The ups and downs of cholesterol

Philip J. Goscienski, M.D.

October 2007

Does cholesterol matter or doesn't it? Is it OK to eat eggs? Should you take a prescription medicine to bring your cholesterol down? Is it worth it?

It's true that persons with a high blood level of cholesterol have a greater tendency to have a heart attack but the total cholesterol level doesn't tell the whole story. Your physician wants to know if your LDL cholesterol is too high or your HDL cholesterol is too low. Either situation puts you at greater risk of heart disease and stroke.

Eating a couple of eggs every few days will not likely change any of these levels but if you add lots of ham, sausage and bacon to those eggs you certainly will raise your cholesterol level.

If you watch more than a few minutes of TV a day you've seen hundreds of commercials that promote cholesterol-lowering drugs. They all have side effects and unless you have a very high risk of heart disease or your cholesterol profile is really abnormal you should consider asking your physician about non-prescription alternatives.

HDL, high-density lipoprotein, is called the good cholesterol. The best way to raise it is to lose excess weight and to exercise. There are several food products that help to raise HDL and each of them has other health benefits. Dark chocolate, fruits and vegetables, omega-3 fats from fish or fish oil, soy products and oat bran raise HDL. Dark chocolate has become the health food du jour but even though it has some healthy ingredients it also has plenty of calories.

LDL, low-density lipoprotein, is the villainous form of cholesterol, according to most experts. Saturated fat raises LDL and so does trans fat. Partially hydrogenated on a nutrition label is another term for trans fats. A label that proclaims "zero trans fats" doesn't mean that it's health food. It could still contain high levels of saturated fat and lots of sugar, both of which lead to weight gain.

For the U.S government, zero is a relative value. A food product that contains less than 0.5 grams of trans fat is allowed to carry the zero trans fat label.

Exercise and losing weight are key elements in lowering LDL but diet certainly helps. A combination of foods referred to as the portfolio diet is effective and it's easy to include in meal planning. The key components are almonds, cereal fiber, soy protein and plant sterols (Smart Balance spread, for example). The polyphenols and flavonoids in tea and citrus fruit help to lower LDL. Garlic and artichokes have modest cholesterol-lowering effects and Mediterranean diet recipes often contain both.

Only your physician can assess your need for treatment but these suggestions are entirely without risk. Side effects from prescription medications that lower cholesterol occur only in a small percentage of patients but as the number of at-risk persons who take them increases, so will the absolute number of unlucky individuals.

Should you take herbal remedies such as red yeast rice and guggul? They do work in animal models and in some human studies but both have occasional serious side effects. Don't jump on the bandwagon until the benefits are more certain and the risks better known.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.