Posts Tagged ‘LDL Cholesterol’

How Do Blood Tests Fit Into the Comprehensive Exam?

Cooper Clinic’s in-house lab provides same-day results for the patient to review with their physician.

We began a blog series to define the components of the standard-six comprehensive preventive exam at Cooper Clinic with, ‘What Does a Comprehensive Exam Entail?.’ In this post, we introduced the series and covered the first of six components, Medical Exam & Counseling. Our second component of six is Laboratory Analysis.

Component #2: Laboratory Analysis

Comprehensive lab testing includes cholesterol profile, blood sugar level, complete blood count, homocysteine, urinalysis, high sensitivity C-reactive protein, thyroid stimulating hormone, vitamin D, omega-3 and other important tests. Cooper Clinic’s in-house lab provides same-day results for our physicians to review with the patients. Depending if the patient is new or returning, we examine up to 70 blood tests.

There are a number of risk factors for the development of chronic disease that can only be identified by blood tests. You certainly would not want to find out that you have high cholesterol by having a heart attack!

A complete cholesterol panel is an important test for prevention. Knowing the numbers in your cholesterol profile (total cholesterol, HDL (good) cholesterol, LDL (bad cholesterol) and triglycerides) helps define your risk for heart disease and stroke.

Almost 32 million adults have significantly high cholesterol levels (≥240 mg/dL). More than one of four adults has high triglyceride levels (risk factor for heart disease and stroke). An HDL cholesterol level <40 mg/dL in adult males and <50 mg/dL in adult females is considered low and is a risk factor for heart disease and stroke; about half of all adults have an HDL cholesterol < 52 mg/dL. What side of 52 mg/dL median level is your HDL? Given that in more than a third of patients, the very first sign of heart disease is death, this is definitely a chronic disease you want to prevent.

Fasting Blood Sugar
A fasting blood sugar measurement and a hemoglobin A1C measurement (which estimates your average blood sugar over the last three months) are important tests for prevention. An estimated 20 million American adults have been diagnosed with diabetes (fasting glucose ≥ 126 mg/dL). Another eight million adults have full blown diabetes, but don’t know it. More than 87 million adults (38 percent of the population) have prediabetes (fasting blood glucose 100-125 mg/dL). If you have prediabetes, you can take active steps in improving lifestyle to significantly lower your risk of developing full blown diabetes. Given that the presence of diabetes can result in vision loss, kidney dysfunction, heart attacks, strokes, poor circulation and amputations, this is definitely a chronic disease you want to prevent.

Kidney disease is another chronic condition that is detected by changes in blood work long before symptoms occur. More than 26 million adults (13 percent of the population) have chronic kidney disease and many do not even know it. Another 20 million are at risk for developing kidney disease because they have risk factors for kidney disease like diabetes or high blood pressure. Chronic kidney disease is a risk factor of heart disease and stroke.

The sooner you know if your kidney blood tests are abnormal, the sooner you can take proactive steps to protect your kidneys from further damage. Given that chronic kidney disease may require treatment with dialysis or kidney transplantation, this is another chronic disease you can prevent.

Vitamin D
Vitamin D is a fat-soluble vitamin that has helps keep calcium and phosphate levels in the blood normal which is important for healthy bones. Although more research is needed in these areas, preliminary studies have demonstrated that vitamin D deficiency is associated with increased risk of death from all causes, cardiovascular events including sudden cardiac death and stroke, diabetes, hypertension and impaired function of the immune and musculoskeletal system.

If you visit, where all on-going clinical trials are listed, and search vitamin D, you will see that vitamin D deficiency and vitamin D supplementation is being studied in countless conditions including  preventing diabetes, improving periodontal (gum disease), reducing hot flashes and improving fatigue! It is clearly the “it” vitamin of this decade.

Vitamin D is made in the skin in the presence of sun exposure. We can also get vitamin D from natural sources like fatty fish (less commonly) and more commonly from fortified foods (milk, breads and cereals). Despite the fact that sun exposure is not hard to come by and that fortified foods are generally available, vitamin D deficiency is shockingly common. A recent national survey of American adults (NHANES survey) identified that 42 percent of adults were vitamin D deficient.

