Ramadan is an excellent opportunity to shed some extra pounds. You are already resetting your metabolism by the protracted, long overnight fast, as well as the daily fasting. Your metabolism resets and your body begins to change the way it does things.

Weight loss during the first few days is just dehydration. It may be exciting to see that you lost 2-3 pounds in the first day or two, but that's all water loss and dehydration. No human can lose 2 pounds of fat overnight. It's just water. But it's still exciting!

So how can we maximize weight loss during Ramadan?

The most important factor is to avoid gorging or "binge eating" at night. We have found that gorging once a day is the fastest way to gain weight. Your body thinks it's in a state of famine, and will store everything you eat as fat, because it is worried about food supply. Further, eating once a day scares your body and your body starts to shut down and slow down your metabolism. You don't want to slow down your metabolism or you will gain weight.

Eating small meals through out the evening and morning (after sunset) is the best way to maintain an adequate metabolism level and avoid the highs and lows of blood sugar associated with eating one massive meal. After eating a large meal, our blood sugar level increases. In response to this, our pancreas secretes a ton of insulin to bring the levels back down. That extra sugar is stored as fat. That is very bad. We want to eat small, well proportioned meals and snacks throughout the evening to avoid the sudden rise in blood sugar. We want to maintain an even and balanced level of blood sugar. Certain foods raise blood sugar levels more than others, and we will discuss that thoroughly.

Why do I feel hungry?

A lot of people ask why they don't feel hungry throughout the day if they skip Suhoor (breakfast meal before dawn), but are starving by 9AM if they eat Suhoor. It all comes down to blood sugar levels.

Eating a massive meal in the early morning hours (before dawn) leads to a large surge in blood sugar and a subsequent secretion of a lot of insulin to help bring down your sugar level. In about 2-3 hours your blood sugar levels will drop to lower than normal, and this triggers a hunger response. By 9AM you will feel like you are starving. And you have the whole day left. By noon that feeling will go away, but why do you want to do that to yourself? You can avoid that problem by eating the right things throughout the evening and early morning and you can avoid this feeling of hunger. Later on I will discuss what you can eat to minimize the hunger response.

The other option is to just skip Suhoor. If you can't do that or you want to fulfill the religious recommendation (not obligation), just wake up and drink some water. Water has no consequences in terms of blood sugar levels. You could also just skip it altogether and continue the overnight fast into the day, you are already living off your fat stores, and can continue to do so throughout the day. You won't feel hungry. Overnight, your liver makes sugar for you to live off of, but can only do so for a limited period of time. If you continue this overnight fast into the day, you can start living off your fat stores. Isn't that the best way to lose weight? By burning fat?

So what can you eat?

What we are talking about is "Glycemic Index". This is a measurement of your blood sugar response to certain foods. For example, consuming 50 grams of pure white sugar, has a glycemic index of 111. That's really high. The idea is to eat foods that don't raise your blood sugar level. This will keep you from feeling hungry and will fill you up with very healthy food choices.

Vegetables like celery, lettuce, cucumbers, onions, and spinach have a glycemic index of less than 15. They have almost no effect on your blood sugar levels. Berries like strawberries, blue berries, raspberries as well as apples, have a glycemic index of 20-30 and are better than other fruit options. Some fruits like mangos and bananas have a glycemic index in 40-55 range. The fruit with the highest glycemic index is a pineapple with a GI (glycemic index) of about 66. This is still better than eating bread and baked goods.

Some vegetables are higher in sugar than others and have a higher glycemic index. Potatos, corn, tomatos (really a fruit), and carrots are all higher in simple sugars than other more fibrous vegetables. In fact, a baked potato has a GI of 115! That's about as high as it gets. The reason is that a baked potato is so processed, that it is very easy for our stomach to get at the simple sugars. The stomach has to do almost no work at all to get to the sugars. They are all there and readily accessible. Leaving the skin on and eating the baked potato with the skin, decreases the GI to 98, but it's still high. The skin acts as a fibrous buffer that keeps some of the sugars away from the stomach. The more fiber you eat, the harder it is for the stomach to get at the sugars. Leave the peel on apples, cucumbers, peaches, apricots, dates, kiwis, and other edible peels. Eat a lot of fiber!

