasing number of

Cooper advocates

fifteen miles a

might be three days of running

ommending

for years.

the equivalent of

five

The College

two miles

fif-

week. He

is

studies.

a runner, so his fifteen miles

miles a day. That's what he's been rec-

of Sports Medicine

now

sets guidelines at

a day. Well, that's fourteen miles a

week. Just

about the same. In a 1991 article in Circulation, researchers reported that "vigorous" ex-

140

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

was needed

ercise

mined

to avoid heart attack

and

the ability of men's blood to dissolve blood clots

The

tion.

The researchers

stroke.

deter-

that exercise training at a high level of intensity significantly increases

intense exercise

minutes four or

for forty-five

task doesn't

hours of

and

to prevent clot forma-

done was strenuous walking, jogging, and bicycling times per week.

five

If

you multiply

seem so daunting. Those men were doing

that out, the

a total of three to four

week. Figuring they were averaging 4.5 miles per hour

activity a

walking or jogging, that comes out to

— once agam — about

fifteen miles a

week. It

doesn't

make one

bit of difference

walk them one mile

in three outings or

whether you run those

at

fifteen miles

a time twice a day throughout the

week. For that matter, you can replace the running or walkmg with any

activ-

your body's organs functioning beyond the METs required

ity that gets

to

maintain a prone position on the couch.

That does

it

for aerobic exercise/activity.

But don't stop there.

Fill

out

your exercise regimen with sessions of both strength training and stretching achieve

maximum

GRANDMA Don't

mean

we

that

THE WEIGHT LIFTER

roll

your eyes

you have

get older

to

htness.

— and

is

suggestion of strength training.

at the

pump

iron like Arnold.

happens

that

strength. That loss

sudden, you

to

to all of us

The

one day

at a

time

— we

doesn't

It

inevitable truth

is

lose

imperceptible over the years, and then one day,

realize that

you

can't get

any number of things you used

up from

a chair

that as

body

all

of a

without assistance or do

to take for granted. But

such deterioration

doesn't have to happen.

Researchers from Tufts University Center for Aging have done

work and six

that puts the

nineties,

movie Cocoon

unable in

weeks put them

ally

miraculous.

It

many like

shame. They took people

in their eighties

cases to walk without a walker, and for a mere

into training

was

to

some

on Nautilus machines. The

result

was

virtu-

Lourdes.

As part of the study, the participants returned

to a

sedentary

lifestyle,

without the exercise. Benefits quickly disappeared. There was an uproar; "Give us back our exercise!" As

won't want to give

work

it

I've

said before, give exercise a chance,

up when you

for folks in their eighties

and

see

how

nineties,

it

it

can change your can work

for

you.

life.

and you If it

can

Exercise Your Heart, Exorcise Your Cholesterol

What That's

all

work out

does

it

take? Figure about twenty minutes three times a week.

you need. No doubt the best way in a

141

•

do strength traming would be

to

to

gym with Nautilus or other equipment. The first sessions should who can instruct you in the best, most efficient, and safest

be with someone

techniques. You don't need a fancy health club; the local

YMCA is just

fine.

Resistance training, as researchers refer to strength exercising, has a

ber of benefits

beyond toning one's body. Blood pressure

Weight control

is

more

LDL

while the harmful

No

And both blood

falls.

question about

a routine, fitness it

efficient. Levels of the protective

it,

falls significantly.

HDL cholesterol

rise

sugar and insulin levels improve.

the toughest part

programs become

num-

is

to get going. After getting into

a part of your

life.

You won't want

to give

up. Start

by taking

cycle in the garage or

something

you can

a

walk

do

— perhaps twenty

to thirty

your stamina and

amazed

that heart beating inside

Promise to do

daily, to the slightly.

point that

Keep

a jour-

quickly you'll develop

your chest. Think of

your "pet" perhaps. That heart works for you.

at

how

off.

off the bi-

start feeling better.

Think about friend,

been putting

minutes

your heart beating firmly and you perspire

nal listing the day's activity. You'll be

works

one block or two. Dust

that gardening you've

active for at least

feel

just

Now do

something

athero-genesis to athero-exodus!

for

all

day long;

it

it

never

as

your

rests. It

your heart. Exercise can take you from

ENERGY REQUIREMENTS OF 1

MET

COMMON

ACTIVITIES IN

(Metabolic Equivalent) equals the amount of energy needed

Sleeping Lying

in

when

the

METS

body

is

at rest.

a chair

Sitting quietly in

bed

2 METs equal twice the amount of energy used Standing

at rest.

Playing cards

Talking

Walking

when

Light

mph)

(1

housekeeping

(dusting)

Typing/word processing

Reading

Shaving

Writing

Dressing/brushing hair

2-3 METs Walking

mph)

(2

Moderate housekeeping

Playing piano

Meal preparation

Playing golf (electric cart)

Bicycling (5

Bathing/showering

Bowling

Washing

(light

laundry)

mph)

hair

3-4 METs Walking

mph)

(3

mph)

Bicycling (6-7

Driving a car

Climbing

in light traffic

stairs

Heavier housework (scrubbing dishes) Ballroom dancing

(foxtrot)

Factory labor

slowly

4-5 METs Walking

(4

mph)

Playing badminton/light tennis

mph)

Heavy housekeeping (mopping, vacuuming)

Bicycling (8

Gardening/raking Light carpentry

Mowing lawn

House painting Driving a car

(power)

heavy

in

traffic

Washing windows

5-6 METs Walking (4.5 mph) Bicycling (10

mph)

Golfing (carrying/pulling clubs)

Very heavy housework (scrubbing Carrying

Roller-skating Light shoveling,

digging

wood

or groceries

Social dancing (tango)

6-7 METs Walking

(5

Bicycling

(1

mph) 1

mph)

Mowing lawn

Playing tennis (singles)

Splitting

Waterskiing

Snow

Swimming

Moving

leisurely

(push

Square dancing

wood

shoveling furniture

mower)

floors)

ENERGY REQUIREMENTS OF

COMMON

ACTIVITIES IN

METS

7-8 METs Jogging

mph)

(5

Bicycling

2 mph)

(1

Playing football

Horseback

riding at gallop

Downhill skiing

Climbing

hills

Canoeing

Climbing

stairs (continuous)

Swimming

laps (slow)

(moderate)

Playing tennis (competitive singles)

8-9 METs Jogging (5.5 mph) Bicycling (13

Swimming

mph)

laps

(fast)

Cross-country skiing Playing basketball

Carrying groceries upstairs

10+ METs Handball, racquetball, squash

Climbing

hills

with a load

Jogging

(6

mph and

faster)

n

•

•

Happy Heart, Healthy Heart

Even

in ihe face of adversity

happy man children,

for

and

truly

and numerous hardships,

his

stress that his

life.

Then

came

life

that stress or to just

father

was

a very

life.

He was remarkably healthy and

spected and valued in his community. every day of his

my

He loved my mother enormously, adored enjoyed his work as a pharmacist who was greatly

most of

Simply enough. Dad was unable

walk away from

it.

re-

relished

an occurrence that produced such

a tragedy struck,

apart.

his

Within

a year

to

cope with

he died of a massive heart

attack at the age of hfty-seven.

My brother was ries of

one of the most happy-go-lucky guys

bad investments and business decisions

was so overwhelmed by

stress that for years

I

ever knew.

A se-

financially ruined him,

and he

m

a cold

he awoke every night

sweat. His heart attack hit at age forty-nine.

As

I've

traveled the country speaking with heart patients I've heard

over and over: "Stress caused tal

stories are the data piling

at virtually

up

in the

medical literature and being presented

risk factor, right

up

my mind

that stress will eventually be listed as a

there with high blood pressure, cigarette smoking,

elevated cholesterol counts, and sedentary behavior. stress isn't already

included as

measuring what we easily

shrugged It's

it

pursuasive than such anecdo-

every scientific conference linking the emotions with heart disease.

There's no doubt in

major

my attack." More

off

difficult

stress are far

call stress.

The only reason

a risk factor is the difficulty in

What may

be horribly stressful

that

quantifying and to

me might

be

by another person.

even to give stress an absolute definition. Determinations of

more

subjective than objective. Are

you were yesterday? Did your reaction

to

you more angry today than

your boss or your spouse or your

kids rate a four or a seven or a nine on a scale of one to ten?

What we do know

for certain is that

depression appears to be an inde-

pendent predictor of heart disease. Researchers from Johns Hopkins

more and McGill University

in

ihey shared with the scientific

in Balti-

Montreal collaborated in collecting data that

community

in

1994. In nearly twelve hundred

Happy

Heart, Healthy Heart

who were

medical students from the classes of 1948 to 1964 thirty- five years,

•

1

45

studied for

depression was directly associated with heart attacks even

after adjusting for other risk factors. In other

words, take two

having sim-

and the depressed

indi-

vidual has a far greater risk of suffering a heart attack, according to the

Hop-

ilar levels

of cholesterol, blood pressure,

and so

men

forth,

kins investigators. In Montreal, Dr.

ops following

Nancy Frasure-Smith found

that depression that devel-

a heart attack continues to increase the risk of

dying over an

eighteen-month period. Conversely, those patients without depression were

make

likely to

a complete recovery.

You can add anger

to the

emotions that place our hearts in jeopardy.

A

team of scientists from Harvard Medical School asked more than sixteen hundred

men and women

in fifty-three hospitals to evaluate their

after their heart attacks.

out. Bingo.

The average

anger one week

Again, influences of other risk factors were canceled risk of heart attack

was increased by 2.3 times

in the

two hours following the onset of moderate or greater anger. Those were not

happy people.

The study of the with, say, our a handle

on

heart's

emotions remains in

knowledge of hypertension.

this risk factor.

It's

its

a lot

infancy

more

when compared

difficult to really get

Moreover, our assessment of the impact of our

emotions has changed significantly over the past several years. In the 1970s, the emphasis

was on the "Type A"

driven, ambitious, impatient person ical

conclusion, that description

and businessperson patient,

many

is

was thought

means

a cardiac time

to

be

And

Taken

to its log-

that every successful doctor, lawyer,

bomb. Think about those

obnoxious orchestra conductors. They wave

calories.

personality: the time-

at risk.

their

arms

arrogant, ima lot,

they don't bottle up their frustrations. They

burning

live well into

their eighties.

Then sonality

the focus narrowed.

Maybe

spectrum that placed certain

Dr. Redford Williams of

Those were emotions

Duke

it

was

certain traits within that per-

men and women

University zeroed in

that could actually be

inventory. Sure enough, in both doctors

at risk. In the

on anger and

measured by way of

1980s

hostility.

a personality

and lawyers studied, those with

higher measured assessments of anger and hostility as students later suffered early heart attacks.

Calmer individuals were spared.

Currently psychologists emphasize the importance of depression, anxiety,

and a general

feeling of hopelessness, in addition to anger

general sense,

happy hearts

are healthy hearts.

and

Unhappy

hostility. In a

more

hearts are at risk.

146

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

Physicians tend to be a very pragmatic

emotion have a physical

number of years or at least any

ago,

effect?

no psychological

faster,

lot.

Why

As one world-renowned stress

should an intangible cardiologist told

could make the heart beat as

was known

fact,

he posited, since physical stress

to strengthen the heart, so, too,

wrong, and doctors

a

fast,

than demonstrated during physical exercise on a tread-

no

mill test. Therefore, he reasoned, psychological stress could be

physical stress. In

me

now

are paying

more

riskier

than

form of exercise

in the

might psychological

stress.

He was

attention to stress as a risk factor in

heart disease.

