February 10, 2021
Heart disease is the most common cause of death in America. Last year alone over 675,000 Americans died from heart related problems. A major contributor to heart disease is the molecule known as cholesterol. Cholesterol is a critically important molecule that helps your body make sex hormones, numerous tissues and vitamin D. In fact, your liver typically makes a large amount of cholesterol for use by the body. A second major source of cholesterol is diet. The building blocks of cholesterol are found in a variety of foods. Most of these are various types of fats.
So if cholesterol is so useful, why has it become so vilified? Cholesterol circulates in our blood stream. When levels become too high, they can combine with other substances in the blood to form plaques. These plaques can stick to the side of arteries, causing them to become less flexible. The medical term for this is atherosclerosis, but it is commonly known as “hardening of the arteries”. Worse, these plaques can form in arteries that supply oxygenated blood to critical organs such as the heart and brain. When these plaques break off from the side of the artery, they can travel downstream and cause a blockage to part of the heart or brain. This results in either a heart attack or a stroke.
There are two major types of cholesterol. These are classified on the type of fatty molecules within the cholesterol. LDL cholesterol (which stands for low density lipoprotein) is the type of cholesterol that is associated with increased heart disease. It typically can become part of plagues in the arteries and cause blockages. HDL cholesterol (which stands for high density lipoprotein) is the healthy type of cholesterol. It usually does not form plaques in the arteries. In fact, it has been shown to carry bad LDL cholesterol away from plaques already formed. I tell my patients that LDL is “lousy” cholesterol, while HDL is “healthy” cholesterol.
Your cholesterol can be measured by a simple blood test. Ideally, it is taken when you have been fasting for at least eight hours. You will be given several numbers: total cholesterol, LDL cholesterol, HDL cholesterol and a ratio of total to HDL. The most important numbers are LDL, HDL, and ratio. Current recommendations are that the LDL be below 100, and HDL be above 50. The ratio of total cholesterol divided by HDL should be less than 4. Note that we are no longer concerned with the total cholesterol value.
If you have high LDL cholesterol, the goal is to lower it, and there are a number of strategies that can lower the value. The first recommendation is to evaluate your diet. Foods high in certain types of fats, especially hydrogenated fats, contribute to high cholesterol values. But not all fats are bad! Fats that occur in non-processed foods are essential to our health. These include omega 3 fatty acids that are critical to our brain growth, and may help the heart as well. These are found in fatty fish such as wild salmon, and in plants such as flax seeds and chia. Fats from processed baked goods, meats and dairy products can be harmful to your heart health. Read the labels! Avoid foods containing hydrogenated fats. These are not natural, and can be harmful. Also avoid fats from certain vegetable oils such as corn. Safflower oil is a healthy alternative.
Other components of a heart healthy diet are fruits, vegetables, whole grains and non-processed meats. I advise all of my patients to eat non-processed foods as much as possible. Our modern western diet is high in processed foods, which have been shown in numerous studies to contribute to chronic diseases, including heart disease.
The other component to lowering your cholesterol is to maintain a healthy weight through exercise. Current recommendations are for a minimum of 150 minutes of moderate activity each week. Walking at a brisk pace is a great exercise. In some cases lifestyle changes alone may not affect cholesterol enough and a medication may need to be prescribed. It is always important to discuss your specific situation with your provider. Working with your provider to monitor and manage your cholesterol is an important part of overall heart health.
Dr. David Krainacker is a primary care physician at St. Peter’s Health Medical Group’s North Clinic. Dr. Krainacker is an avid gardener and a supporter of Helena Community Gardens and he is committed to ensuring everyone in our community has access to nutritious food. Each year, he cultivate plots at community gardens and donates the produce to Helena Food Share with his wife Nina and St. Peter’s Health volunteers. He is also certified in culinary medicine.