Lower Your Cholesterol -- If You Must
(January 23, 2018)
Right now – at this very moment – people are embarking on a new journey (new as of this year, anyway) of diet and exercise. Before doing so, the more cautious among us usually go to their doctors for clearance. And many of those, instead of getting a hearty handshake and a "go get 'em, tiger", instead are informed that their blood levels of cholesterol are high and handed a prescription for a medication to lower it. What’s that all about?
Well. Cholesterol is a sort of a waxy substance that is essential in human nutrition, and because of that your body packages it in several different ways and carries them all around in your bloodstream. If your lifestyle and/or genetics is not quite up to snuff, there will be too much of the form of cholesterol in your blood known as "LDL cholesterol". This supposedly means that you are at a higher risk for cardiovascular disease, and that is why your doctor wants you to lower it with a medication.
But now look at this.
1) The majority of people who have heart attacks do NOT have high LDL cholesterol, which immediately raises the issue of whether your LDL level is really all that important to begin with.
2) People over 60 very likely have LESS of a chance of a heart attack if their cholesterol levels are on the high side. And
3) Medications that lower high LDL cholesterol, despite the most valiant efforts of the pharmaceutical companies over many decades to prove otherwise, do not appear to lower your chances of having a heart attack UNLESS you already have had one.
Huh. Maybe LDL cholesterol isn’t the big hairy deal that it’s usually made out to be. Or – and this is probably a better way to look at it – maybe it’s just one of many factors, not all of which we currently understand, that increase the likelihood of cardiovascular problems. And maybe it's not even the most important one.
Statins, the preferred class of medications to lower LDL cholesterol, can’t be taken by everyone. For one thing, they can have some nasty side effects (including cognitive problems, of which, if you can go by the skill level of the average driver, we already have quite enough). They still cost some real money, at least here in the U.S. And some people just plain don’t want to take them.
So – do you really need to lower your blood cholesterol levels? If you do, must you do it with medication? And if not with medication – what else works?
There are four ways that you can lower your LDL cholesterol levels without medication: 1) Exercise; 2) Weight loss; 3) Diet; and 4) Supplements.
1) Exercise. This works the least well of all four of those methods at lowering LDL cholesterol. In fact, it does not work well at all (unless you combine it with a good diet). So then why did I mention it?
Because exercise is one of the bestest things, if not THE absolute bestest thing, you can do for your heart and cardiovascular health. Even though it doesn’t do jack diddly squat for your cholesterol levels. Interesting, eh?
Obviously this is another way to illustrate that lowering your blood levels of LDL cholesterol is NOT AT ALL the same thing as lowering your risk of cardiovascular disease. Exercise all by its lonesome does great things for your heart and blood vessels, and nothing at all to speak of for your cholesterol level.
If you want a healthy heart, you will have to exercise. And if you exercise in addition to eating well, you will get some extra lowering of your LDL cholesterol. Not, as it appears, that that matters all that much.
Increasing exercise will also help you to
2) Lose weight. If you are overweight, losing 5-10% of your body weight by whatever means will most likely result in your LDL cholesterol levels dropping significantly. Losing just ten pounds can drop it by 10%. This is a pretty simple fact, so I will leave it at that and not try to make it any more complicated.
3) Diet. The absolute worst thing to eat for your blood LDL level is trans fat, which despite some media hoopla is still very much with us. Look for “partially hydrogenated fat/oil” on the labels of any foods you are considering purchasing to detect their presence. 2018 is supposed to be the last year that trans fats are present in our food system to any degree, but somehow I have the funniest feeling that that is going change sometime soon. So you will need to keep your eyes peeled for them for a while yet.
Too much saturated fat in your diet will also raise your LDL cholesterol levels. There has been some dispute about this recently, mostly because there is always a cottage industry around to stoke controversy in the name of making a few extra bucks by telling people whatever they want to hear. It is true that “saturated fat” is a broad category that includes many sub-fats of different kinds, and that a few of those sub-fats are not as villainous as others, and maybe even somewhat beneficial. However, most actual foods (including beef, butter and coconut oil) contain far more of the nasty ones than the more benevolent ones. So minimizing saturated fat (particularly if you substitute foods with more unsaturated fats) is still a good thing to do to improve LDL cholesterol levels.
Here is the thing about sugar. Sugar does not affect LDL cholesterol at all. So you could live on jellybeans and marshmallows (ugh) and not see your LDL cholesterol levels even twitch. But that WOULD probably make a mess of your blood sugar and body weight and impair your heart health that way. See what I mean about focusing on just one number?
There are some foods (mostly those with a lot of soluble fiber, which helps to usher saturated fat out of the body) that in themselves have a strong and positive effect on cholesterol levels. If you eat a bowl of oatmeal and two apples for breakfast every day, you’ll see your LDL cholesterol go down by as much as 30%. That is a LOT. A daily cup of beans can lower your cholesterol by 10%. A daily ounce of walnuts or a clove of garlic will give you up to a nine point drop. If you like any of these enough to eat them daily, they are worth putting into your meal plan. And none of these foods will get you in any trouble. (Except, depending on who you socialize with, maybe the garlic.)
4) Supplements. There are several supplements that are very good at lowering LDL cholesterol. But I am probably already trying your patience, so I will leave them for next time.
For today, then, I would like to wind up by saying that there is probably too much focus on lowering LDL cholesterol at the expense of other aspects of cardiovascular health. So if you are otherwise healthy, especially if you try some of these other measures, you should be able to safely avoid medication for it.
--dr. diane holmes
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