Foods to eat with high cholesterol, how do they work? What role nutrition plays in fighting hypercholesterolemia?
This pathology can have a genetic and a dietary component (in some cases, both). In the last 30 years, the standard cholesterol values have increased by 5% in both women and men. Moreover, the pervasiveness of hypercholesterolemia amplified from 20 to 35% in men and 24 to 37% in women.
The causes are not only food but also a lifestyle that is certainly more sedentary and less healthy. Regarding nutrition, the preference for foods that are less valid from a nutritional point of view certainly had a weight. Just think of the increasing use of processed meats of very fatty cheeses.
In parallel, one must consider a very strong reduction in fruit, vegetables, legumes, and dried fruit consumption. Unfortunately, the majority believe that taking medication may be the simplest solution to a problem. But, in most cases of hypercholesterolemia, on the contrary, improving the lifestyle should represent the first ‘cure.’
There are 4 million deaths from cardiovascular disease every year, and more than 50% of cases occur in women. Among the main causes of cardiovascular diseases is an increase in the cholesterol levels circulating in the blood.
The importance of nutrition.
Nutrition plays a significant role in all forms of hypercholesterolemia. In fact, in cases of the sturdy impact of the diet on blood cholesterol levels, modifying the diet turns into the first therapy to trail. Add to this the element that staying active is just as beneficial.
Playing sports, not consuming alcohol, overcoming a sedentary lifestyle, and not smoking pledges a very important plus, not to be underestimated. Eating balanced, healthy, and well, cannot be neglected. This outlook of lifestyle affects particularly the waistline.
Values above 88 cm for women and 102 cm for men are statistically associated with a high cardiovascular risk. Ideally, circumferences should be less than 80cm for women and 94cm for men.
Understanding what cholesterol is.
Cholesterol is a very dense fat that our body produces and whose production is mainly in the liver. In reality, a small part of this molecule is part of our diet.
Our body biosynthesizes about 80-85% of total cholesterol, and only 15-20% directly depends on nutrition. Once produced, it releases into the blood. For this to happen, the cholesterol molecule is bound to proteins.
There are two categories of cholesterol LDL and HDL.
Low-density lipoprotein (LDL) cholesterol is also described as ‘bad cholesterol.’ In fact, the low density of this complex makes it very sticky and able to adhere to the walls of blood vessels.
The formation of these deposits is the narrowing of the lumen of the vessels and an increased risk of atherosclerosis. The latter is, in turn, the cause of the development of many cardiovascular diseases such as heart attack, stroke, etc.
Around 40 mg/dl reduction in LDL cholesterol associates with about 20-25% reduction in cardiovascular causes and nonfatal myocardial infarction deaths.
High-density lipoprotein (HDL) cholesterol is denoted as good cholesterol.
Thanks to its lower viscosity, it acts as a real scavenger. More specifically, by removing cholesterol from the walls of the vessels to transport it to the liver, it is a guarantee of protection if present in good quantity.
Functions of cholesterol.
Cholesterol is not a ‘knockout’ molecule. On the contrary, it has many physiological roles.
Primarily, it is a basic constituent of bile. Our liver produces the latter one and sends it to the first section of the intestine. It is where it does its job, which is to ensure the proper digestion of fats.
Furthermore, cholesterol is a precursor of the vitamin D molecule (bone health) and regulates the fluidity of cell membranes. This aspect is important for the health of the cells, which can effectively eliminate the catabolites and get the nutrients inside them.
Finally, we must not forget that many hormones, especially sexual ones (testosterone and estrogen), are synthesized from cholesterol.
High cholesterol values.
Hypercholesterolemia is a pathological condition in which the cholesterol values circulating in the blood are higher than they should be.
This condition is quite common and can have two main causes.
The first is innate; that is, a genetic predisposition does not allow it to be dosed properly. In this case, we speak of familial hypercholesterolemia.
