Health & Other Matters Of The Heart

"The poor Filipino diet of vegetables and rice is healthier than that of the rich," says Dr. Manuel ChauChiaco, Jr., also known as Dr. Chuck, a cardio-vascular surgeon and chief of surgery at the Philippine Heart Center. This is perhaps the one and only advantage that 40 percent of the population who live on less than P100 per day have over their rich compatriots.

"Our dishes contain junk—cheeks, ears, spleens, kidneys, lungs, brains, and blood—all very high in cholesterol," Dr. Chuck goes on to say. And when you combine that with the trans fats and saturated fats in fast, processed, and other junk foods, plus the all of the calories, the outcome is lethal.

 

Heart and vascular system diseases have consistently ranked as #1 and #2 causes of death since 1996, according the Department of Health. This is up from #7 for heart ailments from1966 to 1970.

In 1975, the year of its inauguration, the Philippine Heart Center performed four by-pass operations. In 2005, that number rose to 662. Dr. Chuck alone does close to 200 by-pass operations annually. One operation was on his father, a cardiologist, who was 79 years old at the time.

High cholesterol is just one of a number of factors that lead to heart disease. But it is perhaps the most easily controlled among the primary causes—which include age, family history of heart disease, high blood pressure (hypertension), diabetes, smoking, obesity, and high cholesterol. And the way to manage it, even if you are taking cholesterol-lowering medications such as Lipitor, is through diet and exercise.

Lipitor is readily available in the Philippines, but very expensive. Ten milligrams cost P75, and the average dose is between 10 and 40 mg per day. A patient can spend up to P300 daily on Lipitor alone, not counting other medications for hypertension and diabetes, both prevalent diseases.

Many people treat Liptior as a hang-over drug, fooling themselves into thinking they can have their lechon or balut tonight, and double their dose of Lipitor in the morning. Cholesterol-lowering medications are not a free ticket to pig out. Even people taking medications need to follow a heart-healthy diet and exercise.

"People think that drugs alone solve the problem," says Dr. Chuck.

What is cholesterol? Basically, cholesterol is a fat-like substance in your blood used for producing cell membranes and some hormones. Your liver produces some cholesterol and the rest comes from the food you eat.

Cholesterol and other fats are not dissolved in your blood. They are transported throughout your body by lipoproteins. LDL (low-density lipoprotein) is the bad, artery-clogging, atherosclerosis-producing cholesterol. That level should be under 100 mg/dL (milligrams per deciliter). HDL (high-density lipoprotein) is the good, cardio-protective cholesterol which carries cholesterol away from your artery walls. This level should be high, ideally 60 mg/dL and above. Your combined LDL and HDL cholesterol level should be less than 200 mg/dL.

I ask Dr. Chuck if most Filipinos get their cholesterol levels checked. "No, it’s too expensive. Only people with health insurance do," he says. But you don’t need numbers to start following a heart-healthy diet and lifestyle that includes exercise.

Your daily cholesterol intake should not exceed 200 milligrams. All animal products—including meat, poultry, fish, shellfish, dairy products, and eggs—contain cholesterol. Vegetables, fruits, and grains do not. Following these basic rules will lower your bad cholesterol and raise your good. But bear in mind that levels require three to four months to change, so don’t expect immediate results.

Balance out what you eat during the day. For instance, eggs and shrimp are high in cholesterol (one egg contains 212 mg of cholesterol, and 3 ounces of shrimp has 166 mg) but they are good sources of protein and vitamins, and contain very little fat. Therefore, an egg in the morning or shrimp at lunch is okay, but you should avoid cholesterol-laden foods for the rest of the day. The same applies to innards, which are extremely high in cholesterol. If dinuguan or kare-kare is lunch, eat only rice and vegetables, or a salad for dinner.

Ideally, a heart healthy diet applies to the whole family, including children over the age of two years. "Vascular diseases can start young," says Dr. Chuck. "Once, during a kidney transplant, we harvested the kidney of a thirteen-year-old girl and there were already cholesterol plaques in her renal arteries."

Women need to be especially vigilant about their heart health. More and more women are developing heart disease and dying from it, currently at twice the rate of men following the first three years of a heart attack. Post-menopausal women with decreased levels of estrogen are particularly at risk.

"There is no cure for atherosclerosis—it’s a progressive disease," Dr. Chuck tells his patients undergoing by-pass surgery. "Controlling the risk factors to stop the disease where we find it, and not let it get any worse, is the best thing."

The good news is that following a heart-healthy diet, exercising, and reducing stress are proven ways to prevent high cholesterol and to lower it.

To Lower LDL or Bad Cholesterol

• Avoid saturated fats, or fats that are solid at room temperature, such as butter, stick margarines, lard, and Crisco. Soft margarines from vegetable oils are okay.

• Avoid trans fats, also called partially hydrogenated oils, in processed foods (such as cookies, crackers, and breakfast cereals) and fast foods, particularly deep-fried items. Trans fats trigger your liver to produce more cholesterol.

• Eat heart-healthy unsaturated oils from plant sources, such as canola oil or olive oil. Polyunsaturated oils, including corn, sunflower, safflower, and soybean oils, have been found to lower LDL and total cholesterol levels.

• Eat more fiber. Aim for 25 grams of soluble fiber (from oatmeal, whole wheat bread, and brown rice) per day. Soluble fiber reduces LDL. Insoluble fiber in fruits and vegetables is essential for good health though it does not have the same cholesterol-reducing effects. Folic acid, found in leafy green vegetables, asparagus, spinach, mongo beans, and citrus fruits, is particularly good for your heart.

• Eat little or no high-cholesterol red meats and avoid all innards. High-protein tofu and beans are excellent substitutes for meat and poultry. To Increase HDL or Good Cholesterol

• Consume fish high in omega-3 fatty acids (salmon, albacore tuna, mackerel, trout, and shrimp) which can boost HDL.

• Lose weight gradually and consistently by reducing calories and increasing exercise. For every 10 pounds of weight lost, HDL rises 2 mg/dL on average, according to one analysis.

• Exercise for 30 minutes a day to reduce cholesterol, and 60 minutes for weight loss. Exercise has been shown to boost HDL modestly.

• Quit smoking. Smoking lowers HDL.

• If you drink, consider one drink a day. Alcohol can raise HDL.

Ms. Jones is the author of "Eating for Lower Cholesterol: A Balanced Approach to Heart Health with Recipes Everyone Will Love" available at National Book Store. She currently lives in Manila.