According to the CDC, among the leading causes of death in the United States, heart disease (which includes heart disease, stroke and other cardiovascular diseases) ranks at number one claiming 611,105 deaths in 2013 which is about one in every four Americans. Coronary heart disease is the most common type of heart disease killing over 370,000 people in the United States each year. Did you know that every year, about 735,000 Americans have a heart attack)? Although there are many risk factors for heart disease that we are unable to control such as age, gender, race or ethnicity and genetics, there are many risk factors that we DO have the ability to control. The three key risk factors for heart disease are high blood pressure, high cholesterol and smoking and half of Americans have at least one of these risk factors. What are the risk factors that you can have an impact on? Your LIFESTYLE! One of the biggest concerns and inquiries I get as a dietitian is my cholesterol is high! What can I do to change that? And rightly so because having high cholesterol is one of the major controllable risk factors for heart disease! First let’s talk about what cholesterol is and what your lab work means.
What is cholesterol?
Guess what! Cholesterol isn’t bad! In the body, cholesterol is a waxy substance that you not only get from the food you eat, but also from your liver which produces cholesterol. Your body needs cholesterol as it is part of cell membranes, hormones and vitamin D! The problem happens when you have too much cholesterol in the body. Too much cholesterol can build up in the arteries, narrowing the passages and leading to blocked, clogged arteries and increasing the work of the heart to get blood through those narrowed passages which in turn increases blood pressure.
Screening for heart disease will include drawing a lipoprotein profile that includes total blood cholesterol level and breakdown of blood cholesterol. Often other blood work is drawn as well such as Lp(a) and C-Reactive protein. A complete lipoprotein profile will give you total blood cholesterol, HDL cholesterol, LDL cholesterol and triglycerides.
Total blood cholesterol: Your total cholesterol level is a combination of HDL, LDL and triglyceride level. Knowing just your total blood cholesterol level will not give you the whole picture of whether your cholesterol is good or bad. This is why you will get not only total cholesterol but your HDL, LDL and triglycerides as well. Looking at all these numbers together will give you a better picture of where your health stands. The recommend total blood cholesterol level is <200 mg/dL.
LDL cholesterol: LDL cholesterol is regarded as the “bad” cholesterol because it is believed to contribute to plaque buildup in the arteries. Having a high LDL cholesterol level can put your at risk for heart disease. The recommended blood LDL cholesterol level is <100 mg/dL.
In addition to LDL cholesterol, some research shows that the particle size of LDL cholesterol has an impact on disease risk as well. There are two types of LDL cholesterol- small dense LDL which contribute to heart disease risk and large less dense LDL which may not contribute as much to heart disease risk. Physicians don’t normally order the blood test that would show which type of LDL cholesterol a person has (NMR Lipoprofile test) but it is gaining in popularity. If your LDL cholesterol is high, knowing what type of LDL cholesterol you have may be beneficial in further determining your heart disease risk.
HDL cholesterol: HDL cholesterol is regarded as the “good cholesterol” because it is believed to seek out LDL cholesterol and takes it away from the arteries by returning it to the liver where it can be broken down, recycled or removed from the body. Having a high HDL cholesterol level can be protective against heart disease. The recommended blood HDL cholesterol level is >60 mg/dL.
Triglycerides: Triglycerides compose not only most of our dietary fat but most of the fat found in our body. Excess dietary fat is stored as triglycerides in the adipose tissues of our bodies. Risk factors for elevated triglyceride levels include overweight and obesity, physical inactivity, smoking, excess alcohol consumption and a diet very high in carbohydrates. Having a high triglyceride level combined with a high LDL and/or low HDL cholesterol can increase your risk for heart disease. The recommended blood triglyceride level is <150 mg/dL.
So you go to the doctor and he tells you your total cholesterol is 240, your LDL is 155, your HDL is 45 and your triglycerides are 200. He tells you that you need to change your lifestyle and to stop eating animal products and eat oatmeal every morning and sends you on your way. Yikes! You might be leaving there thinking “No animal products? I have to become a vegan? How can I do that! I love meat!” Did you know that you don’t have to become a vegan in order to have an impact on your blood cholesterol levels and reduce your risk for heart disease?!
Here are the top 3 things your can do nutritionally to impact your blood cholesterol level and reduce your risk for heart disease.
# 1– Change the type of fat your consuming
The number one thing I can tell you to do is change the type of fat that you eat. If you take away anything from this post, I hope this is it! For so many years it was stressed that we have to eat a “low fat” diet. We now know this isn’t the case and that fats are extremely healthy for us! It’s not that we need to remove fat from our diet but quite the opposite! We need to eat fat and lots of it, just the right type of fat!!
