High cholesterol: how does it work and what role does nutrition play in combating hypercholesterolemia?

This pathology can have a food and a genetic component (in some cases both). In fact, it is estimated that in the last 30 years, the average cholesterol levels have increased by 5% in both men and women. In addition, the prevalence of hypercholesterolemia increased from 20 to 35% in men and from 24 to 37% in women.

The causes are not only food but must be read in a lifestyle that is certainly more sedentary and less healthy. As far as nutrition is concerned, the predilection for foods that are less valid from a nutritional point of view certainly had a weight. In fact, just think of the increasing use of meat, often processed, and very fat cheeses. In parallel, a very strong reduction in the consumption of fruit, vegetables, legumes and dried fruit should also be considered. Unfortunately, it is increasingly believed that taking a medicine can be the simplest solution to a problem. But, in most cases of hypercholesterolemia, on the contrary, improving the lifestyle should be the first ‘cure’.

The risky lifestyle choices Canadians are making can be seen in these statistics:

• Roughly 49.5% of the Canadian population fails to get the recommended amount of physical activity.
• 56.2% of the Canadian population consumes fewer than five servings of fruit and vegetables a day.
• 51% of Canadians age 18 or older — and 62.2% of Canadians ages 55 to 64 — are overweight or obese, increasing their risk for diabetes, high cholesterol, and high blood pressure.
• Canadians ages 75 to 84 have the highest incidences of diabetes in Canada.
• 18.8% of women and 17.3% of men in Canada have high blood pressure.²
• 16.7% of the Canadian population is made up of daily smokers; smoking increases the risk for high blood pressure and narrowing of the arteries.

^{Source – https://pwc.ottawaheart.ca/education/heart-health-education/general-information}

Diet for high cholesterol: the importance of nutrition

In fact, in cases of strong influence of diet on blood cholesterol values, correcting the diet becomes the first therapy to follow. Added to this is the fact that keeping active is just as therapeutic. In fact, playing sports, overcoming a sedentary lifestyle, not consuming alcohol and not smoking guarantee a very important plus, which should not be underestimated.

Eating well, healthy and balanced, cannot be neglected. In fact, this aspect of lifestyle affects above all the waistline.
Values greater than 88 cm for women and 102 cm for men are statistically associated with a high cardiovascular risk.

Anti-cholesterol diet: understand what cholesterol is

Cholesterol is a very dense fat that our body produces and whose production is mainly borne by the liver. In reality, a small part of this molecule is taken with the diet.

In fact, it is estimated that about 75% of total cholesterol is biosynthesized by our body and only 25% depends directly on food. Once produced, it is released into the blood. For this to happen, the cholesterol molecule is bound to proteins.

There are two categories of cholesterol:

• LDL
• HD

LDL cholesterol

Low-density lipoprotein (LDL) cholesterol is referred to as ‘bad‘.

In fact, the low density of this complex makes it very viscous and able to adhere to the walls of blood vessels.

The result of the formation of these deposits is the narrowing of the lumen of the vessels and an increased risk of atherosclerosis. The latter is in turn the cause of the development of many cardiovascular diseases:

• heart attack
• stroke, etc.

In fact, it is estimated that a reduction of 40mg/dl of LDL cholesterol is associated with a 20 – 25% reduction in deaths from cardiovascular causes and non-fatal myocardial infarction.

HDL cholesterol

High-density lipoprotein (HDL) cholesterol is referred to as ‘good‘ cholesterol.

Thanks to its lower viscosity, it acts like a real sweeper. In more detail, removing cholesterol from the vessel walls to transport it to the liver is a guarantee of protection if present in good quantities.

Cholesterol functions

Cholesterol is not a molecule ‘to be eliminated’. On the contrary, it has many physiological roles.

Primarily, it is a basic constituent of bile. The latter is produced by the liver and sent to the first part of the intestine. It is precisely here that it performs its task, which is to ensure the correct digestion of fats.

Furthermore, cholesterol is a precursor of the vitamin D molecule (bone health) and regulates the fluidity of cell membranes. This aspect is important for the health of the cells, which are able to effectively eliminate the catabolites and allow nutrients to enter them.

Finally, we must not forget that many hormones, especially the sexual ones (testosterone and estrogen) are synthesized from cholesterol.

