LDL Cholesterol: 146mg/dL

What does an LDL level of 146 mean? Are there any symptoms associated with this level?

An LDL level of 146 mg/dL is considered elevated. An optimal LDL level is <100 mg/dL. Although cholesterol is involved in several important functions in the body, elevated LDL cholesterol may put you at greater risk for heart disease. 

Elevated LDL cholesterol doesn’t have symptoms, which is why it’s important to know your levels. Lowering your cholesterol will reduce your risk of developing heart disease and other health issues. If you already have heart disease, lowering your LDL can reduce your odds of serious complications, like a heart attack or stroke. 

Factors that could contribute to a level of 146: 

• Diet: Diets that are low in dietary fiber and high in saturated fats, trans fats, and added sugar can cause LDL cholesterol to rise.

• Weight. Being overweight can cause total and LDL cholesterol levels to increase. 

• Physical inactivity. A sedentary lifestyle can increase LDL (bad) cholesterol and lower HDL (good) cholesterol levels. 

• Smoking. Smoking lowers your HDL (good) cholesterol which can contribute to a higher level of LDL (bad) cholesterol.

• Medications: Some medications can increase cholesterol levels. These include corticosteroids, beta-blockers, thiazide diuretics, antivirals, retinoids, and growth hormones.

• Diseases: Certain diseases like chronic kidney disease, diabetes, and HIV/AIDS can elevate LDL and total cholesterol.

• Age and Sex: Premenopausal women tend to have lower LDL cholesterol levels than men of the same age. However, cholesterol levels tend to increase with age in both women and men. After the age of menopause, women's LDL cholesterol levels tend to rise.

• Genetics (heredity): High blood cholesterol can run in families. This is because your genes partly determine how much cholesterol your body makes. 

• Race. Certain races may have an increased risk of high blood cholesterol. For example, Blacks/African Americans typically have higher HDL and LDL cholesterol levels than Caucasians.

What to do if your level is 146?

Making some basic diet and lifestyle changes can help reduce your LDL cholesterol level. Here are some things you can do to help lower your LDL:

• Aim to consume 30-40 grams of fiber daily from fiber-rich foods including veggies, fruit, whole grains, and legumes. 

• Limit the amount of refined carbs and added sugars in your diet. These are commonly found in foods like white bread, pasta, and rice, packaged snacks and baked goods, , and sweetened milk and yogurt. 

• Avoid trans fats (partially hydrogenated oils) and reduce your saturated fat intake to < 10% total calories. 

• Eat small, fatty fish at least twice a week. Good sources include salmon, sardines, and trout at least twice a week. 

• Move your body every day. Aim to get 30-60 minutes of physical activity 5x/week. 

• Get 2g of plant sterols and stanols daily, from foods and/or a supplement. 

• Lose excess weight.

• Quit smoking.

• If you have diabetes, achieve and maintain good blood sugar control (HbA1c).

Medications and supplements used to improve results

Medications and supplements can help reduce your LDL if diet and lifestyle changes are not enough on their own.

Medications

Some common cholesterol medications include:

• Statins: Statins (including atorvastatin, simvastatin, and rosuvastatin) reduce cholesterol production in your liver. Because they typically need to be taken for life, statins are only prescribed if diet and lifestyle changes aren’t enough [3].

• Bile acid sequestrants: These medications block cholesterol-rich bile acid from being absorbed into the bloodstream and can be prescribed in place of or in addition to a statin. 

• Ezetimibe can be helpful for those with familial hypercholesterolemia and/or who have side effects with statins.

• Lomitapide: Another commonly prescribed medication if you have familial hypercholesterolemia. Lomitapide requires liver enzyme monitoring as it can cause liver damage and is commonly taken with vitamin E. 

• PCSK9 inhibitors: This medicine is injected under your skin every 2 or 4 weeks. If you are at risk of a heart attack, stroke, or have familial hypercholesterolemia, it may also be prescribed with a statin.

Supplements

• Plant sterols and stanols: Found in plant cell membranes, plant sterols and stanols (also called phytosterols) block dietary cholesterol from being absorbed since they are similar in structure. Phytosterols can be found in small quantities in vegetable oils, nuts, legumes, whole grains, fruits, and vegetables, however, the average daily intake (500 mg)  is typically not enough to lower cholesterol. Studies show consuming 2000 mg (2 g) of plant sterol and stanols daily from diet and/or supplements to be most effective [4]. Plant sterol and stanol supplements are taken before or with meals can help lower total cholesterol in parallel with other recommended diet and lifestyle changes [4]. 

• Beta-glucan: Beta-glucan is a form of soluble fiber that has been shown to help lower cholesterol levels. It’s found naturally in whole grains like barley, oats, rye, wheat, mushrooms, and seaweed, and can also be taken as a nutritional supplement. For cholesterol-lowering benefits, consume 3-7 g of beta-glucan daily from your diet and/or a supplement.

• Psyllium: Another type of soluble fiber made from the husk of psyllium seeds, psyllium is good for digestive health and regularity, and can also be helpful in lowering cholesterol. Psyllium supplements are sold in powder form and can help reduce lipid levels when taken daily at a dose of 8-12g/day. 

• Alpha-lipoic acid: Alpha lipoic acid is a potent antioxidant made in the body and also found in foods including carrots, beets, spinach, broccoli, potatoes, and red meat. Research indicates that 600 mg/day of alpha-lipoic acid from your diet and/or a supplement may help lower total cholesterol and LDL (bad) cholesterol [8]. 

• Bergamot extract: Taking bergamot extract (made from the juice of the bergamot fruit) may be effective for reducing cholesterol and triglyceride levels in adults with high cholesterol [9,10]. One study suggests taking bergamot extract daily for a month may be as effective as taking a low dose of the cholesterol-lowering drug called rosuvastatin (Crestor) [10]. A recent research review indicates that 1000 mg/day may be most effective for lowering cholesterol. 

• Green tea extract: Green tea extract is a natural supplement made from the leaves of the Camellia Sinensis plant that has been shown to help lower LDL (bad) and total cholesterol [11]. A daily dose of 400 mg may help lower your cholesterol but check with your doctor first as green tea extract can interact with certain medications, including beta-blockers and blood thinners. In addition, green tea extract may also have a stimulant effect.

• Berberine: A compound extracted from a variety of medicinal herbs, some studies suggest berberine can reduce LDL (bad) cholesterol and triglycerides in type 2 diabetics, as well as slightly increase HDL (good) cholesterol [12]. A standard dose of berberine is 900-2000 mg/day (divided into 3-4 doses), taken with or just after a meal.