All my adult life, I had
higher than normal “Cholesterol levels”.
What is Cholesterol and what we can do to improve and maintain healthy
levels?
Continuing my journey in
learning about my Heart and how to
keep it healthy and running for a long time, I explore the subject of
Cholesterol and it’s many properties.
Cholesterol
Cholesterol isn't entirely
the health villain it's made out to be, its name darkly linked to heart attack,
stroke, and other types of cardiovascular disease. Our bodies need cholesterol,
which is a type of lipid (another name for fat) to make cell membranes, key
hormones like testosterone and estrogen, the bile acids needed to digest and
absorb fats, and vitamin D. Cholesterol is so important to the body that the
liver and intestines make it from scratch.
What is "bad"
about cholesterol isn't the substance itself - in fact, we can't live without
it, but how much of it is in the bloodstream.
The body packages
cholesterol in two main particles: low-density lipoprotein (LDL), the so-called
bad cholesterol, and high-density lipoprotein (HDL), the so-called good
cholesterol. Too much LDL in the bloodstream helps create the harmful
cholesterol-filled plaques that grow inside arteries. Such plaques are
responsible for angina (chest pain with exertion or stress), heart attacks, and
most types of stroke.
What causes a person's LDL
level to be high? Most of the time diet is the key culprit. Eating foods rich
in saturated fats, trans fats, and easily digested carbohydrates boost LDL.
Genes are sometimes at the root of high cholesterol, and some medications can
boost LDL.
If you have high
cholesterol, making changes in your diet can help bring it do
wn into the
healthy range. Exercise can help boost the level of protective HDL. Several
types of medication, notably the family of drugs known as statins, can
powerfully lower LDL. Depending on your cardiovascular health, your doctor may
recommend taking a statin.
11 foods that can help lower your
cholesterol
Focus on fiber-rich
foods and avoid saturated fats.
If your cholesterol level has crept up over
the years, you may wonder whether changing your diet can help. Ideally, your
total cholesterol value should be 200 milligrams per deciliter (mg/dL) or
lower. But it's the harmful LDL cholesterol value that experts worry about the
most. Excess LDL builds up on artery walls and triggers a release of
inflammatory substances that boost heart attack risk.
"To prevent heart disease, your LDL
should be 100 mg/dL or lower," says Dr. Jorge Plutzky, director of
preventive cardiology at Harvard-affiliated Brigham and Women's Hospital. But
many Americans have LDL values that are less than optimal (100 to 129 mg/dL) or
borderline high (130 to 159 mg/dL).
If you fall into either of those categories,
you may be able to nudge down your LDL to a healthier level by changing what
you eat, particularly if your current diet could use some improvement. However,
most people with higher LDL values likely will also need to take a
cholesterol-lowering drug, such as a statin, says Dr. Plutzky.
Dietary directives
Avoiding foods that are high in cholesterol isn't the best way
to lower your LDL. Your overall diet — especially the types of fats and carbohydrates
you eat — has the most impact on your blood cholesterol values. "As the
American Heart Association has noted, you'll get the biggest bang for your buck
by lowering saturated fat and replacing it with unsaturated fat," says
registered dietitian Kathy McManus, director of the Department of Nutrition at
Brigham and Women's Hospital.
That means avoiding meat, cheese, and other high-fat dairy
products such as butter, half-and-half, and ice cream. Equally important is
replacing those calories with healthy, unsaturated fats (such as those found in
vegetable oils, avocados, and fatty fish) rather than refined carbohydrates
such as white bread, pasta, and white rice. Unlike healthy fats, these starchy
foods aren't very filling, and they can trigger overeating and weight gain.
The other big problem with refined carbs? They're woefully low
in fiber, which helps flush cholesterol out of the body (see "The fiber
factor").
The fiber factor
Your
body can't break down fiber, so it passes through your body undigested. It
comes in two varieties: insoluble and soluble. Fiber-containing foods usually
feature a mix of the two.
Insoluble
fiber does not dissolve in water. While it doesn't directly lower LDL, this
form of fiber fills you up, crowding other cholesterol-raising foods out of
your diet and helping to promote weight loss.
Soluble
fiber dissolves in water, creating a gel. This gel traps some of the
cholesterol in your body, so it's eliminated as waste instead of entering
your arteries.
