Change your Oil: Fats and Cholesterol

"Eat a low-fat, low-cholesterol diet" has been the mantra for healthful eating for decades. The low-fat approach to eating may have made a difference for the occasional individual, but as a nation it hasn't helped us control weight or become healthier. I am seeing a larger number (even very thin) patients with high cholesterol and triglycerides.  Why hasn't cutting fat from the diet paid off as expected? Detailed research—much of it done at Harvard—shows that the total amount of fat in the diet isn't really linked with weight or disease.

What really matters is the type of fat in the diet.
Bad fats, meaning saturated fats, increase the risk for certain diseases.
Very bad fats, meaning trans fats,  are worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL.
Good fats, meaning monounsaturated and polyunsaturated fats, do just the opposite. They are good for the heart and most other parts of the body. There is no good evidence that replacing saturated fat with carbohydrates will protect you against heart disease, while there is solid proof that replacing saturated fat with unsaturated fats will help. Here are three helpful tips:

1. Try to eliminate trans fats from partially hydrogenated oils. Check food labels for trans fats; avoid fried fast foods.

2. Limit your intake of saturated fats by cutting back on red meat and full-fat dairy foods. Try replacing red meat with beans, nuts, poultry, and fish whenever possible, and switching from whole milk and other full-fat dairy foods to lower fat versions.

3. In place of butter, use liquid vegetable oils rich in polyunsaturated and monounsaturated fats in cooking and at the table such as canola and olive oil.

My patients often ask, "How much fat should I eat per day"?

• It generally is figured as a percentage of your daily caloric intake, which varies with your age, sex, and activity level.
• The American Heart Association recommends limiting dietary fat to 30% of total calories, however, if you are overweight, need to lower blood cholesterol or have another medical concern, you may need less than the recommended 30%. Back to the math: for 1,600 calories diet - Limit fat to 50 grams.
• The Dietary Guidelines for Americans recommend no more than 10 percent of your total daily calories come from saturated fat (for a 2,000-calorie diet this would be about 20 grams per day), and your trans fat consumption should be as low as possible.

C is for Cholesterol

My husband is an interventional cardiologist who is on-call for Howard County Hospital’s Heart Attack Team every Tuesday evening. We often get wake-up calls in the middle of the night about a patient with chest pain. My husband rushes to the hospital when there is a heart attack. Time is critical when it comes to opening up the clogged arteries that bring blood to the heart. It’s a true emergency. Someone in America dies every 37 seconds from some form of cardiovascular disease.


Since I am also awoken in the middle of the night, I wonder, “What has caused that patient’s arteries to clog?” My goal is to get to the root of the problem before it has time to grow. I want my patients to grow up healthy and never have to be faced with a heart attack.

Thanks to many studies and thousands of patients, researchers have found certain risk factors that play an important role in a person's chances of developing heart disease. Some risk factors can be changed, treated, or modified, and some cannot. One of those risk factors for having heart disease is having high cholesterol.

What is cholesterol?

Cholesterol is a fat-like substance (lipid) that is found in all body cells. Your liver makes cholesterol. We also can get cholesterol from the foods we eat such as meat, fish, eggs, butter, cheese and milk. We need some cholesterol to help our brain, skin, and other organs grow and do their jobs well. There are two main types of cholesterol: HDL and LDL.

LDL cholesterol is more likely to clog blood vessels because it carries the cholesterol away from the liver into the bloodstream, where it can stick to the blood vessels. LDL is also known as “lousy cholesterol”. 

HDL cholesterol, on the other hand, carries the cholesterol back to the liver where it is broken down. HDL is know as "healthy cholesterol". When your HDL cholesterol is high, it's actually good for your health.


When should children have their cholesterol checked?

Screening should take place after age two but no later than age 10, if your child is at risk.

The American Academy of Pediatrics (AAP) considers the problem serious enough to have issued recommendations to help parents and physicians identify children potentially at risk for problems with high cholesterol. The recommendations target children and adolescents who have:

• a family history of premature cardiovascular disease

• at least one parent with a high blood cholesterol level

• other factors for heart disease including obesity, high blood pressure or diabetes

Like most things, cholesterol levels are different for kids, so make sure you discuss those numbers with your pediatrician.

Helpful Tips

If you don’t know your family’s health history, have the child’s cholesterol level checked between 2-10 years of age.

If a child's fasting cholesterol profile is normal, then it should be repeated every three to five years.

If a child is found to have high cholesterol, his or her physician will likely recommend treating the problem with a combination of diet management and physical activity. If a problem is severe enough, medications may be used to lower the cholesterol.

To help your family have healthy cholesterol levels, have a Heart Healthy Diet, one that is low in cholesterol and saturated fat.


Let’s help our children stay away as far as possible from heart disease: keep their blood flowing freely through their arteries by having a Heart Healthy Diet and staying physically active together.