There is a lot of confusion about cholesterol

Most people know that it is linked to heart disease and fat- but that’s about the extent of their knowledge Cholesterol is a whitish fatty   wax like substance. that is both produced in the body and found in food. Excess cholesterol in the bloodstream can clog and narrow the arteries Increasing the risk of heart attack stroke and kidney disease. Hyperlipidemia is the technical name for the presence of abnormally high levels of lipids cholesterol and triglycerides within the blood A high level of the fats is a risk factor in heart disease, which kills 83.000 men and 20.000 men in Great Britain every year but the positive news is that evidence strongly suggests that improving the blood fat profile helps reduce the risk of heart disease.

As many as two in every three men and increasingly more women. have unhealthy levels of blood fats. Symptoms include yellowish nodules of fat in the skin beneath the news knees and in the tendons, or in some cases a whitish ring around the eye. The majority are unaware of these symptoms – opticians may be the first ones to notice People may discover that they have hyperlipidemia when they undergo a routine blood test.

Astonishingly we are now finding children as young as eight or nine with raised lipid levels and even the first signs of atherosclerosis, furring of the arteries This is a trend we need to stop. Encouraging your child to eat and live healthily is most important.

 CHOLESTEROL

Cholesterol is produced by the body, primarily in the liver. It is also present in certain food. The cholesterol we eat is known as dietary cholesterol. and has little relationship with the cholesterol in the blood. Cholesterol is not all bad news It plays an apart in the production of sex hormones involved in the synthesis of vitamin D and is also needed for the production of the myelin sheath, the protective substance which surrounds the nerves.

Cholesterol only creates a problem when you have too much of it in your body: then, a can promote the production of a fatty plague which can clog up your arteries If this happens the blood flow is interrupted, which in a main heart vessel can cane a heart attack or in the blood vessel leading to your brain, a stroke. Blocked arteries also cause circulation problem numbness and pain in your hands and feet.

The cholesterol made within the body needs to be broken down to usable form and delivered to the cells which need it. The liver repackages cholesterol as low-density lipoprotein (LDL). As LDL flows through the blood, latches on to receptor sites on the cells which need the cholesterol. When the bells have had enough cholesterol, they stop producing the receptor sites. When this happens, the unused LDL stays in the blood and can irritate the blood vessel lining, which in turn causes a forty plaque to form.

Other factors can irritate the cells in the lining of the blood vessels animal them more susceptible to developing a plaque. The nicotine from cigarettes, and abnormally high sugar levels, such as are found in uncontrolled diabetics are two such factors Fundamentally, however the plaque would not be able to form if there was no LDL around. If you have too much LDL in your Blood this is usually referred to as having bad cholesterol The good type of cholesterol is high-density lipoprotein (HDL). HDL carries the excess LDL cholesterol from your blood back to your intestine, where it is excreted.

TRIGLYCERIDES

These are another type of blood fat, produced in the body in response to alcohol. hormones and sugar. Although they are different from cholesterol, they too hue been linked with heart disease and pancreatic cancer so it is important to keep them within the ideal range.

Blood fats may increase with age, consequently a cholesterol value in the reference range of 7.0 mmol/l would be much more noteworthy in person of 25 years than one of 55 years.

• Triglycerides are generally higher in men than women; HDL levels are higher in women than men. Up until a woman enters her menopausal years, the female hormone estrogen alters the metabolism of cholesterol and helps to keep LDL levels low.

After the menopause, when estrogen levels drop considerably, the effect is last, which explains why women’s risk of heart disease and strokes increases at this paint. Nowadays more and more women are sidestepping the menopausal years by taking hormone replacements for various reasons Hormone replacement therapy can lower LDL and increase beneficial HDL. levels, but so far this has been demonstrated only among women who take a pure estrogen-based hormone replacement, which is prescribed only to women who have had their womb removed Other hormonal medication, such as the contraceptive pill, can increase LDL. and lower HDL levels, which is one of the reasons why doctors need to make regular checks on women taking the pill, For men there does not appear to be any hormone-related change in their life risk of developing heart disease.

TESTING YOUR BLOOD FATS

As I have already said, many people are unaware that they have a blood fat problem. In this case, ignorance is not bliss, high blood fats present a serious risk of heart disease, but the risk can be reduced through modifications to your diet and lifestyle. Your doctor can give you a blood test or you can buy accurate self-testing kits at pharmacies Since the food you ear can raise your blood fat levels; doctors recommend that you take a fasting sample this is best done first thing in the morning. because you must not eat anything for eight to ten hours before the test. Look at the results in conjunction with the previous paragraph to see whether or to what extent, you need to alter you’re eating habits.

WHY DOES IT MATTER?

To reduce the risk of heart disease you need to make sure your LDL and triglyceride levels are low and your HDL level is high to excrete as much LDL as possible. Every case of hyperlipidemia is slightly different, but the best way to see your way through the jungle of advice is to understand how to build up a good blood profile. If you have high blood fat levels, you can decrease them by 25 per cent by adopting a healthy diet. Your body produces 75 per cent of your blood fats.

regardless of what you eat. However, the 25 per cent reduction can significantly reduce your risk of developing heart disease and therefore should be taken seriously It is never too late to change your blood profile for the better. If you don’t have raised blood fats, this is the point at which you should pay most attention, as the longer you can save them off the healthier your life should be. Equally, those of you with children should remember that hyperlipidemia is not confined to adults, young people die of heart disease, so the sooner you begin to protect your child’s blood vessels the better.

