High Cholesterol

High blood cholesterol is one of the major risk factors for heart attack, the leading cause of death in the United States. Other risk factors are high blood pressure, smoking, overweight or obesity, and not enough physical activity. 

Cholesterol is a type of fat your body needs for several important tasks. Cholesterol forms part of cell membranes; it produces adrenal hormones, sex hormones and provitamin D, which is used to make vitamin D on the skin’s surface; and it makes bile acids to help digest fat. It takes only a small amount of cholesterol to meet all these needs, and your liver makes enough for this. Cholesterol is also found in foods that come from animals.

Various factors can cause your blood cholesterol to rise, such as the foods you eat and the genes you inherit. When the level of cholesterol in your blood stream is high, a condition called hypercholesterolemia, the excess cholesterol can be deposited in your arteries, where it contributes to the formation of a plaque, a fatty substance that builds up on the artery walls. Plaque buildup can narrow or block the arteries and cause atherosclerosis, a hardening of the arteries. Over time, this process decreases the flow of oxygen-rich blood to the heart muscle. In some cases, pieces of the plaque break off and form a clot, which can slow or stop blood flow in a small artery. Insufficient oxygen in the heart muscle causes a condition called angina or, in severe cases, a heart attack. 

About Lipids

Lipid is the scientific name for fatty substances. Cholesterol and triglycerides are two kinds of lipids carried in the blood to tissues throughout the body. In order for cholesterol and triglycerides to be carried in the bloodstream they are combined with a protein. These protein packages are called lipoproteins. Two types of lipoproteins carry cholesterol: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). The protein packages that carry triglycerides are called intermediate or very low density lipoproteins and chylomicrons. Blood tests can measure the amount of total cholesterol, as well as each type of cholesterol (LDL and HDL) and triglycerides. These blood tests are used to assess your risk for heart disease.

Low-Density Lipoproteins

LDLs transport most of the cholesterol in the blood. They carry cholesterol to body tissues. When the LDLs are exposed to a chemical process called oxidation, they are modified and form a plaque. The plaque formation eventually can lead to a heart attack or hardening of the arteries. This is why the cholesterol in these particles is often called "bad" cholesterol. High levels of LDL increase the risk for heart disease. LDL levels partially depend on foods you eat. Eating foods that contain saturated fat, found mostly in foods of animal origin; and cholesterol, found only in food of animal origin, can increase LDL levels. Your genes also play a part in how fast LDL is made and removed from the blood. Excess weight contributes to high LDL levels.

High-Density Lipoproteins

HDLs carry the same form of cholesterol as LDLs. The cholesterol in HDLs, however, is not used to form plaques. HDL particles pick up cholesterol from the walls of arteries and other tissues in the body and return it to the liver, where it is eliminated from the body. The cholesterol in these packages is called "good" cholesterol because higher levels of HDL protect against heart disease. Exercising regularly can raise HDL levels. Drinking moderate amounts of alcohol can raise HDL levels, but don’t begin drinking alcohol for this reason; it can have other less desirable effects.

Triglycerides

Triglyceride is the chemical form of fat in food and the form in which fat is stored in the body. Stored fat is an important source of energy and provides essential nutrients. Some of the triglycerides in your body come from the foods you eat. Your body also makes triglycerides. When you consume more calories than you need, your body converts them into triglycerides and stores them as fat. The same lipoproteins that transport cholesterol also move triglycerides to cells where they are needed. High triglyceride levels in the blood are associated with low HDL levels and may be a sign of a lipoprotein problem that contributes to a risk for heart disease. Very high levels of triglycerides can cause pancreatitis, an inflammation of the pancreas. Diets high in carbohydrates seem to raise triglycerides and decrease HDL levels in some people.

Measuring Your Blood Cholesterol

Everyone age 20 or older should have his or her cholesterol measured at least once every five years. A lipoprotein profile will measure your total cholesterol, HDL, LDL and triglycerides. You need to be fasting for these tests to be accurate.

