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Cholesterol Guidelines Emphasize Healthy Lifestyle, Personalization, and Stepped Treatment

Ivor Benjamin, AHA, cholesterol guidelinesIvor Benjamin, MD, FAHA
The American Heart Association and the American College of Cardiology have released new clinical practice guidelines on the management of blood cholesterol.

The guidelines emphasized the importance of a healthy lifestyle for reducing atherosclerotic cardiovascular disease (ASCVD) risk, an evaluation individual risk factors in estimating 10-year CVD risk, and a stepped approach to escalating statin therapy, adding ezetimibe if lipid levels remain high, and finally to introducing a PCSK9 inhibitor if further reduction is required.

The 2018 guidelines were presented at the AHA Scientific Sessions 2018 in Chicago, Il.

“The updated guidelines reinforce the importance of healthy living, lifestyle modification, and prevention. They build on the major shift we made in our 2013 cholesterol recommendations to focus on identifying and addressing lifetime risks for cardiovascular disease,” said Ivor Benjamin, MD, FAHA, president of the American Heart Association, in a statement.

The guidelines also stressed the importance of a personalized care plan tailored to each patient’s history and risk factors. The guidelines include an update to the risk calculator introduced in the 2013 guidelines that adds “risk-enhancing factors” such as family history and ethnicity, as well as conditions including metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia, and high lipid biomarkers.

“High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care,” said Michael Valentine, MD, FACC, president of the American College of Cardiology, in a statement.

A supplement to the guidelines, focused on risk-assessment tools, gives providers a more detailed guide to the use of quantitative tools for estimating 10-year cardiovascular disease risk. The authors note that the pooled cohort equations may underestimate CVD risk in patients from certain racial/ethnic groups, those with lower socioeconomic status, or those with chronic inflammatory diseases, while overestimating risk in patients with high socioeconomic status or who have benefitted from careful preventive health care measures.

When lifestyle modifications aren’t sufficient to manage cholesterol levels, the guidelines recommend a stepped approach that begins with statins before progressing to ezetimibe in addition to statins, and finally to the addition of a PCSK9 inhibitor.

The top-level recommendations state that for certain patients at high risk or who do not respond sufficiently to statins or ezetimibe in addition to statins, “adding a PCSK9 inhibitor is reasonable, although the long-term safety (3 years) is uncertain and cost effectiveness is low at mid-2018 list prices.”

“There have been concerns over the cost of PCSK9 inhibitors and some insurance companies have been slow to cover them, so it’s important to note that the economic value of these new medications may be substantial only for a very specific group of people for whom other treatments haven’t worked,” Benjamin said.

The guidelines were published simultaneously in the American Heart Association journal, Circulation, and the Journal of the American College of Cardiology. The supplement, “Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease,” was also published in those journals.

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Encouraging healthy living at the YMCA

3705 CTH 25, La Crescent, MN 55947
Phone: 507-895-1919 or 800-947-9969 (WXOW)

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La Crosse Healthy Living Collaboration seeks hero nominations

Whenever Mike Tighe posts new content, you’ll get an email delivered to your inbox with a link.

Email notifications are only sent once a day, and only if there are new matching items.

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Healthy Living: Monarch Confirms Cancer

Lung cancer kills more Americans than breast, prostate and colon cancer combined and like other forms of cancer, the earlier it’s caught, the better chance patients have to survive.

Now a new device is helping doctors diagnose lung cancer in one minimally-invasive procedure.

We explain how in Healthy Living. 

The Monarch received FDA clearance at the beginning of 2018.

Dr. Hogarth says, so far, a handful of major medical centers across the country have begun using the technology for diagnosis.

Dr. Hogarth is a consultant with Auris Health, the company that helped create the Monarch and owns stock in the company.



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Healthy Living: Diabetes

SAN DIEGO (KUSI) – Close to one and a half million Americans are diagnosed with diabetes each year. According to the American Diabetes Association, it’s the seventh leading cause of death in the United States.

