Fighting cholesterol

Uh oh! Your latest blood test revealed a higher than normal level of cholesterol, just like nearly two out of five Canadians. What can you do?

Don’t panic: whether you are 30, 40 or 60, it is possible to turn this problem around in only a few months and improve your next blood test results. How? By eating better, becoming more active and, if you’re a smoker, breaking the habit for good. Here are some frequently asked questions and answers about cholesterol.

Why monitor your blood cholesterol levels?

  • Because it is one of the major modifiable risk factors for heart disease, along with physical inactivity, smoking, obesity, diabetes and hypertension (high blood pressure).
  • Because a high blood cholesterol level will not trigger any visible symptoms.
  • Because an excess of this soft, waxy substance will build up inside the arteries, also increasing your risk of heart problems and stroke.

What is cholesterol?

It’s an essential substance used to help build cell membranes, hormones, vitamin D and bile acids necessary for digestion. It comes from two sources: the liver produces 80%, while 20% comes from food you eat. Even though cholesterol made by the liver dominates, cholesterol in food should not be overlooked, especially by people with a family history of high cholesterol.

Your doctor has talked to you about your LDL and HDL levels. You’re all mixed up!

  • Composed of fat and protein, these two molecules are used to carry blood cholesterol.
  • Fewer in number, HDL are carriers that collect cholesterol in the blood and return it to the liver where it is destroyed. This is why it is called “good cholesterol.”
  • LDL carry cholesterol to cells that need it and then return it to the liver to be picked up again. When our needs are met, excess cholesterol in LDL builds up and sticks to cell walls as plaque, gradually blocking the flow of blood. This is where problems begin: accumulation of fat deposits in the arteries, inadequate blood circulation, angina, heart attack and stroke. Hence, it’s nickname “bad cholesterol.”

At what point do you have high cholesterol?
Total cholesterol is not the best indicator for determining cardiovascular risk. Each person is different, so a doctor should establish target levels for good (HDL) and bad (LDL) cholesterol. He or she will need to take the following into account: age, sex, blood pressure, family history, diabetic or not, smoker or not. The higher your risk of heart disease, the lower the target set by a doctor. Talk to your doctor about establishing your individual target levels.

What food contains good cholesterol?
Dietary cholesterol, which is neither good nor bad, is present only in foods of animal origin, whether it be meat and poultry, giblets, cold cuts, fish and seafood, eggs, butter and fat in dairy products. Plant-based foods contain no cholesterol, even though some have a higher fat content, such as peanut butter, nuts and avocadoes. 

  • Food (for 100 g/3 1/2 oz. or amount indicated): calf liver
  • Amount of cholesterol (mg): 485
  • Food (for 100 g/3 1/2 oz. or amount indicated): 1 egg
  • Amount of cholesterol (mg): 215
  • Food (for 100 g/3 1/2 oz. or amount indicated): shrimp
  • Amount of cholesterol (mg): ​195
  • Food (for 100 g/3 1/2 oz. or amount indicated): grain-fed lean veal
  • Amount of cholesterol (mg): 115
  • Food (for 100 g/3 1/2 oz. or amount indicated): roast chicken, white meat without skin
  • Amount of cholesterol (mg): 85
  • Food (for 100 g/3 1/2 oz. or amount indicated): lean sirloin roast 
  • Amount of cholesterol (mg): 77
  • Food (for 100 g/3 1/2 oz. or amount indicated): salmon
  • Amount of cholesterol (mg): 67
  • Food (for 100 g/3 1/2 oz. or amount indicated): 50 g (1 1/2 oz.) of cheddar 
  • Amount of cholesterol (mg): 52
  • Food (for 100 g/3 1/2 oz. or amount indicated): 15 ml (1 tbsp.) salted butter
  • Amount of cholesterol (mg): 37
  • Food (for 100 g/3 1/2 oz. or amount indicated): 50 g (1 1/2 oz.) of partly skimmed mozzarella (15% MG) 
  • Amount of cholesterol (mg): 27
  • Food (for 100 g/3 1/2 oz. or amount indicated): 250 ml (1 cup) of 2% milk
  • Amount of cholesterol (mg): 20

What are the worst things to put on the menu?

Food that is high in saturated fat and cholesterol, because it increases the level of bad cholesterol in the blood, especially in those at higher risk.

Limit-yourself to 200 mg of dietary cholesterol a day.

How? By cutting your consumption of the following to a minimum: high-fat meats, bacon, high-fat processed meats, cheese with more than 20% fat content, cream, ice cream, whole and 2% milk, butter, coconut, as well as food containing lard, palm oil and palm kernel oil. These oils are important sources of saturated fat in our diet, and are found on the list of ingredients of many processed foods.

Trans fat is even more harmful. It not only increases bad cholesterol (LDL), but also reduces good cholesterol (HDL) — the exact opposite of what you want to happen. So avoid shortening and hydrogenated or partially hydrogenated vegetable oil, sources of trans fat in pie pastry, cookies, crackers, pastries, breaded or fried food, partially hydrogenated hard or soft margarine, some chips and frozen fries, coffee whiteners, store-bought waffles…

Your best tools at the grocery store are:  

  1. The list of ingredients: scan for the ingredients mentioned above and leave foods that contain them out of your shopping cart;
  2. The Nutrition Facts table: be on the lookout for cholesterol, of course, but also the amount of saturated fat and trans fat. In high amounts, they can wreak havoc on your cholesterol.

