I have cholesterol issues. I blame my dad. And my grandma before him. And their ancestors before them, going back to when we had to fight neanderthals for our fatty meats. Because if it weren’t for their genes, I probably wouldn’t be 27 years old, a healthy 125 pounds, and dealing with high cholesterol. All of our bodies produce cholesterol, because we need it for some essential life functions (see left sidebar). But some people—like me, for instance—have a hereditary tendency to produce more cholesterol than their bodies need, and the extra ends up in the bloodstream. Add to that the cholesterol from foods like meat, cheese, and ice cream, and it eventually develops into a problem.
A big problem: high blood cholesterol is one of the major risk factors for heart disease, along with a slew of other things, such as high blood pressure, diabetes, and obesity. And since heart disease leads to heart attacks and strokes, avoiding it is absolutely worth the trouble. That’s why it’s important to get your cholesterol checked; the official recommendation is once every five years once you turn 20. If your cholesterol levels come back high, or even borderline high, like mine unexpectedly did a few years ago, you’ll need to take steps to lower them. The rest of this article goes over lifestyle changes and medications that can help you get your cholesterol back to healthy levels.
What is Cholesterol?
It’s a waxy substance similar to fat. It’s made in the liver and participates in important bodily functions, including the production of cell membranes, hormones, vitamin D, and bile acids used in digestion. Because it can’t dissolve in the blood, it binds to proteins in the liver, creating a lipoprotein that carries cholesterol through the circulatory system. LDL (low-density lipoprotein) is considered “bad” because it stays in the bloodstream and can build up on artery walls. If there is too much LDL in the bloodstream, this build-up leads to atherosclerosis, which blocks the passage of blood through the circulatory system and can cause heart attacks and strokes. HDL (high-density lipoprotein) is “good” because it carries cholesterol back to the liver, where it’s excreted from the body. That’s the type of cholesterol everyone likes.
Ideally, your total cholesterol level should be lower than 200 milligrams per deciliter of blood, with dangerous LDL accounting for less than 100 milligrams and protective HDL making up at least 40 milligrams of the total.
Best Ways to Lower Cholesterol
Regular exercise is one of the most important factors in preventing heart disease, and it can directly improve cholesterol levels.
Even just being physically active (walking, cleaning the house, gardening) for a total of 30 minutes most days of the week can positively effect your cholesterol. If you also do at least 30 minutes of heart-rate-raising aerobic exercise 3-4 times a week, you’ll be strengthening your heart while your “bad” LDL cholesterol level goes down and your “good” HDL cholesterol level goes up.
If you smoke, quitting is an excellent idea.
You probably know that already, but you may not realize that smoking is a risk factor for developing heart disease. This is true in part because cigarette smoke lowers your levels of HDL cholesterol. Since HDL offers protection from heart disease, smoking leaves you more vulnerable to a heart attack or stroke. Even if you don’t smoke, you should avoid secondhand smoke as much as possible.
Switching to a more heart healthy diet is a major step.
Not only should you reduce your intake of cholesterol-rich animal products like meat, eggs, and dairy, but you should also avoid foods that contain much saturated fat or trans fat, since these lead to heightened production. When possible, check nutrition labels to ascertain whether a product is heart healthy. But in general, eat lean cuts of meat, poultry without skin, 1% or skim milk, and lots of vegetables, fruits, and whole grains.
Increasing the soluble fiber in your diet is a relatively easy way to lower cholesterol levels.
Whereas insoluble fiber passes through your system pretty quickly, soluble fiber spends some time in your system, and while it’s there, it binds with cholesterol. This means that when you excrete any soluble fiber you’ve eaten, it takes “bad” LDL cholesterol with it. Soluble fiber is found in quite a few foods, including nuts, barley, beans, and the psyllium husk used in dietary supplements like Metamucil. But one of the best sources of soluble fiber is oatmeal or oat bran, which can of course be found in some breakfast cereals, especially Cheerios.
Eating fish high in Omega-3 fatty acids is good for your cardiovascular health in many ways.
Triglyceride is the form in which fat is stored in the body, and high levels of it usually correlate to high levels of “bad” LDL cholesterol and low levels of “good” HDL cholesterol. So eating Omega-3-rich fish such as salmon, trout, and albacore tuna a couple times a week can positively affect your overall cholesterol. If you don’t want to eat that much fish, you can get similar benefits from a fish oil supplement.
If you have high cholesterol, your doctor may recommend that you focus on the lifestyle changes discussed above. But if your cholesterol is very high, you have multiple risk factors for heart disease, or diet and exercise don’t significantly lower your levels, your doctor may also prescribe one of the following types of medication.
Statins, the most common class of cholesterol drugs, lower levels of LDL partly by reducing the amount produced by the liver. But statins also indirectly stimulate receptors that bind with the cholesterol, removing it from circulation in the bloodstream and releasing it back into the liver, where it can be excreted. Selective cholesterol absorption inhibitors ensure that cholesterol leaves the body with other waste by blocking mechanisms that would absorb it into the bloodstream from the intestine. Resins take advantage of cholesterol’s role in bile production by binding to bile and rendering it useless in digestion. This forces the liver to make additional bile for digestion. In the process, the liver uses more, so it never reaches the bloodstream. Fibrates stimulate an enzyme that breaks down triglycerides. Because fibrates don’t lower levels of LDL cholesterol, they are sometimes prescribed in combination with statins. Finally, niacin curbs the liver’s production of LDL and triglycerides while increasing production of HDL. It’s available as a prescription medication or as a dietary supplement, but because supplements aren’t as well-regulated as prescription medications, quality and dosages can vary, which impacts both effectiveness and side effects.