08 October 2022
Considering heart disease is the leading cause of death in the United States – someone dies every 34 seconds, according to the Centers for Disease Control and Prevention – words like cholesterol and blood pressure tend to evoke fear in people who monitor their health. These feelings aren’t without merit, as high cholesterol levels can cause plaque build ups that increase your risk of heart attack, heart disease and stroke.
That said, there are many myths out there that focus on eliminating high-cholesterol foods from your diet to control blood cholesterol levels. Instead, this blog will explain how eating fewer animal products, along with a boost from medications, can keep your cholesterol levels at bay.
The confusion with cholesterol
To understand cholesterol, it’s important to start with its function and source. Cholesterol automatically has a negative connotation due to its impact on our health, but it serves an important function in day-to-day life. Cholesterol, which is naturally produced in the liver, is a building block for cell membranes. It also helps make vitamin D, hormones such as testosterone and estrogen and bile acids that help break down fats.
Cholesterol production in the liver accounts for 75 percent to 85 percent of cholesterol, and the remaining amount comes from animal products, mainly meat and dairy. Translation: If your cholesterol numbers are high, that doesn’t necessarily mean you’re eating too many foods high in cholesterol. As the percentages suggest, your diet only plays a small role.
The science backs this up, too. In 2019, the American Heart Association Journal analyzed 50 studies and didn’t find a notable link between dietary cholesterol and cardiovascular risk.
Further, the latest Dietary Guidelines for Americans from the U.S Department of Agriculture released in 2021 didn’t include a maximum amount of cholesterol per day. The previous guidelines recommended no more than 300 mg.
However – and part is important – loading up on foods high in cholesterol such as full-fat dairy products, fatty cuts of meat, fried food and processed meats can cause your blood cholesterol to skyrocket, just not for the reason you may think. The real culprit is saturated fats.
This doesn’t mean you don’t have to monitor your intake – some dietary cholesterol is fine – but the focus should be on saturated fat. For example, eggs are high in cholesterol but they also have other health benefits when eaten in moderation. The more concerning aspect is when people eat eggs with a heavy, saturated fat-laden meal such as biscuits, bacon or sausage and home fried potatoes.
As a reminder, “good” cholesterol levels in adults vary by sex and family history, but in general, strive for the following numbers:
- Total cholesterol under 200 mg/dL
- HDL cholesterol more than 40 mg/dL
- LDL cholesterol less than 100 mg/dL
- Triglycerides less than 150 mg/dL
Is cholesterol only found in animal products?
Yes. Plants don’t make cholesterol. While you won’t find cholesterol in plants, vegans, vegetarians and other non-meat eaters aren’t immune from developing high cholesterol. Plant-based foods can still contain saturated fats that increase cholesterol. Examples include coconut oil and palm oil.
Does saturated fat raise cholesterol?
Here’s the kicker – saturated fat, not foods high in cholesterol, will have more of an impact on your blood cholesterol.
Why? Simply put, once digested, foods high in saturated fat increase the amount of LDL cholesterol produced. The theory is that excessive amounts of saturated fat affect the efficiency of LDL receptors. LDL receptors are a group of amino acids on the cell membranes of liver cells called hepatocytes. These receptors play an important role by releasing LDL and triglycerides needed to carry out several jobs. If the receptors don’t perform as anticipated, too much LDL cholesterol can stay in the blood.
Excess LDL can form a buildup of plaque in your arteries. Eventually, the arteries will begin to narrow and increase the likelihood a blockage occurs. Plaque can also dislodge and clot, causing a heart attack or stroke due a lack of blood supply to the heart or brain.
All saturated fats aren’t created equal, though. There are many different types of saturated fats composed of different fatty acids of varying carbon chain lengths.
Here is an overview of each type of saturated fat:
Stearic acid: Made up of 18 carbon atoms, stearic acid is mostly found in animal fat and is the second most common type of saturated fat.
Palmitic acid: Made up of 16 carbon atoms, palmitic acid is the most common saturated fat. You’ll find it primarily in palm oil, although about a quarter of palmitic acid is found in red meat and dairy.
Myristic acid: Made up of 14 carbon atoms, myristic acid is less common and is found in coconut oil and palm kernel oil.
