Ten (Okay, Eleven) “Eureka!” Cholesterol Moments: Announcing the bad news about saturated fats, Naming cholesterol as a heart risk, Tuning up with Mr. Fit, Pinning the rap on LDLs and Introducing cholesterol-buster meds.

Ten (Okay, Eleven) “Eureka!” Cholesterol Moments

In This Chapter

� Announcing the bad news about saturated fats

� Naming cholesterol as a heart risk

� Tuning up with Mr. Fit

� Pinning the rap on LDLs

� Introducing cholesterol-buster meds

this chapter is a handy guide to a half-century’s worth of advances in the science of protecting your heart by keeping your arteries clean and your body in tip-top shape.

As you read through the list, think about all those people who spent their time sitting at lab benches or adding up statistics to enhance your possibility of living a full, rich life. Clearly, a heartfelt, “Thanks a lot,” is in order.

Finding the “Wow!” factor

The word eureka loosely translates from the Greek as, “Oh, boy, look what I discovered,” a statement most commonly attributed to the ancient Greek mathematician Archimedes.

Sitting in his bath one day, Old Archie suddenly realized that he could calculate the volume of an irregularly shaped solid object, such as him- self, by immersing the object into water and measuring how much liquid it displaced.

Some versions of the Archimedes tale say that right after shouting “Heureka!” (Greek for “Eureka!”), Archimedes leaped out of the tub and ran starkers through the streets of his native Syracuse. Whether his fellow citizens shouted “Heureka!” upon seeing him is lost to history.

1957: The Prudent Diet

The Prudent Diet was the brainchild of the Diet and Coronary Heart Disease Study Project of the Bureau of Nutrition at the New York City Department of Health.

Well before the establishment decided that the risk of heart attack may be lowered by reducing the intake of foods high in saturated fats while empha- sizing unsaturated fats, the New Yorkers (whom I’m proud to say included my uncle, Seymour H. Rinzler, MD) said, “Let’s try it.”

Boy, were they ever right. By the end of the fourth year of the study, the incidence of heart attack among the middle-aged, often-overweight male participants was far below the numbers that researchers had predicted.

As a result, the Prudent Diet became the role model for the American Heart Association’s Step I and Step II eating plans (check ’em out in Chapter 4), and a new approach to eating your way to a healthy heart was born.

1958: Introducing Cholesterol Busters

Cholestyramine (brand name: Questran, Questran Light) was the first cholesterol- lowering drug approved by the U.S. Food and Drug Administration (FDA).

This prescription drug sops up natural digestive juices and bile acids found in your intestines and eliminates them from your body. Because you need bile compounds to digest food, your body responds by converting cholesterol into bile, thus lowering the amount of cholesterol in your blood vessels. (Read the whole story in Chapter 12.)

Cholestyramine is almost 50 years old, and although some of its market has been taken over by the statin drugs (see “1986: Unveiling Statins” later in this chapter), it’s still selling. Two years ago, cholestyramine’s manufacturer appealed to the FDA for permission to sell it as an over-the-counter product rather than a prescription drug. The FDA nixed the idea.

1971: Naming Cholesterol an Official Risk Factor for Heart Attack

Framingham, Massachusetts, is a small industrial town about 20 miles west of Boston. I mean no disrespect to its hardworking inhabitants when I say that you would probably never have heard of Framingham if a team of Boston

University Medical School researchers hadn’t set up shop there shortly after World War II. But they did. And they recruited most of the town’s nearly 30,000 citizens as volunteers in a study of who gets heart disease and why.

Within 20 years, an analysis of hundreds, maybe even thousands, of tests per- formed on the Framingham residents produced statistics showing a relation- ship between high serum (blood) cholesterol and the risk of heart attack. Here are the numbers:

Do those figures look familiar? You bet they do. Just check out the current breakdown for high, medium, and low cholesterol levels in Chapter 3.

More to the point, these numbers led the Framingham researchers and the National Heart Institute to create the first task force on arteriosclerosis, another big step on the road to the general public becoming interested in controlling cholesterol. Yeah, team!

1971: MRFIT Gets Going

The Multiple Risk Factor Intervention Trial (MRFIT) was an eight-year (1974–1982) study in which 250 scientists at 28 medical centers across the United States interviewed 361,662 middle-aged men to get 12,866 volunteers.

The volunteers were thought to be at high risk for heart attack based on risk factors such as age, smoking habits, a high-cholesterol diet, high blood pressure, and obesity.

The guys were divided into two groups: One group was taught to modify their behavior; the other was left to their own devices. At the end of the trial, the big news was that nonsmokers with lower cholesterol and lower blood pressure were less likely to have a heart attack. Today we take that for granted.

1984: Indicting Hypercholesterolemia

In 1984, a 14-member panel of distinguished scientists gathered at the National Heart, Lung, and Blood Institute for a Consensus Development Conference to

analyze the existing studies on cholesterol and heart disease and invite testimony relating to evidence linking the risk factor to the disease.

What they heard was so convincing that they certified hypercholesterolemia — a nine-syllable way to say high cholesterol — as a medical condition worthy of treatment. And just like that, practically overnight, millions of people who

once considered themselves healthy had something to worry about. Ain’t science great?

