Introduction
The word cholesterol is a compilation of the Greek word chole, meaning “bile” and stereos, meaning “solid”, followed by the chemical suffix ol for an alcohol. Contrary to what the media might have us believe, cholesterol is not an alien taken up residence in our body; it is an organic chemical substance classified as a waxy steroid of fat and is absolutely necessary, in the right and natural quantities, to the body. It’s an essential structural component of human cell membranes and is required to establish proper membrane permeability and fluidity (allows substances to flow in to, and out of, the cell).
A faulty liver is one reason why, despite a careful diet and exercise routine, some people still have high levels of cholesterol in their bodies. Seventy-five percent of the cholesterol that circulates in our blood is produced in, and comes from, the liver however every other cell in your body can create cholesterol as well. The other twenty-five percent comes from the food we eat, primarily from animal sources. If your genetics lumber you with a liver that produces too much cholesterol, you may be waging an uphill battle that may even include the need for prescription medications. But wage it you must because the alternative is too hard on your heart.
High cholesterol levels in your body don’t throw up any symptoms but can cause damage. This is why you should have your cholesterol levels checked by your primary health care provider once every five years after the age of 20.
Types of Cholesterol
A lipoprotein that is a combination of a greater amount of lipid (fat) and a moderate amount of protein that transports cholesterol in the blood. Lipoproteins are the form in which lipids are transported in the blood.
LDL is often referred to as the “lousy” cholesterol (“L” for lousy, “L” for LDL). Bundles of LDL in your bloodstream have their function but can also leave behind stray cholesterol hanging around in places where it shouldn’t which will, eventually, put you at higher risk for coronary heart disease, stroke, and peripheral artery disease.
A lipoprotein that is a complex of lipids and proteins in approximately equal amounts (slightly more protein than lipids) that functions as a transporter of cholesterol in the blood.
HDL has been dubbed the “good” cholesterol because it can actually help prevent conditions such as arteriosclerosis by picking up excess cholesterol from artery walls and delivering it back to the liver where it is then disposed of. This is why you want to see higher numbers for your HDL score. Think of HDL as the “janitor”; it picks up the trash and takes it to a disposal unit.
You don’t hear tell of VLDL (very low density lipoprotein) and IDL (intermediate density lipoprotein) very often but they are taken into account when considering your total cholesterol count (VLDL + LDL + IDL + HDL = total cholesterol).
How and Why Your Body Produces Cholesterol
Your body actually monitors your cells, and if it senses that a cell doesn’t have enough cholesterol, it will produce more. Cholesterol also is an essential building block for naturally produced vitamin D and other good stuff like estrogen and testosterone. But even though every cell can make its own cholesterol, some cells need extra help with their supply. This is where your liver comes in.
Your body, mainly your liver, produces seventy-five percent of your cholesterol; your small intestine also aids in both the creation and absorption of cholesterol. The average diet adds another 300 to 500 mg of cholesterol. But even if you eat foods without cholesterol, the carbs, fats and proteins all break down eventually and release carbon, which your liver turns into cholesterol.
If your liver thinks the ovaries need more cholesterol to produce estrogen, the organ produces new cholesterol, bundles it with a protein in the form of an LDL (low density lipoprotein) and sends it into the bloodstream. When that LDL leaves your liver, any cell that needs it can claim it. Your liver can produce about 1,000 mg of cholesterol a day, so this stuff is always present. To reclaim unused LDL’s, your liver bundles cholesterol into HDL’s (high density lipoprotein) which pass through your body and collect stray LDL’s. When these lipoproteins return to the liver, it recycles them or uses them to build bile acids, which the intestine absorbs for use in digestion.
