Garage Cleaning

So this morning, I was feeling guilty about how very not-lo-co I’d been for the first half of this weekend. With my only child now gone off to college, we’d decided to spend at least 2 weekends a month in New York City and this was our first foray.

Friday night, we made plans to meet friends at Rouge Tomate, a health-oriented, one-star Michelin restaurant on New York’s Upper East Side. I was intrigued by Frank Bruni’s 2009 review and excited to try this new-to-me place. Overall, though, it was disappointing; we found the food expensive and precious. Or as my husband later said, ‘that was the most we’ve paid for a pretty small amount of food. And it wasn’t even great.’ In the end, I left the restaurant hungry … and that led to unhealthy munching… the exact opposite of the restaurant’s – and my – intentions.

Sigh.

Sadly things got worse.  I was still hungry the next morning, so after an early Starbucks run that included half a multigrain bagel, we strolled across the park (at least the day was gorgeous) and met up with a different NYC friend for brunch at Bar Boulud. Still feeling hungry (at this point, I’m not sure I can blame this on Rouge Tomate, but, um, I am), I ordered their version of eggs florentine – and I even replaced the ham with lox (though that’s because I prefer lox, not because I was being at all virtuous.)

My brunch choice might have been fine-ish, lo-co-wise if I had not eaten much of the hollandaise. But not only did I eat it, I scooped it up with a piece of bread. Very uncharacteristic of me.  Sadly delicious.

Then we trekked back to Grand Central, and since we were going to a chili-and-beer party that night we stopped at Baked By Melissa to get a 24 pack as a hostess gift (lest you think I’ve gone totally mad, these are MINI cupcakes.. one bite each!) And, well, I just had to get a 3 pack for the train ride home.

So this morning, after a 24 hour binge of far too much non-lo-co eating and the only exercise a slow walk back and forth through Central Park, I decided today would be better.  After a reasonable breakfast, we decided to clean the garage.

Which took four hours.

Feeling like I’d been run over by a train, I looked up how many calories I’d burned. Garage cleaning wasn’t listed in My Fitness Pal (read why I ADORE this fab app here), but ‘cleaning as a light, moderate effort’ was — and for four straight hours, I’d burned 548 calories for a person my size.  And let me tell you, what we did today was no ‘light effort.’ I’m not sure if what we did would count as ‘heavy, vigorous effort’ for 4 hours, but if it did, that’d be 658 calories burned.

So my garage cleaning penance burned something like 600 calories.

Who knew garage cleaning could burn so many calories?  Woot!

Of course, we then decided we’d earned a trip to Shake Shack.

Luckily, the line at 2pm on Sunday was too-too-too long, so we left and headed to a taco place where I devoured 2 fish tacos and a side of black beans.

So now all I’ve got to do is figure out how to have a lo-co dinner and I’ll be back on track.

The only problem is… that bottle of wine is calling to me…..

 

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Statin Medications – A Primer

I am not a proponent of taking a statin to lower cholesterol IF one’s only heart disease risk factor is high cholesterol (see my post, Statin Statin, Do You Really Need A a Statin?) That said, there are millions for whom statin meds are a literal lifesaver. So if you are taking a statin because you have several heart disease risk factors, you might be hankering for some information about the different statin meds on the market. Here’s an overview of the top selling statins in the US.

The most common statins prescribed in the US include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin (Pravachol), and Fluvastatin (Lescol).

Lipitor (Atorvastatin)

Available in the US since 1977, Pfizer’s Lipitor is probably the best known and most widely prescribed drug to lower cholesterol. Indeed, in 2010, Lipitor was the #1 selling drug sold in the United States (not #1 cholesterol drug, #1 of ALL drugs), with $7.2 billion in sales. Sales of branded Lipitor declined dramatically after it went off patent in late 2011 (in fact, in 2013 Lipitor fell out of the top 100 drugs sold). That said, millions of Americans still take Lipitor (or have switched to generic Atorvastatin) to lower their cholesterol, and it is a fine statin for many who need to take it.

KEY TO KNOW:  It’s vital that anyone taking Lipitor or Atorvastatin avoid eating grapefruit and drinking grapefruit juice. That is because grapefruit boosts absorption of this drug into the bloodstream, which in turn increases the likelihood of potentially serious side effects. Do NOT ingest grapefruit if you take a statin unless you’ve discussed with your doctor.

