Heart Health: Do I need to eat less cholesterol?

Typically the first food items that are eliminated on a cholesterol-lowering diet are eggs and other foods rich in cholesterol.  But does eating less cholesterol help lower blood cholesterol levels and reduce the risk of heart disease?

The American Heart Association guidelines recommend that you aim to eat less than 300 milligrams of cholesterol each day.¹  Even more strict is the National Institute of Health’s Therapeutic Lifestyle Changes (“TLC”) diet, which recommends that you eat less than 200 milligrams of cholesterol per day to lower LDL cholesterol by 3-5%.²   

On the other end of the spectrum is Harvard School of Public Health, stating “for most people dietary cholesterol isn't nearly the villain it's been portrayed to be. Cholesterol in the bloodstream, specifically the bad LDL cholesterol, is what's most important. And the biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet—not the amount of cholesterol you eat from food.”³

Clearly there are conflicting opinions about whether or not lowering the cholesterol in your diet will make a difference.  Why?  Dietary cholesterol does not have a significant impact on blood cholesterol levels and there are other more important risk factors for heart disease. 

Of the total amount of cholesterol in the body, approximately 75% is made by the liver and 25% comes from foods.  Cholesterol is critical for health; we could not survive without it.  It is important for the structural integrity of our cells, for defense against infections, for brain and nervous system tissue, digestive health, and mood.  It is so important for normal bodily functions that the level is closely regulated; if there is less cholesterol in the diet, the liver makes more and vice versa. 

According to the USDA National Nutrient Database, one extra-large egg contains 203 milligrams of cholesterol.⁴   So are eggs healthy or are they a high-cholesterol trap?  One researcher found that it depends on what the hen eats. Dr. Niva Shapira of Tel Aviv University's School of Health Professions says that all eggs are not created equal. Her research indicates that when hens are fed with a diet low in omega-6 fatty acids from a young age — feed high in wheat, barley, and milo and lower in soy, maize and sunflower, safflower, and maize oils — they produce eggs that may cause less oxidative damage to human health. This is especially important for preventing the development of plaque that could block arteries.

While most people believe that increased dietary cholesterol has a direct connection to the development of plaque in blood vessels, there are other more critical factors.  The real risk is oxidative damage, which depends on the basic vulnerability of the LDL particle (the higher the polyunsaturated fat content, the greater the risk of oxidation), antioxidant status of the cells, the amount of time the LDL particle is in the bloodstream (the shorter the better), and the cumulative exposure to factors that increase oxidative stress (smoking, stress, environmental toxins, infections, and lack of exercise.)

Eating a low cholesterol diet alone is definitely not a sure thing to decrease your risk of heart disease.  Before you give up eggs for the long-term, be sure to ask questions and learn about all of the factors that help protect you from heart disease.  It is far better to adopt a more holistic approach to your diet and lifestyle to protect your health and your life.

References:

¹ Diet and Lifestyle Recommendations.  American Heart Association website. http://www.heart.org/HEARTORG/GettingHealthy/Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp  Accessed December 20, 2012.

² Your Guide to Lowering Your Cholesterol With TLC. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute.  NIH Publication No. 06-5235.  December 2005.

³ The Nutrition Source, Fats and Cholesterol.  Harvard School of Public Health website. http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/  Accessed December 20, 2012.

⁴ USDA National Nutrient Database for Standard Reference, Release 25.  United States Department of Agriculture website. http://ndb.nal.usda.gov/  Accessed December 20, 2012.

Fiber Up, Cholesterol Down

Yesterday I saw one of the frequent commercials for Cheerios, with the claim “Cheerios helps lower cholesterol as part of a heart healthy diet.”  Have you ever thought about how much fiber is enough to make a difference?

The FDA has been on top of health claims such as these so as not to mislead consumers.  The remainder of the claim reads:

“Studies show that 3 grams of soluble fiber daily from whole grain oat foods, like Cheerios cereal, in a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. Cheerios cereal provides 1 gram per serving.”

How does soluble fiber help reduce cholesterol?  Soluble fiber helps reduce the amount of fat absorbed from food, causes cholesterol in the blood stream to be used for bile synthesis, and inhibits the synthesis of cholesterol in the body.

Soluble fibers are commonly found in fruits (especially pear, apple, and citrus fruits), oats, barley, and legumes.  These water-soluble fibers form gels within the digestive tract, and provide many beneficial health effects including:

·     Contributes to feelings of fullness and decreases appetite.

