Study Proves Exercise Staves Off Bad Cholesterol

I’ve been in an exercise black hole since January 29th – the day I hurt my elbow shoveling. Since I had tennis elbow surgery 10 years ago, I knew this time to immediately stop playing tennis and quit spin to let my elbow heal. Suddenly it was 4 months later and I’ve gained weight and am out of the regular exercise habit.

YES, I could have done some other exercise. YES, I have both a treadmill and an elliptical in my home. NO, I didn’t use them and instead wallowed in my sadness that I’d reinjured my elbow.

And YES, I regret my sloth as I gained 5 pounds in four short months.

My elbow is still not 100% but now I’m on the slow path to regaining cardio fitness – and hopefully losing the weight that irks me daily as my jeans don’t fit.

And while exercise is harder than ever for me (getting old really bites: various body parts scream in protest when pushed), the good news is that a recent study of 11,000+ men proves that exercise may delay age-related high cholesterol levels.

An article entitled,The Effect of Cardiorespiratory Fitness on Age-Related Lipids and Lipoproteins was published online in the Journal of the American College of Cardiology, on May 11, 2015. While I can’t read the actual article as it costs $35 to purchase (!) I’m writing based on several reputable sources who reported on this study.

Researchers used data from the Aerobics Center Longitudinal Study in Dallas, Texas, collected from more than 11,000 men between 1970 and 2006 to assess total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides.

As Lisa Rapaport of Reuters reported in her article, Men Who Exercise May Delay Age-Related High Cholesterol, in the study, “researchers followed thousands of men over several decades, periodically drawing blood to test their cholesterol and then making them run on treadmills to measure their cardiorespiratory fitness. Men who could run longer and faster – signs that their bodies more easily deliver oxygen to muscles – also had lower cholesterol.”

“The better men did on fitness tests, the more likely they were to have lower total cholesterol, as well as lower levels of what’s known as low-density lipoprotein (LDL), the bad kind of cholesterol that builds up in blood vessels and can lead to atherosclerosis, blood clots and heart attacks.

Fitter men also had higher levels of so-called high-density lipoprotein (HDL), the good cholesterol that helps purge the bloodstream of LDL.

Men with higher cardiorespiratory fitness levels had better cholesterol profiles than less fit men from their early 20s until at least their early 60s, though the difference diminished with older age.

At the same time, men with lower fitness levels reached abnormal cholesterol levels before age 40.”

Said differently, unfit men were at risk of developing high cholesterol in their early 30s, but those with better fitness levels did not see it rise until their mid-40s, around 15 years later.

Dr. Gregg Fonarow, professor of cardiology at the University of California, Los Angeles, was widely quoted about this article online: “Exercise is a vital component of achieving lifelong cardiovascular health. Regular physical activity and maintaining physical fitness has been shown to be associated with a lower risk of [heart attack], stroke, and premature cardiovascular death.”

How much exercise is needed? According to study co-author Dr. Xuemei Sui, an Assistant professor at the Arnold School of Public Health at the University of South Carolina, to achieve the fitness levels necessary to ward off age-related high cholesterol, men should get 150 minutes a week of moderate activity (gardening, dancing, brisk walking) or 75 minutes of vigorous activity (jogging, running, swimming, cycling).

That’s 30 minutes of aerobic activity (a brisk walk!) five days a week, or 3-4 runs a week (or for me: tennis or spin 2-3 times a week).

Of course this study was done just with men. Actually, healthy white men. Of course that is incredibly frustrating. But I am going to go out on a limb and assume the same healthy benefits may confer on men and women in general.

And hope that getting back to the regular/daily exercise that will make my jeans fit again will also keep bad cholesterol at bay.

 

 

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Moist Dry-Poached Chicken Breasts

Two weeks ago, things reached a new level of low when my good friend, cartoonist Chris Juneau, asked, “Do you EVER cook anymore or do you eat out every night?”  While that felt a tad unjust (Chris’ query was in reply to my dinner invitation! At a restaurant where we’d won a gift certificate at Chris’ charity fundraiser!!), in the end, she was right. I’d pretty much stopped cooking (and gained weight, but that’s another story).

And with that single snarky comment, I’d been shamed right back into the kitchen.

