Your doctor just told you your cholesterol is too high and she wants you to lower it. She is especially concerned about your LDL cholesterol. 

OK, but what is cholesterol? What is LDL and why is she so worried about it? And how in the world do I lower it?

Good questions. Here are your answers.

What is cholesterol?

Because of its association with heart disease, cholesterol has a bad reputation. But truth be told, it’s not entirely the villain it’s made out to be.

Our body absolutely needs cholesterol for making cell membranes, testosterone, estrogen, vitamin D and bile salts for digesting and absorbing fat. Cholesterol is so important that, under normal circumstances, our body makes all we need.

The problem is not with the waxy cholesterol molecule itself, but how much is in the bloodstream, which can be measured by a blood test. There are two main types of cholesterol in the blood that make up the majority of your total cholesterol number:  LDL ”bad” cholesterol and lesser amounts of  HDL “good” cholesterol.

Why is LDL “bad” cholesterol?

Too much LDL cholesterol in the bloodstream can lead to coronary heart disease, the number one killer of Americans for over a hundred years. Nearly one out of every three American adults have high LDL levels,(1) which create the plaques (fatty deposits) that build up inside the arteries that supply blood to the heart, called the coronary arteries. This process is known as atherosclerosis, which over time causes the coronary arteries to become narrower and stiffer, increasing the risk of a heart attack. 

Generally speaking, the higher your LDL cholesterol, the greater your risk of having a heart attack. Numerous studies have suggested the optimal LDL level is less than 100 mg/dL (milligrams per deciliter) for otherwise healthy people.(1)

What about HDL cholesterol?

HDL is called “good” cholesterol because it absorbs cholesterol and carries it to the liver to be flushed from the body. But HDL cholesterol doesn't completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL. While improving HDL cholesterol levels is good, lowering a high LDL cholesterol is key to preventing heart disease. 

Optimal levels for HDL cholesterol in adult men and women are at least 40 and 50 mg/dL, respectively.

If you don’t know what your total, LDL or HDL cholesterol is, work with your doctor or use a service like Quest Diagnostics to get it measured.

Steps for a Healthy LDL and HDL Cholesterol

Here’s the great news: there are inexpensive, low-tech, lifestyle habits that can help you lower your LDL cholesterol and risk of heart disease, while at the same time raising your HDL cholesterol. 

#1: Stop smoking

We all know smoking is bad for us, but did you know cigarette smoke raises your LDL cholesterol?(2) Smoking further increases risk of heart disease by promoting the process of atherosclerosis at all stages: it damages the cells that line the coronary arteries, it increases plaque buildup, it causes thickening and narrowing of the coronary arteries, it can make blood stickier and more likely to clot, which can block blood flow to the heart.

The good news is that tremendous health benefits happen immediately upon quitting, so if you need to quit smoking, talk to your doctor and check out the helpful, free resources at smokefree.gov. 

#2: Exercise

We all know we need to be physically active, but did you know regular exercise is one of the most important lifestyle habits for lowering your LDL cholesterol and raising your HDL?(3) Plus, it comes with the added benefit of helping reduce the risk of being overweight or obese. That’s important because living with extra weight also increases your chances of a high LDL.(4,5)

Any kind of physical activity is beneficial, but the kind that’s best for optimizing both cholesterol levels is aerobic exercise. Anything that involves the steady, rhythmic movement of the muscles in the legs and/or arms is great for the heart and helps move LDL cholesterol out of the bloodstream. Good examples include brisk walking, jogging, bicycling, swimming and dancing. 

The goal is at least 150 minutes of moderate intensity (you can talk while you’re doing it) exercise a week. Break it up any way that fits your daily schedule. To help keep you motivated: do what you enjoy, mix it up and include a friend or family member whenever possible.

#3: Eat a plant predominant, high-fiber diet - the Full Plate Living Approach

The Full Plate Approach is a high-fiber way of eating where 75% of each meal is some combination of whole, unprocessed fiber foods: fruits, vegetables, beans and cooked whole grains. All other foods can be added to the remaining 25% of the plate and heart-healthy 25% plate options are encouraged. 

