Practical examples of help on diet for high cholesterol, please
February 28, 2010 10:31 PM   Subscribe

I have high cholesterol and have been told to make the lifestyle changes by my doc. Most of the lifestyle changes are already my lifestyle CHOICES - lots of exercise, not overweight (well BMI is 26), low salt, 5 fruit and veg portions each day. I'm looking for practical resources (not theory) - a list of foods with fat and saturated fat content and personal experiences - maybe a blog or a forum or group. More info below. Not looking for theory, got all that!

Me: female, 38, BMI of 26 (no discussion on BMI validity just an example).

I do want: personal experience of now to cut out those last saturated fats. What do you do about cheese? Can you cook with low sat fat spreads? Is there a recommendation of a maximum amount per day/week of sat fats a person on a low cholesterol diet should have. UK info, UK online groups/blogs/your experiences

I don't want: the theory, rants about doctors being obsessed with cholesterol - got all that already thank you. And I know it can be inherited but I'm trying this for 6 months to see if it has an effect.

Will happily answer any questions you need to know the answers to although be gentle with me, I'm quaking in my boots at the thought of giving up cheese!!
posted by LyzzyBee to Health & Fitness (40 answers total) 11 users marked this as a favorite
There is pretty good clinical evidence that Flora/Becel pro-activ can lower LDL cholesterol when used regularly. Like all such evidence it works on averages, so it might not work for you specifically, but it's not supposed to have side effects so the main downside would be the cost (here at least it's a bit more expensive than other types of margarine). It's a fairly easy concrete thing you can try at least.
posted by shelleycat at 11:00 PM on February 28, 2010

My mother's family tend towards high cholesterol and the things that worked for her were eating tons of fish (not farmed fish, ocean fish) and giving up pretty much all dairy products. Giving up bacon and brie made her cry but she still manages to bake and cook pretty well with that godawful Flora stuff that passes for butter.

She eats no red meat, just pork chicken and fish and a lot of vegetables. She also gave up white bread, the dairy and all dessert/ sweet stuff. And soy for some reason, can't remember why. Oatmeal for breakfast every morning. Cholesterol is down to normal again.

She did all this after deciding not to take the medication anymore because it made her lose too much muscle mass. Like you, she was never overweight or unhealthy in any other way, it's just genetic.
posted by fshgrl at 11:08 PM on February 28, 2010

I highly recommend heading over to and utilizing their calorie database. You can punch in a food and find out the nutrition information there, and keep a diary on what you're eating. I found it extremely helpful and I've been able to drop 30 pounds, and was also able to get my cholesterol in check, YMMV, of course, but knowing what you eat is a powerful tool.

Cheese - you don't have to cut it out completely. It's like anything else - enjoy in moderation. I don't know what you use cheese for, but when I use it it's to cover something I'm baking, such as enchiladas. I found that I can use half as much and still get good flavor; in fact, by using less, the rest of the flavors come through nicely and everything tastes better. I recently did a batch of enchiladas with 6 oz of cheese, where I would have used 16 oz in the past, and they were fantastic. Pay attention to serving sizes. It's easy to plow through 4 oz of cheese in a plate of food without even thinking about it, and that's 4 servings.

You mention that you are eating fruits and veggies, which is good. Did the doc happen to mention anything about soluble fiber? There's two types of dietary fiber, insoluble and soluble. Soluble helps your cholesterol stay in check. Whole grains and certain fruits and veggies (but not all) have a lot of soluble fiber.

Cooking with spreads? I don't. Try olive oil instead. Or canola oil. A lot of spreads out there have trans fats, which you really dont want. Tip - if the ingredients say partially hydrogenated vegetable oil, skip it.

Good luck!
posted by azpenguin at 11:18 PM on February 28, 2010

She eats no red meat, just pork chicken and fish and a lot of vegetables. She also gave up white bread, the dairy and all dessert/ sweet stuff. And soy for some reason, can't remember why. Oatmeal for breakfast every morning. Cholesterol is down to normal again.

