What to eat if you have high cholesterol
Cosa mangiare in caso di colesterolo alto

Cholesterol and lifestyle

Cholesterol is an important fat: it is produced by our organism and participates in the synthesis of vitamin D and other substances and helps hold the cells together.
Cholesterol also enters the body through food, and if present in excess it can cause risks, because it increases the probability of developing some illnesses (like heart attacks and strokes).
Excessively high cholesterol levels may depend on an array of factors, including:

  • improper diet,
  • excess weight and obesity,
  • physical inactivity,
  • diabetes,
  • smoking,
  • age.

Some of these factors can be modified by changing your lifestyle, including these habits:

  • a healthy diet,
  • weight control,
  • regular physical activity (at least 30 minutes per day, every day),
  • avoiding/limiting harmful habits like smoking and drinking alcohol.

These changes contribute to reducing the concentration of bad cholesterol (LDL cholesterol*), total cholesterol and triglycerides, and increase the levels of good cholesterol (HDL cholesterol*).

*LDL (Low Density Lipoprotein); HDL (High Density Lipoprotein).

 

A dietary regimen based on balanced consumption of fruit, vegetables, whole grains, nuts, legumes, fish, poultry and low fat dairy products, as well as limited consumption of sweets, sugared beverages and red meat, is the foundation of an effective prevention strategy for reducing bad cholesterol and protecting your heart.

A “healthy” diet* should include the following foods and amounts:

  • VEGETABLES: ≥200 grams (2-3 portions) per day;
  • FRUIT: 200-500 g (2-3 portions) per day;
  • GRAINS: 50 g for bread and baked goods; 80 g uncooked pasta or rice (ca. 6 portions per day);
  • FISH: ca. 150 g per portion, at least twice a week;
  • CHEESE: ca. 75 g per portion, no more than 3 times a week;
  • COLD CUTS: ca. 50 g per portion, no more than twice a week;
  • SWEETS: ca. 100 g per portion, no more than twice a week;
  • SUGARED BEVERAGES: ca. 330 ml (a normal size can), less than once a week;
  • ALCOHOL: (including wine, beer and spirits) less than 20 g per day for men and 10 g per day for women.

*List derived from the food pyramid proposed by the Italian Institute of Health [Istituto Superiore di Sanità] as part of the “CUORE” project (www.cuore.iss.it); portions were calculated based on the Reference Levels of Intake of Nutrients and Energy [Livelli di Assunzione di Riferimento di Nutrienti ed Energia] (LARN).

 

Dietary tips for reducing high cholesterol

Eat more fish

Fish, whether fatty or lean, is a food defined as having “a low content of saturated fats”.
Salmon, trout and herring contain high amounts of Omega-3 unsaturated fats, natural remedies (present also in some foods of plant origin, such as walnuts and flax seeds) that favor the normal functioning of the heart.

 

Fruit and vegetables: keys to wellbeing

Consuming 5 or more portions per day of fruit and vegetables, naturally cholesterol-free, ensures a high intake of nutrients (vitamins and minerals), protective antioxidants and fiber and a limited quantity of calories. Healthy eating habits can contribute to reducing high levels of cholesterol.

Tips and suggestions for preparing healthy dishes with fruit and vegetables:

  • When you cook vegetables, use a tablespoon of extra virgin olive oil and, if necessary, add a little water while cooking.
  • Replace heavy sauces and condiments with spices and herbs.
  • Add several colored vegetables to your salads; carrots, broccoli and cauliflower are rich in fiber; broccoli, asparagus, fresh peas and spinach contain high amounts of folic acid, which is important in lowering levels of homocysteine (a substance that favors the oxidation of bad cholesterol).
  • Use puréed fruit or vegetables instead of oil when you make muffins, cookies and cakes.

 

Legumes: a tasty alternative to meat

Legumes, like beans, peas, lima beans, chick peas and lentils, are naturally rich in protein and fat-free; these characteristics make them a valid and healthy alternative to meat.

