Dear NP

Dear NP,

“How can I lower my cholesterol without taking prescription medications? Does a keto diet worsen cholesterol levels?”

Dear Reader,

Prescription medications are often recommended to treat elevated cholesterol levels. However, many people wish to try to lower their cholesterol levels through diet before taking medication.

When considering how to lower cholesterol levels, you’ll need a basic understanding of the different types of cholesterol and how they respond to various interventions. There are several parts to your cholesterol lab report.

The first is the total cholesterol. This is just what it sounds like – the total amount of cholesterol measured through your blood. The goal for total cholesterol is less than 200mg/dl.

The next reading is the LDL or low-density lipoprotein cholesterol. LDL is commonly referred to as “bad” cholesterol, and LDL is the type of cholesterol that tends to cause fatty build-up in the arteries and may contribute to heart attacks or strokes. The goal for LDL is less than 100mg/dl for most people and less than 70mg/dl if you have heart disease or diabetes.

HDL or high-density lipoprotein cholesterol is referred to as “good” cholesterol. This type of cholesterol protects you against the harmful effects of LDL cholesterol. The higher this number, the better. However, if you have high HDL cholesterol, it may cause your total cholesterol reading to be higher, which can be misleading. The goal for HDL cholesterol is 40mg/dl or higher for men and 50mg/dl or higher for women.

The final piece of your cholesterol is triglycerides. Triglycerides are a type of fat that sugars are stored as if they are not used quickly. The goal for triglycerides is 150mg/dl or less.

Decreasing cholesterol levels without medication requires several lifestyle changes. These include changing your diet habits and exercise levels.

Dietary changes that will impact your cholesterol levels include reducing your intake of saturated fats. Saturated fats are found in red meats and dairy products, and reducing saturated fat intake will lower your LDL cholesterol levels.

Next, eliminate your intake of trans fats. Trans fats or partially hydrogenated vegetable oil are commonly found in processed and convenience foods. Trans fats will raise your overall cholesterol level.

Increase your dietary intake of foods rich in omega-3 fatty acids. These foods include mackerel, salmon, herring, flaxseed and walnuts. Omega-3 fatty acids lower blood pressure and reduce triglyceride levels.

Also, increase your intake of dietary fiber. Eating more fiber-containing foods like oatmeal, beans, fresh fruits and vegetables reduces the absorption of cholesterol through your bloodstream.

Exercise is critical to raising your HDL cholesterol. Aim for gradually increasing your activity level to 30 minutes of exercise five times a week. If you are a smoker, quitting smoking will improve your HDL cholesterol levels.

You may have heard about keto or ketogenic diets and wonder how they affect cholesterol levels. When following a ketogenic diet, a very low amount of carbs are consumed, and a higher percentage of healthy fats are eaten.

It would seem that this diet should make cholesterol levels higher; however, the opposite appears to be true. Initially, you may see an elevation in total and LDL cholesterol levels when starting a keto diet, but these levels fall, and HDL levels become higher in the long term.

When you do not consume carbohydrates, your body will use the fats you eat immediately for fuel instead of storing them as cholesterol. If you have elevated cholesterol levels and are starting a keto diet, you should check with your healthcare provider and have your levels monitored during the diet.

Unfortunately, some people cannot lower cholesterol levels to healthy ranges despite their best efforts at lifestyle modification. There may be genetic factors that cause cholesterol levels to remain dangerously elevated even with a healthy lifestyle. Your healthcare provider can monitor your cholesterol and recommend the safest treatment options for you.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]