By Mike DuBose with Blake DuBose and Surb Guram, MD
Cardiovascular disease is responsible for 1 in every 3 American deaths, and each year, more 610,000 people die of heart disease (including heart attacks), according to the US Department of Health and Human Services. The biggest risk factor leading to these deadly conditions is high cholesterol. In fact, according to the Cleveland Clinic, one of America’s top research hospitals for heart health, having high cholesterol increases not only the risk of heart disease, but also some of the other top causes of death, including stroke, Type 2 diabetes, and high blood pressure. In addition, recent studies by the University of California have shown that high levels of LDL cholesterol and low HDL may also be associated with dementia and Alzheimer’s disease.
Of course, having high cholesterol does not guarantee that you will experience heart disease, a heart attack or stroke, or any of these other frightening illnesses. Some people with excellent genetic protective factors live to old age with high cholesterol, while others with low cholesterol die prematurely. However, for most people, the higher your cholesterol, the more likely you are to experience a traumatic—and perhaps disabling or deadly—vascular event.
What is cholesterol?
To understand why it’s important to lower cholesterol, it’s helpful to know more about what it is and where it comes from. Cholesterol is a waxy, odorless substance that is generated by the liver and also enters the body through the foods and liquids we consume. Some cholesterol is good for the body because it protects cells, helps the body to send messages back and forth, encourages the generation of Vitamin D, works with the gallbladder in the digestive process, and assists in building hormones such as estrogen and testosterone.
However, when cholesterol reaches high levels, it becomes a silent killer. When there is too much cholesterol in your bloodstream, it builds up on the walls of your arteries; over time, excessive amounts of plaque can cause atherosclerosis, or “hardening of the arteries.” The arteries become very narrow and blood flow to the heart is slowed down or blocked. When the flow ceases completely, a heart attack occurs. Blood flow to the brain is also impacted, diminishing the amount of oxygen reaching it, which can cause a stroke.
Unfortunately, there are no outward symptoms when high cholesterol is in its early stages. Without taking blood tests, people are often unaware they have it until more serious symptoms (including heart attacks, angina, chest pains, or stroke) occur. Sadly, the realization that they have high cholesterol comes far too late for many individuals.
There are two main types of cholesterol: HDL and LDL. Most cholesterol is LDL (low-density lipoprotein) cholesterol. LDL cholesterol is more likely to clog blood vessels because when it is attached to a protein, it travels away from the liver into the bloodstream, where it can stick to the blood vessels. Remember this culprit by referring to it as the “lousy cholesterol.” HDL (high-density lipoprotein) cholesterol carries the cholesterol back to the liver, where it is broken down. Remember it as the “healthy cholesterol.”
Another important type of lipid to consider (apart from cholesterol) is triglycerides. Triglycerides are different in that they are fats, while cholesterol is not a fat. Triglycerides mostly come from our diet, including alcohol, sugar, and highly caloric foods. While there is no definitive study demonstrating a direct link between high triglycerides and heart disease, high triglycerides are a risk factor for pancreatitis, so levels over 500 are generally treated.
How do I determine my cholesterol levels?
Every year, you should undergo a thorough medical examination under the care of a doctor, preferably an internist who has been trained in advanced medical diagnosis. One of the most important tests for high cholesterol that you will want to ensure he or she performs on you is called a “lipoprotein profile.” This test is done while fasting, which means you must abstain from eating or drinking anything other than water for 12 hours beforehand. This will give your doctor an accurate reading of your cholesterol numbers. You will also want to ask for a C-reactive protein test, a blood test that measures inflammation in your arteries. (By the way, going on a healthy diet right before your blood tests will not significantly alter your results!)
LDL and HDL particles are different sizes, and the health effects of the differing types of particles has been a matter of intense study recently. Research shows that smaller, denser LDL cholesterol is inflammatory and toxic to blood vessels. Even more troubling is a high level of lipoprotein-a, or Lp(a)—the most dangerous blood lipid. Lp(a) is a specific type of small LDL cholesterol particle that inflames the blood and makes it sticky, and patients with Lp(a) are more prone to clotting. Standard cholesterol tests, however, won’t tell you about your HDL and LDL ratios or Lp(a). Therefore, ask your doctor for Vertical Auto Profile (VAP) and Lipoprotein Particle Profile (LPP) blood tests.
