What Is Cholesterol?
We may associate
cholesterol with fatty foods, but most of the waxy substance is made by our own
bodies. The liver produces 75% of the cholesterol that circulates in our blood.
The other 25% comes from food. At normal levels, cholesterol actually plays an
important role in helping cells do their jobs. But cholesterol levels are
precariously high in more than 100 million Americans.
Symptoms of High Cholesterol
High cholesterol
does not cause any symptoms. But it does cause damage deep within the body.
Over time, too much cholesterol may lead to a buildup of plaque inside the
arteries. Known as atherosclerosis, this condition narrows the space available
for blood flow and can trigger heart disease. The good news is high cholesterol
is simple to detect, and there are many ways to bring it down.
Cholesterol Testing
People older than
20 should have their cholesterol levels checked at least once every five years.
This is done with a simple blood test known as a fasting lipoprotein profile.
It measures the different forms of cholesterol that are circulating in your
blood after you avoid eating for nine to 12 hours. The results show your levels
of "bad" cholesterol, "good" cholesterol, and triglycerides.
'Bad' Cholesterol
Most of the
cholesterol in the blood is carried by proteins called low density lipoproteins
or LDL. This is known as the bad cholesterol because it combines with other
substances to clog the arteries. A diet high in saturated fats and trans fats
tends to raise the level of LDL cholesterol. For most people, an LDL score
below 100 is healthy, but people with heart disease may need to aim even lower.
'Good' Cholesterol
Up to a third of
blood cholesterol is carried by high-density lipoproteins or HDL. This is
called good cholesterol because it helps remove bad cholesterol, preventing it
from building up inside the arteries. The higher the level of HDL cholesterol,
the better. People with too little are more likely to develop heart disease.
Eating healthy fats, such as olive oil, may help boost HDL cholesterol.
Triglycerides
The body converts
excess calories, sugar, and alcohol into triglycerides, a type of fat that is
carried in the blood and stored in fat cells throughout the body. People who
are overweight, inactive, smokers, or heavy drinkers tend to have high
triglycerides, as do those who eat a very high-carb diet. A triglycerides score
of 150 or higher puts you at risk for metabolic syndrome, which is linked to
heart disease and diabetes.
Total Cholesterol
Total cholesterol
measures the combination of LDL, HDL, and VLDL (very low density lipoprotein)
in your bloodstream. VLDL is a precursor of LDL, the bad cholesterol. A total
cholesterol score of under 200 is considered healthy in most cases. People who
score in the "high" range have an increased risk of developing heart
disease compared to those who score below 200.
Cholesterol Ratio
To calculate your
cholesterol ratio, divide your total cholesterol by your HDL cholesterol. For
example, a total score of 200 divided by an HDL score of 50 equals a
cholesterol ratio of 4 to 1. Doctors recommend maintaining a ratio of 4 to 1 or
lower. The smaller the ratio, the better. While this figure is useful in
estimating heart disease risk, it's not as important in guiding treatment.
Doctors look at total cholesterol, HDL cholesterol, and LDL cholesterol to
determine treatment.
Cholesterol in Food
Cholesterol-rich
foods, like eggs, shrimp, and lobster are no longer completely forbidden.
Research shows that the cholesterol we eat has only a small effect on blood
cholesterol levels for most people. A few people are "responders,"
whose blood levels spike up after eating eggs. But for most, saturated fat and
trans fats are bigger concerns. Daily cholesterol limits are 300 mg for healthy
people and 200 mg for those at higher risk. One egg has 186 mg of cholesterol.
Cholesterol and Family History
Cholesterol comes
from two sources -- the body and food -- and either one can contribute to high
cholesterol. Some people inherit genes that trigger too much cholesterol
production. For others, diet is the main culprit. Saturated fat and cholesterol
occur in animal-based foods, including meat, eggs, and dairy products made with
milk. In many cases, high cholesterol stems from a combination of diet and
genetics.
What Boosts Your Risk?
Several factors
can make you more likely to develop high cholesterol:
- A diet high in saturated fats and cholesterol
- A family history of high cholesterol
- Being overweight or obese
- Getting older
Cholesterol and Gender
Until menopause,
women typically have lower total cholesterol levels than men of the same age.
They also have higher levels of HDL cholesterol, the good kind. One reason is estrogen: The female sex hormone raises
the level of HDL cholesterol. Estrogen production peaks during the childbearing
years and drops off during menopause. After age 55, a woman's risk of
developing high cholesterol begins to climb.
