Category Archives: Cholesterol

So Long, Trans Fats

On June 16, the U.S. Food and Drug Administration (FDA) ordered food manufacturers to phase out artificial trans fats from their products by June 2018 by finalizing a ruling that removes trans fats from the list of food additives that are “generally regarded as safe.”  Trans fats, listed on food labels as “partially hydrogenated oils,” are vegetable oils that undergo a chemical alteration process to make them semi-solid at room temperature.  Food manufacturers like them because they’re a cheap way to prolong the shelf life of packaged foods; your body, on the other hand, isn’t so fond of trans fats, as they raise cholesterol levels more than any other type of fat you consume.  Due to mounting evidence about the negative health consequences associated with their consumption (unlike other types of fat, the government recommends you consume absolutely no trans fat – that’s 0.0 grams/day), manufacturers have slowly been phasing out trans fats from their products over the past few years.  Whereas partially hydrogenated oils were once found in large quantities in margarine, baked goods, and other packaged treats, they have now been replaced with other types of oils or appear in significantly lower amounts However, this doesn’t always mean that the reformulated product is healthier, as high-in-saturated-fat palm oil is often used as a substitute for partially hydrogenated oils, and trans fat, even when present in very small amounts, can still be detrimental to one’s health.

While the slow decline of trans fats was a small step in the right direction, the FDA’s ruling will all but ensure that the foods we eat will be completely free of these heart-unhealthy fats in a few short years.  Manufacturers have the right to ask for an exception to the ruling if they can prove that there is “reasonable certainty of no harm” from the trans fats used in their products, but it’s highly unlikely that many, if any, manufacturers will have their requests approved.  Until manufacturers are required to produce completely trans fat-free products, you will need to be proactive in phasing out trans fats on your own by reading ingredients lists carefully to make sure they don’t contain the words “partially hydrogenated oil.”  But three years from now, you won’t need to be a food detective when it comes to rooting out trans fats, as they – and the increased risk of high cholesterol and heart disease that comes with their consumption – will be ancient history.


Fish Oil and Omega-3 Fatty Acids

Chances are, if you have high cholesterol, are at high risk of developing heart disease, have inflammatory issues, or are concerned about brain health, you have probably talked with your doctor about taking fish oil pills, which have been shown to help with all of these conditions. The reason fish oil has such beneficial effects on a number of conditions is that it’s high in omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), two types of fat that are crucial for optimal health.  EPA and DHA are also known as essential fatty acids, meaning your body can’t produce them on its own, so the only way you can meet your needs for these nutrients is through food or supplementation.  Many people turn to fish oil supplements as a convenient way to meet their essential fatty acid needs, but there are actually other, tastier ways to do so.

Fish oil is made from, obviously, fish, which means that eating the “real thing” will provide you with the same nutrients as a pill.  The bonus of eating fish that contain omega-3s is that your body will absorb more of these fatty acids than if you were to take a pill, plus the fish will provide other beneficial nutrients like protein. The best sources of omega-3s are oily fish like salmon, tuna, sardines, and anchovies, although most types of fish contain EPA or DHA in varying amounts.  You can meet your body’s needs for omega-3s through food alone if you eat two servings of oily fish each week; a serving of fish is generally considered 3.5 ounces.

Some people, myself included, are not fans of oily fish, but there’s hope for us yet, as other healthy foods, like flaxseeds and walnuts, also contain omega-3 fatty acids.  The type of omega-3 found in foods other than fish is of a slightly different variety, however, which is not as well-absorbed as the omega-3s found in fish.  The omega-3 fatty acid found in flaxseeds and walnuts is called alpha-linolenic acid, or ALA.  Although ALA on its own doesn’t confer the same nutritional benefits as EPA and DHA, your body is able to partially convert it to its more beneficial omega-3 counterparts.  What this means is that, when you eat a food that contains ALA, an extra step has to occur in order for your body to use it in the same way it uses EPA and DHA.  Therefore, ALA is not used as efficiently or absorbed as well as EPA and DHA, although it’s a still a great way to increase omega-3 intake without eating oily fish or taking fish oil supplements.

