Table of Contents
What is cholesterol?
Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues, and produce certain hormones. Your liver makes all the cholesterol your body needs. Your body also gets cholesterol directly from the food you eat (such as eggs, meats, and dairy products). Too much cholesterol can have negative impacts on your health.
What is the difference between “good” cholesterol and “bad” cholesterol?
Low-density lipoprotein (LDL) is often called “bad” cholesterol. It delivers cholesterol to the body. High-density lipoprotein (HDL) is often called “good” cholesterol. It removes cholesterol from the bloodstream.
This explains why too much LDL cholesterol is bad for the body, and why a high level of HDL cholesterol is good. For example, if your total cholesterol level is high because of a high LDL level, you may be at higher risk of heart disease or stroke. But, if your total cholesterol level is high only because of a high HDL level, you’re probably not at higher risk.
Triglycerides are another type of fat in your blood. When you eat more calories than your body can use, it turns the extra calories into triglycerides.
Changing your lifestyle (diet and exercise) can improve your cholesterol levels, lower LDL and triglycerides, and raise HDL
Causes & Risk Factors
Risk factors for heart disease
- Cigarette smoking
- High blood pressure
- Older Age
- Have an immediate family member (parent or sibling) who has had heart disease
- Overweight or obese
Diagnosis & Tests
When should I start having my cholesterol level checked?
You can’t tell if you have high cholesterol without having it checked.
Men 35 years of age and older and women 45 years of age and older should have their cholesterol checked. Men and women 20 years of age and older who have risk factors for heart disease should also have their cholesterol checked. Ask your doctor how often you should have your cholesterol checked.
What can I do to improve my cholesterol level?
If you have high cholesterol, it may be necessary for you to make some lifestyle changes. If you smoke, quit. Exercise regularly. If you’re overweight, losing just five to 10 pounds can help improve your cholesterol levels and your risk for heart disease. Make sure to eat plenty of fruits, vegetables, whole grains, and fish. All of these foods promote heart health. Reduce red meat, processed meats, and fried foods.
What about medicine to lower cholesterol?
Depending on your risk factors, your doctor may suggest medicine along with lifestyle changes.
Why is a high cholesterol level unhealthy?
While some cholesterol is needed for good health, too much cholesterol in your blood can increase your risk for heart disease, including heart attack or stroke.
If you have high cholesterol, your body may store the extra cholesterol in your arteries. Your arteries are blood vessels that carry blood from your heart to the rest of your body. Buildup of cholesterol in your arteries is known as plaque. Over time, plaque can become hard and make your arteries narrow. Large deposits of plaque can completely block an artery. Cholesterol plaques can also split open, leading to formation of a blood clot that blocks the flow of blood.
If an artery that supplies blood to the muscles in your heart becomes blocked, a heart attack can occur. If an artery that supplies blood to your brain becomes blocked, a stroke can occur.
Questions to Ask Your Doctor
- Am I at risk for heart disease?
- How often should I get my cholesterol tested?
- What are my cholesterol levels? What do they mean?
- What lifestyle changes do I need to make to help improve my cholesterol levels and heart health?
- Is there a chance that I’ll need cholesterol-lowering medicine?
- What are the risks and benefits of taking this medicine?
What should my cholesterol levels be?
Your ideal cholesterol level will depend on your risk for heart desease.
- Total cholesterol level – less than 200 is best, but depends on your HDL and LDL levels
- LDL cholesterol levels – less than 130 is best, but this depends on your risk for heart disease
- HDL cholesterol levels – 60 or higher reduces your risk for heart disease
- Triglycerides – less than 150 milligrams per deciliter (mg/dl) is best
Lifestyle Changes to Lower Your Cholesterol
What lifestyle changes can I make to help improve my cholesterol levels?
Exercise can raise HDL cholesterol levels and reduce levels of LDL cholesterol and triglycerides. If you haven’t been exercising, try to work up to 30 minutes, 4 to 6 times a week. Make sure you talk to your doctor before starting an exercise plan.
Lose weight if you are overweight.
Being overweight can raise your cholesterol levels. Losing weight, even just 5 or 10 pounds, can lower your total cholesterol, LDL cholesterol and triglyceride levels.
If you smoke, quit.
Smoking lowers your HDL cholesterol. Even exposure to second-hand smoke can affect your HDL level. Talk to your doctor about developing a plan to help you stop smoking.
Eat a heart-healthy diet.
- Eat plenty of fresh fruits and vegetables. Fruits and vegetables are naturally low in fat. Not only do they add flavor and variety to your diet, but they are also the best source of fiber, vitamins and minerals for your body. Aim for 5 cups of fruits and vegetables every day, not counting potatoes, corn and rice. Potatoes, corn and rice count as carbohydrates.
