Cholesterol, High Cholesterol

Diet recommendations by the AHA:

• Eat a healthful diet the majority of the time including vegetables, fruits, whole grains, fat-free or low fat dairy, beans, lean meat, poultry, and oily fish at least twice weekly. Limit total cholesterol to 300 mg per day for healthy adults and for patients with LDL cholesterol under 100 mg/dl. Limit cholesterol to 200 mg per day for patients with coronary artery disease.
• Total fat intake limited to under 25–35 percent of total calories per day.
• Saturated fat intake limited to under 7 percent of total calories per day.
• Trans fat intake should be under 1 percent of total calories per day.
• Other fat in the diet should come from monounsaturated or polyunsaturated oils from unsalted nuts, seeds, oily fish, and vegetable oil such as canola or olive oil.
• Maintain a healthy bodyweight: Preventive Health Advisor recommends a diet focused on weight loss for body mass index over 25 kg per meter squared for control of lipid levels, and then continued weight loss to reach ideal body weight. Overweight and obese individuals run a much higher risk of developing type 2 diabetes, elevated cholesterol, and high blood pressure. Patients have the ability to reverse this risk by losing 8%-10% of initial body weight, an even a 5% weight loss maintained long term can have beneficial effects on cholesterol and glucose control (4).
• Maintain a healthy bodyweight with a body mass index (BMI) between 18.5-24.9 kg/m². The AHA defines overweight as 25-29.9 kg/m², and obesity as greater than or equal to 30 kg/m². BMI can be calculated from the basic formula: [Weight (lb) / (Inches of height)²] x 703. BMI may also be calculated using a commonly available BMI calculator such as that available here: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm from the NIH National Heart, Lung and Blood Institute.
• Weight loss leads to an improved lipid profile. Please see weight loss in Preventive Health Advisor. To reach ideal body weight, Preventive Health Advisor recommends a low calorie diet with fat intake about 30% of calories with mostly monounsaturated fat and at least 1 gram of protein per kilogram of bodyweight plus an exercise program to maintain a higher metabolic rate.
• Achieve lipid profile goals with lifestyle changes and Integrative Medicine as described here as well as use traditional pharmacological therapy if necessary. Work to reach lipid profile goals by continuous monitoring and follow up with the primary care physician.
• Blood pressure goal: Focus on achieving normal blood pressure. According to the AHA, the lifetime risk of hypertension is about 90% and any elevation above a normal blood pressure of 120 systolic over 80 diastolic increases risk of coronary heart disease even if elevated into pre-hypertensive levels. For more information, please see the hypertension section of Preventive Health Advisor.
• Blood glucose levels: Keep blood glucose in normal range: According to the AHA, normal fasting blood glucose is less than or equal to 100 mg/dL and a fasting blood glucose of greater than or equal to 126 is diagnostic of diabetes. Weight loss, exercise, and avoidance of concentrated sweets can greatly improve control of glucose and insulin resistance. For more information, please see the diabetes mellitus section of Preventive Health Advisor.
• Exercise goals: Maintain a physically active lifestyle. Regular activity promotes cardiovascular fitness. For further information about benefits of aerobic exercise or resistance training, please see these sections of Preventive Health Advisor.
• Smoking: Stay away from tobacco. Please see the section on smoking cessation in Preventive Health Advisor.

Dietary adjustments for hyperlipidemia:

Preventive Health Advisor recommends a diet focused on weight loss for body mass index over 25 kg per meter squared for control of lipid levels, then continued weight loss to achieve ideal body weight. For adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease, the U.S. Preventive Services Task Force (USPSTF) recommends intensive behavioral dietary counseling, and primary care clinicians or other specialists such as nutritionists or dietitians are qualified to provide this counseling (5).