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Cholesterol: Not all bad

Nancy Johnson (South Bend Tribune) -- If cholesterol were a movie, it might be called "The Good, the Bad and the Ugly."

Cholesterol isn't all bad. Some of it is good -- in fact, necessary for body's health. Still, it has its ugly side. Too much bad cholesterol in the bloodstream can lead to heart disease, but changes in diet and exercise usually can make a dramatic improvement.

Cholesterol is a white, waxy, fat-like substance found naturally in the body, and it has several jobs: to build cell walls, nourish cell membranes, insulate the nerves, produce certain hormones and help the liver digest food.

There are two types of cholesterol: There is the bad -- low density lipoproteins or LDLs, which build up and clog the arteries. Then there's the good -- high density lipoproteins, or HDLs -- which cleanse the arteries. Without a high level of HDLs compared to LDLs, cholesterol can't be properly be removed from the arteries and the result is atherosclerosis, or narrowing of the arteries.

Playing a big role in clogged arteries is the saturated fat in foods, which can raise blood cholesterol levels. Another factor is heredity: Some people have a genetic disposition for a high cholesterol count.

But diet and exercise are within our control, said Wahida Karmally, a spokeswoman in New York for the American Dietetic Association.

She said she is seeing more and more clients seeking nutrition advice for being overweight and at risk for heart disease.

Even if the client is taking cholesterol-reducing drugs, "any effort to optimize the blood cholesterol level to reduce the risk of coronary artery disease should begin with diet modification," she said.

She advises clients to cut back on sources of saturated fat: higher-fat red meats, processed meats like bologna, sausage and hot dogs, poultry with skin and whole-milk dairy products. Saturated fat turns up in coconut oil, palm oil and hydrogenated oils, which are often used in commercially prepared cakes, cookies and pies. She also suggests they cut back on sources of dietary cholesterol: eggs, meats, butter and whole-milk dairy products.

Karmally tells clients to look out for trans fatty acids, which behave like saturated fats and raise bad cholesterol. They are often found in margarines, so she suggests using margarine with low trans fat, "or better yet, just use jam or jelly on toast," she said.

At the same time, she advises clients to eat more fruits, vegetables and whole grains, especially those with soluble fiber, and choose skim or lowfat milk products. In addition, she advocates fish such as salmon, mackerel, bluefish and tuna, which have omega-3 fatty acids that can lower the blood fat level.

Karmally also teaches clients how to change their habits for the better. "If they are used to stopping by the coffee shop for an egg and bagel with cream cheese and coffee with cream, they need to learn to ask for the lower fat alternative, and have the higher-fat foods less frequently," she said.

Karmally also gives tips on how to dine out. She advises cholesterol-watching clients to choose pasta dishes with tomato-based or oil-and-garlic sauce rather than cream sauces, to ask for salad dressing on the side, to order fruit or sorbet rather than cheesecake and pie, to avoid egg-heavy dishes such as hollandaise sauce and egg drop soup, and to order dishes made with a lot of vegetables, such as Chinese beef and broccoli.

But she knows no one will follow food guidelines if they aren't enjoying their meals. That's why she teaches clients how to make food flavorful with herbs, spices and nuts, how to use olive oil instead of butter, and how to bake without saturated fat. "Dietary modifications are for long-term use, so enjoyment is very important," she said.

Making these changes has its payoffs. Following a low-fat, low cholesterol diet can dramatically reduce bad cholesterol levels. Cholesterol can be lowered by 10 to 15 percent just by limiting saturated fat, 5 percent more by adding soluble fiber such as oatmeal, and at least 10 percent more by adding functional foods, such as Benecol margarine, Karmally said.

Exercise helps too: Regular aerobic activity can raise the level of beneficial HDLs in the blood stream. "We need to make our diets more healthy and exercise more," Karmally said.

Unfortunately, she added, there is no magic bullet to control cholesterol.

Not even in a spaghetti western.

(c) 2001 South Bend Tribune

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