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HDL cholesterol: How to boost your 'good' cholesterol

The higher your HDL cholesterol, lower your risk of heart disease.

Your doctor says you need to lower your low-density lipoprotein (LDL) cholesterol. You're working hard at that goal but now your doctor says it's important to raise your high-density lipoprotein (HDL) cholesterol. You're not sure whether you're coming or going. It might sound like a mixed message, but this one-two punch — reducing LDL cholesterol and increasing HDL cholesterol — is the best way to lower your risk of heart disease.

Understanding HDL cholesterol

Cholesterol is carried through your blood attached to proteins. The cholesterol-protein package is called a lipoprotein.

Low-density lipoproteins. LDL, or "bad," cholesterol carries cholesterol throughout your body, depositing it along the walls of your arteries. Cholesterol buildup forms plaques that make arteries hard and narrow — ultimately increasing the risk of coronary artery disease.

High-density lipoproteins. HDL, or "good," cholesterol picks up excess cholesterol in your blood and takes it back to your liver for disposal. The higher your HDL cholesterol, the less bad cholesterol you'll have in your blood.

* The message to lower LDL cholesterol is loud and clear — but it might not be enough for people at high risk of heart disease. So doctors are beginning to turn their attention to HDL cholesterol.

Important: In one study, every 1 percent increase in HDL cholesterol was linked to a 2 percent reduction in the development of coronary artery disease. In the same study, participants with the highest HDL levels had half the risk of developing coronary artery disease as did those with the lowest HDL levels.

Set your target

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. When it comes to HDL cholesterol think high. Most people should aim for an HDL level of 60 mg/dL or above. An HDL level below 40 mg/dL increases the risk of heart disease.

For the average man, HDL cholesterol ranges from 40 to 50 mg/dL. Thanks to female sex hormones — which have a positive effect on HDL cholesterol — the average woman fares better, with HDL cholesterol ranging from 50 to 60 mg/dL. But both men and women can benefit from increasing those averages.

If you don't know your HDL level, ask your doctor for a baseline cholesterol test. If your HDL value isn't within a desirable range, your doctor may recommend lifestyle changes to boost your HDL cholesterol.

Make your lifestyle count

Your lifestyle has the single greatest impact on your HDL cholesterol. Even small changes to your daily habits can help you meet your HDL target.

Don't smoke. Smoking lowers HDL cholesterol and increases your blood's tendency to clot. If you smoke, quit. To increase your odds of success, you might want to try more than one strategy at a time. For example, combine medication to reduce nicotine cravings with a support group or individual counseling. Talk with your doctor about your options for quitting.

Maintain a healthy weight. Excess pounds take a toll on HDL cholesterol. But there's good news. If you're overweight, losing even a few pounds can improve your HDL level. For every 2 pounds you lose, your HDL may increase by .35 mg/dL. That's about 1 mg/dL for every 6 pounds. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Get more physical activity. In one study, regular aerobic exercise increased HDL cholesterol by 3 percent to 9 percent in otherwise healthy sedentary adults. Try to get at least 30 to 60 minutes of aerobic activity on most days of the week. Better yet, exercise every day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.

Choose healthier fats. A healthy diet includes some fat, but there's a limit. In a heart-healthy diet, up to 25 percent to 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 7 percent of your total daily calories. Avoid foods that contain trans fat, which raises LDL cholesterol and lowers HDL cholesterol. This includes many margarines, most commercial baked products and anything that contains partially hydrogenated vegetable oil. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Nuts, fish and other foods containing omega-3 fatty acids are other good choices.

Drink alcohol only in moderation. In some studies, moderate use of alcohol (particularly red wine) has been linked with higher levels of HDL cholesterol — but the benefits aren't

strong enough to recommend alcohol for anyone who doesn't drink already. If you choose to drink alcohol, do so in moderation. This means no more than one drink a day for women, and one to two drinks a day for men.

What about medication?

Some medications used to lower LDL cholesterol may also increase HDL cholesterol, including niacin, fibrates (Lopid, others) and statins (Lipitor, Zocor, others).

