We've all heard the saying "You are what you eat." It makes sense then that if you eat a high cholesterol diet, you will have high cholesterol. As mentioned previously, the body manufactures the cholesterol it needs. To function properly, the body requires the vi-tamins, minerals, amino acids, and other nutrients it gleans from food. Although cholesterol is important, the body does not need any more than it can make. That's why paying attention to the cholesterol content of your food becomes critical if you are to control or reduce cholesterol.
Less of These
The United States government has established a Recommended Dietary Allowance (RDA) for key nutrients our body needs to function properly. There is no RDA for cholesterol, but there is a maximum recommended daily dosage. While a diet that provides very little cholesterol is optimal, the AHA recommends we keep our total daily cholesterol to 300 mg or less. If for breakfast you have a glass of whole milk, an egg, and a piece of toast with butter, you have reached the AHA recommendation of choles-terol for the entire day. For a list of cholesterol amounts for some com-mon foods, refer to the sidebar "Cholesterol Content of Some Common Foods" on page 14.
From a practical standpoint, it's important to read prod-uct labels. Reading food labels is a good habit to get into for a number of reasons including finding out the cholesterol content of the foods you are eating. The cholesterol amount will nearly al-ways be listed on the products you choose. Remember, just be-cause something says, "lean" or "low-fat" does not mean it is low in cholesterol.
Most dairy based foods are high in cholesterol.
Some foods don't have labels or listed cholesterol amounts. It's impor-tant to be aware of foods that can sabotage your cholesterol-lowering ef-forts. Limit your intake of common high cholesterol foods including:
- Whole milk
- Cream, cream cheese, and ice cream
- Shellfish such as shrimp
- Organ meats such as kidney or liver
- Duck and goose
As you can see, high cholesterol foods are primarily animal products. By reducing the amount of animal products you eat, you will reduce the amount of cholesterol in your diet. One of the goals of a healthy choles-terol program is to increase levels of HDL, the good cholesterol. Keep in mind, however, that there are no food sources of this good cholesterol. All dietary sources of cholesterol can become dangerous when eaten in excess, especially for individuals who have already been diagnosed with high cholesterol or those who have a family history of high cholesterol.
A great diet that I often recommend is the South Beach Diet, created by my colleague and friend Arthur Agatston, MD. The book The South Beach Diet discusses in detail the issues of "white foods," including white rice, white bread, potatoes, and pasta. These calories (based in carbohydrates) come with virtually no redeeming qualities and don't fill us up, so we keep eating. Remember the last time you went to an Italian restaurant and had a whole bowl of warm bread and then continued to eat a full meal. Or think of your experiences at Mexican restaurants with the bowls of chips and salsa they serve. These white foods provide a lot of calories yet fail to fill us up, so we keep eating. Fortunately, there are some great-tast-ing foods that we should keep eating if we want to control cholesterol.
More of These
It's not surprising that fruits, vegetables, and grains do not contain any cholesterol. This is still another reason why increasing your consumption of these foods is critical to your health. And if you need one more reason to increase your daily intake of fruits and vegetables, do it because they contain valuable B vitamins.
To keep homocysteine levels in check, we need to get enough of three key B vitamins via our diet and dietary supplements. Healthy food sources for these key B vitamins include:
- Vitamin B6 = seeds, beans, bananas, fortified oatmeal, spinach, and avocado
- Vitamin B12 = fish and fortified cereals
- Folic Acid = green leafy vegetables, citrus fruits, fortified grains, beans, and peas
In 2007 the FDA reviewed the scientific literature on five specific foods proven to be beneficial to the heart. As a result of that review, the FDA has decided to give these foods a health claim for managing cholesterol. In addition to vegetables and fruits, individuals wishing to lower their cho-lesterol should increase their daily intake of the following five cholesterol-lowering foods:
- Fatty fish (e.g. salmon, trout, tuna)
- Oat bran
- Foods fortified with plant sterols (more about plant sterols in Chap-ter Three)
Some studies have shown that a vegetarian diet that includes fish can help lower cholesterol levels. Several European studies have demonstrated that vegetarians have fewer risk factors for cardiovascular disease, includ-ing high cholesterol. A recent study published in The Chinese Journal of Physiology showed that postmenopausal vegetarian women had lower LDL cholesterol and triglyceride levels. In addition to eliminating animal products, vegetarians typically also have a higher intake of whole grains, oatmeal, oat bran, nuts, beans, fruits, and vegetables, which can also help explain why they have lower cholesterol levels.
In addition to fiber and B vitamins, plant foods contain valuable, heart-healthy compounds called sterols. These compounds have been shown to reduce cholesterol. For more information about plant sterols, refer to Chapter Three.
