Cholesterol treatment guideline

The new Cholesterol guideline was published in November and is the result of a joint task force of the American College of Cardiology and the American Heart Association. The report was published in the journal Circulation.

Cholesterol moleculeFirst, a couple of caveats: Dietary supplements by law cannot claim to treat or prevent any illness. So to some degree, it makes sense that clinicians would not turn to them first to help patients who already have high cholesterol. Also, it should be noted that the guideline would be aimed first and foremost at specialists, who likely would be consulted only after a patient has been referred with a treatable condition.

Paucity of information on Cholesterol prevention

Nevertheless, it is telling that so little effort is spent in the guideline on discussing how to help patients to keep from crossing over the line into the treatment category, rather than spending page after page on how to fix the boat after it has sprung a leak. In the 120-page document, which includes 69 pages of actual text, only two short sections were devoted to lifestyle factors in the prevention of development of hyperlipidemia.

“Patients should consume a dietary pattern that emphasizes intake of vegetables, fruits, whole grains, legumes, healthy protein sources (low-fat dairy products, low-fat poultry (without the skin), fish/seafood, and nuts), and nontropical vegetable oils; and limits intake of sweets, sugar-sweetened beverages, and red meats,” the guideline states.

One other section of the guideline addresses prevention specifically.

“Primary prevention of ASCVD over the life span requires attention to prevention or management of ASCVD risk factors beginning early in life,” the guideline states. It then refers the reader to a table that includes one statement about encouraging a healthy lifestyle and then devotes the rest of the information on statin therapy, starting as early as age 8.

Lipid ingredients, polyphenols shown to have effects

A number of dietary ingredients have been researched for their positive effects on blood lipid profiles including lipid ingredients and many plants and fruit extracts rich in phytochemicals.

Omega-3s, for example, have been shown to have positive effects on high triglyceride levels, but the effects on LDL cholesterol specifically are less clear-cut. Levels can actually increase slightly, but the size of the LDL particles changes as well, which is a good thing. And HDL (the “good” cholesterol) goes up, too, indicating a generally positive overall trend.

Extra virgin olive oil, which is rich is some polyphenolic compounds such as hydroxytyrosol, has been suggested to benefit blood lipid profiles via a multifaceted action that includes both anti-inflammatory aspects and the promotion of cholesterol efflux. Olive is, of course, one of the main components of the Mediterranean diet, which is frequently recommended for heart health.

Drug hits one target –  supplements hit many

But this multifactorial approach doesn’t fit neatly into the mostly drug-focused paradigm of the new guideline, said James Kennedy, Ph.D. president of ingredient supplier Polyphenolics, which has a line of grape seed extracts which are among the more comprehensively researched polyphenol-based ingredients on the market.

“There is no question that statins can dramatically reduce your blood cholesterol levels,” Kennedy told NutraIngredients-USA. “They absolutely can reduce cholesterol much further than any polyphenol from a fruit or vegetable.”

“But for me it’s about lifestyle first. It just struck me as odd that here is a group concerned about our heart health and they were pretty much exclusively recommending drugs,” he said.

Kennedy said that cardiovascular disease is a multifaceted condition. Statins target one aspect of this situation and hits that nail squarely on the head. But natural ingredients, perhaps especially when offered in combination, take a more comprehensive approach to the problem.

Polyphenolics offers a line of grape seed extracts that includes MegaNatural BP, which has been researched for its effect on supporting blood pressure in the healthy range. That effect takes into account the healthy flow dynamics of the circulatory system, something that a myopic focus on cholesterol numbers glosses over.

Evidence backing many polyphenols

Grape seed extracts are just one of many polyphenol-based ingredients on the market that have been researched for their benefits in ameliorating the risk factors of CVD.

grapes are recommended in low cholesterol diets

“If you look at cardiovascular disease as a whole, a lot of polyphenols – and grape seed extract in particular – address the various areas including blood pressure and blood glucose as well as hypercholesteremia. Our industry offers a food-first approach which makes sense to consumers. They look at supplementation as a complement to everything else they are doing to address all aspects of heart disease, not just one piece of it” Kennedy said.

The entourage effect implied by the research backing polyphenols (they all appear to do slightly different things) is now starting to be borne out by research. A recent study in the journal Nutrients showed that just two weeks on a polyphenol-poor diet could alter vascular biomarkers in a group of healthy men.

