Cholesterol and Your Child

When it comes to their kids, many parents don't even think about cholesterol. But high levels of cholesterol are known to be a major factor contributing to heart disease and strokes, and the latest medical research shows coronary artery disease has its roots in childhood.

Childhood cholesterol levels weren't tracked until recently, but some experts think that high cholesterol in kids is a major underreported public health problem. In the past few years, studies have shown a dramatic increase in obesity in children and the problems that result from being overweight. And some pediatricians report seeing a significant increase in the number of children with elevated cholesterol levels than they did years ago.

Because the problems associated with high cholesterol generally don't show up for years, making the connection between kids' health and cholesterol is difficult for many people. So it's important to be aware of your child's cholesterol levels, especially if either parent has high cholesterol.

What Is Cholesterol?

Cholesterol is a waxy substance produced by the liver. It's one of the lipids, or fats, your body makes and is used to build cell walls and form some hormones and tissues.

If you never ate another bowl of ice cream or another cheeseburger, your body would have enough cholesterol to run smoothly. That's because your liver makes enough for healthy body function. In fact, the liver produces about 1,000 milligrams of cholesterol a day. The rest comes from the foods you eat.

Although vegetables, fruits, and grains don't have any cholesterol, the following foods from animals do:

• egg yolks
• meat
• poultry
• seafood
• whole-milk dairy products (including milk, cheese, and ice cream)

How Does Cholesterol Work?

Cholesterol doesn't move through the body on its own. It has to combine with proteins to travel through the bloodstream to where it's needed. Cholesterol and protein traveling together are called lipoproteins.

Two kinds - low-density lipoprotein (LDL) and high-density lipoprotein (HDL) - are the most important and the ones people talk about a lot. Around the water cooler or in the break room at work, you may have heard a coworker say, "My doctor told me my LDL is high, and my HDL is low." Someone responds, "Tsk, tsk, tsk," and nods knowingly. But what are they talking about?

Low-density lipoproteins, sometimes called "bad cholesterol" (think low-density for "lousy"), are the primary cholesterol carriers. If there's too much LDL in the bloodstream, it can build up on the walls of the arteries that lead to the heart and the brain. This buildup forms plaque - a thick, hard substance that can cause blood vessels to become stiffer, narrower, or blocked. Atherosclerosis is the name for hardening of the arteries. If a blood clot forms and gets jammed in a clogged artery, you could have a heart attack or a stroke. Atherosclerosis can also diminish blood flow to other vital organs, including your intestines or kidneys.

High-density lipoproteins, sometimes called "good cholesterol" (think high-density for "happy, healthy, or hard-working"), move the remaining one fourth to one third of your body's cholesterol. HDL carries the cholesterol away from the arteries and back to the liver, where it's processed and sent out of the body.

High levels of LDL increase the risk for heart disease and stroke. But high levels of HDL can offset that risk and help protect your circulatory system. However, in general, too high a level of cholesterol in the blood is known as hypercholesterolemia, which can lead to health problems.

Should I Worry About My Child's Cholesterol?

Three major factors contribute to high cholesterol levels:

• diet - a diet high in fats, particularly saturated and trans fats, which are common in baked treats and commercial snack products
• heredity - having parents or a parent with high cholesterol
• obesity - related to both diet and lack of exercise

Other risk factors for coronary artery disease include high blood pressure, smoking, and diabetes mellitus.

If your child is active, eats healthy foods, doesn't have a family history of high cholesterol, and isn't overweight, you probably don't have much cause for concern.

How Is High Cholesterol Monitored and Treated?

Current recommendations encourage cholesterol screening in only those children, starting at 2 years old, who are at risk for having high cholesterol. Factors that would make a cholesterol screening necessary are if your child:

• has a parent with a total cholesterol higher than 240 mg/dL
• has a parent or grandparent who had a history of heart disease prior to the age of 55
• has an unknown family history
• is overweight or obese

Your child's doctor can use a simple blood test to tell you if your child's cholesterol is too high. According to the American Heart Association, the ranges of total cholesterol for children 2 years to 19 years old are:

Category	Total cholesterol (mg/dL*)
Acceptable	Less than 170
Borderline	170-199
High	200 or greater

*Mg/dL means milligrams per deciliter. A milligram is one thousandth of a gram, which is 1/28th of an ounce. A deciliter is 1/10th of a liter, which is a little more than a quart.

If the results are considered "acceptable," then your child should be screened every 5 years. If your child's total cholesterol is 170 or higher, then your child's doctor will probably have your child fast for 12 hours and then repeat the test (called a fasting cholesterol). If your child's initial cholesterol level is greater than 200, then your child's doctor will order both a fasting cholesterol and a lipoprotein analysis (which would identify your child's HDL and LDL levels).

Although it's believed that the problems caused by high cholesterol can start in childhood, it still isn't entirely clear what high cholesterol levels indicate for a child. Therefore, the recommendations focus primarily on good eating and exercise behaviors for everyone, but especially those who have higher cholesterol and lipoproteins.

Medication should only be considered for children over 10 years old after changes in diet and exercise have been tried but haven't had the desired effect. After 3 months of dietary changes or medication, a child's cholesterol levels should be retested.

10 Ways to Lower Your Family's Cholesterol

Here are some simple steps you can take to keep your family's cholesterol at healthy levels:

1. Have the cholesterol levels of both you and your child checked.

2. Read labels so that you can limit cholesterol and saturated and trans fat intake. It's recommended that cholesterol intake be less than 300 milligrams a day. To determine how much cholesterol is in the foods your family eats, read nutrition labels. Also, the American Heart Association recommends that total fat intake should be 30% or less of your total calories and that saturated fat should be 10% or less. Because they usually contain substantial amounts of cholesterol, you and your family should try to avoid, as often as possible:

• saturated fats - all animal fats and some tropical oils
• trans fats - fats formed when vegetable oils are hardened into margarine or shortening (In 2006, the amount of trans fats in foods will begin to appear on nutrition labels. For now, when checking labels, look for the word "hydrogenated.")

3. Eat healthy snacks that are low in fat and cholesterol, such as:

• fruit
• raw vegetables and low-fat dips
• plain unsalted popcorn or pretzels
• low-fat yogurt and gelatin

4. Replace some meals of red meat with:

• poultry
• fish
• beans
• peas
• lentils
• tofu
• soy products (many on the market today are very tasty and mimic hamburgers, hot dogs, chicken fingers, etc.)

