High levels of cholesterol, one of several fatty compounds in the blood, are an important contributing factor to increased risk of heart disease. Therefore, doctors now advise patients who have elevated cholesterol levels to lower these levels. Decreasing the intake of dietary cholesterol and fats, adding non-fat and low-fat foods to the diet, losing excess weight and increasing physical activity are means of achieving lower cholesterol levels. For some patients, doctors prescribe drugs that regulate cholesterol levels.
Cholesterol is one of several fatty, wax like substances, called lipids, derived from the diet or manufactured by the body from carbohydrates and fats. In moderate amounts, cholesterol is vital to good health. It is used by the body to build cells and to produce bile salts and sex hormones.
Because lipids are fats and blood is made up mostly of water – and water and fat do not mix – lipids are carried in the blood encased in proteins, in structures called lipoproteins. Although other lipoproteins also contain cholesterol in varying amounts, the most important cholesterol carrying lipoprotein in terms of heart disease risk are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). High levels of LDL and low levels of HDL are associated With an increased risk of heart disease. Ask your doctor what your LDL and HDL levels are.
High levels of cholesterol in the blood contribute to the development of atherosclerosis, the buildup of fatty deposits in the arteries, blocking the flow of oxygen and nutrient containing blood. If the flow of blood through the coronary arteries, which supply the heart muscle tissue, is reduced, the result may be chest pain (angina) or a heart attack.
Unlike LDL, which deposits cholesterol in the lining of the arteries, HDL appears to carry cholesterol away from the artery walls, thereby providing protection from heart disease. A large number of studies have shown that high levels of total cholesterol and LDL cholesterol are associated with an increased risk of heart attack and that lowering these levels reduces the risk.
In addition to being manufactured by the body, cholesterol is supplied by foods of animal origin, including fatty meats, egg yolks, and the saturated fats present in whole milk, butter, cream, cheese, and other dairy products. Saturated fats (those solid at room temperature) increase the amount of cholesterol in the blood. Fats from animal sources, such as suet, lard, butterfat, and chicken fat, are highly saturated; so are two vegetable fats, coconut oil and palm oil, which are widely used in prepared foods such as cakes, puddings, and frozen dinners.
Unsaturated fats, which are oils at room temperature, are of two types: monounsaturated and polyunsaturated. Both help to reduce the cholesterol level in the blood. Peanut oil and olive oil are monounsaturated and corn, soybean, safflower, and sunflower oils are polyunsaturated.
Everyone should know his or her cholesterol levels. Persons with total cholesterol levels below 200 need take no further action other than to have their cholesterol levels checked every 5 years. Persons with a cholesterol level between 200 and 239 are considered borderline and need to discuss with their doctor other possible risk factors for heart disease. Family history or personal history of smoking, premature heart disease, high blood pressure, low HDL level, diabetes, or history of stroke are all important risk factors that need to be discussed with your family doctor.
| MEATS, FISH | Marbled beef, pork, bacon, sausage, and other pork products; fatty fowl (duck, goose); skin and fat of turkey and chicken; processed meats; luncheon meats (salami, bologna); frankfurters and fast-food hamburgers (they're loaded with fat); organ meats (kidneys, liver); canned fish packed in oil. |
| EGGS | Limit egg yolks to two per week. |
| FRUITS | Coconuts (rich in saturated fats). |
| VEGETABLES | Avoid avocados. Starchy vegetables (potatoes, corn, lima beans, dried peas, beans) may be used only if substitutes for a serving of bread or cereal. (Baked potato skin, however, is desirable for its fiber content.) |
| BEANS | Commercial baked beans with sugar and/or pork added. |
| NUTS | Avoid nuts. Limit peanuts and walnuts to one tablespoonful per day. |
