How You’re Kidneys Work

The kidneys maintain water volume and balance as well as regulate blood
composition.

Did you know that kidney stone plagued even the ancient Egyptians [source:  Or that 26
million Americans have chronic kidney disease. Hundreds of thousands of people suffer
from renal failure each year and undergo dialysis or await a kidney transplant.

But what do your kidneys do? Why are they so important? Don't they just produce
urine? In this article, we'll take a close look at our kidneys and find out exactly what they
do.

Your kidneys are two bean-shaped organs, each about the size of your fist. They are
located in the middle of your back, just below your rib cage, on either side of your spine.
Your kidneys weigh about 0.5 percent of your total body weight. Although the kidneys
are small organs by weight, they receive a huge amount -- 20 percent -- of
the blood pumped by the heart. The large blood supply to your kidneys enables them to
do the following tasks:
  Regulate the composition of your blood: Keep the concentrations of various ions
and other important substances constant; Keep the volume of water in your body
constant; Remove wastes from your body (urea, ammonia, drugs, toxic
substances); Keep the acid/base concentration of your blood constant

 Help regulate your blood pressure

 Stimulate the making of red blood cells

 Maintain your body's calcium levels

Your kidneys receive the blood from the renal artery, process it, return the processed
blood to the body through the renal vein and remove the wastes and other unwanted
substances in the urine. Urine flows from the kidneys through the ureters to the bladder.
In the bladder, the urine is stored until it is excreted from the body through the urethra.

Now let's take a look inside your kidneys.

Diagram showing the parts of the kidney and the nephron

Inside Your Kidneys

If you were to cut a kidney in half, you would see the following parts:
  Renal capsule - a thin, outer membrane that helps protect the kidney

 Cortex - a lightly colored outer region

 Medulla - a darker, reddish-brown, inner region

 Renal pelvis - a flat, funnel-shaped cavity that collects the urine into the ureters

If you look closely at the cortex and medulla, you can see many tiny, tubular structures
that stretch across both regions perpendicular to the surface of the kidney. In each
kidney, there are one million of these structures, called nephrons. The nephron is the
basic unit of the kidney. It's a long, thin tube that is closed at one end, has two twisted
regions interspaced with a long hairpin loop, ends in a long straight portion and is
surrounded by capillaries.

The parts of the nephron are as follows:

 Bowman's capsule - This closed end at the beginning of the nephron is located
in the cortex.

 Proximal convoluted tubule or proximal tubule - The first twisted region after

the Bowman's capsule; it's in the cortex.

 Loop of Henle - A long, hairpin loop after the proximal tubule, it extends from the
cortex down into the medulla and back.

 Distal convoluted tubule or distal tubule - This second twisted portion of the

nephron after the loop of Henle is located in the cortex.

 Collecting duct - This long straight portion after the distal tubule that is the open
end of the nephron extends from the cortex down through the medulla.

Each part of the nephron has different types of cells with different properties -- this is
important in understanding how the kidney regulates the composition of the blood.

The nephron has a unique blood supply compared to other organs:

  Afferent arteriole - connects the renal artery with the glomerular capillaries

 Glomerular capillaries - coiled capillaries that are inside the Bowman's capsule

 Efferent arteriole - connects the glomerular capillaries with the peritubular

capillaries

 Peritubular capillaries - located after the glomerular capillaries and surrounding

the proximal tubule, loop of Henle, and distal tubule

 Interlobular veins - drain the peritubular capillaries into the renal vein

The kidney is the only organ of the body in which two capillary beds, in series, connect
arteries with veins. This arrangement is important for maintaining a constant blood flow
through and around the nephron despite fluctuations in systemic blood pressure.

Regulating the composition of the blood involves the following:

 Keeping the concentrations of various ions and other important substances

constant

 Keeping the volume of water in your body constant

 Removing wastes from your body

 Keeping the acid/base concentration of your blood constant

The kidney does this by a combination of three processes:

 It filters 20 percent of the plasma and non-cell elements from the blood into the
inside of the nephron (the lumen).

 It reabsorbs the components that the body needs from the lumen back into the
blood.

 It secretes some unwanted components from the blood into the lumen of the
nephron.

