Was it the duck confit or the succulent pork belly? Could it have been the chips cooked in goose fat or the coconut milk-drenched laksas? Those platefuls of bacon and eggs were another possible culprit. Or even that recent cheese platter overdose. Just what, precisely, had triggered my cholesterol to surge into dangerous territory?
The blood on my fingertip and the subsequent vial sucked from my arm delivered the same disturbing results. My total cholesterol was nudging an artery-choking 7.2mmol/L, while my LDL “bad” cholesterol was more than double the Heart Foundation’s recommended level. It didn’t take a culinary detective to pinpoint some of the causes, but it took this blood test to jolt me into acknowledging the extent of my overindulgence.
Admittedly, my waistline had already broadcast some pretty strong signals about my eating habits. My weight had recently hit 90 kilograms – an ill fit for my 180-centimetre frame. The running shorts I’d worn several years earlier to complete Sydney’s City2Surf in less than an hour had long ago been superseded by a pair the size of a spinnaker.
My job was a major factor. In my role as new product and business development manager at a Sydney gourmet food producer, I was required to taste up to 40 meals a day. To identify any faults in the cooking, I had to give each dish my “sensory” seal of approval before dispatching it to customers. Many of these were foods brimming with saturated fat: mashed potato with butter and cream, risottos oozing with cheese and curries spiked with ghee.
Compounding the problem was the fact that after a solid day at work, food was also my primary form of recreation. I wrote a blog about food, I cooked obsessively – I even travelled to France specifically to eat. Like a lot of blokes in their mid-thirties, juggling a busy job and a young family, I’d stopped paying sufficient attention to my health. The result was a cholesterol problem that needed to be addressed – fast.
So what did I do? I completely overhauled my diet, donned the running shoes again and, in just six weeks, slashed my total cholesterol by a quarter and cut my LDL by almost a third, shedding 4kg in the process. Best of all, I didn’t touch a single drug or offend my palate in the process.
According to CSIRO guidelines, a cholesterol level of 6.5mmol/L or greater means your risk of heart disease is about four times that of someone with a level of 4mmol/L. Things are even bleaker if you’ve got a family history of heart disease: my grandfather had dropped dead from a heart attack at 48.
I knew little about cholesterol at the time, but my figure of 7.2mmol/L shocked people who did. People like my doctor, who, peering over his half-moon spectacles, told me that if I didn’t act immediately, my baby daughter might soon be fatherless.
He also explained that although my relationship with food bordered on the fanatical, my condition was depressingly common. The Heart Foundation calculates that 51 per cent of Australian adults – a whopping 6.4 million people – have high blood cholesterol. The higher your LDL cholesterol, the greater your chance of ending up with heart disease – something that kills about 50,000 Australians every year, two-thirds of whom are men.
Brandishing a nauseatingly revolting picture of a cholesterol-clogged artery, my doctor pointed out that I was one of the unfortunate people who see a direct correlation between the amount of saturated fat we consume and the level of LDL cholesterol in our bloodstream.
The image of the blocked artery he was waving was the direct result of excess LDL cholesterol that causes build-ups of fatty deposits – known as plaque – on the artery wall. This plaque narrows the artery and can raise the risk of heart attack or stroke. My LDL was 5.1mmol/L, which is more than twice the Heart Foundation’s target level of 2.5mmol/L.Worse still, “the more LDL, the faster plaque builds up”, explains Professor Dmitri Sviridov, head of lipoproteins and atherosclerosis at the Baker IDI Heart & Diabetes Institute in Melbourne. Some people can consume plenty of saturated
fat without a corresponding jump in LDL, he adds, but you need a blood test to find out if you’re one of the fortunate or the damned. Sadly, it seems a lot of us are in the latter category.
If the 6.4 million of us with high cholesterol were otherwise in perfect health, cholesterol itself wouldn’t pose a massive problem. But a Federal Government report on cardiovascular disease warns that alarm bells should start ringing if high cholesterol is accompanied by excessive alcohol intake, physical inactivity, low fruit and vegetable intake, being overweight, smoking or high blood pressure. If you can tick off three or four of these factors, the report concludes, you’re “twice as likely to have a heart attack” than other Australians.
Cholesterol doesn’t confine itself to those on the other side of 30, either. The American Academy of Paediatrics recently endorsed guidelines for LDL cholesterol checks for children as young as nine. A subsequent report by Harvard Medical School explained, “the biological basis for these guidelines is that atherosclerosis (the fatty gunk in arteries) starts during youth and, if unaddressed, atherosclerosis progresses inexorably”.
The bottom line: if you’ve got a cholesterol problem, the time to act is now. “You can slow down the growth of plaque, you can even arrest it, but you can’t reverse it,” warns Sviridov. “Once you’ve got it, it stays with you.” Averting my eyes from the doctor’s grisly picture, I listened closely to his advice on how to avoid becoming a dead person.