That week, I made my usual favorites: Baked Arctic Char with Baked Sweet Potatoes (recipes on Going Lo-Co Recipe page) and Mustard Roasted Fish (see my Mmm Mmm Mustard Roasted Fish post for info and recipe).

Then I switched things up by using salmon instead of arctic char and made them both again. Yes, that was sarcasm.  Yes arctic char and salmon taste nearly identical. Yes, at this point, my husband bought some steak and grilled it while I baked more fish.

Clearly I needed help.

So at 5:30 one evening the following week I went to a different market – one where fish is not their best offering – and peered at some nice looking chicken. The package was labeled “dry-rubbed, beer-seasoned (oxymoronic on two levels: crazy, right?) boneless chicken breast.” They looked and sounded great, so I grabbed them.

It wasn’t until I got home that I found a problem: no cooking directions. Oh, and also that’s when I remembered that I absolutely detest dry chicken breast. And here I was with what was already advertised as dry.

Sigh.

But now it was dinner time and I was hungry and it was too late to go buy some fish. I briefly considered tossing the chicken and dining out, but even I was sick of pizza. That and Chris’s wagging finger taunted me (okay, so that part wasn’t literally true, but it kind of felt that way. It doesn’t help that Chris is a great cook and gardener. If she wasn’t so smart and so very funny I’d hate her.)

So I hopped online to look for a way to make the damn chicken I’d bought – and make sure it would be easy – and tasty.  What I found was a new-to-me technique called “dry-poaching” (yes, oxymorons abound in this post). I decided to give it a whirl because of it’s oh-so appealing title: “How To Bake Chicken Breasts in the Oven: The Simplest, Easiest Method.”

And it was GOOD and EASY.

My husband and I very much enjoyed this dry-rubbed chicken which I dry-poached, served alongside some leftover sweet potato and a kale salad I’d purchased at the same market.

A PDF of the recipe is here:  Dry-Poached Chicken Recipe. Read TheKitchn recipe editor Emma Christensen’s post for excellent photos and directions.

To me, this method is easier than cutting parchment paper into heart shapes and crimping them shut which is recommended in most ‘en papillote’ method directions – which feels a fussy to me. Though that said, one en papillote recipe to try might be Rachael Ray’s Chicken In A Sack which doesn’t sound fancy or fussy at all!

Finally, one last kick in the butt – this one to myself from myself. It wasn’t until I penned this post that I remembered I have another great, easy way to make moist chicken in like 15 minutes: my countertop grill/panini maker. I’d completely forgotten about my panini maker because with my son in college now I’m not making breakfast paninis all the time (see Panini Magic for recipes.) So my panini maker is no longer on my counter and I’d totally forgotten about it.

So now I’m recommending two lo-co, home-cooked-chicken alternatives to dining out: pull out some parchment paper and try this dry-poaching recipe or grab your George Forman indoor grill and griddle up a nice chicken breast. If you toss a few sweet potatoes in the oven (they warm up well – make more for leftovers!) and pair the chicken and potatoes with some pre-made fresh kale salad (and wine) and it’s as good as dinner out.

And certainly healthier and more lo-co than most of my dining out options. Plus there’s the added benefit of no risk of snarky comments from friends!

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Why You Should Ask For Advanced Lipid Testing

Controversies in Cardiovascular Medicine is the intriguing title of a 2009 article in the American Heart Association’s Circulation publication.

Stop laughing – cholesterol research can be intriguing!  I’d label the situation frustrating more than intriguing, but here’s what is going on.

The controversy is essentially that advanced lipid testing (explained in Cholesterol Tests Your Doctor Hasn’t Told You About) has been around for 50 years and is a better predictor of cardiovascular disease risk than standard cholesterol blood tests, and yet these ‘advanced’ tests are still not widely prescribed.

In fact, the ‘standard’ cholesterol blood panels (total cholesterol, LDL and HDL) often inaccurately portray risk for many people: those, for example, with normal cholesterol levels who heart attacks. And yet, standard lipid testing is still the norm.  It’s kind of crazy.

As explained in the Circulation article:

“Standard tests of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) misidentify coronary heart disease (CHD) risk status in a substantial portion of the population. Tests of apolipoprotein concentrations are superior to standard LDL-C tests, and it can be argued that they should replace standard lipoprotein cholesterol testing.”

