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.

Read More

Mouth-Watering Morsels for Special Occasions: Creating healthy munchies with satisfying flavor and crunch and Trying some delicious heart-healthy recipes.

Mouth-Watering Morsels for Special Occasions

In This Chapter

� Creating healthy munchies with satisfying flavor and crunch

� Trying some delicious heart-healthy recipes

When your doc gives you the good news that your cholesterol is under control, you have

cause to celebrate. And even when you’re still working toward lowering your cholesterol, special occasions abound. Unfortunately, party foods, by definition, are full of flavor and not short on fat. But missing your son’s wedding, skipping out on your best friend’s birthday party, or opting not to throw your annual holiday bash isn’t an option.

The good news is that many of the foods recommended for heart health are already standard party fare. Nuts to nibble, avocado in guacamole, smoked salmon with capers, and olives of all sorts are green-light foods. Making sure they’re healthy is just a matter of how you prepare them.

Think of cooking as an art rather than a science. The recipes in this chapter are guidelines; don’t stress if you can’t find the exact ingredients or if your measurements are just a bit off. Adding a little more or less of an ingredient won’t ruin anything, and you just might end up creating something you like even better. The prep time estimates I give you include the time it takes to wash fruits and veggies under cold running water and to cut, assemble, and measure all ingredients. The temperature for all recipes is in Fahrenheit. Also note that the little tomato you see on the “tabs” in front of the recipe names indicate that the recipe is vegetarian.

In this chapter, you discover heart-healthy foods with crunch that haven’t been deep-fried, and satisfying nibbles high in the right sort of fats. I give an assortment of quick and easy recipes for basic party offerings, including a vegetarian pâté and marinated olives. Presentation of food is also part of the drill. Read on to find all sorts of suggestions for creating scrumptious party offerings that meet your dietary needs.

If you love this chapter, check out Low-Cholesterol Cookbook For Dummies by Molly Siple, MS, RD (Wiley) for more great culinary tips and tempting recipes to help get your cholesterol under control.

Little Bites a Cardiologist Would Love

The hors d’oeuvres and little nibbles that meet the nutritional requirements of a cholesterol-lowering, heart-healthy diet are so numerous they would fill a buffet table. These morsels feature raw vegetables, fresh herbs, healthy fats, chicken, and fish. In addition, these foods are eaten in very small amounts, but many are so tasty that you’ll be tempted to make a meal out of them.

Adding crunch to party fare

Healthy foods, perhaps because they’re never deep-fried, often lack crunch, leaving you longing for the sound of crispy food and a satisfying chew. Party favorites like potato chips and tacos are full of crunch, while healthier foods, such as grains, nut butters, and vegetables, are quiet foods. The following gives you ways to combine the best of both worlds: the cholesterol-conscious and the crispy.

Crostini

Toast is crunchy, so how about starting with that and making some crostini, which means “little toasts” in Italian. Here’s how to prepare crostini:

1. Adjust the rack of a broiler so that it’s at least 4 inches from the heat source and preheat the broiler.

2. Cut a slim baguette of French bread (about 2 inches in diameter and sold in specialty bakeries and upscale supermarkets) into thin slices and place on a large baking sheet.

Cut slices of bread on the diagonal for a stylish presentation.

3. Brush the slices on one or both sides with a little olive oil and rub one or both sides with a halved clove of garlic.

4. Broil the bread so that one side is lightly toasted.

5. Turn the bread over and broil for a minute or two, making sure that the bread doesn’t toast all the way through.

Use crostini as a platform for other foods. Here are some suggested toppings:

� A smear of tapenade, an olive paste seasoned with capers, anchovies, garlic, and lemon juice and sold in jars

� Goat cheese mixed with fresh herbs, such as basil and parsley, and topped with a sliver of sun-dried tomato

� A spoonful of garlicky, mashed cannellini beans scented with oregano

Homemade baked tortilla chips

Instead of noshing on corn chips fried in who-knows-what kind of oil and loads of salt, enjoy the crunch of home-baked tortilla chips. Start with corn tortillas or whole-wheat tortillas, both made with whole grains, far healthier than white flour tortillas. Here’s the procedure:

1. Using a pastry brush, brush each side of a corn tortilla with unrefined safflower oil or lightly spray each side, using an oil sprayer filled with unrefined oil.

