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Cholesterol: Should I change my diet?

Reviewed by our expert panel
Heart made of cholesterol-lowering foods

If you have high cholesterol, take heart. It is possible to manage your cholesterol levels through diet. Nutritionist Fiona Carruthers looks at what foods are good for your heart and can help lower cholesterol and editor Andrea Duvall explores the Portfolio Diet for lowering cholesterol.

Here’s what we cover:

Try to think about eating a healthy, balanced diet rather than restricting or forcing yourself to eat specific foods. That said, it’s important to look carefully at the food you’re eating.

Foods containing cholesterol are not necessarily the ones you have to stop eating. Originally it was thought eating foods containing cholesterol would increase blood cholesterol levels.

Makes some sense after all, but the body is cleverer than us. If we eat cholesterol in our food, our body makes less to compensate.

Eggs are a good example of a cholesterol-containing food, and one previously restricted. We now know eggs and other cholesterol-containing foods, such as prawns, shrimps, squid, liver and kidney, can still be enjoyed in moderation when you are trying to reduce your blood cholesterol level. On average we eat three eggs a week, which is fine for most people.

More important than the cholesterol in a food is the fat, specifically the saturated fat. It can increase cholesterol levels by increasing the ‘bad’ LDL carriers.

About half of the saturated fat in our New Zealand diet comes from animal foods, namely butter, dairy products like milk and cheese, and fatty meats.

Other foods contributing significant amounts of saturated fat include cakes, biscuits, pies and pastries, where the saturated fat is hidden and can’t be removed. They also contain trans fat. So it’s a good idea to cut out or at least limit some foods like pies and cakes and other manufactured snack foods.

But dairy products and meat are important sources of many nutrients in most people’s diets. Reduce your saturated fat intake by choosing low-fat milk or yoghurt and lean cuts of meat, and removing skin from chicken.

Take care with cooking methods and dressings; watch the hollandaise sauce on your eggs benedict as it’s high in saturated fat. Enjoy your eggs ‘undressed’: boiled, poached or scrambled with low-fat milk rather than fried in butter, and eat your seafood grilled or pan-fried in unsaturated oil, not battered and deep-fried.

Butter vs margarine for cholesterol

Butter and dairy foods, such as cheese, cream and blue-top milks, all contain saturated fat.

Margarine, in contrast, is usually higher in unsaturated fat, when it is made from sunflower, canola, olive or similar oils. This means margarine should be better for lowering cholesterol levels.

But it’s worth taking a look at the label on your spread. The process of turning oil into margarine changes the shape of some fats, producing what are called ‘trans’ fats. This type of fat not only increases ‘bad’ LDL levels, but also reduces ‘good’ HDL levels. But before you rush back to butter, the good news is margarine manufacturers have worked hard to reduce the levels of trans fat in their products, and many now legitimately claim to be virtually trans fat-free.

It’s also worth remembering butter or margarine must be 80% fat to be called that on the labels, but there are now many other spreads much lower in fat, some as low as 40%.

Lowering your fat intake will help control your weight so the bottom line is, with any spread, spread it thinly. If you can see your teeth marks clearly, you’re using too much.

Cheese and cholesterol

With most dairy foods there are lower-fat versions available, and cheese is no exception. Choose small amounts of the lower-fat varieties, or those already lower in fat, such as cottage cheese, edam, brie and camembert.  The table below shows how much fat is in each type of cheese:

Type of cheese % fat % saturated fat
Cream cheese 37 23
Cheddar; colby 35 22
Blue vein 30 20
Parmesan; powder 29 19
Edam 26 17
Reduced-fat cheddar 24 16
Camembert 22 14
Feta 20 13
Parmesan; block 20 14
Mozzarella 18 12
Light cream cheese 13 8
Ricotta 11 7
Low-fat cheese slices 7 5
Cottage cheese 4 2
Low-fat cottage cheese <1 <1

Also consider cheese as part of a meal rather than a snack food, so avoid cheese and crackers before a meal for example. Save cheese for a lunchtime sandwich or within a main meal dish and really savour it.

