Help me to help my brother!!

[VictoriaL]

I just got back from a few days away and found an e-mail from my brother. The little twerp, eater of all things fried and red meat (especially fried red meat!!!), just got a scare. He is going to be starting his own practice (he is a psychologist specializing in geriatrics) and was applying for health insurance. He got his bloodwork tests back and found that he is incredibly unhealthy-- a cholesterol level of 218, LDL of 200 (!), and HDL of 37. He asked me for advice. I told him that, for the immediate future, to do these four things:
#1- cut out all fried foods.
#2- eat a variety of lean protein (fish, chicken, turkey, beef, pork are all okay), grilled or broiled
#3- watch the saturated fat intake (whole fat milk, cream, ice cream, butter, etc.)
#4- eat 7-8 servings of fruit and veggies each day (this also fills you up, leaving less room for "bad foods")

Okay, any suggestions on what step to suggest that he take next? He always poked fun at me a bit since I eat a lot of lowfat foods and whole grains and no red meat, but now is realizing (at almost 40 years old!!!) that he should be following the same pattern. But he eats a lot of fast food and red meat. I also told him to start exercising, about 45 minutes of moderate activity (weather it be bike riding or brisk walking) at least 4 days a week.

Now what do I do? Any suggestions would be greatly appreciated!!!

[sunberst]

i am sorry to hear about your brother vicci.

your advice is good. but unfortunately not everyone listens to good advice. a co-worker of mine, who is 42, found out that he is unhealthy and has extremely high cholesterol. the doctor put him on lipitor. he changed for maybe 2 weeks. he started to bring healthy foods in and such. but now he is back to his ways. mcdonalds & kfc several times a week, and t.v. dinners & other bad foods. i have never seen anyone eat so many bad foods. and he doesnt exercise. but he doesnt seem to care, or doesnt care enough because he wont change. he goes to the mcdonald's drive-thru, eats a big mac, then pops a lipitor.

oh, and this guy did ask for my advice when he came back from the doctor and found out about his health. he knows that i eat fairly healthy. i gave him tons of advice. he seemed sincere in wanting it. but once the initial scare was over and he got drugs, it was too easy for him to slip back in his old ways because after all, he is 42 and it is hard to change someone. they have to want it.

[VictoriaL]

Beth,
Luckily, my brother doesn't really want to take cholesterol-lowering drugs. But isn't it funny? He is the same brother that I was telling you about last week-- who came to visit and got so fed up with my "healthy food" that he shot off to Burger King for lunch!
I am older. I am wiser. Well, in this particular respect-- but it does feel good to be asked for my advice!!!

[Paula H]

Big lifestyle changes are hard, so I'd recommend that your brother start of with just one of your recommendations, then build from there. My choice would be to increase fruit and vegetable servings (filling, good for your body, and it may change his taste in food to healthier things). Then in a month or so, when he's got that down, maybe move onto fat intake.

Throwing multiple big life/diet changes at a person makes it really hard for them to change and succeed in changing. Many small changes over time are much more effective, and easier to maintain long-term (if you have the luxury of time, of course, without looming health crises).

[michellemseymour]

I agree...sounds like a major lifestyle change is in order, but trying to do it overnight almost guarantees failure. Instead of eliminating all fried foods, maybe he could start by cutting his intake in half. He may be intimidated by trying to cook healthy, so if you live close you might invite him for a meal a couple times a week. If you live far away, maybe send him a recipe or 2 to remind him to watch his diet.

He has to want it though...if he is the goal-setter type, you can help him to set reasonable goals over time. If he starts to see progress, he might be more willing to stick with it. Good luck!

[SusanT]

Exercise will help raise his HDL which will improve the ratio of LDL to HDL. I have high cholesterol which has not responded to diet (genetic - thanks Dad!) but I have been able to raise my HDL with exercise to a level such that my doctor is not concerned about the overall level.

I think sometimes the cholesterol lowering drugs give people the feeling they have a free pass to eat anything. Both my father-in-law and father are on these meds and they eat just as badly as before their heart attacks.

