High Cholesterol and Food Choices
High blood cholesterol is one of the major risk factors for heart attack, the leading cause of death in America. Cholesterol is a waxy substance your body produces to help it function properly. Because your liver makes all the cholesterol your body needs, you don't need to consume additional cholesterol.
Lipids is the scientific name for fatty substances. Cholesterol and triglycerides are two kinds of lipids carried through the blood. In order for cholesterol to move easily throughout the body, it is packaged with a protein. These protein packages are called lipoproteins. Two different kinds of lipoproteins -- low density and high density -- are used to assess your risk of heart disease.
Low-density lipoproteins (LDLs) contain most of the cholesterol in the blood. They carry cholesterol to body tissues, including the coronary arteries. The cholesterol found in LDL is considered most responsible for the formation of plaque, a fatty substance that builds up on the walls of the arteries. The plaque formation eventually can lead to a heart attack or hardening of the arteries. This is why the cholesterol in these particles is often called "bad" cholesterol. High levels of LDL increase the risk of heart disease.
High-density lipoproteins (HDLs) carry the same form of cholesterol as LDLs. However, the cholesterol in HDLs is not used to form plaques. HDL particles actually pick up cholesterol from other tissues in the body and are believed to be responsible for removing excess cholesterol from your blood. The cholesterol in these packages is called "good" cholesterol, because higher levels of HDL protect against heart disease.
Triglyceride is another type of fat. Fat is an important source of energy and provides essential nutrients for health. Some of the triglycerides in your body come from the fat you eat. Your body also makes triglycerides when you consume more calories than you need from carbohydrates, proteins, and alcohol. The same lipoproteins that transport cholesterol also move triglycerides to cells where they are needed. High triglycerides are associated with an increased risk for heart disease, especially when HDL levels are low.
Measuring Your Blood Cholesterol
Everyone age 20 or older should have their cholesterol measured at least once every 5 years. A lipoprotein profile will measure your total cholesterol, HDL, LDL, and triglycerides. You need to be fasting for these tests to be accurate.
Cholesterol levels rise with age. Women's LDL levels rise after menopause. High blood cholesterol can run in families. If you have high blood cholesterol, ask other family members if they have had their cholesterol measured.
100-129 Near optimal/above optimal
130-159 Borderline high
>190 Very high
200-239 Borderline high
150-199 Borderline high
>500 Very high
*Optimal LDL goal if you have heart disease, diabetes, or multiple risk factors.
High blood cholesterol is one of the major risk factors for heart disease, but there are other factors your doctor considers when determining what your blood cholesterol goal should be and how it will be treated:
High blood pressure (greater than 140/90 mm Hg)
Family history of early heart disease (father or brother less than 55 years or mother or sister less than 65)
Age (men 45 years and older, women 55 years and older)
Low HDL level (less than 40)
Personal history of diabetes, heart disease or stroke
Some individuals may require the added benefit of medication to help control blood lipids. Even if you do require medications to lower your cholesterol, it is important to continue to eat healthfully and be active. There are many different types of medications. Your doctor will work with you to choose the most effective medication for blood lipid control.
Self-Care Steps for High Blood Cholesterol
Eat less fat. Reducing your total fat intake to 30 percent or less of your calories and your saturated fat intake to less than 7 percent is a major step in lowering blood cholesterol. Eliminating all fat is not necessary. The table below gives suggested limits for calorie and fat intake.
Eat less saturated fat. Saturated fat raises your LDL more than anything else in your diet. All animal fats and some vegetable fats -- coconut oil, palm kernel oil, palm oil, cocoa butter, and hydrogenated oils -- are high in saturated fat.
Eat less cholesterol. Cholesterol found in certain foods also can raise your blood cholesterol level. By eating less fat and limiting foods high in saturated fat, you can reduce your intake of dietary cholesterol.
Eat more dietary fiber. Studies show soluble fiber can help lower blood cholesterol. Some good sources of soluble fiber include oats, barley, dried beans and peas, apples, pears, and carrots.
If you are overweight, consider losing a few pounds. People who are overweight often have high blood cholesterol levels. A weight loss of 10 to 20 pounds can be beneficial. Use the table below to determine a safe caloric intake for weight loss.
Be active. Activity plays an important role in promoting heart health. Aerobic activities, such as swimming, biking, jogging, and cross-country skiing, are especially beneficial. If you are not exercising now, try walking or another activity. Always check with your healthcare provider before increasing your activity level.
Fruits and Vegetables
Adults need at least five servings per day. Vegetables and fruit can be fresh, frozen, or canned without added fat or sugar. Try to eat a dark green leafy or deep yellow vegetable each day.
One serving equals:
1/2 cup cooked vegetables
1 cup raw vegetables
1/2 cup canned or frozen fruit
1/2 cup fresh berries or cut-up pieces of larger fruit, such as melons
1 small piece (the size of a tennis ball) of fruit
Starches, Grains, Starchy Vegetables, and Legumes
Adults should eat between 6 and 9 servings per day.
