Everyday foods can be the best medicine for people with high cholesterol, says Nicole Senior.
What is cholesterol?
Cholesterol is a waxy substance made in the liver. It has various useful functions; it's a component of cell membranes, sex hormones, vitamin D and bile, which digests fats. There are two different types of cholesterol - the good and the bad. Our liver processes most of the cholesterol in our bodies, but when we eat foods high in saturated fat, our liver can't cope so it's returned to the bloodstream. Too much cholesterol in the bloodstream can cause fatty deposits to build up, narrowing the arteries and eventually leading to heart disease and stroke. At present, 50% of Australians have high cholesterol.
What are the risks?
Cardiovascular disease (CVD) is the leading cause of death in Australia and New Zealand. The risk factors for CVD, heart attack and stroke are well established, and having high blood cholesterol is one of them. The only way to find out if you have high cholesterol is to have a blood test.
How can diet help?
Changing what you eat has an enormous impact on blood cholesterol. Professor David Jenkins and a team of researchers at the University of Toronto developed the 'portfolio' diet, which achieved a reduction in cholesterol of more than 20% - a similar result to using cholesterol-lowering medication. The portfolio diet is based on adding certain cholesterol-lowering foods to a healthy base diet low in saturated fat. These foods are:
soy (such as soy burgers and tofu)
plant sterols (found in margarine)
soluble fibre (found in oats, barley and psyllium)
The great news is these foods also fight other heart disease risk factors and have much in common with cancer-fighting foods, and indeed those recommended for good health.
10 cholesterol-busting foods
Two serves of fruit and five of vegetables daily. A variety of colours will add fibre, phytochemicals, vitamins and minerals.
Skip salt and rev up the flavour with herbs and spices. These add flavour plus a protective phytochemical cocktail.
Wholegrains - at least half your grains should come from oats, brown rice and pasta, and wholegrain bread and cereal.
Eat at least 1 1/2 tablespoons of healthy oils and spreads daily. These contain the good fats that help lower cholesterol.
Include legumes such as chickpeas, lentils or kidney beans in at least two meals each week.
Eat low-GI foods at most meals - oats, legumes, pasta, sweet corn and low-fat dairy foods. These help lower insulin and blood glucose levels, which reduce heart disease risk.
A small handful of (raw and unsalted) nuts most days is associated with reducing CVD risk by up to half. Plus they contain healthy oils, fibre and phytochemicals.
Eat fish at least twice a week, preferably oily fish such as salmon, tuna, sardines and mackerel.
If you have high cholesterol, include 2-3g plant sterols daily (found in 25g of sterol-enriched margarine spread or 3 serves of milk or yoghurt with added plant sterols). This will lower your cholesterol in three weeks by an average of 10%.
Stick to 1 or 2 standard alcoholic drinks a day.
How high is too high?
A total cholesterol level above 5.5mmol/L* is high. If you have other risk factors, such as high blood pressure, obesity or diabetes, your total cholesterol should be less than 4mmol/L. Studies have shown when it comes to total and LDL cholesterol and CVD risk, the lower the better. Ideally, your HDL (good) cholesterol should be 1.0mmol/L or above. The ratio of total cholesterol to HDL cholesterol is also used as a good indicator of risk, and the lower the better. *mmol/L (millimoles per litre) is the standard unit of measurement for blood cholesterol.
Do I need to cut out all fat?
To lower cholesterol, you should replace saturated fats with the good, unsaturated fats. Switch from butter to a margarine with added plant sterols and eat some of this every day. You can further cut saturated fat intake by choosing lean meat, skinless chicken and low-fat dairy products. Limit biscuits, cakes, chocolates and fast foods as these are often high in saturated fat. Check labels and stick to 20g of saturated fat per day, no more. If you need to lose weight, focus on reducing your total kilojoule intake, rather than cutting all fats from your diet.
I just learned I have high cholesterol. What now?
Healthy living is paramount. It's helpful to see a dietitian for a personalised diet plan and for ongoing motivation. Have a follow-up blood test 6-8 weeks after you change your diet to see how well you're doing. Success is a great motivator.
What's the difference between good and bad cholesterol?
