Cholesterol

Cholesterol is a natural, waxy, fat-like substance that is made in the liver as well as obtained through the diet. High amounts of cholesterol are found in the liver, kidney, adrenal glands and brain. Cholesterol has many uses including insulating nerves, maintaining cell walls and producing vitamin D, digestive juices and certain hormones.

Most of the cholesterol that circulates in your blood is there because your liver produced it. High blood cholesterol levels are one of the risk factors for heart disease. However, people often confuse blood cholesterol with dietary cholesterol. Foods that contain dietary cholesterol, such as meat, poultry, seafood, eggs, and dairy products, do not automatically increase blood cholesterol levels.

When it comes to diet, excess saturated and trans fats, not dietary cholesterol, have a greater impact on increasing blood cholesterol levels.

Yes. Cholesterol forms a basic part of all our cells and plays an important role in insulating nerves. The body also needs cholesterol to produce hormones, vitamin D and digestive juices that help us digest our food. Newborns also need cholesterol for brain development. As you can see, cholesterol is essential for life. It occurs naturally in your body and is not an illness.

The cholesterol that circulates in your blood is called blood cholesterol. The cholesterol you get from foods is called dietary cholesterol.

About 80% of the cholesterol in your blood is there because your body produced it in your liver. Only about 20% of your blood cholesterol is influenced by what you eat.

Dietary cholesterol has little effect on most people's blood cholesterol. When you eat more cholesterol than you need, your body tries to maintain a balance by producing less.

When it comes to diet, research indicates that it is the excess saturated and trans fats and not dietary cholesterol that have the greatest impact on your blood cholesterol
levels.^{1, 2, 7, 8, 9, 10}

Cholesterol is only a concern if your doctor has told you that you have high blood cholesterol levels that need to be controlled. Otherwise, most healthy people can eat foods containing cholesterol.

For most people, cholesterol from foods has little effect on blood cholesterol levels because your body tries to maintain a balance. If you eat more cholesterol than you need, your body will produce less. Eating too much fat, especially saturated and trans fat, has a greater influence on increasing blood cholesterol levels than dietary cholesterol.^{7, 8, 9}

High blood cholesterol levels are a risk factor for heart disease. If you want to keep your blood cholesterol at a normal level, the best strategy is to limit your total intake of fat, especially saturated and trans fat, eat more complex carbohydrate and high-fibre foods
(e.g. grains, vegetables and fruits), increase your activity level and achieve and maintain a healthy weight.

Dietary cholesterol is found, in varying amounts, only in foods of animal origin, such as meat, fish, poultry, seafood, eggs, and dairy products. Dietary cholesterol is absorbed directly by our bodies. Including a variety of these foods in our diet is consistent with healthy eating guidelines.

Many foods that contain cholesterol are high in important nutrients, such as protein, iron, zinc, calcium, and B-vitamins. Eliminating these foods from your diet would limit your intake of vitamins and minerals.

If you are concerned about your blood cholesterol levels, cut back on fat, especially saturated and trans fat.

Yes. Dairy products, meat and eggs all contain cholesterol, yet they are all included in Canada's Food Guide as part of a balanced and healthy diet.

If you deny yourself these foods, you could miss out on some important sources of nutrients, such as calcium, protein, iron, zinc and B-vitamins. Canada's Food Guide says it is important to enjoy a variety of foods from each food group every day, while choosing lower-fat foods more often.

When it comes to your cholesterol levels, the most important eating habit you can change is to cut down your intake of saturated and trans fats. If you are wondering whether you should cut out foods which contain cholesterol, the answer is simple. If your blood cholesterol level is normal, there is no need for you to avoid eggs or any other food that contains cholesterol.

The answer is not simple because it varies from person to person. Most healthy people, who have normal blood cholesterol levels, are able to maintain healthy blood cholesterol levels in spite of what they eat. However, in order to keep blood cholesterol levels in a healthy range it is important to adhere to a healthy eating pattern most of the time. For example, eating a variety of higher-fibre foods, such as whole grains, vegetables, fruits, beans, peas, and legumes, lower-fat milk products and leaner meats. It is also important to choose higher-fat foods in moderation and control your total daily fat intake.

People who have had or are at risk for coronary heart disease, who must modify their diet and blood cholesterol levels, need to reduce the amount of fat they eat. Some very high-risk individuals may need to control how much dietary cholesterol they eat. These individuals should discuss their particular diet with their physician and a registered dietitian.

