Eating Right as a High Cholesterol Treatment

We've all heard that diet has an effect on cholesterol, but there's much confusion about what you should or shouldn't eat. Here's a rundown of the current evidence.

• Fat. If you have high cholesterol, you should cut down on saturated fat -- found in fatty meats and whole milk dairy products like cheese, ice cream, and butter. You also need to reduce your intake of trans fats, a man-made fat found in many processed foods, like stick margarine.
  
  But the message isn't as simple as "fat is bad." There are a number of foods with healthy unsaturated fats that will actually improve your cholesterol. They include fatty fish like tuna and salmon, walnuts, and almonds. Since even good fats are high in calories, you should still eat them in moderation.

So what sort of diet works as a high cholesterol treatment? Ask your doctor for specific recommendations. Some experts recommend a Mediterranean-style diet, which cuts down on saturated and trans fats, while boosting intake of healthy unsaturated fats from fish and nuts.

If an improved diet doesn't help your cholesterol, don't feel like a failure. Because of their genes, some people just don't respond as well to this approach.

Weight Loss & Exercise as a High Cholesterol Treatment

Being overweight or obese ups your odds of having high LDL (bad cholesterol) and triglyceride levels and low HDL (good cholesterol) levels. It can also lead to other serious risks like high blood pressure, diabetes, and heart disease. So it's crucial to keep a healthy weight.

As a high cholesterol treatment, physical activity can have a modest effect. Exercise can lower your triglycerides (and bad LDL cholesterol to a lesser extent) and boost your good HDL cholesterol. So you should aim to get some physical activity -- even just a brisk walk -- for 30-60 minutes most days of the week.

But there are limits to what exercise can do. "For most people, exercise by itself wouldn't be an effective therapy to lower cholesterol," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga. But it can keep your weight down and reduce other cardiovascular risks.

Medications as High Cholesterol Treatments

If lifestyle changes haven't been enough as a high cholesterol treatment -- or if you're at high risk of cardiovascular problems -- your doctor will likely turn to medications. In most cases, the first drug you will try is a statin.

Statins like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor work by blocking the effects of an enzyme that helps make cholesterol. They can lower bad LDL cholesterol by an impressive 20-55%. They have a modest effect on triglycerides and give a mild boost to your good cholesterol, too.

But don't assume that taking a statin makes you invulnerable. They won't cancel out a diet of french fries and fondue. "Statins are a complement to dietary changes," says Hutter, "not a replacement for them."

As with any drug, there are side effects. They can cause muscle aches, an increase in liver enzymes, and other issues. But the risks are low and it's important to keep them in perspective.

"On one hand, statins can reduce your risk of death, heart attack, stroke by 30-35%," says Sperling. "On the other, they pose a 1-2% risk of generally mild side effects." The benefits are often worth the small risk, Sperling says.

Although they tend to be overshadowed by statins, other medicines are also important high cholesterol treatments instead of, or in addition to, statins. They include:

• Bile acid resins like Colestid, Lo-Cholest, Prevalite, Questran, and WelChol. They stick to cholesterol in the intestines and prevent it from being absorbed. They can lower LDL cholesterol by 15-30%.
  
• Ezetimibe (Zetia) blocks some of the cholesterol from being absorbed by your body. It can lower LDL levels by 18-25%.
  
• Fibric acid like Antara, Atromid, Lopid, and Tricor. They reduce your triglycerides and may give a mild boost to your HDL.
• Niacin, available as Niacor, Niaspan, and Nicolar. Niacin lowers LDL cholesterol and triglycerides and raises HDL cholesterol. LDL levels are usually cut by 5-15%.
• A combination medicine like ezetimibe with simvastatin (Vytorin) which uses a statin to block production of cholesterol and ezetimibe to prevent cholesterol from being absorbed.

Remember that medicines aren't right for everyone. Since they're often taken for life, you and your doctor need to carefully discuss whether you should use them.

Do Alternative High Cholesterol Treatments Work?

While lifestyle changes and medicines have been shown to lower cholesterol and reduce your risk of cardiovascular disease, the same can't always be said for many alternative treatments. Some of the various supplements and herbs that have been touted as high cholesterol treatments are garlic, policosanol, and guggul.

While a few studies of garlic have found a modest benefit, a recent study of policosanol found no effect. However, none of these studies have been large enough to be definitive, experts say.

Keep in mind that, unlike medications, herbal products are not regulated by the FDA. They are not evaluated to see if they work. They could also interact with other medicines you use.

"You just don't know what you're getting when you buy these products," says Wong.  So if you want to take an alternative high cholesterol treatment, be sure to talk to your doctor.

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