It may surprise you to know that cholesterol itself isn't bad. In fact, cholesterol is just one of the many substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is produced naturally (and can be affected by your family health history), while some of it comes from the food we eat. Whenever we hear the word 'cholesterol' we often think hamburgers, thickshakes, people who need a double seat in an aircraft, clogged arteries and an early death.
In fact cholesterol is essential to life. It's a that occurs naturally in the body. Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body's cells. It's normal to have cholesterol. It's manufactured by the liver, and is essential for many of the body's metabolic processes. It helps make hormones like oestrogen, testosterone and adrenaline. It's used in the production of vitamin D, and also in the production of bile acids, which help the body digest fat and absorb fat-soluble vitamins in the small intestine. But too much cholesterol in the blood is a major risk for coronary heart disease (which leads to heart attack) and for stroke.
Cholesterol is a combination of steroid, alcohol and lipid. It can be found in foods such as eggs and dairy products and is also manufactured in the body, especially the liver. The trouble starts when we get too much cholesterol in our diet or when the liver over produces causing the levels of cholesterol in our blood to rise to more than we need.
If it rises above normal levels, that is above 5.5 millimoles per litre it can build up into fatty deposits on the surface of our arteries, which can form calcium plaques. These narrow the arteries and block blood from flowing, leading to heart disease, stroke and other conditions. This is a condition known as atherosclerosis. High cholesterol is one of the risk factors for atherosclerosis, along with smoking, being overweight, and having high blood pressure.
There are two types of cholesterol which is often referred to as either “good” or “bad.” It’s important to understand the difference, and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type or not enough of another can put you at risk for coronary heart disease, heart attack or stroke.
There are two major types of these 'carrier' lipoproteins known as either, low-density lipoprotein (LDL) or high-density lipoprotein (HDL). LDL is the major carrier of cholesterol from the liver to the rest of the body. When cholesterol levels are excessive, LDL deposits cholesterol onto the arteries causing the damage.
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HDL on the other hand, mops up cholesterol from the bloodstream and takes it back to the liver. So it reduces cholesterol, and lessens the chance of it being deposited in the arteries. HDL cholesterol is sometimes called 'good cholesterol' and LDL cholesterol 'bad cholesterol'. The more HDL you and have and the less LDL that is, the higher the ratio of HDL to LDL the lower your risk of artery disease.
How much LDL and HDL we have in our blood is influenced by the types of fats we eat. Biochemists divide fats in our diets into different types, according to their chemical composition. They talk about saturated, monounsaturated and polyunsaturated fats. These terms refer to the differences in the numbers of hydrogen atoms in the fat molecules.
Eating a lot of saturated fat tends to elevate the levels of LDL in the blood, so these kinds of fats are often called 'bad fats'. Foods high in saturated fats include full fat dairy products, processed meats like salami and sausages, snack foods like chips, takeaway foods (especially deep fried foods), cakes, biscuits and pastries, coconut oil and palm oil. If you want to avoid artery disease, stay away from these foods.
Eating monounsaturated or polyunsaturated fats, on the other hand, tends to increase the levels of HDL. And HDL reduces cholesterol in the blood, so these fats are called 'good fats'. Eating these will reduce your risk of artery disease. Foods high in monounsaturated fats include olive oil, canola oil, avocados and most nuts. Foods high in polyunsaturated fats include oils of seeds and grains, such as sunflower, safflower, corn, soybeans and walnuts.
As mentioned cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat.
Generally speaking, LDL cholesterol is produced naturally by the body, but many people inherit genes that cause them to make too much. Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different.
Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test.
When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result. About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup.
Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels.
High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk.
When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it forms plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.
As discussed, cholesterol can be both good and bad, so it's important to learn the facts about what cholesterol is, how it affects your health and how to manage your blood cholesterol levels. Here are some common misconceptions, along with the true story, about cholesterol.
1. My choices about diet and physical activity are responsible for my cholesterol level.
Diet and physical activity contribute to overall blood cholesterol levels as well as the cholesterol that is made naturally by the body. The amount of LDL (bad) cholesterol in the blood is controlled in two important places; the liver and the intestines. The liver produces cholesterol (using it to make digestive acids called bile) and also removes cholesterol from the blood. The intestines absorb cholesterol, which comes from food and from bile. For some people, the liver produces more cholesterol than the intestines absorb. If this is the case for you, your physician may prescribe medicine to manage your cholesterol. However, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health. Have your cholesterol tested and work with your healthcare professionals on the plan that's best for you. Learn more about the sources of cholesterol.
