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Eating to Lower Your High Blood Cholesterol

High Blood Cholesterol

High blood cholesterol is a serious problem. Along with high blood pressure and cigarette smoking, it is one of the three major modifiable risk factors for coronary heart disease. Approximately 25 percent of the adult population 20 years of age and older has "high" blood cholesterol levels - levels that are high enough to need intensive medical attention. More than half of all adult Americans have a blood cholesterol level that is higher than "desirable."

Because high blood cholesterol is a risk to your health, you need to take steps to lower your blood cholesterol level. The best way to do this is to make sure you eat foods that are low in saturated fat and cholesterol.

What You Need to know About High Blood Cholesterol

Why Should You Know Your Blood Cholesterol Level?

There are important reasons for you to be concerned about your blood cholesterol level. Over time, cholesterol, fat, and other substances can build up on the walls of your arteries (a process called atherosclerosis) and can slow or block the flow of blood to your heart. Among many things, blood carries a constant supply of oxygen to the heart. Without oxygen, heart muscle weakens, resulting in chest pain, heart attacks, or even death. However, for many people there are no warning symptoms or signs until late in the disease process.

Heart disease is the leading cause of death in this country. Scientists have known for a long time that high blood cholesterol, high blood pressure, and smoking all increase the risk of heart disease.

Research now shows that the risk of developing atherosclerosis or coronary heart disease also increases as the blood cholesterol level increases. And it has now been proven that lowering high blood cholesterol, like controlling high blood pressure and avoiding smoking, will reduce this risk.

How High Is Your Blood Cholesterol Level?

The medical community recently set guidelines for classifying blood cholesterol levels. They advise that a total cholesterol level less than 200 mg/dl is "desirable" for adults - above 200 mg/dl the risk of coronary heart disease steadily increases.

Does Your Total Blood Cholesterol Level Increase Your Risk For Developing Coronary Heart Disease?

Desirable Blood Cholesterol - Less than 200 mg/dl
Borderline High Blood Cholesterol - 200-239 mg/dl
High Blood Cholesterol - 240 mg/dl and above

Borderline-High Blood Cholesterol

Without Other Risk Factors
If your total cholesterol level is in the range of 200-239 md/dl, you are classified as having "borderline-high" blood cholesterol and are at increased risk for coronary heart disease compared to those with lower levels. However, if you have no other factors that increase your risk for coronary heart disease (risk factors include high blood pressure, cigarette smoking, family history of coronary heart disease before the age of 55, diabetes, vascular disease, obesity, and being male.), you should not need intensive medical attention. But you should make dietary changes to lower your level and thus reduce your risk of coronary heart disease.

With Other Risk Factors
On the other hand, if you have borderline-high blood cholesterol and have coronary heart disease or two other risk factors for coronary heart disease, you need special medical attention. In fact, you should be treated in the same way as people with "high" blood cholesterol - 240 mg/dl or greater - who could be at high risk for developing coronary heart disease and warrant more detailed evaluation and medical treatment.

Additional evaluation helps your physician determine more accurately your risk of coronary heart disease and make decisions about your treatment. Specifically, your doctor will probably want to measure your low density lipoprotein (LDL) cholesterol level - since LDL-cholesterol more accurately reflects your risk for coronary heart disease than a total cholesterol level alone. LDL-cholesterol levels of 130 mg/dl or greater increase your risk for developing coronary heart disease. After evaluating your LDL-cholesterol level and other risk factors for coronary heart disease, your physician will determine your treatment program.

What Should Your Blood Cholesterol Goal Be?

If you have high blood cholesterol or need intensive treatment because of other risk factors, your physician will probably set an LDL-cholesterol goal for you. This goal will vary depending on your overall risk and what may be a realistic goal for you. Remember, a total cholesterol level below 200 mg/dl and an LDL-cholesterol level below 130 mg/dl are desirable. Even though achieving your LDL-cholesterol goal is more important than your total cholesterol goal, your physician may choose to check your progress by measuring your total cholesterol level because it is a good deal simpler and you do not have to fast before its measurement. When you reach your total cholesterol goal, your physician will probably measure your LDL-cholesterol to confirm that you also reached your LDL-cholesterol goal.

How Does Your Blood Cholesterol Level Become High?

What you eat can raise or lower your blood cholesterol level. The average American diet of high-saturated fat, high-cholesterol foods like fatty meats, many dairy products, fried foods, cookies, cakes, and eggs contributes to high blood cholesterol.

In some countries like Japan, for example, people eat diets rich in rice, fruits, vegetables, and fish. The Japanese have lower blood cholesterol levels and lower rates of coronary heart disease than Americans. This is in part because these foods are low in fat, particularly saturated fat, which is the greatest dietary contributor to high blood cholesterol.

While diet plays an important role in raising or lowering your blood cholesterol level, inherited cholesterol tendencies also influence your level. A small percentage of people can eat a diet that is high in saturated fat and cholesterol and still maintain a low blood cholesterol level. On the other hand, there is a small percentage of people who may not be able to lower their blood cholesterol even with a low-saturated fat, low-cholesterol diet. However, both of these groups constitute a minority of the population of the United States. Most people can control their blood cholesterol levels by following a diet that is low in saturated fat and cholesterol.