1985: Recognizing the Risk from LDLs

For years, cholesterol researchers plodded along thinking plain old high choles- terol was the basic risk factor for heart disease. They also wondered why some people with sky-high cholesterol readings never had heart attacks.

Joseph L. Goldstein and Michael S. Brown of the University of Texas Health Center in Dallas changed all that on October 14, 1985, when they won the Nobel Prize for identifying LDLs as the true risk factor in the cholesterol game. Bravo, Goldstein and Brown!

1985–1987: Establishing the National Cholesterol Education Program

The National Cholesterol Education Program (NCEP) was created in 1985, released to an advisory panel in 1986, and announced to the American public in 1987. Based on the Framingham stats (see “1971: Naming Cholesterol an Official Risk Factor for Heart Attack” earlier in this chapter), the NCEP formally designated levels of cholesterol as “high” (>240 mg/dL), “borderline high” (200–239 mg/dL), and “desirable” (<200 mg/dL).

This classification formally declared more than 25 percent of all Americans as being at risk of heart attack from high cholesterol. Wow! Who knew?

1986: Unveiling Statins

Statin is shorthand for a class of drugs that lowers cholesterol at the source by interrupting your liver’s natural production of this fatty substance. The first two statins — pravastatin (Pravachol) and simvastatin (Zocor) — appeared in 1986. The third, lovastatin (Mevacor), came online the following year.

For the full story on statins, check out Chapter 12. For the big problem with statins, run your finger down to “2001: Baycol Bombs.”

1988, 1993, 2001: ATP I, ATP II, ATP III

The National Cholesterol Education Program’s Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults report is one whale of a mouthful, so the whole thing is commonly called ATP (adult treatment panel), which certainly slides more easily off the tongue.

ATP I, published in 1988, focused on prevention and offered tips for warding off heart disease in healthy people with high cholesterol. The report also identified LDLs as a primary target, advising people whose LDLs are higher than “normal” to work with their doctors to reduce their risk for heart disease by lowering LDLs.

ATP II came out in 1993. Once again, the report stressed the importance of getting LDLs down into a healthy range, but ATP II added something new. Moving from prevention for healthy people to the management of existing heart disease, the report urged people who’d already had a heart attack to lower their LDLs, preferably to 100 mg/dL (or less).

ATP III, the current version, appeared in 2001. The advice to lower LDLs is still included, but once again, the National Cholesterol Education Program has come up with something new. The report identifies a new condition called metabolic syndrome (multiple risk factors, such as high blood pressure, obesity, smoking, and high cholesterol) as an important warning of heart disease ahead.

ATP III also offers a version of a medical crystal ball — a risk-factor-based formula that enables you to determine whether you should be on cholesterol- busting drugs (see Chapter 12) and guesstimate your odds of having a heart attack in the next ten years. If you’re brave enough to face the future, you can do the math in Chapter 3.

2001: Baycol Bombs

Baycol, the brand name for the drug cerivastatin, was introduced by Bayer A.G. in 1997 and, as you can see from the date on this entry, taken off the market a scant four years later.

One side effect of statin drugs, a class of cholesterol-lowering drugs, is rhabdomyolysis — the destruction of muscle cells. If enough muscle cells are destroyed, the debris may pile up in your kidneys, triggering kidney failure. Among Baycol users, the incidence of cell damage was ten times greater than it was for people using other statins, and the effect was far more likely to be fatal.

By August 7, 2001, when Bayer took Baycol off the market, at least 31 deaths were linked to the medication in the United States, and the FDA had reports of nine more abroad. As of 2007, the number of deaths attributed to Baycol worldwide has climbed past the 100 mark.

For more details on Baycol and the risks associated with other statins, turn to Chapter 12. The lesson to take away from this short set of paragraphs is simple: Never take any drug without reading the fine print.

2001–2004: Anti-Cholesterol Combo Pills

When it comes to therapeutic drugs, time marches on and so do the innovations. In 2001, Kos Pharmaceuticals introduced Advicor, the first anti-cholesterol com- bination pill. Advicor contains extended-release niacin (believed to raise HDLs, the “good” cholesterol) and the statin drug lovastatin (Lipitor). Three years later, Merck/Schering-Plough released Vytorin, a combo that includes ezetimibe (a drug that reduces the body’s absorption of fats, including cholesterol) plus the statin drug simvastatin (Zocor). And Pfizer introduced Caduet, which contains the anti-hypertension drug amlodipine (Norvasc) plus the statin lovastatin (Lipitor).

The good news about these two-fers is that a person who needs two drugs can get them both in a single pill. The bad news is that the pill provides the risk of two drugs along with the benefits.

Whether the benefits outweigh the risks for a specific patient is a question only that person (and his doctor) can decide. For investors, the answer is crystal clear. In 2006, Advicor scored $116 million in sales; by summer 2007, Vytorin was a $2 billion/year blockbuster; and Caduet sales are predicted to hit $1.1 billion by 2008. Eureka!

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Ten Cholesterol Myths: Quantifying cholesterol’s risks for women and kids, Fooling around with fiber facts, Getting it right on red meat and Fighting cholesterol with Woody Allen and the Duchess of Windsor.

Ten Cholesterol Myths

In This Chapter

� Quantifying cholesterol’s risks for women and kids

� Fooling around with fiber facts

� Getting it right on red meat

� Fighting cholesterol with Woody Allen and the Duchess of Windsor

In the words of the queen in Lewis Carroll’s classic tale, Alice’s Adventures in Wonderland, “I’ve believed as many as six impossible things before breakfast.” Who hasn’t?

