How to Control High Cholesterol


With so much written in the popular press about high cholesterol and so many TV commercials selling cholesterol lowering medications, I am always surprised by how little my patients know about it. Here’s a little primer on high cholesterol to put you in the know.

Why should you care if your cholesterol is high?

High cholesterol is a risk factor for cardiovascular disease. It has absolutely no symptoms. You will not feel it or even know your cholesterol is high unless you have a blood test. Over years and years it gradually builds up in your blood vessels and can lead to a catastrophic event – like a heart attack or stroke.

Where does cholesterol come from?

  1. Most of the cholesterol in our bodies is produced in our liver. The purpose of cholesterol is to digest fat. That’s why a high fat diet raises cholesterol – if you eat more fat, you need more cholesterol to digest it. Some people, because of their genes, have livers that over-produce cholesterol no matter what they eat. If you are one of them, you will probably need medication to control your cholesterol even if you eat a very low fat, low cholesterol diet.
  2. The rest of cholesterol in our blood comes from food. People who consume too much fat and cholesterol in their diet (more than 200 mg/day) may develop high cholesterol. These people can often successfully lower their cholesterol levels to goal numbers with lifestyle changes alone and avoid medication.

What should your cholesterol profile be?

  • Total Cholesterolless than 200 mg/dl
  • Triglyceridesless than 150 mg/dl
  • HDL (the “good cholesterol”) – greater than 50 mg/dl in men, greater than 55 mg/dl in women and the higher the better in everyone
  • LDL (the “bad cholesterol”) – at least below 130 mg/dl, ideally below 100 mg/dl, and the lower the better in everyone

What foods are high in cholesterol?

Cholesterol is ONLY found in foods that come from animals. If it doesn’t come from an animal – it doesn’t have cholesterol.

Most of the cholesterol is in the visible fat in marbled red meat and pork, in bacon and sausage, the skin of poultry and the yolks of eggs. By contrast, leaner cuts of meat without visible fat, skinless chicken, egg whites and low fat milk are much lower in cholesterol. Red meat of any kind is higher in cholesterol then white meats such as chicken, pork and fish.

Foods that contain cholesterol:

  • meat
  • chicken
  • fish and shellfish
  • eggs
  • dairy products – butter, cheese, whole milk, ice cream.

Foods that do NOT contain cholesterol:

  • cereals
  • fruits
  • vegetables
  • pasta
  • breads
  • rice and other grains.

What are the different types of fat?

Saturated Fats – these are fats that will raise cholesterol (particularly LDL – the “bad” cholesterol). They include fatty fresh and processed meats, the skin of poultry, high fat dairy products like whole milk, cheese, cream, butter, and ice cream, lard, palm oil and coconut oil.

Trans-fats – these are vegetable oils that have been chemically treated by a process called “hydrogenation” that solidifies liquid oils and extends the shelf life of processed foods. They are found in stick margarine, fast foods and store bought baked goods. These fats will raise LDL (the “bad” cholesterol) and lower HDL (the “good” cholesterol). Neither is good. These are bad, bad fats – try to limit them or avoid them altogether. These are culprits that put the “junk” in junk food.

Unsaturated Fats – these are the healthy fats and they do NOT raise cholesterol. (Though, like all fats, they are high in calories.) There are two types:

  • Monounsaturated fats include olive, canola, sunflower and peanut oils.
  • Polyunsaturated fats include vegetable oils – soybean, corn and cottonseed – as well as many kind of nuts and seeds. Another polyunsaturated fat is the omega 3 fish oils that are found in fatty fish such as salmon, tuna and mackerel. Omega 3 fish oils can lower high triglycerides and also have anti-inflammatory properties that help protest against heart attack and stroke.
    NOTE: Omega 3 fish oils can also be obtained by taking over the counter supplements or a prescription medication called Lovaza. The recommended daily dose of omega 3 fish oils is 4 grams or 4000 milligrams (mgs) per day.

5 Steps for Lowering High Cholesterol

  1. Know your cholesterol profile. Get a blood test if you do not know your numbers.
  2. Follow a low fat, low cholesterol diet most of the time, but do not deny yourself pleasurable foods. Moderation is the key. You don’t have to eat perfect – just better.
  3. Exercise! Exercise has so many benefits. Relevant to cholesterol, aerobic exercise will burn up fat and cholesterol in your blood the way a driving a car burns up gas.
  4. Lose weight if necessary.
  5. After a three month trial of lifestyle modifications that includes a low fat, low cholesterol diet, increased exercise and a little weight loss, if your cholesterol profile is still not to goal, take medications if your health provider advises. You may be one of those people who over-produce cholesterol in your liver. If so, BOTH a healthy lifestyle AND medications will be needed to get your numbers to goal. If you do need medications, you will probably need them for life. If you stop taking them, your cholesterol will go right back up again.

Here are some links where you can find more information:

I cover this subject in much more detail and put it into a larger perspective in my book.

Goal Standard is a website to help consumers get their cholesterol to goal.

And here are the official national treatment guidelines health professionals use to treat you. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Guidelines

So, do you have any tips or success stories to share that might help others get their cholestrol under control?

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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