A study on a promising HDL-raising drug called torcetrapib was halted in late 2006 because more people than expected died while taking the experimental medication. But, while researchers continue to study other options, lifestyle changes will help you on your way to an optimal HDL level.

If your doctor prescribes medication to help control your cholesterol, take it as directed while you continue to focus on a healthy lifestyle.

Lowering cholesterol: Could your diet use some TLC?

Lowering cholesterol often takes dietary changes. The Therapeutic Lifestyle Changes (TLC) diet can help.

Are you at risk of heart disease? Is lowering cholesterol a priority? The key to better heart health may be in your hands — or in your kitchen.

Consider the TLC diet

The Therapeutic Lifestyle Changes (TLC) diet is recommended by the National Cholesterol Education Program of the National Institutes of Health for people who have high cholesterol, heart disease or significant risk factors for heart disease. The premise is simple. Lower your cholesterol — and reduce your risk of heart disease — by limiting the amount of saturated fat and cholesterol in your diet.

The guidelines

The TLC diet allows just enough calories to help you achieve or maintain a healthy weight. Work with your doctor or a registered dietitian to determine the right number of daily calories for you. Plan your meals based on these general guidelines:

Fat. Up to 25 percent to 35 percent of your total daily calories can come from fat — but limit saturated fat to less than 7 percent of your total daily calories. The specific amount of fat will vary depending on how many calories you're allowed a day.

Cholesterol. Limit cholesterol intake to less than 200 milligrams a day. Sodium. Limit sodium intake to less than 2,400 milligrams a day — or even less if you have

high blood pressure.

What can I eat?

Focus on foods low in saturated fat — which are often low in cholesterol, too. This includes fruits, vegetables, whole grains, low-fat or fat-free dairy products, and lean cuts of meat. Avoid fatty meat and poultry with the skin. To reduce your sodium intake, flavor your food with herbs and spices rather than salt.

You can also think of your food choices in terms of daily servings. For example:

Food group

Number of daily servings Serving size

Fruits2 to 4 1 piece of fruit, 1/2 cup diced fruit

or 3/4 cup fruit juice

Vegetables

3 to 5 1 cup leafy or raw vegetables, 1/2 cup cooked vegetables or 3/4 cup vegetable juice

Grains6 to 11 1 slice of bread, 1 ounce dry cereal

or 1/2 cup cooked pasta

Low-fat dairy

2 to 3 1 cup skim milk, 1 cup yogurt or 1 ounce fat-free cheese

ProteinVaries (up to 5 ounces a day of lean meat, poultry and fish; up to 2 egg yolks a week; egg whites or egg substitutes are unlimited)

Substitute 1/2 cup dry beans, peas or tofu for 1 ounce meat

Fats and oils

6 to 8 1 teaspoon soft margarine or vegetable oil, 1 tablespoon salad dressing or 1 ounce nuts

Challenge yourself to modify your typical eating habits. Instead of a muffin for breakfast, top cold cereal with fresh fruit or eat whole-grain toast. Try pasta with stir-fried veggies rather than heavy

meat or cream sauces. Add barley or beans to stews and casseroles. Eat fresh fruit for dessert. Occasional sweets and snacks are OK, as long as healthier foods are the main part of your diet.

What about exercise?

What you eat is important — and so is physical activity. Regular exercise can help you maintain a healthy weight, lower low-density lipoprotein (LDL or "bad") cholesterol and boost high-density lipoprotein (HDL or "good") cholesterol. With your doctor's OK, begin a regular exercise program. Try a brisk daily walk, swim laps or join an exercise class.

How does the TLC diet differ from other heart-healthy diets?

The principles are much the same. But the TLC diet restricts saturated fat and cholesterol intake more than do other diets intended to promote heart health. Although the TLC diet may be appropriate for anyone, it's designed for people who have high cholesterol, heart disease or significant risk factors for heart disease.

What if it doesn't work?

Diet, exercise and weight control are often the key to lowering cholesterol. But sometimes a more aggressive approach is needed. If your doctor prescribes medication to lower your cholesterol, take it as directed — and use the principles of the TLC diet as the foundation for a lifetime of healthy eating.