5. Stay away from butter or stick margarine. Use liquid vegetable oil for cooking and tub margarine for table use.

6. Limit intake of commercially prepared baked goods and treats.

7. Avoid soda and sugary fruit drinks because excess sugar is transformed into fats.

8. Pack healthy lunches and teach children to pick the healthiest items in their school cafeterias or vending machines.

9. Get plenty of exercise. Go for walks as a family. Go hiking or biking, or play soccer, basketball, or ice hockey. Exercise helps boost HDL levels in the blood - and that's a good thing!

10. Make controlling your cholesterol levels and living healthier a family affair. Kids usually aren't the only ones at risk, so it's important to make this a family effort. And parents who don't know their own cholesterol levels should get them checked. The strides you take to improve your family's lifestyle can have a huge effect on your health not only now, but far into the future.

Reviewed by: Barbara P. Homeier, MD

Low Cholesterol Diet

If your cholesterol (LDL) is too high, your doctor may suggest you follow a low cholesterol diet such as the National Cholesterol Education Program (NCEP)'s Therapeutic Lifestyle Changes diet or TLC. Such diets help the average American could reduce total cholesterol levels by 15 percent. Additional percentage points of cholesterol may be reduced while also raising "good" HDL by adding regular exercise.

The low cholesterol diet prescribed in the TLC program is a low saturated fat, low cholesterol diet that will help to reduce your blood cholesterol level to decrease your chance of developing heart disease, future heart attacks, and other heart disease complications.

The Therapeutic Lifestyle Diet (TLC)

The TLC diet is a low-saturated fat, low-cholesterol eating plan. The TLC diet is for anyone whose LDL is above his or her goal level.

You should eat according to the following TLC guidelines:

• Less than 7% of the day's total calories from saturated fat.
• 25-35% or less of the day's total calories from fat.
• Less than 200 milligrams of dietary cholesterol a day.
• Limit sodium intake to 2400 milligrams a day.
• Just enough calories to achieve or maintain a healthy weight and reduce blood cholesterol level. (Ask your doctor or a registered dietitian what is a reason able calorie level for you.)

Other Low Cholesterol or TLC diet factors:

• Soluble fiber may be increased in the diet if LDL is not lowered enough by reducing saturated fat and cholesterol.
• Certain food products that contain plant stanols or plant sterols (e.g., cholesterol-lowering margarines and salad dressings) can also be added to the diet to boost its LDL-lowering power.

What to eat

Eat foods low in saturated fat, such as:

• fat free or 1% dairy products
• lean meats
• fish and shellfish
• skinless poultry
• whole grain foods
• fruits
• vegetables

Note:
Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). For more on choosing fats and oils, see the National Heart, Lung, and Blood Institute Tipsheet Fats and Oils to Choose at: http://www.nhlbisupport.com/chd1/Tipsheets/tipsheet-satfat.htm.

Eat foods high in soluble fiber, such as:

• oats
• certain fruits (e.g., oranges and pears)
• certain vegetables (e.g., Brussels sprouts and carrots)
• dried peas and beans

What NOT to eat

Limit foods high in cholesterol, such as:

• liver and other organ meats
• egg yolks
• full-fat dairy products (National Heart, Lung, and Blood Institute 2001a; National Heart, Lung, and Blood Institute, 2002m).

For more details on making wise food choices for the TLC diet, see the National Heart, Lung, and Blood Institute Tipsheet TLC Diet Daily Food Guide Food Groups at: http://www.nhlbisupport.com/chd1/Tipsheets/foodgroup.htm.

Limit foods high in saturated fat, such as:

• High fat processed meats (e.g., sausage, hot dogs, bologna, salami) and fatty, untrimmed red meats
• Fried foods (American Heart Association, 2002c).

How to prepare food

When preparing foods, the following cooking methods tend to produce lower saturated fat levels:

• bake
• broil
• microwave
• poach
• grill
• roast (when roasting, place meats on a rack so fat can drip away)
• lightly stir-fry or sauté in cooking spray, small amounts of vegetable oil, or reduced sodium chicken broth ( National Heart, Lung, and Blood Institute, 2002k).

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts

To keep your blood cholesterol level low, choose only the leanest meats, poultry, fish and shellfish.

• Choose chicken and turkey without skin or remove skin before eating.
• Some fish, like cod, have less saturated fat than either chicken or meat.
• Since even the leanest meat, chicken, fish, and shellfish have saturated fat and cholesterol, limit the total amount you eat to 6 ounces or less per day.

Poultry

In general, chicken and turkey are low in saturated fat, especially when the skin is removed. When shopping for poultry remember:

• You can buy chicken and turkey pieces with the skin already removed. Or buy pieces with the skin on and remove it yourself before eating. It is easy to do. Remember, the white meat itself always contains less saturated fat than the dark meat.
• Limit goose and duck. They are high in saturated fat, even with the skin removed.
• Try fresh ground turkey or chicken that is made from white meat like the breast.
• Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also "lean" beef hot dogs and vegetarian (made with tofu) franks that are low in fat and saturated fat.

Fish and Shellfish

When shopping for fish and shellfish remember that:

• Most fish is lower in saturated fat and cholesterol than meat or poultry.
• Shellfish varies in cholesterol content. Shellfish have little saturated fat and total fat. Even shrimp can be enjoyed occasionally on a Heart Healthy Diet provided you eat less than 300 milligrams of cholesterol a day. For example, 3 ounces of steamed shrimp has 167 milligrams of cholesterol.

Meat Substitute

Dry peas and beans and tofu (bean curd) are great meat substitutes that are low in saturated fat and cholesterol. Dry peas and beans also have a lot of fiber, which can help to lower blood cholesterol. Try adding a ½ cup beans to pasta, soups, casseroles, and vegetable dishes. Tofu takes on the flavor of marinades well. Try marinating tofu in a nonfat dressing or a tangy sauce and grilling or baking for a heart healthy dish.

Eggs

Egg yolks are high in dietary cholesterol--each contains about 213 milligrams. So, egg yolks are limited to no more than 4 yolks per week. This includes the egg yolks in baked goods and processed foods. Check the label to see how much cholesterol the food contains or ask the bakery if the recipe uses whole eggs. Limit these types of foods for occasional treats.

Egg whites have no cholesterol, and you can substitute them for whole eggs in recipes -- two egg whites are equal to one whole egg. You can also use cholesterol-free egg substitute in place of whole eggs - In many baked goods, you can't tell the difference.

Milk, Yogurt, and Cheese Group

Like high fat meats, regular dairy foods that have fat -- such as whole and 2% milk, cheese, and ice cream -- are also high in saturated fat and cholesterol. However, dairy products are an important source of nutrients. You should eat 2 to 3 servings per day of lowfat or nonfat dairy products. Here is a guide to buying low fat and nonfat dairy foods:

Milk

• Buy fat free and 1% milk rather than whole or 2% milk. Fat free and 1% milk have just as much or more calcium and other nutrients as whole milk - with much less saturated fat and cholesterol.