- Pick “good” fats over “bad” fats. Fat is part of a healthy diet, but you need to know the difference between “bad” fats and “good” fats. “Bad” fats, such as saturated and trans fats, are found in foods such as butter; coconut and palm oil; saturated or partially hydrogenated vegetable fats such as shortening and margarine; animal fats in meats; and fats in whole milk dairy products. Limit the amount of saturated fat in your diet, and avoid trans fat completely. Unsaturated fat is the “good” fat. Most fats in fish, vegetables, grains and tree nuts are unsaturated. Try to eat unsaturated fat in place of saturated fat. For example, you can use olive oil or canola oil in cooking instead of butter.
- Use healthier cooking methods. Baking, broiling and roasting are the healthiest ways to prepare meat, poultry and other foods. Trim any outside fat or skin before cooking. Lean cuts can be pan-broiled or stir-fried. Use either a nonstick pan or nonstick cooking spray instead of adding fats such as butter or margarine. When eating out, ask how food is prepared. You can request that your food be baked, broiled or roasted, rather than fried.
- Look for other sources of protein. Fish, dry beans, tree nuts, peas and lentils offer protein, nutrients and fiber without the cholesterol and saturated fats that meats have. Consider eating one “meatless” meal each week. Try substituting beans for meat in a favorite recipe, such as lasagna or chili. Snack on a handful of almonds or pecans. Soy is also an excellent source of protein. Good examples of soy include soy milk, edamame (green soy beans), tofu and soy protein shakes.
- Get more fiber in your diet. Add good sources of fiber to your meals. Examples include fruits, vegetables, whole grains (such as oat bran, whole and rolled oats and barley), legumes (such as beans and peas) and nuts and seeds (such as ground flax seed). In addition to fiber, whole grains supply B-vitamins and important nutrients not found in foods made with white flour.
- Eat more fish. Fish are an excellent source of omega-3 fatty acids. Wild-caught oily fish, such as salmon, tuna, mackerel and sardines, are the best sources of omega-3s, but all fish contain some amount of this beneficial fatty acid. Aim for 2 6-oz servings each week.
- Limit how much cholesterol you get in your diet. You should limit your overall cholesterol intake to less than 300 milligrams per day, or less than 200 milligrams if you have heart disease.
Add supplements to your diet.
Certain supplements may help improve your cholesterol levels if changing your diet isn’t enough. Some examples include:
- Plant sterols and stanols. Plant sterols and stanols can help keep your body from absorbing cholesterol. Sterols have been added to some foods, including margarines and spreads, orange juice and yogurt. You can also find sterols and stanols in some dietary supplements.
- Omega-3 fatty acids. If you have heart disease or high triglycerides, consider taking an omega-3 or fish oil supplement. Make sure the supplement has at least 1,000 mg of EPA and DHA (these are the specific omega-3 fatty acids found in fish).
- Red yeast rice. A common seasoning in Asian countries, red yeast rice may help reduce the amount of cholesterol your body makes. It is available as a dietary supplement. Talk to your doctor before taking red yeast rice, especially if you take another cholesterol-lowering medicine called a statin. The recommended dose of red yeast rice is 1,200 milligrams twice a day.
This content was developed with general underwriting support from Nature Made®.
- Improving Your Cholesterol with Diet and Exercise by Kelly R( 05/01/10)
- Mayo Foundation for Medical Education and Research. High Blood Cholesterol. Accessed 05/11/10
- Mayo Foundation for Medical Education and Research. Cholesterol: Top 5 foods to lower your numbers. Accessed 05/11/10
- Mayo Foundation for Medical Education and Research. Triglycerides: Why do they matter?. Accessed 05/11/10
- American Heart Association. Lifestyle Changes to Improve Your Cholesterol. Accessed 05/11/10
- National Heart, Lung and Blood Institute (NHLBI). Your Guide to Lowering Your Cholesterol With Therapeutic Lifestyle Changes. Accessed 05/11/10
Plant Sterols and Stanols
What are plant sterols and stanols?
Plant sterols and stanols are substances naturally found in fruits, vegetables, whole grains, legumes, nuts and seeds.
How do plant sterols and stanols affect my body?
Research has shown that plant sterols and stanols help lower cholesterol. Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues and produce certain hormones. Your liver makes all the cholesterol your body needs. Your body also gets cholesterol directly from the food you eat (such as eggs, meats and dairy products).
