A month to change your heart: Day 3

A typical cholesterol (or lipid) panel consists of four components:  a total cholesterol value, the LDL cholesterol, HDL cholesterol and triglyceride measurement.   How important are these numbers?  Here is what we know. 

LDL (low density lipoprotein) is the so-called “bad” cholesterol and it should be as low as possible. Recently, there has been controversy about how low that number should be, or even if we should target a specific number, but if you like to set goals, then aim for anything below 70 mg/dl.
HDL (high density lipoprotein) is the “good” cholesterol and it should be above 45 mg/dl.
Triglycerides should be below 150 mg/dl.  Checking a lipid panel is important, because it can help predict your risk of having a heart attack.

LDL transports cholesterol to your cells from your liver, and HDL picks up the extra cholesterol and helps rid the body of it.  Think of it as the body’s cholesterol garbage man.  HDL cholesterol is increased by exercise.  Unfortunately, although some medications can raise HDL cholesterol, such as niacin, there is no good evidence at this time that raising HDL levels with medication will help you live longer or prevent a heart attack. 

Abnormal cholesterol values can affect the lining of the blood vessels of the coronary arteries, which is called the endothelium.  Although often compared to plumbing or pipes, these vessels are not rigid and inflexible.    They are dynamic and can expand and contact. Our job is to keep these vessels flexible, and to do this, we need to prevent plaque from building up. This build up is also called atherosclerotic disease, and the plaque embeds itself into the lining of the arteries, irritating them, and can lead to heart attacks.

There is still another component of the lipid panel, called triglycerides that we will learn more about next week.

About 10-20% of people have genetically high LDL levels and no matter what kind of diet they might follow, their cholesterol levels will be too high.  Another 10% of people have genetically low cholesterol, and no matter what they eat, their numbers will always be perfect.  These people have won the cholesterol genetic lottery.  The rest of us, about 75-80% of the population, have cholesterol levels that vary depending on how we live – or mainly, how we eat.

Much of the LDL cholesterol in the blood comes from saturated fat — the kind found mainly in meat and dairy products. But our liver also produces cholesterol on its own, often much more cholesterol than we need in a typical day to help with cell function. A buildup of cholesterol and other substances- known as plaque- can form on the walls of our coronary arteries, leading to blockages.  There is evidence that this process occurs as early as our teenage years.   

Here is an example of how important it is to see if your own cholesterol can be changed by improving your diet:

Mary is a 66-year-old woman who comes from a large family.  She has six brothers, all with high cholesterol and taking statins to lower it.  Her LDL cholesterol is 165 mg/dl, she has been reluctant to take medications, and has never had a heart problem.  She has always assumed that her cholesterol was elevated because of her genetics and someday she would need a statin.  After following the Heathy Change of Heart Program for 12 weeks, she had repeat cholesterol levels checked.  Her LDL cholesterol was now 90 mg/dl, and her HDL cholesterol was 45 mg/dl.  She had lost 12 pounds, was exercising regularly, and felt great.  She did not have genetically elevated cholesterol numbers at all, but had been following a poor lifestyle.  It is important to point out that if she had been on a statin, her cholesterol numbers would have been just as good or better.  But, she would not have lost weight, or improved her overall heath in the same manner as she did by making these changes.

On the third day of Healthy Change of Heart, the doctor said to me:

  1. Know that just one fast-food meal can reduce the ability of your blood vessels to function normally for several hours, by irritating the endothelial lining of the vessels
  2. A heart rate monitor or tracker (like a FitBit) can help get you going, and monitor your progress
  3. Try a simple relaxation technique.  It is simple, and involves.slow, deep breathing. If you are stressed at work or during the day, try removing yourself from the situation, sit in a quiet room and shut the door.  Turn down the lights if you can, empty your mind of thoughts, and spend 5 or 10 minutes doing nothing but concentrating on taking deep breaths.  This can help settle you down, and get you ready for the rest of the day


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