Cholesterol

Coronary artery disease is the No. 1 killer of both men and women and its leading cause is high cholesterol. Yet, some cholesterol actually fights heart disease. How can that be?

The body needs cholesterol.

Cholesterol is a fat, or lipid, in the bloodstream. Your body uses it to form the membranes of cells throughout the body. It’s also a chief component of bile, which we use to absorb fats and vitamins, and without cholesterol we couldn’t produce essential hormones such as estrogen and testosterone. But this is not an invitation to super-size your order at the drive-thru.

According to the American Heart Association, “Typically the body makes all the cholesterol it needs, so people don’t need to consume it. … The average American man consumes about 337 milligrams of cholesterol a day; the average woman, 217 milligrams. Some of the excess dietary cholesterol is removed from the body through the liver.” AMH recommends a daily cholesterol intake of under 300 milligrams, and under 200 milligrams if you already have heart disease.

“Good” cholesterol actually helps prevent heart disease.

Cholesterol travels through the circulatory system with proteins and other substances in particles called lipoproteins. Low-density lipoproteins (LDL) are commonly referred to as “bad” cholesterol, while high-density lipoproteins (HDL) constitute “good” cholesterol.

What makes cholesterol bad or good? When there is an excess of LDL, it can accumulate on the inside walls of arteries with other deposits and inflame the arterial lining, forming a clot that inhibits blood flow (this condition is known as atherosclerosis, which you can read more about here. A clogged artery can rob the heart or brain of oxygen-rich blood, resulting in heart attack or stroke. HDL, on the contrary, has the capacity to pick up cholesterol where it has accumulated and whisk it off to the liver, where is converted into usable bile or secreted from the body.

“No fat” is no good.

Americans have only recently overcome a widespread fear of fat in food. Based on the overgeneralization that fat causes heart disease, a “no fat” trend emerged. Cutting out fats was the wrong idea, and didn’t make anyone thinner or healthier. Diets that are very low in fat will actually decrease the good, fat-cleansing HDL cholesterol.

The far healthier goal is to limit saturated fats and trans-fatty acids, which are both related to artery-clogging LDL cholesterol. Read more about the fats in various foods at the American Heart Association here.

Statins such as Mevacor, Lipitor and Crestor are drugs that reduce cholesterol production in the body, and Americans probably consume as many statins as french fries. In 2005, Pfizer sold $12.2 billion worth of Lipitor, the best-selling drug of all time. Unquestionably these drugs save many lives, though they have effectively been used as a thumb in the dam of the U.S. obesity epidemic. What Crestor pitchman Mandy Patinkin and friends aren’t telling you is that a) you may be able to manage cholesterol without a pill; and b) the risks associated with a drug will sometimes outweigh its benefits. A study reported in the May 2006 issue of the American Journal of Clinical Nutrition found that men on a diet to reduce carbohydrate intake also reduced their bad cholesterol levels and increased their good. In other words, a good diet can work. So, before you seek a quick fix, talk to a doctor and consider whether it’s time to make some lifestyle changes.

People have also flocked to vitamin E, beta carotene and folate (folic acid) believing they could reduce cholesterol, but none has proved to be an effective intervention.

High cholesterol is within your power to control.

Heredity, age and various disorders are risk factors for cholesterol-related disease, but the greatest risk is also the most controllable one. “Controlling cholesterol is about diet, it’s about physical activity, and it’s about body weight,” says Alice Lichtenstein, professor of nutrition science and policy at Tufts University. “People need to look at the whole package. That doesn’t mean going on a diet; it’s about making fundamental changes in the way they eat and the way they live their lives—changes that they feel they can live with. There aren’t any easy answers, but if you make the investment you can decrease risk and maintain health as you age. In the long-term, it’s worth it.”

To learn more about cholesterol, visit the“Live Healthier, Live Longer” page at the National Heart, Lung, and Blood Institute. Also see the Cholesterol Health Center here at MSN Health & Fitness, and download How Can I Lower High Cholesterol? courtesy of the American Heart Association.

Thank you to Professor Alice Lichtenstein of Tufts University for providing background and guidance.

Find more on MSN Health & Fitness:

• The Best Foods to Lower Your Cholesterol
• Good Cholesterol, Bad Cholesterol
• Cholesterol Message Boards