I recently had my cholesterol levels tested as part of an annual physical and was surprised to learn that my LDL or “bad” cholesterol is creeping towards the high range. My “good” HDL cholesterol continues to be high. That spurred my investigation into some of the research on LDL cholesterol and what dietary changes may be necessary.
Cholesterol is measured by the density of the lipoproteins which are fat proteins. The medical profession considers high-density lipoproteins (HDL) to be “good” or healthy and low-density lipoproteins (LDL) to be “bad” or unhealthy. But some researchers are focusing on the size of the LDL particles, which range from very small, densely concentrated particles to large “fluffy” ones. The smaller dense LDL particles have been associated with a higher risk of heart disease compared to larger particles, which may be relatively benign.
The smaller LDL particles seem to be able to slip through the tiny openings between the cells that line the inside of your arteries. That means it’s a lot easier for them to build up into the plaques, or blockages, that can cause heart attack or stroke. You can have a normal LDL test and still have these dangerous LDL particles. For example, your LDL can be 110 which is a healthy number, and have lots of small, dense LDL particles, that may significantly increase your coronary risk.
What do cholesterol numbers mean?
You may also have metabolic syndrome which increases the risk of cardiovascular disease and is characterized by low HDL, high triglycerides (fats in the blood), hyperglycemia, high blood pressure, and obesity. If you have higher than normal LDL and metabolic syndrome or a few of these risk factors, you may want to pursue tests for LDL particle size.
Here are three available tests:
- NMR LipoProfile Test (developed by LabCorp)
- Lipoprotein Particle Profile (LPP) Test (developed by SpectraCell)
- Cardio IQ Report (offered through Quest Diagnostics
According to integrative cardiologist Dr. Stephen Sinatra, “these tests examine the types of cholesterol particles in your blood which gives you and your doctor a far more accurate profile of your cardiovascular risk than standard cholesterol tests alone.”
How to have a high HDL
As I mentioned earlier, having a high HDL means having a lot of healthy cholesterol, which I have. However, this is not the norm . Most people eating the standard American diet have too low HDL and too high LDL. The American Heart Association states that “a healthy HDL cholesterol level may protect against heart attack and stroke. Studies show low levels of HDL cholesterol increase the risk of heart disease.”
How to increase your HDL:
- Focus on getting plenty of Omega 3 (a polyunsaturated fat) found in fatty fish, nuts, and seeds and their oils. For Omega 6s (also a polyunsaturated fat), focus on extra virgin olive oil, avocados/avocado oil, and sunflower oil. Avoid corn, soy and safflower oils.
- Eat moderate amounts of pastured grass-fed meat and poultry that is hormone-free and antibiotic-free.
- Avoid foods with partially hydrogenated oils by reading ingredients listed under the Nutrition Facts.
- Get regular exercise. Some studies show that regular aerobic exercise for a period of about 12 weeks can modestly increase beneficial HDL cholesterol—between 5 and 10 percent, and more for some people. Your triglyceride level and blood pressure should respond, too. Shoot for at least 30 minutes of moderate aerobic exercise five to seven days a week.
How do you decrease your LDL level? That’s the main question I have been grappling with since as mentioned earlier, my HDL is excellent. Although an above normal LDL level may not indicate a high risk for coronary disease, mine is now in the borderline high range and I see this as an opportunity to lower it. A cautionary tale is that when my mother stopped exercising and paying attention to her diet at about age 75, she had a major stroke at age 83. She spent the last two years of her life completely paralyzed on her left side. She didn’t also believe in seeing doctors and thus didn’t know that her total and LDL cholesterol had skyrocketed.
Our bodies need some saturated fat but it should not be make up more 10% of our total calories. I have realized it’s easy to exceed that with a combination of grass-fed butter, whole-fat milk for hot drinks and grass-fed meats all from my favorite farmer. So, I have decided to try some conventional wisdom out by cutting back on saturated fat and cholesterol and increasing antioxidants.
Here’s some of the recommended changes:
- Limit butter to 2 teaspoons daily whether cooking or adding to vegetables.
- Eat more fish/seafood and poultry and less red meat even the grass-fed kind.
- Trim the fat on meat if necessary.
- Eat chicken breast which has less cholesterol than other parts of the chicken.
- Replace organic whole-fat milk with low-fat/skim milk.
- Increase antioxidants by buying red grapefruit in addition to the red wine, dark chocolate (at least 80% cacao) green tea, and berries I already consume.
- Increase fiber by eating even more steel-cut oats, apples, sweet potatoes, and other high-fiber root vegetables. I also plan to add lentils and brown or black rice to the menu. Beans, especially pinto beans, can help reduce LDL but I don’t really like them and they can increase inflammation in some people.
Certain supplements such as niacin (B3) and red yeast rice can reduce LDL but they should be taken under a health care practitioner’s supervision because both can have unpleasant side-effects, especially at high doses. I will focus on making dietary changes first and then consider a supplement if needed. I will keep you posted.