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Cholesterol, a waxy, fat-like substance made by the liver, is kind of like The Force – it has a light side, and a dark side.

The light side of cholesterol is that we all have it, we all make it, and we all need it to live. The dark side is that too much of it can lead to some serious health problems. The first step toward maintaining a healthful cholesterol level is getting tested.

Dr. Gerald Pytlewski, D. O., a cardiologist with St. Luke’s Hospital & Health Network and the cardiology division of Progressive Physician Associates, Inc., recommends cholesterol screening as early as age 16, “although some people who have a strong family history of heart problems have been tested at the age of two.”

And what do the test results mean?

Your “total cholesterol,” in milligrams-per-deciliter (mg/dL), reflects the combination of HDL (high-density lipoprotein) and LDL (low-density lipoprotein) cholesterols. The American Heart Association recommends levels of 200 mg/dL or lower, absent of any other risk factors for heart disease. Your heart disease risk factor is more determined by your cholesterol:HDL ratio – the worst case scenario would be high total cholesterol and low “good” cholesterol, according to Jennifer M. Doane, MS, RD, LDN, ATC, of Advantage Nutrition and Wellness, Bethlehem. HDL equals “happy” or “high” cholesterol—this is your good cholesterol, Doane says. This number is beneficial to be higher than 40. LDL is your low, or “bad” cholesterol.

If your result is above 200, that’s not necessarily a problem. Look at each component first: A relatively high HDL level (above 60 mg/dL) is actually desirable because it somewhat protects you from heart disease.

But if your LDL is high, that’s not so good.

“This is the dangerous cholesterol in the body,” says Dr. Pytlewski. “When there’s an excess amount, LDL can deposit its cholesterol in your blood vessels, causing atherosclerosis. That can lead to coronary artery disease, angina pectoris, and heart attacks.”
If you require treatment, you and your physician can determine how to proceed. And cholesterol-lowering medication isn’t always the first line of attack.

“It depends on the patient’s level of risk,” Dr. Pytlewski says. “If there’s evidence of prior heart disease, arterial plaque, or other high-risk factors, I’ll start medical treatment right away. “But if other risk factors are relatively low, lifestyle changes might be enough.”
What kinds of changes? Here are a few:

Exercise. Physical activity can increase HDL levels, and can help control other risk factors, including diabetes, obesity and hypertension. Aerobic exercise also strengthens your heart and lungs. “We routinely recommend higher levels of ‘sweating’ exercise to our clients with high cholesterol levels because of the great benefits it can have on raising your HDL levels,” Doane says.
Avoid tobacco smoke, either first- or second-hand.

Maintain a healthy diet. Cholesterol from dietary sources mainly comes from animal products, according to Doane. Most individuals highly associate cholesterol with the “fat” in their food; however this is only true when we are consuming animal-based sources. Plant based fats do not typically contain cholesterol and would be your best as well as most heart healthy, choices. Examples of plant based dietary fats include olive or canola oil, nuts, seeds, avocado, and trans-fat free margarine spreads.

Suzanne Ickes RD, LDN, a registered dietitian in private practice in Wescosville and a clinical dietitian for Sodexo, adds, “We produce about 75 percent of the cholesterol that’s in our bodies, and we produce it when we digest fats.”

If your cholesterol is high, Ickes says, avoid saturated fats, trans fats and hydrogenated/partially hydrogenated oils. They’re commonly found in meats, butter, margarine, whole milk, shortenings, cheese, and many commercial baked goods and fast foods.

On the other hand, foods high in soluble fiber can actually remove cholesterol from the blood stream. Ickes says you’ll find varying amounts of soluble fiber in oatmeal, all sorts of beans (including lentils and chick peas), Brussels sprouts, carrots, butternut squash and other foods.
“Eating six to nine grams of soluble fiber a day is beneficial,” Ickes says. “I’ve seen people take that route and lower their LDL readings by 60 points in just six weeks.”

And if diet and exercise alone can’t do the job, medications might be in order.

One of the most commonly used types is the statin class, Dr. Pytlewski says. “They block the production of cholesterol in the liver,” he explains, “and the liver, in turn, absorbs cholesterol from the bloodstream, keeping it away from the arteries.” Familiar brand names include Zocor®, Lipitor® and Crestor®.

Drugs such as ezetimibe (Zetia®) help by reducing the absorption of dietary cholesterol. Acid-binding resins (Questran®, for example), in conjunction with a proper diet, remove naturally occurring bile acid from the liver; this causes the liver to use cholesterol as it produces more bile acid.

As important as healthful cholesterol levels are now, we can expect more focus on them in the future.

“The NCEP [National Cholesterol Education Program] hasn’t issued new guidelines since 2001,” Dr. Pytlewski says. When that happens in 2010, “I expect more and more people will receive medical therapy. The average total cholesterol level in the US today is 210; that’s twice the normal level..”

He adds that guidelines for LDL levels are already getting more aggressive. “It appears that if we can get the LDL value below 70 [rather than the common goal of 100], we can arrest the progression of atherosclerosis, and maybe even reverse it.”

Dr. Pytlewski sums up the need for careful monitoring pretty well: “It’s one of the primary ways to prevent a [cardiac] problem from occurring, as well as to prevent a second problem.”

RESOURCES
Dr. Gerald Pytlewski, DO
610-435-5913

Suzanne Ickes, Rd, LDN
610-597-1512

Advantage Nutrition & Wellness
2005 City Line Rd, Ste 104
Bethlehem, PA 18017
610-443-1885
www.AdvantageNutritionAndWellness.com