Motherhood Magazine
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Nourishing Notions

The Cholesterol Myth

Heart Healthy Dietary Clarification
By: Dr. Rezzan Khan

Dr. Rezzan Khan Dr. Rezzan Khan is the Country Representative of Pakistan at the American Overseas Dietetic Association, and a Consultant Nutritionist at Shifa International Hospital, Islamabad.

The Cholesterol Myth The Pakistani population has one of the highest risks of coronary heart disease (CHD) in the world, which is directly related to cholesterol levels in the blood. CHD is a serious health problem and is the reason for one of every four deaths in the United States annually. A healthy diet can help you to lower your blood cholesterol level, which can protect you from fatal CHD. In this article, we describe a number of food choices that can protect you and your family from an untimely death.

Confusion can arise when people with a high cholesterol level are wrongly advised to avoid certain foods because they are ‘high in cholesterol’. Only a small amount of cholesterol in the blood comes directly from our food. Cholesterol in the blood is produced in the body by the liver. Generally cholesterol from food has very little effect on blood cholesterol level; the amount of saturated fat you eat is far more important. What we should focus on, is eating a balanced diet and cutting down on our intake of saturated fat, rather than excluding cholesterol-containing foods.

You can prevent CHD by lowering low-density cholesterol level (LDL), which is called “bad cholesterol”. You can lower your LDL by achieving and maintaining a normal body weight, maintaining regular physical activity, and restricting dietary intake of saturated fat, trans-fats, and cholesterol. In addition, incorporation of dietary adjuncts that favorably affects LDL, such as soluble fibers and plant sterols and stanols, are recommended.

Eggs are commonly misperceived as a dangerous source of cholesterol. Research shows that egg consumption is unrelated to blood cholesterol level or to coronary heart disease incidence. One egg yolk a day is okay for most healthy people, as long as their total cholesterol comes in at 300 mg a day or less. One large egg yolk has about 180 mg of cholesterol; egg whites are cholesterol free. It is a good source of protein, vitamins A and D, B complex vitamins’ and phosphorus. Furthermore, eggs supply lutein and zeaxanthin, which may promote healthy vision. There are actually no nutritional differences between organic, fertile, free-range and brown or white color of eggs.

Shellfish, such as crab, oysters and mussels, can play an important part in a healthy balanced diet. Many types of shellfish are valuable sources of the heart-protective omega 3 fats. They are also a rich source of many key minerals, such as iron, zinc, selenium and iodine, nutrients that are not readily available in many other foods. Shellfish are naturally low in saturated fat and eating shellfish counts towards the recommended three ounces of two portions of seafood we are advised to eat each week. In particular, some shellfish contain as much omega-3 as some oil-rich fish.

In a small number of people (about 1 in 100) high blood cholesterol can be caused by a genetic condition called Familial Hypercholesterolaemia (FH) or Familial Combined Hyperlipidaemia (FCH). Those with this condition often need to be more cautious in their consumption of high cholesterol foods. If you eat an egg or shellfish on a given day, it's important to limit other sources of cholesterol for the rest of that day. Consider substituting servings of vegetables, pulses or nuts for servings of meat, or avoid high-fat dairy products for that day.

Several food components can help reduce the risk of CHD. In particular, dietary fibers, fatty acids, soy protein, phytoestrogens, vitamin E, plant stanols and sterols help protect from CHD. Dietary fiber is found in oat bran, oatmeal, oat flour, barley, rye, psyllium seed husk, peas, beans, apples, citrus fruit. Other fibers that are beneficial include whole grains, cereal grains, whole wheat bread, oatmeal and brown rice. Beneficial fatty acids include tree nuts, olive oil, canola oil and omega-3 fatty acids. Phytoestrogens are in soybeans and soy-based foods, flax, rye and some vegetables. Vitamin E is also helpful with CHD and can be found in sunflower seeds, almonds, hazelnuts and turnip greens. Plant stanols and sterols are found in corn, soy, wheat, fortified foods and beverages, fortified table spreads and dietary supplements.

Eating sterol and stanol-containing foods is an easy way to lower your LDL, which helps reduce the risk of heart disease. Plant sterols and stanols are substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. The FDA gave these products the status of a "health claim." This means that experts widely agree on the cholesterol-lowering benefits of stanols and sterols. It is easy to add in beneficial sterols and stanols to your diet. If you use butter or margarine now, just switch over to one of these sterol-fortified spreads on your whole-grain bread or rolls.  If you don't eat butter or margarine now, it is probably more beneficial to your health to avoid them, as they are very high in calories. Since sterols and stanols have powerful cholesterol-lowering properties, manufacturers have started adding them to foods. You can now get stanols or sterols in margarine spreads, cereals, granola bars, some cooking oils, salad dressings, milk, yogurt, and some juices.
The US National Cholesterol Education Program recommends that people who have high cholesterol should consume two grams of stanols or sterols a day. The American Heart Association does not recommend sterol and stanol-fortified foods for everyone. Instead, it suggests that only people who need to lower their cholesterol or who have had a heart attack should use them.

Strategic changes in your diet can protect you and your loved ones from an untimely death and crippling strokes. We have presented you with a number of food choices that could help. For more options, or for a more effective personalized food plan, please consult with a qualified nutritionist.