Understanding Parkinson’s Disease

Understanding Parkinson’s Disease is about understanding our brain. We rely on our brains for every movement we make, whether writing, walking, talking, or even sleeping. But a serious brain disorder like Parkinson’s disease can rob a person of the ability to do everyday tasks that many of us take for granted. There’s no cure, but treatment can help. And researchers continue to seek new understanding to improve medical care. Continue reading “Understanding Parkinson’s Disease”

Managing Migraine Headaches

Migraine Management on PhilipsburgPharmacy.com

Almost 10% of the population and three times more women than men suffer from migraine headaches. Although any head pain can be miserable, a migraine headache is often disabling. It is believed that even 50% of migraines are not diagnosed or mislabeled as tension or sinus-headache (which is rare according to experts).  In some cases, migraines are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine headache is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.  When left untreated, a migraine headache typically lasts from four to 72 hours, but the frequency with which they occur can vary from person to person. You may have migraines several times a month or just once a year.

Fortunately, management of migraine headache pain has improved dramatically in the last decade. If you’ve seen a doctor in the past and had no success, it’s time to make another appointment. Although there’s still no cure, specific life style adjustments and medications can help reduce the frequency of migraine headaches and stop the pain once it has started.  Most important: You are the manager of your life and need to communicate with your doctor how to keep the migraine under control.  If you ask your doctor about help with migraine and his answer is handing over a prescription, please look for another doctor. Initially medications may help, but without the right knowledge in using them they could quickly become counter effective.

Migraine headache symptoms in children

Migraines typically begin in childhood, adolescence or early adulthood and may become less frequent and intense as you grow older. Children as young as age 1 can have these headaches. In addition to physical suffering, severe headaches often mean missed school days and trips to the emergency room, as well as lost work time for anxious parents.
Children’s migraines tend to last for a shorter time. But the pain can be disabling and can be accompanied by nausea, vomiting, lightheadedness and increased sensitivity to light. A migraine headache tends to occur on both sides of the head in children, and visual auras are rare. However, children often have premonition signs and symptoms, such as:
·    Yawning
·    Sleepiness or listlessness
·    A craving for foods such as chocolate, hot dogs, sugary snacks, yogurt and bananas

Migraine headache triggers.
Migraine is a genetic neurological disease affecting the bloodvessels in the brain. Whatever the exact mechanism of migraines is, a number of things may trigger them. Common migraine headache triggers include:
·    Hormonal changes. Fluctuations in estrogen and progesterone seem to trigger headaches in many women with migraine headaches. Women with a history of migraines often have reported headaches immediately before or during their periods.  Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines but sometimes also give relief.
·    Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; caffeine; monosodium glutamate — a key ingredient in some Asian foods. Skipping meals or fasting also can trigger migraines.
·    Stress. A period of hard work followed by relaxation may lead to a weekend migraine headache. Stress at work or home also can instigate migraines.
·    Sensory stimulus. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner, secondhand smoke and my co-workers armpit.
·    Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in sleep patterns — including too much or too little sleep — often  initiate a migraine headache.  It is important for migraineurs to keep a steady daily rhythm
Triggers may not inevitably lead to migraine, often more triggers are needed to offset the brain i.e. lack of sleep, dehydration and alcohol. Although sensitive people might get migraine every time they drink a glass of red wine .Migraine Food Triggers on Philipsburg Pharmacy

Management and Medical  Advice

Migraines are a chronic disorder, but they’re often undiagnosed and untreated, often waived as incidental headaches.  If you experience signs and symptoms of migraine, track and record your attacks and how you treated them including (or especially) the over the counter medication you took. Then make an appointment with your doctor to discuss your migraines and decide on a treatment plan.

·    If you don’t have a treatment plan when a migraine headache strikes, try over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) or  paracetamol, or other self-care measures for a day or two. Keep in mind that soluble formulations in a high starting dose often work the best and can be combined with i.e. domperidon or metoclopramide to promote absorption if the migraine is accompanied with  nausea . If you don’t get relief, see your doctor.

