Ka Wai Ola - Office of Hawaiian Affairs, Volume 6, Number 4, 1 April 1989 — ʻAi Pono, EOla [ARTICLE+ILLUSTRATION]

ʻAi Pono, EOla

By Terry Shintani, M.D.

The Second Three Steps to Lowering Cholesterol

Two months ago, we discussed the single most important dietrelated factor we ean change to increase our lifespan and the survival of the Hawaiian people. That factor is our cholesterol level. Last month we went into some detāil about the first three steDS to

lowering cholesterol. This month we will discuss the second three steps. As you recall, thefirst three steps included 1) decreasing our intake of all animal food because all animal food has cholesterol, 2) decreasing saturated fats, and 3) decreasing total fats. Last month's eolumn detailed 'now to do this. The fourth step to lowering cholesterol is to increase the amount of starch in our diet. That's right — increase the starch in our diet. Years ago, it was though that too mueh starch was fattening and bad for our health. Today, we know better. Today, we know tht all major traditional cultures on earth ate mainly starch. We also know that people eating this way rarely died of heart disease whieh is currently the number one killer of native Hawaiians and Americans in general. A good example of this is illustrated by a conversation that I had at a party recently. We were discussing heart disease and the fact that this was primarily a disease of modern civilization and that it

was not present years ago. Someone disagreed and said that heart disease had always been a major killer. At that point, I asked my colleague, Dr. Huja, who trained in India, as to how many heart attacks he saw during his training there. Dr. Huja thought for a moment and said that he saw none. Not a single one! As you know, most of India is vegetarian or semi-vegetarian and eats rice and other starchy foods such as chapati as its chief food. This dietary pattern undoubtedly is one of the main reasons that there are so few, heart attacks in India and so many in America and Hawai'i. One of the reasons for this is that the high starch diet has fewer ealories in the form of fats and oils, and less cholesterol as starch contains none. In addition, starchy foods have fiber in them, whieh brings us to the next way to lower cholesterol. The fifth step to lowering cholesterol is to increase the amount of fiber in our diets. Studies have found that individuals who ate 100 grams of oat bran (about 3-1/2 ounces) per day lowered their choiesterol from 13-19 percent more than individuals who were not eating oat bran. These studies suggested that it was the soluble fiber in the oat bran that was responsible for this decrease. It is likely that eating more foods with fiber in them, including kalo (taro) should decrease cholesterol levels although no studies have been done on them. In any case eating oatmeal or oatmeal products for breakfast is not a bad idea for those interested in lowering cholesterol.

The sixth step to lowering cholesterol is to increase our rate of exercise. In studies done by the Institute for Aerobics Research, it was found that individuals who were rated "good" in level fitness had cholesterol levels 5 percent lower that those who rated "poor" in level of fitness. More importantly , it was found that their level of "good cholesterol", the HDL (high-density-lipoprotein) cholesterol, was significantly higher and that their cholesterol/HDL ratio was better. Based on this and other studies whieh yielded similar results, we recommend you do some aerobic exercise (such as brisk walking) for at least 30 minutes three times a week to help lower cholesterol and raise your "good" HDL cholesterol level. The native Hawaiian lifestyle accomplished all these steps. The diet was high in starchy foods such as kalo (taro), ulu (breadfruit), uhi (yams) and sweet potato. There was plenty of fiber in the diet and people were physically active! Perhaps by returning to some of these traditional lifestyle patterns we ean return to the low rates of heart disease as found among the millions of people on their traditional diets in India and among the many throughout history who were on the traditional diet in Hawai'i. Dr. Shintani, Director of Preventive Hea\th Services at the Waianae Coast Comprehensive Health Center, is a physician and nutritionist. He is also coordinator of their Malama Ola Preventive health program. A majority of the Center's clients are native Hawaiians.