Today, however,

We

body.

we

are

aware of just what psychological

can measure the chemical changes just as certainly as

sure cholesterol levels or blood pressure. Simply enough, cally different

when we

are

happy

as

What, you might be asking by on

diet

stress

and cholesterol? Well,

it

we

we can mea-

are physiologi-

compared with when we this point, is this

does to the

are unhappy.

chapter doing in a book

turns out that the emotions are strongly linked

with both our cholesterol levels and with the degree of clogging of our

Meet George Kaplan, Ph.D., chief of the in the California

Human

Department of Health Services

arteries.

Population Laboratory

in Berkeley.

He and

his co-

men

in a Finnish

heart study that investigated the medical and lifestyle influences

on the devel-

workers examined the medical records of eleven hundred

opment

of atherosclerosis.

buildup of

fatty deposits in

They learned

that

depression intensifies the

both coronary and carotid

the effects of other risk factors

arteries

by amplifying

and thus increasing the chances of suffering a

heart attack.

Kaplan found that smoking almost tripled the amount of atherosclerosis in the arteries of depressed

men. The impact of LDL on clogging was nearly

men when they were compared with more emotionally Men who were depressed and had high circulating levels of

double in depressed

happy

individuals.

the protein hbrinogen, an essential part of blood clot formation that encour-

ages plaque development in the arteries, were almost four times as likely as

men who were not depressed to develop these deposits One of the arguments used against the belief that are responsible for heart disease has long

in their

blood

vessels.

cholesterol elevations

been the observation that while one

person with a high count has a heart attack, another person with an equally elevated level doesn't have heart disease. As Dr. Kaplan points out, the psyche

may be the critical factor. What if the cholesterol level isn't so high that it narrows the arteries? Would negative emotions still have an impact? Definitely. Anger results in the very well

Happy

spasm

to the heart's muscle.

in the arteries of the heart,

The

result

Combine such a spasm with be and often

is

•

1

47

from the adrenal glands. That

release of the biologically toxic chemical Cortisol Cortisol causes a

Heart, Healthy Heart

stopping the flow of blood

either angina pain or even heart attack.

already narrowed arteries, and the situation could

is fatal.

We know that the good cholesterol HDL can block the deleterious effects bad LDL. But those who

of the

easily

become angry and who

negative emotions have lower levels of

son

at

Brigham and Women's

HDL. A coincidence?

register other

Dr.

JoAnn Man-

Hospital in Boston explains that every time one

experiences a strong emotional response, the body produces more Cortisol and adrenaline, both of

which lower HDL.

But what about more chronic, Ungering, negative emotions, such as what

might be termed hopelessness? Such individuals are sad, lack optimism, and are, again,

agnosed

unhappy. They

aren't overtly

as clinically depressed.

angry or

hostile.

They wouldn't be

They're mildly depressed.

If

nothing

is

di-

done

about that chronic unhappiness, these people progressively damage their cardiovascular systems.

One

researcher looking at this problem

Dr. Robert

is

Anda

of the Cen-

ters for Disease Control and Prevention in Atlanta.

He and

his

team tracked

nearly three thousand adults for twelve years,

whom

were

free of heart

disease and other chronic illnesses

of the volunteer subjects

all

of

at the start of the study.

About

1 1

had symptoms of mild depression; another

percent 1 1

per-

cent cited moderate hopelessness, and 3 percent reported severe hopelessness. All three

groups had a signihcantly higher heart disease death

rate over the

years than more emotionally healthy individuals.

Death was four times greater

in those

with severe hopelessness than in

those without such negative emotions. Nonfatal heart attacks were also prevalent in the

unhappy

individuals. Dr.

pression and hopelessness

may

Anda

more

speculates that prolonged de-

contribute to heart disease by promoting the

formation of blood clots and the thickening of arterial walls.

Then

there's

blood pressure, another major risk factor

as well as for stroke.

Looking

in Massachusetts, investigators

at participants in the

rises

Framingham Heart Study

found that heightened anxiety, intensified anger,

and suppressed expression of anger increase the Blood pressure

for heart disease

with anger, and

when

risk of hypertension.

that anger subsides, the pres-

sure goes back to normal in healthy persons. That's referred to as labile hypertension. But

when emotional

the pressure rises

and

falls for a

flurries get

strung together on a regular basis,

while but eventually stays up. Liken the phe-

148

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

nomenon

to a

rubber band losing

too often and too

our fast-paced, uncertain society have feelings of

living in

Most manage

to cope.

But for some that anxiety becomes severe. Doc-

Department of Health and Social Behavior tracked nearly

tors at Harvard's

hundred men

fifteen

up

for

to thirty-two years,

fatal

symptoms

of severe

two or more symptoms had more than three

of anxiety, those with

times the risk of a

noting

Compared with men showing no

anxiety and observing their heart health.

symptoms

spring back after being stretched

far.

Many people anxiety.

ability to

its

and more than

heart attack

five

times the odds of sud-

den death. This too

much

is all

quite frightening stuff, and

anxiety for you! The good

one can modify behaviors

to lessen the

mean converting

No, this does not

and I'm not going

is

I

hope reading

is

it

hasn't caused

that, as for other risk factors,

danger of negative emotional

to a life of passivity

states.

and purposelessness,

waste paper on publishing more bromides of count

to

your blessings and smell the tions

news

roses.

However, coming

an integral part of a heart-healthy

lifestyle.

to grips

with one's emo-

The solutions

are real

and

they work.

For openers, stress in various forms, and face.

But

how we

life

itself is

not a bad thing.

We all experience stress in

wouldn't be very interesting without the challenges

deal with that stress

one way, that cardiologist

I

spoke of

makes

earlier

we

the difference in the world. In

all

was somewhat

correct in

compar-

ing physical and psychological stresses. By purposefully adapting to them,

we

can become more capable of enduring both.

One does a

not begin a physical fitness program by going out and running

marathon or entering

the block

and perhaps

sistance to stress a

a weight-liftmg contest.

a few sit-ups. Similarly,

little at

a time,

It

we

starts

with a walk around

learn to strengthen our re-

and we just might need

a personal trainer to

get us started.

You need

a

blood

test to

determine your cholesterol count, and your

doctor can measure your blood pressure. But only you can determine whether you're at risk because of your emotional state. This

may seem

many

conclusion that answer-

researchers, but over the years I've

ing just one question

makes

come

the diagnosis: Are

to the

simplistic to

you happy or unhappy?

You could take personality assessments and subject yourself logical profile analyses to

determine your anger,

hostility,

hopelessness, or any other emotion. But you can easily cut out the

and just ask

yourself.

Am

I

happy or unhappy?

to

psycho-

depression, anxiety,

middleman

Happy

Of

•

1

49

course, that's not like asking whether you're pregnant or not preg-

nant. There's a lot of gray between the black are going to describe mainly a relatively

happy,

Heart, Healthy Heart

and

that's pretty certain,

diac risk every day

it

and white. Those shades of gray

happy

state of affairs. If you're

that unhappiness,

my

friend, puts

you

un-

at car-

continues.

Lowering your cholesterol

level

and blood pressure can certainly pro-

vide a sense of satisfaction and gratitude that your risk has been reduced.

I

doubt, however, that such accomplishments will leave you feeling exuberant for

On

days and years to come.

of unhappiness can

make you

can get happier! Again,

risk

I

the other hand,

feel,

well,

seeming

overcommg your

happy! Even

happy now, you

you're

if

current state

simplistic in this analysis, but

some-

times the most significant truths are, indeed, quite simple.

How

does one begin to seek happiness? Seeking a guru

Tibetan peak

isn't

way. However,

possible to change, to

make emotional

curse the dark; light a candle. As we'll see, there are a

own

way, but knowing the options

is

adjustments. Don't

number

the dark. Besides candles there are flashlights, bonfires, find his or her

top of a

very practical and probably wouldn't be too productive any-

is

it

at the

of ways to light

and lamps. Each must

a start.

IDENTIFYING YOUR UNHAPPINESS

Why

aren't

yourself that

you happy? Do you know? Can you say with honesty

you were

if

to

make

you would be happy? Then, by

may be your job, your spouse, for?

Few

might be

things

m

life

are.

a certain

all

or

change or

means, go

some

for

it.

factor only

to

attain a given goal that

The cause of unhappiness

you know.

Is

it

worth dying

Cutting loose from the cause of your unhappiness

difficult in the short term,

but the change

is

essential for long-term

health. It

may

well be that you're unable to identify the cause of your distress.

You may answer yes

to a

number

of the following:

Difficulty in sleeping at night Little

motivation to get out of bed in the morning

Little

enjoyment

in

life's

pleasures

Thoughts about death being an Lack of

alternative

satisfaction in vocation or avocation

Frequent sadness, hopelessness, crying

150

If

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

more than one

of these phrases apply to you,

fessional counseling.

more than

calls for

you were

If

a

Such depression quick

strongly urge you to seek pro-

1

classifies as a life-threatening illness

and bright-red,

to cut yourself in the kitchen

was spurting from the wound, you wouldn't apply can provide.

stitches only a health professional

from it.

a ladder

You

when

If

revealing

it

is

arterial

a Band-Aid.

skin,

blood

time for

It's

you broke your

and the bone protruded through the

get the point. Depression

Start with

and

fix.

leg falling

you wouldn't ignore

very real and nothing to be ashamed of

to a professional healer.

own

your

physician. You'll probably be surprised that he or

she registers no shock. That's because depression frequently treated.

The only way depression can

doctor has a number of options

what

to a psychologist for

will

is

so

common

get better

at his

or her disposal.

most

likely

is

today and so

to treat

One option

is

it.

Your

a referral

be a remarkably short period of

counseling. Happily, most insurance plans cover psychological care. Your

may opt

physician

Taken on

They can for

to

prescnbe one of the antidepressant drugs such as Prozac.

a short-term basis, lift

such agents have proven remarkably

you out of depression enough

for

you

effective.

to recognize the potential

happiness you actually have but were blinded to by your emotional

Much

has been written about Prozac, and there

cating that effort. Suffice

it

to say that

if

is little

antidepressants are used properly and

with adequate guidance, those drugs can be the equivalent of a tossed to a

tive role in

life

preserver

drowning man.

Getting out of a deep rut

amount

state.

point in dupli-

is

important.

It is

then necessary to take an ac-

maintaining one's psychological equilibrium, which takes a certain

of effort.

which, just

View your work

like physical fitness,

as

your program of psychological

you have

to

do by and

fitness,

for yourself.

WILLINGNESS TO CHANGE Dr.

Suzanna Kobasa of the University of Chicago found

least stressed individuals are those

who

have the "three Cs"

that the happiest,

in their lives:

com-

mitment, challenge, and control. Commitment might be the result of one's belief in

one's

work or

career or devotion to one's family. Challenge provides a

sense of satisfaction in seeing a job done well, whether in one's work, play,

church

efforts, family,

tantly, control

or other endeavors. Finally, and possibly most impor-

means having a reasonable degree of freedom

to "do

it

my way."

Happy

While top executives may be perceived dle

managers

under the

are

as

having the most

in the

middle are expected

I

spoke of orchestra conductors

able degree of control,

long

a while back; they, too,

commitment, and challenge, and, not

at-

have a remark-

surprisingly, live

underlying sense of pessimism pervades the unhappy

one might expect, those

classified as pessimistic are

prone

spirit,

and

as

to heart disease. In

patients with pessimistic views regarding their recovery following heart

attacks are far

more

likely to

have a

optimistic or pessimistic plays an

prophecy Whether one

self-fulfilling

enormous

role in all aspects of

mately determines happiness or unhappiness. The salesman believe that this will

a given ap-

have the heart

lives free of heart disease.

