High Cholesterol and High Triglycerides
Topic 9
1. What is cholesterol?
a. A waxy, fat-like substance, otherwise known as a lipid
b. Cholesterol is found throughout the entire body
c. Performs role in cell development
2. What is hypercholesterolemia?
a. High levels of cholesterol in the blood
3. How is cholesterol transported through the blood?
a. Cholesterol attaches to proteins and is carried throughout the blood stream
i. Otherwise known as a lipoprotein
1. Consider it a vehicle which transports fat
4. What are the types of cholesterol?
a. There is only one type of cholesterol
b. Classifications of lipoproteins
i. Relates to the proportion of protein and lipid
1. Low-density lipoprotein (LDL)
2. High-density lipoprotein (HDL)
5. What is a low-density lipoprotein?
a. Primary lipoprotein that is a risk factor for heart disease
i. Carried throughout the body
1. Used in muscle tissue cells
2. Production of hormones
b. Triglycerides are stored in VLDL (very low density lipoproteins)
i. Precursor to LDL
c. Otherwise known as “bad” cholesterol
6. What is a high density lipoprotein?
a. Lipoprotein that carries cholesterol back to liver where it is either recycled
or discarded
b. Otherwise known as “good” cholesterol
7. What do cholesterol labs values mean (general guidelines)?
a. Labs values are known as a lipid panel or a lipid profile
b. Labs are taken at a fasting level (nothing to eat 8 hours prior)
i. Total cholesterol
1. Desirable—below 200 mg/dL
2. Borderline high—200-239 mg/dL
3. High—above 240 mg/dL
ii. LDL
1. Individuals at high risk for heart disease—below 70 mg/dL
2. Individuals at risk for heart disease—below 100 mg/dL
3. Ideal—100 mg/dL
4. Borderline high—130-159 mg/dL
iii. HDL
1. Poor—Men: below 40 mg/dL and Women: below 50
mg/dL
2. Better—50-59 mg/dL
3. Best—60 mg/dL
8. What are the sources of cholesterol?
a. Internal
i. The liver makes cholesterol
b. External
i. Food sources
1. Animal products
a. The only dietary source of cholesterol
9. Risk factors associated with high cholesterol (Defined by Mayo Clinic staff)
a. Smoking
i. Cigarette smoking damages the walls of blood vessels
ii. Walls can accumulate fatty deposits
iii. Can lower HDL
b. Obesity
i. Body mass index (BMI) of 30 or greater increases risk
c. Poor diet
i. Red meat and full-fat dairy products
ii. Saturated fat from animal products
iii. Trans fats from some commercially baked cookies and crackers
d. Lack of exercise
i. Exercise helps increase HDL while lowering your LDL
e. High blood pressure
i. Increased pressure on artery walls damages arteries
1. This can speed up the accumulation of fatty deposits
f. Diabetes
i. High blood sugar contributes to higher LDL and lower HDL
ii. High blood sugar also damages the lining of arteries
g. Family history of heart disease
i. Parent or sibling developed heart disease before age 55
10. Complications associated with high cholesterol
a. Accumulation of cholesterol on arteries (plaque) can cause a blockage of
blood flow
i. Chest pain
ii. Stroke
iii. Heart attack
11. Lowering cholesterol levels?
a. See handout: Hypercholesterolemia Healthy Lifestyle Choices
12. What are triglycerides?
a. Another form of lipid found in the blood
b. They are considered the storage unit of food that is not immediately used
by the body for energy
c. Stored in fat cells and released for energy in between meals
d. When individuals consume more calories than are required for energy
triglycerides can become elevated
13. What is hypertriglyceridemia?
a. High triglycerides found in blood
14. What do triglyceride levels mean (general guidelines)?
a. Normal — Less than 150 mg/dL
b. Borderline high — 150 to 199 mg/dL
c. High — 200 to 499 mg/dL
d. Very high — 500 mg/dL
15. What food sources can contribute to elevated triglycerides?
a. Increased alcohol intake
b. High sugar intake
16. Lowering triglyceride levels?
a. See handout: Triglycerides and Omega-3s
b. See handout: Hypertriglyceridemia Healthy Lifestyle Choices
17. Risk factors associated with high triglycerides
a. Poor type 2 diabetes control
b. Low levels of thyroid hormones (hypothyroidism)
c. Liver or kidney disease
d. Genetic conditions (rare) that affect how body converts fat to energy
e. Side effect of certain medication
i. Beta blockers
ii. Birth control pills
iii. Diuretics
iv. Steroids
v. Tamoxifen (drug for breast cancer)
