Cholesterol can be a confusing topic. Some cholesterol levels are labeled “good” and others “bad”. We get mixed messages about which foods affect these levels, and there has been much debate about the levels that are considered to be healthy.
Let’s start by defining cholesterol. Cholesterol is a waxy, fat-like substance (a sterol) that is made in the liver and found in animal products, like eggs, dairy, and meat. Cholesterol is necessary for our body as it is used to make bile, steroid hormones, (including Vitamin D), and our cell membranes, among other functions. Though cholesterol is an essential nutrient, it is created through body processes. Therefore, we don’t need to get it through our food. People who follow a vegan diet, which is by definition, void of animal products, are able to make sufficient cholesterol to meet their needs.
Cholesterol has to be carried through the blood by proteins, and this combination is called a lipoprotein. Lipoproteins vary in their composition and this is where we get the different names, or types, of cholesterol, which are analyzed in a blood draw. They are composed of not just cholesterol and protein in differing amounts, but also triglycerides and phospholipids. There are six classes of lipoproteins: Chylomicrons, VLDL, IDL, LDL, and HDL. We are going to focus on LDL and HDL, since these are two that continue to be studied for their effects on heart health.
LDL stands for Low-Density Lipoprotein meaning that it has a greater ratio of fat to protein, making it less dense. LDL is infamous for its association with atherosclerosis, heart attack and stroke. Lowering LDL levels is a primary health goal for medical providers.
HDL, on the other hand, stands for High-Density Lipoprotein and has the most protein of all the lipoproteins. As a comparison, LDL is 50% cholesterol and 25% protein while HDL is 20% cholesterol and 50% protein. HDL is touted as the “good cholesterol” (though it is more accurate to call it a “good lipoprotein”) primarily for its role in removing cholesterol from the walls of the arteries to the liver to be excreted or recycled. HDL is associated with reduced risk for heart disease.
There are many lifestyle factors that can affect cholesterol levels. To promote healthy cholesterol levels and decrease cardiovascular health risks, it is beneficial to be physically active, practice stress management, refrain from tobacco use, and follow a balanced diet.
The following diet recommendations may improve your cholesterol levels:
- Increase intake of fiber, especially soluble fiber (food sources: beans, oats, flax and chia seed, some fruits and vegetables)
- Replace saturated and trans fat with unsaturated fats, especially omega-3 fatty acids: The main sources of saturated fat in the U.S. diet include cheese, desserts, milk, eggs, butter, and high-fat meat products like bacon, sausage and burgers. Trans fat does double-duty by both raising LDL and lowering HDL. It is found primarily in partially hydrogenated oils in baked good, packaged crackers or snack foods, stick margarines, coffee creamer, etc. Omega-3’s work the opposite of trans fats and can lower LDL and raise HDL. Good food sources include fatty fish like salmon, mackerel, sardines, herring; walnuts, flax and chia seed, canola oil and microalgae supplements.
- Add plant sterols and stanols to your diet: These have a similar structure to cholesterol and therefore may be able to block absorption of cholesterol and reduce levels. Common sources are fortified dairy, orange juice, soft margarine spreads, and more fortified products continue to come to the market such as cereals, oatmeal, cookies, beverages, and snack bars.
There is continued debate about the role of dietary cholesterol in raising blood levels and a recommended daily limit. Studies have shown that saturated and trans fat have a much greater negative effect than dietary cholesterol on lipid levels, though it may be beneficial to reduce the intake of all three. Excessive alcohol intake can also have a negative effect, so use it in moderation (one drink per day for women or two per day for men) or continue to abstain if you don’t drink. In addition, weight may be a contributing factor and weight loss may be recommended on an individual basis.
Get your cholesterol levels checked at least annually and implement lifestyle change for a healthy heart.
For your reference, here are the general guidelines for cholesterol levels from the National Cholesterol Education Program’s ATP III: Note that a 2004 update recommends a LDL levels of < 70mg/dL as a therapeutic option for very high-risk patients.
Michaela Ballmann, MS, RD is enthusiastic about guilt-free eating, whole person care, and nourishing food. Her main interest is in getting people to love food, their bodies, and themselves. Michaela seeks to share the truth about nutrition and help restore you to what you once were–a healthy, whole human being. Connect with her through her podcast, blog, and nutrition counseling at Wholify.