What is cholesterol?
We hear the word so much but many of us don’t really understand what cholesterol is so let’s get that cleared up first of all.
Cholesterol is a waxy, fat-like substance that is found in every cell of the body. It’s a necessary ingredient to make cell membranes, hormones, and vitamin D, among other essential functions.
Cholesterol isn’t inherently bad, it’s actually essential to life! While cholesterol is crucial for proper bodily functions, having high levels of certain types of cholesterol in the blood can increase the risk of cardiovascular complications.
The Basics of Cholesterol
Cholesterol is transported around the bloodstream by something called lipoproteins. There are two main types of lipoproteins that carry cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL cholesterol is often referred to as "bad" cholesterol because high levels of it can lead to the build up of plaque in arteries, narrowing them and increasing the risk of atherosclerosis (thickening/hardening of the arteries).
HDL cholesterol, on the other hand, is often termed "good" cholesterol because it helps remove excess cholesterol from the bloodstream, reducing the risk of plaque build up.
Triglycerides, another type of lipid (or blood fat), are also present in the blood and serve as a source of energy. Elevated triglyceride levels are associated with an increased risk of heart disease, especially when combined with high LDL levels.
Recommended Cholesterol Levels
Health organisations provide guidelines for recommended cholesterol levels. These guidelines can vary based on individual risk factors, but in general, the following levels are recommended:
Total Cholesterol: Less than 5.2 mmol/L
LDL Cholesterol: Optimal: Less than 3mmol/L;
HDL Cholesterol: Greater than 1.0 mmol/L
Triglycerides: Normal: Less than 1.7 mmol/L
It’s also a good idea to look at the ratio of triglycerides to HDL cholesterol which should be a close to 1 as possible.
When cholesterol can become an issue
If you are at a healthy weight, have a decent diet and a good lifestyle with marginally high cholesterol results, there is likely no need to panic. However, if you are pre-diabetic or diabetic for example, have a lot of extra weight on board and struggling with diet, exercise and stress then your risk of poor cardiovascular health will be higher.
My cholesterol is too high – now what?
Statin Therapy for High Cholesterol: Balancing Benefits and Considerations
Statin medication is the most widely prescribed treatment for high cholesterol. They work by blocking an enzyme crucial for cholesterol production in the liver, thus lowering levels of LDL cholesterol, the "bad" cholesterol. However, some people experience side effects including muscle pain and liver function abnormalities.
In light of this, it's essential to explore additional evidence-based approaches that can be employed alongside statin medication to lower cholesterol levels and safeguard cardiovascular health, as well as overall well-being.
Let’s start with what is at the end of your fork! I love to take the approach of adding beneficial foods into the diet rather than focusing on removing foods.
Food based strategies to lower your cholesterol levels
The Portfolio Diet Approach
The Portfolio Diet is a plant-based eating plan designed to lower cholesterol levels. It incorporates specific cholesterol-lowering foods known as "portfolio components." This is a general outline of the portfolio approach.
1. Soluble Fibre: Foods rich in soluble fibre help lower LDL cholesterol levels by binding to cholesterol in the digestive tract and facilitating its excretion. Good sources of soluble fibre include oats, barley, legumes (beans, lentils, peas), fruits (apples, oranges, berries), and vegetables (carrots, Brussels sprouts).
Recommended Level: Aim for at least 25-35g of dietary fibre per day, with a significant portion coming from soluble fibre sources. Depending on your current intake, you might need to revisit where your currently sourcing soluble fibre and assess if you need to add more foods into the mix. For instance:
Allocate half your plate to vegetables during dinner and opt for soups and salads at lunch.
Include wholegrains like brown rice in lunch and dinner, and incorporate oats and seeds such as flax and chia seeds into breakfast.
Enjoy fruits as snacks throughout the day, and consider adding berries to your breakfast.
Integrate legumes like beans and pulses (e.g., chickpeas in curry, dried lentils in homemade soup) into your meals.
Other fibres I like to use are functional fibres such as beta-glucans, psyllium and pectin which as well as being supportive to healthy cholesterol can also benefit immune health, blood glucose balance and digestive complaints.
2. Plant-Based Proteins: Plant-based proteins, such as those found in soy products and legumes, can be beneficial for heart health by replacing animal proteins that often come with saturated fats.
Recommended Level: Include soy-based foods like tofu, tempeh, edamame, and other legumes (beans, lentils) in your diet regularly. Aim for 100g of cooked legumes 4 times a week.
Nuts: Nuts contain healthy fats, fibre, and plant sterols that contribute to lower LDL cholesterol levels and improved heart health.
Recommended Level: Consume a handful of unsalted nuts (such as almonds, walnuts, pistachios, or peanuts) 4 to 5 times a week. Aim for about 28g per portion.
3. Plant Sterols: Plant sterols are compounds naturally found in certain plant foods that can block the absorption of cholesterol in the intestines.
Recommended Level: You can include foods fortified with plant sterols, such as some yogurts, in your diet as well as generally greatly increasing plant based foods overall. Evidence points to 2g of plant sterols per day.
4. Fruits and Vegetables: A diet rich in a variety of colourful fruits and vegetables provides antioxidants, vitamins, minerals, and dietary fibre that collectively contribute to heart health.
Recommended Level: Aim to fill half your plate with fruits and vegetables in each meal. Aim for a minimum of 5 servings of vegetables and 2-3 servings of fruits per day. In case you are wondering, a portion is 80g.
