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Cholesterol The Facts and the Myths

By now, most people know that high levels of blood cholesterol can lead to blocked arteries. If an artery that supplies blood to your heart becomes blocked, a heart attack may occur. If an artery that supplies blood to your brain becomes blocked, a stroke could occur. Still, confusion abounds over the role of diet in affecting cholesterol.

Although often portrayed as a dietary evil, cholesterol is essential to life. The body needs it to make sex hormones, bile, vitamin D, cell membranes, and nerve sheaths. These and other functions fall to serum cholesterol, a waxy, fatlike compound, termed a "lipid," that circulates in the blood stream. The liver manufactures about a gram each day, which is all the body requires.

Dietary cholesterol is found only animal products. The body does not need this cholesterol, but anyone other than a strict vegetarian who excludes all animal products will consume varying amounts of it. Many factors exercise, genetics, gender, and other components of the diet influence how the human body processes dietary cholesterol; some people can consume large amounts but have normal blood levels, while others eat very little but have high blood cholesterol. Diet appears to account for about 20 percent of the cholesterol in the body, with the remaining 80 percent produced by the liver. 

Good versus bad cholesterol

To travel through the bloodstream, cholesterol molecules attack themselves to lipid-carrying proteins, or lipoproteins. Two types of lipoproteins are the major transporters of cholesterol: low-density lipoproteins (LDLs) carry two-thirds of it; most of the remainder is attacked to high-density lipoproteins (HDLs). LDLs tend to deposit cholesterol in the artery walls, leading to atherosclerosis and an increased risk of heart disease. In contrast, HDLs collect cholesterol from the artery walls and other tissues and take it to the liver to be metabolized and eliminated form the body. this is why LDLs are often called the "bad" cholesterol and HDLs the "good." A third type, very-low-density lipoprroteins (VLDLs), carries a small amount of cholesterol and triglycerides.

A blood cholesterol test measures the amount of cholesterol in the blood. This can be expressed in two ways, in terms of milligrams (mg) of cholesterol per deciliter, or millimoles (mmol) of cholesterol per liter. The multiplication factor 0.026 converts the milligram system to the millimole system. A value below 200 mg/dl (5.2 mmol/l) is considered desirable. If the total is more than 200 mg/dl, LDL and HDL levels should be measured individually. LDL levels should be below 130 mg/dl (3.5 mmol/l); 130 to 159 (3.5-3.9) is classified as borderline high, over 160 (4.0) is considered high risk for coronary artery disease and a heart attack. HDL levels should be at least 45 mg/dl (1.2 mmol/l), and the higher the better. In assessing cardiovascular risk, doctors calculate the LDL/HDL ratio by dividing the total cholesterol by the HDL figure. A desirable ratio is less than 4.5.

How diet can help

Experts agree that dietary modification is appropriate if the total cholesterol count is greater than 200 mg/dl (5.2 mmol/l) or if the LDL level exceeds 130 mg/dl (3.5 mmol/l). Reducing intake of saturated fats has the greatest effect on lowering blood cholesterol levels. A diet that limits fat intake to 20 percent or less of total calories and restricts saturated fats to 7 percent or less can lower total blood cholesterol an average of 14 percent. Most people can significantly lower intake of saturated fats by cutting down on, or eliminating fatty meats, whole milk, and other full-fat dairy products, as well as tropical oils (coconut, palm, and palm kernel). It is also important to lower intake of trans fatty acids found in partially hydrogenated oils and foods containing them such as cookies, crackers, other commercial baked goods, many snack foods, and some margarines and spreads.


Tobacco should be avoided. Firsthand and secondhand smoke both cause a drop in health-promoting antioxidants such as vitamin C. Tobacco smoke also encourages the immune system to increase LDLs.


Stricter diets yield even better results

Try a vegetarian diet. The vegetarian low-fat (less than 10 percent of calories) program developed by Dr. Dean Ornish can lower LDL cholesterol substantially. His program also calls for exercise and meditation.

Be sure to include foods that actually lower cholesterol. It isn't just what you don't eat that matters consuming foods that have a cholesterol-lowering effect also helps. Flavonoid-rich foods, including citrus fruits and onions, are known to promote healthy cholesterol levels. Soluble fiber is flaxseed. The pectin in apples and other fruits lowers cholesterol, as does the soy protein found in tofu, tempeh, and soy milk. It has also been established that regular daily consumption of carrots can lead to a reduction of LD cholesterol levels.

Eat fish rich in omega-3s. Two or three servings a week of salmon, sardines, and other cold-water fish are linked with a thought that the omega-3 fatty acids in fish reduced cardiovascular risk by lowering blood cholesterol levels; however, recent studies suggest that their benefit comes from interfering with blood clotting and from possible changes in the way the liver metabolizes other lipids.

Eat lots of soy products. A large body of evidence has shown that adding soy protein to a low-fat diet helps to lower cholesterol levels. Soy protein is found in soybeans and products made from these beans, including tofu and soy beverages.

Look for margarine with plant sterols. Plant sterols have been shown to help lower cholesterol levels when consumed as part of a heart-healthy diet. They are found in plant-sterol enriched margarines, vegetable oils, nuts, sesame and sunflower seeds, soy and other legumes.

At one time, increasing the intake of polyunsaturated fats corn, cottonseed, safflower, soy, and sunflower oils was advocated to lower cholesterol, but studies have found that these oils reduce the levels of the protective HDLs at the same time as they lower the harmful LDLs. In contrast, monounsaturated fats found in canola and olive oils, some nuts and avocados have the opposite effect, cutting LDLs without altering HDL levels.

The role of dietary cholesterol is still unclear; recent studies indicate it is not as potent in raising blood cholesterol as saturated fats are. Still, some experts recommend limiting dietary cholesterol intake to 300 mg a day the mount in one an done-half egg yolks, 4 oz (115 g) of beef liver, or 2 cups of whole milk, a 6-oz (170 g) steak, and 1 cup of ice cream.


Other approaches

Increased exercise, weight loss, and stress reduction can all lower cholesterol or improve the LDL/HDL ratio. Women are protected from developing coronary artery disease during their reproductive years by the estrogen their body produces; but according to the most recent research, estrogen supplements taken after menopause do not offer similar protection.

Moderate alcohol intake lowers the risk of heart attack. This may be due to alcohol's ability to raise HDL, its tendency to reduce the stickiness of platelets, or the presence of antioxidants, such as resveratrol, in red wine. If dietary and other lifestyle changes fail to reduce blood cholesterol, drugs may be prescribed.


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