Cholesterol is an essential component of our cell membranes, needed for nerve cell protection, bile production, hormone production and vitamin D production. However, in excess it increases the risk of heart disease and stroke. It is consumed in the diet and produced in the liver and intestines.

Low density lipoproteins are more than half cholesterol and are created by the liver to transport triglycerides and cholesterol from your liver to the rest of your body. If there is excess it is deposited in your arteries and oxidized, making them hard and narrow. High density lipoproteins are more than half protein and are created by the liver to pick up excess cholesterol and other lipids from your arteries and return them to your liver for metabolism. This is why we call HDL “good” cholesterol and LDL “bad” cholesterol.

LDL only becomes really dangerous if it is oxidized, so a diet high in anti oxidants is also important.

Inflammation (indicated by elevated cRP) has been linked to CVD more closely than elevated LDL. Eating an anti inflammatory diet (see separate diet sheet) reduces this risk.

Increased insulin is associated with an increase in triglyceride levels and cholesterol production as well as lowering HDL, so a low GI diet would be expected to lower cholesterol.

Diet can play an important role in lowering your cholesterol. Cholesterol lowering diets used to be only about which foods to avoid, more recently evidence has been emerging about the effectiveness of adding certain foods to your diet.

Foods to eat

Soy – include soy products such as soy milk and tofu.

Viscous fibre – add foods such as oats, barley, eggplants, legumes, apples, pears, psyllium, and prunes. Viscous fibre reduces the absorption of cholesterol from your food.

Plant sterols are found in small quantities in most fruit and vegetables, and also in fortified margarines. The use of these margarines is controversial, with some researchers questioning their value. Eating a diet rich in fruit, vegetables, nuts and legumes will supply plant sterols.

Unsaturated fats come from plant sources such as olives, nuts and seeds, and from fish.

Nuts –almonds and walnuts have been shown to reduce cholesterol (30g per day)

Antioxidant fruits – adding strawberries to the diet has been shown to stop the cholesterol converting to the more damaging oxidised form.

Garlic – 2.5g per day

Foods to avoid

Saturated Fats –should account for less than 7% of your total energy. Saturated fats come from meat and dairy products and contribute more to the production of cholesterol than unsaturated fats.

Trans Fats – Also known as hydrogenated fats, trans fats are produced by adding hydrogen to vegetable oils to make them more solid, less likely to spoil and feel less greasy. Initially, trans fats were thought to be a healthy alternative to animal fats because they come primarily from plant oils. However we now know that trans fats increase LDL cholesterol, decrease HDL cholesterol, increase triglycerides, increase lipoprotein a and increase inflammation, increasing the risk of heart disease by 25% with as little as 5g per day. In Australia, labeling laws do not require trans fat to be included as a separate entry, so it is difficult to exclude from your diet. It may be included in the ingredient list as trans fat or “partially hydrogenated oil”. Studies show that fast food, such as fries and nuggets, as well as some commercially baked goods contain trans fats, so it may be wise to try to limit your intake of these foods.

A study in The Journal of the American Medical Association (Aug.24/31, 2011) found that a vegetarian diet emphasizing a "portfolio" of cholesterol-lowering foods did a better job of reducing low-density lipoprotein — the so-called "bad" cholesterol — than a low-saturated-fat vegetarian diet. All participants in the study followed a heart-healthy diet rich in fruits, vegetables, and whole grains. Those in the portfolio group were told to emphasize cholesterol-lowering foods in their diets — soluble fibre, nuts, soy protein — while those in the low-saturated fat group were told to avoid these foods.

For someone eating 2,000 calories per day, a portfolio diet would aim to provide the following amounts of these cholesterol-lowering foods:

Soluble fibre: 18 grams per day of fibre from foods such as oatmeal, oat bran, barley, peas, beans, lentils, psyllium, and vegetables such as okra and eggplant

Nuts: one ounce, or about one handful, per day

Soy protein: 42.8 grams per day from soy-based foods such as soy milk, tofu, and soy meat substitutes (four ounces of tofu contains 9.4 grams of soy protein; eight ounces of regular soy milk contains six grams of soy protein)

Below is a representative diet followed by participants in the portfolio group:

Breakfast: Porridge or oat bran, soy beverage, strawberries, psyllium, oat bran bread, avocado

Snack: Almonds, soy beverage, fresh fruit

Lunch: Black bean soup, sandwich made from hoummous, oat bran bread, lettuce, tomato, and cucumber

Snack: Almonds, psyllium, fresh fruit

Dinner: Tofu (baked with eggplant, onions, and sweet peppers), pearled barley, vegetables (broccoli, cauliflower, etc.)

Snack: Fresh fruit, psyllium, soy beverage

Meal Ideas

Breakfast

Raw muesli, soy milk, strawberries

Blend of nuts and seeds, prunes

Baked beans, mushroom, wholemeal toast

Avocado, tomato and wholemeal toast

Oat porridge, blended mix of nuts and seeds, stewed apple

Lunch

Wholemeal sandwich with salad and tuna

Vegetable soup with kidney beans and barley

Brown rice with tofu and vegetables

Hoummos and vegetable sticks with wholemeal crackers

Dinner

Roast eggplant and tomato sauce on wholemeal pasta

Oven baked fish and vegetables

Chickpea casserole and rice

Dhal with brown rice and vegetables

Snacks

Apples

Pears

Almonds, walnuts