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Cholesterol Facts You Should Know
10 Ways to Control Your Cholesterol
Cholesterol Content in Common Foods
Counting Cholesterol Numbers - What They Mean?
Controlling Kids' Cholesterol

Since you will see the word "cholesterol" on just about every food package you buy, it's important to know what it is, what it does, and how much is safe.

What cholesterol is. Cholesterol is not a fat. Biochemically it's called a "sterol." It contains no calories, so the body cannot derive any energy from it. Cholesterol forms an integral part of the cell membranes throughout your body, sort of like the mortar that holds the brick wall together. It is particularly important in the cellular structure of the brain and central nervous system, and is an important component of the myelin sheath that provides insulation to the nerves. The body uses cholesterol to make bile acids, which are necessary for proper food digestion. It's also a vital part of adrenal and sex hormones (estrogen, progesterone, testosterone), and it helps the body manufacture vitamin D.

Only the cell membranes of animal tissue contain cholesterol. Cell membranes of plants are composed of fiber, not cholesterol. When you see "no cholesterol" on a package of fruit, vegetables, grains, or even vegetable oil, don't believe that the manufacturer has done you a favor by removing the cholesterol. There was no cholesterol in these foods to begin with. While cholesterol is essential to life, the body makes all the cholesterol it needs. You can live quite well, even better, with eating little or no cholesterol.

What cholesterol does. Cholesterol enters the body from saturated fats in animal sources, such as meat, poultry, egg yolks, liver, butter, cheese, and other dairy products. The cholesterol goes to the liver where it joins the cholesterol that is made there. The cholesterol is transported from the liver to the cells by low density lipoproteins (LDL), which acts like a nutritional ferry boat, loading up the cholesterol and navigating through the bloodstream, stopping at cells and depositing cholesterol to the cells that need it. If a cell already has enough cholesterol, it "refuses delivery" of the cholesterol cargo. The excess LDL stays in the blood where the cholesterol is deposited in the walls of arteries, causing atherosclerotic plaque. The more plaque that builds up, the narrower the arteries become, until eventually the blood supply to vital organs is reduced. This is why LDLs are known as the "bad cholesterol."*

But take heart, a nutritional rescuer is also present in the bloodstream, the high density lipoproteins, or HDLs. These are known as "good cholesterol," since they travel like a vacuum cleaner through the bloodstream, picking up excess cholesterol in the bloodstream, and also possibly sucking the cholesterol from the fat-laden plaques. The HDLs carry this excess cholesterol back to the liver, which converts it to bile, which is eliminated into the intestines. How your liver handles cholesterol is determined primarily by genetics, and secondarily by your diet.

While this is an oversimplification of a complicated biochemical process, it helps us understand two conclusions:

• Any diet that raises cholesterol and LDLs and/or lowers HDL is bad.
• Any diet that lowers cholesterol and/or raises HDL is good.

NUTRIMINDER To remember which cholesterol is "good" and which is "bad," think of LDL as "lousy" cholesterol, and HDL as "healthy" cholesterol. As a further reminder, "lousy fats," the ones that are saturated or hydrogenated, contribute to lousy cholesterol.

How much cholesterol do you need? If your body has just the right amount of cholesterol, HDL, and LDL, it is in cholesterol balance. But how much is the right amount?

Homemade versus dietary cholesterol. For most people, about eighty percent of the cholesterol in their blood is made by their own body, with the rest coming from their diet. In fact, your body needs cholesterol so much that it makes around 3,000 milligrams per day that's ten times the maximum recommendation for daily dietary cholesterol. It is estimated that around thirty percent of people are sensitive to the cholesterol-raising effects of dietary cholesterol. Normally, when a healthy person eats high cholesterol foods, the liver reduces its own cholesterol production to keep blood cholesterol at a healthy level. In cholesterol-sensitive individuals, this internal monitoring mechanism doesn't operate, so that their blood cholesterol level goes up when they eat high-cholesterol foods.