I have family members who have had the cholesterol crisis talk with their doctors, and this is their solution. Lean meats, tons of veggies, very few breads/sweets. Typical dinner is a giant salad, a smallish portion of lean meat, maybe some cooked veggies alongside. Lunch might be multigrain crackers/toast with bean spread/hummus or a slice of lean meat and lettuce/tomato, then fruit or yogurt. They have been disciplined about the diet change and very successful in reducing their cholesterol counts.
posted by LobsterMitten at 11:32 PM on February 28, 2010 [1 favorite]

Response by poster: Wow - thank you people so far! The doctors weren't that great (as usual) just gave me a leaftlet. I will definitely look at the soluble fibre - that's porridge for breakfast then!

I use olive oil usually (but have been told avocado oil is "better") but you can't use that to replace the fat when you make cakes or biscuits, can you?

Re the flora/benecol, we are looking at getting some plant stanol capsules from the health food store, presumably that has the same effect? We hardly use spread anyway so don't think we'll eat enough to get the benefit (and those yoghurt drinks are all pro-biotic, which upsets my stomach!)

Great to get some actual real-life examples, I asked my facebook friends and they all just got into an argument about theories!
posted by LyzzyBee at 11:33 PM on February 28, 2010

For baking, you might look at vegan baking sites and see how they handle baking without dairy and eggs. I know there are vegan egg replacers, but i don't know how they are on cholesterol. Some recipes will use eg, applesauce or other wet ingredients in place of butter or cream. (Of course, I don't know how big a portion of your diet this really is, maybe it's a small enough portion that it's not worth worrying about - if you have cake once a month, go wild!)
posted by LobsterMitten at 11:38 PM on February 28, 2010

If the plant sterols you're getting in a supplement are the same type as in Flora and you're getting the same amount then yeah, that would be fine. Read the ingredients list though, last time I tried to buy a specific supplement at a health food store they wanted to sell me pills with only a teeny tiny amount of the ingredient I needed plus a bunch of other crap I didn't. I don't know how much info Unilever gives out but the research is peer reviewed and available, and that site I linked has info about amounts at least. If it's different sterols or in a lesser amount then I don't know, Unilever probably don't care enough to research other people's products so the studies may not have been done.

I was actually looking for a specific thing for my cat so getting the pure ingredient was pretty important, so I ended up going to a compounding pharmacy. That might be another place to look if you get stuck.
posted by shelleycat at 11:59 PM on February 28, 2010

I wouldn't speak with a doctor about nutrition. They seem rather useless in that regard. I would, however, consult with a nutritionist. They are often rather useful. Doubly so if you're at all athletic and trying to reduce your cholesterol levels.
posted by dfriedman at 12:22 AM on March 1, 2010

I think dfriedman makes a good point actually. Since you mentioned the UK the British Nutrition Foundation might be a good place to start, here's their page on how to find a professional.
posted by shelleycat at 12:36 AM on March 1, 2010

Response by poster: "Doubly so if you're at all athletic and trying to reduce your cholesterol levels."

-- is there an issue there then? Just on not getting enough calories etc or something else? Although not an "athlete" as such, I am a runner who is keen enough to run 20-25 miles a week / do half-marathons / do gym and weights stuff. Hadn't heard that there's anything different for the fit so would appreciate more info on that.

You're all great by the way - I'd mark everything as best answer if I could!
posted by LyzzyBee at 1:09 AM on March 1, 2010

What I mean is that a lot of sources of high protein also have high cholesterol--red meats, eggs, cheeses, etc. Since you're athletic you want to make sure that whatever dietary changes you make will still give you adequate protein intake.

That said, there are workarounds: lean meats, soy products, avocados, spinach, fish, etc.