High cholesterol levels

Hypercholesterolemia is the pathological condition in which the values ​​of circulating cholesterol in the blood are higher than necessary.

This condition is quite common and can have two main causes.

The first is innate, i.e., there is a genetic predisposition that does not allow it to be dosed appropriately. This is referred to as familial hypercholesterolemia.

Instead, the second cause is food. In fact, an unbalanced diet loaded with fats and sugars can lead, over time, to an increase in the blood values ​​of this fat. The second case is more common in adults while the first can occur from an early age (with development).

Cholesterol blood values

Studies by various observers, have shown that the incidence of hypercholesterolemia has significantly increased in the last decade.

But what are the ‘good’ cholesterol levels?

• Total cholesterol: the reference range has changed in recent years. To date, values ​​between 130 and 200mg/dl are considered good.
• HDL: the range varies if we are talking about a man or a woman. In the first case, values ​​above 35mg/dl are considered good. Unlike this, for women, the values ​​should exceed 45mg/dl.
• LDL: the optimal range is between 40mg/dl and 130mg/dl.

HDL-cholesterol/total cholesterol ratio: should be between 0.24 and 0.48.

Familial hypercholesterolemia.

This is the only case of hypercholesterolemia on which it is not possible to work only by correcting the diet.

In fact, it is a real genetic mutation that alters the functioning of the genes that code for the LDL receptor. Furthermore, in the most severe homozygous forms, the risk is very high. In these cases, the activity of the LDL receptor is completely altered.

The result is that these individuals can reach LDL concentrations well above 500 mg/dl. Thus, this condition can cause cardiovascular damage very early and lead to death even before the age of 20 if left untreated.

Familial hypercholesterolemia diagnosis

An index known as the Dutch Lipid Clinic Network (DLCN) is used to diagnose this genetic disease.

In fact, values ​​higher than 8 of these indexes give certainty of the diagnosis of familial hypercholesterolemia. In these individuals, the use of statins (above all atorvastatin and rosuvastatin), is unavoidable.

High cholesterol diet: how it works

Unfortunately, thinking of quickly lowering all cholesterol values ​​is not always the most direct way even if it appears to be the most functional to achieve the desired goal.

For example, a low-fat regimen is not the best strategy to counteract hypercholesterolemia.

On the contrary, what is effective is a modification of the type of fats that are taken with food and a correction of the diet. Only in this way can the fat mass of the individual be regulated, also optimizing the blood cholesterol values.

More fat… unsaturated and less saturated

An increase in unsaturated fats at the expense of a reduction in saturated ones, intervenes from a metabolic point of view on excess cholesterol levels in the blood.

Therefore, ample space for dried fruit, vegetable oils (especially extra virgin olive oil), avocados and seeds, especially flax seeds.

As far as polyunsaturated fats are concerned, habitually consuming foods rich in omega 3 could be a valid support for our state of health. So, fish, especially blue fish and, in general, sea products.

High Cholesterol Diet: Increase your fiber intake

Increasing the fibers taken during the meal, especially the insoluble ones, guarantees a reduction in the absorption of dietary fat.

Consequently, the assimilation of cholesterol is also reduced in this way. In this regard, fruit, vegetables, whole foods, legumes (including soy), are the kings as regards the contribution of this category of nutrient.

Sterols and stanols

They are cholesterol-like plant molecules that we are unable to biosynthesize but that we can only take in with the diet.

These molecules have complex names (Beta-sitosterol, Brassica sterol, Camp sterol, Stigmasterol) and act like real ‘crooks’ in our intestines.

In fact, the cholesterol molecule is not recognized as the sterols are absorbed in its place. Therefore, this category of nutrients is purely of plant origin. Not surprisingly, you can naturally find them in:

• vegetable oils
• dried fruit, including some seeds such as flax seeds, in legumes, cereals and fruit and vegetables.

High cholesterol diet: allowed foods

When we talk about cholesterol, we must always emphasize that we are referring to a physiological molecule. By this term I mean that cholesterol is produced by our body because it has various functions that make it necessary.

In reality, the problem is not related to the presence of this fat in the body but to its excessive presence in the blood. In this regard, diet affects only about 15% of blood cholesterol values.

Therefore, even more than eliminating or exceeding the consumption of certain foods, it would be necessary to correct incorrect lifestyles.

