Making sense of the statin guidelines

For years, doctors prescribed cholesterol-lowing statins based largely on cholesterol test results. The goal was to lower total cholesterol to under 200 mg/dL, and LDL (bad) cholesterol to under 100 mg/dL. But in late 2013, new guidelines on statin use issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) proposed a major change to that strategy.

These guidelines shifted from a numbers-based approach to a risk-driven approach. Instead of aiming for a specific cholesterol value, doctors were urged to look at a person's entire cardiovascular risk profile when considering treatment. This is a reasonable approach that can help simplify how doctors think about whom to treat.

The 2013 guidelines were met with more than the usual criticism, however. In fact, they've generated considerable debate over their departure from the approach of earlier guidelines. The new guidelines don't, for example, specify normal and abnormal levels for total cholesterol, LDL, HDL, and triglycerides, as past versions have done. Perhaps the best way to look at these guidelines is as a scientific statement reviewing what has been definitively established to date.

Who should take a statin?
The 2013 guidelines recommend a daily statin for individuals who fall into the following four categories:

anyone age 21 or older with a very high level of harmful LDL cholesterol (190 mg/dL or higher)

anyone who has cardiovascular disease, including stable or unstable angina (chest pain with exercise or stress); has had a heart attack, stroke, or transient ischemic attack ("ministroke"); has peripheral artery disease; or has had bypass surgery or angioplasty to treat a cholesterol-clogged artery

anyone age 40 to 75 who has diabetes

anyone age 40 to 75 who does not have cardiovascular disease but has a greater than 7.5% chance of having a heart attack or stroke or developing another form of cardiovascular disease in the next 10 years (as determined using the online risk calculator cited below).

That last category represented a major shift. In principle, if doctors follow the guidelines and start treating people who don't have heart disease but are at risk for it, several million more people will take a statin every day. It's not yet clear if that has happened, however, as studies examining this question have offered differing results.

4 ways to lower cholesterol!!!!!!!

Many people can reduce cholesterol levels simply by changing what they eat. For example, if you are a fan of cheeseburgers, eating less meat (and leaner cuts) and more vegetables, fruits, and whole grains can lower your total cholesterol by 25% or more. Cutting back on saturated fat (found in meat and dairy products) and trans fat (partially hydrogenated oils) can reduce cholesterol by 5% to 10%.

Here are four steps for using your diet to lower your cholesterol.

Stick with unsaturated fats and avoid saturated and trans fats. Most vegetable fats (oils) are made up of unsaturated fats that are healthy for your heart. Foods that contain healthy fats include oily fish, nuts, seeds, and some vegetables. At the same time, limit your intake of foods high in saturated fat, which is found in many meat and dairy products, and stay away from trans fats. These include any foods made with "partially hydrogenated vegetable oils."

Get more soluble fiber. Eat more soluble fiber, such as that found in oatmeal and fruits. This type of fiber can lower blood cholesterol levels when eaten as part of a healthy-fat diet.

Include plant sterols and stanols in your diet. These naturally occurring plant compounds are similar in structure to cholesterol. When you eat them, they help limit the amount of cholesterol your body can absorb. Plant sterols and stanols are found in an increasing number of food products such as spreads, juices, and yogurts.

Find a diet that works for you. When a friend or relative tells you how much his or her cholesterol level dropped after trying a particular diet, you may be tempted to try it yourself. If you do, and after a few months you discover that you're not getting the same benefits, you may need to chalk it up to genetic and physiological differences. There is no one-size-fits-all diet for cholesterol control. You may need to try several approaches to find one that works for you.

Although diet can be a simple and powerful way to improve cholesterol levels, it plays a bigger role for some people than for others. Don't be discouraged if you have followed a diet but not reached your goal blood level. Keep it up. Even if you do end up needing medication to keep your cholesterol in check, you likely will need less than if you didn't make any dietary changes.

Microwaving food in plastic!!!!

Let's cover the original misinformation first: The earliest missives warned that microwaved plastic releases cancer-causing chemicals called dioxins into food. The problem with that warning is that plastics don't contain dioxins. They are created when garbage, plastics, metals, wood, and other materials are burned. As long as you don't burn your food in a microwave, you aren't exposing yourself to dioxins.