Secure copies of all your blood and other tests and store them in a file so you can monitor changes each year. (I made a chart of my results that I can review with my doctor when comparing tests over time.) You don’t need an appointment with your doctor to obtain copies of the tests; just call ahead to ask for the documents. You may have to sign a form to receive them, though.
Treatments vary based on your HDL, LDL, and triglyceride levels, so study each of the lipids and what you can do to get them to healthy levels. The more dangerous cholesterol particles that show up in your blood tests, the more aggressively you’ll need to treat your cholesterol—because the more you have, the greater your risk for cardiovascular disease, stroke, and death.
How do I interpret the blood tests?
Your LDL is not measured directly; rather, it is calculated from your total cholesterol, HDL, and triglyceride levels. The calculation used to derive LDL is: LDL = total cholesterol – HDL – (20% of your triglycerides). For example, if your total cholesterol is 164, HDL is 65, and triglycerides are 75, your LDL comes out to be 84. Triglyceride levels are affected by food intake, which is why you must fast prior to cholesterol testing to obtain an accurate lipid profile.
According to the American Heart Association, a total cholesterol score of 180 mg/dl or less is optimal (some physicians continue to use the former standard of 200 mg/dl or less), although the individual components are more important than the total cholesterol level. In terms of specific lipids, Cleveland Clinic and the Mayo Clinic both recommend shooting for an HDL of more than 40, LDL of 100 mg/dl or less, and triglycerides lower than 150 mg/dl.
Nowadays, doctors also consider risk factors such as diabetes, previous heart attacks or strokes, blockages, heart disease, family history, age, and other risk factors when establishing individual cholesterol goals. In fact, cholesterol usually increases as we age, but children as young as two years old can have high cholesterol! The American Academy of Pediatrics generally recommends first testing children for lipids between the ages of 9 and 11.
What causes high cholesterol?
According to the Mayo Clinic and WebMD.com, the seven greatest risk factors for high cholesterol are:
Sometimes, the reason for high cholesterol is another organ that is operating incorrectly. For example, a thyroid that is underperforming (called hypothyroidism), and liver or kidney diseases can be culprits. This can be difficult to diagnose, which is why you need a highly experienced internist to carefully examine any potential causes if you have high cholesterol.
A number of medicines have also been scientifically linked to elevated cholesterol levels. These drugs include: diuretics, beta blockers, estrogen, steroids, diabetic drugs, vitamin D supplements (in too large of a dosage), certain antidepressants, creatine, prednisone, progestin, and retinoids (for acne), to name just a few. Never stop taking any medications without consulting your physician or pharmacist, but if you have high cholesterol, you will want to thoroughly research any medications you are taking and see if they may be contributing. Drugs.com is an excellent source of research and offers a tool where you can cross-reference all of your medicines. I discovered which drugs impacted my cholesterol through an even simpler method: going to Google and asking the question: “Does (name of medicine) increase my cholesterol?” If high cholesterol is a side effect of one of your drugs, you won’t miss that fact by using this strategy!
Once you have done your research, speak to your doctor about your findings. He or she may want to try you on an alternative drug or give you tips on how to lower your cholesterol through other means.
Treatment options for high cholesterol
Different treatment options have varying effects on the individual components of your cholesterol score (LDL, HDL, and triglycerides). For example, one strategy may increase your good HDL cholesterol, but fail to impact your triglycerides or vice versa. With your doctor’s guidance, you will want to work on all three individually and in combination to bring your numbers into the safe range.
Depending on your risk factors and lipid numbers, your doctor may suggest that you implement lifestyle changes (lose weight, eat healthier, change cooking methods, implement regular exercise, quit smoking, reduce stress, etc.) and/or take a statin drug. According to the Mayo Clinic, “Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks. Statins include medications such as Lipitor, Lescol, Altoprev, Livalo, Pravachol, Crestor, and Zocor. Lower-cost generic versions of many statin medications are available.”