[sharon]

Have faith. My brother, who is just turning 40 this year and officially know in our family as the fast food king, got a little bit of a health scare two years ago. He completely changed his lifestyle. Joined a gym and started exercising. Cut out red meat and started eating lean meats and now has gone almost completely veggie for the most part.

He also learned to cook! Low fat veggies based meals with complex carbs. Now, he had the help of a very good friend who was living with him at the time who taught him how to actually cook and told him what he needed to do with his diet. But a man who actually used to live of sugared soda from 7-11 now actually carrys around a bottle of water

You may have to be the one that actually teachs him what is "healthy" eating. But it can be done as my bro now actually reads nutrition labels! He lost over 60 pounds in the process and, even better, his health issues completely resolved themselves. Good luck.

[jem927]

Hello all!

I have to agree with Susan as these meds can give a false sense of security and well-being to those that take them. I unfortunately have a double-whammy genetic effect as both of my parents, and their parents before them, have always had issues with heart disease and cholesterol. Both parents are on statins, and Mom watches he eating habits, but dear Father feels that this gives him free reign to eat whatever comes his way. Mom tries to incorporate healthier foods into the diet, but that doesn't prevent him from eating unhealthy snacks during the day.

As for me, I'm a 33yo female and I have been on Lipitor for approx 6 months, and use that in conjunction with exercise and a low fat/cholesterol diet. My numbers as of today (just got the results, actually): Total-176; HDL-56; LDL-81; and Triglycerides-197. I'm not completely pleased with the results so far, especially the triglycerides, but they are MUCH better than before. So, I can't complain. Actually, I feel pretty good about it!!!! YEAH!

I guess my thought is that despite the diet and exercise, it wasn't enough to fix the problem, and I don't want to end up like my father - 2 quadruple bypasses later, and overall poor health. The combination of the drugs and the diet/exercise seem to be working well, and I would definitely recommend it to others with the understanding that the drugs are not a replacement for better eating and healthy living.

Just my two cents for the day! (stepping off the soapbox now...)

Jamie

[HeidiD]

Vicci, my "brother story" is similar to what Sharon posted. Our dad died of a heart attack in his mid-40s so we have always known we are at higher risk for heart disease. I have had my cholesterol tested every few years since age 15 and have tried to stay in a healthy weight range, but have been worried about my brother, who had been steadily gaining on a diet of McD's and BK. Six months ago, approaching 41, my brother decided to change his health for the better, taking a pretty simple approach. He has lost 25 pounds by walking 2 miles, 5 days a week, and not eating fast food anymore. He has not had his cholesterol re-tested yet but I'm sure it's improved. I am so relieved that he is finally paying attention to his health and will hopefully live a longer life.

In my own experience, my cholesterol ratio only improved when I added daily walking to my routine. My cholesterol levels are now better than they were 20 years ago when I weighed nearly 20 lbs less. I hope your brother can incorporate some exercise into his daily routine. You can tell him it worked for me and my brother!

[Valerie226]

Lots of men feel invincible ( nothing like that will ever happen to ME!!) until a friend or colleague drops over dead at a similar age. It takes a lot to get their attention! like a 2X4 over the head.

Even fast food places have some better choices these days. mcd's has some new salads etc. a salad plus a plain burger is pretty good. A cardio exercise program should help raise his HDL.

sometimes people don't like advice from family. third party advice is more 'acceptable". can you get him a book he might read? Did his doctor suggest anything? statin drugs do work, but many use them as a free pass to eat even worse than they did before. some people have bad reactions to statins too.

those numbers aren't great but they aren't really terrible. thing is, if he doesn't change behavior they will probably worsen as he gets older.

[DmOrtega]

Temptation is everywhere and everything in moderation is the key to keeping temptation at bay. He needs to start an excercise program and start making one meal a day healthy, to offset the others that are not. Think and practice BALANCE. It is very much like an alcholholic (sp?). Start slow and keep it steady and things will change, if not, well he's a grown man and must make up his own mind, just like the rest of us.

[Alethea]

Like others who have posted before, my family has a long history with hereditary heart disease and cholesterol. It seems that healthy, active people have bypasses earlier and earlier.

