Archive for the ‘hypercholesterolemia’ Category

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Dealing With Cholesterol

Friday, August 22nd, 2008

Hypercholesterolemia is said to be one of the main disorders leading to even more serious conditions, such as heart diseases and, in the end, to heart attacks. This is why if we happen to be diagnosed with high cholesterol level we must act in order to restore the normal one. To reduce cholesterol is not an option we may take or not take in such circumstances. On the contrary, if we care at all about our health the reasonable thing to do is to make the decision of following a proper treatment. Lowering cholesterol is a complex process but, despite of this feature, it is still urgent.

Many are the measures one can take in order to deal with cholesterol issues. Some of them refer to dietary habits, meaning we have to reduce or to remove the intake of certain foods, such as yolk-based dishes, fatty meat, organs, shrimps, pastry, regular milk, cream and cheese. Also, changing one’s diet means to enrich meals with other healthier nutrients, like oat, different types of nuts, various species of fish, and so on. Other recommendations made while undergoing a treatment intended to reduce cholesterol refer to physical exercises. Working out alleviates not just cholesterol-related problems, but also has a positive overall impact on our organisms. It helps to reduce our body weight and implicitly it improves the blood pressure.

The process of lowering cholesterol implies, in addition, the necessity to quit smoking. Irrespective of the fact that smoking is extremely damaging from many points of view, it only complicates more whatever heart diseases we may have. Alcohol intake must be eliminated or reduced as much as possible as well. But the thing about the above mentioned manners to deal with cholesterol issues is that they are partial, that is, in order to get visible results one must combine them all or at least some of them into a single conjoint effort. Sometimes, this proves to be a demand too great to be able to satisfy.

But researchers developed some new supplements with the purpose of enabling the process of lowering cholesterol. In time, it was proven that some natural substances improve the low level of HDL, also referred to as the “good” cholesterol, and to diminish hypercholesterolemia which is caused by a high level of LDL, or “bad” cholesterol. Niacin, for instance, is a very powerful compound, also known as nicotinic acid or vitamin B3.

Because of this, it may be possible that it generates some unpleasant side effects, it is usually employed as inositol hexaniacinate. Policosanol may as well count as a supplement helping to lower bad cholesterol and to improve the good one. Guggul and green tea extracts are also proven to decrease the LDL level and to increase the HDL one. Garlic is healthful just as well, and fish oils, rich in omega-3 fatty acids, are extremely efficient in doing the same job. lowering cholesterol is not something we are allowed to ignore if the circumstances ask us to pay attention to our health, especially if we consider that hypercholesterolemia is the main cause of heart diseases. In order to reduce cholesterol some measures are within our reach, and with the purpose of helping our regimen, some supplements with proven efficiency are nowadays offered to us.

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Cholesterol Testing

Sunday, July 27th, 2008

Normal cholesterol level for adults should be less than 200 mg/dL. If a blood test shows 200-240 mg/dL cholesterol in blood, you cholesterol level is high but can still be lowered by lifestyle changes. Hypercholesterolemia is diagnosed when your blood cholesterol level exceeds 240 mg/dL.

Regular cholesterol testing can help you prevent arteries hardening and lower the risk for stroke and heart attack. It is recommended to pass cholesterol blood test at least every 5 years for adults and more frequently for people over age 40 and for those who experience cholesterol level higher than the normal one.

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High Cholesterol (Hypercholesterolemia)

Thursday, June 5th, 2008

Healthy Today – Sick Tomorrow

Unfortunately, high cholesterol (hypercholesterolemia) has become the dominating health concern of the 21st century. It is actually an invented disease that doesn’t show up as one. Even the healthiest people may have elevated serum cholesterol and yet their health remains perfect. But they are instantly turned into patients when a routine blood test reveals that they have a “cholesterol problem.”

Since feeling good is actually a symptom of high cholesterol, the cholesterol issue has confused millions of people. To be declared sick when you actually feel great is a hard nut to swallow. So it may take a lot of effort on behalf of a practicing physician to convince his patients that they are sick and need to take one or more expensive drugs for the rest of their lives. These healthy individuals may become depressed when they are being told they will need to take potentially harmful drugs to lower their cholesterol levels on a long-term, daily basis. When they also learn that they will require regular checkups and blood tests, their worry-free, good life is now over.

These doctors cannot be blamed for the blunder of converting healthy people into patients. Behind them stands the full force of the U.S. government, the media, the medical establishment, agencies, and of course, the pharmaceutical companies. All of them have collaborated to create relentless pressure in disseminating the cholesterol myth and convincing the population that high cholesterol is its number one enemy. We are told that we need to combat it by all means possible to keep us safe from the dreadful consequences of hypercholesterolemia.

The definition of a “healthy” level of cholesterol has been repeatedly adjusted during the past 30 years, which certainly does not give me much confidence in a system of medicine that professes to be founded on sound scientific principles. In the early days of measuring cholesterol levels, a person at risk was any middle-aged man whose cholesterol was over 240 and possessed other risk factors, such as smoking or being overweight.

After the adjustment of parameters during the Cholesterol Consensus Conference in 1984, the population was hit by a shock wave. Now, anyone (male or female) with overall cholesterol readings of 200 mg percent (200mg per 100 ml) could receive the dreaded diagnosis and a prescription for pills. The claim that 200 blood serum cholesterol is normal and everything above is dangerous was scientifically unfounded, though. At least, this was the consensus of all the major cholesterol studies. In fact, a report in a 1995 issue of the Journal of the American Medical Association showed no evidence linking high cholesterol levels in women with heart conditions later in life.

Although it is considered completely normal for a 55-year-old woman to have a cholesterol level of 260 mg percent, most women that age are not told about this. Also healthy employees are found to have an average of 250 mg percent with high fluctuations in both directions.

The lack of evidence linking elevated cholesterol with increased risk of heart disease, however, didn’t stop the brainwashing of the masses. In the U.S. 84 percent of all men and 93 percent of all women aged 50-59 with high cholesterol levels were suddenly told they needed treatment for heart disease. The totally unproved but aggressively promoted cholesterol theories turned most of us into patients for a disease that we probably will never develop. Fortunately, not everyone has followed the advice to have their cholesterol levels checked but, unfortunately, millions of people have fallen into the trap of misinformation.

To make matters worse, the official, acceptable cholesterol level has now been moved down to 180. If you have already had one heart attack, your cardiologist will tell you to take cholesterol-lowering statins even if your cholesterol is very low. From the viewpoint of conventional medicine, having a heart attack implies that your cholesterol must be too high. Hence you are being sentenced to a lifetime of statins and a boring low-fat diet. But even if you have not experienced any heart trouble yet, you are already being considered for possible treatment.

Since so many children now show signs of elevated cholesterol, we have a whole new generation of candidates for medical treatment. So yes, current edicts stipulate cholesterol testing and treatment for young adults and even children! The statin drugs that doctors use to push cholesterol levels down is LIPITOR (atorvastatin). If you decide to follow your doctor’s advice and take one of these drugs, make certain to read the list of side effects so that you know the risks you are taking.

