Clogging: Curb cholesterol to live longer


In Asia, red meat is as rare as pink diamonds in America (though I'm sure J Lo might have a trove).

When my cousins immigrated from South Korea in 1975, I remember how much red meat they ate. They ate so much steak and Korean beef BBQ that I thought they were going to put on cowboy boots and lasso up some steers. "Yeehaa! Beef!"

Does beef taste that much better than fish? I guess so, because studies have shown Asians in the U.S have more heart disease than their relatives back in Asia. Like vampires, we are putting "steaks" through our hearts. I have to be careful though– remember what happened to Oprah. (In 1996, she was sued by Texas cattlemen for fanning fears about "mad cow disease.") Thus I wonder, "Do most Americans worry about their cholesterol?"

I am amazed how much we talk about cholesterol yet so few people understand it. We see cholesterol information everywhere: in commercials, on food packages, at restaurants, on bottles of cooking oil. What I have observed is that most people don't realize certain fats become cholesterol inside the body.

I'm fascinated to see really unhealthy food packages brag in bold letters, "No cholesterol!" It's like the infomercials, "No cholesterol?" "That's right! No cholesterol." "You mean this is free of cholesterol?"

The ads are right: When you are eating these foods, they contain no cholesterol at the time you swallow. However, some of the fats in the food are converted into cholesterol once you digest them.

So in these cases, advertising, "No cholesterol!" is like saying gasoline is carbon monoxide free. Sure it is, but once your car engine burns it up, carbon monoxide is produced.

When I have a new patient, I often hear, "My cholesterol was checked and something was good and something was bad. I'm not sure what it means." When I send my patients their cholesterol values, I write down what's what.

HDL, high density lipoprotein, is good for you. It helps keep your pipes (arteries) clean, like Drano. People who exercise a lot and drink wine with dinner tend to have high HDLs. (I have a really high HDL. If someone has a higher HDL than mine, I compliment her not that I'm competitive!)

Now, LDL, low density lipoprotein, is the evil cholesterol. It's like pouring bacon grease down your sink clogs the pipes and leads to heart attacks and strokes. Triglycerides are also evil, like a hairball stuck in your drain. Then there are all sort of other lipids like Lp(a) and Apo B that we won't talk about today.

Diet and exercise are the best and safest ways to control your cholesterol. I don't think the pharmaceutical industry likes to hear this because cholesterol-lowering medications is one of the biggest markets. I don't think the pharmaceutical industry will every have to worry about most Americans lowering their cholesterol naturally.

Someone I love dearly (my father) has told me, "Why eat well? Why exercise? Enjoy and take medicine!" I must admit that sounds tempting. However, cholesterol-lowering medications can have side effects, like making you feel you just ran the Boston Marathon or just pickled your liver with a case of bad gin.

Cholesterol is pretty invisible. It's not like having a migraine or arthritis that you can feel. Cholesterol is like hair slowly clogging the tub: When it starts, your tub simply takes longer to empty. Then one morning when you're in a rush, you can't drain the water.

I know we all have to die sometime, but I tell my patients, "What makes you so sure you'll die if you have a heart attack or stroke? You might survive and be disabled."

Food for thought.

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