Can blood cholesterol levels be controlled through other methods besides diet?

Yes. One of the most effective ways to keep total blood cholesterol levels down, as well as increasing “good” or HDL cholesterol levels, is to include lots of physical activity in your life. Exercise can help keep your blood cholesterol profile, as well as your muscles and heart, in great shape. Traditionally, the people in the Mediterranean had highly active lifestyles, probably a contributing factor to their ex cellent heart health.
Smoking has also been linked to increased blood cholesterol levels, so quitting the tobacco habit is an obvious way to help control blood cholesterol levels. Also, obesity tends to raise blood cholesterol, so achieving and maintaining a healthy weight is an effective way for many people to keep blood cholesterol levels in check.

Fat in the Mediterannian

We’ve already introduced you to the notion that the entire Mediterranean region is olive country and that the primary fat in the Mediterranean diet is olive oil. Olive trees with their fruits burgeoning with oil virtually rim the Mediter ranean Sea. When ripe, the olives are mashed into a paste and pressed between mats, squeezing the cherished oils into vats below. The process is simple, and the first pressing of the olives yields the olive oil that is the most pure, the most nutrient-rich, and the most flavorful: extra virgin olive oil. Extra virgin olive oil is the least processed olive oil.
Depending on the region where the olives were grown, olive oil varies in color, from gold to green. According to Nancy Harmon Jenkins in her Mediterranean Diet Cook book:

[The] strong-flavored, green-tasting Tuscan oils are very different themselves from the lighter, rounder, fat - ter oils from Apulia in Italy’s South. Which again are distinctive from the oils of Catalonia with their hints of almond and the richer, full-bodied oils from Greece and farther east in Lebanon and the bland, sweet oils from North Africa.

Although strongly (and deliciously) flavored, olive oil is more versatile than some strongly flavored oils because its strong flavor diminishes or disappears when heated. It can, therefore, be used with great success in baking. Lesser grades of olive oil are progressively more processed and re fined. Their slightly cheaper prices are not worth the loss of flavor and the benefits of other substances in the oil, not to mention the added undesirable effects of processing. (Keep olive oil out of the light and refrigerate any oil you won’t use in one month.)
Although not a component in traditional Mediterranean cuisine, a good olive oil substitute is canola oil, another rich source of monounsaturated fatty acids. Canola oil, some times called rapeseed oil, contains a large proportion of monounsaturated fatty acids, like olive oil, as well as vitamin E and omega-3 fatty acids. Although it costs less than its Mediterranean cousin, it is also far more refined, less flavor ful, and less widely consumed, historically. Canola oil is also devoid of phytochemicals (nonnutritive substances in plants that appear to offer protective health effects), those extra “goodies” available in olive oil that has been cold pressed. In terms of a heart-healthy choice, however, it still ranks just below olive oil.
During the time when Ancel Keys was conducting his research, some Mediterranean countries consumed greater or lesser amounts of olive oil. Remember how Cretans were found by Keys to be the olive oil heavyweights, consuming an average of about a half cup of olive oil per day per per son? A full one-third of the calories in the Cretan diet came from olive oil. The Greek population in general received about one-fifth of its calories from olive oil. Elsewhere throughout the Mediterranean, olive oil consumption was not quite up to Cretan standards, but still far exceeded con sumption in the United States. According to Keys, average olive oil consumption throughout the Mediterranean region equaled about 15 to 20 percent of total calories, “except in the most northerly part of Italy and the non-Mediterranean parts of France and Spain.”
Coronary heart disease rates in these countries, as we have mentioned before, were (and still are, although not as dramatically) lower than in the United States, and although olive oil is not the only factor, researchers have narrowed the field enough to surmise that a high proportion of mo nounsaturated fatty acids in the diet is likely a significant factor in lower coronary heart disease rates.
But olive oil is healthy for more reasons than the monounsaturated fatty acids that lower the risk of coronary heart disease. As mentioned, olive oil contains phytochemicals, more specifically carotenoids, that give vegetables and their oils color, and the antioxidant vitamin E. Antioxidants in hibit the formation of free radicals, elements produced in the body by pollutants and human metabolism that appear to damage the immune system and may contribute to chronic disease. Remember how oxidized LDL leads to hardened and clogged arteries? Vitamin E helps to further prevent LDL from oxidizing (antioxidants are explained in more de tail in the next chapter).
Again, when it comes to fat, moderation is the key. Focus on consuming a healthy proportion of monounsaturated fats compared to saturated and polyunsaturated fats. Use the Mediterranean Diet Pyramid to help change your diet to re flect the eating patterns and fat consumption of the traditional Mediterranean diet. Overall, fat consumption was moderate, and olive oil was certainly the fat of choice. Olive oil infused the cuisine of the Mediterranean with its rich aroma and its health-bestowing properties. It was (and still is) a culinary star—but not the only star in a richly varied, heart-healthy, Mediterranean-inspired diet.