2. Using margarine instead of butter will help lower my cholesterol.
Both margarine and butter are high in fat, so use both in moderation. From a dietary perspective, the major factor affecting blood cholesterol is how much saturated fat and trans fat is in the food. Limiting food high in saturated fat and trans fat may help lower your LDL (bad) cholesterol. Most vegetable oils and soft or liquid margarines have less saturated and trans fat than the solid spreads have, and are preferable to the stick forms of margarine for a heart-healthy diet. When selecting a margarine, it's best to choose one that has “0 g trans fat” on the Nutrition Facts label.
3. Thin people don’t have to worry about high cholesterol.
Any type of body can have high cholesterol. Overweight people are more likely to have high cholesterol, but thin people should also have their cholesterol checked regularly. Often people who don’t gain weight easily are less aware of how much saturated and trans fat they eat. Nobody can “eat anything they want” and stay heart healthy. Have your cholesterol checked regularly regardless of your weight, physical activity and diet. Learn more about what you can do to manage your cholesterol levels.
4. My doctor hasn’t said anything about my cholesterol, so I don’t have to worry.
Your health is your responsibility. Ask your healthcare professional if your cholesterol needs to be tested. Learn how to interpret all the numbers, including HDL (good) cholesterol, LDL (bad) cholesterol and triglyceride levels. If you’re in a high or borderline-high range, discuss options with your physician. Depending on your risk profile and your cholesterol levels, your doctor may recommend diet and lifestyle changes and/or medication. Follow all of your doctor's instructions, and have your cholesterol retested as your doctor recommends. See a list of questions to ask your doctor about cholesterol.
5. Since the nutrition label on my favorite food says there’s no cholesterol, I can be sure that it’s a “heart-healthy” choice.
Nutrition labels on food are very helpful when choosing heart-healthy foods, but you need to know what to look for. Many “low-cholesterol” foods contain high levels of saturated fat and/or trans fat — both of which contribute to high blood cholesterol. Even foods that claim to be “low-fat” may have a higher fat content than expected. Look for the amount of saturated fat, trans fat, cholesterol and total calories in a serving of the product. Also check how much a serving is. Often it’s smaller than you think. The first ingredient listed is the one used most in the product, so choose products where fats and oils appear later in the ingredient listing. The Food and Drug Administration now requires foods to be labeled for trans fats. Trans fats are found in variable amounts in most foods made with partially hydrogenated oils such as baked goods, cakes, cookies, crackers, pastries, pies, muffins, doughnuts, fried foods, shortening and some margarines and dairy products. Know your fats.
6. Since I started taking medication for my high cholesterol, I don’t have to worry about what I eat.
Drug therapy is usually prescribed for those who despite adequate dietary changes, regular physical activity and weight loss still have elevated levels of cholesterol, or those who have elevated risks for heart disease and stroke. Modern medications have come a long way in helping to control blood cholesterol levels, and some can target the cholesterol that your body makes on its own. But making diet and lifestyle changes as well as taking the medication is the best way to help prevent heart disease. You should still eat a heart-healthy diet and get at least 30 minutes of moderately vigorous physical activity on five or more days of the week.
7. I recently read that eggs aren’t so bad for your cholesterol after all, so I guess I can go back to having my two eggs for breakfast every morning.
One egg contains about 213 milligrams of dietary cholesterol. The daily recommended cholesterol limit is less than 300 milligrams for people with normal LDL (bad) cholesterol levels. An egg can fit within heart-healthy guidelines for those people only if cholesterol from other sources such as meats, poultry and dairy products is limited. People with high LDL blood cholesterol levels or who are taking a blood cholesterol-lowering medication should eat less than 200 mg of cholesterol per day.
