Tens of millions of Americans have high cholesterol, which increases the risk of heart disease.
Here & Now‘s Peter O’Dowd looks at how to lower your cholesterol with Dr. Leslie Cho, professor of medicine, section head of preventive cardiology at the Cleveland Clinic, and director of the Cleveland Clinic Women’s Cardiovascular Center.
11 questions with Dr. Leslie Cho
There are two kinds of cholesterol. There’s the one we’re talking about today, LDL cholesterol, bad cholesterol. That’s the one that can cause all kinds of serious health problems. Is that right?
“Absolutely. L for lousy. And then there’s the other type of cholesterol called HDL H for happy, which is the good type of cholesterol.”
What kind of damage does lousy cholesterol do inside your body?
“So lousy cholesterol goes around and it has to go somewhere. So, either you eliminate it from your body, it goes into your liver, or it ends up sticking around in your blood vessel, causing hardening of the arteries, causing heart attacks, stroke and then vascular dementia.”
What is the number one thing you can do to improve your cholesterol level so it’s not swirling around in your blood like you just described?
“Yes. So, the number one thing we do is exercise and diet. I know people fixate on medicine, but really the cornerstone of prevention, which is what we’re talking about, is diet and exercise. And if you can’t control it with diet and exercise, then we start on medication. There are obviously patients who we need to start on medications right away, but for a majority of us, it’s diet and exercise first.”
What does eating better mean?
“Cholesterol is mostly found in anything that comes from an animal. Obviously, we need protein. Protein is good for us. But you can get your protein from plants, then fish, then comes chicken and turkey, and at the very, very bottom comes things like beef, pork, lamb, shrimp and lobster.
“You know, oftentimes people are confused about different diets. There’s the DASH diet, there’s the Mediterranean diet, there is the portfolio diet. But, you know, these are diets that are specific for DASH, for salt; portfolio for cholesterol; and Mediterranean for sort of overall. But trying to cut down on animal protein is important.”
Are there some animal products that are worse than others?
“Yes. So, there is some animal product that’s worse than the others. So, of course, red meat, you should really be having no more than four ounces of red meat a week. If you want to follow the Mediterranean diet and the other portfolio diet, you want to limit saturated fat because saturated fat is bad for you. You want to focus more on unsaturated things. You want to do healthy oils like olive oils. These are monounsaturated fats.”
I was looking at a food label the other day on a bag of chips, and it said on the label that there was zero cholesterol, none. So, I felt good about that. But then you look down a little bit further and there were all kinds of saturated fat. So how do you make sense of that?
“Well, saturated fat is anything that’s solid at room temperature. And of course, those are really bad for cholesterol. And they raise your bad cholesterol level.”
So even if you have food that has no cholesterol on the label, if there’s saturated fat, it could still raise your cholesterol levels?
“Yes.
“So, potato chips, potato itself doesn’t have any saturated fat. But, you know, potato chips are fried in saturated fat. You know, of course, you can have potato chips sometimes, but it’s just you have to be mindful about the amount of saturated fat consumption you have.
“You know, I think it’s hard for patients because they think it’s all or none. It can’t be all or none. We are human beings. Sometimes you’re at a party, you’re going to have some trips. That’s okay. Yeah, but it’s about making an overall sort of healthier eating habits. And I think that’s where I think it becomes very problematic because you screw up one day and you feel dejected, right? That’s not the point.”
Are there foods that can reverse cholesterol levels?
“The simple answer is there are definitely foods that can lower your cholesterol. So, for example, increasing soluble fiber, there are two types of fiber soluble versus insoluble. Soluble fibers bind cholesterol, and you eliminate it from your body. They are found in foods like oats, beans and lentils and apples and carrots. And of course, people take soluble fibers to keep regular. Those are really important part of lowering your cholesterol.”
How long does it take for cholesterol levels to start improving once you start making some changes to your lifestyle?
“So, we usually give patients about 3 to 6 months to really see an effect.
“Now there are people who are hyper absorbers of cholesterol from their small intestine. So, for those people, when they make changes, you can see a dramatic improvement right away. But those people are about 15% of the population. The rest of us are only moderate absorbers of cholesterol from our small intestine. So, for the rest of us, it takes about six months to see, you know, dramatic changes.
“Now, if you have been eating not so well, maybe you can see some pretty dramatic results right away.
“But if you’ve been eating what you think is a pretty healthy diet and now you’re making more tweaks, then it’s going to take a little bit longer.”
The Cleveland Clinic, where you work, recently conducted a phase-one study that uses gene editing to lower cholesterol. Talk about that. How would it work, and how big of a deal would it be if it does work?
“It’s a very, very big deal. And obviously, you know, these are amazing scientific achievements. But for most of us, we don’t need gene editing. We need to change our diet, exercise more, and our cholesterol issues can be overcome with taking a medication that’s been around for the last 40 years, which is a statin.
“You know, lots of people have very strong feelings about statins in the recent era, and that’s kind of interesting. But statins have been around since the 1980s. They don’t cause cancer. They make people live longer, have less heart attacks, less strokes. They’re amazing medicine. And for most of us, all we need is a statin or, you know, some other compound. And for those of us that can’t take statins because we have muscle aches, we now have injectable medications.”
“Maybe in the very, very far future, patients with genetic disorders can have gene editing. But for the rest of us, we don’t need that.”
What are the risks if someone out there is listening to this and just decides to ignore their cholesterol levels?
“No, don’t ignore it. We are lucky to live in an era where we can measure our cholesterol and actually act on it.
“Most of us, if we make some tweaks in our diet, can actually do pretty well. And it’s not about all or none. It’s about incorporating a healthy lifestyle and being able to do it. It’s like exercise. We all know it’s good for us. Some of us do it, some of us don’t. But for the most part, if you exercise most days of the week, you’re going to do great. And we should feel that way about diet as well.”
This interview was edited for clarity.
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Jill Ryan produced and edited this interview for broadcast with Catherine Welch. Michael Scotto produced it for the web.
This article was originally published on WBUR.org.
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