Many individuals are aware of the importance of cholesterol as it relates to their health, but there is still much confusion about cholesterol, even among health professionals. Cholesterol is essential for our bodies to work, so why are there so many health warnings about high cholesterol levels? Here are the facts.
What is Cholesterol?
Cholesterol is waxy, fat-like material that your body needs to make hormones, vitamin D, and acids for digesting food. Cholesterol forms part of the outer membrane that surrounds every cell. It is used to insulate nerve fibres (and so make nerve signals travel properly) and make hormones, which carry chemical signals around the body. Your body makes all the cholesterol it needs. You do not need to add to it in your diet.
It is important to keep your cholesterol levels within healthy limits. If you have other risk factors for developing heart disease, you need to be even more careful — especially with your low-density lipoprotein (LDL), or “bad,” cholesterol level.
Are there differences between the sexes?
Before about age 50, men tend to have higher total cholesterol than women, but women’s “bad” cholesterol tends to rise with menopause when the female hormone estrogen declines. After about age 50, women usually have higher cholesterol than men of the same age.
What are the symptoms of high cholesterol levels?
There are no specific symptoms of high cholesterol levels. To know if your cholesterol is too high, you have to have a blood test. This can be done inAnguilla. Although cholesterol levels generally increase with age, you do not have to be older to have high cholesterol. Even children can be at risk — especially if they have a family history of high cholesterol and heart disease. Everyone should start getting cholesterol tests at age 20 — or earlier — according to the American Heart Association.
Types of cholesterol
HDL (high-density lipoprotein) cholesterol is actually the “good” cholesterol. An HDL level of 60 mg/dL (milligrams of cholesterol per deciliter of blood) or above reduces your risk of heart disease.
Too much LDL (low-density lipoprotein) cholesterol raises your risk of heart disease. An LDL level of130 mg/dL or above is considered high. Excess LDL will contribute to the formation of thick, hard buildups, known as plaque, on the walls of your arteries. Your arteries become narrower and harder, so less oxygen-rich blood can flow through. This is known as atherosclerosis — a leading cause of heart attacks and strokes.
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in theUnited Statesand some other countries.Canadaand most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your cholesterol test (lipid panel or lipid profile) results back to see if your cholesterol falls in an ideal range.
Total cholesterol
U.S.and some other countries Canadaand most ofEurope
Below 200 mg/dL Below 5.2 mmol/L Desirable
200-239 mg/dL 5.2-6.2 mmol/L Borderline high
240 mg/dL and above Above 6.2 mmol/L High
LDL cholesterol
U.S.and some other countries Canadaand most ofEurope
Below 70 mg/dL Below 1.8 mmol/L Ideal for people at very high risk of heart disease
Below 100 mg/dL Below 2.6 mmol/L Ideal for people at risk of heart disease
100-129 mg/dL 2.6-3.3 mmol/L Near ideal
130-159 mg/dL 3.4-4.1 mmol/L Borderline high
160-189 mg/dL 4.1-4.9 mmol/L High
190 mg/dL and above Above 4.9 mmol/L Very high
HDL cholesterol
U.S.and some other countries Canadaand most ofEurope
Below 40 mg/dL (men)
Below 50 mg/dL (women) Below 1 mmol/L (men)
Below 1.3 mmol/L (women) Poor
50-59 mg/dL 1.3-1.5 mmol/L Better
60 mg/dL and above Above 1.5 mmol/L Best
Triglycerides
U.S.and some other countries Canadaand most ofEurope
Below 150 mg/dL Below 1.7 mmol/L Desirable
150-199 mg/dL 1.7-2.2 mmol/L Borderline high
200-499 mg/dL 2.3-5.6 mmol/L High
500 mg/dL and above Above 5.6 mmol/L Very high
Do we need to eat foods with cholesterol?
Yes! All of us need to eat foods that contain cholesterol. You need some fat in your diet. Fats supply energy and essential fatty acids, and they help absorb nutrients from the foods you eat. The trick is to eat the best kind of fats. When you can, replace animal fats with plant fats, which can actually help lower cholesterol. Eat as little transfat as possible, and cut saturated fat to less than 10% of your calories.One of the biggest misconceptions people have is that many foods are packed with cholesterol. In fact, very little cholesterol is found in foods. The main culprits are eggs, dairy products and shellfish. You should try to eat less of these foods.
