HEALTH NEWS

BY BROOKE BOSTIC, M.D. Greene Family Medicine
Published: July 31, 2008

Cholesterol is a daily concern for many people, It is mentioned at most doctor visits and it is on our minds when we select foods at the grocery store and in restaurants, as well as when we are motivating ourselves to do some form of exercise. A good cholesterol level often brings a sigh of relief and a high cholesterol level means more medication or more work on lifestyle changes. So, why are we so concerned about our cholesterol level, what makes it go up and down, and why was the same level good before but now is too high? The main reason we are concerned about cholesterol level is because it is one of the significant controllable factors that contributes to vascular disease. Vascular disease causes strokes, heart attacks, and claudication (pain, cramping, and weakness of the legs when walking). Cholesterol-laden plaques gradually clog up blood vessels and prevent blood flow to our heart, brain, and/or muscles, causing heart attacks and strokes. Along with cholesterol, there are other factors that affect clogging of the arteries. Fish oil seems to help change the character of the plaque so that it is less likely to cause clogging. Exercise helps but is not enough on its own, Cigarettes certainly contribute to the clogging of the arteries. Other diseases also make it worse, such as hypertension and diabetes. Genetics, or family history, plays a primary role as well. Thus, there are many factors that contribute to vascular disease, and cholesterol is one contributor.
It is a confusing process. Some people have very high cholesterol and never seem to get any vascular disease. So where does cholesterol come from? Our genetic setpoint or thermostat for cholesterol determines our level to a large extent. Cholesterol is important for our bodies. It is the main building block for many hormones. It is also used in our digestion process to help absorb oil, and it is the main ingredient in bile. When we eat, we secrete bile, which contains cholesterol, into our intestine and reabsorb it. Eating more dietary fiber, such as whole grains and vegetables, helps bind up the cholesterol and lets it pass all the way through our system without being reabsorbed. Eating less cholesterol is also important. Food products that come from animals have cholesterol in them - dairy products, meat, and eggs in particular. When cholesterol levels are too high, reducing these foods does help to lower cholesterol. Eating these foods in moderation is also a part of a generally healthy diet. Carbohydrates in our diet, such as starches like French fries and sugars, including high-fructose corn syrup, which is in many juices and soda, contribute to cholesterol. There is no cholesterol in starch or sugar, but they cause higher insulin levels, and high insulin levels turn on the cholesterol-manufacturing process in our bodies so that we make higher levels. Exercise is a good way to lower cholesterol effectively. It also changes the type of cholesterol from “bad” to “good” or “protective.“ There are several categories of medicine that help lower cholesterol. These will be discussed in more detail in a future article.
What is a good cholesterol level? A good cholesterol level depends on an individual’s risk factors. It also depends on the type of cholesterol. A cholesterol level consists of several components. The main components are the “good” cholesterol also known as HDL; the “bad” cholesterol, also known as LDL; and triglycerides, which are equivalent to the fat level in the blood. An LDL above 150 may be acceptable in a low-risk person who does not smoke and has a limited family history and a healthy lifestyle. Once hypertension is diagnosed, the goal for LDL is 100 or less. If there are other diseases, then the goal for LDL needs to be lower to help prevent complications from these many factors. For example, once a person has been diagnosed with vascular disease or a heart attack, then the goal for the LDL cholesterol is less than 80. Diabetes is one of the contributing diseases. Once diabetes is diagnosed, the goal for LDL is less than 80. This is why when hypertension or diabetes is diagnosed, cholesterol medication is often given in addition to blood pressure or diabetic medication. This also explains why what seemed to be an OK cholesterol level before is now too high, even though the actual numbers did not change that much.
How do we make our cholesterol level better? Exercise and diet are the primary means. Exercise, particularly aerobic exercise, increases HDL and reduces LDL significantly. Thirty minutes of aerobic exercise three times a week has been shown to make a big difference. Exercise also reduces blood sugar levels and insulin, which reduces the production of cholesterol, and it reduces blood pressure, which affects the buildup of plaques. Diet also makes a huge difference. Whole grains, such as whole wheat, brown rice, barley, and oatmeal, help reduce cholesterol because they contain extra fiber that binds to cholesterol and carries it through our system. Whole grains are also absorbed more slowly than refined starches, such as white flour and white rice, or simple starches, such as potatoes, so that those starches are absorbed more slowly and insulin levels remain lower and produce less cholesterol in that way. Fiber supplements help, including fiber cereal. Fiber One and All-Bran are very high-fiber cereals and can be mixed with others cereals for taste. They can also be mixed into other foods. There is a large selection of fiber options at most grocery stores.
Avoiding cholesterol in our diets is important and can be challenging and confusing. Some people need to be more strict, whereas most people can use moderation. Bacon, eggs, and sausage are important foods to eat in moderation. Good oils, known as omega-3 oils, are particularly helpful. Fish oil and flaxseed oil are in this category and have an important protective effect and can actually increase the level of good cholesterol and reduce the level of bad cholesterol. These usually come in 1000-mg capsules. One to two capsules a day is very beneficial. Some people are advised to take five to six capsules a day to reduce certain components of their cholesterol level. When these measures are not enough to reach cholesterol goals, medications are frequently used. These will be discussed in a future article.
In summary, there are many issues that contribute to your cholesterol level. Simple healthy choices and lifestyle are the same for many diseases. Eat a good diet, exercise, and avoid tobacco products, and hopefully your blood vessels will stay clear of cholesterol plaque buildup for years to come.
This article is one in a series of monthly columns by Greene Family Medicine where doctors will answer your health-related questions. If you have any questions that you would like to ask a doctor for this column, please send them to: Greene Family Medicine, Attention: Paige Herndon, 140 Stoneridge Drive, Suite 100, Ruckersville, Virginia 22968