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Core Knowledge


How to Manage Cholesterol


A person’s total blood cholesterol level is one of the most identifiable markers of heart disease, even though there are at least a dozen other predictors. High blood cholesterol can put you at risk for cardiovascular diseases like atherosclerosis, the narrowing or hardening of the arteries, heart attack, and stroke. While some people do monitor their blood cholesterol, only one in four women knows their blood cholesterol levels. The good news: High blood cholesterol is largely preventable and treatable with a healthy diet and exercise.

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The body uses cholesterol in several essential processes such as hormone production and maintaining cell membrane structure. The liver and other cells in the body produce about 75 percent of the cholesterol present in the bloodstream, while the remaining 25 percent usually comes from food. Some people have a genetic predisposition that causes the body to produce too much cholesterol, while others eat too many foods containing saturated fat, trans fat (partially hydrogenated oil), dietary cholesterol, and not enough fiber. Either situation is dangerous, but combining a genetic predisposition with and unhealthy diet and too little exercise.

High cholesterol doesn't always produce symptoms. You may not know there is a problem until you have a check-up or experience a heart attack or stroke.

How Cholesterol Works

Cholesterol is a waxy, fat-like substance that is produced naturally by the body. If the body produces too much cholesterol or if a person eats too many foods high in saturated fat or cholesterol, it shows up in the blood. It then begins to build up in the blood vessels inside the heart, which leads to atherosclerosis. When that happens, the flow of blood through the heart is restricted and can cause a heart attack. A stroke is possible when blood flow is restricted to the brain.

Cholesterol by the Numbers

20 years or older
Everyone 20 years of age and older should get their cholesterol levels checked. Establishing a base number early in life will make comparisons easier later on.

200 mg/dL (milligrams per deciliter)
For most people, a total cholesterol level below 200 mg/dL is desirable.

200-239 mg/dL
The total cholesterol level that is considered borderline high.

240 mg/dL and over
The total cholesterol level that is considered high.

Types of Cholesterol

Most professional literature has moved beyond the terms “good” and “bad” cholesterol. Instead, they focus on lipoprotein particle size. It's the lipoprotein particles that carry cholesterol throughout the body, not the cholesterol itself that is responsible for the key steps in plaque build-up. “Protective” versus “damaging” cholesterol might be more appropriate terms.

HDL - "Healthy" or "Protective" Cholesterol

There are several kinds of blood cholesterol. High-density lipoproteins (HDL) prevent arteries from clogging up and offers protection against heart disease. HDL is responsible for taking cholesterol out of the arteries and carrying it to the liver to be excreted.

The American Heart Association recommends HDL cholesterol levels of greater than 40 mg/dL for men and greater than 50 mg/dL for women to be considered protective against heart disease. HDL cholesterol also fights inflammation and clot formation. There is limited evidence that suggests increasing HDL cholesterol can reduce the risk of heart attack and stroke, even without changes in low-density lipoprotein or bad cholesterol. A substance called HDL2b positively correlates with heart health because it's an indicator of how well excess lipids are removed.

LDL - "Lowsy" or "Damaging" Cholesterol

The job of low-density lipoprotein (LDL) is to transport cholesterol all over the body. When we eat foods that are high in saturated fat and cholesterol, cholesterol builds up in the bloodstream. If the bloodstream contains too much cholesterol, then LDL drops cholesterol off in the arteries where it can build up inside arterial walls leading to heart disease and stroke.

LDL particles can be large or small and the amount of cholesterol carried within these particles can vary. Higher LDL counts may indicate a higher amount of smaller particles in the bloodstream. Smaller particles are often associated with a greater risk of cardiovascular disease. An optimal LDL cholesterol level is under 100 mg/dL.

The National Cholesterol Education Program has identified these three additional LDL substances that increase the risk of heart disease:

  1. Small, dense LDL refers to particles that are easily oxidized and that can penetrate the layer of cells on the interior surface of blood vessels to form plaque. Small, dense LDL can also become lodged in cracks of the arteries, causing atherosclerosis.
  2. Lipoprotein (a)-Lp(a) is a small, dense LDL that is involved in blood clotting. It's the genetic variation of LDL and, when elevated, it is considered a cardiovascular risk factor.
  3. Remnant lipoprotein (RPL) contributes to atherosclerosis, has a similar composition and density of plaque, and is believed to be a building block of plaque. Very low-density lipoproteins (VLDL) are high in a type of fat called glycerides, which attaches to proteins in the blood. As with LDL, VLDL creates large cholesterol particles that can block the flow of blood or create smaller passages within the heart to accommodate blood flow. A normal VLDL cholesterol level is between 5-40 mg/dL.

Cholesterol and Dietary Considerations

The human body is typically very good at regulating cholesterol production so it's not necessary to get cholesterol from dietary sources. Instead, the following information focuses on foods that are low in cholesterol like plant foods, recommendations for fat intake, and foods that reduce LDL cholesterol and increase HDL cholesterol.

