10 Top Questions About Lowering Your Cholesterolby Amanda McDonald Health Writer
You’ve heard about “good” (HDL) and “bad” (LDL) cholesterol. You might have heard that your liver makes cholesterol, which helps build cell walls, and you likely definitely know that it also comes from food like eggs, meats, and dairy products. But why is one kind of cholesterol good and the other so bad? And how can too much cholesterol lead to disease? We've got answers to all these questions and more. Read on.
What's the Difference Between LDL and HDL?
LDL stands for low-density lipoprotein. This protein coats cholesterol in your bloodstream to carry it to your body’s tissues, build cell walls, and make hormones—but too much of it leads to plaque buildup in the arteries. “The biggest risk with high LDL cholesterol is the increased risk of heart attack, stroke, and other diseases related to blockages in the blood vessels,” says Micah J. Eimer, M.D., a cardiologist from Northwestern Medicine’s Feinberg School of Medicine in Chicago. High-density lipoproteins (HDLs), on the other hand, carry excess cholesterol back to the liver to be processed as waste, getting rid of what it doesn’t need.
What Are Triglycerides?
Triglycerides are one of the most common fats found in your bloodstream. They're there to use as a backup energy source. But when levels soar, high tris contribute to the hardening of your arteries, increasing your risk for high blood pressure (HBP), diabetes, and obesity, according to the Mayo Clinic. Extremely high triglycerides can lead to inflammation of the pancreas. The usual culprits? Overeating, smoking, hypothyroidism, kidney disease, and certain inherited lipid disorders.
What Are Healthy Cholesterol Levels?
Ideally, your total cholesterol should be 200 or less, according to the Cleveland Clinic in Ohio. You HDL should be 60 or higher, and your LDL below 100. Triglycerides should be under 150. “Putting [these] numbers into context helps guide treatment,” says Seth Martin, M.D., associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore. That’s because LDL measurements don’t always sound the alarm. New research from Ohio University tracked people who’ve had heart attacks who didn’t have high LDL. Age, gender, and family history affect risk, too.
What Impact Does Family History Have?
Maybe you’re a health nut who lives on kale and quinoa. Seriously—that’s great! But sometimes—and this is a bummer, but it’s true—your bloodwork can still reveal LDL cholesterol numbers that are unhealthy. Sound familiar? You might be able to blame your DNA. “If you have a family history of high cholesterol, you could be an exercising vegan drinking rainwater and you're still going to have high cholesterol,” says Dr. Eimer. “Despite your best efforts, you can't outrun your genetics.” This is where medications can come in—more on drug treatments in just a moment.
What Can I Eat to Lower My Cholesterol?
To help lower LDL levels naturally, try a high-fiber diet that includes vegetables like Brussels sprouts and broccoli, fruits like apples and oranges, legumes like beans and peas, plus whole grains, nuts, and seeds, says Amy Shapiro, R.D., founder of Real Nutrition in New York City. “Fiber doesn’t get digested by the body, so it moves through our GI tract and eventually gets eliminated,” she explains. “During its journey it captures free-floating cholesterol and removes it.” The American Heart Association (AHA) says women need 21 to 25 grams of fiber per day, while men need 30 to 38 grams.
Can I Still Eat Meat and Dairy?
Yes, but in moderation. And Shapiro says if you are going to eat meat, make sure the packaging says “'grass-fed' since one-hundred-percent grass-fed beef tends to have more omega-3 fatty acids.” According to the Mayo Clinic, omega-3s help reduce triglycerides in the blood, which can lower blood pressure and help protect the heart—so, go ahead and ask the butcher at your supermarket for the healthier option. Then, swap dairy milk for soy—or add soy to your diet in other forms, like tofu—to help lower LDL cholesterol by 3% to 4%, according to a 2019 study published in the Journal of Nutrition.
What About Eggs?
Chicken eggs—which are naturally high in cholesterol, all of which is found in the yolk—have pros and cons when it comes to heart health, according to The Heart Foundation. They’re a great source of lean protein and heart-healthy omega-3s. Most healthy people can eat seven eggs each week but studies indicate you should limit your egg intake to no more than 2 to 3 eggs per week. However, if you have high cholesterol or diabetes consider using egg substitutes, since the research is mixed. If you’re an egg lover and don’t want to give them up, go for egg whites, which have zero cholesterol.
Does Exercise Help Lower My Cholesterol?
Exercise protects you from cholesterol buildup, according to the AHA. A brisk, 30-minute walk five days each week is enough to meet its recommendation for 150 minutes of moderate to intense weekly activity. “If you exercise more, your good cholesterol goes up and triglycerides go down,” says Dr. Eimer, adding, “When people exercise, they eat better.” A 2018 study found that a 15-week exercise program inspired more than 2,500 college students to snack less and eat more fruits and vegetables—so get moving! Dr. Martin suggests using an Apple Watch or Fitbit to track your power-walking progress.
When Is Medication Needed?
When diet and exercise don’t lower your LDL, or if high cholesterol runs in your family, medication may be the way to go. Statins like Crestor (rosuvastatin calcium), Lipitor (atorvastatin), and Livalo (pitavastatin ) can lower cholesterol by 50% or more, according to Dr. Martin. Another option is Zetia (ezetimibe). Both statins and ezetimibe are pills that are taken daily. Other cholesterol-lowering meds, like Praluent (alirocumab) and Repatha (evolocumab), sometimes complement statins and are self-injected. Talk to your doctor about which medication is right for you.
Is It Too Late to Improve My Cholesterol?
There’s no time to waste: After learning your LDL and HDL cholesterol numbers—and triglyceride count, too!—get started on improving all by following your doctor’s specific guidelines. While creating new habits can be hard, taking the right steps to lower high LDL— including taking medication, if needed—can also help improve other conditions like high blood pressure, heart disease, and diabetes. “The sooner the better when it comes to prevention,” says Dr. Martin. “The longer you do it, the more benefits you accrue.”