Managing cholesterol

High blood cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke.

As your blood cholesterol rises, so does your risk of coronary heart disease.

What is blood cholesterol?

Cholesterol is a fat found in the blood. There are two main types of blood cholesterol: high density or HDL cholesterol and low density or LDL cholesterol.

LDL cholesterol is referred to as ‘bad’ cholesterol that can form plaque or fatty deposits on your artery walls and block blood flow to the heart and brain, if your LDL level is high.

HDL cholesterol is referred to as ‘good’ cholesterol because it helps to remove excess cholesterol from the body.

Cholesterol is naturally made by your body but is increased through our diet.

Dietary cholesterol — found in meat, poultry, eggs and regular dairy products — have less impact on blood cholesterol than foods with saturated and trans fat.

Foods containing saturated fat include processed foods, fatty meats, full-fat milk products, butter and lard. Foods containing trans fat include partially hydrogenated margarines, deep-fried foods and many packaged crackers, cookies and commercially baked products.

Normal blood flow through healthy artery (top) and blocked blood flow in artery with yellow plaque and red blood clot (bottom).

Diagnosis

Understand your risk

The only way to know if you have high cholesterol levels is to have a simple blood test.

Canadian guidelines recommend having your cholesterol tested if you:

• are a male over 40 years of age
• are female over 50 years of age and/or post-menopausal
• have heart disease, diabetes or high blood pressure
• have a waist circumference greater than 94 cm (37 inches) for men and 80 cm (31.5 inches) for women
• smoke or have smoked within the last year
• have erectile dysfunction
• have a family history of heart disease or stroke.
  
  

Understand your test results

Your test results will include:

• HDL cholesterol (good cholesterol) - good to have a high number
• LDL cholesterol (bad cholesterol) - good to have a low number
• Non HDL cholesterol (total cholesterol – HDL cholesterol) - good to have a low number
• Triglycerides - high reading may be tracked over time

Your doctor will review your test results along with your risk factors, medical history and present health.

Familial hypercholesterolemia or inherited high cholesterol

People with familial or inherited high cholesterol levels have a much higher risk of heart disease early in life.

If you have a personal or family history of premature heart disease and/or a very high cholesterol level at a young age, you should speak to your physician to see if you are a candidate for genetic testing. If you or any of your family members have familial hypercholesterolemia, it is very important to be treated early.

Prevention and management 

Making some lifestyle changes is a positive way to control your blood cholesterol levels.

What you eat has a huge impact on your health. Highly processed foods are a major source of saturated fat and are usually high in calories, salt (sodium) and sugar. Saturated fat increases LDL or bad cholesterol levels in the blood.

Heart & Stroke recommends that you:

1. Eat a healthy balanced diet.

• Choose a variety of whole and minimally processed foods at every meal. This means foods that are either not packaged or have few ingredients.
• Fill half your plate with vegetables and fruit at every meal. Choose vegetables and fruit for snacks. Select fresh, frozen or canned vegetables and fruit. You want them to be plain, without sauce, sugar or salt added.
• Choose whole grains. Look for whole grain breads, barley, oats (including oatmeal), quinoa, brown rice, bulgur, farro, etc.
• Mix up the centre of your plate. Choose more vegetarian options such as beans, lentils, tofu and nuts. Include vegetarian options as often as possible in your weekly meal plan. Make sure your meat is lean, poultry without the skin and include fish a couple of times per week. Limit your portion sizes.
• Choose lower fat dairy products or alternatives with no added sugar. Select 1% or skim milk, plain yogurt and lower fat cheeses.
• Plan healthy snacks with at least 2 different types of food. For example try: hummus and baby carrots; apple wedges and lower fat cheese or plain yogurt with berries.
• Drink water or lower fat plain milk to satisfy thirst.
• Avoid sugary drinks including soft drinks, sports drinks, sweetened milk or alternatives, fruit drinks, 100% fruit juice and ready-to-drink sweetened coffees and teas.
• Note: If your blood cholesterol level is high, your physician or dietitian may recommend restricting your intake of foods high in dietary cholesterol such as egg yolks, organ meats, full- fat dairy products and processed meats.

2. Cook and eat more meals at home

• Cooking at home allows you to select whole and minimally processed foods.
• Develop and share skills in food preparation and cooking with your family.
• Buy a healthy cookbook or try some of our healthy recipes.
• Select the top ten recipes your family loves and get everyone involved in the meal preparation.
• Reduce the amount of sugar, salt and solid fats used in your favourite recipes.

3. Make eating out a special occasion

Eating out usually results in you consuming large amounts of food, more fat, salt and sugar.

