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More than ten years ago, I joined forces with other medical leaders in a revolution that has exploded into the consciousness of the general publica revolution that has required us to confront head-on the lethal danger posed by cholesterol to the human heart and blood vessels. Through my bestseller Controlling Cholesterol, published in 1988, I was able to share insights from my own three decades of clinical work with cholesterol with millions of readers around the world.
Today, the revolution roars on. We now have learned that we can exert powerful control over cholesterol in natural ways that no one ever anticipatedthrough functional foods, or nutriceuticals, the terms now commonly used for table foods that have been specially designed to heal and prevent disease.
As chairman of the Cooper Institute for Aerobics Research, I elected to approve and supervise clinical trials on how certain functional foods behave in relation to harmful LDL cholesterol, beneficial HDL cholesterol, and other components of the blood lipid profile.
These and related research projectsat such far-flung centers as the Mayo Clinic, the University of Helsinki, McGill University in Montreal, and the University of British Columbiahave broken much new ground. The startling findings have convinced those of us directly involved in the investigations that it is indeed possible to "eat your way to good health."
Yet what continues to amaze me is just how many of my conclusions in Controlling Cholesterol have not changedeven though much of our understanding about the operation and treatment of cholesterol has changed.
What Has Changedand What Hasn't
What has changed on the cholesterol scene in the past ten years? A detailed answer will emerge in upcoming chapters, but here are some of the highlights:
Functional foods are revolutionizing our treatment strategies. Now it's so much easier to control cholesterol naturally, without having to resort to medications.
Our understanding of "normal" total cholesterol has changed. Ten years ago "normal" total cholesterol for an adult in the middle or older years would have been a reading below 235 to 240 mg/dl. Today acceptable total cholesterol is a measurement below 200.
Total cholesterol has taken a backseat to various cholesterol subcomponents. I can still remember when many labs provided only one cholesterol number for a blood testtotal cholesterol. Patients and physicians had to request specifically a reading on the important subcomponentssuch as the "bad" LDL (low-density lipoprotein), the "good" HDL (high-density lipoprotein), and the ratio of total to HDL cholesterol.
Today every competent lab automatically reports these subcomponents because now we finally understand the serious danger posed both by low HDL cholesterol and by high LDL cholesterol.
Triglyceridesblood fats related to cholesterolhave assumed increasing importance as a cardiovascular risk factor. Among other things, high levels of triglycerides are now regarded as a strong and independent predictor of the future risk of a heart attackespecially when total cholesterol levels are also high.
More attention is being paid to treating the cardiovascular concerns of womenespecially those who have moved past menopause. Although I warned in Controlling Cholesterol that postmenopausal women would lose the protection of estrogen and would become more vulnerable to heart disease, research into this subject was sparse ten years ago. Now we know that it's as essential to evaluate and treat women as it is to treat men.
Antioxidantsespecially vitamins E and Care assuming increasing importance in cholesterol-control programs. Ten years ago the terms antioxidant and free radical were largely unknown to the general public or to practicing physicians. Today antioxidant vitamins have become an integral part of preventive medicineand a powerful tool in controlling cholesterol the natural way.
More than ever, we are making use of what I call the Compound Effect in treating cholesterol. This technique can reduce drug doses or even eliminate the need for them altogether. With this strategy (which I describe in detail in chapter 5) you begin with one approach to lowering cholesterol, such as functional foods, and then add a second approach, such as a low-fat diet. If necessary, you can add still another treatment, such as one of the new "statin" drugs.
The combination of two or more of these treatments produces an exponential effect in controlling cholesterol, above and beyond what we've witnessed in the pastand typically limits the need for medications.
Noninvasive computer-imaging devices have taken much of the guesswork out of diagnosing clogged arteriesand are dramatically changing treatment strategies. These new diagnostic techniqueswhich have been validated by several important studies published in major medical journalsare just emerging as a tool for practicing physicians in the United States and abroad. But the new technology, which is now available at the Cooper Clinic, has taught us that it's often not necessary to treat high total cholesterol with drugsif a computer-imaging diagnosis plus a stress test indicate no coronary artery blockage.
For example, ten years ago I would have prescribed medications for anyone with total cholesterol of 300 mg/dl (milligrams per deciliter).
Today if a very low calcification score on computer imaging indicates no buildup of plaque (fatty deposits on arteries) and the treadmill stress test is normal, I wouldn't recommend drugs. Instead I would put the person on a cholesterol-lowering functional food regimen.
Yet even though many things have changed, many have remained the same. In reevaluating Controlling Cholesterol, I found that:
A low-fat, low-cholesterol diet, accompanied by endurance exercise, is still the best starting point for a program to control cholesterol successfully.
Saturated fats, such as those contained in butter and whole-milk products, continue to be a major dietary villainand have been joined by trans fats, or those produced in the hydrogenation process during commercial manufacture of many foods.
Monounsaturated fatssuch as those found in olive and canola oilcontinue to be the dietary fats of choice because, as Dr. Scott Grundy's research has demonstrated, they are associated with lower cardiovascular risk.
Obesity is still as dangerous to your cardiovascular health and cholesterol levels as we believed ten years ago.
Stress can upset a healthy blood cholesterol balance as much today as in the past.
There is still a clear correlation between aerobic exercise and higher levels of "good" HDL cholesterolfor both men and women.
The statin drugs were just coming into their own when I had the opportunity, in Controlling Cholesterol, to introduce them to a much broader segment of the general public. Now, when medications are required, statins are the treatment of choiceand many more of them are available.
So we made a good start in dealing with the dangers of blood fats back in 1988, and considerable progress has been made since then. But most important, the message is getting across both to the medical community and to the general publiceven though public awareness has sometimes been slow in coming.