Cholesterol and Children
There's evidence
that cholesterol can begin clogging the arteries during childhood, leading to
atherosclerosis and heart disease later in life. The American Heart Association
recommends kids and teenagers with high cholesterol take steps to bring it
down. Ideally, total cholesterol should be below 170 in people ages 2 to 19.
Why High Cholesterol Matters
High cholesterol
is one of the major risk factors for coronary artery disease, heart attacks,
and strokes. It also appears to boost the risk of Alzheimer's disease. As we
saw earlier, high cholesterol leads to a buildup of plaque that narrows the
arteries. This is dangerous because it can restrict blood flow. If the blood
supply to a part of the heart or brain is completely cut off, the result is a
heart attack or stroke.
Cholesterol Buster: Eat More
Fiber
Diet changes
offer a powerful way to fight high cholesterol. If you've ever wondered why
some cereals claim to be heart-healthy, it's the fiber. The soluble fiber found
in many foods helps reduce LDL, the bad cholesterol. Good sources of soluble
fiber include whole-grain breads and cereals, oatmeal, fruits, dried fruits,
vegetables, and legumes such as kidney beans.
Cholesterol Buster: Know Your
Fats
No more than 35%
of your daily calories should come from fat. But not all fats are equal.
Saturated fats -- from animal products and tropical oils -- raise LDL
cholesterol. Trans fats carry a double-whammy, boosting bad cholesterol, while
lowering the good kind. These two bad fats are found in many baked goods, fried
foods (doughnuts, fries, chips), stick margarine, and cookies. Unsaturated fats
may lower LDL when combined with other healthy diet changes. They're found in
avocados, olive oil, and peanut oil.
Cholesterol Buster: Smart Protein
Meat and full-fat
milk offer plenty of protein, but they are also major sources of cholesterol.
You may be able to reduce LDL cholesterol by switching to soy protein, such as
tofu, at some meals. Fish is another great choice. It's rich in omega-3 fatty
acids, which can improve cholesterol levels. The American Heart Association
recommends eating fish at least twice a week.
Cholesterol Buster: Low-Carb Diet
There's growing
evidence that low-carb diets may be better than low-fat diets for improving
cholesterol levels. In a two-year study funded by the National Institutes of
Health, people who followed a low-carb plan had significantly better HDL (good
cholesterol) levels than those who followed a low-fat plan.
Cholesterol Buster: Lose Weight
If you're
overweight, talk to your doctor about beginning a weight loss program. Losing
weight can help you reduce your levels of triglycerides, LDL, and total
cholesterol. Shedding even a few pounds can also boost your good cholesterol
level -- it tends to go up one point for every 6 pounds you lose.
Cholesterol Buster: Quit Smoking
Giving up tobacco
is tough, but here's one more reason to try. When you stop smoking, your good
cholesterol is likely to improve by as much as 10%. You may be more successful
if you combine several smoking cessation strategies. Talk to your doctor about which
options are best for you.
Cholesterol Buster: Exercise
If you're healthy
but not very active, starting an aerobic exercise program could increase your
good cholesterol by 5% in the first two months. Regular exercise also lowers
bad cholesterol. Choose an activity that boosts your heart rate, such as
running, swimming, or walking briskly, and aim for at least 30 minutes on most
days of the week. It doesn't have to be 30 continuous minutes; two 15-minute
walks works just as well.
Treatment: Medications
If high
cholesterol runs in your family, diet and exercise may not be enough to get
your numbers where you want them. In that case, medication can give your
cholesterol levels an extra nudge. Statins are usually the first choice. They
block the production of cholesterol in the liver. Other options include
cholesterol absorption inhibitors, bile acid resins, and fibrates. Your doctor
may recommend a combination of these medications.
Treatment: Supplements
Certain dietary
supplements may also improve cholesterol levels. These include flaxseed oil,
fish oil, and plant sterols, such as beta-sitosterol. Prescription niacin, a
B-complex vitamin, has been found to raise good cholesterol while reducing bad
cholesterol. Niacin found in ordinary supplements should not be used to lower
cholesterol.
Herbal Remedies
Some studies
suggest garlic can knock a few percentage points off total cholesterol. But
garlic pills can have side effects and may interact with medications. Other
herbs that may reduce cholesterol include:
- Fenugreek seeds
- Artichoke leaf extract
- Yarrow
- Holy basil
How Low Should You Go?
Many people are
able to lower cholesterol levels through a combination of medication and
lifestyle changes. But how low is low enough? For people with diabetes or a high
risk of developing heart disease, an LDL score of less than 100 is desirable.
