Saturday 12 October 2019

[www.keralites.net] Should You Be Worried About Your Cholesterol?

 




    
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Should You Be Worried About Your Cholesterol?


What Should Your Cholesterol Levels Be?

The idea that a cholesterol level should be under 200 dates back to before I was practicing medicine. Some smart scientists had noticed that people with high cholesterol had a higher risk of heart attack. More scientists got together and decided that, based on the evidence, 200 was a good cut-off point. To celebrate their decision, they went out to a dinner of bacon cheeseburgers and donuts.

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OK, I'm not really sure about the celebration, but they did decide on 200 as the cutoff.

What are the Different Types of Cholesterol?

Some time later, some other scientists noticed that there are people with cholesterol over 200 who don't have heart attacks, whereas others with levels under 200 do. Their research showed that there are several types of cholesterol of varying density. They named these types of cholesterol High Density Lipoproteins, or HDL, Low Density Lipoproteins, or LDL, and Very Low Density Lipoproteins,or VLDL.

What is the Difference Betwen HDL and. LDL?

Anyhow, it turns out that a high LDL is associated with higher risk of heart disease while a high HDL is associated with a lower risk. The VLDL, which is mainly triglycerides, has a much smaller effect than the HDL and LDL, so we'll ignore it for now. LDL is commonly referred to as bad cholesterol, and HDL as good cholesterol. You have to wonder how long these politically-incorrect names will be used. LDL's self-image must be shot by now with all the praised being heaped on HDL.

Back in the science lab, some other scientists began to notice that a few people with high LDL didn't develop heart disease, and some with low LDL did. I say this only to point out that my explanation is a simplified one, and should not be taken as an exhaustive explanation. I also do it to point out how annoying some scientists can get if they have time on their hands.

When Should You Worry About Cholesterol?

So what about good old Ralph and his cholesterol over 200? Should he be worried? It's hard to say. Total cholesterol is calculated by using a formula that includes HDL, LDL, and triglycerides. That makes the overall cholesterol number of limited use to me as a doctor. It's kind of like if you asked someone for the score of a football game and they answered "42," adding together the scores of both teams. Technically, they are right in their answer, but the information is probably not what you want. You want to know the score of the good team and how it compares to that of the bad team.

In the same way, the LDL and HDL numbers are far more important to Ralph than the total cholesterol. In fact, there is a calculation called the Framingham Risk Score which uses HDL and LDL levels, along with other risk factors, and calculates a person's 10-year risk of having a heart attack. I'll put a link to this formula in the show notes.

When you get down to it, people don't die from high cholesterol, they die from heart attacks and strokes. If I knew a person with high cholesterol would stay healthy until they were 90, I wouldn't bother treating them. That is what makes the Framingham Risk Score useful to me: it focuses on what really matters. It's not a perfect formula, but it gives a decent idea of risk. My goal as a doctor is to get that 10-year risk as low as possible.

So what does this mean to you? Here are my quick and dirty tips about cholesterol:

Tip #1: Get Your Cholesterol Checked

It's important to know what your risks are, and since heart attacks are associated with higher LDL and lower HDL, it is good to know these numbers. This is especially important as you get older, as heart attacks get much more frequent as people age.

Tip #2: Don't Focus on the Total Cholesterol

Knowing your HDL and LDL will allow you to know your real risk. For low-risk people—or people without any risk factors (which I'll get to in my next tip) the goal is to have an LDL under 160. But that goal changes as the number of risk factors goes up. For people with diabetes, for example, the LDL should be under 70.

As for your HDL level, you want that to be over 40, although over 50 is even better.

Tip #3: Know Your Other Risk Factors

Knowing your risk factors for heart disease —aside from cholesterol-- will tell you how closely you'll need to monitor your cholesterol.

There are six major risk factors:

  1. High Cholesterol

  2. High Blood Pressure

  3. Smoking

  4. Diabetes

  5. Strong family history of heart disease in your immediate family

  6. Advanced age

Additionally, men are generally at higher risk for heart disease than women are.

The family history needs to be put in perspective. If your uncle Harry had a heart attack when he was 90, it's doesn't really increase your risk, but if your father had a heart attack at age 40, you should be far more concerned about cholesterol. I don't treat cholesterol numbers without knowing the overall risk.

It's like hurricanes. If you live in Florida, you worry about hurricanes, keeping tabs on the weather and having a house that can withstand high winds and water. If you live in Idaho, on the other hand, you don't have to worry at all about hurricanes (although I guess your risk of being pelted with potatoes goes up).

Your doctor should figure out your real risk of heart disease. If he or she doesn't calculate your risk, do it yourself and show them the results.. Check out episode 37 for help on which tests diagnose heart problems.

