Cholesterol Unchained: What's Your Number?

It’s widely known that coronary artery disease is the leading cause of death for American men and women.

According to the Centers for Disease Control (CDC), one out of six adult Americans is at risk for heart disease, but many say the numbers may actually be higher.

Experts also say that while genetics play a factor, a fatty diet and increasingly sedentary lifestyle also are culprits. The good news is that both are easily remedied, but commitment is key.

“Obesity and cardiovascular disease will be an epidemic for the next generation,” said Jill Edwards, an exercise physiologist in the Cardiac Rehabilitation Program at Sarasota Memorial Hospital.

What is cholesterol?

While many patients can recite the numbers in their lipid profile, its complexity makes some of the details challenging to understand.

Here’s the breakdown:

Cholesterol is actually a waxy substance produced by our bodies. It's crucial for the production of hormones, Vitamin D and bile, which help digest foods. Additional cholesterol is consumed by eating animal-based foods such as meat, dairy and seafood. Cholesterol is transported throughout our bodies as low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both is critical to maintaining optimal health. Too much cholesterol can be life-threatening.

William Mark Mahoney, an emergency room physician at Sarasota Memorial Hospital, says the trick is maintaining a balance and choosing healthier options. Mahoney advocates a blend of exercise and nutritional moderation, including portion control.

Cholesterol components:

Cholesterol, which is manufactured in our bodies, has several components.

High-density lipoprotein (HDL) is referred to as “good” cholesterol, because it carries cholesterol away from the arteries and back to the liver. Scientists have theorized that higher levels of HDL can be cardio-protective.

Low-density lipoprotein (LDL) is commonly referred to as "bad" cholesterol because when too much circulates throughout your bloodstream, it can bond with other substances and clog your arteries with plaque, thus increasing your chances of a heart attack or stroke. Eventually, the plaque hardens, narrowing your coronary arteries and disrupting the normal flow of oxygenated blood to the heart muscle.  When plaque buildup reaches a dangerous level, the result is coronary artery disease, the leading cause of death in this country.

Triglycerides are another subset of blood fat produced by our bodies. Yet levels may become elevated due to obesity, alcohol intake, smoking, and a diet excessively high in carbohydrates. Genetics also affect lipid profiles.

Cholesterol by the numbers:

Total Cholesterol Levels-

• Less than 200 mg/dL = desirable level
• 200 to 239 mg/dL = borderline high
• 240 mg/dL and above = high blood cholesterol

HDL (Good) Cholesterol Levels-

• Less than 40 mg/dL (for men) = Low HDL
• Less than 50 mg/dL (for women) = Low HDL
• 60 mg/dL = High HDL, considered protective against heart disease.

LDL (Bad) Cholesterol Levels-

• Less than 100 mg/dL = optimal
• 100 to 129 mg/dL = Near or above optimal
• 130 to 159 mg/dL = Borderline high
• 160 to 189 mg/dL = High
• 190 mg/dL and above = Very High

Triglyceride Levels-

• Less than 150 mg/dL = Normal
• 150 - 199 mg/dL = Borderline High
• 200 - 499 mg/dL = High
• 500 mg/dL and above = Very High

Numbers provided by the American Heart Association's website.

Why are the numbers important?

Lowering our cholesterol levels can reduce or even halt arterial plaque accumulation. This is important because plaque can rupture and cause life-threatening blood clots.

Jill Edwards, an exercise physiologist  working in cardiac rehabilitation at Sarasota Memorial Hospital, advocates exercise most days of the week and getting two-thirds of your nutrition from a plant-based diet. She said LDL levels in adults should be below 100 with HDLs 40 mg/DL or above, and triglyceride levels under 150 mg/dL.

“Cholesterol is necessary for cell membrane function, and hormone production (such as estrogen and testosterone),” said Mahoney. “It’s really about maintaining a balance.”

Identifying and treating risk factors are also important to ensuring optimal cardiovascular health. While elevated levels of cholesterol are reliable predictors of atherosclerosis, or hardening of the arteries, preventing that has proven to be elusive.

In 2002, the United States Institute of Medicine advocated lower consumption rates of trans fats to ensure cardiovascular health. That advice remains important, said Edwards. Yet with so many Americans suffering the ravages of cardiovascular disease, perhaps the designation of February as Heart Healthy Month offers a chance to get heart smart.

Are children at risk?

A mounting body of evidence shows children are also at risk for developing cardiovascular disease. I spoke with Dima Turpin, a pediatric cardiologist at All Children’s Hospital in St. Petersburg. She said poor diet choices have caused a massive jump in the number of young patients with cardiovascular symptoms. But she also cautioned that it’s wise for parents to consider the bigger picture.

“It’s related to a whole common lifestyle issue, “she said. “Families should sit down and eat whole food versus grabbing fast food, whenever possible.

“Children should be taught about healthy snacking at young ages, and to embrace a lifestyle that includes an hour of vigorous physical exercise on most days.”