Anything (fluid, ions, small molecules) that has not been reabsorbed from the lumen
gets swept away to form the urine, which ultimately leaves the body. Through these
processes, the blood is maintained with the proper composition, and excess or
unwanted substances are removed from the blood into the urine.

Next, we'll look at how the kidneys regulate blood composition by three main processes:

 Filtration
  Reabsorption

 Secretion

The glomerular capillaries, peritubular capillaries and the Bowman's

capsule are all integral to the filtration process.

Kidney Filtration

In the nephron, approximately 20 percent of the blood gets filtered under pressure
through the walls of the glomerular capillaries and Bowman's capsule. The filtrate is
composed of water, ions (sodium, potassium, chloride), glucose and small proteins (less
than 30,000 daltons -- a dalton is a unit of molecular weight). The rate of filtration is
approximately 125 ml/min or 45 gallons (180 liters) each day. Considering that you have
7 to 8 liters of blood in your body, this means that your entire blood volume gets filtered
approximately 20 to 25 times each day! Also, the amount of any substance that gets
filtered is the product of the concentration of that substance in the blood and the rate of
filtration. So the higher the concentration, the greater the amount filtered or the greater
the filtration rate, the more substance gets filtered.

This filtration process is much like the making of espresso or cappuccino. In a

cappuccino machine, water is forced under pressure through a fine sieve containing
ground coffee; the filtrate is the brewed coffee. The arrangement of the glomerular
capillaries in series with the peritubular capillaries is important to maintain a constant
pressure in the glomerular capillaries, and thus a constant rate of filtration, despite
momentary fluctuations in blood pressure. Once the filtrate has entered the Bowman's
capsule, it flows through the lumen of the nephron into the proximal tubule.

BLOOD IN THE URINE

The filtrate only includes small molecules and water. No red blood cells get filtered.
Therefore, no blood appears in the urine under normal conditions. If you find blood in
your urine, you should contact your physician as soon as possible because it could be a
sign of kidney problems.
Kidney Reabsorption

Once inside the lumen of the nephron, small molecules, such as ions, glucose and
amino acids, get reabsorbed from the filtrate:

 Specialized proteins called transporters are located on the membranes of the

various cells of the nephron.

 These transporters grab the small molecules from the filtrate as it flows by them.

 Each transporter grabs only one or two types of molecules. For example, glucose
is reabsorbed by a transporter that also grabs sodium.

 Transporters are concentrated in different parts of the nephron. For example,

most of the Na transporters are located in the proximal tubule, while fewer ones
are spread out through other segments.

 Some transporters require energy, usually in the form of adenosine

triphosphate (active transport), while others don't (passive transport).

 Water gets reabsorbed passively by osmosis in response to the buildup of

reabsorbed Na in spaces between the cells that form the walls of the nephron.

 Other molecules get reabsorbed passively when they are caught up in the flow of
water (solvent drag).
  Reabsorption of most substances is related to the reabsorption of Na, either
directly, via sharing a transporter, or indirectly via solvent drag, which is set up by
the reabsorption of Na.

The reabsorption process is similar to the "fish pond" game that you see in some
amusement parks or state fairs. In these games, there is a stream that contains different
colored plastic fish with magnets. The children playing the game each have a fishing
pole with an attached magnet to catch the fish as they move by. Different colored fish
have different prize values associated with them, so some children will be selective and
try to grab the colored fish with the highest prize value. Now suppose our nephron is the
stream, the filtered molecules are the various colored fish, and our children are the
transporters. Furthermore, each child is fishing for a specific colored fish. Most children
start at the beginning of the stream and some spread out further downstream. By the
end of the stream, most of the fish have been caught. This is what happens as the
filtrate travels through the nephron.

Two major factors affect the reabsorption process:

 Concentration of small molecules in the filtrate - the higher the concentration, the
more molecules can be reabsorbed. Like our children in the fish pond game, if
you increase the number of fish in the stream, the children will have an easier
time catching them. In the kidney, this is true only to a certain extent because:
There is only a fixed number of transporters for a given molecule present in the
nephron. There is a limit to how many molecules the transporters can grab in a
given period of time.

 Rate of flow of the filtrate - flow rate affects the time available for the transporters
to reabsorb molecules. As with our fish pond, if the stream moves by slowly, the
children will have more time to catch fish than if the stream were moving faster.

