Cholesterol: Types, Tests, Levels, Foods, & Treatments

What is Cholesterol?

Cholesterol is the component found in all the cells of your body. It is a fat-like substance or lipid which is usually waxy. People have rather misunderstood cholesterol as an inessential substance in the body. But, it is not the fact. It is crucial for the body, if available in the required amount. The body needs cholesterol for making hormones, Vitamin D, and substances required for the digestion of food.

Cholesterol is also needed in the human body to build healthy cells. But one should always maintain its level, as its presence in more than the required amount may create problems. The body itself produces all the required amount of fat. It is also present in some animal-based foods such as cheese, meats, egg yolks, etc. A healthy diet and regular exercise help to maintain the cholesterol level and to keep the body healthy.  

Cholesterol is a lipid that your liver produces naturally. It doesn’t dissolve in water, and thus can’t move through your blood on its own. To help in its transport, your liver produces lipoproteins.

Lipoproteins are particles that are made from fat and protein. They carry cholesterol through your bloodstream. The two major types of lipoprotein are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL cholesterol is the cholesterol that is carried by low-density lipoproteins. You may be diagnosed with high cholesterol, also known as hypercholesterolemia if your blood has too much LDL cholesterol. Without treatment, hypercholesterolemia (high cholesterol) may lead to several health issues, like heart attack and stroke.

In the beginning, high cholesterol hardly causes any symptoms. Also, the condition with low cholesterol levels is known as hypocholesterolemia. Hence, it’s very essential to regularly check your cholesterol levels.

In this article, I will explain to you every important information related to cholesterol such as its types, tests, levels, prevention, foods, treatment, etc.

What are The Types of Cholesterol?

Cholesterol travels through the blood. But, it does not do it on its own due to its non-dissolving nature in water. Cholesterol travels throughout the body with the help of proteins which are named lipoproteins. These lipoproteins are produced by the liver. They are tiny particles that consist of protein as well as fat.

There are 3 types of lipoproteins that carry different kinds of cholesterols. These are:

1)  LDL (Low-Density Lipoprotein)

2) HDL (High-Density Lipoprotein)

3) VLDL (Very Low-Density Lipoprotein)

Tests for Cholesterol

The doctor may suggest the cholesterol test (or lipid profile test) as a normal routine or if they suspect any related complications. Usually, it is recommended that every individual above 20 years of age should get their cholesterol test (or lipid profile test) done. And they should check their cholesterol levels at least once every 4 to 6 years.

To check the levels of cholesterol in your blood, a blood test is done by the healthcare provider.

The blood test helps to determine the complete amount of cholesterol as well as triglycerides in the blood. It is also known as a complete cholesterol test, lipid panel, or lipid profile. The complete or total cholesterol test is used to determine levels of the following in the blood:

• Total cholesterol

• LDL

• HDL

• VLDL

• Triglycerides

• Non-HDL cholesterol and

• The ratio between cholesterol and HDL

There is some disagreement among the health care providers, regarding whether this test is suitable to check the heart disease risk or if some advanced tests should be done.

It is recommended to fast for almost 9 to 12 hours before going for the cholesterol test (or lipid profile). But it is not always a compulsion and one should consult healthcare providers about it. If you are unable to fast or are younger than 20 years or due to some other health conditions, you may be given relaxation from fasting.

Normal Cholesterol Levels

The ideal cholesterol level varies with each person depending on age and gender. So, let’s understand the normal levels of cholesterol for people of each gender.

High Cholesterol

High cholesterol levels in the body can be the result of inheritance. There might be other reasons too for this. But one can prevent and treat high cholesterol if detected on time.

What are the Symptoms of High Cholesterol?

High cholesterol is usually a silent process. An individual with high cholesterol often has no signs or symptoms. He/she can only detect high cholesterol levels with the help of a blood test.

Without a blood test, the person won’t realize that he/she is having high cholesterol until it gets severe. Taking consultation from a health care provider is essential. It is good to understand the requirement of cholesterol detecting tests (like lipid profile tests).

What are the Causes of High Cholesterol?

There are certain factors that can become the reason for causing high cholesterol in your body. Let’s understand them.

