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Question: A week or so ago you discussed the role of triglycerides and heart disease. What about high cholesterol? Would you discuss this issue please?Answer: High cholesterol is one of the four major risk factors for cardiovascular disease, along with hypertension, cigarette smoking and lack of exercise. The American Heart Association estimates that cardiovascular disease cost $101.3 billion in 1991 in medical care and lost productivity. Approximately 101.2 million Americans have cholesterol levels over 200 mg/dl - the borderline level for high cholesterol - and are therefore at higher risk for heart disease than they should be.

I'll discuss the topic of cholesterol using the very understandable information from a publication from Krames Communications, "Cholesterol, A Guide to Low-Cholesterol Living."Where does cholesterol come from? Actually, your liver makes most of your body's cholesterol and places it with other fats and protein in packages called lipoproteins. The three kinds of lipoproteins are VLDL (very low-density lipoproteins), LDL (low-density lipoproteins) and HDL (high-density lipoproteins). HDL is called "good" cholesterol because it finds and rescues stuck LDL pieces and brings them back to the liver. LDL is called "bad" cholesterol because pieces of it easily become stuck along blood vessel walls to help form atherosclerosis. VLDL carries fat from the liver to other parts of your body. VLDL becomes LDL after it unloads fat. The problem with a high-fat diet is that it forces your liver to make extra VLDLs to carry the excess fat. With more VLDL there is more LDL. If you don't have enough HDL to pick up the bad pieces of fat, the blood vessels in the heart may become blocked and a heart attack may occur.

Changing your diet is often the most effective way to lower or maintain your cholesterol at a desirable level, though it may take a few months to see the results. The diet guidelines are as follow:

1. Eat less fat. Many of us eat nearly half of our daily calories in fat. The goal is to limit fats to less than one-third of total calories. Do this by avoiding obvious fats such as butter and hidden fats used in many processed foods.

2. Eat more fiber. One kind of fiber (soluble fiber) lowers your cholesterol by keeping the cholesterol you eat from being absorbed by your body. Oats, beans and fruit are rich in soluble fiber.

3. Eat less cholesterol. Eating high-cholesterol food may raise your cholesterol level even though most of the cholesterol is made by the liver. Limit your use of high-cholesterol food such as eggs and meat from all animals, especially organ meats.

4. Eat more starches. Starches (complex carbohydrates) aren't fattening and can lower your cholesterol level by "diluting" the fat you eat. Eat more starches such as grains, beans and root vegetables.

5. Drink less caffeine and alcohol. Both caffeine and alcohol can raise your cholesterol level by raising the fat levels in your blood.

I'll continue the discussion of this topic next week.