Focus on Low Density Lipoprotein-Cholesterol (LDL-C)

Cholesterol is a type of fat that is principally made in the liver (about 75%), and with a smaller contribution from animal source (through diet). Cholesterol cannot dissolve in blood and therefore travels to and from cells on transporters or carriers known as lipoproteins. The types of lipoproteins involved in this transport include low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Cholesterol carried by LDL is referred to as LDL-cholesterol (LDL-C). It is a bad cholesterol that can build up in the wall of arteries causing what is called atherosclerosis and consequently lead to heart attack, , stroke, disease of the arteries of the lower limbs known as peripheral arterial disease or claudication (that typically presents as lower limb pain, often occurring after walking a predictable distance). Other consequences of the damage to arteries (atherosclerosis) resulting from high LDL-C include narrowing of arteries of the kidney (which may lead to a condition known as renovascular hypertension), arteries of the male genital organs resulting in erectile dysfunction (ED)

Therapeutic Lifestyle Tips to Lower LDL-Cholesterol:

LDL-C can be lowered by a combination of therapeutic lifestyle changes including appropriate diet and exercise and certain cholesterol lowering medications. A heart healthy eating plan include a lot of plant foods, like legumes (cooked beans), nuts, fruits and vegetables, and lean protein foods, low-fat diary foods, and healthy fats

Replace foods high in saturated fat with foods that contain healthy fats: Use canola, corn, olive, peanut, safflower, sesame, and soybean oils in place of butter, lard and coconut oil. Use avocados, unsalted nuts, and seeds at meals and snacks. These provide polyunsaturated fats that help lower LDL- cholesterol. Avoid margarine, regular ground beef, fatty cuts of meat, and fast food hamburgers as these contain saturated fat that will raise LDL-cholesterol. Limit total daily saturated fat intake to less than 7% of total calories.

Eat more foods rich in soluble fiber, like beans (including black-eyed peas, lentils, kidney beans, garbanzos), peas, bananas, pears, sweet potatoes, eggplant, okra, oats, oat bran, and ground flax seeds. Strawberries, grapes, apples and citrus fruits such as oranges, tangerines, lime, lemons are rich in pectin – a type of soluble fiber that lowers LDL-cholesterol. Soluble fiber binds to cholesterol in the bowels and drags them out of the body in stools and therefore prevents most cholesterol from being absorbed into the body. It therefore decreases absorption of cholesterol. They consequently make for good deserts as they help decrease amount of cholesterol consumed after a meal! It is a good habit to eat at least 5 to 10 grams of soluble fiber a day [the recommended total daily viscous (soluble) fiber intake per day by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) is 10 to 25 grams; total recommended daily dietary fiber is 20 to 30 grams]. Intake of 5 to 10 grams of viscous (soluble) fiber a day could lower LDL-C by 5-11 gm/dl

Eat foods fortified with plant sterols and stanols which limit the body’s ability to absorb cholesterol from the digestive tract. The recommended daily intake of sterols and stanols is 2 grams (per NCEP ATP III). This may result in up to 10% lowering of LDL-cholesterol.

Eat whole grains as these in general could reduce LDL-cholesterol (and total cholesterol but not triglycerides)

Nuts such as walnuts, almonds, peanuts. Two ounces of nuts a day can decrease the LDL-cholesterol by about 5%. Caution with cashew nuts, as these in addition to good fat (polyunsaturated fats), also contain about 17% of bad fat (saturated fats) as against 6-7% bad fat (saturated) fat contained in almonds and walnuts. Salted roasted nuts, while more delicious are not as healthy as “raw” nuts.

Fatty fish – two large fish meals at least two times a week can lower LDL-C. Fatty fish is a source of omega-3 fats that can lower LDL-cholesterol, triglycerides and raise HDL-C

Soybeans and foods made from them such as soy milk, tofu can lower LDL-cholesterol. Twenty-five grams of soy protein a day (for example 2 ½ cups of soy milk or 10 ounces of tofu) may decrease LDL-cholesterol by 5 to 6%

Limit your cholesterol intake to less than 200 mg per day. Limit egg yolks to 2-3 a week. One large egg contains 186 mg of cholesterol – all of which are contained in the egg yolk. Choose egg white and egg substitutes – they don’t have cholesterol. Avoid organ meats like liver and gizzards and fatty cuts of red meat (beef, pork, and lamb).

Avoid foods with trans fat: Do not buy foods with “partially hydrogenated oil” on the ingredient list. Trans fat are also found in deep fried foods. Trans fat raise LDL-C, Triglycerides and lower HDL-C (the good cholesterol)

Avoid sugar sweetened drinks or beverages, like soda, sweetened tea, fruit punch, and sport drinks, and sugary foods, like donuts, cookies, pies, pastries, and candy. Avoidance of these can also help you achieve a healthy weight.

Smoking – while research have not conclusively shown that smoking changes LDL-C levels, but they have shown that smoking does significantly potentiate the detrimental effects (heart attack, stroke, etc.) of LDL-C in the body and these detrimental effects are even multiplied astronomically in the presence of other heart disease risk factors. In other words, LDL-C is more toxic in an environment of smoking (including second hand smoke exposure). One third of all heart disease deaths are contributed to by smoking [Centers for Disease Control and Prevention (CDC)]. Smoking cessation has both immediate and long-term benefits – your risk of heart attack may drop by 30% within one year of smoking cessation; and your risk of heart attack drops to same level as one who had never smoked by 5 to 10 years of smoking cessation!

Burn 2000 or more calories each week by doing 200 to 300 minutes of moderate or high intensity physical activity each week. You can do this by briskly walking for 30-45 minutes 5-7 days per week. If you have not been exercising at all, start with just a few minutes of light activity at a time.

Eating to Lower Your LDL-C Can be Easy:

. Fill ½ your plate with colorful non-starchy vegetables like broccoli, kale, spinach, green beans, and carrots

. keep starchy foods to ¼ of your plate. Choose whole grains like brown rice, quinoa, and fiber-rich whole-wheat bread. Tip – the darker the grain, the more the fiber content, and consequently the healthier it is. Choose healthy starchy vegetables like sweet potatoes or beans and peas.

. Make lean protein ¼ of your plate. Choose lean protein sources like fish, chicken and turkey with no skin, lean red meat, soy, lentils, and beans. Limit red meat, turkey, chicken and fish or seafood to about 6 to 7 oz each day.

. Have fresh fruits for dessert or snack.

. Drink 1% or no fat milk or eat nonfat yogurt for a snack

A registered dietician nutritionist (RDN) can help you make a heart-healthy meal plan that works best for your lifestyle and support you in your nutrition journey. Consult with a registered dietician nutritionist for the answers to your nutrition questions

In summary, while all these therapeutic lifestyle changes can contribute to achieving lower LDL-cholesterol levels, they may not by themselves significantly decrease LDL-cholesterol to a level low enough to reduce your chances of having a heart attack or stroke, or the other aforementioned sequelae of atherosclerosis such as renovascular hypertension, peripheral arterial disease, erectile dysfunction. Consequently, your health care provider may still recommend one or a combination of the various Food and Drug Administration (FDA) approved LDL-cholesterol lowering medications.



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