Crestor (Rosuvastatin)

You probably have figured out that the next big branded cholesterol drug (now that Lipitor is off-patent) is Crestor – their advertising budget appears to be enormous. And it’s working. In 2013, AstraZeneca’s Crestor was the top-selling statin, and the #4 drug sold in the US.  But what you might not know is that Crestor is the most potent of all the statin medications. And that means there is a higher likelihood of potentially serious muscle damage risk with Crestor than with other statins. If you take Crestor, it’s extremely important to immediately report any muscle pain or weakness to your doctor.

Zocor (Simvastatin)

Merck’s Zocor was one of the top 10 selling drugs in the US through 2006, when it went off patent. Sales of Zocor fell off dramatically as soon as it went off-patent, and they fell even further in June 2011 when the FDA issued new warnings about the dangers of high-dose Zocor or Simvastatin.  The warning: that at high doses, this drug is more likely to cause muscle damage. The FDA also issued restrictions for even mid or low-dose simvastatin. The response was that many doctors who used to prescribe Simvastatin have switched their patients to other statins – which explains why Zocor is now out of the top 100 drugs sold, and Simvastatin doesn’t even make that list. Net, Zocor and Simvastatin are likely the right statin for many, but it might be a good time to review statin options with your doctor if you’ve been taking Zocor or Simvastatin for a long time.

Also, key to note that Zocor and Simvastatin also interact with grapefruit, so as with Lipitor, grapefruit and grapefruit juice must be avoided by those taking this statin.

Mevacor (Lovastatin)

Lovastatin’s claim to fame is that it was the first statin approved for human consumption. The compound was first introduced by Merck scientists in 1978; after Lovastatin they went on to develop Simvastatin, a close chemical derivative of Lovastatin. (Merck branded Simvastatin as Zocor as explained above – and they marketed it more than Mevacor because it had a later patent expiration date.) Lovastatin is not widely prescribed any longer – and has been out of the top 200 in sales in the US since 2005 – but its relevance in the world of statin meds is that it was very the first statin medication.

Pravachol (Pravastatin)

Discovered by Sankyo scientists in Japan in 1979 and launched in Japan in 1989, Pravachol is a statin that is a modified version of Lovastatin. People with muscle disease who can’t tolerate statins can sometimes tolerate Pravachol. That said, Simvastatin and Atorvastatin are far less expensive options, so Pravachol and Pravastatin are now rarely prescribed in the US.

Key to note: Pravachol and Pravastatin also interact with grapefruit, so as with Lipitor, grapefruit and grapefruit juice must be avoided by those taking this drug.

Lescol (Fluvastatin)

Lescol or Fluvastatin was introduced by Novartis in the US in 1993.  It is the least potent statin – so it’s a good choice for those committed to making lifestyle changes to lower cholesterol but who still need a statin because they have several heart disease risk factors.  Also since it’s one of the more mild statins, it is the medication that is often prescribed when a patient cannot tolerate the side effects with other statin medications.

Summary

If you have multiple heart disease risk factors and need a statin to reduce cholesterol, ask your doctor why he/she has prescribed that particular statin. They have different potencies and whether you use a generic or branded statin can make a huge difference to your wallet. With any statin, be sure to discuss ALL medications you take with your doctor as these statins react not only with grapefruit (some of them) but also with a wide array of other medications.

Statins can have side effects – sometimes serious. Serious side effects can include liver damage, type 2 diabetes, and muscle problems – which can range from myositis, which is essentially muscle inflammation, to rhabdomylysis, which is extreme muscle inflammation and muscle damage. If you take any statin, be sure to go to your follow up appointments where your liver will be checked — and tell your doctor if you have any muscle pain.

If you are currently taking a statin and you are not sure if you really need it, do some research and then discuss your heart disease risk and medication plan with your doctor. (Of course, you should never stop taking a medication without discussing with your doctor.) For more about calculating heart disease risk, see my Calculate Your Heart Attack Risk Online post.

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Learning About Cholesterol

It’s been rather a long while since I wrote about the importance of finding reputable online resources for learning about cholesterol. You can permanently locate links to educational resources on my Resources/Info Links page, but I thought it might be helpful to discuss in a post.

