When it comes to cholesterol, there’s a lot to know — and making sense of cholesterol can be tricky. Is cholesterol “bad”? What do your cholesterol numbers mean when you get them checked at your doctor’s office? Are eggs off limits? And should you be taking medicine to lower your cholesterol? Let’s get these questions answered!
Not necessarily. Cholesterol is a waxy, fat-like substance that is found in all the cells in your body. Your body needs cholesterol for certain things, such as making hormones, vitamin D, and substances that help you digest food. We make all the cholesterol that we need. If there’s too much cholesterol in the blood, however, that’s when it can become a problem. Too much cholesterol can lead to plaque buildup in the arteries (called atherosclerosis). If the arteries get narrowed or blocked by plaque, it’s called coronary artery disease, or CAD, for short. People with diabetes have a higher risk of CAD than people without diabetes.
When your health care provider checks your cholesterol, he or she may order what’s called a lipid profile. Included in the lipid profile are HDL and LDL cholesterol. HDL (high-density lipoprotein) is the “good” cholesterol because it carries cholesterol back to the liver. The liver then flushes it from the body, helping to lower your risk of heart disease and stroke. LDL (low-density lipoprotein) is the “bad” cholesterol because it raises the risk of heart disease and stroke. There’s another lipoprotein that might be measured: VLDL, or very-low density lipoprotein. This lipoprotein carries triglycerides, a kind of fat, in the blood. High triglycerides can also raise the risk of heart disease and stroke. Triglycerides are also typically included in a lipid panel.
Cholesterol numbers are measured in milligrams per deciliter (mg/dl). Cholesterol goals can be different, based on age and other health conditions, so you should always check with your provider about your own goals. Here are general goals for people with diabetes:
There are certain factors that can make it more likely to have high cholesterol, including:
It’s important to know your risk factors. While you can’t change your family history, age, or race, you CAN make changes to your diet, weight, and level of physical activity, and you can take steps to stop smoking and drink less alcohol.
The short answer is yes! All foods that come from animals contain cholesterol (animals have livers, too!). But when it comes to your blood cholesterol levels, it’s really the type of fat that you eat that affects your cholesterol. Saturated fat, which is solid at room temperature, is the main driver of high cholesterol levels. Foods high in saturated fat include butter, lard, cheese, and red meat. Trans fat, another unhealthy fat, can also raise blood cholesterol. Cholesterol in food has little to no effect on your blood cholesterol levels.
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Again, the answer is yes! If your cholesterol is high, don’t get discouraged. Focus on eating foods that can help you lower your cholesterol. Soluble fiber, a type of fiber that binds to cholesterol in the digestive tract; unsaturated fats, which lower LDL cholesterol; and plant sterols and stanols, which prevent the body from absorbing cholesterol, are foods to include in your eating plan. Foods high in soluble fiber include:
Foods rich in unsaturated fats include:
Foods that contain plant sterols and stanols include:
If your HDL cholesterol is below 50 if you’re a woman or below 40 if you’re a man, there are some lifestyle changes that may help give it a boost. These include:
There isn’t enough evidence to recommend taking medication to raise HDL cholesterol. And keep in mind that having a high HDL cholesterol doesn’t “override” having a high LDL cholesterol — you still need to focus on getting your LDL to a safe level.
Some people can achieve healthy cholesterol levels by making lifestyle changes. But some people may also need to take medication to manage their cholesterol levels. These include:
Talk with your provider about your risk factors and if you should start on a medication to lower your cholesterol. Remember that cholesterol-lowering medication is not a substitute for making healthy lifestyle changes.
All medications have side effects — some more so than others. Whenever your provider recommends that you start taking any type of medication, be sure to talk about the pros and cons to make sure that it’s right for you. Statins are potent, effective medicines that help to lower LDL cholesterol and protect against heart attacks and strokes. The American College of Cardiology states that “statins are very well tolerated and about 85-90% of patients report no side effects.” The most worrisome side effects include muscle pain and damage, liver damage, memory loss or confusion, and an increased risk of type 2 diabetes. Keep in mind, though, that not everyone who takes a statin will have side effects. You may be at risk for side effects if you:
Most people can safely take a statin with few, if any, side effects. If you’re concerned about taking a statin, talk with your provider and decide, together, if this is the best medicine for you. And if not, there are other types of cholesterol-lowering medicines that can be prescribed.
There are some dietary supplements that may help you lower your cholesterol. But before you rush to start taking a supplement, realize that, like medications, supplements can have side effects and may interact with medications that you’re taking. Don’t be fooled into thinking that because supplements are “natural” they are automatically safe to take.
Here are a few supplements that can help lower cholesterol and/or triglyceride levels:
Fish oil, flaxseed, and green tea extract may interfere with blood thinning medication; niacin can cause itching and flushing at high doses; and psyllium, flaxseed, and berberine may cause gas, bloating, and diarrhea.
Another supplement that is often touted to lower cholesterol is red yeast rice. Red yeast rice products may not be safe — some may contain monacolin K, which is chemically identical to the active ingredient in lovastatin, a drug used to lower cholesterol. Other red yeast rice products might contain citrinin, which could cause kidney failure. Despite actions from the FDA, some red yeast rice products on the market in the U.S. may contain monacolin K, although it’s practically impossible to know which ones do or don’t. It’s best to avoid taking this supplement; definitely don’t use red yeast rice if you are pregnant or nursing, or if you are already taking a statin.
Want to learn more about maintaining healthy cholesterol levels? Read “Natural Ways to Lower Your Cholesterol,” “Statin Alternatives: Other Medications That Can Lower Cholesterol,” and “HDL: Nine Ways to Lower Your Cholesterol.”
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