How to Take Control of Your Cholesterol

If youre under doctors orders to improve your cholesterol numbers, several new studies offer good news: Whether or not your physician prescribes cholesterol-lowering medications such as statins, you can take control of your cholesterol with diet and lifestyle changes. Separately or in combination with medication, these simple steps can move those nagging numbers in the right direction and reduce your risk of heart disease.Despite its downsides, cholesterol is vital to human life. Your cells need it for the proper permeability and fluidity of their membranes. Your body uses it to make bile acids, hormones, vitamin D and other essentials. But your body can make all the cholesterol it needs, primarily in the liver. Any extra cholesterol- a waxy, fat-like substance-can get trapped in artery walls. Over time, this accumulated cholesterol forms plaque, which narrows blood vessels and makes them less flexible-resulting in atherosclerosis, popularly known as hardening of the arteries.When plaque affects the arteries of the heart-the coronary arteries-your heart muscle may not be able to get enough oxygen and nutrients from blood. This may result in angina- chest pain. Atherosclerosis of these arteries-coronary heart disease-is the main type of heart disease. Plaques can also rupture, triggering blood clot formation that in turn can block blood flow and cause a heart attack.Just as oil and water dont mix, fatty cholesterol and watery blood cant directly combine. So cholesterol in your blood rides along in packages called lipoproteins, which (among other things) have cholesterol inside and protein on the outside. The two main types of these lipoproteins are whats actually measured when the lab tests your cholesterol:
Low density lipoprotein, or LDL, carries cholesterol to your tissues, earning it the nickname of bad cholesterol. Most of the cholesterol in your blood is in the form of LDL. An optimal LDL level is less than 100 milligrams (mg, a measure of weight) per deciliter of blood (dL, a measure of volume-a little less than half a cup). LDL levels of 130-159 mg/dL are considered borderline high, 160-189 mg/dL are high, and 190 mg/dL and above are very high.
High density lipoprotein, or HDL, gets labeled good cholesterol because it carries cholesterol away from tissues to the liver, which removes it from the body. You want higher levels of HDL, ideally 60 mg/dL or greater, according to the National Heart, Lung and Blood Institutes (NHLBI) National Choles – terol Education Program.Your lipoprotein profile test, done after a 9- to 12-hour fast, will also provide information about triglycerides, another form of fat in your blood. Fasting triglyceride levels above 150 mg/dL are considered borderline high, and 200 mg/dL or more are high.

Fat Smarts
Originally, scientists thought the main dietary contributor to LDL cholesterol was, logically enough, the cholesterol found in foods such as meat and eggs. It turns out, however, that only some dietary cholesterol finds its way into the bloodstream as serum cholesterol. Its still a good idea, especially if youre at risk for heart disease, to limit dietary cholesterol. The Ameri – can Heart Association recommends keeping cholesterol intake in the general public to less than 300 mg per day. For individuals either with or at high risk of heart disease, the NHLBIs Therapeutic Lifestyle Changes (TLC) diet calls for consuming less than 200 mg of dietary cholesterol per day. (One egg, for comparison, contains about 175 mg.)Today, most experts believe the chief LDL cholesterol culprit is saturated fat-found in high quantities in animal products such as meat, full-fat dairy and butter. A good rule of thumb is if the fat is solid at room temperature, with the exception of traditional margarines and shortenings (partially hydrogenated oils, see below), it is high in saturated fat. Although the connection between saturated-fat intake and heart-disease risk remains the subject of study (see story on page 1), both the American Heart Association and the TLC diet call for limiting saturated-fat intake to less than 7% of your total calories; the average American gets about 11% of calories from saturated fat. Switching from saturated fat to mono- or polyunsaturated fats has been shown to reduce the risk of heart disease (see The NEW Skinny on Fats, July 2009).You should also avoid trans fat, found in the partially hydrogenated oils used in some baked goods and packaged products, which raises LDL cholesterol. Since revelations about the effects of trans fats, however, theyre much less common than saturated fat.What about total fat intake? The emphasis has shifted from reducing the quantity of fats of all kinds in your diet to improving the quality of fats. The American Heart Association does recommend consuming no more than 25% to 35% of your total calories from fats, as does the TLC plan.Eating to Beat Cholesterol
