The Best Way to Lower Cholesterol

Achieving lower cholesterol is one of the best ways to protect yourself from heart attack and stroke. A fat-like substance found in the blood, cholesterol can build up and form deposits in your arteries. These cholesterol deposits can clog arteries -- or in some cases completely block -- the passage of blood and oxygen to the heart. The result, for hundreds of thousands of people every year, is chest pain, heart attack, or other cardiovascular problems.

There are two kinds of cholesterol: HDL (high-density lipoprotein) and LDL (low-density lipoprotein) cholesterol. HDL is often called the "good" kind of cholesterol because it helps remove unneeded cholesterol from the body. LDL is the "bad" cholesterol; it's made up primarily of fat and is a particular risk factor for heart disease.

So when you set out to lower cholesterol, you need to know your HDL number, your LDL number, and your total cholesterol number (which is not the total of your HDL and LDL cholesterol) too.

Total Cholesterol (mg/dL)	HDL (mg/dL)	LDL (mg/dL)
Best: Below 200	Men: 40-50	Best: Below 130
Borderline: 200-239	Women: 40-60	Borderline: 130-159
High risk: 240	High risk: Below 40	High: 160 or above

If any of your cholesterol numbers are in the high risk category, you're at an increased risk for heart disease -- which may lead to heart attack.

The good news is you have several options to help you get back in the cholesterol safety zone. These four options can all work separately -- or together -- to lower cholesterol, and keep it under control.

• Diet
• Exercise
• Weight loss
• Medications

Diet to Lower Cholesterol

The body gets cholesterol in two ways: by making it and from food. Most of the cholesterol we eat comes from animal fats found in foods such as meat, butter, margarine, milk, and fish. One of the easiest ways to lower cholesterol is to lower your intake of certain kinds of fats.

Just as there is "good" cholesterol and "bad" cholesterol, there are "good" fats and "bad" fats. To keep your cholesterol low, your total dietary fat intake shouldn't be more than 25% to 35% of your diet -- and most of those fats should be the good kind, like vegetable fats (monounsaturated fats and polyunsaturated fats), and omega-3 fatty acids, found mostly in fish.

To help lower LDL cholesterol, you'll want to avoid or reduce saturated fats (usually found in animal products like meats, eggs, and dairy), and trans fats, which are formed when hydrogen is added to vegetable oil (think French fries and doughnuts).

Exercise to Lower Cholesterol

Regular physical activity is key to keeping your cholesterol low. Studies have found that even moderate exercise is enough to boost HDL (good) cholesterol and lower LDL (bad) cholesterol. In a recent study of young and middle-aged women in Spain, researchers found that the more calories a woman burned through moderate exercise, the lower her LDL level and the higher her HDL level.

Exercise, in combination with a healthy diet, is also important because while a low-fat lower calorie diet helps lower total cholesterol and bad LDL cholesterol, one study showed it can also drop good HDL cholesterol by 7% over a year. That same study showed an increase in good HDL cholesterol (and a decrease in LDL and total cholesterol) for those who walked or jogged about 8 miles a week.

Weight Loss to Lower Cholesterol

Both a healthy diet and regular physical exercise can lead to another important tool in lower cholesterol: weight loss.

Excess weight tends to increase your LDL cholesterol level. If you are overweight and have high LDL cholesterol, losing weight may help you lower it. Weight loss also helps to lower triglycerides (another form of fat in your blood and one which you should aim to keep below 150 mg/dL) and raise HDL ("good") cholesterol levels.

Medications to Lower Cholesterol

Some people find they can't lower cholesterol enough with lifestyle changes alone. "There are genetic factors that affect cholesterol levels," says Gotto. "One person may be able to keep their cholesterol low without much effort at all, while someone else may eat right, exercise, keep their weight down, and still have high cholesterol."

That's where medications come in. There are several types of cholesterol-lowering medications, but the most commonly prescribed are statins. There's a good reason for that, says Gotto. "They are very effective in lowering LDL levels in the majority of patients." Studies have shown that statins can lower LDL cholesterol by 20% to 60%.

