Many of us grew up thinking that high cholesterol foods should be avoided at all costs. We believed we had to eat only egg white omelets, without the cheese, to stay healthy and prevent heart disease. But that advice has changed over time.
It’s still true that diet is an important factor in heart health, and high cholesterol levels are related to cardiac issues. But the cholesterol numbers on nutrition labels are actually not that important – another factor is.
Here’s what you need to know about cholesterol today, how high cholesterol relates to your risk of heart disease, and what you can do to prevent it.
Cholesterol Production in the Body
Cholesterol is a fat that your body needs to build cells, make hormones, and support metabolism and healthy digestion. The body naturally produces cholesterol, but you can also get it from the foods you eat. Cholesterol is found only in foods that come from animal sources.
“Cholesterol is an essential component of all of your cell membranes. Your body, specifically your liver, makes cholesterol. You don’t actually need to eat cholesterol – your body will always make all the cholesterol that you need,” said WWMG cardiologist Dr. Thomas Richardson.
“It’s a continuous cycle where your liver makes cholesterol, the cholesterol gets secreted into the digestive system, then gets resorbed back into the bloodstream, back to the liver.”
When only some of the cholesterol is resorbed, the remainder stays in your bloodstream. High levels of cholesterol in your blood are bad for you. Over time, the buildup can form plaque in the arteries, increasing your risk of heart disease or stroke.
HDL vs LDL Cholesterol
There are two kinds of cholesterol, commonly referred to as HDL (high density lipoprotein) and LDL (low density lipoprotein). Both the cholesterol that you eat, and cholesterol made in the liver, can end up as HDL or LDL in the body.
HDL is considered the “good” kind of cholesterol. It carries cholesterol back to the liver for reabsorption, so having a high level of HDL is considered good for your health.
LDL, which is made of smaller particles, is the “bad” cholesterol. LDL particles accumulate to form plaque on the arteries, and contribute to an inflammatory process called atherosclerosis. Atherosclerosis can cause narrowing of the arteries or sudden obstructions that decrease blood flow and lead to heart attacks, strokes, and peripheral artery disease.
An excessive amount of LDL is considered high cholesterol.
Diet and Cholesterol
Based on extensive research, the 2015–2020 Dietary Guidelines for Americans removed the recommendation to restrict cholesterol in one’s diet. “If you have some [sources of] cholesterol in your diet, it doesn’t necessarily have a huge impact on what the cholesterol levels are in your blood,” said Richardson. It’s the components of your diet that make a difference.
Cholesterol and saturated fats often show up on the same plate, and even in the same foods, such as fried foods and deli meats. And it’s the saturated fat that contributes to high cholesterol.
What you eat “influences how much cholesterol your body makes. Depending on the type of diet you eat, more or less of that cholesterol will be resorbed” into the liver, said Richardson. When less cholesterol is absorbed, more remains in your bloodstream, elevating LDL. This can begin to form the plaque that leads to coronary artery disease.
There’s no cholesterol in food that comes from plants. And research shows that eating a plant-based diet can lower your total cholesterol levels and improve heart health. A completely plant-based diet incorporates vegetables, fruits, whole grains, legumes, nuts and seeds, and is absent of meat, eggs and dairy. Examples of predominately plant-based diets are The Mediterranean Diet and the DASH diet.
The further you move in the direction of a plant-based diet, the more your health will improve.
The Importance of Fiber in Your Diet
The common factor in foods that are good for your heart is that they are high in fiber.
“If you have a high fiber diet, that tends to bind some of the cholesterol” which is then flushed out of the body, “so you don’t end up with as much cholesterol being resorbed from your gut,” said Richardson. This decreases the level of cholesterol being recirculated through the body in the digestive cycle.
“If you have a diet that is mostly fruits, vegetables, whole grains, legumes, nuts and seeds you’ll automatically have a high fiber diet. That will have beneficial effects on cholesterol. It will also have benefits like decreasing high blood pressure and inflammation, and even cancer risk and dementia,” said Richardson.
You could start scanning nutrition labels for high fiber and low-fat content. But a simpler way to achieve a heart-healthy diet is to avoid animal products in favor of minimally processed, plant-based foods.
Treating or Managing High Cholesterol
There are two types of patients with high cholesterol:
- Patients who have already suffered a coronary event – heart attack, stroke, bypass surgery, or a coronary stent for angina.
“These patients need to be on a statin regardless of what their cholesterol level is. We know that if you’ve had a heart attack or a stroke, a potent statin would reduce the risk of a recurrence by about 30%-40%,” said Richardson.
- Patients who have not had – but are at risk of – a cardiac event.
Healthcare providers consider a patient’s risk factors including:
- Age
- Diabetes
- High blood pressure
- Total and HDL cholesterol levels, and
- Smoking history
- Family history of heart issues
and calculate a risk score based on the probability of the patient having a cardiac event within 10 years.
If the patient’s risk score is determined to be high, medication will be prescribed. If they’re at medium risk, a CT scan may be recommended to check for coronary calcium deposits. If the imaging scan identifies calcium deposits (a sign of plaque buildup), the patient is then categorized as high risk, and medication will be recommended. But medication is not a cure-all.
Except for rare instances of disorders that lead to high cholesterol, diet and exercise are the most effective factors in controlling cholesterol levels.
“The cornerstone of any cholesterol treatment plan is trying to improve the patient’s diet. Eating well will have as much, and probably more, effect than any medication,” concludes Richardson.
How to Find Out if You Have High Cholesterol
If you have one or more of the risk factors associated with high cholesterol, visit your WWMG Primary Care provider for labs to measure your HDL and LDL levels. They can also provide support with diet and lifestyle modifications, medication, or refer you to a Cardiologist for further assessment.
If you’ve already suffered a coronary event, or know you’re at high risk, contact WWMG Cardiology for a thorough evaluation. Our experienced and caring Cardiology team will work with you to create an individualized treatment plan to keep you healthy for many years to come.