Adventures in Cholesterol Land

What to do when your doctor puts on a black hood and talks of heart attacks

Among the millions of chemicals that make us up, there are two called cholesterols that cuddle up to the red cells in our blood. One kind is what we get in fried eggs, bacon and sausage. Low-Density-Lipids. LDL. Bad Stuff.

Well, not quite - our liver makes about a gram a day of them even if we don't eat them. Otherwise our body cells would starve to death, and us with them. But, our cells are supposed to convert all the LDL to HDL - High-Density-Lipids - then happily absorb nutrients for another day. If we eat too much LDL, the excess gums up our arteries and we get heart attacks. Or something like that.

Well, Judgement Day came for me.  A call from my doctor's office.  My recent blood tests.  Cholesterol.  LDL 6.3 mmol/l; HDL 1.6  (Americans, divide your mg/dl by 39 to get international units.)  After 65 years of gobbling everything in sight and charging all over the landscape, it seems I ought to restrain myself if I want to keep enjoying this marvellous world of ours.

Now, I've got a good doctor. She did note that I could solve my problem by becoming a pill-popper. Statins, they're called. But, there's no history of heart disease in my family. No diabetes or high blood pressure either. As a result, I'm only at 13% excess risk of heart attack compared to baseline. Diet modification might work. For example, how about losing a bit of that weight I've put on since retirement? Not too much, mind - at 6'4" and 190 lb, I'm only a bit above ideal weight.  5 lb or so? (Here's how it ended up.)

To start, I consulted the glossy pamphlets. One, by an Egg Marketing Board, announces that solid fats of any kind, margarines especially, are no-no's - full of filthy-saturated fats and even-worse trans-fats. But, eggs are 100% natural - wonderful things. We've thrived on them ever since we had to dodge dinosaurs. The next, by a Margarine Company, swears that egg yolks will clog my heart in a day, but that their special margarine might just keep my heart going for a hundred years. With a non-stop smile too. The third, by a Major Drug Company, is certain that their drugs will keep me in glowing health for a hundred years all by themselves. With attractive women hanging on to my every word, yet.

And we wonder why our politicians feel they can fib to us now and then.

However, the majority scientific view is that, barring excess dietary cholesterol (the usual limit quoted is 300 mg/day), our body chemistry pretty well decides on its own what blood cholesterol level to maintain. Many studies have found that adding small amounts of cholesterol to a low-cholesterol diet, with nothing else changed, does not increase blood levels significantly. Needless to say, on the web skip any pages with pictures of eggs or margarine! The average North American does not eat a low-cholesterol diet. Nor, as it turned out, did I.

It seems that diet change can only succeed if it persuades our body to change its cholesterol control level. There is lots of general advice to control body weight, exercise regularly, reduce dietary saturated fats and increase dietary fiber. But, apart from exercise, none of it is backed up by proper studies. And, several other factors are known to significantly decrease the risk of heart attack at a given cholesterol level, vitamin E and fish oil in particular. In fact, there is some evidence that natural cholesterol might not be a problem at all, it's only when it gets oxidized in the body that problems arise.

Try diet first. The College of Family Physicians of Canada warns that going on cholesterol medication is a lifelong treatment, so it should be thought about only if healthy habits don't work. Besides, I don't like popping pills.

So, what foods really might be worst? All the pamphlets agree: fatty red meats. But, I hardly touch them except for Italian sausage. I can find something else to flavour tomato sauce. Eggs (2 out of 3 of course), but I only use them to make bread. Cheese - oh oh! 20% saturated fat by dry weight or more. Usually much more. Damn, I love the stuff. (In fact, it turned out that cheese was 80% of my dietary cholesterol.) Prepared foods - palm oil is worse than raw lard, and just look at coconut oil! So much for my favourite frozen lasagna. And, I guess I always knew I really shouldn't be hooked on Ritz crackers.

OK, hit Google. "Ape Diet Could Reduce Need For Drugs, Researcher Says". "A vegetarian diet can lower cholesterol as effectively as cholesterol drugs, says a new Canadian study". The proposed 'ape diet' begins with a special margarine. Where have I heard that before? It continues with gobs of tofu, which didn't feature in the diet of any ape I've ever heard of either. Other elements of the diet include beans, nuts and fruit, but mostly, it seems, eggplant. How much eggplant do gorillas eat? But, the Journal of the American Medical Association thought it was worth publishing (D.Jenkins et.al 23 July 2003).