The first option we considered was cholesterol-lowering drugs, including statins. These are the most commonly prescribed drugs in Australia, yet some medical professionals argue this trend has gone too far.
“It’s likely that doctors are over-prescribing statins for patients at low risk of heart disease,” argues Associate Professor Jane Smith, from the Faculty of Health Science and Medicine at Bond University on the Gold Coast. “The risk of developing heart disease can also be reduced by modifying lifestyle factors, such as exercising regularly, stopping smoking, ensuring good nutrition, reducing alcohol intake and reducing stress levels.”
Nevertheless, statins remain the quick and easy way to lower cholesterol, despite being expensive and having potential side-effects, including muscle problems and liver damage. With a keen interest in any dish laced with luscious fat, they seemed the simplest way to tackle my problem without curbing my culinary indulgences. But I couldn’t help but feel my high cholesterol was my body telling me I was doing something wrong.
That’s why I listened as my doctor outlined his proposed drug-free option before giving me two hand-scrawled lists. The first list contained all the delicious stuff brimming with saturated fat I would need to avoid if I wanted cleaner arteries and a longer future. It was a depressingly long list, including cakes, pastries, soft biscuits, full-fat cheese, full-fat milk, processed meat, fatty meat, mince, cream and butter. When he mentioned paté I almost burst into tears. We didn’t specifically discuss confit, but I’d learned enough in five minutes to realise duck fat cooked in goose fat probably wasn’t going to feature regularly in my new regimen.
The second part of the drug-free strategy revealed the foods that I would now have to ingest in large quantities. This list contained a selection of foods that would actively help lower my cholesterol. This basically boiled down to fish, oats, legumes and a variety of other po-faced ingredients mainly characterised by their absence from my pantry.
Leaving the surgery, I walked home disconsolately, clutching my lists and mulling over the challenge ahead. How could I take on board all this supposedly “good” food without insulting my palate, especially when I was about to be deprived of all the delectable foods I loved? Yet I was beginning to understand that having caused my high cholesterol with diet, I also had the opportunity to solve the problem the same way.
Concerned about the possible side-effects of statins, I decided to reject the medication option offered. I would preserve my liver for more noble battles.
Step one was to wage war on saturated fat. The Heart Foundation identifies those foods high in saturated fat as, “hard and full-fat soft cheeses; full-fat dairy products; cream; crème fraiche; chicken skin; fat on meats; processed meat such as sausages, burgers and salami; pastry; coconut oil and coconut milk; palm oil; fatty or fried take-away foods; packaged cakes and biscuits”.
Armed with this information, my first move was a thorough kitchen stocktake. Anything that originally gushed from a cow, or was part of a cow, was swiftly binned. Any biscuit that crumbled under slight pressure joined the bovine exodus. I kissed the remaining slices of bacon goodbye and sacrificed them, too. I tore the wad of takeaway menus from the side of the fridge and thoughtfully separated them into the recycling bin. I put a strict embargo on pizzas, burgers and cheese.
Then, leaving the car in the garage, I walked to the supermarket. Facing aisles I’d never before ventured into, I started stockpiling items as per my doctor’s instructions. As I rounded the aisle near the meat cabinets, a robust bloke with a frying pan accosted me with a free sausage sample. It smelled incredible, but I somehow managed to decline. Emotionally drained, I announced my return home with the clanging of lentil tins, the swishing of salad leaves and the thud of oats on the kitchen bench.
The following day I stopped by the bakery as it opened, for a soy and linseed sourdough. Arriving at work, I ate my oats and topped up on the bread. With a full stomach I then successfully addressed my workplace quandary by relying more heavily on my sense of smell and consuming terrifyingly tiny droplets of each dish. Not surprisingly, eating less butter chicken first thing in the morning made me feel better.
Overnight, I became an avid reader of saturated fat levels on the back of packaged foods. These nutritional panels are particularly useful when comparing things like ice-creams and biscuits. Choose the right ones and they don’t need to disappear from your diet. A soft, creamy biscuit like an Arnott’s Monte Carlo, for example, has 2.4 grams of saturated fat per biscuit, while hard ones like the Ginger Nut contain only 0.55g.
Professor James Tatoulis, chief medical adviser at the Heart Foundation, suggests the average male attempting to reduce his cholesterol should eat less than 20g of saturated fat a day. If it still remains high after sticking to this regimen, you should cut back to 15-16g a day. This means that if someone threatens “the average male” with a Streets Magnum Gold containing a spectacular 19.2g of saturated fat (almost twice that of a Big Mac), I suggest he politely decline and instead request a Streets Chocolate Paddle Pop, with a mere one-tenth the saturated fat at only 1.9g per serve.
Avoiding the wrong foods meant I was successfully starving my liver of the insidious saturated fat it was previously converting into LDL cholesterol. The second step was to eat foods that actively lower these LDL levels, as well as boosting my “good” HDL cholesterol.