18. Questions?
19. Reference materials
a. National Cholesterol Education Program
i. http://www.nhlbi.nih.gov/about/ncep/index.htm
b. American Heart Association
i. http://www.americanheart.org
c. Mayo Clinic
i. http://www.mayoclinic.com
d. National Heart, Lung, and Blood Institute: National Cholesterol Education
Program
i. http://www.nhlbi.nih.gov
Strategies for Improving Blood Cholesterol
Adapted from http://RD411.com
Get at least 30 minutes of daily aerobic exercise (15 minutes, two times per day) to help
raise the “good” cholesterol in your bloodstream, high-density lipoprotein (HDL)
cholesterol.
Exercise
Consider trying the following activities:
Brisk walking
Cycling
Swimming
Dancing
Aerobics
Saturated fat
Reduce the amount of saturated fat you consume from dairy products, butter, red meat,
sausage, bacon, and tropical oils (coconut and palm). Plan your meals with vegetables,
fruits, beans/legumes, and whole grains, with moderate amounts of animal foods that are
lower in saturated fat, but high in protein, such as nonfat dairy products, fish, and egg
whites.
Further reduce saturated fat intake by removing the skin from poultry, trimming the fat
around meat, and choosing lean beef, pork, lamb, or veal.
Trans fat and partially hydrogenated vegetable oils
Avoid foods that contain trans fat or partially hydrogenated vegetable oils (check the
ingredients on nutrition labels). Aim for no more than 2 grams (g) of trans fat/day. This
fat often is found in fried foods and processed foods, such as stick margarine, crackers,
baked goods, baking mixes, and desserts.
High-fiber foods
Eat foods that are naturally high in fiber, particularly soluble fiber, which can help reduce
low-density lipoprotein (LDL) cholesterol. Soluble fiber is found in:
Oats
Fruits
Root vegetables
Barley
Flaxseeds
Unsaturated fats
Eat unsaturated fats, especially monounsaturated and omega-3s. Cook, sauté, and bake
with canola oil or olive oil. Enjoy nuts and seeds regularly (1 ounce [oz]=1 serving). Eat
a 3-oz serving of fish at least two times each week.
Smaller meals
Eat four to six smaller meals each day, instead of one or two large meals.
Sugar
Reduce the amount of added sugar you consume to help reduce triglycerides in the
bloodstream and assist with weight management. Big sources of added sugars include:
Sodas
Juices
Baked goods
Candy
Sweetened beverages, such as iced tea and coffee
Many breakfast cereals
Plant sterols and stanols
Consider eating foods, beverages, and condiments containing plant sterols or stanols to
help reduce LDL cholesterol. Plant sterols/stanols are found in some brands of margarine,
yogurt, salad dressing, and nutritional products, such as Ensure®, and Glucerna® Shake.
Check out the nutrition labels.
Weight loss
If you are overweight and trying to lose weight, exercise regularly, and eat foods that are
high in fiber and low in calories.
Soy protein
Include soy protein in your diet each day. Try:
Roasted soy beans
Soy nut butter
Steamed edamame
Tofu
Soy milk
Veggie meat alternatives (burgers, nuggets, hot dogs, etc)
Hypercholesterolemia: Lifestyle and Home Remedies
Generated by Mayo Clinic staff
Lifestyle changes are essential to improve your cholesterol level. To bring your numbers
down, lose excess weight, eat healthy foods and increase your physical activity. If you
smoke, quit.
