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It's been 20 years since I completed the Ironman Triathlon. Now my Olympic dreams have given way to the nightmare of paying for my kids education. Still, I workout regularly, eat well and almost fit into the jeans I wore in the '80s. So'

How Could I Possibly Have A Cholesterol Problem?

Since I'm your doctor, I'm a little embarrassed to reveal my cholesterol numbers. But if we're going to beat it together-here they are:

'My total cholesterol is 213 (not terrible, since the goal for total cholesterol is below 200).
'My LDL (low density aka bad cholesterol) is 155. The ideal for bad cholesterol is below 130 (100 if you have heart problems). LDL, cholesterol's evil step brother, got its bad reputation by filling your arteries with fat causing high blood pressure, heart attacks, strokes and dementia. The LDL may be the single most important number we measure.
'My HDL (good cholesterol) is 55. HDL should stay over 45 for men and 55 for women. The higher the better since HDLs remove the fatty plaques from your arteries and brings them to the liver for elimination

The ratio of total cholesterol to HDL is important to measure. It tells us the amount of fatty material floating around in comparison to the amount being removed. The ideal ratio is 3.5 or less. So if my HDL is 55, to have an ideal cholesterol to HDL ratio of 3.5, my total cholesterol has to be 192 or less (your HDL x 3.5 = the highest total cholesterol you can have and still be ideal.) Try it out'plug in your HDL, multiply it by 3.5 and see if your cholesterol is out of balance.

All Men May Be Created Equal, But All Fats Aren't

The leading causes of death in the U.S. are heart attacks, cancer and strokes. These diseases all have one thing in common; they are all related to the type of fat we eat. Notice that I didn't say the amount of fat. That's not nearly as important (although obesity is!).

Some fats actually improve our health. They correct our cholesterol balance, prevent heart attacks, reduce the chance of stroke and prevent inflammatory diseases such as Rheumatoid Arthritis.

You'll spot the good fats. They're liquid at room temperature and consist of:

'Monounsaturated Oils like olive oil, canola oil, oils derived from nuts and avocados.
'Polyunsaturated Oils like corn, soybean, and safflower oils and fish.

Some Fats Aren't So Good. They're solid in room temperature and are called:

'Saturated Fats. They're found in whole milk, red meat, chicken skin, butter, cheese, chocolate and even coconuts. Basically, milk products and meat contain saturated fats. They raise both good and bad cholesterols, but hurt the proper cholesterol/HDL ratio.

Some of us have to be more careful than others since 75% of our cholesterol is manufactured by the liver. In other words, if you've got the bad cholesterol genes and your liver continually pumps out cholesterol, you need to act on this newsletter. Others can just pass it on to those who aren't so blessed.

The Most Evil Fat of All is:

'Man made and prematurely ages and kills thousands of people every year.
'Not safe in any amount to anyone (Institute of Medicine).
'Responsible for Significantly Raising our Bad Cholesterol While Lowering Our Good Cholesterol.
'So unhealthy that even bacteria and mold won't grow on it.

They are called Trans Fats

These are fake, man made fats. They started as real oils but were heated then cooled until they became solid. This process is called hydrogenation (because it adds hydrogen). You know who they are; they're the fried foods, fast foods, commercial packaged baked goods, margarine, vegetable shortening and all products that say 'hydrogenated or partially hydrogenated' in the ingredients.

You'll see them all over packaged foods because they never die or go bad. They nearly last forever, since mold and bacteria won't even grow on them. Nothing will!

In fact, The Nurses' Health Study found when they replaced only 30 calories of carbohydrates with 30 calories of trans fats the risk of heart disease nearly doubled. When they replaced 80 calories of carbohydrates with 80 calories of either polyunsaturated or monounsaturated fats (the good fats), your chance of heart disease dropped by 30 to 40 percent. THAT's A BIG HEALTH GAIN WITH LESS THAN 100 CALORIES OF DIET CHANGE!