If you want to obtain objective and untainted information on cholesterol, agencies like the National Institutes of Health and the American College of Cardiology are certainly not the places from which to obtain it. Until recently, they wanted you to keep your overall cholesterol level below 150. Then, in 2001, they finally admitted that measuring overall cholesterol levels makes no sense at all, so they began recommending an LDL level below 100. Now their aim is to keep LDL lower than 70. Every time they lower the target, the number of “patients” requiring treatment jumps dramatically, much to the benefit of the drug producers. Being officially backed by these agencies, doctors feel motivated, if not obliged, to prescribe these expensive drugs to their new patients.

The extensive promotional campaigns by the pharmaceutical giants have already brainwashed the masses to believe they need these drugs to be safe from sudden heart attack. Even if a doctor knows the truth about the cholesterol deception, these anxious patients will demand a prescription from him. This is not just affecting their health, but everyone’s economic future. The massive sales of these best-selling drugs of all time drive up health care costs to levels that undermine economic growth and make basic health care unaffordable to an ever-increasing number of people. The masses have been so brainwashed with misinformation that this lurking financial crisis doesn’t seem to be their immediate concern.

In 2004, there were already 36 million statin candidates in the U.S., with 16 million using LIPITOR alone. When the official LDL target level drops to 70, another 5 million people will be eligible for their use. At the consumer markup price of LIPITOR, you can understand the incentive that the pharmaceutical industry has to push their products and make them a mass commodity.

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Cholesterol: More on the Story

Thursday, April 10th, 2008

How often do your club members, clients and class participants come to you as a result of being told to reduce their cholesterol levels, lose a little weight and get fitter?

There is a wealth of research to suggest that elevated blood cholesterol is a risk factor for Coronary Heart Disease (CHD).

Other risk factors include obesity and inactivity, so you are in an ideal position to help out; but do you really have the knowledge to do so? The following update examines the role of diet and exercise in the cholesterol controversy, providing information to help you implement current guidelines to advise your clients.

What is cholesterol?

Cholesterol is a fat-like substance found in animal-derived foods. It is a member of a group of lipids called sterols and can be manufactured by the body, in the liver. If the diet is low in cholesterol, the liver makes more as necessary. Although cholesterol is often labelled as being ?bad?, it is an essential part of every cell in the body and is involved in the production of vitamin D and certain hormones, including oestrogen and testosterone. It is also used in the production of bile acids which are needed for the digestion of fats in the gut.

Factors affecting blood cholesterol

- Genetics, family history

- Dietary fat intake: saturated fatty acids raise blood cholesterol

- Exercise levels

- Central obesity (intra-abdominal fat)

- Other factors, e.g., alcohol intake, smoking, anabolic steroids, high body mass index, age

Dietary cholesterol

The main dietary factor associated with high blood cholesterol is a high fat intake and the type of fat in the diet. A ?low? cholesterol diet simply aims to reduce the amount by reducing the intake of foods containing cholesterol (e.g., shell fish and egg yolks), although there is little correlation in healthy people between the intake of cholesterol and blood cholesterol levels. However, there is a strong link between this and the intake of saturated fatty acids since saturates raise the level of cholesterol in the blood.

Saturated, Poly-unsaturated and Mono-unsaturated Fats

Fats and oils in food are made up of units called fatty acids which can be classified as saturated, polyunsaturated and monounsaturated. All fats and oils contain a mixture of these three fatty acids. Saturated fats (SFA) are usually hard at room temperature and of animal origin. Some dietary sources are beef, butter, lard, cream, whole milk, eggs and cheese. Non-animal vegetable saturated fats are coconut and palm kernel oil, cocoa butter and non-dairy milk and cream substitutes.

Polyunsaturated fats (PUFA) are usually liquid at room temperature and of vegetable origin. They are found in nuts, seeds, meat and many vegetable oils and spreads made from them, e.g., corn, sunflower, safflower. The two main groups are the essential fatty acids linoleic (n-6 or omega-6 family) and alpha-linoleic acid (n-3 or omega-3 family). Current dietary intakes should not be increased.

Monounsaturated fats (MUFA) are considered to be a healthier option. Olive oil is high in MUFA. The high intake of MUFA in Mediterranean countries is thought to contribute to their low incidence of coronary heart disease.

The Effect of Diet Lipoproteins are carriers that transport fat and cholesterol through the circulation. There are several different lipoproteins: however, the two that are usually considered are called low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL cholesterol is often termed bad because high levels are associated with a greater risk of heart disease. HDL cholesterol is often termed good as it helps to have a protective effect . Raised plasma cholesterol concentrations usually reflect elevated levels of LDL cholesterol. LDL is enriched in cholesterol and is the end product resulting from the transport of fat from the liver to the other tissues. Having delivered the fat to the tissues the remnant particle (LDL) is removed from the blood mainly by the liver.

The amount of LDL in the blood depends upon the rate at which it is synthesised and the rate at which it is removed from the blood. Upon reaching a certain concentration, LDL is taken up by macrophages (white blood cells) in the blood vessel wall. These then fill with cholesterol containing LDL, take on a foamy appearance and make up the fatty streaks seen in arteries. Some of these fatty streaks disappear and some go on to form atherosclerotic plaques.

Current research suggests that atherosclerosis may be prevented by anti-oxidant nutrients (including beta-carotene, vitamins C and E), possibly by preventing the oxidation of LDL cholesterol. PUFA in the LDL particle are susceptible to oxidation by the action of free radicals, which are highly reactive oxygen molecules. Free radicals are produced in the body as a by-product of normal metabolism and can also be taken into the body from the environment (e.g., via cigarette smoking, exhaust fumes, radiation)

Considering the potential damage that may occur when LDL cholesterol is oxidised, there is concern about diets with very high levels of PUFA. COMA has therefore set an upper limit of 10% dietary energy from n-6 PUFA. In other words, although partial substitution of n-6 PUFA for SFA helps to lower LDL cholesterol, it is considered unwise to tilt the balance too far. Anti-oxidant vitamins may help to reduce or prevent this oxidation and foods containing them should be increased in the diet.

Dietary sources of beta-carotene: carrots, tomatoes, red and yellow peppers, yellow and orange fruit and vegetables, green leafy vegetables.

Dietary sources of vitamin C: kiwi fruit, oranges, lemons, limes, green peppers, tomatoes, new potatoes, blackcurrants, strawberries.

Dietary sources of vitamin E: wholegrain breakfast cereals and bread, vegetable oils e.g., sunflower, almond, cheese, dairy products, margarine, eggs, avocado

Note that dietary cholesterol alone makes only a minor contribution to the amount of LDL cholesterol in the blood. COMA currently recommends that the current dietary intakes of between 300 and 400 mg/day should not rise. Restriction of dietary cholesterol (e.g., from eggs, shellfish) is advocated for those with particularly high levels because although dietary cholesterol is only moderately absorbed it seems to amplify the effects of saturates by restricting the liver clearance of LDL cholesterol. Fish oils (e.g., from mackerel, sardines, pilchards and salmon) may help reduce the tendency of blood to clot.

