Cholesterol Myths that May Surprise You

 

Life insurance companies know a surprising secret about cholesterol that most doctors never tell patients: When it comes to rating your risk for a fatal heart attack, the least important cholesterol number is your level of LDL (bad) cholesterol. In fact, life insurance actuaries don’t even look at LDL levels, because large studies show it’s the worst predictor of heart attack risk.

Instead, life insurance companies use a simple math formula to rate your heart attack risk: They divide your total cholesterol by the level of HDL (good) cholesterol.

“If the ratio is below three, and there’s no inflammation in your arteries, you’re practically bulletproof against heart attacks and strokes, even if your LDL is high,” reports Amy Doneen, MSN, ARNP, medical director of the Heart Attack & Stroke Prevention Center in Spokane, Washington.

Here’s a look at eight common cholesterol myths.

Myth: Cholesterol is inherently evil.

Fact: You couldn’t survive without cholesterol, since this waxy substance produced by the liver plays many essential roles in our body, from waterproofing cell membranes to helping produce vitamin D, bile acids that help you digest fat, and sex hormones, including testosterone, estrogen, and progesterone.

Cholesterol is ferried through your body by molecular “submarines” called lipoproteins, such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Cholesterol: The Good, The Bad, The Essential

Myth: Low cholesterol is always a sign of good health.

Fact: Although low levels of LDL cholesterol are usually healthy, a new study reports that people who develop cancer typically have lower LDL in the years prior to diagnosis than those who don’t get cancer.

Researchers compared 201 cancer patients to 402 control patients without cancer, matched by such factors as age, gender, smoking, blood pressure, diabetes, and body mass index. None of the patients had taken statins.

Thirteen earlier randomized clinical trials of statin therapy also found a link between low LDL and cancer, causing medical debate about whether statins raise risk. The new study suggests that an unknown biological mechanism—rather than cholesterol-lowering medication—may be the culprit.

Myth: High LDL means you could be headed for a heart attack.

Fact: Nearly 75 percent of people hospitalized for a heart attack have LDL (bad) cholesterol levels that fall within current recommended targets, and close to half have “optimal” levels, according to a national study of about 136,000 people. The researchers also reported that levels of protective HDL (good) cholesterol have dropped in heart attack patients over the last several years, probably due to the rise in obesity, diabetes, and insulin resistance. Only 2 percent of the patients studied had ideal levels of both LDL and HDL.

Myth: All LDL particles are equally dangerous.

Fact: The size of the particles matters, says Doneen. “Think of beach balls and bullets. Some LDL particles are small and dense, making it easier for them to penetrate the arterial lining and form plaque, while others are big and fluffy, so they tend to bounce off the artery walls.”

People who mostly have small, dense LDL cholesterol are up to three times more likely to have heart attacks than those with big, fluffy particles.

Find Foods that Lower Cholesterol but Keep Flavor

Myth: Americans have the world’s highest cholesterol levels.

Fact: Contrary to the stereotype that most of us are just a few big Macs away from a heart attack, US men rank 83rd in the world in average total cholesterol and US women 81st, according to the World Health Organization. For both sexes, the average is 197 mg/dL, slightly below the borderline high range (200 to 239 mg/dL).

In Colombia, men average a whopping 244 mg/dL—a level that doubles heart-disease risk—while Israeli, Libyan, Norwegian, and Uruguayan women are in a four-way tie for the highest average with 232.

Myth: Triglycerides trigger heart disease.

Fact: “Triglycerides, a type of blood fat, don’t invade the artery wall and form plaque,” explains Doneen. “However, high triglycerides mark another huge problem: insulin resistance, a pre-diabetic condition that is the root cause of 70 percent of heart attacks.”

High triglycerides are also one of the warning signs of metabolic syndrome, a cluster of abnormalities that multiply risk for coronary artery disease, stroke, and type 2 diabetes. To be diagnosed with metabolic syndrome, you must have three or more of these disorders: high blood pressure, high blood sugar, a large waist, high triglycerides, and low HDL.

Myth: Eggs clogs up arteries.

Fact: It’s true that eggs are high in dietary cholesterol, with upwards of 200 mg, mainly in the yolk. Research shows, however, that eating three or more eggs a day boosts blood concentrations of both good and bad cholesterol.