Foods with the highest glycemic index are baked goods and simlpe carbohydrates like bread, cake, desserts, pasta, rice, potatos, fruit juices, candy, soda, pop, and coffee and tea that you put a lot of sugar into. Some of these have glycemic indices as high as 100 or more. The food with the highest glycemic index is Corn Flakes breakfast cereal with a GI of 132. Breakfast cereals have some of the highest GIs. Instead eat real oatmeal with fruits slices! Real oatmeal doesn''t have as high of a GI as the prepackaged ready to eat stuff. Or make your own yogurt parfait with real fruit slices and sprinkle oat meal on top.

The sugar maltose, which is found in beer, has a GI of over 150 and signals to the body to start storing the extra calories as fat right away! That's why you see a "beer belly" in people who drink a lot of beer.

There is an entire section on Glycemic Index on the Alo Diet Website. Check it out!

What can I eat?

The key is to eat foods that have a minimal glycemic index impact, yet still eat healthy and nutritious foods. Fruits, vegetables, nuts, beans, eggs, and lean meats are all very natural and very good for you. They also don't cause a significant increase in blood sugar levels.

Timing of meals

Here in the US, most Muslims indulge after sunset and don't wake up to have an early meal. Busy work schedules and busy lifestyles promote this bad eating behavior. This is a major contributor to gaining weight. The human body is very smart. The body figures out that it is only getting one meal a day and decides that it needs to store everything. So everything you eat gets stored as fat.

Normally, we tell our patients to eat small frequent meals throughout the day. Well, you can't do that in Ramadan. So you have to eat small, frequent meals throughout the night. This helps avoid the spikes in blood sugar levels and will keep you even and balanced.

So what do you eat?

At Iftar time (break-fast time), eat the traditional three dates and drink plenty of water. If you are really concerned about the amount of sugar in the dates, eat one date, but take three bites (or skip the date). Then take a break, go pray Maghrib (sunset prayer) and come back for the actual meal. For your meal, drink plenty of water, start with soup and salad, and pace yourself. It takes 20 minutes for your stomach to tell your brain that it is full. So slow down your process. Drinking plenty of water also starts stretching the stomach earlier and lets you know you are full earlier.

Then you can go to Taraweeh (the Ramadan nightly prayers), afterwards eat a small snack like a cheese stick or a handful of almonds or a bowl strawberries and light whip cream. You could even drink some unsweetened tea or coffee (or use a sugar substitute). Then you can go to sleep.

Wake up before dawn, and do not eat cereal! Eat an omlette with spinach, mushroooms, onions, brocholli, and some other healthy alternatives. Even a few nuts and an apple is fine. Or you could eat a banana and dark chocolate. Or another bowl of strawberries and bananas and light whip cream, but put some cocoa powder on the whip cream this time!

What should I avoid?

Avoiding simple sugars, processed foods, and baked goods will go a long way towards improving your metabolism, your health, and your well being. You will also feel more energetic and feel happier. Simple sugars (carbohydrates) are the culprits we discussed above; sugar, bread, potatos, pasta, rice, ice cream, sweets, candy, dessert, baked goods like cakes, muffins, and many others.

You don't have to avoid these every day. You can have these once a week. But you must cut down on portion size. Eat a third of what you normally would eat. Cut a slice of cheese cake into thirds and eat just a small amount. You have to control your portions. Otherwise, you are just going back to your previous state of metabolism and gluttony.

Ramadan is meant to be a month where Muslims feel what poor people feel. We are supposed to empathize with the poor and needy. We are not supposed to be gorging and over-eating at night. That is the opposite of what Ramadan is supposed to be about. You aren't supposed to like Ramadan! It's supposed to be hard.

What about desserts?

Ramadan is a time when families make certain desserts and foods that they don't normally make. Kanafa, Katayif, Baklawa, special ice creams, and sweet rice puddings are all traditional Ramadan treats. You have to restrain yourself. Once a week is ok, but very small portions. Do not indulge. Otherwise, you will put weight back on. It's very hard to control yourself sometimes. But remember what Ramadan is supposed to be about.

What about after Ramadan?

