Cholesterol

Cholesterol

The Less, the Better

S ometimes it seems that everybody is talking about cholesterol: How to lower it. How to maintain it. What their latest cholesterol count was.

And it doesn't stop there. Food packages scream their "no cholesterol" proclamations. Items on restaurant menus are often marked with red hearts, reminding you that if you know what's good for you, you'll limit your choices to low-cholesterol dishes.

We have met the enemy, and it is disguised as a white, waxy, fatty substance called cholesterol. Ask the experts, and they'll tell you that high cholesterol is a major contributor to one of America's most dreaded age-related health problems: heart disease. And if you think you can breathe a sigh of relief because heart disease afflicts only men, think again. It's a woman's disease, too.

Reason for Concern

Yes, your female hormones provide you with some natural safeguards against high cholesterol levels in your premenopausal years. Estrogen can lower the bad (low-density lipoprotein, or LDL) portion of the cholesterol in your blood and raise the good (high-density lipoprotein, or HDL) part. But that kind of protection won't last forever, thanks to the aging process. As your body's production of estrogen wanes in menopause, so does your Teflon-like anticholesterol refuge. Welcome to the real world of women and high cholesterol.

Here are the heartless facts: A good cholesterol level is below 200 milligrams of cholesterol per deciliter of blood. Before age 45, women have an average total blood cholesterol of 190; from ages 45 to 64, those cholesterol figures rise to between 217 and 237. In all, about 55 million adult women have cholesterol levels of 200 or above. And as our cholesterol figures go, so goes the onslaught of heart problems in women.

For example, one major study--the Lipid Research Clinics investigation, conducted in medical centers across the country--showed that women with total cholesterol levels above 235 have a 70 percent higher risk of death than women with lower cholesterol readings.

One in seven women between the ages of 45 and 64 has some type of heart disease or has had a stroke. For those 65 and over, those figures increase to one in three. No wonder the American Heart Association calls heart disease a silent epidemic in women.

But even amid this quicksand of bad news, there is some reason for optimism. We still live longer than men by about seven years, and because of estrogen, we have extra protection against heart disease in our premenopausal years. Still, the lower you can get your cholesterol count, the better. If you take the initiative, you can outsmart cholesterol, no matter what your age, and make those extra years healthier ones.

The Nature of the Beast

There's some irony to the bad news about cholesterol. After all, some of the cholesterol floating through your bloodstream is actually produced by your own liver. Without cholesterol, your cells could not function properly, and life itself would be threatened.

So while having some cholesterol isn't the problem, having too much of it is. Because cholesterol is consumed in your diet (exclusively from foods of animal origin), it can end up circulating in the blood in excess, joining forces with the cholesterol manufactured by your liver as well as with the saturated fat you eat. And as these substances navigate through your bloodstream, some of them attack and attach to the walls of your arteries, forming plaques that over time narrow your arteries and impede the flow of blood to your heart. This ominous process, called atherosclerosis, can age you before your time, leading to agonizing angina (chest pain) and heart attack.

To outwit cholesterol, the first step is to get your cholesterol checked. Your doctor should measure not only the total cholesterol level in your bloodstream but also your HDL cholesterol level. If these tests show signs of potential trouble, your doctor should check your LDL level, too, since evaluating all these numbers can be important in determining your risk.

Let's look more closely at these cholesterol factions. Cholesterol maneuvers through your bloodstream by catching rides on cooperative molecules called lipoproteins. While the cholesterol transported on the LDL carriers is the instigator of trouble in your arteries, the HDL carriers are the good guys, rounding up cholesterol and booting it right out of the body. In other words, while LDL cholesterol is the bully of your bloodstream, HDL cholesterol is the good Samaritan.

Unfortunately, too many of America's bloodstreams have too many LDLs and too few HDLs, a combination that gives unhealthy total cholesterol numbers. In the United States, the average total cholesterol is about 206, which is higher than the desirable level of less than 200.

