Overview
Cholesterol is a waxy substance found in your blood. Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease.
With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, those deposits can break suddenly and form a clot that causes a heart attack or stroke.
High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
Symptoms
High cholesterol has no symptoms. A blood test is the only way to detect if you have it.
When to see a doctor
According to the National Heart, Lung, and Blood Institute (NHLBI), a person's first cholesterol screening should occur between the ages of 9 and 11, and then be repeated every five years after that.
The NHLBI recommends that cholesterol screenings occur every one to two years for men ages 45 to 65 and for women ages 55 to 65. People over 65 should receive cholesterol tests annually.
If your test results aren't within desirable ranges, your doctor might recommend more-frequent measurements. Your doctor might also suggest more-frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as diabetes or high blood pressure.
Causes
Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol, based on what the lipoprotein carries. They are:
- Low-density lipoprotein (LDL). LDL, the "bad" cholesterol, transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
- High-density lipoprotein (HDL). HDL, the "good" cholesterol, picks up excess cholesterol and takes it back to your liver.
A lipid profile also typically measures triglycerides, a type of fat in the blood. Having a high triglyceride level also can increase your risk of heart disease.
1. Maintain a healthy-for-you weight
Having excess weight or obesity can increase your risk of developing high cholesterol levels. Every 10 pounds of excess fat produces roughly 10 mg of cholesterol per day. The good news is that losing weight, if you have excess weight, can decrease your cholesterol levels.
Research shows that people who lost between 5–10% of their weight significantly reduced their total cholesterol and LDL cholesterol levels, as well as triglycerides. Those who lost more than 10% of their weight reduced cholesterol and triglyceride levels significantly more.
One study involving weight loss for women found that a diet high in healthy oils lowered both good and bad cholesterol. Women with overweight or obesity engaged in a 1-year behavioral weight loss program and randomly assigned to 1 of 3 diets:
- low fat and high carbohydrate
- low carbohydrate and high fat
- low carbohydrate and walnut-rich high fat
The walnut-rich diet affected cholesterol levels the most. It decreased LDL and increased HDL. The high fat, low carb group, whose diet emphasized monounsaturated fats, did not have the same beneficial cholesterol results as the walnut-rich diet group, whose diet emphasized polyunsaturated fatty acids.
Overall, weight loss has a double benefit on cholesterol by decreasing harmful LDL and increasing beneficial HDL. Work with your doctor closely to determine a nutrient-dense and sustainable weight loss plan.
SUMMARY
Weight loss reduces total cholesterol, in part by decreasing the creation of new cholesterol in the liver. Weight loss also helps decrease LDL (bad) cholesterol and increase HDL (good) cholesterol.
2. Avoid smoking
Smoking increases the risk of heart disease in several ways. One of these is by changing how the body handles cholesterol.
The immune cells in smokers are unable to return cholesterol from vessel walls to the blood for transport to the liver. This damage is related to tobacco tar, rather than nicotine .
These dysfunctional immune cells may contribute to the faster development of clogged arteries in smokers.
Cigarettes contain a toxic chemical compound called acrolein that can be absorbed into the bloodstream through the lungs. Scientists believe it impairs how HDL in the body transports cholesterol and thereby increases LDL levels, which may lead to the development of heart disease.
Giving up smoking, if possible, can help reverse these harmful effects.
SUMMARY
Smoking has been shown to increase LDL, decrease HDL, and hinder the body’s ability to transport cholesterol back to the liver to be stored or broken down. Quitting smoking can help reverse these effects.
3. Use alcohol in moderation
Alcohol’s role in providing heart-protective benefits is one of today’s major health debates. Some research indicates that when used in moderation, alcoholic drinks can increase the good HDL cholesterol and reduce the risk of heart disease.
Both the Centers for Disease Control and Prevention (CDC) and the AHA disagree. The AHA does not endorse drinking wine or any other alcoholic beverage specifically to lower your cholesterol or improve heart health. Both organizations say there is no credible research linking alcohol and improved heart health.
The AHA acknowledges there may be a small rise of the good HDL cholesterol with moderate alcohol use, but it says exercise is a better way to achieve this benefit.
Some research recommends that alcohol consumption recommendations be reconsidered in light of its harmful effects on cardiovascular health, even in lower amounts.
What especially worries researchers about recommending moderate use of alcohol is the slippery slope down to misuse.