Anyhow, in addition to all the great recommendations posted, I would also encourage your brother to switch to olive or canola oil for cooking, in lieu of corn/peanut/safflower oil or butter. It's still a fat, but it's a heart-healthy one. Also, if he likes salmon, or other foods rich in omega 3 fatty acids, he should try to make these a regular food choice. And if there's any way he could incorporate whole grains into his eating, these can also be beneficial. Good luck! You're a good sister for helping him out!
-Thea

[VictoriaL]

I'm going to send my dear little brother the link to this so he can read all of your responses. DH and I have been eating healthy and exercising for several years now, and it was he who reminded me that we started out very slowly (I tend to remember as having made all of these changes in our lifestyle in only a few short years, but I suppose that time flies as I get older, plus I can forget those pesky details as well!!!). There's lots of good, practical info for him to ponder.
And I have already began getting together recipes to send.
Thanks to all (and keep getting up on those soapboxes!)

[DocAgocs]

I have an excellent nutritional supplement protocol if you'd like it. Requires specific brands of things, so PM me and I'll let you know it. Cholesterol is a poor correlation for heart disease, but unfortunately most doctors and insurance companies don't pay attention to the research. Based on your borther's diet I doubt he's in good health, but some people have enormously high cholesterol and they have nothing to worry about. There are other lab tests that are better predictors of cardiovascular disease. I feel like I'm the only person who's noticed this, but if you pay attention to Lipitor, et al. ads, at the end in ridiculously tiny print you'll see the words "Has not been shown to reduce the chance of cardiovascular disease" or something along those lines. In other words "What we tell you this drug does, it doesn't do."

[Ralph]

I second most all the information already mentioned - life-style changes are paramount.

Originally posted by DocAgocs
There are other lab tests that are better predictors of cardiovascular disease.

True, but the literature is not entirely conclusive on these other tests. Frankly, the best "test" for CV disease is a heart catheterization, but that's not a test that is easily performed, or without complications, or inexpensive

I feel like I'm the only person who's noticed this, but if you pay attention to Lipitor, et al. ads, at the end in ridiculously tiny print you'll see the words "Has not been shown to reduce the chance of cardiovascular disease" or something along those lines. In other words "What we tell you this drug does, it doesn't do."

Not entirely correct. You're right in that it has not been proven to "reduce the chance of cardiovascular disease." However, that's because in order to make that claim, a drug must be subjected to rigorous (expensive), double-blinded clinical trials. Double-blind means neither the patient (clinical subject) nor the doctor/researcher know if the subject is taking the active drug or a placebo. For obvious ethical reasons, that's not the easiest thing to study with drugs like this. Gee, you're on placebo or active drug; we don't know; let's see if you get cardiovascular disease! Patients shouldn't just be arbitrarily treated with Lipitor & the like just because their cholesterol is elevated. But right now, they're the best things we've got.

[Jessica]

I recently lowered my cholesterol through dietary changes, since I already was exercising regularly. There is no way to know which change actually helped my numbers, but I do eat a bowl of cereal with 3g soluble fiber every morning (mine is Kashi GoLean but there are others, or oatmeal).

I agree with the other posters that you need to make the changes gradually. Perhaps he can try to add a new healthy habit every week or two. Good luck!

[DocAgocs]

Here are some facts about cholesterol that may make you wonder, again, why people are taking expensive drugs to lower it:

-The Framingham Heart Study found that 80% of those who developed coronary heart disease (CHD) have pretty much the same cholesterol numbers as those who don't.
- 50% of arteriosclerosis (narrowing of arteries) can't be explained by the traditional risk factors (smoking, high cholesterol, diet, etc)
- A study of 360,000 men found that 24% who died of heart attacks had cholesterol lower than 200.
- Christie Ballantine, M.D., the director of the center for cardiovascular prevention at Methodist Hospital/Baylor school of medicine says, concerning cholesterol "If you're judging the health of your heart by it, you're way off."
- The average HDL cholesterol of men in the Framingham study was 43, which is 23% higher than what guidelines say is "protective"
- According to Framingham study, average LDL of those who had heart attacks was 150, which is borderline

