With an estimated 1 out of 3 American adults with high cholesterol levels, it’s no surprise that questions about diet changes to lower cholesterol come up often. If you have been diagnosed with high cholesterol taking a look at your diet is a great place to start because there are actually a few different ways foods can lower cholesterol levels.
What Is Cholesterol?
Cholesterol is a waxy substance produced in the liver and essential to human health. We often think of cholesterol in a negative light but it has important functions in the body including serving as a structural component of hormones, nerve impulse conductivity, and the endogenous production vitamin D. In addition to what is made in the body, cholesterol can also be absorbed from food sources.
What Does It Matter If Cholesterol Is High?
Having high cholesterol increases the risk of atherosclerotic cardiovascular disease (ASCVD) which is when plaque builds up in the blood vessels of the heart, brain, and peripheral arteries. According to the Center for Disease Control, heart disease and stroke are the first and fifth leading cause of death in the United States.(1)It’s recommended that healthy adults have their cholesterol checked every 4 to 6 years. For those at greater risk or with a history of heart disease more frequent checks may be needed.
What To Eat If You Want to Lower Your Cholesterol?
1. Increase Soluble Fiber
Soluble fiber works to decrease cholesterol by binding bile salts in the digestive tract. Bile salts are made in the liver using cholesterol and play an important role in digestion and absorption of food. When they are bound and excreted with the soluble fiber it helps to reduce reabsorption and regulates cholesterol levels in the body. Aim for a daily goal of at least 10 grams of soluble fiber. This makes up around one- third of your total daily goal of 25-30 grams. Good sources of soluble fiber with at least 2 grams per serving include oatmeal, mango, figs, black beans, oat bran, and brussels sprouts.
2. Add Plant Sterols
Cholesterol plays several important roles in the human body including cell wall structure, while plants don’t have cholesterol they do have a similar compound known as phytosterols. Phytosterols are so structurally similar to cholesterol that they compete for absorption sites in the intestines and can limit cholesterol absorption from foods. The Food and Drug Administration has approved a health claim stating that 1.3 grams of plant sterol esters daily may reduce the risk of heart disease. (2) The National Cholesterol Education Program recommends adding 2 grams of phytosterols daily for people with high cholesterol.(3) Food sources include avocados, nuts, and vegetable oils. It is also possible to use foods fortified with phytosterols such as margarine spreads and juices.
3. Choose Foods Higher in Monounsaturated Fatty Acids More Often
A study published in the American Journal of Clinical Nutrition found that a diet higher in monounsaturated fatty acids (MUFAs) successfully reduced LDL cholesterol by 14% without raising triglycerides or lowering protective HDL cholesterol.(5) The diet higher in MUFAs was concluded to have greater cardiovascular risk-lowering benefits as compared to a low-fat diet due to these protective effects. If you are looking to add more MUFAs to your diet avocados, nuts, and olive oil are great sources.
4. Limit Saturated Fat
We used to think that eating cholesterol in the diet had the greatest impact on serum cholesterol levels however recent research doesn’t support this as the primary contributor. As it turns out it’s the saturated fat in foods that appears to have a greater influence. If you are watching your cholesterol levels it’s best to limit saturated fat to no more than 7% of total daily calories. For a typical 2000 calorie diet, this would equate to about 15 grams a day. This may seem like quite a bit but if you choose to have a hamburger with a slice of cheese and modest 1/2 cup serving of Ben and Jerry’s vanilla ice cream that would bring you up to about 19 grams of saturated fat. Other foods high in saturated fat include whole milk and yogurt, butter, cream, fatty cuts of beef and pork, sausages, poultry with the skin, coconut and palm oils.
Considerations For People With Diabetes
When managing type 2 diabetes we tend to focus blood sugars however people with diabetes are also at greater risk for dyslipidemia. It’s recommended to have cholesterol levels checked annually and aim to keep LDL cholesterol < 70 mg/dL.(4) Knowing your personal trends and targets is part of knowing your “ABCs” or A1C, blood pressure and cholesterol goals to reduce the risk of diabetes-related complications.
You may have heard the name but there is often some confusion about what exactly is metabolic syndrome, in fact, keyword research shows over 74,000 Google searches for “metabolic syndrome” in just the past 24 hours. Also called syndrome x, metabolic syndrome is the name for a group of conditions that raise the risk of cardiovascular diseases and diabetes. When an individual has three of the five conditions a diagnosis of metabolic syndrome can be made. According to data from the National Health and Nutrition Examination Survey (NHANES) the prevalence of metabolic syndrome has been on the rise since the early 1990s and by 2012 it’s estimated that more than one-third of US adults met the diagnostic criteria.
