DALLAS -- For people trying to control their cholesterol levels, eating right is usually not enough. They also have to get up off that couch, start exercising and lose weight, according to new federal guidelines.
The recommendations are the first revision of the landmark 1988 report on cholesterol that created the craze for butter substitutes and nonfat foods. Both sets of guidelines were crafted by the National Cholesterol Education Program, a 25-member panel now headed by Dallas researcher Dr. Scott Grundy.
"Before, we mainly concentrated on saturated fat and cholesterol," said Dr. Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center.
But Dr. Grundy said studies show that obesity and a lack of exercise are just as much a contributor to high blood cholesterol levels as a person's diet.
"We're going to have to do all three if we really want to control cholesterol," Dr. Grundy said in a telephone interview from Washington, where the guidelines were announced yesterday.
The commission also discouraged the use of cholesterol-lowering drugs, except for people who have other heart-disease risks, such as high blood pressure. "The question has been raised that the side effects from these drugs may offset the value of their use," Dr. Grundy said at a Washington news conference. He said it has been suggested, but not proved, that use of some cholesterol-lowering drugs can actually raise mortality from other causes.
Studies show that exercise and weight loss combined with a healthier diet lower the level of LDL, the "bad" cholesterol that helps cause heart disease, while raising HDL cholesterol levels. Doctors call HDL the "good" cholesterol and say it helps protect a person from heart disease.
More than 50 million American adults have cholesterol levels so high they should change their lifestyle, according to a report by the National Center for Health Statistics that was released in conjunction with the Grundy panel's recommendations. Cholesterol is considered high if it exceeds 240 milligrams per deciliter of blood.
But the center's report wasn't all bad news. It also said yesterday that cholesterol levels have dramatically dropped in recent years.
Between 1978 and 1990, the average cholesterol level in the United States dropped from 213 milligrams per deciliter to 205 milligrams. Also, the proportion of adults with high blood cholesterol fell from 26 to 20 percent.
"It's really quite exciting, actually," said Dr. Grundy, who says that adults should begin cholesterol tests after age 20.
But the tests should be more detailed than in the past, the Grundy panel said yesterday in its new recommendations. Instead of seeking just an overall level, doctors should check separately for LDL and HDL.
The new guidelines, which are to be published today in the Journal of the American Medical Association, are intended to help doctors, dietitians and nurses guide adults who are trying to lower their cholesterol levels.
They give special consideration to the 11 million Americans who have high cholesterol and have already had a heart attack or coronary bypass surgery. "We're trying to be more aggressive about treating people who already have heart disease," Dr. Grundy said.