What Is Cholesterol?

We may associate
cholesterol with fatty
foods, but most of the
waxy substance is made
by our own bodies. The
liver produces 75% of the
cholesterol that circulates
in our blood. The other
25% comes from food. At
normal levels, cholesterol
actually plays an important
role in helping cells do
their jobs. But cholesterol
levels are precariously high
in more than 100 million
Indians.

Symptoms of High
Cholesterol
High cholesterol does not
cause any symptoms. But
it does cause damage
deep within the body. Over
time, too much cholesterol
may lead to a buildup of
plaque inside the arteries.
Known as atherosclerosis,
this condition narrows the
space available for blood
flow and can trigger heart
disease. The good news is
high cholesterol is simple
to detect, and there are
many ways to bring it
down.

Cholesterol Testing
People older than 20
should have their
cholesterol levels checked
at least once every five
years. This is done with a
simple blood test known as
a fasting lipoprotein profile.
It measures the different
forms of cholesterol that
are circulating in your
blood after you avoid
eating for 9 to 12 hours.
The results show your
levels of "bad" cholesterol,
"good" cholesterol, and
triglycerides.

"Bad" Cholesterol
Most of the cholesterol in
the blood is carried by
proteins called low density
lipoproteins or LDL. This is
known as the bad
cholesterol because it
combines with other
substances to clog the
arteries. A diet high in
saturated fats and trans
fats tends to raise the level
of LDL cholesterol. For
most people, an LDL score
below 100 is healthy, but
people with heart disease
may need to aim even
lower.

"Good" Cholesterol

Up to a third of blood
cholesterol is carried by
high-density lipoproteins or
HDL. This is called good
cholesterol because it
helps remove bad
cholesterol, preventing it
from building up inside the
arteries. The higher the
level of HDL cholesterol,
the better. People with too
little are more likely to
develop heart disease.
Eating healthy fats, such
as olive oil, may help boost
HDL cholesterol.

Triglycerides
The body converts excess
calories, sugar, and alcohol
into triglycerides, a type of
fat that is carried in the
blood and stored in fat
cells throughout the body.
People who are
overweight, inactive,
smokers, or heavy drinkers
tend to have high
triglycerides, as do those
who eat a very high-carb
diet. A triglycerides score
of 150 or higher puts you
at risk for metabolic
syndrome, which is linked
to heart disease and
diabetes.

Total Cholesterol
Total cholesterol measures
the combination of LDL,
HDL, and VLDL (very low
density lipoprotein) in your
bloodstream. VLDL is a
precursor of LDL, the bad
cholesterol. A total
cholesterol score of under
200 is considered healthy
in most cases. People who
score in the "high" range
have an increased risk of
developing heart disease
compared to those who
score below 200.

Cholesterol Ratio
To calculate your
cholesterol ratio, divide
your total cholesterol by
your HDL cholesterol. For
example, a total score of
200 divided by an HDL
score of 50 equals a
cholesterol ratio of 4 to 1.
Doctors recommend
maintaining a ratio of 4 to
1 or lower. The smaller the
ratio, the better. While this
figure is useful in
estimating heart disease
risk, it's not as important in
guiding treatment. Doctors
look at total cholesterol,
HDL cholesterol, and LDL
cholesterol to determine
treatment.

Cholesterol in Food
Cholesterol-rich foods, like
eggs, shrimp, and lobster
are no longer completely
forbidden. Research shows
that the cholesterol we eat
has only a small effect on
blood cholesterol levels for
most people. A few people
are "responders," whose
blood levels spike up after
eating eggs. But for most,
saturated fat and trans fats
are bigger concerns. Daily
cholesterol limits are 300
mg for healthy people and
200 mg for those at higher
risk. One egg has 186 mg
of cholesterol.

Cholesterol and Family

History
Cholesterol comes from
two sources -- the body
and food -- and either one
can contribute to high
cholesterol. Some people
inherit genes that trigger
too much cholesterol
production. For others, diet
is the main culprit.
Saturated fat and
cholesterol occur in
animal-based foods,
including meat, eggs, and
dairy products made with
milk. In many cases, high
cholesterol stems from a
combination of diet and
genetics.

What Boosts Your Risk?

Several factors can

make you more likely
to develop high
cholesterol:
A diet high in
saturated fats and
cholesterol
A family history of
high cholesterol
Being overweight or
obese
Getting older

Cholesterol and Gender

Until menopause, women
typically have lower total
cholesterol levels than
men of the same age. They
also have higher levels of
HDL cholesterol, the good
kind. One reason is
estrogen: The female sex
hormone raises the level of
HDL cholesterol. Estrogen
production peaks during
the childbearing years and
drops off during
menopause. After age 55,
a woman's risk of
developing high
cholesterol begins to climb.

Cholesterol and Children

There's evidence that
cholesterol can begin
clogging the arteries
during childhood,
leading to
atherosclerosis and
heart disease later in
life. The American
Heart Association
recommends kids and
teenagers with high
cholesterol take steps
to bring it down.
Ideally, total
cholesterol should be
below 170 in people
ages 2 to 19.

