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Cholesterol — the good, the bad and the essential

By Suezette Olaker, M.D.

When you hear the word cholesterol, what comes to mind? Your mouthwatering favorite meal or treat, which is often high in fat or sugars? Or do you think about obesity, diabetes, high blood pressure, heart disease and stroke? Too often, people say with a degree of guilt, “I know, my cholesterol is high and I should eat better.” But what should you really do?

Before you accept too much guilt, recognize that some cholesterol is essential for life. In the skin, it helps make vitamin D and makes the skin water-proof. In the nervous system, it lines and insulates nerve cells, making for smooth, rapid nerve signals. During digestion, some cholesterol is used to make bile, which helps digest food. With regard to metabolism, cholesterol is a storage form of energy fuel. Cholesterol is used in making steroid, adrenal gland and sex hormones. It also maintains integrity of cell walls. All cell walls in the body contain cholesterol. The body determines whether more cholesterol needs to be created or be stored. If more is needed, it is made in the liver.

Cholesterol is a waxy type of fat. Although essential for life, higher levels are not better. Different types of lipids (fats) are:

– LDLs — which are mainly in circulation, and associated with plaque formation

– Triglycerides — which tend to increase after ingestion of too many grains and sugars, cigarette smoking, physical inactivity and consumption of alcohol

– Lipoprotein (a) — a genetic risk factor for coronary heart disease and stroke

– HDLs — the “good” cholesterol, which is believed to remove some plaque from arteries and transport cholesterol back to the liver for excretion or re-use elsewhere in the body

The problem with cholesterol is the plaque. Nicks (varying degrees of damage) occur in blood vessel walls and inflammation results. Bits of cholesterol appear at the sites to repair injury. As repair continues, the plaque forms (the atheroma). Platelets and blood cells consolidate the plaque and over time, calcium combines to form atherosclerosis — scarring, narrowing and hardening. These are like scars, where blood vessels have healed from injuries, but are no longer perfect.

Plaque can prevent adequate blood flow or break off in pieces and obstruct blood flow elsewhere in the system. The results can be high blood pressure (the heart must work too hard to pump needed blood through a small space), heart disease (the heart eventually fails to pump efficiently) or heart attacks and strokes if bits of debris block blood vessels in the heart or brain.

Q. What’s the message to remember about high cholesterol?

A. High cholesterol increases your risk of developing heart disease, which is the No. 1 killer of men and women in America. It also is associated with high blood pressure, obesity, and diabetes. If you have diabetes or high blood pressure, treat them. If you are overweight, lose it.

Q. How do you know if you have high cholesterol?

A. A blood test informs you. It is recommended that you check your cholesterol level every five years after the age of 20.

Q. What do the numbers mean?

A. Total cholesterol, LDL and HDL are measured. In addition to knowing your total cholesterol level, you should know the ratio of HDL to total cholesterol. Higher levels of HDL and lower levels of LDL are considered protective against heart disease. Total cholesterol of 200 mg/dL or less is recommended. HDL should be at least 20 percent of total cholesterol – the higher, the better. LDL of 100 mg/dL is advised. HDL should be half of LDL; more HDL is better.

Q. What can you do about high cholesterol?

A. Risk factors for high cholesterol include some things you cannot change (age, gender, family history of heart disease). Multiple lifestyle practices significantly reduce your risks.

Eat a diet high in fruits and vegetables. These natural foods do not contain cholesterol.

Avoid foods that increase inflammation — processed grains, processed carbohydrates and sugars (especially high fructose corn syrup). Foods that increase inflammation increase damage to the blood vessels. Decrease dietary sources of cholesterol. Decrease saturated fats (fatty meats from all animals, butter, lard, whole fat dairy) and eggs. Avoid red meat. But if you must consume it, eat organic, grain-fed types that are lower in fat.

Avoid partially hydrogenated fats (often found in margarines and processed foods). These include vegetable fats that are solid at room temperature. Notable exceptions are coconut oil and avocado. Include raw nuts and seeds in your diet. Avoid cooking food at high temperatures.

Avoid trans fats, which are used to prevent food from becoming rancid.

Exercise regularly — at least 30 minutes (constant or in divided periods) most days of the week. Exercise boosts HDL, and can assist in increasing metabolism as well as weight loss.

If you are overweight, lose weight and keep it off!

Do not smoke, or use alcohol. Both contribute to inflammation.

Confer with your doctor. Pharmaceutical approaches also help control high cholesterol.

As with many other chronic conditions, high cholesterol is not a death sentence. Being aware of your numbers, then taking consistent action to reduce your risks, is the best approach.

Dr. Suezette Olaker is a Detroit-based physician who serves as vice chairman of the Detroit Food Policy Council. She can be reached at

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