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WHAT IS CHOLESTEROL? Cholesterol is a soft waxy substance made by our bodies. It is one of the fats (lipids) found in the blood and every cell of the body. We often think that cholesterol is only linked to health problems. In fact, cholesterol is vital if we are to have healthy cell membranes, hormones and vitamin D levels. Without cholesterol, our bodies could not function. WHERE DOES CHOLESTEROL COME FROM? The liver makes about 80 per cent of the cholesterol in your body. The other 20 per cent comes from the foods you eat. Almost 40 per cent of Canadian adults have high cholesterol levels. WHY IS HIGH CHOLESTEROL A HEALTH PROBLEM? High cholesterol levels can make the arteries narrow. People with narrow arteries (tubes that carry blood from the heart to other parts of the body) are more likely to suffer a heart attack or stroke. The cause of narrow arteries (also known as atherosclerosis) is a build-up of a sticky coating called plaque on the inside of arteries. Over time, plaque slowly blocks the tubes. The main ingredient in plaque is cholesterol. CHOLESTEROL LEVELS AND OTHER RISK FACTORS When deciding your target cholesterol ranges, your doctor will review your cardiovascular risk factors (i.e. things that increase your risk of heart disease and stroke). RISK FACTORS • Age & Gender: ° Men aged 55 and older ° Women who have gone through menopause • Ethnicity: ° People of South Asian descent are at a greater risk of heart disease • People with a family history of heart attack or a stroke before age 55 (male relative), or before age 65 (female relative) • High blood pressure (hypertension) • Diabetes • Smoking • Physical inactivity • Being overweight HOW CAN I KNOW IF I HAVE HIGH CHOLESTEROL? Most people have no signs of high cholesterol. The only way to know your cholesterol levels is to have a simple blood test. Not sure if you should be concerned about your cholesterol levels? Ask your doctor. Canadian guidelines recommend having your cholesterol tested if you: • are a male over 40 years of age • are a female over 50 years of age and or/post-menopausal • have heart disease, diabetes or high blood pressure • have a waist measurement greater than 90 cm for South Asian men or 80 cm for South Asian women • smoke or have smoked within the last year • have erectile dysfunction • have a family history of heart disease or stroke The blood test can measure three kinds of fat found in blood. Two of the fats are types of cholesterol, while the third kind of fat is called triglycerides. UNDERSTANDING YOUR TEST RESULTS Lipoproteins are tiny packages that carry cholesterol in the blood. A cholesterol blood test measures two kinds of lipoproteins: • Low-density lipoproteins, known as LDL cholesterol, and • High-density lipoproteins, known as HDL cholesterol LDL cholesterol is “BAD” because it promotes the build-up of plaque in the artery walls. HDL cholesterol is “GOOD” because it helps carry LDL cholesterol away from the artery walls. Triglycerides are the third kind of fat measured by the test. High levels of triglycerides occur mostly in adults who are overweight, consume too much alcohol or have diabetes. Total cholesterol (TC) is a test result that adds your LDL “bad” and HDL “good” numbers together. The final result on a cholesterol test is a ratio between HDL “good” cholesterol and your overall cholesterol levels. TRACKING MY CHOLESTEROL LEVELS You may want to track your levels using this grid. This can help you notice any changes over time. 1. Total cholesterol (TC) LDL and HDL cholesterol are added together. Strive for a lower number. 2. HDL cholesterol Known as “good” cholesterol, it is better to have a high reading. 3. LDL cholesterol Known as “bad” cholesterol, it is better to have a low reading. 4. Triglycerides High readings may need to be tracked over time. 5. Ratio of TC/HDL This ratio shows how high your HDL “good” cholesterol is, compared to your overall cholesterol levels. Having lower numbers is better. What is the best kind of test result? You and your doctor need to review your test results along with your risk factors, medical history and present health. Your doctor is the best person to help you understand your test results and advise you on what to do next. • Follow a lower-fat diet. Less than 30 per cent of calories per day should come from fat. • Avoid trans fats, which are found in foods made with shortening or partially hydrogenated vegetable oils. Trans fats raise “bad” LDL cholesterol and lower “good” HDL cholesterol levels. • Reduce your intake of foods that are high in saturated fat. Such foods include fatty meats and dairy products such as butter, cheese, cream and homogenized milk. • Choose to eat healthy unsaturated fats found in oils, nuts and fish. • Include more vegetables, fruits, whole grains, nuts, beans and pulses in your daily diet. Fibre is a vital part of a healthy diet but most Canadians consume much less than the recommended amount. Good sources of fibre are whole-grain products such as wild rice, brown rice and oatmeal, as well as vegetables and fruit. When shopping for packaged food, check the Nutrition Facts label carefully. Products with 2 g of fibre or more are a healthy choice. What are plant sterols? Plant sterols occur naturally in small amounts in vegetable oils, nuts, whole grains, vegetables and fruit. Research shows that plant sterols can help lower LDL “bad” cholesterol. Health Canada now allows food producers to add plant sterols to certain foods. You may see labels about plant sterols on mayonnaise, margarine, salad dressing, yogurt and yogurt drinks, as well as on some bottles of vegetable and fruit juices. To get 2 g of natural plant sterols per day, you would need to eat 210 carrots, 83 oranges or 20 tablespoons of sesame seeds. Foods in Canada are now allowed to have up to 1 g of added plant sterols per serving. Plant sterols can reduce LDL “bad” cholesterol levels by 10 per cent, but they have no impact on HDL “good” cholesterol or triglycerides. The best way to create a total cholesterol profile that is healthy is to follow a healthy diet and be active. Physical