So… My cholesterol is high. I’m honestly just shook about this. I’m literally the most consistently health conscious person that I know and my LDL was elevated at my annual checkup. I don’t eat much of the bad stuff and I’m pretty consistent and content with an active lifestyle. How in the world did I get here and how do I fix it? After wrestling with a lot of confusion, I think I may have the answer- a path forward, if you will. I’ve realized that focusing solely on macronutrients—proteins, fats, and carbohydrates—while neglecting the importance of fruits, vegetables, and healthy fats, may have contributed to my unexpectedly elevated LDL levels. So now I’m adding an extra lens to my health vision and I’m doing things a little differently. Let’s talk about how this happens and how to fix it. And I hope you’ll join me in this journey. First things first…

Why Do Cholesterol Levels Matter?

Having the right balance of cholesterol is crucial for heart health and overall well-being. There are two main types of cholesterol that doctors monitor:

1. Low-Density Lipoprotein (LDL) – “Bad” Cholesterol: High levels of LDL cholesterol can lead to plaque buildup in the arteries, a condition known as atherosclerosis. This narrows the arteries and makes it harder for blood to flow, increasing the risk of heart disease, stroke, and other cardiovascular problems.
2. High-Density Lipoprotein (HDL) – “Good” Cholesterol: HDL helps remove LDL cholesterol from the bloodstream by carrying it back to the liver for processing and elimination. Higher levels of HDL are generally protective against heart disease.

So, maintaining a healthy balance of cholesterol—keeping LDL levels low and HDL levels high—helps reduce the risk of cardiovascular problems (heart attacks and strokes). Monitoring cholesterol is especially important if you have other risk factors, such as high blood pressure, diabetes, or a family history of heart disease.

Heart Disease Just Sounds Like a Medical Buzz Word At This Point. Is It Really That Big of a Deal?

You should definitely care. If you don’t care now you’ll definitely wish you had cared if you ever develop heart disease. This is the side of heart disease that you don’t often hear about:

1. Physical Limitations:
   • Many people with heart disease experience fatigue, shortness of breath, and reduced exercise tolerance. Activities that once felt easy may now be difficult or exhausting.
   • Chest pain or discomfort can occur, especially with exertion or stress, which can be scary and uncomfortable.
   • Swelling in the legs, ankles, or abdomen can be common, particularly in conditions like heart failure, where the heart struggles to pump blood effectively.
2. Medications:
   • People with heart disease often need to take medications to manage symptoms, lower cholesterol, reduce blood pressure, or prevent blood clots. This can be a lifelong commitment, with the potential for side effects.
   • Adhering to a medication regimen can be challenging but is essential for managing the condition.
3. Frequent Medical Visits:
   • Regular check-ups, tests (like EKGs, stress tests, or echocardiograms), and monitoring are often required to keep track of the condition and adjust treatment as necessary.
4. Financial Impact:
   • The time off from work, copays, and prescriptions can accumulate over time. It’s much less costly to prioritize your health.
5. Emotional Impact:
   • Living with heart disease can lead to anxiety or depression, especially with the fear of heart attacks, strokes, or sudden cardiac events. The uncertainty of how the condition may progress can be mentally and emotionally challenging.
   • Lifestyle changes, such as altering diet or exercising more, can also be hard to adjust to and may create feelings of frustration.

As If That’s Not Enough: The More Concrete Dangers Of Heart Disease

These are the dangers you’re used to hearing about- and you don’t want any of it.

• Heart Attack: The most immediate danger is a heart attack, where a blockage in the arteries cuts off blood flow to the heart muscle. This can lead to permanent damage to the heart, and in severe cases, death.
• Stroke: If the blood vessels in the brain become narrowed or blocked due to atherosclerosis (plaque buildup), it can lead to a stroke, causing brain damage, loss of function, or death.
• Heart Failure: If the heart becomes too weak to pump blood effectively, it can lead to heart failure. This can cause a buildup of fluid in the lungs and other parts of the body, leading to difficulty breathing, fatigue, and other complications that can severely limit daily activities.
• Arrhythmias (Irregular Heartbeats): Heart disease can disrupt the heart’s electrical system, leading to arrhythmias (irregular heartbeats). Some arrhythmias can be life-threatening, such as ventricular fibrillation, which can cause the heart to stop beating, leading to sudden cardiac arrest.
• Sudden Cardiac Arrest: In some cases, heart disease can lead to an abnormal heart rhythm that causes the heart to stop beating suddenly. Without immediate intervention (such as CPR or defibrillation), this can be fatal.

