EATING PLAN FOR HIGH CHOLESTEROL (HYPERLIPIDEMIA)Thisplanwilllimityourintakeofsaturatedfat,transfatandcholesterolwhileincreasingfruit,vegetablesandwholegrains.

Cholesterol Defined A serum lipid test is a measure of your blood cholesterol levels. Your blood sample will be measured for four different components. The total cholesterol, triglycerides, low density lipoprotein (LDL or bad cholesterol) and the high density lipoprotein (HDL or good cholesterol) are reported to your doctor. These levels are compared to target values appropriate for reducing your risk for heart disease. If your values are not at target, improving eating habits, becoming more active, avoiding smoking and taking medications can improve your cholesterol values.

10 Tips to Help Reduce Your Cholesterol Levels1. Eatplentyofvegetablesandfruits-7servingsormoreeachday2. Eatwholegrainfoodsrichinsolublefibre–oats,psylliumandbarley3. Include2Omega3richfishmealsperweek–salmon,trout,sardines4. Include2beanbasedmealsperweek–kidneybeans,chickpeas,lentils5. Eatnutssuchasalmondsandwalnuts–smallportions5timesaweek6. Improvethequantityandqualityoffatsyoueat7. Oilsarebestforaddedfat–usesmallamounts,avoidfrying8. Beactive–moveyourbody30minuteseachday9. Ifyouareoverweight,worktoreduceyourweightby10%10. Ifyourtriglyceridesarehigh,limitsugarsandalcohol.

Cholesterol Facts • Highcholesterolcanincreaseyourriskofheartdisease.• Cholesterolinyourbloodcomesfromwhatyourliverproducesand

whatyouconsumeinyourdiet.Highlevelsofcholesterolinyourbloodcanentertheliningofyourarteriesandformdepositsor“plaques”.Theseplaquescangrowovertimeandblocktheflowofbloodinyourarteries.Thisputsyouatriskforaheartattackorstroke.

• Makingchangestoyoureatingtoloweryourintakeofsaturatedfat,transfatandcholesterol,whileincreasingfibre,canloweryourcholesterolbyasmuchas35%.

Build a healthy heart from the ground up – an eating plan based on fruit, vegetables, whole grains, nuts and legumes with lean protein choices is the foundation for managing your cholesterol.

Healthier Eating Guidelines for Lowering Cholesterol• Focus on Quantity and Quality of Fat

– Quantity–1/4to1/3ofyourcaloriescancomefromfat.Thismeansthatyoucaneatbetween50to70gramsoffateachday.Thenumberoffatgramsthatarerightforyoumaybelessormorethanthisdependingonyourgender,activitylevelandweightgoals.ARegisteredDietitiancanhelpdeterminehowmuchisrightforyou.

– Quality–unsaturatedfatssupportahealthycholesterolprofile.Thesefatsareliquidorsoftsolidatroomtemperature.Oilslikeoliveoil,canolaoil,soyoilandnon-hydrogenatedmargarinesaregreatqualityfats.Useinmoderation.Oneteaspoonofoil,thesizeofyourthumbtip,adds5gramsoffat.

• Limit saturated and trans fats, or hard fats, to 15 grams or less per day.Thesefatsarefoundinfullfatdairyproducts,meats,poultryskin,lard,palmkerneloil,hydrogenatedoilsandbakedgoodsmadewiththesefatsandoils.

• Eat less cholesterol – aim for less than 300 mg of cholesterol per day. Cholesterolisfoundonlyanimalfoods.Reducingportionsofmeat,avoidinghighfatcutsofmeatandchoosinglowerfatdairychoiceswillhelp.

• Eggs–Recentstudieshaveshownthateatinganeggadaywillnotincreasecholesterolorriskforheartdisease.However,ifyouhavediabetesyoushouldlimityoureggconsumptiontonomorethan6eggsperweek.

• Nuts such as almonds, walnuts, pecans and pistachios can help lower cholesterol.Studiesshow1.5ozorabout36almonds5daysperweekhelpedreducebadcholesterol.Ifyouareworkingtoloseweightasmallerportionof10-12nutsisrecommended.

Fibre – yes, for your heart!Fibreisfoundinplantbasedfoods.Vegetables,fruit,wholegrains,nuts,seeds,beans,peasandlentilsareallgreatfibresources.Functionalor“soluble”fibrehelpstoreducecholesterolbybindingwithcholesterolinyourstomachandbowel.Thischolesterolistheneliminatedinyourstool.Studiesshowweshouldinclude10to25gramsofthisfibreeachday.Hereisalistofthesolublefibrefoodsandthegramsoffibretheyprovide.