LDL (which stands for low-density lipoprotein), is the bad type. It deposits cholesterol onto blood vessel walls where it contributes to the damaging process of atherosclerosis (hardening of the arteries). HDL (high-density lipoprotein) is the good type. It carries cholesterol away from the blood vessels back to the liver. It's easy to remember which is which: just think of H for 'healthy'!
Can I eat eggs and prawns?
Yes! Although both contain cholesterol, cholesterol in food is not a major determinant of cholesterol in the blood - saturated fat is much more influential. Cholesterol is found only in animal foods, so making 'cholesterol-free' claims on vegetable oils, avocadoes and other vegetable products is meaningless.
How can oats, psyllium and fibre help?
Oats contain a soluble fibre called beta-glucan, which has been proven to lower cholesterol. Studies with psyllium have shown similar results. Psyllium is available as a supplement, and is added to some breakfast cereals. You'll also find soluble fibre in legumes and many fruits and vegetables.
Who is at risk of high cholesterol?
Being male, being older and having a family history of CVD increases your risk, but you can't do much about these. Lifestyle change is where you can make a big difference. Besides lowering your blood cholesterol, you can also reduce your risk by giving up smoking, maintaining a healthy blood pressure and healthy weight, looking after your blood sugar levels and being active.
What foods should I eliminate?
Trans fats increase LDL (bad) cholesterol and decrease the HDL (healthy) cholesterol - an effect that increases heart disease risk. You can reduce trans fats by avoiding foods high in saturated fat such as butter, fatty meats, pastries, pies and deep-fried fast food. Also look out for trans fat content on labels and the term 'partially hydrogenated' on ingredients lists.
Can medication lower my cholesterol?
While a heart-friendly eating plan is important, in some cases cholesterol-lowering medication is also needed. The good news is the beneficial effects of medication and diet are additive. Plus, a heart-friendly diet can also tackle many other health risk factors.
Real life story...
Marie-Christine is 47 years old and lives in Sydney. She successfully reduced her cholesterol from 6.9 to 3.6 with some simple lifestyle changes.
How did you find out you had high cholesterol?
I had a cardiac stress test, which turned out to be positive. I was admitted to the coronary care unit, they did a cholesterol test and it was 6.9. I was pretty alarmed! Especially as the doctors made it clear this was dangerous and could lead to a heart attack.
What changes did you make?
I changed my diet to include only good fats, lots of wholegrains and low-GI foods. I ate a lot more fish and made sure I had a tablespoon of plant-sterol-enriched margarine spread daily.
I also resumed my meditation practice, started wearing a pedometer and walked a lot more.
My doctor also recommended I start cholesterol-lowering medication (statin), but it made me feel unwell so I stopped.
What change did you find the hardest?
Having to cut down on chocolate! I still eat it, but a lot less, and always 75 per cent cocoa for the antioxidants.
What results did you achieve?
I lost weight and lowered my cholesterol to 3.6.
What was the best thing you learned?
You definitely are what you eat. I have the power to improve my health with simple changes to my diet.
What would you say to someone who has just found out they have high cholesterol?
Take it very seriously and consult a dietitian who can support you through your dietary and lifestyle changes.
How does your heart health rate?
Your risk of cardiovascular disease is calculated as the likelihood you will experience a heart attack or stroke over the next five years, based on the following risk factors. Read this list and tick off those which apply to you.
I am male
I am 45 years or older
I have a close relative who has had angina, heart attack or stroke
I have Aboriginal, Torres Straight Islander, Pacific Islander, Maori, or Indian background
My blood pressure is higher than 130/85
My blood cholesterol is above 5.5mmol/L
I do less than 30 minutes a day of moderate physical activity (eg walking)
My body mass index (BMI) is above 25
My waist measurement is more than 94cm (men) and 80cm (women)
I have diabetes or pre-diabetes (high blood glucose levels)
If you ticked three or more, see your doctor for a check-up.
What’s your BMI?
Being overweight increases your risk of heart disease. To calculate your body mass index (BMI), divide your weight (in kilograms) by your height (in metres squared).
Eg: for someone who weighs 73kg and is 165cm tall:
BMI = 73 ÷ 2.72 (1.65 x 1.65)
BMI = 26.8 (overweight)
18.5 –2 4.9 = normal
25 – 29.9 = overweight
30 or more = obese
Note: BMI gives an indication of a healthy weight, but it’s best to see your doctor.