You Ask, I Answer: Butter or Margarine?

I am concerned with heart health (I am on a statin), so am I better off with grass-fed butter (paying attention to portion control) or a "Smart Balance" type, trans-fat-free margarine?

-- Greg (last name withheld)
(city withheld), IA

In your case, I highly recommend using a trans-fat-free margarine (or a vegetable oil-based spread, like Smart Balance) fortified with phytosterols.

Clinical trials have shown that adding 2 grams of phytosterols a day to the diets of patients on statins results in lower total cholesterol levels than statins alone.

Each tablespoon of Smart Balance provides 80 calories and 0.5 grams of phytosterols. This means it takes 320 calories to get your suggested phytosterol intake.

I mention this because it is important to remember that waist circumference is the best predictor of heart disease risk.

Bottom line -- you still need to be mindful of calories, no matter what type of fat you are spreading on your toast.

I have come across a fair number of people who inaccurately think the 20 or 30 extra pounds they are carrying on them are no longer a threat to their health since they are on statins. Not so!

In The News: For A Healthy Heart, Watch Your Waist

Tim Russert's death last week was shocking on many levels.

From a health standpoint, the NBC news anchor -- who had been diagnosed with coronary artery disease -- certainly didn't appear to be a high-risk patient.

He didn't have any troubling symptoms and, as The New York Times reports, "he was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight."

Pay special attention to the last six words of that quote.

As much as Mr. Russert was medicated and his LDL cholesterol was kept in check, the main risk factor here was, simply, his weight.

Dr. Michael A. Newman, Mr. Russert's internist, tells the Times that “if there’s one number that’s a predictor of mortality, it’s waist circumference.”

Thank you, thank you, thank you.

This is why weight control is at the pinnacle of health promotion.

It's simple. Plenty of evidence supports that when overweight people reduce those excess pounds, they also lower the risk and prevalence of a variety of diseases, including diabetes, certain cancers, and heart disease.

What is frightening is that many people with heart disease appear to incorrectly think that taking cholesterol-lowering medications are "sufficient," forgetting that reaching their desirable body weight is crucial.

Also, although many cardiologists -- and their patients -- become fixated on lowering LDL's (the "bad" cholesterol), many of them forget that increasing HDL's (protective, "good" cholesterol) is just as important.

In Mr. Russert's case, autopsy findings revealed that his HDL figures were low.

The procedure also concluded that there were "significant blockages in several coronary arteries."

This is why heart disease, in my opinion, should be in parents' minds as they help develop their children's eating habits.

These conditions develop over decades. Mr. Russert's health was not the product of the last 5 years, but of 25, 30, 35 years of consistent dietary patterns.

Many people often comment that nutrition and health are complicated subjects, full of rules, numbers, facts, and figures.

However, the best dietary advice is usually quite simple. In my case, one of the best recommendations I can make is to always be mindful of your ideal body weight and stay as close to it (no more than 5% above or below) as possible while consuming little junk food.