It’s especially prevalent within Native American communities, and because of that, the San Diego American Indian Health Center is working to promote awareness and share resources through their new diabetes program.

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5 Enriching Additions to Your Morning Routine

The early morning hours are a precious time, made for soft slippers, slow blinks, candles and tea — all the tea. Truly, is there anything better than waking up to a glowing sunrise? Waking up in this relaxed manner has lots of benefits, too.

A carefully crafted morning routine provides us with the space we need to meditate and reflect, set intentions for our day, and calm any stresses that might sidetrack us along the way. If this time is left unprotected, it gets filled with snoozed alarms, a rushed blow dry and toast in the car on the way to work. That’s a lot less enriching, isn’t it?

Ready to reclaim your mornings? Here are 15 creative additions you can add to your morning routine to make it a little sweeter, a little calmer and a little more healthful. Who knows, maybe this is where things turn around for you.

1. Head straight for your meditation spot.

Meditating first thing might sound a little ambitious, but it doesn’t have to be! Simply create a quiet, comfortable space and make it your first stop along your morning journey. You can even keep your eyes closed.

2. Light a candle and only a candle.

Waking up with the sun is such a treat. Don’t pollute your space with artificial light in the morning. Instead, light a candle to take with you to meditation or to the kitchen until the sun starts flooding the room on its own.

young woman enjoying morning sun next to her window

3. Start tongue scraping.

This is a weird one, but those who do it swear by it. Tongue scraping helps manage the coating of bacteria that lives on the tongue and leads to better breath in the long run. Plus, it’s actually kind of a nice massage!

4. Wake up your digestive system, too.

Drinking hot lemon water in the morning on an empty stomach is a lovely, gentle way to wake up your digestive system while also getting a number of health benefits. Lemon water is a rich source of vitamin C, helps maintain the pH balance of the body and can even help fight infections.

5. Go for a walk.

Fresh air, dew on the grass, sunlight glinting off the greenery…a walk early in the morning will certainly set your day off right. Plus, if you have a dog, this is a wonderful opportunity for quality time together. Don’t worry about getting yourself dressed up before you head out. Sweats and a messy bun are entirely appropriate.

How do you wake up in the morning? What has helped you reclaim those precious morning moments?

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Foods that Purge Heavy Metals

Realize it or not, most people are exposed to heavy metals on a regular basis. They include: cadmium, lead and mercury, to name a few of the most prevalent ones.

Dealing with heavy metals requires a two-fold approach: reduce your exposure and increase the foods that help purge them from your body.

Reduce Your Heavy Metal Exposure

First, it is imperative to reduce your exposure to metals. While it is not possible to eliminate them altogether, we can make a concerted effort to minimize our exposure to them. There are many common sources of heavy metals. Here are some of the most common ones:


Cadmium is potentially toxic to every bodily system because it interferes with critical mineral absorption in the body. Minerals like calcium, iron and zinc are needed for a healthy immune system, brain, bones, nerves and much more, so interfering with their absorption can cause serious health issues. Cadmium is found in: black rubber, burned motor oil, some ceramics, cigarettes, some drinking water, fertilizers, some floor coverings, pesticides, soft drinks (from vending machines with cadmium in the pipes) and tires.


Once lead gets into the body it can be difficult to remove, so it is essential to reduce exposure. Once inside the body it can interfere with brain and mental functions. It is most commonly found in: canned food, ceramic dishes, cigarette smoke (first or secondhand), lead candle wicks, paint in older homes, water pipes, some municipal water supplies, some chocolate and vehicle emissions.


Mercury is a well-established nervous system toxin that can have damaging effects on the brain, mental functioning and the nervous system. It is most commonly found in older dental fillings, some fish (particularly farmed fish) and in most vaccines. The fish that tend to regularly show up as having the highest levels of mercury in them include: mackerel, farmed salmon, shark, swordfish, tilefish and tuna. Additionally, it is emitted into the environment from coal-fired power plants.

