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Warning Signs Of High Cholesterol & How To Get Back On Track

Elizabeth Klodas, MD, FACC
August 11, 2023
Elizabeth Klodas, MD, FACC
By Elizabeth Klodas, MD, FACC
Elizabeth Klodas is a board-certified Cardiologist, Author, Speaker, Founder of the Preventative Cardiology Clinic near Minneapolis, Minnesota, and the Founder and Chief Medical Officer of Step One Foods.
Image by Toma Evsuvdo / Stocksy
August 11, 2023
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Cholesterol is a component of every cell wall of every organ, and it fuels the formation of various hormones as well as bile (which helps us digest food). Unfortunately, any excess cholesterol circulating in your bloodstream can become trapped in artery walls, forming plaque. Plaque buildup is responsible for heart attacks, strokes, and the need for stent implantation and bypass surgery. No wonder doctors are so focused on helping patients keep their circulating levels of cholesterol low1.

As a cardiologist, here are my insights on how to monitor your cholesterol levels, detect issues early, and get your numbers back to healthy levels.

How to interpret your cholesterol results

Cholesterol is a waxy, fat-like substance that is absorbed from the intestines during digestion. It's also manufactured internally by the liver. The majority of cholesterol circulating in your blood does not come from the foods you eat but rather is manufactured internally.

When you get a cholesterol result, you are typically provided with four numbers: total cholesterol, HDL, LDL, and triglycerides. Total cholesterol should fall below 200 mg/dL, but the other three values are much more important in terms of risk assessment.

HDL is "good" cholesterol: This is the cholesterol that's not depositing in your arteries but is on its way out. So you want HDL numbers to be high. In men, HDL should be above 40 mg/dL. In women, HDL should be above 50 mg/dL. Values lower than those represent an additional risk factor for developing plaque deposits.

LDL is "bad" cholesterol: This is the cholesterol that's potentially depositing in your arteries. You want LDL numbers to be low; the lower, the better. Cardiologists would say that everyone's LDL should fall below 130 mg/dL. If you have additional risk factors (i.e., if you're a smoker, have high blood pressure, or have low HDL), LDL should fall below 100 mg/dL. If you've had a heart attack, stroke, bypass surgery, or a stent, or if you have diabetes, LDL should fall below 70 mg/dL. LDL well under 50 mg/dL is considered additionally protective2

TGs are an indicator of general metabolic health: TGs are mostly fatty particles that don't contribute much to the total cholesterol number. Normal levels are under 150 mg/dL. TGs are more of an indicator of general metabolic health, and levels over 150 mg/dL can be a warning sign of faulty blood sugar control. Levels over 500 mg/dL are typically genetically driven and require medical management to reduce the risk of developing pancreatitis3.

Signs your LDL cholesterol is too high

High LDL cholesterol can make itself known in very dramatic ways:

  • As chest pain4 or unusual shortness of breath with exertion (due to cholesterol deposits in heart arteries leading to narrowings)
  • As a stroke or a heart attack (from cholesterol deposits in arteries becoming unstable and rupturing)
  • As erectile dysfunction5 (due to cholesterol deposits interfering with the ability of arteries to dilate)
  • As visible cholesterol deposits around the eyelids or over elbow and/or Achilles tendons—called xanthomas

These are all late manifestations of high LDL. By the time you can see deposits around your eyelids, had a stroke, or experience ED, cholesterol has been depositing in your blood vessels and other tissues for many years—even decades. Most high cholesterol, especially early on, is completely silent. 

The time to find out if you have high LDL is way before you develop any of these signs or symptoms so you can avoid them entirely. The only way to know if your LDL cholesterol is high is to get a blood test.

Tips for getting LDL down

In most people, high LDL is caused in part or in whole by a deficiency of the right foods. To combat elevated readings, here are the nutrients to include in your diet every single day:


Eat whole food fiber

Most Americans don't get enough fiber in their diets. And that's a problem because dietary fiber traps bile cholesterol in the digestive system and prevents it from being reabsorbed. This leads to the body having to use more circulating LDL to make bile for the next meal, helping to clear LDL out of the bloodstream. High-fiber foods include whole grains, beans, legumes, leafy greens, and whole fruits and vegetables.


Prioritize plants

Plant sterols are natural plant components found in all whole plant-based foods. Plant sterols compete with bile cholesterol for absorption6, leading to similar effects on circulating LDL as seen from high fiber intake. Americans consume around 300 mg of plant sterols per day. To help lower LDL and support heart health, the FDA recommends intakes closer to 1,300 mg per day.


Get more omega-3 fatty acids

There are three types of omega-3 fatty acids: EPA, DHA, and ALA. Of these three, only ALA is considered "essential" because we need it for multiple biochemical processes but can't manufacture it inside our bodies.

ALA is found in high amounts in foods such as flax, chia, and walnuts and, like all omega-3s, helps lower LDL but also helps raise HDL and lower TGs. Nutrition experts consider optimal ALA intake7 to fall between 2 and 3 grams per day. Most of us get about half of that. 


Bring on the antioxidants

Before LDL can be incorporated into artery walls, it has to be oxidized. Antioxidants prevent this from happening, making any circulating LDL less toxic8. Antioxidants are found in especially high amounts in fruits, vegetables, and leafy greens.

When combined, adequate intakes of these four key nutrients can yield marked LDL reductions. A clinical trial performed at the Mayo Clinic and the University of Manitoba9 revealed that getting these nutrients through a couple of specially formulated snacks per day (like those from my company, Step One Foods) could yield highly significant LDL reductions in as little as 30 days, with many individuals experiencing medication-level cholesterol drops.

The takeaway

High LDL cholesterol is a significant risk factor for plaque buildup and multiple unwanted health effects, but the only way to know if you have high cholesterol is to have it checked through a blood test. Although some people will require medications to control their readings, medication-level LDL reductions are possible when you eat the right combinations of the right nutrients in the right amounts. Prioritizing fiber, omega-3 fatty acids, plant sterols, and antioxidants is key.