For example, everyone knows that (a) chocolate is bad for your heart, (b) margarine is better than butter, and (c) women don’t need to worry about cholesterol. Except (a) it isn’t, (b) it isn’t, and (c) I’m getting ahead of myself. In short, this chapter uncovers the truth hiding behind several common misperceptions about cholesterol.

Most of the Cholesterol in Your Body Comes from Food

Yes, you get some cholesterol from food, but the surprising fact is that most of the waxy material floating through your bloodstream is made right in your very own body. Your liver processes the proteins, fats, and carbs you eat to churn out about 1 gram (1,000 milligrams) of cholesterol every day.

Your body uses a lot of this homemade cholesterol to perform various functions such as enabling your brain cells to shoot messages back and forth. (Check out Chapter 2 for the other uses.) But when you bring in additional cholesterol from food, trouble may loom.

To keep your cholesterol level within healthy bounds, the Dietary Guidelines for Americans, from our good friends at the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS), recommend that you consume no more than 300 milligrams of cholesterol a day from food.

But here’s a surprise: Overall, the total amount of fat and saturated fat in your diet now seems to be more important than the amount of cholesterol in the foods you eat in determining your cholesterol level. Which leads me nicely into the very next myth.

All Fatty Foods Raise Your Cholesterol

Wrong. Why? Because — here comes some good info — all dietary fats are not alike. The difference lies in saturation, the number of hydrogen atoms attached to the carbon atoms on dietary-fat molecules. I won’t waste your time by reprinting the entire fat/saturation spiel I present in Chapter 5.

Suffice it to say that saturated fatty acids, commonly known as “sat fats,” increase the amount of fat in your blood, including the amount of low-density lipoproteins (LDLs), the “bad” particles that ferry cholesterol into your arteries.

On the other hand, monounsaturated fatty acids and polyunsaturated fatty acids, like those found in high-fat plant foods such as nuts and avocados (see Chapter 6), may actually reduce the amount of fats in your blood, including LDLs.

But before you go getting too excited, keep these facts in mind:

� All fats are relatively high in calories. (They contain twice as many calories per gram as proteins and carbs.)

� A higher-calorie diet promotes weight gain.

� Weight gain raises cholesterol.

The moral of this little tale? Not all dietary fats are “bad,” but a little goes a long way.

Women Never Have to Worry about Their Cholesterol

Ah, if only it were true. Women do tend to have lower cholesterol levels than men do from adolescence right through middle age. One protective weapon in a woman’s cholesterol-fighting arsenal seems to be the female body’s continuous, natural stream of estrogen.

Researchers have made this deduction from the fact that a woman’s cholesterol level rises with the onset of menopause and the slowdown in her natural production of estrogen.

Older women are actually more likely than older men to have high cholesterol, but women do have one other lifelong advantage in the heart game. Their blood vessels are more elastic — that is, they are more likely than a man’s blood vessels to stay wide open — which may help protect against high blood pressure and a heart-stopping blood clot.

Children Have No Cholesterol Problems

Ah, if only this were true, too. Infants require fatty acids, including saturated fatty acids, to promote and sustain proper growth and development, including the growth and development of nerve and brain cells (see Chapter 2, please).

In the 1980s, when overzealous parents sought to protect their babies by feeding them formulas made of skim milk, a disastrous epidemic of babies who failed to grow and develop as normally expected occurred.

Today, the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend a food plan with sufficient amounts of all fats for children up to the age of 2. After that, the kiddy cholesterol squad gets tough with the tykes.

According to the AHA, by age 12, as many as seven out of every ten American children have fatty deposits in their arteries. To counter this trend, the AHA recommends testing cholesterol levels in any child older than 2 who has a family history of coronary artery disease in parents or grandparents younger than 55.

Eating More Dietary Fiber Lowers Blood Cholesterol

The answer to this myth is another, “Not necessarily.” As you can see in Chapter 5, there are two kinds of dietary fiber, insoluble and soluble.

Insoluble dietary fiber is the rough stuff — cellulose, lignin, and hemicellulose — in leaves, grasses, twigs, seeds, and bran (the hard outer covering of grains).

Human beings literally don’t have the stomach for insoluble fiber. To pull nutrients out of insoluble fibers, animals need a very long gut and sometimes more than one stomach — a physical setup common to animals such as cows but not to us.

Soluble dietary fiber — gums and pectins — is found in the flesh of grains, fruits, and veggies. Examples include pectin in apples and beta glucan, the gum that makes oatmeal sticky. (Beans are also a good source of beta glucan.)

Soluble dietary fiber sops up cholesterol. Insoluble dietary fiber doesn’t. Increasing your consumption of insoluble dietary fiber, which moves food through your intestinal tract faster, will reduce your risk of constipation, but it won’t lower your cholesterol.

Increasing your consumption of soluble dietary fiber will turn those cholesterol numbers downward, but only by about 10 percent (or less). Listen, nothing’s perfect.

Cholesterol Is the Only Thing That Leads to Plaque in Your Arteries

Actually, no. An amino acid called homocysteine may be equally at fault. Your body makes homocysteine as a byproduct of digesting proteins.