Complications

Sometimes your efforts to control your pain cause problems. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause side effects such as abdominal pain, bleeding and ulcers, especially if taken in large doses or for a long period of time.
In addition, if you take over-the-counter (OTC) or prescription headache medications more than two or three times a week or in excessive amounts, you may be setting yourself up for a serious complication known as rebound headaches. Although these drugs can give you temporary relief, they not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle. If you’re caught in the rebound headache trap, talk to your doctor.

Treatment

At one time, aspirin was almost the only available treatment for headaches. Now there are drugs specifically designed to treat migraines. Several drugs commonly used to treat other conditions also may help relieve migraines in some people. All of these medications fall into two classes:

·    Pain-relieving medications. These stop pain once it has started.
·    Preventive medications. These reduce or prevent a migraine headache.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:

·    Nonsteroidal anti-inflammatory drugs (NSAIDs).  (Ibuprofen, Naproxen, Diclofenac, others) may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren’t effective alone for severe migraines.  Combination drugs are suspected to have a higher incidence of initiating medication induced (rebound) headache.

·    Triptans. Sumatriptan (Imigran) was the first drug specifically developed to treat migraines. It mimics the action of serotonin by binding to serotonin receptors and causing blood vessels to constrict. Sumatriptan is available in oral, nasal and injection form. Injected sumatriptan works faster than any other migraine-specific medication — in as little as 15 minutes — and is effective in most cases. A number of similar drugs have become available, including rizatriptan (Maxalt),  zolmitriptan (Zomig) and eletriptan (Relpax). Experience has shown that sometimes people have to try 3-5 different triptans before they find the one that suits them best. A look at the different durations of effect and relative strengths might be helpfull. Dispersable tablets (wafers) do not have a quicker onset of effect or additional advantage with nausea. In fact the highest concentration in the blood is reached even at a later time then with conventional tablets. Taking triptans during the aura has no effect and might reduce the effect due to earlier elimination. Taking them when the pain becomes unbearable has no use either, they will not work anymore.

·    Ergots. Drugs such as ergotamine (cafergot) and dihydroergotamine help relieve pain. Due to the fact they have more side effects than triptans, they are less prescribed and reserved when the patient is resistant to other drug therapies. Most used is DHE as injectable.

·    Medications for nausea. Metoclopramide (Primperan) or domperidon are useful for relieving the nausea and vomiting associated with migraines, not the migraine pain itself. It also improves gastric emptying, which leads to better absorption and more rapid action of many oral drugs. It’s most effective when taken early in the course of your migraine or even during the aura before your headache begins.
Morfine like medications like vicodin, oxycodone etc. are very effective painkillers as long as they last. Due to their highly addictive properties, drug dependency  and weaning of effect they should be avoided for treatment of headaches.

Preventive medications

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of pain-relieving medicines used during migraine attacks. In most cases, preventive medications don’t eliminate headaches completely, and some can have serious side effects. They are considered an option with more than 2 attacks per month.

·    Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers and certain RAAS drugs (atacand) are also used. Consider these medication as choice if you suffer from high bloodpressure as well.

·    Antidepressants. Certain antidepressants are good at helping prevent several  types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, taken in low dosage at night) Newer antidepressants (SRNI’s), however, generally aren’t as effective for migraine prevention. Effect has been measured with ie venlafaxine. In some people these drugs may cause headaches.

·    Anti-seizure drugs. Some anti-seizure drugs, such as valproic acid (Depakin) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. They might stabilize the nerve cells that trigger migraines.

·    Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
Preventive medications are normally tried when suffering more then 2 x monthly from migraines. It may take 3 month of slowly increasing dosage before the effect can be evaluated.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

·    Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, try to establish a daily routine with regular sleep patterns and regular meals. 
To detect triggers it is important to keep a daily diary in which you keep note of daily life events and medications taken and effect on possible migraine as well. Most smartphones have apps for migraine diaries.

·    Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.

·    Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, or if you have a family history of stroke or high blood pressure, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Women that experience migraines during the stopweek might consider continuous  treatment. Talk with your doctor about the best alternatives or dosages for you.

·    Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make headaches worse.

·    Supplements to consider.  Additional Vitamin B2 (riboflavin) Magnesium and CoQ10 , have shown effect in several studies

·    Relaxation techniques, massage, physical therapy, yoga etc. can all have a beneficial effect.

Summarizing.