 

Grains, whole if possible

Eating 6 or more portions of grains per day (particularly whole grains), like pasta, rice, bread and other baked goods, ensures an adequate intake of complex carbohydrates, vitamins, minerals and fiber.
Carbohydrates are classified based on their glycemic index (GI), which reflects their capacity to increase glucose levels (glycemia): the lower the GI, the less glycemia induced.
Foods rich in low GI carbohydrates are particularly recommended for the prevention and treatment of pathologies of involving the metabolism of carbohydrates, like diabetes.
Fibers contribute to lowering cholesterol, inducing a feeling of satiety and helping to control body weight.
Suggestions for eating the right amount of fiber:

  • choose bread or pasta made from whole grain flour;
  • use whole wheat bread also for making bread crumbs and croutons;
  • use brown rice instead of white rice.

 

Fats: ok, but of high quality (and in the right amount)

Although the consumption of fats should be limited, fatty foods should not be entirely shunned. It is advisable, therefore, to pay attention to the quality and quantity of the fats included in your diet.

  • Quality – not all fats are alike: vegetable oils (for example, extra virgin olive oil, rich in unsaturated fat) are high quality fats; if consumed in moderation, they can be a regular part of your diet. Unsaturated fats are also present in some nuts, like walnuts, and in avocado and salmon. Low quality fats are instead found in margarine, tropical oils, fatty or processed meat, sweets, cream, butter and cheese (all foods high in saturated and trans fats).
  • Quantity – Fats should account for one quarter to one third of daily caloric intake (or about 50-70 grams per day). Factors such as sex, degree of physical activity and body weight can influence these values, so it is advisable to consult your physician to evaluate the amount of fat that you should consume as part of your daily diet.

 

Eggs are allowed, but in moderation

Recent studies have shown that eating one egg every day does not increase cholesterol levels or the risk of cardiovascular disease. However, eggs should be consumed in limited amounts if you have diabetes.
Nuts (like almonds, walnuts and pistachios) can help reduce cholesterol.
Studies have found that consuming 36 almonds (equal to ca. 42.5 grams) 5 days a week can contribute to reducing levels of bad cholesterol.

 

The Mediterranean diet: an ideal cuisine

This dietary regimen is based on the consumption of large amounts of fruit, nuts, vegetables, legumes, fish and, above all, extra virgin olive oil (which helps lower total cholesterol and bad cholesterol) and limited consumption of red meat and saturated fat.

 

What foods to avoid if you have high cholesterol

In a dietary approach designed to keep cholesterol levels under control, it is recommended to avoid (or at least limit) the consumption of foods containing:

  • Saturated fats: these substances contribute to an increase in levels of LDL cholesterol: for this reason, it is important that the amounts of these animal fats not account for more than 10% of your daily caloric intake. Saturated fats are concentrated in products of animal origin: products based on whole milk and fatty meat are high in saturated fats, while fish and crustaceans, like shrimp, crab and lobster contain low levels of saturated fats.
  • Trans fats: It has been shown that trans fats (for example, hydrogenated fats) impact cholesterol levels, increasing the proportion of LDL (bad) cholesterol and reducing HDL (good) cholesterol. This means that you should consume as little as possible of foods rich in trans fats, like margarine.
  • Cholesterol: this fat, derived from dietary intake, contributes to increasing levels of cholesterol in the body, although not as much as saturated fats. Like saturated fats, cholesterol is also present in foods of animal origin, and is particularly abundant in eggs and mollusks.
  • Refined sugar: refined sugar (contained in abundance in sweets and sugared beverages) has a negative impact on carbohydrate metabolism and the lipidic balance (increasing triglycerides and reducing HDL cholesterol) and should thus be replaced by foods containing more complex sugars (like bread and pasta).
  • Salt: excessive consumption of salt (sodium) can be dangerous for the heart, so it is important to cut down on the amount of salt you consume daily.

Some simple strategies can help you apply these recommendations concretely.

Eat less meat

Red, fatty meat, like salami, game and meat with visible fat should be consumed in limited quantities, because of their high saturated fat content, and instead replaced with white meat like chicken and turkey (skinless), veal and rabbit, and in general with leaner cuts (bresaola, prosciutto without fat, filet).
The following tips will help you reduce the saturated fat content in meat as much as possible:

  • Select the meat with care, choosing the leaner cuts (ex: beef sirloin or tenderloin, pork filet or loin), with the least visible fat.
  • Cut away all the visible fat on the meat before cooking.
  • Moisten the meat with wine, lemon juice or an olive oil marinade instead of solid fats like butter or margarine.
  • Stews, boiled meat, broth and other meats cooked in liquid can be refrigerated, making it easy to skim off the fat that forms on the surface of the cooking liquid.
  • Brown your meat on a grill instead of in a pan.
  • Choose chicken and turkey over duck and goose, which contain more fat.
  • Remove the skin from chicken and turkey before cooking or before eating.
  • Limit or eliminate consumption of processed meat like sausage, luncheon meat and salami.

