Cholesterol is an essential substance for our bodies’ functions and is found in all of our cells. It is needed to make hormones, vitamin D, and substances that help you digest foods. Your liver produces a majority of the cholesterol in your body, and the rest is ingested through our diet, mainly in animal-based foods. Cholesterol is transported through our blood in small packages called lipoproteins, such as low-density lipoproteins (LDL). Elevations of these cholesterol-containing lipoproteins can be a risk factor for cardiovascular disease and stroke. The first step in reducing your risk is
to understand your diagnostic testing and treatment options.
Terminology – First, let’s break down all the different terms we use when talking about cholesterol.
Total cholesterol: The total amount of cholesterol found in lipoproteins. Your total cholesterol includes low-density lipoprotein (LDL, or “bad”) cholesterol and high-density lipoprotein (HDL, or “good”) cholesterol.
Low-Density Lipoprotein Cholesterol (LDL, LDL-C): The most commonly used marker to assess cardiovascular risk. A measurement of the cholesterol content within LDL particles.
High-Density Cholesterol (HDL, HDL-C): A measure of the cholesterol within the HDL particles. High levels are associated with decreased cardiac risk.
Triglycerides: An ester of glycerol and 3 fatty acids. In a lab test, this is the concentration of this fat found within the lipoproteins. Elevation can be an independent risk factor for cardiovascular disease.
Lipoprotein Particle Profile (LPP) or Vertical Auto Profile (VAP): Advanced form of lipoprotein testing which augments the standard lipid panel. It further evaluates subgroups of cholesterol which can more accurately assess a patient’s risk for
cardiovascular disease. This can include total cholesterol, LDL-C, LDL-P, HDL-C, HDL-P, VLDL, triglycerides and several other cardiac risk markers. LDL-P: Studies are finding this marker may be more indicative of overall cardiac risk. This is the total number of LDL particles, regardless of size.
HDL-P: The total number of HDL particles.
Very Low-DensityLipoprotein (VLDL): A measurement of the cholesterol content within VLDL particles. The content is mostly composed of triglycerides.
Lp(a): Another type of lipoprotein containing cholesterol. Elevations in this marker are mainly due to genetics and can be an independent risk factor for atherosclerosis. For treatment, diet and exercise have little impact, but Niacin can potentially help to lower.
ApoB: The main protein component of atherogenic lipoproteins including LDL, IDL, and VLDL. Elevations of this marker are strongly associated with increased risk for cardiovascular disease and may be more predictive than LDLC.
Familial hypercholesterolemia: a genetic disorder that causes significant elevations in cholesterol which can lead to cardiovascular disease. This is an inherited disorder and although diet and lifestyle changes are important, medications are typically indicated to reduce risk.
Traditional Lipid Panel: The standard blood cholesterol test which includes measurements of total cholesterol, LDL-C, HDL-C, and triglycerides. These are general markers of cardiovascular risk.
WHAT ARE SOME TREATMENT OPTIONS?
Medications and Supplements
Statins: A group of drugs that work in the liver to prevent the formation of cholesterol and also act to upregulate the number of receptors which clear cholesterol. They mainly act to reduce levels of LDL, but can also have some effects on lowering triglycerides and elevating HDL.
CoQ10: An antioxidant micronutrient that can be depleted if you are on statin drugs. A supplement of 60-120mg daily can prevent this.
Fenofibrate: A group of medications used to mainly lower triglycerides. They do have some LDL lowering effects as well as the ability to increase HDL.
Niacin (vitamin B3): Often combined with statins, Niacin can increase HDL, lower triglycerides and Lp(a), and modestly lower LDL. The most notable side effect associated with Niacin is flushing of the skin.
PCSK9 inhibitors: A powerful new class of injectable medications which significantly decrease LDL cholesterol when combined with a statin. This class of drugs works on receptors to clear more cholesterol from the body.
Plant Sterols: Plant-based foods containing nutrients beyond vitamins and minerals are known as sterols and stanols. These substances help to block the absorption of dietary cholesterol. Research has shown that consuming 2 g of plant sterols/stanols daily can improve cholesterol numbers by up to 14%. Plant sterols and stanols are fortified in foods (like Benechol) and also found in vitamins and as a single supplement.
