What You Need to Know About Cholesterol Management
The ever-swirling cholesterol controversy can leave you feeling confused about what to think and do about your cholesterol levels. From total cholesterol to good and bad cholesterol ratios, it’s hard to keep up with the current recommendations. In 2013, the topic was turned on its head yet again with a new set of guidelines from the American College of Cardiology and the American Heart Association.
Instead of only using LDL cholesterol (or bad cholesterol) levels to determine who is at risk for cardiovascular disease, the guidelines encourage looking at risk factors such as age, blood pressure, and smoking status.1 They also include the importance of both self-help and medical options for keeping cholesterol levels in check. The following guidelines can help you manage your cholesterol levels and stay in control of your health.
Diet and Nutrition
Making a few basic dietary modifications may lower your cholesterol levels by as much as 30%. Let's peruse the menu of cholesterol-lowering dietary choices.
As recently as 2010, the U.S. Department of Health and Human Services advised eating less than 300 mg per day of cholesterol. However, new evidence shows that, for many people, eating a diet high in dietary cholesterol doesn't necessarily equal higher blood cholesterol levels. In fact, it has been shown that decreasing the amount of cholesterol eaten to under 200 mg per day only accounts for a 3-5% decrease in blood levels on average.
Accordingly, dietary cholesterol has now taken a back seat to two other dietary components: saturated fat and trans fat.
For any two people who consume the same amount of cholesterol, the one whose diet is lower in saturated fat is likely to have lower levels of LDL cholesterol (the bad form of cholesterol), in his or her bloodstream. Current U.S. Department of Health and Human Services guidelines recommend less than 10% of calories from saturated fatty acids. Take that concept a little further, say, to under 7% and you could see an 8-10% reduction in blood cholesterol levels, according to some researchers.
A couple of quick (and delicious!) tips to get you started: replace butter with heart-healthy olive oil and swap out a few red meat or poultry meals with heart-healthy, omega-3-rich fish.
Trans fats are man-made fats that are added to foods during processing. They contribute to inflammation and increase your risk of developing heart disease. Trans fats are commonly found in fried foods, packaged baked goods, and even movie theater popcorn. If you see >0.5 grams of trans fat or the words “partially hydrogenated oil” on a nutrition facts label, it’s best to avoid that food.
Eat more helpings of fresh fruits and vegetables and you may get closer to your healthy cholesterol goals! Soluble fiber found in many plant foods forms a thick gel that blocks absorption of cholesterol from the digestive tract, preventing some of your dietary cholesterol from reaching your bloodstream.
Increasing soluble fiber consumption by 5-10 grams per day has been found to reduce LDL cholesterol by up to 5%. You should aim for 25 grams of fiber per day for women and 38 grams per day for men. Citrus fruits and apples are good sources of the soluble fiber pectin, as are berries, peaches, bananas, and grapes. Also high in soluble fiber are beans, peas, lentils, barley, oats and (surprise!) avocados.
Plant Stanols and Plant Sterols
Present in certain plant foods in smaller amounts than soluble fiber, these compounds work in similar ways to soluble fiber to block cholesterol absorption. Eating just 2 grams/day of plant sterols and stanols can decrease blood cholesterol levels by 5-15%. Foods high in sterols and stanols include wheat germ, wheat bran, peanuts, almonds, and Brussels sprouts.
A balanced trans-fat free diet high in fruits, vegetables, and whole grains and low in saturated fat is a vital part of a successful cholesterol management plan. Combining a healthy diet with exercise can help you lower your risks even further.
Offering significant benefits for cholesterol management, regular exercise plays a vital role in a heart-healthy lifestyle for a number of important reasons. Exercise is a powerful way to lower serum triglyceride levels and high triglycerides are a risk factor for heart disease.
Additionally, regular exercise helps you reach and maintain your ideal weight, which can lower your LDL cholesterol levels. It is also one of the few ways known to raise levels of high-density lipoprotein, or HDL, the good form of cholesterol. Exercise has even been found to lower a number of inflammatory markers related to heart health, including a protein called homocysteine, which promotes the formation of artery-clogging cholesterol plaques.