Cheese

• When looking for hard cheeses, go for the versions that are "fat free," "reduced fat," "low fat," or "part skim." Choose varieties that have 3 grams of fat or less per ounce.
• When looking for soft cheeses, choose low fat (1%) or nonfat cottage cheese, farmer cheese, or part-skim or light ricotta. Some of these cheeses have 3 grams of fat or less per ounce.
• If you are watching your sodium intake, choose lower sodium cheeses. Read the label to compare the sodium content.

Frozen Dairy Desserts

• Buy frozen desserts that are lower in saturated fat, like ice milk, low fat frozen yogurt, low fat frozen dairy desserts, fruit ices, sorbets, and popsicles.

Other Dairy Foods

• Buy low or nonfat yogurt; like many other dairy foods, it is an excellent source of protein and calcium. Eat lowfat or nonfat yogurt alone or as a topping or in recipes. Try topping with fruit.
• Try lowfat or nonfat sour cream or cream cheese blends. Many taste as rich as the real thing, but have less fat and calories.

Fats and Oils

You can help keep your blood cholesterol low when you replace saturated fats with unsaturated fat. Just be sure to limit the total amount of fats or oils to keep calories in check.

When buying fats and oils, remember to:

• Choose liquid vegetable oils that are high in unsaturated fats -- like canola, corn, olive, peanut, safflower, sesame, soybean, and sunflower oils.
• Buy margarine made with unsaturated liquid vegetable oils as the first ingredient. Choose soft tub or liquid margarine or vegetable oil spreads.
• Limit butter, lard, fatback, and solid shortenings. They are high in saturated fat and cholesterol.
• Buy light or nonfat mayonnaise and salad dressing instead of the regular kind that are high in fat. For example, two tablespoons of regular Italian dressing can add as many as 14 grams of fat.

Fruits and Vegetables

You should be eating at least 3 to 5 servings of fruits and vegetables each day. Fruits and vegetables are very low in saturated fat and total fat, and have no cholesterol. A diet high in fruit and vegetables may also help keep cholesterol levels low. So, fruits and vegetables are great substitutes for foods high in saturated fat and cholesterol.

When shopping, remember to:

• Buy fruits and vegetables to eat as snacks, desserts, salads, side dishes, and main dishes
• Add a variety of vegetables to meat stews or casseroles or make a vegetarian (meatless) main dish.
• Wash and cut up raw vegetables (carrot, broccoli, cauliflower, lettuce, etc.) and store in the refrigerator for quick and easy use in cooking or snacking.
• Serve fresh fruit for dessert or freeze (banana, berries, melon, grapes) for a delicious frozen treat.
• Display fresh fruit in a bowl in the kitchen to make fruit easier to grab as a snack.

To keep naturally lowfat vegetables low in fat and saturated fat, season with herbs, spices, lemon juice, vinegar, fat free or lowfat mayonnaise or salad dressing.

Breads, Cereals, Rice, Pasta, and Other Grains

Breads, cereals, rice, pasta, and other grains, and dry beans and peas are generally high in starch and fiber and low in saturated fat and calories. They also have no dietary cholesterol, except for some bakery breads and sweet bread products made with high fat, high cholesterol milk, butter and eggs.

Like fruits and vegetables, naturally low fat, low cholesterol breads and other foods in this group are also good choices. You should be eating 6 to 11 servings of foods from this group each day. If you have high triglycerides and/or low HDL, you should keep your carbohydrate intake below the maximum of 60% of total calories. You can choose a diet up to 35% fat, substituting unsaturated fat for saturated fat.

When buying foods from this group, remember to:

• Choose whole grain breads and rolls often. They have more fiber than white breads.
• Buy dry cereals, most are low in fat. Limit the high fat granola, muesli, and oat bran types that are made with coconut or coconut oil and nuts, which increases the saturated fat content. Add fat free milk or 1% milk instead of whole or low fat (2% milk) to save saturated fat and cholesterol.
• Buy pasta and rice to use as entrees. Hold the high fat sauces (butter, cheese, cream, white).
• Limit sweet baked goods that are made with lots of saturated fat, mostly from butter, eggs, and whole milk such as croissants, pastries, muffins, biscuits, butter rolls, and doughnuts. These are also high in cholesterol.

Sweets and Snacks

Some sweets and snacks -- like baked goods (cakes and cookies) cheese crackers, and some chips -- often are high in saturated fat and cholesterol.

Here are some low fat sweets and snacks to buy and use only now-and-then:

• Angel food cake topped with fruit puree or fresh fruit slices
• Fat free or low fat brownies, cakes, cheesecake, cupcakes, and pastries
• Fat free or lowfat cookies like animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, and vanilla or lemon wafers
• Frozen lowfat or nonfat yogurt, fruit ices, ice milk, sherbet, and sorbet
• Gelatin desserts - watch the whipped cream!
• Graham crackers
• Puddings made with 1% or fat free milk

Just remember that, while these treats are may be low in fat, most are not low in calories. So choose them only every now-and-then, especially if you are trying to control your weight to improve your blood cholesterol levels.

Not all snack foods are high in saturated fat and cholesterol. Buy some of these low fat ones and keep them on hand for snack attacks:

• Bagels
• Bread sticks*
• Ready-to-eat cereals without added sugar*
• Frozen grapes or banana slices; or other fresh fruit
• Fruit leather or other dried fruit
• Low fat or fat free crackers* like melba toast, rice cakes, rye crisp, and soda crackers
• No-oil baked tortilla chips*
• Popcorn (air popped or "light")*
• Pretzels*
• Raw vegetables with nonfat or low fat dip

__________
*If you are watching your sodium intake, be sure to look for low sodium or unsalted varieties.

References:

• NIH
• NHBLI
• National Cholesterol Education Program (NCEP)

Fats & Cholesterol

Fats and Cholesterol - The Good, The Bad, and The Healthy Diet

"Eat a low-fat, low-cholesterol diet." Most of us have heard this simple recommendation so often over the past two decades that we can recite it in our sleep. Touted as a way to lose weight and prevent cancer and heart disease, it's no wonder much of the nation - and food producers - hopped on board.

