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"What is Cholesterol ?" continues >>
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"The Harvard Medical School Guide to Lowering your Cholesterol"
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Category : Cookbooks - Heart Health - Hypertension -
cholesterol management - nutrition
cholesterol management - nutrition
Betty Crocker's Low-Fat, Low-Cholesterol Cooking Today,
By Betty Crocker Editors
By Betty Crocker Editors
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What is Cholesterol?
An Overview of the Basics.
An Overview of the Basics.
1- ABSTRACT.
Managing Cholesterol levels is a constant preoccupation for those who have been diagnosed with hypercholesterolemia (high blood cholesterol), atherosclerosis (hardening of the arteries) or told that they suffered from Coronary Heart Disease. The results they achieve in managing their cholesterol levels can sometimes vary wildly. One month, blood cholesterol measures at 81 mg/dL (2.1 mmol/L), and the following month it is at 132 mg/dL (3.41 mmol/L) ! This can be very frustrating to either old-time or newly diagnosed cholesterolemics. A constant low level of LDL-C is desirable. Many people have achieved great success in managing their cholesterol levels. They, of course, have mastered their condition. In order to do so, they have come to know the very nature of their ailment; they have a good knowledge of just what is cholesterol and of the ways to keep it low. Having figured out how hypercholesterolemia works (its physiology), they can now master it. Actually, their blood cholesterol levels are often far better than those in the general population.
Managing Cholesterol levels is a constant preoccupation for those who have been diagnosed with hypercholesterolemia (high blood cholesterol), atherosclerosis (hardening of the arteries) or told that they suffered from Coronary Heart Disease. The results they achieve in managing their cholesterol levels can sometimes vary wildly. One month, blood cholesterol measures at 81 mg/dL (2.1 mmol/L), and the following month it is at 132 mg/dL (3.41 mmol/L) ! This can be very frustrating to either old-time or newly diagnosed cholesterolemics. A constant low level of LDL-C is desirable. Many people have achieved great success in managing their cholesterol levels. They, of course, have mastered their condition. In order to do so, they have come to know the very nature of their ailment; they have a good knowledge of just what is cholesterol and of the ways to keep it low. Having figured out how hypercholesterolemia works (its physiology), they can now master it. Actually, their blood cholesterol levels are often far better than those in the general population.
Contents of Article
>> 1 - Abstract / Introduction
>> 2 - The Nature of the Substance
>> 3 - What is The Utility of Cholesterol
>> 4 - What is the Source of Cholesterol
>> 5 - What is LDL-Cholesterol
>> 6 - What is HDL-Cholesterol
>> 7 - What is the Cholesterol Ratio
>> 8 - What is Hypercholesterolemia
>> 10 - NUTRITION and Cholesterol
>> 9 - Medication to Lower Cholesterol
... on Page 2
>> 11 - References
>> 12 - Helpful Links
2 - THE BIOCHEMICAL NATURE OF THE SUBSTANCE
If you were to try to isolate or extract cholesterol in a laboratory, you would be left with a whitish substance. To the touch, it would feel somewhat like paraffin or any white wax. Cholesterol belongs to a class of substances known as lipids, or fats.
Aside from being a lipid, its chemical structure is that of a steroid with an alcohol group on it. A steroid is a mostly carbon "frame" made up of 4 rings bound together. As is the case with most fatty substances, it does NOT dissolve very well in water or water-based solutions such as blood.
If you were to try to isolate or extract cholesterol in a laboratory, you would be left with a whitish substance. To the touch, it would feel somewhat like paraffin or any white wax. Cholesterol belongs to a class of substances known as lipids, or fats.
Aside from being a lipid, its chemical structure is that of a steroid with an alcohol group on it. A steroid is a mostly carbon "frame" made up of 4 rings bound together. As is the case with most fatty substances, it does NOT dissolve very well in water or water-based solutions such as blood.