If you prefer to take a supplement to ensure adequate omega-3 intake, know that fish oil has been proven to be more effective (and safer) than up-and-coming “designer” counterparts like krill oil.  Flaxseed oil is a good vegetarian alternative to fish oil, but like flaxseeds themselves, the omega-3s it contains will not be as well-absorbed.  Although fish oil supplementation is generally safe, research shows that consuming greater than 3,000 mg (or 3 grams) of fish oil a day increases the risk of serious side effects like stroke.  As always, make sure to talk to your doctor before starting any supplementation routine, and aim to get your intake of omega-3 fatty acids, and most other nutrients, the natural way – through food!

The Good News About High-Cholesterol Foods

We all know that having too much cholesterol in our bloodstream can be a bad thing.  Abnormal cholesterol levels (generally defined as total cholesterol greater than 200 mg/dL; LDL, or “bad” cholesterol greater than 130 mg/dL; and/or HDL, or “good” cholesterol less than 40 mg/dL) can lead to an increased risk of developing heart disease or stroke.  This is due to the fact that many people with abnormal cholesterol often have high levels of LDL, which clings to artery walls and leads to the buildup of fatty plaques, and low levels of HDL, which normally helps remove excess LDL (but cannot do so efficiently if present in low quantities).

What we’re often unaware of, however, is just what causes abnormal cholesterol levels in the first place.  For some people, it’s a genetic issue in which their bodies are unable to properly remove LDL from the bloodstream.  For many others, however, the issue lies in the foods that they eat.   Just which foods are these?  The answer may be surprising.

It was long thought that foods that were high in cholesterol (like eggs and shellfish) raised cholesterol levels (particularly LDL) in the bloodstream.  Thus, foods like the extremely nutritious egg received a bad reputation, and many people refrained from eating them.  However, research has shown, and the recommendations from the 2015 Dietary Guidelines Advisory Committee reaffirm, that the cholesterol found in foods has little or no effect on blood levels of cholesterol.  This means that eating eggs or other high-cholesterol foods in moderate amounts won’t cause you to have high or abnormal cholesterol levels.

The real culprits when it comes to abnormal cholesterol levels are saturated and trans fats, which are found in animal products and margarine and baked and processed foods, respectively.  Excessive consumption of foods that contain these nutrients has been shown to raise blood cholesterol levels, particularly levels of heart-unhealthy LDL.  So what does this mean for your diet?  Moderate consumption of high-cholesterol foods like eggs and shellfish is okay, especially since these foods are rich in other beneficial nutrients like iron.  Regular consumption of high-saturated and –trans fat foods like red meat and pastries, on the other hand, is not recommended, as eating too many of these types of foods is likely to cause an increase in LDL cholesterol levels.  If you’ve been avoiding consuming foods that contain cholesterol because of what was previously believed, there’s no time like the present to start adding these foods back into your diet, preferably as a substitute for some of their higher-saturated fat counterparts!

Cholesterol – Knowing Your Numbers

We’ve all heard that having too much cholesterol can be a bad thing – it creates fatty plaques in our arteries and can lead to heart disease, a heart attack, or a stroke.  However, we actually need cholesterol in small amounts (it’s responsible for producing the cells in our body, as well as the hormones estrogen and testosterone, bile acids, and Vitamin D), and not all cholesterol is considered “bad.”  When it comes to your cholesterol, you need to consider not just your total cholesterol levels, but your levels of each different type of cholesterol, most notably:


  • LDL (low-density lipoprotein, or “bad” cholesterol). LDL clings to the walls of your arteries, which leads to a buildup of the fatty plaques that can contribute to heart disease.
  • HDL (high-density lipoprotein, or “good” cholesterol). HDL protects you against this fatty plaque buildup by acting as a broom and sweeping the LDL from your arteries.  HDL also helps protect you against heart disease and stroke in other ways:  it’s anti-inflammatory, anti-thrombotic (meaning it protects against blood clots), and has antioxidant properties.