Foods that Help Purge Heavy Metals

There are many foods that can help purge metals. Start by eating a high fiber diet since fiber can bind to some metals to help escort them out of the body. That means eating more legumes like black beans, chickpeas, kidney beans, navy beans, pinto beans and many others. Strive to get at least a half-cup to one-cup of beans in your diet every day.

Apples, citrus fruits and berries tend to be high in a particular type of fiber known as pectin. Add more apples, oranges, grapefruit, blackberries, blueberries, raspberries and other foods to your daily diet. Choose organic options or you may be adding more heavy metals from pesticides into your body.

Other foods that can help purge heavy metals include: chlorella, cilantro, garlic, green tea, probiotic-rich foods like sauerkraut or kimchi, seaweed, spirulina, tomatoes and turmeric. Some of these foods bind to metals to escort them out of your body while others like garlic contain important sulfur compounds that help to clear liver pathways to ensure efficient detoxification systems, and therefore improved likelihood of removal from the body.

Equally important, you’ll want to reduce the amount of processed and fatty foods you eat since metals tend to accumulate in fat. So that includes: most meat and dairy, as well as fried foods.

Eliminating heavy metals from your body is not an overnight process. It takes time and patience, and persistence through metal avoidance and a healthy diet with a focus on metal-eliminating foods.

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Dr. Michelle Schoffro Cook, PhD, DNM is the publisher of the free e-newsletter World’s Healthiest News, the Cultured Cook, co-founder of BestPlaceinCanada, and an international best-selling and 20-time published book author whose works include: Cancer-Proof: All Natural Solutions for Cancer Prevention and HealingFollow her work.

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Healthy Living: You are more than numbers on a scale

Probably once a week maybe more, I talk to someone who is upset by the numbers they see when they step on the scale. And I SO get it because I always have the same gut reaction. Generally I want to pitch the scale out back and let the horses trample it. I have a love-HATE relationship with my scale. Stupid digital numbers anyway. You work so hard to stay on track the majority of the time with your nutrition and exercise, YET the scale does not seem to reflect that hard work.

Breaking it down, yes the scale does give you a PART of the picture but you are so much more than that one little number. For the past 12 months or so, every visit I had to the doctor was reflecting my blood pressure higher than it should be. I could not figure out what was going on. My weight although not where I like it had not changed. Nothing really changed. Or had it?

It had. Unknowingly, I was not doing as much aerobic exercise as I had in the past. An increase in cardio exercise during the week brought my blood pressure back in the range it should be — and where I like it. Did my weight change? It did not. But the 20 points off my blood pressure are even more important to me than 5 pounds off the scale as there is heart disease in my family. I don’t take that on personally but I am aware of it and know my blood pressure is a part of my overall health picture so needs to be kept in check.

My mother has completely eliminated her diabetic medication. Another friend has eliminated her blood pressure medication. And another friend was able to stay OFF medication. What did we all have in common? We all exercise and stay on track for the most part. Maybe not all the time, but we are on track the MAJORITY of the time.

We need to remember to look at the BIG picture and not be so hard on ourselves. Health and wellness is a journey and journeys like hills will have ups and downs. Taking it a step further, CELEBRATE our successes instead of being so darn focused on what we perceive as failure.

So the next time you step on the scale and you do not see what you like, think about what you HAVE improved on. Maybe you can walk longer today than you did a month ago. Maybe you are taking a harder fitness class now than you did a month ago. Maybe you have changed your nutrition so that you are eating more fruits and vegetables than you did last year. Or you have replaced soda in your diet and now drink more water. ALL SUCCESSES.

One step forward today is better than no steps at all. Country Strong Gym will have a Health Wellness Fair Saturday, Nov. 3, at 10 a.m. There will be speakers talking about nutrition, exercise and more. Free and open to everyone. Have a wonderful week.