Margarine (special or otherwise): All margarines are mostly saturated or trans-fat - that's why they don't drip. Eating monounsaturated fats (oils) instead of saturated fats reduces LDL. Polyunsaturated oils reduce both LDL and HDL, so those who believe HDL to be beneficial recommend avoiding them. (Besides, they are all omega-6, see below.) I use olive oil. Almost all monounsaturated, it tastes great. Just stick to "extra virgin" grade packed in glass in Italy or Greece, where the phrase is legally binding. Anything else can be anything at all. Canola oil is similar to olive oil, but without the taste. Costs less too. No matter what oil you use, keep it refrigerated once open to keep it from oxidizing. The less saturated fat in a product, the more important refrigeration is.

Tofu: The equivalent of cottage cheese made from soybeans. No higher in proteins than natural grains, very high in omega-6 and phytates. And, believe me, the stuff can grow food poisoning as fast as raw chicken can. Don't touch it with less than a week to go to the best before date. As soon as it's opened, wrap tightly any you won't use within a day and freeze it in 3 oz pieces (one serving protein). Recook anything you use it in thoroughly after more than a day in the frig.

Beans: I love them. White beans with molasses, kidney beans with pepper, romano beans with garlic, mung beans with chopped cucumber. Delicious stuff, from 40 above to 40 below, breakfast, lunch, supper, snacks. Carry them for a month on a wilderness trek and they're still in great shape to cook. But, indoors I have difficulty with beans: gas. I mean, when your cat gives you a dirty look and stalks off to the far end of the house to continue her snooze, you've got a problem. The gas comes from raffinose and related sugars that I can't digest. People with my problem are supposed to bring beans to the boil, soak them for 4 hours to dissolve out the sugar, cook them in fresh water, then wash them again after cooking. Well, I once tried a week of soaking kidney beans, changing water twice a day. Mrow! pat, pat, pat ... Of course, if you don't have my problem, go for them - they're great food.

Nuts: I'm nuts about them. Literally - I even grow them. When my mom won a 2 lb box of chocolates at a bridge bee, she would come home, eat the whole box at one sitting, then diet for the next month and announce it was worth it. I'm that way about nuts - cashews in particular. They're great food - just high in calories.

Fruit: What memories fruit brings back. Growing up surrounded by peaches, pears and grapes just outside the back door in the Niagara peninsula. The hundred apple trees in Cumberland that gave all the fresh-pressed apple juice I and 5 children could drink, all the organic zero-additive applesauce we could eat all year round. (Applesauce makes great pancakes and bread, among many other things.) Raspberries and currants right off the bushes, wild strawberries in the fields, plum tomatos by the basket full. Wax-coated pesticide-tainted works of art at local stores sure pale by comparison. Still, given the number of foods I'm cutting out, I'll add a few more to the shopping basket.

Eggplant: Why on earth eggplant? There must be a hundred other vegetables, particularly in the cabbage and onion families, that are more nutritious, taste better, and don't have to be trucked from Mexico all year round. Carrots, spinach, cauliflower, broccoli, peas, corn, potatos, any kind of onion, any kind of lettuce ... I can eat all of them, as fast as a starving rabbit, any day.

After Google, I checked the local library. The Pritikin Program: if you don't live to 100 it will sure seem like it - total food boredom. The Kowalski Cure: phytate-loaded oat bran and near-toxic doses of niacin are magic bullets. Atkin's Agenda: anything goes as long as you stuff yourself with steak. The Drinkers' Diet: resveratrol and saponins in red wine are cholesterol fighters. Magnetotherapy . . . Wow.

What about grains to reduce cholesterol? Wheat, rice, oats and barley in particular? Well, it's a cat fight out there. Real back alley style, complete with bared claws, yowls and thrown bottles.

Essentially all who insist (with distressingly little experimental evidence) that low dietary fat, the lower the better, saves our hearts claim that nothing is better for us than grains. Those who study aboriginal diets from northern latitudes (but who forget that our ancestors didn't have central heating - even my mother didn't until she went to teachers' college) insist that a diet of 40% fat works just fine for lots of cultures, and add that real apes don't eat grains at all.

