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Think of it as two opposing forces:
Two knights jousting.
Two football teams, one advancing the ball, the other trying to stop it.
Two home remodelers, one putting plaster on the wall, the other knocking it down.
Congratulations. You now have a better idea of cholesterol.
Most of us know that we should monitor our cholesterol levels and that lower numbers are better.
But there's more to cholesterol. Here's some of what it's all about:
WHAT IS CHOLESTEROL?
It's a fatty, waxy substance made in the human liver and found in animal foods - meats, dairy products.
You need cholesterol: It's important for cell function and repair, and for proper nerve conduction. The body uses it to make vitamin D and hormones such as estrogen and testosterone.
But "it doesn't take much," says physician Jim Early, associate professor of preventive medicine and public health at the University of Kansas School of Medicine-Wichita.
Your body makes all that it needs, even if you're a vegetarian, though you also get more from food.
THE GOOD AND THE BAD
Cholesterol is a lipid, or fat, that mixes with a protein to become a lipoprotein so that it can be carried through the bloodstream. (Remember, oil and water don't mix.)
Low-density lipoprotein, or LDL, cholesterol is commonly called "bad" cholesterol. It's considered bad because it tends to accumulate on the walls of your arteries. Early compares it to plaster put on a wall. That leads to reduced blood flow, increasing the risk of heart disease and stroke.
High-density lipoprotein, or HDL, cholesterol is the good guy, the one who knocks the plaster back off the wall. It helps keep the arteries clean and carries cholesterol back to the liver, to be reused or eliminated from the body.
Then there's very-low-density lipoproteins, made up mostly of triglycerides. Early says they're like big, fatty globs that collect on the top of a bowl of soup. They form a reservoir for making new LDL.
Cholesterol levels are measured through blood tests. It used to be that doctors wanted you to have 200 or fewer milligrams of cholesterol per deciliter of blood.
Then they decided a total cholesterol reading didn't tell the whole story because if your LDL level is too high, or your HDL level is too low, the "plaster" is building up on your arteries.
Current recommendations are for an LDL reading of less than 130, Early says, if you have no risk for heart disease or diabetes. That means you are young, not overweight, don't smoke and don't have relatives with heart disease.
That also means pretty much everyone should have LDL cholesterol of 100 or less. People with heart disease or diabetes should aim for 70 or less.
Women should have an HDL cholesterol reading of 50 or more; for men, the magic number is 40, Early says. In this case, the higher the number, the better.
Your triglyceride level should be below 150.
WHEN TO CHECK
Children normally don't need their cholesterol checked, unless they have a strong family history of heart disease or other risk factors.
But by the time you're in your 20s, sitting at your desk rather than playing on the playground, adding an inch or so to your waistline here and there, it's time to pay attention.
Have your cholesterol checked every five years or so, unless it's high. When you hit 40, start checking it annually.
WHAT TO DO IF IT'S HIGH
Federal health officials recently recommended that people at moderate risk for heart disease start taking cholesterol-lowering drugs if their LDL was more than 100. That recommendation has been controversial: Before, drugs were recommended for those with LDL of 130 or higher, and most of those making the recommendation have made money from companies that make the drugs.
Early, who has been taking cholesterol-lowering medicine since 1987, says the lower number makes sense, based on the evidence. He counts himself in the evidence, based on his family's history.
But there are ways beyond drugs to lower your cholesterol, he says. If your doctor recommends cholesterol-lowering drugs, perhaps you can try these methods first:
-Use products that contain plant stanols or plant sterols, such as Take Control or Benecol margarines. Such products block the absorption of cholesterol. Oatmeal, split peas, garbanzo beans and pinto beans have a similar effect.
-Eat more fiber. The fiber from fruits and vegetables and from products such as Benefiber helps carry harmful substances through the gut and out of the body.
-Choose lean cuts of meat and low-fat dairy products.
-Use monounsaturated fats, such as canola oil and olive oil.
-Limit trans-fatty acids, found in products such as baked goods, chips and so on.
-Eat fatty fish, such as tuna, salmon and mackerel. They contain omega-3 fats, which have a protective effect.
-Exercise. It helps reduce LDL levels, raise HDL levels and burn up triglycerides. Consistent cardiovascular exercise is the key.
(c) 2004, The Wichita Eagle (Wichita, Kan.). Distributed by Knight Ridder/Tribune News Service.