Ask the Experts: Managing Lipid Levels

Cheryl Collier

Clinical Dietitian
BC Women's Hospital and Health Centre
Vancouver

Your nutrition choices can help reduce your bad cholesterol. This involves cutting back on certain foods and adding heart-healthy foods to your diet. Both saturated and trans fats raise bad cholesterol. Most saturated fat comes from processed foods, fatty cuts of meat, high-fat dairy products and tropical oils, such as coconut and palm. Instead of fatty meat, you can eat leaner meat, skinless poultry, fish, legumes and vegetarian protein, such as peas and beans or soy protein. Select lower-fat dairy products and steer away from highly processed foods. You don't need to eliminate high-cholesterol foods, but try to eat less of them.

Incorporate more of the following into your diet:

• Fibre, particularly soluble fibre -- it prevents the absorption of bad cholesterol from the food you eat. Good sources include oatmeal and oat bran, barley and psyllium. Increase fibre by including vegetables, fruit and whole grains with meals.
• Nuts -- almonds, walnuts and other tree nuts can help reduce cholesterol. They are a source of healthy fat and are high in calories, so if you're trying to lose weight, limit your portion to a quarter cup a day.
• Omega-3 fatty acids -- cold-water fish (such as salmon, sardines and trout) are an excellent source and can help lower triglycerides. If you don't like fish, these oils are available in capsules. Ask your doctor for advice on dosage.

For clients with high cholesterol who are also struggling with unwanted weight loss, I look at what is contributing to the weight loss and help them reach and maintain a healthy body weight. Replacing saturated fats with high-calorie healthy fats from nuts, avocados, and olive and canola oils can help cholesterol levels and boost calorie intake.

It's more common, however, for people to work on losing extra weight and exercising (both are good for the heart). For people who don't currently exercise and are finding it hard to start, I suggest participating in an activity they enjoy once or twice a week. Once a consistent routine is achieved, they can start exercising more.

Lifestyle changes take time. Start with one to two key goals and go from there. Diet and exercise can make a difference, even in situations where HIV medication is contributing to high cholesterol or triglycerides, but it's important to recognize that sustainable change takes time.

Tasleem Kassam

Naturopath
Clinic Director, Effective Health Solutions
Calgary

Vegetables are not very sexy. We'd all rather eat a corn dog than sit down to a plate of vegetables. But the reality is that the more vegetables you eat, the better. Lots of vegetables and moderate amounts of fruit should be the mainstay of our diets. I tell my clients to think of meat as a condiment. Many people find this shocking, but meat should take up no more than a quarter of the real estate on your plate. Vegetables and whole grains should fill the rest of your plate.

You can also grind up flax seeds and sprinkle them on a salad. Flax seeds help keep the arterial system working well because they're high in fibre and omega 3-fatty acids.

The less you eat processed food that comes out of a factory, the healthier you'll be. It can be difficult to do on a limited budget because processed food is often less expensive (plus the food industry has a vested interest in tempting you with factory food, which generates profit).

I also recommend the following supplements:

• Krill oil -- a type of fish oil that contains the antioxidant astaxanthin (a pigment, or carotenoid, responsible for making shrimp and flamingos pink), which can improve lipid levels. Make sure you get a balanced intake of carotenoids (mixed carotenoids); and
• Vitamin B complex -- contains pantothenic acid (B₅), useful for correcting lipid metabolism and raising good cholesterol even when medications, diet and exercise have been tried to little avail. Pantothenic acid should not be taken on its own but as part of a B complex. You may want to supplement this with pantethine (a derivative of pantothenic acid) to help manage lipid levels.

Most people with HIV are already taking more medication than the average person. It's a lot for the liver to process. In my opinion, it's best to try to manage your cholesterol naturally, if possible, because taking a cholesterol-lowering medication adds to the liver's workload. Most people who make the right changes to their diets see the payoff in their blood work results.

Jennifer McPhee is a freelance writer who contributes regularly to The Positive Side. Her work has also appeared in numerous publications, including Chatelaine, The Globe and Mail and Childview.