3 - WHAT IS THE UTILITY OR FUNCTION OF CHOLESTEROL IN THE BODY
You may ask yourself why the body bothers making cholesterol in the first place. Actually, a SMALL amount of cholesterol is necessary. Among other things, cholesterol is necessary in the manufacture of cell membranes. It can be viewed as a building block of the cell structure.
Cholesterol is also the raw material that will be used to synthesize hormones such as sexual hormones and cortico-steroids.
Cholesterol is also necessary in the digestive process. The liver transforms it into bile acids that it will excrete in the intestinal tract. Those bile acids are indispensable in the digestion of lipids.
So, cholesterol is necessary. But that does not mean one should have more... as if it were good for you! Only SMALL amounts are needed. The problems that we experience due to an excess of cholesterol in our bloodstream are due either to genetic factors or, especially, to our very delinquent western or North American diet. Our primitive ancestors lived on cereals, legumes, fruits and vegetables. We have not yet been genetically programmed to live on burgers, hot-dogs, fries, pizza and gallons of pop. It may be many thousands of years before natural selection turns us into beings adapted fully to an industrial fast-junk-food diet.
You may ask yourself why the body bothers making cholesterol in the first place. Actually, a SMALL amount of cholesterol is necessary. Among other things, cholesterol is necessary in the manufacture of cell membranes. It can be viewed as a building block of the cell structure.
Cholesterol is also the raw material that will be used to synthesize hormones such as sexual hormones and cortico-steroids.
Cholesterol is also necessary in the digestive process. The liver transforms it into bile acids that it will excrete in the intestinal tract. Those bile acids are indispensable in the digestion of lipids.
So, cholesterol is necessary. But that does not mean one should have more... as if it were good for you! Only SMALL amounts are needed. The problems that we experience due to an excess of cholesterol in our bloodstream are due either to genetic factors or, especially, to our very delinquent western or North American diet. Our primitive ancestors lived on cereals, legumes, fruits and vegetables. We have not yet been genetically programmed to live on burgers, hot-dogs, fries, pizza and gallons of pop. It may be many thousands of years before natural selection turns us into beings adapted fully to an industrial fast-junk-food diet.
4 - WHAT ARE THE SOURCES OF CHOLESTEROL
Many people feel that their cholesterol levels "must be" just fine since they often purchase foods that have "cholesterol free" written in bright colors on the package. In reality, while a bag of potato chips does not contain any cholesterol, since potatoes and vegetable oil are not of animal origin, the effect of a large intake of potato chips on your blood cholesterol level is surprisingly important. Those chips or fries contain exatcly what your liver was waiting for to turn on its cholesterol-making machine. Even if it said "Cholesterol-Free!" on the package or box that you have bought.
There are in fact two sources of cholesterol: DIETARY and DE NOVO. Dietary cholesterol is of course the one we ingest directly by eating cholesterol-containing foods such as eggs, cream, butter and meat. De Novo cholesterol is the one our own body will produce. The liver and the lining of the intestinal tract have the ability to produce new (novo) cholesterol. Saturated and trans- fats are especially notorious promoters of cholesterol synthesis by the liver.
These are reasons why many leading cardiologists today are advocates of low-fat diets. When it comes to saturated and trans-fats, they will favour an even lower intake, since your liver is likely to turn a fraction of them into LDL-Cholesterol (the bad one). As we will see later, slowing the production of cholesterol in the liver will be one of your Doctor's options to lower your cholesterolemia.
Many people feel that their cholesterol levels "must be" just fine since they often purchase foods that have "cholesterol free" written in bright colors on the package. In reality, while a bag of potato chips does not contain any cholesterol, since potatoes and vegetable oil are not of animal origin, the effect of a large intake of potato chips on your blood cholesterol level is surprisingly important. Those chips or fries contain exatcly what your liver was waiting for to turn on its cholesterol-making machine. Even if it said "Cholesterol-Free!" on the package or box that you have bought.
There are in fact two sources of cholesterol: DIETARY and DE NOVO. Dietary cholesterol is of course the one we ingest directly by eating cholesterol-containing foods such as eggs, cream, butter and meat. De Novo cholesterol is the one our own body will produce. The liver and the lining of the intestinal tract have the ability to produce new (novo) cholesterol. Saturated and trans- fats are especially notorious promoters of cholesterol synthesis by the liver.
