If you’re like most Americans, you’re struggling to reduce your cholesterol to a healthy level. You’ve probably sworn off eating eggs and liver and cut way back on your consumption of red meat. You’re learning to carefully read labels to keep saturated fat and cholesterol from sneaking into your diet. And all of that vigilance is no doubt paying off. It’s translating into a lower level of cholesterol in your blood, plus a reduced chance of heart disease and stroke. So with your new healthy habits in place, you can now stop worrying and get on with living. Right?
That depends. The cholesterol level in your blood is usually divided into at least three numbers. One number reflects the total amount of cholesterol circulating in your blood. Another number reflects the part of that total that contains LDL cholesterol, the “bad” stuff that gets stuck in your arteries and helps initiate the disease process that can cause a heart attack or a stroke. And the third number reflects the amount of HDL cholesterol, the “good” kind that’s known to put a half nelson on the bad stuff and escort it to the liver for disposal.
Some doctors recommend that you keep your total cholesterol below 200. But others, like William Castelli, M.D., former director of the Framingham Heart Study and now medical director of the Framingham Cardiovascular Institute in Massachusetts, suggest striving for an even lower number. “We have to remember that 35 percent of all heart attacks occur in people whose total cholesterol is under 200,” says Dr. Castelli.
He looks for HDL numbers above 35 in both men and women and LDL under 160 if there are no other risk factors. If you have two or more risk factors—you have a family history of heart disease, you smoke or have diabetes, for example—your LDL should be below 130, he says. Dr. Castelli notes that for anyone with a total cholesterol reading of more than 150, it is the ratio of total cholesterol to HDL that’s important. “If that ratio is four or above, your risk of heart disease is progressive and you should be following a diet and exercise program recommended by your doctor,” he says. “If your total cholesterol is less than 150, you have nothing to worry about,” says Dr. Castelli.
| Food Factors Several of the most important strategies for lowering artery-damaging LDL cholesterol and raising its artery-cleaning cousin HDL cholesterol involve tinkering with your diet. Here's how experts suggest it should be done. Watch those numbers. Cut dietary cholesterol to less than 300 milligrams a day. Most experts agree that avoiding liver, limiting eggs, reducing consumption of red meat and adding up and monitoring the cholesterol amounts listed on packaged goods are good ways to keep your cholesterol down. Lower fat. The key strategy behind any cholesterol-lowering effort is lowering the amount of saturated fat in your diet to less than 10 percent of calories, says Nancy Ernst, R.D., nutrition coordinator for the National Heart, Lung and Blood Institute in Bethesda, Maryland. That's because excess saturated fat overloads the body's cholesterol-clearing system and can lead to clogged arteries. Start lowering saturated fat by choosing fish, poultry and very lean red meats, trimming all visible fat from meats, using low-fat dairy products and reading labels to determine exact fat content. Redistribute your fat. Scientists suggest that you can lower your LDL cholesterol by changing the balance of fats in your diet. What's the best mix? For someone with high cholesterol, it's 7-10-13. Reduce saturated fat--the kind found in meats, for example--to less than 7 percent and polyunsaturated fat--the kind found in vegetable oils--to less than 10 percent of the calories in your diet. You should also increase monounsaturated fat--the stuff found in canola oil and olive oil--to 13 percent. Keep in mind that for every 1 percent decrease in your diet's saturated fat, your cholesterol level goes down nearly two points. Just don't lower your total dietary fat too much, because that can cause a drop in beneficial HDL, warns Margo Denke, M.D., an expert on women and cholesterol at the University of Texas Southwestern Medical Center at Dallas and a member of the panel of experts on HDL and heart disease of the National Institutes of Health in Bethesda, Maryland. Research shows that a diet that gets 30 percent of its calories from fat is best for cholesterol control. Get hooked on fish. Studies measuring the effects of omega-3 fatty acids, found in fish such as tuna, mackerel, salmon and sardines, on HDL indicate that regularly adding fish to your diet anywhere from once a week to every day is a good way to reduce saturated fat intake. What's more, an Australian study of more than 100 men between the ages of 30 and 60 found that eating fish once a day can counteract the drop in HDL that can be caused by eating a diet that's too low in fat. Fill up on fiber. Adding fiber-rich foods such as whole-grain cereals and breads to your diet can also reduce your level of LDL cholesterol. But make sure that every bite is of the most fiber-dense sources you can find, since nutrition experts say that you need between 15 and 30 grams of fiber in your diet to affect cholesterol levels. You can get that much by adding one cup of blackberries or raspberries to your breakfast, a half-cup of baby lima beans to your lunch, one cup of whole-wheat spaghetti to your dinner and five dried peach halves as a snack. Look for soy. Soy products, such as tofu and the texturized vegetable protein often added to ground meat, contain natural plant chemicals called isoflavones. Studies indicate that these chemicals may help flush artery-damaging cholesterol out of your body. |
Vitamin C Gives a Boost
Scientists have known for some time that keeping a close eye on your dietary fat intake and your cholesterol consumption is the key to lowering your LDL cholesterol level. The rule for cholesterol is simple: Eat less than 300 milligrams a day. The rule for fat is a little more complicated. By now we have all heard that a diet in which you get less than 25 percent of your calories from fat is best. But for someone with high cholesterol, that’s not the case. Research has shown that a diet too low in fat will lower not only your level of damaging LDL but also your level of beneficial HDL. A diet that gets 30 percent of its calories from fat is better for someone with high cholesterol, because it lowers LDL levels without lowering HDL.
