Joy Bauer MS, RD, CDN TODAY nutritionist and diet editor • Profile • E-mail

I often tell my clients to take nutritional changes at a pace that feels comfortable to them. That’s not good enough when it comes to cardiovascular disease. The consequences of doing too little are severe — heart attack, stroke, or even worse. Sadly, not everyone gets a second chance. So please don’t wait until after the next vacation, or your daughter’s wedding, or that anniversary dinner to start. My advice is to start immediately and go for broke! Change your diet, change your habits, change your lifestyle. 

Cholesterol 101
Cholesterol is a natural fat-like substance found in all animal tissue — humans included—because it is part of all cell membranes. Cholesterol is also part of the myelin sheath that surrounds and protects nerves, and it is used to make vitamin D, bile, and some hormones. Our bodies make all the cholesterol we need for good health, so extra cholesterol coming from a poor diet provides NO benefit (in fact, quite the contrary — it clogs our arteries).

Cholesterol comes in two main varieties: low-density lipoprotein (LDL) cholesterol (commonly called “bad cholesterol” — remember L for LOUSY), and high-density lipoprotein (HDL) cholesterol (“good cholesterol” — remember H for HERO). LDL cholesterol is one of the components of vessel-clogging plaque. Over time, plaque can incorporate calcium and other substances that make the plaque hard and brittle. If the plaque deposits grow large enough, they can block a blood vessel. In addition, the brittle plaque can break off, travel through the blood stream, and form a clot anywhere in the body.

LDL-Cholesterol
The higher your LDL cholesterol, the greater your risk of developing life-threatening plaque. So, you want your low-density low. According to the National Institutes of Health (NIH), the optimal level of LDL cholesterol is below 100 mg/dL. High LDL cholesterol is defined as 160 mg/dL and higher — but certainly anything above 130 is worth treating.

HDL-Cholesterol
HDL cholesterol, on the other hand, is like nature’s plaque vacuum cleaner — it picks up the vessel-clogging cholesterol and carries it away to the liver, where it is disposed of in the form of bile. The higher your HDL levels, the cleaner your blood vessels will be. So, you want your high-density high. According to the NIH, people with HDL of 60 mg/dL or higher have a lower risk of heart disease … whereas HDL below 40 mg/dL is considered too low.

Cholesterol Ratio
Because HDL is so important to the health of blood vessels, some physicians prefer to talk about the cholesterol ratio — your total cholesterol divided by your HDL cholesterol. For example, if your total cholesterol number is 250 and your HDL is 50, your ratio is 250/50 or 5. A ratio of 3.5 is considered optimal, and people are urged to aim for a ratio of 5 or less.

High cholesterol can be caused by several factors, some you can change, and some you can’t. Heredity can play a big part. Some people can have a perfect heart-healthy lifestyle, and still have skyrocketing cholesterol because their bodies naturally make too much of it — our bodies’ production of cholesterol is independent from what we eat. Also, LDL cholesterol increases naturally with age, so even if you put up all-star numbers when you were younger, each passing year has made you that much more likely to have problems.

High LDL cholesterol (the “lousy” type) leads to atherosclerosis …which causes narrowing of the blood vessels…which means your heart has to pump that much harder to squeeze blood through them…which means increased blood pressure and other life threatening concerns. You can improve your cholesterol profile by reducing body weight (if you are overweight), increasing physical activity, and following my cholesterol-busting nutrition program.

Lowering cholesterol through Diet!
Right off the bat, I tell you this: If you are overweight, focus on losing weight. Research has shown that losing just 10 pounds can reduce LDL cholesterol by 5 to 8 percent. Become more physically active. Even moderate exercise can help improve your cholesterol, as well as triglycerides, and blood pressure.

Specific foods to limit or avoid:
The top dietary recommendations for lowering cholesterol are to eliminate or at least drastically limit the foods you eat that contain saturated fats, trans fats, dietary cholesterol, and refined carbohydrates.

• Saturated fats: They are found in animal-based foods, including meats, butter, whole-milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. The Nurses’ Health Study, which included more than 80,000 participants, showed that saturated fats increase the risk of coronary artery disease. Numerous studies have shown that by replacing saturated fat with olive oil or nuts (monounsaturated fat)… you can reduce LDL-cholesterol by significant amounts.
  
  
• Trans fats: They were developed in a laboratory to improve the shelf life of processed foods —and they do. But calorie for calorie, trans fats are even more dangerous than the saturated fats. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, potato chips, snack foods, fried foods, and fast food that use or create “hydrogenated oils”. (All food labels must now list the amount of trans fats, right after the amount of saturated fats – good news for consumers.) By substituting olive oil or vegetable oil for trans fats in just 2 percent of your daily calories, you can reduce your risk of heart disease by 53 percent. In a 2000 calorie-a-day diet, that’s about 40 calories. Think of it this way — an average serving of French fries contains about 5 grams of trans fats, or about 45 calories worth of evil trans fats, and a daily serving would be enough to double your risk of heart disease. There is no safe amount of trans fats, so try to keep them as far from your plate as possible. 
  
  
• Cholesterol-rich foods: Years ago, doctors used to recommend that people with heart disease avoid all high-cholesterol foods. But dietary cholesterol does not harm health as much as saturated fats and trans fats do. Research into the effects of dietary cholesterol have been mixed, which is not surprising — different people have different susceptibilities. Still, if you want to take a firm hand to reduce your risk factors, you may want to consider cutting down on all high-cholesterol foods, including egg yolks, shellfish, liver, and other organ meats like sweetbreads and foie gras.

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