Why?

Well, quite frankly it’s because when discussing high cholesterol and heart disease risk, many doctors – who speak daily, probably, about cholesterol – rush through the conversation and use unfamiliar terms. On the receiving end it can feel like a tornado rather than a give and take discussion of personal cholesterol results and the resulting medical goals.

Plus, you’re going to google cholesterol anyway, you know you are.

Which is good, actually, because the more you know about cholesterol and heart disease risk – and treatment alternatives — the more committed you are likely to be to your cholesterol management program. Well, maybe. (My commitment waxes and wanes.) At the very least, researching online will enable you to create a list of questions to ask your doctor at a follow up appointment.

And researching should help you question whether prescription medication is absolutely necessary for your personal cholesterol management plan. Which is a vital step many seem to skip.

Truth be told, cholesterol-lowering statin medication is absolutely justified for many, many people – and these meds have undoubtedly saved many lives. But if high cholesterol is your only risk factor, you should question the validity of statin meds for you individual case. Have a discussion about the pros and cons with your doctor. And to do that well, you need knowledge.

But you don’t want to search just anywhere on the web. Some sites – such as WedMD — are largely funded by big pharmaceutical companies so you’ll want to know their slant. To help ensure you are gleaning information from reputable, unbiased sites, here are a few to check out.

An excellent source is the National Cholesterol Education Program (NCEP) which I recently wrote about in my post, September is National Cholesterol Education Month. This site has a great deal of useful information, though it’s layout makes it difficult to navigate. See my post for specific links to the useful sections of this site – including an online calculator for heart disease risk.

For an excellent overview about cholesterol, a visit to the American Heart Association – Cholesterol Overview site is a great place to start. This site explains that cholesterol itself is not ‘bad’ and that it is created both by our bodies and from the foods we eat. Scrolling through this article you’ll find an explanation of ‘good’ and ‘bad’ cholesterol, and there’s even an animation if you really want to get a visual of what cholesterol is and how it works in your body.

The Mayo Clinic is one of my favorite sites for unbiased, well-explained information about cholesterol and heart disease risk. (Go ahead. Color me geeky.) It is vital to truly understand your personal heart disease risk; the Mayo Clinic’s High Cholesterol Risk Factors page explains that there are seven conditions which, when combined with high cholesterol, elevate heart disease risk.

Test results are a big factor in risk assessment, and it’s pretty likely that your doctor zoomed through your personal lipid panel test results and what they mean. To learn more about why the goal for ‘total cholesterol’ is at or under 200 mg/dL, what triglycerides are, and what those HDL and LDL numbers really mean, visit the Mayo Clinic’s incredibly useful High Cholesterol Tests and Diagnosis page. This page is an excellent reference that explains the targets for each key cholesterol measure – and relates them to heart disease risk level. In my humble opinion, this page is one of the most useful online resources available.

Finally, if you want to avoid statin medication by lowering cholesterol through diet and lifestyle, you’ll want a good nutritional resource. For that, the Cleveland Clinic’s Nutrition-Cholesterol Guidelines is a terrific resource that explains what’s good and bad about things like the different kinds of fats, dietary cholesterol, protein, carbohydrates, and plant sterols. Even better, it gives a daily target for each. Best of all (major geek alert), there’s a handy chart that summarizes the key info all in one place. Make sure you scroll to the bottom of the page to see this useful chart.

And OK, I lied a minute ago. In my humble opinion, the Cleveland Clinic’s nutrition-cholesterol guidelines page is one of the most useful online resources available.

Let’s make it a tie. I vote that the Mayo Clinic’s High Cholesterol Tests and Diagnosis page wins for explaining test results and targets, and the Cleveland Clinic’s Nutrition-Cholesterol Guidelines page wins for showing how to combat high cholesterol, nutrition-wise.

Beyond these there are, of course, many other great online sources for information about cholesterol and heart disease risk. And your doctor is potentially the best resource of all. That said, the more you know, the better questions you can ask your doctor — and that will go a long way to ensure the program you and your doctor devise is the best possible course for you.