A Diary is important to evaluate if you use your medication the right way.  The right time, dosage form, rate of effectiveness and if you are not using to much or maybe to less. It is also important to identify possible triggers for the migraine. A 2 month period of recording would give your doctor (and yourself) a good assessment tool.

Lifestyle is important, taking the right medications is also important. Worrying on dietary triggers is less important. 
It will probably take several months to get the combinations right of type and dosage. This may count for preventive and relieve medication.

Keep in mind to limit the amount of painkillers and triptans to 2-3 days per week. If not you might see a tendency of increase in the frequency of headaches and related an increase in medicine consumption and before you know it you are in a vicious circle of medication dependent headaches. You can always improve !  Do not hesitate to ask for help.

When the Heart gets Tired

Your Heart

Local St. Marten health professionals received an update on hypertension statistics and were made aware of an interesting statistic: the prevalence of  heart attack rate is lower and heart failure rate is higher in comparison to people with hypertension and coronary disease in Holland or the USA.  Lifestyle and genes might have a relation.

All of us lose some blood-pumping ability in our hearts as we age. But the more serious loss that we call heart failure results from the added stress of health conditions that either damage the heart or make it continuously work too hard. In fact, all of the behaviors that you probably associate with heart disease or heart attack — such as having high blood pressure, smoking, being overweight, eating foods high in fat and cholesterol, not exercising and having diabetes — can also cause heart failure. In some cases people who develop heart failure were born with structural heart defects, while in others a virus damaged the heart muscle.

Compensatory Mechanisms

The body has several mechanisms to compensate for heart failure. The body’s first response to duress and strain, including that due to heart failure, is to release the fight-or-flight hormones,  like epinefrin (adrenalin). These hormones cause the heart to pump faster and more forcefully. They help the heart increase the amount of blood pumped out (cardiac output), sometimes to a normal circulating amount of blood required, and thus help compensate partially and temporarily for the heart’s impaired pumping ability.

People who do not have heart disease usually benefit from release of these hormones when more work is temporarily required of the heart. However, for people who have chronic heart failure, this response results in increased demands on an already damaged heart. Over time, the increased demands lead to further deterioration of heart function.

Another of the body’s main compensatory mechanisms for heart failure is to decrease the amount of salt and water excreted by the kidneys. Retaining salt and water instead of excreting it into urine increases the volume of blood in the bloodstream and helps maintain blood pressure. The larger volume of blood also stretches the heart muscle, enlarging the heart chambers, particularly the ventricles, which pump blood out of the heart.

The more the heart muscle is stretched, the more forcefully it contracts. At first, this mechanism improves heart function, but at some point, stretching no longer helps but instead weakens the heart’s contractions (like a rubber band being overstretched). Consequently, heart failure worsens.

Another important compensatory mechanism is enlargement of the muscular walls of the ventricles (ventricular hypertrophy). When the heart must work harder, the heart’s walls enlarge and thicken, as biceps muscles enlarge after months of weight training. At first, the thickened heart walls can contract more forcefully. However, the thickened heart walls eventually will become stiff, worsening diastolic dysfunction. Eventually, the contractions become weaker, causing systolic dysfunction.

The more common forms of heart failure — those due to damage that has accumulated over time — can’t be cured. But they can be treated, quite often with improvement in symptoms. We tend to think of treatment as something from our doctors — like a pill or a surgical procedure. That’s not the case with heart failure. Rather, successful treatment depends on your willingness to get involved in managing this condition, whether you’re the one diagnosed or you’re caring for someone who is. The three most important treatment strategies include…

  • Lifestyle changes
  • Medications
  • Surgery

LIFESTYLE CHANGES

Following recommendations about diet, exercise and other habits can help to alleviate symptoms, slow the disease’s progression and improve everyday life. In fact, people with mild to moderate heart failure often can lead nearly normal lives as a result of:

  • Quit smoking
  • Lose weight
  • Avoid alcohol
  • Eat a low-saturated-fat, low-sodium diet
  • Exercise on your own or participate in a structured rehabilitation program
  • Reduce stress

Making these changes is easier said than done. Dealing with new restrictions and responsibilities is challenging, but working these changes into your routine one at a time can make a real difference.

