Cholesterol

Cholesterol is a fatty substance that your body needs as a building material. Your liver makes most of the cholesterol itself.

In 2 cases, the cholesterol in your blood can increase the risk of cardiovascular disease: if the cholesterol level is too high and if the ratio between the types of LDL-cholesterol and HDL-cholesterol is skewed.

Especially a skewed ratio poses a higher risk. You can improve the ratio between LDL and HDL cholesterol by being moderate with saturated fat and replacing saturated fat with unsaturated fat. This can be done by choosing lean products, and replacing hard fats with semi-lard varin, soft margarine and liquid frying and roasting fats or oil.

Furthermore, cholesterol in foods such as eggs, organ meat, eel and shrimps has a small effect on blood cholesterol levels.

What is cholesterol?

Cholesterol is a fatty substance that the human body needs as a building block for body cells, hormones and bile. Most cholesterol is produced in the liver. A small part enters the body through food.

LDL and HDL cholesterol

The blood carries cholesterol by binding it to certain proteins. These proteins are called lipoproteins. There are different types of lipoproteins: High Density Lipoprotein, known as the 'HDL' and Low Density Lipoprotein, known as the 'LDL'. The compound of an LDL and cholesterol is called LDL-cholesterol.

• LDL transports cholesterol through the blood to the rest of the body, where it is necessary, for example, to repair damage in tissues. But with too much LDL cholesterol, it can stick to the inner wall of blood vessels. This usually happens in places where the wall of the blood vessels is damaged. Damage to the blood vessel wall may result from smoking, increased blood pressure or age. This slowly creates a 'stick' in the blood vessel. As a result, the blood vessels slowly close, making it increasingly difficult for the blood to flow through them. This process is known as artery calcification (atherosclerosis). Also, a piece of the accumulated slice can come loose and cause congestion in a narrow part of the blood vessel. That could lead to a heart attack. In this way, an excessively high LDL contributes to the development of cardiovascular diseases. LDL cholesterol is also known as‘ bad ’cholesterol.
• HDL removes cholesterol from the blood and drains it to the liver, where it is broken down. These breakdown products then leave the body via bile and stool. By removing cholesterol, HDL protects the body from cardiovascular diseases. The compound of HDL and cholesterol is called HDL-cholesterol. HDL cholesterol is also called the ‘good’ cholesterol.

A donkey bridge to remember which cholesterol protects against cardiovascular diseases is: LDL cholesterol is a Loser and HDL cholesterol is a Hero.

What are the health effects of cholesterol?

There are 2 relevant cholesterol levels: total cholesterol and cholesterol ratio. For both: the higher the value, the higher the risk of (death from) a heart disease. The cholesterol ratio is the best predictor for getting cardiovascular disease. Below we will tell you more about total cholesterol, the cholesterol ratio, the causes of too high cholesterol and which products increase and decrease LDL cholesterol.

Total cholesterol

A blood test indicates the level of cholesterol in millimoles per litre of blood (mmol/l). Cholesterol levels in the blood can fluctuate. Therefore, it is advisable to examine the cholesterol level several times. In the case of an increased cholesterol level, there must be a constant increase.

An overview of possible results of the blood test:

Cholesterol ratio and cardiovascular disease

The ratio between LDL and HDL is called the cholesterol ratio. A ‘skewed’ relationship with too much LDL poses an important risk for cardiovascular diseases.

The cholesterol ratio is calculated by dividing the total cholesterol content (LDL + HDL) by the HDL. The ratio should be less than 5.

Important limit values are:

• LDL cholesterol: less than 2.5 mmol/l = optimal, more than 3.5 mmol/l = too high
• HDL cholesterol: less than 0.9 mmol/l = too low
• ratio total/HDL cholesterol: less than 5 = good
• Triglycerides (another fatty substance in the blood that carries cholesterol in the blood together with LDL and HDL): more than 2.1 mmol/l = too high

Causes of excessive cholesterol

The liver usually balances the amount of cholesterol that the liver produces with the level of cholesterol in the blood. The amount of cholesterol the liver produces is influenced by the lifestyle. Smoking, little exercise and a diet high in saturated fat can disturb the balance. As a result, an undesirable shift to more LDL can take place. Unsaturated fat in the diet reduces LDL cholesterol.

In addition to diet-related causes, hereditary factors also play a role. In the Netherlands, for example, 1 in 300 people are predisposed to a greatly increased level of LDL cholesterol in their blood. Other causes of high cholesterol are overweight, type 2 diabetes and a slow acting thyroid gland.

Decrease and increase in LDL cholesterol

*2 grams of DHA per day increases LDL cholesterol  by approximately 0.20 mmol/l. More research is needed to understand this mechanism and to assess its relevance. The fish fatty acids EPA and DHA and eating fish reduce the risk of heart disease.