Identifying vitamin D deficiency is simple (with a single blood test) and improving vitamin D levels is  easy too once you know you need to do it! Given the myriad of on-going clinical trials  involving vitamin D, who knows how many chronic diseases vitamin D levels may influence.

To learn more about a preventive exam at Cooper Clinic, click here or call 866.906.2667 (COOP). Stay tuned for the third component within the exam, cardiovascular screening.

Nuts and Bolts on Nut Butter Nutrition

November 14, 2013 Leave a comment

Not too long ago peanut butter was one of the only choices when it came to nut butters. Now the popularity of almond, cashew and others has grown exponentially. Let’s navigate all the “new” options and break it down so you can choose the best one for you.

There are a number of health benefits nut butters have to offer. They are primarily made of heart healthy fats known to raise healthy (HDL) cholesterol and lower bad (LDL) cholesterol. Nut butters are a good source of vitamin E, many other vitamins and minerals, and fiber. Because they are fats, a little bit goes a long way. Most have about 200 calories per two tablespoons. Scan the ingredient list to make sure it’s short and does not include harmful hydrogenated oils.

Are some nut butters really better than others? Check out the stats to compare the differences. Note these numbers represent averages. Look at the brand labels for specific data on each product.

Nut Butter Nutrition (for two tablespoons):

Nut Calories Total Fat Saturated Fat Fiber Protein
Almond 190 16 g 1.5 g 4 g 7 g
Cashew 190 15 g 3 g 2 g 5 g
Peanut 190 16 g 2 g 3 g 8 g
Soy 200 14 g 2 g 2 g 10 g
Sunflower 200 16 g 2 g 4 g 3 g

The Many Ways to Enjoy Nut Butters:

Almond butter: spread on a whole grain waffle; use in recipes for homemade energy bars

Cashew butter: use on sandwiches; substitute for peanut butter in Thai and Indian dishes

Peanut butter: spread on a banana or to dip apples; use in curry paste or in Asian dipping sauces

Soy butter: use as a dip with fresh vegetables or with whole grain crackers

Sunflower butter: smear on whole grain crackers; add vanilla or cinnamon for a flavor kick

Nuts are chock full of nutrition and now with the many options to choose from, you might venture out and try something different. Taste matters, so aside from noting the nutrition stats, you may want to select the ones you enjoy the most.

What is your favorite nut butter?

For more Health Tips and meal preparation inspiration check out the Cooper Aerobics Pinterest page or Recipes section on our website.

Nuts and Bolts About Coconut Nutrition

CoconutThere’s a lot of chatter about coconut these days. Many new products containing coconut are lining grocery store shelves, from coconut milk and water to flavored yogurts and frozen desserts. Some popular doctors, celebrities and diets tout the health benefits, but for now more reliable scientific research is needed before drawing any real conclusions.

Health Claims for Coconut Oil:

There are multiple health claims regarding the benefits of coconut oil, including promoting weight loss and improving heart health. One study looked at women ages 20-40 years of age who supplemented their diet with coconut oil. The results showed a decrease in abdominal fat. The participants were also given dietary and exercise advice so it is hard to prove how much of an effect the coconut oil had on their fat loss. As for improving cholesterol and heart health, there are a few studies that looked at coconut oil and found the combination of fatty acids in this oil improved the “good” HDL cholesterol, but on the flip side it raised the “bad” LDL cholesterol.

Where Coconut Oil Fits Into the Total Fat Equation:

According to the 2010 Dietary Guidelines for Americans, dietary fat from both healthy, (unsaturated) fat and unhealthy (saturated and trans) fat sources should make up no more than 35 percent of your daily calories. Some healthy fats include peanut butter, nuts, avocados, olive and canola oil. Some unhealthy fats are found in high fat meat and animal products, full fat dairy foods and oils such as palm and coconut oil and foods prepared from these oils.

Cooper Clinic recommends for a 2,000 calorie a day diet less than seven percent of total calories come from saturated fat. That equates to 16-22 grams of saturated fat a day. One tablespoon of coconut oil contains about 12 grams of saturated fat which is a big chunk of your saturated fat allotment! Most popular food products (see list below) are proportionately high in saturated fat to total fat. Even small amounts of either unsaturated or saturated fats are calorie-dense so accounting for the portion is a key factor. If you choose to include small amounts of coconut products in your diet, keep in mind how they fit into the total amount of your saturated fat budget. As with all foods, stick with moderation.

