I’ve been a bit cheeky this week. My GP wanted me to repeat my cholesterol tests after 6 months but I had made some changes and wanted to know if I was on the right track. One of the advantages of being a GP is being able to order your own pathology tests, so voila… I tested myself for cholesterol! I’m celebrating because my cholesterol is now the best it’s ever been, and the changes I have made have been sustainable and enjoyable. I’m going to share with you what I did.
But firstly, the question is, will these changes make a difference? There is some controversy over this, as the evidence that low-fat diets reduce the risk of having heart attacks is mixed. There’s a lot of talk about how we’re allegedly eating less fat than ever and heart disease and obesity rates are rising – this is simply untrue, as American data shows that Americans are eating as much fat as they were in 1963 and this has remained consistent for decades. What we do know now that it’s not just a low saturated fat diet that makes a difference, but it’s a low saturated fat and high mono-unsaturated fat diet with high fruit and vegetable intake that probably makes the most difference. Low-fat diets have consistently failed to show appreciable benefits on heart attack risk, unless they were Mediterranean style diets that included olives and other sources of mono-unsaturated fats. In one randomised study, the participants consumed a diet of 10% saturated fat and 22% mono-unsaturated fat.
So, does high cholesterol lead to heart attacks? The answer is a bit complicated. From my (somewhat limited) understanding, cholesterol is not the cause but perhaps the straw on the camel’s back. The underlying cause is damage to blood vessels (from trans-fats, high blood pressure, diabetes). The damaged blood vessel lining kind of looks like a graze. Cholesterol is the stuff that patches up this graze – kind of like using putty to close up a hole in a wall. Trouble is that it can be too good of a plug, and causes narrowing of the vessels, which then leads to complete blockage. High cholesterol levels are linked to heart disease, especially at very high levels, and lowering cholesterol with statin drugs does lead to a reduction in heart disease risk. Dr Dean Ornish also demonstrated that a very low fat diet plus stress management program and regular exercise can reverse the blood vessel damage seen in heart disease.
Despite the controversies surrounding cholesterol, I have chosen not to adopt a cavalier attitude and instead chose to change my diet. I didn’t have a terrible diet but I was having a lot of eggs, red meat, and the occasional ice-cream. I was training for a race so I was actually losing weight, but it certainly didn’t help my cholesterol levels. I have no doubt we’ll continue to discover more about cholesterol and heart disease risk.
There is also some evidence that a high-fat diet may also be linked to breast cancer, and that it may change the gut microbiome adversely.
My approach was to focus on restricting saturated fat (note: not all fat; I didn’t pay any attention to the other fats apart from eliminating all trans-fats) and increasing plant foods. I used a combination of a Mediterranean diet and an Ornish diet. I didn’t read any books, just some websites and guidelines, and used Myfitnesspal and/or read nutrition labels. I immediately got to know the foods high in saturated fat – these are full fat dairy and certain meats such as bacon, sausages, chicken thighs, and lamb. All fried foods like chips were also high in saturated fat. I learned that chips were 6g of sat fat a bucket, lasagne was 8g a serve, and Magnums were a whopping 18g a serve!!! (a Mini Magnum, however, was a more modest 6g a serve).
So my diet guidelines were something like this:
Saturated fat: Less than 10% of daily calories, which for me was about 13g per day. (To calculate your daily caloric requirement, go to the Eat for Health website). The good protein choices were low fat yoghurt, low fat cheese, chicken breast (a third of the fat of chicken thighs), lean red meat such as eye fillet steak (only 4g saturated fat per small fillet!), nuts and fish. I could eat normal amounts of these foods with a minimum of saturated fat, so I never felt hungry. I found that having other fats such as the mono-unsaturated fats from nuts helped with satiety. I got a bit peckish if I had a completely low fat diet.
Vegetables: Heaps and heaps of vegetables at every meal; if I didn’t fill my vege drawer up in the fridge I knew I wasn’t going to be having enough. Vegies have lots of fiber which helps you feel full and also soaks up cholesterol so you poop it out. I made at least half my plate veges. I ate vegie sticks as a snack. (Seriously! I love celery!)
Legumes: I introduced one or two meals with legumes every week. Sometimes I would mix this up with some animal protein as well. Some days I got away with a completely vegetarian meal!
Very few eggs: I sadly gave up my two egg a day habit, and only had two eggs a week. I quickly forgot about the eggs and now I don’t miss them. Could the 14 eggs a week have been the sole reason for my high cholesterol? Quite possibly, but there is no harm in changing other parts of my diet.
Oats: Every. Single. Morning. Sometimes I had Bircher muesli. Usually I had oats with honey or banana, and sometimes I added Nutella. (Only 1.4g sat fat per serve!) Sometimes I even had Bircher Muesli as a snack!
Portion control: Occasionally we would have a high-fat meal – like when my partner feels like having chorizo, or we eat out, or at a friend’s house. Portion control was my friend – I learned that you can have a small amount of said foods and load up on other foods like veges instead. And of course, once or twice a week I would forget about my sat fat allowance and have whatever I wanted. The first couple of weeks were difficult, but I soon adjusted to not having as much saturated fat in my life and I felt fantastic. I also found that by keeping things flexible this way (not making a big deal about food) I could eat normally, and the family was happy.
I was also careful not to replace the saturated fat with sugar, so I stuck to low glycemic index foods only and very little sugar. I wasn’t aiming to lose weight but I’m definitely leaner and have lost 1 kg.
Looking forward, I’m now going to focus on having more mono-unsaturated fat in my diet (avocadoes, nuts, fish and olives) and perhaps introduce more eggs into my diet, as they are an excellent source of protein and nutrients (I could have the whites only for example; the cholesterol is contained in the egg yolk). My family and I seem to be enjoying the new way of eating, and I now include more of what they enjoy in our meals eg sausages, but I’ll make this as a sausage and chickpea stew and they have more sausages, I have more chickpeas.
What I did wasn’t rocket science; it is basically removing the stuff we don’t need heaps of and replacing it with stuff that we should eat plentifully. I believe that it is this substitution that is the key – you can’t remove saturated fat and replace it with high GI carbs or trans fats and expect to live a long and healthy life. You can’t “cheat” on this stuff. More plant, less animal. And a little bit of Nutella every now and then 😉