These are reasons why many leading cardiologists today are advocates of low-fat diets. When it comes to saturated and trans-fats, they will favour an even lower intake, since your liver is likely to turn a fraction of them into LDL-Cholesterol (the bad one). As we will see later, slowing the production of cholesterol in the liver will be one of your Doctor's options to lower your cholesterolemia.
5 - WHAT IS LDL or LOW-DENSITY LIPOPROTEIN CHOLESTEROL
We have seen earlier that cholesterol, a lipid or fat, does not dissolve well in water-based solutions such as blood. How does it manage to travel in the bloodstream ? It uses a sort of "piggy-back" method. It can be bound chemically to some particles so it can then travel in the bloodstream with that particle. In the liver, it can be bound, for instance, to a protein-containing particle of small density. We then have a particle containing a lipid fraction and a protein fraction containing our cholesterol. We are now looking at a Low-Density LipoProtein. Hence the terms: low-density lipoprotein cholesterol or LDL-C. A low-density particle is not the best of alternatives for transporting cholesterol, as far as our arteries are concerned. It seems the nature of the particle allows it to do some harm, such as to infiltrate under the lining of the arteries and causing atherosclerotic plaque to build up. This is why LDL-C is referred to as the bad cholesterol, it causes plaque to build up inside our arteries, thereby constricting or reducing the lumen or passageway. In the heart vessels, this situation develops into Coronary Artery Disease, or simply Heart Disease. In the other arteries, such the ones in our legs, it is referred to as Peripheral Artery Disease. Cholesterol is a necessary building block of Coronary Heart Disease.
We have seen earlier that cholesterol, a lipid or fat, does not dissolve well in water-based solutions such as blood. How does it manage to travel in the bloodstream ? It uses a sort of "piggy-back" method. It can be bound chemically to some particles so it can then travel in the bloodstream with that particle. In the liver, it can be bound, for instance, to a protein-containing particle of small density. We then have a particle containing a lipid fraction and a protein fraction containing our cholesterol. We are now looking at a Low-Density LipoProtein. Hence the terms: low-density lipoprotein cholesterol or LDL-C. A low-density particle is not the best of alternatives for transporting cholesterol, as far as our arteries are concerned. It seems the nature of the particle allows it to do some harm, such as to infiltrate under the lining of the arteries and causing atherosclerotic plaque to build up. This is why LDL-C is referred to as the bad cholesterol, it causes plaque to build up inside our arteries, thereby constricting or reducing the lumen or passageway. In the heart vessels, this situation develops into Coronary Artery Disease, or simply Heart Disease. In the other arteries, such the ones in our legs, it is referred to as Peripheral Artery Disease. Cholesterol is a necessary building block of Coronary Heart Disease.
6 - WHAT IS HDL or HIGH-DENSITY LIPOPROTEIN CHOLESTEROL
The cholesterol fraction could, of course, also be bound to a higher density particle. We would then be looking at High-Density Lipoprotein Cholesterol or HDL-C, also referred to as the good cholesterol. The bond involving the high-density particle seems to be particularly strong. LDL particles do not seem to "spill their loads" all over the endothelium of our arteries. On the contrary they are deemed capable of plucking cholesterol from the arterial wall and carry it back to the liver where it can be excreted in the bile.
This is referred to as "reverse cholesterol transport". This means that HDL-C is responsible for carrying cholesterol from the blood stream back to the liver for elimination. HDL can be referred to as the highly desirable fraction of the serum Total Cholesterol.
The cholesterol fraction could, of course, also be bound to a higher density particle. We would then be looking at High-Density Lipoprotein Cholesterol or HDL-C, also referred to as the good cholesterol. The bond involving the high-density particle seems to be particularly strong. LDL particles do not seem to "spill their loads" all over the endothelium of our arteries. On the contrary they are deemed capable of plucking cholesterol from the arterial wall and carry it back to the liver where it can be excreted in the bile.