Instead, the second cause is food. An unbalanced diet loaded with fats and sugars can lead, over time, to an increase in the blood values of this fat. The second case is more common in adults, while the first can manifest itself from an early age (with development).
One person in every 500 inhabitants probably suffers from this genetic disease.
Blood cholesterol values.
Studies by various observatories show that the incidence of hypercholesterolemia has significantly increased in the last decade. But what are the ‘good’ cholesterol values?
- Total cholesterol: The reference range has undergone variations in recent years. To date, good values are between 130 and 200mg/dl.
- HDL: The range varies in the case of a man or a woman. Values above 35mg/dl are considered good in the first case. Unlike this, for women, the values should exceed 45mg/dl.
- LDL: The optimal range is between 40mg/dl and 130mg/dl.
- Cholesterol-HDL/total cholesterol ratio: Should be between 0.24 and 0.48.
It is the only case of hypercholesterolemia in which it is not possible to work only by correcting the diet.
It is a real genetic mutation that alters the genes that code for the LDL receptor. Furthermore, the risk is very high in the most severe homozygous forms. In these cases, the LDL receptor activity completely alters.
The result is that these individuals can reach LDL concentrations well above 500 mg/dl. Hence, this condition can cause cardiovascular damage very early and lead to death even before age 20 if left untreated.
Diagnosis of familial hypercholesterolemia.
An index known as the Dutch Lipid Clinic Network (DLCN) helps diagnose this genetic disease.
Values higher than eight on this index give certainty of the diagnosis of familial hypercholesterolemia. In these individuals, statins (especially atorvastatin and rosuvastatin) are unavoidable.
Diet for high cholesterol: how it works?
Unfortunately, lowering all cholesterol values quickly is not always the most direct way, even if it appears to be the most functional to achieve the desired goal. For example, a low-fat regimen is not the best strategy to combat hypercholesterolemia.
On the contrary, what is effective is modifying the type of fats we eat with food and correcting the diet. Only in this way can the individual’s fat mass be regulated, also optimizing blood cholesterol values.
More fat, unsaturated, and less saturated.
An increase in unsaturated fats at the expense of a reduction in saturated ones intervenes from the metabolic point of view on the levels of excess cholesterol in the blood.
Therefore, plenty of space for dried fruit, vegetable oils (in particular extra virgin olive oil), avocado, and seeds, especially those of flax. As for polyunsaturated fats, habitually consuming foods rich in omega-three could represent a valid support for our state of health. So fish, especially blue and, in general, seafood, are the best go-to options.
Increase Your Fiber Consumption.
Increasing the fibers taken during the meal, especially the insoluble ones, guarantees a reduction in the absorption of dietary fats.
Consequently, the assimilation of cholesterol also reduces in this way. In this regard, fruits, vegetables, whole foods, and legumes (including soy) are the kings when supplying this category of nutrients.
Sterols and stanols.
We cannot biosynthesize cholesterol-like plant molecules, but we can only take them with our diet. These molecules have complex names (Beta-sitosterol, Brassicasterol, Campesterol, and Stigmasterol) and act like real ‘scammers’ in our intestines.
The cholesterol molecule is not recognized as the sterols are absorbed in their place. Hence, this category of nutrients is pure of plant origin. Not surprisingly, you can find them naturally in:
- Vegetable oils.
- Nuts, including some seeds such as flax seeds, in legumes, cereals, fruits, and vegetables.
Diet for high cholesterol: permitted foods.
When it comes to cholesterol, always remember that it refers to a physiological molecule. By this, we mean that our body produces cholesterol because it has several functions that make it necessary. In reality, the problem is not the presence of this fat in the body but its excessive presence in the blood. In this regard, nutrition only accounts for about 15% of blood cholesterol values.
Therefore, even more than eliminating or exceeding the consumption of certain foods, it would be necessary to correct incorrect lifestyles.