Why High Cholesterol

Matters
High cholesterol is one of
the major risk factors for
coronary artery disease,
heart attacks, and strokes.
It also appears to boost the
risk of Alzheimer's disease.
As we saw earlier, high
cholesterol leads to a
buildup of plaque that
narrows the arteries. This
is dangerous because it
can restrict blood flow. If
the blood supply to a part
of the heart or brain is
completely cut off, the
result is a heart attack or
stroke.

Cholesterol Buster: Eat More

Fiber
Diet changes offer a
powerful way to fight
high cholesterol. If
you've ever wondered
why some cereals
claim to be hearthealthy, it's the fiber.
The soluble fiber
found in many foods
helps reduce LDL, the
bad cholesterol. Good
sources of soluble
fiber include wholegrain breads and
cereals, oatmeal,
fruits, dried fruits,
vegetables, and

Cholesterol Buster: Know Your

Fats

No more than 35% of your

daily calories should come
from fat. But not all fats
are equal. Saturated fats
-- from animal products
and tropical oils -- raise
LDL cholesterol. Trans
fats carry a doublewhammy, boosting bad
cholesterol, while
lowering the good kind.
These two bad fats are
found in many baked
goods, fried foods
(doughnuts, french fries,
chips), stick margarine,
and cookies. Unsaturated
fats may lower LDL when
combined with other
healthy diet changes.
They're found in
avocados, olive oil, and
peanut oil.

Cholesterol Buster: Smart

Protein
Meat and full-fat milk offer
plenty of protein, but they
are also major sources of
cholesterol. You may be
able to reduce LDL
cholesterol by switching to
soy protein, such as tofu,
at some meals. Fish is
another great choice. It's
rich in omega-3 fatty acids,
which can improve
cholesterol levels. The
American Heart
Association recommends
eating fish at least twice a
week.

Cholesterol Buster: Low-Carb

Diet
There's growing
evidence that low-carb
diets may be better
than low-fat diets for
improving cholesterol
levels. In a two-year
study funded by the
National Institutes of
Health, people who
followed a low-carb
plan had significantly
better HDL (good
cholesterol) levels
than those who
followed a low-fat

Cholesterol Buster: Lose

Weight
If you're overweight,
talk to your doctor
about beginning a
weight loss program.
Losing weight can help
you reduce your levels
of triglycerides, LDL,
and total cholesterol.
Shedding even a few
pounds can also boost
your good cholesterol
level -- it tends to go
up 1 point for every 6
pounds you lose.

Cholesterol Buster: Quit

Smoking
Giving up tobacco is
tough, but here's one
more reason to try.
When you stop
smoking, your good
cholesterol is likely to
improve by as much
as 10%. You may be
more successful if you
combine several
smoking cessation
strategies. Talk to your
doctor about which
options are best for
you.

Cholesterol Buster: Exercise

If you're healthy but not
very active, starting an
aerobic exercise program
could increase your good
cholesterol by 5% in the
first two months. Regular
exercise also lowers bad
cholesterol. Choose an
activity that boosts your
heart rate, such as
running, swimming, or
walking briskly, and aim
for at least 30 minutes on
most days of the week. It
doesn't have to be 30
continuous minutes; two
15-minute walks works just
as well.

Treatment: Medications
If high cholesterol runs in
your family, diet and
exercise may not be
enough to get your
numbers where you want
them. In that case,
medication can give your
cholesterol levels an extra
nudge. Statins are usually
the first choice. They block
the production of
cholesterol in the liver.
Other options include
cholesterol absorption
inhibitors, bile acid resins,
and fibrates. Your doctor
may recommend a
combination of these

Treatment: Supplements
Certain dietary
supplements may also
improve cholesterol levels.
These include flaxseed oil,
fish oil, and plant sterols,
such as beta-sitosterol.
Prescription niacin, a bcomplex vitamin, has been
found to raise good
cholesterol while reducing
bad cholesterol. Niacin
found in ordinary
supplements should not be
used to lower cholesterol.

Herbal Remedies

Some studies suggest

garlic can knock a few
percentage points off
total cholesterol. But
garlic pills can have
side effects and may
interact with
medications. Other
herbs that may reduce
cholesterol include:
Fenugreek seeds
Artichoke leaf
extract
Yarrow
Holy basil

How Low Should You Go?

Many people are able to
lower cholesterol levels
through a combination of
medication and lifestyle
changes. But how low is
low enough? For people
with diabetes or a high risk
of developing heart
disease, an LDL score of
less than 100 is desirable.
If you already have heart
disease or coronary artery
disease, some doctors
recommend reducing LDL
to 70 or lower.

Can the Damage Be

Undone?
It takes years for high
cholesterol to clog the
arteries with plaque. But
there is evidence that
atherosclerosis can be
reversed, at least to some
degree. Dean Ornish, MD,
has published several
studies showing that a lowfat vegetarian diet, stress
management, and
moderate exercise can
chip away at the build-up
inside the coronary
arteries. Other research
supports the idea that big
drops in cholesterol can
somewhat help open
clogged arteries.