Heart Health Mixture=1/3groundflax,1/3oatbran,1/3psyllium.Use2tbspeachdayaddedtoyourfood.Itmixeswellwithyogurt,hotcerealandsaladdressing.

Salt – Shake the HabitTips to reduce salt (sodium) intake:• Home prepared fresh or frozen foods are best. Ifusingcannedfoods,lookforlabelssuchas“noaddedsalt”or“low

sodium”.• Avoid adding salttoyourfoodandomitfromrecipeswherepossible.• Season your food with herb and spice blends. Checkingredientliststoavoidthosewithsalt.• Limit condiments such as ketchup, mustard, soy sauce etc. • Use Nutrition Facts Labels. Bestchoiceshavelessthan200mgsodiumperserving.Avoidpackagedfoodwithmorethan

400mgofsodiumperserving.Checklabelscarefully.• Use ingredient lists-foodslistingsaltorsodiumatthebeginningofthelistormultipletimesinthelistarehighinsalt.• Restaurant foods are often high in sodium. Trytoavoidfastfoodbutdousetherestaurants’NutritionInformationto

identifylowersodiumoptions.Wheneatingout,askyourserverifthemealcanbepreparedwithoutaddedsalt.Requestsaucesontheside.

Item Soluble Fibre (g) Item Soluble Fibre (g)

Barley (1/2 c) 1 Navy Beans (1/2c) 2

Oatmeal (1/2 c) 1 Chickpeas (1/2 c) 1

Oat bran (1/2 c) 2 Carrots 1

Apple 1 Brussels Sprouts 3

Citrus (oranges) 2 Psyllium Seeds (1 Tbsp) 5

Pears 2 Metamucil (1 tsp) 2

Kidney Beans (1/2c) 3 All Bran Buds (1/3c) 2

Omega-3 Fats Omega3’sareunsaturatedfatsfoundincoldwaterfattyfish(salmon,mackerel,arcticchar,sardines,troutandherring)andinplantfoodsincludingwalnutsandflaxseeds.The“fish”omega-3’sarecommonlyknownasEPAandDHA.The“plant”omega-3’sareknownasALA.ALAisconvertedtoEPAandDHAinyourbody.Foodshouldbeyourfirstchoicetoachieveyouromega3’s(seebelow).Aimtoeat2mealsincludingfisheachweekandusetheHeart Health Mixtureasnotedonthepreviouspage.Ifyouhaveheartdiseaseoryourtriglyceridesarehigh,yourdoctorordietitianmayrecommendanOmega3supplement.

If you have High TriglyceridesInadditiontotheguidelinesformanagingyourcholesterol,youmaybenefitfromthefollowingrecommendations:• Alcohol: Men-limittolessthan2drinksperdayor14perweek.Women–limitto1drinkadayor9perweek.• Dependingonyourtriglyceridelevel,yourdoctormayaskthatyoufurtherreducethisamount.• Sugars -reduceaddedsugare.g.tablesugar,syrup,jam,honey,molasses.Limitjuice,pop,candies,sweets,chocolate

andbakedgoods.• Ifyouhavediabetes,workwithyourhealthcareteamtoimproveyourbloodglucose(sugar)control• Omega 3 supplements–adding2000to4000mgofEPA+DHAfromfishoil.Thisshouldbedoneunderthesupervision

ofyourdoctor• Niacin by prescription–thisBvitaminmayberecommendedtoloweryourtriglycerides.ItalsohelpsraiseHDL(good

cholesterol)

Reducing alcohol can promote weight loss and help decrease triglyceride levels.

Decoding Food LabelsTheNutritionFactstablefoundonthesideofpackagedfoodcanhelpyoumakebetterfoodchoices.Alwayschecktheservingsizefirstandconsiderthisinrelationtohowmuchofthefoodyouusuallyeat.

Lookforchoiceswithlessfat,saturatedfat,cholesterolandsodium.Lookforchoicesthatgiveyoumorefibre.Learn more about using food labels to make healthy choices on the web:Health Canada –www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.phpHealthy Eating Is In Store for You –www.healthyeatingisinstore.ca

OMEGA 3 CONTENT OF FOODS

Fish (2.5 oz) EPA/DHA (mg) per serving

Nuts/Seeds/Oils ALA (mg) per serving

Enriched Foods Total Omega -3 (mg) per serving

Herring 1600 Almonds (1/4 c) 150 Milk + DHA (1 c) 20

Mackerel 1490 Wheat Germ (27 g) 190 Soy beverage + flax 700

Salmon 1300 Canola Oil (1tsp) 430 Eggs + DHA (2) 800

Sardines 1050 Soybeans 760 Omega 3 yogurt (3/4 c)

500

Trout 870 Flaxseed, ground (1Tbsp)

1600

Arctic Char 680 Tofu (3/4c) 2020

Tuna, white (canned)

650 English Walnuts (1/4 c) 2300

To Reduce Weight • Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including

potatoes),1/2vegetables• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.

Learnmorefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.• “Waistloss”isasimportantasweightloss.FortipsonhowtotrimyourwaistseeourWaistingAwaynutrition

factsheet.

ForamoredetailedplanforweightlosspleasereadWaistingAway-HealthyWeightManagementavailableinourclinicoronthewebatwww.ottawacvecntre.com

Portions to Live By • Oneservingofwholegrainsis1/2cup

cooked,notthe3ormorecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.

• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideon-lineatwww.healthcanada.gc.ca/foodguide.

Prepare for Success• Cookwithoutaddingfat–bake,broil,roast,barbeque,grill,steam• Limitpanfryingandavoiddeepfatfrying• Tryusing1/3lessfatthanyourrecipecallsfor• Addflavourtofoodwithherbsandspices–thinkgarllic,lemon,gingerandmore• Refrigeratesoupsandstewsandskimofffatwhensolid• Useasprayofoiltopreventstickingandaddflavour

Food and Medication InteractionsReviewyourmedicationswithyourDoctor,DietitianorPharmacist.• Cautionwithgrapefruit,grapefruitjuice,pomelosandSevilleorangesCertainmedicationsforcholesterol

andheartdiseaseinteractwiththesefoods.

Supplements for Cholesterol Control CheckwithyourDoctor,DietitianorPharmacistbeforestartingasupplement.• Heart Healthy Mixture=1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayadded

tofoodsorbeverages.• Omega 3 supplements

– ifyouhaveheartdisease:1000mgperdayasEPA+DHA– ifyourtriglyceridesareelevated:2000to4000mgperday(underthesupervisionofyourdoctor).

• PlantSterols–consuming2gramsofplantsterolsperdayfromenrichedfoods,suchasmargarinewithplantsterols,hasbeenshowntoreduceLDLcholesterol.

• Redyeastricecanbeeffectiveatloweringcholesterolbuttheseproductsareunregulated.Theircontentisunreliableandthereforetheyarenotrecommendedforuse.

• Supplementsofgarlic,soyandlecithindonotappeartoreducecholesterolbasedoncurrentresearch.• Lecithindoesnotappeartoreducecholesterol.• CoenzymeQ10–evidencetodatedoesnotshowthatCoQ10reducesmusclepainassociatedwithcholesterol

loweringmedications.

Protein

Fruit

Protein

Vegetables

StarchStarch

Breakfast Lunch & Supper

Move your body, lower your bad cholesterol, raise your good cholesterol• Includingatleast30minutesofbriskactivity,suchaswalking,four(4)ormore

daysperweekcanloweryourLDLandraiseyourHDL.• Startwithabrisk10minutewalkafewtimesperdayandincreasegraduallyfromthere.• Gentlestretchingexercisesincreaseyourflexibilityandreleasetensioninyourmusclesandjoints.Aimfor4ormore

stretchingsessionsperweek.• Strengthexercisesimprovemuscleandbonedensitykeepingyoustrongandstable.Includethese2-4timesper

week.• Remembertostartslowlyandconsultyourphysicianbeforestartinganew

exerciseprogram

Keeping active can lower your blood sugar, cholesterol, blood pressure, help you feel better, relieve tension and stress, improve your muscle tone and help you lose weight!

Eating Plan for High CholesterolCholesterollowering–maximum15mgofsaturatedfatperday,300mgofcholesterolReadfoodlabelsforlessfat,saturatedfat,cholesterolandsodiumandmorefibre.

Vegetables and Fruit• Freshandfrozenarebest• Unsweetenedcannedfruit,unsaltedcanned

vegetables• Limitfruitjuicewithelevatedtriglycerides• Lowsodiumvegetablejuice• Avocadosandolivesinmoderationforhealthyfat

• Vegetablespreparedwithbutter,creamorsauce;batteredanddeepfried

• Fruitpackedinheavysyruporsugar;sweetenedfruitjuice,fruitdrinks,sportsdrinks

FOODS TO CHOOSE FOODS TO LIMIT OR AVOID

Whole Grains• bread,buns,rolls,pitabread,Englishmuffinsand

tortillas• lowfatcrackers,breadsticks,melbatoast,soda

crackers(unsaltedtops)• Unsweetenedhotorcoldcereal–oats,oatbran,

psylliumforsolublefibre• Brownrice,barley• Wholegrainpasta• Lowfatbakedgoods–addoatbran,groundflaxto

boostfibre

• Avoid“white”products• Cheeseoreggbread,croissants,sweetrolls• Crackersover5gramsoffatperserving,commercial

crumbcoatings• Sweetenedcereals• Pastawithbutter,creamorcheesesauce,chowmien

noodles,ramennoodles• Commercialmuffins,cakes,donuts,Danish,high-fat

cookies

Milk and Alternatives• Anywith1%MilkFat(MF)orless• Cheesewithlessthan20%MF–occasionaluse

