Cholesterol - healthy eating tips

Cholesterol is a waxy, fatty substance produced naturally by your liver and found in your blood. Cholesterol is used for many different things in your body, but it can become a problem when there is too much of it in your blood.

High levels of cholesterol in your blood are mainly caused by eating foods that aren’t part of a heart-healthy eating pattern. By following a heart-healthy eating pattern, you will be eating in a way that is naturally low in unhealthy fats and high in healthy fats.

Types of cholesterol

The two main types of cholesterol are:

• Low-density lipoprotein (LDL) – also known as ‘bad’ cholesterol because it can add to the build-up of plaque (fatty deposits) in your arteries and increase your risk of coronary heart disease.
• High-density lipoprotein (HDL) – also known as ‘good’ cholesterol because it can help to protect you against coronary heart disease.

How is cholesterol measured?

Most people with high cholesterol feel perfectly well and often have no symptoms.

Visit your GP to find out your cholesterol level (with a blood test) and to find out what you need to do if your levels of bad cholesterol are high.

For people aged 45 years and over, you can have your cholesterol checked as part of a Heart Health Check with your GP.

If you identify as Aboriginal and/or Torres Strait Islander, you should have your cholesterol checked from age 18 years.

What causes high cholesterol?

Some causes of high cholesterol include:

• High intake of foods containing unhealthy fats (saturated fats and trans fats) – such as fatty meats and deli-style meats, butter, cream, ice cream, coconut oil, palm oil and most deep-fried takeaway foods and commercially baked products (such as pies, biscuits, buns and pastries).
• Low intake of foods containing healthy fats – healthy fats tend to increase the good (HDL) cholesterol. Foods containing healthy fats include avocado, nuts, seeds, olives, cooking oils made from plants or seeds, and fish.
• Low intake of foods containing fibre – foods that are high in dietary fibre, particularly soluble fibre, can reduce the amount of bad (LDL) cholesterol in your blood. Include fibre-containing foods in your diet by choosing vegetables, fruits, wholegrains, legumes, nuts and seeds every day.
• Low levels of physical activity and exercise.
• Being overweight or obese and having too much body fat around your middle.
• Smoking can lead to high cholesterol levels.
• Genetics – your family history may affect your cholesterol level. In some families, several people might be diagnosed with high cholesterol or heart disease at a relatively young age (men below age 55 years and women below 65 years). This type of pattern can be caused by genetics, including a genetic condition called familial hypercholesterolaemia. It’s best to speak to your doctor as soon as possible if you think you might be affected.

Drinking too much alcohol can increase your cholesterol and triglyceride levels. Some medical conditions can cause high cholesterol levels including kidney and liver disease and underactive thyroid gland (hypothyroidism). People with type 2 diabetes and high blood pressure often have high cholesterol. Some types of medicines you take for other health problems can increase cholesterol levels as well.

Cholesterol and healthy eating

What we eat has an impact on our cholesterol levels and can help reduce our risk of disease. The Heart Foundation recommends following a heart-healthy eating pattern, which means eating a wide variety of fresh and unprocessed foods and limiting highly processed foods including take away, baked goods, chocolate, chips, lollies and sugary drinks. Not only does this help to maintain a healthy and interesting diet, but it provides essential nutrients to the body.

A heart-healthy eating pattern includes:

• plenty of vegetables, fruit and wholegrains
• a variety of healthy protein-rich foods (especially fish and seafood), legumes (such as beans and lentils), nuts and seeds. Smaller amounts of eggs and lean poultry can also be included in a heart-healthy eating pattern. If choosing red meat, make sure it is lean and limit to one to three times a week
• unflavoured milk, yoghurt and cheese. People with high cholesterol should choose reduced fat varieties
• healthy fats and oils. Choose nuts, seeds, avocados, olives and their oils for cooking
• herbs and spices to flavour foods, instead of adding salt.

This way of eating is also naturally high in fibre, which is good news, because a high intake of dietary fibre can also reduce levels of bad cholesterol in the blood.

Also, be mindful of how much you are eating. Portion sizes have increased over time and many of us are eating more than we need which can increase our cholesterol and risk of heart disease.

Ideally, a healthy plate would include servings of ¼ healthy proteins, ¼ wholegrains and ½ colourful vegetables.

Serving size can vary depending on age, gender and specific nutrition needs.

Healthy eating tips to lower cholesterol

As well as sticking to a varied and healthy diet, try these tips to help you manage your cholesterol:

• The Heart Foundation recommends that people follow a heart-healthy eating pattern, which is built on eating mostly plant-based foods. Eating more plant-based foods like vegetables, legumes, fruit, wholegrains, nuts and seeds is good for heart health.
  • Include legumes (or pulses such as chickpeas, lentils, split peas), beans (such as haricot beans, kidney beans, baked beans , bean mixes) in at least two meals a week. Check food labels and choose the lowest sodium (salt) products.
  • Beans make a great alternative to meat in tacos, or snack on hummus with vegetable sticks. You can also add legumes to soups, pasta sauces, curries and stews.
  • Use tofu or lentils instead of meat in stir fries or curries.
• Choose wholegrain breads, cereals, pasta, rice and noodles.
• Snack on plain, unsalted nuts and fresh fruit (ideally two serves of fruit every day).
• Use avocado, nut butters, tahini or spreads made from healthy unsaturated fats (such as canola, sunflower or extra virgin olive oil) instead of those made with saturated fat (such as butter, coconut oil and cream).
• Use healthy oils for cooking – some include canola, sunflower, soybean, olive (extra virgin is a good choice), sesame and peanut oils.
• For people at high risk of heart disease, the Heart Foundation recommends people eat 2-3 grams of plant sterol-enriched foods every day (for example, plant sterol-enriched margarine, yoghurt, milk and cereals).
• Enjoy fish two to three times a week (150 grams fresh or 100g tinned).
• Most people don’t need to limit the number of eggs they eat each week. However, a maximum of seven eggs each week is recommended for people with high cholesterol, type 2 diabetes and heart disease. Select lean meat (meat trimmed of fat, and poultry without skin) and limit unprocessed red meat to less than 350g per week.
• Choose unflavoured milk, yoghurt and cheese. People with high cholesterol or heart disease should opt for reduced fat options. Check the labels to make sure there’s no added sugar. Non-dairy milks and yoghurts are ok too; opt for versions that have no added sugar and have had calcium added.
• Limit or avoid processed meats including sausages and deli meats (such as ham, bacon and salami).