To give you an idea of the quantity of reabsorption across the nephron, let's look at the
sodium ion (Na) as an example:

 Proximal tubule - reabsorbs 65 percent of filtered Na. In addition, the proximal

tubule passively reabsorbs about 2/3 of water and most other substances.

 Loop of Henle - reabsorbs 25 percent of filtered Na.

 Distal tubule - reabsorbs 8 percent of filtered Na.

 Collecting duct - reabsorbs the remaining 2 percent only if the

hormone aldosterone is present.
Kidney Processes Working Together

Some substances are secreted from the plasma into the lumen by the cells of the
nephron. Examples of such substances are ammonia (NH 3). As in reabsorption, there
are transporters on the cells that can move these specific substances into the lumen.

Now let's put all of these processes -- filtration, reabsorption and secretion -- together to
understand how the kidneys maintain a constant composition of the blood. Let's say that
you decide to eat several bags of salty (NaCl) potato chips at one sitting. The Na will be
absorbed into your blood by your intestines, increasing the concentration of Na in your
blood. The increased Na in the blood will be filtered into the nephron. While the Na
transporters will attempt to reabsorb all of the filtered Na, it's likely that the amount will
exceed their ability. Therefore, excess Na will remain in the lumen; water will also
remain, due to osmosis. The excess Na will be excreted into the urine and eliminated
from the body. So whether a substance remains in the blood depends on the amount
filtered into the nephron and the amount reabsorbed or secreted by various
transporters.

Let's look at an another example: Why do you have to keep taking repeated doses of
any given medicine? Well, once you take the medicine, it gets absorbed by the intestine
into the blood. The medicine in the blood acts on its target cell and also gets filtered into
the nephron. Most medicines don't have transporters in the nephron to reabsorb them
from the filtrate. In fact, some transporters actively secrete medicines into the nephron.
Therefore, the medicine gets eliminated in the urine and you must take another dosage
later.

We've seen how the kidney can regulate ions and small molecules and eliminate
unwanted substances. In the next section, we'll see how the kidney maintains water
balance.

Maintaining Water Volume

Your kidneys have the ability to conserve or waste water. For example, if you drink a
large glass of water, you'll find that you will have the urge to urinate within an hour or so.
In contrast, if you don't drink for a while, such as overnight, you will not produce much
urine and it will usually be very concentrated (i.e. darker). How does your kidney know
the difference? The answer to this question involves two mechanisms:

 The structure and transport properties of the loop of Henle in the nephron.

 The anti-diuretic hormone (ADH), also called vasopressin, secreted by the

pituitary gland.
The loop of Henle has a descending limb and an ascending limb. As filtrate moves
down the loop of Henle, water is reabsorbed, but ions (Na,Cl) aren't. The removal of
water serves to concentrate the Na and Cl in the lumen. Now, as the filtrate moves up
the other side (ascending limb), Na and Cl are reabsorbed, but water isn't. What these
two transport properties do is set up a concentration difference in NaCl along the length
of the loop, with the highest concentration at the bottom and lowest concentration at the
top. The loop of Henle can then concentrate NaCl in the medulla. The longer the loop,
the bigger the concentration gradient. This also means that the medulla tissue tends to
be saltier than the cortex tissue.

Now, as the filtrate flows through the collecting ducts, which go back down through the
medulla, water can be reabsorbed from the filtrate by osmosis. Water moves from an
area of low Na concentration (high water concentration) in the collecting ducts to an
area of high Na concentration (low water concentration) in the medullary tissue. If you
remove water from the filtrate at this final stage, you can concentrate the urine.

ADH, which is secreted by the pituitary gland, controls the ability of water to pass
through the cells in the walls of the collecting ducts. If no ADH is present, then no water
can pass through the walls of the ducts. The more ADH present, the more water can
pass through.

Specialized nerve cells, called osmoreceptors, in the hypothalamus of the brain sense

the Na concentration of the blood. The nerve endings of these osmoreceptors are
located in the posterior pituitary gland and secrete ADH. If the Na concentration of the
blood is high, the osmoreceptors secrete ADH. If the Na concentration of the blood is
low, they don't secrete ADH. In reality, there is always some very low level of ADH
secreted from the osmoreceptors.

Now let's look at how your kidneys maintain water volume.

