Monday, July 28, 2014

Nutrition and your Cholesterol

One of the most commonly asked questions that I have received this summer is "What should I eat to help lower my cholesterol?" And no wonder, because around 71 million people across the U.S. are classified as having high cholesterol.1 Therefore, I thought I would break down the issue of high cholesterol a bit for you today.

What is Cholesterol Anyway? How does it Affect my Body?
While we use the word quite frequently, do people actually know what cholesterol is? The waxy, fat-like substance that is found in our bodies and in many foods is known as cholesterol.2 While it has a bad reputation, it does have functions in the body. According to The Harvard Medical School Guide to Lowering Your Cholesterol, it serves three main purposes, including: helps make the outer coating of cells, makes up the bile acids actively used to digest foods, and it allows the body to make Vitamin D and other hormones including estrogen.3 However, the problem lies when we consume too much of certain foods and the cholesterol builds up in our arteries. In fact, when your cholesterol does build up, the deposits (known as plaque) will narrow your arteries, allowing less blood to pass through the passageway.This is dangerous because a heart attack is the result of a totally blocked artery. In addition, angina (more commonly referred to as chest pain) may also result from partial plaque blockage in the coronary artery. This blockage reduces the blood flowing to the heart.2


The terms LDL and HDL are commonly thrown around when discussing a person's cholesterol. They are the carriers (lipoproteins) of cholesterol through the bloodstream. People often will refer to LDL (low-density lipoproteins) as the "bad" cholesterol, while the HDL (high-density lipoproteins) as the "good" cholesterol. The reason that LDL cholesterol is less desirable is because it contributes to plaque buildup in the arteries.4 This could later result in heart disease.4 HDL, on the other hand, is helpful to the body because it assists in removing the LDL cholesterol from the arteries.4 It is also estimated that a healthy level of HDL cholesterol may help protect the body against heart attack and stroke.4 A total cholesterol level that is considered high is 240mg/dl or higher.5 For LDL, 190mg/dl or higher is considered very high, while a level between 100-129mg/dl is optimal.5 For HDL, a person is at major risk for heart disease if their level is below 40mg/dl, but a level of 60 or greater is considered protective against heart disease.5

What causes high cholesterol?
High cholesterol is mostly caused by lifestyle factors, though genetics does play a role. As people age, their risk for high cholesterol tends to increase.A person with diabetes is also found to be more likely to develop high cholesterol.7 The reason I am asked so much about high cholesterol is because diet plays a large role. Foods high in saturated fats, trans fats, dietary cholesterol, or triglycerides have been shown to increase a person's risk for high cholesterol.8 Some health professionals promote foods high in saturated fats, raving that these fats are "good" for you. However, the bulk of the research points to the negative effects of saturated fats and this is the information that I would rely on at this point in time.

How do I know if I have high cholesterol?
When a person has high cholesterol, it is difficult to diagnose because there are no apparent signs and symptoms.6  The only way you can truly know if you have high cholesterol is by having a blood test performed. This will result in a number in the units mg/dl (as outlined in the HDL and LDL section above.

Avoiding high cholesterol by food choices
If you are a person who already has high cholesterol or has a family history, it may be time to start considering your lifestyle choices. While there are medications that can help with a person's cholesterol, I am going to focus on nutrition and exercise, since that is my area of expertise. Plus, part of my goal is to help you avoid having to begin taking medications. According to the Nutrition Care Manual, it is recommended that people with high amounts of cholesterol in their blood go on the Therapeutic Lifestyle Changes diet, better known as the TLC Diet.9 Below are the main guidelines to follow:9

  • Limit Saturated fats and trans fats 
    • Pay attention to your intake of animal products (including fatty meats, whole milks, cream, and butter)
  • Limit the amount of cholesterol consumed to less than 200 milligrams per day
    • Foods to look for include egg yolks (having 212mg per yolk), fatty meats, whole milk, cheeses, shrimp, lobster and crab
  • Consume omega-3 fatty acids
    • Foods higher in omega-3's include: salmon, tuna, mackerel and sardines
    • Walnuts, canola, and soybean oils
    • Flaxseed
  • Limit overall fat intake to 25-35% of all calories consumed each day
  • Make sure your fiber intake is between 20-30g per day
    • Strive for eating plenty of fruits, vegetables, whole grains, and dried beans
  • Strive to get around 30 minutes of exercise on most days

The nice thing about this "diet" is that, in reality, it's really not a diet. These guidelines are what all Americans should be following on a regular basis to strive for a healthy life. This is no crazy, off-the wall, Dr. Oz-promoted diet that I am bringing to your attention. Thank heavens. Because, do we really need more than one Dr. Oz in the world?!

1. CDC. Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein choleterol--United States, 1999-2005 and 2005-2008. 2011;60(4):109-14. 

2. CDC. About high blood cholesterol--United States. 2010. Accessed July 28, 2014. Retrieved from:

3. Freeman MW and Junge C. The Harvard Medical School Guide to Lowering your Cholesterol. Chapter 1: Understanding Cholesterol: the god, the bad, and the necessary. 2005. Accessed July 28, 2014. Retrieved from:

4. American Heart Association. Good vs. Bad Cholesterol. 2014. Accessed July 28, 2014. Retrieved from:

5. National Institute of Health Medline Plus. Cholesterol Levels: What You need to Know. 2012. Accessed on July 28, 2014. Retrieved from:

6. CDC. Health, United States, 208. Hyattsville, MD: National Center for Health Statistics. 2008.

7. National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). NIH Pub. No. 93-3095. Bethesda, MD: National Heart, Lung, and Blood Institute. 1993.

8.  CDC. Cholesterol: Signs and Symptoms. 2010. Accessed on July 28, 2014. Retrieved from:

9. Nutrition Care Manual. High Cholesterol Nutrition Therapy. 2014. Accessed July 28, 2014. Retrieved from: 

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