activity will help you improve your cholesterol levels and general heart health. Aim for 150 minutes a week. This can be accumulated in sessions of 10 minutes or more. Cycling, swimming and playing outdoor games like cricket and kabaddi are great ways to keep active. Or take a brisk walk around the neighborhood after dinner. Being overweight or obese raises your level of triglycerides and lowers your HDL “good” cholesterol level. It also raises your risk of diabetes, heart disease and stroke. By being at a healthy weight, you can reduce those risk factors. Smokers have lower levels of HDL “good” cholesterol than non-smokers. However, a few weeks after becoming smoke-free, levels of HDL “good” cholesterol start to rise. HOW TO BE IN CHARGE OF DIETARY FAT Dietary intake accounts for 20 per cent of cholesterol levels. This applies especially to saturated fats and trans fats. Taking a low-fat approach to food means that only 20 to 35 per cent of your daily calories should come from fat. For a woman, this means 45 to 75 g of fat a day For a man, this means 60 to 105 g of fat a day Use this guideline for men and women to compare how much fat is in a food or recipe with how much fat you should eat each day. KNOW YOUR FATS All fats are not created equal. Some are bad for your health while others, in moderate amounts, are good. The goal is to reduce bad fats, especially trans and saturated fats. If you replace some of them with unsaturated fats and foods high in fibre and nutrient content, you will be helping to lower cholesterol levels. Good choice or poor choice? Monounsaturated fat (Monounsaturates) Olive, canola and peanut oils, non-hydrogenated margarines, nuts, seeds and avocados Good choice, in moderation Polyunsaturated fat (Polyunsaturates) Safflower, sunflower and corn oils, non-hydrogenated margarines, nuts and seeds* Good choice, in moderation Omega-3 fat Fish such as mackerel, herring, trout, salmon and sardines, canola and soybean oils, flaxseeds, omega-3 enriched eggs, walnuts, pecans and pine nuts Good choice, in moderation Saturated fat (Saturates) Ghee, fatty meats, full-fat milk products, butter and lard, coconut, palm and palm kernel oils, fast foods, snack foods, many packaged foods and all foods made with hydrogenated vegetable oil Poor choice Trans fat All foods made with shortening or partially hydrogenated vegetable oil, snack foods, fast foods and many packaged foods Poor choice * While nuts and seeds provide a healthy type of fat, they are also high in calories. Eat them in moderation. To learn more about portion sizes, visit heartandstroke.ca/healthyliving MAKE THE NUTRITION FACTS LABEL YOUR FRIEND Eating more foods that do not come in a package may be a good step toward healthy eating. When you buy packaged foods, the Nutrition Facts label can help you make better choices. If you have high cholesterol levels, you will need to limit saturated and trans fats. All packaged food sold in Canada must have a label that states the amount of trans fat in the product. Along with the Nutrition Facts label, read the ingredient list. The words “partially hydrogenated” or “vegetable oil shortening” means that a product contains trans fats. The Health Check logo ensures that a packaged food product meets the healthy eating standards of the Heart and Stroke Foundation. To learn more, visit healthcheck.org Sometimes diet and exercise are not enough to lower your cholesterol levels. Some people have inherited a tendency towards high cholesterol levels. If this applies to you, your doctor may prescribe medication. Several types of drugs are available to lower your cholesterol. Your doctor will help you decide which one is best for you. These medications do not cure high cholesterol or replace a healthy lifestyle. These drugs block an enzyme that your liver uses to make cholesterol. As a result, your liver makes less cholesterol and picks up LDL “bad” cholesterol from your bloodstream. They are the most widely used kind of medicine for lowering cholesterol. There is currently only one cholesterol absorption inhibitor that doctors may prescribe in Canada. This drug lowers the levels of total and LDL-cholesterol in your blood. These drugs reduce the absorption of cholesterol from the intestines. The resulting decreased delivery of cholesterol to the liver prompts more clearance of LDL (bad cholesterol) from the blood stream. Your body breaks down cholesterol to make bile acids — that help you digest fats in your food as well as fat-soluble vitamins. Bile acid sequestrants bind to bile acids in the intestine to form an insoluble complex that is excreted in the feces. This process reduces bile acid levels in the liver and promotes more synthesis of bile acids from cholesterol, thereby decreasing liver cholesterol levels. These drugs work by lowering your triglycerides. Lowering your triglyceride levels can increase the levels of HDL (good cholesterol). Sometimes, this kind of drug is used along with other drugs that lower cholesterol. Niacin helps to raise HDL “good” cholesterol. It is a form of vitamin B that should only be taken to lower cholesterol when prescribed by your doctor. Go to heartandstroke.ca to find: • Delicious heart-healthy recipes • Tips to get active for life • Current heart disease and stroke patient information • Breaking news on Foundation funded research • Free newsletters, [email protected] • Information on volunteering for the Heart and Stroke Foundation in your community This publication How to Manage Your Cholesterol is for informational purposes only and is not intended to be considered or relied upon as medical advice or a substitute for medical advice, a medical diagnosis or treatment from a physician or qualified healthcare professional. You are responsible for obtaining appropriate medical advice from a physician or other qualified healthcare professional prior to acting upon any information available through this publication. The Heart and Stroke Foundation thanks RBC Foundation for providing the funds to make development of this resource possible. Acceptance of financial support by the Heart and Stroke Foundation does not constitute an endorsement.