Eggs? Can I eat them if I have high cholesterol?
Yes. The number varies depending on your eating habits. If you eat a lot of meat and cheese, limit yourself to 2-3 eggs a week. Part-time or full-time vegetarians generally consume less saturated fat and cholesterol and so are allowed more. Since cholesterol is found in egg yolk, there is no limit to the amount of egg whites you can eat, and it’s an excellent source of protein.

Top 5 things to do to lower your “bad cholesterol” or LDL level

  1. Eat as many fruits and vegetables as you can, 7 to 8 servings a day (one serving = 1 apple, 1 carrot… or 125 ml / ½ cup).
  2. A few times a week, replace a meal containing animal fat with a legume: lentils, beans, chick peas, tofu, etc.
  3. Pick sources of unsaturated fat, such as olive, canola, sunflower or corn oil, soft non-hydrogenated margarine, nuts, almonds, seeds, avocadoes.
  4. Add fatty fish to the menu twice a week (salmon, tuna, sardines, herring and mackerel). Remember to also include food rich in omega-3: walnuts, ground flaxseed in cereal, chia seeds, nut or flaxseed oil in salad. Warning: omega-3 supplements may slightly increase your level of bad cholesterol (LDL), so it’s more advantageous to obtain it from food.
  5. Add food rich in soluble fibre to your menu: oat bran and flour, oatmeal, barley, legumes, flax seeds, pectin-rich fruit and vegetables (apples, pears, strawberries, peas, asparagus…)  Psyllium, a more concentrated source, would also be beneficial; you can find it in flake or powder form, or in psyllium-enriched cereals (ex. All-Bran Buds, Guardian, Smart Bran).

How to increase your “good cholesterol” or HDL level?
No food can do this, with the exception of red wine, which has a small effect if consumed in moderation, 1 glass a day for women, 2 glasses a day for men. On the other hand, alcohol in general can negatively influence other components of your blood. The only effective way to progressively increase good cholesterol, in addition to providing other benefits, is to get regular physical activity and quit smoking.

What fat should I cook with?
Olive or canola oil is a good choice on a daily basis, for two reasons: 1) they are both plant-based and so contain no cholesterol; 2) they are less saturated and contain a lot of monounsaturated fats, which also helps to lower bad cholesterol.

And duck fat?
The composition of this fat lies between butter and olive oil. Duck fat is more beneficial than butter, because it contains two times less saturated fat and cholesterol, and burns slower. Use it in moderation to replace butter, because duck fat is still fat.

You’ve heard of products enriched with plant sterols. What’s that?
Interestingly, this new option has been added to the nutritional arsenal to fight against high cholesterol. Plant sterols occur naturally in plant-based foods, and their chemical composition is very similar to that of cholesterol from animal sources. Their main advantage: they partly block the absorption of food cholesterol in the intestines, also helping to lower the level of bad blood cholesterol (LDL).

To reduce LDL cholesterol by 10%, Health Canada recommends eating 2 to 3 g of plant sterols daily, divided into two servings a day. Plant sterols are naturally found in vegetable oils, bread and cereal, fruit and vegetables, as well as nuts. Their contribution to our daily intake is not that high and varies between 0.15 and 0.4g.

Fallen by the wayside, you say? Not at all! Since 2010, Health Canada has approved fortifying food with plant sterols. The label will list it. These products specifically target people with high blood cholesterol for whom any reduction would be quite beneficial.  

Enriched foods contain a maximum of 1 g per serving. Some examples on the market include: margarine (Becel’s Pro.activ and President’s Choice Blue Menu Celeb with plant sterols), yogurt to eat (Astro’s BioBest) and to drink (Danone’s Danacol), as well as fruit juice (Health Break by Oasis). It’s also allowed in mayonnaise, fillings, salad dressings, vegetable juice and spreads. That being said, certain sterol sources are better on a regular basis if you are watching calories because you’re overweight. This is the case with yogurts to eat or drink and with margarine. This kind of juice is an interesting replacement for regular juice, but it still adds substantial calories to the daily overall count. 

Health Canada recommends you consult a health professional before adding food enriched with plant sterols to your menu. It is not recommended for children under 5, pregnant or nursing women. These groups have specific nutritional and dietary needs and lowering blood cholesterol is not normally a priority for them. If you take medication to lower your cholesterol, your doctor may adjust your dosage.

Is there a way to prevent high cholesterol?
Although some cases are hereditary, many can be prevented by adopting healthy eating habits, such as those described above, taking the time to participate in 30-60 minutes of daily physical activity, maintaining a healthy weight and not smoking. There’s no absolute guarantee, but millions of people could derive a number of benefits that go well beyond normal cholesterol levels.

Blood cholesterol or triglycerides?
Both are a lipid, or fat, that circulates in the bloodstream, but they have different functions. Unlike cholesterol, triglycerides are chains of high-energy fatty acid stored in body fat that can build up over the years, often more than we would like. In moderate amounts, this accumulation is used to insulate and protect our organs, and these two molecules are necessary for our body to function well. But, in excessive amounts, they have a negative impact on the health of your heart.

Hélène Laurendeau

A nutrition and health enthusiast who loves to share: this description fits Hélène Laurendeau to a tee. She has been active for more than 25 years in the media and communications field. Nutritionist, host, columnist, author and speaker, Hélène holds a Bachelor degree in Nutrition and a Master degree in Epidemiology. She has spread her knowledge alongside Ricardo every week since 2005, as part of his daily show broadcast on ICI Radio-Canada Télé, as well as in Ricardo magazine, where she pens the Bien se nourrir (Eating Well) column.