Registered dietitian, Annica Rust, explains why improving your cholesterol profile with diet is important.

What is blood cholesterol?

Many components in our body are sterols. For example: bile salts, sex hormones, cortisol, vitamin D and cholesterol. These components perform essential functions in our body.^1,2

Cholesterol serves as a precursor to synthesise these components in our body and is also a structural compound of all cell membranes. Total blood cholesterol, which consist of low-density lipoproteins (LDL)(bad cholesterol), high-density lipoproteins (HDL) (good cholesterol)l and triglycerides, are used to assess a blood lipid profile. ^1,2

Atherosclerosis

An elevated blood lipid profile is dangerous as fat can accumulate in the arterial wall and will form a plaque/deposit. This hardening of arteries due to the formation of fatty deposits is known as atherosclerosis.^1,2

The fatty deposits will restrict blood flow or can rupture which then causes blood clot formation in the artery which can cause a heart attack and a stroke.^1,2

Atherosclerosis, high blood pressure and a heart attack can be classified under cardiovascular diseases (CVD).^1,2 The risk for CVD in Type 2 diabetes is two to three times higher in men and three to five times higher in women when compared to people without diabetes.³

Dietary cholesterol

Dietary cholesterol is often confused with blood cholesterol levels. Blood cholesterol levels is not only influenced by dietary cholesterol alone but also by saturated fat and trans-fat.^1,2

A diet high in saturated fat, trans fat and cholesterol may all increase the LDL-cholesterol levels in your blood. Studies have found that saturated fats have the biggest impact in increasing LDL-cholesterol. Saturated fat content of food items is thus more important than the cholesterol content of food.^1,2

It has been found that a diet high in soluble fibre and omega-3 fatty acids may have cholesterol lowering effects. The replacement of saturated fats and trans fats with monounsaturated and polyunsaturated fats (as shown in the table below) can also lower LDL-cholesterol levels.^1,2

Lifestyle factors, such as stress, sleep, smoking, alcohol and exercise, must be addressed in combination with a healthy balanced diet for the best results. Smoking increases inflammation and blood clotting which can also contribute to atherosclerosis. Regular physical activity can lower blood triglycerides, raise HDL levels and will lower blood pressure to lower CVD risk. Studies have proven that a 5-10% loss of body weight can be beneficial to reduce cholesterol and glucose levels as well as reduce your risk for heart disease.^1,2

Types of fats

Steps to improve your blood cholesterol levels:^1,3

1. Control energy intake: Adjust energy/kJ intake to achieve an ideal body weight.
2. Increase omega 3 fatty acids: Aim for 2-3 servings of oily fish per week, such as tuna, sardines, salmon and trout.
3. Choose healthy fats: Reduce saturated fat and trans-fat intake by eating less red and processed meats and refined foods. Remove all visible fat from meat before cooking. Total fat intake should also be limited to less than 30% of total energy. Reduce the amount of fat used for food preparation and use non-stick pans as an alternative to butter and/or oil. Consume more MUFAS and omegas 3 fatty acids.
4. Increase soluble fibre intake: Most fruits and vegetables are high in soluble fibre.
5. Increase plant stanols and sterols by consuming more fruits and vegetables. Switch out butter for margarine with added stanols and sterols.
6. Improve beta glucan intake: Eat more oats which contains beta glucans or consider supplements with beta glucans in.
7. Consume antioxidants by eating more fruits and vegetables.
8. Cut back on sugar and sugar sweetened beverages.

Beneficial diets: Low-GI diet, Mediterranean diet and DASH diet. The above mentioned are general guidelines. Please contact a registered dietitian for individualised advice on how to practically implement the above-mentioned guidelines.

References:

1. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.
2. Rolfes, S.R., Pinna, K., & Whitney, E. 2012. Normal and clinical nutrition. 9th edition. Wadsworth: Cengage Learning.
3. SEMDSA Type 2 Diabetes Guidelines Expert Committee. JEMDSA 2017; 22(1)(Supplement 1): S1-S196.

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Annica Rust, a registered dietitian, explains the benefits of nut butter options.

Benefits of nuts

Consuming more nuts, including peanuts (and nut butter options), may provide numerous benefits for a person with diabetes. These benefits include an improvement in inflammation, decreased cardiovascular risks and a favourable influence on your blood glucose levels. To keep a close eye on your fat intake is thus as important as controlling your carbohydrate intake.