Homocysteine circulates into your arteries, and it can rough up the interior surface of the vessels, producing miniscule chinks and ledges for cholesterol to cling to.

After cholesterol latches on the arterial wall, it attracts more cholesterol particles and other cellular debris, building teeny-weeny little piles of junk that become plaque. Alert: Heart attack looms.

As you can see in Chapter 2, a diet rich in the B vitamin folate appears to reduce homocysteine levels, thus reducing the risk of a heart attack. One group of foods truly packed with folic acid is green, leafy veggies. (Turn back to Chapter 2 — yes, again — for a list of foods high in folic acid.)

Red Meat Has More Cholesterol Than Chicken or Turkey

No. Although red meat, even lean beef, has more total fat per ounce and up to five times as much saturated fat as chicken or turkey, dark chicken or turkey (the succulent leg and thigh) may deliver more cholesterol per ounce.

A Heart Attack Is the Only Health Risk Associated with High Cholesterol

Alas, no. Plaque buildup is not specific to the coronary arteries. A person with high cholesterol may also develop plaque deposits in the arteries that feed blood to the brain.

Cerebral thrombosis, the most common form of stroke, occurs when a blood clot (thrombus) forms in a cerebral blood vessel, blocking the vessel and depriving brain cells of blood and oxygen. According to the American Heart Association, cerebral thrombosis is most common in arteries already damaged or narrowed by plaque.

This is not a trivial matter. According to the American Heart Association/ American Stroke Association Heart Disease and Stroke Statistics, 2007 Update, in 2004, stroke was to blame for 1 of every 16 deaths in the United States.

The Centers for Disease Control and Prevention’s National Center for Health Statistics ranks stroke as the third leading cause of death for Americans, right up there behind heart disease and cancer. Here are the facts concerning stroke in the United States:

� On average, every three to four minutes someone in America dies of a stroke.

� In 2004, 150,147 Americans suffered a fatal stroke.

� More women than men die after having a stroke; in 2004, the numbers were 91,487 women versus 58,660 men.

� Of the people who suffer a stroke, 4.5 percent are younger than 60.

Finally, here is a cholesterol fact to ruin your romantic evening. Most of us worry about cholesterol’s effects on coronary arteries, but the truth is cholesterol doesn’t differentiate between a coronary blood vessel and one in any other part of the body, like the penis.

Yes, you read that right. High cholesterol may cause plaque buildup that blocks the blood vessels carrying blood to the penis. A reduction in blood flow to the penis caused by a blocked vessel in the leg or penis itself would “certainly” affect a man’s ability to sustain erection, says one urologist at the male sexual dysfunction clinic at Johns Hopkins Medical Centers in Baltimore, Maryland.

Chew on that one the next time you plan dinner for your beloved — if your beloved is male, of course.

Changing Your Diet Is the Only Way to Control Your Cholesterol

No again. In fact, this book includes one whole chapter (Chapter 8) on how regular exercise lowers cholesterol, a second one (Chapter 7) on the virtues of weight control, a third (Chapter 9) on why you should stop smoking right now, and last but not least, a fourth (Chapter 10) describing the cholesterol- control benefits of consuming alcohol in moderation.

You Can Never Be Too Rich or Too Thin, and Your Cholesterol Can Never Be Too Low

I’m a writer, a class of workers rarely overburdened with too much cash, so I’m not going to argue with the first part of that heading. But I am a nutrition writer, so I know that excessive thinness can be a sign of poor health or the result of an eating disorder such as anorexia nervosa or bulimia.

As for cholesterol, believe it or not, too low can be as problematic as too high. For example, if your cholesterol suddenly takes a nosedive into the basement below 100 mg/dL, your doctor may not be smiling when he brings you the news. Hypocholesterolemia — very low cholesterol — can signal danger ahead. What kind of danger? Malnutrition, an overactive thyroid, cirrhosis of the liver, and certain forms of cancer (colon cancer and liver cancer are good guesses).

Having consistently low cholesterol is not always a guarantee of long life. In the late 1990s, in a survey of 3,500 Japanese American male residents of Hawaii, researchers found a higher death rate among the men with the lowest cholesterol levels (about 149 mg/dL) than among men whose cholesterol levels circled around the supposedly borderline 232 mg/dL mark.

Since then, both American and British medical journals have published reports that state a total cholesterol level below 160 mg/dL appears to be tied to a higher risk of death from the diseases and conditions I mention above, especially in men who drink, smoke, and have high blood pressure. That is, if they don’t take matters into their own hands first:

� A relatively early study (1966) reported in the prestigious British Medical Journal carried results of a French survey of data for 6,393 men showing that those with low cholesterol had an incidence of suicide three times higher than the incidence among men with middling or high cholesterol.

� Moving right ahead, in 1999, the British Journal of Psychiatry published a report from Finland’s Public Health Institute in which men with very low cholesterol were more likely than men with high cholesterol to be hospitalized for depression.

