Chapter I - Understanding Cholesterol

 

“When diet and exercise alone are not enough, talk to your doctor about . . ..” says the ad on TV.
But what kind of diet is that? What can you eat? What should you leave out? And how long does it have to last? Furthermore, there are concerns about the long term effects of the drugs doctors use to lower cholesterol on health and mental function as well as liver or muscles. Therefore, the food you eat, and the way you cook it, is more important than ever.

It has been four decades since cholesterol was identified as a major culprit in heart disease and atherosclerosis (formerly known as hardening of the arteries). It was simple then. A high cholesterol level was connected with early heart attacks. Diet could help.

The years since have made the story more complex. Researchers isolated a long list of chemicals called lipoproteins that carry cholesterol in the blood. Light-weight lipoproteins, called low-density lipoproteins or LDL carry cholesterol to the cells where it is needed to manufacture and maintain cell walls and for storing cholesterol in cells. Heavier lipoproteins (HDLs) carry excess cholesterol away from the cells for elimination from the body. HDL is a good lipoprotein because it limits the amount of cholesterol while LDL is the bad guy making it build up. So, too much cholesterol and LDL are clearly bad for you and a lot of HDL is good. The proportion or ratio of HDL to the total cholesterol in the blood measures the risk of early heart disease. The lower the ratio of HDL to the total amount of cholesterol, the better.

In the beginning, cholesterol, and the fats the body used to make it, were the only targets of treatment available and controlling what you eat was the only way to get cholesterol down. Today we know that only one-fourth of the cholesterol in the blood comes from food. The rest is made in the liver. You can reduce your cholesterol about ten percent simply by changing what you eat.

The cholesterol made in the liver can also reflect what you eat since certain fats increase the amount the liver makes. Unfortunately, the rest come from your genes. If one or both of your parents had a liver that made too much cholesterol or not enough HDL, you could have the problem, too.

Aerobic exercise, exercise that makes you sweaty and short of breath and increases your heart rate, can also lower cholesterol, about another five to ten percent.

The first medicines used to treat high cholesterol interfered with its absorption. They cut cholesterol both from the liver and from what you eat. They worked, but unfortunately, they were not as successful as hoped for. They are still used today as a part of total care, but no longer are considered the only way to manage cholesterol.

Fiber in your food can absorb some of the cholesterol. Eating more fiber in foods like vegetables, oats and other grains does help, but it is not enough by itself.

Scientists have learned how to interfere with making cholesterol in the liver. They developed medicines to increase the production of HDL and limit that of LDL. The medications are called statins and they change the chemical processes in the liver. They also affect those same chemical processes in muscle cells and, in some people, can therefore cause aches and pains in the arms and legs even while they are protecting the muscle in the heart.

For a long time, doctors have known that alcoholics might die of liver disease, even though they had healthy arteries. Alcohol does seem to limit cholesterol from building up in arteries so moderate use of alcohol can be acceptable. Wine contains resveratrol, thought to be a chemical that lowers cholesterol, but resveratrol pills have not been effective.