The Ups and Downs of Managing Your Cholesterol

By Victoria Shanta Retelny, RDN

Vicki is a registered dietitian nutritionist, lifestyle nutrition expert, writer, culinary and media consultant and author of two books.

victoriashantaretelny.com

High cholesterol levels put individuals at an increased risk of heart disease, which is the leading cause of death in U.S. adults. It’s important for older adults to manage their cholesterol levels to reduce their chance of heart disease.

The trick to managing blood cholesterol levels is not necessarily to reduce the cholesterol you eat in foods. It’s actually more important to limit the saturated fat and refined carbohydrates that you eat. Physical exercise and reducing your stress will also help you manage your cholesterol levels.

Cholesterol, along with blood pressure and blood glucose, is a key factor for cardiovascular health, according to the American Heart Association.

“Cholesterol can build up in arteries, reducing blood flow to critical organs like the heart or the brain. Roughly speaking, the higher the cholesterol, the higher the risk of having these blockages. But cholesterol is just one of many risk factors for heart attack and stroke,” says Micah J. Eimer, MD, a cardiologist at the Bluhm Cardiovascular Institute of Northwestern Medicine in its Glenview outpatient center.

Cholesterol in the body

To understand why we need to reduce cholesterol, we first need to understand what cholesterol does in the body.

Cholesterol is in the foods we eat. It is also naturally produced in our liver. Cholesterol is a type of lipid (fat) in the blood, with an important role. Our bodies need cholesterol to form cell membranes, to make hormones, such as estrogen and testosterone, and to make vitamin D, as well as other important compounds.

To transport cholesterol in the blood, our bodies package it in lipoproteins, specifically low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

HDL cholesterol is called “good” cholesterol because it pulls excess cholesterol from the bloodstream and deposits it back into the liver. On the other hand, LDL cholesterol gets the name “bad” cholesterol because an overabundance can cause plaque to form in the arteries, which can lead to blockages, heart attacks, and strokes.

Triglycerides, which transport the fat you eat to your cells, are another type of lipid. When triglyceride levels get too high, it can pose a risk for heart disease, too.

“Some forms of cholesterol are very responsive to changes in lifestyle, such as the HDL, as well as triglycerides, which is why I call them ‘lifestyle lipids,’” Eimer says.

To manage cholesterol, lifestyle changes such as diet, physical activity, and stress management are key.

Cholesterol and diet

You would think that foods high in dietary cholesterol — such as meat, cheese, and eggs — would cause high blood cholesterol. But that’s not necessarily the case.

For most people, if you eat more cholesterol in your diet, your blood cholesterol levels may not rise much. However, some people, called hyper-responders, do see their blood cholesterol levels increase if they eat high-cholesterol foods.

Also, the aging process can affect how you respond to cholesterol, making you more susceptible to cholesterol in your food.

“As you age, your food moves more slowly through your gut and allows for greater cholesterol absorption from the foods you eat,” explains Kristin A.R. Gustashaw, RD, a certified specialist in gerontological nutrition at Rush University Medical Center.

For most people, instead of dietary cholesterol being the problem, carbs and the mixture of types of fats in the diet are most likely to blame for high blood cholesterol levels.

“Consuming excess saturated fat and trans fats primarily from processed foods can increase your LDL cholesterol,” Gustashaw says.

The recent Dietary Guidelines for Americans 2020 – 2025 Executive Summary Report recommends a shift from saturated fat — found in red and processed meats, butter, cheese, and milk chocolate — to unsaturated fats, which are found in olive oil, nuts, seeds, and fatty fish.

Eggs, which are high in dietary cholesterol with about 200 mg in one large egg yolk, may not be detrimental to blood cholesterol levels. Interestingly, eggs are relatively low in saturated fat and high in unsaturated fat. Eggs have been shown to potentially raise beneficial HDL cholesterol with no significant increase in LDL cholesterol, according to a review study in the journal Nutrients.