It’s a pretty amazing system, but it’s imperfect. Genetics plays a part in controlling cholesterol levels, but some people are better at self-regulating than others. If they consume too much dietary cholesterol, their bodies accordingly slow down the natural production of this waxy substance. Other people, though, can take in too much cholesterol and their bodies don’t limit production. 2
Reading the Numbers
The American Heart Association recommends that blood cholesterol levels should be checked every 5 years after the age of 20. The screening test that is usually performed is a blood test called a lipid profile. Men over the age of 35 and women over the age of 45 should be screened more frequently than every five years. When your doctor receives the results of your blood test, it will be recorded as a “score”. Here’s how to read the numbers:
If LDL cholesterol levels are high (usually over 200 mg dL), people are often started on medication to reduce the cholesterol and are usually advised to begin a low-cholesterol diet. Follow-up is done about every three months thereafter to see if the levels normalize. Once the levels normalize, they are monitored and rechecked at least once a year. If you have pre-existing heart disease or blood vessel disease, your doctor might even encourage you to try and lower your LDL to around or below the 70 mark.
Your HDL (or “good” cholesterol) numbers are actually opposite to your LDL numbers. You want to see higher HDL numbers. Sixty and above is optimal and associated with a lower risk for heart disease. Less than 40 in men and less than 50 in women is considered low and at risk for heart disease.
Your total cholesterol levels take into account HDL, LDL and other lipids in your blood. You’re looking for a score of under 200 here; less than 200 is desirable, 200 – 239 is mildly high and 240 and above is high.
To watch a quick video on cholesterol scores, CLICK HERE.
When Your Cholesterol Numbers Are Too High
So, you’ve had the blood test and your doctor tells you your LDL numbers are a little high. Now what? Now you need an action plan to lower your LDL and raise your HDL. At this point, your goal is to lower your LDL numbers over the next six months or so, depending on your doctor’s recommendations. Lowering you LDL numbers helps:
- reduce or stop the formation of new cholesterol plaques on your artery walls,
- reduce existing cholesterol plaques,
- prevent the rupture of cholesterol plaques, and
- decrease the risk of heart attack, stroke, and peripheral artery disease.
At the same time, you’re looking to increase your HDL numbers to around 50 for men and 60 for women. So let’s take a look at what a sample action plan might consist of.
1. Know Your Target Number and Set a Goal
Talk with your doctor and decide, based on your overall health, what your optimal cholesterol score should be. If you’re a high risk candidate (meaning there are many factors involved that could affect your health if you don’t lower your cholesterol), your doctor will probably have you shoot for a score of 70 or lower. Then you’ll want to decide on a time frame to do this in. Depending on how far or how quickly you have to bring your numbers down, a goal of six months before your retest is reasonable. Even if you don’t reach your target numbers at this retest, your results will give you a good indicator of how you’ve done over the past six months and if you need to adjust any of your strategies.
2. Start with the obvious – cut out excess cholesterol from your diet.
Bulk out your diet with fruits and vegetables and keep animal products to a minimum, including dairy products. Start using a technique referred to as crowding out, which simply means eating in a healthy way so that you never even have the chance to feel hungry. Here’s how it works; add healthier choices to whatever else you’re already eating, including nutrient-dense, fiber-rich foods which stop you from feeling the cravings. Make choices that include lots of raw fruits and vegetables, whole grains and increase your intake of water. Chef Salads are a good choice because in and of themselves they’re a meal and they start with a base of mixed greens so whatever else you add to them is a bonus. Choices include garbanzo beans, grated carrots, thinly sliced English cucumbers, low-fat hard cheese, quartered tomatoes, raisins, sunflower seeds, etc. Just give the creamy salad dressings a miss, along with hard-boiled eggs, full fat cheeses, and bacon.
Here’s a website that’s packed with recipes for salads you can use as meals.
3. Reduce the amount of saturated fats you consume.
Saturated fats are to be avoided and are found in foods such as fatty meats, poultry skin, coconut and palm oil (unless it’s virgin coconut oil), pastries, cookies, and high fat dairy products. You’ll want to stick with polyunsaturated fats, found in foods like salmon, sardines, corn/safflower oil, and monounsaturated fats found in foods like peanuts, almonds, hazelnuts, pecans, and canola/olive oil. Make your own salad dressings with extra virgin olive oil.