One serving equals:
1 small tortilla
1 slice of bread, 1 dinner roll, or 4 to 5 crackers
1/2 cup cooked rice, pasta, corn, potatoes, beans, peas, or lentils
1 ounce of dry cereal or 1/2 cup cooked cereal
1/2 English muffin or small bagel
1/2 pita bread
Choose low-fat starches (containing no more than 2 grams of fat per serving):
Low-fat baked goods, such as angel-food cake, ginger snaps, low-fat muffins, yeast breads, or bread sticks
Low-fat snacks, such as pretzels, low-fat crackers, or baked chips
Limit high-fat baked goods and snacks:
Starches with added fat, such as granola, potato chips, tortilla chips, french fries, and onion rings
High-fat baked goods, such as pies, cakes, doughnuts, pastries, croissants, muffins, quick breads, and high-fat cookies and crackers
Eat at least three servings of nonfat or low-fat dairy products per day.
One serving equals:
8 ounces of nonfat milk
8 ounces of nonfat yogurt
Choose nonfat (skim) or low-fat (1 percent) dairy products:
Skim or 1% milk
Use nonfat or low-fat cheese as a substitute for meat:
1 ounce of cheese or 1/4 cup of cottage cheese can be substituted for 1 ounce of meat
Low-fat cheese (any cheese with less than 5 grams of fat per ounce), such as low-fat cottage cheese, part-skim mozzarella, farmer's or string cheese
Nonfat cheese (any cheese or cottage cheese with less than 1 gram of fat per ounce)
Limit high-fat dairy products:
Regular and 2 percent milk and milk products, such as regular evaporated milk or yogurt
Whole milk, processed cheese and natural cheese, such as cheddar, Swiss, Brick, Brie, Monterey Jack, Colby, American, or cream cheese
Rich dairy desserts and condiments, such as ice cream, whipped toppings, sour cream, or half-and-half
Limit intake of cooked lean beef, pork, chicken, turkey, or fish to 6 ounces or less each day (3 ounces of cooked meat are equivalent to 4 ounces of raw meat).
A 2-ounce serving equals:
1 small chicken leg or thigh
1/2 cup ground or chopped meat or tuna
2 slices of sandwich-sized meat
A 3-ounce serving equals:
1 medium pork chop
1 quarter-pound hamburger
1 split chicken breast
1 unbreaded fish filet
Cooked meat the size of a deck of cards
Choose lean meats (containing no more than 3 grams of fat per ounce):
Chicken, turkey, fish, and shellfish (without skin or added oil)
Lean, trimmed cuts of beef, pork, or lamb, such as
Beef or veal: tenderloin, sirloin tip, round steak, ground round, rump roast, flank steak
Pork: loin chop, tenderloin, center-cut ham, Canadian bacon
Lamb: loin or leg roasts, chops
Limit high-fat, high-cholesterol meats:
High-fat, processed meats, such as bacon, bologna, salami, sausage, or hot dogs
High-fat cuts of beef, pork, and lamb, such as prime-grade steaks, roasts, ribs, or veal cutlets
High-cholesterol meats, such as liver, sweetbreads, kidneys, or brains
Limit egg yolks (including those used in baked goods and cooking) to no more than three per week. One egg yolk has 5 grams of fat.
Fats and Oils
Limit all added fats, especially sources of saturated fat. Depending on your caloric intake, eat no more than three to eight servings per day. One serving contains 4 to 5 grams of fat. Added fat includes fat used in cooking and baking, and fat contained in convenience foods. Limit fat intake carefully to avoid extra calories.
One serving of fat equals:
1 teaspoon butter, margarine, or oil
2 teaspoons salad dressing or 2 tablespoons light salad dressing
2 teaspoons peanut butter, nuts, or seeds
5 large olives (black or green)
1/8 medium avocado
Choose unsaturated fats:
Unsaturated oils, such as corn, olive, canola, safflower, sesame, soybean, or sunflower
Margarine made with the unsaturated or partially hydrogenated oils listed above; the softer the margarine, the less hydrogenated it is
Nuts, seeds, olives, avocados, or peanut butter
Salad dressing or mayonnaise made with unsaturated vegetable oil. Use reduced-fat versions of these products.
Limit saturated fats:
Saturated fats and oils, such as butter, lard, bacon fat, coconut oil, or palm oil
Hydrogenated oil found in shortening, some margarines, some salad dressings, and peanut butter
Note: These recommendations are not intended for children under age 2. Recommended limits are based on typical calorie needs for adults. Individuals with higher calorie needs can have more unsaturated oils and fats and should increase their intake of fruits, vegetables, and starches.
March 21, 2017
Well Advised, December 2002 Edition
Carolyn BrownCarolyn Brown RN MN CCRN CNS,Godsey, Cynthia M.S., M.S.N., APRN,Lambert, J.G. M.D.