Cholesterol-Lowering: Heart-Healthy Strategies

What is cholesterol?

Cholesterol is a soft, fat-like, waxy substance only found in animal products. Too much cholesterol leads to a build-up of fatty materials and debris (called plaque) on the walls of the arteries supplying blood to the heart and other organs. Some cholesterol is needed by the body. In fact, cholesterol plays a role in normal body functions, including the formation of cell walls, production of hormones, and manufacture of bile acids, which are needed for digestion. Because the liver has the ability to make all the cholesterol our bodies need, there is no need for extra cholesterol in the diet.

Strategies to lower cholesterol

• Limit fat. Limit total fat to 25-35% or less of your total calorie intake, which for a 2,000-calorie diet is 55-65 grams. Limit saturated fat to 5%-6% or less of total calories, which is 11-13 grams or fewer per day. Avoid trans fats. Read label guidelines to select products that have no trans fat and less than 2-3 grams saturated fat per serving.
• Replace unhealthy saturated and trans fats with healthier monounsaturated and polyunsaturated fats. Saturated fat is usually solid at room temperature and comes from animal fats, coconut, and palm oils. Some sources of saturated fat include butter, cheese, high-fat meats. Trans fats are found primarily in snack foods, with small amounts occurring naturally in some animal products. Check the ingredient list on the label; if it lists partially hydrogenated oils, the product contains trans fats. Healthier unsaturated fats are liquid at room temperature and come from plants. Some sources of unsaturated fats include olive oil, canola oil, peanut oil, safflower oil, sunflower oil, and corn oil.
• Limit cholesterol. The 2015 Dietary Guidelines does not give a figure for daily cholesterol intake but does suggest eating as little cholesterol as possible while eating healthy meals. However, the various Healthy Eating Patterns show cholesterol intake of 100 to 300 mg per day. Foods high in cholesterol include egg yolks (one egg yolk has about 212 mg of cholesterol), fatty meat, whole milk, cheese, shrimp, lobster, and crab. Buy leaner cuts of meat, trim all visible fat, and take the skin off the chicken or turkey.
• Maintain a healthy weight. If you are overweight, losing weight will help lower your total cholesterol and raise your high-density lipoprotein (HDL).
• Aerobic exercise helps raise your HDL. If you have not exercised in a while, check with your doctor before starting. Start your exercise slowly and build up to 30-40 minutes at least five times per week. Brisk walking counts as aerobic exercise. If you develop any unexplained, recurrent chest pain, skipping of the heart, shortness of breath, or lightheadedness, see your personal physician or cardiologist for evaluation.
• Gradually increase fiber intake. A daily goal for women is 25 grams per day, while a goal for men is 38 grams per day. Select whole grain products. Try to make at least half of the fiber goal soluble fiber. Good sources of soluble fiber include fruits, legumes, dried beans, root vegetables, oats, barley, and flaxseed. Consuming soluble fiber lowers LDL. Blueberries, nectarines, raspberries, apples, apricots, figs, prunes, zucchini, cabbage, beans, peas, and lentils are all excellent sources of soluble fiber. Psyllium is a soluble fiber added to foods like cereals and breads. It is also found in laxative products.
• Choose skinless chicken, turkey, and fish - baked, broiled, or grilled--as your animal sources of protein. Limit total animal sources to six ounces per day. Try limiting lean red meat (beef, veal, lamb) to once a week, selecting only the leanest cuts. Rather than making meat the focal point of the meal, try the plating method. Fill half of the plate with non-starchy vegetables and one-quarter of the plate with a starchy vegetable like potato, peas, corn, lima beans or brown rice, or pasta. That leaves only one-quarter of the plate for lean protein.
• Include foods rich in omega-3 fatty acids in your diet. Fatty fish like salmon, tuna, herring, sardines, and mackerel are good sources of omega-3 fatty acids, which lower the risk of cardiovascular disease. Aim for at least two portions per week (six ounces total). Other good sources of omega-3 fatty acids are chia seeds or flaxseed. Add chia seeds or ground or milled flaxseed to cereal or sprinkle it on salad. Aim for two tablespoons/day. (Whole flaxseed is not absorbed by the body and will not provide the same benefit.) Eat foods such as walnuts, almonds, Brazil nuts, hazelnuts, pecans, and spinach for additional omega-3 fatty acids.
• Choose at least one meatless meal per week. Try using protein sources like dried beans or canned beans like navy, pinto, black, kidney, or garbanzo.
• Do not skip meals. Research indicates that cholesterol levels may be higher when you eat fewer meals. Skipping meals may also contribute to overeating later in the day.
• Eat a variety of foods to get all the nutrients you need. For a tasty and healthy diet, try to eat more than five servings of fruits and vegetables per day. Try to consume at least two servings of low-fat or fat-free dairy products daily, such as low-fat yogurt or skim milk.
• Try to include two grams of plant stanols/sterols per day. Plant stanols/sterols are derived from plants. Examples include fortified margarine, juice, and vegetable oils.
• Limit refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks, soda pop, and sweetened beverages). The American Heart Association recommends:
  1. No more than six teaspoons of sugar or 100 calories a day for most women.
  2. No more than nine teaspoons of sugar or 150 calories a day for most men.

The 2015 Dietary Guidelines suggest limiting added sugars to no more than 10% of calories. For example, a 2000-calorie diet would be limited to 200 calories from sugar.