Cholesterol levels naturally rise with age. Women's LDL levels rise after menopause. High blood cholesterol can run in families. If you have high blood cholesterol, ask other family members if they have had their cholesterol measured.

*Optimal LDL goal if you have heart disease, diabetes or multiple risk factors.

Treatment

High blood cholesterol, low HDL cholesterol and high triglycerides are major risk factors for heart disease, but there are other factors your doctor considers when determining what your blood cholesterol goal should be and how it will be treated:

• Tobacco use

• High blood pressure (greater than 140/90 mm Hg)

• Family history of early heart disease (father or brother less than 55 years or mother or sister less than 65)

• Age (men 45 years and older, women 55 years and older)

• Personal history of diabetes, heart disease or stroke

• Alcohol use

Some people may require medication to help control cholesterol. Even if you do require medications, it is important to continue to follow a healthy diet, be active and not smoke. There are many different types of medications. Your doctor will work with you to choose the most effective one.

Self-Care Steps for High Blood Cholesterol

• Eat less fat. Adults should reduce their total fat intake to 25 to 30 percent or less of their daily calories and saturated fat intake to less than 10 percent. This is a major step in lowering blood cholesterol. Eliminating all fat is not necessary.

• Eat less saturated fat. Saturated fat raises LDL more than anything else in the diet. All animal fats and some vegetable fats -- coconut oil, palm kernel oil, palm oil, cocoa butter and hydrogenated oils (trans fats) -- are high in saturated fat.

• Eat less cholesterol. Cholesterol found in animal-based foods such as eggs, meats and whole-fat dairy products can raise your blood cholesterol level. You should try to keep your daily cholesterol intake to 300 mg or less.

• Eat less trans fat. Trans fat is a type of fat found primarily in processed foods that have hydrogenated vegetable oils. It raises the LDL cholesterol.

• Eat more dietary fiber. Studies show soluble fiber can help lower blood cholesterol. Some good sources of soluble fiber include oats, barley, dried beans and peas, apples, pears and carrots.

• If you are overweight, consider losing a few pounds. People who are overweight often have high blood cholesterol levels. A weight loss of 10 to 20 pounds can be beneficial.

• Be active. If you are in good health, try for 30 to 60 minutes of moderate physical activity most days of the week. Activity plays an important role in promoting heart health. Aerobic activities such as swimming, biking, jogging and cross-country skiing are especially beneficial. If you are not exercising now, try walking or another activity. Always check with your health care provider before increasing your activity level.

Food choices

Fruits and Vegetables

Adults need at least two cups of fruit and 2-1/2 cups of vegetables per day. Vegetables and fruit can be fresh, frozen or canned without added fat or sugar. Try to eat a dark green leafy or deep yellow vegetable each day.

One serving:

• 1/2 cup cooked vegetables

• 1 cup raw vegetables

• 1/2 cup canned or frozen fruit

• 1/2 cup fresh berries or cut-up pieces of larger fruit, such as melons

• 1 small piece of fruit (the size of a tennis ball)

Starches, Grains, Starchy Vegetables and Legumes

Adults should eat between approximately 6- to 9-ounce-equivalents of grains and starches per day, of which approximately half should be whole grain. 

One serving (equal to approximately 1 ounce):

• 1 small tortilla

• 1 slice of bread, 1 dinner roll or 4 to 5 crackers

• 1/2 cup cooked rice, pasta, corn, potatoes, beans, peas or lentils

• 1 ounce of dry cereal or 1/2 cup cooked cereal

• 1/2 English muffin or small bagel

• 1/2 pita bread

Choose low-fat starches (containing no more than 2 grams of fat per serving):

• Low-fat baked goods, such as angel-food cake, ginger snaps, low-fat muffins, yeast breads or bread sticks

• Low-fat snacks, such as pretzels, low-fat crackers or baked chips

Limit high-fat baked goods and snacks:

• Starches with added fat, such as granola, potato chips, tortilla chips, french fries and onion rings

• High-fat baked goods, such as pies, cakes, doughnuts, pastries, croissants, muffins, quick breads, and high-fat cookies and crackers

Dairy Products

Consume at least three one-cup servings of nonfat or low-fat milk or equivalent product per day.