Saturated fat is a bigger culprit than cholesterol in your diet. What is important is the type of fat in the food you choose, especially saturated fat. Once inside the body, the liver turns this fat into cholesterol.
Meats, dairy products, and other foods from animals can be loaded with saturated fats. It is also in some vegetable oils such as palm and coconut oil.
Cheese contains a lot of saturated fat. Just one small piece of cheddar cheese, for instance, could contain nearly 30 mg. In fact, cheese is the biggest source of saturated fat in many Western country’s diet. Choose low-fat or non-fat cheeses, or consider skipping cheese.
Soluble fibres can lower blood cholesterol levels. Oatmeal is a good source of soluble fibre. So are beans and many fruits and vegetables. In studies, LDL cholesterol dropped 5% in people who added five to 10 grams of soluble fibre a day to their diet. A bowl of oatmeal and a banana is about 10 grams.
Eggs have a lot of cholesterol. In fact, you could eat more than 50 slices of a typical chocolate cream pie (about 6 mg per slice) and still not get as much cholesterol as you’d get from just two eggs (about 212 mg each). Egg whites or yolk-free egg substitutes are a good alternative.
Exercise or other regular physical activity can help lower your “bad” LDL cholesterol and raise your “good” HDL cholesterol. Adults should get at least 30 minutes of moderate-intensity exercise on most days of the week, but any regular physical activity lowers your risk of high cholesterol and heart disease.
All of us should aim for a total cholesterol level of less than 200 mg/dl.
For LDL (bad cholesterol), anything under 100 mg/dL is best. Levels of HDL (good cholesterol) that are lower than 40 mg/dL put men at high risk for heart disease. HDL levels less than 50 mg/dL increase the risk for heart disease in women.
Most people don’t need drugs to lower their cholesterol. Diet, exercising, and losing weight can help do it. The main goals are to eat less saturated fat, cholesterol, and get more physically active. If despite these measures your levels are still high then your doctor might recommend one or more medications.
Are you at high risk for heart disease?
You are considered to be at a high risk of heart disease if you have:
• A previous heart attack or stroke
• Artery blockages in your neck (carotid artery disease)
• Artery blockages in your arms or legs (peripheral artery disease)
In addition, two or more of the following risk factors might also place you in the very high risk group:
• Smoking
• High blood pressure
• Low HDL cholesterol
• Diabetes
• Family history of early heart disease
• Age older than 45 if you’re a man, or older than 55 if you’re a woman
• Elevated lipoprotein (a), another type of fat (lipid) in your blood
Lifestyle changes
If your LDL cholesterol is too high, the first thing your doctor will probably suggest is lifestyle changes. These changes include:
• Quitting smoking if you are a smoker
• Eating more soluble fibre, found in oatmeal, beans, fruits and vegetables
• Eating less fat and cholesterol from meat and dairy products
• Losing weight
• Exercising at least 30 minutes a day on most days of the week
Being overweight and inactive tends to increase your LDL cholesterol and lower your HDL cholesterol, exactly the opposite of what you want. Exercise and weight loss can help reverse this trend. This is especially important for people who have large waist measurements — more than 40 inches (101.6 centimeters) for men and more than 35 inches (88.9 centimeters) for women — because people with this body shape are more likely to develop heart disease.
Medications
When lifestyle changes are not enough to reach your cholesterol targets, your doctor may prescribe medications to help lower your cholesterol levels. These drugs, such as statins, are not a replacement for lifestyle changes. You’ll still need to eat properly and exercise. Statins are the best-known type of cholesterol-lowering medication. They can drop LDL cholesterol by 20% to 55%. Statins help the liver produce less cholesterol and boost its ability to remove LDL cholesterol already in the blood. They also help raise “good” HDL cholesterol.
Conclusion
Cholesterol is an essential type of fat that is carried in the blood. All cells in the body need cholesterol for internal and external membranes. Cholesterol is also needed to produce some hormones and for other functions. The body generally makes all the cholesterol it needs. Some dietary cholesterol is normally excreted via the liver, however eating too much saturated fat leads to excess cholesterol in the blood stream. High levels of cholesterol in the blood stream are a risk factor for coronary artery disease (heart attacks and angina).The most effective way to lower cholesterol is to reduce animal fats in the diet. If you have a family history of heart disease you may need to make bigger changes. If you are concerned about your cholesterol or triglyceride levels see your doctor.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over twenty eight years in clinical practice. Dr Hodge has a medical practice in theJohnsonBuildingin The Valley.
