Cholesterol and the low FODMAP diet

October is cholesterol awareness month in the UK. This month is to raise awareness of cholesterol and how it can be best managed. 39% of the world’s population has high cholesterol so you may have already heard of it, but what does it mean? In this article we will discuss what exactly cholesterol is, how it interacts with nutrition and IBS, and how to manage and prevent high cholesterol on a low FODMAP diet.

What is cholesterol?

Cholesterol is essential for the body. It is a type of fat that is produced by the liver and used for many different things such as production of hormones, production of bile acid and being part of the cell walls in the body.
There are three types of cholesterol; they include high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides (TG).
The two types of lipoproteins (HDL and LDL) carry cholesterol to and from cells and TG store excess energy in your body’s fat deposits and are released to make energy in between meals

Good cholesterol vs bad cholesterol

High levels of bad cholesterol can increase the chances of developing heart disease, as our liver makes cholesterol and eating foods high in cholesterol can add to that already made. Then, an excess of bad cholesterol can cause arties to narrow and block blood flow (atherosclerosis) which can then lead to heart diseases.

• Bad cholesterol
LDL is the bad cholesterol because it leaves the cholesterol in your arteries and this is what leads to a build-up of it which then causes blocked arteries and risk of heart disease. Therefore it is recommended to keep LDL levels low to avoid this build up, recommended levels are <2.0mmol/L.

• Good cholesterol
HDL is the good cholesterol. It helps to protects against heart disease by removing the excess cholesterol from your arteries and taking it back to the liver to be removed from the body. Therefore, we want high levels of HDL to protect the arteries from a build-up, recommended levels are >1.0mmol/L.
Total cholesterol is measured using both HDL and LDL. Both types of lipoproteins are crucial, although to avoid heart disease, it is ideal to have high HDL and low LDL.

What are the dietary recommendations for cholesterol?

Foods that are high in saturated and trans fats encourage the liver to produce more of the LDL cholesterol. Often saturated fats are found in energy dense foods which can also increase TG. If you eat more energy than you need, you may have high TG; this can also cause heart disease. Having a poor diet is one of the leading causes of heart disease in Australians. Therefore, often a Mediterranean diet is recommended for preventing heart diseases and lowering cholesterol. This diet is an evidence-based diet which has scientifically shown to lower the risk of heart diseases and high cholesterol. The principles of the diet are not that different to general healthy eating advice.

Key recommendations from the Mediterranean diet are:
• Eat plenty of vegetables, fruits and wholegrain breads and cereals
• Chose reduced-fat and unflavoured dairy products
• Include healthy fats fat and oils
• Eat a range of healthy protein-rich foods, focusing on including plant based proteins and including fish and sea food more often whilst limiting red and processed meats.
• Using herbs and spices to flavour foods instead of salt
• Reduce surgery drinks and alcohol
• Include regular physical activity

How to lower the bad high cholesterol

In order to lower the LDL (bad) cholesterol you should have more fibre and unsaturated fats whilst limiting your intake of saturated and trans fats.
Saturated and trans fats
These fats are mainly found in:
– processed/deli meats and fatty cuts of meat
– full fat dairy products
– some vegetable oils (palm oil and coconut oil) and butter
– takeaway foods (such as burgers, pizza, sausage rolls/pies)
– deep fried foods
– highly processed foods (such as pastries, biscuits, cakes, chips)

Limiting these foods can lower the bad cholesterol. Additionally, increasing unsaturated fats (including monounsaturated and polyunsaturated fats) and fibre, particularly soluble fibre can improve cholesterol by reducing the amount of LDL cholesterol in your blood.

