Cholesterol lowering through lifestyle changes
Your doctor may have suggested you make changes to your diet and physical activity levels to lower your cholesterol, because while cholesterol is essential for your body, high levels of cholesterol in the blood can increase your risk of heart disease and stroke.
Changes to diet and physical activity can play an important role in lowering cholesterol. By simply making changes to their diet and activity levels, some people can reduce their need for cholesterol-lowering medicines or avoid them entirely.
‘Good’ and ‘bad’ cholesterol
Not all cholesterol is the same. The important types are:
- LDL-cholesterol – so-called ‘bad’ cholesterol, which contributes to atherosclerosis (narrowing and hardening of the arteries) by depositing plaque in the artery walls. In this way, LDL cholesterol contributes to heart disease, heart attack and stroke.
- HDL-cholesterol – so-called ‘good’ cholesterol, which helps remove LDL from the bloodstream and takes it back to the liver. High levels of HDL cholesterol in the blood are associated with a reduced risk of heart disease.
And, there is another type of lipid, like cholesterol, that is important in heart health called triglycerides:
- Triglycerides – a type of fat found in blood that comes from your diet. Triglycerides are stored in your fat cells, to be used later when you need extra energy. They contribute to narrowing and hardening of the arteries and so raise the risk of heart disease, heart attack and stroke.
There are some basic lifestyle measures you can take to improve your levels of good and bad cholesterol and triglycerides.
Saturated fat and trans fat
Too much saturated fat in the diet can lead to raised LDL (‘bad’) cholesterol levels, so it’s advisable to reduce your intake of saturated fat.
- Saturated fats are found in foods from animal sources, such as red meat, poultry fat, dairy products, and also in some plant oils, including coconut oil and palm oil. Where possible, they should be replaced with heart-healthy unsaturated fats, such as olive oil, avocados, nuts and canola oil.
Trans fat is a type of unsaturated fat that acts like a saturated fat in the body. Trans fat is thought to be especially damaging to heart health because it increases your LDL (‘bad’) cholesterol level and decreases your HDL (‘good’) cholesterol level.
- Trans fats can be found in commercially baked cakes, biscuits, crackers and chips, but at the moment are not required to be listed on food labels in Australia. Foods labelled as containing “partially hydrogenated” vegetable oils contain trans fats.
The Australian Dietary Guidelines provide general guidance for everyone, but if you follow them they will reduce your risk of heart disease. The Guidelines stress that healthy eating should be followed long term.
The Guidelines recommend Australians:
- consume a variety of vegetables, fruit, wholegrain breads and cereals, and legumes (such as chickpeas, lentils and kidney beans);
- eat 2-3 serves of oily fish per week;
- replace full-fat dairy foods with low-fat dairy products;
- choose lean meat and poultry;
- do not add salt to cooking or meals;
- avoid highly processed foods;
- limit intake of foods containing saturated fat, added salt, added sugars and alcohol;
- drink water.
The Australian Dietary Guidelines form general advice for healthy eating which will result in a lowering of your risk of cardiovascular (heart, stroke and blood vessel) disease. But some of the following foods have been shown to have specific cholesterol-lowering properties:
- Soluble fibre: Soluble fibre can reduce the absorption of cholesterol into your bloodstream. Examples of foods that contain soluble fibre are oats, lentils, kidney beans, barley, apples and pears and psyllium husks.
- Monounsaturated fats such as avocado and olive oil have been shown to improve blood cholesterol.
- Tree nuts (also monounsaturated fats) such as almonds, walnuts, hazelnuts, pecan nuts and pistachio nuts have been shown to improve cholesterol levels. Remember they are high in calories, so a handful a day is a good serve.
- Fish contains polyunsaturated fatty acids, which may help heart health, and for this reason the Heart Foundation recommends that you eat 2 to 3 (preferably oily) fish meals per week. Fish oil supplements are often part of treatment to lower triglycerides.
Plant sterols (phytosterols) and plant stanols are compounds naturally occurring in plants, which have been shown to have LDL-cholesterol-lowering properties. The Heart Foundation recommends that adult Australians at high risk of cardiovascular disease consume 2-3 g of phytosterols per day. While a small amount of this can come from eating vegetable oils, seeds, legumes, and fruit and vegetables, to obtain a cholesterol-lowering effect, a person needs to eat some plant-sterol enriched foods, such as special margarines, breakfast cereals, reduced fat yoghurt, reduced fat milk, or lower fat cheese. These enriched foods can be found in most supermarkets. Plant sterols will be listed as an ingredient on the nutrition label. They should not be taken by pregnant women or children without seeking medical advice first. Taking more than the recommended amount will not lower your cholesterol any further than already achieved.
Maintain a healthy weight or lose weight if you are overweight or obese. This means you should aim for a BMI (body mass index) between 18.5 and 24.9, however, even a weight loss of 5-10% of your original bodyweight can have a beneficial effect on your heart risk.