Soluble
fiber also binds to bile acids, which carry fats from your small intestine
into the large intestine for excretion. This triggers your liver to create
more bile acids - a process that requires cholesterol. If the liver doesn't
have enough cholesterol, it draws more from the bloodstream, which in turn
lowers your circulating LDL.
Finally,
certain soluble fibers (called oligosaccharides) are fermented into
short-chain fatty acids in the gut. These fatty acids may also inhibit
cholesterol production.
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The "best" foods
The following 11 foods are good sources of fiber or unsaturated
fat (or both). But they're not in any particular order and are simply
suggestions. Most whole grains, vegetables, and fruits are good sources of
fiber. And most nuts and seeds (and the oils made from them) provide
monounsaturated or polyunsaturated fats.
1. Oatmeal. This whole grain is one of the best sources of soluble
fiber, along with barley (see "Grain of the month," at right). Start
your day with a bowl of steel-cut or old-fashioned rolled oats, topped with
fresh or dried fruit for a little extra fiber.
2. White beans. Also called navy beans, this variety ranks highest in
fiber content. Try different types of beans as well, such as black beans,
garbanzos, or kidney beans, which you can add to salads, soups, or chili. But
avoid prepared baked beans, which are canned in sauce that's loaded with added
sugar.
3. Avocado. The creamy, green flesh of an avocado is not only rich in
monounsaturated fat, it also contains both soluble and insoluble fiber. Enjoy
this fruit sliced in salad, pureed into dip, or mashed and spread on a slice of
whole-grain toast.
4. Eggplant. Although not everyone's favorite, these deep purple
vegetables are one of the richest sources of soluble fiber. One idea:
oven-roast or grill whole eggplants until soft and use the flesh in a Middle
Eastern dip called baba ghanoush.
5. Carrots. Raw baby carrots are a tasty and convenient snack — and
they also give you a decent dose of insoluble fiber.
6. Almonds. Among nuts, almonds are highest in fiber, although other
popular varieties such as pistachios and pecans are close behind. Walnuts have
the added advantage of being a good source of polyunsaturated, plant-based
omega-3 fatty acids.
7. Kiwi fruit. Contrary to popular belief, you don't need to peel these
fuzzy, brown fruits. But to avoid the skin, slice one in half and scoop out the
inside with a spoon for an easy, fiber-rich, sweet snack.
8. Berries. Because these fruits are packed with tiny seeds, their
fiber content is higher than most other fruits. Raspberries and blackberries
provide the most, but strawberries and blueberries are also good sources.
9. Cauliflower. This cruciferous veggie not only provides fiber; it can
also serve as a substitute for white rice. Just shred or whirl in a food
processor until it resembles rice, then sauté with a little olive oil until
tender.
10. Soy. Eating soybeans and foods made from them, such as soy
milk, tofu, and tempeh, was once touted as a powerful way to lower cholesterol.
More recent analyses showed the effect is modest, at best. Still, protein-rich,
soy-based foods are a far healthier choice than a hamburger or other red meat.
11. Salmon. Likewise, eating cold-water fish such as salmon twice a
week can lower LDL by replacing meat and delivering healthy omega-3 fats. Other
good fish options include chunk light canned tuna and tinned sardines.
Supplements for three common conditions
Certain herbs, vitamins, minerals, and other compounds may help
control cholesterol, blood pressure, and anxiety.
High cholesterol, high blood pressure, and anxiety are three
common conditions that are often treated with medication. But sometimes people
can't tolerate those drugs or are reluctant to use them. In these instances,
dietary supplements may be an option, says Dr. Donald Levy, medical director at
the Osher Clinical Center for Integrative Medicine at Brigham and Women's
Hospital and assistant clinical professor of medicine at Harvard Medical
School.
Studies have shown that some herbs, vitamins, minerals, and
other substances, alone or in combination with traditional treatments, may be
effective in treating these conditions, and are largely safe to use — provided
your doctor approves.
High cholesterol
Statins are the
most commonly prescribed class of medication to improve high cholesterol, but
there are alternatives for people who can't take them.
Vitamin D3. If you cannot tolerate a statin
medication and have a vitamin D deficiency (which Dr. Levy defines as a blood
level below 32 nanograms per milliliter), a vitamin D3 supplement
could help, according to Dr. Levy. "It's interesting, because after taking
the supplement, some people are then able to tolerate statins when they
couldn't in the past," he says.
Phytosterols. Phytosterols (also called plant stanols or sterols) are
derived from the cell membranes of plants and can be taken in pill form. They
are also found naturally in foods such as nuts, beans, fruits, and vegetables.
