Vegans & High Cholesterol

Free of all animal products, a strict vegan diet contains no cholesterol. Yet, a vegan may face elevated levels of cholesterol. A paradox? Not really. We all are highly effective at producing and recycling cholesterol. Each cell wall requires cholesterol. Cholesterol serves as a building block for important hormones. Cholesterol plays a role in the digestion of dietary fats. We can manufacture cholesterol at a cellular level. We produce cholesterol in our livers. For many Americans, their own body produces 70%-80% of the cholesterol found in the blood stream. Only the residual comes from foods.

Within the context of our modern lifestyles and extended life spans, our well developed ability to manufacture cholesterol can adversely affect our heart and vascular health. This is true for vegans, vegetarians and omnivores alike.

If you are a vegan, how should you think about your cholesterol levels? Start with the facts. Get a blood test that provides information on your total cholesterol and its components—LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. Then factor in your own family history to frame your understanding of these numbers. Then consider that a health circulatory system can play an important role in your long term health and wellness.

Other Benefits of a Vegan Diet

In terms of cholesterol management, vegans often enjoy benefits other than restricted intake of dietary cholesterol. The diet may be lower in saturated fats. Research shows that these fats, particularly those from animal and dairy products, elevate cholesterol levels. Interestingly, certain saturated fats from plants have been shown to be cholesterol neutral.

Vegans and vegetarians also consume a higher level of plant sterols. Plant sterols are the plant kingdom’s equivalent of cholesterol. At 2 grams per day, these sterols have been shown to lower LDL blood cholesterol levels by 15% or more. Omnivores typically consume 250mg (.25g) per day, while vegetarians consume between 400mg and 750mg.

Other Nutritional Measures for Cholesterol Management

If you are a vegan and still face issues related to your cholesterol levels, you can consider other measures consistent with your philosophy and commitment. Utilize high monounsaturated oil, like extra –virgin olive oil, in place of other oils and fats, search out plant sterol fortified foods, and increase your intake of cholesterol-lowering soluble fiber from oats, barley, beans, psyllium and fruit. For additional resources on Natural Cholesterol Management , click on to the Kardea Nutrition website.

Is Your Doctor Doubtful? Developing a Partnership with Your Health Providers

O.K. you have done your homework, and you are convinced that natural cholesterol management can and should be a meaningful part of your personal approach to long term health and longevity.

But you want to engage your doctor in setting up a system to monitor your progress. You know you need to monitor what is working and what is not. This will require periodic blood tests prescribed by your doctor and hopefully paid for by your health insurance.

But you are concerned that your doctor will be dismissive of your desired course of action.

No doubt, some physicians are more knowledgeable than others about natural nutritional approaches to cholesterol management. But most physicians, when presented with the evidence, are willing to explore the options.

So, if you meet resistence, suggest that your doctor read the recommendation of the NIH's National Cholesterol Education Program most recent report of the effecteness of "therapeutic lifestyle changes." In the NCEP recommendations, it is noted that this approach can achieve results similar to that attained by cholesterol lowering medication.

The NCEP reports, plus a listing of related research and studies, can be found on the Kardea Nutrition website.

Your doctor's views about natural cholesterol management also may hinge on concerns about compliance. Many doctors routinely recommended the therapeutic lifestyle changes, but patents often have difficulty changing their habits. It is on this point that you need to be honest with yourself. Can you maintain --- on a daily basis--the steps necessary to be effective with natural cholesterol management.

Sometime this is not easy. I know. I have been working on it. I designed the Kardea Nutrition products to make it easier for me to maintain the program and achieve measurable and signficant improvements in my blood lipid levels.

Give us a holler and let know how you are developing your relationships with your health care provider. Others will find your experience and advice really helpful!

So Now I Know What Menopause Feels Like

I was at a reception tonight celebrating the first anniversary of the Connecticut Center for Entrepreneurship and Innovation. I used some of the services of this Center in launching Kardea Nutrition.

As a leading Kardea missionary, I found myself in discussions with a couple in their 60's working to manage their cholesterol levels through natural means. They had some misconceptions, but they had many elements of the program down, including the use of niacin. We got to sharing our experiences of the flushing effect of this essential B vitamin. The wife looked me straight in the eye, and said "you've got to admit, it feels like menopause all over again."

