The Cholesterol Balancing Act

Having a low cholesterol count is a good thing, but it isn't the only thing.
What's more important is keeping both kinds—artery-helping HDL and
artery-harming LDL—in equilibrium.

By H.K. Jones

February 2006

During the past 20 years “cholesterol” has become a household word, and concerns about its health dangers have generated thousands of scientific trials. A recent study, for example, shows that Americans’ cholesterol levels are falling. By now we all know that high cholesterol is a one-way ticket to the cardiology unit, so lower levels must be a step in the heart-health direction.

Well, maybe a baby step. While it is true that levels among older people are dropping, this is mostly due to an increased use of statins (pharmaceutical drugs used to treat high cholesterol), not positive lifestyle changes. In addition, there’s little improvement in cholesterol levels in young adults, and the American diet has not taken a turn for the better.

  While many folks understand that lowering cholesterol is essential to good health, few know that you need to go beyond simply dropping your levels by also maintaining a proper balance between the two main types of cholesterol, known as LDL and HDL. Making cholesterol-smart lifestyle changes will help you take better care of your heart and live a healthier, longer life.

The Basics

The paradox of cholesterol is that it can be both friend and foe. This waxy substance is needed to create and maintain walls of every cell in the body and to produce hormones, among many other necessary bodily functions. But we all know that too much cholesterol in the blood is dangerous.

Another recent study helps clarify just why excess cholesterol is such a killer. Researchers found that buildups of cholesterol within arterial walls seem to crystallize, expand and then rupture, releasing material into the bloodstream. This jump-starts the body’s natural clotting process, which in turn essentially shuts down the artery. If that artery leads to the heart muscle itself, the result is a heart attack; if it feeds brain tissue, a stroke ensues.

The bottom line? Having excess cholesterol is really bad for you. If your total cholesterol is less than 200 milligrams per deciliter (mg/dl), your heart attack risk is relatively low. If it’s between 200 to 239 you’re borderline high risk and at 240 or more, you’re in big trouble.

So where does all this cholesterol come from? Your body makes some of it, while the rest comes from dietary cholesterol in the animal products you consume, such as meats, fish, eggs, butter and cheese. Foods rich in saturated and trans fats (manmade lipids that are harmful to health) also cause your body to produce more cholesterol. In fact, saturated fats affect blood cholesterol levels even more than dietary cholesterol itself.

Equalization Process

Cholesterol can’t dissolve in the blood and has to be chauffeured around the body attached to protein packages called lipoproteins. Think of low-density lipoproteins (LDL) as reckless drivers, dropping off cholesterol willy-nilly in arterial walls where it can build up and narrow the arterial openings. On the other hand, high-density lipoproteins (HDL) are safe and helpful transporters that navigate cholesterol out of the body and away from your arteries. That’s good news for you and your heart.

But there’s even more good news: Driving unwanted cholesterol out of the body isn’t the only protective feature of helpful HDL. It also has antioxidant and anti-inflammatory properties, and like aspirin, it helps prevent the creation of blood clots. New evidence suggests that every 1 mg/dl increase in HDL is associated with a 2% to 3% decrease in coronary artery disease risk.

That means you don’t just want to lower your total cholesterol count but also keep your cholesterol in balance by changing your ratio, so you have more HDL and less LDL. HDL levels greater than 40 mg/dl, and LDL levels less than 100 mg/dl, are considered optimum for heart health. To find out your ratio you need to divide your HDL number into your total cholesterol number. For example, if your total cholesterol is 200, and your HDL is 50, your ratio would be 4:1. You should strive to keep your ratio below 5:1, the ideal ratio being 3.5:1.

The Drug Connection

The most commonly prescribed drugs for high cholesterol are the statins (Lipitor, Pravachol, Zocor, Mevacor, Lescol and Crestor), which block an enzyme necessary for producing cholesterol. Statins, used primarily to reduce LDL, certainly help people. But like all drugs, they aren’t without significant potential hazards.