Plant sterols and stanols

Plant sterols and plant stanols (phytosterols) are bioactive substances. Low levels of phytosterols are found in vegetable oil and cereal products. They are also found in functional nutrition, for example added to (enriched) margarine.

Plant sterols and plant stanols inhibit the absorption of cholesterol in the intestine and increase the amount of cholesterol excreted with the stool. In this way, they lower the cholesterol level in the blood. On average at 10% with a use of about 2 grams per day. Therefore, plant sterols are sometimes added to products for people with high cholesterol levels.

The European Union maintains a maximum of 3 grams of plant sterols or plant stanols per day, as a safe intake.

Garlic

It is sometimes said that garlic has a positive effect on cholesterol levels. But there's not enough evidence for this.

Advice to avoid high cholesterol

A healthy diet according to the Wheel of Five, a healthy weight and a healthy lifestyle with sufficient exercise, not too much stress and not smoking, reduce the risk of an increased cholesterol level.

Nutritional advice for high cholesterol

Do you want to lower your cholesterol to reduce your risk of cardiovascular disease? Usually, healthy eating and a healthy lifestyle are part of your treatment plan, in addition to medication. Your doctor will guide your treatment and determine whether you need cholesterol-lowering medications or additional dietary advice. Your doctor can refer you to a dietician.

Discuss with your doctor whether products containing plant sterols or stanols fit into your treatment plan. Think of special margarines and yoghurt drinks enriched with plant sterols or stanols.

The Disk of Five as a Base

If you eat according to the Disc of Five, you take good care of yourself, even if you have an elevated cholesterol level. The Disc of Five lists foods that contribute to lowering LDL cholesterol, such as whole wheat products, nuts and legumes. An excess of LDL cholesterol sticks to the inside of your blood vessels.

The Disk of Five also contains products with not too much saturated fat. Eating less saturated fat is good for your cholesterol.

Do not take too many and not too often products outside the Disc of Five. Think of snacks or fatty meat products that contain a lot of saturated fat.

See what's in the Disc of Five

Healthy Weight

If you're too heavy, losing weight helps lower your cholesterol. Especially if you have a large abdomen. With our BMI meter, you can calculate whether you have a healthy weight. Or take a look at our pages about losing weight. If you are overweight, losing 5 to 15% weight can already improve the cholesterol level in your blood.

Tips for increased cholesterol

1. Replace saturated with unsaturated fat

Saturated fat increases LDL cholesterol. Saturated fat is found, for example, in butter and hard margarines. Unsaturated fat is contained in oils, margarine and halvarine in a tub. Which fats are unhealthy?

2. Take skimmed milk products

Cheese, milk and other dairy products contain saturated fat, which increases LDL cholesterol. Yet they are products that are good for your health. Therefore, opt for products with less fat, such as 20+ and 30+ cheeses, mozzarella, cottage cheese and dairy spread and for semi-skimmed and skimmed milk(products).

3. Moderate with meat and range with fish, legumes, egg and nuts

For a good cholesterol level, we recommend that you at least keep to:

• Once a week legumes, such as brown beans, lentils and chickpeas
• 1x per week fatty fish, such as salmon, herring and mackerel
• A handful of unsalted nuts every day
• Not more than 300 grams of red meat (beef, veal and pigmeat)
• 2 to 3 eggs (3 to 4 for vegetarians)

4. Drink as little unfiltered coffee as possible, go for filtered coffee

Unfiltered coffee increases LDL cholesterol due to the dust of cafestol. Cooked coffee (where you pour water directly next to the coffee powder) and coffee from the cafeteria are therefore better not to drink. You can have regular coffee. Check out the coffee recommendations.

5. Eat enough fiber

It's good to eat about 30 to 40 grams of fiber every day. Most people do know that fiber is good for digestion, but fiber can also lower LDL cholesterol. Fibres from whole grains and fruit in particular do this. Therefore, choose mainly whole wheat and eat fruit twice a day.

6. Move enough

Exercise enough reduces the risk of cardiovascular disease. A lot of sitting still increases the risk.

Adults are advised to exercise for at least 2.5 hours per week and to do at least two bone and muscle strengthening exercises per week. Above the age of 65, you will also be advised to do balance exercises twice a week.Do you want to know what activities you can use to strengthen your bones and muscles? Or what are balance exercises? Check the exercises on the website allesoversport.nl.

7. No smoking

No smoking and quitting smoking reduces the risk of cardiovascular disease. You want to quit smoking? Find help at www.rokeninfo.nl.

Fees

Do you have high cholesterol? If so, you will receive reimbursement from your health insurance company for a dietician. Are you also overweight? Then you are also eligible for a combined lifestyle intervention. Find out exactly what's going on with reimbursements for nutrition and lifestyle advice.

Source: Voedingscentrum.nl