Last week, in part 1 of this series, I talked about how much you may be able to lower your cholesterol with food, why it might be worth trying, even if you’re on cholesterol-lowering medication, and three dietary strategies:
- Peanuts, walnuts, cashews, pecans, sunflower seeds… (all things nut and seed)
- Barley, psyllium, kidney beans, chia seeds, oats… (soluble fibre foods)
- Sprouted grain bread, sweet potato, lentils… (low glycemic index foods)
So without further ado, let’s look at tool #4:
4. Fish, olive oil, canola oil, avocado…
What we’re after here are unsaturated fats. Specifically, for the nutrition geeks, the evidence that they not only lower LDL cholesterol but also benefit long-term cardiovascular outcomes is best for polyunsaturated fats, including both omega-3 and omega-6 (yes really). There is also some evidence, albeit not as strong, for monounsaturated fats, particularly from plant foods.
But let’s talk food, not nutrients! The foods above are a good place to start, as well as nuts and seeds, which are so beneficial I discussed them separately in part 1. They’re all sources of mostly heart-healthy fat. Especially good sources of polyunsaturated fats include walnuts, flaxseed (eaten ground), chia seeds, tahini, and sunflower seeds. But other nuts and seeds offer other nutritional perks, so go with a variety of what you enjoy.
While these heart-healthy fat sources, in and of themselves, may not deliver massive LDL cholesterol lowering, they’re heart-healthier alternatives to saturated fat rich foods (think fatty meats, cheese, coconut oil, chocolate), which brings us to controversy #1.
On one hand we have the establishment recommending, in no uncertain terms, that we decrease (although not completely avoid) saturated fats to help lower LDL cholesterol.
The 2019 European guidelines for the management of dyslipidemias (from the European Society of Cardiology and European Atherosclerosis Society) notes that “saturated fatty acids are the dietary factor with the greatest impact on LDL-C levels,” which in turn cause “atherosclerotic cardiovascular disease (ASCVD)” (i.e. clogged blood vessels).
I mention the European guideline because it’s the most recent, but the Canadian (2016) and American (2017) guidelines come to similar conclusions.
On the other hand are scientists like we heard from last week who argue that “current limits on saturated fats are no longer justified.” Even Canada’s Heart and Stroke Foundation has stopped recommending that we aim for a specific level of saturated fat in our diets.
Confused yet? How can experts look at the same studies and come to such different conclusions? What’s an eater to do?
Common Ground
Don’t give up in frustration! There’s common ground here, despite how the headlines make it seem. Both sides would agree that:
- It’s what you DO eat that matters, more than what you cut out, and these foods rich in unsaturated fats are heart-healthy choices.
- Foods rich in saturated fat vary in their health impact, depending on type of saturated fat and other nutrients. Of course that makes sense. Whole milk yogurt is not equivalent to pepperoni pizza.
- Your overall dietary pattern matters the most: Plenty of vegetables, fruit, and other plant foods, minimally processed, nutrient-dense foods are key, no matter which side of this argument you’re on.
So, if you’re debating whether or not to eat a certain food, look at the big picture. Cheese may have saturated fat, but it also has calcium, protein, and more nutrition to offer. You also might find it satisfying, and that matters too! (Emerging evidence suggests, by the way, that dairy may even be beneficial for heart health, despite the saturated fat.) 
Compare that to ice cream, which doesn’t offer much nutritionally. But if you enjoy it, it’s still okay to have it occasionally! With no guilt. Foods like that can fit into an overall heart healthy diet and lifestyle. Plus ice cream is a nice way to celebrate and connect with others. Those things impact heart health too, and make life worth living.
When Canada’s Heart & Stroke Foundation stopped recommending a specific saturated fat limit, they said it was because they wanted Canadians to focus instead on what has the most impact on health – the overall quality of one’s diet. Can’t disagree there.
But if you’re particularly keen on lowering your LDL cholesterol, you may want to do both: Eat mostly high quality foods and swap unsaturated for saturated fats where it works for you. Cutting back on saturated fat (and cholesterol), afterall, has been shown to reduce LDL by 10-16%. The debate arose when more recent studies showed that reducing saturated fat didn’t automatically translate into fewer heart problems and deaths as was expected. A bit of a shocker.
The more important matter, it seems, is what you eat instead. Often when people reduce fat they increase sugar and other refined carbohydrates: Fat-free brownies, rice cakes, frozen yogurt, sweetened low-fat salad dressings… Not helpful! You’d be better off having a steak and grilled tomatoes for breakfast than Special K and a big glass of orange juice. Really. But oats with walnuts, pears, and yogurt are better yet.
But cutting back on saturated fat and replacing it with foods rich in healthy fats (or low-GI carbohydrates, or whole grains), does seem to help both cholesterol and development of heart disease. Think olive oil over butter, avocado or peanut butter on toast versus breakfast sausages, salmon over prime rib.
Pears = soluble fibre too.
So look at your favourites, other considerations from allergies to ethics, and find the balance that works for you. If LDL cholesterol is a concern for you, you might want to lean towards more nuts and seeds, fish, and olive and other vegetable oils, as well as the good stuff in part 1.
(Also, if you drink unfiltered coffee, that can affect cholesterol too. Learn more here.)
Whew! That’s not so complicated now is it? I hope I’ve made it more clear!