One theory that explains cholesterol sensitivity is humans are by nature vegetarians. Originally, human bodies were not genetically equipped to metabolize dietary cholesterol, since plants are cholesterol-free. As the human diet began to include animal products, some people's bodies developed metabolic ways to dispose of excess cholesterol and some didn't. People who descended from the ones that didn't adapt are the cholesterol-sensitive ones.

Gender differences of cholesterol. Women tend to have higher levels of HDL than men, since female sex hormones release HDL and male sex hormones lower HDL. At menopause, estrogen production drops, and so does HDL. Just another mid-life biochemical quirk that should stimulate menopausal-age women to start an HDL-raising exercise program.

With every one percent reduction of total blood cholesterol, there is about a two percent reduction in the risk of heart attack. Getting your total cholesterol down and your HDL, or good cholesterol, up is good medicine. Here's what you can do to control your cholesterol.

1. Eat less fat. Keep your total daily fat intake below 20 percent of your daily calories. If you average 2,250 calories a day, eat no more than 450 calories from fat, or 50 grams of fat (there are 9 calories per gram of fat).

NUTRITIP: How Much Cholesterol Every Day? The American Heart Association recommends that people keep their total daily cholesterol intake under 300 milligrams.

2. Eat the right fats. Eat foods that are low in saturated fats, that contain mostly monounsaturated fats, and that are high in essential fatty acids. This means eating fats from seafood and plant sources. Minimize foods of animal origin, which are high in saturated fats. Keep your saturated fats to less than ten percent (better is seven percent) of your total daily calories.

Get used to checking the package label for grams of saturated fat per serving. Avoid "hydrogenated" or "partially hydrogenated" oils and shortenings. New insights into the fatty food/heart disease correlation reveal that the amount of saturated fats and hydrogenated fats in a food may actually do more harm to the fats in your blood than the cholesterol in the food. The trans fatty acids in hydrogenated fats do all kinds of bad things to blood fats, such as: increase LDL (bad) cholesterol, decrease HDL (good) cholesterol, increase triglycerides, and increase lipoprotein A - the blood fat that contributes to plaques in the arteries. Look for labels that claim "contains no saturated fats" or "contains no hydrogenated oils."

Eat more fish that contain omega 3 fatty acids (coldwater fish: seabass, salmon and albacore tuna), which help lower blood fat levels and reduce the risk of blood clots, which can clog arteries and cause strokes and heart attacks. Replacing saturated fats in your diet with unsaturated ones (for example, vegetable and fish oils) can reduce blood LDL levels. Yet, a diet that is too high in polyunsaturated fat (more than 10 percent of daily calories) can suppress production of HDL. Choose monounsaturated fats instead, such as olive oil, canola oil, and nut oils. These monounsaturated fats do not lower HDL levels.

3. Cut cholesterol-containing foods. Too much cholesterol in the diet increases the number of LDLs, the bad cholesterol. As we said above, cholesterol is found only in animal products, not plant foods. Therefore, eating less animal foods and more plant foods will lower the blood cholesterol. While eating lean beef and peeling the skin off chicken reduces the cholesterol in these foods, there is still cholesterol and saturated fat within even lean meat and poultry. Organ meat (such as liver) is particularly loaded with cholesterol. (Making cholesterol is the liver's job.) Lean beef, lean lamb, and lean chicken are all about the same in the amount of cholesterol they contain. Egg yolks, milk fat, and shellfish (shrimp and lobster) are high in cholesterol. Other oily fish (such as salmon and tuna) are much lower in cholesterol. White-fleshed fish tend to be the lowest in saturated fat.

While your goal may be to raise the good cholesterol, you can't get "good cholesterol" directly from foods. If you already have a high cholesterol, temporarily switching to a vegetarian diet (with fish and non-fat dairy products, such as yogurt) may help lower your levels quickly. Persons who go on a vegetarian diet and reduce their fat intake by 26 percent have shown a significant drop in blood cholesterol levels in just six weeks. One study showed that switching from whole milk to nonfat milk lowered the total cholesterol of people in the study by seven percent and the LDL (bad) cholesterol by eleven percent after six weeks.

