Cholesterol: Know The Facts

Cholesterol: Know the Facts

            To Your Health
            April, 2007 (Vol. 01, Issue 04)

      Cholesterol: Know the Facts
      By Peter W. Crownfield
      It's in the news on a near-weekly basis. Research studies address various
      aspects of it. National organizations and expert panels issue
      recommendations on it. "It" is CHOLESTEROL. Here are the answers to
      frequently asked questions about this strange substance that can have a
      profound effect on your health.
      Do you know the causes of high cholesterol and the steps you can take to
      reduce your risk of serious disease? Do you know the different types, and
      how each type can affect your health? What you know is vital to your
      longevity: According to the American Heart Association (AHA), an estimated
      70 million Americans suffer from one or more forms of cardiovascular
      disease (CVD). These diseases claimed 927,448 lives in the U.S. in 2002 -
      more than the total lives claimed by cancer, accidents and HIV combined.
      And in case you view CVD as a condition exclusive to the elderly
      population, take note that more than 150,000 of those killed by CVD in
      2002 were under the age of 65.
      The major type of cardiovascular disease, coronary heart disease (CHD), is
      caused by arteriosclerosis: the thickening or hardening of the coronary
      arteries. Here's where cholesterol enters the picture. Findings from the
      massive Framingham Heart Study, which began in 1948 under the direction of
      the National Heart Institute (now known as the National Heart, Lung and
      Blood Institute), show that blood cholesterol is a risk factor for
      coronary heart disease, and that the higher the cholesterol level, the
      greater the CHD risk.
       THE BASICS Cholesterol is a soft, wax-like lipid that occurs naturally in
      the bloodstream and in cell walls and membranes. It is a normal and
      important part of a healthy body because of the essential role it plays in
      cell membrane, hormone, and vitamin D production, as well as the digestive
      process.
      The liver produces approximately 1,000 milligrams (mg) of cholesterol
      daily from other fats, which is all the cholesterol the body needs. In
      other words, you don't need to consume cholesterol from dietary sources to
      stay healthy. (Infants are the exception: During the growth process, their
      bodies make new cell membranes so rapidly that they require a certain
      amount of dietary cholesterol.)
      Because the body doesn't need dietary cholesterol, particularly not
      cholesterol with "no place to go," it means that consumption of
      cholesterol-laden foods can cause plaque formation/buildup and resulting
      cardiovascular problems.
      LDL, HDL AND TRIGLYCERIDES First, a little technical background: Dietary
      fat is absorbed by the intestine and transported to the liver. The liver
      then converts fat into cholesterol and releases it into the bloodstream.
      Because cholesterol isn't water-soluble, cholesterol and triglycerides (a
      blood lipid) combine with proteins to form lipoproteins, which then
      transport cholesterol through the watery blood system.
      Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are the
      two main types of lipoproteins; they differ markedly from one another in
      their ratio of cholesterol and triglycerides to protein, and thus, in
      their effect on blood levels of cholesterol.
       LDL: the "bad" cholesterol. LDLs carry a great deal of cholesterol,
      because they help transport it from the liver to the rest of the body. Too
      much LDL cholesterol circulating in the blood can cause buildup on the
      inner walls of the arteries that feed the heart and brain. Over time, LDL
      cholesterol can contribute to the formation of plaque - a thick, hard
      deposit that clogs arteries, resulting in atherosclerosis. As arteries
      narrow, the oxygen supply to the heart is gradually compromised, and the
      risk for a heart attack grows.
       HDL: the "good" cholesterol. HDLs carry relatively little cholesterol -
      they actually circulate in the bloodstream, helping remove excess
      cholesterol from blood and tissues. Specifically, evidence suggests that
      HDLs tend to carry cholesterol away from the arteries and back to the
      liver, where it is then eliminated from the body; and that HDLs also
      remove excess cholesterol from plaque in the arteries, resulting in a
      slower potential buildup of plaque.
       TRIGLYCERIDES transport and store fat in the body. It's clear that high
      triglyceride levels aren't good for the body and can be particularly
      problematic when combined with excess levels of LDL cholesterol. People
      with high triglycerides often have high total cholesterol, high LDL
      cholesterol, and low HDL cholesterol. And some lipoproteins are rich in
      triglycerides that also contain cholesterol.
      The National Cholesterol Education Program, developed by the National
      Heart, Lung and Blood Institute of the National Institutes of Health, has
      set the "safe" total cholesterol level at 200 mg/dL. A score of 200 or
      higher signifies increased risk for developing heart disease; over 240
      puts you in the high-risk category.
      An LDL cholesterol level of less than 130 mg/dL is acceptable for most
      people; less than 100 mg/dL is ideal. The desirable level of LDL
      cholesterol depends on whether an individual has risk factors for coronary
      artery disease, or a pre-existing health condition caused by
      atherosclerosis or diabetes.
      The AHA and the American Diabetes Association currently recommend HDL
      levels of at least 40 mg/dL for men and at least 50 mg/dL for women. A
      blood level of 60 mg/dL or above is ideal.
      The HDL:LDL ratio is crucial - perhaps more so than the total cholesterol
      score. For example, if you have a total cholesterol score of less than 200
      mg/dL, you could still be at risk for developing cholesterol-related
      atherosclerosis - if your LDL level constitutes a large percentage of that
      score. By comparison, if your total cholesterol is higher than 200 mg/dL,
      you may actually be at less risk, if your HDL score is high.
       THE FOOD FACTOR: SATURATED VS. UNSATURATED Way back in 1984, the Coronary
      Primary Prevention Trial provided some of the first evidence that reducing
      total and LDL cholesterol levels significantly reduces the incidence of
      CHD; more recent investigations have affirmed this association. Dietary
      habits play a major role in determining your total blood cholesterol
      level, as well as the relative distribution of HDL and LDL cholesterol.
      Consumption of foods high in saturated fat and LDL cholesterol are a major
      reason for out-of-control cholesterol levels and rising heart attack rates
      in the United States.
       All foods that contain fat have different distributions of saturated and
      unsaturated fats. Saturated fat is found primarily in foods that come from
      animals - red meat (particularly fatty cuts), poultry with the skin on,
      whole-milk dairy products (whole milk, butter, cheese, ice cream), and
      tropical oils (coconut, palm kernel, etc.). Consumption of saturated fat
      increases LDL and total cholesterol in the bloodstream.
      On the other hand, unsaturated fats do just the opposite: They increase
      HDL cholesterol and reduce LDL cholesterol and triglycerides. Good sources
      of monounsaturated fat are canola, peanut and olive oil; olives; avocados;
      and most nuts. Polyunsaturated fat can be found in corn, soybean,
      safflower, and cottonseed oils, as well as in fish. And let's not forget
      omega-3 fatty acids, a type of polyunsaturated fat. Evidence suggests
      omega-3s, good sources of which are fatty fish, such as mackerel, salmon,
      sardines or swordfish, may help prevent heart disease. That's one reason
      why the American Heart Association currently recommends that everyone eat
      at least two servings of fish on a weekly basis.
      THE HOT TOPIC: TRANS FATS Trans fats are liquid vegetable oils that are
      transformed via a process called "hydrogenation" into solids at room
      temperature. This chemical process transforms healthy vegetable oils into
      unhealthy fats that have been shown to raise LDL cholesterol.
       In today's world of processed foods, more and more non-animal products
      contain hydrogenated fats/oils, a source of trans fats - which actually
      cause your body to make more cholesterol. Foods that contain trans fats
      include margarines, vegetable shortening, partially hydrogenated vegetable
      oil, countless fast foods (especially French fries), and most commercial
      baked goods (crackers, donuts, potato chips, etc.).
      The good news, if there is any, regarding trans fats is that as of 2006,
      the Food and Drug Administration requires that food manufacturers list
      amounts of trans fats on the nutrition information labels of products.
      You've probably also noticed that increasing numbers of manufacturers now
      make it clear that their products contain no trans fats.
       THE EGG "CONTROVERSY" The egg is perhaps the ultimate cholesterol
      question mark. On the one hand, eggs are a great source of important
      nutrients, including vitamin D, vitamin B12, riboflavin and folate, that
      may help reduce the risk of heart disease. They also provide high levels
      of protein, iron and phosphorus.
      However, since the 1960s, when the connection between cholesterol and
      heart disease first became a public health concern, it was recommended
      that egg consumption be restricted to only one egg per week. Why? Because
      one large egg contains a whopping 213 milligrams of dietary cholesterol.
      (The American Heart Association recommends limiting dietary cholesterol to
      300 mg per day.)
      But studies conducted at Harvard University found that people who ate one
      egg per day were actually no more likely to develop heart disease or
      suffer a stroke than people who ate one egg per week or less. The egg yolk
      contains all the cholesterol (and fat), so limiting consumption of egg
      yolks (to no more than four per week, according to the AHA's current
      recommendation), and products that contain egg yolks, may be an important
      aspect of managing cholesterol.
      THE BOTTOM LINE When it comes to cholesterol, particularly with respect to
      your diet, moderation is probably the best approach, whether it's eggs or
      any other food that can affect cholesterol. Finding a healthy balance of
      diet, exercise, weight management and stress reduction are vital steps in
      winning the battle against high cholesterol.