• Try to limit the number of times you eat in a restaurant per month.
• When you do eat out, choose restaurants that serve freshly made dishes using whole and minimally processed foods and provide nutrition information.
• Share meals, order the appetizer size or ask for half the meal to be packed up to eat the next day.

4. Achieve and maintain a healthy weight

Being overweight or obese increases your LDL or bad cholesterol level, lowers your HDL or good cholesterol level and raises your triglyceride levels. Reducing your weight is a positive way to reduce your blood cholesterol levels.

5. Maintain physical activity

Being physically active will help improve your cholesterol levels and general heart health. Aim for 150 minutes a week. That is less than 25 minutes per day!

Choose activities you like. Cycling, swimming, gardening, walking are great ways to keep active.

6. Be smoke-free

Smoking is a risk factor for heart disease. It reduces the level of your HDL “good” cholesterol. Once you quit, within a few weeks your HDL levels will start to rise.

Nutrition labelling

Almost every packaged food will have an ingredient listing which is listed in descending order starting with the ingredient in the highest amount.

The package will also contain a Nutrition Facts Table that provides information on a single serving size and the calories and nutrients a serving contains.

All of the nutrient information is based on a single serving. You will find information on the amount of fat, cholesterol, sodium, carbohydrate, fibre, sugars, protein and some vitamins and minerals.

When reviewing the Nutrition Facts Table on a package, always look at the sodium and trans fat values. If you have a high cholesterol level, you may also need to look at the cholesterol value. The % Daily Value on the label will tell you whether there is a lot or a little of a nutrient in a single serving. 15% or more is a lot and 5% or less is a little.

Plant sterols

Research shows that plant sterols can help lower LDL “bad” cholesterol.

Plant sterols occur naturally in small amounts in vegetable oils, nuts, whole grains, vegetables and fruit.

It is recommended that you consume 2g of plant sterols per day to help lower your LDL cholesterol.

It is not possible to obtain enough plant sterols naturally from foods.

Foods in Canada are now allowed to have up to 1g of plant sterols per serving added to them. Look for foods fortified with plant sterols such as mayonnaise, margarine and salad dressing

Dietary fats

Dietary fats and oils provide our bodies with energy, provide essential fats and help absorb fat soluble vitamins such as A, D, E and K.

There are different types of fats:

• polyunsaturated fats (omega-3 and 6)
• monounsaturated fats
• trans fats
• saturated fats

Both the quality and amount of fat you eat matters. It is important to not focus on just one nutrient – it is your overall diet that will make the biggest difference to your health. For example, foods marketed as “low fat” can be highly processed and contain lots of refined carbohydrates, calories, sugar and sodium.

Choose more often: polyunsaturated fat (omega-3)

Food sources:

• fatty fish: salmon, trout, mackerel, sardines, herring
• oils: canola, soy, sunflower, flaxseed
• nuts and seeds: walnuts, flaxseeds (ground), chia seeds
• legumes: soybeans and tofu
• omega-3 fortified products: omega-3 soy beverage, omega-3 yogurt, omega-3 eggs

Choose more often: monounsaturated fat

Food sources:

• fats and oils: olive, canola, peanut, safflower, sesame, non-hydrogenated margarines made from these oils, salad dressings made from these oil
•  nuts, nut butters and seeds: almonds, pecans, hazelnuts, peanuts, pine nuts, sunflower seeds
• avocados

Eat in moderation: polyunsaturated fats (omega-6)

Food sources:

• fats and oils: safflower, sunflower, corn
• legumes: soybeans
• nuts and seeds

Choose less often: saturated fats

Food sources:

• fatty meats
• full-fat dairy products
• fats and oils: butter, hard margarines, lard, coconut oil, ghee, palm oil
• highly processed foods are a major source of saturated fat and are also usually high in calories, sodium, sugar and sometimes trans fat:
• processed meats such as sausages, bologna, salami, hot dogs, liver, meat pate
• prepared foods
• snack foods
• chocolates and sugary drinks.

Saturated fat intake should not be an issue if you are eating a healthy, balanced diet, few or no highly-processed foods and appropriate portion sizes.

Medication to lower cholesterol 

Sometimes diet and exercise are not enough to lower your blood cholesterol levels. Several drugs are available to lower your blood cholesterol. Your doctor may prescribe medications to including statins and other cholesterol lowering medication.

These medications do not cure high blood cholesterol or replace a healthy lifestyle.

Related information

How to manage your cholesterol (PDF)

Find health eating tips here

Learn more about other risk factors for heart disease