In the past, doctors focused mainly on total cholesterol levels, but new research is showing that LDL and HDL levels are actually a better indicator of heart disease/stroke risk.  Low LDL and high HDL levels are desirable:


Total Cholesterol

Less than 200 mg/dL                                       Desirable
200 – 239 mg/dL                                               Borderline High
240 mg/dL or higher                                        High



Less than 130 mg/dL                                       Desirable
130-159 mg/dL                                                  Borderline High
160 mg/dL or higher                                        High



Less than 40 mg/dL                                         Low (Undesirable)
Greater than 60 mg/dL                                  High (Desirable)


If any of your numbers are not within the desired range, your doctor will work with you to get them where they need to be by making certain dietary and lifestyle changes.  He or she may also run additional tests to help better determine your risk for heart disease or stroke.  Cholesterol levels alone don’t paint the entire picture, but they can help you understand your risk – and spur you to make positive lifestyle changes to reduce that risk.

Cholesterol-Lowering Supplements – Which One Should You Choose?

High cholesterol is becoming more and more common, due to higher rates of both screening and obesity, a major driver for developing the condition. As mentioned in a previous post, one of the best and safest ways to lower cholesterol is by following the TLC (or Therapeutic Lifestyle Changes) Diet, developed by the National Institutes of Health to help Americans lower their cholesterol levels by eating a heart-healthy diet and exercising regularly.

For some people, diet and exercise alone are not enough to get their cholesterol levels to where they need to be. These people are usually prescribed cholesterol-lowering medications, like statin drugs, which they often need to take for the rest of their lives. If the prospect of taking a prescription medication for the next 40 or 50 years seems daunting, there is what I consider to be an “in-between” option for when diet and exercise don’t work and taking a prescription drug isn’t the first choice on your list: over-the-counter supplements.

Supplements can be seen as a more “natural” way to lower cholesterol, since their active ingredients are naturally-occurring, rather than man-made. A “dietary supplement,” as defined by the Dietary Supplement Health and Education Act (DSHEA) of 1994, is a product “taken by mouth that contains a ‘dietary ingredient’ intended to supplement the diet.” These dietary ingredients include vitamins, minerals, herbs, and enzymes. While cholesterol-lowering medications, particularly statins, are some of the drugs most commonly-prescribed by doctors, cholesterol-lowering supplements are just as popular among consumers.

Perhaps the most well-known (and well-studied) cholesterol-lowering supplement is fish oil. Fish oil supplements contain the omega-3 fatty acids that are naturally found in oily fish like salmon, tuna, and sardines. These concentrated sources of heart-healthy omega-3s are commonly sold in capsule form and have few side effects, the most common being belching and a fishy aftertaste (although “belch-free” formulations are becoming more and more prevalent). Fish oil is generally safe to consume, although adverse effects such as an increased risk of stroke have been reported in people who consume greater than 3,000 mg, or 3 g, of fish oil a day. However, fish oil taken in lower amounts has been shown to be effective in lowering total cholesterol and triglyceride levels, reducing inflammation, and preventing heart disease and heart attacks.

Two other cholesterol-lowering supplements that have been in the news lately are krill oil and flaxseed oil. Krill oil is an up-and-coming “designer” alternative to fish oil. While krill oil may seem trendy, it also comes with a much higher price tag than fish oil, and its safety and effectiveness haven’t been adequately studied. What studies have shown, however, is that krill oil comes with a higher risk of side effects than fish oil, so it might not be a worthwhile investment, since it may not be safe and it hasn’t yet been proved to be effective. Flaxseed oil, a vegetarian source of omega-3 fatty acids, is generally thought to be safe to use, but it isn’t as effective as fish oil. Our bodies don’t absorb plant-based omega-3 fats as well as those that come from animal sources, so flaxseed oil doesn’t offer as much “bang for the buck” as fish oil does, since its cholesterol-lowering effects aren’t as potent. It remains, however, a good alternative for vegetarians or those concerned about the mercury content of fish oil supplements.

