Three White Coats
Healthy Living to Improve Blood Lipid Profile
Lipids are a diverse group of water-insoluble molecules that, among other substances, includes fats (triglycerides), waxes, fatty acids, cholesterol, and fat-soluble vitamins. Lipids have important and varied physiological functions: they serve as an integral part of cell membranes (cholesterol, phospholipids); as an energy source (triglycerides i.e. fats); as enzyme helpers or co-factors (fat soluble vitamins); and as signaling molecules that affect vital cellular processes, such as growth or survival (fatty acids, eicosanoids, steroids). However, when present in excess in blood, some lipids, namely triglycerides and cholesterol, can lead to serious cardiovascular complications such as heart disease, heart attack or stroke.
Embracing a healthy lifestyle that normalizes lipid levels is an essential and necessary step in reducing your chance of cardiovascular disease.
Fats vs. Carbs. Saturated fats, primarily found in red meat and dairy, have long been known to increase cholesterol levels. Because high cholesterol levels increase the risk of cardiovascular disease, consumption of saturated fats was, by association, considered to be a major cardiovascular risk. In an effort to lower the risk of cardiovascular disease, as well as to address obesity and chronic conditions associated with it, many health authorities, from the American Heart Association to the USDA and HHS, have promoted a diet low in total fat, saturated fat, and cholesterol. Food guide pyramids encouraged people to use fats only sparingly, and to almost freely indulge in various carbohydrates - bread, rice, pasta. In addition, the food industry, responding to the dietary guidelines, introduced thousands of “healthy” fat-free and low-fat food items that were often loaded with sugars for improvement of taste. The strategy of
replacing fat with carbohydrates, especially refined carbohydrates, did not produce the expected results - obesity continued to rise, as did the rate of type 2 diabetes. Recent reviews of the studies investigating the effects of different macronutrients on dyslipidemia and cardiovascular risk confirmed that fat-for-sugar swap does not improve metabolic or cardiovascular risk factors.
The debate whether a low-fat or low-carb diet is optimal for our health is still ongoing. Studies, however, show that both diets, when done right, help with weight loss and improvement of metabolic risk factors. Instead of taking sides, it is important to avoid bad players in both camps and to keep in mind that moderation is the key to healthful eating.
Dietary fat is a macronutrient essential for good health. Fat provides insulation, stores energy, and is crucial in the absorption of a number of fat-soluble vitamins. Dietary fats can be categorized as saturated, unsaturated (mono- and poly-) and trans fats (also unsaturated, but with a different type of molecular structure).
Trans fats have only harmful effects on our health and should be avoided. They are obtained by industrial processing of oils and are most commonly found in commercially prepared foods such as cake frostings, crackers, pie crusts, deep fried foods. Small amounts are also found naturally in some meats and dairy. Because of the FDA ruling on the dangers of trans fats, all commercially prepared food items must be free of added trans fats by 2018.
For decades, low saturated fat diets were recommended as a way to reduce one’s risk of cardiovascular disease. Replacing saturated fat calories with refined carbohydrates with high glycemic index does not improve metabolic risk factors (such as blood lipid profile) and may even worsen them. On the other hand, substituting saturated fats with unsaturated fats, particularly long-chain polyunsaturated omega-3 fatty acids found in oily fish, is generally found to provide a cardiovascular benefit. Some studies suggest that, for improving the lipid profile, it is the balance between saturated and unsaturated fats that is more important than the absolute amount of total and saturated fat. In other words, reducing the amount of saturated fats in your diet can have less of an impact on your blood lipid profile than supplementing your diet with sources of mono- and poly-unsaturated fats, such as nuts, olive oil or oily fish. Considering that overconsumption of vegetable oils rich in omega-6 polyunsaturated fats can also contribute to the development of metabolic syndrome, it seems that balancing and moderating the intake of saturated, mono- and poly-unsaturated fats might provide the most reasonable approach to lowering your risk of cardiovascular disease.
Omega -3 fatty acids. Long chain polyunsaturated fatty acids found in oily fish, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are clinically proven to lower the level of triglycerides in the blood and are considered to be heart healthy. However, a typical Western diet is deficient in these omega-3 fatty acids as well as in an essential omega-3 PUFA, the alpha-linolenic acid (ALA). ALA can be converted to EPA and DHA, although the conversion depends on many factors, such as gender or presence of other micronutrients. Eating oily fish (mackerel, herring, salmon) several times a week provides a sufficient amount of omega-3 for a healthy person. Higher doses of omega-3s that are typically needed to lower triglycerides are available as fish oil supplements.
Carbohydrates comprise a big and diverse group of molecules. While some carbohydrates, such as refined starches and added sugars, are best avoided, others, like fiber, confer significant health benefits.A large study found that the effect carbohydrates have on blood lipid levels and cardiovascular risk depends on their glycemic index.
