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Doctor’s Whiteboard: “High Cholesterol 101”

Cholesterol, and its role in the body, is one of the most misunderstood topics in the world of healthcare. You’ve likely read or watched numerous news reports about the dangers of cholesterol in your diet and how it can lead to heart disease. But that’s far from the whole story.

Cholesterol is a crucial building block of every cell in your body. It’s so important that your liver actually produces most of the cholesterol that you’ll ever need, regardless of your diet.

There are two main types of cholesterol. LDL, or low-density, cholesterol particles are a combination of fat and protein that travel through your bloodstream and deliver cholesterol to the tissues that need it, such as nerve cells. HDL, or high-density, cholesterol particles contain a much higher ratio of protein to fat, and their function is to scour the bloodstream, vacuuming up excess bits of cholesterol and returning those to the liver. HDL also helps keep the blood vessels and arteries clear, and that’s why it’s often referred to as “good” cholesterol.

Cholesterol can become dangerous when your body has too much LDL or “bad” cholesterol. These fatty particles can accumulate inside of blood vessels and form clogs, or plaques, which can lead to a heart attack.

For many people, it’s possible to control cholesterol levels by making changes to their diet, like avoiding saturated fats, and getting more exercise. However, since the liver produces roughly 75 percent of a person’s total cholesterol, lifestyle changes are not always effective. 

One of the key medications to treat high cholesterol is a class of drugs called statins. Statins work to block the production of cholesterol in the liver and have been shown to bring down LDL levels, boost HDL levels, and lower the risk of developing heart disease.

Statins, like any medication, have side effects and may interact with treatments for related conditions. People who are taking other medications, such as blood thinners, may be at risk for developing drug interaction side effects. Many medications are metabolized, or broken down, in the liver. For some people with elevated cholesterol, it sometimes makes sense to use a statin that breaks down outside of the liver where there is less of a chance for dangerous side effects.

The good news about cholesterol is that through a combination of diet, exercise, and working with your doctor, it’s possible to dramatically reduce your risk of heart disease. If you’d like to learn more about treating high cholesterol, take a look at the information we have here at Healthline or make an appointment with your doctor.

Unless your cholesterol is dangerously high, lifestyle modifications—such as exercising regularly and eating a heart-healthy diet—are often recommended as the first line of treatment.

Healthy Diet

Dietary modifications combined with weight loss can lower LDL cholesterol by as much as 20 to 30 percent. Heart-healthy diets promote fruits, vegetables, whole grains, and legumes and limit foods high in sugar, sodium, and saturated fat. Vegetable shortening and any item made with hydrogenated oil contains trans fat and should be avoided. What sets heart-healthy diets apart from others is the emphasis on good fats, such as those found in fish, nuts, olive oil, avocados, and seeds. When used in place of saturated and trans fats, these oils—known as polyunsaturated and monounsaturated fats—can help reduce cholesterol. Some research also indicates that avoiding refined carbs may boost “good” HDL cholesterol and lower triglycerides. Refined carbohydrates include white rice, white bread, soft drinks, and baked goods.

Weight Loss

People who are obese—having a body mass index more than 30—tend to have lower levels of “good” HDL and higher levels of “bad” LDL cholesterol and triglycerides than people of normal weight. Losing weight can help bring your good cholesterol up and your bad cholesterol down. Research shows that for every kilogram (2.2 pounds) of weight that an obese or overweight person loses, they may be able to raise their HDL by .35 mg/dL.

Some research suggests that what you eat to lose weight may also affect your cholesterol outcome. According to a study in the Archives of Internal Medicine, people who ate a low-calorie, low-carbohydrate diet high in plant-based protein (such as tofu, beans, and nuts) had the biggest LDL-lowering benefit compared to people who lost weight on other kinds of diets.

Avoid or Quit Smoking

Quitting smoking is good for your heart in more ways than one. Research shows that giving up cigarettes can increase a person’s “good” HDL by 4 mg/dL, on average. HDL helps clear the body of artery-clogging “bad” LDL cholesterol.


Research shows that being inactive elevates LDL. Exercise, on the other hand, can lower it. Moderate activity like brisk walking can also help lower triglycerides, while vigorous exercise like running can boost HDL. Cardiovascular exercise can also strengthen your heart and reduce blood pressure, which is a major risk factor for stroke.


In addition to lifestyle changes, your doctor may also recommend taking medication to manage your cholesterol. In general, drug therapy tends to affect cholesterol levels more quickly than your diet and exercise will. So if your doctor feels it’s important to get your cholesterol down immediately, he or she will likely opt for medication. There are several different types of cholesterol-lowering medications. Your doctor can determine which one or ones are right for you.