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Alexandra Kathryn Mosca | November 26, 2022

Two years ago, after my annual physical, I learned that my cholesterol was elevated. This came as a total surprise to me. I am nothing if not a healthy eater: My breakfast of choice alternates between a steaming bowl of slow-cooked Irish oatmeal and whole grain cereals, like Cheerios, which claims cholesterol-lowering properties.

Both breakfasts are served with a heaping mix of berries, walnuts, and almonds At lunch and dinner, vegetables, greens, and grains regularly fill my plate. I rarely eat red meat; in fact, I visit my favorite steakhouse only at three-month intervals.

And despite my fondness for french fries (Five Guys makes my favorite) that is maybe a twice-a-year indulgence. What’s more, I am slim, with a low BMI, and seldom miss a day racking up 10,000 steps on my Fitbit.

A Year’s Journey

Determined to get my score down naturally, for the next year I scrutinized nutrition labels for their cholesterol, saturated fat, and total fat content, eschewing products with even the slightest bit of each. I read up on natural ways to lower cholesterol and incorporated more beet juice, orange juice and seeds like chia, sesame, pumpkin, and sunflower into my diet. I even considered going vegan.

So that’s why, when I got the results of my most recent checkup, I was surprised to learn that my cholesterol had crept up yet again. It was now borderline.

How could that be? Had all my dietary sacrifices been in vain, I wondered. For the past year, I had been extra vigilant about what I ate, even forgoing my most favorite treat: ice cream. There would be no rewarding my diligence with a celebratory surf and turf dinner, with an ice cream sundae for dessert.

Joan Kremen, a nurse practitioner in New Hyde Park, New York, advised a statin. But before prescribing medication, she suggested I take the Coronary Artery Calcium Score (CAC) test, a CT scan that measures the amount of calcified plaque in your arteries. The results may determine whether you need medication, or dietary and lifestyle changes, to lessen your risk for cardiac problems.

A week after I took the test, Kremen called to tell me my score was zero, the best possible outcome. So, for now, medication is not required.

If you’re a candidate for this test, be aware: the calcium score test is not covered by insurance. My own insurance company deemed it as “not medically necessary.”

It occurred to me: if I’m going to manage my cholesterol levels, I owe it to myself to learn more about it.

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance produced in the liver that is necessary for the body to function properly. But an overabundance can cause dangerous plaque buildup on your blood vessel walls, raising your risk for heart disease and stroke.

The majority of cholesterol is produced by our body, with the rest coming from what we eat, primarily animal sources such as egg yolks, meat, and full-fat dairy products. Smoking, being overweight, and being inactive also play a part.

Bear in mind that heredity, too, impacts your cholesterol. Because of that, dietary changes may not be enough to get your numbers down to a healthy range. In that case, a statin may be necessary.

The Battle of the Cholesterols: Good vs Bad

Generally, there are no symptoms of high cholesterol. Rather, the condition is detected through a lipid panel, a blood test which measures your cholesterol levels.

There are two types of cholesterol: low-density lipoprotein (LDL), also labeled as “bad” cholesterol and high-density lipoprotein (HDL), commonly known as “good” cholesterol, which helps remove cholesterol from your bloodstream.

According to the CDC, the Centers for Disease Control and Prevention, optimal numbers to strive for are an LDL level of less than 100 mg/dl, and for HDL a 50 mg/dl or higher for women (40 mg/dl for men).

“You should also know your triglyceride levels. These numbers combined all compose your total cholesterol score,” said Dr. Elias Bonaros, a board-certified cardiologist, in Lake Success, New York.

High triglyceride levels also put you at risk for heart disease, as well as diabetes. Suggested levels should be less than 150 mg/dl, with a total cholesterol level below 200 mg/dl.

Saturated Fat and Trans Fat

Both saturated fat and trans-fat are unhealthy fats that can raise the levels of LDL “bad” cholesterol in your blood.

Whenever possible, limit your intake of saturated fat. Avoid processed meats such as hot dogs, bacon, sausage, and full-fat dairy products including butter, cheese and heavy cream and whole milk. And while your body needs some saturated fat for overall health, it is easy to overdo it. Try to limit your intake.

On the other hand, trans fats offer no health benefits, so it’s best to avoid them altogether if you can. Fried, processed, and fast foods are the biggest offenders. Commercially baked goods like cakes, cookies, doughnuts, and pastries, are also significant sources.

Certain ingredients may help lower your LDL cholesterol. Soluble fiber, a form of fiber that is water-soluble, is one of them. Foods which contain soluble fiber include dried beans, lentils, oats, oat bran and brown rice.

Eat Like You’re in the Mediterranean

“We’re in a society of high fat consumption,” notes Kremen. For heart health,she says, “it’s best to do the Mediterranean diet.” Bonaros concurs, explaining that the first step in getting your cholesterol down is to change your diet. “I believe in a balanced diet. The American Heart Association and Mediterranean diet are two I recommend.”

Interest in the Mediterranean diet began in the 1950s when it was observed that heart disease was less common in Mediterranean countries, like Greece and Italy, than it was in the United States. Plant-based foods – which include vegetables, fruits, nuts, legumes, whole grains – are the diet’s foundation.

Moderate servings of lean poultry, seafood, and fish – especially “fatty” fish such as salmon, sardines, and albacore tuna – are included in moderation.

Essentially, the Mediterranean diet replaces saturated and trans fats with healthy monosaturated fats, like olive oil, nuts, and seeds. Studies have shown that the Mediterranean diet may lower your risk of cardiovascular disease.

“Whatever diet you choose, make sure it’s a diet that can be maintained, and that you can sustain for life,” said Bonaros.

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