Meat

Enjoying a steak is one of life’s many pleasures and can be continued when trying to reduce a high cholesterol level. Although fat on meat is about 50% saturated, it’s also visible, so it can be removed easily.

Red meat in New Zealand comes from animals raised on pasture, which means it contains very little fat within the meat itself, unlike the ‘grain-fed’ meat that’s common overseas.

Always buy lean cuts of beef and lamb, which generally contain less than 10% fat, comparable with other lean meats like chicken. With pork look for lean or ‘trim’ cuts and always take off the fat, and be careful with bacon – avoid the streaky types and always take any fat off.

Processed meat – salami, pastrami, sausages etc – can be very high in fat which can’t be removed (the white bits in salami are fat!) so use these in smaller amounts or cut them out altogether and replace them with leaner meats.

Porridge

About 1 1/2 cups of cooked oats may be enough to affect your cholesterol levels. It is the type of fibre in oats, known as soluble, which appears to lower ‘bad’ LDL, as well as possibly protect blood vessels from its harmful effects.

But that is a huge serving, so if your bowl size is more modest, try adding some dried or stewed fruit to your porridge as additional sources of fibre.

Cholesterol-friendly snacks

  • Chopped vegetables sticks with low-fat dips, such as a tomato salsa
  • A handful of nuts – but only the one!
  • Rice crackers with a small sachet of tuna or salmon
  • Whole grain bread sandwich with lean roast beef
  • Milky coffee made with trim milk
  • Oatcake with low-fat cheese
  • One or two squares of chocolate – the predominant type of saturated fat in chocolate doesn’t raise cholesterol, but it still contains plenty of calories, so keep it as a treat!

The Portfolio Diet

This diet involves — you guessed it — a portfolio (or group) of foods that have been clinically proven to lower raised cholesterol, by up to 35 per cent in some cases. This is the same degree of reduction that doctors can achieve with drugs. (Health professionals often prescribe statins, drugs that reduce blood-cholesterol levels, to people who have coronary heart disease or believed to be at high risk of developing the condition.)

Safety first

The Portfolio Diet is a very healthy way of eating, but it’s not meant to replace medication. For people with high-cholesterol levels and no added complications, this eating plan can be a successful starting point for bringing down cholesterol. Keep in mind, if you’re currently taking any prescribed cholesterol-lowering drugs, it’s important you continue to do so.

The good news is this eating plan can work well alongside prescription drugs, so talk to your doctor about whether it’s suitable for you. If so, he or she can then design a balanced treatment program to help you fight high cholesterol on all fronts.

So what can I eat?

The Portfolio Diet is based on the following foods and nutrients, all of which are readily available, and should feature on your day-to-day menu.

Nuts

In a nutshell, almonds are great for our health. High in heart-friendly fats and vitamin E, they appear to reduce some of the production of LDL cholesterol — the ‘bad’ type of cholesterol. According to studies, other types of nuts including peanuts, cashews, pecans, pistachios, walnuts and Brazil nuts, are likely to have a similar effect. Nuts are also low in unhealthy saturated fat and are great sources of hunger-busting fibre and protein.

Still, portion control is key. Nuts are high in kilojoules, so you risk gaining weight if eaten in large amounts warns Milena Katz, the spokesperson for the Dietitians Association of Australia. “Nuts are energy dense, so you have to rid your diet of other energy-dense foods such as biscuits and cakes.”

Your daily target: About 30g (a small handful)

  • Make unsalted nuts your go-to morning or afternoon snack
  • Scatter chopped almonds or walnuts on top of cereal
  • Toss cashews into a salad for lunch or a stir-fry for dinner
  • Add whole or ground nuts to home-made loaves and muffins

Soy

Soybeans are full of soluble fibre, the type that helps absorb excess cholesterol in the blood. These protein-rich beans are also rich in heart-friendly phytoestrogen, a plant hormone that mimics the effects of the body’s hormone, oestrogen. While researchers are unsure of the exact mechanism behind soy’s beneficial effects on blood cholesterol, studies show populations that rely on soy as a staple, such as Japan, enjoy lower rates of heart disease than those who eat a typical meat-based Western diet.