To give the chips a southwest flavor, sprinkle the oiled tortillas with ground cumin or chili powder.

2. Stack the tortillas and cut them into 8 wedges, as you would a pie.

3. Place the wedges in a single layer on an ungreased baking sheet and bake in a preheated 400-degree oven, until they just begin to become golden, 10 to 12 minutes.

Serve tortilla chips with a bean dip for a dose of soluble fiber. Or use guacamole, which is a great source of folate, or classic tomato salsa, which is full of healthy ingredients.

Doing the crudité dip

Eating raw vegetables at parties became chic when the veggies took on the name crudité, which is French for “raw.” They are indeed refreshing, crispy, and full of all the vitamins and minerals nature gave them. But what do you do with all the bits of vegetable after you cut them? Choose one of the following ideas to bring order to the chaos:

� Start with sticks of carrot, celery, and seeded cucumber, and maybe some blanched asparagus or blanched string beans, and give each vegetable a separate container, such as glass tumblers, colorful ceramic mugs, or small flower vases. Cluster the containers on the serving table, creating a vegetable forest.

� Arrange vegetables on a long, rectangular platter or basket lined with kale, and give each vegetable its own row.

� Tuck raw vegetables between the leaves of a full head of Boston lettuce, following the instructions in the recipe, Crudité with Mango Salsa and Creamy Avocado Dip.

Figure on 1 cup of dip for every 20 guests. If you’re serving chunky dips, you may need a bit more.

The fat of the matter: Acceptable appetizers

One of the great pleasures of party food is that it’s full of hard-to-resist assertive flavors, in part because the food is also full of fat, a flavor carrier. Taking a holiday from diet restrictions, the most careful of eaters will graciously accept the hot cheese puffs and chocolate truffles being offered. But there’s no reason you can’t enjoy the feel of fat, even if you’re watching your cholesterol. You have options.

Nuts and olives

Nuts and olives are two classic cocktail nibbles that are perfectly acceptable heart-healthy foods. In numerous studies, both nuts and olives, the basis of the famed Mediterranean diet, have been linked to a lower risk of heart dis- ease. In addition, the monounsaturated and polyunsaturated fats in these foods help control cholesterol.

So which nuts have the most of these healthy fats and are low in the cholesterol-raising saturated kind? Here are a few that fit the bill:

� Almonds

� Filberts

� Pecans

� Pistachios

� Walnuts

One way to include nuts in a party menu is to add walnuts to hummus, puree- ing them along with the other ingredients. The rich, mellow flavor of walnuts blends well with the flavors of the other ingredients, and walnuts add omega-3 fatty acids, making hummus even more nutritious. Here’s how to make it: In a food processor, combine 2 cups chickpeas (one 15-ounce can), 1⁄2 cup walnuts, 1⁄2 cup tahini sesame paste, 1⁄4 cup fresh lemon juice, and 1 clove garlic, plus water or oil to reach the desired consistency. Season with cumin and salt.

Cheeses

You can save on fat by eating lowfat and nonfat cheeses or having a soy cheese look-alike, but I can’t promise you great flavor or texture in all cases. For instance, I’d rather have a shaving of world-class Parmigiano-Reggiano as a garnish for slices of pear topped with a paper-thin slice of prosciutto, than a large wedge of rubbery, nonfat mozzarella any day. But do sample some lowfat cheese and see what you think. For instance, lowfat ricotta can be very satisfying. If you want to cut back on fat intake and still eat cheese, modified products let you keep these creamy-tasting foods in your diet.

When shopping for cheese, be sure to read the label for content of total fat and saturated fat as well as cholesterol. The amounts present vary among producers. Cheeses such as Camembert, Brie, Roquefort, cheddar, and American processed cheese can contain more than 25 percent of your daily quota of saturated fat and about 10 percent of a day’s worth of cholesterol. And these amounts are in just 1 ounce, which isn’t very much, especially for a devoted cheese eater. Best to stay away from these unless you can stop after one nibble. Feta and mozzarella, the full-fat kind, are lower in fat and cholesterol and are better choices.

