Cholesterol CONUNDRUM

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RESEARCH released earlier this month suggesting that an egg is more unhealthy than a KFC Double Down sandwich has left many Canadians baffled about the food they eat and its effect on blood cholesterol.

The firestorm of confusion started when the University of Western Ontario announced its cholesterol review, published in the November issue of the Canadian Journal of Cardiology.

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In the announcement, three researchers from the school made the point that one egg yolk contains more cholesterol (215 to 275 mg ) than a deep-fried, sodium-heavy fast-food sandwich (which has 150 mg of cholesterol).

The researchers said that the public -- as well as doctors -- are under the spell of egg marketers who have us all fooled into thinking eggs are a health food.

Amanda Nash, a registered dietitian with Manitoba's Heart and Stroke Foundation says such statements need to be taken into context.

"When you're looking at a high-fat fast-food sandwich, it's not going to be a healthier alternative to eggs," says Nash, noting that one egg has only five grams of fat, about 70 calories and is loaded with vitamins.

Meanwhile, KFC's Double Down sandwich -- which features two chicken breasts, bacon, processed cheese and a dollop of KFC's special "Colonel's Sauce" -- clocks in at 540 calories, 30 grams of fat and 1,740 milligrams of sodium.

Nash says studies prove that saturated fat -- that's the kind found in animal products -- have a greater impact on blood cholesterol levels than cholesterol itself.

She says that the average person should take in about 300 mg of dietary cholesterol a day. A person at high risk for heart disease should take in about 200 mg.

"(The researchers) were looking for a shock value. And what they were pointing out was that eggs have more cholesterol than a fast-food sandwich. They just missed some of those key nutrients while pointing that out."

Dr. Arthur Agatston, the cardiologist-author of the bestselling South Beach Diet, is also irked by the University of Western Ontario journal article.

"Today, what's caused the problem of obesity and kids and early diabetes is not (that) they are eating too many eggs. It's because they are eating too much Kentucky Fried Chicken and fast food in general," says the Florida-based Agatston, noting that saturated fats and the white bread found in fast-food sandwiches can all have detrimental effects on the heart.

Maybe you already know that cholesterol is a waxy substance that can clog up your arteries and lead to heart attack and stroke. But do you know how to interpret the cholesterol results you get from your doctor?

Below, cardiologist Agatston helps me figure out my most recent lipid profile:

TOTAL CHOLESTEROL

Definition: A number that most often combines low-density lipoprotein (LDL) cholesterol, high-density liprotein (HDL) cholesterol and triglycerides, a blood fat.

Significance: Many heart experts say that total cholesterol will not accurately determine your heart attack risk. "The fact is that total cholesterol is a poor predictor of future coronary disease," says Agatston. That's because while your LDL (unhealthy cholesterol) and triglycerides (also unhealthy) may be low, your HDL may be elevated. (A high HDL is generally good for your heart, but can drive up your total values).

My results: 6.57 mmol/L. This is considered higher than normal.

Desired range: Under approximately 5.2 mmol/L, according to numerous medical bodies.

Doc's analysis: Agatston agrees that my total cholesterol is high. But based on my overall numbers, he says it looks like I'm at low risk for coronary disease.

TRIGLYCERIDES

Definition: These aren't cholesterol. Rather, they are blood fats (also known as a lipids) that are stored by the body under the skin and on the organs.

Significance: Generally, triglycerides are not good for the heart, blood vessels or the pancreas. So the lower the number, the better. Agatston says people with high triglycerides likely overindulge in quick-acting carbohydrates. He says patients can reduce their triglycerides by exercising, reducing belly fat and eating less white flour/sugar. The deadly combination to watch out for, says Agatston, is high triglycerides and low HDL. "That's definitely dangerous," he says, noting that high triglycerides and low HDL are often precursors to insulin resistance and Type 2 diabetes. He says omega-3 fish oil can lower high triglycerides. He prescribes them to patients whose triglycerides are through the roof. But an over-the-counter fish oil can also help. So can making omega-3s -- in the form of fish, avocado, beans and olive oil -- part of your everyday diet.

My results: 0.7 mmol/L

Desired range: Under 1.7 mmol/L, according to the Mayo Clinic.

Doc's comments: "Your triglycerides are very low. That's very good. With your numbers, I would predict that you are thin. Triglycerides are what I call a lifestyle number."

HDL CHOLESTEROL

Definition: This is the so-called healthy, or good cholesterol. HDL cholesterol acts like a vacuum to clean up the LDL, or bad cholesterol from your vessel walls. It transports it back to your liver where bad cholesterol is broken down and excreted.

Significance: Generally, a higher HDL means that there's less chance your bad cholesterol will stick to your vessels and narrow them. Agatston warns, however, that he treats a few patients who have dysfunctional HDL mechanisms, meaning that they have extremely high HDL levels that aren't protecting their hearts. But for most people, a high HDL is heart-protective. You can increase your HDL through exercise and weight loss. Alcohol consumption can also increase HDL. The bad news is that alcohol can also raise triglycerides to dangerous levels. (Agatston says patients who drink moderately often have high triglycerides and high HDL). Something else to keep in mind: If you have a family history of heart disease or early heart attacks, don't rely on your high HDL to save your life.

My results: 2.47 mmol/L

Desired range: Higher than 1.6

Doc's comments: "Yours is very good. It generally indicates a very good prognosis. At your levels, your HDL is protective.

LDL CHOLESTEROL

Definition: This is the so-called bad cholesterol. It can build up in the artery walls and lead to blockages.

Significance: LDL can be major indicator of heart disease. Although we need cholesterol to make cells and hormones, it's still a good idea to aim for lower LDL levels in the blood. Agatston says studies indicate that saturated fat has a greater impact on LDL than the cholesterol found in foods. Doctors may choose to put you on a cholesterol-lowering drug if your LDL is high or if you have risk factors for heart disease. Agatston says it may be difficult for some people to lower their LDL with lifestyle choices. "If you have high LDL in isolation, sometimes it's genetic and doesn't respond well except with medication. But some people can lower their LDL very significantly with diet and exercise. It's always worth a try." Tips: Exercise, eating soluble fibre -- the kind found in oatmeal -- and limiting your intake of animal fats can all lower LDL. Scientists have also proven that plant sterols can lower LDL cholesterol. Look for products enriched with the ingredient. Beware that trans fats can raise your LDL and lower your HDL.

My results: 3.78 mmol/L

Desired range: Under 3.3 mmol/L. Lower if you're at a higher risk for heart disease.

Doc's comments: Agatston suggests that I consider having a heart scan to check for blocked vessels. (That's because I have had Type 1 diabetes for two decades. The autoimmune, metabolic condition can lead to narrowed arteries over time, thanks to the long-term effects of even minimal excess glucose in my blood. I also have slim family members with elevated LDL levels. That apparently makes me genetically inclined to have high LDL levels myself).

RATIO

Definition: Some laboratories calculate this as he ratio of total cholesterol to HDL cholesterol.

Significance: Experts say this is a far better indicator of heart disease risk than total cholesterol alone.

My results: 2.66 mmol/L

Desired range: Should be less than 4.45 mmol/L

Doc's comments: "Your ratio is clearly good," says Agatston, noting that my high HDL helped create a healthy ratio.

Have an interesting story you'd like Shamona to write about? Contact her at Shamona.Harnett@freepress.mb.ca

Republished from the Winnipeg Free Press print edition November 15, 2010 D1