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Frequently Asked Questions

1. How to prevent getting high cholesterol?

You may help to prevent high cholesterol by staying on a healthy diet and exercising daily. Avoid high-fat foods (eggs, fatty red meats, palm or coconut oil, dairy products made with whole milk). Instead eat more fresh fruits and vegetables, whole-grain breads and cereals, and low-fat dairy products.

2. What are the treatment methods?

The initial treatment of high cholesterol should always be lifestyle changes. This means altering your diet and getting more exercise. Some people respond dramatically to dietary changes.

Diet

There is no consensus on the best diet. The most effective diet to lower total and LDL cholesterol is a vegetarian diet. However, this is not an easy diet to follow.

Many people prefer a "Mediterranean style" diet. There is no strict definition for what should be included in this type of diet. In general, this means

  • Getting the majority of daily food calories from plant sources, especially fruits and vegetables, grains, beans, nuts, and seeds
  • Using olive oil as the principal fat, replacing other fats and oils
  • Having some low fat cheese and/or yogurt daily
  • Eating fish a couple times per week
  • Limiting processed foods
  • Drinking alcohol in moderation unless medically not indicated. No more than two drinks per day for men and one per day for women.

The National Cholesterol Education Program recommends the following diet:

  • Saturated fat - less than 7% of calories
  • Monounsaturated fat - about 20% of calories
  • Polyunsaturated fat - about 10% of calories
  • Protein - about 15% of calories
  • Carbohydrates - about 50% of calories
  • Fiber - about 25 grams of soluble fiber per day
  • Cholesterol - less than 200 milligrams per day

Avoid all trans fats.

To maintain a desirable weight, you should take in only as many calories as you burn each day. If you need to lose weight, you need to take in fewer calories than you burn.

People who aren't sure how to follow such a diet may find it useful to work with a health care professional such as a dietitian, nutritionist, doctor or nurse.

In addition to dietary changes, you should get at least 30 minutes of moderate-intensity exercise, such as brisk walking, daily.

Medications

Whether you need medication to lower your cholesterol level depends on how you respond to diet and your personal risk of heart attack and stroke.

There are five types of cholesterol-lowering medications:

  • Bile acid-binding resins, including cholestyramine (Questran) and colestipol (Colestid). They are used less often today because they lower HDL (good) cholesterol as well as LDL (bad) cholesterol.
  • Niacin (several brand names).
  • Fibrates, including gemfibrozil (Lopid), fenofibrate (Tricor) and clofibrate (Abitrate). Fibrates are especially helpful for people with high triglyceride levels.
  • Statins, also called HMG - CoA reductase inhibitors, including lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Statins block an enzyme called HMG-CoA reductase, which is necessary for the production of cholesterol. They are the most commonly prescribed cholesterol lowering medication.
  • Selective inhibitors of intestinal cholesterol absorption - There is only one available, ezetimibe (Zetia).

If your cholesterol is not controlled with diet and other lifestyle changes, your doctor may recommend that you take one or more of these medications. Each type of medication works differently and has different types of side effects.

In addition to dietary changes or medication, people with high cholesterol should try to control their other risk factors for coronary artery disease. This means keeping blood pressure at normal levels, not smoking, controlling your blood sugar, maintaining or losing weight and following a regular exercise schedule.

3. When To Call a Professional?

Because it is possible to have high cholesterol for many years without symptoms, it is important to have your blood cholesterol level checked periodically. Current guidelines recommend that adults older than 20 undergo a full fasting lipid profile once every five years. This test measures LDL and HDL cholesterol and triglyceride levels. If the numbers are outside the desirable range, your doctor may suggest that you change your diet and monitor your cholesterol more frequently.

4. What is prognosis ?

The effectiveness of following a healthy diet and using medications to lower cholesterol varies from person to person. On average, diet and exercise can lower LDL cholesterol by about 10%. Medications can lower LDL cholesterol by another 20% to more than 50%.

5. I've heard that a couple of drinks of alcohol a day will help my cholesterol. Is this true?

It is true that modest alcohol ingestion will raise the "good" (HDL) cholesterol. It appears that the equivalent of one or two ounces can raise the level by 5-10%. Red wine may provide some additional benefit, as can some dark beers.

6. Does a patient have to be fasting for a total cholesterol or HDL?

No. It has been shown in the recent years that total cholesterol can range up and down 30mg/dL daily - unassociated with the fasting state. The daily variation shown is not greater than the variation from a recent diet. Just as the body strives to maintain a 20:1 balance between bicarbonate and carbonic acid, the body tries to maintain electrolyte neutrality. The concentration of anions should equal the concentration of cations in the body.

7. How can I improve my HDL, or "good cholesterol," without taking medications?

Consuming monounsaturated fats can improve your HDL as well as reduce triglycerides and bad cholesterol (LDL). These include olive oils and other vegetable oils, nuts and avocados. Some foods such as peanuts, green peas, sunflower seeds and corn can also raise HDL. Other important strategies to raise HDL include a regular exercise program, alcohol in moderation and the cessation of smoking. Calcium supplements have also been shown to increase HDL levels.

8. How can I raise my HDL level?

quot;Good cholesterol", as HDL is known, is a very important factor in preventing heart disease. The higher the level, the better. Unfortunately, going on a low fat diet may lower your total cholesterol, but it won't raise the HDL. In fact, HDL often goes down on a low fat, high-carbohydrate diet. Mono-unsaturates like olive oil may help, as will fish oils. Losing weight and exercising regularly can also help. Medication may raise it, but often not by very much.

9. What Is Bird Flu?

Bird flu, also known as Avian Influenza A, is a contagious disease of birds. It normally only infects birds, but has been reported in some cases of human infections. Avian Influenza is known as a "zoonotic disease" -- infections caused by animal viruses or bacteria that can cross species to infect humans.

There are two forms of bird flu. The “low pathogenic” form is mild and may go undetected among birds. The “highly pathogenic” form spreads rapidly, affecting internal organs and rapid death among domestic poultry. Some researchers believe that migratory birds can spread low pathogenic virus to domestic poultry, and these viruses can mutate to the highly pathogenic forms.

10. How Do You Get Bird Flu?

Most cases of bird flu in humans have occurred following contact with sick or dead infected poultry. Spread of the disease occurs from viruses found in the saliva, nasal secretions, and feces of infected birds. If you are at risk of being exposed to infected poultry, it is recommended careful hand hygiene and use of personal protective equipment, as well as following biosecurity and infection control practices.