Studies show that phytosterol supplements can lower "bad" LDL
cholesterol by up to 14% in people taking 2,000 to 3,000 milligrams (mg) a day,
says Dr. Levy. When choosing a product, look for a quality seal (see
"Worried about supplement safety? Here's what you should consider"),
and also look for a product that contains phytosterol esters, says Dr. Levy.
Red yeast rice. Red yeast rice supplements are made from a type of yeast
that is grown on white rice. Red yeast rice has long been used in Chinese
medicine, and modern studies show that people taking 2,400 to 3,600 mg a day
for six months were able to reduce their LDL cholesterol by 20% to 25%, says
Dr. Levy. One 2008 study published in The American Journal of Cardiology found that red yeast
rice was also effective in reducing deaths and recurrent heart attacks in
nearly 5,000 people who took the supplement after having a heart attack. Look
for a high-quality product, says Dr. Levy, because red yeast rice can contain a
dangerous contaminant, citrinin, which is a toxin produced by fungus that can
cause food poisoning, kidney damage, and immune system problems.
Worried about supplement safety? Here's what you should
consider
While
some supplements are potentially helpful (or at least harmless), a lack of
regulatory oversight of these products means that others might be ineffective
or dangerous, or might contain hazardous contaminants. Identifying the safe
choices requires a little detective work, says Dr. Donald Levy, medical
director at the Osher Clinical Center for Integrative Medicine at Brigham and
Women's Hospital and assistant clinical professor of medicine at Harvard
Medical School. Before taking a supplement, always talk to your doctor to
make sure that it's safe for any medical conditions you may have and that it
won't interact with any medications you are taking.
Although
supplement makers must follow FDA rules for good manufacturing practices, the
agency does not require testing the estimated 9,000 products on the market to
make sure they do contain the ingredients they claim, and don't contain
contaminants, such as dangerous bacteria, arsenic, cadmium, or lead. This
means there is no guarantee that any particular product is effective or safe.
To add a degree of protection, look for products that have voluntarily gone
through quality testing, which is certified by a seal on the packaging. Some
good ones to look for are those from U.S. Pharmacopeia, ConsumerLab.com, and
NSF International.
High blood pressure
A few supplements have been shown to be effective in reducing
high blood pressure, says Dr. Levy.
Magnesium citrate or glycinate. Some people are
deficient in the mineral magnesium. But blood tests aren't good at detecting
total magnesium levels inside the body, because much of your body's magnesium
is stored within cells. Many people find the deficiency only after a
nutritionist analyzes their diet, says Dr. Levy. In those individuals,
supplements can boost magnesium levels and help reduce high blood pressure when
taken along with traditional blood pressure treatments. It typically takes up
to six weeks for the supplements to show an effect. However, not everyone
should take magnesium, particularly those with kidney disease, says Dr. Levy,
so be certain to consult with your doctor or integrative medicine specialist
before taking it.
Lycopene. An antioxidant supplement that may also help reduce high
blood pressure is lycopene, which gives vegetables like tomatoes their red hue.
While tomato-based products, including canned sauces, contain lycopene, those
foods often have a lot of sodium. So, it's better in many instances to opt for
a supplement. Look for one that also contains tomato extract for an added
benefit, says Dr. Levy. Typically, people need to take 15 to 25 mg of lycopene
daily to see a reduction in blood pressure.
Anxiety
Problems with anxiety are common, especially around the time of
menopause.
Chamomile extract. This extract, which comes from a flower, has long been
used as a therapy for anxiety. Anxiety often goes hand in hand with
sleeplessness, so it's no surprise that chamomile is also often recommended as
a sleep aid. Many people drink chamomile tea, but taking a supplement may be
more convenient (and require fewer late-night trips to the bathroom if taken before
bed). Studies have found that people who took chamomile supplements saw a
significant reduction in anxiety when compared with people who took a placebo,
says Dr. Levy. Typically, it's best to start by taking one 220-mg capsule
daily. Look for one that contains 1.2% of a substance called apigenin.
Beyond "bad" cholesterol: A closer look at your blood
lipids
For assessing heart disease risk, a standard cholesterol test
doesn't always tell the whole story. Who should consider an additional test?
