Statins for Our Kids?

The American Academy of Pediatrics is recommending wider cholesterol screening for children. Underpinning these recommendations is the understanding that elevated LDL (bad) cholesterol in kids can lead to an onset of cardiovascular disease earlier in adulthood. It recognizes that the plaque in an adult's arteries may have begun developing very early in life.

The recommendations call for cholesterol screening of children and adolescents, starting as early as the age of 2 and no later than the age of 10, if they come from families with a history of high cholesterol or heart attacks before 55 for men and 65for women.

Screening is also recommended for children when family history is unknown, or if they have other risk factors, like being at or above the 85th percentile for weight, or have diabetes. If the child’s cholesterol level is normal, retesting is suggested in three to five years.

The report also suggests that for a selected group of children, prescribing a statin medication might be appropriate. Drug treatment, according to these recommendations, should be considered for children 8 and older who have very elevated LDLs, or when family history or weight indicate multiple risk factors for developing heart disease.

Not surprisingly, these recommendations raised an outcry.

“When you have a kid whose cholesterol looks like an overweight 65-year-old, what do you do?” asks Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston and quoted in The New York Times. In developing the recommendations, we "had to balance the risks of treating children with powerful drugs, about which there is limited long-term data, with the risks of not treating children with unprecedented cardiovascular disease risk factors.”

Dr Ludwig also is reflective about these recommendations. Quoted in the Times, he comments “my concern is what this is saying about society when we are so quick to prescribe drugs for these conditions before having systematically attacked the problem from the public health perspective”.

For many, the systematic solution focuses on addressing childhood obesity. No doubt, an extraordinarily important challenge in its own right. Yet, cholesterol management in children go beyond issues associated with obesity. Elevated cholesterol can be found in otherwise fit and thin adults and children alike.

Between weight loss and medication lies therapeutic nutrition as outlined by the National Cholesterol Education Program (NCEP) of the National Institutes of Health. Eating a balanced diet that replaces saturated fats and trans fats with monounsaturated fats (e.g. fats in olive oil, nut butters), adds high levels of soluble fiber from oats, beans, high-pectin fruits, and psyllium) and adds plant sterols can significantly improve cholesterol and blood lipid profiles. Other nutrients, including Omega-3s from fish oils, also have been found useful.

The NCEP asserts that therapeutic lifestyle changes with a particular emphasis on what we eat (not simply how much we eat) can deliver results comparable to many cholesterol-lowering medications. For links to the NCEP reports, clinical research and other educational materials advancing natural cholesterol management: Kardea Nutrition http://www.kardeanutrition.com/. For recipes: http://www.kardeagourmet.com/

Total Dietary Fat: Recommendations of the National Cholesterol Education Program

NCEP Evidence Statement: Unsaturated fatty acids do not raise LDL cholesterol concentrations when substituted for carbohydrates in the diet (Strength of Evidence: A2, B2).

NCEP Recommendation: It is not necesary to restrict total fat intake for the express purpose of reducing LDL cholesterol levels, provided saturated fatty acids are reduced to goal levels (less than 7% of daily calories).

NCEP Evidence Statement: The percent of total fat in the diet, independent of caloric intake, has not been documented to be related to body weight or risk for cancer in the general population. Short-term studies suggest that very high fat intakes (greater than 35% of calories) modify metabolism in ways that could promote obesity (C2). On the other hand, very high carbohydrate intakes (greater than 60% of calories) aggravate some of the lipid and non-lipid risk factors common in the metabolic syndrome (A2. B2, C2).

NCEP Recommendations: Dietary fat recommendations should emphasize reduction in saturated fatty acids. Further, for persons with lipid disorders or the metabolic syndrome, extremes of total fat intake--either high or low--should be avoided. In such persons, total fat intakes should range from 25-35 percent of calories. For some persons with metabolic syndrome, a total fat intake of 30-35 percent may reduce lipid and non-lipid risk factors.

Polyunsaturated Fatty Acids: Recommendations from the National Cholesterol Education Program

NCEP Evidence: Linoleic acid*, a polyunsaturated fatty acid, reduces LDL cholesterol levels when substituted for saturated fatty acids in diets (Strength of Evidence: A1,B1). Polyunsaturated fatty acids can also cause a small reduction in HDL cholesterol when compared with monounsaturated fatty acids (B2). Controlled clinical trials indicate that substitution of polyunsatuarated fatty acids for saturated fatty acids reduces risk for CHD (coronary heart diseases) (A2,B2).

NCEP Recommendations: Polyunsaturated fatty acids are one form of unsaturated fatty acids that can replace saturated fat. Most polyunsaturated fatty acids should be derived from liquid vegetable oils, semi-liquid margarines, and other margarines low in trans fatty acids. Intakes of polyunsaturated fat can range up to 10 percent of total calories. (Note: recommendation for monounsaturated fatty acid is a higher at up to 20 percent of total calories).

*Linoleic acid is a colorless to straw-colored, polyunsaturated fatty acid that is liquid at room temperature and of the omega-6 series. Good sources of linoleic acid from vegetarian sources are sunflower oil, and safflower oil.

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).