Heart disease is the leading cause of death in the United States, but lowering your cholesterol can reduce your risk. However, a quick search on the internet will yield confusing results about exactly how to lower your cholesterol.
On one extreme, we have the low-fat craze which can lead you to believe that butter is the source of all of your suffering. On the other end of the spectrum, the recent popularity of diets like the keto diet may lead you to believe you can’t get enough high-fat foods in your diet.
So now you may be wondering, what is the truth about cholesterol? Newer research takes a more nuanced look at the different types of fats resolving that some may be helpful, while others are harmful. It is also important to consider how exercise and other nutrients, like fiber and sugar, all work together to impact your cholesterol levels and overall heart health.
What is Cholesterol?
Cholesterol is a type of fat found in the bloodstream. Although it gets a bad rep for making your blood vessels sticky and increasing blood pressure, cholesterol actually plays a vital role in the creation of important hormones and also aids tissue growth. However, if your cholesterol gets out of balance, it can lead to unwanted consequences.
Types of Cholesterol
If you’ve ever had your total cholesterol levels tested, you will have noticed that you got several results back. That’s because your total cholesterol is actually made up of more than one type of cholesterol. A standard cholesterol panel will test for the following:
- LDL Cholesterol – also known as Low-Density Lipoproteins, this “bad” cholesterol causes a buildup of plaque in the arteries
- HDL Cholesterol – the “High-Density Lipoproteins” are considered “good” cholesterol because it helps decrease LDL levels and prevents plaque buildup
- Triglycerides – are the fat used for energy and are also found circulating in the blood. High levels circulating in the blood vessels is associated with increased risk for high blood pressure, heart attack, and stroke
Consequences of High Cholesterol
If left unchecked, the plaque buildup from high LDL cholesterol and triglycerides can lead to narrowing of the arteries. This can block blood flow and lead to complications, such as heart attacks, stroke, and carotid or peripheral artery disease.
Risk Factors for High Cholesterol
The following are considered risk factors for developing high cholesterol:
- Family history
- Poor dietary habits
- Sedentary/inactive lifestyle
- Use or exposure to tobacco
The good news is that, aside from genetics, the risks for high cholesterol are within your control.
Nutrition for Managing Cholesterol
While you may already know that diet is closely linked with cholesterol, it can be tough to figure out where to start when it comes to improving your eating habits. Some major players when it comes to cholesterol include fats, fiber, sugar, and alcohol. Let’s break it down.
Fats: The Good, The Bad, and The Ugly
While we used to think a low-fat diet was all you needed to maintain your cholesterol levels within the healthy range; it turns out it’s not that simple (it almost never is). A study published by the Journal of the American Medical Association in 2006 found that simply reducing fat intake did not reduce the risk of heart attacks or stroke and suggested a “more focused” approach. Following this research, more emphasis was placed on the different types of fats found in foods, some helpful and some harmful for cholesterol.
Unsaturated fats, both monounsaturated and polyunsaturated, are considered the “good guys”. These fats are usually liquid at room temperature (think: olive oil) and can improve your cholesterol, preventing the unwanted problems associated with narrowing blood vessels.
Research has found that when you eat more unsaturated fat, your risk for heart disease goes down. Sources of unsaturated fats include nuts, seeds, olives, avocados, and fatty fish. One of the most well-known types of unsaturated fats is called omega-3, found in fish oil.
Saturated fats, found mainly in meat, full-fat dairy, and eggs, and other animal products, have been a controversial topic in the nutrition world recently. Once thought to be a major contributor to high cholesterol, high blood pressure, and heart disease, more recent research indicates that early claims about the role of saturated fats in heart disease were exaggerated.
Most foods with saturated fats are also good sources of protein, necessary for muscle growth and development. For now, dietary guidelines emphasize moderate portions of lean varieties of saturated-fat–containing foods, while still encouraging the intake of beneficial unsaturated fats, too.
By now you’re likely coming to the realization that dietary recommendations are not always straightforward. However, one thing nutrition researchers can definitely agree on is that trans-fats are not your friend. Most trans-fats are man-made and found in processed foods like fast food, Crisco, and Twinkies. It was created to help extend the shelf-life of food but wound up having the opposite effect on heart health.
Not only does trans-fat (in any amount) increase the risk for heart disease, but it can also lead to depression, cognitive decline, and even Alzheimer’s disease. In 2015 the U.S. government called for a ban on trans-fats; however, the food industry was granted an extension on 3-year the deadline leaving these harmful ingredients on the supermarket shelves. Currently, the deadline is set for June 2019 to have complete removal of artificial trans-fats in US food products.
