Lifestyle measures can have a greater impact on preventing coronary heart disease and heart attacks than on practically any other disorder. More specifically, lifestyle changes can reduce elevated cholesterol levels - and the simplest change to make is to limit your intake of high cholesterol foods and saturated fat. The average American diet contains about 35% to 40% of energy from fat. Not all of this fat is bad - in fact, some types of fat, such as mono- and polyunsaturated fat, have a beneficial effect on blood lipids and may lower the risk of developing coronary heart disease or dying of it. But the prevalent type of fat in the American diet is saturated fat, the major dietary factor that raises blood cholesterol levels. In fact, saturated fat has a bigger impact on blood cholesterol levels than dietary cholesterol itself. Saturated fat includes most animal and dairy fats and some oils, such as palm and coconut oils.

Natural Sources of Cholesterol and High Cholesterol Foods

Some other high cholesterol foods include:

• Butter
• Cream
• Ice cream
• Cream cheese
• Whole-milk dairy products
• Certain shellfish, such as shrimp
• Other organ meats, such as kidney and brain
• Duck and goose (the skin on these animals is high in cholesterol).
  

Please note that duck and goose have more cholesterol than chicken or turkey. Cholesterol level in the body is simply a balance of eating foods that raise cholesterol levels and foods that lower cholesterol levels. Actually, for most people, the main cause of high blood cholesterol is eating too much of certain types of fat. Saturated fat and trans fatty acid (also known as trans fat) are types of fat that raise your cholesterol levels.

Modifying your fat intake

The National Cholesterol Education Program (NCEP) guidelines recommend reducing total fat to between 25% and 35% of total energy, with the majority of fat energy coming from mono- or polyunsaturated fat. Also advised is limiting the intake of saturated fat in order to reduce blood cholesterol levels—specifically LDL (“bad”) cholesterol. The guidelines recommend these dietary measures even when blood cholesterol is normal, since a modified fat intake can help maintain optimal cholesterol levels. A reduction in total fat may also help to maintain an ideal weight, because a gram of fat contains more than twice as many energy (38 joules) as a gram of carbohydrates or protein (17 joules). (Fat and protein are more filling than carbohydrates, however.) Blood cholesterol levels are also raised by dietary cholesterol, but not as much as by saturated fat.

A few high cholesterol foods - egg yolks, lobster, and shrimp - are especially high in dietary cholesterol. The NCEP guidelines also recommend limiting dietary cholesterol. While modifying fat intake is desirable, it is important not to get too carried away with restricting fat in the diet.

According to the American Heart Association, short-term studies reveal that lowering fat intake to 15% or less of total energy does not reduce LDL cholesterol levels much further than a standard low-fat diet. In addition, very–low-fat diets decrease heart-protective HDL cholesterol and increase triglyceride levels, whereas the moderate-fat diet recommended by the NCEP guidelines can help reduce triglycerides and raise HDL cholesterol, particularly in people with metabolic syndrome, a condition that markedly increases the risk of coronary heart disease and diabetes. (Metabolic syndrome is characterized by abnormally high blood sugar levels due to insulin resistance, accompanied by other factors that include abdominal obesity, high blood pressure, low levels of HDL cholesterol, and high levels of triglycerides.)

Saturated Fats

• Bee
• Poultry
• Veal
• Processed meats (such as sausage, bologna, salami, and hot dogs)
• Egg yolks
• Butter
• Whole milk dairy products (such as milk, cream, cheese, and ice cream)
• Baked goods (store-baked goods are often made with egg yolks and saturated fats and frequently contain trans fatty acids).
  

• Coconut and coconut oil
• Palm oil
• Palm kernel oil.
  

Mono- and polyunsaturated fats

When fat is consumed, monounsaturated fats should be chosen whenever possible so that they contribute up to 20% of total energy. Olive and canola oils, almonds, and avocados contain large amounts of monounsaturated fat. When they are substituted for saturated fat in the diet, monounsaturated fats can lower LDL cholesterol levels and stabilize or even raise HDL cholesterol levels.