An fact,

perform tasks and

who

proach or management philosophy They're the ones

mid-

the decisions

performance whether they agree or not with

to achieve levels of

tacks.

to

151

•

stress, in truth

Top executives make

greatest duress.

and see them through. Those

Heart, Healthy Heart

do

so.

is

the day he'll

The only way

make

that big sale

easily; for others,

would

recommend another book

is

ulti-

who continues to who eventually

the one

is

To

has to be learned. To that end

it

I

your reading: Learned

for

Optimism by Martin Seligman, Ph.D., professor of psychology of Pennsylvania. Be an optimist and believe that reading

some

and

to get that girl to say yes to a date is to ask her.

some optimism comes enthusiastically

life

it

at

the University

will help

change

of your attitudes!

stress busters

(who

ya

gonna

call?)

Not too long ago, the connections between doing one thing and achieving another were not well understood.

How

ier?

That millions of

men and women from

been doing meditation

Then

scientists

could

more

ing to think about nothing cause one to be

cultures

to

measure the changes

and physiology achieved by those practiced found reduced blood pressure and heart changes in brain waves on sophisticated chines.

mones

make

They measured increased in the blood,

one's risk of heart disease

that

plummet.

and attemptand health-

over the world had

its validity.

in the

body's chemistry

in the skills of meditation

rate.

EEG

levels of

and they concluded

all

prove

for centuries didn't really

began

sitting quietly

relaxed, at ease,

They recorded

and

significant

(electroencephalogram) ma-

calming neurotransmitter horall

these things could and

would

152

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

For some, meditation has been

member. They

call

prayer. Dr. Herbert

it

wrote about meditation

tal

lowed the

that

titled

back as they can

re-

Benson of Boston Deaconess Hospi-

book The

in his first

up with another

enormous power While prayer

a part of life as far

Relaxation Response and

Beyond The Relaxation Response

fol-

when he saw

of prayer as a calming practice.

calls for

one

to

pay active attention

recited, meditation seeks to free the

mind

of

all

to the

words mentally

conscious thought.

Some

in-

dividuals are able to learn the process themselves, perhaps aided by one of the

many books on

YMCAs

at

the subject. Others benefit from training available in every city

and elsewhere; yoga centers

will typically

have information as to

where one can take lessons on meditation. For those

who

might be just the thing. Here, Biofeedback

is

some

too,

to relaxation, biofeedback

training can facilitate the technique.

predicated on the individual's ability to consciously alter phys-

We all can do a bit

iological states of the body.

By

approach

prefer a high-tech

of this without any instruction.

actively controlling one's breathing, for example,

rate.

one can reduce one's pulse

Devices enable one to physically measure physiological changes brought

about by conscious

effort in

much the same way that lie detectors measure

gal-

vanic skin responses.

One

of the

work together

most remarkable demonstrations of how the mind and body

involves the simple act of smiling.

muscles into that posture

known

as a smile,

When

calming substances, including serotonin, and your to

hormones

increase blood pressure,

that constrict the

and make you

feel

blood

in anger,

when

things

happen

here's the really remarkable part.

smile even

when you

don't feel like

that

make you angry and

it

a try;

— and

it

will

it.

If

to lose except

sure-fire

breathing. Sure, you breathe deliberate. in

and of

The

It

forms the basis

itself to

activated se-

LDL counts,

feel like

hostile.

smil-

Okay,

you're feeling angry, force yourself to a traffic ticket

be almost as though you've swallowed a Valium. Give

what do you have

Want another

of

Your body responds favorably when you

—

example

is

your body

vessels, raise

smile through whatever unpleasantness you're experiencing for

facial

number

on edge and uncomfortable.

Well, that's very nice, you might say, but you don't often ing, especially

a

immune system

enhance good health. Conversely, when you scowl

cretes deleterious

you move your

your body releases

way

all

to

your anger?

change your

mood

for the better?

the time, but this kind of breathing

for all relaxation

techniques and

may

is

Try

deep and

be enough

provide the regular calming that you need.

difference

between the regular breathing we do unconsciously and

Happy

deep therapeutic breathing

is

sofa to get a snack during a

ation

and

commercial and jogging. Breathing

calm you during tough times has marvelous

to

153

•

between getting up from the

like the difference

TV

Heart, Healthy Heart

for relax-

powers

restorative

and, like smiling, results in the flow of beneficial hormones and neurotrans-

LDL

mitters that favor heart health, including the reduction of

cholesterol.

Breathing for relaxation takes no special equipment, clothing, or ties.

You can and should

cult

moments. But recognize

to

make

try to

do

that this

1

at a cardiologist's

complained that he found himself under a

support group session in Chicago

lot

or steal his parking space.

car, his level of stress

skyrocketed.

It

seemed

when driving his car. him off, change lanes er-

of stress

Other drivers just drove him nuts when they'd cut

I

diffi-

a skill and, as such, requires practice

is

perfect.

One man counseled

ratically,

facili-

every day, especially during tough,

it

that every time he got into his

Deep breathing, he

wasn't under stress.

The answer was

oping the

he could

skills that

later

most people, George was willing

no.

no good.

said, did

asked whether he ever practiced that deep breathing

at

times

then suggested that he do

1

when he devel-

so,

use in those stressful driving times. Unlike

to give

a

it

and

try,

a

few months

later

he

re-

ported that deep breathing really did work. It's

really too bad,

a legitimate

trial.

but most people really won't give relaxation techniques

I'm certainly not the

deep breathing, and very

likely you've read

have not attempted to make

it

part of your

avoid eggs, take antioxidants, and do cholesterol level

and improve your

as simple as breathing.

Well, here's the

person to write about the value of

first

Kind of

way

to

don't

do

At

life.

it

before. But

you probably

You'll convert to

skim milk,

sorts of other things to control

heart's

silly, it.

all

about

your

health, but you won't do something

you think?

least

once

a day, every day, set aside a

few minutes to relax and do some deep breathing. Pick a spot where you can

be alone, without interruption, where

it's

quiet

and dimly

lit.

You can

sit

in a

comfortable straight-backed chair or on the floor with your back against the wall and your legs crossed. Close your eyes, put your hands

on your

and keep your elbows

slightly

close to your hips. Let your

and begin

to take a deep,

head

up from your

rises

fullest capacity.

expanding

Then

to

deep breath

chest and

you

in

head

accomodate

all

that

it all,

air.

feel

Now

feeling

forward

through your nose, such that your the air filling your lungs to their

Pay attention to that breath. Feel the

slowly, slowly release

fall

thighs,

air.

Sense your rib cage

hold your breath

your body

for a

few seconds.

literally deflating like a bal-

loon with a slow leak. Then begin the process over. Start with two minutes and

154

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

build 10 ten. Afterward you'll

feel

relaxed, even the

and

time,

first

just keeps

it

getting better.

While doing your deep breathing, don't think about your work, your your finances, or anything

kids,

your choice:

a

your

else in

mountain glade with

beach with the waves gently rolling

the

in,

the leaves turn beautiful colors of gold, red, special place in

your mind,

do not want

I

when

stressed,

and

as

relaxation but also

when

is a skill.

it

be

will

at

it

it,

a pristine

autumn day

a crisp

and orange. Take yourself and

the while deeply breathing in

all

George found,

"turn on" this special tool,

Picture an idyllic setting of

woods on

be redundant about

to

breathing as a relaxation technique tice

life.

stream running through

a

this,

Try

it

as

to that

out.

but remember that deep

without any previous prac-

when you

won't work. But

learn to

your disposal not only during times of

stresses threaten

your well-being.

MINDFULNESS The swamis and

passively, as

is

called

it

"walking meditation." Rather than

the case for standard meditation, this

acutely conscious while being active.

is

sitting quietly

the practice of being

An example of mindfulness is paying con-

centrated attention to one's breathing while briskly walking, jogging, or swim-

ming.

No

longer

is

that activity boring. Rather,

body's natural functions. at rest,

wet the

to

T-shirt,

and

purifying and cooling

is

it is

it

I'll

itself.

good because one

all

is

life

means

is

try

I've

leg.

It

spoken with, meditation

might be right

my body and

close attention to the trees. In the

afternoon

the things around me.

dew on I

Out

revel in the sensation of the

I

things.

mean spending

the

classic sense. Sit

is

is,

for

me, un-

daily renewal, a part to.

But not for me. By

is

perfect.

I

become

early in the

acutely

morning,

I

pay

ground and hanging on the needles of pine

glory in watching the sunset.

evening, I

the

fore-

how

for you.

For me, mindfulness or walking meditation

aware of

on the

Appreciate your body.

wonderful and something to look forward it.

when

Concentrate on the miracle of walking,

admit that I'm not an accomplished meditator in the

that

than

aware of

while and do some deep breathing, sure. But to meditate

comfortable. For others of

with awareness of the

the body. Sweat begins to form feels

balancing on one foot while swinging the other

for a

filled

feels also the heart beating, far faster

pumping blood throughout

head and

body

One

Now,

I

sun on

don't

my skin.

mean just

a great deal of time concentrating

Later in the

noticing those

on them

— catch-

Happy

Heart, Healthy Heart

155

•

ing the glistening of that dew, studying the colors of that sunset. Whatever the

time of the day,

know

I

I

immerse myself

my health, my heart would

a

and well-being.

I

ease as

and

I

I

in the

but for the grace of

that,

my

marvels of

God and my

body's functioning.

determination to fight

disease might well have killed me. Just as

most loathed enemy and destroyer, so now don't take that health for granted.

continue to work hard to maintain

it.

As

1

when

Most people health are.

was

not traveling,

just don't get

They don't

a patient of Dr.

I

it.

feel

my health.

They don't

new

health

to attain

it,

I

work out

sense

realize

how

gym

in the

flow through me.

it

wonderful

life

and

One such person

Martin Rossman in Mill Valley, California. Marty worked

he guided her through a process a

my

love

worked hard

I

give their bodies a second thought.

with her as she recovered from a heart attack

made

hated the dis-

1

walk on the beach or climb

the stairs in a building instead of using the elevator or

every morning

I

for

known

at the fairly early

as imagery.

age of

fifty-six;

As time went on,

Sally

friend: her heart.

She had

really paid

no attention

to that

magnificent organ in the past.

Like millions of Americans, Sally abused her heart with a high-fat diet, cigarette

smoke, and sedentary behavior. After her MI she changed those haviors but needed more. Dr.

with her heart, to get to in her chest, providing a very real

way and

Rossman taught her how

know it

as a friend, to be

to

aware of its untiring

blood as needed. Today she pictures her

thinks about

it

lifestyle

be-

have a conversation

and "communicates" with

it

own

activity

heart in

regularly

when

walking, working, or relaxing. I'm sure that Sally and her heart will get along beautifully for

many

years to come. She and her heart are healthy and happy.

what's most important? What's the most important thing you can do

to protect

your heart

against disease? Lowering cholesterol levels? Losing weight? Controlling blood

pressure? Quitting smoking? Exercising regularly? Certainly those are

components chapter that to

may

in this or

any program of heart health. But,

be the most important chapter

major

m this entire book.

I

truly believe

have a healthy heart you must have a happy heart.

How can anyone be

expected to follow a low-fat diet or quit smoking or

choose exercise over an extra thirty minutes

happy?

all

in a very real way, this

Why

bother to save a

life

that isn't

in

bed when

worth

living?

that person

When

one

pressed or angry, that bacon, double-cheese, monster burger washed

is

un-

is

de-

down by

156

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

an exira-nch chocolate milk shake and accompanied by a

mouniam

of fries

can be one of hfe's small consolation prizes. Give such food up? Hell no, make that with

double the special sauce! Only when one reaches some

state of

hap-

piness can one expect to go on to that next plateau of seeking improved health.