5. Healthy Fats: Choose sources of healthy fats, such as avocados, olives, and olive oil, which are rich in monounsaturated fats and can help improve cholesterol profiles. These have been shown to increase HDL levels.
Recommended Level: Include sources of healthy fats in your diet while being mindful of portion sizes. Aim for 1-2 tablespoons of olive oil per day.
Foods to reduce to help your cholesterol levels
You may have been told that you need to cut out saturated fats such as red meat and dairy but as always it’s a little more nuanced than that.
Sugar, refined and ultra-processed foods
Refined carbohydrates and added sugars are also associated with unfavourable cholesterol profiles. A high intake of sugary foods and beverages, as well as refined grains like white bread, pastries and sugary cereals, has been linked to elevated triglyceride levels and reduced levels of HDL (good) cholesterol. A systematic review published in the American Journal of Clinical Nutrition highlights the adverse effect of added sugars on heart health markers. Replacing these refined carbohydrates with wholegrains, fruits, vegetables, and sources of healthy fats can promote better cholesterol balance.
(Watch out for hidden sugars in processed foods, see link at the end of article for Food Labels Decoded: Making Informed Choices for a Healthy Diet).
Saturated fats, primarily found in animal products like meat, dairy and eggs.
Let’s start with meat.
First of all, there is nothing wrong with including some good quality meat in your diet. However, eating lots of processed, fatty or red meats isn’t the best thing to do for your cholesterol and most meat eaters consume more than enough meat and not nearly enough of the plant based protein sources as mentioned above.
We have good quality dairy in this country and there’s nothing nicer than Irish butter but again, if you are overdoing butter, cream and cheese and not doing enough of the helpful food and lifestyle implementations then you might find that your cholesterol is high.
Fermented dairy products, on the other hand have shown evidence that they have a more favourable impact on cholesterol levels. Some studies have shown that certain strains of probiotics found in fermented dairy can have modest cholesterol-lowering effects. Additionally, the fermentation process can modify the fatty acid composition, potentially reducing the saturated fat content in these products.
These products include yogurt, kefir, and some types of cheese like cottage cheese.
Eggs and cholesterol levels is something I am asked about a lot.
Eggs are such a wonderful, nutritious and convenient wholefood and I would hate to think that people feel that they can’t eat eggs if their cholesterol is high. The up-to-date evidence show us that you can safely eat eggs in moderation and it won’t negatively impact your cholesterol levels. There is a subset of people who are hyper-responders to dietary cholesterol meaning that they are very sensitive to the dietary cholesterol found in eggs but for the majority they are absolutely fine.
Lifestyle factors that influence Cholesterol
Research consistently shows that smoking significantly contributes to heart disease, impacting both blood vessels and overall cardiovascular function.
Losing excess weight can help lower LDL cholesterol and triglyceride levels. Even a modest weight loss can have a positive impact on cholesterol levels and overall health so every little bit helps. Now, I know that managing weight is very challenging for some people and this could be due to their physiology and hormones more so than what they eat. This is where a personalized approach with an experienced nutritional professional is worth its weight in gold.
Emerging evidence underscores the link between sleep quality and cholesterol. Disrupted sleep patterns, characterized by insufficient sleep or sleep apnoea, may contribute to unfavourable cholesterol profiles. Sleep deprivation can lead to insulin resistance, which is associated with higher LDL and lower HDL cholesterol levels. Insulin resistance can also affect your weight and lead to problems managing blood glucose.
Chronic stress affects the body's physiological responses, including cholesterol regulation. Elevated stress levels might prompt behaviours like overeating unhealthy foods, impacting cholesterol levels indirectly.
Exercising for Heart Health
Engaging in regular physical activity is obviously going to help with cholesterol management. Aerobic exercises like walking, jogging, swimming, and cycling enhance HDL cholesterol levels, contributing to cardiovascular well-being. Aim for 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity weekly.
Incorporating resistance exercises like weightlifting and bodyweight exercises enhances muscle mass, metabolism, and insulin sensitivity, all of which influence cholesterol profiles.
High-intensity interval training (HIIT) alternates between short bursts of intense exercise and recovery periods. Studies suggest HIIT can improve cholesterol markers, including reducing LDL levels.
Yoga and Stress Reduction
Chronic stress can impact cholesterol levels. Yoga, meditation, and deep breathing techniques mitigate stress, potentially benefiting heart health.
As always, pick an exercise that you enjoy and that you can fit into your weekly routine. Don’t feel like you have to do everything, because then you won’t do anything!
Understanding cholesterol is essential for managing our health and reducing the risk of cardiovascular complications. While cholesterol is necessary for vital bodily functions, high levels of certain types can be detrimental making it important to prioritise cholesterol control.
As you can see, there is so much that you can do to influence your cholesterol levels, with or without medication, and for some as well as. Managing cholesterol levels involves maintaining recommended ranges, focusing on a balanced diet rich in plant-based foods, and incorporating beneficial lifestyle habits. Avoiding excessive consumption of saturated fats, refined carbohydrates, and added sugars, along with quitting smoking, maintaining a healthy weight, prioritizing quality sleep, managing stress, and engaging in regular exercise, all play significant roles in maintaining healthy cholesterol levels. By adopting these evidence-based food and lifestyle implementations, not only will your cholesterol and cardiovascular health improve but your overall wellbeing, energy and mood will. It’s a win-win!
If you are worried about your cardiovascular health and cholesterol levels in particular I do recommend contacting your GP for a full health review. We offer tailored and personalised nutrition and health plans to help manage cholesterol. Please get in touch and book a free health check today. For more information on our 1:1 programmes click here.
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