Here are some tests that can be run on blood that may be better at predicting heart problems than cholesterol:
1) Apoprotein B? gives a precise count of LDL circulating in the blood
2) Lipoprotein(a)? Lp(a) alone can raise heart attack risk by as much as 70%. Niacin, a B vitamin, is the best way to keep it low.
3) Fibrinogen? the higher the amount of fibrinogen, the thicker your blood is, potentially overstressing the heart and arteries. This correlates with cigarettes, obesity, sedentary lifestyle, aging and diabetes.
4) C-reactive protein? capable of predicting first heart attack 6-8 years in advance. Acummulates in theliver as blood vessels become inflamed.
5) Homocysteine- Responds well to B vitamins, again, and is a good predictor of problems.
6) Insulin- in conjunction with high triglycerides, low HDL, high fibrinogen it points to a strong predisposition for atherosclerosis.
7) LDL IIIa and IIIb- these are the most destructive types of LDL, accordingto what is known now.
8) HDL2b- 2b is the most beneficial HDL. The more you have, the less likely for a heart attack.

The science is extremely complicated, but unfortunately as it works now, if your cholesterol is over about 175, it seems like, you're going to get a lifetime prescription for Lipitor or whatever else the drug du jour is. So, the current wisdom is to prescribe a drug with lots of side effects to lower something that may or may not have much to do with heart disease and heart attack that studies have shown probably leans away from it, and the drug company itself admits that it doesn't prevent heart disease, and for what, exactly?

As far as the expense of doing clinical trials on Lipitor et al. Clinically, MD's use Lipitor et al to treat high cholesterol, thinking that lower cholesterol = better cardiovascular health. So, extrapolating this, Lipitor et al are drugs to prevent cardiovascular disease, heart attacks, etc. Wouldn't you think that the company that makes Lipitor would study to see if it actually does what it is supposed to do? Also, with $7.97 billion in sales of Lipitor in 2002 alone, I would think that Pfizer could probably afford the clinical trials. Maybe I'm wrong!

In any case, there is a LOT more to cardiovascular health than cholesterol levels. Make your MD work for you and determine if you really have enough of a risk to use a drug like Lipitor. Their job is to protect your health, not take a 5 second look at a blood test and write you a prescription without determining if you really need it or not. If they don't know how to determine if you're at risk for CVD, over and above cholesterol testing, then find an MD who is current in the research and understands the problem. These drugs are serious stuff and I see patients on a daily basis who have lots of musculoskeletal problems that are the direct result of Lipitor and its buddies. And, if your MD determines this is what you need after properly trying to figure it out, then that's the way it goes. But even then there are alternatives to these drugs that lower cholesterol, for what that's worth, so don't just automatically jump to the prescription when something with no side effects can do the same thing.

[akairo]

Everyone that I know that has taken Red Yeast Rice (found in health food stores) has had a considerable drop in their overall cholesterol levels without the side effects of Lipitor. A friend went from
238 (HDL 43 LDL 171) to 157 (HDL 40 LDL 89)in two months. He also adjusted his diet and began excercising 4-5 days a week. I see little point in him taking medications of any kind if he in unwilling to change his lifestyle. There is no wonder drug that allows you to eat junk and still be healthy. If you poured grease down your kitchen sink everyday what would happen? Eventually you will need a plumber and possibly a whole new drainage system. Costly. If you do this with your body the habit could be deadly.

All your commiserations are for naught. It will only work if he wants to do it. Realistically he needs to see a nutritionist in conjunction with his physician and get on a new program. Quit the fast food/fried food/junk food cold turkey and start a new lifestyle. But you can't do it for him. He has to come to this of his own accord. My guess is that it won't become a reality until he has had a heart attack.

My little brother was much the same. No matter what was said he did nothing until he made the decision himself. He has since then lost 150 pounds, totally changed his eating habits and his very involved in fitness. Physically, he is a new man.

Good luck.

[VictoriaL]

Amazingly enough, he has begun with exercising, no fried food (and he's on vacation at the Delaware State Fair this week-- no funnel cakes!), and started to eat a salad with dinner (he never eats salad!). I realize that he's only a week into this, but he really seems to be determined to make a change. Luckily, a heart-attack was not the catalyst. I just hope that he continues (and thanks to all who have entered their suggestions/ opinions-- he read them all).