       Winning the Fight Against High Cholesterol
      KNOW YOUR CHOLESTEROL SCORE. A simple blood cholesterol test will let you
      (and your doctor) know your HDL, LDL and total cholesterol scores. If your
      scores are good, you're on the right track; if they're not so good, your
      doctor can help you get started on the road to better health.
      KNOW WHAT YOU'RE EATING. Consume foods low in saturated fat and trans
      fats, and high in omega-3 fatty acids and "good" fats (such as lean meats,
      whole grains, and fruits and vegetables). Avoid processed foods and limit
      your portion sizes.
      KNOW YOUR FAMILY HISTORY. A genetic history of high cholesterol, high
      blood pressure or heart disease can increase the risk of health problems.
      It means you'll have to monitor your cholesterol more closely than the
      average person.
      EXERCISE DAILY. Just 30 minutes of physical activity a day can have a
      positive impact on your cholesterol levels. By the way, it also helps with
      weight control, prevention of numerous diseases, and can improve your
      overall sense of well-being and health.
      TALK TO YOUR DOCTOR. In extreme high-risk cases, your doctor may prescribe
      cholesterol-lowering drugs in addition to lifestyle changes. But your
      doctor should always pursue natural interventions, particularly diet and
      exercise, before prescribing any type of medication.

      Peter W. Crownfield is the executive editor of To Your Health. Direct all
      comments and questions to editor@toyourhealth.com .

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