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Cholesterol lowering through diet @LWNurses #LWN #LearnWithNurses Michaela Nuttall RGN MSc @thisismichaela Founder, Learn With Nurses Director, Smart Health Solutions Clinical Advisor for CVD Prevention, Public Health England Associate in Nursing, C3 Collaborating for Health Chair, Health Care Committee HEART UK Member, Nurses Working Party and Guidelines & Information Working Party, British and Irish Hypertension Society Trustee, PoTS UKCholesterol and diet What is cholesterol? substance which is mainly produced by the body itself - Vital to all cells; • building block in cell membranes • starting material for bile acids • starting material for certain hormones and vitamin D atherosclerotic cardiovascular diseaseisk ofHIGH CVD RISK BHF (2021) • It’s estimated that close to half of adults in the UK are living with cholesterol levels above national guidelines total cholesterol (greater than 5mmol/L) • People living with heart and circulatory diseases may have an even lower target cholesterol level • Around 7-8 million adults in the UK are currently taking lipid-lowering drugs such as statins We need fat in our diet • An important source of food energy (38 kJ/g, 9 Kcal/g) • Provides and enables the absorption of fat soluble vitamins (A, D, E & K) • Provides the essential fatty acids • Palatability – mouth-feel (fat globules) and carries flavours • Structural lipids (58% body weight) – important in cellular membranes (e.g. brain) • Protects and cushions delicate organs • Substrate for hormone and prostaglandin production • Subcutaneous fat reduces loss of body heat (very important in newborns) HEARTUK.org.uk 6 cholesterol busting foods! • Foods rich in unsaturated fats • Fruit and veg • Oats and barley • Nuts • Foods with added plant sterols and plant stanols • Soya foodsDifferent types of fatty acids Insoluble vs. soluble fibre Insoluble fibre Soluble fibre • This is the fibre that the body can't digest and so it passes • This fibre can be partially digested and through the gut helping other food and waste products move may help to reduce the amount of through the gut more easily. It helps keep bowels healthy cholesterol in the blood and stop constipation. Foods rich in this sort of fibre are more bulky and so help make us feel full, which means we • Particularly good sources of soluble are less likely to eat too much fibre include oats and pulses such as beans and lentils. • Wholegrain bread, brown rice, wholegrain breakfast cereals and fruit and vegetables all contain this type of fibre.24. Gylling H, Plat J, Turley S et al; European Atherosclerosis Society Consensus Panel on Phytosterols. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 2014; 232(2): 346–360. 57. De Jong A, Plat J, Lütjohann D et al. Effects of long-term plant sterol or stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment. Br J Nutr 2008; 100: 937–941. 65. Blair SN, Capuzzi DM, Gottlieb SO et al. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol 2000; 86: 46–52 A dietary portfolio effectively reduces LDL- cholesterol levels Week 0 Week 2 Week 4 0 -5 -8.5% -10 -15 Control diet Control diet + statin -20 Dietary portfolio -25 -29.6%* LDL 3holesterol (% change ) -33.3%* -35 34 adults 4 week interventions # Dietary portfolio = plant sterols, soya protein, viscous fibre, almonds * Significantly different from control (low saturated fat diet) Jenkins et al. AJCN 2005 Myth: Its good for heart health Fact: Coconut oil is solid at room temperature so there should be no surprise that it is really high in saturated fat - largely lauric and myristic acids. Both these fats increase your LDL cholesterol. Some have suggested that because lauric acid also raises HDL cholesterol it might have health benefits. However, the small increase in HDL-cholesterol is far outweighed by the negative increase in LDL cholesterol. trusted/www.heartuk.org.uk/news/latest/post/16-heart-uk-says-bbc-coconut-oil-claim-not-to-be- In summary • Cholesterol can be lowered through diet modifications • Replace saturated fats with healthier unsaturated fats • Increase the intake of dietary fibre through eating more fruit/veg/fibre/oats etc • Add plant stanols and plant sterols to your diet