The LDL particles tend to be the light, fluffy ones that are least likely to enter the arterial wall, while the increased HDL helps keep the arteries clean, suggesting that most people’s bodies handle cholesterol from eggs in a way that’s unlikely to harm the heart. The researchers say that their findings add to growing evidence that eggs are not “a dietary evil.”

Read Our Guide to Cholesterol-Free Foods

Myth: There are no visible symptoms of high cholesterol.

Fact: Some people with high cholesterol develop yellowish-red bumps called xanthomas that can occur on the eyelids, joints, hands, or other parts of the body. People with diabetes or an inherited condition called familial hypercholesterolemia are more likely to have xanthomas.

The best way to tell if your cholesterol is too high is to have it checked every three years, starting at age 20, or more often, if advised by your healthcare provider.

 

Cholesterol Myths & Facts

 

 

Cholesterol is an important part of a healthy diet. It is a soft substance, waxy in texture, that is used to form cell membranes. It also is used in the production of certain hormones. However, too much cholesterol in the blood can be a health risk as it is linked to coronary artery disease. This disease is often a precursor to a heart attack. This information has caused cholesterol's positive benefits to be discounted and myths about this important substance to become believed as fact.

 

 Facts about cholesterol

 

Cholesterol is not soluble in the blood stream. It needs carriers to move it to the cells. The vehicles used for this are called lipoproteins. Lipoproteins are what are actually measured in the laboratory to get the cholesterol count. There are two types of lipoproteins, low density (LDL) and high density (HDL). The low-density lipoproteins are the biggest carrier of cholesterol. High-density lipoproteins carry cholesterol to the liver to be flushed out of the body.

 

LDLs, the truth

 

Myths surround low-level lipoproteins, namely that all cholesterol is bad and should be avoided at all costs. The truth is that too many LDLs are bad. They cause a buildup in the arteries called plaque. This condition is called artherosclerosis, and it can be a precursor to heart attacks. The main culprits in a diet that increase LDLs are saturated fats and trans fats.

 HDLs-the truth

 

HDLs refute the myth of bad cholesterol. HDLs carry cholesterol to the liver away from the arteries. It is then passed from the body. HDLs in high enough levels actually can help prevent heart disease, stroke and heart attack. Conversely, too low levels of HDLs can increase the risk of these health problems.

 

Myth of eating fats

 

Consuming fats has been considered a negative activity, as it supposedly increases cholesterol levels. In reality, fat is an important dietary component as it aids in satiation, creating body cells and regulating body temperature.

 

This myth is partially correct, in that saturated and trans fats should be avoided because they raise LDLs. However, mono and polyunsaturated fats raise the HDLs, which then increase protection from heart and stroke issues. Polyunsaturated fat actually lowers cholesterol levels. These good fats include olive oil, safflower oil and peanut oil.

 

The egg-myth vs. reality

 

The biggest victim in the cholesterol myth has been the egg. The egg has been given as the example of what not to eat. In reality, there is no evidence that eating eggs raises your cholesterol level. Eggs do not contain saturated or trans fats, and therefore are not the risk that they have been accused of being. The Harvard School of Public Health has done research that shows that limiting eggs and other cholesterol containing foods has no effect on cholesterol levels. The positive effect of dietary changes on cholesterol is seen only when foods high in saturated and trans fats are minimized or deleted.

 

Still in question

 

The American Heart Association suggests that cholesterol intake should be limited to less than 300 mg/dl daily. However, other health agencies such as the Harvard School of Public Health now put no limit on cholesterol intake, but instead target the amount of trans and saturated fats. This topic is under debate, though all agree that decreasing fatty foods composed of trans and saturated fats will decrease the risks associated with high cholesterol.

 

Cholesterol and Heart Disease

When too much cholesterol is present, plaque (a thick, hard deposit) may form in the body's arteries narrowing the space for blood to flow to the heart. Over time, this buildup causes atherosclerosis (hardening of the arteries) which can lead to heart disease.

When not enough oxygen-carrying blood reaches the heart chest pain -- called angina -- can result. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing.

What Factors Affect Cholesterol Levels?

A variety of factors can affect cholesterol levels. They include:

Diet. Saturated fat and cholesterol in the food you eat increase cholesterol levels. Try to reduce the amount of saturated fat and cholesterol in your diet.