Thin quiz

Wait. Before you go, who’s thought to have first said that quote about never being too rich or too thin?

a. Paris Hilton and Nicole Richie

b. The Duchess of Windsor

c. Fergie, the Duchess of York

d. King Lear

Answer: (b) The Duchess of Windsor, also known as Wallis Warfield Simpson, the “original” Camilla Parker Bowles. To marry Wallis, a divorced woman, King Edward VIII gave up the British throne on December 11, 1936, to King George the VI, the father of Queen Elizabeth II, the mother of Prince Charles, and mother-in- law first to Princess Diana and then to Ms. Parker Bowles. Whether Wallis actually uttered the rich/thin words, the second part is still bad advice, health-wise.

Some researchers suggest these increased rates of depression and suicide may occur because low-fat or low-cholesterol diets reduce the levels of a brain chemical called serotonin that promotes a feeling of well-being.

In the end, one is left to ponder the strangeness of life and the weirdly prescient message in Woody Allen’s character who, in the 1973 movie, Sleeper, wakes up in the year 2173 to discover that hamburgers, French fries, and milkshakes are health food. In 2007? Not so much.

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Ten Nutrition Web Sites: Describing nutrition Web sites, Determining cholesterol and fat counts for common foods, Developing heart smartsand Losing weight to lower cholesterol.

Ten Nutrition Web Sites

In This Chapter

� Describing nutrition Web sites

� Determining cholesterol and fat counts for common foods

� Developing heart smarts

� Losing weight to lower cholesterol

As with every other list of Web sites I’ve compiled for my For Dummies

books (Nutrition For Dummies and Weight Loss Kit For Dummies, Wiley Publishing, Inc.), if my editors had made this section the Part of 100s, I could have easily met the goal.

When you’re looking for reliable nutrition guidelines and information, the ten Web sites listed in this chapter are the cream of the crop, or better yet, the highest-grade skim milk. Each of the sites is an old friend I’ve come to lean on. Each has something special to offer. If I’ve missed your particular favorite, or you find a site that you think is especially useful, don’t hesitate to let me know, perhaps for inclusion in the next edition of this book. Just e-mail the info to www.dummies.com/register.

In the meantime, eat well and, as the song says, be happy.

Watch out for curves on the information superhighway. For reasons known only to their webmasters, even successful Web sites are susceptible to change without notice. What was there last week can disappear into some parallel Internet universe, never to be found again. If the appearance of a site listed in this book changes, just snoop around the site a bit for the info you need. If the site disappears altogether, try looking up key words, such as USDA or cholesterol, via a universal search engine like www.google.com.

The American Cancer Society

www.cancer.org

Yes, the American Cancer Society (ACS) Web site is dedicated primarily to infor- mation about cancer: definitions, treatments, research, and support services. Yes, most of the nutrition news you find here is available elsewhere. But this site’s defined focus provides easy access to other cancer-related topics.

Even, yes, again, cholesterol. Try it: Type cholesterol into the search bar on the ACS homepage, and bingo! You’ve opened a grab bag of ACS information about cholesterol’s effect on your body and your risk of various kinds of cancer.

Until now, the ACS was barely a blip on the screen of nutrition sources. Today, with a growing number of well-designed studies to demonstrate that some foods and diet regimens — not to mention some drugs, such as those used to lower cholesterol — may affect your risk of certain types of cancer, the ACS Web site offers solid reporting on this area of nutritional research.

American Council on Science and Health, and the Center for Science in the Public Interest

www.acsh.org www.cspinet.org

This two-for-one special gives you nonprofit, consumer-friendly organizations whose Web sites provide news releases, position papers, and highly reliable information about nutrition issues and your health.

Your bonus is that the American Council on Science and Health (ACSH) and the Center for Science in the Public Interest (CSPI) are usually on opposite sides of any nutritional issue. For example, the CSPI spearheaded the drive against the fat substitute Olestra, while the ACSH contended that the substitute was useful in some foods for some people. This kind of disagreement ensures that typing in the same search word or phrase, such as low cholesterol, on both sites provides you with the pros and cons associated with that topic.

Neither site is overly fancy. But both provide straight talk on specific issues, such as which fast foods have the most artery-clogging trans fatty acids (boo) and the least saturated fats (yea) or why tobacco is bad for you (maybe the only subject on which these guys agree).

The sites also feature online membership enrollment and order forms for publications, like the list-filled Nutrition Action Healthletter from the CSPI or the well- sourced and footnoted reports from the ACSH. The ACSH site takes on a cool and calm personality, while the CSPI resembles a hot-button advocate. In practice, both are solid and respectable as all get out.

The American Dietetic Association

www.eatright.org

The American Dietetic Association (ADA), which shares initials with the American Diabetes Association, is the world’s largest membership association of nutrition professionals. Its Web site is jam-packed with food and diet tips, guidelines, research, policies, and stats.

The ADA homepage displays seven bright green boxes, each labeled with a subject. Food & Nutrition Information has diet tips. Shop Online is a guide to ADA publications. Media is fun if you’re addicted to press releases. Careers & Students, Conferences & Events, Advocacy & the Profession, and Professional Development are clearly for association members.

The most useful choice for folks trying to figure out exactly how to create a cholesterol-busting meal plan may be the button up and to the right that says Find a Nutrition Professional. Click that link, and you get a page asking you to accept the Association’s conditions. Say yes, and you move on to a page where more clicks get you info explaining how to find a dietitian in your area.

If you can bend your brain around the much-too-adorable Net address (Eatright? Give me a break!), this site is a true treasure. And golly gee, who wouldn’t love having a personal dietitian to lead the way through the maze of conflicting fat and cholesterol directives?