Ramdan is a great time to start new good habits and stop bad habits. There is no reason why you can't continue eating this well and this healthy after Ramadan. Diets aren't temporary. You eat every day! Why not make sure you are eating the right things every day? Use this to kickstart a new way of eating and living.

If you quit smoking (or hookah) during Ramadan, use this opportunity to continue to avoid these awful habits. Make no mistake, smoking of any kind IS KILLING YOU! Use this time to reflect on that and stop smoking.

In cardiology, we know that the single biggest risk factor for heart disease is either being a current smoker or having a history of smoking in your past. If you could make one single change in your life, it should be to quit smoking. I don't mind if you put on 30 pounds of fat, just quit smoking. Smoking is far worst than being overweight. Don't do it!

Go on! Lose Weight!

If you enjoyed reading these recommendations and want a diet and life plan for the rest of your life, I highly recommend reading the Alo Diet online. It's totally free! No regsitration, no subscriptions, no fees! And it's physician approved!

You will get an in depth education on nutrition, metabolism, digestion, glycemic index, cardiology, diabetes, women and weight loss, and lots of tips and tricks for losing weight. If you are a physician, have your patients follow the diet. They can read it all online for free and download plenty of resources and pamphlets. Tell all your friends about it to!

http://www.AloDiet.com

From the website:

A free, healthy, easy to follow, physician approved diet that works!

Other diets have come along over the years and advanced our knowledge of metabolism, nutrition and weight loss. The Alo Diet aims to take all of the information from previous diets, improve on certain aspects, eliminate concepts that have been proven wrong, and bring us up to date on everything we know on diet and weight loss. The Alo Diet is a totally free and comprehensive diet and life plan!

• What have we learned from other diets?
• Why is the Alo Diet different?
• Why do women have trouble losing weight?
• Is Obesity genetic?
• Never feel hungry
• Calculating your Body Mass Index
• How to break through a weight loss plateau
• Substitution
• Losing weight year round
• Don't count calories
• You don't have to exercise to lose weight
• Things humans should never eat
• Diabetes and weight loss
• Men and weight loss
• You can eat cholesterol
• Do we need Supplements?
• Stop blaming your thyroid

While other diets require you to buy the book, pay for food, subscribe, pay fees, register for their website, The Alo Diet doesn't require any of that.

The Alo Diet doesn't require registration, fees, nor purchases. You don't even have to register for our website!

Click over to the book section and start reading and start losing weight

Totally Free!

I was tasked with writing "board style questions" after giving a series of lectures. A lot of people have asked that I publish these on my blog and give answers and explanations. The questions are written in USMLE/Comlex Step 2 and 3 format, and may also be found on Internal Medicine In-Service exams. Here are the first few questions in a "Board Review Series".

1. A 56 year old male was mowing the lawn and began having chest pain. The pain radiated down his left arm and he became nauseous and lightheaded. He sat down to take a break and then pain slightly improved but was still there. It was a dull achy, squeezing pain that was a 6-8 out of 10. His wife activated EMS and an ambulance brought him to the hospital. Upon arrival his vitals were pulse of 150, respirations of 20, blood pressure of 155/88, and SpO2 of 100% on room air. On exam he was alert and oriented X3, in mild to moderate distress, No JVD, Lungs were clear, Heart was regular, No murmurs, No S3 or S4, Abdomen was soft and obese, extremities were not edematous. An EKG was performed by the ED staff and demonstrated Sinus Tachycardia and ST elevations of 3-4mm in leads V2-V4. The ED staff has placed him on O2, given him 325mg of chewable Asprin, and placed an inch of nitro paste on him. In addition to activating the cardiac catheterization team, what would be the next best step?

A. Start a IIb/IIIa inhibitor
B. Give him clopidigrel
C. Start an ACE Inhibitor
D. Start a Beta Blocker
E. Start Insulin

2. In the cath lab, which vessel was the most likely stenosed vessel in the above patient?
A. Left Circumflex
B. Posterior Descending
C. Right Coronary
D. Left Anterior Descending
E. Right Posterior Lateral

3. Upon discharge, all AMI patients (not just the previous patient) should be on which combination of medications?
A. Statin, Asprin, ACE Inhibitor, Beta Blocker
B. Statin, Asprin, Clopidigrel, Beta Blocker
C. Statin, Asprin, ACE Inhibitor, Calcium Channel Blocker
D. Asprin, Beta Blocker, Spironolactone, ACE Inhibitor
E. Asprin, Nitroglycerin, Beta Blocker, Statin

Mom brings in her 24 year old daughter and says that she is not sure what happens, but the daughter suddenly goes into convulsions and starts shaking and having a seizure. You attach the EKG machine for fun, then you capture the following over the next 10 seconds. Is this artifact and shaking or something very bad?