| BREADS, GRAINS | Any baked goods with shortening and/or sugar. Commercial mixes with dried eggs and whole milk. Avoid sweet rolls, doughnuts, breakfast pastries (Danish), and sweetened packaged cereals (the added sugar converts readily to triglycerides). |
| MILK PRODUCTS | Whole milk and whole-milk packaged goods; cream; ice cream; whole-milk puddings, yogurt, or cheeses; nondairy cream substitutes. |
| FATS, OILS | Butter, lard, animal fats, bacon drippings, gravies, cream sauces, as well as palm and coconut oils. All these are high in saturated fats. Examine labels on "cholesterol-free" products for "hydrogenated fats." (These are oils that have been hardened into solids and in the process have become saturated.) |
| DESSERTS, SNACKS | Fried snack foods like potato chips; chocolate; candies in general; jams,jellies, syrups; whole-milk puddings; ice cream and milk sherbets; hydrogenated peanut butter. |
| BEVERAGES | Sugared fruit juices and soft drinks; cocoa made with whole milk and/or sugar. When using alcohol (1 oz liquor, 5 oz beer, or 2 1/2 oz dry table wine per serving), one serving must be substituted for one bread or cereal serving (limit, two servings of alcohol per day). |
| MEATS, FISH | Choose lean meats (chicken, turkey, veal, and nonfatty cuts of beef with excess fat trimmed; one serving = 3 oz of cooked meat). Also, fresh or frozen fish, canned fish packed in water, and shellfish (lobster, crabs, shrimp, oysters). Limit use to no more than one serving of one of these per week. Shellfish are high in cholesterol but low in saturated fat and should be used sparingly. Meats and fish should be broiled (pan or oven) or baked on a rack. |
| EGGS | Egg substitutes and egg whites (use freely). Egg yolks (limit two per week). |
| FRUITS | Eat three servings of fresh fruit per day (1 serving = 1/2 cup). Be sure to have at least one citrus fruit daily. Frozen or canned fruit with no sugar or syrup added may be used. |
| VEGETABLES | Most vegetables are not limited (see reverse side). One dark-green (string beans, escarole) or one deep-yellow (squash) vegetable is recommended daily. Cauliflower, broccoli, and celery, as well as potato skins, are recommended for their fiber content. (Fiber is associated with cholesterol reduction.) It is preferable to steam vegetables, but they may be boiled, strained, or braised with polyunsaturated vegetable oil (see below). |
| BEANS | Dried peas or beans (1 serving = 1/2 cup) may be used as a bread substitute. |
| NUTS | Almonds, walnuts, and peanuts may be used sparingly (1 serving = 1 tablespoonful), Use pumpkin, sesame, or sunflower seeds. |
| BREADS, GRAINS | One roll or one slice of whole-grain or enriched bread may be used, or three soda crackers or four pieces of melba toast as a substitute. Spaghetti, rice, or noodles (1/2 cup) or 1/2 large ear of corn may be used as a bread substitute. In preparing these foods, do not use butter or shortening; use soft margarine. Also use egg and sugar substitutes. Choose high-fiber grains, such as oats and whole wheat. |
| CEREALS | Use 1/2 cup of hot cereal or 3/4 cup of cold cereal per day. Add a sugar substitute if desired, with 99% fat-free or skim milk. |
| MILK PRODUCT'S | Always use 99% fat-free or skim milk, dairy products such as low-fat cheeses (farmer's, uncreamed diet cottage), low-fat yogurt, and powdered skim milk. |
| FATS, OILS | Use soft (not stick) margarine; vegetable oils that are high in polyunsaturated fats (such as safflower, sunflower, soybean, corn, and cottonseed). Always refrigerate meat drippings to harden the fat and remove it before preparing gravies. |
| DESSERTS, SNACKS | Limit to two servings per day; substitute each serving for a bread/cereal serving:
ice milk, water sherbet (1/4 cup); unflavored gelatin or gelatin flavored with sugar substitute (1/3 cup); pudding prepared with skim milk (1/2 cup); egg white souffles; unbuttered popcorn (1 1/2 cups). Substitute carob for chocolate. |
| BEVERAGES | Fresh fruit juices (limit 4 oz per day); black coffee, plain or herbal teas; soft drinks with sugar substitutes; club soda, preferably salt-free; cocoa made with skim milk or nonfat dried milk and water (sugar substitute added if desired); clear broth. Alcohol: limit two servings per day (see reverse side). |
| MISCELLANEOUS | You may use the following freely: vinegar, spices, herbs, nonfat bouillon, mustard, Worcestershire sauce, soy sauce, flavoring essence. |