The most important strategy to protect against heart disease and to control blood cholesterol levels is to keep your intake of fat to less than 20 - 35% of total daily calories. Dietary fat, especially saturated and trans fat, has a greater influence on increasing blood cholesterol levels than dietary cholesterol.^{7, 8}

Health Canada's Dietary Reference Intake recommendation for cholesterol states to keep it as low as possible while consuming a nutritionally adequate diet.⁹

One large egg contains 195 mg of cholesterol. One large egg contains only 5 grams of fat of which 1.5 grams is saturated fat. This means that eggs can easily fit into a reduced-fat diet.

HDL cholesterol is made in your body, by your body. You can't eat it! In order to travel through your blood, cholesterol joins with protein to form a lipoprotein. High-density lipoprotein (HDL) is the so-called "good" cholesterol because it takes cholesterol back to the liver where it is removed from the body.

Low-density lipoprotein (LDL) or "bad" cholesterol is also made by your body. It is called "bad" because it can result in fatty deposits which clog up your arteries which can stop your blood from flowing properly.

If your doctor orders a cholesterol test, try to find out your ratio of HDL ("good") cholesterol to LDL ("bad") cholesterol. The higher the ratio of HDL to LDL, the better.

HDL "GOOD" CHOLESTEROL:

Cholesterol attached to HDLs is taken to liver for removal.



LDL "BAD" CHOLESTEROL:

Cholesterol attached to LDLs is deposited on artery walls.

Visit the Resource Centre to download the "Cholesterol Clues" brochure and for more educational material.

Many factors influence your blood cholesterol levels. The single most important risk factor influencing your blood cholesterol level is your family history. If one or both of your parents had high blood cholesterol then you have a greater chance of having high blood cholesterol.

A high blood cholesterol level is a heart health concern, but there are also other important heart disease factors. If you think you have two or more of the risk factors below, consult your doctor to see if a cholesterol test is needed.

Family History
The health history of your parents and grandparents is the main factor in determining your blood cholesterol levels. A history of high blood cholesterol in your family means that you may be more at risk for heart disease. If high blood cholesterol runs in your family let your doctor know.

Disease
High blood cholesterol levels can be caused by diseases, such as diabetes as well as thyroid, kidney or liver disease.

Age & Gender
The risk of heart disease increases as you grow older, with men more at risk than
pre-menopausal women. After menopause, a woman's risk for heart disease and stroke is about the same as a man's.

Smoking
High blood cholesterol levels are a heart health concern, particularly if you smoke. Smoking tends to decrease your HDL ("good") cholesterol levels and increases the rate at which fatty deposits form on artery walls.

Lack of Exercise
An active lifestyle helps your heart, lungs and blood vessels work better and can help you maintain a healthy weight. Regular physical activity helps increase your HDL ("good") cholesterol levels.

Excess Body Weight
Having a healthy weight can help you control your blood cholesterol and prevent high blood pressure. Reducing excess body weight cuts the strain put on your heart and may increase your HDL ("good") cholesterol levels.

High Fat Diet
High blood cholesterol levels can be caused by diets which are high in fat, particularly saturated and trans fats. For more information, click on the Low-Fat Cooking FAQ.

No. Eggs laid by free-range hens or Aracauna fowl, or fertilized eggs do not contain less cholesterol than regular supermarket eggs. The amount of cholesterol in an egg is determined by many factors, especially the size of the egg.

The amount of cholesterol in an egg is determined primarily by the genetic background of the hen and the hen's diet. It is not affected by the lecithin content of the egg. Lecithin is found in the egg yolk. It contains a phospholipid, acetylcholine, which helps improve brain function. Lecithin helps to stabilize emulsions when making mayonnaise and salad dressings.

It is not necessary to limit egg consumption, unless you are following a special diet recommended by your doctor or registered dietitian.

In the past, nutrition science focused on getting people to reduce their cholesterol intake to control high blood cholesterol levels. More recent research indicates that it is more important to focus on reducing the total amount of fat you eat, especially saturated and trans fat, rather than eliminating foods that contain cholesterol.^{7, 8, 9}

A senior's need for nutrients may actually increase while their energy needs decrease. This reinforces the importance of nutrient-dense food choices.¹¹ In addition, the protein/energy ratio to meet protein needs increases with age and may be difficult to achieve in those over 75 years old. Nutrient-dense foods, such as eggs, can help improve a senior's diet and nutritional status.

Most seniors can enjoy eggs. They are a very nutritious food that provides high quality protein and many vitamins and minerals. Eggs are an ideal food choice for seniors because they are nutritious, economical, and very versatile.

Rather than limit nutrient dense food like eggs from your diet, try reducing your intake of high-fat foods. Here are some suggestions:

• Eat more grain products, vegetables and fruits.
  
• Select lower-fat milk and milk products (less than 2%).
  
• Cut down on fried foods, use a non-stick fry pan.
  
• Trim or drain fat from meat and remove the skin from the chicken.
  
• Select fatty luncheon meats, bacon, and sausages less often.
  