Monounsaturated and polyunsaturated fats
These fats are found in:
– margarine spreads
– some oils (sunflower, safflower, soybean, canola and olive oil)
– nuts and seeds
– oily fish (such as salmon, tuna, sardines)

Fibre
Fibre is found in:
– fruits and vegetables
– wholegrain products (such as breads, cereals, brown rice and quinoa)
– nuts and seeds
– legumes
– oats

Physical activity and cholesterol
Regular exercise has shown to improve cholesterol. Although there is no direct link between physical activity and LDL cholesterol, there is however evidence linking regular physical activity to lower triglycerides and increase in HDL (good) cholesterol.

Can you have high cholesterol and IBS

Yes, it is possible to have both high cholesterol and IBS. Both IBS and high cholesterol are highly prevalent in Australia so there is potential to have both.

Is there a link?
Some data has shown a link between triglycerides and HDL cholesterol with gut microbiota and IBS can be associated with a surplus of bacteria in the intestines. However, there is no evidence of a direct link between gut microbiota and development of atherosclerosis (build-up in arteries from high cholesterol).

Can you follow the low FODMAP diet if you have high cholesterol?

You can follow a low FODMAP diet if you have high cholesterol with some adjustments.

The recommendations involve reducing saturated fat intake which is found in high fat and processed foods. These foods can also be triggers in IBS therefore it is best to avoid foods such as processed meat, sugary drinks, and takeaway foods and to increase intake of unsaturated fats and fibre. Include low FODMAP foods such as wholegrains, seafood and fish.

Tips for following the low FODMAP diet if you have high cholesterol

Include healthy fats

• Sunflower and olive oils
• 30g of almonds or walnuts
• 1 of linseeds or sunflower kernels
• ¼ avocado

Eat a range of healthy protein-rich foods

Aim to include plant based proteins and seafood 2-3 times per week each

• 100g of firm tofu – aim for 2-3 times per week
• ½ cup of canned lentils, rinsed and strained
• Include oily fish and seafood
• Limit red meat to 1-3 meals per week
• Avoid processed/deli meats

 Increase fibre intake

Fruits and vegetables – aim for 2 and 5 such as:

• 1 cup of salad vegetables
• ½ a medium starchy vegetable
• ½ cup of carrots or cucumber
• 1 unripe banana
• 1 cup of berries (blueberries or raspberries)
• 1 date
• 1 cup of grapes
• 2 small mandarins or kiwi fruit
• 1 medium nectarine
• 1 cup of pineapple
• 30g nuts (walnuts or almonds)
• 5 corn thins
• ½ cup quinoa
• 1 cup of cooked rice
• 2 slices of Alpine Breads Spelt and Barley
• ½ cup of canned lentils, rinsed and strained
• ½ cup of Uncle Toby’s rolled oats

For more options of low FODMAP foods download the FODMAP Friendly App, available for Apple /iPhones and Android.

Aim for 25-30g of fibre per day.

Additional FODMAP Friendly certified products that can help meet nutritional needs for those on the low FODMAP diet concerned about cholesterol include fibre supplements.  If you struggle to get enough fibre, you can try FODMAP Friendly certified Kfibre and  happiGut™.

Additionally, plant sterols help to lower LDL (bad) cholesterol and are found naturally in various foods such as nuts, fruit and vegetables. However, to help lower your cholesterol further, plant sterols can be found in some sterol enriched foods such as yoghurt and breakfast cereals. These can be found by looking at the ingredients list or nutritional information panel, find plant sterols under the fats section. Alternatively, look for products which say something similar to ‘cholesterol lowering’ on the package. 2-3 g per day can help lower LDL (bad) cholesterol levels. But keep in mind, having more than 3 grams does not provide any additional benefits.

In summary

In summary cholesterol is a common condition but there are evidence based dietary changes that can be made in order to improve and prevent high bad cholesterol. The Mediterranean diet can easily be used in conjunction with the low FODMAP diet and should not compromise it. Cholesterol can be managed by including healthy fats and fibre as well as including regular physical activity.
As always, it is important to work with your Dietitian and Doctor to navigate your condition.

Written by: Ijmeet Maan, Dietitian
Reviewed by: Kiarra Martindale (Accredited Practising Dietitian)