The American Heart Association recommends 40 minutes of moderate to vigorous-intensity aerobic exercise 3 to 4 times per week for lowering cholesterol-related risk of heart attack and stroke. To fine-tune your exercise program for optimal cholesterol management benefits, the following recently published exercise science studies provide a few different options for fitting exercise into your lifestyle:
Low-intensity resistance training has been found to significantly increase HDL levels and decrease levels of lipoprotein (a), a particularly strong risk factor for cardiovascular disease. In a study of sedentary women aged 30 to 60 years, a 12-week program of strength exercises using their own body weight resulted in increased HDL levels as well as a decrease in total cholesterol and triglycerides. Low-intensity resistance training is also a good way to moderately elevate your heart rate.
Can't fit 40-minute exercise sessions into your schedule? Don't worry; several short sessions can still add up to big gains. In a study in which men exercised in short-term bouts consisting of a minimum of 10 minutes per session, participants gained an average of 16% higher HDL levels over their more sedentary counterparts.
Switching to a sit-stand workstation and using the standing position for about an hour and a quarter out of an 8-hour work day can shave off a few cholesterol points. In addition to burning more calories, sit-stand desks improve your circulation and decrease blood pressure, which can help fend off cholesterol buildup.
Go with the Flow
Tai chi, a series of slow, mindful, fluid motions, helped lower total cholesterol levels in elderly women, in one study. Participants practiced tai chi once per week for three months.
For best cholesterol benefits, consider a combination approach that includes both aerobic and resistance exercises. In a study of Type 2 diabetics, participants completed 12-month combination programs that included moderate-intensity resistance, aerobic, and flexibility training. When results were tallied they revealed an average of nearly 15% decrease in total cholesterol and a 20% drop in LDL cholesterol.
Not sure how to get started with exercise? Why not make it a group effort? Ask a friend or neighbor to start a walking group with you, sign up for classes at your local community center, or schedule a weekly hike with your family. Having support can help you stick to your new lifestyle changes.
If you've got your diet and exercise bases covered yet your cholesterol levels are still elevated or your risk factors continue to place you in the higher-risk category, your doctor may talk to you about your medical options for cholesterol management.
The class of drugs known as statins work by blocking cholesterol production in the body. By far the most effective drugs for this purpose, statins lower LDL levels by up to 55% and have been the gold standard in medical treatment for high cholesterol since they entered the market in 1987. Statins are so widely used that they now hold the distinction of being the single most prescribed category of drugs in the U.S., a trend that has increased even more since the American Heart Association issued its 2013 revised guidelines.
In spite of their widespread success, statins can cause a range of potential side effects, some of which can lead to serious health complications. Most commonly, statins cause depletion of the energy producing molecule coenzyme Q10 or CoQ10.
Required by every cell of your body, CoQ10 production relies on the same pathway as cholesterol production. So when statins block cholesterol production, they also block the production of CoQ10. To counteract the statin-related depletion of CoQ10, many doctors have begun to advise their statin patients to take a CoQ10 supplement along with their prescriptions.
In addition to potential CoQ10 depletion, up to 15% of statin users experience a range of muscular symptoms, collectively referred to as statin myopathy, with symptoms such as muscular soreness, aching, weakness and/or muscle fatigue.
While cholesterol levels are no longer the only risk factor doctors take into account when looking at your risk of cardiovascular disease, cholesterol management is still a huge part of lowering your risk. Strategies such as eating a healthy diet, including more exercise, and discussing medication options with your doctor can help you keep your cholesterol in check. If you are prescribed statin medications, it's important to discuss the side effects with your doctor, including the depletion of CoQ10.
If you have been prescribed statins for cholesterol management, we invite you to download our FREE eBook on Statin Side Effects.
- Blog Contributor