Lipid Panel: Total Cholesterol
Cholesterol has received a lot of negative attention in the past decade. The word alone stirs up images of a “bad” substance that is not wanted in the body. However, this is not entirely accurate; cholesterol is an essential fat that contributes to your normal biological functioning. Produced by the liver, cholesterol is required to create cell membranes as well as bile acids for fat digestion. Cholesterol is also the principal building block of many of your hormones—including estrogen, testosterone, and progesterone—and it plays a vital role in vitamin D production. Although the body naturally manufactures cholesterol, it is also acquired through dietary sources such as beef, dairy products, and eggs.
Like triglycerides, cholesterol circulates throughout the body, aided by lipoproteins in the blood. In general terms, high-density lipoprotein, or HDL, is the so-called “good” cholesterol because it carries cholesterol away from the arteries to the liver, where it is eventually removed from the body. Low-density lipoprotein, or LDL, on the other hand, is considered the “bad” cholesterol because it transports the substance through the bloodstream, creating the risk of clogged arteries. LDL cholesterol is the type that contributes to heart disease when levels become too high. There is also very low-density lipoprotein, or VLDL, which is mostly composed of triglycerides that convert to LDL in the blood, thereby raising the level of “bad” cholesterol.
The particle size of HDL and LDL, which is measured by Vertical Auto Profile (VAP) or NMR lipid profile tests, is also important in determining cholesterol’s total effect on the body. Large HDL particles are considered more beneficial than their smaller counterparts, and are associated with a lower risk of heart disease. Recently, doctors have started to measure oxidized LDL, a value representing the amount of damaged cholesterol in your blood, which can lead to plaque buildup and, eventually, atherosclerosis.
Total cholesterol is the sum of HDL, LDL, and VLDL measurements. The next table lists the reference ranges used by most labs for this value.
While it is possible to have very low total cholesterol levels, this condition is rare. People with abnormal cholesterol readings usually fall into in the “borderline high” or “high” categories. High cholesterol, or hypercholesterolemia, may be due to one or several factors.
|Reference Ranges for Total Cholesterol|
|Total Cholesterol (mg/dL)||Category|
|Greater than 239||High|
|200 to 239||Borderline high|
|Less than 200||Desirable|
|Target Range: 150 to 200 mg/dL|
WHAT CAUSES HIGH TOTAL CHOLESTEROL?
There are several reasons for total cholesterol levels that are high, borderline high, or simply not ideal. If your blood test results are abnormal, your doctor will review your medical history and request additional blood work to determine the cause. Some causative factors include:
- Being overweight or obese (BMI of 25 or above)
- Bile duct obstruction
- Binge drinking or excessive alcohol consumption
- Certain medications, such as progestin and steroids
- Chronic stress
- Diet high in refined carbohydrates and sugars, as well as trans fats (partially hydrogenated oils)
- Environmental toxicity due to heavy metals, pesticides, or other contaminants
- Family medical history
- Food allergies
- Insufficient exercise or lack of exercise
- Insulin resistance
- Intestinal conditions
- Kidney disease
- Poorly controlled diabetes
- Sex hormone imbalance, particularly as regards DHEA, estrogen, and testosterone
- Underactive thyroid (hypothyroidism)
- Vitamin C or E deficiency
Research has also indicated that some people may experience increased cholesterol levels during the winter months. Scientists have not determined what triggers this change—alterations in blood chemistry and reduced exercise are two possibilities—but it should be taken into consideration when evaluating blood test results.
High cholesterol may lead to a number of medical complications, many of which can be life threatening if left untreated. Like high triglycerides, elevated cholesterol can cause atherosclerosis, which is usually a precursor to coronary artery disease and increases the risk of heart attack and stroke. Angina (chest pain) and transient ischemic attacks (TIAs), or “little strokes,” are also potential complications. In addition, high cholesterol contributes to problems that affect other parts of the body besides the heart. These conditions include diabetes and insulin resistance, kidney disease, liver disease, general inflammation, and metabolic syndrome.
WHAT ARE THE SYMPTOMS OF HIGH TOTAL CHOLESTEROL?
High cholesterol alone does not produce any physical symptoms. If the risk factors for high cholesterol—such as smoking, lack of physical activity, and poor diet—apply to you, have your lipid levels tested. Do not ignore warning signs such as chest pain or shortness of breath, as they may indicate a serious problem that might be related to elevated cholesterol levels.
HOW CAN HIGH TOTAL CHOLESTEROL BE TREATED?
High cholesterol can be managed effectively with medication, but a healthy lifestyle is vital for maintaining balanced cholesterol levels. Below are some recommendations for treating the condition to discuss with your physician. When cholesterol is very high, it is often necessary to prescribe a drug that will quickly bring your level within a healthy range. Your doctor may recommend one drug or a combination. Take every substance prescribed to you only as directed. If you experience any persistent side effect or symptom that concerns you, consult your medical provider. Your prescription may need to be changed.