Statin drugs are beneficial since they have the potential to reverse coronary disease. WebMD.com states: “Statins reduce the risk of heart attack, stroke, and even death about 25 to 35%. Studies also show that statins can reduce the chances of recurrent strokes or heart attacks by about 40%.”
Unfortunately, as WebMD notes, millions of people suffer side effects when taking statins, including headaches, insomnia, flushing of the skin, drowsiness and dizziness, nausea, and muscle or joint pains. The good news, however, is that studies have shown that a multipronged approach incorporating diet, exercise, stress reduction, and social support can match statin drugs’ health benefits! It is not always easy to implement, but it is a wise choice for those who need to lower cholesterol without using statins.
Before resorting to statin drugs, ask your doctor if you can attempt to reduce your cholesterol using some of the following lifestyle changes first. Schedule a four-month follow-up appointment with a lipid blood test so that you can jointly review your progress and decide how to move forward. Many of these scientifically-proven methods (especially losing weight, exercising more, and eating healthier) helped me to lower my overall score from 199 mg/dl to 164 mg/dl (35 points)! Try implementing some of them for a healthier lifestyle, and you may be able to skip statins altogether.
If you do take a statin drug and experience side effects, consider trying other brands of statins since they work on different parts of the body. When starting on statins, ask your doctor if you can begin with a low dose and take it every other day to see how the statin impacts your body and mind. Then, increase the dosage slowly (if needed) under your doctor’s supervision.
Commit to changing: If you really want to reduce your high cholesterol, then you must make a solid commitment to examine your lifestyle, what you consume, how much you exercise, your stress levels and coping strategies, and the other factors mentioned in this article and make improvements. You do not have to turn your life upside down to reap important health benefits—several small changes can add up to a major cholesterol reduction! For example, you don’t have to eat a bland, rigid diet; just practice moderation instead. Try playing at reducing cholesterol like a game, or team up with your spouse or a friend to work together to improve your health.
Develop a written strategy: After reviewing the following research, make a list of the changes you are going to make and how you will execute the plan—it’s almost like planning a trip! Establish a target overall cholesterol number that you would like to reach by the end of the first 120 days. I suggest beginning with a very achievable objective like a 10% reduction (i.e. if your overall cholesterol is 250, initially shoot for 225) to avoid discouragement. You may still be in the high zone after the four months are up, but as a Harvard psychiatrist once told me, “When you want to change behaviors, take baby steps.” Then, over the next 120 days, shoot for another 25 points. Keep this up and celebrate the small victories as you travel down the path to a lifestyle that manages your total cholesterol within a safe range.
Control your sugar levels (if diabetic): Diabetics need to watch their diets carefully and maintain good sugar readings to help keep their cholesterol within normal ranges. Long-term regulation is measured by a blood test called an A1c, and the goal is to keep it at 7.0 or lower.
Lose weight: Being overweight, as Susan Davis and Cynthia Haynes, MD noted in a WebMD article, “tends to increase the amount of low-density lipoprotein (LDL) in your blood.” Before I set an objective to lose weight, I was approaching 240 pounds with a 42” waist. I stepped out of the “danger zone” for my weight and waist measurements by losing 35 pounds over 30 weeks (see this blog for details on how I accomplished this). Speak to your doctor about how you can change your diet and safely increase exercise to shed excess pounds.
Exercise: As Davis and Haynes wrote, “Researchers aren't entirely sure how exercise lowers cholesterol, but they are beginning to have a clearer idea.” Several recent studies have researched the effect of exercise alone (versus exercise paired with dietary changes) to get a better idea of how it works to promote heart health. Davis and Haynes noted two distinct exercise benefits: first, it “stimulates enzymes that help move LDL from the blood (and vessel walls) to the liver. From there, the cholesterol is converted into bile (for digestion) or excreted. So the more you exercise, the more LDL your body expels.” Second, it increases the size of the protein particles carrying cholesterol through the blood, which is good because it prevents smaller, denser particles from attaching to the lining of the heart and blood vessels.
