Understanding Cholesterol Management: A Weight-inclusive, Non-Diet Approach
by Allison Cain, RD, associate at On the Brink Nutrition Collective
At On The Brink, we recognize that navigating the topic of cholesterol can feel overwhelming. With a sea of conflicting advice, it's hard to know what's right for your health. That's why we're here to break it down and offer a clear, holistic view of cholesterol and its role in your body—without pushing diet culture or weight loss.
What is Cholesterol?
Cholesterol often gets a bad rap, but did you know it’s essential for your body to function? Cholesterol is a waxy, fat-like substance found in your blood and every cell in your body. It’s vital for building cells, producing hormones, and aiding digestion through bile production. So, cholesterol isn't the enemy—your body needs it to thrive.
Often, questions arise about "good" cholesterol versus "bad" cholesterol. When we talk about good and bad cholesterol, we are actually referring to the lipoproteins that transport cholesterol through the bloodstream, not cholesterol itself. Let’s delve into what these lipoproteins are and how they impact your health.
The Role of HDL and LDL
HDL (High-Density Lipoprotein): Often dubbed “good” cholesterol, these particles are made up of fat (lipids) and protein, and carry cholesterol away from your arteries and back to your liver, where it's processed and eliminated. High levels of HDL can lower your risk of heart disease.
LDL (Low-Density Lipoprotein): Known as “bad” cholesterol, these particles are made up of fat (lipids) and protein, and carry cholesterol through the bloodstream to the gonads, adrenal gland, muscle, and adipose tissue. LDL also deposits cholesterol in the walls of arteries. High levels of LDL can lead to plaque buildup in your arteries, increasing the risk of heart disease and stroke.
Lipoprotein(a): A type of lipid, or fat, in the body that contains and is similar in structure to low-density lipoprotein (LDL) cholesterol. Like LDL cholesterol, Lp(a) deposits cholesterol in the arteries and can show up in plaque. It’s also found in cells that line small blood vessels and in tissues where regeneration and healing occur. Elevated levels of Lp(a) can increase the risk of cardiovascular diseases, including heart attacks and strokes, independent of other cholesterol levels. Lp(a) is primarily determined by genetics and is not significantly affected by diet or lifestyle changes.
How Nutrition Supports Balanced Blood Cholesterol
At On The Brink, we believe in a non-restrictive, additive approach to nutrition. Instead of only focusing on what to remove from your diet, we guide you in incorporating nutrient-dense, heart-healthy foods that support your overall wellbeing.
Add Fiber for Heart Health
Fiber, particularly soluble fiber, plays a key role in managing cholesterol by helping reduce LDL levels. Soluble fiber binds with cholesterol in the digestive system, aiding its removal from the body. Foods rich in soluble fiber include oats, beans, lentils, apples, citrus fruits, and barley (1).
Embrace Heart-Healthy Fats
Not all fats are created equal! Monounsaturated and polyunsaturated fats can help improve cholesterol levels by reducing LDL and boosting HDL. You can find these healthy fats in olive oil, avocados, nuts, seeds, and fatty fish like salmon (2)
Plant Sterols and Stanols: Natural Allies for Cholesterol Balance
Plant sterols and stanols, found naturally in foods like nuts, seeds, and vegetable oils, can help lower LDL cholesterol by blocking its absorption in the intestines. These natural compounds can be an excellent addition to your holistic heart health routine.
Foods rich in plant sterols and stanols include:
Whole grains (oat bran, rice bran, wheat germ)
Nuts and seeds (almonds, sunflower seeds, sesame seeds)
Vegetables like broccoli, cauliflower, and avocados
Adding 2-3 grams of these compounds daily, whether through foods or supplements, can effectively lower LDL cholesterol (3, 4).
Understanding Dietary Cholesterol
There’s been a lot of confusion around the cholesterol found in food (aka “dietary cholesterol”) and its impact on blood cholesterol. For most people, dietary cholesterol—found in animal products—has a minimal effect on blood levels. However, genetics plays a big role in how much dietary cholesterol your body absorbs through the small intestine (5). The current guidelines suggest keeping dietary cholesterol consumption "as low as possible without compromising the nutritional adequacy of the diet."
These recommendations leave room for flexibility and the RDs at On the Brink are here to help you figure out what that looks like in your diet.
A Word on The Role of Genetics in Cholesterol Management
Cholesterol management isn’t one-size-fits-all. Genetics play a significant role in how your body processes cholesterol. Conditions like familial hypercholesterolemia can result in high LDL levels despite dietary efforts. Knowing your genetic predispositions can help you and your healthcare team create a personalized plan for long-term heart health.
Conclusion: A Holistic Path to Heart Health
At On The Brink Nutrition, we understand that laboratory vaules, including cholesterol, are just one piece of the puzzle when it comes to health. We embrace an approach to wellness that helps care for your heart without the pressure of weight loss or restriction. Our dietitians are here to support you in making mindful, nutrition-focused choices that improve your cholesterol balance while honoring your unique needs.
Remember, it’s not about fear or restriction—it’s about nurturing your body with the care and balance it deserves.
The RDs at On the Brink Nutrition are here to help you:
develop creative, attuned, and effective interventions - this includes eating plans and nutrition recommendations that guide and support without unnecessary restriction,
feel truly and compassionately seen,
evaluate your situation thoroughly, from every angle,
consider the emotional and developmental context for understanding your experience with eating,
increase self-compassion and decrease shame (and reactivity),
slow down and get curious about medical, behavioral, developmental, relational, and familial factors.
References:
Slavin, J. L. (2013). Fiber and prebiotics: Mechanisms and health benefits. Nutrients, 5(4), 1417-1435. https://doi.org/10.3390/nu5041417
Sacks, F. M., Lichtenstein, A. H., Wu, J. H., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., & Miller, M. (2017). Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation, 136(3), e1-e23. https://doi.org/10.1161/CIR.0000000000000510
Plat, J., & Mensink, R. P. (2001). Effects of plant stanol esters on LDL receptor activity and biliary and fecal cholesterol excretion in normo- and hypercholesterolemic subjects. Journal of Lipid Research, 42(4), 646-653. https://doi.org/10.1016/S0022-2275(20)31598-4
Jones, P. J. H., Vanstone, C. A., Raeini-Sarjaz, M., & St-Onge, M. P. (2003). Phytosterols: Efficacy and safety. American Journal of Clinical Nutrition, 77(3), 760-766. https://doi.org/10.1093/ajcn/77.3.760
Berger, S., Raman, G., Vishwanathan, R., Jacques, P. F., & Johnson, E. J. (2015). Dietary cholesterol and cardiovascular disease: A systematic review and meta-analysis. American Journal of Clinical Nutrition, 102(2), 276-294. https://doi.org/10.3945/ajcn.114.100305
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