• Allmilkproductswhicharemorethan1%MF• Cheese21%MForhigher

Beverages• Water,sodawater,mineralwater• Sugar-freesoftdrinks• Coffee,Tea–limitto4cupsperday• Cerealbeverages(e.g.Postum,Ovaltine)

• Regulartonicwater• Regularsoftdrinks,lemonade,sweetenedicedtea,

regulardrinkcrystalmixes• Flavoredinstantcoffee• Liqueurs,Cocktailmixes

Note: Underlined foods are commonly higher in salt (sodium)– limit use in cases of hypertension or other condition requiring salt restriction.

FOODS TO CHOOSE FOODS TO LIMIT OR AVOID

Meat and Alternatives• Fishandshellfish:fresh,frozen-unbattered,cannedinwater• Poultry:chicken,turkey–withoutskin• Meat:leancuts,fattrimmed

– Beef:round,rump,sirloin,extralean/leanground– Veal:round,rump,tenderloin– Lamb:leg,loin,shank,leanground– Pork:tenderloin,backbacon,ham– DeliMeat:ham,roastbeef,pork,turkey,turkeyorreducedfatwieners

– WildGame:moose,venison,rabbit• Legumes:chickpeas,kidneybeans,lentils,limabeans,

soybeans,splitpeas,tofu• Eggs:ifyouhavediabetes,limitto6perweek• Nuts:unsaltedalmonds,walnuts,pecans,pistachios–

limit1/4cperday• Peanutbutter:naturalornon-hydrogenatedorlight• Seeds:flax,pumpkin,sesame,sunflower

• Fishcannedinoil,commerciallyfried,frozenbatteredfish• Poultry:duck,goose,friedorbatteredchicken,chicken

wings• Meat:fattymarbledmeats,ribs,medium/regularground

meat,organmeats,bacon,sausage(unlesslowfat),cannedmeats

• Delimeat:pate,bologna,salami,high-fatluncheonmeats,wieners

• Peanutbutterwithhydrogenatedoil

Fats and OilsLimitaddedfatsto3teaspoonsperday.• Oils:olive,canola,corn,peanut,sesame,soy,sunflower• Margarine:non-hydrogenatedsoft(regularorlight)• Saladdressing/Mayonnaise:lowcalorie,caloriereduced,

oil-free,homemadewithrecommendedoils• Lowfatsourcream,creamcheese• Gravy:defatted

• Hydrogenatedorblockmargarine,butter,lard,shortening,suet

• Saladdressingsmadewithcheeseorregularsourcream• “Tropical”oils:palmkernel,coconut• Fullfatgravy,creamsauces

Sweets• Sugar:substitutes(e.g.sucralose,),lowsugarjams,jellies,

syrups• Sugarfree:candies,gelatins,gum• Bakedgoods:lowinsugar,fatandhighfibre• Frozendesserts:lowfat,lowsugaricecream,icemilk,

frozenyogurtandsherbet• Cocoapowder

• Sugar–useinmoderation• Regularjams,jellies,syrups• Regularcandies,gelatins,gum• Bakedgoods-regularcakes,pies,cookies-avoid“white”foods• FrozenDesserts:regularicecream,icemilk,frozenyogurt,

sherbet• Chocolatebars,chocolate

Snack Foods• Popcorn:hotairpoppedorlowfatmicrowave• Pretzels,bakedchips,ricecrispsandcakes

• Popcorn–regularandhighfatmicrowave,cornchips,potatochips,cheesies

Miscellaneous• Condiments(ketchupetc),herbs,spices,vinegar,pickles• Soups:preparedwithskimmilkorfat-freestock,bouillon,

broth,consommé

• Soups-cream

Eating Plan for High Cholesterol, August 2010DanielleAldous,BSc,RD(FromOriginal,2005:HeleneCharlebois,BSc,RD&JasnaRobinsonDI)©ContinuingMedicalImplementation®Inc.

Ottawa Cardiovascular Centre502-1355BankStreetOttawa,ONK1H8K7Phone: (613)738-1584Email: admin@ottawacvcentre.com

Other Nutrition Fact Sheets Available: EatingPlanforHypertensionEatingPlanforCongestiveHeartFailureEatingPlanforType2DiabetesWaistingAway–HealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information