A 20 year old patient comes in to the ER complaining that he was playing soccer, and the ball hit him in his chest. He feels like "I got the wind knocked out of me" and is doing well otherwise. He has no medical history, vitals are stable. One of the brightest ER interns decides to get an EKG, and you see the following:

What is this?

I just turned 34 this year and thought I needed to establish care with a physician. Plus I really wanted to know my numbers. Everyone should know their credit score, their lipid panel, their fasting glucose, their blood pressure, their TSH, and their Vitamin D level. These figures will tell you all you need about your health and what you need to do.

I recommend to all my 30-something friends, go see your doctors and get your numbers! Don't wait for one of these silent killers to strike!

I just got my results back and here they are: (in parenthesis are the goals or normal values)

Total Cholesterol: 184 (<200)
HDL: 44 (males >40, females>50)
LDL: 129 (<160, optional <130)
Triglycerides: 51 (<150)
Chol/HDL Ratio: 4.2 (<5)

BP: 130/70 (<120/80)

BMI: 26.3 (18.5-24.9)

Fasting Glucose: 80 (60-99)

Vitamin D level: 23 (>30)

TSH: 1.74 (1-5)

My impression and plan:

Lipids:

As far as my lipid panel goes. I don't like it. Yes, it falls within guidelines and looks pretty decent. But I like to be more aggressive about cholesterol control. 

If a patient walked in with this lipid panel I would be all over them about lifestyle modification, diet modification, exercise, and I'd give them 3 months to try and make some improvement. If they can't they'd be on a statin. 

In my case, I don't have much wiggle room in terms of lifestyle modification. I weigh at or very close to my ideal body weight, I eat very healthy, I don't eat saturated fat, I exercise like a mad man at least 2-3 times per week, sometimes way more, and I don't smoke or drink. Hence, this is my lipid panel. This is my genetics. In my case, I will probably start a low dose statin and see what happens. Probably a Crestor 5 or a Lipitor 10.

My total cholesterol is 184. I don't like this number. If I were a patient of mine, I would double whatever statin dose I was on, or start one. The guidelines state that a total cholesterol under 200 is ok.... but do you really want to be the guy with the 196? No. Guidelines are good basic information, but we need to strive for better. The guidelines from the NCEP ATP III are slightly outdated and need to be updated anyways. I am not going to be the guy with the cholesterol of 180 and settle for "mediocre".

My HDL (Healthy Cholesterol)  is 44. Sure it's over 40. But,  we like it to be over 45. Crestor and Lipitor can raise your good cholesterol. There are only a few things that raise HDL; exercise, Niacin, and a few statins (Crestor and Lipitor). Otherwise, you're stuck. Since I already exercise, this is another reason to start a statin.

My (Lethal Cholesterol) LDL is 129. The guidelines technically say under 160 if you have minimal risk factors, and under 130 if you have a few risk factors. I don't have any risk factors (obesity, hypertension, smoking, diabetes, family history, age, male sex, etc). If anything, I am a male.... so that is a risk factor. LDL is the primary target of therapy. When treating patients, I like to see it under 100 or under 70 in very high risk patients (diabetics, or already have CAD). So, statins are great at lowering LDL. That's their job.

My Triglycerides were only 51. This is a number I am especially proud of. I have never seen TGs this low before. This usually represents excess sugar that you have floating around in your blood stream. Triglycerides are chains of 3 sugars bound together. People who eat excess carbohydrates will have high TGs. Since, I don't eat carbs (unless they come from fruits and vegetables), this number is very low. Normally, we tell people with high TGs to start taking fish oil or flaxseed oil (Omega 3s) to help bring this down. I have some flaxseed oil pills at home and pop some every once in a while, but not consistently. So maybe that helped a little. Salmon and tuna have the most omega 3 of most fish we can eat.