Omega 3 fatty acids: Also known as Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), these medications or supplements are derived from fish oil. They are intended to lower triglycerides. These are essential fatty acids, meaning your body can’t make them on their own.
Red Rice Yeast: Rice that has been fermented by the red yeast Monascus Purpureus and has a statin like effect. Red Rice Yeast has long been used in traditional Chinese medicine. More recently, it has been used as a supplement to lower cholesterol. It is classified as a dietary supplement by the United States Food and Drug Administration.
Diet and Lifestyle
Weight loss: 10% body weight loss alone can improve HDL and triglycerides.
Improve insulin sensitivity: There is an association between Insulin Resistance and elevated triglycerides/low HDL. For those patient’s with Metabolic Syndrome, Insulin Resistance or Type II Diabetes, improving insulin sensitivity via a low carbohydrate diet may help to improve lipids.
Diet: Strategies to support healthy cholesterol levels and overall health include eating a diet rich in plant-based foods to increase soluble fiber, and consuming lean meats and fish, which are lower in saturated fats.
Eat a diet rich in plant-based foods.
Fruits: apple, apricot, avocado, banana, blackberry, blueberry, boysenberry, cherry, coconut, cranberry, cucumber, date, dragon-fruit, fig, grape, grapefruit, guava, kiwifruit, kumquat, mango, melons, nectarine, olive, oranges, papaya, passionfruit, peach, pear, persimmon, plantain, plum, pineapple, pomegranate, raspberry, star fruit, strawberry, tomato
Veggies: artichoke, arugula, asparagus, eggplant, beets, chard, bok-choy, broccoli, brussels sprouts, cabbage, carrots, cauliflower, celery, collard greens, endive, lettuce, spinach, greens, mushrooms, okra, chives, garlic, leek, onion, shallot, scallion, peppers, , rhubarb, ginger, parsnip, rutabaga, turnip, radish, squash, jicama, potato, yam, water chestnut, watercress, zucchini.
Grains: amaranth, barley, buckwheat, corn, farro, freekeh, kamut, khorasan, kañiwa, millet, oats, quinoa, rice, rye, sorghum, spelt, teff, triticale, wheat.
Nuts: acorn, almond, beech, breadnut, chestnuts, pistachios, hazelnut, macadamia, cashew
Seeds: pumpkin, hemp, chia, sunflower, ground flax, sesame
Legumes/Beans/Lentils: azuki beans, black beans, black-eyed peas, chickpeas/garbanzos, green beans, kidney beans, lima beans or butter bean, mung beans, navy beans, pinto beans, split peas, soybeans, peas, snap peas
When eating animal-based foods, have a strategy. The American Heart Association recommends for most people to have <10% of their total intake come from saturated fat. This could mean <25 g daily for most people. We recommend focussing on mindfulness, which means looking at it in terms of balance and moderation. Focus on eating very lean and lean cuts of meat most of the time. Look at medium and high-fat meats as once in a while foods. For instance, you may have BBQ ribs on the 4th of July as a special occasion, whereas most of the time, you have lean or very lean protein sources.
When eating dairy foods, have a strategy. Hard cheeses are high in saturated fat, but also very flavorful, so you may only need 1 serving versus 3 at one meal time. Try consuming lower fat options for your everyday routine and higher fat dairy products for the sometimes and once in a while foods.
Remember, there are no bad foods. Each person has their own individual threshold. Do you have questions? Look at your individual weight management plan, protein list or ask us at your next visit!
HAVE A MEASURABLE PLAN IN PLACE TO REACH YOUR WELLNESS GOALS.
Meeting your wellness goals includes setting up steps to reach them. This may include 10% weight loss in 4-6 months. It may include lowering LDL cholesterol by 10% and/or increasing activity to 4-5 days per week. Be realistic in your goals. These goals become habits. These habits become part of your wellness journey for long-term sustainable wellness and quality of life.