If you already have heart disease or coronary artery disease, some doctors
recommend reducing LDL to 70 or lower.
Can the Damage Be Undone?
It takes years
for high cholesterol to clog the arteries with plaque. But there is evidence
that atherosclerosis can be reversed, at least to some degree. Dean Ornish, MD,
has published several studies showing that a low-fat vegetarian diet, stress
management, and moderate exercise can chip away at the build-up inside the
coronary arteries. Other research supports the idea that big drops in
cholesterol can somewhat help open clogged arteries.
We may associate
cholesterol with fatty foods, but most of the waxy substance is made by our own
bodies. The liver produces 75% of the cholesterol that circulates in our blood.
The other 25% comes from food. At normal levels, cholesterol actually plays an
important role in helping cells do their jobs. But cholesterol levels are
precariously high in more than 100 million Americans.
High cholesterol
does not cause any symptoms. But it does cause damage deep within the body.
Over time, too much cholesterol may lead to a buildup of plaque inside the
arteries. Known as atherosclerosis, this condition narrows the space available
for blood flow and can trigger heart disease. The good news is high cholesterol
is simple to detect, and there are many ways to bring it down.
People older than
20 should have their cholesterol levels checked at least once every five years.
This is done with a simple blood test known as a fasting lipoprotein profile.
It measures the different forms of cholesterol that are circulating in your
blood after you avoid eating for nine to 12 hours. The results show your levels
of "bad" cholesterol, "good" cholesterol, and triglycerides.
Most of the
cholesterol in the blood is carried by proteins called low density lipoproteins
or LDL. This is known as the bad cholesterol because it combines with other
substances to clog the arteries. A diet high in saturated fats and trans fats
tends to raise the level of LDL cholesterol. For most people, an LDL score
below 100 is healthy, but people with heart disease may need to aim even lower.
Up to a third of
blood cholesterol is carried by high-density lipoproteins or HDL. This is
called good cholesterol because it helps remove bad cholesterol, preventing it
from building up inside the arteries. The higher the level of HDL cholesterol,
the better. People with too little are more likely to develop heart disease.
Eating healthy fats, such as olive oil, may help boost HDL cholesterol.
The body converts
excess calories, sugar, and alcohol into triglycerides, a type of fat that is
carried in the blood and stored in fat cells throughout the body. People who
are overweight, inactive, smokers, or heavy drinkers tend to have high
triglycerides, as do those who eat a very high-carb diet. A triglycerides score
of 150 or higher puts you at risk for metabolic syndrome, which is linked to
heart disease and diabetes.
Total cholesterol
measures the combination of LDL, HDL, and VLDL (very low density lipoprotein)
in your bloodstream. VLDL is a precursor of LDL, the bad cholesterol. A total
cholesterol score of under 200 is considered healthy in most cases. People who
score in the "high" range have an increased risk of developing heart
disease compared to those who score below 200.
To calculate your
cholesterol ratio, divide your total cholesterol by your HDL cholesterol. For
example, a total score of 200 divided by an HDL score of 50 equals a
cholesterol ratio of 4 to 1. Doctors recommend maintaining a ratio of 4 to 1 or
lower. The smaller the ratio, the better. While this figure is useful in
estimating heart disease risk, it's not as important in guiding treatment.
Doctors look at total cholesterol, HDL cholesterol, and LDL cholesterol to
determine treatment.
Cholesterol-rich
foods, like eggs, shrimp, and lobster are no longer completely forbidden.
Research shows that the cholesterol we eat has only a small effect on blood
cholesterol levels for most people. A few people are "responders,"
whose blood levels spike up after eating eggs. But for most, saturated fat and
trans fats are bigger concerns. Daily cholesterol limits are 300 mg for healthy
people and 200 mg for those at higher risk. One egg has 186 mg of cholesterol.
Cholesterol comes
from two sources -- the body and food -- and either one can contribute to high
cholesterol. Some people inherit genes that trigger too much cholesterol
production. For others, diet is the main culprit. Saturated fat and cholesterol
occur in animal-based foods, including meat, eggs, and dairy products made with
milk. In many cases, high cholesterol stems from a combination of diet and
genetics.
Several factors
can make you more likely to develop high cholesterol:
Until menopause,
women typically have lower total cholesterol levels than men of the same age.
They also have higher levels of HDL cholesterol, the good kind. One reason is estrogen: The female sex hormone raises
the level of HDL cholesterol. Estrogen production peaks during the childbearing
years and drops off during menopause. After age 55, a woman's risk of
developing high cholesterol begins to climb.
