Ldl Cholesterol: How Low Can You Go
- By Dara K. Lee Lewis, MD, Contributor
Elevated low-density lipoprotein cholesterol is a clearly established risk factor for the development of cardiovascular disease . Lowering LDL with medications and/or lifestyle changes has been shown to lower CVD risk. Just how far to lower LDL, however, has remained controversial.
Current guidelines developed by the American Heart Association, American College of Cardiology, and several other professional organizations recommend lowering elevated LDL levels to 70 milligrams per deciliter in people with high-risk CVD. However, recent studies have suggested that CVD risk may continue to drop as LDL is lowered beyond these targets, leading some cardiologists to believe that our current guidelines are not aggressive enough. Others are concerned that lowering LDL too much may lead to harm.
What Causes High Cholesterol
Some causes of high blood cholesterol include:
- Low intake of foods containing healthy fats healthy fats tend to increase the good cholesterol.
- High intake of foods containing unhealthy fats such as fatty meats, full-fat dairy products, butter, coconut oil, palm oil and most deep-fried takeaway foods and commercially baked products . Foods high in trans-fats include most commercially baked products and deep-fried takeaway foods.
- Low intake of foods containing fibre foods that are high in dietary fibre, particularly soluble fibre, can reduce the amount of LDL cholesterol in your blood. Include fibre-containing foods in your diet by choosing vegetables, fruits, wholegrains, nuts and seeds every day.
- Cholesterol in food this has only a small effect on LDL cholesterol -saturated fats and trans-fats in food have a much greater effect.
- You can also eat up to 7 eggs a week as part of a healthy, balanced diet low in saturated and trans-fats, without increasing your risk of heart disease.
Some people will have high cholesterol even if they follow a healthy, balanced diet low in saturated fats and trans-fats. These people may need to take cholesterol-lowering medicine as prescribed by their doctor.
Consider Plant Sterols And Stanols
Multiple types of supplements show promise for managing cholesterol.
Plant stanols and sterols are plant versions of cholesterol. Because they resemble cholesterol, they are absorbed from the diet like cholesterol.
However, because parts of their chemistry are different from human cholesterol, they do not contribute to clogged arteries.
Instead, they reduce cholesterol levels by competing with human cholesterol. When plant sterols are absorbed from the diet, this replaces the absorption of cholesterol.
Small amounts of plant stanols and sterols are naturally found in vegetable oils and are added to certain oils and butter substitutes.
A research review reported that clinical studies show that taking 1.53 grams of plant sterols/stanols daily can reduce LDL concentration by 7.512%. Researchers said taking it with a main meal twice per day allows for optimal cholesterol-lowering .
Although research has established the cholesterol-lowering benefit of plant stanols and sterols, it has not yet proved that they decrease the risk of heart disease. Numerous clinical trials have suggested that plant sterols supplements and enriched foods may lower heart disease risk, but hard data is still lacking .
Plant stanols and sterols in vegetable oil or margarines compete with cholesterol absorption and reduce LDL by up to 20%. They are not proven to reduce heart disease.
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When Should My Cholesterol Levels Be Tested
Your GP may recommend that you have your blood cholesterol levels tested if you:
- have been diagnosed with coronary heart disease, stroke or mini stroke , or peripheral arterial disease
- have a family history of early cardiovascular disease
- have a close family member who has a cholesterol-related condition
- are overweight
Focus On Monounsaturated Fats
As opposed to saturated fats, unsaturated fats have at least one double chemical bond that changes the way your body uses them. Monounsaturated fats have only one double bond.
Some recommend a low fat diet for weight loss, but research is mixed on its effectiveness in controlling blood cholesterol.
One research report acknowledged that lower fat intake is an effective way to reduce blood cholesterol levels. However, researchers were concerned over potential negative effects of low fat diets, such as lowering HDL and increasing triglycerides .
In contrast, research has shown that a diet high in monounsaturated fats, such as the Mediterranean diet, helps reduce levels of harmful LDL and increase levels of healthy HDL .
Monounsaturated fats may also reduce the oxidation of cholesterol, according to research. Oxidized cholesterol can react with free radicals and contribute to clogged arteries. This can lead to atherosclerosis or heart disease .
Overall, monounsaturated fats are healthy because they decrease harmful LDL cholesterol, increase good HDL cholesterol and reduce harmful oxidation (
Monounsaturated fats like those in olive oil, canola oil, tree nuts, and avocados reduce LDL cholesterol, increase HDL cholesterol, and reduce the oxidation that contributes to clogged arteries.
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Who Is Most At Risk For Fh
Familial hypercholesterolemia can affect anyone whose family carries the genetic mutation. However, its found more frequently in those who are of French Canadian, Ashkenazi Jewish, Lebanese or Afrikaner descent. The biggest problem with FH is that more than 90% of people who have it havent been diagnosed, which means you should pay careful attention to your family history,
Seth Martin, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Advanced Lipid Disorders Center.
