The full treatment package – Atorvastatin, diet, physical activity & weight control

1. Diet and nutrition

In general, the advice is to follow a low-fat (saturated fat and trans-unsaturated fatty acids) and low-cholesterol diet plan before pharmacological treatment begins. The new adjustments to diet must be adhered to every day thereafter. Nutrition changes are thus recommended as a long-term adjustment for maximum benefit in conjunction with exercise activity and a set medication-taking schedule.

Other factors, such as heavy alcohol consumption and smoking habits will likely be advised against for the greater good of a person’s overall wellbeing.

A high-fat / high-cholesterol diet or bad habits will counteract the effectiveness of pharmacological treatment, thus making therapy virtually redundant.

The National Cholesterol Education Program advises a TLC diet plan (Therapeutic Lifestyle Changes) ⁽⁷⁾ The programme also covers areas of physical activity and weight management, which are regarded as vital components in lowering LDL-cholesterol levels. A healthy diet can make a significant difference in helping to lower blood pressure (where it is abnormally high), manage weight, better control or prevent diabetes, as well as contribute to the avoidance of blood clot formations.

If a good diet plan is followed on a daily basis, it has the potential to help keep dosages of medication at the lower end of the strength scale too.

A treating doctor is likely to advise what a patient’s LDL-cholesterol target should be based on various applicable risk factors. It’s important to know the target level so that a diet plan can factor this in, in the most beneficial way.

The initial few months of diet adjustments are likely to be primarily aimed at lowering cholesterol levels, only consuming as many calories as are needed for maintaining a healthy body weight. A patient can expect to discuss progress relating to diet adjustments at each follow-up consultation with a treating doctor as well.

Whatever diet plan is followed, all will need to focus on three main factors which have an impact on cholesterol levels:

• Saturated fat: This type of fat is largely found in animal products, like fatty cuts of meat, poultry (with skin), lard, and whole-milk dairy products. It can also be found in some vegetable oils. Saturated fat can elevate LDL-cholesterol levels significantly and is regarded as a leading contributor to high / unhealthy levels, along with the below.
• Trans fat / trans-unsaturated fatty acids: This is mostly high in foods containing hydrogenated oils and fats, such as French fries or margarine (hardened). Trans fats can raise LDL-cholesterol levels in a similar way to saturated fats. Hydrogenation involves a process in which hydrogen is added to unsaturated fat. This is done to make fat more solid and stable when kept at room temperature. Some trans fats can also be found in certain animal fat products (i.e. dairy or meat), as well as baked products, like crackers, breads and biscuits.
• Cholesterol in foods: This is also largely found in animal products, such as organ meats, shrimp, egg yolks and whole milk products (like butter, cheese and cream). Cholesterol in the diet will naturally raise levels in the bloodstream. In many instances foods high in cholesterol are also high in saturated fats. Omitting one will, in some ways, help to take care of the other.

Not all fat is bad. It is, in essence, a nutrient which contributes to various functions within the body. Energy is one and assisting other nutrients in achieving their functions is another. The quantity that is needed is what matters.

Unsaturated fat is often found in nuts, olives, vegetable oils, avocadoes and fatty fish (such as salmon). Unsaturated fat is divided into two different types – mono-unsaturated and poly-unsaturated. These fats are capable of lowering cholesterol levels. Mono-unsaturated fats can be found in plant-based foods such as canola, sunflower, peanut and olive oils. Poly-unsaturated fats can be found in nuts, as well as sunflower, cottonseed, soybean, corn and safflower oils. Omega-3 fatty acids are a type of poly-unsaturated fat and can be found in tuna, salmon and mackerel. This type may not directly help lower cholesterol levels but does contribute to overall heart health and is thus well worth factoring into a new diet.

A doctor or dietician will ensure to keep track of total fat consumption in a diet, considering quantities of fats that will have an effect on elevated cholesterol levels versus those that won’t. Fat is calorie-dense, and thus will have an impact on weight control too.