8. I’m a woman so I don’t have to worry about high cholesterol. It's a man’s problem.
Premenopausal women are usually protected from high LDL (bad) levels of cholesterol, because the female hormone estrogen tends to raise HDL (good) cholesterol levels. But cholesterol levels tend to increase as you age, and postmenopausal women may find that even a heart-healthy diet and regular physical activity aren’t enough to keep their cholesterol from rising. If you’re approaching menopause, it’s especially important to have your cholesterol checked and talk with your doctor about your options. You may still have high cholesterol levels even if you eat a heart-healthy diet, stay active, watch your weight and don't smoke or breathe others' smoke. If lifestyle changes alone don't work, your doctor may prescribe a cholesterol-lowering medication be sure to take it as instructed.
9. You don’t need to have your cholesterol checked until you reach middle age.
Everyone should start getting a cholesterol test at age 20, but it’s a good idea to start having cholesterol checked at an early age. Even children, especially those in families with a history of heart disease, can have high cholesterol levels. And evidence exists that these children are at greater risk for developing heart disease as adults. Lack of regular physical activity, poor dietary habits and genetics can all affect a child’s cholesterol levels. Parents and caregivers can help kids develop a heart-healthy lifestyle by serving foods low in saturated fat, trans fats and cholesterol; encouraging at least 60 minutes of physical activity on most (and preferably all) days; and stressing the importance of avoiding tobacco products. Learn more about safe levels of cholesterol in children.
Why is high cholesterol a problem?
High levels of cholesterol in the blood stream are a risk factor for coronary artery disease (heart attacks and angina). If your cholesterol level is 6.5 mmol/L or greater your risk of heart disease is about 4 times greater than that of a person with a cholesterol level of 4 mmol/L. Not all people with high cholesterol levels get heart disease. About 30 per cent of the community will die of heart disease and most of these will be over 65 years old. Heart disease usually takes 60-70 years to develop, but if you discover your cholesterol level is high you should see your doctor within the next 2-3 months, not necessarily tomorrow. Other risk factors for heart disease include smoking, high blood pressure and obesity.
What to do if your cholesterol level is high
The most effective way to lower your cholesterol is to reduce the amount of animal fat in your diet by various means. You could:
• Reduce cheese intake and/or substitute low fat varieties
• Choose reduced fat milks
• Substitute polyunsaturated margarine for butter
• Choose lean cuts of meat and remove all visible fat
• Eat skinless chicken, fish or beans
• Beware of pies, pasties, fish and chips and commercial cakes (hidden fat)
• Lose weight if overweight.
If you make a number of changes to your diet you can expect your cholesterol to fall by 10 per cent. About 15 per cent of people will see no change and another 15 per cent will see changes of 20-30 per cent.
How high is high?
If your cholesterol is between 5.5 and 6.5 your risk of heart disease is only increased by a small amount. Don’t panic but make a few moderate changes to your diet. However if you already have heart disease, or one of your parents developed heart disease at an early age, (less than 55 years of age) then you need to make bigger changes. If your cholesterol is higher than 6.5 then you need to make more changes.
If despite changes to your diet your cholesterol level remains above 6.5 you may need medication, especially if you have the other risk factors mentioned or you have a family history of heart disease- see your doctor.
What about triglycerides?
Triglycerides are a stored energy source. Most of the triglyceride is found in the very large particles, the VLDL. Under some circumstances high blood triglyceride can be a risk factor. If your cholesterol is high (greater than 6.5) and your HDL cholesterol is low (less than 0.9) then triglycerides can increase the risk of heart disease if they are greater than 1.7. Triglyceride levels greater than 10 can cause inflammation of the pancreas which is a very serious condition.
How can I lower my triglyceride?
Reduce your intake of animal or hard vegetable fats, lose weight and reduce alcohol intake. Alcohol is very powerful at elevating triglyceride. Lowering LDL cholesterol involves losing excess weight, exercising regularly, and following a diet that is low in saturated fat and cholesterol.
Medications and Supplements to lower cholesterol
Medications and Supplements can prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most widely used medications to lower LDL cholesterol are called statins. Most of the large controlled trials that demonstrated the heart attack and stroke prevention benefits of lowering LDL cholesterol used one of the statins. Other supplements used in lowering LDL cholesterol and in altering cholesterol profiles include red rice extracts, sugar cane wax extracts and nicotinic acid (niacin).
