Diet and Lifestyle

Living with high cholesterol, familial hypercholesterolemia (FH), or elevated Lp(a) might make you more alert to your own nutrition. Rightly so. Just because your high cholesterol and Lp(a) is genetic, that doesn’t mean you can’t take steps now to limit your risk for heart disease. You can’t eat your way to those high levels of cholesterol, and no dietary or lifestyle changes will normalize your elevated LDL. With that said, your food choices can make a difference in your cholesterol. A low saturated fat diet has been shown to lower LDL by approximately 10% in individuals with FH. This could lead to a smaller dose of cholesterol lowering medication(s) to manage your LDL. Anyone with an elevated Lp(a) should also work on lowering their LDL cholesterol as much as possible. Even without available medication, you can work to reduce all other risk factors. Overall, healthy eating may help reduce your risk for other health conditions like diabetes, high blood pressure, and certain cancers.

How to Eat Healthy When You Have Inherited High Cholesterol

Living with high cholesterol or FH may cause you to be on alert for nutrition/health related topics and rightly so. Just because your high cholesterol is due to your genetics, doesn't mean that you can't take measures to limit your risk for heart disease.  For those with FH, cholesterol lowering medication(s) is required to lower your cholesterol and LDL-C levels.  You can’t eat your way to those high levels of cholesterol and LDL cholesterol (LDL-C). FH is a genetic disorder that is inherited. No dietary or lifestyle interventions will normalize your elevated LDL-C level.

With that said, diet and your food choices can make a difference in your LDL-C.  A low saturated fat diet has been shown to lower LDL-C by approximately 10% in individuals with FH.  This may allow you to use a smaller dose of cholesterol lowering medication(s) to manage your LDL-C.  Also eating in a healthy way may help to reduce your risk for other health conditions like diabetes, high blood pressure and certain cancers.

Cholesterol-lowering Health Tips
    • Limit intake of cheese. Just one ounce of cheese (one inch cube) has roughly 6 grams of saturated fat. Try a low-fat cheese or use a cheese slicer to slice a couple of slivers of a flavorful cheese to top apple slices or a few whole grain crackers.
    • Eat leaner cuts of beef and pork, such as eye of round and pork tenderloin, and trim as much visible fat as possible before cooking. Reduce portions to 3 ounces, about the size of a deck of cards, and supplement your plate with a variety of colorful vegetables and some whole grains.
    • Replace butter with a liquid oil from the Healthier Fats chart (see below), use cooking oil sprays (Misto Sprayers work great!), or use a small amount of tub margarine.
    • Switch to fat free or 1% milk instead of whole milk, or try soy or almond milk.
    • Use low fat milk in your coffee instead of cream.
    • Replace high fat ice cream and desserts with naturally sweet and colorful fruits or sherbet.
    • In casseroles, soups and stew, cut the amount of animal protein in half and substitute beans (drain and rinse first, if using canned beans) for the remaining amount of meat.
    • Remove skin from chicken and other poultry before eating.
    • Fish is a great source of healthy omega-3 fats. The American Heart Association recommends eating 3.5 ounces of fish (especially oily, omega-3 rich fish) at least twice a week. Note: Tilefish, shark, swordfish, and king mackerel have high mercury content and should be eaten only occasionally.
    • Include a meatless meal at least once a week. Some people are trying “Meatless Monday”, but you can choose the day of the week that works best for you.
    • Choose breads that list the word “whole” as part of the first ingredient, such as “whole wheat flour.” Look for 2 to 3 grams of fiber per slice.
    • Switch to whole grains such as brown rice, quinoa, hulled barley, whole wheat couscous, whole wheat pasta, or bulgur cracked wheat for side dishes.
    • Keep a clear bowl of whole fruit on the counter or table. Research shows that keeping fruits close-by and visible helps us eat more of these disease-fighting super-foods.
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Let's Chat About Fats

As highlighted above, a diet in low saturated fat diet can lower your LDL-C (bad cholesterol). This is because saturated fat tends to cause your LDL receptor sites to "become lazy" at clearing LDL cholesterol out of the system. If your diet is high in saturated fats, it is counter-productive to the medications you take to lower your cholesterol, such as statins, which work hard to increase LDL cholesterol clearance.

The table below highlights which fats are cholesterol-raising and which fats are healthier.

 

CHOLESTEROL-RAISING FATS HEALTHIER FATS
Saturated Fats Trans Fats Monounsaturated Fats Polyunsaturated Fats
Animal Sources: butter, cheese, cream, fatty cuts of meat and processed meats (hot dog, bacon, bologna, salami, sausage), ice cream, lard, poultry skin, sour cream, whole milk

Plant Sources: coconut, palm, palm kerne

Foods with a high probability of containing partially hydrogenated oils:

Baked Goods biscuits, cakes, cookies, doughnuts, muffins, pancake mix, pastries, pie crust, pizza dough

Fried Foods French fries, breaded chicken or breaded fish

Snack Foods - crackers, microwave popcornStick margarine, shortening and non- dairy creamer

Nuts, seeds and natural nut butters: almonds, hazelnuts, pecans, peanuts, pine nuts, pistachios, pumpkin and sesame seeds

Avocados, olivesOils: canola, extra virgin olive, peanut, sesame

High omega-3 seafood: Arctic char, Atlantic mackerel, black cod (sablefish), herring, mussels, wild salmon, sardines, trout

Nuts and seeds: chia, ground flaxseeds, hemp seeds, soy nuts, sunflower seeds, walnuts

Oils: soybean, safflower, corn

FINALLY: Add plant sterols and plant stanols to your diet. They actively reduce LDL-cholesterol and can be found in certain food supplements and substitutes (look for margarine or cheese that states “With added plant sterols/stanols”). An enhanced daily consumption of 2000 to 2500 mg of plant sterols/stanols per day may lower LDL-cholesterol by up to 15%!