What is Cholesterol?
High cholesterol is an extremely common in the US and in other industrialized countries. About 32 percent of Americans (73.5 million) have elevated levels of LDL or “bad cholesterol.” Of these, less than a third has their cholesterol in good control.
Fewer than half of all Americans with elevated LDL cholesterol levels are receiving some kind of treatment for high cholesterol. This puts them at double the risk of developing heart disease when compared to people with normal cholesterol levels.
As there are no symptoms of high cholesterol, the only way you can know that you have the problem is to have a blood test that indicates your lipid profile. The lipid profile test will tell you what your total cholesterol is as well as the levels of LDL (“bad”) cholesterol, HDL (“good”) cholesterol, and triglycerides. You need to know these levels as elevated levels of cholesterol, especially LDL cholesterol have been linked to strokes and heart attacks.
HDL – The Good Cholesterol
HDL cholesterol is considered a healthy type of cholesterol to have. It removes the bad cholesterol (LDL cholesterol) from the blood and brings it to the liver for metabolism. After it is metabolized, it is flushed away through your bile.
LDL – The Bad Cholesterol
LDL cholesterol is considered the bad cholesterol. It goes into the bloodstream and can cause cholesterol plaques to collect along the inner walls of your arteries. When this happens, you develop atherosclerosis, which can subsequently lead to heart disease and strokes.
The plaques of cholesterol also contain calcium and can narrow the arteries that supply blood to the heart and brain.
Your triglycerides are a different type of fat located in the fat cells of the body. You can have high triglyceride levels if you are a smoker, are overweight, exercise little, or eat a diet rich in carbohydrates. Triglycerides, like cholesterol, can result in atherosclerosis.
It is recommended by the American Heart Association that you have your lipid profile checked beginning at age 20 and every 4-6 years for the rest of your life (and more often if you have been found to have high cholesterol levels). You need to be completely fasting without eating or drinking (except water) for 12 hours before having your blood drawn.
If your lipid profile is good, your LDL cholesterol level is low, your triglyceride level is low, and your HDL cholesterol level is high. The test will measure the amount of cholesterol and triglycerides in milligrams per deciliter.
Cholesterol Levels And Diagnosis
- Ideally, your total cholesterol will be 200 mg/dL or lower
- If your total cholesterol is 200-239 mg/dL, it is considered to be borderline
- If the total cholesterol is greater than 240 mg/dL, it is considered to be high
- A good HDL cholesterol level is above 60 mg/dL
- It is considered to be fairly good if the HDL cholesterol level is between 40 and 50 mg/dL in men and 50 and 59 mg/dL in women
- If the HDL cholesterol level is lower than 50 mg/dL for women or 40 mg/dL for men, it is considered to be poor
- Normal levels of LDL cholesterol are between 100 and 129 mg/dL
- The LDL cholesterol level is borderline if the level is between 130 and 159 mg/dL
- High LDL cholesterol level is greater than 160 mg/dL
- A normal triglyceride level is 150 mg/dL or lower
- It is considered to be borderline if the level is between 150 and 199 mg/dL
- High levels of triglycerides range in numbers greater than 200 mg/dL
If you have high cholesterol or hypercholesterolemia, your risks of heart attack and stroke go way up. The worst case scenario is a low HDL cholesterol and a high LDL cholesterol. This is when your risk of atherosclerosis is at its highest and the chances that plaques are on the inside of your arteries are the greatest. In atherosclerosis, your arteries become blocked and this causes poor blood supply to the heart and brain.
Causes Of High Cholesterol
There are several reasons why you might have high cholesterol. Some of these include the following:
- What you eat. A diet high in saturated fat increases risks that cholesterol levels will go up. Things that are high in saturated fat include cheese, butter, eggs, milk, beef, and pork. If you eat processed foods containing cocoa butter, palm oil, or coconut oil, you will also increase your saturated fat levels. High levels of saturated fat can also be found in crackers, cookies, salty snacks, chips, vegetable shortening, and margarine.
- How much you weigh. If you are overweight, especially if your fat is carried around the abdomen, you will have a greater risk of having low HDL levels, and elevated levels of triglycerides. Losing weight can decrease your total cholesterol and triglyceride levels, which decreases your heart disease and stroke risk.
- Your exercise level. If you don’t exercise, you will have an increase in your LDL cholesterol level and a decrease in your HDL cholesterol level. Exercise has been shown to increase HDL levels, decreasing your risk for heart disease and stroke.
- Your sex and age. Cholesterol levels gradually creep up after the age of 20. In men, the cholesterol levels reach their peak at the age of 50, while in women, the cholesterol levels are usually within normal limits until menopause. After menopause, the cholesterol levels increase to similar levels as is seen in older men.
- Other diseases. There are certain diseases that will increase your risk of having high cholesterol levels. These include hypothyroidism and diabetes. If you have these diseases, you should have your lipid profile analyzed more often than every 4-6 years.