Nutrionists are better equipped to help out with this knd of advice than are doctors. Doctors are good at identifying problems, but not so mch at providing solutions. Of course, identification of the problem is important, but it doesn't give all the answers. Hence your question here.
posted by dfriedman at 1:30 AM on March 1, 2010

Response by poster: Thanks for that clarification, that's as I thought. I had started eating more red meat as I trained harder but I also eat lots of beans etc too. Never ate eggs as I can't bear them!

So people - help - what the heck do I eat for snacks? Am I reduced to oatcakes with a smear of honey? I just gave away my fig rolls and cashews as the cashews seemed to have a lot of sat. fat in.... or am I just panicking now as someone just brought in a box of biscuits for her birthday?!
posted by LyzzyBee at 2:06 AM on March 1, 2010

Once you've assembled an eating plan you could ask your GP for an appointment with the practice dietician, s/he will be able to review your plan, make suggestions, and so on.

My OH is handling a similar problem (dietician appointment tomorrow evening!) so thanks for asking the question and good luck!
posted by ceri richard at 2:21 AM on March 1, 2010

Response by poster: We don't have a dietician at our doctor's practice :( just a nurse who is great but isn't a qualified dietician or nutritionist. I'm getting there though. Good luck to your OH Ceri, hope the appointment goes well!
posted by LyzzyBee at 2:29 AM on March 1, 2010

azpenguin: Cooking with spreads? I don't. Try olive oil instead. Or canola oil. A lot of spreads out there have trans fats, which you really dont want. Tip - if the ingredients say partially hydrogenated vegetable oil, skip it.

Yeah, trans fats are even worse for cholesterol than saturated fats. And not just for cholesterol, for everything. If you're replacing any of your saturated fat intake with trans fats, which is easy to do if you're looking for vegetable substitutes for animal fats, you're making things worse.

It would definitely be worth checking out food labelling laws where you live. Here in Australia, hydrogenated oil can just be called "vegetable oil", "canola oil" etc, and nutrition labels generally don't have to declare trans fat content. I'm not sure how it works in the UK, but that should be easy to find out.

Note that a lot of canola oil is partially hydrogenated (=plenty of trans fats). Personally I just refuse to buy anything with unspecified "vegetable oil" on the ingredients.
posted by A Thousand Baited Hooks at 3:15 AM on March 1, 2010

Response by poster: I know about the trans fats and I think in the UK they are disguised as vegetable fats too. But thanks for mentioning. Looking at labelling I think they have to put the fat but the supermarkets put in the sat, mono and poly counts too which is handy.

But it doesn't help me accept no chocolate so I'm on a mission to find the chocolate with the lowest sat fat content I can. I can't give up chocolate and cheese, I just can't!

Course I'll hopefully find in 6mo that it's inherited anyway!
posted by LyzzyBee at 3:21 AM on March 1, 2010

nthing seeing a nutritionist if at all possible. Doctors always took with me a simple hard-line "you need to eat better!!!" cataclysm stance which left me feeling confused and frustrated because of the urgency of their demands and the complete unhelpfulness of their recommendations. When I saw a nutritionist, I felt for the first time like he was a) actually listening to me, b) not just fat-shaming me, and c) giving me concrete, current, and realistic advice that I can actually implement. Since seeing him ~7 months ago, I've gone from being slightly obese to being on the low half of overweight, the only substantial weight loss I've ever achieved. I know you're not looking to lose any weight, I'm just illustrating how effective the help of a nutritionist can be at giving you tools to change your diet.
posted by threeants at 4:15 AM on March 1, 2010

I know you said you're not looking for theory, and I really don't want to derail, but my dad has had excellent luck reducing his blood cholesterol levels while on a low-carb diet. If your current approach doesn't get you to where you want to be after the 6 months you say you're going to try it, consider going the low-carb route for 6 months or so and compare your results. Some compelling arguments for it here.
posted by beandip at 5:45 AM on March 1, 2010

Porrideg, oatmeal, call it what you will but eat it a lot. I had the same problem and Monday to Friday oatmeal worked wonders. The weekend is for fried eggs!
posted by merocet at 5:52 AM on March 1, 2010

My husband had really high cholesterol (in the 300s and he's only 190lbs). He cut out the soda, we would have eliptical "competitions" on endurance, and he stopped eating 3 more meals after dinner (usually ice cream, cereal, and peanut butter).

