Cholesterol - All You Need to Know!

When you go to the doctor and he tells you your cholesterol level, you typically are told your TOTAL blood cholesterol level. Ever wondered how cholesterol gets into your blood? The body's liver makes most of the cholesterol it needs - yes, NEEDS. Some cholesterol is absorbed from the food you eat.

Why does the body NEED cholesterol?
The body needs cholesterol to make several important hormones including estrogen and testosterone. In addition, cholesterol is part of the protective covering that surrounds nerves and other cell membranes.

Why is having a high blood cholesterol level bad?
Elevated cholesterol levels are associated with heart disease. For a better assessment of your risk of heart disease, it is important to know not only your total cholesterol but also your HDL. The total cholesterol consists of HDL (high-density lipoprotein), LDL (low-density lipoprotein), and VLDL (very low-density lipoprotein). LDL is the bad guy. HDL is the good guy. Why? LDL cholesterol sticks to your the walls of your blood vessels and can cause blockage. VLDL is the precursor to LDL cholesterol. HDL goes around in the blood stream, collects bad cholesterol, and carries it back to the liver where it is broken down.

What is considered a healthy level in the blood?
It is desirable to keep total cholesterol levels below 200mg/dl. Values above 240 mg/dl are considered significantly elevated. If you know your LDL value, it is desirable to have this type of cholesterol below 130 mg/dl. Values for LDL above 160 are considered significantly elevated. Because HDL is the good guy, you want this level high. Values below 35 mg/dl are a HIGH risk indicator for heart disease. It is more desirable to have HDL levels close to 50 mg/dl or higher.

The Total Cholesterol:HDL Ratio is a good indicator of risk. To calculate this important ratio, divide your Total cholesterol value by your HDL value. The HIGHER the ratio, the GREATER the risk of heart disease. For example: Total = 240 mg/dl HDL = 30 mg/dl Ratio = 240/30 = 8.0
*This is a high risk ratio.

--IDEAL RATIO FOR MEN IS LESS THAN OR EQUAL TO 4.0.
--IDEAL RATIO FOR WOMEN IS LESS THAN OR EQUAL TO 3.5.

What is cholesterol?
It is a waxy, fat-like substance.

What foods contain cholesterol?
Foods of animal origin are the ONLY foods that contain cholesterol. Foods of plant origin, even those naturally containing fat, DO NOT contain cholesterol.

Cholesterol in food:
There are a number of factors that affect your blood cholesterol level. One factor, is a diet high in dietary cholesterol. Moderation is advised to keep cholesterol levels in check. The American Heart Association and the National Cholesterol Education Program recommend that you consume 300 mg of cholesterol or less per day.

As stated above, foods of animal origin are the ONLY foods that contain cholesterol. Foods of plant origin, even those naturally containing fat, DO NOT contain cholesterol. Are certain foods of animal origin higher in cholesterol than others? Yes.

Not many people enjoy eating organ meats, such as liver. If you are someone who does, you should know that organ meats are high in cholesterol, 270 mg per 3-ounce serving of liver. While liver is nutritious, if you are at risk for heart disease then you need to limit your intake.

Egg yolks have gotten a bad rap in the past. Why? It is because egg yolks are high in cholesterol, 215 mg per yolk. The yolk is definitely nutritious, its purpose is to provide nutrients for a chick embryo to develop. Unfortunately, it contains too much cholesterol to eat it as you please. You should limit the number of yolks you eat to 3 or less per week. What about the whites? Eat as many whites as you like. The white part of an egg contains no cholesterol and is a rich, complete source of protein.

To limit the number of egg yolks, you can substitute 2 egg whites for one whole egg when baking. For example, a recipe calls for 2 eggs. You could either use 1 whole egg plus 2 egg whites OR 4 egg whites. By doing this simple substitution, you will decrease the cholesterol content. Another option is to use an egg substitute, check label for egg equivalent.

As for meats, look for leaner cuts of meat, fish, and poultry. Cut away excess fat before cooking. Choose low-fat dairy products. By following these steps, you will not be able to eliminate all the cholesterol but you are taking important steps towards healthy eating.

Read food labels for foods low in cholesterol or foods that are cholesterol free. How do you know if a product is low in cholesterol? Here are the food label requirements (government regulated):

Label claim -- Per Serving:
(1) Cholesterol Free - Less than 2 mg cholesterol and Less than or equal to 2 g of saturated fat
(2) Low Cholesterol - Less than or equal to 20 mg cholesterol and Less than or equal to 2 g of saturated fat
(3) Reduced OR Less Cholesterol - At least 25% less cholesterol than the original and Less than or equal to 2 g of saturated fat

The above shows requirements for saturated fat. This is because blood cholesterol levels are significantly affected by dietary saturated fat intake. Cholesterol and saturated fat usually are found in the same foods, thus sometimes get confused. In animal products, both the lean portion (flesh or muscle) and the fatty tissue contain cholesterol. This is why some low-fat foods (animal) can be relatively high in cholesterol. Foods such as shellfish and organ meats are high in cholesterol yet low in saturated fat.