- Hereditary factors. There are certain inherited high cholesterol syndromes, such as familial hypercholesterolemia, that run in families. If you have a first-degree relative (sibling, parent, or child) with high cholesterol, you have a greater risk of developing high cholesterol yourself.
- Smoking Cigarettes. Smoking can decrease the levels of HDL or good cholesterol in your bloodstream. This increases your risk of atherosclerosis and the development of heart disease or stroke.
Co-conditions And Health Risks
High cholesterol is linked to several other medical conditions that increase your chances of poor health and dying from high cholesterol conditions. Some of the diseases linked to high cholesterol include the following:
Strokes happen when the cholesterol plaques build up in the arteries that lead to the brain. The arteries become narrowed and less blood gets to the brain. This can cause poor oxygenation to the brain and blood clots can form in the narrowed arteries, resulting in a “brain attack” or stroke.
2| Coronary Artery Disease
This is the most common co-morbidity seen in elevated cholesterol conditions. The cholesterol in the bloodstream causes plaques to build up in the arteries leading to the heart. Blood clots can form in these narrowed arteries, cutting off the blood supply and causing a lack of oxygen to reach the cells of the heart. The end result is chest pain that can mean you are having a heart attack.
3| Type 2 Diabetes
People with type 2 diabetes have a greater risk of also having high cholesterol levels. Diabetes and high blood sugar levels result in elevated cholesterol levels. Even if you have good control over your diabetes, the levels of triglycerides and LDL cholesterol are higher than in non- diabetics and your HDL cholesterol level will be lower. This causes an increased risk of having atherosclerosis.
4| Peripheral Vascular Disease
Elevated cholesterol levels cause plaques to build up on the arteries leading to the extremities. Peripheral vascular disease is a condition where the arteries leading to the arms and legs become blocked with cholesterol plaques. This can lead to a lack of circulation, especially to the legs. There will be pain when walking and can ultimately lead to gangrene and amputation of the legs due to high cholesterol levels.
5| Elevated Blood Pressure
Hypertension or high blood pressure is also connected to having elevated cholesterol levels. When the arteries develop plaques and narrow from the cholesterol lining the arteries, the blood vessels can stiffen and can make it more difficult for the heart to pump blood throughout the body. This ultimately leads to high blood pressure and the secondary complications of high blood pressure, such as kidney failure.
Preventing High Cholesterol
There are several things you can do to prevent high cholesterol levels. Some ways you can do this include the following:
- Exercise. Exercise can improve your cholesterol status. When you exercise, your HDL cholesterol levels will go up and you may see moderate decreases in LDL cholesterol. Even if you don’t see changes in your cholesterol numbers, exercise can keep your heart stronger so you have a lesser chance of having heart disease. According to the American Diabetes Association, you should get about 150 minutes of aerobic exercise each week. This can be done 30 minutes at a time on most days of the week.
- Eat omega 3 fatty acids. You can lower your cholesterol levels by eating more omega 3 fatty acids. These can be found in fatty, cold water, ocean fish, such as tuna, sardines, mackerel, and salmon. If you aren’t a big fan of fish, you can take fish oil supplements or eat non-fish sources of omega 3 fatty acids, including nuts, Brussels sprouts, and flaxseed.
- Weight control. If you are able to lose weight, you can decrease your cholesterol levels. This means eating less. Instead of eating large portions of food, have several small meals per day so that you end up eating less and lowering your cholesterol levels. If you are eating meat, you should know that a single serving of meat is only 3 ounces, which can fit in the palm of your hand. If you eat at restaurants a lot, know that the portions are often much too large so you should eat half or less of what is offered and take home the rest for leftovers.
- Eat Fruits and Vegetables. While limiting your intake of starch and protein, you should eat plenty of fruits and vegetables, which are good for your heart. Fruits and vegetables do not contain cholesterol and instead contain complex carbohydrates that don’t affect the cholesterol levels. You can also lose weight if you eat more fruits and vegetables, instead of eating processed food or junk foods. Beans are especially good at decreasing your LDL cholesterol levels.
- Stop smoking. If you are a smoker, stopping smoking can decrease the LDL or bad cholesterol levels and can increase your HDL or good cholesterol levels. Smoking is bad for you in other ways and is one of the greatest risk factors for heart disease.
Lowering Cholesterol With Diet
You can decrease your cholesterol levels by eating foods that lower cholesterol and avoiding foods that are high in cholesterol. You can control your cholesterol levels just by manipulating your diet so that you eat more of the foods that help to lower cholesterol levels.
Good Food Choices
Foods that can help you lower your cholesterol levels include the following:
- Oats. Eating oatmeal in the morning for breakfast has been shown to decrease your LDL cholesterol levels. In one study, two servings of oatmeal have been shown to decrease the LDL cholesterol levels by more than 5 percent after six weeks on the new diet. Oats contain beta glucan, which bind LDL cholesterol, allowing it to pass through the digestive tract instead of being absorbed into the bloodstream.
