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Холестеролът е един от най-често изследваните елементи на кръвта. Понякога хората изпадат в паника, когато видят завишени стойности. Те невинаги са повод за безпокойство, казва проф. Волфрам Делиус, кардиолог от Мюнхен. Холестеролът изпълнява някои важни задачи в организма и е незаменим за него. Какво представлява той? Холестеролът е подобна на мазнините субстанция, която е незаменима за изграждането и функцията на клетките. Участва в образуването на хормоните, например половите, както и за отделянето на жлъчната киселина и за синтеза на витамин D. Голяма част от холестерола се образува от самия организъм, най-вече в черния дроб. После той се преобразува главно в жлъчна киселина, една малка част попада в кръвообращението. Ако приемаме твърде много холестерол с храната (препоръчителната дневна дажба е около 300 милиграма дневно), собствената продукция се потиска. Онази част от холестерола, която попада в кръвта, стига до клетките под формата на мастно-протеинови съединения (липопротеини). Там холестеролът се свързва с определени структури в клетъчната мембрана (рецептори) и се приема в клетките. Излишният в кръвта холестерол се връща отново в черния дроб. Поради различни смущения, понякога наследствени, броят на рецепторите в черния дроб може да намалее. Тогава той не може да приеме целия излишен холестерол. Така той остава в кръвообращението и се превръща в рисков фактор за атеросклероза (калциране на съдовете). Важен е балансът между добър и лош холестерол Установеният чрез лабораторни изследвания в кръвта, се състои от различни елементи. Основните са т.нар. „добър“ – HDL холестерол, който е с висока плътност, и „лош“ – LDL, който е с ниска плътност. По принцип нивата и на двата се увеличават с възрастта. Младите жени имат по-ниски нива от младите мъже, но с годините тази разлика се стопява и възрастните жени дори изпреварват връстниците си мъже. Твърде много лош (LDL) холестерол в кръвта се отразява негативно на организма. Допринася за прогреса на атеросклерозата. И обратно – добрият (HDL) холестерол предпазва съдовете от стареене, тъй като подпомага връщането на мазнините от кръвта за преработка в черния дроб. Затова когато се говори за холестерол, трябва да се изследват и двата вида, за да се види не само нивата им поотделно, но и балансът между тях. Повишени нива на „лошия“ холестерол обаче невинаги означават автоматично повишен сърдечен риск, както се смяташе по-рано. Това сочат нови големи проучвания в тази област, казва проф. Делиус. Има данни, че хора с наследствено висок добър холестерол HDL също може да страдат от сърдечносъдови заболявания. Ниските му стойности обаче продължават да се свързват с кардиоваскуларен риск. Хляб и захар стават на други мазнини в кръвта – триглицериди Други важни мазнини в кръвта са триглицеридите, наричат ги още неутрални. Те са 95% общо от всички мазнини в организма. Триглицеридите произхождат пряко от храната, която съдържа мазнини, но те са също така и продукт на обмяната. Човешката мастна тъкан и мерният дроб превръщат в процеса на усвояване въглехидратите в мазнини. Това означава, че ако хапвате повече бял хляб, сладкиши, увеличавате нивата на тези мазнини в кръвта. Лабораторните им стойности зависят силно от това, което консумираме. Ако човек например е пил алкохол и подсладена безаколохолна напитка, триглицеридите скачат. Високите им нива може да са наследствено обусловено, заради възникващ или наличен диабет. При трайно завишени стойности в комбинация с ниски нива на добрия холестерол човекът е застрашен от атеросклероза. Ако само триглицеридите са високи, учените не са на едно мнение дали има риск. Липопротеините са белтъчни молекули, които транспортират мазнините в кръвта. Те са отделен рисков фактор за атеросклерозата, а концентрацията им в кръвта до голяма степен е генетично обусловена. Има и болести, които могат да повишат нивото им – те са свързани с бъбреците, черния дроб или щитовидната жлеза. Препоръчва се поне веднъж те да бъдат изследвани, особено ако в рода има човек, починал рано от инфаркт. Кога холестеролът е заплаха за инфаркт Медицинската преценка за риска при завишени стойности на някои от мазнините в кръвта е индивидуална. За много хора леко отклонение не представлява проблем, при тях не се налага и лечение. Ако обаче има и други рискови фактори – високо кръвно, диабет, пушене, както и коронарна сърдечна болест или прекаран инфаркт, терапията е наложителна. Лекарят прави комплексна преценка, не назначава лечение само въз основа на нивата на холестерола. При нисък общ сърдечносъдов риск, тоест при наличието на най-много само още един допълнителен рисков фактор, лошият LDL-холестерол не бива да надвишава 160 милиграма на децилитър. При няколко рискови фактори има среден общ сърдечносъдов риск. Тогава LDL-холестеролът не бива да е над 115 мг/дл. Висок риск има, когато например човекът има много високо кръвно. Тогава целевите стойности трябва да са още по-ниски – до 100 мг/дл. При много висок риск – диабет тип 2 или прекаран инфаркт, стойностите трябва да са под 70 мг/дл. Ако тази цел е непостижима, стойностите на LDL-холестерола