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Cholesterol has a nasty reputation as a major risk factor for heart disease. But wait a minute: It's not all bad. In fact, the waxy substance is vital to your life and health. Without it, your body can't make sex hormones or the bile acids that help you digest fats. Cholesterol is also a major component of your cell membranes.
The bad part is overdosing on that waxy stuff. It takes only a little cholesterol-very little-to meet all of your body's needs. And your liver makes just enough. As soon as you start eating foods that contain cholesterol, you're at risk for having too much.
All that extra cholesterol gets processed by your liver and sent out into your bloodstream attached to low-density lipoprotein (LDL) molecules. That's why LDLs are called bad cholesterol. When your LDLs are high, you have lots of cholesterol floating around in your blood.
High-density lipoprotein (HDL) molecules, on the other hand, pluck cholesterol out of your blood and return it to your liver for elimination. That's why HDLs are called good cholesterol. The higher your HDLs, the more excess cholesterol gets swept out of your blood.
As LDLs-and their relatives, the very low density lipoproteins (VLDLs)-circulate in your blood, much of their cholesterol load gets incorporated into pimplelike deposits that develop along the walls of your arteries. These deposits, or plaques, narrow your arteries and impair blood flow. Once your arteries become significantly narrowed, you're at risk for serious health problems: heart attack, stroke, congestive heart failure, angina, high blood pressure, impotence, and intermittent claudication (impaired blood flow in the legs).
According to the American Heart Association, almost half of American adults have cholesterol levels higher than 200 mg/dl (milligrams per deciliter of blood), the top end of the official desirable range. About 18 percent have cholesterol levels higher than 240, which make them candidates for heart attack.
Lowering your cholesterol can have a big impact on your risk of heart attack and other cholesterol-related conditions. For every 1 percent drop in your total cholesterol, your chances of having a heart attack fall by 2 to 3 percent. And for every 1 percent increase in your HDLs, your risk drops by about 3 percent.
There are two basic approaches to cutting cholesterol: lifestyle modifications and drugs. A combination of the two may provide the fastest results. "Aggressive treatment of elevated cholesterol prevents heart attacks, slows atherosclerosis, and saves lives," says James Cleeman, M.D., coordinator of the National Cholesterol Education Program, a project of the National Heart, Lung, and Blood Institute of the National Institutes of Health in Bethesda, Maryland.
Minimize animal products. Oxford University epidemiologist Robert Clarke, M.D., analyzed 395 studies of the relationship between diet and blood cholesterol. His conclusion: If you replace 60 percent of saturated fat with polyunsaturated fat and eliminate 60 percent of dietary cholesterol, your total cholesterol would fall by 10 to 15 percent. The chief dietary sources of saturated fat and cholesterol are meats and whole-milk dairy products.
Avoid margarine. Many Americans believe that margarine is healthier than butter. In fact, the opposite is true. To make margarine, manufacturers add hydrogen to vegetable oils, a process that creates trans fatty acids. Research has shown that trans fatty acids raise LDLs and lower HDLs.
"Butter is better than margarine, but both should be restricted;" says Joseph E. Pizzorno Jr., N.D. As an alternative, he recommends using canola, safflower, or olive oil.
Enjoy fish twice a week. The American Heart Association recommends fish as an excellent source of lean protein and omega-3 fatty acids, which can help lower your cholesterol. For cholesterol control and general heart health, make fish your main dish twice a week, advises William Connor, M.D., professor of medicine at the Oregon Health Sciences University in Portland. Cold-water species such as salmon, mackerel, and halibut are the best sources of omega-3's. But make sure that it's broiled, baked, or steamed-not fried or drowned in butter.
Look beyond oat bran. In the late 1980s, a highly publicized study showed that eating oat bran-a soluble fiber found in oatmeal-can lower cholesterol by spurring its elimination from ,the body in bile. "But any and probably all plant fibers lower cholesterol," says James A. Duke, Ph.D. He recommends eating plenty of fiber-rich whole grains, beans, fruits, and vegetables.
Eat an apple a day. Apple pulp is rich in pectin, a soluble plant fiber. One apple a day can cut your total cholesterol by around 5 percent, Dr. Pizzorno says. Other good sources of pectin include carrots, pears, oranges, and grapefruit.
