For San Francisco advertising executive Fred Goldberg, high cholesterol is an occupational hazard. Between business meals and clients that include Round Table Pizza and Dreyer's Grand Ice Cream, his cholesterol level hit a towering 380 five years ago, and it still routinely hovers around 250. To compensate, the 50-year-old adman takes two different cholesterol-lowering drugs a day, runs three times a week, and often skips meals. "I'm living proof," he sighs, "that a pill is not enough for someone who started out where I did."
Alas. Recent publicity on the effectiveness of Merck's cholesterol-lowering agent Mevacor in reversing atherosclerosis, a leading cause of heart disease, was great news for the company. But for most Americans, the cholesterol story hasn't changed much.
Drugs such as Mevacor, niacin, and Pravachol, a new agent from Bristol-Myers Squibb, have been proven to work. But they carry high price tags, and some can have unpleasant side effects. And unless the drugs are paired with dietary changes, their effect on cholesterol, says Judith Levine, consulting nutritionist to the American Heart Assn. (AHA), "is like bailing water out of a boat with a hole in it."
Studies have shown that for every percentage point drop in your cholesterol, your chance of heart disease drops two points. While doctors are still debating some fine points of cholesterol management, the essential advice is to lower your fat and cholesterol intake. With a little common sense and some basic information, you can get through the cholesterol-saturated holidays and on to a healthier heart.
Your battle against cholesterol starts with a numbers game. Learn your total cholesterol count, your good-to-bad cholesterol ratio, and then a new way of evaluating the healthiness of your diet.
First, have your doctor check your cholesterol level. In families with a history of heart disease (such as one in which a close relative under 55 has suffered a heart attack), many doctors say even young children should be checked. Otherwise, establish a baseline cholesterol level at about age 25 with subsequent checks during annual physical exams.
GAME PLAN. Most doctors recommend not exceeding a total cholesterol level of 200. But your total cholesterol level includes two main parts, so-called high-density and low-density lipoproteins, or HDL and LDL. LDL is often called bad cholesterol because it leads to arterial buildups. HDL appears to carry cholesterol away from arteries to the liver where it can be eliminated. Evidence is growing that raising HDL levels can protect you from heart attacks. The AHA recommends that your LDL level not exceed 130, with a corresponding HDL level then falling in the 60-70 range. Doctors say a 1:3 ratio of HDL to LDL is generally acceptable.
It's important to base your game plan for controlling cholesterol on various risk factors. If your total cholesterol level is over 240 and you are overweight, a smoker, or have a family history of heart disease, your doctor may put you on medication immediately. But most people, even those with healthy cholesterol levels, first are advised to maintain a low fat and cholesterol diet.
There is a fairly short list of foods so high in cholesterol that most doctors recommend cutting them out entirely: egg yolks, organ meats -- such as liver or brains -- and most shellfish. Also, dairy products and meats tend to be high in cholesterol, and cooking foods with butter should be avoided. Experts recommend consuming no more than 300 milligrams a day -- about the equivalent of one egg scrambled in one pat of butter.
So-called saturated fats raise blood cholesterol levels, too, and such fats are found in both plant and animal foods. That's one reason why the Food & Drug Administration has come down hard on some food companies who trumpet "no cholesterol" on labels for baked goods: The products may actually contain high levels of saturated fats from tropical oils such as palm or coconut.
Nutritionists recommend that you limit your saturated fat intake as much as possible. In cooking, you can do that by swapping saturated fats for unsaturated fats, such as that contained in corn, safflower, canola, olive, or peanut oil. In addition, recent findings show that by using monounsaturated fats, including olive and canola oil, you may help lower total cholesterol without lowering good HDL.
FACTS ON FAT. But here's the rub: Heart disease is not the only byproduct of a fatty diet. It's also been implicated in certain kinds of cancer. Thus, you can't just eat unlimited amounts of unsaturated fats. Strict diet plans such as Pritikin recommend that fat not comprise more than 10% of your total caloric intake. Meanwhile, the AHA and others say at minimum limit fat intake to 30%.
To educate yourself about the foods you eat, turn to nutrition books and healthful cookbooks to find calorie counts, cholesterol and fat contents listed by grams and breakdowns of saturated and unsaturated fat. One suggestion: The Chez Eddy Living Heart Cookbook ($25; Prentice Hall), compiled by the doctors and staff of a gourmet restaurant in Houston's Methodist Hospital. You can calculate fat as a percentage of total calories by multiplying the grams of fat times 9 and dividing by the number of calories. If fat accounts for more than 30% of total calories, go easy on that particular food, or compensate by eating other very low-fat foods that day. Regulators also are pushing foodmakers to provide better fat content indicators on food labels.
Year-round adherence to a good diet is the key -- not a Scrooge-like posture during the holidays. Advises Levine: "There are 10 holidays from Halloween to Super Bowl Sunday. It's not 10 days out of 90 that give you trouble. Eat what you like on the holidays, but take smaller portions." Skip the turkey skin. Take twice the salad and half the stuffing. But take a sip or two of eggnog if you want to.
If you are preparing meals, follow the example of entrepreneur Judy O'Shea, 46, co-founder of Cholestech, a Hayward (Calif.) company trying to develop better cholesterol tests and treatments. O'Shea roasts her turkeys with the skin off. She cooks the stuffing separately and puts only a small pat of butter in it. She uses monounsaturated oils. And her husband and seven kids don't complain: Her famous holiday dessert, meringue smothered in raspberries (minuscule fat and cholesterol), disappears in a twinkle.
Diet is the single most important factor in lowering cholesterol, but recent studies have reinforced the importance of exercise, too. Combining 90 minutes of aerobic exercise per week with dietary changes has been found to raise HDL levels while lowering total cholesterol.
GENE THERAPY? The jury's still out on alcohol, although many doctors believe a glass of red wine a day may in fact raise HDL levels. But beware of faddish solutions. "You can't have your steak and eat it, too," warns Cardiologist Thomas Bersot of the University of California at San Francisco's Gladstone Foundation Laboratories. "Focusing on drinking wine or oat bran takes away from the central message of lowering fat, especially saturated fat."
Researchers are still unlocking clues to the cholesterol puzzle. Some scientists believe doctors may someday be able to insert genes in people to counteract genetically inherited cholesterol problems. But in the meantime, get your cholesterol checked. Educate yourself about the fat content of the foods you eat. Maintain an exercise regimen. And if your numbers are still high, for heaven's sake, stay out of advertising.
WAYS TO HELP YOUR HEART DURING THE HOLIDAYS 1 Know your cholesterol level: Your total cholesterol should not exceed 200; your LDL, or bad cholesterol, should not exceed 130 2 Try to exercise at least 90 minutes a week to lower total cholesterol but raise good HDL cholesterol levels 3 Eliminate high-cholesterol foods such as eggs, shellfish, and organ meats, but also pay attention to your fat intake as a percentage of total calories. It should not exceed 30% 4 Save high-fat or high-cholesterol foods you love for special occasions; then, take smaller portions of offenders and double up on salads and low-fat foods 5 If you cook, cut back on all oils, especially saturated fats, such as butter. Try to use monounsaturated fats such as olive, peanut, and canola oil, which appear to raise good cholesterol levels DATA: AMERICAN HEART ASSN.; BW