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Straight
Track #98 Clearing
Up Confusion Over Cholesterol
J. Dillon Hoey
Hoey & Farina Partner
1-888-425-1212
Good health is something we all wish for our family, our friends and
ourselves. We ran across several articles in the December, 2001, edition
of “Healthy Living Made Easier”, a publication of the Pritikin
Longevity Center in Aventure, Florida (www.pritikin.com),
we thought we would share with our readership.
With a nod to the graying of the work force in the railroad industry,
the first article concerns the health risks surrounding cholesterol
levels, which are a major concern to many railroaders and their families.
The second article deals with the often overlooked psychological effects
of exercise, and the emerging research reporting that moderate aerobic
exercise three times a week works as well as popular antidepressants in
lifting depression.
=================================
“My doctor thinks my good cholesterol is too low.”
Clearing Up The Confusion Over New Federal Guidelines
Jack Heintz was proud of himself, and rightly so.
Three months ago, the Indianapolis stockbroker had started a low-fat
exercise program. Now, all those hours in the gym and bowls of homemade
minestrone were paying off. His latest blood results showed that his LDL
(the “bad” cholesterol) had plummeted to 100 mg/dl. His total
cholesterol had fallen as well – down to a very admirable 140.
But his doctor was not pleased. “Your HDL, your good cholesterol, has
dropped a little,” he warned. “It’s only 36, and that concerns me,
especially given the new government guidelines.”
National Cholesterol Education Program
Presented in May, 2001 by health officials at the National Cholesterol
Education Program (NCEP) in Bethesda, Maryland, the new federal guidelines
call for more aggressive goals for healthy cholesterol levels, including
HDL cholesterol. Now, urges the NCEP, Americans should strive for an HDL
of 40 mg/dl or higher. Anything less, they advise, may put some Americans
at increased risk of having a heart attack.
True, in an overweight, sedentary society like the United States, a low
HDL is associated with increased risk of heart disease. But a growing body
of research is now suggesting that you need not be concerned about a
modest drop in HDL if it’s the result of adopting a very low-fat diet
rich in fruits, vegetables, and whole grains. Explains Dr. James Kenney,
Nutrition Research Specialist at the Pritikin Longevity Center: “A low
HDL on a 10% or 15% fat diet does not carry the same risk as a low HDL on
a 35% or 40% fat diet.”
Lowest Heart Disease Rates
Scores of studies have found that populations who eat a low-fat,
semi-vegetarian diet tend to have HDL levels that, by American standards,
are quite low – 30 mg/dl and below. Do these populations – among them,
the Tarahumara Indians of Northern Mexico, men living in Japan, and
villagers of rural China – suffer alarmingly high rates of heart
attacks? Hardly. In fact, their incidence of heart disease is among the
lowest in the world.
Concurs Robert Pritikin, Program Director of the Pritikin Longevity
Center: “My HDL is only 28. Am I worried? Not at all. My LDL
cholesterol, the most critical risk factor for heart disease, is
incredibly low – just 60. My total cholesterol is 110. With numbers like
these, I’m not concerned about my HDL.”
Affirms James Cleeman, M.D., Chief Coordinator of the National Cholesterol
Education Program: “Chances are, people on [a low-fat exercise program]
who have lowered their LDL to 100 or below and their triglycerides to 150
or below are doing very well. Clearly, these are beneficial levels.”
The Bigger Picture
Steven Masley, M.D., Medical Director at the Pritikin Longevity Center,
advises that we look not at HDL in isolation, but at the bigger picture.
“One of the best predictors of the risk of developing cardiovascular
disease is the ratio of total cholesterol to HDL. On [a low-fat exercise
program], this ratio usually improves because the drop in total
cholesterol is often much greater than the drop in HDL.”
Risk of heart disease is very low when total cholesterol is less than 160
mg/dl, and the ration of total cholesterol to HDL is less than 4 to 1. A
total cholesterol of 140 and an HDL of 35, for example, is a 4 to 1 ratio.
Another good predictor of heart disease risk is the ratio of triglycerides
to HDL. Again, a ratio of less than 4 to 1 indicates decreased
cardiovascular risk.
Initial Drops in HDL
When many people […] first switch from a high-fat to a low-fat diet, HDL
levels tend to drop modestly. Growing scientific evidence indicates,
however, that this HDL drop may be perfectly natural as well as transient
in nature, according to Dr. James Kenney and Dr. James Barnard, UCLA
Department of Physiological Science.
Garbage Workers
On a low-fat, high-fiber diet, our bodies may not need as much HDL. To
illustrate, let’s think of HDL cholesterol as the body’s garbage
workers. Every day, the HDL garbage workers pick up excess cholesterol
(trash) from the body’s tissues and haul this trash to the liver (the
“dump”, if you will) where it’s recognized as waste material and
disposed of.
