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If we were to heed the advice of Hippocrates, the Greek physician and founder of medicine, we should all be asking our doctors to write out a grocery list for us instead of a prescription to help lower cholesterol.
 High blood cholesterol is one of the most significant risk factors for CVD (cardiovascular disease, ie heart attacks, strokes and blood vessel disease), which is the leading cause of death in New Zealand. CVD puts 90 of us in hospital, and 25 of us into a coffin, every day.
What exactly is cholesterol?
Cholesterol is a waxy, fat-like substance, produced by the liver. A certain quantity of it in the body is essential to maintain health because, among other things, it’s used to form cells and some hormones. Cholesterol is carried in the bloodstream on lipoproteins of which there are two main kinds: low density lipoproteins (LDLs) and high-density lipoproteins (HDLs).
LDLs start off as VLDLs (very low-density lipoproteins) which transport cholesterol to various parts of the body. After the VLDLs drop off their cholesterol load they turn into LDLs, which then carry any leftover cholesterol around the body. When there is too much LDL cholesterol circulating in the blood it can form a thick, hard plaque-like substance (called atherosclerosis) in the lining of artery walls.
The effect of this is to make the blood flow turbulent, leading to the formation of clots that can quickly block an artery and cause a heart attack or stroke. For this reason LDLs are often referred to as ‘bad cholesterol’.
In contrast, HDLs remove deposits of cholesterol from the artery walls and return them to the liver where they are broken down and eliminated from the body. This is why HDLs are said to protect against heart disease and are often referred to as ‘good cholesterol’.
The good news is that in many cases ‘good’ and ‘bad’ cholesterol levels can be controlled through diet, and subsequently measured and monitored through simple blood tests that can be carried out by your family doctor or a medical clinic.
Cholesterol is measured in terms of millimoles (mmol) per litre. The National Heart Foundation of New Zealand recommends:
- Total cholesterol levels below 4.0 mmol/L
- LDL below 2.5 mmol/L
- HDL above 1.0 mmol/L
If you have no idea how you measure up, it may be time to roll up your sleeve and put your best vein forward. There are some relatively rare genetic conditions that predispose people to high LDL (bad) cholesterol levels and in these instances a doctor may recommend taking medication.
However, popping pills alone will not keep LDL levels down. A healthy, heart-friendly diet is even more essential when taking cholesterol-reducing medication so that the drugs can have optimal effect.
Reducing ‘bad’ cholesterol
Saturated fat is the major dietary factor raising our LDL-C or ‘bad’ cholesterol. New Zealanders eat a lot of saturated fat, mainly because of our liking for butter, standard-fat milk and milk products, cheese, fatty meats, pies, pastries and foods cooked in lard. For example, more than 20% of people who took the online Southern Cross Health Test up to February 2007 still opted for standard-fat milk despite having reduced-fat alternatives readily available.
To reduce saturated fats various options can be used: for example, substituting high-saturated fat foods with lower saturated fat counterparts (eg trim milk in place of standard-fat milk); reducing the portion sizes of commonly eaten high-saturated fat foods like cheese; and modifying food preparation techniques like draining animal fat from meat during cooking.
Boosting ‘good’ cholesterol
Not all fats are bad from a heart health viewpoint. Monounsaturated fats and polyunsaturated (omega-6 and omega-3) fats are protective of the heart and blood vessels. Products richer in omega-6 polyunsaturated fats lower LDL more than other fats and oils. Even though they may be great for flushing unwanted cholesterol out of your arteries, they’re still high in calories and may
contribute to you gaining unwanted kilos.
So what should you be eating to get maximum benefit from the ‘good’ fats?
MONOUNSATURATED FATS: canola oil, olive oil, peanut oil, avocado, almonds, cashews, pistachios, pecans, macadamias, and spreads with at least 25 grams monounsaturated fat per 100 grams.
OMEGA-6 POLYUNSATURATED FATS: wheatgerm oil, soy oil, walnuts, brazil nuts, pine nuts, pumpkin seeds, sunflower seeds, and spreads with at least 18 grams polyunsaturated fat per 100 grams.
OMEGA-3 POLYUNSATURATED FATS: all fish and seafood, soy oil, linseeds (flaxseeds), walnuts, canola oil, and omega-enriched eggs.
A sensible intake of these fats isn’t the only dietary method for giving your good cholesterol levels a boost. It has been well documented that soluble fibre (found in some grains, fruits and vegetables) helps remove cholesterol from the system, too. You can help maintain a good cholesterol level by exercising regularly, maintaining a healthy weight, and not smoking.
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