Chapter 1

Managing Cholesterol Is Easier Than You Think

IN THIS CHAPTER

Sorting out the kinds of cholesterol

Cutting back on cholesterol and saturated fat

Souring on added sugars

Using the guidelines to decide what to eat

Turning yourself into a savvy cook

Looking at the recipes

The heart goes about its business, beating 100,000 times a day, and you probably hardly give it a thought, until perhaps you have your cholesterol checked and find out it's too high. Then suddenly caring for this precious piece of yourself takes center stage. Self-care starts with knowing what to eat and how to cook the foods that are best for you. That's the reason I wrote this cookbook - to give you a tool for managing cholesterol and keeping your heart healthy with good nutrition.

This chapter serves as your jumping-off point to managing your cholesterol. It tells you about the several ways diet plays a role in cholesterol and introduces you to a healthy way of eating that can reverse your high cholesterol. You can use this information as a preview for the book where I discuss in greater detail shopping for heart-healthy ingredients and setting up a workable kitchen so you're ready to cook the recipes that are in Part 5.

Understanding Cholesterol - It Doesn't Grow on Trees

The liver produces cholesterol, whether it's your liver or the liver of a chicken or cow. Only animal products, such as eggs, meat, and dairy foods, contain cholesterol. Plants don't have livers, and they don't contain any cholesterol, which is one reason why a cholesterol-controlling diet features plant foods.

Although you may have worries about having high levels of cholesterol in your blood, you don't need to fear cholesterol itself. Cholesterol is essential for your body to function. It's a natural substance your body uses to build cell membranes, make hormones such as testosterone and estrogen, and create bile acids needed to digest and absorb fats. Cholesterol is also an important precursor to vitamin D. Your liver produces all the cholesterol your body needs, but you also absorb a relatively small amount of cholesterol from foods such as eggs, milk, and meats.

What your healthcare provider is referring to when you hear that you have high cholesterol is the kind circulating in the blood, which is a lipoprotein. A lipoprotein is a package of cholesterol, protein, and fat that the liver assembles and releases into the bloodstream.

There are many different types of lipoproteins, but the two you hear most about are as follows:

• Low-density lipoproteins (LDL): LDL hauls out cholesterol from the liver; it's this cholesterol that deposits in arterial walls and initiates the formation of plaques that can narrow the artery. A blood clot at the site where the artery has narrowed can block the flow of blood and trigger a heart attack. (That's why it's called the bad cholesterol.)
• High-density lipoproteins (HDL): HDL carries cholesterol back to the liver for conversion into bile acids and excretion via the intestinal track. (In this way, HDL earns its nickname, the good cholesterol.)

Therefore, the purpose of a cholesterol-controlling diet is not just to lower total cholesterol, but also to lower LDL and raise HDL.

Managing Cholesterol with Diet

Altering what you daily eat can lead to significant improvements in your total cholesterol level, your levels of LDL and HDL, and triglycerides (a type of fat found in the blood). Some foods show little benefit whereas others are powerful allies. Research about what aspects of diet most affect blood cholesterol is ongoing, and in recent years the emphasis has shifted, which I discuss here.

Considering the new dietary guidelines

Cholesterol and saturated fat are now seen in a new light, whereas a third factor, easily absorbed carbohydrates, for example sugars, has become cause for concern. Take note of the following:

• The amount of cholesterol in the foods you eat isn't the worry it used to be, at least for many people. For those individuals, avoiding foods high in cholesterol is no longer a cure-all and may have little effect.
• The longtime advice to cut way back on saturated fat is still in place, but now with an important difference: Rather than aiming at just following a lowfat diet, the new recommendation is to replace saturated fat calories with other kinds of fats that manage cholesterol and are good for the heart. Refer to Chapter 3 where I discuss these other kinds of fats.
• Research is showing a link between cholesterol levels and high intake of sugars. The modern diet, with its dependence on food products and fast-food meals, is full of added sugars, and they need to be greatly reduced. Chapter 3 looks at how to reduce these sweeteners.

Eating cholesterol: Yes or no?

Cutting back on the amount of cholesterol you eat to reduce the amount in your blood sounds like good advice, and for some people this suggestion works. But for many, the amount of cholesterol-rich foods in their diet has little or no effect on their blood cholesterol levels. About two-thirds of people fall into this group, a conclusion based on a growing number of studies as well as clinical experience. These folks can enjoy their eggs in the morning and a shrimp dinner at night. When they consume more cholesterol, their body makes less, and when they eat less cholesterol, their body makes more. For them, the liver tightly controls how much cholesterol it makes.

However, the other third of the population does see changes in their cholesterol levels according to how much cholesterol is in their everyday meals. Foods that contain cholesterol raise their blood cholesterol levels. These people are cholesterol-responders, a tendency thought to be genetic. Lowering their cholesterol intake continues to be a key part of their dietary plan. Switching to a modified or fully plant-based diet may be in order and can be effective.

Unfortunately no test can determine which group you're in. The only way to find out if you're a cholesterol-responder is to have your cholesterol levels checked, cut cholesterol from your diet, and test your cholesterol again. If you're sensitive to the cholesterol you eat, you'll likely see a change in your lab numbers in about three months.

Turning your back on saturated fat

To manage cholesterol, you need to keep the amount of saturated fat you have in your meals to a modest amount. The reason: The liver produces cholesterol and breaks it down, and saturated fat alters the process. As a result, the level of LDL cholesterol increases, raising the risk of heart disease and stroke.

The 2020-2025 Dietary Guidelines for Americans, determined by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA),?limits saturated fats to "less than 10 percent of the calories" you consume per day. The American Heart Association goes even further for people who need to lower their cholesterol, dropping calories from saturated fat for both men and women to less than 6 percent of total caloric intake. That's about 100 to 120 calories, or around 11 to 13 grams for a 2,000-calorie daily diet. With that as your goal, you'd reach your quota in no time. For example, a cup of vanilla ice cream contains 9 grams and a cheeseburger anywhere from 11 to 22 grams.

Refer (again) to Chapter 3 for foods high in saturated fat and how to limit them. I also discuss trans fatty acids that behave similarly to saturated fat, elevating LDL cholesterol almost as much and raising triglycerides. You can also find information about the healthy fats, the monounsaturates and polyunsaturates, and all the foods that contain them.

Cutting back on sugars

Having too much sugar in your diet in its many forms, such as high fructose corn syrup and sucrose found in so many food products, can raise cholesterol and undermine heart health. Such sweeteners impact blood lipids in the following ways:

• A diet high in sugars raises LDL cholesterol, triggering the liver to make more.
• A sugary diet lowers HDL cholesterol.
• Excess sugar greatly raises triglycerides, at the same time inhibiting an enzyme that breaks them down.

Chapter 3 expands on this connection between the intake of sugars and cholesterol explaining reasons for this link and outlines a variety of actions you can take to make sure your blood sugar levels stay steady and within normal range.

Deciding What's for Dinner

To be able to translate the nutrition guidelines into what to cook for dinner, you need specifics. That's where Chapters 2 and 3 come in. Chapter 2 is about all the foods that can help you manage your cholesterol and support general heart health, whereas Chapter 3 takes a considered look at the kinds of foods that cause concern, such as high-cholesterol foods and saturated fats, and advises on how to deal with them.

The following sections focus on which foods are best and why. I also give you a handy way to think about foods in terms of which and how often.

Choosing foods for their fiber and nutrients

Soluble fiber is a gel-like substance that helps cart cholesterol out of the...