Frequently Asked Questions
Today, people are more aware than ever of the risks of having a high blood cholesterol level.
High cholesterol levels can lead to clogged arteries, heart attack or stroke. So if you have high cholesterol, you should take steps to lower it. Simple dietary and lifestyle changes can reverse your course and set you back on the path of good health. For those who have coronary artery disease, or are at unusually high risk for it, lowering your lipid levels can reduce further coronary events and the possible need for interventions such as surgery or angioplasty.
What is cholesterol?
Cholesterol is a waxy substance produced by the liver that is also found in animal foods such as red meat and whole milk dairy products, which are usually high in fat as well. (Plant sources do not contain cholesterol.) Your body uses cholesterol to build cell walls and other necessary tissues. High-fat diets stimulate the liver to produce excessive cholesterol. As a result of the amount your body manufactures normally and in response to a fat-laden diet, you can accumulate too much cholesterol in your blood. That is when trouble occurs in the form of cardiovascular disease.
Cholesterol travels through the blood in packages called lipoproteins. Low-density lipoproteins (LDL), or bad cholesterol, have a tendency to cling to the inner walls of the arteries as plaque. This plaque restricts the flow of blood to the heart or brain, which can lead to heart attack or stroke. High-density lipoproteins (HDL), or good cholesterol, whisk surplus cholesterol from the blood and arterial walls, thus lowering the odds of developing cardiovascular disease.
What do my cholesterol numbers mean?
Total blood cholesterol is the number most people are familiar with. Doctors no longer measure just the total cholesterol level in your blood, because that only provides part of the picture. Your doctor should do a complete lipid profile, which includes measuring your levels of good (HDL) and bad (LDL) cholesterol and triglycerides. (Although completely different from cholesterol, triglycerides likewise are fats found in foods and manufactured in the body. Most of the fat we eat is in the form of triglyceride.) Other lipid tests are also available, if needed, to help your doctor and you define your risk level.
Ideally, your LDL cholesterol should be below 100; a desirable HDL level is 45 or higher. The lower the LDL and the higher the HDL, the more protected you are from cardiovascular disease. Most pre-menopausal women have high levels of HDL because of the female hormone estrogen, which offers added protection against heart disease. After menopause, though, a woman's risk for heart attack jumps until she is 65, by which time it is almost as great as a man's.
Triglyceride levels above 150 mg/dl are abnormally high. A high triglyceride level often accompanies a higher total cholesterol and LDL cholesterol level, and especially a lower HDL cholesterol. The combination of high triglycerides and low HDL levels in concert with disorders such as diabetes or high blood pressure is termed "metabolic syndrome." Metabolic syndrome is strongly associated with abdominal obesity, which itself has been shown to put you at risk for coronary artery disease. Whatever your cholesterol counts, keep in mind other important risk factors as well. Age, heredity, family history, high blood pressure, diabetes, smoking and lifestyle should all be considered when evaluating your risk of cardiovascular problems.
How can I lower my cholesterol level?
You can take control of your cholesterol by making lifestyle changes. Eating a heart-healthy diet is often an effective way to bring your blood cholesterol within a normal range. Limit saturated fat to no more than 7 percent of your daily calories and trans fat to no more than 1 percent, and substitute more whole-grain and high-fiber foods.
Load up on fish, fruit, vegetables, beans, rice and other whole grains in place of meat or baked goods. Switch to low-fat or skim milk dairy products. When you must cook with fat, choose the monounsaturated varieties, such as olive or canola oils. Don't overdo your use of even these oils, however, as they are still high-fat foods. Fat in the diet stimulates the liver to raise blood cholesterol levels; it is not just eggs that elevate blood cholesterol.
Additionally, since regular exercise has been shown to increase the level of good cholesterol, get active. Because smoking reduces the level of good cholesterol, smokers should quit. Everyone should maintain a normal body weight, as above-normal weight and obesity contribute to abnormal lipid levels, as well as diabetes, high blood pressure and other disorders. The rewards of changing your habits are well worth it; for every 1 percent drop in bad cholesterol, you get a 2 percent drop in cardiovascular risk.
Are foods labeled 'Cholesterol Free' safe bets?
Don't be fooled by food labels that say "cholesterol free." Foods bursting with saturated fat are sometimes disguised with these healthier-sounding labels. Likewise, products made with hydrogenated vegetable oils may seem good for you but are actually rich in fat. Current U.S. Food and Drug Administration regulations cut down the hype surrounding terms used on food labels, such as "cholesterol free." To prevent being misled, however, read nutrition labels to learn the amount of fat in a serving. A truly low-fat product contains three grams or less of fat for every 100 calories.
Should I consider cholesterol-lowering drugs?
Drugs that can help normalize blood cholesterol may be necessary for people at higher risk who can't control their levels through diet. Dietary changes should often be tried before medication, however. Within three months of following a low-fat diet, you should notice a reduction in your cholesterol count. If this self-care method doesn't lower your cholesterol to an acceptable level, you may need to add medication to your regimen, particularly if you have other risk factors for cardiovascular disease. Since drugs that lower cholesterol can have side effects, however, you should consult your physician before deciding if medication is appropriate.