How to build up a good blood profile

There are several nutritional measures which can change your blood fat profile Some people believe that eggs, shellfish and offal (liver, kidneys) should be banished from their diet and margarine should replace butter. This is not strictly correct. Although these foods contain cholesterol (as do all animal derived foods, including cream cheese chicken and fish), they do not have a significant impact on blood cholesterol levels.

The cholesterol from the food we eat is broken down quite efficiently Obviously, if you have a lot of these foods and few of the cholesterol lowering foods your blood cholesterol level may be a little high but in the majority of people, I see this is riot the situation. So, lobster, prawns, liver and eggs need not be banned from the table (they all contain plenty of other useful nutrients), they just need to be eaten in moderation and in a way that allows the body to metabolize the food efficiently This normally means combining them with some fiber. The major principles in building a healthy blood scenario are.

• to keep your intake of saturated fats low

• to keep the HDL level high enough to excrete the LDL

.to prevent excess LDL from depositing in your blood vessels

• to avoid exposure to any other heart disease risk factors.

You need to know which foods to eat more of and which are the foods to watch .

KEEP YOUR INTAKE OF SATURATED FATS LOW

The major influence on the level of LDL in the blood is not the intake of cholesterol-rich foods, but the intake of saturated fats. Sometimes these are found in the same foods – butter, cream cheese – but prawns and offal, although high in cholesterol, are low in fat. Saturated animal fats stimulate the liver to produce more LDL, therefore keeping the intake of these foods low is the best way to keep your blood cholesterol level down. Choose lean meat rather than Tatty cuts, and have small amounts of butter, cream and cheese because you enjoy the taste: not just out of habit.

I do not suggest that you avoid all cheese, not only is it delicious, it is also a good source of calcium and other nutrients. Interestingly, the creamier cheeses Such as Brie and Camembert contain slightly less fat than the harder varieties Also, if you cut off the white rind, you virtually halve the fat content. Saturated fat is also found in some margarines, especially hard margarines Even if you do not buy them as such, remember that they are used in many top-bought cakes, biscuits and pastry products. For cooking stick to using a small amount of vegetable oils such as olive or sunflower.

One trap that some of my patients fall into is to think they can cure their high cholesterol levels and then go back to their old ways. They go for weeks replacing butter with margarine, cheese with low fat’ cheese substitutes, avoiding eggs, shellfish and offal, and feeling deprived and desperate for the day when the results come back from the lab saying that their cholesterol level has come down, so that they can get back to eating the real foods they love. It is much better to adjust to a generally healthier lifestyle which can include butter cheese and other delicious foods, as long as they are eaten in moderation and in a way that helps the body deal with fats efficiently – with some fiber and water.

INCREASE YOUR INTAKE OF FIBRE

The best way to control the amount of LDL in the body is to change the balance between foods that produce LDL and those that allow the body to excrete LDL. Fiber helps your body in two ways. Firstly, the fiber produces substances that help to clear the blood of LDL and secondly the presence of fiber in your meals acts as a buffer. Less fat is brought into contact with your blood vessels, which means that less fat is absorbed and more LDL is kept bound within the gut and then excreted.

A Healthy, well balanced diet rich in high fiber foods such as wholegrain breads and cereals, pulses, vegetables and fruits enable the body to excrete more LDL. Eating the recommended five helpings of fresh vegetables and fruits and a selection of other high fiber foods every day really helps to bring your blood fat profile within the ideal range:

Oats are a particularly good form of fiber for reducing cholesterol so begin your day with porridge or an oat cereal have oatcakes as snacks and use oats in main meals such as fruit or vegetable crumbles Oats are useful for people who have a limited tolerance of gluten the gluten content is far lower than in wheat products such as bread and pasta. Oatcakes are a perfect partner for cheese, the oat fiber reduces the intake of saturated fat from the cheese and helps your body produce more HDL, which will enable LDL to be excreted.

INCREASE YOUR INTAKE OF HDL PRODUCING FOODS

Two foods that have been the subject of much research are oily fish and garlic Olly fish such as herrings, mackerel, tuna and salmon contain beneficial types of fat called omega 3 and omega 6 fatty acids. These fatty acids encourage your body to produce HDL, which helps to remove LDL Garlic also contains a substance which raises your HDL levels. Both garlic and oily fish contain other substances which reduce your risk of developing a blood clot or thrombosis. A clot is a collection of blood cells which can block a blood vessel in a similar way to a deposit of fatty plaque so the more we can do to prevent this, the better.

Try to use garlic and oily fish in your weekly eating plan Garlic could be included almost every day, and I recommend that you aim to have two or three fish-based meals every week. Many of the soups and savory recipes in this book contain garlic, and for your fish suppers you could try seared tuna on a bed of spinach or simple barbecued sardines or grilled herrings. If you worry about the aftertaste and smell of garlic, chewing a sprig of parsley or sucking a coffee bean are said to reduce the effects.

