“If you make the appropriate changes, you can lower your cholesterol and your risk for these serious health problems.”
I think cholesterol is the epitome of changing healthcare recommendations over time. And how health guidelines can sometimes just be plain wrong. Seriously, this topic can be so confusing because of all the conflicting information out there.
So I’m here today to bring you the latest information on cholesterol from the most-trusted resources. What that means is this post is based on scientific research findings and is the best we have right now. That’s not to say the recommendations won’t change again. They very well could. But I’m going to share with you why these guidelines do absolutely make sense and what the medical field has found to be working.
Why is this topic important?
Because high cholesterol can severely worsen your health by increasing your chance of developing cardiovascular disease. The more plaque in your coronary (heart) arteries, the more likely you are to have a heart attack. And the more plaque in your arteries, especially your carotid arteries (the ones in your neck that supply blood to your brain), the more likely you are to have a stroke.
I’m not telling you this to scare you, I’m telling you because it’s true. BUT! If you make the appropriate changes, you can lower your cholesterol and your risk for these serious health problems. The issue is that many people just don’t know what to do about high cholesterol or don’t even have their levels checked at all, which you should start doing as young as 20 years old. It’s such a problem.
So let’s get into it. And be sure to share this information with friends and family!
What are the basics about cholesterol? Give me the bullet points.
- Cholesterol is a fatty substance that circulates in the blood
- When we refer to cholesterol we’re referring to several different components (more on that later)
- It’s vital for the body to function properly: used in hormone production, digestion, and is a component of our cells
- When levels are abnormal, you’re at an increased risk for plaque accumulating on artery walls
- Increased plaque accumulation narrows artery walls, increasing risk for heart attack
- Through diet, exercise, and (if needed) medications, you can control blood cholesterol levels
How is it tested? How do I have it drawn properly?
To check blood cholesterol levels, you need to have a blood draw. For cholesterol, the lab test is called a lipid panel. This can be done while at your yearly appointment with your primary care physician. If you have one, your cardiologist may also order lipid panels if yours haven’t been checked in awhile.
To get the most accurate results, you’ll need to fast for 12 hours prior to the blood draw. If you don’t, it can mess with some of your results, particularly your triglyceride level.
What’s in a lipid panel?
A lipid panel typically contains four test results. You’ll get the numbers for your:
Total cholesterol: a type of fat found in your blood. High amounts have been directly linked to causing heart disease.
HDL: stands for high-density lipoproteins. It’s your “good cholesterol” because it acts like a broom, cleaning your arteries of cholesterol and bringing it back to the liver. So you actually want HDL to be high.
LDL: does the opposite of HDL. Standing for low-density lipoproteins, it’s your “bad cholesterol” because it transports cholesterol from your liver out to your blood, contributing to the accumulation of plaque on artery walls. So you want LDL to be low.
Triglycerides: are another type of fat in the blood and are highly impacted by your diet. The higher they are, the more likely your chance of heart disease.
What cholesterol values do I want?
- 75-169 mg/dL for those age 20 and younger
- 100-199 mg/dL for those over age 21
- Greater than 40 mg/dL
- Less than 130 mg/dL if you’re at low risk for coronary artery disease
- Less than 100 mg/dL if you’re at high risk for coronary artery disease or have multiple risk factors
- And less than 70 mg/dL if you have coronary artery disease or metabolic syndrome
- Less than 150 mg/dL (150 – 199 mg/dL is considered borderline high)
How can I lower cholesterol?
Many guidelines still say:
Limit saturated fat to 10% daily calories and cholesterol to 300 mg/day if at low risk for coronary artery disease. As an example:
- For women eating 1800 calories, no more than 180 calories should come from saturated fat
- For men eating 2000 calories, no more than 200 calories should come from saturated fat
Limit fat saturated fat to 7% of daily calories and cholesterol to 200 mg/day if you are at high risk or have coronary artery disease. As an example:
- For women eating 1800 calories, no more than 126 should come from saturated fat
- For men eating 2000 calories, no more than 140 should come from saturated fat
Have high LDL? The American Heart Association (AHA) recommends increasing consumption of monounsaturated fats and soluble fiber as they can help lower it
- Monounsaturated fats: nuts, nut butters, olive oil, canola oil, and avocados
- Polyunsaturated fats are also beneficial: sunflower oil, fax seeds, flaxseed oil, fish
- Soluble fiber: beans, lentils, fruits, vegetables, flaxseed, oats, barley
What does it mean when you hear a food is “high in cholesterol”? The eggs vs. sugar conundrum…
In my post “Why is Sugar Bad for You?”, you can read all about why sugar is actually the biggest dietary contributor to high cholesterol. For the longest time, everyone told us that eating high fat foods such as meat and eggs was the worst thing we could do (as seen above). But now we know that eating high amounts of added sugar from a high carbohydrate diet, frequent dessert items, and sneaky processed foods is detrimental to your cholesterol levels. So while it’s still important to limit saturated fats and trans fats, it’s also crucial to eat sugary foods sparingly.