When cholesterol is very high, it is often necessary to prescribe a drug that will quickly bring your level within a healthy range. Your doctor may recommend one drug or a combination. Take every substance prescribed to you only as directed. If you experience any persistent side effect or symptom that concerns you, consult your medical provider. Your prescription may need to be changed.
|Drugs for High Total Cholesterol|
|Bile acid sequestrants (colestipol, cholestyramine) Colestid, LaCholest, Prevalite, Questran||Potential side effects include blurred vision, diarrhea, fatigue, headache, liver problems, loss of appetite, memory loss, nausea, and vomiting. Bile acid sequestrants can also increase your risk of bleeding and deplete the body of essential nutrients, such as beta-carotene, calcium, folic acid, iron, magnesium, phosphorus, vitamin B12, vitamin D, vitamin E, and vitamin K. Therefore, it is recommended that you take a daily vitamin or mineral supplement while using bile acid sequestrants.|
|May cause side effects such as diarrhea, joint pain, and increase in infections. Long-term side effects, like gall stones, muscle weakness, and liver problems, are also possible. This drug can deplete essential nutrients from the body, including vitamin D. You should take 1,000 IU of vitamin D3 daily when using ezetimibe.|
|Niacin (extended-release)||Speak to your healthcare provider before using if you are on blood-thinners or diabetes medication. Extended-release niacin usually does not cause flushing.|
|Statins (atorvastatin, rosuvastatin, lovastatin, pravastatin) Lipitor, Crestor, Mevacor, Pravachol||Statin drugs can deplete essential nutrients from the body, including CoQ10, vitamin D, and vitamin E. Take 100 mg of CoQ10 daily along with a multivitamin or mineral supplement to prevent nutritional deficiencies. Side effects may include headache, muscle pain, nausea, weakness, elevated liver enzymes, memory loss, and kidney problems. Inform your doctor or pharmacist if you are currently on cholesterol-lowering drugs to avoid adverse drug interactions. Do not take with grapefruit juice.
Nutritional supplements are also effective for enhancing general health and well-being, and may be a better option for those who have adverse reactions to drug therapy. A prominent cardiology researcher at the University of Minnesota, for example, discovered that he could not tolerate cholesterol-lowering statins, and had to turn to diet and supplements to lower his cholesterol. The nutritional supplements listed in the table below support healthy cholesterol levels. Speak to your doctor before taking any of these substances.
|Supplements for High 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.|
|Artichoke Extract||250 mg to three times a day||This supplement is reported to improve cholesterol balance by reducing total cholesterol and LDL cholesterol levels. Do not use if you have an allergy to plants in the daisy family, such as aster, dandelion, goldenrod, and yarrow. If you have liver or gall bladder problems, or digestive issues, consult your medical provider before taking artichoke. Use a standardized extract.|
|Coenzyme Q10 (CoQ10)||30 mg three times a day or 50 mg twice a day, depending on dose per capsule||CoQ10 is important for energy production, oxygen (CoQ10) use, high blood pressure, and heart health, especially in people with kidney disorders. It can also boost . endurance, improve insulin sensitivity, and lower triglycerides and blood glucose levels. This supplement is especially recommended if you are taking statin drugs, red yeast rice, and certain diabetes medications, which may result in a CoQ10 deficiency.|
|Omega-3 essential fatty acids DHA and EPA (fish oil)||1,000 mg two to three times daily||In addition to its anti-inflammatory properties, fish oil is reported to lower total cholesterol levels and decrease oxidative stress, which is associated with DHA and EPA 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.|
|Plant sterol esters||1.7g one to two times daily||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 daily||Probiotics help normalize beneficial flora in the 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 heatstable 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.|
Although lifestyle often contributes to high cholesterol, it can also be the key to lowering it. By following the guidelines below, you will be able to reduce and control your cholesterol levels. Even if high cholesterol is not a present worry, incorporating these behaviors into your daily life will help you keep your level in check.
- Avoid inflammation-causing foods. These foods can increase oxidation of cholesterol, making it more likely to build up in the arteries and form plaque. Stay away from foods that contain refined and added sugars like high-fructose corn syrup, which is often added to condiments, sauces, commercially produced snack foods, and sweetened beverages. Refined carbohydrates (white bread, pasta, bagels, and other foods made from white flour), processed and smoked meats, and fried foods should also be eliminated from the diet.
- Break bad habits. Smoking and regular alcohol consumption are unhealthy behaviors that can contribute to health problems. Studies show that ending these habits have a positive impact on your total cholesterol level.