MEDICATIONS

Most people with heart failure take a number of medications that work in different ways. Some help to improve circulation by strengthening the heart muscle’s pumping action or expanding the blood vessels. Others help to reduce the amount of water and sodium in the body, which in turn reduces the heart’s workload..

ACE Inhibitors captopril,  ramipril or lisinopril are most used locally ACE inhibitors (angiotensin-converting-enzyme inhibitors) are now considered first-choice treatment and are the cornerstone of heart failure drug therapy.  ACE inhibitors have been proven to slow the progression of heart failure. They are a type of vasodilator, which are medications that cause the blood vessels to expand, lowering blood pressure and reducing the heart’s workload. ACE inhibitors prevent the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure.
There are some side effects to look out for when taking an ACE inhibitor. Some people develop a persistent cough.

Diuretics (Water Pills)hydrochlorothiazide, furosemide, spironolactone or indapamide are common examples. Diuretics are prescribed for almost all patients who have fluid buildup in the body and swelling in the tissues. A diuretic causes the kidneys to remove more sodium and water from the bloodstream than usual and convert it into urine. This helps to relieve the heart’s workload, since there’s less fluid to pump throughout the body. It also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.

Many people find it best to take diuretics in the morning so trips to the bathroom to urinate happen during the day. Taking diuretics in the evening or at night often results in interrupted sleep, because the urge to empty the bladder continues for hours. Furosemide is a special fast and short acting diuretic which may be taken as well around 4pm to relieve water before bedtime Spironolacton is a mild diuretic but has also a beneficial effect on the heartmuscle.

Vasodilators i.e isosorbide dinitrate, hydralazine , rilmedine
Vasodilators cause the blood vessel walls to widen or relax, allowing blood to flow more easily. We’ve already described one type of vasodilator, called ACE inhibitors. People who can’t tolerate an ACE inhibitor are often prescribed other types of vasodilators  to relieve symptoms and improve their tolerance for exercise.

Nitroglycerin tablets are a type of vasodilator prescribed to ease chest pain. Patients are usually instructed to take one, wait five minutes, and take another if the chest pain is still there. If the chest pain doesn’t go away after  3 pills, they should call an a doctor right away.

Side effects to watch out for include a drop in blood pressure upon sitting or standing, which can cause fainting or dizziness; headaches; flushing; heart palpitations, which feel like the heart is pounding or racing; and nasal congestion.

Digoxin (Lanoxin)
Digoxin increases the force of the heart’s contractions, which can be beneficial in heart failure. This relieves heart failure symptoms, especially when the patient isn’t responding to ACE inhibitors and diuretics. Most people continue taking the drug even after they feel well, to keep the heart working effectively.

Beta Blockers i.e carvedilol  metoprolol , atenolol.
The heart tries to compensate for its weakened pumping action by beating faster, which puts more strain on it. Beta blockers reduce the heart’s tendency to beat faster. The drugs block specific receptors (“beta receptors”). This allows the heart to maintain a slower rate and lowers blood pressure. Beta blockers are used for mild to moderate heart failure and often with other drugs such as diuretics, ACE inhibitors and digoxin.

Angiotensin II Receptor Blockers ie losartan, valsartan, telmisartan ACE inhibitors prevent the formation of  angiotensin II. Rather than lowering levels of angiotensin II , angiotensin II receptor blockers prevent this chemical from having effects on the heart and blood vessels. This keeps blood pressure from rising. Angiotensin II receptor blockers don’t appear to cause any significant side effects.

Calcium Channel Blockers ie amlodipine and nifedipine
Muscles of the heart and blood vessels need calcium to contract. Calcium channel blockers are used to treat the high blood pressure often associated with heart failure, because these drugs interfere with calcium’s role in the contraction of these muscles. This causes the muscles to relax. This lowers blood pressure and can improve the blood circulation in the heart. These medications aren’t used often to treat heart failure.

As with most drugs that improve the blood flow through the body, calcium channel blockers can cause headaches, facial flushing and dizziness. They also can cause ankle swelling. These symptoms generally disappear with continued treatment.

Drugs to be aware off

Anti-inflammatory painkillers (Ibuprofen, Aleve etc.) can give water retention (salt) and vasoconstriction esp. in the kidneys which may increase symptoms of heart failure.  Since these drugs are available without prescription one has to be careful with them.