If Cholesterol is So Bad, Why Do We Even Make It?

You read that correctly- make. We actually make cholesterol in our bodies. This is of course in addition to the cholesterol that we eat. As you might guess, we make it because it’s really important and is actually essential for many functions in the body.

• Cell Membranes: Cholesterol is a key component of cell membranes, helping to maintain their structure and fluidity, which is crucial for proper cell function.
• Hormone Production: It plays a vital role in producing several important hormones, including sex hormones like estrogen, testosterone, and progesterone, as well as cortisol, which helps manage stress and inflammation.
• Vitamin D Production: Cholesterol is used by the skin to produce Vitamin D when exposed to sunlight, which is crucial for bone health, immune function, mental health, and other body processes.
• Bile Production: It is necessary for producing bile, which helps digest fats and absorb fat-soluble vitamins (A, D, E, and K).

I Believe You… But What Causes of Elevated LDL Cholesterol?

This is where my mind has been since I saw my labs this week. How did I mess this up? I pay a decent amount of attention to my macros (carbs, fats, proteins) and I exercise almost every day. While I stand by this practice and highly recommend it for anyone looking to lose weight or maintain their progress, it’s easy to lose sight of some important points. For me, (and I’m embarrassed to say this) I haven’t been eating enough fruits, vegetables, and healthy fats. Face palm. Let’s just… Let’s just get into this…

1. Poor Diet

Foods High in Saturated Fats:

• Fatty cuts of red meat: Beef, pork, and lamb, especially when cooked with added fat, can be high in saturated fats.
• Full-fat dairy products: Whole milk, cream, cheese, butter, and ice cream contain high levels of saturated fat.
• Processed meats: Sausages, bacon, hot dogs, and deli meats often contain both saturated fat and cholesterol.
• Lard and palm oil: These fats, often used in cooking or processed foods, are high in saturated fats.

Foods Containing Trans Fats:

• Partially hydrogenated oils: Found in many processed and packaged foods, such as baked goods, pastries, and some margarine, trans fats are very harmful for cholesterol levels.
• Fried foods: Fast food, fried snacks, and deep-fried items like French fries and fried chicken often contain trans fats that can significantly raise LDL cholesterol.
• Packaged snacks: Crackers, cookies, cakes, and other packaged snacks often contain trans fats to improve shelf life.

High-Cholesterol Foods:

• Egg yolks: While eggs are a good source of protein and other nutrients, the yolk is high in cholesterol. However, moderate egg consumption (like 3-4 eggs per week) is typically fine for most people.
• Shellfish: Shrimp, lobster, and other shellfish are high in cholesterol. While they are low in saturated fats, consuming them in excess can raise cholesterol levels.

Fast Food and Highly Processed Foods:

• Many fast food items, like burgers, fried chicken, and pizza, are high in unhealthy fats and cholesterol.
• Highly processed foods like pre-packaged meals and snacks may contain unhealthy fats, additives, and preservatives that raise cholesterol levels.

Certain Oils:

• Coconut oil and palm kernel oil: These oils are high in saturated fats, which can raise LDL cholesterol levels. Although they are plant-based, they have a similar effect on cholesterol as animal fats.

2. Lack of Physical Activity (How Physical Activity Helps)

• Increased HDL (Good Cholesterol): Exercise, especially aerobic activities like walking, running, and cycling, can increase high-density lipoprotein (HDL) cholesterol. HDL helps remove excess cholesterol from the bloodstream and transport it to the liver, where it’s processed and eliminated from the body.
• Lower LDL (Bad Cholesterol) and Triglycerides: Regular physical activity can reduce low-density lipoprotein (LDL) cholesterol and triglycerides, both of which are linked to an increased risk of heart disease. Exercise helps improve the body’s metabolism and fat processing, leading to a reduction in these harmful fats. 
• Improved Lipid Profile: Physical activity enhances the body’s ability to metabolize fats and sugars, improving overall lipid profile. As a result, people who exercise tend to have a healthier balance of cholesterol levels.
• Weight Management: Regular physical activity helps maintain a healthy weight or promotes weight loss, which in turn can lower LDL cholesterol and triglycerides. Losing excess weight, especially abdominal fat, has a positive impact on cholesterol levels.

