Article for September, 2006

Women and High Cholesterol: Ways to Lower It with Diet and Exercise

By Catherine Jones

"Mom just had a heart attack. We're at the hospital now. She's okay. We're waiting for the test results to see if there was any heart damage."

"When did this happen? How could this happen?"

"Mom said she had chest pains at around four in the morning, but she waited until six to wake me up to drive her to the hospital," Mark said. That sounds like mom, I thought to myself.

Mark went on, "she told me she had chest pains earlier in the week but thought she just pulled a muscle wallpapering the bathroom. On Friday, they got so bad she called 9-1-1. The paramedics came and tried to take her to the hospital but she wouldn't go. She told them that she was feeling better and signed a release form. She promised to see her doctor that afternoon, but she never did. She was too busy. Too busy! Can you believe it?"

"Yes, I can," I said.

A week later I flew to New Hampshire to take care of my mom when she got out of the hospital. I was responsible for making sure she followed a heart-healthy diet and did her exercises. I felt like the food police and drill sergeant rolled into one. Ironically, it was my mother who taught me the pleasures of cooking as a little girl. She planted the seed that started my career as a chef and food writer. And now, here I was telling her she couldn't eat her favorite foods. In her mind, food was to enjoy, not to be measured in calories, grams of saturated fat, or milligrams of cholesterol. As for cardiovascular exercise, she considered housework and running errands exercise enough.

What I wanted at that moment was for someone to explain the confusing world of cholesterol and fats so I could understand it. I wanted someone to tell me what foods can raise or lower cholesterol levels, and how to design heart-healthy meal plans. I found Elaine Trujillo, a registered dietitian, who answered all of my questions, and explained complicated terms in understandable words. We decided to put our talents together to write a health-cookbook entitled, Eating for Lower Cholesterol: A Balanced Approach to Heart Health with Recipes Everyone Will Love.

One of the most important lessons I learned from Elaine is that women need to stay on top of their heart health by getting their cholesterol levels checked and following a cardiac-friendly diet and lifestyle. Estimates show that 107 million Americans have high cholesterol, and of those, 56.5 million are women! An increased risk of heart disease in women occurs after menopause when levels of estrogen decline. Estrogen is associated with higher levels of HDL (good) cholesterol and lower levels of LDL (bad) cholesterol, so this protective effect is highest during childbearing years and plunges after menopause. It was thought that Hormone Replacement Therapy (HRT), also called Postmenopausal Hormone Therapy (PHT), would be a promising option for women. But in major studies, Hormone Replacement Therapy did not prevent heart disease or stroke in postmenopausal women, and was found to result in potentially higher rates of cancer.

Heart disease is the leading cause of death among American women, as well as men. Prevention through a heart-healthy diet and lifestyle starting at a young age is ideal. For women with heart disease, the American Heart Association recommends statins as the first line of drug therapy, which are very effective in lowering LDL cholesterol levels and have few immediate short-term side effects. Any drug therapy should be combined with a low-saturated fat and low-cholesterol diet, weight management, and regular exercise. Taking a pill alone does not solve the problem.

It is vital to recognize that symptoms of a heart attack in women can differ slightly from men: pain or discomfort in the center of the chest or areas of the upper body, including the arms, back, neck, jaw, or stomach; shortness of breath; breaking out in a cold sweat; nausea; severe vomiting; severe abnormal fatigue; or light-headedness. If you experience any of these warning signs, or just don't feel right, get help immediately. Please don't wait or make excuses like my mother did!

Ways to Lower Your Cholesterol with Diet and Exercise

Vegetables and Fruits

• Eat an abundance of vegetables and fruits; aim for nine servings daily. The more colorful the produce, the more vitamins it contains. The less you cook vegetables, the more vitamins they retain.

• Fruits and vegetables high in folic acid are particularly good for your heart. Some good choices include: green leafy vegetables, asparagus, avocado, spinach, citrus fruits and juices, beans, lentils, and chickpeas.

Whole Grains and Fiber

• Half of your grains should be whole-grains instead of refined grains; 3 or more ounce-equivalents of whole-grain products per day are recommended. Whole wheat cereals and breads, brown rice, and whole wheat pasta are good choices.

• Soluble fiber, found in whole grains, oatmeal, barley, ground flaxseeds, psyllium, and beans, reduces LDL cholesterol levels. Insoluble fiber, from fruits and vegetables, is necessary for good health, though it does not have the same cholesterol-reducing effects.