The Effect of Exercise

Even gentle exercise such as brisk walking has been shown to increase the HDL levels and reduce LDL levels and this effect is more marked with more intense exercise. These benefits have been shown particularly with aerobic exercise within the ACSM guidelines, but are probably also present within resistance training with medium resistance and high repetitions. In some people the total amount of cholesterol may remain the same, but HDL is, as we have seen, protective against CHD. So, combining a low cholesterol diet with regular exercise will lower significantly the risk of CHD

Is it really necessary to know blood cholesterol level?

Knowing that you have a high cholesterol level may increase stress levels and since stress is itself a risk factor for CHD, it may be better to do everything possible to lower levels without actually knowing how high they are. People with a strong family history of very high cholesterol levels or of CHD (relatives suffering before 50 years of age) however should have cholesterol levels measured and lowered by drug therapy if necessary. The newer drugs available to doctors will lower very high cholesterol levels and reduce the risk of CHD.

PRACTICAL ADVICE TO DECREASE SATURATED FAT INTAKES:

- Major sources of SFA in the UK are meat products and dairy products. – Use semi-skimmed or skimmed milk in place of whole milk. – Use half fat cheese in place of regular cheese. – Buy lean cuts of meat. Trim the visible fat. – Choose cooking fats high in unsaturates, e.g. soya, corn, olive, rapeseed oils. – Use butter sparingly. – Avoid cream.

12 Tips to lower blood cholesterol levels

* Reduce intake of foods high in saturated fat
* Keep total fat intake low
* Eat more foods containing fibre
* Be regularly active
* Eat more beans and pulses
* Eat at least five portions of fruit and vegetables every day
* Choose vegetable oils for culinary purposes, e.g., olive, rapeseed, sunflower.
* Eat more complex carbohydrate foods, e.g., bread, rice, pasta, cereals and potatoes.
* Eat oily fish, e.g., sardines, herrings, mackerel, trout and salmon two to three times per week. – Avoid smoky areas and jogging along busy streets.

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The Definitive Guide to Cholesterol

Wednesday, February 20th, 2008

With all the talk of fighting, battling, combating and beating cholesterol into submission, you’d think it had a black plastic body suit and James Earl Jones’ voice. Big Pharma has, dutifully created quite an arsenal for our supposed defense, and the medical community has been a willing faction, delivering the rhetoric that would incite us all to pick up arms. Now if only we could put down the Big Macs. And the Ding Dongs, HoHos, Twinkies and…you get the point.

Preposterous.

But the insidious rogue, that menacing villain isn’t to be found at the helm of the Death Star. Turns out, there is an enemy within and it’s not even cholesterol. Before you fall to your knees, rip your shirt and gnash your teeth, you might want to consider news you don’t hear often enough: the much aligned compound in question is absolutely essential to your physical, psychological and cognitive functioning.

Yes, the message these days seems to be that no number is too low when it comes to cholesterol (except HDL but we’ll get to that later). I’d like to offer a deeper look into the issue, user-friendly enough but more complex and contentious than you’ll get from the commercial sound bytes telling you to talk to your doctor about blah, blah, blah. Consider it one of MDA’s definitive guides that we’re happy to serve up for our gregarious and always thoughtful community.

Excuse me, have you met cholesterol?

(10R,13R)-10,13-dimethyl-17-(6-methylheptan-2-yl)-2,3,4,7,8,9,11,12

,14,15,16,17-dodecahydro-1H-cyclopenta[a]phenanthren-3-ol

Cholesterol is a waxy, charming lipid gracing every cell’s membrane and our blood plasma. Its jobs, which are many, include insulating neurons, building and maintaining cellular walls, metabolizing fat soluble vitamins, producing bile, and kick-starting the body’s synthesis of many hormones, including the sex hormones. Cool stuff actually.

Given all the work cholesterol has to do, the liver is careful to ensure the body always has enough, producing some 1000-1400 milligrams of it each day. In comparison, the 300 milligram recommended limit for dietary cholesterol (your tax dollars at work in the USDA) is a drop in the bucket. And get this: our livers come with feedback mechanisms (at no additional cost) that regulate cholesterol production in response to our dietary intake. When we eat more, it makes less, and vice-versa. Imagine that!

(Interesting note: While animal products like meat, eggs and dairy, are far and away the primary source of dietary cholesterol, plants contain trace amounts of cholesterol and cholesterol-like substances called phytosterols, which may help lower blood or “serum” cholesterol. Not that that matters, as we shall soon see.

So, what’s with all the acronyms on my cholesterol profile, you ask. Let’s take a look. First, there are high density lipoproteins (HDL). (Lipoproteins are spherical fat particles with water-soluble proteins around their exterior. They transport cholesterol). HDL: everybody loves this guy. He has the popular job of transferring cholesterol from the body’s tissues back to the liver. It’s basically the end of the line with this route, and the liver then excretes it through bile. HDL is the one to naturally help get rid of excess cholesterol when the body’s done with it, hence his universal popularity. Some cholesterologists (just made that up) even refer to him as Nature’s garbage truck.

Next, there are low density lipoproteins, LDL. LDL is a lipoprotein and delivery man as well. He has the disgraced job of transporting cholesterol after production from the liver to the body’s tissues. Remember, this is an important job! That cholesterol has a honey-do list a mile long.

Ironically, it turns out that it’s not the cholesterol part of the LDL or HDL moiety that is dangerous, but the actual lipoprotein part. Unfortunately, once medicine had found a way to differentiate between the amount of HDL and LDL in a cost-effective blood test, it was the cholesterol part that got the short end of the deal.

The latest research into LDL shows that there are actually sub-categories of this cholesterol transporter and that some are more dangerous than others. The larger, more billowy LDL particles are now thought to have little or no significant role in heart disease. On the other hand, the smaller, dense LDL particles are the ones believed to be most involved in the process of inflammation that begins the atherosclerosis cascade. And wouldn’t you know it, but it’s a diet high in simple carbs that most readily promotes the formation of these small LDL particles! Unfortunately, this important distinction is probably something your doctor knows very little about, yet it’s the number of small particle LDL that might be the most important reading in any cholesterol test. So a total cholesterol of, say, 230 or even 250 might not be dangerous at all if your HDL is high and your small particle LDL is low.

Before we move on, let’s give brief mention to triglycerides. Triglycerides are essentially the form that fat takes as it travels to the body’s tissues through the bloodstream. The relationship between triglycerides and cholesterol is more of an association. A high triglyceride level, which is unequivocally fueled by a high carb diet, is very often a marker for other problems in the body, particularly insulin resistance (and accompanying risk of diabetes) as well as inflammation (with its risk of heart disease). High levels are often seen with low HDL cholesterol. Once again, the high carb diet wreaks havoc.

The Rise of Cholesterol Panic

Cholesterol free zone looks to have a mascot.

