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HDL cholesterol: How to boost your 'good' cholesterol
Food Combo as Good as Cholesterol Drugs

HDL cholesterol: How to boost your 'good' cholesterol

The higher your HDL cholesterol, the 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.

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.

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.

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.


Food Combo as Good as Cholesterol Drugs

Four-Part Veggie Diet Cuts "Bad" Cholesterol by 29%

You really can eat your way to heart health. A combination of cholesterol-busting foods offers as much heart protection as cholesterol-lowering drugs, a Canadian study finds.

Earlier studies have shown that four types of food can each lower cholesterol by 5-10%. The new study -- the first to try all four at once -- shows that these effects add up. After eating all of these foods for a month, study participants dropped their "bad" LDL cholesterol levels by 29%. For most of them, this meant the difference between high and normal levels.

"Instead of just using a diet with just one component we thought, 'Let's put them all together and see if we can do better,'" study leader David J.A. Jenkins, MD, tells WebMD. Jenkins is director of the clinical nutrition and risk factor modification center at St. Michael's Hospital and professor of nutritional sciences at the University of Toronto, Ontario, Canada.

Thirteen otherwise healthy, slightly overweight men and women with high cholesterol levels took part in the experiment. They already were on the low-saturated-fat, low-cholesterol diet recommended by the U.S. National Heart, Lung, and Blood Institute.

Their diet had four components:

Soy-based. "We were looking at soy-based meat substitutes such as soy burgers, soy hot dogs, and soy cold cuts," Jenkins says. "And we also used soy milk as a dairy substitute."

Sticky fiber. Study patients used the natural psyllium product Metamucil -- many used it to thicken their soy milk -- and ate oat-bran cereal and barley-based soups.

Plant-sterol enriched margarine. This Unilever product is sold in the U.S. as Take Control and in other countries as Becel/Flora pro.activ.

Nuts. Study patients ate a handful of almonds every day.

These foods were part of a seven-day diet plan using foods available in supermarkets and health-food stores. The foods included vegetables such as broccoli, carrots, red peppers, tomato, onions, cauliflower, okra, and eggplant. A typical day on the diet offered a breakfast of soy milk, oat-bran cereal with chopped fruit and almonds, oatmeal bread, sterol-enriched margarine, and jam. Lunch might be soy cold cuts, oat-bran bread, bean soup, and fruit. Dinner might be a stir-fry dinner with vegetables, tofu, fruit, and almonds. Snack foods would include nuts, yogurt, and soy milk thickened with Metamucil.

The drop in the study participants' cholesterol level was almost entirely due to a drop in "bad" LDL cholesterol. This drop was roughly the same as that seen by patients taking the cholesterol-lowering drugs known as statins. Jenkins speculates that patients with very high cholesterol could add statins to get an even better effect. They could also reduce high statin doses by adding these foods to a low-fat/low-cholesterol diet, he suggests.

These results greatly impress Gene Spiller, PhD, director of the Sphera Foundation and Health Research and Studies Center, Los Altos, Calif. Spiller is co-author (with John W. Farquhar, MD) of the book Diagnosis: Heart Disease, a guide to a heart-healthy lifestyle. Spiller says Jenkins's study provides hard evidence for what he's been saying for years.

"It is very important what Dr. Jenkins is doing now. It is a crucial idea to combine these dietary elements," Spiller tells WebMD. "Most researchers want to know what such-and-such food does, so they study it in isolation. But they are really missing the boat. The fact these things are additive is the greatest and most important idea."

To get the maximum anti-cholesterol effect, a person would have to eat several portions of each type of cholesterol-lowering food every day. It would also be important to stay away from animal fats, foods with high levels of saturated fats, and foods high in cholesterol. But Jenkins and Spiller each say that those who can't make this kind of lifestyle change can still lower their cholesterol levels by doing as much as they can.

"My advice is try a little of all of these foods," Jenkins says. "A few nuts are never a bad thing -- just a handful of almonds is enough. Try some of the soy foods -- soy milk with your breakfast cereal and soy substitutes for meat. Try oat bran, it is a good breakfast. And try a few things on a cold day like vegetable barley soup. Try incorporating these things into your diet little by little. Ease your way in and find the foods you like and eat them more often. If you do that each day, have one or two and build up, you should get a measurable effect on your cholesterol levels."

SOURCES: Metabolism, December 2002 • David J.A. Jenkins, MD, director, clinical nutrition and risk factor modification center, St. Michael's Hospital, Toronto, Ontario, Canada and professor of nutritional sciences, University of Toronto • Gene Spiller, PhD, director of Sphera Foundation and Health Research and Studies Center, Los Altos, Calif., co-author of Diagnosis: Heart Disease,

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