The Circulation article goes on to explain that the advanced testing used to be difficult and expensive – but this testing is now more widely available:

“Advanced lipoprotein tests that were previously available only from university research laboratories are now provided by several commercial laboratories.”

Indeed, since Berkeley Heart Lab (which was one of very few offering advanced lipid testing years ago) was bought first by Celera Corp in 2007 and then by Quest Diagnostics in 2011, it is now far easier — and inexpensive — to get advanced lipid testing!

And yet, it’s not widely prescribed.  Sigh.

I just had an advanced lipid panel done in December 2014. It wasn’t easy to get (my internist said not necessary; it wasn’t until I had to see cardiologist for sudden high blood pressure that he agreed it was a good idea). But I’m glad I did because I now have a much better understanding of my personal cardiac disease risk.

Here’s what I learned – and below these key points is some further info about test results that may be pertinent as you consider ASKING FOR advanced lipid testing:

  • My total cholesterol is ‘high’ at 266 and my LDL cholesterol is ‘high’ at 159
  • I have elevated ApoB (score of 123) which contributes to higher cardiac disease risk. But that is offset by other test results.
  • My LDL pattern is type A, which is optimal.  This is the fluffy kind that doesn’t stick to the arteries like the smaller, denser, more dangerous Type B LDL cholesterol.
  • My C-Reactive Protein score of 0.8 is also considered optimal / low risk.

Total and LDL Cholesterol: I find it frustrating that the lab reports still characterize my Total 266 and LDL cholesterol of 159 as ‘abnormal’ or ‘high’ (meaning, high ‘risk’) even though the November 2013 cholesterol guidelines say these scores are not, indeed, high or risky or need treatment. (The new guidelines indicate risk when  LDL>190, along with other factors).

Why do the lab reports not match the new guidelines?  This is inane.

ApoB: I am concerned about my elevated ApoB.  I wrote about apolipoprotein (ApoB) testing and explained why many believe it’s a better predictor of cardiac risk than LDL and total cholesterol testing in ApoB and Cardiovascular Risk.  So this is something I need to keep track of. Interestingly, the lab report says my score is ‘high’ risk and yet, when I dug further, I found a table that showed my personal target is probably <130 (see blog post for details).  Frustration #2 that there are not clear standards.

LDL Pattern Type: The type of LDL cholesesterol you have matters. As explained in the Physican’s Weekly article In The LDL World, Size Matters, roughly half of all people who have heart attacks have ‘normal’ cholesterol levels.  That’s because small sized LDL (Pattern B) can puncture the walls of the arteries and cause plaque buildup – so even ‘normal’ amounts can be dangerous.  If you have high LDL but it’s the Pattern A type which is big and fluffy, that cholesterol bounces off arterial walls so causes less plaque buildup and is thus less dangerous even if you have a ‘lot’ of it.

While I have the preferred / less dangerous Pattern A LDL cholesterol, I found in researching that Pattern B can be modified: if you have Pattern B, you can get it to change to pattern A with diet and exercise!  Which is great.  But that leads me to wonder whether just because I have pattern A now means it sticks (sorry, pun intended) or if it can change to pattern B.  I intend to stay with my lo-co diet and exercise plan, just wondering if I risk changing to Pattern B if I’m not careful. I need to check in with my cardiologist on this.

C Reactive Protein: I was relieved to find my C Reactive Protein score was low. As explained in a Circulation article from 2003 entitled C Reactive Protein: A Simple Test to Help Predict Risk of Heart Attack and Stroke, the C Reactive Protein test is an important measure in assessing cardiac risk. “When measured with new “high sensitivity” CRP assays, levels of CRP less than 1, 1 to 3, and greater than 3 mg/L (milligrams per liter) discriminate between individuals with low, moderate, and high risk of future heart attack and stroke…  Evidence also indicates that individuals with high CRP levels are at increased risk of developing diabetes.”

Now that the Advanced Lipid testing has provided a more in-depth look at my cardiac disease risk, I understand why my cardiologist feels that my 266 Total cholesterol is not terribly concerning. And doesn’t need treatment.

So if you, like me, want a far clearer understanding of your personal risk of cardiac disease, you should ask your doctor to order Advanced Lipid Testing, including scores for:

  • Advanced Lipid Panel Reflex Direct LDL (measures direct LDL and provides the info on particle pattern, number and size)
  • ApoB
  • C-Reactive Protein – the high sensitivity test

Sad to say you’ll probably have to ask your doctor to order Advanced Lipid Testing – he or she is NOT likely to order these tests unless you ask. Which is a shame.

