Tag Archives: cholesterol

Megan Madden, MS, RD quoted on SHAPE.com

Check out Megan’s comments on avocados, whole grains, olive oil, nuts, plant sterols & salmon as featured on Shape.com’s “20 Artery-Cleansing Foods You Should Be Eating”.  Here’s to a healthy heart!

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Are Nut Butters Worth The Hype?

Question:  I’ve heard that peanut butter alternatives, like almond butter, are better for you. The problem is, they can cost twice as much! Are the health benefits worth shelling out the extra dough?

Answer: A small container of peanut butter may cost $3.50, while an even smaller jar of almond butter might run you $7 bucks! The thing is, these “nut butters” are all very similar nutritionally and it mostly comes down to what your taste buds prefer.

Real butter comes from animal sources and contains a lot of artery-clogging saturated fat. Nut butters are made from plant-based sources, such as almonds, peanuts and cashews. Nut butters also contain a large amount of fat, but they are low in saturated fat and high in heart-healthy unsaturated fats.

The following table lists the nutrient profiles of 1 Tbsp of several nut butters. They generally have the same amount of calories, but peanut butter contains the most protein, which is what fills you up. Unfortunately, peanut butter also contains the most saturated fat (2 g per Tbsp), although not significantly more than the other nut butters.

Calories Protein Total Fat Saturated fat Monounsaturated fat Polyunsaturated fat
Peanut butter 95 cal 4g 8g 2g 4g 2g
Almond butter 101 cal 2g 9g 1g 6g 2g
Cashew butter 94 cal 3g 7.5g 1.5g 4.5g 1.5g
Sesame butter/Tahini 89 cal 3g 7.5g 1g 3g 3.5g
Sunflower butter 93 cal 3g 7.5g 1g 1.5g 5g

The nut butters highest in monounsaturated fats are the best for cardiovascular health, but all are great vegetarian options. Nut butters make great snacks, high in protein, calcium and iron! Here are a few healthful ideas: top a half a bagel or an apple with nut butter or spread nut butter on a whole-wheat tortilla and add sliced banana.

I found a 2003 study examining how eating different forms of almonds affect men and women with high cholesterol levels (Spiller et al). The subjects all followed a heart-healthy diet, which included 100 grams daily of roasted salted almonds, roasted almond butter or raw almonds for four weeks. All three forms lowered LDL (“bad”) cholesterol, but only roasted and raw almonds lowered total cholesterol. HDL (“good”) cholesterol did not change in the raw or roasted almonds groups, but slightly increased with almond butter!

All nut butters are healthy choices when used in moderation and when substituting for an unhealthy snack. If you’re interested, you can choose “natural” varieties that contain no hydrogenated oils or trans fats. Regular peanut butter contains a tiny amount of partially hydrogenated oil (a.k.a. trans fat), which keeps the product from separating and makes it taste creamier. “Natural” nut butters made with zero hydrogenated oils may have a layer of liquid at the top of the container, which needs to be stirred into the mixture prior to consumption. However, since the amount of trans fat in regular peanut butter is insignificant, government regulations allow products to remain labeled as containing “no trans fats per serving!”

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Fast Facts on Fats

Q: There are so many types of cooking oil on the market. Which one should I use?

A: The healthiest oils are those with the least amount of saturated fat. Choose canola oil, corn oil, olive oil, safflower oil, sesame oil, soybean oil and sunflower oil. These varieties are higher in mono- and polyunsaturated fats, which are heart healthy, because they are able to lower total cholesterol and LDL (“bad”) cholesterol if used in place of other fats. No matter which oil you pick, however, it’s important to use it sparingly. Each tablespoon of a vegetable-based oil packs 120 calories! Stay away from coconut oil, palm oil and palm kernel oil – these three oils are high in saturated fat, which raises your risk for heart disease.

