Signs of the Times
Over the past couple of decades, mounting research has been shared with the public on the risks of high cholesterol on heart health. At times information on what to eat, how much to eat, and how it should be prepared is simply overwhelming. A new diet or set of expert recommendations about food seems to appear on the covers of magazines almost daily. In addition, service providers have to keep up-to-date with each consumer’s Individual Program Plan components regarding nutrition and overall healthcare.

Whether you provide residential services, help out during lunch at a day program, assist someone in supported living to make out a grocery list, or otherwise interact with consumers regarding their dietary needs, information about cholesterol is well worth keeping in mind. The following section is intended to provide service providers with information they can use in their work with consumers as well as at home with their own families.

Why is it important to know about cholesterol?

• Heart disease and stroke rank No. 1 and No. 3, respectively, as the leading causes of death in this country.
• Heart disease is one of the leading causes of premature, permanent disability among working adults.
• Stroke alone accounts for the disability of more than 1 million people in the U.S.
• A high cholesterol level is a major risk factor for heart disease and stroke.

What is cholesterol?

• Cholesterol is a soft and waxy substance that the body uses to, among other things, form the membranes of cells and certain hormones.
• Cholesterol is found among the fats, or lipids, in your bloodstream as well as in all cells of your body.
• If there is too much cholesterol in your blood, it can build up in the walls of the blood vessels (arteries) that supply blood to the heart and the brain. If cholesterol combines with other substances, it can form artery-clogging plaque. If a blood clot forms, a blockage can lead to a heart attack or stroke.

Where does cholesterol come from?

• Approximately 1,000 mg of cholesterol is actually produced in the liver of the human body each day. For the vast majority of people, this is all the cholesterol that is needed for healthy functioning. The liver is also where the body gets rid of some excess cholesterol.
• Other cholesterol comes from certain foods a person eats. This is referred to as dietary cholesterol. Dietary cholesterol is found in egg yolks, meat, fish, seafood, whole-milk dairy foods, and other animal products.
• It is very important to know that particular fats you eat also raise the level of cholesterol in your blood. These are saturated and hydrogenated fats, and trans-fatty acids, commonly referred to as trans-fats.
  • Saturated fat is found primarily in foods from animals such as beef, pork, poultry, lamb, cheese, butter, cream, and other dairy foods made from whole milk or cream. Some foods from plants, though limited, also contain saturated fat. These include tropical oils (coconut oil, palm oil, palm kernel oil) and cocoa butter. Many processed foods, including some ready-to-eat breakfast cereals, are made with tropical oils.
  • Hydrogenated fat refers to fats that have undergone a chemical process called hydrogenation used in food production. These fats are frequently found in margarine and shortening, but also in a variety of other processed, pre-packaged foods.
  • Trans-fat is also found in various hydrogenated items as well as in some animal products, e.g., beef, pork, lamb, and the butterfat content in butter and milk. A wide selection of ‘partially-hydrogenated’ vegetable oils, margarine and shortening provide almost 75% of the trans-fats Americans consume.

Buyer Beware

• Packaged foods carrying the label ‘Cholesterol Free’ can frequently be misleading. Just because a product does not contain dietary cholesterol doesn’t necessarily mean that it won’t raise your cholesterol level. Reading the label for the content of different fats will provide you with far better information for decision-making.
• Similarly, foods labeled ‘Fat Free/Cholesterol Free’ may have traded fat for sugar and other simple carbohydrates as well as increased caloric value. Knowing a consumer’s nutritional and eating plan goals should guide you in evaluating the options on the shelves.

Is any cholesterol good?

• When evaluating a person’s cholesterol risk, physicians primarily take into account total cholesterol and the measures of what are known as LDL and HDL cholesterol.
• LDL (low-density lipoprotein), when elevated, reflects an increased risk of heart disease.
• HLH (high-density lipoprotein), when elevated, reflects a degree of protection from heart disease.
• Only a physician can assess what laboratory findings mean for an individual consumer’s health status. Healthcare professionals can assist that person and their team in setting parameters for the intake of foods containing cholesterol and fats, as well as supporting lifestyle changes beneficial to heart health.

What can you do now?

• Use unhydrogenated cooking oils such as canola or olive oil.
• Shop for processed foods made without hydrogenated oil or saturated fat.
• Instead of butter, substitute soft (liquid or tub) margarine.
• Look for margarine that has no more than 2 grams of saturated fat per tablespoon.
• Margarine labels should list liquid vegetable oil as the top ingredient.
• Look for ‘trans-fat free’ labels on margarine containers.
• Because so many commercially produced fried foods and baked goods are high in trans-fats, saturated fats, or both, eat them on an infrequent basis. These include such things as French fries, fried chicken, doughnuts, tacos, egg rolls, croissants, and fried onion rings, just to name a few.
• Consider adding foods in eating plans that have an impact on the different types of cholesterol. For example, foods such as nuts and some fish (salmon, mackerel, sardines, and others containing Omega-3 fatty acids) serve to raise levels of HDL (beneficial) cholesterol. Foods containing oat bran (oatmeal, toasted oat cereals) tend to lower levels of LDL (harmful) cholesterol. As with any food, service providers should consider the overall nutritive value of a particular food, including caloric content to ensure that each consumer’s individual dietary needs are being met.
• When going out to eat, be advised that seemingly healthy Salad Bars have hidden sources of cholesterol and saturated fat. Look for fat-free dressings and salad items that are prepared with little or no mayonnaise.
• Have it your way! Don’t be reluctant to ask servers in restaurants how dishes are prepared and request modifications that will reduce fat and cholesterol.
• Involve consumers in as many aspects of meal planning, grocery shopping, and food preparation as possible. Consumers should be supported in learning about their own heart health and making healthy choices in the future.