This is referred to as "reverse cholesterol transport". This means that HDL-C is responsible for carrying cholesterol from the blood stream back to the liver for elimination. HDL can be referred to as the highly desirable fraction of the serum Total Cholesterol.
7 - WHAT IS THE CHOLESTEROL RATIO
From the above, one can see that a person could have an acceptable level of total cholesterol and still be at high risk for heart problems if that total is made up mostly of LDL-C while the level of HDL-C is too low. Such a scenario is quite common. When a disorder in lipid profile (dyslipidemia) is suspected, your doctor will want to go beyond the value of total cholesterol in your blood. He/she will want to measure and assess the amount of HDL relative to LDL. He or she will order a test that will measure the amounts of each.
From these values, the ratio will be determined by dividing the total cholesterol by the value of the HDL. So if your total serum cholesterol was 230 mg/dl and your HDL was 45 mg/dl, 230 / 45 = 5.11. This would be a bit high. On the other hand if your total chol. were 220 mg/dl and your HDL 55 mg/dl, your ratio would be 4.0. When it comes to the cholesterol ratio: the lower, the better! Even tough there is almost no difference in the total cholesterol, the person with a ratio of 4.0 is at a much lesser risk of cardiac events than the one with a 5.1 ratio. The American Heart Association considers a 3.5 ratio as being optimum. In secondary care (secondary to having had a cardiac event), many cardiologists are pushing for an even lower number. The cholesterol ratio is also looked at as a sort of risk ratio.
From the above, one can see that a person could have an acceptable level of total cholesterol and still be at high risk for heart problems if that total is made up mostly of LDL-C while the level of HDL-C is too low. Such a scenario is quite common. When a disorder in lipid profile (dyslipidemia) is suspected, your doctor will want to go beyond the value of total cholesterol in your blood. He/she will want to measure and assess the amount of HDL relative to LDL. He or she will order a test that will measure the amounts of each.
From these values, the ratio will be determined by dividing the total cholesterol by the value of the HDL. So if your total serum cholesterol was 230 mg/dl and your HDL was 45 mg/dl, 230 / 45 = 5.11. This would be a bit high. On the other hand if your total chol. were 220 mg/dl and your HDL 55 mg/dl, your ratio would be 4.0. When it comes to the cholesterol ratio: the lower, the better! Even tough there is almost no difference in the total cholesterol, the person with a ratio of 4.0 is at a much lesser risk of cardiac events than the one with a 5.1 ratio. The American Heart Association considers a 3.5 ratio as being optimum. In secondary care (secondary to having had a cardiac event), many cardiologists are pushing for an even lower number. The cholesterol ratio is also looked at as a sort of risk ratio.
8 - WHAT IS HYPERCHOLESTEROLEMIA
Cholesterolemia refers to the amount of cholesterol in your blood. Therefore Hypercholesterolemia would be an excessive amount of cholesterol in one's blood. Hypercholesterolemia often is often related to genetics. People who are hypercholesterolemics often have parents who were also hypercholesterolemics. In such a case, your physician may want to put you on medication to lower your cholesterol, so as to prevent future complications.
At what level is one at risk and at what level is one at reduced risk ?
> 240 mg/dl , at 240 and more, a person is considered to be at HIGH RISK.
200 to 239 mg/dl, at that level a person is considered in a BORDERLINE High Risk zone.
< 200 mg/dl, a level of less than 200 is considered as desirable.
However, many clinicians now feel that those standards should be lowered still, as epidemiological studies confirm that lower risk is associated with even lower numbers. For LDL-C values the optimal value was set at 100 mg/dl. Newer guidelines suggest that an optimal or safer LDL-C level is rather between 70 to 50 mg/dl.
Cholesterolemia refers to the amount of cholesterol in your blood. Therefore Hypercholesterolemia would be an excessive amount of cholesterol in one's blood. Hypercholesterolemia often is often related to genetics. People who are hypercholesterolemics often have parents who were also hypercholesterolemics. In such a case, your physician may want to put you on medication to lower your cholesterol, so as to prevent future complications.
