Takeaways

• There are 2 main types of lipoprotein: high-density lipoprotein (HDL), or “good” cholesterol, and low-density lipoprotein (LDL), or “bad” cholesterol.

• Making lifestyle changes and incorporating foods high in soluble fiber, omega-3 fatty acids, phytosterols, and plant stanols (e.g., oats, barley, psyllium husk, and avocadoes) is a great first step to getting your cholesterol levels under control.

• When incorporating these foods into your diet, it is important to also look at your diet on a broader level and consider the total number of calories you’re consuming.

• If the lifestyle measures cannot bring down your cholesterol levels sufficiently, your doctor may prescribe medications to help.

What is Cholesterol? Is it good or bad?

Cholesterol is a fat-like substance that is found in your blood and is produced by your liver. Cholesterol is important for normal function of the body, including formation of cell membranes, certain hormones, and vitamin D. 

Cholesterol cannot dissolve in blood. To help cholesterol travel in your body, our liver produces lipoproteins that consist of protein and cholesterol. There are two main kinds of lipoprotein: high-density lipoprotein (HDL), or "good" cholesterol, and low-density lipoprotein (LDL), or "bad" cholesterol. 

• Low-density lipoprotein (LDL) cholesterol is known as “bad” cholesterol. It carries cholesterol to the cells that need it, but if you have more cholesterol in the blood than you need, it gets stuck to the walls of your arteries. This can clog and damage your arteries, which can make it difficult for blood to flow through. If the arteries leading to your heart and brain get blocked and damaged, it can lead to a heart attack or stroke. The lower your LDL levels, the lower your risk for cardiovascular disease.

• High-density lipoprotein (HDL) cholesterol is known as “good” cholesterol. It takes the “bad” cholesterol out of your blood to the liver, where it is broken down and removed from your body. This helps to prevent “bad” cholesterol from building up in your arteries. The higher your HDL levels, the better your protection against cardiovascular disease.

 Doing a cholesterol test can measure the amounts of each type of cholesterol in your blood.

Causes of high cholesterol

Causes of elevated LDL cholesterol levels include non-modifiable factors like increasing age and family history, and modifiable factors such as being overweight, poor diet (e.g. diet high in saturated and trans-fat), lack of physical activity and smoking.

Managing high cholesterol

In general, adopting the following measures can help reduce our cholesterol levels.

• Eating a healthy diet, in particular (1) by reducing saturated and trans-fat intake (e.g. fried foods, red meat, pastries and desserts), and (2) by increasing fibre intake (e.g. taking more vegetables, fruits or fibre supplements).

• Exercising at least 150 minutes a week

• Losing excess weight, aiming for a health BMI of less than 23 if you are of Asian ethnicity, or less than 25 if you are of other ethnicity

• Stopping of smoking

• Drinking alcohol in moderation

In addition to lifestyle changes, medications such as statins may be added to help improve your cholesterol levels, depending your risk for cardiovascular disease.

Healthy foods you can eat to reduce your cholesterol levels

Besides the above measures, there are some healthy foods that you can incorporate into your diet, that have been shown to lower cholesterol levels as well. These foods tend to be high in soluble fibre, omega-3 fatty acids, phytosterols as well as plant stanols. Below is a list of foods that have one or more of the preceding properties, that have been shown to lower bad cholesterol.

Oats and Barley

Eating whole-grain foods reduces your risk of heart disease. Oats and barley are extra special because they are high in a type of soluble fibre called 'beta-glucan'. Beta-glucan helps to lower 'bad' LDL cholesterol in your blood. However, flavoured oat products like 'quick’ or ‘instant’ oats often contain added salt and/or sugar. Choose products that contain 100% oats (like rolled or steel-cut oats) as they are the least processed.

It has been shown that diets supplemented with around 7 grams/day (around 2.5 cups of cooked oats/ barley) beta-glucans decreased LDL cholesterol levels by up to 7% compared with control diets.

Psyllium Husk

Psyllium is a type of soluble fiber that passes through the small intestine without being completely broken down or absorbed. It absorbs water and becomes a viscous compound that can help with blood sugar, blood pressure, cholesterol, weight loss, constipation and diarrhoea.

Psyllium binds to fat and bile acids, which helps the body to excrete them. In the process of replacing the lost bile acids, the liver uses cholesterol to produce more bile for digestion. As a result, LDL cholesterol gets “cleared” from the blood effectively and therefore experiencing a drop in serum LDL cholesterol levels. Meta-analysis research done on psyllium husk suggests that supplementing with psyllium husk can help to reduce LDL cholesterol levels by up to 10%. 

Some people may notice constipation, cramping, gas, or bloating when first starting out. Start with small doses of 5 grams up to three times per day (15g), and increase to up to a maximum tolerable amount of up to 30 grams in total a day. Do consume more water than you normally would if you are planning to start supplementing with psyllium husk, which might help those who experience constipation.

Flaxseeds

Flaxseed is a plant-based food that provides antioxidants, healthy fat, and fiber. Termed as a “functional food,” people also consume it to boost their health due to its various benefits. Flaxseed also contains phytosterols, which help prevent the absorption of cholesterol in the intestines. Consuming phytosterols may, therefore, help reduce levels of low-density lipoprotein (LDL), or “bad,” cholesterol in the body.

