Tips To Lower Your Cholesterol

Cholesterol is a waxy fat-like substance that is absorbed from the intestines during digestion and is also manufactured internally by the liver — and by every cell in our body. The majority of cholesterol circulating in our blood does not come from the foods we eat, but is rather manufactured internally. Cholesterol is a component of every cell wall and serves as a substrate for the formation of hormones and bile (which helps us digest food). Most of us have too much of it circulating in our bloodstreams.

High cholesterol has multiple potential causes including genetics, physical inactivity, excess weight, and — most importantly — poor diet. In general, genetics alone are typically not the entire reason for high cholesterol. Even when people have genetically driven high cholesterol, other lifestyle factors usually coexist and make the numbers worse, sometimes markedly so.

LDL is the Lousy cholesterol — and we want to keep our LDL number Low. LDL (low-density lipoprotein) is the form of cholesterol that can deposit in our arteries and cause blockages. It is the major target for cholesterol treatment.

You can think of LDL as garbage. It's what's left over from other circulating cholesterol particles after the body has extracted all it needs. Because all our cells can make cholesterol internally, LDL does not serve much of a biologic purpose — and it's easy to see why high LDL could cause blockages to build up.

HDL is the Happy cholesterol — we want to keep our HDL number High. HDL (high-density lipoprotein) is not depositing in our arteries but rather is on its way out. So we want as much of our total cholesterol in the HDL form. Although high HDL levels are felt to be protective, they are not an absolute guarantee against heart events.

Most people think that eating foods high in cholesterol are the worst for raising blood cholesterol. That's actually not the case. It's the overall composition of foods that really determines blood cholesterol levels — especially their saturated fat and simple carbohydrate content.

Saturated fats (solid at room temperature, from butter, cheese, beef marbling, chicken fat, egg yolks) can be very potent stimulants for raising LDL in some people. Simple/processed carbohydrates (white bread, white rice, cakes, cookies, added sugar) are also big stimulants for raising cholesterol.

The main culprits are foods high in saturated fats and/or simple/processed carbohydrates. Eating to lower cholesterol does NOT mean eating a low fat or low carb diet — it means choosing healthy fats and healthy carbs instead.

Healthy fats are unsaturated (liquid at room temperature): olive oil, nut and seed oils, avocado, fish. Healthy carbs are complex/unprocessed: steel-cut oats, whole fruits, whole grains. These are high in fiber and plant sterols and are absorbed slowly, preventing blood sugar spikes.

Every time we eat, bile (which is cholesterol-rich) is squeezed into the digestive system to help digest food. Normally we reabsorb unused bile to maintain an adequate supply. The more bile we fail to reabsorb, the more circulating cholesterol we need to pull from the bloodstream to make more bile — which means circulating cholesterol levels drop.

Fiber wastes bile because we can't digest it. A bile molecule attaches to a fiber molecule and tries to digest it — but before it figures out this is futile, it's past the point of no return. People who eat high-fiber diets waste more bile and therefore have lower cholesterol levels.

Plant sterols are the plant versions of cholesterol. They leverage the bile circulation system in a clever way: they trick the body by being similar enough to bile cholesterol that the body tries to reabsorb them — but because they're structurally slightly different, they can't get through the bile absorption sites, effectively blocking them. This means we waste more bile and LDL levels drop.

Most cardiologists would say LDL should definitely be below 130 mg/dL, with optimal levels below 100 mg/dL in otherwise healthy individuals. If you have known heart disease, diabetes, OR familial hypercholesterolemia, your LDL should be closer to or below 70 mg/dL. Attaining LDLs below 50 mg/dL is additionally protective for those who have had multiple cardiovascular events. As a reference point, people in Blue Zones (areas of exceptional healthy longevity) have average LDL levels around 90 mg/dL.

People who should be on statins include those with known atherosclerotic cardiovascular disease, those with diabetes, and those with familial hypercholesterolemia (LDL over 190 mg/dL regardless of lifestyle). In everyone else, lifestyle efforts — and especially dietary adjustments — should be tried first. Consideration should also be given to checking a coronary calcium scan before starting statins in someone with elevated LDL who does NOT have heart disease.

Cholesterol levels can change very quickly in response to diet. In studies where every morsel of food was controlled, LDL fell to its lowest attainable levels within 2 weeks! In a real-world setting, using Step One Foods consistently can yield meaningful cholesterol reductions in most people after just 30 days.

YES! It's so common for people to think that because they take a medication to lower cholesterol they no longer need to pay attention to what they eat. If you eat in a way that supports lowering cholesterol, you will need lower doses of medications to get to your cholesterol goal. Turns out, for any cholesterol reduction, risk is lower if the reduction was achieved with the combination of medications AND diet.