Healthy Cholesterol Levels

We have all heard of cholesterol. What exactly is cholesterol and the different types? How do we check for problems with cholesterol? At what age should we be screening for problems with cholesterol? How do we manage high cholesterol from lifestyle interventions? These are all questions that will be discussed in this article.

Heart disease is the #1 killer in the United States and is rapidly growing. It affects 1 in 4 adults (about 85 million Americans). It is estimated that 7% of U.S. children ages 6-19 have high cholesterol and that 90% of heart disease is preventable. This is indicating that lifestyle factors are at the forefront of our approach to preventing and treating heart disease. 

Cholesterol is a waxy, fat like substance that is found in all cells in your body. Your body makes and needs cholesterol to make hormones, vitamin D and substances that help you digest your food. Cholesterol is found in foods from animal sources such as egg yolks, meat and cheese. 

Too much of a good thing is at play here. If you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque, which sticks to the walls of arteries and can lead to coronary artery disease, where the arteries in your heart become narrow or worse, blocked. This could lead to a heart attack or stroke. 

There are different types of cholesterol: All are a combination of fat (lipids) and proteins. 

> HDL-(high density lipoprotein) is “good cholesterol” that carries cholesterol from other parts of your body back to your liver which is then removed from your body. 

> LDL-(low density lipoprotein) or the “bad cholesterol” because at high levels can lead to build up of plaque in your arteries. 

Triglycerides are the fat content of the blood, excess carbohydrates gets stored as fat. 

> VLDL- (very-low-density lipoprotein)-your liver makes VLDL and releases it into your bloodstream. The VLDL particles mainly carry triglycerides. VLDL is similar to LDL cholesterol, but LDL mainly carries cholesterol to your tissues instead of triglycerides. 

The term dyslipidemia means there is a problem with cholesterol metabolism. This could lead to increased levels of total cholesterol and LDL cholesterol, a varied presentation of triglycerides and/or decreased HDL. Problems with cholesterol can be genetic in regard to family history or acquired. Acquired dyslipidemia can result from obesity, medications, excess alcohol, metabolic disorders, liver disease and other causes such as anorexia.

Familial hypercholesterolemia (elevated cholesterol) is the most common congenital metabolic disorder resulting from a mutation in the LDL receptor or another mutation in protein genes which do not allow the cells to rid themselves of LDL cholesterol through the liver. High cholesterol does not typically present with symptoms which makes this more imperative to check in adults and screen children as well. The cholesterol panel is an indication of overall cardiovascular disease. 

At Empowered Health, we pair this cholesterol panel with other markers of overall inflammation and insulin resistance as a more comprehensive approach to predicting cardiovascular events. 

When to begin screening? 

Screening for cholesterol should begin around 9-11 years of age. Patients that have a strong family history of heart disease or high cholesterol, it is recommended to begin a lipid profile at this time and then again around 17-19 years of age. Adults should have cholesterol panels more often. 

Lifestyle Management: 

Dietary changes are the forefront of lifestyle intervention, that really begin from birth. Too many carbohydrates in our daily diet are being stored as fat due to an overconsumption vs what is needed for fueling our bodies. This increased fat causes insulin resistance to further complicate matters. Making changes in our diets is a great first step: 

• Increasing fiber in our diets from foods is so important
• Switching olive oils, or avocado oils can drop LDL cholesterol
• Refraining from corn fed red meat
• Vegetables are the top nutrient-dense foods high in vitamins, minerals and fiber  
• Nuts and seeds are rich in fiber and healthy fats that assist with lowering cholesterol and decreasing triglycerides
• Fatty fish such as salmon are packed with omega 3 fatty acids which relieve inflammation and decrease cholesterol
• Turmeric is a powerful compound that can reduce levels of total and LDL cholesterol in the blood 
• Gluten- free whole grains have been associated with lower levels of cholesterol and improved heart health, such as buckwheat, quinoa and brown rice
• Foods to avoid: sugar and refined carbohydrates, alcohol, caffeine, and trans fats. Lastly, smoking causes detrimental effects on the arteries and increased plaque formation
  

Exercise:  

When it comes to reducing cholesterol levels, getting adequate physical activity is as essential as making changes in your diet. Children need at least 1 hour of moderate-vigorous physical activity every day, while adults should opt for 150 minutes of cardiovascular activity per week. 

Making small changes in your diet and increasing cardiovascular exercise each week can prove very beneficial in reducing cholesterol, inflammation and insulin resistance. Always be sure to discuss with your healthcare provider to find the best course of treatment for you. 

References: 

Cholesterol. Medline plus.gov 

Pediatric Primary Care. C. Burns. 6^th edition 

Functional medicine: Cholesterol. IFM.org