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Keeping Cholesterol Under Control

Uh-oh! Your lab results are back and your cholesterol levels are in the danger zone. Your doctor has given you an ultimatum: start exercising and watch your diet, or you'll have to start taking a cholesterol-lowering medication.

Millions of American adults are being handed the same marching orders--whip those cholesterol levels into shape or go on a prescription medication. Others, like former President Bill Clinton, must endure more radical treatments. In Bill Clinton's case, the solution was quadruple heart bypass surgery because the cholesterol in his body had left his arteries clogged with plaque.

Whether you're a lifelong couch potato or simply confused about how to take control of your blood cholesterol, take note: September is National Cholesterol Education month. This is the perfect time to learn about what your cholesterol levels mean and what you can do to improve them.

America's war on lowering high cholesterol levels has never been as ferocious as it is today. Some studies have shown that the more people reduce their low-density lipoprotein (LDL) cholesterol--the "bad" kind of cholesterol known to clogs arteries--the lower their risk for heart attack and stroke.

Studies also show cholesterol-lowering medications (such as statins) are extremely effective, slashing LDL levels by 25 to 35%. There's evidence that statins may raise HDL, the "good" cholesterol too, which can further protect people against heart attacks.

U.S. health officials developed guidelines recommending people at very high risk of heart attack, such as cigarette smokers, those with existing cardiovascular disease, or poorly controlled high blood pressure, to lower their LDL to less than 70 milligrams per deciliter, from the previous goal of 100. The guidelines also recommended drug therapy for high-risk individuals with LDL levels of 100 or higher.

To help people reach these recommended levels, physicians are prescribing more cholesterol-lowering medications; they're also beginning to use them more aggressively. Instead of giving patients a "starting dose" of a statin to see whether it works, many times they'll double the dose, said Dr. David J.A. Jenkins, a professor in the department of nutritional sciences at the University of Toronto. "Physicians are increasingly encouraged to do this and that's not just in North America," he said. "They'd rather that you started with a therapeutic dose rather than work up to a therapeutic dose."

Cholesterol, a fatty substance found in blood and cells, is needed for normal body functions. Yet most Americans have total cholesterol counts that are too high--200 and above--putting them at risk of cardiovascular disease, the nation's No. 1 killer.

Too much LDL cholesterol in the blood can form plaque deposits that clog arteries, blocking blood flow to the heart and brain. Most people should strive for LDL cholesterol levels of less than 100. HDL levels, conversely, protect the heart and should be high.

According to the American Heart Association, people with total cholesterol of 240 and above have double the risk of heart disease as those who keep their cholesterol under 200, High cholesterol can run in families. And as people age, cholesterol levels tend to increase. Still, people can do a lot to dramatically improve their odds against heart disease and stroke, the heart association says. Following are some tips to help you do this:

1. Reduce the amount of saturated fat and cholesterol in your diet.
2. If you're overweight, shed excess pounds to help reduce your LDL cholesterol and boost good HDL cholesterol.
3. Do 30 minutes of exercise on most days, if not every day, to improve cholesterol levels and keep you trim.

Dr. Carol L. Roberts, president-elect of the American Holistic Medical Association, encourages patients to do more exercise and switch to a low-fat diet that's relatively low in carbohydrates. But her approach to cholesterol is rather unconventional.  "First of all, I don't think cholesterol's the enemy here," she said. Cholesterol is a symptom of a hormonal imbalance, she explained, and once patients are given therapy to boost low hormone levels, cholesterol levels often improve. "My philosophy is to do everything natural first--use drug therapy only if needed--and so the statins may fit into an overall program," she said. Jenkins said statin therapy inevitably will play a critical role in reducing the nation's cholesterol levels because most people won't be able to achieve the new recommended goals through diet and exercise alone.

Meanwhile, the list of foods and "nutraceuticals" boasting a natural cholesterol-lowering effect continues to expand. The U.S. Food and Drug Administration (FDA) allows most nuts and foods containing whole oats, psyllium and soy to claim that they may reduce the risk of heart disease as part of a diet low in saturated fat and cholesterol. New margarine-like spreads containing an ingredient from plants that blocks cholesterol absorption also are allowed to make that claim.

"If you decide to put all those things together in a diet that people can eat, you may actually get the same cholesterol-lowering effect as you got with the first generation statins," Jenkins said.

SOURCES: David J.A. Jenkins, M.D., Ph.D., D.Sc., professor, nutritional sciences, University of Toronto, and director, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto; Carol L. Roberts, M.D., ABHM, president-elect, American Holistic Medicine Association, and founder and medical director, Wellness Works, Brandon, Fla.; American Heart Association; National Heart, Lung, and Blood Institute.


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