It's politically correct to insist that whole grains are Better For Us than refined ones. It's true that the bran and endosperm contain most of the B vitamins. Raw dietary fiber in grain brans is believed by many to assist digestion of food. But, few indiginous cuisines agree - they mostly soaked their grains before cooking. Modern science disagrees too - several compounds in grain brans, phytates in particular, are now known to be significant impediments to good nutrition, specifically of absorption of metal nutrients, unless deactivated.

Relax: in Canada 'whole wheat' flour isn't - it's just refined white flour with a bit of processed bran added back, unless you get it fresh ground from a health food store. But, pot barley is still pretty much the real thing, and 'brown' rice and wheat kernels ('berries') can also be found. Although most oatmeal sold for hot cereal is heavily modified, it's not too difficult to find plain rolled oats with baking supplies. It's important, though, to soak all truly-whole grains in water overnight to deactivate phytic acid and similar enzymes. Don't count on the ultimate health step: sprouting them to turn them into vegetables. Almost all suppliers now chemically treat grains to kill them so they can't sprout. Even health food stores' suppliers.

Then there is the omega-3 factor. (Fats and oils are both 'lipids'; omega is one way of classifying them.) This is no cat fight, it's a love-in. You can find books by the dozens and web sites by the thousands claiming that omega-3 from fish and flax seed will cure a hundred different things that ail us. If you've read the patent medicine testimonials that clogged our newspapers a century ago, they will sound very familiar. Big food industry is accused of pushing excess 'bad' omega-6 (grain-fed meats and farm fish), while the egg industry touts their pricy omega-3-boosted eggs despite their cholesterol. On the fringe, there are flax seed and fish-oil capsule peddlers.

In the face of all this hype, it's useful to remember: small quantities of each omega (roughly a gram of each per day) are almost certainly essential nutrients for us. Not necessarily large quantities. And, the corelation of population-wide fish consumption with a low rate of heart attacks and with overall mental health is widely accepted.

Basically, grains are high in omega-6, natural fish in omega-3. Some vegetables are higher in omega-3 than omega-6, but starchy ones aren't. Farm fish are fed mostly with grains, high in omega-6. Fish are what they eat too. Grains, flax seed included, contain solely one omega-3 lipid, none of the most important ones; fish provide a variety. Every one of our ancestors who lived near any kind of water ate as much fish as they could get. There is even a hypothesis that our human brain developed because our ancestors ate fish. But, they didn't get their fish from new lakes, created behind dams, that are full of mercury from decomposed trees. Nor did they get them from rivers fed by industrial pollution, like Canada's Wabigoon. Most experts recommend sticking to very small doses of any fresh water fish these days.

Almost everyone, though, recommends at least two servings a week of natural ocean fish. (The Japanese eat two per day.) Except, those who believe we are running out of them. Skip the frozen 'breaded' versions of course - palm oil etc.

But, are those fish oils truly helpful? Or, are they merely better than red-meat fat? Pelagic fish such as mackerel reach 15% lipids, while groundfish such as cod are typically 1%. If fish oils are truly good for us, we should go for mackerel. Otherwise we should prefer cod. As I read the literature, the important issue seems to be to keep lipids in balance. Given the preponderance of omega-6 in grains, we should choose other foods by their omega-3 content. Here are some numbers for foods with more omega-3 than omega-6 (USDA data, Canadian dollars late 2003):

foodservingtotal lipids cholesterolcost/g omega-3
frozen seafood
chum salmon83 g3.8%61 mg$.81
pollock1091.0771.68
flounder/sole1101.2524.42
cod1220.7524.90
canned seafood
herring509.038 .21
sardine5410.437 .28
jack mackerel646.351 .28
sockeye salmon607.3291.49
albacore tuna783.0331.75
oyster1472.5784.46
clam1351.0467.07
crab1151.19014.80
vegetables(short omega-3 only)
spinach323 .0801.98
cauliflower400 .102.30
broccoli330 .3502.94
lettuce800 .1503.00
squash250 .104.15
green bean323 .1208.32
pills
fish oil,refined111000 .38

So, canned herring is the lowest cost for omega-3. And, if you include dietary cholesterol in your evaluation (divide cholesterol by % lipids), herring looks even better.

There's only one problem with thinking about all this lovely food: it makes me want to cook it all and eat it. But, I'm supposed to be losing weight . . .

Well, I did start cooking. And, I put on 5 lb the first two weeks! And so, I entered the world of Diet Land.

John Sankey
other notes on nutrition