Heart disease took off in the early part of the twentieth century, and doctors frantically searched for the cause throughout the next several decades. Tests in the fifties initially showed an association between early death by heart disease and fat deposits and lesions along artery walls. Because cholesterol was found to be present in those deposits (of course it would!) and because researchers had previously associated familial hypercholesterolaemia (hereditary high blood cholesterol) with heart disease, they concluded that cholesterol must be the culprit. In fact, what happens is that in response to an inflammatory situation, the body uses cholesterol as a “band-aid” to temporarily cover any lesions in the arterial wall. In the event the inflammation is resolved, the band-aid goes away and repair takes place. No harm, no foul. Unfortunately, in most cases, the inflammation proceeds, the cholesterol plaque is eventually acted on by macrophages and is oxidized to a point at which it takes up more space in the artery, slows arterial flow and eventually can break loose to form a clot. And all this time the cholesterol was just trying to be the good guy! Blaming cholesterol for all this is like blaming a cut finger on all the band-aids you have lying around your house.

Death from heart disease, according to the CDC, has declined over 50% since its peak in the 1950s. The success is attributed to a number of factors, including a decrease in smoking and better diagnosis and treatment of high blood pressure. Included in the list of factors was the opportunity for public education regarding the scientific findings/theories related to cholesterol; however, measures (including CDC estimates) of dietary saturated fat intake show that intake has generally stayed the same or risen.

But the dietary cholesterol message stuck.

Early drugs that “battled” high cholesterol prevented its absorption in the digestive tract. The side effects on the digestive system were unpleasant enough and the results modest enough that the drugs never garnered much support from either side of the prescription pad. Enter statins. Statins inhibited the natural production of cholesterol. Side effects were not as immediately noticeable or uncomfortable, and the results were quite good (at least at lowering cholesterol). (The recently beleaguered Vytorin and Zetia combined statin actions with a substance that reduces absorption of dietary cholesterol, preventing your body from trying to compensate for the lower natural cholesterol production.)

But what about the body’s natural impetus to produce a given and necessary amount of cholesterol? What happens to the parts of the body that need the cholesterol? What about the liver’s regulating mechanism? What happens when you mess with evolution? Exactly. Those are the sorts of questions that get thrown aside when you’re riding Big Pharma’s cholesterol hobby horse.

What Are the Problems With This (”Lipid”) Model?

Million Dollar Question

Oh, boy. There’s the million dollar question. First off, let’s go back to the evolutionary question. As a naturally self-regulating system, the body will react if it doesn’t have enough cholesterol (yes, the body’s definition of enough and not Merck’s). If there’s not enough cholesterol, the alarm goes off, strobe lights flash and the body goes into crisis mode. Corticoid hormones coordinate a redistribution of cholesterol, a triage of sorts in which cholesterol is rationed among the many areas of the body that need it. Nonetheless, the body is now working under hardship conditions.

Adequate cholesterol isn’t available for the body’s repair system, for the uptake of serotonin, for the full initiation of Vitamin D and hormone production and their regulation of blood sugar and inflammation, etc., etc. What does your logic tell you here? Yup, nothing is running the way it should.

Let me also add that everyone’s cholesterol profile is going to be different, no matter what. And I acknowledge that a very small percentage of people out there genuinely have *true* hereditary high blood cholesterol, familial hypercholesterolemia, a metabolic condition with impaired or even lack of ability to metabolize cholesterol. This condition can have serious health consequences. By the way, this condition, in its heterozygous form affects at most 1 in 500 people. Total serum cholesterol in these folks is in the 400 mg/dl range (as opposed to the 200 recommended). The homozygous form affects about 1 in 250,000. You likely don’t know anyone in this category because their disorder almost always ends their lives at a very young age.

I mention familial hypercholesterolemia because I want to distinguish it from the claim made by Big Pharma ads that you may have higher cholesterol because people in your family did, and – can you believe it – their company is here to help. Duh! Everyone’s family influences cholesterol profiles. It’s, in small part, genetic. No big worry there. Just because you come from a family with “elevated” cholesterol doesn’t mean you have the familial hypercholesterolemia metabolic disorder. You can pretty much bet a whole lot o’ money on the likelihood that your cholesterol profile – good or bad – has more to do with learned behaviors like diet and exercise. “Elevated” cholesterol doesn’t equate with metabolic disorder.

Officer, You Got the Wrong Guy!

I’ve said it before, and I’ll say it again. Sound and reliable medical research hasn’t proven that lowering (or low) cholesterol in and of itself reduces risk of death from heart disease across a population. Yes, there is always that single isolated guy who throws off the curve, but he (or she) is a statistical anomaly and doesn’t negate the legitimacy of the model. For instance, the Japanese people of Okinawa are among the healthiest in the world. Their heart disease rate is extremely low, but they tend to have “elevated” cholesterol levels.

The fact is, half of all first time heart attack sufferers have a perfectly “normal” cholesterol profile. What does this tell you? There must be some other piece here behind the “other half” and, I would solidly argue, behind the first half. Cholesterol is a red herring.

It all boils down to inflammation. Inflammation is the number one factor in heart disease. This is an accepted fact now, but it still gets little attention and no real prevention or treatment. Think about it: you have your cholesterol levels checked every five years or more if your profile is “problematic.” When do you have biomarkers for inflammation checked? Unless you’ve had a heart attack or been diagnosed with a serious medical condition, probably never.

Fighting inflammation near and far…

Inflammation. What is it caused by? Not fat, but carbohydrates. Yes, sugars and processed carbs are highest on the list of perpetrators here, but grains and starches as a whole contribute to the problem. LDL rises directly not with the amount of saturated fat you eat but with rising levels of inflammation caused by carbs and trans fats.

Oxidation. Furthermore, nearly every study suggests that LDL is only a true threat when it’s oxidized. What oxidizes it? Free radicals. We’re talking trans fats primarily, that beast of an additive found in countless food products (as opposed to foods). What counteracts free radicals (because we all naturally have some in us)? Anti-oxidants: veggies and fruits, of course, as well as nuts, olive oil, etc. Consider also a broad-based multi-antioxidant supplement containing those nutrients shown to decrease oxidation.

Back to the red herring issue. Substantially “elevated” cholesterol, low HDL or high LDL might be reason to give you pause, but not for the reason you might think. The number can tell you that something is amiss, but they’re a symptom of the larger concern rather than the main issue itself. Cholesterol profile can be impacted by other conditions such as hypothyroidism, untreated diabetes or pre-diabetes, pregnancy (surprise!), lactation, stress, liver conditions, heart disease (symptom, not cause of), etc. Talk to you doctor about what your numbers mean in the grand scheme of your health. And see if you can get a read on other markers, like C-reactive protein (an inflammatory indicator) and those small particle LDL numbers.

