Cutting the Fat and Cholesterol
The National Institute of Health used to claim a reduction of 10-50 mg/dL in cholesterol levels on a cholesterol-lowering diet is possible "over time." Other experts suggest a cholesterol reduction of more than 30% is not possible through diet and exercise. Now they are recanting.
Before I retired in 1997, my total cholesterol level was 294. Three years after retiring, my total levels were at 321 or 346, depending on which test I chose to accept.
My primary care physician at that time said with a level as high as mine (her test results: 346 mg/dL total cholesterol), I could achieve close to normal levels only by taking statin drugs for the rest of my life.
I found a cardiologist at Concord Hospital who was willing to monitor my effort to reduce those levels through diet and exercise. No one with elevated cholesterol levels should try this approach without consulting with their physician first.
The cardiologist who supported my effort referred me to a qualified nutritionist. Both visits to the nutritionist and visits to the cardiologist every 6 months for testing and consultation were covered by our insurance company. A cost savings for them if you compare it to a lifetime of prescription drug coverage!
I dropped 100 points from my total levels over the next two years (2002). During my 6-month visit, the cardiologist said he could livel with my still high level of 256, since my other risks were low. He cut me loose.
As of this update(July 2007), I am back to ground zero after a year of lapses in diet and exercise following hip surgery. The doctor has agreed to another 6-month regimen of diligent exercise and diet.
One important observation/conclusion: you cannot reduce cholesterol levels through diet alone. Exercise is a critical element and it must be consistent!
Personal Dietary Goals.
Limiting meat and eggs, eating more fish--especially salmon-- eating at least one serving of green vegetables a day, using olive oil in most recipes, baking instead of frying where possible, eliminating processed foods, and switching to brown rice or pasta, probably attributes to most of my cholesterol reduction. Counting saturated fat in grams is much easier than calories and helped me achieve my daily ceiling of less than 10 grams -- more severe than the American Heart Association recommends.
The nutritionist calculated my daily limits of the following elements after converting calories into grams and factoring in my daily exercise habits and body weight. You can use the AHA recommendations, but even my nutritionist suggested they were too generous for someone with levels as elevated as mine. Instead, she recommended the Mayo Clinic Step II guidelines. I am omitting my specific measurements of the following goals. Consult a nutritionist and physician to figure your own personal dietary needs.
* x mg total fat
* x mg saturated fat
* x mg cholesterol
* x mg fiber
* red wine
* x mg soy protein
* 2 Tablespoons plant stanol esters
* unprocessed and unenriched products
Plant stanol and sterol esters, an ingredient of plants, and soy protein are reported to reduce the absorption of cholesterol in the intestine, so she recommended these two elements.
I added two more elements. One is approved by the AHA-- and Julia Child: a glass of red wine a day. It certainly makes cooking dinner at the end of the day more pleasurable! A tablespoon a day of unsulphured molasses provides 8% of the daily requirement of iron, which, for some reason is not included in our daily vitamin pill. I adopted a more conservative goal for saturated fat intake and, because I'm severely allergic to diets and calorie-counting, used that as a benchmark for my daily eating habits and meal-planning.
The nutritionists' goals are expressed in milligrams instead of fat calories. This makes sense, because food labels list content in milligrams, making daily counting much easier. I opted for counting only saturated fat intake, thinking total fats and cholesterol levels would fall into place. Many saturated fat sources are also primary sources of cholesterol. Meat and dairy products are good examples.
Cooking Changes. Taking your fat and cholesterol hits with food items you miss the least makes the diet easier to handle. In my case, meat, eggs, butter, fried foods, and ice cream were the first to go.
I had been cooking with and using non-fat and low-fat dairy products for decades, so I had a little edge in changing my eating habits. In addition, though an admitted chocoholic, my standard for chocolate and other desserts were already high. Only the best -- Lindt chocolates or Haagen Daz, Ben & Jerry's or 31 Flavors ice cream -- or, home-baked desserts. Since I rarely bake and avoid ice cream and candy shops like the plague, the kitchen was generally dessert-free. My husband does the shopping, and fortunately his tastes are different than mine, so the desserts he brings home are not tempting. (He got tired of hearing me say "It's not worth the calories.")
Once you learn things like one Tablespoon of unsalted butter equals your daily allowance of saturated fat, it helps make those tough tradeoff decisions. If I want to splurge and have dessert, I will make a Salmon Dish instead of Chicken Parmegiana.
The American Heart Association Cookbook and other credible internet sources in Recipe Links-- especially the U.S. Dept. of Agriculture online Nutrient Database-- gave me most of the information I needed to retrofit my recipes. Three articles included in Shirley's Recipes Nutrition Bin provided the understanding I needed of how cholesterol and fat can produce heart disease and how to reduce them through diet and exercise.
It's very tricky when you are the cook and other family members do not need to diet. There are some tricks to escape detection, though. You can replace or dilute ingredients and use less meat, pork, or poultry in a dish without altering the flavor too much. For example, sour cream or cheese substitutes are easily detected on baked potatoes or in dips, but less so in sauces, soups, or dressings. It helps to have low-fat dishes on hand for yourself, when you cook steaks or hot dogs for the family.
