How to Lower LDL?

What is LDL cholesterol?

Cholesterol has two types: LDL called Low-density cholesterol and HDL or High-density cholesterol. These are lipoproteins that are the incorporation of fat (lipid) and protein. Proteins are a measure to move and transport the fats through the blood all over the body. LDL is well-known as bad cholesterol because the high LDL level can build up a fat or lipid layer in arteries. It leads to narrowing the vessels, and it may cause hypertension and clots that can have other dangerous complications. The LDL or the bad cholesterol collected in arteries walls can be a risk factor for health and heart problems like heart attack and strokes.
Based on Dietary guideline 2020, the importance of limiting intakes of saturated fat is needed to support healthy dietary patterns. Staying within saturated fat limits and replacing saturated fat with unsaturated fat is essential during the adult life stage. The prevalence of coronary heart disease increases with age, and high LDL cholesterol peaks between the ages of 50 to 59 in men and 60 to 69 in women.
We should note that all of the cholesterols are not bad, and some of the body substances and functions need these lipids to have a good health condition. For example, the nervous system and the hormones are based on some of the lipids and cholesterols.
The body can make some of the cholesterol itself, and some of the cholesterols are originated from the food intakes. The diet has a crucial role in determining the lipid status of the body.
LDL is a droplet of outer lipoprotein and cholesterol in the center of it.
HDL is a high-density lipoprotein, which means it carries cholesterol from all parts of the body and brings them back to the liver. The liver clears them from the body. Most of the body's cholesterol is LDL, and the HDL brings back the HDL to the liver for removing them from the body. Therefore, a high HDL level is needed to prevent heart attack and other related diseases such as strokes.

How can LDL raise the risk of other diseases?

A high LDL level means too much LDL cholesterol in the blood, and these extra lipids will form the plaque. The plaque in the arteries will make them narrower, and this condition leads to atherosclerosis.
When the plaques accumulate in the heart's arteries' inner layer, it is called Coronary artery disease. Slowing down the blood flow to the heart decreases the oxygen needed for the heart's cells, leading to chest pain or angina. If the blood flow stops and becomes blocked, ultimately, a heart attack can occur. Coronary artery disease and peripheral artery disease are essential, and they should be prevented and under control. Blood thrombogenicity increases with high LDL cholesterol and diabetes.

The American College of Cardiology (ACC) and American Heart Association (AHA) released practice guidelines for the assessment of cardiovascular risk (Stone et al., 2014). These guidelines are referred to as the Adult Treatment Panel 4 (ATP 4) and replace the Adult Treatment Panel 3 (ATP 3). Four high-risk groups are identified:

There are four high-risk groups of lipid indices of cardiovascular risk:
♦ Adults with atherosclerotic cardiovascular disease (ASCVD)
♦ Adults with diabetes, aged 40 to 75 years, with low-density lipoprotein (LDL) levels 70 to 189 mg/dL
♦ Adults with LDL cholesterol levels of at least 190 mg/dL
♦ Adults aged 40 to 75 years who have LDL levels 70 to 189 mg/dL and at least 7.5% 10-year risk of atherosclerotic cardiovascular disease

What can change the level of LDL?

Overweight and obese people have an increase in the total cholesterol status, higher LDL level, and low status of HDL. Therefore, paying attention to the weight is essential.
Diet can help to balance the weight. Some recommendations such as avoiding the SFAs (saturated fatty acids) and restricting them, using healthy fats and oils can modify the blood cholesterol level.
Besides diet, having a lifestyle change and doing more physical activity can lead to better life quality. Low physical activity means weight gain and obesity, and it can raise the LDL or the unhealthy cholesterol level.
Another lifestyle alternative is quitting cigarette smoking because smoking can decrease the level of good cholesterol or HDL. On the other hand, HDL is needed to removing the LDL from arteries. Quitting smoking is a helpful factor in healthily maintaining lipid and cholesterol levels.
Ageing can raise cholesterol levels. Menopause can have an adverse effect on LDL levels in women. The importance of family history is due to genetics. High cholesterol runs in generations of families. Familial hypercholesterolemia is an inherited form of high blood cholesterol.
People should notice the medicine they take because some of them, especially those that include steroids, can raise the LDL level—for example, the medicines of hypertension or HIV medicines.
Some disease conditions like chronic kidney disease, HIV/AIDS, and diabetes may upper the LDL cholesterol level.
Some races, like African Americans, have higher HDL and LDL cholesterol levels than other ethnicities.
The doctors use a calculator to determine the chance of inducing high LDL levels and heart problems. The status of your cholesterol level, age, blood pressure, smoking cigarettes or not, diabetes, family history, and taking blood pressure pills or not can affect this chance.

