How To Manage Cholesterol
Heart disease is the leading cause of death in Ireland today. The good news is that 80% of heart disease is preventable simply by changing your lifestyle. There are lots of things that can affect your risk of heart disease. These include having high blood pressure, being overweight, getting older and being male. Some things you can’t change – like age and sex – but some things you can. Cholesterol is one of these!
Cholesterol is a type of fat that is found in your blood. At healthy levels, cholesterol helps your body to work properly by making important hormones. There is only a problem with cholesterol when you have too much. When your blood has too much cholesterol, it can start to stick to the walls of your arteries. If this happens then blood can’t get through and you can have a heart attack, a stroke or develop problems like angina. Once any cholesterol has lined your arteries, you cannot remove it, but you can stop it from getting worse. This is why it is so important to look after your cholesterol and to work on lowering your levels straightaway if they are too high!!
Luckily there is a lot you can do to have healthy cholesterol. One of the best ways to look after cholesterol is to look after what you eat. There are some foods that will increase cholesterol levels and others that will help to reduce them. This fact sheet takes a look at what food to eat and what food to limit to help keep your cholesterol, and your heart, healthy.
What are healthy cholesterol levels?
Less than 5.0
If your total cholesterol is higher than 5.0 then you need to reduce it – don’t put it off!
Less than 3.0
This type of cholesterol is often called ‘bad’ cholesterol as it is the type that blocks arteries.
More than 1.0 for men and more than 1.2 for women
HDL is called ‘good’ cholesterol as it helps to remove LDL cholesterol from your blood.
Less than 1.8
This is another type of fat found in your blood and high levels are linked with an increased risk of heart disease.
A LITTLE BIT MORE ABOUT LDL ("BAD") CHOLESTEROL
For most people, LDL cholesterol should be less than 3.0. However, if you already have heart disease (e.g. if you have had a heart attack or surgery for heart disease) or if you have other risk factors like high blood pressure, then you need to aim for even lower levels of LDL cholesterol.
The table below sets out the figures to keep in mind:
If you already have heart disease, type 2 diabetes or organ damage from type 1 diabetes.
1.8 or less
If you do not have any of the problems listed above but you do have high levels of one of the other risk factors for heart disease, such as high blood pressure
2.5 or less
WHAT FOODS DO I NEED TO REDUCE?
Cholesterol in your blood comes from two main places.
Firstly, you can eat cholesterol in certain foods. Eggs, crustaceans (like prawns, lobster and crab) and liver all have cholesterol in them. However, this type of cholesterol is only responsible for a small amount of the cholesterol found in your blood.
The second place cholesterol comes from is saturated fat: this is where most of the cholesterol in your blood comes from. When you eat saturated fat, your liver makes cholesterol from it and this is why saturated fats raise blood cholesterol levels. Saturated fat is the type of fat found mainly in animal foods like cream, cheese and butter and the fat on meat. It is also found in biscuits, cakes, pastries and scones, because we use saturated fat to make them. Saturated fat is also found in processed meat like sausages, black & white pudding, pâté and so on. You can look at labels to see how much saturated fat there is in your food.
What is High and What is Low Saturated Fat?
High saturated fat is more than 5g of saturated fat per 100g of the food
Low saturated fat is less than 1.5g of saturated fat per 100g of the food
WHAT CAN I DO TO REDUCE SATURATED FAT?
Eat less butter and cream and limit cheese. Remember that dairy foods like milk and yoghurt are important sources of calcium in your diet so it is not healthy to cut out these foods. Do choose low-fat or skimmed milk and low-fat yoghurts. If your cholesterol is high it is best to limit the amount of cheese you eat.
Choose low fat cooking methods – swap frying for grilling, boiling and baking. Try steaming more moods and choose healthier fats for roasting such as rapeseed oil instead of lard or butter.
Trim the visible fat from meat and remove the skin from chicken. Most of the fat in chicken is just under the skin!
What About Coconut Oil?
Coconut oil is a very popular oil that is high in saturated fat. It is claimed that the type of saturated fat found in coconut oil (called stearic acid) doesn’t raise cholesterol levels.
Is this Really True?
There are a lot of studies looking at stearic acid and cholesterol. Where stearic acid is used instead of other saturated fats, you do see a small decrease in cholesterol in some studies or no change at all in others. However, in studies where stearic acid is compared to olive oil, you tend to see an increase in cholesterol with the stearic acid.
There is still more research needed in this area but, for now, the advice is to stick with olive oil and watch this space!
What Fats Should I Use?
Healthier fats to choose are olive oil and rapeseed oil and spreads that are made from them. You can use olive or rapeseed oil in cooking or dressings. Just remember that these fats have as many calories as any other type of fat so only use a small amount to help keep weight healthy,
What Foods Help to Lower Cholesterol?
Oats: Eating porridge is a great way to help to lower cholesterol. If you don’t like porridge, try adding dry oats to muesli or other cereals or look for oatcakes.
Beans and lentils: These high fibre foods can help keep cholesterol levels healthy. Try to have beans or lentils 3-4 times a week. Try baked beans chickpeas or kidney beans in salads, soups made with lentils and chilli-con-carne.
Barley: Barley is rich in a type of fibre called beta-glucan which can also help to lower cholesterol. Try adding some traditional ‘soup-mix’ to soups, stews and casseroles.