Table 1: Nut butter comparison

Nuts, cardiovascular disease and cholesterol

Having diabetes increases your cardiovascular risk significantly, it is therefore important to make sure that the modifiable risk factors, such as your dietary intake, is well-controlled. ¹

The latest scientific evidence found that the type of fat* (saturated fat, monounsaturated fat and polyunsaturated fat) consumed, may be more important than the total fat intake to prevent cardiovascular disease^2,3. It is therefore important to replace unhealthy fats (saturated-and trans fats) with healthy fats, such as monounsaturated-or polyunsaturated fats, in order to decrease the risk for cardiovascular disease^2,3.

In the above nut butter comparison, salted butter was compared to nut butters, which is locally available in South Africa. The nut butters will have much less saturated fats when compared to salted butter. The monounsaturated fat in nut butter is also significantly higher than normal butter.

Nuts or nut butter can definitely replace an unhealthy fat portion or even a protein portion. 

Types of fats*

Nuts and glycaemic index (GI)

The GI of food can be used to compare the effects of food that contains carbohydrates on blood glucose levels.³ Foods with a low-GI will be digested and absorbed at a lower rate and will keep your blood glucose levels constant. As such, nuts with a low-GI will therefore have a positive impact on your blood glucose as it will be slowly digested and absorbed. Monounsaturated fats (which includes nuts) are also associated with improved blood glucose control³.

Nuts and inflammation

Walnuts are high in omega 3 fatty acids which has anti-inflammatory properties. 

Conclusion

Nuts remain one of the better fat options when consumed in moderation and when used to replace an unhealthy fat. Controlling your fat intake in conjunction with a healthy balanced low-GI diet, remains important to all people with diabetes. Please contact a registered dietitian for individualised guidelines.

Note: People who have diabetes and have a nut allergy need to remember that nut butters are not an option for them.

References

1. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline
2. Saturated Fat as Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study

“I want to eat healthier, but it’s just too expensive.” Have you said this before? Many people feel that the price of food is the biggest deterrent to healthy eating. Would it surprise you that it can be done? You can be healthy on a budget! Here’s how:

Convenience costs

Avoid using convenience foods as you pay for the convenience. Rather cook meals from scratch, cook in bulk and freeze meals to save both time and money.

Planning is key

Plan your meals in advance and make a shopping list and stick to the list. By doing this you won’t buy unnecessary food items. Your wastage will also be less because you have planned meals using the items that you purchased.

Buy bulk

Buy certain non-perishables in bulk, saving on packaging costs and reducing your trips to the supermarket. Basic food items that can be bought in bulk include pasta, rice, oatmeal, dried fruit, nuts, seeds, cereals, tinned foods and beans.

Shop seasonally

Always shop for produce that is in season for the best prices. Food packages may state when a food is in season. Alternatively, there are charts available online you can refer to.

Less expensive fruits and vegetables to look out for are apples, bananas, oranges, naartjies, sweet melon, cabbage, carrots, pumpkin, butternut, tomato, onions and spinach. Purchasing them whole and not pre-cut is also less expensive.

Pro plant proteins

Add vegetable sources of protein, such as lentils, beans and chickpeas, to your meat dishes to stretch the meal, as meat is often the most expensive part of a grocery bill. Extending this purchase to serve more meals can make a big difference. Try adding chickpeas to a Chicken à la King, beans to a stew, or lentils to Cottage Pie.

Meat-free meals

Plant-based proteins are much more affordable than meat, chicken or fish. Start with one dinner a week being meat-free and slowly increase from there. Delicious vegetarian meal ideas are Mexican bean bowls, chickpea mushroom stroganoff, bean burgers, lentil dhal, bean and butternut curry and more.

Pack lunch

Take a few minutes every evening to pack a healthy lunch and snack box for yourself and the family. Some examples are a tuna sandwich with lite mayo and a handful of cherry tomatoes, or a ham and mushroom omelette or chickpea curry with brown rice.

Snack wisely

Snacks, such as granola bars, chips, chocolates, and sweets, can add up quickly and cost more than fresh food. Rather snack on fresh fruit, boiled eggs, veggie sticks, like carrot or cucumber, and homemade popcorn.

Frozen is fine

Frozen vegetables are still rich in vitamins, mineral, fibre and low in calories. There is not a notable difference between fresh and frozen composition. The key is how you cook the frozen veg. If you over-cook the vegetables, they will lose their nutrient value.

Be water wise

Drinks can be the fastest and sneakiest way to increase grocery spend. Avoid drinking fruit juices, cold drinks, and energy drinks. Aim to drink water most of time, as it’s free.

Still need convincing?

Maybe you still aren’t quite convinced about healthy eating on a budget. Let’s crunch some numbers. A bought lunch of a burger, packet of chips and a snack bar can cost you about R40-R80. A homemade egg mayonnaise sandwich with a fresh apple and homemade popcorn will cost you R9-R12 in total. It’s possible to eat healthier on a budget with effort and planning.

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