Trans-Fatty Acids and Hydrogenation

Trans-fatty acids are made from the hydrogenation of unsaturated fats. Recent research has suggested that trans-fatty acid, which is found in most margarines and many processed baked goods, may be even more hazardous to our heart health than saturated fats! Confused? Isn’t margarine supposed to be better for us than that saturated-fat villain known as butter? Nutritionists today say absolutely not!

Eating Less Fat

Like so many other nutritional concepts, the fat picture isn’t as simple as it often may sound in the latest news story or web site. Will you solve a cholesterol problem by com pletely eliminating animal products in your diet without changing anything else? Maybe, but maybe not. Will you develop a chronic disease if you eat too much polyunsatu rated fat? Probably not, but nutritionists don’t have a definitive answer to this question, either. Will you live to be one hundred years old if your fat intake comes primarily from monounsaturated fats? Again, maybe, and maybe not. No body exists in a vacuum, and even the Mediterranean diet is bigger than what kind of fat it includes. Common sense, and the traditional Mediterranean diet, dictate that moderation in all dietary aspects makes the most sense: small amounts of meat and dairy, with an emphasis on monounsaturated fats.

Blood Cholesterol : the Players

Your blood cholesterol level can be determined through a simple blood test. Some cholesterol tests give you an overall cholesterol level, and the best tests break down your total cholesterol into LDL and HDL categories. (Those free or low-cost cholesterol screenings you sometimes see at shop ping malls tend to give you only overall cholesterol level, while tests performed through your physician are usually more accurate and may give more specific information, making it worth the extra bucks if cholesterol concerns you.)
In general, according to levels set by the National Heart, Lung, and Blood Institute, your total cholesterol level should be under 200 mg/dl, although some researchers, such as Dr. Dean Ornish, feel that a level of 150 mg/dl is more de sirable to effectively prevent heart disease. A cholesterol level in the 200 to 239 mg/dl range could be a red flag alert ing you to be careful and take steps to lower your blood cholesterol, although a cholesterol level in this range might be better than it seems if good cholesterol levels are high and bad cholesterol levels are low. A blood cholesterol level of 240 mg/dl and above puts you at a high risk for heart dis ease, but again, keep in mind the HDL/LDL numbers separately.
Generally, strive to keep your “good” or HDL cholesterol level above 35 mg/dl and your “bad” or LDL cholesterol level below 130 mg/dl. If you haven’t had a blood cholesterol test, or if you haven’t had one recently, you should be able to schedule a physical exam with your primary care doctor and request a test to determine your blood cholesterol level. Or, if you see one of those free or low-cost tests at your local mall, why not check your blood cholesterol level while it’s convenient? If your reading is high, give your physician a call to schedule a more complete test. Blood cholesterol should be screened every five years.
What do the results of a more complete test really mean, and why is “good” cholesterol good and “bad” cholesterol bad? HDL (high-density-lipoprotein) cholesterol is called the “good” cholesterol because this type of cholesterol moves through the body, picks up excess cholesterol, and delivers it to the liver, where it can be eliminated. High lev els of HDL cholesterol have been linked to a decreased risk of coronary heart disease. Monounsaturated fats like olive oil have been shown to be promoters of HDL cholesterol.
Consuming a diet rich in monounsaturated fats has also been shown to make LDL cholesterol less prone to oxidation—a process that leads to atherosclerosis, or hardening of the ar teries, that can lead to heart attack or stroke. For this reason, monounsaturated fats are recommended to make up the greatest proportion of fats in the diet (as they do in the tradi tional Mediterranean diet).
LDL (low-density-lipoprotein) cholesterol, the so-called bad cholesterol, has been linked to an increased risk of heart disease. LDL cholesterol takes cholesterol from the liver to be deposited throughout the body. (The body needs choles terol for a variety of purposes, such as making hormones.) Unfortunately, LDL is highly prone to oxidation (more on oxidation later). Oxidized LDL (or o-LDL) is believed to cause damage to the walls of the arteries. Once damaged, fatty deposits (or plaque) can accumulate, which causes the artery walls to harden. Once plaque begins to form, blood is unable to flow as freely. Sometimes so much plaque accu mulates that there is a complete occlusion of blood flow. The result is either a heart attack or a stroke.
There has been some recent research that shows oxidized LDL particles arise primarily from the ingestion of a certain type of polyunsaturated fat found mostly in corn oil, saf flower oil, and other oils used widely in processed foods. LDL particles arising from monounsaturated fat metabo lism, however, appear to be resistant to oxidation and, therefore, less available for incorporation into atherosclerotic plaques, which slows or halts the progression of atheroscle - rosis.
Once again, saturated fat in the diet has been shown to in- crease LDL cholesterol levels. Polyunsaturated fats have been shown to lower LDL cholesterol levels, but can also lower HDL cholesterol levels. Best of all, monounsaturated fats like olive oil have been shown not only to lower LDL cholesterol levels, but also to make any LDL cholesterol present less prone to the damaging oxidation process.
Keeping LDL blood cholesterol levels low will help to keep our arteries clear, flexible, and healthy, and dietary al terations are among the most effective ways to keep LDL levels in a healthy range.