- Consume healthy fats. Good fats are required for nutrition, and new studies show that moderate intake has a positive impact on your health. You can incorporate these fats into your diet by cooking with high flash-point oils, such as macadamia oil and other nut oils. Add olive oil only to foods that have already been prepared, since it breaks down easily when heated. If you must use butter, switch to organic butter for a purer product; avoid margarine, which is loaded with partially hydrogenated oils. Finally, start snacking on nuts like almonds, Brazil nuts, hazelnuts, pecans, and walnuts, which are all great sources of healthy fats. However, most nuts are calorically dense, so eat them sparingly.
- Eliminate trans fats. Hard margarine, fried and processed foods, and commercially baked goods—including breads, muffins, cookies, and pastries— usually contain partially hydrogenated oils, which are the primary source of trans fat. Stay away from these foods, as trans fats have been shown to raise LDL (“bad”) cholesterol levels and lower HDL (“good”) cholesterol. It’s important to note that foods can still contain trans fat even if its nutrition label claims otherwise. Make sure partially hydrogenated oils are not listed as ingredients before buying any packaged food item.
- Exercise. Studies have conclusively shown that physical activity plays a significant role in lowering cholesterol. Begin by exercising for twenty- to thirty-minute sessions at least three to four times a week, and gradually increase the duration and level of intensity. An ideal fitness routine includes both aerobic exercise and strength training.
- Get rid of belly fat. A large waist circumference is a tell-tale sign of high cholesterol. To lower your total cholesterol level, you must lose abdominal fat.
- Get your hormone levels checked. Low testosterone levels in men are associated with hyperlipidemia and heart disease, as is the absence of the hormone estradiol in post-menopausal women.
- Go green. Green tea, which is rich in antioxidants and compounds known as polyphenols, has been found to lower total cholesterol and raise HDL levels simultaneously. Research suggests that polyphenols block the absorption of cholesterol in the digestive tract and promote its removal from the body.
- Have an egg. Forget the old ban on eggs. Contrary to popular belief, eggs do not have much impact on cholesterol levels—though some people may be more “sensitive” than others to the dietary cholesterol in eggs. Studies have shown that for the majority of people, it is excessive intake of carbohydrates, not proteins or fats, that contribute to hyperlipidemia. Therefore, it is perfectly acceptable to eat a whole egg four or five times per week with your breakfast. On the other mornings, have a protein shake or a high-protein and low-carbohydrate meal.
- Incorporate omega-3s. Omega-3 fatty acids, such as EPA and DHA, have an anti-inflammatory effect on the body and reduce the risk of heart problems. Dietary sources of omega-3 include albacore tuna, cod, herring, mackerel, salmon, anchovies, and sardines, among other cold-water fish oils. Chia seeds, flax seeds, and walnuts are also rich in omega-3 fatty acids. However, do not rely on nuts and seeds for your total intake, as their omega-3s are not immediately bioavailable, undergoing chemical reactions before they are able to be used by the body.
- Limit your intake of whole grains. Although all grains should be eaten only in moderation, you should always choose whole grains over breads, cereals, and pasta made from refined flour. Whole grains are higher in fiber and lower on the glycemic index than refined versions. Still, they contain carbohydrates that eventually must be processed by the body. Eating too many grains—even whole grains—can lead to problems with glucose and insulin regulation, in turn stimulating the formation of LDL and VLDL. Eating too many grains can also trigger intestinal inflammation, thereby causing food allergies in people who have food sensitivities. When you eat whole grains, opt for gluten-free sources like brown rice.
- Look for lean cuts. Make sure you choose meat and poultry that contain the least amount of unhealthy fats. Beef is best from cows that are grass-fed, while eggs, chicken, lamb, fish, and bison should be free-range. If you can, buy organic meat, poultry, and animal products; but if conventionally raised meats are your only option, select the leanest meats possible, as well as skinless chicken, turkey, and fish.
- Make your plate colorful. Add plenty of fresh vegetables to your daily diet, especially leafy greens like kale and spinach, which have been shown to lower cholesterol levels. Also eat more low-glycemic fruit, such as strawberries and grapefruit, but limit your intake to two servings per day.
- Reduce the amount of dairy in your diet. Most doctors recommend that people with high cholesterol switch to reduced- or low-fat milk to avoid consuming too many saturated fats, which are found in whole dairy products. In some individuals, dairy also triggers inflammation, resulting in damaged arteries. To prevent these problems, replace cow’s milk with unsweetened almond milk, coconut milk, or soy milk. Rice milk, another option, may be higher in carbohydrates, so select brands with the lowest amount. When replacing cow’s milk with non-dairy versions, be sure to compensate for the loss in calcium by finding other dietary sources or taking supplements recommended by your doctor. In addition, stay away from soy milk made with genetically modified soy. If your family has a history of breast or prostate cancer, or if you have food allergies or sensitivities, do not take soy without first speaking to your doctor.
- Sleep. Studies show that insufficient sleep can raise the risk of high cholesterol, and sleep disorders can increase inflammation, leading to the formation of oxidized LDL. To prevent this, it’s recommended that you get seven to eight uninterrupted hours of sleep every night.
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