To maximize your benefits, perform thirty minutes of vigorous exercise (where you are huffing and puffing) every day. Mix it up for some fun: try brisk walking, gardening, dancing, swimming, bicycling, aerobics, climbing stairs, and tennis, to name a few. My wife, Debra, and I walk about two miles daily either at the mall or outside (when temperatures permit). It not only helps our health but also elevates our moods, reduces negative feelings, and gives us a chance to spend time together.
Control stress: Stress and anger can surface for many reasons, such as dissatisfaction or frustration with our jobs or the workplace, marriages, and child-rearing; medical problems; depression; conflicts with relatives and friends; caring for aging parents; being too busy and involved in an excessive number of activities, etc. While not all stress can be controlled, we bring much of it on ourselves and are usually capable of reducing it a good bit! Read more about stress reduction here.
Change your diet: Diet is very important in managing cholesterol. Not only is it vital to maintaining a healthy weight (or losing weight, if necessary), but certain foods can also inhibit bad LDL cholesterol and raise good HDL cholesterol. There are a variety of foods, oils, and liquids that all have unique effects on cholesterol, and you should try to incorporate multiple heart-healthy choices to maximize your health benefits.
As reported in the Harvard Heart Letter, “When it comes to investing money, experts recommend creating a portfolio of diverse investments instead of putting all your eggs in one basket. The same holds true for eating your way to lower cholesterol. Adding several foods that fight high cholesterol in different ways should work better than focusing on one or two… Of course, shifting to a cholesterol-lowering diet takes more attention than popping a daily statin. It means expanding the variety of foods you usually put in your shopping cart and getting used to new textures and flavors. But it’s a ‘natural’ way to lower cholesterol, and it avoids the risk of muscle problems and other side effects that plague some people who take statins. Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay flexible and responsive. It’s good for bones and digestive health, for vision and mental health. That’s a portfolio worth protecting.”
There are many diets out there for weight loss, and you want to find a safe, healthy plan that is doctor-recommended. Even amongst healthy, proven diets, some work better for some people than others. Ultimately, it is up to you to find a diet that is satisfying and fun while also helpful to your health goals. We will discuss the benefits of individual foods and food groups in greater detail below, but you many want to do some additional research on diets like the Atkins (low-carb) Diet, Mediterranean Diet, and DASH (Dietary Approaches to Stop Hypertension) Diet as a starting point. The Atkins Diet has been proven very effective for weight loss, and the Mediterranean Diet, which emphasizes monounsaturated fatty acids found in olive oil and the omega-3 fatty acids in fish and vegetables, offers protection from coronary heart disease and colon cancer.
Which fats are bad, and which are good?
Before we discuss specific foods, it’s helpful to review the difference between “good” fats, which can help your heart, and “bad” fats, which can damage it!
The good: Monounsaturated and polyunsaturated fats are known as “good fats.” When eaten in moderation, they can have a beneficial effect on your heart, raising HDL cholesterol and reducing inflammation. These fats are found in olive, canola, peanut, safflower, and sesame oils, and in certain foods and drinks. One rule of thumb is that they tend to stay liquid at room temperature.
The not-so-good: Saturated fats consist of triglycerides containing only saturated fatty acids. They are found in butter, lard, whipped cream, coconut and palm oils, and animal sources such as red meat, poultry, and full-fat dairy products. There is a debate in the scientific community about the dangers of saturated fats, with a 2014 review of hundreds of studies concluding that people who ate more saturated fats did not exhibit higher rates of heart disease. For example, the traditional Inuit (or Eskimo) diet is rich in saturated fats (coming from wild animals traditionally hunted by the group for food in a harsh climate where few plants can grow), but this population has a lower rate of heart disease than many other people in the world, including Americans. New research published in the Annals of Internal Medicine journal also found that people who ate higher levels of saturated fat didn’t necessarily have higher rates of heart disease than those who ate less. It also failed to find proof of less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil. However, the American Heart Association (AHA), Consumer Reports, and major research hospitals still contend that saturated facts are bad for you and should be reduced or avoided in your diet. To play it safe until more studies can be conducted, follow the AHA’s recommendation and limit saturated fats.