- Red Wine. Red wine that is made from high fiber grapes can decrease your cholesterol levels. A research article out of Spain indicated that people who ate the supplement found in red wine had a decrease in their LDL cholesterol levels by 9 percent. People who had high LDL cholesterol levels already had a 12 percent decrease in their LDL cholesterol levels. One to two glasses of wine per night are all that is necessary to decrease cholesterol levels.
- Fatty fish. Fatty fish are high in omega 3 fatty acids that are known to decrease the risk of heart disease, dementia, and stroke. It turns out that omega 3 fatty acids also decrease cholesterol levels. A research study out of Loma Linda University showed that eating omega 3 fatty acids instead of saturated fat could raise the HDL cholesterol level by about four percent. Omega 3 fatty acids are found in fatty fish, such as sardines, tuna, herring, mackerel, and salmon.
- Nuts. According to an article in the American Journal of Clinical Nutrition, those who ate 1.5 ounces of walnuts per day for six days out of a week for a month had a decrease in total cholesterol by more than 5 percent and a decrease in the LDL cholesterol by about 9 percent. You can also get the same effect by eating cashews and almonds. You need to eat just 1.5 ounces of nuts per day, however, because they are high in calories.
- Tea. Tea not only has antioxidants that fight off cancer but it also decreases LDL cholesterol levels. The USDA has done research on black tea, indicating that cholesterol levels can be decreased by drinking black tea by about 10 percent. This can greatly decrease your risk of developing heart disease and strokes.
- Beans. By simply eating a half-cup of beans per day, you can decrease your total cholesterol level by about 8 percent. Beans are high in fiber that binds cholesterol so that it doesn’t get absorbed by the intestines but instead is passed through the stool. Black beans, pinto beans, and kidney beans are good choices of cholesterol-lowering fiber.
- Chocolate. Dark chocolate especially can decrease the cholesterol levels and will increase HDL cholesterol levels. A study published in AJNC indicated that subjects who ate cocoa powder as part of their diet had a 24 percent increase in their HDL levels after doing this for 3 months. This is compared to a control group that had only a 5 percent increase in HDL cholesterol levels during the same period of time. Milk chocolate is less effective than dark chocolate, which seems to keep platelets from sticking together, causing blood clots, heart attacks, and strokes.
- Garlic. Besides being a good addition to bland meals, garlic can also decrease cholesterol levels. This is a good food to eat if you want to decrease your blood pressure, fight off infection, and prevent blood clot formation. Garlic has been shown to decrease plaque formation in the arteries by preventing cholesterol from attaching to the inner lining of arteries. You need to eat 2-4 cloves of garlic per day, however, to have a major effect on cholesterol.
- Spinach. Spinach is high in lutein, which can not only prevent damage to the retina of the eyes but can decrease the attachment of cholesterol to the inner lining of arteries. Spinach can be eaten fresh in a salad or cooked in the microwave or stovetop.
- Olive oil. Olive oil is high in monounsaturated fatty acids that have been found to decrease the LDL cholesterol levels. Olive oil is also known to decrease the amount of fat you have around your waist. You can eat olive oil as part of a marinade to fish and chicken, as a vehicle for roasting vegetables, or in salad dressings.
- Avocados. This vegetable/fruit is high in monounsaturated fatty acids that can lower LDL cholesterol and raise HDL cholesterol. More than any other type of fruit/vegetable, avocado’s are high in beta sitosterol, which is a fat found in plants that decrease cholesterol levels. They are relatively high in calories so you should not eat more than a serving of avocados several times a week.
Foods To Avoid
There are foods you should not eat when you want to lower cholesterol levels or are at risk for high cholesterol.
- Egg Yolks
- Chicken Liver
- Animal Fat
- Cheese and foods made with it, like macaroni and cheese
- Red Meat, including burgers with cheese and steak
- Butter and foods made with it, like buttered popcorn
- Fried chicken – always eat chicken grilled without the skin
- Anything fried, including onion rings and Tempura
- Fast food, especially burgers and French fries
- Baked goods made with butter and milk
- Commercial baked goods, including, pies, cookies, muffins and others
- Foods with trans fats
- Coconut products
- Hydrogenated oils like palm oil
- Dairy products, like milk, ice cream and cheese
The Importance Of Exercise
Exercise is vital in decreasing your cholesterol levels. Much research has been done on this that shows that regular aerobic exercise to a moderate degree can increase the good HDL cholesterol and decrease bad LDL cholesterol levels, though it has a greater effect on the HDL cholesterol levels than it does on the LDL cholesterol levels.
Aerobic Activity Includes:
- Brisk Walking
- Fitness Classes
- Elliptical Machines
- Steppers and Climbers
- Any rigorous movement that increases heart rate
High cholesterol is associated with the development of plaques on the arterial walls, which can increase your risk of developing heart disease, peripheral vascular disease, and stroke.
While there are medications that can be given for extremely high cholesterol, the best way to reduce moderately high levels of cholesterol are to exercise on a regular basis, eat foods known to lower cholesterol levels, and avoid foods known to raise cholesterol levels.