Outsmarting The Street
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Hormone Replacement Therapy: Should You, or Shouldn’t You?

Cholesterol, Fat,
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When Parents Come to Depend on Children

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Exercise While
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Bad Fat

Saturated fats contribute to plaque deposits in blood vessels. Saturated fats are not essential to health. Like cholesterol, they are found in animal foods, including meat, shellfish, butter, shortening, baked goods, dairy products, and some oils. You can recognize saturated fats because they tend to get hard at room temperature (think butter and bacon) in contrast to unsaturated fats, such as canola and olive oil.

Transfats, or transfatty acids, are created when any fat or oil is processed to create shortening or "hydrogenated" oils. Transfats are found in most margarine, prepared baked goods, and snack foods such as crackers and potato and corn chips. At one time, margarine and hydrogenated fats were promoted as being healthier than saturated fats, but now researchers know that the transfats these contain actually raise LDL cholesterol levels while lowering good HDL cholesterol.

Triglycerides are defined by the American Heart Association as "the chemical form in which most fat exists in food, as well as in the body." Besides being in what you eat, your body manufactures triglycerides from high-calorie carbohydrates and proteins. Even small amounts of alcohol raise
blood triglyceride levels. High levels are linked to coronary artery disease.

Good Fat

If fat is so bad, what can you eat? Here are the "good" fats:

Mono-unsaturated fats are found mainly in olive oil, grape-seed oil, canola oil, nuts, and seeds. They are good for you because they provide nutrients needed by your body while also helping reduce harmful LDL cholesterol.

Poly-unsaturated fats occur in fish, grains, vegetables and nuts. They are better for you than saturated fats, although less good than mono-unsaturated fats (polyunsaturates tend to reduce good HDL cholesterol, along with bad LDL cholesterol).

Omega 6 and Omega 3 essential fatty acids, a special category of polyunsaturated fats, are particularly important to health. They assist in regulation of mental health, growth and vitality. They also assist the transport and uptake of oxygen throughout the body, combating cell-damaging free-radicals. Omega 6 occurs in unrefined safflower, corn, sesame and sunflower oils. Omega 3 is found in oily fish, and also in linseed, flax and soybean oil, as well as pumpkin seeds, walnuts, and dark green vegetables. Most people consume enough Omega 6, but too little Omega 3. To get more Omega 3, eat fish at least twice a week, or consider taking Omega 3 in supplement form.

AJanice Carrington, a Brooklyn mother in her 40s, went for a medical checkup recently. A few days later, her doctor called to say she was worried about Janice’s blood cholesterol level, measured at 260. Janice went back for a second, "fasting" cholesterol test, which revealed a total cholesterol level of 243. "That’s not terrible," the doctor said, "but your LDL cholesterol–the ‘bad’ one–is high compared to the ‘good’ HDL level." She gave Janice a list of foods to avoid, including eggs and red meat. "Those are some of my favorite foods," Janice complains. "I try to eat right, but I don’t understand the whole cholesterol thing. Aren’t they saying that high cholesterol might not be as bad as they once thought? I’ve also heard there are drugs that can lower it. Why do I have to change what I eat?"

The Cholesterol Question
Janice’s puzzlement, and her resistance to giving up foods she likes, are familiar to Luther Clark, MD, Chief, Division of Cardiovascular Medicine at SUNY Downstate Medical Center. Changing habits is hard. But the dangers posed by cholesterol are real, Dr. Clark says. Elevated cholesterol can contribute to cardiovascular disease (CVD), namely heart attack and stroke.

But the topic is complex. First of all, cholesterol comes in two versions: the so-called "bad" LDL cholesterol (for low-density lipoprotein) and the "good" HDL cholesterol (for high-density lipoprotein). Secondly, cholesterol is only one factor that has been linked to CVD. Other threats include saturated fats, transfats, and high blood levels of triglycerides, homocysteine, and something called "C-reactive protein." "The good news is that the same steps that control cholesterol also address these other issues," Dr. Clark says. "Eating less fat and exercising more reduces all of these risk factors."

Cholesterol, Bad and Good
Cholesterol is a fatty/alcohol substance that is carried in the bloodstream within molecules of lipoprotein ("lipo" generally refers to fat). Cholesterol is important to life because it helps synthesize hormones and other substances needed by the cells. Our bodies manufacture cholesterol in the liver, and we also consume it in such fatty foods as egg yolks, dairy products, meats, and oils.
Bad News: Cholesterol poses a problem when too much LDL cholesterol circulates in the blood-stream, where it may penetrate the walls of blood vessels and build up over time, creating plaques that slow blood flow. This contributes to hypertension (high blood pressure) and arteriosclerosis (hardening of the arteries). Also, pieces of plaque can break off and be carried in the bloodstream. A fragment may then lodge in a small blood vessel, block blood flow, and precipitate a heart attack or stroke.