This two-pronged approach to cholesterol reduction has scientific support. Research by Dr David Jenkins, Canada research chair in the Department of Nutritional Sciences at the University of Toronto, showed that eradicating saturated fat alone would only lower LDL cholesterol by a pitiful three per cent.But by lowering saturated fat intake while simultaneously eating more of what he called a “portfolio” of LDL-slashing foods, you can achieve far superior results. In one study overseen by Jenkins last year, 351 participants adhering to the portfolio diet were, on average, able to reduce their LDL cholesterol by 13 per cent over six months and
20 per cent over 12 months.
Luckily, my doctor wasn’t as extreme as Dr Jenkins, who instructs his disciples to cut out meat, fish and dairy, while upping their intake of things like okra, soy milk and tofu. Nonetheless, my inner-foodie still harboured reservations – the oats and legumes sounded like a painful culinary burden. But with some thought and a bit of creativity, I found this palate adjustment surprisingly easy (see “The Cholesterol-Killing Pantry”, starting at left) – hell, maybe even enjoyable.
The third part of my cholesterol-smashing plan was exercise. “Physical activity increases consumption of fat,” says Sviridov. Essentially, this means that less fat winds up being pumped into circulation by your liver. Exercise, he explains, helps your whole system to run faster, giving the LDL less time to be assimilated or stick to your artery walls.
I found myself a personal trainer at the local YMCA and started lifting weights for the first time. Throwing myself into high-intensity cardio sessions, I also climbed back into my running shorts and started cycling again after a 20-year hiatus. Two weight sessions and two cardio sessions each week meant I melted kilograms while watching my cholesterol levels dip.
Tatoulis isn’t surprised that regular exercise helped slash my cholesterol. Muscle cells, he explains, “use up greater numbers of free fatty acid molecules circulating in the plasma as part of the exercise/energy-producing process”. So if you eat the occasional burger, but also regularly work out, then you’re doing something positive to counter the damage.
Six weeks after my dietary shake-up I submitted to another blood test. I entered the surgery with trepidation. Had the sacrifices paid off? The answer was signalled by a rare smile on my doctor’s usually deadpan face. The results were in: my total cholesterol was down 25 per cent and my LDL cholesterol was down almost 30 per cent.
His congratulations were instantly qualified, however, as he warned me not to get complacent. The really hard part was about to start. “Lots of people can lower their cholesterol quickly – not many keep it there,” he warned. “Most of them slide back into the same old habits.”
Leaving the surgery, I was determined not to be one of these relapsed “failures” – but only after celebrating with a ricotta cannoli. It was my first pastry in almost two months and the wait made it all the more sweeter. After dusting the exquisite icing sugar from my lips, I regained my focus.
My doctor’s closing words had made me realise that to avoid a relapse, my diet had to become more sustainable. Total self-denial simply wasn’t realistic on a long-term basis. As a result, I decided to occasionally re-introduce a few villains from his prohibited list – strategically. I’d be careful never to eat a load of junk on the same day, for successive meals, or day after day. Success, I reasoned, can also be achieved by the cumulative effect of many small changes.
Today, these small changes still infiltrate all my eating. Now, if I eat crap, I’ll eat it in a far a more selective way. I’ve always loved bacon and eggs, for example, but now only enjoy a fry-up once a month at best. Having come to treasure my precious saturated fat allocation, I refuse to waste it on a piece of B-grade cheese, slapped on a sandwich from a C-grade shop.
If I have pizza on a Friday night, I won’t think about takeaway for at least a week. Bangers and mash would be lucky to touch my lips on a monthly basis. Rather than give up caffeine, I generally drink black coffee or have a macchiato with just a splash of full-fat milk. Coconut milk-based curries are now a rarity and I’ll only eat a pie while watching my beloved Sydney Swans. Duck is a bird I only infrequently meet and while pork belly still features in my life, we are now passing acquaintances, rather than best friends. The almost total elimination of real butter from my diet is perhaps the most devastating amendment.
All these little things seem to be working and my bloodstream is certainly happier. The results speak for themselves.
Today, five years after that frightening trip to the doctor, my total cholesterol is still 25 per cent lower, my triglycerides are down 24 per cent, my good HDL is up 13 per cent (50 per cent higher than the Heart Foundation’s target), and my bad LDL remains almost 30 per cent down. Another fantastic bonus? I’m also 8kg lighter.And the truth is, it’s been relatively painless. I haven’t contributed to the millions of dollars Australians spend every year on statins. I haven’t become a humourless vegan. I’ve simply made (and stuck to) a lot of small changes that basically amount to exercising more regularly, eating less fatty food and consuming more cereals, fish and legumes. The most surprising part is that I’ve managed to remain on excellent terms with my finicky tastebuds throughout. Yes, you really can lower your cholesterol while still enjoying your food.