How to Maintain True Heart Health

Better use two hands…

Now that we’ve conquered the cholesterol frenzy (because the frenzy itself is the real threat), let’s get to the genuine issue of maintaining heart health. Maintaining heart health is about keeping inflammation at bay. As we say here at MDA, that means an anti-inflammatory diet (with exercise), and primal nutrition fits the bill: copious amounts and variety of veggies, fruits, good quality meats, healthy fats and proteins.

Also, plenty of omega-3 fatty acids, particularly fish oil, will thin the blood and help prevent clotting, which along with atherosclerosis (inflammation related), is a serious set up for heart disease and stroke. Fish oil also happens to generally lower triglycerides and increase “good” HDL.

Read up in our MDA archives for additional info on inflammation and healthy living. Thanks for tuning in.

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Understanding Cholesterol

Monday, February 18th, 2008

* Elevated cholesterol levels are very common in Western society and are one of the most important risk factors for cardiovascular disease (i.e. heart attacks and strokes) together with smoking, high blood pressure, a family history of heart disease and diabetes.

* In the next few articles we will look at cholesterol metabolism and what foods have a harmful or helpful effect on cholesterol levels.

* Contrary to popular opinion cholesterol is an essential nutrient for good health – it is a vital component of cell membranes, bile acids, Vitamin D and sex hormones.

* Cholesterol is transported around the body bound to proteins:

i) HDL (high density lipoprotein or ‘good cholesterol’) – transports cholesterol from tissues back to the liver for disposal (equivalent to a vacuum cleaner). When LDL levels get too high, HDL cannot keep up and LDL levels rise to harmful levels.
ii) LDL (low density lipoprotein or ‘bad’ cholesterol) – transports cholesterol from the liver to the tissues.
iii) Other Types e.g. ‘ApoA’ and ‘ApoB’.

* Total Cholesterol = HDL + LDL + Other Types

* The harmful effects of cholesterol occur as the result of a process called oxidation. Whenever wood is burned, smoke is produced as a byproduct. Similarly whenever fuel is burned by our cells oxygen is utilized (hence the name ‘oxidation’) and toxic byproducts are formed e.g. free radicals. Free radicals are molecules of oxygen that are missing one electron and are highly unstable. It is estimated that every cell in your body (over 70 trillion) is subjected to 100,000 free radical hits per day – this causes cumulative damage to all cell structures, particularly cell membranes and DNA. If cholesterol (particularly LDL) becomes oxidized, it turns rancid – this sets up a chain of inflammation and damage ultimately resulting in a build-up of plaque within the walls of your blood vessels (a process known as atherosclerosis). This in turn predisposes to heart attacks and strokes. This is the main reason why elevated cholesterol levels are a risk factor for cardiovascular disease.

* Levels of cholesterol that are accepted as ‘normal’ in the Western world are much higher than levels found in healthy cultures (e.g. Asians).

* Every 1% reduction in total cholesterol levels results in a 2% reduction in risk for heart disease.

ANOTHER FAT – TRIGLYCERIDES

* Triglycerides are the main kind of body fat.
* Triglycerides make up 95% of the fats we eat.
* Most of the stored fat we carry in our bodies is composed of triglycerides.
* Triglycerides are also carried in the bloodstream – high blood triglyceride levels are a risk factor for cardiovascular disease (heart attacks and strokes) similar to high cholesterol levels.
* Triglycerides are the main type of fat found in animal products (e.g. meat, dairy and egg yolks).
* Depending on their chemical structure they are labeled saturated, monounsaturated or polyunsaturated. These have different effects on your health.

FOODS THAT HAVE A HARMFUL EFFECT ON CHOLESTEROL LEVELS

* 25% of your body’s cholesterol comes from dietary intake. All cholesterol comes from ANIMAL sources – the major dietary sources are meat, eggs (yolks) and  full-fat dairy products (milk, yoghurt, cream, ice-cream, butter and cheese). Other sources are seafood (e.g. shellfish, oyster, lobster, crab & shrimp) and organ foods (e.g. liver, kidney, heart and brain).

* The remaining 75% is produced in your liver. Because your body makes cholesterol on its own, limiting the amount of cholesterol in your diet is only part of the solution to managing elevated cholesterol levels.

* The component of food in your diet that has the biggest effect on blood cholesterol levels is SATURATED FAT – this is found in animal products e.g. meat, eggs (yolks) and full-fat dairy products (milk, yoghurt, cream, ice-cream, butter and cheese) and some plant products e.g. coconut and palm oils. Saturated fats increase the amount of LDL and the total amount of cholesterol in the bloodstream.

FOOD NUTRIENTS THAT HAVE A BENEFICIAL EFFECT ON CHOLESTEROL LEVELS:

FIBRE:

* Fibre is tough structural part of a plant that is not broken down during digestion – strictly speaking, fibre isn’t a nutrient because it isn’t absorbed into the body but is excreted largely unchanged. In spite of this, fibre is incredibly beneficial to our health.

* There are 2 types of fibre:

i) Soluble – as soluble fibre passes through the digestive tract it forms a gel-like material that traps cholesterol and prevents it from being absorbed into your body. Pectin is a particular type of soluble fibre that has other beneficial effects as well – it decreases cholesterol production in the liver. Studies have shown that increasing soluble fibre consumption from 4 grams a day to 7 grams a day can decrease your chances of dying from heart disease by 40%.

ii)Insoluble (‘roughage’) – insoluble fibre doesn’t break down in the body; it stays in the intestine and absorbs a lot of water thereby making stools bulkier and easier to pass. By speeding the transit time through the bowel it reduces the amount of cholesterol (and other harmful substances) that is absorbed.

Aim to consume 30 grams of fibre every day.

FATS:

i)Monounsaturated: 

Monounsaturated fats (e.g. found in avocadoes, olives and many nuts) can decrease LDL while leaving the beneficial HDL untouched.

Olive oil may also improve the liver’s ability to remove LDL from the bloodstream.

 ii)Poly-unsaturated (Omega-3):

Found in deep sea fish (tuna, trout, salmon and sardines) and flaxseeds.
Lowers triglyceride and raises HDL levels.

PROTEIN:

Certain types of protein can reduce cholesterol levels e.g. those found in buckwheat, soybeans or beans.

ANTI-OXIDANTS:

Anti-oxidants stop the destructive process of oxidation by donating an electron.

i) Carotenoids – these are the pigments that give fruits and vegetables their colour. They are found in all rich yellow, orange and red vegetables as well as deep green leafy vegetables. The most important classes of carotenoids are B-carotene, lutein, lycopene and zexanthin.
ii) Tocotrienols – these act as anti-oxidants as well as acting on the liver to decrease cholesterol production.
iii) Lignans – these are other compounds with anti-oxidant ability.
iv) Flavonoids (e.g. rutin and quercetin) – these are water-soluble anti-oxidants that also shrink the size of LDL particles.
v) Vitamin C – is a powerful water-soluble anti-oxidant.
vi) Vitamin E – is a powerful fat-soluble anti-oxidant.