Another problem with animal foods is that they are high in saturated fat. A quick lesson in fats tells us that there are good fats and bad fats. Saturated fats are bad fats that can weaken the immune system and clog arteries. Trans fats are synthetically created liquid fats and are also con-sidered very bad fats. Trans fats are so dangerous that in January 2006, all food manufacturers were required to list the amounts of both saturated and trans fats on the label. Prior to this, consumers did not know how much trans fats were in the foods they were eating. Some states have even banned trans fats from being used in restaurants.
Saturated and trans fats have been clearly linked to a weakened immune system and heart disease. For this reason, all fats have inadvertently been lumped into the same category: bad foods that should be avoided. But the fact is, there are some fats that are absolutely critical to our health and the efficient function of our heart. These fats are called essential fatty acids (EFAs). Two important EFAs are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
One of the reasons I tell my patients to eat more fish is because they con-tain EPA and DHA, which have been proven to be beneficial to heart func-tion. These fish oils have been shown in clinical studies to enhance heart health and prevent heart disease. Olive and flax oils are also considered healthy oils. When cooking, avoid vegetable and flax oils because they are susceptible to damage from the heat and can become more toxic to your health. I recommend olive oil for cooking. If you do not eat fish several times a week, you may want to consider supplementing your diet with a quality fish oil supplement. The brand I recommend is Kyolic EPA.
Essential fatty acids, along with the dietary recommendations in this chapter, will also help control inflammation. I agree with the many re-searchers who feel that inflammation, along with high cholesterol and elevated homocysteine, is a significant contributor to arterial damage and heart disease. An overactive inflammatory response in the arteries can lead to plaque fragments and clots. The foods we eat and the dietary supple-ments we take on a daily basis can help normalize inflammation, cho-lesterol, and homocysteine. For this reason, EPA and DHA are important additions to a heart-healthy diet.
Having a healthy diet will help you maintain a healthy body weight. The research has consistently and conclusively proven that being over-weight increases your risk of high cholesterol and heart disease. An inter-esting fact about weight gain and heart disease involves your waistline. Research indicates that a waist size of less than 40 inches for men and less than 35 inches for women lowers cardiac risk. Focus on making your waist smaller than your hips.
Some people turn to diet pills and nutritional supplements contain-ing ephedra and other stimulants. You should avoid these diet pills and supplements, especially if you have high blood pressure or a family his-tory of heart disease.
In addition to eating at least five servings of fruits and vegetables daily, I recommend the following:
- Eat 20 to 30 grams of fiber each day.
- Drink at least eight 8-ounce glasses of pure water each day (avoid unfiltered tap water).
- Reduce or eliminate simple sugars.
- Alcohol raises your good cholesterol, but strictly limit it to one to two servings per day maximum (for example, a glass of wine, bottle of beer, or shot of hard liquor).
- Choose organic, fresh, unprocessed foods whenever possible, and avoid preservatives, additives, and food colorings.
- Reduce "white foods" including white rice, white bread, potato products, and pastas.
- Reduce sodium and saturated fat intake.
Avoid the temptation of jumping on the next diet bandwagon. Healthy, long-lasting weight loss requires dietary adjustments that you can live with for a lifetime. When you combine a healthy diet with consistent physi-cal activity, you are well on your way to naturally controlling cholesterol while helping to prevent the No. 1 disease killer of our time heart dis-ease. Remember, your day-to-day diet and lifestyle choices have a colossal effect on your long-term heart health. Keep everything in moderation so you can enjoy a longer and more enjoyable life.
Next to diet, physical activity is the most important thing you can do for your heart. Many studies have shown that exercise increases HDL and decreases LDL cholesterol. Exercise also helps reduce body fat, uses up ex-cess sugar in the bloodstream, lowers blood pressure, and trains the heart to pump more efficiently. It also staves off the onset of diabetes. These are all key heart-healthy benefits.
Before you begin a new exercise program, consult with your physician, especially if you have a history of heart disease or high blood pressure and you have been fairly inactive.
In addition to the amazing cardiovascular benefits of exercise, studies have shown that exercise can:
- Stimulate a positive immune response
- Release "feel-good" endorphins in the brain
- Increase oxygen and blood flow to the brain
- Increase bone density and muscle mass
For these reasons, exercise will not only help you prevent heart disease, but it can also help with depression, anxiety, osteoporosis, fatigue, diabe-tes, and weight loss. Exercise has also been shown to relieve pain, increase mental sharpness, and improve sleep quality. In general, exercise will help you live longer. There is no pill or surgical procedure available today that can do all that!
