Lipid Panel: LDL Cholesterol
Known as the “bad” cholesterol, low-density lipoproteins, or LDLs, carry the majority of cholesterol in the body (about 70 percent) through the bloodstream and distribute it to the cells and tissues. The main problem with LDL cholesterol is that its molecules are oxidized—made toxic—more frequently than other lipid particles. This oxidized form of LDL, which is even more harmful than regular LDL, becomes lodged in arteries, slowing or completely blocking the flow of blood to your heart and other parts of the body. This sets the stage for coronary artery disease and peripheral artery disease, which can lead to heart attack, stroke, or blood clots in other parts of the body. As such, high LDL cholesterol is not something to take lightly; it may result in a major and potentially fatal health problem.
The target range for LDL values has dropped progressively lower over the last decade as scientists have learned more about the substance and the health dangers it poses. The current reference ranges are listed in the table below:
|Reference Ranges for LDL Cholesterol|
|LDL Cholesterol (mg/dL)||Category|
|Greater than 189||Very high|
|160 to 189||High|
|130 to 159||Borderline high|
|100 to 129||Slightly above normal|
|Less than 100||Normal|
|Target Range: 80 mg/dL or lower|
People who have diabetes or a pre-existing heart condition should stay to the lower end of the target range, while those who are in generally good health can keep their LDL around 100 mg/dL. Since cholesterol is needed to make hormones and other vital compounds, very low LDL can actually be detrimental. Some studies have shown a correlative relationship between very low LDL levels and increased risk of cancer and Parkinson’s disease; however, it is unclear whether very low levels precede or follow the onset of these conditions. Researchers are also unsure of the role, if any, that cholesterol-lowering statin drugs play in raising the risk of the two diseases. Men who take lipid lowering medications, for example, have twice the risk of lowered testosterone, which is associated with the progression of heart disease and diabetes. More studies are needed before scientists can say with certainty if very low LDL levels are harmful. And since few people experience this condition, this section focuses on high LDL.
WHAT CAUSES HIGH LDL CHOLESTEROL?
Since LDL cholesterol is part of your total cholesterol, the causes of high LDL cholesterol and high total cholesterol overlap. One or more of the factors below may lead to raised LDL:
- Being overweight or obese (BMI of 25 or above)
- Binge drinking or excessive alcohol consumption
- Chronic stress (elevated cortisol)
- Diets high in refined carbohydrates and sugars, trans fat, and other inflammatory foods
- Family medical history
- High blood pressure
- Insufficient exercise or lack of exercise
- Insulin resistance
- Kidney disease or failure
- Poorly controlled diabetes
Age is also a risk factor for elevated LDL, as men over the age of forty-five and women older than fifty-five are more likely to have raised levels. Men and women within these age groups are encouraged to have blood tests on a yearly basis to more effectively manage their LDL cholesterol.
In addition to heart problems—which include atherosclerosis, coronary artery disease, and heart attack—high LDL cholesterol is associated with increased risk of stroke, peripheral artery disease, metabolic syndrome, kidney disease, and liver disease, as well as low testosterone levels in men. And since insulin resistance and type 2 diabetes often go hand-in-hand with elevated LDL cholesterol, you may want to consider having a blood glucose test if your cholesterol is high.
WHAT ARE THE SYMPTOMS OF HIGH LDL CHOLESTEROL?
While elevated LDL cholesterol does not cause symptoms on its own, heart disease is often indicated by chest pains, dizziness, and shortness of breath. Frequent leg cramps and poor circulation due to blocked arteries may also result. If you experience these symptoms, you should seek medical attention immediately.
HOW CAN HIGH LDL CHOLESTEROL BE TREATED?
Even if high LDL cholesterol shows up on your blood test results, it’s not too late to lower your number and achieve a level that is ideal for you. In addition, with some changes to your lifestyle, you can prevent your level from reaching the point where medication is necessary. The following recommendations can put your LDL level on the right (downward) track.
