Cholesterol – The Good, The Bad, and the Triglycerides

September 4, 2002
Hershey, Pa. – Hardly a day passes without news on cholesterol and heart disease. One day fat is bad for us. The next day, fat is OK, but carbohydrates are bad. Good cholesterol vs. bad cholesterol vs. triglycerides. Chocolate is good, but the calories are bad. Wine is good, but only the red. How can we make sense of the conflicting information? Since September is Cholesterol Awareness month – now is as good a time as any to sort out the facts.

Cholesterol actually serves an important role. The body uses it to build cells and make hormones, but many of us make too much of the wrong type of cholesterol. “Bad” cholesterol is called LDL or low-density lipoprotein. It sticks to the inside of arteries clogging them. When LDL clogs arteries of the heart it can lead to a heart attack.

High-density lipoprotein or HDL is the “good” cholesterol. It helps take bad cholesterol out of circulation. The more HDL you have, the cleaner your arteries.

A third word often associated with cholesterol is triglycerides, the chemical name for fat. Our triglyceride level measures the fat in our circulation. Contrary to what many of us might think, our triglyceride level is not necessarily related to your weight. Thin people can have high triglycerides and heavy people can have normal levels (although weight loss is often part of correcting the problem). High triglycerides can damage other organs in addition to your heart. Triglycerides are increased by dietary fat and by carbohydrates which include sugars found in fruits, table sugar and honey plus starches such as bread, rice, pasta, potato and vegetables. Excess carbohydrates raise triglycerides first and then LDL. As LDL increases, HDL levels drop resulting in more clogging of your arteries.

Our liver makes all the cholesterol we need so our dietary limit is 300 mg, slightly more than what can be found in one egg yolk. Only animals produce cholesterol. There isn’t any in fruits and vegetables—only in meat and dairy products. Shellfish, egg yolk and “organ meats” such as liver and kidney have the most cholesterol. Consumption of cholesterol raises blood levels for a day. More important than cholesterol intake is limiting calories from fat, especially saturated fat since the fat we eat contributes to the continued production of cholesterol.

The first step in controlling cholesterol is a sensible diet. If cholesterol is high, limit snacks to small amounts of low calorie foods. If you need to lose weight, you may want to avoid snacks altogether. Be careful of “cholesterol free” foods. Just because they’re cholesterol free, it doesn’t mean they’re free of saturated fat that can cause our bodies to produce LDL. A balanced diet of lean meat or fish in small amounts plus vegetables and fruits is a good approach to controlling cholesterol.

Be wary of “natural” products touted to lower cholesterol. Many have not been tested, are not as effective as FDA-approved medications and have potential side effects and drug interactions. Omega 3 fatty acids found in some fish can help lower cholesterol but no one knows if it is better to take supplements than to include these fish in your diet. Garlic has only a tiny effect on lowering cholesterol. Flavinoids in red wine, red grape juice, dark beer and chocolate can reduce cholesterol’s “stickiness”—but remember these foods can also pack a calorie wallop, so moderation is the key.

Read the nutrition labels on foods. Try to keep fat calories below 30 percent of any meal and the saturated fat below 10 percent. Divide the number of calories per serving by the calories from fat to get the percentage. Having some meals lower in fat will make up for the occasional higher fat meal. For example, a lunch of vegetable soup could compensate for a small steak dinner that evening.

Sometimes our genetic make-up contributes to high cholesterol. When our bodies make too much cholesterol we may need medication to reduce its production or to speed its elimination. Compared to the damage cholesterol causes, these medications are safe and have been proven to reduce the risk of heart attack.

The bottom line for most people is to eat a variety of foods that include vegetables, fruits, lean meat and fish in quantities that maintain a normal body weight and to keep snacks and desserts as a small part of your diet. Finally, be sure to get your cholesterol checked regularly. Knowing our cholesterol counts can help all of us reduce our cholesterol and prevent heart disease.

For more information on cholesterol see: http://www.hmc.psu.edu/healthinfo/c/cholesterol.htm and http://www.hmc.psu.edu/cardiovascular/patient/articles/cholesterol.htm.

“Medical Minute” is a service of Penn State Newswire brought to you by John Messmer, M.D., a family physician, medical director of Penn State Milton S. Hershey Medical Center’s University Physician Group practice in Palmyra, and a 1977 graduate of Penn State College of Medicine. In 2002, Messmer was one of only 40 nominees statewide for the Family Physician of the Year Award, sponsored by the Pennsylvania Academy of Family Physicians.