Despite this, it has been proven that some foods are able to regulate the absorption of dietary cholesterol in the intestine. This step is regulated by the fibers which reduce the absorption of dietary cholesterol and facilitate the reabsorption of bile acids. The latter are in fact rich in endogenous cholesterol.

Furthermore, the fibers, fermenting in the intestine, guarantee the formation of a category of fats known as short chain fatty acids (Short Chain Fatty Acids, SCFA).

These are four fatty acids:

• Vinegar.
• Propionic.
• Butyric.
• Valeric.

In particular, propionic acid is able to act by reducing the production of endogenous cholesterol.

Now let’s see specifically which foods are most useful for limiting the increase in cholesterol with nutrition (not only because they are rich in fiber).

Oats

When it comes to cholesterol, the first food ally is oats.

This happens both for the richness in fibers and above all for the presence of beta-glucans inside. These molecules are real scavengers able to bind to the acids of the bile, preventing it from being reabsorbed.

In this way, the cholesterol is eliminated with the feces and this expedient helps to lower the LDL-cholesterol values. This property has been known for almost 60 years, since the first scientific studies published in international journals in 1963.

To date it is hypothesized that especially oat bran, if consumed in about 3g/day, can help lower total cholesterol values ​​from 8% to 23%.

Just think that 1% less total cholesterol means 2% less cardiovascular risk. A very valid reason to consume this oat regularly if you suffer from hypercholesterolemia.

Legumes

There is no rule that states that one type of legume is more effective than another.

Therefore, carte blanche for the consumption of beans, chickpeas, peas, lentils, broad beans and lupins whenever they are i is subject to hypercholesterolemia. Their action is carried out thanks to the high intake of fibers they provide.

In particular, insoluble fibers facilitate intestinal transit and favor the decrease in the absorption of fats, including cholesterol. Let’s see which are the most fibrous legumes (in 100g of fresh product):

• lentils (dried): 30.5g.
• Borlotti beans: 24.7g.
• Chickpeas: 17.4g.
• Cannellini beans: 15.2g.
• Adzuki beans: 12.7g.
• Soy: 9.3g.
• Borlotti beans (canned): 6.3g.
• Fresh peas: 5.1g.
• Fresh broad beans: 4.2g.

Diet for high cholesterol: consume soy

Its action is twofold. On the one hand, soy is a legume and as such helps regulate intestinal transit.

On the other hand, it contains molecules known as phytosterols which, mimicking cholesterol, are absorbed by the intestine instead of cholesterol itself.

They are a kind of deception that we provide to our digestive system which absorbs the phytosterols and… lets the cholesterol pass. Not being absorbed, the latter is eliminated with the feces.

If you are interested in the topic, discover our in-depth study on soy.

Fruits and vegetables

Again, their role is twofold. The first is always connected with the high fiber content. The second is linked to the high satiating power of this food category.

By consuming them in good quantities in each meal, it is easier to avoid exceeding with foods such as protein or fat second courses, excesses of condiments or sweets.

Fish

Fish, as well as foods rich in omega 3, improve the metabolism of all lipids transported in the blood.

This concept is valid for both cholesterol and triglycerides. In this regard, improving the blood lipid profile is essential to reduce cardiovascular risk.

In fact, omega 3s are fundamental in this respect thanks to their anti-thrombotic, anti-inflammatory and hypotensive function.

Lean cold cuts or lean meats

Foods of animal origin are all characterized by the presence of fats. This does not mean that they should not be consumed if you suffer from hypercholesterolemia.

On the contrary, due to their supply of noble proteins, all 20 amino acids and some essential vitamins such as B12 should never be missing. So how to do?

Choose leaner cuts of meat, such as white meat. Or, alternatively, slices or strips of veal or veal, which are also much less fat than other cuts of the same type of meat.

Dairy products and cheeses

In this case, we are talking about real fake news (or, better still, very summary news). In fact, there is no doubt that higher fat cheeses, as well as whole milk or yoghurts, contain higher amounts of cholesterol.

But, at the same time, skimmed milk and yoghurt or low-fat cheeses such as cow’s milk ricotta can absolutely be consumed even if you suffer from hypercholesterolemia.

So why ban these foods? Rather, we choose the right ones, i.e., those with lower fat content.

Dried fruit

Walnuts, hazelnuts, almonds, pumpkin seeds, flax seeds etc. they are excellent allies because they contain omega 6, a category of polyunsaturated fats known as ‘good fats’.