He dropped the cholesterol so much our doc was shocked and he didn't have to be put on meds.

Unfortunately, he's back into the old habits, minus the soda.
posted by stormpooper at 6:34 AM on March 1, 2010

Response by poster: That's the thing, if I ate a lot of terrible stuff I could cut out some and get the cholesterol down; as it is there's not much I can lose and it's the important stuff I couldn't bear to lose when I was on my original health kick!

But I've realised - if I have one day a week where I can have choc and cheese, that's still 1/7 of the fat I used to consume in those, isn't it!
posted by LyzzyBee at 7:00 AM on March 1, 2010

I use olive oil usually (but have been told avocado oil is "better") but you can't use that to replace the fat when you make cakes or biscuits, can you?

More a cooking tip than a medical one, but olive oil is often super yummy in baking. I have a blood orange infused olive oil for zucchini bread and it is lovely. (I'll be so sad when it's got because the company doesn't ship outside of the US.) Makes the baking so citrusy and fresh-tasting. But even regular extra-virgin olive oil often works in baking.
posted by Kurichina at 8:19 AM on March 1, 2010

Nuts are a good source of cholesterol-free protein.
posted by mareli at 8:30 AM on March 1, 2010

I have genetically high cholesterol, and while my decent eating habits keep it in check now, it was rather out of control when I was 10 and they first discovered it. I remember not being allowed to have bacon or ice cream or McDonalds. And needing to eat more fish and good fats like olive oil. My mom learned to bake with olive oil - she found recipes for cookies and other baked goods that allowed her to use oil instead of butter. So that is definitely an option.

As for snacks, popcorn popped in olive oil is yummy. I remember eating a lot of popcorn.
posted by thejanna at 9:09 AM on March 1, 2010 [1 favorite]

Is it bad to suggest taking the pills to lower cholesterol? I have high cholesterol and I would really hate to have to go on a crazy diet just to lower something that my body has decided it's going to produce naturally. Now, I could deprive my body of those good things that make me happy (bacon, cheese, etc) and maybe lower my cholesterol. Or I could take a pill every day, be aware of what I eat/exercise, etc and live a happy life.

Please tell me if I'm thinking about this wrong.
posted by TheBones at 9:22 AM on March 1, 2010

Response by poster: TheBones - it is fine to have that attitude if that's what you feel yourself. I am already on pills for high blood pressure and went through hell and high water to persuade the doctor* that I couldn't stand the side effects (weight gain and lethargy) on the millions I tried till I found one that is bearable. The thought of going on the statins, which again there are loads, and they have side effects including on muscle mass etc. All for something which frankly yet again in the UK (and OK I'm going to have a little rant here but I don't want to derail the useful conversation we're all happening) is due to a change in doctor's targets rather than real health issues. Another example - they are OBSESSED with me being BMI 26. I run 25 miles a week or do 4 gym and cardio sessions plus yoga every week, muscular and fit, but of course if they can bring it down to 24 they can tick another success and god help the person who is obese and doesn't know what to do about it when they can edge someone over into normal weight. BP was only ever borderliine yet I'm medicated for that.

Sorry - rant over. I have been sobbing over porridge which burst all ove the microwave and was foul to eat and I do want to ask another sensible question....

*change my doc? Yeh right. We are only allowed to go to one surgery, nearest the house. I've been through all the docs in the surgery to find one i can tolerate and she still patronises me....
posted by LyzzyBee at 10:20 AM on March 1, 2010

Response by poster: Sensible question now: on the fats

if it has some sat fat but lots more (5 times) the monounsaturated fat, is that better than no sat fat and a bit of mono? I really can't tell.

posted by LyzzyBee at 10:21 AM on March 1, 2010

Response by poster: Thejanna thanks for the advice about cooking with olive oil. Presume the low-cholesterol cookbooks will have all those recipes in or do you happen to know a good resource?
posted by LyzzyBee at 10:22 AM on March 1, 2010

Primary care physician here. Blood cholesterol levels are determined by genetics and diet, with the relative importance of each varying from person to person. I'd say the genetic influence ranges from 25% to 75%. So a person with a low genetic disposition for high cholesterol on a high fat diet can make a big impact with a diet change, some people's diet has no apparent impact.