Now, we would assume that the more garbage workers (HDL) we have, the more
cholesterol our bodies would get rid of. But new research in both animals
and humans has found that those eating a low-fat, high-fiber diet cleared
cholesterol from their bodies just as efficiently as those on a high-fat
diet, even though the high-fate eaters had HDL levels that were
significantly higher.
To understand this process, let’s return to our HDL garbage workers.
Imagine two crews, both of whom are removing trash (cholesterol) from the
body. One crew has more workers. If you took a snapshot, this
well-populated crew would look as if it were getting rid of the trash
quicker than the other crew. But the smaller-staffed crew, it turns out,
moves faster. By the end of the shift, it has removed as much trash as the
larger crew.
What these studies suggest, then, is that a lower HDL on a low-fat diet
may work just as industriously as a higher HDL on a high-fat diet, and, as
a result, may be just as heart-protective. What may ultimately matter, in
effect, is not how much HDL you have, but how efficiently your HDL is
functioning.
Less Trash
Keep in mind, too, that if you’re on a low-fat eating plan, your body
isn’t accumulating much trash (cholesterol) in the first place. You have
less garbage build-up. As a result, you need fewer garbage workers (HDL)
for the clean-up job. You’ve eliminated, in effect, the need for a
higher HDL level.
Reversal of Heart Disease
Certainly, the heart patients in Dr. Dean Ornish’s Lifestyle Heart Trial
did not have high HDL levels. After following an eating and exercise plan
[…], their HDL levels remained about the same or decreased a little. But
their total and LDL cholesterol levels dropped markedly. The net result?
After one year, Dr. Ornish’s patients experienced a 91% reduction in
angina compared to the control group.
What’s more, a year later, angiograms revealed coronary arteries that
were starting to unclog. “This is excellent data,” states Dr. Kenney.
“It demonstrates that a drop in HDL in people adopting a 10% fat diet is
not associated with increased risk of heart disease. Quite the contrary.
These patients made tremendous improvement. They saw reversal of coronary
atherosclerosis.
Pounds of Trouble
“To protect your HDL,” advises Robert Pritikin, “one of the most
important things you can do is avoid weight gain.” Plenty of studies
have found that as weight goes up, HDL levels tend to slide down.
Bottom Line
If you’re eating a lot of saturated and trans fat, such as red meat,
full-fat dairy products, and hydrogenated fast from foods like cookies,
chips, and margarines, a lower HDL is indeed a problem. It certainly
increases your risk of a heart attack. You need a lot of HDL “garbage
workers” to clear those huge amounts of cholesterol “trash” out of
your blood vessels.
But if you’ve adopted [a low-fat exercise program], and if your total
cholesterol/HDL ratio and triglyceride/HDL ratio are less than 4 to 1,
don’t be concerned if your HDL drops a little. Large studies have
demonstrated that populations following essentially [a low-fat exercise
program] have the lowest rates of heart disease in the world (despite
lower HDL levels.) Moreover, following [a low-fat exercise program] with
its very low-fat diet high in unrefined carbohydrates like fruits,
vegetables, and whole grains has been proven to reverse atherosclerosis.
Remember, too, that a drop in HDL may not be permanent. That’s because a
low-fat diet full of whole foods that are low in caloric density, like
fruits and vegetables, does a fantastic job of shaving off pounds, “and
long-term weight loss,” points out Robert Pritikin, “is one of the
best ways to increase HDL.”
There are, in fact, several excellent ways to raise your HDL, including:
- Exercising (walking 12 to 15 miles or more per week)
- Losing weight (and keeping it off)
- Quitting smoking
- Lowering triglycerides (by avoiding sugar and other refined
carbohydrates)
- Drinking one serving of wine with dinner (not more than two
servings)
- Taking medications (if lifestyle change has proved inadequate)
“But if your HDL stays on the low side, don’t be discouraged,”
assures Robert Pritikin. “With [a low-fat exercise program], you can be
confident you’re doing what’s best to prevent heart disease. You’re
lowering triglycerides, LDL cholesterol, and total cholesterol, and
you’re stabilizing plaque in the arteries. All these factors
significantly decrease your risk of a heart attack. A higher HDL is a good
thing, but if you’re on [a low-fat exercise program], it’s not
crucial.”
From “Pritikin Perspective: Healthy Living Made Easier,” Dec. 2001,
Volume 11, Number 5, a publication for the graduates of the Pritikin
Longevity Center in Aventure, Florida (www.pritikin.com).
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