Introduce more fish and fish oil supplements into your diet each week. The omega-3 fatty acids found in salmon, tuna, halibut and herring are excellent for lowering your cholesterol. The Recommended Daily Intake of omega-3 for men, aged 19-50, is 1,600mg/day, and for women, aged 19-50, it’s 1,100mg/day. Check with your doctor about what amount is right for you. To read the full article on Omega 3, 6 and 9, CLICK HERE.
4. Try and include plants sterols in your diet.
It may also be possible to lower cholesterol naturally by eating foods high in plant sterols. According to FDA studies, as well as reports from Harvard Medical School, “adding these foods to a healthy diet…can be a step in significantly lowering your cholesterol.” Not only do these foods contain beneficial plant sterols, but they also contain important vitamins and minerals, as well as fiber. Consider adding whole grains (all of which are high in plant sterols) such as rice and oat bran, and brown rice. Legumes are a good choice; include dried peas, beans and lentils. Reach for nuts and seeds when snacking; stick with almonds, walnuts, sunflower seeds (unsalted) and sesame seeds.
You would think that fruits and vegetables would be the main event when it comes to plant sterols but, in actual fact, they only contain trace amounts. Fruits and veggies with the highest amounts of plant sterols include broccoli, cauliflower, Brussels sprouts, apples, avocados, tomatoes, and blueberries. Some foods are fortified with plant sterols such as orange juice, margarine, and yogurt drinks. Just watch for high sugar content when choosing a product to include in your action plan.
Shoot for approximately 400 – 500mg of plant sterols each day. Here’s a chart to get you started.
| Almonds Apple Corn Oil Garbanzo beans Minute Maid Heartwise OJ Sesame Seeds | 1 ounce 1 medium 1 tablespoon 1 ounce 8 ounces 1 tablespoon | 30 mg 25 mg 135 mg 10 mg 1,000 mg 100 mg |
5. Focus on losing some weight and becoming a “grazer”.
If you’re including more veggies in your diet, it’s likely you’ll start losing weight anyway. Raw veggies provide the fiber you need to feel fuller longer. And don’t forget to drink more water which will also keep you feeling full as, most of the time, what you think is hunger is actually dehydration.
Grazing is a technique that allows you to eat 5 or 6 small meals per day. This keeps your blood sugar balanced (no spikes and valleys, no cravings) and is great for busy people as you can eat smaller, quicker meals without having to skip a chance to refuel with proper food. It just takes a little forethought and preparation time, but once you’ve worked it into your schedule, it becomes second nature. A large study of British adults found that people who ate six or more times a day had significantly lower cholesterol than those who ate twice a day. In addition, grazers reduced their risk of coronary heart disease by 10 to 20%. 3.
6. Look for the Whole Grain Option
Work as many whole grains as you can into your new eating plan, starting with oatmeal for breakfast every day. A lot of research has gone into oats, and thanks to this research, oatmeal manufacturers are now legally allowed to say that oats have cholesterol-lowering benefits. Have whole grain toast with raw honey instead of jam or jelly; one study found that participants’ HDL levels rose after 15 days of consuming a solution containing honey every day4.
7. Indulge in the Fruit of the Vine
And now for the best news…you can include one glass of red wine per day because the plant compounds, called phenols, in red wine have been shown to lower cholesterol levels as well. Resveratrol is a polyphenol found in the skins of red grapes and in red wine that has been noted to decrease LDL cholesterol. Not only does it decrease LDL levels, but it also has protective qualities when it comes to your heart and blood vessels. It seems that resveratrol slows the formation of deposits on artery walls, relaxes blood vessels and helps to maintain the steady beat of your heart5. TIP: One study found that approximately ½ tbsp.of cinnamon per day reduced LDL cholesterol in people with type 2 diabetes nearly 30% and cut total cholesterol 26%. You can add this ½ tbsp to your coffee grounds or include it on your oatmeal, in muffins, or smoothies. It’s best to ration out the
half tablespoon throughout the day.