Unfortunately, this simple message is now largely out of date. Detailed research -much of it done at Harvard - shows that the total amount of fat in the diet, whether high or low, isn't really linked with disease. What really matters is the type of fat in the diet. New results from the large and long Women's Health Initiative Dietary Modification Trial showed that eating a low-fat diet for 8 years did not prevent heart disease, breast cancer, or colon cancer, and didn't do much for weight loss, either.(1-4)

What is becoming clearer and clearer is that bad fats, meaning saturated and trans fats, increase the risk for certain diseases while good fats, meaning monounsaturated and polyunsaturated fats, lower the risk. The key is to substitute good fats for bad fats.

And cholesterol in food? Although it is still important to limit the amount of cholesterol you eat, especially if you have diabetes, dietary cholesterol isn't nearly the villain it's been portrayed to be. Cholesterol in the bloodstream is what's most important. High blood cholesterol levels greatly increase the risk for heart disease. But the average person makes about 75% of blood cholesterol in his or her liver, while only about 25% is absorbed from food. The biggest influence on blood cholesterol level is the mix of fats in the diet.

DIETARY FATS
Type of Fat	Main Source	State at Room Temperature	Effect on Cholesterol Levels Compared with Carbohydrates
Monounsaturated	Olives; olive oil, canola oil, peanut oil; cashews, almonds, peanuts, and most other nuts; avocados	Liquid	Lowers LDL; raises HDL
Polyunsaturated	Corn, soybean, safflower, and cottonseed oils; fish	Liquid	Lowers LDL; raises HDL
Saturated	Whole milk, butter, cheese, and ice cream; red meat; chocolate; coconuts, coconut milk, and coconut oil	Solid	Raises both LDL and HDL
Trans	Most margarines; vegetable shortening; partially hydrogenated vegetable oil; deep-fried chips; many fast foods; most commercial baked goods	Solid or semi-solid	Raises LDL*

*Trans fat increases LDL, decreases HDL, and increases triglycerides when compared to monounsaturated or polyunsaturated fat.

The Cholesterol--Heart Disease Connection

Cholesterol is a wax-like substance. The liver makes it and links it to carrier proteins called lipoproteins that let it dissolve in blood and be transported to all parts of the body. Why? Cholesterol plays essential roles in the formation of cell membranes, some hormones, and vitamin D.

Too much cholesterol in the blood, though, can lead to problems. In the 1960s and 70s, scientists established a link between high blood cholesterol levels and heart disease. Deposits of cholesterol can build up inside arteries. These deposits, called plaque, can narrow an artery enough to slow or block blood flow. This narrowing process, called atherosclerosis, commonly occurs in arteries that nourish the heart (the coronary arteries). When one or more sections of heart muscle fail to get enough blood, and thus the oxygen and nutrients they need, the result may be the chest pain known as angina. In addition, plaque can rupture, causing blood clots that may lead to heart attack, stroke, or sudden death. Fortunately, the buildup of cholesterol can be slowed, stopped, and even reversed.

Cholesterol-carrying lipoproteins play central roles in the development of atherosclerotic plaque and cardiovascular disease. The two main types of lipoproteins basically work in opposite directions.

Low-density lipoproteins (LDL) carry cholesterol from the liver to the rest of the body. When there is too much LDL cholesterol in the blood, it can be deposited on the walls of the coronary arteries. Because of this, LDL cholesterol is often referred to as the "bad" cholesterol.

High-density lipoproteins (HDL) carry cholesterol from the blood back to the liver, which processes the cholesterol for elimination from the body. HDL makes it less likely that excess cholesterol in the blood will be deposited in the coronary arteries, which is why HDL cholesterol is often referred to as the "good" cholesterol.

In general, the higher your LDL and the lower your HDL, the greater your risk for atherosclerosis and heart disease.

For adults age 20 years or over, the latest guidelines from the National Cholesterol Education Program recommend the following optimal levels:

• Total cholesterol less than 200 milligrams per deciliter (mg/dl)
• HDL cholesterol levels greater than 40 mg/dl
• LDL cholesterol levels less than 100 mg/dl

Dietary Fat, Dietary Cholesterol, and Blood Cholesterol Levels

One of the most important determinants of blood cholesterol level is fat in the diet - not total fat, as mentioned already, but specific types of fat. Some types of fat are clearly good for cholesterol levels and others are clearly bad for them.

Cholesterol in food

While it is well known that high blood cholesterol levels are associated with an increased risk for heart disease, scientific studies have shown that there is only a weak relationship between the amount of cholesterol a person consumes and their blood cholesterol levels or risk for heart disease. For some people with high cholesterol, reducing the amount of cholesterol in the diet has a small but helpful impact on blood cholesterol levels. For others, the amount of cholesterol eaten has little impact on the amount of cholesterol circulating in the blood.

In a study of over 80,000 female nurses, Harvard researchers actually found that increasing cholesterol intake by 200 mg for every 1000 calories in the diet (about an egg a day) did not appreciably increase the risk for heart disease.(5)

Eggs

Long vilified by well-meaning doctors and scientists for their high cholesterol content, eggs are now making a bit of a comeback. Recent research by Harvard investigators has shown that moderate egg consumption--up to one a day--does not increase heart disease risk in healthy individuals.(5) While it's true that egg yolks have a lot of cholesterol--and, therefore may slightly affect blood cholesterol levels--eggs also contain nutrients that may help lower the risk for heart disease, including protein, vitamins B12 and D, riboflavin, and folate.

So, when eaten in moderation, eggs can be part of a healthy diet. People with diabetes, though, should probably limit themselves to no more than two or three eggs a week, as the Nurses' Health Study found that for such individuals, an egg a day might increase the risk for heart disease. Similarly, people who have difficulty controlling their blood cholesterol may also want to be cautious about eating egg yolks and choose foods made with egg whites instead.

Dietary Fats

The Bad Fats

Some fats are bad because they tend to worsen blood cholesterol levels.

Saturated Fats

Saturated fats are mainly animal fats. They are found in meat, seafood, whole-milk dairy products (cheese, milk, and ice cream), poultry skin, and egg yolks. Some plant foods are also high in saturated fats, including coconut and coconut oil, palm oil, and palm kernel oil. Saturated fats raise total blood cholesterol levels more than dietary cholesterol because they tend to boost both good HDL and bad LDL cholesterol. The net effect is negative, meaning it's important to limit saturated fats.

Trans Fats

Trans fatty acids are fats produced by heating liquid vegetable oils in the presence of hydrogen. This process is known as hydrogenation. The more hydrogenated an oil is, the harder it will be at room temperature. For example, a spreadable tub margarine is less hydrogenated and so has fewer trans fats than a stick margarine.