If people in your family have had heart attacks, needed stents or had bypass surgery earlier in life before age 55 in men and before 65 in women those are signals that theres something causing your family to be at higher risk for heart disease, he explains. It could be familial hypercholesterolemia.
Eat Fewer Refined Grains Such As White Flour
Were a nation of white food eaters white bread, white rice, white pasta, and white-flour foods like muffins, croissants, bagels, crackers, dried cereals, tortillas, pretzels, and chips. Yes, more than half of many Americans typical diets are made up of hyperprocessed refined white flour, often injected with sugar, salt, and/or fat.
Thats a real problem in part because the more white, or refined, grains we eat, the fewer whole grains we tend to take in. Research has found that eating whole grains can help lower both total and LDL cholesterol, and improve heart health.
In Harvard Universitys Nurses Health Study, for example, women who ate two to three servings of whole-grain products each day were 30% less likely to have a heart attack or die from heart disease over a 10-year period than women who ate less than one serving of whole grains per week.2
When first starting to make the switch from refined to whole grains, many people often feel a bit confused. Where to begin? Whats whole? What isnt?
The registered dietitians at the Pritikin Longevity Center start with one very simple rule. When looking at products like breads and cereals, they recommend turning the package around and making sure the first word in the Ingredient List is whole. If you see the word whole at the top of the list, its a good bet that what youre buying is in fact 100% whole grain, or close to it.
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How Do I Know If I Have High Cholesterol
Many Australians don’t know they have high cholesterol, because there are no symptoms. High cholesterol can only be detected through a blood test.
Some people have a condition called familial hypercholesterolaemia where a genetic problem leads to high cholesterol. About one in 500 Australians has this condition and many dont know they have it. If you have a family history of high cholesterol or of heart disease at a young age, ask your doctor about your risk.
Saturated And Unsaturated Fat
There are 2 main types of fat: saturated and unsaturated. Eating too many foods high in saturated fat can raise the level of cholesterol in your blood.
Most people in the UK eat too much saturated fat.
Foods high in saturated fat include:
- meat pies
- cakes and biscuits
- foods containing coconut or palm oil
Eating foods that contain unsaturated fat instead of saturated fat can actually help reduce cholesterol levels.
Try to replace foods containing saturated fats with small amounts of foods high in unsaturated fats, such as:
- oily fish such as mackerel and salmon
- nuts such as almonds and cashews
- seeds such as sunflower and pumpkin seeds
- vegetable oils and spreads such as rapeseed or vegetable oil, sunflower, olive, corn and walnut oils
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Plant Sterol And Stanol Supplements
Plant sterols and stanols are substances found in many fruits, vegetables, nuts, seeds, grains, and other plants. Some processed foods are also fortified with plant sterols or stanols, such as fortified margarine, orange juice, or yogurt products.
Plant sterols and stanols may help lower your risk of heart disease. They help prevent your small intestine from absorbing cholesterol. This can lower LDL cholesterol levels in your blood.
Medications To Treat High Cholesterol
For most people who need medication to manage high cholesterol, doctors will prescribe statins. Statins, also known as HMG CoA reductase inhibitors, are a class of drugs that prevent cholesterol from forming in the liver, where both LDL and HDL cholesterol are made. This lowers the amount of cholesterol circulating in the blood. They are most effective at lowering LDL cholesterol but can also lower triglycerides and HDL cholesterol.
If you have certain conditions, or if statins arent working to decrease your high cholesterol sufficiently, your doctor may prescribe one of these other cholesterol-lowering medications:
- PCSK9 Inhibitors A newer type of medicine, PCSK9 inhibitors bind to and inactivate a protein on certain liver cells, which then lowers LDL cholesterol. Administered by injection, they are often used in patients with high cholesterol that doesnt respond to statins or people with familial hypercholesterolemia.
- Selective Cholesterol Absorption Inhibitors The most commonly used nonstatin agent, according to the AHA, selective cholesterol absorption inhibitors prevent cholesterol from being absorbed in the intestine. This means less cholesterol is delivered to the liver and, ultimately, the blood.
- Bile Acid Sequestrants Also known as bile-acid-binding agents, these drugs work by removing bile acids from the liver. Since LDL cholesterol is needed to make bile acids, the body then breaks down more LDL cholesterol particles.
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Which Foods Are Highest In Cholesterol
Only animal products contain cholesterol. These include:
- Milk and dairy products.
Plant-based foods dont have cholesterol. You wont find it in peanut butter or avocados, says Zumpano. However, dietary cholesterol doesnt necessarily cause elevated blood cholesterol. The real problem lies with eating the wrong kind of fats.
Most Any Exercise Will Do If You Do It Often
All of these exercises are helpful for reducing cholesterol and protecting you from cardiovascular disease. You can choose which is best for you based on your overall health, joint health, and lifestyle.
There are other options, as well. If you play tennis or dance regularly, youre likely to be expending about the same energy as someone who walks briskly or runs. The important thing is to get in at least 30 minutes of moderate-intensity exercise daily, with resistance training two times a week. Then add in more throughout your day when you can. Wherever you are, get up and move!