The goal is to work up to about 40 grams of fiber a day, but if you don’t like counting, focus on the visual of filling 75% of your plate with those whole, unprocessed fiber foods and the fiber grams will add up quickly.

Additional Guidance from the Experts - The American Heart Association

The Full Plate Approach is in harmony with the recently-released, updated American Heart Association (AHA) Dietary Guidance for lowering LDL cholesterol to prevent heart disease. 

Here are seven of their evidence-based dietary recommendations:

1. Eat plenty of fruits and vegetables, choose a wide variety 
2. Choose foods made mostly with whole grains rather than refined grains
3. Choose healthy sources of protein: mostly protein from plants (legumes and nuts), fish and seafood, low-fat or fat-free dairy products instead of full-fat dairy products, if meat or poultry are desired, choose lean cuts and avoid processed forms
4. Use liquid plant oils rather than tropical oils (coconut, palm and palm kernel), animal fats (eg, butter and lard), and partially hydrogenated fats 
5. Choose minimally processed foods rather than ultra-processed foods
6. Minimize the intake of beverages and foods with added sugars 
7. Adhere to this guidance regardless of where food is prepared or consumed

These guidelines are in line with the Full Plate Living Approach and in sharp contrast to the Standard American Diet (SAD).

The Standard American Diet is characterized by the daily consumption of highly processed foods, fried foods, fast food, refined grains, sugary treats and  beverages, high-fat dairy products and red and processed meats, with very low amounts of fruits, vegetables, beans, whole grains, nuts and seeds. This results in a high intake of saturated and trans fat, sugar, white flour products, processed foods and low fiber, all of which contribute to raising LDL cholesterol levels.(6,7,8,9)

The great news

Today you can take steps  to optimize your LDL cholesterol and reduce your risk of our number one killer by starting to put into practice these powerful lifestyle habits: 

1. stop smoking
2. enjoy at least 150 minutes of aerobic exercise every week
3. focus on eating more whole, unprocessed fiber foods.

Your heart will thank you.

And we’re here to help. Join in the FREE Full Plate Living Membership to find programs and support for your health journey.

 

If you are under medical supervision for any reason, please consult with your doctor before following any of these recommendations.

 

 

 

 

References:

1. https://www.heart.org/en/news/2018/11/10/new-guidelines-cholesterol-should-be-on-everyones-radar-beginning-early-in-life
2. Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ. 1989;298(6676):784-788. doi:10.1136/bmj.298.6676.784
3. Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med. 2014;44(2):211-221. doi:10.1007/s40279-013-0110-5
4. Jokinen E. Obesity and cardiovascular disease. Minerva Pediatr. 2015 Feb;67(1):25-32. Epub 2014 Nov 11. PMID: 25387321.
5. Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P, van Dam RM, Hu FB, Visscher TL, Menotti A, Thorpe RJ Jr, Jamrozik K, Calling S, Strand BH, Shipley MJ; BMI-CHD Collaboration Investigators. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med. 2007 Sep 10;167(16):1720-8. doi: 10.1001/archinte.167.16.1720. PMID: 17846390.
6. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2012.02553.x
7. https://www.nejm.org/doi/full/10.1056/NEJMoa2007123
8. DiNicolantonio JJ, Lucan SC, O'Keefe JH. The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease. Prog Cardiovasc Dis. 2016;58(5):464-472. doi:10.1016/j.pcad.2015.11.006
9. Marialaura Bonaccio, Simona Costanzo, Augusto Di Castelnuovo, Mariarosaria Persichillo, Sara Magnacca, Amalia De Curtis, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello, for the Moli-sani Study Investigators, Ultra-processed food intake and all-cause and cause-specific mortality in individuals with cardiovascular disease: the Moli-sani Study, European Heart Journal, Volume 43, Issue 3, 14 January 2022, Pages 213–224, https://doi.org/10.1093/eurheartj/ehab783