Good News: Our bodies have a built-in remedy for "bad" cholesterol. Scientists have learned that the good, HDL cholesterol actually cleanses artery walls, carrying excess LDL cholesterol back to the liver, where it is metabolized. Thus, HDL cholesterol protects against CVD.

Testing for Cholesterol
The difference between LDL and HDL cholesterol explains why Janice Carrington’s doctor insisted on a second cholesterol test. The quick test administered in most physician offices shows only a person’s total cholesterol level–combining LDL, HDL and triglycerides into one number. If the total is below 200, there is usually nothing to worry about. But if the number is above 200 ("border-line high"), a more accurate test is called for. "There is always some cholesterol in the blood, but quantities fluctuate depending on what we ate most recently," Dr. Clark explains. Testing cholesterol after fasting (not eating for 8 hours) permits an accurate gauge of your normal, background cholesterol level.

When a person’s total cholesterol reading is above 200, it is important to find out how much of the total is due to LDL cholesterol, and how much is HDL cholesterol. As a rule, LDL cholesterol levels up to 129 are acceptable in individuals who do not already have heart disease.

About Fat
Dietary fat is another two-faced friend. Some is necessary, but too much of the wrong kinds is bad for your health. Moreover, calorie-rich fat of any kind can make you fat (fats have twice the calories of an equivalent amount of protein or carbohydrate). Being overweight or obese–defined as being more than 30 pounds overweight– significantly raises the risk of CVD, and it also raises your risk factor of diabetes.

Protecting Yourself
The blizzard of facts on fat and cholesterol can make your head spin, but controlling consumption is important if you are at risk for cardiovascular disease (the number one killer of women and men in the US). Fortunately, the way to do this is clear: Eat a low-cholesterol diet, avoid saturated fat, and get lots of exercise. Some patients may require drug therapy.

Modifying Diet: First, experts advise eating a minimum of meat and trimming fat and skin from all meat and poultry. Increase fish consumption, choose low-fat milk and cheese; limit eggs to three a week (eggs are nutritious, but the yolks are cholesterol-rich); increase consumption of green leafy vegetables, served without butter or other fat; and substitute nuts, dried fruit and seeds for chips and crackers. Other steps: Eat low-fat salad dressings containing canola or olive oil; substitute olive oil for butter on bread; and eliminate or cut way back on high-fat deserts.

Exercise advice: Experts now advise 30 minutes of aerobic activity (such as fast walking) every day. Combined with a healthy, low-fat diet, this amount of exercise will go far to keep weight down and cholesterol in check.

Other CVD Threats and Remedies
Two other blood factors: elevated levels of the amino acid homocysteine, and elevated C-reactive protein, could also lead to CVD even without the usual risk factors of overweight or high LDL cholesterol.

Fortunately, a low-fat and low-cholesterol diet combined with exercise– the remedies that fight LDL cholesterol– also reduce blood levels of homocysteine and C-reactive protein. A diet high in B vitamins–particularly B-6, B-12 and folic acid–also seems to help reduce homocysteine levels. "For my cardiovascular patients, I generally suggest a good multivitamin with at least half a gram of folic acid," says Dr. Clark.

The Role of Pharmaceuticals
What about drugs to protect against cardiovascular disease? They have a definite role to play for some patients, says Dr. Clark. Daily intake of aspirin has long been used to reduce the risk of heart attack and stroke. Prescription drugs known as ACE inhibitors are often prescribed to control hypertension, and recent studies indicate they are protective against heart disease, independent of their effect on blood pressure.

Statins, drugs that reduce total and LDL cholesterol, may be prescribed for patients whose high cholesterol levels are resistant to control via diet and exercise alone. But they can have serious side effects, Dr. Clark cautions. Each patient must be evaluated carefully by his or her physician.

A Note About Smoking
Anyone looking to reduce the possibility of CVD should not overlook a major risk factor–smoking. Smoking significantly raises the risk of suffering a heart attack or stroke,and it is a particularly potent risk factor when smoking is combined with high blood levels of LDL cholesterol, triglycerides, homocysteine and/or C-reactive protein. Quitting smoking, along with improved diet and increased exercise, helps reduce these other risks.

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