While being careful not to lower your HDL is important, you should also take action to pump up your level of this good cholesterol. Researchers are just beginning to learn how you can do that.
Some studies indicate that a little alcohol (one or two drinks a day), heart-pumping exercise several times a week and avoiding tobacco are three strategies that will raise HDL. And several studies from researchers at Tufts University in Medford, Massachusetts, indicate that the higher the level of vitamin C in your blood, the higher your HDL level.
Blood levels of vitamin C and HDL were tested in 1,372 men and women at Tufts. Those who had the highest levels of vitamin C in their blood had 10 percent more HDL than those with the lowest vitamin C levels.
In a study at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, 138 men and women ages 20 to 65 took 1,000 milligrams of vitamin C a day for eight months. “We saw significant increases in HDL cholesterol—an average of 7 percent—among those volunteers who started with low levels of vitamin C in their blood,” says Paul Jacques, Sc.D., an epidemiologist at the center and one of the authors of the study. More than half of the adults in the United States who don’t take supplements containing vitamin C have low levels of this vitamin in their blood, according to vitamin C expert Robert A. Jacob, Ph.D., a research chemist in micronutrients at the U.S. Department of Agriculture Western Human Nutrition Research Center in San Francisco. Dr. Jacob suggests increasing these levels with “three to four servings a day of the top vitamin C sources, such as citrus fruits, potatoes, broccoli, cauliflower, strawberries, papayas and dark green, leafy vegetables.”
Researchers who are following up on these studies for the Baltimore Longitudinal Study on Aging, of the National Institute on Aging in Bethesda, Maryland, agree. The Baltimore researchers measured blood levels of vitamin C in 316 women and 511 men between the ages of 19 and 95, then asked them about the amount of vitamin C they consumed through either foods or supplements.
The result? The researchers found that the more vitamin C people got, the higher their HDL—but only up to a point. The study indicated that women who took 215 milligrams a day and men who took 346 milligrams a day increased their bodies’ HDL to maximum levels.
Doctors who recommend vitamin C for high cholesterol suggest taking 250 milligrams a day, an amount that’s more than four times the Daily Value of 60 milligrams but that’s generally considered to be quite safe.
| Prescriptions for Healing Lowering cholesterol is a key strategy in the fight against heart disease. And although scientists have not yet figured out all of the different ways that nutrients can help, studies indicate that these two vitamins can be of assistance. Nutrient Daily Amount
Vitamin C 250 milligrams Vitamin E 100-400 international units
MEDICAL ALERT: If you have been diagnosed with high cholesterol, you should be under a doctor's care. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
Vitamin E: The Neutralizer
Vitamin C is a water-soluble vitamin and is found in blood and other water-containing solutions in the body. But vitamin E is a fat-soluble vitamin, which means it actually becomes part of an LDL particle in the bloodstream. Vitamin E helps prevent the LDL from oxidizing or going rancid and thus clogging arteries, explains Balz Frei, Ph.D., associate professor of medicine and biochemistry at Boston University School of Medicine. With plenty of vitamin E around, the LDL particle harmlessly passes into the artery wall instead of forming plaque. Vitamin C acts as a helper by regenerating vitamin E when stores are low.
The Daily Value for vitamin E is 30 international units. Doctors who recommend vitamin E supplements to prevent heart disease, however, generally call for at least 100 international units a day. Up to 600 international units daily is a safe dose, according to medical experts, although people taking anticoagulants should not take vitamin E supplements.