Maintain a healthy weight Reducing excess weight almost certainly lowers your cholesterol levels. So MOVE more, and EAT less. Remember is TOTAL CALORIES not carbs that can force you to put weight on. So keep a balanced diet of lean protein, good LOW GI carbs and plenty of fresh fruit, vegetables and water.
Keep saturated fats low. Saturated fats from butter, cream and cheese, fat on meat and fried fast food raise cholesterol and LDL cholesterol. They also increase the likelihood of obesity which in turn puts you at a higher risk of heart attack. Trim visible fat from red meats, grill and steam foods and steer clear from creamy sauces like mayonnaise and hollandaise.
Up your anti-oxidants Anti-oxidants can protect against heart disease by preventing the bad LDL cholesterol from being oxidized and producing "foam" cells, which can then become fatty streaks on the inside of the walls of our blood vessels. Naturally occurring plant anti-oxidants like flavonoids, carotenoids and sterols are all thought to help this. Don't forget the staples though, vitamins A, C, and E and Flaxseed oil.
Avoid or control diabetes. Losing excess weight and exercise can lessen insulin resistance and improve the uptake of glucose by the muscles and will prevent or slow the onset of adult type II diabetes
Add more fibre Soluble forms of dietary fibre, such as pectins, gums, and saponins, can speed the removal of cholesterol form the body. Soluble fibre is found in oats, oat bran, barley bran, rice, rice bran (but not wheat bran) dried beans, lentils, barley, fruit and vegetables.
Alcohol in moderation People who drink moderately suffer fewer heart attacks and live longer than people who totally abstain from alcholol. High-density lipoprotein cholesterol which protect against heart attack is increased by alcohol. Wine in particular red wine is an excellent source of anti-oxidants in the form of polyphenols. Remember the key word here is moderation.
Keep active Regular moderate exercise is essential for a healthy heart. It burns up kilo-joules and can boost the levels of protective HDL cholesterol in the blood. Choose an exercise that you enjoy, that uses the legs, torso or arms and gets your breathing going for 20 to 30 minutes three times a week. Walking, swimming, bicycling, skipping or rowing machine are all good choices. Avoid sudden or over exertive exercise which can strain an unfit heart.
Take your VITAMIN B A high intake of folate and vitamin B12 are beneficial in decreasing homocysteine levels which is an amino acid that when elevated can cause heart problems. Folate is found in vegetables, fruit, juices, breakfast cereals, breads and yeast spread such as vegemite. Supplements containing sugarcane wax and or extracts of red rice have also shown possible benefits when managing cholesterol
Mind/body - hostility and anger In the workplace, studies have consistently shown that people in high-stress jobs but with little sense of control have the highest rate of heart attacks. Mediate and learn to relax and control an out of control temper. A hot bath, a good book and some calming music and oils all work wonders to promote a stillness and calm to your personality.
Heredity: Be aware of your family heritage. If you know that it is in your family history ask for a test to be performed by your doctor and then take steps to control your cholesterol before it controls you.
Dietary approaches to lowering cholesterol
It's worth taking steps to lower cholesterol because lowering cholesterol by 10 per cent reduces the risk of heart attack by 20 per cent. So if your doctor finds you have elevated cholesterol, we recommend the following:
A diet low in saturated fats and high in monounsaturated and polyunsaturated fats means to choose the following:
• Low-fat or reduced-fat milk, yoghurt and other dairy products .
• Lean meat (meat trimmed of fat or labeled as 'heart smart').
• Limited fatty meats, including sausages & salami, with leaner sandwich meats like turkey breast or chicken instead.
• Fish (fresh or canned) at least twice a week.
• Butter and dairy blends replaced with polyunsaturated margarines.
• Plenty of fresh fruit, vegetables and wholegrain foods, nuts, legumes and seeds.
• Plant sterols are a type of alcohol structurally similar to cholesterol and found in some margarines and fortified foods, in corn, rice, vegetable oils and nuts. They also include supplements containing Sugarcane wax and Red Rice extract.
• Regular exercise (for example, at least 30 minutes of brisk walking daily). Exercise increases HDL levels and reduces LDL levels in the body.
To discuss the availability of Red Rice Yeast extract and products containing Sugar Cane Wax please contact us on 02 4734 9010 (Australia).