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Study Suggests Lower Ldl Cholesterol Is Better
A recent meta-analysis published in JAMA Cardiology suggests that it is both safe and effective to lower LDL below 70 mg/dL. The authors reviewed a large database of CVD patients with LDL levels averaging 70 mg/dL or less at the start of the studies. On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.
The benefit was consistent regardless of the medications used to lower cholesterol. The JAMA Cardiology meta-analysis looked at studies in which LDL was lowered with a statin drug, which works by lowering LDL production in the liver, or with a different type of medication, including ezetimibe , which interferes with absorption of LDL from the intestine, or PCSK9 inhibitors, newer injectable medicines that increase uptake of LDL from the bloodstream into the liver. The drop in CVD risk was in line with previous studies of patients who started with LDL levels around 130 mg/dL, and saw a drop in CVD events of about 22% for every 39 mg/dL drop in LDL.
In this study, there was no increased risk of adverse outcomes , even when LDL was lowered to as low as 20 mg/dL. Although statin medications themselves have been linked to side effects, especially at high doses, it appears that extremely low LDL concentrations are not responsible for side effects.
Becoming More Physically Active
A sedentary lifestyle lowers HDL cholesterol. Less HDL means theres less good cholesterol to remove bad cholesterol from your arteries.
Physical activity is important. At least 150 minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure. And you have lots of options: brisk walking, swimming, bicycling or even yard work can fit the bill.
What Are Early Signs Of Fh
When you have FH, early detection of high cholesterol levels is key to getting the treatment that can lower your risk of cardiovascular disease. In addition to family history of early cardiovascular problems, you may also notice lumps forming under your skin.
These fatty deposits are called xanthomas, and are particularly noticeable around tendons in the hands, knees, Achilles tendons and elbows, and under the skin around your eyes. Sometimes an ophthalmologist may spot signs of cholesterol deposits in your eyes as well.
Whether or not you have obvious signs of high cholesterol, you should get checked if heart disease runs in your family. Talk to your family doctor about your concerns a simple blood test is all it takes to see if your cholesterol levels are in the healthy range. A high cholesterol level at a young age is a particular red flag that you may have FH. If your doctor suspects you have the condition, you can undergo genetic testing to confirm the diagnosis.
Simple Ways To Lower Your Cholesterol
70 million American adults have high cholesterol, according to the Centers for Disease Control and Prevention . Of these, only 1 in 3 has their condition under control, and less than half are getting treatment. People with high cholesterol have twice the risk of developing heart disease as people with healthy levels. Learn more about what lifestyle changes you can make to get your cholesterol levels in check.
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Best Exercises For Lowering Cholesterol
Some research has indicated that it may be that how much you exercise is more important than what kind of exercise you do. That means its worth it to incorporate more activity into your day however you can. Take a walk during your lunch hour, choose the stairs, stand up to take phone calls, or store a jump rope at your desk.
In addition, try to incorporate at least 30 minutes of structured exercise into each day. Any exercise is better than none, but the following six types have shown in studies to be effective at reducing cholesterol levels.
Signs And Symptoms Of High Cholesterol
Typically, high cholesterol doesnt cause any symptoms until it causes a medical emergency, like a heart attack or stroke. These heart-disease-related events dont occur until high cholesterol levels have led to fatty plaque building up in the arteries. In turn, this leads to a narrowing of the arteries and a change in the makeup of the arterial lining, also known as heart disease.
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Strike A Few Yoga Poses
After all this talk about aerobic exercise and lifting weights, it may seem odd that yoga would show up on the list. After all, yoga is mostly stretching, right?
Studies show, however, that yoga may reduce risk of heart disease. In some cases, it may directly affect cholesterol levels.
Researchers reported in the Indian Heart Journal that a three-month yoga program helped reduce total cholesterol and LDL cholesterol. It also improved HDL cholesterol levels in diabetics. The participants practiced for about one hour a day.
In a large study review published in the European Journal of Preventive Cardiology, those who regularly practiced yoga showed significant improvement in LDL cholesterol, HDL cholesterol, and blood pressure over those who didnt exercise.
If Lifestyle Changes Arent Enough
Take medications, if you need to, to lower your cholesterol into healthy ranges. Drugs like statins can be very effective, says Dr. Danine Fruge, MD, ABFP – Medical Director at the Pritikin Longevity Center, but do continue in your efforts to eat well and exercise because a healthy lifestyle can give you far, far more than drugs alone.
With a healthy living program like Pritikin, youre not only reducing cholesterol quickly, youre also creating changes throughout your body that can profoundly improve your overall well-being. Youre reducing blood sugar levels and blood pressure. Other heart disease risk factors like triglyceride fats are also dropping dramatically. Youre also reducing inflammatory factors that sicken arteries. Youre shedding excess weight. And, quite simply, youre feeling better, much better. Many of our guests at Pritikin tell us, I had no idea I could feel this good again.
Can any pill or combination of pills do all of the above? I highly doubt it. But a healthy lifestyle like Pritikin can.
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