The World Health Organization (WHO) defines Metabolic Syndrome diagnosis with any three of the following:
High blood pressure ( systolic reading of 135 mm Hg over diastolic 85 mm Hg or greater)
Impaired glucose tolerance (fasting blood glucose of 100 mg/dL or greater)
High waist circumference (greater than 40 inches in men and 35 inches in women)
High triglycerides (150 mg/dL or greater)
Low HDL cholesterol (less than 40 mg/dL in men and 50 mg/dL in women)
3 Ways to Reduce Your Risk
Metabolic syndrome is treated by addressing the conditions that contribute to the diagnosis. Interventions with diet and lifestyle can often help to reverse the conditions that make up metabolic syndrome. For example, a weight loss of as little as 3% can lead to improvements in blood lipids and meeting minimum recommendations for daily exercise can help keep blood pressure in check. If you are looking to reduce your risk, try starting with the three tips below:
1. Know Your Numbers
Being an active participant in your healthcare and knowing where you stand can help you better understand your risk. Blood pressure, fasting glucose and blood lipids are tests that should be done each year at your annual check-up visit. Knowing where you stand now and watching the trends year after year can help you take action sooner if one area starts to creep up.
2. Don’t Ignore Your Weight
A prospective study published in the American Journal of Medicine in 2000 estimated that the average American gains and then maintains about a pound of weight annually. This may not seem clinically significant enough to warrant intervention at an annual check-up visit however year after year of gradual gains can become significant and contribute to the development of metabolic syndrome. Your weight may not fit perfectly within the BMI scale but knowing what’s a healthy range for you and watching your trends is important.
3. Strive For 150
Participating in some form of physical activity is well established in the research to have protective effects against the conditions that contribute to metabolic syndrome including lowering blood pressure, maintaining weight and reducing insulin resistance. Check in to see how close you are getting to meeting the minimum recommendations of 150 minutes of physical activity per week. Already there? See if you can reach 300 minutes a week for additional benefits. For more on the benefits of exercise check out my post on the 2018 Exercise Guidelines from the US Department of Health and Human Services.
The 2018 Exercise Guidelines: What the Past 10 Years Have Taught Us
The United State Department of Health and Human Services has updated its exercise guidelines! The 2018 guidelines are an update to the first-ever published recommendations in 2008, which included a weekly goal of at least 150 minutes to 300 minutes of moderate-intensity physical activity in bouts of at least 10 minutes at a time. In this second edition of the Physical Activity Guidelines for Americans what they recommend may not surprise you: most of us need to move more! The Department estimates that at present 50% of Americans are not meeting the current exercise recommendations and 30% of Americans report doing no moderate-vigorous intensity physical activity at all. With the release of the new guidelines maybe what changed most significantly is the growing body of evidence behind the reasons why we should care about this.
A Growing List of Benefits
While some benefits were known and highlighted in the 2008 guidelines the 2018 report continues to add to the list of conditions which benefit from regular physical activity, including:
Reduced risk of developing or progression of certain chronic conditions including type 2 diabetes, hypertension, and osteoarthritis
Improvements in brain health including reduced incidence of dementia and improved mood
Prevention of weight gain
Improved sleep including a reduction in time to fall asleep and improvements in sleep quality
Reduced risk of developing gestational diabetes during pregnancy
Reduction in the incidence of postpartum depression
Reduced risk of falls and related injuries, in older adults
Reduced risk of certain cancers including breast, colon, endometrial, esophagus, kidney, lung, stomach and bladder
The report also released new findings that show for individuals who perform little or no moderate-vigorous activity, replacing their sedentary time with light-intensity activity reduces the risk of all-cause mortality, incidence of type 2 diabetes and cardiovascular disease. The evidence in this area was previously lacking.
What’s Else is New?
Removal of the 10-minute bouts minimum- all movement now counts toward the daily goal
New recommendations to include preschool-aged children (ages 3-5 years old) and the benefits seen in bone health and reduced risk of excessive weight gain
A new Move Your Way campaign to help promote and inspire regular exercise
Individuals who move more tend to feel better, sleep better and have reduced risks of certain diseases! For the most benefit, Americans are encouraged to participate in some form of moderate to vigorous physical activity for 150 minutes to 300 minutes per week, plus 2 days of strength exercises. If that is not possible exercise appears to provide benefit in a dose-dependent manner, even including light-intensity movement, so any amount of movement is better than none. If you are looking for support to start, check out the interactive Activity Planner on Move Your Way, set a goal on your wearable fitness tracker or schedule it into your calendar. If you set a goal, rather than leaving it to chance, you’re more likely to follow through.