Here’s how to choose among some of the “healthier” oil options:

Canola oil: Has the least amount of saturated fat (only 7%)! Great for sautéing, stir frying, baking and salad dressings. Canola oil does not give off a strong flavor and can be used over high-heat.

Olive oil: Contains a large amount of good, monounsaturated fat. Use it for dressings, marinades, roasting, grilling and low-heat cooking. Olive oil will start to break down at very high temperatures.

Vegetable oil: This oil is usually made from soybeans. It is an all-purpose oil that can be used for baking, sautéing and pan frying. Since vegetable oil has a relatively high saturated fat content, canola oil is a healthier choice.

Corn oil: With about 13% saturated fat, corn oil is not the best option. It can be used for deep frying, stir-frying, sautéing and baking, because of a very high tolerance to heat.

Peanut oil: While it is often used in yummy Asian-inspired stir fry dishes, peanut oil has a very high saturated fat content (about 18%)! This makes it costly to your cardiovascular health.

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Protecting your heart

Q: My doctor says I have high cholesterol. What can I do to lower it?

A: There are several components to a “lipid profile” – total cholesterol, LDL (“bad”) cholesterol, HDL (“good”) cholesterol and triglycerides. If your physician is telling you that you have “high cholesterol,” he is referring to either the total cholesterol number, your LDL reading or both. A desirable profile is as follows:

Total cholesterol <200 mg/dl

LDL cholesterol <130 mg/dl

HDL cholesterol >40 mg/dl (>50 mg/dl for women)

Triglyceride level <150 mg/dl

Cholesterol is a component of animal products and is not found in plant-based foods. It is necessary in the body for the production of bile, which helps digest fats, and steroid hormones (e.g. vitamin D, estrogen and testosterone). While the body utilizes cholesterol for important functions, the liver is also able to synthesize necessary amounts – it is not necessary to ingest it as part of your diet! Total cholesterol, LDL and triglyceride levels that are too high put you at risk for cardiovascular disease.


Let’s focus on LDL cholesterol, since it has been linked to atherosclerosis, coronary heart disease, heart attack and stroke. Several factors influence LDL levels, including age, diabetes, obesity, reduced estrogen levels and diet.  Diets high in saturated fat and cholesterol elevate LDL. In addition, trans-fats can raise LDL and lower HDL (“good”) cholesterol – a double whammy!

Lower your saturated fat intake! Saturated fat intake has a much greater negative effect on blood cholesterol than does dietary cholesterol. (Dietary cholesterol, however, is often found in the same foods that are high in saturated fat.) Choose lean meats, select skim milk, low-fat dairy products and stick to vegetable oils that are liquid at room temperature (e.g. cook with olive or canola oil, rather than butter or lard.) To further cut back on fat intake, remove the skin from chicken before eating, substitute margarine for butter and grill or bake fish, meat and poultry instead of frying.

Eat a minimum amount of trans-fat. Select products that are made with no hydrogenated (or partially hydrogenated) vegetable oils. Check the ingredient list before buying!!

Lastly, up your intake of viscous or soluble fiber. Choose more fruits, vegetables, beans and whole grains, especially barley and oats.

While there are several ways to manage blood cholesterol levels with medication, try modifying your diet first. Just a 1-point decrease in your LDL cholesterol level corresponds to a 1-2% decrease in your risk for developing coronary heart disease!

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Grapefruit-Medication Interactions

Q: I heard grapefruit interacts with certain medications. Is this true?

A: Yes. Unlike other citrus fruits, grapefruit interferes with the metabolism of a few dozen drugs (see partial list below). A chemical component within the fruit prohibits a certain digestive enzyme in the body from breaking down these medications. By continuing to consume grapefruit or grapefruit juice, you decrease the efficacy of the medication you’re on, and the drug itself can build up to dangerously high levels in the blood. Grapefruit should be fully avoided, as its effects wear off very slowly and are still evident 24 hours after consumption. Separating medicine and grapefruit by several hours will not prevent the drug-nutrient interaction. Having grapefruit once accidentally, most likely, will do no harm, but it’s advisable to switch to another type of fruit or fruit juice. The National Institutes of Health recommends not making any sudden diet changes, however, if you’ve always taken your medication with grapefruit. Speak to your doctor first, as your body may be accustomed to a certain level of the drug in your blood.

