Cholesterol — the myths and the facts
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Your cholesterol matters. In fact, it’s so important that the Centers for Disease Control have designated September as National Cholesterol Education Month.
Cholesterol levels are health concern whose lingo — HDL, LDL, triglycerides — and complicated scoring system send most of us running for a calming salty margarita or slice of coconut cream pie.
Perhaps the biggest myth surrounding this health concern is that children have no worries about their cholesterol and heart health, and that only adults need worry.
The truth of the matter is that coronary artery disease is a pediatric disease, since the risk factors start in childhood. Indeed, between one in every 200 to one in every 500 Americans inherit sky-high cholesterol levels of 250 mg/dL to 600 mg/dL, which increases the risk of a heart attack in one’s forties or earlier if left untreated.
Children ages 9-11 should be screened at least once for elevated cholesterol levels, and even starting at age 2, if their families have histories of high cholesterol or heart disease. That means children should be screened early if one or both parents has/have a total 240 cholesterol level or if a male relative has had a major heart problem, such as bypass surgery, before age 55, and a female relative has had heart disease before age 65.
That’s the recommendation that the American Academy of Pediatrics and the National Heart, Lung and Blood Institute published in 2011 — a guideline developed partly by Dr. Irwin Benuck, division head for community pediatrics at Lurie Children’s Hospital and professor of pediatrics at Northwestern University’s Feinberg School of Medicine.
Lurie is one of several hospitals in the Chicago area, including Loyola and Cook County Health and Hospitals System, that test children and help them change their lifestyles so they exercise regularly, eat healthier, smaller portions and, when necessary, take medication to control their risks.
Cardiology specialists at Chicago’s major hospitals offer these other myths and facts surrounding cholesterol and heart disease risks:
MYTH: Cholesterol is the single most important factor in a person’s heart-attack risk. It’s all bad.
FACT: Your body needs some cholesterol because, according to Dr. Evan Stein, who runs the lipid clinic at the University of Chicago Medicine’s Hyde Park campus, it’s an essential building block — part of the wall of every cell. It’s vital so your body can generate hormones, Vitamin D and substances that help digest food.
It’s bad when you have too much cholesterol in your bloodstream and it builds up on your arteries’ walls. People at risk of heart disease can have a combination of 14 risk factors, including smoking cigarettes, having diabetes, high blood pressure and/or a family history of heart disease, being obese and sedentary and having inflammatory diseases like rheumatoid arthritis.
MYTH: If you feel good and have no obvious problems — no chest pain, no shortness of breath — you’re OK.
FACT: Many patients first find out that they’re at risk when they have a heart attack, said Dr. Khaled Dajani, associate professor of medicine in the cardiology division at Loyola University Medical Center and medical director at Loyola’s Cardiac Prevention and Lipid Clinic. “Your health is priceless,” Dajani said. “It’s better to get an assessment of your overall cardiovascular health.”
MYTH: Figuring out “good” (HDL) cholesterol from “bad” (LDL), combined with triglycerides, is too overwhelming to figure out.
FACT: Stein, of U of C, says just think of HDL as “the H stands for happy” and LDL as “the L stands for lousy.” It’s essential to get your blood tested to get those numbers because that’s how you can prevent a potential heart attack and stroke. Doctors can quickly calculate your risks on their computers based on HDL and LDL cholesterol and the other risk factors, such as age, smoking, diabetes or having high blood pressure.
MYTH: Women are at less risk of heart attack than are men.
FACT: Women catch up with men in their risk of having a heart attack when they go into menopause. That’s because women transitioning into menopause experience a sharp drop in estrogen, a heart-protecting protein, and go through changes in body fat that may lead to greater inflammation. In fact, over 50 percent of women will die of stroke or heart attack from cardiovascular disease.
MYTH: All fats are bad when it comes to cholesterol.
FACT: Three types of fats play very different roles in contributing to high cholesterol, said Dr. Mark Loafman, chair of family and community medicine at Cook County Health and Hospitals System.
Trans fats and saturated fats are no-nos. Trans fats are found in cookies, crackers, pies, cake, doughnuts and other highly processed, sugary foods.
Saturated fats are found in cream, lard, cheese, butter, potato chips, candy bars, processed meats, and coconut and palm kernel oil. The good kind of fats — unsaturated — come primarily from plant foods, such as avocado, olives, nuts and seeds. Examples include vegetable oils such as olive, peanut, safflower, sunflower, soybean and corn.
“They’re easy to read on a [food] label,” Loafman said.
“In fact, human evolution shows that only in the past 30 to 40 years have we eaten meat on a daily basis,” Loyola’s Dajani said. “It used to be a luxury, something you’d eat on a special occasion — and certainly not for breakfast, lunch and dinner.”
Dajani recommends eating meat only on weekends or special occasions. For those who can’t resist, he suggests limiting meat consumption to two ounces or 50 grams a day.
MYTH: Eggs are deadly.
FACT: Go ahead and eat “the bare naked egg” — with or without the yolk — but say ‘no’ to the bacon, bread, butter and sauces, said Dr. Samuel Grief, professor of clinical family medicine at the University of Illinois at Chicago.
“Eggs have 100-200 milligrams of cholesterol per egg or yolk (if it’s a single yolk),” Grief said. “That amount of cholesterol doesn’t have a lot of bearing on the amount of cholesterol in your blood.”
MYTH: Set aside a big portion of your budget to buy medications, supplements or protein shakes in hopes of lowering your cholesterol.
FACT: Save your money. “We suggest, for the most part, people use the money to buy healthy foods, like fruits and vegetables,” Loafman said.
Dajani said that “jumping right into taking medication as an aggressive treatment” for high cholesterol is a mistaken assumption.
“Diet and exercise play a big role,” he said.
On the other hand, cholesterol-lowering statin drugs may be an appropriate treatment for some, and their benefits can outweigh theoretical risks of causing dementia or diabetes, Dajani said.
MYTH: Vaping is a safe substitute for cigarette smoking and won’t affect your heart.
FACT: The new wave of vaping, like smoking, increases the incidence of heart disease.
MYTH: There’s no difference in the kinds of exercise you do to maintain heart health.
FACT: You need to sweat and get your heart rate up.
“You want to have an aerobic impact so you’re a little short of breath — unable to speak in complete sentences,” Loafman said. Or, as UIC’s Grief put it, “If you take it easy, even if you’re moving, chances are it’s not doing that much.”
Finally, seek stress relief so you can look at healthy choices as rewards — feeling proud of yourself — rather than as punishment, the doctors said.
Sandra Guy is a local freelance writer.