Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

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Reviewed by SIAHMSR medical team.

Cholesterol lowering diet

      Dyslipidemia is the medical terminology for elevation of plasma cholesterol, triglycerides (TGs), or both, or a low level of high-density lipoprotein [ HDL] cholesterol level that contributes to the development of atherosclerosis. Or plaques , clots in blood vessels.

Causes of high cholesterol may be primary (genetic) or secondary [caused by lifestyle and other factors].

A sedentary lifestyle with excessive dietary intake of total calories, saturated fat, cholesterol, and trans fats cause elevated levels of bad cholesterol.

Other causes are diseases of liver, pancreas , thyroid and kidneys which leads to high cholesterol. Insulin resistance, obesity and diabetes promotes high cholesterol and eventually clot formation.

Impact of high cholesterol on health

 Commonly high cholesterol causes no symptoms but gradually it can lead to symptomatic diseases such as heart attack, stroke, and peripheral arterial disease.

High levels of triglycerides [TGs] (> 500 mg/dL ) may lead to acute pancreatitis. Very high triglyceride levels can also cause breathing difficulty, confusion and liver enlargement. TGs cause xanthomas on tendons.

High levels of LDL cholesterol is equally dangerous. It may form tendinous xanthomas at the Achilles tendon of heels, elbow, and knee tendons and over metacarpophalangeal joints. High LDL can cause liver cirrhosis in the long run.

 How to diagnose high cholesterol ?

Serum lipid profile [it includes total cholesterol, TG, and HDL cholesterol, LDL cholesterol and VLDL cholesterol)

Diagnosis is by measuring plasma levels of total cholesterol, TGs, and individual lipoproteins.

Treatment involves dietary changes, exercise, and lipid-lowering drugs.

Even if you don’t have any of the symptoms of high cholesterol it is recommended that check your lipid profile at least annually.

Those who are obese, diabetic , hypertensive must check it more frequently to make adequate dietary  or medical treatment

. Physical exercise also has great role in reducing cholesterol and associated risk for various organ diseases.

The diet plan must be formulated based on following things:

v Avoid  saturated fats and take healthy unsaturated fats

v Limit  intake of sugar, sweetened drinks, and red meat

v Include  more fiber rich foods

v Consume  more plant-based protein sources such as beans than choosing red meat.

v Steaming , roasting vegetables with a small amount of vegetable oil is helpful to reduce cholesterol.

v American heart association recommends DASH and the Mediterranean diet as examples of nutritious diets but low in cholesterol and saturated fats.

 DASH diet

This diet pattern includes whole grains ,fruits, vegetables, nuts, fish, lean meat and low-fat dairy foods etc. Fruits and vegetables provide nutrients like potassium, calcium, magnesium, and fiber that are important for fighting high blood pressure. These nutrients can also help improve insulin and glucose levels.

·       The DASH diet promotes consumption of more whole-grain foods, fish, poultry,  nuts

·       Lean meat is recommended while red meat is limited.

·       Healthy fats, such as olive and canola oil or avocados, nuts are included in DASH diet.

·       The diet limits sodium, sweets, sugary drinks, and red meats.

·       Foods that are high in saturated fat, cholesterol, and trans fats

       [Read more]

  Mediterranean diet

Mediterranean diet is a way of eating that focuses on the traditional diet patterns. Mediterranean cuisines mean food choices of people of countries that border the Mediterranean Sea. They choose chiefly foods from plant kingdom, such as whole grains, vegetables, legumes, fruits, nuts, seeds, herbs and spices etc. as the foundation of their diet. Olive oil is the main source of added fat. Mediterranean diet is adapted from this.

    Fish, seafood, dairy and poultry are included in moderation in Mediterranean diet infrequently. Red meat and sweets are eaten only occasionally. The diet focuses mainly on vegetables, fruits, whole grains, pulses, nuts and seeds. Healthy fats such as avocados, olive oil etc. are preferred.