Migrating chemicals

There's no single substance called "plastic." That term covers many materials made from an array of organic and inorganic compounds. Substances are often added to plastic to help shape or stabilize it. Two of these plasticizers are
bisphenol-A (BPA), added to make clear, hard plastic
phthalates, added to make plastic soft and flexible
BPA and phthalates are believed to be "endocrine disrupters." These are substances that mimic human hormones, and not for the good.
When food is wrapped in plastic or placed in a plastic container and microwaved, BPA and phthalates may leak into the food. Any migration is likely to be greater with fatty foods such as meats and cheeses than with other foods.
The FDA long ago recognized the potential for small amounts of plasticizers to migrate into food. So it closely regulates plastic containers and materials that come into contact with food. The FDA requires manufacturers to test these containers using tests that meet FDA standards and specifications. It then reviews test data before approving a container for microwave use.
Some of these tests measure the migration of chemicals at temperatures that the container or wrap is likely to encounter during ordinary use. For microwave approval, the agency estimates the ratio of plastic surface area to food, how long the container is likely to be in the microwave, how often a person is likely to eat from the container, and how hot the food can be expected to get during microwaving. The scientists also measure the chemicals that leach into food and the extent to which they migrate in different kinds of foods. The maximum allowable amount is 100–1,000 times less per pound of body weight than the amount shown to harm laboratory animals over a lifetime of use. Only containers that pass this test can display a microwave-safe icon, the words "microwave safe," or words to the effect that they're approved for use in microwave ovens.
When Good Housekeeping microwaved food in 31 plastic containers, lids, and wraps, it found that almost none of the food contained plastic additives.
What about containers without a microwave-safe label? They aren't necessarily unsafe; the FDA simply hasn't determined whether it is or not.
Is Styrofoam microwave safe?

Contrary to popular belief, some Styrofoam and other polystyrene containers can safely be used in the microwave. Just follow the same rule you follow for other plastic containers: Check the label.

The bottom line

Here are some things to keep in mind when using the microwave:
If you're concerned about plastic wraps or containers in the microwave, transfer food to glass or ceramic containers labeled for use in microwave ovens.
Don't let plastic wrap touch food during microwaving because it may melt. Wax paper, kitchen parchment paper, white paper towels, or a domed container that fits over a plate or bowl are better alternatives.
Most takeout containers, water bottles, and plastic tubs or jars made to hold margarine, yogurt, whipped topping, and foods such as cream cheese, mayonnaise, and mustard are not microwave-safe.
Microwavable takeout dinner trays are formulated for one-time use only and will say so on the package.
Old, scratched, or cracked containers, or those that have been microwaved many times, may leach out more plasticizers.
Don't microwave plastic storage bags or plastic bags from the grocery store.
Before microwaving food, be sure to vent the container: leave the lid ajar, or lift the edge of the cover.

Ways To Snack Smarter!!!!!

It's a great idea to choose snacks wisely. But many foods that seem to be of great nutritional value just aren't. For example, bran muffins and cereal bars can be packed with unhealthy fats and added sugar. Even "fat-free" foods often contain lots of added salt and sugar.

Here are 7 tips for smarter snacking.

Go for the grain. Whole-grain snacks can give you some energy with staying power. Try some whole-grain low-salt pretzels or tortilla chips, or a serving of high-fiber cereals.

Bring back breakfast. Many breakfast foods can be repurposed as a nutritious snack later in the day. How about a slice of whole-grain toast topped with low-sugar jam? Low-sugar granola also makes a quick snack.

Try a "high-low" combination. Combine a small amount of something with healthy fat, like peanut butter, with a larger amount of something very light, like apple slices or celery sticks.

Go nuts. Unsalted nuts and seeds make great snacks. Almonds, walnuts, peanuts, roasted pumpkin seeds, cashews, hazelnuts, filberts, and other nuts and seeds contain many beneficial nutrients and are more likely to leave you feeling full (unlike chips or pretzels). Nuts have lots of calories, though, so keep portion sizes small.

The combo snack. Try to have more than just one macronutrient (protein, fat, carbohydrate) at each snacking session. For example, have a few nuts (protein and fat) and some grapes (carbohydrates). Or try some whole-grain crackers (carbohydrate) with some low-fat cheese (protein and fat). These balanced snacks tend to keep you feeling satisfied.

Snack mindfully. Don't eat your snack while doing something else — like surfing the Internet, watching TV, or working at your desk. Instead, stop what you're doing for a few minutes and eat your snack like you would a small meal.

Take it with you. Think ahead and carry a small bag of healthful snacks in your pocket or purse so you won't turn in desperation to the cookies at the coffee counter or the candy bars in the office vending machine.

6 things you should know about vitamin D

Figuring out all the factors that can affect your vitamin D level is complicated. Your body makes vitamin D when sunlight hits the skin. You can also get the vitamin from food (mainly because it's been added; few foods are natural sources of vitamin D) or by taking a supplement.

The process by which the body makes vitamin D is complex. It starts when the skin absorbs rays in the invisible ultraviolet B (UVB) part of the light spectrum. The liver and the kidneys also participate to make a form of the vitamin that the body can use.

A number of factors influence a person's vitamin D levels. Here are six important ones.