Lose extra pounds
Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds can help lower
total cholesterol levels. Start by taking an honest look at your eating habits and daily
routine. Consider your challenges to weight loss — and ways to overcome them. Set
long-term, sustainable goals.
Eat heart-healthy foods
What you eat has a direct impact on your cholesterol level. In fact, a diet rich in fiber and
other cholesterol-lowering foods may help lower cholesterol as much as statin medication
for some people.
Choose healthier fats
Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more
than 10 percent of your daily calories from saturated fat. Monounsaturated fat — found in
olive, peanut and canola oils — is a healthier option. Almonds and walnuts are other
sources of healthy fat.
Eliminate trans fats
Trans fats, which are often found in margarines and commercially baked cookies,
crackers and snack cakes, are particularly bad for your cholesterol levels. Not only do
trans fats increase your total LDL ("bad") cholesterol, but they also lower your HDL
("good") cholesterol.
You may have noticed more food labels now market their products as "trans fat-free." But
don't rely only on this label. In the United States, if a food contains less than 0.5 grams of
trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you
eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the
ingredients list. If a food contains a partially hydrogenated oil, that's a trans fat, and you
should look for an alternative.
Limit your dietary cholesterol
Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if
you have heart disease. The most concentrated sources of cholesterol include organ
meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and
skim milk instead.
Select whole grains
Various nutrients found in whole grains promote heart health. Choose whole-grain
breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are
other good choices.
Stock up on fruits and vegetables
Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on
seasonal fruits. Experiment with vegetable-based casseroles, soups and stir-fries.
Eat heart-healthy fish
Some types of fish — such as cod, tuna and halibut — have less total fat, saturated fat
and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in
omega-3 fatty acids, which help promote heart health.
Drink alcohol only in moderation
Moderate use of alcohol may increase your levels of HDL cholesterol — but the benefits
aren't strong enough to recommend alcohol for anyone who doesn't drink already. If you
choose to drink, do so in moderation. This means no more than one drink a day for
women and one to two drinks a day for men.
Exercise regularly
Regular exercise can help improve your cholesterol levels. With your doctor's OK, work
up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim
laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise
group. And, you don't need to get all 30 to 60 minutes in one exercise session. If you can
squeeze in three to six 10-minute intervals of exercise, you'll still get some cholesterollowering benefits.
Don't smoke
If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits
don't end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24
hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is
half that of a smoker's. Within 15 years, your risk of heart disease is similar to that of
someone who's never smoked.
Hypertriglyceridemia: Healthy Lifestyle Choices
Generated from Mayo Clinic staff
Lose weight
If you're overweight, losing 5 to 10 pounds can help lower your triglycerides. Motivate
yourself by focusing on the benefits of losing weight, such as more energy and improved
health.
Cut back on calories
Remember that extra calories are converted to triglycerides and stored as fat. Reducing
your calories will reduce triglycerides.
Avoid sugary and refined foods
Simple carbohydrates, such as sugar and foods made with white flour, can increase
triglycerides.
Limit the cholesterol in your diet
Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if
you have heart disease. Avoid the most concentrated sources of cholesterol, including
meats high in saturated fat, egg yolks and whole milk products.
Choose healthier fats
Trade saturated fat found in meats for healthier monounsaturated fat found in plants, such
as olive, peanut and canola oils. Substitute fish high in omega-3 fatty acids — such as
mackerel and salmon — for red meat.
Eliminate trans fat
Trans fat can be found in fried foods and commercial baked products, such as cookies,
crackers and snack cakes. But don't rely on packages that label their foods as free of trans
fat. In the United States, if a food contains less than 0.5 grams of trans fat per serving, it
can be labeled trans fat-free. Even though those amounts seem small, they can add up
quickly if you eat a lot of foods containing small amounts of trans fat. You can tell that a
food has trans fat in it if it contains partially hydrogenated oil.
Limit how much alcohol you drink
Alcohol is high in calories and sugar and has a particularly potent effect on triglycerides.
Even small amounts of alcohol can raise triglyceride levels.