Polyunsaturated fats—found in safflower, sunflower, and corn oils—also lower LDL cholesterol levels. Omega-3 fatty acids, another type of polyunsaturated fat, seem to have cardioprotective benefits beyond lowering LDL cholesterol. There are three principal types of omega-3 fatty acids: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alphalinolenic acid (ALA). EPA and DHA, found only in fish (particularly fatty fish), can reduce the tendency for blood to clot, decrease the risk of arrhythmias (abnormal heart rhythms), and lower triglyceride levels; the benefits of ALA are unclear.

Trans fat

Trans fatty acids, or trans fats, are made when liquid vegetable oil is heated in the presence of hydrogen. This process is known as hydrogenation. The more hydrogenated an oil is, the harder it will be at room temperature and the more trans fat it will contain. People should minimize their intake of trans fat—a type of fat found in foods made with hydrogenated or partially hydrogenated oils. Some examples are margarine and commercial baked goods. Trans fat (also known as trans fatty acids) is formed during the addition of hydrogen atoms to unsaturated oils to make them more saturated and therefore solid at room temperature and more shelfstable. Trans fat may be even more harmful to health than saturated fat because trans fat not only raises LDL cholesterol, but also lowers HDL cholesterol. The Institute of Medicine, a branch of the National Academy of Sciences, recommends that trans fat consumption be as low as possible.

Trans fat is found in:

• Commercially baked good
• Margarines
• Snack foods (cookies and crackers)
• Processed foods
• Fried foods (such as French fries or doughnuts).
  

Trans fats are even worse for cholesterol levels than saturated fat and cholesterol itself because they raise LDL cholesterol and lower HDL ("good") cholesterol. When reading food labels, look for the words "hydrogenated" and "partially hydrogenated" in the ingredient list. These foods are loaded with trans fat and saturated fat. Also, look for the words "trans fat" on the food label. Eating a heart-healthy diet is not only about limiting high cholesterol foods; it's also about limiting foods high in saturated fats and trans fat. Eating smart begins by learning how to read a food label and being aware of different types of fat and cholesterol in foods you eat. If a healthy-heart diet does not lower cholesterol enough, your healthcare provider may recommend increasing your soluble fiber intake and/or adding other cholesterol-lowering foods to your diet.

Recommendations for Fat Intake

1. Above all, keep saturated fat intake to less than 7% of energy.

This is the simplest dietary measure you can take to lower your risk of a heart attack. Reaching this goal will help reduce your blood cholesterol levels, specifically your LDL cholesterol. Meats, poultry skin, and whole-milk dairy products contain the most saturated fat and thus should be limited in the diet.

2. With few exceptions, limit total fat intake to between 25% and 35% of total energy.

For those whose fat intakes have exceeded the recommended amount, fat energy should be replaced with ones from complex carbohydrates, with an emphasis on whole grains, vegetables, fruits, and legumes (beans and peas). As much as possible, avoid energy from products that contain a lot of refined carbohydrates, such as sugar and white flour.

3. Get half your total fat intake from monounsaturated fats.

These fats are particularly plentiful in olive oil, canola oil, almonds, walnuts, and avocados. Because these sources are also concentrated sources of total fat energy, they must be eaten in moderation to maintain a diet containing no more than 35% of energy from fat and to avoid weight gain.

4. Get less than 300 mg of dietary cholesterol per day, and less than 200 mg if you have elevated levels of LDL cholesterol.

Although saturated fat raises blood cholesterol levels more than dietary cholesterol, experts still recommend limiting dietary cholesterol.

5. Eat fatty fish at least twice a week.

The omega-3 fatty acids in fatty fish appear to have some protective effects, and fish are a good source of protein and are low in saturated fat. Salmon, sardines, and albacore tuna are all good choices.

6. Limit trans fats to less than 1% of total energy.

Check food labels. The Food and Drug Administration (FDA) now requires manufacturers to list the amount of trans fats on food labels; the amount is listed below the amount of saturated fat.

7. Remember that these recommendations need not be followed at each meal.

It is more important to even out fat intake over the course of a week. If you eat a high-fat lunch, for example, you can compensate by eating a low-fat dinner or a little less fat than usual over the next several meals.