Glycemic index (GI) is a food ranking system that describes how quickly and easily carbohydrates are digested and broken down into glucose. It is a number that characterizes the rise in blood glucose after ingestion of a food item. Foods with high glycemic index, such as refined starches (white flour, white bread, white rice) and sugars, were found to increase the risk of heart attacks, while low-glycemic index foods, such as green vegetables and legumes, lowered it.
A similar association was found between cardiovascular risk and another type of carbohydrate ranking system – the glycemic load.
Fiber. Because it can not be digested by human enzymes, fiber does not cause the rise in blood glucose. However, a particular type of fiber, the soluble fiber, can lower the glycemic index of foods ingested alongside. Additionally, whole grains and soluble fiber, such as psyllium, can lower total and LDL-C (bad) cholesterol. Despite the relatively small reduction in blood lipids, increasing your fiber intake will have a positive effect on your cardiovascular risk and your overall health.
Although we now know a lot about the effects different macronutrients (fats, carbohydrates, proteins) have on blood lipid levels and, more broadly, on cardiovascular disease, it seems more valuable to look at their interplay in the framework of one’s diet. In other words, rather than focusing on any individual macronutrient, you should aim to eat a wholesome, well-balanced diet.
Overwhelming evidence supports the importance of diverse, plant-based diets in achieving and maintaining cardiovascular and overall health. The Mediterranean and DASH diets, rich in whole vegetables, fruits, legumes, nuts, seeds and grains, and low in processed foods, red meat, and sweets, are proven effective in reducing cholesterol, specifically LDL-C or “bad cholesterol". LDL-C cholesterol can, when present in excess, form plaques in blood vessels that may cause life-threatening blockages. Rather than being diets with a strict set of rules or severe calorie or food restrictions, the Mediterranean and DASH diets offer guidelines for a healthful eating philosophy that can be adopted and sustained throughout life.
Snack on Nuts
Nuts are packed with valuable nutrients - proteins, carbohydrates (fiber), fats (mostly unsaturated),
minerals, vitamins and antioxidants - and as such fit perfectly in a healthy diet. A review of 25 studies found that daily consumption of nuts lowers both total and LDL-C or bad cholesterol. This lipid lowering ability, along with the antioxidant and anti-atherosclerotic properties, helps explain the reduction of cardiovascular risk associated with frequent nut consumption. In addition, a large study that compared a nut-supplemented Mediterranean diet (30g daily, 15 g walnuts, 7.5 hazelnuts, 7.5 g almonds) with a low-fat diet, found that the former substantially reduced the risk of cardiovascular events (heart attack and stroke). The same reduction was observed in a Mediterranean diet supplemented with olive oil.
Besides increasing the level of triglycerides in the blood, alcohol overuse has a multitude of harmful effects: it damages the heart, liver, and pancreas, increases the risk of certain cancers (breast, liver, esophagus), and impairs mental function. The belief that light to moderate alcohol consumption is cardioprotective is based on observational studies that cannot conclusively attribute the observed benefits to alcohol intake. In an effort to provide a more definitive answer about the cardio-benefits of moderate alcohol consumption, National Institute of Health (NIH) is undertaking a large, worldwide clinical trial. Until the data from that trial is in, it is best to avoid alcohol unless your doctor specifically encourages moderate alcohol intake as a way of reducing your cardiovascular risk.
Physical activity improves lipid profile by increasing the levels of HDL- “good cholesterol” and decreasing the levels of triglycerides. Although the exact mechanism behind the lipid-lowering ability of exercise is not fully understood, the enhanced ability of muscles to utilize fat instead of glycogen (a storage form of glucose) during physical activity may at least partially play a role. Regular physical activity will not only improve your lipid profile but will lower your risk of diabetes and cardiovascular disease, improve your mood and sleep, help control your weight and increase your life expectancy.
No smoking, please!
Numerous studies established smoking as one of the major risk factors for cardiovascular disease and the primary avoidable cause of all deaths. The lipid profile of smokers differs from that of nonsmokers. Smokers generally have higher levels of triglycerides and “bad cholesterol” and lower levels of “good cholesterol”. This altered lipid profile may in part be responsible for the development of atherosclerosis – narrowing and hardening of the blood vessels that can lead to serious complications such as heart attack and stroke. The risk of such complications may be especially increased in smokers who are insulin resistant.
Lose extra weight
Overweight and obese people generally have higher levels of cholesterol and triglycerides compared to people with normal weight. In addition to abnormal lipid profile, excess weight contributes to the risk of developing diabetes or cardiovascular disease. Weight loss in overweight people improves both cholesterol and triglyceride levels. It also helps normalize blood pressure and reduces the risk of developing diabetes, cardiovascular disease, as well as some cancers. You do not need to commit to any particular diet to lose weight. Both low-fat and low-carb diets were found to be similar in terms of weight loss and improvement of metabolic risk factors (lipid levels, insulin resistance, blood glucose). By paying attention to your eating habits, you can design a diet - or better yet, a healthy eating philosophy - that will work specifically for you.
Last updated: July 28, 2017