These fatty acids have a direct action on the production of endogenous cholesterol since they are directly involved in the biosynthesis process of this molecule.

But always be careful not to abuse the quantity. In fact, although considered good fats, omega 6s are still fats.

Avocado

It is a fruit with a content of monounsaturated fatty acids comparable to that of the more famous dried fruit. As such, consumed in moderation due to the total caloric intake, it helps to reduce total cholesterol values.

Diet for high cholesterol: the right seasoning

It is always important to remember that often the problem associated with an unbalanced diet does not lie in the type of food chosen but, in the seasoning, used.

Just think of a plate of pasta: 90g of pasta would be very different if they were served with simple or carbonara sauce. Cholesterol is also influenced by the fat contained in condiments.

So, watch out for abusing the ‘bad’ ones, saturated fats coming from:

• Lard.
• Butter.
• Hydrogenated vegetable oils.

These, in fact, act directly on cholesterol by increasing the fraction of LDL cholesterol. On the contrary, ample space for non-hydrogenated vegetable oils. An example above all? The king of the Mediterranean Diet… EVO oil.

Fortified foods

A fortified food is nothing more than a normal food to which nutrients have been added. In a nutshell, it is as if we added supplements to a food.

In this way, it is possible to consume it while also benefiting from the properties of the molecules that have been added to it. No In the case of cholesterol, plant sterols and stanols can be added to foods because they bind cholesterol (together with the fibers) and hinder its intestinal absorption.

The most common added sterol is the phospholipid lecithin.

In reality, more than a sterol, in this case it is a biological molecule capable of modifying the chemical conformation of the cholesterol molecule. As a result of this modification, lecithin acts as a ‘broom’ capable of cleaning the vessels from the deposited cholesterol.

But where can we find lecithin? This is added, for example, to yoghurts making them real supplements (or, better still, functional foods).

High cholesterol diet: foods to avoid

As previously mentioned, diet affects only 15% of blood cholesterol values. Therefore, there are no foods to eliminate if you suffer from hypercholesterolemia.

On the contrary, there are some foods which, having high concentrations of this fat, should be consumed in moderation.

In general, if you suffer from hypercholesterolemia, you should regulate your intake of:

• animal fats (butter, lard, cream) or excessively fatty meats, including offal and sausages.
• Whole milk or dairy products made from whole milk
• Alcohol.
• Simple sugars.
• Offal
• Saturated vegetable oils: palm and rapeseed or hydrogenated vegetable fats (margarine).
• Molluscs or crustaceans.
• Cooking methods

It is also important to prefer cooking methods that are not excessively greasy, it could therefore be useful to prefer cooking at:

• steam.
• Cartoccio.
• Microwave.
• Low temperature.
• pressure.

High cholesterol diet: example of a weekly menu

The Mediterranean diet, in itself, is recognized for its beneficial properties in the cardiovascular field.

So, the secret is to diversify. In this way, even the occasional consumption of foods containing high doses of cholesterol would have no effect on our health.

Let’s take a closer look at an example of a weekly food pattern to manage our cholesterol.

Cholesterol diet? How to change your lifestyle

When it comes to cholesterol, one aspect should never be overlooked.

In fact, the blood values ​​of this fat can be influenced by food but also by lifestyle.

If the latter were healthy, characterized by a fight against a sedentary lifestyle and constant physical activity, the cholesterol values ​​would be better under control. But what should be done to be able to consider one’s lifestyle healthy? Here are some pointers:

Smoke

Smoking should be avoided as it can alter the elasticity of blood vessels. This loss of function could predispose to a higher incidence of cardiovascular disease.

Sport

Playing sports means stimulating the production of HDL cholesterol at the expense of reducing LDL. The advice is to choose aerobic sports, in which the heart rate can be stimulated for longer times.

Therefore, ample space for ‘extensive’ sports such as:

• Run.
• Cycling.
• Team sports such as volleyball, soccer, or basketball.

Very good options could also be particularly welcome. For example: brisk walking (at least 4-5km/h) and dancing.

Prevention

Monitor for other conditions that may show co-morbidities with high cholesterol. In this regard, above all:

• diabetes mellitus.
• Arterial hypertension.

Source:Iss-Anmco Cardiovascular Epidemiological Observatory