Lowering Cholesterol

For the past few years I’ve been getting an annual physical that includes a blood test for various vitamin concentrations, a blood glucose test to screen for diabetes, and a lipid panel to test for cholesterol levels. The lipid panel has to be taken after you’ve been fasting for at least twelve hours because fat in food you’ve recently eaten can artificially raise your triglycerides and throw off the results.

I had a “holy shit” moment this year when I got my results back and found my total cholesterol and LDL (the “bad” cholesterol) were both high for the first time. When I dug up my results from the last two years it’s clear I should’ve been concerned about this sooner. Last year I was right on the cusp of having high cholesterol and didn’t think anything of it. My doctor even warned me about it in her letter accompanying the results, but I paid it no mind, probably because it was just under the normal range.

Here’s how my cholesterol has crept-up since 2010:

This year, though, my doctor’s letter contained an implied threat: if I couldn’t get my cholesterol down through diet and exercise alone in three months, I’d have to start taking statin drugs. Challenge accepted! Statins are a prescribed medication that have various side-effects and other nasty business of which I want absolutely no part. Could I really reduce my cholesterol naturally? I was determined to try.

What The Hell Is Cholesterol, Anyway?

Cholesterol is a waxy, fat-like steroid found in every cell of your body. About 75% of your cholesterol is produced by the liver, and you get the other 25% from the food you eat. Your cells need cholesterol to function, and they get cholesterol delivered to them via the bloodstream. If a cell has enough cholesterol, then the cholesterol globules continue through your body until they’re reabsorbed by your lower intestines where they’ll go back to your liver to be recycled.

When you have an abundance of cholesterol in your blood, though, that won’t be accepted by cells and is more than the liver can re-process, your body will start to store it throughout the areas where your blood travels, usually throughout your arteries, gunking up the walls of the little tubes your blood flows through. Yes, even your blood can get fat. Then it will start to build up in the heart, which can impair its function and eventually cause a heart attack.

The problem with having high cholesterol is that there are no symptoms until you have your first heart attack. Getting a cholesterol screening can help diagnose potential issues while you still have a chance to remedy the situation.

Cholesterol is a kind of fat and can be screened by what’s known as a lipid panel or lipid profile (“lipid” being the fancy scientific term for “fat”).

A lipid profile typically includes measurements for:

• Total cholesterol
• High-density lipoprotein cholesterol (HDL)
• Low-density lipoprotein cholesterol (LDL)
• Triglycerides

An extended profile (which is much more expensive, and not typical) may also include:

• Very low-density lipoprotein (VLDL)
• Non-HDL

However, most cholesterol testing doesn’t include a full lipid panel, and instead only measures LDL cholesterol and total cholesterol, and then the results of the others are calculated from those. If your initial cholesterol screen looks like you may have high cholesterol, your doctor may order a more complete profile.

Cholesterol levels are measured in mg/dL, or how many milligrams of each cholesterol lipoprotein are contained in a deciliter of blood. When I refer to “points” or “levels” I’m talking about a measurable quantity of mg/dL. For reference, Americans, a deciliter is a little less than half a cup. The average human body contains about five and a half quarts of blood (depending on size different people will hold more or less blood in their body). So the cholesterol test takes a sample and then projects how much total cholesterol you have.

LDL vs. HDL

Low-density lipoprotein, or LDL (“bad” cholesterol) is a fatty protein that transports cholesterol through the bloodstream when your cells reject its delivery (because they have enough). It’s “bad” because it deposits excess cholesterol in the walls of arteries, or wherever else it can. It just stuffs it wherever it’ll fit.

When that happens white blood cells attack the LDL and try to digest it, but are unable to, so the LDL is converted into a toxic, even waxier substance called plaque, which builds up in arterial walls and makes it harder for red blood cells to carry oxygen through those parts of your cardiovascular system. Plaque tends to build up over time, and eventually can cause a rupture, on which a blood clot can form and if that clot breaks free and travels to the heart, can cause a heart attack.

High-density lipoprotein, or HDL (“good” cholesterol), scavenges LDL cholesterol and returns it back to the liver where it can be broken down and essentially recycled for when it’s needed again. HDL also scrubs the walls of your blood vessels so that plaque doesn’t form.

It’s long been thought that higher levels of HDL in your blood prevented heart attacks, but new research conducted in May 2012 suggests that raising the HDL levels of people with low HDL doesn’t lower their chances of getting a heart attack, probably because of other factors that lead to heart attacks, such as a sedentary lifestyle and poor diet.

While HDL alone may not be the panacea for your heart’s health, higher levels of HDL are beneficial mostly because they control the levels of your LDL cholesterol, and that’s good.

Triglycerides

Triglycerides are the main form of fat in the body. When you consume excess calories, food is broken down into triglycerides and stored in your fat cells (adipose tissue) where it may be used again when you burn more calories than you take in. Triglycerides are packed together in the liver and wrapped up inside the strands of very low-density lipoprotein, or VLDL, and then go on their way through your bloodstream until they’re tucked neatly away in one of your body’s fat stores.