One serving:

• 8 ounces of nonfat milk

• 8 ounces of nonfat yogurt

Choose nonfat (skim) or low-fat (1 percent) dairy products:

• Skim or 1 percent milk

• Nonfat yogurt

Use nonfat or low-fat cheese as a substitute for meat:

• 1 ounce of cheese or 1/4 cup of cottage cheese can be substituted for 1 ounce of meat

• Low-fat cheese (any cheese with less than 5 grams of fat per ounce), such as low-fat cottage cheese, part-skim mozzarella, farmer's or string cheese

• Nonfat cheese (any cheese or cottage cheese with less than 1 gram of fat per ounce)

Limit high-fat dairy products:

• Regular and 2 percent milk and milk products, such as regular evaporated milk or yogurt

• Whole milk, processed cheese and natural cheese, such as cheddar, Swiss, Brick, Brie, Monterey Jack, Colby, American or cream cheese

• Rich dairy desserts and condiments, such as ice cream, whipped toppings, sour cream or half-and-half

Meats

Limit intake of cooked lean beef, pork, chicken, turkey or fish to approximately 6 ounces each day depending on your age, gender and activity level. Three ounces of cooked meat are equivalent to 4 ounces of raw meat.

A 2-ounce serving:

• 1 small chicken leg or thigh

• 1/2 cup ground or chopped meat or tuna

• 2 slices of sandwich-sized meat

A 3-ounce serving:

• 1 medium pork chop

• 1 quarter-pound hamburger

• 1 split chicken breast

• 1 unbreaded fish filet

• Cooked meat the size of a deck of cards

Choose lean meats (containing no more than 3 grams of fat per ounce):

• Chicken, turkey, fish and shellfish, without skin or added oil

• Lean, trimmed cuts of beef, pork, or lamb, such as beef or veal: tenderloin, sirloin tip, round steak, ground round, rump roast, flank steak; pork: loin chop, tenderloin, center-cut ham, Canadian bacon; lamb: loin or leg roasts, chops

Limit high-fat, high-cholesterol meats:

• High-fat, processed meats, such as bacon, bologna, salami, sausage or hot dogs

• High-fat cuts of beef, pork and lamb, such as prime-grade steaks, roasts, ribs or veal cutlets

• High-cholesterol meats, such as liver, sweetbreads, kidneys or brains

Eggs

Limit egg yolks, including those used in baked goods and cooking, to no more than three per week. One egg yolk has 5 grams of fat.

Fats and Oils

Limit all added fats, especially sources of saturated fat. Fats should constitute no more than 30 percent of your total daily caloric intake. Saturated fats should make up less than 10 percent of your total daily calories, or less than 1/3 of your total fat calories. A typical serving contains 4 to 5 grams of fat, or 36 to 45 calories. Added fat includes fat used in cooking and baking, and fat contained in convenience foods. Limit fat intake carefully to avoid extra calories.

One serving:

• 1 teaspoon butter, margarine or oil

• 2 teaspoons salad dressing or 2 tablespoons light salad dressing

• 2 teaspoons peanut butter, nuts or seeds

• 5 large olives (black or green)

• 1/8 medium avocado

Choose unsaturated fats:

• Unsaturated oils, such as corn, olive, canola, safflower, sesame, soybean or sunflower

• Margarine made with the unsaturated or partially hydrogenated oils listed above; the softer the margarine, the less hydrogenated it is

• Nuts, seeds, olives, avocados or peanut butter

• Salad dressing or mayonnaise made with unsaturated vegetable oil; use reduced-fat versions of these products

Limit saturated fats:

• Saturated fats and oils, such as butter, lard, bacon fat, coconut oil or palm oil

• Hydrogenated oil found in shortening, some margarines, some salad dressings and peanut butter

Note: These recommendations are not intended for children under age 2. Recommended limits are based on typical calorie needs for adults. People with higher calorie needs can have more unsaturated oils and fats and should increase their intake of fruits, vegetables and starches.