Understanding cholesterol

Do any of your family members have high cholesterol or heart problems? Or, do you realise that your diet is high in fat and that you may be carrying extra weight? If so, it's time to talk to your doctor about your cholesterol.

What's cholesterol? Cholesterol is a fat-like material present in the blood and most tissues, especially nervous tissue. An elevated concentration of cholesterol in the blood (high cholesterol) is a serious risk factor for hypertension and heart disease. High-density lipoprotein (HDL) cholesterol is often called the "good" cholesterol because it helps "cleanse" cholesterol from the blood vessels. In contrast, low-density lipoprotein (LDL) cholesterol is often referred to as the "bad" cholesterol.

over time, it can accumulate in the blood vessels with other substances to form plaques. That can cause a blockage, resulting in heart attack or stroke.

What's good diet for high cholesterol? Diet alone can help reduce high cholesterol levels in the blood. But there is not a single diet plan that will work for every person. An appropriate diet should be developed by the patient and a registered dietitian based on medical history, previous dietary patterns, individual lifestyles, and personal preferences. In addition, patients will vary in their willingness and ability to adapt to dietary restrictions. Collaboration between dietitian and patient to evaluate all of these variables is essential. The most important factor to control is the saturated fat in the diet. Saturated fat comes primarily from food of animal origin such as meat or dairy products. Foods high in soluble fibres such as lentils, beans and oatmeal also assist in reduction of blood cholesterol. These foods should be consumed several times a week. Consuming soy based "vegetarian" type meals may also help to lower cholesterol. Keeping your diet high in fruits and vegetables is also important, not only for risk of heart disease but it lowers cancer risk as well. Some fruits like apples and oranges, and some dried beans may even help reduce blood cholesterol levels. Research is showing that one who east 2 to 3 apples a day may have lower cholesterol. Studies show that the LDL (bad cholesterol) dropped while the HDL (good cholesterol) went up. Researchers believe that the pectin in the apples is one of main reasons why total cholesterol decreased. Much of the pectin the apple has is in the peel (skin). Pectin through research has been found to be effective in lowering serum cholesterol, triglycerides, and blood sugars. Apples are also a good source of thiamine (vitamin B1) needed to help brain function.

I have high cholesterol and need to be treated but I don't want to take drugs. Do I really need to? The reason for wishing to treat high lipid levels is that they are a risk factor for certain conditions, particularly cardiac disease. Within populations, there is an exponential relationship between serum cholesterol and the incidence of coronary heart disease. This depends on LDL cholesterol, which usually comprises some 70-80% of total cholesterol in men and a little less in women. The optimal serum cholesterol is 200mg/dL or less. A level of 250 is considered to indicate a moderate risk, and 270 a high risk. For serum HDL cholesterol, a lower limit of normality of 40mg/dL, and an ideal level above 60mg/dL is desirable. Cholesterol values must always be viewed in the context of the individuals' overall cardiovascular risk. This is because, although each risk factor for cardiac disease is important, the presence of more than one more than doubles the importance. Therefore, for example, if you just have high lipid levels on their own, there might be less of an indication to treat you than if you had high lipid levels and, say, high blood pressure too. Always remember that the reason for identifying risk factors is to reduce the risk that these factors suggest. However, one final point is that medication might not be indicated in the first instance and dietary and other means of control could well be tried first. By eating a healthy diet you help raise the "good" cholesterol levels and lower the "bad" cholesterol levels. Regular exercise is also necessary to reduce and/or maintain normal body weight, along with no smoking.

I have diabetes and high blood pressure and high cholesterol levels. What can I safely eat? You have three risk factors for cardiovascular disease (and the diabetes also can cause other complications). Each of these risk factors responds to diet.

We will deal with each in turn.

Let us start with diabetes. The immediate question here is whether you are overweight or not. If you are, then successful management depends essentially on dietary treatment to reduce you weight. This is particularly important if you have type II diabetes. Meals should be slowly digested and absorbed. The need for regular feeding should be stressed in insulin dependent diabetics. Do not forget about the benefits of exercise.

High blood pressure can be controlled by weight reduction, alcohol restriction, avoiding extra salt to cooking. Potassium ( in fruit and vegetables) is probably very important. There is some evidence too that certain fish oils lower blood pressure.

For high cholesterol reduce obesity. The main dietary effort should be to reduce dietary fat, especially saturated fat, which should be less than 10 per cent of the dietary intake. Saturated fat should be substituted with a mixture of unrefined carbohydrate and monounsaturated and polyunsaturated fats such as sunflower, corn oil and fish oil. Fibre is particularly advisable. Some dietary fat is needed for good health. Choose low-fat milk products, lean meats, fish, poultry, beans, and peas to get essential nutrients without substantially increasing calorie and saturated fat intake. Eat less red meat, especially ground beef and fatty processed meat like sausages and hot dogs, and full-fat dairy products like whole milk, regular cheese, ice cream, and butter. And remember: egg yolks are the biggest source of dietary cholesterol.