Well, my wife tells me that launching Kardea Nutrition may be my manifestation of male menopause, but I think for the male, menopause is largely an emotional passage. In any event, I am grateful for the insight.

So guys, if you also want to be able to relate better to your spouse during a hot flash, try some niacin. Separately, I have learned not only to tolerate the niacin flush, but also to appreciate the sensation....and the science supporting niacin's role as part of a broader program for natural cholesterol management is impressive and extensive.

For an overview of natural cholesterol management, join us at http://www.kardeanutrition.com/cholesterol/index.aspx. You also can search on this site to find selected information and articles related to niacin.

Cumin Spiced Black Beans-Quick & Delicious

A great pleasure in the culinary arts is stumbling on an incredibly easy, quick and flavorful recipe. I can devote hours to the preparation of some dishes only to receive praise for a five minute side. Everything may taste great, but sometimes these easy dishes find their way to top honors. A spiced black bean salad falls into this category.

Spiced Black Bean Salad

How to Make
Ingredients
16 ounce Canned Black Beans
2 -3 Tablespoons White Distilled Vinegar
1/3 Cup Green Olives-Pitted & Chopped(with or without pimentos)
2 Tablespoons Extra Virgin Olive Oil fortified with Plant Sterols
3-4 Tablespoons Chopped Onion or Scallion
1/8-1/4 Teaspoon Cumin
Hot Sauce to Taste

Rinse beans until water flows clear and drain. This freshens the canned beans and provides a more natural flavor. It also reduces the amount of salt added by the manufacturer. Add all the other ingredients. It best if you let this marinate for about an hour or two, but it can be served immediately.

Depending on the availability of fresh produce, you can build this into a main dish that’s great for a summer lunch. Add cucumber, tomato, zucchini, radish, apple, pear.... let me know what's working.

Spiced Black Beans & Natural Cholesterol Management

As we have emphasized, natural cholesterol management (NCM) targets a daily intake of 10-25g of soluble fiber, 2-3g of plant sterols and at least 500mgs of Omega-3 fatty acids from marine sources. You also want to replace saturated fats with monounsaturated fats. Collectively, these nutrients can drop your LDL cholesterol by 30%.



For a 5 ounce serving, this spiced black bean salad delivers 2g soluble fiber and .25g of plant sterols. Utilizing only olive, this dish is high in monounsaturated fats and saturated fats are held to 5.6% of total calories, less than the 7% recommended by the National Cholesterol Education Program. (see chart above for % of therapeutic levels achieved with a single serving)

The spice black beans also complement a tumeric barley pilaf (see barley pilaf blog for recipe and NCM nutrient levels). To round out this meal, serve with a grilled chicken with a raisin port reduction (blog post coming).

Kardea Nutrition's Natural Bars for Cholesterol Management

O.K. I have gone off on a policy & political tangent over the past view days. I do think that the events and debates of last week regarding cholesterol medications required that I chime in.

Focusing back to the core goal of Kardea: to develop nutritional tools that enable natural cholesterol management. As a formulation standard we look to multiple product attributes: delicious, convenient, natural, calorie-mindful and therapeutic.

To optimize these attributes, I started looking at those foods that I am likely to eat everyday. If I was already eating, I was likely to keep eating it. If I wasn't already eating, I did not want to add a new source of calories. The trick was how to keep it something I crave while being effective, being therapeutic.

The nutritional bars were a really convenient place to start. Before founding Kardea, I had spent the last 12 years of my life running a specialty chocolate company. I had developed a habit--a craving--for a daily piece piece of dark chocolate (with a late morning cup of coffee--this has to be one of nature's great taste combinations!).

Certainly, dark chocolate is getting good reviews for its cardiovascular benefits. I certainly have tracked this, and discussed it with some people over at the Yale Medical School. This science seems promising, but I am not sure I would yet incorporate chocolate into my program for natural cholesterol management. Instead, I looked to develop a substitute for my morning craving. The Kardea bars achieved this goal, and then some.

First off, I think these bars really are tasty. All natural ingredients such as almond butter, authentic spices like nutmeg, clove or cardamom, real fruit and full flavors.

These bars also provide meaningful levels of plant sterols (1 full gram), fiber (7 grams; 3 grams of heart hearthy soluble fiber) and protein (7 grams total and close to 4 grams of soy protein). The FDA has endorsed these nutrients for their ability to help improve blood lipid profiles including a lowering of LDL (bad) cholesterol.