трябва поне да бъдат намалени наполовина спрямо изходната ситуация. За общия холестерол експертите препоръчват не повече от 200 мг/дл. За триглицеридите се смята, че е препоръчително да са под 200 мг/дл, а още по-добре – под 150 мг/дл. Добрият HDL холестерол при жените не бива да е под 45 мг/дл, а при мъжете – да не е под 40 мг/дл. Ако вътрешната стена на кръвоносните съдове (ендотел) е увредена, лошият холестерол се отлага по нея. Там той се окислява. В променения си вид той привлича определени бели кръвни телца – макрофагите. В крайна сметка така се стига до възпаления в съдовата стена, натрупва се атеросклеротична плака. Появява се рискът от тази плака да се откъснат парченца, които попадат в кръвта и образуват тромб. Стигне ли той до някой от захранващите сърцето кръвоносни съдове, човекът получава инфаркт. Ендотелът се уврежда най-вече от пушене, диабет и високо кръвно. Рискът от възпаления може да се установи и с изследване на С-реактивен протеин в кръвта. Храната – може с холестерол, важното е какъв Храните, които съдържат най-много холестерол, са дреболии, яйца, хайвер, масло, скариди. За човешкото здраве обаче е много по-важно видът на мазнините в продуктите. Колкото по-малко наситени мастни киселини има в тях, толкова по-добре. Затова консумацията на животински продукти като масло, месо, колбаси, мляко и млечни продукти трябва да е с мярка. Опасни могат да са и растителните мазнини – например трансмазнините. Те се получават след химическата обработка на растителни мазнини с цел втвърдяването им. Влагат се масово в бисквити, бързи закуски и снаксове. Продукти без никакъв холестерол са например плодовете, зеленчуците, салатите, ориза и картофите. Полезните ненаситени мастни киселини се съдържат в рибата, ядките, семената и растителни масла като зехтина. Внимание – тази статия служи само за обща ориентация и не е повод за самолечение. Точна диагноза и терапия могат да се получат само от лекар специалист.
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This section is a summary of information that has been provided by research from the American Heart Association. These tips will help you understand more about eating habits and what foods to avoid. For more information, we recommend that you visit the web site, Weight Awareness.com Does my body need fats? Yes, it does. Dietary fats are essential to give your body energy and to support cell growth. They also help protect your organs and help keep your body warm. Fats help your bodies absorb some nutrients and produce important hormones, too. How many different fats are there? There are four major dietary fats in the foods we eat: saturated fats, trans fats, monounsaturated fats and polyunsaturated fats. The four types have different chemical structures and physical properties. The bad fats, saturated and trans fats, tend to be more solid at room temperature (like a stick of butter), while monounsaturated and polyunsaturated fats tend to be more liquid (like liquid vegetable oil). Fats can also have different effects on the cholesterol levels in your body. The bad fats, saturated fats and trans fats raise bad cholesterol (LDL) levels in your blood. Monounsaturated fats and polyunsaturated fats can lower bad cholesterol levels and are beneficial when consumed in moderation. What are saturated fats? Saturated fats have a chemical makeup in which the carbon atoms are saturated with hydrogen atoms. Saturated fats are typically solid at room temperature. How do saturated fats affect my health? What foods contain saturated fats? How do saturated fats affect my health? Eating foods that contain saturated fats raises the level of cholesterol in your blood. High levels of blood cholesterol increase your risk of heart disease and stroke. Be aware, too, that many foods high in saturated fats are also high in cholesterol – which raises your blood cholesterol even higher. What foods contain saturated fats? Saturated fats occur naturally in many foods. The majority come mainly from animal sources,including meat and dairy products. Examples are fatty beef, lamb, pork, poultry with skin, beef fat(tallow), lard and cream, butter, cheese and other dairy products made from whole or reduced-fat (2 percent) milk. These foods also contain dietary cholesterol. In addition, many baked goods and fried foods can contain high levels of saturated fats. Some plant foods, such as palm oil, palm kernel oil and coconut oil, also contain primarily saturated fats, but do not contain cholesterol. What’s my daily limit for foods with saturated fats? The daily recommended limiting the amount of saturated fats you eat to less than 7 percent of total daily calories. That means, for example, if you need about 2,000 calories a day, no more than 140 of them should come from saturated fats. That’s about 16 grams of saturated fats a day. What are trans fats? Trans fats (or trans fatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. Another name for trans fats is “partially hydrogenated oils.” Look for them on the ingredient list on food packages. Why do some companies use trans fats? Companies like using trans fats in their foods because they’re easy to use, inexpensive to produce and lasta long time. Trans fats give foods a desirable taste and texture. Many restaurants and fast-food outlets use trans fats to deep-fry foods because oils with trans fats can be used many times in commercial fryers. How do trans fats affect my health? Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. Eating trans fats increases your risk of developing heart disease and stroke. It’s also associated with a higher risk of developing type 2 diabetes.. Why did trans fats become so popular if they have such bad health effects? Before 1990, very little was known about how trans fat can harm your health. In the 1990s, research began identifying the adverse health effects of trans fats. What foods contain trans fats? Trans fats can be found in many foods – but especially in fried foods like French fries and doughnuts, and baked goods including pastries, pie crusts, biscuits, pizza dough, cookies, crackers, and stick margarines and shortenings. You can determine the amount of trans fats in a particular packaged food by looking at the Nutrition Facts label. You can also spot trans fats by reading ingredient lists and looking for the ingredients referred to as “partially hydrogenated oils.” Are there any naturally occurring trans fats? Small amounts of trans fats occur naturally in some meat and dairy products, including beef, lamb and butterfat. It isn’t clear; though, whether these naturally occurring trans fats have the same bad effects on cholesterol levels as trans fats that have been industrially manufactured. How much trans fat can I eat a day? The recommended daily limiting the amount of trans fats you eat to less than 1 percent of your total daily calories. That means if you need 2,000 calories a day, no more than 20 of those calories should come from trans fats. That’s less than 2 grams of trans fats a day. Given the amount of naturally occurring trans fats you probably eat every day, this leaves virtually no room at all for industrially manufactured trans fats. How can I stay within my daily limit for trans fats? Read the Nutrition Facts label on foods you buy at the store and, when eating out, ask what kind of oil foods are cooked in. Replace the trans fats in your diet with monounsaturated or polyunsaturated fats. Are all foods labeled “trans fat-free” healthy foods? Not necessarily. Foods labeled “0 trans fat” or cooked with “trans fat-free” oils may contain a lot of saturated fats, which raise your bad cholesterol levels. “Trans fat-free” foods may also be unhealthy in terms of their general nutrient content. For example, baked goods tend to be high in added sugars and low in nutrients. What are monounsaturated fats? From a chemical standpoint, monounsaturated fats are simply fats that have one double-bonded (unsaturated) carbon in the molecule. Monounsaturated fats are typically liquid at room temperature but start to turn solid when chilled. Olive oil is an example of a type of oil that contains monounsaturated fats. How do monounsaturated fats affect my health? Monounsaturated fats can have a beneficial effect on your health… when eaten in moderation and when used to replace saturated fats or trans fats. Monounsaturated fats can help reduce bad cholesterol levels in your blood and lower your risk of heart disease and stroke. They also provide nutrients to help develop and maintain your body’s cells. Monounsaturated fats are also typically high in vitamin E, an antioxidant vitamin most Americans need more of. Are monounsaturated fats better for me than saturated fats or trans fats? Yes. Monounsaturated fats and polyunsaturated fats can have a positive effect on your health, when eaten in moderation. The bad fats – saturated fats and trans fats – can negatively affect your health. Which foods contain monounsaturated fats? Most foods contain a combination of different fats. Examples of foods high in monounsaturated fats include vegetable oils such as olive oil, canola oil, peanut oil, sunflower oil and sesame oil. Other sources include avocados, peanut butter, and many nuts and seeds. Are monounsaturated fats lower in calories? Monounsaturated fats – like all fats – contain nine calories per gram. How much monounsaturated fat should I eat in a day? The fats in the foods you eat should not total more than 25–35 percent of the calories you eat in a given day… and, for good health, the majority of those fats should be monounsaturated or polyunsaturated. Eat foods containing monounsaturated fats and/or polyunsaturated fats instead of foods that contain saturated fats and/or trans fats. What are polyunsaturated fats? From a chemical standpoint, polyunsaturated fats are simply fats that have more than one double-bonded (unsaturated) carbon in the molecule. Polyunsaturated fats are typically liquid at room temperature and when chilled. How do polyunsaturated fats affect my health? Polyunsaturated fats can have a beneficial effect on your health when consumed in moderation and when used to replace saturated fats or trans fats. Polyunsaturated fats can help reduce the cholesterol