Most of the trans fats in the American diet are found in commercially prepared baked goods, margarines, snack foods, and processed foods. Commercially prepared fried foods, like French fries and onion rings, also contain a good deal of trans fat.

Trans fats are even worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL. They also fire inflammation,(6) an overactivity of the immune system that has been implicated in heart disease, stroke, diabetes, and other chronic conditions. While you should limit your intake of saturated fats, it is important to eliminate trans fats from partially hydrogenated oils from your diet. (Manufacturers must now list trans fats on the food label, right beneath saturated fats.)

The Good Fats

Some fats are good because they can improve blood cholesterol levels.

Unsaturated Fats--Polyunsaturated and Monounsaturated

Unsaturated fats are found in products derived from plant sources, such as vegetable oils, nuts, and seeds. There are two main categories: polyunsaturated fats (which are found in high concentrations in sunflower, corn, and soybean oils) and monounsaturated fats (which are found in high concentrations in canola, peanut, and olive oils). In studies in which polyunsaturated and monounsaturated fats were eaten in place of carbohydrates, these good fats decreased LDL levels and increased HDL levels.(7)

Percentage of Specific Types of Fat in Common Oils and Fats*
Oils	Saturated	Mono-unsaturated	Poly-unsaturated	Trans
Canola	7	58	29	0
Safflower	9	12	74	0
Sunflower	10	20	66	0
Corn	13	24	60	0
Olive	13	72	8	0
Soybean	16	44	37	0
Peanut	17	49	32	0
Palm	50	37	10	0
Coconut	87	6	2	0
Cooking Fats
Shortening	22	29	29	18
Lard	39	44	11	1
Butter	60	26	5	5
Margarine/Spreads
70% Soybean Oil, Stick	18	2	29	23
67% Corn & Soybean Oil Spread, Tub	16	27	44	11
48% Soybean Oil Spread, Tub	17	24	49	8
60% Sunflower, Soybean, and Canola Oil Spread, Tub	18	22	54	5
*Values expressed as percent of total fat; data are from analyses at Harvard School of Public Health Lipid Laboratory and U.S.D.A. publications.

Dietary Fats and Heart Disease: Beyond the "30%" Recommendation

For years, a low-fat diet was hailed as the centerpiece of a heart-healthy lifestyle, even though there was little evidence that this eating strategy prevented heart disease. The American Heart Association and others urged everyone to limit fat intake to 30% or less of daily calories. One problem with a generic low-fat diet is that it throws out fats that are good for the heart with those that are bad for it. Another problem is that many people who switch to a low-fat diet replace fats with pasta, white rice, bread, and other foods chock full of easily digested carbohydrates.

Several reports over the years have questioned the wisdom of recommending a low-fat diet for preventing or retarding heart disease. Perhaps the biggest nail in the coffin came from the Women's Health Initiative Dietary Modification Trial, published in the February 8, 2006, Journal of the American Medical Association.(3) This eight-year trial, which included almost 49,000 women, found virtually identical rates of heart attacks, strokes, and other forms of cardiovascular disease in women who followed a low-fat diet and women who didn't.

The relation of fat intake to health is one of the areas that Harvard researchers have examined in detail over the last 20 years in two large studies. The Nurses' Health Study and the Health Professionals Follow-up Study have found no link between the overall percentage of calories from fat and any important health outcome, including cancer, heart disease, and weight gain.

What was important in these studies was the type of fat in the diet.(8) There are clear links between the different types of dietary fats and heart disease. Logically, most of the influence that fat intake has on heart disease is due to its effect on blood cholesterol levels.

Ounce for ounce, trans fats are far worse than saturated fats when it comes to heart disease. The Nurses' Health Study found that replacing only 30 calories (7 grams) of carbohydrates every day with 30 calories (4 grams) of trans fats nearly doubled the risk for heart disease.(9) Saturated fats increased risk as well, but not nearly as much.

For the good fats, there is consistent evidence that high intake of either monounsaturated or polyunsaturated fat lowers the risk for heart disease. In the Nurses' Health Study, replacing 80 calories of carbohydrates with 80 calories of either polyunsaturated or monounsaturated fats lowered the risk for heart disease by about 30 to 40 percent.(8)

Fish, an important source of the polyunsaturated fat known as omega-3 fatty acid, has received much attention for its potential to lower heart disease risk. There is strong evidence that fish and fish oil consumption reduces the risk of heart disease deaths and so-called "sudden deaths." A combined analysis of multiple studies suggests that eating just 6 oz per week of fatty (dark meat) fish, such as salmon, herring, mackerel, anchovies, or sardines, may be enough to reduce the risk of dying from heart disease by 36 percent.(10) Higher intakes may be beneficial for people who already have heart disease: One large trial found that by getting 1 gram per day of omega-3 fatty acids over a 3.5 year period, people who had survived a heart attack could lower their risk of dying from heart disease by 25 percent.(11) The study participants got their omega-3s from a capsule; getting a gram a day from fish would mean eating two to three 6-oz servings per week of fatty fish. (For more information on the health benefits of omega-3 fats, see Ask the Expert - Omega 3 Fatty Acids.)

Eating fish may help prevent heart disease in several ways. It may replace red meat or other less-healthy sources of protein. More importantly, the omega-3 fats in fish appear to protect the heart against the development of erratic and potentially deadly cardiac rhythm disturbances. The American Heart Association currently recommends that people eat at least two servings of fish a week.(12)

Although there has been some recent concern about contaminants in fish such as mercury and PCBs, the evidence suggests that the proven health benefit of fish consumption is much greater than the potential for harm among individuals who consume fish one to two times per week.(10) So for most people, the best advice is simply to eat a variety of different seafood twice a week, without worrying about mercury or PCBs. The main exception to this advice is for women who are or might become pregnant, nursing mothers, and young children: These groups should include fish in their diets, since omega-3 fats promote normal brain development in children and are important for the health of the mother. But these groups should avoid eating four specific fish species that are higher in mercury - swordfish, tilefish/golden bass, shark, and king mackerel - and should limit albacore tuna to no more than 6 ounces per week. Instead, they should eat two servings per week of a variety of other fish and shellfish, such as salmon, shrimp, chunk light tuna, and scallops. (For more information, see the FDA/EPA dietary advice statement on mercury in fish and shellfish).

If you eat a lot of fish - five or more servings a week - be sure to vary the types of fish you eat and limit consumption of the four species that are higher in mercury (swordfish, tilefish/golden bass, shark, and king mackerel). And one final piece of advice on fish: Levels of PCBs and dioxins in fish are very low, similar to levels in meats, dairy and eggs, so this should not influence your decision about which fish to eat. But if you eat a lot of freshwater fish - more than one serving a day - or eat locally-caught sports fish from inland waters, it makes sense to consult local advisories. (The EPA website has links to state fish advisories.)

