Cholesterol Figures Can Do a Number on You

What’s your cholesterol?

That question, says Robert Kowalski, has become the ‘90s equivalent of “What’s your sign?”

As author of the former bestseller “The 8-Week Cholesterol Cure” (Harper & Row) Kowalski is partly responsible for making the waxy, fatty substance a household word.

Thanks to low-cost screenings available everywhere from drugstores to shopping malls to county fairs, these days it’s as easy for people to find out their cholesterol level as it is their blood type.

Problem is, when finding out their cholesterol level--in the form of a number--most people aren’t as likely to understand what that number means or what to do to lower it, say Kowalski and other experts.

There are several types of cholesterol in the body, and the ratio between them can be more significant than the total in determining who is at risk for heart disease.

Adding to the confusion are all those new food labels that proclaim “no cholesterol” on everything from peanut butter to chocolate chip cookies to french fries. Sometimes they’re meaningful; in other cases, they’re misleading.

But when Kowalski came to Orange County last Thursday night to speak to a group of heart patients, doctors and nurses at the Saddleback Memorial Medical Center Heart Institute in Laguna Hills, he brought along good news from the cholesterol-fighting front.

The food industry has begun to get the message, he says, and is now offering so many healthy alternatives to traditional foods that it’s possible to eat just about any kind of food--or at least a palatable equivalent--without worry.

Like a grilled cheese sandwich, for example. Put some slices of nonfat cheese--only available on store shelves within the last two months--between two slices of bread, zap the sandwich for 30 seconds in the microwave, then flavor the bread with a spritz of butter-flavored cooking spray on each side, brown it in a non-stick skillet, and “you would swear that you’re eating something you shouldn’t,” Kowalski says.

“As time goes on, it’s going to start getting easier and easier to eat right,” he says. “A couple of years ago, I told my son, ‘Someday we’ll be able to have things like ice cream and hot dogs again.’ And now we can.”

So far, just about the only cholesterol-laden food that doesn’t have a healthier equivalent is squid and caviar.

“Most people could probably say, ‘OK, I’ll give up squid,’ without much problem,” Kowalski says. “It’s almost as easy to say, ‘I’ll give up caviar.’ Except at weddings.”

Even shrimp, which as recently as five years ago was thought to be high in cholesterol, has since been exonerated.

“Now we know that except for squid and caviar, just about anything that comes from the sea is good for you,” Kowalski says.

Unfortunately, the demand for healthier foods is so great that some products are being represented as something they aren’t, says Diane Keddy, assistant director of clinical nutrition at Saddleback.

Peanut butter, for example, is now being touted as having “no cholesterol” when it never did in the first place, says Keddy.

“It’s a plant product, and cholesterol only comes from animal products,” Kowalski says.

And many products labeled “low fat” aren’t, Keddy says. “Something like 99% fat-free hot dogs can be more than 30% fat, when you consider what percentage of the calories come from fat.”

In any case, cholesterol is only one of several kinds of fats found in foods, and some of those--fish oil and mono-unsaturated fats, such as olive and canola oils--have recently been found to actually lower cholesterol levels in the blood. But cholesterol-free oil is still fat, Keddy says.

“Just because Carl’s Jr. cooks their fries in canola oil doesn’t mean you can eat all you want without any problem,” Keddy says. “All fats have the same amount of calories, 9 per gram. And most of us have to pay attention to our overall calorie intake as well as the amount of fat we eat.”

Kowalski is living proof that such lifestyle changes as diet and exercise can actually reverse heart disease. He suffered a heart attack at age 35, underwent bypass surgery and was told he didn’t need to make any changes to prevent a recurrence.

“That was in 1978. By 1984, I had stopped smoking, and I was eating ‘California healthy,’ a lot of chicken and fish, but I never worried about the butter I put on it. When they told me I’d need a second bypass operation, I was shocked. I went home and cried, and swore that if I recovered, this would never happen again.” Now, according to a recent angiogram, his coronary arteries are free of blockage.

His blood cholesterol was 284 milligrams per deciliter when he began, far above the ceiling of 200 now considered safe. Kowalski, a medical writer, went out and did his own research on ways to lower his cholesterol. He put together a plan based on that information, then followed it.

After eight weeks, his total cholesterol level had dropped to about 169. It now hovers around 160, he says, although his HDL (high-density lipoprotein) cholesterol is about 40. That works out to a ratio of about 4 to 1, which is the highest in the “safe” range, he says.

The ratio, Kowalski says, is actually more important than the total number. A woman in the audience at Saddleback asked him about her own cholesterol number, a total of 256. But her HDL cholesterol was 86, giving her a ratio of 3 to 1 and a relatively low risk of heart disease.

“I’d be glad to switch places with you,” Kowalski told her.

Cheryl Jacob, program coordinator for cardiac fitness testing at Saddleback Heart Institute, says she is constantly pointing out that cholesterol alone is only one factor in heart disease.

“People put a lot of emphasis in one area, such as not eating red meat or eggs because they’re avoiding cholesterol, but they need to look at the overall picture,” she said.

For that reason, when Jacob does cholesterol screenings at local businesses or other locations, “we do a total risk assessment,” she said. “That way we get the most meaningful information.”

Kowalski will speak again Thursday at Mission Hospital Regional Medical Center in Mission Viejo, but a hospital spokeswoman said there is no more room at the free event. A waiting list is being prepared, however, in case of cancellations. For information, call (714) 364-1770 or (714) 364-7755.