Poor Diet

Consuming a lot of saturated and trans fats can lead to an increase in unhealthy cholesterol levels. Full-fat dairy products and fatty cuts of meat contain saturated fats. Trans fats are mostly present in desserts and packaged snacks.

Obesity

Having a BMI (body mass index) of 30 or higher puts you at increased risk of high cholesterol.

Lack of Exercise

Having a sedentary lifestyle or lack of exercise increases the risk of high cholesterol. Regular exercise aids boost your body’s HDL cholesterol (the good one).

Smoking

Smoking tobacco products may lower your level of HDL cholesterol (the good cholesterol).

Alcohol

Drinking excessive amounts of alcohol can raise your total cholesterol level.

Genetic or Family History

Genetic factors can also contribute to high cholesterol.

Familial Hypercholesterolemia

Individuals with the inherited condition familial hypercholesterolemia also have very high LDL levels.

Some Medical Conditions

Medical conditions that can increase your unhealthy cholesterol levels are:

• Diabetes

• Chronic kidney disease

• HIV/AIDS

• Lupus

• Hypothyroidism

Some Types of Medicines

Cholesterol levels can also be increased by some types of medicines that you may be taking for other health problems, like:

• Cancer

• HIV/AIDS

• Acne

• Irregular heart rhythms

• High blood pressure

• Organ transplants

What Are The Risk Factors For High Cholesterol?

You may have an increased risk of developing high cholesterol if you:

• Eat a lot of saturated and trans fats.

• Have a limited physical activity or a sedentary lifestyle

• Have a family history of high cholesterol

• Are suffering from obesity.

• Smoke tobacco products heavily

• Have diabetes, kidney disease, or hypothyroidism

Other Risk Factors For High Cholesterol

Following are the other risk factors for high cholesterol:

Age

As you age, your liver’s ability to remove LDL cholesterol decreases. Thus, men above 45 years of age and women above 50 years of age are at increased risk of having unhealthy cholesterol levels.

Menopause

LDL levels tend to rise after menopause, thus women who have crossed their menopausal age.

Waist Circumference

Women with a waist circumference of more than 35 inches and men with a waist circumference of more than 45 inches.

Prevention Of High Cholesterol

To maintain the cholesterol levels in your body and prevent you from having high cholesterol, you should follow the below-given heart-healthy lifestyle changes:

• Manage the level of stress.

• Include low-salt foods in your diet such as whole grains, vegetables, and fruits.

• Avoid alcohol, or drink it in moderation.

• Always maintain a healthy weight and reduce any extra gained weight.

• Exercise at least 30 minutes a day for at least 5 days a week.

• Avoid smoking completely.

• Eat a healthy diet that is low in animal fats, and high in fiber. Also, consume good fats in moderation.

You can manage lifestyle factors, but can’t control your genetic risk factors for high cholesterol.

If you are at risk of high cholesterol or coronary heart disease (CHD), then your doctor will likely recommend you get your cholesterol levels tested on a regular basis. 

Foods To Eat And Avoid For High Cholesterol

Here, we will understand what to eat and what not to eat if you have high cholesterol.

Foods To Eat During High Cholesterol

You should eat the following foods if your cholesterol levels are high:

Oats

Oats can help to reduce cholesterol levels. This is because they contain a type of soluble fiber known as beta-glucan, which binds to cholesterol in the intestine and prevents it from being absorbed into the bloodstream.

Nuts

Nuts, such as almonds and walnuts, are a good source of monounsaturated fats, which can help to lower LDL cholesterol levels.

Avocados

Avocados are high in monounsaturated fats and also contain antioxidants that can help to improve LDL cholesterol levels in people who are overweight or obese and protect against heart disease.

Olive Oil

Olive oil is another good source of monounsaturated fats. Using olive oil also is helpful in raising HDL cholesterol levels.

Fish

Fish, such as salmon, tuna, and mackerel, are a good source of omega-3 fatty acids. These can reduce your triglycerides and reduce your blood pressure and risk of developing blood clots.

Garlic

Garlic has antioxidant and anti-inflammatory properties that can help to protect against heart disease.

