Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Time to answer some letters. I received a letter from a Mrs.
W concerning standards for cholesterol and dealing with
diet/medications/and exercise for both high cholesterol and
obesity.
I start off by saying that high cholesterol can lead to high
risks of stroke, heart disease and pancreatitis.
Cholesterol is a complex molecule which is very similar to
the hormones testosterone and estrogen. It can be made by the
body in the presence of fat. Most of the cholesterol you take
in from eating is not kept in the body, as your body will
synthesize what it needs from the fat in the body. However,
at times this system doesn't work well, and cholesterol
readings can rise. Signs of this are often absent and the way
most people find out is through a routine blood test.
The cholesterol is then broken down into a profile with the
LDL type being the troublemaker, and the HDL type being
better. As cholesterol is involved in atherosclerosis or
"hardening of the arteries," it is important to have a low
cholesterol and triglyceride profile (the latter is a by-
product of fat metabolism). As far as I could tell, the
standards in Israel are the same as the USA, which is LDL
should be less than 130, HDL greater than forty for a man and
50 for a woman, and triglycerides should be less than 150.
Total cholesterol should be less than 200.
Diet therapy begins at LDL 160 and medical therapy is added
when 190 is reached. Higher risk individuals (those with
relatives who had heart disease below 55 in a male relative,
and below 65 in a female relative, those with diabetes, high
blood pressure, older than 45 in a male and 55 in a female
and menopause without hormone replacement therapy) should
start diet changes from when LDL factor is greater than 100
and medications when LDL goes above 130. This last risk is
controversial, as it isn't clear that hormone replacement
therapy is beneficial and it may cause more danger, but in
any case it's prudent to lower your cholesterol.
Diet. Diets to lose weight succeed rarely -- about 10 percent
of the time. But diets to lower cholesterol do work. A
dietitian will help you, but you must lower total fat intake
to less than 30 percent of your calories in a day, with most
of that being monounsaturated. This is the type found in fish
and nuts. Saturated fats are the biggest no no. You'll find
them in meats, egg yolks, whole dairy products, palm and
coconut oils. However partially hydrogenated and hydrogenated
fats in many Israeli products are the same as saturated fats
no matter what their source.
In Israel, we eat a lot of vegetables and nuts
(pitzuchim). Great! But we also eat a lot of
hydrogenated fat, palm oil for Pesach and kugel full
of eggs. Contact me for low-fat recipes.
The rest of the diet should include plenty of fiber -- bran
is a good source -- and carbohydrates, but not too many.
While there is a move towards more protein intake, overloads
of both things cause the body to turn them into fat. No
matter what, best are fruits and vegetables. Write me in care
of the Yated.
A message from Glaxo, sponsor of this column. Pramin--
the most common drug used for vomiting in Israel, pushes food
forward, but doesn't reduce the urge to vomit from the
vomiting center in our brains. Zofran is a potent anti-
vomiting drug that does influence this area in our brains and
that is why it is so effective.
