Tips for Lowering Your Cholesterol

Increases in blood cholesterol are becoming more common in people taking anti-HIV medication. Sometimes the higher cholesterol is caused by the medication, HIV disease itself, a result of your family history, gaining weight or a combination of all of these elements. Total cholesterol levels over 200 should be watched. There are two types of cholesterol: LDL, or bad cholesterol, and HDL, or good cholesterol. LDL levels should be less than 130 mg/dl and HDL levels should be over 35 mg/dl in a fasting blood test.

If you want to avoid taking medications to lower cholesterol, following a low cholesterol diet may help. Often times, losing weight can lower your cholesterol enough so that you can avoid taking cholesterol-lowering meds.

There are two types of fat: saturated fat (which mostly comes from animals) and unsaturated fat (which comes from plant sources such as corn, olives, peanuts, etc.). The saturated or animal fat is where most of the cholesterol is; your intake of these foods should be reduced if you are trying to lower your cholesterol.

A few plant sources such as coconuts, palm oil, and chocolate (from cocoa seeds) have higher amounts of saturated fat and should also be reduced. Fats in general, whether they are from plant or animal sources, should be decreased in your diet to reduce your total fat intake.

The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have developed diets to help you lower your weight and cholesterol. The NCEP Step 1 and Step 2 diets are designed to help you eat healthier, reduce the fat in your diet -- especially the saturated fat -- and teach you about the foods to avoid that are high in cholesterol. The Step 1 diet is used when cholesterol levels are moderately elevated. The Step 2 diet is stricter and is used when cholesterol levels are too high (usually over 300mg/dl).

The recommendations of both diets include reducing saturated fats to 10% or less of your total calorie intake, restricting cholesterol to 300mg/day or lower, and reaching and staying at your desirable body weight. The use of unsaturated fats, usually called healthy fats, should be restricted to 20% or less of your total calories/day so that your calorie intake from fat (saturated and unsaturated) is 30% or less of your total calorie intake. Research has shown that lowering elevated blood cholesterol helps reduce the risk of heart disease.

Reading food labels for cholesterol content and altering your food preparation can help you meet the goals discussed above. Trimming meats of visible fat, buying leaner cuts of meat, removing the skin from poultry, eating more fish, avoiding cured meats such as bacon or sausage, taking the yolks out of eggs, and baking or broiling rather than frying are some of the things you can do to reduce the fat and cholesterol in your diet. Since your protein needs are higher with HIV disease, you may want to incorporate soy, beans, and nuts in your diet as these are good sources of high quality protein and are low in cholesterol. Reducing the overall amount you eat can also help promote weight loss and lower your cholesterol. A regular exercise routine that includes aerobic or "cardio" exercise also helps meet these goals.

The AHA has information and cookbooks on low fat, low cholesterol cooking which are available at most major bookstores or at your local AHA chapter. Many good cookbooks and magazines are also available on this topic.

A dietitian specializing in HIV care can help you with the right diet and exercise program. If you do not need to lose weight and your body fat is low, losing weight may not be a good idea. Discuss with your doctor what is the right course of action for you.

Margaret is a dietitian with extensive experience in treating HIV clients in the San Francisco Bay Area.