PHYTO-OESTROGENS:

Soy products (e.g. tofu, miso & tempeh) contain phyto-oestrogens which help transport LDL cholesterol from the bloodstream to the liver where it is broken down and excreted.
Soy foods also increase the activity of LDL receptors on cells thereby trapping LDL molecules from the bloodstream.
2-3 servings a day can reduce cholesterol levels by 10-13%.

CAPSAICIN:

Some evidence suggests that capsaicin consumption my lower LDL levels.
This substance is found in chillies.

ALLICIN:

Garlic contains a compound called allicin that changes the way the body uses cholesterol.
Eating ½ – 1 clove of minced or crushed garlic a day can lower your cholesterol levels by 10%.

MILK:

Studies have shown that milk contains substances that reduce the liver’s production of cholesterol. Make sure you use choose low-fat varieties e.g. ‘trim’ or ‘supertrim’.

ERITADENINE:

This compound found in Shitake mushrooms can effectively lower cholesterol levels.

SAPONINS:

Saponins appear to bind cholesterol and bile acids and aid their removal from the body.
Saponins have a special ability to target the cholesterol found in cancer-cell membranes – saponins selectively bind to these cells and destroy them.

POLYPHENOLS:

Powerful antioxidants.
Olive oil is a rich source

LIGNANS:

Plant oestrogens that help keep levels of human oestrogen in check and also lower LDL levels.
Flaxseeds are a rich source.

ORYZANOL:

Found in the outer bran layer of brown rice.
Reduces the body’s production of cholesterol – this compound is chemically similar to cholesterol-lowering agents.

 SUMMARY: To raise HDL levels:

·        Exercise daily
·        Consider drinking 1 glass of red wine every 2nd day.

 To lower Total Cholesterol, LDL and Triglyceride levels:

* Eat less saturated fats and cholesterol i.e. meat, animal fats (e.g. lard), full-fat dairy products (milk, yoghurt, cream, butter, ice-cream), tropical fats (palm and coconut oil), processed foods (e.g. sausages and salami), takeaways (e.g. fried foods), snack foods (e.g. biscuits, cakes, pastries, potato or corn chips), organ foods and sea-foods (e.g. shellfish and shrimps).
* Eat a minimum of 30 grams of fibre per day.
* Eat a variety of fruits, vegetables and whole grains (see chart below for best choices).

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Genetic Variant Predicts Heart Disease Risk

Monday, February 18th, 2008

A newly identified risk factor for heart disease also seems to indicate which patients will benefit from popular statin therapies.

Testing for a genetic variation could predict the likelihood that a patient will respond well to certain statins. But some researchers say it’s too soon to use the variation to determine treatment.

Researchers from Celera reported yesterday in the Journal of the American College of Cardiology that a single substitution in the sequence of a gene called KIF6 makes people both more susceptible to heart attacks and more responsive to certain drugs that lower cholesterol. Though there is no known biological explanation linking the variation to heart disease, the study found that it increases the risk of heart attacks and strokes by 55 percent.

Celera, the company best known for sequencing the human genome, examined 35 single-nucleotide polymorphisms (SNPs) in 30,000 patients. Of those, “KIF6 is by far the most significant,” says Thomas J. White, chief scientific officer at Celera. In fact, nearly 60 percent of the study population was found to carry the KIF6 variant. (According to the study, these findings take into account other factors, such as smoking, high blood pressure, and cholesterol levels.)

The researchers also found that carriers of the KIF6 variant responded better to the cholesterol-lowering drugs pravastatin (Pravachol) and atorvastatin (Lipitor). For example, among patients with the genetic variation, those who took pravastatin were 37 percent less likely to experience a heart attack than those who took the placebo. Those without the genetic variation who took the drug were only 14 percent less likely to experience a heart attack than those who took the placebo. Statins are big sellers for the pharmaceutical industry. In 2006, Lipitor, the world’s best-selling drug, brought in $13 billion in global sales.

“This is one of the first studies to show an interaction with therapy” and genotype, says Marc Sabatine, professor of medicine at Harvard Medical School and a coauthor on one of the papers. “That is very exciting to see.”

Surprisingly, the researchers found that KIF6 doesn’t appear to work by lowering levels of LDL or “bad” cholesterol, the standard by which drugs used to prevent heart attacks are normally measured. White says that KIF6 may instead act by stabilizing “vulnerable plaques,” which are particularly prone to triggering heart attacks.

Celera is developing a diagnostic that would test for the KIF6 variant and expects to launch it in a few months.

But some experts caution that it may be premature to introduce such diagnostic tests before there is further confirmation of KIF6′s role in heart disease.

“Even if there are beneficial results, the standard should be that you need to document that knowing the genetic information is clinically useful,” says Sekar Kathiresan, director of preventive cardiology at Massachusetts General Hospital.

Coronary heart disease caused one of every five deaths in the United States in 2006, so scientists have for quite some time been on the hunt for genes linked to heart attacks.

Rapid advances in technology have made that task much easier. At the same time, many of the genetic links to heart disease identified so far haven’t held up on further analysis. At present, the only credible link is to a variant of the gene 9p21, identified last year by the Icelandic company deCODE Genetics, says Kathiresan. DeCODE offers a $200 diagnostic test for the 9p21 variant. (See “Gene Variant Linked to Heart Disease.”)

A second gene, PCSK9, also looks promising, Kathiresan adds. “Nearly everything else is in the realm of ‘possible but not definite.’”

It’s good that KIF6 has been identified as a potential risk factor in several different studies, Kathiresan says. In each of the studies, he notes, there is less than a one-in-20 probability that the finding is a result of chance, which is generally considered an acceptable threshold for statistical significance.

But because of the high possibility of false positives, the threshold for genome-wide association studies should be much higher, on the order of one in 20 million, Kathiresan says. Both the 9p21 and the PCSK9 pass that test, he says.

“The key issue here is we don’t know if these [KIF6 studies] are real results,” Kathiresan says. “You need to show that it is clinically useful, and they have not crossed that threshold.”

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Health and Cholesterol: The Facts

Saturday, February 16th, 2008

Cholesterol seems to be one of those things that strikes fear into the hearts of many, so to speak. But is the reputation that this oily substance has acquired truly deserved? What is certain is that the ‘little knowledge’ that the media often imparts means many folks assume cholesterol is simply a ‘bad’ thing. Alternately, a good number of us may have heard the terms ‘good’ cholesterol and ‘bad’ cholesterol bandied about without knowing much about what this really means. In fact it is a fairly safe bet that if you asked anyone on the street for his or her instinctive response, if asked about cholesterol, they would probably say that we simply need to ‘reduce it’.

The ‘noddy-science’ offered by marketing men to a generally scientifically-naive public has led many people to believe that we should replace certain food choices with specially developed products that can help ‘reduce cholesterol’. Naturally this comes at a price and requires those who can afford it to pay maybe four or five times what a ‘typical ordinary’ product might cost. But is this apparent ‘blanket need’ to strive towards lowering our cholesterol justified? And, indeed, is it healthy?