Do I need to worry about my child's cholesterol levels?
Research indicates that one out of four children and teenagers has a high cholesterol level. Clearly, it's never too early to start thinking about your child's cholesterol. Although the American Academy of Pediatrics does not recommend universal screening of all children, it's wise to test children over two years of age who have a family history of early heart attacks or elevated cholesterol. Overweight children or those with high blood pressure, diabetes or other risk factors for heart disease should also be screened. An abnormal level warrants dietary modifications, but it is best to consult your doctor in individual cases.
Eating habits are established at a young age, and regardless of whether your child has a clean bill of health, you should set an example for a healthy future by serving low-fat meals to children over two years old. Remember, though, that children need some fat in their diets to help them grow.
How can I ensure an accurate cholesterol test?
It's usually better to get tested at your doctor's office rather than at a mass screening at a mall. To obtain a correct measurement of blood cholesterol, you need to fast for 12 hours prior to an HDL/LDL/triglyceride workup for a total profile.
How often should cholesterol be checked?
A high cholesterol level produces no warning symptoms, so it makes sense to test periodically. The American Heart Association recommends a lipid profile by age 20 or earlier in some cases. If your levels are acceptable, return to your doctor every five years for subsequent checks until age 45; after that, screenings should be scheduled every three years.
Before menopause, some degree of protection is afforded to most women, but they should still be tested. After menopause, all women should have their cholesterol measured every three to five years.
Can a cholesterol level ever be too low?
Usually, a low cholesterol level is a good health indicator. In other cases, it may point to a systemic disease that needs treatment. Ask your family physician to discuss your cholesterol measurement with you.
About 75 percent of Americans have foot problems at some point during their lives. A complex structure of 26 bones, 40 joints, and an intricate maze of tendons, muscles, and ligaments, the average foot endures remarkable stresses throughout a lifetime. Yet, as much as we use our feet, we often take them for granted.
Although most foot problems are not life threatening, their presence can spoil many of life's enjoyable activities.
What are the common foot problems?
Many foot problems can be corrected by modifying shoes, by medication, or through a simple procedure to relieve pain and suffering. Some common foot problems are listed below.
Bunions are swellings or enlargements that develop at the joint of the big toe where it meets the foot. Women develop bunions about 10 times as often as men, and the prevalence of bunions increases with age. Left untreated, bunions may lead to bursitis (inflammation of the sac that cushions the joint), pressure and foot pain. Changing the type of shoe to accommodate the bunion will usually reduce pain. If this doesn't work, surgery may help.
- Corns and calluses
Thickened and hardened patches of dead skin cells, these cause pain as they transmit pressure to the bones of the feet. Corns usually develop on the toes, while calluses are more likely to occur on the soles.
People with diabetes are particularly prone to foot problems because of nerve damage associated with the disease. Pressure sores or infections often occur in people with diabetes. Because diabetes may impair the sense of feeling in the feet, people with this illness need to be particularly vigilant about foot care. Sores and infections may take much longer to heal, so any cuts should receive immediate medical attention.
- Fallen arches (flat feet)
This is a condition in which the arch of the foot has dropped, causing muscle fatigue and aching, pain or stiffness in the feet, legs and lower back. Custom-designed orthotics may be prescribed to alleviate the problem. Sometimes, surgery is indicated.
- Fungal and bacterial conditions
Athlete's foot and similar conditions can cause redness, peeling, blisters and itching of the skin. If not treated promptly, these can become chronic and difficult to cure.
A hammertoe is a painful deformation of the toe joint in which the toe curls downward, resembling a claw. Pain occurs on the top of the middle joint of the toe. Roomier shoes, splints, exercises and orthotic devices can alleviate pain. In more severe cases, surgery can provide relief.
- Heel pain
Pain occurring around the heel can often be attributed to nerve compression or inflammation of the tissues attached to the heel bone. Wearing well-fitted shoes, using orthotic devices or casts, stretching exercises, prescribed medications and, in severe cases, surgery, are all methods used to correct this problem.
- Ingrown toenails
The result of poor trimming of the nails or pressure from a nail deformity, ingrown toenails can cause infection and disabling pain. Once infected, they require medical attention.
- Morton's neuroma
This condition is the inflammation of a nerve in the ball of the foot. Pain sometimes extends toward the tip of the toe or to the ankle and lower leg. Your doctor may suggest roomier shoes, shoe pads, or cortisone injections. If these treatments don't work, surgery may be recommended.
- Ankle sprains
Patients can frequently injure the ligaments of their ankles with simple twisting injuries. About 23,000 ankle sprains occur daily in the United States. Most of these improve by themselves when treated with rest, ice compression and elevation. Some patients will need to see their physician for additional treatment, bracing or a physical therapy prescription. Sometimes, patients with chronic ankle sprains, or pain which does not improve with physical therapy or conservative treatment, may require operative intervention. This may incorporate arthroscopic procedures or open procedures.
