By Irene Maher. This article was published in The Age on 25 October 2016.
It’s a sad fact. The cholesterol count of the average middle-aged person makes most cardiologists cringe.
Cholesterol seems to start creeping up in our 30s or 40s as careers, kids and other obligations leave us more stressed, less physically active and heavier than ever. That’s a problem because high cholesterol can increase your risk of heart disease and stroke.
Lowering it without medication can be difficult, depending on your age and other health problems. For those with genetically high cholesterol, it can be nearly impossible without taking a statin, a prescription cholesterol-lowering medication.
But for many of us, lifestyle changes are enough to bring cholesterol down. Doctors almost always recommend exercising and not smoking, along with eating less saturated and trans fat. And losing weight – as little as two to five kilograms – can have a big impact on cholesterol.
But there’s another step you can take that may surprise you: Eat less sugar.
Sugar has a complicated relationship with cholesterol. But, simply put, if you eat more calories than your body needs to fuel daily activity, the excess is stored as triglycerides, a type of fat or lipid that circulates in the blood and makes up your total blood cholesterol number, along with HDL and LDL. This is especially true with low-nutrition foods that are high in sugar and white flour, such as cupcakes, cookies and candy bars.
In general, doctors want your total cholesterol below 200 milligrams per decilitre, and they want your triglycerides below the 150 mark.
You get into trouble if you routinely eat sweets and fail to burn off the extra calories. Not only will you gain weight, but your triglycerides will likely rise, too, increasing your total cholesterol and your risk for heart disease, heart attack and stroke.
For reasons that aren’t fully understood, high triglycerides contribute to the stiffening or hardening of artery walls, as well as to the formation of plaque deposits that cause narrowing of blood vessels. That narrowing can reduce blood flow to the heart, causing chest pain. Or, if a piece of that plaque buildup in your vessels breaks off and travels to a narrow section of an artery, blood flow to the heart or brain could be blocked, resulting in a heart attack or stroke.
That’s why, when a low-fat diet and exercise don’t seem to be lowering your cholesterol, your doctor may ask how many doughnuts you’re eating and how often.
“I see it in my patients all the time,” said Dr. James Smith, a cardiologist with USF Health and Florida Hospital Tampa’s Pepin Heart Institute. “For some people, the main problem with their cholesterol is sugar consumption.”
Smith routinely asks patients to keep a food diary in which they record everything they eat for several days. They’re almost always surprised to see how many refined sugar and white flour treats they’re eating. So, it’s not just full-fat dairy, bacon and prime marbled beef that’s elevating our cholesterol.
“And, if you have high triglycerides, your HDL, or good cholesterol, tends to be lower, so you lose its protective effect,” Smith said.
While it can be difficult to improve HDL and LDL cholesterol levels with dietary changes alone, triglycerides respond well and quickly to lowering sugar consumption.
“We ask patients to eliminate concentrated sweets, those empty calories we all indulge in, and to lose a little weight, which helps improve triglycerides fast,” said Morton Plant Hospital outpatient dietitian Nadine Pazder. “Within just a few weeks you’ll see significant improvement. Triglycerides move pretty quickly, where it can take months to see improvement in HDL and LDL with dietary changes.”
One of the biggest sources of added sugar in the American diet is beverages, especially sports and energy drinks, sodas, cocktail mixers, bottled iced teas and coffees and fruit-flavored drinks. Commercially packaged foods like barbecue, pasta and steak sauces, dried fruit, salad dressings, anything called sweet and sour, even yoghurt and granola bars can be loaded with added sugar, so it’s important to read labels.
Watch the ingredient list for some of the other names for sweeteners, such as sucrose, fructose, dextrose, lactose and maltose. Also remember that even brown sugar, honey, molasses, agave syrup and raw sugar are still added sugars.
The American Heart Association recommends limiting added sugar to 418 kilojoules or about 25 grams per day for women and 628 kilojoules or about 36 grams per day for men. One Emory University study found that most people consume about 1500 kilojoules of added sugar a day.
Tips for lowering cholesterol
Lose weight: Losing just two to five kilograms can lower triglycerides.
Don’t smoke: Improves HDL cholesterol.
Cut back kilojoules: Extra calories not burned off with physical activity are converted to triglycerides and stored as fat.
Limit sugary, refined foods: Eating lots of foods made with sugar and white flour can increase triglycerides. Limit these added sweets to 25 grams per day for women, 36 grams per day for men. One teaspoon of regular sugar or honey equals 4 grams.
Limit fruit juice: Even 100 percent natural fruit juice is high in sugar. According to registered dietitian Nadine Pazder, “It’s like drinking liquid sugar and is one of the first things eliminated when trying to lower triglycerides.” Even most pediatricians advise families to limit young children to 4 to 6 ounces of fruit juice a day, and up to 12 ounces for kids over age 6. It’s much better to eat whole fruits.
Choose healthy fats: These include olive, canola, peanut, sunflower and corn oils. Avoid trans fats or partially hydrogenated oils found in packaged cookies, crackers and snacks. Avoid solid fats.
Limit alcohol: Drinking too much can elevate triglycerides and increase blood pressure. One alcoholic drink per day has been associated with higher HDL levels. But, if you don’t drink, don’t start. Avoid sugary mixers.
Exercise: Get at least 30 minutes of physical activity about every day to lower triglycerides and increase HDL, or “good” cholesterol.
Fish oil: Eat seafood high in omega-3 fatty acids regularly. Talk to your doctor about whether you need fish oil supplements to lower triglycerides.
Add these to your diet: Avocados, almonds, walnuts, flax, whole grains, plant sterols and stanols found in fortified products, including margarine-like spreads, milk, yoghurt, some cooking oils and salad dressings.
Increase soluble fibre: Eat more oats and oat bran, fruits, beans and lentils to lower LDL cholesterol.
Add whey protein: When given as a supplement, whey protein powder (found in grocery and health food stores) has been shown to lower LDL and total cholesterol.
Sources: Mayo Clinic and the American Heart Association