My Cholesterol to HDL ratio is 4.2. Pretty high. We like it to be under 5.... but 4.2 is too close for me. I like to see numbers like 2.0 or 2.5. Not 4.2!

Blood Pressure:

Mine was 130/70. Pretty good. I had just walked in and barely had a chance to sit down when she took it. I am sure it'd be lower if she waited a few minutes. Not worried about that number. The lower your blood pressure, the longer you live, regardless of anything else. And for every 20/10 that your blood pressure is above 115/75, your chance of having a stroke doubles.

Body Mass Index:

This tells us how much you should weigh in relationship to your height. I'm five foot eight inches and weigh 173 pounds. It is used for males and females. Normal is between 18-24.9. Women should be to the lower end of the scale around 19-22 while men can be a little higher around 23-24. Yes, according to my BMI, I am overweight. Overweight is 25-29.9. Over 30 is obese. And over 40 is extremely obese.

While my BMI is in the "overweight" category, I don't mind. BMI doesn't work for that well for more muscular individuals. If you played high school sports, or carry around a lot of muscle mass, you will be at the higher end of normal. I've been involved in sports and weight lifting my entire life, and I know I carry around a lot more muscle than the average joe. In order for me to get under 25, I would have to lose about 10 pounds and get to a weight of 163. That's not impossible. And I could probably do it. I will work on this and see what happens. But I don't have much wiggle room here. Losing a few pounds isn't going to change my lipid panel either. 

Glucose:

My fasting glucose is way under 100. I'm very happy. No one's fasting glucose should even be close to 100. If your fasting glucose is creeping up and getting into the 90s, you and your doctor need to have a talk about insulin resistance (type 2 diabetes). I hate when physicians ignore fasting glucose numbers that are "high normal" and aren't aggressive about this issue. If this was you, would you want to wait until you are a full fledged diabetic and can't see, can't feel, and are peeing out protein? Get aggressive about this! Especially, if type 2 diabetes runs in their family! The only way you can get type 2 diabetes is if you inherit it! Please start taking Metformin right away!

Vitamin D:

Vitamin D plays a crucial role in nearly every metabolic reaction in our body. It's actually a hormone, not a vitamin. We are finding out more an more about Vitamin D every day. If you want your number, ask your doctor for a 25OH Vitamin D (25 Hydroxy Vitamin D). Not the other two. None of the others matter or are even useful. Vitamin D is important for our bone health, cardiovascular health, helps suppress inflammation, prevents myalgias, joint pain, stiffness, and nearly everything else.

My number was 23. This is low. Normal is considered 30 and up. But you start seeing problems in humans with vitamin D levels less than 40. So we ideally aim for a level of 50-70. So mine is pretty low. Under 10 is considered Vitamin D deficiency, and 10-30 is considered insufficiency. 

If you live north of Atlanta, cover all your skin with clothes (most Muslim women), wear sunblock or have darker skin.... you are deficient. Get it checked and get treated. Our body uses sunlight to convert Vitamin D to it's active form. So yes, I started taking Vitamin D supplements.

TSH:

This tells us about your thyroid function. Mine is 1.74. Perfect! When we treat people with thyroid issues, we like to see their TSH be between 1 and 2. So this is perfect!

Any thoughts?

I would like to hear all of your thoughts and analysis. Would you be as aggressive? In a 34 year old, otherwise healthy, compliant male? Would you start a statin?  Try anything else?

No, you do not need to exercise to lose weight. It's true. You can lose almost all the weight you want just by changing your eating habits. The vast majority of people can get to with 10-15% of their desired weight with diet alone.

Too often physicians tell patients, "Diet AND exercise." We hear this all the time. Diet AND exercise. The fact of the matter is, that diet alone is usually enough to achieve very significant weight loss.

Most Americans find excuses to not have time to exercise. Work, kids, time, money, motivation, running late, etc. Exercise is usually our last priority. This is unfortunate, but true.

When doctors tell patients that weight loss requires diet AND exercise. We have already built excuses into the system. They can't find time to exercise, hence, they will not be able to lose weight. We are giving people a reason to not lose weight.