Think about

it.

Stress, anger,

unhappiness, whatever you want to

call

it,

not only sets the stage for heart disease by raising blood pressure and cholesterol,

may

bnnging on spasms of the

be the precipitating factor

my father, my brother, tional distress is

no pleasure

cigarette,

a

all

those terrible things, but also

for a heart attack.

countless people

major

and

I

I

know

that

was the case

for

have spoken with, and myself. Emo-

risk factor. But, unlike those other risk factors, there

in stress, anger, or hostiUty.

You may enjoy

that cheeseburger or

but there's no joy in being unhappy.

Like tion for

is

arteries,

all

you

risk factors,

will

however,

this

one can be modified. Maybe the solu-

be as simple as doing some deep breathing. Maybe you need

something more, such

as biofeedback.

Or perhaps

assistance in counseling or medication. Truly that's

you'll require professional

no

different than

how one

person can lower his cholesterol with just a few dietary changes while another

might need

a

dose of niacin or even prescription medications to control hers.

The important thing

is

to get the

You and your heart

will

job done.

be happy that you did!

12

•

•

The Ultimate Solutions FOR Weight Control

Read the loss

matters,

who

title

of this chapter carefully.

and weight control

which

are highly

are not served

be considered. We'll look

by

says solutions, not solution. Weight

a one-size-fits-all

much

has weight to lose has

It

complex physiological and psychological

in

common

approach. While everyone

with others, differences must

those commonaUties and special needs in this

at

chapter.

Overweight poses problems of epidemic proportions States.

A

study pubhshed

1994 revealed

m

in the

United

the Journal of the American Medical Association in

that one-third of

all

U.S. adults are considered overweight,

weighing between twenty and twenty- four pounds or more than they should. That's not just a cosmetic concern. Obesity, weighing

20 percent or more over what you should,

hazard. Losing weight lowers blood pressure, often to a degree that

is

a health

makes

tak-

ing hypertension drugs no longer necessary. Attaining a healthy weight can virtually eliminate the

symptoms

pounds on threatens one's

Hfe

Type

of non-insulin-dependent

When weight comes down, so do cholesterol counts.

II

diabetes.

Conversely, keeping those

by way of high blood pressure, diabetes, and

cholesterol elevations.

And women,

especially,

may

suffer

the Nurses' Health Study in Boston, Dr.

gain even a modest heart disease as

amount

even more. Looking

JoAnn Manson found their

vard study, published in 1995, tracked the health of

women

data from

that those

who

of weight over the years have an increased risk of

compared with those who keep

At that time, the

at the

were asked

how much

1

weight steady. The Har15,818

RNs

since 1976.

weight they had gained since

they were eighteen. In the years a

between 1976 and 1995, those gaining

25 percent higher

risk of heart disease.

Women who

increased their risk by 64 percent, and the nurses

44 pounds

tripled their risk.

1 1

to 17

pounds had

put on 17 to 24 pounds

who had

gained more than

158

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

WEIGHT VERSUS HEALTHY WEIGHT

IDEAL

Which weight many pounds

of so

tables are for

most appropriate? You know the ones:

—

considering body-stature type. In perts

— those

a range

men and women, sometimes also my opinion and that of many weight ex-

varying height for

tables are worthless.

The ranges

stated are so

and

of lean muscle tissue

wide

that they

have no meaning. The proportion

not considered and special medical conditions

fat is

are not taken into consideration. Let's shoot, instead, for a healthy weight.

For example, as

blood pressure

little

as a 5 percent reduction in weight can reduce

significantly.

But diabetic patients in that condition might have

to achieve a 15 percent It's

weight reduction

A

tained even twenty or thirty years ago. for

what you weighed

at, say,

pounds then?

If

healthier approach

when you

felt

Don't give in to popular old-wives' after you've

college, don't believe that

But weight alone

us, the

to

There

Is

If

proportion of muscle and

fat

you were

if

age, there

happens

exactly

larger the proportion of lean

is

muscle

muscle

tissue diminishes.

calories,

The process Gradually the the exchange

lost is

even the same diet

tissue, the

as

it

did before, but

I

to

an

in-

what they

more

calories

men

can eat

it

or lose

It"

physical activity

adage.

will eventually lead to

is

replaced by

fat.

At

first

there

pound-for-pound. Slowly the body, with

energy and deposits

a ten-

With

less

weight gain.

insidious, going entirely unnoticed perhaps for years.

is

muscle

acting as the calorie-burning engine,

than

the old "use

It's

is

that, for

capable of burning calo-

more than most women of the same age and circumstances. As muscle to burn

rea-

not overweight.

one can consume without gaining weight. That's one reason most

lessens,

Is

changes owing

who weigh

Science has an explanation. Only muscle tissue

The

you

a football player in

we

really

tissue

creasingly sedentary lifestyle. In fact, even those

ries for energy.

If

Did you weigh 130

fat.

no excuse. What

did in college are likely to be "overfat"

aim

no physiological

is

only part of the story. Yes, as

to gain weight, but aging

most of

tales.

had children.

muscle turns

tells

best as well.

to

an "ideal" weight of 130 pounds now.

not, don't try to achieve

son to weigh more

would be

age eighteen or before you started to gain.

think back, that was probably

dency

an improvement.

to see

rather unrealistic to shoot for an "ideal" weight that one never at-

I

fat.

is

One can

no longer able

is

no weight

far less

to use

honestly say that

gain, as

muscle

tissue

incoming food as

"I eat

no more today

keep putting on weight."

Does everyone go through

this

unpleasant process? No.

Some

avoid

it

The Ultimate Solutions Jor Weight Control

by maintaining

partially or entirely

about that

first

thing to do

Getting back

down

and

to

is

tissue.

More

to

wear before

not reasonable.

is

your early adult weight when you were feeling healthy,

terrific is.

Expect success. Don't

concern you.

First,

those scary headlines about 90 percent failure

let

those

numbers come from

weight-loss industries that are often

even a 90 percent

There's no reason

more geared

more answers today

science and medicine have cess. Third,

your healthy weight.

to set a reasonable goal for

you were never able

Fitting into a dress size

rates

59

later.

The

energetic,

1

a lifestyle that includes regular physical ac-

maintain and perhaps even increase their body's muscle

tivity to

•

why you

failure rate

the totality of commercial

to profit

than health. Second,

that can help ensure

means

your suc-

a 10 percent success rate.

shouldn't be the one to succeed.

DEAR DIARY

What come even

did you eat yesterday?

remembering

close to

dieters unable to lose weight caloric intake

by 500

about

accurately.

on

calories per

How

last

A 1994

week? Most people

study demonstrated that

a 1,500-calorie diet

day as well as

can't

underestimated their

their exercise

output by about

1,000 calories per day.

They weren't

deliberately lying.

It's

just difficult to

much attention to. Many overweight men and women

things

we

remember

accurately

don't pay

truly believe they eat "like a bird."

may not eat all that much at one sitting, but they tend to eat almost continuously. So how much do you really eat? And even more importantly, what do you really eat? Probably you don't know Well, that's probably accurate, since birds

the answers to those questions with any accuracy or precision.

As

a very useful first step, then, start

thing you put into your water.

Do

mouth

keeping a food

— everything you

that for a couple of weeks,

and

needn't share your journal with anyone

you'll

diary.

eat or

Record every-

drink

— including

probably amaze yourself. You

else. It's

not meant to embarrass you

but, rather, to start an education process. It

doesn't matter whether your target healthy weight calls for losing ten

know your starting point accurately. SciThen looking at your own records you'll be able

pounds or one hundred. You need entists call that the "baseline."

to

make some judgments about

to

the necessary changes.

160

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

Virtually every weight-loss expert I've talked with over the years agrees

when thinking about how few much trouble. Perhaps they don't

with this approach, yet most shake their heads

people follow

want

to

it.

Maybe people think

admit their

come your reasons tween success and It

own

it's

too

behaviors, even to themselves. But

for resistance, the

bound notebook you can keep you don't want sloppy

data.

nuts," take another handful

more

you can over-

the difference be-

My

If

preference

Remember

you've marked

a small, spiral-

and count those

Remember, no one

that this

down

is

a pencil or

science,

and

handful of mixed

"a

nuts. But don't eat that

alcohol blur your perceptions: was

like three or four?

is

your purse or pocket along with

in

pen. Be as detailed as you possibly can be.

let

if

failure.

doesn't have to be anything fancy.

handful. Don't

mean

food diary can

second

really

two drinks, or

will see this diary

but you. Don't

it

cheat yourself.

SMACKING: THE AMERICAN OBSESSION No one for the early

in the

world snacks

like

we do

in

One

America.

economic woes of EuroDisney was the poor

compared with those gers, but think

at

the Florida or California parks.

about your

own

habits

and look

at

I

of the reasons

sales of

won't point any

your food

much

as

fin-

diary.

Probably the worst part of the American snacking obsession the habit itself as

snacks as

isn't

much

so

what we snack on. Most people don't reach

for

an

apple or a bunch of grapes or a breadstick or a carrot. Chips, cookies, candies, cakes, and pies are the snacks of choice. Calories pile

up

fast.

Frequently an overweight individual skips breakfast, has a tiny lunch, then a horrible, enormous dinner. "Worse, eating continues through the entire evening, often a response to stress. authorities, including

UCLA's

Compare

that eating style with

Dr. Heber, consider to be the

what most

most healthful ap-

proach: several small meals throughout the day While four to six or seven

meals daily

may make

sense theoretically, most Americans wouldn't find that

practical.

But

it

is

possible,

and even

practical, to hit a healthy

compromise.

with a good breakfast of your choice. Have a lunch that you've planned vance. See chapters

23 and 24

for

some

suggestions.

time to pass before your next food intake.

Then

Start

in ad-

don't allow a long

The Ultimate Solutions for Weight Control

you're ravenous

If

when you

sit

down

161

•

beyond your

to dinner, you'll eat

needs, before the body's blood glucose "fuel gauge" has a chance to kick

when snacking can be

Here's

Have something Michigan

healthful

an hour before dinner.

to eat at least

State University

by regularly eating two

and actually part of a weight-loss

slices of

When

down

the bread eaters sat

weren't as hungry and they ate

suggesting a piece of

fruit in

less.

blood sugar signaling

First,

set

up

a release of

that lasts

from dinner

With

off.

evening meal, they just

to the

if

you

eat less for dinner,

your compulsive snacking afterward.

huge amounts of insulin, which require

Second, you won't have

set

up

the

car-

"feedmg frenzy"

to bedtime.

today's frenetic schedules, seven hours might pass between lunch

and dinner.

If that's

the case for you, consider

a very real sense you're

now up

to five

dessert at the dinner table. Instead, save

number

satiety

and vegetables.

less ravenously, you'll lessen

you won't

at

weight

Other experts update that approach by

But what about the evening snacking? Probably

bohydrates to balance

study

lost

addition to the bread, since most of us do not get

the daily five servings of fruits

and do so

classic

bread before meals. They effectively killed

their appetites, as the bread resulted in a rise of to the brain.

A

by Dr. Olaf Mickleson showed that people

in.

plan.

meals it

two snacks during daily.

that time. In

Next, put off having that

for later as a snack.

You just

hit

meal

six.

But what about classic American snacking?