Other healthy considerations when it comes to diet include fibre. Fibre can help to lower the risk of heart disease and aid the digestive tract too. Those needing to shed some weight can benefit from fibre in their diet as it can help to reduce the number of calories needed daily (i.e. it helps a person to feel fuller for longer).

Insoluble fibre passes through the digestive tract largely undissolved and is commonly referred to as ‘roughage’. This is helpful for colon function. Whole grain foods, skinned fruits, legumes and vegetables are good sources. Soluble fibre is more dissolvable (becoming gel-like) and aids in blocking fats and cholesterol from being absorbed into the bloodstream via the wall linings of the intestines. A dietician or doctor may caution that fibre increases should be done gradually - sudden introductions of higher quantities may result in bloating and abdominal discomforts.

Plant stanols and sterols (often taken from soybean oils) can also help to block cholesterol absorption in the digestive tract but should be included in a diet with care when it comes to calorie-control.

Healthier food, cooked in more nutritious ways is paramount in order to help lower LDL-cholesterol levels effectively. Less fat and salt (which aggravate the risks associated with high cholesterol) doesn’t necessarily mean that a diet needs to be bland. Flavour can be added in the form of curry powder, herbs, ginger, garlic, paprika, mustard, nutmeg, cinnamon, cloves, cumin, lemon juice and onion.

Consuming large quantities of grapefruit juice and alcohol will be advised against, for reasons previously discussed. It is well worth avoiding these substances when under treatment with Atorvastatin / Lipitor.

A patient should follow the guidance of a dietician and treating medical doctor in order to gain the maximum benefit when it comes to the dietary component of treatment. It has an influence on the overall effectiveness of Atorvastatin / Lipitor and can significantly control cholesterol, aiding in overall good health.

2. Physical activity

Along with pharmacological treatment and diet adjustments, exercise activity also plays a major role in overall therapy effectiveness. Regular activity benefits the whole body, as well as helping to reduce LDL-cholesterol levels and aiding in raising HDL-cholesterol levels. It’s also a very effective way to manage weight, along with healthier nutrition. Better weight management means healthier cholesterol levels too.

For patients with additional risk factors, like hypertension, excess weight (or obesity), or diabetes, regular physical activity can contribute to reducing blood pressure, lowering triglycerides, and decreasing the need for insulin.

A doctor will recommend that physical activity be introduced gradually and increased at a steady pace. This will also help to avoid injuries. There’s no need to hit the ground running. A doctor will factor in a patient’s age and overall physical condition when it comes to activity recommendations.

The general rule of thumb is at least 30 minutes of moderate-intensity exercise a day. Brisk walking could suffice for many. Other options include a variety of interests like golf, cycling, bowling or dancing. Even a little gardening and housework could qualify as ‘physical activity’. More intense physical activities can also be encouraged, like swimming, aerobics, jogging or running, and tennis. A doctor will advise on what level activity intensity should be in relation to a person’s overall state of health, taking into consideration the best means to achieve set treatment targets.

It’s important to engage in physical activity safely. If too intense, a person can experience cold sweats, dizziness, pain, pressure or even syncope (fainting). If working with a fitness coach or trainer, it is best to ensure that a doctor’s key guidelines for physical activity are taken seriously so as to achieve the healthy state that best benefits a patient.

3. Weight Loss / weight management

If diet and physical activity adjustments are well aligned, weight management and weight loss should be achievable. Weight loss is not likely to be a quick fix, but is a necessary lifestyle change for those carrying unhealthy excess.

A doctor will likely calculate a patient’s BMI (body mass index) to determine a healthy weight target. Little by little, even weight loss that is achieved in small increments can prove beneficial for the heart, and especially so for those who are high risk for cardiovascular complications.

Maintaining a healthy weight will need to become a lifelong commitment as well. Excess weight picked up along the way can directly elevate LDL-cholesterol and triglyceride levels, which will counteract positives achieved using Atorvastatin / Lipitor.

Reference:

^{7. US NationalHeart, Lung and Blood Institute. December 2005. Your Guide to Lowering your Cholesterol with TLC: https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf [Accessed 05.02.2018]}