Patient Education & Resources

Patient Education Module 8 - Nutrition 2

Cholesterol and triglycerides are both lipids (fats) found in the blood and other parts of the body. They are important substances that are produced naturally by the body and which are found naturally in food.

When the blood levels of cholesterol and triglycerides are too high, fatty deposits may accumulate on the walls of blood vessels. Eventually a blockage may occur, cutting off circulation to a part of the body. This could lead to a heart attack, if the blockage is in the vessels of the heart, or a stroke, if the blockage occurs in the vessels leading to the brain.

Cholesterol must be carried in the blood by substances called lipoproteins. Two of the lipoproteins that will be measured by your doctor are LDL and HDL. These along with triglycerides will make up most of the total cholesterol.

LDL and HDL

LDL:  Many people have too much LDL cholesterol circulating in their blood. This excess cholesterol can be deposited on the walls of the arteries, along with other substances forming atherosclerotic plaques. This can block the flow of blood and oxygen and may lead to heart attack and stroke. This is the reason LDL is often called the bad cholesterol. A high level of LDL cholesterol means an increased risk of heart attack.

HDL:  The role of HDL is to pick up cholesterol from the arteries and tissues and carry it back to the liver, where it can be eliminated from the body. HDL is known as good cholesterol because a high level of HDL is associated with a low risk of heart attack. Weight loss, quitting smoking, and increasing aerobic exercise are the best ways to raise the level of HDL cholesterol.

Triglycerides:  To get an accurate measurement of your triglyceride level, it is necessary to have a blood sample taken after an overnight fast. Weight loss, reduction in alcohol intake, exercise and good control of diabetes often normalize triglyceride levels.

How Do I Know if I Have High Cholesterol?

Patients with high cholesterol usually have no obvious symptoms, but it can be detected easily with a blood test. Ideal cholesterol levels for people with heart disease are:

Total cholesterol	< 5.2
LDL	< 1.8
HDL	> 1.2 for females > 1.0 for males
Triglycerides	< 2.0

The goal: The goal is to keep your total cholesterol count as low as possible; decreasing Triglyceride and LDL levels and increasing the HDL.

What can I do about Cholesterol?

Elevated cholesterol will not go away on its own (nor will the danger of heart attack or stroke). For control and treatment, there are guidelines that will help you.

1. Diet
   
   
   • Reduce Saturated Fat (found in animal products, tropical oils, hydrogenated fats)
   • increase Fibre (found in grains, legumes and fruits and vegetables)
   
   
2. Maintain Ideal Body Weight
   
   
   • frequently your cholesterol count will come down as you lose weight
   
   
3. Exercise
   
   
   • exercise helps raise HDL and helps lower triglycerides
   
   
4. Medications
   
   
   • There are a number of genetic factors which regulate cholesterol levels and for some people, a cholesterol lowering diet is not enough to bring blood cholesterol levels down to low risk values. That is why your doctor may prescribe a medication to regulate the lipid carriers - LDL & the lipid removers HDL.

   Remember that medication is meant to work with diet and exercise, not in place of them.

Shopping and Label Reading

What foods you eat at home primarily depends on what foods you buy at the grocery store. Buying foods that are low in fat and cholesterol is the first step in following the heart-healthy diet. Reading and understanding food labels is also important when you are shopping. However, this can be a difficult task. There are three major points to look for when you read labels:

1. The claim on the package

   Be very careful when you see a product labeled light or lite. This does not necessarily mean lower in fat or calories. It could mean less salt or lighter in taste or colour. Read the label carefully and look for information on calories and type and quantity of fat in the product.

   Claims about Fibre

   There are claims of moderate, high and very high sources of fibre on various products. Some cereals, cookies and bread carry such claims, but these products may also be high in calories, sugar and fat. Look at the ingredient list for the presence of saturated or hydrogenated fat. Do not buy a product based on one claim only, look at the overall information.

   Other Claims

   The following list of claims are examples of information you may see on food labels. These claims must meet certain standards per serving.

   Low in fat	No more than 3 grams total fat
   Low in Saturated Fat	No more than 2 grams saturated fatty acids and no more than 15 per cent of its energy value from saturated fats
   Low In Cholesterol	No more than 2 grams saturated fatty acids and no more than 15 per cent energy from saturated fatty acids. No more than 20 milligrams cholesterol.
   Cholesterol Free	No more than 2 grams saturated fatty acids and no more than 15 per cent energy from saturated fatty acids. No more than 3 milligrams cholesterol per 100 grams.

   The fat content, particularly the saturated fat content is more important than cholesterol. Some of the no cholesterol foods, like potato chips, are in fact loaded with fat. Saturated fat is found in foods from animal and vegetable sources.

   Foods with the least saturated fat are recommended for a healthy diet. Read the nutritional information and the ingredient list to make a decision on the product.

2. Nutrition Information Labeling

   In Canada this is voluntary, except when a specific claim is made on the product. In this case there are regulations regarding the specific nutritional information that appears on the label.

   A claim about fat or cholesterol must be accompanied by the following nutritional information:

   • fats in grams
   • polyunsaturates in grams
   • monounsaturates in grams
   • saturates in grams
   • cholesterol in milligrams
   
   
3. Ingredients

   Ingredients are listed in the order of their amount. The first is the largest, the last is the smallest. Fats should be listed as the third ingredient or farther down the list. Check the label for this. Avoid products containing the following fats unless they are listed below the third ingredient on the label:

   • palm oil
   • coconut oil
   • hydrogenated fat
   • lard
   • beef tallow
   • shortening

Dining Out

When choosing restaurants and ordering meals, keep in mind the new lifestyle you have adopted in regards to the heart-healthy diet.

• limit meat, fish or chicken portions to 4-6 ounces
• ask that sauces or salad dressings be served on the side so that you can control how much of them you eat