Cholesterol guidelines and throw away lines

At this year’s American Heart Association conference, new guidelines for the management of cholesterol were unveiled in a giant hall packed with meeting attendees. The presentation covered 90 minutes and 72 recommendations.  From management of high cholesterol in children (start testing cholesterol as early as age 2 and, if needed, start statin drugs at age 10) to how many drugs to use to get patients to goal LDL levels (if statins alone don’t get you there, add ezetimibe (Zetia) and then start injecting PCSK9 inhibitors (such as Repatha)). If a little drug is good, apparently more is better.

The press coverage of the guidelines focused on how “personalization” has been introduced into the protocols. As someone who sat in the audience and listened to the guideline unveiling, what I was struck by was that the majority of personalization was focused on which drugs should be used for what cholesterol level. Without ever mentioning personalization of diet or exercise.

Yes, the presenters all dutifully commented that a heart healthy lifestyle is the foundation of all cholesterol management. But, unlike for using drugs, for which detailed instructions were provided, there was not one instruction – or even hint – on how to help patients be successful at the diet and exercise part. In the end, it felt like a throwaway line.

Because it is. After all, doctors’ offices are not typically overflowing with extremely fit individuals with high cholesterol. Let alone with yoga-practicing vegans! It only takes looking around a mall or airport terminal to see how deeply we are failing at this. Yes, we talk about how important lifestyle is. But no one actually does the food and exercise bit. Because it's hard and it takes time - to teach and to do.

If you’re a regular reader of our blogs, you know that at Step One Foods we are not against using medications. But we are about trying to help patients be successful at arguably the most difficult part of their treatment plan – nutrition.  By providing a validated, convenient and credible solution that actually works. 

As almost a countervailing argument to the guidelines, it was encouraging to see the interest Step One Foods’ data generated at the conference. Every attendee who saw our presentation immediately commented on how easily Step One Foods could fit into a cholesterol lowering and heart treatment plan. It probably also helped that we were handing out samples of our bars!  Amazingly, there were no other presentations that looked at using food as a strategic intervention to measurably impact health - at the entire conference. 

Being pioneers is not always easy. But when you see that the status quo is not working, someone has to step up and try to change it. Thank you for joining us on this journey. You are pioneers with us. And we do not take your faith in us lightly.

Elizabeth Klodas MD, FACC