By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

[EDITOR’S NOTE: September is National Cholesterol Education Month.]

“LIFESTYLE CHANGES” STILL THE MAINSTAY OF CHOLESTEROL MANAGEMENT

Question: Both of my parents have high cholesterol, but they are both overweight. I am only 31. Should I get my cholesterol checked, and what should it be? What about the good and bad cholesterol -- what should they be?

Answer: Cholesterol -- a major component of every cell -- is actually essential to life. Problems develop, though, when we have too much of it. This can happen in two interconnected ways. Your body may manufacture significantly more cholesterol than you need, or you may eat a diet with too much cholesterol or too much saturated fat.

According to recent research, about 25 percent of the cholesterol in your bloodstream comes from dietary intake of cholesterol. The other 75 percent is manufactured in your liver. The amount manufactured by your liver is determined by two major factors -- your genetics and the type of fat in your diet. Saturated fat, the kind in dairy products, red meats and coconut, is most easily converted by your liver into cholesterol and, thereby, raises your total cholesterol level the most.

When there is too much cholesterol in the bloodstream, it can narrow the arteries by allowing plaque to build up. These narrowed arteries can eventually plug up completely. If the coronary arteries that supply the heart muscle become blocked, you can have a heart attack.

There are two types of cholesterol, low density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL carries cholesterol from the liver to the rest of the body. In the process it can deposit cholesterol on your artery walls. Since this can lead to clogged arteries, LDL has been called the “bad cholesterol.” HDL, on the other hand, carries cholesterol from the bloodstream back to the liver. Because a higher level of HDL makes it less likely that cholesterol will be deposited on your artery walls, it’s often called the “good cholesterol.”

So what should your numbers be and when should you have them checked? The current recommendation is that you should have your cholesterol checked around age 20, and then if it’s OK, every five years for the rest of your life. Optimally your total cholesterol should be less than 200 mg/dL. The good HDL cholesterol should be at least 60 mg/dL and the bad LDL cholesterol should be less than 100 mg/dL. If you have other medical conditions or risk factors, your doctor may recommend different numbers for you.

Let me end with advice that will help you lower your cholesterol readings if they are too high, or prevent you from developing a cholesterol problem if your levels are OK now. Here are my tips: don’t smoke or don’t start; eat a diet that is low in animal fats and cholesterol; lose weight or maintain a healthy weight; increase the fiber in your diet (this helps prevent cholesterol from being absorbed) and get regular physical exercise.

In spite of doing all of the right things, some people still need medication to get their cholesterol to the appropriate level. If you are one of these people, your doctor will work with you to find the right medication. Lifestyle changes, however, are still the mainstay of cholesterol management.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.