Maintaining Water Balance

When you drink a large glass of water, the water gets absorbed into the blood and the
following happens:

 The absorbed water increases the amount of water filtered in the glomerulus.

 The absorbed water in the blood reduces the Na concentration a little.

 The reduced Na concentration lowers the amount of Na filtered in the

glomerulus.

 The nephron reabsorbs all of the reduced Na load and some of the
accompanying water, leaving excess water in the filtrate.
  The reduced Na concentration is sensed by the osmoreceptors.

 The osmoreceptors do not secrete as much ADH.

 Because the collecting ducts don't see as much ADH, they don't allow much
water to be reabsorbed in response to the Na concentration gradient set up by
the loop of Henle.

 The excess water gets excreted in the urine.

 When the excess water is excreted, the Na concentration of the blood returns to
normal.

Typically, we don't drink water overnight when we sleep. So, our intestines aren't
absorbing water:

 Decreased water absorption by the intestine reduces the amount of water in the
blood.

 Decreased water in the blood reduces the amount of water filtered in the
glomerulus.

 Decreased water in the blood increases the Na concentration in the blood.

 Increased Na concentration in the blood increases the amount of Na filtered in

the glomerulus.

 The nephron doesn't reabsorb all of the filtered Na, and some water remains with
it in the filtrate.

 The increased Na concentration in the blood is sensed by the osmoreceptors.

 The osmoreceptors secrete ADH.

 The collecting ducts see more ADH and allow water to be reabsorbed in
response to the Na concentration gradient set up by the loop of Henle.

 More water gets reabsorbed from the collecting ducts, producing a concentrated
urine. A little water is lost in the urine because of the Na; we can't excrete solid
urine.

 The removal of Na and increased reabsorption of water help return the blood
concentration of Na to normal.
So, the loop of Henle sets up the Na concentration gradient across the medulla,
allowing for water to be reabsorbed from the collecting ducts, and ADH allows the water
to pass through those collecting ducts.

Your blood maintains a constant concentration of hydrogen ion (pH) by a chemical

mixture of hydrogen ions and sodium bicarbonate. The sodium bicarbonate is
produced by the carbon dioxide (CO2) formed in the cells as a byproduct of many
chemical reactions. The CO2 enters the blood in the capillaries, where red blood
cells contain an enzyme called carbonic anhydrase that helps combine CO 2 and
water (H 2O) to form carbonic acid (H 2 CO3 ) quickly. The carbonic acid formed then
rapidly separates into hydrogen ions (H+ ) and bicarbonate ions (HCO3-). This reaction
can also proceed in the reverse direction, whereby sodium bicarbonate plus hydrogen
ion yields carbon dioxide and water.

Carbonic Anhydrase

CO 2 + H 2 O <---------> H 2 CO3 <---------> H+ + HCO 3-

The correct pH is maintained by keeping the ratio of hydrogen ion to bicarbonate in the
blood constant. If you add acid (hydrogen ion) to the blood, then you will reduce the
bicarbonate concentration and alter the pH of the blood. Similarly, if you reduce the
hydrogen ion by adding alkali, you will increase the bicarbonate concentration and alter
the pH of the blood.

Now, the acid/base balance of our blood changes in response to many things including:

 Diet - diets rich in meats provide acids to the bloods when digested. In contrast,
diets rich in fruits and vegetables make our blood alkaline because they are rich
in bicarbonates.

 Exercise - exercising muscles produce lactic acid that must be eliminated from
the body or metabolized.

 Breathing - high altitude causes rapid breathing that makes our blood alkaline.
In contrast, certain lung diseases that block the diffusion of oxygen can cause the
blood to be acidic.

In the next section, we'll take a look at how the kidneys regulate blood composition.

Regulating Blood Composition

The kidney can correct any imbalances by:

 Removing excess acid (hydrogen ion) or bases (bicarbonate) in the urine and
  Restoring the bicarbonate concentration in the blood to normal

The kidney cells produce a constant amount of hydrogen ion and bicarbonate because
of their own cellular metabolism (production of carbon dioxide). Through a carbonic
anhydrase reaction similar to the red blood cells, hydrogen ions get produced and
secreted into the lumen of the nephron. Also, bicarbonate ions get produced and
secreted into the blood. In the lumen of the nephron, filtered bicarbonate combines with
secreted hydrogen ions to form carbon dioxide and water (carbonic anhydrase is also
present on the luminal surface of the kidney cells). Whether the kidney removes
hydrogen ions or bicarbonate ions in the urine depends upon the amount of bicarbonate
filtered in the glomerulus from the blood relative to the amount of hydrogen ions
secreted by the kidney cells. If the amount of filtered bicarbonate is greater than the
amount of secreted hydrogen ions, then bicarbonate will be lost in the urine. Likewise, If
the amount of secreted hydrogen ion is greater than the amount of filtered bicarbonate,
then hydrogen ions will be lost in the urine (i.e. acidic urine).