While only 150 calories each, these bars are more satisfying that the morning chocolate fix. I suspect this is a tribute to the protein and fiber levels.

Further, the bars are sweentened with lower glycemic agave syrup and brown rice syrup. Couple these with the fibers which slow glucose uptake, and I feel that I evened out the sugar spike. So by lunch, I no longer have the urge to eat too fast and too much.

The whole family has been eating the samples through the development process. We all ---friends and family--really enjoy them. Our first production run is now scheduled for mid-February, and they will be available to ship at the end of this month.

To get a product availability alert with an introductory 25% coupon, sign up for our newletter, UpBeat. http://visitor.constantcontact.com/email.jsp?m=1101913937814&p=oi

For additional product information: http://shop.kardeanutrition.com/merchant.mvc?Screen=SFNT&Store_Code=KNFNCM

The Cholesterol "Pill" & Health Policy

Over the past few days, the media has meted out criticisms of Big Pharma and their cholesterol medications. Certainly, some of it is well deserved. Some, however, confuses the issues and does not consider some fundamental issues related to health policy.

A Bit of Background

Statins and other cholesterol medications represent a critical piece of Pharma's profits. Worldwide, cholesterol meds represent the single largest class of drugs sold--exceeding $25 billion per year.

Why so much?

These medications do work to reduce LDL (bad) cholesterol, and the relationship between LDL cholesterol, heart disease and stroke has been well study and confirmed.

Then there is the magnitude of the issue. Combined, cardiovascular diseases are the primary causes of death and morbidity in the United States.

But, these medication do not "heal". Stop taking these medications, and your LDL cholesterol will rise--all other things being equal. Users of cholesterol medications thus may find themselves on these drugs for decades.

Overall, couple the huge population at risk of cardiovascular disease with the length of time that these medications are potential used, and a huge market is created.

An Oversold Solution?

Cholesterol medications have been oversold and hyped in their ability to remedy heart issues.

Managing cholesterol can improve the cardiovascular system, but it is not and cannot be a guarantee of heart health. Cholesterol also can be managed by means other than medications--nutrition, weight control and exercise. Nutritional approaches that combine nutrients that actively and positively influence blood lipids ---Omega-3 & monounsaturated fatty acids in lieu of saturated fats, plant sterols, soluble fiber, niacin---can achieve results equivalent to many of medications, particularly for the borderline line high cholesterol types like me. This view is widely endorsed in the medical community including the American Heart Association and the American College of Cardiologists.

Certainly, this does not mean that these drugs are without value. For many, the lifestyle and nutritional approaches are not adequate. Medications is required, and for those at high short term risk, they may be essential. Yet, theses meds should complement the therapeutic lifestyles. The approaches should be integrated and the medications should not be the first line of therapeuty.

Moreover, these medications are most effective in affecting only a component of cholesterol---lowering LDL cholesterol. There are other aspects of blood lipids that are important for heart health---the level of HDLs, the ratio of total cholesterol to HDLs, the size of the LDL particle--to name just a few.

Even in regard to LDL cholesterol, a single medication may not achieve heart risk adjusted targets (to calculate your risk-adjusted ldl targets, go to http://www.kardeanutrition.com/cholesterol/ldl_calculator.aspx ). The pharmaceutical solution is to identify other drugs to be taken with the existing medications.

No doubt, new drugs are coming to market or are in development that work with existing medications to favorably affect blood lipid levels. So, you can look forward to taking more medications! Today, we find ourselves with many people taking many drugs, and overall, we are only dimly aware of their interactions and long term afffects on health.

Drivers of a Healthcare Imbalance

From a health policy perspective, we need to give careful thought to what is going.

One issue is that we allow Big Pharma to spend hundreds of millions dollars per year promoting these medications. At whose expense? Well for one, the consumer advertising campaigns dwarf the public health education campaigns that advance nutritional and lifestyle alternatives. We all would be well served if the consumer received more balance input.

A few policy alternatives could be considered. We could require the pharmaceutical companies to contribute an equivalent amount of advertising money to lifestyle and nutrition public health education. This would not be unlike the tobacco companies funding of smoking cessation programs. Alternatively, we could require those media outlets that air these promotion to donate airtime to publilc health education.