Let's put it another way'

By replacing that glob of margarine with olive oil, you'll lower your chance of heart disease by one-third.

Is it worth it?

This is so important that in January 2006, a law requiring all food packaging to state whether it contains trans fats goes into effect.

To summarize, fats can be either liquid or solid at room temperature. Always choose liquids, they are the good fats. Fats that are solid at room temperature should be avoided. When cooking with oil, stir fry'don't deep fry.

If you need to buy foods with trans fats, make sure they are listed as low as possible on the ingredient list. The higher on the list, the more in the food.

Is There Anything I Can Take, Naturally, To Balance My Cholesterol?

There appears to be three or four effective products worthy of a try, such as:

Garlic: While there is disagreement in the literature, the garlic that hasn't had its odor removed (wild garlic) may lower your total cholesterol, bad cholesterol and triglycerides (circulating blood fat) about 10%.

Fish Oil: An abundant quantity of research seems to conclude that 1-2 grams of a fish oil supplement per day reduces your chance of a heart attack and stroke by preventing dangerous, irregular heart rhythms, thinning the blood, lowering triglycerides and preventing inflammation. In fact, one large trial found that by taking just 1 gram per day of fish oil over a 3.5 year period reduced the risk of dying from heart disease by 25 percent in those who already survived one heart attack. While it significantly lowered triglycerides, it seemed to slightly raise bad cholesterol.

Since women's hearts are especially sensitive to high triglycerides. Those whose levels are high may benefit from taking 4 g/day of fish oil. Adding apple pectin (a type of fiber) to the fish oil seems to increase its triglyceride lowering ability even further. Flax seed oil, also an Omega 3 fatty acid (like fish oil), doesn't seem to lower triglyceride levels.

So make sure it's fish oil not just Omega 3 Fatty Acids.
Niacin: (Nicotinic acid) Lowers bad and total cholesterol and raises good cholesterol. It also can lower triglycerides. Unfortunately the dose needed for treatment is about 100 times more than the Recommended Daily Allowance and can potentially be toxic, especially to your liver. It should be considered a medication and taken only under your doctor's directions if the other natural alternatives weren't effective or appropriate.
Plant Sterols and Stanols: These plant products are added to some margarines and prevent the absorption of cholesterol in our intestines. In daily use, it has consistently lowered bad cholesterol about 10%.3,7 So far it does not appear to have long term negative effects. Life long use is predicted to result in a 20% decrease in coronary events.

But, The Best Is Saved For Last

Policosanol: A sugar cane derivative that lowers total cholesterol by 16% to 21%, bad cholesterol by 21% to 29% and raises good cholesterol by 8% to 15%. Although it's triglyceride lowering effects have not been consistent, other cardiac benefits such as the prevention of clots and the dangerous oxidation of bad cholesterol have been demonstrated. Three year follow-ups have not shown negative side effects. 10-20 mg/day seems to be just as beneficial as higher doses.

Standard pharmaceutical treatments today include Statin Drugs, such as:
' Mevacor
' Zocor and
' Pravachol

They work by interfering with the liver's ability to produce cholesterol and increasing its ability to remove cholesterol from the blood. Although statins can lower LDL cholesterol by as much as 60 percent, they can also damage the liver and, in rare incidences, cause a serious or deadly illness.
But, there's good news. The chances of dying from the three leading causes of death (coronary vascular, cancer and strokes) are largely under your control.

Don't Tell Me These Three Steps Are Too Hard'

1. Test your cholesterol (good, bad and total) and triglycerides

2. Watch the type of fats you eat.
o Eat fats that are oils at room temperature
o Moderately limit meat and dairy fats
o Severely limit margarine, fried foods and packaged food with the word 'hydrogenated' in the ingredients.

3. If your cholesterol or triglycerides are elevated or out of balance, talk to us about whether you are a candidate for natural treatments. They can be very effective and may prevent the need for medications. Sometimes medications are necessary but the supplements may allow you to take a lower dose.