Hospital & Healthcare System: Preventing Heart Disease: Cholesterol

Preventing Heart Disease
Cholesterol

High blood levels of cholesterol (240 mg/dL and higher) greatly increase an individual's risk of heart disease.

Cholesterol is a fatty substance that is used by the body to make cell membranes, hormones, and other substances. We get cholesterol from two sources: 1) our own bodies (it is produced primarily in the liver), and 2) by eating animal products such as meat (beef, chicken, fish), egg yolks, cheese and other whole milk products.

Because the body can easily make all the cholesterol it needs, it doesn't need any additional cholesterol from foods.

Do you know if your blood cholesterol level puts you at risk for heart disease? The table below details the standard breakpoints of total cholesterol levels.

Total Cholesterol Levels
< 160 mg/dL	optimal for people with a history of heart disease
< 200 mg/dL	desirable for the general population
200 mg/dL to 239 mg/dL	borderline high blood cholesterol
240 mg/dL or greater	high blood cholesterol

Unlike sugar, cholesterol does not break down in the blood. Cholesterol is packaged as insoluble protein/fat particles called lipoproteins. These lipoproteins travel through the blood, delivering cholesterol to all the parts of our bodies.

Excess cholesterol in the blood can be deposited in artery walls, contributing to a progressive disease called atherosclerosis or hardening of the arteries. As arteries narrow and harden, blood flow is restricted and the heart needs to pump harder to do its job. Hardened arteries can rupture, bleed, hemorrhage, or clot. Heart attacks and strokes occur when a blood clot completely blocks an artery, cutting off blood flow to the heart or brain.

LDL/HDL

Two types of lipoprotein packages that carry cholesterol, LDL and HDL, get a lot of press when it comes to heart health. Too much LDL (Low Density Lipoprotein) cholesterol, called the "bad" cholesterol, can endanger the heart. LDL cholesterol contributes to plaque build-up and clogging of the arteries. The more LDL in your blood, the higher your risk of heart disease.

HDL (High Density Lipoprotein) cholesterol, called the "good" cholesterol, protects the heart. HDL counteracts "bad" cholesterol by helping to remove LDL deposits from the arteries. The more HDL in your blood, the lower your risk of heart disease.

Reducing LDL

To decrease your LDL ("bad") cholesterol, limit all animal and hydrogenated fats. Instead use moderate amounts of vegetable oils, such as canola, soy, or olive oil. Eat more unrefined foods such as whole-wheat bread and cereals, oatmeal (oat bran is especially helpful in lowering LDL cholesterol), brown rice, and, of course, fruits and vegetables. Legumes (peas, beans, soybeans, garbanzo beans) are high in dietary fiber and help lower LDL cholesterol. Nuts and avocados are also beneficial.

The National Institutes of Health, National Heart, Blood and Lung Institute, devised two eating plans, the Step I and Step II Diets, aimed at lowering LDL cholesterol. The goals of the Step I Diet are to limit cholesterol intake to less than 300 mg per day and fat intake to 30 percent or less of the day's total calories, with only 8 percent to 10 percent of calories from saturated fat. The more aggressive Step II Diet limits cholesterol intake to less than 200 mg per day and fat intake to 30 percent or less of the day's total calories, with less than 7 percent of total calories from saturated fat.

Saturated fats, which are solid at room temperature, derive from beef, pork, lamb, chicken, turkey, butter, egg yolks, coconut oil, palm oil and palm kernel oil. Bacon grease, for example, is saturated fat.

Step Diet Recommendations
Eat More	Limit or Avoid
Lean, well-trimmed cuts of meat	Beef, pork, lamb, organ meats, hamburger, spare ribs, fatty cuts
Poultry without skin	Fried chicken, poultry skin, gravy
Fish, shellfish	Fried fish, fried shellfish
Lean or low fat cold cuts and processed meats	Cold cuts, hot dogs, sausage
Egg whites (two egg whites can be substituted for a whole egg in recipes)	Egg yolks (no more than 4 per week on the Step I Diet and no more than 2 per week on the Step II Diet, including eggs used in baked goods)
Skim milk, 1% milk, buttermilk, low fat or nonfat sour cream	Whole milk, 2% milk, imitation milk such as coffee creamers, whip cream, half and half, sour cream
Low fat or nonfat yogurts	Whole milk yogurts
Low fat cheeses	Regular cheese (American, blue, Brie, cheddar, Colby, Edam, Monterey Jack, whole-milk mozzarella, Parmesan, Swiss), cream cheese, Neufchatel cheese
Low fat or nonfat cottage cheese	Regular cottage cheese (4% fat)
Low fat or nonfat frozen yogurt or ice milk	Regular ice cream
Unsaturated fats such as safflower, sunflower, corn, soybean, cottonseed, canola, olive or peanut	Coconut, palm or palm kernel oils
Margarine made from the oils above	Butter, lard, shortening, bacon fat, hard margarine
Low fat or fat-free salad dressings	Creamy dressings
Seeds and nuts	Coconut
Whole-grain breads	Croissants, breads made with a lot of eggs, fat or butter
Oat, wheat, corn and multigrain cereals	Most granolas
Pasta, rice, dry beans, peas, low fat crackers	High fat crackers
Homemade baked goods made from low fat or nonfat recipes	Commercially baked goods
Reduced fat or low fat soups	Soups made with whole milk or cream
Fresh, frozen or canned vegetables	Vegetables in butter, cream or cheese sauces
Fresh, frozen or canned fruit, fruit juice	Fruit in butter or cream sauces

Source: adapted from the Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, National Institutes of Health, National Heart, Lung and Blood Institute, 1993.

Increasing HDL

Proven ways to increase your HDL ("good") cholesterol include:

Increasing your level of physical activity (to 30 minutes or more daily).
Losing weight/maintaining a healthy weight.
Refraining from smoking.
Replacing saturated fats with polyunsaturated or monounsaturated fats, such as soybean, olive, or canola oils.

Additional Cholesterol-lowering Tips:

Soluble Fiber

The soluble fiber in some foods adheres to excess cholesterol in the intestines, blocks its absorption, and ushers it out of your body. Foods high in soluble fiber are oat bran, cooked dry beans, dry peas and lentils. Eat these foods to lower your overall cholesterol level. (Remember to drink six to eight glasses of water each day to help the fiber work.)

Omega-3

Research has shown that the omega-3 fatty acids found in fish can help reduce cholesterol levels and decrease the likelihood of blood clotting. In general, the darker the meat of the fish, the higher the amount of omega-3. To reap the benefits of omega-3, try mackerel, lake trout, herring, fresh albacore tuna, sturgeon, whitefish, salmon or halibut for dinner once or twice a week.

Omega-3 fatty acids are also found in soybean oil, canola oil, nuts, soy, and flax seeds.

Medication

If you need additional help to lower your cholesterol, your physician may prescribe medication. Take the medication as directed and make sure you follow your physician's advice about nutrition and physical activity.

Steps You Can Take Today:

If you don't know your cholesterol level, make an appointment with your physician to have it checked.
Eat more whole grains.
Eat more fruits and vegetables (at least five per day). They have no cholesterol.
Avoid foods high in saturated fats and cholesterol. Read "Nutrition Facts" labels on packaged food to help you choose items lower in saturated fat and cholesterol.

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