But can such dietary changes really improve your cholesterol count, even if youre already taking statins? A study published earlier this year in the Journal of Nutrition says it can. Anette E. Buyken, PhD, and colleagues looked at the effects of dietaryfat changes on 903 participants (ages 49 and up) in the Blue Mountains Eye Study in Australia. Over 10 years, those who decreased their consumption of saturated fat in general and butter in particular showed moderate decreases in total cholesterol-independent of whether they were also on cholesterollowering medication. (At the studys start, only 5% were taking medications such as statins, but after a decade onequarter were using such drugs.)Buyken and colleagues also looked at the effects of omega-3 fatty acids such as those in fish. Increased consumption of omega-3s and fish was associated with moderate increases in HDL as well as decreases in triglycerides. For every 1% increase in omega- 3 intake, healthy HDL levels rose by about 2.5 mg/dL. (The American Heart Association recommends eating fish, particularly those high in omega-3s, at least twice a week. See page 6 for some easy, economical ways to put more fish on your plates.)The findings, says Buyken, show that the benefits of reducing saturated fat and increasing omega-3 fat are the same for those who are on statins and those who are not.Another dietary change you can try, not tested in the study, is increasing consumption of soluble fiber. Soluble fiber binds with cholesterol-containing bile and helps carry it out of your body-this is the science behind oatcereals claims to improve cholesterol. Along with a diet high in fruits and vegetables, you can get soluble fiber from sources such as oats, barley and dried beans (legumes). (See The Facts on Fiber, February 2009.)Other steps you can take to control cholesterol, according to the NHLBIs National Cholesterol Education Program, include losing weight if youre overweight and getting regular physical activity. Getting 30 minutes of physical activity on most days of the week can help lower LDL and raise HDL; its particularly important if youre overweight and have high triglyceride or low HDL levels.Overall, according to the NHLBI, these diet and lifestyle changes can put a big dent in your LDL numbers:
Reduce saturated fat to less than 7% of calories: 8-10% LDL reduction
Decrease dietary cholesterol to less than 200 mg/day: 3-5%
Add 5-10 grams/day of soluble fiber: 3-5%
Lose 10 pounds if overweight: 5-8%Add Phytosterols to the Fight
Another cholesterol-combating weapon thats getting increasing attention is phytosterols, which the NHBLI says can cut your LDL 5-15%; the recommended amount is 2 grams a day. You can find phytosterols added to specially marked products such as spreads, yogurt and orange juice, as well as in pill form. Chemically similar to cholesterol, phytosterols occur naturally in plants-just not in high enough concentrations to have an independent effect. Both plant sterols and related compounds called stanols have been shown to lower LDL by blocking the bodys absorption of cholesterol.Two new studies demonstrate phytosterols potential to improve cholesterol levels. In one, published in the American Journal of Clinical Nutrition, Susan B. Racette, PhD, of Washington University in St. Louis, and colleagues tested two levels of phytosterol intakes against a placebo. In random, fourweek periods, 18 adults received either 400 mg, 2,000 mg (2 grams) or placebo as part of a controlled-feeding trial. Both amounts of phytosterols were associated with significant increases in cholesterol excretion and reductions in intestinal cholesterol absorption. While on the highest amount, participants saw significant decreases in LDL (average 8.9 mg/dL); the lower amount also showed a trend toward LDL reduction.In the second study, published in Nutrition, Metabolism & Cardiovas – cular Diseases, Greek researchers compared phytosterols to the much-ballyhooed Mediterranean diet. They concluded that if you cant stick to a Mediterranean-style eating pattern- which, ironically, more people in Mediterranean countries are drifting away from-foods enriched with phytosterols might be the next best thing.V.G. Athyros, MD, of Aristotelian University and colleagues tested 150 participants with mildly elevated cholesterol levels over four months. Subjects were randomly assigned to a Mediterranean-style eating plan, a diet containing 2 grams daily of phytosterols added to a spread, or a placebo spread. The Mediter ranean group gradually reduced levels of total and LDL cholesterol, triglycerides and blood pressure, leading to an overall reduction in cardiovascular disease risk calculated at 24% to 32%. But those consuming phytosterols did almost as well, seeing a rapid and sustained drop in total and LDL cholesterol that led to a 26% to 30% reduction in cardiovascular disease risk after only one month.Taking control of your cholesterol with a combination of these steps can lower your LDL numbers as much as 20-30%, according to the NHLBI, while increasing your HDL count. Even if youre taking statins or similar drugs, you can still do more to improve your cholesterol and protect your heart.TO LEARN MORE: Journal of Nutrition, January 2010; abstract at dx.doi.org/10.3945/jn.109. 110486. American Journal of Clinical Nutrition, January 2010; abstract at dx.doi.org/10.3945/ ajcn.2009.28070. Nutrition, Metabolism & Cardiovascular Diseases, online before print; abstract at dx.doi.org/10.1016/j.numecd.2009.08.014. National Cholesterol Education Program www.nhlbi.nih.gov/about/ncep. Lowering Your Cholesterol with TLC www.nhlbi.nih.gov/health/ public/heart/chol/chol_tlc.pdf. American Heart Association www.americanheart.org/ presenter.jhtml?identifier=1516.