For anyone who has had the official diagnosis of ‘high cholesterol’ in their bloodstream, they may even have embarked upon a program of medicinal intervention. In fact it is quite likely that they may have joined the legions of long-term pill-poppers who are already lining the pockets of the profit-oriented pharmaceutical giants.

But let’s take a moment, now, to review some of the facts and fallacies about the much-maligned substance: cholesterol.

First of all, cholesterol is a naturally occurring lipid. This means it is a type of fat or oil and it is in fact an essential component in creating and sustaining the membranes of the cells of all bodily tissues. So this alone means we need cholesterol to survive! Most of the cholesterol that is found in our bodies is actually naturally manufactured within our own cells. However there is also an additional contribution that we get from external ‘nutritional’ sources – the foods we consume. In a typical diet providing around 400mg of cholesterol per day from food sources, about half to two-thirds of this amount is actually absorbed through the process of digestion. The body will normally secrete about a gram (1000mg) of cholesterol per day into the bile via the ducts, and approximately three-fifths of this is then re-absorbed.

Where our tissues or organs are a particularly dense complex of cells, which have closely packed cell membranes, there will naturally be higher levels of cholesterol. The key organs that need, and contain, these higher amounts of cholesterol include the liver, the brain and the spinal cord – none of which would work well if we reduced cholesterol too much!

In effect cholesterol plays an essential role in the development and maintenance of healthy cell walls. It is also a critical factor in the synthesizing of steroid hormones, which are a key factor in our natural physical development. Cholesterol is used by the adrenal gland and the sex glands to create these necessary hormones. As you may know, hormones are important regulators of many control mechanisms that occur throughout our bodies as we grow, develop and simply function every day.

Being a lipid, cholesterol is fat-soluble, but it is not soluble in blood. However it needs to be transported around the body to the places where it can be utilized. This is why, in order to be moved around, it must become ‘associated’ with certain lipoproteins which feature a water-soluble (therefore ‘blood transportable’) coat of proteins. There are two key types of lipoproteins that transport cholesterol around the body: low-density and high-density variants. The essential cellular function of cholesterol requires that sufficient amounts are manufactured by specialized sub-systems (or organelles) within the body’s cells called the endoplasmic reticulum. Alternatively, the cholesterol we need must be derived from our diet. During the process of ‘digestion and assimilation’ of foods, it is the low-density lipoprotein (LDL) that carries dietary cholesterol from the liver to various parts of the body.

When there is sufficient cholesterol for cellular needs, the other key transport mechanism in this amazing ‘logistics system’ – high-density lipoprotein (HDL) – can take cholesterol back to the liver from where any unnecessary excess can be processed for excretion.

The ‘noddy-science’ of the so-called ‘functional food’ manufacturers would have us believe that there is such a thing as ‘bad’ cholesterol and ‘good’ cholesterol. This is, in fact, totally untrue. The cholesterol itself, whether being transported by LDL or HDL, is exactly the same. Cholesterol is simply a necessary ingredient that is required to be regularly delivered around the body for the efficient healthy development, maintenance and functioning of our cells. The difference is in the ‘transporters’ (the lipoproteins HDL and LDL) and both types are essential for the human body’s delivery logistics to work effectively.

Problems can occur, however, when the LDL particles are both small and their carrying capacity outweighs the transportation potential of available HDL. This can lead to more cholesterol being ‘delivered’ around the body with lower resources for returning excess capacity to the liver.

LDL can vary in its structure and occur in particles of varying size. It is the smaller LDL particle sizes that can easily become ‘trapped’ in the arteries by proteoglycans, which is, itself, a kind of ‘filler’ found between the cells in all animal and human bodies. This can then cause the cholesterol the LDL carries to contribute to the formation of fatty deposits called ‘plaques’ (a process known as atherogenesis). As these deposits build up, they restrict the arteries’ width and flexibility. This causes an increase in blood pressure and can also lead to other cardiovascular problems such as heart attacks or strokes.

The LDL itself is consequently sometimes referred to as ‘bad cholesterol’, but you can now appreciate the fact that this is simply incorrect. In fact LDL, HDL and cholesterol are all essential to our health. However, it seems that it has become common for humans to have a preponderance of ‘unhealthily’ small LDL particles, which can become a precursor to heart and arterial disease due to the mechanisms described. It is apparently healthier to have a smaller number of larger LDL particles carrying the same quantity of cholesterol than a large number of small LDL particles might transport, but for some reason this is less common. This is an interesting area that demands more research.

When LDL becomes retained by the glycol-proteins in the arteries it is subject to being oxidized by ‘free radicals’. This is when the process can become health threatening. It has therefore been suggested that increasing the amount of antioxidants in our diet might effectively ‘mop up’ free radicals, and consequently reduce this harmful oxidation. Although the idea of consuming foods rich in antioxidants, or even using supplements, is now widely promoted, the scientific evidence for their efficacy still remains to be fully established.

Another point to consider is the occurrence of substances called ‘very-low-density-lipids’ or VLDL, also known as triglycerides. VLDL is converted to LDL in the bloodstream and therefore contributes towards increased levels of LDL and to subsequent potential cholesterol-related health problems. This is why triglycerides are usually measured when a cholesterol test of your blood is undertaken.

The production of VLDL in the liver – which amounts to a combination of cholesterol and low-density apolipoprotein – is exacerbated by the intake of fructose. Fructose is the type of sugar found in many fruits, it is also a component of sucrose and of the widely used food ingredient high-fructose corn syrup. This implies that anyone whose LDL or triglyceride levels are unduly high should cut back on those sweet sugary snacks, and even on the sweeter, fructose laden fruits; not simply reduce their intake of fatty foods!

Vitamin B3, otherwise known as niacin, on the other hand, actually lowers the amount of VLDL, and therefore also LDL. In addition, niacin helps to stimulate the production of helpful HDL, the lipoprotein that carries excess cholesterol back to the liver for excretion. However, in keeping with the best traditions of consuming ‘all things in moderation’, currently recommended upper limits for daily intake of niacin is 35mg, given that it can have toxic effects in larger amounts. Even so, medical professionals have been known to prescribe niacin in doses as high as 2g, up to three times a day, for treatment of those with dangerously high blood cholesterol levels. Naturally you should never self-medicate with high doses of niacin without taking appropriate medical advice.

Niacin in the diet is typically derived from high protein foods including liver and other meats, as well as significant amounts being found in certain nuts and whole grains.

However one of the fashionable types of pharmaceutical drugs of recent times, introduced to treat the apparently increasing incidence of high cholesterol levels particularly in the West, are Statins. These drugs work by interfering with the liver function and reducing the production of LDL. But Statins are a questionable innovation on at least a couple of accounts. Firstly they are not without side-effects: they can, for example, lead to the breakdown of major muscular material, which can ultimately overwhelm the kidneys and even cause acute renal failure.

