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Picture this—you’ve just had your labs drawn, and your doctor noticed that your cholesterol levels were abnormal. Your doctor then tells you that if your cholesterol doesn’t improve, you could be at risk for cardiovascular disease in the future. You may also need medication (or a higher dose of your current medication) to help improve your cholesterol levels.
You then start to wonder—is there a way I can improve my cholesterol without having to go on medication, or more medication?
Maybe you were just released from the hospital after suffering a heart attack or being diagnosed with heart failure. Your cardiologist recommended that you follow a heart healthy or low sodium diet.
You’re at home now, looking at your pantry and in your fridge, and suddenly you aren’t so sure that your favorite foods are part of that diet the cardiologist was referring to.
In situations like these, it’s easy to become overwhelmed due to lack of information or uncertainty of how to use the limited information you may have received on the way out of your doctor’s office or the hospital.
But there is hope.
As a former cardiac rehab dietitian (and current tele-health dietitian specializing in heart health and weight management), I have heard plenty of heart health nutrition questions over the years. Whether they came from someone with a new diagnosis of heart failure or someone wanting to work on cholesterol levels to prevent a heart attack (or another heart attack), my patients and clients have asked me some very good questions.
And in this post, I’d like to share some of the most frequent questions I’ve received with you. From how to improve cholesterol levels all the way to what to eat after open heart surgery, we’ll discuss some of the most important questions that others who have been in similar situations to you have asked.
Quick disclaimer—although I am a registered dietitian nutritionist, your reading of this or any articles on this website does not constitute medical nutrition therapy advice nor create a practitioner-client relationship. The information I provide here on this website is for educational and informational purposes only. Please see my full disclaimer for more information.
Question 1: Cholesterol Confusion
“My doctor told me my bad cholesterol was high but my good cholesterol was low. What do all these cholesterol values mean anyway?”
When your lipid panel is drawn, you’ll usually see several different values, such as total cholesterol, LDL, HDL, and triglycerides, along with VLDL cholesterol, non-HDL cholesterol, and total cholesterol to HDL ratio.1 In many cases, the first 4 types are the most frequently discussed when it comes to a heart healthy diet.
Total cholesterol is basically the sum of the different types of cholesterol. If it’s high, there may be some room for dietary changes.1 We’ll discuss these in a bit.
LDL cholesterol is often termed the “bad” cholesterol. When it is high, a person may be at higher risk for blockages in the arteries, which can often lead to heart attacks or strokes.1
HDL cholesterol, often known as the “good” cholesterol, is considered more protective in terms of heart disease risk because it helps to clear out the arteries of excess cholesterol.1
(Check out my post for more details on cholesterol levels.)
Triglycerides are not actually a type of cholesterol, but they can be influenced by what we eat. When they’re high, they can put you at risk for further cardiac concerns or even pancreatitis.2
(See my post for more details on triglycerides.)
If your numbers are not optimal, what you eat can help change them to some degree. (Side note, improving HDL and LDL levels can help improve your total cholesterol level.) This leads us on to our next question.
Question 2: Diet and Your Cholesterol
“Is it actually possible to improve my cholesterol levels through what I’m eating?”
The answer is that for many people, it is definitely possible to see improvement in cholesterol levels with dietary changes.
How do you go about doing so? We can think of the solution in terms of a 2-point approach.
A great first strategy is working on lowering LDL cholesterol levels by reducing saturated fats and more refined carbohydrates and instead choosing foods high in viscous soluble fiber. More details on how to do that can be found in my post here.
The second part of the plan is to optimize your HDL cholesterol by choosing heart-healthy fats in place of not as heart-healthy fats. How to do that can be found in my post about foods that can help you manage your cholesterol levels.
Question 3: The Significance of Sodium
“My doctor told me I have to follow a low sodium diet. What does this mean, and what can I eat? I stopped using the salt shaker already.”
For a quick refresher, recall that sodium is an element (remember the periodic table from high school chemistry class?) that is one part of the salt (sodium chloride) we typically use in the salt shaker.
