Health Maintenance: Controlling Cholesterol

What is cholesterol?

Cholesterol is a type of fat. It has both good and bad effects on the body. Your body uses cholesterol to make hormones and to build and maintain nerve cells. However, when your body has too much cholesterol, deposits of fat in the blood called plaque form inside blood vessel walls. The blood vessel walls thicken and the vessels become narrower (a condition called atherosclerosis). This change in the blood vessels reduces blood flow through the blood vessels, possibly leading to heart attacks or strokes.

Most of the cholesterol in your blood is made by your liver from the fats, carbohydrates, and proteins you eat. You also get cholesterol by eating animal products such as meat, eggs, and dairy products.

How is cholesterol measured?

When you get your cholesterol checked, your health care provider will give you a number for your total cholesterol level. You can use the chart below to see if your total cholesterol is high.

 
Total Cholesterol Level (mg/dL) 
----------------------------------------
less than 200   good 
200 to 239      borderline high 
240 or above    high 
----------------------------------------

When your cholesterol is measured and found to be high, your health care provider may also check the amount of LDL (low-density lipoproteins) and HDL (high-density lipoproteins) in your blood. LDL and HDL carry cholesterol through your blood. LDLs carry a lot of cholesterol, leave behind fatty deposits on your artery walls, and contribute to heart disease. HDLs do the opposite. They clean the artery walls and remove extra cholesterol from the body, thus lowering the risk of heart disease. LDL is called "bad" cholesterol. (You can think of "L" for "lousy" cholesterol.) HDL is called "good" cholesterol (think of "H" for "healthy" cholesterol). It is good to have low levels of LDL and high levels of HDL.

The recommended levels of LDL are shown in the following chart:

 
Recommended LDL Cholesterol Level (mg/dL) 
---------------------------------------------------------------
Less than 160   For most people 

Less than 130   If you have an increased risk of heart 
                disease 

Less than 100   If you have heart disease, diabetes, 
                peripheral artery disease, abdominal aortic 
                aneurysm, or symptomatic carotid artery disease 
---------------------------------------------------------------

For HDL, a level below 40 mg/dL is too low. The recommended HDL level is 45 mg/dL or higher.

How can I control my cholesterol level?

Cholesterol levels can usually be controlled by eating right, exercising, and not smoking.

Follow these diet guidelines to help control your cholesterol:

• Reduce the amount of cholesterol in your diet. The American Heart Association recommends eating no more than 250 to 300 milligrams (mg) of cholesterol a day.
• Eat less fat. Fats should contribute no more than 30% of your daily calories. Only 10% of the fat you eat should be saturated fat.

  Some kinds of fats are better than others. Polyunsaturated and monounsaturated fats are better than saturated fats. Monounsaturated fats are found in olive oil, canola oil, and avocados. Polyunsaturated fats are found in fish and some vegetable oils.

  Saturated fat raises your blood cholesterol because it makes it hard for the body to clear the cholesterol away. Saturated fat is found in different amounts in almost all foods. Butter, some oils, meat, and poultry fat contain a lot of saturated fat.

• Adjust the amount of calories you eat and exercise regularly to maintain a lean body weight.

To control the amount of fat and cholesterol you eat:

• Check food labels for fat and cholesterol content.
• Limit the amount of butter and margarine you eat.
• Use sunflower, safflower, soybean, canola, corn, or olive oil rather than tropical oils such as palm or coconut.
• Use salad dressings and margarine made with polyunsaturated and monounsaturated fats.
• Use egg whites or egg substitutes rather than whole eggs.
• Replace whole-milk dairy products with nonfat or low-fat milk, cheese, spreads, and yogurt.
• Eat skinless chicken, turkey, fish, and meatless entrees more often than red meat.
• Choose lean cuts of meat and trim off all visible fat. Keep portion sizes moderate.
• Avoid fatty desserts such as ice cream, cream-filled cakes, and cheesecakes. Choose fresh fruits, nonfat frozen yogurt, Popsicles, etc.
• Reduce the amount of fried foods, vending machine food, and fast food you eat.
• Limit the amount of nuts you eat, especially nuts high in saturated fat. Examples of nuts that are especially high in saturated fat are cashews, pistachios, and Brazil and macadamia nuts.
• Eat fruits and vegetables (especially fresh fruits and leafy vegetables), beans, and whole grains daily. The fiber in these foods helps lower cholesterol.
• Look for low-fat or nonfat varieties of the foods you like to eat, or look for substitutes.

Exercise goes hand-in-hand with a healthy diet for controlling cholesterol. Exercise helps because it:

• Keeps your weight down.
• Decreases your total cholesterol level.
• Decreases your LDL (bad cholesterol).
• Increases your HDL (good cholesterol).

A good exercise program includes aerobic exercise. Aerobic exercise is any activity that keeps your heart rate up (such as swimming, jogging, walking, and bicycling). You should get 20 to 30 minutes of aerobic exercise at least every other day.

If you haven't been exercising, ask your health care provider for an exercise prescription and start your new exercise program slowly.

If you smoke, quit. Smoking increases your risk of heart disease because it lowers HDL levels.

High cholesterol may run in families. Know your family history and discuss it with your health care provider.

In summary, to control your cholesterol level:

• Eat healthy.
• Get regular exercise.
• Don't smoke.
• Check your cholesterol yearly.