Despite this, some foods can regulate the absorption of dietary cholesterol in the intestine. Fibers regulate this passage, reducing dietary cholesterol absorption and facilitating bile acid reabsorption. The latter is, in fact, rich in endogenous cholesterol.
In addition, the fibers fermenting in the intestine ensure the formation of a class of fats known as short-chain fatty acids (Short Chain Fatty Acids, SCFA).
These are four fatty acids:
In particular, propionic acid can act by reducing the production of endogenous cholesterol.
Now let’s see which foods are most useful for limiting cholesterol with food (not only because they are rich in fiber).
When it comes to cholesterol, the first food ally is oats.
It happens both for the richness of fibers and, above all, for the presence of beta-glucan inside it. These molecules are real scavengers able to bind to the acids of the bile, preventing it from being reabsorbed.
In this way, the body gets free of cholesterol through stool, and this device helps lower LDL-cholesterol values. This property has been known for almost 60 years, to be precise, from the first scientific studies published in international journals in 1963.
To date, there is an assumption that, especially oat bran, if you consume about 3g/day, it can lower total cholesterol values from 8% to 23%.
Just think that 1% less total cholesterol means 2% less cardiovascular risk. A valid reason to regularly consume this food is if you suffer from hypercholesterolemia.
No rule establishes greater effectiveness of one type of legume than another.
Therefore, carte blanche to consuming beans, chickpeas, peas, lentils, broad beans, and lupins if you are subject to hypercholesterolemia. Their action is carried out thanks to the high intake of fibers that they provide.
In particular, the insoluble fibers facilitate intestinal transit and favor the decrease in the absorption of fats, including cholesterol. Let’s see which are the most fibrous legumes (in 100g of fresh product):
- Lentils (dried): 30.5g
- Borlotti beans: 24.7g
- Chickpeas: 17.4g
- Cannellini beans: 15.2g
- Adzuki beans: 12.7g
- Soy: 9.3g
- Borlotti beans (canned): 6.3g
- Fresh peas: 5.1g
- Fresh broad beans: 4.2g
3. Consume soy.
Its action is twofold. On the one hand, soy is a legume and, as such, helps to regulate intestinal transit. On the other hand, it contains molecules known as phytosterols which, mimicking cholesterol, are absorbed by the intestine instead of cholesterol itself.
They are a kind of deception that we supply to our digestive system, which absorbs the phytosterols and lets the cholesterol pass. Not being absorbed, the latter eliminates in the feces.
4. Fruits and vegetables.
Again, their role is twofold. The first always connects with the high fiber content. The second links to the high satiating power of this category of food. Consuming them in good quantities in every meal makes it easier to avoid overeating foods with protein or fat main courses, excesses of condiments, or sweets.
Fish and foods rich in omega-3 improve the metabolism of all lipids carried in the blood.
This concept holds for both cholesterol and triglycerides. In this regard, improving the blood lipid picture is essential to reduce cardiovascular risk.
Omega 3 is fundamental in this respect thanks to its anti-thrombotic, anti-inflammatory and hypotensive function.
6. Lean cold cuts or lean meats.
Foods of animal origin are all characterized by the presence of fats. It does not mean you cannot consume them if you suffer from hypercholesterolemia.
On the contrary, due to their supply of noble proteins, all 20 amino acids and some essential vitamins such as B12 should never be lacking. So, how to do it?
Prefer leaner cuts of meat, like white meat. Alternatively, slices or strips of veal or beef are also much less fat than other cuts of the same type of meat.
One clarification if you opt for poultry: remove the skin because many fats can be found there, including cholesterol.
7. Dairy products and cheeses.
Undoubtedly, higher-fat cheeses, such as whole milk or yogurt, contain higher quantities of cholesterol.
But, at the same time, skimmed milk and yogurt or low-fat cheeses can be consumed even if you suffer from hypercholesterolemia.
So why banish these foods? Rather, we choose the right ones, those with the lowest fat content.
