Controlling Cholesterol

What is cholesterol?

Cholesterol is a fatty substance, also called a lipid. It has both good and bad effects on the body.

Your body makes some cholesterol and gets the rest from foods such as meats, eggs, and some milk products.

Your body needs small amounts of cholesterol to make hormones and to build and keep healthy cells throughout the body. However, when you have too much cholesterol, it builds up and forms plaque in the walls of the blood vessels. The blood vessel walls get stiffer and narrower. This is a condition called hardening of the arteries, or atherosclerosis. It makes it harder for blood to flow through your blood vessels and bring enough oxygen to the heart and brain. Plaque can form a lump in the blood vessel wall. If the lump breaks away from the blood vessel wall, it can block blood flow to the heart or brain and cause a heart attack or stroke.

Controlling the level of cholesterol in your blood lowers your risk for heart disease. It also reduces the chance of a heart attack or death from heart disease, even if you already have heart disease.

What are the different types of cholesterol?

Two important types of cholesterol are LDL (low-density lipoprotein) and HDL (high-density lipoprotein).

• LDL carries a lot of cholesterol, leaves behind fatty deposits on artery walls, and contributes to heart disease. LDL is called bad cholesterol. (You can think of "L" for "lousy" cholesterol.)
• HDL does the opposite: It cleans the artery walls, removes extra cholesterol from the body, and lowers the risk of heart disease. HDL is called good cholesterol. (Think of "H" for "healthy" cholesterol.)

It is good to have low levels of LDL and high levels of HDL.

How can I control my cholesterol level?

You can often control cholesterol levels by:

• eating right
• exercising
• not smoking
• losing weight if you are overweight
• getting your cholesterol levels checked as often as your provider recommends

If you have a high risk for heart disease, your healthcare provider may prescribe cholesterol-lowering medicine as well as changes in your diet and other aspects of your lifestyle.

Eat right.

A diet high in fiber and low in saturated fat and cholesterol can help to lower cholesterol levels. Follow these diet guidelines to help control your cholesterol:

• Be careful about the amounts and types of fat that you eat. You can find out how much and what kind of fat a food has by reading the food label.
  • Get no more than 20 to 35% of your total calories from fat.
  • Most of the fat you eat should be polyunsaturated or monounsaturated fat. These 2 types of fat are healthier than saturated fat and trans fats. Healthy fats are found in fish (such as tuna, mackerel, and salmon), avocados, and some vegetable oils (such as olive oil and canola oil). They are also in many nuts (especially almonds and walnuts) and seeds (such as sunflower and flax seed).
  • Less than 7 to 10% of your calories should come from saturated fat. Whole milk products (cheese, butter, ice cream, cream), lard, fatty cuts of meat, poultry with the skin on, and some tropical vegetable oils (coconut and palm) are examples of foods that have saturated fat.
  • Try to eat as little trans fatty acid, often called trans fat, as possible. Trans fats are mostly in foods made with oil that is chemically changed (hydrogenated) to make it solid and keep it fresh longer. Stick margarine, shortening, french fries, cookies, crackers, and bakery goods are examples of foods that often have trans fat. If the list of ingredients of a food product includes the words "partially hydrogenated" (usually referring to some kinds of oils), the product probably has trans fats.
• Limit the cholesterol in your diet to less than 300 mg per day. If you have heart disease, limit cholesterol to less than 200 mg per day.
• Adjust the amount of calories you eat so you can lose weight or keep a healthy weight.

To control the cholesterol and types and amounts of fat you eat:

• Check food labels for fat and cholesterol content. Choose foods with less fat per serving.
• Limit the amount of butter and margarine you eat.
• Use olive, canola, sunflower, safflower, soybean, peanut, or corn oil. Avoid tropical oils such as palm or coconut oil. Also avoid oils that have been hydrogenated or partially hydrogenated.
• Use salad dressings and margarine made with polyunsaturated and monounsaturated fats.
• Use egg whites or egg substitutes rather than whole eggs.
• Drink nonfat or 1% milk instead of whole milk, and eat fat-free or low-fat milk, cheese, spreads, and yogurt.
• Eat fish, chicken and turkey cooked without the skin, and meatless entrees more often than red meat or processed meats (like salami, bologna, hot dogs, sausage, and bacon).
• Choose lean cuts of meat and trim off all visible fat. Choose the lowest-fat ground beef (at least 90% lean). Keep portion sizes moderate.
• Eat more fruit, beans, oats, and barley. The soluble fiber in these foods helps lower cholesterol.
• Plant sterols or stanols added to some foods, such as special margarines, milk, and orange juice, can help lower LDL. The label will say if a food contains plant sterols or stanols. The recommended amount is 2 grams/day.
• Eat 4 to 5 servings of nuts a week. Examples of nuts that can be a part of a healthy diet are walnuts, almonds, hazelnuts, peanuts, pecans, and pistachio nuts.
• Eat less fried food and junk food, like French fries, chips, cookies, crackers, and doughnuts. Look for low-fat or nonfat varieties of the foods you like to eat, or look for substitutes. Choose healthier desserts, such as fresh fruits, nonfat frozen yogurt, and Popsicles. Avoid fatty desserts such as ice cream, cream-filled cakes, and cheesecakes.
• Consider replacing protein foods high in saturated fats and cholesterol with soy protein. For example, use tofu or soy meat substitutes instead of beef, pork sausages, or hot dogs.
• It’s best to limit alcohol to no more than 2 drinks a day for men and 1 drink a day for women because alcohol can raise your cholesterol.

Exercise.

Being physically active also helps control cholesterol. Exercise helps because it:

• Keeps your weight down.
• Decreases your total cholesterol level.
• Decreases your LDL (bad cholesterol).
• Increases your HDL (good cholesterol).

A good exercise goal is at least 2 hours and 30 minutes (150 minutes) of moderate exercise a week. Moderate exercise means you're working hard enough to raise your heart rate and break a sweat. Examples of moderate exercise are walking fast, doing water aerobics, or playing doubles tennis. Increasing the intensity of your exercise or getting at least 5 hours (300 minutes) of moderate exercise a week will have even greater health benefits. It can help you lose weight and keep a healthy weight.

If you haven't been exercising, ask your healthcare provider for an exercise prescription and start your new exercise program slowly.

Don’t smoke.

Do not smoke. Smoking increases your risk of heart disease because it lowers HDL levels, increases your risk of blood clots, and decreases oxygen to the tissues.

Lose excess weight.

Losing excess weight:

• Helps lower both total cholesterol and bad LDL cholesterol.
• Increases your energy and helps you feel better (both physically and mentally) and become more active.
• Lowers your risk for heart attack or stroke.

Talk to your healthcare provider about your weight. If you need to lose weight, plan for gradual weight loss, just 1 or 2 pounds a week.

A good example of a diet for lowering LDL cholesterol is the TLC (Therapeutic Lifestyle Changes) program. TLC includes a physical activity and weight management plan. You can ask your healthcare provider or dietitian for a copy of this program, or get a free copy from the Internet at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.htm.

Check your cholesterol levels.

Get your cholesterol levels checked regularly. At first your cholesterol level may need to be checked every 3 to 6 months until it is staying in the normal range. Then you may need to check it just once a year.