Fats to reduce:
Trans fats– Trans fats are a fat created by adding hydrogens to liquid vegetable oils to make them more solid. Doing this can increase the shelf life of these fats and also give them the properties that give bakery products the texture and taste that people crave. Trans fats have been found to promote heart disease by raising your LDL cholesterol level and lowering your HDL cholesterol level and are found in many fried foods and baked goods. You will also find trans fats hidden in many boxed items you purchase at the grocery store such as packaged pizza dough, pie crusts, cookies and crackers. It is recommended that you consume less than one percent of your calories each day from trans fats. To do this you will need to basically eliminate all trans fats from your diet. How do you know if something contains trans fats. In order to determine if a product contains trans fats you must read the nutrition facts label. Here you can find how many grams of trans fats an item contains. However, there is a loophole that manufactures can get around. If a food item contains less than half a gram of trans fats they are able to label it as zero grams trans fat. So to further determine if something contains trans fats go to the ingredient list and look for the words “partially hydrogenated”. If you see these words then that food item contains trans fats and you should not consume this food item.
Saturated fats- Saturated fats are found in animal products. By choosing lean cuts of meats, removing skin from poultry and choosing low fat dairy products, you can reduce the amount of saturated fat in your diet. Another place saturated fats are found are in coco butter, palm oil, palm kernel oil, coconut and coconut oil. There currently is a great debate on whether coconut oil is good for you or not- but that debate is information for another post. For now, I will say proceed with caution because although coconut oil has been found to be beneficial in some areas, it is still a saturated fat and too much of it can have the same effect as other saturated fats on your blood cholesterol level. It is recommended that <7% of your calories each day come from saturated fats. Here are some tips to reduce the amount of saturated fat from your diet:
- Meats: Choose lean cuts, trim any visible fats before cooking, avoid cuts of meat with a lot of marbling and remove skin from poultry.
- Dairy products: Choose skim or 1% milk and choose yogurt, cheeses and any other dairy products made from skim or 1% milk.
- Use coconut products sparingly.
Fats to increase:10
Unsaturated fats- Unsaturated fats are considered to be your healthy fats. These fats are found in plant products such as olives, olive oil (click here to find out what my favorite olive oil brand is!), avocados, nuts and seeds and found in fish such as salmon, trout and herring (omega 3 fatty acids). These types of fats have been found to reduce LDL cholesterol levels and raise HDL cholesterol levels. Simply replacing your trans and saturated fats for unsaturated fats can alter your blood cholesterol levels in a positive way and help reduce your risk for heart disease.
#2- Remove added sugars from your diet.
First let me explain the difference between an added sugar and a natural sugar. Natural sugars are the sugars that naturally occur in foods such as the sugar we find in fruits and vegetables. In addition, these food items have vitamins, minerals and phytonutrients that further support health. Added sugars are the sugars that we find added to our food supply during processing. Added sugars are found in almost all of our processed foods. In fact it’s hard to find food products that don’t have added sugar in them. These food items are just the opposite of those that have natural sugar in them. Not only do they have added sugar but lack healthy vitamin, minerals and phytonutrients. In fact they don’t have much of anything to support a healthy body. How do you know if there is added sugar to your food products? Nutrition facts labels don’t list the amount of added sugars in a product. On a nutrition facts label where you see the line for “sugars” that includes added and natural sugars. So in order to determine if a product has any added sugar you must go to the ingredient list and look for the words sugar, high fructose corn syrup, agave, brown sugar, corn sweetener, corn syrup, fruit juice concentrate, honey, invert sugar, malt sugar, molasses, raw sugar, syrup or anything that ends in the letters “ose”. Currently the average American diet provides about 22-28 teaspoons of added sugar a day which can add up to over 100 pounds of added sugar a year! According to the 2015-2020 dietary guidelines, most of the added sugar consumption in the United States comes from sugar sweetened beverages at 47% and sweets and snacks at 31%. Studies are now showing that too much added sugar in the American diet is contributing to increased inflammation throughout our bodies and to heart disease risk. The 2015 dietary guidelines also state that there is strong evidence that diets low in added sugars are associated with reduced risk of cardiovascular disease in adults.
#3- Increase your consumption of fruits and vegetables.
Fruits and vegetables are packed full of amazing nutrients that support so many body functions. As we mentioned above, they are full of vitamins, minerals and phytochemicals which support multiple body processes. In addition, they are a healthy source of carbohydrates that our body utilizes as energy but they also have dietary fiber which can alone help reduce blood cholesterol levels. Dietary fiber is able to bind to cholesterol in the form of bile in the body and it is then eliminated through our feces. This forces the body to use more cholesterol to make more bile therefore reducing our blood cholesterol levels.
There are other things that support a healthy heart such as reducing sodium consumption, getting enough sleep, increasing physical activity, reducing alcohol consumption, not smoking and reducing stress in the body. But changing the types of fats your consuming, reducing added sugars in your body and increasing your fruit and vegetable consumption can be the start of changing your lifestyle to not only support a healthy heart but support a healthy and revolutionized you!
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