The American Heart Association

www.americanheart.org

The American Heart Association (AHA) site is a must-see on any cholesterol tour of the Web. True, most of the info here is geared to reducing the obesity- related risks of heart disease. However, the AHA also dishes up solid advice for anyone looking for basic nutritional information and the lowdown on cholesterol. But boy oh boy, do they make you work to get to it! The multiple clicks will give your clicking finger a charley horse — but your brain (and you heart, of course) will appreciate the exercise.

For example, the homepage has 18 subjects you can investigate, ranging from Heart Attack/Stroke Warning Signs at the top to Local Info at the bottom. Click on Healthy Lifestyle (in the middle of the column), and you get several more choices. Pick Diet & Nutrition, and you receive the following six options:

� Dietary Recommendations

� No-Fad Diet

� Nutrition Facts

� Smart Shopping

� Delicious Decisions

� Face the Fats

I’m not saying this isn’t all good stuff. I’m just saying, I’m exhausted. The best bet is simply to noodle around the site.

The Food Allergy & Anaphylaxis Network

www.foodallergy.org

The Food Allergy & Anaphylaxis Network (FAAN) is a nonprofit, membership organization (individuals can join for $30 per year) whose participants include families, doctors, dietitians, nurses, support groups, and food manufacturers in the United States, Canada, and Europe. The group provides education about food allergies, as well as support and coping strategies for people who are allergic to specific foods. The site’s best feature, an e-mail allergy-alert system, is free.

Open the FAAN homepage, and you can easily log on to updates, daily tips, newsletter excerpts, and all the usual service-oriented goodies. To start receiving allergy alerts, click on the Special Allergy Alerts link, fill out the electronic form, and zap it off. Performing this quick task connects you to an early-warning system of allergy-linked news and information about product recalls, such as a July 2007 recall of dark chocolate bars whose label didn’t list milk, a potential allergen. This no-nonsense, highly accessible site can help you avoid such incidents.

The Food and Drug Administration

www.fda.gov

Entering the FDA Web site is like opening the door to the world’s biggest toy store. The virtual shelves contain so much stuff that you hardly know what to grab first. Luckily, all the toys are free in this store. You can linger here happily for days (weeks, years, or maybe forever) following the maze of cross-references and sources.

As you can see by its name, the first concern of the Food and Drug Administration is what you eat. Yes, the homepage offers information

about medicines for people and pets, poisons and their side effects, medical devices (think pacemaker), and FDA field operations (rules and regulations enforcement). They even have a place to report an adverse event (“I took that antibiotic and got hives!”). But for foodies, food is the main event.

To access the food part of the site:

1. Go to the homepage.

2. Click Food in the column on the left side of the page.

Say, “Wow!” What you get is access to a page for the Center for Food Safety and Applied Nutrition. Say, “Wow!” again because this covers everything. And I mean everything.

3. Now, browse to your heart’s content.

Food and Nutrition Information Center

www.nal.usda.gov/fnic

The Food and Nutrition Information Center (FNIC) houses one of several nutrition-related data collections in the U.S. Department of Agriculture’s National Agricultural Library. Like the basic Food and Drug Administration (FDA) Web site (see the preceding section), the FNIC site is chock-full of facts. You can dive in and swim around for hours without coming up for air.

But getting to exactly the info nugget you need can take a couple of clicks. Be patient, it’s worth it. After you get to the homepage, find the link to the resources list. Click on it to bring up a long list of possibilities.

Browse as you please, but click the nutrition and cardiovascular diseases link when you’re ready to fight cholesterol. Up pops a list of, well, resources: books, cookbooks, magazines, and newsletters, all dedicated to teaching you how to plan a diet that lowers your cholesterol and reduces your risk of heart disease. Click on the items that look interesting. Now wasn’t that worth the clicks?

The U.S. Department of Agriculture Nutrient Database

www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

The U.S. Department of Agriculture Nutrient Database is the ultimate nutrition chart. Cholesterol, calories, vitamins — you name it, and this site measures it.

The simple fact is that you just can’t plan a low-cholesterol, controlled-fat diet (or any other diet for that matter) without this chart, which serves up nutrition data on more than 5,000 foods and breaks the information down according to different sizes, portions, and different methods of preparation (boiled, broiled, fried, dried, and so on).

Each entry on the list is a snapshot of a specific food serving (“raw apple with skin,” for example) that shows how much the serving weighs and how much of these it contains:

� Calcium

� Carbohydrates

� Cholesterol

� Dietary fiber

� Fat

� Folate

� Food energy (calories)

� Iron

� Magnesium

� Niacin

� Phosphorus

� Potassium

� Protein

� Riboflavin (vitamin B2)

� Saturated, monounsaturated, and polyunsaturated fat

� Sodium

� Thiamin (vitamin B1)

� Vitamin A

� Vitamin B6

� Vitamin B12

� Vitamin C

� Water (as a percentage of the serving’s weight) Here’s how to find the food you’re looking for:

1. Type its name into the empty search box and then press Enter.

For example, apple.

2. Ignore the fancy stuff. Scroll down and click something basic.

Up comes a list of possibilities such as “Baby food, juice, apple and grape” or “Baby food, apples and turkey, strained.” In this case, clicking “Apples, raw, with skin” brings up a new screen listing various forms of raw apples such as “100 grams edible portion” or “1 cup, quartered

or chopped” or “1 large (31⁄4" diameter) (approx 2 per pound).”

