"I'll have a double cheeseburger, fried onion rings, milkshake and an ice cream dessert." Sound familiar? If so, please spare a couple of minutes to consider what these high-fat content foods may be doing to your health, especially if you have high cholesterol.

Heart disease is now the number one cause of death in the developed world. Many of these deaths can be attributed to excessive blood levels of cholesterol and other lipids. In fact, cholesterol is one of the major risk factors for heart attacks, strokes and premature aging of the circulatory system (atherosclerosis). The adverse effects of elevated cholesterol begin during early adulthood. Over time, atherosclerosis will result in progressive hardening, narrowing and clogging of the arteries throughout the body. Depending on which arteries are worse affected, atherosclerosis can result in heart disease (coronary artery disease), strokes (cerebral artery disease), kidney failure (renal artery disease) and leg pain and atrophy (peripheral vascular disease).

Cholesterol is broken down into two fractions, the good fraction known as high-density lipoprotein cholesterol (HDL-C), and the bad fraction known as low-density lipoprotein cholesterol (LDL-C). Elevated levels of total cholesterol and LDL-C, and low levels of HDL-C are associated with increased risk of heart disease and other atherosclerotic related diseases. In diabetes as well as several genetic metabolic disorders, triglycerides is also a marker for heart disease. Excessive cholesterol and other lipids in the blood are often the result of heredity. For these people, a diet limiting the amount of saturated fat and cholesterol is essential. A recent study recommends that everyone, beginning at the age of adolescent, should have their cholesterol tested to check if they are at risk. Cholesterol testing is especially important in all young persons who have a family history of heart disease. Ideally, measurement of cholesterol and other lipid test should be done after an overnight fast. The following is a risk classification for cholesterol blood levels:

Risk Classification	Total Cholesterol in Blood (mg/dl)	LDL Cholesterol (mg/dl)	HDL Cholesterol (mg/dl)
Desirable	<200	<130	>50
Borderline High	200 to 239	130 to 159	35 to 50
High	>240	>160	<35

How can elevated cholesterol levels be lowered?

Diet modification, in particular reduction of saturated fat and cholesterol is the initial therapy for lowering high cholesterol levels. Dietary fat should be reduced to less than 30% of total calories, saturated fat reduced to less than 10% of calories, and cholesterol intake reduced to less than 300 mg per day.

Saturated fat consumption is reduced by limiting portion sizes of beef, pork, and lamb to 3 ounces. Cuts of these meats should be lean and well trimmed. Fish, and chicken and turkey (with the skin removed) are preferable to meat. However, total meat, chicken, fish and other animal protein consumption should be limited to 6 ounces per day. Fried foods and vegetable oils that are highly saturated, such as coconut oil and palm oil, should be avoided. Monounsaturated fats such as olive and canola oil may be taken, as long as they do not exceed 15% of total calories. Low-fat dairy products can be substituted for whole-milk products. Soft margarine, liquid vegetable oils, and low-fat cheese should replace butter, solid vegetable shortening, and high-fat cheese.

Cholesterol intake can be reduced by restricting egg yolks and organ meats such as liver, kidney, and brains. A maximum of four egg yolks per week (including those used in prepared foods) can be eaten.

Fresh fruit, vegetables, and whole-grain products should be used to increase variety and provide nutrients and fiber. Carbohydrates, especially complex carbohydrate, should make up 55 to 60% of total calories.

In addition to a low cholesterol and saturated fat diet, overweight people should reduce their weight. Exercise is often helpful in lowering triglyceride and cholesterol levels and raising HDL-C. It can also help to maintain normal body weight, lower blood pressure, increase physical fitness and imbue a sense of general well-being.

Diet therapy to reduce cholesterol should be tried for at least several months before adding cholesterol lowering drugs. During this time, cholesterol levels should be checked every six to eight weeks. However, cholesterol lowering medication may need to be started much sooner for people with very high levels of cholesterol, especially if they have heart disease or have multiple risk factors for heart disease. Medication is no substitute for a low cholesterol and saturated fat reduction diet, weight control and exercise efforts to reduce cholesterol levels to normal. These measures should be continued while taking cholesterol lowering medication.