A standard cholesterol test (also known as a lipid profile or
lipid panel) tells you the amount of cholesterol and triglyceride carried in
your blood. These lipids (fats) travel inside tiny particles called
lipoproteins. Created in your intestines and liver, lipoproteins come in a
range of shapes, sizes, and densities. The value of greatest concern is
low-density lipoprotein (LDL) cholesterol, often referred to as "bad"
cholesterol. Too much LDL in the bloodstream helps to create the plaque that accumulates
inside arteries, raising the risk of a heart attack. The higher your LDL, the
higher your risk of having a heart attack.
However, about half of heart attacks occur in people who have a
"normal" LDL cholesterol value (also referred to as an optimal or
near-optimal LDL; see "The range of LDL cholesterol"). What might
explain this observation? In addition to LDL, other lipoproteins can contribute
to clogged arteries. Known as atherogenic particles, they include
intermediate-density lipoprotein (IDL), very-low-density lipoprotein (VLDL),
and chylomicrons, the largest, lowest-density particles, which consist mainly
of lipid.
The range of LDL cholesterol
These
values are for people without heart disease. For those with known heart
disease, doctors recommend an LDL of less than 70 mg/dL.
|
|
LDL
cholesterol level
|
LDL
cholesterol category
|
|
Less
than 100 mg/dL
|
Optimal
|
|
100–129
mg/dL
|
Near
optimal/above optimal
|
|
130–159
mg/dL
|
Borderline
high
|
|
160–189
mg/dL
|
High
|
|
190
mg/dL and above
|
Very
high
|
Particle numbers, explained
Some cholesterol tests report your "non-HDL
cholesterol," which is your total cholesterol minus the high-density
lipoprotein (HDL). While that value captures all the cholesterol in the
atherogenic particles, it doesn't tell you one potentially important thing—the
actual number of particles.
"There's increasing recognition that it's not just the
cholesterol that matters, but the number of lipoprotein particles," says
Dr. Samia Mora, a cardio-logist at Harvard-affiliated Brigham and Women's
Hospital. That's because both size as well as composition matter: larger LDL
particles carry more cholesterol, while smaller particles carry less. If the
LDL particles in your blood are mostly on the small side, you will have a
greater number of these particles for any given LDL cholesterol level compared
to someone with larger particles. The more particles there are traveling
through your blood, the more likely they are to become stuck inside artery
walls.
Growing evidence suggests that knowing the total number of all
atherogenic lipoprotein particles is a better indicator of cardiovascular
disease risk than the standard LDL cholesterol value. This number can be
assessed with an inexpensive, widely available test that measures
apolipoprotein B (apoB), a single protein found on all atherogenic particles.
Evolving guidelines
So why isn't apoB testing done routinely? In most cases, an LDL
value is sufficient. In general, if it's high, there's no reason to check your
apoB because you already know you're at higher risk for heart disease. (You can
assess your risk and possible need for a cholesterol-lowering statin
here: www.health.harvard.edu/heartrisk.)
However, the thinking about apoB's relevance is evolving. In
fact, the current guidelines from the European Society of Cardiology recommend
apoB testing to better assess a person's heart attack risk. The guidlines of
the American College of Cardiology/American Heart Association say that apoB is
better than LDL cholesterol for assessing risk and that people with apoB levels
higher than 130 milligrams per deciliter (mg/dL) might benefit from taking a
statin to lower their heart attack risk. They suggest apoB testing for people
with triglyceride values of 200 mg/dL or higher.
Testing advice
Some cardiologists, including Dr. Mora, advocate more widespread
apoB testing. Consider a group of healthy people, all with LDL cholesterol
values of around 120 mg/dL. For those who eat a healthy diet and are in a
normal weight range, there's no reason for an apoB test. But those who have
signs of an unhealthy metabolism - such as prediabetes, a big belly, or
elevated triglycerides - are far more likely to have a high apoB, Dr. Mora
explains. At least a quarter of the population may fall into this second
category and should consider getting an apoB test, she says. She also
recommends apoB testing in people with a family history of heart disease.
The good news is that even if your apoB is high, lifestyle
habits such as following a Mediterranean-style eating pattern and getting
regular exercise can help bring it down.
I know that is a lot of information to take on and digest, but
the subject matter is so complicated and involved and I had to keep it as short
as possible, after all, my goal here is to give you as much information as I
possibly can without have you or me get a degree in the subject
matter. With my own research, I was able
to put this information together and to make it as understandable as
possible. I hope you have enjoyed
reading it and found it educational and interesting at the same time. Please give me your feedback and comments
below.
