Keeping Your Cholesterol in Check

Dave Romaine, 74, was the guy in charge at the Cleveland-area pig roast, cooking the succulent meat and cutting up the loins. But he didn't take a single bite -- or even lick his fingers. Romaine had recently completed an intensive program to lower his cholesterol, and roast pork was definitely off the menu. Once a dedicated meat eater, he no longer eats meat or meat products. As a " modified vegan," he says passing on the main course at the pig roast "didn't faze me. It's a mind-over-matter thing."

[See: 'Healthy' Foods You Shouldn't Be Eating.]

Getting Clear on Cholesterol

Cholesterol -- a waxy fat made in your body and also found in food -- is complicated. While it's notorious for raising heart attack and stroke risk, you need cholesterol to live. You can have too much bad cholesterol in your blood, or too little good cholesterol. Exercise and eating right alone can stave off high cholesterol -- sometimes. Middle-aged men are at greatest risk, but women are affected too, and high levels have been measured in teens and kids.

There's more than one type of cholesterol: Low-density lipoprotein or LDL cholesterol is the bad guy. High-density lipoprotein or HDL cholesterol is the hero, removing bad LDL from the blood and sending it to the liver, where it's treated as waste. Triglyceride is a related type of unhealthy fat. One goal in controlling cholesterol is keeping LDL and triglyceride levels low, while making sure HDL levels stay high enough.

Your body -- mostly the liver -- produces cholesterol to help coat cells, make bile acid to digest food and enable the body to make vitamin D and hormones such as testosterone and estrogen. The problem is that while you already make enough cholesterol, many common foods pump more into the bloodstream. Excess cholesterol can lead to atherosclerosis -- plaque buildup in the lining of the arteries.

Most people know about heart attack and stroke, but that's only part of the risk cholesterol poses. Plaque buildup can occur "in any of the plumbing systems anywhere in the body," says Reena Pande, a cardiologist with Brigham and Women's Hospital in Boston. "That could be the heart, where people develop coronary artery disease and have, out of consequence of that, heart attacks or heart failure. It could be in the blood vessels that supply the brain, the carotid arteries, where the consequences of that could be stroke."

In your lower extremities, Pande says, plaque can lead to peripheral artery disease, blocking the blood vessels that supply the leg muscles, and people can have "discomfort in the blood vessels when they walk, or don't get enough blood flow to their legs, so they can develop gangrene or ulcers of the toes and feet."

[See: 10 Ways to Lower Your Risk of Stroke. ]

Lifestyle Trial

So you've had that fasting blood draw, and it turns out you have high cholesterol. What happens next?

After determining patients have high cholesterol -- and considering their overall health status as well -- Pande often suggests a trial period of several months when they just make lifestyle changes. "Sometimes it's as simple as getting fit, exercising more, losing weight, eating better to get their cholesterol down -- it's worth a try," she says.

Certain diets -- notably the TLC Diet and Mediterranean Diet -- have been shown to reduce cholesterol levels.

While diet isn't the only factor, what you eat has a huge effect on controlling cholesterol and keeping it down, says Kristin Kirkpatrick, manager of Wellness Nutrition Services at Cleveland Clinic Wellness Institute. The patients she works with through the institute's 12-week Cardiac Lifestyle Intervention Program "go pretty much fat free of any oils -- no animal products," she says. "We've actually seen some amazing results in their numbers for cholesterol."

Romaine, who went in with a cardiac condition, high cholesterol and a weight he says he "couldn't get seem to get a hold of," completed the CLIP program in January. Today, the former steak-and-hamburger man eats a lot of tofu, greens, beans, peas, lentils, quinoa -- "things I'd never heard of before," he admits.

In terms of dairy products, he says, the program allows nonfat items such as yogurt or skim milk, although he prefers soy milk. And he'll have Egg Beaters once in a while.

[See: The Facts on Heart Disease .]

Does Your Food Have a Mother?

For people with health issues, Pande and Kirkpatrick stress that it's important to look at the whole patient and their entire range of lifestyle, medical and family risk factors when coming up with a cholesterol-lowering plan. If you're just trying to figure what to eat, Kirkpatrick offers some dietary advice. "No. 1: Any animal product has cholesterol," she says. "That's a really easy way to decipher what has cholesterol and what doesn't." Egg yolks, red meats and dark-meat chicken all contain cholesterol.

But you don't have to eliminate eggs completely from your diet. "From the sole standpoint of cholesterol, it's perfectly fine to have egg whites every day," she says. Poaching and hard-boiling are good ways to prepare eggs, and if you prefer scrambled, she suggests that instead of cooking with butter, use a little olive oil, which has been shown to reduce cholesterol.

Despite popular belief, cutting out cholesterol-containing foods alone is not enough. Foods high in saturated fats or trans fats -- such as cookies, cakes and muffins -- can also boost cholesterol, Kirkpatrick says. And studies suggest that sugar may boost triglyceride levels. But it's also not about never eating fat again. "It's the type of fat you choose that has the most impact," she says. Walnuts, for instance, are a good source of healthy omega-3 fatty acids, and fish such as tuna or salmon help decrease LDL cholesterol. Olive and canola oil also help, as does soy.

"Understand that 'plant' doesn't just mean a piece of spinach," Kirkpatrick says. "Olive oil is a plant-based food. The soluble fiber you get in oatmeal -- that's a plant-based food. So if something doesn't have a mother, it's probably a good thing for you to help reduce your cholesterol."

Exercise has been shown to reduce triglyceride levels, while raising levels of good HDL cholesterol. As part of CLIP, Romaine worked out an hour on a stationary bike or treadmill every day, although he admits slacking off at the gym since then. "But I do try to get in as much walking as I can," he says.

[See: 7 Mind-Blowing Benefits of Exercise.]

Time to Start Statins?

When it comes to controlling cholesterol, some circumstances such as genetics and gender are beyond your control. With patients who have a history of high cholesterol in their family tree, for instance, Kirkpatrick encourages a more aggressive dietary approach, not just giving up red meats and incorporating more omega-3s, but going entirely fat free. In general, men are at higher risk than women -- until menopause, when women's LDL levels may rise.

"There are some situations where the patient has some medical condition that puts them at higher risk, or their cholesterol levels are so high that irrespective -- they should do those good lifestyle changes no matter what," Pande says, adding that she might consider starting the patient on a cholesterol-lowering medication alongside those changes.

Statins are the standard go-to prescription pills for lowering cholesterol, unless allergies or side effects make other drugs a better option. Statin medicines include Lipitor, Crestor, Pravachol and Zocor, as well as less costly generic versions -- such as atorvastatin, simvastatin and pravastatin.

Romaine was already taking statins "for some time" before he started CLIP, he recalls. But it wasn't until he changed his diet that his total cholesterol levels showed a "dramatic" drop. His triglycerides, which had previously run in the 250-to-350 range, afterward fell to about 145. More importantly, he felt much better. "I have a lot more energy," Romaine says. "I don't sit down and fall asleep a lot. That used to be my trademark."

If you're curious about your own numbers, check out the chart below.

Cholesterol: Where Do You Fall?

The U.S. National Heart, Lung, and Blood Institute provides a rundown of cholesterol numbers:

* Cholesterol levels are measured in milligrams of cholesterol per deciliter (mg/dL) of blood.

Source: Adapted from the NHLBI website and NIH MedlinePlus.

Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.