Fact or Fiction: high cholesterol

I recently received an interesting email:

"I was in for my annual physical two weeks ago and the letter you sent me said that my cholesterol reading had increased from 210 to 216 over the last year.  You said you wanted me to come back in 6 months to get retested.  My questions are:

1.       I take one 900 mg fish oil tablet a day - would it be beneficial to double that?

2.       Some of the "natural" remedy information indicates that cinnamon tablets are helpful - any thoughts on that?

3.       My wife wants me to take "Cholest-Off" which is advertised as an all-natural means of reducing LDL numbers - would that be worth trying?

4.       Any thoughts on the Juice Plus program and if that might help?

5.       I eat a fair amount of peanut butter at lunch and drink 2% milk most nights for dinner - is that a problem?

I am eliminating or reducing my favorite vices - brats and ice cream sandwiches - probably  a good thing no matter what my cholesterol number is."  Name Withheld

I thought this would serve as a good launching point to discuss cholesterol.  Let me first explain what cholesterol is, what it's function is and how it can cause problems.  

Cholesterol is basically blood fat.  It is made mostly in the liver and is used in the body to create the membranes that keep our cells intact.  There are many different components to it.  The most important to understand are the LDL (low density lipoprotein), the HDL (high density lipoproetein) and the TGs (triglycerides).  The LDL particles are the most atherogenic (meaning they cause blockages in the arteries).  When in excess, they will be deposited in the membrane of blood vessels and start an inflammatory process resulting eventually in build up or "plaques."  They are referred to as the "bad cholesterol."  HDL particles are like tiny little fat vacuums. They circulate and will take up the extra LDL and other fat particles keeping them from forming plaques.  The higher the HDL, the better off you are.  The triglycerides are particles that are less toxic than LDL particles but still harmful.  Together with fatty acids, they will also strain the body's metabolism and increase insulin resistance, which can lead to diabetes.  

The total cholesterol is the sum of the LDL and the HDL and 1/5 of the TG's.  We typically say that the total cholesterol should be less than 200 mg/dl.  However, that depends on the makeup of the other particles.  For example, I just saw a patient whose total cholesterol was 240 mg/dl.  That seems rather high but her HDL was outstanding at 135 mg/dl.  Her LDL and TGs were well within the normal range so her cholesterol  profile was perfectly normal.  I could only wish mine be so good.  We would like to see everyone above 40 mg/dl for the HDL.  As of yet there have been no good medications developed to increase the HDL.  Regular cardiovascular exercise remains the best way to increase it.  That and having good genes.  

The LDL is partly genetic but greatly influenced by the foods that we eat.  The culprits tend to be animal fats (red meat, bacon are the worse).  Butter and other oils which are solid at room temperature are also dangerous.  The LDL in low risk individuals should be under 130 mg/dl.  In higher risk patients it should be less than 100 mg/dl and even some studies show that driving it down to 70 mg/dl gives additional benefit.  Those at high risk are anyone who has had a heart blockage, those who have blood vessel disease elsewhere such as in the neck, brain or legs, and anyone who has diabetes.  I'll talk more about specific dietary recommendations in a future post.  

The triglycerides are the easiest to lower without medication.  They are increased by ingesting too much greasy food, alcohol and simple carbohydrates.  Sugared beverages are some of the worst culprits.  Even the simple carbs in bread and pasta can cause elevated triglycerides.  The TGs should be less than 150 mg/dl.  A level over 200 mg/dl greatly increases one's chance of developing diabetes.  At very high levels, such as 800-1000 mg/dl, pancreatitis can even be triggered.  

With a basic understanding of the cholesterol components, I can now start answering the questions I received above.  Stay tuned next week for some answers!