Weight Loss, Diets and Nutrition

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The Role of Diet in Treating High Cholesterol and Related Conditions

High lipid levels are treated with diet and exercise, and in certain circumstances, drugs are also prescribed. Drugs reduce levels either by affecting the way the body absorbs fat from the intestine, or by stopping the liver producing too much cholesterol. However, drugs are not seen as an alternative to lifestyle changes, as they are more effective when combined with dietary change, and as they can have adverse side effects. Furthermore, dietary change can deliver other benefits beyond cholesterol reduction, for both the health of the heart and for health in general.

The aims of dietary treatment are:

- To help prevent narrowing of the arteries by reducing the levels of LDL cholesterol and triglycerides in the blood
- To increase the levels of certain protective fats in the blood
- To achieve a healthier weight and reduce the waist to hip ratio

The levels of cholesterol in the blood are strongly linked to the quantity and type of fat consumed in the diet. Studies have shown that as the amount of saturated fat in the diet rises so does the cholesterol level, and in particular the LDL type. Some foods, such as eggs, offal and shellfish, actually contain cholesterol. However, the majority of the cholesterol in the blood is synthesised by the liver, and not provided directly by the diet. The amount and type of fat consumed has a far greater impact on blood cholesterol levels. Cholesterol containing foods, therefore, do not necessarily need to be eliminated from the diet.

The most important dietary factors affecting triglyceride levels are alcohol intake, being overweight, or an excessive intake of sugar. Alcohol and sugar are metabolised by the liver and excessive intakes increase the amount of triglyceride that the liver has to produce. The triglycerides are then released into the bloodstream.

HDL levels are affected less by diet but there is some suggestion that fish eaters, particularly of oily fish, have higher levels of HDL cholesterol. Exercise also increases HDL cholesterol.

A type of fat known as omega-3s, found in oily fish, can help to reduce the stickiness of the blood, thereby reducing the risk of clots (thrombus) being formed.

Studies have shown that as well as reducing blood cholesterol levels, dietary intervention can also help slow down the development of further blockages, and may even reverse some of the damage.

Functional foods or nutraceuticals are relatively new types of foods now available. They are foods which generally contain an ingredient which is of medical benefit, and one category is margarines that lower cholesterol levels. These are only effective if consumed in adequate amounts each day. The cholesterol lowering effect is lost if consumption ceases.

The margarines contain plant sterols, which are naturally occurring components of vegetable oils normally extracted during processing to stabilise the oils produced. If the sterols are added back in a modified form known as plant stanol esters, they produce a fat which can have a significant effect on lowering blood cholesterol levels. It can mean that conventional drug therapy is withheld or dosage reduced. However, these products are often more expensive than standard versions, and their use should not distract from the importance of making other dietary changes.

The principles of the diet

- Reduce the amount of fat in the diet, especially from saturated fat, which mostly comes from animal sources, and from trans fat, which mostly comes from processed foods.
- Use polyunsaturated, or even better, monounsaturated, fats in preference to saturated fat.
- Eat something starchy with every meal, such as bread, potatoes, pasta, rice or cereals. These foods should form the basis of all meals.
- Eat plenty of fruit and vegetables. Aim for five portions each day.
- Aim for a diet high in fibre, particularly soluble types such as oats, pulses, lentils, fruit and vegetables.
- Try to cut down on sugar and sugary food.
- Avoid an excessive alcohol intake.
- Use less salt in cooking and avoid adding extra at the table.
- Try to eat oily fish two to three times per week.

However, armed with only this very valid but general advice, the majority of people would be unable to sustain the required dietary changes.

Many people initially tackle the whole breadth of their diet with great enthusiasm, but fail to make sustainable changes. Others fail to make enough changes in the first instance.

Dietitians can help by providing practical and personalised advice based on an individual’s specific medical diagnosis, current dietary intake, likes, dislikes and lifestyle, such as travel and eating out habits.

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