For the feel of fat on the tongue, use lowfat yogurt and lowfat sour cream, both very palatable, in your hors d’oeuvres.

Caviar

If any food says “special occasion,” it’s caviar. Caviar is salted fish eggs, so, just like chicken eggs, it’s a whole food and a balanced source of nutrition. In addition, although fat contributes 61 percent of the calories, caviar, like fish, contains mostly the healthy monounsaturated and polyunsaturated kinds. Admittedly, caviar is high in sodium (containing 240 mg per tablespoon) and in cholesterol (containing 31.3 mg per teaspoon), but you’re not likely to be eating a bowlful of caviar anyway.

I give you two ways of serving caviar that give you a smidgeon of this glamorous stuff. On a budget, use black lumpfish caviar, golden whitefish caviar, or salmon red caviar, all sold in little jars in supermarkets. Otherwise, invest in some American farm-raised caviar or the even pricier imported sevruga, osetra, or beluga caviar.

1. Boil round, red potatoes, the smallest you can find, until they’re cooked through and tender.

2. Peel the potatoes, slice in half crosswise, and cut some potato off the base of each half, so the potato is steady when placed on a plate.

3. Using a melon baller, cut into the flat surface of each potato half and scoop out a little bowl in the middle.

4. Fill the hollow of each potato with lowfat sour cream and sprinkle the sour cream with caviar.

For this elegant hors d’oeuvre, caviar is displayed on pale chartreuse Belgium endive.

1. Wash a head of Belgium endive and cut it at the base to separate leaves.

2. Using a teaspoon, place a small dollop of lowfat sour cream at the wider end of each leaf and then sprinkle caviar on the sour cream.

3. Garnish the caviar and sour cream with a tiny sprig of dill.

4. On a round serving platter, arrange these like spokes, with the narrow end of the leaf pointing out.

Getting some help: Ready-made appetizers

I often serve canned stuffed grape leaves and no one is the wiser. My guests sometimes even ask for the recipe. You can find heart-healthy, ready-made appetizers in supermarkets or natural foods stores. Offer some of the following on their own or add them to a few of your own appetizers:

� Roasted sweet red peppers

� Marinated artichoke hearts

� Smoked salmon

� Sliced veggies from the salad bar, to serve as crudités with a dip

� Stuffed tortellini (serve it on skewers)

� Freeze-dried vegetable crunchies, such as corn, peas, red bell peppers, carrots, and tomatoes, produced with no added fat and sold in natural food stores

� Canned stuffed grape leaves

Tasty Recipes to Impress Your Guests

The recipes in this section are attractive to the eye, and you and your guests will likely count them among your favorites for regular snacking. The Citrus- Scented Marinated Olives, in particular, are known to be highly addictive!

Some of the following recipes are hearty and healthy enough to be served as a main course as well as party munchies. You can even turn the Mushroom Pâté into a pasta sauce, as I explain in the recipe introduction. Use this section as inspiration — take a look at your favorite heart-healthy meals to see whether you can serve any of them as hors d’oeuvres at your next gathering.

Almonds have more of the monounsaturated fats, the cornerstone of the heart-healthy Mediterranean diet, than any other nut. Scent them with spices, add some raisins, and you’ve created a healthy treat. The small amount of butter in this recipe imparts its inimitable flavor without adding much saturated fat. When nuts are toasted in this way, they don’t absorb much of the cooking oils because they already contain a large amount of fat. Serve this snack with cocktails or after-dinner coffee.

1 In a skillet over medium heat, melt the butter and combine with the oil.

2 Add the almonds and toss to coat with the oil. Sprinkle the almonds with the cinnamon, ginger, and nutmeg and toss to combine ingredients. Toast, stirring occasionally, for 5 minutes.

3 Add the raisins and continue to cook the almond mixture until the nuts begin to brown, an additional 2 to 3 minutes. Season to taste with salt. Make sure to cool the nuts completely before storing.