Many

dietitians

recommend

replacing the chips with sliced fruits and the mixed nuts with carrot sticks.

Some people can them,

actually pull that

off.

Not many, but some.

If

you're one of

entirely.

View snacks,

terrific. If

you might consider swearing

not,

off

snacking

even the nonfat versions, in the same way that smokers trying to quit view arettes.

It's

almost impossible to "cut back" rather than going "cold turkey."

Find something a walk.

cig-

Read

a

else to

book.

occupy yourself at the times you normally snack. Take

Go

to a lecture

— do anything, go any

place,

where you're

not likely to tear open a bag of corn puffs or a Butterfinger.

Snacking

is

a habit.

You can break

that habit.

BEHAVIORAL MODIFICATIONS Weight-loss techniques have, like most things, changed over the years.

Some

things are fads and deserve to be forgotten. Others are relegated to lesser

162

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

imponance. That's the case with the approach called "behavioral modifica-

was so popular

tion" that

The

in the 1970s.

prevailing theory back then

was

that

responsible for weight gain. Eating too

fast

resulted in eating too

down between

your fork

Chew your

bites.

our eating habits were largely

foods so

many

lowing. Never eat in front of the television. Use smaller plates.

and savor every

attractive

The advice went on and

bite.

much, so put

times before swal-

Make food more

on. Valid?

Such

niques might be helpful to some people, but they don't really get

tech-

at the

un-

derlying problems, both physiological and psychological.

On plete

the other hand, those

program of limiting

little

calories

tricks

can be a useful adjunct to a com-

and increasing exercise

detail in the balance of this chapter. There's

watching TV, breaking that habit

SUPPORT GROUPS

no doubt

that

as we'll discuss in if

you snack when

will help.

AND

COMMERCIAL CENTERS Are you the kind of very open person

who might

actually enjoy talking

about yourself in front of a group of people? Then "confessing" on a regular

Anonymous might be not the way to go.

basis at Overeaters sort of shy, this

is

useful. If you're a private person,

Support groups can be the secret ingredient tually

ment

undermine your

can make the

one

efforts

and lead

may As

final decision. Realize that

turn you

off,

to failure. Before

groups

making

a general rule,

women do

will benefit or that

Weight cial

a

differ significantly,

loss has

commit-

Only you and while

another might offer the assistance you need. better with support groups than

That's also true for cigarette-cessation programs. But that doesn't

women

can ac-

in success, or they

of any kind, take the time to check out the group thoroughly.

no men

become

do men.

mean

that all

will.

a mullibillion-dollar industry.

While commer-

weight loss centers aren't as popular as they were in the 1980s, they

main an option

re-

to consider.

Quality of service varies considerably from one vestigate thoroughly just ing. If the

and

company

what you're getting

relies

on prepackaged

for

company

to another. In-

your money. Get

it

all

in writ-

foods, calculate the realistic cost

over the expecte.d weight-loss period. Learn about the counselors.

Some com-

panies offer the services of registered nurses and nutritionists, while others

The ultimate Solutions for Weight Control

someone who has gone

hire previous customers. Talk with

163

•

to the center you're

considering.

Do such

centers work? Typically one can expect to lose weight as

promised, by foUowmg the program

nance of that weight

some

loss.

Long-term

The problem

lies in

mainte-

results are less than wonderful.

Still, for

faithfully.

individuals the commercial weight-loss centers can provide a

jump

start

to a successful effort.

How would

you

hnd

like to

cian specially trained in obesity

can

tailor a diet to

a weight-loss center that provides a physi-

management,

nutritionists

who

dietitians

your personal needs, psychologists and counselors

you with emotional hurdles, exercise physiologists

to help

to function as personal

and even researchers who can potentially apply cutting-edge tech-

trainers,

nology that won't be available

You can

true?

and

to the public for years?

find such centers in virtually every

Sound too good

to

be

major metropolitan region

of the United States. They're found in major academic centers such as Harvard in Boston;

Columbia /St. Lukes

in

Clinic in Rochester, Minnesota,

New York City; UCLA in Los Angeles; Mayo

and

satelUte centers elsewhere in the country;

Baylor University in Texas; the University of Chicago as well as Northwestern University and others in that city; and virtually everywhere there

Most people don't

school.

And for

realize these are

open and

is

a

medical

available to the public.

you'll get the very best care possible. Just call the nearest center

and ask

information about weight-loss programs.

COMPONENT FOR SUCCESS

THE ESSENTIAL

Suppose

told

1

program could

(1) help

ciently; (2) help fat to

be burned;

in a better

you

that a "secret,

magic component" of

your body burn more calories and do so more

end the vicious cycle of insulin

(5) build self-esteem; (6)

effi-

resistance; (3) release stored

help you sleep better, perform better

(4)

mood;

a weight-loss

at

work, and put you

improve your hgure

as well as de-

crease your clothing size; (7) lose weight consistently, helping to avoid plateaus;

and

(8)

provide the best

known

insurance against gaining weight

back. Oh, and as fringe benefits that magic

from

a

number

happier

life.

of degenerative diseases

Sound

like

snake

component

and contribute

whether trying

to lose

you

oil?

There's nothing magic about that component. Ufe,

will help protect

to a longer, healthier,

weight or not.

It's

It

belongs in everyone's

physical activity, otherwise

164

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

.

known about

as exercise.

this

Now, before you turn

me

magic ingredient, give

make your own

ihe page

and refuse

any more

to read

a chance, please. Just read the facts

and

decision.

FACT: The only

your body capable of burning calories

tissue in

One

muscle. The more you have, the more calories you can burn.

Dawn's good friends

is

younger and

than she

taller

Yet

is.

Dawn

of

is

lean

my

wife

can eat more

food and has an easier time controlling her weight. Her friend gets frustrated

because every bite puts on another pound. Simply enough. physical condition, has a better percentage of lean to

Dawn

is

in better

and exercises

fat tissue,

regularly.

As one

starts

an exercise program, the percentage of

may

of lean tissue increases. There

drop and the body looks

sizes

number of calories

regularly

fat

not be any weight loss at

drops while that

first,

As the amount of muscle

better.

but clothing

increases, the

burned grows, since the new muscle

needs

tissue

additional energy.

even

Ironically,

body

is

when one

loses weight

by simply cutting

incapable of burning calories any better than

it

calories, the

did previously. With ex-

treme regimens such as the OptiFast program used by Oprah Winfrey, icant is

amounts of lean muscle

tissue are lost

along with the

fat.

Thus

signif-

the person

actually less capable of burning calories than before starting to diet. That

was Oprah's problem. Sure, she was wearing those Calvins and

smiling, but

she had the deck stacked against her. Even small amounts of food inevntably

would bring

the weight back.

And

it

did, in front of millions of her fans.

Today Oprah maintains the weight tical

combination of components I'm proposing

and sugars and increasing

FACT: Any and the 1980s

on

tive

is

all

a daily basis. For

and you're more

you

exercise counts.

to join her,

more on

ting

ing

news

at a

and you've made

stair climber,

all

it's

fats

a matter of staying ac-

10.

commitment

the

to exercise

her; she'll

with you,

encourage you.

walk or jog when someone's waiting

commitment

that

enjoy,

and

to

for

to her.

you'll slick

with

it.

If

you hate

nowhere, don't even bother.

I

sit-

like to

or other equipment while listening to the morn-

gym. Dawn hates exercising

machines. So she takes

back on

no gain" philosophy of

pain,

that

You encourage

to take that

on the stationary bike peddling

use a treadmill,

to you: cutting

chapter

this, see

make

likely to succeed.

FACT: Do something you

The "no

Today we know

a friend to

tough to decide not

by using the iden-

exercise.

totally out of date.

FACT: Sign up

It's

loss she achieved

in the

morning, and she hates those

sorts of classes in the afternoon after

work.

The Ultimate Solutions for Weight Control

FACT:

best to

It's

do

You

bicycling the third, and so on.

be

We

FACT:

and

get less

all

of an exercise

strongly advocate yoga.

attend a class

at a

less flexible as

Look

for a tape in

and

different muscles,

we

age,

and

Go

you'll

dancing.

that leads to dis-

program should include stretching of your video store

all sorts.

buy or

to

I

rent or

YMCA or local gym.

FACT: Muscle grows when

we want

work more

will

65

1

walk another, go

day,

bored. Skip rope. Play with a hula hoop.

less likely to get

abilities. Part

Swim one

a vanety of activities.

•

to build as

strength training. As a side note,

used and atrophies when

it's

much muscle

we

as

it's

group of retirement home residents

it's

can, seriously consider a

never too

Remember

late to start.

in their nineties

not. Since

program of that a

were started on Nautilus-

type equipment. At the beginning of the program sponsored by Tufts Univer-

cooperation with the National Institutes of Health, the

sity in

were truly

frail,

unable

just six weeks, they

FACT: Keep what you

did,

a

out of chairs without assistance. At the end of

to get

were rejuvenated beyond little

how you

reward.

"If

You'll I

and so

do better

stick with

cure." "At the

at

if

first

be amazed

forth. You'll

dreams.

at

and

date,

how much you've

those early entries after a few weeks.

you

set certain goals

my program

end of the

their wildest

log to record your progress. Note the day

felt,

improved when you look back

FACT:

men and women

for

month,

I'll

two weeks

buy

that

and promise yourself in a row,

book

I've

I'll

a

get a mani-

been wanting

to

read."

FACT: Within

a

few weeks, you'll

start feeling better, sleeping better,

working more productively, and noting improvement pect of your will It's

become

life.

much

so

just as easy to

about every as-

a part of

your

lifestyle that

you won't want

program

to give

it

up.

form good habits as bad.

Think of yourself the elevator.

in just

After ninety days, only three months, your activity

as a physical person.

Choose the parking place

Walk

farthest

the stairs instead of taking

from the

store. Breathe deeply,

thinking about your breaths as you exercise rather than taking them for

Walk with purpose.

granted.

Is

Slow Exercise Best

Fast or

for

Weight Loss?

Many magazines have paced exercise

for

featured articles claiming superiority of slow-

weight control. The idea has been that such workouts,

in-

166

IHli

•

REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

eluding walking rather than jogging, burn

expend carbohydrates. But

while more strenuous activities

fat,

not quite that simple.

it's

mam-

Recent research has shown that slow-paced exercise has to be tained for

long periods of time to be

somewhat

miles burns

fat

problem

most people

is

for

effective. Yes,

better than does jogging that

is

time.

The

is

same

five

or

more

distance, but the

one goes, the quicker the workout

faster

and the energy expenditure

over,

walking four or

same

the

for covering that distance

whether by walking, brisk walking, jogging, or running. Second, research of calories

at

Georgia State University demonstrated that the kind

you burn during

a

workout

isn't as

important as the

used up those calories and have created a caloric

and according

that deficit later,

ing

fat

from your stomach and

ers

Some burned

three

used up the same energy

week

for three

came

to the

as quickly as

When

you can.

group of overweight

hundred

calories

at a brisker pace.

months. Both groups

same conclusion:

Rupp,

does so by tak-

it

hips.

In the Georgia research study, a a treadmill.

Your body makes up

deficit.

to physiologist Jeffrey

you've

fact that

If

lost 3

time

is

women walked on

by walking slowly, while oth-

They "walked"

percent of their body

four times a fat.

Dr.

a consideration, get the exercise

you have some

on

leisure time, say

a

Rupp done

weekend,

take a nice lengthy, leisurely hike or bike ride. Picture yourself as

eyes and

call

LIFESTYLE,

up

you want

that positive

NOT

to be, as

in the

way you

pectations of a healthy weight.

expect to do

it

for the rest of

switching from beef to tofu

that

you

I

harken back

will

go

weight control are

to

Whatever you do has

your

life;

be. Close

be a

your

reality.

thoughts of to

be

to hate tofu

Going on

a diet

—

it

If

even

realistic ex-

realistic

otherwise, don't bother.