Plant sterols/stanols are natural substances found in some foods – such as almonds, soy bean oil and sesame seeds. Studies show that taking 1.5-2.4g of plant sterols/stanols per day can reduce cholesterol by 7-10% in about 3 weeks. Plant sterols and stanols work by blocking the amount of cholesterol your body absorbs from the food you eat. Cholesterol also gets into your digestive tract from your liver and the plant sterols/stanols help to reduce the amount of this type of cholesterol you re-absorb as well. Just remember that although these ingredients can help to lower cholesterol, they are not miracle workers - you will still need to eat healthily to get the best benefit.
Dosage: If you have high cholesterol it is useful to aim for about 2g per day to get the best effect. Plant stanols or sterols can be found added to yoghurts, spreads and yoghurt drinks. Some brands include Benecol, Flora Pro-Activ and Danocol. The yoghurt drinks usually contain between 1.6 and 2g of the plant stanols/sterols so one a day is enough. If you choose to use yoghurts or spreads containing plant sterols or stanols, you will usually need to have 2-3 portions of each per day to get the amount you need. This might be two slices of bread with plant sterol-enriched spread and one pot of yoghurt.
Just remember: if your cholesterol levels are normal, there is no need for you to use foods with added plant stanols/sterols. They are also not suitable for pregnant women or for children.
WHAT OTHER FOODS SHOULD I CHOOSE?
Fish: Although fish will not help to lower cholesterol, it has lots of benefits for your heart. Omega-3 fats, which are found in oil-rich fish such as salmon, trout, mackerel, herring and sardines, are very beneficial for your heart. Did you know that eating fish once a week can cut your chances of a fatal heart attack by over 30%? Omega-3 fats are found in fresh, frozen, tinned, fried and smoked fish. Tuna is the one exception – fresh tuna has omega-3s but tinned tuna generally doesn’t. However, tinned salmon, tinned mackerel and tinned sardines are all good sources of omega-3s.
What About Omega-3s From Nuts and Seeds?
Did you know there are three main types of omega-3s? There is DHA and EPA, the types of omega-3s found in fish. Then there is ALA, which is the type of omega-3 that is found in nuts and seeds like flaxseed and walnuts. In the past it was thought that the omega-3s from plants were as useful to the body as the type from fish. We now know that, although ALA does have some benefits, the main benefits from omega-3s come from EPA and DHA, the type found only in fish.
Is it Still Worth Eating Nuts and Seeds?
Yes! Nuts and seeds are rich in healthy fats as well as vitamins and minerals but for omega-3 you do need to include some oil-rich fish at least once a week.
Fruit and Vegetables: Fruit and vegetables are rich in vitamin C and antioxidants which can help to keep your heart healthy. They are also good sources of potassium, which helps to keep blood pressure at healthy levels as well. Aim for 5 a day (that’s 5 altogether, not 5 of each. Although, if you want to get to 10 a day feel free…). Fresh and frozen fruit and vegetables are the best choices. The easiest way to get your 5-a-day is to think about having some fruit or vegetables at every meal. Try slicing a banana over breakfast cereal, drinking a glass of fruit juice at breakfast. Then add some salad to your sandwich at lunchtime or a bowl of vegetable soup. Finally, make sure that vegetables or salad make up 1/3 of your plate at dinner.
WHAT IF MY TRIGLYCERIDES ARE HIGH?
If your triglycerides are high, start by following the advice for lowering cholesterol. However, there are a few extra things that you will need to do:
Reduce sugar: Sugar and sugary foods increase triglycerides so reducing these foods will help. Cut back on sugar-sweetened drinks like soft drinks and limit fruit juice to one glass a day or less. Also stop adding sugar to food – stop adding sugar to tea and coffee as well as cereal. Cut back on sweet foods like cakes, biscuits, sweets and chocolate.
Reduce alcohol: Alcohol increases triglycerides. If you have high triglycerides, have no more than one alcoholic drink per day and try to have at least 3 alcohol-free days every week.
Eat oil-rich fish: aim to have oil-rich fish such as salmon, trout, mackerel, herring or sardines once or twice a week.
WHAT ELSE CAN I DO?
Exercise: Being physically active is one of the most important things you can do for your heart. Exercise helps to increase your HDL (good) cholesterol, lower blood pressure and strengthen your heart muscle.
Did you know that if you walk for 30 minutes per day that you reduce your chances of having heart disease by 30%? If you increase this to 1 hour a day, you reduce your chances of having heart disease by 50%. Any exercise is good as long as you are breathing a little faster- you should be able to talk but not sing! – and you should be getting warmer. Walking is excellent exercise but cycling, swimming, running, aerobics, skipping, anything will help. Check with your doctor before you start any new intense exercise and stop immediately if you get any chest pain.
Stop Smoking: If you smoke, stop. There is lots of help available now to anyone who wants to quit. Talk to your GP for advice and help.
Get to a Healthy Weight: Being overweight can put more pressure on your heart. If you are overweight, then losing weight, even if it is just a few pounds can make a difference. If you struggle to get your weight under control ask to be referred to your local dietitian or check out our ‘find a dietitian’ list to find someone in your local area who can help.
Created by Sarah Keogh, on behalf of the Cardiology Interest Group, October 2013.
Review date: October 2015
© 2013 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian/clinical nutritionist. It is intended for educational and informational purposes only.