Dietary Fats and Cancer

Heart disease is not the only condition that has been linked with fat intake. Researchers once suspected an association between dietary fat and certain cancers. Here again, the type of fat - and not the total amount - seemed to be most important.

Breast Cancer

By the early 1980s, most nutrition experts believed that dietary fat was a major cause of breast cancer.(13,14) This thinking was largely based on international comparisons showing higher breast cancer rates in countries with higher per capita fat intake. But such comparisons are very broad in nature. As more detailed studies were performed over the next couple of decades, the apparent link between total fat intake and breast cancer has faded.(15) The Women's Health Initiative Dietary Modification Trial, which was specifically designed to examine the effect of a low-fat diet on the development of breast cancer, showed similar rates of breast cancer in women eating a low-fat diet and in those eating a "regular" diet.(4)

Other studies - including those by Harvard researchers - of different types of fat have failed to find a link with breast cancer. However, some European studies have reported suggestive findings of lower breast cancer risk among women with a high intake of monounsaturated fats (mainly in the form of olive oil).(16,17)

Colon Cancer

As with breast cancer, international comparisons initially suggested an association between total dietary fat intake and colon cancer risk. But later studies contradicted these earlier findings and revealed instead an association that was weak at best. As was the case with breast cancer, women in the Women's Health Initiative Dietary Modification Trial who ate a low-fat diet developed colon cancer at the same rate as women who didn't.(1) Although fat intake doesn't seem to increase colon cancer risk, high consumption of red meat still does appear to do so.(18)

Prostate Cancer

Although the exact connection between dietary fat and prostate cancer is far from clear, there is some evidence that diets high in animal fat and saturated fat increase prostate cancer risk. However, some studies have also shown no association, while others have implicated unsaturated fats. Clearly much more research is needed to clear up the exact links between dietary fat and prostate cancer.

Other Cancers

Preliminary research has also linked the intake of certain kinds fat with other cancers, though much more research is needed to confirm these results. In the Nurses' Health Study, Harvard researchers found that a high intake of trans fats increased the risk for non-Hodgkin's lymphoma and that a high saturated fat intake increased the risk for endometrial cancer.

Dietary Fat and Obesity

It is a common belief that the more fat you eat, the more body fat you put on, and the more weight you gain. This belief has been bolstered by much of the nutrition advice given to people over the past decade, which has focused on lowering total fat intake while increasing carbohydrate intake. But it isn't completely true, and the advice has been misguided. For example, while Americans have gradually decreased the proportion of calories they get from fat over the last decade, rates of obesity have increased steeply.

Over the short term, following a low-fat diet does lead to weight loss. But so does following a high-fat, low-carbohydrate diet. Actually, almost any diet that helps you take in fewer calories works over the short term. In other words, low-fat diets appear to offer no apparent advantages over diets with fat levels close to the national average. This was demonstrated in the Women's Health Initiative Dietary Modification Trial. Women in this trial who were assigned to a low-fat diet did not lose, or gain, any more weight than women eating a "usual" diet.(2)

Although more research is needed, a prudent recommendation for losing weight or maintaining a healthy weight is to be mindful of the amount of food you eat in relation to the amount of calories you burn in a day. Exercising regularly is especially beneficial.

The Bottom Line: Recommendations for Fat Intake

Although the different types of fat have a varied - and admittedly confusing - effect on health and disease, the basic message is simple: chuck out the bad fats and replace them with good fats. Try to limit saturated fats in your diet, and try to eliminate trans fats from partially hydrogenated oils (a report from the Institute of Medicine has concluded that there is no safe level of trans fats in the diet).(19) Replace saturated and trans fats with polyunsaturated and monounsaturated fats.

As of January 1, 2006, trans fat must be listed on food labels. More and more "trans-fat" free products are becoming available (there's even a trans fat-free Crisco on the market). Keep in mind, though, that according to the FDA, a product claiming to have zero trans fat can actually contain up to a half gram. (Canada set a different standard of zero as under 0.2 grams.) So you may still want to scan the ingredient list for "partially hydrogenated vegetable oil" and "vegetable shortening," and look for an alternative product without those words, especially if it's something you eat regularly.

Tips for lowering trans fat intake:

• Choose liquid vegetable oils, or choose a soft tub margarine that contains little or no trans fats.
• Reduce intake of commercially prepared baked goods, snack foods, and processed foods, including fast foods. To be on the safe side, assume that all such products contain trans fats unless they are labeled otherwise.
• When foods containing partially hydrogenated oils can't be avoided, choose products that list the partially hydrogenated oils near the end of the ingredient list.
• To avoid trans fats in restaurants, one strategy is to avoid deep-fried foods, since many restaurants continue to use partially hydrogenated oils in their fryers. You may be able to help change this cooking practice by asking your server, the chef, or manager if the establishment uses trans-free oils.

Copyright From : HARVARD SCHOOL OF PUBLIC HEALTH

Cholesterol Under Control

by John Henkel

Cholesterol is the Jekyll and Hyde of the body.

Like the literary split personality, it has a good side because it is needed for certain important body functions. But for many Americans, cholesterol also has an evil side. When present in excessive amounts, it can injure blood vessels and cause heart attacks and stroke.

The body needs cholesterol for digesting dietary fats, making hormones, building cell walls, and other important processes. The bloodstream carries cholesterol in particles called lipoproteins that are like blood-borne cargo trucks delivering cholesterol to various body tissues to be used, stored or excreted. But too much of this circulating cholesterol can injure arteries, especially the coronary ones that supply the heart. This leads to accumulation of cholesterol-laden "plaque" in vessel linings, a condition called atherosclerosis.

When blood flow to the heart is impeded, the heart muscle becomes starved for oxygen, causing chest pain (angina). If a blood clot completely obstructs a coronary artery affected by atherosclerosis, a heart attack (myocardial infarction) or death can occur. (See "How a Heart Attack Happens.")

Heart disease is the number one killer of both men and women in this country. More than 90 million American adults, or about 50 percent, have elevated blood cholesterol levels, one of the key risk factors for heart disease, according to the National Heart, Lung, and Blood Institute's National Cholesterol Education Program.

While the institute estimates that heart disease killed nearly half a million in 1996, the most recent year for which figures are available, a study published in the New England Journal of Medicine in September 1998 says heart disease deaths have declined steadily over the last 30 years. Indeed, between 1990 and 1994, heart disease deaths decreased by 10.3 percent, the study says. From this and other studies, it appears that this is due largely to improvements in medical care after heart attack, a reduction in the number of repeat heart attacks, and better prevention of heart disease development.