Foods considered “high in cholesterol” are those high in saturated fat: visible fat on meats, red meats, skin on meat, fried/oily foods, full-fat dairy products, and butter. It’s also been suggested to avoid trans fat (including products that are partially hydrogenated) because they increase LDL levels.
Apparently this isn’t entirely true.
According to Dr. Mark Hyman, a leader in the field of functional medicine, “Fats, including saturated fats, have been unfairly blamed. With the exception of trans fats, fats are actually protective. This includes omega-3 fats, nuts and olive oil, which was proven to reduce heart attack risk by more than 30% in a recent large randomized controlled study.” Note that the foods he lists are unsaturated fats.
As Dr. Hyman says and as I talk about in my post “Why is Sugar Bad for You?”, sugar is actually what causes high cholesterol a lot of the time, along with trans fats. Which is crazy because that’s not at all what we were told for a very, very long time.
Sugar is in everything: tomato sauce, salad dressing, yogurt, cereals, granola bars – not to mention things like cookies, cakes, donuts, and candy. While you may think you’re doing a good job of avoiding it, start taking a long, hard look at your food labels to learn if this is actually true. Since whole grains, fruits, and vegetables all break down into sugars, by the time you have your healthy carbohydrates you don’t really have much room for more sugar. Plus, with the fiber from healthy carbohydrate options, they’re absorbed into your bloodstream much slower and will not cause the damage that things like candy and desserts will.
Regular, purposeful, aerobic exercise is beneficial for so many reasons. While I won’t get into all of them just now, you can check out The Basics of a Healthy Exercise Routine for more info. In the context of cholesterol, cardio exercise has been shown to decrease triglycerides while increasing HDL levels. Exercise has not been shown to impact LDL levels, so it’s important to manage those through healthy eating. While 150 minutes per week is beneficial, some sources say 200 minutes per week is best for cholesterol maintenance.
You may also be placed on a cholesterol-lowering medication if your doctor thinks it will help. There are a large number of cholesterol medications out there, though I’d say I most frequently see statins. These include medications such as atorvastatin, simvastatin, rosuvastatin, and pravastatin. However, I’ve seen patients on a wide variety of others for various reasons. For more on cholesterol medications, check out this list from Cleveland Clinic.
Doesn’t your body make all the cholesterol it needs?
Yes, actually it does! Your body produces cholesterol and thus doesn’t need the cholesterol in your diet, which is only found in animal products. That’s why vegetarians and vegans are fine on cholesterol even when cutting out these food groups. However, it’s still unclear exactly how dietary cholesterol impacts your blood cholesterol levels.
Do genetics play a factor?
Yes, they absolutely can. Having a family member with high cholesterol or a history of cardiovascular disease is a risk factor for developing these things yourself. However, you can absolutely decrease your chances by eating heart healthy and exercising regularly. By having your cholesterol checked from 20 years old on, at least every five years and more frequently if your levels are abnormal, you can also stay on top of it.
To sum it up:
- Have your cholesterol checked early on and regularly throughout your life
- Evaluate and decrease the amount of sugar in your diet – as far as we know right now, it’s the biggest dietary contributor to high “bad” cholesterol and low “good” cholesterol
- Continue decreasing the saturated and and trans fats, while increasing unsaturated fats and fiber (an apple a day keep the doctor away!). Following these guidelines will only help!
- Exercise at least 150 minutes per week (some even suggest 200 minutes per week for cholesterol control)
The main takeaway:
You can have high cholesterol as young as your teenage years and start the process of accumulating plaque then. So while you may not have a heart attack until you’re 50 or 60 years old, the process could likely have been prevented or slowed.
So just because you’re young doesn’t mean you can eat an unhealthy diet, for more than just calorie and metabolism reasons.
And just because you’re older doesn’t mean you can’t make changes to improve your heart health as well.
I hope this clears up some of the cholesterol confusion! Please leave any questions you have below, and I’ll either answer them or point you in the direction of a reliable resource!