Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Cholesterol

By age 45 all women should have their cholesterol level screened. Though the term cholesterol is used, really what are monitored are the components of cholesterol. These components included triglycerides, and the lipoproteins. High density lipoprotein or HDL is often refereed to as good cholesterol and low density lipoprotein or LDL is referred to as bad cholesterol. For many women who are found to have borderline elevation of theses components of cholesterol, the first recommendation they will receive from their doctors is to attempt to lower cholesterol with diet and exercise. Diet and exercise may be very effective for lowering cholesterol if real lifestyle changes are made. First, lets talk about exercise. It is no secret that the average American does not get enough exercise. Though many women have physically demanding work schedules, this unfortunately does not count as sustained healthy exercise. Keep in mind that as the body adapts, the amount and duration of the exercise will need to increase to have continued benefit. For most women, thirty minutes of sustained exercise with an additional 15 minutes to warm up and 15 minutes to cool down three days a week will be adequate. Equally important to exercise is diet. Cholesterol comes from animal sources. It would seem then that a vegetarian diet would solve all the problems. Unfortunately, it is a little more complicated. The average American now consumes the majority of their trans-unsaturated fatty acids from the industrialized hydrogenation of polyunsaturated fats. In other words, many of the commercial foods we eat contain oils that have been chemically altered. The altered oils do not spoil as easily and stay solid at room temperature. This is why margarine stays more firm than butter at room temperature. Most store-bought cookies and pastries are made with these oils. Simply by reading the packages of breads, pasta, and snack foods can help to significantly reduce the intake of trans-unsaturated fatty acids and therefore reduce cholesterol. Avoiding fried foods (which are generally fried in these oils) and fast food also helps significantly. Attempting to eat a completely fat-free diet can actually be harmful for two reasons. First, a diet very low in fats also means a diet low in fat soluble vitamins (A, D, E, and K). Second, foods that are altered to be fat free or low fat often have much higher levels of carbohydrates. A diet high in carbohydrates may lead to diabetes and difficulty with weight loss. Fats and fatty acids are not unhealthy; we often eat too much fat but not enough variety of the fatty acids that we require. For example, it has long been known that populations of people who consume high levels of omega-3 polyunsaturated fatty acids such as fish oils or flax seed have lower levels of cholesterol. This is because these fatty acids are thought to reduce the synthesis of very low density lipoprotein (VLDL) or very bad cholesterol. In some studies, 15gm of fish oil per day was noted to lower trigycerides by 50%. It may also decrease blood pressure. The problem with high doses of these fatty acids is that they may lower the absorption of vitamin E and they may also cause side effects from absorption. These effects may include stomach upset, bloating, and diarrhea. In general, two six ounce serving of fish per week should provide adequate amounts of fish oil with out side effects.

There are many other foods that have been shown to be beneficial for improving cholesterol. The foods best studied include: Soy, fiber, nuts, and calcium. Soy products are a good source of protein and may also lower low density lipoprotein (LDL) by as much as 8%. Currently the American Heart Association recommends 25 grams per day of soy product. Increasing fiber also helps to lower cholesterol. Oat products and psyllium are the best for reduction of cholesterol. Nuts are rich in polyunsaturated fats and are a healthy snack food. In addition to helping to prevent osteoporosis, calcium supplementation of 1,000mg or more reduces cholesterol Calcium binds fatty acids and therefore interferes with absorption. The bottom line is that both diet and exercise are essential for maintenance of good health including low cholesterol. For women who need to lower their cholesterol, there are a few basic guidelines. First, avoid fast food, fried food, or food prepared with trans fats. Second, do not feel that all fat is bad. Fat is an essential nutrient and is important in a healthy diet. It is more important to increase the good fats and reduce the bad. Good fats include omega-3 fats (fish oil, flax seed), nuts, and natural vegetable oils (olive oil). Finally, fiber and calcium help to reduce cholesterol by interfering with the absorption of fats.