Let's consider a few examples:

 Acid Diet Hydrogen ions added to the blood by breaking down a meat-rich diet
combine with bicarbonate in the blood and form carbon dioxide and water. This
reaction reduces the bicarbonate concentration and the pH in the blood. The
decreased bicarbonate concentration in the blood reduces the amount of
bicarbonate filtered in the glomerulus. All of the filtered bicarbonate combines
with the hydrogen ion secreted by the kidney cells in the lumen to form carbon
dioxide and water. Because the filtered load of bicarbonate was less than the
amount of hydrogen ion secreted by the kidney cells, there is an excess of
hydrogen ion in the urine. The amount of bicarbonate secreted from the kidney
cells into the blood was equal to the hydrogen ion secreted into the lumen and
greater than the filtered load of bicarbonate from the blood -- therefore, the blood
has a net gain of bicarbonate. This process continues to lose hydrogen ions in
the urine and gain bicarbonate in the blood until the concentrations of hydrogen
(pH) and bicarbonate ions in the blood are restored to normal.

 Alkaline Diet Bicarbonate added to the blood from the fruit or vegetable-rich diet
combines with hydrogen ions to form carbon dioxide and water. This reaction
reduces the hydrogen ion concentration and increases the pH. The increased
bicarbonate concentration increases the amount of bicarbonate filtered in the
glomerulus. The filtered bicarbonate exceeds the amount of hydrogen ion
secreted by the kidney cell, and excess bicarbonate is lost in the urine. The
amount of bicarbonate secreted from the kidney cells into the blood was equal to
the hydrogen ions secreted into the lumen and less than the filtered load of
bicarbonate from the blood -- therefore, the blood has a net loss of bicarbonate.
 This process continues to lose bicarbonate in the urine and reduce the
bicarbonate in the blood until the concentrations of hydrogen (pH) and
bicarbonate ions in the blood are restored to normal.

Now that we have seen how the kidneys regulate the composition of our blood, let's look
at how they help regulate our blood pressure

How Kidneys Influence Blood Pressure

The blood pressure in your body depends upon the following conditions:

 The force of contraction of the heart -- related to how much the heart muscle gets
stretched by the incoming blood.

 The degree to which the arteries and arterioles constrict -- increases the
resistance to blood flow, thus requiring a higher blood pressure.

 The circulating blood volume -- the higher the circulating blood volume, the more
the heart muscle gets stretched by the incoming blood.

The kidney influences blood pressure by:

 Causing the arteries and veins to constrict

 Increasing the circulating blood volume

Specialized cells are located in a portion of the distal tubule located near and in the wall
of the afferent arteriole. The distal tubule cells (macula densa) sense the Na in the
filtrate, and the arterial cells (juxtaglomerular cells) sense the blood pressure. When
the blood pressure drops, the amount of filtered Na also drops. The juxtaglomerular
cells sense the drop in blood pressure and the decrease in Na is relayed to them by the
macula densa cells. The juxtaglomerular cells then release an enzyme called renin.
Renin converts angiotensinogen (a peptide, or amino acid derivative) into angiotensin
I. Angiotensin I is then converted to angiotensin II by an angiotensin-converting
enzyme (ACE), which is found mainly in the lungs. Angiotensin II causes blood vessels
to contract -- the increased blood vessel constrictions elevate the blood pressure.

Now let's take a look at how the kidney increases the circulating blood volume.
Angiotensin II also stimulates the adrenal gland to secrete a hormone
called aldosterone. Aldosterone stimulates more Na reabsorption in the distal tubule,
and water gets reabsorbed along with the Na. The increased Na and water reabsorption
from the distal tubule reduces urine output and increases the circulating blood volume.
The increased blood volume helps stretch the heart muscle and causes it to generate
more pressure with each beat, thereby increasing the blood pressure.

