Now that you understand Cholesterol Basics, I recommend a two-pronged approach to improving your numbers. First, you need to reduce your intake of saturated fats, trans fats, and dietary cholesterol. Second, increase your consumption of some key foods that have been shown to improve heart health.
Specific foods to limit or avoid:
The top dietary recommendations for lowering cholesterol are to eliminate or at least drastically limit the foods you eat that contain saturated fats, trans fats, dietary cholesterol, and refined carbohydrates.
Saturated fats: Saturated fats are found in animal-based foods, including meats, butter, whole-milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. Numerous studies have shown that by replacing saturated fat with olive oil or nuts (monounsaturated fat), you can reduce LDL-cholesterol by significant amounts.
Trans fats: Trans fats were developed in a laboratory to improve the shelf life of processed foods — and they do. But trans fats are even more dangerous than saturated fats. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, potato chips, snack foods, fried foods, and fast foods that use or create “hydrogenated oils.” (All food labels must list the amount of trans fats, right after the amount of saturated fats — good news for consumers.) There is no safe amount of trans fats, so try to keep them as far from your plate as possible.
Cholesterol-rich foods: Years ago, doctors used to recommend that people with heart disease avoid all high-cholesterol foods. But dietary cholesterol does not harm health as much as trans fats do. Studies on the effects of dietary cholesterol have yielded mixed results, which is not surprising — different people have different susceptibilities. Still, if you want to take a firm hand to reduce your risk factors, you may want to consider cutting down on all high-cholesterol foods, including egg yolks, shellfish, and liver and other organ meats like sweetbreads and foie gras.
Good foods to choose
Soluble fiber: Soluble fiber may help reduce cholesterol by grabbing onto cholesterol and escorting it through your digestive system and out of your body. It also may reduce the intestinal absorption of cholesterol as well. Some of the best soluble-fiber-rich foods include oatmeal, barley, lentils, brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apples, blackberries, pears, raisins, oranges, grapefruit, dates, figs, prunes, apricots, broccoli, and sweet potatoes.
Omega-3 fatty acids: There was a time when heart researchers slapped the same label — “bad” — on every kind of fat. Now, we know that trans fats and certain types of saturated fat are dangerous for cardiovascular health, but omega-3 fats and monounsaturated fats are actually good for your heart. Heart-healthy fish oils are especially rich in omega-3 fatty acids. In multiple studies, people who ate diets high in omega-3s had 30 to 40 percent reductions in heart disease and fewer cases of sudden death from arrhythmia. Omega-3s seem to reduce inflammation, reduce high blood pressure, decrease triglycerides, help to make blood thinner and less sticky so it is less likely to clot, plus raise HDL cholesterol (that’s the good cholesterol). So omega-3s affect nearly every risk factor for heart disease. I recommend eating at least three servings (four-ounce portions) of one of the omega-3-rich fish every week — fish like wild salmon, sardines, anchovies, and mackerel (not king). If you cannot manage to eat that much fatty fish, incorporate omega-3-fortified eggs and additional plant-based sources like walnuts, soybeans, chia seeds, and ground flax — and consider taking a fish oil supplement.
Monounsaturated fats: Scientists discovered the benefits of monounsaturated fats, mainly found in olive oil by observing Mediterranean populations. They use olive oil more than any other form of fat and typically have low rates of coronary artery disease. Research shows it doesn’t help to just add monounsaturated fats to your diet — you need to replace some of the unhealthy fats that are already in your diet with better choices. There is evidence that substituting olive oil for saturated fat and low-quality refined carbohydrates can lower LDL cholesterol (the bad cholesterol) and increase HDL cholesterol (the good cholesterol). Best foods for monounsaturated fats include: olive oil and olives, canola oil, avocado, nuts (and nut butters), and seeds.
Plant sterols or stanols: Sterols and stanols are natural substances found in small amounts in the cell membranes of plants, including fruits, vegetables, legumes, nuts, and seeds. They are found in relatively high amounts in pistachio nuts, sunflower seeds, and wheat germ. Sterols and stanols have a structure similar to cholesterol, and they compete with cholesterol for access to receptors in the small intestines, effectively blocking its access. (Imagine 15 people all hoping to get a ride in their friend’s Volkswagen Beetle — not everyone is going to be riding in the car.) Research has shown that sterols and stanols have been shown to reduce LDL cholesterol levels by 5 to 14 percent. You can reap these cardiovascular benefits with just 2 g of sterol/stanol per day, though you can’t get that much eating fruits and vegetables alone. Sterols and stanols have been added to certain heart-healthy spreads that taste and cook just like margarine. That said, they’re only for those with cholesterol problems, who should consume no more than the amounts recommended: two to three tablespoons per day (each tablespoon provides 1 g of sterol/stanol). You can use it on whole-grain bread, melt it on heart-healthy vegetables, or use it in cooking. I recommend trying the light versions of these spreads to save yourself 30 calories per tablespoon. If you’re not a bread eater, please don’t start just to have a vehicle for these spreads! Instead consider the plant stanol/sterol supplements.
When it comes to lifestyle changes that help your heart, don't wait. Do them all. You may be able to heal yourself. But even if you do need medication to lower your cholesterol, that doesn't diminish the good that you're doing for yourself. Study after study has shown that the more heart-healthy living you do, the greater the benefit — so if you have high blood pressure or high triglycerides, get to work on those issues too. The good news is that many positive lifestyle changes that are good for one heart condition are also good for the others!
Ready for your heart-healthy shopping list? Take my Food Cures Cholesterol Quiz to get it.