And a recent review article in the journal Molecules had this to say: “Consumption of polyphenols from plant extracts and fruits increases antioxidant levels in plasma which protect vasculature and improve anti-inflammatory and lipid profiles, blood pressure, HDL-C, and vascular function.”  The review focuses on a number of polyphenols and other naturally occurring compounds, including gallic acid and punicalagin from pomegranate.

Combo products increasing in popularity

Kennedy said there is increasing interest among supplement product formulators in taking advantage of the evidence supporting the multifactorial effects of polyphenols.

“We do come into contact with customers who say they want to put together a heart health formula and want to know what they can combine our grape seed extract with,” he said.

“Recently we had a customer who wanted to combine our grape seed extract with a blueberry extract and a bergamot extract. When you go into the store you frequently see our extract in formulation with other ingredients,” Kennedy said.

The beauty of the natural approach to heart health is these ingredients can be combined with virtually no concern about antagonistic interactions, Kennedy said. Polyphenolics has continually worked on its GRAS dossier, with higher and higher dosages proven to be safe, he said.

“For the most part these are natural products and they are not known to have any cross indications. With statins, you have to dial the dose in and the patient has to be monitored very carefully.”

 

Body Mass Index Measurement

This post deals with measuring Body Mass Index (BMI) for adults, children, and teens. Body mass index, or BMI, is a measure of body size. It combines a person’s weight with their height. The results of a BMI measurement can give an idea about whether a person has the correct weight for their height. 

BMI (Body Mass Index) is a screening tool that can indicate whether a person is underweight or if they have a healthy weight, excess weight, or obesity. If a person’s Body Mass Index is outside of the healthy range, their health risks may increase significantly.

Carrying too much weight can lead to a variety of health conditions, such as type 2 diabetes, high blood pressure, and cardiovascular problems.  In a previous post, we offered five simple exercises which can help a person achieve some of their weight goals.

A weigh that is too low can increase the risk of malnutrition, osteoporosis, and anemia. The doctor will make suitable recommendations.

Body Mass Index does not measure body fat directly, and it does not account for age, sex, ethnicity, or muscle mass in adults.

However, it uses standard weight status categories that can help doctors to track weight status across populations and identify potential issues in individuals.

BMI (Body Mass Index) in adults

Body Mass Index calculator shows healthy weight
A BMI chart or calculator can show a person if they have a healthy weight.

Calculating BMI involves measuring a person’s height and body weight.

 

Metric

  • To calculate BMI in metric units, use the following method: BMI = kg/m2
  • So, to calculate an adult’s BMI: Divide their weight in kilograms (kg) by the square of their height in meters (m2)

Since most people measure height in centimeters (cm), divide height in cm by 100 to get height in meters.

Imperial

  • When using imperial units, the formula is: BMI = lbs x 703/in2
  • In other words: Multiply a person’s weight in pounds (lbs) by 703. Then divide by their height in inches, squared (in2)

To avoid using the math, a person can use a calculator or a chart to find their BMI.

BMI calculator

Enter height or weight in either imperial or metric measurements to find your BMI.

1) Metric BMI Calculator

2) Imperial BMI Calculator

BMI charts

People can also work out their BMI using a chart. Click here to see a chart provided by the National Heart, Lung, and Blood Institute (NHLBI).

Locate your height in inches on the side of the chart, then look across to find your body weight in pounds. Scan to the top to see if the result corresponds to a normal weight, overweight, or obesity.

Understanding the results

The following table shows the standard weight status categories associated with BMI ranges for adults.

BMI Weight status
Below 18.5 Underweight
18.5–24.9 Healthy
25.0–29.9 Overweight
30.0 and above Obese

BMI of less than 18.5

A BMI of less than 18.5 indicates that you are underweight, so you may need to put on some weight. You are recommended to ask your doctor or a dietitian for advice.

BMI of 18.5–24.9

A BMI of 18.5-24.9 indicates that you are at a healthy weight for your height. By maintaining a healthy weight, you lower your risk of developing serious health problems.

BMI of 25–29.9

A BMI of 25-29.9 indicates that you are slightly overweight. You may be advised to lose some weight for health reasons. You are recommended to talk to your doctor or a dietitian for advice.