Your daily target: 50g of soy protein

  • Add calcium-fortified soy milk or soy yoghurt to breakfast cereal or porridge
  • Order coffees with soy milk
  • Add firm tofu to stir-fries and curries
  • Switch to soy–linseed bread for toast and sandwiches
  • Use silken tofu to make salad dressings or egg-based dishes, such as quiche
  • Try soy-based products such as vegetarian soy burgers

Soluble fibre

Like soy, foods such as oats, barley, lentils, kidney beans, chickpeas and fruit (particularly pears, oranges and grapefruit) are high in soluble fibre.

Fibre works wonders for our bodies. This helpful substance combines with water in the stomach to form a gel, trapping some of the cholesterol in our digestive systems. The good news is, the body then excretes the gel, lowering the amount of cholesterol our body is able to absorb.

Your daily target: 20g of soluble fibre

  • Eat porridge or an oat-based cereal for brekkie
  • Fill up on baked beans at lunch
  • Spread hommous on wraps and sandwiches, or eat with crudités
  • Toss chickpeas, lentils or barley into salads, soups and casseroles
  • Snack on fresh fruit such as berries, apples and pears

Plant sterols

Studies show if you eat these naturally occurring substances in the right amounts, they can lower cholesterol by as much as 10 to 15 per cent.

Research suggests phytosterols help to lower cholesterol much like soluble fibre does: They hold onto cholesterol in the digestive system, preventing our bodies’ from absorbing it properly into our bloodstream.

Small amounts or plant sterols can be found naturally in foods such as vegetables, fruit, olive oil, seeds, legumes (including beans, chickpeas and lentils) fruit, nuts and soy.

But to get the full benefits for your heart health, you will also need to eat foods that have been enriched with phytosterols.

Your daily target: 2-3g of plant sterols

  • Enjoy two to three cups of Dairy Farmers HeartActive milk, on cereal or in fruit smoothies
  • Replace butter with two teaspoons of a plant sterol-enriched table spread such as Flora pro-activ or Logicol
  • Meet your daily quota of five serves of veg by piling half your plate with colourful produce at lunch and dinner

More reading: Your questions on cholesterol answered 

First published: Jul 2007
Last updated: November 30, 2020

Article sources and references

  • Peng‐Fei Xia, et al. Dietary Intakes of Eggs and Cholesterol in Relation to All‐Cause and Heart Disease Mortality: A Prospective Cohort Study. Journal of the American Heart Association. 2020;9, Originally published13 May 2020https://doi.org/10.1161/JAHA.119.015743
    https://www.ahajournals.org/doi/10.1161/JAHA.119.015743
  • Dongjoo Cha and Yongsoon Park. Association between Dietary Cholesterol and Their Food Sources and Risk for Hypercholesterolemia: The 2012–2016 Korea National Health and Nutrition Examination Survey. Nutrients. 2019 Apr; 11(4): 846. Published online 2019 Apr 15. doi: 10.3390/nu11040846
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520795/
  • Rita Nilsen, et al. Effect of a high intake of cheese on cholesterol and metabolic syndrome: results of a randomized trial. Food Nutr Res. 2015; 59: 10.3402/fnr.v59.27651. Published online 2015 Aug 19. doi: 10.3402/fnr.v59.27651
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543447/
  • Vanu R Ramprasath, et al. Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds. Nutr J. 2014; 13: 101. Published online 2014 Oct 18. doi: 10.1186/1475-2891-13-101
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223745/
  • Kay-Tee Khaw, et al. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open. 2018; 8(3): e020167. Published online 2018 Mar 6. doi: 10.1136/bmjopen-2017-020167
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855206/

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