It’s not currently known how high triglyceride levels in the blood affect the heart. Part of the reason is that high triglycerides tend to occur when you have other risk factors for heart disease, like high LDLs or high blood pressure.

There is also a direct correlation between alcohol consumption and high triglyceride levels. Drinking more than one drink per day for women, or two drinks a day for men may raise triglyceride levels considerably. Of course, if you’re trying to lose weight you’ve already cut back on drinking alcohol for the calories alone.

How Can You Lower Your Cholesterol?

Besides medication, there are some all-natural ways you can lower your cholesterol:

• Aerobic Exercise
• Diet
• Supplements

I wrote them in that order so they wouldn’t have the acronym “SAD.” By fighting cholesterol on all three fronts you may have a better chance of lowering it, and thus lowering your risk of heart disease.

Exercise Lowers Cholesterol

So how does exercise lower your cholesterol? Exercise raises the level of your lipoprotein lipase (LPL) enzymes[1] which in turn attach to triglycerides to essentially remove them from the bloodstream, thus lowering your triglyceride levels too.

Exercise also increases the size of both LDL and HDL cholesterol, which means that the LDL can’t nestle into the tiny nooks & crannies of your heart and blood vessels.

While there’s a direct correlation between exercise (especially aerobic exercise like walking, running, or otherwise moving your body without resistance) and lowering cholesterol, researchers aren’t quite sure why exercise works, but they know it does.

A 2002 study at Duke University Medical Center found that more intense exercise lowers LDL cholesterol far more than moderate or light exercise. People who exercised more vigorously also raised their HDL cholesterol. Win-win. So you have to push yourself harder to have a greater effect in lowering cholesterol.

Foods That Lower Cholesterol

In addition to exercise, certain foods are known to help lower cholesterol.

• Oatmeal – Oats contain a substance called beta-glucan which absorbs LDL cholesterol and removes it from your body. If there’s any one magic bullet for lowering cholesterol, oats are it. If anything, since the 1980s when the FDA allowed oat-based foods to carry a health claim, additional research has proven that above all other foods, oats can lower cholesterol by as much as 20%.
• Fish – Especially those high in omega–3 fatty acids, like salmon, herring, sardines, and tuna, can lower your cholesterol. Sure, you can take a fish oil supplement, but you gotta eat, and adding more fish to your diet can help lower your cholesterol and provide healthier proteins than red meat or poultry.
• Flax Seed – Flax is like a wick that soaks up that bad cholesterol and removes it from your body. Add a tablespoon or two to your oatmeal, yogurt, or other healthy food, and you probably won’t even notice it’s there. Flax seeds are also high in omega–3. Do you see a trend? Fiber and omega–3 fatty acids work to reduce cholesterol.
• Chia Seeds – You know those novelty terra cotta Chia Pets that grow little greens? Eating the seeds rather than planting them may help reduce your LDL. Cha-cha-cha chia!
• Olive Oil – Not only does olive oil help to lower LDLs, but because it’s a monounsaturated fat it doesn’t lower your HDLs, so a little olive oil in your diet can help you in more ways than one.
• Avocado – Speaking of omega–3 acids, avocados are loaded with the stuff, and taste great when mashed up with a little lime juice, onion, cilantro and salt. I could probably eat guacamole every day.
• Walnuts – Also high in omega–3 fatty acids (unlike most other nuts), which can help slow down the growth of plaque in your arteries. Other nuts, like almonds, pecans, pistachios, and peanuts also help to lower cholesterol, mostly because they’re high in fiber, but none are as effective as walnuts.
• Blueberries – The high level of antioxidants in blueberries have been found to reduce cholesterol… in hamsters. However, they taste great in oatmeal, so it’s worth trying (plus blueberries contain numerous compounds known to be beneficial).
• Red Wine – In vino veritas… and it has been found to lower cholesterol, too. Only the red wines, though, ladies. Your chardonnay, while delightfully crisp and oaky, won’t have much effect because white wines do not contain a chemical known as a flavonoid, which has a protective effect that makes your heart and arteries less able to accept LDL cholesterol for storage. The flavonoids are stronger in red wine because they come from the grape’s stem, seeds, and skins, which are skimmed out of white wine earlier in its fermentation process. The tannins in red wine also suppress the peptide responsible for hardening arteries. As beneficial as red wine can be for your health, it still contains a lot of alcohol and therefore should only be consumed in moderation (one glass per day for women, two glasses for men).
• Dark Chocolate – The darker (i.e. containing more cacao) the better. Dark chocolate also contains flavonoids (as well as 300 other chemical compounds known to cure a great many ills both physical and psychological).