Put one of these olives in your mouth, close your eyes, and you can taste summer in Provence! Let the Mediterranean flavors transport you. This recipe uses brine-cured olives, but if you want to cut back on salt, ordinary canned olives work fine as well. Use pitted ones so that more of the marinade can find its way into the olives. You can also marinate these olives in olive oil, but I use water here to cut back on calories and create a lighter taste.

1 tablespoon grated orange peel 1 tablespoon grated lemon peel 2 bay leaves

2 anchovies, minced, or 2 tablespoons anchovy paste

1⁄2 teaspoon dried thyme

1 Combine the olives, garlic, orange juice, lemon juice, orange peel, lemon peel, bay leaves, anchovies, and thyme in a glass jar with a tight-fitting lid.

2 Add enough water to the citrus marinade to cover the olives.

3 Seal the jar with the lid and shake the jar several times to distribute and combine the ingredients.

4 Refrigerate the olives for 3 days, shaking the jar once each day to keep the marinade well mixed.

Go-With: Serve the olives with goat cheese and a baguette of French bread.

Skewered Scallop Seviche with Avocado

Seviche, popular in Latin America, is raw fish that has been marinated in citrus juice, usually lime. The acid in the fruit “cooks” the fish. Any white-fleshed fish or scallops can be prepared this way. Shellfish has a reputation for being high in cholesterol, but a serving of 4 skewers of these scallops contains only 16 mg of cholesterol.

1 In a shallow 8-inch square baking dish, combine the juice, cilantro, onion, and garlic.

2 Rinse the scallops. If necessary, remove the tough, stark white hinge that attaches the scallop to the shell. Place the scallops in the lime juice marinade. Cover and refrigerate a minimum of 4 hours, or overnight. The scallops are “cooked” when they’re opaque.

3 Cut each tomato in half crosswise. Peel and remove the seed of the avocados and cut them into 3⁄4-inch cubes. The cubes need to be substantial enough so that they don’t fall off the skewer. Drain the seviche and season to taste with salt and pepper.

4 Assemble the skewers by threading the components in this order: 1 scallop, 1 cube avocado, 1 scallop, and 1 cherry tomato half. Run the skewer through the center of the face of the tomato where it was cut and then out the top through the skin, so the tomato becomes a cap on the other foods.

5 On a round platter, arrange the skewers of seviche like spokes of a wheel, with the tomato caps at the center. Or use a horizontal tray and place the skewers in a row with the food colors forming stripes.

Crudités with Mango Salsa and Creamy Avocado Dip

The inspiration for this recipe is a delicious combo dip I buy ready-made, a container with a layer of fresh guacamole topped with a layer of mango salsa. The combination of smooth and spicy is just right. The Creamy Avocado Dip included here is full of healthy monounsaturated fats and is high in folic acid, while the Mango Salsa gives you an effortless way to increase your fruit intake. For the crudités, try using only green and white vegetables, like I suggest here, for a designy, high-style look.

1 Taking the base of a head of Boston lettuce in one hand, gently open the leaves of the lettuce with the other hand, wiggling your fingers down between the leaves. (If the lettuce is sandy, submerge the opened head in a sink filled with water and briefly swish to loosen dirt. Drain upside down in an empty dish rack before proceeding.)

2 Meanwhile, peel the turnip and cut in 1⁄4-inch rounds. Picture the turnip slice as the earth and cut a small V-shaped wedge at the North Pole and South Pole. Also make two V-shaped wedges at each end of the “equator.”

3 Bring about an inch of water to boil in a skillet and add the asparagus. Cook until the asparagus is bright green and al dente, about 2 minutes. Remove with tongs, and sub- merge the asparagus spears in a bowl of cold water until they reach room temperature.

4 Tuck the turnip slices, asparagus, endive leaves, and cucumber between the lettuce leaves. Serve with the Mango Salsa and Creamy Avocado Dip.

Vary It! If you decide your crudité composition is begging for more color, add carrot sticks.

