Cholesterol - The Basics

The other day a lady came into my pharmacy and during our conversation mentioned she has high cholesterol but is not taking anything for it as the side effects of the medications were too much for her. I informed her that there are new formulations of the old and completely new classes of anti-cholesterol medications and of course there are supplements that either mimics medications or provide relief through different pathways. So, I figure there may be more than one more person who could benefit from this conversation and this article will hopefully help others.

I will not spend words justifying the need for the maintenance of cholesterol. But I will detail why it is needed, where it comes from, which levels of each part are good, moderate, and bad, and provide a summary of the different ways to lower the body’s cholesterol. Cholesterol is an essential part of every cell structure, is needed for proper brain/nerve function, is the backbone to the creation of sex hormones, and helps transport fat-soluble vitamins. The body gets cholesterol from not only its diet but also from its own liver. This allows two pathways for us to reduce the body’s influx of cholesterol and thusly reduce the total cholesterol in the body.    

To measure if your body has too much cholesterol, we measure three things in the blood: LDL-Cholesterol, HDL-Cholesterol, and Total Cholesterol. Cholesterol is a fatty substance, so it does not move through the mostly water-based blood in the body. Due to this, other molecules are necessary for its transport to the areas of need in the body; Low-density Lipoproteins (LDL) and High-Density Lipoproteins (HDL) are these transports. LDLs are the major molecules that transport cholesterol throughout the body, the issue with them is the LDLs seem to encourage the binding of cholesterol to the atrial walls which builds up a plaque that hardens the walls of the arteries. HDLs carry unused/unnecessary cholesterol away from the cells and back to the liver for destruction (hence nicknamed “good cholesterol”). Below, are the levels for LDL, HDL, and total cholesterol:

LDL

Less than 100 mg/dL                       Optimal

100 – 129 mg/dL                              Near Optimal

130 – 159 mg/dL                              Borderline High

160 – 189 mg/dL                              High

190 and above                                  Very High

HDL

Less than 40 mg/dL                         Low, major risk factor for heart disease

60 mg/dL and above                       Considered protective against heart disease

Total Cholesterol

Less than 200 mg/dL                       Desirable

200-239 mg/dL                                 Borderline High

240 and above                                  High

So, the options to reduce or maintain the body’s current cholesterol levels are changing your diet, exercise level, adding supplements, or prescription(s). It is good to discuss with your care provider which one, or combination, would be a good start.

Diet – adding (or increasing) the intake of the following foods have been shown to decrease the cholesterol levels in the body: raw almonds, apples, bananas, carrots, cold-water fish, low-fat dairy products (instead of whole), dried beans, garlic, grapefruit, margarine (based with plant sterols) oats, olive oil, raw pecans, salmon, strawberries, raw walnuts, soybeans, and water-soluble dietary fiber. Decreasing the amount of the following foods has shown benefits as well: Saturated fat, fatty meats, dairy (whole), and fried products. How much of each item and how often should be discussed with your care provider, nutritionist, or knowledgeable pharmacist to make sure you gain the best effect of these changes.

Exercise - The American Heart Association recommends 40 minutes of moderate- to vigorous-intensity exercise or activity 3 to 4 times a week to get the best gain on cholesterol reduction.

Supplements – Adding these following supplements to your daily regimen have also been shown to reduce cholesterol levels in the body: Chinese red yeast rice extract, apple pectin, CoQ-10, Fiber (soluble), Garlic, L-Carnitine, Lecithin, Vitamin A, Vitamin B, Vitamin C, Cayenne, and Cinnamon. 

Prescriptions – There are several different classes of cholesterol lowing medications and each one has its own benefit/risk factors (just like all the other options). It is best to have an honest discussion with your care team to find which variation of these options best suits your needs, capacity to maintain, and reduction of detrimental side effects. 

Remember to always include all supplements, vitamins, dietary regimens, etc. in your listing of medications for all your care providers.