Are statins the answer to heart disease? PART 2

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Yesterday’s post PART 1 was all about cholesterol; where it comes from and why it’s harmful. So lets take this further and look at how we can lower the harmful LDL, or ‘bad’ cholesterol levels in our body, including the role of statins.

Before we start, lets look at what are our cholesterol levels should be:

Cholesterol levels are measured via a blood test.  To get an accurate result, you should not eat for 10-12 hours before the test. This ensures that any food you will have eaten the evening before will have been completely digested and will not affect the result – cholesterol levels can fluctuate after eating, taking around 3hrs to peak, depending on what you have eaten.

The tests are designed to determine your risk of developing cardiovascular disease (and suffering a heart attack or stroke) within the next 10 years. So what is measured?

Total cholesterol level

Healthy adults should have a total cholesterol level in their blood of 5mmol/L.  

Over 60% of adults have levels above this figure and often women have slightly higher levels than men.

Knowing more than the total amount of cholesterol is often more helpful though in determining someone’s risk of heart disease. It can be very useful to know what your total cholesterol level is made up of, i.e. how much good cholesterol do you have and how much bad.  For example if your cholesterol level is a little over 5mmol/L, there may be no need to worry if you have lots of the good cholesterol (HDL) and not very much of the bad cholesterol (LDL).

Level of LDL

Healthy adults should have an LDL level of 3mmol/L or less. This being the bad stuff, less is best.

For those who may already be at risk of cardiovascular disease (because it runs in the family, or they have diabetes or high blood pressure), we look for an LDL level of less than 2mmol/L.

Level of HDL

HDL should be above 1mmol/L. In other words more is better.

A lower level of this good cholesterol can increase your risk of heart disease.

Diet and cholesterol

What can I eat so that my cholesterol levels are at a healthy level.

There are 3 things you can do:

  1. Cut down on saturated fats
  2. Choose unsaturated, healthy fats instead
  3. Eat plenty of fibre rich food (fruit and vegetables)

Cut out the saturates

In my previous post I explained we should be eating fewer foods that contain saturated fat because these raise our cholesterol levels.

  • Men should eat no more than 30g of saturated fat a day.
  • Women should eat no more than 20g of saturated fat a day.

To help you pick foods the right foods when shopping, check the traffic light colours on food labels and GO FOR GREEN:

High: More than 5g saturates per 100g. These foods should be limited.

Medium: If the amount of saturated fat per 100g is in between 1.5-5g Consume these foods in moderation.

Low: 1.5g saturates or less per 100g. It’s fine to eat these foods.

For more information about cutting down on saturated foods, please click this link to the NHS Choices page: http://www.nhs.uk/Livewell/Goodfood/Pages/Eat-less-saturated-fat.aspx

Choose unsaturated fats

We don’t need to cut down on all fats. Unsaturated fats can actually help protect our heart and many of us should be eating more of them. Eating unsaturated fats instead of saturated can help increase the levels of HDL (good) cholesterol and lower our risk of cardiovascular disease.

Good sources of unsaturated fats are:

  • oily fish (mackerel, pilchards, sardines, herring, salmon and fresh but not tinned tuna)
  • vegetable and nut oils like sunflower, corn, linseed, walnut and olive oils
  • nuts and seeds – any type (as long as they are unsalted) like almonds, cashews, walnuts, peanuts and Brazil nuts, sunflower and pumpkin seeds.
  • avocados

What we do need to remember however is that all fats are the same when we think about energy (Calorie) content. Fats contain over double the amount of calories compared to carbohydrates and proteins so we need watch how much fat we have. There are around 100 Calories in 1 tablespoon of olive oil so we should still remember to use fats and oils sparingly. Just because something is good, more is not necessarily better but it will certainly help if we swap the bad fats for the good ones!

Eat more soluble fibre

Soluble fibre is probably best known for its cholesterol lowering effect (specifically lowering LDL cholesterol), when eaten as part of a low-fat diet.  It can work in 2 ways:

  1. Most foods contain both soluble and insoluble fibre.  Soluble fibre absorbs water in the bowel forming a soft gel-like substance. This gel binds with cholesterol and therefore makes it easier to eliminate from the body.
  2. Another benefit from eating soluble fibre is that although we don’t digest it directly ourselves, the bacteria that live in our gut do. They break it down through a fermentation process that yields products called short chain fatty acids (SCFA’s).  Some of these have been shown to slow our body’s production of cholesterol by the liver, so again if combined with a healthy diet, soluble fibre can help lower our total cholesterol levels. Great stuff!

