Cholesterol - healthy eating tips

Cholesterol is a 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.

Some foods contain cholesterol. This is called ‘dietary cholesterol’ and it is found only in animal products. For most people, eating foods high in dietary cholesterol only has a small influence on their blood cholesterol. 

High levels of cholesterol in your blood are mainly caused by eating foods high in saturated fats and trans-fats, and not including foods with unsaturated fats and with fibre.

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. The best way to find out if your cholesterol is high is to have a blood test (known as a lipid panel or profile). 

Visit your GP to determine whether you need to lower your cholesterol level and what action to take. 

GPs can also do a heart health check, that calculates your heart disease and stroke risk.

What causes high cholesterol?

Some causes of high blood cholesterol include: 

• Low intake of foods containing healthy fats – healthy fats tend to increase the good (HDL) cholesterol. 
• High intake of foods containing unhealthy fats (saturated fats and trans-fats) – such as fatty meats, full-fat dairy products, butter, coconut oil, palm oil and most deep-fried takeaway foods and commercially baked products (such as pies, biscuits, buns and pastries). Foods high in trans-fats include most commercially baked products and deep-fried takeaway foods.
• Low intake of foods containing fibre – foods that are high in dietary fibre, particularly soluble fibre, can reduce the amount of LDL cholesterol in your blood. Include fibre-containing foods in your diet by choosing vegetables, fruits, wholegrains, nuts and seeds every day.
• Cholesterol in food (dietary cholesterol) – this has only a small effect on LDL (bad) cholesterol -saturated fats and trans-fats in food have a much greater effect. 
• You can also eat up to 7 eggs a week as part of a healthy, balanced diet low in saturated and trans-fats, without increasing your risk of heart disease.
• Genetics – your family history may affect your cholesterol level (also known as familial hypercholesterolaemia). 

Some people will have high cholesterol even if they follow a healthy, balanced diet low in saturated fats and trans-fats. These people may need to take cholesterol-lowering medicine as prescribed by their doctor.

Cholesterol and healthy eating

What we eat has an impact on our cholesterol levels and can help reduce our risk of disease. Try to eat a wide variety of foods from each of the five food groups. Not only does this help to maintain a healthy and interesting diet, but it provides essential nutrients to the body. 

The Heart Foundation recommends: 

• Plenty of vegetables, fruits and wholegrains.
• A variety of healthy protein sources (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 diet. If choosing red meat, make sure it  is lean and limit to 1-3 times a week.
• Unflavoured milk, yoghurt and cheese. Those with high blood cholesterol should choose reduced fat varieties.
• Healthy fat choices –  nuts, seeds, avocados, olives and their oils for cooking
• Herbs and spices to flavour foods, instead of adding salt.

Also, be mindful on how much you are eating and whether you are filling up on unhealthy foods. Portion sizes have increased over time and many of us are eating more than we need which can lead to obesity and increase our risk of cardiovascular disease. 

Ideally, a healthy plate would include servings of  – ¼ protein, ¼ carbohydrates and ½ 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: 

• Limit takeaway foods to once a week (such as pastries, pies, pizza, hot chips, fried fish, hamburgers and creamy pasta dishes).
• Limit salty, fatty and sugary snack foods to once a week (these include crisps, cakes, pastries, biscuits, lollies and chocolate).
• Eat plenty of vegetables – aim for 5 serves of vegetables every day. (1 serve is ½  a cup of cooked vegetables).
• Choose wholegrain breads, cereal, pasta, rice and noodles.
• Snack on plain, unsalted nuts and fresh fruit (ideally two serves of fruit every day).
• Include legumes (or pulses) – such as chickpeas, lentils, split peas), beans (such as haricot beans, kidney beans, baked beans three-bean mix) into at least two meals a week. Check food labels and choose the lowest sodium (salt) products. 
• Use spreads and margarines 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.
• Use salad dressings and mayonnaise made from oils – such as canola, sunflower, soybean, olive (especially extra virgin), sesame and peanut oils.
• Include 2 or 3 serves of plant-sterol-enriched foods every day (for example, plant-sterol-enriched margarine, yoghurt, milk and bread).
• Have 2 to 3 portions (150 grams each) of oily fish every week. Fish may be fresh, frozen or canned.
• Include up to 7 eggs every week.
• Select lean meat (meat trimmed of fat, and poultry without skin) and limit unprocessed red meat to less than 350g per week.
• Choose  reduced fat, no added sugar milk, yoghurt, or calcium-added non-dairy food and drinks. 
• Limit or avoid processed meats including sausages and deli meats (such as salami).

If you are having trouble with your cholesterol levels, a dietitian can help you to eat healthily for your specific needs.

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. 

These foods include:

• fruit 
• legumes (such as chickpeas, lentils, soybeans, three-bean mix and baked beans)
• wholegrain cereals and foods (for example, oats and barley).

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:

• fatty cuts of meat
• full fat dairy products (such as milk, cream, cheese and yoghurt)
• deep fried fast foods
• processed foods (such as biscuits and pastries)
• takeaway foods (such as hamburgers and pizza)
• coconut oil
• butter.

Foods high in (unhealthy) trans fats include:

• deep fried foods
• baked goods (such as pies, pastries, cakes and biscuits)
• butter.

Healthy fats

Foods high in (healthy) polyunsaturated fats include:

• margarine spreads and oils such as sunflower, soybean and safflower
• oily fish
• some nuts and seeds. 

Foods high in (healthy) monounsaturated fats include:

• margarine spreads and oils (such as olive, canola and peanut)
• avocados
• some nuts.

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 (hypertriglyceridaemia). 

Lowering triglycerides

Some ways to reduce triglyceride levels include:

• Stick to  a healthy diet by following the heart healthy eating recommendations.
• Limit sugary, fatty and salty takeaway meals and snacks. 
• Limit intake 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). 

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.

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 Association of Australia Tel. 1800 812 942 or (02) 6189 1200
• Heart Foundation Helpline Tel. 13 11 12
• Diabetes Victoria Tel. 1300 437 386
• Stroke Foundation or StrokeLine Tel. 1800 787 653
• Community health centre