This post is about cholesterol, that familiar nutrient which has been so villanized that food labels are blessed with an aura of health by merely asserting its absence. Yet despite its villanous reputation, it is a nutrient essential to our bodies. Surprisingly, it is only weakly connected to eating foods that contain it. Watch out though, because by eating other kinds of foods it appears in our bodies in its most villanous forms. This post is concerned with cutting through the fog of misinformation about the true threats from cholesterol. A companion post coming next week, called Loving Your Heart – Most Only Get One, will review what each one of us can to do thwart this demonic Mr. Hyde from arising within our bodies; rather, let cholesterol arise within us in virtue and strength like the good Dr. Jekyll.

The results of cholesterol in its Mr. Hyde form are found in the statistics on heart disease. Although death rates from cardiovascular disease (CVD) have declined, heart disease is still the number one cause of death in the U.S. It appears that the overweight/obesity epidemic underwrites a considerable portion of the CVD; in addition to the resulting diabetes—another leading accelerator of CVD. The American Heart Association’s Heart Disease and Stroke Statistics – 2011 Update place the blame of the overweight/obesity on the increases in calories. They trace these extra calories primarily to greater average carbohydrate intake, in particular, on starches, refined grains, and sugars. In addition, they mention larger portion sizes, greater food quantity and calories per meal, increased consumption of sugar-sweetened beverages, snacks, commercially prepared (especially fast food) meals, and more energy-dense foods.

Don’t miss the fact that young and middle-aged Americans are having a dramatic increase in prevalence of strokes, even though the number of strokes is dropping in older people. Some are guessing that the obesity epidemic is beginning to shift the age burden of the disease. The point is that this is a big problem, for all of us; not just the elderly.

Now let me explain the metaphor of the evil Mr. Hyde, instead of the good Dr. Jekyll “arising in our bodies”. The topic of cholesterol is confusing, and I am seeking a way to explain it simply and clearly, and its relationship to heart disease. First, not much cholesterol comes as pre-made cholesterol from the food we eat. Although there is cholesterol in food, about 75% of the cholesterol in our blood is made by our own bodies, building it from the food that we eat. This is true whether or not these foods contain a lot of cholesterol to begin with. A diet high in saturated fats and trans fats tends to encourage the level of the LDL cholesterol (bad cholesterol) to “rise within us.” Trans fats are especially bad because they not only raise bad cholesterol but also lower HDL (good) cholesterol. The good high-density (HDL) cholesterol is responsible for carrying the bad cholesterol out of the body and protecting the arteries from a build up of plaque (cholesterol and other substances). Are you asking why our bodies make cholesterol, if it’s not good for our heart and blood system? The waxy substance, cholesterol is a very important and necessary component of our brain and cells. This function, and HDL function, is cholesterol in its good Dr. Jekyll role, the role intended for it. Unfortunately, many, many Americans are making way too much of the Mr. Hyde kind within their own bodies, and in this role, cholesterol can be enormously destructive.

Here is how the Mr. Hyde form of cholesterol in the blood (hypercholesterolemia) does its damage. The worst form is the large low-density lipoprotein cholesterol (LDL). It can combine with other substances and build up in the arteries – this is called atherosclerosis. The goop build-up, called plaque, makes our arteries resemble a corroded pipe – the space in the middle of the artery becomes smaller and makes the heart work really hard to pump blood. Often there are no symptoms of this silent building project; sometimes, the first sign is a heart attack (blood flow restricted or blocked to the heart) or a stroke (blood flow restricted or blocked to the brain). But it is fairly easy to learn if your body is making too much cholesterol or not – as simple as a trip to the doctor to have your blood tested.

About 25% of the cholesterol in our blood is from the cholesterol found in animal products we consume. It is only from animal products, not plants. So it comes from meat, cheese, eggs, and dairy products. It is better to give a wry chuckle, rather than be annoyed, that companies selling products like peanut butter and olive oil would print “cholesterol-free” on their labels. Olives and peanuts are plant products and have never contained cholesterol. We have spoken of many forms of nutritionism in these posts. This selling of the absence of nutrients with a bad reputation is a form that costs the food manufacturers nothing but the cost of two words on a label, but perhaps sells more of their products to those who think that “cholesterol free” means cholesterol has, by processing magic, been banished from the product. (At least 7up did not assume we were uniformed when they said, “caffeine free, never had it, never will”).