Because as the Circulation article concludes, these tests have been around for 50+ years, are now easily and widely available, and they pick up risk that typical cholesterol panel testing might miss:

“One advantage of ALTs is the greater insight they provide clinicians into individual patient disorders often masked by standard lipid tests considered to be within “normal” ranges.”

It’s important to ask, because advanced lipid testing might reveal that although your cholesterol is not high, you are still at risk. This testing is easy, cheap and could save your life. It will provide you with a more in depth understanding of your cardiac disease risk.

It’s a simple, important question. Ask about advanced lipid panel testing the next time you see your doctor.

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ApoB and Cardiovascular Risk

In Cholesterol Tests Your Doctor Hasn’t Told You About, I briefly describe a cholesterol blood test for Apolipoprotein B (ApoB).  This simple blood test measures the number and size of LDL (bad) cholesterol: it’s an important test if you have high LDL (bad) cholesterol or are at ‘high risk’ of cardiac disease, as it provides a more finely tuned assessment of cardiovascular risk.

In fact, it might be a critical test for those with low LDL (bad) cholesterol – because it can reveal hidden cardiac risk.

While studies show ApoB is a better predictor of cardiac risk, it is not yet a test that is widely prescribed. Indeed, the American Heart Association is waiting for more studies to determine if ApoB is a test doctors should recommend. Personally, I find this frustrating (of course this means nothing as I’m not a doctor, but…) To me, it’s frustrating because this is a simple blood test that provides a detailed risk assessment.

Scientific American’s Heart Health Special Report entitled ApoB – A Better Marker For Heart Attack Risk Than LDL-Cholesterol explains why it’s an effective and important test:

“A high level of low-density lipoprotein (LDL, or “bad”) cholesterol is an important risk factor for a heart attack. Yet about half of the people who develop coronary heart disease have normal or even low LDL cholesterol levels. Some research suggests that a component of LDL—called apolipoprotein B, or apo B—may be more accurate at predicting coronary heart disease.

A Limitation with LDL Cholesterol Testing
The problem with using LDL cholesterol levels to determine heart attack risk is that the test measures only the amount of cholesterol in the LDL cholesterol particles, not the number or size of these particles. Apo B measurements, on the other hand, provide information on the number of LDL cholesterol particles.

For example, people with a higher apo B value than LDL cholesterol value tend to have smaller, denser LDL cholesterol particles. Studies have shown that small, dense LDL cholesterol particles are more strongly associated with heart attack risk than large, “fluffy” LDL cholesterol particles.

The test itself is a simple blood test. It’s easy and cheap: easier, even than the standard cholesterol lipid panel as it does not require fasting.  In fact, the test can be done in conjunction with a standard lipid panel.

Finally, after I visited a cardiologist, I got the ApoB test and my results were, of course, mixed.

Ha! ha ha ha ha ha ha ha

Part of the problem is that since ApoB testing isn’t a standard test there is conflicting info on what the goal ApoB levels should be. My cardiologist was happy with my results because my ApoB is lower than my LDL level, my LDL Pattern is the far healthier Type A / Fluffy LDL, and because my C-Reactive Protein was low risk (more on C-Reactive Protein and LDL patterns in another post.).

But my actual lab report shows my ApoB level of 123 as ‘high risk’ and simply references a desired range of 49-103.  So at 123, I have ‘high’ ApoB.

Ruh Roh.

Who to believe?

Well, it’s simple.  My cardiologist. After a lot of online research (again, I’m no doctor so take all this with a grain of salt), I think the reason my cardiologist is OK with my ApoB score of 123 is because of all those elements I mention above AND ALSO because  I fall into the ‘low risk’ of cardiac disease segment. It turns out that there are different ApoB goals based on a person’s general cardiac disease risk, and the lab report seems not to take this into account.

ApoB goals by risk pool is well explained in Medscape’s emedicine article entitled Apoliprotein B article, in the chart here:

Screen Shot 2015-03-14 at 5.22.44 PM

 

Since my 10 year risk factor via the cardiac disease risk calculator is low (and I also have just 1 risk factor from the ‘old’ way of calculating risk), then it’s probably OK that my ApoB is 123 as it’s lower than 130.