Consumer behavior and incentives also are at issue. The advertising ---this unnecessary hype- works in large part because many consumers want to believe that a single pill will eliminate the risk of heart disease--regardless of what they eat, how much they weigh or how much exercise they get. Intellectually, not many of us would ever concede that we believe in the power of the single pill. Practically, the single pill gives us comfort when we fail to live heart healthy lifestyles.

At least for the well-insured consumer, it also may be cheaper, both in terms of time and money, to pursue the pharmaceutical approach than to embrace the alternatives.

Presidential candidates from both parties are discussing fundamental changes in our health care system. Special interest, including Big Pharma, can be expected to mold this system to their benefit. As citizen, we will be best served by making sure that real public health is advanced. Make your voice heard in this debate!

"Cholesterol Drug Bombs"-New York Times Editorial Misses Opportunity

Yesterday, the New York Times editorial board wrote "there have long been suspicions, but it was still very disturbing to learn this week that a heavily promoted cholesterol-lowering drug had flunked a clinical trial of its effectiveness in reducing fatty deposits in arteries....The drug, Zetia, and a combination pill that contains it, Vytorin...generated more than $5 billion in sales last year."

You probably know the ads for Vytorin. They have run on T.V., in magazines and on-line. They certainly are clever, creative and very expensive. According to Nielsen Monitor-Plus, in 2006 the companies spent $136.3 million to advertise Vytorin and $115 million from January to October of 2007.

Vytorin combines Zocor, a statin produced by Merck (and also marketed by generic drug manufactures and sold at lower prices) with the Schering-Plough's Zetia. Statins work by reducing the production of cholesterol in the liver. Zetia works to reduce the absorption of dietary and liver-produced cholesterol from the intestines into the blood stream.

The study compared the effects of treating patients with Vytorin, the combination drug, with a statin alone. The patients all had abnormally high LDL cholesterol. In the study, LDL cholesterol was reduced more significantly by Vytorin than with the statin alone. These results are consistent with the results of a number of other studies.


It also was hypothesized that the added cholesterol-lowering effect of Vytorin would lead to a more significant reduction of arterial plaque growth. This relationship did not hold. The lower cholesterol achieved by the Vytorin did not yield a reduction in plaque build-up as compared to the statin only. In fact, the Vytorin group was found to have a more rapid development of plaque than the statin-only group.

The Times reports that these companies had been “cynically sitting on the results for more than a year” while spending hundreds of millions of dollars to convince consumers that the Vytorin is a preferred cholesterol drug. This certainly is a very legitimate criticism.

The Times continued that "the findings also raise doubts about the current belief that lowering cholesterol is the key to cardiovascular health. The study showed that Vytorin reduced bad cholesterol significantly more than Zocor alone. The problem was that it failed to reduce the formation of plaque."


And here is perhaps were the Times should have been somewhat more careful. This study now represents a single set of data among a sea of data that concludes lower LDL cholesterol lowers the risks of heart attacks and strokes. Numerous studies also indicate that LDL cholesterol above 100mg/dl will lead to the development of arterial plaque.

Instead of casting doubt on the general wisdom of cholesterol management, the Times would have served the public well by offseting the barrage of pharmaceutical advertising and reinforce the well-documented science regarding natural alternatives to cholesterol management. An extensive NIH report (http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.htm), for instance, concludes that the "amount of LDL reduction from Therapeutic Lifestyle Changes compares well with many of the cholesterol-lowering drugs." Among the recommendations are the consumption of certain positive nutrients such as plant sterols, soluble fibers, monounsaturated fats in place of saturated and trans fats, and Omega-3s. Needless to say, weight management and exercise is part of the NIH recommendations.

For more information on natural cholesterol management nutritients: http://www.kardeanutrition.com/cholesterol/program.aspx

Soluble Fiber--From Hype to Health

Take a walk through the grocery aisle, and you will quickly find many products claiming to be heart healthy.

For many of these products, the heart healthy claims flows from two essential nutritional characteristics. They are low in saturated and trans fats, and they deliver levels of soluble fiber sufficient to meet certain FDA-allowed heart health claims. To make these claims, the FDA requires that the products deliver in each serving at least .75 grams of soluble fiber from oats or barley, or 1.7 grams of soluble fiber from psyllium.

