Cholesterol, by definition, is a waxy fat-like substance manufactured by the liver and acquired through the diet. It is needed in the manufacturing of bile acids, sex hormones, vitamin D and cell membranes. So as you see, cholesterol is needed by the body but in limited amounts. Excess cholesterol in the blood is known as hypercholesterolemia and is one of the risk factors behind heart disease.
What are the types of cholesterol?
Cholesterol is carried in the blood on carrier proteins or lipoproteins.
High-Density Lipoprotein or HDL is one of those proteins that is made of more protein than cholesterol and triglycerides. It carries cholesterol from the distant tissues to the liver to be processed, reused or disposed from the body and that’s why it is known as the ”good” cholesterol.
Low-Density Lipoprotein or LDL is another protein made of cholesterol and triglycerides more than protein. It carries cholesterol from the liver to the neighboring tissues where it deposits on arteries causing the buildup of plaque on the arterial walls. That’s why it is known as the “bad” cholesterol. High levels of LDL in the blood increases a person’s risk of heart disease and stroke.
Very Low Density Lipoprotein or VLDL is the lipoprotein that has the greatest percentage of triglycerides among the three and is related to increased risk of coronary artery disease but since there is no direct way of measuring it in labs, VLDL is measured as a percentage of triglycerides level in the blood.
Know your numbers!
|in mg/dL||Optimal/ Desirable||Borderline||High/ Undesirable|
|Total Cholesterol||Less than 200||200-239||above 240|
|LDL||Less than 100||100-129||above 130|
|HDL*||above 60||less than 40|
|* Higher numbers with HDL are more desirable|
As discussed at the beginning, cholesterol is manufactured inside the liver so genetics play a role in the levels of cholesterol in the blood. If high cholesterol is hereditary, it is known as familial hypercholesterolemia ( usually treated with drugs even though lifestyle changes can greatly affect dosage) . Gender also affects the cholesterol level. Women tend to have higher protective HDL than men; however, with menopause LDL levels start to increase. Genes, gender and age are factors that are out of control but we can control our diet and lifestyle. So, what can we do to boost our HDL and decrease our LDL?
First things first;
The TLC diet or Therapeutic Lifestyle Changes diet is a 3-way approach to lowering cholesterol and reducing the risk of cardiovascular disease and heart attacks. The three parts are:
a- Decrease saturated fat, trans fat and cholesterol. Saturated fats raise blood cholesterol more than anything else in the diet. It is mainly found in foods of animal sources including fatty cuts of meats, full-fat dairy products, poultry with skin as well as coconut oil and palm oil. Saturated fat should be limited to less than 7% of the total diet. Trans fats tend to raise blood cholesterol similar to saturated fats. There are mainly found in foods made with hydrogenated vegetable oils such as cookies, crackers, margarines, and foods fried with hydrogenated vegetable oils and shortenings such as chicken and fries. Dietary cholesterol should be kept to less than 200mg per day. It is found in animal products only including organ meats, egg yolks, shrimp, and whole milk dairy products including butter, cheese and cream. Please do not fall for marketing pitches where apple cider vinegar is being sold for twice its price because it is labeled ”no cholesterol”! Foods from plant origin do not contain cholesterol!!
b- Add plant stanols and sterols and increase intake of soluble fibers. Soluble fibers dissolve into a gel-like substance in the intestines blocking cholesterol and fat from being absorbed into the blood. You should aim for 10-25 grams of soluble fiber per day. Soluble fibers are found in oats, barley, fruits, vegetables, beans and lentils. Plant stanols and sterols occur naturally in small amounts in plants but they are added to certain foods such as margarines and orange juices. Loke soluble fibers, they bind to cholesterol in the digestive tract and prevent it from being absorbed. Research has shown that 2 grams of plant stanols or sterols can decrease LDL by 10-15% within weeks. However, since foods containing these compounds are not calorie free, you should reduce calories elsewhere from the diet.
2- Physical activity. Try to engage in a 30 minute physical activity on most and preferably all days of the week. Regular exercise helps you control your weight, increase your HDL levels, lower your triglycerides and your blood pressure, increase the fitness of your heart and lungs and reduce stress. For heart health month start a workout routine with your partner. It will increase the time spent together and will make the workout more fun.
3- Weight management. Losing weight even as little as 2 to 5kg can lower LDL cholesterol.
4- Omega-3 Fatty Acids. Omega-3 fats have a protective effect over the heart and they may prevent blood clots from forming and help in reducing inflammation of the arterial walls. Studies suggest that omega-3 fatty acids reduce risk of heart attack for those who already have heart disease. Baked or steamed fish, a handful of walnuts or a sprinkle of flaxseed on your dishes can add to your daily omega-3 intake.
5- Quit smoking. Quitting smoking can increase HDL cholesterol.
6- Alcohol. Alcohol in moderation ( 1 drink per day for females, 2 drinks per day for males namely red wine) has been linked to increased levels of HDL cholesterol but if you don’t drink, please do not start. Too much alcohol is associated with heart and liver damage and high triglycerides levels.
7- Olive oil. Olive oil contains antioxidants that can lower your LDL cholesterol but leave your HDL cholesterol untouched. Aim to replace other fats in your diet with olive oil, especially the extra-virgin variety which is less processed and contains more heart-healthy antioxidants.
8- Garlic. A meta-analysis of 26 studies just published in the Journal of the Science of Food and Agriculture that daily intake of garlic can lower cholesterol and triglyceride levels. Add garlic to your salad, your stir-fries and your stews.
What if even with the dietary and lifestyle changes you still have high cholesterol? Your doctor may then prescribe cholesterol-lowering drugs namely belonging to the statin family ( Crestor, Lipitor…) while advising you to maintain the lifestyle changes you’ve been implementing.
Just to conclude with a word of advice, get your cholesterol levels checked. It’s a simple lab test that can save your life. Even if you are young and thin, an unhealthy diet will most likely increase your cholesterol levels and put you at risk of heart disease and heart attacks.
Resources: National Institute of Health, MayoClinic, NutraIngredients, Journal of the Science of Food and Agriculture