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Managing Cholesterol

[Editor's note: I lost the original post I wrote on this topic, which had much more scientific explanation. I'm going to choose to take it as a sign to keep it more simple and practical, since I didn't have the emotional energy to go back and find everything in time to get this posted. But you know I love the science, so let me know if you want it :)]

We discussed the "what" of cholesterol, and today we're talking about the "how". Now that you know what the different components are, it's helpful to know how to make a difference. A few things to think about before we dive into it.

A heart healthy diet is good for everyone! It's not a fad diet, it's not extreme, it's not niche. There are plenty of diseases that make eating difficult, I know! But this isn't one of them. Don't think that if someone in your family needs to lower their cholesterol that you have to cook separately for them. Everyone in your house will benefit from this :)

I always advocate using diet and exercise to improve your cholesterol. While drug therapy can help a lot of people, there are benefits from changing your lifestyle that you just can't get from a pill. Talk to your doctor about ALL of your options before signing up for something!

Without further ado, here are is my top 10 list for managing your cholesterol.

1. Lose excess weight.

Losing just 5-10% of your body weight can make a significant difference in your cholesterol levels. I love this fact, because it means there is measurable difference on the way to a bigger goal. You do not have to get down to a “normal” weight to see the benefits. You will see the benefits in all areas of your lipid panel – LDL, HDL, total cholesterol and triglycerides (TG).

Take for example a woman who is 5’6” and weighs 200 pounds. She has a BMI that classifies her as obese. Her “ideal” weight – according to scientific formulas – is about 130 pounds. Losing 70 pounds doesn’t feel super realistic. But losing 10-20 pounds? That’s doable. Note that even if she loses 20% of her weight, her BMI still is classified as overweight. But she’s made great improvements to her heart health.

2. Exercise regularly.

Aim for 30 minutes of activity on most days. While upping the intensity might burn more calories, duration is actually more important when it comes to cholesterol. So if jogging a little slower means that you can go for 30 minutes instead of 20, it’s worth it! Not only does this help you meet the goal of losing excess weight, getting your heart rate up strengthens your heart muscles. Exercise can have a double effect – by both lowering your LDL and raising your HDL. In fact, it’s one of the few things you can do to improve your HDL. So get moving!

3. Quit smoking.

I’m hoping that this isn’t an issue for you, but I have to say it! It will make exercising a lot easier, and will help raise your HDL levels, as well.

4. Moderate alcohol.

I would never recommend that you start drinking for the health benefits! But, 1 drink per day for women and 2 drinks per day for men can improve your overall heart health. The major caveat is that too much alcohol (i.e. more than 1 or 2 drinks per day) will negatively impact your TG levels. An important distinction is that 1 drink per day is very different than 7 drinks per week. Meaning that if Sunday through Thursday you don’t drink anything, but you have 3-4 drinks on both Friday and Saturday – that’s not moderate alcohol consumption! If TGs are your concern, really stick to that daily limit.

5. Chill out.

Chronic stress is no bueno for your heart. Getting your heart rate up while exercising = good. Getting your heart rate up because you’re pissed or overwhelmed? Not so much. Some people thrive by finding ways for quiet and meditation. I like a strong beat in my headphones while hitting the gym. Whatever works for you!

6. Soluble fiber.

Remember, soluble fiber for cholesterol and insoluble fiber for regularity :) And while most foods contain a combination of the two kinds, some foods are especially rich in the soluble kind. Oats are the quintessential soluble fiber food. But in addition, here are some foods that are pretty easy to get: apples, green peas, black or kidney beans, whole wheat and barley. Increasing your nut and seed consumption can also help!

7. Watch your sugar.

Too much sugar is linked to high TG levels. You’ll notice that the two big things affecting your TG (a fat!) are sugar and alcohol. It’s counterintuitive, but true. If you want the science, let me know. But I won’t overwhelm the masse with that info! In addition to higher TG levels, refined carbohydrates are associated with higher total cholesterol and LDL levels.

8. Fat matters....

But not exactly how you might think. Adding fat in the form of omega-3 fats or monounsaturated fats is beneficial to your heart health, and can lower LDL! You’ve heard this list before, but remember that this is fatty fish, flax and chia seeds, walnuts, almonds, peanuts, olives, avocado, olive and organic canola oils.  

Cutting back on saturated fat – meat, eggs, dairy – can lower your LDL…but only if you replace that saturated fat with other healthy nutrients. Replacing saturated fats with unsaturated fats is better than replacing them with carbohydrates (especially the refined kind). So if you’re looking for a heart healthy alternative to a rib-eye, think tuna steak over bowl of pasta.

Newer research isn’t as concerned about saturated fat intake as previously thought. We now know that the length of the fat molecules makes a difference. You may have heard the term MCTs – for medium chain triglycerides – which is especially high in coconut. MCTs are classified as saturated fats, but the body treats them differently than LCTs (long-chain triglycerides). All this means the issue is not as black and white as we once thought.

Trans fats are still a big problem. Many companies have removed trans fats from their products. But if you buy margarine or packaged sweet treats (cookies, cakes, etc), it’s important to read the label!

9. ...But dietary cholesterol might not.

As we said earlier this week, your body makes its own cholesterol – to the tune of 800-1500 mg per day. Compare that number to the average daily intake of cholesterol: 333 mg for men and 224 mg for women. Which do you think has more impact on what’s floating around in your blood? So eating eggs probably isn’t going to cause your high cholesterol. But reducing your animal food consumption might help you control already high levels.

Cholesterol isn’t something that many people keep track of, so let me give you a couple of numbers to bring it into perspective. One cup of 2% milk or one ounce of cheese each contains about 25 mg. One egg is about 185 mg. An 8-ounce rib eye steak about 186 mg versus an 8-ounce skinless chicken breast about 165 mg.

10. Two “diets” to try: Mediterranean or Whole Foods, Plant-Based.

The Mediterranean Diet has been associated with better heart health and an improved lipid panel. A whole foods, plant-based diet has, as well.


So there you have it. As I always say, trying to do EVERYTHING on this list isn't going to be practical - at least not all at once. What can you do this week to move towards better cholesterol levels?