Quiz question:
Nuts are high in fat, 80-89% of calories coming from fat. Do they contain cholesterol?
A: No. Nuts are from plant origin therefore they contain NO cholesterol.

Do not assume that dishes that contain vegetables or grains are cholesterol free. Vegetables and grains start off cholesterol free BUT most recipes include egg yolk, milk, meat, or butter. The cholesterol content depends on the recipe ingredients as a whole.

Effects of Saturated Fat:
If you have heart disease or have a family history of heart disease, it is likely your doctor has asked you to follow a diet low in fat and cholesterol. The fat to watch is saturated fat. Saturated fat INCREASES the level of "bad" LDL cholesterol in your blood. This is why it is so important to pay attention to the amount of saturated fat that is in your diet.

You do not have to avoid all fats. Unsaturated fats actually lower LDL cholesterol levels. "Unsaturated fats" includes polyunsaturated and monounsaturated fats. Monounsaturated fat is considered better than polyunsaturated fat. Why? In addition to lowering the "bad" LDL cholesterol, polyunsaturated fat lowers the "good" HDL cholesterol. As discussed above, HDL is beneficial because it collects LDL and brings it back to the liver where the LDL is broken down. Monounsaturated fat leaves the beneficial HDL cholesterol intact.

*Sources of Polyunsaturated Fat: Corn Oil, Sunflower Seed Oil, Safflower Oil, Soybean Oil
*Sources of Monounsaturated Fat: Olive Oil, Canola Oil, Peanut Oil

The main sources of saturated fat are from foods from animal origin and some from plants. Animal foods that are high in saturated fat include beef, veal, lamb, pork, butter, cream, milk (whole and 2%), cheese, and other dairy products made from whole milk. Plant foods that are high include coconut oil, palm oil, palm kernel oil, and cocoa butter. Check food labels to see which type of oil or fat was used in production.

The American Heart Association's dietary guidelines recommend (1) Total Fat intake should be Less Than 30 Percent of daily calories, and (2) Saturated fat intake should be Less Than 10 Percent of calories.

Cooking Tips from the American Heart Association --

To reduce saturated fat in meat:
(1) Use a rack to drain off the fat when broiling, roasting, or baking. Instead of basting with drippings, keep meat moist with wine, fruit juices or an acceptable oil-based marinade.
(2) Cook a day ahead of time. Stews, boiled meat, soup stock or other dishes in which fat cooks into the liquid can be refrigerated. Then the hardened fat can be removed from the top.
(3) Make gravies after the fat has hardened and can be removed from the liquid.
(4) Broil rather than pan-fry meats such as hamburger, lamb chops, pork chops, and steak.
(5) When a recipe calls for browning the meat first, try browning it under the broiler instead of in a pan.
(6) Avoid adding butter or margarine to vegetables when cooking. Instead use herbs and spices for flavor

Cholesterol-Lowering Medications:
If you have high cholesterol and you make the necessary changes in your diet and activity level, your cholesterol level should begin to go down after three to six months. If not your doctor may recommend cholesterol-lowering medication. If you are prescribed a cholesterol-lowering medication, remember that this is only the part of the plan. For maximum benefit and effectiveness, you must continue eating foods low in fat and cholesterol and continue exercising.
Other lifestyle changes you should make to avoid heart disease include losing weight if you are overweight, stop smoking if you smoke, control high blood pressure, and manage stress in your life. Traditionally, physicians have used medication to control blood cholesterol.

Here is a fact for you to think about before you decide to take cholesterol-lowering medication:
75% of all heart disease can be prevented by lifestyle changes including dietary changes and increased activity.

Cholesterol-lowering drugs are known as "antihyperlipidemic agents". There are five major groups: (1) Fibric acid derivatives - Atromid-S (clofibrate) and Lopid (gemdibrozil), which work by preventing the liver from making or releasing cholesterol into the bloodstream, (2) Bile acid sequestrants - Questran (cholestryamine) and Colestid (cholestipol), which bind to bile acids and prevent their absorption, (3) Nicotinic acid - Nicolar (nicotinic acid), which decreases the secretion of VLDL thus the formation of "bad" LDL cholesterol, (4) Probucol - Lorelco (probucol), which enhances the clearance of cholesterol including LDL and HDL cholesterol, and (5) HMG-CoA reductase inhibitors - Mevacor (lovastatin), Pravastatin, and Zocor (simvastatin), which work to help lower LDL cholesterol.

Now that you know which drugs are available and their general method of action in the body, you can hopefully make an educated decision along with your doctor on whether or not cholesterol-lowering drugs are necessary. Again, it cannot be stressed enough, a proper diet and exercise regimen can help you in your fight against high cholesterol. Good luck!

Written by: Laura S. Garrett, RD
Registered Dietitian & ACE Certified Personal Trainer
Keep Laura's advice at your fingertips, wherever you and your cell phone go with "Text ur R.D." -- Learn more at:
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