I’m glad I got the ApoB test done – but it’s only because I asked two doctors for it.  If you want a more detailed risk assessment, ask your internist or cardiologist about ApoB testing.

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Slow Cooker Part Deux…A Failure and A Find

A prevalent pet peeve is how Facebook distorts reality.  It’s far too easy to conclude that everyone except you is having SO much fun…because no one posts pics about staying home alone … or how it’s a bummer to see pics of parties to which you’re not invited… or, well, all that kind of stuff.

That got me thinking about recipe blog posts.  It’s an apt corollary; the majority of recipe blog posts are about successes.  Indeed, I do it too — to date, all my recipe blog posts have been about recipe successes.

So with this post I am bucking the trend.  Because this post is about a lo-co cooking failure. And I think that it’s an important topic because cooking lo-co is tough enough without the false belief that everyone else’s dishes turn out well all the time. Because they do NOT.

Case in point: last week I tried a slow-cooker recipe for Char Siu Pork Roast that had huge promise, but that failed.  Miserably.  Actually, it was absolutely awful.

This dish was so appalling I threw it out and ate cereal for dinner. Worse, I could not get the stench of this dish out of my house fast enough (challenging when it’s sub-freezing outside, but open the windows I did!)

I was particularly disappointed in Char Siu Pork Roast because: a) the recipe was from Cooking Light, and I (now nearly) always have good luck with their dishes; b) it was listed in an article with the promissory title of, “100+ Slow-Cooker Favorites“; and c) there were 108 reviews and it got four stars.  FOUR STARS. OUT OF FIVE. (I went back and looked to see if it was four starts out of ten, but nope, out of five).

I don’t know who these 108 people are, but man, they have different tastebuds than I do. Not only that, my easy-going husband didn’t like it either.  The problems were many, IMHO.  The 5 spice flavor was overwhelming; several ingredients seemed to flavor-fight with each other; and worst of all, it was dry dry dry.  I guess I should have paid more attention to the several reviewers who panned this recipe; my POV was eerily similar.

So.  A lo-co failure.  I should have taken a photo, but basically could not throw out this food fast enough!

And then – another fail – I bought a pork tenderloin a few days later but accidentally grabbed one that was seasoned with pepper when what I wanted was plain.

Sigh.  I am not a fan of peppercorn-marinaded anything.

pressure-29744_640But I didn’t want to throw away a perfectly good (though not my taste) pork tenderloin, so that inspired a search for a slow-cooker recipe that would mask the massive pepper. I readied the cereal boxes in case it was another failure… but was pleasantly surprised last night with “The Best Crock-Pot Pork Tenderloin” dish. Especially since the recipe was from a site I’d never seen before (usually I only cook from Cooking Light or Epicurious).

The site WhiskingMama.com must have really great SEO — the only reason I clicked on this recipe is that it was the #1 result in search for ‘pork tenderloin crock-pot recipe.” I decided to try it because I already had the (wrong) tenderloin, these ingredients looked like they’d cover up the pepper, and I happened to have all the ingredients on hand (with a few substitutions: dijon for yellow mustard and garlic cloves instead of garlic powder).

I forgot to take a photo, but this dish was easy, quite tasty, and while it might not be the “best” crock pot pork tenderloin recipe ever (I mean, who’s to judge?), I’d make it again. We’re planning leftovers for dinner tonight, actually – so the cereal’s been put back in the pantry for breakfast.

Here’s the recipe for “The Best Crock Pot Pork Tenderloin” if you prefer a PDF to clicking on the link above.  I made it with a 1 pound tenderloin instead of 2 pounds, and just read this morning in Sam Sifton’s A Simmer View of the Slower Cooker article that I should have cut the marinade in half. His quote refers to different recipe/ingredients but the basic tenet is the same:

“The most important thing is not to have too much liquid in the pot. For a small slow cooker, use a smaller cut of meat and a proportionately smaller amount of fish sauce, hoisin and water.”

I will make this Crock-Pot Pork Tenderloin again, this time with regular rather than the despised peppered tenderloin, and will either cut the marinade in half OR will make it with 2 pounds of tenderloin because it was delicious enough to want leftovers.

So a recipe to avoid – and one to try!  Feel free to send me your lo-co recipe failures or favorites!

 

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