The most direct way to treat an abnormal lab value is medication, particularly statin drugs—the most effective and widely used pharmaceuticals for bringing down high LDL cholesterol. These include Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin calcium), Mevacor (lovastatin), Pravachol (lovastatin), and Zocor (simvastatin). When using this class of drugs, 100 mg of coenzyme Q10 (CoQ10) should also be taken, as statins are known to deplete the body of this vital nutrient, leading to severe muscle aches. Side effects such as headache, nausea, and fatigue may also occur. Speak to your health practitioner before taking a statin drug. It’s important to note that unless your levels are dangerously high, it’s advisable to try dietary and lifestyle modifications before taking pharmaceutical drugs.
In addition to medication and lifestyle adjustments you may choose to take a nutritional supplement. People who have adverse reactions to drugs may also consider natural therapies like supplementation. The substances listed in the table below have been found to support cardiovascular health and help lower LDL cholesterol. Ask your healthcare provider to recommend an appropriate dosage and suppliers of high-quality products.
|Supplements for High LDL Cholesterol|
|Aged Garlic Extract||600 mg 1 to 3 times daily||Aged garlic extract is used to protect the heart and blood vessels, and is reported to help decrease oxidative stress markers, including those related to blood sugar regulation problems. Aged garlic has also been reported to reduce liver enzymes and fatty liver, as well as decrease the formation of advanced glycation end-products (AGEs), which are implicated in various health problems, such as heart disease, kidney problems, and cancer. Aged garlic is not reported to interfere with blood thinners.|
|Chromium||200 mcg once a day||In addition to lowering triglycerides, total cholesterol, and LDL cholesterol, chromium is reported to improve insulin sensitivity and glucose tolerance.|
|Fiber||Check the product label for dosage guidelines. The recommendation for women is 25 g per day, and for men 30 g per day||Guar gum (Sunfiber) is an excellent source of soluble dietary fiber. Potential side effects include abdominal discomfort and bloating. Excess fiber may also interfere with the absorption of certain nutrients like iron and calcium.|
|Magnesium||250 to 500 mg twice a day||Use magnesium aspartate, citrate, taurate, glycinate, or any amino acid chelate. Supports bone building and balances calcium intake. The ratio of calcium-to-magnesium intake should be between 1 to 1 and 2 to 1. This supplement is reported to improve blood vessel function and insulin resistance, in addition to decreasing LDL cholesterol, total cholesterol, and triglycerides. Also essential for phase-I liver detoxification. If you experience loose stools after taking magnesium, cut your dose in half and gradually increase over the course of a few months. Consult your health-care provider for dosage advice|
|Omega-3 essential fatty acids DHA and EPA (fish oil)||1,000 mg two to three times a day||Fish oil is one of the first supplements recommended by doctors for lowering triglycerides. In addition to its anti-inflammatory properties, fish oil is reported to ower total cholesterol levels and decrease oxidative stress, which is associated with LDL, or “bad” cholesterol. Speak to your doctor before taking if you are on blood-thinning medication, as fish oil may increase the risk of bleeding. Be sure to use only high-quality oils that have been tested for contaminants.|
(pantothenic acid or vitamin B5)
|250 mg two to three times a day||Has been reported to improve cholesterol levels by lowering total cholesterol, LDL cholesterol, and triglycerides, while increasing HDL cholesterol. You may also consider taking a good-quality multivitamin that contains pantethine.|
|Plant sterol esters||1.7 g one to two times a day||Plant sterol esters have been shown to improve cholesterol levels and help lower LDL cholesterol. May interact with blood thinning medications, including aspirin. Effects of plant sterols may be counteracted by ezetimibe (Zetia).|
|Probiotics||5 to 10 billion CFUs two to three times a day||Probiotics help normalize beneficial flora in the CFUs gastrointestinal tract, and are reported to decrease triglyceride and cholesterol levels. They are also reported to improve BUN levels and quality of life in people with kidney disease. It’s best to use heat-stable products that do not require refrigeration. If using an antibiotic, wait three hours before taking probiotics. If diarrhea occurs, decrease your dosage. If this side effect persists for longer than 48 hours, stop taking the supplement and contact your doctor. Live cultures should be guaranteed through the date of expiration on label. For optimal results, take probiotics with meals, as food improves the survivability of the cultures.|
Most healthcare professionals agree that diet and lifestyle changes should always be your first course of action when trying to lower your cholesterol. Even if your LDL cholesterol is not officially high, you should still take the steps needed to prevent your number from climbing upwards. There are plenty of natural approaches that will allow you to attain and maintain an optimal lab value. If you are currently taking medication for high LDL cholesterol, you should adopt these healthy behaviors to keep your medication dosages as low as possible and achieve better overall health.