Turning the Tide

Experts say that by making some moderate lifestyle adjustments, you can dramatically lower your cholesterol. Studies show that for every 1 percent cut in your cholesterol level, you can deflate your chances of a heart attack by 2 percent. With dietary changes alone, you can whittle away an average of 10 percent of your cholesterol reading--and perhaps even more. Margo Denke, M.D., assistant professor of medicine at the University of Texas Southwestern Medical Center at Dallas's Center for Human Nutrition and a member of the nutrition committee of the American Heart Association, says that the higher your cholesterol count, the greater impact a heart-healthy diet can have. For example, a woman with a cholesterol reading of 280 may be able to steamroll 25 percent off the top by eating right. If longevity and anti-aging are your goals, that's a bottom line you can't afford to ignore.

To outmaneuver high cholesterol and the havoc it can wreak, give these cholesterol busters a try.

Switch fat. "Decreasing saturated fat is the most effective anticholesterol strategy you can use," says Karen Miller-Kovach, R.D., chief nutritionist at Weight Watchers International in Jericho, New York. That means eating less red meat, butter, cheese, whole milk and ice cream, all which raise LDL and total cholesterol levels. On the other hand, monounsaturated fat, known as the good fat, can actually help decrease cholesterol.

"When you switch from a diet high in saturated fat to one high in monounsaturated fat, and your weight stays about the same, your LDL cholesterol will fall while the HDL cholesterol remains stable," says Robert Rosenson, M.D., director of the Preventive Cardiology Center at Rush-Presbyterian - St. Luke's Medical Center in Chicago. "That's why olive oil is so popular, since it's high in monounsaturates." Better yet, increase your consumption of fatty fish, such as salmon and tuna. The fat in these fish are monounsaturates.

Eat less cholesterol. As important as reducing saturated fat can be, don't forget about dietary cholesterol. The cholesterol in your blood that isn't produced by your own body comes from your diet. Here's how to keep it under control.

Try to eliminate organ meats (such as liver) from your diet. Limit the amount of lean meat, poultry and fish to three ounces a day. And when it comes to eggs, limit your consumption of yolks to no more than two a week. Make your own cookies, cakes and pies, and use egg whites and egg substitute when you bake or cook.

Finally, when you're going through the buffet line, reach with gusto for vegetables, fruits and grains, which contain absolutely no dietary cholesterol. But show some willpower in holding out against high-fat salad dressings, sauces and butter.

Feed on fiber. Fiber is just what the doctor ordered to help fill the void as saturated fat beats a retreat in your meal planning. Concentrate on soluble fiber, the kind that's jam-packed in dried beans, lentils, citrus fruits, peas and apples. Adding soluble fiber to your diet could help lower your blood cholesterol by 5 to 10 percent.

Feel your oats. Oat bran has been on a roll for years. But how much is hype, and how much holds water? Researchers at the University of Minnesota in Minneapolis reviewed all the studies examining the power of oats and reached an artery-cleansing conclusion: Add 1 1/3 cups of oat bran cereal (or three packets of instant oatmeal) to your daily diet, and watch your cholesterol level dip by 2 to 3 percent. If your cholesterol level is already high, you'll reap even more benefits, with oat bran skimming 6 to 7 percent off the top.

Get fit. This one won't surprise you: Exercise does a body good. In fact, to get your HDL level high, jump into an exercise class and work up a sweat. And don't worry about having to go to extremes. "We've learned that even moderate aerobic exercise (brisk walking, jogging, swimming) raises HDLs, although this often takes six months to a year to occur," says Dr. Rosenson.

Trim your tummy. Too many women lead lives of diet desperation, with not much to show for their efforts but a lot of frustration. But a sensible, moderate weight loss program can hit your cholesterol where it hurts. Dr. Denke has found that when young women are carrying around excess body weight, their total and LDL cholesterol levels tend to be higher, and their HDL levels are lower. Losing weight produces the reverse effect.