You can also speak to an Accredited Practising Dietitian for specific advice.

Check out the Heart Foundation website for a range of simple, delicious recipes including vegetarian recipes and those that include plant-based proteins such as lentils, chickpeas and beans:

Dietary fibre

If you are trying to lower your cholesterol, aim to eat foods that are high in dietary fibre (particularly soluble fibre), because they can reduce the amount of LDL (bad) cholesterol in your blood.

You can increase your fibre intake by eating:

• fruit
• vegetables
• legumes (such as chickpeas, lentils, soybeans and bean mixes)
• wholegrains (for example, oats and barley)
• nuts and seeds.

Dietary fats

Following a healthy, balanced diet that is low in saturated fats and trans-fats can help to lower your cholesterol.

Aim to replace foods that contain unhealthy, saturated and trans-fats with foods that contain healthy fats.

Unhealthy fats

Foods high in (unhealthy) saturated fats include:

• processed or deli-style meats (such as ham, bacon and salami)
• deep fried fast foods
• processed foods (such as biscuits and pastries)
• takeaway foods (such as hamburgers and pizza)
• fat on meat and skin on chicken
• ghee, lard and copha
• coconut oil
• palm oil (often called vegetable oil in products)cream and ice cream
• butter.

Foods high in (unhealthy) trans fats include:

• deep fried foods
• baked goods (such as pies, pastries, cakes and biscuits)
• takeaway foods
• butter
• foods that list ‘hydrogenated oils’ or ‘partially hydrogenated vegetable oils’ on the ingredients list.

Healthy fats

Foods high in (healthy) polyunsaturated fats include:

• soybean, sunflower, safflower, canola oil and margarine spreads made from these oils
• pine nuts, walnuts and brazil nuts.
• fish
• tahini (sesame seed spread)
• linseed (flaxseed) and chia seeds

Foods high in (healthy) monounsaturated fats include:

• cooking oils made from plants or seeds, including: olive, canola, peanut, sunflower, soybean, sesame and safflower
• avocados
• olives
• unsalted nuts such as almonds, cashews and peanuts.

Triglycerides in your blood

In addition to cholesterol, your blood also contains a type of fat called triglycerides, which are stored in your body’s fat deposits. Hormones release triglycerides to make energy between meals.

When you eat, your body converts any extra energy (kilojoules) it doesn’t need right away into triglycerides.
Like cholesterol, your body needs triglycerides to work properly. However, there is evidence to suggest that some people with high triglycerides are at increased risk of heart disease and stroke.

If you regularly eat more energy than you need, you may have high triglycerides.

Lowering triglycerides

Some ways to reduce triglyceride levels include:

• stick to a healthy diet by following a heart-healthy eating pattern and limiting unhealthy fats, salt and added sugar
• opt for water, tea and coffee (without adding sugar) as heart-healthy drinks, instead of sugar-sweetened drinks (such as soft drinks, cordial, energy drinks and sports drinks)
• include foods with healthy omega-3 fats (for example, fish such as salmon, sardines and tuna)
• reduce or limit your alcohol intake
• maintain a healthy weight and reduce fat around your middle.

Treatment for high cholesterol

Making lifestyle changes, especially changing some of the foods you eat, and regular physical activity, are very important to help reduce high LDL (bad) cholesterol.

• Move more. Regular physical activity is one of the best things you can do for your heart health. Increasing your physical activity from as little as 10 minutes a day to the Australian government’s recommended 30 to 45 minutes a day, five or more days of the week, can help manage your cholesterol levels and reduce your risk of heart disease.
• Quitting smoking reduces the risk of heart disease and can help reduce cholesterol levels. The most effective way to stop smoking is with a combination of stop-smoking medicines (like nicotine replacement therapy) and support from a service like Quitline (Tel: 13 78 48). Speaking to your GP is also a great first step.
• Drinking alcohol doesn’t have any health benefits. Alcohol contributes unnecessary kilojoules (energy) and is of low nutritional value. Alcohol is not a necessary or recommended part of a heart-healthy eating pattern. If you do drink, to reduce your risk of alcohol-related harm, healthy women and men should drink no more than 10 standard drinks a week and no more than four standard drinks on any one day.
• You may also need to take cholesterol-lowering medicines (such as statins) to help manage your cholesterol and reduce your risk of having a heart attack or stroke. Talk to your doctor about finding the most appropriate treatment for you.

Where to get help

• Your GP (doctor)
• Dietitians Australia Tel. 1800 812 942
• Heart Foundation
• Diabetes Victoria Tel. 1300 437 386
• Stroke Foundation or Tel. 1800 787 653
• Community health centre