• Reviewed on 1/12
    By Dr. Fenster

High Cholesterol: Lifestyle Management

Tips to Keep a Healthy Heart

While carbohydrates now occupy considerable attention, cholesterol remains an important determinant of cardiovascular disease.

Cholesterol is, in fact, a necessary building block for producing hormones, cellular membranes, and digestive acids. However, the vast majority of us eat significantly more cholesterol than we need. Cholesterol, as we refer to it, is composed of three different groups: LDL (low density lipoprotein, or "bad" cholesterol), HDL (high density cholesterol, or "good" cholesterol) and triglycerides. High LDL, low HDL, and elevated triglyceride levels are all associated with plaque development in the arteries, which can lead to heart attack and stroke.

While cholesterol-lowering medications are generally safe and effective, a heart-healthy lifestyle can significantly reduce your cholesterol levels, in some cases in place of medication. Here are a some tips to help you in your efforts to go heart-healthy:

  1. Dairy productsAvoid Bad Fats. Saturated and trans-fats both raise LDL ("bad" cholesterol) levels. Saturated fats are found mainly in animal products (red meat, whole milk, butter and cheese) and tropical oils (coconut, palm and tropical oils). Trans-fats are typically found in margarines, baked goods, or anything containing "partially hydrogenated vegetable oil." The American Heart Association (AHA) recommends keeping fat intake to less than 25-35 percent of total caloric intake, saturated fat to less than 7 percent, and trans-fats to less than 1 percent. Keep in mind 2 slices of bacon have 17 grams of saturated fat. Surprisingly, dietary fat intake may have a greater impact on blood cholesterol levels than cholesterol itself. While the AHA recommends that healthy individuals limit cholesterol intake to 300 mg of cholesterol/day, it recently acknowledged an egg (217 mg of cholesterol) a day may be healthy provided other sources of cholesterol are minimized.
  2. Increase Good Fats. Previous efforts to characterize fat as unhealthy neglected the positive benefits of "good fats" best demonstrated by the Mediterranean diet. Mono- and polyunsaturated fats, such as those found in olive oil, canola oil, and nuts, can be particularly beneficial to your lipid profile. Walnuts and almonds can lower LDL cholesterol by as much as 12 percent while raising HDL ("good" cholesterol). Keep in mind nuts can also be high in calories, so a handful a day is plenty.
  3. Omega-3 Fatty Acids. Omega-3 fatty acids can lower triglycerides by 25-30 percent while modestly elevating HDL. Since omega 3 fatty acids are not produced by the body, we are dependent on marine sources (salmon, herring and fish oil supplements), plant sources (soy, canola and flax seed oils) and food sources (walnuts and flaxseeds) which are rich in the most healthy omega 3's, EPA and DHA. The AHA recommends eating 2 servings/week of fish while enriching your diet with plant sources of omega 3's. Fish is preferred over fish oil capsules, but supplements can be utilized when necessary. Keep in mind that high dose omega 3's can also increase LDL.
  4. Increase Your Fiber Intake. Soluble fiber lowers the absorption of cholesterol in the intestines. Eat at least 25 to 30 grams of soluble fiber a day. A cup and half of cooked oatmeal contains 6 grams of fibers. Other excellent sources of soluble fiber include bran, bananas, kidney beans and vegetables.
  5. Exercise. Exercise can raise HDL approximately 5 percent within 2 months of starting a program while lowering triglycerides. Increasing your HDL can in turn lower your LDL. Moderate-intensity, aerobic activity is best. Aim for 30 minutes/day, 5 days/week. Be sure to include at least two days/week of strength building exercise to maintain muscular endurance. Remember to consult your doctor before initiating an exercise program.
  6. Weight Loss. Excess weight lowers HDL and raise triglycerides; weight loss tends to raise HDL and lower triglycerides.
  7. Quit Smoking. We all know that smoking is bad for your heart. What you may not know is that smoking lowers HDL, which in turn can raise LDL.
  8. Margarine and Plant Sterols/Stanols. It was not that long ago that margarine was loaded with trans fats. Trans-fats are felt to be so unhealthy New York city now outlaws their use in restaurants. Many margarines are now not only trans fat-free but also contain heart healthy plant stanols and sterols. Plant sterols and stanols (essential components of plant membranes) are structurally similar to cholesterol, thereby reducing intestinal absorption of cholesterol. Two grams a day, or roughly 2 tablespoons/day of a sterol/stanol-enriched butter-substitute can lower LDL by 5 to 15 percent. Yogurt and mayonnaise can also be enriched sources of stanols and sterols.
  9. Watch the Alcohol. The information surrounding alcohol and heart disease can be confusing for patients and doctors alike. On the one hand, alcohol (in moderation) can raise HDL while reducing the risk of heart attack and stroke. However, significant alcohol intake can fuel high triglycerides and cause liver problems, particularly if you take cholesterol-lowering medications. If you have high triglycerides, it's best to minimize if not avoid alcohol altogether.
  10. Cholesterol Medications. Cholesterol medications are not just for high cholesterol patients. In fact, patients with normal cholesterol may still benefit from cholesterol medication. Plaque development in the arteries is an inflammatory disease, and C reactive protein (or CRP) is elevated by inflammation. In a recent study involving individuals with normal cholesterol but CRP levels, subjects who received a statin medication had fewer heart attacks, strokes, and cardiovascular deaths than those taking placebo. Because of this study, it may be worth checking CRP in individuals with normal cholesterol to see if they would merit treatment with statin medication.
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