Being physically active on a consistent basis is the most important fac-tor. That doesn't necessarily mean going to the gym or participating in for-mal exercise classes. Some people may prefer gardening, walking, riding the bike, or playing golf several times a week. Be sure to vary your physical activity so you don't get bored or give up. When it comes to exercise, you want to focus on three key areas:
- Aerobic activity (brisk walking, biking, swimming)
- Stretching (yoga, tai chi)
- Strength training (Pilates, weight lifting)
Exercise is one of the most important healthy lifestyle activities you can choose. Here are some exercise tips to keep in mind:
- Make physical activity part of your daily routine.
- An organized exercise routine should include a minimum of 30 minutes, four times a week.
- Choose activities you enjoy, and mix it up to make it fun.
- Be sure to warm up and cool down with simple stretching.
- Make a habit to take the stairs instead of the elevator when feasible.
When you are physically active, you look and feel better. Exercise has been shown to help prevent and even reverse high cholesterol levels. Make exercise a part of your daily heart-healthy plan.
In addition to diet and exercise, there are many proactive things you can do to enhance your heart health and lower your cholesterol. The top two culprits that can sabotage your cholesterol-lowering efforts are smoking and stress.
If you smoke, you need to quit. I know it's not easy, but tobacco use (cigarettes, cigars, snuff) is the single most dangerous lifestyle activity you can choose. Smoking causes heart disease and can trigger a heart attack. The good news is that the benefits of quitting smoking are almost im-mediate. According to the World Health Organization, just one year after quitting, a previous smoker's risk of heart disease decreases by 50 percent. After 15 years, the risk of dying from heart disease for an ex-smoker is almost identical to someone who has never smoked.
While quitting smoking is the most important thing you will ever do, it may also be one of the most difficult things you do. Here are some things to try:
- Acupuncture = although there are no clinical studies proving the effectiveness of acupuncture to help someone stop smoking, there are many testimonials.
- Cold turkey = if you can make it through the first two weeks, you have a great chance of succeeding.
- Exercise = this will help calm your anxiety and channel your energy away from smoking.
- Hypnotherapy = there are no clinical studies regarding smoking, but clearly many people have benefited from this therapy.
- Props = try chewing gum, holding a cigarette without lighting it, or chewing on carrots or celery.
- Support = surround yourself with people who support your decision to quit.
- Dietary supplements = the herb lobelia has been shown to help some people stop smoking.
- Prescriptions = pills, gum, and even prescription nasal spray can help some smokers quit gradually (be sure to discuss these options thoroughly with your doctor because some have side effects).
Many people say they smoke because it helps calm their nerves. Stress is a big part of our lives. Living with stress and finding healthy ways to cope with it is absolutely critical to controlling cholesterol and preventing heart disease.
In addition to exercise, I recommend finding stress-reduction tech-niques that you can relate to and incorporate into your daily life. Some healthy relaxation methods include:
- Being in nature or around animals
- Doing volunteer work
- Talking to supportive friends, family, or a therapist
When we are under stress, it can be tempting to participate in unhealthy behaviors. During times of high stress, try to avoid alcohol, overeating, caffeine, and excessive behaviors like overworking. Do not isolate your-self. Find ways to manage your stress in healthy ways so your body can rebound and rebuild.
Top 10 Tips
Many well-designed clinical studies have clearly shown that there is a connection between love, our health, and the health of our heart. Con-versely, loneliness and isolation can be damaging to your health. In ad-dition to surrounding yourself with loving, supportive people, here is a review of the top 10 things you can do from a diet and lifestyle standpoint to help keep your cholesterol in check:
- Know your numbers (for blood sugar, blood pressure, and cholesterol) = proper detection and diagnosis is paramount.
- Eat fewer high-cholesterol foods = especially eggs, meat, shell-fish, and dairy
- Eat more low-cholesterol foods = start your day with oatmeal and walnuts, and eat more fish.
- Focus on fruits and vegetables = get five servings every day.
- Emphasize essential fatty acids = avoid saturated and trans fats.
- Be physical = take the stairs, park farther away, and do whatever it takes to become more physically active.
- Decrease sodium and increase fiber = you should eat less than 2,300 mg of sodium a day and at least 20 to 30 grams of fiber.
- Stay hydrated = drink more water and less alcohol and caffeine.
- Do not smoke = also, avoid secondhand smoke whenever possible.
- Relax = make stress reduction a part of your daily routine.
The cholesterol-management goal with diet and lifestyle is to delay or halt the progression of plaque buildup in the arteries or reverse the plaque buildup process entirely. In some cases, dietary supplements should be used to achieve this goal.