There's evidence
that cholesterol can begin clogging the arteries during childhood, leading to
atherosclerosis and heart disease later in life. The American Heart Association
recommends kids and teenagers with high cholesterol take steps to bring it
down. Ideally, total cholesterol should be below 170 in people ages 2 to 19.
High cholesterol
is one of the major risk factors for coronary artery disease, heart attacks,
and strokes. It also appears to boost the risk of Alzheimer's disease. As we
saw earlier, high cholesterol leads to a buildup of plaque that narrows the
arteries. This is dangerous because it can restrict blood flow. If the blood
supply to a part of the heart or brain is completely cut off, the result is a
heart attack or stroke.
Diet changes
offer a powerful way to fight high cholesterol. If you've ever wondered why
some cereals claim to be heart-healthy, it's the fiber. The soluble fiber found
in many foods helps reduce LDL, the bad cholesterol. Good sources of soluble
fiber include whole-grain breads and cereals, oatmeal, fruits, dried fruits,
vegetables, and legumes such as kidney beans.
No more than 35%
of your daily calories should come from fat. But not all fats are equal.
Saturated fats -- from animal products and tropical oils -- raise LDL
cholesterol. Trans fats carry a double-whammy, boosting bad cholesterol, while
lowering the good kind. These two bad fats are found in many baked goods, fried
foods (doughnuts, fries, chips), stick margarine, and cookies. Unsaturated fats
may lower LDL when combined with other healthy diet changes. They're found in
avocados, olive oil, and peanut oil. 
Meat and full-fat
milk offer plenty of protein, but they are also major sources of cholesterol.
You may be able to reduce LDL cholesterol by switching to soy protein, such as
tofu, at some meals. Fish is another great choice. It's rich in omega-3 fatty
acids, which can improve cholesterol levels. The American Heart Association
recommends eating fish at least twice a week.
There's growing
evidence that low-carb diets may be better than low-fat diets for improving
cholesterol levels. In a two-year study funded by the National Institutes of
Health, people who followed a low-carb plan had significantly better HDL (good
cholesterol) levels than those who followed a low-fat plan.
If you're
overweight, talk to your doctor about beginning a weight loss program. Losing
weight can help you reduce your levels of triglycerides, LDL, and total
cholesterol. Shedding even a few pounds can also boost your good cholesterol
level -- it tends to go up one point for every 6 pounds you lose.
Giving up tobacco
is tough, but here's one more reason to try. When you stop smoking, your good
cholesterol is likely to improve by as much as 10%. You may be more successful
if you combine several smoking cessation strategies. Talk to your doctor about which
options are best for you.
If you're healthy
but not very active, starting an aerobic exercise program could increase your
good cholesterol by 5% in the first two months. Regular exercise also lowers
bad cholesterol. Choose an activity that boosts your heart rate, such as
running, swimming, or walking briskly, and aim for at least 30 minutes on most
days of the week. It doesn't have to be 30 continuous minutes; two 15-minute
walks works just as well.
If high
cholesterol runs in your family, diet and exercise may not be enough to get
your numbers where you want them. In that case, medication can give your
cholesterol levels an extra nudge. Statins are usually the first choice. They
block the production of cholesterol in the liver. Other options include
cholesterol absorption inhibitors, bile acid resins, and fibrates. Your doctor
may recommend a combination of these medications.
Certain dietary
supplements may also improve cholesterol levels. These include flaxseed oil,
fish oil, and plant sterols, such as beta-sitosterol. Prescription niacin, a
B-complex vitamin, has been found to raise good cholesterol while reducing bad
cholesterol. Niacin found in ordinary supplements should not be used to lower
cholesterol.
Some studies
suggest garlic can knock a few percentage points off total cholesterol. But
garlic pills can have side effects and may interact with medications. Other
herbs that may reduce cholesterol include:
Many people are
able to lower cholesterol levels through a combination of medication and
lifestyle changes. But how low is low enough? For people with diabetes or a high
risk of developing heart disease, an LDL score of less than 100 is desirable.
If you already have heart disease or coronary artery disease, some doctors
recommend reducing LDL to 70 or lower.
It takes years
for high cholesterol to clog the arteries with plaque. But there is evidence
that atherosclerosis can be reversed, at least to some degree. Dean Ornish, MD,
has published several studies showing that a low-fat vegetarian diet, stress
management, and moderate exercise can chip away at the build-up inside the
coronary arteries. Other research supports the idea that big drops in
cholesterol can somewhat help open clogged arteries.