ACCORDING TO FIGURES from the Centers for Disease Control and Prevention, more than 102 million American adults aged 20 or older have total cholesterol levels that are considered too high. More than 35 million of these people have very high cholesterol levels that put that at high risk for developing heart disease.
Cholesterol is a waxy, fat-like substance found in the body and in many foods. You need some cholesterol for your cells to function normally, but too much can become problematic. Other fat-soluble substances called triglycerides also circulate in the blood. Having high levels of cholesterol and/or triglycerides in your blood – a condition called hyperlipidemia – can have implications for heart health.
"Hyperlipidemia means there's an excess amount of fat circulating in your blood," says Dr. Brian Lima, director of cardiac transplantation at the Sandra Atlas Bass Heart Hospital, located at North Shore University Hospital in Manhasset, New York, and author of "Heart to Beat: A Cardiac Surgeon's Inspiring Story of Success and Overcoming Adversity – the Heart Way."
Hyperlipidemia is risky because "it can lead to the harmful buildup of atherosclerotic plaque – or fatty deposits – in your arteries, which may eventually cause heart attacks and strokes," Lima adds.
Diet Tips for Controlling Hyperlipidemia
- Choose a plant-based diet. Animal products often contain cholesterol, and if you're trying to lower your cholesterol, it's best to bulk up on plants rather than animal products. Eat a diet that's rich in whole grains, fruits and vegetables," Bhatt says. "The data have been consistent over decades," that a plant-based, low-fat diet is good for heart health and can help you lower your cholesterol and triglyceride levels.
- Read the labels. Using diet to help control hyperlipidemia "starts with paying attention to what you're eating by reading food labels," Lima says. A heart-healthy diet should contain "minimal amounts of saturated fats and sugary foods. Instead, try eating more fruits and vegetables, and opt for low-fat or fat-free dairy products."
- Pay attention to calories. "Especially for people who are overweight, the first thing you should do is reduce the number of calories you're eating," Bhatt says. "It's less important which diet you follow – fads come and go – but the basics of weight loss are based on thermodynamics. If you're putting more calories in than you're burning, the first step is to cut down the number of calories."
- Choose fish and some lean meats. If you're going to eat meat, make sure to select lean cuts. "Choosing lean poultry, fish or plant-based protein sources, rather than red meat or pork, is another way to reduce saturated fat intake," Milks says. "In particular, fish such as salmon have a special kind of unsaturated fat, called omega-3 polyunsaturated fatty acids, which may have specific health benefits."
- Up your fiber intake. "Foods with high fiber content add bulk to the diet and can help with both heart and digestive health," Milks explains. Fiber helps remove cholesterol from the body by trapping it and carrying it out of the body via stool. Opt for grains like oatmeal, quinoa, brown rice and barley and fruits and veggies, including legumes, beans, avocados, Brussels sprouts, carrots, apricots, apples, pears and oranges or other citrus.
- Avoid high-cholesterol foods. Greasy, deep fried and processed foods tend to be higher in cholesterol and bad fats, all of which can contribute to hyperlipidemia, Bhatt says. Baked goods and packaged desserts can also contain high levels of cholesterol.
- Drop trans fats. Trans fats are the unhealthy fats that are often found in fast foods and convenience foods such as cookies, crackers, vegetable shortening, coffee creamer and other processed foods. They're inexpensive, give food a pleasant flavor and texture and can be used to cook multiple batches of food in deep fryers. But they're really bad for your heart. Many food manufactures have already removed trans fats from their products, but be on the lookout for them. If the label contains the words "partially hydrogenated oil," that's a signal that the item contains trans fats. The nutrition facts label will also note their presence.
- Select unsaturated rather than saturated fats. Saturated fats are "the kind of fat that is usually solid at room temperature, such as fats in meat, butter, coconut oil and full-fat dairy products, as well as a variety of packaged foods, snack foods and desserts," Milks says. Keep your intake of such fats under 10% of your daily calories and replace them with unsaturated fats. This means using olive oil instead of coconut oil for cooking. Other plant-based oils that you can substitute in cooking, dressings and baking include canola, grapeseed, avocado, safflower and corn oils.