— and you happen

enough

you

diet

to

by

won't be long

almost by definition

off that diet.

Most authorities agree for

will

to involve elaborate trendy fads or

eat.

before you go back to your old habits.

means

it

DIET

Weight control doesn't have major changes

you know you can

image frequently. Soon

fat

that the

two nutrition components

to cut

back on

and simple sugars. Those two represent concentrated

sources of calories and can easily be replaced by complex carbohydrates and protein.

Simple sugars

may

not be a problem for most people, as

I

explain in de-

The Ultimate Solutions for Weight Control

tail

on page 200. But

for

two reasons.

they're

First,

on the taboo

Ust for those

wanting

167

•

to lose

weight

simple sugars supply calories without nutrients. Sec-

ond, they invoke a release of insulin into the bloodstream, which actually cre-

more

ates cravings for

eride levels in the blood; sleep. Especially is

and

sugar; leads to retention of salt

dunng

and has

fluid; raises triglyc-

impact on well-being, mood, and

a negative

and

the early stages of weight loss

well into a maintenance phase of control,

it's

at least until

one

much

best to avoid sugar as

as possible.

For someone with just a general,

and on

fat

and sugar

bit of

weight

It

involves a condition

known

lose,

For insulin-resistant individuals, typically weighing

more

hormone

For those insidi-

at

UCLA.

at least

20 percent

no longer efficiently

insulin

m

an area of expertise of

renowned endocrinologist

than their healthy weights, the

loss.

sugar can be particularly

as insulin resistance,

Dr. Calvin Ezrin, an internationally

back on calories

weight

in particular, will achieve

with a significant amount of weight to ous.

to lose, cutting

dis-

poses of blood sugar (glucose) by either supplying immediate energy needs or storing

it

for later use. Therefore, instead of falling in

blood sugar

levels rise

and the pancreas

to metabolize the glucose.

The

secrete

more

response to insulin,

insulin in a further effort

resulting increased level of insulin in the blood

has several negative consequences.

High

levels of

msulin interfere with sodium and water metabolism. Tis-

sues retain sodium, which, in turn, retains water. in such individuals rise in the

is,

blood, often signaling a sort of prediabetic condition.

persons go on

Many

start to

Many such

to develop frank diabetes.

obese patients have compelling carbohydrate cravings that have

been linked with a deficiency in serotonin.

The

swings, depression, and sleep disturbances difficult

Much of the excessive weight

indeed, caused by water buildup. Sugar levels

and prevent proper

Desperate

resulting state of anxiety,

make weight

mood

control even

more

exercise.

for serotonin, the brain resorts to

manufacturing more by a

complex insulin-mediated disposal of amino acids out of the bloodstream spares tryptophan, the building block of serotonin.

The amino

promotes the easy entry of tryptophan into the brain sulin.

This temporary increase in serotonin accounts

that these patients feel after glutting is

short-lived

and the prolonged

that

sounds

much

fat-building, salt-retaining,

compound

like a terrible, vicious cycle,

it is.

in-

of the "comfort"

on carbohydrates. However,

ulating adverse effects of insulin remain to If

acid shift that

brought about by

is

for

that

the comfort

and appetite-stim-

the initial obesity. It

helps to explain

why

168

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

greatly overweight persons have

provides an understanding of

mental

state. Tragically,

and

to begin with: fat

And

such a

why

those

m

time

difficult

men and women

The

Virtually eliminating the simple sugars

fits

poor

rise.

Blood pressure

risk of heart disease multiplies geometrically.

and relying on protein and com-

plex carbohydrates while increasing physical activity a insulin resistance

are often in a

they turn to the very things that caused the problems

more. Triglyceride and cholesterol levels

there's

also

It

sugar.

increases significantly.

description

losing weight.

under control and lead

a time

little at

to very satisfying

weight

can bring

loss. If this

you, a physician's care will help. To find the right doctor,

one of the organizations mentioned on page

The paradox of

the 1990s has been

to nonfat foods in the

call

176.

how

so

many people have switched

hopes of weight control as well as cholesterol lowering

only to find that they actually gain weight. Most of those products replace

with sugars, and the result

is

a calorie

count as high as the

considered, that's not bad, and certainly might help

if

original. All things

management

cholesterol

were the only consideration. Moreover, the idea should be

fats

to replace

one serv-

ing of a high-fat food with one serving of the nonfat counterpart. But, too often,

not what happens. The nonfat label seems to give people the green flag

that's

to eat all they want,

Cut

fat,

and

their calorie intake goes

cut calones, lose weight.

It

really

bohydrate contains four calories. The same socks you with

at least nine,

is

beyond what that simple.

for protein.

gram

about 100

wine 140

calories.

calories;

and

a

before.

One gram

of car-

But that gram of

now

fat

believe

of alcohol provides seven calories. In

practical terms, a twelve-ounce can of beer has about glass of

was

and most nutrition researchers

eleven, calories. For the record, a

ounce

it

150 calones;

1.5-ounce shot of 80-proof

a seven-

spirits

has

But while those seem like large amounts, they pale in com-

parison with fatty foods.

Cut back on you'll lose weight.

the details of

fat

without replacing those

How can

how one

lost calories

with sugars, and

one do that painlessly? Certainly

I've

spelled out

can eat virtually everything one wants v^thout paying

the "fat-tax" throughout this book: snacks, breakfast, lunch, dinner,

meals in restaurants.

works

to facilitate

Start

USDA the

Let's

weight

look

some

specific

examples of just

with some ground beef for whatever dish you'd

Use

my method

how

this

loss.

standard ground beef

fat.

at

and even

of

is

30 percent

trimming

fat,

like to prepare.

yielding 270 calories just from

off the fat

from

a piece of

round steak

The ultimate Solutions for Weight Control

and you

prior to grinding,

Prefer a steak?

of

225

That's a savings of

fat.

yielding 171

fat,

A

get just 5 percent fat with only 45 calories calories in only

The same

from the

one 3V2-ounce serving.

6-ounce cut of choice

fat calories.

169

•

mignon has nineteen grams

filet

size portion of filet

mignon from

Meucci Beef (see page 239) has only four grams of fat, yielding 36

You

calories.

save 135 calories.

You never outgrow your need

but you don't need the

for milk,

eight-ounce glass of whole milk has eight grams of fat and to 2 percent low-fat

The next calorie

gram

step

is

to

milk and you're

down

to five

1

50

calories; cut

grams of

fat

and 121

percent low-fat milk, and the fat-gram count

1

count of 100; graduate to skim (nonfat) milk, and

of

fat

and just 90

Next we go

calories. Calculate

provides nine grams of

with one gram of

fat

A

cheddar cheese.

to

fat

and 60

40

each, and you'll save 30 to

of Kraft Healthy Favorites cheddar?

two with

you'll get less

a

than a

slice of the full-fat variety

Borden's Lite slices

for

calories. Prefer the richness

has four grams of

It

back

calories.

your savings each step of the way.

one-ounce

70 calories. Opt

to

is

An

fat.

fat

and 70

calories,

with a savings of 30 calories per ounce. Margarine ter yields ten

down

you're

when

it's

for

to

fat

toast?

One tablespoon

and 90

calories. Pick

some onions, do the

all

fat

with butter flavor

and calones. Use the

It's

Not But-

and

Pam and

Can't Believe

I

It's

And

you'll

Not But-

but a fraction of a gram of

all

and philosophies regarding weight

Cut

fat.

that

amount

of calories

an additional 3,500 calories and gain

To make a point,

Dawn's

late father

that time he

was

let

make

Ben decided

a difference? But

Now

for a little

by ten teaspoons per it,

is

and of

come and

go,

fat

but certain

that 3,500 calories equals lose

one pound of

The way

fat;

add

fat.

to simple sugars for just a

needed

that he

in his early seventies.

two teaspoons of sugar

pound

a

me jump back

to quit using sugar in his coffee.

thing

nating

loss

immutable. The most principal of these

facts are

one pound of

was

Can't Believe

I

the Lite version instead,

a smattering of calories. Beliefs

tle

it

spray to "lubricate" an ear of corn and zap

and

of

up

seven grams and 60 calories, a sa\dngs of 30 calories.

time to saute

get rid of practically ter

your

grams of

to lose

he'd

about ten pounds. At

do

Everyone laughed.

moment.

it,

he told the family,

How could such a

lit-

Ben was resolute and stopped putting those

into his five daily

cups of

coffee.

mathematics. At 16 calories per teaspoonful, multiplied day, that sugar

Ben cut out 3,500

came out

to

160 calories

calories every twenty-two days.

daily.

By elimi-

So every twenty-

170

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

two days Ben

pounds just

pound. In

lost a

less

than eight months, he'd

lost his extra ten

as he planned.

As we saw with the examples even more dramatic caloric

and getting some regular

I

used, cuttmg back on

deficits. Just

exercise,

by choosing foods with

one can gradually

can produce

fat

no

or

little

fat

attain the target healthy

weight.

BODY YOU WANT

FEED THE

On

page 44

go into some detail as to

I

how

to calculate the

grams of

fat

to allot yourself in order to bring the calories from fat m your diet down to 20

And

percent.

1

provide some examples of

fat

allotments for

men and women

with varying levels of activity and healthy weights.

Now when

I've

me

let

introduce a concept that

found very helpful

I've

done presentations throughout the country.

body you have,

feed only the

body you want and

away. You'll starve those extra, unwanted pounds

Take

a look at that table

like to achieve.

on page

people

like the

the rest will eventually go

right out of existence.

for that

person

physical activity. That's the allotment to gradually attain the

healthy weight you want. Sounds

for

you don't

Find the healthy weight you'd

.

Note the fat-gram allotment

If

it?

But

it's

me

her

story.

simple, doesn't

at that level of

body with

true,

and

it

the

works

beautifully.

A woman ally

in

Topeka, Kansas, wrote to

seen her weight go from 125 pounds

pounds after children. After hearing 125 pounds she

felt

me

tell

She had gradu-

when she was married to 140 Mary decided to feed only the

speak,

healthy with ten years ago.

Moderately active, Mary determined that she needed fourteen calories to maintain

Wanting that

350

each pound of healthy weight. That meant 1,750 calories daily

to follow

calories

ple sugars of to three

all

my 20

would come from about

kinds. Othervvdse,

weeks, she'd look

months, Mary arnved like

I

was on

percent of calories-as-fat approach, she calculated

a diet,

at the scales

in

found,

my

original

much

grams of

fat.

She avoided sim-

what she wanted. And every two

and see

I

that she'd lost a

pound. 'Within

book

"1

never

felt

never expect to gain those pounds back again."

Other readers have reported, more

gram

forty

ate

her target healthy weight, and she said,

at

and

Mary

to

typically, that they

followed the pro-

lower their unhealthful levels of cholesterol and

to their delight, that

weight came off without even trying.

The Ultimate Solutions Jor Weight Control

But today

foods available to

was back

in

First, there are

so

a lot easier to lose weight than

it's

The 8-Week Cholesterol Cure was all

published.

first

of us that are reduced in

we

foods as ingredients in the recipes

it

and

fat

calories.

171

•

1987 when many more Using those

we

enjoy as our personal favorites,

will

automatically slice off calories and lose weight. Every dish you love can be a "diet" food!