SURGERY

Surgery is the other treatment option for heart failure. In some cases coronary artery bypass surgery (or a non-surgical procedure known as angioplasty) can ease heart failure symptoms by increasing blood flow to the heart.

The New Cholesterol Guidelines

The New Cholesterol Guidelines

Bringing the Science to your Dinner Table

Cholesterol is a waxy substance produced by the body and found in foods that come from animals. Cholesterol is needed by your body to make hormones, skin oils, digestive juices and vitamin D. You could not live without some cholesterol in your body.

However, too much cholesterol is a major risk factor for heart disease, particularly LDL (low density lipoprotein) cholesterol. LDL causes the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen to your heart.

It is estimated that millions of people are at much greater risk for heart disease than previously realized. This means more and more people will be walking away from their doctor’s office with a cholesterol-lowering drug prescription in hand. Medications aside, the new guidelines also vividly illustrate the growing epidemic of poor dietary habits, obesity, hypertension, hyperlipidemia and sedentary lifestyles that lead to the number one killer in the “Civilised World” today.

Measure your LDL and other blood lipids

Everyone age 20 and older should have their cholesterol checked at least every five years through a blood test. The guidelines recommend you have a complete “lipoprotein profile” that measures total cholesterol, LDL, high-density lipoprotein (HDL, the good cholesterol that may help prevent heart disease), and triglycerides, another type of fat in the blood stream. The test should be performed after fasting.

Low density lipoprotein (LDL) goal values:

  • Less than 70 mg/dL for those with heart or blood vessel disease and for other patients at very high risk of heart disease (those with metabolic syndrome,(obese, diabetes, hypertension)
  • Less than 100 mg/dL for high risk patients (for example: some patients who have diabetes or multiple heart disease risk factors)
  • Less than 130 mg/dL otherwise

Total cholesterol (TC) goal values:

  • 75-169 mg/dL for those age 20 and younger
  • 100-199 mg/dL for those over age 21

High density lipoprotein (HDL) goal value:

  • Greater than 45 mg/dl (the higher the better)

Triglyceride (TG) goal value:

  • Less than 150 mg/dl

Should I take cholesterol-lowering medication?

Drugs to reduce LDL include the “statins,” bile acid sequestrants, nicotinic acid and fibric acid. If your LDL and heart-disease risk are both high, doctors may prescribe medications at the same time as lifestyle changes. For others, medication may be added if six to 12 weeks on the TLC plan fail to adequately reduce LDL. Those who are started on a cholesterol-lowering medication will need to continue lifestyle changes.

Identifying those with metabolic syndrome

A group of specific risk factors, known as the metabolic syndrome, raise your risk for coronary disease at any LDL cholesterol level. If you have three of the following risk factors, you may have metabolic syndrome, and need more rigorous cholesterol lowering:

  • Abdominal obesity (a waistline over 35 inches in women and 40 inches in men)
  • Triglycerides of 150 of higher
  • Low HDL (lower than 40 in men and lower than 50 in women)
  • Blood pressure of 130/85 mm Hg or higher
  • Fasting glucose of 110 mg/dL or higher

Middle-aged men (age 35-65) are predisposed to abdominal obesity and the metabolic syndrome. As a result, they carry a relatively high risk for heart disease. For those with high risk, intensive LDL reducing strategies should be followed.

Because of all the above the guidelines for nutrition, physical activity and weight control in the treatment of elevated cholesterol have been modified and called the “Therapeutic Lifestyle Changes” (TLC) treatment plan. Even if you come out with a gold star on your cholesterol level and overall risk for coronary heart disease, most of us would surely benefit from implementing these guidelines.  Why the word therapeutic in the TLC guidelines?, because if you would stick to it you probably have a better effect than taking medications.
The following table can help you implement the guidelines into practical terms you and your family can enjoy and reap heart-healthy benefits:

New TLC guidelines

Why?  What does this mean?
Examples
Why?: Saturated Fat – less than 7% of total calories
What does this mean? Saturated fats are thought to have the most potent cholesterol raising potential.
Examples: Fatty cuts of meat, skin on poultry, egg yolks, lard, butter, palm oil, coconut oil, desserts and sweets, fried foods and most snack foods and fast foods.
Why?: Trans Fat – as little as possible
What does this mean? Trans fatty acids are formed when a liquid fat is turned into a solid one; a process called hydrogenation.
Examples: Limit foods with the following ingredients: partially hydrogenated oil, hydrogenated oil, stick margarine and shortening. Limit your intake of fried foods, cakes, pies.

