It has often been said that you are what you eat. To a large degree, this is true as one’s diet plays a large role in one’s state of health. There are several considerations when trying to eat healthy. And there is a tremendous amount of information available on nutrition and sometimes the science is controversial.
I like to say we have take a view from thirty thousand feet to understand where we have gone so wrong in westernized civilization in terms of our diet. Obesity, diabetes, hypertension, physical inactivity and hypercholesterolemia (elevated serum cholesterol) are epidemic in our society. It would be remiss to discuss what dietary choices affect just cholesterol, as diabetes, hypertension, and hypercholesterolemia all travel together.
It’s especially timely now to have this dialogue, as February is American Heart Month. Heart disease is a major problem. According to the Centers for Disease Control, every year, about 715,000 Americans have a heart attack. About 600,000 people die from heart disease in the United States each year—that’s 1 out of every 4 deaths. Heart disease is the leading cause of death for both men and women. But the good news is that heart disease is preventable and controllable.
When patients ask how they can lower their cholesterol, I typically break the issue down into two types of patients. The first and most common is the overweight individual who is simply addicted to simple carbohydrates. The second is the individual who appears rather fit but has quite elevated LDL-C (the cholesterol carried in the low density lipoproteins). This is largely genetic and rather than too many simple carbohydrates driving the process, it is saturated fat.
In the first type of patient, food addiction to simple carbohydrates leads to abdominal obesity and insulin resistance and/or diabetes. What then happens is a dangerous metabolic process leading to elevated triglycerides and low HDL-C (good cholesterol) and rather low LDL-C (bad cholesterol). The total cholesterol may be low, but this dyslipidemic pattern is very dangerous for cardiovascular disease.
The carbohydrates that contribute unfavorably to this process are white bread, white rice, potatoes, white pasta, and even bananas. Refined baked goods like cakes, cookies, muffins, and bagels are typically overconsumed. Many of these baked goods also contain trans-fats. And finally, liquid calories from milk, juice, Gatorade, regular soda, and alcohol all contribute negatively if consumed routinely. Remember, low fat milk doesn’t mean low sugar (lactulose) milk!
For the second type of patient who tends to eat a seemingly healthy diet and appears fit but has dangerously elevated total and LDL-cholesterol, the problem is consumption of saturated fat. Believe it or not, the cholesterol content in a food does not contribute to one’s cholesterol as much as the saturated fat content of the food. For these individuals, avoidance of excess fat in animal products like chicken or beef is important. Remember, chicken skin is more of a saturated fat than is beef fat. These individuals also need to avoid too much saturated fats in butters, creams, and cheeses, and of course avoid trans-fats in baked goods and stick margarine.
For many, there is a combination of dietary problems. Most fast food choices include lots of high glycemic index carbohydrates in the white bun, french fries, and of course the soda and lots of saturated fats in the beef and the deep fryer. So, what to eat? To quote a few good choices, the South Beach Diet, the Mediterranean Diet, and the Stone Age Diet are good places to start. Just think about what humans were made to eat. When we arrived on this planet, we ate fruits, vegetable and nuts, along with lean meats from deer and fish- and just some grains. There was no soda or manufacturing plants to grind the whole wheat into flour or refined sugar. Our digestive systems should be doing the food processing and not a factory.
If you are eating much like our primitive ancestors then you probably won’t have high cholesterol contributing to heart disease and stroke. And the good news for us in Baltimore - eating cholesterol found in shellfish like crabs and shrimp does not contribute largely to high cholesterol. Our intestines have a protein that prevents much of this cholesterol from being absorbed...but be careful of the butter you put on it and what else is on the plate!
-John R. Brown, D.O., is a physician at the GBMC at Hunt Valley office. Dr. Brown is a Diplomat in the American College of Osteopathic Family Medicine and a Diplomat in the American Board of Clinical Lipidology