Exercise regularly
Aim for at least 30 minutes of physical activity on most or all days of the week. Regular
exercise can boost "good" cholesterol while lowering "bad" cholesterol and triglycerides.
Take a brisk daily walk, swim laps or join an exercise group. If you don't have time to
exercise for 30 minutes, try squeezing it in 10 minutes at a time. Take a short walk, climb
the stairs at work, or try some sit-ups or push-ups as you watch television. It's also
important to control diabetes and high blood pressure if you have high triglycerides and
one of these conditions.
Triglycerides and Omega-3s
Adapted from Mayo Clinic Staff
Triglycerides are a type of molecule that contains both fat and sugar. High triglyceride
levels are a risk factor for heart disease. High triglyceride levels also are related to
diabetes, high blood pressure, obesity, chronic kidney disease, liver disease and
circulatory disease.
Omega-3s, called fatty acids, are a family of molecules. Specific types of omega-3 fatty
acids are within this family. The two most commonly known types are docosahexaenoic
acid (DHA) and eicosapentaenoic acid (EPA).
The benefits of omega-3s:
Strongly supported research has shown that DHA and EPA together help to lower
triglyceride levels, as well as to lower blood pressure and help prevent secondary heart
disease.
Sources of DHA and EPA are found in fatty, coldwater fish, such as:
Bluefish
Carp
Catfish
Halibut
Herring
Lake trout
Mackerel
Pompano
Salmon
Striped sea bass
Tuna (albacore)
Whitefish
The American Heart Association recommends eating fish at least twice a week. If you do
not eat fish at least twice a week, talk with your doctor about whether you should take a
fish oil supplement.
How much DHA and EPA to take:
The American Heart Association recommends 1000 milligrams (mg) DHA + EPA daily
for people with known heart disease.
Example: The label indicates that one pill=120 mg DHA and 180 mg EPA. This is 300
mg total DHA + EPA/pill. If you took three pills/day, that would equal 900 mg DHA +
EPA, which is close to the target of 1000 mg/day DHA + EPA.
Example: The label indicates that two pills=700 mg DHA and 500 mg EPA. This is 350
mg DHA and 250 mg EPA/ pill. Taking two pills would equal 1200 DHA + EPA, which
is adequate for the day.
For people who need to lower their triglyceride levels, higher levels of DHA + EPA are
recommended. The American Heart Association recommends 2000-4000 mg DHA +
EPA/day for those with documented high triglyceride levels.
Caution: The US Food and Drug Administration (FDA) considers up to 3000 mg DHA +
EPA as safe. However, anyone taking more than 3000 mg DHA + EPA should do so only
under the direct supervision of a physician.
Choosing a fish oil supplement:
First, look for a supplement that will provide the appropriate dose of DHA + EPA (see
previous section). It is also important to look for supplements that contain a balanced
mixture of DHA + EPA. Choose a mixture that is as close to 50% DHA, 50% EPA as
possible. For example, a supplement containing 160 mg DHA and 140 mg EPA is a good
choice (55% DHA, 45% EPA). A supplement containing 50 mg DHA and 250 mg EPA
is not as good of a choice (15% DHA, 85% EPA).
It is also important to make sure the oil is coming from fish sources. Read the ingredient
label to find out where the oil is coming from.
May limit gastrointestinal side effects:
Start taking fish oil supplements at a low dose, gradually increasing to the recommended
dose.
Take fish oil supplements with meals.
Freeze fish oil capsules to help decrease gastrointestinal side effects (helpful for some
people).
Mercury accumulates in the meat of fish, but not as much in the oil. Therefore, fish oil
supplements generally do not contain mercury.
Who should not take fish oil supplements:
You should always let your doctor(s) know all of the supplements you are taking,
including dosage information. Do not start taking fish oil supplements until you have
talked with your doctor(s).
Do not take fish oil supplements if pregnant or breastfeeding, or if you have:
Fish allergy or hypersensitivity to fish
Chronic low blood pressure
Congestive heart failure
Chronic recurrent angina
Any conditions that indicate the heart is receiving insufficient blood flow
High levels of low-density lipoprotein (LDL)