- Arthritis of the foot and ankle
Arthritis can affect any joint of the foot and ankle just as it affects the larger joints throughout the body. Forms of arthritis include inherited, traumatic, overuse and inflammatory. These can be treated with medication, modified shoe wear and physical therapy. Arthritic conditions of the foot and ankle may require operative intervention involving arthrodesis, also known as fusion, in which joints are screwed together. Arthrodesis is often performed to relieve pain and improve function. Ankle replacement surgery is a new and potentially promising form of therapy for patients with ankle arthritis.
- Plantar warts
These are viral skin infections found on the soles of the feet. Plantar warts require medical attention.
Who treats foot problems?
Orthopaedic surgeons are medical doctors who have received additional, specialized training to treat the bony structures of the body. You should see an orthopaedic surgeon to treat more complex foot and ankle problems. Orthopaedic surgeons specialize in Foot and Ankle Surgery. Doctors of podiatric medicine, or podiatrists, are medically trained specialists who diagnose and treat problems and diseases of the foot, ankle and lower extremities. They are recognized legally and professionally as full members of the health care team. Podiatrists can correct most minor foot and ankle problems.
People with diabetes are nearly three times as likely to have a stroke than someone who does not have the disease. This increased risk may be due to some of the same complications that result from diabetes are also associated with stroke.
What is a stroke?
Stroke is a medical emergency, just like a heart attack. That's why experts in the field now refer to it as a "brain attack." Strokes result from a sudden decrease in the flow of blood to parts of the brain. When blood can't reach the brain, its cells are deprived of oxygen and die, so functions normally controlled by the damaged brain areas are impaired. Among the possible effects are temporary or permanent paralysis of various parts of the body or impaired speech or vision.
What is diabetes?
Diabetes is a disease which affects a person's ability to move blood sugar (or glucose) out of the blood and into the cells – where it is used as the body's primary source of fuel.
There are two types of diabetes:
- Insulin dependent (Type 1) – found in childhood and is characterized by the body's inability to produce enough insulin, which is a hormone that permits the body to metabolize blood sugar (glucose).
- Non-Insulin dependent (Type 2) – more common type of diabetes that makes up over 90 percent of all diabetes cases. It usually develops in adulthood and may go unnoticed for some time. The body is able to produce insulin, but tissues develop a resistance to its actions and blood sugar levels rise above normal.
Why is there a link between stroke and diabetes?
There are a number of risk factors that increase the chance of vascular complications in individuals with diabetes. At the top of this list is high blood pressure.
Hypertension is twice as likely among patients with diabetes. This contributes to a higher stroke risk, and can lead to a stroke from a blood clot or hemorrhage.
Heart disease is another common problem that can result in higher stroke risk among patients with diabetes. Myocardial infarction (heart attack) and atrial fibrillation (irregular beating pattern) are common and increase stroke risk.
Brain damage may be more severe and extensive if blood sugar is high when a stroke happens. Careful regulation of blood sugar, either with insulin or oral blood sugar-lowering drugs, can reduce vascular complications.
What is the treatment for diabetes?
Both types of diabetes can be controlled, reducing the risk of long-term health complications such as stroke. Type I is treated closely by monitoring blood sugar and taking daily insulin injections. Type II, which is worsened by obesity, can frequently be controlled through weight loss, dietary changes and exercise. Daily insulin injections are not usually necessary and are reserved as a last resort.
For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).
Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.
Am I eligible for the liquid fast portion of the Comprehensive Weight Management Program?
The Jefferson Comprehensive Weight Management program is designed for people with a body mass index (BMI) of 30 or more, who have or are at risk of serious medical conditions. The Program also accepts people whose BMI is between 25 and 30 if they have health risks such as hypertension, diabetes, high cholesterol and sleep apnea. To determine whether you are eligible, please call us at 215-955-5732.
How long will the liquid fast portion of the Comprehensive Program take?
The liquid fast and transition to food can take up to 24 weeks. However, maintenance lasts a lifetime. Maintenance sessions are available one to two times per week and many participants continue to attend them long after losing weight. Some also continue to use OPTIFAST® products after the fast period. Our Program is one the largest maintenance programs in the country because we emphasize maintenance.
I've tried every diet out there, losing weight each time, only to gain it back. What makes this Program any different than all the others?
Our Weight Management Program is unique from most others because it is medically as well as behaviorally oriented. After your informational session, you will schedule an appointment with our medical staff for a physical assessment. During this appointment, we take a complete medical history, which includes blood work and a review of current medical conditions and medications. We also give you the tools to become personally responsible for your weight management and offer ongoing education programs.
How often do I have to attend meetings?
During the initial phase of the Program, you will attend meetings once a week. Please consider your schedule before committing to the program. Attendance at these sessions is very important. If you are chronically unable to attend the sessions, we may ask you to discontinue until you have more free time. If you expect to miss a session, we ask that you contact us and arrange a make-up time.
As you transition out of the initial phase, you will attend six education sessions throughout the six-week transitional phase. Even if you have been extensively educated about food in the past, we find that most people learn new information and approaches to old topics. For that reason, attendance at all six sessions is mandatory.
Maintenance groups are offered one to two times per week.
What are my options if I want to lose weight but don't want something as drastic as the Comprehensive Program?
We have two additional programs:
- One-session weight loss class
- Six-session weight loss class