BMI of over 30

A BMI of over 30 indicates that you are heavily overweight. Your health may be at risk if you do not lose weight. You are recommended to talk to your doctor or a dietitian for advice.

BMI in children and teens

In adults, BMI values are not linked to age and are the same for both sexes.

However, measuring Body Mass Index in children and teens is slightly different. Girls and boys develop at different rates and have different amounts of body fat at different ages. For this reason, BMI measurements during childhood and adolescence take age and sex into consideration.

Doctors and other health professionals do not categorize children by healthy weight ranges because:

  • they change with each month of age
  • male and female body types change at different rates
  • they change as the child grows taller

Doctors calculate BMI for children and teens in the same way as they do for adults, by measuring height and weight. Then they locate the BMI number and person’s age on a sex-specific BMI-for-age chart. This will indicate whether the child is within a healthy range.

Calculator and charts for child and teen Body Mass Index

The Centers for Disease Control and Prevention (CDC) have produced a calculator that provides BMI and the corresponding BMI-for-age percentile on a CDC growth chart for children and teens.

First, click here for the calculator.

Next, use the charts to see if a child’s weight is suitable for their age.

Click here for the charts:

What do the results mean?

The following categories explain the meaning of the results:

Weight status category Percentile range
Underweight Below the 5th percentile
Healthy weight 5th percentile to less than the 85th percentile
Overweight 85th to less than the 95th percentile
Obesity Equal to or greater than the 95th percentile

How doctors use BMI

BMI is not accurate enough to use as a diagnostic tool, but it can screen for potential weight problems in adults and children.

If someone has a high or low BMI, a doctor or other healthcare professional might then consider other factors, such as:

  • skinfold thickness measurements, which indicate how much fat is in the body in adults and children
  • evaluations of diet and physical activity
  • discuss any family history of cardiovascular disease and other health problems
  • recommend other appropriate health screenings

The doctor or healthcare professional can then make diet and exercise recommendations based on these results.

Health risks of extra weight

Excess weight has the following effects on the body:

  • It increases how hard the heart has to work.
  • It raises blood pressure, blood cholesterol and triglyceride levels.
  • It lowers high-density lipoprotein (HDL), or good cholesterol levels.
  • It can make diabetes and other health problems more likely.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), carrying extra weight can increase the risk of the following conditions:

  • hypertension, or high blood pressure
  • dyslipidemia, which involves high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides
  • type 2 diabetes
  • coronary heart disease
  • stroke
  • gallbladder disease
  • osteoarthritis
  • sleep apnea and respiratory problems
  • some cancers, including endometrial, breast and colon cancer

Carrying extra weight as a child or teenager can also pose significant health risks, both during childhood and into adulthood.

As with adult obesity, childhood obesity increases the risk of various health problems, including cardiovascular disease, diabetes, and sleep apnea.

The American Heart Association (AHA), point out that children with a high BMI also have a higher risk of:

Benefits of a healthy weight

Walking with the family helps Body Mass Index levels
Walking with family or friends can be an enjoyable way of keeping fit and preventing unwanted weight gain.

Apart from reducing the risk of the health conditions, maintaining a healthy weight offers additional benefits:

  • fewer joint and muscle pains
  • increased energy and ability to join in more activities
  • improved regulation of bodily fluids and blood pressure
  • reduced burden on the heart and circulatory system
  • improved sleep patterns

Other measures of a healthy body

BMI is a useful tool, but it cannot identify whether a person’s weight is made up of muscle or fat.

For example, an athlete with a lot of muscle tissue may have a higher BMI than a person who is not very active. But, this does not mean that the athlete is overweight or unhealthy.

In addition, cardiovascular disease and high blood pressure are more likely to occur in people who have additional fat — known as visceral fat — around their middle rather than their hips.

Other measures of body size include waist-hip ratio, waist-to-height ratio, and body composition, which measures body fat and lean body mass. These measurement systems focus more on the amount of fat a person has and its distribution around the body.

Together with BMI, these additional measures can help to assess more accurately the health risks associated with an individual’s weight.

Takeaway

Body Mass Index can be a useful screening tool for predicting certain health risks. However, people should use it with caution, as it does not take other factors — such as activity levels and body composition — into account.

For children and teens, it is important to include their age and sex when taking a BMI measurement, because their bodies continuously change as they develop.