Sugar and Refined Carbs
During the low-fat craze of the 1990s, many foods were processed to remove fat. In many instances, food manufacturers added sugar to low-fat foods to improve flavor. Further, the fear of consuming fat led to an overall increased intake of carbohydrate foods, which were often in refined forms like white bread and pasta. Unfortunately, research has shown us that replacing saturated fat intake with sugar and other refined carbs can actually increase your risk of developing heart disease.
So are all carbs evil, then? Not necessarily. In fact, more and more research is pointing towards the benefits that a fiber-rich diet can have on lowering cholesterol and triglyceride levels. There are two main types of fiber: soluble and insoluble.
Soluble fiber dissolves into a viscous gel when eaten. This helps lower cholesterol by preventing the absorption of dietary cholesterol in your gut. This beneficial fiber can be found in whole grains, dried beans/peas, and most fruits and vegetables.
Insoluble fiber is not easily digestible. Rather, it remains largely intact as it moves through your digestive system, which adds bulk to your stool and helps keep you regular. Insoluble fiber does not have the same cholesterol-lowering effects as soluble fibers, but it does help support healthy digestion. Plus, many good sources of fiber contain both soluble and insoluble types of fiber.
Perhaps you’ve read the touted benefits of red wine and have been tempted to indulge. Unfortunately, the effect of alcohol on cholesterol is not as clear as wine enthusiasts may lead you to believe.
While alcohol intake is associated with a beneficial increase in good HDL cholesterol, to a larger extent it also leads to a detrimental increase in triglyceride levels. Due to this and other risk factors like potential for alcoholism and increased risk of accidents, the American Heart Association (AHA) does not recommend starting to drink alcohol if you do not already do so.
For those who do choose to imbibe, the AHA recommends limiting alcohol to one drink per day for women, and no more than two drinks daily for men.
Exercise and Cholesterol
As the saying goes, “exercise is the best medicine”. This holds true in the context of cholesterol, too.
A study published in the Journal of Atherosclerosis and Thrombosis found that walking even just 6000 steps per day was associated with lower triglycerides and better HDL levels. Unsurprisingly, the same study found that increasing the intensity of exercise (like jogging or swimming) resulted in even more significant benefits.
Is cardio the only answer? Not necessarily. Researchers have shown that strength training is also an effective method to lower total cholesterol.
More specifically, they found that strength training with heavy weight was just as useful as training with lower weight and higher repetitions. However, they emphasize that moderate intensity exercise was more likely to improve lipid profiles over high-intensity exercise. But really, movement of any type, as often as you can, can improve cholesterol levels and reduce risks for heart disease.
Does Body Composition Affect Cholesterol?
Fat Cell Dilemma
Many people assume excess fat is an inactive storage cell, but this couldn’t be further from the truth. Rather our fat cells are very much involved in the regulation of our hormones. With excess fat, they can produce harmful substances called proinflammatory cytokines. As a result, the bad LDL cholesterol levels increases, helpful HDL cholesterol levels are reduced, and the body has a reduced ability to clear out triglycerides. This is especially true for a type of fat called visceral fat which accumulates well below the surface of the skin, wrapping around internal organs, like the liver.
Research published in the Journals of Gerontology has further explored how body composition can affect cholesterol levels. A group of researchers studied a sample of men who were either master athletes, thin but sedentary, or obese. They wanted to determine whether the athletes had lower cholesterol due to their cardiovascular fitness/endurance, or because of their reduced fat mass. Researchers concluded lower percent body fat was the greatest contributor to improved HDL and lower triglyceride/LDL levels, indicating that exercise is what gets you there, but body composition is a primary factor in maintaining healthy cholesterol levels.
Dietary recommendations for lowering cholesterol have become much more sophisticated in recent years. Dietitians are comfortable giving folks the green light for filling up on satisfying unsaturated fats, while still allowing for the inclusion of more lean varieties of saturated fats. Adding fiber, especially the soluble kind, is also beneficial. However, trans fats, refined carbs, added sugars, and alcohol should be limited as they are proven risk factors.
In addition to the above nutrition changes, get moving! Research shows us that exercise of any kind is helpful for improving cholesterol. This appears to be due to the associated reduction of excess visceral fat.
Cholesterol is within your control, so don’t become a statistic. Make these changes and avoid becoming one of the 15 million Americans suffering from heart disease.
Stephanie Troxell is a Registered Dietitian, Certified Diabetes Educator and National Board Certified Health and Wellness Coach from Denver, Colorado. She specializes in theories of behavior change and has assisted thousands of clients from around the world in uncovering their own unique sources of internal motivation in order to promote lasting healthy habits.