levels in your blood and lower your risk of heart disease. They also include essential fats that your body needs but can’t produce itself – such as omega-6 and omega-3. You must get essential fats through food. Omega-6 and omega-3 play a crucial role in brain function and in the normal growth and development of your body. Are polyunsaturated fats better for me than saturated fats or trans fats? Yes. Polyunsaturated fats and monounsaturated fats can benefit your health, when eaten in moderation. The bad fats – saturated fats and trans fats – can negatively affect your health. Which foods are high in polyunsaturated fats? Most foods contain a combination of fats. Foods high in polyunsaturated fat include a number of vegetable oils, including soybean oil, corn oil and safflower oil, as well as fatty fish such as salmon, mackerel, herring and trout. Other sources include some nuts and seeds such as walnuts and sunflower seeds. Are polyunsaturated fats lower in calories? Polyunsaturated fats – like all fats – contain nine calories per gram. All fats are equally high in calories. How much polyunsaturated fat should I eat in a day? The fats in the foods you eat should not total more than 25–35 percent of the total calories you eat that day and, for good health, the majority of those fats should be monounsaturated, polyunsaturated or both. Eat foods with monounsaturated fats and/or polyunsaturated fats instead of foods with high levels of saturated fat or trans fat. Does eating more healthfully mean giving up my favorite foods? A healthy diet can include the foods you love. You don’t have to avoid sugary or salty treats entirely, but you do need to eat less of these foods since they’re low in nutrition and high in calories. Learning how to read and understand food labels can help you make healthier choices. Here are some tips for making the most of the information on the Nutrition Facts label: What is Cholesterol? Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body’s cells. It’s normal to have cholesterol. Cholesterol is an important part of a healthy body because it’s used for producing cell membranes and some hormones, and serves other needed bodily functions. But too much cholesterol in the blood is a major risk for coronary heart disease (which leads to heart attack) and for stroke. Hypercholesterolemia is the medical term for high levels of blood cholesterol. LDL and HDL Cholesterol: What’s Bad and What’s Good? Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test. LDL (Bad) Cholesterol LDL (bad) cholesterol circulates in the blood; it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result. HDL (good) Cholesterol About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup. Triglycerides Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level,including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels. Lp(a) Cholesterol Lp(a) is a genetic variation of LDL (bad) cholesterol. A high level of Lp(a) is a significant risk factor for the premature development of fatty deposits in arteries. Lp(a) isn’t fully understood, but it may interact with substances found in artery walls and contribute to the buildup of fatty deposits. What Can Cholesterol Do? High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk. When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result. When should I start having my cholesterol level checked? Men aged 35 and older and women aged 45 and older should have their cholesterol checked yearly. Depending on what your cholesterol level is and what other risk factors for heart disease you have (see the box below), you may need to have it checked more often. Risk factors for heart disease • Having already had a heart attack • Being a man 45 years of age or older • Being a women 55 years of age or older • Being a woman who is going through menopause or has completed menopause • Having an immediate family member (parent or sibling) who had heart disease • Smoking cigarettes • Having high blood pressure or diabetes • Being overweight or obese • Being inactive Total cholesterol level • Less than 200 is best. • 200 to 239 is borderline high. • 240 or more means you’re at increased risk for heart disease. LDL cholesterol levels • Below 100 is ideal for people who have a higher risk of heart disease. • 100 to 129 is near optimal. • 130 to 159 is borderline high. • 160 or more means you’re at a higher risk for heart disease. HDL cholesterol levels • Less than 40 means you’re at higher risk for heart disease. • 60 or higher greatly reduces your risk of heart disease. What can I do to improve my cholesterol level? If you have high cholesterol, it may be necessary for you to make some lifestyle changes. If you smoke, stop smoking. Exercise regularly. If you’re overweight, losing just 5 to 10 pounds can help lower cholesterol levels. Make sure to eat plenty of fruits, vegetables, whole grains and fish- all of which promote heart health. Avoid saturated and trans fats, which can raise cholesterol levels. Also limit your overall cholesterol intake to less than 300 milligrams (200 milligrams if you have heart disease) per day.