She’s passionate about the topic and works hard to practice it with her patients and her own three children. Obesity, she said, is at epidemic proportions. That’s why cholesterol screenings are routine for children younger than 10, and in families with risk factors.

“We know that 84 percent of people who were obese as kids will also be obese as adults,” Turpin said.

And the evidence shows it's costing this country billions.

Like Edwards and Mahoney, Turpin is a fierce proponent of education and awareness. She encourages parents to monitor video games and TV watching. She also said avoiding simple sugars will help prevent elevation of triglycerides and diabetes.  

“There’s no magic, one shot approach, “ said Mahoney. “It takes discipline, education, and awareness.”

About one month ago, I became concerned about my own elevated levels of LDLs and began incorporating the principles of a plant-based diet into my own regimen, along with a more vigorous exercise regimen. I’ve already seen a boost in my energy level and I’m hoping to see a downward trend in my LDLs after my next lipid panel in eight weeks.

Here are some tips garnered from a free four-week class recently taken at the Whole Foods store in Tampa. Given the popularity of the films Fresh and Forks Over Knives, and a burgeoning interest in the local food movement, hydroponic and organic farming, it seems that lately, there’s an abundance of information and resources for those seeking a greener diet.

Eat breakfast: Try oatmeal with added grains, such as wheat germ, flaxseed, or Psyllium seed husks. Add fresh fruit (blueberries, raspberries, blackberries, oranges and/or bananas) for a cholesterol-lowering start to your day. (It helps avoid intense drops and rises in insulin levels, provide you with prolonged energy, and forestalls impulse snacking.

Drink lots of water: 8-12 glasses per day helps flush away toxins and fats, keeping you well-hydrated, in our warm, humid climate.

Avoid refined sugar and processed foods: Learning to read labels can be helpful in spotting hidden sugars and refined foods. Avoid sugary drinks and desserts, and chose whole wheat flour versus refined white flour.

Choose veggies and fruits several times daily: adds fiber, mineral, and vitamin content, while providing essential plant sterols. Eggplant, oranges, okra, and pears area also rich in fiber. Choose nutrient-dense foods such as leafy green vegetables (kale, spinach, chard) dried beans and legumes, and whole grains. Sterols and stanols which are extracted from plants,are available in margarines and spreads. They limit your body’s ability to absorb cholesterol from food. As you work up to eating 30 mg  of fiber a day, increase your water intake to avoid constipation.

Limit your dairy intake: Opt for almond milk instead. Consider fat-free or one percent dairy products, lean and grass-fed meats, fish, and skinless poultry, if you eat those.

Limit and reduce your intake of fat and oils. Drs. Caldwell Esselystn and Dr. Neal Barnard are physician leaders advocating plant-strong and vegan diets to reverse cardiovascular disease, but you can try moderation to lower your risk factors.  

Increase your activity level: Regular physical activity is generally defined as moderate for at least 30 minutes on most days of the week. Aerobic exercise can help raise HDLs, lower LDLs, while keeping diabetes and stress at bay.

Plan ahead: Get minerals and vitamins from whole foods versus supplements, whenever possible. Cook whole wheat pastas, rice and grains (such as quinoa and couscous) ahead of time. Have containers of cut veggies available for munching. Having dried fruits on hand will also ensure you grab healthier foods when hunger strikes. Figs, prunes, and cranberries counteract a craving, and may have extra cholesterol-reducing properties.

Exercise: Unless restricted by a medical condition, moderate to vigorous exercise for at least 30-45 minutes on most days of the week, is a great way to lose weight, reduce cholesterol and increase energy levels.

Recommended Foods: Bean varieties, rich in soluble fiber, are abundant. From black beans to navy, pinto, kidney, lentils, and garbanzo beans, plenty of choices exist. Oats, barley, apples, grapes, strawberries, prunes, and citrus fruits all help lower cholesterol, according to nutritional experts. The fruits are rich in pectin, which is a type of soluble fiber.

Keep reading and be aware of misleading food labels and nutrition advice from well-intentioned friends. Nutrition is tricky and many good foods (may interact with medications and other foods. Red yeats rice may have cholesterol-reducing properties, but interacts with statins and thyroid medications. If something sounds too good to be true, it probably is. Tofu or soy is good, but it does have a lot of fat, so eat it in moderation. Many yogurts contain a lot of hidden sugars.

A balanced approach versus an "all or nothing" style allows you to make methodic and permanent lifestyle changes that make sense. Keep redaing to better understand cholesterol and avoid saturated fat, trans fats, and dietary cholesterol, whenever possible. A diet rich in fruits and vegetables -some of it raw -helps maintain healthy weight, incorporate a variety of antioxidants, and maintain healthy levels of HDLs/LDLs.

Start moving, plan ahead, be a smart consumer, and keep your pantry stocked with healthy choices. I will check back in with more tips while making changes of my own and welcome yours!

Online resources:

• National Women's Health Information Center
• National Heart Lung and Blood Institute
• Nutrition.gov
• Physicians Committee For Responsible Medicine
• Fitness.gov