Lauric acid: Made up of 12 carbon atoms, lauric acid is also found in coconut oil and palm kernel oil.
Capric acid: Made up of 10 carbon atoms, capric acid is found in small amounts of palm kernel oil and coconut oil.
Caprylic acid: Made up of 8 carbon atoms, caprylic acid is found in small amounts of palm kernel oil and coconut oil.
Caproic acid: Made up of 6 carbon atoms, caproic acid is found in small amounts of palm kernel oil and coconut oil.
If your diet consists of saturated fats with most meals, consider cutting back on foods with palmitic acid – cheese, meat and butter. While stearic acid is the most common type of saturated fat in animals, it isn’t nearly as hypercholesterolemic (having excess cholesterol) as palmitic acid. The melting point of stearic acid is higher than your body temperature, which makes it harder for your body to absorb
Does soluble fiber bind cholesterol?
Plant-based foods, not animal based-foods, contain soluble fiber that carry many health benefits including the ability to bind cholesterol. For a quick refresher on soluble versus insoluble fiber, soluble fiber dissolves in water to draw water into your digestive tract. The result is a gel-like product that softens your stool to pass through the intestines, into the rectum and out the anus.
When eating foods high in soluble fiber, the fiber binds to cholesterol in the small intestine and prevents cholesterol from entering the bloodstream.
Whole grains: Oatmeal, barley, quinoa
Legumes: Kidney beans, black beans, chickpeas, lima beans, pinto beans
Vegetables: Carrots, cabbage, broccoli, cauliflower, leafy greens, Brussels sprouts
Starchy vegetables: Sweet potatoes, green peas
Healthy fats: Avocado, flax seeds, chia seeds
Fruits: Apple, banana, peach, pear, berries, orange
Choose these foods instead
Avoid eating full-fat dairy products, meat, processed foods and fried foods as your main source of calories. Again, these foods are high in saturated fat and can put you at risk of high cholesterol that can lead to cardiovascular issues.
Instead, choose healthy fats, such as omega-3 fatty acids, monounsaturated fats and polyunsaturated fats, instead of saturated fat or trans fat.
In general, this means avoiding fats that are in a solid state at room temperature – coconut oil, butter, palm oil – and focus on oils that are in a liquid state at room temperature such as plant-based oils.
Omega-3 fatty acids:
- Fatty fish (salmon, mackerel, sea bass, herring)
- Seeds (flax seeds, chia seeds
- Plant-based oils (Olive oil, canola oil, peanut oil, sesame oil
- Peanut butter or other nut butter alternatives
- Tree nuts (Almonds, cashews, pistachios)
- Seeds (Flaxseed, pumpkin, sunflower)
Sometimes diet and exercise isn’t enough
Because your body accounts for anywhere from 75 to 85 percent of cholesterol, dietary changes may sometimes not be enough. In this case, your primary care physician or cardiologist may recommend a cholesterol-lowering drug.
Statins, also known as HMG-CoA reductase inhibitors, prevent the liver from producing cholesterol to lower LDL cholesterol and triglycerides. Atorvastatin (Lipitor), rosuvastatin calcium (Crestor) and simvastatin (Zocor) are among the most common statins.
For some people, statins may not lower LDL cholesterol levels enough. Your doctor may also prescribe one of the following medications:
Ezetimibe: Also known as cholesterol absorption inhibitors, ezetimibe prevents your intestine from absorbing cholesterol.
Bile Acid Sequestrants: These drugs bind to bile in the small intestine to prevent the reabsorption of too much cholesterol. Genetic options include cholestyramine, colestipol and colesevelam Hcl.
PCSK9 inhibitors: This type of injectable drug blocks proprotein convertase subtilisin/kexin type 9 (PCSK9) proteins from breaking down your LDL receptors. PCSK9 regulates how many LDL receptors you have. But some people have too many, causing the breakdown of too many LDL receptors and, therefore, the inability to regulate cholesterol levels.
Adenosine triphosphate-citrate lyase (ACL) inhibitors: Recently approved in 2020, this class of drugs prevents the liver from producing cholesterol. Generic options include bempedoic acid and bempedoic acid and ezetimibe.
Monitor your annual health with an INTEGRIS Health primary care physician and stay on track for healthy cholesterol and a strong heart.
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