What is cholesterol?

Cholesterol is a type of fat. Your body makes some cholesterol and gets the rest from foods such as meats, dairy products, and eggs.

Cholesterol has both good and bad effects on the body. Your body uses cholesterol to make hormones and to build and maintain cells. When your body has too much cholesterol, the excess fat sticks to the inside of the blood vessel walls. This is called plaque. Plaque makes the blood vessel walls thicker and the area inside the vessels smaller. This means less blood can flow through the blood vessels. Also, pieces of plaque may break off and block blood flow, which can cause a heart attack or stroke.

The main types of cholesterol are LDL (low-density lipoprotein) and HDL (high-density lipoprotein).

• LDL 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 lower levels of LDL and higher levels of HDL. Your healthcare provider can check your cholesterol with a blood test.

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

How can I control my cholesterol level?

You can often control cholesterol levels by:

• Eating healthy
• Losing weight if you are overweight
• Exercising
• Not smoking

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. Your provider may also prescribe medicine if you have an inherited tendency to have high cholesterol.

Eat healthy.

A diet high in fiber and low in saturated fat and cholesterol can help prevent or lower cholesterol levels. You can find out how much and what kind of fat a food has by reading the food label.

• No more than 20 to 35% of your total calories should be from fat.
• Most of the fat you eat should be polyunsaturated or monounsaturated fat. These fats are healthier than other types of fat. They can be found in foods such as fish, avocados, vegetable oils (especially olive oil and canola oil), nuts (like almonds, peanuts, and walnuts) and seeds (for example, pumpkin seeds).
• Limit the amount of saturated and trans fat that you eat. Saturated fat is found in whole milk, cheese, butter, ice cream, cream, lard, fatty cuts of meat, poultry with the skin on, and some tropical vegetable oils, such as coconut and palm kernel oil. Trans fat may be found in stick margarine, shortening, French fries, cookies, crackers, and bakery goods. If the food label has the words “partially hydrogenated”, the product probably has trans fat.
• Limit the cholesterol in your diet to less than 300 mg a day. If you have heart disease or a high risk of heart disease, limit cholesterol to less than 200 mg a day.

Changes you can make in your diet include:

• Drink nonfat or 1% milk instead of whole milk, and eat fat-free or low-fat milk, cheese, spreads, and yogurt. Use egg whites or egg substitutes rather than whole eggs.
• Use salad dressings made from healthy oils, such as canola, olive, peanut, and flaxseed oil.
• Eat fish, chicken and turkey cooked without the skin, and meatless entrees.
• Eat red meat (beef, pork, lamb) and processed meats (like salami, bologna, hot dogs, sausage, and bacon) no more than 2 times a week.
• Choose lean cuts of meat and trim off all visible fat. Choose at least 90% lean ground beef. Keep portion sizes moderate, which is about 3 to 4 ounces per serving.
• Eat less sugar and less fried food and junk food, like French fries, chips, cookies, crackers, and doughnuts. Choose healthier desserts, such as fresh fruits, nonfat frozen yogurt, and Popsicles. Avoid fatty desserts such as ice cream, cream-filled cakes, and cheesecakes.
• Eat more fruit, vegetables; beans; and whole grains, such as oats, brown rice, quinoa and bran. The fiber in these foods helps lower cholesterol.
• Eat 1.5 ounces (42.5 grams) a day of unsalted nuts and seeds. Nuts and seeds are full of fiber, protein, and healthy fats. Nuts and seeds are also high in calories, so they should be eaten in small portions and used to replace other protein foods, like some meat or poultry, rather than being added to the diet. Examples of nuts and seeds that can be a part of a healthy diet are walnuts, almonds, hazelnuts, peanuts, pecans, and pistachio nuts, sunflower seeds, and pumpkin seeds.
• Check labels for plant sterols or stanols added to some foods, such as special margarines, milk, and orange juice. These ingredients can help lower LDL. The recommended amount is 2 grams a day.
• Limit alcohol to no more than 2 drinks a day for men and 1 drink a day for women.

Ask your healthcare provider for a referral to a dietician to learn more about eating healthy.

Lose excess weight.

You can lose weight by eating fewer calories. Even losing 5 to 10% of your body weight can help:

• Lower both total cholesterol and bad LDL cholesterol
• Increase your energy and helps you feel better (both physically and mentally)
• Lower your risk for heart attack or stroke

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

Exercise.

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

• Keeps your weight down
• Lowers your total cholesterol
• Lowers your LDL (bad cholesterol)
• Raises 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.

Smoking increases your risk of heart disease because it lowers HDL levels, increases your risk of blood clots and stroke, and decreases oxygen to the tissues. If you smoke, talk to your healthcare provider about quitting.

How can I know if my cholesterol level is normal?

Get your cholesterol levels checked by your healthcare provider 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.