Cholesterol: The Good, the Bad and the Awful!

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Cholesterol: The Good, the Bad and the Awful! JoAnn Guest May 09, 2003 16:27

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Cholesterol:

The Good, the Bad and the Awful

 

 

Cholesterol always gets a bad rap—and it should. But it's important

to understand that cholesterol is a fatty acid that is naturally

found in the brain, nerves, liver, blood and bile—and is needed to

build cell membranes, insulate nerves, produce vitamin D, hormones,

and bile acid for digestion. It even helps provide antioxidant

protection when your vitamin and mineral stores are low. Cholesterol

is so crucial, in fact, that each cell is equipped with the means to

synthesize its own membrane cholesterol, regulating the fluidity of

those membranes when they are too loose or too stiff.

 

Necessary for hormone production

 

The hormones, estrogen, progesterone and testosterone are

manufactured from cholesterol. Also, adrenal corticosteroid hormones,

which regulate water balance through the kidneys, and cortisone, the

anti-inflammatory hormone that also controls our stress response, all

come from cholesterol.

 

Normally, the liver makes all the cholesterol your body needs.

 

Problem is, because of our poor dietary habits and sedentary life

styles, we produce way too much cholesterol …

which increases our risk of cardiovascular disease, heart attack and

stroke.

Also, some people have a genetic disposition to high cholesterol levels.

 

 

A cholesterol primer

 

Cholesterol is carried in blood in the form of substances called

lipoproteins.

 

Cardiovascular risk can be assessed by measuring total

blood cholesterol, as well as the proportions of the different types

of lipoproteins.

 

1) Total cholesterol is the most common measure of blood cholesterol

and the only number many people get from their doctor.

Cholesterol is measured in milligrams per deciliter (mg/dL) of blood. A

total cholesterol reading less than 200 mg/dL means a lower risk of

heart disease, which everyone should try to attain. (Although

cholesterol is not the only marker for heart disease risk. 200-239 is

borderline high cholesterol, and 240 and over is high cholesterol.

 

Lipoproteins

 

2) HDL cholesterol, the " good " cholesterol, helps carry LDL cholesterol

out of the body, including cholesterol deposited inside blood

vessels, where it may block the flow of blood.

 

If there is too much

cholesterol for the HDLs to pick up, or an inadequate supply of HDLs,

cholesterol may aggregate into plaque groups that block arteries.

 

Those blockages are the main cause of heart attacks. Remember that

higher is healthier. A reading of less than 40 is low, at or greater

than 60 is high, and having a level of 60 or greater is considered

a " negative' risk factor that can offset another risk factor.

 

3) LDL cholesterol, the " bad " cholesterol, hauls cholesterol from the

liver to all cells in the body. Remember that lower is healthier.

 

A reading of less than 100 is optimal; 100-129 is near or above

optimal; 130-159, borderline high; 160-189, high; 190 or great is

very high.

 

Rule of thumb:

 

You want to raise your HDL and lower your LDL.

 

 

4) Triglycerides make up most of the body's fat, and are the

storehouse for energy. Edible oils from seeds and animal

fats also are composed mainly of triglycerides.

 

They may not be as corrosive as LDL, but excess triglycerides

exacerbate heart disease

potential when they oxidize and damage artery linings or induce blood

cells to clump. A reading of under 100 is optimal; under 200 is normal;

200-400 is borderline high; over 400 is high.

 

When high triglycerides and low HDL occur together, risk of

cardiovascular disease, high blood pressure, heart and kidney failure

and other degenerative diseases increase.

 

In fact, another up-and-coming index of heart disease risk is your

triglyceride-to-HDL ratio. A ratio of less than 2 is considered good.

 

The best ways to lower your triglyceride levels are:

 

1) to reduce your intake of simple carbohydrates, especially sugar and

starchy foods and 2) to take a high-quality fish oil product.

 

The new cholesterol guidelines

 

In May 2001 27 of America's top cholesterol experts issued new

guidelines. This is only the second time the National Institutes of

Health has revised its guidelines for preventing heart disease. Here

are the highlights:

 

• While artery-clogging, low-density lipoproteins are still

considered the chief target for diet and therapy, the report from the

National Cholesterol Education Program established new parameters for

HDL cholesterol.

 

Any HDL level below 40, rather than 35, is now

considered low. This sets up a new risk-assessment regime for

everyone starting at age 20.

 

• A complete lipoprotein profile should be done every five years,

beginning at age 20. This covers total LDL, HDL and triglycerides.

 

• Reduce saturated fat intake to less than 7% of total calories and

cholesterol intake to less than 200 mg a day.

 

Add more vegetables and 10-25 grams of soluble fiber to your diet

(fruits, vegetables, whole grains and beans). Exercise regularly, and

reduce weight. Men should

keep their waistlines smaller than 40 inches, and women smaller than

35.

