Let’s set the scene. You’ve had blood work done and get a call from your doctor. They say your cholesterol levels look high and with your family history, something needs to be done. If they’re generous, they give you 3-6 months to make lifestyle changes before prescribing medication. This sets the clock ticking and leaves you frantically searching the internet and asking everyone you know for information about how to lower your numbers naturally.
As a dietitian, I see clients with high cholesterol often. Most are in those 3 to 6 months window, feeling panicky and stressed. It’s alarming to be told something negative about our health, but the good news is that this is a health condition that is highly impacted by our lifestyle which means we have the power to change it. To better understand what we can do, let’s begin with defining what it means to have high cholesterol and what puts us at risk.
What is Cholesterol?
Cholesterol is a fatty substance essential to our health and found in our blood. Blood carries cholesterol to different parts of our body. As cholesterol builds in our blood (when you have too much), it starts to collect in our arteries resulting in a plaque build-up that narrows the arteries and the space through which blood can flow. If it gets narrow enough, it can block blood flow entirely which can lead to a heart attack or stroke.
The two main types of cholesterol you’ll often hear about are LDL (low density lipoproteins) and HDL (high density lipoproteins) cholesterol. I like to explain it this way → imagine LDL as little cars in our bloodstream. They drive over to our arteries and drop off cholesterol to contribute to plaque buildup. HDL are like vacuum cleaners, they roam round our bloodstream and clean up the LDL in our arteries to reduce plaque buildup. This means that a good cholesterol balance is one in which LDL is low and HDL is high. Less cars, more vacuum cleaners.
What are the Risk factors?
There are lots of different risk factors for developing elevated cholesterol. Some of these are what’s called “unmodifiable risk factors” which is pretty self-explanatory. Check them out below:
Unmodifiable Risk Factors:
- Family history of high cholesterol
- Men over the age of 40
- Women over the age of 50
- Certain ethnicities
That said, there are many risk factors that we can control. And these are the ones we want to focus on changing to try and manipulate our cholesterol levels.
Modifiable Risk Factors:
- Diet
- Physical Activity
- Smoking
- Alcohol
- Stress
- Sleep
Before we get into how to manipulate these risk factors to improve our health, there are a couple of things that need to be made clear. Everyone’s circumstance is different and this impacts our unique abilities to address these modifiable risk factors. A low socioeconomic status will prevent access to higher quality foods like fresh fish, nuts, and more. A busy schedule limits time available to spend in the kitchen or in the gym. Significant stressors from work, finances, relationships and more don’t disappear because we want them to.
All this to say that real life happens, and that’s okay. Your goals don’t have to be all or nothing, every small step toward lowering your risk for disease is an impactful choice. For some, these lifestyle changes may be enough to lower cholesterol and avoid a diagnosis. However, it might not be possible for everyone to stave off a diagnosis or medication entirely. But making healthy and positive lifestyle changes can help prevent things from becoming worse.
What Makes it Go Up?
As far as our nutrition goes, the main nutrients that can increase cholesterol are saturated fats, trans fats and dietary cholesterol.
Saturated Fats
Saturated Fats typically come from animal sources like meat and dairy. Saturated fats contribute to the production of LDL cholesterol which leads to plaque buildup and narrowing arteries.
Trans Fats
Trans fats operate similarly to saturated fats in that they raise LDL; however, they simultaneously lower HDL cholesterol making trans fats particularly risky. Trans fats can be found in more processed foods like pastries, doughnuts and other packaged items. Reading food labels can help in identifying which foods contain trans fats.
Dietary Cholesterol
Animals, just like humans, produce their own cholesterol. And when we eat animal products, we are also exposed to the cholesterol contained within them – that’s what we call dietary cholesterol. Dietary cholesterol has less of an effect on our blood cholesterol levels so while it’s a good idea to be generally mindful, this isn’t where we need to focus our energy when trying to lower cholesterol. Dietary cholesterol is also at the heart of the great egg debate since they have a little saturated fat but more dietary cholesterol. Can you eat eggs when you have high cholesterol? Yes! Deciding how many per week is something you would need to discuss with your health care provider or dietitian as this answer depends on a number of factors.
What Makes it Go Down?
