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The Cholesterol Story
Many people are frightened when they are told that their cholesterol levels are elevated. They immediately think that only the increase in cholesterol puts them at the “door of a heart attack”. The truth is that there is more to cholesterol than that! High cholesterol does not reliably identify all people with hidden heart disease, nor does lowering it alone cure anyone from heart disease.
Cholesterol is a soft, waxy substance produced by the body. It is found among the fats in the bloodstream and in all the cells of your body. Cholesterol is not the “bad guy”. It is useful for the body. Our body needs it for the formation of cell membranes, the production of bile acids for digestion and the production of hormones and vitamin D. Cholesterol and other fats cannot dissolve in the blood. They must be transported to and from cells using special carriers called lipoproteins. There are several types, but the ones I’ll focus on are low-density lipoproteins (LDL, the so-called “bad cholesterol”) and high-density lipoproteins (HDL, the “good cholesterol”). LDL transports cholesterol to the cells, while HDL transports cholesterol away from the cells. Think of LDL as a garbage truck dumping garbage on the street (blocking your arteries) and HDL as a street sweeper cleaning it up. If there are more dump trucks than cleaners, the street will be congested.
When someone has excess LDL, too much cholesterol can be deposited in the artery walls. On the other hand, an insufficient amount of HDL makes it difficult to transport cholesterol away from the artery walls for disposal in the liver. Therefore, too much LDL and or not enough HDL can set the stage for atherosclerosis. It is a process in which deposits of fat, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of the artery, forming plaque. Plaques can grow large enough to significantly reduce blood flow through an artery. They can rupture and cause blood clots to form. These clots can block blood flow or break off and travel to another part of the body. If anything happens to block the blood vessel that feeds the heart, it causes a heart attack. If this happens in the brain, it causes a stroke. And if the blood flow to the arms or legs is reduced, this can lead to poor circulation.
Research has shown that it is the oxidation of LDL that damages the arteries the most. Oxidation or the development of free radicals is a process that changes the composition of this essential nutrient, turning it into a destructive compound. This oxidized LDL damages the innermost lining of the arterial wall called the endothelium and causes inflammation. Thus, the absolute level of LDL and the oxidation of LDL are involved in atherosclerosis and an increase in the risk of heart attack.
In addition to LDL-cholesterol, there are other risk factors for developing a heart attack or stroke. These include high levels of homocysteine, fibrinogen, triglycerides (another blood fat) and C-reactive protein. The presence of high levels of these other risk factors can cause a person to have a heart attack or stroke, even though their cholesterol levels are low.
Studies have shown that low levels of total cholesterol are associated with depression and anxiety, perhaps because low cholesterol can reduce levels of the brain chemical serotonin. Other research shows that low LDL levels may be associated with an increased risk of certain types of cancer. Pregnant women who have low total cholesterol may be more likely to deliver preterm and low birth weight babies.
A low level of HDL increases the risk of heart disease. For menopausal women, low HDL levels along with being overweight can increase the risk of breast cancer.
What about cholesterol and diet?
The body usually produces all the cholesterol it needs. The liver produces about 800-1500 mg of cholesterol per day and this contributes much more to total body cholesterol than diet. The liver can also make cholesterol from carbohydrates, proteins or fats.
Only foods of animal origin – yolk, meat (which includes mutton and oxtail!), poultry, shellfish, milk and cheese – contain cholesterol. Plant foods do not contain cholesterol. (Thus, ackee and pear do not contain cholesterol). The intake of saturated fats (they are found in animals and some plants) and trans fats in the diet is the main culprit for increasing cholesterol in the blood. Trans fat is created when manufacturers add hydrogen to vegetable oil – a process called hydrogenation; this extends the shelf life and flavor stability of food containing these fats. They can be found in vegetable oils, some margarines, biscuits, snacks and foods prepared or fried in partially hydrogenated oil.
Simple changes can lower your bad cholesterol and increase your good cholesterol.
• Maintain a level of physical activity that keeps you fit. Walk or do other activities for at least 30 minutes most days. If you need to lose weight, be active enough to burn more calories than you eat each day.
• Limit the intake of foods that are rich in calories and low in nutrients; especially limit foods such as soft drinks and sweets. Add foods that are rich in soluble fiber – whole grains, oats, legumes, fruits, vegetables, nuts and seeds. Research suggests that the Mediterranean diet—low in saturated and trans fats, high in healthy unsaturated fats, and low in calories—lowers LDL cholesterol significantly better than other diets. This diet is rich in vegetables, lean fish and chicken, and low in red meat. A very low-fat or no-fat diet does a good job of lowering LDL, but it can also lower HDL. Eating foods and beverages with added phytosterols (plant stanols and sterols) is another way to lower LDL. The American Heart Association recommends 2 to 3 grams of plant sterols per day.
In addition, I recommend the following nutritional supplements
• Vitamins of the B group, especially B6, B12, folic acid and niacin. Niacin is particularly effective in promoting a healthy balance between LDL and HDL cholesterol. Take at least 100 to 200 mg per day. May cause redness and burning of the skin. To prevent this effect, I tell my patients to take baby aspirin and/or 500 mg of vitamin C along with the niacin.
• Fish oil 1000 to 3000 mg per day
• Antioxidants. This includes garlic, vitamins A, C, E, mineral selenium.
• Red yeast rice extract 600 to 1200 mg per day. Do not use this supplement if you are taking a statin (prescription drug to lower cholesterol)
• Artichoke leaf extract. Take 1800 mg daily
• Policosanol Take 10 mg daily
• Coenzyme Q 10 This antioxidant is necessary for energy production in the small cellular engines called mitochondria. Statins deplete the body’s natural stores of this antioxidant. Take 100 to 200 mg daily
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