·     Slows the absorption of carbohydrates which can reduce blood sugar.

·     Helps to lower blood cholesterol and triglycerides.

Another type of dietary fiber is insoluble fiber, commonly found in wheat bran, corn bran, whole grain breads and cereals, as well as vegetables.  The main beneficial effect of insoluble fiber is to facilitate the movement of food through the digestive tract, thus preventing constipation.

Chances are that most people who want the health benefits aren’t eating 3 servings of Cheerios per day and need some additional sources of soluble fiber to round out their diet.  Most foods contain both soluble and insoluble fiber, so the easiest way to maximize your intake is to include a variety of fiber-rich foods with a target of 25-30 grams per day.

 

5 Tips for increasing fiber in your diet:

1. Start the day well

Begin your day with a high fiber cereal - opt for varieties containing wheat, oats, or barley. Why not top your cereal with sliced banana, a handful of berries, or a tablespoon of nuts or dried fruit?  Another great option for adding extra crunch and fiber is to toss a handful of seeds on top.

 2. Make your meals colorful

Aim for at least 5 servings of brightly colored fruits and vegetables each day. A serving is roughly 1/2 cup of fresh, frozen, or canned fruits or vegetables. You could also add finely grated vegetables to casseroles, stews, sauces, or curries. Carrots or sweet potato are a particularly good choice for this.

 3. Add some bulk

You can make your meals go further while also making them healthier, by simply adding lentils, mixed beans, chickpeas or barley to soups, casseroles, stews or salads. There is a wide selection of different canned legumes to choose from, or cook your own from the dried varieties. 

Substitute whole wheat pastry flour in place of up to one-half of the white flour for cakes or muffin recipes.  Another delicious alternative is to replace some of the flour in a fruit crumble topping with oats and nuts for a higher fiber, super crunchy version.

 4. Make half your grains whole

Try to include a sandwich on wholegrain or multigrain bread for lunch, or you could make lunchtime a little more interesting by using wholegrain pitas, crumpets, muffins, or wholegrain crackers instead. Using brown rice, quinoa, couscous and whole wheat pasta are other great ways of adding additional fiber to your diet.

 5. Snack healthy

Snack on dried fruits, nuts or seeds, or add them to yogurt and salads for a tasty alternative. If you like to experiment, try adding different dried fruits, nuts and seeds to your home baked recipes.  Try hummus with raw vegetables or with whole grain crackers with a minimum of 2-3 grams of fiber per serving.  Fresh fruits and vegetables are an easy snack to carry with you every day.

The following foods are rich in fiber, with over 3 grams of fiber per serving.  Choose five or more servings per day for a total of at least 25 grams.  Increase fiber gradually over 3 to 5 weeks to allow your digestive tract to get used to the additional fiber.   

FOOD	AMOUNT	FIBER (grams)
FRUIT
Apples with skin	1 medium	5.00
Banana	1 medium	3.92
Blueberries	1 cup	4.18
Figs, dried	2 medium	3.74
Grapefruit	1/2 medium	6.12
Orange, navel	1 medium	3.40
Peaches, dried	3 pieces	3.18
Pear	1 medium	5.08
Raspberries	1 cup	8.34
Strawberries	1 cup	3.98
VEGETABLES
Avocado (fruit)	1 medium	11.84
Beet greens	1 cup	4.20
Broccoli, cooked	1 cup	4.50
Cabbage, cooked	1 cup	4.20
Carrot, cooked	1 cup	5.22
Cauliflower, cooked	1 cup	3.43
Cole slaw	1 cup	4.00
Corn, sweet	1 cup	4.66
Green beans	1 cup	3.95
Kale, cooked	1 cup	7.20
Peas, cooked	1 cup	8.84
Pop corn, air-popped	3 cups	3.60
Potato, baked w/skin	1 medium	4.80
Spinach, cooked	1 cup	4.32
Sweet potato, cooked	1 cup	5.94
Swiss chard, cooked	1 cup	3.68
Winter squash, cooked	1 cup	5.74
CEREAL, GRAINS, PASTA
Bran cereal	1 cup	19.94
Oats, rolled dry	1 cup	12.00
Pasta, whole wheat	1 cup	6.34
Rice, dry brown	1 cup	7.98
BEANS, NUTS, SEEDS
Almonds	1 oz	4.22
Black beans, cooked	1 cup	14.92
Flax seeds	3 tbs	6.97
Garbanzo beans, cooked	1 cup	5.80