A key factor in this drop is that the public, patients and doctors today are better informed about the risks associated with elevated cholesterol and the benefits of lifestyle changes and medical measures aimed at lowering blood cholesterol. "Public health initiatives such as the National Cholesterol Education Program have raised consumer awareness, promoted effective interventions, and have likely contributed to the reduction in heart disease deaths," says David Orloff, M.D., of the Food and Drug Administration's division of metabolic and endocrine drug products.

Another factor in the drop may be a relatively new class of drugs called statins. These have provided doctors with an arsenal of therapies to lower elevated blood cholesterol levels, often dramatically. To date, FDA has approved six statin drugs.

When Blood Cholesterol Becomes a Problem

Two types of lipoproteins and their quantity in the blood are main factors in heart disease risk:

• Low-density lipoprotein (LDL)--This "bad" cholesterol is the form in which cholesterol is carried into the blood and is the main cause of harmful fatty buildup in arteries. The higher the LDL cholesterol level in the blood, the greater the heart disease risk.
• High-density lipoprotein (HDL)--This "good" cholesterol carries blood cholesterol back to the liver, where it can be eliminated. HDL helps prevent a cholesterol buildup in blood vessels. Low HDL levels increase heart disease risk.

One of the primary ways LDL cholesterol levels can become too high in blood is through eating too much of two nutrients: saturated fat, which is found mostly in animal products, and cholesterol, found only in animal products. Saturated fat raises LDL levels more than anything else in the diet (see "Food for Thought").

Several other factors also affect blood cholesterol levels:

• Heredity--High cholesterol often runs in families. Even though specific genetic causes have been identified in only a minority of cases, genes still play a role in influencing blood cholesterol levels.
• Weight--Excess weight tends to increase blood cholesterol levels. Losing weight may help lower levels.
• Exercise--Regular physical activity may not only lower LDL cholesterol, but it may increase levels of desirable HDL.
• Age and gender--Before menopause, women tend to have total cholesterol levels lower than men at the same age. Cholesterol levels naturally rise as men and women age. Menopause is often associated with increases in LDL cholesterol in women.
• Stress--Studies have not shown stress to be directly linked to cholesterol levels. But experts say that because people sometimes eat fatty foods to console themselves when under stress, this can cause higher blood cholesterol.

Though high total and LDL cholesterol levels, along with low HDL cholesterol, can increase heart disease risk, they are among several other risk factors. These include cigarette smoking, high blood pressure, diabetes, obesity, and physical inactivity. If any of these is present in addition to high blood cholesterol, the risk of heart disease is even greater.

The good news is that all these can be brought under control either by changes in lifestyle--such as diet, losing weight, or an exercise program--or quitting a tobacco habit. Drugs also may be necessary in some people. Sometimes one change can help bring several risk factors under control. For example, weight loss can reduce blood cholesterol levels, help control diabetes, and lower high blood pressure.

But some risk factors cannot be controlled. These include age (45 years or older for men and 55 years or older for women) and family history of early heart disease (father or brother stricken before age 55; mother or sister stricken before age 65).

What Is High Blood Cholesterol?

Cholesterol levels are determined through chemical analysis of a blood sample taken from a finger prick or from a vein in the arm. Home cholesterol kits, first approved in 1993, test only for total cholesterol levels but are as accurate as tests done in a doctor's office, says Steven Gutman, M.D., director of FDA's division of clinical laboratory devices. "These tests can give a consumer very valuable information when screening for high cholesterol," he says. "But they shouldn't be considered substitutes for a test conducted in a doctor's office." He adds that if test results are elevated, consumers should see a doctor right away for a more refined blood analysis. The National Cholesterol Education Program considers cholesterol testing in a doctor's office to be the preferred way because the patient can get advice immediately about the meaning of the results and what to do.

Besides determining total cholesterol levels, doctors often order a lipoprotein profile that shows the amounts of LDL, HDL, and another type of blood fat called triglycerides. This information gives doctors a better idea of heart disease risk and helps guide any treatment.

Cholesterol levels are measured in milligrams per deciliter (mg/dL). The National Cholesterol Education Program developed the following classifications for people over age 20 who do not have heart disease:

• Desirable blood cholesterol--Total blood cholesterol is less than 200 mg/dL; LDL is lower than 130 mg/dL.
• Borderline high cholesterol--Total level is between 200 and 239 mg/dL or LDL is 130 to 159 mg/dL.
• High blood cholesterol--Total level is greater than 240 mg/dL or LDL is 160 mg/dL or higher. For patients with heart disease, LDL above 100 mg/dL is too high. In addition, an HDL level less than 35 mg/dL is considered low and increases the risk of heart disease.

The main goal of cholesterol treatment is to lower LDL in people without heart disease. If the LDL level is in the "high" category and fewer than two other risk factors for heart disease are present, the goal is an LDL level lower than 160 mg/dL. If two or more risk factors are present, the goal is less than 130 mg/dL. If a patient already has heart disease, LDL levels should be 100 mg/dL or less. By reducing LDL, heart disease patients may prevent future heart attacks, prolong their lives, and slow down or even reverse cholesterol buildup in the arteries, according to the National Heart, Lung, and Blood Institute.

Treating High Blood Cholesterol

When a patient without heart disease is first diagnosed with elevated blood cholesterol, doctors often prescribe a program of diet, exercise, and weight loss to bring levels down. National Cholesterol Education Program guidelines suggest at least a six-month program of reduced dietary saturated fat and cholesterol, together with physical activity and weight control, as the primary treatment before resorting to drug therapy. Typically, doctors prescribe the Step I/Step II diet (see "Food for Thought") to lower dietary fat, especially saturated fat. Many patients respond well to this diet and end up sufficiently reducing blood cholesterol levels. Study data reinforce these benefits. For example, a 1998 Columbia University study examined 103 male and female patients of diverse ages and ethnic backgrounds and found that reducing dietary saturated fat directly affected blood cholesterol. For every 1 percent drop in saturated fat, the study showed a 1 percent lowering of LDL in patients.

But sometimes diet and exercise alone are not enough to reduce cholesterol to goal levels. Perhaps a patient is genetically predisposed to high blood cholesterol. In these cases, doctors often prescribe drugs. The National Cholesterol Education Program estimates that as many as 9 million Americans take some form of cholesterol-lowering drug therapy. The most prominent cholesterol drugs are in the statin family, an array of powerful treatments that includes Mevacor (lovastatin), Lescol (fluvastatin), Pravachol (pravastatin), Zocor (simvastatin), Baycol (cervastatin), and Lipitor (atorvastatin). Many doctors say statin drugs have revolutionized patient care.

