Despite a reduction in the average cholesterol level, from 204 mg/dL in 1999-2000 to 199 mg/dL in 2005-2006, some health-and-nutrition experts are warning against relying on pills alone to keep cholesterol levels low.
Many experts credit cholesterol-lowering drugs with the overall reduction, which is based on findings from the Centers for Disease Control's National Center for Health Statistics, Atlanta. Among these is Dr. Neal Weintraub, who also cautions against viewing such medications as "a magic bullet."
"I think it's the widespread use of these medications that is largely responsible for the reduction in cholesterol," says Weintraub, director of the cardiovascular diseases division at the University of Cincinnati Medical Center. "I think the fact that the obesity level has gone up during this time is an indicator that the change is not a result of dietary or healthy lifestyle measures, such as exercise. That's not a good thing. The harder thing is the diet and exercise program. The easy thing to do is to take a pill."
"I think for many people, medication is the only way to keep cholesterol levels down," says Kerry Neville, a spokesperson for the American Dietetic Association, Chicago. "But too many people who take these medications totally disregard diet. That's a mistake, I think, because if they followed a heart-healthy diet, they might be able to take less medication."
This means avoiding foods high in saturated fats and cholesterol, Neville says. This includes fatty cuts of meat, processed meats, bacon, sausage or even turkey with skin. Oils to avoid include hydrogenated vegetable oil, coconut oil, palm oil and palm kernel oil. And restrict your intake of dairy products like egg yolks, half-and-half, cheeses, ice cream and sour cream.
"I have some people who have cut out cheese and are surprised at the impact it has on their cholesterol level," Weintraub says.
Even processed grain products like cookies, cakes, muffins and pastries can be laden with saturated fat or cholesterol, Neville says.
"Saturated fat should be less than 10 percent of calories from fat and dietary cholesterol should be limited to less than 300 mg per day," Neville says. "Trans fat increases LDL cholesterol and decreases HDL cholesterol, so they should be avoided when possible."
Foods in a daily diet that can benefit cholesterol levels, Neville says, include one handful of almonds; less than an ounce of viscous fiber such as oats and barley; 50 grams of soy protein such as tofu or soy milk; and two grams of plant sterol found in many fiber supplements.
And then there's exercise.
"Aerobic exercise is certainly one of the things we recommend," Weintraub says. "It improves the balance between cholesterol levels. Between the good cholesterol (HDL) and bad cholesterol (LDL)."
Exercise can also help increase your HDL cholesterol, Neville says.
Finally, testing your cholesterol regularly is important. In the CDC survey, 75 percent of women and 65 percent of men had been screened for high cholesterol in the previous five years.
"I think that the more people are aware of their personal data the more they are willing to do to correct their cholesterol level," Weintraub says.
In the end, experts agree that exercise, diet and regular testing with a doctor are keys to keeping your cholesterol at a safe level - even with pills.
"I think the mindset is that people don't worry so much about diet because the pill will take care of you," Weintraub says. "But we should be telling our patients not to forget the very important components of lifestyle and exercise."