The actions taken by the kidney to regulate blood pressure are especially important
during traumatic injury, when they are necessary to maintain blood pressure and
conserve the loss of fluids.

Your body stores calcium in the bones, but also maintains a constant level of calcium in
the blood. If the blood calcium level falls, then the parathyroid glands in your neck
release a hormone called parathyroid hormone. Parathyroid hormone increases
calcium reabsorption from the distal tubule of the nephron to restore the blood calcium
level. Parathyroid hormone also stimulates calcium release from bone and calcium
absorption from the intestine.

In addition to parathyroid hormone, your body also requires vitamin D to stimulate

calcium absorption from the kidney and intestine. Vitamin D is found in milk products. A
precursor to vitamin D (cholecalciferol) is made in the skin and processed in the liver.
However, the final step that converts an inactive form of cholecalciferol into active
vitamin D occurs in the proximal tubule of the nephron. Once activated, vitamin D
stimulates calcium absorption from the proximal tubule and from the intestine, thereby
increasing blood calcium levels.

Kidney stones are often caused by problems in the kidney's ability to handle calcium. In
addition, the kidney's role in maintaining blood calcium is important in the bone
disease osteoporosis that afflicts many elderly people, especially women.

As you can see, the kidneys perform many functions that are important to your body:

 Controlling the composition of your blood and eliminate wastes --

filtration/reabsorption/secretion method

 Influencing blood pressure -- renin secretion

 Helping to regulate your body's calcium -- vitamin D activation

If the kidneys fail to function, then renal dialysis methods (artificial filtration methods)
can be used to help you survive by cleansing the blood. This is especially necessary
when both kidneys fail. Although you have two kidneys, it is possible to live with only
one. One healthy kidney can be donated and transplanted into a compatible person with
total kidney failure. Kidney transplants are a common way to help those people survive
and live a normal life.

For more information on the kidney, its functions and its diseases, check out the
following page.
Cholesterol Overview

That monster burger you love isn't so great for your cholesterol levels.

Have you ever been about to take a big bite of your triple chocolate fudge cake when
someone leaned over and said "you better watch your cholesterol"? That's happening to
all of us more frequently. According to The American Heart Association, high levels of
cholesterol are a risk factor for coronary heart disease, the nation's number one killer.
Over 100 million Americans have cholesterol levels that exceed the recommended total
and 20 percent of Americans have levels that are considered high [ref].

What we don't often hear is the important fact that some cholesterol is vital to human
life. In this article, we will take a look at cholesterol, both why it is needed for normal
human--and animal--functions and why at high levels and in many individuals, it can be
deadly. We'll also describe what contributes to and the treatments for high cholesterol
levels so that you can take steps to limit your health risks. But first, let's answer an
important question: "What is cholesterol?"

What is Cholesterol?

Cholesterol is a waxy, fat-like compound that belongs to a class of molecules

called steroids. It's found in many foods, in your bloodstream and in all your
body's cells. If you had a handful of cholesterol, it might feel like a soft, melted candle.
Cholesterol is essential for:

 Formation and maintenance of cell membranes (helps the cell to resist changes
in temperature and protects and insulates nerve fibers)

 Formation of sex hormones (progesterone, testosterone, estradiol, cortisol)

 Production of bile salts, which help to digest food

 Conversion into vitamin D in the skin when exposed to sunlight.

The formation of cholesterol involves a series of complicated biochemical reactions that
begin with the widespread 2-carbon molecule Acetyl CoA: Acetyl CoA (C2) -->
mevalonate (C6) --> isopentenyl pyrophosphate (C5) --> squalene (C30) --> cholesterol
(C27). Cholesterol is made primarily in your liver (about 1,000 milligrams a day), but it is
also created by cells lining the small intestine and by individual cells in the body.

Most of the body's cholesterol is manufactured in

the liver.
Blood Cholesterol vs. Dietary Cholesterol

It may surprise you to know that our bodies make all the cholesterol we need. When
your doctor takes a blood test to measure your cholesterol level, the doctor is actually
measuring the amount of circulating cholesterol in your blood, or your blood
cholesterol level. About 85 percent of your blood cholesterol level
is endogenous, which means it is produced by your body. The other 15 percent or so
comes from an external source -- your diet. Your dietary cholesterol originates from
meat, poultry, fish, seafood and dairy products. It's possible for some people to eat
foods high in cholesterol and still have low blood cholesterol levels. Likewise, it's
possible to eat foods low in cholesterol and have a high blood cholesterol level.