If these foods have anything in common, it’s that they’re high in calories. So moderation is key. Try replacing some other food you were going to eat with these heart-healthy choices and you’ll be lowering your cholesterol in no time.

In addition to eating these special foods, though, improving your overall diet, eating the proper number of calories, and getting ample nutrition is going to be the most effective in preventing various diseases.

Foods High in Cholesterol

It’s not all sunshine and oatmeal. There are a number of (primarily animal-based) foods that contain a lot of cholesterol, such as:

• Egg Yolks – While egg yolks only contain 1.5 grams of saturated fat, eggs have become the poster child for high-cholesterol foods. Of course, eggs have many other health benefits (I’ll write more on how great eggs are later).
• Red Meat – Steak, hamburgers, pork, bacon, etc. are all high in fat and dietary cholesterol.
• Dairy Fat – Dairy fats like butter, cream, cheese, and even whole milk contain cholesterol.
• Shellfish – Shrimp, lobster, oysters, and mussels are all high in cholesterol.

While the dietary cholesterol you ingest doesn’t become “serum cholesterol” in your bloodstream, consumption of saturated fats may stimulate cholesterol production in the liver. It’s long been considered a given that the type of fats you consume influences the types of cholesterol you produce.

My dietician suggested that I reduce (or eliminate) my consumption of the above foods, but there is an abundance of research to suggest that a diet high in saturated fat has no correlation to increased blood cholesterol levels. I expect we’ll see more research in this area in the near future.

Since there are no obvious health detriments to reducing your consumption of saturated fat, however, why not reduce your intake to be on the safe side?

Do Any Vitamins or Supplements Lower Cholesterol?

I’ve been taking Benecol Smart Chews which are essentially a concentration of plant stanol esters. Sounds tasty, no? Plant stanol esters are naturally occurring in vegetables, fruits, nuts, and other natural whole foods, but in such limited quantities as to have little effect on the body. The refined, esterified, and hydrogenated stanols bond with LDL proteins and remove them from the bloodstream. Sterol esters have a similar effect, but are partially absorbed by the body, and thus raise levels over time. Studies suggest that this may be a problem so I’ve stuck with the stanol instead of the sterol esters.

Statins

I’m not down on statin drugs, as they can help reduce cholesterol for a lot of people who can’t rely on exercise and diet alone to reduce it. I just try not to take any more medication than I absolutely have to, and am trying to hold back the march of time on my body. For people who need them, I’m sure that statin drugs are a godsend.

Statin drugs work by blocking production of an enzyme in the liver that is responsible for producing cholesterol (the enzyme is called HMG-CoA reductase, or as it’s known to its friends, “3-hydroxy–3-methyglutaryl COA”).

Statin drugs are the most common prescription drug in the world. Some statin brands prescribed include Lipitor, Crestor, Zocor, Mevacor, Altocor, and the comically named Lescol (for less cholesterol?), Livalo (live a little longer?), and Pravachol (which, uh… prevents cholesterol?). Whatever the brand name, these statin drugs actually provide different statins, so if one doesn’t work another may work better for you. Lipitor recently fell out of patent protection and therefore a generic may be prescribed in its place (although in Summer 2012 the generics aren’t much cheaper than the brand name drug).

Station drugs are known to have some fairly serious side effects, though, including nausea, dizziness, cramping, diarrhea, constipation, headaches, and bloating due to gas. Lovely. The worst side-effect seems to be myositis, or inflammation of the muscles, which can cause injuries when trying to exercise. None for me, thanks.

So How Did I Do?

After improving my diet, adding copious amounts of foods known to help lower cholesterol to my diet, chewing Benecol with each meal, and increasing the amount of exercise I get each day, I gave blood again for another lipid panel.

Here are my cholesterol levels after my most recent blood test:

My total cholesterol reduced by 56 points, and my LDL cholesterol went down by 40 points in three months[2]. Oddly, my HDL, the “good” cholesterol, also decreased, which is typical for those taking statin drugs but unusual for people who achieve lowered cholesterol through diet and exercise alone, especially since exercise is known to lower LDL and raise HDL cholesterol. Puzzling.

I’m not stopping now. While my total cholesterol is now well within the “normal” range you can’t really ever get your LDL too low, and I’d like to lower my LDL as much as possible while raising my HDL even higher.

I’m going to re-check my cholesterol in four months to see how I’ve been progressing, and I’m going to pursue lowering my cholesterol as a good excuse to lose weight and get healthier, and continue to act like my cholesterol is high. After all, heart-healthy foods like oatmeal, avocados, salmon, sweet potatoes, blueberries, walnuts, and olive oil aren’t exactly hard to fit into your diet, because they’re delicious.

Being diagnosed with slightly high cholesterol was just the kick in the pants I needed to get back on track with my Clean Livin’. I’ve lowered my cholesterol by 56 points naturally, yes, but I’ve also lost over 30 pounds in the same interval.