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The new cholesterol guidelines.

Over the past few decades, hundreds of studies have shown a strong link between levels of a certain blood cholesterol and the risk of heart disease. Now, armed with more precise information than ever before, scientists in both the United States and Canada have recently issued new cholesterol guidelines to provide the optimum protection possible. For women in midlife, this is good news because after the age of 50, our risk of heart disease increases substantially.

What is cholesterol & what does it do?

Cholesterol is a waxy substance that circulates in the blood stream. It forms part of cell membranes and bile, and is involved in the manufacture of vitamin D, cortisol, and hormones such as estrogen and testosterone. The liver converts saturated fat (from meat and dairy products), and trans-fats (hydrogenated oils found in baked goods and fast foods) into cholesterol.

Cholesterol piggybacks on certain proteins in the blood to form a variety of particles. One kind is low density lipoproteins (LDL), the so-called "bad" cholesterol because it may accumulate on artery walls, reducing blood flow to the heart and brain. The other kind is high density lipoproteins (HDL), the so-called "good" cholesterol because it carries out excess LDL cholesterol from the blood stream and back to the liver, which disposes of it.

The new guidelines

Recent recommendations by the U.S. National Cholesterol Education Program Adult Treatment Panel and the report of the Working Group on Hypercholesterolemia in Canada, have attempted to harmonize cardiovascular risk assessment across North America. The recommendations outline three levels of risk--low, moderate and high--and define treatment targets for identifiable risk markers. "Bad" LDL should remain low (less than 2.5 mmol/L Canadian measurement, or less than 100 mg/dL U.S. measurement for the high risk group). "Good" HDL should reach an optimal level, more than 0.9 mmol/L or 40 mg/dL. Women may benefit from an even higher HDL level: more than 50 mg/dL.

The risk factors

Routine screening is recommended for postmenopausal women. The highest risk groups include those with established coronary artery disease, chronic kidney disease, and adult diabetes. For all groups, risk factors include current or past cigarette smoking, high blood pressure, a family history of high cholesterol and heart disease, and abdominal obesity. The guidelines recommend that waist circumference should not exceed 88 cm (35") for women.

Lifestyle changes

The researchers also recommended Therapeutic Lifestyle Changes (TLCs), which have three areas of focus: physical activity (which boosts levels of HDL), healthy eating, and weight reduction if necessary. Depending on your level of risk, your doctor may recommend TLCs and possibly cholesterol-lowering medication.

Healthy eating

There are two ways you can influence your cholesterol levels through food. These are healthy recommendations regardless of heart disease risk. One: eat less saturated and trans-fats, and limit foods high in cholesterol such as eggs. Two: eat foods that lower your blood cholesterol such as oatmeal and salmon.

* Use low-fat dairy (skim or 1% milk, * Choose foods with
 yogurts and cheese) and lean meats polyunsaturated fatty acids
 (less than 15% fat). such as corn, safflower,
 sunflower, and soybean oils,
 walnuts and sunflower seeds.
 Do not exceed more than 10%
 of calories from these foods
 or you run the risk of
 lowering HDL.

* Avoid tropical oils such as coconut & * Opt for monounsaturated fatty
 palm kernel that can be found in acids found in canola & olive
 cookies, cakes & crackers. oils instead of saturated

* Reduce or banish trans-fats found in * Increase cardio-protective
 prepared foods with partially omega-3 fats from fish and
 hydrogenated vegetable oil: cookies, plant sources (fatty fish
 crackers, potato chips, commercial like salmon, mackerel,
 baked products, prepared foods, some herring, trout and sword fish
 margarines & fried foods in and flax and flax seed oil).
 restaurants and fast food chains.

* Limit foods high in cholesterol such * Eat more whole grains such as
 as eggs, organ meats & some seafood whole-wheat breads, pasta and
 to 200 mg cholesterol a day. Even brown rice that are low in
 though there is a lack of evidence fat. Add soy to your diet,
 that dietary cholesterol has a too.
 significant effect on increasing
 cholesterol in the blood stream, the
 American Heart Association recommends
 this target level.

 * Up your intake of vegetables,
 fruits, oatmeal and legumes
 to increase soluble fibre &
 to moderate total fat intake.

To assess your 10-year risk of heart attack, go to the National
Institutes of Health web site:
For Canadian guidelines, see the Canadian Association of Cardiac
Rehabilitation web site:

By Nancy Heidenreich, R.D.

A registered dietitian for more than 35 years, Nancy Heidenreich has practised as a research dietitian, a private practitioner and as an educator. She is currently enjoying retirement north of Toronto.
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Title Annotation:NUTRITION
Author:Heidenreich, Nancy
Publication:A Friend Indeed
Date:Sep 1, 2005
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