The Food and Drug Administration (FDA) announced last week that they issued new regulations that require makers of the most widely prescribed drugs in the world—cholesterol-lowering statins—to include warnings about raising risk for type 2 diabetes, memory loss and confusion and muscle pain and weakness.
While the risk for blood sugar spikes and muscle problems is low, the drugs are taken by one-quarter of US adults aged 45 and older, making any increase in risk a potential problem for millions of adults. And, some experts believe that women are at significantly higher risk for developing these unwanted side effects compared to men.
Some of the drugs that are implicated include those that go by brand and trade names such as including Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Others include a combination of the compounds as in Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe)
These drugs have been available for many years now and are effective at lowering both total and LDL-cholesterol levels. However, as a dietitian, I’m also well aware of studies like the Portfolio Diet and many Mediterranean-diet studies that have also found significant declines in total and LDL-cholesterol levels via diet and exercise. In fact, the Portfolio diet, which calls for a combination of cholesterol-lowering foods including nuts, soyfoods, olive oil and leafy greens, that work synergistically together, to lower cholesterol as effectively as first-generation statin medications or up to 30%.
In addition, with any medication, there is always a negative side effect. With diet and exercise, there are only upsides and no downsides. The tried and true recommendations to lower the harmful, LDL-cholesterol levels, the most problematic type of cholesterol.
A 10% reduction in LDL is correlated to a 20-30% reduction in cardiovascular disease risk because every 1% decline in LDL equals a 2-3% reduction risk.
Reduce saturated fat to no more than 7% of total calories and cholesterol to no more than 200mg/day. Saturated fat will raise blood cholesterol more effectively than any other fat, except trans fats, which are being eradicated from our food supply. A goal of 7% of calories is no more than 16 grams per day for most women. To do that, eat more of a plant-based diet rich in fruits, vegetable and whole grains while limiting red meat, full-fat dairy products, baked goods and fried foods. Also, look at food labels and try to track your daily sat-fat grams until you get a handle of how much you’re eating. If you get your saturated fat lowered, cholesterol intake is also naturally being lowered, but is less important than sat fat reduction.
If overweight, reduce to ideal body weight. It’s unclear why excess body fat raises blood cholesterol but ab-fat is particularly heart unhealthy. Women should strive to keep their waist circumference below 35 inches and men below 40. If you’re overweight, strive to lose just 10% of your body weight with diet and exercise.
Eat 5-10 grams More Soluble fiber. Soluble fiber is found in oatmeal, barley, fruits and vegetables. It traps cholesterol in the digestive tract so that is passes through your body rather than getting into your bloodstream. Eating oatmeal for breakfast oatmeal and fruit as snacks can help you meet this goal.
Add 2 Grams Plan Sterols to Your Diet. Plant sterols are natural compounds found in vegetable oils, nuts and seeds that essentially mimic cholesterol in composition so they compete for absorption and therefore, less ingested cholesterol from food is absorbed into the bloodstream and more of it is excreted through the GI tract. Sterol-enhanced foods and beverages are commonplace, with the compounds being added to margarines and spreads and breads, juice, and even snack chips. For best results, take the sterol-enhanced product with meals, and at two different times of day.
Taking Your Heart’s Health to Heart. The cholesterol-lowering benefits from the following changes are similar to what you could expect by taking a cholesterol-lowering medications, but without the negative side effects.
|Diet and Lifestyle||Percent LDL Reduction|
|Add 2 grams plant sterols/day||5-15%|
|Reduce Saturated Fat to less than 7% of calories||8-10%|
|Reduce dietary cholesterol to less than 200 mg/day||3-5%|
|Lose 10 pounds if overweight||5-8%|
|Add 5-10 grams /day of soluble fiber||3-5%|