The very bad: Trans fats are the most dangerous of the fats. They are found in some certain hydrogenated oils, margarine, cake, fast foods, biscuit mixes, chips, breakfast cereals, energy bars, frozen pies, microwave popcorn, coffee creamers, refrigerated dough products like biscuits and cinnamon rolls, frostings, dips, baked goods, candy, and crackers. They are uncommon in nature, but became commonly produced from vegetable fats starting in the 1950s. Trans fats are cheap and are used by prepackaged food producers to prolong shelf life and by restaurants and fast food outlets in their deep fryers. According to the Mayo Clinic, trans fats are “double trouble” because they lower your good HDL cholesterol while increasing your bad LDL. So dangerous are they, in fact, that the Food and Drug Administration (FDA) will require by 2018 that all food manufacturers obtain permission to use trans fats in any foods or liquids! Avoid these fats as much as possible, and be vigilant: as the Mayo Clinic reported, even if the label says no trans fats, there could be traces that add up daily—the law states that less than .5 grams per serving can still legally be referred to as 0% trans fats!
Foods that promote good cholesterol and reduce bad cholesterol
Omega-3 fatty acid-rich fish: Eat at least two servings of fish per week, focusing on the types that are highest in omega-3 fatty acids, like: cod, Atlantic or Pacific herring, Atlantic mackerel, sockeye salmon, wild Alaskan salmon, lake trout with pink meat, sardines, white albacore tuna canned in water, farm-raised Atlantic salmon, and bluefish. Each 3.5 ounce serving of most of these fish equals 1 gram of omega-3. (Salmon and sardines are the lowest in mercury, which you want to make sure you don’t consume much of.) Other fish that are lower in omega-3s but are still good are sturgeon, anchovy, mussels, pollock, tilapia, and Pacific halibut. Consumer Reports recently cautioned about eating fish that were raised or caught in foreign countries, so seek fish raised or caught in the US and its surrounding oceans and lakes. Most shellfish, like shrimp and lobster, actually raise your bad LDL levels and should be limited.
Low-fat dairy products and egg alternatives: Reduced fat dairy products offer much of the flavor of their full-fat counterparts, but with less cholesterol. Try shifting from high-fat dairy products to 1% milk, 2% cheese, and low-fat Greek yogurt. Many people enjoy non-dairy “milks,” such as almond or soy milk, just as much (or more) than regular milk! I was pleasantly surprised to find that unsweetened almond milk with vanilla is quite good.
Eggs are a great source of protein, but limit how many yolks you consume and replace some with egg whites.
Beans and peas: These high-fiber, high-protein legumes make excellent meat substitutes and go well in salads, chili, stuffed potatoes, dips, and spreads. Eat five servings per week—try different types like edamame (soybeans), black-eyed peas, lentils, and navy, pinto, black, white, butter, garbanzo, or kidney beans.
Whole grains: According to WebMD.com, “Eating more whole grains is an easy way to add a layer of 'health insurance' to your life. Whole grains are packed with nutrients, including protein, fiber, B vitamins, antioxidants, and trace minerals (iron, zinc, copper, and magnesium). A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity, and some forms of cancer. Whole-grain diets also improve bowel health by helping to maintain regular bowel movements and promote growth of healthy bacteria in the colon." Examples include: oatmeal (the steel-cut type is recommended); brown rice; oat bran; non-microwave popcorn; whole rye; wild rice; buckwheat; 100% whole wheat flour; and whole grain corn.
Low-salt nuts rich in omega-3s: Most nuts have traces of omega-3s, but the highest amounts are present in walnuts, almonds, Brazil nuts, flaxseed, and butternuts. Eat about 2 ounces per day (a small handful). Nuts are high in calories, so to avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat, or croutons in your salad, add a handful of walnuts or almonds.
Omega-3-rich butters and margarines: Some margarines and butters contain high amounts of saturated and trans fats, so always read your labels! Consumer Reports recommends Land O’Lakes with Canola Oil, Smart Balance (our choice), and I Can’t Believe It’s Not Butter (light spread) to help raise good HDL levels. Generally, avoid using regular butter or most margarines.
