Cholesterol 101 Julia Nordgren, MD
Updated: Nov 19, 2022
I’ll admit, telling people what I do for a living while at a cocktail party can be a little awkward. “A doctor? For kids with high cholesterol?” they ask. I often get a sideways glance and a little skepticism. “Kids really have high cholesterol?” Yes, they do! I say. And what is so fun about my job is I have the great fortune to be able to make it better, before it causes problems. It is preventive medicine at its best! And the best part is that making it better hardly ever requires medicine. The vast majority of kids with high cholesterol can be treated entirely with delicious food and having more playtime. To make it even more fun, the kids I see come in with their families. So, many parents also benefit from learning some basics about cholesterol and how to craft their eating habits to be more nutritious. It is so great to see families cooking more and eating better together—everyone wins!
Before we get to the food part, I like to start with some basics.
Cholesterol 101 Cholesterol, or lipids, are fats that are a normal part of all the cells in our bodies. They have important functions: making cell membranes, producing vitamin D and even some hormones. But high levels of cholesterol can build up in arteries and cause health problems. A basic cholesterol (or lipid) panel is composed of four numbers: TC, the total cholesterol, HDL, high-density lipoprotein (the “good” cholesterol), LDL, low-density lipoprotein (the “bad” cholesterol), Triglycerides, a storage form of fat. The different types of cholesterol play unique roles in our bodies.
TC, total cholesterol This is a calculation based on the three other components. It is far less important than the actual levels of each individual component. LDL, the “bad” cholesterol At high concentrations, LDL can build up on the inside of artery walls. This is bad because our arteries need to be clean and open to do an important job: transporting blood, which carries oxygen and nutrients to all of our organs. Over time, a high LDL cholesterol level can pile up and form a plaque, which can eventually narrow and clog arteries. A plaque that ruptures or clots in the heart or brain can result in a heart attack or stroke, respectively. LDL is well understood to be the main kind of cholesterol responsible for forming plaques and laying the groundwork for heart disease. An ideal LDL level is LOW. HDL, the “good” cholesterol HDL plays a vital role in our bodies. It helps keep the walls of our arteries clean and smooth by taking LDL, the “bad” cholesterol, and moving it back to the liver for recycling. This process is called “reverse cholesterol transport” and is crucial for keeping our arteries healthy. Women tend to have more HDL, which is part of the reason women tend to develop heart disease later than men. An ideal HDL level is HIGH. Triglycerides, a storage form of fat Triglycerides play an important role in energy storage. After we eat, our body breaks down all of our food. Some of the energy is used right away. However, what is not used must either be eliminated or stored. Some sugars and fats are packed up and stored as triglycerides. If these triglycerides are not used, they can build up in the bloodstream and the liver. This is especially true in people who don’t exercise enough. When triglycerides accumulate, they can form fat (or adipose) cells. Triglycerides can also increase the risk of a heart attack and stroke. An ideal level of triglycerides is LOW. Now that we have the basics down, let’s talk about food… One of the most rewarding things about working with families is helping them learn how they can take control of their lives by making some simple changes that can have a tremendous impact on their overall health. I am often amazed by how powerful it is to eat more food at home or just to be more mindful of eating more veggies.
LDL—the “bad” cholesterol High LDL often comes from a diet high in saturated fat. The main culprits are
Red meat, like steak or hamburgers
Convenience food, like take-out, fast food or frozen foods
Desserts, especially ice cream
Bacon, salami and other processed meats
What can you do?
Reduce sources of saturated fats (those items listed above—the kind of fat that is solid at room temperature, like butter). It makes a HUGE difference.
Aim for more vegetables and fruits in your diet. The fiber in fruits and vegetables is so important to help eliminate cholesterol from the body. Even if my patient doesn’t have a wide variety of vegetables they will eat, I encourage them to eat the ones they like, over and over and over again.
Pack a healthy lunch. It’s one of the most impressive ways to lower LDL cholesterol. Almost without exception, a grab-and-go lunch or cafeteria food is not going to be very nutritious. So bringing a healthy sandwich, fruit and vegetable from home can make such a difference.