We should rephrase our recommendations. You need to DIET ONLY. Forget exercise! If you have time, please exercise, it's great for your heart. But it is not necessary for weight loss. But weight loss is necessary! Please lose weight.

We have to be clear and truthful. Diet modification is more than enough to cause major weight loss. Let's not tie it to exercise and destin both to noncompliance. They won't do either.

How useful is exercise?

Assuming you weigh 200 pounds, if you walk or jog for 3 miles you will burn about 300 calories. That's not much! That's one plain bagel from Panera. 

Exercise should not be used as a way to burn calories. It should be used to increase your heart rate and improve your cardiovascular health. But's it's not a good way to burn calories.

A 200 pound person doing squats for 2 minutes straight burns 320 calories. That's only 2 minutes of resistance training! Even if you aren't putting up any weight, just your body weight. Two minutes, 320 calories. Better to do two minutes of squats than run for 3 miles if you just want to burn calories.

Back to our problem, diet does not have to be tied to exercise. You can get to within 10-15% of your target weight with diet alone. If your ideal body weight is supposed to be 150 pounds, you can easily get to 165 with just diet. If you want to weigh 170, you can easily get to 187 with JUST DIET!

Start dieting and lose weight! NO EXCUSES! I don't want to hear about not being able to get to the gym, no time to run, had to pick up the kids, can't afford a gym membership.... etc, etc.

Dieting is free! (and may cost you less than what you are paying now) You will be paying a lot less for food, since you will be eating a lot less food. You don't have time to exercise, but you definitely have time to diet. You eat every day, right? Just eat way less. It's not rocket science.

There are all kinds of diets available to use. What it comes down to is picking one and sticking to it. They all work! Just pick a diet and do it.

Diets should not be temporary. You breathe every day for the rest of your life. You should diet every day for the rest of your life! All "diet" means is what we eat and consume. Start eating way less, and way healthier. We all know what that means. It's not complicated. Eat less, eat better. We don't need a PhD to understand that.

Here are some places to start:

http://www.mypyramid.gov

http://www.nutrition.gov

Every once in a while you wonder if people actually understand what they are dealing with and whether or not they really understand what's going on. A recent encounter with another physician perplexed me.

A patient is brought to the ER because he or she is found unconscious by a family member. It turns out the EKG looks "scary" and they call cardiology. What the ER thought they saw on the EKG was an entity called "ST Elevations" which typically means someone is having an acute heart attack and needs to go to the cath lab to get the artery opened up.

We arrive. It turns out the patient is in acute renal failure, with a creatinine of 3.5, the potassium is over 8 (which gives you a similarly bizarre EKG pattern), and has a blood sugar of over 1300, and a bicarbonate of 5. The ER also ordered a troponin which was indeterminant and a BNP which was 1300.

The patient on paper looks like he is in Diabetic Ketoacidosis, dehydrated as hell, and has gone into acute renal failure from the severe dehydration. Yes, the elevated potassium is very high and at such high levels you get EKG changes which look very abnormal. A potassium over 7.5 gives you wide QRS complexes, wide T waves (the QRSs and Ts look similar), lack of P waves (or very blunted), bradycardia. 

We rehydrate the patient, his potassium quickly comes down (as is expected, because they are really potassium deficient), treat his DKA, and over the next few days his kidneys resume normal function.

A few days later one of the physicians from the ER saw me in the hallway and asked me, "Hey, how do you explain the CHF in that guy?"

I asked, "CHF? Why do you think he was congested? You think he is volume overloaded?"

"His BNP was like 1300"

"He was in acute renal failure."

"So, why was he volume overloaded?"

"He wasn't. He was about as dry as they come. You coulda given him 10 Liters and he'd be fine."

"And the BNP?"

"You can't really evaluate a BNP with renal failure. Nor troponin for that matter. Just toss those two out the window."

Sometimes you just think to yourself, "Wow!" Sometimes things that you think are common knowledge may not always be. We can't rely on merely tests and numbers. We can't be robots. We have to understand what happens behind the numbers.

Medicine humbles you every day! There isn't a day that goes by that I don't learn something new.

Eating cholesterol does not raise your cholesterol! People need to stop worrying about eating cholesterol! Eat all the eggs and shrimp you want!