Comparing Coconut Products:

  • Coconut oil: 1 tablespoon contains about 120 calories, 13.5 grams total fat and 12 grams saturated fat.
  • Canned coconut milk: ½ cup serving contains about 220 calories, 24 grams total fat and 21 grams saturated fat.
  • Coconut milk (So Delicious®, Original): 1 cup contains 80 calories, 5 grams total fat and 5 grams saturated fat.
  • Coconut Greek yogurt: 6 oz. contains 140 calories, 4.5 grams total fat and 3.5 grams saturated fat.
  • Coconut water: 1 cup contains about 45 calories, 0.5 grams total fat and 0.4 grams saturated fat.
  • Coconut milk dessert (So Delicious®, vanilla, no sugar added): 1 cup contains 200 calories, 16 grams total fat and 14 grams saturated fat.

For more information about Cooper Clinic Nutrition Services or to schedule a nutrition consultation, click here or call 972.560.2655.

Interview with Cooper Clinic head of cardiology Dr. Nina Radford about HDL Cholesterol

August 27, 2012 3 comments

Todd Whitthorne recently sat down with Dr. Nina Radford, and discussed HDL Cholesterol. Click here if you would prefer to listen to the interview.

Todd:  Hello, and welcome to another Healthy Living podcast from Cooper Aerobics Center. This is Todd Whitthorne, and I’m joined today by Dr. Nina Radford the head of cardiology at the Cooper Clinic, and Dr. Radford we have a topic today that I think is going to interest a lot of our listeners. Generally when it comes to health, we like to distill things down to takeaways, and when it comes to cholesterol we have a tendency to think that LDL is lousy and the HDL is healthy. There’s a recent study published in May of 2012 in the Lancet that says, well maybe raising HDL is not all that beneficial.  What do we need to know about that?

Dr. Radford: Well Todd, that’s a great question. Historically, when we talk about cholesterol parameters, as you described, we look at LDL, and when it’s high it’s bad for us – it increases the risk of heart attack…, and when we look at HDL, if it’s too low, it increases our risk of heart attack. And those are associations – if we look at a group of people who’ve had heart attacks versus a group of people who haven’t, and you find that high LDL is associated with heart attacks and low HDL is associated with heart attack, but that doesn’t necessarily prove causation.

Now with LDL cholesterol, there have been a number of studies that have gone on from “association” to proving “causation,” and how do we do that? Well first we say “Gosh, if high LDL is associated with heart attack, if we lower it with drugs does that lower the risk?”, and in fact there have been many, many studies showing if you lower LDL cholesterol with diet or medication, you reduce the risk of subsequent heart attacks.

They can also look at from another angle, and that is the genetic angle. There are some people who are actually born with genes that cause their LDL to be low. So, they look in those families who have those genes that cause low LDL, and they ask the question “In those families, is there a reduced risk of having a heart attack?”, and in fact there is. So, whether or not your LDL is low because you take medicine, or you follow specific lifestyles, or it’s low because low LDL happens to run in your family…, either way, both of those situations are associated with a lower risk of heart attack. So you make the transition from “association” to “cause.”

Now investigators are trying to do the same thing with HDL. So we say “Gosh, having a low HDL is associated with heart attacks – having a high HDL must be good for you then!” So we look at studies: If I give you a drug that causes your HDL to increase – something like niacin, for example, will that reduce the risk of having heart? And in fact, there was a recent trial called the Aim-High Trial that took patients who already had a low LDL (so that is they were already on medicine to lower their LDL because they have heart disease), but their HDL was low. Researchers treated patients with a drug that causes the HDL to go and see if it would lower their risk of having another heart event even more! The study did not demonstrate any benefit from increasing the HDL with the medication. So, then all of a sudden, people started to wonder if raising HDL is a good thing, “Is high HDL really protective?” because we didn’t see it in this study. So, what these investigators did in the Lancet study was they looked at people who have a genetic cause of having high HDL – they had genes that ran in their family that actually blessed them with very HDL levels.

Todd:  Dr. Cooper calls that the Methuselah factor. I’ve heard him say that many times.