Bag the cigarettes. There are a lot of good reasons to quit smoking, and here's one more: Smoking can lower your HDL reading, something that no health-conscious person can afford to do.

But even if you're a chain-smoker, there's some encouraging news--if you're willing to toss out your cigarettes for good. By stopping smoking, says Dr. Rosenson, you can reverse the decline in your HDL level in about 60 days. It doesn't take years to eliminate smoking's dirty work.

Make a toast. Perhaps you've heard reports that a drink or two of any alcoholic beverage each day can raise the HDL component of your cholesterol. Well, you've heard correctly. Even so, approach this cholesterol-fighting strategy cautiously. Alcoholic drinks are brimming with calories, so they can defeat your efforts at losing weight. Even moderate drinking may also increase your chances of developing breast cancer. Finally, if you're pregnant or trying to get pregnant, stay away from alcohol altogether for the health of your baby.

Another option? Drink grape juice--the purple kind. Grape skin contains a cholesterol-lowering ingredient, according to Leroy Creasy, Ph.D., professor of pomology at Cornell University College of Agriculture and Life Sciences in Ithaca, New York.

Consider estrogen. Because natural estrogen protects you against cholesterol problems during your premenopausal years, doesn't it make sense that estrogen replacement therapy after menopause might do the same? In fact, that's exactly what research shows: Estrogen replacement therapy can cut your LDL cholesterol and raise your HDL cholesterol by about 15 percent each, according to an American Heart Association report on cardiovascular disease in women.

At the same time, however, estrogen replacement therapy has some red flags of its own, particularly a link to cancers of the endometrium and perhaps of the breast. You and your doctor need to keep these factors in mind when weighing the pros and cons of using estrogen replacement therapy in the war on cholesterol. Fortunately, doctors believe that by combining estrogen with progestin (another female hormone), you may be able to reduce your cancer risk.

How Magical Is Medicine?

Even the most heroic efforts at lowering high cholesterol may run aground. A possible source of help may be anticholesterol medications, which can cut cholesterol readings by an average of 20 percent. Before you take these medications, however, many doctors advise trying a more conservative approach (diet, exercise, weight loss) for about six months. If that doesn't work, drugs may be the answer, particularly if your LDL cholesterol is still high, you have other risk factors for heart disease (such as family history or high blood pressure) or you already have heart disease.

Nicotinic acid and bile acid binders may be your doctor's first medication choices.

Nicotinic acid (such as Niacor) is one form of niacin, the vitamin that can be purchased without a prescription. But since you need to take nicotinic acid in high doses for it to make a difference in your cholesterol reading, doctors consider it a drug. So should you. High doses can cause serious side effects. Make sure that you take only the prescription form of this drug and relay any problems to your doctor.

"Flushing and stomach upset can occur with niacin," cautions Richard H. Helfant, M.D., vice chairman of medicine and director of the Cardiology Training Program at the University of California, Irvine, Medical Center and author of Women, Take Heart. He suggests avoiding niacin completely if you have diabetes, ulcers, liver disease or major heart rhythm problems.

Other medications have potential side effects, too, so your doctor should monitor you closely when you're taking them. Some of these prescription drugs, including the bile acid binders cholestyramine (such as Questran) and colestipol hydrochloride (Colestid), are available in powder form. Most others, including lovastatin (Mevacor) and gemfibrozil (Lopid), come as pills. Some of these drugs--nicotinic acid and bile acid binders--have been around long enough for studies to show that they not only can bring your LDL cholesterol level to its knees but also can decrease your chances of developing heart disease.

Incidentally, even if your doctor prescribes medication, don't think that you're off the hook, Dr. Denke cautions. "Drugs aren't a substitute for healthier eating, losing weight, exercising and other lifestyle strategies that need to be part of getting your cholesterol under control."