The AHA points out that triglycerides and total cholesterol levels increase with heavy alcohol intake. A recent study shows that heart damage may be occurring with heavy alcohol use even before symptoms appear.
Although the question remains about whether or not alcohol can reduce heart disease risk, everyone agrees that too much alcohol harms the liver and increases the risk of dependence. It is important to consume alcohol only in moderation to achieve any potential cardiovascular benefit.
The CDC suggests you moderate drinking by consuming only 2 drinks per day for men or 1 drink per day for women, on days that you drink.
SUMMARY
On days you drink, 1–2 drinks per day may improve HDL cholesterol and reduce the risk of cardiovascular disease. However, heavier alcohol use increases heart disease risk and harms the liver.
4. Consider plant sterols and stanols
Multiple types of supplements show promise for managing cholesterol.
Plant stanols and sterols are plant versions of cholesterol. Because they resemble cholesterol, they are absorbed from the diet like cholesterol.
However, because parts of their chemistry are different from human cholesterol, they do not contribute to clogged arteries.
Instead, they reduce cholesterol levels by competing with human cholesterol. When plant sterols are absorbed from the diet, this replaces the absorption of cholesterol.
Small amounts of plant stanols and sterols are naturally found in vegetable oils and are added to certain oils and butter substitutes.
A research review reported that clinical studies show that taking 1.5–3 grams of plant sterols/stanols daily can reduce LDL concentration by 7.5–12%. Researchers said taking it with a main meal twice per day allows for optimal cholesterol-lowering.
Although research has established the cholesterol-lowering benefit of plant stanols and sterols, it has not yet proved that they decrease the risk of heart disease. Numerous clinical trials have suggested that plant sterols supplements and enriched foods may lower heart disease risk, but hard data is still lacking.
SUMMARY
Plant stanols and sterols in vegetable oil or margarines compete with cholesterol absorption and reduce LDL by up to 20%. They are not proven to reduce heart disease.
5. Try supplements
There is strong evidence that fish oil and soluble fiber improve cholesterol and promote heart health. Another supplement, coenzyme Q10, is showing promise in improving cholesterol, although its long-term benefits are not yet known.
Fish oil
Fish oil is rich in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
One study found that supplementing the diets of older adults who had high blood pressure and high cholesterol with fish oil-based Omega3Q10 reduced high blood pressure and both total cholesterol and LDL levels.
However, the AHA surprised the medical world in 2020 with the announcement that its international STRENGTH trial involving a medication made from fish oil failed to reduce the risk of cardiac events. The study involved 13,000 people who either had existing heart disease or were at risk of developing it.
Researchers acknowledged that while many people take fish oil to reduce risk of developing heart disease, at least with the product they used, this connection did not hold true. Researchers called for another trial to be conducted to resolve the issue.
Psyllium
Psyllium is a form of soluble fiber available as a supplement.
A research review of 28 studies found that psyllium fiber effectively lowers LDL cholesterol levels, potentially delaying the cardiovascular disease risk caused by clogged arteries in those with or without high cholesterol.
The FDA agrees, saying 7 grams of soluble fiber per day, taken from 10.2 grams of psyllium husk, helps reduce the risk of coronary artery disease based on psyllium’s ability to reduce cholesterol levels.
Coenzyme Q10
Coenzyme Q10 is a food chemical that helps cells produce energy. It is similar to a vitamin, except that the body can produce its own Q10, preventing deficiency.
Even if there is no deficiency, extra Q10 in the form of supplements may have benefits in some situations.
Several studies with a total of 409 participants found coenzyme Q10 supplements reduced total cholesterol. In these studies, LDL and HDL did not change
A research review involving people with coronary artery disease showed that CoQ10 supplementation improved their lipid profiles by decreasing total cholesterol and increasing HDL levels. Triglycerides and LDL levels remained unaffected
Another research review examining the effect of Q10 in treating cardiovascular and metabolic diseases. It found many encouraging results on the supplementation of COQ10 in different conditions but concluded that data was controversial and limited, and that more research is needed
SUMMARY
Fish oil supplements and soluble fiber supplements like psyllium improve cholesterol and reduce the risk of heart disease. Coenzyme Q10 supplements reduce total cholesterol levels, but further research is needed on Q10’s role in reducing heart disease.
Sources:
https://www.healthline.com/nutrition/how-to-lower-cholesterol
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
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