- Skip the sugar. "Consuming too much food containing simple carbohydrates and sugars, such as white bread, white rice, potatoes, cakes and other desserts and sweetened beverages can have detrimental health effects," Milks says. Especially for those who are overweight or obese, such foods can be "big offenders that stand in the way of weight loss." For those with diabetes or prediabetes, such foods can lead to high blood sugars and high blood triglycerides. Instead of that soda or sweet tea, drink plain water and keep your intake of simple carbohydrates to less than 10% of your daily caloric intake.
- Add nuts. "Eating more healthy fat does not necessarily lead to weight gain, as fat can tend to keep us full for longer than carbohydrate-rich foods," Milks says. And nuts are a great way to replace saturated fats with unsaturated fats, add fiber and help yourself feel fuller longer. "Nuts like almonds or walnuts are a good source of healthy fat than can make a convenient snack."
- Skip the booze. The NIH recommends reducing alcohol intake or avoiding it all together to help lower your blood lipid levels.
- Get tailored nutritional advice. "No single diet is best for everyone, and what foods to eat for optimal health depend on whether someone has certain health conditions, like heart disease, diabetes or digestive problems," Milks says. Therefore, it's best to "ask your doctor or a registered dietitian what diet is best for you."
Exercise Tips for Controlling Hyperlipidemia
- Increase physical activity. "Exercise can be good for reducing bad cholesterol and triglycerides," Bhatt says. But as you start exercising more, make sure you don't overcompensate by eating too much afterwards. "It's easy to think, 'it's OK, I'm exercising so I can reward myself with a piece of cake.' It's a natural, human tendency. But it doesn't really work that way."
- Find an activity you enjoy and stick with it. Any kind of exercise is good, but find something you enjoy that you will stick with long term. Bhatt says anything from an exercise bike or elliptical to swimming or walking are all good options for exercises that can be safely done and are gentle on the joints. There is no specific ideal exercise for controlling hyperlipidemia. Just be sure to move more.
- Go for time. Milks recommends including both aerobic exercise and some strength training into your routine. "The American Heart Association and American College of Cardiology guidelines recommend that adults should get 150 minutes or more in total of moderate-intensity physical activity – or 75 minutes per week of vigorous-intensity activity. While the intensity of a physical activity session can vary greatly between people due to differences in physical fitness levels, examples of moderate-intensity activities include brisk walking, cycling and recreational swimming."
- Add strength training. Getting more exercise "doesn't necessarily have to entail fancy gym equipment," Lima says. Just focus on adding in "some form of weight or resistance training twice a week," alongside the recommended 75 minutes of vigorous or 150 minutes of moderate aerobic activity. "Collectively, these exercises can help reduce not only your lipid levels, but also your overall risk for heart disease."
General Advice for Living Well With Hyperlipidemia
- Control other comorbidities. High blood pressure, diabetes and other conditions can all make for a worse overall health picture. Making sure your other conditions are well managed and controlled is an important piece of taking care of yourself.
- Avoid weight gain. Weight gain is a predictable part of getting older for a lot of people, but Bhatt says you should do your best to keep it to a minimum. Obesity has been linked with hyperlipidemia, so keeping the excess weight off can help reduce your bad cholesterol and triglyceride levels.
- Quit smoking. Lima says you should "quit smoking as soon as possible because smoking can reduce your good cholesterol, or HDL, and is extremely detrimental to your heart health."
- Follow your doctor's advice. While diet and exercise can help you move the numbers in the right direction, in some cases you may need more help and your doctor may recommend medications. In these cases, it's important that you follow your doctor's advice. "Statins are the most widely used and effective medications," that can lower cholesterol and triglyceride levels and also help mitigate risk of cardiovascular disease, Milks says. Other medications may also come into play, so talk with your doctor about your specific situation and how best to address your needs.
- Don't get discouraged. "Lifestyle modification effects are generally quite gradual," Milks says. "If you do make changes to your diet and exercise patterns, don't be discouraged if it takes 6 or even 12 months or more to realize the full extent of cholesterol lowering."