Take control of your cholesterol

One in 12 New Zealand adults takes medication for cholesterol levels. But it doesn’t have to be that way. You can make a difference to your cholesterol levels with smart food choices, and without giving up favourites.

While genetics may be a contributing factor to high cholesterol, for most of us it simply comes down to a combination of lifestyle factors. The two biggest contributing factors are too much saturated fat in our diet and being overweight. Since high cholesterol can lead to atherosclerosis – the disease which causes heart attacks and strokes – it’s a good idea to take a good look at your diet and make a few easy changes.

Cholesterol basics

Cholesterol is a waxy substance that helps make cell membranes. It can, however, cause serious problems for your cardiovascular system if it builds up in the blood. High blood cholesterol is a risk factor for atherosclerosis, where the arteries harden, increasing the risk of developing heart disease.

Good vs bad cholesterol

The main two types are the ‘bad’ LDL cholesterol and the ‘good’ HDL cholesterol. LDL carries cholesterol from the liver to the blood vessels where it can build up, narrow and eventually block a blood vessel, potentially causing a heart attack or stroke. HDL cholesterol carries cholesterol away from the blood vessels and back to the liver.

What should my cholesterol be?

Ideal blood fat levels are:

• total cholesterol less than 4mmol/L
• LDL cholesterol less than 2.0mmol/L
• HDL cholesterol greater than 1mmol/L
• total cholesterol/HDL ratio less than 4mmol/L
• triglycerides less than 1.7 mmol/L

If you have a family history of cardiovascular disease, are overweight, have high blood pressure, diabetes or are a smoker, it’s even more important to get your level down. See your doctor to have your cholesterol levels checked.

The good news

Because diet and lifestyle factors are to blame for rising cholesterol levels, scientists have established that cutting back on saturated fat and losing excess weight are very effective tools for lowering cholesterol. The most famous study to demonstrate this used the ‘Portfolio diet’, in which participants consumed a diet low in saturated fat, which included foods known to lower cholesterol (such as plant sterols, soy protein, soluble fibre and nuts). After one month, participants achieved a 30 per cent reduction in cholesterol – a result similar to that of a common cholesterol-lowering drug.

Food vs drugs

Although drugs are available (and, in some cases, may be required) to treat high cholesterol, they can have side effects and they don’t address other risk factors. Nor do they really get to the source of the problem: diet and lifestyle. Put simply, drugs are not a cure-all. Making lifestyles changes is still the best way to reduce your cholesterol levels.

Getting practical

If you want to give high cholesterol the flick, the best diet to follow is one which is low in saturated fat, contains healthy, unsaturated oils and features heart-friendly foods such as vegetables, whole grains, fruits, legumes, nuts, seeds and fish. This type of diet encourages the liver to make less cholesterol, while at the same time, sweeping cholesterol out of the body. Of course, it’s important to look after your whole heart, not just your cholesterol levels, so limit salt (sodium) to control blood pressure and watch your portion sizes to prevent weight gain.

Eating plant sterols

Plant sterols are natural substances found in seeds, nuts and legumes that help reduce the amount of cholesterol the body absorbs. Reduced-fat spreads enriched with high levels of plant sterols are readily available these days.

Studies show that consuming two grams of plant sterols a day can lower cholesterol by an average of 10 per cent in three weeks. Two grams of plant sterols can be found in 25g (2 1/2 tablespoons) of plant-sterol spread.

Fibre and cholesterol

Soluble fibre helps ‘mop up’ cholesterol and remove it from the body. Fibrous foods such as oats, barley, legumes, fruits, vegetables and psyllium are your body’s cholesterol-cleaning team. Here are ways to include soluble fibre in your daily diet:

• Have a high-fibre breakfast such as porridge or muesli
• Choose whole grain bread preferably containing oats or barley for lunchtime sandwiches
• Ensure half your dinner plate is filled with a variety of vegetables
• Vegetables high in soluble fibre include artichokes, carrots, eggplants and broccoli
• Fruits high in soluble fibre include oranges, apricots, mangoes, blueberries, apples and pears
• All legumes (such as lentils, kidney beans and chickpeas) are high in soluble fibre, so try to include them in your diet at least twice a week.

A matter of fat

The golden rule with fats is to replace ‘bad’ fats (saturated and trans fats) with ‘good’ (unsaturated) fats. To do this:

• Limit animal fat by choosing lean meats and low-fat dairy
• Eat fewer ‘sometimes foods’ such as fast foods, pastries, cakes and biscuits
• Include healthy oils and spreads, nuts, seeds and fish in your diet
• Use a variety of oils for cooking and dressing salads such as olive, canola, rice bran and sesame oils
• Use a reduced-fat spread instead of butter for spreading and baking
• Eat a small handful of nuts each day. Nuts are high in oil, but these are healthy oils. A small handful (30g) of unsalted nuts will help look after your heart.

What to watch on food labels

All packaged foods must contain a nutrition information panel (NIP). Use the NIP to compare products and find those with less saturated fat and sodium, and more fibre. Another option is to look for the Heart Foundation Tick.

The Tick is a quick and easy signpost for healthier choices within food categories at the supermarket. Foods with the Tick are better choices, although there may be other foods with similar nutrition content without the Tick. It pays to check.

A change of heart: Shop your way to lower cholesterol

Dairy

• Instead of whole milk and yoghurt, and full-fat ice cream, cheese, cream and sour cream.
• Choose low-fat varieties of milk, yoghurt and ice cream such as Meadowfresh Trim milk, Meadowfresh Live Lite yoghurt, Anchor Vital milk, Symbio low-fat probiotic yoghurt and Zilch! ice cream. Look for reduced-fat cheesesuch as Country Goodness Lite Cottage Cheese, Philadelphia Extra Light cream cheese and Perfect Italiano Ricotta Light. Look for evaporated skim milk such as Carnation Light & Creamy Evaporated Milk.

Breads

• Instead of white bread.
• Choose wholegrain bread containing oats or barley such as Bürgen Oatbran & Honey and Vogel’s Sunflower & Barley.

Meats

• Instead of fatty chops, sausages or bacon, regular mince, salami or luncheon meat.
• Choose lean varieties of meat, ham, mince, skinless chicken and low-fat sausages such as The Mad Butcher’s Italian Sausage, Silver Fern Farms Venison, skinless chicken breast or thigh, and beef and lamb with the New Zealand Beef & Lamb Quality mark.

Cereals

• Instead of low-fibre breakfast cereals high in added sugar and/or salt
• Choose porridge, muesli, oat flakes or cereal with added psyllium. Try Harraways Oat Singles, Kellogg’s Guardian, Ceres Organic Honey Toasted Muesli, Healtheries Deluxe Bircher muesli.

Spreads

• Instead of butter.
• Choose reduced-fat spreads such as Flora Pro-Activ, Logicol Light, Alfa One Rice Bran Oil Lite Spread, Gold’n Canola Lite and Olivani Lite.

Sweet treats

• Instead of biscuits, cakes, shortcrust pastry, croissants, pies or tarts
• Choose dried fruit and nuts, filo pastry, fruit buns, fruit bread and fruit scones.

‘Cholesterol-free’

‘Cholesterol-free’ on a label doesn’t mean the food will lower your cholesterol. If you have high cholesterol, the most important thing to limit in your diet is saturated fat, not dietary cholesterol. That’s why foods with a ‘cholesterol-free’ label aren’t necessarily the best choice, and cholesterol-rich foods, such as prawns and eggs (in moderation), are back on the menu for people with high cholesterol.