But sodium can also be combined with other elements to form compounds other than table salt. These combinations are often food preservatives, which may be found in pre-packaged foods, such as frozen meals, soups, and deli meats.
Sodium is significant because many people end up consuming too much of it on a daily basis. In much of the research we have today, higher sodium intake is often associated with higher blood pressure readings over time.
Another area of concern is for patients with heart failure, whose hearts don’t pump as well as they should. During my time in the hospital, I saw plenty of hospitalized patients who ended up retaining a lot of fluid (water weight) because they had taken in too much sodium.
A reasonable amount of sodium often recommended for heart patients is around 1500-2000 milligrams (mg) per day. What does this look like? Visit the links below to learn more:
The Low Sodium Diet Shopping List
Question 4: Fruit and Sugar
“I was told that I need to cut out sugar, so I stopped eating fruit (and candy and soda). But I still like fruit, so can I ever have it again?”
If a question like this has been on your mind at some point in time, I would like to reassure you that it is okay to eat fruit. You will probably not want to follow a diet that is entirely fruit, as you would miss out on a lot of important nutrients. But fruit in a few small portions per day is generally fine for most people.
When the topic of sugar is brought up, many people are under the impression that all sugar, whether from fruit or candy, is not healthy. But that’s actually not quite true.
There are two types of sugar: naturally occurring sugar and added sugar. Naturally occurring sugars are found in the fruit we eat, as well as in some dairy products. Added sugars are the ones added into a product by the manufacturer (like in the case of candy or cookies).
It’s the added sugars (which can be seen on most food labels) that we need to be more mindful of. The American Heart Association has suggested a limit3 that can help reduce your risk for heart disease, or help protect your blood vessels from further damage after a cardiac event.
For a deeper dive into this topic, visit my post on added sugars.
Question 5: Diet After Open Heart Surgery
“I just had open heart surgery. What can I eat?”
Immediately after surgery, the focus should be on ensuring that the large incision wound heals properly. This requires enough protein and certain vitamins and minerals to do the job.
After the incision site is healed, a heart healthy diet is the way to go for the long term. It includes plenty of fruits and vegetables, legumes (like beans), nuts and seeds, lower fat dairy, lean proteins, and whole grains.
More detailed recommendations (including foods to cut back on, like fried foods and foods higher in added sugars) can be found in my post about diet after open heart surgery.
Question 6: The Overwhelm of Changing
“How can I give up all of my favorite foods to follow this new diet? It’s so much to do!”
Oftentimes the solution is not all or nothing, or all at once. Making slow and steady little changes works a lot better for most people.
It may help to write down what you’re eating for a few days, making sure to be as honest as you can. From that information you can see some things you may want to work on.
Think also about your goals. If you need to lower your LDL cholesterol, take a look at how many of the viscous fiber foods you’re eating each day or week, as well as how often you’re having fattier cuts of meat or eating the skin on poultry, etc.
Then determine what one thing might be that you could start with. If it’s trying out oatmeal for breakfast to increase your soluble fiber intake, or if it’s cutting back one day of the week on how much dessert you’re eating, try to find a little change that you know you can stick with and build upon in the future.
The slow, gradual changes are the ones that last—I’ve seen this plenty of times with my patients and clients.
Conclusion
As we come to the end of the heart health nutrition questions, I hope you’ve found some topics that resonated with you. I would encourage you to read through the information that you are most concerned about and think about what you might want to change.
Then go ahead and find that one change that you can start with.
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Sources
- Cholesterol Numbers and What They Mean. Myclevelandclinic.org. Updated July 28, 2022. Accessed July 30, 2024. https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean.
- Lipid Panel. Myclevelandclinic.org. Updated November 9, 2021. Accessed July 30, 2024. https://my.clevelandclinic.org/health/diagnostics/17176-lipid-panel.
- American Heart Association Editorial Staff. Added Sugars. Heart.org. Updated May 22, 2024. Accessed July 30, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars.
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