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These days, it is hard to sit through a news show without hearing something about high cholesterol from either the newscaster or in a television commercial. If you have not studied up on what cholesterol is, why it is important, how to measure it, and how to treat it, then we hope to answer those questions for you.
Cholesterol is a lipid – any of a group of fats or fat-like compounds insoluble in water and soluble in fat solvents – that is found in cell membranes and is transported in the blood plasma of all animals. Cholesterol is an essential component of mammalian cell membranes, and it is a component essential to establish proper membrane permeability and fluidity.
On its own, the human body will synthesize significant amounts of cholesterol, but a portion of the cholesterol in our bodies are digested from the food we eat.
Cholesterol is classified as a sterol (a contraction of steroid and alcohol). It is more abundant in body tissues that either synthesizes more or has more densely packed membranes, such as: the liver, spinal cord and brain. Cholesterol plays a central role in many of the body’s biochemical processes, such as the biochemical composition of cell membranes and the body’s synthesis of steroid hormones.
The thing about cholesterol that confuses most lay patients is the question of good vs. bad cholesterol types.
The first thing to note is that cholesterol cannot dissolve in the blood. Cholesterol must be transported to and from the various cells in the body, by carriers called lipoproteins. This is where the good and bad are defined.
The low- and high-density lipids (lipoproteins), along with triglycerides and Lp(a) cholesterol, are the four measures that are calculated in one’s total cholesterol count. To determine what one’s cholesterol count is, one needs to have a blood test taken.
Low-density lipoprotein, or LDL, is known as the “bad” cholesterol. When too much LDL (bad) cholesterol is circulating in the bloodstream, it can slowly build up in the inner walls of the arteries that feed the heart and brain. This build up on LDL cholesterol on the artery walls can form plaque – a thick, hard deposit that can narrow arteries and make them less flexible. This condition is called atherosclerosis, and we will discuss it at greater length in the next section.
High-density lipoprotein, or HDL, is referred to as the “good” cholesterol. It is estimated that one-fourth to one-third of blood cholesterol is carried through the human body by high-density lipoprotein. HDL cholesterol is considered to be the “good” cholesterol, because a high level of HDL seems to protect a person against heart attacks. Conversely, low levels of HDL (less than 40 mg/dL) may also increase the risk of heart disease. Some experts have suggested that HDL may remove excess cholesterol from arterial plaque, slowing the buildup of the dangerous LDL.
Triglycerides are a form of fat made naturally in the body. Elevated triglycerides may occur due to being overweight or obese, not doing enough physical inactivity, cigarette smoking, excess alcohol consumption or a high-carbohydrate diet (60 percent of total calories or more). The reason why an elevated triglyceride level is important in this discussion is because it generally indicates high total cholesterol level, where the bad LDL cholesterol level will be high, and the good HDL cholesterol levels will be too low. People who have heart disease and/or diabetes tend to additionally show high triglyceride levels.
Lp(a) cholesterol is a genetic variation of the bad LDL cholesterol. High Lp(a) is a significant risk factor, leading to the premature development of fatty deposits in a person’s arteries. Although Lp(a) isn’t fully understood yet, it is believed to interact with substances found in artery walls and to contribute to the buildup of fatty deposits in the artery walls.
Minimum levels of cholesterol are essential for life, but too much cholesterol in the body can cause diseases such as atherosclerosis (the progressive narrowing and hardening of the arteries over time).
According to the National Institute of Health, coronary artery disease (atherosclerosis of the coronary arteries) is the leading cause of death in the United States.
As atherosclerosis develops, certain conditions become more likely.
For example, if a clot forms and blocks a narrowed artery, a heart attack or stroke could result.
If the build up of plaque in the artery suddenly ruptures, this can result in fatty particles and other non-soluble material being released into the bloodstream. After a rupture, the location of the original rupture could seal over with an overlying clot, potentially creating a larger obstacle in the artery. The released fatty particles may become lodged (as embolisms) further downstream in the artery. Once again, these events could result in a heart attack or stroke.
These plaque build-ups can also lead to the artery bubbling on the side of the artery. These bubbles occur creating a weak point in the circulatory system. If the artery enlargement process (bubble on the artery) is excessive, then an aneurysm (rupturing of a blood vessel) may result. Depending on the location of the aneurysm, the patient who experiences one usually dies within five minutes.