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Solving The Pizza Puzzle

Did you know that the USDA publishes a website called the USDA National Nutrient Database for Standard Reference which lists foods and their caloric and nutritional value? It’s very cool.  Except for right now. During the US government shutdown if you click to this wildly useful website, here’s what you’ll see:

USDA Site Shutdown

 

Really people?

You took down a USDA WEBSITE because of the shutdown?

Really?

To me, that the Government decided to take down this particular website is incomprehensible. It’s not like this site is chock-full of up-to-the-minute, breaking-news type of information. Calories and Fat Content do not change day-to-day, people! You could have left it up and running. Why the government wonks didn’t just furlough the webmaster and leave the site live is, frankly, inexplicable. But take it down they did.

Sigh.

So here I sit, jonesing to do some in-depth pizza research but without a rock-solid source. Luckily, I had some key pizza facts gleaned from this site tucked away from earlier research I did for an Answers.com article.

So even though the USDA site is down, I can still proceed as planned with a post about how to enjoy pizza while going lo-co.

AKA solving the pizza puzzle.

Which is not solving, really. Because I was dismayed to find that pizza is not a great lo-co choice.

Before the government took down the nifty USDA nutritional site, I learned that one single solitary slice of regular crust, cheese pizza packs 285 calories, 10 grams of fat, and 18 grams of cholesterol. That’s ONE slice, no toppings.

And who has one slice?

Well, OK, I do. Sometimes. But I’m weird that way.

Most normal people would have 2 slices.  So you need to double those fat calories and cholesterol for a typical pizza meal.

And while I like plain pizza, most folks add a topping.  For example, what if you’re like my friend the hysterical, talented cartoonist Chris Juneau, and want bacon on your pizza? Well, I planned to write a whole bit about bacon (because Chris believes bacon goes on anything) but I can’t because the government took down….

OK, enough about that.

What I can do is tell you about the nutritional value (anti-value?) of a slice of pizza with the the ever-popular pepperoni topping.  A single slice of pepperoni pizza wallops with 313 calories, 13 grams of fat, and 28 grams of cholesterol.

Which means if you lunch on 2 slices of pepperoni pizza, you’ll hit 50% of your total recommended fat consumption and more than 25% of your cholesterol – before the day is half over.

What’s a person to do? Well, there are ways you can solve the pizza puzzle and still fit it into a lo-co lifestyle.

You just have to be smart about what you order – and/or make it at home.

Since I can’t seem to cook at home since my son left for college, I can’t really lecture about home-made pizza (though we used to make that a lot – it’s easy and delicious and healthy). So here are some things to mull as you place your local pizza parlor order:

  • Ditch thick, order thin. Thick crust pizza has more fat than thin crust. (And crust stuffed with cheese? Come on, you weren’t really thinking that, were you?)
  • Choose Less Cheese.  This seems obvious, lo-co-wise.  That’s because it is.  If the rest of your dining companions want regular cheese, that’s fine – just fork some off your slice and leave it on the plate. I do it all the time. And yes, I get weird comments, but if they’re good friends they’ll be said jokingly and with love. And if they’re you’re family, well, they’re stuck with you. So leave some cheese on the plate.
  • Pile on the sauce and veggies. If you can get your pizza-mates to order a pie with less cheese (or, heavens, cheese-less), make up for it with extra sauce – it has lycopene! And pile on any veggies you want – though try to choose the veggies that aren’t breaded and fried – I love eggplant, but it’s not the best veggie topping. Broccoli and/or spinach sauteed in garlic are fabulous pizza toppings. Or go wild and hawaiian. Load up on veggies and you won’t miss the cheese. Truly.
  • If you must have a meat topping, choose ham or canadian bacon, not pepperoni.  (Chris Juneau, this one’s for you!) I wish I could give you the exact nutritional details, but did you know the US Government shut down the USDA site… oh, sorry. The truth is that ham and canadian bacon – or diced chicken or shrimp – are leaner, more lo-co choices than pepperoni, sausage or beef. Maybe your pizza place even has turkey bacon or turkey sausage? Not highly likely, but worth asking!

You can stick with pizza for lunch or dinner (or, hey, breakfast) – and it can be part of a lo-co lifestyle if you choose wisely. And I bet you can find out more once the government shutdown…

Sorry.

But it is, really, a cool site.  Check it out in a few days…weeks…  Hopefully soon.

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