Second, thanks to SeQuester, one can

one

eats.

make of 1 1

Each

a lot of difference.

fat.

literally

reduce the

fat

in the foods

See chapter 7 for details. In terms of weight control, this product can

That's 45 to

calories per gram.

with meals.

It

tablet prevents the absorption of

about six grams

calories,

depending on whether one counts

Round

off to

66

it

50 calories saved per

Moreover, research with the product

SeQuester appears After

1

I

to

somehow curb

my

reported the product in

consumed

tablet

UCLA

at

indicates that there

fell

the appetite as well.

Diet-Heart Newsletter (see page 184),

and how they

sional in Hawaii wrote that she took

four

pounds while reducing her

adamant

lost

one

weight as well.

tablet a

day

for

cholesterol level from

that she did not diet, did not

may

absorp-

fat

me how

started getting wonderful letters full of success stories. Readers told

their cholesterol levels

as 9 or

adding up.

just keeps

be something more involved in weight loss than just prevention of tion.

fat

A

health profes-

one month and

220

lost

She was

to 206.

change her eating patterns, but

still

lost

that weight.

SeQuester

not a panacea.

It

would be absurd and unhealthful

to

block the

fat

is

from high-fat foods

at

should not replace good eating habits.

swallow handfuls of tablets

in

an

It

effort to

every meal. But as part of a total program,

or to allow a special treat or a night out on the

town now and

then, SeQuester

can be very helpful.

A FASTING WAY TO WEIGHT CONTROL Controlling weight a

is

a matter of controlling calories.

No one meal causes

person to become overweight, and no one day's calorie counting

you

to lose that weight.

Weight control

ercise over a period of time.

tallies

up

will allow

a matter of balance, calories,

Think of your weight

your body's accounting ledger sheet during that month

is

at the

as a sort of

bottom

and exline

on

end of a month. Everything you did

to the total registered

on the bathroom

Just as that special treat or that restaurant meal

is

scales.

merely part of the

172

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

whole

accounted

caloric intake,

week

can make up

to fast

on one

for

for those

side of the ledger, picking a day a

indulgences on the other side of the ac-

counting book. No, there's nothing unhealthy about fasting

remember

to

drmk

plenty of fluids. That

now and

means

then, as long as

you

eight-ounce

at least eight

glasses of fluid during the day, mostly as water. Flavor that water with a twist

of

lemon or

a squeeze of lime.

Keep

a

jug handy.

Juices can replace part of the water, but remember that

breakdown

calories. Here's a

all

eight-ounce glasses of some

for

juices have

and veg-

fruit

etable juices:

120

Apple juice

70

Carrot juice

Cranberry cocktail

140

Grapefruit juice

100

Orange juice

110

Tomato juice

50

V-8 juice

50

As you can

You might want

see, those calories

could add up mighty

one of vegetable juice in the evening, and

You can

also enjoy artihcially

I've

fast

during your

to limit yourself to a glass of fruit juice in the

sweetened

suggested this approach for

lots

soft

many

and

lots of

water in between.

drinks or iced tea in moderation.

years.

Some hnd

a

day of

absolutely liberating, a day not to worry about meal planning. told

me

but

it's

about food

fast day.

until

A day of zero calorie

not for everyone.

all

Some hnd themselves hungry and thinking

you

try

it.

is

about food! Will

to obsess

You might even want

Tuesdays and Thursdays, as your If

a complete fast

is

just too

extremely limited calorie intake.

Angeles Dodgers about

It

be

in the

intake really affects the week's

the time. Certainly that's not healthy

weight person needs

know

fast to

One woman

she used the time saved in food preparation and eating to do extra-

long walks on her total,

fast.

morning and

lost

fast

work

to designate

last

for

thing an over-

you? You won't

two days

a

week,

say,

days.

much It's

it

The

to undertake,

really true

consider a day or two of

that Tommy Lasorda of the Los

weight with SlimFast shakes replacing meals. 'We talked

dugout when

I

was working with the Dodgers

improve school lunch programs able diet shakes will do.

in California.

Any

in a

program

to

of the commercially avail-

The Ultimate Solutions for Weight Control

Meal Replacement Can Be in

Weight

Effective

various meal replacements work.

"sensible dinner." That's sort of

backward

of low-calorie options for those meals.

and on and on. So why not

you thmk about

if

The reason

habits.

the

down

if

to a

you may

if

book. Moreover, there

is

on

find this liber-

to prepare

dinner

a

good long-term

going back to one's old eating

you use

while learning to control calories by limiting

it

movie or the museum.

meal replacement programs don't have to the reality of eventually

pile

and lunches and replace

you don't have

go shopping, or

However, the approach can work

Most people

come up with any number

eat sensible breakfasts

ating in terms of the time saved, especially

it.

dinner that most of us

at

It's

of the week's dinners with those shakes? Again,

for others. Instead of eating,

The most

breakfast and lunch with shakes and have a

don't "pig out" at breakfast or lunch, and one can

record comes

73

1

Loss

No question but that the common approach is to replace

some

•

fat

it

as a crutch to lose weight

shown elsewhere

as

in this

no reason why your long-term maintenance program

shouldn't include a meal replacement here and a day of fasting there.

'Weighing in your success on the bathroom scales should be triumphant.

But don't expect overnight take

some time

most

likely to

for

you

remain

results.

to lose

off.

it.

It

took you years to gain that weight, and

In fact, surveys

show

that weight lost slowly

So stay away from those scales

don't weigh yourself more than twice a

week

for at least a

thereafter. After the

of gain, that's the time to get rid of

THOSE BEST-SELLING

timate

hit the best-seller lists

word on permanent weight

see that, as a nation, we've

one out of three adults

is

when

it's still

loss. Yet

by promising

one needs only

grown heavier and heavier

overweight. So what's

to

to be the ul-

look around to

wrong with

Today

those books? it is

as long as

is

ing to change his or her entire etarian diet

a

mounds of vegetables. It's true that nobody ever got obese much steamed broccoli. It's a rare individual who will be will-

to eat

from eating too

gone,

easy to do.

since the 1960s.

Eat More, Weigh Less sounds like a wonderful promise, and

what you want

is

you see

BOOKS

DIET

Dozens of books have

it,

If

is

week, and

weight

use the scales as your barometer for your maintenance program.

pound or two

it'll

advanced

in this

life

to

accommodate

book. The editors

at

the ultra-low- fat, mostly veg-

Glamour magazine challenged

174

THl-

•

REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

themselves to follow the program, and they confessed in print that, as healthy as the diet

sounds on paper, they just couldn't do For

Fit

print.

Life

continues to

The Diamonds,

products

They give

at all.

their

life.

diet; theirs

allows no animal

program

a twist

by proposing

that certain foods

should not be eaten in combination with other foods, properly.

in real

well in paperback, with millions of copies in

sell

advocate a vegetarian

too,

any length of time

for

it

lest

Nonsense and nonscience. That theory was

they not be digested

first

proposed

in the

1920s and has been completely debunked. Dr. Atkins' Diet Revolution lets

you

eat all the fatty foods

you want, just

long as you eat no carbohydrates. This results in an unhealthful ketosis,

which

is

measured by diabetes urine-testing

as

state of severe

strips. Ketosis results

from the formation of ketones, improperly metabolized sugars, in the blood

and

urine. Ketosis

ketosis, as occurs

carbohydrates,

a

is

symptom

when

isn't

and

of diabetes

starvation.

A

mild

state of

following a diet that emphasizes protein and limits

necessarily a

bad thing, but severe ketosis

is

unhealthy. In

addition, the high-fat diet advocated by Dr. Atkins significantly elevates cholesterol levels ally

m the blood.

His program has been severely criticized by virtu-

every nutrition authority. The worst part of the Atkins diet

stop the diet, the weight

comes back with

is

that

once you

a vengeance.

Are any good weight-loss books available? Dr. Katahn's T-Factor Diet and Covert Bailey's

Fit

books

or Fat

sound approach of limiting and well documented.

I

moderate amount of weight If

and II

you have a

especially

if

fat

highly

and increasing

suffer

a sensible, scientifically

exercise.

recommend them,

Both are well written

especially for those with a

loss to achieve.

significant overweight

you

on

are both based

from Type

II

problem of

diabetes, the

fifty

book

or

more pounds,

to read is

Diabetes Diet Book: The Insuhn Control Diet by Dr. Calvin Ezrin

The Type

and myself,

published by Lowell House. There's even a chapter to share with your doctor,

informing him or her about the concepts of to deal

ONE ONE

this

is

designed

with the problem of insulin resistance.

PILL PILL

MAKES YOU LARGER, MAKES YOU SMALL

Jefferson Airplane's

homage

to Alice in

captures the essence of the hope for a magic ists,

program, which

Wonderland, "White Rabbit,"

pill.

there are chemical crutches that can help.

While no such miracle

ex-

The Ultimate Solutions for Weight Control

175

•

Doctors no longer prescribe amphetamines the way they did in the 1960s

and 1970s. Those drugs effective.

A

are far too addictive and, in the long run, weren't very

chemical with a similar mechanism of action can be found in any

drugstore. Phenylpropanolamine (PPA)

weight-loss nostrums that one can

m

the active ingredient

is

buy without

a prescription.

It

dozens of

works

like a

mild form of the amphetamines of old, depressing appetite by revving up your metabolism. Unfortunately, PPA's effectiveness, Uke that of amphetamines, lasts

only two to three weeks. After that time the body adapts, and appetite

turns to normal.

PPA

the effect of drinking too

much

strong coffee.

Newer weight-control drugs and fenfluramine came sions are

now

re-

also has the adverse reaction of jangled nerves akin to

available.

are far

off patent in 1995,

When

more

than PPA. Fenformin

effective

and thus

less

expensive generic ver-

used properly under medical supervision both

can be useful adjuncts to other weight-loss

efforts.

The combmation

of both,

termed "fen-fen therapy," has produced dramatic responses. Other drugs are in final stages of testing

and

will

be available through a physician.

Every magazine and newspaper carried the news in 1995 that genetically obese mice given an engineered hormonal protein termed leptin

lost

weight

dramatically Within weeks of getting leptin, the obese rodents shed half their

weight and soon resembled their slender counterparts. Even slender animals lost it

weight

will

when

be years before a drug

who

For those for

given the protein. Clinical will

come

to

trials are

failed, the last resort

this drastic

measure

for

other hope remains.

At one end of the spectrum, 5 percent of

have a genetic predisposition maintain a healthy weight

is

to obesity.

food beyond

all

who

10 percent of

an exceptionally

difficult

and

women

effort to attain

and

life-long battle.

Ge-

from food and continue

to crave

reasonable needs of the body. At the other end of the spectrum

merely would

sons (although science has In the middle of the

overweight, that

is,

like to lose five or ten

shown

spectrum

No matter where one

fits

some than

again and again, assistance

are millions of individuals

for

cosmetic rea-

is

unhealthful).

who

are clinically

their healthy weights.

into that spectrum, however, everyone

and expend more energy

for others, is

pounds

that even slight weight gain

20 percent or more over

timately take in fewer calories that's easier for

men and

For them, the

netically obese individuals never feel satisfied

are those

but

for 1996,

market.

have tried every other approach and

weight loss can be gastric surgery. Doctors reserve

when no

scheduled

and

available.

for those

who

must

ul-

in exercise. Granted,

have

tried

and

failed

176

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

FINDING A DOCTOR TO HELP already mentioned the potential of university-based weight-control

I've

who

centers throughout the United States. In an ideal world, everyone that help

would have

available. But in reality those centers

it

cessible to you. That leaves patients to rely

have been notoriously ineffective

on

needs

not be ac-

their physicians. But doctors

with weight problems.

have been trained to

Historically, physicians

plaint with

in dealing

may

treat

every ailment or com-

drugs or surgery. Diagnose the condition, determine the proper

treatment, receive proper gratitude from the cured patient, and

Dealing with weight problems

isn't that easy;

it

move

on.

requires a lot of caring and

counseling. Not every doctor can do that, but there are organizations that can

help you locate one in your area.