Plant Foods

Plant foods are naturally cholesterol-free. This is why a plant-based diet is recommended to help reduce blood cholesterol levels. Vegetables, fruits, whole grains, nuts, nut butters, seeds, and vegetable oils are examples of healthy foods that don't contain cholesterol. They're also high in fiber, which helps to clear the system of cholesterol.


The American Heart Association recommends that we follow these guidelines:

  • Keep total fat intake to between 25-35 percent of total calorie intake.
  • Limit saturated fat intake to less than seven percent of calories.
  • Keep trans fat intake to less than one percent of total daily calories.
  • Limit total cholesterol intake to less than 300 mg per day. Those with high LDL cholesterol levels or who take cholesterol medication should stay below 200 mg per day.

Some foods seem to reduce LDL cholesterol and increase HDL cholesterol. They include fish high in omega-3 fatty acids like salmon, sardines, mackerel, herring and tuna. Monounsaturated fats such as olive oil, nuts, and seeds have been found to be neutral, meaning they typically don’t increase or decrease LDL or HDL cholesterol.

Lowering LDL Levels

The good news regarding high cholesterol is that you have the power to do something about it. Few individuals are sensitive to dietary cholesterol. High blood cholesterol is typically not attributed to a diet high in cholesterol, but rather a diet high in fat, particularly saturated fat. Cutting back on foods with saturated and trans fat is a start, along with regular exercise and weight loss. If lifestyle changes alone don't work, medications can help. Evidence shows that statins (Lipitor, Zocor, Crestor) can significantly lower cholesterol levels with minimal side effects.

Plant foods that contain sterols (also known as phytosterols) and stanols are a very important addition to any diet to help keep cholesterol levels in check. Stanols and sterols help block the absorption of cholesterol in the body. Having 2 g of plant stanols and sterols each day can lead to a 10 percent decrease in cholesterol levels. Many foods, like juices and margarines, are fortified with stanols or sterols, but foods that have naturally occurring forms include corn oil, nut and seed oils, and beans.

More than 20 studies have shown a dietary connection between phytosterols and blood cholesterol. Many margarines are now enriched with phytosterols to help lower total blood cholesterol levels. According to the Center for Science in the Public Interest, pregnant and lactating women should avoid phytosterol-fortified foods because the compound can decrease vitamin A levels. However, naturally occurring phytosterols seem to be safe.

Increasing HDL Levels

Here are some strategies to increase your HDL:

  • Exercise. Work out moderately or vigorously five days a week for 30 minutes. Aerobic exercise can boost HDL cholesterol by five to ten percent. Take our walking challenge.
  • Lose weight. If you’re overweight or obese, you can boost your HDL cholesterol level by about 1 mg/dL for every seven pounds lost. Visit our weight loss channel for tips.
  • Decrease high-glycemic foods. Cut back on white bread, white pasta, white rice, cornstarch, and simple sugars such as candy, table sugar, cake, ice cream, etc.
  • Choose high-fiber foods. Aim for 25-30 g of fiber each day from whole grains, fruits, veggies, nuts, and seeds. When choosing grains, look for those that contain at least 3 g per serving. Learn where to find fiber.
  • Reduce or eliminate foods that decrease HDL cholesterol. This includes trans fats found in hydrogenated oils (shortening or Crisco, for example).
  • Supplement with fish oil. Include a good quality fish oil supplement (2-3 g combined EPA/DHA per day). See how to choose the right fish oil.
  • Eat cocoa. Cocoa contains the antioxidants polyphenol and procyanidin that may aid in lowering cholesterol in the bloodstream. Choose chocolate with at least 70 percent chocolate solids and low in sugar and fat.
  • Drink red wine. Limit it to two drinks per day. Ignore this recommendation if you don't already drink alcohol, or at least talk with your doctor before considering this kind of change in lifestyle.
  • Don’t smoke. HDL cholesterol levels rise by as much as 15 to 20 percent after you quit.
  • Consider HDL-raising medications. HDL-raising medications like niacin can work, but discuss this with your doctor before taking anything.
  • Get vitamin D. Increase your vitamin D level with a dietary supplement, which is preferable over increased exposure to sunlight. Learn more with our 5-minute guide to vitamins.

The Keys to Healthy Cholesterol

Cholesterol is a substance that is needed in moderate amounts, but one that is unhealthy when the body produces too much. Cholesterol doesn't have to be eliminated for our lives, but needs to be balanced with a healthy lifestyle. The keys to a healthy cholesterol level are to:

  • Avoid foods high in fat, especially saturated and trans fat
  • Quit smoking
  • Exercise regularly
  • Maintain a healthy weight

Tags: Nutrients, Longevity, Health, Cooking, Fat, Food


  1. American Dietetic Association
  2. American Heart Association
  3. Cleveland Clinic
  4. Harvard Women’s Health Watch
  5. Journal of the American Dietetic Association
  6. MayoClinic.com
  7. Medical News Today
  8. MedlinePlus.com
  9. National Heart, Lung and Blood Institute
  10. Spectracell Laboratories