Doses are often prescribed at levels too strong for treatment goals, causing side effects including abdominal discomfort, muscle and joint pain, and memory impairment. In rare cases, they can damage the liver or kidneys. Statins are also very expensive, and the high cost, combined with the side effects, makes them a less than ideal choice for lowering cholesterol.

  “There is nothing innately wrong with using a statin to reduce cholesterol if indeed the patient’s cholesterol levels indicate it, but patients also have a right to know about the effectiveness of dietary approaches and of natural supplements for reducing cholesterol,” says Jay Cohen, MD, medications expert and author of What You Must Know About Statin Drugs & Their Natural Alternatives (Square One). “Many patients, if given the information, would prefer a dietary approach or proven-effective natural supplements, which are often much less expensive than statin medications.”

Under a health care professional’s guidance, you may want to skip the statins and try other, more natural means of keeping your cholesterol in balance. The first step in increasing HDL cholesterol levels and decreasing your LDL/HDL ratio is lifestyle modification.

The Lifestyle Solution

According to the American Heart Association, more than 54 million Americans are estimated to need higher levels of HDL. If you want to push your HDL levels upward and onward, lifestyle changes are essential. Adopting an HDL-boosting lifestyle can not only help reduce your risk of heart disease, but also help you develop healthy habits to last a lifetime.

The first step? Lose the flab. If you could stand to lose a few pounds, or even more than a few, there’s no time like the present to shake that extra weight. Shedding pounds is one of the best ways to boost your HDL levels. Cardiology experts at Johns Hopkins have issued guidelines for physicians on how best to treat low levels of HDL cholesterol, and they report that every kilogram (1 kilogram is equal to 2.2 pounds) of weight lost raises a patient’s HDL levels by an average 0.35 mg/dl. If you’re already at a healthy weight, work hard to maintain it. Your HDL levels will thank you later.

In designing an HDL-friendly diet, you should aim to obtain roughly 45% to 65% of your total calories from carbohydrates, 20% to 35% from fat and 10% to 35% from protein. To lose weight, you want to reduce your calorie needs by about 20% per day, and remember to always pack your diet full of the good stuff: more whole wheat bread, oatmeal and other whole-grain foods; lots of fresh fruits and vegetables; and lean protein sources including chicken, beans, fish and low-fat dairy.

Watching your calorie intake, while vital, is only part of an HDL-enhancing lifestyle. The following factors are just as crucial:

• Get moving. It’s that simple—exercise raises HDL levels. While your ultimate goal is to get moving for at least 30 to 60 minutes each day, you can start slowly and gradually build up. Exercising is an excellent way to keep your heart healthy, and it also helps keep those pesky pounds at bay, another important HDL-raising strategy.

• Choose the right fats. Saturated fat, the kind in meat and dairy foods, drive up harmful LDL cholesterol more than anything else in the diet, and trans fats (think French fries, cookies, cakes and many fried fast foods) are not far behind. Unsaturated fats, however, raise helpful HDL cholesterol while lowering LDL. These come from oils (olive, canola, soy and flax seed), nuts, avocados, fish (especially small coldwater fish like wild salmon, sardines, herring, anchovies, mackerel and trout) and flax seeds.

• Curb refined carbs. Consumption of processed carbohydrates is associated with low HDL levels. Avoid refined carbs—sugar, white flour, white rice and milled corn. Instead, fill up on fiber, such as whole grains, bran, fruits and vegetables. Fiber-rich carbs have powerful cholesterol-lowering effects, and the filling-factor will help you lose those extra pounds.

• Quit smoking. If you smoke, chances are you’re not reading this article, as you can’t possibly care about your health. Nevertheless, in case you’re interested, according to the Hopkins researchers, quitting smoking provides an average increase in HDL levels of 4 mg/dl. Use every resource necessary to quit this nasty habit once and for all. Drug therapy, nicotine replacement products and counseling are all worth a try, as are supplements designed to make kicking tobacco easier.

Just because millions of Americans take statin drugs doesn’t mean you have to join the crowd. Living a lifestyle that boosts HDL while dropping LDL can help keep your cholesterol in balance—naturally.

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