How Can I Combat High Cholesterol?

By Susan Burke MS, RD, LD/N, CDE
eDiets Chief Nutritionist

Your blood runs cold as your doctor says, “You have high cholesterol." What does it mean and what can you do?

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High blood cholesterol is a major risk factor for cardiovascular disease (CVD). The higher the total cholesterol, the higher the risk. But there are subtle and obvious differences in the type of cholesterol and the degree of risk.

Heart disease is the leading cause of death in women, taking more lives than all forms of cancer combined, including breast and ovarian cancer.

Each year, one in three women develops heart disease, and half a million women die. Men are close behind. Combined, more than a million Americans die every year from heart disease.

It's important to note that all cholesterol is not bad. Produced in the liver, cholesterol is a fat-like substance that is carried by your blood and is present in all the body’s cells. Cholesterol is necessary for cell formation and hormone production.

There are two types of cholesterol that most doctors are monitoring.

LDL is the "bad" cholesterol, because it’s linked to a build-up of plaque in the arteries that may lead to atherosclerosis -- a narrowing of the arteries. This increases the risk for heart attack. The "good" HDL clears fats from the blood. A high HDL can protect against heart disease. Conversely, a low HDL means increased risk.

High or low, good or bad -- it’s no wonder consumers are confused about cholesterol. But the numbers are important. Symptoms of heart disease are often silent, which is why it’s so important for regular testing, especially if you or your family has a history of heart disease, diabetes or metabolic syndrome.

Heart Healthy Recommendations

The American Heart Association (AHA) recommends everyone 20 years of age and older have their blood cholesterol measured at least once every five years. A "lipoprotein profile" is a blood test done after a 9- to 12-hour fast and gives information about your total cholesterol, your LDL cholesterol, your HDL cholesterol and your triglycerides (fats circulating in your bloodstream).

Total cholesterol is the sum of all the cholesterol in your blood. The higher your total cholesterol the greater your risk for heart disease.

Less than 200 is considered optimal. A score of 200 to 239 is borderline high. High is 240 or more; it puts you at twice the risk for heart disease compared to someone whose cholesterol is below 200.

LDL is the main cholesterol transporter, contributing to damaging buildup and blockage in the arteries. Reducing LDL is the main goal of cholesterol-lowering treatment. A score less than 100 is optimal; 100 to 129 is near optimal to above optimal; 130 to 159 is borderline high; 160 to 189 is high; and 190 and above is very high.

HDL carries cholesterol from other parts of the body back to the liver where it’s removed. HDL prevents cholesterol build-up in the walls of the arteries. A score of less than 40 is a major risk factor for heart disease, while 40 to 59 is better and 60 and above is considered protective against heart disease.

High triglycerides are linked to heart disease. Normal is considered less than 150; borderline high is 150 to 199; high is 200 to 499; and very high is 500 and above.

Metabolic Syndrome
One in five Americans is at risk. You may not have high total cholesterol, but you could be at high risk for heart disease. A set of risk factors increases your risk for heart disease and stroke. Health experts link it directly to our unhealthy lifestyles of overeating and under exercising.

The NIH says a patient has metabolic syndrome if he or she meets a certain criterion in the following areas:

Central obesity measured by waist circumference. Where you carry your excess fat influences your risk for heart disease. Your risk goes up if you are a man with a waist of more than 40 inches. For women, the risk jumps at 35 inches or more.

High fasting blood triglycerides greater than 150 mg/dL. This usually caused by poor diet, especially on with an excess of refined carbohydrates and excess alcohol.

Low blood HDL cholesterol. For men, less than 40 mg/dL; for women, less than 50 mg/dL.

High blood pressure (>130/85 mmHg). This increases your risk for stroke.

Impaired fasting glucose of greater than 110 mg/dL. This indicates insulin resistance.

Love Your Lifestyle

Suppose you are diagnosed with high blood cholesterol. Does that mean you’re at risk for a heart attack? Do you need to begin taking medications immediately, and for the rest of your life? Not necessarily.

Your doctor will assess all your risk factors: weight, blood pressure, blood glucose, family history. Certainly, you should discuss your options with your physician.

Depending on your HDL, and the above factors, you may get the chance to enjoy your life without drugs. Although drugs can be lifesavers, all drugs have side effects, so speak with your doctor to get approval to start with a lifestyle overhaul.

For changes you can make, start with healthy menu and get clearance from your doctor to begin a moderate exercise program. Your Heart Smart program on eDiets is a comprehensive program, personalized to your food preferences and fitness level, your busy schedule, as well as your equipment.

A Heart Smart meal plan which will have you avoiding saturated fats in whole-milk dairy and fatty meats. What is included in your diet is fat-free or 1-percent dairy products; lean meats, fish and skinless poultry; tofu, tempeh and soy beans; whole-grain foods such as breads and cereals, crackers and whole-grain rice, plus grains such as millet and barley; and whole fruits and vegetables.

You should always limit foods high in cholesterol such as liver and other organ meats, egg yolks and full-fat dairy products.

It's important to increase fiber -- both insoluble (from whole grains and whole fruits and vegetables) and soluble (the skin of fruits, and in oats, dried peas and beans). Fiber helps increase HDL and lower LDL.

Avoid all trans fat, or hydrogenated fats, found in packaged foods and fried fast foods and convenience foods, which raise LDL and lower HDL. For spreads, choose trans fat-free soft margarines (liquid or tub varieties).

This eating plan is easy to accomplish with the eDiets Heart Smart plan or our CLICK Glycemic Impact Diet. We provide healthy menus that are flexible to suit your food preferences, and you can choose your favorite meals and recipes each time you log on.

Weight loss is important. It helps improve cholesterol and insulin sensitivity. Set a goal of losing 10 percent of your total weight if you’re overweight. Even if you have a normal cholesterol, if you’re overweight or obese, risk for insulin resistance increases, and with it your risk for heart disease. Losing weight helps lower your LDL, and with each point loss you lower your risk significantly.

Increase your activity to at least 30 minutes daily, and 60 to 90 minutes if you’re working on a weight-loss goal. Exercise helps raise HDL cholesterol and helps you lose weight and maintain your weight loss. Exercise increases insulin sensitivity.

Also important for improving heart health:

Stop smoking: The AHA links smoking to high blood cholesterol, even second-hand smoke. And, of course, smoking causes cancer.

Control hypertension: High blood pressure is linked to greater rates of heart disease, especially with high blood cholesterol.

Control blood sugar: Diabetes increases risk for heart disease, and obesity increases risk for diabetes. All the more reason to get to your healthy weight and stay there.

Control stress: According to the NIH, individual responses to stress can be a contributing factor to CVD, and it could be because stress causes people to overeat high saturated fat and sugary foods, drink too much or smoke too much or because of other metabolic factors that cause damage to arteries.

Depending on your risk, your physician may ask you to try medications to help lower your cholesterol. All medications should always be accompanied by a healthy diet and exercise plan. The AHA reports a variety of medications are available to help lower cholesterol, including statins, resins, niacin, gemfibrozil and clofibrate, prescribed individually or in combination with other drugs.

According to the AHA, unless your cholesterol is dangerously high, it's best to try to reduce it by altering your lifestyle. Do it the CLICK eDiets.com way. Adopt healthy lifestyle behaviors permanently, and love your lifestyle.

Need a diet that'll let you eat filling, tasty foods while you lose weight? We offer 23 personalized plans, including the red-hot carb-smart Glycemic Impact Diet Diet. to fill out a free diet profile.

eDiets Chief Nutritionist Susan L. Burke is a registered and licensed dietitian and a certified diabetes educator who specializes in both general and diabetes-related weight management.