Dai Yoshizawa writes:
Similarities of Patient A and Patient
B:
First, they do not have sufficient exercise, even though Patient B rides
her bicycle on weekends. Secondly, their favorite foods are high in cholesterol.
Differences between Patient A and Patient B:
The level of patient A's LDL is 165. It is said that a high level like
that is in the highest risk group ( Less than 130 is a good or desirable
level, 130 to 159 is border line to high risk, 160 or above is high risk
). On the other hand, the cholesterol level of Patient B is 125. So she
doesn't seem to have the risk of heart disease now. Second, Patient A has
angina chest pains and narrowing of the arteries, and Patient B smokes
a little. In addition, there is a history of diabetes in her family history
(her father died of diabetes) and she also suffers from obesity. Patient
In sum, A is now sick with angina pains, but patient B is not suffering
from pain. However she has lots of risk factors.
What these patients should do and why ?
For Patient A , first, he should decrease the LDL level because high levels
of LDLs are usually associated with an elevated blood cholesterol and an
increase risk of heart disease due to cholesterol and fat being deposited
in the arteries. Actually he has narrowing of the arteries, so he should
be careful about his diet.
Dietary fiber helps lower cholesterol. So, to increase the fiber in his
diet, he can eat apples, berries, prunes, carrots, lettuce. And he can
replace white bread with whole-grain breads and cereals such as bran muffins,
or eat brown rice instead of white rice. Let me think how he should do
this. (1) He should eat dry bran cereal for breakfast, but be careful of
the amount of dietary fiber in each brand of cereal because some brands
may have less fiber than we think. (2) He can add one quarter cup of wheat
bran for breakfast. (3) And he can eat cooked beans each week.
Patient A should start with one of these changes which means making a small
change, and wait several days to a week before making another. If the change
doesn't seem to make him feel better, he then can try other dietary changes.
he needs to pay attention to drink more fluids when he increases the amount
of fiber he eats. For example, if he doesn't now drink at least 6 glasses
of liquid a day, he must drink at least two additional glasses of water
a day to assist his new fiber intake.
Next he should avoid high cholesterol foods such as eggs, ice cream and
fatty meats, or substitute foods with cottonseed oil, corn oil, soybean
oil, safflower oil and so on, each of which has lots of monounsaturated
fat. Some recent research studies say that a diet high in monounsaturated
fatty acids is effective in reducing LDL ("bad" cholesterol)
levels while keeping HDL ("good" cholesterol) levels the same.
Patient B does not appear to be in a serious stage but could be in the
preliminary stage of heart disease. She has lots of risk factors such as
smoking, being overweight, doing insufficient exercise, eating high cholesterol
foods, and a family history of diabetes. First, she should resolve the
dangers from diabetes, obesity, lack of exercise by stopping smoking. Increased
exercise and losing excess body fat are also needed for her, because being
overweight may also increase her blood cholesterol level in the future.
Secondly, she should take care of her daily diet and keep in mind not to
take fatty foods, and perhaps substitute some of these unhealthy foods
with better choices, such as using skim milk. For her future, it's important
to have more fiber foods.
Finally she should never forget that the more risk factors she has, the
greater the odds of developing heart-related illness later in life. It
is said if someone has two risk factors, these cause four times the risk
of developing disease than for someone without any risk factors. Now it
is not necessary for her to undergo urgent treatment like Patient A, but
she should never forget the prevention value of reducing her current risk
factors. In addition, and as a caution, after menopause, the cholesterol
level of women usually increase to a level higher than that of men. So
keep she should continue to check cholesterol levels more than a few times
a year.
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