The dangers of cholesterol have received a lot of attention, but very few people realize that they still don't have all the information they need to truly understand this crucial health issue.
For example, most people believe that cholesterol is always bad for you. The fact is, your body needs some cholesterol to produce certain hormones and make healthy cells. It's just that more than half of all Americans have far more cholesterol in their bodies than they need for good health.
Some people with elevated cholesterol, such as those with genetic cholesterol disorders or a history of heart disease, need to take a cholesterol-lowering statin drug and/or other prescription medications to keep their cholesterol in check. But many others can get good results without the potential side effects and expense of such drugs.
Mary P. McGowan, MD, is a leading expert on cholesterol metabolism. Her advice on how to correct elevated cholesterol—or avoid it in the first place...
Important Issues To Discuss
When reviewing your cholesterol profile, you and your doctor should discuss...
- What medications you are taking. Some medications that are widely used to treat other conditions can raise LDL "bad" cholesterol and/ or lower HDL "good" cholesterol. This includes some diuretics and beta-blockers (both commonly used for high blood pressure) and progestin hormones (commonly used in hormone replacement therapy).
In some cases, you may be able to switch to a different drug in the same class that does not negatively affect cholesterol levels as much as the one you are taking.
Examples: Indapamide (Lozol) is a diuretic that tends not to hurt cholesterol levels... carvedilol (Coreg) is a beta-blocker that usually does not adversely affect cholesterol.. and micronized progestin, such as Prometrium, has been found to be the progestin with the least negative impact on cholesterol.
- Your family history. Only about 25% to 30% of the cholesterol in your body comes from your diet. This means that roughly 70% to 75% of your body's cholesterol doesn't come from food-it is made by your liver and often influenced by your genes.
Some people simply have good genes when it comes to cholesterol, but others need to work hard to control their cholesterol levels.
Smart Food Choices
- Think beyond oat bran. High-fiber foods, such as oat bran, have been highly publicized for their ability to help reduce cholesterol. But not all fiber sources have this effect--for example, wheat bran, one of the most common fiber sources in the American diet, does nothing to get total cholesterol to the desirable level of less than 200 milligrams per deciliter (mg/dL). That's because fiber must be soluble (dissolvable in water) to improve cholesterol levels.
Sources of soluble fiber you may not know about: Kidney beans, navy beans, apples, oranges, prunes, grapefruit and Brussels sprouts. Psyllium, which is derived from the husks of seeds from the herb-like shrub Plantango ovata, is another excellent source of soluble fiber. It's found in some cereals, such as All-Bran Bran Buds and Smart Bran.. and in over-the-counter (OTC) fiber products such as Metamucil.
- Check out butter substitutes. Butter has a lot of saturated fat-and most people who like it tend to use a lot of it. Saturated fat impairs the liver's ability to remove LDL cholesterol from the blood.
Instead of butter: Try olive oil or canola oil on your toast in the morning. But remember, while olive oil is healthful, it is high in calories (100 calories per tablespoon), so don't pour it on. Consider using a mister.
If you prefer the taste of butter, replace it with products that contain plant stanols or sterols, which are derived from vegetable oils and wood pulp. Both of these plant-derived compounds lower LDL cholesterol by inhibiting its absorption by the intestine. Plant stanol esters are found in Benecol spread...plant sterols are in Smart Balance spread. Both products are widely available at supermarkets.
Important: When patients' cholesterol levels don't improve on one of these products, they're usually not getting enough-you need to eat an average of two tablespoons daily. Try "light" versions (which have 50 calories per tablespoon versus 70 or 80).
- Snack on pistachios. Walnuts and almonds are well-known sources of omega-3 fatty acids, a kind of healthful fat that can help reduce LDL cholesterol. But if you would like more variety, recent research has found that pistachios also have the same benefits. Just be sure to limit yourself to no more than a handful (about 15 ounces) of pistachios (or walnuts or almonds) per day-nuts are high in calories.
Exercise is essential to maintaining healthy levels of triglycerides (blood fats). Exercise also improves HDL cholesterol levels but has less impact on LDL.
Aim for a minimum of 30 minutes three days a week-but you are likely to get a greater cholesterol benefit if you exercise daily. Be sure to consult your doctor before you begin an exercise routine.
Supplements To Consider
If a low-fat diet and exercise have not helped you achieve optimal cholesterol levels, and you prefer to not take a statin, you may want to ask your doctor about trying…
- Red yeast rice—but don't buy the wrong kind. This supplement, which is made by culturing a red yeast on rice, has been shown in some studies to reduce LDL by roughly 20% when 1,200 mg is taken twice daily with meals.
Important new research: When 12 red yeast rice extracts were tested, tremendous variability was found in the products' levels of monacolins, the active ingredient. The levels of total monacolins ranged from 0.31 mg to 11.15 mg per capsule. Scientists also found that one-third of the supplements contained high levels of citrinin, a toxic contaminant derived from fungus that may harm the kidneys.
Choose a product made by a large, well-known manufacturer—such companies generally have more quality control. Rare side effects of red yeast rice include headache, stomachache or bloating, gas and dizziness. Avoid drinking grapefruit juice with red yeast rice—the combination can increase the risk for liver damage.
- Niacin. This powerful B vitamin can reduce LDL cholesterol by up to 20% and raise HDL by as much as 35%. Niacin also reduces triglycerides by up to 25%.
Typical dose: About 1,000 mg daily.
Niaspan, (niacin extended-release tablets or NERT) a slow-release prescription drug (niacin is its active ingredient), is taken once a day and is generally safer for the liver than OTC niacin, which must be taken three times daily. Both forms can cause flushing and should be taken at bedtime (so flushing occurs during sleep) and with a snack (to avoid stomachache). If you use OTC niacin, avoid niacinamide, a "cousin" of niacin—it does not cause flushing but also has no effect on cholesterol.
To lessen flushing: Take 325 mg of aspirin a half hour before you take either type of niacin. Aspirin has a blood-thinning effect, so be sure to consult your doctor if you have a history of stomach ulcers, anemia, kidney or liver disease or take blood thinners. Also avoid hot beverages, alcohol, hot showers and spicy foods around the time you take the niacin. Anyone taking niacin or Niaspan should have his/her liver function periodically tested by a physician.
Low-Carb Diets Help Control Cholesterol
People on either a low-carb or a low-fat diet I lost about 15 pounds--but those on the low-carb regimen had a 23% increase in HDL (good) cholesterol, compared with a 12% improvement for those on the low-fat diet. The low-carb group was allowed as many calories as they wanted from fat and protein, but their carb intake was limited to 20 grams (g) per day in the form of low-glycemic-index vegetables, gradually increasing by 5 g per week. They also were allowed fruits and small quantities of dairy. The low-fat diet consisted of limited caloric intake of up to 1,500 calories per day for women and 1,800 per day for men, with no more than 30% of calories from fat.