Hypercholesterolemia: 6 + 1 tips to lower your blood cholesterol like a pro!
What is cholesterol?
Cholesterol is a chemical building block found naturally within the cells of the body. It is essential for the production of steroid hormones and vitamin D as well as manufacturing bile acids which help the gut digest and absorb dietary fat.
Cholesterol is carried around the body through the blood, bound on proteins known as high density lipoproteins (HDL) aka ‘good cholesterol’, and low density lipoproteins (LDL) aka ‘bad cholesterol’. HDL is essential as it collects excess cholesterol from the tissues and returns it to the liver, where it can be removed from the circulation. This process helps prevent the build-up of surplus cholesterol in the tissues. On the other hand, LDL cholesterol is atherogenic and can cause blood vessels to become narrowed and eventually blocked.
Raised LDL levels can increase the risk of developing cardiovascular diseases (CVD) including heart attacks (myocardial infarction - MI), chest pain (angina), narrowing of the blood vessels (peripheral artery disease) and stroke. However, raised LDL cholesterol is only one of the risk factors for CVD. Other factors such as smoking, being overweight, hypertension, diabetes, limited physical activity or a strong family history of CVD increase the risk. CVD is the leading cause of deaths worldwide, and reducing cholesterol has been associated with reduced CVD risk.
Approximately only 20% of dietary cholesterol contributes to the total cholesterol circulating in the blood. Foods containing cholesterol, such as egg yolk, have much less effect on our blood cholesterol than the cholesterol that is produced in our body in response to a diet high in saturated fat. Hence, to lower blood cholesterol, cutting down on saturated fat intake is much more important than reducing dietary cholesterol intake. The maximum recommended daily intake of saturated fat does not exceed 20 grams for women and 30 grams for men. Recent studies have shown that most people in the UK consume 20% more than that.
Both saturated and trans fats increase total and LDL cholesterols but, unlike saturated fats, trans fats seem to reduce HDL cholesterol as well. Saturated fats are abundant in whole milk and dairy products of animal origin, butter, fatty meats such as pork and beef, meat products such as sausages, pâté, and salami, and in coconut. Trans fatty acids are industrially produced with partial hydrogenation of vegetable and marine oils, for the production of margarine and cooking fats. Products such as milk chocolate, cakes, biscuits, puddings, pastries and pies are often rich in saturated and trans fats. Replacing saturated and trans fats with unsaturated fats found in olive oil, avocado, nuts and seeds is an effective strategy for reducing total and LDL cholesterol levels in the blood.
You can reduce the total amount of saturated and trans fats consumed if you:
Swap cream or cheese sauces with tomato or vegetable based sauces when cooking.
Replace highly processed fatty meat products such as sausages, burgers, pâté, salami, meat pies and pasties with lean cuts of meat or fish or vegetarian/vegan high protein options like legumes, nuts, seeds and soya products like tofu.
Replace crisps and savory snacks cooked in oil with fresh or dried fruits, or a handful of unsalted nuts and seeds.
Swap full-fat milk, cheese, cream and yogurt with low fat milk or dairy foods, or with plant based options including oat, almond, coconut, rice, or hazelnut milks fortified with calcium and vitamins B12 and D. If you choose the plant-based options go for the plain ones instead of the chocolate/vanilla flavored options as they are often high in sugar.
Avoid cooking in lard, dripping, ghee and butter. Instead grill or dry fry, and use vegetable oils and low fat spreads with low saturated fat content like olive, sunflower, soy or rapeseed oil.
Additional advice to reduce your blood cholesterol
1. Get familiar with food labeling
Beware of hidden saturated fat in manufactured cakes, biscuits, pastries and ready meals. Learn how to read and interpret food labels correctly, and choose products that are lower in saturated fat.
Foods are high in saturated fat if they contain more than 5g of saturates per 100g product. Foods with 1.5-5gr saturated fats per 100gr product have medium saturated fat content. All foods containing 1.5gr or less per 100g product are low in saturated fat. Some foods promoted as low in fat, including low-fat or “diet yogurts”, breakfast cereals and some cereal bars are often high in sugar. A high sugar intake from refined carbohydrates can lower HDL cholesterol. It is therefore better if you swap those foods with others low in saturated fat and refined sugar, including home-made granola, porridge oats and organic plain soy yogurt.
2. Eat more foods rich in soluble fiber
Water soluble fiber is found in psyllium, oats, oat bran, linseeds, barley, fruits and vegetables, as well as in plant proteins such as walnuts, legumes and soybeans. Consuming 5-10g of water-soluble fiber daily has been shown to reduce LDL cholesterol by 5%. Try to include these foods daily in your diet as a good source of low-fat proteins. By swapping meat with alternative sources of protein such as soy and its products, you can also significantly reduce the saturated fat you get from animal products. Most soy foods are naturally low in saturated fat and contribute to unsaturated fat intake which helps reduce LDL cholesterol.
3. Lose weight if overweight or obese
Overweight and obesity are associated with elevated LDL and triglyceride levels and decreased HDL cholesterol. Visceral obesity (fat that accumulates in the abdomen and surrounds vital organs) increases insulin resistance and exacerbates changes in blood lipids. A modest, sustained weight loss of 5-10% can have significant benefits in cholesterol and triglyceride metabolism, and can also reduce the risk of heart disease, high blood pressure, diabetes and cancer. Such a reduction can also help relieve the effect of excess weight on joints and therefore improve your mobility. Weight loss that is achieved with exercise is more effective in raising HDL cholesterol than energy restriction alone.
4. Increase intake of plant stanols and sterols
Plant stanols and sterols are found naturally in vegetable oils, nuts, seeds and whole grains. They are chemically similar to cholesterol, and can decrease the absorption of cholesterol in the gut. The unabsorbed cholesterol is eliminated in the faeces, resulting in a reduction in circulating LDL cholesterol of up to 15% within 2-3 weeks. An optimal intake of 2.0-2.5g/day appears to have this desirable cholesterol lowering effect. You can get this amount from fortified foods such as mini drinks, spreads, milks and yogurts. There are certain situations where consumption of plant stanols and sterols is contraindicated, including women who are pregnant or breastfeeding and in sitosterolanaemia. Discuss the possibility of eating plant stanols and sterols with your current doctor.
5. Soy protein
Soy protein is low in saturated fat and cholesterol, has a low glycemic index and is rich in high quality vegetable proteins, fiber, vitamins, minerals and phytonutrients such as isoflavones (learn more about soy and health here). A broad range of evidence has shown that soy protein can lower LDL cholesterol. Specifically, a systematic review study has demonstrated that consumption of 15-25gr of soy protein per day can lead to up to 10% reduction in LDL cholesterol. You can get this amount by consuming 2 glasses of soy milk, or 100gr of minced soy, or 60-100gr marinated tofu per day. It is also worth noting that a diet high in soluble fiber, plant proteins, stanols and sterols, and nuts can lower LDL cholesterol by up to 24%.
6. Be more active
Regular physical activity and particularly aerobic exercise has beneficial effects on lipid metabolism. It is recommended that you undertake at least 45 minutes of moderate intensity physical activity including brisk walking, swimming or running every day, for at least 5 days a week. It is suggested that we should all walk at least 10,000 steps per day to stay fit and healthy, so it would be great and useful for you if you can use a physical activity tracker or your phone to count the steps you take every day.
7. Stop smoking
Smoking has been found to decrease HDL cholesterol and increase LDL oxidation. Stop smoking to reduce your risk of CVD especially if you have other risk factors present, including those mentioned above.