8. Hit and Miss
Hit the gym and give the T.V. a miss! Regular exercise can raise HDL by up to 10%. And you don’t have to become an Olympic athlete in the process. Even moderate exercise, such as brisk walks, can make a big difference. A walk is considered brisk if you’re walking as if you’re late for the most important meeting in your life. You can still chat during a brisk walk, but it doesn’t come as easily as if you were just strolling. Forty-five minutes is the optimal length of time you should be walking each day but you can certainly break this up into three fifteen minute walks (one before lunch, one mid afternoon and one after supper) if you have to. Just don’t exercise too late into the evening or you’ll be too wound up to sleep and might even go looking for the dreaded late-night snack. Remember to stretch before you go for your walk. Warm muscles = less injuries.
Exercise also allows you to handle stress more efficiently and researchers at Oregon State University and the University of Hawaii found that people who reacted to stressful situations with hostility had lower HDL levels than those who were able to control their aggression.
9. Stop Smoking
You knew it had to be in there somewhere, right? Well, smoking lowers levels of HDL, raises the amount of LDL, accelerates the process of atherosclerosis, and is considered a major risk factor for heart disease. Smoking also depletes your body of many the nutrients that you put into it every day to stay healthy. Why go to all that effort just to negate it with one cigarette?
10. A Cup of Coffee a Day…
A US study looked at 187 people, a third of whom drank three to six cups of caffeinated coffee a day, while a second group drank the same amount of decaffeinated coffee, and the rest had no coffee. Researchers measured the level of caffeine in people’s blood, as well as a number of heart-health indicators, including blood pressure, heart rate and cholesterol levels over the course of the three month study. At the end of the study, the group drinking decaffeinated coffee had experienced an 18% rise in their fatty acids in the blood, which can drive the production of bad ‘LDL’ cholesterol. In addition, a protein linked to bad cholesterol (apolipoprotein B), went up 8% in the decaffeinated group but did not significantly change in the other two groups. 6
Conditions & Diseases Associated With High Cholesterol
You might want to consider how your coffee is made as well. In 2001, a dozen studies were conducted by the Johns Hopkins University School of Medicine and found that people who drank 6 or more cups of unfiltered coffee (like the type made with a percolator or French press) increased total and LDL cholesterol levels. 7
Bottom line, you can have your coffee but stick to one to two cups per day of caffeinated, filtered coffee. Better yet; try drinking green tea instead, it’s loaded with polyphenols.
Deposits of cholesterol can block blood vessels, and depending on which ones become blocked, tests will begin to show signs of a risk for conditions such as coronary heart disease, stroke and peripheral vascular disease. High cholesterol has also been linked to diabetes and high blood pressure.
Coronary Heart Disease
Cholesterol can build up in a lot of places, but the last place you want to see this buildup is on the walls of your arteries. This buildup will eventually cause the artery to narrow and harden, slowing the flow of blood through the artery. When present, these conditions can lead to a illness commonly referred to as “hardening of the arteries” or atherosclerosis. Less blood getting to your heart can cause angina, or chest pain and, in extreme cases, a heart attack if the vessels are blocked completely.
Stroke
Blood vessels may become blocked or burst from the buildup of plaque on their walls. A stroke occurs when a vessel carrying blood to a part of the brain either becomes blocked or bursts. This disruption actually causes that part of the brain no longer receiving oxygen and vital nutrients from the blood supply to begin to die.
Peripheral Vascular Disease (or P.A.D.)
Vascular means, “pertaining to a blood vessel.”
This type of vascular disease happens when blood vessels outside of the heart and brain build up with fatty deposits along their walls. This begins to affect circulation, mainly in the larger arteries leading to the legs and feet. P.A.D. increases the chances of heart attack and stroke.
Diabetes
Diabetes mellitus is a condition that occurs when the body can’t use glucose normally, resulting in excess amounts of glucose in the blood. When excess glucose molecules attach themselves to the LDL package, the new grouping remains in the bloodstream for an unusually longer period of time, allowing it more opportunities to become stuck to blood vessel walls which can lead to the formation of plaque and damage to these same walls. The double whammy here is that people with diabetes also tend to have lower levels of HDL and, when combined with the glucose/LDL issue, boosts the risk of heart and artery disease even further.