Losing weight has a favourable effect on heart disease risk by reducing LDL-cholesterol levels and triglycerides and increasing HDL (good) cholesterol for people who are overweight or obese.
Your doctor or a registered dietitian will be able to advise you on the best way to go about losing weight.
Being physically active can help increase your HDL (‘good’) cholesterol levels. This is a good thing as HDL takes ‘bad’ cholesterol (LDL-cholesterol) out of circulation and back to the liver.
- Australian guidelines recommend 30 minutes of moderate intensity physical activity, such as brisk walking, on most or preferably every day. This can be accumulated in sessions of 10 minutes if it’s not possible to do it all at once. For moderate intensity activity, it should require effort, but you should still be able to have a conversation.
- Increasing your physical activity can also help you lose weight, reduce your blood pressure, and improve both your cardiovascular and mental health.
- Doing any physical activity is better than doing none.
- Start with a comfortable level of activity, and build up gradually to the recommended amount. If you have any concerns about your health, get advice from your doctor first.
- Try to build activity into your daily routine. For example, take the stairs instead of the lift, get off the train or bus one stop early, or walk in your lunchbreak at work,
Drinking alcohol is no longer recommended for improving your heart health, so if you don’t drink alcohol, there is no benefit to starting.
In addition, alcohol seems to have a strong effect on raising triglyceride levels – a type of blood fat that increases the risk of heart, stroke and blood vessel disease by contributing to atherosclerosis (hardening or narrowing of the arteries). So if you have raised triglycerides it is recommended that you reduce your alcohol consumption. In any event, general Australian guidelines recommend limiting alcohol to 2 or fewer standard drinks per day.
Cigarettes damage your heart and blood vessels in several ways, including reducing the level of ‘good’ HDL cholesterol in the blood. The good news is that quitting smoking can improve your HDL levels and can halve your risk of heart disease within 12 months. There are various resources available to help you quit, including counselling, nicotine replacement therapy and other medicines. Your doctor will be able to advise you on the best resources to help you quit. You should also try to avoid exposure to second hand smoke.
You may still need medicines
If lifestyle changes do not lower your cholesterol levels sufficiently, your doctor may suggest you take cholesterol-lowering medicines. However, this does not mean that you should abandon your lifestyle changes – they are still working to lower your risk of cardiovascular disease and may mean you take less medication than you would need otherwise.
2. Behavioural risk factor modification (revised Oct 2012). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Mar. 5. http://online.tg.org.au/complete/desktop/index.htm (accessed June 2015).
3. Australian Government. NHMRC. Dept of Health and Ageing. Australian Dietary Guidelines 2013. Summary. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55a_australian_dietary_guidelines_summary_131014.pdf (accessed June 2015).
4. Heart Foundation. Eat fish for a healthy heart. 13 April 2015. https://www.heartfoundation.org.au/news-media/Media-Releases-2015/Pages/eat-fish-healthy-heart.aspx (accessed June 2015).
5. National Vascular Disease Prevention Alliance. 2012. Guidelines for the management of absolute cardiovascular disease risk. http://strokefoundation.com.au/site/media/AbsoluteCVD_GL_webready.pdf (accessed June 2015).
6. National Vascular Disease Prevention Alliance 2012. Manage your heart and stroke risk. A 3-step guide to better health. http://strokefoundation.com.au/site/media/NVDPA_manage_your_heart_stroke_risk_2012.pdf (accessed June 2015).
7. Department of Health. Australiaâ€™s Physical Activity and Sedentary Behaviour Guidelines. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines/$File/Tips&Ideas-Adults-18-64years.PDF (accessed June 2015).
8. Mayo Clinic. High cholesterol. http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/hdl-cholesterol/art-20046388?pg=2 (accessed June 2015).
9. Icanquit. Discover the health benefits of quitting smoking. https://www.icanquit.com.au/health/reasons-to-quit/health-benefits (accessed June 2015).
10. Food Standards Australia New Zealand. Plant sterols. (Last updated Nov 2011). http://www.foodstandards.gov.au/consumer/nutrition/plantsterol/Pages/default.aspx (accessed June 2015).
11. Dietitians Association of Australia. Plant sterols and stanols. http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/plant-sterols/ (accessed June 2015).
12. Heart Foundation. Position statement: Phytosterol/stanol enriched foods 2007 (updated December 2009). http://www.heartfoundation.org.au/SiteCollectionDocuments/Stanol-enriched-foods-position-statement.pdf (accessed June 2015).
13. Australian Government Department of Health. Australiaâ€™s Physical Activity and Sedentary Behaviour Guidelines. Fact sheet: Adults (18-64 years). http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines/$File/FS-Adults-18-64-Years.PDF (accessed June 2015).