How Do I Keep My Cholesterol Down?

Health Professional


I just found out my cholesterol is high and I should watch what I eat. I'm so confused! I don't eat fried foods. I use olive oil. I take the skin off of chicken. I eat a red meat maybe once a week. I eat alot of fish/salmon. I try to walk alot. I'm not a couch potato. I'm not overweight. (I do have a little extra around my stomach) My cholesterol was high one year ago too. I've made an appt with my doctor, but she is probably going to tell me to watch what I eat again!!!! Suggestions??


Dear reader,

I'm sorry to hear that you are having some trouble with maintaining good cholesterol levels despite eating what sounds like a good heart healthy diet. But I am glad that you are taking your cholesterol level seriously and have been following it over the past year.

The first thing I would suggest is to more closely examine your cholesterol profile including the LDL (bad cholesterol), HDL (good cholesterol), and triglycerides. Remember that total cholesterol is a summation of good + bad cholesterol. It is possible to have a high total cholesterol value and still not be at increased risk for heart disease. This is most often seen in pre-menopausal women or young athletic adults who have elevated levels of HDL cholesterol and normal range LDL levels. Also, the LDL component of your cholesterol profile is of particular importance since LDL can greatly affect your risk of heart disease. High values are >160mg/dl and borderline high values between 130-159mg/dl. (see table below regarding cholesterol levels)

If you do indeed have elevated bad cholesterol and assuming no secondary cause is at play such as low thyroid levels, then action is warranted. A good heart healthy diet is generally what you described"low in saturated fats, trans fatty acid, and cholesterol. A very regimented and consistent healthy diet can lower cholesterol levels on the order of 10-30%. Unfortunately, these types of diets are often difficult to maintain and require constant vigilance as bad fats seem to be ubiquitous in everyday food. It's always a good idea to double check what's in the food you eat and drink especially if you didn't have to make it from scratch. There are some foods you can eat that can actively lower your cholesterol. Red yeast rice, cholesterol lowering margarines such as Benecol or Take Control, nuts such as walnuts and almonds, green tea, and soluble fiber such as psyllium and oat nuts have all been shown to have mild to modest effects in lowering your cholesterol.

Exercise is beneficial to improving cholesterol but it depends on how much, how often, and how hard. You mentioned that you try to walk a lot. The general recommendation is not to try but to do at least 30minutes of moderate-intensity (brisk walking) activity on most, if not all, days of the week. There is a clear association between more frequent, higher intensity exercise and improved cholesterol levels. Often times your HDL and triglycerides will improve more dramatically than your LDL. Perhaps this is an area you can improve upon.

If, however, you continue to have high cholesterol despite becoming the poster person for heart healthy living, then it may be time to add medication. The main determination of whether to start medication is based upon your overall risk of having a heart attack over the next 10 years. This determination is based upon your age, gender, blood pressure, smoking status, total cholesterol, and HDL cholesterol. Here is a link to a website from the National Institutes of Health that can help you calculate this. With this information, your physician can then decide whether medication is warranted. Your target total cholesterol and LDL levels will also be based upon this calculation.

I hope you find this overview helpful. Again, I would emphasize that you analyze your complete cholesterol profile and not just your total cholesterol. When you see your doctor for a follow-up visit, I would also emphasize to her that since you continue to have high cholesterol for over a year despite good healthy living, that it may be time to get more aggressive. Please write back to let us know how it goes or if you have any more questions.

Total Cholesterol:
Desirable Less than 200 mg/dL
Borderline high risk 200-239 mg/dL
High risk 240 mg/dL and over

HDL Cholesterol:
Low - Less than 40mg/dl
High - Greater than 60mg/dl

**LDL Cholesterol Levels**
Less than 100 mg/dL Optimal
100 to 129 mg/dL Near Optimal/ Above Optimal
130 to 159 mg/dL Borderline High
160 to 189 mg/dL High
190 mg/dL and above Very High
**Triglyceride Level** **Classification**
Less than 150 mg/dL Normal
150-199 mg/dL Borderline-high
200-499 mg/dL High
500 mg/dL or higher Very high