The recommended treatment: A blood cholesterol-lowering diet
Whatever the reasons may be for your high blood cholesterol level -diet, heredity, or both - the treatment your doctor will prescribe first is a diet. If your blood cholesterol level has not decreased sufficiently after carefully following the diet for 6 months, your doctor may consider adding cholesterol-lowering medication to your dietary treatment. Remember, diet is a very essential step in the treatment of High Blood cholesterol. Cholesterol-lowering medications are more effective when combined with diet. Thus they are meant to supplement, not replace, a low-saturated fat, low-cholesterol diet.
What Changes Should You Make in Your Diet?
The following chart illustrates some guidelines for dietary changes to help you lower your blood cholesterol level. Your new diet is low in saturated fat and low in cholesterol and is adequate in all nutrients, including protein, carbohydrate, fat, vitamins, and minerals.
Guidelines for Lowering High Blood Cholesterol Levels - Basic Trends
Eat less high-fat food (especially those high in saturated fat).
Replace part of the saturated fat in your diet with unsaturated fat.
Eat less high-cholesterol food.
Choose foods high in complex carbohydrates (starch and fiber).
Reduce your weight, if you are overweight.
Eat Less High-fat Food
There are two major types of dietary fat - saturated and unsaturated. Unsaturated fats are further classified as either polyunsaturated or monounsaturated fats. Together, saturated and unsaturated fats equal total fat. All foods containing fat contain a mixture of these fats.
One of the goals in your blood cholesterol-lowering diet is to eat less total fat, because this is an effective way to eat less saturated fat. Because fat is the richest source of calories, this will also help reduce the number of calories you eat every day. If you are overweight, weight loss is another important step in lowering blood cholesterol levels (as discussed later in this brochure). If you are not overweight, be sure to replace the fat calories by eating more food high in complex carbohydrates.
Remember: When you decrease the amount of total fat you eat, you are likely to reduce the saturated fat and calories in your diet.
Saturated fat raises your blood cholesterol level more than anything else in your diet. The best way to reduce your blood cholesterol level is to reduce the amount of saturated fat you eat.
Animal products as a group are a major source of saturated fat in the average American diet. Butter, cheese, whole milk, ice cream, and cream all contain high amounts of saturated fat. Saturated fat is also concentrated in the fat that surrounds meat and in the white streaks of fat in the muscle of meat (marbling). Poultry, fish, and shellfish also contain saturated fat, although generally less than meat.
A few vegetable fats - coconut oil, cocoa butter (found in chocolate), palm kernel oil, and palm oil - are high in saturated fat. These vegetable fats are found in many commercially baked goods, such as cookies and crackers, and in nondairy substitutes, such as whipped toppings, coffee creamers, cake mixes, and even frozen dinners. They also can be found in some snack foods like chips, candy bars, and buttered popcorn. Because these vegetable fats are not visible in these foods (unlike the fat in meats) it is important for you to read food labels. The label may tell you how much saturated fat a food contains, which will help you choose foods lowest in saturated fats.
Remember: Saturated fats are found primarily in animal products. But a few vegetable fats and many commercially processed foods also contain saturated fat. Read labels carefully. Choose foods wisely.
Substitute Unsaturated Fat for Saturated Fat.
Unsaturated fat actually helps to lower cholesterol levels when it is substituted for saturated fat. Therefore, health professionals recommend that, when you do eat fats, unsaturated fats (polyunsaturated and monounsaturated fats) be substituted for part of the saturated fat whenever possible.
Polyunsaturated fats are found primarily in safflower, corn, soybean, cottonseed, sesame, and sunflower oils, which are common cooking oils. Polyunsaturated fats are also contained in most salad dressings. But be cautious. Commercially prepared salad dressings also may be high in saturated fats, and therefore careful inspection of labels is important. The word “hydrogenated” on a label means that some of the polyunsaturated fat has been converted to saturated fat.
Another type of polyunsaturated fat is found in the oils of fish and shellfish (often referred to as fish oils, or omega-3 fatty acids). This type of polyunsaturated fat is found in greatest amounts in such fatty fish as herring, salmon, and mackerel. There is little evidence that omega-3 fatty acids are useful for reducing LDL-cholesterol levels. However, fish is a good food choice for this diet play anyway because it is low in saturated fat. The use of fish oil supplements are not recommended for the treatment of High Blood cholesterol because it is not known whether long-term ingestion of omega-3 fatty acids will lead to undesirable side effects.
