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Cholesterol: Demystifying the Numbers By Herbert M. Goldberg, M.D., F.A.C.S.  Herbert M. Goldberg earned a B.S. in
Biological Sciences and an M.D. from the University of South Carolina Medical School in
1967. After completing a general surgery internship and residency at the University
of Wisconsin Medical School in Milwaukee, he spent two years in the U.S. Navy practicing
general surgery. He was a teaching fellow in plastic and reconstructive surgery and
resident at the University of South Carolina Medical School. Certified by the
American Board of Surgery and the American Board of Plastic and Reconstructive Surgery,
Dr. Goldberg was a Fellow in the American College of Surgeons. He was in private
practice in plastic and reconstructive surgery in Encino, California, has written for
national journals, and presented papers at local, regional and national conferences.
Since ending his practice two years ago, Herbert Goldberg has traveled extensively,
volunteering his services in Vietnam, Tanzania, Ecuador and Guatemala.
Research
on cholesterol, particularly its role in causing blood vessel obstruction, and the new
medications that can reduce cholesterol collectively, are among the major advances in
modern medicine and public health. But while there is much ado about cholesterol, there is
also much confusion. HDL good; LDL bad. What do the numbers mean, anyway? Here are some
basics that may help.
Cholesterol is a fatty, waxy substance produced in our bodies, mostly by the liver, from the food we ingest. We need cholesterol in our blood to produce many of the hormones which regulate body functions. However, like many good things, too much has been shown to be associated with cardiovascular and other diseases. Cholesterol is made up of several lipid (fatty) parts: mostly high density lipoproteins (HDL) and low density lipoproteins (LDL). Of these, HDL is considered to be "good" cholesterol, because HDL circulates in the blood, a pac-man-like scavenger, gobbling up the "bad" cholesterol. So a high level of HDL cholesterol is actually desirable and levels higher than 35 measured in the blood test are considered desirable. LDL is the so-called "bad" cholesterol and is the type associated with layering, plaqueing and obstructing arteries. LDL should be measured less than 130 to be considered normal. A blood test measuring total cholesterol as under 200 is desirable, up to 220 is "borderline" and above that level is probably worthy of treating with medication. When the level of cholesterol is high (<200), the condition is called hypercholesterolemia or hyperlipidemia (too much fat in the blood). It is estimated that as many as 2/3 of Americans have this condition! Blood cholesterol levels below 160 are thought to be good because the cholesterol deposits already existing on arteries can actually be reabsorbed, thus actually unclogging some vessels. Of course, very low levels of cholesterol might not be desirable, since some cholesterol is necessary in the blood for normal organ and muscle function. It may be helpful to think of blood vessels or arteries as highways running throughout the body, and the blood within the arteries as trucks delivering products to different homes or businesses, i.e. the organs. Should the highways or arteries become clogged or significantly blocked, the trucks or blood can no longer deliver the necessary substances (oxygen, energy products) to the vital organs including the heart. If arteries to the heart -- which are small to begin with -- become blocked, the heart muscle cannot get what it needs to function. It becomes weakened and may die. When enough heart muscle dies (a heart attack), it can fail and ultimately cause death. In the West, heart disease from artery obstruction is the major cause of disease and death. However, the same "hardening" or blockage of the arteries can happen to any organ or muscle in the body resulting in death of these important parts of the body. High blood pressure and strokes are other diseases associated with cholesterol deposits. Symptom-free Unfortunately, many of those suffering cholesterol buildup have no symptoms until late stages of disease when the flow to organs such as the heart becomes so poor that pain (angina) or other symptoms may develop. In many cases, there are no symptoms whatsoever until the blood flow becomes totally obstructed, leading to heart attack, stroke or sudden death. Cholesterol can begin depositing on artery walls as early as our teen years. Some people with excess cholesterol are congenitally predestined to develop this condition. Plaques or deposits of cholesterol, and calcium which adhere to it, build up over the years until the sheer volume of deposits block the flow. Women appear to have fewer problems with plaque until shortly after menopause, when, for reasons now yet known, they lose this advantage. Will lowering cholesterol levels to normal improve health? Most research suggests that the answer is an emphatic YES. Education then is the first important step. What are the factors which can cause high cholesterol and what can we do to alter these factors? Genetics, age, sex, diet, obesity, smoking, lack of exercise, excess alcohol consumption, high blood pressure control are the major factors in heart disease and of these we can do our best to modify our behavior so that we control our diet (what we eat and how much we eat), avoid smoking and excess alcohol, exercise more frequently and take medication if necessary to control blood pressure and cholesterol. While we can obtain some degree of protection by changing our lifestyle when necessary, despite our best efforts at this, we may still require the assistance of medication(s) to obtain the most control in preventing illness. Although there is controversy about what should be included or excluded from our diet, most evidence seems to indicate that maintaining normal weight, avoiding foods rich in saturated fats and eating more of fresh vegetables and fruits, yield benefits. Decreasing our intake of fatty foods such as fatty cuts or processed (luncheon) meats, whole milk, other dairy products such as cheeses and cream, butter, most margarine, ice cream, excess egg yolks, and fried foods, is important. Products to be avoided include those labeled "hydrogenated," which are high in saturated fat commonly associated with raising the level of blood cholesterol. Since most of us develop a taste and a preference for certain foods over a lifetime, and because certain foods are associated with well-being, it often requires a lifestyle change. Substituting chicken and fish for meat, skim milk for whole milk, frozen yogurt for ice cream, fruit or pretzels instead of donuts, potato chips or fries are some examples of changes which can be made. Another lifestyle change that is important but may require some time to properly implement is an exercise regimen. There is some evidence that the heart and muscles work more efficiently, blood flow increases to these organs and that cholesterol levels may even be slightly reduced by an adequate exercise program. Fitness usually means a program involving aerobic exercise such as jogging, biking, walking or swimming for at least 20-30 minutes, three or four times/week, stretching, and weight training. Learning to relax and be calm can improve general well being and may play a role in reducing blood pressure and heart disease. All of the methods mentioned require slow, incremental changes, often supervised by medical personnel. For some who are genetically disposed to plaque buildup, treatment with a class of drugs known as "statins" which have been shown to reduce "bad" cholesterol, may be necessary. Of course, there is no substitute for consultation with your physician to determine if you have high blood cholesterol, whether and what type of diet and exercises are important, and whether you should be using one of the "statin" medications, as well as their dosage and side effects. Our purpose here is to provide general information on a much-misunderstood subject. Perhaps someday we may be able to intervene in treating high cholesterol manifestations by genetic manipulation, but until then education about cholesterol -- what we can do to prevent and treat disease, and what modifications we can make to ensure a more productive and fruitful life -- is critical for a healthier society. Don't let high cholesterol cheat you out of precious moments of life! (The author wishes to thank Zorel Paritzky, M.D., Cardiology, for advice in compiling this work.) Home | True
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