Soluble high-fiber fruits and vegetables: Recommended by the Food and Drug Administration, soluble fiber not only keeps your digestive system working well, but it also been scientifically proven to reduce LDL blood cholesterol, raise HDL levels, and lower triglycerides. Fiber loves LDL, and studies have shown that it absorbs fat in the gut and controls inflammation. Good high-fiber fruits and vegetables include apples, plums, bananas, pears, prunes, avocados (high in monounsaturated fats and niacin, but also in calories), tomatoes, whole grain corn, spinach, barley, eggplant, okra, purple grapes, apricots, butternut squash, cantaloupe, peaches, sweet potatoes, papaya, pineapple, tangerines, yellow peppers, yellow raisins, strawberries, and citrus fruits such as oranges (avoid grapefruit if you are taking medications that negatively interact with it). If you are serious about lowering your cholesterol naturally, shoot for 4-5 servings of fruits and vegetables daily, and watch out for the calorie-laden and high-cholesterol dressings on many salads! Ideally, the more vegetables and fruits you eat and the less dairy and meat products, the higher your chances of successfully lowering your bad cholesterol.
Liquids: Drink black and green teas, which contain flavonoids and antioxidants (but watch the green tea if you are on a prescribed blood thinner, as it also thins the blood). Resveratrol, a compound found in red wines (particularly darker ones like cabernet sauvignon), is believed to raise good HDL cholesterol levels. So, one 5-ounce glass of wine per day for women and two for men may actually be good for you! If you do not drink, though, there’s no need to reach for the bottle: resveratrol supplements are available (but use caution if you are on a blood thinner because there could be side effects.) Resveratrol can also be found in the skins of grapes, blackberries, purple grape juice, and cranberries. Some juices, including Minute Maid Heartwise orange juice, have been enhanced with plant sterols and may help lower cholesterol as well. Avoid drinks that are high in sugar and fructose, like regular colas, fruit drinks, Hi-C, and Kool-Aid.
Sweets: "Dark" chocolate, which contains more cocoa than milk or semisweet chocolate, contains high levels of flavonoids—potent antioxidants also found in tea, red wine, and apples—which protect cells. It also contains magnesium and copper, which help nerves to transmit chemical messages; improves blood flow; promotes positive moods; and protects arteries. It oxidizes LDL and reduces the damage caused by the bad cholesterol while also raising HDL. Eat up to 1-1.5 ounces daily, but watch the calories! One reasonable option is Dove Dark Chocolate Promises, which contain 42 calories and about 3 grams of fat per morsel. Stay away from syrups, sugar, pastries, croissants, cakes, and candies, which tend to raise LDL cholesterol and are high in fat.
Meats: When it comes to animal proteins,WebMD.com recommends choosing the leanest cuts available and trimming off any visible fat. Select poultry, fish, and plant foods more often than red meat, but if you have a craving for beef (or pork), good choices are pork tenderloin, 95% lean ground beef, round, chuck, filet mignon, bison, and flank steak. Look for labels that say “choice” or “select” rather than “prime.” Avoid pizza; processed meats like bologna, sausage, and bacon; fast foods; and all types of livers. Generally, the less fat in the meat, the better it is for you.
The best cooking methods: Avoid frying whenever possible. Instead, grill, broil, steam, microwave, roast, and bake foods to minimize the amount of fat used. When using a slow cooker or regular pot to cook meats and other foods, before the juices cool, skim the layer of fat off the top. This will make it even healthier for you!
When fats are needed, use good oils high in monounsaturated and polyunsaturated fats. University of California at San Diego researchers recommend olive and flaxseed oils, and Consumer Reports echoed these findings plus added canola oils to the recommended list. However, stay away from coconut oil, which has up to 90% saturated fat (as compared to 60% for butter)!
Will supplements help my cholesterol?