A review of studies conducted in 2016 on garlic, has shown that garlic has the potential to lower total cholesterol by up to 30 mg/dL (1).

Dark Chocolate

Dark chocolate contains flavonoids, which are antioxidants that can help to reduce LDL cholesterol levels and improve blood flow.

If you have high cholesterol, your doctor may recommend lifestyle changes and medication to help lower your cholesterol levels. In some cases, statin medications may also be prescribed to lower LDL cholesterol levels.

Foods To Avoid During High Cholesterol

Following are the foods that you should avoid if your cholesterol levels are high:

Saturated Fats

Saturated fats are found in animal products, such as butter, cheese, and red meat. They can raise LDL cholesterol levels and should be limited as much as possible.

The AHA recommends reducing saturated fat intake to not more than 6 percent of your total daily calories (2).

It suggests limiting the consumption of the following foods:

• pork

• lamb

• fatty beef

• dairy products made from whole or reduced-fat milk

• poultry with skin

• saturated vegetable oils, such as coconut oil, palm oil, and palm kernel oil

• lard and shortening

Trans Fats

Trans fats are found in processed foods, such as packaged cookies and cakes. They can raise LDL cholesterol levels and should be avoided as much as possible.

Avoiding trans fats is also very essential. Some foods that are high in trans fats are (3):

• potato chips and crackers            

• commercially fried foods

• packaged cookies, donuts, cakes, and pastries

• buttered popcorn

• products containing partially hydrogenated or hydrogenated vegetable oils

• bakery goods that contain shortening

High-Fructose Corn Syrup

High-fructose corn syrup is often used to sweeten processed foods and can contribute to weight gain. It can also raise LDL cholesterol levels and should be avoided.

Refined Carbs

Refined carbs, such as white bread and pasta, can cause spikes in blood sugar levels. They can also raise LDL cholesterol levels and should be limited as much as possible.

What is the Treatment Of High Cholesterol?

The treatment of high cholesterol varies from person to person. Cholesterol treatment is decided on the basis of certain factors such as:

• Result of the cholesterol blood test.

• Family history.

• Age.

• Running health issues of being overweight, high BP, diabetes, etc.

• If you had or are diagnosed with heart disease before.

• Your risk of developing stroke, heart attack, or any other heart disease.

• Other personal preferences such as smoking, an unhealthy diet, being physically inactive, etc.

The first step to control high cholesterol levels is by healthy lifestyle changes like diet, exercise, weight loss, etc. In some cases, only changing the lifestyle may help to control the level of cholesterol in the blood.

Lifestyle changes are very important for the treatment of high cholesterol. Some home remedies can be used to lower the level of cholesterol in the body. But, if the risk is higher your doctor will prescribe certain drugs or medications. So, let’s understand them.

Treating High Cholesterol through Diet

• Try avoiding pre-packaged foods, sugary food, and fast food as much as possible.

• Avoid consuming food that is high in cholesterol, trans fats, and saturated fats.

• It is better to avoid the consumption of fried or oily foods.

• Consume legumes, fish, chicken, and other related lean sources of protein.

• Prefer foods that are roasted, grilled, steamed, boiled, and baked.

• Eat food items that are high in fiber such as whole grains, vegetables, fruits, etc.

• To reduce the level of cholesterol in the body, you can use foods that are rich in omega-3 fatty acids. These foods include avocados, ground flaxseeds, almonds, walnuts, etc.

Treating High Cholesterol With The Help of Medications

Healthy lifestyle changes like eating a healthy diet and exercising regularly are the first line of treatment for high cholesterol. Even after you have made these lifestyle changes and your cholesterol levels still remain high, then your doctor may recommend medication.

The choice of medications depends on various factors, like your

• age

• personal risk factors,

• health and

• possible drug side effects.

A common choice of medications includes:

Statins

Statins are the most frequently prescribed medications for treatment of high cholesterol. They block a substance your liver needs to make cholesterol and this causes your liver to remove cholesterol from your blood. Some examples of statins are:

atorvastatin

lovastatin

fluvastatin

pravastatin

rosuvastatin

simvastatin

Cholesterol Absorption Inhibitors

Your small intestine absorbs the cholesterol from your food and releases it into your bloodstream. Ezetimibe is a cholesterol absorption inhibitor drug that reduces your body’s absorption of cholesterol and can be prescribed with a statin drug.