Also, remember that there is day-to-day RANDOM variation in cholesterol levels of 5-20%.

For the overwhelming majority of people, exercise has little or no impact on cholesterol levels. Exercise does reduce cardiovascular help directly, though.
posted by neuron at 11:40 AM on March 1, 2010 [1 favorite]

I'm a doctor, but not primary care so I won't be of much help on the nutrition side. Just wanted to share what I have had success with.

I had a mildly high cholesterol of 205 at age 20 or so. I changed my diet to get it down.
- Substitute applesauce for oil in all baking (it does taste a bit apply, but I like that)
- I am basically vegetarian now, when I want meat I eat soy sausage etc., eat some rare chicken, and I eat fish, I worked on finding lots more kinds of fish that I liked and got into sushi, now I am working on salmon (trying to cut down on shrimp which used to be my sole 'seafood'). I also try to take an omega-3 (fish oil) supplement whenever I remember to.
- I always drink skim milk
- Rare cheese, starting to try to use vegan cheese ( zero cholesterol and it does still taste sort of cheese-ish! but it is not cheap)
- Stopped eating cream sauce, pasta alfredo used to be my favorite food but basically I just switched to pink sauces and now I like them better. hey, baby steps...

I know I had a measured cholesterol down to 190 3 years ago, and that was even before I went vegetarian!
posted by treehorn+bunny at 1:29 PM on March 1, 2010

Response by poster: Thanks both doctors! Our doctor started lecturing me about exercise even though I already do loads and of cardiovascular and strength building and flexibility forms. Grr. Anyway I have genetic high blood pressure but I think it's worth the go at the diet for 6 mo to see if it makes a difference.

Treehorn+ thanks for the info. We found rapeseed oil and I'm guessing we can cook with that. And some cheese that has cholesterol lowering stuff in, again v expensive but worth it to have a little bit.

Both - do the US measure different from the UK? I have 7.1 with 5 being acceptable, everyone else seems to measure in the hundreds...???

Cheers again everyone!

Oh and still looking for an answer on the balance of the different kinds of fat...
posted by LyzzyBee at 1:48 PM on March 1, 2010

It sounds like you've got a pretty good handle on the diet and exercise side of things. Might be worth getting a liver function test too.

I've been told that foods that stimulate your liver are also good as they encourage the liver to get rid off the bad cholesterol - maybe visit a naturopath, they might recommend milkthistle, and soluble fibre to encourage the removal of bad cholesterol, or even plant sterols to actively lower it.

Also, avoid diet sodas, if you don't already. My naturopath would rather I drink non-diet soda than the kind with artificial sweeteners, especially aspartame, which is particularly bad on liver function.
posted by robotot at 5:04 PM on March 1, 2010

We don't have a dietician at our doctor's practice

Someone from Dieticians Unlimited spoke at a conference I was at last week and I was impressed. She knew the science but was also very practical, the focus for her (and all the dieticians there actually) was definitely on how to best help and advise her clients. They're linked to from the page I posted yesterday and their site includes a referral service for finding a dietician.

I'd say you should aim to see a properly qualified dietician to start with at least rather than a nutritionist (of course some people can be both, the page I linked has the qualifications to look for) as dealing with situations like yours is what they're trained for. A dietician will answer your questions about fat much better than any of us can and will also work to tweak your overall diet, taking into account your lifestyle, personal tastes, activity level and whatever. Hopefully you can just see them once then get put on the right track since it's not like you need a whole lifestyle overhaul.