Statins also appear to reduce the body’s natural levels of the vitamin-like, cellular protection agent known as Co-enzyme Q10. This benzoquinone plays an important role in cellular energy release, particularly in hard worked areas like the lungs, liver and heart. CoQ10 (as it is sometimes called) has also been shown to protect the brain against neurological degeneration. But perhaps most interestingly, with respect to cholesterol, CoQ10 also acts as an antioxidant, particularly active in protecting the system against LDL oxidation and the potential problems associated with this as described above. So whilst Statins might provide a reduction in LDL per se, they might also be causing more problems in the long-term. Naturally, as with many modern drugs, they generally have to be taken for the long-term by anyone who has been prescribed them.

What is particularly disturbing about Statins is, perhaps, the fact that they may be seen as a ‘quick fix’ for unhealthily high LDL, and consequently cholesterol levels throughout the body. They need to be taken over a long period – which makes them very profitable for drugs manufacturers. But they may also be prescribed without the over-arching message that in order to address any cholesterol problem ‘naturally’, the sufferer must change their lifestyle and diet. Statins can seem an easy option but may indeed merely be the beginning of a process where the ‘negative health pay-off’ is simply delayed rather than actively defused! That is not to say that in extreme cases of high blood cholesterol, or hypercholesterolemia, there may not be a useful role for Statin therapy when natural strategies fail or do not prove effective, or feasible.

In truth, and in summary, cholesterol is an important and essential substance that we need for health at a cellular level. It is most likely that any imbalance in our cholesterol transport system comes down to long-term poor dietary and exercise habits. Ensuring that we consume some extra anti-oxidant foods, along with including niacin rich foods, might well be of benefit. But it is perhaps most important to recognize that deliberate and continued levels of activity and the consumption of a healthful diet is a better solution than questionable quick-fix drugs, if we ever are diagnosed with levels of cholesterol and triglycerides that might give cause for concern.

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Cholesterol and Heart Disease: Is there a link?

Tuesday, February 12th, 2008

The truth is, we’ve always had reason to question the idea that cholesterol is an agent of disease. Indeed, what the Framingham researchers meant in 1977 when they described LDL cholesterol as a “marginal risk factor” is that a large proportion of people who suffer heart attacks have relatively low LDL cholesterol.

So how did we come to believe strongly that LDL cholesterol is so bad for us? It was partly due to the observation that eating saturated fat raises LDL cholesterol, and we’ve assumed that saturated fat is bad for us. This logic is circular, though: saturated fat is bad because it raises LDL cholesterol, and LDL cholesterol is bad because it is the thing that saturated fat raises. In clinical trials, researchers have been unable to generate compelling evidence that saturated fat in the diet causes heart disease.

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What is Cholesterol?

Monday, February 11th, 2008

Cholesterol

AHA Scientific Position
Cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream and in all your body’s cells. It’s an important part of a healthy body because it’s used to form cell membranes, some hormones and is needed for other functions. But a high level of cholesterol in the blood — hypercholesterolemia — is a major risk factor for coronary heart disease, which leads to heart attack.

Cholesterol and other fats can’t dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are several kinds, but the ones to focus on are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

What is LDL cholesterol?

Low-density lipoprotein is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis. A clot (thrombus) that forms near this plaque can block the blood flow to part of the heart muscle and cause a heart attack. If a clot blocks the blood flow to part of the brain, a stroke results. A high level of LDL cholesterol (160 mg/dL and above) reflects an increased risk of heart disease. If you have heart disease, your LDL cholesterol should be less than 100 mg/dL and your doctor may even set your goal to be less than 70 mg/dL. That’s why LDL cholesterol is called “bad” cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease.

What is HDL cholesterol?

About one-third to one-fourth of blood cholesterol is carried by HDL. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe HDL removes excess cholesterol from plaques and thus slows their growth. HDL cholesterol is known as “good” cholesterol because a high HDL level seems to protect against heart attack. The opposite is also true: a low HDL level (less than 40 mg/dL in men; less than 50 mg/dL in women) indicates a greater risk. A low HDL cholesterol level also may raise stroke risk.

What is Lp(a) cholesterol?

Lp(a) is a genetic variation of plasma LDL. A high level of Lp(a) is an important risk factor for developing atherosclerosis prematurely. How an increased Lp(a) contributes to heart disease isn’t clear. The lesions in artery walls contain substances that may interact with Lp(a), leading to the buildup of fatty deposits.

What about cholesterol and diet?

People get cholesterol in two ways. The body — mainly the liver — produces varying amounts, usually about 1,000 milligrams a day. Foods also can contain cholesterol. Foods from animals (especially egg yolks, meat, poultry, shellfish and whole- and reduced-fat milk and dairy products) contain it. Foods from plants (fruits, vegetables, grains, nuts and seeds) don’t contain cholesterol.

Typically the body makes all the cholesterol it needs, so people don’t need to consume it. Saturated fatty acids are the main culprit in raising blood cholesterol, which increases your risk of heart disease. Trans fats also raise blood cholesterol. But dietary cholesterol also plays a part. The average American man consumes about 337 milligrams of cholesterol a day; the average woman, 217 milligrams.

Some of the excess dietary cholesterol is removed from the body through the liver. Still, the American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit your daily intake to less than 200 milligrams. Still, everyone should remember that by keeping their dietary intake of saturated and trans fats low, they can significantly lower their dietary cholesterol intake. Foods high in saturated fat generally contain substantial amounts of dietary cholesterol.

People with severe high blood cholesterol levels may need an even greater reduction. Since cholesterol is in all foods from animal sources, care must be taken to eat no more than six ounces of lean meat, fish and poultry per day and to use fat-free and low-fat dairy products. High-quality proteins from vegetable sources such as beans are good substitutes for animal sources of protein.

How does physical activity affect cholesterol?

Regular physical activity increases HDL cholesterol in some people. A higher HDL cholesterol is linked with a lower risk of heart disease. Physical activity can also help control weight, diabetes and high blood pressure. Aerobic physical activity raises your heart and breathing rates. Regular moderate-to-vigorous-intensity physical activity such as brisk walking, jogging and swimming also condition your heart and lungs.

Physical inactivity is a major risk factor for heart disease. Even moderate-intensity activities, if done daily, help reduce your risk. Examples are walking for pleasure, gardening, yard work, housework, dancing and prescribed home exercise.

How does tobacco smoke affect cholesterol?

Tobacco smoke is one of the six major risk factors of heart disease that you can change or treat. Smoking lowers HDL cholesterol levels and increases the tendency for blood to clot.

How does alcohol affect cholesterol?

In some studies, moderate use of alcohol is linked with higher HDL cholesterol levels. However, because of other risks, the benefit isn’t great enough to recommend drinking alcohol if you don’t do so already.

If you drink, do so in moderation. People who consume moderate amounts of alcohol (an average of one to two drinks per day for men and one drink per day for women) have a lower risk of heart disease than nondrinkers. However, increased consumption of alcohol brings other health dangers, such as alcoholism, high blood pressure, obesity, stroke, cancer, suicide, etc. Given these and other risks, the American Heart Association cautions people against increasing their alcohol intake or starting to drink if they don’t already do so. Consult your doctor for advice on consuming alcohol in moderation.

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