LDL ranges and the diagnosis

Lower numbers of LDL are considered a healthy state. You can see the ranges and the categories of the LDL cholesterol below:

LDL cholesterol ranges and the diagnosis

A blood test can show the content of LDL, HDL, total cholesterol, and triglycerides.
Family history, risk factors, and age are the indicators to know when a blood test is needed for measuring the cholesterol level.

Children and teenage:
The first test can be during 9 – 11 years old.
The family history of high levels of lipids in blood, heart strokes, and attack can be an indicator for the children in those families to start the check-up at age 2
Children should have a blood test to check the lipids about every five years.

Age 20 and older:
Under 45 blood test every five years
Men 45-65 years and women in 55-65 should have a blood test every 1 to 2 years.

If you are into a condition like heart disease or diabetes, your doctor might recommend an LDL goal of 70 mg/dL or below.


How to lower LDL cholesterol level? What treatments are suggested to lower LDL?

One of the valuable ways of lowering the LDL level is following a Low LDL diet. How can we have a low cholesterol diet? The recommendations and modifications in lifestyle and the food intake, finding out the best food as a good choice to lower the cholesterol, such as:
Adding lean meats, chickens, turkey, and fish to the food list can limit the bad cholesterol intake. Fibres (the soluble ones) can impact the digestive system and carry some of the body's excess fats and lipids. Therefore, selecting a wide variety of fruits, vegetables, legumes, and foods containing fibre and can help remove bad cholesterol is essential and needed. If you want to reduce the LDL intake, you have to change the way of cooking. Avoiding fried, fast, junk, processed, and oily foods and focusing on baked, broiled, grilled, and the low fat and preferring the steamed ways. The cholesterol content in egg yolks is very high, and the number of eggs eaten in a week should be controlled. Omega-3 fatty acids in fish like salmon, mackerel, and herring and also available in nuts and seeds such as walnuts, flaxseeds, almonds can reduce the LDL level.
A heart-healthy eating habit that limits saturated fats and trans fats can be another way to reduce LDL content. The dietitians recommend the DASH diet and the TLC diet. If the patient with high LDL cholesterol suffers from obesity or being overweight should be under the weight management procedure. A weight loss diet can be chosen besides the modifications in their lifestyles. For example, we suggest attending regular physical activity like 30 minutes and more three times a week.
If the condition of hyperlipidemia or high cholesterol is diagnosed, the doctor may prescribe cholesterol-lowering drugs along with diet and lifestyle changes. The treatment with Statin, Zetia, and PCSK9 inhibitors are samples of them. Lipoprotein apheresis a filtering machine to remove the LDL cholesterol from the blood and is similar to dialysis, but it is suggested for people with familial hypercholesterolemia (FH).

Food to eat to lowering cholesterol

There are several foods you can eat to lower your blood LDL cholesterol, include below list:

♦ Whole grains
♦ Okra
♦ Eggplant
♦ Onion
♦ Garlic
♦ Mushroom
♦ Avocado
♦ Pepper
♦ Salsa
♦ Brussels sprouts
♦ Kidney beans
♦ Leafy greens
♦ Squash

♦ Barley
♦ Banana
♦ Mango
♦ Citrus
♦ Pears
♦ Plums
♦ Oats and Oatmeal
♦ Apple
♦ Grapes
♦ Berries
♦ Strawberries
♦ Soybeans
♦ Tofu

♦ Soy milk
♦ Whole almonds
♦ Walnuts
♦ Pistachios
♦ Canola oil
♦ Peanut oil
♦ Sunflower oil
♦ Safflower oil
♦ Mackerel
♦ Herring
♦ Tuna
♦ Trout
♦ Salmon

Foods to avoid to lower the LDL

And if you are looking to lower your blood LDL cholesterol, you should avoid the following foods:

♦ Lard
♦ Lam
♦ Pork
♦ Fatty beef
♦ Chicken and poultry with skin
♦ Coconut oil
♦ High-fat dairy

Let us know if you have any questions or comments.