So, why is there so much talk about cholesterol in our diet? It's because the level of
cholesterol already present in your blood can be increased by high consumption of
cholesterol and saturated fat in your diet. This increase in dietary cholesterol has been
associated with atherosclerosis, the build-up of plaques that can narrow or block blood
vessels. (Think about what happens to your kitchen drain pipes when you pour chicken
fat down the sink.) If the coronary arteries of the heart become blocked, a heart
attack can occur. The blocked artery can also develop rough edges. This can cause
plaques to break off and travel, obstructing blood vessels elsewhere in the body. A
blocked blood vessel in the brain can trigger a stroke.
The average American man eats about 360 milligrams of cholesterol a day; the average
woman eats between 220 and 260 milligrams daily. So how are we doing?
The American Heart Association recommends that we limit our average daily
cholesterol intake to less than 300 milligrams. Obviously, people with high levels of
cholesterol in the blood should take in even less.

Good and Bad Cholesterol

Comments about "good" and "bad" cholesterol refer to the type of carrier molecule that
transports the cholesterol. These carrier molecules are made of protein and are
called apoproteins. They are necessary because cholesterol and other fats (lipids)
can't dissolve in water, which also means they can't dissolve in blood. When these
apoproteins are joined with cholesterol, they form a compound called lipoproteins. The
density of these lipoproteins is determined by the amount of protein in the molecule.
"Bad" cholesterol is the low-density lipoprotein (LDL), the major cholesterol carrier in
the blood. High levels of these LDLs are associated with atherosclerosis. "Good"
cholesterol is the high-density lipoprotein (HDL); a greater level of HDL--think of this
as drain cleaner you pour in the sink--is thought to provide some protection against
artery blockage.

A high level of LDL in the blood may mean that cell membranes in the liver have
reduced the number of LDL receptors due to increased amounts of cholesterol inside
the cell. After a cell has used the cholesterol for its chemical needs and doesn't need
any more, it reduces its number of LDL receptors. This enables LDL levels to
accumulate in the blood. When this happens, the LDLs begin to deposit cholesterol on
artery walls, forming thick plaques. In contrast, the HDLs--the "good" guys--act to
remove this excess cholesterol and transport it to the liver for disposal.

A third group of carrier molecules, the very low-density lipoproteins (VLDL) are
converted to LDL after delivering triglycerides to the muscles and adipose (fat) tissue.

The levels of HDL, LDL and total cholesterol are all indicators for atherosclerosis and
heart attack risk. People who have a cholesterol level of 275 or greater (200 or less is
desirable) are at significant risk for a heart attack, despite a favorable HDL level. In
addition, people who have normal cholesterol levels but low HDL levels are also at
increased risk for a heart attack.

Cholesterol Risk Factors

There are a number of factors that influence a person's cholesterol levels. They include
diet, age, weight, gender, genetics, diseases and lifestyle.
Diet
There are two dietary factors associated with increases in blood cholesterol levels:

 Eating foods that are high in saturated fats, even if the fats themselves do not
contain cholesterol. (These include foods containing high levels of hydrogenated
vegetable oils, especially palm and coconut oils, avocados and other high-fat
foods of vegetable origin.) 
 

 Eating foods containing high levels of cholesterol. (This group includes eggs and
red meat--the most maligned of the cholesterol culprits--as well as lard and
shrimp. These foods can significantly raise blood cholesterol levels, especially
when combined with foods that are high in saturated fat.)

It's important to note that only foods of animal origin contain cholesterol. Lack of
awareness of this fact has led to some confusing labels at the grocery store. For
example, some items that are high in saturated fats from plant sources bear labels
claiming that they are 100 percent cholesterol free. The statement may be true, but it's
generally misleading because it implies that the product is definitely beneficial to your
health.

Age
The blood levels of cholesterol tend to increase as we age--a factor doctors consider
when deciding treatment options for patients with certain cholesterol levels.