High Blood Pressure
Blood pressure is exactly that…the pressure that is exerted on the wall of a blood vessel.
When plaque builds up on the wall of your blood vessel, the interior passageway of the vessel begins to narrow. As your blood tries to flow through this narrowed passageway at the same rate and in the same amount as usual, it puts more pressure on the wall of the vessel. This also causes the heart to have to work harder to pump blood through these narrowed passages which can eventually lead to heart disease. Think of how water acts as you squeeze a garden hose. In order to continue flowing, the water has to somehow make it through the narrowed hose, and now the same amount of water is competing for the lesser amount of space. If the hose remains blocked, the water will either stop flowing, or the hose will burst, or both.
Foods that Raise, Foods that Lower Cholesterol
The best way to manage your cholesterol is with your knife and fork. But the trick is knowing exactly which foods to include and which to avoid. In this case, knowledge is king because, as Columbia University nutrition researcher Wahida Karmally, DrPH, RD says, “Foods high in saturated fat can increase cholesterol more than foods high in cholesterol…” If you just avoid all the foods that contain cholesterol, you might be missing the nutritional boat. For example, people see the egg as an icon for high cholesterol because one large egg contains 186 mg of cholesterol (your daily total intake should not be more than 300 mg) but only 1.6 grams of saturated fat. Studies show that saturated fat [and trans fats are] much worse than dietary cholesterol at raising blood cholesterol levels. Red meat shares the same negative press… but if it is lean and the portion is 3 ounces, it is acceptable. 8 The point is, balance is the order of the day and once you’ve worked the more appropriate foods into your diet, and moved the less appropriate foods to the sidelines, you’re on your way to success. Notice that foods were not classified as “bad” or “good”; there are no bad or good foods, just moderation and well-considered choices.
| Walnuts – See “Walnuts Improve Cholesterol Levels” Whole grains and legumes (oats, beans, bran) *Soluble fiber Raw fruits and vegetables (eat a rainbow) Olive oil, walnut oil, avocados, nut butters Wild, cold-water fish (salmon, sardines) Garlic, ginger, curry, chili peppers Onions, leeks, chives, etc. Green tea Magnesium-rich veggies: kale, spinach, yams Nuts and seeds | Saturated and trans fats (try to eliminate completely) Butter, lard, cream, sour cream, cream cheese, whole fat milk Fast foods, junk foods, soda, commercial juices Meat with high fat content, liver Pastries, bakery goods, crackers, processed foods Sugars (table, fructose corn syrup, etc.) Palm oil, palm kernel oil, cocoa butter Beef, pork (make sure they’re lean) Unfiltered coffee (e.g., from a French press) Snack foods (potato chips, dip, ice cream) |
*How fiber reduces cholesterol is not widely agreed upon, but it appears that it binds to cholesterol and bile acids in the intestine, making it unavailable for absorption. Then, when the liver needs to replace the bile acids that went out with the fiber, it pulls cholesterol from the bloodstream to make more bile acids. It’s a pretty neat dietary trick.9
How Exercise Helps Lower Cholesterol
When studies first began on the effects of exercise on cholesterol levels they also included the dietary changes that people were making when they began to exercise. Because dietary information couldn’t be separated from how exercise was, itself, impacting cholesterol levels, researchers haven’t completely understood why exercise helps, until now.
When you exercise, you tend to lose weight and excess weight tends to hold increased amounts of LDL in your blood. We also now know that exercise also stimulates enzymes that help move LDL from the blood to the liver where it’s either converted to bile for digestion or moved out all together (excreted). And size matters; some lipoproteins are small and dense, some are big and fluffy. It’s the smaller ones you have to watch out for because they sneak into the linings of the heart and blood vessels and settle in for a long stay. We now know that exercise increases the size of the protein particles so that they can’t slip in as easily as they could when they were smaller which means they’re much less of a threat.