Bile-Acid-Binding Resins

Your liver uses cholesterol to make bile acids. The bile-acid-binding resins like cholestyramine, colesevelam, and colestipol lower cholesterol indirectly by binding to bile acids. This helps your liver use up excess cholesterol to make more bile acids, which lowers the level of cholesterol in your blood.

Bempedoic Acid

This newer drug works in much similar way as statins but there is less chance of it to cause muscle pain. Adding bempedoic acid to a statin drug can help reduce LDL levels significantly. A combination of both the bempedoic acid and ezetimibe is also available in the market.

PCSK9 Inhibitors

These drugs are more targeted drugs that bind to and block a protein, PSCK9, on your liver cells and help the liver to absorb more LDL cholesterol. This lowers the amount of cholesterol circulating in your blood. Examples of PCSK9 Inhibitors include alirocumab, and evolocumab.  These are expensive and injected under the skin every few weeks.

These drugs may be used in people with a history of heart disease who have intolerance to statins or other cholesterol medications or in people who have a genetic condition that causes very high levels of LDL cholesterol.

Medications for high triglycerides

If you also have high triglycerides levels, then your doctor may recommend:

Fibrates

Fibrates lowers your liver’s production of very-low-density lipoprotein (VLDL) cholesterol and boost the removal of triglycerides from your blood. Generally VLDL cholesterol contains triglycerides. Examples of fibrates are fenofibrate, clofibrate, and gemfibrozil.

The use of fibrates with a statin drug can raise the risk of statin side effects.

Omega-3 Fatty Acid Supplements

Omega-3 fatty acid supplements or omega-3 fatty acid ethyl esters are made from fish oil and can help to reduce your triglycerides. They are available by doctor’s prescription or over-the-counter (OTC). Omega-3 fatty acid supplements can interact with other medications you’re taking. So if you take over-the-counter supplements, consult with your doctor first.

Niacin

Niacin or nicotinic acid is a vitamin that limits your liver’s ability to produce LDL and VLDL cholesterol. It has also been linked to strokes and liver damage, so doctors rarely recommend it except for people who can’t take statins.

Treating High Cholesterol By Using Home Remedies

Some food items that are easily available in your kitchen are meant to lower the cholesterol level naturally. It will be beneficial if you include such foods in your diet along with regular exercise and a healthy diet. Such foods are ground flaxseed, blond psyllium found in psyllium seed husk, plant sterol and stanol supplements, red yeast rice, astragalus, hawthorn, garlic, etc.  

What are the Complications of High Cholesterol?

High cholesterol creates certain complications in the lack of treatment. It causes plaque build-up in the arteries and over time narrows them. This health condition is usually called atherosclerosis. It is a critical condition that can limit the blood flow through the arteries. A person with atherosclerosis is also at a higher risk of developing life-threatening blood clots.

The probable life-threatening complications which can occur from atherosclerosis are:

• Chronic kidney disease

• Peripheral vascular disease

• High blood pressure

• Angina, or chest pain

• Heart attack

• Stroke

There are some other complications that may develop from high cholesterol in a person and these are:

• Bile imbalance

• High risk of gallstones

So, you might have gained enough knowledge regarding cholesterol and its levels. High cholesterol is preventable and treatable and there is no need to panic about it. The only need is to get tested from time to time, as the illness does not have any visible symptoms. So, you need to be careful of yourself.

Moreover, consult an expert healthcare provider in case of any doubt or confusion regarding Cholesterol.

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References:

1) Garlic and Heart Disease

https://escholarship.org/uc/item/01r1171s

2) The Skinny on Fats

https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/the-skinny-on-fats

3) Fats – Saturated, Unsaturated, and Trans Fat. Lifestyle Coach Facilitation

https://www.cdc.gov/diabetes/prevention/pdf/postcurriculum_session2.pdf

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Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local health care professionals.

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