* I chose a more rigid ceiling than that recommended by the nutritionist for daily saturated fat intake: 7 mg of saturated fat. This gives me the wiggle room I need to avoid having to cook two separate meals. The fat from meat that is absorbed into sauces or other one-dish meals probably makes up the rest of my daily ceiling.
* A butter substitute, I Can't Believe It's Not Butter, passed the taste test, even for my husband. Butter is reserved only for special occasions, like fresh rolls or baked potatoes.
* Olive oil and safflower oil contain less harmful saturated fats. Olive oil contains the healthiest type of fat (monounsaturated) and can be used in most frying or sautéing recipes (except Chinese food). Olive oil is an acquired taste for this family, so I reduce the amount in salad dressings and use it on garlic bread, in some dishes, or when frying or sautéing. Olive oil tends to burn easily -- a tad of butter seems to help.
* Although I could eat a whole batch of home-cooked chocolate chip cookies, store-bought products never taste as good. So, the only time this family gets treats like that is when I bake, which is seldom. Though that never stopped my husband from buying his own treats, they were almost always not worth the calories. (There are exceptions. A small bakery in Concord (NH) has the best sticky buns ever. Now that my levels are reduced, I save up my daily levels and splurge on a sticky bun when I'm in town.)
* One of the best substitutes for cream is lowfat 2% evaporated milk. It contains no saturated fat and two tablespoons contains 5 mg of cholesterol. (Eight tablespoons equals 1/2 cup, which would be about 20 mg of cholesterol.) It is creamier than non-fat milk, because most of the water has been removed and readily absorbs the taste of other ingredients and seasonings in sauces and soups.
* The nutritionist agreed that the cholesterol level (200 mg) recommended in the Mayo Clinic Step II level is appropriate for my daily intake.
* A mix of less meat and poultry and more fish allows for a little more wiggle room for desserts or other high-cholesterol favorites. What a surprise to learn that 3 ounces of roasted chicken breast contains more cholesterol that 3 ounces of beef tenderloin.
* Choose meat cuts with less fat. I used to think beef tenderloin cuts (filets) had less fat and cholesterol, until talking with the nutritionist and consulting the USDA Nutrient Database. In fact, it has twice as much saturated fat as eye round cuts and 10% more cholesterol. See other comparisons in the Nutrition Chart.
* Since one egg yolk contains the equivalent in cholesterol (about 213 mg) as a 3-oz piece of red meat, this choice is clear. If recipes call for eggs, you can omit some of the egg yolks but not all. The assumption is that eating one slice of cake or one cookie or one biscuit doesn't mean you're consuming the entire egg.
* Soluble fiber is best at reducing cholesterol levels because it forms a gel that prevent cholesterol and fat molecules from being absorbed into walls of the intestine and then into the bloodstream. Good sources of soluble fiber are beans, peas, lentils, carrots, broccoli, Brussels sprouts, oranges, sweet potatoes, and baked potatoes with skin. Oatmeal is still uncontested in its claim to reduce cholesterol levels. Cereal with high levels of insoluble fiber don't help reducing cholesterol.
* Keep a 3-Bean, pasta with vegetables, coleslaw, or other salad on hand for lunches. You can get three Recommended Daily Allowance (RDA) elements in one serving: vegetables, fiber, and vitamins/minerals).
* An apple or pear or other fruit a day. (Pear has more fiber.)
* Keep a homemade granola on hand for snacks. Pre-mixed granolas often contain too much oil or nuts, which are high in fat. Try mixing a cup of plain, nonfat yogurt with a tablespoon of your favorite preserves and 1/4 cp of granola for a heart-healthy breakfast.
Julia Child was onto something. Even the American Heart Association is endorsing one glass of red wine a day. At any rate, it does make cooking more pleasurable. One study showed that Cabernet Sauvignon contains more heart-friendly elements than others -- and it tastes good!
Soy is one of the most genetically engineered crops in this country. Even Japan and Europe are reluctant to import seeds from us due to the vulnerability of their local wild AND hybrid crops. I have developed a taste for roasted soy nuts, so I have compromised my green-living values by eating a cup a day, which supplies almost my daily recommended value for soy protein. The rest is made up in drinking organic soy milk and occasionally sneaking in some tofu to stir-fried dishes and salads.
Plant Sterols - Plant Stanols
The ability of plant sterol and stanol esters to lower cholesterol has been supported by more than 20 scientific studies, both in the United States and in Europe. Generally, they appear as a margarine-type spread, similar to butter substitutes.
Many of the studies were supported by industry. The U.S. FDA approved the use of label claims to reduce cholesterol in these vegetable fat products.
Processed and Refined Food Products
Processed or refined foods can contain "hidden" fats or unnecessarily high levels of sugar, salt, and other additives for flavor, appearance, or texture. Eating "whole" foods also supplies more RDA of vitamins, fiber, and other nutrients. Bread product labels should NOT contain the word "enriched," which reduces the fiber content of the product. Yet another example of how deceptive labeling can be: the product contains vitamins introduced to the manufacturing process, but removes the critical fibers needed for our daily intake values! Why not just take vitamin pills. . . .
Included in this category are TV dinners; prepared canned sauces; pre-cooked foods; salad dressings; desserts; breads made with enriched ingredients, and lots more.
READ the LABEL!