Dr. Drew WernerSeptember 26, 2004

EAGLE COUNTY - As I am sitting at my computer writing this column andlistening to some downloaded country music, I can't help but think ofsounding like a broken record. With CDs and MP3s playing in perfectdigital music, I still miss my old turntable. I even had one that wouldplay the same side of the album over and over - what a concept.

With great care I would place each record album back in its jacket untilinevitably a party would get into full swing and the albums would pile uplike pancakes until they were eventually put away the next day. If I waslucky, all would be fine. If not, the dreaded scratch would cause themusic to skip, ruining my favorite song. The dreaded broken record.

Well, I hope I'm more like my "fancy" turntable, playing the same songover only to be appreciated more.

Here we go. The answer is diet, weight loss and exercise. And thequestion: How do I lower my cholesterol?

All three lifestyle factors are essential in maintaining a healthycholesterol. Diet remains the core of what ATP III (Adult Treatment PanelIII) calls TLC or therapeutic lifestyle changes.

It stresses lowering saturated fats. Saturated fats are usually solid oralmost solid at room temperature. All animal-derived fats, such as thosein meat, poultry and dairy products, are saturated. Processed and fastfoods are commonly saturated. Vegetable oils also can be saturated aswell, such as palm, palm kernel and coconut oils.

Conversely, polyunsaturated fats and monounsaturated fats typically remainliquid at low temperatures. Polyunsaturated fats are found in vegetableoils such as corn oil, safflower oil, soybean oil, and sunflower oil whilemonounsaturated fats are found in vegetable oils such as olive oil, peanutoil and canola oil.

Specific nutrition guidelines of daily calorie intake include:

Saturated fat: Less than 7 percent of total calories.

Polyunsaturated fat: Up to 10 percent of total calories.

Monounsaturated fat: Up to 20 percent of total calories.

Total fat: 25-35 percent of total calories.

Carbohydrates: 50-60 percent of total calories.

Fiber: 20-30 g/day.

Protein: Approximately 15 percent of total calories.

Cholesterol: Less than 200 mg/day.

Regular aerobic exercise three times a week, and keeping your weight at aBMI (body mass index) of less than 25 are ideal, as well.

If all your efforts fail, medications are in order. There are four basictypes of cholesterol-lowering medications. Each has advantages anddisadvantages, including the possibility of side effects. The importantthing to remember is that any side effect risks are significantly lowerthan the risks of heart attack and stroke.

The classes of medications include:

HMG CoA reductase inhibitors also called statins. These work by blockingan enzyme that is needed by the body to make cholesterol. Since nearly 80percent of your body's cholesterol is synthesized by your liver,cholesterol levels may drop dramatically. While side effects are unusual,the most common ones are an upset stomach, gas, constipation and abdominalpain or cramps. Less common side effects include fever and muscle aches orcramps. Periodic blood tests are also recommended to monitor the action ofstatins on our liver.

Bile acid sequestrants lower cholesterol by binding with cholesterol inour intestines and blocking absorption. Since a significant portion of ourcholesterol is produced in our livers and secreted in our intestines thesemedications are helpful even in low cholesterol diets. With over 30 yearsof use, they are safe but may cause intestinal side effects such as gas,constipation and bloating. Because they bind things, care must be used ifthey are taken with other medications.

Nicotinic acid or niacin only mildly lowers cholesterol, but is veryeffective in lowering triglycerides and raising HDL, or the goodcholesterol. Unfortunately, it has the fairly common side effect offlushing and hot flashes. It may increase the effect of anti-hypertensivemedication and raise blood sugar.

Fibrates, like niacin, are best at lowering triglycerides and raising HDL.Their primary side effects are intestinal, although they may also put youat higher risk of developing gallstones.

As with most medications, side effects diminish or go away over time.Likewise, not all symptoms are side effects. Because intestinal symptomsand muscle aches are so common, it takes careful scrutiny to tell if thesecomplaints are in fact medication related. Most importantly, medicationsare not to replace a healthy diet and lifestyle, but to add to it. If youare still not convinced, take the following test.

See what happens if you lower your cholesterol! Hypothetically, if mycholesterol was elevated and I lowered it 60 points while raising my HDL10 points, I would lower my risk of heart attack by 4 percent over thenext ten years, or cut it by two-thirds! The calculator can be found at:http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof

Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly columnfor the Daily. He encourages health questions. Write him by e-mail toeditor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, 81658.

Vail, Colorado