Olive oil is the main fat used in the Mediterranean diet and it is a great source of healthy, monounsaturated fat, which lowers total cholesterol and low-density lipoproteins [bad cholesterol] levels. Nuts and seeds also provide monounsaturated fat and are good for health if consumed in moderation.

The  preferred animal protein is fish and seafood. Oily fish, such as mackerel, herring, sardines, tuna and salmon, are rich in omega-3 fatty acids. Omega-3 fatty acids also help decrease triglycerides and lower the risk of stroke and heart failure. It is also anti-inflammatory in function. Wine is also a component of Mediterranean diet allowed in moderation. [Read more].

v The  American Heart Association (AHA) points out that  fiber helps improve blood cholesterol levels. It also reduces the risk of developing heart disease, stroke ,obesity ,type 2 diabetes.

       There are mainly 2 types of fibers.

·       Soluble fibers—such as psyllium, oat bran, guar gum, and pectin. Studies have shown that fiber intake  reduce cholesterol levels although the exact mechanism is not fully understood. 

·       Another study shows that the inclusion of 10 to 30 g of soluble fiber in a diet results in an approximately 10% reduction in LDL cholesterol. HDL and triglyceride levels remain unchanged[1].

·       Substitution  of vegetable protein for animal protein in the diet using soy-based products

[ eg: Replacing 2 servings of milk with soy milk and 1 serving of meat with tofu] will lower cholesterol, LDL, and triglyceride levels[2].

·       The omega-3 fatty acids EPA and docosahexaenoic acid (DHA) has some role in reducing cholesterol. These fatty acids lower plasma very low density lipoproteins (VLDL) and triglyceride [TGs] concentrations by depressing synthesis of triglycerides in the liver.

·       People  having high VLDL and chylomicron elevations in serum are most benefited by including  fish or fish oil into their diets[3].

 Therapeutic effects of fish oil on elevated triglycerides and chylomicrons can be achieved with 6 to 15 g a day of fish oil (or 3 to 5 g a day of omega-3 fatty acids).

        Dietary modifications should not be overlooked even if pharmacological interventions or drugs are used to control cholesterol. Dietary modification provides additive benefits in the cholesterol lowering process. Several foods distinctly modify LDL cholesterol levels.

Cholesterol reducing diet plan must include the following :

•   Fruits- Include low glycaemic index fruits like berries, plums, grape ,oranges etc.

•   Vegetables-  Include more vegetables like kale, broccoli, spinach etc.

•   Whole grains- cracked wheat, millets, oats etc.

•   Fat-free or low fat dairy products

•   Lean proteins

•   Foods high in unsaturated fats- olive oil ,avocados, nuts, hempseeds, flax seeds, fish rich in omega-3 fatty acids

•   High fiber foods [Readmore]

References

1.    https://pubmed.ncbi.nlm.nih.gov/7985708/

2.    https://pubmed.ncbi.nlm.nih.gov/7596371/

3.    https://pubmed.ncbi.nlm.nih.gov/9322583/

4.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312230/

5.    Meta-Analysis Nutr Metab Cardiovasc Dis

6.    . 2021 May 6;31(5):1325-1338. doi: 10.1016/j.numecd.2020.12.032. Epub 2021 Jan 16. https://pubmed.ncbi.nlm.nih.gov/33762150/ 

7.    https://www.msdmanuals.com/en-in/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia#:~:text=Dyslipidemia%20is%20elevation%20of%20plasma,primary%20(genetic)%20or%20secondary.

8.     https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801#:~:text=What%20is%20the%20Mediterranean%20diet,the%20foundation%20of%20the%20diet.

9.     https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/#:~:text=Research%20has%20consistently%20shown%20that,the%20course%20of%2012%20years.

10.               https://www.nhlbi.nih.gov/education/dash-eating-plan

11.             https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0034-1376990    

12.             https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01098545/related-content