Cholesterol has long been seen as a villain for heart health, but our understanding of this beast is changing. New recommendations suggest that risk factors should determine who should receive drugs called statins to lower cholesterol levels, and who should simply make lifestyle changes to combat the problem.
Anyone with diabetes, heart disease, "bad" cholesterol over 190 or a 10-year risk of heart attack above 7.5% should be taking a statin, the new guidelines from the American Heart Association and the American College of Cardiology say. Everyone else with high cholesterol: Take matters into your own hands.
There's the caveat, too, that not all cholesterol is alike. There's "good" cholesterol -- high-density lipoprotein, or HDL -- that you want to maintain relatively high, and "bad" cholesterol -- low-density lipoprotein, or LDL -- that needs to be kept at bay.
Here are some lifestyle modifications you can try, with an eye toward pushing the bad cholesterol down and the good toward healthy levels. Keep in mind that, according to the American Heart Association, these strategies may not be enough, especially if you have a family history of high cholesterol. Talk to your doctor about what treatment plan is best for you.
1. Lose weight
You may be able to reduce cholesterol levels significantly by losing 5% to 10% of your body weight, according to the Mayo Clinic.
Accomplishing that isn't necessarily easy, but you can begin with small steps. Incorporate physical activity into your daily routine in simple ways, such as walking up and down stairs. Replace a fast-food lunch with a homemade, healthy meal and munch on carrot sticks instead of potato chips.
Slowly introducing more exercise and healthier foods can have a big impact on your weight and, by extension, lower your cholesterol.
Healthy weight is so important for overall heart health, in fact, that the American Heart Association and American College of Cardiology released a new report calling for physicians to create customized weight loss plans and recommend counseling with a dietitian or certified weight loss professional for at least six months. Doctors should also offer bariatric surgery as a potential option for some patients with high body mass index, the report said.
2. Be a picky eater
What you eat can make a big difference in cholesterol.
Watch out for saturated fats, which lurk in red meat and dairy products. The Mayo Clinic recommends that less than 7% of daily calories come from saturated fat. Alternatives include leaner meat cuts, low-fat dairy products and monounsaturated fats, which you can get from olive, peanut and canola oils.
But avoid foods that contain partially hydrogenated oil -- an ingredient that signals the presence of trans fat, a feature of fried foods and many commercial baked products.
Even products that say "trans fat-free" may not be truly clean of these fats; in the United States, the "trans fat-free" label can be stuck on any food with less than 0.5 grams of trans fat per serving. Such small quantities can add up, so check ingredients for partially hydrogenated oil.
In general, you should consume no more than 300 milligrams of cholesterol daily, and if you have heart disease or diabetes, that number goes down to 200. Organ meats such as liver, egg yolks and whole milk products are full of cholesterol; you can replace them with lean meat cuts, egg substitutes and skim milk.
Whole grains, fruits and vegetables can all help lower cholesterol. Foods rich in omega-3 fatty acids can help lower bad cholesterol, too; these include certain fish -- salmon, mackerel and herring -- as well as walnuts, almonds and ground flaxseed.
Oatmeal is another fighter of bad cholesterol as it contains soluble fiber, which can reduce cholesterol's absorption into the bloodstream. Kidney beans, apples, pears, barley and prunes are also good sources of soluble fiber.
3. Get active
Aim to exercise 30 minutes per day, with your doctor's approval, and you can be on your way to reducing overall cholesterol and raising good cholesterol. Your weight loss journey can begin with 10-minute intervals of physical activity multiple times a day.
Look for opportunities to add exercise. Can you squeeze in a walk during your lunch hour? Can you ride your bike to work? Can you get a sports game going, or take an early-morning run? When you watch TV, can you do some situps?
Finding an exercise partner can help, too. You might also consider starting or joining a group that works out together.
4. No more cigarettes
Everyone knows smoking is bad for your health, so it will come as no surprise that smoking is harmful to the heart. If you quit smoking, you may improve your good cholesterol level.
What's more, your blood pressure decreases within 20 minutes after quitting, according to the Mayo Clinic. Risk of heart attack lowers within 24 hours of quitting smoking, and within a year the risk of heart disease is just half that of someone who smokes. Heart disease risk drops to levels similar to people who have never smoked within 15 years of quitting.
5. Lower alcohol consumption
Excessive drinking of alcohol may lead to high blood pressure, heart failure and stroke. That's why it's recommended that women of all ages and men older than 65 only drink up to one alcoholic beverage per day; for men 65 and under, stick to up to two drinks.
Interestingly, high levels of good cholesterol have been linked to moderate use of alcohol, but this connection hasn't been demonstrated strongly enough to recommend alcohol to nondrinkers.
While these lifestyle changes can be useful, sometimes doctors still need to prescribe cholesterol-lowering medications. If your cholesterol is high, talk to your health care provider and come up with an easy-to-manage plan of attack.