Not all fats are bad. Some, in fact, are good for us. The trick is in knowing which kinds of fat to choose.

• Saturated fat is the main culprit in causing high blood cholesterol. While some plant foods contain high amounts of saturated fat (including coconut oil, palm oil, palm kernel oil, and cocoa butter), the most common sources are animal foods such as meat and dairy products made from whole milk.
• Polyunsaturated fat is found in many liquid vegetable oils (including safflower, sesame, sunflower, and corn oils), nuts (including walnuts, pine nuts, brazil nuts, and chestnuts), and seeds (including sesame and sunflower). This type of fat helps keep blood cholesterol levels down and reduces cholesterol deposits on artery walls.
• Monounsaturated fat is found in canola and olive oils, avocados, and some nuts (including filberts, almonds, pistachios, pecans, and cashews) and is also believed to help reduce blood cholesterol levels.
• Omega-3 fat is a type of polyunsaturated fat found in fish oils. Omega-3 tends to lower blood triglycerides, a type of blood fat that contributes to the development of heart disease. Excellent food sources of this important fat are salmon, trout, and mackerel. Eating two to three servings a week of these fish is a good way to increase the amount of omega-3 in your diet— but remember to broil, bake, microwave, or steam the fish, not to fry it.

Here are a few suggestions that will help you reduce the amount of fat you consume.

• Use a non-stick pan and spray lightly with vegetable oil instead of frying in oil.
• Sauté in water, vegetable stock, or wine instead of oil or fat.
• Choose nonfat or reduced-fat dairy products.
• If you cook with cheese, mix a lower-fat version in with a stronger-tasting cheese.
• Include more vegetables and less meat in stews and casseroles.
• Always measure oil or fat before adding it to food. This will help you keep track of the amount you use.
• In some recipes for baked goods, you can substitute applesauce, mashed banana, or prune puree for the fat or oil.
• Try lower-fat salad dressings or substitute flavoured vinegars for oily dressings.
• Choose low-fat versions of snack foods such as baked tortilla and potato chips.
• Use fresh herbs, spices and other condiments to boost flavour and nutrition without adding any fat or calories.
• Trim visible fat from meat before cooking.
• Bake, barbecue, broil, poach, or microwave foods instead of frying, and drain any excess fat before serving.

For some people, these lifestyle changes will be enough to bring cholesterol levels down to the normal range. Other people will require medication. While cholesterol-lowering medicines can be very effective, they must be used in combination with a healthier lifestyle, not as a substitute for healthy habits.

Cholesterol-lowering medicines are classified by how they work in the body. The classes are statins, resins, cholesterol absorption inhibitors, fibrates, and niacin (a form of vitamin B₃). Each of these drugs has benefits and drawbacks, and not every drug will be right for each person, so doctors must carefully assess which drug to prescribe for each patient. Sometimes a variety of treatments have to be tried before the right drug—or combination of drugs—is found.

Any drug strong enough to be effective is strong enough to cause side effects. Because high cholesterol produces no symptoms and the medicines can have side effects in some people, it may be tempting to stop taking the medication. This is a big mistake. High cholesterol levels that aren’t treated can have very serious health consequences, and side effects can usually be managed. Sometimes adjusting the dose reduces or eliminates the side effects, and sometimes another drug can be substituted that won’t cause unpleasant reactions. If you experience any ill effects from a cholesterol drug, tell your doctor or pharmacist. Do not simply decide on your own to stop taking the medication.

Lowering high cholesterol is a lifelong commitment. Your new healthy lifestyle isn’t a temporary fix; it is a permanent change. This also applies to taking cholesterol-lowering medications, because these drugs work either by blocking your body’s ability to absorb cholesterol from the food you eat or by reducing the amount of cholesterol your body makes. Once you stop taking the medicine, your body returns to its old ways.

If you have any questions about high cholesterol, how to manage it, or the medications you take for it, speak with your doctor or pharmacist.