5.7: Tools for Change

Being conscious of the need to reduce cholesterol means limiting the consumption of saturated fats and trans fats. Remember that saturated fats found in some meat, whole-fat dairy products, and tropical oils elevate your total cholesterol. Trans fats, such as the ones often found in margarines, processed cookies, pastries, crackers, fried foods, and snack foods also elevate your cholesterol levels. Read and select from the following suggestions as you plan ahead:

1. Soluble fiber reduces cholesterol absorption in the bloodstream. Try eating more oatmeal, oat bran, kidney beans, apples, pears, citrus fruits, barley, and prunes.
2. Fatty fish are heart-healthy due to high levels of omega-3 fatty acids that reduce inflammation and lower cholesterol levels. Consume mackerel, lake trout, herring, sardines, tuna, salmon, and halibut. Grilling or baking is the best to avoid unhealthy trans fats that could be added from frying oil.
3. Walnuts, almonds, peanuts, hazelnuts, pecans, some pine nuts, and pistachios all contain high levels of unsaturated fatty acids that aid in lowering LDL. Make sure the nuts are raw and unsalted. Avoid sugary or salty nuts. One ounce each day is a good amount.
4. Olive oil contains a strong mix of antioxidants and monounsaturated fat, and may lower LDL while leaving HDL intact. Two tablespoons per day in place of less healthy saturated fats may contribute to these heart-healthy effects without adding extra calories. Extra virgin olive oil promises a greater effect, as the oil is minimally processed and contains more heart-healthy antioxidants.

Testing Your Lipid Profile

The danger of consuming foods rich in cholesterol and saturated and trans fats cannot be overemphasized. Regular testing can provide the foreknowledge necessary to take action to help prevent any life-threatening events.

Current guidelines recommend testing for anyone over age twenty. If there is family history of high cholesterol, your healthcare provider may suggest a test sooner than this. Testing calls for a blood sample to be drawn after nine to twelve hours of fasting for an accurate reading. (By this time, most of the fats ingested from the previous meal have circulated through the body and the concentration of lipoproteins in the blood will be stabilized.)

According to the National Institutes of Health (NIH), the following total cholesterol values are used to target treatment^[1]

• Desirable. Under 200 mg/dL
• Borderline high. 200–239 mg/dL
• High risk. 240 mg/dL and up

According to the NIH, the following desired values are used to measure an overall lipid profile:

• LDL. Less than 160 mg/dL (if you have heart disease or diabetes, less than 100 mg/dL)
• HDL. Greater than 40–60 mg/dL
• triglycerides. 10–150 mg/dL
• VLDL. 2–38 mg/dL

Balancing Your Diet with Lipids

You may reason that if some fats are healthier than other fats, why not consume as much healthy fat as desired? Remember, everything in moderation. As we review the established guidelines for daily fat intake, the importance of balancing fat consumption with proper fat sources will be explained.

Recommended Fat Intake

The acceptable macronutrient distribution range (AMDR) from the Dietary Reference Intake Committee for adult fat consumption is as follows^[2]:

• Fat calories should be limited to 20–35 percent of total calories with most fats coming from polyunsaturated and monounsaturated fats, such as those found in fish, nuts, and vegetable oils.

• Consume fewer than 10 percent of calories from saturated fats. Some studies suggest that lowering the saturated fat content to less than 7 percent can further reduce the risk of heart disease.
• Keep the consumption of trans fats (any food label that reads hydrogenated or partially hydrogenated oil) to a minimum, less than 1 percent of calories.
• Think lean and low-fat when selecting meat, poultry, milk, and milk products.

The current AMDR for child and adolescent fat consumption (for children over four) are as follows:

• For children between ages four and eighteen years, between 25 and 35 percent of caloric intake should be from fat.
• For all age groups, most fats should come from polyunsaturated and monounsaturated fats such as fish, nuts, and vegetable oils.

Identifying Sources of Fat

Population-based studies of American diets have shown that intake of saturated fat is more excessive than intake of trans fat and cholesterol. Saturated fat is a prominent source of fat for most people as it is so easily found in animal fats, tropical oils such as coconut and palm oil, and full-fat dairy products. Oftentimes the fat in the diet of an average young person comes from foods such as cheese, pizza, cookies, chips, desserts, and animal meats such as chicken, burgers, sausages, and hot dogs. To aim for healthier dietary choices, the American Heart Association (AHA) recommends choosing lean meats and vegetable alternatives, choosing dairy products with low fat content, and minimizing the intake of trans fats. The AHA guidelines also recommend consuming fish, especially oily fish, at least twice per week.^[3]

These more appropriate dietary choices will allow for enjoyment of a wide variety of foods while providing the body with the recommended levels of fat from healthier sources. Evaluate the following sources of fat in your overall dietary pattern:

• Monounsaturated fat. This type of fat is found in plant oils. Common sources are nuts (almonds, cashews, pecans, peanuts, and walnuts) and nut products, avocados, olive oil, sesame oil, high oleic safflower oil, sunflower oil, and canola oil.
• Polyunsaturated fat. This type of fat is found mainly in plant-based foods, oils, and fish. Common sources are nuts (walnuts, hazel nuts, pecans, almonds, and peanuts), soybean oil, corn oil, safflower oil, flaxseed oil, canola oil, and fish (trout, herring, and salmon).
• Saturated fat. This fat is found in animal products, dairy products, palm and coconut oils, and cocoa butter. Limit these products to less than 10 percent of your overall dietary fat consumption.
• Trans fatty acids. Stick margarines, shortening, fast foods, commercial baked goods, and some snack foods contain trans fats. Limit your consumption of these products to keep trans fats to less than 1 percent of your fat consumption.
• Omega-3 fatty acids (linolenic acid). Good sources of these are canola oil, flaxseed oil, soybean oil, olive oil, nuts, seeds, whole grains, legumes, and green leafy vegetables.
• Omega-3 fatty acids (DHA and EPA). Good sources of these are cod liver oil and fish such as tuna, herring, mackerel, salmon, and trout.
• Omega-6 fatty acids (linoleic acid). Eggs, poultry, most vegetable oils, wheat germ oil, whole grains, baked goods, and cereals contain these fatty acids. Omega-6 fatty acids are present abundantly in nuts and seeds such as flaxseeds, sunflower seeds, sesame seeds, and watermelon seeds.

Omega-3 and Omega-6 Fatty Acids

Recall that the body requires fatty acids and is adept at synthesizing the majority of these from fat, protein, and carbohydrate. However, when we say essential fatty acid we are referring to the two fatty acids that the body cannot create on its own, namely, linolenic acid and linoleic acid.

• Omega-3 Fatty Acids. At the helm of the omega-3 fatty acid family is linolenic acid. From this fatty acid, the body can make eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Linolenic acid is found in nuts, seeds, whole grains, legumes, and vegetable oil such as soybean, canola, and flaxseed. EPA and DHA are found abundantly in fatty fish.
• Omega-6 Fatty Acids. At the helm of the omega-6 fatty acid family is linoleic acid. Like linolenic acid, the body uses linoleic acid to make other important substances such as arachidonic acid (ARA) that is used to make eicosanoids. Recall that eicosanoids perform critical roles in the body as they affect a broad spectrum of functions. The word eicosanoid originates from the Greek word eicosa, meaning twenty, because this hormone is derived from ARA that is twenty carbon atoms in length. Eicosanoids affect the synthesis of all other body hormones and control all body systems, such as the central nervous system and the immune system. Among the many functions eicosanoids serve in the body, their primary function is to regulate inflammation. Without these hormones the body would not be able to heal wounds, fight infections, or fight off illness each time a foreign germ presented itself. Eicosanoids work together with the body’s immune and inflammatory processes to play a major role in several important body functions, such as circulation, respiration, and muscle movement.

Attain the Omega-3 and Omega-6 Balance

As our food choices evolve, the sources of omega-6 fatty acids in our diets are increasing at a much faster rate than sources of omega-3 fatty acids. Omega-3s are plentiful in diets of non-processed foods where grazing animals and foraging chickens roam free, eating grass, clover, alfalfa, and grass-dwelling insects. In contrast, today’s western diets are bombarded with sources of omega-6. For example, we have oils derived from seeds and nuts and from the meat of animals that are fed grain. Vegetable oils used in fast-food preparations, most snack-foods, cookies, crackers, and sweet treats are also loaded with omega-6 fatty acids. Also, our bodies synthesize eicosanoids from omega-6 fatty acids and these tend to increase inflammation, blood clotting, and cell proliferation, while the hormones synthesized from omega-3 fatty acids have just the opposite effect.

While omega-6 fatty acids are essential, they can be harmful when they are out of balance with omega-3 fatty acids. Omega-6 fats are required only in small quantities. Researchers believe that when omega-6 fats are out of balance with omega-3 fats in the diet they diminish the effects of omega-3 fats and their benefits. This imbalance may elevate the risks for allergies, arthritis, asthma, coronary heart disease, diabetes, and many types of cancer, autoimmunity, and neurodegenerative diseases, all of which are believed to originate from some form of inflammation in the body.

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1. High Blood Cholesterol: What You Need to Know. National Heart, Lung, and Blood Institute, National Institutes of Health. NIH Publication. www.nhlbi.nih.gov/health/publ...chol/wyntk.htm. Updated June 2005.Accessed September 28, 2017. ↵
2. Dietary Reference Intakes: Macronutrients. Institute of Medicine. https://www.nal.usda.gov/sites/default/files/fnic_uploads/DRIEssentialGuideNutReq.pdf. Published 2006. Accessed September 28, 2017. ↵
3. Fish and Omega-3 Fatty Acids. American Heart Association. healthyforgood.heart.org/Eat-smart/Articles/Fish-and-Omega-3-Fatty-Acids. Updated March 24, 2017. Accessed October 5, 2017. ↵