Surprise! Cholesterol isn't all bad. Your body uses it to make hormones, vitamin D, and substances that aid digestion. But that doesn't mean you should make a run for the bacon. That's because your body makes all the cholesterol it needs on its own, without any extra-fatty foods eaten on your part.
Here's something else you may not have heard: women are less likely than men to keep their cholesterol under control, the American Heart Association reports. Read on to learn more about cholesterol and how to keep your level low.
Killer Cholesterol
More than half of adults have too much cholesterol flowing around in their bloodstreams, a problem that, frighteningly enough, often carries back to their childhoods. Once your total cholesterol reaches 200 mg/dl, your risk of heart disease increases. And with it, your risk of death from heart disease—the number one killer of women.
But what does your total number mean exactly? "We've discovered that total cholesterol is a meaningless number, at least for women," says Barbara H. Roberts, M.D., director of the Women's Cardiac Center at the Miriam Hospital in Providence, R. I. and author of How to Keep From Breaking Your Heart: What Every Woman Needs to Know About Cardiovascular Disease. "That's because total cholesterol is made up of several blood fats, including LDL (so-called 'bad' cholesterol), HDL (so-called 'good' cholesterol), and triglycerides. In women, high levels of triglycerides and low levels of HDL are more significant risk factors for atherosclerosis (hardening of the arteries) than are high levels of LDL."
Cholesterol (called plaque) can build up in your arteries, blood vessels that carry blood full of oxygen and nutrients from your heart and lungs throughout your entire body. High cholesterol has a bad impact on this healthy travel: it encourages the arteries to narrow and block. LDL, the bad type, causes cholesterol to build up in the blood.
Mission Possible
Your goal? Keeping your LDL down. "To lower your cholesterol the drug-free way, eat a plant-based diet, quit smoking, do lots of aerobic exercise, keep your weight under control, and don't fall for the low-fat diet fad," Roberts says. "Eating low fat is counterproductive for women because it lowers your HDL, that is, your good (think H for healthy) cholesterol."
Just what makes HDL so good for your body? It has the power to mobilize cholesterol, moving it throughout your body to your liver where it can be excreted. HDL also has anti-inflammatory and antioxidant properties, two other factors that help lower the risk of your arteries hardening.
How can we increase HDL cholesterol? Forget low-fat diets, and make room for monounsaturated fats in the foods you eat. "The best type is olive oil," Roberts says. "If your HDL is low, you should eat between two and three tablespoons per day—either straight from the spoon, or drizzled on salads or cooked vegetables, substituting it for saturated (animal) fats like butter or polyunsaturated fats like corn oil." And women actually need more of this healthy cholesterol than men do. The lower limit of normal HDL in women is 50 mg/dl, while in men it's only 40 mg/dl.
If you've ever blamed your hormones for tears and moodiness, here's one thing to say thank you for: estrogen, the "female" hormone, may actually help protect you against heart attacks, says Robert H. Eckel, M.D., spokesperson (and former president) of the American Heart Association. From the time your body starts producing it at puberty until production falls in your mid-50s, you'll have higher levels of HDL than the men around you.
Because women make estrogen and men make androgens, women are less likely to have a heart attack than men are (until they reach menopause, when both estrogen and HDL levels drop).
It appears that men have significantly higher total cholesterol levels than women at age 35 to 44, say researchers; however, their total cholesterol remains stable while women's jumps by 10 to 12 points with each decade, so that by age 55 to 64, women have much higher total cholesterol than men.
"Once you've reached your 20th birthday, your doctor should order a full cholesterol panel," says Roberts. This is nothing more than a fasting blood test (you can't eat or drink anything with calories for 12 hours before), but it shows your doctor crucial numbers for assessing your risk of heart disease: your LDL, HDL and triglyceride levels. If your doctor hasn't ordered one, go ahead and ask about it yourself. Having a family history of heart disease makes knowing your numbers even more essential.
Treatment Plan
Take a look at your numbers with your doctor, and set a goal level as to where your LDL should be. If you have no risk of heart disease, yet your cholesterol numbers are less than optimal, your goal should be 160 mg/dl; if you have more risk factors, such as a family history of heart attacks, your goal should be 130 mg/dl. And if you already have heart disease, your goal should be 100 mg/dl at the very highest.
Before you blindly pop the cholesterol-lowering pills your doctor prescribes (likely statins, the go-to med for high cholesterol), consider changing your lifestyle. According to a study from Mount Sinai School of Medicine, 71 patients who had been prescribed statins to bring their "bad" cholesterol down weren't eating any more saturated fat six months later, as many medical professionals assumed they might (perhaps counting on the medication to make up for a steak or two). Some patients also said they would have preferred to try lifestyle changes before taking the drugs.
And in many cases, lifestyle changes may be all it takes to make a difference. In a 5-year study of 535 premenopausal women, researchers from the University of Pittsburgh's Graduate School of Public Health found that lifestyle changes, such as exercising and following a low-fat diet, were able to control increases in LDL cholesterol. (Take that, statins!)
Ready to declare war against high cholesterol? Here's where to start:
* Fill up on fiber, particularly the soluble kind. Soluble fiber slows digestion and helps your body absorb vital nutrients from foods. Good sources include oatmeal, kidney beans and apples.
* Choose fruits and vegetables of all different colors—each type boasts different nutrients and antioxidants, all of which your body needs to function at an optimum level.
* Eat six or more servings of whole grains per day.
* Serve fish at least once a week for its essential fatty acids (EFAs).
Changing your diet isn't the only way to change your cholesterol levels, Japanese researchers report. In a review of 25 studies published between 1966 and 2005, researchers examined the effects of aerobic exercise on HDL cholesterol in a total of more than 1,400 adults aged 23 to 75. On average, study participants exercised 3.7 sessions per week for 40.5 minutes each session. This increased each patient's HDL cholesterol by approximately 2.5 mg/d. Even two hours of movement per week was enough to have some impact on subjects, the study results showed.
As a Last Resort
Follow this diet for four to six weeks, and if your LDL still hasn't dropped to the goal you agreed on with your doctor, it may be time to try statins, Eckel says. Keep in mind, however, that once you start taking them, you'll probably have to stay on them for life. Before your doctor writes up a prescription, have him test to make sure you don't have kidney, thyroid or liver disease, all of which can also mimic high cholesterol.
Keep "bad" cholesterol down and "good" cholesterol up and you'll be sitting pretty. And if your cholesterol levels change, you can be confident that you know what each number on your doctor's chart means. You'll also know that there's no need to turn to medication as a first choice. Change your lifestyle as much as possible; then make your decision, armed with all the knowledge you need to make an informed one.
Jenny Stamos writes about health, nutrition, psychology, work, money and love for magazines such as Self, Shape, Glamour, Women's Health, Prevention and Woman's Day.