For those of us seeking measurable improvements in our cholesterol levels, success requires consuming substantially greater levels of soluble fiber. The National Cholesterol Education Program of the National Institutes of Health recommends 10-25 grams per day. Depending on your chemistry, consumption at these levels can lower LDL cholesterol by up to 8-10%. Some studies have suggested that results could be more significant.

How much oatmeal is required to reach 10 grams of soluble fiber? Roughly 5 servings, or about 2 lbs of prepared oatmeal. For 25 grams, you would need to consume about 5 lbs of prepared oatmeal, or about 2000 calories per day from oatmeal. Nay!

While oats certainly are a good starting point, I begin the day with a heaping tablespoon (=3 teaspoons) of whole psyllium husk. Psyllium seed husks are nature's most concentrated source of cholesterol-lowering soluble fiber. Where oats are only about 5% soluble fiber, psyllium husks are about 60%. With a tablespoon of psyllium husk, I start the day with 9 grams of soluble fiber (note: start with a teaspoon and work your way up).

5-6 servings of fruits and vegetables through the course of the day gets me another 5-6 grams.

From here, I shoot for the upper levels of the cholesterol-lowering soluble fiber targets. Success typically requires some culinary creativity and an understanding of the sources of soluble fiber.



Here is one recipe that you may find a useful addition to your weekly food choices:

Barley Pilaf
4 Servings of About 1 Cup Each

Barley never came to my mind as something I would crave. Yet, I discovered that barley stands side-by-side with oats as an FDA-endorsed food for promoting heart health by lowering cholesterol. I have since set out to explore how barley could be enjoyed in something other than a malted beverage.

As it turns out, a barley pilaf can be a delicious alternative to the rice, potato or pasta “starch” in protein/starch/vegetable triad my mom insists constitutes a meal.

A pilaf can be cooked to complement any number of dishes. Adapt by incorporating any number of spices. Start with the basic pilaf and create from there.

So, you ask "why don't more people eat barley." Part of the answer lies with the fact that cooking barley can be a bit tricky. If you're not careful, you might find your pilaf with hot cereal qualities---perhaps great for a cold morning but not the best for a dinner. But if you take a bit of care, you barley pilaf can be a great nutritious alternative to high glycemic, low fiber carbs.

Ingredients
1 Cup Rinsed Pearled Barley
2 Cups Water
1 Small Onion-Finely Chopped
2 Tablespoons Extra Virgin Olive Oil (preferably fortified with plant sterols)*
½ Teaspoon Turmeric
Salt & Pepper to Taste

*to double-up on the cholesterol lowering abilities of this dish, I formulated an extra-virgin olive oil with added plant sterols. This olive oil is available through the Kardea Nutrition website
http://www.kardeanutrition.com/products/food.aspx . If you want to reduce total fat, cut recipe to 1 tablespoon of oil.


Direction
Heat a sauce pan over medium heat. When pan is hot, add olive oil and chopped onion. Saute for a few minutes. Add rinsed pearl barley and saute for 5 or so minutes, stirring regularly and making sure that barley does not burn or stick to bottom of pan. Add turmeric and then water to the hot barley and stir. Cover, lower heat and cook until tender but still a bit chewy (30 minutes). Remove cover and on very low heat, let steam escape. Periodically fluff to prevent sticking to bottom of pan. Serve when barley appears about the consistency of steamed rice. This all may sound a bit cumbersome, but it works. The turmeric also give the barley a beautiful yellow color, accenting the visual appeal of an entire meal.


Nutritional Facts
(about a cup of cooked barley pilaf)
Calorie: 240 Calories from Fat: 70
Total Fat: 8g from olive oil; monounsaturated: 5.7g; polyunsaturate fat: 1.15g; saturated fat: 1.15g (4.3% of total calories); Trans fat: 0.0g.
Cholesterol: 0.0
Total Carbohydrates: 40g; Total Fiber: 8g; Soluble Fiber: 2g.
Protein: 5g.
Plant Sterol: .25g

Stepping-Up
You can try adding any number of spices. Try curry or cumin when serving lean meats or roasted root vegetables. Try ginger and currents when serving fish. Serve with a kidney bean chili or black bean salad (recipe in next blog) to create a meal that delivers 3-4g of soluble fiber.

Do You Have A Great Barley Recipe? Can you improve this recipe? Post your thoughts and recipes to this blog to share with the Kardea community.