Cholesterol testing is considered a routine part of preventive health care maintenance.
As indicated previously in this article, the way to measure cholesterol is through a laboratory blood test called a Lipid Panel. The blood test will seek out measures of LDL cholesterol, HDL cholesterol, triglycerides and Lp(a) cholesterol.
Cholesterol testing is recommended for all adults, and the test should be conducted at least once, every five years. Healthcare practitioners frequently perform a lipid profile in conjunction with a routine physical exam. The cholesterol test is usually ordered in unison with other tests, including HDL-C, LDL-C, and triglycerides – often called a lipid profile.
For patients who have been prescribed diet and/or drugs to lower their cholesterol, cholesterol tests are generally given more often, mostly to measure the success of any cholesterol lowering treatments that have been prescribed by practitioners. Healthcare practitioners consider the cholesterol tests to be an integral part of lowering the risk of developing heart disease.
Depending on the actual level of your cholesterol numbers, your practitioner is advised to prescribe different treatments for your individual situation. Some treatments will require the use of pharmaceutical drugs, while other people will be able to simply change their dietary habits.
As always, it is very important to control other risk factors you may have such as high blood pressure and smoking.
Therapeutic Lifestyle Changes (TLC) is a treatment roadmap for high cholesterol. It is specifically designed to help lower your LDL cholesterol. It recommends a number of changes including a low-saturated-fat, low-cholesterol eating plan that includes less than 7 percent of calories will be from saturated fat and that a patient will confine his or her daily dietary cholesterol intake to less than 200 mg. The TLC diet definitely recommends that the patient will only consume enough calories to maintain a desirable weight and to avoid weight gain. TLC recommendations also include proper weight management and getting more physical activity during the course of the day.
Foods that are low in saturated fat include: fat-free or 1-percent dairy products, lean meats, fish, skinless poultry, whole-grain foods, and fruits and vegetables.
It is recommended that when shopping for margarines that the patient should seek out soft margarines, such as those found in liquid form or in a tub, that are low in saturated fat and contain few or no trans fats (another type of dietary fat that can raise your cholesterol level).
Foods that are high in cholesterol, such as the liver and other organ meats, egg yolks, and full-fat dairy products should be avoided altogether.
If your practitioner also recommends soluble fibers, then you should add oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), dried peas and beans to your diet.
Saturated fat is the main dietary cause of high blood cholesterol. Saturated fat is found in dairy and other foods and meats that come from animals. Foods such as beef, lamb, veal, poultry fat, pork, lard, butter, cheese. cream, milk, and other dairy products contain cholesterol. Coconut, coconut oil, palm oil, palm kernel oil, and cocoa butter also contain saturated fat.
The American Heart Association’s Nutrition Committee strongly advises the following guidelines for fat intake in those over the age of 2:
We cannot emphasize enough the importance of working with your practitioner to diagnose your cholesterol levels and to find the best treatment for your level of good and bad cholesterols.
Foods made with partially hydrogenated or saturated fats such as cakes, crackers, cookies, muffins, pastries, pies, doughnuts and French fries should be eaten rarely.
Omega-3 fatty acids- There is good evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood.
Fiber — Several studies have shown that soluble fiber (found in beans, oat bran, barley, apples, psyllium, flaxseed, and glucomannan) may lower LDL cholesterol and triglycerides.
Soy — Many studies have shown that eating soy protein (tofu, tempeh, miso) rather than animal meat helps lower blood cholesterol levels, especially when you eat a diet low in saturated fat.
Policosanol Several studies have indicated it may lower LDL (‘bad”) cholesterol and possibly even raise HDL (“good”) cholesterol. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medication.
Beta-sitosterol (800 mg to 6 g per day in divided doses about 30 minutes before meals) — Beta-sitosterol is a plant sterol, a compound that can stop cholesterol from being absorbed by the intestines.
Coenzyme Q10 (CoQ10) — CoQ10 may inhibit blood clot formation and boost levels of antioxidants. People who take statins may have low levels of CoQ10. If you take statins you may want to ask your doctor about taking a CoQ10 supplement.
Polyphenols — Polyphenols are chemical substances found in plants that have antioxidant properties.
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*These statements have not been evaluated by the Food and Drug Administrations. These products are not intended to diagnose, treat, cure or prevent any disease.