At what level is one at risk and at what level is one at reduced risk ?
> 240 mg/dl , at 240 and more, a person is considered to be at HIGH RISK.
200 to 239 mg/dl, at that level a person is considered in a BORDERLINE High Risk zone.
< 200 mg/dl, a level of less than 200 is considered as desirable.
However, many clinicians now feel that those standards should be lowered still, as epidemiological studies confirm that lower risk is associated with even lower numbers. For LDL-C values the optimal value was set at 100 mg/dl. Newer guidelines suggest that an optimal or safer LDL-C level is rather between 70 to 50 mg/dl.
9 - MEDICATION TO LOWER CHOLESTEROL
In many cases, using medication to control cholesterol levels is necessary. Some people strongly object, as a matter of principle, to taking any medication whatsoever. When it comes to LDL-Cholesterol, the consequences of not using lipid and cholesterol-lowering medication are serious in nature. The benefits of taking the medication may far outweigh the disadvantages. There are a few drugs to control cholesterolemia. We will cover the main ones.
A- The STATIN DRUGS. They are known to the patients mainly as Lipitor, Crestor, Pravachol and Zocor. They work by inhibiting the action of an enzyme that is used in the liver to produce cholesterol. They are particularly efficient, especially in reducing the bad LDL-Cholesterol. In clinical trials, it has been demonstrated that an aggressive statin therapy was even associated with a slow regression or reversal of the disease. This is very good news indeed. Until recently it had been assumed that coronary heart disease patients would only experience progression of the disease. Statin drugs are reported to be particularly good at halting or even reversing heart disease when combined with lifestyle changes such as a low-fat diet and smoking cessation.
B- NIACIN -Nicotinic Acid form only- is also used. It has the distinct advantage of raising the good HDL-Cholesterol.
It is not as efficient as statins in reducing LDL-C.
C- Bile Sequestrants - Questran, Welcol etc. - As their name indicates they bind to the cholesterol-containing bile acids in the bowel and increase the rate of cholesterol elimination through the stools.
D- Cholesterol absorption inhibitors (Ezetimibe - Zetia, Ezetrol). They work by competing with cholesterol for the receptor sites in the intestine. When the receptor site is occupied by Ezitimibe, the cholesterol cannot use that site to be absorbed. It is then likely to be eliminated with natural bowel movement.
In many cases, using medication to control cholesterol levels is necessary. Some people strongly object, as a matter of principle, to taking any medication whatsoever. When it comes to LDL-Cholesterol, the consequences of not using lipid and cholesterol-lowering medication are serious in nature. The benefits of taking the medication may far outweigh the disadvantages. There are a few drugs to control cholesterolemia. We will cover the main ones.
A- The STATIN DRUGS. They are known to the patients mainly as Lipitor, Crestor, Pravachol and Zocor. They work by inhibiting the action of an enzyme that is used in the liver to produce cholesterol. They are particularly efficient, especially in reducing the bad LDL-Cholesterol. In clinical trials, it has been demonstrated that an aggressive statin therapy was even associated with a slow regression or reversal of the disease. This is very good news indeed. Until recently it had been assumed that coronary heart disease patients would only experience progression of the disease. Statin drugs are reported to be particularly good at halting or even reversing heart disease when combined with lifestyle changes such as a low-fat diet and smoking cessation.
B- NIACIN -Nicotinic Acid form only- is also used. It has the distinct advantage of raising the good HDL-Cholesterol.
It is not as efficient as statins in reducing LDL-C.
C- Bile Sequestrants - Questran, Welcol etc. - As their name indicates they bind to the cholesterol-containing bile acids in the bowel and increase the rate of cholesterol elimination through the stools.
D- Cholesterol absorption inhibitors (Ezetimibe - Zetia, Ezetrol). They work by competing with cholesterol for the receptor sites in the intestine. When the receptor site is occupied by Ezitimibe, the cholesterol cannot use that site to be absorbed. It is then likely to be eliminated with natural bowel movement.