Other medications to lower cholesterol include:

• Bile acid sequestrants
• Nicotinic acid (niacin)
• Fibric acids
• Cholesterol absorption inhibitors
• Combination drugs such as Vytorin, Advicor

Each of these drugs act in slightly different ways. For example, some lower LDL cholesterol, while others treat high levels of triglycerides and/or raise HDL cholesterol. Your doctor will help you decide which medication -- or combination -- is best for you.

However, medication may not help you as much if you don't help yourself.

Diet, exercise, weight loss, and medication: Your cholesterol-lowering toolbox has all you need to help you lower cholesterol -- and keep it low.

Low-Carb Diets Improve Cholesterol Long Term

Low-carbohydrate weight loss diets have an edge over low-fat diets for improving HDL cholesterol levels long term, according to a study funded by the National Institutes of Health.  

Dieters who followed low-carb or low-fat plans for two years along with a lifestyle modification program lost the same amount of weight -- on average about 7% of their body weight or 15 pounds.  

But throughout the two-year study, low-carbohydrate dieters had significantly increased HDL, or "good," cholesterol levels compared to low-fat dieters. 

Heart Risk Factors Improved

During the first six months of the study, the low-fat dieters had greater reductions in  LDL, or "bad," cholesterol, but the differences did not persist over time.

The study is not the first to suggest that low-carb weight loss programs like the Atkins diet are safe and may be slightly better than low-fat diets for reducing risk factors for heart disease.

But it is one of the longest to show this, says lead researcher Gary D. Foster, PhD, of Temple University’s Center for Obesity Research and Education.

Roughly three-fifths (58%) of the low-carb dieters and two-thirds (68%) of the low-fat dieters stayed on the respective diets for two years.

The study appears in the September issue of the journal Annals of Internal Medicine.

“For many years there have been concerns that the low-carbohydrate approach to weight loss was bad for the heart,” he says. “This study would suggest those concerns are largely unfounded.”

Low-Carb Diet Heart-Healthy

A total of 307 obese people took part in the research, with half following a low-carb diet and half following a low-fat diet.

The low-carb group was instructed to restrict carbohydrates to no more than 20 grams a day for three months, increasing their carb intake by about 5 grams a week after that as long as they continued to lose weight.

As with the Atkins plan, these dieters ate mostly protein from meat sources during the induction phase along with about three cups of green leafy vegetables, Foster says.

The low-fat dieters were told to restrict total calories to between 1,200 and 1,800 a day, with no more than 30% of those calories coming from fat.

All the participants attended group sessions designed to motivate them to stay on the diets. The groups met weekly at first and then monthly toward the end of the study.

“The No. 1 thing was getting people to keep track of what they ate and their activities on a daily basis,” Foster says.

Other topics included limiting eating to specific places and times, managing the holidays, and getting back on track after overeating.

Even though HDL profiles were better in the low-carb group, Foster says dieters who successfully lost weight on both diets showed improvements in heart disease risk.

He says people who want to shed pounds should pick a diet that is most likely to work for them.

“I think the main message is that people need to spend less time worrying about whether they should follow a weight loss diet that is low in this or high in that and spend more time learning strategies to help them stick to the diet they chose.”

Expert: ‘Extreme Diets Don’t Work’

Weight loss researcher Frank M. Sacks, MD, of Harvard School of Health says the more extreme the diet, the less likely someone is to stick to it.

“Extremely low-carbohydrate diets may be safe, but people tend to get sick of them after a few months,” he says. “In this study, 42% of the low-carbohydrate dieters dropped out over time. They also reported more symptoms associated with the diet.”

Those symptoms included constipation, bad breath, and dry mouth.

He agrees that dieters should choose a weight loss plan they can stick to, with the goal being safe, gradual weight loss.

By following his own advice, Sacks was able to lose 15 pounds over nine months and keep it off.

“Half a pound a week may not sound like much, but over the course of a year that’s 24 pounds, which is huge,” he says.