The very image of cholesterol chills the imagination. Lurid and unsavory, it would seem to bob through the bloodstream like blobs of fat congealed on cold soup, slathering itself onto arteries.

Cholesterol is in fact a normal, natural substance in our bodies, found in the brain, nerves, liver, blood and bile. Cholesterol is so crucial that each cell is equipped with the means to synthesize its own membrane cholesterol, regulating the fluidity of those membranes when they are too loose or too stiff.

We manufacture steroid hormones-the female hormones estrogen and progesterone, and the male hormone testosterone-from cholesterol. Adrenal corticosteroid hormones, which regulate water balance through the kidneys, and the hormone cortisone, the vital anti-inflammatory that also governs our stress response, come from cholesterol.
Other jobs of cholesterol: production of vitamin D and bile acid (for the digestive process); healing and protecting skin, and antioxidant compensation when vitamin and mineral stores are low.<p>
How can mere mention of this invaluable component in our body chemistry make our blood run cold?

Guilt by Association
Cholesterol's reputation as a bad character actually originates in the crowd it runs with: the lipoproteins, protein molecules to which it binds in order to travel back and forth through the bloodstream to the liver, where it is manufactured.

Not really a nasty round glob of fat at all, cholesterol is a crystalline substance, technically a steroid, but soluble in fats rather than water, thus classified as a lipid, as fats are. Thousands of cholesterol molecules bind with lipoproteins, spherical fat molecules that transport them through the bloodstream.

Three different kinds of lipoproteins participate in this necessary process, not always with the same salutary effect. Here's how they work:

High-density lipoprotein (HDL): referred to as the "good cholesterol." Carries relatively little cholesterol. Travels through the bloodstream removing excess cholesterol from the blood and tissues. HDLs return the surplus to the liver, where it may once again be incorporated into low-density lipoproteins for redelivery to the cells.

Low-density lipoprotein (LDL): the so-called "bad cholesterol," heavily laden with cholesterol, hauling it from the liver to all cells in the body.

Ideally, this system should be in balance. But if there is too much cholesterol for the HDLs to pick up, or an inadequate supply of HDLs, cholesterol may aggregate into plaque groups that block arteries.

Lipoprotein(a), or Lp(a): the "really bad" cholesterol, can step in, providing the glue that actually sticks to the arterial wall. Lp(a) is an LDL particle with an extra adhesive protein wrapped around it, enabling it to attach fat globules to the walls of blood vessels. The potentially deadly results are atherosclerotic ("plaque") deposits. Simple LDL lacks adhesive power and presents little risk for cardiovascular disease.

Researchers confirmed the existence of Lp(a) in the August 1996 issue of the Journal of the American Medical Association, disclosing that high levels of Lp(a) in the blood can double a man's risk of heart attack before age 55. Doctors estimate that about 20% of all Americans carry elevated levels of Lp(a).

One troubling aspect of the report, part of the ongoing 40-year-old Framingham Study, concerned the fact that the men who suffered heart attacks entered the project with no signs of heart disease and only slightly elevated cholesterol.

  But during the 15-year investigation, 129 men out of 2,191 developed premature heart disease.

The culprit? High levels of Lp(a)

Experts don't know for certain where Lp(a) comes from, or its normal function, although they suspect the body's quotient of Lp(a) is mostly due to your genes. According to the study, they also believe that aspirin, a blood thinner, and red wine (or its grapeseed and skin extracts) may mitigate the damage of Lp(a). That also would explain why the French, who tend to wash down their fat-rich diet with red wine, experience a relatively moderate incidence of cardiovascular disease

The Terrible Triglycerides
The body also transports fats via triglycerides (TGs), the main form of body fat and the storehouse for energy. Edible oils from seeds, egg yolk and animal fats also are composed chiefly of TGs. Although not as corrosive as LDL, excess TGs intensify heart disease potential when they oxidize and damage artery linings or induce blood cells to clump.

An "acceptable" level of triglycerides is thought to be 200 milligrams, although under 150 is probably healthier. And some researchers think your triglyceride reading should be below 100. High triglycerides and low HDL often occur together, increasing the risks of cardiovascular disease, high blood pressure, heart and kidney failure and other degenerative diseases.

What To Do About Your Cholesterol
Have it checked. High cholesterol alone shows no symptoms. Your health practitioner can perform a laboratory test to measure your levels. Thoroughly share your own medical history and as much as you know about your family members: heredity and related illnesses definitely are important influences. People with diabetes, for example, can have high levels of triglycerides, which also may lead to pancreatitis (painful inflammation of the pancreas) at extremely high levels.

According to the National Cholesterol Education Program, a reading of under 200 mg/dL is desirable; 200 to 239 is borderline high; 240 and above is high. Your LDL level should be 130 or under; HDL should not be lower than 35. A triglyceride level below 200 is considered desirable; readings above 400 are high.

Adjust your diet. Cholesterol levels are readily controllable, primarily through changes in your diet. Leslie C. Norins, MD, PhD, suggests all-out war in his Doctor's 30-Day Cholesterol Blitz (Advanced Health Institute) with saturated fats, which raise cholesterol more than any other component in your diet, as your number-one target. Out with saturated fats like butter, cheese, whole milk, ice cream, red meat and some vegetable fats found in tropical oils like coconut and palm; in with fruits, vegetables, brown rice, barley (a good source of soluble fiber, the kind that soaks up fats and cholesterol and escorts them out of the body), beans, potatoes and pasta, prepared or dressed with monounsaturated fats in olive and canola oils (the so-called Mediterranean diet concept). Feast on cold-water fish (mackerel, salmon, sardines and herring) rich in omega-3 fatty acids that help reduce serum lipids, among many other healthful advantages.<p>
Exercise. Move it and lose it are the words to live by when it comes to cholesterol. Researchers from the Stanford Center for Research in Disease Prevention reported in the July 2, 1998 New England Journal of Medicine (vol. 339, pages 12-20) that a weight-loss diet like that of the National Cholesterol Education Program plus exercise significantly lowered LDL (bad) cholesterol levels for men and postmenopausal women. The diet alone failed to lower LDL in these folks with high-risk lipoprotein.

Educate yourself. In addition to your health practitioner, books and magazines can guide you in cholesterol management. A trove of information is the National Cholesterol Education Program (NCEP), launched in 1985 by the National Institute of Health. Their address is: National Cholesterol Education Program, Information Center, P.O. Box 30105, Bethesda, MD 20824-0105; telephone (301) 251-1222; they're on the web at http://www.nhlbi.nih.gov/nhlbi/.

Recommended Reading:
Fats that Heal, Fats that Kill (Alive, 1993), by Udo Erasmus.

Prescription for Nutritional Healing (Avery, 1997), by James F. Balch, MD, and Phyllis A. Balch, CNC.

The Healthy Heart Formula (Chronimed, 1997), by Frank Bary, MD.

Eradicating Heart Disease (Health Now, 1993), by Matthias Rath, MD.