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TAKING CARE OF YOUR HEART: DIET AND BLOOD CHOLESTEROL
Usually, a liter of blood plasma contains about 1 to 2 1/2 grams of cholesterol. The actual amount of cholesterol is influenced by many factors, including our genes. There are inherited diseases, in which very high levels of blood cholesterol are seen, but such diseases are not common; for example, the disorder of familial hypercholesterolemia affects about three out of every thousand people.
Many items in the diet affect our blood-cholesterol levels. The first to be recognized is cholesterol itself: foods rich in this substance, such as egg yolk, liver, sweetbread and brains, tend to increase the blood cholesterol. But this increase is limited by subtle processes which compensate for changes in intake.
Saturated fat in the diet increases the level of blood cholesterol. Add a saturated fat, such as butter or coconut oil, or the saturated fat of meat to the diet and the blood cholesterol rises promptly, staying high for as long as the new diet continues. This seems to be a major reason why average cholesterol levels are so much higher in those countries in which saturated-fat intake is high, compared with those in which little saturated fat is eaten.
The Africans in South Africa obtain as little as 20 per cent of their energy from dietary fat; the white population get some 40 per cent of energy from fat. In one study in Johannesburg the average African’s cholesterol level was 150 mg per 100 ml and the average in whites was 220 mg/100 ml. When a group of Africans was given a typical ‘white’ diet for twelve months their cholesterol levels rose to 210 mg/100 ml; simultaneously a group of white subjects receiving a diet of ‘African’ type showed a fall in blood cholesterol, reaching 165 mg/100 ml.
Now these effects are true of most saturated fats, especially those rich in a fatty acid called palmitic acid which is found in meat and dairy produce. But unsaturated fats do not show this effect. If a mono-unsaturated fat such as olive oil is fed in place of, say, starch the blood cholesterol does not change materially; and if saturated fat is replaced by olive oil the cholesterol level falls. This is evident in Mediterranean communities, where blood-cholesterol levels are low (and heart attack is infrequent). Dr Ancel Keys has shown that the diet in Corfu and Crete, and in rural parts of Greece, is relatively high in fat; but this fat is chiefly olive oil, which is the mono-unsaturated kind, and it contains very little saturated fat. To keep one’s blood cholesterol low, therefore, foods containing unsaturated fats like olive oil are better than those rich in saturated fat.
Polyunsaturated fat differs even more from saturated fat: replace a saturated fat in the diet by a polyunsaturated one, such as sunflower oil, and the blood cholesterol drops steeply. Even if sunflower oil is added to a diet containing a saturated fat, the blood cholesterol will still fall to some extent. What is the reason for this effect Dr Edward Janus at St Thomas’ Hospital has shown that we produce the lipoproteins VLDL and LDL more slowly when the diet contains polyunsaturated fat than when it contains saturated fat. Some of the cholesterol not required for making lipoprotein is probably broken down and excreted when the diet is rich in polyunsaturated fat; hence such a diet appears to get rid of redundant cholesterol.
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