Cut cholesterol with carotenoids. Red, orange, and yellow fruits and vegetables get their vibrant colors from carotenoids, compounds in the vitamin A family. Carotenoids are potent antioxidants that help protect your heart. "Many studies show that as fruit and vegetable consumption increases, risk of heart attack and stroke decreases," Dr. Pizzorno says.
Experiment with soy. "Soy foods definitely help lower cholesterol," says Alan P. Brauer, M.D. "But you have to eat at least an ounce a day." That's not difficult: Just add cubed or shredded tofu to the dishes you ordinarily make.
Eat a heart-healthy breakfast. According to the second National Health and Nutrition Examination Study (NHANES-II), skipping breakfast is associated with high cholesterol levels. Of course, a breakfast of bacon and eggs can also boost your cholesterol into the danger zone. "But for most people, breakfast is the meal that's easiest to transform into a cholesterol-lowering experience," says Anne Simons, M.D. "Just eat a whole-grain cereal or bread with some fruit."
Oil your arteries. If you're not fond of fish, you can get omega-3 fatty acids from fish oil or flaxseed oil. According to Seattle naturopath Michael T. Murray, N.D., flaxseed oil is a better choice because the effective, cholesterol-lowering dose is just 1 tablespoon a day. With fish oil, you need a great deal more.
Benefit from niacin. One of the B vitamins, niacin lowers cholesterol by reducing the liver's production of VLDLs, the chemical building blocks of LDLs. "Niacin is especially useful for people like me, who have a stubborn hereditary predisposition to high cholesterol," says clinical nutritionist Shari Lieberman, Ph.D. "Using diet and exercise only, I was able to lower my cholesterol from 270 to 245. Now that I've added extra niacin to my program, my cholesterol stays at or below 200."
The effective dose of niacin ranges from 250 to 1,800 milligrams a day, well above the Daily Value of 20 milligrams. In such high doses, the vitamin causes flushing, a sudden, uncomfortable feeling of heat and discomfort similar to a menopausal hot flash. So you need to check with your doctor before supplementing with doses above 35 milligrams.
Pop pills of pantethine. Pantethine is the most active form of pantothenic acid, a B vitamin that helps your body digest fats and interferes with your liver's production of cholesterol. Dr. Lieberman recommends taking 300 milligrams of pantethine three times a day.
Raise your C level. Vitamin C helps increase your supply of HDLs, which lower your risk of heart attack, says Melvyn R. Werbach, M.D., assistant clinical professor at the University of California, Los Angeles, School of Medicine. For the most benefit, you need to take 2,000 milligrams of vitamin C a day. You may want to combine your supplements with a soluble fiber source, such as oat bran or pectin, to help your HDLs eliminate cholesterol.
For extra protection, add E. According to Alan Gaby, M.D., vitamin E may offer the greatest protection against high cholesterol because it speeds the breakdown of LDLs while simultaneously increasing HDLs. "Several large studies have demonstrated that blood vitamin E levels may be better predictors of future heart attack than total cholesterol levels," he says.
Stay one step ahead of high cholesterol. Any type of exercise improves your cholesterol profile, according to William L. Haskell, Ph.D., professor of cardiovascular medicine and deputy director of the Center for Research on Disease Prevention at Stanford University School of Medicine. It's especially good for shifting your LDL/HDL balance by lowering levels of LDLs and raising levels of HDLs.
Aim for less stress. Stress is a well-documented risk factor for heart attack. It doesn't raise cholesterol directly. "But when some people are under stress, they console themselves by eating fatty foods, cutting back on exercise, and generally veering away from a healthy lifestyle to a lifestyle that raises cholesterol," Dr. Cleeman says.
Martin L. Rossman, M.D., urges everyone to adopt a daily stress-management routine. Practice whatever relaxation technique appeals to you-meditation, visualization, music therapy, massage, tai chi, or yoga.
Be generous with garlic. Dozens of studies have demonstrated that garlic lowers cholesterol. How much of the herb do you need? The studies used anywhere from 1 to 10 cloves a day. Commission E, the German expert panel that evaluates the safety and effectiveness of herbal medicines, recommends 4 grams of fresh garlic a day-that's 2 to 4 average-size cloves.
For an odorless alternative, try garlic supplements. In one study, 23 men with heart disease who took 300 milligrams of a popular deodorized supplement every day had significantly lower cholesterol within 3 weeks.