Weight
People who are overweight are more likely to have high blood cholesterol levels. They
also tend to have lower HDL levels. The location of the excess weight also seems to
play a role in cholesterol levels. A greater risk of increased cholesterol levels occurs
when that extra weight is centered in the abdominal region, as opposed to the legs or
buttocks.

Gender
Men tend to have higher LDL levels and lower HDL levels than do women, especially
before age 50. After age 50, when women are in their post-menopausal years,
decreasing amounts of estrogen are thought to cause the LDL level to rise.

Genetics
Some people are genetically predisposed to having high levels of cholesterol. A variety
of minor genetic defects can lead to excessive production of LDLs or a decreased
capacity for their removal. This tendency towards high cholesterol levels is often passed
on from parents to their children. If your parents have high cholesterol, you need to be
tested to see if your cholesterol levels are also elevated.
Diseases
Diseases such as diabetes can lower HDL levels, increase triglycerides and accelerate
the development of atherosclerosis. High blood pressure, or hypertension, can also
hasten the development of atherosclerosis, and some medications used to treat it can
increase LDL and triglycerides and decrease HDL levels.

Lifestyle
Factors that negatively affect cholesterol levels also include high levels of stress, which
can raise total cholesterol levels, and cigarette smoking, which can lower a person's
HDL level as much as 15 percent. On the other hand, strenuous exercise can increase
HDL levels and decrease LDL levels. Exercise also can help reduce body weight,
which, in turn, can help reduce cholesterol. Recent research has shown that
moderate alcohol use (one drink per day for women, two drinks a day for men) can raise
HDL cholesterol and therefore reduce the risk of heart attack. Despite such research, it
is difficult to recommend the habitual use of alcohol, because there are also negative
health consequences associated with alcohol use and a high potential for abuse.

Always remember that risk factors for high cholesterol and cardiovascular disease don't
exist in a vacuum--they tend to amplify each other. Reducing the risk of a
cardiovascular disease involves eliminating all of the risk factors that we can control and
seeking medical advise for those we can't.

Cholesterol Testing and Prevention

How often should I have my cholesterol levels tested?

You should get your cholesterol tested every three to five years, more often if you have
high cholesterol levels. Please refer to the table below for guidelines for total
cholesterol, LDL and HDL levels.

Desirabl Borderlin Undesirabl

e e e

Total Below
200-240 Above 240
Cholesterol 200

HDL Above
35-45 Below 35
Cholesterol 45

LDL Below
130-160 Above 160
Cholesterol 130
 Total
Below
Cholesterol/HD 4.5-5.5 Above 5.5
4.5
L

LDL/HDL Below 3 3-5 Above 5

What can I do to reduce my cholesterol?

There are several steps you can take to reduce your cholesterol levels. The first is to
eat a low-fat, low-cholesterol diet. That means keeping your total fat consumption--
saturated, polyunsaturated and monounsaturated--to fewer than 30 percent of your daily
intake of calories. Remember to keep your cholesterol intake to fewer than 300
milligrams per day. Saturated fats contained in butter, whole milk, hydrogenated
oils, chocolate shortening, etc. should comprise no more than one third of your total fat
consumption. To reduce your total fat and cholesterol intake, limit your consumption of
meats such as beef, pork, liver and tongue (always trim away excess fat). In addition,
avoid cheese, fried foods, nuts and cream, and try to curb your intake of eggs to no
more than four per week. Try to eat meatless meals several times a week, use skim
milk and include fish in your diet. Eat a wide variety of vegetables, pasta, grains and
fruit. Another good tip is to look at the package label of the foods you buy, and restrict
your choices to foods containing 3 grams of fat or less per serving.

There is evidence that water-soluble fibers can aid in lowering cholesterol; these foods
include the fiber in oat or corn bran, beans and legumes, pectin found in apples and
other fruits, and guar that is used as a thickener. Although highly touted by the media
and health food stores, the phospholipid Lecithin has not been confirmed as a reducer
of blood cholesterol levels.

If you are overweight, trying to lose weight and including aerobic exercise in your
routine can help raise those desirable HDL levels. Diet and exercise alone can
decrease cholesterol levels by up to 15 percent.

It probably comes as no surprise to you that, if you smoke, you should quit to avoid a
wide range of health problems, including lower HDL levels and increased risk of heart
attack.