The State of Our Health - Women's Health: Fat, Sugar, And Salt

Cholesterol is good. Our body makes it in our liver from meat and animal products that we eat. The body then sends the cholesterol to other regions in the blood. The body turns cholesterol into hormones, bile acid, and Vitamin D. So what's all the controversy about? Too much of a good thing.

Excess cholesterol deposits in our arteries lead to atherosclerosis, the deposit of fatty substance that interferes with and that also can block blood-flow; this leads to heart disease. Cholesterol comes in two forms. High Density Lipoprotein (HDL) is known as "good cholesterol," low density (LDL) as "bad." HDL is good because it is the body's way of "packaging" excess cholesterol for return to the liver for recycling. LDL is not such a package, and high levels of it in the blood ("serum cholesterol") correlate with heart disease.

As shown on the graphic, serum cholesterol has been dropping both for white and black women in the period shown. This is the biomedical counterpart of the "fat free" promotions launched by every purveyor of food. Since only animal products end up as cholesterol in blood, by way of the liver, reducing our intake of animal fats (and organ meats, like liver, which contain high amounts) also reduces the level in us. Fats and oils from plants do not contain cholesterol.

Of course, it is precisely animal fats that give food taste. If the producer removes the fat, he or she also removes some of the pleasure. All three substances that improve "eatability," to borrow a phrase from advertising — fat, sugar, and salt — are on the healthy eater's list of "no-nos." In practice, when fats are removed, sugar or salt (or both) are added in compensation. If sugar is removed, fat can lift the taste. This has turned diet- conscious Americans into avid and sometimes frustrated readers of labels on cans and on jars.

Increased levels of sugar in the blood (blood glucose) worsen the condition of those with diabetes (people whose pancreas does not produce enough insulin to handle the "overdose" or whose body does not respond effectively to insulin). Those without insulin problems get fat. Both diabetes and obesity are up sharply. The chart on the left shows the prevalence and incidence of diabetes for the years 1980 to 1994. It is worth noting that age-adjusted rates of prevalence are up 14.9%, of incidence (new diagnoses) up 48%. Actual people with diabetes increased 40.1%. Obesity expanded 54% between the periods 1976-1980 and 1988-1994. Meanwhile, cholesterol levels for all women are down, from 1975-80 to 1988-1994 by 28.8%.

The correlation between diet, weight, and exercise is well established. The growing prevalence of diabetes cannot be directly blamed on people eating more sugar, but controlling sugar-intake mitigates the damages of diabetes. Diabetes is more common now because the population is aging, does not exercise, and is getting obese. Some of that may be related, indirectly, to other dietary stratagems that bring down cholesterol.

Salt, which is very high in fast foods and abounds in many prepared foods and sauces, contributes to high blood pressure in some. The recommended daily intake (National Academy of Sciences) is 1,100 to 3,300 milligrams for adults. Not surprisingly, the average intake of American adults is 4,000 to 5,000 milligrams a day. Pass the salt.

Balance, obviously, is everything. The choice for those among us who love fat, sugar, and salt may be to live long but dreary lives — or grossing out and dying young but happy.

Prevalence and Incidence of Diabetes

Source: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. October 31, 1997. Online. Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/00049741.htm.