Foods rich in soluble fibre include:

  • oats
  • bananas
  • apples
  • carrots
  • potatoes
  • peas
  • beans
  • lentils

Plant sterols

You could also consider including some plant sterols in your diet but I must emphasise this suggestion is only for those with raised cholesterol levels – there is no real benefit if your cholesterol level is normal. They are also not suitable for children, pregnant or breast feeding women.

You will probably have seen plant sterols in the chilled section of the supermarket? Products like Flora proactive or Benecol? They make a range of spreads, yoghurts and milks that contain substances called sterols.  Basically, these look like and mimic cholesterol. Sterols compete with dietary cholesterol for absorption, reducing the amount of cholesterol we absorb in the gut. Over time, more and more cholesterol is removed from the bloodstream as our body uses it up, the result being our cholesterol levels lower.

Current advice suggests eating between 1.5g – 2.4g of plant sterols each day to significantly reduce LDL (bad cholesterol) by up to 10%.  There is no additional benefit in taking more than 3g per day. You could achieve this by consuming the following:

250ml fortified milk + 2 teaspoons of a fortified spread + 1 individual fortified yoghurt OR 1 fortified yoghurt drink (67.5-100ml)

I must add however, that plant sterols will not compensate for a poor diet. In other words eating a slice of cake, followed by a yoghurt drink will not work!

Finally  we come to statins.

What do statins do?

Statins primarily reduce the production of cholesterol by the liver, which makes around 70%  of the total cholesterol in the body. They may also have a number of other effects that can help cardiovascular health but I won’t go into them here. Statins switch off an enzyme in the liver, blocking the pathway to make cholesterol ourselves. Combined with a healthy diet, they can be very effective at helping to lower cholesterol levels but like sterols are not a substitute for a poor diet. Lowering your cholesterol needs a ‘whole lifestyle approach’ – if you are offered statins, you will also be advised about stopping smoking, watching your alcohol intake and taking regular exercise.

Statins have been used since the mid 1990’s and there is plenty of evidence supporting their use in preventing heart disease – there are no major concerns about their use. What has popped up in the news this week though is the proposal to lower the ‘treatment threshold’ so that millions more people at a lower risk of heart attack or stroke would be given them.  The worry is that with more people taking statins, it is likely to increase the number of people experiencing side effects.

Now all drugs have side effects, even paracetamol – this is not new.  It’s about weighing up the benefits and risks – in high risk patients the side effects will be negligible compared to their benefits in cutting the chances of heart disease, it’s a no-brainer! But lowering the threshold at which patients would be put into statins (to include low-risk patients) could mean that the side effects may outweigh the small benefits of them taking statins.  Arguments have taken place this week because the recommendations that will be published at the end of July are based on data that has not been made available for researchers to review. How can an ‘evidence based’ recommendation be made if we can’t see the evidence?! So it’s ‘watch this space’  but in the mean time one of the big questions is this:

Should I carry on taking my statins?

Absolutely, yes. The current guidance, under which you will have been prescribed a statin, is not disputed.

I hope you have found these 2 posts useful and they have given you some food for thought…………..please do share / like / comment or ask me questions!!

Posts coming soon will include butter vs margarine and coconuts (as there has been a surge of popularity concerning coconut water drinks and coconut oil). see you soon 🙂

 

 

Are statins the answer to heart disease? PART 1

This is a 2 part post…….

I have  just about emerged alive from a month-long marking marathon, hence my absence from the blogosphere.  I am glad to be back writing again so have plumped for what’s in the news this week – another statin scare.  I was on the radio last month (when there was a previous panic about statins) talking about some misleading figures that suggested side effects were more common than previously calculated. In fact these figures were withdrawn and the statement retracted  but the damage had already been done. People that were on statins became very wary about taking them and the worry then was they would stop taking them.

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So I thought it might help to explain what all this most recent  fuss is about – should you believe what you read about these statins? Should you be worried? Should you do anything?  Or perhaps you have no idea what everyone is going on about, you have no idea what statins do and don’t understand what this cholesterol stuff is anyway so you are just going to bury your head in the sand and ignore it all. Either way, I am hoping I can shed some light on the situation.

Today’s post is part 1 – all about cholesterol. If we get what cholesterol does in the body, we can better understand why we need to eating more healthily to be more healthy, understand what exactly we should and should not be eating. And if you want to know about statins, I will explain all tomorrow…………why people take them, what they do and what the current advice is.  I must add here however, that if you are on statins, you keep taking them.

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So let’s set the scene; people take statins to help lower their cholesterol levels in the body.  We shouldn’t consume too much saturated fat or cholesterol in our diet as it increases the risk of developing cardiovascular disease. This means we could be more likely to develop coronary artery disease (where the vessels or the heart get blocked by fatty deposits) angina (chest pain caused by the coronary artery disease), have a heart attack (where the blood supply to the heart is blocked) or stroke (blood supply to the brain is blocked). So basically, statins can help lower the risk of disease by lowering your cholesterol levels.  I’ll come back to these tomorrow so let’s get to grips with cholesterol.