To your health,


Denise Sanger is a certified fitness instructor, Silver Sneakers Instructor, AMPD Kettlebell Instructor, licensed Zumba, STRONG by Zumba instructor, gentle flow yoga, teaches morning classes at Country Strong Health Fitness. Denise may be reached at, 386-292-6105 or

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Healthy Living James from Poole

DORSET food blogger James Wythe, known as Healthy Living James, has become a social media sensation with around 45,000 followers.

The 29-year-old health coach based in Ashley Cross, Poole, specialises in creating simple, healthy, gluten, wheat, dairy, egg and refined sugar free recipes – which also taste absolutely delicious.

But only eight years ago, James became so unwell that he was bedbound, and so weak he could hardly speak.

Life had been going well for James until December 2010. He had just completed his sports science degree at Bournemouth University and he was an accomplished golfer who played for the uni and also the Dorset County first team.

One morning he woke up feeling sick and dizzy. At first he thought it was just a touch of food poisoning, but he became so ill that he was later rushed into hospital for suspected brain tumour.

“I had several brain scans but I was so weak at that point having lost nearly three stone in weight that I couldn’t eat, drink or even stand up,” says James.

“After multiple attempts to get help from the doctors they finally, after nearly six months, diagnosed me with M.E. (Myalgic Encephalomyelitis) also known as CFS (Chronic Fatigue Syndrome). I was told there was no cure and all I could do was rest and wait.”

As part of his long road to recovery, James started to see a nutritionist.

“The nutritionist I was seeing at that time had also suffered from M.E many years earlier and therefore could relate to my story.

“She told me to immediately cut gluten and dairy from my diet. I’d always had a pretty balanced diet and never feasted on typical takeaway food but we hadn’t considered looking more carefully at what I was really eating.

“That was the first step into changing my diet and nutrition along with taking supplements, some of which came from America specifically designed for M.E sufferers.

“At first this was a major change from eating a normal balanced diet to really having to think about exactly what to eat and what that food actually contained. My mum also had to change the way she prepared food but after just a short while this became less of a challenge and actually became the norm.

“Now, I am at a stage where I can look back and see what a huge impact food has had in my recovery, the more I clean up my diet the better my energy levels become.

“I keep discovering more and more ways to eat healthily but without making it super complicated.”

James adds: “I’m not unique and there are many people that have suffered or are suffering from similar health problems.

“Healthy living is one of the ways I have found that works and I hope that sharing my experiences through my blog may offer a way forward.

“My aim is to inspire and motivate people to make better food choices and to improve their overall lifestyle.

“Many believe that cooking healthy recipes is expensive and time consuming and I want to change that. With a few tweaks to what you store and use in your kitchen, you too can live a healthier more balanced life.”

But you don’t have to have food intolerances to benefit from his recipes.

“I enjoy experimenting with different foods and flavours – most of my recipes are quite seasonal but I always test a recipe at least three to five times. I want people to know that they can trust me.”

(I’ve tried both his Peanut Butter Granola and his Spinach and Chickpea Curry (I added chicken to mine) and they are now firm favourites. Try his recipes here and see for yourself).


Extremely simple and delicious gluten free, vegan and refined sugar free granola that you can easily make at home with a few quick steps.

This granola is one for the nut butter fans out there… It’s crunchy, so easy to make and can be used in lots of different ways.

And of course if you don’t like or have an allergy to peanut butter this recipe works with any nut butter you choose!

It only uses these 7 ingredients that you will most likely already have in your kitchen at home.