 

• People with diabetes who do not have heart disease are in the same

high-risk category as those who already have heart disease

 

" Studies show conclusively that lowering the level of LDL the " bad "

cholesterol, " can reduce the short-term risk for heart disease by as

much as 40%. Treatment may lower risk over the long term, beyond 10

years, even more. "

 

Dr. Claude Lenfant, director of theNational Heart, Lung and Blood

Institute

 

 

According to NDS Health, a health-care information services company

based in Atlanta, more than 110 million prescriptions were written

for statin drugs in 2001.

 

But they're expensive … and they're not

without risk.

 

The hidden side effects of cholesterol-lowering drugs

 

Unfortunately, like most pharmaceuticals, these drugs usually have

side effects. The symptoms vary depending on what type of cholesterol

drug is being taken, but they include:

 

 

• Hot flashes

 

• Nausea

 

• Allergic reaction (skin rashes)

 

• Heartburn

 

• Dizziness

 

• Abdominal pain

 

• Constipation

 

• Decreased sexual desire

 

• Vomiting

 

• Diarrhea

 

• Indigestion

 

• Gas

 

• Peptic ulcers

 

• Gout

 

• High blood sugar

 

• Bloating

 

• Cholesterol gallstones

 

 

In addition to the above side effects, some drugs may carry the risk

of serious side effects, such as:

 

• Rhabdomyolysis - a muscle condition that can cause kidney failure

 

• Muscle pain or weakness

 

• Liver abnormalities 2

 

 

 

How do statins work?

 

Statins all work by the same mechanism: they inhibit a liver enzyme

called HMG CoA reductase that enables the liver to make cholesterol.

 

 

The liver is the body's main source of cholesterol. But when the

liver can not make its own, it removes cholesterol from the blood to

fulfill your body's other needs for cholesterol, as previously

described (see " Necessary for hormone production " ). Ideally, blood

levels of cholesterol decrease, which reduces the tendency for

arteries to become clogged with fatty deposits.

 

Statin Hazard

 

 

In a clinical advisory issued recently, the American College of

Cardiology, the American Heart Association and the National Heart,

Lung and Blood warned doctors about possible serious adverse effects

and factors that could

 

increase the risk of statin-caused muscle

disorders.

 

In fact, in January 2002 Bayer Pharmaceutical announced that its

cholesterol drug *Baycol* has been linked to approximately

 

100 deaths

 

since its withdrawal from the market in August 2001, and Baycol was

recalled after it was linked to about 40 deaths in the US. Bayer is

currently facing several lawsuits from patients who were injured

while taking the drug. 3

 

New York Times health writer Jane E. Brody recently reported

(December 10, 2002) that last summer an 82-year-old Kansas woman died as

a result of an undetected muscle disease caused by the statin she

had been taking for years to control her cholesterol.

 

During the entire time she was taking it, the woman had muscle pains

that doctors never attributed to the drug.

 

" She even had a shoulder operation, which did nothing, of course, to

cure the

 

drug-induced pain

 

that might have been correctly diagnosed through a simple blood

test, " wrote Brody.

 

" Then she was mistreated with an anti-fungal

agent for skin lesions that actually resulted,

 

not from a fungus, but from the muscle breakdown caused by the drug. "

 

It's been shown that when anti-fungals are combined with statins,

they can greatly increase the risk and severity of muscle

disorders.

 

" Within three months, the woman's condition worsened and

she became so weak she could not stand or breathe on her own. Two

weeks later, she was dead, " reported Brody.

 

Public Citizen Calls for Stronger Warnings on Statins

 

Statins may also cause a liver disorder in about one percent of

patients.

 

Public Citizen, a consumer advocacy group, has petitioned

the FDA for stronger warnings on all statin drugs in the wake of the

August 2001 recall of Baycol.

 

The petition asks the FDA to include a

warning that muscle pain or weakness can lead to muscle damage.

 

What's wrong with this picture?

 

Consider this metaphor: You're flying an airplane and one of the

meters indicates that the airplane is going down rapidly and that

you're going to plunge to the ground in minutes.

 

You pull out your

handgun and shoot the meter, destroying not only the meter but

causing damage to other electrical equipment.

 

There! Problem solved,

right? Obviously not.

 

The situation with statin drugs is strikingly similar yet apparently

this isn't obvious to the conventional medical system.

 

Cholesterol is just a risk factor, one of many. Sure, you'd like to see

that high reading come down, but – and here is the most important

message of

this article – you want that reading to come down for the right

reasons.

 

You want your cholesterol to come down as a result of an

overall improvement in your health.

 

 

References:

 

Vella, C.A., Kravitz, L., & Janot, J.M. (2001). A review of the

impact of exercise on cholesterol levels. IDEA Health & Fitness

Source, 19, 10, p. 48. Retrieved March 26, 2002 from Expanded

Academic ASAP.

 

Lane, Jane, " Cholesterol Conundrum, " Energy Times Feb. 1999, pg. 53.

 

 

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