3. Being Overweight or Obese

• Increased Fat Stores: Excess body fat, particularly abdominal fat, can lead to an imbalance in cholesterol production. When there’s more fat in the body, it can increase the production of low-density lipoprotein (LDL or “bad” cholesterol) and decrease the production of high-density lipoprotein (HDL or “good” cholesterol). This results in a higher level of harmful cholesterol and a lower level of protective cholesterol.
• Insulin Resistance: Obesity, especially when combined with poor diet and lack of exercise, can lead to insulin resistance. Insulin resistance can disrupt the liver’s ability to process fats properly, leading to higher levels of triglycerides (another type of fat) and LDL cholesterol. It also reduces the clearance of fats from the bloodstream.
• Inflammation: Obesity is associated with chronic low-grade inflammation. Fat cells (especially those around the abdomen) release inflammatory markers that can affect the liver’s ability to regulate cholesterol and other lipids in the blood. This inflammation can contribute to an increase in cholesterol and triglyceride levels.
• Impaired Lipid Metabolism: In obese individuals, the body may not efficiently break down and use fats. This can cause a buildup of cholesterol and other lipids in the bloodstream, leading to high levels of LDL and triglycerides while also reducing HDL levels.
• Changes in Liver Function: Excess fat in the liver (fatty liver disease) is common in people with obesity. This condition can impair liver function and disrupt the liver’s ability to manage cholesterol production, often resulting in higher levels of LDL cholesterol and lower HDL cholesterol.

4. Genetics (Familial Hypercholesterolemia)

• Some people inherit genetic conditions that cause their bodies to produce too much LDL cholesterol or have difficulty clearing it from the bloodstream. This is known as familial hypercholesterolemia, which can lead to very high LDL levels, even in childhood.

5. Smoking

• Lower HDL (Good Cholesterol): Decreased levels of high-density lipoprotein (HDL), often referred to as “good” cholesterol, which helps remove excess cholesterol from the bloodstream.
• Higher LDL (Bad Cholesterol): Increased low-density lipoprotein (LDL), or “bad” cholesterol, which can build up in the walls of arteries.
• Inflammation and Oxidative Stress: Smoking promotes inflammation and oxidative stress, both of which can further damage blood vessels and increase cholesterol plaque formation in arteries.

6. Alcohol Consumption

• Increased Production of VLDL: Alcohol is metabolized by the liver, where it stimulates the production of very-low-density lipoprotein (VLDL), a type of lipoprotein that carries triglycerides in the bloodstream. As VLDL levels rise, it can convert into LDL, leading to an increase in “bad” cholesterol.
• Increased Fat Accumulation in the Liver: Excessive alcohol consumption can lead to fat buildup in the liver, known as fatty liver. This impairs the liver’s ability to process and clear fats, including triglycerides. As a result, triglyceride levels in the blood increase.
• Interference with Lipid Metabolism: Alcohol can disrupt the normal metabolism of fats in the liver, leading to the accumulation of both triglycerides and cholesterol in the bloodstream. This disrupts the balance of lipoproteins and can raise LDL and triglyceride levels.
• Caloric Intake: Alcohol is high in calories, and excessive consumption can lead to weight gain, which is another factor that can raise triglyceride levels. More body fat can increase the production of triglycerides.

7. Certain Health Conditions

• Diabetes: High blood sugar levels can lower HDL cholesterol and raise LDL cholesterol. Poorly controlled diabetes increases the risk of cardiovascular problems.
• Hypothyroidism: An underactive thyroid can lead to higher levels of LDL cholesterol.
• Chronic Kidney Disease: Some kidney diseases can lead to higher cholesterol levels, including elevated LDL.

8. Age and Gender

• Cholesterol levels tend to rise with age, especially after menopause in women. Both men and women are at increased risk of high LDL as they get older.

9. Medications

• Certain medications, such as steroids, diuretics, and some beta-blockers, can raise LDL cholesterol levels as a side effect. The benefit may outweigh the risk in these situations so don’t just stop taking your medications. You may actually be able to switch to a similar medication that hasn’t been shown to affect cholesterol. It’s extremely important to discuss any medication changes with your doctor.

10. Stress

• Hormonal Response: When you experience stress, your body releases stress hormones like cortisol and adrenaline. These hormones can trigger an increase in the production of glucose and fatty acids as part of the body’s “fight or flight” response. Elevated cortisol levels can promote the liver’s production of LDL cholesterol, which may lead to higher levels of “bad” cholesterol in the bloodstream.
• Inflammation: Chronic stress can contribute to systemic inflammation. Inflammation is a key factor in the development of atherosclerosis, where cholesterol and other substances build up in the arteries. The body may respond by producing more LDL cholesterol, which contributes to the formation of plaques in the arteries.
• Unhealthy Coping Behaviors: Stress often leads to unhealthy behaviors like overeating, consuming high-fat foods, drinking alcohol, or smoking. These behaviors can directly raise LDL levels and negatively affect lipid metabolism. For example, overeating, especially high-fat or sugary foods, can lead to higher levels of LDL and triglycerides.
• Sympathetic Nervous System Activation: Stress activates the sympathetic nervous system, which can increase heart rate and blood pressure. This heightened activity may also stimulate the liver to produce more cholesterol, including LDL, as part of the body’s efforts to manage stress and maintain energy levels.

