September is National Cholesterol Education Month! Cholesterol is often used as a general marker of heart health with high cholesterol indicating poorer health. Food companies love to market products as “low cholesterol” or boast that their product can help to lower cholesterol. You may not know that not all cholesterol is “bad” and our body actually needs cholesterol to function. Let’s take a look at what cholesterol is, what it does, and what is considered healthy.
What is cholesterol and what does it do?
Cholesterol is a type of lipid, or fat, that can be produced by the liver or from the foods we eat. Cholesterol from the food we eat is absorbed by the body and combines with triglycerides to form a molecule called a chylomicron. From there, it can be sent to a variety of different places depending on what the body needs it for. This cholesterol is largely used to assist with energy production and storage of energy into adipose tissue, aka fat cells. What is left goes toward the creation of low-density lipoprotein (LDL).
Cholesterol produced by the liver undergoes a different process. Some of it is converted to a liquid called bile that helps the body to break down fats during digestion. Other uses include helping our body produce vitamin D, aiding in the repair of damage to our body, and helping to produce hormones such as estrogen. These are all obviously good things, it is in excess that cholesterol can contribute to cardiovascular disease and other negative health outcomes.
Cholesterol is carried throughout the body by molecules known as lipoproteins. Most people have heard that LDL is “bad” cholesterol and high-density lipoprotein (HDL) is “good”. These lipoproteins earned their labels not because of what they are but because of their function in the body. LDL is the lipoprotein that deposits cholesterol in tissue whereas HDL is used to remove cholesterol from the body. If you have high LDL and low HDL, more cholesterol is being deposited than what is being removed. This is important to remember when discussing how cholesterol contributes to cardiovascular disease.
How does cholesterol lead to cardiovascular disease?
Atherosclerosis occurs when cholesterol and other fats accumulate along the inside of blood vessels creating what are referred to as atherosclerotic plaques. LDL is a strong contributor to plaque buildup. These plaques cause a narrowing on the inside of the blood vessel making it difficult for blood to pass through. Without proper blood flow, oxygen cannot be adequately delivered to organs and other tissues. Individuals often have no symptoms until a significant amount of plaque is present. Symptoms vary depending on the areas that are not receiving enough blood:
- In coronary artery disease, the arteries that supply the heart itself are affected. When the heart does not get enough blood flow and oxygen it causes a pain commonly referred to as angina pectoris. This pain is commonly described as squeezing, pressure-like, and located behind the sternum. Initially, this pain typically presents during exercise and goes away with rest. As the disease worsens, pain may present even at rest. Coronary artery disease greatly increases the risk of having a heart attack.
- In peripheral artery disease, the arteries leading to your legs are affected. Arteries in the arms and pelvis can be affected too but this is not as common. Peripheral artery disease tends to cause cramping pain in your calves when walking which is alleviated at rest.
- In carotid artery disease, the carotid arteries are affected. These arteries run up alongside your neck into your brain. Most people do not have symptoms until the narrowing is severe. At this point, the presenting symptom is often what is called a Transient Ischemic Attack (TIA) which is also referred to as a “mini-stroke.”
- Vertebral artery disease affects arteries that go to the brain which can lead to stroke.
- Renal artery disease affects the arteries that go to your kidneys. This can lead to kidney disease and high blood pressure which can be difficult to treat with medications.
- Mesenteric artery ischemia affects arteries that supply blood to the GI tract. This can lead to cramping pain with eating and weight loss.
Plaques can also rupture. When this happens a blood clot is often formed. This clot can get lodged in an artery and partially or completely block the artery. This can lead to heart attack, stroke, loss of limb, erectile dysfunction, and vascular dementia, to name a few. sclerosis. This combination of hardening and plaque build-up can lead to high blood pressure.
How do I know if I have high cholesterol?
How often you need to be screened for high cholesterol is determined by your risk factors. Family history, age, ethnicity, sex, sedentary lifestyle, cigarette smoking, poor diet, alcohol abuse, stress levels, and the presence of comorbid health conditions like diabetes and kidney disease may impact your risk for high cholesterol and cardiovascular disease. Most organizations recommend screening all adults ages 40-75 with the initiation of screening at age 20 if sufficient risk is present. Testing is simple and involves a blood test called a lipid panel. Talk to your primary care provider if you think you might be at risk of elevated cholesterol.
What do I do if my cholesterol is high?
In most cases, the first step is lifestyle modifications:
- Aim to get at least 30 minutes of exercise five days a week. This can be as simple as taking a walk. If you are a member of PUSH511 aim for three WODs per week.
- The DASH diet is a dietary pattern that emphasizes low sodium, added sugar, saturated fat, and increased fruits and vegetables. It has been proven to help reduce blood pressure and cholesterol. Foods that will increase LDL cholesterol are red meat, fried food, full-fat dairy, butter, baked goods, and tropical oils like palm and coconut oil. Foods that will help raise HDL include fruits, vegetables, whole grains, tree nuts (cashew, almond, walnut), polyunsaturated fats like olive, sunflower, and canola oil, and oily fish such as salmon.
- If you smoke, it is important to stop. Tobacco use has been linked not only to high blood pressure and cardiovascular disease but to other diseases such as lung and bladder cancer. The National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848) is a good resource for individuals trying to quit smoking.
- Other lifestyle changes include stress management and getting adequate sleep.
If these changes are not enough, your medical provider may put you on medication to help lower cholesterol. It is important to follow along with a primary care provider to monitor your progress. As always, if you need help reaching your health goals through nutrition, reach out to PUSH to learn about one-on-one nutrition coaching!
About the Author
I am a Licensed Registered Dietitian with experience in critical care, cardiology, weight loss, allergy services, and food service. I graduated from Penn State University with a BS in nutrition and finished my RD training at the University of Maryland. I am currently in PA school and am looking forward to combining my love of nutrition with medicine. After moving to Baltimore in 2019, I did a trial class at PUSH511 Fitness as I was looking for accountability and to meet new people. When I walked into the gym for the first time, everyone was congregated on one side cheering on a member who was struggling with ring muscle-ups at the end of the workout. It was such an uplifting moment to witness. I left the gym that day in dire need of ginger ale, but also very excited about this amazing and supportive community I had stumbled upon. I am grateful for this opportunity to give back and share my love of nutrition!