Coronary artery disease is among the most common cause of death in the United States.  There are numerous risk factors for coronary artery disease, including high cholesterol.  High cholesterol may be due to a genetic predisposition, or more commonly, due to an acquired condition from obesity, high carbohydrate diet, or diabetes.  It is of interest to know your cholesterol, even if you do not yet have heart disease.  Cholesterol may be simply thought of as two components: LDL and HDL.  The LDL or low density cholesterol, transports to the site of action in the body, whereas HDL transports cholesterol to the liver.

For good health, it is suggested to keep total cholesterol below 200 mg/dL. The LDL should be 100 mg/dL or less, and the HDL above 40 mg/dl.  These are associations to cardiac events, but are reasonable guidelines.  There are simple ways to achieve these goals:  reduction of weight; increase in aerobic exercise; decrease in dietary fats.  It is dangerous and misled to use drug therapy to keep cholesterol under control while not changing dietary fat and cholesterol consumption.   Dean Ornish, in his book, Reversing Heart Disease, describes a diet that can correct this problem.  The Ornish diet is under 10%fat, a vegetarian diet, and has been shown to reverse coronary heart disease, when used with a program of stress reduction, exercise, and yoga.  Omega 3 supplements, at 1-3 gram a day, while not lowering cholesterol, are beneficial in preventing progression of coronary artery disease.  The Mediterranean diet, rich in olive oil, a monounsaturated fat, can lower LDL cholesterol.  Fiber, in general, can lower cholesterol by moderate amounts.  Yogurt and other fermented milk products may interfere with metabolism of cholesterol, and so may lower cholesterol.  The twin behavioral changes of weight loss and especially vigorous exercise both effect cholesterol; exercise by increasing HDL, and weight loss by decreasing LDL. 

Supplements that can effect cholesterol include plant sterols (these compounds are found in many plants); garlic, in doses of one clove per day, is effective in lowering cholesterol.  And as mentioned above, fiber, for example psyllium at 10 gram per day in 8 oz water, can lower cholesterol.

The best source of omega 3’s is food: fresh cold water fish, 4 servings per week.  Other sources include walnuts, and ground flaxseed, and some vegetables.  There are numerous other supplements with lowering effects on cholesterol which I will only mention: gugulipid; fenugreek; artichoke leaf; turmeric; green tea, and a plant pharmaceutical, red yeast rice.

The most important fact about cholesterol is to realize it is associated with heart disease.  To only focus on cholesterol, and neglect the numerous lifestyle factors is a mistake, in my opinion.  Also, to commit with treatment, for  example with drug therapy, without changing lifestyle, is also, in my opinion, a mistake.