Where you live. The further away from the Equator you live, the less vitamin D–producing UVB light reaches the earth's surface during the winter. Residents of Boston, for example, make little if any of the vitamin from November through February. Short days and clothing that covers legs and arms also limit UVB exposure.

Air quality. Carbon particles in the air from the burning of fossil fuels, wood, and other materials scatter and absorb UVB rays, diminishing vitamin D production. In contrast, ozone absorbs UVB radiation, so pollution-caused holes in the ozone layer could end up enhancing vitamin D levels.

Use of sunscreen. Sunscreen prevents sunburn by blocking UVB light. Theoretically, that means sunscreen use lowers vitamin D levels. But as a practical matter, very few people put on enough sunscreen to block all UVB light, or they use sunscreen irregularly, so sunscreen's effects on vitamin D might not be that important. An Australian study that's often cited showed no difference in vitamin D between adults randomly assigned to use sunscreen one summer and those assigned a placebo cream.

Skin color. Melanin is the substance in skin that makes it dark. It "competes" for UVB with the substance in the skin that kick-starts the body's vitamin D production. As a result, dark-skinned people tend to require more UVB exposure than light-skinned people to generate the same amount of vitamin D.

Weight. Body fat sops up vitamin D, so it's been proposed that it might provide a vitamin D rainy-day fund: a source of the vitamin when intake is low or production is reduced. But studies have also shown that being obese is correlated with low vitamin D levels and that being overweight may affect the bioavailability of vitamin D.

Age. Compared with younger people, older people have lower levels of the substance in the skin that UVB light converts into the vitamin D precursor. There's also experimental evidence that older people are less efficient vitamin D producers than younger people.

Two keys to strong bones: Calcium and Vitamin D

Although bone-weakening osteoporosis is quite common among older people, it isn't an inevitable part of aging. There's a lot you can do to shield your bones from this disease.

The best insurance against osteoporosis is building the highest bone density possible by your 30s and minimizing bone loss after that. But if you're already in midlife or beyond, there is still much you can do to preserve the bone you have and perhaps even to replace lost bone. Daily weight-bearing exercise, like walking, is the best medicine. Getting enough calcium and vitamin D are two other critical strategies for keeping bones strong.

Calcium

Calcium is an important nutrient for building bone and slowing the pace of bone loss. But it's not a single magic bullet, and some scientists suggest that too much calcium or dairy products may be unhealthy. Keep in mind that in addition to calcium, there are other nutrients and foods that help keep your bones strong — most importantly vitamin D, but also vitamin K.

How much calcium? The recommended daily intake for calcium is 1,000 milligrams (mg) a day for adults up through age 50 and 1,200 mg a day for people ages 51 and older, when bone loss accelerates. With age, the intestines absorb less calcium from the diet, and the kidneys seem to be less efficient at conserving calcium. As a result, your body can steal calcium from bone for a variety of important metabolic functions.

Because some research suggest that high calcium intake may increase the risk of prostate cancer, men should avoid taking calcium supplements or taking too many calcium-rich antacids.

Vitamin D

In building bone, calcium has an indispensable assistant: vitamin D. This vitamin helps the body absorb calcium, and some researchers think that increasing vitamin D can help prevent osteoporosis. Milk sold in the United States is fortified with vitamin D. Vitamin D is also prevalent in fortified breakfast cereals, eggs, and vitamin supplements. Some brands of yogurt are fortified with it, as well as some juices.

If possible, a small amount of sun exposure can help your body manufacture its own vitamin D — about five to 30 minutes of sunlight between 10 a.m. and 3 p.m. twice a week to your face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin. People with fair skin that burns easily should protect themselves from skin cancer by limiting sun exposure to 10 minutes or less.

Food and sun exposure should suffice, but if not, some experts advise getting 1,000 IU of vitamin D daily from a supplement.

How medications can affect your balance

Medications make a difference — generally a positive one — in the lives of many people. But at the same time, all drugs carry side effects — and with many medications, one or more of those side effects can alter your balance. How? According to the Centers for Disease Control and Prevention, common problems include vision changes, dizziness or lightheadedness, drowsiness, and impaired alertness or judgment. Some medications can even damage the inner ear, spurring temporary or permanent balance disorders.

Some of the commonly prescribed medications that can affect balance include:

antidepressants

anti-anxiety drugs

antihistamines prescribed to relieve allergy symptoms

blood pressure and other heart medications

pain relievers, both prescription and non-prescription

sleep aids (over-the-counter and prescription forms)

Sometimes the problem isn't a single drug, but a combination of medications being taken together. Older adults are especially vulnerable because drugs are absorbed and broken down differently as people age.

If you are concerned about how your medications may be affecting your balance, call your doctor and ask to review the drugs you're taking, their doses, and when you take them. It is never a good idea to just stop taking a medication without consulting your doctor first.