[DocAgocs]

Vicci, I was doing some reading over breakfast this morning and found some research that psyllium will also lower choleterol when used with meals. Psyllium is nasty stuff and I have used it just to see if it is worth it or not to recommend to patients. It works well, but it's awful stuff. Capsules made from psyllium would bypass the taste/texture problem, though, so there's another thing to try. I would probably only use psyllium (fiber supplement) with one meal per day because the extra fiber can block uptake of some nutrients in the diet. Also, this same resource cited some research from 1997 that a drop in 15-20% of overall cholesterol numbers is thought to have at least a 30% reduction of the diseases associated (loosely, as I've shown) with elevated cholesterol levels, so there are health benefits even from small reductions, just as with weight loss.

Getting the trans fatty acids out of the diet by eliminating fried foods is a good move. A lot of the research done on "saturated fats" actually uses trans fatty products, not true saturated fats, so the research is pretty muddy on that topic. There's nothing good about them, other than the fact that when you open your Oreo's there isn't a big puddle of oil at the bottom.

[mcraig13]

Sort of half-way listening to the news last night while fixing dinner--There was a report on an article coming out today in the Journal of the AMA or in the New England Journal of Medicine. If I heard it correctly it is about the use of cholestorol-lowering drugs vs. a healthy diet. I think this article talks specifically about a particular vegetarian diet. It might be a good place to get more information.

[DocAgocs]

I didn't get a chance to read the article in full in my paper, but the gist of it is that a vegetarian diet is almost as effective at lowering cholesterol as "low fat" diets and statin drugs combined. Unfortunately, the study only looks at the effect of the diet on cholesterol. Very low fat diets wreck havoc on the body because they cut out a crucial element that the body needs. We get a lot of female patients who are on restricted fat diets and their endocrine systems are shot. The female body is particularly sensitive to what fats are in the diet because it needs them for hormone production (so does the male body, but it's different, obviously).

My office's weight management program is based on publications for health care providers published by the National Heart, Lung and Blood Institute. We use a 21 day program of vegan diet (fresh fruits and veggies only) with whole food concentrates. The supplements and the diet further focus on foods that are known to positively effect the body's detoxification mechanisms (Cytochrome P450 enzyme chemical reactions) and cleanse key systems and organs (blood, lymph, kidneys, GI tract, liver, gall bladder). These foods are things like kale, Brussels srputs, broccoli, asparagus, red beets, garlic and that sort of thing. Our average patient loses 15 pounds in that 21 days and typically reports clearer skin, improved clarity of thought, allergy elimination (food and environmental) and improved energy. If you're used to the typical American diet that provokes insulin spikes and subsequent drops (reactive hypoglycemia), you wouldn't believe how good you feel eating in a way that regulates key hormones like insulin.

Patients who extend this way of eating, with some modifications to insure enough protein intake, generally continue to lose weight, or maintain current weight, and drop triglycerides, cholesterol, etc with no problem. The "magic" is that it is a living food diet full of nutrition but low on calories and without all the biojunk that we've been lead to believe is "food" available at the grocery store.

[akairo]

Victoria - I am so glad that he has started to change his diet and that I was so very wrong. In my family most are so HUA that they won't change even after a heart attack. Sad to say my dad is a walking coronary waiting to happen. Heck he could even be diabetic. He has so many indicators for heart disease and the poorest of eating habits imaginable. Even angina didn't scare him. Oh well, glad it is better for you.

[VictoriaL]

Originally posted by akairo
Sad to say my dad is a walking coronary waiting to happen. Heck he could even be diabetic. He has so many indicators for heart disease and the poorest of eating habits imaginable.

I'm sorry that you are going through this. Shouldn't there be some kind of law that, after we reach a certain knowledgable age (!), forces our parents to listen to us? My Mom is losing her hearing, but steadfastly refuses to acknowledge it. And she can't understand why I leave the room with her screaming grandchildren as she sits there and smiles lovingly at the little monsters...
sigh
Maybe your Dad will have a revelation or something. You can only hope.