Before starting any supplementation regimen, talk with your doctor, as certain supplements can interact with medications or other supplements you may be taking. Also be aware that supplements are not regulated by the FDA, so you can’t be 100% sure if the supplements you purchase are going to be as safe and effective as their labels tout them to be. But if you must choose a supplement to lower your cholesterol levels, go with fish oil, as there is the most evidence out there on its safety and effectiveness.

Hidden Causes of High Blood Pressure

February is Heart Month, and I’m sure we’ve all been hearing a lot about controlling two chronic conditions that, when left untreated, can lead to heart disease – high cholesterol and high blood pressure. Previous posts have focused on treating high cholesterol and high blood pressure with food.    While it’s important to be aware of the many treatment options available to you (especially those that focus on diet and exercise in lieu of medication), it’s just as important to understand what causes these conditions in the first place.

High blood pressure is often known as the “silent killer,” because it has no symptoms, and some people learn that they have it only after they suffer a heart attack or stroke.  Many other people, however, are lucky enough to be diagnosed with hypertension as part of a routine visit to their doctor’s office, allowing them to begin treatment before suffering long-term damage.  No matter when a person gets diagnosed with hypertension, they probably ask, “why me?”  In some cases, the cause of high blood pressure may be obvious – chronic stress, family history.  But for many others, it’s a complete shock and mystery. 

For some people, there is really no identifiable cause of hypertension.  It can develop gradually as you age, creeping up slowly as the years go by.  For others, an underlying medical condition or a medication being taken for another health issue are to blame.  Hypertension can be caused by conditions as varied as kidney problems, tumors of the adrenal gland, or congenital blood vessel defects.  It can also be caused by common medications such as oral contraceptives, cold medicine and decongestants, and over-the-counter pain relievers.  In these cases, treating hypertension simply involves treating the condition or stopping the medication that caused it.

Other people develop what’s known as “white coat hypertension,” which stems from the nervousness that accompanies a visit to the doctor’s office.  This form of hypertension often only appears at the start of a doctor’s appointment.  Other variables that can temporarily raise blood pressure, some of which may come into play right before your blood pressure is checked, include eating, standing up from a seated position, talking, exercising, or watching an exciting tv show.  In order to get the most accurate blood pressure reading, try to stay calm at the doctor’s office and refrain from performing any of the activities known to cause blood pressure to rise.  Also be sure to talk with your doctor about any underlying conditions you may have or medications you take, as these could all be the culprits of your high blood pressure.  Treating these issues is often a lot easier – on your body and wallet – than going on blood pressure medication.

Lowering Your Cholesterol, The Tasty Way

It’s easy to think that the only surefire way to lower your cholesterol is through the use of medication.  In reality, medication is often used as a last resort – a healthy diet and regular physical activity may be enough to achieve normal cholesterol levels in many people.  The National Institutes of Health developed the Therapeutic Lifestyle Changes, or TLC model, to help those with high cholesterol lower their numbers without the use of medication.  The main principles behind this diet are to eat less saturated and trans fat and more fiber.  This can be done by eating fewer processed foods and red meat and more fruits, vegetables, and whole grains. 

Fruits, veggies, and whole grains are not the only foods that can help lower your cholesterol.  Foods that contain soluble fiber (the kind that helps you feel full and clears the bad cholesterol from your body), polyunsaturated fat, plant sterols and stanols, and omega-3 fatty acids also have cholesterol-lowering effects.  According to Harvard Medical School, the ten best foods to lower cholesterol contain one or more of these components:

  1. Oats such as oatmeal or cold, oat-based cereal like Cheerios
  2. Barley and other whole grains
  3. Beans
  4. Eggplant and okra
  5. Nuts
  6. Vegetable oils such as canola, sunflower, and safflower
  7. Apples, grapes, strawberries, citrus fruits
  8. Foods fortified with sterols and stanols, which include foods ranging from margarine and granola bars to orange juice and chocolate
  9. Soy, such as tofu or soy milk
  10. Fatty fish

Whether you have high cholesterol or not, it wouldn’t hurt to regularly include these foods in your diet.  They may help lower your cholesterol and are an easy way to incorporate a variety of nutritious, delicious foods into your everyday eating.