Tip: If the Boston lettuce on display has had the outside leaves removed, ask the produce manager where you shop to bring you a full and untrimmed head from the cartons of pro- duce stored in the back.

Per serving: Calories 8 (From Fat 1); Fat 0g (Saturated 0g); Cholesterol 0mg; Sodium 8mg; Carbohydrate 2g (Dietary Fiber 1g); Protein 1g.

Mango Salsa

This recipes lives and dies on whether the mango is sweet with a smooth texture, so chose your mango with care. When ripe, a mango yields to gentle pressure like a ripe avocado, and the stem end has a gentle aroma. Choose plump mangos, avoiding those with bruised or shriveled skin. This nonfat mix of healing fruits and vegetables also goes great with chicken and fish.

1 Put the mango, sweet red pepper, onion, chile, cilantro, and lime juice in a mixing bowl. Toss gently to combine the ingredients.

2 Season to taste with salt and serve immediately.

Per serving: Calories 16 (From Fat 9); Fat 1g (Saturated 0g); Cholesterol 0mg; Sodium 20mg; Carbohydrate 2g (Dietary Fiber 1g); Protein 0g.

Creamy Avocado Dip

Sour cream dips have just the right tartness to complement the sweetness of fresh, raw vegetables. Cut the saturated fat of the cream by making the dip with lowfat or nonfat sour cream, and as in this recipe, substituting some of the sour cream with avocado to add healthier fats.

1 Put the sour cream in a food processor fitted with a metal blade.

2 Add the cumin to the sour cream in the processor, and then add the avocado, garlic, and cilantro. Process until smooth, scraping down the side of the processor bowl if necessary to incorporate all the ingredients.

3 Season to taste with salt and pepper. Transfer the dip to a small serving bowl and garnish with chopped cilantro. Serve immediately. (The dip can also be prepared earlier the same day you plan to serve it. Press plastic wrap onto the surface of the dip so that no air comes in contact with the avocado in the dip to keep it from turning brown. Refrigerate until ready to serve and add the cilantro garnish right before serving.)

With its hearty texture, rich brown hues, and a dash of sherry, this vegetarian mush- room pâté is much more than a passable substitute for the regular pork and liver versions. Instead, cashews are added as a source of oils. This pâté is such a winner that I experimented thinning it with a little white wine and making it into a pestolike pasta sauce, served with penne. It worked!

1 In a large, heavy skillet over medium heat, heat 4 tablespoons of the oil and add the shallots, garlic, and mushrooms. Cook until the mixture begins to brown and all the liquid evaporates, stirring frequently, 15 to 20 minutes, depending on the moisture content of the mushrooms. Remove the skillet from the heat.

2 In a food processor fitted with a metal blade, chop the cashews until they have a fine texture. Add the remaining 1 tablespoon oil and continue to process to make a coarse paste.

3 Add the mushroom mixture, basil, parsley, and sherry. Pulse the processor on and off until the pâté has a coarse texture. Season to taste with the salt and pepper.

4 Transfer the mushroom pâté to a small ceramic loaf pan, or a bowl lined with plastic wrap so you can easily pop out the pâté. Cover and chill 4 hours. Serve in the loaf pan, or turn the pâté out of the bowl and garnish with sprigs of parsley. Enjoy on crostini.

Read More

Identifying Meds That Raise Cholesterol: Finding the facts on hormones and HDLs, Discovering how diuretics affect blood fats, Protecting statins and Naming the problems with vasoconstrictors.

Identifying Meds That Raise Cholesterol

In This Chapter

� Finding the facts on hormones and HDLs

� Discovering how diuretics affect blood fats

� Protecting statins

� Naming the problems with vasoconstrictors

Believe it or not, several common medications, such as diuretics (also known as water pills), work like a dream to cure or alleviate conditions they were designed to treat, such as swelling caused by water retention, but may send your “bad” cholesterol up, your “good” cholesterol down, and your triglycerides heaven- knows-where (see the section “Lowering Fluids with Diuretics” later in this chapter).