2 cups gluten free oats 200g

1 cup almonds 150g

1 cup pecans 150g

1 cup ground almonds 100g

4 tbsp coconut oil melted

6 tbsp maple syrup

4 tbsp peanut butter

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Pre-heat your oven to 160C

In a large mixing bowl add all the ingredients and mix well

Line a baking tray with baking paper and add the granola, making sure to evenly spread it across the tray so that it cooks evenly

Place in the oven at 160C for 25 minutes (or until lightly golden brown)

Remove from the oven and either eat warm or allow to cool


This will last in a sealed container for a while so make a big batch


A really simple and tasty curry that can be made in one pot in just 10 minutes!

This is the perfect dish for when you don’t have much time and fancy something comforting. You will definitely be surprised how much flavour this packs in from cooking for such little time.

The best part about this 10 minute curry apart from the fact it is so quick to make is that this is so inexpensive too, only costing roughly £1 per portion.

The more you make this curry the quicker you will become. I think it can be made in under 10 minutes quite easily once you have made it a couple times.

Just make sure you make extras as this can be kept in the fridge in an airtight container for up to 2 days or it can be frozen so you have a healthy meal another time.

2 tbsp olive oil or coconut oil

3 garlic cloves crushed

1 red onion roughly diced

1 tsp paprika

1/2 tsp cayenne pepper

1/2 tsp ground coriander

Pinch of chilli flakes

2 tbsp tomato puree

2 cans chickpeas 400g x2

200 ml veg stock

1 can coconut milk

1/2 cup ground almonds 60g

200 g spinach


Heat a large pot on a medium heat with olive oil/coconut oil and crushed garlic

Meanwhile roughly dice the red onion and add to the pot to cook down for a minute

Add all the spices and tomato puree and stir

Now add the chickpeas, coconut milk, veg stock and cook on a medium/high heat for 5 minutes making sure to stir

Add the ground almonds and stir. Allow to cook down for a further 2-3 minutes

Finally take off the heat and stir through the spinach until wilted


Serve with a side of brown rice or quinoa.


Bounty Bars were always one of my favourite ever chocolate bars when growing up, although it has been roughly 8 years now since I have had one. I am sure it was as favourite for many of you also!

It is one of my dads favourite chocolate bars and as it is his birthday in just 3 days I fancied trying to make my own for him.

These mini bounty bars are gluten free, vegan and refined sugar free with only 5 easily sourced ingredients compared to the 12 in the original bar.

They are so simple yet great fun to make so if you have kids then get them to make them, they will absolutely love it!

They will easily last in the fridge for a few days if you haven’t eaten them all by then.


Portion: 8 bars

1/2 cup desiccated coconut (50g)

1/2 cup coconut flour (50g)

3 tbsp maple syrup

2 tbsp coconut oil, melted

Ingredients for the chocolate:

4 tbsp cacao powder (25g)

3 tbsp coconut oil, melted

2 tbsp maple syrup


Add the desiccated coconut and coconut flour into a large mixing bowl and hand whisk, making sure there are no lumps

Now add the maple syrup and melted coconut oil and mix well

In your hands, form bar shapes with the mix (this doesn’t need to be perfect, I prefer mine more rustic with random shapes)

Now place onto a plate and put them into the fridge for 10-15 mins to harden

When there is 5 minutes left on the timer, add the melted coconut oil and maple syrup over a bain-marie and stir

Now add the cacao powder and mix in well making sure there are no lumps

Remove the coconut bars from the fridge and simply dunk into the chocolate mixture, making sure to cover evenly

Place the bars onto a cooling rack or baking paper and place back into the fridge for 1 hour to harden (you can add to the freezer if you want to speed up the process)

Just before serving I like to drizzle the leftover chocolate mixture over the top along with some desiccated coconut.

  • For more recipe ideas, visit or follow him on Instagram

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Avoid “push up bras” for healthy living, expert warns women

Avoid “push up bras” for healthy living, expert warns women

Abubakar, an Assistant Director, Nursing Services, Abubakar Tafawa Balewa Teaching Hospital, Bauchi, gave the advice while speaking with the News Agency of Nigeria (NAN) on Friday.

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