Cholesterol and Your Child

Cholesterol gets unfairly demonized sometimes. It is a critical ingredient for many things we need to live like cell membranes (we have trillions of those) and vitamins and hormones. But it is a waxy substance that doesn’t mix very well with water and humans are made of mostly water: about 70%. The liver combines cholesterol very carefully together with another waxy fat or lipid called triglycerides plus proteins into packages called “lipoproteins” (lipid plus protein) that can dissolve in blood and travel safely through the body to do important work. Triglycerides are also uber-important for the body as terrific sources of stored energy.

The work of cholesterol is so important in fact that every cell in the body knows how to make it! If you never ate any cholesterol, your body would still make enough to run smoothly. Only some cholesterol comes from animal foods we eat, like egg yolks, meat, poultry, fish, or dairy. Some cholesterol gets made from fat and sugars in the diet.

The levels of cholesterol and triglycerides in our blood are the reflection of how much fat and cholesterol our bodies eat and make, how they are packaged, and how well they get in and out of our cells. Some of this is determined by genes we inherit. A lot of this is a function of our food and activity; essentially our daily choices. Moving muscles activate pathways important for packaging the fats and cholesterols in our diets healthfully. Eating right and exercise are synergistic not additive!

High levels of cholesterol have been shown to be a major factor contributing to heart disease and stroke, and medical research shows that these diseases have their roots in childhood. More pediatricians are screening lipid and cholesterol values in children, especially if there's a family history of high cholesterol or early heart disease in parents or grandparents. “Early” means before 55 years old in women and 65 years in men. Furthermore, with the increase in childhood obesity, more kids are at risk for problems with fat and sugar metabolism that affect cholesterol.

If there are known risk factors for abnormal cholesterol or early heart disease in your family, it is important to know your own and your kids' cholesterol levels. But it can be hard to know exactly what the results mean and what should be done about them.

All of your body’s circulating lipid (cholesterol and triglyceride) is packaged in three main kinds of lipoproteins described by their density (how much they weigh for their size). “Low density” lipoprotein (LDL) and “high-density” lipoprotein (HDL) are the ones most people have heard about. “Very low density” lipoprotein is another package that mostly carries triglycerides. You may know your or your child’s “TOTAL cholesterol” number. Total cholesterol = LDL + HDL + VLDL and the devil is all about the details of the relative proportions of each kind of package.

Low-density lipoproteins, or LDL are the primary cholesterol carriers. If there's too much LDL in the bloodstream, it can build up on the walls of the arteries that lead to the heart and the brain. This buildup forms plaque: a thick, hard substance that can cause blood vessels to become stiffer, narrower, or blocked. Atherosclerosis is the name for hardening of the arteries and it is a process that starts in childhood if there are too many LDL particles.

High-density lipoproteins or HDL carries excess cholesterol away from the arteries and back to the liver, where it's processed and sent out of the body. It may even help remove cholesterol from already formed plaques.

Very low-density lipoproteins or VLDL don’t carry too much cholesterol but have a lot of triglyceride so are only elevated when there is a problem processing fats in the body and triglyceride levels build up too high. Our body’s lipoprotein production starts with VLDL that then gets broken down into LDL and HDL. How much triglyceride is packed into the starting VLDL has a big influence on both the quality and quantity of LDL and HDL, and you can see how interconnected these packages are.

High levels of LDL increase the risk for heart disease and stroke. High levels of HDL can help protect against these diseases. High levels of VLDL are a risk factor mostly because they are associated with lower levels or HDL and higher levels of LDL. It’s all connected!

No routine lipid screening is recommended before age 8 for kids who are physically active, eat healthy foods, don't have a family history of high LDL or triglycerides (VLDL) and/or low HDL, and aren't overweight. These kids probably aren't at risk for cholesterol problems. Your doctor can help decide whether you should have your child's cholesterol level checked. By age 9, current recommendations are that all children have either a fasting or non-fasting lipid profile checked.

Here are 10 ways to help keep your family's lipid and cholesterol packages at healthy levels:

1. Know your own cholesterol level and if it's abnormal, ask to have your kids checked.
2. Serve a diet rich in fruit, vegetables and whole grains – foods naturally high in healthy soluble and insoluble fibers and loaded with nutrient value.
3. Choose lean meats and flexitarian protein alternatives, including fish, legumes (dried beans, peas and lentils), and tofu or other soy products.
4. Limit solid saturated and especially trans fat intake and favor healthy unsaturated fats from fish, nuts, and olive and canola vegetable oils.
5. Drink water and low fat milk. Avoid sugary drinks including juice. (Try to always eat, rather than drink your fruit.)
6. Limit foods with added sugars. Make most of your grains fiber-rich whole grains. Too much refined sugar and fluffy white fiber-free starch (that turns into sugar fast) is quickly made into triglyceride by the body and forced into VLDL packages that can adversely affect the quality and quantity of your LDL and HDL packages.
7. Limit commercially prepared baked and highly processed foods – most are low in fiber and high in unhealthy fats.
8. Get plenty of exercise. Exercise builds muscles that use lipid fuel and influence their packaging, helping especially to boost healthy HDL levels in the blood. Kids 2 years of age and older and teens should be physically active at least 60 minutes a day.
9. Margarines and yogurt drinks fortified with plant sterols can help reduce LDL by more than 10%. The amount of daily plant sterols needed for results is at least two grams.
10. Make living healthier a family affair – kids usually aren't the only ones at risk. The strides you take to improve your family's lifestyle can have a positive effect on everyone’s energy and health not only now, but far into the future.