The following sections make up a representative list of medicines that may alter your cholesterol levels, sending some kinds of cholesterol up and others down. But hey, forewarned is forearmed.

Hankering for Hormones

In the past few decades, hormone products have become part of everyday life. The female sex hormones estrogen and progesterone are used for birth control, “morning after” pills, and postmenopausal hormone replacement therapy. Some athletes skirt the law by using steroids (male hormones) to build muscles. In each case, the use of hormones, like the ones listed in this section, can have unexpected effects on cholesterol levels.

Birth control pills

The most popular oral contraceptives (OCs) are a combination of the female hormones estrogen and progestin (a synthetic form of progesterone, the second female sex hormone). The less effective and thus less frequently used “mini- pill” is plain progestin.

Estrogen seems to be the more cholesterol-friendly female hormone. Estrogen lowers total cholesterol and boosts HDLs, the “good” cholesterol. But higher doses of progestins lower HDLs. You can read all about it for yourself in this quote from the package insert that comes with all OCs sold in the United States:

A positive association has been observed between the amount of estrogen and progestogen [another way to say “progestin”] in oral contraceptives and the risk of vascular disease. A decline in serum high-density lipoproteins had been reported with many progestational agents. Estrogens increase HDL cholesterol. The net effect of oral contraceptives depends on a balance achieved between doses of estrogen and progestogen. Most scientists now believe that the reason women on hormone replacement therapy had a higher incidence of heart attacks is because the therapy stimulates the clot- ting system, and since the first event in a heart attack is a clot forming in the coronary arteries, that is the reason for the increased number of heart attacks and not the effects of cholesterol.

Hormone replacement therapy (HRT)

Now that researchers have proven the link between HRT and a higher risk of breast cancer and disproved the assumption that taking hormones after menopause lowers a woman’s risk of heart disease, fewer women are using these pills.

For those who do — or for those women who take estrogen for a few weeks or months after a surgical menopause (translation: total hysterectomy that removes both the uterus and the ovaries) — I want to point out that estrogen does increase levels of HDLs. Wait. I already said that in the preceding section.

Table 13-1 lists the words used for “estrogen” or “progestin” on the labels for birth control pills and postmenopausal hormone-therapy products.

Muscle builders

The male sex hormone testosterone promotes muscle mass, which is why the average man has bigger biceps than the average woman.

In medicine, anabolic androgenic steroids (muscle-building, testosterone-like compounds) are used legally to treat the results of abnormally low levels of testosterone, such as delayed male puberty, some forms of impotence, and the wasting of lean muscle mass associated with certain illnesses — AIDS being one of them.

Although these meds are banned from all legitimate athletic competition, some athletes use them secretly in an attempt to enhance performance. In the long run, it’s a losing game. According to the National Institute on Drug Abuse (www.nida.nih.gov), steroid abuse — using the drugs to build muscles for athletic competition — comes with a full complement of horrible side effects, including liver tumors; liver cancer; yellowish pigmentation of skin, tissues, and body fluids; high blood pressure; kidney tumors; severe acne; trembling; shrunken testicles; infertility; increased risk of prostate cancer; male pattern baldness (in men and women) . . . no, no, I can’t go on. This book is called Controlling Cholesterol For Dummies, not Steroids For Dummies, so I have to stick with the main event: Taking anabolic androgenic steroids raises LDLs and lowers HDLs. No gold medal there, guys.

Lowering Fluids with Diuretics

Diuretics are drugs that make you urinate more frequently, eliminating excess fluids from your body tissues. Some ingredients, such as caffeine, in over-the- counter (OTC) products have a diuretic effect, but the most effective diuretics are the ones available only by prescription.

Common prescription diuretics

Prescription diuretics may be either single ingredient products or combination products. The active ingredient in a single ingredient prescription diuretic is most commonly either furosemide, spironolactone, or a member of the thiazide drug family. Table 13-2 lists some well-known single ingredient prescription diuretics.

The primary active ingredient in combination diuretic products is commonly a thiazide diuretic. The second active ingredient varies according to what the drug is designed to accomplish. This is done because diuretics make most blood-pressure-lowering drugs work better. For example:

� The active ingredients in Aldochlor are a thiazide diuretic (chlorothiazide) and methyldopa, a drug that lowers blood pressure by relaxing blood vessels.