GOOD OLD ALCOHOL

Another foodstuff which has been shown to increase HDL cholesterol and therefore reduce LDL levels, and also reduce the risk of thrombosis, is alcohol – in moderation Alcohol in excess of the recommended maximum of 28 units for men and 21 units for women can increase not only the total amount of cholesterol and LDL but also blood triglycerides all of which increase the risk of heart disease. Excessive alcohol also increases the risk of cardiomyopathy disease of the heart muscle and liver damage.

Wine drinkers seem to enjoy better cardiovascular health than either beer drinkers or teetotalers, provided they have no more than two glasses of wine. a day. The next best drink seems to be cloudy sediment on yeasty) beer, but all forms of alcohol are better for the blood fat levels than abstention Red wines are also rich in antioxidants (see below), substances that prevent

LDL from depositing in the blood vessels. Recent studies suggest that a couple of glasses of red wine, a day can reduce the risk of heart disease because of high levels of the antioxidant’s anthocyanin and tannin For those of you who don’t like red wine the darker beers contain there beneficial antioxidants than paler beers, but not as many as red win Do check with your doctor before you drink any alcohol in case any medication you are taking is likely to interact adversely or indeed there may be another contraindication in your health.

KEEP UP YOUR INTAKE OF ANTIOXIDANTS

There is little harm in fat circulating around the body, unless it starts to deposit. In order for far to deposit it needs to oxidize Nutritionally we can stop this by eating plenty of foods containing antioxidants, as well as drinking a moderate amount of alcohol (see above).

The most powerful antioxidants found in food are beta carotene (which the body converts to vitamin A, vitamin C and vitamin E. Good sources of these are discussed in more detail in the section on Understanding your nutritional needs, but basically if you eat at least five portions of fresh fruits or vegetables every day you should cover your needs, By a portion. I mean a piece of fruit such as a whole orange or kiwi fruit, a large helping of spinach broccoli or carrots, or a bowl of vegetable soup.

I suggest you have three pieces of antioxidant-rich fresh fruits and include a salad or vegetable portion at your two main meal Besides green leafy vegetables and avocados (a particularly rich source), vitamin E is also found in nuts such as almonds and hazelnuts, seeds such as sunflower Seeds and therefore sunflower oil – and oil wholegrain cereals.

There has been so much interest surrounding antioxidants in connection with reducing heart disease and cancer that many people wonder whether they should be taking a supplement I do riot believe that this is necessary as long as you are eating a well-balanced diet with at least five portions of fresh fruits or vegetable every day, don’t smoke and don’t bombard your body with Junk food.

HOW GUT BACTERIA MAY HELP

Two bacteria found in the intestine, acidophilus and bifid, are thought to produce substances which encourage the body to excrete more LDL and possibly raise HDL levels. Research is still in its early days, but I suggest you eat a small pot of live yoghurt containing these bacteria every day.

EAT SMALL MEALS OFTEN

Leaving your gut without any food for hours and hours and then putting a large meal into it is not healthy. This habit not only puts a strain on your digestion. It is also thought to raise your LDL levels.

Other risk factors

Besides the above nutritional measures, you can take to improve your blood fat profile. there are other influences to consider. Some are hormonal but other factors seem to affect men as well as women, these include smoking being over-fat, and lack of exercise. Diabetics are prone to suffer from heart disease, but hopefully as we come to understand more about controlling blood sugar levels (see the chapter on Diabetes) this will cease to be such a risk factor.

• Caffeine and nicotine both irritate the blood vessel linings, making them more likely to develop fatty plaques. Try to keep your caffeine intake down to no more than two or three cups of coffee, tea or cola a day, and stop smoking.

Exercise, particularly aerobic exercise, helps to reduce blood fat levels and also helps reduce your risk of developing heart disease in other ways Three times a week try to include a twenty-minute session of an aerobic exercise such as running, jogging power walking or brisk walking, swimming or cycling Always check with your doctor before you take up any form of exercise.

• In addition to the lipid lowering effects of aerobic exercise, exercise is a good Stress reliever Stress can cause your liver to produce more fat, in particular LDL cholesterol. Since stress is also a risk factor in many other diseases, you should take steps to reduce the stress levels in your life.

Excess weight, or more specifically excess fat, especially around the middle is bad news for your heart in two ways. Firstly, obesity and you reduce the levels of the good HDL cholesterol in your blood and secondly it leads to an increased risk of high blood pressure It is the fat which fills the stomach area and puts pressure on the major blood vessels to the heart that causes most concern.

This tends to be more common in men than women Cutting down on your intake of saturated fats and increasing the number of vegetables, fruit and high fiber foods will encourage healthy weight loss. If you need more advice, Achieving your ideal weight. Don be tempted to crash diet, and this can place undue strain on your heart High cholesterol is a risk factor not a disease. If your lifestyle is healthy and your lipid levels remain slightly above the ideal don’t worry too much