What is cholesterol and where does it come from?

Cholesterol is a fatty substance, that if you held in your hand, would be very much like the very fine waxy scrapings of a candle. Too much of it affects how blood flows through the body and is certainly harmful towards our health.

Cholesterol comes from food and this is known as dietary cholesterol.  Foods quite high in dietary cholesterol include kidneys, eggs and prawns.  You might be surprised however, to hear that dietary cholesterol is not the culprit when it comes to cardiovascular disease. Saturated fat is.  The cholesterol found in food has much less of an effect on the level of cholesterol in your blood than the amount of saturated fat that you eat.

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Eating foods that are high in saturated fat can raise  levels of ‘bad’ cholesterol in the blood.

Foods high in saturated fat include:

  • meat pies, sausage rolls etc.
  • sausages, fatty bacon
  • fatty cuts of red meat and chicken skin!
  • butter, lard and ghee
  • cream, ice cream and other desserts
  • hard cheeses
  • cakes, pastries and biscuits
  • foods containing coconut or palm oil (used in South Asian and African cooking)

What happens to this saturated fat when we eat it?

Saturated fat, along with all the other types of fat from our diet gets broken down, absorbed and ultimately enters the bloodstream. On this journey, these fats get taken to the liver for processing and ultimately travel to various destinations around the body.  It is the saturated fat that increases the amount of cholesterol circulating in the blood, which can potentially reach harmful and dangerous levels.

Cholesterol flows through the bloodstream, but this is not a simple process. Because lipids are oil-based and blood is water-based, they don’t mix. As a result, we have to transport cholesterol attached to a carrier. A bit like a taxi, these carriers pick  the cholesterol up and drop it off somewhere else in the body.

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So there are two types of taxi:

  1. one taxi travels from the liver to the body cells and tissues, whilst the other taxi travels in the reverse direction:
  2. one taxi travels from the body cells back to the liver.

So lets start with the first one – this taxi is called LDL, or Low Density Lipoprotein -funnily enough this is made of lipid (fat), hence the lipo bit combined with protein. It’s job is to pick up cholesterol from the liver and take it to the cells in the body that need it. The problem with this is that this taxi tends to deposit cholesterol in the blood vessels of the body.  Now this is not good – a build up of cholesterol in the blood vessel walls can block them, preventing blood and oxygen form reaching important cells (i.e. in the heart or brain). This is why we call LDL ‘bad’ cholesterol.

The other taxi is called HDL, or High Density Lipoprotein. This guy scavenges cholesterol, picking it up from the cells and tissues and taking it back to the liver.  The liver’s job is to get rid of this cholesterol – this is the only route by which we can eliminate harmful cholesterol from the body so HDL is very important to us.  This is why we call it ‘good’ cholesterol.

So cholesterol is not all bad news then?

Cholesterol does get a bad press.  It’s the villain and we need to get shot of it.  Well yes and no.Yes, LDL (bad) cholesterol is one of the main contributors to the high levels of heart disease we have in our society today but cholesterol is not all bad news – we need some in our body for important functions!

We use cholesterol to make cells, hormones like testosterone and oestrogen and to make Vitamin D in the body.  We also need cholesterol to make substances called bile acids that help us digest fats in the gut.  What we don’t need is too much cholesterol and we certainly don’t want too much of the bad stuff.

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Because we have a need for cholesterol we have an ability to make it ourselves in the liver. Now that’s fine if we don’t go overboard and top up these levels unnecessarily (through eating fatty foods, specifically foods rich in saturated fat). The problem we have these days is that many of us rely heavily on processed, convenience foods which are ‘naturally’ rich in saturated fat.  It’s the processed food that is the villain in this story.  Basically, eating too much crap is what is raising our blood cholesterol levels beyond manageable levels and more specifically increasing the bad (LDL) cholesterol. This is also the reason why statins can be helpful in more quickly lowering cholesterol to safer levels.

Now there is another issue here – it is true that some of us will be genetically programmed to have a high cholesterol level, no matter how healthy our diet is. This is a condition called familial hypercholesterolaemia – try saying that without your false teeth in. It’s much easier to say FH isn’t it?!

It is also important to note that smoking, being overweight, being inactive, having diabetes  or high blood pressure or simply getting older are all associated with high cholesterol levels.

Next I will be explaining what we can do to improve our cholesterol levels; how we can lower the levels of LDL and increase the HDL through diet and lifestyle changes, but also examining the role of statin medication…………..please click here to read it.