Cook at home more often and focus on vegetables. Cooking at home almost always means eating more healthy fats (like food sautéed in olive oil rather than deep-fried or topped with cheese). Especially helpful is increasing the portion of vegetables on a plate. I have seen kids dramatically lower their LDL by adding salads and grilled vegetables to their routine.
Triglycerides High triglycerides often come from a diet high in sugar and refined carbohydrates. Unfortunately, this is the diet of many people in the United States. Strategies for improving triglyceride levels:
The first step in reducing triglycerides is cutting out sugary drinks. While I find most people aren’t drinking soda anymore, they opt instead for sports drinks, smoothies and Frappuccinos, which are even higher in sugar! These drinks can put an enormous strain on your metabolism; almost always, the sugar in them is far more than our body needs. So I encourage drinking milk or water only. No Gatorade!
The next step is shifting to whole grains. That means eating things that are made out of whole wheat instead of white flour. It can be hard to figure out if a product is truly whole grain, versus “made with (a tiny amount of) whole grain.” Or “multigrain,” which often means made with a variety of processed grains. The health claims on the front of the package can be very misleading. For every grain you buy (like cereal and bread), flip the package over and look for the word WHOLE as the first ingredient. Make sure sugar isn’t the second or third ingredient. I use a simple strategy for food labels: make sure the fiber content plus protein content (ingredients found in whole grains) add up to be higher in grams than the sugar content. It isn’t a perfect rule, but it helps weed out a lot of unhealthy options.
There are some tasty solutions out there. Try different grains like farro, millet and quinoa. They are healthy for you and can be so delicious. Try a new recipe like this farro salad with skillet roasted tomatoes. You might be surprised to learn how easy it is to prepare and just how yummy it is!
For breakfast, steer clear of highly processed items like instant oatmeal. Try steel cut oats or rolled oats. I have seen many patients lower their triglycerides (and weight!) just by getting rid of a highly refined cereal and eating steel-cut oats with fruit. Delicious!
HDL—the “good” cholesterol HDL has a strong genetic component and it doesn’t like to move too far. But it can be improved. I have seen some great changes.
How to improve HDL:
Increase healthy fats (these are delicious, too) like olive oil, fish, nuts (all kinds) and avocados. These kinds of fats increase HDL and help us feel full and satisfied after a meal.
Lastly, believe it or not, I am NOT going to encourage anyone to exercise. I have found that using the word “exercise” can be off-putting. And while some people love the gym, many cringe at the thought of getting on the treadmill. So instead, I encourage this. Get outside. Have fun. Kick a ball and chase people around. Ride your bike up a hill and around a park. Run around on a beach. Challenge your family to a football game. Enjoy this great, beautiful world we live in, the people around you and the body you are given. After all, what could be better?
"Fat and Cholesterol," Harvard Nutrition Source: www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/
"Fats," American Heart Association: www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats
"What about Fat and Cholesterol?" HealthyChildren.org, American Academy of Pediatrics: www.healthychildren.org/English/healthy-living/nutrition/Pages/What-About-Fat-And-Cholesterol.aspx
Julia Nordgren, MD
Julia Nordgren is a physician, an expert in childhood obesity and cholesterol disorders and a trained chef. Her clinical practice is at the Palo Alto Medical Foundation, where she sees children of all ages with cholesterol issues, prediabetes or weight concerns. She is a passionate advocate of lifestyle medicine, which helps patients succeed through nutritious, delicious eating.
Dr. Nordgren teaches hands-on culinary medicine to medical students and physicians, promoting self-care through healthy eating habits and helping medical professionals develop skills to be effective at lifestyle and dietary counseling.
She is the author of The New Family Table, a collection of recipes, techniques and stories about making healthy family eating a reality. Her book can be purchased through Amazon or her website drjuliacooks.com.
You can also follow her on Instagram, @drjuliacooks.
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