Dietary Strategies to Improve Cholesterol Levels

This is what I suspect is the path to correcting my cholesterol. I’m not proud of it, but at least there’s a plan of action. These are some foods and supplements I’ve started incorporating more of into my diet (and you should too):

• Increase Fiber Intake: Eating more soluble fiber can help reduce LDL cholesterol by preventing its absorption in the blood stream.
  • Oats and Whole Grains: Rich in soluble fiber, oats and whole grains like barley and brown rice can help reduce LDL cholesterol.
  • Beans and Legumes: Beans, lentils, and other legumes are excellent sources of soluble fiber, which aids in lowering cholesterol.
  • Fruits Rich in Pectin: Apples, grapes, strawberries, and citrus fruits are high in pectin, a type of soluble fiber that can lower LDL cholesterol.
  • Psyllium Husk: A soluble fiber supplement that can help lower cholesterol levels by binding to cholesterol in the digestive system, preventing its absorption.
  • Supplements like Benefiber can be added to a lot of things, including beverages, yogurt, and baked goods.
• Limit Saturated and Trans Fats: Reducing consumption of foods high in saturated fats (like fatty cuts of meat, butter, and full-fat dairy) and avoiding trans fats (found in some processed foods and baked goods) can help lower LDL levels.
• Choose Healthy Fats: Replacing unhealthy fats with healthier options like monounsaturated and polyunsaturated fats can help raise HDL cholesterol while lowering LDL.
  • Nuts and Seeds: Almonds, walnuts, and other nuts contain healthy fats and fiber that can help lower LDL cholesterol.
  • Olive Oil
  • Avocados
  • Fatty Fish (Salmon)
• Eat Omega-3 Fatty Acids: Omega-3 fatty acids can help lower LDL cholesterol and triglyceride levels.
  • Fatty fish like salmon
  • Chia seeds
  • Flax seeds
  • Walnuts
• Green Tea: Contains compounds that may help lower LDL cholesterol.
• Garlic: May slightly reduce cholesterol levels, though studies have been conflicting.

Lifestyle Modifications

I realize you hear these over and over again, but it’s for good reason:

• Regular Physical Activity: Engaging in regular aerobic exercise (e.g., brisk walking, running, swimming) can raise HDL cholesterol and lower both LDL cholesterol and triglycerides while simple strength training is known to raise HDL. Aim for at least 30 minutes of moderate exercise most days of the week.
• Weight Management: Achieving and maintaining a healthy weight can positively influence your entire lipid profile.
• Smoking Cessation: Quitting smoking can improve HDL cholesterol levels and reduce the damage caused by oxidative stress and inflammation. It also helps improve overall cardiovascular health, lowering the risk of atherosclerosis and heart disease.
• Moderate Alcohol Consumption: If you choose to drink, do so in moderation  (up to one drink per day for women and two for men), as excessive alcohol intake can lead to higher cholesterol levels.
• Stress Reduction: Chronic stress can raise cortisol levels, which in turn may increase LDL cholesterol. Practicing stress-reduction techniques such as prayer, mindfulness, meditation, yoga, or regular physical activity can help keep cholesterol levels in check.
• Blood Pressure and Cholesterol Checks: Regular visits to your healthcare provider for monitoring blood pressure and cholesterol levels are essential. Managing other health conditions, such as high blood pressure and diabetes, also helps protect against high cholesterol.

Final Thoughts: Progress Over Perfection

It’s important to focus on progress instead of perfection- don’t beat yourself up over it. Rome wasn’t built in a day, but there was a definite intention and consistent effort. Do make sure you cling to that, as this is true with most things in life. Now that the shock of my lab results has worn off and I’m getting into the habit of a more balanced diet, I’ve started to actually feel better. It takes several weeks to months for the changes to be reflected on blood tests, but I’m expecting good things at my next check up. I hope you don’t feel alone in your mission to be healthier. I’m with you in spirit and I’m happy to share this journey with you. Press on, friends!