Guidelines for Lowering Your High Blood Cholesterol

Eat less than 30% of your total daily calories from fat.*

Less than 10% of your calories should come from saturated fat. No more than 10% of your calories should come from polyunsaturated fat. 10-15% of your calories should come from monounsaturated fat.

Eat less than 300 mg of cholesterol each day.

Eat 50-60% of your daily calories from carbohydrates.

Adjust your caloric intake to achieve or maintain a desirable weight.

*You can calculate the percent of your total daily calories from fat with the following equations (use the numbers from food labels):

Percentage of calories from fat = (total fat calories/total calories) X 100
Total fat calories = total fat (grams) X 9

In other words, if your daily calorie need is 2,000 calories, 30% of your total daily calories from fat would equal 600 calories, or 67 grams of fat.

Remember, when you are using these equations, that not everything you eat must have fewer than 30% calories from fat, but that you should balance foods with a slightly higher fat content with foods that have a much lower fat content.

The differences between these two diets are subtle and appear to be small, but they are very important for lowering your blood cholesterol level. All of these small changes add up to big improvements in your blood cholesterol level. Take a look at the sample menus. Although the new low-fat diet has the same number of calories as the average American diet, it has much less fat. And, the sample menus show that because the fat you were eating was so calorie-rich, the new diet actually allows you to eat more food!


Average American Diet (37% fat)

1 fried egg 2 slices white toast with 1 teaspoon butter 1 cup orange juice black coffee or tea
1 doughnut
1 grilled cheese (2 ounces) sandwich on white bread 2 oatmeal cookies black coffee or tea
20 cheese cracker squares
3 ounces fried hamburger with ketchup 1 baked potato with sour cream 3/4 cup steamed broccoli with 1 teaspoon butter 1 cup whole milk 1 piece frosted marble cake

Nutrient Analysis
Calories 2,000
Total fat (percent of calories) 37%
Saturated fat (percent of calories) 19%
Cholesterol 505 mg


A New Low-Fat Diet (30% fat)

1 cup corn flakes with blueberries 1 cup 1% milk 1 slice rye toast with 1 teaspoon margarine 1 cup orange juice black coffee or tea
1 toasted pumpernickel bagel with 1 teaspoon margarine
1 tuna salad (3 ounces) sandwich on whole wheat bread with lettuce and tomato 1 graham cracker tea with lemon
1 crisp apple
3 ounces broiled lean ground beef with ketchup 1 baked potato with low-fat plain yogurt and chives 3/4 cup steamed broccoli with 1 teaspoon margarine tossed garden salad with 1 tablespoon oil and vinegar dressing 1 cup 1% milk 1 small piece homemade gingerbread with a maraschino cherry and sprig of mint

Nutrient Analysis
Calories 2,000
Total fat (percent of calories) 30%
Saturated fat (percent of calories) 10%
Cholesterol 186 mg


A New Low-Fat Diet (30% fat)

1 cup shredded wheat with peach slices 1 cup 1% milk 1 slice whole wheat toast with 1 teaspoon margarine 1 cup pink grapefruit juice black coffee
1 toasted English muffin with 1 teaspoon margarine
3 ounces turkey salad on lettuce with tomato wedges 1 thick slice of French bread 10 animal crackers tea with lemon
1 banana
3 ounces broiled halibut with lemon and herb seasoning 1/2 cup brown rice with mushrooms 1 dinner roll with 1 teaspoon margarine 3/4 cup carrot strips with 1 teaspoon margarine spinach salad with 1 tablespoon oil and vinegar dressing 1 cup 1% milk 1 small piece homemade yellow cake*
*Homemade desserts should be made with unsaturated fats instead of saturated fats. Two egg whites may be substituted for one egg yolk.

Nutrient Analysis
Total calories 2,000
Total fat (percent of calories) 30%
Saturated fat (percent of calories) 10%
Cholesterol 172 mg


What Kind of Cholesterol-Lowering Success Can You Expect

Generally your blood cholesterol level should begin to drop 2 to 3 weeks after you start on a cholesterol-lowering diet. Over time, you may reduce your level 30-55 mg/dl. The reduction in your blood cholesterol level depends on several factors:

The amount of saturated fat in your diet - If your diet is very high in saturated fats, you will probably see a greater reduction in your cholesterol level once you start to change your eating pattern than if your initial diet was only moderately high in saturated fat.

Your blood cholesterol level prior to starting your new diet - In general, the higher your blood cholesterol level is, the greater reduction you can expect from your new diet. If your level is very high, you might be able to lower your cholesterol level even more than 55 mg/dl.

How responsive your body is to your new diet - Genetic factors play a role in determining your blood cholesterol level and, to some extent, can determine your ability to lower your level by diet.

Sources: National Cholesterol Education Program National Heart, Lung, and Blood Institute. U.S. Department of Health and Human Services.

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