Salute psyllium. Rich in soluble fiber, psyllium is the main ingredient in the bulkforming laxative Metamucil. It also helps lower cholesterol. Dr. Simons recommends taking 1 tablespoon of Metamucil three times a day, at mealtimes. Be sure to drink at least 8 ounces of water along with it.
Get acquainted with gugulipid. An extract of the Indian mukul myrrh tree, gugulipid contains a compound called guggulsterone that lowers cholesterol by stimulating the liver to break down LDLs. A few studies suggest that after 3 months or so, gugulipid can cut total cholesterol by about 20 percent, reduce LDLs by 30 percent, and raise HDLs by about 18 percent. Look for gugulipid supplements that contain 25 milligrams of guggulsterone per pill, Dr. Pizzomo says. Take 500 milligrams three times a day.
Find fenugreek. Rich in soluble fiber, combination of bitter celery and maple syrup. If you like their flavor, try adding them to soups, salads, and sauces.
Lift a glass to lower cholesterol. Several studies have shown that moderate alcohol consumption can raise HDL levels by 7 to 10 percent. Even a modest increase in HDLs means major protection against heart attack, the nation's leading killer.
Of course, alcohol has its downside, too. It can be addictive, and excessive consumption can raise your risk of liver disease and several types of cancer. Many experts agree: If you don't drink, don't start. If you do drink, do so in moderation. That means one drink a day for women, two for men. A drink is defined as 12 ounces of beer, 5 ounces of wine, or a cocktail made with 1 1/2 ounces of 80-proof distilled spirits.
Drink filtered coffee. Unfiltered coffee contains large amounts of cafestol and kahweol, both of which raise cholesterol. By using paper filters, you remove most of these compounds. Both the Nurses' Health Study and the Health Professionals' Follow-Up Study, which together involve more than 100,000 people, have found no evidence that drinking as many as five cups of filtered coffee a day significantly raises cholesterol. And don't worry about instant coffee: Its processing removes cafestol and kahweol.
Kick the cigarette habit. Smoking lowers HDLs and is considered a major risk factor for heart disease. So if you smoke, make every effort to quit.
Other Good Choices
Prevent phlegm. Practitioners of Chinese medicine attribute high cholesterol to excess mucus brought on by a diet too rich in fatty, greasy foods. "Greasy foods generate Heat," explains Efrem Korngold, O.M.D., L.Ac. "Heat dries Moisture in your body and increases phlegm to the point where it congeals as deposits on your arteries."
To lower cholesterol, Dr. Korngold prescribes herbs that prevent deposits, improve circulation, and clear Heat. The herb of choice is pseudoginseng root, but sage root, borneol crystals, and tea also help. "The Chinese always drink lots of tea when they eat fried foods because it promotes circulation and helps clear Heat, which keeps the blood vessels healthy," he says.
Nudge your cholesterol with needles. Acupuncture can also help lower cholesterol, Dr. Korngold says. But it must be administered by a professional acupuncturist. If you prefer a self-care approach, try acupressure instead. Apply steady, penetrating finger pressure for 3 minutes to each of the following points.
Try Ayurvedic herbs. To treat high cholesterol, Ayurvedic physicians prescribe a high-fiber diet and a number of herbs, including garlic, fenugreek, and gugulipid. Vasant Lad, B.A.M.S., M.A.Sc., director of the Ayurvedic Institute in Albuquerque, New Mexico, also recommends cinnamon and trikatu (a mixture of ginger and two kinds of peppers). If you want to try trikatu, talk to an Ayurvedic practitioner.
Today, an estimated 5 percent of American adults take cholesterol-lowering medication. There are three major types of cholesterol-lowering drugs. Each has advantages and disadvantages, and each is appropriate for some people but not others.
Statins, the newest and most popular class of drugs, interfere with the action of an enzyme involved in cholesterol synthesis in the liver. Bile acid sequestrants act in the digestive tract to prevent the release of cholesterol into the bloodstream. Gemfibrozil (Lopid) is usually prescribed only when triglycerides are very high. All of these have side effects.
Cholesterol-lowering drugs may be prescribed individually or in combination. Some physicians combine them with niacin. They also work much better if you eat a low-fat, low-cholesterol diet and exercise regularly.
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