High cholesterol is common. In fact, about one-third of adults in the United States have high cholesterol without even knowing it. Many more may have it without even knowing.1
That's because high cholesterol has no symptoms. But it can still put you at risk of heart disease, said Louis Gleckel, MD. He's an internist and cardiologist (heart doctor) at ProHealth, part of Optum, in Lake Success, New York.
Heart attacks and strokes are two types of heart disease and among the most common causes of death around the world, according to the World Health Organization.2
Your first line of defense? Knowing your cholesterol numbers and keeping them in a healthy range. Dr. Gleckel provides tips on how to get there.
What is high cholesterol?
When we talk about cholesterol, it's usually about the amount of fat in your blood. Doctors measure four things:
- Total cholesterol
- Low-density lipoproteins (LDL)
- High-density lipoproteins (HDL)
- Triglycerides
You may hear this called a lipid panel, which consists of the four numbers grouped together.
- Total cholesterol: This is exactly what it sounds like — the total amount of cholesterol in your blood. A healthy range is generally 200 milligrams per deciliter (mg/dL) or less.3
- LDL cholesterol: This is known as the "bad" type of cholesterol. It causes fatty buildup in the arteries, which increases the risk of a heart attack or stroke. A healthy range is generally 100 mg/dL or less.3
- HDL cholesterol: This is known as the "good" type of cholesterol. It carries the bad LDL away from the arteries and back to the liver. Then, it's broken down and passed from the body. A level over 60 mg/dL is ideal. Men should aim for 40 mg/dL or higher. Women should aim for 50 mg/dL or higher.3
- Triglycerides: These are a different kind of blood fat. They're how the body stores extra calories and are not part of your total cholesterol number. But like LDL, high triglycerides can also cause buildup in the arteries. Aim for 150 mg/dL or less.3
Looking at these four numbers together gives a clearer picture of your heart health, explained Dr. Gleckel.
The American Heart Association suggests that adults age 20 years and older have their cholesterol checked every 4 to 6 years.4
If you're older or have other risk factors, your doctor may want to check your numbers more often.
What causes high cholesterol levels in the first place?
Too much saturated fat, sugar, and calories can raise bad cholesterol. Saturated fat is mostly in meat and dairy products, along with tropical oils like coconut and palm.5 Not being active can lower good cholesterol.
Smoking is another cause of high cholesterol. It can raise LDL and lower HDL cholesterol.
But high cholesterol isn't just about what you eat or how little you move. Your family history also plays a part.
You can inherit medical problems that make it hard for the body to handle cholesterol. One is called familial hypercholesterolemia. About 1 in 250 people have it.6 But you can have cholesterol problems without it.
"Sometimes you have bad genes, which aren't your fault," said Dr. Gleckel. "Your responsibility is to take care of it."
5 tips for lowering cholesterol levels
"If their levels aren't terribly high, I like to start with lifestyle changes," explained Dr. Gleckel. Making changes to your meals and moving more can make a big difference.
1. Get moving
Exercise can increase HDL cholesterol. You should aim to get at least 30 minutes of moderate physical activity on most days of the week. You know you're working hard enough if you can talk but not sing.
And being active doesn't mean you have to hit the gym daily. Going on a few 10-minute walks each day could be a good place to start.
2. Cut back on refined carbs
Dr. Gleckel suggests cutting back on refined carbs. That includes pasta, white bread, and sugary snacks and drinks. Those foods can raise LDL cholesterol. Swapping in whole grains and other high fiber foods will improve your numbers. Good choices include vegetables, fruit, beans and legumes.
3. Eat the right fats
You may have grown up hearing that you need to eat low fat foods and stay away from cholesterol. That has been largely debunked. Doctors now better understand the role of different kinds of fats:
- Trans fats: These are mostly artificial and were once most often added to processed foods. But Food and Drug Administration (FDA) regulations now prevent their use in the food supply.7 Still, check labels on items like margarine and snack foods. You want to see zero grams of trans fat.`
- Saturated fats: The main sources are animal foods, including red meat and dairy. Aim to limit these foods, but you don't need to cut them out completely. "You can have some steak on a special occasion, maybe once a week, but not every night," said Dr. Gleckel.
- Unsaturated fats: These are the "good" fats. They can help raise your good cholesterol and lower the bad. They're in plant foods such as nuts, seeds, avocados, olives, plant-based oils, and fish. Tip: Use olive oil in place of butter when cooking.
4. Pay attention to how you grocery shop
"I tell people to pay attention to how they shop because how you shop is how you eat," said Dr. Gleckel. And be sure to involve the whole family.
If you're not the one doing the shopping and cooking, get that person on board. Plus, making lasting changes is easier if the whole household makes the commitment.
5. Make it a family affair
Dr Gleckel advises to use exercise as a time to connect with your family. Go for a bike ride or play a sport with your kids. Take a walk after dinner with your partner or a friend. It can be a chance to decompress and chat at the end of the day.
Your family can keep you motivated and hold you accountable. "If you have teenage [or adult] kids and they know you have a cholesterol problem, they'll push you to do better. They don't want to lose you," he said.
What if you're the only one with high cholesterol? That's OK. Everyone can benefit from eating a little better and moving more.
6. Work with a doctor on a personalized plan
Your doctor can help you adopt a heart-healthy eating plan that works for you. They can also help determine whether medicine is the right choice.
You can also ask to meet with a registered dietitian. They can look at what you eat and help you set goals that fit your lifestyle.
Does everyone with high cholesterol need medicine?
Medicines can help lower cholesterol, but they're not always necessary. "Not everyone can change how they live," Dr. Gleckel said. At least not overnight. If it's important to improve your numbers quickly, your doctor will likely prescribe a drug called a statin to help.
More than 40 million adults in the United States take statins.8 They reduce the amount of cholesterol your body makes and help it get rid of the excess. "They save a lot of lives," noted Dr. Gleckel.
Statins are safe for most people, and they don't have many side effects. Some people report joint and muscle pain on statins. Dr. Gleckel often prescribes a Co-Q10 supplement to help with the pain. Ask your doctor if that may be right for you.
Do you have to take statins for the rest of your life?
"If you start on statins, you are usually on them for the rest of your life," explained Dr. Gleckel. "But not always." Continue working on eating better and moving more, even if you're taking medicine. Eating well and exercising have a lot of other benefits. Eventually, it may be enough to keep your cholesterol in check without medicine.
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Summary
Every small change you make adds up to a healthier, stronger you. Whether adjusting your diet, getting active, or discussing medicine choices with your doctor, lowering your cholesterol doesn't have to be complicated.
Your doctor is there there to support you every step of the way. They can connect you to resources, expert advice, and personalized care and help you make informed decisions about your health.
They work together witih you to help you feel your best for the long haul.