The most natural way to fight high LDL cholesterol is through lifestyle modifications like quitting smoking, limiting alcohol consumption, exercising regularly, and perhaps most importantly, eating a healthy diet. In fact, a recent study published in the Journal of the American Medical Association suggests that diet may be more important than previously believed. According to the findings, four specific food substances—plant sterols, soy protein, soluble fiber, and nuts—can lower cholesterol by as much as 14 percent when incorporated into a healthy diet. By including these foods in your diet and following the guidelines below, you can eat your way to a healthier LDL level. Keep in mind that this type of diet also promotes the loss of body fat, which helps you lose weight. Reducing your weight by as little as five pounds can have a positive impact on LDL cholesterol levels.
- Add soy protein to your diet. Studies have shown that 25 g per day can lower your risk of heart disease. You can consume this amount easily by eating foods like edamame, tempeh, tofu, soy cheese, soy nuts, soy yogurt, and whole beans, and by replacing cow’s milk with soy milk. However, be sure to stay away from genetically modified soy products, and avoid soy in general if breast or prostate cancer runs in your family. Also keep in mind that soy is a common allergen and should not be eaten in excessive quantities. If you have experienced symptoms such as unexplained achy joints, headaches, fatigue, or chronic sinus problems—common signs of food sensitivities—see your doctor. It may not be a good idea for you to consume soy protein.
- Avoid processed foods. Processed and refined foods often contain unhealthy ingredients such as high-fructose corn syrup, a harmful sugar found in condiments, sauces, snack foods, and sweetened beverages.
- Be careful with your carbohydrate choices. Most people believe that reducing fat intake is the most important factor in lowering cholesterol, but the quality and quantity of the carbohydrates that you eat has a greater impact. Choose bread, cereal, pasta, rice, and other grain products that are made from whole grains, which are rich in fiber and plant sterols. Limit your intake to one to two servings daily, as eating too many starchy carbohydrates is one of the main reasons for the current obesity epidemic in the United States. The most recent USDA dietary guidelines recommend filling no more than a quarter of your plate with whole grains. Vegetables and fruits should make up half the plate (more vegetables than fruits), and the remaining one-fourth of the plate can be filled by lean protein.
- Incorporate fish into your diet. Eating fish like herring, lake trout, mackerel, and sardines will allow you to benefit from the health-enhancing properties of omega-3 fatty acids.
- Increase your intake of fiber, especially soluble fiber. You can do this by eating foods such as apples, pears, prunes, kidney beans, barley, and oatmeal. Leafy green vegetables, including spinach and kale, are also high in fiber, not to mention plant sterols. Consuming 20 to 30 g of soluble fiber per day can decrease your LDL cholesterol.
- Purchase lean cuts of meat and poultry. Make sure they are from grass-fed and free-range animals whenever possible. Your lean protein sources should make up 34 percent of your diet if you are following a modified-carbohydrate, low-glycemic-load diet. You can also follow the USDA’s dietary recommendations, which state that one-fourth of your plate should be filled by lean protein.
- Replace your fat sources. Trans and saturated fats should be swapped for healthier monounsaturated fats, which you can do easily by cooking with nut oils and eating nuts like almonds, walnuts, and hazelnuts. Nuts are also a good source of antioxidants and plant sterols, a substance that is now being added to a variety of foods.
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