Fats, Oils, and Cholesterol

• Minimize saturated fat consumption. Saturated fats are found mostly in animal products, such as meat and cheese, and are solid at room temperature.

• Limit cholesterol consumption to 300 milligrams (mg) per day (200 mg per day if you have high LDL cholesterol). A 4-ounce serving of chicken breast has 66 mg of cholesterol; pork tenderloin has 74 mg; and ground beef has 96 mg.

• Avoid products that contain trans fats, also known as partially hydrogenated oils. These include almost all processed foods such as cookies, crackers, deep-fried frozen foods, packaged mixes, stick margarine, and fast foods.

• Choose heart-healthy unsaturated fats from plant sources. These fats increase HDL (good) cholesterol when they replace saturated fats and carbohydrates in the diet. Polyunsaturated fats have the additional benefit of decreasing total and LDL cholesterol levels. Oils high in cholesterol-reducing polyunsaturated fat include corn, sunflower, safflower, and soybean. Good monounsaturated oils include canola, olive, and peanut.

• Soft margarine made from vegetables oils is the best. Avoid hard or stick margarines and hardened vegetable oils, such as Crisco, for baking.

• Keep calcium intake high (1,000 mg daily for women under 50 and 1,200 mg daily for women over 50), but consume only fat-free or low-fat dairy products.

Lean Meats and Seafood

• Research suggests that having about two servings of fish per week (approximately 8 ounces total) may lower the risk of death from coronary heart disease. Choose fatty fish and shellfish high in omega-3 fatty acids – polyunsaturated fats – that can reduce triglyceride levels, which appear to be higher in women. Good omega-3 fish sources include salmon, albacore tuna, trout, shrimp, and scallops.

When it comes to eating fish, there are some important safety limits for women. Women who are pregnant, breastfeeding, or of childbearing age:

• should avoid shark, swordfish, king mackerel, and tilefish because they have high levels of mercury that could be dangerous to unborn and breastfeeding babies.

• can eat up to 12 ounces (2 average meals) a week of a variety of other fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock, and catfish.

• can eat up to six ounces of albacore tuna per week. Albacore or "white" tuna has more mercury than canned light tuna.

For people who are not pregnant, breastfeeding, or of childbearing age, the mercury content in fish and shellfish is not a health concern.

• Plant sources of omega-3 fatty acids include soybean oil, canola oil, walnuts, and flaxseed.

• Always choose the leanest white meats (such as chicken or turkey without the skin—breast meat or drumstick is best) and decrease consumption of red meats.

• Beans and legumes are excellent meat substitutes.

• For women ages 19 to 30, the daily recommended amount from the meat and beans food group is five and one-half ounces; the recommendation for women over the age of 30 is five ounces. Women who are more physically active may need more from this food group.

Exercise

• Your intake of calories from healthy foods should be balanced by exercise that burns off those calories. Exercise can increase your good cholesterol and decrease your bad.

• Make daily exercise a priority. Why? It reduces your risk of heart disease, high blood pressure, osteoporosis, diabetes, and obesity. It helps you maintain a healthy weight. It contributes to your mental well-being, helps relieve stress, increases your energy, and it helps you sleep better.

• Engage in at least 30 minutes of moderate-intensity physical activity, such as walking, jogging, or tennis, on most days of the week. This amount of exercise has been shown to help prevent chronic disease in adulthood.

• To help manage body weight, engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week.

Don't try to revamp your diet and lifestyle overnight. Gradual and realistic changes tend to be more lasting. As a safety net, take a multivitamin with minerals daily. Consume less than 2,300 mg of sodium per day. If you have high blood pressure, your doctor may advise you to consume less than 1,500 mg of sodium daily.

If you drink alcoholic beverages, do so in moderation (up to one drink per day for women and two drinks for men). Limit your consumption of refined carbohydrates and foods that contain high fructose corn syrup, such as sodas, candy bars, and other junk food. Avoid fast food, especially the "value combos" that are loaded with fats, sodium, and calories. And, watch your portions at every meal. The earlier we begin to take care of our hearts, and those of our loved ones, the healthier and happier everyone will be.

Most of the health information contained in this article is adapted from, Eating for Lower Cholesterol: A Balanced Approach to Heart Health with Recipes Everyone Will Love (Marlowe & Company, December 2005), by Catherine Jones and Elaine Trujillo, MS, RD, CNSD. For more information about cholesterol and heart-healthy recipes go to www.staybalanceddiet.com.

More Information:

Current as of September 2006