For the most part, as the Mayo Clinic reported, supplements are not very effective for controlling cholesterol. However, although there is insufficient research available, scientists are seeing promising results from artichoke, barley, Metamucil (contains psyllium), oak bran, and sitostanol. Some supplements, like red yeast, contain cholesterol-lowering components, but may be unsafe. Here are some of the most popular supplements marketed toward people with high cholesterol and some notes on their effectiveness:
Multi-vitamins: A long-term study with large numbers of participants using a Centrum brand multivitamin found no evidence that it decreased the incidence of heart disease or had any impact on participants’ cholesterol. Consumer Reports also stated in 2013 that studies of folic acid and B, C, and E vitamins did not prove that they impacted cholesterol levels. High levels of vitamin E did increase the risk of strokes, however!
Niacin: This vitamin B supplement has long been believed to help raise good HDL cholesterol. However, according to Mayo Clinic and other reports, a large-scale study was recently stopped because over-the-counter niacin was found not to lower cholesterol and triglycerides, and there were harmful side effects such as liver damage and small increases in risk of stroke, bleeding, diabetes, and infection.
Garlic: For many years, garlic was considered a heart-healthy supplement, but a recent study found that it did not lower cholesterol. More research is still being conducted.
CoQ10: This supplement is an antioxidant made in the human body that is needed for basic cell function, according to the Mayo Clinic and WebMD. CoQ10 levels decrease with age and may be low in people with cancer, certain genetic disorders, diabetes, and heart conditions. CoQ10 has been shown to reduce LDL cholesterol in mice, but it has not been adequately researched in humans. It also presents side effects: taking 100 mg a day or more has caused mild insomnia in some people, and research has detected elevated levels of liver enzymes in people taking 300 mg per day for long periods of time. Other reported side effects include rashes, nausea, upper abdominal pain, dizziness, sensitivity to light, irritability, headache, heartburn, and fatigue.
Fish oil: This supplement has been proven to help many medical conditions, and is especially effective in lowering triglycerides, according to the National Institutes of Health and Consumer Reports. Harvard University Medical School also says that it may help alleviate depression, and it has also been linked to reduced joint and muscle pains and improved heart rhythms. To reduce triglycerides, NIH recommends beginning by taking one 360 mg omega-3 pill per day with food and gradually increasing to three or four.
Buying fish oil can be confusing, but as a rule of thumb, look at the milligrams of omega-3s that are present. The first number on the label usually means how much overall fish oil is contained in one tablet, often 1,200 milligrams. Look for the second number, which is the amount of actual omega-3 oil, and aim for 360 mg. Eat fish, nuts, and/or other foods rich in omega-3s in combination with fish oil supplements to ensure you are getting enough. Consumer Reports noted that taking a fish oil supplement alone without eating other foods rich in omega-3 is insufficient to reach the levels needed to lower your cholesterol.
Studies have not completely determined how much fish oil one should safely take. Taken in daily dosages of 4 grams or less, it’s considered safe with few side effects. However, in dosages of more than 4 grams per day, it can have some side effects, such as bleeding (it thins the blood), an impaired immune system, heartburn, bad breath, nausea, rashes, allergies, lowered blood pressure, and loose stools. It can also interfere with birth control medicine and harm sugar level regulation in diabetics, so consult with your doctor before taking this supplement.
Consumer Reports recommends the brand Nature Made (choose the burpless, which is coated and lessens the possibility of fish breath), the only over-the-counter certified fish oil purified to remove the mercury that can be found in some other brands. (Look for “buy one get one free” deals at pharmacies like CVS or Walgreens every few weeks.) Nature Made does not contain any colors, artificial flavors, preservatives, or glutens.
The bottom line: We know that high blood pressure, high cholesterol, strokes, heart attacks, heart disease, and possibly even dementia and cancer may be related to things both within (stress, foods, and lifestyles) and outside of our control (genetics). How we choose to live our lives plays a large role in preventing or delaying disease, disabilities, and even premature death! Every day, we make choices that will influence our future. We hope that you will utilize some of the strategies discussed in this article to help make your life a long, healthy, and happy one!
About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected].
Mike DuBose, a University of South Carolina graduate, is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, DuBose Fitness Center, and Columbia Conference Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, health, and personal published articles.
Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).
Katie Beck serves as Director of Communications for the DuBose family of companies. She graduated from the USC School of Journalism and Honors College.
Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.
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