Cholesterol

High cholesterol increases the risk of cardiovascular disease. What is the role of bad cholesterol (LDL) and good cholesterol (HDL)? What about triglycerides? What foods should you avoid? Get the answers to these common questions about cholesterol.

What is cholesterol?

Cholesterol is a type of essential fat, but the body only needs a small amount to function properly. Cholesterol is transported everywhere in our body by the blood. To carry it, the blood needs transporters called lipoproteins. There are 2 types of lipoproteins in the blood:

  • LDL (or low density) lipoproteins, commonly called “bad cholesterol.”
  • HDL (or high density) lipoproteins, which is known as “good cholesterol.”

How is cholesterol “good” and “bad”?

When LDL cholesterol gets too high, cholesterol builds up in the arteries and forms deposits or plaque that prevent blood flow. This is called atherosclerosis. In the long term, this condition can block arteries: if the artery is in the heart, this can cause myocardial infarction (heart attack). If the artery is in the brain, this can cause stroke. People with high levels of bad (LDL) cholesterol are therefore more at risk of developing cardiovascular disease.

Good (HDL) cholesterol removes excess bad cholesterol from the blood and transports it to the liver, where it is eliminated.

Triglycerides are another type of fat that the body needs. But when blood triglycerides get too high, this also increases the risk of diseases such as cardiovascular disease and pancreatitis. High triglyceride levels also decrease good cholesterol (HDL).

How to know if you have a normal cholesterol level

To determine your blood cholesterol, your doctor will order a blood test called a lipid profile. The result of this test will indicate whether your LDL and HDL cholesterol and triglyceride levels are within the normal range. Target values may vary from person to person depending on factors like your health condition, age and family history. If required, your doctor will talk to you about how to reduce your cholesterol or triglycerides.

You should get a lipid profile done if:

  • You are a man aged 40 or over.
  • You are a woman who is aged 50 or over or who has gone through menopause.
  • You have cardiovascular disease, hypertension or diabetes. 
  • You have a family history of hypercholesterolemia (high blood cholesterol) or cardiovascular disease.
  • You have excess weight around your waist.
  • You smoke.
  • You have erectile dysfunction.

Where does blood cholesterol come from?

The majority of cholesterol (80%) is produced by the liver. The rest comes from our food. Only foods from animal sources contain cholesterol. These foods include meat, fish, seafood, eggs and dairy products. However, other types of dietary fat increase our cholesterol levels, and these types are saturated fat and trans fat.

Triglycerides mainly come from alcohol and sugar, as the liver transforms these sugars into fat.

Several factors can affect your cholesterol and triglyceride levels. Heredity is a factor, but most factors are related to lifestyle and can be controlled with healthy choices.

Diet to maintain good blood cholesterol​

A healthy and balanced diet similar to a Mediterranean-type diet is recommended to keep your blood cholesterol and triglycerides at the recommended levels.

Fat

We need to eat fat, but not just any fat, and the fats we do eat should be in very small quantities. Some types of fat are harmful, while others are essential. To keep your cholesterol and triglycerides at the right levels, you need to limit the total amount of fat you eat and choose good fats. Here is an overview of good and bad fats and examples of foods that contain them:

Good fats

  • Monounsaturated fats
  • Polyunsaturated fats, especially omega-3 fatty acids

These fats help reduce bad cholesterol. Omega-3s lower your triglyceride level. Foods:

  • Olive, canola, flax and hemp oils
  • Soft margarines made from non-hydrogenated oils
  • Salad dressings made from these oils
  • Sunflower, corn and soybean oils (consume in moderation)
  • Almonds, hazelnuts, pecans, walnuts, pine nuts
  • Sunflower, flax and chia seeds
  • Fatty fish: salmon, trout, swordfish, sardines, herring

Bad fats

  • Saturated fats
  • Trans fats

These two types of fat increase bad cholesterol. Trans fats also lower good cholesterol. Foods:

  • Prepared meats and giblets (bacon, sausage, foie gras, etc.)
  • Fatty meats (meat with visible fat, chicken or turkey skin, duck)
  • Milk and yogurt with over 2% M.F.
  • Cheese with over 20% M.F.
  • Butter, cream
  • Palm and coconut oils
  • Hard margarines made from hydrogenated oils
  • Vegetable shortening
  • Crackers
  • Fried foods, potato chips
  • Pastries and cookies

Low fat doesn’t mean healthy!

Many products on the market are labelled as low fat or cholesterol free. This doesn’t mean that they’re healthy. To compensate for the lack of taste, these products have a lot of added sugar or salt. The secret to making good choices is to read the nutrition facts table. Don't hesitate to consult a dietitian or nutritionist, who can help you make the best choices for your diet.

Protein

To limit your intake of saturated fat, eat protein sources like tofu, legumes, fish (at least 2 times a week), poultry and seafood (eat shrimp in moderation if you have high cholesterol). Nuts (e.g., almonds) and eggs (maximum of 3 egg yolks per week if you have high cholesterol) are also good choices. You don't have to give up red meat completely, but you should eat less of it. You should also choose lean meats more often, cook meat with as little fat as possible, and eat smaller portions.

Fibre 

Make sure you eat 7 to 10 servings of fruits and vegetables every day and choose whole grain products (bread, pasta, rice, oats, quinoa, rye, etc.). These foods are high in fibre. Also, a type of fibre called soluble fibre helps lower bad cholesterol.

Other lifestyle habits that promote good blood cholesterol

  • Don’t smoke. Smoking reduces good cholesterol levels. This is just one of its many harmful effects. If you need help to quit, ask your pharmacist or doctor for advice.
  • Limit your intake of alcohol (maximum of 1 to 2 drinks per day), as alcohol increases your triglyceride levels. Avoid sugary drinks (soft drinks, fruit juices, etc.).
  • Get 30 minutes of moderate physical activity at least 5 times a week. Combined with a healthy diet, physical activity helps you achieve and maintain a healthy weight, another factor that contributes to good cholesterol and triglyceride levels.
  • Learn to manage stress, as high stress levels have a negative impact on blood cholesterol.

Cholesterol medications

Better food habits and an active lifestyle are essential for controlling cholesterol. If you have a low to moderate risk of cardiovascular disease, your doctor will recommend that you apply this approach for the first 3 to 6 months. If this isn’t enough or you have a high risk of cardiovascular disease, your doctor will then prescribe medication in addition to recommending that you adopt a healthy lifestyle.

You need to take your medication every day as prescribed if you have hyperlipidemia, as this condition can have serious consequences if left untreated. Since this condition doesn’t cause symptoms, you won't feel the effect of the medication. However, the effects will be observed in your blood 6 to 12 weeks after you start treatment.

Phytosterol supplements

Phytosterols, or plant sterols, are substances found in the cells of plants that can lower blood LDL levels. Many foods naturally contain them, and these include vegetable oils, nuts, seeds, grains and legumes. Some foods on the market are fortified with sterols (e.g., margarine, mayonnaise, salad dressings, yogurt, fruit or vegetable juice). To find out if they do, check the nutrition facts table.  These foods often have a logo indicating their benefits for preventing cardiovascular disease.

Phytosterol supplements are also sold over the counter at pharmacies and at natural health stores. However, you must consult your pharmacist or doctor before taking them, as these supplements have contraindications.

Don’t hesitate to talk to your pharmacist or doctor about your concerns and questions about cholesterol.

For more information, visit the website of the Heart and Stroke Foundation.

Find a Pharmacy