Understanding Cholesterol

At her heaviest, Joanne Morse, 68, weighed 210 pounds.

She would skip breakfast and eat Chinese food or a hamburger for lunch -- if she ate lunch.

At night, she ate bowls of ice cream.

Being overweight placed the 5-foot-6 Morse at high risk for heart disease and diabetes. To make matters worse, she also had high cholesterol, which her doctor said further increased her risk for heart disease and stroke.

At it's highest, Morse's total cholesterol, which includes both the good (HDL) and the bad (LDL) cholesterol, was 297, which is considered to be very high.

"I had yo-yo dieted all my life," said Morse, who teaches anatomy and physiology and alternative medicine in the School of Pharmacy at Hampton University in Hampton, Va. “Every diet they come up with works, but to a certain extent.”

Cholesterol is a fat-like substance in the blood that can build up in the walls of the arteries. High cholesterol, if allowed to build up over time, can cause a hardening or narrowing of the arteries, which may reduce or block blood flow to the heart, resulting in a heart attack or stroke.

“You need some cholesterol, but the excess comes from fatty foods, greasy foods like fried chicken, steaks and rich desserts,” said Dr. Roger Blumenthal, director of the John Hopkins Ciccarone Prevention Cardiology Center in Baltimore, Md.

Good vs. Bad Cholesterol?

So what, exactly, is a healthy cholesterol level?

A total cholesterol of less than 200 is ideal, 201-239 is considered borderline high, while 240 or above is high.

But not all cholesterol is bad cholesterol.

HDL or high-density lipoprotein, is considered good cholesterol. It helps remove plaque from the body and transports waste out of the body, sometimes through excrement. HDL cholesterol should be at least 40.

LDL or low-density lipoprotein, is the bad cholesterol that clogs arteries. An LDL cholesterol of less than 100 is optimal, 100 to 129 is near optimal, 130 to 159 is borderline high, 160 to 189 is high, and 190 is very high.

“HDL is like a trash collector; LDL is like a trash depositor,” said Blumenthal, who teaches heart disease risk assessment. “If you don’t have a good sanitation department, you’re going to have a messy, filthy city block.”

An unhealthy diet is not the only thing that leads to high cholesterol, Blumenthal said. Other risk factors include genetics, diabetes, obesity and stress.

“Genetics play a role, as does the environment,” Blumenthal said. “Some people are born with extremely high cholesterol, and even with diet they still have problems.”

Morse took action to lower her cholesterol two years ago, and she now has total cholesterol of less than 200 and has lost 44 pounds. She has written a book about her experiences called “How Low Can You Go? Nutritional Limbo."

Managing Cholesterol

A simple blood test can detect high cholesterol, which can affect people of any age.

The American Heart Association estimates that 106.7 million Americans -- 50.8 million men and 55.9 million women -- age 20 and older have total blood cholesterol levels of 200 milligrams.

To obtain a healthy cholesterol level, Blumenthal suggested individuals eat more fruits and vegetables, whole grains and less red meat.

They should also increase their physical activity, he said.

He suggested walking a minimum of two miles or 5,000 steps per day to control weight, since weight is a key contributor to elevated cholesterol levels.

“If you can, average 10,000 steps, which is about four miles each day, to keep weight off,” Blumenthal said.

Understanding what foods contain bad cholesterol is also important, Blumenthal said, and so is having a routine discussion with your doctor.

The American Heart Association recommends these points of discussion for persons with cholesterol concerns:

— An explanation of cholesterol numbers;

— How often cholesterol needs to be screened;

— Personal cholesterol goals;

— How smoking affects cholesterol;

— Acceptable foods to eat.