� The active ingredients in Aldactazide are a thiazide diuretic (hydrochlorothiazide) and spironolactone, a drug that reduces the amount of the mineral potassium lost when you take a diuretic and urinate a lot (yes, your body eliminates potassium through urinating).

� The active ingredients in Lopressor HCT are a thiazide diuretic (hyrochlorothiazide) and metroprolol tartrate, a drug that helps control the rapidity and force of your heartbeat.

Diuretics and cholesterol levels

Taking either a thiazide or furosemide diuretic raises total cholesterol levels and levels of triglyerides (another blood fat described in Chapter 2). The increase, however, is believed to be small enough that it doesn’t increase the risk of heart disease. Because diuretics are so valuable for controlling high blood pressure, your doctor can work with you to establish a diet that helps control your cholesterol while allowing you to continue taking the water pills.

Any medicine, prescription or over-the-counter, that causes you to lose too much water can have serious effects, like causing you to collapse from dehydration. That’s why you should never use diuretics without the knowledge or consent of your own personal physician.

Sabotaging Cholesterol Therapy

Your cholesterol is on the high side, so your doctor prescribes a cholesterol- lowering statin drug, such as atorvastatin (Lipitor), pravastatin (Pravachol), or simvastatin (Zocor), or a statin combo drug, such as Vytorin. You take the pills right on schedule, but when your doctor tests your blood, your cholesterol level hasn’t gone down. Why? One possibility is that you’re taking a second medication that makes your statin less effective. Gee. Sometimes you can’t win for losing.

Considering interactions between cholesterol and meds, I thought it important to mention statin interactions. But for more on how the other meds you take can affect a statin’s ability to control your cholesterol, turn back to Chapter 12, which has absolutely everything you need to know about statins and other cholesterol-lowering drugs, including these pesky drug/drug interactions.

Narrowing Your Options

Having high cholesterol is risky because cholesterol particles in your blood- stream may snag on artery walls, catch other particles floating by, and build plaque deposits that block the artery, stop the normal flow of blood to your heart, and trigger a heart attack. Given this set of facts, you can understand why medicines that further narrow the blood vessels may be problematic for someone with high cholesterol or known coronary artery disease.

Drugs that make blood vessels constrict (narrow down) are called vasoconstrictors. Drugs that make blood vessels dilate (open wider) are called vasodilators. Vasoconstrictors raise your blood pressure and vasodilators lower it.

Vasoconstrictors are used in both prescription and OTC medicines, as you can see here:

� An example of a prescription vasoconstrictor product is the Epipen, a device that enables the patient to inject a dose of epinephrine.

� An example of an OTC vasoconstrictor product is a cold remedy, cough medicine, or anti-asthma product in which the vasoconstrictor functions as a decongestant, an ingredient that helps shrink swollen tissues in your nose and throat. Hemorrhoid relief products may also contain vasoconstrictors, but you apply them to your skin, so they’re less likely to be problematic.

By the way, if you’re still smoking, you should know that nicotine is a vasoconstrictor. For more about smoking and your cholesterol, check out Chapter 9.

Right now, take a look at Table 13-3, which contains a list of common decongestant ingredients from the Physicians’ Desk Reference 2001. All these ingredients are vasoconstrictors, so if you have high cholesterol, you want to ask your doctor before using these products.

Getting the Last Word

Every drug can be valuable — heck, even lifesaving — when prescribed for the condition it’s intended to treat and for a patient whose body tolerates the medicine. On the other hand, every drug has side effects. And sometimes a drug that works for one person is ineffective or downright dangerous for another person.

The trick is to maximize the benefits and minimize the risks. In other words, try to knock off the illness or medical condition without harming the patient. Doing that requires you and your doctor to work together. She by doing her homework so she knows what may go wrong; you by taking your meds as directed and reporting any problems immediately. And each of you needs to listen to one another. It’s a hard job, but you can do it. So do it.

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