==> Dietary Recommendations: The first step in preventing heart disease is to eat a healthy diet. First, eat more whole foods rich in phytonutrients, plant molecules that give your body the nutrients it needs.



Here are some tips:

1. To avoid blood sugar imbalances that increase heart-disease risk, eat protein with every meal, even at breakfast.

2. Use lean animal protein like fish, turkey, chicken, lamb, and vegetable protein like nuts, beans, and tofu.

3. Combine protein, fat, and carbohydrates in every meal.

4. Avoid white flour and sugar.

5. Eat at least 50 grams of fiber daily. Beans, whole grains, vegetables, nuts, seeds, and fruit all contain fiber.

6. Avoid processed junk food, including soda and juice.

7. Increase omega-3 fatty acids by eating wild salmon, sardines, herring, flaxseeds, and seaweed.

8. Reduce saturated fat and use more grass-fed or organic animal products, which contain less saturated fat.

9. Eliminate hydrogenated fat, found in margarine, shortening, processed oils, baked goods, and processed foods.

10. Use healthy oils, like olive, cold pressed sesame, and other nut oils.

11. Avoid alcohol, which increases triglycerides and fat in the liver and creates blood sugar imbalances.

12. Eat every three to four hours to keep your insulin and blood sugar normal.

13. Don't eat three hours before bed.

14. Have a protein breakfast every day.

15. Eat two to four tablespoons of ground flaxseeds every day in salads or whole grain cereal. This can lower cholesterol by 18 percent.

16. Drink green tea.

17. Use soy foods, which can help lower cholesterol by 10 percent.

18. Eat at least eight to ten servings of colorful fruits and vegetables a day.

==> Supplements Along with a healthy diet and exercise program, supplements can dramatically affect your risk of cardiovascular disease:

1. Take a good multivitamin/mineral, plus a purified fish oil supplement containing 1,000 to 2,000 grams a day of EPA/DHA.

2. Try policosanol (10 mg to 20 mg twice a day).

3. Red rice yeast (two 600-mg capsules twice a day).

4. Plant sterols (2 grams a day).

5. Soy protein isolate shakes.

6. Fiber supplements such as PGX (Konjac fiber) -- 4 before each meal with a glass of water.

==> Lifestyle and Exercise Get 30 to 45 minutes of cardiovascular exercise at least six times a week.

You may try interval training (described in "UltraMetabolism") if you are feeling stronger. I also encourage strength training to build muscle and reduce body fat composition.

==> Stress Reduction Stress alone can cause a heart attack. It also contributes to heart disease by creating inflammation, raising your cholesterol and blood sugar, causing high blood pressure and increasing blood clotting. Reduce stress by doing regular relaxation exercises.

==> Medications Many of my patients can lower their cholesterol over 100 points by following the comprehensive program I outline above. Occasionally I recommend medications if I feel that my patient is swimming upstream genetically, or if there is significant heart disease present already.

When I do need to use medications, here are the ones I have to choose from:

==> Statins These block the production of cholesterol in the liver, lower inflammation, and may even reverse plaque in the arteries.

Statins deplete the body's stores of the vital component Coenzyme Q10. If you're on statins, take at least 100 mg of CoQ10 a day.

Statins can also cause muscle pain and aching and require regular liver function tests.

==> Niacin Very high doses (1000 to 3000 mg a day) of niacin can raise good cholesterol (HDL) and lower high triglycerides.

The major side effect is flushing, which you can prevent by taking a baby aspirin (81 mg) half an hour before your take the niacin.

I usually recommend long-acting Niaspan and build up slowly over the course of 2 to 6 weeks to the desired dose of 1,500 to 2,000 mg daily.

==> Ezetimbe (Zetia) Zetia prevents absorption of cholesterol from the intestine. It can interact with statins to increase the risk of liver toxicity.

==> Fibrates These medications include fenofibrate (Tricor) and gemfibrozil (Lopid), which help to lower triglycerides and raise HDL.

The verdict is still out on their effectiveness and safety. I prefer to use niacin, which achieves the same results, at lower cost with less risk.

==> Bile Acid Binding Agents Drugs like Questran and WellChol bind up bile in the gut and promote the elimination of cholesterol from the body. Bile is comprised of cholesterol among other things, and getting rid of bile helps lower your cholesterol.

==> Summary Remember, cholesterol is only one of many factors that lead to cardiovascular disease.

Diet, supplements, exercise, and other lifestyle approaches can have dramatic effects on cholesterol, lowering it by 100 points or more within a few months of comprehensive therapy.

Medications are a last resort. I never start them without trying an integrated approach to cholesterol management.

If you are willing to make the changes in diet and lifestyle and take a few supplements, your numbers will change dramatically -- and so will your life.