NUTRITIP: Overweight Cholesterol We think of fatty foods as the cause of high cholesterol, yet eating more calories than we need from any food (fats or carbohydrates) can raise blood cholesterol, since being overweight itself raises blood cholesterol and increases the risk for heart disease. So, controlling your intake of all foods is important in controlling your cholesterol.

4. Eat cholesterol-lowering foods. Besides avoiding cholesterol-containing foods, plant foods actually lower blood cholesterol. Plant foods have chemicals in them called sterols which, like cholesterol, hold the cell membranes together. By a fortunate biochemical quirk, plant sterols are not absorbed through the intestines and into the bloodstream, but they do decrease the absorption of sterols (cholesterol) in animal foods. The following are some plant foods that lower blood cholesterol.

• Soy protein. Switch from sirloin to soy. Replacing animal protein with soy protein reduces blood cholesterol levels, even when the total amount of fat in the diet remains the same. A recent review of 38 studies concluded that eating soy protein lowered blood cholesterol by an average of 32 milligrams (9 percent), LDL cholesterol by 22 milligrams (13 percent), and triglyceride (total fats) concentrations by ten percent. As an added perk, the HDL cholesterol increased a bit. Soy protein worked best in people who needed it most. While the amount of soy protein it takes to lower your cholesterol varies considerably among individuals, as a general guide, if half of your daily protein comes from soy (between 30 and 40 grams of soy protein a day), you should notice the cholesterol-lowering effect. This can be accomplished by simply changing from cow's milk to soy milk, meat to soy substitutes, or from dairy products to tofu. As an added health benefit, soy products contain phytonutrients called "isoflavones," which reduce the risk of some cancers.

• Fiber. Soluble fiber slows the absorption of the cholesterol from animal foods and acts as an intestinal broom to sweep the cholesterol out. Top-billing for research-backed, cholesterol-lowering effects of fiber goes to oatbran . Eating one to two ounces a day (30-60 grams) along with a lowfat, low cholesterol diet can reduce blood cholesterol by ten to fifteen percent. Similar benefits can be obtained from other soluble fiber-rich foods, such as beans, cruciferous vegetables, apricots, prunes, and a super-soluble fiber-rich food, psyllium, a bran-like grain which has been shown to lower cholesterol by fifteen percent within two to four months, after eating an average of ten grams (three tsp.) per day.

  NUTRITIP: Can Yogurt Lower Cholesterol? While medical studies are inconclusive about whether or not yogurt lowers cholesterol, there is some experimental evidence to suggest that byproducts of lactobacilli fermentation (which is what turns milk into yogurt) inhibit the body's ability to make cholesterol. Obviously, the cholesterol-lowering effect was greatest with non-fat yogurt. The most striking results were seen in experiments on swine. Since these animals seem to metabolize cholesterol similar to humans, it is possible that yogurt may lower cholesterol in humans, too.

• Nuts. A recent study showed that volunteers who got 30 percent of their daily calories from fat, yet got two thirds of this fat from walnuts lower their cholesterol by twelve percent within four weeks. The cholesterol lowering effect of nuts was thought to be due to the combination of fiber, B- vitamins, and vitamin E, and to the fact that these fats are primarily unsaturated ones. Yet, don't go too nutty. Since nuts are high in fat, it's important not to eat too many.

• Garlic. The jury is still out on whether or not garlic will lower your cholesterol. Powdered garlic supplements probably will not. Eating one clove of garlic per day may. Watch the medical news for a garlic update. Until then, stick to the proven cholesterol-lowering foods, soy and fiber, and eat garlic because you enjoy it.

• Alcohol. You may also read that 1 to 2 alcoholic drinks a day can raise HDL cholesterol. Yet, similar to garlic, the jury is still out on whether the HDL-raising effect is significant enough to lower the risk of heart disease and to outweigh the potentially harmful effects of alcohol abuse.

NUTRITIP: Read the Fine Print While some foods boast "cholesterol-free" on the front of the package, the fine print on the back tells you they are full of saturated and fake fats. Highly saturated tropical oils, such as palm kernel oil, may have a worse effect on cholesterol levels than foods that contain cholesterol. Hydrogenated fats will also push cholesterol levels higher. Some cereals, for example, may be labeled "cholesterol-free" on the front of the package, yet if you read the fine print these contain hydrogenated tropical oils.

