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updated 4/12/2004 3:17:41 PM ET 2004-04-12T19:17:41

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have a question about your health, you should consult your personal physician. This event is meant for informational purposes only.

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Our experienced medical journalist Daniel J. DeNoon took your questions about cholesterol to specialists. Here's what he found out.

Question: My cholesterol is a little high. Do you think it would be wise to go on a high-protein diet or the Atkins diet?

Answer: The best-controlled studies to date indicate that a Mediterranean diet -- with fish twice a week or fish-oil-capsule supplements -- will reduce risk of heart disease and will lower cholesterol if you are currently on a high-fat diet.

A low-carb diet appears to be successful with regard to weight loss -- and while you are losing weight, LDL cholesterol drops. But a steady diet with fat content over 27-30 percent has been associated with an increase in cholesterol and coronary heart disease.

So with regard to the Atkins diet, the reality is that as long as you are losing weight on the diet, the assumption is the effect on weight will overcome the effect of fats. And if you add fish oils, you'll lower your LDL and triglyceride levels. Dr. Atkins' book recommends that while you're losing weight, fish oil is a good thing to do.

But there are no studies of what perpetually being on Atkins will mean. From the information we have, if you're just eating as many calories as you burn, the more fats you eat the more LDL cholesterol and greater cardiovascular risk you will have. Obtaining a good weight and staying there is a critical issue in nutrition. Does this benefit balance off the harm of eating more trans fats and fats? I don't know. But if you had to make a recommendation based just on prudence, the prudent thing to do would be to lose weight that way and then, in the long-term, try to get fats down below 30 percent of your calories. -- Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

Question: Does eating foods such as eggs and shrimp that contain cholesterol raise your cholesterol level? Are they more or less dangerous than foods with high saturated fat?

Answer: Not much. You absorb only half the cholesterol you eat. Most -- about 80 percent -- of your blood cholesterol is made in your liver. Fats, especially saturated fats and trans fats, increase cholesterol production. You should limit cholesterol consumption to 200-300 mg a day. That's one egg yolk, so eggs a few times a week is fine. This is also true of shrimp. -- Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

It's less dangerous than foods high in saturated fat. That raises triglycerides twice as much as eating cholesterol-rich foods. Saturated fat is the primary enemy. Cholesterol in food is a sort of secondary enemy. Don't worry about the second when you haven't dealt with the first. Saturated fats and trans fats are the worst.-- Dr. Richard Milani, director of the cardiovascular health center at Ochsner Clinic, New Orleans.

Question: I am a 50-year-old male in good health and weigh 160 pounds. I exercise 30 minutes, four days a week…. My cholesterol is 250; my triglycerides are almost 200. My doctor wants me to cut down on my white starches and sugars…. How many carbs should I allot to my diet and what percentage of simple and complex? Carbs and cholesterol?

Answer: Since weight loss is not an issue -- assuming his height is at least 5'8" -- the ideal diet for him would contain 27-30 percent fats with avoidance of saturated fats and foods with trans fats, and cold-water fish meals twice a week. Protein should be 20-25 percent, leaving carbohydrates at 55 percent. These carbs should as much as possible be in the forms of fruits and vegetables and some whole grains with high fiber. -- Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

I don't know his HDL and LDL. And I don't know how tall he is, but let's say that at 160 pounds he is probably not overweight. If his HDL was 85, that 250 total cholesterol may not be the worst in the world. If it's only 25, my gosh, we have a problem. An A+ in triglycerides is under 150, but under 200 is not horrible. He is not in a horrible place. He is not getting an A, but he's not flunking. Simply reducing white starches and sugars would probably help. If his HDL was 30, his big problem would be LDL and he should worry about saturated fat. It is hard to steer toward exact percentages. But if all it comes down to is, will avoiding white starches and sugar lower his triglycerides, the answer is yes. -- Dr. Richard Milani, director of the cardiovascular health center at Ochsner Clinic, New Orleans.

Question: Is a vegetarian diet the best way to avoid cholesterol and control it?

Answer: A lot of valid things, such as spiritual and ethical concerns, affect a person's choice of diet more than health. But in large respect, if you can eat fish or at least eat fish oil capsules, it would be a good thing for your health.

There are levels of vegetarian diets. You can go all the way up to macrobiotic diets, where you don't even cook vegetables, or the vegan diet, which is only vegetables. If you are a lacto-vegetarian, you can eat skim milk. If you're an ovo-vegetarian, you can eat eggs.

The latter two types of vegetarian diets are preferable because you don't have to match proteins, such as beans and corn, to get the complete proteins you need. If you're a vegetarian, the problem is there are 12 essential amino acids you need to get by eating. If you're deficient in any of these, you won't grow and develop and your body won't have what it needs to make the proteins that are the building blocks of your system.

When people go on simple vegetarian diets, those are usually lacto-ovo diets. I think that is a good idea. But you can basically get to the same point by eating small portions of lean beef and fish. And there is good evidence that cold-water fish may be a very good tool to reduce cardiovascular health.

A lacto-ovo vegetarian diet is a good way to lower cholesterol and heart risk -- but you can achieve the same benefits with a diet that includes some small servings of fish, chicken/turkey, and lean beef. -- Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

No, a healthy diet is not necessarily vegetarian. If you want to reduce cholesterol, a very low-fat diet is the best. A vegetarian diet can be very high in fat. So a low-fat vegetarian diet would be the best way to lower cholesterol. Is that the best diet for overall health and for lowering your risk of heart disease? No. So far, the best diet for the heart is the Mediterranean diet, high in seafood and olive oil and fish oil and nuts. That is shown to reduce heart attacks and death from heart disease.

Overall, the best diet is a spectrum of foods. What I tell people is the optimal diet to reduce cholesterol is a very-low-fat Dean Ornish vegetarian diet. And the worst diet for cholesterol is to start your day with an Egg McMuffin and lunch with fries and all the terrible things like donuts that are loaded with saturated fat. You are probably between the two extremes. So the closer you get to one or the other will affect your cholesterol for good or for bad. It is not like an on/off switch. You can still make dramatic reductions in cholesterol without being a vegetarian. -- Dr. Richard Milan, director of the cardiovascular health center at Ochsner Clinic, New Orleans.

Question: I am vegetarian and do not wish to use fish oil to get [essential fatty acids]. Is it all right to add wheat germ to my cereal instead to get my EFAs? Or use walnuts or flax? Also isn't the natural form of food better for you, i.e., ground flaxseed rather than flax seed oil, or fish rather than fish oil?

Answer: Diets high in oils from flaxseed, walnuts, and almonds will increase the body's ability to make its own essential fatty acids. There are not direct head-to-head comparison studies, but if you don't wish to eat fish, this is good strategy. -- Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

I don't know why they don't want to use fish oil. But if they really don't want to, walnuts and flax are good. And yes, ground flaxseed is better than nonground, but flaxseed oil is fine because that is what you get from flax. Is fish better than fish oil? Not necessarily. There is nothing wrong with fish, so if they aren't getting fish, fish oil may be even more important. And with fish oil, one of beauties of that is it doesn't have the toxins like mercury present in some fish. -- Dr. Richard Milani, director of the cardiovascular health center at Ochsner Clinic, New Orleans

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