Weight. In addition to being a risk factor for heart disease, being overweight can also increase cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as increase HDL cholesterol.

Exercise. Regular exercise can lower LDL cholesterol and raise HDL cholesterol. You should try to be physically active for at least 30 minutes on most days.

Age and Gender. As we get older, cholesterol levels rise. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, however, women's LDL levels tend to rise.

Diabetes. Poorly controlled diabetes increases cholesterol levels. With improvements in control, cholesterol levels can fall.

Heredity. Your genes partly determine how much cholesterol the body makes. High blood cholesterol can run in families.

Other causes. Certain medications and medical conditions can cause high cholesterol.

How Can I Lower My Cholesterol and Risk of Heart Disease?

A few simple changes can help lower cholesterol and risk for heart disease:

Eat low-cholesterol foods. The American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit daily intake to less than 200 milligrams. People can significantly lower their dietary cholesterol intake by keeping their dietary intake of saturated fats low and by avoiding foods that are high in saturated fat and that contain substantial amounts of dietary cholesterol.

Quit smoking. Smoking lowers HDL ("good") cholesterol levels. This trend can be reversed if you quit smoking.

Exercise. Exercise increases HDL cholesterol in some people. Even moderate-intensity activities, if done daily, can help control weight, diabetes, and high blood pressure -- all risk factors for heart disease.

Take medication as prescribed by your doctor. Sometimes making changes to your diet and increasing exercise is not enough to bring cholesterol down. You may also need to take a cholesterol-lowering drug.

What Drugs Are Used to Treat High Cholesterol?

Cholesterol-lowering drugs include:

Statins

Niacin

Bile-acid resins

Fibric acid derivatives

Of these, statins are the only drugs proven to prevent heart attacks. These medications are most effective when combined with a low-cholesterol diet.

Since you’ve recently been diagnosed with high cholesterol, ask your doctor these questions at your next visit.

 

Cholesterol is a paradox: Everyone needs it, but too much of this good thing can spell trouble for some people. A soft fat-like substance, cholesterol aids vital bodily functions such as building new cells and producing hormones. The body gets cholesterol in two ways: 80% of it is produced by the liver and the rest comes from your diet. Cholesterol is found in foods derived from animal products like meat, cheese, poultry, or fish. Note that foods that don't contain animal products may contain another...

 

1. What are the dangers of having high cholesterol? Can other problems develop?

2. What could have caused my cholesterol to be too high? Is it inherited?

3. Are there things I can do at home or in my life to reduce my cholesterol?

4. Is medicine necessary? Are there alternative treatments?

5. If medicine is needed, how does the medicine work?

6. How long can I take medicine? What are the side effects? Is long-term use harmful?

7. How can exercise help to lower my cholesterol?

8. Where can I learn more about how to live with high cholesterol?

9. What changes should I make to the way I eat?

10. How often do I need to get my cholesterol level checked?

Understanding Cholesterol Numbers

Cholesterol levels should be measured at least once every five years in everyone over the age of 20. The screening test that is usually performed is a blood test called a lipid profile. Experts recommend that men aged 35 and older and women aged 45 and older be more frequently screened for lipid disorders. The lipoprotein profile includes:

LDL (low-density lipoprotein cholesterol, also called "bad" cholesterol)

HDL (high-density lipoprotein cholesterol, also called "good" cholesterol)

Triglycerides (fats carried in the blood from the food we eat. Excess calories, alcohol, or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.)

HDL Cholesterol

When it comes to HDL cholesterol -- "good" cholesterol -- the higher the number, the lower your risk. This is because HDL cholesterol protects against heart disease by taking the "bad" cholesterol out of your blood and keeping it from building up in your arteries. The table below explains what the numbers mean. 

60 and above

High; Optimal; associated with lower risk

Less than 40 in men and less than 50 in women

Low; considered a risk factor for heart disease

Total Cholesterol

Your total blood cholesterol is a measure of LDL cholesterol, HDL cholesterol, and other lipid components. Doctors recommend total cholesterol levels below 200

Less than 200

Desirable

200 - 239

Mildly High

240 and above

High

The Trouble with Triglycerides

You’ve probably heard of triglycerides, and you’ve probably also heard that consistently high blood levels of triglycerides can be a bad thing. But what are triglycerides, exactly? Why would your doctor shake his head if your cholesterol report says that your triglycerides are high? And what do they have to do with diabetes and a group of worrisome symptoms called the “metabolic syndrome?”