There are so many different options to choose from here! Reducing your intake of saturated and trans fats seems an obvious strategy. Reducing smoking and alcohol is also helpful. But often when we think about changes, we can make to our diet to improve our health we think about what we should stop eating or push out of our diet. We rarely think about what we can pull in. This concept is popularly known as “nutrition by addition” and it’s a positive way to maintain or develop a healthy relationship with food while also addressing your health concerns.
There are a couple of different types of nutrients that we can bring into our diets to help lower cholesterol. The first is unsaturated fats, which is an umbrella term for fats like polyunsaturated fats, monounsaturated fats etc. One of the main ones you hear about is omega-3 which s a type of polyunsaturated fat that our bodies cannot make, rendering it essential to be consumed from food. Unsaturated fats can help to lower LDL cholesterol and increase HDL cholesterol! That’s the balance we’re looking for.
Another functional nutrient that lowers LDL cholesterol is fibre, specifically soluble fibre. Foods that contain soluble fibre are digested and metabolized in a way that promotes a lower LDL cholesterol.
Movement is beneficial for our physical and mental health in more ways than we can count. Suffice it to say, it is also very helpful in lowering cholesterol and improving your cardiac health.
What YOU can do
So now that we have a general understanding of how cholesterol works and where it comes from, let’s talk about some real-life strategies you can start implementing to see some change.
- Choose your fats wisely.
Swap out a few sources of saturated fats with unsaturated. This simultaneously reduces your saturated fat intake and increases your unsaturated fat intake. This means that your overall caloric intake may not change much, but the function of your nutrition does. Try limiting red meat consumption to 1-2 times a week. Try a lower fat percentage for your dairy products like milk and yogurt. Include fish more often. Not a fan of fish? No problem! Bring in more nuts (walnuts are very high in omega 3’s!) and seeds, try ground flax seeds added to your stews and smoothies. Try less deep frying and more pan frying with olive or avocado oils. Go for broth-based soups and dips more often than cream-based ones.
- Engage in enjoyable movement.
If you are not already an active person, it’s never too late to start! My biggest piece of advice to all clients is to choose an activity that you truly enjoy. There is no faster way to fail than to do an activity or eat a food that you hate. Dont like broccoli? Not a problem, there are plenty of other green veggies to choose from. The same theory applies to movement. If you don’t like gong to the gym, don’t! Go for a brisk walk in your neighbourhood, dance in your kitchen, do some gardening, vacuum twice a week instead of once, use the stairs instead of the elevator. Choose an actvity that works within the boundaries of your comfort, safety and enjoyment.
- Manage your stress and sleep.
Managing your stress and sleep are also impactful strategies toward lowering cholesterol. Don’t be afraid to seek support from your health care provider or ask for a referral to a specialist who might be able to help you find the tools you need to better manage your stress and help you achieve better quality sleep.
- Increase your fiber.
Look for whole grains more often (like brown bread instead of white) to easily increase your fiber. Include plant-based proteins likes beans and lentils more often. These contain little to no saturated fat and tons of insoluble and soluble fiber to help lower cholesterol. They are affordable and come in a wide variety, try a meatless Monday to start. If cooking with beans and lentils is new for you, make use of the internet and social media to find recipes you might enjoy. Certain ethnic cuisines lean on beans and lentils more than others, try a bean burrito bowl or a dhaal and rice!
- Find your balance.
Check out Canada’s Food Guide to see what a balanced plate can look like. Try not to overconcern yourself with the portions on the plate (because everyone’s needs are different) and focus instead on getting all three food groups at main meals. When you are putting your plate together, ask yourself if that meal has all three food groups. If not, how can you change it? Maybe instead of a full plate of chicken and rice, you can make room for a salad, some veggies, or a side of fruit.
- Meal prep.
I know, I know, this concept conjures up all sorts of Pinterest images of perfectly portioned containers all beautifully lined up in a pristine fridge. It doesn’t have to be this organized. Most of my clients focus on washing and cutting their produce to have ready for snacks and sides. This removes a barrier to increasing your fruit and veggie intake through the weekdays when you are too busy to cut a salad in the middle of the day!
Your journey toward lowering your cholesterol should be a unique one that feels realistic and therefore sustainable in the long-term. Remember to focus on the quality of your nutrition over the quantity and to take baby steps toward an ultimate lifestyle goal!
Alia Virjee, MScFN, RD
Tangible Wellness