Olive and canola oil (rapeseed oil) are examples of oils that are high in monounsaturated fats. Like other vegetable oils, these oils are used in cooking as well as in salads. Recently, research has shown that substituting monounsaturated fat, like substituting polyunsaturated fat, for saturated fat reduces blood cholesterol levels.
Remember: Unsaturated fats when substituted for saturated fats help lower blood cholesterol levels.
Eat Less High-Cholesterol Food
Dietary cholesterol is a waxy, fat-like substance found in foods that come from animals. Although it is not the same as saturated fat, dietary cholesterol also can raise your blood cholesterol level. Therefore, it is important to eat less food that is high in cholesterol. While cholesterol is needed for normal body function, your liver makes enough for your body’s needs so that you don’t need to eat any cholesterol at all.
Cholesterol is found in eggs, dairy products, meat, poultry, fish, and shellfish. Egg yolks and organ meats (liver, kidney, sweetbread, brain) are particularly rich sources of cholesterol. High-fat dairy products, meat, and poultry all have similar amounts of cholesterol. Fish generally has less cholesterol, but shellfish varies in cholesterol content. Foods of plant origin, like fruits, vegetables, grains, cereals, nuts, and seeds, contain no cholesterol.
Since cholesterol is not a fat, you can find it in both high-fat and low-fat animal foods. In other words, even if a food is low in fat, it may be high in cholesterol. For instance, organ meats, like liver, are low in fat, but are high in cholesterol.
Because many foods such as dairy products and some meats are high in both saturated fat and cholesterol, it is important to limit the amount of these high-fat foods that you eat, choosing lean meats and low-fat dairy products whenever possible.
Remember: Organ meats and egg yolks are high in cholesterol. High-fat dairy products, meat, and poultry have similar amounts of cholesterol. Some fish has less. Foods of plant origin like fruits, vegetables, vegetable oils, grains, cereals, nuts, and seeds contain no cholesterol.
Substitute Complex Carbohydrates for Saturated Fat
Breads, pasta, rice, cereals, dried peas and beans, fruits, and vegetables are good sources of complex carbohydrates (starch and fiber). They are excellent substitutes for foods that are high in saturated fat and cholesterol. The type of fiber found in foods such as oat and barley bran, some fruits like apples and oranges, and in some dried beans may even help reduce blood cholesterol levels.
Contrary to popular belief, high-carbohydrate foods (like pasta, rice, potatoes) are lower in calories than foods high in fat. In addition, they are good sources of vitamins and minerals. What adds calories to these foods is the addition of butter, rich sauces, whole milk, or cream, which are high in fat, especially saturated fat. It is important not to add these to the high-carbohydrate foods you are substituting for foods high in fat.
Remember: Foods that are high in complex carbohydrates, if eaten plain, are low in saturated fat and cholesterol as well as being good sources of vitamins, minerals, and fiber.
Maintain a Desirable Weight
People who are overweight frequently have higher blood cholesterol levels than people of desirable weight. You can reduce your weight by eating fewer calories and by increasing your physical activity on a regular basis. By reducing the amount of fat in your diet, you will be cutting down on the richest source of calories. Substituting foods that are high in complex carbohydrates for high-fat foods will also help you lose weight, because many high-carbohydrate foods contain little fat and thus fewer calories.
Fat has more than twice the calories as the same amount of protein or carbohydrate. Protein and carbohydrate both have about 4 calories in each gram, but all fat-saturated, polyunsaturated or monounsaturated fat - has 9 calories in each gram. Thus, foods that are high in fat are high in calories. And all calories count. So, to maintain a desirable weight, it is important to eat no more calories than your body needs.
Remember: To achieve or maintain a desirable weight, your caloric intake must not exceed the number of calories your body burns.
How Should You Change Your Daily Menu?
So far we have discussed the basic dietary trends for reducing your blood cholesterol level. Now, we will focus on how to make specific changes in the foods you choose to eat. The following chart describes these dietary changes in terms of percentages of daily calories.
Since fat, carbohydrates, and protein are the three major sources of calories, the amounts that you eat of each of them makes up your daily calorie intake. For example, as shown below, the average diet of an adult American provides about 35-40 percent of calories from fat, and about 47 percent from carbohydrate and 16 percent from protein. On a cholesterol-lowering diet, the percentage of calories from total fat decreases, while the percentage of calories from carbohydrate increases and protein may stay the same.
Revision date: June 11, 2011
Last revised: by Andrew G. Epstein, M.D.