 

Limit your intake of fats contained in milk

  • Low fat (1%) or skim milk can be used in many recipes instead of whole milk.
  • Replace high fat cheese and dairy products with ricotta or low fat cheese.

 

If possible, avoid adding salt to your food, following the tips below:

  • The use of herbs and spices to add flavor to your food can be a valid alternative to salt.
  • Reduce the amount of salt you add to your food, both during cooking and before eating.
  • Limit your use of sodium-rich condiments, like ketchup, mustard, soy sauce, etc.
  • Read the nutritional content labels. The best options have less than 200 mg of sodium per portion. Avoid processed food with more than 400 mg of sodium per portion.
  • Avoid fast food, which often has a high sodium content.
  • If you are eating at a restaurant, ask that your dishes be prepared without adding salt.

 

A “Blacklist” of foods to avoid (or to eat in limited quantities):

  • hypercaloric foods,
  • pickled products,
  • cakes, sweets and sugared beverages,
  • solid fats (butter, lard, hard margarine),
  • processed and preserved animal products,
  • egg yolks,
  • palm and coconut oil,
  • excess alcohol.

 

Cholesterol and dietary supplements

A healthy and balanced diet, control of your body weight, regular physical activity (sport, walking, biking, doing housework) and abstaining from smoking are important factors for keeping levels of LDL cholesterol within normal limits. Sometimes, however, adopting a healthier lifestyle is not enough to keep bad cholesterol under control, and a specifically designed treatment may be necessary.
Current guidelines for managing dyslipidemias suggest dietary strategies, based on the consumption of specific foods and/or nutritional supplements, to be used in combination with a healthy dietary regimen.
Among the supplements that can help lower cholesterol, the guidelines indicate the following:

  • phytosterols (plant sterols), compete with cholesterol for intestinal absorption, thus helping keep total cholesterol under control. They are found naturally in vegetable oils, greens, fresh fruit, chestnuts, grains and legumes.
  • Soy proteins, which can replace proteins of animal origin.
  • Nutritional fiber, particularly insoluble fiber, found mostly in whole grains, greens and fruit.
  • Omega 3 unsaturated fatty acids, found in fish oil, chestnuts, some vegetables and some seed oils.
  • Monacolin and red yeast rice, used in China for centuries as a food coloring and flavor enhancer, contributes to maintaining levels of circulating cholesterol within normal limits.
  • Policosanols, found in sugar cane, rice and wheat germ.
  • Berberine, found in many medicinal plants, this substance has historically been used in Chinese traditional medicine.

Bibliography

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  • Documento di consenso e raccomandazioni per la prevenzione cardiovascolare in Italia. G.Ital Cardiol 2018.
  • ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart Journal. 2016;37: 2999–3058
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  • Istituto Superiore di Sanità – Epicentro. Colesterolo e ipercolesterolemia. http://www.epicentro.iss.it/colesterolo/. Ultimo accesso: Luglio 2019
  • Istituto Superiore di Sanità- progetto CUORE. Disponibile al link: http://www.cuore.iss.it/prevenzione/prevenzione.asp. Ultimo accesso: Luglio 2019
  • Ministero della Salute – direzione generale per l’igiene e la sicurezza degli alimenti e la nutrizione – Linee Guida Per La Prevenzione Dell’aterosclerosi. Sett 2004.
  • National Institute of Health- Your guide to lowering your cholesterol with TLC. Disponibile al link: https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf
  • Ottawa Cardiovascular Centre. Eating plan for high cholesterol (hyperlipidemia). Disponibile al link: http://www.cvtoolbox.com/downloads/diets/high_cholesterol_eating_plan_2010.pdf. Ultimo accesso: Luglio 2019
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