Tip #4: Do What You Can to Have the Best Cholesterol Possible

There are many things you can do to lower your LDL and raise your HDL. These include:

Foods rich in saturated and trans-fats tend to raise the LDL, whereas foods rich in unsaturated fats can actually raise the HDL--the good cholesterol. In general, this means that you should minimize animal fats --- more common in red meats -- but don't cut back on vegetable fats. Olive and canola oils are rich in the good unsaturated fats, and so are actually good to have. Also avoid "hydrogenated" oils, which are fats that have been turned from unsaturated to saturated fats by food manufacturers. They do this to make its consistency better, but it makes the food much less healthy.

Read labels. Know what you are putting in your mouth. Again, The Nutrition Diva  is an excellent resource on this if you want more information. 

Tip #5: Consider Cholesterol-Lowering Drugs if You are at Increased Risk

I only use medications when I feel the risk of taking them is outweighed by the risk of not taking them. Studies have shown that bringing the LDL down with specific medications in high-risk people lowers the risk of heart disease and death. Which people and which medicines? That's what I did all my training to know. You'll need to see your own doctor to find out if these medications are appropriate for you. In general, though, I think a person with a 10-year risk over 10% should be considered for treatment and someone over 20% should clearly be treated.

Are Cholesterol Drugs Dangerous?

Are cholesterol drugs dangerous? I don't think they're dangerous, but they do have significant risks. That's why I have to have a license to prescribe them, and why they aren't in the grocery store next to the candied yams. All drugs should be used only when the benefit significantly outweighs the risk.

Ultimately, the decision is between you and your doctor. As the person taking the medication, you should be aware of the risk you take by taking the medication and also the risk of not taking it. There is, in my opinion, pretty strong evidence that using "statin" drugs can significantly improve the survival and quality of life of high-risk people.




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[www.keralites.net] Relieve Stress Naturally with the Ashwagandha Herb

 




    
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Relieve Stress Naturally with the Ashwagandha Herb

Want to relieve stress naturally? Consider Ashwagandha, a type of Indian herb. Also known as Indian ginseng, ashwagandha has extraordinary stress-relieving properties. Its calming effects can be compared to those of traditional depression and anxiety treatments.

Ashwagandha can help you to reduce or even avoid the use of often-harmful and over-prescribed pharmaceuticals. But that's just one potential benefit. In addition to relieving stress, Ashwagandha has been shown to protect brains cells against the physiological damage that stress puts on your body. It's been used for thousands of years in Ayurvedic (Indian) medicine. Not just to target stress, but also to boost hormones and strengthen the immune system.

Modern-day medicine has shown ashwagandha to be just as effective as some antidepressant drugs. Specifically, oral administration of ashwagandha for five days led to:

Anxiety-relieving effects similar to those achieved by the anti-anxiety drug lorazepam (Ativan), and

Antidepressant effects similar to those of the prescription antidepressant drug imipramine (Tofranil).

Ashwagandha achieves these effects by increasing specific antioxidant enzymes in the body that are depleted during stressful times.

In another study, 85% of the brain cells observed in the animals exposed to chronic stress showed signs of degeneration. It is this type of cellular degeneration that can lead to long-term cognitive difficulties.

When ashwagandha was administered to chronically stressed animals, the number of degenerating brain cells was reduced by 80%!

Ashwagandha can help manage not only mental stress, but also physical. As anyone who has been stressed, which is everyone, can attest to — it's not just the mind that is affected but the body as well. It sucks your energy from you no matter how hard you try. And for severe cases of depression, it can be physically difficult to even get out of bed.

This is because stress causes the release of a hormone called cortisol. Cortisol is needed in the body. But too much of it can have negative effects on the body like weight gain, compromised immune function and higher risk for chronic disease.

Studies show ashwagandha can reduce cortisol levels in the body up to 26%. It can also prompt a decline in fasting blood sugar levels, and improve lipid profiles.

The key component in ashwagandha that provides these remarkable benefits is a chemical called withanolide. Unfortunately, cheap ashwagandha supplements either have very lower levels of withanolides, or come from the leaf of the plant have no withanolides at all. Effective ashwagandha must come from the root of the plant.

Ashwagandha effects may take a month or so for you to really notice, but they should only get better over time. Unlike dangerous pharmaceutical medications, which are simply a band-aid, ashwagandha can help you heal in both body and mind.

From the most extreme cases of depression to the daily stresses of modern life, this healing herb may be right for you. But before you add it to your daily routine or use it to replace other medications, be sure to check with your doctor first.

--a


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