 

Eat more vegetables, fruits, and whole grains. The dietary fiber in these foods helps lower “bad” LDL cholesterol -- one of the main contributors to heart attack and stroke. Put these on your plate with every meal to reach these daily amounts: At least 5 cups of fruits and vegetables and three 1-ounce servings of whole grains a day.

Eat more legumes (beans), seeds, and nuts. Your weekly target: 4 servings of either nuts, seeds, or legumes such as black beans, garbanzos or lentils.

Put healthier fats to work for you.

Cook with oils high in healthy, unsaturated fats, such as canola, olive, and peanut oils. These oils are less likely than butter or lard to clog your arteries.

Use plant stanols or sterols found in fortified margarines, salad dressings, and yogurt. (Check the labels.) These plant compounds help lower “bad” LDL cholesterol.

Eat fish that are high in omega-3 fatty acids, including albacore tuna, salmon, or sardines. This fat is a powerful defender against heart attack and stroke. Omega-3s seem to lower triglycerides, fight plaque in your arteries, lower blood pressure, and reduce your risk of abnormal heart rhythms.

Eat lean, unprocessed protein. Make fish and chicken your mainstays. They help lower your chance of a heart attack and stroke, while red meats (beef, pork, and lamb) increase your risk. The American Heart Association suggests you eat at least two 3.5-ounce servings of fish a week. Tofu and soy protein are also lean sources of protein – and not just for vegetarians anymore.

If you’re craving some type of processed meat -- bacon, deli meats, hot dogs, sausage, chicken nuggets, or jerky – limit those to no more than 2 servings a week.

Feed your body regularly. When you skip a meal, you’re more likely to overeat later. For some people, eating 5 to 6 mini-meals works best to limit calories, help control blood sugars, and regulate metabolism. For others, 3 meals a day works better, since extra meals can trigger overeating. See which approach works for you.

Experiment with new flavors. Try using dried herbs and spices instead of salt, which can drive up your blood pressure. For chicken, try using rosemary, garlic, or sage. For fish, try dill or tarragon. Try vinegars – from balsamic to rice vinegar, to add zest to ho-hum food.

Exercise. Activity is good medicine. Exercise strengthens your heart, improves blood flow, raises "good" HDL cholesterol, and helps control blood sugar and body weight.

Add years to your life by quitting. No matter how many years you've been smoking, know this: Research shows that quitting works as well -- if not better -- than just about any heart drug available.Quitting now will lower your risk of death from heart disease by 33%.

Celebrate each pound you lose. Small steps help with obesity and heart health. Just dropping 5 or 10 pounds -- even if you're still technically overweight afterward -- will reduce your risk of having a heart attack or stroke by lowering your blood pressure, cholesterol, and blood sugar levels.

Sparkling water, tea, lemonade

Manage your cholesterol. You can take an important first step toward a healthier heart by enrolling in the American Heart Association's Cholesterol Low Down Program. High cholesterol is a leading risk factor for coronary heart disease and stroke. Sign up by phone ([800] AHA-USA1) or online at American Heart Association's Cholesterol Low Down Program to receive life-management tools such as a newsletter, health risk assessment, and healthy-living cookbooks and fitness tips.

Understanding Cholesterol Problems: Symptoms

A high level of cholesterol in the blood doesn't have obvious symptoms, but it can increase your risk for conditions that do have symptoms, including angina (chest pain caused by heart disease), high blood pressure, stroke, and other circulatory ailments. Also: Soft, yellowish growths or lesions on the skin called xanthomas may indicate a genetic predisposition to cholesterol problems. Many people who are obese or have diabetes also have high cholesterol. In men, impotence may be caused...

Cholesterol-lowering drugs include:

Statins

Niacin

Bile-acid resins

Fibric acid derivatives

Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a healthy diet and exercise.

How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling and headache. A recent research study suggested that adding nicotinic acid to statin therapy was not associated with a lower risk of heart disease. Examples of nicotinic acid medication include:

Nicolar and Niaspan