Understanding cholesterol levels and improving them

Guest Post Sally Marchini, Dietitian

I often see clients who come to me with high cholesterol readings, even though they’re on a cholesterol medication. When we look at the cholesterol breakdown on their blood tests it often helps them to understand how they can make dietary/lifestyle improvements to help with their heart health. This blog intends to break down the various parts of the cholesterol blood test results and give you easy to understand tips in managing the different numbers.

Of course we know that it’s important to manage cholesterol, and especially so for us with diabetes. We know that people with diabetes are 3 to 4 times more likely to develop cardiovascular disease (including heart attack and stroke) than those who do not have diabetes. In addition, around 75% of all people with diabetes die from cardiovascular disease, including heart attack and stroke.

I want to make the clear point that you should NOT make any changes to your medications without checking with your doctor first.

A basic explanation indicates that the total cholesterol number is made up of several smaller components, each that have a ‘healthy target’ range.

Primarily these include:

• Triglycerides
• LDL (the bad cholesterol)
• HDL (the good cholesterol)

In a nutshell we want to reduce the triglycerides and LDL numbers and increase the HDL (happy) cholesterol.

Triglycerides

Triglycerides are fairly easy to understand and also fairly easily managed through lifestyle changes. They are a form of fat that results from the breakdown of fats, poor quality carbs and alcohol in the diet and ‘high’ triglycerides are strongly linked with atherosclerosis (or artery plaque) that leads to heart attacks and strokes. This link is made stronger when the HDLs levels are lower and the LDL levels are higher. The tips below will show you how to achieve that.

LDL and HDL

I think this brief Wikipedia explanation works well here to provide the basic idea of how these work together before we move onto the food/lifestyle ways to improve the numbers from our blood test:

“Lipoprotein molecules enable the transportation of lipids (fats), such as cholesterol, phospholipids, and triglycerides, within the water around cells (extracellular fluid), including the bloodstream. Studies have shown that increasing levels of LDL particles (perhaps type-B, i.e. smaller particles, less so than type-A, larger LDL particles) are associated with health problems, including cardiovascular disease. Although the nickname is simplistic and thus quite misleading, LDL particles (composed of thousands of various molecules) are often called bad cholesterol because they can transport their content of many fat molecules into artery walls, attract macrophages, and thus drive atherosclerosis. In contrast, HDL particles (composed of thousands of various molecules) are frequently referred to as good cholesterol or healthy cholesterol, because they can remove fat molecules from macrophages in the wall of arteries.”

How can we improve our results with diet?

Fortunately there’s been a lot of research conducted in this area, and I’m sure there’ll be much more to come in future. Being evidence-based, following the Australian Dietary Guidelines is always an excellent start.  Then it’s all about ensuring there’s more of the healthy stuff than the unhealthy.

The first three of the five guidelines summarise well how we can improve our dietary cholesterol, as well as our overall health. I’ll cover specifics after this, but feel it’s worth the reminder to read these first three guidelines yourself:

Guideline 1

To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.

• Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly.
• Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.

Guideline 2

Enjoy a wide variety of nutritious foods from these five food groups every day:

• Plenty of vegetables of different types and colours, and legumes/beans
• Fruit
• Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley – look for low GI grains and determine the amount that is right for your eating plan. Even a low carb diet can include some low GI grains such as quinoa and couscous
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
• Milk, yoghurt, cheese and/or their alternatives

And drink plenty of water.

Guideline 3

1. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.

• Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savoury snacks.
• Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking margarine, coconut and palm oil with foods which contain predominately polyunsaturated and monounsaturated fats such as olive oils, spreads, nut butters/pastes and avocado.
• Low fat diets are not suitable for children under the age of 2 years.

1. Limit intake of foods and drinks containing added salt

• Read labels to choose lower sodium options among similar foods.
• Do not add salt to foods in cooking or at the table.

1. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.
2. If you choose to drink alcohol, limit intake. For women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option.”

And now for some specifics:

1)  Consume more of these foods

• Plant foods – ensure you get your 5 serves of veg and 2 serves of fruit every day
• Fibre – remembering there’s three types. Read up on fibre in a previous blog here.
• Oats – full of beta glucans known to improve cholesterol levels. Read up on oats in a previous blog here.
• Nuts – one to two 30g handfuls a day of mixed unsalted nuts can make a big difference. Read up on nuts in a previous blog here.
• Oily fish and good fats – the omega-3 fats found in deep sea fish have anti-inflammatory properties and have been shown to improve heart health. Read more about the good fats in this previous blog.
• Legumes – not enough of us eat enough of these amazing foods! Read more about them here, how to include more of them each day and how they’ll improve your health in so many ways.
• Choose plant sterol fortified dairy products. This link from the Dietitians Association of Australia explains more.

2) Consume less of these foods/drinks

• Sugar sweetened softdrinks
• Processed fruit juice
• Alcohol
• High glycemic index/poor nutritional quality carbs – read more here to choose better carbs.
• Saturated fats
• Processed/junk foods

3) And do your best to increase your physical activity levels! The National Physical Activity Guidelines recommends:

• Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
• Be active on most, preferably all, days every week.
• Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
• Do muscle strengthening activities on at least 2 days each week.

Hoping that’s made understanding how food and lifestyle affects your cholesterol levels a little clearer. Please let me know if you have any questions. Sally 🙂

Sally is owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.