The Weight Information Network

a function of the National Institutes

is

them

of Health in Washington, D.C. Call

at

(301) 951-1120 for a medical

referral.

The American Society

for Clinical Nutrition

ASCN

perts in various geographic locations. Call

The American Board eral

and weight control

medical

at

offers a

(301) 530-71

list

of ex-

10.

of Nutrition certifies specialists in nutrition in gen-

—

in particular

For a

specialties.

(ASCN)

list

similar to board certification in other

of certified physicians in your area, call (205)

975-7110.

Very frequendy, depression accompanies overweight. That certainly true in cases of insulin resistance,

overweight son's

life.

is

men and women. Food can be

Depression in and of

impossible, to achieve.

Many new

and

Thus

it

itself is

the only consoling element in a per-

can make weight control

the

is

often a contributing factor for other

first

difficult, if

thing to deal with in

many

not

cases.

prescription drugs can be useful in treating depression. That's an-

other good reason to find a knowledgeable and compassionate physician to

help you.

Weight

loss

and maintenance

fort

worthwhile. As

lost

weight and kept

faction.

I've it

aren't easy, but the

spoken with men and off,

I

women

Go

for

it.

ef-

who have

have noted a particular pride and sense of

That pride and satisfaction are well deserved.

sure, you'll succeed!

rewards make the

over the years

satis-

This time, for

13

•

Does

It

•

Really

Work?

Here's Proof!

Among my most cherished possessions, I treasure my file of letters I've received over the years from men and women who read my original book. Their success stories have inspired me to keep working. Let me share just a few of their comments: I

would

tive for

like to tell

me.

had

1

you how much

tried to bring

from 261 infanuary

to

254

I

my

enjoyed your book.

cholesterol

down by

in April. Fortunately for

It

has been very informa-

diet but

my

me,

it

only

came down

doctor recommended

your book and the oat bran-niacin approach. In July my cholesterol had come

down 53

192.

to

to 55.

1

My

triglycerides from

feel great

tion. I also lost

152

to 77,

LDLfrom 170

and together with an aerobic workout

to

122,

HDL from

don't need medica-

I

12 pounds. Thank you for putting your experience

and

in print

al-

lowing people such as myself to benefit from your findings.

Sonia Z.

AZ

Phoenix,

I

followed your plan and in 2 months

and my

my

Thank

ratio fell from 5.7 to 2.69.

total cholesterol

went from 305

Linda

my two

to

recent blood

tests,

erasing heart disease from one's

brought

me a copy

niacin until

I

took your book into his

have found the success in

May and

Another plus

166 is

life.

It

was my lucky day when a friend

of your book. Ten years have gone by that diet with

in

no success.

office. I

to be fantastic. After

August. This

today

I

all

B.

OK

you have not overstated your promise of

literally

a cholesterol count of 280 by

M5

You!!!

Norman,

According

to

My

I

have tried

began your plan with

2 blood

to

reduce

internist never suggested

tests cholesterol

his approval.

occurred since reading your book

no longer need the blood pressure

I

count was 188 in

March.

pills.

Pauline K. Philadelphia,

PA

178

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

I'm particularly pleased

when my

readers

my book

through their doctors. While

skeptical,

it

has

come

to recognize the value of

Many

for their patients.

me

tell

at first the

my

that they learned

approach and

physicians, in fact, subscribe to

benefits

its

my Diet-Heart Newslet-

keep themselves informed so they can pass the information along

ter to

about

medical community was

to their

patients.

Through plements, and

it

more

program, added new foods and sup-

and easy

effective

to follow. Fortunately,

my news-

subscribers have learned about those developments every step of the

letter

way

my

the years I've revised

made

for the past several years. I've

enjoyed their feedback as

suggested

I've

such products as SeQuester and the combined regimen of immediate- and sustained-release niacin.

The program slowly evolved and eventually became

revolutionary approach it all

program

Keenan

I

did in 1985,

to share I

in a clinical setting.

of Santa

met

study. 'We

One

new book

together in a Just as

I

believe can eradicate heart disease.

Monica

I

turned to

for help.

He

my

friend

the

put

Dr. Charles

Monday evening

for several

1995

weeks.

time we'd talk about heart-healthy shopping and nutrition label reading.

subsequently became the book you're

you have become I

a part of

now

stress reduction, the

my world, and

were following. As

I

reading. In a very real way, then,

some

you're

consuming on

how much you It'll

if

a log of

would help me

learn but also

their regular progress.

you can

a daily basis.

progress over the

keep

program they

sort of diary. Jot

ages you eat and drink and then see

to

the aspects of the

explained, this not only

suggest that you also keep

importance

presented the information that

welcome you!

and

would help keep them focused and show

fat

I

I

provided everyone with a notebook and asked them

the foods they ate, the exercise they got,

take.

and physician

invited patients to participate in the

of exercise, or weight control. In other words,

of

to

realized the importance of carefully testing the

Other times the topic would be restaurants,

see

was time

with the world.

Keenan's office every

at Dr.

It

down

the foods

calculate the

definitely

and bever-

number

of grams

activities

and

the supplements

you

Record your exercise

coming weeks. Note

I

help keep you on track.

Our

Santa Monica study took place over an eleven-week period. Partic-

ipants represented a real cross-section of typical American

men and women.

We had schoolteachers, a lawyer, office workers, retirees, a professional golfer, and even an NBA Hall of Fame former basketball player. It was a wonderful experience, and

The

we

quickly became friends, almost like a large family.

participants received oat products from the

Quaker Oats Company,

Does

It

Work?

Really

Here's Prooj!

•

1

79

including ready-to-eat oat bran cereal, hot oat bran from which either cereal

We

or muffins could be prepared, and oatmeal. Fibe, the

new

passed out canisters of Pro-

soluble fiber product detailed in chapter

KCD

7.

provided

Inc.

supplies of SeQuester. Endurance products of Tigard, Oregon, supplied niacin,

vitamin /mineral supplements, and antioxidants. Samples of Spice sausage mixes

pants were able to purchase ultra-low-fat beef products to

n' Slice

the group experiment with those useful products. Partici-

let

reduced

at

cost,

thanks

combining orders and thus cutting shipping costs. Phytosterol was not

we could

able at the time of our study, so

Dr. Keenan's office staff took

not include

blood samples

avail-

it.

for testing cholesterol

and

chemistries at the beginning, at the end of five weeks, and at the conclusion of the study at eleven weeks.

182.

Owing

The findings

are

summarized

Some admitted

it

A

men and

total of ten

compliant with the regimen. Not everyone did as well.

that their diets

pills as directed.

on page

and business confUcts, some of the participants were

to personal

unable to complete the entire eleven-week program.

women did so and were

in the table

As they

say,

were not on

you can lead

target,

and others

a horse to water,

forgot to take the

but you can't make

drink.

As

however, even looking

you'll see,

entire group, results

17 percent, and triglycerides results for those

who

cholesterol

down by 28

down by 58

the average

improvement of the

by 38 percent. Far more spectacular were the

fell

followed the program to the

Look

you're going to do.

at

were remarkable. Total cholesterol declined an average of

at these

percent,

fullest

—

the

numbers and predict your own

LDL down by 30

percent. Note that the

improvements

way

I'm sure

success: total

percent, and triglycerides

really indicate a slashing of

heart disease risk.

Pay particular attention fell

to

from an original 242

to

to the individual results: TB's total cholesterol

167 JG's dropped from 249

197 BS's came from 267 down

put your mind to

to

to 196.

EH

from 283

197 That's what can happen when you

it.

While weight

loss

was not the focus of the

study, a satisfying loss of ap-

proximately one pound per week was reported by those

and who followed the program

common, and one

as directed.

who needed

to

reduce

Five-pound weight losses were

individual lost fifteen pounds.

Impressed by the results of our study. Dr. Keenan's brother Joseph University of Minnesota suggested that

paper

I

wrote was accepted, and

we

we submit

presented

Health Conference in Barcelona, Spain, in

it

at the

May

1995.

it

at

for presentation.

2nd

the

The

International Heart

—

.

180

THE REVOLUTIONARY CHOLESTEROL BREAKTHROUGH

•

PROGRAM

THE

AT A

GLANCE

For years you've heard and read about the importance of cholesterol

duction as part of a but

tried

to get the

failed,

or

maybe you

slipped along the

way and have now

too. Here's the

Monica

program

Have your

1

numbers under

get their

control.

Now you

can do

it

at a glance.

lipid profile tested at

your doctor's

measurements of all the components, including

lesterol,

resolved

job done. This book contains the entire program that helped the par-

ticipants in Santa

get

total

re-

approach to preventing heart disease. Perhaps you've

may wish

Make

total cholesterol,

HDL cholesterol, triglycerides, and risk ratio.

tory of heart disease you

office.

If

you have

sure you

LDL cho-

a family his-

to include a test for the Lp(a) risk factor.

For details see page 52. Get the exact

numbers from your doctor; don't

settle

for "everything's fine."

improving your

Start

2.

of this book. Shoot for sible.

diet

20 percent

with the information you'll get in part 4

fat,

avoiding as

much

fat

as pos-

Enjoy alcohol in moderation. Maintain a food diary to keep you focused.

Determine your healthy weight and make up your mind

3.

The

that weight.

low-fat diet will put

you on the

weight you want, not the pounds you want to

Add

4.

right track.

taining

barley,

and suggested supplements

Block the absorption of

phytosterols. fat

6.

Make

Feed only the

plenty of soluble fiber to your diet. Don't limit yourself to just

beans and peas, 5.

to achieve

lose.

one kind. Combining the different types of soluble

als.

saturated

Keep

a

fat

fiber

from oat bran, dried

will achieve the best results.

and cholesterol with both SeQuester and

supply conveniently located so you don't eat a meal con-

and cholesterol without them.

Supplement your

diet

with a good spectrum of vitamins and miner-

sure you gel plenty of the B vitamins to prevent the buildup of ho-

mocysteine in the blood. 7.

Use antioxidants

of vitamins will

C and

to stop

E, beta-carotene,

help keep your arteries 8.

LDL

A daily regimen ACES of chapter 8

cholesterol oxidation.

and selenium

—

the

clear.

Get plenty of aerobic exercise regularly. Make physical activity a part

of every day's routine by walking

and choosing the

stairs rather

than an ele-

.

Does

vator.

Think of your heart

as a loved "pet"

It

Really

Work?

you want

Here's Proof!

to take for a

181

•

walk every

day! 9.

Control your stress and

Everyone has

stress. It's

how we

make an

deal with

it

effort to relax

that

makes

and enjoy

the difference.

life.

Work

relaxation techniques into your daily routine. 10.

Retest your cholesterol levels after about ninety days.

see a great deal of progress.

If

normal,

terrific. If

the

numbers

are

You should still off,

talk

with your doctor about adding niacin to your program. 1 1

Keep up

to date v^th the latest

developments in research and new

products with the Diet-Heart Newsletter. Just send a self-addressed, stamped, business-size envelope

to:

The Diet-Heart Newsletter Post Office Venice,

Box 2039

CA 90294

You'll receive a

sample issue and subscription information.

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