There are 2 types of cholesterol: low-density lipoprotein (LDL), or “bad” cholesterol, and high-density lipoprotein (HDL), or “good” cholesterol. High levels of LDL cholesterol can damage your arteries and contribute to heart disease. A high level of HDL cholesterol, on the other hand, can actually help protect your arteries and prevent atherosclerosis.
If you have high cholesterol, eating plant sterols and stanols can help lower your LDL cholesterol while keeping your HDL cholesterol the same. Normally, your body’s small intestine absorbs cholesterol from the foods you eat. To your body, plant sterols and stanols “look” a lot like cholesterol. They can prevent your body from absorbing LDL cholesterol. Over time, this lowers the level of LDL cholesterol in your blood.
How much do I need to help lower my cholesterol?
If you need to lower your cholesterol, the National Cholesterol Education Program recommends that you take in 2 grams of plant sterols and stanols each day. However, it is important to remember that plant sterols and stanols alone will not help you reach your cholesterol goals. To improve your cholesterol levels, you will also need to make lifestyle changes that include eating a heart-healthy diet, exercising and quitting smoking.
What foods contain plant sterols and stanols?
Although plant sterols and stanols are naturally found in some foods, these amounts have only a very small effect on cholesterol levels. To use sterols and stanols to reduce your LDL cholesterol level, you will need more than these foods can provide.
Some foods are now fortified with plant sterols and stanols. These include fortified margarines, cheese, orange juice. milk and bread. Dietary supplements are also available. Ask your doctor whether getting your sterols and stanols from a fortified food or a dietary supplement is right for you.
If you do use these products, keep in mind that the amount of plant sterols/stanols varies from product to product. For example, a 2- to 4-tablespoon serving of margarine fortified with plant sterols provides the recommended 2 grams. Two 8-oz. servings of fortified orange juice also provides the recommended amount. You must read label information carefully to find out the appropriate daily dosage or serving size of these products. Also, remember that more isn’t always better. You still need to eat a wide variety of foods and be aware of how many calories you are eating.
Do plant sterols and stanols interact with any foods or medicines?
No, plant sterols and stanols have not been shown to interact with any foods or medicines. It is important to take your medicine just as your doctor prescribed. You should not use plant sterols and stanols as a substitute for your cholesterol-lowering medicine.
This content was developed with general underwriting support from Nature Made®.
- Cleveland Clinic. Boost your cholesterol-lowering potential with phytosterols. Accessed 10/20/10
- Mayo Foundation for Medical Education and Research. Cholesterol: Top 5 foods to lower your numbers. Accessed 10/20/10
- National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Accessed 10/20/10
Why did my doctor prescribe cholesterol-lowering medicine for me?
Lowering your “bad” cholesterol (also called LDL, or low-density lipoprotein) can reduce your risk of having a heart attack or stroke. A number of lifestyle changes can help you improve your cholesterol level. However, if these lifestyle changes don’t help after about 6 months to 1 year, your doctor may suggest medicine to lower your cholesterol.
Even if you take cholesterol-lowering medicine, it’s important to keep up with your lifestyle changes. Eating a healthy diet and being physically active can make your medicine more effective. Your doctor can give you tips on how to make healthy food choices and include physical activity in your daily routine.
What are some common cholesterol-lowering medicines?
Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.
Statins (also called HMG-CoA reductase inhibitors) slow down your body’s production of cholesterol. These drugs also remove cholesterol buildup from your arteries (blood vessels).
Resins (also called bile acid sequestrants) bind to bile acids. Bile acids help with digestion, and are made by your liver using cholesterol. When resins bind to the bile, the body gets rid of them. This prompts your body to use excess cholesterol to make more bile acids. This lowers your LDL cholesterol level.
Cholesterol absorption inhibitors help lower your cholesterol by reducing the amount that is absorbed by your intestines. This type of medicine is often given in combination with a statin.
Fibrates (also called fibric acid derivatives) help lower your cholesterol by reducing the amount of triglycerides (fats) in your body and by increasing your level of “good” cholesterol (also called HDL, or high-density lipoprotein).
Do cholesterol-lowering medicines have any side effects?
Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.
Common side effects of cholesterol-lowering drugs include the following:
Tell your doctor as soon as possible if your side effects become severe.
- Diarrhea or constipation
- Abdominal pain, cramps, bloating or gas
- Muscle aches or weakness
- Flushing (skin turning red and warm)
- Sleep problems
What is a drug interaction?
If you take 2 or more medicines at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a “drug-drug interaction.” Vitamins and herbal supplements can also affect the way your body processes medicine.
Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a “drug-food interaction.”
Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine, or use a vitamin or herbal supplement.
It’s important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using your cholesterol-lowering medicine.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.