Avoid grapefruit and grapefruit products when taking the following:

  • The high blood pressure/angina drugs Plendil and Procardia/Adalat
  • The cholesterol-lowering agents Zocor, Lipitor and Mevacor
  • The immunosuppressant medications Sandimmune and Rapamune
  • The anti-anxiety/anti-insomnia drugs Valium, Halcion and Versed
  • The neurological medications BuSpar, Zoloft and Tegretol

Note: This is not a complete list of medications that interact with grapefruit. Always check with your physician and/or pharmacist.

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Benefits of Fiber

Q: What exactly is ‘fiber’ and why is it so good for you?

A: Fiber is an indigestible carbohydrate, or a string of sugar units held together by bonds that human digestive enzymes cannot break. There are two types: soluble and insoluble fiber.

Food Sources

Soluble fiber: barley, oats, oat bran, rye, fruits (especially apples and citrus), beans, vegetables, seeds

Insoluble fiber: Brown rice, fruits, beans, seeds, vegetables (cabbage, carrots, brussels sprouts), wheat bran, whole grains

While fiber does not provide energy, it has many other beneficial effects:

1. Lowers blood cholesterol: Soluble fiber reduces cholesterol and the risk of heart disease by several mechanisms. (Note: This is why General Mills is able to claim that eating whole grain oat Cheerios can help lower your cholesterol.)

2. Maintains bowel function: Insoluble fiber speeds up the transit of food through your system, while soluble fiber slows it down.

3. Assists blood glucose control: Soluble fiber slows the absorption of glucose from the intestine into the blood stream, thereby preventing a spike (and crash) in blood glucose after a meal. This can lower the risk of type 2 diabetes.

4. Promotes weight management: Fiber makes you feel full and lessens hunger

5. May defend against colon and rectal cancer: Scientific studies are mixed, but insoluble fiber speeds up the removal of cancer-causing agents from the colon, while resident bacteria in the colon ferment soluble fiber, producing a beneficial compound that may help colon cells resist injury.

Recommended Intake: Since most fiber-rich foods supply a mixture of soluble and insoluble fiber, recommendations are given without regard to type. The American Dietetic Association suggests 20 – 35 grams of fiber daily, which is about twice the average intake. That said, don’t overload on fiber and make sure to increase fluid consumption as you gradually increase fiber intake.

Fruits, vegetables, whole grains and beans are among the best sources of fiber! Also, remember that fiber supplements are not necessarily substitutes for whole, fiber-rich foods.

Check the nutrition facts on the back of products to find out how much fiber is in one serving! Here are some examples:

½ cup whole grain barley – 3g fiber

½ cup instant oatmeal – 2g fiber

1 slice whole wheat bread – 3g fiber

1 slice white bread – 1g fiber

½ cup cooked brown rice – 2g fiber

½ cup cooked white rice – less than 1g fiber

¾ cup (2 oz) whole wheat penne pasta, dry – 6g fiber

¾ cup (2 oz) regular penne pasta, dry – 2g fiber


1 medium apple (with skin) – 3g fiber

1 medium pear (with skin) – 5g fiber

½ cup blackberries – 4g fiber

½ cup strawberries – 2g fiber

1 medium orange – 4g fiber

½ cup orange juice – less than 1g fiber

½ cup American grapes – less than 1g fiber


½ cup lentils – 8g fiber

½ cup chickpeas (garbanzo beans) – 5g fiber

½ cup black beans – 7.5g fiber


½ cup cooked broccoli – 2.5g fiber

1 medium artichoke – 10g fiber

1 medium baked potato (with skin) – 4.5g fiber

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