3. Click the box in front of the serving you prefer and click the Submit button.

There you are — calories and nutrients for one large apple, including cholesterol, dietary fiber, and the different kinds of fats.

The Weight Control Information Network

www.niddk.nih.gov/health/nutrit/win.htm

Weight control is an important path to controlling cholesterol, so the Weight Control Information Network (WIN) site belongs on your must-see list. The homepage for this site, which is maintained by the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), gives you access to a database with articles, books, and audiovisual material related to weight loss, plus a wealth of statistics on weight and weight maintenance, and NIH research studies.

In fact, the list of information is so complete you could lose weight just lifting it.

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Ten Clicks to Reliable Cholesterol Information: Reading through the government’s cholesterol guidelines, Volunteering for a drug test trial, Checking out cholesterol-lowering products, Navigating a cholesterol information quiz and Finding facts about general drugs.

Ten Clicks to Reliable Cholesterol Information

In This Chapter

� Reading through the government’s cholesterol guidelines

� Volunteering for a drug test trial

� Checking out cholesterol-lowering products

� Navigating a cholesterol information quiz

� Finding facts about general drugs

Rules are made to be broken, so this Part of Tens is actually a Part of Seventeens (which is to say, 11 entries with 17 different links to cholesterol info). The plain fact is that the Internet has too many ultra-good, cholesterol-centered Web sites for me to whittle them all down to a measly list of ten. Enjoy the bonus sites listed here, as well as the other cholesterol info sites scattered throughout the chapters in this book.

Keep two things in mind when surfing the medical Web:

1. Be cautious. Absolutely anyone can dream up a Web page, so you’re not always guaranteed accurate information. When choosing among sources, exercise good judgment. Look for a reputable name and reasonable advice, not pie-in-the-sky (even if it’s a low-fat and cholesterol-free pie) recommendations. The sites listed in this chapter meet those guidelines. So click to your heart’s content. Or rather, to its health.

2. Things change on the Web, more quickly and more often than you may expect. If you can’t find a site listed here or if when you do find it, the contents don’t match the listing, just go with the flow. After all, the new stuff may be even better than the last round.

The American Heart Association

You can also reach the American Heart Association’s Cholesterol Low Down by calling up the basic AHA site (www.amheart.org), clicking on the site map, and scrolling to Cholesterol Low Down under Healthy Life Style. Or, as with other big sites that have smaller sections on cholesterol, you can get where you’re going by clicking on the address above.

The Cholesterol Low Down is the American Heart Association’s national cholesterol education program whose primary aims are to urge us all to see the doctor, determine our cholesterol numbers, and set out on a five-step plan for long-term heart health. Accordingly, this page has five buttons to click: Getting Started, Adjust Your Diet, Get Active, Check Your Progress, and Keep it Up (and Down).

Each button leads to a well-designed page with concise directions. For example, click Adjust Your Diet and you get a page pointing you toward sub- sections such as Eating to Lower Your Cholesterol, How to Shop, Fat Facts, and (goody!) Recipe of the Month. All in all, this information is pretty much the kind of solid info you’ve come to expect from people who spend their professional lives worrying about your heart.

Brand Name Cholesterol-Lowering Drugs

www.caduet.com

www.crestor.com

www.lipitor.com

www.pravachol.com

www.vytorin.com

www.zocor.com

You’ve got questions. These sites have answers about the medical drugs most frequently prescribed for lowering cholesterol. The general format includes information similar to that found on other sites. The hot stuff on these is the occasional offer of a free course of the med via a coupon you take to your doctor who writes a prescription that you hand to the pharmacist. What? You thought they were going to send it through the mail?

Of course, you can also access online information about these drugs by typing their generic names into the search box of any search engine. Table 15-1 lists brand-name drugs and their generic equivalents.

Center for Drug Evaluation and Research

www.fda.gov/cder/drug/default.htm

As its Web address indicates, the Center for Drug Evaluation and Research (CDER) is a division of the Food and Drug Administration (FDA). The CDER Web site offers valuable information and evaluations of drug products, including those used to lower cholesterol levels.

For another path to cholesterol-specific medications, you can go to the main FDA homepage at www.fda.gov and type cholesterol-lowering drugs in the search box. You get millions of documents and pages of articles on every- thing even faintly linked to these medicines. The site is pure heaven for hypochondriacs. No, no, I didn’t mean you!

Centers for Disease Control and Prevention (CDC)

www.cdc.gov/cholesterol

You can go to the homepage for the CDC (www.cdc.gov) and try to maneuver your way through to the page devoted to cholesterol, a workout in itself.

Or you can simply go right to the cholesterol page with the address above. Me? I chose the second path. But then, I get my workout on a balance board every day, so who needs all that extra clicking? Either way, the CDC cholesterol page gives you what this agency is famous for — facts, statistics, and prevention strategies. And, of course, the latest news and press releases. Neat.

The Mayo Clinic

www.mayohealth.org

When it comes to consumer-health communications, the Mayo Clinic is true blue, just as cozy and user-friendly as all get out. I typed cholesterol into the search box and up popped more than 200 essays on cholesterol. Most relevant? The first 50, from High Blood Cholesterol to Heart Attack.