What raises your cholesterol is saturated fats! These are fats that are SOLID at room temperature. Butter, margarine, cheese, fat on steak, bacon, chicken skin, pork, goose fat, cream, ice cream, and the fat in milk (even though it looks like liquid, it's actually solid fat particles floating around in liquid).

Eighty-five to ninety percent of your total cholesterol comes from your liver. Our liver makes over 85% of our cholesterol! Only a small percentage comes from food you eat. If you don't eat cholesterol, your liver makes more to make up for the difference. If you eat cholesterol, your liver will make less. So it doesn't matter how much you eat!

What tells your liver to make cholesterol?

SATURATED FAT!

Fats that are solid at room temperature. Avoid those and you will be ok! If you remember that, you will be fine.

We always tell our patients to first try diet and exercise to help improve their cholesterol numbers. So they go around and stop buying foods that say "cholesterol" on the label, or buy "cholesterol free" foods. Bad idea! You liver will just make up the difference.

What we should tell them to do is to avoid foods that have saturated fat in them. Solid at room temperature! Remember that!

Saturated fats are found in high amounts in:

Butter, Coconut, all those butter substitutes, Cheese, Pork, Beef, Chicken skin, Goose fat, veal, sausage, hot dogs, bacon, processed meats, cream, milk and other dairy products, ice cream, etc. You get the picture. SOLID FATS! When you look at that steak and see the marbelling and fat in between the muscle fibers, or the fat on ribs and lamb chops....  IT's SOLID FAT!!!!!

Avoid Solid Fat!

But, there are two liquid fats that contain a lot of saturated fat; coconut oil and palm oil. But my guess is no one really eats those. Especially, not here in the United States. Butter, cheese, cream, bacon, pork, and beef are our main problem.

What about trans fats?

These are liquid fats (like vegetable oil) that are heated in the presence of hydrogen to make them semi-solid. Like all those butter substitutes. These are awful!

Trans fats are even worse for cholesterol levels than saturated fat and cholesterol itself because they raise LDL ("bad") cholesterol AND lower HDL ("good") cholesterol.

February is Women's Heart Disease Awareness Month! In honor of women's heart health, I will dedicate a majority of my posts in February to Women's Cardiovascular Health Issues.

I plan on covering several topics: (possibly more)

1. General Cardiovascular Health
2. Tobacco Cessation
3. Why it's harder for women to lose weight, and how to break through
4. What really raises your cholesterol? (it's not the cholesterol you eat)
5. The Alo Diet (hey, if Atkins can have one, so can I)
6. How to look young for a long time

For starters, did you know:

Cardiovascular disease kills approximately 450,000 women each year, about one every minute.

While 1 in 40 American women die of breast cancer, about 1 in 3 die from cardiovascular disease.

More women die of cardiovascular disease than the next five causes of death combined, including all forms of cancer.

Ninety percent of women have one or more risk factors for developing heart disease.

Only 1 in 5 women believe that heart disease is her greatest health threat.

Heart disease is largely preventable.

In fact, 80 percent of cardiac events in women may be prevented if women make the right choices for their hearts, involving diet, exercise and abstinence from smoking.

Cigarette smoking contributes adversely to the top 5 killers of women.

Lear more at http://www.goredforwomen.org/

Try to wear something BRIGHT RED throughout February to raise awareness of the number one killer of women!

If the ladies can do it....

Then men can too....

A while back we were discharging a patient from the hospital and gave her prescriptions for all of her medications. One of her prescriptions was for Crestor (the most powerful cholesterol lowering medication). The nurse calls me and says that the patient would like to ask me a few questions before she leaves.

"Doctor, I'm allergic to Crestor. Can I take something else."

"Maam, how do you know you are allergic?"

"I break out in hives and get itchy when I take it."

"Well, you've been on Crestor for the past two weeks while here in the hospital."

"Oh really?"

"Yes."

"Well, maybe that's why I haven't been able to sleep. Can I have a different medication?"

"Like what?"

"Vicodin?"

I look at her puzzled and ask, "How will that fix your cholesterol?"

"I don't know. Isn't that for cholesterol?"

"No, it's a pain reliever."

"Well, if I'm not in pain, won't my cholesterol get better?"

"No, maam. I'll give you a prescription for something else."

Any other funny patient stories, post them below!