"These drugs have had a fantastic impact on cholesterol treatment," says Redonda Miller, M.D., assistant professor of medicine at Johns Hopkins University School of Medicine. "They all lower cholesterol levels, but the side effects are minimal."

A study published in the medical journal Circulation in 1998 showed that statins dramatically lower the risk of dying from heart disease. Research found that for every 10 percentage points cholesterol was reduced, the risk of death from heart disease dropped by 15 percent.

So far, only three of the drugs--Mevacor, Zocor and Pravachol--have been studied in long-term, controlled trials. "Based on existing evidence, [statin drugs] all have similar safety profiles and are effective at lowering cholesterol in appropriately selected patients," says FDA's Orloff. "The difference between drugs lies mainly in their absolute capacity to lower cholesterol--that is, at the highest approved daily doses."

One landmark study completed in 1994, the Scandinavian Simvastatin Survival Study, or 4S, showed a 42 percent reduction in deaths from heart disease and a 30 percent drop in death from all causes over five years in patients with coronary heart disease whose high LDL levels were lowered with Zocor. The West of Scotland study, reported in 1995, revealed similar benefits from lowering LDL levels with Pravachol in patients without heart disease. And the Cholesterol and Recurrent Events (CARE) study, reported in 1996, showed that lowering LDL levels with Pravachol reduced heart attacks and deaths in patients with a previous heart attack but with cholesterol levels relatively average for the general population. This study showed that Pravachol treatment not only reduced death from heart disease but also death from all causes in a group of heart disease patients with average cholesterol levels.

A 1997 study, the Air Force/Texas Coronary Atherosclerosis Prevention Study, showed that Mevacor helped prevent a first heart attack or unstable angina in men and women with average cholesterol levels but with below-average HDL.

Statins work by interfering with the cholesterol-producing mechanisms of the liver and by increasing the capacity of the liver to remove cholesterol from circulating blood. Statins can lower LDL cholesterol by as much as 60 percent, depending on the drug and dosage.

Heart patient Norbert Hoffmann, 65, of Northfield, Minn., saw what he calls "a dramatic drop" in cholesterol levels after taking Zocor for three months. For example, his total cholesterol went from 270 to 145 mg/dL and LDL from 182 to 82 mg/dL.

But patients can respond differently to drugs. Some patients may have fewer side effects with one drug than another. "I had problems such as stomach cramps with Zocor," says Oklahoma patient Linden Gilbert, 50. His doctor ultimately switched him to Lipitor, which he credits with lowering his total cholesterol from 230 to 150 mg/dL.

Other Drug Treatments

These include:

• Nicotinic acid (niacin)-This lowers total and LDL cholesterol and raises HDL cholesterol. It also can lower triglycerides. Because the dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin and thus can potentially be toxic, the drug must be taken under a doctor's care.
• Resins--Doctors have been prescribing Questran (cholestyramine) and Colestid (colestipol) for about 20 years. These "resins" bind bile acids in the intestine and prevent their recycling through the liver. Because the liver needs cholesterol to make bile, it increases its uptake of cholesterol from the blood.
• Fibric acid derivatives--Used mainly to lower triglycerides, Lopid (gemfibrozil) and Tricor (fenofibrate) can also increase HDL levels.
• Aspirin--Because studies have shown that aspirin can have a protective effect against heart attacks in patients with clogged blood vessels, doctors often prescribe the drug to patients with heart disease.

The decision of which drug to prescribe is one the doctor makes based on factors such as degree of cholesterol lowering desired, side effects, and cost. "If a patient has only a modest cholesterol elevation, I might prescribe Mevacor," says Johns Hopkins' Miller. "But if a more drastic reduction is needed, especially of LDL, I'll prescribe Lipitor."

The potential for drug interaction is a crucial concern, says FDA's Orloff. "Some statin drugs are known to interact adversely with other drugs, and that information may guide a decision about which statin to use." In June 1998, FDA announced the withdrawal of the drug Posicor (mibefradil), used to treat high blood pressure and stable angina, because it caused adverse reactions in patients taking various other drugs, including Mevacor and Zocor.

Though it is impossible to know yet just how many lives cholesterol-lowering therapies have saved, public health experts say awareness efforts such as the National Cholesterol Education Program are getting the word out to Americans about heart disease, its prevention and management. Reflecting on his own experience with elevated cholesterol, Hoffmann says, "Get informed [about cholesterol]. Read books, search the Internet, look at your risk factors, and, most of all, don't wait to do something about it if you have a [cholesterol] problem."

John Henkel is a staff writer for FDA Consumer.

---

Food for Thought

One of the main ways blood cholesterol can reach undesirable levels is through a diet high in saturated fat and cholesterol. Fatty cholesterol deposits can collect in blood vessels, raising the risk of heart disease.

Drugs, exercise, and other therapies may be prescribed. But in many cases, cholesterol levels can be lowered by revising dietary habits and limiting the kinds of foods known to boost cholesterol, such as those high in saturated fat. This doesn't mean totally eliminating all your favorite foods, such as desserts, says the National Cholesterol Education Program (NCEP). It means taking a more prudent approach to the kinds and amounts of foods you eat.

When elevated cholesterol is first discovered in a person without heart disease, doctors often start patients on the Step I diet recommended by the American Heart Association and NCEP. On this program, patients should eat: 8 to 10 percent of the day's total calories from saturated fat, 30 percent or less of total calories from fat, less than 300 milligrams of dietary cholesterol a day, and just enough calories to achieve and maintain a healthy weight. A doctor or a registered dietitian can suggest a reasonable calorie level. Food labels also are very helpful in determining how much saturated fat, cholesterol, and calories are in various foods.

If the Step I diet doesn't result in desirable cholesterol levels, doctors may try the Step II diet, which changes the daily saturated fat limits to below 7 percent of daily calories and dietary cholesterol to below 200 milligrams. Step II also is the diet for people with heart disease.

In many patients, blood cholesterol levels should begin to drop a few weeks after starting on a cholesterol-lowering diet. Just how much of a drop depends on factors such as how high the cholesterol level is and how each person's body responds to changes made. With time, cholesterol levels may be reduced 10 to 50 milligrams per deciliter or more, a clinically significant amount.

For more information on lowering blood cholesterol through diet or other means, contact:

National Cholesterol Education Program
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
www.nhlbi.nih.gov

Create From : Food And Drug Administration Home Page