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March 2009 - Cholesterol
Cholesterol the fatty, waxy substance produced by the liver, is a good thing, because it helps your body build new cells, insulate nerves and produce hormones. But cholesterol can also be a bad thing.
There are two types of cholesterol — HDL (high density lipoprotein), also called “good” cholesterol, and LDL (low density lipoprotein) or “bad” cholesterol. High “bad” cholesterol and low “good” cholesterol can lead to plaque build-up in the arteries. LDL is the main source of artery-clogging plaque, while HDL actually works to clear cholesterol from the blood.
| “LDL cholesterol (LDL-C) is larger in size than HDL cholesterol (HDL-C) and is more likely to build up in the arteries and lead to heart disease,” said Nora Young, RD, CD, a Froedtert Hospital dietitian. “HDL-C helps transport cholesterol back to the liver where it can be removed from the body.”
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Food Sources of CholesterolIn addition to the liver making cholesterol, it also enters your body through certain foods.
“Foods containing trans fats, saturated fat and cholesterol can all raise blood cholesterol, which increases the risk for heart disease.” Young said, “But you can also lower your LDL-C through your diet.” (To raise HDL-C, exercise — in addition to changing your diet — is more effective.)
Young recommends the following steps to lower your LDL-C through diet:
- Avoid trans fats. Trans fat is made when food manufacturers turn liquid oils into solid fats to increase the shelf life and flavor of foods. Trans fat is found in vegetable shortening, some margarines, crackers, cookies, snack foods and other foods. Trans fats raise your LDL-C and decrease your HDL-C, which increases your risk for heart disease.
- Keep your intake of saturated fat to less than 7 percent (15 grams/day) of your daily calories. Saturated fat, the main dietary cause of high blood cholesterol, is found mostly in foods from animals such as beef/beef fat, veal, lamb, pork, poultry/poultry fat, butter, cream, milk, cheeses and other dairy products. It’s also found in some plant sources, such as coconut, coconut oil, palm kernel oil and cocoa butter.
- Keep your intake of dietary cholesterol to less than 300 mg/day, or less than 200 mg/day if you have heart disease. Foods high in cholesterol include eggs, cream cheese, cheddar cheese, butter, ice cream, lamb, beefsteak, chicken, beef kidney and beef liver.
- Consume 25 to 35 grams of fiber per day. Good sources of fiber are oatmeal, beans, legumes, whole grain products, fruits and vegetables.
- Loose weight if you are overweight.
Saturated fat, trans fat and cholesterol are identified on food labels to help you choose foods that help reduce the risk of heart disease.
In many people, blood cholesterol levels should begin to drop a few weeks after starting on a cholesterol-lowering diet.
“For people with elevated LDL-C, reducing saturated fat to less than 7 percent of caloric intake can reduce LDL-C by 8 percent to 10 percent,” Young said. “Eating more fiber can reduce LDL-C up to 9 percent, losing 10 lbs of body weight (if overweight or obese) can reduce LDL-C by up to 5 percent, and consuming less than 200mg/day of cholesterol can reduce LDL-C by up to 8 percent.
“Other dietary changes that can reduce LDL-C include consuming 2gm/day of plant sterols, consuming viscous fiber and consuming 25 gm/day of soy protein.”
- Sterol, a substance in plants, occurs naturally in fruits, vegetables, nuts, seeds, cereals, legumes, vegetable oils and other plant sources. Foods made with plant sterols include some margarines, beverages and snacks such as granola bars. Plant sterols can be absorbed in the intestines in place of dietary cholesterol, resulting in lower blood cholesterol levels.
- Viscous fiber is the “sticky” fiber found in oats, barley, beans and vegetables such as okra and eggplant.
- Sources of soy protein include tofu, soymilk, soy flour, textured soy protein (used as a meat substitute or filler), tempeh and miso.
“In addition to making dietary changes, some people will need medication to control their cholesterol,” Young said. “And don’t forget that regular exercise can be effective in raising your HDL-C levels, which is good for your heart.”
Testing GuidelinesTotal blood cholesterol levels above 240 mg/dl are considered high. Levels between 200-239 mg/dl are considered borderline high. Levels under 200 mg/dl are considered desirable. Mg/dl = using milligrams per deciliter (one-tenth of a liter)
The American Heart Association endorses the National Cholesterol Education Program guidelines for detection of high blood cholesterol in adults age 20 and older. The guidelines recommend a fasting lipoprotein profile (a blood test that measures cholesterol and triglycerides) every five years. If one or more of the following situations applies, you may need to be checked more often:
- Total cholesterol 200mg/dl or more
- Man over age 45 or woman over age 50
- HDL cholesterol is less than 40mg/dl
- Other risk factors for heart disease and stroke
ResourcesSmall Stones, a health resource center of Froedtert & The Medical College of Wisconsin, offers the following resources on controlling cholesterol and heart health:
The New 8-Week Cholesterol Cure by Robert E. Kowalski
Outsmart High Cholesterol by the Editors of Prevention Health Books
The Everything Low-Cholesterol Cookbook by Linda Larsen
Lowering Your Cholesterol by Mason W. Freeman, MD
The Complete Idiot's Guide to Lowering Your Cholesterol by Joseph Lee Klapper, MD
Before The Heart Attacks by H. Robert Superko, MD, FACC, FAHA with Laura Tucker
Reversing Heart Disease by Dean Ornish, MD
Mind Your Heart by Aggie Casey, MS, RN, and Herbert Benson, MD
The Healthy Heart Kit by Andrew Weil, MD
Author: Marla Fraunfelder | Medical Reviewer: | Nora Young, RD, CD |
Last Review Date: March 1, 2009 Online Editor(s): Christopher Sadler
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