8. Dried fruit.
These fatty acids directly affect the production of endogenous cholesterol since they are directly involved in the biosynthesis process of this molecule. But always be careful not to abuse the quantity. Although considered good fats, omega 6s are still fats.
It is a fruit with a monounsaturated fatty acid content comparable to the most famous dried fruit. As such, consumed in moderation due to the total caloric intake helps reduce total cholesterol values.
10. The Right Seasoning.
It is always vital to remember that often the problem linked to an unbalanced diet does not lie in the type of food chosen but in the condiment used.
Just think of a plate of pasta: 90g of pasta would be very different if seasoned with simple sauce or carbonara. The fats in condiments can also be the reason to influence hypercholesterolemia.
So, watch out for abusing those ‘bad’ saturated fats from:
- Hydrogenated vegetable oils.
These act directly on cholesterol by increasing the fraction of LDL cholesterol. In contrast, there is plenty of room for non-hydrogenated vegetable oils.
11. ‘Fortified’ foods.
Fortified food is nothing more than normal food with additional artificial nutrients. In short, it is as if we were adding supplements to food.
This way, it is possible to consume it while also benefiting from the properties of the molecules added to it. In the case of cholesterol, plant sterols and stanols can be added to foods because they bind cholesterol (together with fiber) and hinder intestinal absorption. The most common added sterol is phospholipid lecithin.
In reality, more than a sterol, in this case, it is a biological molecule capable of modifying the chemical conformation of the cholesterol molecule. As a consequence of this modification, lecithin acts as a ‘broom’ able to cleanse the vessels of the cholesterol deposited.
But where can we find lecithin? For example, it is added to yogurt, making them real supplements (or, better still, functional foods).
Diet for high cholesterol: foods to avoid.
As previously mentioned, diet only accounts for 15% of blood cholesterol values. Therefore, there are no foods to eliminate if you suffer from hypercholesterolemia.
On the contrary, some foods have high-fat concentrations, and we should consume them in moderation.
In general, if you suffer from hypercholesterolemia, moderate the intake of:
- Animal fats (butter, lard, cream) or excessively fatty meats, including offal and sausages.
- Whole milk or dairy products are made from whole milk.
- Simple sugars.
- Saturated vegetable oils: palm and rapeseed or hydrogenated vegetable fats (margarine).
- Mollusks or crustaceans
It is also important to prefer cooking methods that are not excessively fat. It could therefore be useful to prefer cooking to:
- Low temperature
When it comes to cholesterol, never overlook this one aspect.
The blood values of this fat can be influenced by food but also by lifestyle.
If the latter were healthy, characterized by a fight against a sedentary lifestyle and constant physical activity, the cholesterol values would be more under control. But what should be done to be able to consider one’s lifestyle healthy? Here are some pointers:
Avoid smoking, as it can alter the elasticity of blood vessels. This loss of function could predispose to a higher incidence of cardiovascular disease.
Playing sports means stimulating the production of HDL cholesterol at the expense of a reduction in LDL. The advice is to choose aerobic sports, where the heart rate can be stimulated for longer.
So, plenty of room for ‘extensive’ sports such as:
- Team sports such as basketball, football and volleyball
Very good options might also be particularly welcome. For example, brisk walking (at least 4-5km/h) and dancing.
Monitor other conditions that may show co-morbidities with high cholesterol. In this regard, above all:
- Diabetes mellitus
By paying consideration to these characteristics, we can battle high cholesterol thanks to nutrition. However, diet is not the only aspect to watch out for. To control cholesterol, it is also important to practice regular physical activity.
In some cases, then, it is essential to take medicines. One principle applies to everyone: only by following your doctor’s instructions can you be sure that you are truly protecting your cardiovascular health.
In the end, we’ll always advise you to contact nutrition professionals such as dieticians and nutritionists, who can formulate tailor-made food plans suitable for those suffering from high cholesterol.