Ask the MD: Good Heart Health

Wondering about how and when to get your cholesterol checked, or how exercise can boost your cardiovascular health? We got answers to some common heart health questions from Dr. Brad Jacobs, MD, and Chair of Pharmaca’s Integrative Health Advisory Board.

How often should I have my cholesterol checked?
Typically we recommend you get your cholesterol checked once a year. For men that should start at age 35, and women age 45. If you have an increased risk (i.e. a family history of early heart disease), then we recommend you check it at least once between the ages of 20-35. If it’s elevated at that point, continue to get it annually, otherwise you can continue with the normal guidelines.    

When you do get it checked, make sure you have both your HDL and LDL tested, since total cholesterol is less relevant. The LDL should be as low as possible, and the “good stuff,” HDL, as high as possible. The general guidelines are to aim for higher than 45 for HDL, and below 130 for LDL-unless you’re at risk for heart issues, in which case we recommend an LDL below 100.

What integrative therapies can I use to lower my cholesterol?
The most important things are lifestyle changes. I’m a big fan of modifying people’s diet. Everyone seems to know what they’re supposed to eat, but it’s hard to implement that in their life.

Instead I tell people to change the proportion of types of food they put on their plate. Rather than filling your plate with half meat and carbs and a quarter vegetables, reconfigure it so that three-quarters of the plate is filled with vegetables, at least at lunch and dinner. When you do that, it can dramatically change your overall heart health and cholesterol.

When you do eat meat and carbohydrates, make them whole grain carbs, and diversify your protein sources by incorporating legumes, fish, soy or, if necessary, a lean meat. I recommend eating red meat modestly, about 1-2 times per month. (For more information on healthy eating, I recommend the Harvard School of Public Health’s Healthy Eating Pyramid by Dr. Willett.)

Eating this way increases your fiber consumption, and reduces your saturated fat intake, both powerful tools for lowering your cholesterol and your risk for heart disease. If you can’t get enough fiber through food (ideally 20 g per day), try supplements such as psyllium husks, triphala (a fiber-based compound from India), or beta glucans. Make sure you’re drinking enough water as well. When you’re eating this much fiber, staying hydrated allows bowel movements to flow more freely, which can help relieve both diarrhea and constipation. Vegetables themselves also allow you to have more rapid bowel movements, which can reduce colon cancer risk, allow you to lose weight, lower cholesterol, etc.

Another important lifestyle change is maintaining a healthy weight, as weight itself affects cholesterol. If you can lose more than 5 percent of your weight you can reduce your cholesterol. Find a peer you want to lose weight with, since the buddy system almost always makes losing weight more successful. If you don’t have one, try WeightWatchers or SparkPeople, fantastic programs that have hundreds of thousands of participants. (Read more about my weight management tips here).

I also recommend the following supplements for lowering cholesterol:
·     Niacin: Take in small doses several times per day to help increase your HDL levels.
·     Garlic: Research has linked it to modest lowering of cholesterol, and it can be beneficial for overall health.
·     Omega-3s: Strong evidence shows that these reduce your triglycerides, and can help increase heart attack survival rates.
·     I’ve also found plant sterols to be quite effective, especially beta-sitosterols, which are quite helpful for modifying LDL. You can find them in spreads such as Benacol or in supplements like Natural Factors’ Cholesterol Formula.

What about blood pressure?
There is some overlap with blood pressure and cholesterol. Stopping smoking, reducing your weight and managing your stress can all can reduce your blood pressure. Decreasing your alcohol and salt consumption can also help.

As for supplements, magnesium and calcium are thought to have modest blood pressure-lowering effects, and CoQ10 is thought to lower systolic blood pressure. Finally, there is a lot of research showing that yoga can have dramatic effects on blood pressure, as it affects breathing, reduces overall stress and reduces the stress hormone cortisol.

Should I be taking an aspirin every day?
I am in favor of taking a baby aspirin (81 mg) for men and women over 40. Research shows that it can reduce the rate of cancer by up to 33 percent in this group, and can prevent heart disease. It’s important to note that some people are at increased risk for bleeding, and aspirin can exacerbate that, so speak with your doctor before starting an aspirin regimen. Asthmatics can also see a worsening of symptoms with aspirin. 

How should exercise figure in to a heart-healthy lifestyle?
Exercise itself has been shown to improve cholesterol. The most important thing is to find an exercise that you like to do. What did you do in high school for fun? Try and do something based on that. Any exercise is exponentially better than none, so just getting out and walking for 20 minutes can give you significant health benefits.

National guidelines recommend 30-60 minutes, 5 days per week. If it’s too difficult to find that much time, incorporate exercise into your normal activities such as walking to/from work, taking stairs instead of elevators or doing a ‘walking’ meeting instead of sitting in your chair.

Ideally, you should aim for exercises that strengthen the body and improve your cardiopulmonary system. I’m also a big fan of exercises that affect the mind, like tai chi, yoga, since they stretch and strengthen the body while relaxing and calming the mind, (which can lower blood pressure).

What is the connection between oral health and heart health?
There’s thought to be a relationship between oral hygiene and heart health, since people with poor oral hygiene are thought to have chronic inflammation in the body, which puts you at higher risk for heart attack. Chronic inflammation in the mouth is like a low-grade infection, which keeps your system in a revved up state where the cytokines and immune system are always activated. That’s why a diet that’s high in anti-inflammatory compounds can reduce your heart disease risk.

For more advice about maintaining good cardiovascular health, speak with a Pharmaca practitioner today.

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