As with all nutrients, not everyone responds to dietary cholesterol the same way, and responses vary based on genetic and metabolic factors. In fact, in the Dietary Guidelines for Americans 2020 – 2025, the recommendation for dietary cholesterol is more of a general statement to keep intake as “low as possible without compromising the nutritional adequacy of the diet.”

Carbs are important to look at too. Eating refined carbohydrates — like baked goods, sugar-laden cereals, and sweetened yogurt and coffee drinks — as well as drinking alcohol can raise triglycerides. The body stores excess carbohydrates that are not used for energy as fat in the form of triglycerides.

Heart-healthy plant foods

Look to the Mediterranean diet for foods that are lower in fat, refined carbs, and dietary cholesterol. This healthy approach can help you lower your blood cholesterol.

The Mediterranean diet mostly involves plant foods, such a whole vegetables, fruits, whole grains, beans, peas, lentils, nuts, and seeds. Unlike animal foods, plant foods naturally do not contain cholesterol and have low saturated fats. Instead, they’re jam-packed with fiber and other heart-healthy plant compounds.

Soy has been shown to be beneficial for lowering blood cholesterol and helping with cardiovascular health, according to a 2017 review article in the journal Nutrients. Choose whole soy foods, such as tofu, edamame, and soymilk, rather than heavily processed soy.

Dietary fiber is also a big player in cholesterol management. Soluble fiber, which is found in pectin in fruits, vegetables, and whole grains, such as apples, beans, peas, oats, barley, and psyllium forms a gel-like substance in the stomach and intestines, which blocks the absorption of fat and cholesterol. This process can also aid in lowering LDL cholesterol.

Get moving

Increasing physical activity, losing weight, and quitting smoking can also help you manage your cholesterol. “Generally speaking, the better your lifestyle, the lower your triglycerides and the higher your HDL,” Eimer says.

“Physical activity definitely does move cholesterol levels in a healthy direction,” Eimer says. “The exact mechanism of this effect is not entirely clear, but it probably reflects some combination of increased HDL, which helps to remove plaque from the arteries, increased breakdown of cholesterol in the muscles, and changes in body fat composition.”

Physical activity, a pillar of cardiovascular health, is important at every age.

Older adults should include different types of physical activity, including balance training, aerobic exercise, and muscle-building activities, such as Pilates and yoga, according to the U.S. Department of Health & Human Services’ Physical Activity Guidelines for Americans.

Be aware of your own fitness level and be as active as your abilities allow. If you have chronic conditions, be aware of your limitations. The recommendation of 150 minutes a week (or 30 minutes, five days a week) of moderate-intensity activity only applies if you are in the condition to do it.

Manage stress better

When life gets out of whack and stress levels run high — especially during these uncertain times — your cholesterol levels can reflect that. Under stress, your body releases hormones, such as cortisol and adrenaline, causing an elevation in blood sugar and a boost in triglycerides, which leads to more circulating LDL cholesterol in the blood.

“There is a relationship between stress and increased cortisol that seems to negatively affect cholesterol levels as well as food metabolism by both increasing LDL cholesterol and possibly decreasing HDL cholesterol,” Gustashaw says.

Plus, stress has a ripple effect. With chronic stress comes surging levels of the stress hormone cortisol. Higher cortisol levels can lead to poor eating choices and weight gain, due to increased cravings for sugary and fatty foods.

Along with stress and anxiety may come a lack of motivation to exercise — making for an unhealthy cycle.

With this in mind, think about simple ways to manage stress with daily meditation, regular physical activity, phone calls and video conferencing with friends and family, and stocking healthy foods for meals and snacks at home.

Small adjustments in diet, physical activity, and stress reduction can do big wonders for keeping your cholesterol levels in check.

Know Your Lipid Ideals

Confused by your cholesterol numbers? Aim for these healthy levels of cholesterol:

• Total Cholesterol: Less than 200 mg/dL

• HDL Cholesterol: 60 mg/dL or above

• LDL Cholesterol: Less than 130 mg/dL; less than 100 mg/dL for people with diabetes or other risk factors; less than 70 mg/dL for people with cardiovascular disease or a family history of it.

• Triglycerides: Less than 150 mg/dL