For people fuzzy about cholesterol facts, the Mayo Clinic’s absolute claim to fame, on exhibit here, is its intelligent, balanced, and easily accessible pre- sentation of serious technical stuff. Not to mention its sly (maybe uninten- tional) sense of medical humor. For example, did I mention that in its list of cholesterol-related essays the Mayo Clinic lists “Heart attack” right after “Erectile Dysfunction: A sign of heart disease?” Hmmmmm.

MedicineNet.com

www.medicinenet.com

MedicineNet.com — don’t you just love the spiffy capital N right there in the middle? — is a doctor-owned, doctor-maintained Web site with a newsy point of view. Medical info junkies may browse through all the topics or choose the cholesterol-specific info, which dishes up a tasty smorgasbord of cholesterol bits and bytes.

When I typed cholesterol into the search bar, I got back a list of more than 1,000 cholesterol-related articles on

� Diseases and conditions

� Health and living

� Ask the experts

� Medications

� Procedures and tests

� Health news

I also received general tips for living well while controlling my cholesterol. Frankly, I figure if you read them all, you can wave good-bye to your doctor and hang up your own shingle to treat your own cholesterol conditions. Just kidding.

MedlinePlus.com

www.nlm.nih.gov/medlineplus/cholesterol.html

MedlinePlus is a service of the National Library of Medicine and the National Institutes of Health. Right there on the homepage is an alphabet that gives you access to absolutely tons of information about practically any medical subject that crosses your mind. You can access cholesterol information directly with the address above, or you can go to the homepage at — what else? — http://medlineplus.gov, click C, and then pick your way through to Cholesterol.

Either way, you get to look at Basics, Research, Overviews, Latest News, Diagnosis/Symptoms, Treatment, Prevention/Screening, Alternative Therapy, Nutrition, Disease Management, and Specific Management. But, as Thomas P. “Tip” O’Neill, one-time Speaker of the U.S. House of Representatives used to say, “All politics is local.” The same goes for cholesterol: If yours is worrisome, you want help right in your hometown. So my favorite click on this site is the one labeled Go Local. Click here, choose one of the 19 states listed either from a drop-down list or an interactive map, and you can wander through resources as far as the eye can see — or the typing finger takes you. The only complaint: How come they don’t list all 50 states? For now, the simple answer is, what you see is what you get. But check back later: And, no, I have no answer right now.

National Cholesterol Education Program

www.nhlbi.nih.gov/about/ncep/index.htm www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

The National Heart, Lung, and Blood Institute (NHLBI) launched the National Cholesterol Education Program (NCEP) in November 1985 with a goal of reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol.

Through educational efforts directed at health professionals and the public, the NCEP aims to raise awareness and understanding about high blood cho- lesterol as a risk factor for CHD and the benefits of lowering cholesterol levels as a means of preventing CHD.

The first Web site listed above takes you directly to NCEP. The second provides access directly to the latest cholesterol guidelines:

� The executive summary of the 2001 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, also known as Adult Treatment Panel III (or ATP III for short)

� The full ATP III

� The ATP III Update 2004: Implications of Recent Clinical Trials for the ATP III Guidelines

These reports are widely considered the official word on cholesterol evaluation and treatment for most high-powered health groups, such as the American Heart Association — and for your doctor, too. (For a dissenting view to the ATP III Update, check out Chapter 12.)

Other goodies on this second site include information about cholesterol- lowering drugs and conditions that may increase the risk of elevated cholesterol levels. The “fun part” is an interactive calculator that enables you to predict your ten-year risk of heart attack based on your cholesterol level and other personal risk factors.

National Heart, Lung, and Blood Institute

www.nhlbi.nih.gov

You got a taste of NHLBI from the first list of Web sites in this chapter that sent you to ATP III. Now, open up the door to a ton of statistics and snippets of health information about (what else?) your heart, your lungs, and your blood.

Before you leave this site, take note of something special: a link to studies seeking patients. Before a new medicine or treatment method is approved by the Food and Drug Administration, there must be proof that it’s “safe and efficacious.” (Translation: It won’t kill you, and it does work.)

Much of the required proof comes from government-sponsored trials. To find out more about trials currently in progress, run your mouse over to the left side of the page to the headline Clinical Trials, then go down one line, and click NHLBI Studies Conducted at NIH in Bethesda, MD, to pull up various ongoing studies. Check this out to see if you want to join a trial to assess the potential of a new treatment program.

Stedman’s Online Medical Dictionary

www.stedmans.com/section.cfm/45

Listen, making your way through medical terms, including the various forms of cholesterol, can be a daunting task. Stedman’s is the ne plus ultra (Latin for, “nothing better than this”) medical look-up book. On this version, you can type in a whole word, search by the first two letters of the word, or search backwards, meaning you can type in a keyword or definition and get the exact word you’re looking for. So do it!

WebMD

www.webmd.com

This site is just terrific. Go to the homepage, type cholesterol into the search box, click Enter, and there’s no end to the things you can discover.

The medical experts who run this site keep adding information on cholesterol guidelines, cholesterol-lowering drugs, and cholesterol-control diets. You name it, and it’s here. Best of all, the material is accessible, reliable, and . . . well, you fill in whatever good word comes to mind.

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