Dear Doctors: I had my physical last fall, and it included some blood tests. One of them showed that my cholesterol levels rose a bit since last year. My doctor says that if they keep going up, I should consider using meds to control them. What is cholesterol? Can you lower it naturally?
Dear Reader: Cholesterol is a fatty, waxy substance that is carried by the blood and used by tissues throughout the body. Although most often discussed as a risk factor in cardiovascular disease, cholesterol actually plays many essential roles in health and well-being. Your body needs cholesterol to produce hormones, build and maintain cell walls and membranes, manufacture vitamin D and aid in digestion. The highest concentration of cholesterol in the body is in the brain, where it is essential to the creation and maintenance of neurons and other tissues.
When assessing cholesterol levels, your doctor checks two specific factors. Each is calculated in milligrams of cholesterol per deciliter of blood, or mg/dL. One is a measure known as total cholesterol, which is just as it sounds. The other looks at the proportions of two subsets of cholesterol. These are low-density cholesterol, or LDL, and high-density cholesterol, or HDL.
HDL, aka the good cholesterol, helps usher cholesterol out of the blood. LDL molecules, the so-called bad cholesterol, are larger and stickier than HDL. They can build up within the arteries, form plaques and lead to cardiovascular disease and stroke.
About 80% of the cholesterol in your body is produced by the liver. The rest comes from diet — and that’s one area where changes can have a positive effect.
Numerous studies have found a high-fiber and plant-forward diet can measurably improve blood cholesterol numbers, particularly LDL. This means switching from animal proteins to foods like beans, legumes, seeds, nuts, soy products and chickpeas. Also important are plenty of fresh, leafy greens, berries, fruit and healthful oils.
Although diet is often seen as the main culprit in poor cholesterol numbers, not getting enough exercise plays a role as well. The current recommendation is 150 minutes of moderate exercise per week, or 75 minutes of high-intensity activity. It turns out that when you get your heart pumping, the body responds by releasing HDL into the blood — lipoproteins that collect cholesterol and carry it to the liver for disposal. Sedentary people get an extra bonus: Data show that those who have not previously exercised often see the most noticeable improvement.
Lowering stress and getting enough high-quality sleep are also important. Too much of the first and not enough of the latter can lead to increased levels of cortisol and adrenaline. Each of those can not only cause a spike in cholesterol production, but can also increase inflammation and have an adverse effect on blood sugar control. Also important: quitting smoking.
For people whose cholesterol numbers are merely a bit elevated, lifestyle changes can be safe and effective. It’s wise to check in with your doctor to share your game plan and let them become a partner in your efforts.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.