What is cholesterol?

Cholesterol is a waxy, fat-like substance that is found in the walls of cells throughout your body. Your body not only obtains cholesterol from external sources but also produces it on its own. It uses cholesterol to produce hormones, bile acids, vitamin D, and other essential substances necessary for life. If your diet doesn’t contain cholesterol, your body will manufacture all the cholesterol it needs. This means that merely changing your diet is insufficient; you need to simultaneously change your lifestyle. Cholesterol is produced in the liver and performs numerous vital functions. For instance, it helps maintain the elasticity of cell membranes. However, like everything in the body, when there is too much cholesterol or when cholesterol accumulates in the wrong places, it can lead to problems.

Cholesterol circulates in the blood, but it cannot exist in the blood by itself. Similar to oil, cholesterol is fat-soluble, whereas blood is water-soluble, and they do not mix. Therefore, cholesterol is transported in the blood by carriers known as lipoproteins, which contain lipids (fats) inside and proteins on the outside. The two most well-known lipoproteins are:

• Low-Density Lipoprotein (LDL) or “bad” cholesterol, as it carries cholesterol to tissues, including arteries. The majority of cholesterol in the blood is in the form of LDL cholesterol. Higher levels of LDL cholesterol in the blood are associated with an increased risk of cardiovascular diseases.
• High-Density Lipoprotein (HDL) or “good” cholesterol, as it transports cholesterol from tissues to the liver, where it is removed from the body. Lower levels of HDL cholesterol in the blood increase the risk of cardiovascular diseases.

When there is too much cholesterol in the blood, it can accumulate on the walls of arteries. Over time, this cholesterol buildup can narrow the blood vessels and make them less flexible, a condition known as atherosclerosis or “hardening of the arteries.” This process can occur in blood vessels anywhere in the body, including the coronary arteries, which supply the heart.

If the coronary arteries become partially blocked by this buildup, it can result in insufficient oxygen delivery to the heart muscle, leading to chest pain and, potentially, a heart attack. Some cholesterol-rich plaques are unstable; they have a thin covering and can rupture, releasing cholesterol into the bloodstream. This release can trigger the formation of a clot above the plaque, blocking blood flow through the artery and potentially causing a heart attack. When atherosclerosis affects the coronary arteries, this condition is referred to as ischemic heart disease.

Since elevated levels of cholesterol in the blood are linked to coronary artery disease, it is a major risk factor for heart disease.

Risk factors can be categorized into those that cannot be changed and those that can be modified. Fortunately, most risk factors for cardiovascular diseases can be modified. Risk factors that cannot be changed include your gender and genetics. Risk factors that can be modified include smoking, high blood pressure, high blood cholesterol levels, obesity, physical inactivity (sedentary lifestyle), and diabetes.

Lifestyle Changes to Lower Cholesterol

Medications can lower cholesterol levels, but it’s better to start by making lifestyle changes to reduce cholesterol levels.

Dietary changes can lower cholesterol levels:

Reduce saturated fats: Saturated fats, primarily found in red meat and high-fat dairy products, increase overall cholesterol levels. Reducing saturated fat intake can lower LDL cholesterol levels, the “bad” cholesterol.

Eliminate trans fats: Trans fats, sometimes labeled on food labels as “partially hydrogenated vegetable oil,” are often used in margarine, packaged cookies, crackers, and pastries. Trans fats increase overall cholesterol levels and should be avoided. Food and Drug Administration (FDA) regulations have banned the use of partially hydrogenated vegetable oils in foods since January 1, 2021.

Consume omega-3 fatty acids: Omega-3 fatty acids do not affect LDL cholesterol but offer other health benefits, including reducing blood pressure. Foods rich in omega-3 fatty acids include salmon, mackerel, sardines, walnuts, and flaxseeds.

Increase fibre intake: Fiber can reduce the absorption of cholesterol in the bloodstream. Foods high in fibre include oatmeal, beans, Brussels sprouts, apples, and pears.

Add whey protein: Whey protein, found in dairy products, is beneficial for heart health. Studies have shown that whey protein, as a supplement, can reduce both LDL cholesterol and total cholesterol levels, as well as lower blood pressure.

Increase Physical Activity.

Moderate physical activity can help raise the level of high-density lipoprotein (HDL) cholesterol, the “good” cholesterol. If there are no other contraindications, engage in physical exercises for at least 30 minutes five times a week or do aerobic workouts for 20 minutes three times a week. Adding physical activity, even in short intervals several times a day, can help you get started with weight loss. Consider these options:

• Take a brisk daily walk during your lunch break.
• Cycle to work.
• Engage in your favourite sport.
• To stay motivated, think about finding an exercise partner or joining a sports group.

Quit Smoking

Giving up smoking improves the level of HDL cholesterol. The benefits become evident quickly:

• Within 20 minutes of quitting smoking, your blood pressure and heart rate start to return to normal after the spike caused by a cigarette.
• Within three months of quitting, your blood circulation and lung function begin to improve.
• Within a year of quitting, the risk of heart disease is cut in half compared to that of a smoker.

Shed Excess Weight

Even a few extra kilograms contribute to high cholesterol. If you consume sugary soft drinks and juices, switch to water. Snack on nuts, but watch your calorie intake. If you crave something sweet, try dark chocolate with a high cocoa content (85%+).

• Look for ways to increase your activity level throughout the day, such as taking the stairs instead of the elevator or parking your car farther from the office entrance.
• Take walks during work breaks.
• Try to increase physical activity: household chores (without using toxic chemicals) or gardening also have a positive impact on your health.

Consume Alcohol in Moderation

• Moderate alcohol consumption is associated with higher levels of HDL cholesterol.
• Excessive alcohol consumption can lead to serious health problems, including high blood pressure, heart failure, and strokes.
• If you consume alcohol, do so in moderation. The less alcohol you consume, the better.

If Lifestyle Changes Are Insufficient…

Sometimes, adopting a healthy lifestyle is not enough to lower cholesterol levels. In such cases, you can consider using herbs and dietary supplements, which can also help reduce cholesterol levels. Herbs may include garlic and additional fibre. Increased consumption of dietary fibre, soy products, omega-3 fatty acids, and plant compounds similar to cholesterol (plant stanols and sterols) can significantly lower LDL cholesterol levels, also known as “bad cholesterol.” Always consult with your doctor to see if there are any interactions between your current treatments for other conditions and these supplements.

If your doctor still recommends using medications to help lower cholesterol levels, take them as prescribed and continue to modify your lifestyle. Combining lifestyle changes with supplements may help you maintain a lower dose of medications. The lower the dose of medications, the better, as many medication side effects depend on the dosage.

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COVID-19, or those with high blood pressure, diabetes and cardiovascular disease, is due to high cholesterol levels in the tissues. (Wang H, Yuan Z, Pavel MA, Hansen SB. The role of high cholesterol in age-related COVID19 lethality)