Up to 50 grams (¼ cup) of flax seeds a day has been shown to reduce LDL cholesterol in healthy young adults by up to 8%, and up to 14% in people with high cholesterol (hypercholesterolemia). 

Avocados

Avocados are a rich source of monounsaturated fats and fiber — two nutrients that help lower “bad” LDL and raise “good” HDL cholesterol, making them an exceptionally nutrient-dense fruit. There are also one of the foods with the highest amount of fibre.

An analysis of 10 studies concluded that by substituting other dietary fats, especially saturated fats for at least one avocado a day, was linked to lower total cholesterol, LDL and triglyceride levels. 

Nuts

Nuts are another exceptionally nutrient-dense food which is high in monounsaturated fats. In particular, almonds, pistachios and walnuts are also rich in the plant variety of omega-3 fatty acids, a type of polyunsaturated fat associated with heart health.

What’s more, nuts provide phytosterols. These plant compounds are structurally similar to cholesterol and help lower cholesterol by blocking its absorption in your intestines.

In an analysis of 25 studies, consuming around 2–3 servings (2-3 handfuls) of nuts (almonds, pistachios, walnuts) per day had been shown to decrease “bad” LDL cholesterol by an average of 10.2 mg/dl.

Legumes

Legumes (or pulses) come from a group of plant-based foods such as peas, beans and lentils. They contain a good amount of fiber, minerals and protein. It has been shown that replacing some of your daily refined grains and processed meats in your diet with legumes, can help to lower your risk of heart disease.

A review of 26 randomized controlled studies demonstrated that eating around a 1/2 cup (100 grams) of legumes per day is effective at lowering “bad” LDL cholesterol by an average of 6.6 mg/dl, compared to those who do not consume legumes.

Vegetables and Fruits

Eating a variety of colourful vegetables and fruit every day can help protect you against heart disease, stroke and some cancers. Many vegetables and fruit are high in soluble fibre which helps to reduce the absorption of cholesterol and lower 'bad' LDL cholesterol in your blood. 

On top of that, vegetables and fruit also contain a wide range of essential vitamins and minerals that our bodies need. For instance, most are good sources of Vitamin C, folate and potassium, while calcium and iron come mostly from leafy green vegetables. Vegetables and fruit are major sources of phytochemicals, natural plant chemicals that protect health. The best way to get the complete range of vitamins and minerals available from fruit and vegetables is to have at least four or more servings a day. 

Foods fortified with Sterols and Stanols

Sterols and stanols are compounds which are of identical shape and size as cholesterol. They are absorbed from the intestines into the bloodstream and block some cholesterol from being absorbed, which in turn lowers the cholesterol in your blood.

We get a small amount of sterols from plant-based foods such as vegetable oils, nuts, seeds, whole grains, fruits and vegetables. But the amounts from these foods may be too low to reduce LDL cholesterol. So, food companies have developed foods with plant sterols or stanols added to them, such as margarine, mini yoghurt drinks, fat spreads, milk, cereals, orange juice, etc. They are also available as standalone supplements.

Check your food labels and ingredient lists to verify if the food has added plant sterols. Foods alone may not have enough plant sterols you need to lower your LDL cholesterol. Therefore, you might need to use both foods and supplements to reach at least 1 to 3 grams each day. 

Meta-analyses were done on sterols and stanols, and the results consistently reaffirmed that LDL cholesterol levels can reduce up to 15% compared to placebo, by having an intake of 1 to 3 grams of phytosterols (or stanols) a day.

Easy to prepare items to lower cholesterol

Overnight oats with berries and almonds

Start off your day with a great breakfast that can keep you full for the entire morning!

Ingredients:

• Steel-cut / rolled oats 5 tablespoons

• Milk fortified with plant sterols* ½ cup / 120ml

• Greek yogurt 1/3 cup / 80g

• Chia seeds 1 tablespoon

• Berries or other fresh fruits as desired, diced 0.5 cup

• Roasted almond diced 1 tablespoon

How to prepare:

1. In a small container, mix together the oats, milk, yogurt, and chia seeds.

2. Cover and chill in the fridge for at least 2 hours or preferably overnight.

3. The next morning, add berries and almonds. Enjoy!

Banana tofu smoothie

Give this tasty and nutritious smoothie a try if you are looking for a healthy snack option!

Ingredients:

• Banana 1 medium piece

• Silk tofu 0.5 cup

• Milk fortified with plant sterol* 1 cup

• Flaxseed, ground 1 tablespoon

• Walnuts 4 pieces

How to prepare:

1. Peel banana and slice. Cut tofu into smaller pieces.

2. In a mixer, blend all ingredients together until smooth. Serve.

*These 2 milk options contain plant sterols and can be easily found in Singapore: HL milk with plant sterols, and Nestle Omega Plus.

Conclusion

If you have high blood cholesterol, you can make changes to lower your risk of cardiovascular complications. Making lifestyle changes and incorporating these healthy foods into your diet is a great first step to get your cholesterol under control.

When incorporating these foods into your diet, it is important to also look at your diet on a broader level and consider the number of calories you are consuming. Simply adding these food items on top of the food that you usually consume will increase your total calorie consumption, which might lead to weight gain and have negative implications on blood sugar.

If the lifestyle measures are not able to bring down your sufficiently, your doctor may prescribe medications to help. Just remember - by making modest changes now you can reduce your risk of a more serious complication later!