The type and duration of exercise seems to matter as well. While moderate exercise will help lower LDL levels and keep them from rising any further, vigorous exercise seems to lower it even further. And vigorous exercise has the added benefit of increasing HDL at the same time. If you’re sticking with moderate exercise, sixty minutes per day seems to be the magic number, thirty minutes if it’s more intense. And the good news is you don’t have to do it all in one sitting. You can break up your exercise sessions into four fifteen minute exercise periods, six ten minute, or two thirty minute. Breaking up your exercise sessions throughout the day also gives you more of an opportunity to mix it up and fit in a few intense sessions in between a few moderate sessions. It also keeps it more interesting this way.
Natural Supplements that Help Control Cholesterol
Phytosterols are the compounds found in plant cell membranes. These esters look similar to cholesterol on a molecular level, and get in the way of real cholesterol being absorbed into the bloodstream. Although phytosterols can be found naturally in sources such as soybeans and flaxseeds, there is not enough concentration to make an impact on cholesterol. Fortified foods and capsule supplements should be taken to achieve the desired results. Other natural supplements that seem to have cholesterol-lowering benefits include:
| Artichoke leaf extract AlfalfaCayenne pepper Chromium Coenzyme Q10 Garlic Green tea Lecithin Niacin (vitamin B3) QuercetinRed yeast rice Turmeric | Lowers total cholesterol levels. *Saponins in alfalfa attach to cholesterol and prevent its absorption, may also reduce the build-up of plaque. Stimulates blood flow, aids circulation. Lowers total cholesterol, improves HDL-to-LDL levels. A powerful antioxidant, **inhibits LDL oxidation, important for heart health. Lowers total cholesterol levels. Lowers total cholesterol levels. A fat emulsifier, lower total cholesterol levels. Increases HDL, decreases LDL, protects against heart disease. One of the better known flavonoids that helps reduce plaque build-up in arteries and protect against damage caused by LDL. Contains monacolins which help control cholesterol and lower LDL. Inhibits free radical damage and oxidation of cholesterol. |
All of the above supplements have not been definitively described as cholesterol-lowering supplements but have extensive anecdotal evidence behind them. The top three that seem to have the most research behind them are artichoke leaf extract, garlic, and turmeric. Any use of these supplements should be discussed with your primary health care provider to ensure there are no contraindications with any existing conditions you may have or prescription medications you may be taking.
*Saponins are chemicals from plants (found in most vegetables) which have foaming characteristics.
**Oxidized cholesterol is what damages blood vessels and builds up in the plaques that can lead to heart attack and stroke.
Cholesterol Levels Pictures Slideshow: What They Mean, Diet and Treatment
Cholesterol-Lowering Foods
Shopping for Cholesterol-Lowering Foods
Food and Fitness Planner – Set your goals, calorie & nutrition information,
exercise planner, track your progress online.
“Your Guide to Lowering Your Cholesterol with TLC, Therapeutic Lifestyle Changes”
“Is High Cholesterol and Plaque Build-Up Putting Your Health At Risk?” – Self-Assessment
1. Wikipedia – Cholesterol
2. Discovery Fit & Health
http://health.howstuffworks.com/diseases-conditions/cardiovascular/cholesterol/difference-between-ldl-and-hdl-cholesterol1.htm
3. & 4. 10 Ways To Lower Your Cholesterol
http://www.readersdigest.ca/health/home-remedies/10-ways-lower-your-cholesterol?id=2
5. Conclusion of a research study published in the November 2008 issue of “Nutrition Research”.
6. BBC News, “Decaf Coffee Linked to Heart Risk”
http://news.bbc.co.uk/2/hi/4444908.stm
7. Foods That Raise Cholesterol
http://www.livestrong.com/article/2737-foods-that-raise-cholesterol/
8. WebMD – “9 Surprising Foods That May Raise Your Cholesterol”
By Kathleen M. Zelman, MPH, RD, LD
http://www.webmd.com/cholesterol-management/9-surprising-foods-that-may-raise-your-cholesterol
9. Cholesterol Control: The Alternatives
http://www.webmd.com/cholesterol-management/guide/cholesterol-control-alternatives