It’s that time of year again. The time you must forgo breakfast and cream in your coffee to fast for your annual physical or bio-metric screening at work. Black coffee or water only allowed. We’ve all been through it at least once in our adult lifetime.You have your blood drawn or finger pricked and anxiously await the results. Did my overindulgence over the weekend affect my results? And then the bad news hits- your cholesterol, LDL or triglycerides are out of the “desirable” range. Now what?Cholesterol is a waxy material found naturally in our bodies.  It is made in the liver and needed to make hormones and bile, which is necessary for fat digestion.  If the level of blood cholesterol becomes too high, cholesterol and other fats can stick to artery walls.  This increases the risk of heart attack and stroke. A normal level is below 200 mg/dL.Blood cholesterol is carried in the body in packages called lipoproteins.  HDL (high density lipoprotein) is considered “healthy” cholesterol because it collects excess cholesterol and brings it to the liver to be disposed.  A desirable HDL level is over 40 for men and over 50 for women.  The higher, the better.  Your ratio of cholesterol to HDL should be < 4.0 to be a low risk for heart disease.  For example, if total cholesterol is 200, but HDL is 20, the ratio is 10, which is very high.  If cholesterol is 220 and HDL is 60, the ratio is 3.66. Exercise, medication and moderate alcohol intake raise HDL.LDL cholesterol (low density lipoprotein) is “lousy” cholesterol.  It is the type of cholesterol that builds up on the arterial walls and increases the risk of heart disease.  Your level should be below 100 unless you have multiple risk factors for heart disease such as family history, smoking, high blood pressure, diabetes or metabolic syndrome. In these cases, your LDL cholesterol, ideally, should be below 70 mg/dL. For many people, diet alone won’t reduce LDL cholesterol enough to lower their risk of coronary artery disease or stroke. Your doctor may discuss medication in this case. ¹A low-fat diet is advised to reduce cholesterol and prevent heart disease.  A low-fat diet is also suggested for individuals with diabetes as they are at higher risk for heart disease, though the type of fat matters.  Fat contains 9 calories/gram and can add up. Take a look at the different types & their health effects. Approximately 25-30% of calories should come from fat if you are limiting your fat intake.Saturated fats are solid at room temperature.  This type of fat raises blood cholesterol and has been linked with development of certain cancers. These are typically animal-based (with the exception of coconut oil) and should be limited in your diet.  Sources include:

• Beef or lard
• Butter, pork fat, bacon, sausage
• Chicken and turkey skin
• Cream cheese, sour cream
• Whole milk, yogurt or cheese made from whole milk, full fat ice cream
• Coconut and other palm and palm kernel oils

Trans-fat is a type of processed fat that’s formed when hydrogen is added to liquid fat, making it solid.  Read the ingredients label.  If the words “partially hydrogenated” or “hydrogenated” are listed, the food contains some trans-fat.  This type of fat raises blood cholesterol as well as inflammation, and is linked with some cancers.  Experts recommend no more than 2 grams trans-fat per day.  Sources include:

• Baked goods such as cakes, cookies, doughnuts, pastries, and pies
• Fast food
• Margarine (stick and tub)
• Potato and corn chips
• Snack crackers, cakes, cookies, pastries, microwave or movie popcorn

Unsaturated fats include monounsaturated and polyunsaturated fats.  These types of fat are liquid at room temperature (with exception of olives and avocado) and are heart healthy.  Mono and polyunsaturated fats improve blood cholesterol by lowering total cholesterol and raising HDL (‘healthy’) cholesterol and may also reduce inflammation.  Sources include:

• Avocado
• Canola
• Olive
• Peanut oil

Polyunsaturated fats come from plant sources and include:

• Corn oil
• Flaxseed oil, flaxseeds, walnuts
• Safflower oil
• Sunflower oil
• Vegetable oils

Fats from salmon, tuna, mackerel and flaxseed are a good source of omega-3-fatty acids, and have been found to lower triglyceride levels and risk of heart disease in populations that consume fish often.How much should I eat?Fat should make up approximately 30% of your total caloric intake.  This means if you consumed 2000 calories per day, about 600 calories should come from fat (66 grams).  Only 7-10% of total calories should come from saturated fat.  Experts suggest we eat no more than 2 grams of trans fat per day.  About 10% of calories should be from monounsaturated and 10% should be from polyunsaturated fat.A low-fat food contains no more than 3 grams of fat per 100 calories.  Read the label for fat content, not just cholesterol!  Cholesterol-free food may still contain fat (such as stick margarine).Cholesterol intake is no longer a restriction. As of 2015 information has changed as new research does not support the previous restriction of 300 mg per day for most individuals and 200 mg/day for those at high risk for heart disease. ²What else can I eat to control cholesterol?Whole grains such as oatmeal, oat bran, or Cheerios should be consumed often as they contain soluble fiber- the type that binds cholesterol.  Legumes and dried beans are also a good source of soluble fiber, as are fresh fruits such as apples, citrus, pears and grapes.  Include at least 5-9 servings of fruits and vegetables daily for vitamins, minerals, antioxidants and fiber.Eat a diet that’s low in saturated fat, trans fat, and cholesterol.  Choose more mono and polyunsaturated fats when possible.  Eat fatty fish twice per week if possible. Get regular exercise to raise HDL and lower LDL levels. Eat plenty of vegetables, fruit, whole grains and beans and consume adequate water. For more information on how to control your cholesterol, check with your health care provider.References:

1. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol
2. https://www.ahajournals.org/guidelines/cholesterol

Submitted by Lisa Andrews, MEd, RD, LDDownload: Cholesterol Quiz Handout[shopify embed_type="collection" shop="nutrition-education-store.myshopify.com" product_handle="heart-health-tearpads"][shopify embed_type="collection" shop="nutrition-education-store.myshopify.com" product_handle="heart-health-powerpoint"][shopify embed_type="collection" shop="nutrition-education-store.myshopify.com" product_handle="heart-posters"]