Dr. Radford: They’re just lucky they were born with a high HDL. Investigators looked at 21,000 people in one study and 12,000 people in another group, so they combined those groups and were looking at over 30,000 individuals who had this gene, and they predicted that the risk of having a heart attack should be lower in these people because they have HDL, and in fact they did not see that the risk was lower.

So here we have this Genetic Study, right on the heels of this Drug Trial, and all a sudden people are saying “Hey, I thought having a high HDL was good for you! What’s going on here?” Well, you have to be careful about dismissing decades of historical data based on a couple of studies.

For example, in this study where they gave a drug to increase the HDL to see if it would reduce risk, well we know that LDL, the bad cholesterol, is a bigger driver of risk than HDL. So if I lower your LDL and get it super low with a drug, plus you’re on an aspirin, and an ACE inhibitor, and fish oil, and you’re meditating, and you’re doing all the right things…, and on top of all those really good things, I add another good thing, it may be that the effect is not big enough that you can see it. Because you’re doing six other good things, and when you add the seventh the benefit isn’t big enough. And so, that may be part of.

But then when you look at this Genetics Study, and you add it to the Drug Study, what’s the story? Well, the story is this: It may be that having a high HDL is a marker for some other thing that you’re doing that’s good. So, for example, we know that if you want to increase your HDL and you exercise, you can do it. But what if exercise causes another thing to happen? So, and I’m going to make it up….. Let’s say exercise increases your “Todd” factor. So, if you’re a regular exerciser, your “Todd” factor goes sky high. Now, your HDL also goes sky high, and we can measure the HDL, but we don’t know how to measure the “Todd” factor.

Todd:  At least not yet!

Dr. Radford: So, it may be that HDL is kind of going along for the ride and the real benefit of exercise is the “Todd” factor that we’re not smart enough to measure yet. So, that’s what we’re not clear about.

Now, should you stop doing things we know will raise HDL? Like being at your ideal body weight, taking some fish oil, exercising regularly? Absolutely not! But whether or not you should take medications to raise your HDL, beyond the other good heart healthy things that you’re doing, is not clear, and what most physicians are doing is taking it on a case-by-case basis.

If you’re taking a medication to raise your HDL don’t stop it, because we’ve only got that one Trial that’s raised some questions…, but it’s a good thing to ask your doctor when you see them next. You’re reviewing all your meds – it’s a good thing to do every year – and say you’re taking this for your blood pressure, taking this for cholesterol, this for prostate, this to make your hair shiny, etc. Every year you’ll want to look at all those meds and talk with your doctor and say “Do I need to take each of these (medications)?” And, if you happen to be on a drug for raising HDL, it’s a good time to review (taking it) and decide if you still need it.

Todd:  So, where are we from your perspective – historically, it’s the question that comes up all the time – “Is at HDL? Is it LDL? Is it the combination, that atherogenic index, of total cholesterol divided by HDL?” Dr. Nina Radford, head of cardiology at the Cooper Clinic, what you think is the most important component? Or, is there a magic number we need to be thinking about, as the average patient?

Dr. Radford: Well, that is a great question! It depends a little bit on what your other risk factors are; what your age is; and what your gender is. So, for example, compared to men, HDL is probably a bigger driver of risk in women. But that has to do with probably differences in our hormones. LDL is still a driver of risk in women – it doesn’t mean you can willy-nilly have your LDL be high and super size your fries, but it looks like some studies suggest in women before they’re had their first heart attack or heart disease HDL is a big driver of risk.

In men, LDL appears to be a bigger driver. When you talk about patients who already had their first heart attack; had a stent; have heart disease…, LDL is a very big driver of risk, and needs to be very specifically controlled.

Todd:  In both men and women?

Dr. Radford: Absolutely! In both genders! So it depends a little bit on the age and the clinical background in terms of which factors I’ll be more concerned about.

Todd:  So the takeaway is case-by-case, patient-by-patient, one size does not fit all?

Dr. Radford: Absolutely.

Todd:  Very good. Dr. Nina Radford, the head of cardiology at Cooper Clinic, great information as always! We appreciate your time Dr. Radford.

Folks, if you want more information, you can always sign up for the Get Cooperized Newsletter. We’ll have more podcasts in the very near future. Stay with us. We’ll see you soon.