The story of the rise of the evil Mr. Hyde of bad cholesterol is tied in with triglycerides as well as with saturated and trans fats. Triglycerides are a third type of fat in the blood; it’s different from cholesterol, but is one of the major factors in metabolic syndrome, which drives diabetes and heart disease. Eating a diet high in simple carbohydrates can drive this problem. Think: juice, soda pop, refined grains (crackers, cookies, snack bars, breads, rolls, bagels, doughnuts, English muffins), croissants, and candy, for example. Also too much alcohol, being overweight, being inactive, and smoking can lead to having high triglycerides. The simple carbohydrates named above, eaten in excess, may also reduce the good HDL cholesterol. So there are two really good reasons to be careful with the simple carbohydrates.

Although genetics are involved with how efficiently we make cholesterol, there’s not much we can do about our genes. But there are steps that we can take to change our ratio of good and bad cholesterol and often even influence our total cholesterol. Even if our genes are designed to be efficient producers of cholesterol, we can often slow the process and contribute to an improved cholesterol profile by controlling our diet and exercising.

The essentials of this information about the Jekyll and Hyde of cholesterol has been known for a long time, but this knowledge has not been accepted widely until recently.  That is one reason so many people think foods with cholesterol are taboo, and avoiding them is enough. I was very fortunate to be a student of Roslyn B. Alfin-Slater Ph.D. and professors at UCLA School of Public Health in the 1980’s.  The reason that I feel so fortunate is that she and others at UCLA, who did research on fats and cholesterol, knew that the main problem with excess cholesterol in the blood was more a problem with too much saturated fat in the diet. She was really way ahead of other public health educators at that time. Now it is fairly commonly known, that it far more important to be careful in the intake of saturated fats, than to severely restrict the low-fat, but high cholesterol containing foods like eggs, shrimp, and other shell fish. Over the years, considerable research has verified Alfin-Slater’s work, and now, it is commonly known that most people only have a small response to eating high cholesterol-containing foods.

In addition, it is also now well known that the main concern in cholesterol problems is eating saturated fats and trans fats.  Frankly, I think the trans fats should be a fairly easy problem to solve. Trans fats are not found in natural foods, only those that are hydrogenated, so if we strive to stay away from processed foods, fast foods and restaurant foods, we can eliminate much of the trans fats. I do realize that it is a fairly costly problem to resolve, because the food processors and many restaurants and fast food establishments are having a difficult time giving up their cheap hydrogenated and partially hydrogenated fats. Even though they know that these fats are, essentially deadly, they also know that hydrogenating or partially hydrogenating fats makes the fats last for ages without becoming rancid. Moreover, they can be used to cook at really high temperatures without breaking down; so economically (short term vision) they are a real bargain. Note: I think this is short-term vision, because overall, we pay when we have to give medical care to those who end up with heart disease. Certainly, it is all of us who pay the long-term medical expenses; with insurance premiums and government taxes. But furthermore, many of us pay in years of pain, suffering, and loss of happy days and years of quality living.

Sources of saturated and trans fats include French fries and other fried foods (chips, doughnuts), many baked goods, cookies and crackers, stick margarine. In addition, full-fat milk and dairy products (especially hard cheeses), and meat are sources of saturated fat and cholesterol itself. These can be decreased in your diet by choosing fish, lower fat meats, beans and soy protein as alternatives to meats and cheeses. Soy protein has been shown to reduce the risk of heart disease, when used as a part of a diet otherwise low in saturated fat and cholesterol.  It doesn’t mean that you can never enjoy red meat again, but it does mean to eat meat sparingly and in much smaller portions. These alternatives can help you decrease the frequency of these foods in your diet. It has been known since the original Alaskan Inuit study, that fish offers a positive double whammy, with its omega-3 fatty acids, which can improve both cholesterol levels and triglyceride levels, and therefore, reduce heart disease.

The next post will go into much more detail on what we can do to prevent the evil Mr. Hyde forms of cholesterol from arising in our bodies, and encourage the kindly Dr. Jekyll kind instead. But I must say a few words about it here. It’s easy to replace at least two meals a week with fish, by making a tuna or salmon salad. I put the canned salmon directly on a mixed green salad and serve with a little hummus (Great! Add another cholesterol-lowering item, beans.) If everyone wants grilled steak this summer, could you try delicious grilled salmon or other firm fish? It’s really tasty with a little olive oil, lime or lemon, pepper, dill weed, fresh oregano or basil and a slight sprinkling of salt.

Of course a great diet works hand in hand with exercise to manage our weight, prevent or control diabetes, and manage cholesterol.  Mary Ireland addressed the physical activity issue in her blog called, Exercise Protects Against Disease.

For now, the first step toward preventing the evil Mr. Hyde cholesterol from arising in our bodies, and to encourage the good Dr Jekyll kind, is to understand them.  This has been my intent in this blog post.