5. Get lean. Trimming excess body fat can increase the levels of good cholesterol (HDL). It is not only excess body fat that influences cholesterol levels, it's where you carry it. Studies show that men who carry excess fat around the middle (a body type we refer to as "apples") are at a higher risk of coronary artery disease than those who carry excess weight around the hips and buttocks ("pears"). Research has shown that apple-shaped people should pay even more attention to staying lean through a combination of exercise and a lowfat diet. Being over-fat increases LDL and decreases HDL, just the reverse of what you want, and this effect seems to be more aggravated in "apples" rather than "pears."

6. Exercise. Aerobic exercise (the kind that gets your heart rate up) raises the level of HDL cholesterol and may also reduce the level of LDL. In fact, since there is no such thing as eating foods high in HDL cholesterol, the only two ways you can raise HDL cholesterol is by exercising and reducing your body fat. Exercise is one of the few cholesterol-lowering activities that accomplish all three goals: lowering total cholesterol, raising HDLs, and lowering LDLs. Exercise stimulates the body to manufacture more HDL. The cholesterol level of athletes is much lower than that of sedentary individuals.

NUTRITIP: Is Cholesterol Really the Cardiac Culprit? The healthcare industry has built a whole cardiovascular complex (almost a religion) around heart disease and cholesterol, and certainly experimental evidence seems to indicate that there is a cause-and-effect relationship between high cholesterol diets and a high incidence of heart disease. Yet, other factors may be involved. Is it really the cholesterol in the food that causes problems, or could there be something else present (or absent) in high cholesterol foods that affects heart disease? Why do plant-food-eaters have lower cholesterol than animal-food-eaters? While the obvious answer is that plant food doesn't contain cholesterol and animal food does, could there be another explanation? Plant foods are high in phytonutrients and antioxidants, such as vitamin C, and fiber. Meat, on the other hand, is low in vitamin C and fiber. Our belief is that while it's easier to blame heart disease on the one chemical-cholesterol-the connection is more complex. Switching from a primarily animal-based diet to one based on plant and seafood sources may be just what the heart doctor ordered.

7. Relax. Stress releases stress hormones, such as adrenaline, which can elevate blood cholesterol levels. A daily relaxation program, such as meditation, deep-breathings or mental imagery can lower blood cholesterol.

8. Graze. Grazing on many mini meals throughout the day rather than eating three big meals can lower cholesterol. In studies comparing frequent snackers to three-meal-a-day eaters, the grazers had lower cholesterol.

9. Don't smoke. Smoking makes everything that's bad for the heart worse.

10. Raise low cholesterol kids. Children who grow up with a plant and seafood-based diet rather than one high in animal-based foods are more likely to grow up with healthier hearts.

Here are some of the more common cholesterol-containing foods:

FOOD	CHOLESTEROL (milligrams)
Human milk	32 (varies)
Meats (3 ounces) Liver Lean ground beef, lamb, chicken breast, pork	400-500 78
Egg, whole or egg yolk (1 large)	213
Fish (3 ounces): Shrimp Lobster Mackerel Salmon Catfish Tuna Crab Snapper Cod Halibut Clams Orange roughy	130-166 81 62 47-60 49 42-50 36-50 40 37 35 29 17
Dairy products: Milk (1 cup) nonfat 1 percent 2 percent whole (3.3-3.7 percent) Yogurt (1 cup): nonfat lowfat whole Cheese (1 ounce): cheddar cheddar, lowfat Cottage cheese (1/2 cup) nonfat 1 percent fat 2 percent fat Butter (1 tbs.)	<5 10 18 33-35 <5 15 29 30 6 10 10 15 10

Note: Recommended maximum daily cholesterol allowance: less than 300 milligrams per day. There is no RDA minimum for cholesterol. Since your body makes all it needs, it's not essential that you eat any.

Here are some cholesterol numbers you should know in case your doctor presents them to you and you wonder what they mean:

Total cholesterol