• Use butter, margarine, spreads, and salad dressings in smaller amounts.

The amount of cholesterol in an egg is determined by many factors, primarily the genetic background of the hen, the hen's diet and the size of the egg. Cholesterol content is not affected by the cooking method. However, the fat content is increased when fried in butter, margarine or oil and when other fat-containing ingredients are added to the egg mixture.

For more information, click on Low-Fat Cooking FAQ.

If your blood cholesterol level is normal and your total fat intake is reasonable, there is no need for you to cut out eggs or any other cholesterol-containing foods. If you have had a heart attack or are at risk for heart disease and have high blood cholesterol, the most important thing to do is to eat less fat, especially saturated and trans fat, and to check with your doctor or a registered dietitian about your egg intake.

Health Canada recommends that we limit our total fat intake to 20 - 35% of our daily calories.⁹ A healthy daily fat intake for women is about 45 - 75 grams and about 60 - 105 grams for men. Growing children need more fat in their diet.⁹ Their need for fat decreases gradually (from infancy when they get about 40% of their calories from fat) to the adult recommendation when they reach their full adult height in late adolescence.

For the fat content of certain foods, click on the question "What is the Fat content of certain foods?" in the Fat FAQ section.

Foods that boast a "cholesterol-free" label can in fact be high in fat. A handful of
cholesterol-free potato chips (28 g) contains about 10 grams of fat while three chocolate chip cookies give you about 8 grams of fat. To find out what you are really getting in a food, check the nutrition information panel on the label. Remember, for most people it's more important to lower total fat intake than it is to avoid cholesterol.

Trans fatty acids act like saturated fats and can increase LDL ("bad") cholesterol levels. They can also decrease HDL ("good") cholesterol levels.

Trans fatty acids are the fats that form when vegetable oils are hydrogenated in processed foods. Hydrogenation is the process that keeps liquid oil solid at room temperature. It's hard to tell if you are eating these fats, since they are not currently listed on food labels.

Hydrogenated fats are found in processed foods, such as some margarines, shortening, French fries, doughnuts, pastries, cookies, crackers, chips, etc. The best way to avoid trans fatty acids is to limit foods containing hydrogenated oils.

For more information on trans fatty acids, click on the question "How can I reduce my intake of fat, including saturated and trans fatty acids?" in the Fat FAQ section.

There are two different kinds of fibre that we need to eat for health. Soluble fibre plays a role in reducing blood cholesterol levels and controlling blood sugar levels. Insoluble fibre keeps our digestive system working properly and helps protect against bowel disorders as well as rectal and colon cancer.⁵⁰

We need to eat both types of fibre to maintain health.

Foods high in soluble fibre include dried peas, beans, lentils, barley, oats and some vegetables and fruit (green beans, cabbage, squash, apples, and oranges).

Foods high in insoluble fibre include wheat, wheat bran and other whole grains, many vegetables (broccoli, carrots, peas) and skin of fruits.

Most people can keep their blood cholesterol in a healthy range with a lower-fat, higher-fibre diet and by having an active lifestyle.

The single most important change you can make to control your blood cholesterol levels is to reduce your intake of total fat. In today's world, finding lower-fat foods has never been simpler.

Follow these tips and you can easily eat less fat, especially saturated fat and trans fatty acids.

Fat Tips

• Choose lower-fat foods from each of the four food groups in Canada's Food Guide.
• Limit chips, crackers, cookies, croissants, doughnuts and other baked goods and deep-fat fried foods which contain hydrogenated vegetable oils.
• Enjoy vegetables without adding extra fat, such as butter, margarine, cream sauces or salad dressing.
• Try skim or 1% milk, low-fat yogurt or cottage cheese (less than 2% milk fat) and lower-fat cheeses (less than 15% milk fat).
• Choose leaner meat, poultry and fish. Trim excess fat from meat and remove skin from poultry. Buy canned fish packed in water instead of oil and reduced-fat deli meats, lean ham or turkey.
• Try lower-fat ways of cooking foods, such as baking, broiling, microwaving or using a non-stick frying pan.

Fibre Tips

• Increasing your intake of fibre is another very important dietary change for you to make. Certain types of fibre have been shown to help reduce fatty build-up on artery walls and to help lower blood cholesterol levels.
• Choose a variety of whole-grain breads and cereals made with wheat, oats or rye.
• Eat more vegetables, such as green peas, potatoes (with skin), corn, carrots, broccoli, tomatoes, and dark yellow squash.
• Enjoy a variety of fruits including apples, dried apricots, berries, pears, prunes, raisins, and oranges.
• Have baked beans, lentils, chick peas, kidney beans or pinto beans more often. Make meatless meals based on hearty grains, vegetables and beans, peas or lentils.