Nutrition for Life - 2017

Fats Part II: Cholesterol & Heart Health

By Parul Kharod

South Asians have four times the risk of heart disease as the general population and have a much greater chance of having a heart attack before age 50. Heart attacks strike South Asian men and women at younger ages and the attacks are deadlier compared to any other ethnic group. Almost one in three in this group will die from heart disease before age 65. In India, cardiovascular disease remains the No. 1 cause of death. One study found that South Asians developed heart disease 10 years earlier than other groups. That is why it is vital to monitor your cholesterol levels and eat a heart healthy diet.

What is Cholesterol?

Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Our body needs cholesterol to make hormones, vitamin D, and enzymes that help with digestion. Our body makes all the cholesterol we need, but we get excess from food.

Cholesterol is transported in the blood in substances called lipoproteins, which have fat on the inside and protein on the outside. There are two types of lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important.

Lipid Profile

A lipid profile is used to determine your risk of heart disease and to help make decisions about what treatment may be best if there is borderline or high risk. A complete lipid panel measures four types of lipids, or fats, in your blood:

• Total cholesterol: This is the total amount of cholesterol in your blood.
• Low-density lipoprotein (LDL) cholesterol: This is referred to as “bad" cholesterol. Too much of it raises your risk of heart attack, stroke, and atherosclerosis.
• High-density lipoprotein (HDL) cholesterol: This is referred to as “good" cholesterol because it helps remove excess cholesterol from your blood.
• Triglycerides: When you eat, your body converts the calories it doesn't need into triglycerides, which are stored in your fat cells. People who are overweight, diabetic, eat a diet high in sugar and/or simple starches, or drink too much alcohol can have high triglyceride levels.

What are normal cholesterol levels?

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) published new guidelines on treatment of cholesterol to reduce cardiovascular disease risk in adults.

Total Cholesterol

• Desirable: Less than 200 mg/dL (5.18 mmol/L)
• Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L)
• High: 240 mg/dL (6.22 mmol/L) or higher

LDL Cholesterol

• Optimal: Less than 100 mg/dL (2.59 mmol/L); for those with known disease (ASCVD or diabetes), less than 70 mg/dL (1.81 mmol/L) is optimal
• Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
• Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L)
• High: 160-189 mg/dL (4.15-4.90 mmol/L)
• Very high: Greater than 190 mg/dL (4.90 mmol/L)

HDL Cholesterol

• Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women
• Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women
• High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women

Fasting Triglycerides

• Desirable: Less than 150 mg/dL (1.70 mmol/L)
• Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L)
• High: 200-499 mg/dL (2.3-5.6 mmol/L)
• Very high: Greater than 500 mg/dL (5.6 mmol/L)

How to lower cholesterol & triglycerides

• Saturated fats are present in animal products, such as meat, dairy products (especially cheese), and eggs, and also a few vegetable oils, such as palm oil, coconut oil, and cocoa butter. Saturated fat can increase your levels of LDL cholesterol, so it is best to limit these foods.

• Trans fats are a byproduct of a process called hydrogenation that turns liquid vegetable oil into solid margarine or shortening. Trans fats are used as a preservative to increase shelf life. They have been proven to increase risk of heart disease as they increase LDL cholesterol and triglyceride levels while reducing levels of HDL cholesterol. It is best to completely avoid trans fats. Limit packaged processed foods, fast food, and processed meats. Avoid foods that have partially hydrogenated oil in the ingredient list.

• To lower triglycerides, limit all sugars in foods and beverages. Limit all simple starches such as maida (all-purpose flour), white rice, and fried foods.

• Increase foods with soluble fiber, which binds cholesterol and its precursors in the digestive system and helps remove them from the body. Eat a variety of whole grains, beans and legumes, and plenty of vegetables.

• Eat heart healthy fats such as nuts, seeds, olives, and avocado. Limit the total amount of oil used in cooking and avoid fried foods. Walnuts and flax seeds are especially beneficial in lowering cholesterol and triglycerides as they are a good source of omega-3 fats.

Best Foods to Lower Cholesterol

• Oats
• Barley
• Beans (Whole pulses & Lentils)
• Green Leafy Vegetables
• Broccoli
• Sweet Potato (orange variety)
• Walnuts
• Flax seeds (raw, powdered)
• Apple
• Cinnamon

-- Parul Kharod, MS, RD, LDN is a registered dietitian and licensed nutritionist and works as a Clinical Dietitian with Outpatient Nutrition Services at WakeMed Hospital in Cary and Raleigh. She can be reached at