Cholesterol

by Eleanor Mayfield

Cholesterol is sort of a "cousin" of fat. Both fat and cholesterol belong to a larger family of chemical compounds called lipids. All the cholesterol the body needs is made by the liver.

It is used to build cell membranes and brain and nerve tissues. Cholesterol also helps the body produce steroid hormones needed for body regulation, including processing food, and bile acids needed for digestion.

People don't need to consume dietary cholesterol because the body can make enough cholesterol for its needs. But the typical U.S. diet contains substantial amounts of cholesterol, found in foods such as egg yolks, liver, meat, some shellfish, and whole-milk dairy products. Only foods of animal origin contain cholesterol.

Cholesterol is transported in the bloodstream in large molecules of fat and protein called lipoproteins. Cholesterol carried in low-density lipoproteins is called LDL-cholesterol; most cholesterol is of this type. Cholesterol carried in high-density lipoproteins is called HDL-cholesterol.

A person's cholesterol "number" refers to the total amount of cholesterol in the blood. Cholesterol is measured in milligrams per deciliter (mg/dl) of blood. (A deciliter is a tenth of a liter.) Doctors recommend that total blood cholesterol be kept below 200 mg/dl. The average level in adults in this country is 205 to 215 mg/dl. Studies in the United States and other countries have consistently shown that total cholesterol levels above 200 to 220 mg/dl are linked with an increased risk of coronary heart disease. (See "Lowering Cholesterol" in the March 1994 FDA Consumer.)

LDL-cholesterol and HDL-cholesterol act differently in the body. A high level of LDL-cholesterol in the blood increases the risk of fatty deposits forming in the arteries, which in turn increases the risk of a heart attack. Thus, LDL-cholesterol has been dubbed "bad" cholesterol.

On the other hand, an elevated level of HDL-cholesterol seems to have a protective effect against heart disease. For this reason, HDL-cholesterol is often called "good" cholesterol.

In 1992, a panel of medical experts convened by the National Institutes of Health (NIH) recommended that individuals should have their level of HDL-cholesterol checked along with their total cholesterol.

According to the National Heart, Lung, and Blood Institute (NHLBI), a component of NIH, a healthy person who is not at high risk for heart disease and whose total cholesterol level is in the normal range (around 200 mg/dl) should have an HDL-cholesterol level of more than 35 mg/dl. NHLBI also says that an LDL-cholesterol level of less than 130 mg/dl is "desirable" to minimize the risk of heart disease.

Some very recent studies have suggested that LDL-cholesterol is more likely to cause fatty deposits in the arteries if it has been through a chemical change known as oxidation. However, these findings are not accepted by all scientists.

The NIH panel also advised that individuals with high total cholesterol or other risk factors for coronary heart disease should have their triglyceride levels checked along with their HDL-cholesterol levels.

Food and Drug Administration Publication No. (FDA) 99-2286