As an aside I'm very sympathetic with you about the Drs hassling you for your weight. It doesn't make sense given the rest of your life style. Overall body composition is going to be much more important at your BMI than the exact weight/height ratio, because it doesn't take that much extra muscle to push you over the arbitrary cut off. Hopefully a dietician will be better at dealing with this kind of issue since weight/size/etc is more within their speciality, certainly the nutritionists at the conference were much more realistic about the inexactness of correlation between size and health in that under-30 BMI region.
posted by shelleycat at 6:04 PM on March 1, 2010

People sometimes ask me how I manage to consume truly ridiculous amounts of saturated fat (I work with pork farmers and often receive things like pork belly and lard as payment) and still have low cholesterol. Good genes is probably part of it, and the rest I chalk up to the other components of my diet: marine foods, berries, and leafy greens. Marine foods include wild fish, fish oil, shellfish, and seaweed. These are a big part of my diet. Dip some nori in soy sauce and toast it for a delicious snack. Omega-3 fatty acids in marine foods are now known to reduce cholesterol.

Also, food for thought: Does saturated fat really cause anything?
posted by melissam at 8:33 PM on March 1, 2010 [1 favorite]

Response by poster: Robotot - liver and kidney tested 3 years ago and last month and are in excellent shape (get tested cos of my blood pressure pills)

Shelleycat - thanks for that info, I thnk we will look at that although a bit calmer on the diet front now (OH found cholesterol reducing cheese - I know it's not the answer but it means we can have cheese!) and thanks for the BMI stuff
posted by LyzzyBee at 10:32 PM on March 1, 2010

Response by poster: And Melissam (sorry, I was interrupted by a cat crisis) I think mine is prob partly in genes like my BP... can't have soy sauce really as too salty but luckily I do love sushi in general! And I appreciate the link but as I said at the top, I'm not looking too much into theory at the moment, there is a theory "proving" everything and the doc said to do the lifestyle changes and cutting down (all) fat is the only one that isn't already part of my lifestyle, so that's why I'm doing it.
posted by LyzzyBee at 11:45 PM on March 1, 2010

Also, look at the heartscan blog, specially the posts on cholesterol and triglycerides.

He does have interesting perspectives on various supplements and can go on and on about the dangers of wheat.
posted by Arthur Dent at 4:57 PM on March 2, 2010 [1 favorite]

Realize that a lot of the dietary science that the food pyramid is based on is really bad science. Scientists clinging to their hypothesis and ignoring parts of their studies that didn't mesh with what they wanted to prove.

Good Calories, Bad Calories by Gary Taubes picks apart the science and tries to show that the low-fat, high-carb diets are not the way to lower cholesterol and increase overall health. IIRC, the bibliography itself is over 100 pages long.

You can get a taste of the content in the book by reading his NYT's article, What If It's All Been A Big Fat Lie?
posted by Nerro at 2:16 PM on March 3, 2010 [2 favorites]

Response by poster: Just to say I really don't want all this controversy etc and theory at the moment - although I'm grateful for the time people have spent giving me these references, the doctor's leaflet is what I'm going by, and the thing I stated very clearly that I wanted was peoples' personal experiences of what worked for them (which people have provided for me)

I'm doing ok with it so far, the only thing I still need to check is, is some sat fat ok as long as there's more monounsaturated and, to an extent, polyunsaturated, in the same item?

posted by LyzzyBee at 1:37 AM on March 4, 2010

Response by poster: Hey everyone, just wanted to let you know that by not eating anything more than 1% sat fat (or about 2g per serving) I have brought my cholesterol total down from 7.1 to 6.4 and by exercising a lot I have higher "good" chol than I need - so a cardiovascular disease risk level of only 1.5% and no statins for me as bringing cholesterol down to 5 would only bring risk to 1.1%. Thanks for all the help and suggestions. Nurse hardly ever meets anyone who brings it down through diet!
posted by LyzzyBee at 1:05 PM on June 8, 2010 [3 favorites]

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