Cholesterol: The best foods to lower your cholesterol and protect your heart

High cholesterol: Discover the best foods to reduce your cholesterol.

Can a bowl of oatmeal help prevent a heart attack? How about a handful of walnuts, or even your baked potato dressed in sterol-fortified margarine? A few simple tweaks to your diet — like these — may be enough to stave off a cholesterol problem.

Oatmeal and oat bran

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, brussels sprouts, apples, pears, psyllium, barley and prunes.

Soluble fiber appears to reduce the absorption of cholesterol in your intestines. Gel-like soluble fiber binds bile (which contains cholesterol) and dietary cholesterol so that the body excretes it.

Five to 10 grams of soluble fiber a day decreases LDL cholesterol by about 5 percent. Eating 1.5 cups of cooked oatmeal provides 4.5 grams of fiber — enough to lower your cholesterol. To mix it up a little, try oat bran or cold cereal made with oatmeal or oat bran.

Walnuts, almonds and more

Studies have shown that walnuts can significantly reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy and elastic. Almonds appear to have a similar effect, resulting in a marked improvement within just four weeks.

A cholesterol-lowering diet in which 20 percent of the calories come from walnuts may reduce LDL cholesterol by 12 percent. For a 1,200-calorie per day diet, a little less than 1/3 of a cup of walnuts is about 240 calories, or 20 percent of the total calories for the day.

All nuts are high in calories, however, so a handful will suffice. As with any food, good or bad, eating too much can cause weight gain, and being overweight places you at higher risk of heart disease. To avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, luncheon meat or croutons in your salad, add a handful of walnuts or almonds.

Fish and omega-3 fatty acids

Studies in the 1970s showed that Greenland Eskimos had a lower rate of heart disease than did other individuals living in Greenland at the same time. Analysis of dietary differences between the groups showed that the Eskimos ate less saturated fat and more omega-3 fatty acids found in fish and whale and seal meat.

Research since that time has supported the heart-healthy benefits of eating fish. If you can't dine with the Eskimos, other good sources of omega-3 fatty acids include flaxseed, walnuts, canola oil and soybean oil.

Omega-3 fatty acids are noted for their triglyceride-lowering effect, but they also help the heart in other ways such as reducing blood pressure and the risk of blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — significantly reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in mackerel, lake trout, herring, sardines, albacore tuna and salmon. However, to maintain the heart-healthy benefits of fish, bake or grill it.

Foods fortified with plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Margarines and orange juice fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of "good" high-density lipoprotein (HDL) cholesterol. Nor do they interfere with the absorption of the fat-soluble vitamins — vitamins A, D, E and K.

However, the American Heart Association recommends foods fortified with plant sterols only for people who actually have high levels of LDL cholesterol.

Soy

Long thought to have cholesterol-lowering effects, a recent meta-analysis by the American Heart Association's Nutrition Committee showed soy protein actually has very little impact on reducing cholesterol levels. In January 2006, the American Heart Association issued a statement saying the cardiovascular health benefits of soy protein are minimal at best. No benefit was seen on HDL, triglycerides, or blood pressure and even with a large intake of soy, only a small impact on LDL was seen.

Though it may not lower your cholesterol, soy does contain vitamins and minerals and is a good source of fiber. It's also a healthy low-fat alternative source of protein.

Cut fats first

The first step for a heart-healthy diet is to reduce your intake of bad fats — especially saturated and trans fats. If cutting out bad fats isn't enough to reduce your cholesterol, you may want to try adding soluble fiber, nuts and fish to your diet. If you need more boost from your foods, try adding foods fortified with plant sterols.

Eating a combination of these cholesterol-lowering foods increases the benefit. But dietary changes alone are not always enough for everyone. If your cholesterol is still high after you've revised your diet and increased your physical activity, your doctor may suggest adding cholesterol-lowering medications to your treatment plan.

Prepared by:Dr.Humayun Mirza

OASIS-Primary Healthcare for all by 201521- Gulfishan Colony

Post Office Road Off Multan Road LHR-54500.Pakistan.