Why?: Polyunsaturated Fat – up to 10% of total calories
What does this mean? Diets moderate in polyunsaturated fats are generally recommended. .
Examples: Margarine, soybean, safflower, sunflower, cottonseed and corn oils, pumpkin and sunflower seeds, most salad dressings and mayonnaise.

Why?: Monounsaturated Fat – up to 20% of total calories
What does this mean? Most desirable source of fat in the diet.
Examples: Olive and canola oils, nuts, nut butters and oils (e.g. peanut butter, almond oil), avocados and olives.


Total Fat – 25% – 35% of total calories

All of the fat you consume on a daily basis should not exceed 35% of total calories.
All of the sources of fat noted above.
Dietary Cholesterol – less than 200 milligrams each day
Excesses in dietary cholesterol have been linked to increases in coronary heart disease.
Cholesterol comes from two sources – that which your body creates and that which is found in animal products (meat, poultry, fish, egg yolks and dairy contain dietary cholesterol)


Carbohydrates – 50% of total calories

Why?: Carbohydrates are the building blocks of a heart-healthy diet.

What does this mean? Choose complex carbohydrates (instead of refined ones with white flour) to get the maximum nutritional benefit from these foods.
Examples: Whole grain or oat based breads, crackers, pastas and cereals, other whole wheat/grain based flour products; brown or wild rice; couscous, quinoa, barley, buckwheat; lentils, split peas and beans; fruits and vegetables.

Fiber – 20-30 grams per day

Why?: Dietary fiber, specifically the viscous (soluble) form, is associated with a decrease in cholesterol and contributes to a host of other health benefits.
What does this mean? All of the above complex carbohydrate food sources.

Examples: Aim for a minimum of 10 or more grams of viscous (soluble) fiber each day by increasing oats, barley, lentils, split peas, beans, fruits and vegetables


Protein – Approximately 20% of total calories

Dietary protein can come from both plant and animal sources and is an essential nutrient to good health. The problem is, many protein sources (especially animal sources) contain a lot of saturated fat and cholesterol so choose your protein sources wisely.
Major sources of protein in the diet: beef, veal, pork, fish, chicken, legumes like lentils and beans, dairy products, nuts, seeds and soy foods.
Total Calories – balance energy intake with output to achieve or maintain a desirable body weight
Excessive calories, regardless of the source, results in weight gain.

General advise: Aim to consume 4-6 small meals and snacks daily. Avoid skipping meals and eating late at night.

You may wonder HOW it is you can incorporate these guidelines into your and your families hectic lifestyle. Take the following steps one day at a time and focus first on the foods in your diet that are high in saturated fat and cholesterol. Start making simple substitutions for saturated fats with mono and polyunsaturated fats, couple this with a focus on fruits, vegetables and whole grains, some physical activity and you are well on your way towards reaching your nutritional goals. Below is an example of how the TLC guidelines would be implemented for someone on a 1,800-calorie diet. You may require more or less calories for weight loss or maintenance, see your registered dietitian or physician for more information on your caloric needs.

Nutrient

For a 1,800-calorie diet

  • Saturated fat, <7% of calories
  • 14 grams or less per day

Polyunsaturated fat, up to 10% of calories

  • Up to 20 grams per day

Monounsaturated fat, up to 20% of calories

  • Up to 40 grams per day

Total fat, 25% to 35% of calories

  • Between 50 and 70 grams per day

Carbohydrate, 50% to 60% of calories

  • Between 225 and 270 grams per day

Protein, about 15% of calories

  • Around 67 grams per day

Cholesterol

  • Less than 200 milligrams per day

Fiber

  • 20-30 grams per day with a focus on viscous (soluble) fiber

If the above is still to difficult to implement in your dietary habits, the statins are for most people a effective strategy to maintain or even regain better cardiovascular health and lower their risks for heart attack and stroke.